Correlation of gender and age with magnetic resonance imaging findings in patients with arthrogenic temporomandibular disorders: a cross-sectional study.

The objective of this study was to analyse the correlation between the gender and age of individuals with arthrogenic temporomandibular disorders (TMDs) and magnetic resonance imaging (MRI) findings. A total of 199 patients were included in the study and were divided into four age groups: group A, ≤30 years; group B, 31-44 years; group C, 45-55 years; group D, ≥56 years. MRI scans were analysed for the presence or absence of the following conditions: morphological changes in the mandibular condyle and/or articular tubercle, disc displacement with (DDWR) and without reduction (DDWoR), bone oedema, effusion, and avascular necrosis. Statistical analyses were conducted using logistic regression models (P<0.05). The mean patient age was 44.47±16.39 years; 158 (79.4%) were female and 41 (20.6%) were male. Only DDWoR was more significantly found in females than in males (P<0.05). Group D showed an odds ratio three times higher for the presence of morphological changes than group A (odds ratio 3.042, 95% confidence interval 1.421-6.512; P=0.0042). No differences were found among groups for the other findings. Based on the results of the present study it may be concluded that MRI findings tend to differ according to age and gender.

[Perioperative evaluation and treatment of cardiovascular risk patients for noncardiac surgery : Guidelines of the European Society of Cardiology/European Society of Anaesthesiology 2014]. / Perioperative Beurteilung und Behandlung kardiovaskulärer Risikopatienten für nichtherzchirurgische Eingriffe : Leitlinien 2014 der European Society of Cardiology/European Society of Anaesthesiology.

In late summer 2014, the joint working group of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) presented new guidelines for the evaluation and treatment of cardiovascular risk patients undergoing noncardiac surgery. In addition to the preoperative collation of patient and intervention-specific risks, the guidelines deal with anaesthesiological and cardiological aspects of the perioperative management of patients with diseases of the heart and common comorbidities. This article summarizes the essential aspects of the guidelines in a clearly arranged form.

Thromboelastometric detection of clotting Factor XIII deficiency in cardiac surgery patients.

AIM(S): In this article, we aimed to investigate plasma Factor XIII levels after extracorporeal circulation in cardiac surgery by thromboelastometric detection, as extracorporeal circulation causes various coagulation disorders due to the exposure of blood to artificial surfaces, inflammatory induction and mechanical destruction of platelets and coagulation factors, which may particularly affect factors with long half-lives, such as Factor XIII. BACKGROUND: Since transfusion algorithms are often empirical and laboratory analysis of Factor XIII plasma levels may not be available 24 h a day, bed-side testing using rotational thromboelastometry (ROTEM) could offer a splendid option to define the cause of excessive peri-operative bleeding disorders in general and Factor XIII levels in particular in a timely manner and thus facilitating exact substitution therapy. METHODS: In this trial, we investigated 25 cardiac surgery patients with extracorporeal bypass times over 100 min. Standard laboratory and ROTEM analyses were performed post-operatively at the time of intensive care unit admission and 6 h later. We implemented EXTEM with additional Factor XIII (teenTEM) as additional test by adding 0·625 IU Factor XIII to standard EXTEM reagents. RESULTS: In this observational study, we could not demonstrate a correlation between Factor XIII and MCFEXTEM , CFTEXTEM or MLEXTEM . Neither Factor XIII plasma levels nor MCFEXTEM could predict blood loss. In accordance with previous findings, we were able to demonstrate increased maximum clot firmness (MCF), decreased clot formation time and decreased maximum lysis by adding Factor XIII in vitro (teenTEM vs EXTEM) indicating an improvement in the coagulation process. As shown before, we also found a strong correlation between MCF and platelet and fibrinogen plasma levels. CONCLUSION: In summary, 'teenTEM' test does not seem to detect Factor XIII deficient patients in cardiac surgery. Furthermore, post-operative blood loss could not be predicted neither by ROTEM nor by laboratory analysis of Factor XIII. In vitro administration of Factor XIII appears to improve laboratory measures of haemostasis.

Use of osseointegrated implants in the intermaxillary suture: a new possibility for the prosthetic rehabilitation of atrophic maxillae.

Patients with atrophy of the maxillae, generally the elderly, are usually difficult to handle clinically, mainly due to the lack of retention, stability, and masticatory effectiveness of the total removable prosthesis. A new technique involving osseointegrated implants that are parallel to each other and arranged in the intermaxillary suture seems to provide great advantages over the current options for oral rehabilitation. This technique is quick and effective, being performed with local anesthesia and without a bone graft, and still presents low morbidity and cost.

Perioperative management of patients with cytoreductive surgery for peritoneal carcinomatosis.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) has become an important tool in the management of patients with peritoneal malignancies. It is a complex surgical procedure with significant fluid loss during debulking leading to relevant pathophysiological alterations and therefore a challenge for anesthesiologists and critical care physicians. This review summarizes perioperative changes in hemodynamics, oxygen supply, coagulation, hematopoetic parameters and fluid status during cytoreductive surgery and HIPEC and how to deal with these pathophysiological alterations.

[Case report: Libyostrongylus douglassii-associated proventriculitis in ostriches in Germany]. / Libyostrongylus douglassii-assoziierte Magenentzündungen bei Straussen (Struthio camelus) in Deutschland.

Cases of Libyostrongylus douglassii-associated proventriculitis in an adult female ostrich and two ostrich chicks occurring on two farms in different federal states of Germany are described. The adult bird was recently bought and kept under quarantaine conditions without contact to other animals of the herd. Without developing clinical signs of illness, the animal died. At necropsy, typical lesions of wireworm infection were found. The lining of the stomach had a moth-eaten appearance. Massive amounts of adult stages of trichostrongyloid nematodes were diagnosed in histological specimens of the proventricular mucosa and under the koilin layer of the ventriculus. The worms were isolated from the proventriculus and identified as L. douglassii. The feces of the bird contained high amounts of typical eggs of the worms with a medium size of approximately 70 x 40 microm. A polyphasic degeneration of heart and skeletal muscle was diagnosed in addition to the wireworm infection and interpreted to be a result of a malnutrition (Vit. E-/selenium deficiency). The ostrich chicks were reared on another farm and submitted for necropsy because of high mortality (8 out of 12 chicks died). A massive invasion of the proventricular mucosa with L. douglassi was macroscopically and histologically detected at necropsy of the anemic birds.

[Chlamydial diseases of domestic animals--zoonotic potential of the agents and diagnostic issues]. / Chlamydienerkrankungen der Nutz- und Haustiere--Zoonotisches Potential der Erreger und diagnostische Fragen.

The role of chlamydiae as agents of a number of important animal and human diseases is still the subject of intensive research. Recently, a proposal for taxonomic reclassification of this group of obligate intracellular bacteria was published, which was based on a large amount of new data on genetic relatedness. According to this proposal, the family Chlamydiaceae now comprises two genera (Chlamydia and Chlamydophila) with 9 largely host-related species. The previously accepted classification scheme had distinguished 4 species within the genus Chlamydia. The most important animal chlamydiosis with zoonotic character is psittacosis, a systemic disease in psittacine birds of acute, protracted, chronic or subclinical manifestation. The analogous infection in domestic and wild fowl is known as ornithosis. Avian strains of C. psittaci (new classification: Chlamydophila psittaci) can also infect humans, the symptoms being mainly unspecific and influenza-like, but severe pneumonia, endocarditis and encephalitis are also known. The main group of persons facing an elevated risk of infection includes those having frequent contact with domestic and companion birds at work or in their spare time. In Germany, the annual average of notified cases is approximately 100. Cases of transmission to humans were repeatedly reported in connection with enzootic abortion in sheep (causative agent: C. psittaci or Chlamydophila abortus, respectively). Various chlamydial species occur as pathogens and commensals as well in cattle, pigs, horses, and cats. The assessment of the actual epidemiological importance is, however, often difficult because of their almost ubiquitous spread. Likewise, those strains of C. pneumoniae (new classification: Chlamydophila pneumoniae) found in several animal species can not yet be assessed for pathogenic properties. The possibilities for diagnostic detection of chlamydiae have considerably improved following the introduction of molecular methods, particularly the polymerase chain reaction (PCR), which permits direct identification from clinical specimens and differentiation of species.

Genetic characterization of a Chlamydophila pneumoniae isolate from an African frog and comparison to currently accepted biovars.

The amphibian isolate DE177 identified as Chlamydophila (C.) pneumoniae was sequenced in five genomic regions: 16S ribosomal RNA gene, 16-23S intergenic spacer, ompA, ompB, and groESL genes. Comparison with corresponding sequences of the currently accepted equine, human and koala biovars of C. pneumoniae revealed that koala strains represented the most closely related taxon, although sequence dissimilarities in the ompA (VD4) and ompB gene regions were noted. In this respect, the present isolate is distinct from a previously described frog isolate (Berger et al., 1999) whose sequence analysis yielded identity to the koala biovar. As three of the nucleotide substitutions in ompA (VD4) of DE177 will be translated into two altered amino acids the possible existence of another biovar is discussed.

Idiopathic megarectum complicating pregnancy: report of a case.

Pregnancy often exacerbates constipation in young women with chronic constipation syndromes. The presence of the fetus presents a challenge in both the diagnosis and treatment of these syndromes. This study was conducted to report a rare case of idiopathic megarectum complicating a pregnancy. An aggressive polyethylene glycol (PEG) regimen allowed the patient to carry the child to term and to have a normal vaginal delivery. Successful proctocolectomy was performed with coloanal anastomosis 3 months postpartum. The patient has been free of constipation for 18 months without the need for cathartics or laxatives. All efforts to avoid operative intervention should be made in constipated patients during pregnancy. This principle holds true even in the setting of dilated large bowel. Idiopathic megarectum and the management of constipation in pregnancy are discussed.

Clostridium difficile toxins influence hepatocyte protein synthesis through the interleukin 1 receptor.

HYPOTHESIS: Clostridium difficile toxins require interleukin 1 (IL-1) production or a functioning IL-1 receptor to elicit acute-phase protein production by murine hepatocytes. DESIGN: Experimental study. SETTING: Research laboratory at the DVA Medical Center, St Louis, Mo. CELLS STUDIED: Hepatocytes prepared from normal mice, from knockout mice deficient in IL-1 production due to loss of IL-1 converting enzyme, or from knockout mice deficient in the IL-1 p80 receptor. INTERVENTIONS: Cells were treated with lipopolysaccharide, a crude C difficile toxin extract, or purified C difficile toxins A or B for 24 hours in vitro, then radiolabeled with (35)S methionine. Newly synthesized acute-phase proteins were identified by electrophoresis and autoradiography. MAIN OUTCOME MEASURES: Synthesis of a 23-kd acute-phase protein in response to the various stimuli. RESULTS: Lipopolysaccharide, C difficile culture extract, and purified toxins A and B stimulated the synthesis of the 23-kd acute-phase protein by hepatocytes from normal mice and by hepatocytes from knockout mice deficient in the IL-1 converting enzyme. However, hepatocytes from knockout mice deficient in the IL-1 p80 receptor failed to produce this acute-phase protein when treated with the C difficile toxins, although they responded fully to lipopolysaccharide. CONCLUSIONS: Stimulation of acute-phase protein synthesis by C difficile toxins does not require IL-1 production, but does require a functioning IL-1 p80 receptor. This suggests that some of the actions of these toxins are mediated by this receptor.

Sigmoid volvulus in Department of Veterans Affairs Medical Centers.

PURPOSE: Sigmoid volvulus is the third leading cause of large-bowel obstruction. The optimal management strategy remains controversial. This study was undertaken to evaluate the care of patients with sigmoid volvulus recently treated at Department of Veterans Affairs hospitals. METHODS: All patients with the International Classification of Diseases, Ninth Revision, Clinical Modification, Third Edition code for colonic volvulus during the period 1991 to 1995 were identified in the computerized national Department of Veterans Affairs database. Data on patient demographics, clinical course, and outcomes were analyzed. RESULTS: Two hundred twenty-eight patients had volvulus of the sigmoid colon and sufficient clinical data for evaluation. The mean age was 70; all were males. Endoscopic decompression was attempted in 189 of 228 (83 percent) patients and was successful in 154 of 189 (81 percent). Management included celiotomy in 178 of 228 (78 percent) patients. There were no intraoperative deaths. Twenty-five of 178 (14 percent) patients died within 30 days of surgery. The mortality rate was 24 percent for emergency operations (19/79), and 6 percent for elective procedures (6/99). Mortality was correlated with emergent surgery (P < 0.01) and necrotic colon (P < 0.05). Among those 50 patients managed by decompression alone, six (12 percent) died during the index admission. Ten of the remaining 44 (23 percent) patients eventually developed recurrent volvulus requiring further treatment, and 2 of 10 (20 percent) patients died. CONCLUSIONS: In this cohort sigmoid volvulus often presents as a surgical emergency. Initial endoscopic decompression resolves the acute obstruction in the majority of cases. Surgical intervention carries a substantial risk of mortality, particularly in the setting of emergent surgery or in the presence of necrotic colon.

Role of cytosolic phospholipase A2 in cytokine-stimulated prostaglandin release by human gallbladder cells.

Eicosanoids are involved in gallbladder inflammation, epithelial water transport, and mucous secretion. Phospholipase Asubscript2 enzymes liberate arachidonic acid from membrane phospholipids for the synthesis of eicosanoids. The purpose of this study was to determine the effect of selective cytoplasmic and secretory phospholipase A2 inhibitors on basal and stimulated arachidonic acid and prostaglandin E2 release in gallbladder cells. Western immunoblotting was employed to evaluate both cytosolic and secretory phospholipase A2 enzymes in human gallbladder cells. Cells were incubated for 22 hours with (3)H-labeled arachidonic acid. Arachidonic acid and prostaglandin E2 release was then measured in the supernate after 2 hours of exposure to human interleukin-1beta, alone or after pretreatment for 1 hour with the inhibitors. Unstimulated gallbladder cells express both 85 kDa cytosolic and 14 kDa secretory phospholipase A2++. The 85 kDa phospholipase A2 was induced by interleukin-1beta, whereas there was no apparent change in secretory phospholipase A2 enzyme concentrations. Both the secretory phospholipase A2 inhibitor p-bromophenylacyl bromide and the cytosolic phospholipase A2 inhibitor arachidonyl trifluoromethyl ketone decreased basal and interleukin-1beta-stimulated arachidonic acid release. In contrast, only inhibition of cytosolic phospholipase A2 led to a decrease in interleukin-1beta-stimulated prostaglandin E2 release. Basal and interleukin-1beta-stimulated arachidonic acid release appears to be the result of the activity of both cytosolic and secretory phospholipase A2. Interleukin-1beta-stimulated prostaglandin E2 release appears to be dependent on the activity of cytosolic phospholipase A2.

Clostridium difficile toxin: cytoskeletal changes and lactate dehydrogenase release in hepatocytes.

BACKGROUND: We have found that Clostridium difficile toxins can evoke hepatocyte acute-phase protein synthesis, and that this effect is dependent on a functioning interleukin-1 (IL-1) receptor. The present study was undertaken to determine if C. difficile toxicity, as determined by actin rearrangement and lactate dehydrogenase (LDH) release, also requires a functioning IL-1 receptor. METHODS: Primary hepatocyte cultures were prepared from normal mice, knockout mice deficient in the IL-1-converting enzyme (ICE), and knockout mice deficient in the IL-1 p80 receptor. Hepatocytes were treated for 24 h with C. difficile culture extract, purified C. difficile toxin A, or purified C. difficile toxin B. The actin cytoskeleton was examined using confocal microscopy, and LDH release was measured by spectrophotometric analysis. RESULTS: C. difficile culture extract, toxin A, and toxin B induced collapse of the actin cytoskeleton in hepatocytes from normal mice. Hepatocytes from both the ICE-deficient mice and the IL-1 p80 receptor-deficient mice demonstrated similar responses to both toxins. These toxins also induced significant LDH release in a concentration-dependent fashion in the normal hepatocytes and the ICE-deficient hepatocytes. However, no significant increase in LDH release was observed in hepatocytes from IL-1 p80 receptor-deficient mice. CONCLUSIONS: C. difficile toxins induce actin cytoskeletal collapse independent of IL-1 or the IL-1 receptor. In contrast, toxin-stimulated LDH release was dependent on the presence of the IL-1 receptor. Thus, separate pathways appear to mediate toxic effects as manifested by actin rearrangement and LDH release.

The effect of phospholipase A2 inhibitors on proliferation and apoptosis of murine intestinal cells.

BACKGROUND: Group II phospholipase A2 (PLA2) enzymes, the rate controlling enzymes in arachidonic acid metabolism, have been well characterized and subdivided into secretory 14-kDa PLA2 (sPLA2) and cytoplasmic 85-kDa PLA2 (cPLA2). Previous research has demonstrated increased PLA2 in colorectal tumors. The present study was performed to determine the effect of specific PLA2 inhibitors on the proliferation and induction of apoptosis of intestinal epithelial cells. METHODS: A continuously proliferating rat small intestinal cell line (IEC-18) and a mouse colon cancer cell line (WB-2054-M4) were utilized for these experiments. The cells were placed in microwells with serum-free or serum-supplemented media. The effects of serum on proliferation were then evaluated in the presence of the cPLA2 inhibitor, methylarachidonyl fluorophosphate (MAFP), or the sPLA2 inhibitor p-bromophenacyl bromide (BPB). The sPLA2 and cPLA2 protein was estimated by Western blotting. Proliferation of intestinal cells was quantitated by incorporation of [3H]thymidine into DNA and PLA2 activity was evaluated by quantitating arachidonic acid formation and prostaglandin E2 production. RESULTS: Western blotting of IEC-18 and WB-2054 cell protein demonstrated sPLA2 and cPLA2 enzyme in cells incubated in media containing 10% serum. Spontaneous DNA synthesis was present in both cell lines and serum consistently increased proliferation. In IEC-18 cells [3H]thymidine incorporation stimulated by serum was inhibited by MAFP and BPB, while in the malignant cell line, proliferation was inhibited only by BPB. BPB, but not MAFP, produced a dose-dependent increase in apoptotic ratios in both cell lines. Arachidonic acid and PGE2 formation, stimulated by serum, was inhibited by MAFP and BPB. CONCLUSIONS: A differential effect on intestinal cell mitogenesis was seen with different PLA2 inhibitors. The sPLA2 inhibitor, but not the cPLA2 inhibitor, significantly inhibited [3H]thymidine incorporation in the malignant cell line. This occurred with an induction of apoptosis. sPLA2 inhibitors may be specific inhibitors of growth of malignant cells. The inhibition of arachidonic acid and PGE2 production did not correlate with the inhibition of proliferation, suggesting that the two processes may be unrelated.

Eagle's syndrome: a case report.

The authors analyzed, through a review of the literature, Eagle's Syndrome which is a complex entity which presents common symptoms varying from an aching sensation in the throat to dysphagia and pain when rotating the head. Diagnosis and treatment are the main topics discussed relative to this abnormality which involves the styloid/stylohyoid complex. A case report is presented of a woman, aged 52, who submitted to surgical treatment using an extraoral approach for removal of the elongated styloid process to illustrate and facilitate the explanation of Eagle's Syndrome, including its manifestations and proper treatment.

[Protein patterns of Pasteurella multocida strains in relation to the animal host and the geographic site of isolation]. / Proteinmustertypen von Pasteurella multocida in Abhängigkeit von der Herkunft der Stämme bezüglich Tierart und geographischer Lage der Bestände.

Protein patterns from 681 Pasteurella multocida strains of different animal species and distinct geographical regions were analyzed by PAGE. We found 9 protein types taking the most intense band as reference. This band represents a protein of the outer membrane (OMP). In assigning the strains to protein types a relation to animal hosts of the strains was established. The majority of isolates from rabbits (88%) belongs to type P6, which is not found in strains isolated from cattle or pigs. Strains from pigs did not include the protein types P2, P4 and P8, in cattle strains type P9 was absent. The distribution of protein types in bovine isolates was shown to be related to the geographical location. The results are discussed with particular emphasis on immuno-prophylaxis. It appears promising to develop P. m. vaccines specific for certain animal species.

Polycystic liver disease, complicated by Salmonella infection.

BACKGROUND: Polycystic liver disease is a relatively uncommon congenital condition. Infections of these cysts do occur, but there are no reports of salmonella as the aetiologic agent. Salmonellosis, complicating hydatid disease of the liver has been described. CASE: A patient with a long-standing polycystic liver disease suddenly developed an infection of one of the cysts, caused by Salmonella javiana. Under sonographic guidance a percutaneous drain was inserted into the cyst, followed by systemic antibiotic treatment and, later, intracystic instillation of tetracycline. CONCLUSION: The sclerosing treatment was successful, thus preventing laparotomy.

Decreased bone mineral density in patients with pustulosis palmaris et plantaris.

BACKGROUND: Focal skeletal changes in patients with pustulosis palmaris et plantaris (PPP) are known to occur in a minority of patients. It is unknown whether these changes are unique events or whether they merely represent more progressed cases. OBJECTIVE: The study was undertaken in order to investigate possible diffuse bone changes in patients with PPP. METHODS: Bone mineral density (BMD) and biochemical markers of bone turnover were studied in 18 female patients and 18 age-matched controls. RESULTS: A significant correlation was found between lower-forearm BMD and disease duration (< 0.05). With increasing age, patients had significantly lower values than controls for both forearm and spine BMD (p < 0.005); patients who had PPP for more than 2 years had significantly reduced forearm BMD (19.8%; 95% CI: 5.6-32.8%) and spine BMD (17.4%; 95% CI: 0.9-33.8%). No significant differences were observed in biochemical markers of bone turnover, physical activity or body mass index between patients and controls. The proportion of smokers among patients was four times higher than among controls (p < 0.0005). No significant dose effect was found between number of pack-years and BMD. CONCLUSION: Although we cannot exclude that prolonged use of topical steroids under occlusion is a confounding factor, the study suggests that PPP patients have decreased BMD due to primary pathogenic events, and that osteoporosis may be an additional problem for these patients.