Diffuse skin findings secondary to lymph node tularemia in a patient with chronic rheumatoid arthritis on methotrexate

Tularemia has many atypical presentations which can represent a diagnostic challenge. The history is essential in the investigation of this disease. Bite-induced primary skin lesions should be distinguished from the infrequent immune-mediated secondary skin lesions. Herein, we present an atypical pseudovesicular rash secondary to Francisella tularensis.

Smell functions in patients with multiple sclerosis: a prospective case-control study

Smell functions in patients with multiple sclerosis: a prospective case-control study.

OBJECTIVES

The aim of this study is to evaluate the smell function in patients with multiple sclerosis (MS).

METHODS

Twenty subjects (six males, 14 females) who were diagnosed as having MS, based on the 2010 Revised McDonald criteria, and 20 healthy individuals (six males, 14 females) were included in this study. In order to measure smell identification abilities, each subject completed the 12-item Brief Smell Identification Test (BSIT). Central and peripheral regions of smell were measured using cranial magnetic resonance (MR) images. The central regions of smell (the temporal lobe insular gyrus and the corpus amygdala) and the peripheral regions of smell (the olfactory bulb, tract and sulcus) were examined in the cranial MR images. Regions of smell were also evaluated for the presence of MS lesions (plaques).

RESULTS

The total BSIT scores of the subjects in the MS group were found to be significantly lower than those of the control group (p<0.05). In the MS group, measurement values of the central regions of smell (right corpus amygdala diameter, right and left corpus amygdala) were significantly higher than those of the control group (p<0.05). There were no MS 'lesions in the peripheral regions of smell, but MS lesions were observed in the central regions: the right temporal lobe insular gyrus (four patients, 20.0%); the left temporal lobe insular gyrus (two patients, 10.0%); and the right corpus amygdala (one patient, 5.0%). While these results are not sufficient for statistical analysis, the total smell scores of these patients were found to be low.

CONCLUSION

There is a deterioration in the smell functions of patients with MS. Therefore, we highly recommend that ENT specialists use the easily accessible and reliable BSIT for the diagnosis of smell disorders.

Giant serpentine aneurysm with acute spontaneous complete thrombosis

We report a case of a giant serpentine aneurysm (GSA) of the middle cerebral artery (MCA) that underwent complete spontaneous thrombosis after angiography. The patient was a 24-year-old man who had an acute headache. CT and MR examinations revealed a large partially thrombosed aneurysm of the MCA with residual flow in the artery. Angiography demonstrated a GSA arising from the left MCA. Thirteen days later, a second angiography showed complete thrombosis of the aneurysm.

Fetal biometry: size and configuration of the third ventricle

PURPOSE

To evaluate the normal configuration and size of the third ventricle in second and third trimester fetuses in a normal population, and to compare our values with those of previously published studies.

MATERIAL AND METHODS

Evaluation of fetal third ventricular width and configuration was obtained by antenatal ultrasonography in 474 fetuses with gestational age between 12 weeks and term (mean 28 weeks). Percentiles for third ventricle width were estimated by combining separate fractional polynominal regression models fitted to the mean and standard deviation, assuming that the measurements had a normal distribution at each gestational age. Appearance of the third ventricle was correlated with each gestational age.

RESULTS

The third ventricle could be visualized in 471 (99%) of 474 fetuses. The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. The third ventricle was seen as a single echogenic line in 153 (32.4%) of 474 fetuses. Two-hundred-and-ninety-nine (61.5%) of all fetuses had parallel echogenic lines outlining a fluid-filled lumen. V-shaped third ventricular configuration was seen in only 28 (5.9%) of the fetuses. From 24 weeks to term, parallel echogenic lines were the most commonly (83.7% to 79.6%) encountered configuration for the third ventricle.

CONCLUSION

The 97th percentile of the third ventricle in preterm fetuses was measured as 3.6 mm in size. In the early second trimester, 77% of the fetuses had a single echogenic line appearance on ultrasonography. As the brain and ventricular structures mature, a parallel echogenic line becomes the prominent ultrasonography appearance (>80% of fetuses) in third trimester healthy fetuses.

Periodontal lesions in lipoid proteinosis

Lipoid proteinosis is a rare autosomal recessive heritable disease. Clinical features are hoarseness starting in infancy and the formation of yellowish papules and plaques on the skin and mucous membranes of the nose, oral cavity, pharynx and larynx. Light and electron microscopy demonstrates a subepithelial accumulation of PAS-positive (hyaline) material around blood vessels and in the dermis. This case is unusual in that the gingiva is also involved in the lipoid proteinosis.

Grievances in cases using antibiotics due to orodental problems and assessment of the need for antibiotics

OBJECTIVE

To assess the complaints of patients who were prescribed antibiotics following orodental problems and the need for antibiotics prescribed for this purpose.

SETTING

Examinations were carried out in the Department of Oral Diagnosis and Radiology, Ege University, Turkey.

PARTICIPANTS

A total of 203 patients (129 females and 74 males) between 8-70 years of age (mean age 37.7 +/- 13.9).

INTERVENTION

Examination and report.

MAIN OUTCOME MEASURES

Frequency of unnecessary antibiotic use.

RESULTS

Antibiotic therapy was not necessary for 151 (74.4 per cent) cases. Antibiotics were unnecessarily prescribed in 45 cases of acute irreversible pulpitis, 10 chronic apical abscess, 6 acute apical paradontitis, 7 gingivitis, 10 periodontitis, 4 epulis, 2 TMJ (temporomandibular junction) dysfunction, 2 sharp ridge of alveolar bone, 1 burning mouth syndrome and 1 recurrent aphthous stomatitis. In 108 (53.2 per cent) of the cases, the prescribed antibiotics were found to be penicillins, 102 of which were broad-spectrum. It was also determined that only 6 (7.7 per cent) of the 78 cases diagnosed as acute apical abscess were given drainage as local therapy.

CONCLUSIONS

Principles for treating dental infections suggest that an antibiotic should only be used to supplement and not substitute for conventional surgical methods. Therefore, in cases with acute apical abscess, mechanical treatment (drainage) should be the first step. Inappropriate antibiotic use is quite widespread in dentistry. Dentists should avoid inappropriate use of antibiotics. To prevent inappropriate administration, necessary precautions need to be taken against dispensing antibiotics without prescription.

Complete replacement resorption after replantation of maxillary incisors: report of case

This article describes the treatment of a 17-year-old patient with complete root resorption of the maxillary permanent central and lateral incisors following avulsion and replantation seven years ago. The most important factor influencing the prognosis of replanted teeth is the status of the periodontal ligament (PDL). As a result of replantation, the PDL cells necrosed and tooth replacement resorption occurred. The main factors, which affected the resorption after replantation and survival of PDL cells, could be summarize as; dry extraoral time greater than 30 minutes, the kept tooth in a dry environment, touching the cementum surface, and splint treatment for a prolonged time. Since complete root resorption was found in our case, these factors probably also occurred.

[Cowden syndrome (multiple hamartoma syndrome). Role of the dentist in early detection]

First lesions of Cowden syndrome appear in the oral cavity and on the skin. Malignant transformation is a late, common event in thyroid and breast. The early diagnosis of Cowden disease prior to the development of internal malignancy, particularly of the breast and the thyroid gland, is very important. We emphasize that the dentist may be the first health care professional who recognizes the syndrome, and this is a crucial step in the prevention and cure of the predictable malignancy. This article presents a typical case of Cowden disease.

The radiographic determinability of the distance between the pulp horns in the permanent first and second molar teeth

The purpose of this study was to investigate the determinability of the distance between the pulp horns (PHD) radiographically under routine clinical conditions. This study was carried out on 36 maxillary and 28 mandibular first and second molars which were extracted because of periodontal diseases. Prior to extraction two radiographs were taken from each tooth, one using the bisecting-angle technique and the other by using the bitewing technique. After the extractions, each tooth was burred on the distal and mesial approximal surfaces and pulp horns were found. The distance between the pulp horns was measured (anatomical measurement). Using bisecting-angle and bitewing radiographs, 11 clinicians measured the PHD values of each tooth (radiographic measurement). In our study the residual error in mandibular molar teeth was statistically lower when compared to maxillary molar teeth (p < 0.01). Statistically significant differences were found between anatomic and radiographic measurements (p < 0.01) in maxillary molars. No statistically significant difference was found between anatomical and bisecting-angle measurements in mandibular first and second molars. As a result, it is concluded that bisecting-angle techniques are useful in correctly determining the PHD values in mandibular molars.

Salivary cortisol levels in children during dental treatment

Cortisol which is also called as stress hormone, is used as an indicator in the stress evaluation studies. 60 children who never visited a dentist before, participated in the present study. Saliva samples were collected from 30 children without any dental treatment (control group). Experimental group comprised 30 children with caries. Saliva samples were obtained at various stages during dental treatment. Totally 180 samples were collected and the cortisol levels were measured. Paired-t test has shown that the salivary cortisol levels at various stages of dental treatment in the experiment group were significantly higher in comparison with the control group. It is concluded that dental treatment may cause extreme stress in children who never had dental treatment experience before.

The radiographic investigation of the visibility of secondary caries adjacent to the gingiva in Class II amalgam restorations

The aim of this study was to investigate the visibility of secondary caries in the gingivobuccal and gingivolingual corners of teeth restored with amalgam restorations. Standard Class II cavities were created in 15 orthodontically extracted mandibular premolar teeth, and the teeth were randomly divided into five groups of three teeth each. In four of the groups, a 1.0- or 1.5-mm cavity was prepared in the gingivolingual or gingivobuccal corner of the restoration. No lesions were created in group 5, the control group. The teeth were restored with amalgam. The teeth were adapted in the actual tooth space of 15 volunteers with one mandibular premolar missing. Radiographs of each patient were taken with the bisecting-angle technique and the bite wing technique. The radiographs were sorted at random and given to 15 members of the professoriate who were often involved in detecting caries and to 17 members who were not normally involved in detecting caries. The bitewing technique was found to be more reliable than the bisecting-angle technique in detecting secondary caries in gingivobuccal approximal corners (P < .05). It was also found that, in group 1, the bisecting-angle technique was more reliable than the bitewing technique in detecting caries in gingivolingual corners (P < .05). No significant differences were found in the correct evaluation of radiographs between the faculty who were normally involved in the detection of caries and those who were not.

Evaluation of surface smoothness detected by a periodontal probe

An investigation was designed to determine whether or not the required smoothness has been reached. This is still a controversial subject among clinicians. Ten cylindrical metal samples of equal sizes with various degrees of smoothness were prepared, and their degrees of smoothness were assessed in a blind manner by 14 periodontists, who were asked to group them as smooth or rough using a periodontal probe. Along with the metal samples, the roughness of root surfaces smoothed in clinics was also evaluated using a Profilometer. The average value defined as a smooth surface on a max.-min. scale was 1.86 +/- 0.42, and values above 3.57 were considered to be rough. Consequently, decisions taken using the sense of touch about the smoothness of a surface were confirmed to be reliable for clinical use.

Herpetic whitlow

This paper describes a case of transmission of herpetic whitlow to the index finger of a dental student from a patient with herpes simplex virus. The recognition of intraoral viral infections in patients is important because these viruses have serious implications for health care providers. Rubber gloves must be worn when patients with primary or secondary herpetic lesions are treated. Asymptomatic permanent herpes virus carriers must also be treated with appropriate precautions.