Subdural empyema secondary to sinus infection in children

Objective  To evaluate the impact, on morbidity and mortality, of aggressive surgical management of subdural empyema of sinus origin in children. Method  The authors conducted a retrospective review of 20 children admitted between 2000–2007 to Alder Hay Children Hospital and The Walton centre for Neurology and Neurosurgery for subdural empyema secondary to sinus infection. Clinical presentation, duration of symptoms, radiological investigations, surgical treatment and post-operative outcome were evaluated. Results  Outcome was favourable in 19 cases. In four cases, there were re-accumulation requiring surgical evacuation, four patients experienced post-operative seizures but were seizure-free at follow-up. There was only one mortality in the series. Conclusion  Subdural empyema secondary to sinus infection, although uncommon, it could be associated with a relative high morbidity and mortality rate. Early aggressive surgical and medical management with drainage of intracranial or sinus collections and antibiotics therapy lead to a low mortality or morbidity rate and good clinical outcome.     

Bilateral procedures in maxillofacial surgery in the United Kingdom: survey of higher trainees' performance and experience

We conducted a survey targeting all higher surgical trainees in oral and maxillofacial surgery in the United Kingdom to find out their dominant hand, ability and confidence using powered instruments, and any trends in the likelihood of operating on one or other side of an index bilateral operation: the bilateral sagittal split mandibular osteotomy. We also explored the attitudes of trainees and trainers towards non-dominant manual dexterity, and whether senior consultants were more likely to adopt certain rehearsed routines and approaches when supervising trainees.     

Deconstructing evidence in orthodontics: making sense of systematic reviews, randomized clinical trials, and meta-analyses

Much has been written in support of systematic reviews and the randomized clinical trials and meta-analyses upon which they are based. Clearly, the medical profession (as opposed to the dental profession) has been the leader in publishing the benefits of systematic reviews over the traditional, qualitative narrative reviews. At the same time, the medical profession also appears to be ahead of the dental profession in recognizing the limitations of such reviews. That said, there are a number of inherent problems with systematic reviews, as well as the randomized clinical trials and meta-analyses that back them up. To better facilitate evidence-based decision making, this article discusses the shortcomings of systematic reviews so that practitioners are fully aware of their drawbacks, as well as their benefits.     

Involvement of superoxide dismutase and glutathione peroxidase in attenuation of radiation-induced hyperthermia by interleukin-1α in rats

Pretreatment with recombinant human interleukin-1α (rhIL-1α) 20 h before irradiation attenuates radiation-induced hyperthermia. Experiments were conducted to determine the role of antioxidant enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GSHPx) in rhIL-1α-induced attenuation of radiation-induced hyperthermia. Radiation exposure increased SOD and decreased GSHPx levels in the hypothalamus, while treatment with rhIL-1α increased GSHPx levels and had no effect on SOD levels. However, rhIL-1α and irradiation together increased hypothalamic SOD level but prevented the fall in GSHPx level. Our results suggest that attenuation of radiation-induced hyperthermia by rhIL-1α may involve stimulation of SOD and GSHPx because rhIL-1α treatment and irradiation together increased hypothalamic GSHPx and SOD levels, and intracerebroventricular administration of SOD and GSHPx attenuated the radiation-induced hyperthermia.     

Effect of Kaempferol Pretreatment on Myocardial Injury in Rats

The present study was undertaken to evaluate the effect of kaempferol in isoprenaline (ISP)-induced myocardial injury in rats. ISP was administered subcutaneously for two subsequent days to induce myocardial injury. Assessment of myocardial injury was done by estimation of hemodynamic functions, myocardial infarcted area, cardiac injury markers, lipid profile, oxidative stress, pro-inflammatory cytokines and histopathology of heart and liver. Rats pretreated with kaempferol showed reduction in the myocardial infarcted area and heart rate. However, no improvement was observed in change in body weight, mean arterial, systolic and diastolic blood pressure. Kaempferol showed significant decrease in serum LDH, CK-MB, troponin-I and lipid profile. However, highest dose of kaempferol did not reduce the serum triglyceride level. Further, antioxidant enzymes, SOD and catalase, were also higher. However, reduced glutathione, serum SGOT and creatinine did not show any improvement. Kaempferol showed reduction in MDA level. Kaempferol at highest dose showed reduction in pro-MMP-2 expression and MMP-9 level. mRNA expression level of TNF-α was not different in kaempferol-pretreated myocardial injured rats with ISP-alone group. Pretreatment with kaempferol at highest dose showed mild mononuclear infiltration and degenerative changes in heart tissue section of myocardial injured rats. Rats pretreated with kaempferol at higher concentration showed normal cordlike arrangement of hepatocytes with moderate swelling of hepatocytes (vacuolar degeneration) around the central vein. Study suggests that kaempferol attenuated lipid profile, infarcted area and oxidative stress in ISP-induced myocardial injury in rats.     

The evolution of temporomandibular disorders: A shift from experience to evidence

After over 80 years of much obsession as well as avoidance of the subject of temporomandibular disorders (TMDs), the dental profession is still divided over what they are and how to deal with them. Over this period, nearly every discipline in dentistry has played some role in the development of this field. Unfortunately, a significant amount of this information has been based on personal opinion, experience-based philosophies, or poorly conducted research. Furthermore, each dental specialty has been responsible for contributing to the concepts of the etiology and management of TMDs with their own professional bias; for example, orthodontists describe these problems in orthodontic terms and offer orthodontic treatments or solutions for their patients. As various treatment approaches were found to be effective at least some of the time, this has further led to misinformation and confusion within the profession. Advances in research from diverse fields, including neurophysiology, pain pathophysiology, genetics, endocrinology, behavioral sciences, and psychology, have significantly altered our understanding of TMDs and how they should be managed. The rigid mechanical and dental-based model of the past has been gradually replaced by a biopsychosocial medical model for the diagnosis and treatment of TMDs as well as other acute and chronic pain disorders. This paper discusses the evolution of our understanding of TMDs since they were first described 85 years ago. Contemporary scientific findings and their implications are presented in some detail for clinicians who wish to provide the appropriate management for their orofacial pain patients.     

Ultrasound Imaging of the Renal Parenchyma of Premature Neonates for the Assessment of Renal Growth and Glomerulomegaly

Evidence is increasingly showing that prematurity results in chronic kidney disease. We hypothesized that we could use ultrasound imaging to measure and monitor the growth of the renal parenchyma in premature neonates. We conducted a prospective, case-control study to compare renal parenchymal growth between neonates born prematurely and term neonates. The study patients underwent ultrasound assessment at 32 wk postmenstrual age (PMA) and 37 wk PMA. Term neonates (gestation >37 completed wk) admitted to the neonatal unit with minor neonatal conditions were recruited into the control group. Complete data sets were available in 91 premature neonates and during the same period, 56 term neonates were recruited as the control. The median birth weight (preterm babies) was 930 g (780–1220 g), and the mean gestational age was 27.0 wk (2.1 wk). Total renal volume (TRV) increased from 14.6 (4.3) cm³ to 20.5 (5.3) cm³ from 32 to 37 wk PMA. During the same period, the total renal parenchyma (TRP) thickness increased from 1.6 (0.3) cm to 1.8 (0.3) cm. At 37 wk PMA, ex-premature neonates have a significantly smaller total renal volume (20.5 [5.3] versus 25.9 [6.4] cm³; p < 0.001) and total renal parenchyma thickness (1.8 [0.3] versus 2.0 [0.2] cm; p = 0.015) compared with term (control) neonates. However, premature neonates at 37 wk PMA have a larger TRP:TRV ratio compared with term neonates (0.09 [0.02] versus 0.0 8 [0.02] cm^?2; p < 0.001). Reduced nephron endowment as a result of prematurity may cause the remaining nephrons to undergo compensatory glomerulomegaly and we postulate this is the reason for the observed differences. Ultrasound imaging of the renal parenchyma shows promise in assessing the effects of prematurity on the developing kidney.     

Central effect of dibutyryl cyclic AMP on the temperature in the conscious rabbit

In the rabbit, intracerebroventricular administration of dibutyryl cyclic AMP (DBC) produces fever which is selectively antagonised by phenoxybenzamine. This indicates the involvement of central alpha-adrenoceptors in DBC-induced fever. The decrease in DBC hyperthermia after 6-hydroxydopamine (6-OH-DA) supports the viewpoint that DBC-induced fever is dependent on the presence of noradrenaline (NA) in the central nervous system. The accentuation of NA hyperthermia by theophylline suggests that NA fever may be mediated by cAMP. It is unlikely that DBC-induced hyperthermia in the rabbit is mediated via prostaglandins since indomethacin does not inhibit this response to DBC.