Concepts for the treatment of adolescent patients with missing permanent teeth

INTRODUCTION: Missing permanent teeth is observed with syndromes or is frequently hereditarily propagated in families. The treatment of these patients is a multi-task of specialists of oral surgery, orthodontics and prosthodontics. DISCUSSION: Despite functional and aesthetic considerations, the main problem of all treatment is that it had to be performed in a growing child. This article discusses the conventional and implant-driven concepts to treat patients from childhood to adolescence with selective or multiple missing permanent teeth.     

Complication rate in unprotected carotid artery stenting with closed-cell stents

Introduction

The discussion on the use of protection devices (PDs) in carotid artery stenting (CAS) is gaining an increasing role in lowering the periprocedural complication rates. While many reviews and reports with retrospective data analysis do promote the use of PDs the most recent multi-centre trials are showing advantages for unprotected CAS combined with closed-cell stent designs.

Methods

We retrospectively analysed 358 unprotected CAS procedures performed from January 2003 to June 2009 in our clinic. Male/female ratio was 2.68/1. The average age was 69.3 years. Seventy-three percent (261/358) showed initial neurological symptoms. All patients were treated on a standardised interventional protocol. A closed and small-sized cell designed stent was implanted in most cases (85.2%). One hundred seventy-one (47.8%) were controlled by Doppler ultrasonography usually at first in a 3-month and later in 6-month intervals.

Results

The peri-interventional and 30-day mortality/stroke rate was 4.19% (15/358). These events included three deaths, five hyperperfusion syndromes (comprising one death by a secondary fatal intracranial haemorrhage), one subarachnoid haemorrhage and seven ischaemic strokes. Only 20% (3/15) of all complications occurred directly peri-interventional. The overall peri-interventional complication rate was 0.8% (3/358). Most complications occurred in initial symptomatic patients (5.36%). The in-stent restenosis rate for more than 70% was 7% (12/171) detected at an average of 9.8 month.

Conclusion

Our clinical outcome demonstrates that unprotected CAS with small cell designed stents results in a very low procedural complication rate, which makes the use of a protection device dispensable.     

Early childhood caries and quality of life: child and parent perspectives

PURPOSE: The purpose of this study was to investigate the effects of early childhood caries (ECC) on children's oral health-related quality of life (QOL) before and 4 weeks after its treatment, as assessed by the children themselves as well as by their parents/guardians. METHODS: This study had a longitudinal intervention design. Sixty-nine children diagnosed with ECC and 43 children without caries (combined children's mean age=50.4 months; range=22 to 70 months) and their parents/guardians responded to face-to-face administered surveys before a dental treatment was started (baseline assessment). Thirty-seven children with ECC completed dental rehabilitation. Four weeks after the treatment was completed, these 37 children as well as their parents/guardians responded to a second survey (follow-up assessment). RESULTS: The results show that children with ECC have significantly lower oral health-related QOL than children without ECC as assessed both by the children and the parents/guardians at baseline. The children with ECC who received dental treatment had a significantly improved oral health-related QOL at the follow-up assessment when compared with their baseline measurement as measured both with the children's self-ratings of oral health-related QOL and the parents'/guardians' perception of their child's oral health-related QOL. CONCLUSIONS: ECC and its treatment affect children's oral health-related QOL in a significant way. Oral health-related QOL can be assessed validly and reliably both in self-reports from children as young as 36 months of age as well as by asking parents/guardians about their perceptions of their child's oral health-related QOL.     

Discoid lupus erythematosus

Discoid lupus erythematosus is a manifestation of chronic cutaneous lupus erythematosus with a small risk of systemic involvement. In this review article, the role of predisposing factors such as haplotype, hormones, antibodies and sunlight are discussed. The clinical features, including variants and associations, and management options are presented.     

High resolution proton magnetic resonance spectroscopy of human cervical mucus

High resolution 1H NMR spectroscopy is a powerful method for qualitative and quantitative analysis of the highly viscous human cervical mucus (CM). Up to 23 compounds could be identified in this study and can be observed in the 1H NMR spectra of native mucus without the need of any complicated preparative chemistry. Storage conditions could be excluded as a possible reason for variations observed between different samples. pH values decreased after freezing and storing at 253 K. For NMR studies, lyophilization proved to be most useful, allowing the determination of the water content, replacement of H2O by D2O, and most importantly, absolute quantification of low molecular mass compounds. In a small collective of women the concentrations of some of the small constituents of the CM are strongly correlated; an example is the mutual positive correlation of taurine, citrate and creatinine. In conclusion, high resolution 1H NMR spectroscopy is a valid method to investigate mucus composition and to determine absolute concentrations of low molecular mass compounds in CM.     

Acceptability of a new modular protein substitute for the dietary treatment of phenylketonuria

The major source of protein in the dietary treatment of phenylketonuria (PKU) is a phenylalanine-free amino acid mixture. Traditionally, these medical products have also contained other nutrients and have been in powder form. However, their disagreeable taste and odour, the large volume required to provide sufficient protein and the inconvenience of their preparation and storage have hindered compliance with consumption among adolescents and adults. We studied the acceptability of a new medical product for the treatment of PKU. This product, Phlexy-10 (SHS North America, Gaithersburg, MD, USA), is available in three forms: sachets of premeasured powder to be constituted as a drink, fruit-flavoured bars and prefilled capsules. A vitamin–mineral mixture is separately provided. The forms are interchangeable because each component (one sachet, one bar or 20 capsules) provides 10 g of amino acids. Since the product is primarily a source of amino acids, protein requirements can be met using a smaller volume than with traditional medical products. Eleven subjects enrolled in a 24-week trial that included clinical and laboratory evaluations. Nine subjects completed the study and 8 remained on the Phlexy-10 after the study. The powder drink was the favourite module used. One-third of the subjects included the bars and another third included the capsules in their regimens. The vitamin–mineral mixture was the least acceptable component. Mean weekly blood phenylalanine decreased by 40% from mean baseline levels. Blood concentrations of vitamins and minerals were normal except for a low zinc concentration in two subjects and a low vitamin B₁₂ concentration in another. The lower caloric content and the separate vitamin–mineral mixture require careful monitoring of these nutrients. Phlexy-10 appears to be an adequate medical product for the treatment of PKU. Its convenience, flexibility of form and improved taste are appealing to many individuals on diet for PKU.     

Über die Form des Femoralispulses und ihre Veränderungen unter dynamischer und mechanischer Beeinflussung

Zusammenfassung Zur Ausdeutung größerer Pulskurvenmeßreihen am Menschen war zu prüfen, von welchen mechanischen und kreislaufdynamischen Faktoren die Form des Femoralispulses abhängig ist. Hierzu wurde an Hunden der Volumenpuls der freigelegten Arterie bei verschiedenen Kreislaufzuständen registriert.Die Herzdynamik übte weder durch die Blutdruckamplitude noch durch das Schlagvolumen einen direkten Einfluß auf die Gipfelzeit (Gzt) und die Grundschwingungsdauer (T _fem) des Femoralispulses aus.Der Austreibungszeit kommt nach Wezler und Greven nur ein Effekt auf die Stärke der Dikrotie, nicht aber auf T _femzu.Der mittlere arterielle Blutdruck hatte in physiologischen Grenzen keinen direkten Einfluß auf die Pulsform.Sowohl in der peripher abgeklemmten als auch in der freiblutenden A. fem. blieb T _femunverändert.Aus diesen Befunden wird geschlossen, daß Gzt und Grundschwingungsdauer (T _jem) weitgehend vom Zustand der zentralen Arterien abhängig sind, sofern nicht stärkere Rückwirkungen aus der Peripherie anderer Gefäßgebiete angenommen werden müssen.Mit 6 Textabbildungen.     

Intracardiac thrombi: Frequency,location, etiology,and complications: A morphologic review—Part III

Intracardiac thrombus may develop as a consequence of multiple underlying cardiac disorders. Left ventricular (LV) aneurysm following acute myocardial infarction has been associated with intra-aneurysmal thrombus and emboli. Part III of this 5-part article on intracardiac thrombus focuses on the frequency and consequence of thrombus associated with LV aneurysm.