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Objective: This study aims to reduce the waste generated from primary cleft lip and/or palate (CL/P) repair., Design: A retrospective chart review examined a single surgeon's experience with CL/P repair using standard draping technique and reduced draping technique. Fisher's exact tests were performed comparing complication rates between techniques., Setting: All procedures were conducted at a single academic medical center under the care of a board-certified pediatric plastic surgeon and fellowship-trained pediatric anesthesiologists., Patients: The study included all patients ≤ 24 months of age who underwent primary CL/P repair using a reduced draping technique at the senior author's institution. An equivalent number of patients who underwent CL/P repair by the senior author immediately prior to implementation of the reduced draping technique were included for comparison., Intervention: Patients undergoing CL/P repair before the change in technique were draped using the standard CL/P draping. The senior author then switched to using a reduced draping on all CL/P repairs afterwards., Main Outcome Measures: Weights and costs of both draping sets were obtained and differences calculated. A manual chart review was performed to assess rates of accidental intraoperative extubation, postoperative infection, fistula formation, and wound dehiscence., Results: The implementation of a reduced draping technique resulted in a 530 gram weight savings and $7.49 cost savings per procedure. Fisher's exact tests revealed no statistically significant differences in complication rates except for oral mucosal dehiscence, which was lower in the reduced draping group., Conclusions: Reduced draping in CL/P repairs significantly reduces operative waste without compromising surgical outcomes., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Intravenous drug incompatibilities are a common cause of medical errors, contributing to ineffective therapy and even life-threatening events. The co-administration of drugs must always be supported by studies confirming compatibility and thus guarantee the therapy's safety. Particular attention should be paid to the possible incompatibilities or degradation of intravenous cephalosporins in different infusion regimens since the administration of drugs with inadequate quality may cause treatment failure. Therefore, an appropriate stability test should be performed. The study aimed to present various aspects of the stability and compatibility of five cephalosporins: cefepime (CFE), cefuroxime (CFU), ceftriaxone (CFX), ceftazidime (CFZ), and cefazoline (CFL). The degradation studies in parenteral infusion fluids and PN admixtures were conducted for CFE and CFU. The interactions between CFX or CFZ and PN admixtures, as well as the compatibility of CFL with five commercial parenteral nutrition (PN) admixtures, were investigated. The content of CFX and CFZ in PN admixture after 24 h was >90%. CFL administered simultaneously with PN admixture by the same infusion set using Y-site was compatible only with Nutriflex Lipid Special. CFE and CFU were stable in all tested infusion fluids for a minimum of 48 h and decomposed in PN admixtures during storage.

Small ubiquitin-related modifiers (SUMOs) are important regulator proteins. Caenorhabditis elegans contains a single SUMO ortholog, SMO-1, necessary for the reproduction of C. elegans. In this study, we constructed transgenic C. elegans strains expressing human SUMO-1 under the control of pan-neuronal (aex-3) or pan-muscular (myo-4) promoter and SUMO-2 under the control of myo-4 promoter. Interestingly, muscular overexpression of SUMO-1 or -2 resulted in morphological changes of the posterior part of the nematode. Movement, reproduction and aging of C. elegans were perturbed by the overexpression of SUMO-1 or -2. Genome-wide expression analyses revealed that several genes encoding components of SUMOylation pathway and ubiquitin-proteasome system were upregulated in SUMO-overexpressing nematodes. Since muscular overexpression of SMO-1 also brought up reproductive and mobility perturbations, our results imply that the phenotypes were largely due to an excess of SUMO, suggesting that a tight control of SUMO levels is important for the normal development of multicellular organisms., (© Springer Basel AG 2011)

Trans-fatty acids (TFAs) enter the diet through industrial processes and can cause adverse human health effects. The present study was aimed to examine the effects of dietary cis- and trans-fatty acids on the model organism Caenorhabditis elegans. Cis- or trans-18:1n9 triglycerides (25 μM) caused no apparent changes in the numbers of viable progeny of wild-type N2 animals. However, in fat-3 mutants lacking delta-6-desaturase, the trans-isomer caused modest decreases in lifespan and progeny after three generations. Long-chain polyunsaturated fatty acids (PUFA) profiles were significantly altered in fat-3 mutants compared to wild type but were not altered after exposure to dietary cis- or trans-18:1n9. Genome-wide expression analysis of fat-3 mutants revealed hundreds of changes. Several genes involved in fat metabolism (acs-2, fat-7, mdt-15) were significantly increased by cis- or trans-18:1n9 without discrimination between isomers. These results provide support for the hypothesis that dietary trans fats are detrimental to development and aging., (Copyright © 2011 Wiley Periodicals, Inc.)

The aryl hydrocarbon receptor (AHR) is a eukaryotic transcription factor that plays an essential role in neuronal, immune, vascular, hepatic and hematopoietic development. In mammals, AHR induces metabolism-associated genes in response to xenobiotics. AHR is evolutionarily conserved, and the C. elegans AHR ortholog likely shares many physiologic functions with the mammalian version. While the role of AHR in development is known, the molecular basis of AHR action is less well understood. To understand the physiologic role of AHR in C. elegans, a combination of fatty acid profiling, transcriptomics, and phenotyping approaches was used. Fatty acid profiles from L4 larval stage whole animals indicated that C17isoA, C18:1n9t, C20:3n6 and C20:4n6 were significantly increased in an ahr-1 mutant compared to wild-type. Consistent with these changes, we observed a significant 5.8 fold increase in fat-7, and 1.7-1.9 fold increases in elo-5, nhr-49, and mdt-15 gene expression during the L4 stage. The ahr-1(ju145) mutant displayed deficits in growth and development including a reduced number of eggs laid, a higher proportion of dead embryos, delay in time to reach L4 stage, and movement deficits including a fewer number of body bends and a longer defecation cycle. To understand global effects of AHR-1 on transcription, microarray analysis was performed on L1 stage animals. Expression changes (324 under- and 238 over-expressed) were found in genes associated with metabolism, growth, and development. These results indicate a role for C. elegans AHR in regulating fatty acid composition and in contributing to some aspects of development. Since the transcriptional control of AHR targets may be evolutionarily conserved, these results provide a deeper understanding of the molecular actions of AHR in a model invertebrate system that may be informative for higher organisms.

The purpose of the study was to see if nematodes (Caenorhabditis elegans, Caenorhabditis briggsae, and Pelodera strongyloides) produce endocannabinoids; i.e., anandamide (AEA) and 2-arachidonoylglycerol (2-AG). In this study, AEA and 2-AG were identified as endogenous products from nematodes by using electrospray-ionization ion-trap MS/MS (ESI-IT-MS) experiments operated in the positive-ionization mode. Endocannabinoids were identified by product ion scan and concentrations were measured by triple quadrupole mass spectrometry in the multiple reaction monitoring mode (MRM). Both AEA and 2-AG were identified in all of the nematode samples, even though these species lack known cannabinoid receptors. Neither AEA nor 2-AG were detected in the fat-3 mutant of C. elegans, which lacks the necessary enzyme to produce arachidonic acid, the fatty acid precursor of these endocannabinoids.

Four methods of enamel preparation before orthodontic bonding that are currently in use or proposed for use were investigated. The study consisted of two parts. Part one evaluated the roughness of the prepared enamel surfaces by using optical profilometry and scanning electron microscopy (SEM). Part two compared the debonding force for the prepared enamel surfaces by using a mechanical testing machine. The teeth were divided into four groups as follows: In group A, the surfaces were only sandblasted. In group B, the surfaces were sandblasted and acid etched. In group C, the surfaces were buffed with an 1172 fluted bur and acid etched. In group D, the surfaces were pumiced and acid etched. There was no statistical difference in surface roughness among the four groups at p < 0.05, nor was there any statistical difference in bond strength among the three groups that were acid etched. However, there was a significant difference in bond strength between these groups and the group that received only sandblasting (no acid etching). Thus, in this preliminary study, sandblasting does not appear to damage the enamel surface and can therefore be used as a substitute for polishing with pumice. It should be followed by acid etching to produce enamel surfaces with comparable bond strengths.

The head and neck region is a limited anatomical area in radiological diagnostics. Nevertheless, head and neck radiology has a long and interesting history with excellent scientists involved in its development. Before the discovery of X-rays, no information about the head and neck could be obtained without surgery or even autopsy. Therefore, conventional radiograms and special projections were an important step forward. During the 1950s, a second diagnostic breakthrough was achieved by the introduction of tomographic techniques. Film tomography was the first step in this important development. Computed tomography and magnetic resonance imaging yielded astonishing and unforeseen results. Especially in the field of magnetic resonance imaging, the technical development has not yet come to an end. Scientific research and continuing education are required in order to achieve further advances in head and neck radiology, and European cooperation is on the way.

Background: The high value of computer tomography (CT) for detailed imaging of nasopharyngeal and paranasal sinus tumors is known. Less known is the influence of such diagnostic findings on decisions of the therapist. An analysis of this influence might help to compare the value of CT and MRT., Patients and Methods: We performed a retrospective study on 104 treated patients with malignant tumors of the nasopharynx (n = 54) and the paranasal sinuses (n = 50). The study analyzed the influence of CT on primary tumor diagnosis, tumor staging, treatment decision, therapy planning, detection and time of recurrences and retreatment of relapses., Results: Tumors of the nasopharynx: The value of CT for tumor staging was 76% but there was no influence on treatment decision. Radiotherapy planning was influenced in 37% of cases. CT for follow-up was done in 22% of cases. Most relapses occurred within the first 2 years. Paranasal sinus tumors: There was no influence of CT on primary diagnosis of the tumor. Tumor staging was influenced by CT in 94%, treatment decision in 44% and radiotherapy planning in 60%. CT control immediately after therapy was of value in 40%. Most relapses were found within 3 years but some in the 4th and 5th year. Some patients survived 3 to 9 years after retreatment., Conclusions: In tumors of the nasopharynx there is less influence of CT on therapy strategies than diagnostic radiologists might think. No CT is needed for treatment decision since radiotherapy is the only choice of treatment. CT influenced radiotherapy planning however, in about 1/3 of our cases answering sufficiently the 2 main questions: tumor spread into the anterior half of the facial skull or involvement of the base of skull. The retreatment of recurrences detected by CT showed poor results. Late recurrences seem to have better prognosis. We recommend therefore routinely 1 basic CT 6 months after primary treatment followed by 1 CT yearly from the 3rd to 5th year. MRT might offer more diagnostic details than CT. However, at present therapy is not influenced much by this. Since CT is cheaper and faster, MRT could be discussed as additional procedure when CT presents equivocal findings and this fact could be decisive for therapy planning. Paranasal sinus tumors: The influence of CT on tumor-staging and treatment decision is high and convincing. CT helps also at radiotherapy planning and control of tumor response after therapy. CT has high value in detecting recurrences. Retreatment could control disease in some of our patients for 3 to 9 years. Better results could be achieved possibly with earlier diagnosis of recurrence. We propose therefore a basic-CT 6 months after first treatment and 1 CT routinely from the 2nd to 5th year. From the therapist's point of view we recommend CT as first imaging procedure in sinonasal tumors. MRT, more time- and cost consuming, should be applied when CT is equivocal and treatment decision could be influenced.

More than 100 anomalies are associated with this syndrome. In this case, a cyst removed from a 15-year-old male was diagnosed as an odontogenic keratocyst. The long history of this syndrome with its associated problems is described.

High energy electrons have, in comparison with 50-100 kV X rays, definitive advantages in treating large, thick or deeply infiltrating skin cancers. Moreover, a skillful therapeutic policy (fractionation, use of acrylic absorbers, shrinking field technique) often leads to excellent late results, with none or only insignificant side effects especially on bone and cartilage.

Germany has always deserved a great interest to electron beam radiotherapy (betatron, linear accelerator). At St. Vincentius Hospital in Karlsruhe the percentage of electron treated patients grew up in the years from 15% to 45%. Electron energies between 7 and 12 MeV are the most commonly used. Major RT Centres need a wider range of energies (5/7-20 MeV), but the minor ones should have at least electron beams of 5-12/15 MeV.

A prospective comparison study of the water-soluble contrast media Amipaque and Dimer-X was performed on 200 lumbar myelograms. During this investigation, and amongst a total of 1702 myelograms with Dimer-X, there were only transient mild side effects; these were somewhat more common with Amipaque. There were no sequelae, particularly those of a neurological nature. After careful clinical examination, and by observing certain precautionary measures, it is possible to perform lumbar myelography with water-soluble contrast media on an out-patient basis.

Radiographic examination during pregnancy and pelvimetry before pregnancy are still required for particular indications. The use of digital radiography (lateral topogram on CT) reduces the radiation dose to the foetus and ovaries by a factor of 10 to 100, as compared with conventional pelvimetry, as described by Guthmann. The accuracy of this method is satisfactory, the technique is simple, it is rapid and is easy for the patient, particularly for pregnant women. As long as pelvimetry is not possible without ionising radiation, we consider pelvimetry with digital radiography, when strictly indicated, to be acceptable. In order to determine the transverse diameter of the pelvis, a single additional CT cut through the narrowest part of the pelvis is suggested.

Ways of evaluating the therapeutic environment in psychiatry and psychotherapy are discussed, and an account of work with Engels Ward Assessment Form is given.

Follow-up after tumorectomy and intensive irradiation for carcinoma of the breast creates new diagnostic problems. In particular, more experience is necessary about the value of mammography. We have therefore analysed the mammograms of 104 patients intensively followed over one to eight years after primary treatment. Changes in the appearances of the breast due to irradiation are compared with mammographic changes caused by recurrence of tumor. It can be shown that definite structural patterns can be recognised regularly. Optimal diagnosis of recurrencies, however, is only possible by comparing all follow-up mammograms, and additionally the pre-operative films. Close cooperation between the surgeon, radiotherapist and diagnostic radiologist is essential.