- Email: [email protected]
Fibromyalgia syndrome in children and adolescents: Clinical features at presentation and status at followup
217
CURRENT LITERATURE authors analyzed data from the time of radiation until the end of 1991. The long period of follow-up since exposure enables a more thorough approach to the effect on the salivary glands and particularly the parotids. For this particular study group, the age at exposure ranged from 1 to 15 years (about half were 6 to 8 years of age). The sex ratio was 1: 1. Irradiation followed the Adamson-Kienbok technique of a five-field treatment for the scalp. Patients were irradiated by 70- to lOOkilovolt (peak) superficial x-ray machines with a 0.5~mm aluminum filter. Total computed radiation dose to the salivary glands was 78 cGy per treatment. Most of the malignant and benign tumors were located at the parotid gland. Two thirds of the malignant tumors were of the mucoepidermoid variety whereas all of the benign tumors were mixed tumors. A 4.5-fold increase of cancer (P < .Ol) and a 2.6-fold increased of benign tumors were noted. The mean period of latency until tumor development was 11 years for malignant tumors and 2 1.5 years for benign. A clear dose response effect for both cancer and benign tumor was demonstrated. According to the authors, only scarce information is available on the etiology of salivary gland neoplasms, with radiation being the only well established risk factor. This study confirms major several aspects of former studies: 1) a dose response relationship, 2) a relatively long latency period, 3) no gender predilection, and 4) an increased yield of malignant neoplasms than that of benign tumors. The study corroborates the role of radiation in salivary gland carcinogenesis and indicates a need for better awareness, a comprehensive examination, and long-term follow-up of patients who have been subjected to head and neck radiation.-H. PATINO Reprint requests to Dr Modan: Department of Clinical ogy, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Cost of Dental Education and Student Zwemer JD. J Dent Educ 62:354,1998
Epidemiol-
Reprint requests to Dr Myers: School of Georgia, Augusta, GA 30912-1020.
of Dentistry,
Medical
College
Comparative Study of Inferior Alveolar Disturbance Restoration After Sag&al Split Osteotomy by Means of Bicortical Versus Monocortical Osteosynthesis. Fujioka M, Hirano A, Fujii T. Plast Reconstr Surg 102:37, 1998 The purpose of this study was to compare the effects of bicortical rigid fixation and monocortical fixation on the incidence and recovery of inferior alveolar nerve disturbance. A follow-up study of 114 patients who underwent bilateral sagittal split osteotomy over the course of 5 years was performed. In the bicortical fixation group (n = 62) osteosynthesis was achieved with two or three lag screws 2.7 mm in diameter where as in the monocortical group (n = 52) a miniplate and four 2.0 diameter screws were used. For the light-touch skin test, the lower lip and mental region of each side of the mandible were examined with semmes-Weinstein pressure esthesiometer. A sensory disturbance was noted in the light touch skin test in 31% of the bicortical fixation group and in 32% of the monocortical group 2 weeks after surgery. During the postoperative period of 6 to 12 months the number of patients continuing to have light-touch sensory disturbance was significantly less in the monocortical group. Additionally, the number of patients who subjectively complained of “numbness” was less in the monocortical group. The authors conclusion is that these findings are suggestive that monocortical osteosynthesis has less damage to inferior alveolar nerve leading to better restoration of neurosensory function in patients whom nerve damage was moderate.-J. BROKLOFF Reprint
requests
to Dr Fujioka:
Department
of Plastic
Surgery,
Nagasaki School of Medicine l-7-1 Sakamotomachi Nagasaki City, Japan, 8552.
Debt. Myers DR,
Regardless of repeated studies addressing the cost of dental education and student debt, the student cost of dental education and the level of student indebtedness have continued to increase. The authors compared dental costs and indebtedness with the index for the overall economy. Results showed that the cost for dental education has increased at about the same rate as the economy as a whole. However, there has been a relative decline in state and federal government support for dental education. To compensate for this, dental schools have been increasing tuition revenues. This translates into 4-year tuition costs for dental students that outpace the level of the economy. This is true for both public and private institutions. Concurrently, dental education indebtedness has also been increasing at a more rapid rate than the gross domestic product. In 1995, the average indebtedness of dental graduates was $67,772. To repay this loan (at an 8% interest rate), the new graduate would require an annual net income of about $12 1,554. Although average net income of dentists has increased to $126,898 in 1995, it is increasing at a signiticantly lower rate than the economy as a whole. This poses a serious economic dilemma, as the indebtedness of new graduates continues to increase at a rate greater than the growth of the economy, while income lags behind. The authors conclude that the dental education communities must act to level the rate of student indebtedness and net income with the rate of the overall economy for dentistry to prosper.-AJ. LISUNAO
Fibromyalgia Syndrome in Children and Adolescents: Clinical Features at Presentation and Status at Followup. Siegel DM, Janeway D, Baum J. Pediatrics 101:377, 1998 Fibromyalgia Syndrome (F’s) is a noninflammatory disorder characterized by prominent symptoms of diffuse pain and specific tender points found on physical examination. American College of Rheumatology criteria specify that there must be no other diagnosis to explain the presenting illness. FS has been ranked as the 12fh most common new patient diagnosis identified by pediatric rheumatologists, representing 2.1% of new diagnoses made among children and adolescents. In this study, a total of 45 subjects (91% female, 93% white) were identified, of which telephone interviews took place with 33. The mean age was 13.3 years (range, 9 to 20 years) and the mean duration was 2.6 years from the initial diagnosis of the disease (ranging up to 7.6 years). Of a possible 15 symptoms associated with FS, subjects reported a mean of 9 symptoms, with >90% experiencing diffuse pain and sleep disturbances. Telephone interviews showed improvement in most patients over time. The mean number of tender points summed over all visits was fewer than the criterion of 11 established for adults. Symptoms included fatigue, stiffness, sleep disturbance, changes with weather, paresthesias, headaches, lack of energy, depression, anxiety, and others. Treatment included use of low-dose tricyclic antidepressant medication, moderate exercise, and nonsteroidal anti-inflammatory drugs as needed.-ROGER E. ALEXANDER
218 Reprint General
CURRENT LITERATURE requests Hospital,
to Dr Siegel: Department of Pediatrics, Rochester 1425 Portland Ave, Rochester, NY 14621.
Scarless Healing: The Fetal Wound. Mackool GK, Longaker MT. Clin Plast Surg 25357, 1998
RJ, Gittes
Cutaneous scarring may be defined as a macroscopic disturbance of normal architecture, resulting from an end product of a healed wound, and may manifest itself as an elevated or depressed site with an alteration of skin texture, color, vascularity, nerve supply reflectance, and biochemical properties. Histologically, scarring may be defined as the macroscopic alteration of tissue architecture, with collagen deposition and organization that differ from the surrounding unwounded tissue. Although adult skin wounds heal with scar formation, early gestation fetal skin wounds (second to early third trimester) do not. Differences exist between the adult and fetal environment that are intrinsic (oxygen tension of fetal skin) and extrinsic (amnionic fluid and its many components) and that may influence wound healing. It appears from both human and animal experimentation that the intrinsic properties of fetal and adult skin cells determine whether wounds heal with or without scars. The transition from scarless to scarring repair in fetal skin may be
related to epithelial-mesenchymal interactions, the cytokine response to wounding, the complexity of dermal and subdermal tissue architecture, and the ability of the fetus to generate an inflammatory response. Adult and fetal tissue response differ between species and the specific organs involved. Several studies have established distinct differences in the intrinsic properties of adult and fetal fibroblasts. Fetal tissues deposit all forms of collagen faster than adult counterparts, and the relative concentrations of these collagens differ in fetal and adult wounds. Larger amounts of the adhesion molecule fibronectin in fetal wounds, stimulates immediate cell attachment, whereas the rapid deposition of tenascin allows cells to migrate and fully epithelialize the wound more rapidly than in the adult. The altered inflammatory response and increased presence of macrophages in fetal wounds may provide a unique fetal wound environment, with modified cytokine profiles and collagen deposition, and may promote scarless healing.-R.H. HAUG Reprint requests to Dr Longaker: John Marquis Converse of Plastic Surgery Research, Laboratory of Developmental and Repair, Room H-169, 550 First Ave, New York Medical Center, New York, NY 10016.
Professor Biology University
CURRENT LITERATURE authors analyzed data from the time of radiation until the end of 1991. The long period of follow-up since exposure enables a more thorough approach to the effect on the salivary glands and particularly the parotids. For this particular study group, the age at exposure ranged from 1 to 15 years (about half were 6 to 8 years of age). The sex ratio was 1: 1. Irradiation followed the Adamson-Kienbok technique of a five-field treatment for the scalp. Patients were irradiated by 70- to lOOkilovolt (peak) superficial x-ray machines with a 0.5~mm aluminum filter. Total computed radiation dose to the salivary glands was 78 cGy per treatment. Most of the malignant and benign tumors were located at the parotid gland. Two thirds of the malignant tumors were of the mucoepidermoid variety whereas all of the benign tumors were mixed tumors. A 4.5-fold increase of cancer (P < .Ol) and a 2.6-fold increased of benign tumors were noted. The mean period of latency until tumor development was 11 years for malignant tumors and 2 1.5 years for benign. A clear dose response effect for both cancer and benign tumor was demonstrated. According to the authors, only scarce information is available on the etiology of salivary gland neoplasms, with radiation being the only well established risk factor. This study confirms major several aspects of former studies: 1) a dose response relationship, 2) a relatively long latency period, 3) no gender predilection, and 4) an increased yield of malignant neoplasms than that of benign tumors. The study corroborates the role of radiation in salivary gland carcinogenesis and indicates a need for better awareness, a comprehensive examination, and long-term follow-up of patients who have been subjected to head and neck radiation.-H. PATINO Reprint requests to Dr Modan: Department of Clinical ogy, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Cost of Dental Education and Student Zwemer JD. J Dent Educ 62:354,1998
Epidemiol-
Reprint requests to Dr Myers: School of Georgia, Augusta, GA 30912-1020.
of Dentistry,
Medical
College
Comparative Study of Inferior Alveolar Disturbance Restoration After Sag&al Split Osteotomy by Means of Bicortical Versus Monocortical Osteosynthesis. Fujioka M, Hirano A, Fujii T. Plast Reconstr Surg 102:37, 1998 The purpose of this study was to compare the effects of bicortical rigid fixation and monocortical fixation on the incidence and recovery of inferior alveolar nerve disturbance. A follow-up study of 114 patients who underwent bilateral sagittal split osteotomy over the course of 5 years was performed. In the bicortical fixation group (n = 62) osteosynthesis was achieved with two or three lag screws 2.7 mm in diameter where as in the monocortical group (n = 52) a miniplate and four 2.0 diameter screws were used. For the light-touch skin test, the lower lip and mental region of each side of the mandible were examined with semmes-Weinstein pressure esthesiometer. A sensory disturbance was noted in the light touch skin test in 31% of the bicortical fixation group and in 32% of the monocortical group 2 weeks after surgery. During the postoperative period of 6 to 12 months the number of patients continuing to have light-touch sensory disturbance was significantly less in the monocortical group. Additionally, the number of patients who subjectively complained of “numbness” was less in the monocortical group. The authors conclusion is that these findings are suggestive that monocortical osteosynthesis has less damage to inferior alveolar nerve leading to better restoration of neurosensory function in patients whom nerve damage was moderate.-J. BROKLOFF Reprint
requests
to Dr Fujioka:
Department
of Plastic
Surgery,
Nagasaki School of Medicine l-7-1 Sakamotomachi Nagasaki City, Japan, 8552.
Debt. Myers DR,
Regardless of repeated studies addressing the cost of dental education and student debt, the student cost of dental education and the level of student indebtedness have continued to increase. The authors compared dental costs and indebtedness with the index for the overall economy. Results showed that the cost for dental education has increased at about the same rate as the economy as a whole. However, there has been a relative decline in state and federal government support for dental education. To compensate for this, dental schools have been increasing tuition revenues. This translates into 4-year tuition costs for dental students that outpace the level of the economy. This is true for both public and private institutions. Concurrently, dental education indebtedness has also been increasing at a more rapid rate than the gross domestic product. In 1995, the average indebtedness of dental graduates was $67,772. To repay this loan (at an 8% interest rate), the new graduate would require an annual net income of about $12 1,554. Although average net income of dentists has increased to $126,898 in 1995, it is increasing at a signiticantly lower rate than the economy as a whole. This poses a serious economic dilemma, as the indebtedness of new graduates continues to increase at a rate greater than the growth of the economy, while income lags behind. The authors conclude that the dental education communities must act to level the rate of student indebtedness and net income with the rate of the overall economy for dentistry to prosper.-AJ. LISUNAO
Fibromyalgia Syndrome in Children and Adolescents: Clinical Features at Presentation and Status at Followup. Siegel DM, Janeway D, Baum J. Pediatrics 101:377, 1998 Fibromyalgia Syndrome (F’s) is a noninflammatory disorder characterized by prominent symptoms of diffuse pain and specific tender points found on physical examination. American College of Rheumatology criteria specify that there must be no other diagnosis to explain the presenting illness. FS has been ranked as the 12fh most common new patient diagnosis identified by pediatric rheumatologists, representing 2.1% of new diagnoses made among children and adolescents. In this study, a total of 45 subjects (91% female, 93% white) were identified, of which telephone interviews took place with 33. The mean age was 13.3 years (range, 9 to 20 years) and the mean duration was 2.6 years from the initial diagnosis of the disease (ranging up to 7.6 years). Of a possible 15 symptoms associated with FS, subjects reported a mean of 9 symptoms, with >90% experiencing diffuse pain and sleep disturbances. Telephone interviews showed improvement in most patients over time. The mean number of tender points summed over all visits was fewer than the criterion of 11 established for adults. Symptoms included fatigue, stiffness, sleep disturbance, changes with weather, paresthesias, headaches, lack of energy, depression, anxiety, and others. Treatment included use of low-dose tricyclic antidepressant medication, moderate exercise, and nonsteroidal anti-inflammatory drugs as needed.-ROGER E. ALEXANDER
218 Reprint General
CURRENT LITERATURE requests Hospital,
to Dr Siegel: Department of Pediatrics, Rochester 1425 Portland Ave, Rochester, NY 14621.
Scarless Healing: The Fetal Wound. Mackool GK, Longaker MT. Clin Plast Surg 25357, 1998
RJ, Gittes
Cutaneous scarring may be defined as a macroscopic disturbance of normal architecture, resulting from an end product of a healed wound, and may manifest itself as an elevated or depressed site with an alteration of skin texture, color, vascularity, nerve supply reflectance, and biochemical properties. Histologically, scarring may be defined as the macroscopic alteration of tissue architecture, with collagen deposition and organization that differ from the surrounding unwounded tissue. Although adult skin wounds heal with scar formation, early gestation fetal skin wounds (second to early third trimester) do not. Differences exist between the adult and fetal environment that are intrinsic (oxygen tension of fetal skin) and extrinsic (amnionic fluid and its many components) and that may influence wound healing. It appears from both human and animal experimentation that the intrinsic properties of fetal and adult skin cells determine whether wounds heal with or without scars. The transition from scarless to scarring repair in fetal skin may be
related to epithelial-mesenchymal interactions, the cytokine response to wounding, the complexity of dermal and subdermal tissue architecture, and the ability of the fetus to generate an inflammatory response. Adult and fetal tissue response differ between species and the specific organs involved. Several studies have established distinct differences in the intrinsic properties of adult and fetal fibroblasts. Fetal tissues deposit all forms of collagen faster than adult counterparts, and the relative concentrations of these collagens differ in fetal and adult wounds. Larger amounts of the adhesion molecule fibronectin in fetal wounds, stimulates immediate cell attachment, whereas the rapid deposition of tenascin allows cells to migrate and fully epithelialize the wound more rapidly than in the adult. The altered inflammatory response and increased presence of macrophages in fetal wounds may provide a unique fetal wound environment, with modified cytokine profiles and collagen deposition, and may promote scarless healing.-R.H. HAUG Reprint requests to Dr Longaker: John Marquis Converse of Plastic Surgery Research, Laboratory of Developmental and Repair, Room H-169, 550 First Ave, New York Medical Center, New York, NY 10016.
Professor Biology University