Prostate volume measurement by TRUS using heights obtained by transaxial and midsagittal scanning: comparison with specimen volume following radical prostatectomy

OBJECTIVE

The purpose of this study was to determine, when measuring prostate volume by TRUS, whether height is more accurately determined by transaxial or midsagittal scanning.

MATERIALS AND METHODS

Sixteen patients who between March 1995 and March 1998 underwent both preoperative TRUS and radical prostatectomy for prostate cancer were included in this study. Using prolate ellipse volume calculation (height x length x width x pi/6), TRUS prostate volume was determined, and was compared with the measured volume of the specimen.

RESULTS

Prostate volume measured by TRUS, regardless of whether height was determined transaxially or midsagittally, correlated closely with real specimen volume. When height was measured in one of these planes, a paired t test revealed no significant difference between TRUS prostate volume and real specimen volume (p =.411 and p =.740, respectively), nor were there significant differences between the findings of transaxial and midsagittal scanning (p =.570). A paired sample test, however, indicated that TRUS prostate volumes determined transaxially showed a higher correlation coefficient (0.833) and a lower standard deviation (9.04) than those determined midsagittally (0.714 and 11.48, respectively).

CONCLUSION

Prostate volume measured by TRUS closely correlates with real prostate volume. Furthermore, we suggest that when measuring prostate volume in this way, height is more accurately determined by transaxial than by midsagittal scanning.

Brenner tumor of the ovary: CT and MR findings

PURPOSE

The purpose of this study was to determine the CT and MR characteristics of Brenner tumors, rare epithelial neoplasms of the ovary.

METHOD

CT and MR scans of eight pathologically proven Brenner tumors of the ovary (seven benign, one malignant, and one associated with mucinous cystadenoma) were retrospectively reviewed. The masses were analyzed for location, size, external configuration, internal architecture, enhancement pattern, presence of calcification, and metastatic spread.

RESULTS

The patients' median age was 63 years (range 39-79 years), and the mean size of the tumors was 11.4 cm (7.5-17 cm). All tumors were unilateral and had a well-defined margin. The mass was mostly solid in three, mostly cystic in one, and "mixed" solid and cystic in four cases. The tumors with cystic components (n = 5) were mostly multilocular in appearance (n = 4). All the solid components showed mild homogeneous enhancement on postcontrast CT and MRI. Extensive amorphous calcification within the solid component on CT was seen in five of six cases (83%). No characteristic findings discriminating malignancy from benign Brenner tumor could be found.

CONCLUSION

Extensive amorphous calcification in a solid mass or solid component in a multilocular cystic mass is a characteristic finding of Brenner tumor of the ovary on CT and MRI.

Ciliary neurotrophic factor promotes the regrowth capacity but not the survival of intraorbitally axotomized retinal ganglion cells in adult hamsters

Ciliary neurotrophic factor has recently been shown to promote the axonal regrowth of retinal ganglion cells into a peripheral nerve graft following an intracranial transection of the optic nerve (approximately 7 mm from the optic disc). It is unclear whether the enhancement of axonal regrowth by ciliary neurotrophic factor application correlates with the enhancement of survival of retinal ganglion cells and/or the up-regulation of expression of growth-associated protein-43 messenger RNA in retinas. The present study evaluated the regenerative capacity of retinal ganglion cells following intraorbital transection of the optic nerve (approximately 1.5 mm from the optic disc) and the attachment of a peripheral nerve to the ocular stump of the optic nerve. In addition, we have determined the survival of retinal ganglion cells and the expression of growth-associated protein-43 messenger RNA in ciliary neurotrophic factor-treated retinas following optic nerve transection. The results showed that in the ciliary neurotrophic factor-treated retinas, the number of retinal ganglion cells which had regrown axons into a peripheral nerve is about four times more than the control. In the axotomized retinas, ciliary neurotrophic factor initiated sprouting of axon-like processes at 14 and 28 days post-axotomy and up-regulated the expression level of growth-associated protein-43 messenger RNA at 7, 14 and 28 days post-axotomy. However, ciliary neurotrophic factor did not prevent the death of axotomized retinal ganglion cells. We suggest that one possible mechanism for the axonal regeneration of axotomized retinal ganglion cells by ciliary neurotrophic factor could be mediated by the up-regulation of growth-associated protein-43 gene expression and not by increasing the pool of surviving retinal ganglion cells after axotomy.

Ventricular pressure monitoring during bilateral decompression with dural expansion

OBJECT

The management of massive brain swelling remains an unsolved problem in neurosurgery. Despite newly developed medical and pharmacological therapy, the rates of mortality and morbidity caused by massive brain swelling remain high. According to many recent reports, surgical decompression with dural expansion is superior to medical management in patients with massive brain swelling. To show the quantitative effect of decompressive surgery on intracranial pressure (ICP), the authors performed a ventricular puncture and measured the ventricular ICP continuously during decompressive surgery and the postoperative period.

METHODS

Twenty patients with massive brain swelling who underwent bilateral decompressive craniectomy with dural expansion were included in this study. In all patients, ventricular puncture was performed at Kocher's point on the side opposite the massive brain swelling. The ventricular puncture tube was connected to the continuous monitor via a transducer device. The ventricular pressure was monitored continuously, during the bilateral decompressive procedures and postoperative period. The initial ventricular ICP was variable, ranging from 16 to 65.8 mm Hg. Immediately after the bilateral craniectomy, the mean ventricular ICP decreased to 50.2+/-16.6% of the initial ICP (range 5-51.5 mm Hg). Additional opening of the dura decreased the mean ICP by an additional 34.5% and reduced the ventricular pressure to 15.7+/-10.7% of the initial pressure (range 0-15 mm Hg). Ventricular pressure measured postoperatively in the neurosurgical intensive care unit was lowered to 15.1+/-16.5% of the initial ICP. The ventricular ICP trend in the first 24 hours after decompressive surgery was an important prognostic factor; if it was greater than 35 mm Hg, the mortality rate was 100%.

CONCLUSIONS

Bilateral decompression with dural expansion is an effective therapeutic modality in the control of ICP. To obtain favorable clinical outcomes in patients with massive brain swelling, early decision making and proper patient selection are very important.

CT features of torsion of benign cystic teratoma of the ovary

PURPOSE

The purpose of this work was to evaluate the usefulness of CT scans for distinguishing torsed from uncomplicated benign cystic teratoma (BCT).

METHOD

Retrospective analysis was performed in 14 torsed BCTs (14 patients) and in 23 uncomplicated BCTs (20 patients) for comparison. The features on CT scans were compared to the pathologic findings.

RESULTS

CT findings indicating torsed BCT were the presence of eccentric wall thickening of >1 cm, peritumoral infiltration, and presence of enlarged solid tubal mass adjacent to the uterus (p < 0.05).

CONCLUSION

The present study suggests that CT is useful in differentiating torsed from uncomplicated BCT. Although CT findings are not specific for some patients, detection of certain CT findings could increase the diagnostic accuracy.

Anterior thalamoperforating artery aneurysm associated with internal carotid artery occlusion: case report

OBJECTIVE AND IMPORTANCE

We describe a rare case of a ruptured distal anterior thalamoperforating artery aneurysm associated with right internal carotid artery occlusion.

CLINICAL PRESENTATION

A 59-year-old woman experienced sudden occipital headache, vomiting, and subsequent coma as a result of massive intraventricular hemorrhage. An initial angiogram revealed only an occlusion of the right internal carotid artery just distal to the posterior communicating artery. Repeat angiography 1 month later, however, revealed a saccular aneurysm at a distal anterior thalamoperforating artery in addition to the occlusion of the internal carotid artery.

INTERVENTION

We approached this aneurysm through the right temporal horn after opening the ambient cistern. The aneurysm, which was located in the brain parenchyma just medial to the temporal horn, was successfully resected.

CONCLUSION

This rare aneurysm probably developed as a result of hemodynamic stress on the anterior thalamoperforating artery after occlusion of the internal carotid artery and/or secondary to chronic hypertension.

A 45-kDa cAMP-dependent phosphoprotein which is related to the product of Mst57Dc in Drosophila melanogaster

In Drosophila, the catalytic subunit of cAMP-dependent protein kinase (PKA) is preferentially expressed in the brain and the male reproductive organs. Although the cAMP response element binding protein (CREB) is a major target of PKA in the brain, the target of PKA in the male reproductive organs has been unknown. In the present study, three cAMP-dependent phosphoproteins (referred to as pp45, pp20, and pp10) were detected in the lumen fluid of male accessory glands. They were tissue-specific secretory proteins that accumulated only after eclosion, and were transferred to females during mating as other secretory proteins of the accessory glands. Among them, the 45-kDa phosphoprotein was partially purified and characterized. The purified protein was phosphorylated in vitro by the catalytic subunit of PKA. The partial amino acid sequence of this 45-kDa phosphoprotein was identical to the predicted amino acid sequence of the Mst57Dc cDNA, which is a male accessory gland transcript.

Sequential segmental approach to fetal congenital heart disease

The sequential segmental approach is now universally used in the diagnosis of congenital heart disease. Its utilization during fetal sonography has not been well described. In this review, we show how the fetal heart can be approached in a sequential segmental manner by using six basic sonographic views. The transverse view of the fetal upper abdomen is obtained to determine the arrangement of the abdominal organs, which, in most cases, provides the important clues to the determination of the atrial arrangement. The four-chamber view is obtained to evaluate the atrioventricular junctions. The views of the left and right ventricular outflow tracts are obtained to evaluate the ventriculoarterial junctions. The three-vessel view and the aortic arch view are obtained for the evaluation of the arrangement and size of the great arteries, which provides the additional clues to the diagnosis of the abnormalities involving the ventriculoarterial junctions and the great arteries. The standard protocol to acquire these six basic views is also introduced.

Fetus-in-fetu in the scrotal sac of a newborn infant: imaging, surgical and pathological findings

We report a case of fetus-in-fetu located in the scrotal sac of a newborn male infant. Plain radiography (including specimen radiography), ultrasonography and MRI clearly demonstrated vertebral column, ribs, skull, pelvic bones, femurs and a portion of tibiae and humeri. The diagnosis was confirmed by pathological examination.

Surgical correction of cryptotia using Medpor

Cryptotia is a congenital auricular anomaly found more commonly in Orientals than whites. The characteristics of cryptotia are the invagination of the upper part of the auricle under the temporal skin and the deformity of the auricular cartilage. The goals of the repair of cryptotia are to release the upper ear from the side of the head to restore the retroauricular groove, to correct the malposition, and to correct the cartilaginous deformity. To lengthen the skin between the superior portion of the auricle and the scalp, the authors used both the modified Z-plasty and the temporal advancement flap. We partially detached the abnormal insertion of the superior auricular muscle at the upper part of the helix to make it weak. After complete exposure of the posterior aspect of the upper auricular cartilage, the constricted intrinsic transverse and oblique muscles were cut, and everting horizontal mattress sutures were inserted on the antihelix to expand the constricted body and crus of the antihelix. Thereafter, an ultrathin Medpor sheet (0.85-mm thickness) was fixed with 6-0 nylon sutures to the posterior aspect of the corrected antihelical cartilage for lengthening and splinting the relatively shortened upper pole of the deformed cartilage. This operative method is thought to be useful in maintaining the lengthened auricular height and shape, and in preventing the relapse of ear cartilage deformities.

Periodontal repair in dogs: effect of rhBMP-2 concentration on regeneration of alveolar bone and periodontal attachment

The objective of this study was to evaluate the effect of recombinant human bone morphogenetic protein-2 (rhBMP-2) concentration on regeneration of alveolar bone and cementum, and on associated root resorption and ankylosis. Contralateral, critical size, supra-alveolar, periodontal defects were surgically produced and immediately implanted with rhBMP-2 in an absorbable collagen sponge (ACS) carrier in 8, young adult, male, beagle dogs. 6 animals received rhBMP-2/ACS (rhBMP-2 at 0.05, 0.10, or 0.20 mg/mL; total construct volume/defect approximately 4.0 mL) in contralateral defects following an incomplete block design. 2 animals received rhBMP-2/ACS (rhBMP-2 at 0 and 0.10 mg/mL) in contralateral defects (controls). The animals were euthanised at 8 weeks post-surgery and block sections of the defects were collected for histologic and histometric analysis. Supra-alveolar periodontal defects receiving rhBMP-2 at 0.05, 0.10, or 0.20 mg/ml exhibited extensive alveolar regeneration comprising 86%, 96%, and 88% of the defect height, respectively. Cementum regeneration encompassed 8%, 6%, and 8% of the defect height, respectively. Root resorption was observed for all rhBMP-2 concentrations. Ankylosis was observed in almost all teeth receiving rhBMP-2. Control defects without rhBMP-2 exhibited limited, if any, evidence of alveolar bone and cementum regeneration, root resorption, or ankylosis. Within the selected rhBMP-2 concentration and observation interval, there appear to be no meaningful differences in regeneration of alveolar bone and cementum. There also appear to be no significant differences in the incidence and extent of root resorption and ankylosis, though there may be a positive correlation with rhBMP-2 concentration.

Synergistic effect of optic and peripheral nerve grafts on sprouting of axon-like processes of axotomized retinal ganglion cells in adult hamsters

We investigated the sprouting response of retinal ganglion cells (RGCs) following the transplantation of peripheral nerve (PN) and/or optic nerve (ON) into the vitreous of the eye and the intraorbital transection of the optic nerve in hamsters. Our previous results showed that an intravitreal PN graft could induce sprouting of axon-like processes in axotomized RGCS [3] (Cho, E.Y. and So, K.F., Characterization of the sprouting response of axon-like processes from retinal ganglion cells after axotomy in adult hamsters: a model using intravitreal implantation of a peripheral nerve, J. Neurocytol., 21 (1992) 589-603). In this model, we have examined the effect of intravitreal ON graft on the sprouting of RGCs both following a co-transplantation of PN and ON into the vitreous and transplantation of ON alone. The present results show that sprouting is increased by more than two-fold in retinas having PN and ON grafts than a PN graft alone. However, the ON graft by itself rarely induced sprouting in RGCs. These results suggest that the ON graft enhance the number of RGCs to sprout axon-like processes in the presence of PN graft by exerting a synergistic rather than an additive effect, since ON graft alone did not induce sprouting. In addition, no diffusible inhibitory effect of ON graft on PN induced sprouting was observed.

Reactive oxygen species-induced apoptosis and necrosis in bovine corneal endothelial cells

PURPOSE

The loss of corneal endothelial cells associated with aging and possibly other causes has been speculated to be related to exposure to reactive oxygen species (ROS). The current study was conducted to investigate, by use of photosensitizers, the underlying mechanisms involved in the death of bovine corneal endothelial cells (BCENs) caused by ROS.

METHODS

BCEN cells in primary culture were treated with a photosensitizer (riboflavin or rose bengal) with light exposure. The patterns of cell damage and death were assessed using an acridine orange-ethidium bromide differential staining method, TdT-mediated dUTP nick-end labeling (TUNEL) assay, and transmission electron microscopy. The cytotoxicity was assayed by mitochondrial function using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) testing. Antioxidants, including catalase, L-histidine, salicylic acid, and superoxide dismutase, were used to determine the types of ROS involved. Activation of nuclear factor (NF)-kappaB was examined by fluorescent immunocytochemistry with anti-p65 antibody.

RESULTS

Light-irradiated riboflavin or rose bengal resulted in a significant decrease in viability of BCEN cells. Chromosomal condensation and fragmentation were observed in apoptotic cells, and membrane lysis and damage of cell ultrastructures were observed in necrotic cells. Riboflavin induced apoptosis at 30 minutes and thereafter and induced necrosis after 2 hours. Rose bengal was shown to cause similar effects within half the time required for the effects of riboflavin. Catalase and salicylic acid were found to provide protection for BCENs from cytotoxic effects of riboflavin, and L-histidine was found to protect BCENs from cytotoxicity induced by rose bengal. Kinetic studies using immunocytochemistry showed that NF-kappaB was translocated into the nucleus within 15 minutes and 30 minutes after treatment with rose bengal and riboflavin, respectively.

CONCLUSIONS

The cytotoxic effects of photo-irradiated riboflavin and rose bengal are shown to be mediated by two distinct but parallel pathways, one leading to apoptosis and the other to necrosis. Possible involvement of NF-kappaB in cell death is suggested. These findings provide potential leads for future investigation into the molecular mechanisms of loss of corneal endothelial cells related to aging, oxidative stress, and possibly other similar causes.

Microbial removal of Fe(III) impurities from clay using dissimilatory iron reducers

Fe(III) impurities, which detract refractoriness and whiteness from porcelain and pottery, could be biologically removed from low-quality clay by indigenous dissimilatory Fe(III)-reducing microorganisms. Insoluble Fe(III) in clay particles was leached out as soluble Fe(II), and the Fe(III) reduction reaction was coupled to the oxidation of sugars such as glucose, maltose and sucrose. A maximum removal of 44-45% was obtained when the relative amount of sugar was 5% (w/w; sugar/clay). By the microbial treatment, the whiteness of the clay was increased from 63.20 to 79.64, whereas the redness was clearly decreased from 13.47 to 3.55.

Alveolar bone formation at dental implant dehiscence defects following guided bone regeneration and xenogeneic freeze-dried demineralized bone matrix

The present study evaluated rate and extent of alveolar bone formation in dental implant dehiscence defects following guided bone regeneration (GBR) and implantation of xenogeneic freeze-dried demineralized bone matrix (xDBM). A total of 16 titanium plasma-sprayed (TPS) and 16 hydroxyapatite-coated (HA) titanium cylinder implants were inserted in 4 mongrel dogs following extraction of the mandibular premolar teeth. Four implant sites per jaw quadrant (2 TPS and 2 HA implant sites) were prepared into extraction sockets in each dog. Buccal alveolar bone was removed to create 3 x 5 mm dehiscence defects. Two jaw quadrants in separate animals received GBR, GBR + xDBM, xDBM (control), or gingival flap surgery alone (GFS; control). Thus, four conditions were available for each implant type (TPS or HA): GBR, GBR + xDBM; xDBM and GFS. The animals received fluorescent bone labels to allow observations of rate and extent of bone formation. Animals were sacrificed at 12 weeks postsurgery and block sections were harvested for histologic analysis. There were no apparent histologic differences between TPS and HA implant defects. GBR and GBR + xDBM resulted in almost complete bone closure of the dental implant dehiscence defect. Rate of bone formation appeared higher following GBR alone. Extent of bone formation appeared somewhat greater following GBR + xDBM; however, delayed. xDBM alone did not adequately resolve the bony defect. In conclusion, GBR results in rapid, clinically relevant bone closure of dental implant dehiscence defects. Adjunctive implantation of xDBM does not appear to significantly improve the healing response in the model used.

Periodontal repair in intrabony defects treated with a calcium sulfate implant and calcium sulfate barrier

THIS RANDOMIZED, CONTROLLED, CLINICAL STUDY was designed to evaluate outcome following surgical implantation of an allogeneic, freeze-dried, demineralized bone matrix-calcium sulfate (DBM+CS) composite with a CS barrier in intrabony periodontal defects. Twenty-six patients contributing 26 deep intrabony defects completed the study. Thirteen patients received the DBM+CS implant. Thirteen patients received gingival flap surgery alone (GFS; control). Clinical outcome was assessed at 6 and 12 months postsurgery. At 12 months postsurgery, probing depth (PD) reduction (mean +/-SD) for the DBM+CS and GFS group was to 4.3+/-0.5 and 3.0+/-1.3 mm; clinical attachment gain was to 2.9+/-0.8 and 1.7+/-1.5 mm; and probing bone level gain was to 2.9+/-1.4 and 1.2+/-1.2 mm, respectively. There were no apparent differences between evaluations at 6 and 12 months postsurgery. Clinical improvements were significantly different from presurgery for both groups at both observation intervals (P < 0.01). There were no significant differences between groups in PD reduction and clinical attachment gain. Probing bone level gain was significantly greater in the DBM+CS group compared to controls (P < 0.05). In summary, surgical implantation of DBM+CS with a CS barrier resulted in reduced PD and improved attachment levels comparable to that achieved by gingival flap surgery alone. However, gain in probing bone levels in deep intrabony periodontal pockets assessed by clinical parameters was greater than that observed by gingival flap surgery alone. These changes were noted at both 6 and 12 months after surgery. This regenerative technique needs further biologic evaluation before being generally accepted.

OK-432 and 5-fluorouracil, doxorubicin, and mitomycin C (FAM-P) versus FAM chemotherapy in patients with curatively resected gastric carcinoma: a randomized Phase III trial

BACKGROUND

The streptococcal agent OK-432 is used widely as a potent biologic response modifier. Accumulated evidence suggests that OK-432 exerts antineoplastic effects by a direct cytotoxic or inhibitory effect on tumor cells. The clinical efficacy of OK-432 has been reported for various tumors. In this randomized Phase III study, the authors compared 5-fluorouracil (5-FU), doxorubicin, mitomycin C, and the intradermal administration of OK-432 (FAM-P) with the standard FAM regimen in patients with gastric carcinoma who underwent curative resection.

METHODS

From May 1988 until November 1991, a total of 99 patients were entered into this randomized trial. The patients were stratified according to the American Joint Committee on Cancer stage of disease (i.e., Stage IB, II, and III). Fifty patients were treated with the FAM regimen here and throughout text.: 5-FU, 750 mg intravenously (i.v.), on Days 1, 8, 29, and 36; doxorubicin, 30 mg/m2 i.v., on Days 1 and 29; and mitomycin C, 10 mg/m2 i.v., on Day 1. Forty-nine patients received the FAM-P regimen: 5-FU, 750 mg i.v., on Days 1, 8, 29, and 36; doxorubicin, 30 mg/m2 i.v., on Days 1 and 29; mitomycin C, 10 mg/m2 i.v., on Day 1; and OK-432 5.0 Klinishe Einheit (clinical unit) injected intradermally weekly.

RESULTS

The survival difference was statistically significant between the patients receiving the FAM and FAM-P regimens (5-year survival of 52% vs. 62%; P = 0.04). A comparison between disease free survival in FAM and FAM-P patients showed a borderline advantage for the FAM-P group (P = 0.053). When Stage IB, Stage II, and Stage III patients were analyzed separately, the difference in survival between two regimens was significant in Stage III patients (P = 0.049) and the disease free survival was of borderline significance (P = 0.06), but not in patients with Stage IB and II disease. The significant toxicity of OK-432 was mild fever, which was controlled with acetaminophen.

CONCLUSIONS

The results of this study show that OK-432 may be an active, well tolerated agent for the treatment of curatively resected gastric carcinoma. However, these findings should be confirmed by a multicenter randomized study with a large sample size.

Effect of a calcium sulfate implant with calcium sulfate barrier on periodontal healing in 3-wall intrabony defects in dogs

This controlled, split-mouth, preclinical study was designed to evaluate outcome following surgical implantation of an allogeneic, freeze-dried demineralized bone matrix-calcium sulfate (DBM+CS) composite with a CS barrier in 3-wall intrabony periodontal defects in 4 dogs. Control conditions included surgical implantation of DBM or CS and gingival flap surgery (GFS) alone. Three-wall intrabony defects (4x4x4 mm) were surgically created at the mesial and distal aspect of the maxillary and mandibular first and third premolars, respectively. Maxillary and mandibular defects each received 1 of the 4 experimental conditions. Experimental conditions were rotated between defect sites in subsequent animals. Block sections of the defects were collected at sacrifice 8 weeks postsurgery and processed for histometric analysis. Histometric defect height (means +/- SD) for the DBM+CS, DBM, CS, and GFS groups amounted to 4.2 +/- 0.5, 4.3 +/- 0.7, 4.0 +/- 0.2, and 4.1 +/- 0.2 mm, respectively. Connective tissue adhesion (connective tissue contact to the root without apparent cementum formation) amounted to 0.4 +/- 0.3, 0.4 +/- 0.3, 0.5 +/- 0.2, and 1.6 +/- 0.5 mm for the DBM+CS, DBM, CS, and GFS groups, respectively; the DBM+CS, DBM, and CS groups being significantly different from the GFS group (P < 0.05). Cementum regeneration amounted to 3.0 +/- 0.3, 3.1 +/- 0.4, 2.5 +/- 0.4, and 1.6 +/- 0.3 mm for the DBM+CS, DBM, CS, and GFS groups, respectively; the DBM+CS, DBM, and CS groups being significantly different from the GFS group (P < 0.05). Alveolar bone regeneration amounted to 2.7 +/- 0.4, 2.7 +/- 0.3, 1.8 +/- 0.5, and 0.7 +/- 0.1 mm for the DBM+CS, DBM, CS, and GFS groups, respectively; the DBM+CS, DBM, and CS groups being different from the GFS group (P < 0.05), and the DBM+CS and DBM groups being different from the CS group (P < 0.05). None of the DBM-containing implants provided evidence of bone metabolic activity. In summary, surgical implantation of DBM and CS, alone or in combination, may result in significantly improved regeneration of alveolar bone and cementum in this preclinical model. Observed regeneration is likely unrelated to a biologic activity inherent in DBM. Rather it appears that space-providing properties of the implants supported observed regeneration.

A case of hemolytic uremic syndrome associated with Epstein-Barr virus infection

The precise etiology of hemolytic uremic syndrome (HUS) is unknown. However, it has been associated with bacterial (Shigella, Salmonella, E. coli, S. pneumoniae), Bartonella, and viral (coxsackie, ECHO, influenza, varicella. Epstein-Barr) infections and with endotoxemia. Recently, we experienced a case of HUS in a 16-year-old boy who was in the acute phase of an Epstein-Barr virus (EBV) infection. He had typical manifestations of HUS and EBV infection. He also transiently presented disseminated intravascular coagulation. His renal dysfunction recovered by supportive care, including hemodialysis, plasmapheresis, antihypertensive medication and aspirin. We present this case with a review of the literature as the second report of HUS associated with EBV infection.

Effect of calcium sulphate on the healing of periodontal intrabony defects

The purpose of this series of three studies was to evaluate the regenerative potential of calcium sulphate in the treatment of periodontal intrabony defects.

Periodontal repair in dogs: effect of allogenic freeze-dried demineralized bone matrix implants on alveolar bone and cementum regeneration

The objective of this study was to evaluate alveolar bone and cementum regeneration following surgical placement of an allogenic, freeze-dried, demineralized bone matrix (DBM) cortical strip implant. Critical size, supraalveolar periodontal defects were surgically created around the second, third, and fourth mandibular premolar teeth in eight mongrel dogs. Contralateral jaw quadrants in six animals were randomly assigned to receive the DBM implant, or serve as surgical control. Two additional animals received bilateral DBM implants. Flaps were coronally advanced to submerge teeth and implants, and sutured. Three animals were exited from the study due to extensive early wound failure. Remaining animals were sacrificed at 8 weeks postsurgery. Histometric recordings included defect height, bone regeneration/DBM implant height, cementum regeneration height, root resorption, and ankylosis. Large areas of unresorbed DBM exhibiting fragmentation and empty osteocyte lacunae were observed adjacent to new bone formation, or bone formation was observed adjacent to or within the implant, often exhibiting ankylosis. Cementum regeneration appeared enhanced in shelter of the DBM implant. Histometric recordings (mean+/-SD) for DBM and control defects, respectively, were: defect height, 4.8+/-0.2 mm and 4.4+/-0.2 mm; bone regeneration/DBM implant height, 4.0+/-1.3 mm and 1.2+/-0.6 mm; cementum regeneration height, 1.4+/-0.4 mm and 0.7+/-0.2 mm; root resorption, 0.5+/-0.3 mm and 1.2+/-0.3 mm; and ankylosis, 0.5+/-0.2 mm and 0.1+/-0.1 mm without statistically significant differences between experimental conditions (N=3). Within the limitations of this study, the histologic observations suggest that surgical implantation of allogenic, freeze-dried DBM cortical strip implants may have a potential to support cementum regeneration, possibly by providing conditions for guided tissue regeneration, however, alveolar regeneration appears unpredictable.

MR imaging of intersexuality

Intersexuality involves an intermingling of the characteristics of each sex in varying degrees as a result of some flaw in embryonic development. Accurate demonstration of genital anatomy is essential for proper gender assignment and for treatment of intersexual disorders. Genital anatomy is well demonstrated with MR imaging, which offers unsurpassed soft-tissue contrast, multiplanar capability, and no radiation exposure. Intersexual disorders can be categorized into female pseudohermaphroditism, male pseudohermaphroditism, gonadal dysgenesis or agenesis, and true hermaphroditism. In female pseudohermaphroditism, MR images show normal internal female genitalia with masculinized external genitalia. In male pseudohermaphroditism, MR images show normal or mildly defective testes with incompletely masculinized external genitalia. In gonadal dysgenesis, combinations of normal, dysgenetic, and streak gonads are seen on MR images; in gonadal agenesis, no gonads are evident. In true hermaphroditism, both testicular and ovarian tissue is seen on MR images. MR imaging is essential for management of intersexual disorders.