Incidental findings on MRI of the temporomandibular joint

OBJECTIVES

The aim of this study was to determine the prevalence of incidental findings in MRI of the temporomandibular joint (TMJ).

METHODS

MRI reports of 730 patients were assessed. The reports were analysed by one consultant and one clinical lecturer in dental and maxillofacial radiology. The prevalence of intracranial and extracranial incidental findings was recorded and categorized.

RESULTS

There were 53 (7.3%) incidental findings, of which 11 (1.5%) were intracranial and 42 (5.7%) were extracranial (divided into paranasal sinuses, mastoid air cells, muscle hypertrophy, lymphadenopathy and salivary glands). A total number of eight intracranial findings needed further dedicated imaging and/or specialist clinical opinion. Only one tumour (a meningioma) was found and required surgical intervention.

CONCLUSIONS

Incidental findings on TMJ MRI are rare but not unheard of. The clinical relevance of incidental findings can be significant, and it is therefore important to ensure that the full data set of images is inspected, including any scout slices. A close working relationship between the areas of dental and maxillofacial radiology and neuroradiology is essential in expediting a second opinion relating to intracranial findings. All incidental findings should be communicated to referring clinicians in a timely manner, based on their urgency and clinical significance.

Is there a therapeutic role for cranioplasty?

Cranioplasty is often undertaken as a joint neurosurgical and maxillofacial procedure. The principal aims remain to improve cosmesis and to protect the underlying brain. We report two cases of cranioplasty with subsequent improvement in neurological function and discuss the possible therapeutic role of cranioplasty.

EMS in the pastoral industries of western Queensland: from customisation to implementation

This paper outlines the customisation of Environmental Management Systems (EMS) for the pastoral industry of western Queensland, the recruitment and training of pastoral producers, and their development and implementation of EMS. EMS was simplified to a 7-step process and producers were recruited to trial this customised EMS. Producers from 40 properties received EMS training, either as groups or individually. Of these, 37 commenced Pastoral EMS development through a facilitated approach that allowed them to learn about EMS while developing an EMS for their property. EMS implementation has been more effective with producers who were trained in groups. At this stage, however, most producers do not see value in EMS as there are currently no strong drivers to warrant continued development and implementation. Key findings resulting from this work were that personal contact and assistance is vital to encourage producers to trial EMS, and that a staged approach to EMS implementation, commencing with a self-assessment, is recommended. EMS training is most successful in a group situation; however, an alternative method of delivery should be provided for those producers who, either by choice or isolation, have to work alone. A support network is also necessary to encourage and maintain progress with EMS development and implementation, particularly where no strong drivers exist.

Persistence of extracellular baculoviral DNA in aquatic microcosms: extraction, purification, and amplification by the polymerase chain reaction (PCR)

Genetically-modified baculoviruses have potential uses as bio-pesticides in forestry. However, the baculoviral occlusion bodies (OBs) may release genetically-modified DNA into the forest environment. In this research, outdoor aquatic microcosms, spiked with 673 microg of genomic DNA (4.4 x 10(12) target copies) from the genetically modified baculovirus Choristoneura fumiferana MNPVegt-/lacZ+, were exposed to natural summer conditions. A 530 bp DNA fragment from the genome of CfMNPVegt-/lacZ+ was detected in field microcosm water samples for about 24 h. The introduced DNA may have persisted for a longer time, but was below the detection limit of the PCR analysis (13.5 pg DNA or 8.9 x 10(4) target copies ml(-1) water). The detection limit of PCR was determined by spiking water samples with a dilution series of CfMNPVegt-/lacZ+ genomic DNA, extracting and purifying the DNA, and then PCR analysis. This study provides some of the first information on the persistence and detection limits of this viral DNA under aquatic ecological conditions, and the methods that can be used to conduct such a molecular-based field study.

Extraction, detection and persistence of extracellular DNA in forest litter microcosms

A DNA extraction method was developed that preferentially extracted extracellular DNA rather than intracellular DNA from forest litter. The method purposely avoided the use of harsh chemicals and physical disruption steps used in total DNA extraction to release DNA from cells. The detection limit of PCR, determined by spiking forest litter samples with a dilution series of Choristoneura fumiferana MNPVegt(-)/lacZ(+) genomic DNA, was about 1 ng DNA or 6.85 x 10(6) target copies 0.5 g(-1) moist forest litter or 0.14 g(-1) dry forest litter. In this study, outdoor terrestrial microcosms, each spiked with 49.2 microg of genomic DNA (from the baculovirus CfMNPVegt(-)/lacZ(+)), were exposed to summer conditions. A 530 bp DNA fragment from the genome of the baculovirus CfMNPVegt(-)/lacZ(+) was detected in these microcosms for about 3 months. The DNA may have persisted for a longer period but was below the detection limit of the PCR analysis.

Percutaneous osteosynthesis of the zygomatic buttress

We describe a technique of percutaneous miniplate osteosynthesis of the zygoma, using the transbuccal approach. It can be used in conjunction with an extraoral approach, or in isolation. Excellent access was achieved to the posterior zygomatic buttress and arch of zygoma, and the infraorbital rim. No complications developed in the two cases presented. This technique is a useful addition to the armamentarium of maxillofacial surgeons.

Caregivers' attitudes toward their family members' participation in Alzheimer disease research: implications for recruitment and retention

Current levels of participation in Alzheimer disease (AD) research are inadequate, particularly among nonwhites. This study was conducted to examine caregivers' attitudes toward their family members' participation in AD research. Six focus group interviews were conducted with 38 white and 12 African-American caregivers of participants enrolled in clinical research projects. Both white and African-American families participated in research to help their care recipients and future generations, receive support from the clinical and research staff, and obtain feedback about patient status and research results. Among white caregivers, primary barriers to participation in research included the potential for no direct benefit, problems with the procedures and tests involved, lack of time and resources, and difficulty accepting the diagnosis. Among African-American caregivers, primary barriers included general skepticism about the research process and firmly established attitudes about medical treatment and help seeking that serve as disincentives to research participation. To maximize the perceived benefits of research participation, potential participants should have access to regular personal contact with staff, information about health status changes in the care recipient, and the short-term and long-term results of the research studies in which they are participants. In addition, researchers should be sensitive to the concerns that may serve as barriers to participation, particularly among African Americans.

Extraction and detection of baculoviral DNA from lake water, detritus and forest litter

AIMS

This paper describes a quick, reproducible, sensitive method for baculoviral DNA extraction, purification and detection from freshwater and forest litter environments.

METHODS AND RESULTS

The extraction protocol utilizes enzymatic and chemical lysis and physical disruption. To assess the efficiency of the extraction and purification protocol, PCR was used to detect a 530 bp DNA fragment from the genome of a genetically-modified baculovirus, Choristoneura fumiferana NPVegt-/lacZ+. The detection limit of PCR amplification was routinely about 4.1 x 102 occlusion bodies (OBs) 450 microl-1 lake water. Template DNA from the detritus and forest litter samples required 100-fold dilutions before use in PCR reactions. The detection limits for detritus and forest litter samples were routinely about 7.41 x 103 and 2.08 x 104 OBs 0.5 g-1 dry weight, respectively.

CONCLUSION

The DNA extraction and purification methodology is reproducible, sensitive and can be used in lieu of, or in conjunction with, insect bioassays.

SIGNIFICANCE AND IMPACT OF THE STUDY

The DNA extraction and purification protocol described in this paper will facilitate risk assessment and ecological studies of both wild-type and genetically-modified baculoviruses.

Squamous cell carcinoma presenting as a peritonsillar abscess

Peritonsillar abscess is a rare presentation of squamous cell carcinoma of the tonsil. We report two cases illustrating the need to be aware of the possibility and reinforcing the need to send all excised tissue for histopathological diagnosis.

Hyponatraemia and seizures after ecstasy use

A patient presented to our unit with seizures and profound hyponatraemia after ingestion of a single tablet of ecstasy. The seizures proved resistant to therapy and ventilation on the intensive care unit was required. Resolution of the seizures occurred on correction of the metabolic abnormalities. The pathogenesis of seizures and hyponatraemia after ecstasy use is discussed. Ecstasy use should be considered in any young patient presenting with unexplained seizures and attention should be directed towards electrolyte levels, particularly sodium.

Advanced practice nursing role: clinical nurse specialist

The public continues to demand quality health care that focuses on the achievement of quality patient outcomes. The clinical nurse specialist is an advanced practice role that originated in the early 1900s as a result of similar public demand, and continues to evolve to meet quality health care needs. Advanced practice nurses have many opportunities to create expanded nursing roles. Orthopaedic nurses also continue to refine their practice roles, and the clinical nurse specialist is one such example.

Infectivity and effects of gypsy moth and spruce budworm nuclear polyhedrosis viruses ingested by rainbow trout

Rainbow trout fingerlings were fed dried krill injected with gypsy moth or spruce budworm nuclear polyhedrosis virus (LdNPV and CfNPV, respectively) at a total dose of 1.4 x 10(7) occlusion bodies (OBs) per fish. By the end of the 21-day experimental period there were no adverse effects on fish survival or behavior and no significant differences in feeding rates or growth between treated and control fish. The internal organs of all fish were examined at the end of the experiment and there were no signs of lesions, discoloration, swelling, hemorrhaging, or other aberrations. Visceral tissues were analyzed with a horseradish peroxidase-labeled whole genomic DNA probe (enhanced chemiluminescence procedure) to detect infection by the NPVs. There were no indications of NPV infection (no positive signals) in stomach and intestinal tract tissues of treated fish. High background signals were obtained from liver samples, but further analyses indicated that these were not due to the presence of LdNPV or CfNPV. The protocols outlined here should be applicable to determining infectivity and effects of genetically modified insect viruses on fish.

Comparison of forest soil microcosm and acute toxicity studies for determining effects of fenitrothion on earthworms

The effects of the organophosphate pesticide fenitrothion on Eisenia fetida Savigny and Dendrobaena octaedra Savigny were studied using the OECD acute toxicity test and microcosms containing forest organic matter. In the acute toxicity study, both species were relatively susceptible to fenitrothion, although D. octaedra (LC50 = 393.9 ml/cm2) was approximately eight times more sensitive than E. fetida (LC50 = 54.1 ml/cm2). E. fetida was unable to utilize oak/maple litter for growth, and attempts to use this species in microcosms were abandoned. In microcosm studies, reproduction of D. octaedra was affected at the expected environmental concentration (EEC), whereas growth and maturation rates did not decrease until 100x the EEC was used. Even at 100x EEC, a significant effect on survival of D. octaedra in microcosms was not demonstrated. The use of microcosm studies to provide insight into possible ecological effects of pesticides is discussed.

Increasing coordination of the dementia service delivery network: planning for the Community Outreach Education Program

Dementia is an emerging public health concern because of its prevalence and the cost and extent of care typically needed for people with cognitive disorders. When family members seek assistance in providing care, they frequently encounter a fragmented service delivery network. To increase the coordination of services for people with dementia, the Community Outreach Education Program (COEP) has been designed to provide educational interventions to disseminate information about the diagnosis, assessment, management, and treatment of dementia to health care professionals, service providers, staff of volunteer and community organizations, and family members. This article describes plans for the COEP within the context of a community development perspective.

Attitudes about autopsy: implications for educational interventions

Although the role of autopsy in confirming diagnoses and advancing research is well documented, family members are inadequately informed about the procedure. The present study examined attitudes about autopsy among older adults. Focus group interviews were conducted with members of three caregiver support groups and two senior centers. Predominant themes included: benefits, barriers, religious views, and concerns about procedures. Results suggest the need to design educational interventions to: (a) involve family members in advance planning; (b) provide counseling regarding the purpose, process, and procedures of autopsy; and (c) facilitate communication skills and awareness of local autopsy services and policies among physicians.

Effects of lethal and sublethal concentrations of the herbicide, triclopyr butoxyethyl ester, in the diet of zebra finches

Lethal and sublethal effects of dietary triclopyr butoxyethyl ester (TBEE) on zebra finches (Poephila guttata Gould) were determined in laboratory experiments conducted between 8 January and 1 May 1991. The 8-day median lethal dietary concentration, LC50 (95% confidence interval), of TBEE to zebra finches was 1,923 (1,627 to 2,277) mg/kg. In the sublethal effects experiment, when birds were exposed to 500 mg/kg TBEE in the diet for 29 days, food consumption and body weight were significantly depressed (P < 0.05). Similar prolonged exposures to 50 and 150 mg/kg TBEE in the diet had no significant effect on food consumption or body weight (P > 0.05). Perch-hopping activity was depressed relative to controls in the 500 mg/kg group, and elevated in the 150 mg/kg group, but neither of these differences was significantly (P > 0.05). Disappearance of TBEE residues from treated seeds over the 29 day experimental period followed an exponential decay model, with half-lives in the order of 15 to 18 days. On the basis of our observation that TBEE had no significant adverse effects at a concentration greater than the maximum expected environmental concentration, we propose that forestry applications of triclopyr at registered dosage rates pose little risk to wild songbirds.

Services for persons with dementia and their families: a survey of information and referral agencies in Michigan

In planning a statewide Dementia Program, Michigan agencies (N = 244) providing geriatric information and referral (I&R) were surveyed to determine service availability, families' needs, and problems providing I&R for persons with dementia and their families. Home-delivered meals, nursing and social work assessments were considered more available. Medical assessment, however, was considered "very available" by only 60%. Respite and adult day care were least available and most needed. Least was known about autopsy and financial services. For several services, non-urban areas reported less availability than urban areas. With additional information and training, existing agencies could provide more available and extensive I&R for persons with dementia and their families, forming a statewide network.

Pathologists' participation in postmortem examinations for patients with dementia

Pathologists (n = 571) in Michigan were surveyed to examine the problem of limited access to autopsy experienced by families of patients with dementia and to assist with the implementation of the Michigan Dementia Program. The survey determined the extent to which pathologists performed autopsies for patients with dementia and/or were willing to do so as part of a statewide Postmortem Examination Program. Responses from 394 pathologists (69%) indicated that 49% were willing to perform brain removal and 44% were interested in learning more about the statewide program. The survey results were used to recruit pathologists, to identify potential problems, and to provide baseline data against which to measure the effects of a fully implemented program.

Systemic lupus erythematosus: medical and nursing treatments

Systemic lupus erythematosus is a multisystem autoimmune disease that may affect skin, joints, mucous membranes, heart, lungs, kidneys, nervous system and all the blood cell lines. Although its cause is unknown, abnormal immune function results in the formation of antibodies directed against various components of the human body (autoantibodies). Treatment depends of the severity of the illness and may include nonsteroidal antiinflammatory agents for arthritis; antimalarial therapy for skin disease and other mild lupus manifestations; and corticosteroids and immunosuppressive agents including azathioprine, cyclophosphamide, and methotrexate for more severe lupus manifestations. Persons affected by lupus and their families need help in understanding the condition and require support as they deal with fear, depression, and possible disability. Implications for nursing are varied and include patient/family education about medication, joint protection principles, energy conservation, pain and stress management, and coping techniques.

Effects of the herbicides hexazinone and triclopyr ester on aquatic insects

Experiments were conducted to measure acute lethal response of aquatic insects to hexazinone (Velpar L) and triclopyr ester (Garlon 4) in flow-through laboratory bioassays, and to determine lethal and behavioral effects of these herbicides on insects in outdoor stream channels. No significant mortality (chi 2 P greater than 0.05) occurred in 13 test species exposed to hexazinone in laboratory flow-through bioassays (1-hr exposure, 48-hr observation) at the maximum test concentration of 80 mg/liter. The survival of insects exposed to 80 mg/liter hexazinone in outdoor stream channels was likewise unaffected. Significant drift (chi 2 P less than 0.001) of Isonychia sp. occurred during a hexazinone treatment of the stream channels, but only at the maximum concentration of 80 mg/liter, and survival of the displaced Isonychia sp. was not affected. In flow-through bioassays with triclopyr ester, 10 of 12 test species showed no significant mortality at concentrations greater than 80 mg/liter. Survival of Isogenoides sp. and Dolophilodes distinctus was significantly affected at less than 80 mg/liter. Lethal concentrations were estimated by probit analysis of concentration-response data (1-hr exposure, 48-hr observation) for Simulium sp. (LC50 = 303 mg/liter), Isogenoides sp. (LC50 = 61.7 mg/liter), and D. distinctus (LC50 = 0.6 mg/liter). Triclopyr ester applications to the stream channels resulted in significant drift and mortality of D. distinctus at 3.2 mg/liter (no effects at 0.32 mg/liter), Isogenoides sp. at 32 mg/liter, and Hydropsyche sp. and Epeorus vitrea at 320 mg/liter. The risk to aquatic insects of these herbicides used in forest vegetation management is discussed.

Development of a nursing automated documentation system

As hospital length of stay has decreased and patient acuity has increased, the nurse is confronted daily with the challenge of managing time between patient care and documentation. Documentation of care has consistently been a time-consuming and frustrating part of nursing practice. The nursing shortage has only compounded this problem. St. Joseph's Hospital has creatively begun to facilitate documentation by developing a Nursing Automated Documentation System (NADS) in collaboration with CliniCom, Inc. of Boulder, Colorado. This article documents the development and implementation of the system.

Evaluation of the child with short stature

The author reviews the various causes of short stature in childhood. The different patterns of growth seen with each of these conditions are emphasized, as an understanding of these patterns is essential to diagnosis. Short stature is a frequent finding in childhood, with endocrine causes being relatively rare.

The lethal toxicity of Matacil 1.8 F to rainbow trout and its in vivo metabolism

Fingerling rainbow trout (Salmo gairdneri Richardson) were used to determine the lethal toxicity of Matacil 1.8 F and Matacil 1.8 D ready-to-use formulations. The 96-h LC50s were 21.3 mg/l for water-based Matacil 1.8 F; 19.1 mg/l for oil-based Matacil 1.8 F; and 0.36 mg/l for Matacil 1.8 D. Aminocarb (4-dimethylamino-m-tolyl N-methylcarbamate) and MA (4-methylamino-m-tolyl N-methylcarbamate) were detected in fish tissue 96 h after exposure. More than 50% of the total residue (Aminocarb + MA) were the parent compound. The bioaccumulation ratio ranged from 1.70 to 3.32 at different concentrations of aminocarb. Both aminocarb and MA were rapidly eliminated after the fish had been transferred to clean water; the total residue declined by more than 90% in 72 h and became non-detectable in 96 h.