Clinical Examination (clinical + examination)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Clinical Examination

  • full clinical examination
  • objective structure clinical examination
  • routine clinical examination
  • standard clinical examination
  • structure clinical examination
  • thorough clinical examination

  • Selected Abstracts

    The use of the OSCE in postgraduate education

    R. C. Arnold
    Abstract Background:, The Objective Structured Clinical Examination (OSCE) is a method of assessing the clinical skills of undergraduates in medicine, dentistry and other health sciences and is employed increasingly in postgraduate education. Aim:, To describe the application of the OSCE to the development of Lifelong Learning and Continuing Professional Development (CPD) for General Dental Practitioners (GDPs). Methods:, A postgraduate course was designed as an OSCE for GDPs. The OSCE comprised 12 stations covering different aspects of general dentistry. After an introductory seminar outlining the aim of the course, the participants spent 7 min at each station. Each question or task required 10 answers and was designed to highlight areas of weakness or interest and to stimulate further study of the presenting topic. Solutions and answers were provided at each station for self-assessment along with a list of locally presented courses related to that subject. Participants were invited to leave contact details and to make suggestions for future postgraduate courses. The final session consisted of a group discussion and participants were invited to complete an evaluation form to express opinions on the course. Results:, The evaluation demonstrated that most candidates found participation in the OSCE stimulated their interest in CPD. The OSCE also highlighted areas of weakness in knowledge of certain clinical procedures. Group discussion confirmed that practitioners found the hands-on component valuable and that they were likely to participate in further OSCEs to enhance their CPD. Suggestions received during the discussion were used to modify the course. Conclusions:, The OSCE course fulfilled its aim of assisting practitioners to organise their CPD. The reflective nature of the course was helpful in evaluating clinical knowledge and the unique multidisciplinary style fulfilled its objective in promoting thoughts regarding future study. [source]

    The introduction and perception of an OSCE with an element of self- and peer-assessment

    T. Larsen
    Abstract The purpose of the present study was to encourage reflective dental students by performing an educational Objective Structured Clinical Examination (OSCE) with an element of self- and peer-assessment. An interdisciplinary OSCE comprising cariology, endodontics and microbiology was set up for all third-year students. A blueprint secured representation of the skills to be tested, i.e. knowledge, interdisciplinary knowledge, communication, clinical reasoning and practical procedures. At each station positive and constructive feedback was given to the students based on predefined criteria. Further, the students received written marks after completion of the OSCE. At one station the feedback and marks were replaced by self- and peer-assessment performed by the students in groups after the OSCE. Afterwards, the 68 students and 8 teachers participating in the OSCE answered a questionnaire on their opinion and perception of the examination. The results showed good correlation between the marks given and the students' perception of task difficulty. Generally, there were no systematic variations in the marks given during the week or by individual assessors at the same station, except for one, as well as agreement with marks of the ordinary clinical assessment. The marks given during self- and peer-assessment differed widely, indicating a need for training in this aspect. The questionnaires revealed a very positive perception of the OSCE from both students and teachers. Thus, the majority found the examination relevant and of educational benefit, capable of improving the learning of the students and useful for assessment purposes. Also, the self- and peer-assessment was found useful by the students. In conclusion, this interdisciplinary OSCE stressing constructive feedback to the students was perceived very positively by students and teachers and recognised for its beneficial possibilities in education and assessment. [source]

    Rethinking the OSCE as a Tool for National Competency Evaluation

    M. A. Boyd
    The relatively recent curriculum change to Problem-Based Learning/Case-Based Education has stimulated the development of new evaluation tools for student assessment. The Objective Structured Clinical Examination (OSCE) has become a popular method for such assessment. The National Dental Examining Board of Canada (NDEB) began using an OSCE format as part of the national certification testing process for licensure of beginning dentists in Canada in 1996. The OSCE has been well received by provincial licensing authorities, dental schools and students. ,Hands on' clinical competency is trusted to the dental programs and verified through NDEB participation in the Accreditation process. The desire to refine the OCSE has resulted in the development of a new format. Previously OSCE stations consisted of case-based materials and related multiple-choice questions. The new format has case-based material with an extended match presentation. Candidates ,select one or more correct answers' from a group of up to15 options. The blueprint is referenced to the national competencies for beginning practitioners in Canada. This new format will be available to students on the NDEB website for information and study purposes. Question stems and options will remain constant. Case histories and case materials will change each year. This new OSCE will be easier to administer and be less expensive in terms of test development. Reliability and validity is enhanced by involving content experts from all faculties in test development, by having the OSCE verified by general practitioners and by making the format available to candidates. The new OSCE will be pilot tested in September 2004. Examples will be provided for information and discussion. [source]

    The effects of education and training on clinical practice in wound healing

    Michael A Seeley
    Abstract This article considers the effects of two different types of educational programme on community nurse clinical practice in venous ulceration. One group of nurses (the experimental group) attended an educational programme designed to take account of training needs and learning styles. A second group of nurses (the control group) attended a standardised educational programme. A multiple-choice question examination and Objective Structured Clinical Examination were used to measure knowledge and skills. Kolb's Learning Styles Inventory was used to measure learning styles. Findings were that experimental nurses failed to show improved post-intervention clinical practice compared with the control group. [source]

    Nursing competence 10 years on: fit for practice and purpose yet?

    Ann Bradshaw PhD, Dip N
    Aims and objectives., This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments. Background., In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the ,knowledgeable doer' and examines the consequences of the change on nursing competency from the 1990s to the present day. Methods., This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn. Conclusions., From 1923,1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty-five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors' surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses ,fit for practice and purpose' may still prevail. Relevance to clinical practice., The present paper demonstrates that United Kingdom nurse training still has no uniform and mandatory system in place to ensure, as far as is possible, that all registered nurses are clinically competent and safe to practice. [source]

    The Objective Structured Clinical Examination in Anaesthesia: Practice Papers for Teachers and Trainees

    ANAESTHESIA, Issue 11 2009
    W. Whiteley
    No abstract is available for this article. [source]

    Evaluation of a pharmacotherapy context-learning programme for preclinical medical students

    J. A. Vollebregt
    What is already known about this subject ,,Context-learning in medicine is mainly based on theories explaining how medical expertise is achieved, particularly with regard to diagnostic problem solving. ,,By frequently solving diagnostic clinical problems doctors generate so-called networks of organized knowledge in their memory. ,,Preclinical medical students are well able to learn to choose and prescribe drugs. What this study adds ,,Preclinical pharmacotherapy context learning for medical students has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information. ,,The effect can be obtained with role-play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students. Aim To evaluate a context-learning pharmacotherapy programme for approximately 750 2nd, 3rd and 4th year preclinical medical students with respect to mastering cognitive pharmacotherapeutic skills, i.e. choosing a (drug) treatment and determining patient information. Methods The context-learning pharmacotherapy programme consists of weekly organized role play sessions in the form of consulting hours. Fourth year students sit for a therapeutic Objective Structured Clinical Examination (OSCE) in the form of consulting hours at the outpatient clinic. Sixty-one 2nd, 74 3rd and 49 4th year medical students who attended the role play sessions and the OSCE were randomly selected. Their performances were assessed by clinical examiners and clinical experts and compared with a reference group of 6th year graduated students. Additionally, the scores of a questionnaire on study load and appreciation were collected. Results The level of the pharmacotherapeutic skills of the 4th year students who followed the pharmacotherapy context-learning programme was not far below that of 6th year graduates who had finished their clinical clerkships, but had not followed the pharmacotherapy programme. The time spent on the programme was about 1% of the total study load per year. The students appreciated the role play sessions and OSCE by around 80% and 99% of the maximum possible scores. Conclusions Preclinical pharmacotherapy context learning has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information. This effect has been obtained with role play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students. [source]

    Investigation of prolonged neonatal jaundice

    ACTA PAEDIATRICA, Issue 6 2000
    S Hannam
    Jaundice persisting beyond 14 d of age (prolonged jaundice) can be a sign of serious underlying liver disease. Protocols for investigating prolonged jaundice vary in complexity and the yield from screening has not been assessed. In order to address these issues, we carried out a prospective study of term infants referred to our neonatal unit with prolonged jaundice over an 18 mo period. Infants were examined by a paediatrician and had the following investigations: a total and conjugated serum bilirubin, liver function tests, full blood count, packed cell volume, group and Coombs' test, thyroid function tests, glucose-6-phosphate dehydrogenase levels and urine for culture. One-hundred-and-fifty-four infants were referred with prolonged jaundice out of 7139 live births during the study period. Nine infants were referred to other paediatric specialties. One infant had a conjugated hyperbilirubinaemia, giving an incidence of conjugated hyperbilirubinaemia of 0.14 per 1000 live births. Diagnoses included: giant cell hepatitis (n= 1), hepatoblastoma (n= 1), trisomy 9p (n= 1), urinary tract infections (n= 2), glucose-6-phosphate dehydrogenase deficiency (n= 3) and failure to regain birthweight (n= 1). Conclusions: In conclusion, a large number of infants referred to hospital for prolonged jaundice screening had detectable problems. The number of investigations may safely be reduced to: a total and conjugated bilirubin, packed cell volume, glucose-6-phosphate dehydrogenase level (where appropriate), a urine for culture and inspection of a recent stool sample for bile pigmentation. Clinical examination by a paediatrician has a vital role in the screening process. [source]

    Histologic Study of Depressed Acne Scars Treated with Serial High-Concentration (95%) Trichloroacetic Acid

    BACKGROUND Acne scarring is a common manifestation that remains a therapeutic challenge to dermatologists, dermatologic surgeons, and plastic surgeons. Although multiple therapeutic modalities exist, treatment often remains inadequate. The use of high-concentration (95%) trichloroacetic acid (TCA) applied focally to atrophic acne scars has been described. OBJECTIVE The current study confirms the utility of focal application of 95% TCA to acne scars in addition to a histologic examination of this technique. METHODS Acne scars in three patients were treated with focal 95% TCA by serial application. Wooden applicators were used to apply TCA focally and repeated at 6-week intervals for a total of six treatments. Punch biopsies were performed at baseline and at 1 year postoperatively. Histologic examination was performed with routine hematoxylin/eosin, Masson trichrome, and Verhoeff-van Gieson staining. RESULTS Clinical examination revealed apparent cosmetic improvement in both depth and appearance of acne scars. Patient satisfaction was high. Histologic examination demonstrated a decrease in the depth of acne scars. In addition, increased collagen fibers and fragmentation of elastic fibers were noted. There were no complications from the procedure. CONCLUSION Focal application of high-concentration TCA to atrophic and "ice-pick" acne scars appears to produce clinical improvement. Histologic changes of this technique are described. [source]

    Manometric study in Kearns,Sayre syndrome

    K. H. Katsanos
    Although swallowing difficulties have been described in patients with Kearns,Sayre syndrome (KSS), the spectrum of manometric characteristics of dysphagia is not yet well known. Moreover, it is conceivable that a combination of various degrees of swallowing difficulties with different patterns in manometric studies exist, each playing a major role in the prognosis, natural history, and quality of life of KSS patients. An 18-year-old girl diagnosed at the age of 5 years with KSS (muscle biopsy) was admitted to our department with an upper respiratory tract infection and dysphagia. Clinical examination revealed growth retardation, external ophthalmoplegia, pigmentary retinopathy, impaired hearing, and ataxia. An electrocardiogram revealed cardiac conduction defects (long Q-T), and brain magnetic resonance imaging showed abnormalities in the cerebellar hemispheres. A manometric and motility study for dysphagia was conducted and the pharynx and upper esophageal sphincter (UES) resting pressures were similar to control group values, but the swallowing peak contraction pressure of the pharynx and the closing pressure of the UES were very low and could not promote effective peristaltic waves. Relaxation and coordination of the UES were not affected although pharyngeal and upper esophagus peristaltic waves proved to be very low and, consequently, were practically ineffective. The patient was started on treatment comprising a diet rich in potassium, magnesium, and calcium, and oral administration of vitamin D and co-enzyme Q10 100 mg daily; she was discharged 6 days later with apparent clinical improvement. [source]

    Topical ascorbic acid on photoaged skin.

    Clinical, topographical, ultrastructural evaluation: double-blind study vs. placebo
    Abstract:, Vitamin C is known for its antioxidant potential and activity in the collagen biosynthetic pathway. Photoprotective properties of topically applied vitamin C have also been demonstrated, placing this molecule as a potential candidate for use in the prevention and treatment of skin ageing. A topically applied cream containing 5% vitamin C and its excipient were tested on healthy female volunteers presenting with photoaged skin on their low-neck and arms in view to evaluate efficacy and safety of such treatment. A double-blind, randomized trial was performed over a 6-month period, comparing the action of the vitamin C cream vs. excipient on photoaged skin. Clinical assessments included evaluation at the beginning and after 3 and 6 months of daily treatment. They were performed by the investigator and compared with the volunteer self assessment. Skin relief parameters were determined on silicone rubber replicas performed at the same time-points. Cutaneous biopsies were obtained at the end of the trial and investigated using immunohistochemistry and electron microscopy. Clinical examination by a dermatologist as well as self-assessment by the volunteers disclosed a significant improvement, in terms of the ,global score', on the vitamin C-treated side compared with the control. A highly significant increase in the density of skin microrelief and a decrease of the deep furrows were demonstrated. Ultrastructural evidence of the elastic tissue repair was also obtained and well corroborated the favorable results of the clinical and skin surface examinations. Topical application of 5% vitamin C cream was an effective and well-tolerated treatment. It led to a clinically apparent improvement of the photodamaged skin and induced modifications of skin relief and ultrastructure, suggesting a positive influence of topical vitamin C on parameters characteristic for sun-induced skin ageing. [source]

    Endodontic and periodontal treatments of a geminated mandibular first premolar

    S. Aryanpour
    Abstract Aim, To describe a rare case of gemination involving a mandibular first premolar. Summary The complex morphology of geminated teeth renders their endodontic and periodontal management difficult. Root canal and periodontal treatments were performed on a geminated mandibular first premolar with three canals. Clinical examination showed two separated crowns with united roots. Radiographically, two distinct pulp chambers with two joined and a third independent canal were seen. Conventional root canal treatment resulted in complete healing of the apical lesion. However, the occurrence of a vertical fracture led to the extraction of the mesial segment. At the follow-up visit, the distal segment was clinically healthy and continued to satisfy functional demands. Key learning points ,Failure to diagnose the initial crack along a gemination groove resulted in further propagation and finally complete vertical fracture. ,Owing to the abnormal morphology of the crown and the complexity of the root canal system in geminated teeth, treatment protocols require special attention. ,For asymptomatic cases without aesthetic or orthodontic problems and without associated pathosis, routine review and careful maintenance are required. [source]

    Oral mucous membrane pemphigoid in a 6-year-old boy: diagnosis, treatment and 4 years follow-up

    Background., Childhood oral pemphigoid is extremely rare and usually takes the form of desquamative gingivitis. Case report., We describe a 6-year-old boy who presented with gingival bleeding, pain, eating difficulty, and peeling of the gums. Clinical examination revealed desquamative gingivitis with no extra-oral involvement. The diagnosis was established as oral pemphigoid based on the clinical, histological, and immunofluorescence findings. Symptoms resolved on treatment with occlusive topical corticosteroids. The patient was a carrier of the HLA-DQB1*0301 allele. Conclusion., Mucous membrane pemphigoid should be considered in the differential diagnosis of chronic desquamative gingivitis in childhood. Occlusive therapy with topical fluocinonide may alleviate the symptoms. [source]

    Apert syndrome with glucose-6-phosphate dehydrogenase deficiency: a case report

    G. TOSUN
    Summary., Apert syndrome is characterized by midface hypoplasia, syndactyly of the hands and feet, proptosis of eyes, steep and flat frontal bones, and premature union of cranial sutures. Maxillary hypoplasia, deep palatal vault, anterior open bite, crowding of the dental arch, severely delayed tooth eruption, and dental malocclusion are the main oral manifestations of this syndrome. In this report, a case of Apert syndrome with glucose-6-phosphate dehydrogenase (G6PD) deficiency is presented. The patient, a 4-year-old male and the fourth child of healthy parents, was admitted to our department because of delayed tooth eruption. He had all the cardinal symptoms of the Apert syndrome. Clinical examination revealed that primary centrals, canines and first molars erupted; however, primary second molars and laterals had not erupted. The patient had no dental caries. Preventive treatments were applied, and subsequently, the patient was taken to long-term follow up. [source]

    Periodontal treatment of patients with Papillon,Lefèvre syndrome: a 3-year follow-up

    T. Lundgren
    Abstract Background/aim: Conventional mechanical periodontal treatment of Papillon,Lefèvre syndrome (PLS) has often been reported to fail. This study describes the outcome of a non-surgical periodontal therapy including antimicrobial treatment of nine patients diagnosed with PLS. The patients originate from a total of 15 children and adolescents with PLS for which clinical characteristics are presented. Methods: Clinical examination including conventional periodontal measurements. Initial treatment including oral hygiene instruction, scaling and root planing and systemic amoxicillin,metronidazole therapy for 6 weeks. After that the patients were enrolled in a 3-month recall maintenance program. In addition to this mechanical supportive maintenance treatment, tetracycline was prescribed and used continuously for 1.5 years. Results/Conclusion: On five patients who were showing acceptable standard of oral hygiene and also compliance with the antibiotic medication, development of periodontitis on erupting teeth was prevented and disease activity on the previously periodontally involved teeth controlled during a 3-year period. Poor results of treatment were observed for three patients, all siblings. These patients failed to comply with the medication and also failed to improve their oral hygiene. [source]

    Five-year maintenance follow-up of early-onset periodontitis patients

    Joanna J. Kamma
    Abstract Objectives: The purpose of this study was to evaluate the clinical and microbiological status of patients with early-onset or aggressive periodontitis (EOP) who had received supportive periodontal care (SPC) every 3,6 months for a period of 5 years, following active periodontal treatment. Material & Methods: The study population consisted of 25 individuals with early-onset periodontitis. Clinical examination and recordings of probing pocket depth (PPD) and clinical attachment level (CAL) were performed at baseline prior to treatment (T0), 3 months following the termination of active periodontal treatment (T1) and annually at the SPC appointments (T2,T3,T4,T5). Microbiological samples were obtained at the 5-year SPC (T5). Subgingival plaque samples for each individual were collected from one deep pocket (>5 mm), based on pretreatment measurements, randomly selected in each quadrant. The levels of Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis and Treponema denticola were determined using oligonucleotide probe hybridization. Results: During the 5-year period, the mean of SPC/patient was 12.7 sessions. A significant improvement was observed in PPD, CAL, gingival bleeding index and suppuration following treatment. However, between T1 and T5, 134 sites in 20 patients deteriorated with a CAL loss of,2 mm. Out of these 134 sites showing disease progression, microbial samples were randomly obtained in 13 sites (9.7%) from 8 patients. Among other factors, smoking and stress were found to have significant predictive value on the future attachment loss. P. gingivalis, T. denticola and total bacterial load were statistically significantly higher in patients who experienced disease progression during the 5-year maintenance period. Conclusions: For most EOP patients, regular SPC was effective in maintaining clinical and microbiological improvements attained after active periodontal therapy. However, a small percentage of sites was identified as progressive in 20 patients. Variables found to be related to periodontal progression were the presence of as well as the high bacterial counts of P. gingivalis, T. denticola and total bacterial load, number of acute episodes, number of teeth lost, smoking and stress. Zusammenfassung Erhaltungstherapie über fünf Jahre bei Patienten mit früh einsetzender Parodontitis (EOP) Ziele: Der Zweck dieser Studie war es, 5 Jahre nach aktiver Parodontalbehandlung den klinischen und mikrobiologischen Zustand von Patienten mit früh einsetzender oder aggressiver Parodontitis (EOP), bei welchen alle 3-6 Monate eine parodontale Erhaltungstherapie (SPC) erfolgte, zu evaluieren. Material & Methoden: Die Studienpopulation bestand aus 25 Individuen mit früh einsetzender Parodontitis. Die klinische Untersuchung und Aufzeichnung der Sondierungstiefe (PPD) sowie des klinischen Attachmentniveaus (CAL) erfolgten bei der Eingangsuntersuchung vor der Behandlung (T0), drei Monate nach Beendigung der aktiven Parodontalbehandlung (T1) und jährlich bei den SPC-Terminen (T2,T3,T4,T5). Die mikrobiologischen Proben wurden bei der 5-Jahres-SPC gewonnen (T5). Für jedes Individuum wurden die subgingivalen Plaqueproben in jedem Quadranten aus einer tiefen Tasche (>5mm) entnommen. Dies geschah randomisiert und auf der Grundlage der Messungen vor der Behandlung. Das Niveau von Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis und Treponema denticola wurden unter Verwendung der Hybridisierung mit Oligonukleotid-Sonden bestimmt. Ergebnisse: Während der 5-jährigen Periode betrug die mittlere Anzahl der SPC-Sitzungen pro Patient 12,7. Nach der Behandlung wurden bei PPD, CAL, Gingiva-Blutungs-Index und der Pusentleerung signifikante Verbesserungen beobachtet. Jedoch haben sich zwischen T1 und T5 bei 20 Patienten 134 Taschen mit einem CAL-Verlust von=2mm verschlechtert. Bei 8 Patienten wurden aus diesen 134 Taschen, mit Progression der Erkrankung, von 13 Taschen (9,7%) randomisiert mikrobiologische Proben entnommen. Innerhalb anderer Faktoren wurde bei Rauchen und Stress ein signifikanter Vorhersagewert für zukünftigen Attachmentverlust vorgefunden. Bei den Patienten, die in der 5-jährigen Erhaltungsperiode eine Progression der Erkrankung erfuhren lagen P. gingivalis, T. denticola und die bakterielle Gesamtbelastung höher. Schlussfolgerungen: Für die meisten EOP-Patienten die regelmäßig an der parodontalen Erhaltungstherapie teilnahmen war diese hinsichtlich der Aufrechterhaltung der nach der aktiven Parodontaltherapie erzielten klinischen und mikrobiologischen Verbesserungen erfolgreich. Jedoch wurde bei 20 Patienten ein geringer Prozentsatz von Taschen als fortschreitend identifiziert. Die Variablen, von denen gefunden wurde, dass sie eine Beziehung zur Progression haben waren: sowohl Vorhandensein von P. gingivalis, T. denticola als auch hohe Bakterienzahl von P. gingivalis, T. denticola und die bakterielle Gesamtbelastung, Anzahl der akuten Episoden, Anzahl verlorener Zähne, Rauchen und Stress. Résumé Suivi en maintenance sur 5 ans de patients atteints de parodontites d'apparition précoce. Objectifs: Cette étude se propose d'évaluer l'état clinique et microbiologique de patients atteints de parodontites d'apparition précoce ou agressive (EOP) qui furent suivis en maintenance (SPC) tous les 3-6 mois pendant une période de 5 ans après un traitement parodontal actif. Matériel & Méthodes: La population étudiée consistait en 25 individus atteints de parodontites d'apparition précoce. L'examen clinique et l'enregistrement des profondeurs de poche (PPD) et du niveau d'attache (CAL) furent réalisés avant le traitement (T0), 3 mois après la fin du traitement actif (T1) et chaque année aux rendez vous de maintenance (T2,T3,T4,T5). Des échantillons microbiologiques furent prélevés lors de la maintenance à 5 ans (T5). La plaque sous-gingivale de chaque patient fut prélevée d'une poche profonde (>5mm), sur la base des examens initiaux, choisis au hasard dans chaque quadrant. Les niveaux d' Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Porphyromonas gingivalis et Treponema denticola furent déterminés par hybridation par sonde d'oligonucleotides. Résultats: pendant la période d'examination de 5 ans, la moyenne des SPC par patient fut de 12.7 sessions. Une amélioration significative fut observée pour PPD, CAL, l'indice de saignement gingival et la suppuration suite au traitement. Cependant, entre T1 et T5, 134 sites chez 20 patients connurent une détérioration avec une perte d'attache de 2 mm. De ces 134 sites qui présentaient une progression de la maladie, des échantillons microbiologiques furent obtenus aléatoirement dans 13 sites (9.7%) chez 8 patients. Parmi d'autres facteurs, le tabagisme et le stress furent reconnus comme ayant une significative valeur prédictive pour de futures pertes d'attache. P. gingivalis, T. denticola et la charge bactérienne totale étaient de façon statistiquement significatif plus importants chez les patients chez qui la maladie progressait au cours des 5 ans de maintenance. Conclusions: pour la plupart des patients atteints d' EOP, des soins parodontaux de soutien réguliers sont efficaces pour maintenir les améliorations cliniques et microbiologiques obtenus par le traitement actif. Cependant, un petit pourcentage de sites progressait chez 20 patients. Les variables en ralation avec cette progression étaient la présence et aussi un comptage important de P. gingivalis, T. denticola et la charge bactérienne totale, le nombre d'épisodes aigus le nombre de dents perdues le tabagisme et le stress. [source]

    Prevalence of Actinobacillus actinomycetemcomitans and clinical conditions in children and adolescents from rural and urban areas of central Italy

    Michele Paolantonio
    Abstract Background: The aim of this study was to report on the prevalence of Actinobacillus actinomycetemcomitans (Aa) and the periodontal clinical conditions in children and adolescents from a rural area of central Italy compared with the ones from an urban area of the same region. Method: The study population consisted of 780 systemically healthy children, aged 6,14 years inhabiting the county of Chieti. 505 children attended 3 primary and 2 secondary schools from a rural area whereas 275 individuals attended 1 primary and 1 secondary school from the city of Chieti. The 2 provincial areas present a great difference in socioeconomic level and cultural background. Clinical examination consisted of recording the % of gingival sites positive for the presence of plaque (Pl+), bleeding on probing (BOP+), mean probing depth (PD) from each primary or permanent tooth fully erupted in the oral cavity. Loss of periodontal attachment (AL+) was evaluated only in interproximal sites. AL+ subjects were distinguished in juvenile periodontitis (JP) prepubertal periodontis and early periodontitis (EP) patients. 8 gingival sites were microbiologically sampled in each subject and cultured, after pooling, for the presence of Aa. Results: 30.3% of rural subjects, were positive for the presence of Aa, the difference from urban children (16%) being statistically significant (p=0.01) irrespective of gender and age. Aa showed a significantly (p=0.006) higher mean proportion in subgingival plaque samples from rural children (0.13% versus 0.02%). Loss of periodontal attachment in at least one site was found in 18 rural children (3.56%) (3 JP; 15 EP) and 2 urban girls (0.72%) (1 JP; 1 EP). No significant differences for AL were observed within the rural group according to the gender and age differentiation. In the urban group, both AL+ subjects were Aa+, while among children from rural areas all 3 JP and 13 EP subjects were Aa+. Rural subjects evidenced significantly worse clinical parameters with respect to urban children (% Pl+ sites: p=0.000; % BOP+ sites: p=0.010; mean PD: p=0.000.) The relative risk for AL+ sites was significantly greater (2.42) in rural subjects harboring Aa in subgingival plaque. Similarly, the presence of Aa in subgingival plaque was related to a greater risk of more than 50% of BOP+ gingival sites in both rural and urban subjects (1.45 and 8.40, respectively). Conclusions: Results of this study suggest that Aa colonization in children and adolescents from central Italy is affected by socioeconomic and cultural factors; these factors also affect the periodontal condition of the subjects. [source]

    Primary cutaneous osteosarcoma of the scalp: a case report and review of the literature

    Daniela Massi
    The patient had been previously submitted to electrodessications of the scalp due to multiple solar keratoses. Histopathologically, the lesion showed features of a high-grade conventional osteoblastic osteosarcoma involving the dermis. Computed tomography showed no involvement of the underlying bone tissues. Clinical examination and extensive total body radiologic workup revealed absence of bone lesions in any body site, thus suggesting a final diagnosis of primary cutaneous extraskeletal osteosarcoma. The clinico-pathological features of the case are discussed in light of the rare cases previously described in the literature. [source]

    Primary Cutaneous Carcinosarcoma (PCCS0 Aka Metaplastic Carcinoma)

    Ramin Ram
    We describe a case of PCCS in a 73 year-old male who presented with a rapidly growing tumor of 6 months duration on the right ear. Clinical examination revealed a 5 × 4 × 4-cm ulcerated, crusted, exophytic tumor on the superior aspect of the helix. Histologically, the mass revealed a biphasic tumor with malignant epithelial and mesenchymal components. The epithelial component consisted of a few foci of basal cell carcinoma (BCC). The majority of the tumor was composed of osteogenic sarcoma and malignant fibrous histiocytoma (MFH). An intricate transition of BCC into sarcoma was noted in a few foci. Atypical mitosis and necrosis were common. The BCC and tumor giant cells in the MFH area showed positive immunoreaction for cytokeratin and CD68 respectively. The tumor was negative for S-100 protein, HMB-45, muscle actins, chromogranin, and synaptophysin. In conclusion, a PCCS growing predominantly as osteosarcoma and MFH is reported. Although the exact histogenesis of PCCS is unknown, primitive mesenchymal cells of the dermis, surrounding the follicular units, are capable of pluripotent differentiation and are likely the source of origin of the sarcoma. The known aggressive biological behavior warrants wide excision and given the rare reports of metastasis and death, regular follow-up is required [source]


    V Palma
    A randomised open study has been carried out to evaluate the efficacy of riluzole versus riluzole plus gabapentin in 50 patients (23 males, 27 females) affected by amyotrophic lateral sclerosis (ALS), who received the diagnosis according to El Escorial WFN criteria. At baseline, the mean age of the patients was 58.8 ± 11.7 years and the mean disease duration was 11.4 ± 5.9 months. Twenty patients had bulbar and 30 spinal onset. Twenty-eight patients were randomly assigned to riluzole (100 mg/day) and 22 to riluzole plus gabapentin at the initial dose of 300 mg/day, slowly increased to 1800 mg/day. Informed consent was obtained in all cases. Before treatment, each patient underwent neurological examination, Appel rate scale, pulmonary function tests, electromyography, and transcranial magnetic stimulation. Clinical examination and electrophysiologic tests were repeated at three-month intervals. Over the course of the trial, 4 patients (8%) were lost to follow-up and 16 (32%, 9 in the riluzole and 7 in the riluzole plus gabapentin group) died. The mean age at death was 65.0 ± 6.5 years after a mean disease duration of 20.8 ± 7.9 months (range 13,36). There was no significant difference in response to treatment when severity and duration of the disease were compared in the two groups. [source]

    New once-daily, highly effective rescue triple therapy after multiple Helicobacter pylori treatment failures: a pilot study

    L. G. V. Coelho
    Summary Background:,Helicobacter pylori treatment failure is a growing problem in daily practice. Aim:, To determine the efficacy of the combination of rabeprazole, levofloxacin and furazolidone as a rescue therapy. Methods:, Duodenal ulcer patients previously submitted, without success, to at least two H. pylori treatment regimens were included. Gastroscopy (urease test, histological examination and culture) and 13C-urea breath test were performed. All patients received a combination of rabeprazole 20 mg, levofloxacin 500 mg and furazolidone 200 mg (two tablets) administered in a single dose in the morning for 10 days. Clinical examination and a new 13C-urea breath test were performed 90 days after therapy. Results:, Twelve patients (eight females and four males), mean age 43 (30,58) years were included. Two patients failed to complete the treatment because of nausea and vomiting. Ten patients completed the study and took all the medications as advised. Culture was obtained in six patients: 100 and 83% of the samples were sensitive to furazolidone and levofloxacin, respectively. Per-protocol and intention-to-treat eradication rates were 100 and 83% (P = 0.019). Conclusions:, the combination of rabeprazole, levofloxacin and furazolidone in a single daily dose for 10 days constitutes a highly-effective and low-cost alternative as a third-line therapy in patients infected with H. pylori. [source]

    Impact of allergic rhinitis on asthma in children: effects on bronchodilation test

    ALLERGY, Issue 2 2010
    M. Capasso
    To cite this article: Capasso M, Varricchio A, Ciprandi G. Impact of allergic rhinitis on asthma in children: effects on bronchodilation test. Allergy 2010; 65: 264,268 DOI: 10.1111/j.1398-9995.2009.02168.x. Abstract Background:, Relevant relationship exists between upper and lower airways. Bronchial obstruction is a paramount feature of asthma and its reversibility is considered a diagnostic step for asthma diagnosis. Objective:, This study aimed at evaluating a large group of children with allergic rhinitis alone for investigating the degree of brochodilation and possible factors related to it. Methods:, Two hundred patients with allergic rhinitis and 150 normal subjects were consecutively evaluated. Clinical examination, skin prick test, spirometry, and bronchodilation test were performed in all patients. Results:, Rhinitics showed a significant FEV1 increase after bronchodilation test (P < 0.0001) in comparison both to basal values and to controls' levels. More than 20% of rhinitics had reversibility (,12% basal levels). Patients with reversibility had lower FEV1 levels, longer rhinitis duration, and perennial allergy. Conclusion:, This study highlights the close link between upper and lower airways and the relevance of performing bronchodilation test in patients with allergic rhinitis and these characteristics. [source]

    Impact of allergic rhinitis on asthma: effects on bronchial hyperreactivity

    ALLERGY, Issue 3 2009
    I. Cirillo
    Background:, Remarkable relationship exists between upper and lower airways. Bronchial hyperreactivity (BHR) is a paramount feature of asthma and may be considered a strong risk factor for the onset of asthma in patients with allergic rhinitis. Objective:, This study is aimed at evaluating the presence of BHR in a large group of patients with moderate-severe persistent allergic rhinitis alone, and at investigating possible risk factors related to severe BHR. Methods:, Three hundred and forty-two patients with moderate-severe persistent allergic rhinitis were prospectively and consecutively evaluated. Clinical examination, skin prick test, spirometry and bronchial methacholine (MCH) test were performed in all patients. Results:, Twenty-two (6.4%) patients had severe BHR, 74 (21.6%) patients had mild BHR and 192 (56.2%) had borderline BHR; 54 (15.8%) patients had a negative MCH test. The logistic regression analysis evidenced that trees and house dust mites sensitization (ORAdj: 8.1), rhinitis duration > 5 years (ORAdj: 5.4) and FEV1 , 86% of predicted (ORAdj: 4.0) were significantly associated with severe BHR. The discriminative ability of this model is appreciably satisfactory, being the AUC = 0.90. Conclusion:, This study highlights the close link between upper and lower airways and the role of some risk factors, such as tree and mite sensitization, > 5-year duration, and , 86% FEV1 values, as risk factors for severe BHR in patients with moderate-severe persistent allergic rhinitis alone. Therefore, BHR is frequently present in patients with chronic rhinitis and should be suspected in the presence of defined risk factors. [source]

    Cytokines in gingival crevicular fluid of adolescents and young adults

    J. Kamma
    Background/aim:, The purpose of this study was to compare the levels of the cytokines interleukin-1, (IL-1,), IL-4, and IL-8 in the gingival crevicular fluid (GCF) of adolescents and young adults. Methods:, Twenty-five adolescents aged between 14 and 16 years (Group A) and 20 periodontally healthy young adults aged between 25 and 35 years (Group B) were selected from two private dental clinics limited to pedodontics and periodontics respectively in Piraeus Greece. All subjects were systemically healthy. Clinical examination included probing pocket depth (PPD), presence or absence of plaque, and bleeding on probing (BOP). GCF was collected from four sites per subject. IL-1,, IL-4, and IL-8, measured as total amounts (pg/30 s), were evaluated in 180 samples using a commercially available sandwich enzyme-linked immunosorbent assay. Results:, IL-1, mean levels of Groups A and B were adjusted for BOP and PPD. Differences of IL-1, mean levels between the two age groups were statistically significant (F = 50.245, P < 0.001) in favour of Group A. Adolescents showed statistically significantly lower mean levels of IL-4 than young adults in the presence of BOP (F = 10.690, P = 0.001). There was no statistically significant difference between adolescents and adults for the means of IL-8 adjusted for BOP and plaque presence (F = 2.032, P = 0.161). Conclusions:, Within the limits of this study the differences reported in mean levels of IL-1, and IL-4 may be attributed to the different age status. [source]

    Squamous cell carcinoma: a rare complication of dermoid cysts

    K. Ashkan
    Introduction:, Dermoid cysts constitute 0.3% of all brain tumours. Carcinomatous differentiation has been described only in a handful of cases. Material and methods:, A 44-year-old-man presented with a several-year history of headaches and a 5-week history of progressive visual deterioration in the left eye. Clinical examination confirmed a normal visual acuity but an impaired left visual field. A magnetic resonance imaging scan showed a lesion in the left paraclinoid area compressing the ipsilateral optic nerve. Signal characteristics of the lesion were consistent with a dermoid or epidermoid cyst. At operation, the lesion was thought to be typical of a dermoid cyst and a near-complete excision was achieved leaving behind parts adherent to the optic nerve. Histology showed invasive squamous cell carcinoma arising within the dermoid tumour. Postoperatively the patient received radiotherapy. Results:, The patient's clinical condition initially stabilized. At 15 months follow up, however, there was clinical and radiological evidence of tumour progression and he died 1 year later. Conclusion:, Squamous cell carcinoma may rarely arise from an intracranial dermoid tumour. This may hinder total excision of the lesion and confounds the prognosis. [source]

    Non-neurogenic urinary retention (Fowler's syndrome) in two sisters

    Simon Podnar
    Abstract Aims To report for the first time occurrence of obstructed voiding due to excessive activity of the urethral sphincter (US) muscle in two sisters with polycystic ovaries (Fowler's syndrome). Methods In both patients precise micturition history was obtained. In addition, clinical neurological and gynecological examinations, cystometry, urethral pressure profile measurements, gynecological ultrasound, measurement of gonadotropic hormone levels, and concentric needle electromyography (EMG) of the US muscle were performed. Results Both sisters reported symptoms of severely obstructed voiding. Clinical examination, and filling cystometries were normal. Urethral pressures were increased (99,134 cm water). The first sister was not able to void, and the urinary flow was slow and intermittent in the second on voiding studies. Profuse complex repetitive discharges and decelerating burst activity were found on concentric needle EMG of the US in both of them. Both sisters had increased LH/FSH ratio (2.96 and 2.64), and ultrasonographic abnormalities compatible with polycystic ovaries. Conclusions Diagnosis of Fowler's syndrome was made in both sisters. Due to very low incidence rate of this syndrome (0.2/100.000 per year), we think that it is highly unlikely to find it in two sisters just by chance. We suggest that the probable explanation is a genetic predisposition to polycystic ovaries, with which this condition has been shown to be associated. Neurourol. Urodynam. 25:739,741, 2006. © 2006 Wiley-Liss, Inc. [source]

    OC7 Trigeminal neuropathy and autonomic neuropathy , a rare combination

    ORAL DISEASES, Issue 2006
    C Frezzini
    Introduction, Idiopathic trigeminal neuropathy is an uncommon orofacial symptom giving rise to paraesthesia and/or anaesthesia of one or more divisions of the trigeminal nerve in the absence of an obvious aetiology. Idiopathic autonomic neuropathy is a rare disorder giving rise to cholinergic and/or adrenergic dysfunction of the autonomic nervous system. The combination of trigeminal and autonomic neuropathy in the absence of diabetes mellitus is unusual. Signs and symptoms, A 45-year-old male was referred to the Oral Medicine Unit of UCL Eastman Dental Institute and UCLHT Eastman Dental Hospital for assessment of possible xerostomia secondary to autonomic neuropathy. Medical history & social history. The patient had long-standing trigeminal neuropathy, long-standing autonomic neuropathy giving rise to dysphagia, gastrointestinal and bladder function and orthostatic hypotension. There was a previous history of Hodgkin's disease. Oral disease history, Clinical examination revealed neurotrophic destruction of the nasal septum (trigeminal trophic syndrome), chronic periodontitis, but no features of long-standing xerostomia. Resting sialometry was >0.1 ml min,1. Diagnosis, Trigeminal trophic syndrome secondary to trigeminal neuropathy and partial autonomic neuropathy. Treatment, The patient was referred for appropriate periodontal therapy. Conclusion, This is a unique example of trigeminal sensory neuropathy and autonomic neuropathy in the absence of diabetes mellitus. Early diagnosis of both disorders is important to ensure avoidance of facial complications such as trigeminal trophic syndrome and the oral consequences of long-standing xerostomia. [source]

    Foreign body granuloma in the submental region due to fish bone: a case report

    ORAL SURGERY, Issue 1-2 2010
    X. Ding
    Abstract The purpose of this article was to describe the clinical and microscopic features of a foreign-body granuloma in submental region that resulted from a fish bone embedded in the floor of mouth. A 45-year-old female patient complained of a hard mass in submental region. Clinical examination showed a non-compressible, firm, fixed lump, painless on palpation. Ultrasound examination showed an internally uneven, uncircumscribed, hypoechoic mass with a steaky hyperechoic spot of 1.1 cm length in the center. A microscopic examination showed newly-formed granuloma, composed of lympocytes and epithelioid cells, and some microabscess with neurophiles. The final diagnosis was a foreign-body granuloma with fish bone. Even though foreign-body granulomas in submental region are rare lesions, surgeon should be familiar with their features and include them in the differential diagnosis of tissue masses. [source]

    Anal canal neuroendocrine carcinoma with Pagetoid extension

    Limei Guo
    A case of anal canal neuroendocrine carcinoma with Pagetoid intraepithelial extension is presented. An 80-year-old man was admitted to hospital with a complaint of pain in the anorectal region. Clinical examination revealed a hard and fixed mass in the anal canal, and subsequent biopsy of the lesion showed it to be a carcinoma. The surgically resected specimen showed a solid tumor measuring 3.4 × 3.2 cm within the area from the surgical anal canal to the anatomical anal canal. Tumor cells proliferated predominantly with compact nests. Many tumor cells had a high nuclear-to-cytoplasmic ratio, dispersed chromatin, and conspicuous nucleoli. Additionally, neoplastic cells focally formed a glandular structure. Some polygonal neoplastic cells were small with round nuclei. A rosette-like arrangement was also focally observed. In addition, tumor cells exhibited Pagetoid extension into the overlying epithelium of the histological anal canal. Both the underlying original neoplastic cells and the Pagetoid spreading tumor cells showed cytoplasmic granules positive for Grimelius staining and immunopositivity for carcinoembryonic antigen, synaptophysin and cytokeratins 7 and 20. These findings are highly suggestive of neuroendocrine differentiation of adenocarcinoma cells. To the best of our knowledge, this is the first case of anal canal neuroendocrine carcinoma with Pagetoid extension into the overlying epithelium of the histological anal canal. [source]

    Alpha interferon and lamivudine combination therapy for chronic hepatitis B in children

    Mukadder Ay, e Selimo
    Abstract Background: Lamivudine is a new alternative therapeutic agent for chronic hepatitis B, in which alpha interferon (IFN-,) monotherapy is not successful enough. Published reports have revealed no satisfactory data on IFN-, and lamivudine combination therapy in children. The aim of this study is to investigate the efficacy and safety of this combination therapy in children with chronic hepatitis B. Methods: Children with chronic hepatitis B were given either IFN-, and lamuvidine (group 1, n = 47) or IFN-, alone (group 2, n = 30). Alpha interferon was administered as 5 million U/m2 s.c., thrice a week for 6 months and lamivudine 4 mg/kg per day p.o., maximum 100 mg, for 1 year. Clinical examination was performed; blood cell counts and serum alanine aminotransferase (ALT) and amylase were studied at each visit. At the third, sixth and twelfth month, serological markers were determined. Results: End of therapy response was achieved in 19 (40.4%) patients in group 1 and in 14 (46.7%) children in group 2 (P > 0.05). In group 1, pretreatment serum ALT and hepatic activity index (HAI) were statistically higher in children who responded to therapy (P < 0.005). In group 2, mean serum ALT was higher and hepatitis B virus (HBV) DNA was lower in responders. Sustained response rate was 40.4 versus 43.3% in two groups. Conclusion: The response rate of IFN-, and lamivudine combination therapy in children with chronic hepatitis B was similar to that of IFN-, monotherapy. High ALT level and HAI, rather than low HBV-DNA level were found to be important predictors of response. [source]