The duration of hyaluronidase and optimal timing of hyaluronic acid (HA) filler reinjection after hyaluronidase injection.

BACKGROUND: Hyaluronidase injection is a commonly performed treatment for overcorrection or misplacement of hyaluronic acid (HA) filler. Many patients often wants the HA filler reinjection after the use of hyaluronidase, though the optimal timing of reinjection of HA filler still remains unknown. OBJECTIVES: To provide the optimal time interval between hyaluronidase injections and HA filler reinjections. METHODS: 6 Sprague-Dawley rats were injected with single monophasic HA filler. 1 week after injection, the injected sites were treated with hyaluronidase. Then, HA fillers were reinjected sequentially with differing time intervals from 30 minutes to 14 days. 1 hour after the reinjection of the last HA filler, all injection sites were excised for histologic evaluation. RESULTS: 3 hours after reinjection of HA filler, the appearance of filler material became evident again, retaining its shape and volume. 6 hours after reinjection, the filler materials restored almost its original volume and there were no significant differences from the positive control. CONCLUSIONS: Our data suggest that the hyaluronidase loses its effect in dermis and subcutaneous tissue within 3-6 hours after the injection and successful engraftment of reinjected HA filler can be accomplished 6 hours after the injection.

Utilization of oil by-product from the purification process of conjugated linoleic Acid as feeding supplements for the accumulation of conjugated linoleic acid in the egg yolk.

This study was performed to examine an efficient way to use oil by-product which is obtained during the purification process of conjugated linoleic acid (CLA) from safflower oil. The CLA by-product (CBP) was fed to the laying hens to accumulate CLA in the egg yolk. Egg yolk samples from 3 different dietary groups were analyzed: control; CBP, 2%; and CLA-80 (which contained 80% free form of CLA), 2%. Fatty acids from the yolk were analyzed by gas chromatography, and the parameters of egg quality were determined. During the feeding trial, there was little alteration in the egg quality and egg production of the tested groups. The CLA contents in the test group with CBP, which contain CLA as glyceride form, significantly increased in the first week of feeding and had the highest level among the tested groups throughout the feeding trials, whereas the CLA group showed an increase in CLA contents from the third week. Moreover, the contents of total CLA isomers in CLA-80 and CBP oils were decreased by 12.92 and 0.51% after heat treatment in 48 h, and the contents of linoleic acid (LA) isomer in LA-80 (which contained 80% free form of LA) and LA by-product (LBP) oils were decreased by 19.63 and 5.78%, respectively. It was confirmed that a major form of fats in CBP was mainly esterified forms, whereas the fats in CLA-80 and LA-80 were composed of free fatty acids. There was no significant difference in the egg quality and production among the tested groups. It is meaningful that the oil by-product could be utilized as a source for functional foods of animal origin without influencing egg quality and production.

Effects of protein deprivation on subsequent growth performance, gain of body components, and protein requirements in growing pigs.

Forty-eight barrows were used in a 2 x 6 factorial arrangement to test a hypothesis that feeding a protein-deficient diet affects subsequent growth response by altering the efficiency of protein utilization. Barrows were individually fed either a 9% crude protein (CP) diet or an 18% CP diet from 20 to 30 kg of body weight (BW) (depletion phase). From 30 to 45 kg BW (realimentation phase), pigs were fed one of six experimental diets with CP levels of 11.8, 13.1, 14.3, 15.6, 18.8, and 21.8%. Four pigs were slaughtered at 20 kg BW to determine initial body composition. Four pigs from each treatment in depletion phase (a total of eight) were slaughtered at 30 kg BW, and all pigs from each treatment in realimentation phase (a total of 36) were slaughtered at 45 kg BW for subsequent compositional analysis. Pigs were bled at 20, 30, and 40 kg BW for blood urea nitrogen (BUN), insulin-like growth factor (IGF)-I, and IGF-binding protein (IGFBP) assays. Pigs were given three times the maintenance digestible energy requirement (3 x 120 kcal BW(-0.75) x d(-1)) in three equal meals daily. The feed allowance was adjusted every 3 d. During the depletion phase, pigs fed the 18% CP diet grew faster and more efficiently (P < 0.01) and gained more (P < 0.01) water and protein than did pigs fed the 9% CP diet. Pigs fed the 18% CP diet showed higher (P < 0.01) BUN values, IGF-I concentrations, and IGFBP ratios than pigs fed the 9% CP diet. During the realimentation phase, pigs fed the 9% CP diet during the depletion phase grew faster (P < 0.05), tended to grow more efficiently (P = 0.066), gained more water (P < 0.01), and tended to gain more protein (P = 0.068) than pigs fed the 18% CP diet during the depletion phase. Pigs fed the 9% CP diet during the depletion phase tended (P = 0.069) to have a higher protein requirement during the realimentation phase than pigs fed the 18% CP diet during the depletion phase. When measured at 40 kg BW, pigs fed the 9% CP diet had a lower (P < 0.05) BUN than pigs fed the 18% CP diet during the depletion phase. However, the plasma IGF-I concentration and IGFBP ratio at 40 kg BW were not affected by dietary CP level fed during the depletion phase. This study indicates that pigs fed a protein-deficient diet exhibit compensatory growth. During the period of compensatory growth, the requirement of CP for those pigs is higher than that of pigs previously fed an adequate diet. This study also suggests BUN can be used as an indicator of protein utilization efficiency and compensatory growth.

A case of giant congenital nevocytic nevus with neurotization and onset of vitiligo.

The authors report the case of a 21-year-old woman with a giant congenital nevocytic nevus (GCNN) who developed vitiligo at the age of 16 years on skin areas remote from the GCNN. This is the first reported case of GCNN developing neurotization combined with vitiliginous changes within the GCNN lesion. Treatment with PUVA achieved repigmentation of the vitiligo lesions, except for the hypochromic areas within the area of the nevus that were shielded from UVA radiation.

Alteration of biochemical profiles after high-dose intravenous immunoglobulin administration in Kawasaki disease.

UNLABELLED: Intravenous immunoglobulin (IVIG) has been used as an immunomodulatory treatment for several immune-mediated diseases. Early effects of high-dose IVIG treatment on biochemical profiles including lipids and proteins were evaluated in patients with Kawasaki disease (KD). Twelve children with KD (9 boys) were treated with IVIG at 2 g/kg over a period of 12 h. Serial sera samples were collected from the patients four times: before IVIG treatment and 2 h, 24 h and 7 d after IVIG treatment. The samples were frozen at -20 degrees C before biochemical analysis. A significant decrease in albumin concentration was found 2 h and 24 h after IVIG treatment, but this recovered to the pretreatment level after 7 d. Total cholesterol and triglyceride increased slightly after 7 d. A significant decrease in HDL-cholesterol and C-reactive protein was seen 2 h and 24 h after IVIG treatment. CONCLUSION: High-dose IVIG affects immediate changes in protein profiles and HDL-cholesterol in KD. Changes in HDL-cholesterol induced by IVIG may be the result of changes in systemic protein metabolism.

Giant serpentine intracranial aneurysm: a case report.

The authors present a case of giant serpentine aneurysm (a partially thrombosed aneurysm containing tortuous vascular channels with a separate entrance and outflow pathway). Giant serpentine aneurysms form a subgroup of giant intracranial aneurysms, distinct from saccular and fusiform varieties, and in this case, too, the clinical presentation and radiographic features of CT, MR imaging and angiography were distinct.

Functional, dynamic, and anatomic MR urography: feasibility and preliminary findings.

RATIONALE AND OBJECTIVES: The authors assessed the feasibility of using magnetic resonance (MR) urography to acquire functional, dynamic, and anatomic information in human subjects with normal and hydronephrotic kidneys. MATERIALS AND METHODS: In subjects known to have or suspected of having hydronephrosis, split renal filtration fractions were measured with a customized magnetization-prepared, inversion-prepared gradient-recalled echo sequence to determine the T1 of flowing blood in the inferior vena cava and aorta before and after contrast medium administration and in the renal veins and arteries after contrast medium administration. Multiple timed sets of coronal fast spoiled gradient-echo 70 degrees flip-angle images were acquired before and after contrast medium administration to derive MR renograms from changes in the signal intensity of the cortex and medulla. Precontrast T2-weighted images were obtained with a three-dimensional fast spoiled gradient-echo maximum intensity projection pulse sequence, and postcontrast T1 maximum intensity projection images were also obtained to depict the renal anatomy. RESULTS: Split filtration fraction differentiated normal from hydronephrotic kidneys. MR renograms depicted vascular, tubular, and ductal phases and differentiated between normal and hydronephrotic kidneys (P < .05, n = 20). Contrast medium dose correlated with the peak of the cortical signal intensity curves on the renogram (r = 0.7, P < .0005; n = 20). The sensitivities for the visual determination of hydronephrosis and unilateral delayed excretion of contrast material were both 100%, and the specificities were 64% and 85%, respectively. CONCLUSION: The preliminary findings show promise for the use of MR urography in the comprehensive assessment of renal function, dynamics, and anatomy.

The induction of BDNF and c-fos mRNA in the hippocampal formation after febrile seizures.

In this study we investigated the expression of brain-derived neurotrophic factor (BDNF) and c-fos mRNA in the hippocampal formation after febrile seizures (FSs) with in situ hybridization histochemistry using riboprobes. The induction of BDNF mRNA was firstly observed in the dentate gyrus at 30 min after FSs. The expression in the dentate gyrus peaked at 3 h and returned to basal level at 24 h. It was also observed in the CA3 of hippocampus from 2 to 3 h. The induction of c-fos mRNA was observed in the dentate gyrus at 30 min and 1 h. These observations suggest that BDNF and c-fos are the genes whose expression can be altered by FSs and might be related to pathologic alterations after FSs.

Varying effects of intravenous immunoglobulin on mononuclear cell proliferation in vitro.

Intravenous immunoglobulin (IVIG) is being increasingly used to treat numerous immune-mediated diseases. However, there is a paucity of knowledge on the specific mode of action of IVIG in vivo. In this study, the in vitro effects of IVIG on peripheral blood mononuclear cell (PBMC) proliferation using phytohemagglutinin (PHA), anti-CD3 monoclonal antibody (MAb), phorbol myristate acetate (PMA), or purified protein derivatives (PPD) have been analyzed. The PBMCs were obtained from more than 10 individual donors. In all cases, IVIG almost completely inhibited PBMC proliferation at concentration above 20 mg/mL except when used in conjunction with PMA. PHA-induced proliferation of PBMCs at concentrations ranging from 1 to 15 mg/mL did not show significant differences. Anti-CD3 MAb-induced proliferation showed dose-dependent inhibition at concentrations ranging from 1 to 10 mg/mL. Interestingly, PMA-induced proliferation of PBMCs showed a dose-dependent increase at the same concentration range. PPD-induced proliferation of PBMC at concentrations ranging from 1 to 10 mg/mL did not show any statistically significant differences. These results suggest that high dose IVIG may be necessary to immune modulation in vivo and IVIG has various effects on PBMCs proliferation in limited concentration in vitro.

Laparoscopic Heller myotomy relieves dysphagia in patients with achalasia and low LES pressure following pneumatic dilatation.

BACKGROUND: Although pneumatic dilatation is said to relieve dysphagia in achalasia if it decreases lower esophageal sphincter (LES) pressure to 10 mmHg (n = 23); group C, no previous balloon dilatation and LES pressure >10 mmHg (n = 25). All patients underwent a laparoscopic Heller myotomy and Dor fundoplication. The severity of dysphagia was gauged on a scale of 0-4. RESULTS: In group A, LES pressure was 7 +/- 2 mmHg preoperatively and 8 +/- 3 mmHg postoperatively; the dysphagia score was 3.3 +/- 0.7 preoperatively and 0.9 +/- 1.1 postoperatively. Eighty-nine percent of patients had excellent or good results. In group B, LES pressure was 23 +/- 8 mmHg preoperatively and 10 +/- 1 mmHg postoperatively; the dysphagia score was 3.3 +/- 0.7 preoperatively and 0.3 +/- 0.5 postoperatively. All patients had excellent or good results. In group C, LES pressure was 23 +/- 11 mmHg preoperatively and 14 +/- 12 mmHg postoperatively; the dysphagia score was 3.6 +/- 0.6 preoperatively and 0.2 +/- 0.5 postoperatively. All patients had excellent or good results. CONCLUSIONS: These results show that (a) a LES pressure of <10 mmHg after pneumatic dilatation does not guarantee relief of dysphagia, and (b) laparoscopic Heller myotomy relieves dysphagia in most patients with a postdilatation LES pressure <10 mmHg. Thus, a laparoscopic Heller myotomy is indicated if dilatation does not relieve dysphagia, even if LES pressure has been decreased to <10 mmHg. Esophagectomy should be reserved for the occasional failure of this simpler operation.

Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures.

BACKGROUND: In the treatment of achalasia, surgery has been traditionally reserved for patients with residual dysphagia after pneumatic dilatation. The results of laparoscopic Heller myotomy have proven to be so good, however, that most experts now consider surgery the primary treatment. HYPOTHESIS: The outcome of laparoscopic myotomy and fundoplication for achalasia is dictated by technical factors. SETTING: University hospital tertiary care center. DESIGN: Retrospective study. PATIENTS AND METHODS: One hundred two patients with esophageal achalasia underwent laparoscopic Heller myotomy and Dor fundoplication. Fifty-seven patients had been previously treated by pneumatic dilatation or botulinum toxin. The design of the operation involved a 7-cm myotomy, which extended 1.5 cm onto the gastric wall, and a Dor fundoplication. Esophagrams, esophageal manometric findings, and video records of the procedure were analyzed to determine the technical factors that contributed to the clinical success or failure of the operation. MAIN OUTCOME MEASURE: Swallowing status. RESULTS: In 91 (89%) of the 102 patients, good or excellent results were obtained after the first operation. A second operation was performed in 5 patients to either lengthen the myotomy (3 patients) or take down the fundoplication (2 patients). Dysphagia resolved in 4 of these patients. The remaining 6 patients were treated by pneumatic dilatation, but dysphagia improved in only 1. At the conclusion of treatment, excellent or good results had been obtained in 96 (94%) of the 102 patients. CONCLUSIONS: These data show that a Heller myotomy was unsuccessful in patients with an esophageal stricture; a short myotomy and a constricting Dor fundoplication were the avoidable causes of residual dysphagia; a second operation, but not pneumatic dilatation, was able to correct most failures; and that the identified technical flaws were eliminated from the last half of the patients in the series.

Clinical usefulness of magnetic resonance cisternography in patients having hemifacial spasm.

To evaluate the usefulness of MR cisternography fourteen patients that had hemifacial spasm and 20 control patients underwent MR cisternography. All the patients with hemifacial spasm had a confirmed vascular compression after surgery. MR cisternography was performed using a 1.5-tesla superconducting MR magnet in which a 3D (dimensional) heavily T2-weighted turbo spin-echo sequence was used. In 34 randomly selected individuals, we retrospectively determined whether MR cisternography images could be used to evaluate symptoms, and what the benefits of obtaining this image was. The results were correlated with the surgical findings. The sensitivity was 100% and the specificity was 94% in all patients having a hemifacial spasm. The offending vessels were the anterior inferior cerebellar artery (AICA) in six patients cases, the posterior inferior cerebellar artery (PICA) in six, both the vertebral artery and PICA in one, and the vertebral artery in one. All the images showed good resolution and contrast, and also showed the exact correlation between the facial nerve and intracranial vessels in the multiplaner image. The findings of neurovascular compression were well correlated with the surgical findings. We believe that high-resolution 3D MR cisternography is a very useful method for evaluating the neurovascular compression in patients that have hemifacial spasm.

Complications of eyelash and eyebrow tattooing: reports of 2 cases of pigment fanning.

Eyelash and eyebrow tattooing are commonly performed procedures that have a very low rate of reported complications. We describe one case of infraorbital pigmentation after eyelash tattooing and another of periorbital pigmentation after eyebrow tattooing. Although most complications related to eyelash and eyebrow tattooing, including pigment fanning, have been reported by ophthalmologists, pigment fanning is also of concern to dermatologists.

Tic convulsif caused by cerebellopontine angle schwannoma.

A case is presented of painful tic convulsif caused by schwannoma in the cerebellopontine angle (CPA), with right trigeminal neuralgia and ipsilateral hemifacial spasm. Magnetic resonance images showed a 4 cm round mass displacing the 4th ventricle and distorting the brain stem in the right CPA. The schwannoma, which compressed the fifth and seventh cranial nerves directly, was subtotally removed by a suboccipital craniectomy. Postoperatively, the patient had a complete relief from the hemifacial spasm and marked improvement from trigeminal neuralgia. The painful tic convulsif in this case was probably produced by the tumor compressing and displacing the anterior cerebellar artery directly.

Functional magnetic resonance imaging of visual object construction and shape discrimination : relations among task, hemispheric lateralization, and gender.

We studied the brain activation patterns in two visual image processing tasks requiring judgements on object construction (FIT task) or object sameness (SAME task). Eight right-handed healthy human subjects (four women and four men) performed the two tasks in a randomized block design while 5-mm, multislice functional images of the whole brain were acquired using a 4-tesla system using blood oxygenation dependent (BOLD) activation. Pairs of objects were picked randomly from a set of 25 oriented fragments of a square and presented to the subjects approximately every 5 sec. In the FIT task, subjects had to indicate, by pushing one of two buttons, whether the two fragments could match to form a perfect square, whereas in the SAME task they had to decide whether they were the same or not. In a control task, preceding and following each of the two tasks above, a single square was presented at the same rate and subjects pushed any of the two keys at random. Functional activation maps were constructed based on a combination of conservative criteria. The areas with activated pixels were identified using Talairach coordinates and anatomical landmarks, and the number of activated pixels was determined for each area. Altogether, 379 pixels were activated. The counts of activated pixels did not differ significantly between the two tasks or between the two genders. However, there were significantly more activated pixels in the left (n = 218) than the right side of the brain (n = 161). Of the 379 activated pixels, 371 were located in the cerebral cortex. The Talairach coordinates of these pixels were analyzed with respect to their overall distribution in the two tasks. These distributions differed significantly between the two tasks. With respect to individual dimensions, the two tasks differed significantly in the anterior--posterior and superior--inferior distributions but not in the left--right (including mediolateral, within the left or right side) distribution. Specifically, the FIT distribution was, overall, more anterior and inferior than that of the SAME task. A detailed analysis of the counts and spatial distributions of activated pixels was carried out for 15 brain areas (all in the cerebral cortex) in which a consistent activation (in > or = 3 subjects) was observed (n = 323 activated pixels). We found the following. Except for the inferior temporal gyrus, which was activated exclusively in the FIT task, all other areas showed activation in both tasks but to different extents. Based on the extent of activation, areas fell within two distinct groups (FIT or SAME) depending on which pixel count (i.e., FIT or SAME) was greater. The FIT group consisted of the following areas, in decreasing FIT/SAME order (brackets indicate ties): GTi, GTs, GC, GFi, GFd, [GTm, GF], GO. The SAME group consisted of the following areas, in decreasing SAME/FIT order : GOi, LPs, Sca, GPrC, GPoC, [GFs, GFm]. These results indicate that there are distributed, graded, and partially overlapping patterns of activation during performance of the two tasks. We attribute these overlapping patterns of activation to the engagement of partially shared processes. Activated pixels clustered to three types of clusters : FIT-only (111 pixels), SAME-only (97 pixels), and FIT + SAME (115 pixels). Pixels contained in FIT-only and SAME-only clusters were distributed approximately equally between the left and right hemispheres, whereas pixels in the SAME + FIT clusters were located mostly in the left hemisphere. With respect to gender, the left-right distribution of activated pixels was very similar in women and men for the SAME-only and FIT + SAME clusters but differed for the FIT-only case in which there was a prominent left side preponderance for women, in contrast to a right side preponderance for men. We conclude that (a) cortical mechanisms common for processing visual object construction and discrimination involve mostly the left hemisphere, (b) cortical mechanisms specific for these tasks engage both hemispheres, and (c) in object construction only, men engage predominantly the right hemisphere whereas women show a left-hemisphere preponderance.

A biodegradable polymer scaffold for delivery of osteotropic factors.

Despite discoveries and developments in osteotropic factors, therapies exploiting these macromolecules have been limited due to a lack of suitable delivery vehicles and three dimensional (3D) scaffolds that promote bone regeneration. To address this limitation, an emulsion freeze-drying process was developed to fabricate biodegradable scaffolds with controlled microarchitecture, and the ability to incorporate and deliver bioactive macromolecules for bone regeneration. The effect of median pore size and protein loading on protein release kinetics was investigated using scaffolds with different protein loading and median pore sizes ranging from 7 to 70 microm. Graphs of protein release from scaffolds showed an initial burst followed by a slower sustained release. Release kinetics were characterized using an unsteady-state, diffusion-controlled model with an effective diffusivity that took tortuosity (tau) and partition coefficient for protein adsorption (Kp) onto the scaffold walls into account. Tortuosity and partition coefficient significantly reduced the protein diffusivity by a factor of 41 +/- 43 and 105 +/- 51 for 60 and 30-microm median pore-sized scaffolds, respectively. The activity of the protein released from these scaffolds was demonstrated by delivering rhBMP 2 and [A-4] (an amelogenin derived polypeptide) proteins from the scaffold and regenerating bone in a rat ectopic bone induction assay [Whang et al. J Biomed Mater Res 1998;42:491-9, Veis et al. J Bone Mineral Res, Submitted].

Effect of starter feeding program on growth performance and gains of body components from weaning to market weight in swine.

Three experiments were conducted to test the hypothesis that different starter feeding programs (High, high quality; Low, low quality) will affect growth performance and body composition of pigs from weaning to market weight and that this effect may be influenced by gender (barrows or gilts) and breed (F, Yorkshire-Duroc x Hampshire; P, PIC Camborough 15 x PIC line 405). In Exp. 1, 21 +/- 4-d-weaned F pigs (n = 90) were used in a 2 (High or Low) x 2 (barrows or gilts) factorial design. In Exp. 2, 21 +/- 3-d-weaned pigs (n = 184) were used in a 2 (F or P) x 2 (High or Low) x 2 (barrows or gilts) factorial design. In Exp. 3, 21 F pigs from each gender and feeding program treatment were killed at d 0, 3, 7, 14, 42, 82, or 152 postweaning for evaluating body composition. Two starter feeding programs (High or Low) were applied to pigs for 6 wk postweaning. Pigs from both High and Low treatments were provided the same corn-soybean meal-based diets for the growing and finishing periods. Although the ADG of all pigs receiving the High treatment during the early starter period were higher (P < .01) than those of the Low, the terminal BW of F barrows were similar between High and Low (Exp. 1 and 2) and those of gilts were similar between High and Low (Exp. 2) (P > .80). However, the BW of P pigs receiving the High treatment, regardless of gender, tended to be heavier than those receiving the Low (Exp. 2) and F barrows receiving the High treatment tended to be heavier than those receiving the Low (Exp. 1). For the first 7 d postweaning, the High-fed pigs gained more protein (P < .05) and lost less fat (P < .05) than Low-fed pigs. During the growing-finishing period, the Low-fed pigs exhibited compensatory protein gain and achieved a body protein content similar (P < .60) to High-fed pigs by termination. Protein gains from weaning to termination between High- and Low-fed pigs were not different in Exp. 2 and 3. The protein gain of gilts was higher (P < .05) than that of barrows. Similarly, fat gain within genders was not affected by starter feeding program. Fat gain of gilts, however, was lower (P < .08) than that of barrows in Exp. 3. In conclusion, the nutritional quality of the starter feeding program affected growth performance immediately after weaning but did not affect protein gain over the entire production period.