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Radiographic Evidence (radiographic + evidence)
Selected AbstractsTwo-Year Outcome with Nobel Direct® Implants: A Retrospective Radiographic and Microbiologic Study in 10 PatientsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2009Tommie Van de Velde LA ABSTRACT Introduction: The Nobel Direct® implant (Nobel Biocare AB, Göteborg, Sweden) was developed to minimize marginal bone resorption and to result in "soft tissue integration" for an optimized aesthetic outcome. However, conflicting results have been presented in the literature. The aim of this present study was to evaluate the clinical and microbiologic outcomes of Nobel Direct implants. Materials and Methods: Ten partially edentulous subjects without evidence of active periodontitis (mean age 55 years) received 12 Nobel Direct implants. Implants were loaded with single crowns after a healing period of 3 to 6 months. Treatment outcomes were assessed at month 24. Routine clinical assessments, intraoral radiographs, and microbiologic samplings were made. Histologic analysis of one failing implant and chemical spectroscopy around three unused implants was performed. Paired Wilcoxon signed-rank test was used for the evaluation of bone loss; otherwise, descriptive analysis was performed. Results: Implants were functionally loaded after 3 to 6 months. At 2 years, the mean bone loss of remaining implants was 2.0 mm (SD ± 1.1 mm; range: 0.0,3.4 mm). Three out of 12 implants with an early mean bone loss >3 mm were lost. The surviving implants showed increasing bone loss between 6 and 24 months (p = .028). Only 3 out of the 12 implants were considered successful and showed bone loss of <1.7 mm after 2 years. High rates of pathogens, including Aggregatibacter actinomycetemcomitans, Fusobacterium spp., Porphyromonas gingivalis, Pseudomonas aeruginosa, and Tanerella forsythia, were found. Chemical spectroscopy revealed, despite the normal signals from Ti, O, and C, also peaks of P, F, S, N, and Ca. A normal histologic image of osseointegration was observed in the apical part of the retrieved implant. Conclusion: Radiographic evidence and 25% implant failures are indications of a low success rate. High counts and prevalence of significant pathogens were found at surviving implants. Although extensive bone loss had occurred in the coronal part, the apical portion of the implant showed some bone to implant integration. [source] Clinical findings, diagnosis, prevalence and predisposing factors for lameness localised to the middle carpal joint in young Standardbred racehorsesEQUINE VETERINARY JOURNAL, Issue 2 2006C. M. Steel Summary Reasons for performing study: Lameness related to the middle carpal joint (MCJ) occurs in up to 30% of young Standardbred horses in race training and the incidence increase with radiographic severity of third carpal bone (C3) sclerosis on DPr-DDIO (skyline) view of the carpus. Factors predisposing horses to carpal injury have not been well investigated. Objectives: To determine the importance of MCJ lameness as a cause of wastage in young Standardbred racehorses, stage of training at which it occurs and predisposing factors, and to describe clinical findings and diagnosis. Methods: Standardbred horses (n = 114) entering their first year of race training were examined at approximately 3-month intervals over 12,18 months. For 87 of the horses, a training diary was available and these horses were trained at 3 different stables, each using a different exercise regime. At each examination, forelimb conformation, MCJ effusion, MCJ lameness and radiographic findings were graded, and training history and reasons for lost training days recorded. Nuclear scintigraphy and exploratory arthroscopy were performed on a limited selection of horses. Results for horses that developed MCJ lameness during the study period were compared statistically with results for horses that did not. Results: Carpal lameness occurred in 28% of horses and was present in 56% with forelimb lameness. In most cases lameness was mild, bilateral and with little or no MCJ effusion and was attributed to subchondral bone pain associated with radiographic evidence of C3 sclerosis. Carpal lameness was the most common reason for >1 month's rest during the study period. It occurred at any stage of training but, in most cases, some speed training had begun. Of the variables studied, poor forelimb conformation and more intense speed training were predisposing factors. Conclusions and potential relevance: The information gained should assist in making recommendations regarding training young Standardbreds to reduce the incidence of MCJ lameness. However, further investigations to determine the optimal training regime are warranted. [source] Arthroscopic laser extirpation of metacarpophalangeal synovial pad proliferation in eleven horsesEQUINE VETERINARY JOURNAL, Issue 3 2001D. J. MURPHY Summary A new surgical technique for treatment of chronic metacarpophalangeal synovial pad proliferation in the horse and the findings and long-term follow-up from 11 clinical cases are described. The medical records of all equine lameness cases attributed to metacarpophalangeal synovial pad proliferation admitted to the College of Veterinary Medicine at Cornell University (1991,1996) were reviewed and all those treated surgically by laser extirpation were included in this study. Retrieved data included subject details, preoperative lameness, ultrasonography, radiography and synovial fluid evaluations and lesion histopathology. Lesions were ablated using a CO2 or a Nd:YAG laser intra-articularly with arthroscopic guidance. Long-term follow-up was provided by telephone conversation with owners or trainers. All horses had fetlock joint effusion and were lame at presentation. Mean synovial pad thickness measured ultrasonographically was 9.0 mm (range 6,15 mm). Seven horses (64%) had radiographic evidence of remodelling of the dorsal cortex of distal McIII and 3 horses (27%) had concurrent dorsal proximal P1 fractures. No postoperative complications were noted. All 11 horses returned to training within 90 days of surgery without recurrence of the lesion(s). Laser extirpation of metacarpophalangeal synovial pad proliferation using arthroscopic guidance provided a rapid, safe and efficient method for surgical removal of such lesions without complications or recurrence. This surgical technique provides a suitable alternative to more conventional treatments for chronic metacarpophalangeal synovial pad proliferation in horses, particularly for removal of very large, fibrotic masses. [source] Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects: a randomized controlled clinical studyJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2003A. Stavropoulos Abstract Objectives: To evaluate whether Bio-Oss® used as an adjunct to guided tissue regeneration (GTR) improves the healing of 1- or 2-wall intrabony defects as compared with GTR alone, and to examine whether impregnation of Bio-Oss® with gentamicin may have an added effect. Material and methods: Sixty patients, with at least one interproximal intrabony defect with probing pocket depth (PPD) 7 mm and radiographic evidence of an intrabony component (IC) 4 mm, were treated at random with either a resorbable membrane (GTR), a resorbable membrane in combination with Bio-Oss® impregnated with saline (DBB,), a resorbable membrane in combination with Bio-Oss® impregnated with gentamicin (DBB+), or with flap surgery (RBF). Results: All treatment modalities resulted in statistically significant clinical improvements after 1 year. Defects treated with GTR alone presented a probing attachment level (PAL) gain of 2.9 mm, a residual PPD (PPD12) of 4.9 mm, a radiographic bone level (RBL) gain of 3.1 mm, and a residual IC (IC12) of 2.7 mm. GTR combined with Bio-Oss® did not improve the healing outcome (PAL gain: 2.5 mm; PPD12: 4.9 mm; RBL gain: 2.8 mm; IC12: 3.3 mm). Impregnation of the Bio-Oss® with gentamicin 2% mg/ml resulted in clinical improvements (PAL gain: 3.8 mm; PPD12: 4.2 mm; RBL gain: 4.7 mm; IC12: 2.1 mm), superior to those of the other treatment modalities, but the difference was not statistically significant. Defects treated with only flap surgery showed the most inferior clinical response (PAL gain: 1.5 mm; PPD12: 5.1 mm; RBL gain: 1.2 mm; IC12: 4.2 mm) of all groups. Conclusion: The results failed to demonstrate an added effect of Bio-Oss® implantation in combination with GTR on the healing of deep interproximal 1- or 2-wall, or combined 1- and 2-wall intrabony defects compared with GTR alone. Local application of gentamicin, on the other hand, improved the treatment outcome but not to an extent that it was statistically significant. Zusammenfassung Von Proteinen befreiter boviner Knochen und Gentamycin als Adjuvans der GTR bei der Behandlung von infraalveolären Knochentaschen. Eine randomisierte kontrollierte klinische Studie. Ziele: Die Evaluation ob, Bio-Oss® welches als Adjuvans zur GTR verwendet wird, die Heilung von 1- oder 2-wandigen Knochentaschen im Vergleich zu alleiniger GTR verbessert. Sowie die Untersuchung, ob die Imprägnierung von Bio-Oss® mit Gentamycin einen zusätzlichen Effekt haben könnte. Material und Methoden: 60 mit wenigstens einer approximalen Knochentasche mit Sondierungstiefe (PPD) ,7 mm und röntgenologischem Nachweis einer infraalveolären Komponente (IC) von ,4 mm, wurden randomisiert entweder mit einer resorbierbaren Membran (GTR), einer resorbierbaren Membran in Kombination mit Bio-Oss® welche mit Kochsalzlösung imprägniert war (DBB-), einer resorbierbaren Membran in Kombination mit Bio-Oss® welche mit Gentamycin imprägniert war (DBB+) oder mit Lappen-OP (RPF) behandelt. Ergebnisse: Nach einem Jahr hatten alle Behandlungsweisen eine statistisch signifikante klinische Verbesserung zum Ergebnis. Defekte, die mit alleiniger GTR behandelt wurden zeigten einen Gewinn an klinischem Attachmentniveau (PAL) von 2,9 mm, einer PPD (PPD12) von 4,9 mm, einem Gewinn an röntgenologischem Knochenniveau (RBL) von 3,1 mm und einer IC (IC12) von 2,7 mm. GTR in Kombination mit Bio-Oss® verbesserte das Ergebnis der Heilung nicht (PAL Gewinn: 2,5 mm; PPD12: 4,9; RBL Gewinn: 2,8 mm; IC12: 3,3 mm). Die Imprägnierung von Bio-Oss® mit Gentamycin 2% mg/ml hatte klinische Verbesserungen zum Ergebnis (PAL Gewinn: 3,8 mm; PPD12: 4,2 mm; RBL Gewinn: 4,7 mm; IC12: 2,1 mm), die größer waren als die der anderen Behandlungsweisen, jedoch waren die Unterschiede nicht statistisch signifikant. Defekte, die nur mit Lappen-OP behandelt wurden zeigten das schlechteste klinische Ergebnis von allen Gruppen (PAL Gewinn: 1,5 mm; PPD12: 5,1 mm; RBL Gewinn: 1,2 mm; IC12: 4,2 mm). Schlussfolgerung: Die Ergebnisse konnten im Vergleich mit alleiniger GTR keinen zusätzlichen Effekt der Bio-Oss®-Implantation in Kombination mit GTR hinsichtlich der Heilung von tiefen approximalen 1- oder 2-wandigen oder kombinierten 1- oder 2-wandigen Knochentaschen aufzeigen. Auf der anderen Seite verbessert die lokale Applikation von Gentamycin das Behandlungsergebnis, jedoch war das Ausmaß nicht statistisch signifikant. Résumé Os bovin déprotéiné et gentamicine comme adjuvant à la RTG pour le traitement des lésions intra-osseuses. Une étude clinique contrôlée et randomisée. Objectifs: Evaluer si Bio-Oss® utilisé comme adjuvant de la RTG améliore la cicatrisation des lésions intra-osseuses par rapport à la RTG seule et examiner si l'imprégnation de Bio-Oss® avec de la gentamicine pourrait avoir un effet supplémentaire. Matériels et Méthodes: 60 patients, présentant au moins une lésion intra-osseuse interproximale avec une profondeur de poche au sondage (PPD) ,7 mm et la présence avérée radiologiquement d'une composante intra-osseuse (IC) ,4 mm, ont été traités au hasard avec soit une membrane résorbable (GTR), une membrane résorbable en combinaison avec du Bio-Oss® imprégné de solution saline (DBB-), une membrane résorbable en combinaison avec du Bio-Oss® imprégné de gentamicine (DBB+), ou par chirurgie à lambeau (RBF). Résultats: Toutes les modalités de traitement entraînaient des améliorations cliniques significatives statistiquement après un an. Les lésions traitées par RTG seule présentaient un gain d'attache de 2.9 mm, une PPD résiduelle (PPD12) de 4.9 mm, un gain de niveau osseux radiographique (RBL) de 3.1 mm, et un IC résiduel (IC12) de 2.7 mm. La RTG combinée avec le Bio-Oss® n'améliorait pas le devenir de la cicatrisation. (gain de PAL: 2.5 mm; PPD12: 4.9; gain de RBL: 2.8 mm; IC12: 3.3 mm). L'imprégnation du Bio-Oss®avec la gentamicine (2% mg/ml) apportait des améliorations cliniques (gain de PAL: 3.8 mm; PPD12: 4.2 mm; gain de RBL: 4.7 mm; IC12: 2.1 mm), supérieurs à ceux des autres modalités de traitement, mais la différence n'était pas significative. Le traitement des lésions par lambeaux seulement entraînait la réponse clinique la moins bonne (gain de PAL: 1.5 mm; PPD12: 5.1 mm; gain de RBL: 1.2 mm; IC12: 4.2 mm). Conclusion: Ces résultats ne pouvaient démontrer un effet supplémentaire, sur la cicatrisation de lésions profondes interproximales avec une ou deux parois, de l'implantation de Bio-Oss® en combinaison avec la RTG par rapport à la RTG seule. L'application locale de gentamicine, par contre, améliorait le devenir du traitement mais pas suffisamment pour être statistiquement significatif. [source] Myeloperoxidase and chlorinated peptides in osteoarthritis: potential biomarkers of the diseaseJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 9 2007Marla J. Steinbeck Abstract Osteoarthritis (OA) is a disabling condition in which multiple initiating events or conditions (heritable and nonheritable) result in eventual loss of articular cartilage. However, the etiology of OA remains poorly understood, and diagnosis of early disease is difficult due to the lack of specific identifiers. Recent literature suggests that a series of inflammatory processes may be involved in initiating and propagating OA. We hypothesized that products of neutrophils and macrophages, namely myeloperoxidase (MPO), a specific enzyme responsible for the production of both highly reactive hypochlorous acid (HOCl) and chlorine gas (Cl2) and chlorinated peptides, may be present in the synovial fluid of patients with OA. We examined the synovial fluid from 30 patients to identify and profile the presence of MPO. We divided the samples into three groups using radiographic and clinical assessment: (1) control, patients with acute knee injury with no history of OA and no radiographic evidence of OA; (2) early OA, patients with a mild OA based on radiographs; and (3) late OA, patients with a longstanding history of OA and with radiographic evidence of complete joint loss. Patients with early OA demonstrated significantly elevated levels of MPO. We also demonstrated the presence of HOCl and Cl2 modified proteins (Cl-peptides) in early OA synovial fluid samples by liquid chromatography and mass spectrometry. Patients in the control and advanced OA groups demonstrated little elevation in MPO levels and Cl-peptides were undetectable. These results indicate that MPO and Cl-peptides may serve as diagnostic markers for the detection of early OA. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1128,1135, 2007 [source] The use of magnetic resonance imaging in the management of pharyngeal penetration injuries in dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 2 2008M. J. Dobromylskyj Objectives: To investigate the correlation between the magnetic resonance imaging findings and subsequent surgical findings for a series of dogs presenting with suspected pharyngeal stick injuries to the Animal Health Trust, Newmarket, between 1995 and 2004. Methods: Magnetic resonance imaging findings were reviewed for patients undergoing a scan of the pharyngeal or cervical area for suspected foreign bodies during the years 1995 to 2004. Results: Case signalment, history and clinical signs were similar to those reported in previous studies. Magnetic resonance imaging demonstrated foreign material in six of seven cases where this was present. There was good correlation between diagnosis of a foreign body at magnetic resonance imaging and subsequent surgical identification. Clinical Significance: Compared with other imaging modalities, magnetic resonance imaging is very helpful for this type of injury, especially in chronic cases where radiographic evidence of a foreign body is unlikely. It is a valuable aid in the diagnosis of pharyngeal penetration injury and in surgical planning. [source] Feline odontoclastic resorptive lesions: unveiling the early lesionJOURNAL OF SMALL ANIMAL PRACTICE, Issue 11 2002C. Gorrel The purpose of this study was to increase understanding of the factors initiating feline odontoclastic resorptive lesions (FORLs). Fifty-six teeth (clinically and radiographically unaffected by ORLs) were harvested. Of these, 43 were from cats that had ORLs in other teeth (group A) and 13 were from cats with no clinical or radiographic evidence of ORLs in any teeth (group B). Twenty-six teeth in group A and one tooth in group B showed histological evidence of external root resorption (surface resorption and replacement resorption resulting in ankylosis). Some teeth in group B showed healed cementum resorption. It has previously been assumed that FORLs were similar to lesions associated with peripheral inflammatory root resorption, and were associated with periodontal disease. These histological findings suggest instead that a FORL is a non-inflammatory replacement resorption, resulting in ankylosis. The periodontal ligament of resorbing teeth lacked normal fibrous architecture, but was not inflamed. Resorption was not identified in cervical cementum. However, the histological appearance of the cervical cementum differed between the two groups. Several aetiopathogenetic explanatory models which arise from these observations are discussed. [source] Calciphylaxis , a topical overviewJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 5 2006G Arseculeratne Abstract ,Calciphylaxis', a calcification syndrome associated with ischaemic cutaneous necrosis, is acquired naturally in humans in disease states. It is a life and limb-threatening complication, usually observed in patients with renal disease and secondary hyperparathyroidism, but known to occur in the absence of renal or parathyroid disease. The reported mortality rate, which ranges from 60,80%, relates to wound infection, sepsis and organ failure. It is a small-vessel vasculopathy, which is estimated to occur in about 4% of haemodialysis patients. Clinically, violaceous, reticulate areas of cutaneous necrosis and eschar may be evident, particularly in the extremities. In addition to the clinical picture, a raised calcium phosphorous product, an elevated parathyroid hormone level, radiographic evidence of vessel and soft-tissue calcification and the finding of mural calcification affecting small arteries and arterioles on histopathology help to confirm the diagnosis of this entity which generally has a poor prognosis. A high index of suspicion and an active multidisciplinary management approach, with rigorous attention to wound care and prevention of sepsis, are vital in the management of these patients. In this overview, we discuss the pathophysiology, clinical features and associations, risk factors, diagnosis and management issues relating to calciphylaxis. [source] Retrospective Study: Cause and clinical characteristics of rib fractures in cats: 33 cases (2000,2009)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 4 2010Christine Adams DVM Abstract Objective , To characterize the clinical features and population differences among cats sustaining traumatic and nontraumatic rib fractures. Design , Retrospective clinical study. Setting , University small animal hospital. Animals , Thirty-three cats with radiographic evidence of rib fractures. Interventions , None. Measurements and Main Results , Cats with rib fractures were identified by performing a computer search of the radiology database. Thirty-three cats that sustained rib fractures were identified between January 2000 and September 2009. Seventeen cats had fractures due to trauma and 16 were deemed to occur from nontraumatic causes. A Mann-Whitney rank-sum test revealed statistically significant differences in the median ages between the 2 groups. Older cats were more likely to sustain rib fractures as a result of a presumed nontraumatic causes. A Chi-square analysis showed that nontraumatic fractures occurred significantly more often in the midbody region and involved the 9th,13th ribs. The majority of cats with presumed nontraumatic rib fracture had respiratory disease; the remaining cats had chronic renal disease or neoplasia. Cats with traumatic rib fractures had external signs of trauma. Conclusion , Rib fractures in cats may be clearly associated with trauma, or may be an incidental finding in cats with comorbidities. Cats with diseases that cause prolonged respiratory effort or coughing, metabolic diseases, or certain neoplasms, are at increased risk of spontaneous nontraumatic rib fractures. [source] Treatment of a Myasthenic Dog with Mycophenolate MofetilJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2000C.W. Dewey DVM, DACVIM (Neurology), DACVS Summary A ten-year-old, male castrated Springer Spaniel was presented for dysphagia, ptyalism, and regurgitation. Evidence of megaesophagus and mild aspiration pneumonia were apparent on thoracic radiographs. A diagnosis of focal acquired myasthenia gravis was suspected and subsequently confirmed with a positive serum acetylcholine (ACh) receptor antibody concentration (3.87 nM/L). A gastrostomy tube was placed shortly after presentation; food and drugs (including azathioprine) were administered through the tube. After transient improvement, the dog suddenly deteriorated clinically, experiencing frequent episodes of regurgitation and developing severe aspiration pneumonia. Mycophenolate mofetil (MMF), a novel immunosuppressive drug with relative specificity for lymphocytes, was instituted every twelve hours via the gastrostomy tube. Within four days of beginning MMF therapy, both clinical evidence of pharyngeal/esophageal dysfunction and radiographic evidence of megaesophagus had resolved. Initially, clinical side-effects of combined MMF/AZA administration were not apparent, but the patient experienced several vomiting episodes during the third week of treatment. The vomiting resolved after decreasing the dose of both drugs. The patient made a full recovery, and a one-month follow-up ACh receptor antibody concentration was normal (0.26 nM/L). After one month of combination therapy, the patient was weaned off of AZA and maintained on MMF as the sole immunosuppressive drug. The dog was subsequently weaned off of MMF on two occasions. Mycophenolate mofetil was reinstituted after the first discontinuation due to the development of profound appendicular muscle weakness two days after stopping MMF; the weakness resolved within 24 hours of reinstituting MMF. A positive ACh receptor antibody concentration (0.89 nM/L) after the second MMF weaning prompted the second reinstitution of MMF. Two months following this second MMF reinstitution, the dog was again serologically negative (0.51 nM/L) for myasthenia gravis. At the time of last followup, the dog remained in clinical remission eight months after initial presentation. The use of MMF to treat acquired myasthenia gravis in dogs has not been reported previously. The literature concerning MMF and its potential use in treating patients with autoimmune diseases is discussed. [source] Disseminated aspergillosis in two dogs in IsraelMYCOSES, Issue 2 2006Y. Bruchim Summary Aspergillus terreus, normally a soil or plant saprophyte, causes disseminated systemic infection, involving primarily the skeletal and the cardiopulmonary system in humans and dogs.1, 2 We describe two cases of German shepherd dogs that were referred to Koret School of Veterinary Medicine Teaching Hospital with a history of anorexia and weakness. Case 1 suffered from neurological deficits, paraparesis and lumbar pain whereas case 2 suffered from unilateral uveitis and exophthalmus. Both dogs were treated symptomatically, but deteriorated progressively despite therapy and were therefore euthanised. Necropsy revealed disseminated aspergillosis, and numerous organs had multiple, miliary, white-yellow foci. Microscopically, these were identified as granulomas, containing fungal hyphae. Affected tissue included brain, heart, kidneys, spleen, lymph nodes and bones (case 2). Aspergillus terreus was isolated from different organs and from urine culture. We suggest that disseminated aspergillosis should be considered as a differential diagnosis in German shepherd dogs presenting with ocular disease, neurological deficits, spinal column pain, urinary system disorders, and radiographic evidence of skeletal and/or respiratory pathology. [source] Asbestos-related disease among sheet metal workers 1986,2004: Radiographic changes over time,,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2009FACOEM, Laura S. Welch MD Abstract Background In 1985, the Sheet Metal Workers International Association and the Sheet Metal and Air Conditioning National Association formed The Sheet Metal Occupational Health Institute Trust (SMOHIT) to examine the health hazards of the sheet metal industry. Between 1986 and 2004 18,211 individuals were examined. At the time of the first examination 9.6% of all participants (1,745) had findings consistent with parenchymal disease (ILO,>,1/0), and 21% (3,827) had pleural scarring. Methods 2181-Two thousand hundred eighty-one who had no radiographic evidence of pneumoconiosis on baseline examination underwent a second examination. Results By the second examination, 5.3% had developed parenchymal disease on chest radiograph; an additional 12.4% had developed pleural scarring without parenchymal disease. Factors that predicted new cases of pneumoconiosis on radiograph were the calendar year the worker entered the sheet metal trade, smoking, and shipyard work. Forty-seven percent of those smoking at the time of initial exam reported having quit smoking by the second examination. Conclusions Asbestosis is still occurring 50 years after first exposure. Exposed workers benefit from medical screening programs that incorporate smoking cessation. Am. J. Ind. Med. 52:519,525, 2009. © 2009 Wiley-Liss, Inc. [source] Osteoradionecrosis with Combined Mandibulotomy and Marginal MandibulectomyTHE LARYNGOSCOPE, Issue 11 2005Chih-Chun Wang MD Abstract Introduction: To evaluate the outcome of simultaneous anterior mandibulotomy and marginal mandibulectomy for patients with oral cavity cancer. Material and Methods: The medical charts of seven patients who underwent simultaneous anterior mandibulotomy and marginal mandibulectomy for oral cavity cancer between July 1994 and June 2004 in Chang Gung Memorial Hospital, Taiwan were retrospectively reviewed. These seven patients had no prior radiation therapy nor clinical or radiographic evidence of mandible bone invasion. Results: Seven patients, between 34 to 62 years of age, were followed up in the clinics from 4.5 to 39 months with an average of 19.4 months. Five (71%) patients developed mandible osteoradionecrosis. Among them, two patients underwent radical sequestrectomy followed by reconstruction with a free fibular osteoseptocutaneous flap or soft tissue flap, and the other three patients either received removal of the mandible fixation miniplate, limited sequestrectomy of the mandible, or conservative antibiotic treatment individually. Conclusions: Simultaneous anterior mandibulotomy and marginal mandibulectomy results in a high morbidity rate of avascular necrosis of the mandible and therefore should be avoided. To avoid a disastrous complication, segmental mandibulectomy and a composite free fibular osteoseptocutaneous flap reconstruction would be a preferred surgical alternative. [source] Retrospective study of 108 foals with septic osteomyelitisAUSTRALIAN VETERINARY JOURNAL, Issue 1-2 2010KM Neil Objective To determine the clinical characteristics, short-term outcome and future athletic performance of foals with septic osteomyelitis. Design Retrospective clinical study of 108 Thoroughbred foals with radiographic evidence of bone infection that were presented at the Scone Veterinary Hospital between August 1995 and December 2001. Medical records were reviewed and information concerning signalment, the clinical, laboratory and radiographic findings, treatment and outcome was obtained. Racing records were obtained and evaluated for surviving foals that had reached racing age. Results Mean age of foals at initial evaluation was 39 days (range 1,180 days); 21 foals had multiple radiographic bone lesions (19.4%), and 76 had concurrent septic arthritis (70.4%). The most frequently affected bones were the femur, tibia and distal phalanx. In total, 87 foals were discharged from the hospital (80.6%), 79 survived long-term to reach racing age and 52 raced (65.8%). Overall, 48% (52/108) of the foals treated for osteomyelitis raced. Foals less than 30 days of age at the time of diagnosis, critically ill foals and those with multiple bones or joints affected were significantly less likely to be discharged from hospital. Multiple septic joints, but not multiple bone involvement, had an unfavourable prognosis for racing. Conclusions The prognosis for survival of foals with septic osteomyelitis or osteitis is favourable. Multiple bone or joint involvement is an important short-term prognostic indicator; however, the involvement of multiple joints, but not multiple infected bones, is associated with an unfavourable prognosis for racing. [source] High-intensity focused ultrasound for prostate cancer: comparative definitions of biochemical failureBJU INTERNATIONAL, Issue 8 2009Andreas Blana OBJECTIVES To compare the specificity and sensitivity of different definitions of biochemical failure in patients treated with high-intensity focused ultrasound (HIFU) for prostate cancer, to identify the most accurate predictor of clinical failure after HIFU. PATIENTS AND METHODS Consecutively treated patients who underwent HIFU between October 1997 and July 2006 at two centres (Lyon, France; and Regensburg, Germany) were prospectively maintained within a central database and retrospectively reviewed for this study. Clinical failure was defined as a positive prostate biopsy after treatment, radiographic evidence of lymphatic or bony metastatic disease, or salvage treatment for prostate cancer (surgery, radiation, hormonal therapy or second HIFU). The serum prostate-specific antigen (PSA) values after HIFU were assessed as a biochemical surrogate of a therapeutic success or failure. PSA threshold values, ,PSA nadir plus', PSA velocity, PSA doubling time and the American Society or Therapeutic Radiotherapy and Oncology and Phoenix definition of biochemical failure were all considered. The sensitivity, specificity, positive predictive value and negative predictive value of each biochemical definition for predicting clinical failure were determined. RESULTS The data from 285 patients (stage ,,T2, PSA <15 ng/mL, Gleason score ,7) were analysed. The median (range) follow-up was 4.7 (2,10.9) years. The median PSA nadir was 0.13 ng/mL, which occurred at a median of 12.9 weeks after HIFU, and the median PSA at the last follow-up was 0.76 (1.6,2.7) ng/mL. Clinical failure occurred in 71 patients (25%); 24 due to a positive biopsy and 47 through the use of an additional therapy. Biochemical events that best predicted clinical failure were ,PSA nadir plus' values of 1.1,1.3 ng/mL, PSA velocities of <0.3 ng/mL/year and PSA doubling times of 1.25,1.75 years. CONCLUSION A new definition of biochemical failure that is specific to patients treated with HIFU therapy is established, i.e. the ,Stuttgart definition', the ,PSA nadir plus 1.2 ng/mL'. [source] Etiology and outcome of extreme leukocytosis in 758 nonhematologic cancer patientsCANCER, Issue 17 2009A retrospective, single-institution study Abstract BACKGROUND: To the authors' knowledge, the literature regarding extreme leukocytosis in solid tumor patients is sparse, consisting of a few case reports and small case series. METHODS: A total of 3770 consecutive solid tumor patients with a white blood cell count>40,000/,L were retrospectively identified over a 3-year period (2005-2008). Those patients without a secondary cause of their leukocytosis were defined as having a paraneoplastic leukemoid reaction. RESULTS: A total of 758 (20%) patients with solid tumors and extreme leukocytosis were identified. The etiology of the leukocytosis was hematopoietic growth factors in 522 (69%) patients, infection in 112 (15%) patients, high-dose corticosteroids in 38 (5%) patients, newly diagnosed leukemia in 9 (1%) patients, and paraneoplastic leukemoid reaction in 77 (10%) patients. The patients diagnosed with a paraneoplastic leukemoid reaction typically had neutrophil predominance (96%) and radiographic evidence of metastatic disease (78%), were clinically stable, and had a poor prognosis; 78% either died or were discharged to hospice within 12 weeks of their initial extreme leukocyte count. All of the 8 (10%) patients who survived>1 year received effective antineoplastic therapy. CONCLUSIONS: Infection was an uncommon cause of extreme leukocytosis in patients with solid tumors. Patients with paraneoplastic leukemoid reactions typically were clinically stable despite having large tumor burdens. However, clinical outcomes were poor unless effective antineoplastic treatment was received. Cancer 2009. © 2009 American Cancer Society. [source] Detection of Treponema denticola in endodontic infections by 16S rRNA gene-directed polymerase chain reactionMOLECULAR ORAL MICROBIOLOGY, Issue 5 2000J. F. Siqueira Jr. A 16S rDNA-based polymerase chain reaction (PCR) method was used to detect the occurrence of Treponema denticola in root canal infections. Samples were collected from 21 single-root teeth having carious lesions, necrotic pulps and radiographic evidences of periradicular bone loss. DNA extracted from the samples was amplified using the PCR assay, which yielded specific fragment of T. denticola 16S rDNA. T. denticola was detected in 11 of 21 cases (52.4%), regardless of the presence or absence of symptoms. Since this spirochete was found in a relatively high percentage of the endodontic infections examined and because it is a pathogenic microorganism involved in periodontal diseases, there are reasons to believe that T. denticola can also participate in the pathogenesis of periradicular lesions of endodontic origin. [source] Quality of root canal fillings performed by undergraduate dental students on single-rooted teeth,EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2006C. D. Lynch Introduction:, Root canal therapy is an accepted and successful form of tooth conservation. Educational guidelines require dental schools to ensure that their graduates are competent on graduation at performing root canal therapy. The aim of this investigation was to assess the technical quality of root canal fillings placed by undergraduate students in single-rooted teeth. Materials and methods:, A total of 100 radiographs of root canal fillings placed by undergraduate students in single-rooted teeth were examined under even illumination in a darkened room using ×2 magnification. These were graded as ,adequate', where the root canal filling was within 2 mm of the radiographic apex, ,under-filled', where the root canal filling was >2 mm from the radiographic apex, and ,over-filled', where the root canal filling was extruded beyond the radiographic apex. The presence of voids, fractured instruments, and root perforations were also noted. Results:, All teeth were obturated with gutta-percha and sealer (Roth Cement), using a cold lateral condensation technique. Of 100 teeth, 10% (n = 10) had voids. Of the remainder, 70% (n = 63) were judged to be ,acceptable', 21% (n = 19) were ,under-filled', and 9% (n = 8) were ,over-filled'. There was no evidence of fractured instruments or root perforations in any root filling examined. Conclusions:, The quality of root canal fillings placed in single-rooted teeth by undergraduate dental students at the University Dental School and Hospital, Cork was acceptable (63% of root fillings placed in single rooted teeth were graded as ,adequate'). The probable reasons for this are multi-factorial, but may be linked to the amount of pre-clinical and clinical teaching in endodontics at the University Dental School and Hospital, Cork. It should be remembered that factors other than radiographic quality/evidence must be considered when determining the outcome of root canal therapy. [source] | ||||||||||||||||||||||