Maxillofacial fibro-osseous lesions.

During the last decade much has changed in our understanding of fibro-osseous lesions (FOLs) of the jaws with regards to their imaging, their nomenclature and classification, and their potential impact on the overall health of the patient. The changes in nomenclature, classification, and the FOLs' potential association with important syndromes are discussed with the assistance of a flowchart. The lesions, fibrous dysplasia (FD), ossifying fibroma (OF), and osseous dysplasia (OD), though with similar histopathology, have very different clinical and radiological presentations, behaviour, and treatment outcomes. FD of the jaw, which though becoming inactive, does not involute and therefore requires life-long review to monitor for occasional reactivation. OF is completely removed surgically as it has a propensity to recur. No treatment is generally required for an OD unless it is infected or displays expansion. Lesions outside the jaws associated with FOLs of the jaws are identified. Radiology remains central to the diagnosis of FOLs of the jaw, because the pathologist is still not able to distinguish between them. The advent of cone-beam computed tomography (CBCT) with its better radiation dose reduction, accessibility, and spatial resolution has transformed imaging of FOLs. Their presentations on CBCT and the clinical indications for its use are discussed.

Calcification of the external carotid arteries and their branches.

This patient had longstanding hypercalcaemia and hyperphosphataemia owing to chronic renal disease, then finally failure, inducing tertiary hyperparathyroidism. He also had long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. He then reported a painful expansile swelling of the anterior mandible which was diagnosed as a "brown tumour". Subsequent review of the CT data set by an oral and maxillofacial radiologist revealed two patterns of calcification of the carotid arteries. A pipestem pattern was observed bilaterally along almost the entire lengths of the external carotid artery, a muscular artery, and its branches whereas plaque-like calcification was observed in the common and internal carotid arteries (elastic arteries). The pipestem pattern, hitherto an unreported feature affecting the external carotid artery, may represent a metastatic calcified deposit owing to hypercalcaemia and hyperphosphataemia in the tunica media of muscular arteries, resulting in arteriosclerosis, which maintains a patent lumen. The plaque-like pattern is representative of lumen-occluding calcified atherosclerosis associated with the long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. As this patient did not have any symptoms and/or signs of myofacial pain, facial dysfunction or numbness, the calcification of his external carotid arteries and branches were considered as arteriosclerosis. The brown tumour responded to the parathyroidectomy and the renal transplant.

Influence of diurnal phase on startle response in adult rats exposed to dexamethasone in utero.

Depression and pathological anxiety disorders are among the most prevalent neurological diseases in the world and can be precipitated and exacerbated by stress. Prenatal stress alters both behavioral and endocrine responses to stressful stimuli in later life. We have previously observed increased basal acoustic startle response (ASR) in Wistar rats exposed to stress or dexamethasone (DEX) in utero when tested during the light phase of the circadian rhythm, and decreased prepulse inhibition (PPI) in similar animals tested during the dark phase of the cycle. We speculated that this observation of increased basal startle might be influenced by diurnal phase. In the present study, adult female Sprague Dawley rats, stressed prenatally with DEX (200 µg/kg, gestational days 14-21) and postnatally by blood sampling under restraint, were tested for the ASR during both circadian phases (light and dark). Basal startle was increased in animals tested both during the light and the dark phases of the cycle. We hereby replicated our earlier findings in a new strain and laboratory, thus strengthening the validity of our model regarding prenatal stress effects on ASR in female offspring. Our results indicate that observation of increased basal ASR is not solely dependent on diurnal phase. We found no difference in hippocampal glucocorticoid and mineral corticoid receptor expression between groups.

Modulation of NMDA receptors by pituitary adenylate cyclase activating peptide in CA1 neurons requires G alpha q, protein kinase C, and activation of Src.

At CA1 synapses, activation of NMDA receptors (NMDARs) is required for the induction of both long-term potentiation and depression. The basal level of activity of these receptors is controlled by converging cell signals from G-protein-coupled receptors and receptor tyrosine kinases. Pituitary adenylate cyclase activating peptide (PACAP) is implicated in the regulation of synaptic plasticity because it enhances NMDAR responses by stimulating Galphas-coupled receptors and protein kinase A (Yaka et al., 2003). However, the major hippocampal PACAP1 receptor (PAC1R) also signals via Galphaq subunits and protein kinase C (PKC). In CA1 neurons, we showed that PACAP38 (1 nM) enhanced synaptic NMDA, and evoked NMDAR, currents in isolated CA1 neurons via activation of the PAC1R, Galphaq, and PKC. The signaling was blocked by intracellular applications of the Src inhibitory peptide Src(40-58). Immunoblots confirmed that PACAP38 biochemically activates Src. A Galphaq pathway is responsible for this Src-dependent PACAP enhancement because it was attenuated in mice lacking expression of phospholipase C beta1, it was blocked by preventing elevations in intracellular Ca2+, and it was eliminated by inhibiting either PKC or cell adhesion kinase beta [CAKbeta or Pyk2 (proline rich tyrosine kinase 2)]. Peptides that mimic the binding sites for either Fyn or Src on receptor for activated C kinase-1 (RACK1) also enhanced NMDAR in CA1 neurons, but their effects were blocked by Src(40-58), implying that Src is the ultimate regulator of NMDARs. RACK1 serves as a hub for PKC, Fyn, and Src and facilitates the regulation of basal NMDAR activity in CA1 hippocampal neurons.

Notes on the socio-economic and cultural factors influencing the transmission of HIV in Botswana.

Botswana currently has one of the highest recorded incidences of HIV infection in Africa although AIDS was only first publicly recognized in 1985. By this time other countries in the region such as Malawi, Zambia and Uganda were already showing signs of epidemic levels of HIV. The rapid transmission of HIV in Botswana has been due to three main factors; the position of women in society, particularly their lack of power in negotiating sexual relationships: cultural attitudes to fertility; and social migration patterns. These three factors along with other, arguably more minor, ones have been shaped and mediated within the specific context of Botswana's rapid socio-economic development and cultural milieu. This has resulted in a constellation of factors unique to Botswana which accounts for the current high seroprevalence rate in the country.

Factors influencing the acceptance of family planning by blacks in Salisbury, Zimbabwe.

One hundred Black women aged between 16 and 45 years were interviewed in Salisbury, Zimbabwe, using an interview schedule. Respondents were divided into "acceptors" of family planning (48) and "resisters" (52). Tests of significance showed that important factors in the adoption or rejection of family planning are the number of years of schooling of the woman and her husband, the wife working outside the home, the women's age when first married and the death of a child. These findings are discussed and recommendations made to improve the situation of the future.

Beyond the hospital walls--a study of black patients after discharge from hospital.

Ninety-six patients were followed up in their homes 2 weeks, 3 months and 1 year after their discharge from hospital. Within 2 weeks of discharge from hospital, interviews could only be arranged with 80, 9 having died and 7 being untraceable at the given address. The characteristics of the patients, their living conditions, knowledge of their illness, general health and ability to work were noted on the first follow-up visit, and their general health and ability to work were reassessed on two subsequent occasions, by which time a further 8 and 7 had died. As a result of the survey, recommendations are made covering health information for patients and suitable follow-up procedures to ensure maximum benefit from hospitalization.