Early onset of acquired comitant non-accommodative esotropia in childhood

BACKGROUND

The aim of this study was to describe the clinical characteristics and surgical outcome of acquired comitant non-accommodative esotropia without obvious cause in children with an early onset ≤ three years of age.

PATIENTS AND METHODS

24 consecutive patients (13 females) with acquired comitant non-accommodative esotropia underwent strabismus surgery. Outcome measures included amount of deviation and level of binocularity at last follow-up.

RESULTS

An acute onset of strabismus was observed in 83 % of patients. Accompanying features such as diplopia, covering one eye or stumbling were observed in 40 % of the children. Cycloplegic retinoscopy revealed a mild to moderate hypermetropia in all children (mean hypermetropia + 2.2 diopters). 90.5 % of children were aligned within 8 PD of orthotropia. 81 % regained normal stereovision (Lang I/II).

CONCLUSIONS

All children exhibited the typical features of acute acquired comitant esotropia (AACE) type II (Burian-Franceschetti). Collective characteristics of this form of strabismus are a comitant and relatively large deviation, mild hypermetropia, a potential of normal binocular cooperation and absence of an accommodative component and neurological pathology. Time and suddenness of strabismus onset may be less helpful in defining this entity.

Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. In this fourth article, investigation is made into the previously evaluated biology of PRF with the first established clinical results, to determine the potential fields of application for this biomaterial. The reasoning is structured around 4 fundamental events of cicatrization, namely, angiogenesis, immune control, circulating stem cells trapping, and wound-covering epithelialization. All of the known clinical applications of PRF highlight an accelerated tissue cicatrization due to the development of effective neovascularization, accelerated wound closing with fast cicatricial tissue remodelling, and nearly total absence of infectious events. This initial research therefore makes it possible to plan several future PRF applications, including plastic and bone surgery, provided that the real effects are evaluated both impartially and rigorously.

Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part V: histologic evaluations of PRF effects on bone allograft maturation in sinus lift

OBJECTIVE

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. The use of platelet gel to improve bone regeneration is a recent technique in implantology. However, the biologic properties and real effects of such products remain controversial. In this article, we therefore attempt to evaluate the potential of PRF in combination with freeze-dried bone allograft (FDBA) (Phoenix; TBF, France) to enhance bone regeneration in sinus floor elevation.

STUDY DESIGN

Nine sinus floor augmentations were performed. In 6 sites, PRF was added to FDBA particles (test group), and in 3 sites FDBA without PRF was used (control group). Four months later for the test group and 8 months later for the control group, bone specimens were harvested from the augmented region during the implant insertion procedure. These specimens were treated for histologic analysis.

RESULTS

Histologic evaluations reveal the presence of residual bone surrounded by newly formed bone and connective tissue. After 4 months of healing time, histologic maturation of the test group appears to be identical to that of the control group after a period of 8 months. Moreover, the quantities of newly formed bone were equivalent between the 2 protocols.

CONCLUSIONS

Sinus floor augmentation with FDBA and PRF leads to a reduction of healing time prior to implant placement. From a histologic point of view, this healing time could be reduced to 4 months, but large-scale studies are still necessary to validate these first results.

[Chemical odor intolerance. 5 cases]

BACKGROUND

Chemical odor intolerance is a benign, non-specific, generally subjective syndrome triggered by inhalation of non-toxic doses of chemical compounds or products which had been previously well tolerated. We report five characteristic cases and discuss current data.

CASE REPORTS

Five patients (3 women, 2 men; age range 23-52 years) presented the basic criteria of chemical odor intolerance: acquired syndrome, non-specific signs (headache, nausea, vertigo ...) triggered by the odor of one or more chemical substances. Physical examination and exploratory tests were normal. In 3 cases, the course was favorable after evicting the causal substances. For the other 2 cases, intolerance spread to other compounds. Four of the patients changed their work situation because of the chemical odor intolerance.

DISCUSSION

The diagnosis is clinical. Different pathogenic hypotheses have been put forward in the literature: immunological, toxic, neurobiological, psychological, and psychiatric mechanisms have been proposed. The mechanism is probably multifactorial but psychological factors appear to play an important role either as predisposing or triggering factors.

CONCLUSION

Due to the social and occupational consequences of chemical odor intolerance, better knowledge of its prevalence and mechanism would be most helpful in managing these patients.