Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study

PURPOSE

This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge.

METHODS

From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure.

RESULTS

A total of 223 patients (132 women, 91 men; mean age 23.5 years; range 17-65 years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7 % after GBR procedures, 25.9 % after staged horizontal ridge augmentation, and 18.2 % after staged vertical ridge augmentation. Infections were diagnosed in 2 % after GBR procedures, 12.5 % after sinus floor elevation (SFE) (transcrestal technique), 5 % after staged SFE, 11 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2 % after GBR procedures, 37 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7 %), four after GBR procedures (1.6 %), and two (12 %) after staged vertical ridge augmentation.

CONCLUSIONS

Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.

Agreement between accelerometric symmetry scores and clinical lameness scores during experimentally induced transient distension of the metacarpophalangeal joint in horses

REASONS FOR PERFORMING STUDY

Equine lameness examination is based on subjective visual scoring of lameness. Instrumented objective methods for lameness examinations may be complicated to perform and the equipment is often stationary. Accelerometry has a potential clinical use; however, the reduction and interpretation of equine accelerometric data are not yet routine and the value of accelerometry in equine lameness examination is unclear.

OBJECTIVES

To use accelerometric data to calculate 2 different accelerometric symmetry scores and to evaluate the agreement of these with traditional lameness scores done by experienced equine practitioners.

METHODS

Six sound horses were equipped with a 3 axis 10G piezoresistant accelerometer at the lowest point of the back. Horses were trotted and video recorded at 0, 3, 15, 30, 45 and 60 min after injection of saline into one metacarpophalangeal joint. Video recordings were scored in a blind manner according to the AAEP scale by 2 experienced practitioners. Interobserver agreements and 2 symmetry scores S and A, developed on the basis of Fourier transformation of the obtained accelerometric data, were calculated and regression analysis between AAEP scores and symmetry scores was performed.

RESULTS

Interobserver agreements were 70%. There was a statistically significant relationship between AAEP lameness scores and both symmetry scores.

CONCLUSIONS

Both symmetry scores showed a significant relationship with the AAEP scores and can be a valuable tool in the detection and quantification of lameness. While the S score was able to detect changes in degree of lameness, the A score was capable of detecting the lame diagonal. However, more research is needed for the development of a combined accelerometric score to take advantage of the strengths of each of the symmetry scores.

Aortic stenosis in the Dogue de Bordeaux

OBJECTIVES

To evaluate the occurrence of aortic stenosis and establish echocardiographic reference values in the Dogue de Bordeaux in Denmark.

METHODS

Fifty-three dogs were auscultated for evidence of a cardiac murmur and a full echocardiographic examination was performed. The criterion for the diagnosis of aortic stenosis was a peak aortic velocity greater than 2.5 m/s from a subcostal transducer location.

RESULTS

A left-basilar ejection murmur was detected in 38 (72 per cent) of the dogs. An aortic ejection velocity greater than 2.5 m/s was identified in 9 (17 per cent) of the dogs from a subcostal view. The aortic annulus in Dogue de Bordeaux was smaller than that considered normal in other breeds with comparable body size. Furthermore, a decreased aortoseptal angle was noticed in dogs with aortic stenosis.

CLINICAL SIGNIFICANCE

The Dogue de Bordeaux may be highly predisposed to aortic stenosis. The small aortic annulus noted in healthy and affected Dogue de Bordeaux and a decreased aortoseptal angle noted in affected dogs in this study might reflect key aetiological features in the development of aortic stenosis.

Molecular and immunological characterisation of the glucose regulated protein 78 of Leishmania donovani(1)

To identify novel potential Leishmania vaccine antigens, antibodies from patients with visceral leishmaniasis (VL) were used to isolate clones from a cDNA expression library of L. donovani amastigotes. Glucose Regulated Protein (GRP78), a member of the 70 kDa heat-shock protein family was identified and characterised. The GRP78 gene was localised to chromosome 15 in L. donovani, L. major, and L. mexicana by pulse-field gel electrophoresis. The Leishmania GRP78 protein contain a carboxy-terminal endoplasmic reticulum retention signal sequence (MDDL) as does the Trypanosoma cruzi GRP78. Immunofluorescence using antibodies to the recombinant DNA-derived GRP78 protein showed staining localised to reticular material throughout the cytoplasm and in the perinuclear region of promastigotes, suggesting that the protein is localised in the endoplasmic reticulum. The protective efficacy of GRP78 was assessed in mice vaccine experiments. A GRP78 DNA vaccine primed for an immune response that protected C57Bl/6 and C3H/He mice against infection with L. major. Similarly vaccination with a recombinant form of GRP78 purified from Escherichia coli and administered with Freund's as adjuvant induced protective immunity in C57Bl/6 mice.

Cloning, expression and antigenicity of the L. donovani reductase

The protozoan parasite Leishmania undergoes a morphological and biochemical transformation from the promastigote to the amastigote form during its life cycle, which is reflected in the expression of stage-specific proteins. One of these proteins shows homology to a superfamily of reductase proteins. We have cloned the reductase gene from L donovani and have shown that it differs in only one nucleotide from the L. major homologue, resulting in one amino acid change. A cytosine (C) to guanine (G) transposition in the coding sequence leads to a nonconserved substitution of asparagine (N) for lysine (K). Only 2 of 22 plasma samples from patients with visceral leishmaniasis were found to have detectable anti-reductase antibodies and peripheral blood mononuclear cells (PBMC) from one of three individuals previously infected with visceral leishmaniasis proliferated in the presence of recombinant reductase protein. Interestingly, 6 of 10 PBMC isolated from Danish controls proliferated in the presence of the reductase protein. Intracellular IFNgamma was found in a significant percentage of cells in all the tested PBMC cultures from Danes, whereas IL4 was only found in a small proportion of cells, or not at all. The results indicate the presence of cross-reacting CD45R0 memory T-cells in individuals not exposed to Leishmania. Several previous studies have shown that T-cells from nonexposed individuals often respond to crude Leishmania antigen preparations. The present study suggests that this reactivity is partly caused by T-cells recognising L. donovani reductase.

Molecular characterization of a Leishmania donovanii cDNA clone with similarity to human 20S proteasome a-type subunit

Using plasma from patients infected or previously infected with Leishmania donovanii, we isolated a L. donovanii cDNA clone with similarity to the proteasome a-type subunit from humans and other eukaryotes. The cDNA clone, designated LePa, was DNA sequenced and Northern blot analysis of L. donovanii poly(A(+))mRNA indicated the isolation of a full length cDNA clone with a transcript size of 1.9 kb. The expressed recombinant LePa fusion protein induced proliferation of peripheral blood mononuclear cells in one out of seven patients who had suffered from visceral leishmaniasis. Plasma from 16 out of 25 patients with visceral leishmaniasis and four out of 18 patients with cutaneous leishmaniasis contained IgG antibodies which reacted with the purified LePa fusion protein as evaluated in an ELISA. The LePa DNA sequence was inserted into an eukaryotic expression vector and Balb/c mice were vaccinated. DNA vaccination of Balb/c mice with LePa generated an initial significant reduction in lesion size after challenge.

Serodiagnosis of Leishmania donovani infections: assessment of enzyme-linked immunosorbent assays using recombinant L. donovani gene B protein (GBP) and a peptide sequence of L. donovani GBP

The repetitive sequence of Leishmania major gene B protein (GBP) has previously been shown to be a useful tool in the diagnosis of cutaneous leishmaniasis (CL). Here, we have assessed enzyme-linked immunosorbent assays (ELISAs) using recombinant L. donovani GBP (rGBP) and a peptide sequence of L. donovani GBP (GBPP) in the diagnosis of L. donovani infections in Sudan. The sensitivity of the rGBP ELISA in diagnosing visceral leishmaniasis (VL) and post kala-azar dermal leishmaniasis (PKDL) was 92% and 93%, respectively. In contrast, the sensitivity of the GBPP ELISA was 55% for VL and 63% for PKDL. Plasma antibody reactivity of donors with VL and PKDL remained high for an extended period after the end of treatment. Antibody-reactivity to rGBP and GBPP was detected in 71% and 14% of plasma samples from CL patients, respectively. Plasma from healthy Sudanese donors living in an area endemic for malaria but free of leishmaniasis was negative in both assays.

Humoral and cellular immune responses to synthetic peptides of the Leishmania donovani kinetoplastid membrane protein-11

Native kinetoplastid membrane protein-11 (KMP-11), purified from crude extracts of Leishmania donovani parasites, activates T cells from individuals who have recovered from visceral leishmaniasis. In this work we used three 38-mer peptides spanning the amino acid sequence of the L. donovani KMP-11 as solid-phase ligands in enzyme-linked immunosorbent assays (ELISAs) and as stimulating antigens in lymphoproliferative assays in order to evaluate humoral and cellular immune responses to well-defined sequences of the protein. Antibody reactivity against the three peptides was measured in plasma from 63 Sudanese visceral leishmaniasis patients (VL) and the percentage of patients with anti-KMP-11 antibodies in ELISA were 37% (KMP-11-1), 30% (KMP-11-2) and 58% (KMP-11-3). The fraction of VL patients with measurable antibody reactivity in one or more of the three ELISAs was 79%. Cross-reactivity to the KMP-11 peptides was detected in plasma from Sudanese patients suffering from Leishmania major infections and in plasma from Sudanese and Danish patients infected with Plasmodium falciparum. In lymphoproliferative assays, 10 of 17 PBMC isolates from donors previously infected with L. donovani showed a response to one or more of the three KMP-11 peptides.

Serodiagnosis of cutaneous leishmaniasis: assessment of an enzyme-linked immunosorbent assay using a peptide sequence from gene B protein

An enzyme-linked immunosorbent assay (ELISA) using a 28 amino acid sequence of the repetitive element of gene B protein (GBP) from Leishmania major was developed for serodiagnosis of cutaneous leishmaniasis (CL). The assay was compared to ELISAs using crude amastigote and promastigote antigens from L. donovani and the major surface glycoprotein (Gp63) from either L. donovani or L. major as a solid-phase ligand. The sensitivity of the assays was tested in 33 patients suffering from CL caused by L. major. The sensitivity of the GBP peptide (GBPP) ELISA was 82%. This was higher than in the assays using crude amastigote (67%) or promastigote (67%) antigens, but the difference was not statistically significant. The sensitivity in the assays using Gp63 from L. donovani (52%) or L. major (39%) was significantly lower than in the assay using GBPP (P = 0.019 and P < 0.001, respectively). Plasma samples from healthy Sudanese individuals living in an area endemic for malaria but free of leish-maniasis were negative in all the assays. Significantly higher levels of antibodies were found in the patients who had suffered from the disease for more than eight weeks than in patients with a shorter clinical history (GBPP ELISA; P = 0.038; amastigote ELISA; P = 0.004; and promastigote ELISA; P = 0.017). In the former group, the sensitivities of the five ELISAs were 100% (GBPP), 87% (amastigote), 93% (promastigote), 67% (L. donovani), and 53% (L. major), respectively.

Being overweight and multiple fractures are indications for operative treatment of humeral shaft fractures

Excellent clinical results can be obtained with non-operative treatment of humeral shaft fractures. In certain patients, operative stabilization is the treatment of choice. This study was initiated to determine the results of non-operative treatment in relation to multiple fractures and being overweight. From 1985 to 1992 we treated 35 humeral shaft fractures in 34 patients by non-operative methods. The median age was 51 (18-84) years. There were 12 women and 22 men. Nine were in overweight patients and 11 were in patients with multiple fractures. Fractures in overweight patients were followed for 158 (60-597) days and the Neer score was 61 (50-72) points. Patients with multiple fractures were followed for 178 (52-970) days and the Neer score was 72 (38-96) points. Single fractures in non-overweight patients were followed for 70 (35-412) days and the Neer score was 94 (65-100) points. These results show that humeral shaft fractures in certain patients may best be treated by operative stabilization.

Orotic acid sodium salt in kidney stones and urinary deposits

Kidney stones from a plaice, Pleuronectes platessa, have been shown to consist of the sodium salt of orotic acid. Precipitation of orotic acid in human kidneys and urine samples has previously been reported but the precipitates must have been salts, most likely the sodium salt, of orotic acid and not the free acid. This reinterpretation is based on the acid strength of orotic acid and on data for the solubilities of sodium orotate and orotic acid. Sodium orotate is therefore a member on the list of compounds present in human urinary deposits and calculi. X-ray powder diagrams and d-values and IR-spectra of the sodium salt are recorded to facilitate future identifications.