Myositis ossificans circumscripta of the buccinator muscle: First report of a rare complication of mandibular third molar extraction

Myositis ossificans is a self-limiting ossifying process that most often develops following mechanical trauma to skeletal musculature. It chiefly affects the skeletal muscles of extremities of young athletically active adult males. Myositis ossificans is rare in children except for children affected byheritable disorder known as progressive myositis ossificans (fibrodysplasia ossificans progressiva). Children with this disorder develop ossification of muscles and associated soft tissue in early childhood without prior history of trauma. Traumatic form of myositis ossificans also known as myositis ossificans circumscripta (MOC) is rarely encountered in the head and neck musculature. We report a case of MOC within the buccinator which developed as a postoperative complication of mandibular third molar surgery. During extraction of a left mandibular third molar in a 16-year oldmale, a tooth fragment was accidently displaced into the adjacent soft tissue. Retrieval of this tooth fragment caused significant soft tissue trauma. Eighteen months after his third molar surgery, the patient continued to have pain and tenderness anterior to the left mandibular ramus. Radiographic imaging revealed a well-defined ovoid radiopaque mass within the left buccinator muscle. The lesion was surgically removed and the post-surgical course of the patient was uneventful. Histologicalfindings of the mass were characteristic for myositis ossificans.(AU)

Interoperability of a mobile health care solution with electronic healthcare record systems.

Mobile health care solutions involving patient monitoring are an increasingly accepted element in chronic disease management strategies. When used in healthcare systems with different providers, it is essential that the information gathered from the patient is available at each of these providers information repositories. This paper describes the design of a connectivity interface based on the HL7 standard that allows the MOTOHEALTH mobile health care solution to communicate with external electronic healthcare record systems supporting HL7.

What are the facts concerning the number of residency positions in Canada?

Some physicians think the current squeeze facing postgraduate medical education was caused by cuts in the number of residency positions. The authors consulted the Canadian Post-MD Education Registry database to determine the actual state of postgraduate training opportunities and to correct erroneous views that may be affecting the debate over training positions. The danger, they say, is that misinformation may lead to inappropriate strategies for dealing with current challenges.

Relation of cardiovascular responses to mental stress and cardiac vagal activity in coronary artery disease.

Forty-six patients with documented coronary artery disease were studied to examine the relation of cardiovascular reactivity to mental stress and cardiac vagal activity. Cardiac vagal activity was measured by means of frequency-domain analysis of heart rate variability with 48-hour out-of-hospital Holter monitoring. The amplitude of the high-frequency component (0.16 to 0.40 Hz) of heart rate variability is considered to be an index of cardiac vagal activity. Cardiovascular reactivity was measured in the laboratory during a 3-minute public speaking task. Results revealed that (1) the amplitude of the high-frequency component was significantly higher during sleep (24.6 +/- 11.3 ms) than during waking (18.2 +/- 8.0 ms) (p = 0.002); (2) compared to subjects with low diastolic blood pressure reactivity, those who displayed high diastolic blood pressure reactivity exhibited a significantly lower amplitude of the high-frequency component (19.2 +/- 6.9 vs 23.4 +/- 9.6 ms, p = 0.03). These results indicate that decreased cardiac vagal activity may contribute to the exaggerated diastolic blood pressure reactivity to mental stress in patients with coronary artery disease.

Tetanus: an uncommon cause of dysphagia.

A 53-year-old woman was examined at our medical center because of progressive dysphagia of 14 days' duration and a severe inability to open her mouth and swallow saliva. A barium esophagogram showed no obstruction, but pooling of barium in the hypopharynx suggested a neuromuscular disorder. The clinical diagnosis of tetanus was confirmed by electromyography. With appropriate therapy, the patient recovered during a period of 6 weeks. This case illustrates both an uncommon cause of dysphagia and an uncommon initial manifestation of tetanus.

Tetanus after anorectal abscess.

As illustrated by this case report, tetanus can occur as a complication of anorectal surgical procedures or abscesses just as it can in other wounds. A synergistic infection of the perineum occurred in a 62-year-old man 8 days after drainage of an anorectal abscess. He was treated with vigorous debridement and antibiotics and was given tetanus prophylaxis. The next day, tetanus developed, presumably from the original abscess. The patient recovered after aggressive therapy, including muscle relaxants and ventilatory support.

Milankovitch hypothesis supported by precise dating of coral reefs and deep-sea sediments.

Barbados provides a possibly unique opportunity for reconstruction of the times and elevations of late-Pleistocene high stands of the sea. The island appears to be rising from the sea at a uniform rate that is fast enough to separate in elevation coral-reef tracts formed at successive high stands of the sea. Unaltered coral found in the lower terraces enables high-precision Th(230): U(234) and Pa(231): U(235) dating. Three distinct high stands of the sea are found about 122,000, 103,000, and 82,000 years ago. New Pa(231) and Th(230) dates from a deep-sea core also indicate that Ericson's W-X cold-to-warm climatic change occurred close to 126,000 years ago. These data show a parallelism over the last 150,000 years between changes in Earth's climate and changes in the summer insolation predicted from cycles in the tilt and precession of Earth's axis.

Pleistocene age determinations from california and Oregon.

Mollusks have been collected from Pleistocene marine deposits at Tomales Bay, California, and Cape Blanco, Oregon. Dating by the carbon-14 and thorium-230-uranium-234 methods suggests that the shells are at least 33,000 years old. The more probable age of the Tomales Bay locality is >/= 50,000 years.