Facial trauma in geriatric patients in a selected Malaysian hospital

Background:   Road traffic accidents are the main cause of trauma in Malaysia. It has been shown that there was an increase in admissions for trauma patients older than 60 years in the last decade. The purpose of this study was to determine the pattern of maxillofacial injuries in the geriatric patients referred to Seremban Hospital, Malaysia.
Methods:   Records of patients aged 60 years or older who sustained oral and maxillofacial injuries between 1998 and 2002 were reviewed. Data related to age, sex, race, etiology, types of injuries and treatment modalities were obtained.
Results:   A total of 134 geriatric patients with maxillofacial and dental injuries were seen in Seremban Hospital between January 1998 and December 2002. There were 101 (75.4%) men and 33 (24.6%) women. The age ranged 60–92 years with the mean age of 68.3 years (standard deviation, 7.48). Chinese made up the majority of the patients (51.8%), followed by Malays (37.2%), Indian (20.4%) and other ethnic groups (1.5%). The most common cause of injury was due to road traffic accidents (64.2%) However, falls were more common in those aged 76 years and above. The most common bone fracture documented was the mandible (35.7%) followed by fracture of the zygomatic complex (34.0%). The majority of treatment was conservative or closed reduction.
Conclusion:   All the elderly patients with facial trauma were managed conservatively or as closed reduction in this hospital. This was largely because of their comorbid state and financial constraints.     

Managing complications of radiation therapy in head and neck cancer patients: Part III. Provision of dentures

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Pretreatment dental assessment should be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally and, as a result, they succumb to complicated oral adverse effects after radiation therapy. The management of radiation-induced caries, a sequelae of xerostomia has been reviewed in Part II of this series. In this article, the management of difficulty with dentures, another sequelae of xerostomia following radiation therapy is reviewed.     

Managing complications of radiation therapy in head and neck cancer patients: Part I. Management of xerostomia

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they receive radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therapy. Part I of this series reviews the management of xerostomia. The management of the effect of xerostomia to the dentition/oral cavity is discussed in Part II.     

CT perfusion as a useful tool in the evaluation of leuko-araiosis

Background

Leuko-araiosis (LA) and dementia are common geriatric conditions but their pathogenesis and clinical significance are not completely understood. An evaluation of CT perfusion (CTP) in both these conditions can further enhance the understanding of these diseases.

Methods

Twenty-one patients with LA and 21 age-matched controls were studied with CTP and assessed for their cognitive function. The subjects were classified into four groups: Group 1, with LA (n = 21); Group 2, without LA (n = 21); Group 3, with dementia (n = 7); Group 4, without dementia (n = 11). The mean cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) values were compared between groups 1 and 2, while mean CBF values were compared between groups 3 and 4.

Results

Mean white matter CBF was considerably reduced in patients with LA in the frontal region by 42% (p = 0.000), basal ganglia by 37% (p = 0.000) and occipital region by 18% (p = 0.019). The mean white matter CBV was reduced in patients with LA in the frontal region by 36% (p = 0.000) and basal ganglia by 28% (p = 0.017). The mean white matter CBF was dramatically reduced in patients with dementia in the frontal region by 44% (p = 0.000), basal ganglia by 32% (p = 0.038) and occipital regions by 24% (p = 0.001).

Conclusion

The CTP showed reduced white matter CBF and CBV in patients with LA. This is consistent with chronic ischemia as the pathogenesis of LA. The CTP is also a potentially important technique in the diagnosis and management of dementia, because of its ability to reveal cerebral hypoperfusion.     

Terrestrial gamma radiation dose study to determine the baseline for environmental radiological health practices in Melaka state, Malaysia.

Environmental terrestrial gamma radiation dose rates were measured throughout Melaka, Malaysia, over a period of two years, with the objective of establishing baseline data on the background radiation level. Results obtained are shown in tabular, graphic and cartographic form. The values of terrestrial gamma radiation dose rate vary significantly over different soil types and for different underlying geological characteristics present in the study area. The values ranged from 54 +/- 5 to 378 +/- 38 nGy h(-1). The highest terrestrial gamma dose rates were measured over soil types of granitic origin and in areas with underlying geological characteristics of an acid intrusive (undifferentiated) type. An isodose map of terrestrial gamma dose rate in Melaka was drawn by using the GIS application 'Arc View'. This was based on data collected using a NaI(Tl) scintillation detector survey meter. The measurements were taken at 542 locations. Three small 'hot spots' were found where the dose rates were more than 350 nGy h(-1). The mean dose rates in the main population areas in the mukims (parishes) of Bukit Katil, Sungai Udang, Batu Berendam, Bukit Baru and Bandar Melaka were 154 +/- 15, 161 +/- 16, 160 +/- 16, 175 +/- 18 and 176 +/- 18 nGy h(-1), respectively. The population-weighted mean dose rate throughout Melaka state is 172 +/- 17 nGy h(-1). This is lower than the geographical mean dose rate of 183 +/- 54 nGy h(-1). The lower value arises from the fact that most of the population lives in the central area of the state where the lithology is dominated by sedimentary rocks consisting of shale, mudstone, phyllite, slate, hornfels, sandstone and schist of Devonian origin which have lower associated dose rates. The mean annual effective dose to the population from outdoor terrestrial gamma radiation was estimated to be 0.21 mSv. This value is higher than the world average of 0.07 mSv.     

Subsurface tissue lesions created using an Nd:YAG laser and cryogen cooling

BACKGROUND AND PURPOSE: Cooling methods are commonly used in dermatology to protect the skin surface during cosmetic laser procedures. This study investigated deep laser heating of tissue in combination with cryogen cooling of the surface for potential noninvasive targeting of subsurface tissue structures in urology. MATERIALS AND METHODS: Porcine liver and skin were studied because they represent simple and difficult tissue models, respectively, for subsurface lesion production. Gross and histologic methods were used to measure lesion dimensions. RESULTS: Liver lesions measured 4.9 +/- 1.2 mm in diameter, while preserving the tissue surface to a depth of 2.1 +/- 0.4 mm (N = 5). Surface temperatures remained below 40 degrees C, while lesion temperatures ranged from 60 to 70 degrees C. Skin lesions measured 4.1 +/- 0.6 mm, while preserving the skin surface to a depth of 1.2 +/- 0.2 mm (N = 4). CONCLUSION: This technique may prove useful to target subsurface anatomic structures in urology.     

Petrosal sinus sampling in the diagnosis of Cushing's syndrome: preliminary experience in University of Malaya Medical Centre

Differentiating between Cushing's disease of pituitary origin and ectopic ACTH syndrome of extra-pituitary origin remains a major challenge to the clinician because of limitations in the diagnostic accuracy of the high-dose dexamethasone suppression test. Routine use of inferior petrosal sinus sampling (IPSS) is therefore advocated by some authors for these patients. We present our preliminary experience of IPSS in 7 consecutive patients with Cushing's disease and discuss how the results impacted on the patients' management.