Cervical spine fractures associated with maxillofacial trauma: A 3-year-long study in the Greek population.

BACKGROUND: Maxillofacial fractures have been recognized as high risk trauma for concomitant cervical spine or spinal cord injury. OBJECTIVE: To investigate the incidence of concomitant cervical spine fractures (CSF) in patients with maxillofacial trauma and elucidate their relationship, guiding diagnosis and pointing their implications in maxillofacial trauma repair. MATERIAL AND METHODS: An analysis of 432 patients with maxillofacial fractures, treated at the Department of Oral and Maxillofacial Surgery of the "KAT" General Hospital of Attica during a three-year-long period, was conducted to investigate concomitant CSF. RESULTS: 22 patients or 5.1% (14 male/8 female, mean age 39.81 years) sustained a total of 29 concomitant CSF. In 77.3% of the cases the injury mechanism was motor vehicle accidents. The most frequent levels of CSF were C6-C7 (55.17%) and C1-C2 (27.58%). Regarding the type/site of maxillofacial fractures, 5 patients (22.73%) had sustained isolated zygomatoorbital, 5 (22.73%) isolated mandibular and 12 (54.54%) combined fractures. Concomitant injuries (i.e. intracranial hemorrhage, cerebral concussion, etc) were registered in 14 patients; additional thoracic/lumbar spine fractures in 5. Hospital stay ranged from 6 to 86 days (mean 27.6 days). CONCLUSIONS: Maxillofacial surgeons should be aware of the relationship between CSF and maxillofacial fractures, having implications in their patients' treatment.

Primary prostatic lymphoma with components of both diffuse large B-cell lymphoma (DLBCL) and MALT lymphoma.

Although lymphomas involving the prostate gland are rare, they should always be considered in the differential diagnosis. We report a case of primary prostatic NHL in a 70-year-old man presented with hematuria and urinary obstructive symptoms. Routine laboratory tests were within normal limits and prostate-specific antigen (PSA) was 0,01 ng/ml. The patient underwent radical prostatectomy. Histologically, two different coexisting patterns of non-Hodgkin lymphoma, infiltrating the prostatic tissue, were identified. The diagnosis of diffuse large B-cell lymphoma (DLBCL) presenting with an associated low-grade lymphoma of MALT-type was confirmed by immunohistochemistry. The patient received chemotherapy without any complication and has been followed-up for 2 years since surgical resection with no recurrence. The clinicopathologic characteristics of prostatic lymphomas are discussed, while reviewing the current English-language literature.

Mandibular bone density and calcium content affected by different kind of stress in mice.

OBJECTIVES: Stress is considered to affect many body and mental functions. This leads to activation of the hypothalamic-pituitary-adrenal axis and the adrenomedullary sympathetic system resulting to increased glucocorticoid release. Corticosteroids are known to cause systemic bone loss. The aim of the study was to investigate the role of different kinds of stress on the mandible bone mass of Wistar mice. METHODS: 75 male Wistar mice were divided into three groups (n=25 each). The animals of group C were submitted to stress by electroshock with 22-45 volts for a duration of 4 seconds each minute for one hour each day. Group B was submitted to isolation stress and group A was the control group. The duration of the experiment was 137 days. RESULTS: The adrenals weight was increased (group C vs group A, p<0.001; group B vs group A p<0.05), while urine hydroxyproline was reduced under stress. The calcium content of the mandible and the ratio between calcium content and mandible volume was decreased (p<0.05 for both groups). CONCLUSIONS: Mandibular bone mass was affected by different kinds of stress and may represent a considerable parameter for the diagnosis, prevention and treatment of bone mass deficiency.

Prognostic significance of p53 and Ki67 proteins expression in Greek gastric cancer patients.

AIM: The variability of prognosis of gastric cancer (GC) within a pathological stage necessitates the identification of subgroups of patients with a more aggressive disease. The role of p53 and Ki67 expression in gastric carcinoma is far from being fully established. The aim of the present study was to evaluate the expression of p53 and Ki67 in gastric cancer and correlate the findings with several clinicopathological features and prognosis. MATERIALS AND METHODS: Tissue samples from 93 patients treated by gastric resection for gastric carcinoma between 1996 and 2001 were used. Formalin-fixed paraffin-embedded tumors were studied by immunohistochemistry, using monoclonal antibodies to p53 and Ki67. The results were correlated with clinicopathological features and survival. RESULTS: Stronger expression of p53 was related with tumor size greater than 5 cm and advanced stage. Stronger expression of Ki67 correlated with higher ratio of the number of metastatic lymph nodes to the total number of dissected lymph nodes (metastatic lymph node [MLN] ratio) and advanced stage. Moreover, p53 and Ki67 overexpression, tumor size greater than 5 cm, MLN ratio, depth of invasion, lymph node metastasis, stage III and IV and infiltrative macroscopic appearance were adverse prognostic factors. The levels of p53 and Ki67, the MLN ratio, the tumor size (above 5 cm) and the stage of the disease were identified as independent prognostic factors of survival. CONCLUSIONS: In gastric cancer, the expression of p53 and Ki67 provides significant information about prognosis. The routine evaluation of p53 and Ki67 levels could be a useful tool in identification of patient with more aggressive disease and contribute to a better therapeutic approach.

CD8+ lymphocytes/ tumour-budding index: an independent prognostic factor representing a 'pro-/anti-tumour' approach to tumour host interaction in colorectal cancer.

BACKGROUND: The tumour-host interaction at the invasive front of colorectal cancer, including the epithelial-mesenchymal transition and its hallmark 'tumour budding', is an important area of investigation in terms of prognosis. The aim of this study was to determine the prognostic impact of a 'pro-/anti-tumour' approach defined by an established 'pro-tumour' (tumour budding) and host-related 'anti-tumour' factor of the adaptive immunological microenvironment (CD8+ lymphocytes). METHODS: Double immunostaining for CK22/CD8 on whole tissue sections (n=279; Cohort 1) and immunohistochemistry for CD8+ using tissue microarrays (n=191; Cohort 2) was carried out. Tumour buds, CD8+ and CD8+ T-lymphocytes : tumour buds indices were evaluated per high-power field. RESULTS: In Cohort 1, a low-CD8+/ buds index was associated with lymph node metastasis (P<0.001), vascular invasion (P=0.009), worse survival in univariate (P<0.001) and multivariable (P<0.001) analysis, and furthermore in lymph node-negative patients (P=0.002). In Cohort 2, the CD8+/ buds index was associated with T stage (P<0.001), N stage (P=0.041), vascular invasion (P=0.005) and survival in patients with TNM stage II (P=0.019), stage III (P=0.004), and adjuvantly untreated (P=0.009) and treated patients (P<0.001). CONCLUSION: The CD8+ lymphocyte : tumour-budding index is an independent prognostic factor in colorectal cancer and a promising approach for a future prognostic score for patients with this disease.

Mandibular bone density and calcium content affected by long-term anticonvulsant treatment in rats.

OBJECTIVE: Bone is perpetually absorbed and reformed, serving also to electrolyte homeostasis, mainly for calcium and phosphorus. Anticonvulsant medications are traditionally considered harmful to bone because of their interaction with the metabolism of vitamin D, due to hepatic enzyme induction. A study of the effect of anticonvulsant medications on mandibular bone quality was undertaken. MATERIALS AND METHODS: 24 Wistar rats in three groups received diphenylhydantoin or diazepam or placebo intraperitoneally (i.p.). Absolute bone weight, bone to body weight ratio, specific bone weight, absolute calcium concentration, calcium to mandibular bone weight ratio and mineral element concentration were examined after animal sacrifice, three months later. From the results it may be concluded that diazepam and diphenylhydantoin administration affect the mandibular bone density and calcium content in terms of absolute weight and specific weight. Mandibular calcium concentration was affected only by diphenhylhydantoin treatment.

Injuries to the head and neck in Homer's Iliad.

We have found and reported on all injuries to the head and neck described in Homer's Iliad, and give several particularly graphic examples.

Impact of experimental trauma and niflumic acid administration on antimicrobials' concentration in serum and mandible of rats.

Administration of antibiotics and analgesics in surgery or trauma is of great importance for an effective treatment. Trauma, as stress stimulus, causes alterations in various functions of the organism as well as in drug pharmacokinetics. The aim of this study was to determine the effect of trauma upon the serum and bone levels of the antimicrobial ampicillin and cefapirin, with and without co-administration of a non-steroidal anti-inflammatory analgesic (NSAIDs). Fifty-six male Wistar rats were divided into two groups A (control) and B (experimental). Each group consisted of 4 subgroups (n=7) receiving ampicillin, ampicillin with niflunic acid, cefapirin, and cefapirin with niflunic acid. In group B traumatic injury was performed by incision (7 mm length) in the right cheek. The levels of the antibiotics were estimated by the inhibition zone of B. subtilis. An increase in antibiotic levels was observed in group B, being statistically significant only for cefapirin level in the mandible. Upon niflumic acid co-administration a statistically significant rise in serum ampicillin and mandible cefapirin levels was observed in both control and experimental groups (student t-test). It can be concluded that the combination of antibiotics and non-steroid antiinflammatory drugs (NSAIDs) may enhance the antibacterial drug concentration.

Ketamine-induced changes in metabolic and endocrine parameters of normal and 2-kidney 1-clip rats.

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the effect of ketamine on the endocrine and lipid metabolic status of the renal-banded animals. METHODS: Forty male rats were randomly divided into four groups. Group A served as control, Group B animals received ketamine intraperitoneally at a dose of 100 mg kg(-1), Group C was submitted to 2-kidney 1-clip experimental hypertension and Group D received ketamine as above, as well as being submitted to renal artery clipping. Atrial natriuretic peptide, angiotensin II and free fatty acid concentrations were measured in serum. In addition, adipose tissue lipoprotein lipase activity and angiotensin II content were determined, while the left ventricular weight relative to body weight was used as a cardiac hypertrophy index. RESULTS: In renal-banded rats (Groups C and D) serum atrial natriuretic peptide, free fatty acid and angiotensin II concentrations as well as ventricular weight were increased, while adipose tissue lipoprotein lipase activity was lower than in control animals (Groups A and B). Ketamine administration did not influence angiotensin II concentrations either in normal (Group B) or banded rats (Group D). Ketamine increased serum atrial natriuretic peptide and free fatty acid concentrations only in normal animals (Group B). It had no influence on adipose tissue lipoprotein lipase activity either in normal (Group B) or banded animals (Group D). Adipose angiotensin II content did not differ between the four groups. CONCLUSION: Ketamine increased the atrial natriuretic peptide and free fatty acid concentration in normal rats. In 2-kidney 1-clip animals, ketamine did not elicit an additional response of serum atrial natriuretic peptide or free fatty acids levels. Its contribution to these factors was not significant.

Adjuvant arthritis-induced changes on ampicillin binding in serum and tissues under the influence of non-steroidal anti-inflammatory drugs in rats.

Adjuvant arthritis, as a model for investigating rheumatoid arthritis (RA), is characterized by reduced plasma albumin levels and interferes with drug binding in the plasma and tissues (liver and bone). Ampicillin interacts with non-steroidal anti-inflammatory drugs (NSAIDs) due to the acidic pk(a). The aim of this study was to investigate in vitro the concentrations of ampicillin in the serum, femur, mandible and liver proteins following the co-administration of ketoprofen, flurbiprofen, ibuprofen, oxyphenbutazone and ASA in adjuvant arthritis versus healthy control rats. Ampicillin binding was found to be reduced in the serum of arthritic rats, and ampicillin binding to serum proteins was also reduced under the influence of NSAIDs in the control animals. Differences in ampicillin binding were observed in the various tissues due to the effect of adjuvant arthritis as well as that due to the co-administration of NSAIDs. In conclusion, this in vitro study may provide a plausible explanation for the ampicillin-NSAIDs interaction and such a finding may be of therapeutic significance in the treatment of painful arthritic disease such as RA.

Regulation of nitric oxide production in limb and ventilatory muscles during chronic exercise training.

In this study, we evaluated the differential influence of chronic treadmill training (30 m/min, 15% incline, 1 h/day, 5 days/wk) on nitric oxide (NO) production and NO synthase (NOS) isoform expression as well as 3-nitrotyrosine formation (footprint of peroxynitrite) both in limb (gastrocnemius) and ventilatory (diaphragm) muscles. A group of exercise-trained rats and a control group (no training) were examined after a 4-wk experimental period. Exercise training elicited an approximate fourfold rise in gastrocnemius NOS activity and augmented protein expression of the endothelial (eNOS) and neuronal (nNOS) isoforms of NOS to approximately 480% and 240%, respectively. Qualitatively similar but quantitatively smaller elevations in NOS activity and eNOS and nNOS expression were observed in the diaphragm. No detectable inducible NOS (iNOS) protein expression was found in any of the muscle samples. Training increased the intensity of 3-nitrotyrosine only in the gastrocnemius muscle. We conclude that whole body exercise training enhances both limb and ventilatory muscle NO production and that constitutive and not iNOS isoforms are responsible for increased protein tyrosine nitration in trained limb muscles.

Embolization for the treatment of pseudoaneurysm and transection of facial vessels.

Transection of the facial and the internal maxillary arteries while routine operations were performed was the cause of uncontrolled bleeding and a pseudoaneurysm. We present a study of the mechanisms that create and the means that control hemorrhage and pseudoaneurysms in the maxillofacial region.

An audit of mandibular fractures treated by intermaxillary fixation, intraosseous wiring and compression plating.

As the principles of rigid internal fixation and compression osteosynthesis were adopted by maxillofacial surgeons during recent years the time-honoured methods of intermaxillary fixation and intraosseous wiring have gradually been abandoned. We have reviewed our cases of mandibular fractures operated on in recent years and the changing trends in treatment.

Mandibular fractures treated by bone plating and intraosseous wiring. A comparative study.

We studied 79 cases of mandibular fractures treated with bone plates and 79 cases treated with intraosseous wiring. We encountered 3.8% major and 9% minor complications in the first group and 2.6% major and 31% minor complications in the second group. Bone plates were used in more complicated cases such as comminuted and infected fractures. It is our opinion that internal rigid fixation is a promising method of treating fractures of the facial skeleton, which is better tolerated by the patient but requires a certain experience.

Complications associated with rigid internal fixation of facial bone fractures.

Rigid internal fixation is now a common method for treating fractures of the facial skeleton. However, it is a very precise technique that requires more time than intraosseous wiring. This article reports the complications associated with rigid internal fixation of facial fractures in 223 patients and compares the findings with those accompanying intraosseous wiring.

Phleboliths. A report of three unusual cases.

Phleboliths are well established pathological entities that are often associated with vascular lesions. Three cases are reported in which no vascular malformation was detected.

The normal range of mouth opening.

The maximal mouth opening of 1,160 healthy Greek adults, 18 to 70 years old, was measured. The results were similar to those reported by investigators in other countries.