RESUMEN
Oronasal communications are serious sequelae of chronic cocaine abuse. If left untreated, these communications can severely limit a patient's quality of life. The defects can be rehabilitated successfully utilizing either maxillofacial prosthetics or various surgical techniques. Considerations in deciding between prosthetic and surgical approaches are discussed, as well as the basics of maxillofacial prosthetic rehabilitation and the different surgical techniques available. Photographic documentation of both maxillofacial prosthetic and surgical treatments performed by the authors is shown.
Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Enfermedades Nasales/terapia , Fístula Oral/terapia , Obturadores Palatinos , Procedimientos de Cirugía Plástica/métodos , Fístula del Sistema Respiratorio/terapia , Diseño de Prótesis Dental , Colgajos Tisulares Libres , Humanos , Cavidad Nasal/patología , Tabique Nasal/patología , Enfermedades Nasales/cirugía , Fístula Oral/cirugía , Paladar Blando/patología , Planificación de Atención al Paciente , Calidad de Vida , Fístula del Sistema Respiratorio/cirugía , Colgajos Quirúrgicos/clasificaciónRESUMEN
OBJECTIVE: The purpose of this case series is to describe the treatment and outcomes of a series of patients presenting with frozen shoulder syndrome who received a novel chiropractic approach (OTZ Tension Adjustment). METHODS: The files of 50 consecutive patients who presented to a private chiropractic practice with frozen shoulder syndrome were reviewed retrospectively. Two primary outcomes were extracted from the files for initial examination and at final evaluation: (1) the 11-point numeric pain rating scale and (2) the percentage change in shoulder abduction. Each patient received a series of chiropractic manipulative procedures that focused on the cervical and thoracic spine. RESULTS: Of the case files reviewed, 20 were male and 30 were female; and all were between the ages of 40 and 70 years. The median number of days under care was 28 days (range, 11 to 51 days). The median change in Numeric Pain Rating Scale score was - 7 (range, 0 to - 10). Of the 50 cases, 16 resolved completely (100% improvement), 25 showed 75% to 90% improvement, 8 showed 50% to 75% improvement, and 1 showed 0% to 50% improvement. CONCLUSION: Most patients with frozen shoulder syndrome in this case series appeared to improve with the chiropractic treatment.
RESUMEN
Psoriasis is a chronic skin disease that affects millions of people throughout the world. Even though cutaneous signs and symptoms are the most common clinical manifestations, the nails can be involved in up to 50% of cases, and their involvement remains an important yet often overlooked aspect of the disease. There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting and loosening of the nail plate to the less frequent discoloration and splinter hemorrhages seen in the nail bed. This article discusses the normal anatomy and embryology of the nail unit as well as the current understanding of the pathogenesis of the disease. It also provides an extensive review of the existing literature with respect to psoriatic nail therapy. Although there have been many recent advances in the treatment of the cutaneous form of the disease-most notably in the field of immunotherapies-the options for nail psoriasis are far more limited. While a number of treatment alternatives currently exist for nail disease, the general paucity of clear evidence regarding these choices often makes it difficult to select the most efficient, safe, and optimal treatment for the patient. Even though the current literature has shown some support for the use of topical, intralesional, radiation, systemic, and combination therapies for nail psoriasis, the available studies lack sufficient power to extrapolate a standardized therapeutic regimen. Therefore, until better-documented evidence validating the treatment options emerges within the literature, clinicians and patients are left with a vague and relatively unproven approach to psoriatic nail disease.
Asunto(s)
Enfermedades de la Uña , Uñas/anatomía & histología , Psoriasis , Administración Tópica , Corticoesteroides/administración & dosificación , Antralina/uso terapéutico , Ensayos Clínicos como Asunto , Ciclosporina/uso terapéutico , Fluorouracilo/uso terapéutico , Humanos , Inyecciones Intralesiones , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/patología , Enfermedades de la Uña/radioterapia , Enfermedades de la Uña/terapia , Uñas/embriología , Uñas/fisiología , Ácidos Nicotínicos/uso terapéutico , Fotoquimioterapia , Fototerapia , Psoriasis/diagnóstico , Psoriasis/inmunología , Psoriasis/patología , Psoriasis/radioterapia , Psoriasis/terapiaRESUMEN
The use of live patients on the licensing examinations was a part of dentistry for almost the entire twentieth century and continues up until today. Considerable new debate about the appropriateness of using live patients as test subjects began in the mid-1990s and culminated in the passage of a resolution in the American Dental Association's year 2000 House of Delegates calling for an end to this practice by the year 2005. The live patient examination tests a narrow range of clinical skills, creates ethical dilemmas for candidates, for the host institution, and for the profession, and is unable to distinguish between those ready to assume independent practice from those who are not yet at that level of competence. There are other ways to test for such readiness including proposals in New York State to substitute a postdoctoral year or mannequins in place of live subjects. The public and the dental profession will be better off by developing alternative licensing tests to the use of live subjects.