Chronic recurrent osteomyelitis: a surgeon's enigma

Abstract

Background

Chronic recurrent forms of osteomyelitis of the mandible with their morbid clinical course have long been considered a challenge to maxillofacial surgeons in terms of both diagnosis and treatment. Various classifications and treatments have been established through the ages to define and manage the inflammatory symptoms occurring in adults and children. This paper discusses two such entities occurring in an adult and a child, highlighting the diagnostic and treatment challenges of recurrent osteomyelitis.

Methods

A thorough work up which included clinical, radiographic, blood investigations was done, followed by administration of antibiotics and anti‐inflammatory with or without surgical debridement / adjuvant therapies. Correlation of our findings and treatment plan was done with evidence based literature and practice.

Results

Complete resolution of symptoms with radiographic evidence were achieved in both the cases. In the recurrence period, long term steroids, NSAIDs, antibiotics resulted in better outcomes.

Conclusion

The evidence based protocol for osteomyelitis stresses on short inpatient stays predicated on efficient literature. Thorough clinical and radiographic evaluation with aggressive medical management and surgical intervention when necessary can result in longer symptom free periods. Thus understanding the disease, recurrence pattern and response to therapy is essential.

This article is protected by copyright. All rights reserved.

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Futile Recanalization With Poor Clinical Outcome Is Associated With Increased Edema Volume After Ischemic Stroke

Purpose Futile recanalization with poor clinical outcome after endovascular treatment of acute ischemic stroke is poorly understood. Recently, vessel recanalization has been associated with reduced ischemic brain edema in patients with good clinical outcome. As edema volume (EV) may be quantified in computed tomography (CT), we hypothesized that higher EV after revascularization predicts futile recanalization with poor outcome. Methods In this observational study, 67 ischemic stroke patients with M1 middle cerebral artery occlusion fulfilled all inclusion criteria and were analyzed. All patients received successful endovascular recanalization (thrombolysis in cerebral infarction scale 2b/3) and subsequent follow-up CT 24 hours later. Edema volume within the infarct lesion was calculated in follow-up CT applying lesion water uptake quantification and was used to predict clinical outcome (Modified Rankin Scale [mRS] after 90 days) compared with infarct volume. Results The median EV after thrombectomy was 1.6 mL (interquartile range, 0.2–4.2 mL) in patients with mRS 0 to 4 and 8.6 mL (interquartile range, 2.0–49.8 mL) in patients with mRS 5 to 6 (P = 0.0008). In regression analysis, an EV increase of 1 mL was associated with an 8.0% increased likelihood of poor outcome (95% confidence interval, 2.8%–15.4%; P = 0.008). Based on univariate receiver operating characteristic curve analysis, absolute EV over 4.2 mL predicted poor outcome (mRS 5–6) with good discriminative power (area under curve, 0.74; 95% confidence interval, 0.62–0.84; specificity, 77%; sensitivity, 68%). In comparison, the area under curve for infarct volume was 0.68. Conclusions Elevated EV after endovascular thrombectomy was associated with poor clinical outcome and may indicate futile recanalization. Received for publication October 25, 2018; and accepted for publication, after revision, November 5, 2018. Conflicts of interest and sources of funding: J.F. is a consultant for Acandis, Boehringer Ingelheim, Codman, Microvention, Sequent, and Stryker; is a speaker for Bayer Healthcare, Bracco, Covidien/ev3, Penumbra, Philips, and Siemens; and received grants from Bundesministeriums für Wirtschaft und Energie, Bundesministerium für Bildung und Forschung, Deutsche Forschungsgemeinschaft, European Union, Covidien, Stryker (THRILL study), Microvention (ERASER study), and Philips. A.K. is part of the research collaboration agreement, Siemens Healthcare. All the other authors have nothing to disclose. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2kq7jVD). Correspondence to: Gabriel Broocks, MD, Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. E-mail: g.broocks@uke.de. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Iodinated Contrast Agents and Risk of Hypothyroidism in Young Children in the United States

Background Although it is generally acknowledged that exposure to iodine contrast agents can interfere with thyroid function, little is known about the incidence of iodine-induced hypothyroidism in young children (younger than the age of 4 years). Study Objectives This was a retrospective cohort study to estimate the incidence rate of detected hypothyroidism in a US-based general population of pediatric patients exposed to an iodinated contrast agent. Setting The study was conducted in Kaiser Permanente Northern California, an integrated health care delivery system. Study Population This study included 2320 pediatric patients younger than 4 years of age who had a diagnostic procedure with an iodinated contrast agent during years 2008 to 2016. Results Among 2320 young children who met our study criteria, we identified 34 who met the initial criteria to be a case of hypothyroidism. The incidence density ratio for all hypothyroidism in iodine contrast agent–exposed patients was 1.33 per 1000 person months (95% confidence interval, 0.9–1.8). Most cases appeared to have subclinical hypothyroidism. The rate was higher for the probably iodine-induced cases (0.90 per 1000 person months) compared with cases with a possible alternate etiology (0.43 per 1000 person months), for males compared with females, and among children who had a heart catheterization compared with those with a computed tomography scan. It was also highest among the youngest children (younger than 3 months old), and decreased with increasing age. Discussion Our finding of hypothyroidism in young children exposed to iodine contrast agents (1.33 per 1000 person months [95% confidence interval, 0.9–1.8]) is broadly consistent with the sparse literature on this outcome. Received for publication September 11, 2018; and accepted for publication, after revision, November 15, 2018. Conflicts of interest and sources of funding: This study was funded by Bayer AG Germany. Y.C., P.P., and A.M. are employees of Bayer AG. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2kq7jVD). Correspondence to: Susan S. Jick, DSc, Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, 11 Muzzey St, Lexington, MA 02421. E-mail: sjick@bu.edu. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Automatic Tube Current Modulation and Tube Voltage Selection in Pediatric Computed Tomography: A Phantom Study on Radiation Dose and Image Quality

Objectives The aim of this study was to investigate the effects of a modern automatic tube current modulation (ATCM) and automatic tube voltage selection (ATVS) system on radiation dose and image quality in pediatric head, and torso computed tomography (CT) examinations for various clinical indications. Materials and Methods Four physical anthropomorphic phantoms that represent the average individual as neonate, 1-year-old, 5-year-old, and 10-year-old child were used. Standard head, thorax, and abdomen/pelvis acquisitions were performed with (1) fixed tube current, (2) ATCM, and (3) ATVS. Acquisitions were performed at various radiation dose levels to generate images at different levels of quality. Reference volume CT dose index (CTDIvol), reference image noise, and reference contrast-to-noise ratios were determined. The potential dose reductions with ATCM and ATVS were assessed. Results The percent reduction of CTDIvol with ATCM ranged from 8% to 24% for head, 16% to 39% for thorax, and 25% to 41% for abdomen/pelvis. The percent reduction of CTDIvol with ATVS varied on the clinical indication. In CT angiography, ATVS resulted to the highest dose reduction, which was up to 70% for head, 77% for thorax, and 34% for abdomen/pelvis. In noncontrast examinations, ATVS increased dose by up to 21% for head, whereas reduced dose by up to 34% for thorax and 48% for abdomen/pelvis. Conclusions In pediatric CT, the use of ATCM significantly reduces radiation dose and maintains image noise. The additional use of ATVS reduces further the radiation dose for thorax and abdomen/pelvis, and maintains contrast-to-noise ratio for the specified clinical diagnostic task. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Received for publication September 14, 2018; and accepted for publication, after revision, October 26, 2018. Conflicts of interest and sources of funding: This project has received funding from the Euratom research and training program 2014–2018 under grant agreement No. 755523 (MEDIRAD). The funding source had no role in study design, in the collection, analysis, and interpretation of data, nor in the writing or submission of the report. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (https://ift.tt/2kq7jVD). Correspondence to: Antonios E. Papadakis, PhD, Medical Physics Department, University Hospital of Heraklion, Stavrakia, 71110, Crete, Greece. E-mail: apapadak@pagni.gr. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Reduction of Metal Artifacts and Improvement in Dose Efficiency Using Photon-Counting Detector Computed Tomography and Tin Filtration

Objectives The aim of this study was to investigate the impact on metal artifacts and dose efficiency of using a tin filter in combination with high-energy threshold (TH) images of a photon-counting detector (PCD) computed tomography (CT) system. Materials and Methods A 3D-printed spine with pedicle screws was scanned on a PCD-CT system with and without tin filtration. Image noise and severity of artifacts were measured for low-energy threshold (TL) and TH images. In a prospective, institutional review board–approved, Health Insurance Portability and Accountability Act-compliant study, 20 patients having a clinical energy-integrating detector (EID) CT were scanned on a PCD-CT system using tin filtration. Images were reviewed by 3 radiologists to evaluate visualization of anatomic structures, diagnostic confidence, and image preference. Artifact severity and image noise were measured. Wilcoxon signed rank was used to test differences between PCD-CT TH and EID-CT images. Results Phantom TH images with tin filtration reduced metal artifacts and had comparable noise (32 HU) to TL images (29 HU) acquired without tin filtration. Visualization scores for the cortex, trabeculae, and implant-trabecular interface from PCD-CT TH images (4.4 ± 0.9, 4.4 ± 1.0, and 4.4 ± 1.0) were significantly higher (P

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Evaluation of lung transplant perfusion using iodine maps from novel spectral detector computed tomography

p. 436
Nils Große Hokamp, Amit Gupta
DOI:10.4103/ijri.IJRI_35_18  
We report the case of a 51-year-old patient who underwent bilateral lung transplantation and presented with an unstable condition and sepsis 6 days after transplantation. The performed contrast enhanced spectral detector computed tomography (CT) using a dual-layer detector showed absence of perfusion in the left lung on iodine maps, although branches of the pulmonary artery were patent. This prompted retrospective evaluation of CT images and total venous occlusion of the left pulmonary veins was found. Here, iodine maps helped in raising conspicuity of loss of lung perfusion.
http://www.ijri.org/currentissue.asp?sabs=y

Pulmonary atresia and ventricular septal defect,Coronary artery as the primary source of pulmonary blood flow

Collateral or fistula? Coronary artery as the primary source of pulmonary blood flow in a patient with pulmonary atresia and ventricular septal defect p. 433
Anurag Yadav, Salil Bhargava, T B S Buxi, Krishna Sirvi
DOI:10.4103/ijri.IJRI_489_17  
In patients with pulmonary atresia and ventricular septal defect (PA/VSD), a coronary artery being the primary source of pulmonary blood flow is a rare entity. We describe two cases of PA/VSD with coronary-to-pulmonary artery fistula with emphasis on the role of Computed Tomographic Angiography (CTA) in depicting all the sources of pulmonary blood supply, to predict surgical management and need for unifocalization of Major Aortopulmonary Collateral Arteries (MAPCA's).
http://www.ijri.org/currentissue.asp?sabs=y

An accurate tool to detect cardiac amyloidosis

Myocardial nulling pattern in cardiac amyloidosis on time of inversion scout magnetic resonance imaging sequence – A new observation of temporal variability p. 427
Harshavardhan Mahalingam, Binita Riya Chacko, Aparna Irodi, Elizabeth Joseph, Leena R Vimala, Viji Samuel Thomson
DOI:10.4103/ijri.IJRI_84_18  
Context: The pattern of myocardial nulling in the inversion scout sequence [time of inversion scout (TIS)] of cardiac magnetic resonance imaging (MRI) is an accurate tool to detect cardiac amyloidosis. The pattern of nulling of myocardium and blood at varying times post gadolinium injection and its relationship with left ventricular mass (LVM) in amyloidosis have not been described previously. Aims: The aim is to study the nulling pattern of myocardium and blood at varying times in TIS and assess its relationship with LVM and late gadolinium enhancement (LGE) in amyloidosis. Materials and Methods: This was a retrospective study of 109 patients with clinical suspicion of cardiac amyloidosis who underwent MRI. Of these, 30 had MRI features of amyloidosis. The nulling pattern was assessed at 5 (TIS5min) and 10 (TIS10min) minutes (min) post contrast injection. Nulling pattern was also assessed at 3min (TIS3min) in four patients and 7min (TIS7min) in five patients. Myocardial mass index was calculated. Mann-Whitney U test was done to assess statistical difference in the myocardial mass index between patients with and without reversed nulling pattern (RNP) at TIS5min. Results: RNP was observed in 58% at TIS5minand 89.6% at TIS10min. Myocardial mass index was significantly higher in patients with RNP at TIS5min[mean = 94.87 g/m2; standard deviation (SD) =17.63) when compared with patients with normal pattern (mean = 77.61 g/m2; SD = 17.21) (U = 18; P = 0.0351). Conclusion: In cardiac amyloidosis, TIS sequence shows temporal variability in nulling pattern. Earlier onset of reverse nulling pattern shows a trend toward more LVM and possibly more severe amyloid load.
http://www.ijri.org/currentissue.asp?sabs=y

Gujarati hypertensives

: A cross-sectional study p. 153
Jayesh Dalpatbhai Solanki, Hemant B Mehta, Sunil J Panjwani, Hirava B Munshi, Chinmay J Shah
DOI:10.4103/jpp.JPP_59_18  
Objective: To study the effect of different classes and combinations of antihypertensive agents on arterial stiffness and central hemodynamic parameters. Materials and Methods: A cross-sectional study was conducted in 446 treated apparently healthy hypertensives. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed in groups stratified by antihypertensive used. Study parameters were brachial hemodynamics (blood pressure (BP), heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work). Statistical significance was kept at P < 0.05. Results: All groups were selected by matching of age, gender, and body mass index. They were comparable with major confounding factors. There was no difference between study parameters in hypertensives taking exclusive angiotensin-converting enzyme inhibitor (ACEI), calcium channel blocker (CCB), or angiotensin II receptor blocker. Multitherapy showed better hemodynamics and monotherapy showed better stiffness parameters. Addition of CCB to ACEI did not make a difference except with diastolic BP. For most comparisons, most of the results lacked statistical significance. Conclusion: Discrete PWA parameters showed no class difference in hypertensives, treated by conventional monotherapy or combination, ACEI appears to be the best drug. This also indicates that early diagnosis and blood pressure control are more important than antihypertensive used.
http://www.jpharmacol.com/currentissue.asp?sabs=y

contrast media-induced nonrenal adverse drug reactions

contrast media-induced nonrenal adverse drug reactions over the last three decades: A systematic review p. 131
Maurizio Sessa, Claudia Rossi, Annamaria Mascolo, Antonella Scafuro, Rosanna Ruggiero, Gabriella di Mauro, Salvatore Cappabianca, Roberto Grassi, Liberata Sportiello, Concetta Rafaniello
DOI:10.4103/jpp.JPP_92_18  
The aim of this study was to investigate the scientific contribution of Italian clinical research for contrast media-induced nonrenal adverse drug reactions over the last three decades. Ovid Embase, Ovid MEDLINE, Web of Science, and Cochrane Methodology Register were used as data sources to identify Italian descriptive studies, observational studies, meta-analyses, and clinical trials assessing contrast media-induced nonrenal adverse drug reactions as a safety outcome. The population of interest was men and women exposed to a contrast medium. Between 1990 and 2017, 24 original articles investigating contrast-induced nonrenal adverse drug reactions were identified. The cohort study was the most representative study design (10/24; 41.7%). The 24 studies were conducted mainly as monocenter studies (14/24; 58.3%) and without receiving funding (17/24; 70.8%). Seventeen out of 24 studies provided a level of evidence ranging from III-2 (11/24; 45.8%) to IV (6/24; 25.0%) on a Merlin scale. In total, 14 of 24 (58.3%) studies were published in a scientific journal ranked in the first quartile of their subject area. The 24 original articles mainly focused on adverse drug reactions already observed during clinical trials (i.e., idiosyncratic systemic reactions). In conclusion, during the last three decades and a burst was not observed in the Italian clinical research investigating contrast-induced nonrenal adverse drug reactions. High-quality clinical research is needed especially for procedures to prevent the onset of the aforementioned events, to identify risk factors, to minimize the risk of their occurrence, and to optimize their related prognosis.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Phosphodiesterase 7B1 as therapeutic target for treatment of cognitive dysfunctions in multiple sclerosis

 p. 126

Arthi Balsundaram, Darling Chellathai
DOI:10.4103/jpp.JPP_77_18  
Multiple sclerosis (MS) is an autoimmune, chronic degenerative neuroinflammatory disorder affecting younger age groups of the United States of America and Europe. MS prevalence studies in India have shown that India is no longer a low-risk zone. Many studies have shown the seriousness of cognitive impairments (CIs) and its types caused in MS. In this review, the pathological basis for CI in various stages of MS was reviewed and revealed to provide a basis for the treatment. Role of phosphodiesterase 7B1 (PDE7B1) inhibitors in treating CI related to MS were also stated in this review. The literature for this review was collected from PubMed and Embase.
http://www.jpharmacol.com/currentissue.asp?sabs=y

Return to contact sport post ORIF facial fractures

Aims: Contact sports, such as rugby, are responsible for many maxillofacial injuries. To our knowledge there are no guidelines in the medical literature on time to return to contact sports following surgical repair of facial fractures. We describe current practice amongst the oral and maxillofacial community in the UK. We formulate guidelines to inform the clinician on appropriate timing for return to contact sports post fixation of facial fractures.

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Two new surgical techniques to refine surgery around the ear

Numerous incisions around the ear have been described and many are used in oral and maxillofacial surgery for procedures involving the TMJ and the parotid, as well as for rhytidectomy. The traditional pre-auricular and endaural incisions often result in a visible scar. Additionally, surgical procedures around the ear often result in the collection of blood in the ear canal. Although the blood represents minimal risk it is unpleasant, inconvenient and often difficult to remove.

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Oral & Maxillofacial Surgery (OMFS) trainees and consultants resume the trend of letting their dental registration lapse

Introduction: Although the GDC doubled their Annual Retention Fee (ARF) in 2015, it has been almost unchanged in 2016 to 2018.

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Postoperative observations for orbital and zygomatic repairs – A 5 year review

Retrobulbar haemorrhage is a rare complication of peri-orbital or zygomatic complex surgery, with an incidence of 0.3%.(1) However it carries a serious risk of blindness if not detected and managed immediately. Thus, most maxillofacial surgeons advocate post-operative eye observations.

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Managing the complications of injectable dermal fillers – who is picking up the tab?

Introduction: Injectable cosmetic products are being used more frequently year on year and account for up to 75% of cosmetic surgical procedures carried out in the UK each year. With an increasing caseload, complications, whilst rare, are on the increase. The authors present 4 recent cases of complications associated with injectable dermal fillers managed in NHS OMFS clinics, and discuss the literature supporting the management of these complications.

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Frequency of Level IIb Neck Dissections for OSCC

Introduction: Selective neck dissection (SND) is the gold standard in oncological management of the neck, it enables us to reduce the morbidity of neck dissection while maintaining the same oncological results. Spinal accessory nerve dysfunction and related shoulder disability is the commonest morbidity associated with dissection of Level IIb. This study was undertaken to ascertain the frequency of undertaking Level IIb dissection and the rate of Nodal metastasis to this level.

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Audit of Deranged Liver Enzymes In Post-operative Major Head & Neck Reconstructive Surgery - Are our patients coming to harm?

Introduction/Aims: Over the last 18 months, increasing numbers of our post head & neck reconstructive surgery patients have been observed to have deranged liver enzymes that can manifest up to one week post-operatively. NICE guidelines recommend investigation of patients with persistent deranged liver enzymes or more than twice upper border of normal.

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Did not attend

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An audit of the orthognathic treatment pathway in a Regional Maxillofacial Unit

Background and objectives: Orthognathic surgery has become increasingly common to correct malocclusions with a substantial skeletal component.

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Advertising and marketing breaches by non-surgical aesthetic trainers

The practice of non-surgical aesthetics is a booming industry, and discussion is being had about how this area of practice requires regulation in order to protect patients from undue harm. Whilst GMC guidance is available and often adhered to by clinicians advertising clinical services, there is guidance available from the Advertising Standards Authority (ASA) regarding medical services provision and the methods used to promote such practice. Having reviewed these ASA guidelines, we wanted to establish how many providers were in fact in breach of the ASA and GMC guidance.

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Audit on the non-diagnostic rate of fine needle aspirations and the subsequent management in a maxillofacial unit over a 1-year period

Introduction: Fine-needle aspiration (FNA) is a simple technique used in the preoperative diagnosis of head and neck lumps. It has limitations as cellular aspirates may be inadequate or equivocal for diagnosis. FNA performance can be optimised through image guidance, availability of on-site pathologists or ancillary techniques – though it is operator-experience dependent. There is little in the literature to inform on the optimal follow up management of non-diagnostic samples.

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Emergency management of the neck breather A closed loop, multi-centre audit

Aims: A multi centre completed audit cycle to ascertain improvements in knowledge of emergency tracheostomy and laryngectomy management following implementation of a teaching programme. Results were compared with The Global Tracheostomy Safety Project emergency management algorithm with a standard of 100% compliance.

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Preoperative cross-matching: are we using blood efficiently?

Introduction: Additional blood is required perioperatively to compensate for blood loss for patients undergoing major surgery. The hospital trust policy uses Adult Maximum Surgical Blood Order Schedule (MSBOS) suggesting how many blood units should be cross matched for a certain procedure. In 2015 there was a 40% drop in blood donations putting the UK blood bank safety levels at risk. The cost of one unit of blood is £124.46. Because of this it is important we adhere to the cross match guidelines as higher orders can be wasteful and very costly.

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An assessment tool for orbital trauma - should the orbits be included in head CT?

Introduction and Aims: Many patients undergo CT of the head to exclude brain injury, which frequently does not include the orbits. Patients with maxillofacial injuries may go on to receive additional imaging, incurring additional cost, time and radiation exposure. We aim to examine the signs and symptoms of orbital fractures to develop a tool to assess the benefit of including the orbits inpatients already undergoing CT head.

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Orthodontic extractions referrals to oral surgery: Are we complying with the British orthodontic society risk management guidelines?

Introduction: Referrals for orthodontic extractions request the removal of teeth, often with no obvious pathology, and are therefore at high risk of wrong tooth extractions. This can be avoided by ensuring clear communication in referrals. British orthodontic society risk management guidelines (BOS) state how orthodontic extractions should be notated in writing plus a second notation to avoid miscommunication. This audit aimed to assess the quality of orthodontic referrals to the oral surgery department in University of Manchester Dental Hospital (UMDH) by assessing their compliance with the BOS risk management guidelines.

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Immediate oral feeding following head and neck free flaps - influence on length of stay and complications

Free tissue transfer is commonplace in head and neck reconstruction but practice in the United Kingdom varies regarding the commencement of post-operative oral feeding. While some units delay the onset of feeding for over a week others imposing a restrictive dietary regimen e.g. clear fluids only for 48hours after the comment of oral intake.

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Alcohol Status Screening and Intervention: A re-audit comparing primary and secondary care

Introduction: High alcohol intake is linked to a range of adverse health effects. Screening patients is a valuable tool in identifying patients who may benefit from intervention. This has been shown to aid patient reduction of alcohol intake. Therefore, clinicians should provide such services.

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A comparison of patient outcomes following orthognathic surgery with and without the use of hilotherapy

Patients undergoing orthognathic surgery commonly complain of bruising and swelling postoperatively, frequently leading to a delay to return to work. We propose the use of a cooling face mask called "hilotherapy" postoperatively to aid the patients return to work and reduce the burden of care to the NHS.

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An audit to assess GDP registration in paediatric patients attending A+E with dental abscesses

Introduction/Aims: In 2014-2015, more than 26,000 hospital admissions were as a result of dental infections in children age 5-9. The Royal College of Surgeons England state that 42.1% of children did not visit an NHS dentist between 2015-2016. Based on "Delivering Better Oral Health" and NICE Guidelines, all children should be registered and have a recall frequency of no more than 1 year.

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Abstract withdrawn 12 June 2018

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3 faculty members receive school’s top honor

The School of Dentistry honored three faculty members on Monday with the presentation of its annual Bruce R. Rothwell Teaching Awards, the school's highest such recognition.

The post 3 faculty members receive school's top honor appeared first on UW School of Dentistry.

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Magnetic resonance imaging predictors of shoulder instability in adolescents

Abstract

Background

Managing recurrent shoulder instability in an athlete of any age is challenging. The pediatric literature regarding recurrence of instability is difficult to interpret because of the variable treatment protocols and varying ages. The adult literature suggests that bone loss on the humerus, glenoid or both, as detected by CT, has high rates of recurrence following surgical intervention.

Objective

The purpose of this study was to evaluate risk factors for recurrence following arthroscopic capsulorrhaphy in adolescent athletes using preoperative MR arthrograms.

Materials and methods

We reviewed a retrospective shoulder instability database for adolescents (age ≤18 years), who underwent an isolated arthroscopic capsulorrhaphy from 2006 to 2011. We recorded preoperative MRI measurements regarding the dimensions of the glenohumeral joint, as well as glenoid, humeral and labral pathologies. We performed statistical analysis to determine MRI findings that might have predicted recurrence of shoulder instability following capsulorrhaphy.

Results

We reviewed a total of 50 patients (13–18 years) and found 22 patients (44%) to have recurrent instability following capsulorrhaphy. Presence of glenoid bone loss or a bipolar bone lesion (defined as bone loss on both the glenoid and humerus) significantly predicted recurrence of shoulder instability (both P=0.03). There was not a threshold size of glenoid bone loss or bipolar lesion that predicted recurrence. All remaining glenohumeral dimensions or presence or size of an isolated Hill-Sachs did not significantly predict recurrence of instability.

Conclusion

Athletes ≤18 years old have a high rate of failure following arthroscopic capsulorrhaphy in the presence of glenoid bone loss or a bipolar lesion on MRI. Surgeons should consider addressing these lesions in adolescent athletes with shoulder instability. Additionally, MRI is a valid imaging tool to diagnose and measure osseous lesions of the shoulder.

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Rallying call for fellows and members to work with The British Association of Oral and Maxillofacial Surgeons to educate and promote oral and maxillofacial surgery to medics and dentists

As the President, Chair, and member of Council with the "Youth Policy" portfolio, respectively, for the British Association of Oral and Maxillofacial Surgeons (BAOMS) we welcome the recent paper by Payne et al,1 which highlighted the work needed to improve students' knowledge of oral and maxillofacial surgery (OMFS) and to raise their awareness of the specialty as a great choice of career.

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Evaluation of tooth wear and associated risk factors: A matched case–Control study p. 1607 C Atalay, G Ozgunaltay DOI:10.4103/njcp.njcp_203_18 Aim: The aim of this case–control study was to compare the associated risk factors between adults with tooth wear (TW) and age- and sex-matched controls without TW. Methods: Fifty participants with TW and 50 age- and sex-matched controls participated in this study. A questionnaire was prepared to assess oral healthcare and consumption of erosive food and drinks. All participants completed the diet analysis forms. Saliva characteristics were evaluated with GC Saliva-Check BUFFER test. Examiners measured the TW of case patients, using the TW index. Data were statistically analyzed using Chi-square and Mann–Whitney U-tests (P < 0.05). Results: Individuals in the case group brush their teeth more often (P < 0.05). The difference in erosive food consumption between the case and control groups was significant (P < 0.05). There was no erosive

Evaluation of tooth wear and associated risk factors: A matched case–Control study p. 1607
C Atalay, G Ozgunaltay
DOI:10.4103/njcp.njcp_203_18  
Aim: The aim of this case–control study was to compare the associated risk factors between adults with tooth wear (TW) and age- and sex-matched controls without TW. Methods: Fifty participants with TW and 50 age- and sex-matched controls participated in this study. A questionnaire was prepared to assess oral healthcare and consumption of erosive food and drinks. All participants completed the diet analysis forms. Saliva characteristics were evaluated with GC Saliva-Check BUFFER test. Examiners measured the TW of case patients, using the TW index. Data were statistically analyzed using Chi-square and Mann–Whitney U-tests (P < 0.05). Results: Individuals in the case group brush their teeth more often (P < 0.05). The difference in erosive food consumption between the case and control groups was significant (P < 0.05). There was no erosive effect of acidic food when consumed as a main meal or a snack (P > 0.05). Although there was no difference between stimulated saliva flow rate and buffering capacity between groups, the difference between the resting saliva flow rates and pH values was significant (P < 0.05). Although some wear was seen on buccal/labial surfaces of teeth, cervical and occlusal/incisal surfaces were scored higher. No TW was observed on palatal/lingual surfaces. The cervical surfaces of mandibular premolars and incisal surfaces of anterior teeth were most affected. Conclusion: Of the factors investigated, TW in the case group was correlated with consumption of acidic foods, lower salivary flow rate, and pH.
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Anal melanoma: Outcomes of current surgical approaches p. 1622 S Kaya, M Kement, YE Altuntas, O Altin, A Seker, S Mazmanoglu, L Kaptanoglu, N Bildik, HF Kucuk DOI:10.4103/njcp.njcp_254_18 Aim: In this study, we aimed to evaluate the clinical characteristics and outcomes of the patients with anal melanoma (AM), who underwent surgical treatment. Materials and Methods: This study was conducted in Kartal Training and Research Hospital between January 2010 and December 2017. All patients, who underwent surgical resection with a diagnosis of AM, were enrolled. Results: A total of 10 patients were examined, 8 of them were females, and their average age was 69.2 years (range, 47–85 years). Abdominoperineal resection (APR) was performed in five (50%) patients, and local excision (LE) was performed in other five (50%) patients. Three patients (30%) had stage I disease, two (20%) had stage II disease, and five (50%) had stage III disease. All five patients in APR group had stage III disease

Anal melanoma: Outcomes of current surgical approaches p. 1622
S Kaya, M Kement, YE Altuntas, O Altin, A Seker, S Mazmanoglu, L Kaptanoglu, N Bildik, HF Kucuk
DOI:10.4103/njcp.njcp_254_18  
Aim: In this study, we aimed to evaluate the clinical characteristics and outcomes of the patients with anal melanoma (AM), who underwent surgical treatment. Materials and Methods: This study was conducted in Kartal Training and Research Hospital between January 2010 and December 2017. All patients, who underwent surgical resection with a diagnosis of AM, were enrolled. Results: A total of 10 patients were examined, 8 of them were females, and their average age was 69.2 years (range, 47–85 years). Abdominoperineal resection (APR) was performed in five (50%) patients, and local excision (LE) was performed in other five (50%) patients. Three patients (30%) had stage I disease, two (20%) had stage II disease, and five (50%) had stage III disease. All five patients in APR group had stage III disease. In the comparison of the survival period after surgery, the mean survival period of the APR group was 6.2 months (range, 1–16 months) while that of the LE group was 19.6 months (range, 7–43 months). Conclusion: LE with adjuvant radiation seems to offer good locoregional control without reducing the survival and may be an option of treatment for patients with small, superficial AM. However, APR should be offered for patients with locally advanced disease or as a salvage following recurrence.
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Rhabdomyoblastic differentiation in rosai dorfman disease of the orbit in a 12-year-old male p. 1670 E Ezeanosike, OB Ezeanosike, SI Akpan, CN Ezisi DOI:10.4103/njcp.njcp_262_17 Extranodal Rosai–Dorfman disease involving the orbit has been reported severally with extensive discourse on management strategies. However, rhabdomyoblastic differentiation coexisting with the disease is yet unreported. We present the clinical and histopathological features of a 12-year-old boy presenting with both. A 12-year-old boy was referred to our Ophthalmic Plastic Surgical Service with a 5-year history of bilateral, progressively enlarging eyelid, orbital masses causing proptosis, and severe cosmetic blemish. He had suffered vision loss to the right eye following trauma 2 years prior to the onset of the disease. Computed tomography of the orbits revealed preseptal and intraorbital components of well-defined multi-lobulated masses in both orbits. No significant nodal involvement was noted. He unde

Rhabdomyoblastic differentiation in rosai dorfman disease of the orbit in a 12-year-old male p. 1670
E Ezeanosike, OB Ezeanosike, SI Akpan, CN Ezisi
DOI:10.4103/njcp.njcp_262_17  
Extranodal Rosai–Dorfman disease involving the orbit has been reported severally with extensive discourse on management strategies. However, rhabdomyoblastic differentiation coexisting with the disease is yet unreported. We present the clinical and histopathological features of a 12-year-old boy presenting with both. A 12-year-old boy was referred to our Ophthalmic Plastic Surgical Service with a 5-year history of bilateral, progressively enlarging eyelid, orbital masses causing proptosis, and severe cosmetic blemish. He had suffered vision loss to the right eye following trauma 2 years prior to the onset of the disease. Computed tomography of the orbits revealed preseptal and intraorbital components of well-defined multi-lobulated masses in both orbits. No significant nodal involvement was noted. He underwent excision biopsy of the tumor in both eyes performed 1 month apart. A histopathologic diagnosis of the Rosai–Dorfman disease with focal areas of rhabdomyoblastic differentiation was made. He was treated postoperatively with a course of oral steroids with close observation for the rhabdomyoblastic differentiation. Rosai–Dorfman disease is an uncommon disease and has been reported to coexist with other pathologies. We highlight focal myoblastic differentiation within the excised tissues which may not necessarily warrant a diagnosis of rhabdomyosarcoma. Long-term follow-up of this patient is required to establish the safety of observation.
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Recurrent oral squamous papilloma in a pediatric patient: Case report and review of the literature p. 1674 OO Orenuga, Oluwo A, RT Oluwakuyide, AB Olawuyi DOI:10.4103/njcp.njcp_407_17 Squamous papillomas are common lesions of the oral mucosa. They are benign proliferating lesions often painless, slow growing and with a cauliflower appearance. However, its clinical appearance which sometimes mimics exophytic carcinoma, verrucous carcinoma or condyloma acuminatum raises concern when it occurs in the oral cavity. Squamous papilloma occurs predominantly in 30- to 50-year old's. However, they may be seen in children <10 years and accounted for 8% of all oral tumors in children. There is no sex predilection. It has a predilection for the tongue and soft palate, but may occur on any other surface of the oral cavity. Oral squamous papillomas have been associated with infection by the human papilloma virus (HPV). The present report is a case of a recurrent squamous papilloma of the hard pal

Recurrent oral squamous papilloma in a pediatric patient: Case report and review of the literature p. 1674
OO Orenuga, Oluwo A, RT Oluwakuyide, AB Olawuyi
DOI:10.4103/njcp.njcp_407_17  
Squamous papillomas are common lesions of the oral mucosa. They are benign proliferating lesions often painless, slow growing and with a cauliflower appearance. However, its clinical appearance which sometimes mimics exophytic carcinoma, verrucous carcinoma or condyloma acuminatum raises concern when it occurs in the oral cavity. Squamous papilloma occurs predominantly in 30- to 50-year old's. However, they may be seen in children <10 years and accounted for 8% of all oral tumors in children. There is no sex predilection. It has a predilection for the tongue and soft palate, but may occur on any other surface of the oral cavity. Oral squamous papillomas have been associated with infection by the human papilloma virus (HPV). The present report is a case of a recurrent squamous papilloma of the hard palate in a 5-year-old patient with a review of the literature.
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severe skeletal open bite using temporary anchorage devices p. 1678 WX Lv, S Chen, TM Xu, B Han DOI:10.4103/njcp.njcp_223_18 This case report presents the treatment and long-term follow-up of a patient with severe skeletal hyperdivergent open bite, Class II malocclusion, and a severely retruded chin. After failure of early treatment using high-pull headgear with a bite block during the early permanent dentition stage due to an unfavorable growth pattern, orthognathic surgery was proposed but rejected by the patient. Then, temporary anchorage devices were used to correct the occlusion and establish an acceptable overbite and overjet. The overall observation time was 8.5 years; the treatment time using fixed appliances was 3 years and 4 months. The achieved tooth position and occlusal relationship remained stable 2.5 years later without recurrence of the open bite.

severe skeletal open bite using temporary anchorage devices p. 1678
WX Lv, S Chen, TM Xu, B Han
DOI:10.4103/njcp.njcp_223_18  
This case report presents the treatment and long-term follow-up of a patient with severe skeletal hyperdivergent open bite, Class II malocclusion, and a severely retruded chin. After failure of early treatment using high-pull headgear with a bite block during the early permanent dentition stage due to an unfavorable growth pattern, orthognathic surgery was proposed but rejected by the patient. Then, temporary anchorage devices were used to correct the occlusion and establish an acceptable overbite and overjet. The overall observation time was 8.5 years; the treatment time using fixed appliances was 3 years and 4 months. The achieved tooth position and occlusal relationship remained stable 2.5 years later without recurrence of the open bite.
http://www.njcponline.com/currentissue.asp?sabs=y

Feulgen stain as a special stain for mitotic figures and apoptotic bodies in oral squamous cell carcinoma p. 164 Sankari Radhakrishnan, Ramesh Venkatapathy, PD Balamurali, Karthik Shree V Prashad, B Premalatha, Saikat Chakraborty DOI:10.4103/srmjrds.srmjrds_49_18 Background: Oral cancer is one of the most prevalent cancers worldwide. The oral squamous cell carcinoma (OSCC) is graded for the proper treatment planning, and it has been a subjective phenomenon. This grading depends on several features, of which the presence of mitotic figures and apoptotic bodies is one of the important criteria. The routine hematoxylin and eosin (H and E) staining may help in identifying the mitotic figures and apoptotic bodies, but it is difficult to identify accurately. Thus, an attempt was made to evaluate the efficacy of crystal violet and Feulgen stain in identifying the mitotic figures and apoptotic bodies and to observe any variation in different grades of carcinoma. Aims: This study was aimed

Feulgen stain as a special stain for mitotic figures and apoptotic bodies in oral squamous cell carcinoma p. 164
Sankari Radhakrishnan, Ramesh Venkatapathy, PD Balamurali, Karthik Shree V Prashad, B Premalatha, Saikat Chakraborty
DOI:10.4103/srmjrds.srmjrds_49_18  
Background: Oral cancer is one of the most prevalent cancers worldwide. The oral squamous cell carcinoma (OSCC) is graded for the proper treatment planning, and it has been a subjective phenomenon. This grading depends on several features, of which the presence of mitotic figures and apoptotic bodies is one of the important criteria. The routine hematoxylin and eosin (H and E) staining may help in identifying the mitotic figures and apoptotic bodies, but it is difficult to identify accurately. Thus, an attempt was made to evaluate the efficacy of crystal violet and Feulgen stain in identifying the mitotic figures and apoptotic bodies and to observe any variation in different grades of carcinoma. Aims: This study was aimed at using crystal violet and Feulgen stain in identifying mitotic figures and apoptotic bodies in different grades of OSCC. Materials and Methods: Fifteen diagnosed cases of OSCC were retrieved and stained with routine H and E, crystal violet stain, and Feulgen stain. All the sections were scanned for mitotic figures and apoptotic bodies. Apoptotic index (AI) and mitotic index (MI) were calculated. AI and MI were expressed as the average of a total number of apoptotic and mitotic cells counted in ten high-power fields. Results: A significant increase in MI and AI was found in Feulgen stain than crystal violet and H and E stain. Conclusion: Feulgen stain can be considered as the best, cost-effective, relatively cheap stain to visualize mitotic figures and apoptotic bodies.
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Regenerative periodontics in restoring oral functions: A power to regenerate what's lost p. 168 Hunny Sharma, Swati Verma DOI:10.4103/srmjrds.srmjrds_24_18 Although human oral cavity benefits from remarkable mechanical and functional properties, still it faces continuous insult and damage resulting from exposure to microbial attacks. In the past where conventional dentistry was only focused on evaluating, restoration, and replacement of the diseased oral structures. The recent era of advancement in the field of materials science, molecular biology, tissue engineering, and stem cell research's had let to the path of development of new era of periodontal engineering known as regenerative periodontics. The ultimate goal of regenerative periodontics is the regeneration of the lost periodontium due to advanced periodontal disease. Currently, scientists are working on a wide range of biomaterials and scaffolds, genes, stem cells, and growth factors in the hope of achieving more predictab

Regenerative periodontics in restoring oral functions: A power to regenerate what's lost p. 168
Hunny Sharma, Swati Verma
DOI:10.4103/srmjrds.srmjrds_24_18  
Although human oral cavity benefits from remarkable mechanical and functional properties, still it faces continuous insult and damage resulting from exposure to microbial attacks. In the past where conventional dentistry was only focused on evaluating, restoration, and replacement of the diseased oral structures. The recent era of advancement in the field of materials science, molecular biology, tissue engineering, and stem cell research's had let to the path of development of new era of periodontal engineering known as regenerative periodontics. The ultimate goal of regenerative periodontics is the regeneration of the lost periodontium due to advanced periodontal disease. Currently, scientists are working on a wide range of biomaterials and scaffolds, genes, stem cells, and growth factors in the hope of achieving more predictable outcomes in regenerative periodontics. Future research areas in regenerative periodontics include three-dimensional printing, tissue engineering, and gene therapy strategies which give more positive and predictable outcomes of regenerative periodontics. This review provides an overview of current on-going technique and researches in the field of regenerative periodontics and also will show a glimpse of what the future holds.
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Importance of cone-beam computed tomography in dentistry: An update p. 186 Shruthi Hegde, Vidya Ajila, Jasmine Shanti Kamath, Subhas Babu, Devika S Pillai, S Mithula Nair DOI:10.4103/srmjrds.srmjrds_26_18 In this era of advanced technology, cone-beam computed tomography (CBCT) has gained popularity in the field of oral radiology due to its advantages over conventional radiography. The use of CBCT is profoundly increasing for diagnosis and treatment planning in different specialties of dentistry. The incorporation of cone-beam technology into clinical practice is taking place because of the progress in image acquisition and three-dimensional (3D) imaging. The equipment design is easier to use, image distortion is minimal, and the images are compatible with other planning and simulation software. The 3D imaging has made the complex craniofacial structures more accessible for examination. Early and accurate diagnosis of deep-seated lesions is possible. CBCT provides a high-spatial res

Importance of cone-beam computed tomography in dentistry: An update p. 186
Shruthi Hegde, Vidya Ajila, Jasmine Shanti Kamath, Subhas Babu, Devika S Pillai, S Mithula Nair
DOI:10.4103/srmjrds.srmjrds_26_18  
In this era of advanced technology, cone-beam computed tomography (CBCT) has gained popularity in the field of oral radiology due to its advantages over conventional radiography. The use of CBCT is profoundly increasing for diagnosis and treatment planning in different specialties of dentistry. The incorporation of cone-beam technology into clinical practice is taking place because of the progress in image acquisition and three-dimensional (3D) imaging. The equipment design is easier to use, image distortion is minimal, and the images are compatible with other planning and simulation software. The 3D imaging has made the complex craniofacial structures more accessible for examination. Early and accurate diagnosis of deep-seated lesions is possible. CBCT provides a high-spatial resolution of bone and teeth which allows accurate understanding of the relationship of the adjacent structures. CBCT has helped in detecting a variety of cysts, tumors, infections, developmental anomalies, and traumatic injuries involving the maxillofacial structures. It has been used extensively for evaluating dental and osseous disease in the jaws. This paper reviews current advances in CBCT and their uses in dentistry.
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Chemical burns of gingiva and its management p. 174 MM Dayakar, Prakash G Pai, Radhika Priyadarshini M Sooranagi, Vintu Vijayan, Abdul Waheed DOI:10.4103/srmjrds.srmjrds_16_18 Chemical burns on the gingiva can be caused by the use of certain pharmaceutical and nonpharmaceutical products by patients or by injudicious use of caustics by the dental clinician. These lesions in the oral cavity, however, are rarely reported. Hence, information about the product and needful instructions is necessary to be given to the patients for prevention of the same. These burns can be caused by the way of self-infliction, allergic tendency toward certain products, or it may be iatrogenic. A detailed history is the key to diagnosing and managing these cases. Chemical burns are usually treated by eliminating the etiology and managed by palliative therapy.

Chemical burns of gingiva and its management p. 174
MM Dayakar, Prakash G Pai, Radhika Priyadarshini M Sooranagi, Vintu Vijayan, Abdul Waheed
DOI:10.4103/srmjrds.srmjrds_16_18  
Chemical burns on the gingiva can be caused by the use of certain pharmaceutical and nonpharmaceutical products by patients or by injudicious use of caustics by the dental clinician. These lesions in the oral cavity, however, are rarely reported. Hence, information about the product and needful instructions is necessary to be given to the patients for prevention of the same. These burns can be caused by the way of self-infliction, allergic tendency toward certain products, or it may be iatrogenic. A detailed history is the key to diagnosing and managing these cases. Chemical burns are usually treated by eliminating the etiology and managed by palliative therapy.
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Mucormycosis – Can the diagnosis be challenging at times?? p. 191 Vandana Raghunath, K Hanna Rose Priyanka, C Geetha Kiran, R Manasa Deepthi DOI:10.4103/srmjrds.srmjrds_53_18 Mucormycosis is an aggressive and often rapidly progressing fatal form of fungal infection mainly affecting the immunocompromised patients and characterized by destruction and necrosis. The paranasal sinuses get affected commonly in the rhinocerebral type with or without oral cavity involvement. At times, even in the setting of immunosuppression, it presents as a subtle clinical infection posing both as a diagnostic and therapeutic challenge to the clinicians. Further, in such immunocompromised cases, early diagnosis and prompt treatment become utmost demanding to prevent the ensuing morbidity and mortality. We present one such indolent case which presented as a sinus infection in a 50-year-old diabetic woman. Further, the granulomatous presentation on hematoxylin and eosin-stained sections led to an erroneo

Mucormycosis – Can the diagnosis be challenging at times?? p. 191
Vandana Raghunath, K Hanna Rose Priyanka, C Geetha Kiran, R Manasa Deepthi
DOI:10.4103/srmjrds.srmjrds_53_18  
Mucormycosis is an aggressive and often rapidly progressing fatal form of fungal infection mainly affecting the immunocompromised patients and characterized by destruction and necrosis. The paranasal sinuses get affected commonly in the rhinocerebral type with or without oral cavity involvement. At times, even in the setting of immunosuppression, it presents as a subtle clinical infection posing both as a diagnostic and therapeutic challenge to the clinicians. Further, in such immunocompromised cases, early diagnosis and prompt treatment become utmost demanding to prevent the ensuing morbidity and mortality. We present one such indolent case which presented as a sinus infection in a 50-year-old diabetic woman. Further, the granulomatous presentation on hematoxylin and eosin-stained sections led to an erroneous initial diagnosis, which later upon Grocott's methenamine silver staining was diagnosed as mucormycosis-rhinocerebral type. Thus, both clinical and histopathological presentations were defying.
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Salmon calcitonin - a boon in the management of central giant cell granuloma p. 197 D Nivethitha Gangai, G V. Murali Gopika Manoharan DOI:10.4103/srmjrds.srmjrds_50_18 Central giant cell granuloma is an uncommon, benign, proliferative lesion of unknown etiology, most commonly affecting anterior mandible of younger age group. Early diagnosis may be of benefit to the patient as conservative treatment modalities may be used as compared to radical surgical treatment. Calcitonin as a therapy for central giant cell granuloma of the jaws is a promising alternative to surgical curettage, particularly for larger lesions. We report a case of central giant cell granuloma of mandible in a 14-year-old female patient, who is being treated solely with intranasal spray of salmon calcitonin for 14 months showing greater results.

Salmon calcitonin - a boon in the management of central giant cell granuloma p. 197
D Nivethitha Gangai, G V. Murali Gopika Manoharan
DOI:10.4103/srmjrds.srmjrds_50_18  
Central giant cell granuloma is an uncommon, benign, proliferative lesion of unknown etiology, most commonly affecting anterior mandible of younger age group. Early diagnosis may be of benefit to the patient as conservative treatment modalities may be used as compared to radical surgical treatment. Calcitonin as a therapy for central giant cell granuloma of the jaws is a promising alternative to surgical curettage, particularly for larger lesions. We report a case of central giant cell granuloma of mandible in a 14-year-old female patient, who is being treated solely with intranasal spray of salmon calcitonin for 14 months showing greater results.
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Schwannoma of the base of the tongue mimicking fibroma p. 202 Sukhvinder Singh Rana, Neera Ohri DOI:10.4103/srmjrds.srmjrds_35_18 Schwannoma is a slow-growing benign tumor of the nerve sheath. It originates from the Schwann cell of the peripheral, autonomic, and cranial nerve. It is usually a single, circumscribed, firm, painless lesion of variable size. 25%–40% of all schwannomas are considered to affect the head and neck region, with the parapharyngeal space being the most common location. Only 1% of cases are intraoral. The treatment of choice is surgical excision of the tumor. Schwannomas do not show recurrence if completely excised. We report a case of schwannoma of the base of the tongue mimicking fibroma.

Schwannoma of the base of the tongue mimicking fibroma p. 202
Sukhvinder Singh Rana, Neera Ohri
DOI:10.4103/srmjrds.srmjrds_35_18  
Schwannoma is a slow-growing benign tumor of the nerve sheath. It originates from the Schwann cell of the peripheral, autonomic, and cranial nerve. It is usually a single, circumscribed, firm, painless lesion of variable size. 25%–40% of all schwannomas are considered to affect the head and neck region, with the parapharyngeal space being the most common location. Only 1% of cases are intraoral. The treatment of choice is surgical excision of the tumor. Schwannomas do not show recurrence if completely excised. We report a case of schwannoma of the base of the tongue mimicking fibroma.
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Clear-cell squamous cell carcinoma: An uncommon variant of very common malignancy in the head and neck p. 136 Lopa Mudra Kakoti, Debanwita Mahanta, Jagannath Dev Sharma, Zachariah Chowdhury DOI:10.4103/ijohs.ijohs_23_18 Clear-cell squamous cell carcinoma (SCC) is an extremely rare and incompletely understood entity. Clear-cell change occurs due to cytoplasmic accumulation of glycogen, water, intermediate filaments, immature zymogen granules, or a paucity of cellular organelles. Clear-cell change can be seen in any of the neoplasms, but as pure form variant, it is difficult to find in head-and-neck SCC. The World Health Organization has recognized clear-cell SCC as separate entity at other few sites such as penis but not in the head-and-neck SCC, and these are known to aggressive variant. We, hereby, present a case of clear-cell variant of squamous carcinoma in lower gingivobuccal mucosa in a 59-year-old male patient. Histopathology showed sheets of clear cell separated by fibrous s

Clear-cell squamous cell carcinoma: An uncommon variant of very common malignancy in the head and neck p. 136
Lopa Mudra Kakoti, Debanwita Mahanta, Jagannath Dev Sharma, Zachariah Chowdhury
DOI:10.4103/ijohs.ijohs_23_18  
Clear-cell squamous cell carcinoma (SCC) is an extremely rare and incompletely understood entity. Clear-cell change occurs due to cytoplasmic accumulation of glycogen, water, intermediate filaments, immature zymogen granules, or a paucity of cellular organelles. Clear-cell change can be seen in any of the neoplasms, but as pure form variant, it is difficult to find in head-and-neck SCC. The World Health Organization has recognized clear-cell SCC as separate entity at other few sites such as penis but not in the head-and-neck SCC, and these are known to aggressive variant. We, hereby, present a case of clear-cell variant of squamous carcinoma in lower gingivobuccal mucosa in a 59-year-old male patient. Histopathology showed sheets of clear cell separated by fibrous septa and foci showing squamous cells with malignant features. Periodic acid–Schiff and immunohistochemistry (IHC) were done to rule out differentials of clear-cell variants of different sites such as salivary gland, odontogenic origin, and cutaneous adnexal origin. To establish the prevalence, biological nature, significance, and clinical course of clear-cell SCC in the head-and-neck region, more number of case reports are expected to be published in future. We concluded by emphasizing on the need of further analysis of all clear-cell tumors in the head and neck with histochemistry and IHC investigations to arrive at the proper diagnosis.
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The course of double mandibular canal - confront to dentist p. 133 Jayasheela Mallappa, Neeharika Sree, B H Dhanya Kumar, Dhoom Singh Mehta DOI:10.4103/ijohs.ijohs_40_18 The mandibular canal is usually a single canal that begins with mandibular foramen on the medial surface of the ascending mandibular ramus. It transmits the inferior alveolar artery, vein, and the inferior alveolar nerve. The identification of the mandibular canal and its anatomic variations is of great importance in many branches of dentistry, especially in implant dentistry. Sometimes, there may be variations in the normal anatomic structures; one of the rarest among them is double mandibular canal. The clinician should be aware of such variations to avoid complications during the treatment. In the present case report, we have discussed about a case with double mandibular canal and the complications that can arise during the treatment.

The course of double mandibular canal - confront to dentist p. 133
Jayasheela Mallappa, Neeharika Sree, B H Dhanya Kumar, Dhoom Singh Mehta
DOI:10.4103/ijohs.ijohs_40_18  
The mandibular canal is usually a single canal that begins with mandibular foramen on the medial surface of the ascending mandibular ramus. It transmits the inferior alveolar artery, vein, and the inferior alveolar nerve. The identification of the mandibular canal and its anatomic variations is of great importance in many branches of dentistry, especially in implant dentistry. Sometimes, there may be variations in the normal anatomic structures; one of the rarest among them is double mandibular canal. The clinician should be aware of such variations to avoid complications during the treatment. In the present case report, we have discussed about a case with double mandibular canal and the complications that can arise during the treatment.
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Actinomycotic infection of the tonsils: A case report and review of the literature p. 129 Stavanger Singh Bakshi, Ramiya Ramachandran Kaipuzha, Suriyanarayanan Gopalakrishnan, A Govindarajan DOI:10.4103/ijohs.ijohs_43_17 Actinomycotic infections of the head and neck, although fairly uncommon, represent an important entity because of its varied presentation, difficult diagnosis, and long course of treatment. A 20-year-old female presented with throat pain and difficulty in swallowing for 1 year. Examination revealed a Grade IV enlargement of the left tonsil. The patient underwent tonsillectomy, and the postoperative histopathology revealed actinomycosis. Actinomyces is anaerobic filamentous bacteria which are known to colonize as commensals in tonsillar crypts which on histology show an outer zone of granulation tissue and a central zone of necrosis containing many sulfur granules that represent microcolonies of Actinomyces. Actinomycosis of the head-and-neck region is a significant

G.Actinomycotic infection of the tonsils: A case report and review of the literature p. 129
Stavanger Singh Bakshi, Ramiya Ramachandran Kaipuzha, Suriyanarayanan Gopalakrishnan, A Govindarajan
DOI:10.4103/ijohs.ijohs_43_17  
Actinomycotic infections of the head and neck, although fairly uncommon, represent an important entity because of its varied presentation, difficult diagnosis, and long course of treatment. A 20-year-old female presented with throat pain and difficulty in swallowing for 1 year. Examination revealed a Grade IV enlargement of the left tonsil. The patient underwent tonsillectomy, and the postoperative histopathology revealed actinomycosis. Actinomyces is anaerobic filamentous bacteria which are known to colonize as commensals in tonsillar crypts which on histology show an outer zone of granulation tissue and a central zone of necrosis containing many sulfur granules that represent microcolonies of Actinomyces. Actinomycosis of the head-and-neck region is a significant entity because it can mimic other common lesions, especially in the oropharynx. In cases of recurrent tonsillitis and tonsillar hypertrophy, tonsillectomy is the treatment of choice, and histopathological examination of resected tissue is strongly advocated. This report supports the view that Actinomyces may have a causal association with recurrent acute tonsillitis and tonsillar hypertrophy.
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Hemorrhagic bulla on the lip: A diagnostic dilemma p. 124 Aravinda Konidena, Hena Shaw, Mansimran Kaur Uppal DOI:10.4103/ijohs.ijohs_17_18 Angina bullosa hemorrhagica (ABH) is a rare benign disorder characterized by the sudden onset of painless blood-filled blister in the oral cavity that rupture in 24–48 h. We recently encountered an interesting case of ABHon the lower lip of 68-year-old female patient referred back from the prosthodontic department following the procedure of impression making. This case will be presented along with a review of previous case summaries reporting four or more cases.

Hemorrhagic bulla on the lip: A diagnostic dilemma p. 124
Aravinda Konidena, Hena Shaw, Mansimran Kaur Uppal
DOI:10.4103/ijohs.ijohs_17_18  
Angina bullosa hemorrhagica (ABH) is a rare benign disorder characterized by the sudden onset of painless blood-filled blister in the oral cavity that rupture in 24–48 h. We recently encountered an interesting case of ABHon the lower lip of 68-year-old female patient referred back from the prosthodontic department following the procedure of impression making. This case will be presented along with a review of previous case summaries reporting four or more cases.
http://www.ijohsjournal.org/currentissue.asp?sabs=y

unusual presentation of mucoepidermoid carcinoma with review of literature p. 120 Gadadasu Swathi, Tatapudi Ramesh, Moturi Kishore, Govind Raj N Kumar DOI:10.4103/ijohs.ijohs_24_18 Head-and-neck cancers constitute about 30% of cancers in India, of which salivary gland tumor such as mucoepidermoid carcinoma (MEC) was the most common malignant salivary gland tumor. The parotid gland was the most common site of origin in both benign and malignant tumors, followed by submandibular and sublingual glands. Salivary gland tumors comprise a morphologically diverse group of rare tumors. Their multifaceted clinical presentation, varied morphologic configuration, and relatively unpredictable prognosis attract significant medical interest. Here is a rare case report of an asymptomatic swelling in the cheek region which was thought to be pleomorphic adenoma at the outset which on further investigations proved as MEC of early detection.

unusual presentation of mucoepidermoid carcinoma with review of literature p. 120
Gadadasu Swathi, Tatapudi Ramesh, Moturi Kishore, Govind Raj N Kumar
DOI:10.4103/ijohs.ijohs_24_18  
Head-and-neck cancers constitute about 30% of cancers in India, of which salivary gland tumor such as mucoepidermoid carcinoma (MEC) was the most common malignant salivary gland tumor. The parotid gland was the most common site of origin in both benign and malignant tumors, followed by submandibular and sublingual glands. Salivary gland tumors comprise a morphologically diverse group of rare tumors. Their multifaceted clinical presentation, varied morphologic configuration, and relatively unpredictable prognosis attract significant medical interest. Here is a rare case report of an asymptomatic swelling in the cheek region which was thought to be pleomorphic adenoma at the outset which on further investigations proved as MEC of early detection.
http://www.ijohsjournal.org/currentissue.asp?sabs=y

Colonic phenotype of adenocarcinoma base of the tongue: An entity rarely reported and treated with definitive chemoradiation p. 116 Neelam Sharma, Abhishek Purkayastha, Chhavi Arora, Kavita Sahai DOI:10.4103/ijohs.ijohs_55_17 The predominant histological type of oropharyngeal cancer is squamous cell carcinoma and approximately 9 times more frequent when compared with other types. Adenocarcinoma common histopathology for digestive system is very rarely reported in this region. In literature, there are limited data about the clinical presentation, histopathology, and treatment modalities for the primary adenocarcinoma of the base of the tongue (BOT). To the best of our knowledge, five cases of adenocarcinoma of the BOT with colonic differentiation have been reported in the world literature till date, and this is the first case report from India. The challenge in these type of cases is to differentiate between the primary adenocarcinoma of BOT which is extremely rare, metastatic lesio

Colonic phenotype of adenocarcinoma base of the tongue: An entity rarely reported and treated with definitive chemoradiation p. 116
Neelam Sharma, Abhishek Purkayastha, Chhavi Arora, Kavita Sahai
DOI:10.4103/ijohs.ijohs_55_17  
The predominant histological type of oropharyngeal cancer is squamous cell carcinoma and approximately 9 times more frequent when compared with other types. Adenocarcinoma common histopathology for digestive system is very rarely reported in this region. In literature, there are limited data about the clinical presentation, histopathology, and treatment modalities for the primary adenocarcinoma of the base of the tongue (BOT). To the best of our knowledge, five cases of adenocarcinoma of the BOT with colonic differentiation have been reported in the world literature till date, and this is the first case report from India. The challenge in these type of cases is to differentiate between the primary adenocarcinoma of BOT which is extremely rare, metastatic lesion to this site from any other site, or its origin from minor salivary glands which is a more common possibility because all these situations have different treatment implications.
http://www.ijohsjournal.org/currentissue.asp?sabs=y

Multivariant lichen planus of lips and gingiva: Report of a case and a review p. 109 SM Rekha, Apeksha Basawant Annigeri, Sushama R Galgali, P Jagadish DOI:10.4103/ijohs.ijohs_18_18 Oral lichen planus (OLP) is a relatively common inflammatory mucocutaneous disorder that frequently involves the oral mucosa. There are many etiological factors, and some among them are stress, diabetes mellitus, and hypothyroidism. An important complication of OLP is the development of oral squamous cell carcinoma, which led the World Health Organization to classify OLP as a potentially malignant disorder. This article reports a multivariant (reticular, erosive, and papular) case of lichen planus that has affected a 40-year-old medically compromised female who was managed successfully and still under follow-up.

Management of flabby ridge case: An arduous task in undergraduate practice p. 104 Jnanashree Chiplunkar, Masrie Tumbil, MD Chethan, DB Nandeeshwar, Disha Patel DOI:10.4103/ijohs.ijohs_41_18 A fibrous or flabby ridge is a superficial area of mobile soft tissue affecting the maxillary or mandibular alveolar ridges. It can develop when hyperplastic soft tissue replaces the alveolar bone and is a common finding particularly in the upper anterior region of long-term denture wearers. Masticatory forces can displace this mobile denture-bearing tissue, leading to altered denture positioning and loss of peripheral seal. Unless managed appropriately, such “flabby ridges” adversely affect the support, retention, and stability of complete dentures. Many impression techniques have been proposed to help overcome this difficulty. This paper presents case report for prosthodontic rehabilitation of a patient with flabby ridge with McCord and Ahmad impression technique.

Assessment of mandibular retrognathism and maxillary prognathism as contributory factors for skeletal Class II malocclusion: A cephalometric study p. 99 Suraj Prasad Sinha, Krishna U S Nayak, Crystal Runa Soans, PS Murali, Akhil Shetty, MS Ravi DOI:10.4103/ijohs.ijohs_3_18 Aim: The aim of this study is to evaluate the skeletal factor (maxillary excess and/or mandibular deficiency) contributing for the skeletal Class II malocclusion. Materials and Methods: Lateral cephalograms of 100 individuals (50 males and 50 females) in the age group of 18–30 years, having skeletal Class II malocclusion with ANB of more than 4, were evaluated. The parameters to be used for prediction of maxillary prognathism include linear measurement of Nasion perpendicular to point A, and for the mandibular retrognathism, it is linear measurement of Nasion perpendicular to Pogonion, as suggested by Burstone analysis. Results: The 34% of the studied sample size had the Class II skeletal pattern (ANB >4), but

New Guidelines Differ in Advice on PSA Screening

The benefits of prostate specific antigen (PSA) screening for prostate cancer in men has been under controversy for a number of years. Some of the issues are that although prostate cancer is the second leading cause of cancer death in men, most prostate cancers are slow-growing and never cause problems. And while PSA screening can detect cancer early, when it is curable, it is most commonly positive with benign prostatic hyperplasia (BPH), not prostate cancer. (For more details about the issues, see the articles on PSA and Prostate Cancer.)

An international panel of experts recently published in The BMJ (formerly the British Medical Journal) their "Rapid Recommendations" that outlined initiatives advising against routine PSA screening for prostate cancer. Moreover, they suggest that healthcare practitioners should not feel compelled to routinely ask patients about their desire for screening, though they should help patients who raise the issue to make an informed decision.

The recommendations state that for most men, the benefit of screening is small and uncertain, and that there are clear harms and possible side-effects involved in follow-up treatment for positive PSA results. The panel acknowledges that these recommendations may not apply to all men, especially those who have a family history of prostate cancer, are of African descent, or of lower socioeconomic status. For these men, the panel recommends shared decision-making between the patient and the healthcare practitioner.

However, The BMJ panel's guidance contrasts with advice from other organizations that also issue PSA screening recommendations. The U.S. Preventive Services Task Force (USPSTF) earlier this year updated and finalized guidelines that moved from recommending against routine PSA screening to advising that men ages 55 to 69 discuss the issue with their healthcare practitioners to make an informed decision about whether screening is right for them. The Task Force did recommend that men age 70 or older would not need screening.

The change came about after the Task Force reviewed published data on 1,904,950 men on the use of PSA testing to screen for cancer. The USPSTF team's research revealed that the potential harms and benefits of PSA screening for this population are about the same, leading them to conclude that the decision to screen "should be an individual one." Men considering screening should weigh the potential benefits and harms, including:

Potential benefits of PSA screening

• Early detection of cancer when it is most treatable would potentially lower the risk of cancer death for some men.
• Detecting any prostate cancer for men who value knowing their cancer status over possible PSA screening harms

Potential harms of PSA screening

• A false-positive test result (when a man has an elevated PSA level but does not have prostate cancer) could lead to stress and more unnecessary tests, including a prostate biopsy. Possible prostate biopsy side-effects and complications include blood in semen, blood in urine, pain, fever, and sepsis.
• The overdiagnosis and treatment of men with prostate cancer who would never have symptoms or die from their cancer; treatment, which typically includes surgery, chemotherapy and/or radiation therapy, can lead to urinary incontinence, bowel dysfunction and erectile dysfunction. Some men may avoid harms of overtreatment by choosing not to treat immediately but opting for "watchful waiting," which may include occasional PSA tests, or "active surveillance" that involves PSA tests done about every six months with digital rectal examsand prostate biopsies (annually) to monitor the cancer.

The BMJ panel came to their conclusion based on a detailed review and analysis of over 700,000 men in five PSA screening clinical trials who had no previous diagnosis of prostate cancer. Analyses of the clinical trial data revealed that for this population of men, PSA screening reduces prostate cancer deaths, but the effect is small. Most of the men with elevated PSA levels opted to have a prostate biopsy, but no cancer was found. As for the small number of men whose elevated PSA levels were consistent with prostate cancer, many would never experience symptoms or die from their cancer. Therefore, the panel issued a "weak recommendation" against healthcare providers actively offering PSA screening to their patients.

The BMJ panel's recommendation is categorized as weak because of the "small and uncertain benefits of screening on prostate cancer mortality and the large variability in men's values and preferences." More simply put, a weak recommendation means that shared decision-making is important. For men who ask about PSA screening, The BMJ panel urges healthcare providers to share information with their patients so that they can make educated decisions for themselves.

The American Academy of Family Physicians agrees with The BMJ Rapid Recommendations, while other groups, including the American Cancer Society, the American Urological Association, the American College of Physicians, and the U.S. National Comprehensive Cancer Network, have issued PSA screening recommendations that are similar to those of the USPSTF.

https://labtestsonline.org/news/new-guidelines-differ-advice-psa-screening

Valor clínico y pronóstico de la PET/TC con 18F-FDG en el cáncer de endometrio recurrente

Publication date: Available online 17 December 2018

Source: Revista Española de Medicina Nuclear e Imagen Molecular

Author(s): D. Albano, V. Zizioli, F. Odicino, R. Giubbini, F. Bertagna

Resumen

Objetivo

El carcinoma endometrial (CE) es un cáncer con un buen pronóstico general, excepto en los casos de CE recurrente o avanzado. El objetivo de este estudio fue evaluar el rendimiento diagnóstico y pronóstico y el impacto en el manejo terapéutico de la PET/TC con ¹⁸F-FDG en la sospecha de CE recurrente.

Material y métodos

Se evaluaron retrospectivamente 157 pacientes con CE histológicamente probado y reestadificación de PET/TC con ¹⁸F-FDG por sospecha de recurrencia. Las imágenes PET se analizaron visualmente y semicuantitativamente midiendo SUVmax, VMT y GTL. Se tomó como referencia una combinación de seguimiento clínico/radiológico/histopatológico. La supervivencia libre de progresión (SLP) y la supervivencia global (SG) se calcularon usando las curvas de Kaplan-Meier.

Resultados

Setenta y nueve pacientes tuvieron una PET/TC con ¹⁸F-FDG positiva que mostró la presencia de al menos una lesión hipermetabólica compatible con recurrencia, mientras que los 78 restantes fueron negativos. La sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la precisión de la PET/TC con ¹⁸F-FDG fueron del 96, del 99, del 99, del 96 y del 97%, respectivamente, y fueron más altos en comparación con las imágenes convencionales: 97, 62, 72, 96 y 80%. Después de un seguimiento medio de 39 meses, la recaída/progresión ocurrió en 58 pacientes y la muerte en 37, con un tiempo promedio de 22,1 y 27,6 meses, respectivamente. Una PET/TC con ¹⁸F-FDG positiva y un estadio FIGO avanzado se asociaron significativamente con una SLP y SG más cortos. Los resultados de PET/TC tuvieron un impacto significativo en el abordaje terapéutico en 33 pacientes: evitaron terapias innecesarias en 28 y modificaron la terapia en 5.

Conclusiones

La ¹⁸F-FDG-PET/TC tiene un muy buen rendimiento diagnóstico en pacientes con sospecha de CE recurrente, y tiene un importante valor pronóstico en la evaluación de SLP y SG. Además, la PET/TC permitió un cambio en la decisión de tratamiento en aproximadamente el 20% de los casos.

Abstract

Purpose

Endometrial carcinoma (EC) is a cancer with a good overall prognosis, except in cases of recurrent or advanced EC. The aim of this study was to assess the diagnostic performance, the prognostic value and the impact on therapeutic management of ¹⁸F-FDG PET/CT in suspected recurrent EC.

Materials and methods

We retrospectively evaluated 157 patients with histologically proven EC and restaging ¹⁸F-FDG PET/CT for suspected recurrence. The PET images were analyzed visually and semi-quantitatively by measuring SUVmax, MTV and TLG. A combination of clinical/imaging follow-up and/or histopathology was taken as reference standard. Progression-free survival (PFS) and overall survival (OS) were computed using Kaplan-Meier curves.

Results

Seventy-nine patients had positive ¹⁸F-FDG PET/CT showing the presence of at least one hypermetabolic lesion consistent with recurrence, while the remaining 78 were negative. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ¹⁸F-FDG PET/CT were 96%, 99%, 99%, 96%, 97%, respectively, and were higher compared to conventional imaging: 97%, 62%, 72%, 96%, 80%. After a mean follow-up of 39 months, relapse/progression occurred in 58 patients and death in 37 with an average time of 22.1 and 27.6 months, respectively. A positive ¹⁸F-FDG PET/CT and advanced FIGO stage were significantly associated with shorter PFS and OS. PET/CT results had a significant impact on therapeutic approach in 33 patients: avoiding unnecessary therapies in 28 and modifying therapy in 5.

Conclusions

¹⁸F-FDG PET/CT has a very good diagnostic performance in patients with suspected recurrent EC and has an important prognostic value in assessing PFS and OS. Moreover, PET/CT allowed for a change in treatment decision in about 20% of cases.

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Función pronóstica de los parámetros derivados de FDG PET en la estadificación preoperatoria del cáncer de endometrio

Publication date: Available online 17 December 2018

Source: Revista Española de Medicina Nuclear e Imagen Molecular

Author(s): P. Mapelli, A. Bergamini, F. Fallanca, P.M.V. Rancoita, R. Cioffi, E. Incerti, E. Rabaiotti, M. Petrone, G. Mangili, M. Candiani, L. Gianolli, M. Picchio

Resumen

Objetivo

Investigar el papel pronóstico preoperatorio de la PET/TC con ¹⁸F-FDG en pacientes con carcinoma de endometrio (CE).

Material y métodos

Se realizó PET/TC con ¹⁸F-FDG en 57 pacientes para el estudio preoperatorio del CE. Se evaluaron los valores de captación estandarizados máximos y medios (SUVmax, media), volumen tumoral metabólico (MTV) y glicólisis de lesión total (TLG) de tumores primarios, a diferentes umbrales de 40%, 50%, 60% (40-50-60), comparándose con las características anatomopatológicas. Se evaluó el rendimiento diagnóstico de los parámetros PET (categorizados por análisis ROC) en la discriminación de la enfermedad de bajo y mediano riesgo y el papel pronóstico en la supervivencia (supervivencia global-OS, supervivencia libre de enfermedad-SSE).

Resultados

Los TLG40-50-60 categorizados fueron los únicos parámetros relacionados con FIGO estadio I versus II-III-IV (p = 0,0035 para todos). Los puntos de corte para la estratificación del riesgo fueron 83,69, 61,81 y 41,32, respectivamente (sensibilidad: 60%; especificidad, 71,43% para todos los parámetros. El estadio patológico 1 (pT1) del tumor primario se predijo con MTV60 y TLG40-50 (p = 0,0328, 0,0240 y 0,0147, respectivamente). Los umbrales óptimos fueron 7,795, 99,55 y 77,58, respectivamente (sensibilidad: 38,46%, 53,85% y 53,85%, respectivamente; especificidad: 88,64%, 79,55% y 81,82%, respectivamente). SUVmax y SUVmean40-50-60 fueron los únicos parámetros que discriminaron el subtipo endometrioide del no endometrioide. La sensibilidad fue del 64,86% y 62,16% para SUVmax y SUVmean50-60, y 62,16% para SUVmean40; la especificidad fue del 70% para todos los parámetros. La SG media (DE) fue del 79,77% (3,34%) y la SSE media fue del 77,89% (3,73%). El tipo de tumor fue la única variable significativamente asociada a la SG (p = 0,0486). TLG50 > 77,58 cm³ fue la única variable asociada a un mayor riesgo de recaída (p = 0,0472).

Conclusión

TLG40-50-60 y MTV60 de EC primaria tienen valor pronóstico para discriminar FIGO y estadificación patológica. Estos resultados sugieren un posible papel de estos parámetros en la predicción de la agresividad de la CE, mejorando así la caracterización preoperatoria del cáncer de endometrio.

Abstract

Purpose

To investigate the preoperative prognostic role of ¹⁸F-FDG PET/CT in patients with endometrial carcinoma (EC).

Methods

¹⁸F-FDG PET/CT was performed in 57 patients for EC preoperative staging. Maximum and mean standardized uptake values (SUVmax, mean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of primary tumors, at different thresholds of 40%, 50%, 60% (40–50–60), were evaluated and compared with anatomopathological features. The diagnostic performance of PET-parameters (categorized by ROC analysis) in discriminating low-intermediate and high-risk disease and the prognostic role on survival (overall survival –OS; disease free survival – DFS) was evaluated.

Results

The categorized TLG40-50-60 were the only parameters related to FIGO stage I versus II-III-IV (p = 0.0035 for all). The cut-off values for risk stratification were 83.69, 61.81 and 41.32, respectively (sensitivity: 60.00%; specificity; 71.43% for all parameters). Pathological stage 1 (pT1) of the primary tumor was predicted by MTV60 and TLG40-50 (p = 0.0328, 0.0240, 0.0147, respectively). The optimal thresholds were 7.795, 99.55 and 77.58, respectively (sensitivity: 38.46%, 53.85% and 53.85%, respectively; specificity: 88.64%, 79.55% and 81.82%, respectively). SUVmax and SUVmean40-50-60 were the only parameters discriminating endometrioid from non-endometrioid subtype. The corresponding sensitivity was 64.86% and 62.16% for SUVmax and SUVmean 50-60 and 62.16% for SUVmean40; specificity was 70.00% for all parameters. The mean (SD) OS was 79.77% (3.34%) and the mean DFS was 77.89% (3.73%). The tumor type was the only variable significantly associated with OS (p = 0.0486). TLG50 > 77.58 cm³ was the only variable associated with a higher risk of relapse (p = 0.0472).

Conclusion

TLG40–50–60 and MTV60 of primary EC have prognostic value in discriminating FIGO and pathological staging. These results suggest a possible role of these parameters in predicting EC aggressiveness, thus improving the preoperative characterization of endometrial cancer.

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New Guidelines Aim to Improve Health of Women with Polycystic Ovary Syndrome

An international consortium that included the American Society of Reproductive Medicine, the Centre for Research Excellence in PCOS in Australia, and the European Society of Human Reproduction and Embryology has released new guidelines on polycystic ovary syndrome (PCOS), a condition associated with hormone imbalances in women. "It's a global initiative with the intention of improving the health and the quality of life of women with PCOS and supporting their health professionals to partner with them to do so," said Helena Teede, MBBS, PhD, the lead author of the guideline as well as professor of women's health and director of the Monash Centre for Health Research and Implementation at Monash University in Melbourne, Australia.

PCOS can be hard to recognize and diagnose. While the term 'polycystic' refers to cysts on the ovaries, not every woman with PCOS will have cysts. Some women may only have a few features of the condition and these may change over time both in terms of severity and which features are expressed. Some features, such as weight gain and excess facial and body hair, can vary between ethnic groups, according to the guidelines. The variety of symptoms is one of the reasons PCOS can be difficult to diagnose. The diagnosis of PCOS can also be quite challenging in adolescents, as menstrual cycles naturally tend to vary for several months after girls have their first menstrual periods (menarche) and ultrasound characteristics are not used for diagnosis. At present, there is no specific test that can diagnose PCOS.

The main goal of the guidelines, released in July, is to standardize care for women who have PCOS. Dr. Teede says researchers will continue to study the condition and update the guidelines as needed. The new guidelines were published simultaneously in three journals: Clinical Endocrinology, Human Reproduction and Fertility and Sterility. As part of the guidelines release, a patient guide was also published to provide detailed information for girls and women with PCOS.

PCOS is the most common hormone disorder in women, affecting 13% of women worldwide, and is a leading cause of infertility in women. The condition can affect girls as young as 11 years old. It is estimated that 5 to 6 million girls and women in the U.S. have PCOS, yet many don't know they have it.

According to Professor Teede, PCOS is a multi-faceted condition, "with reproductive, metabolic and psychological features, which often means diagnosis is delayed, treatment is often not holistic and opportunities for prevention, treatment and improved health outcomes including in infertility and pregnancy health are missed."

While the exact underlying causes of PCOS are not known, there is a genetic component—women with mothers or sisters who have PCOS are twice as likely to have the condition. It is thought that the main problems are an imbalance of sex hormones and resistance to the effects of the hormone insulin, which helps regulate glucose levels in the blood. Women with PCOS may overproduce androgens such as testosterone and may experience various signs and symptoms, such as excess facial and body hair, acne, and weight gain. When there is insulin resistance, the body tries to compensate by making even more insulin. Too much insulin may cause the ovaries to increase androgen production, which in turn causes the symptoms associated with PCOS.

According to the new guidelines, a diagnosis of PCOS means a woman has two of the following three indicators:

1. Irregular menstrual periods—more frequent or less frequent than monthly
2. Symptoms such as acne (sometimes severe) and increased hair growth, which can be on the face, stomach and/or back, or a blood test showing higher levels of androgens (e.g., a testosterone test may show an elevated level)
3. An ultrasound of the ovaries that shows more than twenty cysts. (No ultrasound is needed if a woman has both of the first two indicators.)

PCOS is often be associated with other conditions, such as infertility, diabetes or insulin resistance, high blood pressure, heart disease and sleep apnea. While there is no cure for PCOS, treatment is aimed at reducing its symptoms and preventing further complications. 

According to the new guidelines, treatment should focus on and address each woman's specific symptoms. The patient booklet addresses emotional well-being and offers a list of lifestyle changes women can make to improve their condition, including diet and exercise. There are also suggestions for treating menstrual irregularity, excess facial and body hair, acne and infertility.

https://labtestsonline.org/news/new-guidelines-aim-improve-health-women-polycystic-ovary-syndrome

SRM Journal of Research in Dental Sciences (SRM J Res Dent Sci) 2018 | October-December | Volume 9 | Issue 4

ORIGINAL ARTICLES
	Micronuclei assay in oral exfoliated buccal cells of pesticides exposed agricultural labourers in Pondicherry population	p. 153
	A Aroumougam, A Santha Devy, AN Uma, N Vezhavendhan, S Vidyalakshmi, KR Premlal DOI:10.4103/srmjrds.srmjrds_74_17   Background: Occupational exposure is caused by the chemical used in pesticides that are toxic to humans and accounts for significant morbidity and mortality, especially in the developing countries. The biologically active compound present in pesticides is with various degrees of toxicity that leads to DNA damage, which, when left unattended, could lead to the process of carcinogenesis. Therefore, it is important to focus on various biometric procedures in order to evaluate the risk associated with occupational health-related issues. One among the biomonitoring test employed, the micronuclei (Mn) assay on the buccal mucosal cells is used as a part of screening in order to assess the cytotoxic status. This assay has been substantiated in the literature for the last few decades. Aims: To assess the cytotoxic damage in agricultural laborers exposed to pesticides using Mn as a biomarker. Subjects and Methods: The study involved data and sample collections from agricultural laborers (Non exposed and exposed to pesticides) by buccal smears, Papanicolaou staining and comparison of number of Mn scores as per Tolbert's and Thomas criteria, respectively. The parameters before and after exposure were analyzed by paired t-tests and partial correlation. Results: The observation of the study revealed the frequency of Mn was high in exposed individuals irrespective of age and habits when compared to that of the control group. Conclusions: In this study, as the duration of exposure increased, there was an increase in the Mn count. This indicates that there was considerable cytotoxic damage.
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	Effect of different chewing gums on dental plaque pH, salivary pH, and buffering capacity in children: A randomized controlled trial	p. 158
	Kameshwaran Muralikrishnan, Sharath Asokan, P R Geetha Priya DOI:10.4103/srmjrds.srmjrds_45_18   Aim: The aim of this study is to evaluate and compare the changes in dental plaque pH, salivary pH, and its buffering capacity after the use of three different chewing gums for 1 month in children aged 8–12 years. Methods: This randomized controlled clinical trial consisted of 90 children with Decayed, missing, Filled teeth (dmft/DMFT) <3. They were randomly divided into three groups to receive one of the following interventions: (a) chewing gum containing xylitol, (b) chewing gum containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and (c) chewing gum containing propolis. Oral prophylaxis was done, and saliva and plaque samples were collected after 48 h as preintervention data. Participants within the experimental groups chewed gums for 10 min, two times a day for a period of 1 month. Pre-and postintervention unstimulated saliva samples were analyzed to compare the changes in dental plaque pH, saliva pH, and buffer capacity. The data were then statistically analyzed using SPSS software. Paired t-test and Student's t-test were done for mean score analysis. Results: There was a statistically significant increase in plaque pH (P = 0.001) level in all three groups. Propolis chewing gum showed an increased salivary pH level (P = 0.036). When compared between genders, girls showed a significant increase in plaque pH level in all three groups and an increase in salivary pH level in xylitol group. Conclusion: Chewing gum containing xylitol can regulate the dental plaque pH, salivary pH, and buffer capacity in a significant way than CPP-ACP and propolis chewing gum.
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	Feulgen stain as a special stain for mitotic figures and apoptotic bodies in oral squamous cell carcinoma	p. 164
	Sankari Radhakrishnan, Ramesh Venkatapathy, PD Balamurali, Karthik Shree V Prashad, B Premalatha, Saikat Chakraborty DOI:10.4103/srmjrds.srmjrds_49_18   Background: Oral cancer is one of the most prevalent cancers worldwide. The oral squamous cell carcinoma (OSCC) is graded for the proper treatment planning, and it has been a subjective phenomenon. This grading depends on several features, of which the presence of mitotic figures and apoptotic bodies is one of the important criteria. The routine hematoxylin and eosin (H and E) staining may help in identifying the mitotic figures and apoptotic bodies, but it is difficult to identify accurately. Thus, an attempt was made to evaluate the efficacy of crystal violet and Feulgen stain in identifying the mitotic figures and apoptotic bodies and to observe any variation in different grades of carcinoma. Aims: This study was aimed at using crystal violet and Feulgen stain in identifying mitotic figures and apoptotic bodies in different grades of OSCC. Materials and Methods: Fifteen diagnosed cases of OSCC were retrieved and stained with routine H and E, crystal violet stain, and Feulgen stain. All the sections were scanned for mitotic figures and apoptotic bodies. Apoptotic index (AI) and mitotic index (MI) were calculated. AI and MI were expressed as the average of a total number of apoptotic and mitotic cells counted in ten high-power fields. Results: A significant increase in MI and AI was found in Feulgen stain than crystal violet and H and E stain. Conclusion: Feulgen stain can be considered as the best, cost-effective, relatively cheap stain to visualize mitotic figures and apoptotic bodies.
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REVIEW ARTICLES
	Regenerative periodontics in restoring oral functions: A power to regenerate what's lost	p. 168
	Hunny Sharma, Swati Verma DOI:10.4103/srmjrds.srmjrds_24_18   Although human oral cavity benefits from remarkable mechanical and functional properties, still it faces continuous insult and damage resulting from exposure to microbial attacks. In the past where conventional dentistry was only focused on evaluating, restoration, and replacement of the diseased oral structures. The recent era of advancement in the field of materials science, molecular biology, tissue engineering, and stem cell research's had let to the path of development of new era of periodontal engineering known as regenerative periodontics. The ultimate goal of regenerative periodontics is the regeneration of the lost periodontium due to advanced periodontal disease. Currently, scientists are working on a wide range of biomaterials and scaffolds, genes, stem cells, and growth factors in the hope of achieving more predictable outcomes in regenerative periodontics. Future research areas in regenerative periodontics include three-dimensional printing, tissue engineering, and gene therapy strategies which give more positive and predictable outcomes of regenerative periodontics. This review provides an overview of current on-going technique and researches in the field of regenerative periodontics and also will show a glimpse of what the future holds.
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	Chemical burns of gingiva and its management	p. 174
	MM Dayakar, Prakash G Pai, Radhika Priyadarshini M Sooranagi, Vintu Vijayan, Abdul Waheed DOI:10.4103/srmjrds.srmjrds_16_18   Chemical burns on the gingiva can be caused by the use of certain pharmaceutical and nonpharmaceutical products by patients or by injudicious use of caustics by the dental clinician. These lesions in the oral cavity, however, are rarely reported. Hence, information about the product and needful instructions is necessary to be given to the patients for prevention of the same. These burns can be caused by the way of self-infliction, allergic tendency toward certain products, or it may be iatrogenic. A detailed history is the key to diagnosing and managing these cases. Chemical burns are usually treated by eliminating the etiology and managed by palliative therapy.
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	Pulpotomy medicaments in primary teeth: A literature review of natural alternatives	p. 181
	Kanamarlapudi Venkata Saikiran, Rekhalakshmi Kamatham, Putta Sai Sahiti, Sivakumar Nuvvula DOI:10.4103/srmjrds.srmjrds_14_18   Pulpotomy is a procedure which involves complete amputation of the coronal pulp, followed by employment of an appropriate medicament that will stimulate healing and preserve the vitality of the tooth. This is the choice of treatment for cariously exposed vital primary molars, with formocresol considered as golden standard. However, controversies surrounding this medicament have generated inquisitiveness to exploration for natural alternatives. This narrative review is to focus on the use of natural products as alternative pulpotomy agents to formocresol so as to guide the clinicians in choosing proper medicament.
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	Importance of cone-beam computed tomography in dentistry: An update	p. 186
	Shruthi Hegde, Vidya Ajila, Jasmine Shanti Kamath, Subhas Babu, Devika S Pillai, S Mithula Nair DOI:10.4103/srmjrds.srmjrds_26_18   In this era of advanced technology, cone-beam computed tomography (CBCT) has gained popularity in the field of oral radiology due to its advantages over conventional radiography. The use of CBCT is profoundly increasing for diagnosis and treatment planning in different specialties of dentistry. The incorporation of cone-beam technology into clinical practice is taking place because of the progress in image acquisition and three-dimensional (3D) imaging. The equipment design is easier to use, image distortion is minimal, and the images are compatible with other planning and simulation software. The 3D imaging has made the complex craniofacial structures more accessible for examination. Early and accurate diagnosis of deep-seated lesions is possible. CBCT provides a high-spatial resolution of bone and teeth which allows accurate understanding of the relationship of the adjacent structures. CBCT has helped in detecting a variety of cysts, tumors, infections, developmental anomalies, and traumatic injuries involving the maxillofacial structures. It has been used extensively for evaluating dental and osseous disease in the jaws. This paper reviews current advances in CBCT and their uses in dentistry.
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CASE REPORTS
	Mucormycosis – Can the diagnosis be challenging at times??	p. 191
	Vandana Raghunath, K Hanna Rose Priyanka, C Geetha Kiran, R Manasa Deepthi DOI:10.4103/srmjrds.srmjrds_53_18   Mucormycosis is an aggressive and often rapidly progressing fatal form of fungal infection mainly affecting the immunocompromised patients and characterized by destruction and necrosis. The paranasal sinuses get affected commonly in the rhinocerebral type with or without oral cavity involvement. At times, even in the setting of immunosuppression, it presents as a subtle clinical infection posing both as a diagnostic and therapeutic challenge to the clinicians. Further, in such immunocompromised cases, early diagnosis and prompt treatment become utmost demanding to prevent the ensuing morbidity and mortality. We present one such indolent case which presented as a sinus infection in a 50-year-old diabetic woman. Further, the granulomatous presentation on hematoxylin and eosin-stained sections led to an erroneous initial diagnosis, which later upon Grocott's methenamine silver staining was diagnosed as mucormycosis-rhinocerebral type. Thus, both clinical and histopathological presentations were defying.
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	Salmon calcitonin - a boon in the management of central giant cell granuloma	p. 197
	D Nivethitha Gangai, G V. Murali Gopika Manoharan DOI:10.4103/srmjrds.srmjrds_50_18   Central giant cell granuloma is an uncommon, benign, proliferative lesion of unknown etiology, most commonly affecting anterior mandible of younger age group. Early diagnosis may be of benefit to the patient as conservative treatment modalities may be used as compared to radical surgical treatment. Calcitonin as a therapy for central giant cell granuloma of the jaws is a promising alternative to surgical curettage, particularly for larger lesions. We report a case of central giant cell granuloma of mandible in a 14-year-old female patient, who is being treated solely with intranasal spray of salmon calcitonin for 14 months showing greater results.
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	Schwannoma of the base of the tongue mimicking fibroma	p. 202
	Sukhvinder Singh Rana, Neera Ohri DOI:10.4103/srmjrds.srmjrds_35_18   Schwannoma is a slow-growing benign tumor of the nerve sheath. It originates from the Schwann cell of the peripheral, autonomic, and cranial nerve. It is usually a single, circumscribed, firm, painless lesion of variable size. 25%–40% of all schwannomas are considered to affect the head and neck region, with the parapharyngeal space being the most common location. Only 1% of cases are intraoral. The treatment of choice is surgical excision of the tumor. Schwannomas do not show recurrence if completely excised. We report a case of schwannoma of the base of the tongue mimicking fibroma.
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