Treatment of sacro-coccygeal intervertebral disc extrusion causing tail paresis and faecal incontinence in a dog.

A 4-year 9-month-old beagle was presented for a 2-week history of acute onset of lowered tail carriage and faecal incontinence. Neurological examination was unremarkable except for an absent perineal reflex, there was no history of trauma. Blood work was unremarkable. Lumbosacral and coccygeal CT pre- and post-intravenous contrast revealed a large sacrococcygeal disc extrusion with mineralised material extending from the level of S2 and to midbody of Cd1. A dorsal laminectomy was performed from the cranial margin of S2 to the caudal margin of Cd1. A large volume of mineralised disc material was removed. The material was confirmed on histopathology to be consistent with extruded nucleus pulposus. The patient regained faecal continence within 3 days of hospital discharge. Based on a literature search this is the first report of a sacrococcygeal disc extrusion resulting in faecal incontinence, with successful surgical management.

Complications and postoperative non-steroidal anti-inflammatory use of three extracapsular cruciate ligament repair techniques performed in a general practice clinic environment.

OBJECTIVE: To report complications and postoperative non-steroidal anti-inflammatory use associated with fabellotibial suture, Tightrope and Ligafiba Isotoggle procedures performed on dogs of varying weights within a general practice setting. MATERIALS AND METHODS: Clinical records of eligible patients from 2009 to 2018 were retrospectively extracted from five general practice clinics. Data for signalment, patient weight, surgery performed, complications, postoperative use of non-steroidal anti-inflammatory drugs, and timing thereof were extracted and analysed using multinomial logistic regression. Predicted probability tables were generated for complications and non-steroidal anti-inflammatory drug use. RESULTS: The study included 370 surgeries, with 97 fabellotibial suture, 158 Tightrope and 42 Ligafiba Isotoggle procedures in patients less than 15 kg, and 43 fabellotibial suture, 16 Tightrope and 30 Ligafiba Isotoggle procedures in patients at least 15 kg. The proportion of patients that can be expected to have no complications was greatest for older dogs (9 years) weighing less than 15 kg (fabellotibial suture, 91%; Tightrope/Ligafiba Isotoggle, 88%), and the highest major medical and surgical complication risks were expected in young dogs (1 year) weighing over 15 kg (fabellotibial suture, 28%; Tightrope/Ligafiba Isotoggle, 59%). The predicted risk of requiring repeated non-steroidal anti-inflammatory drug prescriptions in the 18-month postoperative period for an 15 kg patient was 37% to 39%. CONCLUSION: Weight and age were significant factors influencing complications and postoperative non-steroidal anti-inflammatory drug use in fabellotibial suture, Tightrope and Ligafiba Isotoggle surgical patients in a general practice setting. CLINICAL SIGNIFICANCE: Clinicians should consider the possibility of complications and requirement for ongoing non-steroidal anti-inflammatory drug use before performing extracapsular procedures in patients weighing more than 15 kg.

NHS dental professionals' evaluation of a child protection learning resource.

The aim of this survey was to evaluate the impact of an educational child protection resource which had been developed and made available, free of charge, to all NHS dental practices and salaried primary dental care services in England and concurrently published online. A postal questionnaire was sent to a random sample of 1000 NHS dental practices to assess whether the learning objectives of the educational resource had been met. A total of 467 questionnaires were completed (46.7% response rate). Almost two thirds of participants (63.4%) remembered receiving the Child Protection and Dental Team (CPDT) handbook or seeing the website and almost all of them had used (looked at or read) it and felt able to access it if needed. Of the 265 users, 76.2% felt it had improved their knowledge of child protection, 60.5% had adopted a child protection policy, 53.7% had identified a child protection lead and 25.8% had arranged further training as a result of using the educational resource. The findings from the evaluation indicated that the learning objectives of the CPDT educational resource had been met and highlighted ways in which the resource could be further improved to effectively meet the needs of dental professionals.

The range and demographics of salivary gland tumours diagnosed in a UK population.

Salivary gland tumours are relatively rare and comprise a diverse range of neoplasms. The aim of this study was to determine the range and demographics of all histologically diagnosed salivary tumours in a European population. All entries for salivary gland tumours from 1974 to 2005 inclusive were retrieved and analysed for each diagnosis including number of specimens, male:female ratio and age range. These data were then analysed for the distribution of benign and malignant salivary tumours in major and minor salivary glands. 58,880 specimens were received; of these, 741 cases (1.3% of all specimens) were diagnosed as salivary gland tumours with a male to female ratio of 0.7:1. There were 481 (64.9%) benign and 260 (35.1%) malignant neoplasms, with the most common tumours being pleomorphic adenoma and mucoepidermoid carcinoma, respectively. Our study provides demographic data on a large series of salivary gland tumours in a European population. Accurate diagnosis is essential as salivary lesions have diverse clinical and prognostic outcomes. This study has confirmed that some tumours have a predilection for certain sites and that the risk of malignant disease is also greater at specific sites within the oral cavity.

Post-impact evaluation of an e-learning cross-infection control CD-ROM provided to all general dental practitioners in England.

AIM: To carry out a post-impact evaluation of a cross-infection control CD-ROM, developed for NHS dental teams as a continuing professional development e-learning tool. The program was commissioned by the Department of Health and developed by a project team through the UK Committee of Postgraduate Dental Deans. The Dental Practice Board had originally sent one copy of the CD-ROM to each dental practice in England in 2004. METHOD: A quantitative statistical analysis of the results of 326 online respondents to the learning package and a survey of 118 dental practitioners drawn from the Dental Practice Board database. RESULTS: Practitioners felt the CD-ROM in this instance was well-designed and appropriate for their needs. It is inclusive and accessible to a wide range of dental professionals including nurses and hygienists. CONCLUSIONS: This form of continuing professional development is popular with dental practitioners, although it should not be the only form of continuing professional development available. However, whilst the project was generally regarded as successful, there were problems with the distribution of the CD-ROM. This suggests that an online resource should be made available in the future.

The use of significant event analysis and personal development plans in developing CPD: a pilot study.

This paper describes the work undertaken by the Postgraduate Primary Care Trust (PCT) Dental Tutor for South Yorkshire and East Midlands Regional Postgraduate Dental Education Office during the first year of a two-year pilot. The tutor has special responsibility for facilitating the writing of Personal Development Plans (PDPs) and the introduction of Significant Event Analysis to the 202 general dental practitioners in the four Sheffield PCTs. Data were collected on significant events and the educational needs highlighted as a result. A hands-on workshop format was used in small practice groups and 45% of Sheffield general dental practitioners now have written PDPs compared with a 16% national average. A library of significant events has also been collated from the data collected.

Range and demographics of odontogenic cysts diagnosed in a UK population over a 30-year period.

BACKGROUND: The aim of this study was to determine the range of all histologically diagnosed odontogenic cysts along with age range, sex distribution and site of presentation over a 30-year period. METHODS: All entries for odontogenic cysts occurring during 1975-2004 inclusive were retrieved and analysed for demographic data. RESULTS: A total of 55,446 specimens were received, of these 7121 (12.8%) specimens were diagnosed as odontogenic cysts. Radicular cyst was the most common diagnosis (52.3%), followed by dentigerous cyst (18.1) and odontogenic keratocysts (11.6%). CONCLUSIONS: Our study provides demographic data on a large series of odontogenic cysts in a European population. This is one of the largest series reported to date. Cysts such as the paradental cyst have a predilection for certain ages, sexes and sites. Odontogenic keratocysts and glandular odontogenic cysts have a marked propensity to recur as well as behave aggressively. It is essential that such lesions are detected as early as possible to minimize any necessary surgery.

An analysis of oral and maxillofacial pathology found in adults over a 30-year period.

BACKGROUND: The aim of this study was to determine the range of histologically diagnosed lesions in 44,000 oral and maxillofacial pathology specimens, from adults 17 years and older, submitted for diagnosis to our laboratory over a 30-year period (1973-2002). MATERIALS: All entries for specimens from the patients were retrieved and compiled into 12 diagnostic categories. RESULTS: During the period, 44,007 specimens comprised a male-to-female ratio of 0.9:1. The diagnostic category with the largest number of specimens was mucosal pathology (36.0%) followed by odontogenic cysts (13.8%). Malignant tumours accounted for 5.4% of all specimens and benign tumours 4.6%. CONCLUSION: This survey showed that while the majority of diagnoses are benign, approximately one in 19 cases required major head and neck surgery for malignant disease.

A survey of oral and maxillofacial pathology specimens submitted by general dental practitioners over a 30-year period.

OBJECTIVES: To determine the range and frequency of diagnoses in specimens submitted for histopathological examination by general dental practitioners (GDPs). METHODS: A retrospective analysis was carried out of all cases submitted by GDPs for the period 1974-2003, using a Foxpro Windows database. The data were collated into 10 diagnostic categories each comprising number of diagnoses, percentage of each diagnosis within a diagnostic category and each diagnosis as a percentage of total cases. RESULTS: GDPs submitted 6,666 cases out of a total of 53,474 for this period. While the total number of specimens increased four-fold over the 30-year period, specimens from GDPs increased from 7% to 17%. The range of diagnoses increased from 18 to 45. Of the 617 GDPs who submitted material, 279 (45%) submitted less than two specimens each in 30 years. Nine malignant neoplasms were diagnosed. Other significant pathology included 320 benign neoplasms as well as diagnoses ranging from mucosal lesions such as lichen planus to odontogenic cysts. CONCLUSIONS: It is clear that GDPs have provided an increased number of biopsy specimens over the last three decades. This reflects an increasing demand by GDPs for a diagnostic oral histopathology service and their use of this service should be encouraged.

An analysis of oral and maxillofacial pathology found in children over a 30-year period.

AIM: The vast majority of oral diseases are confined to oral tissues, but numerous underlying systemic conditions may present with signs and symptoms within the oral cavity. Since the epidemiology of diseases is variable between regions, the authors carried out Europe's first paediatric-based survey of oral and maxillofacial pathology specimens submitted for diagnosis. DESIGN: All entries for specimens from children between the ages of 0 and 16 years during the 30-year period from 1973 to 2002 were retrieved and compiled into 12 diagnostic categories. RESULTS: During the study period, 4406 (8.2%) specimens came from children between the ages of 0 and 16 years, with a male to female ratio of 1.01. The diagnostic category with the largest number of specimens was tooth pathology (22.1%), followed by salivary gland disease (19.1%) and mucosal pathology (12.1%). In all, there were 114 benign tumours of nonodontogenic origin, 43 odontogenic tumours and 31 malignant tumours. The most frequently diagnosed lesions were mucous extravasation cysts, which accounted for over 16% of cases. Periapical pathology in the form of a radicular cyst, residual cyst or chronic periapical granuloma formed almost 13% of all cases. CONCLUSIONS: This survey shows that, while nearly 10% of specimens submitted to the authors' laboratory are from children under 16 years of age, the majority of lesions are of a benign nature, requiring minimal intervention; less than 1% of cases comprise malignant lesions. Odontogenic tumours are relatively rare in this age group; however, certain lesions such as adenomatoid odontogenic tumour and ameloblastic fibroma occur predominantly in children and, therefore, remain an important diagnostic consideration.

The role of postgraduate dental deans.

Postgraduate Dental Deans commission and manage the delivery of postgraduate dental and medical education and training for dental practitioners. They are charged with developing and quality assuring opportunities for trainees in primary and secondary care so that they can reach their full potential, and must work with local organisations to ensure that sufficient training places are available to meet the future needs of the NHS. Postgraduate dental deans influence training opportunities and standards in NHS Trusts as well as dental vocational training practices. They also play a role in developing national policies on postgraduate dental education and implement new initiatives. Their roles cover modernising dental careers, national and international recruitment and retention in primary and secondary care. They are involved in leading the development of the dental workforce, including professions complementary to dentistry as well as managing the provision and quality assurance of CPD for general practitioners. They also provide support for doctors and dentists facing difficult situations.

Analysis of the T-cell receptor Valpha repertoire and cytokine gene expression in Sjögren's syndrome.

The antigen receptor diversity of pathogenic T cells in Sjögren's syndrome (SS) may have important implications in the development of the disease; cytokines from these cells and other sources also play a role in the pathogenesis of this disease. Using a semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) technique, we have attempted to correlate the presence of restriction in the T-cell receptor (TCR) repertoire with cytokine profiles. We have analysed TCR V alpha family usage, and the expression of interleukin-1alpha (IL-1alpha), IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-13, interferon-gamma (IFN-gamma) and tumour necrosis factor-alpha (TNF-alpha), in labial biopsies from 12 patients with SS and compared these with samples from three patients with chronic sialadenitis (CS). Only one of the SS biopsies showed evidence of V alpha restriction (three out of 18 gene families). Apart from this, expression patterns were similar in both patient groups. Four of the 12 SS samples demonstrated a 'limited heterogeneity' of the V alpha repertoire with 3-4 families predominantly expressed, in particular V alpha1 and V alpha3. Peripheral blood lymphocytes were unrestricted. The cytokine profiles of the SS and CS biopsies were generally similar. However both IFN-gamma and IL-1alpha were absent from CS, but present in SS samples. The expression of IFN-gamma in the majority of the samples, together with a lack of IL-4 and IL-13 mRNA, suggests the predominance of a Th1 response in SS. There was no clear association between the repertoire of V alpha genes expressed and the cytokine profile observed. However, the V alpha restriction in one SS sample did correspond with a limited diversity of cytokines detected.

Giant cell arteritis--a case report.

Giant cell arteritis is a serious condition, requiring immediate treatment. A case illustrating the difficulties of diagnosis is presented, together with a discussion of the management.

A clinical and histopathological study of osteoarthrosis of the temporomandibular joint.

OBJECTIVES: The aims of this study were (i) to objectively assess the histopathological features in TMJ condylar head specimens to correlate the findings with clinical information obtained from pathology request forms and hospital notes (ii) to analyse the pre- and post operative investigation and management of patients with TMJ-OA. DESIGN: A retrospective histological analysis of 136 specimens using a semi-quantitative scoring system. SUBJECTS: 132 patients with TMJ-OA in Trent Hospital Region (mean age 34: range 14-71) provided 136 condylar heads. MAIN OUTCOME MEASURES: 11 histological parameters were assessed. The global scores obtained were compared with the clinical data. RESULTS: There was no clear correlation between histology and pre- and post-operative clinical data. 95% of patients were treated for at least 6 months before surgery and 94% had pain before surgery. Postoperatively, the success rate was 58% (35% painfree and 23% still in pain but better than before surgery). Non-surgical treatments were not used routinely after surgery. Only 62% of the patients were followed up for at least one year after surgery. 61% of the patients were reported to have macroscopic degenerative changes at surgery whilst all had microscopic OA. CONCLUSION: The mean age of patients presenting with TMJ-OA is younger (M = 31/F = 34) than in some studies while there is still a female preponderance for the disease. Tomograms and arthrograms appear to have a higher specificity than orthopantomograms for diagnosing gross degenerative change. There appears to be a need for a standardised management protocol.

Assessment of sulphasalazine as a treatment modality in Sjögren's disease in NZB/NZW F1 hybrid mice.

OBJECTIVE: Sulphasalazine is a recognised second-line agent in the treatment of rheumatoid arthritis. The aim of this study was to determine if it might prove useful in the treatment of Sjögren's syndrome. METHODS: The trial was performed in NZB/NZW F1 hybrid mice and efficacy was assessed on the basis of a reduction in the lymphocytic infiltration of the submandibular salivary and lacrimal glands. The animals were divided into three groups; the control group remained untreated, the second group received the drug from 14-42 weeks and the third group received sulphasalazine from 26-42 weeks. At four-weekly intervals throughout the study, five animals in each group were killed using ether and the glands assessed for lymphocytic infiltration using a modified focus scoring technique with light microscopy. RESULTS: No significant reduction in the lymphocytic infiltration occurred consistently throughout the trials with sulphasalazine. CONCLUSION: Sulphasalazine did not significantly alter the development of Sjögren's disease in NZB/NZW F1 mice.

Acro-osteolysis (Hajdu-Cheney) syndrome: report of a case with abnormal tooth structure.

The acro-osteolysis (Hajdu-Cheney) syndrome is a rare disorder of bone metabolism characterized by progressive dissolution of a number of bones. Although previous reports have detailed several dental abnormalities associated with this syndrome, this is the first report describing structural changes in the dentin and cementum of teeth.

Combined SHO and Masters programme in Sheffield.

In August 1995, the Charles Clifford Dental Hospital in Sheffield is to launch a new training programme for junior hospital dentists. It comprises a combined SHO post and Masters degree course over 2 years. This article outlines and explains how the Sheffield scheme has been designed to embrace recent developments in training and education in the NHS.

The treatment of Sjögren's disease in NZB/NZW F1 hybrid mice with azathioprine: a two-stage study.

NZB/NZW mice exhibit changes in their salivary and lacrimal glands similar to those occurring in Sjögren's syndrome (SS) in humans. The aim of this study was to determine the efficacy of azathioprine in the treatment of SS in NZB/NZW mice. The experimental animals comprised three groups; the first received the drug daily from 14 weeks of age, the second started therapy at 26 weeks of age and the third group remained untreated. The animals, in groups of five, were killed at four-weekly intervals, up to 42 weeks, using ether. The submandibular and lacrimal glands were assessed for the extent of lymphocytic infiltration using a modified focus scoring system, with light microscopy. During the progression of the disease, azathioprine produced a reduction in the number of lymphocytic foci. This reduction occurred when azathioprine was used both early and late in the condition.