401We report a 21-year-old farmer with a 4-year history of a nodular plaque with fistulas and induration of adjacent skin. The lesion had been treated surgically at another hospital, but recurred 2 years later.Black, charcoal-like grains were observed draining through the fistulas. A biopsy specimen showed brown grains with filaments in an abscess surrounded by macrophages, giant cells, and lymphocytes. Culture demonstrated small white colonies of Madurella mycetomatis . The patient was treated with itraconazole for 6 months, followed by surgery. TNP was initiated in the immediate post-operative period, and copious granulation tissue was observed within 1 week.Autologous skin grafting was performed, and itraconazole was continued for an additional 3 months. Although necrosis of the graft ensued, the functional result was acceptable.The patient appeared free of disease at 18 months of follow-up.Eumycotic mycetoma is an infectious and inflammatory process that occurs after traumatic inoculation of fungi through the skin. Surgery is the treatment of choice, but successful reconstruction may be challenging and recurrence is common. Topical negative pressure (TNP) promotes the formation of granulation tissue, which facilitates closure of deep wounds and chronic ulcers. This case illustrates that eumycotic mycetoma is difficult to treat. Whether TNP contributed to the successful outcome cannot be proven but, given the generally poor response of eumycetoma to therapy, we suggest that the role of TNP in the management of this disease merits attention.
Our objective was to obtain images of a predictable level of quality using an intraoral X-ray system with digital imaging, avoiding patient overexposure. A polymethylmethacrylate (PMMA) physical test phantom was imaged at different exposure times and at various PMMA thicknesses using a dental imaging coupled charge device. Two identical regions of interest (ROIs) were chosen in every image file, and quality was numerically evaluated by measuring high-contrast spatial resolutions, low-contrast thresholds and signal-to-noise ratios. In addition, three practitioners proposed personal quality scores by image inspection. Numerical contents in the ROIs, related to the image quality, were plotted against exposure time. From here, a simple expression linking the exposure time with the thickness to obtain images of comparable quality was deduced. As a result, the optimum exposure time for imaging with a predictable level of quality can be inferred. The potential effect could imply savings above 1000 man Sv, roughly 20 % of the collective dose due to dental imaging, over a population of 1540 millions.
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