Kikuchi-Fujimoto Disease in a Filipino Boy: A Case Report

@#<p><strong>OBJECTIVE:</strong> To report a case of a 12-year-old boy with Necrotizing Lymphadenitis (Kikuchi-Fujimoto disease) presenting as lymphadenitis secondary to multiple diagnosis.</p><p> </p><p><strong>METHODS:</strong></p><p><strong>Design :</strong> Case Report</p><p><strong>Setting:</strong> Tertiary Private Hospital</p><p><strong>Patient:</strong> One</p><p> </p><p><strong>RESULTS:</strong> A 12-year-old boy consulted for two-month history of cervical lymphadenopathy with the underlying cause remaining unclear despite multiple consults, diagnosis and medical treatment. Lymphoma was considered and excision biopsy with further investigations confirmed a diagnosis of Kikuchi-Fujimoto disease. Supportive management was given with no recurrence of symptoms noted on 18 months of follow up. </p><p> </p><p><strong>CONCLUSION:</strong>  Kikuchi-Fujimoto disease in this case was a diagnosis of exclusion. Even with a proper history and physical examination, experts in otolaryngology can be misled to manage this case as malignant. Awareness of the disease and appropriate examinations including immunohistochemistry are important for a timely diagnosis and proper intervention.</p><p> </p><p><strong>KEYWORDS: </strong>lympadenitis; Kikuchi-Fujimoto disease; lymphoma; cervical lymph nodes</p>

Operative time and tympanic membrane graft uptake in endoscopic transcanal versus microscopic post-auricular tympanoplasty for chronic otitis media

Objective@#To compare surgical outcomes (operative time and tympanic membrane integrity) obtained by endoscopic transcanal tympanoplasty (ET) and microscopic post-auricular tympanoplasty (MT) in patient with inactive chronic otitis media. @*Methods@# Design: Retrospective Cohort Setting: Multicenter study in 3 Private Tertiary Hospitals Participants: 18 patients who underwent microscopic or endoscopic tympanoplasty for chronic otitis media. @*Results@#Each group had 9 patients, with median age of 43 (31-65 years) for the MT and 47 (29-59 years) for the ET group. There was no significant difference in median age of the two groups (Mann-Whitney U=17, P=.22). Male: female ratio was (5:4) and (6:3) for the ET and MT group respectively, with no significant difference in gender distribution (c2= 0.90, P=.34). Mean operative time for the ET and MT group was 86.7 minutes and 140.6 minutes, respectively, with significantly lower mean operative time for the ET group (t= 3.57, P=.0025). There was complete tympanic membrane graft uptake in both groups. @*Conclusion@#Regardless of technique, tympanoplasty is an effective surgical treatment among patients with inactive chronic otitis media. Endoscopic tympanoplasty is an alternative to conventional microscopic tympanoplasty that may use less operative time, producing similarly complete graft uptake.

Pulmonary Arterial Hypertension in Glycogen Storage Disease Type I

Abstract Pulmonary arterial hypertension (PAH) is a rare and highly fatal disease that has been reported in 8 patients with glycogen storage disease type I (GSDI). We describe an additional case of an acute presentation of PAH in a 14-year-old patient with GSDI, which was successfully treated with inhaled nitric oxide and sildenafil. We investigated the incidence of PAH in 28 patients with GSDI on routine echocardiography and found no evidence of PAH and no significant cardiac abnormalities. This study highlights that PAH is a rare disease overall, but our case report and those previously described suggest an increased incidence in patients with GSDI. Should cardiopulmonary symptoms develop, clinicians caring for patients with GSDI should have a high degree of suspicion for acute PAH and recognize that prompt intervention can lead to survival in this otherwise highly fatal disease.

Low-level laser therapy effects on pain perception related to the use of orthodontic elastomeric separators

INTRODUCTION: Some patients refer to pre-banding orthodontic separation as a painful orthodontic procedure. Low-level laser therapy (LLLT) has been reported to have local analgesic effect. OBJECTIVE: The aim of this single-blind study was to investigate the perception of pain caused by orthodontic elastomeric separators with and without a single LLLT application (6J). METHODS: The sample comprised 79 individuals aged between 13 and 34 years old at orthodontic treatment onset. Elastomeric separators were placed in first maxillary molars at mesial and distal surfaces and kept in place for three days. The volunteers scored pain intensity on a visual analogue scale (VAS) after 6 and 12 hours, and after the first, second and third days. One third of patients received laser applications, whereas another third received placebo applications and the remaining ones were controls. Applications were performed in a split-mouth design. Thus, three groups (laser, placebo and control) were assessed. RESULTS: No differences were found among groups considering pain perception in all periods observed. CONCLUSION: The use of a single-dose of LLLT did not cause significant reduction in orthodontic pain perception. Overall pain perception due to orthodontic separator placement varied widely and was usually mild. .

INTRODUÇÃO: alguns pacientes referem-se à separação ortodôntica pré-bandagem como um procedimento doloroso. Tem sido relatado que a terapia com laser de baixa intensidade (LLLT) produz um efeito analgésico local. OBJETIVO: o objetivo deste estudo simples-cego foi investigar a percepção da dor causada por elásticos ortodônticos separadores, com ou sem uma única aplicação de LLLT (6J). MÉTODOS: a amostra foi composta por 79 indivíduos com 13-34 anos de idade no início do tratamento ortodôntico. Elásticos separadores foram colocados nos molares superiores, nas proximais mesial e distal, e mantidos por três dias. Os voluntários marcaram a intensidade da dor em uma escala visual analógica (EVA) após 6 horas, 12 horas, 1 dia, 2 dias e 3 dias. Um terço dos dentes separados recebeu aplicações de laser; outro terço, aplicações placebo; e os demais foram usados como controle. As aplicações foram realizadas segundo um desenho metodológico de boca dividida. Portanto, foram comparados três grupos: laser, placebo e controle. RESULTADOS: não foram encontradas diferenças entre os grupos, em relação à percepção de dor, em nenhum dos períodos observados. CONCLUSÕES: a utilização da LLLT em dose única não causou redução significativa na dor ortodôntica. Além disso, a percepção geral da dor devida à colocação de separadores ortodônticos variou muito e foi, geralmente, leve. .

Impact of brackets on smile esthetics: laypersons and orthodontists perception

OBJECTIVE: This study evaluated the influence of orthodontic appliances on smile esthetics assessed by lay adolescents, lay adults and orthodontists. METHODS: A facial photograph of a smiling young woman was used under the following conditions: With metal orthodontic brackets ligated by different elastic ligature colors (green, red and gray), with ceramic bracket brackets (transparent elastic ligature) and without brackets, totaling five 15 x 20 cm pictures. For the photograph assessment, 16 lay adolescents, 16 lay adults and 16 orthodontists were randomly selected. The photographs were randomly arranged in an album, followed by a visual analog scale (VAS) for the scores registration. Scores in both evaluations of each group of evaluators (adolescents, adults and orthodontists) were submitted to error analysis by WILCOXON test and multiple comparison among groups performed by Kruskal - Wallis at 5% significance. RESULTS: Orthodontists, adults and adolescents agreed in their opinions, although the orthodontists gave lower scores in their assessments. It could be observed that ceramic brackets were more acceptable concerning the smile esthetics, whereas the metal brackets received the lowest scores. CONCLUSION: Orthodontists, adults and even adolescents seem to prefer esthetic solutions during orthodontic treatment.

OBJETIVO: esse estudo analisou a influência dos aparelhos ortodônticos na estética do sorriso em avaliação por adolescentes, adultos e ortodontistas. MÉTODOS: foram utilizadas fotografias faciais do sorriso de uma jovem mulher, usando-se as seguintes combinações: aparelho ortodôntico de metal com ligaduras de diferentes cores (verde, vermelho e cinza); aparelho ortodôntico cerâmico (ligadura transparente); e sem aparelho - resultando em cinco fotografias de 15x20cm. Para a avaliação das fotografias, 16 adolescentes leigos, 16 adultos leigos e 16 ortodontistas foram selecionados de forma randômica. As fotografias foram aleatoriamente organizadas em um álbum, acompanhadas de uma escala visual analógica (EVA) para o registro das notas. As notas das duas avaliações de cada grupo (adolescentes, adultos e ortodontistas) foram submetidas à análise de erro (teste pareado de Wilcoxon) e comparação múltipla de grupos pelo teste de Kruskal-Wallis com significância de 5%. RESULTADOS: ortodontistas, adultos e adolescentes concordaram em suas opiniões, porém, os ortodontistas deram notas menores em suas avaliações. Pôde ser observado que os braquetes cerâmicos foram mais aceitos, considerando-se a estética do sorriso, uma vez que os braquetes metálicos tiveram as menores notas. CONCLUSÃO: ortodontistas, adultos e adolescentes parecem preferir soluções estéticas durante o tratamento ortodôntico.

Cirurgia periodontal: uma solução para restabelecimento funcional e estético do sorriso / Periodontal surgery: a solution to functional and aesthetic recovery of the smile

Este trabalho tem como objetivo apresentar um caso clínico ilustrando três técnicas de cirurgia plástica periodontal, realizadas em um mesmo paciente.

Heparin induced thrombocytopenia management with bivalirudin.

We report a case of Heparin Induced Thrombocytopenia (HIT) following percutaneous coronary intervention. The case is unique in that thrombocytopenia occurred very early after heparin administration and responded well to a regime of bivalirudin-a direct thrombin inhibitor readily available in India. Heparin, Thrombocytopenia, Bivalirudin Acute HIT, occurring within few hours of heparin therapy have been reported in patients previously exposed to unfractionated heparin (UFH) or low molecular weight heparin (LMWH) 1. Prompt recognition of the condition and timely intervention with direct thrombin inhibitors, can result in salvaging patients from this potentially fatal complication.