Pediatric sialolithiasis distinctive characteristic in radiological imaging.

AIM: Aim of the present paper was to investigate the imaging and related clinical characteristics of sialolithiasis in Italian pediatric population trying to determine the difference between pediatric and adult. METHODS: Twenty-nine pediatric patients (age range 1-17 years) with pain and postprandial swelling and/or purulent discharge in the salivary gland areas were referred to radiology department after pediatric ear, nose and throat (ENT) evaluation. They all were submitted to ultrasound examination of the main salivary glands. Multidetector computed tomography (MDCT) only was performed in 2/6 patients, in 2/6 patients both sialography and MDCT were performed due to inconclusive MDCT features, 2/6 only sialography was performed. Sialoliths were classified on their location and size. RESULTS: In 6 out of 29 patients (4 males, 2 females, age range 1-17 years) salivary stones were detected. Sialoliths were detected in 5/6 patients in the submandibular gland and 1/6 in the parotid gland. All sialoliths, excepted for a case of multiple sialoliths, were located in the distal part of the main salivary ducts. CONCLUSION: Imaging characteristics of sialolith in pediatric group are similar than in adult population in few aspects. In fact sialoliths are smaller in size and located more frequently in the distal part of the main salivary duct, than in adult, making sialography cannulation more complex and requiring short thickness in MDCT.

A water-filled garment to protect astronauts during interplanetary missions tested on board the ISS.

As manned spaceflights beyond low Earth orbit are in the agenda of Space Agencies, the concerns related to space radiation exposure of the crew are still without conclusive solutions. The risk of long-term detrimental health effects needs to be kept below acceptable limits, and emergency countermeasures must be planned to avoid the short-term consequences of exposure to high particle fluxes during hardly predictable solar events. Space habitat shielding cannot be the ultimate solution: the increasing complexity of future missions will require astronauts to protect themselves in low-shielded areas, e.g. during emergency operations. Personal radiation shielding is promising, particularly if using available resources for multi-functional shielding devices. In this work we report on all steps from the conception, design, manufacturing, to the final test on board the International Space Station (ISS) of the first prototype of a water-filled garment for emergency radiation shielding against solar particle events. The garment has a good shielding potential and comfort level. On-board water is used for filling and then recycled without waste. The successful outcome of this experiment represents an important breakthrough in space radiation shielding, opening to the development of similarly conceived devices and their use in interplanetary missions as the one to Mars.

Internet research: improving traditional community analysis before launching a practice.

Optometric practice management experts have always recommended that optometrists thoroughly research the communities in which they are considering practicing. Until the Internet came along, demographic research was possible but often daunting. Today, say these authors, it's becoming quite a bit easier ... and they show us how.

Sialodochoplasty in the treatment of salivary-duct stricture in chronic sialoadenitis: technique and results.

PURPOSE: This study was undertaken to investigate peroral balloon angioplasty of salivary-duct strictures (sialodochoplasty) in chronic sialadenitis, analysing the technique, results and limitations. MATERIALS AND METHODS: Nine patients underwent sialodochoplasty: seven for Stensen's-duct strictures and two for Wharton's-duct strictures. One patient had a double stricture of Stensen's duct and another a salivary stone associated with a Wharton's-duct stricture. All patients were subjected to preliminary sialography to evaluate stricture site, length and grade. Sialodochoplasty was performed after local anaesthesia and progressive dilation of the salivary-duct orifice. RESULTS: The stricture was successfully dilated in 7/9 patients. The stricture was unchanged after dilatation in one patient, and in another, it recurred after 13 months. In the patient with a double stricture of Stensen's duct, one was resolved and the other was only partially dilated, with significant symptom improvement. One patient developed a new episode of sialadenitis after 3 months, which resolved with medical therapy. Five out of seven patients were asymptomatic at follow-up. CONCLUSIONS: Sialodochoplasty is an effective procedure in the treatment of salivary-duct strictures, improving symptoms in the majority of patients. The procedure is repeatable and can be proposed as a first-line treatment for symptomatic salivary-duct stricture.

The critical difference: scope of optometry practice vs. entry level competency.

This paper proposes a survey-based approach on how optometry can define the critical difference in competency levels between entry level and experienced practitioners. The report describes the design and pilot testing of a survey instrument on clinical competencies. This work is still in an early stage, and these preliminary findings are meant to encourage other individuals to work on empirical models for defining entry level clinical competencies. The pilot study concludes that a full scale project to describe empirically the entry level competencies for optometrists is feasible and worthy of effort. The findings of a descriptive study can help gauge at an institutional or national level what is the extent and diversity of views about what constitutes entry level clinical competencies for optometry.

Identification of the patient at risk: an optometric role in the prevention of stroke.

Identification of patients at risk for stroke and institution of medical management to reduce risk are the essentials of preventing stroke. Optometrists can play a role in the prevention by identifying patients at risk and directing them to appropriate medical care. The paper reviews the pathogenesis and clinical presentation of thrombotic, embolic and hemorrhagic stroke. The profile of potential victims is outlined with emphasis upon risk factors which may present in optometric patients; hyperlipidemia, hypertension, smoking, unruptured aneurysm, retinal emboli, and transient ischemic attacks.

Specialty differentials, limited license practitioners, and Medicare's new fee schedule.

The use of specialty differentials in the newly adopted Medicare fee schedule has been debated over the past 2 years. Arguments supporting the elimination of specialty differentials for optometrists and ophthalmologists are presented. The first recommendations by the Physician Payment Review Commission eliminating specialty differentials represent a victory for optometry in its efforts to achieve parity in the reimbursement of Medicare-covered services. Relative value units and practice costs to be used by the new Medicare fee schedule must be determined for optometry. Estimates of the model fee schedules for eye care procedures have been released by the Department of Health and Human Services.

Predicted and observed effects of the Medicare Optometry Parity Amendment.

The Medicare Parity Amendment of 1987 redefined the conditions of optometric participation and expanded coverage to include all Medicare-covered services which optometrists are authorized to perform under state law. Prior to the law, a number of studies projected costs to Medicare as a result of a change in Medicare policy. This paper reviews these studies in relation to actual Medicare expenditures from 1986 to 1988. The paper describes the impact of the Medicare amendment on payments to optometrists and shows how payments increased from $12 million in 1986 to $81 million in 1988. Optometrists substantially increased their market share of Medicare payments from 2.6 percent in 1986 to 11.1 percent in 1988. Indications suggest that a shift of patient visits from ophthalmologists to optometrists has occurred.

The Medicare Optometry Parity Amendment: predicted and actual payments to optometrists and ophthalmologists.

This paper compares various costs estimates for the expansion of optometric services under the Medicare program that were developed prior to the enactment the Medicare Parity Amendment of 1986. The new law, effective April 1, 1987 redefines the conditions of optometric participation and expanded coverage to include all Medicare covered services for which optometrists are authorized to perform under the state law. The paper describes the impact of the Medicare amendment with regard to payments to optometrists and ophthalmologists. Payments to optometrists increased from $12 million in 1986, a year before the Medicare Amendment to $81 million in 1988, the first full year after the law's implementation increasing their market share of Medicare payments from 2.6% to 11.1%. Ophthalmology incurred a significant decrease in market share from 97.9% to 88.9% during this period.

Implementation of the problem-oriented system in an optometric teaching clinic.

Problem-oriented records, performance audit, and a clinical index were implemented in the eye-care service of the Dorchester House Multi-Service Center, a neighborhood health center and teaching affiliate of the New England College of Optometry. We found that problem-oriented records facilitate communication and encourage logical thinking, that audit helps assure the quality of care and teaching, and that a clinical index provides a perspective on the overall performance of the eye-care service.

Guideline development process for optometric care of the patient with diabetes mellitus. American Optometric Association.

BACKGROUND: The aim of this project was to develop a standard of optometric care for patients with diabetes mellitus in an effort to help the clinician bridge the gap between research and practice. These guidelines are intended to assist optometric practitioners in the prevention, diagnosis, treatment, management, and rehabilitation of their patients. The guidelines are based on the best available research and professional judgment regarding the effectiveness and appropriateness of optometric care and procedures. METHODS: This paper details the methodology used by the AOA's Clinical Guidelines Coordinating Committee, Consensus Panel and the Center for Vision Care Policy of the State College of Optometry, SUNY, to develop practice guidelines for patients with diabetes mellitus.

Problem orientation in vision therapy.

Quantification and retrieval of data in vision therapy is a difficult task for both the private practitioner and optometric educator. The problem-oriented record provides an organizational approach that readily identifies patient's problems, therapeutic objectives, and the results of administered therapy. A minimum data base and the resultant problem list for vision therapy has been designed by us. By combining these two through a system of coding, a ready computer data retrieval system was devised. This system provides a method to clearly define terms, objectives, and results. Utilization of this record system by optometric schools and practitioners should reduce much of the confusion existing in the specialty field of vision therapy.

Response of an agrammatic patient to a syntax stimulation program for aphasia.

A Syntax Stimulation Program (SSP) based on the findings of neurolinguistic studies of agrammatic aphasic patients was used to treat one patient with a three year history of severe agrammatism. The SSP is designed to elicit eight different sentence constructions at two levels of difficulty using a story completion technique. The patient received pre-, mid- and post-treatment testing with the Northwestern Syntax Screening Test (NSST) and the cookie theft picture description of the Boston Diagnostic Aphasia Examination (BDAE). With 10 1/2 weeks of treatment, the patient's NSST expressive scores improved from 0 to 21, and his BDAE picture description showed increased phrase length and use of grammatical constructions. In addition, with this special treatment, the patient was able to produce grammatical speech in spontaneous conversation. Thus, the SSP appears to have therapeutic merit in training syntactic skills in presumably stable agrammatic patients.

Visual action therapy for global aphasia.

Eight globally aphasic patients who had not responded to traditional treatment received Visual Action Therapy (VAT), a nonvocal approach which ultimately trains patients to produce symbolic gestures for visually absent stimuli. Statistical analyses of pre and post VAT scores earned on the Porch Index of Communicative Ability (PICA) showed highly significant improvement on those subtests which measure pantomimic and auditory comprehension skills. The theoretical and practical implications of these findings are discussed.

The value of magnetic resonance imaging in a fistula of Wharton's duct.

A 30-year-old woman developed a fistula of the Wharton's duct following excision of the submandibular gland. The contribution of conventional fistulography, MRI and MRI fistulography in detecting the exact extent of the fistula is discussed.

Interventional treatment of sialoliths in main salivary glands.

PURPOSE: The aim of our study was to demonstrate the effectiveness of interventional radiology in the treatment of sialolithiasis, as the first-choice treatment for the removal of stones located in the middle and proximal tracts of the main salivary ducts, and to assess its limitations and contraindications. MATERIAL AND METHODS: Between February 1998 and May 2001 eleven interventional removals of sialoliths were performed for recurrent obstruction of the main salivary duct associated with chronic sialadenitis. Patients were selected on the basis of a preliminary sialogram, designed to determine the location and size of the stone. Exclusion criteria were location of the stone in the gland hilum or intraglandular stone, maximum stone diameter >20% of the duct calibre, signs of adherence of the stone to the duct wall. Stone removal, performed after obtaining informed consent, involved administering antibiotic therapy and local anaesthesia, and dilatating the duct ostium to enable introduction of the basket catheter. The basket was then advanced along the duct under fluoroscopic guidance and suitably manoeuvred so as to capture and extract the stone. On completing the procedure a sialogram was taken to ensure the complete patency of the duct. Patients were prescribed a short course of antibiotics and were followed up at 1, 3 and 6 months. RESULTS: In 10/11 patients the stone was located in Wharton's duct and in 1/11 in Stensen's duct. Removal of the calculus was successful in 10/11 patients; in 2 of these it was necessary to reintroduce the basket after extraction of the stone, in order to eliminate small stone fragments and salivary sand; in 1 patient a preliminary balloon-catheter sialoplasty was performed prior to the procedure to dilatate a distal stenosis caused by chronic sialadenitis; in 3 patients it was necessary to make a small incision in the orifice to introduce the dilator. Removal of the sialolith was unsuccessful in 1/11 of the patients treated, as it proved impossible to capture the calculus, even after repeated attempts. 8/11 patients reported pain during the procedure and swelling in the gland region immediately after the procedure, which resolved spontaneously within 24-48 hours. 9/11 patients remained asymptomatic in the follow-up; only 1/11 patients experienced a recurrence of sialadenitis after a short time, with pus secretion, which resolved with antibiotic treatment. CONCLUSIONS: The interventional removal of sialoliths in the salivary glands is an effective alternative to the conventional treatment of obstructive diseases of the glandular ducts.