RESUMEN
OBJECTIVES: The aim of this study was to determine the incidence of posterior maxillary fractures involving the posterior maxillary sinus wall, pterygoid plate or both, unrelated to major midface fractures in patients with mandibular fractures, and to characterize associated fractures. METHODS: A CT study was performed in patients with mandibular fractures to identify posterior maxillary fractures. Patients aged under 16 years, those with mandibular fractures involving only dentoalveolar components and those with concurrent major midfacial fractures were excluded. RESULTS: 13 (6.7%) of 194 patients with mandibular fractures also had posterior maxillary fractures (case group). The injury pattern correlated with the external force directed to the lateral side of the mandible (p < 0.001), alcohol consumption (p = 0.049), the presence of multifocal fractures (p = 0.002) and the fracture regions in the symphysis/parasymphysis (p = 0.001) and the angle/ramus (p = 0.001). No significant difference between the case and non-case groups was seen for age, sex or cause of trauma. Non-displaced fractures in the ipsilateral posterior mandible occurred with significant frequency (p = 0.001) when the posterior maxillary fractures involved only the sinus. CONCLUSIONS: Mandibular fractures accompanied by posterior maxillary fractures are not rare. The finding of a unilateral posterior maxillary fracture on CT may aid the efficient radiological examination of the mandible based on possible patterns of associated fractures, as follows: in the ipsilateral posterior region as a direct fracture when the impact is a medially directed force, and in the symphysis/parasymphysis or contralateral condylar neck as an indirect fracture.
Asunto(s)
Fracturas Mandibulares/epidemiología , Fracturas Maxilares/epidemiología , Seno Maxilar/lesiones , Fracturas Craneales/epidemiología , Hueso Esfenoides/lesiones , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/estadística & datos numéricos , Japón/epidemiología , Masculino , Cóndilo Mandibular/lesiones , Fracturas Mandibulares/clasificación , Fracturas Mandibulares/diagnóstico por imagen , Fracturas Maxilares/diagnóstico por imagen , Persona de Mediana Edad , Traumatismo Múltiple/epidemiología , Estudios Retrospectivos , Fracturas Craneales/diagnóstico por imagenRESUMEN
A multicenter and open-labeled clinical trial of human recombinant factor VIIa (rFVIIa) was conducted in Japanese patients with severe hemophilia A or B with inhibitors. The trial consisted of 2 parts. In study 1, the pharmacokinetics, pharmacodynamics, and safety of a single dose of 120 microg/kg of rFVIIa were investigated in 8 patients. In the subsequent study 2, the hemostatic effect and safety of rFVIIa were evaluated during a 24-week period in 10 patients. In study 1, the mean maximum FVII-coagulant activity (FVII:C) was found to occur after 10 minutes; activity then decreased rapidly and returned to the baseline within 24 hours after a single intravenous infusion of rFVIIa. The mean half-life of FVII:C was 3.5 hours. The activated partial thromboplastin time and prothrombin time in the patients were immediately shortened but returned to the baseline within 24 hours after dosing. In study 2, 86 microg/kg to 120 microg/kg of rFVIIa (mean, 97 microg/kg) was administered 1 to 85 times to 10 patients. A total of 58.0% (91/157) of bleeding episodes were treated excellently or effectively, with 5 (3.2%) ineffective episodes. There was no apparent trend in the relationship of the hemostatic effect with bleeding sites, mean dose, or number of injections. The efficacy rate, however, was significantly higher (90.0%) in bleeding episodes treated within 3 hours than in those treated at longer intervals (31.0%). No treatment-related adverse events were observed, and there was no evidence of antibody formation to rFVIIa. In conclusion. rFVIIa is an effective and well-tolerated option for treatment of bleeding episodes in hemophilia patients with inhibitors.
Asunto(s)
Factor VIIa/farmacología , Hemofilia A/tratamiento farmacológico , Adolescente , Adulto , Seguridad de Productos para el Consumidor , Factor VIIa/administración & dosificación , Factor VIIa/efectos adversos , Factor VIIa/farmacocinética , Hemofilia A/inmunología , Humanos , Isoanticuerpos/sangre , Japón , Persona de Mediana Edad , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/farmacocinética , Proteínas Recombinantes/farmacología , Equivalencia TerapéuticaRESUMEN
Specialized sampling equipment and ultra-clean analytical methodology were employed to quantify the concentrations or fluxes of mercury (Hg), cadmium (Cd) and polychlorinated biphenyl (PCBs) in ambient air, precipitation, runoff, sanitary sewer, and wastewater treatment plant (WWTP) influent. The relationship between the atmospheric deposition and runoff on controlled surfaces were explored for the three pollutants. The impact of the atmospheric deposition and runoff to the headwork loading of the WWTP were investigated. Atmospheric deposition was found to be the primary source of the mass of Cd, Hg, and PCBs in runoff from the controlled surfaces. Neither atmospheric deposition nor the runoff was the main sources of the three pollutants to the Detroit Wastewater Treatment Plant (WWTP). Wet weather flow contributes the main portion of the Cd, Hg, and PCBs loading to the WWTP.