1/4. Gingival telangiectases: an underappreciated physical sign of juvenile dermatomyositis.BACKGROUND: medline searches (1966-June 1969) failed to identify references that give detailed descriptions of the oral manifestations of dermatomyositis (DM). However, several reports predating medline provided more complete descriptions of oral lesions associated with DM. OBSERVATIONS: We describe 5 cases of juvenile DM with oral manifestations, primarily in the form of gingival telangiectases. These findings are compared with those descriptions found in earlier reports. CONCLUSIONS: Oral lesions in juvenile DM have rarely been reported. mucous membrane involvement associated with DM may include telangiectases, edema, erosions, ulcers, and leukoplakia-like areas. In cases of DM, gingival telangiectases likely represent an underappreciated diagnostic finding analogous to nail-fold telangiectases.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. A bleeding tendency as the first symptom of a choledochal cyst.We report an 8-month-old male presenting with gingival hemorrhages and nasal bleeding as the first symptom of a choledochal cyst (CC). On physical examination, there was a large cystic mass in the right upper abdominal quadrant. Laboratory studies on admission revealed moderate liver dysfunction and a bleeding tendency due to vitamin k deficiency. After administration of 5 mg vitamin K the bleeding tendency disappeared. At laparotomy, a large CC 5 cm in diameter was found and the liver showed moderate cholestasis. The sudden onset of a bleeding tendency in infants with congenital liver or biliary-tract disease may suggest not only biliary atresia, but also CC.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
3/4. Periodontal treatment in severe aplastic anemia.BACKGROUND: Aplastic anemia (AA) is a rare hematologic disease characterized by hypo-cellular bone marrow. The clinical features include fatigue, increased bruising, and gingival bleeding caused by anemia, leukopenia, and thrombocytopenia. A patient with AA is at high risk for infection because of leukopenia. The risk of systemic infection is especially high in AA patients with severe local infections, including periodontitis. Accordingly, periodontal treatment should include antibiotic prophylaxis to reduce the risk of systemic infection. However, treatment of periodontitis in the AA patient is significantly complicated by the bleeding disorder. We present a case report of the successful periodontal treatment of an AA patient with spontaneous gingival bleeding. methods: The patient was closely monitored for platelet and neutrophil counts before every treatment. The patient's platelet count was always under 10,000/microl. Therefore, it was necessary to increase platelet counts to over 25,000/microl by transfusion, after which subgingival scaling with anesthesia was performed. When the neutrophil count was less than 2,000/microl, local minocycline chemotherapy was applied to the pockets. Periodontal infection was monitored by detection of bacterial dna and measurement of serum immunoglobulin (Ig) G titer against periodontal bacteria. RESULTS: Following the physical and chemical treatment, the gingival appearance improved dramatically and the spontaneous gingival bleeding disappeared. Moreover, the IgG titer against periodontal bacteria decreased to normal range and specific periodontal pathogens were no longer detectable in the tested pockets. CONCLUSION: We believe that the treatment strategy in the present report provides new sight into treatment planning for severely medically compromised patients.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
4/4. Systemic argyria secondary to topical silver nitrate.A case of generalized argyria secondary to topical silver nitrate use on the oral mucosa is described, and the nature and history of argyria reviewed. The patient has extreme pigmentation of her skin and abdominal viscera, as seen on physical examination, gastroduodenoscopy, and laparotomy. Her use of silver nitrate applicators was uncontrolled by her dentist and pharmacist, and the diagnosis of argyria was not made until 2 1/2 years of heavy usage had passed. Avoidance of similar cases requires the careful scrutiny of silver-containing medicinal usage by all health practitioners and pharmacists. Although the systemic distribution of silver in both elemental and ionic forms can be linked with no systemic toxicity, the resultant pigmentation can be devastating to the patient.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |