Hepatitis B virus vaccination and revaccination response in children diagnosed with coeliac disease : a multicentre prospective study.

AIM: This study evaluates hepatitis B virus (HBV) vaccination response in children with celiac disease (CD). Response in initial non-responders after a single booster vaccination as well as factors influencing HBV vaccination response were evaluated. METHODOLOGY: Anti-hepatitis B surface antibodies (a-HBsAB) were checked in all children with CD and a documented complete HBV vaccination. An a-HBsAB <10 U/L was considered as non-response. A single intramuscular HBV-vaccine booster was advised to all non-responders. Response was checked at the next appointment. RESULTS: 133 children with CD were included, median age of 7.3 years (range 1.7-17.3) and 46 (35%) were male. The age at CD diagnosis was 6.0 years (range 1.1-15.7). HBV non-response was documented in 55% (n=73/133). No other factors were influencing the response. A booster was documented in 34/73 (47 %) initial non-responders (3 refused (4%), 36 (49%) had no follow up). Response after booster vaccination resulted in immunity in 22/34 (65%) and persisting non-response in 12/34 (35%). A single booster is able to reduce non-response from 55% (73/133) to 23% (22/94). CONCLUSION: A significantly lower immune response following HBV vaccination in children with CD was confirmed. A single intramuscular booster vaccination is able to induce a serologic response in two thirds of the initial non-responders. Control of HBV vaccination response has to become part of the follow-up in CD patients.

Cognitive factors influencing treatment decision-making in patients with localised prostate cancer: development of a standardised questionnaire.

BACKGROUND: Men diagnosed with localised prostate cancer have to make a well-informed treatment choice between (robot-assisted) radical prostatectomy, external beam radiotherapy and, in selected cases, brachytherapy and active surveillance. We developed and validated a questionnaire to determine the cognitive reasons motivating this choice. MATERIALS AND METHODS: The Prostate Cancer Decision-Making Questionnaire (PC-DMQ) was designed in-house and validated through the Delphi method. Finally, we tested the questionnaire in a cohort of 24 men, recently diagnosed with localised PC, before undergoing RARP (n = 16), EBRT (n = 6), brachytherapy (n = 1) or active surveillance (n = 1). RESULTS: The experts reached consensus after three rounds. In the patient cohort, 75% of men undergoing RARP chose this treatment because 'it provides the best chance of cure'. Reasons to choose EBRT were not as explicit: 33.3% chose this treatment because 'it provides the best chance of cure' and 33.3% because 'the maintenance of potency is important to them'. CONCLUSIONS: The PC-DMQ is a comprehensive and standardised tool that allows further research into cognitive factors that influence treatment decision-making in patients with localised PC.

Initial experience with conservative treatment in cancer patients with osteonecrosis of the jaw (ONJ) and predictors of outcome.

BACKGROUND: Overall survival (OS) and outcome of cancer patients with bisphosphonate-associated osteonecrosis of the jaw (ONJ) using conservative treatment (chlorhexidine 0.12% rinse, intermittent antibiotics, and careful sequestrectomy) are unknown. DESIGN: In all, 33 ONJ patients were studied for OS and ONJ outcome. RESULTS: Median duration of bisphosphonate treatment was 27 months (range 4-115) and was stopped in 25 (76%) patients. Nine (27%) cases presented with stage 1, 21 (64%) with stage 2, and 3 (9%) with stage 3 disease. During median follow-up of 23 months, 11 patients (33%) died (median survival 39 months), with no ONJ-related fatalities. Out of 30 assessable patients, 53% no longer had exposed bone, 37% had stable lesions, and 10% showed progressive necrosis. The hazard ratio for healing with doubling of bisphosphonate exposure was 0.419 [95% confidence interval (CI) 0.178-0.982; P = 0.045], stage 2 versus stage 1 disease 0.216 (95% CI 0.063-0.738; P = 0.015), and stage 3 versus stage 1 disease 0.084 (95% CI 0.008-0.913; P = 0.042). Cessation of bisphosphonate treatment did not influence outcome. CONCLUSIONS: Conservative treatment of ONJ leads to mucosal closure in 53% of patients. Doubling the exposure time to bisphosphonates and higher stages of ONJ significantly reduce ONJ healing rates.

Reclamation of treated domestic wastewater using biological membrane assisted carbon filtration (BioMAC).

Membrane processes are increasingly used as an advanced treatment technique for the reclamation of treated domestic wastewater. Despite their inherent advantages, fouling remains an operational problem, while the removal of dissolved organic components such as volatile organic compounds is negligible. In the present work, the addition of a partially non-submerged biological granular activated carbon filtration to a microfiltration lab-scale reactor was investigated. It was observed that the reactor could be operated under stable flux conditions although regular hydraulic backwashing was necessary. Preferential attached growth of nitrifiers on the activated carbon particles allowed for a complete and very stable nitrification, with permeate total ammonium nitrogen and nitrite levels below 0.2 mg l(-1) regardless of influent concentrations. Chemical oxygen demand of the permeate averaged 5.26 mg O2 l(-1) which is below the Environmental Protection Agency guideline for wastewater reuse. Using an electronic nose, elimination of volatile compounds was assessed. The combined process resulted in complete odour removal, with the permeate odour levels equaling the reference samples (tap water), even during periods of increased reactor load (shock load experiment). A 4.2 log10 CFU and 3.7 log10 CFU removal were observed for total coliforms and E. coli, respectively.

Arthrography of the temporomandibular joint: pictorial essay.

Although arthrography of the TMJ is nowadays considered as old-fashioned, the technique remains a valuable alternative in cases where MRI is contraindicated. The authors discuss the technique of inferior joint space arthrography and present a review of typical arthrographic cases of the most common types of TMJ pathology.

[Importance of diagnosis in facial pain]. / Het belang van de diagnostiek bij facialgieën.

The diagnosis and treatment of facial pain remains a great challenge for oral and maxillofacial surgeons. By taking an exact anamnesis--especially a pain anamnesis--and by starting specific examinations the patient can quickly be recommended to a qualified therapist. The pain syndromes are classified according to the IASP (International Association for the Study of Pain). The pain syndromes the maxillofacial surgeon is most frequently confronted with--idiopathic trigeminal neuralgia, atypical facial pain and the temporomandibular joint--are described. The necessity of a multidisciplinary examination is emphasized and the different diagnostic investigations are illustrated, particularly in the case of myo-arthropathy. Beside the analysis of temporomandibular joint dysfunction, a radiologic examination is performed. In some cases the advise of a neurologist, ophthalmologist or otolaryngologist may be indicated.

Arthro-CT in detecting sideways displacement of the temporomandibular joint disk.

One of the major disadvantages of sagittal arthrotomography of the temporomandibular joint is its limited capability to detect sideways (medial or lateral) disk displacement. Several arthrographic signs, suggesting sideways disk displacement have been described in recent reports. The most important one is the edge sign. In doubtful cases, arthro-CT can be used for depiction of medial or lateral disk displacement.

Arthrographic imaging of post-traumatic temporomandibular joint disorders.

Clinical, arthrographic and surgical findings in 20 patients who showed persisting TMJ-pain or dysfunction after an acute traumatic event were reviewed and compared to findings in a control group of 65 patients who did not remember an acute post-traumatic onset of symptoms. Anterior disk displacement (82%), disk perforation (65%) and rotational anteromedial disk displacement (34%) were the most common abnormalities encountered. Other important abnormalities were joint adhesions and capsule perforation. When compared with the control group, all these abnormalities occurred more often in traumatised joints. Arthrography was found to be highly accurate in detecting most types of abnormalities found during surgery. Arthrography is reported to be more effective than MRI in detecting disk perforations, adhesions and capsule perforations, which points to its continuing importance as an imaging tool for evaluating post-traumatic temporomandibular joint disorders.

[Technique and interpretation of arthrography of the temporomandibular joint. Study of 120 cases]. / Techniek en interpretatie van arthrografieën van het temporo-mandibular gewricht. Studie van 120 gevallen.

The goal of the study was to assess the predictive value of inferior joint space arthrography for detection of abnormalities found during surgery. Therefore, a retrospective analysis of arthrographic and surgical findings in 120 joints was performed. Arthrography showed high accuracy for detection of anterior disk displacement (90%) and disk perforation (90.8%). The shape of the anterior recess proved to be the most valuable arthrographic criterium for detection of anterior disk displacement. Cinematographic registration of joint dynamics after injection of contrast material and arthrotomographic analysis of the shape of the superior margin of the anterior recess of the inferior joint space were necessary for an optimal evaluation of the disk position.

[Peri-orbital surgical approaches]. / Operatieve toegangswegen tot de peri-orbita.

After having made a definitive diagnosis in patients with orbito-frontal pathology, the choice of incision is an important factor to achieve good intra-operative exposure of the region, as well as to obtain a good functional and aesthetic result. In the majority of cases we prefer to utilize the incisions commonly used for blepharoplasty, especially the transconjunctival approach popularized by Tessier. Other more classic accesses such as the superolateral, infra-orbital and intra-oral incisions, are reserved for treatment of cases of orbitomalar (communition) fractures. We feel there are limited indications for use of incisions through the eyebrows with medial extensions for exposure of isolated lesions of the medial orbital wall, orbital roof, and the anterior wall of the frontal sinus. However they may become very useful as the primary incisions in the treatment of open fractures of the orbital region. The bicoronal incision, a classical approach in neurosurgery, is also being used by us in cases of tumors and complicated middle face fractures which appear to extend to the orbito-frontobasal region in 40% of our patients. In addition it provides excellent access for post-traumatic reconstruction of orbito-frontal bone defects and impacted fractures. A combination of different incisions: bicoronal, peri-orbital and intra-oral, may be indicated for the correction of syndromal anomalies such as Treacher-Collins, for treatment of complicated facial fractures, or for pure aesthetic surgery procedures, such as the "mask-lift" introduced by Tessier.

[Pedicled facial bone flap for closure of the approach in Caldwell-Luc type sinus operations. Its role in the prevention of postoperative complications]. / Het gesteeld faciale botdeksel ter afsluiting van de toegang bij sinus-operaties type Caldwell-Luc. Rol bij de preventie van post-operative complicaties.

The primary or secondary reconstruction of the facial access after Caldwell-Luc and the more selective resection of sinusal mucous membranes can be important in the therapy and prevention of postoperative complications such as neuralgic facial pain, formation of cysts and chronic sinusitis. The different osteoplastic sinus operations are described and the use of a pedicled bonelid is illustrated. The most common accepted ethiology of post-operative pain is based on the formation of scar-tissue. Postoperative pain is first being treated conservatively, while in case of persisting pain an exploration with dissection of the infra-orbital nerve and reconstruction of the facial defect can be indicated. In a retrospective study of 36 patients the results of our surgical therapy are illustrated.

[Complications of orbito-frontobasal fractures]. / Complicaties van orbito-frontobasale fracturen.

Complications of fronto-basal trauma can, as a function of their severity, be divided into three classes: life-threatening situations, functional complications and cosmetic defects or facial deformities. They find their origin in the type of trauma, the extent of the lesions of bone and soft tissues, as well as in their timely management and quality of treatment. The etiology of the most common complications and their significance are covered with accent on inadequate primary treatment, insufficient repair of dural lesions, inadequate drainage, unstable osteosynthesis, insufficient treatment of scalp- and frontal defects, and finally the lack of antibiotic prophylaxis. The major complications of frontobasal trauma such as chronic cerebral spinal fluid fistulae and pneumocephalus are reviewed. Attention is also given to the importance of adequate drainage in cases of chronic ethmoidofrontal sinusitis, and on the treatment of osteomyelitis and sinus cysts. The therapeutic possibilities in patients with tissue deficits, i.e. reconstruction of frontal skull defects using autologous hip and rib material, as well as split calvarial bone grafts is discussed.

Submental liposuction in maxillo-facial surgery.

Liposuction is a relatively recent surgical technique used in body contouring plastic surgery to correct fatty dysharmonies. It is of particular interest to the maxillo-facial surgeon to treat submental fat excess. This relatively easy technique is described, using a few clinical examples. Indications in maxillo-facial surgery are the correction of "double chin" deformity and increased submental fullness after orthognathic surgical procedures as mandibular setback, as well as an adjunct to rhytidectomy.

[Role of arthrography in imaging of the temporomandibular joint in 1992]. / De plaats van de arthrografie in de beeldvorming van het temporomandibulair gewricht anno 1992.

In this text we briefly want to discuss the role of the arthrographic examination of the temporomandibular joint for detection of disc pathology. We will mention the normal anatomy and function of the temporomandibular joint, the technique for performing arthrograms and the classification of the most frequent disc pathology. This will be illustrated by some arthrographic examples of anterior disc displacement without reduction, disc perforation, and medial disc displacement. Finally the advantages of arthrography in comparison with other investigation techniques will be discussed.

[Treatment concept of facial pain]. / Behandelingsconcept van facialgieën.

The therapy of chronic facial pain still poses an important challenge. A therapeutical scheme in four steps has been developed. This scheme enables modification of the pain therapy depending on localisation, intensity and former treatment. It consists of the following steps: 1. Transcutaneous electrical nerve stimulation. 2. Medication 3. Extracranial glycerol blocking of the trigeminal nerve 4. Neurosurgical treatment with thermocoagulation, chemical glycerol-rhizotomy and microsurgical decompression. The different therapeutical steps have no influence on each other.

Somato-sensory evoked potentials in facial pain diagnosis.

This study analyses the possibilities of somato-sensory evoked potentials following trigeminal stimulation in order to classify pain sensations provoked by the trigeminal nerve. 43 patients suffering from trigeminal neuralgia, atypical facial pain and from pain due to carcinoma were investigated. Pain sensations correlated with the responses of the evoked potentials--usually with increased latencies. However, it was not possible to point out specific correlative pathological peaks for individual diseases. Therefore, the judgement of TSEP alterations requires knowledge of each patient's clinical symptoms.