Tongue piercing and its adverse effects

Piercing has become so popular during the last 20 to 30 years that many physicians are now treating patients with piercings and dealing with its side effects. We present 3 cases that illustrate the complications of tongue piercing (ie, infection, bleeding, and embedded ornaments). We describe the methods for inserting the ornaments to illustrate the possible adverse effects. Treatment recommendations and their application to those 3 patients are described.     

Large myelinated nerve fiber hypersensitivity in oral malignancy

OBJECTIVES: The purpose of this study was to assess the sensory function of trigeminal nerve A-beta fibers in suspected soft tissue oral malignancies. STUDY DESIGN: Twenty-three patients referred for the evaluation of an oral lesion suspected of malignancy were included in the study. All lesions were classified as in, near, or out of the nerve territory containing the lesion. Within these subgroups we assessed the sensitivity of A-beta primary afferents to weak electrical currents applied bilaterally to regions innervated by 3 peripheral branches of the trigeminal nerve. The ratio of electrical detection thresholds from the affected and the unaffected side was calculated. Electrical detection threshold ratios were contrasted with the results of physical examination, radiographic imaging, and biopsy. RESULTS: For dermatomes containing the lesions, ratios were lower than 0.8 in 12 patients. Biopsy showed that the lesions in 10 of these 12 patients were malignant. No malignancy was found in the remaining 11 patients. CONCLUSIONS: A-beta primary afferent hypersensitivity is observed to occur in nerves exposed to soft tissue oral malignancy.     

Evaluation of the necessity of hospitalization in children with an isolated linear skull fracture (ISF)

Objective

The prevalence of skull fractures after mild head trauma is 2 % in children of all ages and 11 % in children younger than 2 years. The current standard management for a child diagnosed with an isolated skull fracture (ISF), in our institute, is hospitalization for a 24-h observation period. Based on data from the literature, less than 1 % of all minor head injuries require neurosurgical intervention. The main objective of this study was to evaluate the risk of neurological deterioration of ISF cases, in order to assess the need for hospitalization.

Methods

We reviewed the medical charts of 222 children who were hospitalized from 2006 to 2012 with ISF and Glascow Coma Scale—15 at the time of arrival. We collected data regarding demographic characteristics, mechanism of injury, fracture location, clinical symptoms and signs, need for hospitalization, and need for repeated imaging. Data was collected at three time points: at presentation to the emergency room, during hospitalization, and 1 month after admission, when the patients’ parents were asked about the course of the month following discharge.

Results

None of the 222 children included in the study needed neurosurgical intervention. All were asymptomatic 1 month after the injury. Two children underwent repeated head CT due to persistence or worsening of symptoms; these CT scans did not reveal any new findings and did not lead to any intervention whatsoever.

Conclusion

Children arriving at the emergency room with a minor head injury and isolated skull fracture on imaging studies may be considered for discharge after a short period of observation. Discharge should be considered in these cases provided the child has a reliable social environment and responsible caregivers who are able to return to the hospital if necessary. Hospital admission should be reserved for children with neurologic deficits, persistent symptoms, suspected child abuse, or when the parent is unreliable or is unable to return to the hospital if necessary. Reducing unnecessary hospitalizations can prevent emotional stress, in addition to saving costs for the child’s family and the health care system.

     

Phosphorylation of Ribosomal Protein S6 Mediates Mammalian Target of Rapamycin Complex 1–Induced Parathyroid Cell Proliferation in Secondary Hyperparathyroidism

Secondary hyperparathyroidism is characterized by increased serum parathyroid hormone (PTH) level and parathyroid cell proliferation. However, the molecular pathways mediating the increased parathyroid cell proliferation remain undefined. Here, we found that the mTOR pathway was activated in the parathyroid of rats with secondary hyperparathyroidism induced by either chronic hypocalcemia or uremia, which was measured by increased phosphorylation of ribosomal protein S6 (rpS6), a downstream target of the mTOR pathway. This activation correlated with increased parathyroid cell proliferation. Inhibition of mTOR complex 1 by rapamycin decreased or prevented parathyroid cell proliferation in secondary hyperparathyroidism rats and in vitro in uremic rat parathyroid glands in organ culture. Knockin rpS6^p−/− mice, in which rpS6 cannot be phosphorylated because of substitution of all five phosphorylatable serines with alanines, had impaired PTH secretion after experimental uremia- or folic acid–induced AKI. Uremic rpS6^p−/− mice had no increase in parathyroid cell proliferation compared with a marked increase in uremic wild–type mice. These results underscore the importance of mTOR activation and rpS6 phosphorylation for the pathogenesis of secondary hyperparathyroidism and indicate that mTORC1 is a significant regulator of parathyroid cell proliferation through rpS6.