Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria.

The aim of this study was to perform a critical review of published data on the epidemiological, aetiological, clinical, histological, biological, and therapeutic characteristics of patients with angina bullosa haemorrhagica (ABH). A literature search was conducted in the PubMed, Science Direct, Web of Science, and Cochrane Library databases. All publications fulfilling the selection criteria were included in the eligibility assessment according to the PRISMA statement. The full texts of 54 retrieved articles were screened. Forty articles published between 1985 and 2016 describing 225 cases of ABH were finally selected. The mean age of the patients was 55.4 years; the male to female ratio was 0.7. The predominant localization was the palate (66%). A third of patients had no medical history. When specified, a triggering event or promoting factor was frequently found (82%). Biological tests were normal. A biopsy was performed on 35% of the patients. Treatment was symptomatic with a favourable outcome. Recurrences were frequent (62%). In conclusion, ABH is poorly documented and only by studies of low-level evidence. This review did not allow any aetiopathogenic association to be made with a general pathology or treatment. On the basis of this systematic review of the literature, diagnostic criteria aiming to improve the care of patients presenting with ABH are proposed.

Dental implant surgery in patients in treatment with the anticoagulant oral rivaroxaban.

OBJECTIVES: The aim of this study was to evaluate the incidence of bleeding complications after dental implant placement in patients in treatment by the anticoagulant oral rivaroxaban without interrupting its administration or modifying dosage. MATERIALS AND METHODS: About 57 patients were divided into two groups: 18 had been in treatment by rivaroxaban for over 6 month before implant surgery and a control group consisted of 39 healthy subjects. All subjects received dental implants in different positions, without interrupting or modifying rivaroxaban dosage. Patients were treated in an outpatient setting. Non-absorbable sutures were used, and all patients were given gauze impregnated with tranexamic acid 5%, to bite on for 30-60 min. RESULTS: One rivaroxaban patient presented moderate bleeding the day after surgery, and two control patients presented moderate bleeding the day after and on the second day. Bleeding was managed with gauzes impregnated with tranexamic acid. No statistically significant differences (P = 0.688) were found in relation to bleeding episodes between the groups, with a relative risk = 0.919 based on the pooled groups and 95% confidence interval of 0.078-10.844. CONCLUSIONS: Dental implant surgery in patients taking the anticoagulant oral rivaroxaban can be performed safely in outpatients departments applying local hemostatic measures without the need to modify or interrupt anticoagulant medication.

[Acquired hemophilia A. A monocentric retrospective study of 39 patients]. / Hémophilie A acquise. Étude d'une série rétrospective monocentrique de 39 patients.

PURPOSE: Acquired haemophilia A (AHA) is a rare bleeding disorder, due to the presence of an inhibitor directed against factor VIII (FVIII). About 50% of the AHA are idiopathic, while the remaining 50% are related to an underlying disorder or condition (autoimmune diseases, malignancies, postpartum, etc.). PATIENTS AND METHODS: We report on a monocentric retrospective cohort of 39 patients with AHA. Data were collected and compared to recent published data. RESULTS: Thirty-nine patients were admitted for AHA between 1993 et 2011. Mean age at diagnosis was 71.3 years, and we noted a marked male predominance. Although the majority of patients presented a bleeding event at diagnosis (94.9%), the hemorrhagic mortality was low (2.6%). On the contrary, immunosuppressive morbidity and mortality were high in this elderly population. There was a clear correlation between initial FVIII inhibitor titer and complete remission delay. We did not identify prognostic factor for global survival. CONCLUSION: AHA is a rare but potentially fatal disorder. Rapidity of diagnosis and treatment initiation is crucial. Morbidity and mortality, particularly of infectious cause, due to immunosuppressive treatment, should lead to consider other available therapeutical options.

Risk of postoperative bleeding after dental procedures in patients on warfarin: a retrospective study.

OBJECTIVES: The purpose of this retrospective study was to investigate the frequency of bleeding complications after invasive dental procedures in warfarinized patients and the possible risk factors. STUDY DESIGN: The CoaguChek System was used to obtain an in-office international normalized ratio (INR) value for 122 patients (240 appointments), of which the mean age was 57.0 ± 15.9 years and 50% were males. Demographic and clinical information were obtained retrospectively from dental and medical records. RESULTS: Five episodes (mean INR: 2.0 ± 0.8) of persistent bleeding were identified; 4 were after extractions and 1 was after implant placement. The frequency of bleeding was 4.8%, if only considering surgical procedures. Postoperative bleeding was significantly higher (P < .05) in patients who were taking anti-thrombotic medications in addition to warfarin. CONCLUSIONS: There is a low incidence of persistent bleeding after invasive dental procedures in warfarinized patients but the risk appears to increase with the use of concomitant anti-thrombotic medications.

Hemoptisis amenazante: estudio de 154 pacientes / Life-threatening hemoptysis: study of 154 patients

Fundamento y objetivo: La hemoptisis amenazante (HA) es una emergencia médica cuya historia natural no está bien definida. El objetivo de este estudio fue evaluar la etiología, los procedimientos realizados y la evolución de la HA en un hospital universitario. Pacientes y método: Estudio prospectivo en el que se incluyeron en un protocolo 154 pacientes ingresados por HA durante 3 años consecutivos. Se realizaron técnicas broncoscópicas y angiográficas según criterio del médico que les atendía. Se siguió la evolución de los pacientes durante 5 años tras el episodio de HA. Resultados: Un 79,2% eran varones. La edad media (DE) fue de 57 (15) años. La etiología más frecuente fueron las bronquiectasias, la tuberculosis activa y sus secuelas. Un 4,5% de pacientes fallecieron a consecuencia de la HA. La broncoscopia se mostró más segura en la localización del sangrado que la arteriografía cuando las exploraciones se realizaban durante la hemoptisis (84,2 frente a 20,4%) (p<0,001). Cuando la embolización o la broncoscopia se utilizaron como primera medida, durante el ingreso la primera estabilizó el sangrado con mayor eficacia que la segunda (87 frente a 53,5%) (p<0,001). Se produjeron un 10,7% de recidivas de HA, menos frecuentemente cuando la embolización había sido efectuada. Conclusiones: Las bronquiectasias y la tuberculosis fueron las causas más frecuentes. Mientras la broncoscopia durante la hemoptisis se mostró eficiente en localizar el origen del sangrado, la embolización arterial fue más eficaz en su estabilización tanto a corto como a largo plazo (AU)

Background and objectives: The natural history of life-threatening hemoptysis (LTH), a medical emergency, is ill defined. The objective of the study was to evaluate, in a university teaching hospital setting, the etiology, methods used, and evolution of LTH. Patients and methods: Prospective study in which we enrolled 154 patients admitted for LTH over 3 consecutive years. Bronchoscopy and arteriography procedures were performed, as prescribed by the attending physician. Patient evolution was followed 5 years post-event. Result: 79.2% were male. Average age was 57 (SD 15) years. Bronchiectasis and active tuberculosis and its consequences were the predominant etiologies. A total of 4.5% patients died as a result of LTH. Bronchoscopy was more effective in identifying the bleeding than arteriography when the examination was performed during an episode of hemoptysis (84.2 versus 20.4%) (P<.001). When embolization or bronchoscopy were used as first measure, embolization was more effective in stabilizing bleeding than bronchoscopy (87 versus 53.5%) (P<.001) in admitted patients. LTH relapse was 10.7%, while it was lower with embolization. Conclusions: Leading causes were bronchiectasis and tuberculosis. While bronchoscopy during a hemoptysis episode was effective in identifying the source of the bleeding, artery embolization was more effective in stabilizing the patient both at the short and long term (AU)

Clinical characteristics of dental emergencies and prevalence of dental trauma at a university hospital emergency center in Korea.

AIM: The aim of this study was to examine the clinical characteristics of dental emergency patients who visited a university hospital emergency center and to evaluate the incidence of dental trauma. MATERIALS AND METHODS: A retrospective chart review of patients with dental complaints and who visited the Seoul National University Bundang Hospital (SNUBH) emergency center in Gyeonggi-do, Korea, from January 2009 to December 2009 was conducted. Information regarding age, gender, the time, day, and month of presentation, diagnosis, treatment, and follow up was collected and analyzed. RESULTS: One thousand four hundred twenty-five patients with dental problems visited the SNUBH emergency center. Dental patients accounted for 1.47% of the total 96,708 patients at the emergency center. The male-to-female ratio was 1.68:1, with a considerably larger number of male patients (62.7%). The age distribution peak was at 0-9 years (27.5%), followed by patients in their forties (14.1%). The number of patients visiting the dental emergency center peaked in May (14.2%), on Sundays (22.4%), and between 2100 and 2400 h (20.8%). The patients' chief complaints were as follows: dental trauma, dental infection, oral bleeding, and temporomandibular joint disorder (TMD). The prevalence of dental trauma was 66%. CONCLUSIONS: The reasons for dental emergency visits included the following: dental trauma, dental infection, oral bleeding, and TMD, with 66% of the patients requiring management of dental trauma. It is important that dentists make a prompt, accurate diagnosis and initiate effective treatment in case of dental emergencies, especially dental trauma.

The epidemiology of oro-nasal haemorrhage and suffocation in infants admitted to hospital in Scotland over 10 years.

OBJECTIVE: To estimate the incidence of oro-nasal haemorrhage (ONH) and suffocation in infancy and to investigate their aetiology and overlap. Setting A 10-year retrospective hospital based study from Scotland, UK. METHODS: The hospital notes of all infants presenting with ONH or suffocation identified through the Information Services Division of the Scottish Health Service were reviewed by three paediatric consultants, two with child protection expertise. The hospital-based incidences of haemorrhages from different sites were calculated and the causes ascertained. When trauma was involved, a decision was made whether it was likely to have been accidental. RESULTS: 7 cases of suffocation and 88 of ONH were recorded at hospital discharge over 10 years. This gives an incidence of ONH of 1.62 (1.30 to 1.99)/10,000 live births (95% CI) which consists of haemorrhage arising from nose or mouth (N/M), n=65 (1.19/10,000 (0.92 to 1.52)); haematemesis, n=11 (0.20/10,000 (0.10 to 0.36)); haemoptysis, n=3 (0.06/10,000 (0.1 to 0.16)) and pulmonary haemorrhage, n=9 (0.17/10,000 (0.08 to 0.31)). No suffocation cases were recorded as having a coincident ONH, but five ONH cases were probably caused by airway obstruction. 40 of 65 cases of N/M were associated with trauma, which in 15 cases were thought to be probable abuse; four were associated with coagulation abnormalities. 2/3 haemoptysis cases, 2/11 haematemesis cases and 8/65 N/M cases were associated with a coincident respiratory tract infection, though in 4/8 of these cases, there was an associated apparent life-threatening event. CONCLUSIONS: Haemorrhage from the N/M is rare in infancy. Trauma is commonly involved and child protection concerns often poorly explored. Pulmonary haemorrhage and several cases of ONH were associated with probable airway obstruction. Information, in cases of ONH, is in general recorded badly, and an investigation and management plan are suggested.

Bleeding complications after oral surgery in outpatients with compromised haemostasis: incidence and management.

UNLABELLED: PURPOSE AND RESULTS: The aim of this prospective study was to determine the incidence of postoperative bleeding after oral surgery under local anaesthesia performed in outpatients with haemostatic disorders within a 5-year period (2003-2007). One hundred twenty one (70 males, 51 females) out of 2,056 outpatients with different haemostatic disorders (acquired or hereditary) were included in this study. The following data were recorded: medical history and general condition; medications; indication for the surgical procedure; specification of local anaesthesia; applied surgical techniques, considering the kind of haemostatic disorder; and peri- or postoperative bleeding complications. Postoperative bleeding was observed in 12 patients (9.9%). In three cases, inpatient treatment became necessary. The management of two patients with a haemostatic disorder (von Willebrand s disease and haemophilia A) is presented in short case reports. CONCLUSION: In a heterogeneous group of 121 outpatients with known haemostatic disorders, a combination of a few haemostatic agents with appropriate operative technique enables an effective wound management. In cases of failed local interventions after postoperative bleeding, further diagnostic investigations are required.

Sudden oronasal bleeding in a young child.

UNLABELLED: Sudden severe upper-airway obstruction occurring in a hospital setting can sometimes precipitate an episode of acute haemorrhagic pulmonary oedema. A review of 197 published case reports shows that the presenting feature is almost always the sudden appearance of blood stained fluid coming up through the larynx or out through the mouth and nose of an adult or child in obvious respiratory distress. Such overt features are seen in 10-15% of cases of sudden severe, but sub-lethal, upper-airway obstruction. Signs normally appear within minutes once the obstruction is relieved but are occasionally only recognized after 1-4 h. All signs and symptoms usually resolve within 12-24 h. Other causes of acute pulmonary haemorrhage are rare in young children. CONCLUSION: If what looks like blood is seen in, or coming from, the mouth or nose of a previously healthy young child who has suddenly become distressed and started to struggle for breath, that child has most probably suffered an episode of acute pulmonary oedema, and the commonest precipitating cause is sudden upper-airway obstruction.

Complicaciones de la cirugía ortognática: Hospital de San José de Bogotá 2004 - 2007 / Complications following orthognathic surgery: San José Hospital of Bogotá 2004 - 2007

Se presentan las complicaciones de la cirugía ortognática ocurridas en los pacientes intervenidos en el Hospital de San José de Bogotá, del 1º de enero de 2004 al 31 de mayo de 2007. Como no existía una evaluación estadística que diera una visión real de la situación de estos pacientes en el hospital, se realizó una revisión de las bases de datos de cada servicio y de las historias clínicas con el fin de describir las complicaciones más frecuentes y su desenlace. Se encontró que en dicho período fueron intervenidos 31 pacientes de los cuales 10 (32%) presentaron alguna complicación. La más frecuente fue la hemorragia (13%) que en la mayoría de los casos se manifestó como epistaxis, le siguieron en frecuencia el déficit neurológico y las alteraciones anatómicas (6.5% cada una). Solo hubo necesidad de reintervenir a un paciente (3.2%). La cirugía que presentó mayor número de complicaciones fue la bimaxilar. Se concluye que durante el período estudiado la cirugía ortognática realizada en el Hospital de San José de Bogotá presentó una alto porcentaje de complicaciones (32%) en comparación con lo reportado en la literatura que es de 6.4%, que se puede explicar por el bajo número de casos. Ninguna de las complicaciones revistió gravedad.

The aim of this study is to present complications following orthognathic surgery performed at the San José Hospital of Bogotá, between January 1, 2004 and May 31, 2007. As a statistic assessment on the real outlook on these patients did not exist in the hospital we reviewed the data bases and clinical records of various departments in order to describe the most common complications and their outcomes. Thirty-one patients underwent this type of surgical procedure during this period of time, of which 10 (32%) had complications. The most frequent was hemorrhage (13%) and presented as epistaxis in most cases, followed by neurological deficits and anatomic alterations (6.5% respectively). Only one patient (3.2%) required a second surgical procedure. Bimaxillary surgery had the highest number of complications. We conclude that during the studied period, orthognathic surgery performed at the San José Hospital of Bogotá had a high percentage of complications (32%) compared to those reported by published literature (6.4%) and may be explained by the low number of cases. No complication was potentially serious.

Blood contamination in children's saliva: prevalence, stability, and impact on the measurement of salivary cortisol, testosterone, and dehydroepiandrosterone.

The prevalence, stability, and impact of blood contamination in children's saliva on the measurement of three of the most commonly assayed hormones were examined. Participants were 363 children (47% boys; ages 6-13 years) from economically disadvantaged families who donated saliva samples on 2 days in the morning, midday, and late afternoon. Samples (n=2178) were later assayed for cortisol (C), testosterone (T), and dehydroepiandrosterone (DHEA). To index the presence of blood (and its components) in saliva, samples were assayed for transferrin. Transferrin levels averaged 0.37 mg/dl (SD=0.46, range 0.0-5.5, Mode=0), and were: (1) highly associated within individuals across hours and days, (2) positively correlated with age, (3) higher for boys than girls, (4) higher in PM than AM samples, and (5) the highest (>1.0 mg/dl) levels were rarely observed in samples donated from the same individuals. Transferrin levels were associated with salivary DHEA and C, but less so for T. As expected, the relationships were positive, and explained only a small portion of the variance. Less than 1% of the statistical outliers (+2.5 SDs) in salivary hormone distributions had correspondingly high transferrin levels. We conclude that blood contamination in children's saliva samples is rare, and its effects on the measurement of salivary hormones is small. Guidelines and recommendations are provided to steer investigators clear of this potential problem in special circumstances and populations.

[Hydrodissection for tonsillectomy. Results of a pilot study--intraoperative blood loss, postoperative pain symptoms and risk of secondary hemorrhage]. / Tonsillektomie in Hydrodissektionstechnik. Ergebnisse einer Pilotstudie--intraoperativer Blutverlust, postoperative Schmerzsymptomatik und Nachblutungsrisiko.

BACKGROUND: : Tonsillectomy is one of the most common procedures in head and neck surgery. Various techniques have been developed to reduce the risk of postoperative bleeding and postoperative pain. Water-jet technology has been designed for a gentle dissection of parenchymal organs. We report the results of a first pilot study using the water-jet technique for tonsillectomy.METHODS.: Water-jet-cutting tonsillectomy was compared with conventional blunt dissection tonsillectomy. 60 Patients were stratified in two groups within a preliminary prospective randomised study. Postoperative pain scores, frequency of postoperative bleeding and intraoperative blood loss were documented.RESULTS.: There was no difference in the average duration of the surgical procedure. The intraoperative bloodloss was markedly decreased in water-jet-cutting tonsillectomy. Postoperative bleeding and postoperative pain were decreased in the water-jet-cutting group.CONCLUSION.: The results of this pilot study demonstrate that water-cutting tonsillectomy is associated with less intraoperative bleeding, reduced frequency of postoperative bleeding events and with less postoperative pain.

Oral health is impaired in Behçet's disease and is associated with disease severity.

OBJECTIVES: This study aimed to investigate the oral health of Turkish patients with Behçet's disease (BD) and whether it is associated with the disease course. METHODS: One hundred and twenty patients with BD, 35 patients with recurrent aphthous stomatitis (RAS) and 65 healthy Turkish controls (HC) were included in the study. Oral health was investigated by indices applied in a BD out-patient clinic. RESULTS: The mean scores of plaque, sulcus bleeding and gingival indices, probing depth and the number of extracted teeth were observed to be higher in patients with BD and RAS compared to HC (P<0.05). In the linear regression analysis, plaque index score was associated with the presence of oral ulcers and male gender. An elevated plaque index score was observed to be a significant risk factor for increased severity score in patients with BD in the logistic regression analysis (P = 0.034). CONCLUSIONS: Oral health is impaired in BD and associated with disease severity. Improvement of the oral health of BD patients may affect their disease course, leading to a better prognosis.

Oral pyogenic granuloma in Jordanians: a retrospective analysis of 108 cases.

PURPOSE: The purpose of the present study was to retrospectively analyze the clinicopathologic features and treatment of oral pyogenic granuloma in Jordanian patients. PATIENTS AND METHODS: Information regarding 108 cases of pyogenic granuloma of the oral cavity that underwent biopsy were retrieved from the records of patients seen at the maxillofacial and periodontology units of the Faculty of Dentistry, Jordan University of Science and Technology, during an 11-year period from 1991 to 2001. Data were reviewed and analyzed for age, gender, site, treatment, and clinical and histopathologic features. RESULTS: Patient ages ranged from 3 to 85 years (mean, 30 years), with the greatest degree of occurrence (26.8%) in the second decade. The male-to-female ratio was 1:1.7. The mean age for females age was higher than that for males. The most frequently involved site was the gingiva (44.4%); other sites were the lips, tongue, buccal mucosa, and palate. Gingival pyogenic granulomas were more prevalent in the maxilla than in the mandible, with the anterior region of both jaws being more commonly affected. The labiobuccal gingiva of both jaws was more commonly affected. The main complaint was bleeding (59.3%), and almost half of the lesions had a pedunculated base, with surface ulceration in 9.2% of cases. The mean greatest granuloma diameter was 10 mm. All lesions were surgically excised, with 5.8% of cases known to have recurred. CONCLUSIONS: The clinicopathologic features of oral pyogenic granuloma in Jordanians are similar to those of other whites. In this series, we found that with surgical excision of pyogenic granuloma, there was a low recurrence rate.

Dental emergencies in a university-based pediatric dentistry postgraduate outpatient clinic: a retrospective study.

The purpose of this retrospective study was to determine the prevalence and types of dental emergencies occurring in a university-based, pediatric dentistry postgraduate outpatient clinic. All patients presenting for emergency dental care during scheduled clinic hours over a three year were identified, and their charts were retrieved. Each record was reviewed for demographic information, chief complaint and clinical diagnosis. Only those charts with both chief complaints and clinical diagnoses recorded were included in this study. A total of 816 patients received emergency care, representing 15.3 percent of all patient treated during the study period. The patient population had a slight female predilection (53 percent female, 47 percent male) and a mean age of 5.1 years (range 10 days to 15 years). Ethnicity (39 percent African-American, 36 percent Hispanic, 24 percent Caucasian <1 percent Asian-American) was similar to that for the clinic in general. Reimbursement for dental care was primarily via Medicaid (91 percent) with <10 percent covered by insurance or payment by responsible parents. For one quarter of the children, the emergency visit was their first dental visit. Reasons for seeking emergency included 1) pain or discomfort due to caries [30.1 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3) eruption difficulties [18 percent] with 27 percent due to early childhood caries; 2) dental trauma [23 percent];3 eruption difficulties [18 percent];4) soft tissue pathoses [16 percent]; 5) problems with orthodontic appliances or space maintainers [10 percent]; and 6) lost restorations [2 percent]. Pain and bleeding were the most common reasons for seeking emergency dental care. Most causes for seeking outpatient emergency dental care are disease processes which may be avoided by infant oral health and preventive dentistry programs and early treatment intervention.

Clinical manifestations and complications of childbirth and replacement therapy in 385 Iranian patients with type 3 von Willebrand disease.

Type 3 is the most severe form of von Willebrand disease (VWD) transmitted as an autosomal recessive trait. We collected data on the clinical manifestations of type 3 VWD by examining 385 patients from 300 Iranian kindreds, who were compared with 100 age-matched patients with severe haemophilia A. Joint and muscle bleeding was less frequent than in haemophiliacs, perhaps because factor VIII levels were in general higher (median value 4% vs. 1% or less). Mucosal tract haemorrhages such as epistaxis and menorrhagia were the most prevalent symptoms in VWD. Post-circumcision and oral cavity bleeding occurred frequently when prophylactic replacement therapy was not carried out or was inadequate. The course of pregnancy was usually uneventful, but increased bleeding occurred at parturition when affected women were treated with replacement therapy for less than 3-4 d. Ten of 385 (2.6%) of these multitransfused patients developed an alloantibody to VWF and 55% are chronically infected with the hepatitis C virus.

The prevalence of post-extraction complications in an outpatient dental clinic in Kuala Lumpur Malaysia--a retrospective survey.

The aim of this retrospective study is to report on the prevalence of post-extraction complications among patients attending the Oral Surgery outpatient clinic of the Faculty of Dentistry, University of Malaya over a 12-month period from January to December, 1992. The prevalence of post-extraction complications which required further treatment was only 3.4% (n = 100), out of a total of 2968 patients who had extraction of one or more permanent teeth. Analysis based on complete clinical reports (n = 79) showed that dry socket accounted for nine out of ten cases of post-extraction complications. However the aetiology was largely unknown. No obvious association with medical history could be made. Lower teeth were more likely to have complications. The most common teeth associated with dry socket were the molars (76%) and premolars (19%). The most common molars to be affected are the first, followed by the third and lastly the second molars. A brief review of current aetiological factors of dry socket was discussed.

Analysis of oral manifestations of leukemia: a retrospective study.

OBJECTIVE: To evaluate in detail the oral complications of leukemia at initial presentation. Associations between oral manifestations and laboratory data were also investigated. STUDY DESIGN: A retrospective study of 230 cases was conducted to investigate the nature and incidence of oral manifestations at initial presentation. The following data were determined for each patient: age, sex, haemogram at diagnosis (which included haemoglobin, red blood cell counts, differential white blood cell counts, platelet counts), classification of the type of leukemia's systemic symptoms and oral manifestations at the initial physical examination including the dental consultation. RESULTS: It was revealed that the type of leukemia diagnosed, except with CML, is related to the age prediliction of patients. The incidence of leukemia is higher in males than in females. The most common manifestations of leukemia are lymphadenopathy (71.4% in ALL; 45% in AML), laryngeal pain (52.7% in ALL; 37.3% in AML), gingival bleeding (43.2% in AML; 28.6% in ALL), oral ulceration, and gingival enlargement. Fever (92.2%) was the most common symptom in patients with all types of leukemia. Platelet counts from 25,000 mm-3 to 60,000 mm-3 are at sufficiently low levels to result in spontaneous bleeding. Most of the patients had WBC counts of greater than 10,000 mm-3. Only 12.6% of patients had normal WBC counts. CONCLUSIONS: It was concluded that the age prediliction and prevalence of oral manifestations are closely related to the type of leukemia.

Use of intraoperative corticosteroids in pediatric tonsillectomy.

OBJECTIVE: To determine the effects of a single dose of dexamethasone sodium phosphate on postoperative morbidity in children undergoing tonsillectomy. DESIGN: Randomized, double-blind, placebo-control clinical trial. SETTING: Academic, tertiary care children's hospital. PATIENTS: Sixty-nine children (35 boys, 34 girls), aged 3 to 18 years, undergoing tonsillectomy with or without adenoidectomy. INTERVENTION: Patients were randomized to receive a single dose of intravenous dexamethasone or saline. MAIN OUTCOME MEASURES: Pain scores, determined by a Faces Scale, were obtained at 4-hour intervals during the first postoperative day and daily for 7 days thereafter. Total use of an analgesic; type of diet; level of activity; presence of halitosis, nausea, emesis, or fever; and incidence of postoperative bleeding were also compared between the two groups. RESULTS: The two groups of children were similar in age, gender, diagnosis, and surgical time. Pain scores in the postoperative period were identical while the patients were in the hospital and for the first 7 days after discharge. No statistically significant differences were noted in pain scores, nausea, emesis, halitosis, analgesic medications required, diet, or activity levels between the two groups of patients. CONCLUSION: A single intraoperative dose of dexamethasone did not appreciably affect postoperative morbidity in children undergoing tonsillectomy.