Time Of Clinical Examination Research Articles

Papillon-LefÈvre Syndrome: Report of Two Cases in Siblings

<h3>Introduction</h3> Papillon-Lefèvre syndrome (PLS) is an unusual health condition manifested by pre-pubertal extensive periodontal disease that results in early tooth loss and palmoplantar keratosis. The etiology of PLS is loss-offunction mutations in the cathepsin C gene. This gene is a lysosomal protease that plays an essential role in immune and inflammatory responses. <h3>Case Presentation</h3> We present two cases in siblings with PLS. The parents of the patients are relative. The first patient is 20 years old who presented to the clinic with highly resorbed maxillary and mandibular alveolar ridges with only wisdom teeth remaining in the oral cavity at the time of examination. According to the dental history, there was aggressive periodontitis followed by complete destruction of the periodontium and severe bone resorption. There was skin manifestations of PLS including palmoplantar and dorsal keratosis in their extremities as well as the knee and wrist joint regions. The second sibling was 9 years old with only skin manifestations similar to the older sibling. The periodontal status of the younger patient was stable at the time of clinical examination. Interestingly, they reported that their 16-year-old female cousin also suffers from the same condition, with almost the same clinical manifestations as the older sibling. <h3>Conclusion</h3> We report two cases of PLS in patients of same family, which supports the hereditary nature of cathepsin C mutation in PLS patients. In addition, variability of clinical expression of PLS is very evident in the current cases, which reflects that the PLS can show a broad spectrum of clinical features.

The diagnostic value of squirting rectal bleeding: The first description of such bleeding pattern

Background and objective: Rectal bleeding is a common symptom that has many patterns, but none of them are accurately diagnostic. One newly noticed pattern can be diagnostic, namely, the squirting pattern, for which this study was conducted. Methods: The study was conducted between Jan 2013 and Jun 2018, including 132 patients who presented with a squirting pattern of rectal bleeding, which is thought to be due to hemorrhoids. All these patients underwent clinical evaluation and anoscopy, and the majority (n=94) underwent colonoscopy. Results: At the time of clinical examination, 23 patients showed actively bleeding hemorrhoids. Fifteen patients were not convinced to undergo colonoscopy. The rest (n=94) who had no visible active bleeding at the time of examination underwent a colonoscopy to exclude other possible rectal or colonic pathology. All the 94 colonoscopies were negative for other bleeding sources. Two patients showed single benign non bleeding polyps, which were excised and biopsied. Conclusion: This study highlights a pattern of rectal bleeding that is not described before and proved it is a reliable diagnostic pattern for hemorrhoids. It also showed that colonoscopy is not needed in patients below 40 years complaining of squirting rectal bleeding unless indicated for some other reason. This decision is to be made very carefully. Keywords: Squirting rectal bleeding; Hemorrhoids; Colonoscopy.

Assessment of the success rate of endodontically treated patients attending outpatient polyclinic.

Objectives:The aim of this study is to determine the success rate of the endodontically treated teeth in patients attending the Polyclinic, Kulliyyah of Dentistry, International Islamic University Malaysia (IIUM), from 2012 to 2015.Materials and Methods:A retrospective study involved endodontically treated teeth of patients attending the Polyclinic, Kulliyyah of Dentistry, IIUM, from 2012 to 2015. Clinical and radiographic data were recorded and classified as successful or failed, and further analyzed by Fisher's exact test to measure the correlation between the variables using SPSS software version 16.0. Kappa test was used to measure the overall relationship between clinical and radiographic findings.Results:A total of sixty teeth were evaluated clinically and radiographically, the overall success rate was 85% (n = 51). Correlation between the variables showed nonsignificant (P > 0.05) in the success rate among age, gender, and race, upper and lower arches and between anterior and posterior teeth at the time of treatment. At postendodontic fixed restorations, the variables showed statistically significant relationship with the success rate (P < 0.05).Conclusions:Patients with no signs and symptoms and with no radiographical changes at the the time of clinical examination, showed the highest percentage of success rate (85%) of postendodontic fixed restorations. Age, gender, and race have no significant relations with the success rate of endodontically treated teeth.

Description and post-operative evaluation of tie-in technique in tibial osteosynthesis in dogs

ABSTRACT: The aim of this study was to describe and analyse the adaptability and functionality of tie-in configuration in tibial osteosynthesis in dogs. Twenty dogs with tibial fracture were included in this study. An orifice was made on the proximal tibial fragment, on the medial side, close to the tibial crest. The drill piece was angled at 45º and projected into the same orifice on the distal sense of the bone. Others orifices made with the aid of a low rotation drill and drill piece with diameter smaller than the chosen implant. After 10 days post-operative, the animals were evaluated. X-ray analysis was performed at the time of clinical examination; immediate post-operative period; and at 30, 60, 90, and 120 days post-surgery. A questionnaire was given to the owners to provide details on the post-operative period. There were no trans-operative complications or suture dehiscence up to the day of suture removal. Partial development of bone callus was observed in 20 dogs within a mean period of 76 days. Three animals showed bone consolidation within 35 days, nine by 60 days, three by 90 days, and 5 by 120 days post-operative. Dynamization was carried out in 9 animals. The surgical access to the tibial medullary canal through the orifice at the proximal medial face, by the tibial tuberosity, enables the insertion of IMP without risks to articular and peri-articular lesions in the knee in dogs.

Ten-Year Followup after Tension-Free Vaginal Tape-Obturator Procedure for Stress Urinary Incontinence

Suburethral tapes are a standard surgical treatment for stress urinary incontinence. The aim of the study was to evaluate subjective and objective cure rates 10 years after a tension-free vaginal tape-obturator procedure. All 124 patients who underwent the tension-free vaginal tape-obturator procedure at a total of 2 centers in 2004 and 2005 were invited for followup. Objective cure was defined as a negative cough stress test at 300 ml. Subjects completed KHQ (King's Health Questionnaire), IOQ (Incontinence Outcome Questionnaire), FSFI (Female Sexual Function Index Questionnaire) and PGI-I (Patient Global Impression of Improvement). Overall, 55 of 112 women (49%) who were alive were available for clinical examination and 71 (63%) completed the questionnaires. The objective cure rate in the 55 women examined clinically was 69%, 22% were not cured and 9% (5) had undergone reoperation for recurrent or persistent stress urinary incontinence. Treatment was counted as having failed in these 5 women for study purposes. Subjective cure was reported by 45 of 71 women (64%). Three patients (5%) had vaginal tape extrusion at the time of clinical examination. Extrusion in all of them was small and asymptomatic, and did not require treatment for a cumulative extrusion rate of 7%. Six women (9%) had undergone reoperation for tension-free vaginal tape-obturator associated complications and 18 (26%) experienced de novo overactive bladder. Subjective and objective cure rates 10 years after the tension-free vaginal tape-obturator procedure were 69% and 64%, respectively. The vaginal extrusion rate in this study was slightly higher than in other series but major long-term complications appeared to be rare.

Protocol for assessing maternal, environmental and epigenetic risk factors for dental caries in children.

BackgroundExpenditure on dental and oral health services in Australia is $3.4 billion AUD annually. This is the sixth highest health cost and accounts for 7 % of total national health expenditure. Approximately 49 % of Australian children aged 6 years have caries experience in their deciduous teeth and this is rising. The aetiology of dental caries involves a complex interplay of individual, behavioural, social, economic, political and environmental conditions, and there is increasing interest in genetic predisposition and epigenetic modification.MethodsThe Oral Health Sub-study; a cross sectional study of a birth cohort began in November 2012 by examining mothers and their children who were six years old by the time of initiation of the study, which is ongoing. Data from detailed questionnaires of families from birth onwards and data on mothers’ knowledge, attitudes and practices towards oral health collected at the time of clinical examination are used. Subjects’ height, weight and mid-waist circumference are taken and Body Mass Index (BMI) computed, using an electronic Bio-Impedance balance. Dental caries experience is scored using the International Caries Detection and Assessment System (ICDAS). Saliva is collected for physiological measures. Salivary Deoxyribose Nucleic Acid (DNA) is extracted for genetic studies including epigenetics using the SeqCap Epi Enrichment Kit. Targets of interest are being confirmed by pyrosequencing to identify potential epigenetic markers of caries risk.DiscussionThis study will examine a wide range of potential determinants for childhood dental caries and evaluate inter-relationships amongst them. The findings will provide an evidence base to plan and implement improved preventive strategies.

Comparison of serum amyloid A protein and C-reactive protein levels as inflammatory markers in periodontitis.

The purpose of this study was to compare serum amyloid A (SAA) protein levels with high-sensitive C-reactive protein (hs-CRP) levels as markers of systemic inflammation in patients with chronic periodontitis. The association of serum titers of antibodies to periodontal microbiota and SAA/hs-CRP levels in periodontitis patients was also studied. A total of 110 individuals were included in this study. Patients were assessed for levels of hs-CRP and SAA. Nonfasting blood samples were collected from participants at the time of clinical examination. The diagnosis of adipose tissue disorders was made according to previously defined criteria. To determine SAA levels, a sandwich enzyme-linked immunosorbent assay was utilized. Paper points were transferred to a sterile tube to obtain a pool of samples for polymerase chain reaction processing and the identification of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Tannerella forsythia. The serum level of IgG1 and IgG2 antibodies to P. gingivalis, A. actinomycetemcomitans, and T. forsythia was also determined. SAA and hs-CRP levels were higher in periodontitis patients than in controls (P<0.05). In bivariate analysis, high levels of hs-CRP (>3 mg/L) and SAA (>10 mg/L) were significantly associated with chronic periodontitis (P=0.004). The Spearman correlation analysis between acute-phase proteins showed that SAA positively correlated with hs-CRP (r=0.218, P=0.02). In the adjusted model, chronic periodontitis was associated with high levels of SAA (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.6-18.2; P=0.005) and elevated hs-CRP levels (OR, 6.1, 95% CI, 1.6-23.6; P=0.008). Increased levels of serum IgG2 antibodies to P. gingivalis were associated with high levels of SAA (OR, 3.6; 95% CI, 1.4-8.5; P=0.005) and high concentrations of hs-CRP (OR, 4.3; 95% CI, 1.9-9.8; P<0.001). SAA and hs-CRP concentrations in patients with chronic periodontitis are comparably elevated. High serum titers of antibodies to P. gingivalis and the presence of periodontal disease are independently related to high SAA and hs-CRP levels.

Poly Implant Prothèse (PIP) incidence of rupture: a retrospective MR analysis in 64 patients.

The purpose of this retrospective study was to describe the magnetic resonance imaging (MRI) features of Poly Implant Prothèse (PIP) hydrogel implants in a group of 64 patients and to assess the incidence of rupture, compared to other clinical trials. In this double-center study, we retrospectively reviewed the data sets of 64 consecutive patients (mean age, 43±9 years, age range, 27-65 years), who underwent breast MRI examinations, between January 2008 and October 2013, with suspected implant rupture on the basis of clinical assessment or after conventional imaging examination (either mammography or ultrasound). All patients had undergone breast operation with bilateral textured cohesive gel PIP implant insertion for aesthetic reasons. The mean time after operation was 8 years (range, 6-14 years). No patients reported history of direct trauma to their implants. At the time of clinical examination, 41 patients were asymptomatic, 16 complained of breast tenderness and 7 had clinical evidence of rupture. Normal findings were observed in 15 patients. In 26 patients there were signs of mild collapse, with associated not significant peri-capsular fluid collections and no evidence of implant rupture; in 23 patients there was suggestion of implant rupture, according to breast MRI leading to an indication for surgery. In particular, 14 patients showed intra-capsular rupture, with associated evidence of the linguine sign in all cases; the keyhole sign and the droplet signs were observed in 6 cases. In 9 patients there was evidence of extra-capsular rupture, with presence of axillary collections (siliconomas) in 7 cases and peri-prosthetic and mediastinal cavity siliconomas, in 5 cases. The results of this double center retrospective study, confirm the higher incidence (36%) of prosthesis rupture observed with the PIP implants, compared to other breast implants.

Tests for cured proportion for recurrent event count data – Uncensored case with covariates

Sumathi and Rao (2008) proposed a cure model for the recurrent event count data. The proposed model was based on the zero inflated Poisson (ZIP) distribution. Several tests were proposed for testing the cured proportion for recurrent event count data (Sumathi and Rao (2010)). In any health related studies, whether epidemiological or long term follow up studies, it is very essential for an investigator to record the information of patients regarding their demographic and socio-economic status as well as their medical history, at the time of clinical examination. These factors, commonly known as covariates, do play a vital role in influencing the health status of the individuals. The present paper is an extension of the work of Sumathi and Rao (2010). It proposes tests for testing the cured proportion in the presence of covariates when the data are uncensored. The covariates are related to the mean parameter of the proposed model, using the log link function. Although testing for p  0 has been done in the past (Broek (1995)), testing for 0 p  p has not been studied for the ZIP model. The small sample performances of the proposed tests are studied using simulations.

Maternal smoking during pregnancy and reproductive health of daughters: a follow-up study spanning two decades

Does in utero exposure to constituents of cigarette smoke have a programming effect on daughters' age of menarche and markers of long-term reproductive health? In utero exposure to constituents of cigarette smoke was associated with earlier age of menarche and--to a lesser extent--changes in the testosterone profile of the young women. Studies observe potential effects of in utero exposure to constituents of cigarette smoke on the intrauterine formation of female gonads, but the consequences on long-term reproductive health in daughters remain unclear. A prospective cohort study was designed using data from 965 pregnant women enrolled prior to a routine 30th-week antenatal examination at a midwifery practice in Denmark from 1988 to 1989 and a follow-up of their 19-21-year-old daughters in 2008. The pregnant women provided information on lifestyle factors during pregnancy, including the exact number of cigarettes smoked per day during the first and the second trimesters. A total of 438 eligible daughters were asked to complete a web-based questionnaire on reproductive health and subsequently invited to participate in a clinical examination during 2008. Of the 367 daughters (84%) who answered the questionnaire, 267 (61%) agreed to further examination. Information on menstrual pattern was provided at examination, blood samples were drawn to be analyzed for serum levels of reproductive hormones [FSH, LH, estradiol (E(2)), sex hormone-binding globulin, anti-Müllerian hormone, dehydroepiandrosterone-sulphate (DHEAS), free testosterone and free E(2)] and number of follicles (2-9 mm) were examined by transvaginal ultrasound. The daughters were divided into three exposure groups according to the level of maternal smoking during first trimester [non-exposed (reference), low-exposed (mother smoking >0-9 cigarettes/day) and high-exposed (mother smoking ≥ 10 cigarettes/day)]. Data were analyzed by multiple regression analyses in which we adjusted for potential confounders. Both crude and adjusted test for trend were carried out using maternal smoking during the first trimester as a continuous variable. We observed an inverse association between in utero exposure to constituents of cigarette smoke and age of menarche (P = 0.001). Daughters exposed to >0-9 cigarettes/day debuted with -2.7 [95% confidence interval (CI) -5.2 to -0.1] percentage earlier age of menarche, whereas daughters exposed to ≥ 10 cigarettes/day had -4.1 (95% CI: -6.6 to -1.5) percentage earlier age of menarche corresponding to 6.5 (95% CI: -10.7 to -2.2) months. There was a non-significant tendency towards lower levels of testosterone and DHEAS with increasing in utero exposure to constituents of cigarette smoke but no associations with follicle number, cycle length or serum levels of the other reproductive hormones were observed. We collected information on age of menarche retrospectively but the recall time was relatively short (2-10 years) and the reported values were within the normal range of Caucasians. Analyses of reproductive hormones are presented only for the group of daughters who were non-users of hormonal contraceptives because users were excluded, leaving only a low number of daughters available for the analyses (n = 75), as reflected in the wide CIs. The analyses of hormones were further adjusted for menstrual phase at time of clinical examination (follicular, ovulation and luteal phase) because blood samples were not collected on a specific day of the menstrual cycle. This study supports the limited evidence of an inverse association between maternal smoking during pregnancy and age of menarche and further addresses to what extent reproductive capacity and hormones may be programmed by maternal smoking during pregnancy. A trend toward earlier maturation of females is suggested to have implications on long-term reproductive function. Supported by a scholarship from The Lundbeck Foundation (R93-A8476). No conflict of interest declared.

Goldmann applanation tonometry compared with corneal-compensated intraocular pressure in the evaluation of primary open-angle Glaucoma

BackgroundTo better understand the role of corneal properties and intraocular pressure (IOP) in the evaluation of primary open-angle glaucoma (POAG); and to determine the feasibility of identifying glaucomatous optic neuropathy (GON) using IOP corrected and uncorrected for corneal biomechanics.MethodsRecords from 1,875 eyes of consecutively evaluated new patients were reviewed. Eyes were excluded if central corneal thickness (CCT) or Ocular Response Analyzer (ORA) measurements were unavailable. Presence or absence of GON was determined based on morphology of the optic disc, rim and retinal nerve fiber layer at the time of clinical examination, fundus photography and Heidelberg Retinal Tomography. Goldmann-applanation tonometry (GAT) in the untreated state was recorded and Goldmann-correlated (IOPg) and corneal-compensated IOP (IOPcc) were obtained using the ORA. Glaucomatous eyes were classified as normal or high-tension (NTG, HTG) using the conventional cutoff of 21 mm Hg. One eligible eye was randomly selected from each patient for inclusion.ResultsA total of 357 normal, 155 HTG and 102 NTG eyes were included. Among NTG eyes, IOPcc was greater than GAT (19.8 and 14.4 mm Hg; p < 0.001) and the difference between IOPcc and GAT was greatest for this subgroup of patients with NTG (p ≤ 0.01). The maximum combined sensitivity and specificity for detection of GON occurred at 20.9 mm Hg for GAT (59%, 90%) and 18.4 mm Hg for IOPcc (85%, 85%) and the area under the curve was greater for IOPcc (0.93 vs. 0.78; p < 0.001).ConclusionsIOPcc may account for measurement error induced by corneal biomechanics. Compared to GAT, IOPcc may be a superior test in the evaluation of glaucoma but is unlikely to represent an effective diagnostic test.

Accuracy of Clinical Examination of Breast Lumps in Detecting Malignancy: A Retrospective Study

Clinical examination is a simple method to detect breast lumps and their nature as it is inexpensive and non-invasive and if found to be accurate, might be of great value as a diagnostic tool. The aim of this study was to evaluate the accuracy of clinical examination and its contribution towards the diagnosis of a palpable breast lump. The study was record based and conducted at a University Medical College Hospital and a tertiary referral centre of South India. Patient files of those women who presented with a breast lump between January to December 2011 were studied. A total of 120 patients were obtained following necessary exclusions. The accuracy of clinical assessment at an outpatient facility was determined by comparing the physician's diagnosis with the final histopathological diagnosis. The inter-observer agreement (kappa) for diagnosing a breast lump was 81% (95% Confidence Interval = 71% to 92%) indicating a good agreement between clinical and pathological diagnoses. McNemar test also indicated a high degree of concordance between the two diagnoses (4.17% discordance). Sensitivity, specificity, positive and negative predictive values of clinical breast examination in comparison to histopathology were 95, 88, 87, and 95% respectively, with an overall accuracy of 90.8%. 11 lumps were wrongly diagnosed at the time of clinical examination. Clinical examination of breast lumps was found to have a high sensitivity (94.5%) and specificity (87.7%) and can be used as the diagnostic tool to identify the nature of the lump, however, its value in diagnosing breast malignancy remains contributory due to the possibility that malignant lumps could be overlooked and present as advanced cancer at a later stage. Histopathology is recommended in all cases unless clinical examination is supported with strong evidence of benignity based on repeated breast imaging via ultrasound or mammogram (>35yrs).

Estimation and comparison of osteopontin levels in plasma in subjects with healthy periodontium and generalized chronic periodontitis and its assessment after scaling and root planing.

Background:Osteopontin (OPN) is a bone matrix derivative, whose levels reflect active lesions of aggravated periodontal disease accompanied by alveolar bone resorption. OPN is also a component of human atherosclerotic plaque, suggesting a role of OPN in cardiovascular diseases. The present study was conducted to assess and compare plasma OPN levels in subjects with healthy periodontium and generalized chronic periodontitis and to evaluate the effect of scaling and root planing on Plasma OPN levels of generalized chronic periodontitis subjects.Materials and Methods:40 gender matched subjects were divided into two equal groups, Group I- Healthy and Group II- Generalized chronic periodontitis, based on the Periodontal Disease Index. Blood samples were collected from the subjects at the time of clinical examination (Group I, II) and two months after Scaling and Root planning of Group II. Plasma OPN level was determined using a OPN Enzyme Immunometric Assay Kit (Quantikine).Results:The mean value of plasma OPN levels in subjects with generalized chronic periodontitis was higher (153.08 ng/ml) as compared to the subjects with Healthy periodontium (55.09 ng/ml). After treatment of generalized chronic periodontitis group, the level of plasma OPN decreased to 91.53 ng/ml.Conclusion:The findings from the study suggest that Plasma OPN levels were highest in plasma from sites with periodontal destruction; however, scaling and root planing resulted in the reduction of OPN levels.

Prolaktin und Streß durch Masturbation

Fertility patients are in a stressful situation at the time of clinical examination. That condition of stress influences hormonal levels, especially prolactin levels, in blood plasma and in seminal plasma. After masturbation previously stress-induced hyperprolactinemia levels are reduced. This is probably due to the decrease of stressful tension during the period of clinical consultation and not likely due to the relaxation by masturbation. In conclusion, the stress condition of fertility patients must be taken into account while evaluating hormonal data.

Early-onset seizure variant of Rett syndrome: Definition of the clinical diagnostic criteria

Background: Rett syndrome is a severe neurodevelopmental disorder affecting almost exclusively females. Among Rett clinical variants, the early-onset seizure variant describes girls with early onset epilepsy and it is caused by mutations in CDKL5. Methods: Four previously reported girls and five new cases with CDKL5 mutation, ranging from 14 months to 13 years, were evaluated by two clinical geneticists, classified using a severity score system based on the evaluation of 22 different clinical signs and compared with 128 classic Rett and 25 Zappella variant MECP2-mutated patients, evaluated by the same clinical geneticists. Clinical features were compared with previously described CDKL5 mutated patients. Both the statistical and the descriptive approach have been used to delineate clinical diagnostic criteria. Results: All girls present epilepsy with onset varying from 10 days to 3 months. Patients may present different type of seizures both at onset and during the whole course of the disease; multiple seizure types may also occur in the same individual. After treatment with antiepileptic drugs patients may experience a short seizure-free period but epilepsy progressively relapses. Typical stereotypic hand movements severely affecting the ability to grasp are present. Psychomotor development is severely impaired. In the majority of cases head circumference is within the normal range both at birth and at the time of clinical examination. Conclusion: For the practical clinical approach we propose to use six necessary and eight supportive diagnostic criteria. Epilepsy with onset between the first week and 5 months of life, hand stereotypies, as well as severe hypotonia, are included among the necessary criteria.

Methylmercury Exposure and Adverse Cardiovascular Effects in Faroese Whaling Men

BackgroundMethylmercury (MeHg), a worldwide contaminant found in fish and seafood, has been linked to an increased risk of cardiovascular mortality.ObjectiveWe examined 42 Faroese whaling men (30–70 years of age) to assess possible adverse effects within a wide range of MeHg exposures from consumption of pilot whale meat.MethodsWe assessed exposure levels from mercury analysis of toenails and whole blood (obtained at the time of clinical examination), and a hair sample collected 7 years previously. Outcome measures included heart rate variability (HRV), blood pressure (BP), common carotid intima-media thickness (IMT), and brainstem auditory evoked potentials (BAEP). We carried out multiple regression and structural equation model (SEM) analyses to determine the confounder-adjusted effect of mercury exposure. Taking into account correlations among related measures, we categorized exposure and outcomes in groups to derive latent exposure and response variables in SEMs. We used multiple regression analysis to compare the predictive validity of individual exposure biomarkers and the latent exposure variable on individual and latent outcomes.ResultsThe toenail mercury concentrations varied widely and had a geometric mean of 2.0 μg/g; hair concentrations averaged about 3-fold higher. Mercury exposure was significantly associated with increased BP and IMT. This effect was reflected by SEMs, but mercury in toenails tended to be the best effect predictor.ConclusionsThe results support the notion that increased MeHg exposure promotes the development of cardiovascular disease.

Periodontal response to all‐ceramic crowns (IPS Empress) in general practice

The purpose of this study was to investigate the periodontal response to the presence of all-ceramic crowns (IPS Empress) in general practice patients. The convenience sample included 82 IPS Empress crowns placed in 64 patients. These crowns had been in place for an average of 16.27 (SD 9.26) months and ranged from 6.2 to 48.87 months at the time of clinical examination. Periodontal health status (as determined by dental plaque, gingival health status, periodontal pockets) was assessed around all crowned teeth and around matched contralateral teeth by one calibrated examiner. Periodontal indices utilized included the Plaque Index (PI), Gingival Index (GI) and pocket depth (PD) with calibrated probes graduated in millimetres. Plaque, gingival and PD values for crowned teeth were compared with those for control teeth using Wilcoxon signed-rank test for each clinical parameters. Chi-square was used to test the significance of the difference in their distribution between crowns and control teeth. Statistically, PI (0.35), GI (0.41) and mean PD scores (1.42) of IPS Empress crowned teeth compared less favourably with scores of the control teeth (0.27, 0.23 and 0.86 respectively). Teeth with IPS Empress crowns had poorer periodontal health and more clinically evident plaque than uncrowned teeth.

Difficulties in Diagnosing Lesions in the Floor of the Mouth – Report of Two Rare Cases

This article highlights 2 contrasting lesions of the floor of the mouth, the first being a benign lipoma growth and the latter, an adenoid cystic carcinoma. Both of these lesions appear clinically similar, presenting as a swelling with normal overlying mucosa and otherwise asymptomatic at the time of clinical examination. As the swelling for Case 1 is small and fluctuant, no special investigation was ordered, whereas a computed tomographic scan was ordered for the larger expansile lesion in Case 2. The lesions were excised under local and general anaesthesia respectively and a histology henceforth. Recovery for both cases were uneventful and no recurrence or complication was noted to date when this article was written. The two extreme natures of the lesions manifested in the region serve as a cautionary note to clinicians.

Seven years follow‐up after ankle inversion trauma

During one year all ankle inversion injuries seen at the acute ward of our institution were divided into grades of severity and classified according to the maximal area of tenderness at the time of clinical examination. Seven years later 648 of the subjects (91%) evaluated their ankle with the help of a questionnaire. Location of maximal tenderness at the time of injury was: lateral fibular ligaments 61%, lateral midfoot ligaments 24%, base of the fifth metatarsal/peroneal tendons 5% and combined lesions 8%. 39% were considered minor, 46% were moderate, and 15% severe. All cases followed a functional treatment protocol. Seven years post- injury 32% reported chronic complaints of pain, swelling or recurrent sprains. 72% of the subjects with residual disability reported that they were functionally impaired by their ankle - in most cases a question of not performing sports at a desired level. 4% experienced pain at rest and were severely disabled. 19% were bothered by repeated inversion injuries - 43% of these subjects felt that they could compensate by using an external ankle support. There was no correlation between the severity of the sprain as judged at the time of injury and the frequency of residual disability or between the area of maximal tenderness at the time of injury and the area of maximal pain at the time of follow-up.

Experimental design and statistical decisions tutorial: Comments on longitudinal ideomotor apraxia recovery

Basso, Burgio, Paulin, and Prandoni (2000) claimed evidence for recovery from ideomotor apraxia within the first year post-cerebrovascular accident. However, concerns about the excessive use of paired t tests and incongruous experimental designs challenge the reported findings. The ideomotor apraxia recovery data should be analysed with a completely within-subjects design one-way analysis of variance (ANOVA). Further, the locus of lesion by clinical examination time data should be analysed in a two-way mixed design ANOVA with repeated measures on the three levels of examination time. In addition, circularity assumptions (i.e., composition of the covariance matrices) should be addressed for the repeated measures in the recommended analyses. In a tutorial approach, using the proper experimental designs and statistics, the ideomotor apraxia data were reanalysed. The one-way results support the recovery improvements between the first and second examinations. However, conflict with the original findings was found in the two-way mixed design results. Thus, the overall conclusions should be amended, especially given that the Locus of Lesion - Clinical Examination Time interaction failed to reach significance.