Severe odontogenic infections

Background : Severe odontogenic infections are serious potentially lethal conditions. Following the death of a patient in the authors' institution this study was initiated to determine the risk factors, management and outcome of a consecutive series of patients.
Methods : All patients admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with odontogenic infections in calendar year 2003 were investigated. Detailed information relative to their pre-presentation history, surgical and anaesthetic management and outcome was obtained and analysed.
Results : Forty-eight patients, 32M, 16F, average age 34.5, range 19 to 88 years were treated. All presented with pain and swelling, with 21 (44 per cent) having trismus. Forty-four (92 per cent) were as a result of dental neglect and four (8 per cent) were regular dental patients having endodontic treatment which failed. Of those known to have been treated prior to presentation, most had been on antibiotics. Most patients had aggressive surgical treatment with extraction, surgical drainage, high dose intravenous antibiotics and rehydration. The hospital stay was 3.3 (range 1–16) days. Patients requiring prolonged intubation and high dependency or intensive care (40 per cent) had longer hospitalization. No patient died and all fully recovered.
Conclusion : Severe odontogenic infections are a serious risk to the patient's health and life. Management is primarily surgical with skilled anaesthetic airway management. Antibiotics are required in high intravenous doses as an adjunct and not as a primary treatment.     

Radiation dose reduction during hysterosalpingography: an application of scanning-beam digital radiography

Hysterosalpingography was performed in 31 patients by means of a low-dose scanning-beam digital radiographic system. The technique permits adequate evaluation of gynecologic abnormalities while allowing significant reduction in radiation: 2.4-mR (6.1 X 10(-7) C/kg) exposure to the skin and 0.7-mrad (7 X 10(-6) Gy) mean dose to the ovaries per image obtained. Sixteen patients demonstrated readily recognizable and documented abnormalities, corroborated by laparoscopy, laparotomy, or other supportive evidence.     

Ischemia and reperfusion reduce the endogenous basic fibroblast growth factor in rat skeletal muscles: an immunohistochemical study.

Polyclonal antibodies directed against human recombinant basic fibroblast growth factor were used in immunohistochemical studies to localize this growth factor in normal and wounded rat skeletal muscles. According to the intensity of the stain, three main classes of fibers could be identified: the strongly, moderately, and weakly stained fibers. Basic fibroblast growth factor immunoreactivity was found mainly in the extracellular matrix, primarily in the endomysium, which includes the heparin-containing basal lamina, and also in the capillary basal membrane of both normal and wounded muscles; however, the signal intensity was much stronger in normal muscles. The distribution of basic fibroblast growth factor in wounded muscles became markedly heterogeneous and sparse. After 4 hours of ischemia, about 40% of skeletal muscle fibers lost their basic fibroblast growth factor immuno-reactivity. Muscles which underwent 4 hours of ischemia and 24 hours of reperfusion had only a diminished basic fibroblast growth factor immunoreactivity. The pathologic results supported the concept of destroyed cell connection and fiber necrosis in ischemic and reperfused muscles. Potential mechanisms involved in this reduced concentration of basic fibroblast growth factor in wounded muscles may include oxygen free radical activation, a generalized effect of the inflammatory response, and reduced secretion of endogenous basic fibroblast growth factor. These results are only partially compatible with the established mitogenic role of this growth factor and suggest that a reduction of endogenous fibroblast growth factor may partly contribute to a delay in wound healing.     

Management of ectopic ureterocele

We present our experience with 32 cases of ureterocele in children treated between 1972-1984. Five children with ureterocele in a single system underwent ureterocelectomy and ureteral reimplantation. Ten cases were managed by ureteropyeloanastomosis with ureterocelectomy and reimplantation with good results. Nine heminephrectomies and eight nephrectomies were done. The most common complication was ureterovesical stenosis in a "double barrel" reimplant. We were able to preserve renal parenchyma drained by a ureterocele in 15 cases.