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Voinier D, Neogi T, Arbeeva L, Voinier S, Master H, Thoma LM, Brunette M, Jakiela JT, White DK. Association of physical activity with loss of knee joint space width over two years: a compositional data analysis in the Osteoarthritis Initiative. Osteoarthritis Cartilage 2023; 31:1091-1100. [PMID: 36822497 PMCID: PMC10523474 DOI: 10.1016/j.joca.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 02/25/2023]
Abstract
OBJECTIVE There is continued debate as to how engaging in physical activity (PA), including moderate-to-vigorous PA (MVPA), light PA (LPA), and sedentary time (SED), affects one's risk for knee osteoarthritis (OA). Traditional regression methods do not account for the codependence of these categories of PA, whereby when one category increases, the others must decrease. Thus, we used compositional data analysis (CoDA) to examine time spent in each category of PA, or PA composition, and its association with loss of knee joint space width (JSW), a common indicator of knee OA progression. METHODS We performed a secondary analysis of data from a subset of participants in the Osteoarthritis Initiative. These participants had minute-by-minute activity data collected over 7 days at baseline; we then categorized each minute as MVPA, LPA, or SED. Our exposure, PA composition, represented min/day spent in each category. Our outcome, medial JSW loss, was the difference in medial tibiofemoral JSW from baseline to 2 years later. We employed CoDA, using an isometric log-ratio transformation, to examine the association of PA composition with medial JSW loss over 2 years, adjusting for potential confounders. RESULTS We included 969 participants (age: 64.5 years, 56% female, body mass index [BMI]: 28.8 kg/m2). Mean PA composition was: MVPA 9.1 min/day, LPA 278 min/day, SED 690 min/day. Per adjusted regression models, higher MVPA was not associated with greater medial JSW loss (β = -0.0005, P = 0.97), nor was LPA (β = 0.06, P = 0.27) or SED (β = -0.06, P = 0.21). CONCLUSION Using CoDA, PA composition was not associated with medial JSW loss over 2 years.
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Affiliation(s)
- D Voinier
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - T Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
| | - L Arbeeva
- University of North Carolina at Chapel Hill, Thurston Arthritis Research Center, Chapel Hill, NC, USA.
| | - S Voinier
- Department of Mechanical Engineering, University of Delaware, Newark, DE, USA.
| | - H Master
- Vanderbilt University Medical Center, Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA.
| | - L M Thoma
- University of North Carolina at Chapel Hill, Division of Physical Therapy, Chapel Hill, NC, USA.
| | - M Brunette
- Evidation Health Inc, San Mateo, CA, USA.
| | - J T Jakiela
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
| | - D K White
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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Holden MA, Metcalf B, Lawford BJ, Hinman RS, Boyd M, Button K, Collins NJ, Cottrell E, Henrotin Y, Larsen JB, Master H, Skou ST, Thoma LM, Rydz R, Wellsandt E, White DK, Bennell K. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group. Osteoarthritis Cartilage 2023; 31:386-396. [PMID: 36367486 DOI: 10.1016/j.joca.2022.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA). DESIGN A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains. RESULTS The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise. CONCLUSION The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.
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Affiliation(s)
- M A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - B Metcalf
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - B J Lawford
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - R S Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - M Boyd
- Patient Representative, Australia
| | - K Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, UK.
| | - N J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Australia.
| | - E Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - Y Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Belgium; musculoSKeletal Innovative research Lab (mSKIL), Motricity Sciences Department, Institute of Pathology, University of Liège, Belgium; Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Belgium; The Osteoarthritis Foundation, Boncelles, Belgium.
| | - J B Larsen
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Denmark.
| | - H Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| | - L M Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - R Rydz
- Patient Representative, Australia.
| | - E Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
| | - D K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA.
| | - K Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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Felson D, Rabasa G, Jafarzadeh SR, Nevitt M, Lewis CE, Segal N, White DK. Factors associated with pain resolution in those with knee pain: the MOST study. Osteoarthritis Cartilage 2021; 29:1666-1672. [PMID: 33901642 PMCID: PMC9444184 DOI: 10.1016/j.joca.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine how many persons with knee pain have subsequent pain resolution and what factors are associated with resolution, focusing especially on types of physical activity. METHODS Using data from MOST, an NIH funded longitudinal cohort study of persons with or at risk of knee osteoarthritis, we studied participants who at baseline reported knee pain on most days at both a telephone interview and clinic visit. We defined pain resolution if at 30 and 60 month exams, they reported no knee pain on most days and compared these participants to those who reported persistent pain later. In logistic regression analyses, we examined the association of baseline risk factors including demographic factors, BMI, depressive symptoms, isokinetic quadriceps strength and both overall physical activity (using the PASE survey) and specific activities including walking, gardening, and different intensities of recreational activities with pain resolution. RESULTS Of 1,304 participants with knee pain on most days at baseline, 265 (20.3%) reported no knee pain at 30 and 60 months. Lower BMI and stronger quadriceps were associated with higher odds of pain resolution while overall physical activity was not. Of activities, walking decreased the odds of pain resolution (adjOR = 0.86 (95% CI 0.76, 0.98)), but gardening (adjOR = 1.59 (1.16, 2.18)) and moderate intensity recreational activities ((adjOR = 1.24 (1.05, 1.46)) increased it. CONCLUSION Pain resolution is common in those with knee pain. Factors increasing the odds of pain resolution include lower BMI, greater quadriceps strength and gardening and moderately intensive recreational activities.
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Affiliation(s)
- D Felson
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA; University of Manchester and the NIHR, Manchester Musculoskeletal Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - G Rabasa
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - S R Jafarzadeh
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - M Nevitt
- University of California at San Francisco, San Francisco, CA, USA
| | - C E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Segal
- University of Kansas Medical Center, Kansas City, KS, USA
| | - D K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware Newark, DE, USA; Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Newark, DE, USA
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Wang Y, Zhang Y, Bennell K, White DK, Wei J, Wu Z, He H, Liu S, Luo X, Hu S, Zeng C, Lei G. Physical Distancing Measures and Walking Activity in Middle-aged and Older Residents in Changsha, China, During the COVID-19 Epidemic Period: Longitudinal Observational Study. J Med Internet Res 2020; 22:e21632. [PMID: 33027035 PMCID: PMC7592463 DOI: 10.2196/21632] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Physical distancing measures taken to contain COVID-19 transmission may substantially reduce physical activity levels and cause individuals to adopt a more sedentary lifestyle. OBJECTIVE The objective of this study is to determine if there was any change in daily steps, an important component of daily physical activity, and examine risk factors for frequent low daily steps during the COVID-19 epidemic. METHODS We used data collected from the Step Study, a population-based longitudinal study of walking activity among residents aged ≥40 years in Changsha, China. Daily steps were collected via a smartphone linked to WeChat, a social networking platform. We plotted mean daily steps and the prevalence of low daily steps (≤1500 steps/day) 30 days before (reference period) and 30 days after (epidemic period) January 21, 2020 (date of the first COVID-19 case diagnosed in Changsha), and compared it with the same corresponding period from 2019. We examined the association of risk factors with the prevalence of frequent low daily steps (≤1500 steps/day for ≥14 days) using logistic regression. RESULTS Among 3544 participants (mean age 51.6 years; n=1226 females, 34.6%), mean daily steps dropped from 8097 to 5440 and the prevalence of low daily steps increased from 3% (2287/76,136 person-day) to 18.5% (12,951/70,183 person-day) during the reference and epidemic periods, respectively. No such phenomenon was observed during the corresponding period in 2019. Older age (P for interaction=.001) and female sex (P for interaction<.001) were both associated with a higher prevalence of frequent low daily steps and were more pronounced during the epidemic period. More education was associated with a lower prevalence of frequent low daily steps during the reference period but not the epidemic period (P for interaction=.34). Body mass index or comorbidity were not associated with frequent low daily steps during either period. CONCLUSIONS Daily steps of Changsha residents aged ≥40 years dropped significantly during the COVID-19 period, especially among older adults and females. Although successful physical distancing, measured by the rapid downward trend in daily step counts of residents, played a critical role in the containment of the COVID-19 epidemic, our findings of an increase in the prevalence of frequent low daily steps raise concerns about unintended effects on physical activity.
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Affiliation(s)
- Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Daniel Kenta White
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Jie Wei
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Ziying Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyi He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shaohui Liu
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xianghang Luo
- Department of Endocrinology, Endocrinology Research Center, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China
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5
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Corcoran MP, Chui KKH, White DK, Reid KF, Kirn D, Nelson ME, Sacheck JM, Folta SC, Fielding RA. Accelerometer Assessment of Physical Activity and Its Association with Physical Function in Older Adults Residing at Assisted Care Facilities. J Nutr Health Aging 2016; 20:752-8. [PMID: 27499309 DOI: 10.1007/s12603-015-0640-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To describe levels of physical activity among older adults residing at assisted care facilities and their association with physical function. DESIGN Cross-sectional analysis. SETTING Assisted care facilities within the greater Boston, MA area. PARTICIPANTS Older adults aged 65 years and older (N = 65). MEASUREMENTS Physical Activity Level (PAL) as defined by quartiles from accelerometry (counts and steps), Short Physical Performance Battery (SPPB) Score, gait speed, and handgrip strength. RESULTS Participants in the most active accelerometry quartile engaged in 25 minutes/week of moderate to vigorous physical activity (MVPA) and walked 2,150 steps/day. These individuals had an SPPB score, 400 meter walk speed, and handgrip strength that was 3.7-3.9 points, 0.3-0.4 meters/second, and 4.5-5.1 kg greater respectively, than individuals in the lowest activity quartile, who engaged in less than 5 min/wk of MVPA or took fewer than 460 steps/day. CONCLUSION Despite engaging in physical activity levels far below current recommendations (150 min/week of MVPA or > 7000 steps/day), the most active older adults in this study exhibited clinically significant differences in physical function relative to their less active peers. While the direction of causality cannot be determined from this cross-sectional study, these findings suggest a strong association between PAL and physical function among older adults residing in an assisted care facility.
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Affiliation(s)
- M P Corcoran
- Michael P. Corcoran, PhD, Assistant Professor of Health Sciences, Merrimack College, North Andover, MA, 01845. USA. Office: (978) 837-5584; Fax: (978) 837-5014;
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6
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Tandon R, Cunningham LL, White DK, Herford AS, Cicciu M. Overexpression of cyclin A in oral dysplasia: An international comparison and literature review. Indian J Cancer 2014; 51:502-5. [PMID: 26842177 DOI: 10.4103/0019-509x.175324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Oral squamous cell carcinoma (OSCC) is one of the most debilitating cancers in the world and while its causes have been heavily researched, the outcome remains grim. Most of these cancers are identified in the late stage and as a result treatment options are limited. Therefore, researchers have focused their efforts on recognizing and identifying dysplastic tissue that has an increased chance of progressing to cancer. Research has begun to look at cell cycle dysfunctions and in particular, aberrant protein functions as a way of identifying the cellular mechanism at fault. The overexpression of a group of regulatory proteins called cyclins has been demonstrated in many types of dysplasia and carcinomas. Although researchers have identified several different types of cyclins as potential culprits, we chose to focus our study primarily on the overexpression of cyclin A. While most research on oral dysplasia and OSCC has been focused on cyclin D, studies have been done on cyclin A. While the etiology of oral dysplasia/SCC appears to be multifactorial, we chose to compare our results with those of similar studies performed across the globe. The social factors, such as the increased use of tobacco that may have contributed to our results, were compared with similar studies performed in Europe and Asia. While our results were remarkably similar and demonstrated a link between the overexpression of cyclin A in oral dysplasia, there exists some differences and thus may require a multicenter, longitudinal study.
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Affiliation(s)
| | | | | | | | - M Cicciu
- Human Pathology, School of Dentistry, University of Messina, Messina, Italy
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7
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Barwood MJ, Corbett J, White DK. Spraying with 0.20% L-menthol does not enhance 5 km running performance in the heat in untrained runners. J Sports Med Phys Fitness 2014; 54:595-604. [PMID: 24844622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND L-Menthol stimulates cutaneous thermoreceptors and induces cool sensations improving thermal comfort but has also been linked to heat storage responses. Therefore, L-Menthol application could lead to a conflict in behavioural and thermoregulatory drivers improving comfort but leading to a higher rate of deep body temperature rise; the present study examined this possibility. METHODS Six untrained male participants (age 21 [1] years; height 1.80 [0.07] m; mass 78.9 [6.9] kg; surface area 1.98 [0.13] m2) took part. They completed three trials in hot conditions (34 °C) where their clothing was sprayed (CONTROL-SPRAY or MENTHOL-SPRAY) or not sprayed (CONTROL) after a fixed intensity exercise period (15-minutes), which induced thermal discomfort, before completing a 5 km treadmill time trial (TT). Thermal perception (thermal sensation and comfort; TS, TC), thermal responses (aural temperature [Tau], skin temperature [Tskin]), perceived exertion (RPE), heart rate, pacing (1 km split time) and performance (TT completion time) were measured. RESULTS MENTHOL-SPRAY induced improvements in TS (up to 3 km of TT) and TC (up to 1 km) with Tau showing a tendency to be higher than CONTROL-SPRAY (+0.20 [0.29] °C) and CONTROL condition (0.30 [0.34] °C); this was not statistically significant and the rate of rise in Tau was linear. Tau was continuing to rise between the 4th and 5th kilometre of the TT. The other variables were unchanged. TT completion time and pace were not different: CONTROL 27.92 [1.65], CONTROL-SPRAY 28.10 [1.12], MENTHOL-SPRAY 27.53 [2.85] minutes. CONCLUSION Spraying L-MENTHOL prior to exercise in the heat culminated in improved perception but not altered performance.
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Affiliation(s)
- M J Barwood
- Department of Sport and Exercise Science University of Portsmouth, Portsmouth, UK -
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Abstract
Respiratory syncytial virus (RSV) infection may have an effect on the development of T cell memory responses. RSV bronchiolitis in infants is associated with a transient decline in circulating lymphocytes. We hypothesized that the mechanism underlying this lymphopenia is apoptosis. Blood was taken from 32 infants during primary RSV bronchiolitis and three months later. Using flow cytometry, we found that absolute numbers of both CD3+/CD4+ T-helper lymphocytes (P = 0·029) and CD3+/CD8+ cytotoxic lymphocytes (CTL) (P = 0·043) were significantly reduced during acute infection. Up-regulated expression both of Fas (P < 0·001) and tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) receptor (P < 0·001) was found during acute illness on both CD3+/CD4+ and CD3+/CD8+ lymphocytes, when compared with convalescent samples. Expression of Fas on CD4+ lymphocytes was inversely related to CD4+ number (P = 0·03). Plasma levels of soluble Fas ligand (P = 0·028) and caspase-1 (P = 0·037), determined by enzyme-linked immunosorbent assay, were increased during bronchiolitis. Plasma interleukin-18, a product of caspase-1 activity, was not raised. Taken together, these data suggest that in acute RSV infection, CD4+ helper lymphocytes and CD8+ cytotoxic lymphocytes are primed to undergo apoptosis. This is a mechanism through which lymphopenia may occur and T cell memory may be altered.
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Affiliation(s)
- M F E Roe
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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Tasker RC, Gupta S, White DK. Severe head injury in children: geographical range of an emergency neurosurgical practice. Emerg Med J 2004; 21:433-7. [PMID: 15208225 PMCID: PMC1726385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To determine the timings of regional transfer for emergency neurosurgery and intensive care after severe head injury in children, and the effective operational range of a regional service. DESIGN Prospective observational study of admissions to a regional paediatric intensive care unit (PICU). SETTING East Anglia region in England, January 2000 to December 2001, where 18 referring hospitals are within two hours road transit time from the centre. PATIENTS 69 severely head injured children (52 boys and 17 girls, aged 8.4 (3.6 to 12.5) years). MAIN OUTCOME MEASURES Time interval between injury and arrival at first hospital (primary transfer); timing between arrival at first hospital and arrival in PICU or the operating theatre (secondary transfer). RESULTS Arrival in one of the 19 accident and emergency departments occurred (median, IQR) within 48 (35 to 70) minutes of the accident. After arrival, the interval of secondary transfer was 4.4 (3.2 to 5.8) hours. Children rarely received their surgery within four hours of injury; for this to occur, the geographical range of this regional practice would need to be restricted to those hospitals within about 45 minute road transit time from the centre. CONCLUSIONS Good evidence supporting the recommendation that acute neurosurgery for the evacuation of a haematoma within four hours of injury is still scarce. The timings of care after an accident suggest that this guideline is unworkable in regions covering areas with road distance travel times in excess of 45 minutes.
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Affiliation(s)
- R C Tasker
- Paediatric Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
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10
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Beardsall K, White DK, Pinto EM, Kelsall AWR. Pericardial effusion and cardiac tamponade as complications of neonatal long lines: are they really a problem? Arch Dis Child Fetal Neonatal Ed 2003; 88:F292-5. [PMID: 12819160 PMCID: PMC1721562 DOI: 10.1136/fn.88.4.f292] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To estimate the frequency of pericardial effusion/cardiac tamponade associated with the use of neonatal percutaneous long lines (PLLs) over the past five years. METHOD A retrospective nationwide postal survey, of all neonatal and special care units in the United Kingdom. RESULTS Eighty two cases of pericardial effusion/cardiac tamponade were reported from the five year period, during which we estimate that 46 000 PLLs were inserted. The calculated frequency of pericardial effusion/cardiac tamponade occurring with PLLs was 1.8/1000 lines. There were 30 deaths, giving a fatality rate after pericardial effusion of 0.7/1000 lines. CONCLUSIONS Pericardial effusion/cardiac tamponade is a serious but infrequent complication of PLL use.
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Affiliation(s)
- K Beardsall
- Neonatal Intensive Care Unit, Rosie Maternity, Addenbrooke's Hospital, Hills Road, Cambridge, UK.
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11
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Abstract
Dealing with families who have suffered a sudden and unexpected death is a skill that may be needed by any paediatrician. Offering a bereavement follow up meeting to such families is part of accepted practice and is perceived to be of value in helping the family to come to terms with the loss. Unfortunately, there is very little guidance on the objectives for such a meeting, or the training required to help staff conduct such meetings. The nature of the work on a paediatric intensive care unit (PICU) means that staff have a greater experience of handling families in such a situation. We have reviewed our experience over the past five years following up the families of 51 children who have died suddenly and unexpectedly in our regional PICU. In doing this we have identified five key elements that we suggest are essential to a successful follow up meeting, and have supported this with case studies as illustration.
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Affiliation(s)
- P Cook
- Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
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12
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Moore KR, Fischbein NJ, Harnsberger HR, Shelton C, Glastonbury CM, White DK, Dillon WP. Petrous apex cephaloceles. AJNR Am J Neuroradiol 2001; 22:1867-71. [PMID: 11733318 PMCID: PMC7973833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND PURPOSE Petrous apex cephaloceles (PACs) are uncommon lesions that are usually incidental but may be symptomatic. We reviewed MR and CT studies in 10 patients with PACs to identify characteristic imaging features that facilitate their diagnosis. METHODS MR and CT studies from 10 patients with PACs were reviewed retrospectively. In each case the PAC was characterized by lesion center, signal intensity or attenuation, adjacent petrous apex pneumatization, and its relationship to Meckel's cave. Intraoperative findings were reviewed in the three cases in which surgery was performed. RESULTS All 10 patients had lobulated expansile cystic petrous apex lesions centered along the posterolateral margin of Meckel's cave. All cysts were contiguous with Meckel's cave. Three patients had bilateral PACs. Four patients had symptoms that could potentially be explained by the PAC, while findings in the other six were incidental observations. Three patients underwent surgery, during which two lesions were diagnosed as meningoceles while the third was diagnosed as an arachnoid cyst protruding through a dural defect. CONCLUSION PACs represent a protrusion of meninges and CSF from the posterolateral portion of Meckel's cave into the petrous apex, which is their characteristic imaging appearance. PACs are usually incidental but may be symptomatic. Surgical intervention should be approached cautiously and undertaken only when symptoms are clearly linked to the presence of this lesion.
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Affiliation(s)
- K R Moore
- Department of Radiology, University of Utah School of Medicine, Salt Lake City 84132, USA
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Flick L, White DK, Vemulapalli C, Stulac BB, Kemp JS. Sleep position and the use of soft bedding during bed sharing among African American infants at increased risk for sudden infant death syndrome. J Pediatr 2001; 138:338-43. [PMID: 11241039 DOI: 10.1067/mpd.2001.111428] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED Soft bedding increases the risk for death among prone infants. We compared the softness of beds and bedding and infant sleep position for infants sleeping alone and for those bed sharing. STUDY DESIGN Questionnaires were used to record the bedding and sleep practices of 218 consecutive African American infants. Enrollment was prospective. Mechanical models were used in the homes of a subgroup to measure the softness of bedding and its propensity to cause rebreathing. Results were compared by using the Student t test, Mann-Whitney U test, and chi(2) analysis. RESULTS In a cross-sectional sample of infants, at 8.2 +/- 3.3 weeks of age, 61% (133 of 218) had bed shared > or =1 of the previous 14 nights and 48.6% (106 of 218) had bed shared the night before. Breast-feeding rates were not different for bed sharers and those sleeping alone. The rates of maternal smoking for both groups were low (13.6% vs 11.8%). Comforters, pillows, and waterbeds were more commonly used beneath bed-sharing infants. Bed sharers were twice as likely to habitually be placed prone for sleep (18% vs 9%). In the subgroup studied in their homes (13 bed sharing, 19 alone), the shared beds were softer (P <.0001) and could cause more rebreathing (P =.007). CONCLUSIONS Infants at increased risk for sudden infant death syndrome, by sociodemographic criteria, who also bed share are more likely to sleep prone and to use softer beds. These findings may explain part of the risk associated with bed sharing among US infants, a risk that appears to be independent of the effects of maternal smoking.
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Affiliation(s)
- L Flick
- Pediatric Research Institute and the Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri, USA
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14
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Curran AE, White DK, Damm DD, Murrah VA. Polymorphous low-grade adenocarcinoma versus pleomorphic adenoma of minor salivary glands: resolution of a diagnostic dilemma by immunohistochemical analysis with glial fibrillary acidic protein. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91:194-9. [PMID: 11174597 DOI: 10.1067/moe.2001.111306] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Differentiating polymorphous low-grade adenocarcinoma (PLGA) from pleomorphic adenoma (PA) in salivary gland biopsy specimens from the palatal region might be a diagnostic dilemma for the pathologist when tumors are cellular with minimal matrix material. Glial fibrillary acidic protein (GFAP), expressed by a number of cells in the mature central nervous system, is also expressed in tumors not generally considered to be of glial origin. PAs have previously been reported to strongly express GFAP. PLGAs have been examined for the expression of this protein only in small group studies with variable results. The objective of this study was to determine whether differential expression of GFAP in these 2 tumors could be diagnostically significant. STUDY DESIGN A total of 42 PLGAs and 36 PAs, formalin-fixed and paraffin-embedded, were immunostained with rabbit polyclonal antibodies to GFAP. CNS tissue was used as a positive control. RESULTS Results showed the 36 cases of PA to be strongly positive for GFAP. Of PLGAs, 31 were negative and 11 showed faint patchy reactivity in luminal cells. CONCLUSIONS The results strongly support a role for GFAP as a diagnostic adjunct in the microscopic differential diagnosis of PLGA versus PA. This study is the largest investigation with consistent results to date addressing the application of this antibody to the diagnostic problem of PA versus PLGA.
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Affiliation(s)
- A E Curran
- University of Mississippi Medical Center, USA.
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15
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White DK, Davidson HC, Harnsberger HR, Haller J, Kamya A. Accessory salivary tissue in the mylohyoid boutonnière: a clinical and radiologic pseudolesion of the oral cavity. AJNR Am J Neuroradiol 2001; 22:406-12. [PMID: 11156791 PMCID: PMC7973941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND AND PURPOSE Though classically depicted as a continuous muscular barrier between the sublingual and submandibular spaces, the mylohyoid muscle is often discontinuous. These areas of discontinuity may contain fat, blood vessels, salivary tissue, or combinations thereof that may be mistaken both clinically and radiologically for pathologic abnormalities. We sought to demonstrate the prevalence and radiologic appearance of dehiscence of the mylohyoid muscle. METHODS One hundred axial, contrast-enhanced CT studies of the neck, obtained over a 10-month period, were retrospectively reviewed. Inclusion criteria included 3-mm-thick slices and absence of pathologic abnormalities or surgical changes in the oral cavity. Scans were assessed for the presence and contents of mylohyoid defects such as accessory salivary tissue, defined as nonlymphoid tissue within defects in the mylohyoid, having attenuation and enhancement characteristics similar to those of orthotopic sublingual and submandibular salivary tissue. RESULTS Mylohyoid defects were identified in 77 of 100 individuals. The deficiencies were bilateral in 67% and unilateral in 33%. Accessory salivary tissue was identified in 37 of 100. Fat and blood vessels were commonly identified within the mylohyoid defects. Sixty-one percent of the defects contained only fat. Thirty-five percent of the defects contained blood vessels. CONCLUSION Deficiencies in the mylohyoid muscle were visible in 77% of individuals who underwent scanning. The defects may contain fat, blood vessels, salivary tissue, or all three characteristics. Accessory salivary tissue was identified in 37% of individuals who underwent scanning. Recognition of mylohyoid deficiencies and the typical appearance of accessory salivary tissue will allow accurate diagnosis of this benign, anatomic variant.
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Affiliation(s)
- D K White
- Department of Radiology, University of Utah, Salt Lake City 84132, USA
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16
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Abstract
A 48-year-old man, otherwise in good health, was seen with a chronic painful fissure of the upper lip mucosa. For at least 2 years it had failed to respond to a variety of topical agents. Though not previously reported, the primary etiologic factor was thought to be irritation from contact with his misaligned anterior teeth. Eight months into orthodontic treatment, the lesion healed and did not return. Orthodontics included preadusted edgewise mechanics. However, the right maxillary lateral incisor was not bracketed but instead guided into position by direct contact with the archwire.
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Affiliation(s)
- G T Kluemper
- Division of Orthodontics, College of Dentistry, University of Kentucky, Lexington 40536-0084, USA.
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Affiliation(s)
- R D Marciani
- Department of Veterans Affairs, University of Kentucky College of Dentistry, Lexington 40536, USA.
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Davidson HC, Harnsberger HR, Lemmerling MM, Mancuso AA, White DK, Tong KA, Dahlen RT, Shelton C. MR evaluation of vestibulocochlear anomalies associated with large endolymphatic duct and sac. AJNR Am J Neuroradiol 1999; 20:1435-41. [PMID: 10512225 PMCID: PMC7657744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND PURPOSE Large endolymphatic duct and sac (LEDS) is one of the most common anomalies seen in patients with congenital sensorineural hearing loss (SNHL), and is known to occur with other inner ear findings. Our purpose was to use high-resolution T2-weighted fast spin-echo (FSE) MR imaging to describe the features and prevalence of specific anomalies that occur in association with LEDS. METHODS We retrospectively reviewed MR images of the inner ear obtained in 63 patients with LEDS and in 60 control subjects. We evaluated each image for features of cochlear and vestibular dysplasia, including deficiency of the cochlear modiolus, gross cochlear dysmorphism, asymmetry of the cochlear scalar chambers, enlargement of the membranous vestibule, gross vestibular dysmorphism, and abnormality of the semicircular canals (SCC). RESULTS Cochlear anomalies were present in 76% of ears with LEDS. Modiolar deficiency, gross dysmorphism, and scalar asymmetry were seen in 94%, 71%, and 65% of abnormal cochleas, respectively. Vestibular abnormalities were present in 40% of ears with LEDS. Simple enlargement, gross dysmorphism, and distortion of the lateral SCC were seen in 84%, 16%, and 32% of abnormal vestibules, respectively. CONCLUSION Coexistent cochlear anomalies, vestibular anomalies, or both are present in most ears with LEDS, and appear as a spectrum of lesions, ranging from subtle dymorphism to overt dysplasia. The presence of coexistent anomalies in LEDS affects treatment decisions and prognosis. Newer techniques of high-resolution FSE MR imaging provide a means of exquisite characterization of LEDS, as well as more sensitive detection of associated vestibulocochlear anomalies.
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Affiliation(s)
- H C Davidson
- Department of Radiology, 1A 71 Medical Center, University of Utah, Salt Lake City 84132, USA
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19
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Cohen AH, Mallory GB, Ross K, White DK, Mendeloff E, Huddleston CB, Kemp JS. Growth of lungs after transplantation in infants and in children younger than 3 years of age. Am J Respir Crit Care Med 1999; 159:1747-51. [PMID: 10351913 DOI: 10.1164/ajrccm.159.6.9806157] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report serial measurements of lung volume and airflow in small children after lung transplantation. We expected that immature lungs could grow and develop normal volumes after transplantation, despite denervation and immunosuppression. At predetermined intervals, functional residual capacity (FRC) and forced expiratory flow were measured 86 times in 23 recipients younger than 3 yr of age (age at transplant, 13.2 +/- 8.4 mo; range, 2 to 30 mo). FRC was measured using open-circuit N2 washout. Maximal flow at FRC by rapid thoracoabdominal compression was used to distinguish between infants with and those without airflow obstruction. The slope of FRC (in milliliters) versus body length (in centimeters) for all 23 recipients studied was 8.63. For those children without obstruction (flow at FRC >/= 0.9 FRC/s, n = 16), the slope of FRC versus length was 6.61. The coefficient of variation for FRC measurements for all infants was 3.90 +/- 2.80% (range, 0.3 to 16.9%). We conclude that in the absence of significant airflow obstruction the volume of transplanted immature lungs increases at a rate similar to that reported in normal infants.
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Affiliation(s)
- A H Cohen
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
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20
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Damm DD, Tomich CE, White DK, Drummond JF. Intraosseous fibrous lesions of the jaws: a manifestation of tuberous sclerosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87:334-40. [PMID: 10102596 DOI: 10.1016/s1079-2104(99)70219-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Four patients previously diagnosed with tuberous sclerosis are reported with intraosseous fibrous lesions of the jaws. Review of the literature revealed comparable pathosis occurring in extragnathic bones and several previous reports of similar lesions within the jaws. Therefore, these intraosseous fibrous proliferations are thought to represent an intraoral manifestation of tuberous sclerosis and not coincidental findings. In all 4 cases, the tumors demonstrated significant collagenization with numerous interspersed plump fibroblasts. Although histopathologically similar, the features of the lesions are not specific and also can be found in desmoplastic fibromas and simple odontogenic fibromas. The definitive diagnosis requires appropriate clinicopathologic correlation.
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Affiliation(s)
- D D Damm
- University of Kentucky College of Dentistry, Lexington 40515-0297, USA
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21
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Morgan C, Newell SJ, Ducker DA, Hodgkinson J, White DK, Morley CJ, Church JM. Continuous neonatal blood gas monitoring using a multiparameter intra-arterial sensor. Arch Dis Child Fetal Neonatal Ed 1999; 80:F93-8. [PMID: 10325783 PMCID: PMC1720901 DOI: 10.1136/fn.80.2.f93] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To compare arterial blood gas (ABG) readings obtained with a multiparameter intra-arterial sensor with those from an ABG analyser. METHODS An MPIAS with the ability to measure continuously pH, PaCO2, and PaO2 was introduced via an umbilical arterial catheter in 27 neonates requiring intensive care. They underwent 3260 hours of MPIAS monitoring, during which 753 ABG readings were performed. RESULTS Overall bias (mean difference: MPIAS-ABG) and precision (standard deviation of differences) values were: -0.002 and 0.022, respectively, for pH; +0.26 and 0.52 for PaCO2 (kPa); and -0.19 and 0.99 for PaO2 (kPa). This gave 95% limits of agreement as: -0.047 to +0.042 for pH, -0.76 to +1.28 kPa for PaCO2, and -2.13 to +1.75 kDa for PaO2. For each variable, precision across readings from the same individual was better than overall precision for all data. No complications related to the use of the catheter were observed. CONCLUSIONS Continuous MPIAS ABG monitoring is an exciting development, with the potential to reduce blood transfusions and improve ABG homeostasis.
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Affiliation(s)
- C Morgan
- Neonatal Intensive Care Unit, St James's University Hospital, Leeds
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22
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Damm DD, Curran A, White DK, Drummond JF. Leukoplakia of the maxillary vestibule--an association with Viadent? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87:61-6. [PMID: 9927082 DOI: 10.1016/s1079-2104(99)70296-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This report investigates a possible correlation between chronic use of Viadent products and the subsequent development of leukoplakia in the maxillary vestibule. STUDY DESIGN A retrospective review of 88 patients with leukoplakia of the maxillary vestibule is presented. Prevalence of Viadent use was determined in this group and in a group of 100 randomly selected adults who presented themselves for routine preadmission screening at a dental school. RESULTS Of the patients diagnosed with leukoplakia of the maxillary vestibule, 84.1% reported having used Viadent, whereas the prevalence of use was only 3% in the 100 randomly selected adults. CONCLUSIONS Use of Viadent products appears to be associated with an increased prevalence of leukoplakia in the maxillary vestibule.
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Affiliation(s)
- D D Damm
- Division of Oral & Maxillofacial Pathology, College of Dentistry, University of Kentucky, Lexington 40536-0297, USA
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23
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Abstract
The effectiveness of single prong nasal continuous positive airway pressure (CPAP) was compared with the Infant Flow Driver (IFD) in a crossover study in 20 neonates treated with > or = 30% oxygen by nasal CPAP. They were randomized to the device used at the start of the study. Each infant was studied for four consecutive 2-h periods alternating between single prong nasal CPAP and the IFD. The FiO2 from the IFD read 0.02 higher than the same setting on the ventilators used for single prong nasal CPAP. The IFD improved the mean (95% CI) of the FiO2 by 0.05 (0.02-0.08), p = 0.008. Taking into account the systematic error in the FiO2 between the devices the real mean improvement in FiO2 produced by the IFD was 0.03 (-0.005 to 0.06), p=0.09. There were no significant differences in respiratory rate, heart rate, blood pressure or comfort score of infants during periods of single nasal prong CPAP compared with periods on the IFD.
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Affiliation(s)
- J S Ahluwalia
- Neonatal Intensive Care Unit, Addenbrookes Hospital, Cambridge, UK
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24
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Kemp JS, Livne M, White DK, Arfken CL. Softness and potential to cause rebreathing: Differences in bedding used by infants at high and low risk for sudden infant death syndrome. J Pediatr 1998; 132:234-9. [PMID: 9506633 DOI: 10.1016/s0022-3476(98)70437-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study was carried out to determine whether bedding used by infants, who are at either high or low risk for sudden infant death syndrome (SIDS), differs in physical properties favoring rebreathing of exhaled gases. STUDY DESIGN We compared softness and limitation of carbon dioxide dispersal by bedding, using a mechanical model. A questionnaire was used to describe sociodemographic risk factors and sleep practices; bedding was studied in homes with a model positioned where each infant was found sleeping that morning. RESULTS The groups differed with respect to five sociodemographic risk factors (p values all < or = 0.0001). In addition, infants at higher risk were more likely to have been placed to sleep prone (46%, p = 0.02) by parents who were less likely to be aware of the risk associated with the prone position (62% aware, p = 0.005). Infants at higher risk had softer bedding (p < 0.0001, 54.1+/-17.2 cm2 vs 33.7+/-7.7 cm2 in contact with model), which caused more limitation of carbon dioxide dispersal (p = 0.008; CO2 retained, 0.60%+/-0.15% vs 0.34%+/-0.05%). CONCLUSIONS A series of infants who are at high risk for SIDS because of sociodemographic factors more often sleep on bedding that has physical properties favoring rebreathing, and their parents are less often aware of the risk associated with prone sleeping.
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Affiliation(s)
- J S Kemp
- Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, Missouri 63110, USA
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25
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White DK. No health for all without better trained management. World Hosp Health Serv 1996; 33:24-7. [PMID: 10169451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This article notes that existing health professionals and managers constitute the first 'generation' working in a world where Health for All is a practical possibility because, if founded on community-based public and primary health care with hospitals in support and good intersectoral help, we now have the appropriate technology, access to finance and adequate numbers of health workers. What we still lack are sufficient health professionals, at all levels, with the managerial skills and experience to apply the technology, generate the funding and motivate the staff; making full use of community involvement, the co-operation of other sectors and good relationships with local and central government. Management can be learned both at the workplace and in the training room, and from the managers a few of them will emerge as leaders, with the vision to secure the willing support of others in reaching worthwhile health goals. A very useful publication is the Training Manual on Management of Human Resources for Health, WHO/EDUC/93.201 from World Health Organisation, Geneva, Switzerland. The paper closes with examples illustrating four principles for health management development: finding key points of entry; reaching large numbers; accelerating national self-sufficiency; and international.
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26
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Kannan R, Damm DD, White DK, Marsh W, Allen CM. Ectomesenchymal chondromyxoid tumor of the anterior tongue: a report of three cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 82:417-22. [PMID: 8899780 DOI: 10.1016/s1079-2104(96)80307-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ectomesenchymal chondromyxoid tumor is a newly described benign neoplasm that presents clinically as a firm, painless, slow-growing mass that typically involves the anterior dorsal tongue. It has been reported to occur over a wide age range (9 to 78 years) and has no apparent sex predilection. Histologically, the tumor is composed of a well-circumscribed, unencapsulated lobular proliferation of fusiform and polygonal cells in a chondromyxoid matrix. Features such as multilobulated nuclei, foci of cellular atypia, and infiltration may be present. Though disturbing, these do not appear to indicate malignant behavior. We report three cases of ectomesenchymal chondromyxoid tumors that confirm the previously described clinical, histologic, and immunohistochemical features. In addition, we describe the ultrastructural features of one of the cases.
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Affiliation(s)
- R Kannan
- Section of Oral and Maxillofacial Surgery and Pathology, Ohio State University, Columbus, USA
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27
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Miller CS, White DK. Human papillomavirus expression in oral mucosa, premalignant conditions, and squamous cell carcinoma: a retrospective review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 82:57-68. [PMID: 8843455 DOI: 10.1016/s1079-2104(96)80378-7] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The literature of human papillomavirus detection in normal oral mucosa and oral lesions associated with the dysplastic progression of epithelium was reviewed to help define the role of this virus in the development of oral squamous cell carcinoma. STUDY DESIGN All available data from published studies were analyzed by chi-square test for association between the human papillomavirus and age, gender, race, DNA type, location, lesional dysplastic progression, method of detection, tissue preservation, and use of tobacco and alcohol. RESULTS Human papillomavirus was identified with increasing frequency in normal oral mucosa (13.5%), benign leukoplakia (14.8%), intraepithelial neoplasia (18.5%), squamous carcinoma (26.2%), and verrucous carcinoma (27%). It was detected in oral squamous cell carcinoma significantly (p < 0.005) more often (37.1%; 122 of 329) in studies that used a high sensitivity assay (polymerase chain reaction) than studies that used moderate sensitivity assays (25.2%; 84 of 334) (e.g., Southern blot hybridization) and low sensitivity assays (16.9%; 61 of 362) (e.g., immunohistochemistry, in situ hybridization). Human papillomavirus DNA was detected significantly more often (p < 0.001) in frozen oral squamous cell carcinoma (51.6%; 115 of 223) than paraffin-embedded tissue (21.7%; 136 of 628). High-risk human papillomaviruses (2, 16, 18) were detected in 81.4% of OSCCs that contained the virus compared with low-risk human papillomavirus genotypes (6, 11) in 17.9% of oral squamous cell carcinoma that contained the human papillomavirus (p < 0.001). In studies that analyzed the use of chemical cofactors, the use of tobacco and alcohol (87.3%) was associated more often with oral squamous cell carcinoma than the presence of human papillomavirus (51.3%), however, the difference was not significant. CONCLUSION High-risk human papillomavirus genotypes have a significant association with oral squamous cell carcinoma. However, the presence of this virus in a high proportion of oral normal mucosa makes the virus alone a poor prognosticator of progression to malignancy.
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Affiliation(s)
- C S Miller
- University of Kentucky College of Dentistry, USA
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28
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Marciani RD, Gonty AA, White DK, Traurig HH. A preliminary study of reconstruction of the monkey temporomandibular joint with autogenous tissues. J Oral Maxillofac Surg 1996; 54:191-9. [PMID: 8604069 DOI: 10.1016/s0278-2391(96)90446-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE This study investigated the ability of autogenous pericranium-muscle and cranial bone to restore form and function of the temporomandibular joint (TMJ). MATERIALS AND METHODS A right TMJ discectomy, condylectomy, vertical ramus osteotomy with superior repositioning of the proximal fragment, and a cranial bone graft to the mandibular angle were performed in 12 cynomolgus monkeys. Clinical, histologic, and autoradiographic evaluation was done at intervals beginning at 3 days and continuing up to 78 weeks. RESULTS No significant postoperative sequela were identified in any of the monkeys. Jaw mobility and function were restored. Gross morphologic condylar changes were observed. The pericranium-muscle grafts did not differentiate into normal disc-like structures and a cartilage cap did not cover the condyle stump head. CONCLUSIONS The results of this study suggest that the previous TMJ function was restored. However, the histologic changes observed were consistent with advanced degenerative joint disease.
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Affiliation(s)
- R D Marciani
- Department of Veterans Affairs, Lexington, KY, USA
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29
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Schlesinger AE, White DK, Mallory GB, Hildeboldt CF, Huddleston CB. Estimation of total lung capacity from chest radiography and chest CT in children: comparison with body plethysmography. AJR Am J Roentgenol 1995; 165:151-4. [PMID: 7785574 DOI: 10.2214/ajr.165.1.7785574] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate two methods of estimating lung volume using chest radiographs and one using chest CT in children. Estimates made with these techniques were compared with total lung capacity calculated with body plethysmography. MATERIALS AND METHODS CT scans and posteroanterior and lateral radiographs of the chest were obtained in 21 children (14 girls and seven boys) for follow-up evaluation after lung transplantation. Lung volume was measured by CT using a previously validated technique of tracing the margins of the lungs on each axial CT scan. Two methods were used to estimate lung volume on chest radiographs: a technique previously described in adults and children that requires 21 measurements on posteroanterior and lateral radiographs, and a modification of a simplified technique previously reported in adults that uses only two measurements on a posteroanterior radiograph alone. Estimated lung volumes from CT and from both methods using chest radiographs were compared with total lung capacity determined from body plethysmography using regression analysis, and 95% prediction intervals were generated. RESULTS All three methods of estimating lung volumes from radiographs correlated well with total lung capacity from plethysmography (r = .89-.92). However, we found no statistically significant or clinically meaningful difference among the methods of estimating lung volume. CONCLUSIONS Lung volumes in children can be accurately estimated from specific measurements made on chest radiographs and on CT scans. Of the two methods tested with chest radiographs, the technique that required only two measurements from a posteroanterior chest radiograph was as accurate as the more complicated technique that required 21 measurements.
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Affiliation(s)
- A E Schlesinger
- Mallinckrodt Institute of Radiology, St. Louis, MO 63110, USA
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30
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Miller CS, Zeuss MS, White DK. Detection of HPV DNA in oral carcinoma using polymerase chain reaction together with in situ hybridization. Oral Surg Oral Med Oral Pathol 1994; 77:480-6. [PMID: 8028871 DOI: 10.1016/0030-4220(94)90227-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study determined the prevalence of human papillomavirus 16/18 DNA in deparaffinized oral carcinoma specimens on slides with the use of the different sensitivities of in situ hybridization and a technique that combines polymerase chain reaction and in situ hybridization. Human papillomavirus DNA was not detected in the 30 biopsy specimens analyzed by in situ hybridization alone using biotinylated DNA probes specific for human papillomavirus 16/18. Twenty of 30 specimens (66.7%) were found to have human papillomavirus DNA (p < 0.001) with the use of the polymerase chain reaction-in situ hybridization technique. Human papillomavirus 16 was detected in 18 of 26 specimens (69.2%), and 7 of 25 carcinomas (28%) were found to contain human papillomavirus 18. Dual infections were present in 5 of 21 (23.8%) specimens. Human papillomavirus DNA was more prevalent in men (75%) than women (57.1%). However, there was no difference in the mean age of patients with oral carcinoma (men, 67.8 years; women, 67.5 years) who had human papillomavirus and those who did not (67.2 years). Carcinomas associated with dual infections occurred at a lower mean age (59.4 years) than those associated with a single human papillomavirus type (p < 0.005). We conclude that the polymerase chain reaction-in situ hybridization technique enhances our ability to demonstrate human papillomavirus types highly associated with oral squamous cell carcinoma.
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Affiliation(s)
- C S Miller
- Department of Oral Health Science, University of Kentucky College of Dentistry, Lexington
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31
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Abstract
The effectiveness of the Viratype Omniprobe in situ human papillomavirus tissue hybridization kit (Digene Diagnostics) was evaluated for the detection of HPV DNA in common orofacial lesions. Seventy mucocutaneous lesions were hybridized with a biotinylated Omniprobe that was specific for HPV types 6, 11, 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, and 56. Eighteen (25.7%) of the specimens analyzed had intranuclear positive signals for HPV. Probing with HPV 6/11, 16/18, and 31/33/35 to delimit the HPV genotype yielded HPV DNA 6/11 in 16 (88.9%) of the Omniprobe-positive specimens. Only squamous papilloma and condyloma acuminatum were found to harbor HPV DNA. Sites most frequently infected were the labial and buccal mucosa (21.7%) and the floor of the mouth (17.4%). These results suggest that hybridization with the Omniprobe provides appropriate sensitivity and specificity for detecting HPV in some benign proliferations of the oral cavity. However, the detection of HPV in oral squamous cell carcinoma, lichen planus, and keratoacanthoma remains problematic until more sensitive and specific molecular techniques are used.
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Affiliation(s)
- C S Miller
- Department of Oral Health Science, University of Kentucky, College of Dentistry, Lexington 40536-0084
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32
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Abstract
Rats were trained to discriminate between 0.25 mg/kg amphetamine (AMPH) and 0.03 mg/kg haloperidol (HAL) in a two-lever drug discrimination task. In order to test for a drug-induced withdrawal state, animals were assigned to one of three chronic treatment groups and given injections of AMPH, HAL, or distilled water (DW) for 10 consecutive days. Subjects from each treatment condition were then tested at 24, 48, or 72 h after the final injection. At the 24 h retest interval, subjects injected with AMPH responded as though administered an acute dose of HAL (0.028 mg/kg) and subjects injected with chronic HAL responded as though administered an acute dose of AMPH (0.15 mg/kg). By 72 h choice behavior had returned to pretreatment values. To determine whether the rebound observed after 10 days of drug treatment was present after a single injection, independent groups of subjects were injected with single doses of either 10 mg/kg AMPH or 1.0 mg/kg HAL and then retested from 4 h to 48 h later. Single doses of both AMPH and HAL produced significant rebounds that peaked between 20 h (AMPH) and 24 h (HAL) following administration. In a third experiment, animals were tested with or without acute doses of drug following pretreatment with either HAL or AMPH. Receptor supersensitivity accounts for the tolerance observed to HAL 24 h after treatment with 1.0 mg/kg HAL, whereas receptor subsensitivity accounts for the tolerance observed 20 h after treatment with 10 mg/kg AMPH.
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Affiliation(s)
- R J Barrett
- Veterans Administration Medical Center, Department of Psychology, Vanderbilt University, Nashville, TN
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33
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Abstract
An instance of sebaceous carcinoma that presented as a mass in the left buccal mucosa is described. This is the first known report in the English-language literature of a sebaceous carcinoma presenting as an intraoral tumor. The light and electron microscopic findings are described. The histologic differential diagnosis, clinical behavior, and appropriate therapy are discussed. Previously reported intraoral sebaceous neoplasms and sebaceous carcinomas of the parotid are reviewed.
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Affiliation(s)
- D D Damm
- Division of Oral Pathology, College of Dentistry, University of Kentucky, Lexington 40536
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34
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Abstract
The purpose of this study was to compare the sensitivity of ViraType in situ hybridization kit (Life Technologies, Inc. [LT] and PathoGene (Enzo Diagnostics, Inc. [ED]) in situ hybridization kit for human papillomavirus (HPV) DNA detection in oral tissue. Forty benign oral lesions histologically suspicious for HPV infection were analyzed. Specimens were hybridized with DNA probes specific for HPV types 6/11, 16/18, and 31/33/35 [LT] and HPV types 6/11, 16/18, and 31/33/51 [ED]. Positive hybridization reactions were seen for HPV DNA type 6/11 only. Hybridization occurred significantly more often (p less than 0.01, McNemar Exact Test) in LT probed specimens (20/40) than ED assayed sections (12/40). HPV DNA sequences were found in 100% condyloma acuminata (13/13), 100% verruca vulgaris (4/4), and 13% squamous papilloma (3/23) using the LT system. The ED probes yielded positive signals in 77% condyloma acuminata (10/13), 25% verruca vulgaris (1/4), and 4.4% squamous papilloma (1/23). A more intense hybridization signal was exhibited using the LT system. The results indicate that the LT probes and detection reagents are more sensitive for detecting HPV DNA in oral mucosal specimens.
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Affiliation(s)
- C S Miller
- Oral Diagnosis/Oral Medicine Section, University of Kentucky College of Dentistry, Lexington 40536-0084
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35
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Abstract
Commercial biotinylated DNA probes specific for human papillomavirus (HPV) types 6 and 11; 16 and 18; and 31, 33, and 35 were used for in situ hybridization analysis of 105 oral mucosal specimens from 5 cases of verruca vulgaris, 15 cases of condyloma acuminatum, 30 cases of squamous papilloma, 20 cases of hyperkeratosis/acanthosis, 15 cases of epithelial dysplasia, 5 cases of carcinoma in situ, and 15 cases of squamous cell carcinoma. Positive hybridization signals were found in 26 specimens (24.8%). Only HPV-6/11 was detected. HPV DNA occurred significantly more often (p less than 0.005, chi-square analysis) in condyloma acuminatum (100%) and verruca vulgaris (100%) than squamous papilloma (13.3%), hyperkeratotic/acanthotic lesions (10%), and malignant and premalignant lesions (0%). The tongue (19.1%) and labial epithelium (17.1%) were infected most frequently. Nuclear reaction products indicating HPV infection were associated primarily with koilocytes. These results demonstrate the usefulness of commercial biotinylated probes for HPV DNA analysis in routine paraffin-embedded lesion specimens. They confirm HPV involvement in benign lesions of the oral mucosa but fail to associate HPV infection with oral cancer and precancer.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/microbiology
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/microbiology
- Child
- Child, Preschool
- Condylomata Acuminata/genetics
- Condylomata Acuminata/microbiology
- DNA Probes, HPV
- DNA, Neoplasm/analysis
- DNA, Viral/analysis
- Epithelium/microbiology
- Epithelium/pathology
- Female
- Humans
- Leukoplakia, Oral/genetics
- Leukoplakia, Oral/microbiology
- Male
- Middle Aged
- Mouth Diseases/genetics
- Mouth Diseases/microbiology
- Mouth Mucosa/microbiology
- Mouth Mucosa/pathology
- Mouth Neoplasms/genetics
- Mouth Neoplasms/microbiology
- Nucleic Acid Hybridization
- Papillomaviridae/genetics
- Precancerous Conditions/genetics
- Precancerous Conditions/microbiology
- Warts/genetics
- Warts/microbiology
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Affiliation(s)
- M S Zeuss
- Departamento de Atencion Odontologica Integral al Adulto (Patologia Bucal), Facultad de Odontologia, Universidad de Carabobo, Valencia
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36
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Abstract
This report describes an unusual case of verruciform xanthoma of the posterior floor of the mouth that occurred within carcinoma in situ. The significance of this case is described in light of current theories on the etiology and management of verruciform xanthoma.
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Affiliation(s)
- J F Drummond
- Department of Oral Pathology, College of Dentistry, University of Kentucky, Lexington 40536
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37
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Abstract
We present an example of an intraoral benign solid oncocytoma of minor salivary gland origin. A review of intraoral benign solid oncocytomas reported in the English-language literature and discussion of the clinical behavior of these tumors are included.
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Affiliation(s)
- D D Damm
- Department of Oral Pathology, College of Dentistry, University of Kentucky, Lexington
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38
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Abstract
Condylar shaves were performed in monkeys, and the reparative process was studied by histologic and autoradiographic techniques. The condylar surface was found to repair mainly with fibrous connective tissue produced by cells derived from the underlying marrow spaces. The residual condylar cartilage did not play a significant role in this process.
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Affiliation(s)
- R D Marciani
- Veterans Administration Hospital, Lexington, Kentucky
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39
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Abstract
Two examples of an unusual presentation of oropharyngeal candidiasis in cancer patients are offered. The light and scanning electron microscopic appearances of candidiasis involving the dentin of teeth are described. The potential significance of recognition of this form of candidiasis in cancer patients is discussed.
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Affiliation(s)
- D D Damm
- Department of Oral Pathology, College of Dentistry, University of Kentucky, Lexington
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40
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Marciani RD, Traurig HH, White DK, Roth GI. Healing following conventional and cryosurgical discoplasty in the monkey temporomandibular joint. J Oral Maxillofac Surg 1987; 45:1043-50. [PMID: 3480337 DOI: 10.1016/0278-2391(87)90161-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The techniques of conventional discoplasty and the scar producing potential of cryosurgical treatment of the bilaminar region were examined in a study of 17 adult female cynomologous monkeys. Temporomandibular joint (TMJ) tissues were obtained at four and 10 days, four, 20, 52, and 78 weeks after surgery, and compared to TMJ tissues in unoperated control animals. No clinically observable changes in weight, occlusion, or jaw function were identified. All the surgical sites healed normally. At necropsy, lesions of the articular surface of the condyle were apparent in areas that had been surgically "shaved." The anterior, intermediate, and posterior zones of the surgically-treated discs were generally free of change. Two cryosurgically-treated discs showed lesions and perforations. Histologic and autoradiographic observations suggested that the bilaminar area heals quickly with minimal scarring, following both conventional surgical manipulation and cryosurgery. Under the conditions of this experiment the cryosurgical technique was judged not to be superior to the conventional surgical approach.
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Affiliation(s)
- R D Marciani
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Kentucky, Lexington 40536-0084
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41
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Abstract
Monkey mandibular condyles were frozen in situ and subsequently examined clinically and histologically. The frozen bone served as a structural matrix for the formation of new, vital bone. No ankylosis, open-bite deformity or loss of function was observed.
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42
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43
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Damm DD, Drummond JF, White DK, Ferretti GA. Ewing's tumor of the jaws. Pediatr Dent 1985; 7:57-60. [PMID: 3857562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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44
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Damm DD, White DK, Geissler RH, Drummond JF, Gonty AA. Chondromyxoid fibroma of the maxilla. Electron microscopic findings and review of the literature. Oral Surg Oral Med Oral Pathol 1985; 59:176-83. [PMID: 3856804 DOI: 10.1016/0030-4220(85)90014-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A case of chondromyxoid fibroma of the anterior maxilla is presented. The light and electron microscopic appearances of this tumor are described. A review of chondromyxoid fibromas of the jaws is performed, with a discussion of the appropriate therapy.
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45
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Drummond JF, White DK, Damm DD. Megaloblastic anemia with oral lesions: a consequence of gastric bypass surgery. Oral Surg Oral Med Oral Pathol 1985; 59:149-53. [PMID: 3856799 DOI: 10.1016/0030-4220(85)90007-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This report describes the clinical and histologic features of a case of megaloblastic anemia, resulting from a gastric bypass operation, in which oral symptoms were the first significant finding. Although this case appears to be the first of its type reported in the literature, the potential for future cases is increasing with the increased use of the gastric bypass operation in the treatment of morbid obesity.
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46
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Damm DD, White DK, Cibull ML, Drummond JF, Cramer JR. Mycosis fungoides: initial diagnosis via palatal biopsy with discussion of diagnostic advantages of plastic embedding. Oral Surg Oral Med Oral Pathol 1984; 58:413-9. [PMID: 6593669 DOI: 10.1016/0030-4220(84)90335-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The authors present an example of mycosis fungoides which was initially diagnosed from a palatal biopsy. The distinctive nuclear morphology of the tumor cells, with a discussion of their diagnostic importance, is presented. The advantages of plastic-embedded formalin-fixed tissue are delineated.
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47
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Abstract
The lateral periodontal cyst is a developmental cyst of odontogenic origin which is located along the lateral aspect of a tooth root. Thirty-seven previously unreported lateral periodontal cysts ( LPCs ) are presented. Clinical, roentgenographic and histologic features of the LPC are reviewed. Further, the importance of distinguishing the developmental LPC from laterally positioned inflammatory cysts of pulpal or periodontal disease origin and laterally occurring odontogenic keratocysts is stressed.
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48
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Damm DD, White DK, Drummond JF, Poindexter JB, Henry BB. Combined epithelial odontogenic tumor: adenomatoid odontogenic tumor and calcifying epithelial odontogenic tumor. Oral Surg Oral Med Oral Pathol 1983; 55:487-96. [PMID: 6575339 DOI: 10.1016/0030-4220(83)90235-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
1. Two cases of a combined epithelial odontogenic tumor which had areas of AOT and CEOT were presented. 2. A review of the studies on histogenesis of the AOT revealed that the tumor probably consists of preameloblasts, stratum intermedium, and stellate reticulum. 3. A review of the studies on histogenesis of the CEOT revealed that the probable origin was in cells of stratum intermedium. 4. It is suggested that the present cases support the aforementioned theories of histogenesis and represent AOT's which contain foci of CEOT. 5. The suggested treatment is simple surgical excision.
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49
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Marciani RD, Roth GI, White DK. Healing of reimplanted freeze-treated maxillary bone. J Oral Maxillofac Surg 1982; 40:401-6. [PMID: 6953190 DOI: 10.1016/0278-2391(82)90074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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50
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Abstract
Four cases of inverted ductal papilloma are presented. Their origin is the excretory duct reserve cell of minor salivary gland and they appear clinically as a submucosal mass. All tumors occurred in adults and there was equal distribution between men and women. Treatment is complete surgical excision and no recurrences have been reported thus far.
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