Effectiveness and safety of foam sclerotherapy with 5% ethanolamine oleate in the treatment of low-flow venous malformations in the head and neck region: a case series.

The aim of this study was to evaluate the effectiveness and safety of 5% ethanolamine oleate (EO) foam in the treatment of low-flow venous malformations in the head and neck region. Seventeen consecutive patients (six male, 11 female) and 34 low-flow venous malformations were enrolled. The vascular anomalies ranged between 20mm and 80mm in size. The typical clinical indication was a swelling (88.2%) with a purple colour (85.3%); the most frequent location was the tongue (23.5%). Ethanolamine oleate foam was produced via the Tessari method and applied at 10mg per 1cm to the vascular anomalies. This process resulted in the highest clinical healing score in 64.7% of cases, and half of the patients reported a high level of satisfaction (score >9). In the majority of cases (88.2%), the patients reported that the pain immediately postoperative was mild or moderate. There were direct relationships between vascular anomaly size and the volume of EO applied, the number of sessions, and healing (P<0.05). No recurrence was observed during 6 months of follow-up. This case series showed the effectiveness and safety of 5% EO foam for the treatment of venous malformations in the head and neck region.

DNA methylation pattern of apoptosis-related genes in ameloblastoma.

OBJECTIVES: DNA methylation is an important mechanism of gene control expression, and it has been poorly addressed in odontogenic tumours. On this basis, we aimed to assess the methylation pattern of 22 apoptosis-related genes in solid ameloblastomas. MATERIALS AND METHODS: Ameloblastoma fresh samples (n = 10) and dental follicles (n = 8) were included in the study. The percentage fraction of methylated and unmethylated DNA promoter of 22 apoptosis-related genes was determined using enzymatic restriction digestion and quantitative real-time PCR (qPCR) array. The relative expressions of the genes that showed the most discrepant methylation profile between tumours and controls were analysed by reverse-transcription quantitative PCR (RT-qPCR). RESULTS: Lower methylation percentages of TNFRSF25 (47.2%) and BCL2L11 (33.2%) were observed in ameloblastomas compared with dental follicles (79.3% and 59.5%, respectively). The RT-qPCR analysis showed increased expression of BCL2L11 in ameloblastomas compared with dental follicles, in agreement with the methylation analysis results, while there was no difference between the expression levels of TNFRSF25 between both groups. CONCLUSIONS: On the basis of our results, the transcription of the apoptosis-related gene BCL2L11 is possibly regulated by promoter DNA methylation in ameloblastoma. The biological significance of this finding in ameloblastoma pathobiology remains to be clarified.

[Magnetic resonance imaging criteria for the differentiation of traumatic and non-traumatic rotator cuff tears]. / Kernspintomographische Kriterien zur Unterscheidung von traumatischen und nicht traumatischen Rotatorenmanscnerrenrupturen.

It is often not easy to classify a rotator cuff tear into traumatic or non-traumatic. For individual medical examinations the classification depends basically on the following four criteria: Case history, analysis of the accident, analysis of the complaints after the accident (or even before) and the pathomorphological findings. The aim of this study was to identify findings in the magnetic resonance imaging of the shoulder joints of patients with rotator cuff tears that could help in the differentiation of traumatic versus non-traumatic. As a result it could be shown that infraspinatus and subscapularis tears, Hill-Sachs lesions and fractures of the tuberculum majus are significantly more detectable among those patients reporting a trauma. In contrast degeneration of the supraspinatus tendon, calcific tendinitis of the supraspinatus tendon, ac-joint degeneration and an absence of the subacromial fat pad are more verifiable in the non-traumatic group. These results can be used as additional important information in the individual medical examination of patients with rotator cuff tears.

[Relevant aspects of the individual medical examination in SLAP lesion: traumatic versus degenerative/preexisting changes]. / Relevante Aspekte der gutachtlichen Beurteilung der SLAP-Läsion: Traumatische Verãnderungen versus degenerative/anlagebedingte Veränderungen.

In the case of SLAP-lesions the upper part of the labrum glenoidale is affected and the long tendon of the biceps muscle can be involved. In literature different types of the lesions are classified. In the case of an individual medical examination, it should be kept in mind that variations of normal anatomy exist and for that reason the examiner should analyse if there is a real pathological condition. He should also discuss the pathogenesis with special regard to the mechanisms of trauma as published in literature. With SLAP-lesions there should be a functional disabling symptomatology of the affected shoulder that occurs directly or at least shortly after the accident. Also the imaging modalities and, when available the findings of an operative treatment, should be analysed to see if other trauma-lesions exist. These aspects will be discussed in the following paper.

[Practical guidelines for the prevention of chronic symptoms after a whiplash injury, based on published evidence]. / Praktische richtlijnen voor de preventie van chronische klachten na een whiplashtrauma, gebaseerd op gepubliceerde evidence.

Recently, systematic reviews and evidence-based guidelines on whiplash have appeared, from which preventive recommendations can be derived. Fear of moving, catastrophic thoughts and avoidance of activity seem to play an important role in the transition from acute to chronic symptoms. Early reassurance and the advice to remain active can prevent the development of chronic symptoms following whiplash. In the acute and subacute phase, if there is still no recovery despite information designed to reduce anxiety, referral to a physiotherapist for active exercise therapy and management is indicated. In the chronic phase, depending on which factors play a role in the given patient, referral to active exercise therapy or a multi-disciplinary training programme may be considered.

[RSI-repetitive strain injury--a work-related disease?]. / RSI-repetitive Strain Injury--eine Berufskrankheit?

It is not scientifically proven that problems in the neck, shoulder, arm and hand which patients complain of after repetitive activities at work, are due to structural damage caused by physical stress at the workplace. As a consequence, from the orthopedic point of view, RSI cannot be accepted as a work-related disease.

Investigation of the GSalpha gene in the diagnosis of fibrous dysplasia.

Fibrous dysplasia is a benign fibro-osseous disease of bone and its etiology has been previously established. Activating mutations in the gene that encodes the alpha subunit of stimulatory G protein (G(S)alpha) has been described in monostotic and polyostotic fibrous dysplasia and in the McCune-Albright syndrome. The present report describes a patient with monostotic fibrous dysplasia which diagnosis was confirmed by sequencing of the G(S)alpha gene, demonstrating a heterozygous missense mutation on codon 201 (201C --> T). Due to the high prevalence of G(S)alpha gene mutations in fibrous dysplasia in contrast to other benign and malignant fibrous-osseous lesions, mutational analysis are an additional and helpful parameter for the diagnosis of fibrous dysplasia in selected cases.

[Isolated traumatic meniscus rupture--is there progress?]. / Der isolierte traumatische Meniskusriss--gibt es neue Erkenntnisse?

A review of the literature revealed that there are no new scientific data which can rule out the existence of an isolated traumatic meniscus tear. However, the large number of publications on the subject of meniscus pathology do suggest that the traumatic tear of a "healthy" meniscus without ligamental or osseous concomitant lesions is indeed very rare. In order to perform an individual medical examination, therefore, medical experts need every available information to assess such a case.

No stress--no whiplash? Prevalence of "whiplash" symptoms following exposure to a placebo rear-end collision.

Volunteer studies of experimental, low-velocity rear-end collisions have shown a percentage of subjects to report short-lived symptoms, but the cause of these symptoms remains unknown. It is unclear whether the symptoms arise from biomechanical stress causing injury or from psychological stress causing symptom expectation and anxiety. Similarly, the cause of symptoms remains obscure in virtually all "whiplash" patients because it is impossible to identify acute pathology in many cases. In this study subjects were exposed to placebo collisions that almost completely lacked biomechanical stress. It was highly probable that if the symptoms reported following low-velocity collisions were not due to injury but to other factors (including misattribution of symptoms from other sources), then the proportion of subjects reporting symptoms would be similiar to that reported for volunteers in true (experimental) low-velocity, rear-end collisions. A total of 51 volunteers (33 males and 18 females, mean age 32.4 years) were recruited through local newspaper advertisements. An experimental set-up for a placebo collision was constructed using two standard European cars. At time T0, prior to the placebo collision, a history and physical examination was performed, including a psychological analysis (Freiburger Personality Inventory). A symptom history and physical examination were also performed at time T1, immediately after the placebo collision, and the subjects completed symptom questionnaires 3 days (time T2) and 4 weeks (time T3) after the placebo collision. Data analysis included a determination of the predictive value of psychological data for the presence of symptoms following exposure to a placebo collision. At time T1, 9 out 51 participants (17.6%) indicated symptoms. Within 3 days (time T2) after the placebo collision, 10 (19.6%) of the subjects had symptoms, and within 4 weeks (time T3) 5 subjects (9.8%) had symptoms. Of the last group, two of the five did not relate these symptoms to the "collision". Subjects who endorsed symptoms at time T1 had significantly higher scores on the psychological scale of psychosomatic disorders (measured at time T0). Subjects endorsing symptoms at time T2 had significantly higher scores on emotional instability. There was also a tendency to higher scores on this sub-scale for subjects with whiplash-associated disorders (WAD) at time T3. A discriminant analysis using all four psychological scales from time T0 had a power of 87%, 83% and 92% for correct classification of subjects as asymptomatic times T1, T2 and T3, respectively. Approximately 20% of subjects exposed to placebo, low-velocity rear-end collisions will thus indicate WAD, even though no biochemical potential for injury exists. Certain psychological profiles place an individual at higher risk for phenomenon.

Juvenile xanthogranuloma: case report with immunohistochemical identification of early and late cytomegalovirus antigens.

Juvenile xanthogranuloma (JXG) is a dermatological condition of unknown etiology that rarely affects the oral mucosa. There are conflicting reports suggesting that it may represent a reactive virally-induced lesion associated with cytomegalovirus (CMV) infection. The present paper reports an additional case of oral JXG and discusses its possible association with CMV infection. The biotin-streptavidin system was used to detect early and late CMV antigens. Positive immunolabelling for both antigens was demonstrated in some histiocytes in the lesion. These findings suggest that JXG may be associated with CMV infection.

Glandular odontogenic cyst: absence of PTCH gene mutation.

Glandular odontogenic cyst (GOC) is a rare jawbone cyst of odontogenic origin. Human patched (PTCH) is a tumour suppressor gene that has been recently associated with signalling pathways during odontogenesis. Recently alterations of this gene were found on sporadic odontogenic keratocysts. This evidence, together with the biological behaviour similarities of both lesions, and the absence of reports on molecular analysis of GOC, led us to hypothesize that PTCH gene mutations may underlie the tumorigenesis of GOC. Therefore the aim of this study was to report one additional case of GOC and investigate the PTCH gene of the cyst. No mutations were found in the splicing and coding regions of the PTCH gene. In conclusion, the PTCH gene does not seem to be involved in GOC pathogenesis.

Congenital absence of lacrimal puncta and salivary glands: report of a Brazilian family and review.

Congenital absence of the salivary glands and lacrimal puncta is a rare autosomal-dominant disorder with variable expressivity. Only a few instances of this condition have been reported. We present the first Brazilian observation of this syndrome and a review of the literature.

A survey of oral biopsies in Brazilian pediatric patients.

This paper presents a review of 1018 oral biopsies in pediatric patients from the Oral Pathology Service, Minas Gerais Federal University, Brazil. The lesions were divided into ten main categories. The most common oral lesions in this study were follicular cyst in the maxillary anterior region, followed by inflammatory fibrous hyperplasia in the same region, and mucocele in the lower lip. Cysts of the jaws and oral soft tissues comprised 26.1 percent of total oral biopsies. The importance of these findings in oral diagnosis is discussed.

Noninvasive three-dimensional analysis of cervical spine motion in normal subjects in relation to age and sex. An experimental examination.

STUDY DESIGN: Experimental examination in vivo. OBJECTIVES: To determine the precision of the ultrasound-based Coordinate Measuring System (CMS 50; Zebris Medizintechnik GmbH, D-88316, Isny, Germany) and then to establish a reference range for the active range of motion of the cervical spine in normal test subjects grouped according to age and sex. SUMMARY OF BACKGROUND DATA: Many different devices such as inclinometers, goniometers, potentiometers, computer-aided devices, and radiographic procedures have been developed to examine the range of motion of the cervical spine. All of them have more or less inherent limitations. METHODS: To assess the precision of this examination method, preliminary experiments were performed including intraobserver retest and two-observer repeatability, intraindividual variability, a daily profile, and a comparison between active and passive motions. In the subsequent main experiment 157 persons (86 women and 71 men) were examined during active motion. The sex groups were further subdivided into age groups of 10 years each. A comparison of weight and athletic activity was also performed. RESULTS: The range of motion decreased with increasing age, increasing body weight, and decreasing athletic activity. The rotation in the upper cervical spine increases with age to compensate for the reduced range of motion in the lower levels. Women showed significantly better mobility than men of the same age, only above the age of 70. CONCLUSIONS: The CMS 50 device provides precise reproducible measurements of the active range of motion of the cervical spine in all three planes. Criteria such as age, sex, body weight, and athletic activity influence the range of motion of the cervical spine.

Pediatric cervicofacial actinomycosis: a case report.

Cervicofacial actinomycosis in children is a rare disorder. This article reports a case in a 7-year-old-girl. The importance of cervicofacial actinomycosis in the differential diagnosis of cervical masses in young patients is emphasized.

Cell cycle-associated proteins in melanotic neuroectodermal tumor of infancy.

OBJECTIVE: The purpose of the present study was to compare the immunohistochemical expression of cell cycle-associated proteins in neuroblastic and melanocytic cell populations of melanotic neuroectodermal tumor of infancy. STUDY DESIGN: Three cases of melanotic neuroectodermal tumor of infancy were selected. The immunohistochemical expression of MDM-2, p53, proliferating cell nuclear antigen, cyclin D1, and cyclin A was assessed through use of the streptavidin-biotin-peroxidase complex technique. RESULTS: Positive immunostaining for MDM-2, proliferating cell nuclear antigen, cyclin D1, and cyclin A was occasionally observed in the large melanin-containing epithelioid cells. CONCLUSIONS: These data suggest that MDM-2 expression may be important for the development of melanotic neuroectodermal tumor of infancy and that the melanocytic cell population, not the neuroblastic one, is the proliferative component of the tumor.

Regional odontodysplasia: an unusual case with a conservative approach.

A case of a 14-year-old male with regional odontodysplasia is reported. In this presentation many atypical clinical and radiographical features of this condition are present. The chief complaint of the patient was the enlargement of the gingiva and, according to the literature, inflammatory processes are the main reason why patients look for care. Moreover, there was no radiographic evidence of unerupted teeth in this report. The functional and psychological benefits of the conservative approach are emphasised.

Immunocytochemistry of fine-needle aspirates from central giant cell granuloma.

Fine needle aspiration biopsy (FNAB) is an important technique in the diagnosis of oral and maxillofacial conditions. We describe here the cytological and immunocytological findings in four patients with central giant cell granuloma. All the aspirates showed mononuclear cells associated with many giant cells. We conclude that immunocytochemical examination of FNAB specimens helps to confirm the provisional clinical diagnosis of central giant cell granuloma.