[MRI of hippocampal malformations in patients with intractable temporal lobe epilepsy]. / IRM des malformations de l'hippocampe dans l'épilepsie temporale réfractaire.

OBJECTIVE: In some patients with temporal lobe epilepsy, recent MRI studies have revealed several morphological features indicative of discrete hippocampal malformation (HM). Its prevalence is unknown and the relationship between the HM and the origin of seizures has never been investigated. Our purpose is to define the MRI findings of this new entity and to determine its incidence in a group of patients and in a control group in order to evaluate its clinical significance. MATERIALS AND METHODS: MR imaging findings in 97 patients suffering from medically intraceable temporal epilepsy were prospectively evaluated during the preoperative evaluation of surgical candidates. The MR-imaging protocol included oblique coronal slices perpendicular to the temporal lobes using high resolution T2 weighted (HR TSE T2), Fluid attenuated inversion recovery (FLAIR) and inversion-images. This protocol has been completed by axial FLAIR images and axial and sagittal IR images of the whole brain. Coronal HR TSE T2 images were performed in 50 healthy control subjects. Cerebral lesion and hippocampal morphology were evaluated in both groups. RESULTS: Fourteen patients (14%) showed hippocampal morphological modification. The most frequent and specific findings were lack of visualization of the internal hippocampal (lack of linear T2 hypointensity within the hippocampus) and the abnormal shape (pyramidal, vertically oriented or globular-shaped). Other signs were: abnormal position of the hippocampus (medically located hippocampus) and vertical collateral sulcus. Cases without visualization of the internal structure of the hippocampus were considered as a complete form of HM and were correlated with temporal epilepsy. A vertical collateral sulcus was observed in some control group subjects. CONCLUSION: Complete forms of HM could be considered as epileptogenic lesions. Nevertheless, interpretation of the incomplete form is delicate: the abnormal angle of the collateral sulcus can be encountered in healthy subjects and could therefore be considered a normal variant.

The ethical responsibility of professional autonomy.

Dentistry has historically been practiced autonomously, and many dentists place a high value on professional independence. This article outlines the conceptual basis for professional autonomy and asserts that dentists can retain independence only by aligning values with patients and remaining trustworthy in the eyes of the public.

Reflection, introspection, and communication: a psychologist's view of dental ethics.

A psychologist with experience teaching ethics in dentistry observes that ethical practice involves three skills: reflection (to understand the ethical issue), introspection (to discover the forces for action), and communication (to carry ethics into action). Several short cases are presented showing how ethical communication can be difficult. Direct communication (what psychologist call confrontation) is recommended and some tips are offered.

The hepatitis B e-antigen positive dental school applicant.

There are few guidelines available for dental school faculty and administrators in the management of hepatitis B e-antigen positive (HBeAg+) dental school applicants. It is apparent that this serostatus is unique and requires a different approach from that used for applicants with other infectious diseases, such as the human immunodeficiency virus (HIV). The issue is examined from a number of perspectives, including the science, policy, legal, and ethical considerations confronted in establishing a policy for the HBeAg+ dental school applicant.

A trans STT, trans capitate perilunate dislocation of the carpus. A case report.

We report a case of carpal injury not previously described, associating three lesions of the carpus secondary to a hyperextension mechanism: fracture of the capitate, scapho-trapezio-trapezoid sprain and lunotriquetral ligament rupture. The patient was operated by percutaneous pinning after closed reduction. The capitate fracture was not fixed. At follow-up, the patient had no restriction of his everyday activities and was very satisfied.

Response to unethical behavior in oral health care.

By establishing appropriate "rules for discussion," it was possible for a diverse group of professionals involved in oral health care to reach agreement on several aspects of defining, confronting, and preventing unethical behavior. A set of specific recommendations is offered, centered in the perspective that patient well-being is paramount.

[Fracture of the scaphoid carpal bone secondary to an intraosseous cyst. Apropos of a case]. / Fracture du scaphoïde carpien sur kyste intra-osseux. A propos d'un cas.

The authors report a cases of scaphoid fracture secondary to an intraosseous cyst in a young patient performing a high-risk sport. Intraosseous synovial cyst is a frequent and usually asymptomatic disease. Its aetiology remains controversial. No cases of fracture have been previously described. Our patient may have presented several risk factors for scaphoid fracture secondary to a synovial cyst.

Practical ethics in the managed care era.

The dentist of the '90s will have to be a highly competent clinical ethicist to thrive in and feel good about dentistry. Ethics is often mistaken by dental professionals and students to be a dull, dry recounting of the things they must avoid to stay out of trouble. This article points out that ethical reflection is interesting and, on a practical level, essential to both practitioner and patient. Much is new to the dentist in this area, as biomedical ethics have evolved a great deal in the past few years. What follows is an outline of basic normative theory, a discussion of practical modern issues, and some psychological reflection on putting good decisions into action.

Sepsis due to coryneform group A-4 in an immunocompromised host.

Corynebacteria are more commonly being recognized as significant human pathogens. We describe a case of Coryneform group A-4 sepsis secondary to infection of a Hickman catheter in an immunocompromised man; the organism was identified by biochemical analysis conducted at the Louisiana State Reference Laboratory.

Guidelines for the administration of local anesthesia in fearful dental patients.

Fear of dentistry is a major problem for patients and dentists. Fear of local anesthetic injections is one of the most common fears reported by dental patients. It is imperative that local anesthetic injections be administered to dental patients in the context of treatment of the patient's fear. To try to "get through" the injection without addressing the patient's fear is to risk perpetuating or increasing the fear and missing an opportunity to help patients overcome their fear of dentistry. This article describes principles for treatment of dental fear. An injection technique is described that can be used in conjunction with the treatment of a patient's fear and represents a part of that treatment. This "low pain and anxiety" injection technique can be used with any patient.