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Biomedical subjects

James W Little

Publications and source records attributed to James W Little.

At least 19 recordsLinked to original sources
PubMed2006

Thyroid disorders. Part II: hypothyroidism and thyroiditis.

Part II of the series on thyroid disorders discusses hypothyroidism and thyroiditis that may be found in dental patients. An overview of the conditions is presented. Presenting signs and symptoms, laboratory tests used to diagnose hypothyroidism and thyroiditis, and their medical management is discussed. The dental management of patients with hypothyroidism is discussed in detail. The dentist by detecting the early signs and symptoms of hypothyroidism and thyroiditis can refer the patient for medical diagnosis and treatment and avoid potential complications of treating patients with uncontrolled disease. Patients with thyroiditis may have a short period of being hyperthyroid and it may be best to avoid routine dental treatment during that period. Patients with suppurative thyroiditis should not receive routine dental treatment during the acute stage of the disease. The end stage of Hashimoto's thyroiditis results in hypothyroidism. Central nervous system depressants, sedatives, or narcotic analgesics must be avoided in patients with severe hypothyroidism because significant respiratory depression may occur. In addition, myxedematous coma, particularly in elderly hypothyroid patients, can be precipitated by central nervous system depressants, infection, and possibly stressful dental procedures. In medically well-controlled patients the dental treatment plan is not affected and most dental procedures can be offered to these patients.

Adult↗
PubMed2006

Thyroid disorders. Part I: hyperthyroidism.

The significant thyroid disorders that may be found in dental patients are presented in a series of 3 articles. This article (part I) deals with hyperthyroidism, part II with hypothyroidism and thyroiditis, and part III with neoplastic lesions of the thyroid. The signs and symptoms, laboratory tests used to diagnoses hyperthyroidism, and the medical management of patients with hyperthyroidism are presented in this paper. The dental management of patients with hyperthyroidism is discussed in detail. The dentist, by detecting the early signs and symptoms of hyperthyroidism, can refer the patient for medical diagnosis and treatment and avoid potential complications of treating patients with uncontrolled disease. These complications include the rare thyrotoxic crisis (thyroid storm) that may be precipitated by dental treatment, acute infection, or trauma in the patient with uncontrolled hyperthyroidism. Also, the use of epinephrine or other pressor ammines can cause a hypertensive crisis in the patient with uncontrolled hyperthyroidism. Patients will benefit from the early detection and referral by reducing the risks of the medical complications such as hypertension, cardiac arrhythmias, and congestive heart failure.

Antithyroid Agents↗
PubMed2006

Thyroid disorders. Part III: neoplastic thyroid disease.

This paper is part III of the series on thyroid disorders. Thyroid tumors are the most common endocrine neoplasms. Most of these tumors are benign hyperplastic or colloid nodules or benign follicular adenomas. However, 5% to 10% of the lesions that come to medical attention are carcinomas. A major clinical challenge is establishing which nodules are hyperplastic, benign, or malignant. History, clinical findings, ultrasonography, and fine-needle aspiration biopsy are the mainstays for diagnosis. There are 3 main histologic types of thyroid cancer: differentiated, medullary, and anaplastic. Differentiated lesions are subdivided into papillary, follicular, and Hurthle cell carcinomas. In addition, primary lymphoma may occur in the thyroid gland and other cancers may metastasize to the thyroid. An important neoplastic syndrome, multiple endocrine neoplasia type 2 (MEN2), involves medullary carcinoma of the thyroid gland. In 2002 there were 10 cases of thyroid cancer per 100 000 population. During the past 10 years the rate of thyroid cancer has been increasing 5% per year. The overall 10-year survival for papillary carcinoma is 80% to 90%, follicular carcinoma 65% to 75%, and medullary carcinoma 60% to 70%. The prognosis for anaplastic carcinoma is very poor and 5-year survival is rare. The dentist by inspection and palpation of the neck in the area of the thyroid gland may detect single or multiple lesions that may be benign or malignant. Patients with identified nodules or enlarged thyroid glands should be referred for diagnosis and treatment. Patients with thyroid cancer will benefit from the early detection and treatment of their lesions as early detection can lead to a cure or prolongation of their life.

Adenoma↗
PubMed2006

Gonorrhea: update.

Gonorrhea is a worldwide sexually transmitted disease (STD) caused by Neisseria gonorrhoeae. Gonorrhea is the second most often reported STD in the United States behind chlamydia. An estimated 600,000 people each year in the United States are infected. Only about half this number of cases are reported. From 1975 through 1997, the national gonorrhea rate declined 74.3%. After a small increase in 1998, the gonorrhea rate has decreased each year since 1999. In 2003 the South had the highest gonorrhea rate among the four regions of the country. Antimicrobial resistance remains an important consideration in the treatment of gonorrhea. In 2003 the Gonococcal Isolate Surveillance Project found about 16% of collected isolates were resistant to penicillin and/or tetracycline. Since 1998 the number of ciprofloxacin-resistant isolates has been increasing with 270 (4.1%) being reported in 2003. Oral gonorrhea is rare, nonspecific, and varied and may range from slight erythema to severe ulceration with a pseudomembranous coating. The patient with gonorrhea poses little threat of disease transmission to the dentist. However, patients who have or have had gonorrhea should be approached with a measure of caution because they are in a high-risk group for additional STDs. The CDC has published recommendations for standard precautions to be followed in controlling infection in dentistry that have become the standard for preventing cross-infection. Strict adherence to these recommendations will, for all practical purposes, eliminate the danger of disease transmission between dentist and patient. Dentists should be aware of local statutory requirements regarding reporting STDs to state health officials. Syphilis, gonorrhea, and AIDS are reportable diseases in every state. Local health departments or state STD programs are sources of information regarding this matter.

Adolescent↗
PubMed2005

Syphilis: an update.

Syphilis can be spread during the practice of dentistry by direct contact with mucosal lesions of primary and secondary syphilis or blood and saliva from infected patients. The dentist also can play an important role in the control of syphilis by identification of the signs and symptoms of syphilis, patient education, and referral. The incidence of syphilis and the impact of control measures are presented with the emphasis on the past 5 years. The signs and symptoms of primary, secondary, latent, and late (tertiary) syphilis are reviewed. Current medical treatment is presented. The oral manifestations of syphilis are discussed as well as the dental management of the infected patient.

Anti-Bacterial Agents↗
PubMed2004

Complementary and alternative medicine: impact on dentistry.

Complementary and alternative medicine (CAM) represent a group of diverse medical and health care systems, practices, and products that are not considered to be part of conventional medicine. Biofeedback, acupuncture, herbal medication, massage, bioelectromagnetic therapy, meditation, and music therapy are examples of CAM treatments. Some dentists in the United States have used some of these treatments and products in their practices. Complementary medicines include herbal remedies, homeopathic medicines, and essential oils. There has been an increase in the use of herbal medicines in the US over the last 15-20 years. There is a public belief that these medicines are safe because they are made from natural sources. However, some of these products have associated adverse effects including toxicity and drug interactions. The health history taken by the dentist should include questions regarding the taking of herbal and over-the-counter medications. The dentist needs to be informed regarding the herbal and over-the-counter products that may impact the delivery of safe and effective dental treatment. In addition, the use of CAM treatments in dentistry should be based on evidence of effectiveness and safety as demonstrated in randomized clinical trials.

Attitude to Health↗
PubMed2004

Image-guided HIFU neurolysis of peripheral nerves to treat spasticity and pain.

Spasticity, a major complication of central nervous system disorders, signified by uncontrollable muscle contractions, is very difficult to treat effectively. We report on the use of ultrasound (US) image-guided high-intensity focused US (HIFU) to target and suppress the function of the sciatic nerve complex of rabbits in vivo, as a possible treatment of spasticity. The image-guided HIFU device included a 3.2-MHz spherically curved transducer and an intraoperative imaging probe. A focal acoustic intensity of 1480 to 1850 W/cm(2), applied using a scanning method, was effective in achieving complete conduction block in 100% of 22 nerve complexes with HIFU treatment times of 36 +/- 14 s (mean +/- SD). Gross examination showed blanching of the nerve at the HIFU treatment site and lesion volumes of 2.8 +/- 1.4 cm(3) encompassing the nerve complex. Histologic examination indicated axonal demyelination and necrosis of Schwann cells as probable mechanisms of nerve block. With accurate localization and targeting of peripheral nerves using US imaging, HIFU could become a promising tool for the suppression of spasticity.

Animals↗
PubMed2004

Measuring hand intrinsic muscle strength: normal values and interrater reliability.

BACKGROUND: The intrinsic muscles of the hand are of interest in spinal cord injury (SCI) and other myelopathies, because they are innervated by the most caudal cord segments innervating the upper limb. In addition, abnormalities of the peripheral nervous system, such as peripheral nerve entrapments, often affect hand intrinsic muscle strength of SCI patients. Therefore, measuring hand intrinsic strength may allow for early diagnosis of neurologic decline. METHODS: A method was developed for measuring strength of hand intrinsic muscles with a handheld myometer. With the use of a handheld myometer, this study examined the distribution of strength measurements for second-digit abductors, fifth-digit abductors, and thumb opposers in able-bodied participants and in individuals with weakness. The quantitative measurements were compared with manual muscle test scores and interrater reliability is described for these hand intrinsic strength measurements. Thirty-one able-bodied individuals participated (17 men, 14 women; mean age = 37.7 years). In addition, 24, patients with SCI participated (23 men, 1 woman; mean age = 53.5 years; 9 with paraplegia and 14 with tetraplegia as a primary diagnosis). The Bland-Altman method was used to test for interrater reliability. RESULTS: Mean strength of able-bodied participants was 5.0 kg for second-digit abduction, 3.1 kg for fifth-digit abduction, and 5.0 kg for thumb opposition, and the lower limits of normal were 3.0, 1.8, and 3.4 kg, respectively. The 95th percentile of interrater differences were 29.3% for second-digit abduction, 38.5% for fifth-digit abduction, and 43.7% for thumb opposition. CONCLUSION: Abnormal hand intrinsic strength should be suspected if values are lower than the 5th percentile values listed above or if strength change exceeds the 95th percentile for interrater differences shown above. These quantitative hand strength measurements may allow for earlier diagnosis of secondary neurologic complications and may aid in monitoring neurologic recovery in persons with SCI.

Adult↗
PubMed2004

Worsening myelopathy masked by peripheral nerve disorders.

BACKGROUND/OBJECTIVE: Peripheral nerve disorders--whether due to peripheral nerve entrapment or to polyneuropathy--can alter the signs of myelopathy, masking both the sensory loss and distal hyperreflexia. Diagnosis of worsening myelopathy may be missed when there is a coexisting peripheral nerve disorder. METHODS: This study is a case description and analysis of 3 consecutive cases identified over 2 years. RESULTS: Three cases were identified in which the diagnosis of worsening myelopathy was missed and treatment was delayed because neurologic decline was attributed to a coexisting peripheral nerve disorder. This report describes 2 cases of posttraumatic syringomyelia masked by superimposed peripheral nerve entrapments and 1 case of cervical myelopathy due to cervical spinal stenosis from ossification of the posterior longitudinal ligament masked by diabetic polyneuropathy. CONCLUSION: It is important to continually question whether the working diagnosis of peripheral nerve disorder explains the clinical findings, given neurologic decline; or whether a superimposed worsening myelopathy may coexist. Early diagnosis of worsening myelopathy is important, because prompt treatment of syringomyelia and myelopathy due to cervical spinal stenosis may yield better outcomes. Early diagnosis is aided by (a) considering alternative and multiple diagnoses, (b) assessing spinothalamic as well as posterior column sensation and assessing these sensory modalities for proximal as well as distal limbs, (c) assessing tendon hyperreflexia of proximal as well as distal limb muscles, and (d) utilizing electrodiagnostic tests that can identify myelopathy.

Adult↗
PubMed2003

Prevalence of vitamin B12 deficiency in spinal cord injury.

OBJECTIVE: To assess the prevalence of vitamin B(12) deficiency in persons with spinal cord injury (SCI) or disease (SCD). DESIGN: Cross-sectional study with prospective blood collection and retrospective medical record review. SETTING: Regional Veterans Affairs SCI service. PARTICIPANTS: One hundred six adult men with chronic SCI or SCD and without other acute medical or surgical complications; most had SCI or SCD due to trauma or cervical spinal stenosis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Fasting blood samples were obtained at annual evaluation for serum B(12), folic acid, methylmalonic acid (MMA), and homocysteine. Serum levels were analyzed graphically and associated with patient variables by using statistical tests. RESULTS: The vitamin B(12) level was subnormal in 5.7% of subjects; of those, all had supranormal MMA levels, all were age 40 to 59, most had complete SCI, and 67% had symptoms suggestive of B(12) deficiency. Low-normal B(12) levels were associated with a high prevalence of supranormal MMA. Subjects with either subnormal B(12) or low normal B(12) with supranormal MMA, both suggestive of vitamin B(12) deficiency, comprised 13.3% of the total group of subjects. CONCLUSION: Vitamin B(12) deficiency is most common in middle-aged SCI or SCD persons with complete or near-complete spinal cord involvement (ie, American Spinal Injury Association class A-C injuries). Treatment with either parenteral or oral B(12) replacement may optimize health and prevent irreversible neuropsychiatric complications in those with subnormal and low-normal B(12) levels.

Adult↗
PubMed2003

Vitamin B12 deficiency in spinal cord injury: a retrospective study.

BACKGROUND/OBJECTIVE: Vitamin B12 (or cobalamin) deficiency is well known in geriatric patients, but not in those with spinal cord injury (SCI). This retrospective study describes vitamin B12 deficiency in SCI. METHODS: This study utilized a retrospective chart review of patients with SCI who had received serum vitamin B12 testing over the last 10 years. RESULTS: Probable vitamin B12 deficiency was noted in 16 patients with SCI. Twelve patients had subnormal serum vitamin B12 levels (< 220 pg/mL), whereas 4 patients had low-normal vitamin B12 levels (< 300 pg/mL) with neurologic and/or psychiatric symptoms that improved following vitamin B12 replacement. Classic findings of paresthesias and numbness often were not evident; such findings likely were masked by the pre-existing sensory impairment caused by SCI. Of the 16 SCI patients, 7 were ambulatory; 4 of the 7 presented with deterioration of gait. In addition, 3 of the 16 SCI patients presented with depression and fatigue, 2 had worsening pain, 2 had worsening upper limb weakness, and 2 had memory decline. Of the 12 patients with subnormal serum vitamin B12 levels, 6 were asymptomatic. Classic laboratory findings of low serum vitamin B12, macrocytic red blood cell indices, and megaloblastic anemia were not always present. Anemia was identified in 7 of the 16 patients and macrocytic red blood cells were found in 3 of the 16 patients. Only 1 of the 16 SCI patients had a clear pathophysiologic mechanism to explain the vitamin B12 deficiency (ie, partial gastrectomy); none of the patients were vegetarian. Twelve of the SCI patients appeared to experience clinical benefits from cyanocobalamin replacement (some patients experienced more than 1 benefit), including reversal of anemia (5 patients), improved gait (4 patients), improved mood (3 patients), improved memory (2 patients), reduced pain (2 patients), strength gain (1 patient), and reduced numbness (1 patient). CONCLUSION: It is recommended that physicians consider vitamin B12 deficiency in their patients with SCI, particularly in those with neurologic and/or psychiatric symptoms. These symptoms often are reversible if treatment is initiated early.

Adult↗
PubMed2003

Scheuermann's kyphosis following cervical spinal cord injury.

BACKGROUND: Scheuermann's kyphosis is an uncommon autosomal dominant disease that manifests as a progressive thoracic skeletal deformity. It can lead to severe restrictive lung disease or predispose to spinal cord injury (SCI). Neurologic sequelae are rarely reported in the literature. METHOD: Case Presentation SUMMARY: A 47-year-old man sustained a cervical SCI requiring surgical anterior fusion and reoperation for fracture of the affected vertebra. One year after SCI, he presented with further kyphotic progression and cervical spine instability. Clinical presentation and family history led to a diagnosis of Scheuermann's kyphosis. To prevent further progression, he underwent extensive multilevel anterior and posterior surgical stabilization. CONCLUSION: This case illustrates the importance of early diagnosis and treatment of progressive spinal deformities. With proper surgical correction, this patient made substantial gains in mobility, self-care, and respiratory status.

Humans↗
PubMed2002

Sudden onset of cervical spondylotic myelopathy during sleep: a case report.

Cervical spondylotic myelopathy is a common cause of compressive spinal cord dysfunction. The typical course involves either a gradual or an episodic increase in symptoms and neurologic deficits, with impairment evolving over a period of months to years. Acute neurologic deterioration in conjunction with cervical spondylosis has been described almost exclusively in traumatic situations such as disk herniation. We report a case of an acute, nontraumatic onset of tetraplegia in association with cervical spondylosis. A 56-year-old man developed tetraplegia during a 1-hour nap, with loss of volitional control of his extremities, impaired sensation below the C3 dermatome, and increased muscle tone. Magnetic resonance imaging of the cervical spine revealed canal stenosis and increased T2 signal within the cord. This case report describes the rehabilitation course for this patient and reviews the clinical spectrum of onset and progression of cervical spondylotic myelopathy.

Humans↗
PubMed2002

Eating disorders: dental implications.

This article presents updated information on the 2 major eating disorders, anorexia nervosa and bulimia nervosa. Both conditions are found primarily in women. The eating disorders have significant morbidity and mortality associated with them. Patients are vulnerable to sudden death from cardiac arrhythmias. Suicide is a concern in some patients. The etiology of the eating disorders is unknown, but genetic, cultural, and psychiatric factors appear to play a role. Medical management may involve hospitalization to stabilize the patient, behavior modification, drugs, and psychotherapy. The long-term outcome of treatment is unclear at this time. The role of the dentist as a "case finder" is discussed. Also, the role of the dentist in restoring the dental and oral tissues to a healthy state in patients with eating disorders is presented.

Anorexia Nervosa↗
PubMed2002

Antithrombotic agents: implications in dentistry.

Thrombosis and the complicating emboli that can result are important causes of illness and death. Thrombosis is of greater overall clinical importance in terms of morbidity and mortality than all of the hemorrhagic disorders combined. Agents such as heparin, low-molecular weight heparin, warfarin, aspirin, ticlopidine, clopidogrel, and tirofiban are used to prevent venous or arterial thrombosis. Patients taking these antithrombotic agents may be at risk for excessive bleeding after invasive dental procedures. The current antithrombotic agents used in medicine are reviewed, and the dental management of patients taking these agents is discussed.

Anticoagulants↗