The relationship between idiopathic bone cavity and orthodontic tooth movement: analysis of 44 cases.

OBJECTIVES: Idiopathic bone cavity (IBC), also named simple or traumatic bone cyst, is a common lesion of unknown cause. The mandible is a very common location, although it may occur in any bone of the body. The authors performed a retrospective analysis of 44 cases in order to assess the causation of this entity. METHODS: Each case was analysed by two of the authors (IV and SM) for medical and dental history, history of mandibular/maxillary trauma, clinical presentation, radiographic appearance, surgical findings and histopathology. RESULTS: This retrospective study suggested a possible relationship between IBCs and orthodontic treatment. This association was noted in 10/44 cases (22.73%). All of these cases were located in the mandible and were well-circumscribed radiolucencies. Evaluation of these cases disclosed that 6/44 (13.64%) demonstrated scalloping, and 3/44 (6.82%) revealed bony expansion. The age range of the patients evaluated was 9-74 years. None of these cases had a history of trauma or extractions in the area. CONCLUSIONS: The findings of this retrospective study suggest an association between orthodontic treatment and the development of this IBC. This occurrence may be multifactorial; further research in the dental science is required.

Azathioprine and diffuse alveolar haemorrhage: the pharmacogenetics of thiopurine methyltransferase.

Current guidelines support the use of corticosteroids and azathioprine as one possible treatment strategy for idiopathic pulmonary fibrosis (IPF). However, some patients with genetic polymorphisms of thiopurine methyltransferase (TPMT) are at risk of severe azathioprine myelotoxicity. The current authors present the case of an 85-yr-old Caucasian male with IPF who developed diffuse alveolar haemorrhage as a complication of azathioprine-induced myelosuppression. Leukocyte genetic TPMT testing revealed that the patient had homozygous polymorphisms associated with the absence of TPMT activity and severe azathioprine-induced myelotoxicity. Thiopurine methyltransferase deficiency should be considered in patients who develop leukopenia early in treatment with azathiopurine, or who present with severe marrow suppression at usual doses. For centres with equipped laboratories, a dosing suggestion is provided based on thiopurine methyltransferase testing. Even with screening strategies, frequent monitoring of complete blood count and liver biochemistry should remain the mainstay of surveillance for azathioprine toxicity.

Craniometaphyseal dysplasia associated with obstructive sleep apnoea syndrome.

Craniometaphyseal dysplasia (CMD) is a genetic craniotubular bone disorder characterized by early progressive hyperostosis and sclerosis of the craniofacial bones, and abnormal modelling of the metaphyses of the tubular bones. We present the case of a patient with a confirmed history of the autosomal dominant form of CMD, associated with symptoms of obstructive sleep apnoea syndrome. Examination and imaging studies revealed several unusual features in addition to the common findings of CMD such as: bimaxillary retrusion with hyperostosis of the mental area, severe notching of the external occipital protuberance, huge occipital horn, decreased angle of the mandible with notching of the body and thickening of the areas of muscle attachment, and macrodontia. The literature and differential diagnoses are reviewed.

Family caregivers and home care: a declaration of interdependence.

Family caregivers and home care providers need each other. They must recognize their interdependence and learn to work together because millions of frail older people, disabled adults, and medically fragile children rely on family members and home care providers to help them live high-quality lives to the extent possible.

Contralateral coronoid process bone grafts for orbital floor reconstruction: an anatomic and clinical study.

PURPOSE: This study compares the contour of the coronoid process with the orbital floor using skulls and shows the use of this bone as a graft for orbital floor reconstruction. METHODS: Measurements and contour evaluations of the orbital floor and the contralateral mandibular coronoid process (12 right orbital floors with the lateral surface of the left coronoid process and 12 left orbital floors with the lateral surface of the right coronoid processes) were made in 24 dried adult human skulls (age, race, gender unknown) to assess the feasibility of using the mandibular coronoid process for orbital floor reconstruction. Applying the findings of this study, eight patients who had sustained either an isolated orbital floor blowout fracture (n = 2) or orbital floor compromise with an associated zygomatic bone fracture (n = 6) were treated by using their contralateral coronoid process for repair of the orbital floor. RESULTS: Anatomic Study: Measurements and contour comparisons of the right orbital floor with the left lateral cortex of the coronoid process in 12 skulls and the left orbital floor with the right lateral cortex of the coronoid process in the another 12 skulls showed a close match in contour and demension. CLINICAL STUDY: Although minimal trimming of the peripheral bony margins and medial coronoid cortical plate was needed, none of the grafts required recontouring of their lateral cortical surface in the eight patients. Postoperative radiographic studies showed a correct anatomic contour of the orbital floor. A 1-year follow-up of each patient showed no occurrence of diplopia, enophthalmia, muscle entrapment, or infection. All eight patients had transient (1 to 2 weeks) trismus. CONCLUSION: Based on the anatomic studies and clinical results, the coronoid process makes an excellent donor graft site for reconstruction of orbital floor deformities.

Trovafloxacin in the treatment of intra-abdominal infections: results of a double-blind, multicenter comparison with imipenem/cilastatin. Trovafloxacin Surgical Group.

BACKGROUND: Trovafloxacin, a new broad-spectrum fourth-generation quinolone, has in vitro activity against most gram-negative and gram-positive anaerobes and aerobes. Trovafloxacin is available as both an intravenous formulation, alatrofloxacin, and a single daily oral tablet. Excellent tissue pharmacokinetics and oral bioavailability suggest usefulness in the treatment of complicated intra-abdominal infections. Thus, the efficacy of alatrofloxacin followed by oral trovafloxacin was compared with the standard regimen of intravenous imipenem/cilastatin followed by oral amoxicillin/clavulanic acid in this prospective, multicenter, double-blind trial. METHODS: Patients were randomized to receive either 300 mg alatrofloxacin daily followed by 200 mg oral trovafloxacin daily or 1 g imipenem/cilastatin intravenously thrice daily followed by 500 mg oral amoxicillin/clavulanic acid thrice daily for up to 14 days following surgical intervention of a documented intra-abdominal infection. Efficacy was assessed at the end of therapy and at follow-up (day 30). RESULTS: At the end of the study, cure or improvement occurred in 83% (129/156) and 84% (127/152) of clinically evaluable patients in the trovafloxacin and comparative groups, respectively. Pathogen eradication rates, adverse-event profiles, and significant laboratory abnormalities were comparable between groups. CONCLUSION: Intravenous alatrofloxacin with or without oral trovafloxacin was as effective as intravenous imipenem/cilastatin followed by oral amoxicillin/clavulanic acid in complicated intra-abdominal infections.

A study of mandibular ramus anatomy and its significance to sagittal split osteotomy.

A study is presented, which investigates the position of fusion between the buccal and lingual cortical plates. The knowledge of this position will direct the placement of horizontal medial osteotomy in modified sagittal split osteotomy.

A quantitative morphometric study of the kinetics of tissue regeneration after administration of cisplatin.

The effect of the anti-neoplastic drug cisplatin was investigated on several rat tissues using a novel computerized morphometric image analysis system. The rats were sacrificed in pre-determined intervals, ranging from 1 to 36 days after drug administration, and their liver, kidneys and external ears were sampled and sectioned. Tritiated thymidine was injected into each rat 1 h prior to sacrifice to enable autoradiographical explorations. All sections were histomorphometrically studied by a computerized system. The kidneys of the experimental group revealed increased tubular diameters, especially in the corticomedular region. In the ears, decreases of the mean epithelial thickness, in the mean number of nuclei and in the mean nuclear surface were observed. The thickness of the connective tissue also decreased significantly by the end of the first week and returned to its normal size later on. No changes were detected in the ear cartilage. In the liver, no morphometrical differences were noticed in the hepatocyte density, Kupffer cell density or nuclear area. The nuclei of the hepatocytes and Kupffer cells retained a constant ratio to the total number of cells throughout the whole experiment. Liver autoradiography revealed that the hepatocyte and Kupffer cell labelling indexes after cisplatin administration were significantly higher than those of the control group, indicating enhanced replication of cells and increased synthesis of DNA, which in turn is accumulated in the nuclei and turn the cells into polyploids. In addition, the mean radius of the liver acini after cisplatin was diminished, followed by a significant reduction in the size of the progenitor compartment. It is concluded that while the kidneys are the organs most affected by cisplatin, the progenitor compartment of the liver is heavily affected as well. Computerized morphometry was demonstrated as a highly reproducible and accurate quantitative method for evaluation of histopathological changes in various mammalian tissues.

Anatomic relationship of the genial tubercles to the dentition as determined by cross-sectional tomography.

PURPOSE: This study determined the anatomic location and the dimensions of the genial tubercles in relation to the apices of the mandibular central incisors. MATERIALS AND METHODS: Linear cross-sectional tomographic images were made of 41 adult human skulls. A 2-mm-thick section was produced through each central incisor. The vertical distance between the apex of each central incisor and the level of the superior aspect of the genial tubercle was measured on the radiographs. Additional measurements were taken on the dry skulls to determine the horizontal distance between the apices of the two central incisors and the width and height of the genial tubercle. RESULTS: Although 5 mm is considered a safe zone for geniotomies, 29 of the genial tubercles (35.4%) were less than 5 mm from the apices of the mandibular central incisors. The distance between the apices of these incisors ranged from 9 mm to 15 mm. CONCLUSION: Osteotomy of the genial tubercles can be performed within the confines of the mandibular central incisors, but care must be taken to avoid the root apices.

Family caregivers.

The home care industry relies on family caregivers to provide a great deal of the care for patients, and the industry acknowledges that. But do professionals know just who these family members are, and what they think and feel? The National Family Caregivers Association answers these questions and provides guidance on how professionals can help informal caregivers.