1/65. Brain abscesses from neglected open head injuries: experience with 17 cases over 20 years.We are reviewing our experience with 17 civilian cases with post-traumatic brain abscesses treated in the era of CT scanning over a period of 20 years. The principal cause for this intracranial complication was the neglected compound depressed fracture. One was a newborn infant with left parietal abscess caused by a vacuum extraction. We have used the following methods of treating the abscesses: single burr hole aspiration in the newborn with an excellent result; repeated aspiration, with debridement of the depressed fracture, in 5 cases (1 death); aspiration with early subsequent excision, via craniotomy, in 7 cases (no death), and primary excision, via craniotomy, in 4 cases (1 death). The early subsequent excision of the abscess, 2 or 3 days after the initial aspiration, has proved in our experience very satisfactory. In cases with bone fragment into the abscess cavity the excision of the abscess is indicated. The cultured pus from the abscess cavity showed mixed flora (streptococci and staphylococci) in 7 cases; staphylococcus aureus in 4; staphylococcus epidermidis in 2, and no growth in 4 cases. Antibiotics play an important role in the treatment of post-traumatic brain abscesses.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/65. Ultrasound biomicroscopy of chronic hypotony after cataract extraction.Ultrasound biomicroscopy was performed with a UBM 840 (Zeiss-Humphrey) equipped with a 50 MHz probe on a patient with chronic hypotony 1 year after cataract surgery by phacoemulsification with intraocular lens implantation in the capsular bag. This sonographic technique, which provides high-resolution imaging of the anterior segment, showed aqueous humor leakage through the former scleral tunnel incision. Ultrasound biomicroscopy helped detect this patient's postoperative complication and is a good tool for diagnostic procedures in patients with chronic hypotony.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
3/65. Garre's osteomyelitis of an unusual origin in a 8-year-old child. A case report.Garre's osteomyelitis is a type of chronic osteomyelitis that primarily affects children and adolescents. Although the disease is well described in the dental literature and is usually associated with an odontogenic infection resulting from caries, a number of other causative factors have been occasionally reported, such as a dental extraction or a mild periodontitis. There have also been cases of unknown aetiology. This paper describes a case of Garre's osteomyelitis in an 8-year-old child, in whom the condition arose following a local periodontal infection in an ectopically erupting first permanent molar that was in infraocclusion. The lesion remained unresolved for a period of over 6 months as a result of misdiagnosis, following a number of unsuccessful treatment attempts. Identification of the true cause and treatment through periodontal surgery resulted in lesion resolution and resolved the diagnostic problem. dentists should be aware that the periodontium may be a potential source of infection for Garre's osteomyelitis in children, particularly in the presence of ectopically erupting posterior teeth. In such cases, periodontal treatment should be sufficient to treat the disease and extraction of the tooth involved may not be necessary.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
4/65. Severe sensory ataxia and demyelinating polyneuropathy with IgM anti-GM2 and GalNAc-GD1A antibodies.Several polyneuropathy syndromes have been described with polyclonal serum immunoglobulin g (IgG) or immunoglobulin m (IgM) binding to gangliosides GM2 and GalNAc-GD1a that contain the terminal trisaccharide moiety GalNAc(beta1-4)Gal(alpha2-3)NeuAc. We describe the clinical and electrodiagnostic features in two patients with serum IgM monoclonal anti-GM2 and anti-GalNAc-GD1a antibodies. These patients had slowly progressive, panmodal sensory loss with severe sensory ataxia. Electrodiagnostic testing showed demyelinating features. Prominent improvement in gait ataxia occurred after treatment with human immune globulin but not after other immunomodulating therapies. Enzyme-linked immunoabsorbent assay and thin-layer chromatography demonstrate that the patient's serum monoclonal IgM bound to gangliosides GM2 and GalNac-GD1a but not to gangliosides without the GalNAc(beta1-4)Gal(alpha2-3)NeuAc moiety. This neuropathy differs from previously reported neuropathy syndromes associated with polyclonal GM2 and GalNAc-GD1a antibodies and from other chronic demyelinating polyneuropathies. We conclude that a distinct syndrome of chronic demyelinating neuropathy with sensory ataxia, unresponsive to corticosteroids, is associated with monoclonal IgM binding to gangliosides with a terminal GalNAc(beta1-4)Gal(alpha2-3)NeuAc trisaccharide moiety. diagnosis of this syndrome is important to direct appropriate treatment.- - - - - - - - - - ranking = 5.4538212418933keywords = chromatography (Clic here for more details about this article) |
5/65. Otolaryngological complications of osteopetrosis.osteopetrosis is a rare inherited bone disease that affects both humans and various mammals. The authors report on two cases of osteopetrosis with otolaryngological complications. One patient had the childhood form and presented with chronic otitis media and brain abscess. The second patient had the adult form and presented with sinusitis from tooth extraction which developed into chronic osteomyelitis of the maxillary bone.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/65. Chronic postoperative endophthalmitis due to pseudomonas oryzihabitans.PURPOSE: To report a case of chronic postoperative endophthalmitis caused by the gram-negative bacterium pseudomonas oryzihabitans.DESIGN: Interventional case report.methods: A 77-year-old man was referred to our service for nonpainful uveitis in the right eye accompanied by increased intraocular pressure of 2 years' duration with onset 4 months after uncomplicated extracapsular cataract extraction and posterior chamber intraocular lens implantation. The uveitis partially responded to topical corticosteroid therapy but was recurrent with tapering of steroids. An anterior chamber tap and vitreous biopsies sent for cultures were negative. Owing to the persistence of inflammation despite intraocular vancomycin injection, the lens implant and capsule were removed and culture of the latter revealed the bacterium P. oryzihabitans.RESULTS: There was no recurrence of inflammation after removal of the lens implant and capsule.CONCLUSIONS: Unlike other gram-negative organisms, which are associated with poor outcomes, P. oryzihabitans may masquerade as chronic uveitis because of its low virulence.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/65. aspermia and chronic testicular pain after imperforate anus correction. cryopreservation of sperm cells extracted from whole orchiectomized testis: case report.This paper describes an unusual association of aspermia and untreatable, chronic testicular pain in a young man who underwent 14 surgical interventions for an imperforate anus. physical examination and ultrasonography revealed left epididymal and vas enlargement, normal-sized testes, tubular ectasia of the left rete testis and a small intraprostatic paramedian left cyst. Retrograde ejaculation and urogenital infections were excluded, and the FSH and karyotype results were normal. The patient gave his consent to an exploratory intervention with possible radical left orchiectomy. The patency of the left distal seminal duct was unexpectedly normal, and no sperm were found in the epididymis or vas deferens despite their obstructive appearance. Sperm were only found in a 'testicular touch' preparation. The removed testis was immediately opened and most of the testicular lobules were removed, thus allowing the extraction of 25 x 10(6) sperm, which were cryopreserved in 35 straws. An 8-month follow-up examination documented the complete absence of pain and, during the next few months, it is planned to use the thawed sperm for ICSI. Radical orchiectomy plus the cryopreservation of sperm extracted from the whole testis must be considered in the case of the co-existence of chronic unilateral testicular pain and aspermia.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/65. Oral and maxillofacial surgery in patients with chronic orofacial pain.PURPOSE: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required surgical treatment as recommended by an interdisciplinary orofacial pain team. The major goal of this investigation was to determine the role of oral and maxillofacial surgery in patients with chronic orofacial pain. patients and methods: The study population included patients seen at the Center for Oral, Facial and head pain at new york Presbyterian Hospital from January 1999 through April 2001. (120 patients; female-to-male ratio, 3:1; mean age, 49 years; average pain duration, 81 months; average number of previous specialists, 6). The patient population was evaluated by an interdisciplinary orofacial pain team and the following characteristics of this population were profiled: 1) the frequency and types of previous surgical procedures, 2) diagnoses, 3) the frequency of previous misdiagnoses, and 4) treatment recommendations made by the center team. RESULTS: There was a history of previous oral and maxillofacial surgical procedures in 38 of 120 patients (32%). Procedures performed before our evaluation included endodontics (30%), extractions (27%), apicoectomies (12%), temporomandibular joint (TMJ) surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Surgical intervention clearly exacerbated pain in 21 of 38 patients (55%) who had undergone surgery. Diagnoses included myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%), and TMJ fibrosis (2%). Treatment recommendations included medications (91%), physical therapy (36%), psychiatric management (30%), trigger injections (15%), oral appliances (13%), biofeedback (13%), acupuncture (8%), surgery (4%), and Botox injections (1%) (Allergan Inc, Irvine, CA). Gross misdiagnosis leading to serious sequelae, with delay of necessary treatment, occurred in 6 of 120 patients (5%). CONCLUSIONS: Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain. These patients often have multiple diagnoses, requiring management by multiple disciplines. Surgery, when indicated, must be based on a specific diagnosis that is amenable to surgical therapy. However, surgical treatment was rarely indicated as a treatment for pain relief in these patients with chronic orofacial pain, and it exacerbated and perpetuated pain symptoms in some of them.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/65. rhizobium (agrobacterium) radiobacter identified as a cause of chronic endophthalmitis subsequent to cataract extraction.Herein, we report a case of chronic endophthalmitis caused by a ceftazidime-resistant rhizobium radiobacter strain in a 62-year-old male. The patient underwent an uneventful cataract extraction of the right eye a week prior to the appearance of symptoms (pain, redness, and blurring vision) which developed following a golf outing. Upon admission the patient received an emergency vitrectomy. The patient remained symptomatic, and R. radiobacter was isolated repeatedly from vitreous fluid cultures over a 5-month period. Ultimately, the infection responded to intravitreal gentamicin, oral ciprofloxacin, and removal of the lens implant.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
10/65. Non-surgical approach to advanced chronic periodontitis: a 17.5-year case report.This 17.5-year longitudinal case report details the treatment of advanced chronic periodontitis in a female patient commencing at 34 years of age. The woman was provided with periodontal care comprising of temporary fixation, scaling and root planing, intra-pocket irrigation using a root canal syringe and regular supervised maintenance. The patient presented with a 10-year history of bleeding gums. Therapy conducted in general practice had included simple curettage and irrigation. However, these treatments proved unsuccessful and the patient often changed dentists seeking better treatment. She presented to the University Dental Hospital, for diagnosis and treatment of her periodontal conditions after her mandibular lateral incisor had exfoliated. On presentation a purulent exudate could be expressed from all of the pockets. All anterior teeth, excluding the maxillary canines, demonstrated 2 to 3 mobility. The patient did not want any surgical treatment or her teeth extracted. It was decided to treat the patient conservatively without surgery. By postponing extraction, the authors were in a better position to determine the prognosis of the remaining teeth after the infection was under control. Although six teeth were extracted during the 17.5 years, this case report suggests that a non-surgical approach is a viable option while maintaining regular visits for periodontal care.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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