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Maxillofacial osteochondromas are considered benign neoplasms, and compared with their extracranial variant are relatively rare. When they involve the mandibular condyle they can induce significant facial deformity, malocclusion, and various temporomandibular joint symptoms. Complete excision is considered the standard of care, but can lead to a reduction in the height of the ipsilateral mandible with resultant complications. In such cases, reconstruction is usually warranted and may be approached in various ways. This case report demonstrates a straightforward, accurate and reproducible approach to reconstructing the TMJ, facial profile and occlusion following resection of a large TMJ osteochondroma, without the need for concomitant orthodontics.

Background Zygomaticomaxillary complex (ZMC) and zygomatic arch (ZA) fractures are common injuries resulting from facial trauma and frequently require surgical management (Huang et al., Craniomaxillofac Trauma Reconstr 8(4):271-6, 2015). A substantial number of post-operative functional and cosmetic complications can arise from the surgical management of these fractures. These include scarring, inadequate facial profile restoration, facial asymmetries and diplopia (Ellis et al. J Oral Maxillofac Surg 54(4):386-400, 1996; Yang et al. Oral Maxillofac Surg Clin North Am 23(1):31-45, 2011; Kloss et al. Int J Oral Maxillofac Surg 40(1):33-7, 2011). Intuitively, most of these aforementioned complications arise as a result of inadequate fracture reduction; however, current standard practice is to assess reduction post-operatively through plain radiographs or computed tomography (CT) scans. The role of intra-operative CT scanning to assess the reduction of ZMC/ZA fractures and the potential impact on complications, has thus far not been established. Methods This is a prospective randomised controlled trial currently being undertaken at the Royal Brisbane and Women’s Hospital. All patients who require operative management of their ZMC or ZA fractures are offered enrollment in the trial. The patients are randomised into two groups: interventional (intra-operative CT) and control (no intra-operative CT). All patients in each group will have post-operative radiographs taken. From these radiographs, the reduction of the ZMC and/or ZA fracture is graded by a blinded assessor. Patients will be reviewed in clinic at 1 week and 6 weeks post-surgery. During these consultations, all patients will be assessed for scarring, diplopia, facial profile restoration and need for revision surgery. Discussion Many complications associated with surgical management of ZMC and ZA fractures involve poor aesthetic results as a direct consequence of inadequate fracture reduction. Inadequate fracture reduction is predictable given that small incisions are used and only limited visualisation of the fractures is possible during the procedure. This is due to a desire to limit scarring and reduce the risk of damage to vital structures in an aesthetically sensitive region of the body. It follows that an intraoperative adjunctive tool such as a CT scan, which can assist in visualisation of the fractures and the subsequent reduction, could potentially improve reduction and reduce complications. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000693426. Registered on 26 May 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3625-8) contains supplementary material, which is available to authorized users.

Complications related to lateral pterygoid muscle (LPM) botulinum toxin A (BtA) injection for recurrent temporomandibular joint dislocation are uncommon. No cases of velopharyngeal dysfunction (VPD) following LPM BtA injection have been reported to date. This report details the perioperative and follow-up findings for a patient developing VPD following LPM BtA injection.

Chondroid tenosynovial giant cell tumour (TGCT) is an extremely rare disease affecting the temporomandibular joint (TMJ). This report details the peri-operative findings and treatment with custom TMJ replacement of an initially misdiagnosed chondroid TGCT involving the TMJ.

Supplemental material, sj-docx-1-cjk-10.1177_20543581211055001 for Mainstreaming Genetic Testing for Adult Patients With Autosomal Dominant Polycystic Kidney Disease by Mark D. Elliott, Leslie C. James, Emily L. Simms, Priyana Sharma, Louis P. Girard, Kim Cheema, Meghan J. Elliott, Julie L. Lauzon and Justin Chun in Canadian Journal of Kidney Health and Disease

Supplemental material, sj-docx-2-cjk-10.1177_20543581211055001 for Mainstreaming Genetic Testing for Adult Patients With Autosomal Dominant Polycystic Kidney Disease by Mark D. Elliott, Leslie C. James, Emily L. Simms, Priyana Sharma, Louis P. Girard, Kim Cheema, Meghan J. Elliott, Julie L. Lauzon and Justin Chun in Canadian Journal of Kidney Health and Disease

The purpose of this study was to evaluate the effect of formulation and processing changes on the dissolution and bioavailability of propranolol hydrochloride tablets. Directly compressed blends of 6 kg (20,000 units) were prepared by mixing in a 16-qt V blender and tablets were compressed on an instrumented Manesty D3B tablet press. A half-factorial (2(5-1), Resolution V) design was used to study the following variables: filler ratio (lactose/dicalcium phosphate), sodium starch glycolate level, magnesium stearate level, lubricant blend time, and compression force. The levels and ranges of the excipients and processing changes studied represented level 2 or greater changes as indicated by the Scale-up and Post Approval Changes (SUPAC-IR) Guidance. Changes in filler ratio, disintegrant level, and compression force were significant in affecting percent drug released (Q) in 5 min (Q5) and Q10. However, changes in magnesium stearate level and lubricant blend time did not influence Q5 and Q10. Hardness was found to be affected by changes in all of the variables studied. Some interaction effects between the variables studied were also found to be significant. To examine the impact of formulation and processing variables on in vivo absorption, three batches were selected for a bioavailability study based on their dissolution profiles. Thirteen subjects received four propranolol treatments (slow-, medium-, and fast-dissolving formulations and Inderal 80 mg) separated by 1 week washout according to a randomized crossover design. The formulations were found to be bioequivalent with respect to the log Cmax and log AUC0-infinity. The results of this study suggest that (i) bioavailability/bioequivalency studies may not be necessary for propranolol and perhaps other class 1 drugs after level 2 type changes, and (ii) in vitro dissolution tests may be used to show bioequivalence of propranolol formulations with processing or formulation changes within the specified level 2 ranges examined.

We defined the pharmacokinetics of paclitaxel after i.v., i.p., p.o., and s.c. administration of 22.5 mg/kg to CD2F1 mice. Additional mice were studied after i.v. bolus dosing at 11.25 mg/kg or 3-h continuous i.v. infusions delivered at 43.24 micrograms kg-1 min-1. Plasma was sampled between 5 min and 40 h after dosing. Brains, hearts, lungs, livers, kidneys, skeletal muscles, and, where applicable, testicles were sampled after i.v. dosing at 22.5 mg/kg. Liquid-liquid extraction followed by isocratic high-performance liquid chromatography (HPLC) with UV detection was used to determine paclitaxel concentrations in plasma and tissues. After i.v. administration to male mice, paclitaxel clearance (CLtb) was 3.25 ml min-1 kg-1 and the terminal half-life (t1/2) was 69 min. After i.v. administration to female mice, paclitaxel CLtb was 4.54 ml min-1 kg-1 and the terminal t1/2 was 43 min. The bioavailability of paclitaxel was approximately 10%, 0, and 0 after i.p., p.o., and s.c. administration, respectively. Paclitaxel bioavailability after i.p. administration was the same when the drug was delivered in a small volume to mimic the delivery method used to evaluate in vivo antitumor efficacy or when it was delivered in a large volume to simulate clinical protocols using i.p. regional therapy. Paclitaxel was not detected in the plasma of mice after i.p. delivery of the drug as a suspension in Klucel: Tween 80. Pharmacokinetic parameters were similar after i.v. delivery of paclitaxel at 22.5 and 11.25 mg/kg; however, the CLtb calculated in these studies was much lower than that associated with 3-h continuous i.v. infusions. After i.v. administration, paclitaxel was distributed extensively to all tissues but the brain and testicle. These data are useful in interpreting preclinical efficacy studies of paclitaxel and predicting human pharmacokinetics through scaling techniques.

Ten patients with multiple sclerosis (MS) were enrolled in a preliminary trial of the potassium channel blocker, 3,4-diaminopyridine, to evaluate drug toxicity and pharmacokinetics. The patients were treated with oral 3,4-diaminopyridine, first with increasing single doses up to 100 mg and then with divided dosage for up to 3 weeks. Paresthesias were reported by all patients and abdominal pain was dose limiting in 6 patients. 3,4-Diaminopyridine levels and half-life varied widely from patient to patient. Cerebrospinal fluid levels of 3,4-diaminopyridine were about 10% of those in serum. Neither seizures nor epileptiform changes on electroencephalographic examination occurred. Small reversible improvements in specific neurological deficits were seen on examination in all patients and reversible improvement in visual evoked response latencies were found in 2 patients. These results suggest that further study of 3,4-diaminopyridine in patients with MS is warranted.

P synchronous pacing has long been identified as advantageous for patients with atrioveniricular conduction defects and intact sinus node function. Prior endocavitury systems have been infrequently employed, because of unreliable P wave sensing from standard ring electrodes in the atrium or the requirement for a second atriaJ sensing lead. A single endocardial lead employing a unipolar ventricular stimulating electrode and an orthogonal P wave sensing design was developed and tested in 22 patients undergoing electrophysiologic study or pacemaker implantation. Thirteen centimeters from the stimulating tip of a standard permanent pacing lead, three or four electrodes with a surface area of one millimeter squared, equidistant from the tip, were placed circumferentially about the catheter. With the catheter tip normally placed in the right ventricular apex, atrial sensing eJectrodes were positioned in the mid-high lateral right atrium, adjacent to, but not affixed to, the right atrial wall. Bipolar orthogonal leads X and Y were obtained. In 22 patients, during sinus rhythm, atrial electrogram voltages in the X axis of 2.47 plus or minus 1.6 millivolts and 2.32 plus or minus 1.6 millivolts in the Y axis were recorded. QRS voltages of 0.078 millivolts and 0.073 millivolts, respectively, allowed dramatic ability to discriminate P from QRS complexes (P/QRS equals 32/1). There was no change in QRS voltages recorded during spontaneous premature ventricular contractions, bipolar or unipolar ventricular pacing. A single catheter designed for P synchronous pacing empJoying circumferentially placed atrial sensing electrodes has demonstrated unique atrial sensing voltages with excellent QRS signal rejection. (PACE, Vol. 4, November-December, 1981)

Physostigmine, because of its potent parasympathomimetic action, has retained an important position in ophthalmic therapy since first used as a miotic by Laqueur (1876).1It is administered usually in an aqueous solution and less frequently in an ointment or lamella. The official preparation is physostigmine salicylate, although the sulfate, which possesses similar pharmacologic properties, is also available. This paper presents a comparison of the effectiveness of the various methods of local application, including iontophoresis and the use of a wetting agent. new method, its relative advantages and disadvantages must be carefully balanced. As part of the evaluation it is desirable to know the amount of drug entering the eye. Therefore a quantitative estimation was made of the physostigmine content of the aqueous humor of the rabbit's eye with different methods of application. No local or general deleterious effects were noted with any of the procedures described. A temporary corneal

Experimentally, the bacteriostatic effectiveness of sulfathiazole (2-[paraaminobenzenesulfonamido]-thiazole) in vitro is equal to, 1 and in many instances greater than, 2 that of sulfanilamide and other derivatives against infections produced by such organisms as Staphylococcus aureus, 3 Bacillus proteus, 1a Streptococcus (hemolytic), 4 Pneumococcus 5 (types I, II and III) 5 and Gonococcus. 2a It is reasonable to expect satisfactory clinical results in ophthalmology if an adequate concentration of the drug can be introduced into the ocular fluids and tissues. The experiments of Bellows and Chinn and others 6 have shown that oral therapy is inadequate. As far as is known, the local application of sulfathiazole has not been investigated experimentally. 7 The local application of other compounds of the group has met with limited experimental success. Except in the case of sulfanilamide, the concentrations obtained in the eye were too low to be of clinical value. Mengel 7a obtained a

Interference by salicylic acid was noted in a high pressure liquid chromatographic assay of theophylline in serum. The acid eluted very close to theophylline in a mobile phase consisting of 0.01 M acetate buffer, pH 4.0, containing 28% methanol on a C-18 reverse-phase column. The two peaks could be resolved by switching to a mobile phase containing 18% methanol, 1.6% acetonitrile, and 1.6% acetic acid in water. However, in this mobile phase traces of the extracting solvent, ethyl acetate, caused a sharpening of the theophylline peak leading to spuriously high results. The problem was overcome by using chloroform to extract the theophylline from serum.

A technique is described for potential use in the nonsurgical closure of patent ductus artcriosus. Occlusion is accomplished with an Ivalon umbrella, inserted via a catheter placed percutaneously into the femoral artery. The technique was tested in thirteen dogs with surgically created shunts closely simulating patent ductus arteriosus. In two cases, the Ivalon plug was undersize; and incomplete occlusion occurred, but without embolization of the plug. In one case, the umbrella embolized due to improper positioning. Several dogs with successfully occluded ductus were observed from two weeks to six months postoperative. In all cases, the ductus remained closed. The technique has potential application in patients with a small and long patent ductus.

Rapid changes occur in the ultraviolet spectra of tyrosine and tryptophan when they are interacted with mercuric acetate or chloride in aqueous solution. The changes result from an intensification and bathochromic shift in the spectra, as evidenced by peaks in the difference spectra at 286–778 mμ for tyrosine and at 297 mμ and 285–286 mμ for tryptophan. The spectral changes can be attributed to the formation of complexes of the amino acids with the mercuric ions. Additional but much slower changes occur when phosphate is present, and under these conditions changes occur in the spectra of compounds which showed no change with mercuric chloride in the absence of phosphate, as exemplified by N-acetyltryptophan. These slower changes are probably due to the formation of complexes involving both mercuric chloride and phosphate, and the rate of absorbance increase can be expressed by a rate law which is first-order in each of indole derivative, mercuric chloride, and phosphate. Third-order rate constants have been determined for N-acetyltryptophan and indole-3-n-propionic acid. Proteins such as β-lactoglobulin and ovalbumin also show spectral changes in the presence of mercuric salts even when phosphate is absent. These changes are not related to the reaction of mercuric ion with sulfhydryl groups but are probably due to structural changes resulting from the binding of mercuric ions to various sites in the proteins.

Commonly used commercially available plastic catheters were tested and compared for thrombogenicity in dogs. In addition, benzalkonium-heparin complex was applied as a coating to a polyurethane catheter for evaluation. All catheters were thrombogenic when exposed in vivo to arterial dog blood for one hour. The net thrombus weight was determined on an analytical balance. Benzalkonium-heparin coating prevented thrombus formation on polyurethane catheters for one hour. Until a truly nonthrombogenic plastic is found, systemic anticoagulants or heparin-bonding processes appear to be the only available means of preventing thrombus formation in clinical catheterization procedures.

Child Advocacy Centers (CAC) emphasize developing effective cross-agency collaborations between workers involved in serious abuse investigations to foster improvements in agency outcomes, and to minimize distress, confusion and uncertainty for children and families. This study examined the characteristics of CACs, whether models in practice match the predominant model presented in the research literature. Directors of CACs in the United States that were members of the National Children’s Alliance (NCA) mailing list (n = 361) completed an online survey in 2016. While some core characteristics were ubiquitous across CACs, the data suggests that different types of CACs exist defined by characteristics that are not prescribed under NCA principles, but which are arguably relevant to the quality of the response. From the results of a cluster analysis, the researchers propose a typology of CACs that reflects the development and integration of centers: (a) core CAC services (i.e. interviewing & cross-agency case review); (b) an aggregator of external services, and (c) a more centralized full-service CAC. Further research is needed to understand how these variations may impact practice and outcomes; this is particularly important considering many CACs do not match the full-service models most commonly examined in the research literature, which limits the degree to which these findings apply to CACs generally. This article proposes further research framed by the need to better understand how different parts of the response impact on outcomes for children and families affected by abuse. Refereed/Peer-reviewed

While awareness of institutional child sexual abuse has grown in recent years, there remains limited understanding of its occurrence and outcomes as a distinct form of abuse. Drawing on research commissioned by the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, this article presents a rapid review of available evidence on the impacts of institutional abuse on victim/survivors. Literature searches identified 75 sources spanning international peer reviewed work and reports to Government that document or quantify the impacts of mostly historical child sexual abuse occurring in religious, educational, sporting and residential or out-of-home care settings. Consistent with child sexual abuse in other contexts, institutional child sexual abuse is found to be associated with numerous, pervasive and connected impacts upon the psychological, physical, social, educative and economic wellbeing of victims/survivors. Further, institutional child sexual abuse is associated with vicarious trauma at the individual, family and community level, and with impacts to the spiritual wellbeing of victims/survivors of abuse that occurs in religious settings. The identified literature suggests the trauma of institutional child sexual abuse may be exacerbated by the interplay of abuse dynamics in institutional settings, which may reduce or impede circumstances supporting disclosure, belief, support and protection from future harm. Acknowledging the limitations of the present study and the available evidence, this narrative synthesis provides insights into the complex impacts of institutional child sexual abuse. Refereed/Peer-reviewed

The Child Advocacy Center (CAC) model has been presented as the solution to many of the problems inherent in responses by authorities to child sexual abuse. The lack of referral to therapeutic services and support, procedurally flawed and potentially traumatic investigation practices, and conflict between the different statutory agencies involved are all thought to contribute to low conviction rates for abuse and poor outcomes for children. The CAC model aims to address these problems through a combination of multidisciplinary teams, joint investigations, and services, all provided in a single child friendly environment. Using a systematic search strategy, this research aimed to identify and review all studies that have evaluated the effectiveness of the approach as a whole, recognizing that a separate evidence base exists for parts of the approach (e.g., victim advocacy and therapeutic responses). The review found that while the criminal justice outcomes of the model have been well studied, there was a lack of research on the effect of the model on child and family outcomes. Although some modest outcomes were clear, the lack of empirical research, and over reliance on measuring program outputs, rather than outcomes, suggests that some clarification of the goals of the CAC model is needed. Refereed/Peer-reviewed

While human service practice improvement is acknowledged as an important outcome of program evaluation, much evaluation is narrowly focused on accountability requirements. This type of evaluation often has limited use and relevance to human service practitioners. In exploring forms of evaluation that do have practice relevance, this article presents the experiences and perceptions of human service practitioners subject to evaluations that set out to foster learning. Across the cases participants expressed concerns about data quality and credibility, the relevance of evaluation data to the program context, the invasiveness of the evaluation, management of the process (particularly limited consultation with practitioners), and the lack of effective dissemination. These cases illustrate the challenges for evaluation to be useful to practice, and to foster meaningful improvements to services. Refereed/Peer-reviewed