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At least 523 records · Page 29Linked to original sources
PubMed2006

A retrospective study of changes in cerebral oxygenation using a cerebral oximeter in older patients undergoing prolonged major abdominal surgery.

BACKGROUND AND OBJECTIVE: The objective was to carry out a retrospective study of changes in regional cerebral oxygen saturation (rSO2) using the Somanetics Invos Cerebral Oximeter (SICO) in older patients undergoing prolonged major abdominal surgery. Since evidence is accumulating that detection and correction of falls in rSO2 may be associated with a reduced incidence of postoperative cognitive dysfunction, the study assessed the incidence and possible predisposing factors for significant falls in rSO2 and strategies for correction. METHODS: Data from 46 consecutive patients aged 55 yr or above undergoing major abdominal surgery were collected and studied. A SICO electrode was placed over the right forehead prior to commencement of anaesthesia and values of rSO2 were recorded automatically on a floppy disk at 20 s intervals throughout the procedure and until transfer of the patient to the postanaesthesia care unit. Anaesthesia and physiological data were routinely collected by the author on an anaesthetic record computer and transferred to an Excel spreadsheet for analysis. RESULTS: Average duration of the surgery exceeded 7 h. Average blood loss was 1363 mL (interquartile range 500-2000). In 11 of the 46 patients the rSO2 drop exceeded 20%, and in six, there was a significant temporal association of rSO2 drop with ongoing major haemorrhage. In 23 of the 46 patients, a maximum drop in rSO2 occurred, which was about 15% or more. Fall in rSO2 in the 46 patients significantly correlated with blood loss (P < 0.05) and percentage fall in haemoglobin (Hb) (P = 0.01) but not with lowest Hb. Despite maintenance of conventional haemodynamic parameters such as systolic blood pressure (BP) in most patients, the fall in rSO2 seemed only reversible by blood transfusion. In five of the six patients who experienced the greatest decline in rSO2 during haemorrhage, there was no correlation between fall in rSO2 and systolic BP. CONCLUSIONS: This retrospective study confirms that a significant reduction in rSO2 is a common accompaniment to prolonged major abdominal surgery in elderly patients, especially if associated with blood loss, and is correctable by blood transfusion. In most cases, these changes would have gone unnoticed with conventional monitoring.

Abdomen↗
PubMed2004

Clinical experience with aripiprazole treatment in ten elderly patients with schizophrenia or schizoaffective disorder: retrospective case studies.

BACKGROUND: Clinical trials of aripiprazole, a recently Food and Drug Administration-approved atypical antipsychotic, included elderly patients, but more data are needed on the effects of aripiprazole in this population, especially those with comorbid medical illnesses. OBJECTIVE: To assess the response and safety of aripiprazole treatment in elderly patients with schizophrenia or schizoaffective disorder. METHOD: Data was obtained by retrospective review of medical records. Aripiprazole was used to treat 10 elderly hospitalized patients between 62 and 85 years of age who manifested signs of psychosis related to schizophrenia or schizoaffective disorder. All patients had been treated previously with atypical and classic antipsychotics. Response was assessed by clinical observation of patients' behavior and Clinical Global Impression Scale assigned retrospectively. RESULTS: Seven patients responded to treatment, two did not respond, and one had a partial response. The mean Clinical Global Impression Scale scores improved from 6 (severely ill) at baseline to 2.3 (much improved) at discharge. Treatment was discontinued in the two patients who did not respond. Of the seven patients who responded, four presented with positive symptoms and showed significant improvement while three presented with positive and negative symptoms and both symptoms improved significantly. Four patients had preexisting extrapyramidal symptoms (EPS) and these symptoms decreased in three patients. In addition, two patients were able to discontinue antiparkinson medications. One patient who had severe tardive dyskinesia showed significant improvement in the dyskinetic symptoms. Four patients showed postural hypotension (without clinical symptoms) which resolved over time without treatment. Six patients showed a mean weight loss of 5.2 lbs. No adverse consequences occurred when divalproex sodium, carbamazepine, clonazepam or citalopram were given concurrently. CONCLUSION: The reduction of both positive and negative symptoms of schizophrenia and the lack of significant EPS, tardive dyskinesia, sedation, weight gain, anticholinergic effects, and QTc prolongation gives preliminary indication that aripiprazole may be a safe and effective medication for elderly patients with schizophrenia or schizoaffective disorder.

Aged↗
PubMed2004

Prospective and retrospective components in the memory for actions to be performed in patients with severe closed-head injury.

This study investigated the basic mechanisms of the impairment of memory for actions to be performed in a group of 16 chronic survivors of severe closed-head injury (CHI). The experimental paradigm allowed discrimination between the deficit in spontaneously remembering the intention at the appropriate moment (prospective component of the task) and the deficit in remembering the specific actions to perform (retrospective component). The experimental procedure also contrasted a condition in which the time expiration was marked by the ringing of a timer (event-based condition) and one in which the time expiration was not marked by any event and the patient had to monitor the passing of time and completely self-activate the recall of the intention (time-based condition). Two other experimental manipulations were concerned with the duration of the delay interval from the examiner's instructions to the time expiration (10 vs. 45 min) and the fact that the three actions to be performed could be functionally related or not. With respect to a group of 16 normal controls, the patients with CHI were impaired in both the prospective and retrospective components of the memory for actions. Although an impairment of episodic memory is a plausible explanation for the poor retrieval of specific actions to perform, it is unlikely that this deficit played a major role in the CHI patient's reduced accuracy in spontaneously recalling the intention when the event occurred or the time expired. Instead, reduced frequency and less strategic utilization of time monitoring and/or self-reminding likely played a significant role in this sense.

Adolescent↗
PubMed2005

Retrospective search for evidence of the 1957 Windscale fire in NE Ireland using 129I and other long-lived nuclides.

The accident at Windscale in October 1957 resulted in the release to the atmosphere of a large quantity of radioactivity. The presented work is a retrospective search for evidence of contamination from the accident in the northeastern region of Ireland. A lake yielding a high-resolution sedimentary record was identified near the northeast coast of Ireland. This site was used to reconstruct the history of radionuclide input to the region, based on the analysis of a set of cores extracted from the lake. A chronology for sediment accumulation within the lake was established using radioisotopic dating techniques (including 270Pb). High-resolution gamma and alpha spectrometry techniques were used to quantify concentrations of 137Cs, 239,240Pu and 241Am, all of which were released during the accident. The primary radioactive component of the release was 131I (T1/2 = 8 days), but this short-lived isotope has long since decayed. However, 129I (T1/2 = 1.57 x 10(7) years) was also released during the accident, and in a known ratio to 131I. Recent advances in accelerator mass spectrometry now make it feasible to measure 129I at ultra-trace level and thereby retrospectively reconstruct 131I deposition. Clearly resolved concentration profiles for 137Cs, 239,240Pu and 241Am in the lake cores reflect known historical fallout trends. The data suggest that any contamination from the Windscale fire that might have reached this catchment has been overwritten by input from the testing of nuclear weapons in the atmosphere. A time-series for 129I in lake sediment shows that concentrations in recent sediments are approximately 10 times greater than concentrations recorded in strata corresponding to the period of maximum fallout of other radionuclides from atmospheric testing of nuclear weapons (1964). These recent increases in 129I are attributed to increased emissions from the nuclear industry. The study yields no evidence of any enhancement in radioisotope concentrations, over and above global fallout, in strata dated to 1957, and we conclude that contamination from the Windscale fire had negligible impact on the northeastern region of Ireland.

Accidents↗
PubMed2000

Pramipexole augmentation in the treatment of unipolar and bipolar depression: a retrospective chart review.

OBJECTIVE: To assess the effectiveness and safety of pramipexole as an adjunctive medication in refractory bipolar and unipolar depression in a naturalistic setting. METHODS: Retrospective chart review by psychiatrists on staff at a university hospital identified all patients who had received pramipexole. Response was based on moderate to marked improvement in the Clinical Global Impression-Improvement (CGI-I) scale. RESULTS: Pramipexole (mean dose 0.70 mg/d, mean duration 24.4 weeks) was effective in 6/12 (50.0%) of patients with bipolar depression, and 8/20 (40%) of patients with unipolar depression, mean duration of follow-up of 24.4 weeks. One case of transient hypomania was noted. Eight patients discontinued pramipexole due to lack of response and four due to side effects. CONCLUSIONS: Pramipexole, used as an adjunct to antidepressants or mood stabilizers, appeared to be effective and safe in the treatment of unipolar and bipolar depression. These uncontrolled, retrospective, naturalistic pilot data require confirmation by controlled research before conclusions can be made.

Adult↗
PubMed1997

Clinical and microbial spectrum of fungal keratitis in Singapore: a 5-year retrospective study.

BACKGROUND: The epidemiology of fungal keratitis varies geographically, but commonly occurs in warm, tropical climates. To determine the microbial and clinical characteristics of this disease in Singapore, we conducted a 5-year hospital-based retrospective study. METHODS: A retrospective review of culture-positive fungal keratitis at the Singapore National Eye Center and Singapore General Hospital, from January 1991 to December 1995. RESULTS: Twenty-nine consecutive cases of culture-positive fungal keratitis were seen over the study period. The mean age of the cases was 41 years and 23 were males. Amongst the varied occupations, 9 were construction workers. The most common cultured organisms were Fusarium sp. (52%) and Aspergillus flavus (17%). More than half had a history of ocular trauma prior to the development of keratitis, while a quarter had antecedent topical corticosteroid therapy. In contrast, only 2 patients were contact-lens wearers. Despite medical therapy, 10 patients eventually required therapeutic penetrating keratoplasties; of these, 6 were caused by Fusarium species. CONCLUSION: Fusarium is the commonest cultured organism in fungal keratitis in Singapore and is associated with significant ocular morbidity.

Adult↗
PubMed2001

[Distal radius fractures--retrospective quality control after conservative and operative therapy].

BACKGROUND: The distal radius fracture is the most frequent fracture in the adult patient. The wide spectrum of different types of fracture and the coexisting factors make the choice for the optimal treatment difficult. As an interne quality control we retrospectively evaluated all patients with distal radius fractures treated in 1995 at our institution. METHODS: The study included 69 adult patients with 71 distal radius fractures. After on average 26 months 58 patients with 59 fractures were clinically and radiologically evaluated. The patients were asked to give supplementary information about their follow-up treatment as well as any remaining physical difficulties and limitations in the daily life. All x-rays of the broken radius were carefully analysed and compared with the opposite side. The final results were evaluated according to the "Demerit Point System". RESULTS: Patients were treated with five different therapeutical methods. 76.3% of the patients showed a very good/good final result. In 56.7% of the cases secondary fracture dislocation occurred; the dislocation-rate of fractures treated with percutaneous k-wires was 93.3%! A clear correlation between secondary displacement and final results was found. CONCLUSION: A main factor for an optimal outcome is the anatomic restoration of length and axis of the distal radius as well as of joint congruency, also moderate angular deformities are well tolerated. Our collective showed an unexpected high rate of secondary displacement, especially in the k-wire group. The reasons for this unsatisfactory event are manifold: too optimistic indication, insufficient follow-up examination in the first four to six weeks, inconsequent change to a more stable fixation method in case of a secondary dislocation. The results of this retrospective evaluation had a major impact on our concept of treatment. The dorso-radial double-plate technique combined with bone graft will be more used in the future especially in younger patients. The new standardised concept is the base of a present prospective study.

Adolescent↗
PubMed2002

Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: a retrospective study.

BACKGROUND: Hypoglycemic patients treated by the emergency medical service (EMS) system are commonly left home. The criteria for leaving hypoglycemic patients at home and the appropriateness of the procedure remains, however, unvalidated. The present retrospective article addresses these questions. METHODS: The Copenhagen physician-based mobile intensive care unit (MICU) responds to emergency calls in a two-tier rendezvous system. Its prehospital data from 1995 to 1998 were retrospectively incorporated into a clinical database and cross-referenced with clinical information from three Danish national registries, enabling identification of criteria for transportation of the patients to the hospital, and a detailed 72-h follow up on patients left at home. RESULTS: The MICU treated 1148 hypoglycemic patients within the period, of which 84% were released at home. Treatment or no treatment before arrival of the MICU and level of consciousness following MICU treatment, were found to be strong predictors of a need for transportation to hospital; although other factors were implicated. Within the 72-h following MICU treatment less than 8% of the patients left at home needed secondary MICU or hospital treatment because of glucose regulatory problems, and less than 5% experienced secondary hypoglycemia. Less than 1% was admitted to hospital beds with recurrent hypoglycemia within 24 h. Poor compliance with the diabetic treatment instructions often appeared to be involved in cases of recurrent hypoglycemia. A delay in admission was not to blame for a serious secondary patient course in any of the cases. CONCLUSION: The majority of patients with prehospital hypoglycemia may safely be treated and released at home in a physician-based EMS area.

Age Factors↗
PubMed2001

Retrospective assessment of clinical and microbiological factors affecting periimplant tissue conditions.

An increasing number of studies point to the detrimental effect of plaque bacteria on periimplant tissue health. The purpose of this retrospective study was to explore a possible relationship between the clinical and microbiological periimplant conditions of osseointegrated oral implants after several years of service and the dental and medical history, as well as the conditions of the residual dentition. 45 partially edentulous patients (mean age: 51 years, range: 27-83 years), with a total of 64 implants participated in this retrospective analysis. The time between examination and the last dental visit ranged from 6 to 24 months (mean: 13 months) and the time since the last maintenance therapy appointment with a dental hygienist ranged between 3 and 24 months (mean 7 months). During 5 to 10 years between implant installation and examination, 9 implants experienced one episode and an additional 6 implants two episodes of periimplantitis. As a consequence of extensive bone loss associated with these infections, one of these implants, in a patient who had a history of diabetes, was lost. With this exception, the other episodes of periimplantitis were successfully treated employing the principles of the Cumulative Interceptive Supportive Therapy (CIST) protocol. At examination, 42 implants (66%) showed a probing pocket depth exceeding 4 mm. Of the periimplantitis sites, four implants showed cultural evidence for presence of Porphyromonas gingivalis, and 2 implants were positive for Actinobacillus actinomycetemcomitans. Statistical analysis revealed a significant relationship between periimplant probing depth and the total anaerobic cultivable microbiota as well as the frequency of detection of P. gingivalis.

Actinobacillus Infections↗
PubMed1995

Prospective and retrospective reports of mood states before relapse to substance use.

In a prospective design, it was predicted that the role of negative mood in precipitating relapses and crises among alcohol-dependent participants would be greater when assessed with retrospective mood ratings than when assessed by prospective mood ratings because of participants' attributional biases. This hypothesis was not supported. Support was found, however, for a relationship between negative bias and the amount of negative mood assessed at the time the retrospective report was given. As has been previously found, the most frequent precipitant of relapses and crises in this study was negative emotional states. Female participants were more likely to report interpersonal and less likely to report intrapersonal determinants than male participants. Minor relapses were more likely to be precipitated by social pressure and less likely to be related to negative emotions than major relapses.

Adolescent↗
PubMed1999

Childhood victimization and drug abuse: a comparison of prospective and retrospective findings.

This study examined whether childhood victimization increases risk for drug abuse using prospective and retrospective victimization information. Substantiated cases of child abuse/neglect from 1967 to 1971 were matched on gender, age, race, and approximate social class with nonabused/nonneglected children and followed prospectively into young adulthood. Between 1989 and 1995, 1,196 participants (676 abused/neglected and 520 control) were administered a 2-hr interview, including measures of self-reported childhood victimization and drug use/abuse (the National Institute of Mental Health Diagnostic Interview Schedule--Version III--Revised). Prospectively, abused/neglected individuals were not at increased risk for drug abuse. In contrast, retrospective self-reports of childhood victimization were associated with robust and significant increases in risk for drug abuse. The relationship between childhood victimization and subsequent drug problems is more complex than originally anticipated.

Child↗
PubMed1993

Duration neglect in retrospective evaluations of affective episodes.

Two experiments documented a phenomenon of duration neglect in people's global evaluations of past affective experiences. In Study 1, 32 Ss viewed aversive film clips and pleasant film clips that varied in duration and intensity. Ss provided real-time ratings of affect during each clip and global evaluations of each clip when it was over. In Study 2, 96 Ss viewed these same clips and later ranked them by their contribution to an overall experience of pleasantness (or unpleasantness). Experimental Ss ranked the films from memory; control Ss were informed of the ranking task in advance and encouraged to make evaluations on-line. Effects of film duration on retrospective evaluations were small, entirely explained by changes in real-time affect and further reduced when made from memory. Retrospective evaluations appear to be determined by a weighted average of "snapshots" of the actual affective experience, as if duration did not matter.

Adolescent↗
PubMed1997

Remember that? A comparison of real-time versus retrospective recall of smoking lapses.

Research and treatment assessments often rely on retrospective recall of events. The accuracy of recall was tested using accounts of smoking lapse episodes from 127 participants who had quit smoking, and lapses and temptations were recorded in near-real time using a hand-held computer. These computer records were compared with retrospective accounts elicited 12 weeks later, with a focus on recall of lapses in 4 content domains: mood, activity, episode Triggers, and abstinence violation effects. Recall of lapses was quite poor: Average kappas for items ranged from 0.18 to 0.27. Mean profile rs assessing recall for the overall pattern of behavior were .36, .30, .33, and .44 for these domains, respectively. In recall, participants overestimated their negative affect and the number of cigarettes they had smoked during the lapse, and their recall was influenced by current smoking status. The findings suggest caution in the use of recall in research and intervention.

Adult↗
PubMed2005

Inference-based retrospective revaluation in human causal judgments requires knowledge of within-compound relationships.

In an allergist causal-judgment task, food compounds were followed by an allergic reaction (e.g., AB+), and then 1 cue (A) was revalued. Experiment 1, in which participants who were instructed that whatever was true about one element of a causal compound was also true of the other, showed a reverse of the standard retrospective revaluation effect. That is, ratings of B were higher when A was causal (A+) than when A was safe (A-). This effect was taken to reflect inferential reasoning, not an associative mechanism. In Experiment 2, within-compound associations were found to be necessary to produce this inference-based revaluation. Therefore, evidence that within-compound associations are necessary for retrospective revaluation is consistent with the inferential account of causal judgments.

Allergens↗
PubMed2006

Patterns of prospective and retrospective memory impairment in preclinical Alzheimer's disease.

Forty-six preclinical Alzheimer's disease (AD) participants and 188 nondemented control persons from the Kungsholmen Project (L. Bäckman et al., 2004) were compared on prospective memory (ProM) and retrospective memory (RetM) tasks 3 years before dementia diagnosis. The preclinical AD participants showed deficits in both ProM and RetM. Most interestingly, logistic regression analyses revealed that ProM made an independent contribution to the prediction of AD over and above that of RetM. This finding suggests that ProM and RetM tap partly different cognitive operations. Furthermore, within the ProM task, both the retrospective and prospective components were similarly impaired in preclinical AD. Within RetM, the preclinical AD participants were impaired on indices of encoding, storage (forgetting), and retrieval of information. Hence, the findings indicate a rather global episodic memory impairment in preclinical AD that cuts across type of memory assessed (ProM and RetM) as well as across different components of both the ProM and RetM tasks.

Aged↗
PubMed1989

An evaluation of population pharmacokinetics in therapeutic trials. Part III. Prospective data collection versus retrospective data assembly.

The ability to estimate population pharmacokinetic parameters of alprazolam from fragmentary clinical data collected during clinical efficacy trials was evaluated in this series of studies. In the first study modifications to the protocol and case report forms were employed to allow for the prospective collection of accurate dosing and blood sampling time data. In the second study only total daily dose and measured drug concentration data were recorded. Dosage and blood sampling time data were assembled retrospectively by assuming strict adherence to protocol guidelines. Comparisons of the results of these analyses demonstrate the marked impact of prospective data collection efforts on data quality and the ability to determine subsequent pharmacokinetic parameters. Analysis of the prospectively collected data yielded pharmacokinetic estimates for alprazolam that were nearly identical to previously reported values obtained according to traditional methods, whereas the analysis of retrospectively collected data yielded biased estimates of the mean pharmacokinetic parameters and markedly upward biased estimates of both interindividual and residual variability. These analyses demonstrate the ability to estimate population pharmacokinetic parameters from data collected during clinical efficacy trials, provided that critical issues pertaining to the design and use of data collection forms to enhance data quality and the education of patients and staff are satisfactorily addressed.

Adult↗
PubMed2001

Fine-needle aspiration biopsy in the diagnosis and classification of primary and recurrent lymphoma: a retrospective analysis of the utility of cytomorphology and flow cytometry.

We retrospectively reviewed our experience with the fine-needle aspiration biopsy (FNAB) diagnosis of primary and recurrent lymphoma to assess the ability of cytomorphology with and without ancillary flow cytometry (FCM) analysis to diagnose and subclassify these tumors according to the Revised European-American Lymphoma/World Health Organization classifications. We reviewed 139 consecutive FNABS of 84 primary and 55 recurrent lymphomas. FCM was successful in 105 (75%) cases. The overall results, including cases without FCM, included 93/139 (67%) true positive, 7 (5%) false negative, and 39 indeterminate (27 [19%] suspicious and 12 [9%] atypical) diagnoses of lymphoma. In cases with FCM, there were 80/105 (77%) true positive, no false negative, and 25 indeterminate diagnoses (15 [14%] suspicious and 10 [9%] atypical). The overall results of the 84 primary lymphomas were 55 (67%) true positive, 5 (5%) false negative, and 24 indeterminate (14[16%] suspicious and 10 [12%] atypical) diagnoses for lymphoma. Of the 68 primary lymphomas analyzed with FCM, 50 [74%] were true positives, and 28 were indeterminate (11 [16%] suspicious and 7 [10%] atypical). There were no false negatives. Diagnostic accuracy varied among lymphoma subtypes. Subclassification of the positive cases were initially conclusive in only 55/93 cases (59%). However, a retrospective review of the morphologic together with FCM data in 15 of the 23 unclassified cases improved the overall subclassification of positive cases to 77%. Subclassification was best in small lymphocytic lymphoma/chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, Burkitt's lymphoma, mantle cell lymphoma, and plasmacytoma (all 100%). Subclassification was poor in marginal-zone lymphoma (33%), and initially as well in diffuse large B-cell lymphoma (62%), but it improved on review (95%), as did subclassification of follicular lymphoma (77 to 100% on review). Hodgkin's disease was recognized as malignant in only 44% of the cases (7/16) and was classified as such based on morphology alone. This review of our early efforts to diagnose and subclassify lymphoma with FNAB and FCM indicates that although a diagnosis and proper subclassification of lymphoma can be made with certainty in the majority of cases, recurrent or primary, it requires close coordination of cytomorphology and immunophenotyping data, which often comes with close cooperation of cytopathologists and hematopathologists. A mere cytological diagnosis of positive for lymphoma is no longer acceptable if FNAB is to become an independent diagnostic tool for lymphoma.

Biopsy, Needle↗
PubMed2003

Staphylococcus aureus in the oral cavity: a three-year retrospective analysis of clinical laboratory data.

OBJECTIVE: A retrospective analysis of laboratory data to investigate the isolation of Staphylococcus aureus from the oral cavity and facial area in specimens submitted to a regional diagnostic oral microbiology laboratory. METHODS: A hand search of laboratory records for a three-year period (1998-2000) was performed for specimens submitted to the regional diagnostic oral microbiology laboratory based at Glasgow Dental Hospital and School. Data were collected from forms where S. aureus was isolated. These data included demographics, referral source, specimen type, methicillin susceptibility and clinical details. RESULTS: For the period 1998-2000, there were 5,005 specimens submitted to the laboratory. S. aureus was isolated from 1,017 specimens, of which 967 (95%) were sensitive to methicillin (MSSA) and 50 (5%) were resistant to methicillin (MRSA). The 1,017 specimens were provided from 615 patients. MRSA was isolated from 37 (6%) of patients. There was an increasing incidence of S. aureus with age, particularly in the >70 years age group. The most common specimen from which MSSA was isolated was an oral rinse (38%) whilst for MRSA isolates this was a tongue swab (28%). The clinical condition most commonly reported for MSSA isolates was angular cheilitis (22%). Erythema, swelling, pain or burning of the oral mucosa was the clinical condition most commonly reported for MRSA isolates (16%). Patients from whom the MSSA isolates were recovered were most commonly (55%) seen in the oral medicine clinic at the dental hospital, whilst patients with MRSA were more commonly seen in primary care settings such as nursing homes, hospices and general dental practice (51%). CONCLUSION: In line with more recent surveys, this retrospective study suggests that S. aureus may be a more frequent isolate from the oral cavity than hitherto suspected. A small proportion of the S. aureus isolates were MRSA. There were insufficient data available to determine whether the S. aureus isolates were colonising or infecting the oral cavity. However, the role of S. aureus in several diseases of the oral mucosa merits further investigation.

Adolescent↗