RESUMEN

Supraspinatus tendinopathy (ST) and biceps tendinopathy (BT) are common causes of forelimb lameness in large-breed dogs and have historically been treated with conservative management or surgery. Extracorporeal shockwave therapy (ESWT) and therapeutic exercise (TE) are thought to be treatment options for these conditions. The objectives of this study were to report the clinical presentations of dogs treated with ESWT for shoulder tendinopathies, to determine the association between shoulder lesion severity identified on ultrasonography or MRI and outcome, and to compare the outcomes of dogs treated with ESWT with and without TE. Medical records of 29 dogs diagnosed with shoulder tendinopathies and treated with ESWT were reviewed, and 24 dogs were diagnosed with either unilateral BT or BT and ST. None were found to have unilateral ST. Five dogs were diagnosed with bilateral disease. Eighty-five per cent of dogs had good or excellent outcomes determined by owner assessment 11-220 weeks after therapy. Outcomes were found to be better as tendon lesion severity increased (P=0.0497), regardless if ESWT was performed with or without TE (P=0.92). ESWT should be considered a safe primary therapeutic option for canine shoulder tendinopathies. Larger controlled prospective studies are needed to adequately assess these findings.

Asunto(s)

RESUMEN

PURPOSE: To investigate the role of silicone oil as an adjunct to iodine 125 ((125)I) brachytherapy in attenuating radiation dose and reducing radiation retinopathy. METHODS: A 16-mm COMS plaque loaded with (125)I seeds was simulated in vitro on an eye model containing silicone oil as a vitreous substitute using BrachyDose. The radiation dose ratio of silicone oil vs water to ocular structures was calculated at angles subtended from the centre of the eye. Silicone oil was then used in three choroidal melanoma patients who underwent 23-gauge vitrectomy, silicone oil placement, and (125)I brachytherapy. RESULTS: Silicone oil reduced the ocular radiation dose in vitro to 65%. Radiation dose ratios on the retina increased from 0.45 to 0.99 when moving from points diametrically opposed to the plaque's central axis. In 10-24 months' follow-up, no patients have developed radiation retinopathy. Each patient required silicone oil removal and experienced cataract progression, and one also developed a retinal detachment. CONCLUSIONS: This study confirms that silicone oil attenuates radiation dose in vitro, and may protect against radiation retinopathy clinically in patients, however it requires extensive surgical interventions. Further studies in only very selected populations using silicone oil as an adjunct to (125)I brachytherapy will best elucidate its role in shielding radiation retinopathy.

Asunto(s)

RESUMEN

BACKGROUND: This study examined the absolute differences in neutral positions of the joints of the foot with different footwear. This addresses the question of whether separate static trials should be collected for each footwear condition to establish neutral positions. METHODS: A multi-segment kinematic foot model and optical motion analysis system measured four inter-segmental joints of the foot: (1) hindfoot-to-midfoot in the frontal plane, (2) forefoot-to-midfoot in the frontal plane, (3) hallux-to-forefoot in the sagittal plane, and (4) the height-to-length ratio of the medial longitudinal arch. Barefoot was compared to three shoe condition using Nike Free trainers of varying longitudinal torsional stiffness in ten male volunteers. FINDINGS: There was high variability both within subjects and shoe conditions. Shoes in general tended to raise the medial longitudinal arch and dorsiflex the hallux compared to barefoot condition. For the hallux, a minimum important difference of 5° or more was found between shoe conditions and the barefoot condition for majority of the subjects in all three shoe conditions (90% for control, 60% for least stiff, 50% for most stiff). This was less for the frontal plane inter-segmental joints of the foot where 50% of the subjects experience a change above 5° for at least one of the conditions. INTERPRETATION: The choice of using condition-specific neutral trials versus a single common neutral trials should be considered carefully. A single common trial allows for differences in absolute joint angles to be compared between footwear conditions. This can be important clinically to determine whether a joint is approaching its end-of-range and therefore at risk of injury. Several condition-specific neutral trials allows for subtleties in kinematic waveforms to be better compared between conditions, since absolute shifts in joint angles due to changing neutral position are removed and the waveforms are better aligned.

Asunto(s)

RESUMEN

The trajectories of skin-mounted markers tracked with optical motion capture are assumed to be an adequate representation of the underlying bone motions. However, it is well known that soft tissue artifact (STA) exists between marker and bone. This study quantifies the STA associated with the hindfoot and midfoot marker clusters of a multi-segment foot model. To quantify STA of the hindfoot and midfoot marker clusters with respect to the calcaneus and navicular respectively, fluoroscopic images were collected on 27 subjects during four quasi-static positions, (1) quiet standing (non-weight bearing), (2) at heel strike (weight-bearing), (3) at midstance (weight-bearing) and (4) at toe-off (weight-bearing). The translation and rotation components of STA were calculated in the sagittal plane. Translational STA at the calcaneus varied from 5.9±7.3mm at heel-strike to 12.1±0.3mm at toe-off. For the navicular the translational STA ranged from 7.6±7.6mm at heel strike to 16.4±16.7mm at toe-off. Rotational STA was relatively smaller for both bones at all foot positions. For the calcaneus they varied between 0.1±2.2° at heel-strike to 0.2±0.6° at toe-off. For the navicular, the rotational STA ranged from 0.6±0.9° at heel-strike to 0.7±0.7° at toe-off. The largest translational STA found in this study (16mm for the navicular) was smaller than those reported in the literature for the thigh and the lower leg, but was larger than the STA of individual spherical markers affixed to the foot. The largest errors occurred at toe-off position for all subjects for both the hindfoot and midfoot clusters. Future studies are recommended to quantify true three-dimensional STA of the entire foot during gait.

Asunto(s)

Asunto(s)

RESUMEN

The weight-bearing in-vivo kinematics and kinetics of the talocrural joint, subtalar joint and joints of the foot were quantified using optical motion analysis. Twelve healthy subjects were studied during level walking and anticipated medial turns at self-selected pace. A multi-segment model of the foot using skin-mounted marker triads tracked four foot segments: the hindfoot, midfoot, lateral and medial forefoot. The lower leg and thigh were also tracked. Motion between each of the segments could occur in three degrees of rotational freedom, but only six inter-segmental motions were reported in this study: (1) talocrural dorsi-plantar-flexion, (2) subtalar inversion-eversion, (3) frontal plane hindfoot motion, (4) transverse plane hindfoot motion, (5) forefoot supination-pronation twisting and (6) the height-to-length ratio of the medial longitudinal arch. The motion at the subtalar joint during stance phase of walking (eversion then inversion) was reversed during a turning task (inversion then eversion). The external subtalar joint moment was also changed from a moderate eversion moment during walking to a larger inversion moment during the turn. The kinematics of the talocrural joint and the joints of the foot were similar between these two tasks. During a medial turn, the subtalar joint may act to maintain the motions in the foot and talocrural joint that occur during level walking. This is occurring despite the conspicuously different trajectory of the centre of mass of the body. This may allow the foot complex to maintain its function of energy absorption followed by energy return during stance phase that is best suited to level walking.

Asunto(s)

RESUMEN

Two hundred fifty-three femoral-shaft fractures in 246 pediatric patients treated between 1976 and 1986 were retrospectively reviewed, and 186 fractures in 181 patients were available for demographic review. Fifty-nine patients underwent spica casting within 48 h of injury, whereas 127 were placed in traction and underwent delayed casting (>48 h from injury). Fifty-five patients in the traction group and 33 in the immediate-casting group were locatable for long-term follow-up of 8.9 years average (range, 4-20 years). There was no clinically significant difference in limb-length inequalities, or rotational or angular deformities between the two groups at initial casting or at final follow-up. Hospital stay averaged 17.3 days in the traction group and 2.2 days in the immediate-casting group (p < 0.001). Total estimated charges, at current rates, demonstrated an 83% greater patient charge in the traction group than in the immediate-casting group.

Asunto(s)

RESUMEN

Recent studies have shown that bacteremia can result from the removal of intraoral sutures. The authors found that preprocedural use of an antimicrobial oral rinse (0.12 percent chlorhexidine) did not significantly reduce the incidence of bacteremia when compared with no rinse at all. Similarly, a significant relationship between bleeding and bacteremia was not apparent. Most of the positive cultures yielded low colony counts. The results support the rationale for the American Heart Association's 1997 recommendations for use of antibiotic prophylaxis to prevent bacteremia, as well as the importance of good oral hygiene in prevention efforts.

Asunto(s)

RESUMEN

The authors describe an 11-year-old boy who had persistent oral lesions that clinically mimicked first-episode herpetic stomatitis. A biopsy revealed noncaseating sterile granulomas. Investigation of the small and large bowels revealed that the child had Crohn's disease. The oral lesions responded favorably to topical steroid therapy. The authors also discuss the range of oral lesions in inflammatory bowel disease and the differential diagnoses.

Asunto(s)

RESUMEN

The Syntex adjuvant formulation (SAF) containing [thr1]-muramyldipeptide in an oil-in-water emulsion has proven to be an effective adjuvant eliciting both cell-mediated and humoral immune response. As a parenteral emulsion, sterility of the final product was a concern, and various methods of achieving sterility were considered. For emulsions, most conventional sterilization methods are not viable, requiring the more cumbersome technique of sterilizing individual components and assembling/manufacturing under sterile conditions. Emulsion vehicles were manufactured with various models in the Microfluidizer M110 series. All equipment examined was capable of reducing the average dispersed oil droplet size to approximately 160 nm, with varying size ranges. Operating at an internal equipment pressure of greater than 16,000 psi, with at least five cycles through the interaction chamber, the resulting emulsion had a narrow droplet size range distribution, with the largest droplets being small enough to enable sterile filtration. Under specific-manufacturing conditions, the adjuvant emulsion becomes easily filtered through a 0.22-micron cartridge filter, thus yielding a sterile end product. This is the first published example of emulsion sterilization being achieved by terminal filtration.

Asunto(s)

RESUMEN

A case of herniation of the antral membrane through a recent extraction site is presented. The lesion was initially diagnosed as a tumor by the referring dentist. Oroantral fistulas are not an uncommon finding after dental extractions. It is rare, however, to see herniation of the antral membrane with large polyps extending through the fistula into the oral cavity. A search of the literature revealed only two other such cases. Surgical removal of the polyps and closure of the oroantral fistula by means of a buccal sliding flap technique is discussed.

Asunto(s)

Asunto(s)

RESUMEN

Pharmacological management of pain for acute and chronic conditions has been guided by a scientific understanding of peripheral and central acting mechanisms for the control of inflammation as well as pain. Oral surgery pain is a reliable model to reference the effectiveness of commonly used analgesics such as ibuprofen and acetaminophen. A total of 706 patients who were experiencing moderate to severe pain received a single dose of ibuprofen, acetaminophen, or placebo. After 6 hours, the degree of pain relief and tolerance was assessed. Ibuprofen has important implications for postoperative pain in clinical practice.

Asunto(s)

RESUMEN

An unusual complication associated with the placement of osseointegrated root form implants is presented. Discussion of this complication focuses on treatment planning and anatomic considerations in the posterior mandible that impact the viability of implant placement. Vital structures in this location, including the mandibular canal, are often obscured on routine panoramic radiography. Tomograms of the maxilla or mandible can provide data on cortical plate thickness, location of vital structures, and the presence of large medullary spaces, information that will decrease the incidence of implant complications.

Asunto(s)

RESUMEN

The purpose of this investigation was to determine, on the basis of ultrastructural evidence, whether large granular lymphocyte (LGL)-mediated cytotoxic activity could be identified in lesions of chronic adult periodontitis. 18 gingival papilla biopsies were obtained from 8 adult patients, each satisfying the clinical criteria for chronic adult periodontitis. One-half of each biopsy was processed for examination by transmission electron microscopy (TEM). B-lymphocyte, T-lymphocyte, and NK-cell contributions to the inflammatory cell infiltrate were determined by subjecting the remaining one-half to the 3-layer avidin-biotin affinity immunoperoxidase technique. Immunohistochemistry using the anti-human leu-11b monoclonal antibody (representative of NK-cells which are known to comprise approximately 80% of the LGL population) showed that the Leu-11b+ population comprised 3-7% of the total monocytic infiltrate. The Leu-11b+ cells tended to occur as single cells or in small clusters of 3-12 cells. Generally, the Leu-11b+ cells exhibited perivascular locations situated subjacent to the epithelial basal lamina. TEM observations showed LGLs in intimate contact with fibroblasts that exhibited morphologic changes consistent with cellular damage or degeneration. In addition, LGLs were observed to exhibit apparent non-cytotoxic contacts with plasma cells, macrophages and other monocytic cells.

Asunto(s)

RESUMEN

A case of bilateral coronoid hyperplasia is presented. This is a developmental abnormality that occurs primarily in males and is characterized by progressive, asymptomatic limitation of mandibular movements. The condition is usually detected shortly after the age of puberty. A diagnosis is usually made on the basis of the history and the radiographic findings. Surgical removal of the elongated coronoid processes, along with good postoperative range-of-motion exercises, will restore full mandibular movement.

Asunto(s)

Asunto(s)

RESUMEN

Patients' abilities to complete the Trieger modification of the Bender Motor Gestalt Test as an indicator of recovery time were compared following outpatient general anesthesia, using either enflurane or isoflurane on 100 patients who had their third molars removed. The time required for patients who received enflurane to satisfactorily complete the test averaged 32.7 minutes, compared with 34.6 minutes for patients who received isoflurane. Statistical analysis indicated that there was no significant difference in recovery time in this particular setting between enflurane and isoflurane.

Asunto(s)

RESUMEN

Histoplasmosis is a fungal disease resulting from inhalation of airborne spores of the organism Histoplasma capsulatum. The disease is endemic to the Ohio and Mississippi river valleys. Oral lesions are not common, but when present, they are usually associated with the severe disseminated form of histoplasmosis. This particular case is presented as an example of chronic pulmonary histoplasmosis in which a localized gingival lesion represented the initial clinical manifestation of the disease. Diagnosis was based on a positive biopsy and the results of chest radiographic examination. If, as in this case, serologic, hematologic, and physical examination results are negative, the biopsy of suspicious lesions is of paramount importance to the clinical differential diagnosis.

Asunto(s)

Asunto(s)