Traumatic Neuroma Following Sagittal Split Osteotomy of the Mandible

A 16-year-old male underwent bilateral sagittal split osteotomy of the mandible to correct a mandibular deficiency. Twenty-one years later, a routine panoramic radiograph revealed a radiolucent lesion on the left side of the mandible. The lesion was biopsied. As the patient did not have symptoms and the lesion was connected to the inferior alveolar nerve, the lesion was not totally excised in order to preserve nerve function. The histological features were consistent with traumatic neuroma, and no further surgical procedure was planned

Thrust Stand Characterization of the NASA Evolutionary Xenon Thruster (NEXT)

Direct thrust measurements have been made on the NASA Evolutionary Xenon Thruster (NEXT) ion engine using a standard pendulum style thrust stand constructed specifically for this application. Values have been obtained for the full 40-level throttle table, as well as for a few off-nominal operating conditions. Measurements differ from the nominal NASA throttle table 10 (TT10) values by 3.1 percent at most, while at 30 throttle levels (TLs) the difference is less than 2.0 percent. When measurements are compared to TT10 values that have been corrected using ion beam current density and charge state data obtained at The Aerospace Corporation, they differ by 1.2 percent at most, and by 1.0 percent or less at 37 TLs. Thrust correction factors calculated from direct thrust measurements and from The Aerospace Corporation s plume data agree to within measurement error for all but one TL. Thrust due to cold flow and "discharge only" operation has been measured, and analytical expressions are presented which accurately predict thrust based on thermal thrust generation mechanisms

Spatially-Resolved Beam Current and Charge-State Distributions for the NEXT Ion Engine

Plume characterization tests with the 36-cm NEXT ion engine are being performed at The Aerospace Corporation using engineering-model and prototype-model thrusters. We have examined the beam current density and xenon charge-state distribution as functions of position on the accel grid. To measure the current density ratio j++/j+, a collimated Eprobe was rotated through the plume with the probe oriented normal to the accel electrode surface at a distance of 82 cm. The beam current density jb versus radial position was measured with a miniature planar probe at 3 cm from the accel. Combining the j++/j+ and jb data yielded the ratio of total Xe+2 current to total Xe+1 current (J++/J+) at forty operating points in the standard throttle table. The production of Xe+2 and Xe+3 was measured as a function of propellant utilization to support performance and lifetime predictions for an extended throttle table. The angular dependence of jb was measured at intermediate and far-field distances to assist with plume modeling and to evaluate the thrust loss due to beam divergence. Thrust correction factors were derived from the total doubles-to-singles current ratio and from the far-field divergence dat

Risk of acquired drug resistance during short-course directly observed treatment of tuberculosis in an area with high levels of drug resistance.

BACKGROUND: Data on the performance of standardized short-course directly observed treatment (DOTS) of tuberculosis (TB) in areas with high levels of drug resistance and on the potential impact of DOTS on amplification of resistance are limited. Therefore, we analyzed treatment results from a cross-sectional sample of patients with TB enrolled in a DOTS program in an area with high levels of drug resistance in Uzbekistan and Turkmenistan in Central Asia. METHODS: Sputum samples for testing for susceptibility to 5 first-line drugs and for molecular typing were obtained from patients starting treatment in 8 districts. Patients with sputum smear results positive for TB at the end of the intensive phase of treatment and/or at 2 months into the continuation phase were tested again. RESULTS. Among 382 patients with diagnoses of TB, 62 did not respond well to treatment and were found to be infected with an identical Mycobacterium tuberculosis strain when tested again; 19 of these patients had strains that developed new or additional drug resistance. Amplification occurred in only 1.2% of patients with initially susceptible or monoresistant TB strains, but it occurred in 17% of those with polyresistant strains (but not multidrug-resistant strains, defined as strains with resistance to at least isoniazid and rifampicin) and in 7% of those with multidrug-resistant strains at diagnosis. Overall, 3.5% of the patients not initially infected with multidrug-resistant TB strains developed such strains during treatment. Amplification of resistance, however, was found only in polyresistant Beijing genotype strains. CONCLUSIONS: High levels of amplification of drug resistance demonstrated under well-established DOTS program conditions reinforce the need for implementation of DOTS-Plus for multidrug-resistant TB in areas with high levels of drug resistance. The strong association of Beijing genotype and amplification in situations of preexisting resistance is striking and may underlie the strong association between this genotype and drug resistance

Tuberculosis in children in India-II: Chemotherapy for tuberculosis

Tubercle bacilli readily become resistant to the common drugs, and resistant bacilli are more likely to proliferate if they are present in the patient at the start of treatment. So always use more than one drug. The only possible exception is prophylaxis for an asymptomatic case with a normal X-ray. CAUTION! (1) Never give intermittent (twice or thrice weekly) treatment unless every dose can be supervised by a health worker. Daily treatment is usually mandatory. (2) When you give more than one drug, give them both at the same time, so that high blood levels coincide; do not give one drug daily and the other drug less often. THE DOSES of the commonly used drugs for daily and intermittent treatment in children and adults are: lsoniazid (H) 5 mg/kg/24 hours if he is moderately ill and 10 mg/kg/24 hours if he is severely ill. The dose for a twice weekly course is 15 mg/kg. CAUTION! Opinions on the dose of isoniazid vary. Some consider 10 mg/kg/24 hours too much for an Indian child and always give 5 mg. Rifampicin (R) 10 mg/kg/24 hours, or 10 mg/kg twice weekly. Pyrazinamide (Z) 35 mg/kg/24 hours, 75 mg/kg twice weekly or 50 mg/kg thrice weekly, is an important drug for short course treatment, so try to include it whenever it is mentioned in the regimes below. Streptomycin (S) 10-20 mg/kg/24 hours, or 40 mg/kg twice weekly, to a total of not more than 0.75 g. Streptomycin is painful, so avoid it if you can. If you give it, inject in different places each day, because repeated injections into the same site are painful. Ethambutol (E) 25 mg/kg/24 hours for 2 months, then 15 mg/kg/24 hours. Avoid ethambutol in younger children (under 12); they are unable to complain of the early symptoms of retrobulbar neuritis (blindness). Thiacetazone (T) 4 mg/kg/24 hours to a maximum Of 150 mg; unsuitable for intermittent treatment

Tuberculosis in children in India-I

Tuberculosis is different in children. It involves many organs, instead of being the predominantly respiratory disease that it usually is in adults. Fortunately, it readily responds to treatment–if you diagnose it early enough and treat it for long enough! This is the problem. Unfortunately, tuberculosis causes such non-specific symptoms and signs, and you are so seldom able to isolate bacilli, that you may never be sure of the diagnosis. Even experts sometimes disagree. In India particularly, it is a disease of the poorest of the poor, but even in them it causes only a small proportion of their burden of morbidity. The great problem is to reach those infected. Of every thousand Indians, seven children and about twenty adults have active tuberculosis, and five of these adults are sputum positive. Only about half the 9 million in the community at any one time are ever diagnosed, and of these only about 13% complete their treatment, so there is a huge pool of infectious cases, half a million of whom die each year. Fortunately, the incidence of tuberculosis among children reporting to hospital is slowly decreasing, probably largely due to improved coverage with BCG

High prevalence of bronchiectasis is linked to HTLV-1-associated inflammatory disease.

BACKGROUND: Human T-lymphotropic virus type 1 (HTLV-1), a retrovirus, is the causative agent of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukaemia/lymphoma (ATLL). The reported association with pulmonary disease such as bronchiectasis is less certain. METHODS: A retrospective case review of a HTLV-1 seropositive cohort attending a national referral centre. The cohort was categorised into HTLV-1 symptomatic patients (SPs) (ATLL, HAM/TSP, Strongyloidiasis and HTLV associated inflammatory disease (HAID)) and HTLV-1 asymptomatic carriers (ACs). The cohort was reviewed for diagnosis of bronchiectasis. RESULT: 34/246 ACs and 30/167 SPs had been investigated for respiratory symptoms by computer tomography (CT) with productive cough +/- recurrent chest infections the predominant indications. Bronchiectasis was diagnosed in one AC (1/246) and 13 SPs (2 HAID, 1 ATLL, 10 HAM/TSP) (13/167, RR 19.2 95 % CI 2.5-14.5, p = 0.004) with high resolution CT. In the multivariate analysis ethnicity (p = 0.02) and disease state (p < 0.001) were independent predictors for bronchiectasis. The relative risk of bronchiectasis in SPs was 19.2 (95 % CI 2.5-14.5, p = 0.004) and in HAM/TSP patients compared with all other categories 8.4 (95 % CI 2.7-26.1, p = 0.0002). Subjects not of African/Afro-Caribbean ethnicity had an increased prevalence of bronchiectasis (RR 3.45 95 % 1.2-9.7, p = 0.02). CONCLUSIONS: Bronchiectasis was common in the cohort (3.4 %). Risk factors were a prior diagnosis of HAM/TSP and ethnicity but not HTLV-1 viral load, age and gender. The spectrum of HTLV-associated disease should now include bronchiectasis and HTLV serology should be considered in patients with unexplained bronchiectasis

Measurement of 30-Centimeter Ion Thruster Discharge Cathode Erosion

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/76209/1/AIAA-22982-649.pd