Shortening osteotomy and compression plating for atrophic humeral nonunions: surgical technique.

The incidence of nonunion after humeral shaft fractures is low with both operative and nonoperative interventions. However, when a delayed union or nonunion occurs, it can be a very debilitating, leading to limited function and pain. Several methods have been described for the management of humeral diaphyseal nonunions.

Systemic host immuno-inflammatory response to dental extractions and periodontitis.

Objectives: Little is known about the host immuno-inflammatory response to dental extractions. The purpose of this pilot clinical study was to explore the effect of both periodontitis and dental extractions on the host systemic immuno-inflammatory response.

Study Design: We recruited and collected baseline blood samples on 41 essentially healthy patients.

Bacteremia associated with toothbrushing and dental extraction.

Background: Antibiotic prophylaxis recommendations for the prevention of infective endocarditis are based in part on studies of bacteremia from dental procedures, but toothbrushing may pose a greater threat. The purpose of this study was to compare the incidence, duration, nature, and magnitude of endocarditis-related bacteremia from single-tooth extraction and toothbrushing and to determine the impact of amoxicillin prophylaxis on single-tooth extraction.

Methods And Results: In this double-blind, placebo-controlled study, 290 subjects were randomized to (1) toothbrushing, (2) single-tooth extraction with amoxicillin prophylaxis, or (3) single-tooth extraction with identical placebo.

Utility of an international normalized ratio testing device in a hospital-based dental practice.

Objectives: The authors aimed to evaluate the utility of an in-office international normalized ratio (INR) testing device in identifying patients with INR test values considered out of the normal range for dental procedures.

Methods: This prospective cohort study involved use of an INR testing device to obtain INR test values in the dental office for patients thought to be at risk of experiencing bleeding complications after undergoing invasive dental procedures. The authors recorded demographic, social and medical history data, as well as clinical signs and symptoms of liver disease.

Mycobacterium tuberculosis PE_PGRS16 and PE_PGRS26 genetic polymorphism among clinical isolates.

The Mycobacterium tuberculosis PE_PGRS multigene family is thought to be involved in antigenic variation, which can be generated by differential regulation of expression and a high frequency of genetic polymorphism. PE_PGRS16 and PE_PGRS26 are inversely regulated during persistent M. tuberculosis infection, suggesting that differential regulation of the expression of these two PE_PGRS genes may have a role in latency.

Dental treatment planning and management in the patient who has cancer.

The oral cavity has the potential to be a major source of short-term and long-term complications from cancer therapy. Appropriate evaluation and elimination of potential sources of oral infection before cancer therapy is vital because oral bacteria are a known source of bacteremia and septicemia during cancer therapy. Cancer diagnosis with previous and planned treatment, past medical history, past dental history, current medications, drug allergies, social history, family history, laboratory values, extraoral findings, intraoral findings, and radiographic findings must all be evaluated in planning dental treatment for these complex cases.

Oral health needs and barriers to dental care in hospitalized children.

The goal of this study was to examine the oral health status and utilization of dental care reported by hospitalized children. A bedside oral examination was performed on hospitalized children. Past dental treatment and current oral health needs were assessed.

Radiation-induced trismus in head and neck cancer patients.

Purpose: To determine the incidence of trismus in patients who had previously received curative doses of radiation therapy (RT) for head and neck cancer. In addition, we assessed if trismus was associated with quality of life deficits and radiation toxicity.

Methods And Materials: Between February, 2005 and December, 2006, 40 patients with histologically confirmed head and neck cancer who had received curative doses of RT to the area(s) of the masticatory muscles and/or the ligaments of the temporomandibular joint (TMJ) were enrolled in this study.

Professionalism among allied health staff. The PLEASE CARE program.

Professionalism affects the quality of medical care in terms of clinical outcomes, safety, and service. Although often talked about by physicians, professionalism is important for all who are engaged in clinical care. In our continuous effort to improve quality at Mayo Clinic, we hypothesized that patient satisfaction was affected by the professionalism of the allied health staff.

Thigh muscle stiffness assessed with magnetic resonance elastography in hyperthyroid patients before and after medical treatment.

Purpose: To measure the stiffness of the vastus medialis (VM) in hyperthyroid patients before and after treatment.

Materials And Methods: A total of five healthy euthyroid patients and five hyperthyroid patients were tested using magnetic resonance elastography (MRE), which involves the induction of shear waves in the thigh muscles using a pneumatic driver at 90 Hz.

Results: Among the pretreatment hyperthyroid cohort a lower stiffness was found when the muscle was relaxed (2.

Development of new tuberculosis vaccines: a global perspective on regulatory issues.

What are the regulatory challenges for testing and introducing investigative TB vaccines into countries where the disease is endemic?

Aspirin and bleeding in dentistry: an update and recommendations.

Aspirin use in the United States remains high because of its diverse and beneficial activities. In adults at risk for cardiovascular thrombotic events, low-dose aspirin is an excellent preventive agent; however, its antiplatelet properties have contributed to a perceived increased risk for bleeding after dental extractions. This article discusses recent evidence regarding the thrombotic risks associated with discontinuing aspirin use in patients who take aspirin daily and presents a new recommendation for continuing low-dose aspirin during invasive dental procedures.

Endocrinopathy in POEMS syndrome: the Mayo Clinic experience.

Objective: To determine the prevalence and characteristics of endocrinopathies at diagnosis of POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) syndrome.

Patients And Methods: From January 1, 1960, through June 30, 2006, we identified 170 patients with POEMS syndrome in the Mayo Clinic dysproteinemia database. We abstracted information about endocrine abnormalities from their medical records.

Prevalence and characteristics of breakthrough pain in patients receiving opioids for chronic back pain in pain specialty clinics.

Objective: We sought to assess the prevalence and characteristics of breakthrough pain (BTP) in patients with chronic back pain.

Design: Researchers utilized a telephone survey using a pain assessment algorithm. This report represents a subset of patients from a larger survey of 228 patients with chronic pain unrelated to cancer.

The effect of computerized physician-order entry on outpatient prescription errors.

Little information is available regarding the use of computerized physician-order entry (CPOE) in the outpatient setting or the role of pharmacists in preventing prescription errors with CPOE. This study evaluated the effect of CPOE on pharmacist-intercepted prescription errors in the outpatient setting by using data collected from a retrospective survey of 4527 prescriptions ordered in the outpatient clinics of a tertiary academic center between 1996 and 2002. The use of CPOE increased from 1% in 1996 to 59% in 2002 (P < .

The evidence base for the efficacy of antibiotic prophylaxis in dental practice.

Introduction: People with various medical conditions and devices are suggested candidates for receiving antibiotic prophylaxis before undergoing dental procedures. This practice is controversial, however, owing to the lack of proof of efficacy. The authors conducted a qualitative, systematic review to determine the level of evidence for this practice and whether antibiotic prophylaxis prevents distant site infections in these patients.

Salivary dysfunction associated with systemic diseases: systematic review and clinical management recommendations.

Objectives: The objective of this study was to identify systemic diseases associated with hyposalivation and xerostomia and develop evidence-based management recommendations for hyposalivation/xerostomia.

Study Design: Literature searches covered the English language medical literature from 1966 to 2005. An evidence-based review process was applied to management studies published from 2002 to 2005.

Molecular analysis of oral and respiratory bacterial species associated with ventilator-associated pneumonia.

Trauma intensive care unit (TICU) patients requiring mechanical respiratory support frequently develop ventilator-associated pneumonia (VAP). Oral and oropharyngeal bacteria are believed to be responsible for many cases of VAP, but definitive evidence of this relationship is lacking. Earlier studies used conventional culture-based methods for identification of bacterial pathogens, but these methods are insufficient, as some bacteria may be uncultivable or difficult to grow.

Modified Child-Pugh score as a marker for postoperative bleeding from invasive dental procedures.

Objective: The objective of this study was to determine if the modified Child-Pugh score (MCP) is associated with peri- and postoperative bleeding complications from invasive dental procedures in patients with advanced liver disease.

Study Design: Patients with advanced liver disease who underwent an invasive dental procedure were identified retrospectively. The following information was collected for each patient: demographics, the MCP values (albumin, bilirubin, prothrombin time [PT], ascites, and encephalopathy), platelet count, adjunctive postoperative procedures (APPs) (e.

Management of oral epithelial dysplasia: a review.

One of the goals of the fourth meeting of The World Workshop on Oral Medicine (WWOM IV) included a review of the pathophysiology and future directions for the clinical management of patients with oral epithelial dysplasia, excluding the lips and oropharynx. In the pathophysiology review of dysplasia since WWOM III (1998-2006), a wide range of molecular changes associated with progression of dysplasia to squamous cell carcinoma were found. These include loss of heterozygosity, dysregulation of apoptosis, aberrant DNA expression, and altered expression of numerous tissue markers.

An evaluation of perceived education and training needs of staff nurses and care officers.

This study was carried out to ascertain the specific education and training needs of nursing and care officer staff working at the Central Mental Hospital (CMH) in Dublin, Ireland, which provides national forensic psychiatric services. This is the first time an education and training needs analysis was conducted for all nursing and care officer staff.