Are there differences between cephalic and extracephalic cutaneous allodynia in migraine patients?

Cutaneous allodynia (CA), pain in response to innocuous cutaneous stimuli, is recognized as a sign of central sensitization during migraine episodes. It is either restricted within the pain area on the ipsilateral head, or extends within and outside the head. Moreover, CA can be elicited in response to thermal (heat or cold) and/or mechanical stimuli. This raises the question as to whether cephalic and extracephalic CAs share the same properties. We assessed cephalic and extracephalic CAs in migraine episodic patients using a questionnaire completed at home during migraine attacks. A total of 67 episodic migraine patients (58 women, nine men; 4013 years old) addressed all questions in the questionnaire. Forty-nine patients (73%) cited one or more allodynic symptoms during or immediately after the migraine attack. Almost all 49 patients reported cephalic CA, whereas 24 (49%) also reported extracephalic CA. Occurrence and extension of CA correlated (P = 0.005) with headache intensity. Modalities of cephalic and extracephalic CA were different (chi2 = 12.03; P = 0.002), extracephalic CA being mostly thermal (75%) whereas cephalic CA was mostly mechanical (92%). This suggests that cephalic and extracephalic CAs involve different mechanisms.

Profile of the oral healthcare team in countries with emerging economies.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Chewing indicators between adults with Down syndrome and controls.

Down syndrome induces a neuromotor deficiency that affects the orofacial musculature, and thus could be implicated in the feeding difficulties affecting people with this disease. This study aimed to investigate the differences in chewing indicators between a group of 11 adults with Down syndrome and a group of 12 healthy subjects without Down syndrome. Chewing ability was evaluated by means of video recordings taken during a standardized meal that included 10 natural foods. The variables collected were masticatory time, number of masticatory cycles, chewing frequency, number of open masticatory cycles, and number of food refusals. There were several differences in both directions for masticatory time and number of masticatory cycles between the two groups. In addition, with the exception of purée, the group with Down syndrome had significantly lower mean chewing frequency than the reference group, and was unable to eat all the foods presented.

Impact of teaching requirements for students on the activity of a university dental hospital.

OBJECTIVES: This study aimed at investigating the influence of teaching requirements on the clinical activity of a dental hospital. METHOD: The annual clinical activity of seven classes of fifth-year students (n = 294) was monitored between 1994 and 2001 within the conservative dentistry and endodontic departments of a French dental hospital. The variables chosen were: (i) the mean number of procedures performed per student, and (ii) the proportion of different types of treatment within the global activity (i.e. endodontic treatment, anterior, and posterior restorations). These data were analysed in relation to changes in student assessment criteria over time. RESULTS: Quantitative clinical teaching requirements were removed for the academic year 1998-99 and student clinical activity subsequently decreased by 32.7%, going from 51.9 +/- 12.2 dental procedures on average per student in 1997-98, to 29.1 +/- 7.2 in 2000-01. The mean number of patients treated per student also declined significantly during this period. The size of the minimum clinical requirement altered over the years prior to being removed altogether and a positive correlation existed between the volume of activity and the minimum requirement over this time. The types of treatment provided changed independently from the assessment criteria over the study period. There was a decrease in the percentage of amalgams placed and an increase in the number of posterior composites. A negative correlation existed between the evolution of these two types of treatment. CONCLUSION: This study demonstrates that the clinical activity of a department in a dental teaching hospital is directly related to the assessment criteria fixed by the university. This may have repercussions for hospital services.

Renal tubular dysgenesis-like lesions and hypocalvaria. Report of two cases involving indomethacin.

We describe a case of twins with twin-to-twin transfusion syndrome (TTS) who were found to have renal tubular dysgenesis (TRD)-like lesions and hypocalvaria attributed to indomethacin treatment of the mother for acute polyhydramnios. History of pregnancy, postnatal clinical course, pathological findings of the kidneys, and the skulls are presented and discussed. These findings include incompletely differentiated proximal tubules in the kidneys and hypoplastic calvaria in both twins. The renal tubular lesions were more marked in the donor than in the transfused twin, probably due to the greater degree of ischemia in that twin. This seems to be in favor of a vascular etiology of the renal defects. However, the fact that similar renal lesions and hypocalvaria were also present in the transfused twin seems to indicate that indomethacin played a role in their onset. This so-called kidney-skull connection has never been reported in conjunction with indomethacin therapy.

[Abduction of pelvic members and pelvic girdle kinematics]. / Abduction des membres pelviens et cinématique de la ceinture pelvienne.

The analysis of the displacement of the pelvic girdle, during movements of the trunk in the anatomical orthogonal plans, was carried out by the technique of the cutaneous markers on two series of 7 male subjects and 7 female. The photographs made it possible to objectify angular displacements of reliable singular points and to observe that the abduction of hips determines, according to movements carried out, either a facilitation, or a limitation of displacements observed similar in the two series. The precise mechanism of these variations will have to be analyzed by later studies.

[Segmental absence of colonic muscularis propria. Report of a case in an adult]. / Absence segmentaire de musculeuse colique. A propos d'un cas chez l'adulte.

We report a case of segmental defect of colonic muscularis propria revealed by perendoscopic perforation in a 64-year-old woman. Segmental absence of intestinal musculature is well documented in new-borns and infants and is more frequent in small bowel. It is characterized by localised absence of muscularis propria without fibrous scar. The remaining layers of the bowel wall are intact. The pathogenesis of this lesion is discussed.

Arterial vascularization of the gastrointestinal tract in Macaca fascicularis (cynomologus monkey).

We describe the origin, course, and distribution of the arteries responsible for vascularization of the subdiaphragmatic gastrointestinal tract of Macaca fascicularis as well as the characteristics of the celiac trunk and the superior and inferior mesenteric arteries, studied in a series of 50 animals. Detailed knowledge of these systems is an essential requirement if experimental surgery is to be successfully performed in these laboratory animals.

Meckel's cartilage in the human embryo and fetus.

This work studied the development of the ventral part of Meckel's cartilage in a series of human embryos (classified in stages) and fetuses. These stages appeared particularly important: stage 16, appearance of Meckel's cartilage; stage 20, beginning of membranous ossification of mandible; and stage 23, end of the embryonic period (8th week). The primitive bony nodule which develops from the embryonic mesenchyme appears as a double bony layer forming a groove containing the neurovascular bundle, into which the dental lamina is also invaginated. It was concluded that during the fetal period, the cartilage participates in the formation of the body of the mandible in an area close to the mental foramen via endochondral ossification. The cartilage disappears in parallel with the development of ossification by the sixth month.

Relations between Meckel's cartilage and the morphogenesis of the mandible in the human embryo.

Based on a series of human embryos classified in stages, the authors studied the evolution of Meckel's cartilage in its ventral portion and its relations to the morphogenesis of the mandible. Three stages appeared particularly important: stage 16, appearance of Meckel's cartilage; stage 20, beginning of membranous ossification; and stage 23, end of the embryonic period (8th week). The primitive bony nodule which develops from the embryonic mesenchyme appears as a double bony layer forming a groove containing the neurovascular bundle, into which the dental lamina is also invaginated.

[Digestive system metastases from breast cancer. Report of two cases]. / Métastases digestives des carcinomes mammaires. A propos de deux observations.

We have reviewed two unusual cases of gastrointestinal metastases from a primary breast carcinoma. The first case was an unexpected microscopic discovery of metastases in an inguinal hernia sac, eleven years after the patient had surgery for breast carcinoma. The second case was a rectal localization from a unknown breast carcinoma. The incidence of gastrointestinal metastasis from breast carcinoma is underestimated because they have a long latency and screening is difficult. Histologically they are predominantly of the lobular type and the differential diagnosis from a primary gastrointestinal malignancy can be difficult. A wider knowledge of gastrointestinal metastases from primary breast carcinoma is important because an appropriate management allows a long survival period.

The relationship between Meckel's cartilage and the development of the human fetal mandible.

This work studied the development of the ventral part of Meckel's cartilage and its relationship to the morphogenesis of the mandible in a series of human fetuses. The development of the cartilage was followed up to the end of the embryonic period (stage 23, 8th week) when the primary ossification centre, which was formed from a condensation of embryonic mesenchyme, had become two bony plates forming a trough in which lay the neurovascular bundle. From this trough invagination of the bony plate formed the dental crypt. The primary ossification centre disappeared around the sixth month of fetal life.