Stability of Surgically Assisted Rapid Palatal Expansion

The aim of this study was to evaluate the orthodontic retention of maxillary skeletal stability after surgically assisted rapid palatal expansion (SARPE). Ninety digitized plaster casts from 30 adult patients who underwent SARPE were assessed. Thirty patients were divided equally into two groups: the No Retention Group (n = 15) and the Retention Group (n = 15) with a Transpalatal Arch [TPA]). After the end of expansion, the expander appliance was stabilized and remained in place for 4 months. The additional retention period began in the Retention Group as soon as the expander was removed and replaced by a TPA. During the same period, the No Retention Group remained without retention. The casts were created pre-operatively, at 4 months and 10 months post-expansion. The models were digitized by means of a 3D Vivid 9i laser scanner. The palatal area and volume were assessed. Both variables increased after 4 months compared with pre-operative values ( p < .05). At 10 months, patients’ palatal areas and volumes were stable in both groups ( p > .05). In conclusion, no retention other than the expander appliance is needed after SARPE (ClinicalTrials.gov, NCT01770782).

Molecular and structural analyses of maple syrup urine disease and identification of a founder mutation in a Portuguese Gypsy community

Maple syrup urine disease (MSUD) is an autosomal recessive disorder, caused by the defective function of the branched-chain alpha-ketoacid dehydrogenase complex (BCKD). BCKD is a mitochondrial complex, encoded by four nuclear genes (BCKDHA, BCKDHB, DBT and DLD), involved in the metabolism of branched-chain amino acids (BCAAs). Since the MSUD mutational spectrum has not been previously assessed in Portugal, in this study we present the molecular characterization of 30 MSUD Portuguese patients. Seventeen putative mutations have been identified (six in BCKDHA, five in BCKDHB and six in DBT); seven of them are here described for the first time. The most common mutation identified was a C deletion in BCKDHA gene (c.117delC; p.R40GfsX23), already reported in the Spanish population. Interestingly, it was found in all patients of a Gypsy community from South of the country, so a founder effect is probably responsible for the high incidence of the disease in this community. Structural models of MSUD missense mutations have been performed to understand their pathogenic effect, in order to elucidate and often to predict the severity of a mutation clinical consequence.

[Peutz-Jeghers syndrome: variability of gastrointestinal expression at pediatric age]

Peutz-Jeghers syndrome is a rare autosomal dominant condition, characterized by gastrointestinal polyposis, mucocutaneous pigmentation and high risk of neoplasia in multiple organs. At pediatric age, major clinical impact is related to complications associated to intestinal polyps, but neoplasic risk isn't negligible. Though clinical surveillance is recommended since the age of 10 years, relevant lesions may occur before that age. Conventional radiology and endoscopy have recognized limitations at this age group, and new diagnostic and intervention tools, such as video-capsule and per-operative enteroscopy, are not yet widely used. We present 5 pediatric cases (age under 10 years) with diversity of gastrointestinal expression (including one case with histologic evidence of dysplasia in a large colonic polyp), emphasizing the need of specific guidelines concerning young children.

[Necrotizing fasciitis after varicella]

Necrotizing fasciitis is a rare and severe infection characterised by extremely rapid progressive involvement of the superficial fascias and deep dermal layers of the skin, with resultant vasculitis and necrosis. The authors present three clinical cases of necrotizing fasciitis; all three patients previously had varicella rash, rapid progressive spreading erythema with severe pain and toxic shock syndrome. Two patients had positive cultures of b-haemolytic streptococcus. Early stage differential diagnosis with celulitis, aggressive antibiotic treatment and pediatric intensive care support are essential. However, the main therapy is early extensive surgical approach involving all indurate areas, down to and including the muscle fascia.