A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.
http://ift.tt/2txSuV0
Σάββατο 10 Μαρτίου 2018
A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach
Detection accuracy of maxillary sinus floor septa in panoramic radiographs using CBCT as gold standard: a multi-observer receiver operating characteristic (ROC) study
Abstract
Objectives
To investigate diagnostic accuracy of panoramic radiography in detecting maxillary sinus floor septa by means of a multi-observer receiver operating characteristic (ROC) analysis and a standardized protocol for reporting (STARD protocol; Clin Chem 49(1):1–6, 2003).
Material and methods
From our database, 25 cone beam computed tomographies (CBCTs) were selected with one maxillary sinus floor septum (height ≥ 2.5 mm). For the same patient, a recent panoramic radiograph (PAN) had to be available in the database. As controls, 28 CBCTs plus corresponding PANs without evidence of a sinus septum were selected. Using the CBCTs as ground truth, 17 observers from our dental school on a five-point confidence scale rated both sinuses in all 53 PANs with respect to presence/absence of a sinus septum. Areas beneath ROC curves (Az-values), sensitivity/specificity (SNT/SPF), positive/negative predictive values (PPV, NPV), and positive/negative likelihood ratios (LR+, LR−) were computed for each observer and pooled over all observers. Inter-rater reproducibility was assessed by means of the intraclass coefficient (ICC) using a two-way random effects model.
Results
A pooled Az-value of 0.839 was observed (SNT 84.6%, SPF 73.5%). PPV ranged between 0.492 and 0.824 (median 0.627) and NPV between 0.838 and 0.976 (median 0.917). A median LR+ of 3.567 was computed (LR− median 0.193). Inter-rater reliability revealed an ICC of 0.55 (95% confidence interval 0.48 to 0.62).
Conclusions
Our results indicate that PAN is a moderately accurate method for sinus elevation planning for the purpose of septum detection. Ruling out a septum by PAN seems to work more accurately than ruling in.
Clinical relevance
For the purpose of maxillary sinus floor septa detection, panoramic radiography can be relatively safely advocated, particularly for judgment of a septum-free sinus.
http://ift.tt/2FsTW0M
Inflammatory arthritis in pediatric patients with morphea
Pediatric morphea is associated with joint contractures and arthralgia. The findings of this study support the association of inflammatory arthritis with pediatric morphea. Understanding of the relationship between morphea and arthritis in children should lead to increased musculoskeletal vigilance and appropriate systemic therapy.
http://ift.tt/2IheQgZ
Immune Dysregulation in the Pathogenesis of Atopic Dermatitis
http://ift.tt/2FGC5T6
Patch Testing for the Evaluation of Metal Hypersensitivity in the Nuss Procedure
The Nuss procedure has become the predominant reason for the use of metal implants by pediatric general and thoracic surgeons. Current guidelines recommend preimplant testing for all patients undergoing the Nuss procedure, which differs from the guidelines for all other orthopedic procedures. This review was done to further evaluate this discrepancy.http://ift.tt/2FHN9zy
Rubber Accelerators in Medical Examination and Surgical Gloves
Background Rubber accelerators play a significant role in glove-related occupational contact dermatitis, especially among health care workers. Currently, there is limited information readily available outlining the accelerators used in specific medical examination and surgical gloves. Objective The aim of this study was to ascertain the accelerators used in medical examination and surgical gloves for major glove manufacturers within the United States. Methods An initial Internet-based search was performed to establish relevant manufacturers and product lines, with subsequent inquiry with each corresponding company regarding accelerators used in each medical and surgical glove line. Results Eleven glove manufacturers were identified and contacted. Responses were obtained from all manufacturers, but because of legal limitations, changes in product lines, or inability to supply necessary data, only 8 companies were able to be included in the final analysis, totaling data for 190 gloves. Carbamates were the most common accelerator, used in 90.5% (172/190) of gloves, whereas thiurams were used in only 11 gloves (5.8%). Eight companies surveyed are now advertising and offering touted accelerator-free gloves. Conclusions Accelerators are used in most examination and surgical gloves; however, manufacturers are now expanding their product offerings to include accelerator-free options.http://ift.tt/2FGywMJ
The Role of Cleaning Products in Epidemic Allergic Contact Dermatitis to Methylchloroisothiazolinone/Methylisothiazolinone
Background Sensitivity to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) has increased rapidly over recent years. This increase is mainly related to the extensive use of high concentrations of MI in cosmetic products, although a growing number of cases of occupational allergic contact dermatitis are caused by MCI/MI. Objective The aim of this study was to examine the association between the increase in MCI/MI sensitization and the work performed by the patients in our area. Methods A retrospective study was undertaken of the records of a total of 1179 patients who had undergone contact skin patch tests for MCI/MI from January 2005 to December 2015. A multivariate logistic regression analysis was performed to identify the factors independently associated with sensitivity to MCI/MI. Results A constant increase in MCI/MI sensitization was observed over the observation period. The only work associated with a significant increase in the prevalence of MCI/MI sensitization was cleaning, with 38.5% of the cleaning professionals with MCI/MI sensitization consulting for cosmetics-related dermatitis. Conclusions Occupational sensitization to MCI/MI in cleaning professionals is worryingly increasing. This, in turn, could possibly account for many cases of cosmetics-associated contact dermatitis. Our findings suggest that a review of the regulations with regard to isothiazolinone concentrations in industrial and household detergents is necessary.http://ift.tt/2FKAtbf
Prevalence of Contact Allergens in Personal Care Products for Babies and Children
Background Personal care products marketed for babies and children are often regarded as "safe" or "gentle." However, little is known about the prevalence of contact allergens in these types of products. Objective This study assessed the prevalence of important sensitizers in personal care products marketed for babies and children. A secondary objective of this study was to determine whether a product's cost correlates with content of sensitizing ingredients. Methods The ingredient lists of 533 unique personal care products were analyzed for presence of fragrance, betaines, propylene glycol, methylchloroisothiazolinone, methylisothiazolinone, formaldehyde, lanolin, and neomycin. Price per ounce was determined for each product as well. Conclusions Most personal care products for babies and children contain 1 or more sensitizers. Products containing more sensitizers tend to cost less than those without any sensitizing ingredients.http://ift.tt/2FGBT6k
Carmine Red: A Potentially Overlooked Allergen in Children
No abstract availablehttp://ift.tt/2tB5Lwh
Survey of Patch Test Business Models in the United States by the American Contact Dermatitis Society
Background Allergic contact dermatitis (ACD) remains a significant burden of disease in the United States. Patch testing is the criterion standard for diagnosing ACD, but its use may be limited by reimbursement challenges. Objective This study aimed to assess the current rate of patch test utilization among dermatologists in academic, group, or private practice settings to understand different patch testing business models that address these reimbursement challenges. Methods All members of the American Contact Dermatitis Society received an online survey regarding their experiences with patch testing and reimbursement. Results A "yes" response was received from 28% of survey participants to the question, "Are you or have you been less inclined to administer patch tests or see patients needing patch tests due to challenges with receiving compensation for patch testing?" The most commonly reported barriers include inadequate insurance reimbursement and lack of departmental support. Conclusions Compensation challenges to patch testing limit patient access to appropriate diagnosis and management of ACD. This can be addressed through a variety of innovative business models, including raising patch testing caps, negotiating relative value unit compensation, using a fixed salary model with directorship support from the hospital, and raising the percentages of collection reimbursement for physicians.http://ift.tt/2FCRsfx
Allergic Contact Stomatitis Associated With Sweet Vermouth
No abstract availablehttp://ift.tt/2FHN7Ys
A questionnaire to assess olfactory rehabilitation for laryngectomized patients (Provox voice prosthesis users) in Japan
Source:Auris Nasus Larynx
Author(s): Yukinobu Ishikawa, Yukiko Yanagi, Michi Suzuki, Ujimoto Konomi
ObjectiveWe used a questionnaire to investigate olfactory function and the present state of olfactory rehabilitation for laryngectomized patients in Japan.MethodsThis study was conducted using a questionnaire survey. We mailed questionnaires to 190 members of a Japanese laryngectomized patient group (the nonprofit organization YOUSAY-KAI). The survey queried the following items: (1) basic information (age, sex, alaryngeal speech method, etc.); (2) questions about olfactory rehabilitation, such as the individual's experience of olfactory rehabilitation, the number of days from laryngectomy to the start of olfactory rehabilitation, and the location of rehabilitation (i.e., hospital or patient association); (3) free comments; and (4) the self-administered Odor Questionnaire (SAOQ).ResultsWe received 121/190 questionnaires by the submission deadline. Of these, 105 questionnaires were valid. All 105 responders used the Provox voice prosthesis as the alaryngeal speech method. Only 4.7% (5/105) of the patients received olfactory rehabilitation in hospitals. Many comments in the free comment column included demands for olfactory rehabilitation such as "I want to know where we can have olfactory rehabilitation" and "I want to have rehabilitation if olfaction recovers." The SAOQ score was significantly higher in the rehabilitation group (mean, 42.5%) compared to the nonrehabilitation group (mean, 22.1%) (p<0.05). There was no correlation between the SAOQ score and the number of days from laryngectomy to the start of rehabilitation (r=0.08, p=0.76)．ConclusionPatient demand for olfactory rehabilitation is strong, but this therapy is not widely offered to laryngectomized patients in Japan. Notably, the SAOQ scores showed that olfactory rehabilitation may have an effect, even if it is initiated after laryngectomy. We believe that when patients choose voice prosthesis for speech, their olfaction deteriorates unless they undergo olfactory rehabilitation separately from speech rehabilitation. It is therefore necessary to administer olfactory rehabilitation for laryngectomized patients who have never received olfactory rehabilitation, as well as for patients scheduled to undergo laryngectomy.
http://ift.tt/2oZswVI
Extraction of permanent maxillary teeth without palatal injection: a meta-analysis
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Li Cui, Zhuyu Zhang, Ling Xu, Jiao Huang, Dongqing Yin
ObjectiveThe objective of this meta-analysis was to assess the operation success rates of extracting maxillary teeth without palatal injection.Study DesignPubMed, Cochrane Library, Embase, SinoMed and the references of the identified full-text articles were searched for relevant studies published until June 2017 that met the eligibility criteria. Experimental data were combined by meta-analysis using RevMan 5.3 soft- ware.Results7 randomized controlled trials were included in this meta-analysis. Compared with the control groups (were given the combination of buccal and palatal anesthesia recommended by the textbook, also known as routine Infiltration anesthesia), experimental group (single buccal anesthesia) for the removal of maxillary permanent teeth at conventional doses, which resulted in a reduction in the success rate (OR = 0.14, 95% CI = 0.07–0.27, P < 0.00001).ConclusionsThe results revealed that the success rate of the removal of the maxillary permanent teeth has undoubtedly been reduced by the lack of palatal injections. However, larger and higher quality tests are needed to confirm and optimize the effect of this anesthetic procedure.
http://ift.tt/2DgYLEr
Continuity defects of the mandible: Comparison of three techniques for osseous reconstruction and their impact on implant loading
Publication date: Available online 9 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Yunus Okcu, Jan Rustemeyer
Computer-aided design/manufacturing (CAD/CAM) is now widely used, but whether it can help to overcome complications in mandibular reconstruction and accelerate dental implantation is still a matter for debate. Therefore, we aimed to evaluate the benefits of this technique using vascularized iliac crest or fibula flaps in mandibular reconstruction, with respect to the time between reconstruction and implantation, and the ratio of planned to inserted implants. We reviewed retrospectively the records of 54 patients who underwent mandibular reconstructions between 2012 and 2016, and included in our study the last 10 cases representing each of the following groups: iliac crest flap with CAD/CAM (Group 1); fibula flap with CAD/CAM (Group 2); and fibula flap without CAD/CAM (Group 3). Groups 1 (p = 0.045) and 2 (p = 0.034) showed significantly shorter delays when compared with Group 3. Significant differences in average counts of implants placed were also found between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019). The ratio of planned to placed implants was highest in Group 1. The observed differences between Group 1 and Groups 2 (p = 0.04) and 3 (p = 0.019) were significant. Our results indicate an accelerating effect of CAD/CAM on graft consolidation and dental rehabilitation.
http://ift.tt/2FIEexF
Interdisciplinary Treatment Algorithm for Facial Arteriovenous High-flow Malformations and Review of the Literature
Publication date: Available online 9 March 2018
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Katinka Kansy, Jens Bodem, Michael Engel, Christian Freudlsperger, Markus A. Möhlenbruch, Christian Herweh, Martin Bendszus, Jürgen Hoffmann, Steffen Kargus
IntroductionHigh-flow arteriovenous malformations (HF-AVMs) are congenital vascular malformations. Typical localizations include the face, oral cavity, and extremities.Due to the high recurrence rate of AVM after incomplete resection or embolization, a combination of both therapeutic modalities has become the preferred choice of treatment. Therefore, we have developed an interdisciplinary therapeutic treatment algorithm for facial HF-AVM and performed a systematic review of the literature.Patients and methodsIn a retrospective analysis, all patients who were treated using the interdisciplinary therapeutic treatment algorithm for facial HF-AVM between 10/2010 and 09/2014 were included in the study. Small HF-AVMs (n = 2) without prior therapy and with clearly detectable arterial blood supply were treated by surgical monotherapy. Larger, previously unsuccessfully treated HF-AVMs and lesions with complex arterial blood supply were treated using a combined therapy (n = 6). Combined therapy consisted of a preoperative embolization and a subsequent surgical resection 1–2 days later. If an extensive surgical reconstruction became necessary due to the size of the malformation, or the risk of recurrence was high due to the complex vascular anatomical situation, a second postoperative angiogram was performed to safely exclude a residual nidus, using a 'second look' prior to definitive wound closure (n = 3). HF-AVMs that did not allow for curative therapeutic intervention due to their size and localization were treated by interventional monotherapy (n = 1). Patients with suspicion of a primarily hormone-dependent growth during pregnancy were closely followed up clinically, following a 'wait and see' strategy (n = 1). In addition, a systematic literature review was performed to analyze treatment outcomes and current standards.Results13 patients with a mean age of 39 years were included in the analysis. Patients were followed up for a mean of 26.8 months (range 12–60 months). Combined treatment (n = 9) was free of recurrence in all cases (100%) after a mean follow up of 30.3 months (range 12–60 months). Surgical monotherapy (n = 2) was also successful in both cases. Non-curative, interventional monotherapy lead to significant decrease in symptoms and did not have to be repeated. A postpartum decrease of the tumor could be observed in the 'wait and see' group. However, at the end of the observational period, a hormone-independent growth occurred. Results were supported by findings of the review.ConclusionThe treatment of HF-AVMs of the head and neck remains challenging due to high recurrence rates. In our cohort, following the Heidelberg treatment algorithm both surgical monotherapy and combined surgical and interventional therapy had very high success rates. For non-curative, symptomatic therapy, interventional treatment should be discussed in terms of the risk of growth induction of HF-AVMs. Findings from the literature concerning therapeutic strategies and success rates are in line with the developed Heidelberg treatment algorithm. However, a larger sample of patients will be necessary to prove the validity of this algorithm.
http://ift.tt/2txGMtJ
Evaluation of the morphology of the genial tubercle using cone-beam computed tomography
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): Y. Nejaim, D. Duarte Moreira, A.B. Nolasco Fernandes, M.M.G. de Souza, F.C. Groppo, F. Haiter Neto
http://ift.tt/2Ih2pS9
Sialendoscopy for sialolithiasis in children: 4-8 years follow up
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): R. Jouan, E. Picot, R. Hermann, F. Faure, F. Marchal
Sialolithiasis is rare in children, there are no guidelines for its treatment, and there are few, if any, long term follow-up studies. We report a retrospective review of medical records of children who were treated for sialolithiasis by sialendoscopy between 1 January 2007 and 31 December 2011, and who have been followed up for 4-8 years. Personal and clinical details, including age, sex, symptoms, whether the lithiasis was parotid or submandibular, the technique of sialendoscopy and complications, were recorded. Twenty-six children (30 sides) were successfully treated by sialendoscopy between 2007 and 2011 (mean (range) age 12 (3-17) years). Stones were removed from the parotid gland in four patients and the submandibular gland in 22. The main indication for sialendoscopy was swelling of the salivary gland during meals. Twenty-six procedures were done endoscopically. Twelve were treated with a wire basket alone, 10 by the combined approach, and laser was used in eight. Four patients developed complications, but without long-term effects. During follow-up of 4-8 years there were no recurrent swellings. We conclude that endoscopic treatment of stones in childhood is an efficient and conservative option for salivary glands, has few complications and no clinical recurrence at medium to long-term follow-up.
http://ift.tt/2DicM4p
Treatment of intraoral ranulas with a two-incision fistula technique: the management of recurrence
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): Qingtong Zhao, Mengyu Li, Renfa Lai, Shaoyi Wang
The two-incision fistula technique for the treatment of oral ranulas has recently been introduced to clinical practice. We reviewed 52 patients who had recurrences after this treatment, and explored the possible causes and underlying mechanisms. A total of 13/53 ranulas had recurred, so we repeated the operation, and one patient had the ranula and the sublingual gland resected. We found that the thin mucous membrane cracked at the double incisions, which led to the formation of a fistula and promoted the drainage of cystic fluid. The results indicated that the recurrence of ranulas after the two-incision fistula technique can be reduced further. To avoid recurrence, the technique should be adjusted slightly, depending on the type of ranula present.
http://ift.tt/2IiF96k
Forehead reduction and orbital contouring in facial feminisation surgery for transgender females
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Altman
Forehead reduction and orbital contouring form a considerable component of the procedures available to feminise the face in transgender females. In this paper I shall discuss the history and development of techniques to reduce bossing of the forehead and contour the orbits, and describe their classification, assessment, surgical approach, and complications.
http://ift.tt/2DicGd3
Outcomes of treatment for intracapsular fractures of the mandibular condyle: recommendation for a new classification
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): B.B. Ying, Q.Q. Zhang, S.S. Zhu, Y.F. Li
We know of no universally accepted classification for intracapsular condylar fractures. We propose here a new classification based on the concept of a "disc-condyle" unit, and validate the classification based on outcomes of treatment. From 1 January 2010 - 31 December 2014, 55 patients with unilateral intracapsular condylar fractures were classified into three types: type A has no reduction in mandibular height or displacement of the disc (n=7); type B has displacement of the disc with no reduction in mandibular height (n=17); and type C has reduced mandibular height with or without displacement of the disc (n=31). We treated types B and C by open reduction and fixation, while type A fractures were managed non-surgically. At six month follow-up, we found no significant differences in the vertical height of the ramus, mandibular deviation, protrusion, or lateral protrusion between the fractured and healthy sides. All patients had normal occlusion postoperatively and only one patient (type C) reported pain. Magnetic resonance imaging and computed tomography showed good osseous healing and disc-condylar relations in all cases. Our results show that this new classification of intracapsular condylar fractures is a safe and easy way to obtain satisfactory outcomes of treatment. However, it needs further independent validation.
http://ift.tt/2IhYOUb
Use of ultrasound-activated resorbable sheets and pins in the management of fractures of the condylar neck of the mandible: a case series
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): N.M.H. McLeod, D. Van Gijn
The need to treat fractures of the mandibular condyle remains controversial, but when the decision to operate has been made, then multiple forms of fixation are advocated. Traditionally, metal plates and screws have been used, but this is thought to have several disadvantages, particularly in the growing skeleton. Resorbable fixation for maxillofacial fractures has not gained widespread acceptance because of technical difficulties with the materials and concern about inflammatory reactions during their resorption. Because not all patients have typical fracture patterns that fit the size and shape of metal plates, mouldable resorbable fixation materials can be useful, and ultrasound-activated resorbable sheets and pins have the necessary stability to fix fractures of the condylar neck. We present a series of patients in whom ultrasound-activated resorbable sheets and pins were used to fix condylar fractures in which the fracture pattern did not permit the use of stable metal fixation, or the age of the patient in our opinion precluded the use of metal fixation. There were no perioperative complications and no problems related to the stability of the fixation. Minor swelling relating to the resorption of the material in one case did not require any management.
http://ift.tt/2p2xMY0
Reconstruction after resection of carcinoma of the lower lip
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): H. Imura, H. Furukawa, C. Sakuma, M. Yoshida, N. Natsume
http://ift.tt/2IeozEC
Quality of life after reconstruction with a free forearm flap in patients who have survived oral cancer for more than five years
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): A. Rollon-Mayordomo, J. Herce-Lopez, R. Lozano-Rosado, S. Gallana-Alvarez, C.I. Salazar-Fernandez, P. Infante-Cossio
http://ift.tt/2p4qHWY
Editorial Board
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
http://ift.tt/2IjTRKy
Training Groups
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
http://ift.tt/2p4vvLO
WHO is in and WHO is out of the mouth, salivary glands, and jaws sections of the 4th edition of the WHO classification of head and neck tumours
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): R.A. Kennedy
This review of changes to the 4th edition of the WHO classification of head and neck tumours focuses on their impact on the surgical care of diseases that affect the salivary glands, jaws, and oral cavity. Updates to the chapter on the salivary glands include the addition of secretory carcinoma and sclerosing polycystic adenosis. The odontogenic cysts are back, and the odontogenic keratocyst is listed among them, as it has now lost its brief and confusing designation as a neoplasm. The newly-defined sclerosing odontogenic carcinoma and primordial odontogenic tumour have been added. Oropharyngeal tumours have been separated from those of the oral cavity, which reflects the importance of HPV in carcinoma of the tonsils. The problems of grading oral epithelial dysplasia persist.
http://ift.tt/2IgYvcj
Do signs of an effusion of the temporomandibular joint on magnetic resonance imaging correlate with signs and symptoms of temporomandibular joint disease?
Source:British Journal of Oral and Maxillofacial Surgery, Volume 56, Issue 2
Author(s): N. Thomas, D.E. Harper, S. Aronovich
Effusions are common among patients with disorders of the temporomandibular joint (TMJ), but publications are limited and results inconsistent about the correlation between them and important clinical variables, in particular severity of pain and degenerative disease. We organised a retrospective study of patients who presented for the evaluation and management of arthralgia of the TMJ and myofascial pain at the University of Michigan between 2011 and 2014. Inclusion criteria were: patients who had pain that was primarily arthrogenous, and coexisting myogenous pain, who had had initial non-surgical treatment, and arthroscopy of the TMJ with or without intramuscular injection of onabotulinumtoxinA (Botox,® Allegan, Weston, Fl, USA). The primary outcome variables were pain at rest as measured by visual analogue score (VAS) and the presence of degenerative disease of the joint. The secondary outcome variables included the position of the disc and whether it was perforated, signs of synovitis, maximal interincisal opening (MIO), and duration of symptoms. We studied 47 patients (94 TMJ) who met the inclusion criteria. We found no significant differences in pain at rest before or after arthroscopy, between patients with and without effusions, or in maximal MIO or duration of symptoms between the two groups. There was, however, a significant relation between effusions and degenerative joint disease. Effusions were also associated with a lower probability of the disc being in a normal position and a higher probability of anterior disc displacement without reduction.
http://ift.tt/2IhmtDZ
Autotransplantation of teeth with incomplete root formation: a systematic review and meta-analysis
Abstract
Objectives
The objective of this systematic review and meta-analysis was to determine the rates of survival and success and the complications related to autotransplantation of teeth with incomplete root formation. Additionally, we attempted to identify the prognostic factors that influence the outcome of tooth autotransplantation.
Materials and methods
A literature search for all data published until July 2016 was conducted. Inclusion and exclusion criteria were specified. Risk of bias was assessed with the Newcastle checklist. Meta-analysis was performed by using the DerSimonian-Laird random effect model. The 1-, 5-, and 10-year survival rates and the weighted estimated survival, success, and complication rates per year were calculated.
Results
Thirty-two studies were included for analysis. The survival rates reported after 1, 5, and 10 years were 97.4, 97.8, and 96.3%, respectively. The annual weighted estimated survival rate (98.2%), success rate (96.6%), and complication rates in terms of ankylosis (2.0%), root resorption (2.9%), and pulp necrosis (3.3%) were analyzed. No firm conclusions could be drawn with respect to the prognostic factors due to insufficient evidence of high quality.
Conclusion
The survival and success rates of autotransplantation of teeth with incomplete root formation were high (> 95%), with a low rate of complications (< 5%).
Clinical relevance
Current evidence from the literature on autotransplantation of teeth with incomplete root formation shows favorable survival and success rates and low complication rates, indicating it is a reliable treatment option.
http://ift.tt/2DguFRk
Resorptive potential of impacted mandibular third molars: 3D simulation by finite element analysis
Abstract
Objectives
Previous studies have suggested a relationship between resorption in second molars and pressure from the eruptive force of the third molar. The aim of this study was to simulate functional forces in a mandible model by means of finite element analysis and then assess the biomechanical response produced by impacted third molars on the roots of the second molar.
Materials and methods
A cone beam computed tomography scan presenting an impacted mandibular third molar was segmented (Mimics V17 software). The modeling process was performed using the reverse engineering technique provided by the Rhinoceros 3D 5.0 software. The third molar position was changed in order to produce different inclinations of the impacted tooth. Bite forces were simulated to evaluate total deformation, the equivalent von Mises stress, minimum principal stress on hard tissue, and equivalent elastic strain on soft tissue.
Results
Areas of high energy dissipation and compression stress were detected in the second molar root, independently of the inclination of the impacted third molar. In general, the horizontal position was the situation in which major stress and the amount of deformation occurred in the second and third molar regions.
Conclusion
Impacted third molars in close proximity with the adjacent tooth can generate areas of compression concentrated at the site of contact, which suggests an involvement of mechanical factors in the triggering of resorption lesions.
Clinical relevance
The results of these computational experiments contribute to the understanding of the triggering and progression of resorptive lesions in the adjacent second molar.
http://ift.tt/2IhaSor
Outcomes of autotransplanted teeth and prognostic factors: a 10-year retrospective study
Abstract
Objectives
This retrospective study aimed to investigate the clinical outcome of tooth autotransplantation and related prognostic factors.
Materials and methods
Eighty-two cases of transplanted teeth from March 2006 to December 2016 were retrospectively investigated by medical records and radiographs. The clinical outcomes of transplanted teeth, which included tooth survival, inflammatory root resorption (IRR), ankylosis, and marginal bone loss (MBL), and the related prognostic factors were assessed via survival analysis.
Results
The cumulative survival rate of transplanted teeth was 74% at 10 years after autotransplantation. According to Cox proportional hazards regression analysis, the eruption state of the donor tooth, recipient position, and postoperative MBL were significantly related to tooth survival. The donor tooth position was significantly associated with IRR, the recipient position and the timing of orthodontic initiation with ankylosis, and the recipient position with MBL.
Conclusions
Fully erupted donor teeth and a bounded recipient site were significantly associated with longer tooth survival. Periodontal healing and management to prevent postoperative MBL were as important for successful autotransplantation.
Clinical relevance
Knowledge about the prognostic factors that are significantly associated with each particular clinical outcome may guide clinicians to achieve predictable and successful outcomes after tooth transplantation.
http://ift.tt/2DfgnAs
Single tooth anesthesia versus conventional anesthesia: a cross-over study
Abstract
Objectives
The aim of the present study was to compare an electronic device, the Wand Injection System (Milestone Scientific Livingstone), with conventional anesthesia in terms of the following: pain sensation during anesthetic injection; effectiveness in achieving adequate anesthesia for a complete painless dental treatment; post-operative discomfort; and patient's anxiety toward dental treatment.
Materials and methods
Eighty adults from 18 to 70 years were enrolled in this cross-over study. Each patient served as his/her own control being subject to two anesthesia techniques: conventional and Single Tooth Anesthesia (STA) performed with the Wand. A split-mouth design was adopted in which each tooth undergoing conservative restorative or endodontic treatment received anesthesia with both techniques at 1-week interval. Before anesthetic administration, the patients' anxiety levels were determined. Physiological parameteres were measured before, during, and after the two injection procedures, and the Visual Analogue Scale (VAS) was used to assess pain of injection, discomfort, and anesthetic efficacy. Differences in assessment of pain's injection, discomfort, anesthetic efficacy, vital parameters (heart rate, blood pressure, and oxygen saturation), and state anxiety levels were analyzed using Student's t test (p value < 0.001).
Results
The mean injection pain and post-operative discomfort ratings with Wand were lower than those with conventional syringe (p = 0.022 and p < 0.001, respectively). No differences were found in the assessment of anesthetic efficacy. Blood pressure and heart rate mean values were lower during the anesthesia performed with the Wand than with the conventional syringe (p < 0.001). The anxiety level was higher during the first appointment, independently from the device used for the injections.
Conclusion
The STA technique resulted in lower pain, discomfort, and lower intensity of physiological parameters.
Clinical relevance
Single Tooth Anesthesia could be an efficacious alternative to conventional procedures.
http://ift.tt/2IdmXLn
Shaping ability of rotary or reciprocating systems for oval root canal preparation: a micro-computed tomography study
Abstract
Objectives
To evaluate the shaping ability and cleaning after oval root canal preparation using one or more instruments in reciprocating or rotary motion.
Materials and methods
Oval-shaped mandibular incisors were selected, based on the radiographic diameter (2 ≤ diameter ratio ≤ 4), and assigned according to root canal preparation (n = 18): single-file (Reciproc R40); two reciprocating files (Unicone size 20 and 40, .06 taper) or Mtwo rotary files until a size 40, .06 taper instrument. Root canal preparations were performed using an open root canal model. Scanning was performed before and after preparation using SkyScan 1176 with a voxel size of 17.42 μm. Volume, percentage of debris, and percentage of uninstrumented surface were analyzed in the entire root canal and in each root canal third. Data were compared using ANOVA and Tukey or Kruskal-Wallis and Dunn tests (α = 5%).
Results
The initial volume were similar among the groups (p > .05). Unicone preparation was associated with higher debris, increase in root canal volume and uninstrumented surface in entire root canal and in the middle third (P < .05). Mtwo was associated with lower uninstrumented surface in the entire root canal and in the cervical third. The apical third were similar for the three preparations.
Conclusions
Unicone system using two instruments in reciprocating motion resulted in higher increase in volume. However, less remaining debris was observed when Reciproc single-file and Mtwo rotary systems were used.
Clinical relevance
A preparation that volumetrically increases the root canal is not necessarily associated with better cleaning. Shaping and hard-tissue debris removal depends on root canal anatomy, kinematics, number of instruments, and instrument design.
http://ift.tt/2FrfKtB
ANALYSIS OF PROTEOGLYCAN EXPRESSION IN HUMAN DENTAL PULP
Source:Archives of Oral Biology
Author(s): Ana Carla Raphaelli Nahás-Scocate, Gabrielle Ferrante Alves de Moraes, Helena Bonciani Nader, Carolina Meloni Vicente, Leny Toma
Proteoglycans are glycosylated proteins which have covalently attached highly anionic glycosaminoglycans. They can be located on the extracellular matrix, cell membrane or intracellular granules. To date, few studies have reported the presence of proteoglycans in human dental pulp.ObjectiveThe aim of this study was, therefore, to analyze the expression of lumican, versican and glypican proteoglycans in deciduous and permanent human dental pulp by real-time polymerase chain reaction (q-PCR) and immunofluorescence.DesignHealthy human dental pulps were used: 13 from permanent teeth (group 1) and eight from deciduous teeth (group 2). Versican, lumican and glypican (glypican-1 to 6) gene expressions were quantitatively evaluated by real-time PCR technique, using the expression of the endogenous gene GAPDH as control. Pulp sections were submitted to immunostaining procedure with fluorescence labelling, the tissues being fixed and incubated with well-characterized monoclonal and polyclonal antibodies against proteoglycan epitopes, including anti-versican and anti-lumican. Comparisons among the groups of the quantitative scores for each proteoglycan were analyzed using the t-test and ANOVA (P < 0.05).ResultsThe real-time PCR analysis showed expression of versican and lumican proteoglycans in the two groups, with significant predominance of lumican gene (P = 0.03). Considering the glypican genes, glypican-3 was the proteoglycan most significantly expressed in permanent pulps (P < 0.001), while glypican-2 was not expressed in this tissue. The immunofluorescence quantification exhibited no significant differences between lumican and versican among the pulps and groups.ConclusionsThe lumican gene was more expressed than versican and glypican-3 was the isoform more expressed in permanent pulp compared to deciduous.
http://ift.tt/2IfK1t6
ANALYSIS OF PROTEOGLYCAN EXPRESSION IN HUMAN DENTAL PULP
Source:Archives of Oral Biology
Author(s): Ana Carla Raphaelli Nahás-Scocate, Gabrielle Ferrante Alves de Moraes, Helena Bonciani Nader, Carolina Meloni Vicente, Leny Toma
Proteoglycans are glycosylated proteins which have covalently attached highly anionic glycosaminoglycans. They can be located on the extracellular matrix, cell membrane or intracellular granules. To date, few studies have reported the presence of proteoglycans in human dental pulp.ObjectiveThe aim of this study was, therefore, to analyze the expression of lumican, versican and glypican proteoglycans in deciduous and permanent human dental pulp by real-time polymerase chain reaction (q-PCR) and immunofluorescence.DesignHealthy human dental pulps were used: 13 from permanent teeth (group 1) and eight from deciduous teeth (group 2). Versican, lumican and glypican (glypican-1 to 6) gene expressions were quantitatively evaluated by real-time PCR technique, using the expression of the endogenous gene GAPDH as control. Pulp sections were submitted to immunostaining procedure with fluorescence labelling, the tissues being fixed and incubated with well-characterized monoclonal and polyclonal antibodies against proteoglycan epitopes, including anti-versican and anti-lumican. Comparisons among the groups of the quantitative scores for each proteoglycan were analyzed using the t-test and ANOVA (P < 0.05).ResultsThe real-time PCR analysis showed expression of versican and lumican proteoglycans in the two groups, with significant predominance of lumican gene (P = 0.03). Considering the glypican genes, glypican-3 was the proteoglycan most significantly expressed in permanent pulps (P < 0.001), while glypican-2 was not expressed in this tissue. The immunofluorescence quantification exhibited no significant differences between lumican and versican among the pulps and groups.ConclusionsThe lumican gene was more expressed than versican and glypican-3 was the isoform more expressed in permanent pulp compared to deciduous.
http://ift.tt/2IfK1t6
Introduction: Interactions Between the Immune System and Parasites Special Issue
http://ift.tt/2p4LvgR
Host immune responses to Toxoplasma gondii
http://ift.tt/2Gc9q6a
Host responses to intestinal nematodes
http://ift.tt/2HmKmsu
Unforeseen pathologies caused by malaria
http://ift.tt/2oYRqF3
How to master the host immune system? Leishmania parasites have the solutions!
http://ift.tt/2p4hcqL
Spinal meningioma, aortic aneurysms and the missing link of observation: the anchoring heuristic approach
Over the last three decades, the development of systematic and protocol-based algorithms, and advances in available diagnostic tests have become the indispensable parts of practising medicine. Naturally, despite the implementation of meticulous protocols involving diagnostic tests or even trials of empirical therapies, the cause of one's symptoms may still not be obvious. We herein report a case of chronic back pain, which took about 5 years to get accurately diagnosed. The case challenges the diagnostic assumptions and sets ground of discussion for the diagnostic reasoning pitfalls and heuristic biases that mislead the caring physicians and cost years of low quality of life to our patient. This case serves as an example of how anchoring heuristics can interfere in the diagnostic process of a complex and rare entity when combined with a concurrent potentially life-threatening condition.
http://ift.tt/2Fr551Z
Imatinib-induced fulminant liver failure in chronic myeloid leukemia: role of liver transplant and second-generation tyrosine kinase inhibitors: a case report
There is a worldwide problem of acute liver failure and mortality associated with remaining on the waiting for a liver transplant. In this study, we highlight results published in recent years by leading trans...
http://ift.tt/2GdLK1q
Retention rates and caries-preventive effects of two different sealant materials: a randomised clinical trial
Abstract
Objectives
The aim of this study was to compare the caries-preventive effect and the retention rates of sealants prepared with a new modified and a high-viscosity glass-ionomer cement (GIC) in recently erupted first permanent molars.
Materials and methods
Fifty-six children (224 teeth) were included in a split-mouth randomised clinical trial. All children had their four first permanent molars sealed with either Clinpro XT Varnish (CXT) or Fuji IX GP FAST (FJ). FJ sealants were placed according to the ART protocol. Retention rates and caries-preventive effect of both materials were assessed clinically after 24 months, and survival curves were created according to the Kaplan-Meier method. For sealant retention rates, analyses were performed according to both the traditional method and modified sealant retention categorisation.
Results
FJ sealants were retained longer in comparison to CXT sealants (p < 0.05), regardless of the categorisation used. In relation to the caries-preventive effect, no statistically significant differences were observed between materials (p = 0.99). Sealants prepared with the high-viscosity GIC according to the ART protocol survived longer than those prepared with the modified GIC, but both materials were equally effective in preventing cavitated dentine lesions over 24 months.
Conclusion
We concluded that GIC-based sealants are effective in preventing dentine caries lesions.
http://ift.tt/2p1oiNt
Allogeneic bone block for challenging augmentation—a clinical, histological, and histomorphometrical investigation of tissue reaction and new bone formation
Abstract
Objectives
The aim of the present study was the histological investigation of an allogeneic spongious bone block for horizontal and vertical ridge augmentation in humans. The amount of new bone, soft tissue, and residual bone substitute were histomorphometrically assessed after a mean healing period of 6 months.
Materials and methods
Fourteen patients received augmentation with an allogeneic spongious bone block (Tutobone®, Tutogen Medical, Neunkirchen, Germany). After 6 months of healing, 28 implants were placed with simultaneous harvesting of bone biopsies for histological and histomorphometrical analysis. Moreover, samples from the bone blocks were collected as blanks and analyzed histologically. The formation of new bone, connective tissue, and remaining bone substitute material as well as vascularization and formation of multinucleated giant cells (MNCGs) within the augmentation bed were analyzed.
Results
New bone formation could be observed primarily in close proximity to the bone block. Histomorphometrical analyses showed 18.65 ± 12.20% newly formed bone, 25.93 ± 12.36% allogeneic spongious bone block, and 53.45 ± 10.34% connective tissue. MNCGs were observed on the biomaterial surface. Furthermore, organic residues were evident, as donor-related cellular remnants within the osteocyte lacunae were found in the blank bone blocks and in the analyzed biopsies.
Conclusion
Despite the presence of donor-related organic remnants, the bone block shows the ability to serve as a scaffold for new bone formation. Within the limits of the present study, the detect organic remnants seemed not to affect the bone formation or influence the host in the long term.
Clinical relevance
Clinicians have to make a conscious choice of the applied biomaterials with regard to their components and structure to support tissue regeneration and maintain patient safety.
http://ift.tt/2Gdp95b
Radiofrequency Technology in Face and Neck Rejuvenation
Three doctors discuss the current issues and controversies involving the use of radiofrequency and energy-based devices for skin tightening, facial contouring, and other indications. The use of transcutaneous monopolar-, bipolar-, multipolar-, subcutaneous-, and microneedle-based delivery methods are discussed. The controversies involved in the various devices are discussed.
http://ift.tt/2FpbLxv
Lactate gap as a tool in identifying ethylene glycol poisoning
Ethylene glycol toxicity is a known cause of anion gap metabolic acidosis, with the presence of an osmolar gap and the right clinical context suggesting to the diagnosis. Rapid recognition and early treatment is crucial. Unfortunately, ethylene glycol levels are not readily available and must be performed at a reference laboratory. We present a case where recognising the significance of the 'lactate gap' assisted in identifying ethylene glycol poisoning.
http://ift.tt/2IheOFU
Pancytopenia: a rare complication of Graves disease
A 27-year-old male patient who presented to the emergency room with complaints of sweating, palpitations, heat intolerance, insomnia and weight loss for the last 3 months. His medical history was significant for hypertension. On examination, he was tachycardic, hypertensive, had tremors of the upper extremities and a smooth goitre with a thyroid bruit. Laboratory assessment revealed a suppressed thyroid-stimulating hormone, high free thyroxine and positive thyroid receptor antibodies. Complete blood count showed pancytopenia. As part of the work-up for pancytopenia, haptoglobin, ferritin, Coombs test, reticulocyte count hepatitis B and C antibodies were done, all of which were normal. Patient was started on methimazole, propranolol and hydrocortisone. His symptoms improved through the hospital course and he was subsequently discharged. Thyroidectomy was done once the patient's hyperthyroidism was controlled. Levothyroxine was started for the control of postsurgical hypothyroidism. Six months after thyroidectomy, the patient was euthyroid and the pancytopenia resolved.
http://ift.tt/2DhcP0l
Renocolic fistula secondary to urothelial carcinoma
A 77-year-old man presented with watery, bloody diarrhoea, symptomatic anaemia and signs of sepsis. He was well known to our unit with a history of extensive low-grade urothelial carcinoma involving a solitary kidney. CT performed on admission demonstrated a new finding of renocolic fistula. Due to his multiple medical and surgical comorbidities conservative management was elected. He passed away after 1 year of follow-up.
http://ift.tt/2IeWo8R
The novel use of botulinum toxin A for the treatment of Raynauds phenomenon in the toes
Raynaud's phenomenon is a vasospastic disorder of the digital vessels triggered by exposure to cold or stress. It is most commonly observed in the hands, but also frequently affects the toes. We present three cases of patients with severe Raynaud's phenomenon in the toes, secondary to scleroderma. The diagnosis of Raynaud's syndrome and scleroderma was established according to the 2010 American College of Rheumatology and European League Against Rheumatism criteria. Patients were treated with 10 units of botulinum toxin injected into each foot. Two millilitres was injected into the base of each toe in both the left and right feet. Six weeks postinjection into the toes, patients reported an improvement of cold intolerance, colour change and frequency and severity of Raynaud's attacks. The effects were reported to last up to 5 months. To our knowledge, these are the first reported cases of the treatment of Raynaud's phenomenon in the toes with botulinum toxin A.
http://ift.tt/2p3rJT3
Atrial myxoma presenting as infective endocarditis
A 23-year-old Asian student presented to our service with a 1-month history of fever, weight loss of 10 kg, night sweats, fatigue and general malaise. He was previously well with no significant medical or family history. He had a low-grade pyrexia and cardiac auscultation revealed a diastolic murmur consistent with 'tumour plop'. He had no sequelae of endocarditis. He had low-grade pyrexia of 37.7°C, and ECG showed sinus tachycardia at 130 bpm. He had raised inflammatory markers and was started on broad spectrum antibiotics. Blood cultures grew Streptococcus viridans twice. Transthoracic and transo-oesophageal echocardiography revealed a large mobile mass attached to the interatrial septum, suspicious for atrial myxoma, flopping into the left ventricle but not causing left ventricular outflow tract obstruction. All valves looked normal in appearance. He was treated with antibiotics for 2 weeks until inflammatory markers normalised. The patient was referred for cardiothoracic surgery where a large atrial myxoma (5 cmx3 cm) was excised just superior to the mitral valve. It had areas of necrosis and was colonised with S. viridans. He had an unremarkable postoperative course and made a complete recovery.
http://ift.tt/2IcUMw5
Rare case of thoracic endometriosis presenting with lung nodules and pneumothorax
We present the case of a 34-year-old Nigerian woman who was referred to the Respiratory team with a 12-month history of breathlessness. She was concurrently being investigated for an abdominal mass and rectal and vaginal bleeding. Consequently, she underwent cross-sectional imaging of her chest, abdomen and pelvis, revealing a small right-sided pneumothorax and right lower lobe pleural-based lesion. Shortly thereafter, she was admitted to the hospital with chest pain and required chest drain insertion. This partially treated her pneumothorax but she required referral to a cardiothoracic centre for definitive diagnosis and to manage her non-resolving pneumothorax. Biopsies from the video-assisted thoracoscopic surgery confirmed the very rare diagnosis of thoracic endometriosis.
http://ift.tt/2DhcJ8Z
Spontaneous renal infarct heralding bowel ischaemia in an adult male: lessons to learn from a rare clinical association
Spontaneous renal artery dissection (SRAD) is a rare entity with less than 200 cases reported in literature. It usually affects middle-aged men and the clinical presentation is non-specific. Many times it is associated with conditions such as hypertension, fibromuscular dysplasia or vasculitides. We report the case of a patient who initially had renal infarct due to SRAD and then progressed to have bowel ischaemia. The renal infarct preceded bowel ischaemia in this patient and to the best of our knowledge this is the first such association reported in literature. Our report emphasises the point that whenever this condition is diagnosed in a patient one should be vigilant for other vascular disorders.
http://ift.tt/2IeWihv
Randomised controlled trial on differential learning of toothbrushing in 6- to 9-year-old children
Abstract
Objectives
This study aimed to evaluate the effect of differential learning of toothbrushing compared to habitual toothbrushing and instruction/demonstration of toothbrushing on plaque reduction and gingival inflammation of primary school children.
Methods
Children (6–9 years) were subjected to a toothbrushing training consisting of 15 days (3 × 5 days, interval 2 days, 3 min/day) and randomly assigned to one of three groups (each n = 18): habitual toothbrushing/control, instruction/demonstration of toothbrushing, differential learning of toothbrushing. The differential learning approach comprised 15 different movement exercises (1/day), while instruction/demonstration of toothbrushing was based on repetitive practice of toothbrushing. Plaque (Turesky-modified Quigley-Hein plaque index (T-QHI)) and papilla bleeding (papilla bleeding index (PBI)) scores were assessed prior to the first toothbrushing (t0, baseline) and 21 (t1), 42 (t2) and 63 (t3) days after beginning of the study. Primary statistical analyses were performed with cumulative logit regression models with repeated measures. The global significance level was set to 5% two-sided.
Results
At all time points, PBI and T-QHI were significantly reduced by differential learning compared to instruction/demonstration of toothbrushing and habitual toothbrushing. Compared to baseline, differential learning improved PBI and T-QHI significantly at all time points. In the other groups, no significant reduction of PBI compared to baseline was observed. T-QHI was significantly reduced by habitual toothbrushing only at t1 and by instruction/demonstration of toothbrushing at t1 and t2. Differential learning had an improved effect on posterior compared to anterior teeth.
Conclusion
Differential learning of toothbrushing improved plaque reduction and reduced gingival inflammation compared to habitual toothbrushing and instruction/demonstration of toothbrushing in 6- to 9-year-old children in mixed dentition.
Clinical relevance
Toothbrushing skills of children might be improved by differential learning.
Trial registration
ISRCTN14951343, https://www.isrctn.com/ISRCTN14951343?
http://ift.tt/2FCHLxs
Effect of platelet-rich fibrin palatal bandage on pain scores and wound healing after free gingival graft: a randomized controlled clinical trial
Abstract
Objective
This prospective randomized clinical trial was conducted to determine whether the application of a platelet-rich fibrin (PRF) palatal bandage after harvesting free gingival grafts (FGG) would improve healing of donor sites and decrease pain scores and patient discomfort.
Materials and methods
Twenty-four patients received FGG to augment keratinized tissue dimensions. The application of a PRF bandage was decided randomly (n = 12 in each group). Patients reported their pain levels for the first 7 days of healing using the visual analog scale (VAS), 101-point numerical rating scale (NRS-101), and 4-point verbal rating scale (VRS-4). The patients' pre-operative anxiety levels were measured using three anxiety scales. The healing of the donor sites was evaluated and compared to preoperative records. Data were assessed and recorded before surgery and at 1, 2, 3, 4, and 8 weeks postoperatively.
Results
Dental anxiety and state-trait anxiety were evaluated at baseline and correlated to the postoperative pain scores. There were no significant differences in anxiety levels between the two groups; yet, they could potentially influence the outcome of any surgery and were included as covariates. The patients in the PRF group reported significantly lower pain scores and their pain levels returned to baseline levels earlier, compared to the control group.
Conclusions
PRF palatal bandages significantly reduced postoperative pain and discomfort and facilitated wound healing after harvesting FGG.
Clinical relevance
The study provided evaluation of patient-centered outcomes, which is timely, significant, and could benefit both periodontists and patients.
http://ift.tt/2twQqN9
Segregation analysis revealed hemizygotic causative mutations in a pseudoxanthoma elasticum patient
Abstract
Pseudoxanthoma elasticum (PXE, OMIM 264800) is an autosomal recessive disorder in which elastic fibers of skin, eyes, and cardiovascular system become progressively calcified, causing a spectrum of manifestations with a variable phenotype. The proposed prevalence of PXE is 1/25 000, but this might be an underestimate. PXE is associated with mutations in the ABCC6 (ATP binding cassette subtype C number 6) gene.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oXrJ82
Vulvar Neoplasms in 275 Women With Genital Lichen Sclerosus and Impact of Treatment: A Retrospective Chart Review
Abstract
Lichen sclerosus (LS) is a chronic inflammatory disease most commonly affecting the genital area of women. LS-associated vulvar neoplasms are known to occur (1). Treatment of LS is thought to possibly reduce malignancy risk. However, whether medical treatment of LS can prevent vulvar neoplasms is unclear (2,3). We performed a single-institution, retrospective chart review to identify vulvar neoplasm occurrence in women with biopsy-proven genital LS and to determine whether a correlation exists between LS treatments and vulvar neoplasm occurrence.
This article is protected by copyright. All rights reserved.
http://ift.tt/2HmizZm
Patient-dermatologist agreement in psoriasis severity, symptoms and satisfaction: results from a real-world multinational survey
Abstract
Background
Psoriasis is a chronic immune-mediated inflammatory disease, which often requires lifelong treatment. A strong partnership between the patient and healthcare practitioners should help to achieve effective treatment outcomes.
Objective
To assess concordance of views between psoriasis patients and their treating dermatologists relative to psoriasis severity, presence of symptoms and satisfaction with disease control achieved.
Methods
We used data from the Growth from Knowledge (GfK) Disease Atlas real-world evidence programme, a syndicated, retrospective, cross-sectional survey among dermatologists and their systemic therapy eligible psoriasis patients, conducted across 9 countries. Concordance was measured through patients and their dermatologist's identical answers to the same survey questions. Concordance was evaluated using percentage agreement between dermatologists and their patients, and Cohen's kappa (κ) statistic. The level of concordance was defined as "none" (κ≤0), "none to slight" (0.01-0.20), "fair" (0.21-0.40), "moderate" (0.41-0.60), "substantial" (0.61-0.80) and "almost perfect" (>0.8). The analysis was conducted for the overall population and for each participating country.
Results
Overall, 524 dermatologists and 3,821 psoriasis patients were included in the survey. Concordance of patient and dermatologist perceptions of psoriasis severity was fair both at diagnosis, and at the time of the survey (61% agreement, κ = 0.326 and 55% agreement, κ = 0.370, respectively). Higher levels of concordance were reported when patients assessed their psoriasis as moderate-to-severe (using Investigator's Global Assessment/Physician's Global Assessment [IGA/PGA] 5-point scale of 3 or 4). Concordance regarding symptoms ranged from fair to moderate (κ = 0.241-0.575). Satisfaction with psoriasis control was fair (39% agreement, κ = 0.213). Results showed different patterns of concordance across the participating countries although a low concordance was observed on the satisfaction with psoriasis control in all of them.
Conclusion
Results from this multinational real-world survey indicate different perceptions between psoriasis patients and their dermatologist with respect to psoriasis severity, symptoms and disease control.
This article is protected by copyright. All rights reserved.
http://ift.tt/2Fprrkq
Efficacy and safety of cryotherapy versus electrosurgery in the treatment of cherry angioma
Abstract
Cherry angioma (CA) is one of the most common types of acquired vascular proliferation of the skin [1]. The most commonly recommended treatment modalities in the past have been electrosurgery and cryotherapy. These treatment modalities usually show acceptable cosmetic results with minimal discomfort [2,3]. However, there is no study in the literature that compares these treatment modalities. Herein, we plan to assess the efficacy and safety of cryotherapy versus electrosurgery in the treatment of cherry angioma.
This article is protected by copyright. All rights reserved.
http://ift.tt/2HmizIQ
Epidermal necrolysis and autoimmune diseases: two more observations supporting the concept that “toxic” epidermal necrolysis can be “non-toxic”
Abstract
Toxic epidermal necrolysis (TEN, Lyell syndrome) and Stevens-Johnson syndrome are severe cutaneous adverse reactions to drugs characterized by epidermal necrolysis (EN). However, in 15% of cases, no causative drug is identified. In these cases, other triggers such as Mycoplasma pneumoniae have been described. Furthermore, the role of lupus as triggering factor has been suggested. We report 2 cases of EN without any drug causality, revealing autoimmune diseases as a cause.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oYBliO
Cutaneous pseudolymphoma caused by Poly Implant Prothèse breast implants
Abstract
We present a 41-year-old woman with itching polymorphic skin lesions involving the trunk and extremities which first appeared in September 2011 (7 years ago). Physical examination revealed multiple erythematous, scaly macules and patches, indurated red plaques and purplish red and smooth surfaced nodules (Fig. 1a). Over the period of seven years, the skin lesions grew slowly and spread across the body but sometimes they regressed either spontaneously or after insolation.
This article is protected by copyright. All rights reserved.
http://ift.tt/2DfMwbc
Sinecatechins ointment 10% (Veregen®) for genital warts: percutaneous penetration of Epigallocatechin Gallate concentrations in the stratum corneum collected by adhesive tape stripping method
Abstract
Camellia sinensis extract/Sinecatechins/10% ointment is a registered topical therapy for the treatment of external and perianal genital warts, to be applied thrice daily. Pharmacokinetic studies elucidating the most optimal frequency of application have not been undertaken, and a less frequent (more convenient) application schedule might also be effective. Here, we measured epigallocatechin gallate (EGCG) concentrations, the main Camellia sinensis extract component, in the stratum corneum (SC) over time after one application.
This article is protected by copyright. All rights reserved.
http://ift.tt/2FpAd1Z
Dermatomyositis panniculitis: A clinico-pathologic and immunohistochemical study of 18 cases
Abstract
Background
Panniculitis occurring in dermatomyositis is uncommon, with only a few cases described in the literature, most of them as case reports.
Objective
This report describes the clinico-pathological and immunohistochemical findings in a series of 18 patients with panniculitis associated to dermatomyositis.
Methods
In each patient we collected the clinical data of the cutaneous lesions as well as the characteristic clinical and laboratory findings. A series of histopathologic findings was recorded in the biopsy of each patient. A panel of antibodies was used in some cases to investigate the immunophenotype of the infiltrate. Data of treatment and follow-up were also collected.
Results
Of the 18 patients, 13 were female and 5 were male, ranging in age from 13 to 74 years (median, 46,4 years). In addition to panniculitis, all patients presented pathognomonic cutaneous findings of DM and reported proximal muscle weakness prior to the diagnosis of panniculitis. Muscle biopsy was performed in 17 patients and MRI in one, all with the diagnosis of inflammatory myopathy. None of the patients presented any associated neoplasia. Panniculitis lesions were located in the upper or lower limbs. Histopathology showed a mostly lobular panniculitis with lymphocytes as the main component of the infiltrate. Most cases showed also numerous plasma cells and lymphocytes surrounding necrotic adipocytes (rimming) were frequently seen. Lymphocytic vasculitis and abundant mucin interstitially deposited between collagen bundles of the dermis were also frequent findings. Late stage lesions showed hyaline necrosis of the fat lobule and calcification. Immunohistochemistry demonstrated that most lymphocytes of the infiltrate were T-helper lymphocytes, with some B-lymphocytes in the lymphoid aggregates and small clusters of CD-123 positive plasmacytoid dendritic cells in the involved fat lobule.
Conclusion
Panniculitis in dermatomyositis is rare. Histopathologic findings of panniculitis dermatomysositis are identical to those of lupus panniculitis. Therefore, the final diagnosis requires clinic-pathologic correlation.
This article is protected by copyright. All rights reserved.
http://ift.tt/2HoGbMV
Cytokine patterns in vitro, in particular IL-5/IL-8-ratio, to detect patients with nickel contact allergy
Abstract
Background
Patch test (PT) is the gold standard to reveal Nickel (Ni) allergy. In vitro tests are under discussion. We aimed to establish a cytokine based in-vitro assay to detect Ni sensitization.
Methods
From 15 patients with positive (13f, 42-78yrs) and 15 with negative PT to Ni (controls, 3f, 31-82yrs) within a consecutive patient series peripheral blood mononuclear cells (PBMC) were obtained. 6 days stimulation with 3 concentrations of NiSO4 was done. Proliferative response (uptake of tritiated thymidine) and production of the cytokines IL-1β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-17A, TNFα, IFNγ (cytometric bead array) were assessed.
Results
12/15 Ni PT positive patients also had positive LTT, all control patients were PT and LTT negative. The mean SI differed between Ni allergics and controls (p<0.01). Upon Ni stimulation, PBMC of the allergic patients showed (i) enhanced IL-5 response (p<0.0001) and (ii) reduced IL-8 production (p<0.01). The IL-5/IL-8-ratio best distinguished allergics from non-allergics in all 3 Ni concentration with a sensitivity and specificity of 93%.
Conclusion
Assessment of the ratio of Ni induced IL-5 and reduced IL-8 production in vitro is a helpful tool for a better characterization of Ni allergic patients.
This article is protected by copyright. All rights reserved.
http://ift.tt/2FpSjRh
Review and clinical experience exploring evidence, clinical efficacy, and safety regarding nonsurgical treatment of feminine rejuvenation
Summary
Introduction
The use of energy-based devices for the treatment of vaginal laxity, orgasmic dysfunction, and stress incontinence, such as minimally ablative fractional laser and radiofrequency, is gaining momentum. This review aims to answer clinical questions on the application of energy-based devices for feminine genital rejuvenation.
Methods
The target group includes physicians involved in esthetic medicine and feminine genital rejuvenation. A literature review was conducted on technologies in use for feminine rejuvenation to explore their safety, efficacy, tolerability, patient satisfaction, and clinical usability. A panel of physicians with clinical experience conducting these types of treatment reviewed and discussed the results of the literature search and gave clinical evidence-based recommendations.
Results
Energy-based devices may induce wound healing, stimulating new collagen, and elastin fiber formation. Radiofrequency treatment may also increase small nerve fiber density in the papillary dermis, improving nerve sensitivity, sexual function, including arousal and orgasmic dysfunction. Both minimally ablative fractional laser and radiofrequency has been shown to be effective when treating mild to moderate primary or secondary vulvovaginal laxity and associated secondary conditions. These treatments are reported to be safe, effective, and well tolerated with a rapid return to activities of daily living.
Conclusions
As this is an evolving medical field, clinical evidence often lacks robustness. Studies and clinical experience suggest that feminine genital rejuvenation using energy-based devices seems an attractive option for patients with mild-to-moderate medical conditions. The treatment can be safely and effectively delivered by trained staff as part of the comprehensive care, that is, currently available to women.
http://ift.tt/2p1VZ0u
Effect of narrow-band ultraviolet B on the serum of 25-hydroxyvitamin D in vitiligo patients
Summary
Background
Narrow-band ultraviolet B (NB-UVB) is the gold standard in the treatment of vitiligo. 25-hydroxyvitamin D (25-OH- vitamin D) might play a physiological role in photo-induced melanogenesis in human skin so the association between vitamin D levels and vitiligo still needs to be investigated more thoroughly.
Objective
we aim to investigate the influence of cumulative doses of NB-UVB phototherapy on vitamin D in patients with vitiligo and their correlation with NB-UVB-induced pigmentation.
Methods
Eighty patients of vitiligo and twenty number of age and sex matched controls were recruited in a case-control study. Patients with vitiligo were treated with NB-UVB twice weekly for 24 weeks. 25-hydroxy vitamin D levels were measured at 0, 12, and 24 weeks in the cases and at 0 only in control by enzyme-linked immunosorbent assay (ELISA) and Vitiligo Area Severity Index (VASI) were calculated at 0 (baseline) and 24 weeks.
Results
The mean baseline level of 25-hydroxyvitamin D (at 0 week) was significantly lower in patients than the control group. Levels of 25(OH) vitamin D at 12 and 24 weeks showed significant improvement and Patients show significant reduction in VASI score after 24 weeks of therapy.
Conclusions
Cumulative doses of NB-UVB therapy improve low vitamin D levels in patients with vitiligo, which might have a significant role in NB-UVB-induced repigmentation and may contribute to its therapeutic efficacy but further studies with larger sample size are needed to prove the complete mechanisms of NB-UVB-induced pigmentations and vitamin D in vitiligo.
http://ift.tt/2Ij9XUK