Delayed disseminated Staphylococcus aureus infection following chickenpox.

Chickenpox is generally a benign childhood disease. Bacterial superinfection is the commonest complication, and can be severe and life-threatening. We describe a 15-year-old boy with disseminated Staphylococcus aureus infection following chickenpox.

Soft tissue ridge augmentation to correct an esthetic deformity caused by adversely placed implants: a case report.

A patient presented with two osseointegrated implants placed in a ridge deformity that had resulted from a traumatic injury during an automobile accident. The implant placement and subsequent restorative dentistry resulted in a poor esthetic result and difficult maintenance. Treatment included multiple soft tissue grafts to submerge the implants and augment the ridge. The patient was then restored with a conventional fixed partial denture.

Long-term follow-up of childhood Henoch-Schönlein nephritis.

A study of long-term outcome of 78 subjects who had had Henoch-Schönlein nephritis during childhood (at a mean of 23.4 years after onset) shows that severity of clinical presentation and initial findings on renal biopsy correlate well with outcome but have poor predictive value in individuals. 44% of patients who had nephritic, nephrotic, or nephritic/nephrotic syndromes at onset have hypertension or impaired renal function, whereas 82% of those who presented with haematuria (with or without proteinuria) are normal. 17 patients deteriorated clinically from an initial assessment in 1971; 7 of these had apparently completely recovered in 1976. 16 of 44 full-term pregnancies were complicated by proteinuria and/or hypertension, even in the absence of active renal disease. These findings indicate that childhood Henoch-Schönlein nephritis requires long-term follow-up, especially during pregnancy.

Acceptability of antenatal diagnosis for sicke-cell disease among jamaican mothers and female patients

A questionnaire on the need and acceptability of antenatal diagnosis (AND) for sickle-cell disease was given to 112 women with homozygous sickle-cell (SS) disease and 117 AS mothers for patients with SS disease, all aged 15-45 years. AND was favoured by 58% of patients and 76% of mothers, the option for termination of an affected pregnancy being the reason in 43% of patients and in 51% of mothers among this group. Fear of the procedure was the commonest reason for not selecting AND. Of the two common methods, chorionic villus samplis (first trimester) and amniocentesis (second trimester), 74% of all women selected the first trimester method, and 93% considered these tests should be available in Jamaica. Faced with the diagnosis of a foetus with SS disease, 30% of patients and 46% of mothers stated they would request termination

Parvovirus associated aplastic crisis in homozygous sickle cell disease.

Aplastic crises in homozygous sickle cell disease in Jamaica predominantly affect children and occur in epidemics. Of 67 cases in a cohort study of 314 children with homozygous sickle cell disease, 62 were attributable to human parvovirus infection. Affected children were aged 0.5-12.5 years, and the incidence rose to 28% by 10 years. No recurrences were seen. Symptoms and signs on presentation were attributable to the viraemia and acute anaemia. Asymptomatic thrombocytopenia was common. Blood transfusion was given in 54 cases (87%). Thirty eight children (61%) were admitted to hospital, 16 of whom were extremely ill on presentation and one of whom died soon after admission. Twenty four (39%) were managed as outpatients, 16 of whom were transfused. Parvovirus associated aplastic crisis is a self limited condition with excellent prognosis if diagnosed promptly and managed appropriately.

Ligament replacement with an absorbable copolymer carbon fiber scaffold--early clinical experience.

Eighty-two patients, average age 29 years, were surgically treated (during the period from April 1981 to July 1983) for both acute (8%) and chronic (92%) knee ligament instabilities. An absorbable copolymer-carbon fiber ligament prosthesis was used as a tissue scaffold. Seventy-five percent had anterior cruciate ligament reconstructions, 6% had anterior cruciate and posterior cruciate ligament reconstructions, 6% had just posterior cruciate ligament reconstructions, and 9% had other combinations of anterior cruciate ligament, medical collateral ligament, and lateral collateral ligament reconstructions. Preoperative and postoperative evaluation, consisting of questionnaires, physical examinations, and isoskinetic testing, revealed significant improvements in categories of stability, pain, function, and strength persisting to the end of the study at 24 months. Arthroscopic examination and histologic studies of retrieved specimens demonstrated well-vascularized reconstructions with collagenous tissue ingrowth into the carbon-copolymer implants.

Retained ligature wire and periodontal health. Report of a case.

Routine radiographic evaluation 15 years after orthodontic treatment revealed a circumferentially placed ligature wire situated at the crest of bone on the upper right lateral incisor. The wire was surgically exposed via a modified Widman flap technique and subsequently removed without adverse consequences relative to esthetics or periodontal support. It is of interest that the retention and location of this wire over such a long period of time resulted in no loss of periodontal support, especially since circumferential ligature placement is used experimentally to help promote periodontal breakdown.

Accelerated periodontal disease in a patient with essential mixed cryoglobulinemia.

A 32-year-old woman diagnosed as having Type III essential mixed cryoglobulinemia presented with a history of gingival swelling and hemorrhage. Further clinical findings, in addition to sequential radiographs, revealed the presence of an unusual case of rapidly progressive periodontitis. An association between the presence of cryoglobulinemia and the periodontitis is implicated.

Prior abortions and neural tube defects.

Out of a series of 219 women who had had a child with anencephaly or spina bifida (ASB) in the Manchester area, there were 69 where this ASB pregnancy had been both preceded and succeeded by at least one other pregnancy. There was a significant excess of spontaneous abortions when the preceding pregnancy was compared with the succeeding pregnancy. Half of these abortions were followed by curettage of the uterus, a fact which is a little against the trophoblastic rest hypothesis.

PIP: Obstetric histories were collected for 219 women who had had a child with ASB (anencephaly or spina bifida). Of this number, 69 of the ASB cases had been both preceded and succeeded by at least 1 pregnancy. There was a significant excess of spontaneous abortions in the preceding pregnancies in comparison to the succeeding pregnancies. 1/2 of these preceding abortions had been followed by curettage of the uterus, a fact which argues somewhat against the trophoblastic rest hypothesis for ASB. It is concluded that ASB can be expected more commonly after abortions and even more commonly immediately after abortion.

Enamel pearls as contributing factor in periodontal breakdown.

Removal and treatment of an enamel pearl, a contributing factor to periodontal disease because of its anatomy and location, are described.

Acute effects of terbutaline and epinephrine on asthma. Double-blind crossover placebo study.

In order to assess the efficacy and safety of subcutaneous terbutaline 0.25 mg and 0.5 mg as compared to subcutaneous epinephrine, 28 stable asthmatics were studied. After control of environmental exposures in the clinical research facility at the University Hospitals of Case Western Reserve Medical School, the patients were entered into a double-blind crossover placebo-controlled 4-day study. All of the patients showed significant responses to both doses of terbutaline and after epinephrine as compared to placebo (greater than 15% increase in FEV1). In general, the side effects experienced were similar for 0.25 mg epinephrine and 0.25 mg terbutaline. They were slightly more pronounced with 0.5 mg of terbutaline. In terms of duration of action, there was a substantial difference between the duration of effect of subcutaneous epinephrine and subcutaneous terbutaline at both dosages. No cardiovascular side effects of any significance were noted in this study with either agent. We conclude that subcutaneous terbutaline is at least as effective as epinephrine in the management of reversible bronchospasm and may be considered a drug of choice in stable asthmatics.