Review on pharmacological pain management in trauma patients in (pre‐hospital) emergency medicine in the Netherlands

Pain is one of the main complaints of trauma patients in (pre‐hospital) emergency medicine. Significant deficiencies in pain management in emergency medicine have been identified. No evidence‐based protocols or guidelines have been developed so far, addressing effectiveness and safety issues, taking the specific circumstances of pain management of trauma patients in the chain of emergency care into account. The aim of this systematic review was to identify effective and safe initial pharmacological pain interventions, available in the Netherlands, for trauma patients with acute pain in the chain of emergency care. Up to December 2011, a systematic search strategy was performed with MeSH terms and free text words, using the bibliographic databases CINAHL, PubMed and Embase. Methodological quality of the articles was assessed using standardized evaluation forms. Of a total of 2328 studies, 25 relevant studies were identified. Paracetamol (both orally and intravenously) and intravenous opioids (morphine and fentanyl) proved to be effective. Non‐steroidal anti‐inflammatory drugs (NSAIDs) showed mixed results and are not recommended for use in pre‐hospital ambulance or (helicopter) emergency medical services [(H)EMS]. These results could be used for the development of recommendations on evidence‐based pharmacological pain management and an algorithm to support the provision of adequate (pre‐hospital) pain management. Future studies should address analgesic effectiveness and safety of various drugs in (pre‐hospital) emergency care. Furthermore, potential innovative routes of administration (e.g., intranasal opioids in adults) need further exploration.     

Shoulder complaints after nerve sparing neck dissections

The purpose of the study was to analyse the prevalence of shoulder complaints after nerve sparing neck dissection at least 1 year after surgery, and to analyse the influence of radiation therapy on shoulder complaints. Patients were interviewed for shoulder complaints, and patients filled out the shoulder disability questionnaire to evaluate shoulder disability in daily activities. In total 137 patients; 51 after modified radical neck dissection (MRND), 21 after postero-lateral neck dissection (PLND), and 65 after supraomohyoid neck dissection (SOHND) were analysed. After MRND 33.3% of the patients experienced shoulder complaints, after PLND 66.7%, and after SOHND 20% of the patients experienced shoulder complaints. Type of neck dissection was significantly (P < 0.001) related to shoulder complaints. Outcome on the shoulder disability questionnaire also showed a significant (P < 0.01) difference in outcome for type of neck dissection. The prevalence of shoulder complaints after SOHND are low, and reduce disability in daily activities. Radiation therapy does not have a significant effect on shoulder complaints and disability.     

Periodontal inflamed surface area: quantifying inflammatory burden

Background: Currently, a large variety of classifications is used for periodontitis as a risk factor for other diseases. None of these classifications quantifies the amount of inflamed periodontal tissue, while this information is needed to assess the inflammatory burden posed by periodontitis.
Aim: To develop a classification of periodontitis that quantifies the amount of inflamed periodontal tissue, which can be easily and broadly applied.
Material and Methods: A literature search was conducted to look for a classification of periodontitis that quantified the amount of inflamed periodontal tissue. A classification that quantified the root surface area affected by attachment loss was found. This classification did not quantify the surface area of inflamed periodontal tissue, however. Therefore, an Excel spreadsheet was developed in which the periodontal inflamed surface area (PISA) is calculated using clinical Attachment Level (CAL), recessions and bleeding on probing (BOP).
Results: The PISA reflects the surface area of bleeding pocket epithelium in square millimetres. The surface area of bleeding pocket epithelium quantifies the amount of inflamed periodontal tissue. A freely downloadable spreadsheet is available to calculate the PISA.
Conclusion: PISA quantifies the inflammatory burden posed by periodontitis and can be easily and broadly applied.     

Craniofacial, craniocervical, and pharyngeal morphology in bilateral cleft lip and palate and obstructive sleep apnea patients.

OBJECTIVE: The aim of this study was to analyze craniofacial, craniocervical, and pharyngeal morphology in surgically treated bilateral cleft lip and palate (BCLP) men, untreated men with obstructive sleep apnea (OSA), and a reference group of men. SUBJECTS AND METHODS: Lateral cephalograms were obtained of 27 male BCLP patients (mean age 29.0 +/- 8.3 years), 27 untreated male OSA patients (mean age 38.6 +/- 5.3 years), and 27 male controls serving as a reference group (mean age 30.8 +/- 9.2 years). Tracings were made, and 26 variables representing craniofacial, craniocervical, and pharyngeal dimensions were obtained using Viewbox 3.1.1.6. software. The groups were compared using a one-way analysis of variance. RESULTS: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients was similar except for a significantly more retrusive maxilla in the BCLP group. Compared to the reference group, the BCLP and OSA groups had significantly larger craniocervical angulations, smaller depth of the oropharynx at the tip of the velum, and a more inferiorly positioned hyoid bone. Significantly larger vertical dimensions were found in the BCLP group compared to the reference group. CONCLUSIONS: Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients demonstrate substantial similarities except for a significantly more retrusive maxilla in the BCLP group. It is suggested that airway obstruction and postural adaptation to the obstruction may possibly be related to the aberrant craniofacial, craniocervical, and pharyngeal morphology in OSA and in BCLP patients.     

Clinical spectrum of KIAA2022 pathogenic variants in males: Case report of two boys with KIAA2022 pathogenic variants and review of the literature

KIAA2022 is an X‐linked intellectual disability (XLID) syndrome affecting males more severely than females. Few males with KIAA2022 variants and XLID have been reported. We present a clinical report of two unrelated males, with two nonsense KIAA2022 pathogenic variants, with profound intellectual disabilities, limited language development, strikingly similar autistic behavior, delay in motor milestones, and postnatal growth restriction. Patient 1, 19‐years‐old, has long ears, deeply set eyes with keratoconus, strabismus, a narrow forehead, anteverted nares, café‐au‐lait spots, macroglossia, thick vermilion of the upper and lower lips, and prognathism. He has gastroesophageal reflux, constipation with delayed rectosigmoid colonic transit time, difficulty regulating temperature, several musculoskeletal issues, and a history of one grand mal seizure. Patient 2, 10‐years‐old, has mild dysmorphic features, therapy resistant vomiting with diminished motility of the stomach, mild constipation, cortical visual impairment with intermittent strabismus, axial hypotonia, difficulty regulating temperature, and cutaneous mastocytosis. Genetic testing identified KIAA2022 variant c.652C > T(p.Arg218*) in Patient 1, and a novel nonsense de novo variant c.2707G > T(p.Glu903*) in Patient 2. We also summarized features of all reported males with KIAA2022 variants to date. This report not only adds knowledge of a novel pathogenic variant to the KIAA2022 variant database, but also likely extends the spectrum by describing novel dysmorphic features and medical conditions including macroglossia, café‐au‐lait spots, keratoconus, severe cutaneous mastocytosis, and motility problems of the GI tract, which may help physicians involved in the care of patients with this syndrome. Lastly, we describe the power of social media in bringing families with rare medical conditions together.     

Reliability and validity of measurements of facial swelling with a stereophotogrammetry optical three-dimensional scanner

Volume changes in facial morphology can be assessed using the 3dMD DSP400® stereo-optical 3-dimensional scanner, which uses visible light and has a short scanning time. Its reliability and validity have not to our knowledge been investigated for the assessment of facial swelling. Our aim therefore was to assess them for measuring changes in facial contour, in vivo and in vitro. Twenty-four healthy volunteers with and without an artificial swelling of the cheek were scanned, twice in the morning and twice in the afternoon (in vivo measurements). A mannequin head was scanned 4 times with and without various externally applied artificial swellings (in vitro measurements). The changes in facial contour caused by the artificial swelling were measured as the change in volume of the cheek (with and without artificial swelling in place) using 3dMD Vultus® software. In vivo and in vitro reliability expressed in intraclass correlations were 0.89 and 0.99, respectively. In vivo and in vitro repeatability coefficients were 5.9 and 1.3 ml, respectively. The scanner underestimated the volume by 1.2 ml (95% CI -0.9 to 3.4) in vivo and 0.2 ml (95% CI 0.02 to 0.4) in vitro.