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.     

"Indirect" radioisotope cystography after the furosemide test: its diagnostic efficacy compared to "direct" study

The diagnostic efficacy was investigated of "indirect" radionuclide cystography after a furosemide test in the detection of vesicoureteral reflux. A single i.v. injection of 99mTc-diethylenetriaminepentacetic acid (DTPA) was administered during sequential renal scintigraphy. "Direct" radionuclide cystography with 99mTc-DTPA was assumed as the "golden standard". Thirty-three patients, 24 of whom in pediatric age, were examined with "indirect" radionuclide cystography after a furosemide test: the method had 32% sensitivity according to restrictive positivity criteria versus 59% according to less restrictive ones. In conclusion, "indirect" radionuclide cystography, in spite of the advantages coming from the use of the diuretic, cannot be considered as an efficient technique to recognize vesicoureteral reflux, especially when the latter is present at a low degree.     

Granulomatous mastitis: a report of seven cases

The clinical history and histological features of seven cases of granulomatous mastitis are presented. The lesion occurs in young parous women as a tender extra-areolar breast lump. Histologically, non-caseating discrete granulomas are present, confined to breast lobules with, in three cases, coalescence of the granulomas and microabscess formation. Pathogenesis of the changes is discussed. It is thought that granulomatous mastitis is an entity morphologically distinct from duct ectasia/plasma cell mastitis and the commoner forms of granulomatous breast diseases.     

BCG infection (BCGitis) following intravesical instillation for bladder cancer and time interval between treatment and presentation: A systematic review

Objective: Intravesical Bacillus Calmette-Guèrin (BCG) is an effective treatment in non––muscle-invasive bladder cancer, however, extravesical BCG infection may occur in remote organs as a potentially serious complication. Researchers aimed to assess whether a different timing of BCG infection after intravesical administration of BCG could be identified and estimated for each single involved organ. Methods: We performed a systematic literature review over systemic and genitourinary BCG infection case reports, including 271 published case reports for a total of 307 patients. Demographic data, clinical features, and timing of BCG infection development were collected and analyzed for each patient. Results: BCG infection developed with a different timing from last instillation, depending on the involved organ. Among the genitourinary complications, penile lesions occurred as early as 1 (1;3) weeks, while orchiepididymitis occurred as late as 56 (6.25;156) weeks. At the same time, granulomatous hepatitis and lungs involvement such as miliary pulmonary BCG infection occurred earlier, with a median time of 1 (1;4) and 1 (1;6) weeks respectively, whereas vascular, osteoarticular, and muscular complications developed with a median timing from last instillation of 52 (20;104), 68 (14;156), and 93 (29;156) weeks, respectively. The analysis detected a cluster between lungs, liver, and bone marrow complications on one side and muscular and osteoarticular or vascular complications on the other side was also observed. Conclusions: BCG infection after intravesical BCG for bladder cancer may develop even several months or years after the last instillation, depending on the involved organs. When BCG infection interests one or more organ, 2 main associative patterns are common: one involving lungs, liver, and bone marrow, with earlier occurrence but lower rates of microbiological diagnosis achievement, and one involving muscular and osteoarticular or vascular districts, with later occurrence but higher rates of microbiological evidence.     

F-actin levels but not actin polymerization are affected by triphenyltin in HL-60 cells

The toxin triphenyl tin (TPT), Sn(C(6)H(5))(+)(3) caused a rapid decrease in the F-actin content of promyelocytic human leukemia cells (HL-60) chemically differentiated to neutrophils. Prior incubation (2 min) of the cells with 10 μM TPT did not modify the extent of actin polymerization inducible either by a receptor-mediated stimulus (chemotactic peptide fMLP) or by a direct activator of G proteins (AlF(-)(4)). The inorganic tin salts SnCl(2) and SnCl(4) did not affect F-actin content or production of HL-60 cells. Microfilament thiol groups were not reduced by exposure of cells to TPT, but even increased. When F-actin was exposed to 10 |GmM triphenyltin in a cell-free system, the depolymerizing effect was not detectable. Thus, TPT does not affect cytoskeletal protein directly but depends for its toxicity on some other induced change, probably ionic/osmotic in the intact cell.