Rhinolith in a patient with cleft palate: a case report

Dental anomalies are well documented in patients with cleft palate, although reports of intranasal teeth in these patients are extremely rare. This paper discusses the case of a rhinolith associated with tooth-like structures in a patient with a treated cleft palate.     

Osseointegrated implants in a patient with osteoporosis: a case report

OBJECTIVE: To evaluate the performance of in situ piezolectric extracorporeal shock-wave lithotripsy (ESWL) in the middle part of the ureter. MATERIAL AND METHODS: 36 consecutive patients presenting with stones of the middle part of the ureter were treated by in situ piezoelectric ESWL (EDAP LT 02). The maximal dimensions of the stones ranged from 5 to 14 mm (m = 7.8). Moderate or severe ureterohydronephrosis was present in 19 cases (53%) and a double J stent had been previously implanted in 6 cases (17%). The ESWL sessions were performed in the ventral supine position without any anaesthesia or systematic premedication, but an IM injection of 100 mg of pethidine was administered during poorly tolerated treatments. RESULTS: The stone was located easily in 23 cases (64%) and with greater difficulty in 13 cases (36%), as an intraoperative intravenous injection of contrast agent was performed in 6 cases (17%). The number of sessions per patient ranged from 1 to 2 (m = 1.16). The complete sucess rate was 75%, with a 64% success rate after a single ESWL session. The performances were statistically independent of stone dimensions and the degree of obstruction of the urinary tract. The complication rate was 5.5%, but no ancillary endoscopic or percutaneous treatment was required. CONCLUSION: In situ piezoelectric ESWL allows effective management of most stones of the middle part of the ureter. However, the treatment of stones with a maximal diameter < 5 mm, especially poorly radiopaque stones, can raise problems of localization. Very large or impacted stones, especially when complicated by urinary tract infection, should be preferably treated by first-line ureteroscopy.     

Management of the hypertensive patient: a case report

Hypertension is a potentially life-threatening condition that can lead to heart failure, stroke, and kidney disease. Most patients with hypertension can be treated and controlled if they are diagnosed in a timely manner. This case report exemplifies how the dentist can play a key role in the detection of hypertension by simply taking vital signs on all patients. It is incumbent upon us as health-care professionals to understand the causes of hypertension, the therapeutic drugs used and associated side effects, and the potential for drug interactions. The dentist's ability to recognize and appropriately manage hypertension will greatly enhance the health and safety of our patients.     

Abnormal rapid-sequence imaging in a patient with subdural empyema: case report

Static brain images in a patient with subdural empyema showed findings similar to those of a subdural hematoma. The rapid-sequence study, however, showed increased peripheral activity on the affected side. Since this finding suggested an inflammatory process, further neuroradiologic evaluation and immediate surgical treatment were undertaken. The significance of the rapid-sequence study in subdural empyema has not been reported previously.     

Left ventricular fibroma in an aged patient: report of a case

We report herein the case of a 77-year-old man with a left ventricular tumor originating from the papillary muscle of the left ventricular wall, in whom a successful tumor resection with mitral valve replacement was performed. The pathological diagnosis of the tumor was confirmed as cardiac fibroma. His postoperative course was uneventful and he is currently well with no signs of recurrence 2 years after surgery.     

Eating disorders in males: a report on 135 patients

OBJECTIVE: The goal of this study was to better understand the etiology, clinical characteristics, and prognosis of eating disorders in males. METHOD: All males with eating disorders who had been treated at Massachusetts General Hospital from Jan. 1, 1980, to Dec. 31, 1994, were identified. Hospital charts and psychiatric departmental records were reviewed to verify that the eating disorders met DSM-IV criteria and to abstract demographic and clinical data. RESULTS: One hundred thirty-five males with eating disorders were identified, of whom 62 (46%) were bulimic, 30 (22%) were anorexic, and 43 (32%) met criteria for an eating disorder not otherwise specified. There were marked differences in sexual orientation by diagnostic group; 42% of the male bulimic patients were identified as either homosexual or bisexual, and 58% of the anorexic patients were identified as asexual. Comorbid psychiatric disorders were common, particularly major depressive disorder (54% of all patients), substance abuse (37%), and personality disorder (26%). Many patients had a family history of affective disorder (29%) or alcoholism (37%). CONCLUSIONS: While most characteristics of males and females with eating disorders are similar, homosexuality/bisexuality appears to be a specific risk factor for males, especially for those who develop bulimia nervosa. Future research on the link between sexual orientation and eating disorders would help guide prevention and treatment strategies.     

Gastric cancer occurring in a patient with Plummer-Vinson syndrome: report of a case

We report herein the unusual case of a 59-year-old woman with Plummer-Vinson syndrome who developed gastric cancer. The patient had a longstanding history of dysphagia and iron deficiency anemia, for which she had sporadically taken iron supplements that improved the dysphagia to some extent, but not completely. Owing to her tolerance of the dysphagia, she had not been taking iron supplements for the past 17 years. On admission, she was in fair nutritional condition and not anemic. Blood chemistry results were all normal, including the serum iron level. Gastrointestinal radiographic series demonstrated cervical esophageal webs and advanced gastric cancer. Her dysphagia was successfully treated by endoscopic bougienage through the webs, and a distal partial gastrectomy with nodal dissection was performed. Histology of the resected stomach revealed atrophic mucosal change and, by chance, an adenomatous lesion in addition to adenocarcinoma. Her postoperative course was uneventful and she is now well, without any signs of recurrence. Although Plummer-Vinson syndrome is known to be associated with upper alimentary tract cancers, gastric cancer is extremely rare. A discussion on the etiology of Plummer-Vinson syndrome and its link with potential carcinogenesis follows this case report.     

Conservative restoration of function and aesthetics in a bulimic patient: a case report

Traditionally, the treatment of acid erosion lesions of the maxillary and mandibular dentition has been invasive, often utilizing full-coverage crown restorations. Intentional endodontic and post-and-core treatments have been used in the past to gain crown length for retention of cemented cast restorations. The learning objective of this article is to discuss the primary cause of acid erosion-bulimia nervosa-and present an alternative dental treatment modality. The alternative treatment uses conservative tooth preparation, dentin bonding technology, and pressed ceramic restorations, achieving aesthetic results. The indications and advantages are discussed, and a case report illustrates the clinical procedure. The importance of achieving the cessation of the purging habit as a prerequisite to dental treatment is emphasized.     

Purulent pericarditis occurring in a patient with cecal carcinoma: report of a case

We report the unusual concatenation of cecal carcinoma complicated by bacteremia and purulent pericarditis. The organism responsible for the pericarditis was not definitely established. The pericarditis was successfully managed by surgical drainage and antibiotic therapy. Colonic surgery followed eradication of the pericarditis.     

Cerebral sinus thrombosis in a patient with protein S deficiency: a case report

To investigate the role of occupation as a risk factor for hairy cell leukaemia a case-control study on 121 male, hairy cell leukaemia (HCL) patients, and 484 controls matched for age and sex, was conducted. We found significantly elevated risk for HCL among building painters (OR, 5.7; 95% CI, 1.6-20.8; based on six cases and four controls) and construction workers (OR, 3.3; CI, 1.2-9.2; based on seven cases and eight controls). Farming has been suggested as a risk factor in HCL. In this investigation farmers had an OR of 1.2 (CI, 0.6-2.3) and farm workers an OR of 1.5 (CI, 0.8-2.8). However, having ever worked in farming yielded an OR of 1.8 (CI, 1.1-2.9). Having grown up mainly in a rural area gave an OR of 1.4 (CI, 0.9-2.4). UV light has been suggested as a risk factor for non-Hodgkin's lymphoma (NHL). To evaluate the impact of UV exposure, classification of occupations as indoor, outdoor or mixed indoor/outdoor was made. Outdoor and mixed outdoor/indoor work yielded ORs of 2.3 (1.0-4.9) and 1.6 (1.0-2.5), respectively. When the effect of outdoor/indoor or mixed indoor/outdoor work was analysed using a scoring system the OR was 2.0 (CI, 0.9-4.4) for farmers compared with 0.8 (CI, 0.3-1.9) among non-farmers in the highest scoring group. There was no clear correlation between socioeconomic status as defined by the Swedish Socio-Economic Classification (SEI), and the risk of HCL. As many comparisons were made, the possibility of associations occurring by chance can not be excluded.     

POEMS syndrome in a patient with diabetic ketoacidosis: case report and review

This article summarise the main data in the literature on the role of bacteriological contamination of the dialysate fluid in inflammatory reactions in hemodialysis. Pyrogenic substances of small molecular weight from Gram-negative bacteria grown in dialysate can pass across intact dialyzer membrane to stimulate cytokine production by peripheral blood mononuclear cells. Cellulosic hemodialysis membranes are more permeable to endotoxins than synthetic membranes. Polysulfone membranes and polyamide membranes are able to adsorb bacterial toxins on the dialysate side. The diffusive transfer of bacterial products across dialysis membrane from dialysate fluid was demonstrated. Transmembrane passage of cytokine-inducing bacterial products across reprocessed dialyzers is greater than across new dialyzers. Bacteriological contamination of the dialysate fluid is a problem which must be considered with much more care by nephrologists, especially as LAL test is unable to detect all the bacterial products which can contaminate the dialysate fluid.     

Recurrent cutaneous necrotizing vasculitis in a patient with Kikuchi's disease: case report

Kikuchi's disease or histiocytic necrotizing lymphadenitis without granulocytic infilteration, is a clinico-pathologic entity well described in developed countries. We report a case of this disorder presenting with recurrent cutaneous necrotizing vasculitis, with the dual objective of highlighting this condition in developing countries and presenting an uncommon manifestation of this disorder.     

Presumed bilateral herpes zoster ophthalmicus in an AIDS patient: a case report

A 31-year-old man with the acquired immunodeficiency syndrome presented with herpes zoster ophthalmicus on the right. Five days after he began treatment for the zoster pseudodendrites and skin lesions, he developed superficial punctate keratitis, uveitis, and crusting skin lesions in the left eye. After treatment, the ocular lesions resolved in both eyes without incident. The bilateral manifestation of herpes zoster ophthalmicus is a result of the increased severity associated with immunosuppression caused by the human immunodeficiency virus.