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Clinical experience in managing temporomandibular joint ankylosis: five-year appraisal in a Nigerian subpopulation

  • Braimah, Ramat;Taiwo, Abdurrazaq;Ibikunle, Adebayo;Oladejo, Taoreed;Adeyemi, Mike;Adejobi, Francis;Abubakar, Siddiq
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.44 no.3
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    • pp.112-119
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    • 2018
  • Objectives: Temporomandibular joint ankylosis (TMJA) is a joint pathology caused by bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function. Materials and Methods: This is a retrospective study conducted between 2012 and 2016 in the northwest region of Nigeria. The data retrieved includes gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, mouth opening, interpositional materials used, and complications. Results were presented as simple frequencies and descriptive statistics. Results: Thirty-six patients with TMJA were evaluated during the study period. There were 21 males (58.3%) and 15 females (41.7%), yielding a male:female ratio of 1.4:1. The patients' age ranged from 5 to 33 years with $mean{\pm}standard$ deviation ($13.8{\pm}6.6years$). Thirty-five cases (97.2%) were determined to be true/bony ankylosis, while only 1 case (2.8%) was false/fibrous ankylosis. Most of the TMJA cases (16 cases, 44.4%) were secondary to a fall. In our series, the most commonly utilized incision was the Bramley-Al-Kayat (15 cases, 41.7%). The mostly commonly performed procedures were condylectomies and upper ramus ostectomies (12 cases each, 33.3%), while the most commonly used interpositional material was temporalis fascia (14 cases, 38.9%). The complications that developed included 4 cases (11.1%) of severe hemorrhage, 1 case (2.8%) of facial nerve palsy, and 1 case (2.8%) of re-ankylosis. Conclusion: Plain radiographs, with their shortcomings, still have significant roles in investigating TMJA. Aggressive postoperative physiotherapy for a minimum of 6 months is paramount for successful treatment.

Seroepidemiologic Evidence for the Presence of Hantavirus in South Africa (남아프라카 지역내 한타바이러스 존재에 관한 혈청 역학적 증거)

  • Lee, Pyung-Woo;Park, Man-Seong;Keen, G.Anthony;Noveljic, Z.;Tucker, Tim J.;Ryst, Elna van der;Viljoen, Johannes I.;Pretorius, Anne-Marie;Oelofsen, Mike
    • The Journal of Korean Society of Virology
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    • v.29 no.1
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    • pp.11-22
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    • 1999
  • Sero-epidemiologic survey has been carried out to establish serologically the presence of hantavirus in areas of South Africa. The survey was oriented to search natural infection in both of humans and wild rodents and involvement of human disease. The normal human sera were collected from the residents in urban and rural areas of Western Cape, and rural area of Eastern Cape province. The rodent sera came from various species of rodents trapped in Northern Cape and Western Free provinces. The patient sera were selected from the patients of renal failure, pulmonary syndrome and pyrexia of unknown origin (PUQ) according to diagnostic chart among the patients hospitalized in major hospitals of Cape Town area. The sera were screened and titrated by IFA test using antigens of Hantaan (HTN), Seoul (SEO), Puumala (PUU), and Prospect Hill (PH) viruses primarily. Positive cases were subjected to differential IFA test using HTN, PUU and PH antigens and plaque reduction neutralization test for further confirmation. Anti-hantavirus antibodies were detected from 2 of 352 rural, 1 of 172 urban residents of E. Cape, and 5 of 118 rural, 5 of 368 urban residents of W. Cape. The antibody was also demonstrated from 5 of 221 wild rodents, and it was appeared that 2 different species, Aethomys namaquensis and Tatem leucogaster, are involved. Among 318 patients tested, 3 who were diagnosed as chronic renal failure, acute respiratory distress syndrome (ARDS) and glomerulonephritis were proved to be positive. The reaction patterns obtained from all of these positive sera were distinct from hantaviral sero-patterns ever established. This result suggests that new viruses may exist in this area and play an possible etiologic role in human disease. The feature of serologic survey on anti-hantavirus antibody demonstrable newly from African wild rodents which are different from reservoir species in other continents elicits a conjecture that the virus may be different from known hantaviruses ever found. This fact also suggests that an expanded role in etiologic involvement with other unknown human diseases by newly emerging hantaviruses may be possible in this areas.

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How effective has the Wairau River erodible embankment been in removing sediment from the Lower Wairau River?

  • Kyle, Christensen
    • Proceedings of the Korea Water Resources Association Conference
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    • 2015.05a
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    • pp.237-237
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    • 2015
  • The district of Marlborough has had more than its share of river management projects over the past 150 years, each one uniquely affecting the geomorphology and flood hazard of the Wairau Plains. A major early project was to block the Opawa distributary channel at Conders Bend. The Opawa distributary channel took a third and more of Wairau River floodwaters and was a major increasing threat to Blenheim. The blocking of the Opawa required the Wairau and Lower Wairau rivers to carry greater flood flows more often. Consequently the Lower Wairau River was breaking out of its stopbanks approximately every seven years. The idea of diverting flood waters at Tuamarina by providing a direct diversion to the sea through the beach ridges was conceptualised back around the 1920s however, limits on resources and machinery meant the mission of excavating this diversion didn't become feasible until the 1960s. In 1964 a 10 m wide pilot channel was cut from the sea to Tuamarina with an initial capacity of $700m^3/s$. It was expected that floods would eventually scour this 'Wairau Diversion' to its design channel width of 150 m. This did take many more years than initially thought but after approximately 50 years with a little mechanical assistance the Wairau Diversion reached an adequate capacity. Using the power of the river to erode the channel out to its design width and depth was a brilliant idea that saved many thousands of dollars in construction costs and it is somewhat ironic that it is that very same concept that is now being used to deal with the aggradation problem that the Wairau Diversion has caused. The introduction of the Wairau Diversion did provide some flood relief to the lower reaches of the river but unfortunately as the Diversion channel was eroding and enlarging the Lower Wairau River was aggrading and reducing in capacity due to its inability to pass its sediment load with reduced flood flows. It is estimated that approximately $2,000,000m^3$ of sediment was deposited on the bed of the Lower Wairau River in the time between the Diversion's introduction in 1964 and 2010, raising the Lower Wairau's bed upwards of 1.5m in some locations. A numerical morphological model (MIKE-11 ST) was used to assess a number of options which led to the decision and resource consent to construct an erodible (fuse plug) bank at the head of the Wairau Diversion to divert more frequent scouring-flows ($+400m^3/s$)down the Lower Wairau River. Full control gates were ruled out on the grounds of expense. The initial construction of the erodible bank followed in late 2009 with the bank's level at the fuse location set to overtop and begin washing out at a combined Wairau flow of $1,400m^3/s$ which avoids berm flooding in the Lower Wairau. In the three years since the erodible bank was first constructed the Wairau River has sustained 14 events with recorded flows at Tuamarina above $1,000m^3/s$ and three of events in excess of $2,500m^3/s$. These freshes and floods have resulted in washout and rebuild of the erodible bank eight times with a combined rebuild expenditure of $80,000. Marlborough District Council's Rivers & Drainage Department maintains a regular monitoring program for the bed of the Lower Wairau River, which consists of recurrently surveying a series of standard cross sections and estimating the mean bed level (MBL) at each section as well as an overall MBL change over time. A survey was carried out just prior to the installation of the erodible bank and another survey was carried out earlier this year. The results from this latest survey show for the first time since construction of the Wairau Diversion the Lower Wairau River is enlarging. It is estimated that the entire bed of the Lower Wairau has eroded down by an overall average of 60 mm since the introduction of the erodible bank which equates to a total volume of $260,000m^3$. At a cost of $$0.30/m^3$ this represents excellent value compared to mechanical dredging which would likely be in excess of $$10/m^3$. This confirms that the idea of using the river to enlarge the channel is again working for the Wairau River system and that in time nature's "excavator" will provide a channel capacity that will continue to meet design requirements.

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