Quantitative pixel grey measurement of the "high-risk" sign, darkening of third molar roots: a pilot study.

OBJECTIVES: Our aim was to examine the panoramic darkening of the root, which is a "high-risk" sign, using quantitative measurements of pixel grey values to determine different aetiological backgrounds, namely inferior alveolar nerve (IAN) exposure with or without groove formation of the third molar roots or thinning/fenestration of the lingual cortex (LCTF). METHODS: 38 impacted third molars that had been surgically removed and had darkened roots on panoramic radiographs were included in this retrospective case-control study. 15 IAN exposure cases were selected for the case group, and 23 cases with proven lingual cortical thinning or fenestration were chosen for the control group. The mean pixel grey values of selected areas in the dark band (D) and control areas within the same roots (R) were determined with the ImageTool (University of Texas Health Science Center, San Antonio, TX) software. The differences in pixel values (R-D) of the IAN and LCTF groups were analysed using the Mann-Whitney U-test and Pearson's χ(2) test. RESULTS: The medians of the R-D pixel values were 45.7 in the IAN group and 34.3 in the LCTF group, whereas the interquartile ranges were 12.0 (IAN) and 18.3 (LCTF) (p < 0.001). The R-D critical value at which the outcomes differed significantly was 38. If the differences in pixel grey values (R-D) were higher than 38, the chance of IAN exposure was approximately 32 times higher than the chance of LCTF (χ(2) test, p < 0.001; odds ratio, 32.0; 95% confidence interval, 3.5-293.1). CONCLUSIONS: The pre-operative prediction of IAN exposure or lingual cortical thinning in cases with "darkening" is possible based on pixel grey measurements of digital panoramic radiographs.

Darkening of third molar roots on panoramic radiographs: is it really predominantly thinning of the lingual cortex?

This study investigated the exact intra-alveolar aetiology of a panoramic high-risk sign, darkening of the third molar roots. 83 mandibular third molar surgical removals demonstrating dark bands on the third molar roots in preoperative radiographs were included in this prospective study. Exposure of the inferior alveolar nerve (IAN), the root morphology of the third molar (e.g. groove or hook) and the integrity of the mandibular canal or lingual cortical wall were observed. Differences between single (increased radiolucency alone) and multiple darkening cases (increased radiolucency with accompanying 'high risk' signs) and between IAN exposure and groove formation were analysed. In 38 cases (45.8%), the IAN was visible during the operation. Groove was present in 37.4% of cases. 26.5% of the cases showed lingual cortical thinning, while specious root conformation explained the formation of darkening on the radiographic images of an additional 9.6% of the cases. IAN exposure (P<0.001) and groove formation (P<0.001) were significantly more frequent in multiple darkening cases than in single darkening cases. According to these findings, darkening of the third molar roots is more often the result of fenestration of the inferior alveolar canal wall or groove formation of the root than lingual cortical thinning.

Relationship of serum resistin level to traits of metabolic syndrome and serum paraoxonase 1 activity in a population with a broad range of body mass index.

UNLABELLED: The relationship between resistin, one of the adipokines, and metabolic syndrome is not fully elucidated. Altered activity of the HDL-associated antioxidant enzyme paraoxonase 1 (PON1) that participates in the antioxidant defense mechanisms of HDL may have an important role in the obesity-related accelerated atherosclerosis. Inverse associations of PON1 with obesity and serum levels of leptin have been demonstrated. Our aim was to investigate the association of serum levels of resistin with (i) PON1 activity, and (ii) parameters of metabolic syndrome, including some that are additional for research. A total of 74 Caucasian subjects were recruited into the study and divided into 3 age and sex-matched groups. Group 1, 25 non-diabetic overweight/obese subjects with BMI of 28-39.9 kg/m (2); group 2, 25 non-diabetic obese patients with BMI >or=40 kg/m (2); and the control group 3, 24 healthy, normal-weight control subjects. Serum levels of resistin were correlated negatively with BMI (r=-0.27, P<0.05), waist circumference (r=-0.28, P<0.05), serum levels of leptin (r=-0.28, P<0.05), non-esterified fatty acids (NEFA) (r=-0.23, P<0.05), and HbA (1C) (r=-0.26, P<0.05), systolic BP (r=-0.28, P<0.05), and lipid peroxidation (measured by TBARS) (r=-0.40, P<0.01), and correlated positively with PON1 (r=0.24, P<0.05). No association was detected between the serum concentrations of resistin and the following investigated parameters: diastolic BP, levels of uric acid, glucose, insulin, or insulin resistance (measured by homeostasis model assessment, HOMA-IR), triglyceride, total cholesterol, LDL-C, and HDL-C. During multiple regression analyses BMI and TBARS were independent predictors of PON1, while age, gender, blood pressure, HOMA-IR, LDL-C, HDL-C, and resistin were not. CONCLUSIONS: Among the study subjects, serum levels of resistin showed a positive, although not independent correlation with serum PON1, and a negative correlation with numerous parameters of the metabolic syndrome (i.e. adiposity, blood pressure, levels of leptin, free fatty acid, glycosylated hemoglobin, and lipid peroxidation). BMI and TBARS are independent predictors of PON1 activity.

[Normal percentiles of kidney size in children as measured by ultrasonography]. / A gyermekek normális veseméretének UH-vizsgálati percentilis standardjai.

The most anomaly of kidney development and urinary tract diseases have an effect on the size of the kidneys. Kidney size (renal length and parenchymal thickness) is readily measurable by ultrasonography, but the evaluation remains subjective without the use of appropriate standards. The aim of authors was, to produce a centile chart for normal kidney size based on US measurement in healthy Hungarian children. Renal length and renal parenchymal thickness (upper pole, middle part and lower pole) as well body weight and height were measured in 330 children. Normograms (centile charts) with 10th, 50th and 90th centiles were produced for body weight/height and renal length/parenchymal thickness. Renal length correlated strongly with both body weight (r = 0.93, p < 0.001) and height (r = 0.93, p < 0.001). The centile chart for renal size enables the objective evaluation of abnormal kidney size; it can help in the early recognition and follow up of urinary diseases.

Safety and efficacy of treatment with an ephedrine/caffeine mixture. The first double-blind placebo-controlled pilot study in adolescents.

OBJECTIVE: The present study was performed to investigate the efficacy and safety of a caffeine/ephedrine (CE) mixture in obese adolescents. SUBJECTS: Thirty-two (m/f = 16/16) obese children were included into the study. They were treated by diet (calculated daily energy requirement minus 500 kcal) and either CE or placebo (PL) for 20 weeks in a randomized double-blind placebo-controlled trial. Those weighing less than 80 kg took one tablet three times (100 mg/10 mg), whereas those weighing more than 80 kg took two tablets three times per day. There were three dropouts (girls) from the PL group. The age, weight body mass index (BMI) values (mean (range)) of the PL and CE groups were 16.0 (14.3-17.6) and 16.0 (14.2-17.7) y, 103.0 (77.2-126.4) and 104.8 (69.8-150.2) kg, 35.2 (28.3-42.3) and 36.5 (31.3-51.8) kg/m2, respectively. RESULTS: The decrease in relative body weight, BMI and body fat (measured by bioelectric impedance) was significantly (P < 0.05) greater in the CE group (mean +/- s.d.; 14.4 +/- 10.5%, 2.9 +/- 1.9 kg/m2, 6.6 +/- 6.0 kg) than in the PL group (2.2 +/- 5.8%, 0.5 +/- 1.6 kg/m2, 0.5 +/- 2.7 kg). Relative body weight decreased by more than 5% in 81% of the CE group, out only in 31% of the PL group. Adverse events were negligible and did not differ between the CE and PL groups. Withdrawal symptoms were mild, transient and their frequency and severity were not different between the placebo and active groups. CONCLUSION: According to the present pilot study, CE can be a safe and effective compound for the treatment of obesity in adolescents.

Presence of metabolic cardiovascular syndrome in obese children.

UNLABELLED: The aim of the present study was to investigate the aggregation of cardiovascular risk factors (hyperinsulinaemia, impaired glucose tolerance, dyslipidaemia, and hypertension) in 180 (77 female, 103 male) obese and 239 control children. Blood glucose, serum insulin and lipid levels were determined from blood samples taken after an overnight fast. Oral glucose tolerance tests were performed and blood glucose concentrations were monitored. The body mass index, body fat (on the basis of skinfold measurements), lean body mass and waist/hip ratio were calculated and blood pressure was measured five times in all subjects. It was shown that only 14.4% of obese children were free from any risk factors, in contrast to 79.1% of the control children. Four risk factors (metabolic cardiovascular syndrome) were found in 8.9% of the obese children (8.7% in males and 9.1% in females) while none could be detected in controls. Considerable differences were also detected in the prevalence of one, two or three risk factors between control and obese children. Patients with the metabolic cardiovascular syndrome could not be characterized by any of the investigated anthropometric characteristics, but the duration of obesity was significantly longer in these children. CONCLUSION: Potential risk factors for cardiovascular diseases already tend to cluster in childhood and they are strongly associated with obesity. Our observations suggest that the development of the metabolic cardiovascular syndrome has its origin in childhood.

Serologic examinations in acute appendicitis.

Authors studied the formation of endotoxic antibody level in healthy adults and in patients with appendicitis with a technique (indirect haemagglutination) not used till now. They found the antibody level against endotoxin to be increased in 91% of their patients in the postoperative period. Decrease in the antibody level against endotoxin was observed in two patients with gangrenous appendicitis and two patients with perforated appendicitis. Summarizing their results, authors consider mixed (aerobic, anaerobic) infection to be of decisive importance in the development of acute appendicitis, contributing to the weakened immune response of the host.

[Does tonsillectomy cause any change in long-term course of IgA nephropathy?]. / Változik-e tonsillectomia hatására az IgA nephropathia hosszú távú lefolyása?

Tonsillectomy seems to be a logical step in IgA nephropathy owing to the frequent tonsillitis before the beginning and the acute exacerbations of the disease. The usefulness of tonsillectomy is questionable because there are only few and short-term follow-up data after it. We followed up 35 kidney biopsy proven IgA nephropathy patients (25 men and 10 women) for an average of 12.2 yrs (range 7-32) after tonsillectomy. The values of endogenous creatinine clearance, serum creatinine, hematuria and proteinuria were compared at regular intervals during a follow-up with those obtained before tonsillectomy. We considered more than 12,000 data using 2 tailed t test. We found that proteinuria started to decrease significantly already 6 months after tonsillectomy (1.40 +/- 0.27 g/day before tonsillectomy vs 0.92 +/- 0.25 g/day after it, p < 0.05) and was significantly lower under follow-up. The tendency in microhematuria was similar (70.5 +/- 35.0 million RBC/12 hours before and 14.0 +/- 6.5 million RBC/12 hours 6 months after tonsillectomy, p < 0.0001). Furthermore, tonsillectomy stopped gross hematuria appearing in the acute exacerbation of the disease in more than two-thirds of patients. Creatinine clearance did not change in the first 2 years after tonsillectomy, however, from 2.5 years after it is significant slow and continual decrease started (117.0 +/- 9.8 ml/min before and 106.2 +/- 10.8 mil/min 2.5 yrs after tonsillectomy, p < 0.05). End-stage renal failure was detected only in 4 patients out of 35 after 10 years after tonsillectomy, in our non-tonsillectomised control group in 8 patients out of 40.

The number and distribution of bipolar to ganglion cell synapses in the inner plexiform layer of the anuran retina.

The main route of information flow through the vertebrate retina is from the photoreceptors towards the ganglion cells whose axons form the optic nerve. Bipolar cells of the frog have been so far reported to contact mostly amacrine cells and the majority of input to ganglion cells comes from the amacrines. In this study, ganglion cells of frogs from two species (Bufo marinus, Xenopus laevis) were filled retrogradely with horseradish peroxidase. After visualization of the tracer, light-microscopic cross sections showed massive labeling of the somata in the ganglion cell layer as well as their dendrites in the inner plexiform layer. In cross sections, bipolar output and ganglion cell input synapses were counted in the electron microscope. Each synapse was assigned to one of the five equal sublayers (SLs) of the inner plexiform layer. In both species, bipolar cells were most often seen to form their characteristic synaptic dyads with two amacrine cells. In some cases, however, the dyads were directed to one amacrine and one ganglion cell dendrite. This type of synapse was unevenly distributed within the inner plexiform layer with the highest occurrence in SL2 both in Bufo and Xenopus. In addition, SL4 contained also a high number of this type of synapse in Xenopus. In both species, we found no or few bipolar to ganglion cell synapses in the marginal sublayers (SLs 1 and 5). In Xenopus, 22% of the bipolar cell output synapses went onto ganglion cells, whereas in Bufo this was only 10%. We conclude that direct bipolar to ganglion cell information transfer exists also in frogs although its occurrence is not as obvious and regular as in mammals. The characteristic distribution of these synapses, however, suggests that specific type of the bipolar and ganglion cells participate in this process. These contacts may play a role in the formation of simple ganglion cell receptive fields.

Measured and predicted resting metabolic rate in obese and nonobese adolescents.

OBJECTIVES: The validity of equations for the calculation of resting metabolic rate (RMR) were studied and new predictive equations were developed. STUDY DESIGN: The RMR was measured in a sample of 371 10- to 16-year-old prepubertal and postpubertal children. The study group included 193 male (116 nonobese and 77 obese) and 178 female (119 nonobese and 59 obese) subjects; for each group the RMRs predicted from five equations recommended for this age group were compared. The RMR was assessed by indirect calorimetry with a ventilated hood system for 45 minutes after an overnight fast. Body composition was estimated from skin-fold measurements. RESULTS: The mean +/- SD RMR was found to be 5600 +/- 972 kJ/24 hr and 7223 +/- 1220 kJ/24 hr in nonobese and obese boys, and 5112 +/- 632 kJ/24 hr and 6665 +/- 1106 kJ/24 hr in nonobese and obese girls, respectively. All five equations applicable to 10- to 16-year-old children overestimated RMR by 7.5% to 18.1% (p < 0.001 for each equation). Stepwise regression analysis, with independent variables such as age, weight, height, and gender, allowed development of new predictive equations for the calculation of RMR in 10- to 16-year-old boys (RMR = 50.9 Weight (kg) + 25.3 Height (cm) -50.3 Age (yr) + 26.9; R2 = 0.884, p < 0.0001) and girls (RMR = 51.2 Weight (kg) + 24.5 Height (cm) - 207.5 Age (yr) + 1629.8; R2 = 0.824, p < 0.0001). These predictive equations were tested in a second, independent cohort of children (80 male and 61 female subject) and were found to give a reliable estimate of RMR in 10- to 16-year-old obese and nonobese adolescents. CONCLUSIONS: The currently used predictive equations overestimate RMR in 10- to 16-year-old children. The use of the newly developed equations is recommended.

Non-genetic risk determinants for type 1 (insulin-dependent) diabetes mellitus in childhood. Hungarian Childhood Diabetes Epidemiology Study Group.

Using the prospective Hungarian childhood diabetes register, a nationwide case-control study was carried out to investigate the possible role of various non-genetic factors as risk determinants for type 1 diabetes in childhood. A questionnaire (covering family characteristics, social status, fetal and perinatal events, breast-feeding habits, infectious diseases and stressful life events) was sent by mail to all incident diabetic children in 1990 (n = 163) and to two referent children (for each diabetic child), matched for age, sex and county. Diabetic children had a tendency to have mothers > 35 years of age (odds ratio (OR) = 3.52; 95% confidence intervals (CI) 0.74-16.79), a lower proportion of their mothers had higher education (OR = 1.69; 95% CI 0.95-3.0) and these children tended to move home more frequently (OR = 1.99; 95% CI 0.97-4.1). Although the duration of exclusive breast feeding was similar in both groups, the proportion of diabetic children who received no breast milk tended to be higher (OR = 1.76; 95% CI 0.91-3.4). A higher proportion of diabetic children reported non-specific infections (OR = 2.94; 95% CI 1.19-7.21) and the number of stressful life events was higher in diabetic children aged 10-14 years (OR = 3.9; 95% CI 1.14-13.27). As the risk determinants for childhood insulin-dependent diabetes mellitus identified in our low-risk population appear to be similar to those detected in the genetically different, high-risk Swedish population, our study strongly supports an etiological role for these non-genetic risk factors in IDDM.

[Developmental bone abnormalities, their variants and the delay of osteogenesis in children with leukemia]. / Csontfejlödési rendellenességek, variánsok és csontosodási kor lemaradása leukémiás gyermekekben.

When analyzing the Roentgen documentation of 102 leukaemic children, the prevalence of bone anomalies of the extremities, pelvis and vertebral column was studied. The frequency of the abnormal or unusual findings was compared with that of 660 control subjects. The frequency of osseous anomalies proved to be 2 to 3 times higher in leukaemic children tha in the controls. Considering the number of ossification centers and the presence nutritional canal of vertebrae, in leukaemic children the ossification seemed to be retarded.