How best to approach these acute hand infections.

Antimicrobial therapy is not straightforward with the 4 infectious conditions reviewed here. Combination therapy at the start must usually be tailored once an organism is known.

The dental management of a child with congenital insensitivity to pain.

UNLABELLED: Congenital insensitivity to pain is a rare condition present from birth.To date, congenital insensitivity to pain has been described in groups of hereditary sensory and autonomic neuropathies (HSAN). Within the HSAN group there are five conditions described. This case report describes the management of a female with congenital insensitivity to pain up to her present age of six years. The aim of treatment was to prevent episodes of oro-facial trauma and self-mutilation injuries. The primary teeth were removed on eruption and further management of the permanent dentition has involved the use of soft occlusal guards together with behaviour management techniques, including an educational component. CLINICAL RELEVANCE: To highlight the treatment options and possible difficulties in the management of a young child suffering from orofacial trauma and self-mutilation injuries.

[A research in biomechanics of bite marks on porker limb].

This research was designed to illuminate the change in biomechanical parameters of soft tissue for bite marks on porker limb. The authors used a prefabricate nob to press perpendicularly on porket limb and so to establish bite mark under three forces: 100 N, 200 N and 300 N. After the procedure of biting, the stress-strain relationship and changes in extension of soft tissue were recorded. Meanwhile, the elasticity was measured with a press meter at nine time-points. When bite mark was formed, with the development of stress, the strain of soft tissue increased. But the speed of increment slowed down when stress exceeded some extent. After bite mark was formed, the extension and elasticity of soft tissue decreased with the increase of pressure.

Biting behavior, aggression, and seizures.

PURPOSE: To describe the semiologic features of aggressive behaviors observed in human epileptic seizures with particular reference to the act of biting a conspecific. METHODS: We analyzed the biting behavior (BB) and other aggressive gestures occurring in a group of 11 patients retrospectively selected from >1,000 patients subjected to video-EEG/SEEG monitoring for presurgical evaluation of drug-resistant seizures. RESULTS: Patients displaying BB showed (a) a male sex predominance, (b) heterogeneous etiologies and lesion locations, and (c) seizures involving the frontotemporal regions of both hemispheres. The act of biting was a rapid motor action, lasting approximately 600 ms, occurring in the context of strong emotional arousal, fear, and anger, with various bodily gestures with aggressive connotation. BB was mainly a "reflexive" behavior, in that biting acts were evoked (both during and after seizures) by actions of people in close contact with the patient. The sole intrusion of the examiner's hand in the space near the patient's face was effective in triggering BB. Rarely, self-directed or object-directed biting acts were not triggered by external stimuli. Intracranial data (SEEG) obtained in one subject showed that the amygdala/hippocampal region plus the orbitomedial prefrontal cortex had to be involved by ictal activity to observe BB. CONCLUSIONS: Anatomic and electrophysiologic data in our patients suggest that a model of dual--temporal and frontal--dysfunction could account for the occurrence of ictal/postictal BB. Behavioral data suggest also that BB and related aggressive gestures can be considered as the emergence of instinctive behaviors with an adaptative significance of defense of the peripersonal space.

Self-biting induced by activation of L-type calcium channels in mice: dopaminergic influences.

The L-type calcium channel activator +/-Bay K 8644 induces repetitive self-biting and self-injurious behavior in young mice. Since dopaminergic systems have been implicated in prior studies of these behaviors in both humans and animals, the present experiments were designed to test whether drugs influencing the dopaminergic systems could modify the behavioral responses to +/-Bay K 8644. The ability of +/-Bay K 8644 to provoke self-biting and self-injurious behavior was increased by amphetamine and GBR 12909, drugs that augment synaptic dopaminergic concentrations by blocking the reuptake and/or stimulating the release of dopamine. Conversely, self-biting and self-injurious behavior were decreased by tetrabenazine or reserpine, two drugs that deplete vesicular stores of dopamine. These results suggest that dopaminergic systems may play a role in the ability of +/-Bay K 8644 to provoke self-biting and self-injurious behavior.

Safety of intraoperative transcranial electrical stimulation motor evoked potential monitoring.

This article reviews intraoperative transcranial electrical stimulation (TES) motor evoked potential (MEP) monitoring safety based on comparison with other clinical and experimental brain stimulation methods and clinical experience in more than 15000 cases. Comparative analysis indicates that brain damage and kindling are highly unlikely. There have been remarkably few adverse events. Pulse train TES-induced or coincidental seizures (n = 5) are rare, probably because of very brief (<0.03 second) stimuli, anesthesia, and the general absence of predisposing cerebral conditions. Soft bite blocks may prevent tongue or lip laceration (n = 29) or mandibular fracture (n = 1). Rare cardiac arrhythmia (n = 5) and intraoperative awareness (n = 1) may be coincidental. Minor scalp burns (n = 2) are rare. Although possible, no spinal epidural recording electrode complications or injuries resulting from TES-induced movement were found. There have been no recognized adverse neuropsychological effects, headaches, or endocrine disturbances. Comprehensive relative contraindications include epilepsy, cortical lesions, convexity skull defects, raised intracranial pressure, cardiac disease, proconvulsant medications or anesthetics, intracranial electrodes, vascular clips or shunts, and cardiac pacemakers or other implanted biomedical devices. Otherwise unexplained intraoperative seizures and possibly arrhythmias are indications to abort TES. With appropriate precautions in expert hands, the well-established benefits of TES MEP monitoring decidedly outweigh the associated risks.

Bite injuries: pathophysiology, forensic analysis, and management.

Bites are serious injuries that constitute 1 percent of all emergency-department visits in the United States of America. Human bite injuries may lead to loss of function, infection, and gross disfigurement, and often are associated with interpersonal and sexual violence, and child abuse. Issues with infection from oral contaminants, tissue damage, and difficult surgical reconstruction make the management of human bite injuries a challenge. The unique nature of teeth and the bite marks they produce are invaluable in forensic pathology. A systematic and detailed evaluation of bite injuries should be performed by a forensic odontologist in order to provide the necessary information for forensic purposes. Management of human bite injuries includes wound debridement, surgery to repair or replace damaged tissue, and long-term antibiotic therapy.

Fatores morfológicos da mordida aberta e altura facial em indivíduos com maloclusöes de Classe I e Classe II, Divisäo 1 / Morphological factors of open-bite and facial height in individuals with Class I and Class II Division 1 malocclusions

O objetivo deste estudo foi determinar as diferenças morfológicas entre indivíduos com maloclusöes Classe I e Classe II, Divisäo 1, com relaçäo à mordida aberta e à altura facial. A idade dos pacientes variou de 7 a 13 anos. Os resultados desta pesquisa permitiram concluir que a altura total anterior da face (N-Me), a altura anterior inferior da face (ENA-Me), o ângulo SN.GoMe, o ângulo PP.GoMe e a sobressaliência, em geral, säo maiores no grupo de maloclusäo Classe II, Divisäo 1, com mordida aberta do que no grupo de maloclusäo Classe I com mordida aberta. Diferenças significantes foram encontradas entre as idades de 7 e 9 anos, 9 e 11 anos e 11 e 13 anos, em ambos os sexos. A mordida aberta näo apresentou diferenças significantes entre os grupos de maloclusöes nas faixas etárias estudadas e em ambos os sexos

Human bite wounds.

Because only those patients receiving treatment are included in a study, it is difficult to determine the true incidence of infection in human bite wounds. Many undoubtedly never receive treatment since patients normally are reluctant to appear in the emergency department as a result of embarrasing circumstances. However, it is known that infection rates and resulting morbidity can be substantially reduced if the bite wound victim comes to the emergency department promptly after wounding. In addition, a meticulous wound care regimen should be standard for all human bite wounds, rather than relying solely on antibiotics, which is a common practice.