Search

Senescence is a cell fate that contributes to multiple aging-related pathologies. Despite profound age-associated changes in skeletal muscle (SkM), whether its constituent cells are prone to senesce has not been methodically examined. Herein, using single cell and bulk RNA-sequencing and complementary imaging methods on SkM of young and old mice, we demonstrate that a subpopulation of old fibroadipogenic progenitors highly expresses p16(Ink4a) together with multiple senescence-related genes and, concomitantly, exhibits DNA damage and chromatin reorganization. Through analysis of isolated myofibers, we also detail a senescence phenotype within a subset of old cells, governed instead by p2(Cip1). Administration of a senotherapeutic intervention to old mice countered age-related molecular and morphological changes and improved SkM strength. Finally, we found that the senescence phenotype is conserved in SkM from older humans. Collectively, our data provide compelling evidence for cellular senescence as a hallmark and potentially tractable mediator of SkM aging.

Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (

Cellular senescence has emerged as a significant and potentially tractable mechanism of aging and multiple aging‐related conditions. Biomarkers of senescent cell burden, including molecular signals in circulating immune cells and the abundance of circulating senescence‐related proteins, have been associated with chronological age and clinical parameters of biological age in humans. The extent to which senescence biomarkers are affected by interventions that enhance health and function has not yet been examined. Here, we report that a 12‐week structured exercise program drives significant improvements in several performance‐based and self‐reported measures of physical function in older adults. Impressively, the expression of key markers of the senescence program, including p16, p21, cGAS, and TNFα, were significantly lowered in CD3+ T cells in response to the intervention, as were the circulating concentrations of multiple senescence‐related proteins. Moreover, partial least squares discriminant analysis showed levels of senescence‐related proteins at baseline were predictive of changes in physical function in response to the exercise intervention. Our study provides first‐in‐human evidence that biomarkers of senescent cell burden are significantly lowered by a structured exercise program and predictive of the adaptive response to exercise., Our study provides first‐in‐human evidence that biomarkers of senescent cell burden are significantly lowered by a structured exercise program and predictive of the adaptive response to exercise.

We present three medicolegal cases of medical negligence settled out of court. These cases all involved patients who presented to the emergency department (ED) with a suspected diagnosis of kidney stone. Highlighted are the importance of patient communication, addressing incidental findings found during a patient’s ED visit, anticipating complications, and the need for thorough documentation.

Background Few studies have been conducted on patterns of recurrence after resection for distal cholangiocarcinoma (DCC). The aim of this study was to investigate the incidence and pattern of recurrence after resection of DCC, and to evaluate prognostic factors for time to recurrence and recurrence-free survival (RFS). Methods Patients who underwent pancreatoduodenectomy with curative intent for DCC between 2001 and 2010 at one of 30 hospitals in Japan were reviewed retrospectively, with special attention to recurrence patterns. The Cox proportional hazards model was used for multivariable analysis. Results In the study interval, 389 patients underwent pancreatoduodenectomy for DCC with R0/M0 status. Recurrence developed in 213 patients (54·8 per cent). The estimated cumulative probability of recurrence was 54·3 per cent at 5 years. An initial locoregional recurrence occurred in 55 patients (14·1 per cent) and initial distant recurrence in 168 (43·2 per cent), most commonly in the liver. Isolated initial locoregional recurrence occurred in 45 patients (11·6 per cent). Independent prognostic factors for time to recurrence and RFS were perineural invasion (P = 0·001 and P = 0·009 respectively), pancreatic invasion (both P < 0·001) and lymph node metastasis (both P < 0·001). RFS worsened as the number of risk factors increased: the 5-year RFS rate was 70·6 per cent for patients without any risk factors, 50·3 per cent for patients with one factor, 31·8 per cent for those with two factors, and 13·4 per cent when three factors were present. Conclusion More than half of patients with DCC experienced recurrence after R0 resection, usually within 5 years. Perineural invasion, pancreatic invasion and positive nodal involvement are risk factors for recurrence.

Dr. Mark Mattson has had a highly productive and impactful tenure as a neuroscientist at the Intramural Research Program of the National Institute on Aging. He has made notable contributions to understanding the mechanisms by which energetic stress, imparted by behaviors such as physical activity and periods of fasting, promotes rejuvenation and resilience within brain regions critical for learning and memory. In honor of Dr. Mattson’s work, this manuscript will highlight the fascinating mechanisms by which endurance exercise training conveys beneficial effects upon the structure and function of the nervous system; that is, by mediating the synthesis and secretion of factors that directly support brain homeostasis, including brain-derived neurotrophic factor, FNDC5/irisin, ketone bodies, growth factors, cathepsin B, serotonin, and 4-hydroxynonenal. The molecular and cellular effects of these factors are discussed herein. In the face of population aging and an overwhelming surge in the prevalence of Alzheimer’s disease and related disorders, Dr. Mattson’s work as a champion and role model for physically active lifestyles is more important than ever.

Background Little is known about the value of portal vein (PV) resection in distal cholangiocarcinoma. The aim of this study was to evaluate the clinical significance of PV resection in distal cholangiocarcinoma. Methods Patients who underwent pancreatoduodenectomy (PD) for distal cholangiocarcinoma between 2001 and 2010 at one of 31 hospitals in Japan were reviewed retrospectively with special attention to PV resection. Short- and long-term outcomes were evaluated. Results In the study interval, 453 consecutive patients with distal cholangiocarcinoma underwent PD, of whom 31 (6·8 per cent) had combined PV resection. The duration of surgery (510 versus 427 min; P = 0·005) and incidence of blood transfusion (48 versus 30·7 per cent; P = 0·042) were greater in patients who had PV resection than in those who did not. Postoperative morbidity and mortality were no different in the two groups. Several indices of tumour progression, including high T classification, lymphatic invasion, perineural invasion, pancreatic invasion and lymph node metastasis, were more common in patients who had PV resection. Consequently, the incidence of R1/2 resection was higher in this group (32 versus 11·8 per cent; P = 0·004). Survival among the 31 patients with PV resection was worse than that for the 422 patients without PV resection (15 versus 42·4 per cent at 5 years; P < 0·001). Multivariable analyses revealed that age, blood loss, histological grade, perineural invasion, pancreatic invasion, lymph node metastasis and surgical margin were independent risk factors for overall survival. PV resection was not an independent risk factor. Conclusion PV invasion in distal cholangiocarcinoma is associated with locally advanced disease and several negative prognostic factors. Survival for patients who have PV resection is poor even after curative resection.

Systemic amyloid-A (AA) amyloidosis in birds occurs most frequently in waterfowl such as Pekin ducks. In chickens, AA amyloidosis is observed as amyloid arthropathy. Outbreaks of systemic amyloidosis in flocks of layers are known to be induced by repeated inflammatory stimulation, such as those resulting from multiple vaccinations with oil-emulsified bacterins. Outbreaks of fatal AA amyloidosis were observed in growing chickens in a large scale poultry farm within 3 weeks of vaccination with multiple co-administered vaccines. This study documents the histopathological changes in tissues from these birds. Amyloid deposits were also observed at a high rate in the tissues of apparently healthy chickens. Vaccination should therefore be considered as a potential risk factor for the development of AA amyloidosis in poultry.

The aim of this study was to assess whether the application of a lightweight mesh for mesh plug repair (MPR) for primary inguinal hernia could reduce chronic pain or other symptoms associated with the insertion of the prosthesis. Patients over 20 years of age with a unilateral primary inguinal hernia were eligible to participate in the study. The patients were randomly assigned to a lightweight mesh (LWM) or a heavyweight mesh (HWM) group. All the operations were performed under local anesthesia. The operative details, including the hernia type and the nerves that were identified, and the postoperative complications were recorded. All follow-up and outcome measures were obtained based on a physical examination and a questionnaire regarding pain and other symptoms at 1 week, 1, 3, 6, and 12 months after the surgery in a double-blinded manner. The use of LWM significantly reduced foreign body sensation after 12 months to one-third of the incidence reported for the use of HWM (5.8 vs. 17.9 %; P = 0.013), while no significant differences were found in pain parameters, including the use of pain relief medications, between the groups throughout the study period. This study indicated that the use of LWM in the MPR decreases the incidence of foreign body sensation at 1 year after surgery for primary inguinal hernia. LWM may be preferable to MPR, similar to results described previously for Lichtenstein repair.

Background and study aims: Acute colorectal obstruction (ACO) often accompanies colorectal cancer (CRC) and requires urgent treatment, but achieving elective laparoscopy-assisted colectomy (LAC) is difficult in this setting. The aim of the current study was to assess the clinical outcomes of a transanal tube (Dennis colorectal tube [DCT]) for CRC with ACO, focusing in particular on the impact of the DCT on subsequent elective LAC. Patients and methods: Among 1142 patients who underwent surgery for CRC between January 2007 and December 2011, 92 patients with ACO were identified retrospectively. Of these 92 patients, the DCT procedure was performed in 66 patients who fulfilled the indications for DCT, and these patients were included in the study. Results: All 66 patients presented with complete obstruction. Technical and clinical success rates for DCT were 93.9 % and 86.4 %, respectively. Perforation after DCT occurred in 4.5 % and the mortality rate was 1.5 %. The rate of LAC was 48.5 %, and the rate of primary stoma was 13.6 %. For curative stage II/III CRC with ACO, DCT resulted in a primary stoma rate of 13.6 %, a one-stage surgery rate of 90.9 %, a LAC rate of 50.0 %, and a 3-year survival rate of 73.1 %. For stage II/III CRC cases with clinical success by DCT, the one-stage surgery rate was 97.4 % and the LAC rate was 56.4 %. Conclusions: DCT achieved a high rate of clinical success and enabled safe one-stage surgery and LAC for CRC with ACO. DCT followed by LAC is proposed as a promising non-invasive strategy for CRC with ACO.

Introduction: The effect of in vitro fertilization (IVF) on neurodevelopmental outcome is unclear. Probably, IVF does not affect traditional measures of neurological development in infancy, but little is known on long-term effects. Recently a new video-based instrument to evaluate neuromotor development was developed. The Infant Motor Profile (IMP) evaluates neuromotor condition in infants in terms of the quality of spontaneous motor behaviour. The IMP does not only assess traditional neuromotor domains, such as performance, symmetry and movement fluency, but also two novel domains: variation and variability. Movement variation denotes the size of the child's movement repertoire. Previous studies demonstrated that reduced movement variation is associated with early lesions of the periventricular white matter and - more generally - reflects the integrety of cortical connectivity. In addition, reduced variation during infancy is associated with neurodevelopmental disorders in later life and reduced intelligence at school age. Variability denotes the child's ability to select from the repertoire of movements the strategy that suits the situation best. In this prospective, assessor-blinded cohort study, we address the question whether ovarian hyperstimulation and/or the in vitro procedure affect movement variation during infancy. Material and Methods: Singletons born following IVF with conventional controlled ovarian hyperstimulation (COH-IVF, n = 68), following IVF in a modified natural cycle (MNC-IVF, n = 57) and following natural conception born to subfertile couples (Sub-NC, n = 90) were assessed with the IMP at 4, 10 and 18 months. The assessment resulted in a total IMP score and 5 domain scores: variation (i.e. the size of movement repertoire), variability (i.e. the ability to select motor strategies), symmetry, fluency and performance. Primary outcome was the domain score variation. Outcome variables were analyzed with a mixed effects model. Results: The mixed model indicated an overall effect of treatment on variation (p Conclusions: The preliminary data suggest that ovarian hyperstimulation may be associated with reduced movement variation in infancy. These findings stress the need to carefully monitor neurodevelopment in IVF offspring.

Chin-tuck position and reclining posture have been used in dysphagia patients to prevent aspiration during swallowing. However, both behavioural treatments may affect respiratory function. This study was carried out to test the hypothesis that if chin-tuck posture and body reclining affected respiratory function, this would be associated with altered coordination between respiration and swallowing. To investigate this hypothesis, respiratory parameters and manometry were used in each of four combinations of reclining posture and chin-tuck position. In the 60 degrees reclining with 60 degrees chin-tuck position, duration of swallowing apnea (0.89 s.d. 0.17 s) and submental electromyography burst (2.34 s.d. 0.84 s) were significantly longer when compared to both upright sitting and 30 degrees reclining positions. We conclude that 60 degrees reclining from vertical with 60 degrees chin-tuck may affect oral processing stages which delay and reduce a variety of oropharyngeal movements. These in turn significantly influence the coordination between respiration and swallowing.

A new input function monitoring system has been developed using the GSO detector assembly for both PET and SPELT quantitative studies. Due to the rapid rise time of the pulse (about 10nsec), the coincidence time window can be reduced < 1nsec, reducing contribution of randoms associated with the high background activity surrounding the detector. Large light output improved the energy resolution of approximately 11% for 511keV photons, and 20% at 140 keV, as compared with the BGO detector, enabling the use of this system also in SPELT studies. The paired assembly of crystals provided the absolute sensitivity of approximately 7% for PET and 75% for PET tracers. Multiple arrangement of the paired detectors provided possibility of correcting for the transit time of radioactivity through the catheter tube. This study demonstrated that the present system can be of use in both clinical and small animal studies using SPECT and PET tracers.

Vasotocin-producing parvocellular neurones in the medial part of the bed nucleus of the stria terminalis (BSTM) of many species of birds and mammals show sexual dimorphism and great plasticity in response to hormonal and environmental stimuli. In the BSTM of Japanese quail, vasotocin-immunoreactive neurones are visible and sensitive to testosterone exclusively in males. In males, gonadectomy decreases and testosterone restores vasotocin-immunoreactive cells and fibres by acting on vasotocin mRNA transcription. The insensitivity of female vasotocin-immunoreactive neurones to the activating effects of testosterone is the result of organisational effects of early exposure to oestradiol. Female quail also show vasotocin mRNA-expressing neurones in the BSTM, although it is not known whether the insensitivity of the vasotocinergic neurones to testosterone originates at the level of vasotocin gene transcription in this sex. Therefore, initially, the present study analysed the effects of acute treatment with testosterone on vasotocin mRNA expression in the BSTM of gonadectomised male and female quail using in situ hybridisation. Gonadectomy decreased (and a single injection of testosterone increased) the number of vasotocin mRNA-expressing neurones and intensity of the vasotocin mRNA hybridisation signal similarly in both sexes. Notably, testosterone increased vasotocin mRNA expression in ovariectomised females over that shown by intact quail. However, this treatment had no effect on vasotocin immunoreactivity. A second experiment analysed the effects of testosterone metabolites, oestradiol and 5α-dihydrotestosterone, on vasotocin mRNA expression in female quail. Oestradiol (but not 5α-dihydrotestosterone) fully mimicked the effects of testosterone on the number of vasotocin mRNA-expressing neurones and the intensity of the vasotocin mRNA hybridisation signal. Taken together, these results show, for the first time, that gonadal steroids strongly activate vasotocin mRNA expression in the BSTM of female quail.

It has been proposed that advancement of the mandible is a useful method for decreasing upper airway collapsibility. We carried out this study to test the hypothesis that mandibular advancement induces changes in upper airway patency during midazolam sedation. To explore its effect, we examined upper airway pressure-flow relationships in each of 4 conditions of mouth position in normal, healthy subjects (n = 9). In the neutral position, Pcrit ( i.e., critical closing pressure, an index of upper airway collapsibility) was −4.2 cm H2O, and upstream resistance (Rua) was 21.2 cm H2O/L/sec. In the centric occlusal position, Pcrit was −7.1 cm H2O, and Rua was 16.6 cm H2O/L/sec. In the incisor position, Pcrit was significantly reduced to −10.7 cm H2O, and Rua was significantly reduced to 14.0 cm H2O/L/sec. Mandibular advancement significantly decreased Pcrit to −13.3 cm H2O, but did not significantly influence Rua (22.1 cm H2O/L/sec). We conclude that the mandibular incisors’ position improved airway patency and decreased resistance during midazolam sedation.

Sedative doses of anesthetic agents affect upper-airway function. Oral-maxillofacial surgery is frequently performed on sedated patients whose mouths must be as open as possible if the procedures are to be accomplished successfully. We examined upper-airway pressure-flow relationships in closed mouths, mouths opened moderately, and mouths opened maximally to test the hypothesis that mouth-opening compromises upper-airway patency during midazolam sedation. From these relationships, upper-airway critical pressure (Pcrit) and upstream resistance (Rua) were derived. Maximal mouth-opening increased Pcrit to −3.6 ± 2.9 cm H2O compared with −8.7 ± 2.8 (p = 0.002) for closed mouths and −7.2 ± 4.1 (p = 0.038) for mouths opened moderately. In contrast, Rua was similar in all three conditions (18.4 ± 6.6 vs. 17.7 ± 7.6 vs. 21.5 ± 11.6 cm H2O/L/sec). Moreover, maximum mouth-opening produced an inspiratory airflow limitation at atmosphere that was eliminated when nasal pressure was adjusted to 4.3 ± 2.7 cm H2O. We conclude that maximal mouth-opening increases upper-airway collapsibility, which contributes to upper-airway obstruction at atmosphere during midazolam sedation.

A new input function monitoring system has been developed using a GSO detector for both PET and SPECT quantitative studies. The paired assembly of crystals provided an absolute sensitivity of approximately 7% for PET tracers and 70% for /sup 99m/Tc and /sup 201/Tl (SPECT tracers). This system was applied to clinical use and animal study such as monkey and rat. This study demonstrates that the present system can he of use in both clinical and small animal studies using SPECT and PET tracers.

We present an evolutionary modeling method for modeling genetic regulatory networks. The method features a hybrid algorithm of genetic programming with statistical analysis to derive systems of differential equations. Genetic programming and the least mean squares method were combined to identify a concise form of regulation between the variables from a given set of time series. Results of multiple runs were statistically analyzed to indicate the term with robust and significant influence. Our approach was evaluated in artificial data and real world data.

Describes an evolutionary method for identifying a gene regulatory network from the observed time series data of the gene's expression. We use a system of ordinary differential equations as a model of the network and infer their right-hand sides by using genetic programming (GP). To explore the search space more effectively in the course of evolution, the least mean squares (LMS) method is used along with ordinary GP. We apply our method to three target networks and empirically show how successfully GP infers the systems of differential equations.

Diagnosis of fungal infections in compromised hosts has been difficult because of insufficient sensitivity and specificity of conventional methods such as culturing and serum testing. Therefore, antifungal agents are usually started in febrile patients who are resistant to antibiotics even if these monitoring tests were negative. In this study, therefore, in order to increase the reliability of these monitoring, polymerase chain reaction (PCR) methods for detection of blood fungus were also performed in compromised hosts including 14 patients with hematological malignancies and one with solid tumor who were undergoing chemotherapies. From these patients, total of 56 peripheral blood samples was collected periodically, irrespective of the presence of infectious signs. At each time point of venopuncture, status of the patient was allocated to one of the followings: A, receiving an intravenous antifungal therapy because of sustaining fever which had not responded to prior antibiotic therapies and also positive for culturing and/or serum beta-D-glucan tests; B, receiving an additional intravenous antifungal therapy but negative for culturing and serum-tests; C, febrile but not yet receiving any intravenous fungal therapy; D, afebrile status. During the study, 10 blood samples from 3 patients were allocated in group A, and one sample of them was positive while remaining 9 were all negative for PCR. Six samples from 4 patients were in group B, and one was PCR positive while remaining 5 were negative. Fifteen samples from 7 patients were in group C, and 3 were positive and 12 were negative for PCR. Twenty-five samples were in group D, and 5 were positive and 20 were negative for PCR. Thus, the results from fungal PCR in these patients were in some case showed discrepancies from those expected from the clinical course and/or conventional monitoring tests. Further evaluation of fungal PCR may gain insight into the more precise diagnosis of fungal infection in these patients.

Publisher Summary This chapter discusses the application of natural zeolites to purify polluted river water. The ability of zeolites to purify wastewater is compared with that of regular river gravel, which has no ion exchange ability. The results show that calcium (Ca)-rich mordenite is superior to normal river gravel to purify waste river water polluted by ammonium ions. The decrease of ammonium ions in polluted water is a result not only of ion exchange with calcium ions in zeolite, but also of microbiological oxidation on the surface of zeolite. The ability of natural zeolites to oxidize ammonium ions into nitrate ions is a function of the zeolite contents of minerals and the type of zeolite species.

A 22-year-old male was admitted to our hospital with abrupt onset of upper abdominal pain. Abdominal US and CT revealed dilatation of the small intestine between the abdominal wall and a lateral segment of the liver. After a diagnosis of an internal hernia through a defect in the falciform ligament, emergency surgery was performed. Laparoscopic investigation showed incarceration of the small intestine in a defect of the falciform ligament. After releasing an incarceration, the hernia orifice was opened to prevent relapse. He was discharged on the 4th postoperative day. Internal hernia through a defect in the falciform ligament is extremely rare, with six reported cases including our own in Japan. Characteristic images of abdominal US and CT enable preoperative diagnosis of this condition. Surgery should be performed at an early stage after onset. In patients with no prior history of surgery, laparoscopic techniques may be useful.

Cholangitis is a risk factor for posthepatectomy liver failure and therefore should be treated aggressively by urgent biliary drainage before definitive liver surgery for bile duct carcinoma. We present a case of bile duct carcinoma of the hepatic hilus with segmental cholangitis. The patient was a 38-year-old man. Percutaneous transhepatic biliary drainage (PTBD) was performed in the left anterior, right anterior, and right posterior segmental ducts to alleviate jaundice and to evaluate the biliary system. One month after PTBD, the patient developed high fever with leukocytosis, suggesting the onset of segmental cholangitis. An urgent repeat PTBD was carried out at the caudate and left medial segmental bile ducts. The bile juice was purulent, and the tube cholangiogram revealed miliary abscesses. After PTBD, cholangitis was subsided, and extended left hepatic lobectomy with caudate lobectomy was performed. The postoperative recovery was uneventful and the patient has been well for 13 months. We conclude that the onset of fever in patients with hilar bile duct cancer, PTBD catheters, and undrained biliary segments suggests the presence of segmental cholangitis.

A 64-year-old woman who had undergone surgery for gallstones twice was admitted with epigastric pain and fever. Ultrasonography revealed gallstones in the dilated left lateral intrahepatic bile ducts. Abdominal computed tomography disclosed atrophy of the left lateral segment and the right lobe of the liver, and hypertrophy of the left medial segment and the caudate lobe. Percutaneous transhepatic cholangiography demonstrated that the stones were localized in the left lateral intrahepatic bile ducts, and that the choledochoduodenostomy previously established was patent. Percutaneous transhepatic portography revealed that the left portal vein was absent and the left medial segment was supplied by the right portal vein. Left lateral hepatic segmentectomy and release of the choledochoduodenostomy were performed. Postoperative recovery was good, and the patient is now well without any complaint. This report discusses the surgical treatment for intrahepatic stones under very complicated conditions and the relationship between intrahepatic stones and anomalous portal venous system.

An unusual case of an ameloblastoma with adenoid-cribriform features arising in calcifying odontogenic cyst is reported. A possible relationship between this peculiar variant of calcifying odontogenic cyst and a conventional ameloblastoma is discussed.

We succeeded satisfactorily to restore the occlusal function by use of an osseointegrated implant following iliac bone grafting and partial mandibulectomy in 4 patients who underwent surgical resection of odontgenic cyst and benign or malignant tumor of the oral cavity. Case 1: The patient was a 19-year-old man. Partial resection of the mandible was carried out under the diagnosis of odontgenic keratocyst of the left lateral incisor to the 1st premolar region. Iliac bone grafting was performed as secondary surgery. After confirmation of the fusion of the grafted bone, the occlusal function was restored by use of an osseointegrated implant. Case 2: The patient was a 36-year-old man. After segmental resection of the mandible under the diagnosis of ameloblastoma of the left 2nd premolar to the right 2nd premolar region, mandibular reconstruction was carried out with an A-O plate. Iliac bone grafting was performed as secondary surgery. After fusion of the grafted bone had been confirmed, the A-O plate was remounted and the fixture was immediately implanted. Five months later, vestibuloplasty by free skin grafting and attachment of the abutment were carried out. A superstructure was mounted. Case 3: The patient was a 22-year-old woman. The histopathologically confirmed odontogenic myxoma in the right mandible posteriorly from the second premolar was resected. Immediate reconstruction of the mandible was carried out by use of an iliac bone graft. After confirmation of the fusion of the grafted bone, the occlusal function was restored by use of an osseointegrated implant. Case 4: The patient was a 57-year-old woman with carcinoma of the right lingual margin and mouth floor. The tumor was resected with the mandibular margin. Immediate reconstruction of the tongue and mouth floor with a major pectoral muscle skin flap was carried out. In the absence of evidence of recurrence, restoration of the occlusal function was attempted with an osseointegrated implant.

Use of both the oral surgeon and the orthodontist to treat the oral problems of the patient with cleidocranial dysostosis is demonstrated in this case report. Treatment of oral conditions associated with cleidocranial dysostosis is discussed in the following three reports of cases. The first by Miller and associates concerns collaboration between the oral surgeon and orthodontist; the second by Weintraub and Yalisove emphasizes prosthodontic therapy; and the third by Maw, oral surgery and prosthodontics. The rationale and objectives for treatment in each particular case are given, and restoration of function and appearance by the multidisciplinary approach is emphasized.

A 47-year-old woman had a swelling in the floor of the mouth and in the submandibular area on the left side. About four hours earlier, a dentist had extracted the mandibular left second premolar and first molar. The rate and degree of the distension were alarming; the floor of the mouth was at a level with the incisal edges of the mandibular incisors. Five hours later, the floor of the mouth was elevated about 1 1/2 cm above the incisal edges of the teeth. Treatment of the patient and her unusual sensitivity to meperidine and promethazine that caused a depression into Cheyne-Stokes respiration and hypotension are described.