Bilateral Renal Angiomyolipoma with Hidden Tuberous Sclerosis Complex: A Case Report

Angiomyolipomas (AML) are benign tumor of kidney also referred as renal hamartoma composed of varying amounts of mature adipose tissue, smooth muscle, and blood vessels. It is seen in two distinct clinical forms, a sporadic (isolated) form and 55-80% seen in association with Tuberous sclerosis complex (TSC). If the lesion grows to a large size, a series of clinical manifestations and serious complications may occur. Here we present a case of 26 years lady who presented in the Department Radiology & Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with chief complaints of bilateral loin pain and occasional hematuria for 2 months. Ultrasound abdomen and contrast enhanced computed tomography shows bilateral renal angiomyolipoma (left>right). In order to look for tuberous sclerosis features, we followed her with plain computed tomography of head which shows subependymal calcifications.

The effect of chewing gum on the impact, pain and breakages associated with fixed orthodontic appliances: a randomized clinical trial

OBJECTIVES

To determine whether the use of chewing gum reduced the impact and pain of fixed orthodontic appliances.

SETTING AND SAMPLE POPULATION

The Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield, UK. Fifty-seven patients aged 18 years or younger and who were about to start fixed orthodontic appliance treatment.

SUBJECTS AND METHODS

A randomized clinical trial with two parallel groups either allocated to receive chewing gum after placement of their appliance or who were asked not to chew gum. The patients completed a previously validated Impact of Fixed Appliances questionnaire at 24 h and 1 week following each visit up until the placement of the working archwire. A visual analogue scale (VAS) was used to assess the intensity of pain. Appliance breakages were recorded to the end of treatment.

RESULTS

The difference between the median Total Impact Score of the two groups at 24 h was 16, which was significant (p = 0.031; Mann-Whitney U-test). The difference between the median VAS between the two groups at 24 h was 25 mm, which was significant (p = 0.038; Mann-Whitney U-test). There were no differences at 1 week. None of the risk ratios for appliance breakages were significant.

CONCLUSION

Chewing gum significantly decreased both the impact and pain from the fixed appliances. There was no evidence that chewing gum increased the incidence of appliance breakages.