Case report of recurrent temporomandibular joint open lock associated with abrupt reduction of displaced articular disk.

PATIENT: This report describes the case of a 51-year-old male patient who initially presented at age 23 with a habitual intermittent open lock (at >35mm) in the left temporomandibular joint (TMJ). The patient was able to manage this affliction through rapid-repetition jaw opening and closing. Tomography of the joint showed no irregular morphology, but intraoral examination revealed an occlusal interference at the mandibular left third molar during leftwards excursion. For this patient, alteration of lateral guidance using a palatal plate attached to the maxillary left canine precluded this intermittent open lock, but at 22 years of age, the open lock recurred and could not be relieved by the patient, who was unable to assume an occlusal position. Because conservative treatment was ineffective, a pumping manipulation technique was applied to reduce the open lock, after which the patient has maintained good jaw function. MRI taken before and after repositioning indicated that abrupt reduction of a displaced articular disk was the cause of the open lock, and that this articular disk was restored to its proper position during the manipulation. DISCUSSION: Most TMJ open locks occur as anterior dislocation, where the mandibular head becomes trapped anterior to the articular eminences, causing excessive opening and difficulty closing. Our clinical findings from this patient indicate that open lock can occur through abrupt reduction of a displaced articular disk, particularly in patients with chronic internal derangement of the TMJ. CONCLUSION: TMJ open lock can occur following abrupt reduction of a displaced articular disk.

Effect of dalteparin, a low-molecular-weight heparin, as adjunctive therapy in patients with Kawasaki disease: a retrospective study.

BACKGROUND: Dalteparin, a low-molecular-weight heparin, has anticoagulant and anti-angiogenic activity. This study investigated whether dalteparin reduced coronary artery lesion (CAL) prevalence, and resistance to intravenous immunoglobulin (IVIG) therapy in Kawasaki disease (KD). METHODS: This retrospective study comprised two parts. In the first cohort, 126 patients with KD (68 male, 58 female; median age: 22 months, range: 1-67 months) admitted to Nihon University Nerima-Hikarigaoka Hospital from January 2004 to June 2008, received either dalteparin 75 IU/kg/day, IVIG 400 mg/kg/day for 5 consecutive days, and aspirin 30 mg/kg/day, or dalteparin 75 IU/kg/day and aspirin 30 mg/kg/day, until clinical improvement. Control data came from the 2005-6 Nationwide KD survey. In the second cohort, 112 patients with KD (59 male, 53 female; median age: 19 months, range: 1-66 months) admitted from June 2010 to February 2012, received either dalteparin 75 IU/kg/day, IVIG 2.0 g/kg over 12 h, and aspirin 30 mg/kg/day, or dalteparin 75 IU/kg/day and aspirin 30 mg/kg/day. Control data came from the 2009-10 Nationwide KD survey. No patients enrolled in the nationwide surveys received dalteparin. All patients at our institution were given dalteparin in their combination therapy. RESULTS: A comparison of the first cohort with controls in the nationwide survey showed that the prevalence of initial administration of IVIG was 80.2% versus 86.0%; the rate of additional IVIG administration was 7.1% versus 14.0% (p = 0.03); CAL prevalence in the acute period was 4.8% versus 11.9% (p < 0.01); and the prevalence of cardiovascular sequelae was 0% versus 3.8% (p < 0.05). A comparison of the second cohort with controls in the nationwide survey showed that the rate of initial administration of IVIG was 92.9% versus 89.5%; the rate of additional IVIG administration was 8.9% versus 17.1% (p = 0.02); the prevalence of resistance to IVIG was 3.6% versus 14.9% (p < 0.001); and CAL prevalence in the acute period was 2.7% versus 8.6% (p = 0.03). CONCLUSIONS: This study found that adjunctive dalteparin was associated with a lower prevalence of IVIG resistance and CAL in young children with KD. TRIAL REGISTRATION UMIN-CTR: UMIN000010349.

A procyanidin trimer, C1, promotes NO production in rat aortic endothelial cells via both hyperpolarization and PI3K/Akt pathways.

Procyanidins, which are condensed catechins, have been elucidated as absorbable polyphenols, but their health-benefits remain unclear. The aim of this study was, thus, to clarify the efficacy and mechanism of each procyanidin oligomer in NO activation in rat aortic endothelial cells (RAECs). Treatment of RAECs with 50µM procyanidin C1 (4ß→8 trimer) resulted in a time- and dose-dependent hyperpolarization using the membrane potential-sensitive probe bis-(1,3-dibutylbarbituric acid) trimethine oxonol, while no effect was observed for (-)-epicatechin (a monomer) and procyanidin B2 (4ß→8 dimer). The C1-induced hyperpolarization was inhibited by iberiotoxin, a specific inhibitor of large-conductance Ca(2+)-activated K(+) (BK(Ca)) channel, as well as 2-aminoethyl diphenylborinate (2-APB), a store-operated Ca(2+) entry inhibitor. Procyanidin C1 caused a significant increase in NO production from RAECs via phosphorylation of both eNOS and Akt, and the effect was completely inhibited by N(G)-monomethyl-l-arginine or combined treatment with iberiotoxin and the phosphatidylinositol 3-kinase (PI3K) specific inhibitor, wortmannin, as well as combined treatment with 2-APB and wortmannin. Taken together, these findings provide critical evidence that procyanidin C1, but not B2, has potential to induce NO production in RAECs via both Ca(2+)-dependent BK(Ca) channel-mediated hyperpolarization and Ca(2+)-independent PI3K/Akt pathways.

Apple procyanidins induce hyperpolarization of rat aorta endothelial cells via activation of K+ channels.

Apple procyanidins (AP), one of the polyphenol-rich compounds, showed an endothelial-dependent vasorelaxation in rat aorta, but the mechanisms of beneficial effects are still unclear. The present study was designed to clarify the potential role of AP in rat aorta endothelial cells (RAECs). The treatment of RAECs with AP (1-10 µg/ml) resulted in a dose-dependent hyperpolarization with a maximum effect at 10 µg/ml, and for this reason, AP (10 µg/ml) was used in all the following experiments. AP-induced hyperpolarization was significantly inhibited by pretreatment of nonspecific K(+) inhibitor, tetraethyl ammonium chloride or specific K(+) channel inhibitors, iberiotoxin, glibenclamide, 4-aminopyridine and BaCl(2), as well as by high KCl or Ca(2+)-free solution. AP-induced hyperpolarization was also proved using 64-channel multielectrode dish system that can monitor a direct and real-time change of membrane potential. Furthermore, AP treatment caused a significant increase of nitric oxide (NO) production and cyclic guanosine monophosphate levels via endothelial NO synthase messenger RNA expression. The NO production was inhibited by N(G)-monoethyl-l-arginine or Ca(2+)-free solution and was completely abolished by their combination. Also, AP inhibited endothelial proliferation, while the effect was significantly abolished by N(G)-monoethyl-l-arginine or tetraethyl ammonium chloride. These findings suggest that AP induces both hyperpolarization of RAECs via multiple activation of K(+) channels and activation of NO/cyclic guanosine monophosphate pathway via increasing NO production or is responsible for antiangiogenic effect. Diminishment of hyperpolarization as well as NO production of AP in Ca(2+)-free solution implicated that AP would play a crucial role in promoting Ca(2+) influx into endothelial cells so as to promote both actions.

Effect of occlusal contact stability on the jaw closing point during tapping movements.

PURPOSE: We studied the relationship between tapping point reproducibility and stability of occlusal contacts at maximum intercuspation. METHODS: Tapping movements of 12 adult volunteers who had dentition with natural teeth were recorded, and distances between the tapping point (TP) and the intercuspal position (ICP) at the incisal point were calculated. Occlusal contacts at the ICP of individual subjects were also evaluated with black-colored silicone impression material. The correlation between TP-ICP distance and occlusal contact stability was studied. RESULTS: TP-ICP distance exhibited negative correlations with the total number of teeth showing occlusal contact at the ICP. Standard deviations of TP-ICP distance also negatively correlated with the extension of occlusal contact area over dentition. CONCLUSIONS: This finding indicates that occlusal contacts at the ICP affect the kinematic behavior of tapping movements. The results of this study also suggest that jaw movement data may provide useful clinical information for the evaluation of occlusal contact at ICP.

A 7-year-old girl with subcutaneous emphysema, pneumomediastinum, pneumothorax, and pneumoretroperitoneum caused by Mycoplasma pneumoniae pneumonia.

A 7-year-old girl presented with subcutaneous emphysema, pneumomediastinum (PM), pneumoretroperitoneum, and pneumothorax caused by Mycoplasma pneumoniae (MP). The patient had been treated with clarithromycin for pneumonia at another hospital; however, her condition deteriorated and complications developed. Soon after admission to our hospital, we started the patient on minocycline and prednisolone, and the complications improved promptly. Laboratory data showed serum ferritin and urinary beta-2-microglobulin levels were greatly elevated. We therefore speculated that the patient might have underlying hypercytokinemia. Prednisolone is an effective treatment for hypercytokinemia. We therefore recommend prednisolone treatment for cases of severe M. pneumoniae pneumonia that do not respond to antimicrobial agents.

Serum vitamin D concentrations and associated severity of acute lower respiratory tract infections in Japanese hospitalized children.

BACKGROUND: Vitamin D is an immunomodulatory molecule related to innate immunity that may contribute to the increased occurrence of acute lower respiratory infection (ALRI) in children, one of the most common reasons for hospitalization and intensive care unit admission. In the present study, the association between vitamin D deficiency and the severity of respiratory infection was evaluated by determining serum concentrations of 25-hydroxyvitamin D (25(OH)D) in a group of hospitalized children with ALRI. METHODS: Of the 28 children admitted to Nihon University Nerima-Hikarigaoka Hospital with ALRI over the period November 2008­May 2009, 26 were diagnosed as having bronchiolitis and two were found to have pneumonia. A competitive protein binding radioimmunoassay was used to determine serum 25(OH)D concentrations. RESULTS: Mean 25(OH)D concentrations in breast-fed children with ALRI (n = 7) were significantly lower than those in children with ALRI who were bottle fed/weaned (n = 6) or on a regular diet (n = 15; 14.6 ± 9.7, 28.9 ± 6.9 and 24.6 ± 8.8 ng/mL, respectively). There was a significant correlation between vitamin D deficiency (<15 ng/mL) and the need for supplementary oxygen and ventilator management. CONCLUSION: Significantly more children with ALRI who needed supplementary oxygen and ventilator management were vitamin D deficient. These findings suggest that the immunomodulatory properties of vitamin D may influence the severity of ALRI.

Henoch-schönlein purpura complicated by reversible posterior leukoencephalopathy syndrome.

We report a 7-year-old girl with Henoch-Schönlein purpura who developed hypertensive encephalopathy. She showed a sudden onset of neurological symptoms, including hypertension, convulsions, disturbance of consciousness, and cortical blindness. Reversible posterior leukoencephalopathy syndrome was diagnosed from the findings on magnetic resonance imaging. Reports of this syndrome in patients with Henoch-Schönlein purpura are very rare. However, if symptoms suggest central nervous system involvement, neuroimaging should be done for rapid diagnosis, and immediate treatment should be provided to avoid sequelae.

A pediatric patient with acute suppurative thyroiditis caused by Eikenella corrodens.

A previously healthy 6-year-old boy had continuous fever for 6 days before admission to our hospital. His general condition was good except for pyrexia. The left lobe of the thyroid gland was swollen, red, hot, and tender, and neck movement was limited. The provisional diagnosis was upper respiratory tract infection. We demonstrated the existence of an orifice of the left piriform sinus by esophagography in this case, and made a diagnosis of acute suppurative thyroiditis caused by a piriform sinus fistula in the hypopharynx. The causative organisms of acute suppurative thyroiditis include Peptostreptococcus, Staphylococcus haemolyticus, and α-streptococcus, but the organisms responsible are commonly undetectable in clinical cases. We detected Eikenella corrodens in the present patient. Although Eikenella species occasionally causes acute suppurative thyroiditis in adults, it is rare for this to happen in pediatric patients. Antibiotics were administered for 7 days. We also performed aspiration of the abscess on the 8th day of the illness. The abscess was reduced in size and tenderness was relieved after aspiration. In conclusion, if a pediatric patient has swelling, heat, tenderness, and redness of the anterior neck, we should keep in mind acute suppurative thyroiditis and the possibility of a fistula. If there is an abscess, we should immediately perform aspiration, culture, and isolation, and choose the appropriate antibiotics for the causative bacteria.