Phase 1 consists only of reversible occlusal treatment, such as interocclusal appliance therapy, the role of which is diagnostic as well as therapeutic. Unless symptoms are relieved by these measures, irreversible occlusal treatment is contraindicated. Definitive phase 2 irreversible treatment should occur only after TMD symptoms have resolved and then only when malocclusion has been implicated as a perpetuating factor. Addi Abu El-Shar, MD, Constantine Saadeh, MD, and Naziha Nuwayhid, PhD. Department of Internal Medicine, Texas Tech University Health Sciences Center and the Department of Veterans Affairs Medical Center, Amarillo, Tex. Manifestation of APAS in children is unusual.
Antiphospholipid antibodies comprise a heterogeneous group of antibodies.
Therefore, a negative result by one test should not deter the physician from ordering the other test, especially when the clinical findings support the diagnosis. Few cases of APAS in the literature have been reported with slightly elevated aPTT, but to our knowledge this is the first case of a child presenting with DVT with minimal SLE symptoms. Thus, a high index of suspicion is required to diagnose APAS when DVT is the primary presentation in the absence of any other indications. A positive ANA titer should be regarded as a helpful clue. Medicines included imuran, prednisone, Bactrim prophylaxis, and FK 506.