Mesiodens--diagnosis and management of a common supernumerary tooth

Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. Given this high frequency, the general dentist should be knowledgeable about the signs and symptoms of mesiodentes and appropriate treatment. The cause of mesiodentes is not fully understood, although proliferation of the dental lamina and genetic factors have been implicated. Mesiodentes can cause delayed or ectopic eruption of the permanent incisors, which can further alter occlusion and appearance. It is therefore important for the clinician to diagnose a mesiodens early in development to allow for optimal yet minimal treatment. Treatment options may include surgical extraction of the mesiodens. If the permanent teeth do not erupt in a reasonable period after the extraction, surgical exposure and orthodontic treatment may be required to ensure eruption and proper alignment of the teeth. In some instances, fixed orthodontic therapy is also required to create sufficient arch space before eruption and alignment of the incisor(s). Early diagnosis allows the most appropriate treatment, often reducing the extent of surgery, orthodontic treatment and possible complications. This paper outlines the causes and modes of presentation of mesiodentes, and presents guidelines for diagnosis and management of nonsyndromic mesiodentes.     

Usefulness of TAPS (Polish version) for evaluation of CI children's progress in speech rehabilitation--7 years of observation

The speech rehabilitation of pre- and perilingually deafened children with cochlear implants it is a very long process. It should be individualized for needs of every young patient. It is possible only after correct evaluation of speech level. There are many tests for this evaluation. Among them same are more known like TAPS test. Test of Auditory Perception of Speech (TAPS) was elaborated in English at Basel University in Swiss. It was translated to Polish at Adam Mickiewicz University and Karol Marcinkowski University School of Medical Sciences in Poznań. The authors present their own 7-years observations.     

Chromosomal information derived from single blastomeres isolated from cleavage-stage embryos and cultured in vitro

OBJECTIVE: To evaluate the potential of proliferation of single blastomeres isolated from human cleavage-stage embryos for use in preimplantation genetic diagnosis of chromosomal abnormalities. DESIGN: A laboratory study of chromosomal content of blastomeres isolated from embryos of patients from an in vitro fertilization program. SETTING: University hospital laboratory. PATIENT(S): Couples undergoing IVF or ICSI. INTERVENTION(S): Blastomeres were isolated from normally fertilized cleavage-stage human embryos, cultured in vitro or fixed immediately, and analyzed by fluorescence in situ hybridization (FISH) probes. MAIN OUTCOME MEASURES: Chromosomal information yielded by blastomeres cultured in vitro compared with those obtained from blastomeres that were processed for chromosomal analysis directly after isolation. RESULT(S): The percentage of cultured blastomeres that produced FISH results was significantly lower than the percentage of blastomeres processed for FISH directly after isolation (72% vs. 90%). Lack of FISH results from cultured cells, which in most cases was related to nuclear anomalies, was significantly more frequent among nondivided than divided blastomeres (39% vs. 21%). Both cultured and noncultured cells showed diploid, aneuploid and polyploid chromosome complements on FISH. Compared with directly processed cells, cultured cells yielded a higher proportion of polyploid patterns (22.9% vs. 6.1%). Of the cultured blastomeres that divided, 18% produced progeny with mosaicism. CONCLUSION(S): Although blastomere culture may increase the number of cells available for chromosomal analysis, the high frequency of nuclear defects and the occurrence of polyploidy and mosaicism among cultured cells discourage the use of blastomere isolation and proliferation strategy for use in preimplantation genetic diagnosis.     

Analysis of complications of the tension-free vaginal tape procedure for surgical treatment of female stress urinary incontinence

OBJECTIVE: The most common types of urinary incontinence in women are stress, urge and mixed incontinence. Stress urinary incontinence may be caused by an urethral hypermobility and internal sphincter deficiency (ISD). There are over 100 different surgical procedure for the treatment of female stress incontinence. Tension-free vaginal tape (TVT) is a new anti-incontinence surgical technique which was first described by Ulmsten in 1996. The aim of the study was to evaluate the complications of tension-free vaginal tape (TVT) for the surgical treatment of female stress incontinence. METHODS: The study group was consisted of 162 women, aged 32-84. All patients had a basic evaluation that included a history, frequency/volume chart, questionnaire of micturition (self-made), physical examination, stress test, Bonney test, urinalysis and bacterial culture of urine. Women with mixed urinary incontinence and who underwent surgical treatment of SUI in the past had been done urodynamic investigation. The operation was carried out under epidural, subarachnoid and general anesthesia. The TVT procedure was performed as described by Ulmsten. The follow-up was done after 1 day, 1 and 3 and 6 months since the operation. RESULTS: Among complications related to the procedure were 11 cases of cystotomy, 5 cases of urinary retention requiring four days catheterization, 3 cases of bleeding from the vagina, 14 cases of detrusor instability de novo. In 4 cases occurred postoperative obstinate pain. In 4 cases occurred recurrent urinary tract infection. None complication required invasive treatment. No evidence of defect healing or rejection of the tape was found. CONCLUSIONS: We conclude that the TVT procedure is safe method of the surgical treatment of urinary stress incontinence associated with a low complications.     

Clinical and cytogenetic evaluation of patients with disorders of somato-sexual development

Congenital somato-sexual disturbances include wide range of classic syndromes, as well as different types of numerous or isolated developmental defects. 28 women with disorders of sexual development were clinically and cytogenetically analyzed. AIM: Clinical and cytogenetic evaluation of patients with disorders of somato-sexual development. MATERIAL AND METHODS: 28 women, 17-35 years old, were included in the study. Analysis data were performed on the basis of clinical records from Department of Obstetrics and Woman's Diseases of Medical University in Bydgoszczy. Cytogenetic investigations were carried out on standard lymphocyte culture method. RESULTS: Turner's syndrome was found in 12 women; 45, X in 7 mosaic karyotype 45, X/46, XX in 4, isochromosome i(Xq) in 1.3 women had normal, male karyotype, 46, XY. One of them had dysgenetic gonads of malignant dysplesia transformation. One patient's karyotype was 47, XXX. 12 women with gonadal dysgenesis--karyotype 46, XX. CONCLUSIONS: 1. Patients with congenital disorders of somato-sexual development are a heterogenous group. 2. Laparoscopy an effective diagnostic and treatment method in women with disorders of congenital somato-sexual development.     

The effectiveness of postoperative external beam radiotherapy for incompletely resected non-small cell lung cancer

In a retrospective analysis of 150 incompletely resected NSCLC patients treated with adjuvant external beam radiotherapy 32 (21.3%) survived 3 years with no symptoms of disease. Ipsilateral mediastinal/hilar lymph node involvement and macroscopic incomplete surgery were the prognostic factors that unfavourably influenced survival in Cox's proportional hazards model. Postoperative external beam radiotherapy was the efficient adjuvant treatment method in microscopically incompletely resected NSCLC, predominantly with no nodes involvement, but had no benefit in those with macroscopic incomplete surgery.     

Quality of life in psychogenic nonepileptic seizures

PURPOSE: Psychogenic nonepileptic seizures (PNESs) are events that alter or seem to alter the neurologic function and, in their appearance, resemble epileptic seizures (ESs). In patients with ESs the psychological and medical aspects of epilepsy greatly influence the health-related quality of life (HRQOL). The relation between these factors and PNESs is not well established. In this study, we compared HRQOL in patients with PNESs with that of patients with ESs. METHODS: We evaluated 105 patients admitted to the Epilepsy Monitoring Unit of University Hospital between January 20, 2001, and January 20, 2002. Only patients with the definite diagnosis of ESs or PNESs were analyzed (n = 85). Patients completed an epilepsy-specific quality-of-life instrument (QOLIE-89), the Profile of Mood States (POMS), and Adverse Events Profile (AEP). We used t tests and regression analyses to contrast HRQOL in PNESs and ESs and to elucidate the main factors associated with HRQOL in patients with PNESs. RESULTS: In our sample, 45 patients had PNESs, and 40 had ESs. The overall HRQOL and scores on 13 of 19 QOLIE-89 subscales were significantly lower (i.e., worse) in PNES than in ES patients. AEP and scores on five of six POMS subscales also were worse in PNES patients than in ES patients. PNES versus ES diagnosis, POMS depression/dejection, and AEP were significant predictors of HRQOL, jointly explaining 65% variation in HRQOL. The lower HRQOL in PNESs versus ESs was in part explained by depression and AEP. CONCLUSIONS: Patients with PNESs have a lower HRQOL and worse mood problems than do patients with ESs. This disadvantage is primarily due to depression and medication side effects, although these factors influence QOL in much the same way in PNES and ES patients. These baseline HRQOL data on patients with PNESs can be used to evaluate the effects of treatment in this patient population.     

Retrospective assessment of the antidepressants tolerance in the group of patients with diagnosis of depression and different CYP2D6 genotype

The majority of antidepressants undergo the oxidative biotransformation catalysed by cytochrome P-450, particularly by izoenzyme CYP2D6, whose activity is genetically determined. In many cases poor tolerance of antidepressants depends on CYP2D6 activity. The aim of the study was the evaluation of the relationship between the CYP2Dg genotype and the occurrence of side effects during antidepressive pharmacotherapy.