Toothbrush efficacy for plaque removal

OBJECTIVES

To determine the effectiveness of a novel sonic toothbrush in reducing plaque and in maintenance of gingival health when compared to a standard manual brush.

METHODS

This study was a block-randomized, examiner-blind, two-treatment, parallel group, single centre clinical investigation. A total of 84 subjects were enrolled and randomly assigned to receive either the Panasonic EW-DL90 or an American Dental Association-endorsed manual toothbrush. Subjects were instructed to follow a twice-daily brushing regimen without flossing. Plaque levels and gingival health were assessed at baseline and after 1 and 3 weeks of treatment using the Turesky Modification of the Quigley-Hein Plaque Index and the Papillary Bleeding Score.

RESULTS

Subjects assigned to the EW-DL90 group had significantly lower plaque levels after 1 and 3 weeks of treatment than those in the manual group (P = 0.003 and 0.0035, respectively). Both groups showed a reduction in plaque levels at Week 3 relative to baseline. The EW-DL90 group had significantly lower gingival inflammation scores after 1 week of treatment (P = 0.0293), but there was no difference between groups after 3 weeks of treatment.

CONCLUSION

The EW-DL90 toothbrush safely and effectively removes more plaque than a standard manual toothbrush. Improvement in gingival inflammation was observed after 1 week of treatment. There was no difference in Papillary Bleeding Score between the two groups after 3 weeks of treatment.

CLINICAL SIGNIFICANCE

The newly developed sonic brush (Panasonic EW-DL90) tested in this study was found to be more effective than a manual toothbrush at plaque removal. The papillary bleeding scores were significantly lower in the sonic brush group after 1 week of product use. After 3 weeks of product use, both treatment groups had similar papillary bleeding scores almost returning to baseline values.

Immature teratoma of the nose and paranasal sinuses masquerading as bilateral nasal polyposis: a unique presentation

Teratomas are tumors of multipotent cells derived from all three germ cell layers and recapitulate normal organogenesis. Teratomas are hypothesized to arise by misplacement of multipotent germ cells. Teratoma is usually developmental and sometimes congenital neoplasm which displays both solid and cystic components with gross and microscopic differentiation into a wide variety of tissues representative of all three germ layers--ectoderm, mesoderm and endoderm. We are describing a case which was initially diagnosed as bilateral nasal polyposis clinically but histopathology report came out to be immature teratoma. This case is being reported to make aware all ENT surgeons of such unique presentation of sinonasal teratomas as such presentation of these tumors has not been reported in literature previously, and hence teratomas should be considered in the differential diagnosis of nasal polyposis in future.

Abstract B127: Pharmacodynamics and functionality of RheoSwitch® regulated immunomodulatory proteins, expressed from a multigenic embedded cellular bioreactor following intramuscular electroporation in mice

Over the past decade, immunotherapies have emerged as prominent means to fight cancer. It is currently well accepted that combining multiple immunomodulatory therapeutic modalities will likely have a deeper impact in promoting cancer remission than monotherapies. Toward the development of a tri-immuno-therapeutic approach, we evaluated the feasibility and expression potency of multigenic plasmid constructs that simultaneously expressed three immunomodulators - human IL-12, human IFNα, and a CTLA4 decoy - in single, dual or triple combinations. In all constructs, the three effectors were expressed under the control of Intrexon's RheoSwitch Therapeutic System® (RTS®) activated by an orally available small molecule activator ligand (AL), veledimex (also known as INXN-1001). Expression of the three genes of interest (GOI) was driven by distinct RTS® inducible promoters, which allow for conditional gene expression following oral treatment with veledimex. Seven plasmids were constructed; three encoding for each GOI alone, three containing a combination of two GOIs; and one plasmid expressing all three GOIs. Expression of each GOI from each plasmid was evaluated in vitro in HT1080 and HEK293T cells for expression and function, and in vivo following administration through a single IM injection and electroporation into mice pre-exposed to the AL. Three days post IM/EP and daily oral treatment with veledimex, animals were bled and sera were evaluated for the single or concomitant expression and function of the encoded GOIs. Transient transfection and in vivo electroporation of the single and multi-effector plasmids yielded increased levels of hIL-12, hIFNα, and the CTLA4 decoy, when combined with veledimex. In contrast, no expression was seen in cell culture supernatants or sera in the absence of the activator ligand. Importantly, all three effectors, expressed from single plasmids were functionally active in cell based assays - hIL-12 increased IFNγ secretion from NK92 cells, hIFNα enhanced STAT1 activation, and the CTLA4 decoy blocked CD80 binding to CTLA4. Taken together, these results show for the first time the feasibility of systemic expression of three distinct immune effectors from a single RTS® regulated multigenic construct in mice. The in vivo studies also highlight the potential use of an ECB to generate therapeutics for tumor-targeted delivery of single or multiple RTS® regulated cancer immunotherapies. Altogether, use of these novel regulated immunotherapeutic approaches could potentially be translated into an effective clinical regimen for a variety of cancers.

Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B127.

Citation Format: Pooja Agarwal, Stephen Schauer, Xiaohong Ma, Jacques Plummer, Tim Chan, Lindsay Williams, Michele Kaloss, John A. Barrett, Richard Einstein, Laurent M. Humeau, Thomas R. Reed. Pharmacodynamics and functionality of RheoSwitch® regulated immunomodulatory proteins, expressed from a multigenic embedded cellular bioreactor following intramuscular electroporation in mice. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B127.

Do women presenting for first and second-trimester abortion differ socio-demographically?

Background:

To identify the socio-demographic differences between a sample of women who present for first-trimester and second-trimester abortion.

Aim:

To determine whether women presenting late (in the second trimester) for abortion differ socio-demographically from those presenting early (in the first trimester).

Materials and Methods:

Data over 4 years for women presenting for second-trimester abortion were collected from the records of Family Planning Clinic at a public tertiary level teaching hospital in India. Eighty-four cases were analysed. The case presenting for first-trimester abortion after each second-trimester abortion was included for comparison. Information was gathered concerning age, parity, educational background, employment status, educational background of the husband, family expenditure and religion. Data were statistically analysed and significance determined using logistic regression analysis.

Results:

Second-trimester abortions represented 2% (84/4254) of all abortions in the study period. More women of higher age (P = 0.03) and parity (P = 0.02) and higher educational status (P = 0.04) presented for second-trimester abortion as compared to first-trimester abortion. The occupational status of the woman, husband's educational background, monthly family expenditure per person and religion did not significantly influence the time of presentation for abortion.

Conclusion:

Second-trimester abortions are associated with both increasing age and parity and higher education. This group of educated, older and multiparous women should be one of those targeted for counseling to reduce the risks associated with second trimester abortion.

Real-time probe based quantitative determination of material properties at the nanoscale

Tailoring the properties of a material at the nanoscale holds the promise of achieving hitherto unparalleled specificity of the desired behavior of the material. Key to realizing this potential of tailoring materials at the nanoscale are methods for rapidly estimating physical properties of the material at the nanoscale. In this paper, we report a method for simultaneously determining the topography, stiffness and dissipative properties of materials at the nanoscale in a probe based dynamic mode operation. The method is particularly suited for investigating soft-matter such as polymers and bio-matter. We use perturbation analysis tools for mapping dissipative and stiffness properties of material into parameters of an equivalent linear time-invariant model. Parameters of the equivalent model are adaptively estimated, where, for robust estimation, a multi-frequency excitation of the probe is introduced. We demonstrate that the reported method of simultaneously determining multiple material properties can be implemented in real-time on existing probe based instruments. We further demonstrate the effectiveness of the method by investigating properties of a polymer blend in real-time.

A rare presentation of mammary Paget's disease involving the entire breast in the absence of any underlying ductal malignancy

Paget's disease of the breast is an uncommon form of breast cancer presenting as an eczematous eruption over the nipple and/or areola. The diagnosis remains elusive with varied presentations, mimicking many benign skin diseases, the awareness of which is indispensable for diagnosis and minimizing morbidity. Most of the cases have an associated malignancy of the underlying breast tissue. There have been very few reports wherein the disease has occurred independent of any underlying malignancy. Since, the initial presentation is limited to skin; it is the dermatologist who plays a key role in making a diagnosis, thus, facilitating proper management. We report a rare presentation of mammary Paget's disease with a wide cutaneous spread probably attributed to a significantly delayed diagnosis without any associated underlying malignancy.

Synthesis and bioevaluation of novel 4-aminoquinoline-tetrazole derivatives as potent antimalarial agents

A series of novel tetrazole derivatives of 4-aminoquinoline were synthesized and screened for their antimalarial activities against both chloroquine-senstive (3D7) and chloroquine-resistant (K1) strains of Plasmodium falciparum as well as for cytotoxicity against VERO cell lines. Most of the synthesized compounds exhibited potent antimalarial activity as compared to chloroquine against K1-strain. Compounds with significant in vitro antimalarial activity were then evaluated for their in vivo efficacy in Swiss mice against Plasmodium yoelii following both intraperitoneal (ip) and oral administration, wherein compounds 20 and 23 each showed in vivo suppression of 99.99% parasitaemia on day 4.

Outcomes of manual small incision cataract surgery under topical anesthesia with lignocaine 2% jelly

INTRODUCTION

The manual small incision cataract surgery (MSICS) is the surgery of choice in countries with a huge back-log of cataract blindness.

OBJECTIVE

To evaluate the outcome of manual small incision cataract surgery (MSICS) under topical anesthesia with lignocaine 2 % jelly.

MATERIALS AND METHODS

This study was a prospective interventional case series. One hundred and twenty eight patients of senile cataract were operated by MSICS under topical anesthesia using lignocaine 2% jelly. No intra-cameral anesthesia was used. The patients and the single operating surgeon were given a questionnaire to evaluate their experience in terms of pain, surgical experience and complications.

RESULTS

The mean pain score was 0.82 (SD +/- 0.97). Seventy-one patients (55.4 %) had a pain score of zero, that is, no pain. One hundred and twenty one patients (94.5 %) had a score of 3 or less, that is, mild to none pain. All the surgeries except two were complication- free and the surgeon's experience was favorable in terms of the patient's cooperation, anterior chamber stability, difficulty, and complications.

CONCLUSIONS

MSICS can be performed under topical anesthesia with lignocaine jelly, which makes the surgery patient-friendly, without compromising the outcome.

Competitive binding of fluoroquinolone antibiotics and some other drugs to human serum albumin: a luminescence spectroscopic study

Co-administration of several drugs in multidrug therapy may alter the binding of each to human serum albumin (HSA) and hence their pharmacological activity. Thirty-two frequently prescribed drug combinations, consisting of four fluoroquinolone antibiotics and eight competing drugs, have been studied using fluorescence and circular dichroism spectroscopic techniques. Competitive binding studies on the drug combinations are not available in the literature. In most cases, the presence of competing drug decreased the binding affinity of fluoroquinolone, resulting in an increase in the concentration of free pharmacologically active drug. The competitive binding mechanism involved could be interpreted in terms of the site specificity of the binding and competing drugs. For levofloxacin, the change in the binding affinity was small because in the presence of site II-specific competing drugs, levofloxacin mainly occupied site I. A competitive interference mechanism was operative for sparfloxacin, whereas competitive interference as well as site-to-site displacement of competing drugs was observed in the case of ciprofloxacin hydrochloride. For enrofloxacin, a different behavior was observed for different combinations; site-to-site displacement and conformational changes as well as independent binding has been observed for various drug combinations. Circular dichroism spectral studies showed that competitive binding did not cause any major structural changes in the HSA molecule.

Management of mycoplasma contamination in in vitro culture of Plasmodium falciparum without antibiotic treatment - a preliminary report

The presence of foreign contamination, especially of mycoplasmas, is a major hindrance in long term in vitro cultivation of Plasmodium falciparum and may be a source of false-positive results. Efforts have been made to control mycoplasma contamination by trypsinization of P. falciparum culture. Samples of accidentally contaminated cultures were used for this study. The presence of Mycoplasma orale in contaminated culture was ascertained by a species-specific PCR-based mycoplasma detection kit (Takara; Cat. No.6601). Trypsinization was carried out using trypsin-EDTA and the growth profile of P. falciparum was monitored for more than three weeks post-trypsinization. The studies were carried out with four different P. falciparum strains, various serum supplements and human erythrocytes belonging to different blood groups. It was interesting to observe that, irrespective of the different strains of P. falciparum and the variety of serum supplements and erythrocytes, mycoplasma contamination can successfully be removed from P. falciparum culture by trypsinization. No antibiotic except gentamicin, which is routinely used, was added to the medium. Results of this study indicate that the frequent appearance of mycoplasma in continuous long-term cultures of P. falciparum can be managed by trypsinization.

Nonsyndromic tooth agenesis patterns and associated developmental dental anomalies: a literature review with radiographic illustrations

Tooth agenesis is one of the most intriguing phenomena, because it is frequently associated with other oral anomalies, structural variations and malformations of other teeth, late eruption, transposition and crowding. The diagnosis can be quite challenging as radiographic examination is critical for the diagnosis but not always possible and the late developing teeth may be sometimes scored developmentally missing. Accurate diagnosis therefore requires radiographic, clinical, and dental cast examinations. It is an important clinical and public health problem. Patients with missing permanent teeth may suffer from a reduced chewing ability, inarticulate pronunciation, and an unfavorable aesthetic appearance. Clinically, early diagnosis of a dental anomaly can alert the clinician to the possible development of other associated dental anomalies in the same patient or family, and avoid the possible sequelae. Understanding of tooth agenesis patterns and their impact on diagnosis, prevention, and eventually therapeutics are becoming integral parts of comprehensive dental care. Dental examination with radiographic screening of hypodontia in early childhood should be emphasized as part of public oral health policy to allow early diagnosis and timely intervention.

Driving with navigational instructions: Investigating user behaviour and performance

This paper reports the results of an inter-disciplinary study investigating user preferences and performance in relation to spoken in-car route guidance. In-car navigation systems are becoming increasingly popular. However, despite large amounts of research assessing the presentation of spatial information, and the usability and interaction issues surrounding the interfaces, there has been much less investigation of the impacts of auditory presentation of route information. We addressed this issue using a multi-disciplinary approach to collect both qualitative and quantitative data through questionnaires and user experiments. Our research identified a user preference for auditory presentation of route information, as well as a memory advantage for auditory over visual presentation. We also found that simple auditory route instructions could be followed without significant interference to a simulated driving task, whereas more complex auditory instructions did cause interference. Taken together, this research highlights the importance of the design of spoken route guidance instructions in minimising the cognitive demands that they impose.

Lepromatous leprosy with an uncommon presentation: a case report

28 yr old male presented with asymptomatic nodules and few well to ill defined papules on ears, asymmetrical nerve enlargement and evanescent tender nodules on the extremities without any infiltration of the skin and madarosis. Slit skin smear done from normal skin was BI 6+. Skin biopsy showed features of lepromatous leprosy.

Oral health status and needs of homebound elderly in an urban home-based primary care service

OBJECTIVES

This study assessed the oral health status, dental utilization and dental needs of the homebound elderly (HBE) care patients within the Mount Sinai Visiting Doctor program.

METHODS

Of the 334 eligible patients, 57% agreed to participate and 95.4% completed the clinical examinations, the Dental Utilization and Needs survey and Geriatric Oral Health Assessment Index conducted in each subject's home by a trained research team.

RESULTS

Among 75% who were dentate subjects, 40% needed restorative dental care, 45.6% needed dental extractions, and 33% complained of current oral pain. Overall, 92.0% needed some type of dental care and 96% stated that they had not seen a dentist since they became homebound (mean number of years in program = 3.2 ± 2.58).

CONCLUSION

Findings show the oral health status of these homebound elderly was poor and their quality of life was significantly affected by the lack of basic dental care.

Endocrine manifestations of celiac disease

BACKGROUND

Celiac disease can have extra gastrointestinal tract (GIT) presentations, most of which are endocrine. The aim of this study was to present patients diagnosed to have celiac disease from an endocrine department and to study the prevalence of endocrinopathies in celiac disease.

MATERIALS AND METHODS

A total of 36 patients from the endocrinology department (LLRM Medical College, Meerut) between January 2011 and July 2012 and who were diagnosed to have celiac disease were included in the study.

RESULTS

Short stature was the commonest presentation (25%), other presentations included short stature and delayed puberty (20%), delayed puberty (11%), screening for celiac disease in type-1 DM patients (17%), rickets (6%), anemia not responding to oral therapy (6%), type-1 DM with recurrent hypoglycaemia (6%), and osteomalacia (3%). The endocrine manifestations include (after complete evaluation) short stature (58%), delayed puberty (31%), elevated alkaline phospahatase (67%), low calcium (22%), X-rays suggestive of osteomalacia or rickets (8%), capopedal spasm (6%), and night blindness (6%). Anti-TPO antibody positivity was found in 53%, hypothyroidism in 28%, subclinical hypothyroidism in 17%, and type-1 DM in 25% of the patients. A total of 14% patients had no GI symptoms.

CONCLUSION

Celiac disease is an endocrine disrupter as well as the great masquerader having varied presentations including short stature, delayed puberty, and rickets. Some patients who have celiac disease may not have any GI symptoms, making the diagnosis all the more difficult. Also, there is significant incidence of celiac disease with hypothyroidism and type-1 DM, making screening for it important in these diseases.

Correlation of acanthosis nigricans with insulin resistance, anthropometric, and other metabolic parameters in diabetic Indians

INTRODUCTION

Acanthosis nigricans is a non-specific reaction pattern that may accompany obesity, diabetes, excess corticosteroids, pineal tumors, malignancies, and other endocrine disorders. It is considered a cutaneous marker of tissue insulin resistance.

AIMS AND OBJECTIVES

To determine the prevalence of acanthosis nigricans in type 2 diabetes mellitus (DM) and its correlation with various anthropometric measurements and insulin resistance by HOMA-IR and other metabolic parameters.

MATERIALS AND METHODS

One hundred and fifty consecutive subjects with newly diagnosed type 2 DM, attending the endocrinology OPD of LLRM Medical College, Meerut were studied. Acanthosis was graded based on standard scale of 0-4 as described by Burke et al. Anthropometric data were obtained and insulin resistance calculated as HOMA-IR from fasting insulin and fasting blood sugar values.

RESULTS

The average age of the study population was 45.2 years, with male to female ratio of 1:5. The prevalence of acanthosis in males was 56.67% and in females was 86.92%. The acanthosis neck severity grading had a statistically significant correlation with fasting glucose levels, fasting insulin levels, and insulin resistance values: HOMA-IR, HOMA-S, and HOMA-B (P < 0.05). Other acanthosis parameters such as axillary grading, acanthosis at knuckles, and skin tags, did not have a statistically significant correlation with insulin resistance.

CONCLUSION

Acanthosis nigricans neck severity grading correlates well with insulin resistance and can be used as a clinical surrogate for assessment of severity of insulin resistance.

Atypical presentations of Wolframs syndrome

BACKGROUND

Wolfram syndrome is a rare hereditary or sporadic neurodegenerative disorder also known as DIDMOAD. The classically described presentation is of insulin-dependent diabetes, followed by optic atrophy, central diabetes insipidus, and sensory neural deafness. Also included are less well-described presentations of Wolframs syndrome. We here present three cases of atypical presentation of this syndrome. CASE 1: A 15-year-old boy with insulin-dependent diabetes was presented for evaluation of depressive symptoms associated with suicidal tendency. Neuropsychiatric manifestations are described with Wolframs syndrome, and wolframin gene, in recessive inheritance, is associated with psychiatric illnesses without other manifestations of Wolframs syndrome. CASE 2: A 17-year-old diabetic boy on insulin with good control of blood sugar presented for evaluation of delayed puberty. Central hypogonadism and other anterior pituitary hormone dysfunctions are the less publicized hormone dysfunctions in Wolframs syndrome. CASE 3: A 23-year-old female who was on insulin for diabetes for the past 14 years, got admitted for evaluation of sudden loss of vision. This patient had developed a vitreous hemorrhage and, on evaluation, was found to have optic atrophy, sensory neural hearing loss, and diabetes insipidus, and presented differently from the gradual loss of vision described in Wolframs syndrome.

CONCLUSION

Wolframs syndrome being a multisystem degenerative disorder can have myriad other manifestations than the classically described features. Neuropsychiatric manifestations, depression with suicidal risk, central hypogonadism, and secondary adrenal insufficiency are among the less well-described manifestations of this syndrome.

Treatment of actinomycetoma foot--our experience with ten patients

BACKGROUND

Mycetoma is a chronic granulomatous inflammation of the subcutaneous tissue and usually results due to traumatic implantation of soil organisms. Mycetoma can be eumycotic or acinomycotic in origin. Actinomycetoma is susceptible to a large number of chemotherapeutic agents, but the response is variable and affected by various factors such as extent of involvement, duration of disease, presence or absence of bony involvement and drugs used for treatment.

AIMS AND OBJECTIVES

To describe our experience of various treatment regimens used for actinomycetoma.

MATERIAL AND METHODS

It was a prospective, open label study of actinomycetoma. Ten patients who were diagnosed clinically as mycetoma were included in this study. All patients were completely evaluated and investigated including skin biopsy, Gram staining of grains and discharge, Ziehl-Nielson stain, KOH preparation, fungal and bacterial cultures and CT scan/Magnetic resonance imaging (MRI), if required. Patients were treated with different treatment regimens, for example, Ramam regimen, modified Ramam regimen, Welsh regimen and its modification.

RESULTS

Ten patients (eight males, two females) age ranging from 9 to 55 years (mean 29.6 years) were included in this study. Six patients were successfully treated with Ramam regimen, three patients were treated with our modified Welsh regimen (one of these three patients (case 7) initially failed to respond to Ramam regimen), and one patient was treated with modified Ramam regimen.

CONCLUSION

Ramam regimen was found to be quite effective in treating patients of actinomycetoma with only minimal bony involvement, while Welsh regimen and its modification should be used in case of severe disease due to amikacin being more sensitive than gentamicin in treating resistant organisms. Intensive phase of Modified Welsh regimen can be extended to five cycles in case of extensive bony involvement.

Sequential therapy (triple drug-based induction chemotherapy followed by concurrent chemoradiotherapy) in locally advanced inoperable head and neck cancer patients - Single institute experience

Context:

India has a high incidence of head and neck squamous cell carcinoma (HNSCC) mostly presenting in advanced stage. In the majority of inoperable patients a combination of chemotherapy and radiotherapy (CRT) is considered as the treatment of choice. Adding induction chemotherapy (ICT) before CRT has shown to decrease systemic relapse. Incorporation of taxanes to the cisplatin and 5-FU-based ICT has shown increase in response rates.

Aims:

To evaluate the efficacy and toxicity of triple drug-based ICT followed by CCRT in locally advanced, inoperable HNSCC in the Indian context.

Settings and Design:

Prospective, non-controlled, observational study, a single-institute experience.

Materials and Methods:

Consecutive, locally advanced inoperable HNSCC patients were put on sequential therapy consisting of docetaxel, 5-FU and cisplatin for three cycles followed by concurrent weekly cisplatin and radiotherapy for responding or stable disease patients.

Results:

Forty-four patients were enrolled with male,female ratio of 33/44(75%) and 11/44(25%). Hypopharynx 16/44(36.36%) was the most common site followed by oral cavity 12/44(27.27%) and oropharynx 12/44(27.27%); 38/44(86.36%) patients could complete the planned treatment. Seven patients required dose reduction in ICT. As per the RECIST criteria, 16 patients had Complete Response (CR) and 15 had partial response (PR), 10 had stable disease (SD) and three had progressive disease (PD) after ICT. Thirty-eight patients received concomitant chemo radiotherapy (CCRT); 28/44 (66.63%) patients achieved CR, 10/44 (22.72 %) had PR. The main toxicity was mucositis 18/44 (40.90%) secondary to ICT. Grade III and IV hematological toxicity was seen in 16/44(36.36%), of which 6/44 (13.63%) had febrile neutropenia.

Conclusions:

Triple drug-based sequential therapy is tolerable in our context. In this trial from a single institute the results are very encouraging.

In vitro marginal fit of three all-ceramic crown systems before and after cementation

STATEMENT OF THE PROBLEM

Full-coverage all-ceramic restorations are widely used. The impact of various classifications of luting agent on marginal discrepancies is not well understood.

PURPOSE

The purpose of this study was to evaluate the cervical fit of all ceramic crowns (IPS e.maxPress, Cergogold, and In Ceram) on bovine teeth with two luting agents before and after cementation.

MATERIALS AND METHODS

Ninety bovine incisors were embedded in resin. The coronal portions of the teeth were prepared to receive full-coverage crowns. Thirty crowns of 7.0 ± 0.5 mm height, 8.0 mm cervical diameter, and 4.2 mm incisal diameter were fabricated for each ceramic system. The crowns were seated on the teeth, and the marginal discrepancy was measured using a measuring microscope. Then, 15 crowns of each ceramic system were luted on the teeth with resin cement (Variolink II) or resin-modified glass ionomer cement (Rely X luting), and the marginal discrepancy was measured. The results were submitted to analysis of variance, t test and Tukey's test (p<0.05).

RESULTS

The three ceramic systems showed cervical fits after cementation statistically inferior to cervical fits before cementation for the two cements. The IPS e.maxPress showed values for cervical fit statistically superior to Cergogold before cementation. No statistically significant difference was found between IPS e.maxPress and In Ceram and In Ceram and Cergogold. After cementation, no statistically significant difference was found for the three ceramics systems when luted with resin or resin-modified glass ionomer luting agents.

CONCLUSIONS

Within the limitations of this study, it can be concluded that both cements studied increase the marginal discrepancy between the crown and the preparation for the three ceramic systems evaluated.

Closure and augmentation of bladder exstrophy using rectus abdominis musculo-peritoneal flap

Background:

The aim of this study was to investigate the efficacy of the rectus abdominis myo-peritoneal flap (RAMP) technique for the closure and augmentation of small, non-elastic, non-compliant bladder exstrophies.

Materials and Methods:

The RAMP technique was used in three boys with bladder exstrophy who presented late with small, non-elastic, non-compliant bladder. The clinical outcome, imaging, cystoscopy, biochemical and microbiological studies were assessed during a follow-up of 36 months.

Results:

Bladder closure and augmentation was achieved in all patients without any complications. There were no urinary tract infections, metabolic problems or electrolyte disturbances and the kidney function remained normal in all patients. Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the inner peritoneal layer of RAMP with uroepithelium. No stone formation or mucous production was detected.

Conclusions:

The RAMP technique is a good alternative for closing bladder exstrophies and achieves an increase in bladder capacity and compliance. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non-compliant bladder remnants and failed primary closures.