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Because some investigators feel that the hamster buccal pouch is an immune privileged site with no lymphatic drainage, this study was done to demonstrate and further elucidate a drainage system from the pouch to the cervical nodes. Eight hamsters were injected with india ink, submucosally in the right pouch. Dissections at one or 2 days revealed ink in macrophages in the right submandibular nodes at 2 days. Histologically, the ink was noted within macrophages which aggregated around blood vessels. No lymph vessels were noted in the pouch. Six hamsters were injected with fluorochrome-labeled latex microspheres. At 2 and at 4 days the microspheres were noted in both the pouches and the ipsilateral submandibular nodes. The results indicate there is a delayed lymphatic drainage from cheek pouches to the submandibular nodes mediated by macrophages. [ABSTRACT FROM AUTHOR]

The authors report the occurrence of a megaoesophagus in a German Sheepdog puppy secondary to the persistence of the arterioso ligament. The three-month old patient had a record of regurgitation which became evident after weaning, dyspnoea and delayed growth. A simple x-ray of the thorax was made as a complementary diagnostic test. The patient was subjected to a left intercostals thoracotomy to dissect the arterioso ligament and free the oesophagic constriction. After surgery, a soft diet from an elevated level was indicated. At the end of the post-operatory period, the patient showed improved clinical signs despite the persistence of the megaoesophagus. The combination of surgical procedure and the characteristics and modality of the diet proved to be the right treatment. [ABSTRACT FROM AUTHOR]

Background: Endogenous hyperinsulinemic hypoglycemia (EHH) is a rare clinical condition. The aim of this study was to evaluate baseline plasma cortisol concentration and its concentration during hypoglycemic crisis in fasting tests (FT) performed in our center. Secondarily, the aim was to establish the relationship between baseline cortisol and the time of evolution of EHH., Material and Methods: A retrospective, observational, descriptive study was carried out which included patients with hypoglycemic disorder with positive FT., Results: Of a total of 21 patients, 16 presented insulinoma, 1 nesidioblastosis, 2 malignant insulinoma and 2 EHH without pathological diagnosis. The time from the onset of symptoms to diagnosis was 2 years (Q1=1.5-Q2=5.5). The comparison between median baseline cortisol (BC)=11.8 mcg/dl (nmol/L 340.68) (Q1=9-Q3=14.1) and median cortisol during hypoglycemic episode (HC)=11.6 mcg/dl (nmol/L: 303.44) (Q1=7.8-Q3=16.1) showed no differences (Z=-0.08; P>.05). When correlating BC with HC, no significant relationship was observed (r=0.16; P>.05). When correlating the glycemic value in the crisis and the HC, a slight negative trend was found (r=-0.53; P=.01). In addition, we found that recurrent hypoglycemic disorder is associated with lower baseline cortisol values ​​the longer the time of its evolution., Conclusion: We confirmed that cortisol values ​​remain low during hypoglycemic episodes, reinforcing the hypothesis of lack of response of this counterregulatory hormone in cases of recurrent hypoglycemia., (Copyright © 2023 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: The primary objective of this study was to compare the re-rupture rate, clinical results, and functional outcomes six months after the surgical repair of an acute Achilles tendon rupture between three different techniques (open repair, percutaneous repair with the Tenolig®, and minimally invasive repair)., Methods: A prospective, comparative, multicenter, non-randomized study was performed and included 111 patients who had an acute ruptured Achilles tendon: 74 underwent an open repair, 22 underwent a percutaneous repair using the Tenolig® and 15 had a minimally invasive repair. At six months follow-up we analyzed the number of re-ruptures, phlebitis, infections, complex regional pain syndrome, clinical outcomes (muscle atrophy, ankle dorsal flexion), functional scores (ATRS, VISA-A, EFAS, SF-12), and return to running., Results: There were more re-ruptures (p=0.0001) after repair with the Tenolig® (27%) than with open repairs (1.3%) and minimally invasive repairs (0%). The rate of other complications was not different. No clinical differences were found between the three groups. Only some functional scores EFAS Total (p=0.006), and VISA-A (p=0.015) were worse in the Tenolig® group. All the other results were similar between the three groups., Conclusion: Despite heterogeneous studies in literature, the results of this comparative and prospective study between three surgical techniques of Achilles tendon repair confirmed that Tenolig® repair increased the rate of early re-rupture compared to open or minimally invasive techniques., (© 2023. The Author(s) under exclusive licence to SICOT aisbl.)

Introduction: The primary objective of this study was to compare the radiological and clinical results of anterograde and retrograde screwing in subtalar arthrodesis using a single compression screw. The secondary objective was to evaluate the subjective results and consolidation of this procedure. The hypotheses were that isolated screw fixation was sufficient to achieve good consolidation and that there was no difference between the two techniques with a similar rate of bone fusion., Methods: This is a monocentric, retrospective, radio-clinical study based on 99 patients (101 feet), 58 males and 41 females, with an average age of 64 years. The main aetiology was post-traumatic osteoarthritis, which represented 51% of cases. Two groups were formed: group A (52 feet) consisting of fixed arthrodesis with ascending (retrograde) screwing and group D (49 feet) consisting of fixed arthrodesis with descending (anterograde) screwing. The two groups were statistically comparable in terms of demographic data as well as aetiologies and comorbidities. Arthrodeses which were not fused at 6 months were reassessed at one year and in the event of any radio-clinical doubt regarding consolidation, an additional CT scan was prescribed. Average post-operative follow-up was 11 ± 5 years (2-27 years)., Results: Ninety-two arthrodeses (93%) were fused at one year and 9 were considered to be in non-union, 5 (9.8%) in group A, and 4 (8.3%) in group D. We recorded 30 complications, 22 of which were due to a conflict with the screw head, 18 (34.5%) in group A and 4 (8.3%) in group D (p = 0.03). Conflict between the screw head and the heel led to the removal of the screw after consolidation of the arthrodesis. The clinical results were evaluated using Odom's criteria. Nine per cent of patients described their results as excellent, 29% as good, 51% as satisfactory and 11% found the result to be poor., Conclusion: The fusion rate for isolated compression screw arthrodesis is good, and there is no difference between anterograde and retrograde screws. However, the discomfort caused by the screw head being insufficiently embedded in the retrograde group led to a non-negligible number of additional surgeries to remove the screw., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Osteotomies during rhinoplasty are usually based on surgeon's proprioception to determine the number, energy, and trajectory of impacts. Objective: The first objective was to detect the occurrence of fractures. The second objective was to determine when the thicker frontal bone was encountered by the osteotome. Materials and Methods: An instrumented hammer was used to measure the impact force during lateral osteotomies on nine human anatomic specimens. A prediction algorithm was developed using machine learning techniques, to detect the occurrence of fractures, and the proximity of the osteotome to the frontal bone. Results: The algorithm was able to predict the occurrence of fractures and the proximity to the frontal bone with a prediction rate of 83%, 91%, and 93% when allowing for an error of 0, 1, and 2 impacts, respectively. The location of the osteotome in the frontal bone was predicted with an error of 7.7%. Conclusion: An osteotomy hammer measuring the impact force when performing lateral osteotomies can predict the occurrence of fractures and the proximity to the frontal bone, providing the surgeon with instant feedback.

Osteotomies during rhinoplasty are usually based on the surgeon's proprioception to determine the number and the strength of the impacts. The aim of this study is to determine whether a hammer instrumented with a force sensor can be used to classify fractures and to determine the location of the osteotome tip. Two lateral osteotomies were realized in nine anatomical subjects using an instrumented hammer recording the evolution of the impact force. Two indicators τ and λ were derived from the signal, and video analysis was used to determine whether the osteotome tip was located in nasal or frontal bone as well as the condition of the bone tissue around the osteotome tip. A machine-learning algorithm was used to predict the condition of bone tissue after each impact. The algorithm was able to predict the condition of the bone after the impacts with an accuracy of 83%, 91%, and 93% when considering a tolerance of 0, 1, and 2 impacts, respectively. Moreover, in nasal bone, the values of τ and λ were significantly lower (p < 10 -10 ) and higher (p < 10 -4 ) than in frontal bone, respectively. This study paves the way for the development of the instrumented hammer as a decision support system., (Copyright © 2021. Published by Elsevier Ltd.)

Osteotomies are common surgical procedures used for instance in rhinoplasty and usually performed using an osteotome impacted by a mallet. Visual control being difficult, osteotomies are often based on the surgeon proprioception to determine the number and energy of each impact. The aim of this study is to determine whether a hammer instrumented with a piezoelectric force sensor can be used to (i) follow the displacement of the osteotome and (ii) determine when the tip of the osteotome arrives in frontal bone, which corresponds to the end of the osteotomy pathway. Seven New Zealand White rabbit heads were collected, and two osteotomies were performed on their left and right nasal bones using the instrumented hammer to record the variation of the force as a function of time during each impact. The second peak time τ was derived from each signal while the displacement of the osteotome tip D was determined using video motion tracking. The results showed a significant correlation between τ and D ( ρ 2  = 0.74), allowing to estimate the displacement of the osteotome through the measurement of τ. The values of τ measured in the frontal bone were significantly lower than in the nasal bone ( p <10 -10 ), which allows to determine the transition between the nasal and frontal bones when τ becomes lower than 0.78 its initial averaged value. Although results should be validated clinically, this technology could be used by surgeons in the future as a decision support system to help assessing the osteotome environment.

Background: Emerging therapies such as closed-loop (CL) glucose control, also known as artificial pancreas (AP) systems, have shown significant improvement in type 1 diabetes mellitus (T1DM) management. However, demanding patient intervention is still required, particularly at meal times. To reduce treatment burden, the automatic regulation of glucose (ARG) algorithm mitigates postprandial glucose excursions without feedforward insulin boluses. This work assesses feasibility of this new strategy in a clinical trial., Methods: A 36-hour pilot study was performed on five T1DM subjects to validate the ARG algorithm. Subjects wore a subcutaneous continuous glucose monitor (CGM) and an insulin pump. Insulin delivery was solely commanded by the ARG algorithm, without premeal insulin boluses. This was the first clinical trial in Latin America to validate an AP controller., Results: For the total 36-hour period, results were as follows: average time of CGM readings in range 70-250 mg/dl: 88.6%, in range 70-180 mg/dl: 74.7%, <70 mg/dl: 5.8%, and <50 mg/dl: 0.8%. Results improved analyzing the final 15-hour period of this trial. In that case, the time spent in range was 70-250 mg/dl: 94.7%, in range 70-180 mg/dl: 82.6%, <70 mg/dl: 4.1%, and <50 mg/dl: 0.2%. During the last night the time spent in range was 70-250 mg/dl: 95%, in range 70-180 mg/dl: 87.7%, <70 mg/dl: 5.0%, and <50 mg/dl: 0.0%. No severe hypoglycemia occurred. No serious adverse events were reported., Conclusions: The ARG algorithm was successfully validated in a pilot clinical trial, encouraging further tests with a larger number of patients and in outpatient settings.

Obesity is a major public health problem that is reaching pandemic proportion. Currently two thirds of the American population is either overweight or obese and worldwide, 39% of the population is overweight and 13% are considered obese [1,2]. This rapid rise in obesity is associated with increased in diabetes mellitus type 2 (DM2), hypertension (HTN), chronic kidney disease (CKD) and cardiovascular diseases (CVD), the major killer of adults in the USA. Parallel to this epidemic is the rapid rise of sleep disorders such as Obstructive Sleep Apnea (OSA). These disorders lead to increased morbidity and mortality and generally go undiagnosed and undertreated, particularly among minority groups. Accumulating evidence indicates common pathophysiologic background underlying all of these related disorders. Among these include: increased inflammation, increased oxidative stress, endothelial dysfunction, dyslipidemia and hypercoagulability. We discuss the rising epidemic of sleep disorders and its interrelationship with DM2, HTN, CVD and renal disease highlighting the racial disparity in diagnosis and treatment of these disorders that disproportionately affects minority populations. We also discuss the various treatment modalities and the cutting edge developments in this field.

Five patients with small, exophytic, asymptomatic fibrous nodules, single or multiple, of the mandibular mucogingival zone of the anterior labial gingiva are presented. Such nodules are benign and resemble small fibromas. The clinical and histologic appearance distinguishes them from entities such as retrocuspid papilla, reticular mandibular gingival ridges, oral hamartomas associated with Cowden's syndrome, tuberous sclerosis oral lesions, and oral nodules secondary to epidermolysis bullosa. Gingival fibrous nodule, or gingival nodule, is the proposed name for this lesion, which is essentially a variation of normal oral structures that may be mistaken for disease.

Vitamin D is required for the normal development of teeth and bones. When there is excess vitamin D, systemic and dental changes may occur. This is a case report of a girl who experienced hypercalcemia secondary to excess vitamin D derived from the consumption of milk that was incorrectly fortified. The changes in the permanent dentition to date are enamel hypoplasia and focal pulp calcification. These changes correspond to the timing of the toxemia caused by hypervitaminosis D.

A Nutrition and Oral Health Study was conducted on 141 middle-aged and elderly adults (54% female and 46% male; aged 47-83 y, mean = 67; 51% college educated; and 89% white). This study reports on the relationship between root caries and diet. Nutritional composition was derived from two 3-d food diaries. Root caries was measured according to the 1985 Adult Survey Diagnostic Criteria of the National Institute of Dental Research. When the individuals were segregated by their root DFS (decayed and filled surfaces) status into highest (> or = 7) and lowest (< or = 1) quartiles, the sucrose consumption was significantly higher in the higher DFS group. Mean energy consumption and mean number of teeth were the same in both groups. When the individuals were segregated by sucrose consumption into highest (> or = 89 g) and lowest (< or = 31 g) quartiles, DFS root status was significantly higher (P < 0.01) in the highest quartile group (7 g) vs the lowest group (4 g). By using data from subjects with two food diaries, a stepwise-linear-regression model for root caries showed that 4.2% of the variance for root caries was explained by sucrose, 2.8% by plaque, 3.8% by total number of teeth, and 5.6% by gingival recession. These data suggest that root caries has a similar dietary etiology to coronal caries.

This article defines an unusual previously unreported entity afflicting a maxillary lateral incisor. Labial idiopathic external root resorption just apical to the cemento-enamel presented as a gingival (periodontal) problem and was misinterpreted as cervical dental caries. This report defines a new possibility for a radicular defect in a maxillary lateral incisor that may cause periodontal problems.

Central odontogenic fibromas are rare benign tumors. We are presenting a case of a 67-year-old female with a central odontogenic fibroma which posed considerable difficulty in microscopic interpretation. The differential diagnosis ranged from metastatic carcinoma to a benign odontogenic neoplasm. The final diagnosis was made through persisting on multiple pathologic consultations, which allowed for conservative rather than aggressive surgery. Follow-up evaluation has confirmed the benign diagnosis.

Two cases of rare, peripheral, soft tissue odontomas, in different growth phases, are reported. Case one, discovered in an early, rapid growth phase, had no radiographic appearance, was presumed to be a periodontal abscess, and presented a diagnostic challenge. Case two was diagnosed radiographically in its mature phase. Both were treated successfully by excisional biopsy and did not recur. Comparisons are made to the classic intrabony odontomas.

This study tested a hypothesis that some radiopacities on radiographic surveys, specifically in the alveolar bone of the mandible from first molar to first molar, not related to the teeth by position or by pathosis, were related to the taking of oral contraceptives. The random sample included 218 adults entering consecutively for full-mouth radiographic surveys at the Radiology Department. All female patients were asked pertinent questions regarding their use of oral contraceptives. Those not responding (fourteen) were not included in the final tabulations. Radiographs were viewed without regard to sex by two persons at the same time, and an interpretation was made concerning the presence (positive) or absence (negative) of the radiopacities in question. Results were based on 204 patients (112 women and 92 men). Positive radiographic findings were significantly more frequent in women (45/112 versus 14/92; chi-square = 14.12; df = 1; p less than 0.001). Positive radiographs were significantly more likely in women using oral contraceptives (28/45 versus 5/67; chi-square = 36.25; df = 1; p less than 0.001).

This article reviews gonorrhea and discusses various misconceptions that have appeared in the dental literature and in verbal presentations about gonorrhea and dentistry. Facts are presented and some conclusions are offered for the dental profession.

In order to determine whether 13-cis-retinoic acid, an analog of vitamin A, has antitumor activity in an oral cancer model system, the following study was undertaken. Fifty-three adult hamsters were divided into four groups. Group 1 was tested with a 0.5 percent solution of 9,10-dimethyl-1,2-benzanthracene (DMBA) in heavy mineral oil, which was painted on the right buccal pouch three times per week for 12 weeks. Group 2 received DMBA plus 13-cis-retinoic acid (RA) incorporated into gelatinized beadlets and mixed with a powdered commercial diet (dosage, 300 mg per kilogram of diet). Group 3 received only RA; Group 4 received a placebo. The animals were killed at 6, 12, and 18 weeks and tissues were studied clinically and histologically in a routine manner. Results show that all groups receiving DMBA developed epidermoid carcinomas. However, there were several other changes. In the RA-treated animals, particularly those treated with DMBA, there was an ingrowth of surface epithelium with development of ductal structures in the buccal pouch. There were changes in surface epithelium, and there were dense aggregates of lymphoid tissue with development of exophytic nodules suggestive of lymphoma. Animals fed RA showed a relative weight loss. The findings suggest that there was a hypervitaminosis A state yielding prominent epithelial metaplastic changes but not affecting the progression or production of carcinoma.

This case depicts a clinical situation in which the patient's face became flushed after chewing food for approximately 30 seconds. The distribution of the flushing accurately defines the distribution of the zygomaticofacial branch of the trigeminal nerve. A theory involving the parasympathetic supply to this area is presented to explain this clinical pattern.

Epithelial parakeratosis has been observed in zinc-deficient animals of several species. In the rat, it has been reported on the epidermis, footpad, esophagus, soft palate, buccal mucosa, and dorsal tongue. This study reports that the lower lip also shows a striking hyperparakeratosis, as well as epithelial hyperplasia and an increase in mitoses. The appearance of these features was rapid with changes noted at Day 7 and persisting through Day 14 and Day 28. On Day 32, zinc was restored to the diet at control levels and by 42 days the zinc-deficient group showed dramatic increases in food intake, body weight, femur zinc and, in addition, mucosa of the lower lip resembled zinc-adequate controls. These differences are statistically significant. Morphometric comparison of spinous cells from zinc-deficients with those of the controls did not show significant differences.

The median mandibular cyst is a very rare cyst of debatable origin that occurs in the midline of the mandible. A review of the literature and an additional case are presented, with emphasis on diagnosis, treatment planning and the need for endodontic therapy in the area of the lesion.