The Addition of Lipid-Based Contrast Medium does not Inactivate the Detergent Sclerosant Sodium Tetradecyl Sulfate in-vitro.

PURPOSE: To investigate if the detergent sclerosant sodium tetradecyl sulfate (STS) is deactivated by the lipid-based contrast agent ethiodised oil. METHOD: 3% STS was mixed with ethiodised oil and room air in a 2:1:4 ratio in two luer lock syringes and a three way connector and agitated to make foam (the Tessari technique) to replicate the clinical use of the products. The assay of STS in the mixture was assessed using the British Pharmacopoeia method. Briefly this is a manual titration method where the solution of STS is mixed with an indicator solution and titrated with hyamine solution of known concentration; the concentration of the STS can then be calculated with the titration results. To further mimic the clinical environment with the presence of blood, the effect of adding increasing amounts of albumin to the STS-ethiodised oil mixture was assessed. RESULTS: The assay of STS in the solution after mixing with ethiodised oil was 3% indicating that the ethiodised oil did not deactivate the STS. The addition of albumin to the STS-contrast mixture resulted in near linear neutralisation of the STS with increasing concentrations in the same quantities as with STS alone. CONCLUSIONS: The mixture of the lipid-based contrast agent ethiodised oil with the detergent sclerosant STS did not affect the availability of the sclerosant. The continued use of STS-ethiodised oil in the management of vascular malformations can be supported.

Physiochemical properties and reproducibility of air-based sodium tetradecyl sulphate foam using the Tessari method.

Objectives The objectives were to examine the density, bubble size distribution and durability of sodium tetradecyl sulphate foam and the consistency of production of foam by a number of different operators using the Tessari method. Methods 1% and 3% sodium tetradecyl sulphate sclerosant foam was produced by an experienced operator and a group of inexperienced operators using either a 1:3 or 1:4 liquid:air ratio and the Tessari method. The foam density, bubble size distribution and foam durability were measured on freshly prepared foam from each operator. Results The foam density measurements were similar for each of the 1:3 preparations and for each of the 1:4 preparations but not affected by the sclerosant concentration. The bubble size for all preparations were very small immediately after preparation but progressively coalesced to become a micro-foam (<250 µm) after the first 30 s up until 2 min. Both the 1% and 3% solution foams developed liquid more rapidly when made in a 1:3 ratio (37 s) than in a 1:4 ratio (45 s) but all combinations took similar times to reach 0.4 ml liquid formation. For all the experiments, there was no statistical significant difference between operators. Conclusions The Tessari method of foam production for sodium tetradecyl sulphate sclerosant is consistent and reproducible even when made by inexperienced operators. The best quality foam with micro bubbles should be used within the first minute after production.

Influence of prognostic risk indicators on osseointegrated dental implant failure: a matched case-control analysis.

Dental implant treatment is an important therapeutic modality with documented long-term success for replacement of missing teeth. However, dental implants can be susceptible to disease conditions or healing complications that may lead to implant loss. This case-control study identified several risk indicators associated with failure such as smoking and alcohol consumption. The use of postoperative antibiotics or wide-diameter implants may significantly reduce implant failure. Knowledge of patient-related risk factors may assist the clinician in proper case selection and treatment planning.

The aetiology of upper aerodigestive tract cancers among young adults in Europe: the ARCAGE study.

BACKGROUND: The incidence of cancers of the upper aerodigestive tract (UADT) is increasing throughout the world. To date the increases have been proportionally greatest among young people. Several reports have suggested that they often do not have a history of tobacco smoking or heavy alcohol consumption. OBJECTIVE: To determine the contribution of lifestyle factors to the etiology of UADT cancers occurring in those aged less than 50 years. METHODS: A case-control study was conducted in 10 European countries. Cases were cancers of the oral cavity and pharynx, larynx and esophagus, and hospital or population controls were age and sex matched. RESULTS: There were 356 cases younger than 50 years and 419 controls. Risk was strongly related to current smoking [odds ratio (OR) 5.5 95%; confidence interval (CI) (3.3, 9.2)], and risk increased with number of pack-years smoked. Risk was also related to alcohol consumption for both current (OR 1.8; 0.97, 3.3) and past (OR 3.4; 1.6, 7.4) drinkers, and risk increased with number of drink-years. Persons frequently consuming fruits and vegetables were at significantly reduced risk. CONCLUSIONS: Risk factors already identified as being important for UADT cancers in adults are also important influences on risk in younger adults. The implication of these results is that the public health message in preventing UADT cancers remains the same to young and old alike.

Paget's disease of bone and osteonecrosis.

UNLABELLED: Paget's disease of bone, although common in the long bones and pelvis, is less common in the head and neck. A 20-year follow-up is reported of a patient who was diagnosed with Paget's disease following the investigation of her initial oral complaint. Following surgical extraction of two teeth in her maxilla, the sockets have failed to heal, despite numerous attempted interventions. This case highlights both the cranio-maxillofacial and oral manifestations of Paget's disease of bone, its effects on surgical exodontia and the possible effects of bisphosphonate therapy. CLINICAL RELEVANCE: Paget's disease of bone does not manifest in the head and neck commonly but, when it does, there are significant implications for the dentist. Prevention and conservation of the patient's remaining teeth are paramount as the complications of extraction are significant.

Brief report: preliminary results of a suicide awareness mass media campaign in Cuyahoga County, Ohio.

Little information is currently available concerning the effects of suicide awareness and prevention campaigns. This brief report provides preliminary information about the influence of such a media campaign on the number of suicide-related telephone calls to an emergency mental health service in Cuyahoga County, Ohio. Examination of the pattern of calls before, during, and between phases of the campaign suggests that the media campaign significantly increased telephone calls to the emergency service. We provide this information to catalyze similar sharing of data and experiences among those organizations and agencies working to prevent suicide.

Why oral histopathology suffers inter-observer variability on grading oral epithelial dysplasia: an attempt to understand the sources of variation.

The present study attempted to assess the reasons behind the inter-observer variation in grading oral epithelial dysplasia (OED). Three oral pathologists and one general pathologist examined 68 histological slides of OED lesions of variable grade for scoring the presence of each individual characteristic of the architecture and cytology changes that were established by the 2005 WHO classification. The assigned features in each case were correlated with clinical outcomes to understand which features are more commonly associated with malignant transformation. Interestingly, for all individual characteristics, the pairwise inter-examiner and group kappa values ranged from poor to moderate. It appeared that for each characteristic separately there was much dissension. Despite these observations, comparing these data with that from our previous paper on the same slides showed that the inter-observer agreement on the degree of dysplasia either by using the new binary system of "low-risk" or "high-risk" or by using the 2005 WHO classification turned out to be better than the agreement on the individual characteristics of architecture and cytology changes. Certain features show significant association with the clinical outcomes. In the discussion, some explanations to help understanding the sources of variation in grading OED are put forward. In conclusion, grading dysplasia is not an exact science and pathologists are doing their best to reach optimal results. Improvement in the standard of the histopathology reporting of OED lesions could be achieved by consideration of several issues. Of these, there is need for a universal definition of the architectural and cytological features that are the basis of any OED grading process. A minimum dataset for reporting OED lesions should be set up. Also, the use of a consensus scoring process between two or more observers should be encouraged as this would improve inter-observer agreement.

Evaluation of a new binary system of grading oral epithelial dysplasia for prediction of malignant transformation.

The aim of this paper is to assess the reproducibility of a novel binary grading system (high/low risk) of oral epithelial dysplasia and to compare it with the WHO classification 2005. The accuracy of the new system for predicting malignant transformation was also assessed. Ninety-six consecutive oral epithelial dysplasia biopsies with known clinical outcomes were retrieved from the Oral Pathology archives. A pilot study was conducted on 28 cases to determine the process of classification. Four observers then reviewed the same set of H&E stained slides of 68 oral dysplastic lesions using the two grading systems blinded to the clinical outcomes. The overall inter-observer unweighted and weighted kappa agreements for the WHO grading system were Ks = 0.22 (95% CI: 0.11-0.35), Kw = 0.63 (95% CI: 0.42-0.78), respectively, versus K = 0.50 (95% CI: 0.35-0.67) for the new binary system. Interestingly, all pathologists showed satisfactory agreement on the distinction of mild dysplasia from severe dysplasia and from carcinoma in situ using the new WHO classification. However, assessment of moderate dysplasia remains problematic. The sensitivity and specificity of the new binary grading system for predicting malignant transformation in oral epithelial dysplasia were 85% and 80%, respectively and the accuracy was 82%. The new binary grading system complemented the WHO Classification 2005 and may have merit in helping clinicians to make critical clinical decisions particularly for the cases of moderate dysplasia. Histological grading of dysplasia using established criteria is a reproducible prognosticator in oral epithelial dysplasia. Furthermore, the present study showed that more consensus scoring on either the degree of dysplasia, assessment of risk or the presence of each morphological characteristic by a panel should be encouraged.