Oral metal contact allergy: a pilot study on the cause of oral squamous cell carcinoma

BACKGROUND: Intraoral metal contact allergy may result in mucositis that mimics lichen planus and the pathogenesis of squamous cell carcinoma. METHODS: Clinical records of all patients examined in the departments of dermatology and otorhinolaryngology at a tertiary-care academic medical center between June 1994 and June 2000 who had a diagnosis of intraoral squamous cell carcinoma adjacent to a metal dental restoration and who were patch tested with our metal series were reviewed retrospectively. Eleven patients met the inclusion criteria. RESULTS: Ten patients (91%) had positive patch tests to metals. In eight (73%), the oral cancer was adjacent to a dental restoration containing a metal to which the patient was allergic. Prevalence of gold, mercury, silver, and copper allergy among these patients was substantially higher than that reported in the available worldwide patch-test clinic population. CONCLUSION: Contact allergy to metal dental restorations may be a risk factor for development of intraoral squamous cell carcinoma.     

Incidental Lewy body disease: Electrophysiological findings suggesting pre-clinical Lewy body disorders

Objective

Evaluate electrophysiologic findings in incidental Lewy body disease (ILBD).

Methods

ILBD, Control, and Parkinson’s disease (PD) subjects had electrophysiological evaluation within 2 years prior to autopsy. Data analyzed included surface electromyography (EMG) of upper extremity muscles during rest and muscle activation, and electroencephalography (EEG) recording at rest. For EMG, gross tracings and spectral peaks were analyzed. EEG measures analyzed were background frequency and power in delta, theta, alpha, and beta bands.

Results

Three of ten ILBD subjects (30%) showed unilateral rhythmic EMG discharges at rest without a visually apparent rest tremor. The ILBD resting EMG frequency was lower than in the Control group with no overlap (P = .03) and close to that of the PD group. The ILBD group had significantly lower background rhythm frequency than the Control group (P = .001) but was greater than the PD group (P = .01).

Conclusions

The electrophysiologic changes in ILBD cases are between those of Control and PD, suggesting that these findings may reflect changes correlating with ILBD as a possible precursor to PD.

Significance

Electrophysiologic changes in ILBD may assist with the identification of a preclinical stage for Lewy body disorders and help the development of a therapeutic agent for modifying Lewy body disease progression.     

Age-specific reference ranges for polychlorinated biphenyls (PCB) based on the NHANES 2001-2002 survey

The Centers for Disease Control and Prevention (CDC) conducted analyses for 34 polychlorinated biphenyl (PCB) congeners in blood samples collected from a statistically representative sample of the U.S. population during the National Health and Nutrition Examination Survey (NHANES) and reported overall population percentiles. Because the serum concentrations of many persistent organochlorine compounds are strongly age dependent, data were analyzed from the NHANES 2001-2002 sampling cycle to identify age-specific reference ranges for the measured congeners on a lipid-adjusted serum basis. In addition, reference ranges were estimated for the sum of the 34 measured PCB congeners. Because many congeners were frequently nondetectable, estimates for summed PCB levels are dependent upon the assumption used to replace nondetectable concentrations in the calculation. The effect of nondetects on the summed congeners totals is particularly strong for younger ages. The NHANES 2001-2002 PCB serum data demonstrate strong age-related trends, with older individuals displaying higher concentrations of most congeners and of summed PCB congeners. These age-specific reference ranges for PCB concentrations are critical for accurate interpretation of measured serum concentrations of PCB congeners in individuals.     

Thromboelastogram does not detect pre-injury anticoagulation in acute trauma patients

Purpose

Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC.

短期的脱氢表雄酮治疗增加中年男性受试者的血小板cGMP产生

目的临床和人群研究提示,脱氢表雄酮和它的硫酸盐在抗动脉粥样硬化和冠心病中起保护作用。然而,这种作用的机制仍不清楚。最近报道,硫酸脱氢表雄酮通过增加一氧化氮的生成来延缓动脉粥样硬化的形成。方法24岁的男性受试者(年龄65.4±0.7岁;范围58.2~67.6岁)经盲法安慰剂对照研究,使用脱氢表雄酮(每天50 mg睡前口服)或安慰剂2个月。2个月前和2个月后评价血小板环一磷酸鸟苷(cGMP)浓度(作为一氧化氮产生的标记)和血清中硫酸脱氢表雄酮钠、脱氢表雄酮、胰岛素样生长因子1、胰岛素、葡萄糖、雌二醇、睾酮、纤溶酶原激活物抑制剂1抗原、高半胱…     

Repetitive trauma and nerve compression

Repetitive movement of the upper extremity, whether recreational or occupational, may result in various neuropathies, the prototype of which is the median nerve neuropathic in the carpal canal. The pathophysiology of this process is incompletely understood but likely involves both mechanical and ischemic features. Experimentally increased pressures within the carpal canal produced reproducible progressive neuropathy. Changes in vibratory (threshold-type) sensibility appears to be more sensitive than two-point (innervation density-type) sensibility. The specific occupational etiologies of carpal neuropathy are obscured by methodologic and sociological difficulties, but clearly some occupations have high incidences of CTS. History and physical examination are usually sufficient for the diagnosis, but diagnostic assistance when required is available through electrophysiological testing, CT scanning, and possibly MRI. Each of these tests has limitations in both sensitivity and specificity. Treatment by usual conservative means should be combined with rest from possible provocative activities. Surgical release of the carpal canal is helpful in patients failing conservative therapy. Occupational modifications are important in both treatment and prevention of median neuropathy due to repetitive trauma.     

Surgical management of the hyperflexed thumb interphalangeal joint in the hand with ulnar intrinsic palsy

A great deal of attention has been paid to the need to restore balance about the metacarpophalangeal joint when clawing complicates ulnar nerve palsy. Less commonly addressed but perhaps more disabling are the consequences of ulnar palsy on function of the thumb. The hyperflexion of the thumb’s interphalangeal joint (IPJ), popularly termed Froment’s sign, leads to an unstable pinch. When surgically addressed, a common recommendation is fusion of this joint. A simple operative procedure, introduced to provide stability to the tetraplegic hand as part of key grip reconstruction can be equally well applied to the hyperflexed thumb of ulnar nerve palsy. Tenodesis of one half of the flexor pollicis longus into the extensor pollicis longus provides a check-rein against excessive IPJ flexion, promotes a more stable pinch posture, and avoids fusion of the joint.