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Case Series (case + series)
Kinds of Case Series Terms modified by Case Series Selected AbstractsMicrocystic Adnexal Carcinoma: A Case Series Treated with Mohs Micrographic Surgery and Identification of Patients in Whom Paraffin Sections May Be PreferableDERMATOLOGIC SURGERY, Issue 4 2010IOULIOS PALAMARAS MD BACKGROUND Microcystic adnexal carcinoma (MAC) is a rare cutaneous tumor characterized by aggressive local infiltration, including a high propensity for perineural invasion (PNI). OBJECTIVES To report our experience in treating MAC using Mohs micrographic surgery (MMS) with frozen sections and to identify patients in whom that technique may have limitations. MATERIALS & METHODS A review of records between 1992 and 2008. RESULTS Nine patients with MAC were identified. All tumors were located on the face. PNI was noted in the diagnostic biopsies of two patients with periocular MAC, in both of whom tumor persisted after MMS. The mean duration of follow-up was 5.4 years. CONCLUSIONS MMS with frozen sections is reliable for treating primary MAC in which PNI is not present on a diagnostic biopsy. Previous surgery and PNI were associated with greater risk of persistence in periocular MAC. In these patients, it may be appropriate to consider MMS with paraffin-embedded sections, possibly as a layer after apparent clearance on frozen sections. Further excision of orbital contents should be considered in periocular MAC that infiltrate the deep orbital fat or are noted to have PNI. The authors have indicated no significant interest with commercial supporters. [source] The Lateral Ala's Volume and Position Are Critical Determinants of Aesthetically Successful Nasal Reconstruction: A Photographic Case SeriesDERMATOLOGIC SURGERY, Issue 4 2009JONATHAN L. COOK MD First page of article [source] Multiple Primary Acral Melanomas in African-Americans: A Case Series and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 1 2007ANGELA C. S. HUTCHESON MD BACKGROUND Although melanoma accounts for only 4% to 5% of all skin cancers in the United States, it causes most skin cancer,related deaths. We describe a unique group of African-American patients with multiple primary acral lentiginous melanomas (ALMs). OBJECTIVE The purpose of this study was to review the case histories and management of a cohort of patients in the Mohs practice of our dermatologic surgeon with multiple primary ALM. METHODS This is a case series of patients with multiple ALM identified by chart review from 2000 to 2005. A thorough review of the literature was performed. RESULTS Four patients, all African-American, were identified with multiple ALM. All patients were managed with excision or Mohs micrographic surgery utilizing permanent sections. None of the patients with ALM had melanomas at nonacral sites or other types of skin cancer. Several had acral melanosis. Information in the literature on patients with multiple primary acral melanomas was insufficient. CONCLUSION Patients with multiple acral melanomas have not, to our knowledge, been reported thus far. It can be extrapolated from current literature, however, that appropriate management of these patients, including staging work and surgical intervention, is to be determined by the individual characteristics of the melanoma and the patient's concomitant risk factors, if any. [source] Posterior Quadrantic Epilepsy Surgery: Technical Variants, Surgical Anatomy, and Case SeriesEPILEPSIA, Issue 8 2007Roy Thomas Daniel Summary:,Objective: Patients with intractable epilepsy due to extensive lesions involving the posterior quadrant (temporal, parietal, and occipital lobes) form a small subset of epilepsy surgery. This study was done with a view to analyze our experience with this group of patients and to define the changes in the surgical technique over the last 15 years. We also describe the microsurgical technique of the different surgical variants used, along with their functional neuroanatomy. Methods: In this series there were 13 patients with a median age of 17 years. All patients had extensive presurgical evaluation that provided concordant evidence localizing the lesion and seizure focus to the posterior quadrant. The objective of the surgery was to eliminate the effect of the epileptogenic tissue and preserve motor and sensory functions. Results: During the course of this study period of 15 years, the surgical procedure performed evolved toward incorporating more techniques of disconnection and minimizing resection. Three technical variants were thus utilized in this series, namely, (i) anatomical posterior quadrantectomy (APQ), (ii) functional posterior quadrantectomy (FPQ), and (iii) periinsular posterior quadrantectomy (PIPQ). After a median follow-up period of 6 years, 12/13 patients had Engel's Class I seizure outcome. Conclusion: The results of surgery for posterior quadrantic epilepsy have yielded excellent seizure outcomes in 92% of the patients in the series with no mortality or major morbidity. The incorporation of disconnective techniques in multilobar surgery has maintained the excellent results obtained earlier with resective surgery. [source] A 5-year review of teeth filled with the noninstrumentation technologyINTERNATIONAL ENDODONTIC JOURNAL, Issue 7 2009B. Suter Abstract Aim, The aim of this Case Series was to evaluate the radiographic quality of root fillings performed 5 years previously using the noninstrumentation technology (NIT)-obturation method and to assess radiographically the outcome of these root canal treatments. Methodology, Seventeen patients requiring root canal treatment participated in this study and were re-evaluated after 5 years. After instrumentation with K-Flexofiles, Calcium-Hydroxide inter-appointment dressing, re-entry and copious irrigation with NaOCl, the teeth were root filled using the NIT. Results, Immediately after obturation the root fillings were (,0.78 ± 0.11 mm) short when taking the radiographic apex as a reference point. After 60 months these values were ,0.85 ± 0.11 mm. No statistical difference was found (P > 0.05). In the periapical region, PAI rating 1 and 2 increased from 20.1% to 75.6% after 60 months. Conclusions, ,,This prospective Case Series demonstrated the performance of the NIT-obturation method in vivo. ,,Root canals filled by the reduced-pressure method using sealer combined with gutta-percha cones showed good radiographic quality. ,,Periapical healing after 5 years was comparable with conventional filling techniques. [source] A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure® (V.A.C.®) Therapy: Experience and Case SeriesINTERNATIONAL WOUND JOURNAL, Issue 2009Allen Gabriel ABSTRACT Over the last decade Vacuum Assisted Closure® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.® Therapy and V.A.C. Instill® with either GranuFoamÔ or GranuFoam SilverÔ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies. [source] A Prospective Case Series of Pediatric Procedural Sedation and Analgesia in the Emergency Department Using Single-syringe Ketamine,Propofol Combination (Ketofol)ACADEMIC EMERGENCY MEDICINE, Issue 2 2010Gary Andolfatto MD Abstract Objectives:, This study evaluated the effectiveness, recovery time, and adverse event profile of intravenous (IV) ketofol (mixed 1:1 ketamine,propofol) for emergency department (ED) procedural sedation and analgesia (PSA) in children. Methods:, Prospective data were collected on all PSA events in a trauma-receiving, community teaching hospital over a 3.5-year period, from which data on all patients under 21 years of age were studied. Patients receiving a single-syringe 1:1 mixture of 10 mg/mL ketamine and 10 mg/mL propofol (ketofol) were analyzed. Patients received ketofol in titrated aliquots at the discretion of the treating physician. Effectiveness, recovery time, caregiver and patient satisfaction, drug doses, physiologic data, and adverse events were recorded. Results:, Ketofol PSA was performed in 219 patients with a median age of 13 years (range = 1 to 20 years; interquartile range [IQR] = 8 to 16 years) for primarily orthopedic procedures. The median dose of medication administered was 0.8 mg/kg each of ketamine and propofol (range = 0.2 to 3.0 mg/kg; IQR = 0.7 to 1.0 mg/kg). Sedation was effective in all patients. Three patients (1.4%; 95% confidence interval [CI] = 0.0% to 3.0%) had airway events requiring intervention, of which one (0.4%; 95% CI = 0.0% to 1.2%) required positive pressure ventilation. Two patients (0.9%; 95% CI = 0.0% to 2.2%) had unpleasant emergence requiring treatment. All other adverse events were minor. Median recovery time was 14 minutes (range = 3 to 41 minutes; IQR = 11 to 18 minutes). Median staff satisfaction was 10 on a 1-to-10 scale. Conclusions:, Pediatric PSA using ketofol is highly effective. Recovery times were short; adverse events were few; and patients, caregivers, and staff were highly satisfied. ACADEMIC EMERGENCY MEDICINE 2010; 17:194,201 © 2010 by the Society for Academic Emergency Medicine [source] Meningioangiomatosis in Young Dogs: A Case Series and Literature ReviewJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 4 2004Todd M. Bishop Meningioangiomatosis (MA) is a proliferative disorder of the central nervous system (CNS) that has been reported rarely in humans and sporadically in dogs. Meningioangiomatosis may occur in the brainstem or cervical spinal cord of young dogs and can be identified tentatively by magnetic resonance imaging. The histopathologic hallmark of MA is a leptomeningeal plaque that extends along the CNS microvasculature and invades the adjacent neural parenchyma. This case series describes the neurologic signs, clinical progression, diagnostic imaging, and neuropathology of 4 dogs with MA. The 4 dogs with MA are compared and contrasted with 4 previously reported cases in dogs as well as with their human counterpart. [source] Functional Electrical Stimulation-Supported Interval Training Following Sensorimotor-Complete Spinal Cord Injury: A Case SeriesNEUROMODULATION, Issue 3 2009Jack Crosbie PhD ABSTRACT Objective.,To investigate the effect of interval training supported by Functional Electrical Stimulation (FES) on ambulation ability in complete spinal cord injury (SCI). Methods.,We trained four men with sensorimotor-complete (ASIA A) SCI, who achieved gait through FES of the quadriceps femoris, gluteus maximus, and common peroneal nerve on each side on a motorized treadmill. Training involved progressive interval walking exercise, consisting of periods of activity followed by equal periods of rest, repeated until muscle fatigue. We used time to muscle fatigue during continuous treadmill ambulation as the primary outcome measure. We also recorded the patterns of incremental stimulation for all training and testing sessions. Results.,All subjects increased their ambulation capacity; however, the responses varied from subject to subject. Some subjects increased the total distance walked by as much as 300% with progressive improvement over the entire training period; however, others made more modest gains and appeared to reach a performance plateau within a few training sessions. Conclusions.,FES-supported interval training offers a useful and effective strategy for strength-endurance improvement in the large muscle groups of the lower limb in motor-complete SCI. We believe that this training protocol offers a viable alternative to that of continuous walking training in people with SCI using FES to aid ambulation. [source] A Case Series of Pulsed Radiofrequency Treatment of Myofascial Trigger Points and Scar NeuromasPAIN MEDICINE, Issue 6 2009FIPP, Mazin Al Tamimi MD ABSTRACT Introduction., Pulsed radiofrequency (PRF) current applied to nerve tissue to treat intractable pain has recently been proposed as a less neurodestructive alternative to continuous radiofrequency lesioning. Clinical reports using PRF have shown promise in the treatment of a variety of focal, neuropathic conditions. To date, scant data exist on the use of PRF to treat myofascial and neuromatous pain. Methods., All cases in which PRF was used to treat myofascial (trigger point) and neuromatous pain within our practice were evaluated retrospectively for technique, efficacy, and complications. Trigger points were defined as localized, extremely tender areas in skeletal muscle that contained palpable, taut bands of muscle. Results., Nine patients were treated over an 18-month period. All patients had longstanding myofascial or neuromatous pain that was refractory to previous medical management, physical therapy, and trigger point injections. Eight out of nine patients experienced 75,100% reduction in their pain following PRF treatment at initial evaluation 4 weeks following treatment. Six out of nine (67%) patients experienced 6 months to greater than 1 year of pain relief. One patient experienced no better relief in terms of degree of pain reduction or duration of benefit when compared with previous trigger point injections. No complications were noted. Discussion., Our review suggests that PRF could be a minimally invasive, less neurodestructive treatment modality for these painful conditions and that further systematic evaluation of this treatment approach is warranted. [source] Use of Spinal Cord Stimulation in the Treatment of Phantom Limb Pain: Case Series and Review of the LiteraturePAIN PRACTICE, Issue 5 2010Ashwin Viswanathan MD Abstract Introduction: Despite technical advances in spinal cord stimulation (SCS), there is a paucity of recent literature regarding SCS for phantom limb pain. Methods: Between January 2003 and May 2008, four patients at M.D. Anderson Cancer Center underwent SCS for intractable phantom limb pain. A retrospective chart review was performed to assess outcomes and complications. A PubMed search was performed to review previously published series regarding the efficacy of SCS for phantom limb pain. Results: Postoperatively, all patients subjectively reported excellent pain relief (>80%). Patients were all followed with the Brief Pain Inventory. Patients 1 to 3 each reported a two-point decrease in their usual amount of pain using the numerical rating scale. Patient 4's numerical pain scale was unchanged. When using an 11-point scale to assess other symptomology along 10 dimensions, patients 1 to 3 demonstrated a decrease in their total symptom score by 13, 14, and 4 points, respectively. Patient 4 reported an increase by 5 points in his total symptom score. With regard to complications, patient 2 developed an allergic dermatitis to the generator requiring revision with a polyfluoroethylene (GorTex) pouch. Patient 3 developed a surgical site infection after an implantable pulse generator change. Patients 2 to 4 were very satisfied with their stimulator and would choose to undergo implantation again, with patient 1 having an equivocal response. Conclusions: For selected patients who have not obtained adequate relief with medical management, SCS for phantom limb pain can prove an effective intervention.,, [source] Pulsed Radiofrequency Ablation for Residual and Phantom Limb Pain: A Case SeriesPAIN PRACTICE, Issue 5 2010Matt West MD Abstract Residual limb pain (RLP) and phantom limb pain (PLP) can be debilitating and can prevent functional gains following amputation. High correlations have been reported between RLP and the stump neuromas following amputation. Many treatment methods including physical therapy, medications, and interventions, have been used with limited success. Pulsed radiofrequency ablation (PRFA) has shown promise in treating neuropathic pain because of the inhibition of evoked synaptic activity. We present 4 amputees who were treated with PRFA after failing conservative management for their RLP and PLP. All 4 patients underwent PRFA and demonstrated at least 80% relief of RLP for over 6 months. One patient reported a complete resolution of phantom sensation while another patient had significantly decreased frequency of spontaneous PLP and resolution of evoked PLP. In addition, all patients reported improved overall function including increased prosthetic tolerance and decreased oral pain medications. This case series suggests that PRFA is a viable treatment option which might be used for long-term relief of intractable RLP and/or PLP. [source] Childhood Onset Vulvar Lichen Sclerosus Does Not Resolve at Puberty: A Prospective Case SeriesPEDIATRIC DERMATOLOGY, Issue 6 2009Saxon D. Smith M.B.Ch.B. However when it occurs in adult women it is accepted that remission is unlikely and that in addition untreated or inadequately treated disease may be complicated by significant disturbance of vulvar architecture and less commonly squamous cell carcinoma. Our database reveals 18 girls who developed lichen sclerosus prior to puberty who are now adolescents or young adults. Twelve have remained under surveillance and the other six patients have been lost to follow-up. We report a prospective series of these 12 patients. Three patients have achieved complete remission sustained for three or more years, all prior to menarche. Nine patients, or 75% of the cohort, who still had active lichen sclerosus at puberty continue to require maintenance therapy after menarche. Of the 12, six have had significant disturbance of vulvar architecture. The concept that prepubertal lichen sclerosus resolves at puberty would appear not to be true in the majority of patients. Even when diagnosed early and treated effectively, childhood onset lichen sclerosus may be complicated by distortion of vulvar architecture. [source] Epidemiology and Impact of Childhood Molluscum Contagiosum: A Case Series and Critical Review of the LiteraturePEDIATRIC DERMATOLOGY, Issue 4 2005Anna Braue M.B.B.S. Among parents, 82% reported that molluscum contagiosum concerned them moderately or greatly. Concerns focused on physical issues associated with the infection, such as scarring, itching, chance of spread to peers, pain, and the effects of treatments. Quality of life was not affected. Molluscum contagiosum was most common among school-age children. Eighteen of 29 respondents swam in public pools, a common activity in children of this age. All epidemiologic studies of molluscum contagiosum in otherwise healthy individuals, published since 1966, have been critically reviewed herein. The review confirms an association between swimming pool use and molluscum contagiosum. Age, living in close proximity, skin-to-skin contact, sharing of fomites, and residence in tropical climates were also associated with higher rates of infection while sex, seasonality, and hygiene showed no such association. [source] Invited commentary on the case series by J. Krishnan and W. Morrison: Airway pressure release ventilation: A Pediatric Case Series.PEDIATRIC PULMONOLOGY, Issue 1 2007Ped Pulmon 2007;42:8 No abstract is available for this article. [source] Chylous Ascites Requiring Surgical Intervention after Donor Nephrectomy: Case Series and Single Center ExperienceAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2010J. Aerts Chylous ascites as a result of laparoscopic donor nephrectomy (LDN) is a rare complication that carries significant morbidity, including severe protein-calorie malnutrition and an associated immunocompromised state. We report a patient who underwent hand-assisted left LDN and subsequently developed chylous ascites. He failed conservative therapy including low-fat diet with medium-chain triglycerides (LFD/MCT) and oral protein supplementation as well as strict NPO status with intravenous (IV) total parenteral nutrition (TPN) and subcutaneous (SQ) somatostatin analogue administration. Laparoscopic re-exploration and intracorporeal suture ligation and clipping of leaking lymph channels successfully sealed the chyle leak. We review the literature to date including diagnosis, incidence, management options, psychosocial aspects and clinical outcomes of chylous ascites after LDN. [source] Primary Cutaneous Fungal Infections in Solid Organ Transplantation: A Case SeriesAMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2002Peter S. Miele Cutaneous fungal infections in solid-organ transplant patients present in a variety of nonspecific ways, requiring a high index of suspicion to diagnose correctly. In the present series of four transplant recipients, subsequent primary cutaneous fungal infections presented as papules, plaques, ulcers and subcutaneous nodules. Transplantations included one cardiac, two renal and one renal,pancreatic transplant. Fungal infections were limited to the skin; there was no evidence of disseminated disease in any case. The pathogens isolated were Scedosporium apiospermum (Pseudallescheria boydii), Alternaria species, Aspergillus fumigatus, and a coelomycete in the Coniothyrium-Microsphaeropsis complex of dark molds. Individuals were successfully treated with surgical debridement, antifungal agents, and reduction of immunosuppressive therapy. All patients and allografts survived. Accurate diagnosis, aggressive surgery and appropriate antifungal therapy, combined with close outpatient follow-up, optimize the likelihood of a cure in a transplant population. [source] Mechanical Ventilation Was Associated with Acidemia in a Case Series of Salicylate-poisoned PatientsACADEMIC EMERGENCY MEDICINE, Issue 9 2008Andrew I. Stolbach MD Abstract Objectives:, Despite little empiric evidence, mechanical ventilation (MV) in the setting of salicylate poisoning is considered by many to be harmful. When salicylate-poisoned patients are ventilated at conventional settings, the respiratory alkalosis is abolished, more salicylate is able to pass into the central nervous system (CNS), and neurotoxicity worsens. The objective of this study was to identify a relationship between MV, acidosis, and outcome in salicylate-poisoned patients. Methods:, The authors electronically searched a poison control center (PCC) database (2001,2007) for patients with salicylate poisoning, defined as a serum concentration >50 mg/dL, who had MV listed as a therapy. For the 7-year study period, a total of 3,144 salicylate-poisoning cases were identified. Eleven patients met the inclusion criteria of having both salicylate concentrations >50 mg/dL and required MV; only 7 of them had post-MV data available. Results:, In all seven patients with post-MV blood gas data, the post-MV pH was <7.4. In five of six patients with recorded PCO2, the post-MV PCO2 was >50 mm Hg. Two of the seven patients in the study group died following intubation (two patients died within 3 hours [serum salicylate concentrations, 85 and 79 mg/dL, respectively]). Another patient sustained severe neurologic injury (serum salicylate concentration, 84 mg/dL). The other four patients were ultimately discharged home. In the three patients with the worst clinical outcome, deterioration was reported within hours of intubation. Conclusions:, Inadequate MV of patients with salicylate poisoning is associated with respiratory acidosis, acidemia, and clinical deterioration in this series of cases. This supports warnings about the danger of improper MV in patients with salicylate poisoning. A prospective study should be performed. [source] Case Series: Intraocular lymphoma diagnosed by fine-needle aspiration biopsyACTA OPHTHALMOLOGICA, Issue 6 2010Shaden Sarafzadeh Acta Ophthalmol. 2010: 88: 705,710 Abstract. Purpose:, To describe clinical experience in the diagnosis of intraocular lymphoma by fine-needle aspiration biopsy (FNAB) in patients with one or more discrete intraocular infiltrative lesions and limited or absent intravitreal tumour cells. Methods:, Retrospective descriptive analysis of patients who underwent intraocular FNAB of a solid retinal, subretinal pigment epithelial or uveal tumour that proved to be a malignant lymphoma. Results:, After exclusions, our study group consisted of seven patients, each of whom had one or more discrete intraocular infiltrative lesions and limited or absent intravitreal tumour cells and underwent a diagnostic intraocular FNAB that confirmed malignant intraocular lymphoma cytopathologically. These included three patients with one or more geographic yellow subretinal pigment epithelial infiltrates and one patient each with a prominent nodular white subretinal pigment epithelial tumour, a rapidly developing solid placoid choroidal mass, a haemorrhagic retinal infiltrative lesion and an infiltrative iris tumour, respectively. A prominent feature of virtually all aspirates was a large proportion of degenerated lymphoid cells in the background. Cytologically intact tumour cells ranged from relatively homogeneous small round cells with large nucleus to cytoplasm ratio to pleomorphic large cells with irregular knob-like nuclear protrusions. Immunocytochemical stains for lymphoid markers were helpful in confirming the pathological diagnosis of lymphoma in the five patients in whom this testing was performed. Conclusion:, FNAB was a useful diagnostic tool in the described subgroup of patients with suspected intraocular lymphoma. FNAB should be considered as a diagnostic option in selected patients with suspected intraocular lymphoma, especially if there are few or no vitreous cells. [source] Implant Placement in Patients with Oral Bisphosphonate Therapy: A Case SeriesCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2010Ghasem Omati Shabestari DDS ABSTRACT Background: Although the effect of bisphosphonates on dental implant osseointegration is not clear, dental implant failures attributable to oral bisphosphonate therapy have been reported in patients with osteoporosis. Purpose: The aim of this study was to evaluate implant survival in patients with a history of bisphosphonate therapy in a retrospective survey. Materials and Methods: A total of 46 ITI implants placed in 21 osteoporotic patients (females; average age 53 years, range 42,79 years) were evaluated with regard to probing depth, mobility, thread exposure, and bleeding on probing. All patients were under oral bisphosphonate therapy. Results: None of implants showed mobility and all patients could be considered free from peri-implantitis. Time of bisphosphonate therapy before and after implant insertion showed no statistically significant influence on PD, BOP, and TE. Likewise, implant location, prosthetic type, and opposing dentition had no statistically significant influence on the clinical and radiological parameters of implants. Conclusion: Within the limitations of this study, it could be concluded that neither being on oral bisphosphonate treatment before implant placement nor starting bisphosphonate therapy after implant installation might jeopardize the successful osseointegration and clinical and radiographic condition of the implants. [source] Alveolar Ridge Regeneration with Equine Spongy Bone: A Clinical, Histological, and Immunohistochemical Case SeriesCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2009Danilo Alessio Di Stefano DDS ABSTRACT Background: In the case of localized ridge atrophy, a ridge augmentation procedure, with the use of bone substitutes and barrier membranes, may then be necessary. Purpose: The aim of the present study was a clinical, histological, and immunohistochemical evaluation of an equine spongy bone in alveolar ridge augmentation procedures. Materials and Methods: Five patients showing horizontal mandibular ridge defects participated in this study. A ridge augmentation was performed through an onlay apposition of equine bone covered by a titanium-reinforced membrane. After 6 months of healing, five bone cores from nonaugmented sites (control) and five from augmented sites (test) were retrieved. Results: In test sites, no postoperative complications occurred. Horizontal bone width increased from ,4 to ,7 mm. In control sites, the newly formed bone represented 33%, and in test sites, 35% of the total area. The mean value of the microvessel density was 25.6 +/, 3.425 per mm2 in controls, while 33.3 +/, 2.5 vessels per mm2 in the test sites were found (p < .05). Both groups showed a high intensity (++) of vascular endothelial growth factor expression in the newly formed bone, while a low intensity (+) was found in the mature bone. Conclusion: Equine bone appeared to be biocompatible and to be associated with new vessel ingrowth. Within the limits of the small sample size, the present study indicated that equine bone could be used in mandibular ridge augmentations. [source] Functional Restoration of Implants on the Day of Surgical Placement in the Fully Edentulous Mandible: A Case SeriesCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2005Alexandre-Amir Aalam DDS ABSTRACT Purpose: The purpose of this article is to report the clinical experience and outcome of a study of the functional rehabilitation of 16 completely edentulous mandibles with immediately loaded cross-arch screw-retained hybrid prostheses at the University of Southern California. Materials and Methods: After signing informed consent forms 16 patients (9 male, 7 female) aged 47 to 84 years (mean age, 62.6 ± 11.6 years) received 90 Brånemark System® Mk III dental implants (Nobel Biocare USA, Yorba Linda, CA, USA). Stability and radiographs of the dental implants were evaluated at the time of surgery, at 3 months, at 1 year, and at 3 years post loading. Results: Three implants failed to meet the criteria of success, bringing the cumulative success rate to 96.6%, with a 100% prosthetic success rate at 3 years. Thirty-nine (43.3%) of the dental implants placed were 15 mm in length. Seventy-seven (85.5%) of the dental implants were placed in high-density bone. At 3 years post loading, the average bone loss was ,1.2 ± 0.1 mm. Conclusion: Within the limitations of this study, restoration of implants by unreinforced hybrid prostheses at the time of placement provided satisfactory results. The outcome was stable at 3 years post restoration. Mandibular rehabilitation by functional loading of the implants on the day of the insertion requires the comprehension and proper application of surgical and restorative principles. [source] Measurements of Buccal Tissue Volumes at Single-Implant Restorations after Local Bone Grafting in Maxillas: A 3-Year Clinical Prospective Study Case SeriesCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 2 2003Odont PhD, Torsten Jemt LDS ABSTRACT Purpose: The purpose of this study was to measure changes in buccal and proximal tissue volumes after local bone grafting and single-implant treatment. Materials and Methods: Ten patients were provided with buccal bone grafts 6 months prior to implant treatment in central upper incisor regions. Following a healing time of 6 months, abutments and single-implant crowns were installed and followed up for 2 years. Clinical photographs and impressions were taken prior to the surgical intervention as well as after crown placement and at first and second annual checkups. The photographs and study models were analyzed with regard to papilla regeneration and changes in buccal crest volume during the study period by means of a clinical papilla index and optical scanning of study models. Results: All bone grafts healed without problems. A significant reduction of the buccal crest volume (-50%, p <.01) was observed in the grafted area before abutment connection. However, a significant increase of tissue volume (+100%, p <.05) was noticed at the subsequent crown placement, followed by a second but slow reduction of the volume during the following 2 years of function. The interdental papillae increased significantly (p <.05) in volume during the first year, almost completely filling up the embrasure areas after 2 years. Conclusions: It may be concluded that local bone grafting seems to be a valuable protocol to create sufficient bone volume for implant placement. However, significant resorption of the graft may be present, which reduces the impact of grafting on the esthetic outcome. Instead, placement of the abutment cylinder and the crown seems to play a more important role for reestablishing the tissue volume at the implant-supported single crowns. [source] Novel Pretrichial Browlift Technique and Review of Methods and ComplicationsDERMATOLOGIC SURGERY, Issue 9 2009COURTNEY S. McGUIRE BS BACKGROUND The upper third of the face is integral to our perception of youth and beauty. While the eyelids anchor this facial cosmetic unit, the eyebrows and forehead are intrinsically linked to the upper eyelids, and their position and texture play an important role in creating pleasing eyes as well as conveying mood and youth. The most common browlifts are performed with endoscopic visualization. Yet, this technique requires special equipment and a prolonged learning curve. OBJECTIVE To demonstrate a novel pretrichial technique and to review different browlift methods and their potential adverse effects. METHODS Case series and review of the literature. RESULTS The pretrichial browlift results in a mild to moderate browlift with secondary smoothing of the forehead topography. Aside from bruising and swelling, it results in minimal adverse effects. Other techniques are also effective but may create a larger scar such as a direct browlift, may be more difficult in terms of approach such as the browpexy, or require endoscopes. CONCLUSION Browlifts are an important procedure in rejuvenating the upper third of the face and improving the overall facial aesthetic appearance. The pretrichial browlift is a less invasive open technique that is safe and effective for the appropriate patient. [source] How effective is outpatient care compared to inpatient care for the treatment of anorexia nervosa? a systematic reviewEUROPEAN EATING DISORDERS REVIEW, Issue 4 2001Catherine Meads Abstract Objective: To review systematically inpatient compared to outpatient care for the treatment of anorexia nervosa and other eating disorders. Method: Search of electronic databases, references and contact with experts to identify randomized controlled trials (RCTs), case,control studies and case series. Study quality was assessed and data extracted by two independent researchers. Results: Two RCTs and seven case series were identified. Unpublished 5-year follow-up data from one RCT showed a (non-statistically significant) improvement in percentage well in the outpatient compared to the inpatient group, but no difference in mortality. Case series were difficult to interpret because of the inherent biases , follow-up varied from 1.5 to 11.7 years and showed wide variations in outcome. Discussion: There is no evidence that inpatient treatment is more (or less) effective than outpatient treatment for people with anorexia nervosa in the long term. Short-term emergency inpatient treatment of the consequences of eating disorders may still be necessary. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Effect of intravenous immunoglobulin on cerebellar ataxia and neuropathic pain associated with celiac diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2008N. Souayah Background:, Cerebellar syndrome and small fiber neuropathy may complicate celiac disease (CD) and may be resistant to a strict gluten-free diet. Methods:, Case series. Results:, We report three patients with biopsy-proven CD who developed cerebellar ataxia and neuropathic pain despite strict adherence to a gluten-free diet. A small fiber neuropathy was suggested by skin biopsy findings in two patients. All patients' symptoms, including small fiber neuropathy symptoms, responded to treatment with intravenous immunoglobulin (IVIG). Discontinuation of IVIG in two patients resulted in worsened ataxia that reversed after resumption of IVIG. Conclusion:, Intravenous immunoglobulin may be effective in treating cerebellar ataxia and small fiber neuropathy associated with CD, suggesting an immune pathogenesis. Further prospective, controlled studies are necessary to determine the long-term response to IVIG or other immunomodulation therapy. [source] Characteristics of 32 SupercentenariansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2006Emily A. Schoenhofen BA OBJECTIVES: To report phenotypic characteristics of 32 age-validated supercentenarians. DESIGN: Case series. SETTING: U.S.-based recruitment effort. PARTICIPANTS: Thirty-two supercentenarians. MEASUREMENTS: Multiple forms of proof were used to validate age claims. Sociodemographic, activities of daily living, and medical history data were collected. RESULTS: Age range was 110 to 119. Fifty-nine percent had Barthel Index scores in the partially to totally dependent range, whereas 41% required minimal assistance or were independent. Few subjects had a history of clinically evident vascular-related diseases, including myocardial infarction (n=2, 6%) and stroke (n=4, 13%). Twenty-two percent (n=7) were taking medications for hypertension. Twenty-five percent (n=8) had a history of cancer (all cured). Diabetes mellitus (n=1, 3%) and Parkinson's disease (n=1, 3%) were rare. Osteoporosis (n=14, 44%) and cataract history (n=28, 88%) were common. CONCLUSION: Data collected thus far suggest that supercentenarians markedly delay and even escape clinical expression of vascular disease toward the end of their exceptionally long lives. A surprisingly substantial proportion of these individuals were still functionally independent or required minimal assistance. [source] Percutaneous radiofrequency ablation of renal tumours: Case series of 11 tumours and review of published workJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 5 2007TW Watkins Summary Detection of renal cell carcinoma (RCC) is increasing with the greater use of cross-sectional imaging and up to two-thirds of RCCs are discovered incidentally in asymptomatic patients. The traditional option of nephrectomy or partial nephrectomy may not always be appropriate. A minimally invasive treatment alternative is radiofrequency ablation (RFA). We retrospectively reviewed the RFA cases for renal tumours at our institution between January 2004 and June 2006. Thirteen RFA treatment sessions were conducted for 11 neoplasms in 11 patients. Mean patient age was 74.4 years (61,88 years). Imaging was carried out after ablation with a mean follow up of 8.0 months (2,26 months). No residual tumour was observed after the first RFA treatment in 82% of patients (nine of 11). Two patients required a second RFA treatment for residual (one) or recurrent tumour (one). RFA is emerging as a useful technique for treatment of small renal tumour. A number of short-term studies reflect this, however, long-term findings are still lacking. [source] Meta-analysis: yield of diagnostic tests for coeliac disease in dyspepsiaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2009A. C. FORD Summary Background, The prevalence of coeliac disease (CD) may be increased in individuals with dyspepsia, but evidence is conflicting. Aims, To conduct a systematic review and meta-analysis of studies reporting prevalence of CD in dyspepsia. Methods, MEDLINE, EMBASE, and CINAHL were searched up to February 2009. Case series and case-control studies applying serological tests and/or distal duodenal biopsy for CD to unselected adults with dyspepsia were eligible. Prevalence of positive coeliac serology and biopsy-proven CD were pooled for all studies and compared between cases and controls using an odds ratio (OR) and 95% confidence interval (CI). Results, Fifteen studies were identified. Prevalence of positive coeliac serology was higher in cases with dyspepsia (7.9%) compared with controls (3.9%), but not significantly so (OR for positive endomysial antibodies or tissue transglutaminase 1.89; 95% CI 0.90,3.99). Prevalence of biopsy-proven CD following positive serology was also higher (3.2% in cases vs. 1.3% in controls), but again this was not statistically significant (OR 2.85; 95% CI 0.60,13.38). Prevalence of biopsy-proven CD was 1% in ten studies performing duodenal biopsy first-line. Conclusion, Prevalence of biopsy-proven CD in subjects with dyspepsia was 1% and was higher than in controls, although this difference was not statistically significant. [source] A Survey of Evidence in the Journal of Veterinary Internal Medicine Oncology Manuscripts from 1999 to 2007JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010A. Sahora Objectives: To survey and monitor trends in evidence for oncology manuscripts published in the Journal of Veterinary Internal Medicine (JVIM) between 1999 and 2007 based on an evidence-based medicine (EBM) standard. Methods: All veterinary oncology-related articles published in JVIM and 7 other high-impact journals from 1999 to 2007 were collected by database searches. Relevant manuscripts then were characterized including investigator affiliation, subject matter investigated, retrospective or prospective study design, manuscript type, and classifications of manuscripts using an EBM standard. Results: A total of 172 relevant veterinary oncology manuscripts were identified in JVIM between 1999 and 2007. The proportion of oncology manuscripts published each year rose with the total number of manuscripts published in JVIM (mean, 13%; range, 8,15%). The author affiliations and subject matter were similar during this evaluation period. Case series represented the most common manuscript type (40%). With the exception of a progressive increase in prospective manuscripts and a reduction in case reports, no significant changes in the classification of manuscripts using EBM standards were seen. During this same period, veterinary oncology manuscripts published in 7 high-impact journals were associated with higher standards of evidence including prospective studies and randomized trials. Conclusions: The standards of evidence for veterinary oncology manuscripts published in JVIM have remained static between 1999 and 2007. This survey provides an informative benchmark for the state of evidence in previous JVIM oncology manuscripts and may be useful in identifying specific opportunities that may raise the standards of evidence in future publications in JVIM. [source] | |||||||||||||||||||||||||||||||||||||||||||