Biomedical subjects
Publications and source records attributed to M Hekmat.
The publisher regrets that this was an accidental duplication of an article that has already been published in Eur. J. Echocardiogr., 4 (2003) 229-231, . The duplicate article has therefore been withdrawn.
A 34-year-old woman with exertional dyspnoea and clinical diagnosis of mitral stenosis underwent echocardiographic evaluation. Moderate to severe rheumatic mitral stenosis was confirmed but an unsuspected mass lesion in the dilated left atrium attached to inter-atrial septum in fossa ovalis region was found. Although the attachment was in favour of myxoma, it was difficult to differentiate with certainty between left atrial myxoma and thrombus. Warfarin was prescribed but after 1 year the mass lesion remained unchanged. Both the severity of the mitral stenosis and the presence of the mass lesion led to our decision to proceed with surgery. Pathology showed typical histology of a myxoma.
Recent reports have suggested that the practice of prophylactic lower third molar surgery is widespread, possibly account for up to 50% of all patients treated. An objective effort to refute the findings of the previously published data was undertaken by the Maxillofacial Unit of a large district general hospital trust. A prospective study of 454 consecutive patients referred for third molar surgery demonstrated that in 96% of the patients, at least one nationally defined criteria for surgery was present. A concurrent retrospective audit of patients already on the waiting list for surgery identified that 97% had at least one valid criterion for surgery. Of those patients who presented with unilateral symptoms, over half had only the troublesome side removed. Only 11 out of 454 patients were accepted for treatment without a defined criterion, all of whom had partially erupted teeth. The evidence presented in the current study is compared with previously reported data and possible reasons for the variance are discussed.
A national survey was conducted to establish the current practice of postoperative review of third molar surgery by the 255 fellows of the British Association of Oral and Maxillofacial Surgeons. Of the 216 complete responses, 134 say that they routinely reviewed all patients, while 67 did not. A further 15 fellows (7%) are currently considering their practice. Five (2%) stated that routine review should be compulsory and failure to do so was medically negligent. We conclude that a policy of selective rather than routine review is safe for most patients, but if a patient is under age, mentally retarded, taking psychoactive drugs, or has any other associated condition, then routine follow-up should be undertaken.