Esthetic and endosurgical management of Turner's hypoplasia; a sequlae of trauma to developing tooth germ

Turner's hypoplasia usually manifests as a portion of missing or diminished enamel, generally affecting one or more permanent teeth in the oral cavity. A case report of 8 year old girl who met with trauma at 2 years of age leading to primary incisors being knocked out, reported after 6 years with complaint of pain and discharge in her anterior malformed teeth is discussed in this article. The permanent incisors erupted with dilacerated crown, root malformations and missing enamel. Further, patient developed sinus, lateral root pathology, tooth mobility and malocclusion in relation to affected teeth which were managed by esthetic, functional, endodontic and surgical procedure. Root canal treatment along with palatal contouring and esthetic restoration by light cure composite was performed on the tooth with crown dilaceration and sinus, where as surgical management was considered for the tooth with root malformation.

Dietary iron and haem iron intake and risk of endometrial cancer: a prospective cohort study

We used data from a large cohort study of Canadian women to assess the association of meat intake and dietary intake of iron and haem iron with risk of endometrial cancer. Among 34 148 women with an intact uterus at baseline and followed for a mean of 16.4 years, we identified 426 incident endometrial cancer cases. Data from a food frequency questionnaire administered at baseline were used to calculate intake of all meats, red meat, total dietary iron, iron from meat, haem iron, and non-haem iron. Analyses were carried out using Cox proportional hazards models with adjustment for known risk factors and covariates. We found no association of intake of meat or any of the dietary iron-related variables with risk of endometrial cancer.

Structural and Ferromagnetic Properties of Epitaxial SrRuO3 Thin Films Obtained by Polymer-Assisted Deposition

Epitaxial ferromagnetic SrRuO3 thin films with a room-temperature resistivity of 300 microOmega.cm have been successfully grown on LaAlO3(001) substrates at a processing temperature in the range of 550-750 degrees C by a polymer-assisted deposition technique. X-ray diffraction analysis shows good epitaxial quality of SrRuO3 thin films, giving values of the full width at half-maximum (FWHM) of 0.42 degrees from the rocking curve for the (002) reflection and 1.1 degrees from the in-plane phi scan for the (204) reflection. Both the resistivity and the magnetization versus temperature measurements show that the SrRuO3 films are ferromagnetic with a transition temperature of 160 K. The spontaneous magnetization near the ferromagnetic transition follows the scaling law, and the low-temperature magnetization follows the Bloch law.

A cohort study of dietary iron and heme iron intake and risk of colorectal cancer in women

In a cohort study of 49 654 Canadian women, we assessed the association of colorectal cancer with total iron and heme iron intake, excluding iron supplements. Among women aged 40–59 years, followed for an average of 16.4 years, we identified 617 incident colorectal cancer cases. Data from a food frequency questionnaire administered at baseline were used to calculate red meat intake and intake of total dietary iron, iron from meat, and heme iron. Analyses were carried out for all cases and for the proximal colon, distal colon, and rectum, using Cox proportional hazards models. We found no association of intake of iron, heme iron, or iron from meat with risk of colorectal cancer overall or with any of the subsites, nor was there effect modification by alcohol consumption or hormonal replacement therapy.

Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change

BACKGROUND

Nosocomial infections occur in approximately 10% of patients in intensive care units (ICUs). Several studies have shown that a quality improvement initiative can reduce nosocomial infections, mortality, and cost.

CONTEXT

Our hospital is located in Northern Mississippi and has a 28 bed Medical-Surgical ICU unit with 95% occupancy. We joined the ICU collaborative with the IMPACT initiative of the Institute of Healthcare Improvement (IHI) in October 2002. A preliminary prospective before (fiscal year (FY) 2001-2) and after (FY 2003) hypothesis generating study was conducted of outcomes resulting from small tests of change in the management of ICU patients.

KEY MEASURES FOR IMPROVEMENT

Nosocomial infection rates, adverse events per ICU day, average length of stay, and average cost per ICU episode.

STRATEGY FOR CHANGE

Four changes were implemented: (1) physician led multidisciplinary rounds; (2) daily "flow" meeting to assess bed availability; (3) "bundles" (sets of evidence based best practices); and (4) culture changes with a focus on the team decision making process.

EFFECTS OF CHANGE

Between baseline and re-measurement periods, nosocomial infection rates declined for ventilator associated pneumonia (from 7.5 to 3.2 per 1000 ventilator days, p = 0.04) and bloodstream infections (from 5.9 to 3.1 per 1000 line days, p = 0.03), with a downward trend in the rate of urinary tract infections (from 3.8 to 2.4 per 1000 catheter days, p = 0.17). There was a strong downward trend in the rates of adverse events in the ICU as well as the average length of stay per episode. From FY 2002 to FY 2003 the cost per ICU episode fell from $3406 to $2973.

LESSONS LEARNED

A systematic approach through collaboration with IHI's IMPACT initiative may have contributed to significant improvements in care in the ICU setting. Multidisciplinary teams appeared to improve communication, and bundles provided consistency of evidence based practices. The flow meetings allowed for rapid prioritization of activity and a new decision making culture empowered team members. The impact of these changes needs to be assessed more widely using rigorous study designs.

Nephron sparing surgery: A single institution experience

Objective:

To report our experience in managing various benign and malignant renal tumors with nephron-sparing surgery.

Materials and Methods:

Records of patients who underwent nephron-sparing surgery (NSS) either through open or laparoscopic approach between May 1997 and June 2006 at our institution were reviewed. Patient and tumor-related characteristics, treatment modality and complications were noted.

Results:

There were 26 patients (29 renal units), including three with bilateral lesions who underwent nephron-sparing surgery. Mean age at surgery was 47.0 years (range 16-67 years). Mean tumor size was 4.7 cm (range 2-7.5 cm). Mean warm ischemia time was 41 min and 32.5 min, operative time 158 min and 186 min and blood loss 200ml and 85 ml in open (n=24) and laparoscopic approach (n=2) respectively. Complications were seen in five (19.2%) patients of whom two had postoperative bleeding requiring nephrectomy in one and angioembolization in another. One patient with persistent urinary leak required intervention. Local wound infection in one patient and incisional hernia in another were surgically managed. Histopathological profile revealed 13 (44.8%) benign lesions which included angiomyolipoma (eight), simple cyst (two), cortical adenoma (one), metanephric adenoma (one) and myelolipoma (one). The remaining 16 (55.2%) malignant lesions included renal cell carcinoma (15) and metastatic adenocarcinoma (one). At a mean follow-up of 38.6 months (range 1-91) no patient had local recurrence or distant metastasis. Cancer-specific survival was 100% and overall survival was 92.3%.

Conclusions:

Nephron-sparing surgery is a safe and effective alternative to nephrectomy in both benign and malignant lesions of the kidney.

Primary bladder dermoid: a case report and review of the literature

Bladder dermoid is a rare presentation. Diagnosis of this case was made cystoscopically and confirmed histopathologically. Complete excision was possible endoscopically. This is the 3rd case report from the Indian and Asian subcontinent.

Variation in clinical and genitourinary lesions associated with pulmonary hypoplasia in Potter's syndrome--two autopsy reports

Potter's syndrome is a rare entity with an incidence of 1 in 2000 to 1 in 5000 live births. All babies born with this condition are either stillborn or die very early within neonatal period. We present two autopsy cases which presented with abnormal facies, oligohydramnios, pulmonary hypoplasia and genitourinary abnormality. One case presented with infantile polycystic kidney whereas in the other case both the kidneys were normal but had adenomatoid tumour of left testis. Both the children died few hours after birth. In both the cases pulmonary hypoplasia was the cause of death rather than genitourinary abnormality.

Ocular angiostrongyliasis in a child--first case report from India

A rare case report of Angiostrongylus cantonensis (rat lung worm) from the eye is presented here. This worm generally causes eosinophilic meningo-encephalitis and accidentally infects humans by ingestion of uncooked snails, slugs, frogs etc. The child was presented to us with diminished vision in left eye. Slit lamp examination showed an actively motile worm in the anterior chamber. Surgical extraction of the worm was performed and it was identified as A. cantonensis. This is the first case of ocular A. cantonensis infection from India with no signs or symptoms of meningitis. After surgery, the visual acuity of the patient returned to normal.