Dental prosthesis rehabilitation following oral carcinologic treatment

Following the different treatments applied on patients suffering of a mouth cancer, often these are confronted with a functional and esthetic handicap. Thanks to the prosthetic techniques and an eventual resort to implantation, it is possible to improve their quality of life. Different prosthetic reconstructions are considered.     

Plasma transport forms of ingested fatty alcohols in the rat

Previous studies have shown that ingested fatty alcohols are absorbed as fatty acids and fatty acid esters, particularly triglycerides. The present study was carried out to determine whether fatty alcohols are also transported as 0-alkyl glyceryl ethers, alk-1-enyl glyceryl ethers, and as wax esters. Oxidation of fatty alcohols to other lipids was assessed by using a mixture of [1-3H] hexadecanol and [1-14C] hexadecanol of predetermined ratio. The results indicate that the absorption of fatty alcohol, and of its transport forms, parallels the absorption of labeled fatty acids. Six to 25% of plasma radioactivity was present as 1-0-alkyl diacylglyceryl ethers with a smaller proportion of ether lipids in the phospholipid fraction. In addition, 4-13% of the ingested hexadecanol appeared in the plasma as a material having the chromatographic properties of wax ester. Fatty alcohols were not detected in the plasma as alk-1-enyl lipids.     

Dental treatment and the alcoholic

Practising dentists must include in their diagnostic skills the ability to identify the patient with a high intake of alcohol. Dental status can often reflect the patient's perception of health and disease. The development of an appropriate treatment plan for these patients needs to take into account their generally unreliable nature. Appointments are often not kept; there is poor compliance with general health-care information, and compliance with preventive advice on dental care is achieved with difficulty. Symptomatic presentation is common with the alcoholic patient. The dentist should avoid "rushing in" to treat the presenting acute problem without appropriate investigation of the medical history. This should include consultation with the patient's medical advisor and other involved health professionals. A careful review of the oral mucosa for pre-cancerous or cancerous changes should be systematically included in the examination of any patient. Patients with a high intake of alcohol, and especially those who smoke, need to be carefully screened.     

Etiology and indications for the management of impacted teeth

Impacted teeth are a medical deformity brought about by the dietary changes of modern civilization. Ample studies exist to show that the lack of a coarse, abrasive diet--an attritive diet--is the major cause of this problem in modern civilization. Our recent ancestors did not experience this problem or the problem of the underdeveloped lower jaw and resulting Class II malocclusion to the extent present in modern society. Medical and dental scientists, practitioners, and surgeons are aware of the devastation that impacted teeth can cause to the jaws and overall health of an individual and have issued numerous warnings to the profession and to the public regarding the several clear indications for the removal of impacted teeth. The issue has been clouded by the competing economic incentives present in our society, in which fee-for-service practitioners have been and are being replaced by practitioners with a disincentive to recommend surgical care for all but acutely infected or seriously symptomatic patients presenting with impacted teeth. Oral and maxillofacial surgeons practicing in the United States at this time are aware of the many clear indications for removal of impacted teeth and make every effort to communicate this information to their patients and other dental and medical practitioners. They are also aware of the contraindications to the removal of impacted teeth and advised patients appropriately when it is safe to retain and periodically observe by radiograph certain impacted teeth.     

Tuberculosis of the esophagus

A case of tuberculosis of the esophagus is presented in a patient with pulmonary tuberculosis. The patient, complaining of dysphagia, had esophagoscopic examination which showed a submucosal tumor with central ulceration. Tissue biopsy, under direct vision from the tumor mass, confirmed the diagnosis of tuberculosis. The patient has been asymptomatic under treatment. Both esophageal and pulmonary lesions are largely improved.     

Leiomyosarcoma of the esophagus

The authors describe the anatomo-clinical characteristics of a case of leiomyosarcoma of the oesophagus which came under their observation, emphasizing its rarity: 39 cases in the literature examined. They then discuss the numerous problems that this neoplasia involves, especially diagnostic differentiation from other sarcomas and the pseudo-sarcomatous reaction of the stroma during the course of carcinomas. Lastly they divide leiomyosarcoma of the oesophagus into polypoid forms and infiltrating forms, owing to the different therapeutic and prognostic implications that such distinction implies.     

Achalasia of the esophagus

Achalasia, a disease of unknown cause, is characterized by absence of peristalsis in the esophagus body and incomplete relaxation of the lower esophageal sphincter (LES) in response to swallowing. This article reviews the history and pathogenesis of achalasia along with clinical manifestations, diagnosis and management options relating to the disease.     

Neurofibroma of the esophagus

Benign esophageal tumors occur infrequently, with leiomyomas accounting for approximately 70% of cases. Benign neural tumors of the esophagus account for 200 cases reported in the literature and rarely require operative resection. The case of a 58-year-old woman with a 4-month history of progressive dysphagia and odynophagia is presented. A large intramural esophageal mass was resected through a right thoracotomy, and the esophagus was primarily repaired. Histologic examination revealed a neurofibroma.     

Pannus resection through the tilting disc prosthesis: successful treatment preserving the prosthesis

A 59-year-old woman was admitted to our hospital because of heart failure. In 1988, she underwent aortic valve replacement with an Omnicarbon valve and mitral valve replacement with a bioprosthetic valve. She was doing well until July in 1996 when she developed heart failure. Echocardiography revealed massive mitral valve regurgitation, and cinefluoroscopy showed implanted Omnicarbon valve dysfunction with a leaflet opening angle of 35 degrees. At reoperation, it was revealed that pannus formation prevented the valve from functioning well. The pannus was resected through the major orifice, and the leaflet was rotated toward the right anterolateral orientation. The worn bioprosthetic valve was replaced with a mechanical one. Postoperative cinefluoroscopy of the rotated Ominicarbon valve showed the opening angle to be 61 degrees.     

Function of the esophagus and stomach in gastroesophageal reflux

The recognition of abnormal DNA structure by proteins is fundamentally different from sequence-specific DNA binding. Recent crystal structures of uracil-DNA glycosylases show a novel uracil-binding pocket that explains the enzyme's selectivity for uracil-containing DNA and provide a structural basis for exploring the catalytic mechanism of amino-glycosylic bond cleavage.     

Simultaneous M-mode echoesophagram and manometry in the sheep esophagus

We report the simultaneous measurement of esophageal wall layer thickness and intraluminal pressure in the sheep esophagus using a miniature suction device incorporating a high-frequency ultrasound transducer and a manometry system. Transnasal placement of the device into the distal esophagus of a conscious sheep allowed observation of 133 swallowing events during three trials, each lasting from 45 to 60 minutes. In a fourth trial, 11 sequential dry and 23 sequential wet swallows were compared. Maximum manometric pressure, esophageal wall layer thickness, and duration of contraction were measured. All swallowing events produced simultaneous increases in intraluminal pressure and esophageal wall thickness. Mean maximal pressures were lower for dry swallows (18 +/- 2.1 mm Hg) than wet swallows (22 +/- 3.0 mm Hg) (p < .01). Thickness of the inner (circular) muscle layer increased above baseline by 124% for dry swallows and 161% for wet swallows (p < .01). We conclude that thickening of the esophageal inner (circular) muscle layer may be important in the generation of intraluminal esophageal pressure in the sheep esophagus.     

Caustic burns of the esophagus in childhood

Acute burns of the upper gastrointestinal tract require an immediate diagnostic and therapeutic approach. Early endoscopy has been shown to assist greatly in determining the further treatment of corrosive injury. The main task of radiology is to detect perforations. Early corticosteroid treatment seems to be effective in preventing stricture development in second degree burns.     

Biomarkers for malignancy in the columnar-lined esophagus

Toads of the genus Bufo are highly resistant to the toxic effects of digitalis glycosides, and the Na+,K(+)-ATPase of all toad tissues studied to date has been relatively insensitive to inhibition by digitalis and related compounds. In studies of brain microsomal preparations from two toad species, Bufo marinus and Bufo viridis, inhibition of ATPase activity and displacement of [3H]ouabain from Na+,K(+)-ATPase occurred over broad ranges of ouabain or bufalin concentrations, consistent with the possibility that more than one Na+,K(+)-ATPase isoform may be present in toad brain. The data could be fitted to one- or two-site models, both of which were consistent with the presence of Na+,K(+)-ATPase activity with high sensitivity to ouabain and bufalin. Ki (concentration capable of producing 50% inhibition of activity) values for ouabain in the one-site model were in the 0.2 to 3.7 microM range, whereas Ki1 values in the two-site model ranged from 0.085 to 0.85 microM, indicating that brain ATPase was at least three orders of magnitude more sensitive to ouabain than B. marinus bladder ATPase (Ki = 5940 microM). Ouabain was also an effective inhibitor of 86Rb+ uptake in B. marinus brain tissue slices (Ki = 3.1 microM in the one-site model; Ki1 = 0.03 microM in the two-site model). However, the relative contribution of the high ouabain-sensitivity site to the total activity was 17% in the transport assay as compared with 63% in the Na+,K(+)-ATPase enzymatic assay. We conclude that a highly ouabain-sensitive Na+,K(+)-ATPase activity is present and functional in toad brain but that its function may be partially inhibited in vivo.