[An update on focal infection of oral origin]. / Point actuel sur l'infection focale d'origine buccodentaire.

Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.

Usefulness of a quantitative analysis of the recovery phase patterns of the ST-segment depression in the diagnosis of coronary artery disease.

PURPOSE: To assess the diagnostic value of the recovery phase patterns of the ST-segment depression in patients referred for chest pain. PATIENTS AND METHODS: Continuous plots of ST-segment depression against heart rate during exercise and recovery were constructed within a population of 160 consecutive symptomatic patients who all had undergone catheterization (80 with > or = 1 stenosis > or = 50%). We used a new quantitative method of measurement allowing all kinds of rate recovery loops (even the so-called "intermediate" loops) to be considered for analysis. The measurements of the heart rate (HR)-adjusted ST-segment depression were performed at 20 and 60 ms from the J point, providing two different values of a quantified recovery loop index (RLI): RLI 20 and RLI 60. RESULTS: Both RLI showed a higher specificity (0.81 +/- 0.04 and 0.74 +/- 0.05, respectively) than did the standard criterion (0.65 +/- 0.10), but the difference was significant regarding RLI 20 only (P = 0.011). As to the sensitivity, no significant differences were found among all of the criteria (0.74 +/- 0.05, 0.80 +/- 0.04, 0.76 +/- 0.05, respectively). The timing of measurements of the RLI within the repolarization phase did not affect their overall accuracy (0.77 +/- 0.03 for both RLI). The values of the receiver-operating characteristic (ROC) curve areas were significantly greater for both RLI (0.83 +/- 0.06 and 0.84 +/- 0.06 respectively) than for the standard criterion (0.75 +/- 0.07; P < 0.02). Finally, both RLI allowed to differentiate accurately the study subjects according to the number of diseased vessels, whereas the standard criterion could only distinguish between CAD patients and subjects with normal angiograms. CONCLUSION: The quantitative analysis of the rate recovery phase patterns appears to be useful for the diagnosis of coronary heart disease and the assessment of its severity in symptomatic patients.

Comparison of the diagnostic accuracy of different methods of measurement of heart rate-adjusted ST-segment depression during exercise testing for identification of coronary artery disease.

Within a population of 160 consecutive symptomatic patients who all had undergone catheterization (80 with > or = 1 stenosis > or = 50%), we compared the accuracy of different computerized measurements of the exercise-induced changes in ST-segment: (1) the standard criterion (> or = 0.1 mV flat/downsloping ST depression or > or = 0.15 mV upsloping depression, both 60 ms after the J point); (2) heart rate (HR)-adjusted ST-segment depression (ST/HR index measured at 0, 20, 40, 60, and 80 ms from the J point); (3) the HR-adjusted ST integral (ST/HR integral measured from 0 to 40 ms and from 40 to 80 ms after the J point). None of the ST/HR indexes or integrals were found to have a significantly greater sensitivity than the standard criterion. On the contrary, all ST/HR indexes and integrals showed a higher specificity (0.78 to 0.89) than did the standard criterion (0.65); moreover, the earlier the measurement within the repolarization phase, the better the overall accuracy: 0.71 for the standard criterion, 0.83 (p < 0.001), 0.80 (p < 0.01), 0.78 (p < 0.02), 0.78 (p < 0.02), 0.74 (p = NS) for the ST/HR indexes at 0, 20, 40, 60, and 80 ms, respectively; 0.81 (p < 0.001) and 0.78 (p < 0.02) for the ST/HR integrals calculated from 0 to 40 and from 40 to 80 ms, respectively. Consistently, the receiver-operating characteristic curve areas of ST/HR at 0, 20, and 40 ms were greater than those of ST/HR at both 60 and 80 ms. These findings are divergent from some other results given in published reports. We conclude that the accuracy of all exercise criteria is influenced by the population analyzed: our patients were representative of those currently seen by clinicians.

[Improvement of the diagnostic value of exercise test by heart-rate adjusted segment depression. Value of ST 20/HR index]. / Amélioration de la valeur diagnostique de l'épreuve d'effort par le sous-décalage du segment ST rapporté à la fréquence cardiaque. Intérêt de l'index ST 20/FC.

One of the new criteria of positivity of exercise stress testing proposed by Detrano and Kligfield is the ST/HR index, obtained by calculating the ratio of additional ST depression on exercise over the corresponding variation in the heart rate. These authors reported that this ratio improved the diagnostic value of the exercise stress test with respect to the traditional ST segment depression, but that the proportion depended on whether the index was measured 80 or 60 ms after the J point. The object of this study was to assess the diagnostic performance of the ST/HR index measured 0, 20, 40, 60 and 80 ms after the J point by automatic analysis and to compare these five diagnostic indices with the classical ST segment depression (standard criterion) by ROC graphs and the Mac Nemar test. One hundred consecutive patients (73 men and 27 women) all symptomatic, underwent submaximal or symptom-limited exercise stress testing and accepted coronary angiography. The prevalence of greater than or equal to 50% coronary stenosis on at least one main vessel was 48%. None had previous myocardial infarction. The ROC graphs and areas under the curve demonstrated generally the superiority of the ST/HR index over the standard criteria. The optimal diagnostic performance was observed when the index was calculated 20 ms after the J point (ST 20/HR index).(ABSTRACT TRUNCATED AT 250 WORDS)

[Chronic recurrent multifocal osteomyelitis of the mandible. A case report]. / Ostéomyélite chronique multifocale récurrente. A propos d'un cas de la mandibule.

UNLABELLED: Chronic recurrent multifocal osteomyelitis (CRMO) is a disorder rarely localized to the lower jaw. CASE REPORT: A fourteen-year-old boy complained of a swollen of his lower jaw. After a CT Scan, a bone biopsy was performed and yielded S. oralis against which an adapted intravenous antibiotherapy was administered without efficacy. The absence of malignant process and the revelation of an other focus of fixation at the Tc bone scan localized on humerus called to mind the diagnosis of CRMO. CONCLUSION: The diagnosis of this disease is difficult and based on a number of concording arguments:clinical and radiological signs of osteomyelitis, multifocal presentation, recurrent relapses and remissions, inaction of antibiotics, elimination of the other differential diagnosis, in particular the infectious osteitis.

[Semi-rigid bracket splinting of teeth after traumatic luxation]. / Contention semi-rigide par boîtiers des luxations dentaires traumatiques.

We describe a non-rigid procedure using brackets for splinting teeth after traumatic avulsion. This type of appliance preserves alveolodental ligament physiology and enables immediate mastication without occlusal obstruction. Installation is easy, except when severe bleeding or alveolar fracture occurs.

[Comparison of the anti-inflammatory effect of collyria of dexamethasone and diclofenac]. / Comparaison de l'effet anti-inflammatoire des collyres de dexamethasone et de diclofenac.

A clinical double-blind study of patients who had undergone intracapsular cataract extraction with intraocular implant was performed in an attempt to compare the anti-inflammatory effect of Dexamethasone and Diclofenac eye drops. The parameters compared were: degree of inflammation of the anterior chamber; pachymetry of the cornea; objective and subjective tolerance of the eye drops; examination of the fundus (fluorescein angiography on the 60th day); intraocular pressure. The statistical analysis of the different parameters shows a tendency in favor of the non-steroidal agent for intraocular pressure; there was no apparent difference in the anti-inflammatory actions of the two substances.

[Evaluation of mandibular propulsion appliances in children. A study of 18 cases]. / Evaluation des appareils de propulsion mandibulaire chez l'enfant. Etude de 18 cas.

PURPOSE: Mandibular propulsion appliances are used currently in the treatment of class II malocclusion. The purpose of this study was to evaluate their effects on facial development to formulate specific indications. PATIENTS AND METHODS: Eighteen children (mean age 9-12) treated with a propulsion device for a class II division 1 malocclusion with a minimum of 4 mm overjet were included in a retrospective study over a 4 year period. We compared maxillomandibular and dentoalveolar position before and after treatment using Delaire computer software cephalometric analysis and superpositions. RESULTS: Statistically significant effects on molar discrepancy (p = 0.0002), overjet (p = 0.0003), sagittal mandibular position (p = 0.0040 for FM-Me/theoretical and p = 0.0010 for NP-FM-Me), mandibular length (p = 0.004 for FM-Me/theoretical), mandibular corpus length (p = 0.0286 for Go-Me/theoretical), upper incisors palatal version (p = 0.0002), and on lower incisors lip version (p = 0.0436) were assessed. No action on maxillary growth (p = 0.7274 for FM-NP/theoretical), ramus length (p = 0.9651 for Cp-Go/theoritecal), lower facial height (p = 0.7045 for ENA-Me/theoretical) or translation of the alveolar arches (p = 0.9571 for A-Pti'/ENA-Pti and p = 0.1564 for B-Pa'/B-Pa) could be confirmed. CONCLUSIONS: An increase in mandibular corpus development and no effect on alveolar arches suggests a basal mandibular action for this device. This concludes that retromandibular position and brachycorpus with upper incisor lip version, without lower incisors lip version are the best indications for mandibular propulsion appliances. Prospective studies should be carried out to confirm this hypothesis.

[A comparison of standard radiographs and "scout-view" radiographs. The value for cephalometric analysis]. / Comparison des télécrânes et des "modes radios". Intérêt pour le bilan céphalométrique.

Is the scout-view as reliable as the standard lateral view for cephalometric analysis? Cephalometric data (Delaire analysis) were obtained in ten patients with CT-scan and standard x-ray for comparison. Qualitative results showed imprecisions for craniofacial contours and soft tissue ptosis. Quantitative results were analyzed statistically and revealed a significantly higher level of error with scout-view tracings. The scout-view does not appear to be as reliable and takes longer to acquire than the standard lateral x-ray: for the pediatric population, it could be a disadvantage.

[Therapeutic management of traumatic avulsion of permanent teeth]. / Prise en charge thérapeutique des expulsions traumatiques des dents définitives.

Management of avulsed permanent teeth requires perfect knowledge of the different parameters influencing the short and mid-term and above all long-term prognosis. Based on a review of the literature and the analysis of 50 cases cared for in our unit enables us to propose, in accordance with the extra oral delay and the degree of dental maturation, a protocol for the different emergency situations. This clarification emphasizes the contribution of new preserving solutions which allow reimplantation delays up to 24 hours without effect on prognosis.