Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study

ObjectivesParapneumonic pleural effusions/empyema (PPE/PE) are severe complications of community-acquired pneumonia. We investigated the bacterial aetiology and incidence of paediatric PPE/PE in Germany after the introduction of universal pneumococcal conjugate vaccine (PCV) immunization for infants.MethodsChildren <18 years of age hospitalized with pneumonia-associated PPE/PE necessitating pleural drainage or persisting >7 days were reported to the German Surveillance Unit for Rare Diseases in Childhood between October 2010 and June 2017. All bacteria detected in blood or pleural fluid (by culture/PCR) were included, with serotyping for Streptococcus pneumoniae.ResultsThe median age of all 1447 PPE/PE patients was 5 years (interquartile range 3–10). In 488 of the 1447 children with PPE/PE (34%), 541 bacteria (>40 species) were detected. Aerobic gram-positive cocci accounted for 469 of 541 bacteria detected (87%); these were most frequently Streptococcus pneumoniae (41%), Streptococcus pyogenes (19%) and Staphylococcus aureus (6%). Serotype 3 accounted for 45% of 78 serotyped S. pneumoniae strains. Annual PPE/PE incidence varied between 14 (95%CI 12–16) and 18 (95%CI 16–21) PPE/PE per million children. Incidence of S. pneumoniae PPE/PE decreased from 3.5 (95%CI 2.5–4.6) per million children in 2010/11 to 1.5 (95%CI 0.9–2.4) in 2013/14 (p 0.002), followed by a re-increase to 2.2 (95%CI 1.5–3.2) by 2016/17 (p 0.205).ConclusionsIn the era of widespread PCV immunization, cases of paediatric PPE/PE were still caused mainly by S. pneumoniae and, increasingly, by S. pyogenes. The re-increase in the incidence of PPE/PE overall and in S. pneumoniae-associated PPE/PE indicates ongoing changes in the bacterial aetiology and requires further surveillance.     

Clinical and epidemiological study of traumatic root fractures

Abstract    The aim of this work was to study the prevalence and clinical presentation of root fractures in a series of patients with dental trauma. Treatment strategies were classified and outcomes after a 6-month period presented. The study population comprised 76 patients (between the ages of 2 and 55 years) with 93 root fractures in their teeth (18 primary, 75 permanent). Data were collected following the taking of a detailed clinical history, objective clinical examination and photographic and radiological investigation. Since most of the primary teeth were extracted, only cases with root fracture of permanent teeth were followed-up: in all, 24 patients with 31 teeth with root fractures. The prevalence of root fractures in permanent teeth was 7.7% of all injuries, while in primary teeth it was 3.8%. The most frequently involved teeth were the maxillary incisors with a percentage of 75% in permanent teeth. Moreover, 40% of root fractures in permanent teeth were associated with fracture of the alveolar bone and of the soft tissues and in 45% of cases, the adjacent teeth were also injured. The results of this study reaffirm the necessity for scrupulous diagnosis of teeth after a traumatic injury. Adjacent teeth and those in the opposing arch should not be ignored. Treatment is multi-disciplinary, requiring surgical, orthodontic, operative and prosthetic compliance. Periodic check-up is essential.     

The basic proline-rich proteins in human parotid saliva from a single subject.

Eleven Chromatographic fractions of basic proline-rich proteins isolated from parotid saliva from a single donor showed similar but not identical chemical compositions; proline, glycine and glutamic acid-glutamine accounted for 70–80 per cent of the total residues in the proteins. The basic amino acids, lysine and arginine, accounted for a further 10 per cent. All the proteins were in freshly-collected saliva and did not result from post-secretory proteolysis. The most basic of the proline-rich proteins, I-B9, was purified and characterized. The amino terminal residue was serine and the carboxyl terminal residue arginine. The molecular weight determined by quantitative end-group analyses was 9000–9500. Protein I-B9 was resistant to hydrolysis by collagenase and Staphylococcus aureus protease, whereas papain and subtilisin extensively degraded it. I-B9 fragments from clostripain and elastase digestions were isolated for use in sequence determination. Basic proline-rich proteins, acidic proline-rich proteins and proline-rich glycoprotein accounted for 23, 30 and 17 per cent, respectively of the total protein in the parotid saliva.     

The relationship between radionuclide bone scans and dental examinations

Bone scans were evaluated in 57 patients referred from the nuclear medicine clinic. Areas of normal and abnormal radiopharmaceutical accumulation in the maxilla and mandible were correlated with a clinical and radiographic dental examination. There was an 80% agreement between the areas of normal and abnormal uptake with the clinical and radiographic findings. This was statistically significant (p less than 0.001). Twenty-one patients had clinical and radiographic dental examinations that were within normal limits and yet had abnormal bone scans. Five of these 21 patients were subsequently seen on an emergency basis for treatment of dental abnormalities. These positive areas on the bone scans may be indicating areas of pathosis not detectable by conventional clinical and radiographic diagnostic techniques.     

Surgical-prosthodontic reconstruction of advanced maxillary bone compromise with autogenous onlay block bone grafts and osseointegrated endosseous implants: a 12-year study of 32 consecutive patients

During a 12-year period (1984 to 1997), 32 consecutive patients with advanced maxillary bone compromise received surgical-prosthodontic rehabilitation. The most frequent procedure used was maxillary augmentation with a free nonvascularized autogenous onlay block bone graft, and the average time of prosthesis function was 67 months. Twenty-eight patients underwent a 1-stage procedure, in which endosseous implants were placed simultaneously for internal rigid skeletal fixation of the onlay bone graft, and 4 patients underwent a 2-stage procedure, in which endosseous implants were placed secondarily 6 months after complete healing of the previously placed onlay bone graft, which initially was stabilized by titanium miniplates and lag screws. Treatment success was evaluated separately for the first 7 consecutively treated patients (developmental group) and for the next 25 consecutive patients (routine group). Assessment was made of implant survival relative to etiology of bone loss, implant type and length, type of prosthesis, type of opposing occlusion, type of surgical procedure, and presence of discontinuity. The implant survival rate was 91% in the 25 routine patients and 65% in the 7 developmental patients. Implant type and length, prosthesis type, opposing occlusion, and the presence or absence of discontinuity significantly impacted treatment outcome. Onlay block bone graft success (96%) in all 32 treated patients and prosthetic success (96%) in the last 25 patients was recorded.     

The influence of gingival margin recession on loss of clinical attachment in alcohol-dependent patients without medical disorders

BACKGROUND: The objective of this study was to examine the effects of alcohol and cocaine misuse on periodontal status in a group of alcohol-dependent patients. METHODS: Forty verified alcoholics, either exclusively (n = 10) or with cocaine abuse (n = 30), and a matched comparison group of 25 non-alcoholic subjects, 14 of whom abused cocaine, were entered in the study. All subjects were free from systemic illnesses. Blood levels of gamma glutamyl transpeptidase (GGTP), a liver enzyme indicator of alcohol drinking, were determined. A comprehensive periodontal examination was performed on 6 sites per tooth. The gingival index (GI) and plaque index (PI) were recorded. Attachment levels (AL) were computed as probing depth (PD) plus gingival margin level (GM). RESULTS: No statistically significant differences were noted between the groups for average AL, PD, GM, GI, and PI. In alcoholics, Pearson correlation showed a positive association between GGTP levels and loss of periodontal attachment (P<0.05). A series of regression analyses predicting AL from selected periodontal and demographic factors showed that alcoholics manifest AL by greater increases in GM than non-alcoholics (P<0.07). Severe alcohol use as measured by GGTP >51 iu/l worsens PI (P<0.07), which adversely impacts GM, GI, PD, and ultimately AL. No significant associations were found between cocaine use and AL. CONCLUSIONS: The results suggest that persistent alcohol abuse increases periodontitis development by heightening the loss of attachment through recession of gingival margins.     

Analysis of death certification in patients with early stage oral cavity squamous cell carcinoma.

PURPOSE: Although patients with T1 oral cavity carcinoma have a generally good prognosis, there is a significant burden of patients that have locoregional recurrence and mortality from early stage disease. The aim of this study was to investigate the specific cause of death in patients with T1N0M0 oral cavity squamous cell carcinoma (OCSCC) by analysis of death certification. PATIENTS AND METHODS: Patients were identified with T1 OCSCC treated over a 15-year period between 1986 to 2001 from the Mayo Clinic Tumor Registry. All patients were treated by operation without neck dissection or postoperative neoadjuvant therapy as the initial method of treatment. On detailed examination of the death certificate the leading cause of death was identified along with other clinical predictors of death. RESULTS: Two hundred fifty patients were identified and met inclusion criteria from the Mayo Clinic Tumor Registry. Of the study group, 8.5% and 16% developed local and regional recurrence, respectively, as the first recurrence. The majority of recurrences that were amenable to surgery were managed by radical resection and postoperative neoadjuvant therapy. Of 85 deaths in the study group, 40 death certificates were obtained and reviewed to ascertain a specific cause of death. Patients were grouped into death from oral cancer, other cancer, or medical disease. Primary cause of death from the death certificates available for review included uncontrolled locoregional disease (20%), metastatic oral cancer (15%), development of secondary nonoral malignancy (15%), and a variety of medical causes (50%). Patient age at the time of diagnosis older than 65 had a statistically significant increase in mortality. Interestingly, the presence of premorbid medical conditions, history, or persistent tobacco and alcohol use did not seem to be related to overall mortality. CONCLUSION: Early stage OCSCC continues to portend a poor prognosis. Analysis of death certification provides useful information of the specific cause of death.