Prader-Willi syndrome: Periodontal-prosthodontic rehabilitation in an adult patient.

INTRODUCTION: Prader-Willi syndrome (PWS) is a rare genetic multisystemic disease that is the most common inherited cause of severe childhood obesity. PWS patients are prone to significant oral and systemic health issues that detrimentally affect quality of life and decrease longevity. This report documents full-mouth pre-prosthetic surgical and restorative care in an adult PWS patient. CASE REPORT: The patient, a 29-year-old male, presented to the clinic accompanied by his guardians (parents) with the chief complaint that "My Teeth are breaking down and I would like to get them fixed". Periodontal and prosthetic comprehensive clinical and radiographic exams revealed a severely worn dentition, deep anterior overbite, altered passive eruption with generalized biofilm-induced gingivitis, and altered occlusal vertical dimension. Full mouth crown lengthening surgery combined with full mouth prosthodontic reconstruction was performed under parenteral sedation and local anesthesia. Completion of treatment was successful, and the patient was placed on a 3-month periodontal maintenance interval. DISCUSSION: Full mouth periodontal surgical and prosthodontic reconstruction on a PWS patient has not previously been reported in the literature. This case underscores the potential need for complex dental care in patients with this syndrome.

Ascites and Adnexal Mass with Raised CA125: How Arduous can be the Path of Diagnosis.

Ascites, adnexal mass and elevated CA125 levels almost always suggest advanced ovarian carcinoma. We present a case of a 37 years old multiparous lady who presented with such a classical picture. Radiological picture was suggestive of ovarian carcinoma with peritoneal metastasis. However, ascitic fluid cytology was negative for malignant cells. A differential diagnosis of tubercular mass was made. Ascitic fluid was sent for adenosine deaminase test that was negative. Fine needle aspiration cytology failed to reveal any sufficient sample for evaluation. Open laparotomy and biopsy was done that showed granulomas suggestive of tuberculosis. Category one anti tubercular treatment was started and symptoms resolved within one month.

The combination of sorafenib with transarterial chemoembolisation for hepatocellular carcinoma.

BACKGROUND: Standard of practice involves using transarterial therapy for multifocal hepatocellular carcinoma (HCC) alone and sorafenib only for more advanced HCC, but the sorafenib and transarterial therapy combination may provide greater efficacy. AIM: To evaluate the safety and efficacy of concurrent sorafenib and transarterial therapy in HCC. METHODS: Consecutive cases of HCC were treated with sorafenib and transarterial therapy, receiving sorafenib 2 to 4weeks before transarterial therapy. Baseline clinical parameters, adverse events (AEs) and survival were collected. RESULTS: A total of 47 patients received sorafenib and transarterial therapy. The majority of the patients were male (70%) with HCV (60%), median age of 60years, good performance status (0-1), stable cirrhosis (Child: A 72%; B 28%), unresectable tumour (stage: B 81%; C 19%) and median AFP of 24ng/mL. Median follow-up was 12months and median time on sorafenib was 6months. LC Bead TACE was used with a median frequency of 3. The majority of the patients (89%) experienced AEs. The most common AEs were fatigue (51%), hand-foot skin reaction (51%) and diarrhoea (43%). Grade 3 and 4 AEs included fatigue (13%) and hand-foot skin reaction (26%). Most patients required a dose reduction (66%). The main AE related to transarterial therapy was post-TACE syndrome (23%). The disease control rate was 68% at 6months. Overall median survival rate was 18.5months (95% CI 16.1-20.9months). CONCLUSION: Concurrent sorafenib and transarterial therapy is overall safe with no unexpected side effects and encouraging efficacy that warrants further study.