Quantitative PCR assay for Mycobacterium pseudoshottsii and Mycobacterium shottsii and application to environmental samples and fishes from the Chesapeake Bay.

Striped bass (Morone saxatilis) in the Chesapeake Bay are currently experiencing a very high prevalence of mycobacteriosis associated with newly described Mycobacterium species, Mycobacterium pseudoshottsii and M. shottsii. The ecology of these mycobacteria outside the striped bass host is currently unknown. In this work, we developed quantitative real-time PCR assays for M. pseudoshottsii and M. shottsii and applied these assays to DNA extracts from Chesapeake Bay water and sediment samples, as well as to tissues from two dominant prey of striped bass, Atlantic menhaden (Brevoortia tyrannus) and bay anchovy (Anchoa mitchilli). Mycobacterium pseudoshottsii was found to be ubiquitous in water samples from the main stem of the Chesapeake Bay and was also present in water and sediments from the Rappahannock River, Virginia. M. pseudoshottsii was also detected in menhaden and anchovy tissues. In contrast, M. shottsii was not detected in water, sediment, or prey fish tissues. In conjunction with its nonpigmented phenotype, which is frequently found in obligately pathogenic mycobacteria of humans, this pattern of occurrence suggests that M. shottsii may be an obligate pathogen of striped bass.

What are the primary concerns of recently graduated surgeons and how do they differ from those of the residency training years?

HYPOTHESIS: Graduated surgeons have differences in concerns when comparisons are made between fellows and practicing surgeons, practicing surgeons and residents, and male and female surgeons. DESIGN AND SETTING: A survey was distributed to surgeons who graduated from 17 New England residency programs from 1993 to 1996, consisting of 9 demographic questions and 33 items coded on a Likert-type scale (with scores from 1 [least concerning] to 5 [most concerning]). PARTICIPANTS: Surgical fellows and practicing surgeons recently graduated from general surgical residency programs in New England who had participated in a previous study as residents. INTERVENTION: Distribution and completion of the survey. MAIN OUTCOME MEASURE: Personal and career-oriented concerns of recently graduated surgical residents. RESULTS: Personal issues continue to rank high for graduated residents, but the areas of greatest concern became more financially and career oriented. The top concerns of fellows were personal finances (mean score, 3.2), child rearing (mean score, 3.1), salary (mean score, 3.1), postponing family plans (mean score, 3.0), availability of role models (mean score, 2.9), and number of work hours (mean score, 2.8). The top concerns of practicing surgeons were salary (mean score, 3.2), personal finances (mean score, 3.1), number of referrals (mean score, 3.0), support for research (mean score, 2.7), child rearing (mean score, 2.7), and availability of role models (mean score, 2.7). Differences existed between men and women for child rearing, initiating personal relationships, maintaining personal relationships, maternity leave, and promotional advancement. Women were more concerned than men. CONCLUSIONS: Assistance with career planning and job selection during the residency years should be enhanced to diminish the concerns about financial issues and the availability of role models after graduation. Many of the concerns among male and female graduates are still reflective of larger societal expectations, but some, such as promotional advancement, may be attenuated through guidance and mentoring of residents before job selection.

Intraindividual comparative animal study of alpha- and beta-tricalcium phosphate degradation in conjunction with simultaneous insertion of dental implants.

An intraindividual comparative study of proximal tibial marrow defects in nine adult Goettinger miniature pigs (GMPs) was undertaken. The left side of the defect was filled with granular beta-tricalcium phosphate (TCP) ceramic ad modum Cerasorb, and the right side was filled with granular alpha-TCP ceramic ad modum Biobase alpha pore. Simultaneously, dental screw implants were inserted in each ceramic and fixed within the orthotopically replanted corticalis lids. Control defects were made in two other animals. The survival period ranged from 4 to 86 weeks (control study, 16 and 20 weeks). The reorganization and degree of bone regeneration, dynamics of ceramic degradation, and remodeling characteristics of the bone regenerate referring to osseo-integration of the dental implants were examined histomorphologically in nondecalcified specimens. The results reveal that both ceramic types were osteoconductive exclusively. Centripetally oriented angiogene bone regeneration occurred at the margins of the circular defects. Ceramic degradation was performed hydrolytically and within cells. Furthermore, it was demonstrated that decomposition of the intratrabecularly integrated ceramic residues underlies a dynamic process of degradation. Within 86 weeks, nearly 80% to 90% of the larger alpha-TCP granules, and nearly 90% to 95% of the beta-TCP granules were degraded. At this time, especially for the alpha-TCP modification, ceramic microparticles were found in the marrow, either unbound or within polynuclear macrophages. The predictable degradation of both ceramic types provides an early functional adaptation of bone regenerates and facilitates a biofunctional, anisotropic orientation of the neotrabeculae without delay. It is concluded that because of the initially pronounced accumulation of macrophages, dental implants should not be inserted simultaneously with ceramic, but after further progress of ceramic degradation (5 to 6 months after TCP implantation).

The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery: a preliminary report.

PURPOSE: To describe the uses and determine the safety of a commercially available acellular dermal allograft in ophthalmic plastic and reconstructive surgery. The existing literature regarding current applications and results using acellular dermal allograft is reviewed. METHODS: The study design was a retrospective, noncomparative case series. Participants consisted of 63 consecutive patients undergoing ophthalmic plastic and reconstructive surgery using an acellular dermal matrix graft. The main intervention was placement of a dermal allograft. Outcome measures included the degree of clinical improvement and complications for each patient. RESULTS: We used AlloDerm (LifeCell Corporation, The Woodlands, TX, U.S.A.) as a posterior lamellar conjunctival spacer graft, a soft tissue interpositional graft, and an orbital implant wrapping material. Clinical improvement was noted in all cases. There were no complications attributable to the acellular dermal matrix material. CONCLUSIONS: We describe several novel ophthalmic plastic and reconstructive surgical applications using acellular dermal allograft tissue. This material may be used safely as a posterior lamellar conjunctival spacer graft, a soft tissue interpositional graft, and a wrapping material. Clinically, the allograft appears to be biocompatible, nontoxic, and nonallergenic in the orbit, eyelid, and midfacial tissues. Long-term data and studies comparing the efficacy of acellular dermal allograft with conventional materials are necessary.

Management of relative proptosis with a porous polyethylene orbital rim onlay implant.

PURPOSE: The position of the globe relative to the orbital rim plays a significant role in the relationship between the eyelids and the cornea. A prominent globe (relative proptosis) may cause eyelid retraction and exposure keratopathy. Simple horizontal lower eyelid tightening exacerbates eyelid retraction. Optimal correction with an orbital decompression or advancement of the orbital rim entails considerable risk. A technically simpler alternative, placement of an orbital rim onlay implant, was evaluated. METHODS: Fourteen patients with symptomatic relative proptosis underwent placement of a porous polyethylene orbital rim onlay implant. RESULTS: Lower eyelid position, exposure keratopathy, and ocular discomfort were improved in all patients. Two patients required minor surgical revisions. CONCLUSIONS: Porous polyethylene orbital rim onlay implants are a satisfactory option to treat the sequelae of relative proptosis.

Relationship of the eye to the bony orbit, with clinical correlations.

PURPOSE: To examine normal anatomic relationship of the globe to the bony orbit, and relate variations in this relationship to clinical parameters. METHODS: Seventy-nine axial and sagittal magnetic resonance imaging (MRI) scans of the globe and orbit were studied. Any patients with pathology, as reported by the radiologists' findings, were excluded. Measurements were made on the images to determine the position of the globe relative to the bony orbit and to describe the configuration of the anterior face of the maxillary sinus. Clinical measurements were performed on photographs of 36 patients who underwent MRI scans. An independent observer rated these photographs for two clinical findings: inferior scleral show and tear trough deformity. RESULTS: Correlations were found in the following sets of variables. (i) Corneal projection from infraorbital rim and corneal projection from lateral rim; (ii) corneal projection from supraorbital rim and corneal projection from lateral rim; (iii) scleral show and corneal projection from lateral orbital rim; and (iv) tear trough deformity rating and angle of anterior face of maxillary sinus. There were no significant correlations found in the other data variables. CONCLUSIONS: The data show that abnormal relationships between the globe and the bony orbit can have clinical consequences. Inferior scleral show is shown to be related to relative globe prominence, measured from either the lateral or the inferior orbital rims. The tear trough deformity is correlated with a sloping maxillary face. The results provide a rational basis for surgeries designed to normalize these relationships.

The endoscopic forehead lift.

Endoscopic techniques are being successfully applied to address eyebrow and forehead ptosis. The methods rely on extensive subperiosteal and subgaleal release of the forehead and scalp flap, allowing the elevation of soft tissues. Ablation of the depressor supercilli and procerus can be performed to address skin folding in the glabellar region. The mobilized frontotemporal flap is then elevated to the desired level and fixated with microscrews to the outer table of the skull. Laterally, the flap is fixed to the deep temporalis fascia. The technique relies upon a solid knowledge of the regional anatomy and the use of specialized instruments now available for dissecting under the flap. The endoscopic forehead lift can achieve results comparable to those obtained by the open coronal forehead lift while minimizing the incidence and extent of postoperative cutaneous anesthesia and telogenic hair loss, which frequently follows open coronal forehead surgery. In addition, the endoscopic technique is able to address eyebrow ptosis in the balding male without causing disfiguring scarring.

Orbital lesions in the blue rubber bleb nevus syndrome.

PURPOSE: To identify ophthalmologic manifestations of the blue rubber bleb nevus syndrome, a rare cutaneovisceral hemangiomatosis. METHODS: The authors report two patients with a diagnosis of blue rubber bleb nevus syndrome with orbital hemangiomas. RESULTS: In one patient, the orbital lesion presented with signs and symptoms similar to an orbital varix and in the other with lid ecchymosis from an eyelid lesion. CONCLUSION: Patients with the blue rubber bleb nevus syndrome may have vascular orbital lesions associated with intermittent proptosis. Ophthalmologists should be familiar with the syndrome and its life-threatening complication of gastrointestinal hemorrhage.

Adjustable suture technique for levator recession.

OBJECTIVE: To determine whether an adjustable suture technique is clinically useful in levator recession surgery. DESIGN: Consecutive clinical series. SETTING: Inpatient hospital and ambulatory surgical center. PARTICIPANTS: Ten patients who were undergoing levator recession surgical procedures for correction of eyelid retraction constituted the group of subjects of this study. OUTCOME MEASURES: Outcome measures included margin-reflex distance and palpebral fissure measurements. RESULTS: Postoperative margin-reflex distance and palpebral fissure measurements were within 0.5 mm of the desired eyelid position in 10 or 14 procedures and within 1 mm of the desired position in 12 of 14 procedures. CONCLUSION: Adjustable sutures may be a useful adjunct in levator recession surgery.

Rigid anchoring of the forehead to the frontal bone in endoscopic facelifting: a new technique.

A new method for internal fixation of the skull in endoscopic facelifting has been developed using a so-called V-tunnel drill system which eliminates the need for pins and screws to anchor the suspended forehead. This system consists of a conventional drill and a V-tunnel guide. The technique involves anchoring the scalp by means of galea/periosteal stitches and sewing it to the bone with PDS sutures after a V-shaped tunnel has been drilled in the external table to a depth of 5 mm. The sutures can be easily positioned and stitched through the V-tunnel without endangering the cerebrum. This versatile V-tunnel drill procedure is very easy and simple and has many foreseeable applications.

Significance of P-53 antigen in malignant melanomas and naevi of the head and neck area.

DO-7 antibody against p-53 antigen was applied for investigation of melanomas of facial skin (25 cases), oral cavity (17 cases), eye (18 cases) and naevi (25 cases). The p-53 index value (% of p-53 positive cells) was correlated with the thickness of the tumour, the presence of metastases and survival time. The difference in p-53 index between naevi and melanomas was statistically significant (p < < 0.01). A significant correlation was found between the p-53 index value and the thickness of the tumour, the presence of metastases and follow-up for patients with skin, oral and ocular melanomas. The possible diagnostic and prognostic significance of p-53 antigen in melanomas and naevi of the head and neck area is discussed.

An application of MIB antibody to the retrospective study of melanomas of oral mucosa and facial skin.

A new monoclonal antibody prepared against a fragment of Ki-67 antigen MIB, from Dianova, was applied for investigation of malignant melanomas of facial skin (25 cases) and the oral cavity (25 cases), which were routinely embedded in paraffin. The values of the Ki-67 index (expressed as a percentage of positive nuclei) were correlated with TNM characteristics of tumors and patient survival. Significant correlation was found between the Ki-67 index and the level of lymph node involvement (N value), the presence of distant metastases and the time of patient survival. A positive relationship between the Ki-67 value and tumor size was also observed although it lacked statistical significance.

Radiological survey of the cervical spine in cleft lip and palate.

Cleft lip and palate is known to be associated with a number of other skeletal anomalies. The purpose of this study was to investigate the prevalence of possible malformations of the cervical spine and their relationship to velopharyngeal incompetence. The lateral cephalometric radiographs of 30 patients aged between 14 and 27 years of age with cleft lip and palate were compared with these of a control group, who had been involved in cycle accidents. The radiographs were assessed for morphological anomalies of the first and second cervical vertebrate and, in addition, longitudinal and angular measurements performed. Speech was assessed by electromagnetic articulography. A greater number of cervical spine anomalies were found in patients with cleft lip and palate and these were also associated with significantly (P < 0.05) greater osseous-nasopharyngeal depth.

Measurement of interleukin 1 alpha and 1 beta (IL-1 alpha and IL-1 beta) in human cystic lesions of the jaw. Implications for the pathogenesis of radicular cysts.

Human radicular cystic tissue of jaws was found to contain between 0.823 pg/mg to 18.026 pg/mg interleukin 1 beta and from 0.34 pg/mg to 0.708 pg/mg interleukin 1 alpha. No IL-1 beta and alpha could be found in specimens from healthy patients. A finding which may be extremely relevant in cystic growth and episodes of alveolar bone resorption around the cystic lesion.

A rare case of atlanto-axial fusion with dysplasia of odontoid peg in a cleft lip and palate patient.

A case of a 19-year-old female with atlanto-axial fusion and dysplasia of odontoid peg in a cleft lip and palate patient is described. Schematic drawings from radiographs were taken to compare six earlier reported cases of anterior atlas arch fusions with epistropheus including dysplasia or aplasia of odontoid peg from literature.