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The aim of this clinical study was to evaluate the treatment skeletal effects induced by Twin Block in the therapy of Class II malocclusion during or slightly after the onset of the puberal peak in the growth. The study sample was obtained from the records of the author’s private practice and consisted of a parent sample of 70 Class II division 1 subjects treated consecutively with the Twin-block appliance, from which good quality lateral cephalograms were available. From this sample, 23 subjects (Study Sample) 8 males and 15 females, were selected according to the following inclusion criteria: ANB greater than or equal to 4°, full Class II or end-to-end molar relationships, no history of previous orthodontic treatment or surgery treatment, absence of congenital anomalies, same Caucasian race. All patients received active treatment with Twin-block before or during their pubertal growth spurt, as assessed by the cervical vertebral maturation (CVM) method. Lateral cephalograms for each subject was digitized by a single author (AL) respectively at time 1 (T1), immediately before treatment, (mean age 10.0± 1.1years) and at time 2 (T2) immediately after treatment (mean age 12.0 ± 1.1 years). The error of the method was calculated with the formula described by Dahlberg (1940). In addition systematic error and the coefficient of reliability were determined as suggested by Houston. The Control Group consisted of untreated Class II subjects. A modification of the Twin-block appliance, originally developed by Clark, was used in this study. In the present study the mean duration of the Twin -block treatment was 1.2 ± 0.5 years. Results of the statistical comparisons between Study Sample (treated subjects) and Control Group (untreated subjects) on the changes for all cephalometric variables during the T1–T2 observation showed significantly favorable changes: the total mandibular length (Co-Me) and ramus height (Co-Go) and corpus length (Go-Me) increased more in cases than in controls. Our results show a significantly higher average answer in the Study Sample, both in the paired t- test, comparing pre and post treatment, and in the unpaired t- test, comparing the Study Sample and the Control Group. Paired t- test data for the variables Co-Me, Co- Go, Go- Me, with a P=.05 significance level, lead us to reject the null hypothesis (differences average = 0) in favor of the alternative of a positive differences average, meaning that the average of the values is higher after the treatment.

Osteoplant, an equine flexible cortical and spongy bone tissue, is a promising material for bone grafting in orthopedic, maxillofacial and dental surgery. Osteoplant is completely resorbable, inducing oteoclast activation and promoting the substitution of the scaffold with new bone. To study how Osteoplant can induce osteoblast differentiation in mesenchymal stem cells, the expression levels of bone related genes and mesenchymal stem cells marker were analyzed, using real time Reverse Transcription-Polymerase Chain Reaction. Osteoplant is an inducer of osteogenesis on human stem cells, as showed by the activation of bone related genes ALPL, SPP1 and RUNX2, and by the down-regulation of the mesenchymal stem cells marker ENG.

Peptide-15 (P-15) is. P-15 an analog of the cell binding domain of collagen, has been shown to facilitate physiological process in a way similar to collagen, to serve as anchorage for cells, and to promote the binding, migration and differentiation of cells. However, how P-15 alters osteoblast activity to promote bone formation is poorly understood. In this study we investigated the osteo-inductives properties of P15 on stem cells derived from bone marrow. In Real Time Reverse Transcription-Polymerase Chain Reaction (real time RT-PCR) we quantified the mRNA expression of specific genes, like transcriptional factors (RUNX2 and SP7), bone related genes (SPP1, COL1A1, COL3A1, ALPL, and FOSL1) and mesenchymal stem cells marker (ENG). Gene expression in BMSC was then compared with the gene expression in Human Osteoblasts (HOb) treated with P15, to evaluate the potential effect of this biomaterial in osteoblasts differentiation.

Many orthodontic appliances comprise a number of elements soldered together. This technique is known as brazing and has now been in use for over thirty years, although today laser welding is increasingly widespread. Biocompatibility of alloys contained in orthodontic appliances has become a hotly-debated issue and previous studies have shown that it depends on the products of alloy corrosion and their effects on the oral cavity. The present study is intended to compare the corrosion resistance of stainless steel when traditionally soldered - i.e, brazed - and when laser-welded. Samples comprising stainless steel band strips and Remanium® wire were soldere d together traditionally (i.e. brazed) and laser-welded and were then left in artificial saliva for 7 days at 37±1 degrees . Corrosion was studied by: a) SEM observation of sample surface morphology before (TO) and after standardized immersion test (Tl); b) X-ray micro analysis (EDAX). SEM observat ion of the brazed samples showed surface corrosion, which was not visible in the laser-welded samples. Our study shows that laser-welded samples have superior resistance to corrosion. Copyright © by BIOLIFE, s.a.s.

The aim of the study is to compare morphological features and to evaluate wetting capabilities of two fiber-reinforced composites (FRCS); group A: Stick Tech(R), by Stick Tech Ltd, Turku, Finland, and group B: Ribbond(R), by Ribbond Inc., Seattle, Washington, USA, used in orthodontic retention, by scanning electron microscope (SEM). 6 groups were identified in relation to the fiber used, A: Everstick(R), B: Ribbond(R), and to the different times of exposition to a fluid wetting resin (Heliobond(R), by Schaan, Liechtenstein): A1-B1=0 seconds, A2-B2=5 seconds, A3-B3=5 minutes. Wetting was followed by 40 seconds of light curing with a conventional halogen curing light Optilux 501(R) (d) with a light intensity of 930 mW|cm(2) and a wavelength range of 400-505 nm Samples were SEM analyzed both in cross section and lengthwise. SEM observation revealed a lengthwise direction of cylindrically shaped fibers immersed in a metacrylate matrix in group A1 and straight but woven fibers in group B1. In both control groups voids ranging between 0 mu m and 20 mu m were visible between the fibers and groups of fibers. Groups A2 and B2 showed uniform coverage with Heliobond(R) and microcracks were visible. In cross section views it is apparent that wetting with Heliobond(R) for just 5 seconds was not sufficient for the adhesive to impregnate the fibers deeply. Groups A3 and B3 revealed a deeper penetration of Heliobond(R); voids ranging between 5 mu m and 15 mu m could be observed only in the deepest portion of the fiber. The fiber's preparation plays a decisive role: a longer fiber wetting time with fluid resin before curing, enhances the morphological features of FRC, making them more suitable for passive and active orthodontic systems, periodontology or prosthetic dentistry

Warthin’s tumor is the second most common benign neoplasm of the parotid. Most of cases are represented by a single localization, while only a small percentage of patients presents bilateral lesions or unilateral multifocal pattern. Warthin’s tumor has an excellent prognosis due to the low rate of recurrence after surgical treatment. Malignant transformation occurs in less than 1% of cases. The aim of this article is to present two unusual cases of Warthin’s tumor and an updated review of the latest scientific literature.

Experience in the treatment of acute cholecystitis with percutaneous cholecystostomy in 29 high-risk and elderly patients is reported. The treatment group included 14 men and 15 women, 21 of whom were over 70 years of age. The suspected clinical diagnosis of acute cholecystitis was confirmed in all cases by ultrasonography (accuracy: 95.6%). The percutaneous cholecystostomy was successful in 27 of 29 cases and these patients had a sudden improvement in their clinical condition; failure of the procedure was due in one patient to dislodgement of the catheter and in another patient to the guide-wire slipping out of the gallbladder. Six patients complained of pain radiating to the right shoulder which disappeared within 30-60 minutes after the procedure. Twenty-three of the 27 patients subsequently underwent elective cholecystectomy. In 22 patients the ultrasonographic findings were compared with the histology; thus enabling us to establish an ultrasonographic staging of acute cholecystitis related to the seriousness of the disease. Percutaneous cholecystostomy is the treatment of choice in high-risk patients, in the elderly, as well as in young patients with impending perforation.

In Europe there are about 300,000 paraplegics and in every country approximately 1000 new cases per year. Treatment requires a multidisciplinary approach with scientific cooperation targeted to exchange personal knowledge and expertise. At present a completely disrupted spinal cord cannot heal for recovery of motor and/or sensory functioning, although some promising treatment modalities in laboratory animal experiments have been reported. No interventional stem cell procedure so far has shown evidence to restore impaired functioning in human paraplegics. However, functional electrical stimulation (FES) via an implanted neuroprosthesis (SUAW concept) and central nervous system-peripheral nervous system (CNS-PNS) connection have successfully been used for alternative compensatory strategies for voluntary locomotion. This report is to analyse the authors' experience from two European projects in paraplegic. Factors will be identified that might have caused the one or other pitfall since so far both surgical reconstructive procedures have not been adopted by rehabilitation physicians and/or restorative (neuro-)surgeons despite the promising functional results we have achieved. Unexpected plasticity of single neurons following CNS-PNS by-pass procedures is discussed. Future interventions, for example the present phase 1 prospective multiple centre study on the side effects, effectiveness, and reliability of intrathecal treatment of anti-Nogo-A antibodies, are presented and the Chinese stem cell implantation is critically reviewed.

This short paper demonstrates that the Finkelstein's test in De Quervain's tenosynovitis is based on an incorrect assumption. The correct basis for a pathognomic manoeuvre in De Quervain is the provocation of tendons attrition of the first wrist dorsal compartment against their pulley which elicits pain. The Brunelli's test induces this friction and pain by asking the patient to hardly adduct the thumb with the wrist in radial deviation.

Paraplegia means a live long sentence of sensory loss, paralysis and dependence with approximately 1000 new victims in every European country every year and 11.500 new traumatic SCI cases in the US. respectively. Sixty percent are injured before age 30. More than 90% of SCI victims may survive with nearly normal experience of live. Most patients will recover somewhat from SCI over time but no patient who remained plegic for one year regains voluntary motor function after that time period. Despite remarkable efforts and recent achievements in rehabilitation no treatment can be recommended so far to enhance functional recovery and restoring locomotion in paraplegic humans. FES as a technical compensation has become therefore a challenging treatment to restore muscle function and to prevent atrophy and to improve mobility and quality of life at the same time. In paraplegics FES could be the basis to restore locomotion. One of the advantages of an implanted FES version (neuroprosthesis) is that the FES system, electrodes, and cables remain permanently implanted within the body, so that the patient can stay without cables, the programmer attached to the crutches. The SUAW project, supported under BIOMED II Programme by the European Community was aimed to finalize and to put into practice the results of previous research and development. The novel implant with an ASCI-Chip has 16 channels, 8 on each side, 20 mA for monopolar and 2 mA for bipolar stimulation, only one electrode can be stimulated at a given time. Stimulation of 6 muscle groups of both legs are known to be sufficient for locomotion: M. ileopsoas (erector of the body, hip flexor), M. gluteus maximus (hip extensor), M. gluteus medius (lateral hip stabilisator, knee abductor), Mm. hamstrings (knee flexor) stimulated by epimysial electrodes, Mm. sartorius and rectus femoris (knee extensor) stimulated by neural, bipolar electrodes. Patient's selection criteria were: stable spinal cord lesion between T7 and T11, minimum 1 year after the accident without deformity of the spine, the muscle groups for locomotion responding to external FES with the EXOSTIM programmer with the same programme used later for the neuroprosthesis. Two paraplegic male patients, T8, 38 and 31 years old respectively, were operated on by an international group of surgeons according to the protocol in 09/1999, respectively 7/2000. The postop. course was uneventful. Because the threshold of the primary implant was too low regarding scare tissue around the electrodes, this implant was changed in 01/2000 and worked perfectly. Both patients are happy with the success of the novel treatment modalities.

The International Headache Society (IHS) classification system (1988) was developed primarily for headache disorders in adults and its validity for paediatric age is currently under discussion; in 1995 Seshia et al. proposed a revision of the criteria for migraine without aura to make diagnostic criteria more applicable to children. The purposes of the current study were to: (1) compare the IHS classification with the Seshia proposal, (2) compare the children affected by migraine without aura (MO) with the children affected by tension headache (TH) as defined by Seshia, for characteristics which are not included in the classification. The patients are a series of 320 children (mean age 9.9, SD 2.6 years; 144 males, 176 females) with recurrent or chronic headaches referred to a headache clinic in Milan, Italy. Using the Seshia criteria instead of the IHS criteria a higher number of children were included in the MO category: bilateral pain and family history of migraine were the most important factors which allowed a shift of children into this category. However, with the Seshia classification there was no reduction in the number of unclassifiable children. The reason why some children could not be classified was a short duration of attacks; the majority of unclassifiable children were 6 years old or less. No relevant difference was found between children with MO and children with TH for the following variables: occurrence of attacks in the afternoon or evening after school, reduction of attacks during school holidays, full-time schooling, after-school activities on school days, disordered daily life. On the contrary children with MO when compared with those with TH showed a higher number of precipitating factors and for the following factors a significant difference was found: exposure to TV or a computer, sleep deficiency, and strong emotions. Furthermore, children with MO showed a greater severity of attacks.

We have used this vascularised bony graft mainly for recurrent pseudarthrosis of the scaphoid bone. An account of our series will be the subject of a future publication. The use of the vascularised pedicle graft at the expense of the head of the second metacarpal has seemed to us to give encouraging results. The technique, although meticulous, is simple to carry out. The good vascularisation of the graft is assured through the large amount of fatty and connective tissue around the base of the pedicle. The use of vascularised bone in hand surgery has been shown to be useful. This graft, easy to raise, has through the length of its pedicle, a limited displacement. Other donor sites do not have the advantages described here.

The arterial supply of the dorsal surface of 25 thumbs was studied by light microscopy. An artery, located on the dorso-ulnar side and connecting the head of the first metacarpal bone with the dorsal arcade of the nail matrix, was constantly found in all dissections. The authors report the results of the anatomical study and the clinical applications of a skin flap which can be raised on the dorso-ulnar surface of the M.P. joint with a distal pedicle. Clinical experience is based on 22 flaps. In 18 cases this flap was used for distal skin loss coverage (palmar or dorsal) of the thumb as an island flap. In 4 cases it was used for reconstruction of the finger pulp in the form of a cross finger flap.

The authors point out how infection of heterologous prosthesis, widely used in surgery, can be a dramatic event. On the other hand, antibiotic prophylaxis is difficult because of the difference between "in vitro" and "in vivo" activity of many antibiotics, due to the production, by many bacteria, of the so-called glycocalyx. This would allow bacteria to clump and adhere to many surfaces, forming micro-colonies, causing delay in phagocytosis, and reducing the efficacy of antibiotics. On the basis of their, although limited, experience, the authors suggest, for the prophylaxis of prosthesis infection, the use of antibiotics such as clindamycin, able to reduce glycocalyx production.

Use of external fixators in limb lengthening and skin expanders in plastic surgery are well-known operative techniques. In some cases neurologic complications arise due to distraction which is either excessive or too fast. What happens to the nerve in these cases has not yet been thoroughly investigated. We therefore conducted an experiment on the sciatic nerve of rats. In one group of animals the nerve was studied after lengthening the femur, and in the other group after lengthening the nerve itself with a skin expander. Electrophysiologic and histologic studies (optic microscopy and axon teasing) were used to examine the effects of tension on the sciatic nerve. The results suggest that if distraction is performed gradually, the nerve does not undergo any electrophysiologic functional changes. It does, however, undergo some morphologic changes, such as a decrease in both the areas of the axons and the myelin sheaths, an increase in the distances between the nodes, and proliferation of Schwann cells.

Sensory reeducation is very important. Many methods are used but it is difficult to assess their efficiency. Besides the routine methods we are using the gnostic rings which have on their periphery 5 symbols: a letter = A, a number = 3, a geometrical figure = a circle, a rough surface and a smooth convex surface. The symbols of the rings are in 3 different sizes (1.5 - 1 and 0.5 cm). The gnostic rings have 3 advantages: 1) they allow a precise evaluation in percentage. 2) they require an important brain effort, 3) they may be kept in the pocket and used several times during the day.

The authors report on their personal experience with percutaneous cholecystostomy (PC) in 36 cases of acute cholecystitis (AC). PC was successful in 34 cases, improving the clinical condition of the patients within the first hour following treatment and normalizing the laboratory data within 24-48 hours. Twenty-seven patients with calculous AC underwent cholecystectomy within 4-15 days. In 6 cases (3 calculous and 3 acalculous ACs) PC was the only treatment performed; in one case (calculous AC) PC was combined with lithotomy, the stone fragments being extracted via the cholecystostomy. According to literature reports, to date PC has been performed mainly--as an alternative to surgical cholecystostomy--on the patients unsuitable for cholecystectomy due to their age or to severe impairment of their conditions. In our experience, the procedure can be performed on a wider range of patients as a final (notably in acalculous AC) or temporary step (notably in calculous AC where it may allow cholecystectomy to be delayed and thus performed under better clinical conditions, with decreased morbidity and mortality risks).

Mehrere Autoren haben die Kopfschmerzenanamnese von erwachsenen Patienten einer Computeranalyse unterzogen, um die Moglichkeit fur Definition und Klassifikation der Migrane zu prufen. Eine Analyse mit Patienten im padiatrischen Alter wurde von wenigen Autoren durchgefuhrt.

Free microvascular grafts have many advantages over conventional bone grafts. Above all they do not undergo creeping substitution and live on their own vessels, thus being able to heal quickly and fight infection. Research in rabbits has been done with radiographic, scintigraphic and light and fluorescence histologic examination which demonstrated the high superiority of quality, reliability and rapidity in healing of the microvascular bone transfer as related to avascular ones. Eighty-five cases of free microvascular fibular transfers starting in 1975 are presented including six congenital cases, 12 non-unions, eight osteitis, seven tumors, seven large losses of bone and 45 femoral head necrosis. The failure ratio is very low. Six primary failures were cured by plaster or additional cancellous bone grafts. Four failures (in femoral head necrosis) did not cure due to recession of the graft, its reabsorption or progression of avascular necrosis in two corticosteroid cases.

The authors present a technique of direct muscular neurotization consisting of re-innervation by direct implantation of a nerve into one or several muscles in cases of avulsion of the nerve supplying the muscle or traumatic or surgical avulsion of the neural part of the muscle. The biological basis for this operation is that a denervated muscle can accept a new innervation by a foreign nerve even in an aneural zone because its sensitivity to acetylcholine is present throughout the muscle, while, in a normally innervated muscle, sensitivity to acetylcholine is confined to the motor endplates. The results of 47 cases are presented: 42 of them obtained good or very good results.

Arthrodesis of the wrist in cases of paralysis of the upper limb, although rejected by certain authors, is a valid operation provided it is confined to certain indications such as paralyses requiring minimal muscle transfers. Arthrodesis of the wrist is particularly useful in the sequelae of brachial plexus lesions with dissociated paralysis and in total paralysis of the radial nerve with hand drop and preservation of the wrist flexors. Numerous techniques of arthrodesis have been proposed. Over the last 27 years, the authors use a technique with a direct dorsal incision. The first row of carpal bones and the radius are roughened with chisel. A cortico-cancellus graft is then raised from the dorsal surface of the radius, leaving a distal cortical bridge. The graft is slid under this bridge, placed onto the roughened surface of the carpus and pushed under the operculum raised at the base of the 2nd and 3rd metacarpals. The arthrodesis is fixed with two Kirschner pins and a plaster for 3 months. We have used this technique in 31 patients with nerve paralyses since 1971 and have obtained complete consolidation with total patient satisfaction in all but one case.

Surgical treatment represents only a part, albeit a significant one, of nerve repair and recovery. In addition, several forms of physical and medical treatment can improve results in diminishing scar formation, encouraging regeneration, maintaining muscle trophism or joint mobility during denervation, and re-educating the sensory and motor functions. Among those that we routinely use are the following: — Steroids: against scar-formation — X-ray therapy: against scar formation — Magnetic therapy: to reduce fibrosis and improve elastic tissue — Orthosis: to avoid deformities, subluxation, and muscle exhaustion — Electrotherapy: to maintain muscle trophism (used on nerves and on muscles) — Physiotherapy: to maintain muscle trophism and joint mobility — Gangliosides: to improve nerve regeneration — Re-education: motor and sensory

Summary LTC 4 administered intravenously (0.4–1.6 nmoles/kg) to anaesthetized guineapigs induces constriction of peripheral airway and fall of systemic arterial pressure preceded by a short lasting increase. These effects seem to be related with the appearance in the circulating blood of TXA 2 and PGI 2 -like activity as monitored by tonus changes of RbA and BCA. Pretreatment of the animals with aspirin (0.05 mmoles/kg i.v.) significantly reduces the effects of LTC 4 both on pulmonary mechanics and blood pressure. Lungs seem to be a source of arachidonic acid metabolites released by LTC 4 .

Perfused lungs from fetal (26-28 days of gestation) and newborn rabbits preferentially transform arachidonic acid into a substance which mimics PGI2 activity on different isolated tissues in cascase. These data support the hypothesis that antiplatelet and vasodilating vasodilating activity of PGI2 generated in the lungs may contribute to the characteristics of the fetal circulation.

The interaction of leukotriene C4 (LTC4) with the contractile activity of histamine (H), serotonin (5HT) and norepinephrine (NE) has been investigated in isolated vascular preparations. Threshold concentration of LTC4 (5 × 10−9 M) significantly potentiated the vasoconstricting effect of these compounds on guinea-pig pulmonary artery (GPPA). This phenomenon was long-lasting for H since it was still present 40 min after LTC4 had been washed. FPL-55712 (10−5M) counteracted the increased H response on GPPA induced by LTC4. Potentiation of H activity due to LTC4 was also observed on guinea-pig thoracic aorta (GPTA) indicating that LTC4-induced hyperreactivity is not a phenomenon restricted to the pulmonary vascular bed. In the experiments carried out in presence of indomethacin (3 × 10−6M), LTC4 still potentiated H-induced vasoconstriction on GPPA, however the time course of the phenomenon was significantly shorter than that observed in absence of the cyclooxygenase inhibitor. The contractile activity of H and NE on guinea-pig portal vein (GPPV) was not potentiated by LTC4 These results demonstrate that LTC4 induces hyperreactivity of the arterial vascular tissue to vasoactive compounds and suggest that cysteinyl-leukotrienes may have pathological significance in the hemodynamic changes occurring during anaphylactic reactions. Preliminary experiments carried out on human intralobar pulmonary artery strongly support this hypothesis.

To study this capacity of embryono-foetal tissue to regenerate without scar formation, experimental intrauterine surgery has been carried out in rabbits. This study has been performed with regard to the possibility of using intrauterine microsurgery to correct myelomeningocele in humans to avoid scar adhesion between the medulla and the growing vertebral bones and subsequent hydrocephalus. Lesions were produced in the spinal cord of rabbit foetuses, and observation after birth showed repair without scar formation. Further research is in progress to confirm these findings and to adapt this procedure to the clinical situation.

Light microscope and ultrastructural changes in the rat kidney in tourniquet shock are described. The animals (24) were divided into two series; in the first one, the hind limb was kept at room temperature; in the second series, prerefrigeration was used. The effects of different ischemia were studied (2,4,8, and 12 hours for warm ischemia; 4,8,12, and 16 hours for cold ischemia). The animals were sacrificed at 3, 10, and 30 days. Pathological changes were evident, consisting in an increase of cytosomes in the proximal tubules and apical vacuolation in collecting ducts; numerous cytosomes including myelin-like structures were also seen. Large differences between warm and cold ischemia alterations were found. The changes in the tubules were clearly less important in cold ischemia. The authors conclude that there is a protective effect in regard to prevention of renal pathology affordable by prerefrigeration of a limb for reimplantation.

Resume L'hyponeurotisation dans les paralysies spastiques proposee au debut du siecle et abandonnee pour ses resultats inconstants, a ete reprise comme concept mais avec un changement notable sur le plan technique. Il est necessaire d'effectuer un bilan soigneux des muscles a denerver (du median et du cubital) et de la nature de la spasticite. L'incision, plus extensive que dans la technique originale permet un controle plus aise des tranches du nerf median et cubital. Les rameaux nerveux de chaque muscle sont ainsi identifies et c'est par la stimulation electrique per-operatoire que l'on juge de l'importance de la denervation a apporter aux muscles en tenant compte du phenomene d'adoption de fibres musculaires denervees par les fibres nerveuses restantes. On coupe ensuite toute une partie de rameaux sous microscope, pres du muscle, en prenant soin de cauteriser le moignon proximal. Il peut etre necessaire d'associer a ce geste des tenomyotomies ou des capsulotomies. Cette methode donne de bons resultats si l'on respecte la technique et les contre-indications representees par l'athetose, la choree et les deficits cerebraux. Il faut cependant souligner que le resultat de cette intervention depend du dosage de la denervation qui ellememe n'est guere quantifiable et reste fondee essentiellement sur l'experience de l'operateur.