Haemophagocytic lymphohistiocytosis: Five years' experience at tertiary hospitals in Free State Province, South Africa.

Background: Haemophagocytic lymphohistiocytosis (HLH) is a potentially life-threatening syndrome if not recognised and managed early. It involves an uncontrolled pathological activation of the immune system, and it is either genetic or acquired. It presents with clinical and laboratory features of severe inflammation. Early initiation of effective therapy may reduce mortality from 95% to 35%. Objectives: To raise awareness of HLH among healthcare professionals, particularly intensivists. Methods: We report nine cases of secondary HLH seen at tertiary hospitals in Bloemfontein, South Africa. Results: All patients presented with fever, hypertriglyceridaemia, hyperferritinaemia, transaminitis and cytopenia. Haemophagocytosis was noted on bone marrow biopsy in 66.7% (n=6/9) of the patients. More than one-third (44.4%; n=4/9) of the cases were triggered by a lymphoma, 44% (n=4/9) were associated with infection and 11% (n=1/9) were associated HIV. Finally, 11.1% (n=1) of the patients were triggered by an underlying autoimmune disease. More than half (55.6%; n=5/9) of the cases had a fatal outcome. Conclusion: A high index of suspicion may promote the accurate diagnosis of HLH in patients presenting with fever, transaminitis and unexplained cytopenia. Contributions of the study: HLH is a rare, life-threatening condition that may be missed in the intensive care setting. This report emphasises the importance of clinical suspicion, early diagnosis and appropriate intervention.

Treatment efficiency of mini-implant-borne distalization depending on age and second-molar eruption.

OBJECTIVE: The aim of this study was to evaluate the efficiency of molar distalization depending on age and second-molar eruption using the Beneslider. MATERIALS AND METHODS: Treatment of 51 patients (mean age 17.8 ± 9.6 years) was investigated retrospectively by means of pre- and posttreatment cephalograms. Patients were divided into three groups: 14 children with unerupted upper second molars (group 1), 23 adolescents with second molar in place (group 2), and 14 adults (group 3). The distalization forces applied were 2.4 N in group 1 and 5.0 N in groups 2 and 3. Treatment changes were evaluated and examined statistically for significant differences. RESULTS: In all patients a Class I molar relationship was achieved. All mini-implants remained stable during treatment. Mean distalization distance as measured by the displacement of the center of resistance was 3.6 ± 1.9 mm (range 1.2-8.5 mm depending on treatment needs). Since no significant tipping was detected, the type of movement can be described as bodily movement. Mean overall distalization speed was 0.6 ± 0.4 mm per month. There were no statistical differences between the groups. CONCLUSION: We found the Beneslider to be an effective appliance that enables bodily distalization in adequate treatment time. The higher resistance due to erupted second molars can be compensated by the use of higher forces without significantly reducing distalization speed.

Accuracy of torque-limiting devices for mini-implant removal: an in vitro study.

INTRODUCTION: Mini-implants, due to their potential for osseointegration, are exposed to torque levels that may cause them to fracture during removal. Thus, it is advisable to control the torque levels applied during mini-implant removal. MATERIALS AND METHODS: A torque sensor with strain gauges was used to analyze torque-limiting devices for their accuracy in reverse (counterclockwise) operation. Eight devices were tested in this manner, including a group of hand-operated drivers (n=3), a group of battery-operated drivers (n=4), and a mains-operated surgical unit (n=1). Each device was analyzed eight times at each of the various torque levels. Shapiro-Wilk, Kruskal-Wallis H-, and Mann-Whitney U-tests were used to analyze the results. RESULTS: Most of the various devices revealed significant differences upon comparison. The accuracy of torque control offered by the three hand drivers was clinically acceptable. As two of the four battery-operated drivers did not feature torque limitation in reverse mode, they did not prevent high torque levels from occurring. Likewise, some of the maximum torque levels observed in conjunction with the other two battery-operated drivers and the mains-operated surgical unit exceeded considerably the clinically recommended range of 10-25 Ncm. CONCLUSION: Although miniscrews can be removed successfully with hand-operated drivers while limiting torque, we advise against the use of battery-operated drivers or mains-operated surgical units not offering torque limitation in reverse mode.

Multipurpose use of orthodontic mini-implants to achieve different treatment goals.

OBJECTIVES: The goal of the study was to determine whether mini-implants inserted in the palate can be used to achieve more than one treatment goal consecutively or simultaneously in the same patient. MATERIALS AND METHODS: The treatment results of 43 patients were retrospectively assessed. Two implant-supported mechanical systems per patient were applied either consecutively in 19 patients (group A) or simultaneously in 24 patients (group B). Both groups were analyzed and compared by calculating success rates for achievement of the treatment goals, survival of the mini-implants, and quality of anchorage. Durations of treatment were also analyzed for intergroup differences. RESULTS: Except for a single case in group A, the treatment goals were achieved in all patients (success rates 94.7% in group A versus 100% in group B). Anchorage loss was confined to one patient per group (success rates 94.7% in group A and 95.3% in group B). Mini-implant mobility, and hence implant failure, was observed in three implants in group A (survival rate 91.8%) and two implants in group B (survival rate 95.6%). While none of these intergroup differences were statistically significant, the treatment durations in both groups differed widely: those in group B were significantly shorter (10.0 ± 4.2 months) than those in group A (14.4 ± 3.5 months; p = 0.001). CONCLUSION: Mini-implants inserted in the palate for skeletal anchorage can be used to achieve more than one treatment goal in the same patient. Such multipurpose application can succeed consecutively and simultaneously. The latter option can significantly expedite treatments and should, therefore, be preferred when feasible, depending on the nature of coexisting therapeutic indications in a given patient.