Bleomycin A5 sclerotherapy for cervicofacial lymphatic malformations.

OBJECTIVES: The purpose of this study was to document the results of bleomycin A5 sclerotherapy for cervicofacial lymphatic malformations (LMs), and the clinical data of 65 patients between October 2004 and October 2007 were reviewed. METHODS: Of the 65 patients in the study, 60 patients were given intralesional injection of bleomycin A5. Five patients underwent partial resection, and then an injection of bleomycin A5 for the remaining lesion. The outcomes were assessed by physical examination and Doppler ultrasonography scan. The follow-up time was from 6 months to 3 years after the last injection (mean, 16 months). RESULTS: Among the 65 patients, 41 were men and 24 were women (1.7:1 male:female ratio), the age range was 3 months to 45 years (mean, 12 years). Thirty-two lesions (49%) were macrocystic, 30 (46%) were microcystic, and 3 (5%) were combined. Each patient received 1 to 10 injections (mean, 3.0 injections) for the whole course of treatment, and the total dose of bleomycin A5 was from 8 to 80 milligrams (mean, 24.0 mg). Twenty-six of 32 macrocystic lesions (81%) showed greater than 90% reduction, whereas another 6 (19%) exhibited 50% to 90% reduction. Nineteen of 30 microcystic lesions (63%) showed greater than 90% reduction; 10 (33%) had 50% to 90% reduction; and 1 (4%) had less than 50% size reduction. Of the 3 combined lesions, 2 (67%) had greater than 90% shrinkage, and 1 (3%) had less than 50% reduction. The complications included ulceration of oral mucosa, minor soft tissue atrophy, mild fever, and hematoma. There was no recurrence throughout the follow-up period. CONCLUSION: These data suggest bleomycin A5 is a safe and effective intralesional agent for the treatment of macrocystic LMs, superficial oral mucosa LM, and localized deep microcystic lesions. For extensive macrocystic LMs involving contiguous anatomic areas and diffuse microcystic lesions involving deep tissues, bleomycin A5 injection combined with resection is necessary.

Optimal design of thread height and width on an immediately loaded cylinder implant: a finite element analysis.

In this study, we used a finite element method to evaluate the maximum Von Mises stresses in jaw bones of immediately loaded implant with different thread heights and widths, and the maximum displacements in implant-abutment complex. The implant thread height ranged from 0.20 to 0.60 mm, and the thread width ranged from 0.10 to 0.40 mm. Compared to those in standard designed implants, the maximum Von Mises stresses in cortical and cancellous bones with axially loaded implants decreased by 18.85% and 47.46%, respectively, and by 16.38% and 63.46%, respectively in buccolingually loaded implants. The maximum displacement of implant-abutment complex loaded axially and buccolingually decreased by 13.78% and 6.97%, respectively. These results indicated that thread height played more important roles in affecting bone stresses and implant-abutment complex stability than thread width. Immediately loaded cylinder implants with thread height exceeding 0.44 mm and width ranging from 0.19 to 0.23 mm caused the lowest stresses to the type B/2 bone.

Investigation of impacted permanent teeth except the third molar in Chinese patients through an X-ray study.

PURPOSE: To investigate the incidence and the local factors of impacted permanent teeth, except for the third molar, in Chinese patients through an x-ray study. MATERIALS AND METHODS: A total of 548 impacted permanent teeth from panoramic radiographs were studied and recorded according to the patients' gender and age, tooth position, and classification of impaction. The local factors contributing to impacted permanent tooth were also investigated. RESULTS: The incidence of impacted permanent teeth in the Chinese was 6.15%. The impacted tooth showed a predilection for women and was more common in the maxilla. The impaction of the canine had the greatest occurrence, 28.10% of all impacted teeth. Vertical impaction was most common (49.09%). The chief local factor for impacted teeth was the lack of interdental space (49.64%). CONCLUSIONS: All permanent teeth can occur with impaction in Chinese patients. Dentists should perform a thorough evaluation before planning suitable treatment.

99mTechnetium-methylene diphosphonate bone imaging using low-intensity pulsed ultrasound: promotion of bone formation during mandibular distraction osteogenesis in dogs.

Our objective was to assess the value of (99m)technetium-methylene diphosphonate ((99m)Tc-MDP) bone imaging in the use of low-intensity pulsed ultrasound to promote bony formation during mandibular distraction osteogenesis in dogs. The body of the mandibles in 7 dogs were cut between the first and the second premolar and were lengthened at the rate of 1mm/day, twice a day, for 20 days. During the period of distraction one lateral distraction gap was irradiated with low-intensity pulsed ultrasound (LIPUS) for 10min twice a day, and the other side was used as control. Serial radiographic inspections were made at different periods (0, 1, 2, 4, 6, 8, and 12 weeks) during the consolidation phase, followed by a plain radiograph and histological examination. The (99m)Tc-MDP imaging showed that the ratio of bone formation on the LIPUS-treated side was significantly higher than that on the control side during the early period of consolidation (before the 4th week), but later this was reversed and there were no significant differences between the two sides by the 12th week. Plain radiographs and histological examination showed that the new bone on the experimental side had matured earlier than that on the control side. Radionuclide bone imaging is a good way to assess the formation of bone after distraction osteogenesis.

Effect of low-intensity pulsed ultrasound on bone formation during mandible distraction osteogenesis in a canine model--a preliminary study.

PURPOSE: To make a preliminary study of the effect of low-intensity pulsed ultrasound on new bone formation during mandible distraction osteogenesis in dogs. MATERIALS AND METHODS: Bilateral surgical cuts were made in mandibles of 7 dogs between the first and second premolar regions. Anterior mandibles were lengthened by 20 mm at the rate of 1 mm/day twice a day. During the distraction period 1 lateral distraction gap was irradiated by low-intensity pulsed ultrasound for 10 minutes twice a day and the other side was sham irradiated as control. After distraction was completed, the dogs were sacrificed at 0, 1, 2, 4, 6, 8, and 12 weeks. Before sacrifice, dynamic bone imaging with technetium (99)m-methylene diphosphonate ((99)mTc-MDP) single-photon emission computed tomography was performed. Mandible samples were harvested. Then plain x-ray, dual-energy x-ray bone mineral density measurement, 3-dimensional computed tomography, and regular histologic examination were performed. RESULTS: The (99)mTc-MDP bone imaging showed that uptake of (99)mTc-MDP in the experimental side was higher than in the control side at the early period of the consolidation time, but the outcome was later reversed. Plain x-ray showed that new bone of the experimental side was mature sooner than that of the control side. Bone mineral density in the experimental side was higher than that of the control side. Volume of new bone of the 2 sides had no significant difference. Histologic examination showed that trabeculae of the experimental side were more numerous and thicker than those of the control side at the early period of the consolidation time. Endochondral bone formation was observed in the experimental side. CONCLUSION: Low-intensity pulsed ultrasound could accelerate bone formation during mandibular distraction osteogenesis and increase bone mineral density but had no effect on the volume of new bone.

[Follow-up after renal transplantation].

Follow-up after renal transplantation is vital to improve allograft long-term survival and quality of life. This article describes the awareness, frequency, patterns, and contents of the follow-up after renal transplantation, especially 6 factors that may adversely influence the long-term survival of renal transplant recipients.

Prevalence and influential factors of erectile dysfunction in male renal transplant recipients: a multiple center survey.

BACKGROUND: Renal transplants can improve the quality of life for recipients, but the quality of their sexual life might not be improved. This study was conducted to research the prevalence of erectile dysfunction (ED) and the influential factors in male renal transplant recipients (RTRs). METHODS: A cross-sectional survey was conducted in three renal transplantation centers. Structured questionnaires were administrated by trained interviewers to 824 male renal transplant patients, who had active sexual lives in the last 6 months. RESULTS: Complaints of ED were reported by 75.5% of the 809 RTRs (age range 19 - 75 years, mean age (45 +/- 10) years), whose questionnaires were completed. Mild, moderate and severe ED were reported at 53.6%, 8.3% and 13.6%, respectively. The mean age and the graft duration were significantly higher in male RTRs with ED compared to potent graft recipients (P = 0.00 and 0.04, respectively). The prevalence of ED increased with the increase in age. It was 60.7%, 65.8%, 75.2%, 87.5% and 92.2% in patients with age below 30 years, 31 - 40 years, 41 - 50 years, 51 - 60 years and over 60 years, respectively (P = 0.000). Moreover, the severity of ED increased with aging. The percentage of moderate and severe cases of ED increased from 6.7% in patients below 40 years to 28.9% in those over 40 years (P = 0.000). The prevalence of ED in the RTR who had no occupation was higher than in those who were holding a position (P = 0.001). The prevalence of ED decreased with the increase in the education level. The prevalence of ED was 94.3%, 86.4%, 74.0% and 67.8% in men with elementary school or lower, middle school, high school, and college or higher degrees, respectively (P = 0.000). Patients, whose distal end of arteria iliaca interna was interrupted and underwent iterative transplantation, worried transplanted kidney function was impacted by sexual life, and received cyclosporine (CsA)-based immunosuppressive regimens, were more likely to have ED (P = 0.000, 0.001, 0.000, 0.000, respectively). After Logistic regression analysis, only five factors, age, education level, interruption of arteria iliaca interna distal end, worrying transplanted kidney function impacted by sexual life and CsA-based immunosuppressive regimens sustained their significance. CONCLUSIONS: Renal transplant has varying effects on erectile function. ED is highly prevalent among RTRs and its influential factors are multiple. Age, education level, interruption of arteria iliaca interna distal end, worrying transplanted kidney function impacted by sexual life, CsA-based immunosuppressive regimens are the main influential factors of ED in male RTRs.

[Necessity and safety of conversion from mycophenolate mofetil to AzA thioprine after renal transplantation].

OBJECTIVE: To investigate the necessity and safety of conversion from mycophenolate mofetil (MMF) to Azathioprine (AzA) in stable renal transplant patients. METHODS: In a randomised open clinical trial, A total of 87 low-risk renal allograft recipients on triple immunosuppressive therapy (prednisone/MMF/cyclosporine) 6 months after transplantation was randomised into two groups: converted (switching MMF to AzA treatment 6 months after transplantation, n = 42) and control (continued MMF treatment, n = 45). Renal function, acute rejection episodes, side effects and related complications were analysed in each group. RESULTS: The outcome (such as event-free graft survival rate and incidence of acute rejection) of treatment after a 12-months follow-up of patients in two groups was similar. Liver lesion and leukocytopenia, most of which was reversible, occurred more frequently in the converted than in the control group. CONCLUSION: Under the special economic atmosphere and medical insurance system of our country, the conversion from MMF to AzA in some renal transplant patients was necessary and safe. Further study is needed to evaluate the long-term outcome of this conversion.

Kidney transplantation at the Chinese People's Liberation Army General Hospital.

Between October 1977 and December 2004, 2,037 kidney transplants were performed in 1,804 patients with ESRD at the Peoples Liberation Army General Hospital Postgraduate Medical School. Overall graft survival rates at one, 5, 10, 15, and 20 years were 91.6%, 79.3%, 64.3%, 53.8%, and 47.6%, respectively. The number of transplants significantly increased during the past decade. One-year patient and graft survival rates have increased from 40% and 35% in the 1970s to 98% and 96% in the 2000s, respectively. Since CSA was introduced to our clinic, one-year graft survival rates have increased from 33% to 93% and the half-lives have significantly improved from 13.1 years to 21.7 years. Also, the graft survival rate for patients on CSA-based triple therapy using MMF was about 18% higher at 5 years than those for patients using AZA (92% vs. 74%, p < 0.001), and 11% higher at 10 years (71% vs. 60%, p < 0.01). Our analysis showed that transplant year, DGF, rejection, immunosuppressive regimen, ABO blood group, and original disease were independent factors impacting on graft survival and poor HLA matching with 5-6 mismatches had an adverse effect on graft survival compared with 1-2 mismatches. Infection, cardio- and cerebral accidents and hepatic failure were the 3 main causes of death in transplant recipients.

[Diagnosis and treatment of complete necrosis of the ureter after cadaveric renal transplantation].

OBJECTIVE: To deepen the understanding of patients with complete necrosis of the ureter after renal transplantation for early diagnosis and treatment. METHODS: Of 5 patients with complete necrosis of the ureter after renal transplantatioin between January 1991 and April 2001 in our hospital, 4 were male and 1 was female (mean age, 35 years). Seven to 12 days after renal transplantation, native pyeloureterestomy was performed for 1 patient, and the remaining 4 patients received the cutting of the diatal necrosis ureter and vesicoureterostomy because of urine leakage. Six to seven weeks later when the ureter stents were pull out, native pyeloureterestomy or pyeloureteroplasty was performed for the 4 patients because of uropenia and hydronephrosis. RESULTS: Five patients showed normal function of the kidney postopcreation (follow up: 6 - 12 months) without hydronephrosis. CONCLUSIONS: When distal necrosis of the ureter is observed after renal transplantation, complete necrosis of the ureter may occur. Native pyeloureterostomy or pyeloureteroplasty is an effective treatment.