Recurrent CEOT of the maxilla

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign, but locally infiltrating odontogenic neoplasm. It accounts for less than 1% of all odontogenic tumors. This is a case report of recurrent CEOT in the maxilla. A 35-year-old patient reported after three years of surgical excision of the lesion, with a recurrence. It is of particular concern because of its anatomic location in the maxilla. Maxillary tumors tend to be more aggressive and rapidly spreading and may involve the surrounding vital structures. Adequate resection of the lesion with disease-free surgical margins and long-term follow-up is recommended.     

Unusual intraosseous transmigration of impacted tooth

Transmigration of an impacted tooth through the symphyseal suture is a rare and special developmental anomaly of unknown etiology that is unique to the mandibular canine. Maxillary canine transmigration is even rarer. Transmigrated canines are particularly significant due to the aesthetic and functional importance. A maxillary lateral incisor crossing the mid-palatal suture has never been reported in the literature. The aim of this report is to present the first case of simultaneous transmigration of a lateral incisor and canine in the maxilla. The paper also reports four unusual cases of unilateral canine transmigration in the maxilla and mandible and successful eruption of one of the transmigrated mandibular canines following orthodontic traction. Etiology of transmigration and its clinical considerations are also discussed.     

Olfaction and apathy in Alzheimer's disease,mild cognitive impairment,and healthy older adults

Objectives: Apathy is a prevalent neuropsychiatric manifestation in individuals with Alzheimer's disease (AD) that is associated with decreased social functioning and increased caregiver burden. Olfactory deficits are also commonly observed in AD, and prior work has indicated a link between increased apathy and olfactory dysfunction in individuals with Parkinson's disease. Here, we examined odor identification performance in patients with probable AD (n = 172), individuals with mild cognitive impairment (MCI; n = 112), and neurologically and psychiatrically healthy older adults (n = 132) and its relation to apathy, depression, and overall psychopathology. Method: Participants were administered the Sniffin’ Sticks odor identification test and measures assessing severity of apathy, depression, and overall neuropsychiatric symptomatology. Results: Consistent with previous research, AD and MCI patients were significantly worse at identifying odors than healthy older adults. Additionally, a sex by diagnosis interaction was observed. AD patients had significantly higher levels of apathy relative to MCI and control participants. Of note, across the entire sample odor identification deficits were correlated with level of apathy at the level of p < 0.01, but not with depression or neuropsychiatric symptom severity, when controlling for Mini-Mental State Examination (MMSE) score. Conclusion: Collectively, these data suggest that olfactory disturbance and apathy in AD may result from the progression of disease pathology in shared neural substrates.     

Gastrointestinal stromal tumour of the duodenum: single institution experience

Background

Primary gastrointestinal stromal tumours (GISTs) of the duodenum are rare. The aim of this study was to review the surgical management of GISTs in this anatomically complex region.

Methods

Retrospective review from January 1999 to August 2011 of patients with primary GISTs of the duodenum.

Results

Forty-one patients underwent resection of duodenal GISTs. All operations were performed with intent to cure with negative margins of resection. The most common location of origin was the second portion of the duodenum. Local excision (n = 19), segmental resection with primary anastomosis (n = 11) and a pancreatoduodenectomy (n = 11) were performed. Two patients underwent an ampullectomy with local excision. Peri-operative mortality and overall morbidity were 0 and 12, respectively. Patients with high-risk GISTs (P = 0.008) and those who underwent a pancreatoduodenectomy (P = 0.021) were at a greater risk for morbidity. The median follow-up was 18 months. Eight patients developed recurrence. High-risk GISTs and neoplasms with ulceration had the greatest risk for recurrence (P = 0.017, P = 0.029 respectively). The actuarial 3- and 5-year survivals were 85% and 74%, respectively.

Conclusion

The choice and type of resection depends on the proximity to the ampulla of Vater, involvement of adjacent organs and the ability to obtain negative margins. The morbidity depends on the type of procedure for GIST.     

Acute-on-Chronic Liver Failure: What are the Implications?

Acute-on-chronic liver failure (ACLF) is a clinical entity that is well recognized by those who care for patients with cirrhosis, however in spite of this widespread recognition, there remains little consensus with regard to definition and clinical features. While many similarities exist between ACLF and decompensated cirrhosis, there are also key differences, the implications of which are far reaching for both clinicians and patients alike. Among these differences are the possibility of a reversible component, the presence of a defined insult, prognosis, and outcomes associated with ACLF (see Fig. 1). However, for ACLF to have meaningful clinical implications, it first must be defined. If ACLF can be clearly defined and more easily recognized, then clinicians may be better able to prevent, treat, prognosticate, and counsel such patients.     

Trochlear Inclination Angles in Normal and Dysplastic Knees

Trochlear morphology impacts component position in patellofemoral arthroplasty. We devised a measurement of the trochlear inclination angle (TIA) and determined the average TIA in normal and dysplastic knees. Three hundred twenty-nine consecutive magnetic resonance imagings of normal and dysplastic knees were evaluated. The TIA was measured by 2 reviewers. The Student t test was used, and intraobserver reliability measurements were made. The mean TIA in normal and dysplastic knees was internally rotated 11.4° (range, 6°-20°) and 9.4° (range, 4°-15°), respectively. The mean TIA did not differ significantly by sex or age. Trochlear inclination angles in both normal and dysplastic knees tend toward internal rotation. Positioning a trochlear patellofemoral arthroplasty component flush with the articular surface of the native trochlea would result in internal rotation malposition.     

Prospective Study of Unplanned Admission to the Intensive Care Unit after Total Hip Arthroplasty

The morbidity associated with elective total hip arthroplasty (THA) may result in intensive care unit (ICU) admission. A total of 175 consecutive THA patients were prospectively triaged to either an ICU bed or routine post-operative floor according to admission criteria based on a prior published study of 1259 THA patients. Primary end points were a reduction in unplanned ICU admission, as well as major complications. With our triage model, the rate of unplanned ICU admissions dropped from 7.1% to 2.2% (P = 0.013). The as-treated odds of unplanned admission pre- versus post-intervention were 3.2 (1.2, 10.6). The complication rate fell from 12.5% to 2%, and the mortality index decreased from 4.77 to 1.62. Triage according to selected risk factors affects a reduction in unplanned ICU admissions and major complications after THA.