Myxoid angiomyoma of the hard palate: a case report.

Angiomyomas are found with some frequency in the female genital tract. They can also appear in both sexes in the gastrointestinal tract and in the skin. The oral cavity is an unusual site for an angiomyoma. In this article, we describe the case of a 74-year-old woman who came to us with a nodule at the palatal midline. Following surgical excision of the growth and stent placement over the wound site, a biopsy analysis was performed. Histology of the removed tissue revealed an unusual variant of an angiomyoma: a myxoid angiomyoma.

Effect of camera angulation on adaptation of CAD/CAM restorations.

PURPOSE: A significant concern with computer-assisted design/computer-assisted manufacturing (CAD/CAM)-produced prostheses is the accuracy of adaptation of the restoration to the preparation. The objective of this study is to determine the effect of operator-controlled camera misalignment on restoration adaptation. MATERIALS AND METHODS: A CEREC 2 CAD/CAM unit (Sirona Dental Systems, Bensheim, Germany) was used to capture the optical impressions and machine the restorations. A Class I preparation was used as the standard preparation for optical impressions. Camera angles along the mesio-distal and buccolingual alignment were varied from the ideal orientation. Occlusal marginal gaps and sample height, width, and length were measured and compared to preparation dimensions. For clinical correlation, clinicians were asked to take optical impressions of mesio-occlusal preparations (Class II) on all four second molar sites, using a patient simulator. On the adjacent first molar occlusal surfaces, a preparation was machined such that camera angulation could be calculated from information taken from the optical impression. Degree of tilt and plane of tilt were compared to the optimum camera positions for those preparations. RESULTS: One-way analysis of variance and Dunnett C post hoc testing (alpha = 0.01) revealed little significant degradation in fit with camera angulation. Only the apical length fit was significantly degraded by excessive angulation. The CEREC 2 CAD/CAM system was found to be relatively insensitive to operator-induced errors attributable to camera misalignments of less than 5 degrees in either the buccolingual or the mesiodistal plane. The average camera tilt error generated by clinicians for all sites was 1.98 +/- 1.17 degrees.

Alternative treatments for a traumatic bone cyst: a longitudinal case report.

A patient presented with a large, multilocular, refractory traumatic bone cyst. The radiolucency had increased in dimension since her last recall. Over 11 years, therapy had included needle aspiration biopsies followed by simple curettage and closure, the most common therapy for traumatic bone cysts. However, all treatment had proved unsuccessful for this patient. It was decided to treat the patient with a slightly unique method. After curettage of the lesion, the traumatic bone cyst was packed with a mixture of autogenous blood, harvested autogenous bone chips, and hydroxyapatite.

Considerations in the management of the pregnant patient.

Traditionally, general dentists have been reluctant to treat pregnant patients due to uncertainty of the risks that might be imposed on both the mother and the fetus. However, preventive, emergency, and routine dental procedures are all suitable during various phases of a pregnancy, with some treatment modifications and initial planning. This article will review some of the physiologic changes and oral pathology associated with pregnancy, and how these alterations affect dental care for the patient. A brief discussion concerning the risks and benefits of radiation, certain medications, and pre-natal fluoride is also given. Additionally, an overview of possible obstetric emergencies that may arise during a general dental appointment is presented with treatment options outlined.

Glycogen storage disease and von Willebrand's disease implications for dental treatment: dental management of a pediatric patient.

Glycogen storage diseases (GSD) are metabolic disorders which impair the body's ability to store glucose and utilize it later, requiring patients to take multiple daily dietary supplementation with a high carbohydrate content. Patients undergoing this treatment modality are placed at increased risk for gross dental caries and other oral abnormalities. Additionally, GSD may prolong the patient's bleeding time, which may necessitate consultation with the treating physician. In the following case, our patient required a multidisciplinary approach to address not only her dental needs, but also to coordinate the management of both her GSD and an additional complication, von Willebrand's disease. This was best achieved in a hospital setting.

Monoamine oxidase inhibitors. An update on drug interactions.

After initial enthusiasm, the use of monoamine oxidase inhibitors (MAOIs) has been limited by the wide range of MAOI-drug and MAOI-food interactions that are possible, particularly with sympathomimetic medications or tyramine-containing foods, resulting in hypertensive reactions. Despite their clinical benefits, this has led to a reduction in use of such medications. Discovery of the 2 main subgroups of monoamine oxidase, types A and B, led to the synthesis of MAOIs selective for one or other of these isoenzymes. Consequently, selegiline (deprenyl), a selective MAO-B inhibitor, was developed for the treatment of idiopathic Parkinson's disease. This drug is useful in the treatment of the early stages of the disease and later on as an adjunct to other drug therapies. Although the selective MAO-A inhibitor, clorgiline (clorgyline), was found to be effective in the treatment of depression, it still retained the potential to cause hypertensive reactions. Recently, agents that are not only selective, but reversible in their inhibition of MAO-A (RIMAs) have been synthesised (e.g. moclobemide and toloxatone), and have proven antidepressant efficacy. Whilst they are less likely to induce hypertensive reactions with the concomitant administration of sympathomimetic drugs or with tyramine-rich foodstuffs, it still seems wise to advocate care in co-prescribing potentially interacting medications and to advise a degree of caution with regard to the dietary intake of foodstuffs likely to contain a high tyramine content. Although these newer drugs represent an advance in safety, their use has, as yet, only been established in the treatment of depression. RIMAs also retain a potential for adverse interaction with other drugs. Concomitant prescription of serotonin-enhancing drugs should only be undertaken with caution for patients on moclobemide, toloxatone or selegiline. Coprescription of sympathomimetic drugs should also be avoided with these newer MAOIs and patients should be advised against purchasing over-the-counter preparations that may contain sympathomimetic drugs.

Minaprine and dose response in depression. An investigation of two fixed doses of minaprine compared with imipramine.

One hundred and twelve patients suffering from moderate to severe major depression (DSM III) were enrolled into a study to compare the antidepressant activity and side effect profiles of two dosage groups of minaprine (200 mg and 300 mg per day) and one of imipramine (150 mg per day) in psychiatric practice. Eight patients were withdrawn because of unwanted effects (four imipramine, one minaprine 200 mg, three minaprine 300 mg) and seventy-eight spontaneous reports of unwanted effects were made from the imipramine group compared with sixty-four from the minaprine 200 mg and forty-six from the minaprine 300 mg groups. The main efficacy analysis was carried out at 4 weeks on the 89 evaluable patients who completed 2 weeks active treatment, the last observation being carried forward in those patients who did not complete. A secondary analysis was also carried out at 6 weeks. The response in all three treatment groups showed a significant improvement from the severity at entry to the study, and the response rate to minaprine 200 mg daily was similar to that of imipramine (53% vs 54% achieving a reduction of 50% or more on the Hamilton Depression Rating Scale by week 6), although, given the small group sizes, similar efficacy cannot be claimed. In the intention to treat analysis there was a significant dose response relationship with significantly more patients in the lower minaprine 200 mg dose group achieving 50% or more reduction in the Hamilton Rating Scale than the minaprine 300 mg group at week 4 (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

The Glasgow Assessment Schedule: clinical and research assessment of head injury outcome.

A new rating instrument, the Glasgow Assessment Schedule (GAS), is described for the evaluation of head injury outcome. The instrument, which has been used in samples of head-injured men, provides for a comprehensive assessment, and can distinguish mildly and severely injured patients and rate change over time. Inter-rater reliability and concurrent validity with a global rating scale has been found to be satisfactory. It is expected that the GAS will mainly be of use in clinical and research settings in which longer-term management is envisaged.