Rejected

This report describes a case of generalized chronic periodontitis requiring periodontal treatment including regenerative therapy. The patient was a 60-year-old woman who visited the Tokyo Dental College Suidobashi Hospital with the chief complaint of tooth mobility and pain in tooth #26. Periodontal examination at the first visit revealed that 32.0% of sites had a probing depth of ≥4 mm and 43.8% bleeding on probing. Radiographic examination revealed vertical bone resorption in #17. Horizontal resorption was noted in other areas. Initial periodontal therapy consisting of plaque control, scaling and root planing, and caries treatment was performed based on a clinical diagnosis of Stage III Grade B periodontitis. Tooth #26 was extracted due to bone resorption extending as far as the root apex. After reevaluation, periodontal regenerative therapy using recombinant human fibroblast growth factor-2 (rhFGF-2) in combination with carbonate apatite (COAp) granules was performed for #17. Following reevaluation, a zirconia crown (#16) and zirconia bridge (#24-27) were placed. Following further reevaluation, the patient was placed on supportive periodontal therapy (SPT). The periodontal regenerative therapy using rhFGF-2 with COAp granules yielded an improvement in the vertical bone resorption observed in #17. This improvement has been adequately maintained over a 1-year period postoperatively. Continued SPT is needed to maintain stable periodontal conditions.

Shoulder arthrodesis is an end-stage, salvage procedure for the glenohumeral joint and can provide a pain-free, stable shoulder with varying levels of function. Common indications include brachial plexus injury, chronic instability with rotator cuff and deltoid dysfunction, and failed shoulder arthroplasty. Multiple techniques are described, including intra-articular and extra-articular arthrodeses. Fusion can be accomplished with screw fixation, plate fixation, external fixation, and arthroscopic-assisted techniques. The optimal position of the arm is heavily debated in the literature, but the ideal position is thought to be 30° of flexion, 30° of abduction, and 30° of internal rotation. After successful fusion, the patient should be able to bring their hand to their mouth, reach their back pocket, and cross the midline for hygiene. Complications are not uncommon and include nonunion, malunion, fracture, and infection. With the increasing incidence of shoulder arthroplasty, failed arthroplasties are more commonly encountered. In a salvage situation, shoulder arthrodesis may be considered.

Post-traumatic trigeminal neuropathic pain is mainly caused by the extraction of third molars or the placement of dental implants. This report describes the treatment of neuropathic pain arising after guided tissue regeneration (GTR). The patient was a 55-year-old woman who had to undergo GTR due to severe periodontitis in the distal aspect of the right mandibular second molar. Postoperatively, the patient had been prescribed mecobalamin for hypesthesia and allodynia in the right lower lip. No improvement was observed in these symptoms after 4 months, however, so she was referred to our Orofacial Pain Center. Preoperative and postoperative cone-beam computed tomography revealed a cyst-like lesion (radiolucent area) close to the right mandibular second molar and canal. Although the results of quantitative sensory examination were normal, rubbing the right lower lip with a cotton swab elicited mechanical allodynia. The diagnosis was post-traumatic trigeminal neuropathic pain for which the patient was given pregabalin and Neurotropin. The symptoms improved within approximately 32 weeks, with the medication being terminated at 64 weeks. Although hypoesthesia due to nerve injury may suddenly go into remission, allodynia is often intractable. If symptoms show no improvement after 3 months, possible nerve injury should be investigated. Additionally, the distal root of the mandibular molar may be close to the inferior alveolar nerve, necessitating appropriate diagnostic imaging of the operative field. If the lesion or distal root is close to the inferior alveolar nerve, postoperative hypesthesia or neuropathic pain may occur, even without direct trauma.

There is a growing demand for quality osteoarthritis management available in Australia. There has been increasing emphasis on post-total knee replacement pain relief as a significant issue, especially in the context of postoperative recovery protocols which focus on early mobility.

Trigeminal neuralgia occurs in the orofacial region, characteristically causing pain that feels like a transient electric shock. Some histopathological studies have reported that trigeminal neuralgia is caused by mechanical compression of the demyelinated trigeminal nerve; the pathophysiological mechanism behind this phenomenon remains to be clarified, however. Cell-cell interactions have also been reported to be involved in the development and modulation of some types of neuropathic pain. The purpose of this study was to investigate the potential contribution of cell-cell interactions to trigeminal neuralgia by measuring intracellular free Ca concentrations ([Ca]) in primary cultured trigeminal ganglion (TG) cells. Direct mechanical stimulation of TG cells induced an increase in [Ca] in both neuronal and non-neuronal cells, such as glial cells. Moreover, this increase was stimulus intensity-dependent and non-desensitizing. Direct mechanical stimulation increased [Ca] in neighboring cells as well, and this increase was inhibited by application of carbamazepine. These results indicate that direct mechanical stimulation affects Ca signaling. Trigeminal ganglion cells establish intercellular networks between themselves, suggesting that this is involved in the development and generation of trigeminal neuralgia.

Migraine is a chronic disease of global concern, regardless of socio-economic and cultural background. It most often and intensely affects young adults, especially women. Numerous mechanisms of a migraine attack have been identified (disturbances in the reaction of vessels, functions of neurotransmitters, cortical neurons, ion channels, receptors, the process of neurogenic inflammation), and many of its symptoms can be explained by activation of the hypothalamus and disturbances in its communication with other brain regions (including the brainstem). Numerous neuropeptides and neurochemical systems also play a role in migraine. One of them is melatonin, a hormone that allows the body to adapt to cyclically changing environmental and food conditions. In this article, we present the pathophysiological basis of melatonin release from the pineal gland and other tissues (including the intestines) under the influence of various stimuli (including light and food), and its role in stimulating the brain structures responsible for triggering a migraine attack. We analyze publications concerning research on the role of melatonin in various headaches, in various stages of migraine, and in various phases of the menstrual cycle in women with migraine, and its impact on the occurrence and severity of migraine attacks. Melatonin as an internally secreted substance, but also present naturally in many foods. It is possible to supplement melatonin in the form of pharmaceutical preparations, and it seems, to be a good complementary therapy (due to the lack of significant side effects and pharmacological interactions) in the treatment of migraine, especially: in women of childbearing age, in people taking multiple medications for other diseases, as well as those sensitive to pharmacotherapy.

Endometriosis is a benign inflammatory disease associated with infertility and chronic pelvic pain, estimated to affect 7-10% of reproductive-age women, with the possibility of malignant transformation. Recent studies focus on oxidative stress and genetic mutations as risk factors in the pathophysiology of endometriosis-associated infertility. This case-control study is the first in Eastern European women that aimed to investigate four genes' genetic polymorphisms that encode antioxidant enzymes involved in oxidative stress (glutathione peroxidase 1, GPX1 198Pro > Leu, catalase CAT-262C > T, glutathione S-transferase M1, and T1 null genotype) and their association with endometriosis-related infertility. We compared 103 patients with endometriosis-associated infertility with 102 post-partum women as the control group. The endometriosis group had a mean age of 34.5 +/- 6.12 years, while the control group's mean age was 35.03 +/- 5.95 years. For CAT-262C > T polymorphism, the variant genotypes were significantly more frequent in the endometriosis group. Moreover, for the GPX1 198Pro > Leu, the endometriosis group had significantly more frequent CT and TT genotypes. The null genotype of GSTM1 was detected significantly higher in the endometriosis group. No significant differences were found in the frequency of GSTT1 between the two groups. This study suggests that GPX1 198Pro > Leu, CAT-262C > T, and GSTM1 polymorphisms may be risk factors and that the association between the GSTM1-GSTT1 null genotype may play a significant role in endometriosis-associated infertility. Moreover, this study suggests that the GSTT1 null genotype does not influence the disease. Visual identification of endometriotic lesions with microscopic confirmation is the accepted gold standard for diagnosing endometriosis, but general anesthesia and laparoscopy are required. In this regard, a panel of genetic or laboratory markers is needed for the early diagnostics of this prevalent disease, especially in the case of young patients with future pregnancy intention.

To evaluate the effectiveness of an educational program for cancer patients who developed pruritus, rash or photosensitivity induced by chemotherapy, epidermal growth factor inhibitor (EGFRI) treatments, or immunotherapy.

We report on apoplexy of undiagnosed pituitary macroadenoma presenting as sudden onset bilateral sixth nerve palsy.