Treatment of a patient with cleidocranial dysplasia using osseointegrated implants: a patient report

This patient report describes the treatment of a 42-year-old woman with cleidocranial dysplasia. Endosseous implants were used to restore the mandibular and maxillary arches with fixed prostheses. Six implants were placed in the mandible and immediately loaded with an acrylic resin fixed prosthesis. In the maxillary arch, 10 implants were submerged for 4 months prior to functional loading. A transitional denture was relined and placed in the maxilla 10 days after implant placement. Three months later, a definitive mandibular prosthesis was fabricated. The definitive maxillary restoration was delivered 6 months after surgery. The most recent follow-up, 6 months after delivery, confirmed a satisfactory treatment result to date.     

In Vitro Changes in Hardness of Sealed Resilient Lining Materials on Immersion in Various Fluids

Purpose: During clinical use, resilient lining materials undergo changes in hardness that make them ineffective. The aims of this investigation were (1) to determine the effect of a resilient lining sealer on the hardness of four resilient denture liners; and (2) to determine the effect of the sealer on hardness after immersion in various solutions.
Materials and Methods: Two sets of specimens of four resilient liners, Coe-comfort (CC), PermaSoft (PS), Tokuyama soft reline (TK), and Total-Soft (TS), 6-mm diameter by 4-mm thickness, were fabricated. Two coats of Permaseal, a soft reline sealant, were applied to one set of specimens of each material according to manufacturers' instructions. Sealed and unsealed samples were divided into four groups (n = 10). Each group was immersed in one of the following solutions: artificial saliva at 37°C, Efferdent, Efferdent with once daily scrubbing with a soft toothbrush, and 50% ethanol. Shore A hardness numbers were obtained at 0, 1, 3, 7, 30, and 90 days. A two-way ANOVA test was performed using materials (treated and untreated) and immersion solution as independent variables. The percentage change in hardness after the 90-day immersion period was the dependent variable.
Results: The results show that the application of sealant significantly improved the durability of CC, PS, and TS in immersion solutions by maintaining hardness close to preimmersion values or delaying the softening effect of the solutions. The hardness of sealed and unsealed TK showed the significantly ( p < 0.05) lowest change after immersion in the test solutions. Ethanol caused the most severe decrease in hardness of all solutions, followed by saliva. Immersion in Efferdent and daily brushing after immersion in Efferdent showed only a mild effect on the hardness of the soft reline agents.
Conclusion: The use of a sealer can play an important role in the preservation of the hardness of some resilient lining materials.     

The use and effectiveness of complementary and alternative medicine for pain in sickle cell anemia

Pain is the clinical hallmark for sickle cell disease (SCD). The objective of this study was to survey the extent and effectiveness of complementary and alternative medicine (CAM) use for pain control among adults with SCD. Of a total of 227 African-American adults with SCD, 208 (92%) admitted to using at least one type of CAM. The three most common types of CAM were prayer (61%), relaxation technique (44%), and massage (35%). Multiple logistic regression showed that marital status was associated with use of relaxation techniques (p = 0.044), and age between 18 and 24 years and at least a high school level of education were associated with use of prayer (p = 0.008 and p = 0.004 respectively). Our study showed that CAM use is common among adult patients with SCD. Further well designed prospective studies are needed to help develop best practices that emphasize an optimized balance of conventional and evidence based CAM therapies.     

Concomitant pulmonary tuberculosis and leprosy

Concomitant tuberculosis and leprosy is uncommon, even in endemic countries. We report a patient with borderline lepromatous leprosy and type 1 reversal reaction initially diagnosed while the patient was undergoing treatment for pulmonary tuberculosis. The diagnosis was on the basis of characteristic histopathology and Fite-Farraco stain.     

Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens

Intralesional injection of mumps and Candida skin test antigens has been shown to be effective in the treatment of warts. Warts are generally difficult to treat in children. To determine the efficacy of intralesional skin test antigen injection for the treatment of resistant warts in children, we treated 47 pediatric patients with one or more warts with intralesional injection of mumps or Candida skin test antigen into one wart. Twenty-two patients (47%) with resistant warts experienced complete resolution of treated warts. An average of 3.78 treatments were necessary. An additional 34% of children had a greater than 25% improvement in their warts. Sixty-eight percent of subjects with more than one wart also noted at least partial resolution (greater than 25% resolution) of untreated warts at distant sites, with 34% experiencing complete resolution. We concluded that intralesional injection of skin test antigens is an effective therapy for children who have recalcitrant, nongenital, cutaneous warts.     

Phytophotodermatitis due to Ruta graveolens

We report phytophotodermatitis in a 5-year-otd boy, his 6-year-old sister and his mother, evoked by their handling common rue ( Ruin graveolens ), a plant which contains psoralens. Psoralens are photoactive chemicals which, when rubbed on the skin, react with sunlight to produce erythema, hyperpigmentation and blistering. Phytophotodermatitis is an uncommon cause of such ill-effects, in children.     

Myxofibrosarcoma presenting in the skin: clinicopathological features and differential diagnosis with cutaneous myxoid neoplasms

Myxofibrosarcoma (myxoid malignant fibrous histiocytoma) is one of the most common fibroblastic sarcomas in the older patient, where it can sometimes present with anatomically deceptive boundaries. Myxofibrosarcoma is now fully characterized as a distinctive and definable pathologic entity. Clinically there is a tendency for predominantly subcutaneous, multinodular, diffusely infiltrative growth, which may extend to the overlying dermis and present as a cutaneous lesion. Histologically myxofibrosarcoma comprises a spectrum ranging from hypocellular low-grade myxoid to high-grade pleomorphic sarcoma. We report herein 6 cases of myxofibrosarcoma each with dermatological presentation as a cutaneous nodule. The dermal component in each of the lesions was low- to intermediate-grade and predominantly myxoid resulting in confusion with benign myxoid neoplasms in small biopsy specimens. The purpose of this series is to focus the attention of workers in dermatology on a subject rarely discussed in dermatopathology literature: the cutaneous presentation of myxofibrosarcoma and the potential for clinical and histologic misinterpretation, as benign dermal lesions.     

Intra-articular adhesions following hip arthroscopy: a risk factor analysis

Purpose

The purpose of this study was to evaluate possible risk factors for symptomatic adhesions after hip arthroscopy.

Methods

Data were analysed from hip arthroscopies performed between 2005 and 2009. Only primary hip arthroscopies were included. Data collected included demographics, primary treatment, rehabilitation, revision surgery, and presence of adhesions at revision.

Results

One thousand two hundred and sixty-four hips in patients 18 years or older underwent primary hip arthroscopy during the defined period. Eight underwent revision hip arthroscopy by a different surgeon. Patients under 30 years of age were 5.9 times more likely to be in the adhesion group [95 % CI 3.1–11.5]. Patients who underwent microfracture were 3.1 times less likely to have adhesions compared to patients who did not [95 % CI 1.1–8.2]. Patients who did not receive circumduction therapy were 4.1 times more likely to have adhesions compared to those who performed circumduction exercises [95 % CI 1.25–11.0].

Conclusion

Risk factors for adhesions following hip arthroscopy identified were age under 30, modified Harris Hip score under 50, no microfracture performed, and rehabilitation without circumduction.

Level of evidence

IV.