Bioactive glass (S53P4) as obliteration material in subtotal petrosectomy: initial experience.

BACKGROUND: Subtotal petrosectomy for chronic suppurative otitis media requires obliteration of the mastoid cavity and middle ear. Usually, abdominal fat is used for this purpose. However, infection is a risk of using fat, which might require revision surgery. The use of S53P4 bioactive glass with antibacterial properties seems an attractive alternative. METHODS: Two patients with a history of chronic suppurative otitis media, complicated by profound perceptive hearing loss, had already been surgically treated, and were thereafter extensively treated conservatively. Because of recurrent chronic otorrhoea and pain, subtotal petrosectomy with obliteration of the cavity with S53P4 bioactive glass was performed. RESULTS: Follow-up duration was 84 months and 18 months, respectively. No complications occurred peri-operatively. A dry ear was obtained and no late adverse events were observed. CONCLUSION: S53P4 bioactive glass is feasible to use for obliteration after subtotal petrosectomy. Elimination of chronic suppurative otitis media can be achieved with this technique. The bioactive glass granules might be an attractive alternative to abdominal fat, which has a risk of infection.

Oral Health-related quality of life after coronectomy for impacted mandibular third molar in the first postoperative week.

BACKGROUND: Coronectomy of a mandibular impacted third molar is a surgical treatment to minimize the risk for inferior alveolar nerve damage. We aimed to determine whether this procedure affected the oral health-related quality of life (OHRQoL) within the first postoperative week. MATERIAL AND METHODS: This prospective study included 50 patients that underwent a coronectomy for an impacted mandibular third molar. The patients completed the Oral Health Impact Profile-14 (OHIP-14) questionnaire and questions about pain and analgesic intake on every day during the first postoperative week. RESULTS: Mean OHIP-14 scores were highest during the first three postoperative days; the highest mean score (26.40, SD: 8.67) was observed on the first postoperative day. Mean OHIP scores gradually declined during the first postoperative week, and the mean OHIP-14 score was 9.82 (SD: 9.15) on the seventh day. Physical pain was the highest contributor to the overall OHIP-14 score. Pain gradually declined with time; the lowest mean pain score (3.38, SD: 2.2) was observed on the seventh day. OHIP-14 and pain scores were not significantly different between sexes or between different grades of impaction. OHIP-14 scores were positively correlated with pain scores. CONCLUSIONS: A mandibular third molar coronectomy had a strong effect on patient OHRQoL, particularly during the first three postoperative days.

Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal.

In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0-15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case-control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04-1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13-8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course.

A comparative study of the Osstell™ versus the Osstell Mentor™ to evaluate implant stability in human cadaver mandibles.

The aim of this study was to assess the primary stability of dental implants by resonance frequency analysis (RFA) using the Osstell™ and Osstell Mentor™ devices and to investigate the reproducibility and comparability of the results obtained with these devices. Twenty-four Straumann implants (Straumann AG, Basel, Switzerland) were placed in the anterior mandible of 12 fresh edentulous human cadaver mandibles. The implant stability quotients (ISQs) were measured with the Osstell™ and Osstell Mentor™ when implants were inserted at 50% of their length and following their complete insertion. The Osstell™ device measured lower scores compared with the Osstell Mentor™. This was significant for the full position (mean difference = 9·9), t (11) = 7·4, P < 0·001 and for the halfway position (mean difference = 5·9), t (11) = 2·41, P = 0·03. In conclusion, the Osstell™ produced relatively lower ISQ scores than the Osstell Mentor™.

The internal responsiveness of the Oral Health Impact Profile-14 to detect differences in clinical parameters related to surgical third molar removal.

PURPOSE: The present study examined the internal responsiveness of the short-form Oral Health Impact Profile (OHIP-14) and its ability to differentiate between patients with and without pre- and postoperative complaints as well as other clinical variables. METHODS: The sample consisted of 97 patients undergoing surgical third molar removal. The OHIP-14 was filled in preoperatively, on each postoperative day for a week and once more after 1 month. In addition, pre- and postoperative status was measured along with other clinical variables. RESULTS: The OHIP-14 is able to differentiate between the first preoperative day (M = 16.85, SD = 5.35) and all the days within the postoperative week (first day M = 29.46, SD = 9.32). One month postoperatively, mean OHIP scores are reduced to preoperative levels. In addition, differences could be shown between patients with and without pre- (M = 18.9, SD = 8.1 vs. M = 16.2, SD = 3.9) and postoperative complaints (M = 18.9, SD = 8.1 vs. M = 16.2, SD = 3.9), partial (preop; M = 17.8, SD = 6.8, postoperative; M = 27.4, SD = 7.7) and complete mucosa coverage (preop; M = 15.9, SD = 3.2, postoperative; M = 29.5, SD = 10.6) and the level of impaction (Pell and Gregory classification) of the third molar (3B showing the highest increase in the mean OHIP score). CONCLUSIONS: The OHIP-14 can be considered internally responsive to changes in impacts of oral conditions as a result of surgical third molar removal and is able to differentiate the effect of several clinical variables.

[Nontuberculous mycobacterial lymphadenitis]. / Niet-tuberculeuze mycobacteriële lymfadenitis.

A 4-year-old girl was referred with a chronically enlarged left cervical lymphadenitis of the neck. This swelling appeared to be caused by a Mycobacterium avium infection. Mycobacterium avium belongs to the group of nontuberculous mycobacteria. These micro-organisms can cause a cervicofacial lymphadenitis in children in the head and neck region. The children are healthy, and are seen to have a submandibular or preauricular swelling. Early recognition of the disease is important because it gives the best chance that treatment will result in a successful outcome.

[Traumatic ulceration of the tongue in an infant]. / Een traumatisch ulcus van de tong bij een zuigeling.

A 6-month-old baby was referred to an oral and maxillofacial surgeon due to an ulcer that had not healed. The diagnosis was Riga-Fede. The disease is also known as traumatic oral granuloma and is characterized by traumatic ulcerations on the tongue or lower lip. The lesions are caused by repeated trauma of the mucous membrane by emerging teeth in infants, especially the lower incisors. Early recognition of the disease is important because it has been associated with neurological abnormalities. A delayed or incorrect diagnosis or inadequate therapy can result in permanent deformity of the tongue, the floor of the mouth and the lower lip, nutritional insufficiencies, and can, in the longer-term, inhibit growth.

Amplified fragment length polymorphism analysis of human clinical isolates of Mycobacterium haemophilum from different continents.

The role of the species Mycobacterium haemophilum as a pathogenic non-tuberculous microorganism is becoming better defined with the use of specific detection methods. However, epidemiological investigations of this species are still scarce. We analysed the genetic diversity of M. haemophilum by amplified fragment length polymorphism (AFLP) typing and compared isolates from different parts of the world. In total, 128 isolates, including 41 from the USA, 51 from Australia, 28 from Europe and eight from Israel were compared using AFLP methodology. Two restriction enzymes (MseI and EcoRI) and one selective primer were applied and provided a high discriminatory power. Clusters of isolates with identical AFLP patterns, which could indicate a possible common source, were observed from the Netherlands, New York and Australia. No clear clustering on the basis of continental origin was observed; however, types were restricted to geographical areas and not found on other continents. A high genetic stability within the species was demonstrated by the long-term existence of a single type.

Cellulose microfibril deposition: coordinated activity at the plant plasma membrane.

Plant cell wall production is a membrane-bound process. Cell walls are composed of cellulose microfibrils, embedded inside a matrix of other polysaccharides and glycoproteins. The cell wall matrix is extruded into the existing cell wall by exocytosis. This same process also inserts the cellulose synthase complexes into the plasma membrane. These complexes, the nanomachines that produce the cellulose microfibrils, move inside the plasma membrane leaving the cellulose microfibrils in their wake. Cellulose microfibril angle is an important determinant of cell development and of tissue properties and as such relevant for the industrial use of plant material. Here, we provide an integrated view of the events taking place in the not more than 100 nm deep area in and around the plasma membrane, correlating recent results provided by the distinct field of plant cell biology. We discuss the coordinated activities of exocytosis, endocytosis, and movement of cellulose synthase complexes while producing cellulose microfibrils and the link of these processes to the cortical microtubules.

Lymphadenitis in children is caused by Mycobacterium avium hominissuis and not related to 'bird tuberculosis'.

Mycobacterium avium is the most commonly encountered mycobacterium species among non-Mycobacterium tuberculosis complex (nontuberculous mycobacteria) isolates worldwide and frequently causes lymphadenitis in children. During a multi-centre study in The Netherlands that was performed to determine the optimal treatment for mycobacterial lymphadenitis, concern was expressed in the media about the possible role of birds as sources of these M. avium infections, referred to as 'bird tuberculosis.' To examine the involvement of birds in mycobacterial lymphadenitis, 34 M. avium isolates from lymphadenitis cases were subjected to IS1245 restriction fragment length polymorphism (RFLP) typing. This genotyping method enables the distinction of the subspecies M. avium subsp. hominissuis and the 'bird-type' M. avium spp. avium. Highly variable RFLP patterns were found among the lymphadenitis M. avium isolates, and all belonged to the M. avium hominissuis subspecies. A relation to pet birds in the etiology of mycobacterial lymphadenitis could not be established, and the source of the infections may be environmental.

The assessment of the gingival capillary density with orthogonal spectral polarization (OPS) imaging.

OBJECTIVE: In this study we evaluated the inter-observer agreement in the assessment of gingival capillary density using Orthogonal Polarization Spectral Imaging. METHODS: In this study gingival capillary density of 100 healthy subjects was determined by 2 independent observers. Agreement was quantified by calculation of the mean differences between the observers and the standard deviation of this difference and the limits of agreement. Reliability was quantified by means of the intraclass correlation coefficient (ICC). RESULTS: Fifty males and 50 females were included in the study. The mean age for males was 20+/-1.2 years and for females 20+/-1.4. OPS images showed remarkable good quality images of the gingival microcirculation. The interclass correlation between the 2 observers was 0.63 while the interclass correlation for the 6 measurements in observer 1 was 0.95 and 0.94 for observer 2. The mean capillary density for females in observer 1 was 83.69+/-16.4 and 83+/-16.0 in observer 2, versus 60.55+/-12.3 for observer 1 and 60.4+/-12.1 for males. The mean quantitative functional capillary density in male students was 60.48+/-10.7, compared to 83.45+/-13.5 in female students. CONCLUSIONS: OPS imaging enabled for the first time direct in vivo visualization and quantification of human functional gingival capillary density in healthy medical students. The inter-observer agreement was found to be good to fair on the quantification of gingival capillary density between the two independent observers. The intracorrelation coefficient (0.95) was excellent when assessing the reliability of one observer.

Increased cortical atrophy in patients with Alzheimer's disease and type 2 diabetes mellitus.

BACKGROUND: The risk of Alzheimer's disease (AD) is increased in type 2 diabetes (DM2). This increased risk has been attributed to vascular comorbidity, but other mechanisms, such as accelerated ageing of the brain, have also been implicated. OBJECTIVE: To determine whether AD in patients with DM2 is associated with an increased occurrence of vascular lesions in the brain, by increased cerebral atrophy, or a combination of both. METHODS: In total, 29 patients with AD and DM2 and 58 patients with AD and without DM2 were included in the study. Clinical characteristics were recorded, and a neuropsychological examination and magnetic resonance imaging (MRI) scan were performed. MRI scans were rated for cortical and subcortical atrophy, medial temporal lobe atrophy, white matter lesions, and infarcts. RESULTS: The neuropsychological profiles of the two groups were identical. Patients with AD and DM2 had increased cortical atrophy on MRI (p<0.05) compared with the non-DM2 group. In addition, infarcts were more common (odds ratio 2.4; 95% CI 0.8 to 7.8), but this effect did not account for the increased atrophy. The other MR measures did not differ between the groups. CONCLUSION: The results suggest that non-vascular mechanisms, leading to increased cortical atrophy, are also involved in the increased risk of AD in DM2.

A randomized prospective controlled trial of antibiotic prophylaxis in intraoral bone-grafting procedures: preoperative single-dose penicillin versus preoperative single-dose clindamycin.

In this comparative study, 150 consecutive patients undergoing local intraoral bone grafting randomly received either an oral single dose of 600 mg clindamycin or 2 g of the penicillin phenethicillin 1 h before incision. Primary endpoint was wound infection at the receptor site within 8 weeks of surgery. Secondary outcome measurements included postoperative infections at the donor site and adverse events as a result of antibiotic administration. Mean age of the patients was 36.8+/-12.7 years (range 18-67 years), and 98 patients were females (65.3%) and 52 males (34.7%). Infections at the receptor site were seen in 4 patients (5.3%; 95% CI 0.23-10.4%) of the phenethicillin group and in 2 patients (2.7%; 95% CI 0-6.36%) of the clindamycin group. In both groups, 3 patients had an infection at the donor site. Postoperative infections were predominantly caused by alpha-haemolytic Streptococci sensitive to penicillin. No significant difference was found between prophylactic single doses of phenethicillin and clindamycin with regard to postoperative infection in patients undergoing local bone augmentation procedures.

The role of preoperative prophylactic antibiotic administration in periapical endodontic surgery: a randomized, prospective double-blind placebo-controlled study.

AIM: To determine the value of clindamycin prophylaxis in the prevention of postoperative wound infections in patients undergoing endodontic surgery. METHODOLOGY: This study included 256 patients undergoing endodontic surgery in a prospective double-blind placebo-controlled trial comparing oral administration of an oral placebo versus a preoperative 600 mg dose of clindamycin. After randomization the study medication was administered orally 1 h before surgery in a double-blind fashion. For a period of 4 weeks the postoperative course was observed according to clinical parameters of infection. Primary end-point was infection at the surgical site. RESULTS: The mean age of the study population was 44.4 years (SD 11.4, range 18-82 years) with a sex distribution of 147 females (47.4%) and 109 males (42.6%). Mean age of the patients in the clindamycin group was 44.7 years (SD 12.0), and the mean age in the placebo group was 44.1 years (SD 10.8) (P = 0.49). In the clindamycin group, the mean duration of surgery was 32.3 min (SD 8.8) and in the placebo group the mean duration of surgery was 32.5 min (SD 8.4) (P = 0.89). Two infections [1.6%; 95 confidence interval (CI): 0.48-4.72] were identified in the clindamycin group and four (3.2%; 95 CI: 0.42-1.33) in the placebo group (P = 0.448). CONCLUSIONS: No statistically significant difference was found between clindamycin prophylaxis and placebo with regard to the prevention of postoperative infection in endodontic surgical procedures.

Effect of smoking on the gingival capillary density: assessment of gingival capillary density with orthogonal polarization spectral imaging.

OBJECTIVES: Microvascular changes because of smoking are frequently presumed in models because of the negative effect of smoking portrayed on the microcirculation. We hypothesized that cigarette smoke might lead to a decrease in gingival capillary density. MATERIALS AND METHODS: Capillary density was assessed with orthogonal polarization spectral (OPS) imaging, a technique using special optics by which a virtual light source is created at a depth of 1 mm within the mucosa. The light is absorbed by haemoglobin, resulting in an image of the capillaries in negative contrast. The gingival capillary density was measured in 20 healthy male dental students with a mean age of 25. Ten of the students were smokers and 10 were non-smokers. In each subject six images of the right maxillary pre-molar region were obtained, and the mean gingival capillary density was determined through the use of K&K software technology. RESULTS: The mean capillary density in smokers was 69.3 +/- 8.9 capillaries per visual field compared with a mean capillary density in non-smokers of 60.6 +/- 5.4 (p=0.33). CONCLUSION: No significant differences were found between the gingival capillary density of smokers and non-smokers.

Brain atrophy and lesion load as explaining parameters for cognitive impairment in multiple sclerosis.

Multiple sclerosis (MS) is a multifocal demyelinating disease of the central nervous system, with lesions widespread through the brain and spinal cord. An important manifestation is cognitive impairment, which, though difficult to measure, may have a major social impact. To better understand the relationship between structural tissue damage and cognitive impairment, we examined the extent and spatial distribution of brain lesions, as measured by magnetic resonance imaging (MRI), in relation to abnormal cognitive performance as measured by the Brief Repeatable Battery (BRB) in 82 MS patients. Possible confounders, like fatigue, pain and depression were also assessed. Brain MR image analysis included hyperintense T2 and hypointense T1 lesion load in the whole brain and the four lobes separately, as well as whole brain volume measurements. Cognitive impairment (defined as more than two abnormal tests) was found in 67% of the patients. Moderately strong correlations were found between the subtests of the BRB and the lesion loads in the brain regions hypothesized to be associated with that cognitive test, although these correlations were in general not much stronger than those between the subtests and the overall lesion load (due to strong interrelationships). The Spatial Recall Test correlated best with parietal lesion load; the Symbol Digit Modalities Test, the Paced Auditory Serial Addition Task (PASAT) and the Word List Generation best with frontal, parietal and temporal lesion load; while the Verbal List Generation Test Index correlated only with atrophy. Atrophy and lesion load were the main factors determining the test scores, explaining 10-25% of the variance in the test results, and were more important than fatigue, pain and depression; only depression had a minor, but significant, additional effect on the PASAT. In conclusion, cognitive impairment in MS is moderately dependent on amount (and distribution) of structural brain damage, especially in the more physically impaired patients group.

Biomarker profiles and their relation to clinical variables in mild cognitive impairment.

The aim of the study was to compare clinical variables between MCI patients at different risk for Alzheimer's disease (AD) according to their biomarker profile. Fifty-four percent out of 39 MCI patients had a low Abeta42 and high tau in cerebrospinal fluid (CSF) (high-risk), 26% either a low CSF Abeta32 or high CSF tau (intermediate-risk) and 20% a normal CSF Abeta42 and tau (low-risk). Both high-and intermediate-risk subjects differed from the low-risk group in episodic memory, executive functions and the preclinical AD scale (PAS),which combines a set of clinical parameters. Subjects at high risk did not differ from subjects with an intermediate risk. Abeta42 levels correlated with the MTA and PAS scores, tau levels with episodic memory. These correlations suggest that the biomarkers are not independent when compared to the other AD markers. Longitudinal studies are necessary to interpret the correlations between biomarkers, imaging, and neuropsychological markers.

Traditional contrast echocardiography may fail to demonstrate a patent foramen ovale: negative contrast in the right atrium may be a clue.

We describe a patient who suffered a stroke of unknown origin and presented a patent foramen ovale (PFO) at contrast echocardiography. This PFO was clearly detectable after contrast delivery in the femoral vein, while repeated contrast delivery in an antecubital vein only showed a negative contrast effect, which suggests that the blood crossing the PFO originated from the vena cava inferior. However, enhanced detection of a PFO by femoral contrast delivery, compared to antecubital injection has been published many years ago, this mode is not widely implemented yet. With this case report we would like to illustrate that the negative contrast effect may be used as an indicator that a PFO cannot be excluded and a switch to femoral contrast injection is then mandatory.