Objective: The purpose of this study was to determine the effects of prophylactic near-infrared light therapy from light-emitting diodes (LEDs) in pediatric bone marrow transplant (BMT) recipients. Background Data: Oral mucositis (OM) is a frequent side effect of chemotherapy that leads to increased morbidity. Nearinfrared light has been shown to produce biostimulatory effects in tissues, and previous results using nearinfrared lasers have shown improvement in OM indices. However, LEDs may hold greater potential for clinical applications. Materials and Methods: We recruited 32 consecutive pediatric patients undergoing myeloablative therapy in preparation for BMT. Patients were examined by two of three pediatric dentists trained in assessing the Schubert oral mucositis index (OMI) for left and right buccal and lateral tongue mucosal surfaces, while the patients were asked to rate their current left and right mouth pain, left and right xerostomia, and throat pain. LED therapy consisted of daily treatment at a fluence of 4 J/cm 2 using a 670-nm LED array held to the left extraoral epithelium starting on the day of transplant, with a concurrent sham treatment on the right. Patients were assessed before BMT and every 2-3 days through posttransplant day 14. Outcomes included the percentage of patients with ulcerative oral mucositis (UOM) compared to historical epidemiological controls, the comparison of left and right buccal pain to throat pain, and the comparison between sides of the buccal and lateral tongue OMI and buccal pain. Results: The incidence of UOM was 53%, compared to an expected rate of 70-90%. There was also a 48% and 39% reduction of treated left and right buccal pain, respectively, compared to untreated throat pain at about posttransplant day 7 (p < 0.05). There were no significant differences between sides in OMI or pain. Conclusion: Although more studies are needed, LED therapy appears useful in the prevention of OM in pediatric BMT patients. 319
Eosinophilic granuloma is said to be the most benign disorder of the triad commonly known as histiocytosis X. There has been, and still is, confusion about the terminology describing this entity. This article reviews the literature on histiocytosis X, with particular emphasis on eosinophilic granuloma and its oral manifestations. The case of a 22-month-old male child with an eosinophilic granuloma of the right mandible is presented. The diagnostic and treatment methods are reviewed and discussed. During the 4 years that the case has been followed there has been progressive healing of the lesion, but other manifestations of the disease process and of the surgical treatment have become evident. The need for close dental as well as medical follow-up in cases involving the dental structures is stressed.
the cylinder noted for the earliest reaction. The galvanic current should then be used, with a galvanometer in circuit, and the smallest current (in milliampères) noted at which KaSZ and AnSZ occur. Besides this we must note whether contractions be slow or quick. If muscular atrophy be apparent on inspection, careful measurements should be taken, and the presence of fibrillary contractions noted. Of course, the emaciation not uncommon in these cases of protracted illness would never be mistaken for true muscular atrophy. Although the one-sided view of refusing to recognize cases as genuine unless muscular atrophy be present, is utterly incorrect and misleading, still, as I have just said, in the very rare cases where it is present it affords absolute and incontestable evidence of disease, especially where electrical changes are added. I may say, in passing, that general emaciation, to which I have just referred, is, of course, evidence in favor of a chronic disease and it is not. a thing to be simulated. REFLEXES. Cutaneous Reflexes.-The important skin reflexes
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