Evaluation of miniscrew-supported rapid maxillary expansion in adolescents: A prospective randomized clinical trial

Objectives:To evaluate and compare the dental and skeletal changes with conventional and miniscrew-supported maxillary expansion appliances in adolescents.Materials and Methods:Forty patients were divided into two groups, with one group receiving a tooth-borne expander and the other group receiving an expander supported by four miniscrews (bone-borne). Multiplanar coronal and axial slices obtained from cone-beam computed tomography images were used to measure the changes in transverse skeletal widths, buccal bone thickness, tooth inclination, and root length. Paired t-tests and independent-sample t-tests were used to compare the two expansion methods.Results:Bone-borne expansion increased the maxillary suture opening more than 2.5 times than tooth-borne expansion both anteriorly and posteriorly. Between the maxillary first premolars, sutural expansion accounted for 28% and 70% of the total transverse width increase in the tooth-borne and bone-borne expander groups, respectively. Similarly, 26% and 68% of the total expansion was of skeletal nature in the tooth-borne and bone-borne expander groups between the maxillary first molars. The pattern of expansion was variable, with most of the patients in both groups demonstrating a triangular-shaped sutural opening that was wider anteriorly. Subjects in the conventional group experienced significantly more buccal bone reduction and greater buccal inclination of the teeth. No significant differences were observed for root length measurements between the two groups.Conclusion:Use of bone-borne expansion in the adolescent population increased the extent of skeletal changes in the range of 1.5 to 2.8 times that of tooth-borne expansion and did not result in any dental side effects.     

Liver dysfunction after chemotherapy in lymphoma patients infected with hepatitis C

Reactivation of hepatitis B virus (HBV) infection in asymptomatic hepatitis B surface antigen carriers undergoing chemotherapy or immunosuppressive therapy is a well-documented complication. However, data on the consequence of chemotherapy on the course of hepatitis C virus (HCV) infection in HCV+ patients have been controversial. Here, we review the current knowledge about the complications related to HCV in lymphoma patients receiving chemotherapy/immunosuppressive therapy. Although less frequent than HBV, these complications occur in a subset of patients with mortality rates up to 45%. Therefore, baseline screening for HBV and HCV before initiation of chemotherapy is crucial. High-risk patients having chronic active hepatitis, high baseline HCV viral load, HBV co-infection and receiving cytotoxic drugs, corticosteroids and rituximab (particularly if combined) should be closely monitored for serum transaminase, bilirubin and HCV RNA levels.     

The denticulate ligament: anatomical properties,functional and clinical significance

Background  

It is widely believed that the main function of denticulate ligaments (DLs) is to stabilize the spinal cord within the vertebral canal. The aim of this study was to assess the anatomical and histological structure of the DLs and to document any regional differences.     

Meningitis due to methicillin-resistant Staphylococcus aureus (MRSA): review of 10 cases

We evaluated retrospectively, 10 MRSA meningitis cases in our hospital that occurred between January 1999 and June 2004. All were post-neurosurgical and were considered to have hospital-acquired meningitis. Fever, leukocytosis, variable conscious levels were the most common findings. Six patients were treated with regimens including teicoplanin, and four with vancomycin. Mean duration of treatment was 23.5+/-18.8 days (range, 3-60 days). One patient died. In cases of MRSA meningitis, intravenous vancomycin is the mainstay of therapy. However, six of these 10 patients were successfully treated with regimens including teicoplanin, suggesting that this agent may be an alternative to vancomycin in the therapy of these cases.     

Plating after lengthening (PAL): technical notes and preliminary clinical experiences

Introduction Shortening the period of time for the external fixator after limb lengthening decreases the complication rate and increases the patient satisfaction. Material and method We describe the plating after lengthening (PAL) as a new technique on five patients with limb length discrepancy (1 femoral, 4 tibial) who had lengthening procedure with Ilizarov technique. The mean amount of lengthening was 50 mm. The mean lengthening period was 100 days (5–135 days). When the lengthening period ended, the locking compression plate was applied percutaneously by using the technique of minimal invasive plate osteosynthesis, and the Ilizarov external fixator was removed. Results The fixator-free period was achieved at the beginning of the consolidation phase, except in two patients, which were delayed for plating because of pin-tract infection. No complication was encountered except in one patient who had limited flexion of knee joint. There was no need for blood transfusion. Discussion The PAL, which shortened the period of time for the external fixator, was an easy and safe method for the fixation of the bone after limb lengthening.     

Fosfomycin in the treatment of extended spectrum beta-lactamase-producing Escherichia coli-related lower urinary tract infections

Fosfomycin tromethamine (FT) is effective in vitro in extended spectrum beta-lactamase (ESBL)-producing Escherichia coli strains. The aim of this study was to evaluate the effect of FT in the treatment of ESBL-producing E. coli-related lower urinary tract infection. All patients were aged >18; had dysuria or problems with frequency or urgency in passing urine; had >20leukocytes/mm(3) in urine sediment and an ESBL-producing E. coli urine culture (>10(5)cfu/mm(3)); no leukocytosis or fever; and were treated with FT between September 2004 and July 2006 in our outpatient clinic and hospital. ESBL detection was performed by double disk synergy tests. All patients had received FT (3gx1 every other night, three times) and had a control urine culture taken 7 to 9 days after this therapy. Clinical success was defined as resolution of symptoms on the control visit; microbiological success was defined as a sterile control urine culture. In all, 52 patients (aged 55.0+/-18.3, range 19-85; 25 males, 27 females) were included in the study. Overall clinical and microbiological success was 94.3% (49/52) and 78.5% (41/52), respectively. Although it is not a randomized controlled study, these data show that FT may be a suitable, effective and cheap alternative in the treatment of ESBL-producing E. coli-related lower urinary tract infection.     

Bolton tooth size discrepancies in skeletal Class I individuals presenting with different dental angle classifications

The objective of this study was to investigate the frequency and association of Bolton tooth size discrepancies with dental discrepancies. Forty-eight skeletal Class I, 60 Class II, and 44 Class III subjects with similar skeletal characteristics were included in this study. Analysis of variance was performed to compare the mean ratios of Bolton analysis as a function of the Angle classification and sex. To determine the prevalence of tooth size imbalances among the three groups of occlusions and the two sexes, chi-square tests were performed. To determine the correlation of tooth size imbalances with certain dental characteristics, Pearson's correlation coefficients were calculated. No statistically significant differences were determined for the prevalence of tooth size discrepancies and the mean values of Bolton's anterior and overall ratios among the occlusal groups and sexes. Bolton's anterior ratio discrepancies had significant correlations with midline shifts (P < .05) in Angle Class I cases, with U1-SN angle (P < .01) in Angle Class II cases, and with L1-APog distance (P < .05) in Angle Class III cases. Bolton discrepancies related to overall ratio had significant correlations with overjet (P < .05) in Class I cases, with overbite (P < .05) and U1-SN angle (P < .01) in Class II cases, and with IMPA (P < .01) in Class III cases. A high prevalence of tooth size discrepancies in an orthodontic patient population and the statistically significant correlation of some of these with some dental characteristics suggest that the measurement of interarch tooth size ratios might be clinically beneficial for treatment outcomes.