1/8. The interdisciplinary approach to oral, facial and head pain.BACKGROUND: Chronic oral, facial and head pain is a common clinical problem, and appropriate diagnosis and management are a challenge for health care professionals. patients often will first seek the care of dentists because of the pain's localization in the oral cavity and surrounding structures. This article emphasizes the importance of establishing accurate diagnoses and conducting appropriate triage of the patient with complex orofacial pain. CASE DESCRIPTIONS: The authors present two case reports illustrating the complex nature of oral, facial and head pain, and the potential and actual pitfalls in management of this condition. These representative cases demonstrate how orofacial pain--which appears to be localized in the peripheral dental and oral structures--can have extremely complex etiologies involving other anatomical structures, the central nervous system and psychological factors. The reports point to the need for the expertise of a number of specialists in such cases. CLINICAL IMPLICATIONS: If the symptoms and clinical findings do not appear to be consistent with typical oral disease, or if standard treatments do not alleviate the pain, the dental clinician must consider other, more complex orofacial pain diagnoses. The dental professional should not hesitate to make referrals to key specialists or to members of an interdisciplinary team at a pain treatment center who have the expertise to appropriately diagnose and manage chronic oral, facial and head pain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. osteoarthritis in children associated with a mutation in the type II procollagen gene (COL2A1).A single-base mutation resulting in an arginine-519-cysteine (R519C) mutation of type II procollagen (COL2A1) has been shown to result in precocious osteoarthritis with mild spinal chondrodysplasia without severe foreshortening (OMIM 604864). The nature of childhood disease among affected individuals has not been described. The recent presentation of four children with this mutation allows us to provide clinical correlation. This form of premature osteoarthritis may present in childhood and should be considered in the differential diagnosis of childhood arthropathy presenting in the context of a positive family history.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/8. Vertical-split fracture of mandibular condyle and its sequelae.A case of vertical-split fracture of the right mandibular condyle and its sequelae is presented. The patient was a 16-year-old female being assessed for orthodontic treatment. Orthopantomograph and plain joint view radiographs showed a remodelled condyle which had suffered trauma 10 years previously. This type of fracture is unusual in nature but has not led to any secondary lack of growth, restriction of movement or facial asymmetry.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Joint distraction for the treatment of ankle osteoarthritis.Joint distraction has demonstrated substantial promise in the treatment of tibiotalar arthritis. Its minimally invasive nature, combined with the fact that it does not seem to "burn any bridges," lends considerable clinical appeal. Even if joint distraction provides only temporary relief and clinical results slowly deteriorate over time, more definitive and committed procedures potentially can be forestalled for a considerable period of time. Nevertheless, the current literature and clinical experience with this technique is limited. Further research and analysis is ongoing and will be necessary to understand, validate, and refine this novel approach to ankle arthritis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/8. Reversible hepatitis associated with diclofenac.We describe the clinical features, liver histology, and ultrastructure in reversible diclofenac-induced hepatitis and review previous reports of this entity. Although rarely reported, diclofenac hepatitis may be severe, and even fatal. Symptoms, which develop from 1 week to 11 months after starting the drug, include jaundice, pruritus, fever, abdominal pain, nausea, vomiting, and rash. bilirubin and alkaline phosphatase are mildly elevated, transaminases often markedly so. The nature of the idiosyncratic injury appears variable, some cases having features of a hypersensitivity reaction, most being more suggestive of a toxic metabolic effect. light microscopy shows a nonspecific hepatitis with portal and lobular activity, and focal hepatocellular injury that may progress to zonal or massive necrosis. The ultrastructural features in our case are typical of drug or toxin injury. This may be of value in distinguishing this entity from other forms of hepatitis, which is important in view of the frequent reversibility of this potentially lethal form of injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/8. Pathogenetic mechanisms in polyarticular osteoarthritis.This communication has attempted to review causal processes in polyarticular osteoarthritis (poly-OA). Since mechanical features are an almost constant feature of OA joint deterioration, their interplay, both in static and dynamic form, has been stressed. Age-related polyarticular cartilage softening is expounded as an example of degeneration and atrophy--a process not to be confused with OA which is considered as an age-accelerated disorder. I have stressed the influence of genetic factors, best exemplified as a single gene aberration in the occurrence of Heberden's nodes, while a polygenetic interplay may be involved in other forms of hand GOA. These features may predispose an individual to polyarthropathy. The mechanisms by which such genetic factors promote such changes are unknown but attention is drawn to the lack of symptoms in osteoarthritic joints of many if not most poly-OA cases. This occurrence could represent a relative lack of normal proprioceptive feedback or an unusual tolerance to pain. Genetically determined influences marked by the occurrence of hand OA predispose mechanically deranged joints in that individual to deteriorate more rapidly. Mechanically abnormal joints do not inevitably deteriorate, but, in combination with other local and/or systemic factors (genetic, metabolic, hormonal or immune) may undergo accelerated degeneration to which process each additional factor may contribute. Thus in genetically predisposed poly-OA hand cases, local deformity combined with crystal deposition and laxity may provoke dramatic destruction and subluxation. Since mechanical features attend almost all OA joint disease, attention is drawn to a poorly recognized malformation of the knee denoted as dysplasia. Such deformities, well recognized at the hip and shoulder, could occur at other sites in which OA is commonly seen (i.e. DIP joints). Immune-complex deposition probably occurs from time to time in GOA joints. Such events may be associated with local inflammation and aggravate the degradation of cartilage. The available data indicate distinctive differences in the nature and form of such immunopathology to RA in which disease immune-complex deposition in cartilage may play an integral role in tissue destruction and chronic inflammation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. Vascular complications in orthopaedic patients treated by orthopaedic microsurgeons.Over a 20 year period, five patients experienced serious vascular complications involving major arterial insult during various routine orthopaedic procedures. The nature of the vascular damage necessitated immediate surgical repair which was performed successfully by an orthopaedic microsurgeon who was either a member of the initial surgical team or the hospital's Orthopaedic Unit. The purpose of this study is to illustrate not only the severity of these limb and/or life-threatening complications, but also to focus attention on the importance of the orthopaedic surgeon's ability to manage these serious injuries promptly. This suggests the need for Orthopaedic Units to have surgeons with adequate training in microvascular techniques, so as to be able to successfully manage these unexpected and serious complications. We conclude that the presence of a vascular surgeon or an orthopaedic surgeon trained in microvascular surgery represents an invaluable attribute to the orthopaedic team, and minimizes, if not eliminates the potentially disastrous outcome from these serious intraoperative vascular complications.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. Salvage procedures for complex soft tissue defects of the knee.The management options for complex soft tissue defects about the knee are varied. Limb threatening conditions such as exposure of joint prosthesis or bone requires stable coverage to avoid amputation. A study was conducted to review the authors' management protocol and experience with complex defects about the knee. A retrospective analysis from 1986 to 1996 of 35 patients with complex defects about the knee was performed. Treatment options were based on the nature, size, location, and depth of the wound. A specific management protocol was applied for each patient. Treatments included local wound care, debridement and skin graft, fasciocutaneous flap, pedicled muscle flap, and free muscle transfer. Postoperatively, patients were evaluated using knee Society objective and functional scores and other instruments to measure outcome. Successful salvage of the lower extremity was obtained in 34 (97%) patients. Salvage of the total knee prosthesis was obtained in 24 of 29 (83%) patients. Secondary plastic surgery procedures were necessary in eight (23%) patients. Secondary orthopaedic procedures were necessary in five (15%) patients. No patient required an amputation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |