Search

Introduction: Secondary hyperparathyroidism (SHPT) is an insidious disease that develops early in the course of chronic kidney disease (CKD) and increases in severity as the glomerular filtration rate deteriorates. Recent studies have identified fibroblast growth factor-23 (FGF23) as a new protein with phosphaturic activity. It is mainly secreted by osteoblasts and is now considered the most important factor for regulation of phosphorus homeostasis. It is not yet proven if there is any direct relation between parathyroid hormone (PTH) and FGF23. The present study aims to evaluate the relation between serum FGF23, phosphorus, and PTH in end-stage renal disease in patients with SHPT on regular hemodialysis., Materials and Methods: Forty-six consecutive CKD adult patients (case group) and 20 healthy adults (control group) were included in the study. All patients had SHPT and were on regular hemodialysis. Both groups were subjected to full medical history, clinical examination and biochemical studies. Serum phosphorus, calcium, ferritin, hemoglobin level, blood urea, creatinine, PTH, and FGF23 were analyzed., Results: Levels of FGF23 were significantly higher in the case group in comparison with those in the control group, viz., 4-fold, and positively correlated with PTH. Phosphorus levels in the case group were significantly high in spite of the increasing levels of FGF23. Both PTH and FGF23 were positively correlated with phosphorus and negatively with hemoglobin levels., Conclusion: SHPT and FGF23 may have a partial role in the development of anemia in patients with CKD. FGF23 could be a central factor in the pathogenesis of SHPT. Its role in controlling hyperphosphatemia in CKD is vague.

Recurrence of Giant cell tumor of the tendon sheath (GCTTS) is an unresolved issue, though it is a non malignant condition. The authors operated on fourteen cases of GCTTS, after fine needle aspiration cytology confirmation and using a magnifying loupe for complete excision of the lesion including the satellite nodules. In only one case recurrence was noted which was successfully managed by a second wide excision. Preoperative diagnosis and meticulous surgical technique were found the only predictive factor of recurrence. During the 5 year period from 2002, 12 patients [11 females, 1 male, mean age 29.5, ranging from 10-53 years] underwent excision of giant cell tumor of tendon sheath of the hand. The lesions were found over the thumb [n = 7], ring finger [n = 1], index finger [n = 1], and over the hand [n = 2]. The lesions were classified using the Al-Qattan classification. The most common presentation was with a mass over the hand, with a predilection to the thumb [n = 7]. Radiological changes in the form of bony indentation was seen in only 2 cases. FNAC was inconclusive in 2 out of the 12 cases. Due to the high incidence of recurrence, pre-operative planning aided by a tissue diagnosis with fine needle aspiration cytology, wide surgical exposure, and meticulous dissection with help of magnification are imperative for a successful outcome in GCTTS.

Radiological changes have been described in de Quervain's disease of the wrist. The author analyzed the clinical data of 114 patients who reported to the orthopedic clinic of a Regional Referral Hospital for a period of 4 years [2003 to 2007]. Radiographs of the wrist were available for 39 cases, of which 14 [35.89%] were found abnormal. Two patients with abnormal radiographs [14.28%] required surgery where as 7 out of 25 [28%] with normal radiographs were managed surgically. Radial styloid abnormality was not found statistically significant [p < 0.05], and the outcome of management was irrespective of the changes in the radial styloid.

Clear cell meningiomas are rare meningioma variants and are recognized as World Health Organization grade II tumours. They may be difficult to manage given their propensity to recur early especially if present in surgically challenging locations. We describe a rare case of a fourth ventricular clear cell meningioma without dural attachment in a 14-year-old boy with an unusual presentation of failure to thrive. The case is presented in detail and a review of the recent literature is discussed., (Copyright © 2011 S. Karger AG, Basel.)

Purpose: To analyze the indication, complications and outcome of vagus nerve stimulation in intractable childhood epilepsy., Materials and Methods: We retrospectively reviewed the data of 69 children who had insertion of vagal nerve stimulator (VNS) between June 1995 and August 2006 for medically intractable epilepsy. Outcome was based on the Engel's classification. Statistical analysis of the data was also done to see if any of the parameters significantly influenced the outcome., Result: Thirty-eight patients (55.08 %) had a satisfactory outcome (Engel class I, II or III), and in 31 patients (44.92 %), there was no worthwhile improvement of seizures (Engel class IV). There was no statistical significance between the type of seizure and outcome (Fisher's exact test, p = 0.351). Statistical analysis also showed that the following parameters did not significantly influence the outcome (p > 0.05): age at insertion of VNS, age of first fit, duration between first fit and insertion of VNS and the length of follow-up. Complications included infection, lead fracture, fluid collection around the stimulator, neck pain and difficulty swallowing., Conclusion: Vagus nerve stimulation is a relatively safe and potentially effective treatment for children with medically intractable epilepsy.

Although the benefits of clozapine have been well demonstrated in resistant schizophrenia, the frequency of adverse events is of particular concern: up to 76% of patients to whom clozapine was prescribed experienced an adverse event, with a discontinuation rate of 17%. In addition to its major clinical side effect, agranulocytosis, clozapine is reported to induce inflammatory syndromes with polyserositis. Apart from sparse case reports, no study has yet addressed this particularly interesting issue. With the aim of improving the outcome of clozapine-treated patients, we undertook a review of the literature to characterize the clinical features of clozapine-induced serositis, its pathophysiology, and to propose strategies of clinical management.

Malignant gliomas of the brain typically exhibit on CT or MRI a strong peripheral contrast enhancement area with a variable central zone of necrosis. These tumours are not known to change their radiological appearance and contrast enhancement pattern under systemic steroid treatment--a feature usually associated with primary CNS lymphoma. We report two cases of adult patients with glioblastoma multiforme and atypical hemispherical contrast enhancement initially demonstrated on MRI or CT, which disappeared after dexamethasone administration. At the same time, however, another tumour focus became visible, in both cases localised in the corpus callosum. Histological diagnosis was confirmed by stereotactic biopsy in both cases. This unusual changing pattern of contrast enhancement seems to be associated with multifocal malignant glioma with partial blood-brain barrier disruption modified by dexamethasone, and may present diagnostic difficulties in respect to neuroimaging and selection of target areas for tumour biopsy.

Hepatitis B virus (HBV) infection is one of the most prevalent public health problems worldwide, and causes 1 million deaths annually. In Bangladesh, information about prevalence of HBV infection is scarce, and there is no available data on HDV infection. We determined rates of HBsAg and anti-HBc seropositivity in asymptomatic, healthy children (n = 181) and adults (n = 354) presenting to referral facilities in Dhaka, Bangladesh, and tested a separate group of HBsAg-positive patients (n = 180) for prevalence of HDV. Testing of serum was also performed for signs of liver disease. Overall, seropositivity of HBsAg and anti-HBc in studied subjects was 3 per cent (16/534) and 21.1 per cent (113/534), respectively. Prevalence of HBsAg was highest in the 5- to 9-year-old (8.5 per cent, 7/82) and 10- to 14-year-old (5.9 per cent, 2/34) age groups. Unlike HBsAg, prevalence of anti-HBc was lower in children (14.9 per cent in those below the age of 15) than adults (24.4 per cent in those aged 20-34 years) (p < 0.05). Most HBsAg-positive individuals were symptomatic (n = 125, 69.4 per cent). A high rate (24.4 per cent, 44/180) of simultaneous infection with HDV was observed among HBsAg-positive subjects, with higher rates in older individuals. Anti-HDV seropositivity rate was similar among asymptomatic (21.8 per cent, 12/55) and symptomatic (25.6 per cent, 32/125) HBsAg carriers. Our data suggest that Bangladesh is of moderate endemicity for HBV infection, and has relatively high rates of co-infection with HDV. Control HBV and HDV infection in Bangladesh may be best achieved by targeting preschool children, which could fit readily within the existing EPI schedule.

This study presents a quantitative description of temporomandibular joint (TMJ) sounds provided by a rule-based classification system based on sound classification by three dentists, who listened to and classified the sound recordings as no sound, click, coarse crepitus and fine crepitus. The sounds were recorded with microphones in the ear canal from 126 subjects during vertical opening, digitized at 15 000 Hz, and replayed using a computer sound card and speakers. The dentists' classification of a test set resulted in intra- and inter-tester j values ranging from 0.71 to 0.81 and 0.61-0.73, respectively. Pooled j values for the dentists and the dentists plus the rules were 0.67 and 0.58, respectively, which were not significantly different in terms of the sound features on which the rules were based (P = 0.13). Linear discriminant analysis showed the four TMJ sound types were significantly different (P < 0.001). The performance of the rules was equivalent to the dentists and marginally better than the linear discriminant functions (P = 0.08), establishing the validity of the quantitative descriptions they provide. The recording and rebroadcast methodology produced sounds very similar to those observed in the clinic and could be used to train clinicians in classifying TMJ sounds.

Objective: This study was designed to evaluate the association between examination findings based on Research Diagnostic Criteria for Temporomandibular Disorders and performances on bite force and endurance tasks., Methods: Subjects were 126 patients with temporomandibular disorder and 34 pain-free controls. A subset of patients with temporomandibular disorder (n = 56) also were evaluated following a brief conservative 4-week treatment intervention., Results: A multivariate analysis of variance indicated that female patients (P <.001) but not males (P =.17) had lower bite forces than age- and gender-matched controls. Dental examination findings were significantly but modestly predictive of bite task performance (R2 = 0.175), with higher joint pain and smaller maximum unassisted jaw opening associated with lower bite force. The brief treatment interventions resulted in both self-reported and clinically determined improvements. Clinical and self-reported improvement significantly predicted pre-post treatment changes in biting force among female subjects (R2 = 0.237). Specifically, reduction in joint palpation pain and self-reported pain (McGill Pain Questionnaire short form) were the primary predictors of increases in bite force. The improvement in biting force was modest (mean = 7 lb), and the force levels of female patients remained lower than those of control subjects. Treatment did not significantly increase endurance time., Discussion: The brief conservative treatments used resulted in improvements in pain and jaw opening, and 81.8% of patients reported moderate to major improvement. The modest association of the bite task with Research Diagnostic Criteria for Temporomandibular Disorders examination findings and treatment improvement in this heterogeneous sample suggests that the bite and endurance tasks have limited diagnostic utility and sensitivity to treatment effects.

Small artery occlusive disease (microangiopathy) of the palm and digital arteries may produce ischemia with painful ulcerations on the digits. These ulcerations may contribute to secondary infection and severe intolerance to thermal changes. The use of gauze wrappings to minimize ulceration has been tried; however, it is unhygienic and unsightly. A custom-made digit prosthesis is constructed with medical grade silicone over an artificial finger nail to provide positive seating of the prosthesis. The digit prosthesis is hygienic, esthetically acceptable to the patient and greatly protects ulcerated finger tips.

Statement of Problem: There are discrepancies among researchers concerning the reliability and use of temporomandibular joint sounds., Purpose: This study examined the reliability of mandibular movements and sounds and determined the correlation between movements and sounds., Material and Methods: The mandibular movements of 35 subjects diagnosed with temporomandibular disorders were recorded with 2 CCD cameras, and sounds were recorded bilaterally with Panasonic electret condenser microphones in the ear canal. Subjects performed 3 movements, each repeated 5 times., Results: Reliability of maximum movements across the 5 trials was good to excellent, with Intraclass Correlation Coefficients (ICC) between 0.76 and 0.91 for all movements except protrusion. Temporomandibular sound event counts were reliable for most movements, including vertical opening, protrusion, and right and left laterotrusion (ICCs between 0.41 and 0.81). Most subjects produced sound events either in 100% or in none of the trials. Reliability for sound events was better during protrusion (ICCs between 0.56 and 0.81) than vertical opening (ICCs 0.41 to 0.64). Subjects with sound events during vertical opening (followed by closing) were significantly more likely to have sound events during protrusion (followed immediately by vertical opening and closing) (P <.01)., Conclusion: Temporomandibular sound events are generally reliable and warrant study regarding their use in classifying and diagnosing patients with temporomandibular disorders. Condylar translation, which occurs during both vertical opening and protrusion, appears to have a strong influence on the production of temporomandibular sound events.

Statement of Problem: Posterior tooth form selection for implant overdentures is made according to personal preference and experience using the concepts of conventional complete denture prosthodontics., Purpose: This study (1) compared the masticatory efficiency of three occlusal forms, 0 degrees, 30 degrees, and lingual contact (lingualized occlusion), in subjects with mandibular implant overdentures, and (2) determined their effects on the implant supporting tissues., Material and Methods: Eight patients who had four root form implants in the mandibular symphysis area connected with a Hader bar were selected. Maxillary and mandibular dentures were constructed for each patient with interchangeable posterior segments and the three occlusal forms were tested. The masticatory efficiency for each posterior tooth form was assessed with objective food tests and a subjective patient preference questionnaire. Periodic evaluation of implant-supporting tissues also was performed., Results: Reliability analysis showed that all R1 coefficients were > or =0.80 (<0.001), indicating high subject consistency between multiple chewing efficiency trials. MANOVA analysis indicated a significant difference in chewing efficiency among the three occlusal forms (p < 0.001). The 0 degree occlusal form was associated with a significantly higher number of chewing strokes compared with 30 degrees or lingualized occlusal forms. The different occlusal forms were not found to have a clinically detrimental effect on the peri-implant soft or hard tissues., Conclusion: Chewing efficiency tests and patient preference ratings showed that 30 degree teeth and lingual contact provided better chewing efficiency than 0 degree teeth. None of the tested occlusal forms showed any clinical or radiographic detrimental effect on the implant-supporting tissues.

Studies that compare different types of complete denture teeth have repeatedly emphasized the importance of standardizing all denture factors, except the type of teeth. Within-subject comparisons have also been recommended to avoid personal differences between patients. For optimum results, one denture should be constructed for each patient with interchangeable teeth. This article describes a simple and accurate procedure for constructing dentures with interchangeable posterior teeth.

Objective: To compare presenting problems and response to treatment of chronic temporomandibular (TMD) patients who perceive the onset of their symptoms to be related to trauma with those who report symptoms of unknown origin., Design: Prospective treatment outcome study., Setting: Outpatient multidisciplinary pain treatment center at a university medical center., Patients: A total of 361 were evaluated initially, including 103 who perceived traumatic onset of symptoms and 258 who did not perceive onset to be related to trauma. Two hundred thirty-three (59 trauma and 174 nontrauma) returned for follow-up evaluation 6 months after the conclusion of treatment., Interventions: Standardized six-session treatment program consisting of intraoral appliance, biofeedback, and stress management training., Outcome Measures: Clinical changes in muscle pain, temporomandibular joint pain, and mandibular opening. Self-report of change in perceived pain severity (MPQ--short form), depressive symptoms (BDI), catastrophizing about pain (CSQ--catastrophizing scale), MPI--interference scale, oral parafunctional habits, global evaluation of improvement, and use of pain medications at follow-up., Results and Conclusions: Regression of onset type on pretreatment variables indicated that a small but statistically significant proportion of pretreatment variability (8.7%) could be accounted for by onset. Both traumatic and nontraumatic onset groups showed positive outcomes following treatment. No significant differences between groups were found for any of the clinical or self-reported outcome measures with the exception that a significantly higher percentage of the trauma group reported using pain medication at follow-up. These findings are in contrast with previous suggestions that post-traumatic TMD patients show poorer response to treatment than nontrauma TMD patients.

Large nasal septal defect is defined as a defect that exceeds in size a stretched nostril. Large nasal septal defects cannot be closed by hard acrylic resin nasal septal obturators because of access and path-of-insertion problems. However, obturation can be achieved by construction of a nasal stent that fits into one of the nasal cavities. This article describes a procedure used to manage a large nasal septal defect with an intranasal heat-processed acrylic resin stent. The medial wall of the stent indirectly allows for the partition of the two nasal cavities. The stent is rendered patent to allow for comfortable breathing. The impression making and construction of these stents is not difficult. These nasal stents indirectly separate the two nasal cavities and effective obturation of large nasal septal defects is achieved.

An elongated styloid process is an anatomic anomaly present in 2% to 30% of adults; it is occasionally associated with pain. Its prevalence among patients with classic temporomandibular disorder pain symptoms is unknown. The effect of conservative treatment on patients who have symptoms of temporomandibular disorders and an elongated styloid process is also unknown. The objectives of this study were to determine the prevalence of the elongated styloid process in a sample of patients with temporomandibular disorders and to compare patients with and without the elongated styloid process on initial presenting signs and symptoms and treatment outcome. A total of 100 panoramic radiographs of patients with symptomatic temporomandibular disorders were examined to ascertain the presence or absence of an elongated styloid process. All patients participated in a conservative treatment program of biofeedback and stress management and a flat-plane intraoral appliance. Initial symptoms and treatment outcome of patients with and without an elongated styloid process were compared by use of multivariate analysis of variance on several oral-paraoral and psychosocial-behavioral methods. The prevalence of an elongated styloid process in this clinic sample of temporomandibular disorders was 27%. The patients with or without an elongated styloid process were not significantly different in pretreatment symptoms, and both groups exhibited substantial treatment gains. However, patients with an elongated styloid process showed significantly less improvement on unassisted mandibular opening without pain than did patients who did not have an elongated styloid process. This suggests that an elongated styloid process may place structural limitations on pain-free maximum mandibular opening. The results support conservative management of patients with symptoms of temporomandibular disorders when an elongated styloid process is present.

Forty-eight dysfunctional patients (i.e., high levels of pain, interference, and affective distress and low levels of perceived control) with temporomandibular disorders (TMDs) were randomly assigned either to a treatment consisting of an intraoral appliance (IA) and stress management with biofeedback (SM) plus nondirective, supportive counseling (SC) -- IA + SM + SC -- or to a customized treatment that included cognitive therapy (CT) with the IA and SM--IA + SM + CT. Both treatment groups reported statistically significant reductions on a set of physical, psychosocial, and behavioral measures posttreatment and at a 6-month follow-up. However, the intervention that included CT demonstrated significantly greater reductions in pain, depression, and medication use. Only the groups receiving the treatment that included the CT demonstrated continued improvements to the follow-up on pain associated with muscle palpation, self-reported pain severity, depression, and use of medications. These results support the efficacy of the tailored treatment for dysfunctional TMD.

To assess the differential efficacy of two commonly used treatments for temporomandibular disorders (TMD), intraoral appliances (IAs) and biofeedback (BF), separately and in combination, two studies were conducted. The first study directly compared IA treatment, a combination of biofeedback and stress management (BF/SM), and a waiting list control group in a sample of 80 TMD patients. Both treatments were determined to be equally credible to patients, ruling out this potential threat to the validity of the results obtained. The results demonstrated that the IA treatment was more effective than the BF/SM treatment in reducing pain after treatment, but at a 6-month follow-up the IA group significantly relapsed, especially in depression, whereas the BF/SM maintained improvements on both pain and depression and continued to improve. The second study examined the combination of IA and BF/SM in a sample of 30 TMD patients. The results of this study demonstrated that the combined treatment approach was more effective than either of the single treatments alone, particularly in pain reduction, at the 6-month follow-up. These results support the importance of using both dental and psychologic treatments to successfully treat TMD patients if treatment gains are to be maintained.

The three-dimensional finite element stress analysis method was used to determine the pattern and concentration of stresses within the Screw-Vent endosseous implant and its supporting tissues. For this commercially pure titanium implant, maximum stresses were located within the implant collar immediately below the bony crest. These stresses were at least 18 times less than the endurance limit of commercially pure titanium (259.90 MPa). Maximum stresses (19.57 MPa) in the bone were lingual to the superior portion of the collar. Previous longitudinal radiographic studies of a similar implant have revealed bone loss mesial and distal to the implant. For the Screw-Vent, mesial and distal stresses (maximum 0.38 MPa) were much lower than those buccal and lingual to the implant. The clinical significance of the stress transfer to the bone buccal and lingual to the implant has yet to be determined.

Intra-oral and extra-oral prosthetic restorations of acquired and developmental defects (oral, para-oral, and facial) have had a fundamental problem of inadequate stability and retention of the prostheses. Application of osseointegration in maxillofacial prosthetic reconstruction followed the positive results obtained by using osseointegrated implants for retaining and supporting maxillary and mandibular dental prostheses. The two case presentations are illustrative examples of the clinical application of osseointegrated implants for maxillofacial reconstructive prosthetic procedures.

Nasal septal obturators are used to mechanically close nasal septal defects. The use of an impression of the nasal septal defect in the construction of nasal septal obturators is mandatory. A heat-cured, highly polished acrylic resin button constructed from an accurate impression is less likely to induce crusting and bleeding, or to be dislodged, than a Silastic button.

1. A new, easy, and predictable method of border molding an edentulous obturator impression is presented. 2. The use of an open-face impression tray facilitates proper extension in the site of the defect. 3. The manipulation of the modeling compound through the open-face tray assures proper seal, compression, and extension of the prosthesis above the mucodermal scar band. 4. The retention of the obturator bulb is mainly mechanical and is dependent upon engaging under-cuts superior to both scar band and the palatal shelf. 5. There should be a continuous peripheral seal between the defect and nondefect side of the obturator.

A new technique is presented for adding a bypass to an edentulous obturator. Fluids which seep into the defect and nasal secretions may pass to the oral cavity through a diagonal tubing in the obturator. Features of this obturator bypass include: (1) use of 8-gauge wax and autopolymerizing acrylic resin to assure the patency and smoothness of the bypass, (2) beveling of the oral opening and creating a tortuous course for the tube to allow for preservation of intraoral pressure so that speech is not affected, and (3) creation of a funnel where the tube opens on the tissue side of the obturator bulb permitting easy collection of fluids.

Three techniques were studied to control the porosity and the pore size of the one-phase PMMA matrix, namely light sintering and the use of hydroxyapatite- or NaCl-filler. These techniques alleviate the problems of residual monomer inherent in the two-phase PMMA system. A two-step light sintering technique with a solid polymer core and porous outer layer showed improvement in the overall mechanical properties and good potential for anatomical implants. The NaCl-filled PMMA was found to give the best overall mechanical properties and control of porosity. The mechanical properties of the filled, water-equilibrated composites were close to literature values of dry PMMA systems except for a noticeable drop in their modulus. In the instance of hydroxyapatite, the 20 wt %-filled PMMA composites with 35-mesh particle size suffered a substantial loss in their mechanical properties and physical integrity after soaking for one week in water. Polymer-filler particle size ratio should be taken into consideration in compounding in order to obtain the desired filler distribution (either random or network).

Maintenance of an adequate airway, control of bleeding, and neurologic evaluation should take precedence over treatment of facial injuries. Comminuted mandibular fractures are rare and require the use of complex splints. Severe lacerations and bone displacement accompany comminuted mandibular fractures. Extraoral facial splints constructed from donor facial moulages can be used along with intraoral splints for these patients. Preaccident photographs and radiographs are excellent aids to help realign the fractured segments. The use of an extraoral "donor" splint in conjunction with an intraoral splint to stabilize comminuted mandibular fracture helps to eliminate unnecessary gross removal of mandibular bone.

A new technique for intracavitary application of Iridium 192 seeds in carcinoma of the nasopharynx is described. This technique allows for accurate construction of a nasopharyngeal carrier that permits the radiotherapist to deliver an adequate dose of irradiation to the nasopharynx.

This article presents a simple procedure for the construction of facial prosthesis. The use of a split mold lined by silicone 382 is recommended. Pertinent information concerning impression making, sculpturing, coloring, and processing to insure esthetically and functionally accepted prostheses is presented.

The effects of increased and low dietary sucrose levels on the biochemical activities and composition of 4- and 12-day plaque were investigated in eight young men. The subjects were fed supervised, nutritionally adequate diets. Dextran hydrolase, levan hydrolase, and total carbohydrate content were increased during a sucrose-rich diet while invertase activity was decreased. Base-extractable carbohydrate was decreased in four-day plaque during the sucrose-rich diet. Glucosyltransferase and fructosyltransferase activity, buffer-soluble carbohydrate, and buffer-soluble protein were also determined.