Management of second branchial cleft anomalies

Branchial cleft anomalies are developmental disorders of the neck. The aim of this study was to evaluate the data of our patients, who have been diagnosed and treated for second branchial abnormalities in the last six years. We report our clinical experience in second branchial anomalies with a review of the literature. Our study is a retrospective one on a number of 23 patients hospitalized within 2001-2007 in ENT Clinic of Craiova for second branchial abnormalities in relation with age, gender, origin environment, clinical and paraclinical context in which the therapeutic decision was made, surgical procedures, post-surgical evolution. Among the anomalies of the second branchial arch, we encountered 10 (43.47%) patients with branchial cyst and 13 (56.52%) patients with branchial sinus. Twelve (52.17%) of the 23 patients were women and 11 (47.83%) were men; 9 (39.13%) patients were diagnosed and treated within the first age decade, seven (30.43%) within the second age decade, five (39.13%) within the third age decade and two (8.71%) in the fourth age decade. Histological examination of the lesions after excision established the diagnosis in all the cases. Second branchial arches anomalies are the most common branchial anomalies. Sinuses are more frequently than cysts and branchial fistulae are extremely rare. There is no gender predilection. The majority of patients (approximately 70%) were diagnosed and treated during their childhood. Treatment for these lesions is complete surgical excision for prevent recurrences.

Sjögren's syndrome associated with chronic hepatitis C - the benefit of the antiviral treatment

Chronic hepatitis C virus infection (CHCV) has high prevalence of immunological abnormalities. Extrahepatic manifestations (EHM) have been reported in association with CHCV infection, whose heterogeneity makes difficult any correlation between the two disorders. Among extrahepatic symptoms of C virus hepatitis, sicca syndrome is also registered. Sjögren's or sicca syndrome (SS) is a chronic, slowly progressive disease, with inflammatory-immune mediation characterized by lymphocytic infiltration of the lachrymal and salivary glands. A distinct primary form and a secondary one, occurring when presented in the context of an autoimmune or hepatic disease have been described. We present a case of SS in a patient with CHCV, commenting a possible link between primary SS and the CHCV, as well as the similarities and the distinctions among these conditions. Our conclusion is that CHCV can induce SS with some clinical particularities like presence of pericapillary and not pericanalicular lymphocytic infiltrate without destroying the salivary glands, in the absence of SS-A/SS-B antibodies. The favorable evolution of SS under IFN therapy is an argument for an authentic relation. Further studies are necessary to determine if CHCV is an etiological agent of SS or of it can induce a pseudo-sicca syndrome, characterized by a simple glandular inflammation consisting mainly in a simple lymphocytic adenitis.

Use of a robotic arm to perform remote abdominal telesonography

OBJECTIVE

The purpose of this study was to design and validate a method of performing sonography between an expert center and an isolated site. A sonography probe is held on the patient by a robotic arm and remotely controlled from the expert's center. The robotic arm reproduces all the movements of the expert's dummy probe on the patient probe. The system was tested on 87 patients at our hospital.

CONCLUSION

Robotic telesonography can be used for reliable diagnosis without moving the patient. No false diagnoses were made in this study. A bandwidth of 250 Kbps via integrated services digital network or satellite is required for reliable diagnosis. Such a system can provide diagnostic information that is currently unavailable in isolated or inaccessible areas and on rescue vehicles.

Consequences of reduced umbilical and increased foetal cerebral flow during malaria crisis on foetal behaviour

The objectives of this study were (a) to evaluate the sensitivity and specificity of foetal Doppler indices for the prediction of abnormal foetal heart rate (aFHR) at delivery after malaria crisis and (b) to test Doppler parameters against crisis duration for predicting aFHR. Every day during the malaria crisis, the umbilical and cerebral vascular resistance indices were measured by Doppler. These indices allowed evaluation of the amplitude of the foetal flow redistribution induced by malaria (C/U=cerebral resistance/umbilical resistance ratio), the duration of the flow redistribution period and the hypoxic index (mean %C/U change x crisis duration). It was found that the mean duration of the flow redistribution period was: 7 +/- 2 days, mean C/U change -7% +/- 4, hypoxic index -56 +/- 37, prematures 35%, and aFHR 17%. An hypoxic index > 150 predicted occurrence of aFHR with high sensitivity and specificity (100%/91%). The highest foetal flow disturbance (max %C/U) and the duration of the period with flow disturbance (> 7 days) predicted aFHR at delivery with a sensitivity of 10% and 40% and a specificity of 77% and 78%. It was concluded that the hypoxic index was more predictive of aFHR at delivery than the amplitude or the duration (i.e. crisis duration) of the foetal flow redistribution.

Fetal vascular response to maternal deep-vein thrombosis and subsequent heparin therapy

The fetal umbilical and cerebral Doppler changes were recorded in a 27-year-old primigravida referred at 38 weeks for the treatment of an iliofemoral vein thrombosis. On admission and in comparison to a previous Doppler assessment systematically performed during growth scan at 37 weeks, the umbilical resistance index (URI) demonstrated an increase of 19%, the cerebral resistance index (CRI) a reduction of 15% and the cerebral-umbilical (C/U) ratio a decrease of 29% reaching the lowest value of 1.05. Under intravenous heparin therapy, Doppler normalisation was observed within 1 week and the mother delivered a healthy, non-hypoxemic baby by caesarean section at 39 weeks and 2 days. This observation suggests that deep-vein thrombosis (DVT) may, in some cases, be responsible for transient fetal hypoxia. Moreover, treatment with intravenous heparin had a direct beneficial effect on the fetus as it improved placental hemodynamics and fetal oxygenation.

The Black Sea Tele-Diab System: development-implementation-clinical evaluation

This paper describes the application of the GEHR (Good European Health Record) architecture to develop a system to enable the storage and exchange of EHCRs (Electronic Health Care Record) of patients with diabetes, in the Black Sea area. The objectives of the Black Sea Tele Diab System (BSTD) were to develop and evaluate the use of a fully-computerised healthcare record system in a clinical setting, to promote the use of electronic data exchange of healthcare information and to provide a framework for the epidemiological study and monitoring of diabetes care.

Safety and efficacy of insulin lispro in patients with diabetes mellitus

Lispro is a human insulin analogue with a very rapid onset of action, and a shorter duration of activity than soluble insulin. In order to assess the therapeutical value of lispro, we have had an open-label, non-comparative study, for 12 weeks, involving 19 IDDM patients. The treatment regimen with lispro and Humulin N has been adapted depending on each patient characteristics. Patients attended three visits, and the main metabolic control parameters included values of hemoglobin Alc, fasting and postprandial blood glucose monitoring. The patients themselves monitored their blood glucose using a glucometer. The mean age value of 19 patients (8 females and 11 males) was 22.32 (+/- 13.59) years. In patients previously receiving insulin treatment, therapy with lispro insulin significantly reduced postprandial glucose values. Lispro has been administered t.i.d. in 14 patients, and b.i.d. in 5 patients. At visit 1, mean value of HbAlc was 10.32% (+/- 1.63%); at visit 3, mean HbAlc was 9.90% (+/- 1.59%). Total insulin daily dose and the rate of short and long acting insulin did not change from visit 1 to visit 3. There has been reported only one serious adverse event during the study: a ketoacidosis due to a technical dosing error. Ten patients have reported mild hypoglycemic episodes. The outcomes of clinical study and of Quality of Life Questionnaire suggests that lispro--the first human insulin analogue used in humans--is effective, safe, and it is broadening beneficially the spectrum of insulins.

[The results of the Ravitch-Sutherland technic for surgical correction in pectus excavatum]

The aim of our study was to assess the functional and cosmetic results after performing a modified Ravitch-Sutherland procedure in children presenting with excavatum. A series of 31 children with ages ranging between 5 and 16 years, presenting with pectus excavatum, were operated between 1986-1996 in our service. In 5 cases surgical treatment was required by the presence of respiratory and/or cardiac functional impairment due to the malformation. In the other 23 cases operation was performed mainly for cosmetic reasons. In all cases a modified Ravitch-Sutherland procedure was performed. Modification consisted in renouncing at the plicature of the perichondra and in associating a diaphragmatic elongation and Bedouelle laparoplasty in all cases. Longitudinal sternotomy was performed in 2 cases with severely impaired ventilatory capacity. Functional and cosmetic results were good in all cases. In 2 cases, in which recurrence of the condition was observed, a second identical procedure was performed, with a good result. The interval between the operation and the moment of long-term evaluation ranged between 3 months and 11 years. We conclude that the modified Ravitch-Sutherland procedure represents an effective method for the treatment of pectus excavatum cases, offering good functional and cosmetic long-term results.

[Cerebral HITS: diagnosis, clinical relevance, outlook]

After 6 years of experience, Spencer and colleagues described the detection of embolus signals as height intensity transient signals (HITS) within Doppler flow spectrum from intracranial vessels. These signals (gaseous or materials) are recorded in many situations such as cardiac prosthetic valves, atrial fibrillation, carotid stenosis, carotid surgery or angioplasty. The clinical value is not well known: neurological impairment associated with brain lesions is described in case of cardiac prosthetic valves. The observation of HITS in carotid stenosis is associated with an increased risk of stroke. The detection of HITS offers a new orientation in studying stroke but some technical and/or clinical difficulties have to be solved.

[The results of the Ravitch-Sutherland technic for surgical correction in pectus excavatum]

The aim of our study was to asses the functional and cosmetic results after performing a modified Ravitch-Sutherland procedure in children presenting with pectus excavatum. A series of 31 children with ages ranging between 5 and 16 years, presenting with pectus excavatum, were operated between 1986-1996 in our service. In 5 cases surgical treatment was required by the presence of respiratory and/or cardiac functional impairment due to the malformation. In the other 23 cases operation was performed mainly for cosmetic reasons. In all cases a modified Ravitch-Sutherland procedure was performed. Modifications consisted in renouncing at the plication of the perichondrium and in associating a diaphragmatic elongation and Bedouelle laparoplasty in all cases. Longitudinal sternotomy was performed in 2 cases with severely impaired ventilatory capacity. Functional and cosmetic results were good in all cases. In 2 cases, in which recurrence of the condition was observed, a second identical procedure was performed, with a good result. The interval between the operation and the moment of long-term evaluation ranged between 3 months and 11 years. We conclude that the modified Ravitch-Sutherland procedure represents an effective method for the treatment of pectus excavatum cases, offering good functional and cosmetic long-term results.

Investigation of the hydration process in 3CaO�SiO 2 -plasticizer-water systems by X-ray diffraction

The development of the hydration-hydrolysis processes in the 3CaO. SiO(2)-H(2)O system is studied by X-ray diffraction in presence of varying contents of a new plasticizer, belonging to the lignosulphonates class. The influence of the additives upon these processes with increasing time is observed and it is shown to depend on the nature and content of the additives and the reaction time. This influence of the additives on the kinetics of the hydration-hydrolysis processes, retardation or acceleration, is due to the strong adsorption of these admixtures on the surface of the anhydrous or partially hydrated particles of the system. The influence of the additives also appears during the development of the formed hydrocompounds according to structure and composition. As a result of these complex actions provided in the forming system (3CaO. SiO(2)-H(2)O), the mechanical strength is favorized mainly by certain proportions of plasticizer admixtures (0.1% LSC and 2% ADCOM).

Bacterial assay of contact lens wearers

PURPOSE

The goal of the project was to determine the quantity of bacteria on the contact lens and adjacent areas of the eye. This paper is a quantitative study of the contact lens and ocular aerobic microbiota in a mixed group of daily and extended wear disposable contact lens users.

METHODS

The contact lens, the lower fornix, tears collecting at the lower fornix, and edge of the lower lid at the Meibomian gland margin were assayed for the quantity of bacterial colony forming units (CFU). Eighteen patients wearing 49 disposable high water content hydrogel contact lenses were assayed and the mean lens age was 8.8 +/- 4.6 days. Three patients wore their lenses on a daily wear basis and 15 on an extended wear schedule. Tear samples were obtained with sterile microbial loops and the lens was macerated into small particles with a tissue grinder. The samples were poured onto the surface of chocolate agar plates and incubated at 35 degrees C for 48 h in 5% Co2.

RESULTS

The lid margin revealed the greatest bacterial presence (mean = 9.7 CFU; median = 2 CFU; mode = 0 CFU). The lens showed the next greatest presence of CFU (mean = 4.5 CFU; median = 1 CFU; mode = 0). The fornix and tears revealed the least bacterial presence (fornix: mean = 2.6 CFU; median = 0 CFU; mode = 0 CFU). The bacteria were coagulase-negative staphylococci.

CONCLUSIONS

The bacterial assay of disposable lens wearing contact lens subjects indicates that the lid margins are the greatest source of bacteria with the tears being the lowest. These studies support the concept that in the eye, the lens typically does not possess a large number of bacteria under normal conditions.

Shear bond strength of several new core materials

This study compared the shear bond strengths of three core materials: a light activated glass-ionomer cement (VariGlass VLC), a fluoride-release dual cure composite resin (Fluoro Core), and a conventional silver-reinforced glass-ionomer cement (Miracle Mix) when cured to dentin. Fifty-four noncarious molar teeth were extracted, cleaned, mounted in acrylic resin, and sectioned horizontally to expose the dentin surface. Each material was mixed according to manufacturer's instructions, applied in a premade mold to the exposed dentin, and then cured. The specimens were randomized into three group (six teeth from each material) and stored (37 degrees C, 100% humidity) for 15 minutes, 24 hours, and 24 hours and were then thermocycled (5 degrees to 55 degrees C) for 125 cycles. The specimens were tested for shear bond strength with the Instron universal testing machine. The differences among time groups were not statistically significant except for Miracle Mix and VariGlass VLC cements, which showed a greater improvement with thermocycling. This study indicated that the FluoroCore resin exhibited the greatest shear bond strength of the core materials and that VariGlass VLC cement had greater bond strength than Miracle Mix cement except after thermocycling, when VariGlass VLC cement and FluoroCore resin were not significantly different.

Effect of two dentinal desensitizing agents on retention of complete cast coping using four cements

The cementation of artificial crowns is commonly accompanied by sensitivity, so the clinical application of desensitizing agents has become prevalent. This study investigated the effects of Imperva bonding agent and All-Bond desensitizing agent on the retention of artificial crowns. The cements selected for this study were: zinc phosphate, polycarboxylate, glass ionomer, and resin luting agents. Extracted, intact, human molars were mounted in autopolymerizing acrylic resin and prepared for complete cast copings. Thirty-two teeth were treated with All-Bond desensitizing agent, 32 teeth with Imperva bonding agent, and 32 remained untreated. Castings were cemented and tested on an Instron testing machine. The results demonstrated a significant reduction in retention when All-Bond desensitizing agent was used with polycarboxylate cement and some reduction with zinc phosphate cement. Imperva bonding agent demonstrated less retention with glass ionomer cement.

Enamel wear caused by three different restorative materials

The ideal restorative material should cause minimal wear of opposing enamel. This study compared the effects of gold alloy, glazed porcelain, and a laboratory-processed composite on opposing enamel. Ten samples of a type III gold alloy, a porcelain, and a visible-light, heat, and vacuum-processed composite were abraded against cusps of extracted molars for 10,000 cycles on an abrading machine. Pretest and posttest profilometric measurements of the restorative materials demonstrated no statistical difference. Pretest and posttest tracings of the cusps were made on an optical comparator to determine loss of vertical height and surface area. The porcelain caused significantly more loss of vertical height and surface area than the gold alloy or the composite, which were similar.

A comparison of the diametral tensile strength, the flexural strength, and the compressive strength of two new core materials to a silver alloy-reinforced glass-ionomer material

This study compared three mechanical properties of two recently introduced core materials, a light-activated glass ionomer cement (VariGlass VLC) and a fluoride-release dual cure composite resin (FluoroCore), with those of a conventional silver-reinforced glass-ionomer cement (Miracle Mix). Seventy-two samples (eight per product for each property) were prepared for testing diametral tensile strength, flexural strength, and compressive strength. The specimens were cured, stored for 24 hours at 37 degrees C in 100% humidity, and tested with the use of an Instron universal testing machine. The results of this study indicate that the diametral tensile strength, flexural strength, and compressive strength of the FluoroCore and VariGlass VLC materials were significantly higher than those of the conventional Miracle Mix. The values obtained with FluoroCore material were consistently higher than those obtained with VariGlass VLC material.

Insulin resistance: the link between impaired glucose tolerance, body mass index and plasma lipids

Body mass index defined as weight (Kg)/height (cm2) and plasma lipids (total lipids-TL, triglycerides-TG and cholesterol-CH) were determined in 131 patients (61 males and 70 females aged between 21 and 63 years) with impaired glucose tolerance (IGT) defined according to WHO criteria. Blood glucose (BG) values and plasma insulin (PI) levels (radioimmunological assay) were determined during 2 hours OGTT with samples obtained before and after 1 h and 2 h after the intake of 75 g glucose. The sum of blood glucose and plasma insulin levels (0 + 1h + 2h) were compared in each of the following 5 groups of subjects: A--25 cases with IGT but without obesity (BMI: 23.2 +/- 2.6) and hyperlipidaemia (PL: 627 +/- 112; TG: 102 +/- 109 and CH: 208 +/- 35 mg/dl); B--35 cases with IGT and obesity (BMI: 31.2 +/- 2.6) but without hyperlipidaemia (PL: 807 +/- 109; TG: 136 +/- 31 and CH: 254 +/- 41 mg/dl); C--23 cases with IGT and hyperlipidaemia (PL: 1013 +/- 217; TG: 214 +/- 85 and CH: 311 +/- 52 mg/dl) but without obesity (BMI: 25.4 +/- 1.9); D--48 cases with IGT and both obesity (BMI: 30.9 +/- 2.8) and hyperlipidaemia (PL: 1457 +/- 155; TG: 597 +/- 188 and CH: 483 +/- 184 mg/dl); a control group of 49 cases without IGT, obesity (BMI: 26.2 +/- 1.9) or hyperlipidaemia (PL: 726 +/- 99 mg/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

At-home vital bleaching: effects on stained enamel and dentin

In a scanning electron microscope study evaluating the effects of a 10% carbamide peroxide gel on stained enamel and dentin, no surface morphologic changes were observed after 72 hours of contact with the bleaching gel.

Quantitative high-performance liquid chromatography analysis of DNA oxidized in vitro and in vivo

Oxidative modification of genetic material has been implicated as a factor in carcinogenesis, particularly during promotion and progression, and therefore there is a need for sensitive detection of oxidized DNA bases. We developed a method that can be applied to DNA isolated from any source and used to simultaneously quantify oxidized nucleosides without a need to prelabel the DNA or use destructive hydrolytic procedures. This method is based on: (a) enzymatic DNA digestion; (b) HPLC separation of the resultant nucleosides; (c) acetylation of the oxidized nucleosides with [3H]Ac2O (acetic anhydride); (d) removal of the radioactive debris; and (e) quantitative analysis of tritiated nucleoside acetates by HPLC. Enzymatic DNA digestion was optimized using DNase I in the presence of Mg2+ (pH 7), followed by nuclease P1 in the presence of Zn2+ (pH 5.1) and alkaline phosphatase (pH 7.5). Analysis of DNA oxidized with H2O2 in the presence of Fe2+/EDTA for 30 min showed that the levels of 8-OHdG (8-hydroxy-2'-deoxyguanosine) were increased 2.7-fold, HMdU (5-hydroxymethyl-2'-deoxyuridine) 3.15-fold, and FdU (5-formyl-2'-deoxyuridine) 2.5-fold. Although the (-)-isomer of cis-dTG (cis-thymidine glycol) was enhanced 2.3 times, the (+)-isomer remained virtually unchanged. Analysis of DNA isolated from epidermal cells of mice treated in vivo with the tumor promoter TPA (12-O-tetradecanoylphorbol 13-acetate) showed 4.8-, 2.7-, and 8.7-fold increases in the levels of total cis-dTG, 8-OHdG, and HMdU, respectively, and of some unknown DNA oxidation products. These results prove applicability of the 3H-postlabeling method to the analysis of DNA (and potentially RNA) isolated from many sources, including animals and humans.

Not only quantitative but also qualitative changes of serum immunoglobulins in diabetes mellitus

To extend previous observations on the quantitative changes of IgA and other serum Ig in diabetics, additional immunochemical investigations were carried out in 96 patients, 63 males and 33 females, mean age 43.5 +/- 15.7 years, 51 with type 1 (insulin-dependent) and 45 with type 2 (non-insulin-dependent) diabetes. The immunological data were correlated with the clinical-metabolic aspects. In the whole group, the IgA level was increased (144.1 +/- 57.2 I.U.). Significant differences were recorded with respect to age for IgG, to age and diabetes type for IgA, to sex for IgM. Qualitative Ig changes, reflecting disturbances of molecular structure, mainly for IgG, seldom for IgM, but never for IgA, were observed in 20% of the patients with both types of diabetes, more seldom in cases with long disease duration. The IgG with qualitative changes were purified and their functional capacity of inhibiting the natural cytotoxic activity (NK) was tested in comparison with that induced by pretreatment of the effectory cells with normal IgG. Some of these modified IgG showed a reduced capacity of inhibiting the NK activity. These data confirm the existence of certain quantitative changes of the main serum Ig in diabetics and reveal the presence of qualitative disorders of the IgG molecules, with consequences on their functionality.