Diagnostic Performance of PET and Perfusion-Weighted Imaging in Differentiating Tumor Recurrence or Progression from Radiation Necrosis in Posttreatment Gliomas: A Review of Literature.

Tumor resection followed by chemoradiation remains the current criterion standard treatment for high-grade gliomas. Regardless of aggressive treatment, tumor recurrence and radiation necrosis are 2 different outcomes. Differentiation of tumor recurrence from radiation necrosis remains a critical problem in these patients because of considerable overlap in clinical and imaging presentations. Contrast-enhanced MR imaging is the universal imaging technique for diagnosis, treatment evaluation, and detection of recurrence of high-grade gliomas. PWI and PET with novel radiotracers have an evolving role for monitoring treatment response in high-grade gliomas. In the literature, there is no clear consensus on the superiority of either technique or their complementary information. This review aims to elucidate the diagnostic performance of individual and combined use of functional (PWI) and metabolic (PET) imaging modalities to distinguish recurrence from posttreatment changes in gliomas.

A Mini Review of Using the Oralift Appliance and a Pilot Study to See if 3D Imaging Techniques Could Improve Outcomes.

BACKGROUND: Occlusal appliances of various designs have been described in the literature. They usually have to be worn for substantial periods including night time to have the desired effect for which they are designed. The Oralift® appliance has been designed to address the signs of facial ageing and to help stop parafunctional habits. The appliance is based on the principles of the pivot appliance and is worn for very short periods, never at night and not even every day. The maximum usage recommended is two hours every third day. OBJECTIVE: This is a review of five patients who have been treated with Oralift® with the aim of assessing whether the visual changes seen by wearing the appliance can be quantified by changes in volume as measured by 3D Imaging, and if this quantification could be useful in improving the outcomes for each patient. METHODS: The patients were fitted with the appliances in general practice, and 2D images were taken before, during and after treatment. Afterwards, the patient attended King's College London, to have 3D imaging. RESULTS: 3D imaging has been proved far superior to standardized 2D photography in assessing the changes taking place on the face, and helped quantify the volume changes. CONCLUSION: To further improve the outcome for each patient, the 3D imaging should be done before the visit to the practitioner or ideally by the practitioner so that the results could be assessed, and the treatment adjusted accordingly. The implication of the volume changes requires a much larger study.

Peripheral blood T helper type 17 frequency shows an inverse correlation with disease activity and magnetic resonance imaging-based osteitis and erosions in disease-modifying anti-rheumatic drug- and steroid-naive established rheumatoid arthritis.

An increased expansion of T helper type 17 (Th17) cells in the synovium has been shown to play a key role in cartilage and bone destruction in rheumatoid arthritis (RA). Because the correlation of the peripheral blood helper T cell subsets and various inflammatory cytokines with the magnetic resonance imaging (MRI)-based parameters have not been studied adequately to date, we sought to look for the same in this study. RA patients with disease duration less than 36 months, disease-modifying anti-rheumatic drugs (DMARDs) and steroid-naive, were recruited. MRI of the dominant hand and wrist was performed using a 0·2 Tesla MRI machine. Peripheral blood Th1 and Th17 were enumerated by flow cytometry and serum interleukin (IL)-6 and IL-17 by enzyme-linked immunosorbent assay (ELISA). Forty consecutive seropositive RA patients [33 females, mean disease duration 12·2 months, mean disease activity score (DAS)28 = 4·4] were included. MRI revealed erosions in 80% of these subjects. On subgroup analysis, prevalence of erosions (94 versus 68%) as well as mean erosion score (11·5 ± 18·9 versus 3·5 ± 6·0) were significantly higher in established RA (13-36 months' duration) compared to early RA (0-12 months). The median peripheral blood Th17 frequencies were significantly higher in patients (1·4%) compared to healthy controls (0·7%) and had a strong negative correlation with MRI parameters of erosion and osteitis as well as with DAS28 in the established RA subgroup. The frequency of peripheral blood Th17 subset was significantly expanded in established RA which correlated inversely with disease activity as well as MRI based erosions and osteitis.

Survival of a patient with endopharyngeal common carotid blow out due to parapharyngeal abscess as an unusual complication of cholesteatoma.

Parapharyngeal abscess as a complication of cholesteatoma is an uncommon entity. Endopharyngeal common carotid artery rupture due to parapharyngeal abscess is also uncommon, and these cases usually end fatally. We present a 17-year-old male with parapharyngeal abscess due to cholesteatoma who developed an endopharyngeal common carotid blow out and survived after common carotid ligation without any neurological sequalae.

The effect of increasing vertical dimension of occlusion on facial aesthetics.

AIM: To investigate the effect of increasing the vertical dimension of occlusion on facial aesthetics. SETTING: General practice. METHOD: Questionnaires were sent to 96 patients who had been treated in the practice during the period of July 1998 to December 2000, resulting in an overall 72% response rate. All these patients had had their occlusal vertical dimension increased. Photographs of patients were taken before, during and after treatment. The questionnaire asked their opinion on the effects of the treatment on their facial features. To obtain an objective view to substantiate the opinions of the patients, a panel of five judges reviewed the before and after photographs and filled in their own questionnaires. RESULTS: Of the patients who responded to the questionnaire, 79.7% said they looked younger after the treatment. The panel thought 81.2% of the patients treated whose photographs they reviewed looked younger. CONCLUSION: Increasing the vertical dimension of occlusion can have far reaching effects on facial aesthetics, not just on the peri-oral areas but on the whole face.

In pursuit of an added dimension.

For dentists working in general practice, undertaking research is not an easy path to take. I know from my own experience that there are many problems, such as cost, time, and lack of training in methodology. However, I feel it is paramount that GDPs do carry out research and that originality of thought and individuality be allowed to flourish. The profession can only benefit from such challenges.

A preliminary report on the determination of the vertical dimension of occlusion using the principle of the mandibular position in swallowing.

When constructing replacement complete dentures, trying to estimate the correct occlusion vertical dimension (OVD) can be difficult. This paper describes a method of using the swallowing method to estimate the correct OVD and to form occlusal pivots on old dentures prior to constructing new ones. The method has been used on 21 patients. The mean increase in the OVD was 9.7 mm with the largest increase being 19 mm and the smallest 3 mm. All the increases in OVD were done in one step, there were no gradual build-ups. New dentures were constructed to the height of the pivots once the patients were comfortable with the modified old dentures. In three cases the OVD had to be reduced once the dentures had been constructed but in all other cases the patients continued to wear their new dentures. All 21 patients answered a questionnaire about their new dentures. All of them were wearing their new dentures, and 18 out of 21 patients thought that their new dentures were better than their previous ones.

Noise effects in free recall with different orienting tasks.

Subjects were shown either a list of non-associated words or a list on which words could be organized into related groups. In Expt 1 either no orienting instructions were given or subjects had to rate the words for Pleasantness (semantic orienting task). The three-way interaction of noise x list type x orienting task was significant. Eighty-five dBC white noise compared with 65 dBC improved performance on the non-associated list with no orienting task and increased recall in the original sequence, but had the reverse effect with semantic orienting. With the associated list noise had no marked effects in the non-orienting condition, and improved performance in the orienting condition. It is concluded that in noise maintenance rehearsal tends to be adopted unless instructions induce an alternative strategy, and in the latter event noise reinforces use of the alternative strategy. In Expt 2, all subjects carried out a physical orienting task, rating the words for the sounds they contained. Noise aided performance on the non-associated list and impaired it on the associated list. This result is taken to be compatible with the above interpretation of noise effects.

Effects of subvocal suppression, articulating aloud and noise on sequence recall.

Subjects were required to reproduce in order a sequence of five letters; the set of letters was known so only memory for sequence was tested. Experiment 1 showed that suppressing subvocal rehearsal by saying 'the' continously during list presentation and until recall depressed performance to the same level on acoustically confusable and non-confusable lists. Listening to 85 dBC white noise during list presentation improved performance on acoustically confusable lists in non-suppression conditions and had no effect in suppression conditions. The result refutes the hypothesis that noise suppresses inner speech. Expts 2, 3 and 4 showed that articulating the items aloud during list presentation and until recall improved performance when lists were presented at 1/2 s per item and depressed it when they were presented at 2 s per item. Improvement occurred under 85 dBC white noise in Expts 2 and 4, but the improvement was only significant in non-articulation conditions. It is suggested that noise increases subvocal articulation and that both noise and articulation increase maintenance rehearsal at the expense of elaboration rehearsal.