Autotransplantation of Teeth in 215 Patients: A Follow-up Study

Objective:To evaluate the success rate of autotransplantation of teeth in consecutive patients and to analyze factors affecting the outcome.Materials and Methods:The subjects consisted of 215 consecutive patients (101 women and 114 men; aged 9.1–56.4 years, median age 15.2 years [P₁₀  =  11.4, P₉₀  =  19.7]) who had undergone transplantation of a total of 269 teeth, all by the same surgeon. In patients with multiple transplants, only the first transplant was included, to ensure that all transplanted teeth were independent units. The transplants were recorded as unsuccessful if the tooth had been extracted or was surviving but with root resorption or ankylosis. The interval between transplantation and final follow-up was a median 4.8 years (P₁₀  =  2.0, P₉₀  =  5.5) for successful transplants and a median of 2.4 years (P₁₀  =  0.4, P₉₀  =  7.7) for unsuccessful transplants.Results:One-hundred seventy-five (81%) of the transplantations were recorded as successful and 40 (19%) as unsuccessful. Twenty-five teeth had been extracted and 15 had survived but did not fulfill the criteria for success.Conclusions:The success rate of 215 consecutively transplanted teeth was 81%. The highest success rate was for transplantation of premolars to the maxillary incisor region (100%). Complications at surgery such as difficult extraction, deviant root anatomy, or damaged root periodontium affected the outcome. During growth, a successful transplant preserves alveolar bone.     

The use of combinatorial topographical libraries for the screening of enhanced osteogenic expression and mineralization

Nano- and microstructured surfaces are known to impact on the binding and differentiation of cells, but the detailed basic understanding of the underlying regulatory mechanisms is still scarce, which impedes the rational design of smart biomaterials. Towards a comprehensive analysis of the interplay between topographical parameters such as feature design and lateral and vertical dimensions we here report on a combinatorial screening approach, BioSurface Structure Array (BSSA) of test squares each with a distinct topography. Using such BSSA libraries of 504 topographically distinct surface structures, we have identified combinations of size, gap and height of structures which enhance mineralization as well as the expression of osteogenic markers of a preosteoblastic murine cell line. This generic BSSA screening platform is a versatile technology for the systematic identification of surfaces with specific biological properties, and it may for example be useful for optimizing the design of biomaterials for regulating cellular behaviour.     

Phthalate esters I: effects on cytochrome P-450 mediated metabolism in rat liver and lung,serum enzymatic activities and serum protein levels

Dimethylphthalate (DMP), dibutylphthalate (DBP) and di(2-ethylhexyl)phthalate (DEHP) were given i.p. (3.8 mM/kg) to Sprague Dawley rats for 5 days. DBP increased significantly the liver concentration of cytochrome P-450, but decreased the lung concentration by about 40%. DBP decreased the lung concentration of cytochrome b₅ and NADPH-cytochrome-c-reductase activity by about 30%. Only minor effects were seen after treatment with DMP and DEHP. The direction of B(a)P metabolism was changed and the formation of 2- and 3-hexanol metabolites were increased in liver microsomes after DBP treatment. All phthalate esters decreased the lung metabolism of B(a)P. The cytochrome P-450 enzyme system in the lung was ten times more effective than that in the liver as far as metabolism of n-hexane was concerned. Only minor effects were observed in serum enzyme activities, but a significant decrease in the serum level of albumin was observed after treatment with DBP. No relationship was found between the carbon chain length of the investigated chemicals and effects on microsomal enzymatic activities.     

Partial superior laryngeal nerve (SLN) lesions before and after thyroid surgery

The incidence of superior laryngeal nerve (SLN) lesions and their consequences in terms of voice quality was studied in 20 patients undergoing thyroid surgery, performed by surgeons who were not specialists in endocrine surgery. The SLN function was examined by electromyography (EMG) of the cricothyroid muscles before and after surgery. Voice analysis was performed through the registration of the average pitch and range of the speaking voice and the upper pitch limit. The perceptual voice quality was judged by a panel of listeners. Voice problems were registered through a questionnaire. The larynx status was examined by indirect laryngoscopy before and after surgery. Three patients who had not previously been operated on in the neck had partial SLN lesions before surgery. According to the EMG, no SLN at risk developed a complete lesion, but 58% of the SLN's developed partial lesions which persisted 1 year after surgery in all but 1 of the examined patients. Seven of 10 patients with isolated SLN lesions had postoperative voice problems, which had disappeared after 1 year in 4 of them. Standard indirect laryngoscopy failed to diagnose an isolated partial SLN paresis. A significant correlation was found between SLN lesion and a reduction in the average pitch of the speaking voice (p < 0.05). Partial SLN lesions cannot be diagnosed exclusively on voice symptoms and standard indirect laryngoscopy. EMG registrations make a definite diagnosis possible. Measurements of the average pitch of the voice could be used as a noninvasive screening procedure.

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Resumen La incidencia de lesiones del nervio laríngeo superior (NLS) y sus consecuencias en cuanto a calidad de la voz fue estudiada en 20 pacientes sometidos a cirugía tiroidea por cirujanos no especialistas en cirurgía endocrina. La función del NLS fue valorada mediante electromiografía (EMG) de los músculos cricotiroideos antes y después de la cirurgía. El análisis de voz fue realizado mediante el registro del tono promedio y el rango de la voz hablada y el límite máximo del tono. La calidad percibida de la voz fue juzgada por un panel de oyentes. Los problemas de voz fueron registrados a través de un cuestionario. El estado de la laringe fue examinado por laringoscopia indirecta antes y después de la cirurgía. Très pacientes que no habían tenido operaciones sobre el cuello previamente presentaban lesiones parciales del NLS antes de la cirugía. Según la EMG, ningún NLS en riesgo desarrolló lesión completa, pero 58% de los NLS's desarrollaron lesiones parciales que persistieron por un ano después de la cirugía en todos menos uno de los pacientes examinados. Siete de 10 pacientes con lesiones aisladas del NLS presentaron problemas postoperatorios de voz, los cuales habían desaparecido después de un ano en 4 de ellos. La laringoscopia indirecta estandar falló en establecer el diagnóstico de una paresia parcial aislada del NLS. Se hallo una correlación significativa entre la lesión del NLS y una reductión en el tono promedio de la voz hablada (p < 0.05). Las lesiones parciales del NLS no pueden ser diagnosticadas exclusivamente con base en síntomas de voz y la laringoscopia indirecta estandar. Los registros de EMG hacen posible el diagnóstico definitivo. Las mediciones del tono promedio de la voz pueden ser utilizadas como procedimientos de tamizaje no invasivos.

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Résumé L'incidence des lésions du nerf laryngé supérieur (NLS) et leur conséquences sur la voix ont été étudiées chez 20 patients ayant eu une chirurgie thyroïdienne par des chirurgiens non spécialistes en chirurgie endocrine. La fonction NLS a été étudiée par électromyographie (EMG) des muscles cricothyroïdiens avant et après l'acte chirurgical. Ont été analysés: (a) la fréquence moyenne, (b) les fréquences extrêmes de la voix parlée normale, et (c) la fréquence limite supérieure. La qualité de la voix a été appréciée par des auditeurs entraînés. Un questionnaire concernant les problèmes de la voix a été rempli par tous les patients. Tous les patients ont eu un examen laryngoscopique indirect avant et après l'acte chirurgical. Trois patients, n'ayant aucun antécédent de chirurgie cervicale, présentaient déjà des lésions partielles du NLS avant la chirurgie thyroïdienne. Selon les données EMG, aucun patient à risque n'a complété de paralysie du NLS après la chirurgie. Cependant, 58% des NLS exposés au risque ont présenté des lésions partielles du NLS en postopératoire, persistant chez tous les patients sauf un, à un an. Sept des 10 patients présentant des lésions isolées du NLS ont présenté des problèmes vocaux postopératoires, qui ont disparu chez 4 à un an. L'examen laryngoscopique indirect classique n'a pas permis de diagnostiquer de lésion isolée du NLS. La présence de lésion du NLS était corrélée significativement (p < 0.05) avec une baisse de la fréquence moyenne de la voix parlée. Les lésions partielles du NLS ne peuvent être détectées uniquement par la Symptomatologie vocale ou l'examen du larynx de routine. Seul l'électromyogramme permet un diagnostic précis. La mesure de la fréquence moyenne de la voix peut cependant servir comme examen non invasif de dépistage.

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Presented at the International Association of Endocrine Surgeons in Sydney, Australia, September, 1987.

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Supported by grants from the University of Göteborg, the Göteborg Medical Society, and the Swedish Medical Research Council (6534).     

Combined association and linkage analysis applied to the APOE locus

Combined association and linkage analysis is a powerful tool for pinpointing functional quantitative traits (QTLs) responsible for regions of significant linkage identified in genome-wide scans. We applied this technique to apoE plasma levels and the APOEepsilon2/epsilon3/epsilon4 polymorphism in two Dutch twin cohorts of different age ranges. Across chromosome 19, short tandem repeats and the APOEepsilon2/epsilon3/epsilon4 polymorphism were genotyped in adolescent (aged 13-22 years) and adult (aged 34-62 years) Dutch twins. In both samples, evidence for indicative linkage with plasma apoE levels was found (maximum LOD score (MLS)=0.8, MLS=2.5, respectively) at 19q13.32. These linkage regions included the APOE locus. As expected, the APOEepsilon2/epsilon3/epsilon4 polymorphism was strongly associated with apoE plasma levels in both samples. An extension of the between/within families association test developed by Fulker et al. ([1999] Am. J. Hum. Genet. 64:259-267) showed that these associations were not due to population stratification. The combined association and linkage analyses revealed that the association of the APOEepsilon2/epsilon3/epsilon4 polymorphism with apoE plasma levels completely explained the linkage in the adolescent twins and partly in the adult twins.     

Guidelines for direct radionuclide cystography in children

These guidelines, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They contain information on the indications, acquisition, processing and interpretation of direct radioisotope cystography in children. The guidelines should be taken in the context of "good practice" and any local/national rules which apply to nuclear medicine examinations.     

Guiding surgical cannulation of the inferior vena cava with transesophageal echocardiography

We studied 150 adult cardiac surgery patients to assess visualization of the venous cannula and the venous system by intraoperative transesophageal echocardiography and to register the incidence of cannulation of hepatic veins. The quality of images, the dimensions of the venous system, the position of the venous cannula, and the adequacy of venous return were registered. Acceptable image quality of the inferior vena cava and the right hepatic vein (RHV) was obtained in 95% and 87% of cases, respectively. Considerable individual variations were found in the dimensions of the venous system. The cannula position could be determined in 99% of the cases. Ten percent of venous cannulae were primarily placed in the RHV. A short distance between the eustachian valve and the RHV possibly predisposes to cannulation of the RHV. No other patient-related factors were associated with cannula position. Placement of the cannula deep in the inferior vena cava was associated with reduced venous return and may be a more important cause of reduced return than a cannula positioned in a hepatic vein. IMPLICATIONS: Correct positioning of the venous cannula draining blood to the cardiopulmonary bypass circuit is important. Intraoperative transesophageal echocardiography allows satisfactory determination of the cannula position in nearly all patients. Ten percent of venous cannulae are primarily positioned in the right hepatic vein and not in the inferior vena cava as intended.