Intra-articular fracture of the mandibular condyle: a case report

The authors describe a case of intra-articular fracture of the left mandibular condyle, successfully treated by the pumping technique in the upper and lower joint cavities, and show arthroscopic findings in these cavities. The patient was a 15-year-old boy whose maximum mouth opening was 30 mm. Computed tomography revealed a left intra-articular sagittal fracture of the condylar head. Aspiration of the hematoma in the upper and lower joint spaces was performed with ten pumping actions. In the upper and lower joint spaces, arthroscopic examination revealed the disappearance of the hematoma. The patient continued opening, protrusive, and lateral excursive exercises. One month after the surgery, the maximal interincisal distance was improved to 45 mm with straight opening. In the case presented, mouth-opening exercises, along with the pumping technique for treatment of an intraarticular fracture of the mandibular condyle, allowed satisfactory and stable results in the improvement of limited mouth movement.

Terahertz spectroscopy of the reactive and radiative near-field zones of split ring resonator

A terahertz microscope has been used to excite and observe the resonant modes of a single split ring resonator in the reactive and radiative near-field zones. The two lowest resonant modes of an isolated split ring resonator with their corresponding radiation patterns are reported; they showed good agreement to simulations. The passage from the reactive to radiative near-field zone is also discussed. Further, our result introduced a novel technique to perform terahertz time-domain spectroscopy of samples a few tens of micrometers in size by measuring the in-plane radiative near-field zone.

Current practice in preoperative therapy and surgical management of locally advanced rectal cancer: a bi-national survey

AIM

The Australasian colorectal surgeon's current approach to preoperative rectal cancer management was compared with international guidelines.

METHOD

Members of the Colorectal Surgical Society of Australia and New Zealand were surveyed in 2010, on the use of MRI and the management of locally advanced rectal cancer. Surgeons had to decide the appropriate management in five scenarios that were developed from national guidelines.

RESULTS

Of 174 invitations sent, 108 (62.1%) replies were received. Most surgeons (98.1%) had access to MRI. Ninety-three (86.1%) would use MRI routinely for staging. The majority selected a tumour-specific mesorectal resection for upper rectal cancer (58.2%) and a total mesorectal excision for distal cancer (100%). Almost all restorative operations included a covering ileostomy. One third of surgeons recommended that patients with a favourable cT3 mid-rectal tumour (N0, clear circumferential resection margins) should not have preoperative therapy and should proceed directly to surgery. When high-risk features, such as threatened resection margins or cN1 stage, were present, 5% and 15% of surgeons, respectively, would continue to treat by standard resection without preoperative therapy.

CONCLUSION

Evidence-based international guidelines for the management of rectal cancer have changed little in the last 10 years. Despite this, there is a clear gap between these and clinical practice. The main variance relates to the role of radiotherapy in locally advanced rectal cancer. Despite considerable evidence that radiotherapy reduces local recurrence for all stages of rectal cancer, current practice in Australasia is for its selective use.

Managing fistula-in-ano with ligation of the intersphincteric fistula tract procedure: the Western Hospital experience

AIM

To review the preliminary results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas at our hospital.

METHOD

Between March and November 2010, patients with cryptoglandular anal fistulas were recruited prospectively from the colorectal clinic and treated using the LIFT procedure. A database was set up to collect information on demographics, past surgical treatments, fistula characteristics, MRI scan results, operative data and follow-up findings. The primary end-point measured was cure of the disease. The secondary end-point was the degree of postoperative continence. Preoperative and postoperative incontinence rates were recorded using Wexner's Incontinence Scale.

RESULTS

Twenty-five patients (eight women and 17 men; median age, 40 years) underwent the LIFT procedure. Ten patients had recurrent fistulas and previous fistula surgery. The median operating time was 39 min. No intraoperative complications were documented. The median follow-up duration was 22 (3-43) weeks. Primary healing was observed in 17 (68.0%) patients and the median healing time was 6 weeks; one wound remained incompletely healed. Seven patients (28.0%) had disease recurrence presenting between 7 and 20 weeks postoperatively. No patients reported any incontinence postoperatively.

CONCLUSION

The LIFT procedure has favourable healing rates with little or no risk of incontinence. This operation is safe and easy to learn. The early results from this pilot study show promise and affirm some of the findings of other researchers. These results will suggest opportunities to conduct further controlled studies comparing the LIFT procedure with standard therapies.

Relationship between the Effectiveness of Arthrocentesis under Sufficient Pressure and Conditions of the Temporomandibular Joint

Background. The purpose of this study is to investigate the conditions of the temporomandibular joint relative to the effectiveness of an arthrocentesis-like enforced manipulation technique followed by irrigation under high pressure in patients with closed lock. Methods. We performed arthroscopic examination and manipulation followed by irrigation as the initial treatment in 50 joints with closed lock. Relationship between the effectiveness of the procedure and conditions of the temporomandibular joint was statistically analyzed using multiple regression analysis. Results. Significant inverse correlations were found between the extent of improvement in maximum mouth opening after treatment and the initial maximum opening before treatment. There were no significant correlations between improvement of joint pain at mouth opening and in biting and conditions of the temporomandibular joint. Conclusions. Pathologic conditions of the temporomandibular joint did not have an influence on the efficacy of the technique. This result suggests that this procedure has wider application than conventional arthrocentesis.

Tooth-borne distraction of the lower anterior subapical segment for correction of class II malocclusion, subsequent to genioplasty

INTRODUCTION

Alveolar distraction is mainly used to increase height and width of the alveolar crest. This technique, however, is not typically used for lengthening the perimeter of the dental arch or improving teeth axes. We applied alveolar distraction in a tooth-borne manner in the second stage of our original method and obtained favorable results. We therefore present an outline of this method.

CASE REPORT

Genioplasty was first performed to create an infrastructure for sequential advancement of the subapical alveolar segment. After bone union, anterior subapical alveolar osteotomy was performed. The stump of the osteotomized dentate segment was moved forward without changing the incisal edge position, and a box-type bioabsorbable plate with four holes was fixed only onto the dentate segment using two screws. After a latency period, two distraction devices were placed bilaterally to the brackets and activated at 1.0 mm/day. After reaching the desired position, the distractor was immobilized, and then replaced by resin temporary teeth to retain the created space. After the consolidation period, orthodontic treatment was restarted and teeth moved into the newly created space. Bimaxillary surgery was performed after completing pre-surgical orthodontic treatment. Finally, both desirable occlusion and functional masticatory function were obtained.

CONCLUSION

This tooth-borne distraction system is one applicable method for patients with skeletal class II and crowding of lower anterior teeth, achieving good results particularly in combination with our original method.

Procedures of endoscopic periradicular surgery

When a tooth with an apical lesion is identified, an apicoectomy is frequently performed when nonsurgical treatment is considered unfeasible or has previously failed. However, the treatment is usually difficult in molars. This article describes a minimally invasive procedure for removing a gutta-percha point under the maxillary sinus mucosa using an ultrathin arthroscope and a visualization approach in apicoectomy using an intranasal endoscope. These surgical techniques using endoscopes are minimally invasive and reliable procedures that provide limited incision and bone removal and respect the integrity of the maxillary sinus.

A combination of three minimally invasive surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity

We describe a combination of 3 surgical procedures for implant placement in the posterior maxilla with insufficient bone quantity and quality. In these situations, we have performed 3 minimally invasive, safe, and reliable surgical procedures: buccal bone graft with bone harvested from the mandibular molar region, submucous vestibuloplasty using artificial dermis, and bone-added osteotome sinus floor elevation under endoscopic control. These modified procedures can be performed in the office setting under outpatient local anesthesia and may minimize patient discomfort and reduce postoperative complications.

Suppression of tandem-multimer formation during genetic transformation of the mycotoxin-producing fungus Penicillium paxilli by disrupting an orthologue of Aspergillus nidulans uvsC

An orthologue of Aspergillus nidulans uvsC and Saccharomyces cerevisiae RAD51 was cloned from the filamentous fungus, Penicillium paxilli. A mutation in uvsC causes UV sensitivity during germination. The product of RAD51 is involved in meiotic recombination and DNA damage repair. The deduced amino acid sequence of the product of this gene (Pprad51) shared 92% identity with UVSC. Site-specific disruption of pprad51 showed a significant effect for extra-cellular DNA integration. Transformation of the null mutant with pII99, which confers geneticin resistance, resulted in a shift from a predominance of direct repeats at a single site to single copies when compared with a control strain. A copy-number effect of integrated pII99 for geneticin selection was suggested as the frequency of direct repeat formation was less when selected at a lower concentration in the control strain. However, such an effect was not observed in the null mutant, further supporting an involvement of Pprad51 in direct repeat formation.

[A frequent fiber-scopic bronchial lavege for the case of bilateral sever pulmonary contusion with flail chest]

A 26-year-old man was injured in the traffic accident. He had complicated chest trauma. He came to our hospital by ambulance immediately after rescued from crashed his automobile. He had severe pulmonary contusion with frail chest, pulmonary laceration, tension hemopneumothorax, and hypovolemic shock, and air embolism of the brain. He was managed with fiber-optic bronchoscopy under mechanical ventilation and chest drainage. Frequent broncho-scopic bronchial lavage of respiratory tract with thrombin and adrenaline solution was helpful to prevent anoxia due to complicated chest injury. He developed acute bacterial empyema and multiple organ failure due to septic shock during intensive care for trauma. However, he underwent surgical treatment for empyema and fully returned to his work after 6 months after his critical accident.

A human myeloid cell line producing stem cell growth factor, KPB-M15, secretes another growth factor active on murine hematopoietic progenitor cells

Human stem cell growth factor (SCGF) produced by a myeloid cell line, KPB-M15, exhibits species-specific hematopoietic activities. However, KPB-M15-conditioned medium induced colony formation of mouse bone marrow cells. KPB-M15-derived colony-stimulating activity (CSA) was purified through Butyl-Toyopearl 650c and Cu2+ chelating-Sepharose 6B chromatography. TSK-G3000SW gel filtration of the purified preparation presented 3 distinct peaks around Vo, 150 kD and 85 kD. Gel fractions extracted from SDS-PAGE had macrophage colony-stimulating factor (M-CSF)-specific amino acid sequences. PCR, Northern hybridization and ELISA demonstrated that KPB-M15 cells secreted a significant amount of M-CSF and IL-6. Anti-M-CSF but not anti-IL-6 antibody abrogated CSA in KPB-M15-CM. IL-6 hardly synergized with M-CSF to enhance colony formation. Collectively, M-CSF is a sole CSA for murine hematopoietic progenitor cells in KPB-M15-CM. This is the first report of a human myeloid cell line, KPB-M15, constitutively producing M-CSF in addition to SCGF and IL-6. It can be useful in investigating the mechanism of production of M-CSF.

Molecular evolution of a host-range gene in geminiviruses infecting asexual populations of Eupatorium makinoi

Asexual plants of Eupatorium makinoi is frequently infected with tobacco leaf curl geminivirus (TLCV). The host range of TLCV is narrow, and ORF C4 is considered to function as a host range determinant. Using this TLCV-Eupatorium system, we tested the expectation that the rate of amino acid replacements will be accelerated in ORF C4 if resistant genes of the host plants drive molecular evolution in ORF C4. ORF C4 is entirely contained within a longer ORF C1 encoding a replication protein. We analyzed 21 sequences containing ORF C4 and a part of ORF C1. While per-site number of synonymous substitutions exceeded that of replacements in ORF C1, per-site number of replacements exceeded that of synonymous substitutions in ORF C4. However, this excess of per-site replacement in ORF C4 was mostly explained by the overlap gene nature, because most synonymous substitutions in ORF C1 change amino acid of ORF C4. In conclusion, not positive but negative selection is a predominant mode characterizing molecular evolution of ORF C4.

A kinetic study of phosphate adsorption by boehmite

Rates of phosphate adsorption to PT-A (a new type of aluminium oxide hydroxide) and ALG (aluminum hydroxide gel) from a pH 3 phosphate solution were measured by a batch method. Phosphate uptake progressed mainly by the adsorption mechanism for PT-A, but dissolution of aluminum and precipitation of aluminum phosphate took place in addition to phosphate adsorption for ALG. The intraparticle diffusivities (Dp'S) of phosphate were evaluated from the time courses of adsorption using the model of pore diffusion with a Freundlich-type adsorption isotherm. The Dp values were approximately 7 x 10(-7) cm2 S-1 for PT-A and 1 x 10(-6) cm2 s(-1) for ALG. The tortuosity factors calculated from a model of parallel plate pore were 5.1 for PT-A and 6.7 for ALG; these values resembled those for porous inorganic ion exchangers. The adsorption rates are high enough for each of the samples to be utilized as a phosphate adsorbent to prevent hyperphosphatemia in patients on chronic dialysis. PT-A is favored as a phosphate adsorbent because of its high chemical stability against acid.

Increased deoxycytidine kinase activity by etoposide in L1210 murine leukemic cells

Deoxycytidine kinase (dCK) is a rate-limiting enzyme for the activation of ara-C. It is responsible for the phosphorylation of ara-C which is widely used in the treatment of leukemia. We examined the effect of etoposide on dCK in L1210 cells and found that incubation with 10 microM etoposide for 1 h increased dCK activity to 170% of the control. This effect of etoposide on dCK activity was concentration-dependent up to at least 100 microM of the substance.

Pseudomyxoma peritonei: a cytohistopathologic study of nine cases

Cytologic examination of seven peritoneal fluids from nine patients with pseudomyxoma peritonei revealed papillary clusters and isolated neoplastic cells. In all patients, one or both ovaries were replaced by proliferating (borderline) mucinous epithelial tumors of grade I-II intestinal type while three patients had synchronous appendiceal tumors of similar morphologic appearance. Four of the nine patients demonstrated positive correlation between the presence of neoplastic cells in the ovarian interstitial mucin (pseudomyxoma ovarii), the extraovarian peritoneum, and the free peritoneal fluid. Two patients demonstrated a negative correlation. The submission of an inadequate amount of ovarian or appendiceal tissue for histologic examination may account for the discordance in three patients. It is concluded that pseudomyxoma peritonei is a distinct clinicopathologic entity which can be subdivided into two types, acellular and cellular. This distinction, unlike the specific cytomorphologic features, may have prognostic significance.