Necrotizing sialometaplasia of the lip simulating squamous cell carcinoma

A case of necrotizing sialometaplasia of the lip in an 68-year-old pipe smoker is described. Necrotizing sialometaplasia is a self-healing non-neoplastic disease probably of ischaemic nature. Thirty-nine cases of sialometaplasia are described in the literature up to early 1979. These cases appeared in the palate, nasal cavity, gingiva, lip, hypopharynx and maxillary sinus. Six cases have also been reported from major salivary glands. Histologically there is necrosis of mucous cells with partial replacement by squamous epithelium. This entity has often been mistaken for squamous or mucoepidermoid carcinoma. One has to be familiar with the existence of necrotizing sialometaplasia in order to avoid subjecting the patient unnecessary and potentially mutilating surgery.     

Muscular and cardiorespiratory fitness are independently associated with metabolic risk in adolescents: the HELENA study

Artero EG, Ruiz JR, Ortega FB, España‐Romero V, Vicente‐Rodríguez G, Molnar D, Gottrand F, González‐Gross M, Breidenassel C, Moreno LA, Gutiérrez A; on behalf of the HELENA Study Group. Muscular and cardiorespiratory fitness are independently associated with metabolic risk in adolescents: the HELENA study. Objective: To examine the independent associations of muscular and cardiorespiratory fitness with clustered metabolic risk in adolescents. Methods: Participants were 709 adolescents (346 boys) from 10 European centers, aged 12.5–17.5 yr, evaluated as a part of the Healthy Lifestyle in Europe by Nutrition in Adolescents cross‐sectional study (HELENA‐CSS). A muscular fitness score was computed using handgrip strength and standing long jump. Cardiorespiratory fitness was measured using the 20‐m shuttle run test. Age‐ and gender‐specific z‐scores of waist circumference, systolic blood pressure, triglycerides, ratio total cholesterol/high‐density lipoprotein cholesterol, and insulin resistance (homeostasis model assessment) were summed to create a metabolic risk score. Results: Muscular fitness was negatively associated with clustered metabolic risk independent of cardiorespiratory fitness (β = ?0.249, p < 0.001). Independent of muscular fitness, an inverse association was also found between cardiorespiratory fitness and clustered metabolic risk (β = 0.264, p < 0.001). The odds ratios for having a high clustered risk (above or equal 1 standard deviation) were 5.3 [95% confidence interval (CI) = 2.6–10.6] and 4.3 (95% CI = 2.0–9.3) in the least fit quartile compared with the most fit quartile for muscular and cardiorespiratory fitness, respectively. Significant differences in metabolic risk between muscular fitness levels persisted among non‐overweight (p = 0.012) and overweight participants (p = 0.011). Conclusion: Muscular and cardiorespiratory fitness are independently associated with metabolic risk in adolescents. These results support current physical activity recommendations for youth, which include muscle strengthening activities in addition to aerobic exercise.     

Low bone mass in patients with motor disability: prevalence and risk factors in 59 Finnish children

Aim Children with motor disabilities are at increased risk of compromised bone health. This study evaluated prevalence and risk factors of low bone mass and fractures in these children. Method This cross‐sectional cohort study evaluated bone health in 59 children (38 males, 21 females; median age 10y 11mo) with motor disability (Gross Motor Function Classification System levels II–V). Bone mineral density (BMD) in the lumbar spine was measured with dual‐energy X‐ray absorptiometry; BMD values were corrected for bone size (bone mineral apparent density [BMAD]) and skeletal maturity, and compared with normative data. Spinal radiographs were obtained to assess vertebral morphology. Blood biochemistry included vitamin D concentration and other parameters of calcium homeostasis. Results Ten children (17%) had sustained in total 14 peripheral fractures; lower‐limb fractures predominated. Compression fractures were present in 25%. The median spinal BMAD z‐score was ?1.0 (range ?5.0 to 2.0); it was ?0.6 in those without fractures and ?1.7 in those with fractures (p=0.004). Vitamin D insufficiency was present in 59% of participants (serum 25‐hydroxyvitamin D <50nmol/l) and hypercalciuria in 27%. Low BMAD z‐score and hypercalciuria were independent predictors for fractures. Interpretation Children with motor disability are at high risk of peripheral and vertebral fractures and low BMD. Evaluation of bone health and prevention of osteoporosis should be included in the follow‐up.     

Methotrexate toxicity precipitated by azapropazone

We report an episode of bone marrow hypoplasia following the administration of azapropazone to a patient stabilized on regular methotrexate for psoriasis. A pharmacokinetic interaction is postulated.     

Incidence and Predictors of Permanent Pacemaker Requirement after Transcatheter Aortic Valve Implantation with a Self‐Expanding Bioprosthesis

Background: Previous reports have suggested the occurrence of cardiac conduction disorders and permanent pacemaker (PPM) requirement after transcatheter aortic valve implantation (TAVI). Based on a single‐center experience, we aim to assess the incidence of postprocedural conduction disorders, need for PPM, and its determinants after TAVI with a self‐expanding bioprosthesis. Methods: From August 2007 to October 2009, 32 consecutive patients underwent TAVI with the Medtronic CoreValve (MCV) System (Medtronic Inc., Minneapolis, MN, USA). Three patients paced at baseline and two cases of procedure‐related mortality were excluded. We analyzed the 12‐lead electrocardiogram at baseline, immediately after procedure and at discharge. Requirements for PPM were documented and potential clinical, electrophysiological, echocardiographic, and procedural predictors of PPM requirement were studied. Results: After TAVI, eight patients (29.6%) required PPM implantation due to high‐grade atrioventricular (AV) block. The prevalence of left bundle branch block increased from 13.8% to 57.7% directly after implantation (P = 0.001). Need for PPM was correlated to the depth of prosthesis implantation (r = 0.590; P = 0.001). At a cutoff point of 10.1 mm, the likelihood of pacemaker could be predicted with 87.5% sensitivity and 74% specificity and a receiver operator characteristic curve area of 0.86 ± 0.07 (P = 0.003). Of the seven patients with preexisting right bundle branch block (RBBB), four (57.1%) required PPM implantation after TAVI. Conclusions: High‐grade AV block requiring PPM implantation is a common complication following TAVI and could be predicted by a deeper implantation of the prosthesis. Patients with preexisting RBBB also seem to be at risk for the development of high‐grade AV block and subsequent pacemaker implantation. (PACE 2010; 1364–1372)     

Study of titanium screws as retrograde fillings using bacteria and dye

The tightness of retrograde titanium screw fillings and retrograde amalgam fillings was compared in 17 human, single-rooted teeth using Serratia marcescens bacteria in vitro. The root canals were subjected to instrumentation and irrigation, after which 2 mm was cut off from the apical end. Eight of the teeth were sealed using retrograde titanium screw fillings and nine using retrograde amalgam fillings. The teeth were suspended by means of wires in test tubes, with the crowns upwards and the roots immersed in trypticase soy broth. Suspensions of Serratia marcescens bacteria were placed in the root canals, and samples from the broth were plated daily. The bacteria penetrated the apical titanium screw seals in 2 to 7 days, and the retrograde amalgam fillings readily on the first day. Thus, the titanium screws seemed to provide a tighter seal. Staining with India ink showed that penetration had occurred at the tooth-filling margin and that the instrumentation had not caused any fractures to the roots.     

Gingival fluid, beta2-microglobulin and protein levels as indicators of periodontal disease

Abstract— β₂-microglobulin (β₂-m), lysozyme and protein concentrations in gingival fluid were analyzed in 19 patients with severe periodontitis and in 19 controls devoid of any clinical signs of inflammation. A significant increase of the total protein and β₂-m levels was found in periodontal subjects. In contrast, lysozyme concentration did not reflect the inflammatory status of the periodontium. Statistical analyses showed significant correlations between β₂-m and protein concentrations in both groups. Furthermore, the values obtained by Periotron 600 closely correlated with the protein and β₂-m contents, indicating that this method is a reliable aid in assessment of the quantity and quality of crevicular exudate and thus the severity of periodontal disease.     

Biochemical Characteristics and Diagnosis of the Carbohydrate-deficient Glycoprotein Syndrome

29 patienxts with a new inherited complex developmental deficiency syndrome—the carbohydrate-deficient glycoprotein syndrome—were studied biochemically. The most striking biochemical abnormality in these patients is the presence of secretory glycoproteins, that are deficient in their carbohydrate moieties. Serum transferrin shows the most pronounced carbohydrate defect, both quantitatively and qualitatively. Half of this glycoprotein is apparently missing two or four of its terminal trisaccharidcs—sialic acid, galactose and N-acetylglucosamine—while the carbohydrate core appears to be intact. The abnormal transferrin is also present in the liver. This biochemical alteration is a highly specific marker of the syndrome, which can be diagnosed either qualitatively by isoelectric focusing of serum transferrin or quantitatively by the "carbohydrate-deficient transferrin" (CDT) assay. In the CDT assay all of these patients have values approximately ten times above the reference level. The unique carbohydrate defect in secretory glycoproteins indicates that this disorder represents a new type of inborn error of glycoprotein metabolism. Studies of eleven enzymes in glycoprotein synthesis and catabolism have not revealed any deficiency of glycosidases or glycosyltransferases. The nature of the transferrin change and the cathepsin assays performed to date may suggest an as yet unidentified degradation abnormality.     

Client and information: a literature review

Summary

• ? This paper gives a brief review of existing research studies concerning patient information.
• ? The paper outlines two relevant perspectives on information giving and on the meaning of information to the individual patient: ideological and practical.
• ? From these two perspectives the knowledge structures of four patient groups: surgical patients, cancer patients, dialysis patients and psychiatric patients are looked at more closely.