Vacuum-assisted closure as a surgical assistant in life-threatening necrotizing fasciitis in children

Necrotizing fasciitis is a severe soft tissue infection that can involve skin, subcutaneous fat, fascia and muscle. It can result in devastating sequelae including tissue necrosis, sepsis, toxic shock syndrome, cardiopulmonary collapse and death. To control rapidly spreading necrosis, early diagnosis and aggressive surgical treatment with extensive radical debridement of the affected areas is necessary, as well as systemic administration of broad-spectrum antimicrobials and, very often, intensive care support.The subatmospheric negative pressure dressing has been previously used in acute and complex wounds management. The concept of using vacuum-assisted closure dressing as another management component is presented in the current article.     

Nodular vasculitis in systemic lupus erythematosus

A 42-year-old man presented with fever, photosensitivity, headaches, myalgia, hyperhidrosis, muscle weakness, alopecia, nasal crustae, weight loss, painful nails, arthritis, oral ulcers, erythema, discoid cutaneous lesions, and painful subcutaneous nodes. We made a diagnosis of systemic lupus erythematosus (SLE), type II cryoglobulinemia, and nodular vasculitis. In the skin, different types of vasculitis may be observed. Typically, histology shows leukocytoclastic vasculitis of superficial vessels both in SLE and mixed cryoglobulinemia, which clinically results in palpable purpura. In our patient, however, histopathological examination of the subcutaneous nodes not only revealed leukocytoclastic vasculitis of the superficial vasculature but also showed even more extensive involvement of dermal and subdermal small and medium sized vessels, giving rise to a nodular vasculitis.     

Substance use among Dutch dental students

OBJECTIVES: The objectives were to assess the prevalence of substance use among Dutch dental students and to determine their attitudes about substance use and its consequences. METHODS: In association with a national study of drug use among US dental students, a questionnaire was translated from English into Dutch and administered to dental students at two dental schools in The Netherlands. Students received an anonymous 115-item questionnaire in the fall of 1996. RESULTS: Alcohol was the students' drug of choice for lifetime (95%), past year (94%) and past month (88%) use. No significant correlations were found between alcohol use and gender, schools, and years in dental education. In the past month, 58% of students reported drinking on 5 or more days; 53% had 5 or more drinks on the same occasion, 20% had 5 or more drinks on the same occasion on 5 or more days; and 17% reported getting drunk at least monthly. Prevalence rates for past month use of tobacco was 24% and marijuana, 4%. Male students smoked twice as much as females, with significant differences found for all three periods of use (X2>19.00, P<0.01). When asked whether their schools offered policies and education programs on alcohol and other drugs, 52% of students reported that these were not available. CONCLUSIONS: Dental schools should develop effective programmes to educate students about responsible use of alcohol and other licit and illicit drugs. Schools should also inform students about their susceptibilities to substance abuse and dependency.     

Trends in caries prevalence in 5-, 7- and 11-year-old schoolchildren in The Hague between 1969 and 1989.

Starting in 1969, periodic cross-sectional examinations of schoolchildren have been carried out in the city of The Hague. In 1989 the periodic examinations were continued and, in general, caries prevalence was found to be very low; D3MFS values ranged between 1.5 and 2.2 at age 11.8 years. Compared to 1984, 5-year-old-children of low and medium socio-economic levels (SES) in 1989 had significantly higher d3mfs values (p less than 0.01), mainly due to a marked increase in decayed surfaces per child; a significant increase in caries experience of the deciduous dentition amongst 7-year-olds of low social level was found (p less than 0.01). A further reduction of D3MFS values for 7-year-old children of low and medium SES could be observed in 1989 compared to 1984. Between 1978 and 1989 a marked D3MFS reductions amongst 11-year-olds in the three social levels was found. Possible explanations for the observed differences in caries experience between 1984 and 1989 are discussed.     

Reliability and validity issues of laser fluorescence measurements in occlusal caries diagnosis

OBJECTIVES: Recently, a device for detecting occlusal caries lesions based on laser fluorescence measurements (DIAGNOdent) has been introduced. The reliability (reproducibility) and validity of this laser-fluorescence device were investigated. METHODS: In the in vitro part of the study, 49 permanent molars were measured by two observers using two DIAGNOdent devices. In addition, visual inspection was performed. The teeth were sectioned to measure the actual depth and area of the caries lesions. In the in vivo part of the study, 45 sites at the occlusal surfaces of permanent molar teeth in 13 patients were measured by two observers using two DIAGNOdent devices, manufactured in two successive years. RESULTS: The reliability of both DIAGNOdent devices expressed in the intraclass correlation coefficient (ICC=0.90 for observer 1, and 0.88 for observer 2) was high, and so was the interobserver reliability (ICC=0.85 for the 1998-device, ICC=0.90 for the 1999-device). The correlation between DIAGNOdent measurements and the actual depth of the caries lesions was lower than that of visual inspection by one observer, yet higher than that of a second observer. The specificities of visual inspection (0.94 and 0.88) were higher than those of the DIAGNOdent devices, whereas the sensitivities of the DIAGNOdent devices (0.93-1.00) exceeded those of visual inspection The validity of the DIAGNOdent, expressed as the area under the receiver operating characteristic curve, was not statistically significantly different from that of visual inspection (P>0.05). The DIAGNOdent measurements showed a higher association with the enamel part of the caries lesion than with the dentinal part. CONCLUSIONS: The DIAGNOdent is suitable for monitoring small caries lesions. Because of the high reproducibility of DIAGNOdent devices produced in successive years, a DIAGNOdent device may be replaced by a new one. Due to the higher specificity, visual inspection should be preferred to diagnose occlusal caries lesions in populations with a low caries prevalence.     

Towards a system of quality care in dentistry in the Netherlands

Monitoring and improving the quality of rendered health care in a systematic way has been laid down in Dutch legislation. In Dutch family health care particularly, many initiatives have already been taken to improve the quality of health care utilizing a pre-defined systematic approach. In recent years various groups in The Netherlands took initiatives to maintain and improve quality of care in dentistry. This publication reports on some of the frequently used constructs and the state of the art in The Netherlands. A proposition for the development of a system of quality monitoring and improvement is presented. It is furthermore suggested that all parties involved should collaborate to achieve the joint goal.     

An epidemiologic survey of periodontal disease in Dutch adults

An epidemiologic survey was carried out to assess the prevalence and severity of periodontal disease in randomly selected samples of employed populations in the Netherlands. Of the 1,337 persons examined by five examiners, 19.8% were edentulous; 61% of dentate persons had intense gingivitis in an average of 2.4 segments of their mouths; 53% had pockets of 3-6 mm and a further 10.1% had pockets of greater than 6 mm. The prevalence of gingivitis and pocketing increased with increasing age and decreasing levels of education. As no measures of predicting compliance were used and because treatment philosophies differ, no reasonable assessment of treatment needs could be made.     

Inhibitory activity of xanthine oxidase by fractions Crateva adansonii

ObjectiveTo study the inhibitory effect of various extracts from Crateva adansonii (C. adansonii) used traditionally against several inflammatory diseases such as rheumatism, arthritis, and gout, was investigated on purified bovine milk xanthine oxidase (XO) activity.MethodsXanthine oxidase inhibitory activity was assayed spectrophotometrically and the degree of enzyme inhibition was determined by measuring the increase in absorbance at 295 nm associated with uric acid formation. Enzyme kinetics was carried out using Lineweaver-Burk plots using xanthine as the substrate.ResultsAmong the fractions tested, the chloroform fraction exhibited highest potency (IC₅₀ 20.2±1.6 μg/mL) followed by the petroleum ether (IC₅₀ 30.1±2.2 μg/mL), ethyl acetate (IC₅₀ 43.9±1.4 μg/mL) and residual (IC₅₀ 98.0±3.3 μg/mL) fractions. The IC₅₀ value of allopurinol used, as the standard was 5.7±0.3 μg/mL.ConclusionsEnzyme inhibition mechanism indicated that the mode of inhibition was of a mixed type. Our findings suggest that the therapeutic use of these plants may be due to the observed Xanthine oxidase inhibition, thereby supporting their use in traditional folk medicine against inflammatory-related diseases, in particular, gout.     

Electrical Performance and Automatic Capture Characteristics of a 3.5-mm2 Passive Fixation Lead during 1-Year Follow-Up

Background: Bipolar low polarization electrodes are recommended for a regular AutoCapture™ (St. Jude Medical, Inc., Sylmar, CA, USA) function in order to effectively detect the evoked response (ER) signal. The objective of this national multicenter registry was to evaluate the electrical performance and the AutoCapture™ characteristics of the bipolar ventricular pacing lead IsoFlex S, model 1636T or 1646T (St. Jude Medical), in combination with single- and dual-chamber pacemakers.
Methods: Ventricular pacing and sensing thresholds, lead impedance, ER amplitude, and polarization signals were measured at discharge and routine follow-up visits after 1, 3, 6, 9, and 12 months. AutoCapture™ activation was recommended based on the results of the ER sensitivity test.
Results: Of the 252 patients initially included, 109 (43%) have completed the follow-up. The mean ventricular pacing threshold was 0.43 ± 0.19 V at discharge and 0.68 ± 0.32 V at 12 months postimplant. The values for the ventricular sensing threshold were between 9.51 ± 4.12 and 9.99 ± 4.09 mV at discharge and at the 12-month follow-up. The unipolar lead impedance decreased from 533 ± 94 to 476 ± 73 ohms during the follow-up. The mean ER amplitude was 16.47 ± 6.70 mV at discharge and 17.42 ± 7.43 mV after 12 months, and the corresponding mean polarization signals were 0.59 ± 1.00 and 0.74 ± 1.24 mV, respectively. AutoCapture™ activation was recommended in at least 95% of the patients investigated over the 12-month follow-up.
Conclusion: The bipolar ventricular pacing lead IsoFlex S 1636/1646T shows a good electrical performance and is mostly compatible with the AutoCapture™ algorithm.