A systematic review of the clinical and radiographic features of hybrid central giant cell granuloma lesions of the jaws.

OBJECTIVE: Central giant cell granuloma (CGCG) can coexist with other benign lesions of the jaw. These hybrid lesions are diagnostically challenging to both oral pathologists and radiologists. This work systematically reviews the clinical and radiographic features of hybrid-CGCG lesions in the jaws. MATERIALS AND METHODS: Three reviewers conducted an electronic search of five databases for histologically diagnosed hybrid-CGCG lesions in human jaws. RESULTS: Thirty-four of 1224 articles met the inclusion criteria. Of 39 hybrid-CGCG lesions, 14 (35.9%) were central odontogenic fibroma, 11 (28.2%) were central ossifying fibroma, seven (17.9%) were fibrous dysplasia, and seven (17.9%) were other bone conditions. There were 22 females and 17 males with a mean age of 30.5 ± 19.9 years. 89.5% of hybrid-CGCG lesions were well defined, 57.9% were non-corticated, 60.5% were radiolucent, and 66.7% were in the posterior mandible. Most hybrid lesions affected the cortical plates by thinning, expansion, or perforation (93.1%), displaced, or resorbed teeth (60%). CONCLUSION: The radiographic features of hybrid-CGCG lesions vary according to the concurrent bony lesion. Hybrid-CGCG lesions altered the radiographic appearance with the following entities: fibrous dysplasia, melorheostosis, and Paget's disease. Optimal imaging modalities are crucial to detail radiographic features and direct representative biopsy of suspicious sites that may host a CGCG hybridisation.

Patient Perception and Satisfaction with Implant Therapy in a Predoctoral Implant Education Program: A Preliminary Study.

PURPOSE: The purpose of this study was to assess the level of satisfaction and quality of life for patients receiving mandibular implant-supported overdenture (IOD) or single-tooth implant (STI) therapy in a predoctoral dental implant program. MATERIALS AND METHODS: Patients who received IOD and STI therapy and presented for recall visits at University of Illinois-Chicago College of Dentistry Predoctoral Implant Program were recruited. IOD treatment included placement of two endosseous implants in the mandibular canine region, followed by two abutments for resilient attachments. STI treatment included placement of endosseous implants, abutments, and cement-retained crowns. A modified Oral Health Impact Profile (OHIP)-14 questionnaire was given at least 6 months following insertion of implant-supported prostheses for both groups. Patient age, gender, distribution of STI, and OHIP-14 data were gathered and analyzed. Descriptive statistics were used to assess post-treatment data; Mann-Whitney U test was used to analyze the differences between groups older and younger than mean age and gender among the IOD and STI groups. RESULTS: Fifty-one consecutive patients in the IOD (60.7% male, 39.2% female, mean age 63.7) and 50 consecutive patients in the STI group (58.0% female, 42.0% male, mean age 50.8) were included in this recall study. In the STI group, 69 implants were placed for 50 patients; the most common region was the maxillary posterior quadrant (49.3%). Scores from modified OHIP-14 ranged from 0.14 to 0.78 for the IOD group and 0.02 to 0.18 for the STI group. Both IOD and STI data showed satisfaction with the treatment outcome. There was a significant difference found between men and women among the IOD group pertaining to questions regarding pronouncing words, sense of taste, meal interruption, and feeling embarrassed from OHIP-14, but not between the age groups. Also, no significant differences were noted for gender or age group within the STI patients and OHIP-14 scores. CONCLUSION: Dental implant therapy provided in a predoctoral setting had a significant impact on the quality of life and a high level of satisfaction for patients seeking implant treatment.

Dental student perceptions of predoctoral implant education and plans for providing implant treatment.

This study aims to identify dental students' perceptions of pre-patient care laboratory exercises (PCLEs) and clinical experiences that influence their future plans for providing implant care. One of two questionnaires was administered to dental student classes at one dental school (D2: Survey 1; D3 and D4: Survey 2). Future plans as graduates to provide implant diagnosis and treatment planning (DxTP), restoration of single-tooth implants (STIs), and implant-retained overdentures (IODs) were cross-sectionally assessed along with potential influences such as PCLE, clinical experiences, gender, and class. The majority of students planned to provide implant services after graduation (DxTP 68.9 percent; STI 61.2 percent; IOD 62.1 percent). Bivariately, males reflected more preparedness from PCLEs than females (p=.002) and the D2 students more than D3 and D4 students (p<.001). Multivariate models revealed the perceived preparedness from PCLEs generally had the strongest association with future plans for performing implant therapy. However, this varied by gender and class. These findings indicate that PCLEs are important for their influence on students' future plans to provide implant therapy. However, further studies are needed to validate actual PCLEs and clinical implant practices (both longitudinally and for other schools) and to determine educational interventions to optimize the provision of implant care.

Early MR imaging of lower-extremity physeal fracture-separations: a preliminary report.

Magnetic resonance imaging (MRI) was used to evaluate physeal fracture-separations in children soon after at-risk lower-extremity fractures. MRI scans taken during the "acute" period (within 10 days of fracture) resulted in a change in three of four of the Salter-Harris classifications from the injury radiographs. Twelve children had MRI scans performed in the "early" period (3-17 weeks following fracture). Physeal narrowing or tethering and the absence of Harris arrest lines were found in those patients who subsequently required late surgical intervention. Acute MRI provides the most accurate evaluation of the physeal fracture anatomy. Early MRI can demonstrate transphyseal bridging or altered arrest lines in physeal fracture before they become manifest on radiographs.

Joint effusion in children with an irritable hip: US diagnosis and aspiration.

Ninety-six children with an irritable hip possibly representing septic arthritis underwent clinical and laboratory evaluation, radiography, and ultrasonography (US). Forty had normal US scans; none were later shown to have septic arthritis, although three had osteomyelitis. Fifty-six children had effusion at US. Thirty-one of these underwent US-guided aspiration, two unsuccessfully. On the basis of results of aspirate analysis, 15 of these 31 patients underwent surgical drainage, and septic arthritis was diagnosed in all 15. The mean peripheral white blood cell (WBC) count was not significantly higher in patients with septic arthritis (n = 21) than in patients with toxic synovitis (n = 24) (P = .44). However, the erythrocyte sedimentation rate and synovial fluid WBC count were significantly greater in those with septic arthritis than in those with toxic synovitis (P = .002 and P < .0001, respectively). Clinical evaluation, radiographs, and sonograms together determined the need for US-guided aspiration. US-guided aspiration allowed selection of only those with septic arthritis for operative drainage and shortened that procedure. Negative sonograms allow exclusion of septic arthritis but not osteomyelitis.

The function of the quadriceps muscle after a fracture of the femur in patients who are less than seventeen years old.

Thirty-three patients who had been managed for an isolated, closed fracture of the femoral shaft when they were less than seventeen years old were examined at an average of thirty-three months (range, eighteen to fifty-six months) after the injury. Thirteen patients (39 per cent) had a persistent deficit in the strength of the quadriceps of the fractured limb, as identified on testing with a Cybex-II isokinetic dynamometer. Six patients (18 per cent) had a deficit according to the one-leg-hop for distance test, fourteen (42 per cent) had an average loss of ten millimeters in the circumference of the thigh, and sixteen (48 per cent) had an average loss of 10 degrees of flexion of the knee. The etiological factors that were thought to possibly be responsible for the weakness of the quadriceps were evaluated. The amount of maximum displacement of the fracture, as seen on the initial radiographs, was the only factor that was significant for the prediction of weakness of the quadriceps (p = 0.006) at both test speeds of the Cybex dynamometer and in all statistical analyses. Despite the persistent weakness of the quadriceps, none of the patients had a clinical problem at the latest follow-up examination. A subclinical deficit in the strength of the quadriceps may be related to damage sustained by the muscle at the time of the fracture. On the basis of the results of this study, we do not recommend a change from the traditional methods of treatment, which involve early application of a spica cast or use of traction followed by application of a spica cast.

Osteomyelitis in children: gadolinium-enhanced MR imaging.

Fifteen pediatric patients with biopsy- or culture-proved nonspinal osteomyelitis were studied with magnetic resonance (MR) imaging. Osteomyelitis was acute in seven patients, subacute in three, and chronic in five. Four patients had subperiosteal abscesses, one had a large associated soft-tissue abscess, and one had an intraosseous (Brodie) abscess. Areas of active inflammation had decreased marrow signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and enhancement on T1-weighted images obtained after gadopentetate dimeglumine administration (n = 10). Abscesses were rim enhancing (n = 3) or not (n = 2) with gadolinium-enhanced MR imaging. Nonenhancing areas presumably represented necrotic material. Gadolinium-enhanced MR imaging assisted in definition of the presence and extent of nonvascularized fluid collections within the bone and/or adjacent soft tissues and the extent of bone involvement in patients with chronic osteomyelitis. It also helped guide surgical debridement of intraosseous disease (n = 7) and open or percutaneous drainage of subperiosteal or soft-tissue fluid collections (n = 5).

Vaginal microbial flora as a cofactor in the pathogenesis of uterine cervical intraepithelial neoplasia.

The vaginal microbial flora of 106 women with histopathologically confirmed cervical intraepithelial neoplasia and 79 women without disease, was evaluated for Gardnerella vaginalis, Trichomonas vaginalis, Candida albicans and other yeasts. Flora morphology was assessed by gram staining of secretions. Cervical cultures were examined for Herpes Simplex virus, Cytomegalovirus and Neisseria gonorrhoeae. Chlamydia trachomatis antigens in cervical secretions were detected by enzyme immunoassay. Human Papillomavirus was identified by koilocytosis in cytologic or histopathologic specimens. Human Papillomavirus infection (P less than 0.00001), vaginal infection with Mycoplasma hominis (P = 0.012) and abnormal vaginal flora (P = 0.006) were significantly associated with CIN, suggesting that CIN may be promoted by vaginal microorganisms in conjunction with human papillomavirus cervical infection.

Neurologic complications after K-wire fixation of supracondylar humerus fractures in children.

A retrospective review of 143 supracondylar humerus fractures in children treated with K-wire fixation disclosed four neurologic complications after treatment. There were two late ulnar neuropraxias. One ulnar nerve injury and one radial nerve injury resulted from direct trauma during insertion of a K-wire. All patients regained full neurologic function.

MR imaging of fractures of the growth plate.

In order to assess whether MR imaging could be used to evaluate posttraumatic abnormalities of the growth plate cartilage, 28 MR imaging examinations of 26 physeal fractures were performed from 4 days to 2 years after injury. Twelve patients were studied within 6 months of the fracture. MR imaging changed the Salter-Harris classification in six. Interruption of the growth plate detected on T2-weighted images was associated with subsequent growth anomaly in six of eight patients. Horizontal fracture of the physis without interruption was associated with growth disturbance in only one of four patients. Sixteen growth plates were studied beyond 6 months after injury. Twelve had physeal bars and abnormal growth. Of four patients without physeal abnormality on MR imaging, two had normal growth and two had mild deformity. Our results show that MR imaging defects abnormalities in the cartilage that are associated with subsequent growth disturbances and provides accurate mapping of physeal bridging and associated growth abnormalities that have already occurred.

Management of vascular injuries in displaced supracondylar humerus fractures without arteriography.

One hundred forty-three displaced (type III) supracondylar fractures of the humerus in children were treated over a 5.5-year period with 17 (11.9%) having signs of vascular impairment at the time of presentation. Rapid reduction and Kirschner wire stabilization without arteriogram was performed in each case. In three cases in which satisfactory blood supply to the hand was not present after reduction, circulation was restored after exploration of the brachial artery revealed two intimal tears and one arterial entrapment. The remaining 14 patients were normal at follow-up with no late vascular compromise. Based on these findings, we feel prereduction arteriography is not indicated in this injury.

Etiology and outcome of acute pelvic inflammatory disease.

We studied 71 women with the clinical diagnosis of acute pelvic inflammatory disease (PID) by laparoscopy and comprehensive microbiology in order to define the major etiologic determinants of poor fertility prognosis after tubal infection. Fifty women were found to have acute PID. Of the 50 women, 23 were pregnancy seeking and had a subsequent evaluation to determine fertility outcome. Seven of 13 women with non-gonococcal infection had an adverse reproductive outcome, compared with none of 10 women with gonococcal infection (P = .007). Two groups of causes for adverse reproductive outcome were found. Of the seven infertile women, four had initial tubal abscess, and three had evidence of Chlamydia trachomatis infection. This study directly documents the poor fertility prognosis for women with tubal abscess and suggests that women with culture and/or serological evidence of chlamydial infection also have a poor fertility prognosis.

Correlation of auxotype and protein I type with expression of disease due to Neisseria gonorrhoeae.

To explore the correlation of outer membrane protein I (PI) type and auxotype to clinical expression of infection with Neisseria gonorrhoeae, we characterized nutritional requirements by auxotyping and PI serovars by coagglutination assay with monoclonal antibodies of 325 consecutive clinical isolates of N. gonorrhoeae. The clinical status of each infected individual was determined by chart review. The predominant auxotype required proline, citrulline, and uracil with or without hypoxanthine (Pro-Cit-Ura-[Hyx-]) and accounted for 22% of all gonococcal strains. Pro-Cit-Ura-(Hyx-) strains were recovered from seven of 15 men with asymptomatic urethral infections (P less than .01). Of the 325 strains, 33% were PIA and 67% were PIB serovars. All five isolates in disseminated gonococcal infection were PIA serovars (P less than .01). Three percent of 168 urethral infections in men were complicated by epididymitis, and 17% of 135 cervical infections in women were complicated by pelvic inflammatory disease (P less than .0005). Neither of these complications was associated with a particular auxotype or PI serovar.

Giant-cell tumor of the second cervical vertebra treated by cryosurgery and irradiation.

A 17-year-old female presented with a large, destructive, giant-cell tumor of the second cervical vertebra. The lesion was obviously life-threatening. Owing to its proximity to the spinal cord and the danger of a pathologic fracture with cord transection and because of the effectiveness of cryosurgical methods in treating giant cell tumors of long bones, we decided to attempt local freezing of the lesion using a cryoprobe via a transoral approach. To further ensure tumor destruction, we followed cryosurgery with a course of radiotherapy (4600 rads). At this writing, 30 months later, healing has been excellent with no signs of recurrence, pain, tenderness or neurologic problems. To the best of our knowledge, this represents the first time a vertebral body bone tumor has been treated by cryosurgery.