Bony inlet stenosis as a cause of nasal airway obstruction

Two cases of congenital bony stenosis of the nasal piriform aperture (anterior nares) are presented. Both patients experienced episodes of respiratory distress and clinical symptoms similar to those seen in patients with posterior choanal atresia. The underlying anatomic abnormalities in congenital bony inlet stenosis are quite different from those in choanal atresia and require different surgical approaches for correction. Computed tomography demonstrates in detail the underlying anatomic abnormality and allows differentiation of bony inlet stenosis from choanal atresia.     

P43 Effectiveness of a mechanic-chemical method in reducing malodor of dentures

The purpose of this study was to investigate subjective symptoms about oral malodor and the knowledge and attitude for bad breath on dental students. The subjects were 213 students from 1st to 6th year undergraduate course of one dental school in Thailand (male: 70, female: 143). Their mean (s.d.) age was 21.0 (1.9). Questionnaire survey was conducted in November 2003. Questionnaire items were subjective symptoms about oral malodor and dry mouth, the knowledge and attitude for bad breath, oral hygiene practice, smoking/drinking habits, and life stress. Five students (2.3%) answered that they concerned their oral malodor often and 87.8% reported sometimes. Of them, 72.9% wanted to receive treatment for their malodor and 70.8% said they suffer from bad breath in daily life. Two-thirds of students perceived strong oral malodor when waking up. There were no significant differences of the self-perceived malodor rates between gender or among year of study. More than half of the students did not know that oral diseases and poor oral hygiene are the major causes of bad breath. The students' attitudes for bad breath were different if the target was family members or friends. The majority of the students (88.7%) answered they perceived dry mouth. Perception of dry mouth was significantly related with self-reported oral malodor prevalence ( P  < 0.05). However other oral or behavioral factors did not relate to the self-reported malodor rates. In this study, dental students perceived bad breath in high prevalence. However the knowledge for bad breath was not enough even the students who already provided dental treatment to the patients. It would be necessary to give them adequate knowledge and methods in education program for managing not only patients' but also their own oral malodor problem.     

A COMPARISON OF PRESCRIBED MEDICATION IN LEARNING DISABILITY PATIENTS BEFORE AND AFTER RESETTLEMENT FROM HOSPITAL INTO THE COMMUNITY

SUMMARY The use of prescribed medication was examined in 34 people with learning disability who underwent a planned resettlement from a hospital into the community. No significant differences were found in the number of subjects receiving antipsychotic, antimuscarinic, antidepressant, and anticonvulsant medication, lithium preparations, and non-psychoactive medication, just prior to discharge and 1 year after discharge. This study indicates that long-stay hospitalised adults with moderate, severe or profound mental retardation can successfully be relocated into the community — in spite of suffering from behavioural and major psychiatric disorders — with the aid of appropriate medication, psychiatric follow-up, and community resources.     

ORAL DISOPYRAMIDE IN THE TREATMENT OF RECURRENT NEUROCARDIOGENIC SYNCOPE

In neurocardiogenic syncope the normal compensatory response on assuming an upright posture is interrupted after several minutes and replaced by a paradoxical withdrawal of sympathetic activity and increased parasympathetic activity. The resulting reduction in blood pressure is severe, sympathetic activity is inhibited, plasma norepinephrine levels do not increase and the heart rate decreases. The defect is a paradoxical interruption of sympathetic excitation associated with parasympathetic excitation, causing profound vasodilatation and bradycardia. Disopyramide has been shown not only to treat the bradycardia but also to control the hypotension.     

Melphalan and dexamethasone for patients with multiple myeloma who are not candidates for autologous stem cell transplantation

BACKGROUND: Multiple myeloma is a disease for which a number of treatment options are available. The choice of therapy is often based on factors such as cost, ease of administration and faster response as the survival rates are similar with most of the regimens. We assessed the efficacy of a combination of melphalan and dexamethasone as first-line therapy in patients with multiple myeloma who were not candidates for autologous stem cell transplantation. METHODS: Thirty-four patients with multiple myeloma were included in the study. Patients received a maximum of 12 cycles of chemotherapy consisting of oral melphalan 8 mg/m2 on days 1-4 and oral dexamethasone 40 mg on days 1-4 and days 9-12 every 4 weeks. Patients were assessed for response on the basis of M proteins and a bone marrow biopsy with touch preparation. RESULTS: The median follow up of surviving patients was 40 months. Nine patients (26.1%) had complete response/near complete response (5 had negative immunofixation) and 15 (44%) had partial response. The regimen was well tolerated and there were no therapy-related deaths. The 3-year overall and progression-free survival rates using the Kaplan-Meier method were 53% and 34%, respectively. The median duration of overall and progression-free survivals were 58 and 28 months, respectively. CONCLUSION: The combination of melphalan and dexamethasone is safe and effective in patients with multiple myeloma who are not candidates for autologous stem cell transplantation.     

Clival giant cell tumor presenting with isolated trigeminal nerve involvement

Giant cell tumour (GCT) constitutes about 5 % of all skeletal tumors. They rarely occur in the skull. When involved, they preferentially involve the sphenoid or temporal bones. Skull-base GCTs generally present with multiple cranial nerves involvement, most commonly sixth followed by the third cranial nerve. We describe a case of clival GCT presenting with an isolated trigeminal nerve involvement in a 19-year-old man which was managed by surgery and adjuvant radiation. At 18 months of follow-up, the patient is clinically asymptomatic. Clival GCT should also be considered in the differential diagnosis of any isolated trigeminal nerve palsy. Adjuvant radiation has an important role to play in managing this tumour.     

Therapy and outcome of primitive neuroectodermal tumor of the jaw

Data pertaining to outcomes in jaw primitive neuroectodermal tumor (PNET) are lacking. Eleven cases of jaw PNET (five maxillary and six mandibular) were treated at our cancer center with the same chemotherapeutic agents from June 2003 to January 2009. Four patients underwent surgery after neoadjuvant chemotherapy and all received local radiotherapy. At median follow-up of 56 months (range: 19-77 months), 7/11 patients are in sustained remission. There was no difference in outcome with respect to site of tumor, and whether surgery was performed or not. These results support the use of chemoradiation as initial modality of treatment rather than going for extensive and mutilating surgery.