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Practical Neurology Feb 2020Epilepsy surgery offers the chance of seizure remission for the 30%-40% of patients with focal epilepsy whose seizures continue despite anti-epileptic medications.... (Review)
Review
Epilepsy surgery offers the chance of seizure remission for the 30%-40% of patients with focal epilepsy whose seizures continue despite anti-epileptic medications. Epilepsy surgery encompasses curative resective procedures, palliative techniques such as corpus callosotomy and implantation of stimulation devices. Pre-surgical evaluation aims to identify the epileptogenic zone and to prevent post-operative neurological and cognitive deficits. This entails optimal imaging, prolonged video-electroencephalogram (EEG) recordings, and neuropsychological and psychiatric assessments; some patients may then require nuclear medicine imaging and intracranial EEG recording. The best outcomes are in those with an electro-clinically concordant structural lesion on MRI (60%-70% seizure freedom). Lower rates of seizure freedom are expected in people with extra-temporal lobe foci, focal-to-bilateral tonic-clonic seizures, normal structural imaging, psychiatric co-morbidity and learning disability. Nevertheless, surgery for epilepsy is under-used and should be considered for all patients with refractory focal epilepsy in whom two or three anti-epileptic medications have been ineffective.
Topics: Anticonvulsants; Drug Resistant Epilepsy; Electroencephalography; Epilepsies, Partial; Humans; Intraoperative Neurophysiological Monitoring; Preoperative Care; Seizures; Stereotaxic Techniques
PubMed: 31420415
DOI: 10.1136/practneurol-2019-002192 -
Primary Dental Journal Sep 2020Improvements in oral health including increased retention of natural teeth have given rise to a partially dentate older population. Replacement of missing natural teeth...
Improvements in oral health including increased retention of natural teeth have given rise to a partially dentate older population. Replacement of missing natural teeth is important to improve function, aesthetics and quality of life for this patient group. A variety of options are available to replace missing teeth in partially dentate older adults, including fixed, removable and implant retained prostheses. This article will discuss the provision of removable partial dentures including treatment planning and denture design. When planning removable partial dentures, careful attention must be paid to stabilising the patient prior to delivering any prosthesis. Partial dentures should be designed to minimise the potential for plaque accumulation with carefully designed metal based frameworks. Acrylic resin can also be utilised with attention to detail to minimise the risk of damage to delicate supporting tissues. Removable dentures have the advantage that they can be readily added to in the event of further tooth loss which may be particularly relevant for older adults. Partial dentures which optimise support, retention and stability can function very successfully and significantly improve patients' oral health related quality of life.
Topics: Aged; Denture, Partial; Denture, Partial, Removable; Humans; Mouth, Edentulous; Quality of Life; Tooth Loss
PubMed: 32940586
DOI: 10.1177/2050168420943435 -
Seminars in Neurology Apr 2020Rasmussen encephalitis (RE) is a rare, devastating, progressive pediatric epilepsy. First described 60 years ago, RE continues to present challenges in diagnosis and... (Review)
Review
Rasmussen encephalitis (RE) is a rare, devastating, progressive pediatric epilepsy. First described 60 years ago, RE continues to present challenges in diagnosis and management. RE causes a unilateral focal epilepsy in children that typically becomes medically refractory, results in significant hemiparesis, and causes progressive cognitive decline. The etiology is a cell-mediated immune attack on one cerebral hemisphere, though the inciting antigen remains unknown. While the underlying histopathology is unilateral and RE is described as "unihemispheric," studies have demonstrated (1) atrophy of the unaffected hemisphere, (2) electroencephalographic abnormalities (slowing and spikes) in the unaffected hemisphere, and (3) cognitive decline referable to the unaffected hemisphere. These secondary contralateral effects likely reflect the impact of uncontrolled epileptic activity (i.e., epileptic encephalopathy). Hemispheric disconnection (HD) renders 70 to 80% of patients seizure free. While it has the potential to limit the influence of seizures and abnormal electrical activity emanating from the pathological hemisphere, HD entails hemiparesis and hemianopia, as well as aphasia for patients with dominant HD. With the recent expansion of available immunomodulatory therapies, there has been interest in identifying an alternative to HD, though evidence for disease modification is limited to date. We review what is known and what remains unknown about RE.
Topics: Child; Encephalitis; Epilepsies, Partial; Humans
PubMed: 32185790
DOI: 10.1055/s-0040-1708504 -
Journal of Prosthodontics : Official... Apr 2021Multiple clinical studies have been published comparing different philosophies of complete denture occlusion and different types of denture teeth. However, it is unclear... (Review)
Review
PURPOSE
Multiple clinical studies have been published comparing different philosophies of complete denture occlusion and different types of denture teeth. However, it is unclear whether comparable data are available for occlusal schemes used with removable partial dentures (RPDs). Therefore, this review investigated the dental literature related to occlusal schemes for RPDs.
MATERIALS AND METHODS
A PubMed search of English language articles was performed using the term "removable partial denture, occlusion" with 765 results. When the term "occlusion in removable partial prosthodontics" was used there were 784 results. Seventy-four articles were identified using the different search term of "RPD, occlusion" while use of the term "occlusal scheme, with removable partial dentures" listed 18 publications. The term "removable partial denture, occlusion, literature reviews" produced 38 potential publications related to the topic. Using the term "removable partial denture occlusion systematic review" resulted in 2 citations. Using the term "RPD occlusion literature review" resulted in one foreign language manuscript whereas using the term "RPD occlusion systematic review" resulted in one article unrelated to dentistry. The term "clinical studies of RPD occlusion" produced 5 results with none related to the topic. There were 23 results using the term "clinical studies of removable partial denture occlusion" with one potentially related to RPD occlusal schemes.
RESULTS
A review of the titles and abstracts revealed 12 articles that appeared to contain specific information about the occlusal scheme used with RPDs. Following a detailed review of those publications, only 4 contained recommendations for RPD occlusion and were included in this review. The available information regarding the recommendations for occlusal schemes in these articles was based on expert opinion. A decision was made to include a hand search of 9 textbooks containing varying amounts of information related to occlusal schemes for RPDs, but no evidence-based references related to RPD occlusal schemes were found in the textbooks. Since this entire review is based on expert opinion, no attempt was made to critique the opinions expressed by these authors but rather to present their perspectives for evaluation by readers.
CONCLUSIONS
The occlusion developed with RPDs should be physiologically harmonious, allowing the supporting structures to remain in a good state of health with functional stress distributed among all the occluding teeth. Multiple authors indicate the occlusion in maximum intercuspation/centric occlusion should incorporate bilateral posterior contacts with no deflective occlusal contacts. When most occlusal contacts on natural teeth are missing, it has been proposed that extension base RPDs have their occlusal contacts developed in centric occlusion. Regarding eccentric occlusal relationships, a balanced occlusal scheme has been recommended by multiple authors with one author advocating use of a lingualized balanced. An anterior guided (canine-protected) occlusion has also been recommended when the canines are present and not periodontally compromised. When RPDs oppose a complete denture, several authors indicate a bilateral balanced occlusion should be used to help stabilize the complete denture.
Topics: Dental Occlusion; Dental Occlusion, Balanced; Denture Design; Denture, Complete; Denture, Partial, Removable
PubMed: 33783088
DOI: 10.1111/jopr.13313 -
Materials (Basel, Switzerland) Dec 2021To investigate in vitro post-fatigue fracture behavior of endodontically treated molars having been differently restored.
OBJECTIVES
To investigate in vitro post-fatigue fracture behavior of endodontically treated molars having been differently restored.
METHODS
A total of 120 extracted human molars were used. A total of 120 specimens in 14 test groups and one control group ( = 8) were root canal treated. After postendodontic sealing and build-up (AdheSE Universal, SDR), additional MOD preparations were cut. Postendodontic restorations were: Direct restorations (Tetric EvoCeram BulkFill bonded with AdheSE Universal and EverX Posterior/Essentia bonded with G-Premio Bond; as filling (F) or direct partial crown (DPC) after reducing the cusps 2 mm; indirect adhesive restorations (partial crown/PC vs. full crown/FC): e.max CAD, Celtra Duo, both luted with Variolink Esthetic; indirect zirconia restorations (partial crown/PC vs. full crown/FC), luted with RelyX Unicem 2; indirect non-bonded cast gold restorations (partial crown/PC vs. full crown/FC; Degunorm), luted with Ketac Cem. Before and after 300,000 thermocycles (5/55 °C) and 1.2 Mio. A total of 100 N load cycles, replicas were analyzed under a SEM for marginal quality in enamel and dentin (where applicable) and finally, specimens were loaded until fracture.
RESULTS
In direct groups, there was no difference between RC and FRC in fracture strength ( > 0.05); however, direct partial crowns showed higher post-fatigue fracture resistance. Regarding marginal quality, intracoronal FRC restorations exhibited more gap-free margins in enamel than RC. In the indirect groups, there was no significant difference between partial and full crowns in any of the adhesively luted ceramic groups regarding post-fatigue fracture resistance. Zirconia partial crowns exhibited significantly lower marginal quality in enamel. Indirect groups performed significantly better than direct groups in fracture resistance. Within the indirect restorations, both cast gold groups and zirconia full crowns exhibited the highest fracture resistance being superior to control teeth.
SIGNIFICANCES
Within the limits of this in vitro investigation, it can be concluded that any kind of indirect restoration with cusp replacement is suitable for ETT restoration when a certain cavity extension is exceeded. All indirect restorations, i.e., endocrowns, partial crowns, and full crowns showed a promising performance after in vitro fatigue-loading.
PubMed: 34947327
DOI: 10.3390/ma14247733 -
Materia Socio-medica Sep 2022Partial arhinia is an extremely rare congenital malformation with an unclear pathogenesis. In this condition, the external nasal structures and nasal passages are...
BACKGROUND
Partial arhinia is an extremely rare congenital malformation with an unclear pathogenesis. In this condition, the external nasal structures and nasal passages are absent, and it can be associated with somatic anomalies, other craniofacial abnormalities, severe feeding, and airway compromise.
OBJECTIVE
In this article, we describe a case of a baby born with congenital partial arhinia at Prince Rashid AlHasan Hospital in Irbid, Jordan.
CASE PRESENTATION
Her condition was associated with microcephaly, hypotelorism, cleft palate, microphthalmia, and micrognathia. The baby was the result of an unplanned pregnancy; the mother had received a Zoladex implant 2 months before the pregnancy as a treatment for endometriosis.
CONCLUSION
Congenital partial arhinia could be associated with dangerous life-threatening complications such as feeding and airway compromise. Management of the condition is essential and urgent, including surgical correction as needed by a highly skilled team.
PubMed: 36310750
DOI: 10.5455/msm.2022.34.225-227 -
Presse Medicale (Paris, France : 1983) Nov 2021Lipodystrophies are a heterogeneous group of rare conditions characterised by the loss of adipose tissue. The most common forms are the familial partial lipodystrophy... (Review)
Review
Lipodystrophies are a heterogeneous group of rare conditions characterised by the loss of adipose tissue. The most common forms are the familial partial lipodystrophy (FPLD) syndromes, which include a set of disorders, usually autosomal dominant, due to different pathogenetic mechanisms leading to improper fat distribution (loss of fat in the limbs and gluteal region and variable regional fat accumulation). Affected patients are prone to suffering serious morbidity via the development of metabolic complications associated to insulin resistance and an inability to properly store lipids. Although no well-defined diagnostic criteria have been established for lipodystrophy, there are certain clues related to medical history, physical examination and body composition evaluation that may suggest FPLD prior to confirmatory genetic analysis. Its treatment must be fundamentally oriented towards the control of the metabolic abnormalities. In this sense, metreleptin therapy, the newer classes of hypoglycaemic agents and other investigational drugs are showing promising results. This review aims to summarise the current knowledge of FPLD syndromes and to describe their clinical and molecular picture, diagnostic approaches and recent treatment modalities.
Topics: Body Composition; Exercise Therapy; Humans; Hypoglycemic Agents; Insulin Resistance; Leptin; Lipid Metabolism; Lipodystrophy, Familial Partial; Medical History Taking; Metabolic Diseases; Phenotype; Physical Examination; Syndrome
PubMed: 34610417
DOI: 10.1016/j.lpm.2021.104071 -
Updates in Surgery Jun 2021Although safe and feasible, partial adrenalectomy is not a widespread procedure. Endorsement of robotic technologies and fluorescence techniques in adrenal surgery might...
Although safe and feasible, partial adrenalectomy is not a widespread procedure. Endorsement of robotic technologies and fluorescence techniques in adrenal surgery might help develop partial adrenalectomy and could avoid unnecessary total adrenalectomies. When performed in selected cases, partial adrenalectomy is associated with good postoperative outcomes comparable with those reported after total adrenalectomy. It has been hypothesized that one of the advantages of the robotic approach in adrenal-sparing surgery is to reduce manipulation of the gland allowing preservation of the vascularization of the residual adrenal, overcoming some limits when performing a laparoscopic conventional approach. A major drawback of the robotic surgery is its cost, but the overcost due to the use of the robotic system could be balanced by the execution of a high number of partial adrenalectomies leading to fewer life-long replacement steroid treatment. Partial adrenalectomy could become the recommended management for small benign and hormonal active adrenal tumors. Indocyanine green fluorescence (IGF) also seems to be a useful technique to help surgeons identify the adrenal gland and to locate small tumors from the normal adrenal tissue in difficult patients. It is likely that the use of a robotic approach associated with IGF may extend indications of partial adrenalectomy in the years to come.
Topics: Adrenal Gland Neoplasms; Adrenalectomy; Humans; Indocyanine Green; Laparoscopy; Robotic Surgical Procedures; Robotics
PubMed: 33411221
DOI: 10.1007/s13304-020-00957-6 -
Journal of Prosthodontic Research 2023
Topics: Denture, Partial; Denture, Partial, Removable
PubMed: 37839869
DOI: 10.2186/jpr.JPR_D_23_00246