The efficacy of blood flow restricted exercise: A systematic review & amp; meta-analysis. J Sci Med Sport. 2016;19:669-675. [PMID: 26463594 DOI: 10.1016/j.jsams.2015.09.005]

OBJECTIVES

To systematically search and assess studies that have combined blood flow restriction (BFR) with exercise, and to perform meta-analysis of the reported results to quantify the effectiveness of BFR exercise on muscle strength and hypertrophy.

DESIGN

A systematic review.

METHODS

A computer assisted database search was conducted for articles investigating the effect of exercise combined with BFR on muscle hypertrophy and strength. A total of 916 hits were screened in order based on title, abstract, and full article, resulting in 47 articles that fit the review criteria.

RESULTS

A total of 400 participants were included from 19 different studies measuring muscle strength increases when exercise is combined with BFR. Exercise was separated into aerobic and resistance exercise. Resulting from BFR aerobic exercise, there was a mean strength improvement of 0.4Nm between the experimental group and control group, while BFR resistance exercise resulted in a mean improvement of 0.3kg. A total of 377 participants were included in 19 studies measuring muscle size increase (cross sectional area) when exercise was combined with BFR. The mean difference in muscle size between the experimental group and control group was 0.4cm(2).

CONCLUSION

Current evidence suggests that the addition of BFR to dynamic exercise training is effective for augmenting changes in both muscle strength and size. This effect was consistent for both resistance training and aerobically-based exercise, although the effect sizes varied. The magnitude of observed changes are noteworthy, particularly considering the relatively short duration of the average intervention.

The role of an occlusal template during the placement of preformed metal crowns in children under general anaesthesia: a randomised control trial

AIM

This aim was to evaluate preformed metal crowns (PMC) placed under general anaesthesia using an occlusal template in comparison to crowns placed without the use of a template.

METHODOLOGY

CONSORT protocols were followed in the design of the study. A total of 60 children between 4-7 years requiring pulpotomy and PMC for all primary molars met the inclusion criteria for this study. The control group comprised patients for whom the PMC were placed without the use of an occlusal template, while in the test group crowns were placed using a polyvinyl siloxane occlusal template. Patients were followed up at 24 h, 7 days, 3 and 6 months. The time taken for the placement of crowns, instances of post-operative discomfort, success or failure of the pulp therapy and loss of any crowns were compared between the groups.

RESULTS

The mean time taken for completion of the procedure in the control group was significantly greater than the template group (t = 2.566, p = 0.013). Significantly fewer patients in the template group reported symptoms of discomfort or high points at the 24-h recall; however, these differences were not significant at the 1-week, 3- or 6-month recall.

CONCLUSION

The use of an occlusal template for the placement of multiple PMC under general anaesthesia reduces the time taken for their placement and reduces the incidence of immediate post-operative discomfort.

Are maximum bite forces of subjects 7 to 17 years of age related to malocclusion?

OBJECTIVE

To determine the effects of occlusion on maximum bite force of growing subjects.

MATERIALS AND METHODS

Incisor and first molar bite force of children and adolescents was evaluated. Four cohorts were measured annually for 3 years, starting at approximately 7, 9, 12, and 15 years of age, respectively. The initial sample included 182 females and 198 males; there were 130 subjects with normal occlusion, 111 with Class I malocclusion, and 139 with Class II malocclusion. Multilevel analyses were performed to model the growth changes and compare groups.

RESULTS

Maximum bite force increased significantly (P < .05) over time. Incisal forces peaked at 14.3 and 15.3 years of age for females and males, respectively. Maximum molar bite force peaked at 16 years for both males and females. Subjects with normal occlusion had significantly higher bite force than subjects with malocclusion. Maximum molar bite force exhibited a significant testing effect, with forces increasing 2.6 kg each year that the tests were repeated.

CONCLUSIONS

Malocclusion has a detrimental effect on bite force. Changes in maximum bite force are also due to age, sex, and repeated testing.

Preventive Uterine Artery Occlusion: Benefits of the Laparoscopic Posterior Approach

STUDY OBJECTIVE

To present a standardized and minimally invasive procedure to occlude uterine artery via a posterior approach.

DESIGN

Step-by-step explanations of the technique using videos (Canadian Task Force classification III).

SETTING

The preventive occlusion of uterine arteries during uterine surgery reduces perioperative bleeding by temporarily devascularizing the uterus. This technique, usually performed by conventional or robotically assisted laparoscopy, can be combined with surgical procedures that have a potential risk of major bleeding such as myomectomy or hysterectomy, particularly in cases of a large uterus. Here, we describe a minimally invasive technique using a laparoscopic posterior approach of the retroperitoneal space, which allows more direct access to the uterine pedicles. Institutional review board approval was obtained through our local ethics committee in Geneva University Hospitals.

INTERVENTIONS

The main occlusion technique described in the literature involves a superior approach at the level of the lateral pelvic triangle. We propose to access the uterine artery via a posterior approach at the posterior and inferior level of the broad ligament. The peritoneum is opened after previous identification of the uterine artery and the ureter by transparency. After a limited dissection, the occlusion of the uterine artery is performed under direct visual control through the atraumatic placement of a 10-mm endoscopic vascular clip.

CONCLUSION

The posterior peritoneal approach should be favored if, during a laparoscopic procedure, a uterine artery occlusion is chosen to reduce blood loss. This technique offers an easier and a more limited dissection to access the uterine pedicles, thus minimizing the risk of accidental injuries.

Predicted and actual end-of-treatment occlusion produced with aligner therapy

OBJECTIVE

To compare three-dimensional (3D) ClinCheck™ models with the subjects' actual 3D posttreatment models using the American Board of Orthodontics Objective Grading System (OGS).

MATERIALS AND METHODS

This prospective, within-subject study included 27 consecutive cases treated with aligner therapy. The posttreatment plaster models taken immediately after treatment were scanned and converted to stereolithography (STL) files; the ClinCheck models were also converted to STL format. MeshLab software was used to measure the seven components of the OGS, including alignment, marginal ridges, buccolingual inclinations, occlusal contacts, occlusal relationships, overjet and interproximal contacts. An overall OGS deduction score was also calculated.

RESULTS

Compared with the posttreatment models, the ClinCheck models showed significantly (P  =  .016) fewer overall OGS point deductions (24 vs 15). These overall differences were due to significantly (P < .05) more deductions among the posttreatment models than the ClinCheck models for alignment (4.0 vs 1.0 deductions), buccolingual inclinations (4.0 vs 3.0 deductions), occlusal contacts (3.0 vs 2.0 deductions), and occlusal relations (4.0 vs 2.0 deductions).

CONCLUSION

The ClinCheck models do not accurately reflect the patients' final occlusion, as measured by the OGS, at the end of active treatment.

Vascular plugs - A key companion to Interventionists - 'Just Plug it'

Vascular plugs are ideally suited to close extra-cardiac, high flowing vascular communications. The family of vascular plugs has expanded. Vascular plugs in general have a lower profile and the newer variants can be delivered even through a diagnostic catheter. These features make them versatile and easy to use. The Amplatzer vascular plugs are also used for closing intracardiac defects including coronary arterio-venous fistula and paravalvular leakage in an off-label fashion. In this review, the features of currently available vascular plugs are reviewed along with tips and tricks of using them in the cardiac catheterization laboratory.

Comparison of chairside and laboratory CAD/CAM to conventional produced all-ceramic crowns regarding morphology, occlusion, and aesthetics

OBJECTIVES

There are many ways to produce all-ceramic crowns. Computer-aided design and computer-aided manufacturing (CAD/CAM) procedures compete against conventional fabricated restorations. As different methods of production may produce variable results, this study aims to compare chairside and laboratory-based CAD/CAM systems to conventional crowns regarding their similarity to original tooth morphology, number of occlusal contacts, occlusal adjustment time, and subjective aesthetic perception.

MATERIAL AND METHODS

Impressions of caries-free jaws were taken, and the resulting gypsum casts were scanned with a laboratory scanner. Preparations for all-ceramic full crowns were performed on first molars, and three different restorations were made: CEREC restorations (CER), laboratory-produced CAD/CAM crowns (LABCAD), and conventional waxed-up/pressed ceramic crowns (CONV). Time for occlusal adaptation and the number of occlusal contacts were noted. Two dentists performed aesthetic gradings of restorations. Statistical analysis included one-way ANOVA with least significant difference (LSD) post hoc test, t test, and Kruskal-Wallis test.

RESULTS

Metrical deviations of the re-scanned crowns to the original, unprepared tooth surface were 220.55 ± 54.31 μm for CER, 265.94 ± 61.39 for LABCAD, and 252.44 ± 68.77 μm for CONV group. One-way ANOVA showed significant lower deviations for the CER group. LABCAD crowns showed significantly more occlusal contacts, whereas CONV crowns required the least time for occlusal adaptation and showed excellent aesthetic gradings.

CONCLUSION

All three methods had pros and cons regarding different parameters. Further improvements of CAD/CAM software shall lead to restorations comparable to conventional restorations in all aspects, especially in aesthetics.

CLINICAL RELEVANCE

All tested methods of production for all-ceramic crowns produced clinically acceptable results. Thus, in an individual case, the method chosen can be determined by the dentist's preference.

A Simple Technique to Fabricate Custom Made Occlusal Plane Template

The plane of occlusion represents the average curvature of the occlusal surfaces of anterior and posterior teeth rather than a flat surface. An anteroposterior curve, the curve of Spee and the mediolateral curve, the curve of Wilson determine the position of posterior teeth. Management of patients with uneven occlusal plane is an essential step for the long term success of the treatment. Devices, like occlusal plane analyzers, are routinely used to evaluate the occlusal problems and help improve the situation. Yurkstas metal occlusal template is a device frequently used to determine proper occlusal plane. A simple procedure to fabricate a transparent occlusal plane template is described in this article. This occlusal template overcomes the major disadvantage i.e. non-transparency of the Yurkstas metal occlusal template.

Influencing factors of immediate angiographic results in intracranial aneurysms patients after endovascular treatment

The purpose of this study was to analyze influencing factors associated with immediate angiographic results in intracranial aneurysms patients after endovascular treatment (EVT), providing theoretical evidence and guidance for clinical treatment of intracranial aneurysms. Totally 529 patients met the inclusive criteria, consisting of 338 males and 191 females. Gender; age; history of hypertension, diabetes, and smoking; intracranial atherosclerosis; rupture status, size and location, features of aneurysmal neck, shapes; vasospasm; treatment modality; and degree of aneurysm occlusion were all carefully and completely recorded. All data were investigated in univariate and multivariate logistic regression model to determine whether they were correlated with the degree of aneurysm occlusion. According to aneurysm size, aneurysms were classified as micro-miniature, miniature, and large aneurysms. There were 451 narrow-neck aneurysms and 78 wide-neck aneurysms. Totally 417 were regular and 112 were irregular. And 125 were un-ruptured aneurysms; 404 were ruptured aneurysms. The modalities of treatment were as follows: embolization with coil (n = 415), stent-assisted coil embolization (n = 89), and balloon-assisted coil embolization (n = 25). Univariate analysis showed that aneurysm size, feature of aneurysm neck, shape, and rupture status might affect the immediate occlusion after EVT. Multivariate logistic regression analysis indicated that ruptured aneurysm, tiny aneurysm, and wide-neck aneurysm were independent influencing factors of complete occlusion of intracranial aneurysm. Aneurysm rupture status, size, feature of aneurysmal neck, and shape might be the independent influencing factors of immediate angiographic results in intracranial aneurysm patients after EVT. Un-ruptured, micro-miniature, narrow-neck, and regular-shaped aneurysms were more probable to be occluded completely.

Hand ischemia after transradial coronary angiography: resulting in right ring finger amputation

Critical hand ischemia is an extremely rare and serious complication of transradial coronary angiography. It is almost always associated with radial artery occlusion. Early recognition and involvement of vascular surgery is imperative for optimal management. Up to our knowledge, there have been only 5 cases reported in the medical literature. Herein, we describe a case of an 81-year-old male who had undergone transradial coronary intervention complicated by critical hand ischemia requiring amputation of the right 4th finger.

Transesophageal imaging of a left main coronary artery ostium occlusion in infective endocarditis: a case report

A 43-year-old woman was admitted due to fever, chills, and headache for several days and was diagnosed as infective endocarditis. Intraoperative transesophageal echocardiography (TEE) examination confirmed severe aortic stenosis and showed relatively fresh 1.5 cm vegetation on the left coronary cusp of the aortic valve (AV) with frequent diastolic prolapse into the aortic root. This mobile vegetation partially occluded left coronary ostium, but it did not cause cardiac failure. TEE showed the vegetation to be in good position across the AV. The AV replacement with removal of vegetation and mitral valvuloplasty were performed. The patient was weaned from cardiopulmonary bypass without any hemodynamic instability or changes in ST segment on electrocardiography. She was discharged on the 28th postoperative day without any complication.

Anatomical characteristics of catathrenia (nocturnal groaning) in upper airway and orofacial structures

BACKGROUND

Catathrenia is a rare sleep disorder characterized by repeated groaning in a protracted expiration preceded by a deep inspiration. This study aimed to explore whether anatomy is one of pathophysiology of catathrenia by investigating the anatomical features associated with catathrenia in the upper airway, craniofacial structures, and dental patterns.

MATERIAL AND METHODS

Twenty-two patients with catathrenia (7 males, 15 females; age 22 to 69 years) were recruited as well as 66 patients matched by age and gender (matching proportion 1:3) with obstructive sleep apnea syndrome (OSAS). Both groups underwent cephalograms and dental casting, and cephalometric measurements and the Peer Assessment Rating (PAR) index was applied. Differences between the two groups were evaluated and cephalometric measurements in catathrenia group were compared with control values of Chinese patients from previous studies.

RESULTS

As for airway-related measurements, increased PNS-R, PNS-UPW, and H-FH and decreased SPT and TGL were found in catathrenia group compared to normal values. Such trends were found even more evident when compared with the OSAS Group. As for craniofacial parameters, values of U1/NA and U1/SN were found increased in the catathrenia group compared with normal values and values of MP/FH and Y decreased. The differences were more distinct from the OSAS Group. Increased arch lengths and upper inter-first molar widths, and decreased overbite and PAR index, were found in catathrenia group compared with the OSAS Group.

CONCLUSION

Catathrenia patients present with a broad upper airway, yet protrusive upper incisors and flat mandibular angles. Anatomical characteristics of catathrenia are different from those associated with OSAS, namely a wide airway, large skeleton, and good occlusion.

Bruxism: Conceptual discussion and review

Bruxism is commonly considered a detrimental motor activity, potentially causing overload of the stomatognathic structures. The etiology of bruxism is unclear, but the condition has been associated with stress, occlusal disorders, allergies and sleep positioning. Due to its nonspecific pathology, bruxism may be difficult to diagnose. Unfortunately, very little data exists on the subject of a cause-and-effect relationship of bruxism to the point that expert opinions and cautionary approaches are still considered the best available sources for suggesting good practice indicators. The present paper reviewed current concepts on bruxism, etiology, diagnosis and management, underlining its effects on dental structures in an attempt to provide clinically useful suggestions based on scientifically sound data.

Comparison of occlusal contact areas of class I and class II molar relationships at finishing using three-dimensional digital models

Objective

This study compared occlusal contact areas of ideally planned set-up and accomplished final models against the initial in class I and II molar relationships at finishing.

Methods

Evaluations were performed for 41 post-orthodontic treatment cases, of which 22 were clinically diagnosed as class I and the remainder were diagnosed as full cusp class II. Class I cases had four first premolars extracted, while class II cases had maxillary first premolars extracted. Occlusal contact areas were measured using a three-dimensional scanner and RapidForm 2004. Independent t-tests were used to validate comparison values between class I and II finishings. Repeated measures analysis of variance was used to compare initial, set up, and final models.

Results

Molars from cases in the class I finishing for the set-up model showed significantly greater contact areas than those from class II finishing (p < 0.05). The final model class I finishing showed significantly larger contact areas for the second molars (p < 0.05). The first molars of the class I finishing for the final model showed a tendency to have larger contact areas than those of class II finishing, although the difference was not statistically significant (p = 0.078).

Conclusions

In set-up models, posterior occlusal contact was better in class I than in class II finishing. In final models, class I finishing tended to have larger occlusal contact areas than class II finishing.

Waveform patterns and peak reversed velocity in vertebral arteries predict severe subclavian artery stenosis and occlusion

This study investigated the value of analyzing spectral Doppler waveform patterns and measuring the peak reversed velocity (PRV) of the vertebral artery (VA) in predicting proximal severe subclavian artery (SA) stenosis and occlusion. Fifty-one patients with proximal SA stenosis were studied retrospectively. Based on the depth of the mid-systolic notch, the Doppler waveforms of the ipsilateral VA were divided into five subtypes (type I, n = 8; type II, n = 8; type III, n = 6; type IV, n = 13; and type V, n = 16). PRV was also measured. PRV receiver operating characteristic curves were constructed to obtain the best cutoff value for predicting severe SA stenosis or complete SA occlusion. The results indicated that both VA Doppler waveform and PRV were associated with the degree of SA stenosis (p < 0.05). PRV and the Doppler waveform in the VA had similar accuracy in predicting SA occlusion (84.3%, 43/51). PRV was more accurate than VA waveforms in predicting severe SA stenosis (98%, 50/51 vs. 94.1%, 48/51). However, no significant differences between the two methods in predicting severe SA stenosis were observed (p = 0.84). Thus, with severe obstruction of the SA, typical Doppler waveform patterns of the VA could be observed. PRV is a helpful criterion in predicting severe stenosis and occlusion of the SA.

The main occluding area in normal occlusion and mandibular prognathism

OBJECTIVE

To clarify whether the concept of main occluding area, where hard food is initially crushed, exists in patients who have a jaw deformity.

MATERIALS AND METHODS

Nineteen subjects with normal occlusion, 18 patients with mandibular prognathism, and 11 patients with mandibular prognathism who had undergone orthognathic surgery participated in this study. The main occluding area was identified by clenching Temporary Stopping. The coincidence, location of the main occluding area, and distance from the first molars to main occluding area were examined.

RESULTS

High coincidence of the main occluding area was obtained in all groups, signifying that the main occluding area exists even in these patients. Mandibular main occluding area was located on the first molar in all groups. Maxillary main occluding area in subjects with normal occlusion was located on the first molar. However, it was located on the second premolar and first molar in patients with mandibular prognathism, and on the first and second molars in patients with mandibular prognathism who had undergone orthognathic surgery. There was a statistically significant difference in distance from the maxillary first molar to the main occluding area among groups, but there was no difference in the distance from the mandibular first molar among groups.

CONCLUSION

The main occluding area is more stable on the mandibular first molar than the maxilla in all groups.

Arterial occlusion to treat basilar artery dissecting aneurysm

OBJECT

To explore the clinical feasibility of employing occlusion to treat basilar artery dissecting aneurysm.

METHODS

One patient, male and 46 years old, suffered transient numbness and weakness on the right limbs. Cerebral angiography indicated basilar artery dissecting aneurysm. The patient underwent the stent-assisted coil embolization of aneurysm and the result is satisfactory. Digital subtraction angiography (DSA) reviews were performed at 1 month and 4.5 months, respectively after the operation and indicate that the basilar artery is unobstructed and there was no recurrence of the aneurysm. DSA review 1 year after the first treatment indicates the aneurysm recurrence, stent-assisted coils dense embolization of aneurysm was performed again and the result was satisfactory. Ten months after the second operation, DSA review found the basilar artery aneurysm recurrence again and occlusion of the basilar artery was performed.

RESULTS

The basilar artery occlusion was effective. The bilateral posterior inferior cerebellar arteries and the bilateral posterior cerebral arteries are unobstructed. Five months of follow-up found that the patient recovered well. DSA reviews performed 5 months after occlusion indicate no recurrence of the aneurysm.

CONCLUSIONS

Occlusion to treat basilar artery dissecting aneurysm is clinically feasible, but surgical indications should be considered strictly.

Incidence of headaches related to occlusion and bite force imbalance: a case study

AIMS

The purpose of this case report is to share an incidence where a bite force imbalance and occlusal interferences contributed to chronic daily headaches.

METHODS

A TekScan digital occlusal analyzer was used to evaluate the bite and systematically guide alterations to the patient's occlusion.

RESULTS

After the bite was adjusted and optimized, the patient reported a decrease in her headaches.Shortly afterward, she sustained trauma to her face that altered the way her bite came together. Via physical therapy modalities to heal the muscle, occlusion was restored to the pre-trauma relationship.

CONCLUSIONS

Once the patient's bite was balanced and the interferences removed, the headaches were greatly improved.

Basilar artery occlusion: Prognostic signs of severity on computed tomography

PURPOSE

To determine the computed tomography (CT) signs that are predictive of the clinical outcome of basilar artery occlusion (BAO).

MATERIALS AND METHODS

The study population consisted in 37 patients (14 women, 23 men, mean age: 63 years), admitted with onset of neurological deficit, starting 1-72 h prior to admission, who were diagnosed with BAO on the basis of a CT examination with intravenous contrast agent. The following signs were collected on CT scans performed on admission: clot density on noncontrast images, clot length, and clot location, as well as the presence of acute ischemic lesions. The results were compared against the modified Rankin Scale (mRS) score of patients at 3 months, favorable clinical outcome being defined as a mRS score ≤3.

RESULTS

The clinical outcome was favorable in 13 (35%) of the 37 patients and unfavorable in 24 (65%). Signs of acute ischemia were visible in 13 of the 24 patients with unfavorable outcome but in none of the 13 patients with favorable outcome (p<0.001). None of the other CT signs analyzed were significantly correlated with clinical prognosis.

CONCLUSION

Of all the CT signs analyzed, only the presence of signs of acute ischemia on the admission CT of patients with BAO was associated with poor prognosis.

Temporomandibular Disorders (TMD) in Edentulous Patients: A Review and Proposed Classification (Dr. Bader's Classification)

Temporomandibular disorders (TMD) are a collective term given to a number of clinical problems that involve the masticatory musculature, the temporomandibular joints and associated structures, or both. Although the aetiology of TMD has not been fully understood, in general it is considered to be multifactorial. The signs and symptoms of TMD which present in patients with natural teeth may also occur in edentulous patients. These symptoms may appear in various combinations and degrees. TMD has attained a prominent role within the context of dental care due to its high prevalence. The present paper is a review of the current literature on TMD in edentulous patients; with an attempt to propose a classification for the same.

Comparison of low dose versus standard dose heparin for radial approach in elective coronary angiography?

OBJECTIVE

The aim of this study is to evaluate the efficacy and safety of two doses of heparin, a low dose (2500 IU) and a standard dose (5000 IU) in patients who underwent transradial coronary angiography (TRCAG).

METHODS

A total of 459 consecutive patients were included in the present study, 217 in the 2500-IU heparin group and 242 in the 5000-IU heparin group. Radial artery patency was evaluated one month after the TRCAG with Doppler ultrasonography.

RESULTS

The RAO was observed in 15 (3.3%) patients. The RAO was significantly higher in 2500 IU heparin group than 5000 IU heparin group (5.5% vs 1.2% p=0.010, respectively). Female gender (Odds ratio (OR)=66.135, p=0.002, 95% confidence interval (CI)=4.584-954.131), sheath removal time (OR=1.496, p<0.001, 95% CI=1.254-1.784) and administration of 2500 IU heparin (OR=9.758, p=0.034, 95% CI=1.195-79.695) were the independent predictors of RAO in multivariate regression analysis. While the presence of hypertension was independently associated with radial artery patency in multivariate regression analysis (OR=0.022, p=0.005, 95% CI=0.002-0.307).

CONCLUSION

The patients in the standard dose heparin group had lower RAO rates compared to low dose group in this study. This suggests that using the current technique, standard dose of heparin is still required for transradial diagnostic angiography.

Occlusion calculator

Start with end in mind' is a popular cliché in orthodontics. This aptly applies to the therapeutic occlusion the orthodontist strives to achieve. Predicting the post treatment occlusion is an essential component of treatment planning. When no extractions or symmetric extractions are done predicting the final occlusion is somewhat easy. Prediction is challenging when we do unconventional and/or asymmetric extractions. To aid this decision Kesling proposed the 'Kesling Setup'. Though it serves the purpose acceptably; it is time, energy and money consuming. We have developed a model which can help us visualize the final occlusion in matter of seconds. Although this model is primarily intended for orthodontic postgraduate teaching, it can be of considerable use even to a seasoned orthodontist. The regular use of "Orthodontic Calculator" in our department is a testimony to its usefulness.

Compliance and patching and atropine amblyopia treatments

In the past 20 years, there has been a great advancement in knowledge pertaining to compliance with amblyopia treatments. The occlusion dose monitor introduced quantitative monitoring methods in patching, which sparked our initial understanding of the dose-response relationship for patching amblyopia treatment. This review focuses on current compliance knowledge and the impact it has on patching and atropine amblyopia treatment.

Aortic dissection presenting as acute subtotal left main coronary artery occlusion: a case approach and review of the literature

Aortic dissection is the most common fatal condition of the aorta, yet it is often missed on initial clinical presentation. Aortic dissection associated with acute coronary syndrome (ACS) is relatively rare, but if it occurs, it can be diagnostically challenging, and the condition can be fatal. Here we describe a case of aortic dissection presenting as ST-segment elevation myocardial infarction (STEMI) managed via the transradial approach. We describe the current literature on the subject.

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

BACKGROUND

Nasorespiratory function and its relation to craniofacial growth are of great interest because of the basic biological relationship between form and function, and the accumulating findings of the relationship between mode of breathing, craniofacial growth and orthodontic treatment.

OBJECTIVES

The aim of this study was to evaluate the effect of adenoid hypertrophy and sociodemographic variables on the occlusion of children.

METHODOLOGY

A total of 180 subjects aged 3-12 years were selected at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Ninety subjects had hypertrophied adenoids while 90 normal children served as the control group. Orthodontic examinations were carried out and impressions for study models taken. Occlusion was assessed in the anterior-posterior, transverse and vertical planes.

RESULTS

Class I relationship was the most prevalent occlusion in both adenoid and control subjects (55.6% and 72.2%, respectively). The occurrence of class II division 1 was significantly higher among adenoid than control subjects (P=0.003). Posterior crossbites occurred significantly more in adenoid subjects in the 9-12 years category. In the vertical plane, the occurrence of deep bite was significantly greater in male than female adenoid subjects. Age had a statistically significant but weak correlation with anterior open bite (r=0.37). Age and BMI also had significant though weak correlations with posterior crossbite in female adenoid subjects (r=0.39 and r=0.36, respectively). Regression analysis also showed that age had a significant effect on the occurrence of anterior open bite, while BMI had a significant effect on the occurrence of class II occlusion in adenoid subjects (P<0.05).

CONCLUSION

The presence of hypertrophied adenoids affects the occlusion in the three planes. Age and BMI have significant effects on the occurrence of anterior open bite and class II division 1 malocclusion respectively in adenoid subjects.

Large-vessel stenosis in the patients with ischemic stroke in Iran: Prevalence, pattern, and risk factors

BACKGROUND

Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the patients with ischemic stroke using digital subtraction angiography (DSA).

METHODS

This was a prospective cross-sectional study performed in hospitals affiliated to Shiraz University of Medical Sciences from March 2011 to March 2013. Patients with ischemic stroke underwent noninvasive vascular and cardiac investigations to find the etiology of the stroke. Patients suspected of having large artery stenosis underwent DSA. The severity of the stenosis was calculated according to the North American Symptomatic Carotid Endarterectomy (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial criteria. The presence of cigarette smoking, hyperlipidemia, hypertension, and diabetes mellitus were documented for all subjects.

RESULTS

A total of 3703 stroke patients were identified. Of them, 342 patients (62.3%, male) underwent DSA for LAD. The mean age at the time of angiography was 66.7±10.3 years. Extracranial and intracranial arteries were involved in 305 (89.2%) and 162 (47.4%), respectively. And 301 patients (88%) had anterior circulation and 128 patients (37.4%) had posterior circulation involvement. Diabetes mellitus but not age, sex, hypertension, hyperlipidemia, or smoking was significantly associated with intracranial involvement. (P = 0.002).

CONCLUSION

It can be concluded that the distribution of the large arterial atherosclerotic disease in Iran is similar to that seen in North America and Europe. Intracranial stenosis was more prevalent in diabetic patients.

Relationship Between Occlusal Plane and Three Levels of Ala Tragus line in Dentulous and Partially Dentulous Patients in Different Age Groups: A Pilot Study

STATEMENT OF PROBLEM

Correct orientation of the occlusal plane plays a vital role in achieving optimal aesthetics, occlusal balance and function of complete dentures. The use of ala tragus line for determination of occlusal plane has been a topic of debate over past many years. Also, the effect of age on level of ala tragal line has not been investigated in the past.

PURPOSE

To determine the effect of age on location of Ala-Tragus line.

MATERIALS AND METHODS

A total of 180 patients (90 males and 90 females) were selected with complete dentition and were grouped according to their age in three age groups with 60 subjects in each age group (Group A: 20-35 y, Group B: 36-50 y, Group C: 51-65 y). Right lateral profile photographs were taken with subjects having fox plane placed intraorally parallel to occlusal plane. Reference points corresponding to inferior border, middle or superior border of tragus and inferior border of ala of nose were marked on photographs. These were joined to get three different levels of Ala-Tragus line. Images were analysed photometrically and most parallel relationship was determined in between arms of fox plane (that represented the occlusal plane) and three different levels of ala tragus line. Data obtained was subjected to statistical analysis using Pearson chi-square and Likelihood-ratio chi-square test.

RESULTS

Significant correlation was found between age and level of Ala-Tragus line. The occlusal plane was found to be more parallel to Ala-tragus line when inferior border of tragus was considered as posterior reference point in young adult age group (20-35 y). In older age groups, occlusal plane was found to be more parallel to Ala-tragus line when middle of tragus was considered as posterior reference point.

CONCLUSION

Within the limitations of this study, it can be concluded that a definite relationship exists in between age and level of ala tragus line.

The effect of implant splinting on the load distribution in bone bed around implant-supported fixed prosthesis with different framework materials: A finite element study

Analysing the influence of implant splinting and its relation to different framework materials is a complex issue. The stiffness of framework materials and the overload of the implant system directly affect the final transferred load of the bone around implants. A finite element model of a long-span cementable implant-supported fixed prosthesis was created. Three materials were analysed for the framework: Titanium, gold alloy, and zirconia. The connection screws were first preloaded with 200 N. Two loading conditions were studied: The implant at the molar region was first loaded without splinting to the framework, and in the second condition, the implant was splinted to the framework. A total force of 500 N and 1000 N in 30° from the long axis of the framework were applied in buccal or distal direction on the implant system. The stresses and strains within the framework materials, implant system, and bone bed around the supporting implants were analysed. Loading the implant distally was associated with high stresses within the implant system in comparison to buccal loading. By splinting the implant, the stress in the implant system was reduced from 5393 MPa to 2942 MPa. Buccal loading of the implant was more critical than the distal loading. In the splinted condition of the implant, the stresses in the cortical bone were reduced from 570 MPa to 275 MPa.

Investigation of the Relationship between Increased Vertical Overlap with Minimum Horizontal Overlap and the Signs of Temporomandibular Disorders

PURPOSE

The purpose of this study was to test the null hypothesis that there was no relationship between increased vertical overlap (vertical overlap ≥4 mm) with minimal horizontal overlap (horizontal overlap ≤2 mm) and the signs of temporomandibular disorders.

MATERIALS AND METHODS

Thirty participants (20 women, aged 20 to 45 years) with increased vertical overlap and minimal horizontal overlap, and 30 participants (20 women, aged 20 to 45 years) with no contact between the anterior teeth (control group) were examined. Diagnoses, psychological status (depression and nonspesific physical symptoms), and chronic pain severity were judged according to the Research Diagnostic Criteria for Temporomandibular Disorders and then compared. For statistical analysis of quantitative data, along with the descriptive statistical methods (mean, standard deviation, frequency), Student's t-test was used to compare parameters that reflected a normal distribution. Comparison of qualitative data between groups was performed using Chi-square and Fisher's exact tests. The level of significance was set at p < 0.05.

RESULTS

In this study, deviation upon maximum opening was found significantly more frequently in the increased vertical overlap group than in the control group (p < 0.05). Tenderness upon palpation of lateral pterygoid muscles was observed more often in the increased vertical overlap group compared with the control group (p < 0.05). Opening-closing joint sounds occurred significantly more often in the increased vertical overlap group than in the control group (p = 0.050).

CONCLUSION

Within the limitations of this study, deviation upon maximum opening, tenderness of lateral pterygoid muscles (upon palpation), and opening-closing joint sounds occurred more often in the increased vertical overlap occlusions with minimum horizontal overlap compared to the control groups. These results indicated that clinicians should pay special attention to the tempormandibuar joint status of patients with significant vertical overlap anteriorly and position of the incisors when performing dental treatments that require reestablishment of incisor relationships.

Occlusal concepts in full mouth rehabilitation: an overview

Restoration of occlusion in patients with severely worn dentition is a challenging situation as every case is unique in itself. There is great apprehension involved in reconstructing debilitated dentition due to widely divergent views concerning the choice of an appropriate occlusal scheme for successful full mouth rehabilitation. This article is an overview of the various occlusal concepts/philosophies in full mouth rehabilitation which will help the clinician select an appropriate occlusal scheme for an individual case.

Physicochemical characterization of lycopene-loaded nanostructured lipid carrier formulations for topical administration

Nanostructured lipid carriers (NLC) are interesting delivery systems for enhancing the penetration of an active substance through the skin after topical administration. In the present study, lycopene was loaded into NLC, composed of Eumulgin(®) SG, orange wax and rice bran oil, using high pressure homogenization (HPH). Photon correlation spectroscopy analysis showed that the lycopene-loaded NLC had a size of 150-160nm with a relatively small size distribution (PdI<0.15). The entrapment efficiency of lycopene was found to be 100±0% for all formulations. An in vitro release study of lycopene showed a biphasic release profile: a relatively fast release during the first 6h followed by a sustained release during the next 18h. An in vitro occlusion test showed that the occlusive properties of NLC increased with increasing lycopene loading. A free radical scavenging activity test of the NLC loaded with 50mg% lycopene showed a Trolox equivalent antioxidant capacity value of 36.6±0.4μM Trolox/mg NLC which is higher than that of the NLC base (26.6±0.1μM Trolox/mg NLC). The concentration of 50% antioxidant activity (IC50) of the lycopene-loaded NLC was 14.1±0.6mg/mL, and lower than that of the formulation without lycopene (17.7±0.4mg/mL). The particle size, size distribution, and zeta potential of lycopene-loaded NLC stored at different temperatures of 4, 30, 40°C for 120 days did not change in time, demonstrating an excellent colloidal stability of the systems. Chemical stability data indicated that the utilization of NLC increased the stability of lycopene and it was found that the degradation of lycopene was retarded when stored at low temperatures. In conclusion, NLC are attractive systems for the cutaneous delivery of lycopene.

Clinical issues in occlusion - Part I

Good occlusal practise provides an important cornerstone to optimal patient care. Occlusal problems can manifest in different areas of dentistry but these are more apparent when there are restorative aspects to the patient׳s problem. This review highlights areas of restorative dentistry where the appreciation of occlusal aspects can optimise diagnosis and follow up care.

A randomised clinical trial investigating calcium sodium phosphosilicate as a dentine mineralising agent in the oral environment

OBJECTIVE

The ability of a dentifrice containing the bioactive material calcium sodium phosphosilicate (CSPS) to remineralise the surface of dentine and physically occlude patent tubules was investigated in a 20 day in situ randomised clinical study.

METHODS

Changes in surface microhardness and surface topography of dentine specimens treated for 5, 10, 15 and 20 days, twice daily with either a dentifrice containing 5% CSPS or a fluoride-only containing placebo dentifrice were compared. The substantivity of any mineral deposits formed on the surface of dentine were investigated by the application of an intra-oral dietary acid challenge twice daily during the final 10 days of treatment.

RESULTS

After 5 and 10 days of treatment, the dentine samples in both treatment groups demonstrated an increase in surface microhardness. After 10 days of treatment the increase in surface hardness was directionally greater for the specimens treated with 5% CSPS dentifrice. Introducing an intra-oral acid exposure resulted in a reduction in surface microhardness which was significantly greater for the specimens treated with the placebo dentifrice compared to the dentifrice containing 5% CSPS, at day 20. Occlusion of the patent tubules was evident at each time-point and was significantly greater for the 5% CSPS containing dentifrice on days 5 and 10. On day 15 both dentifrices demonstrated the same degree of occlusion.

CONCLUSION

This in situ study demonstrated that dentifrice containing 5% CSPS may have potential to mineralise and occlude the dentine in the oral environment.

CLINICAL SIGNIFICANCE

This work provides evidence of potential agents that can be used to reduce the pain of dentine hypersensitivity when formulated into dentifrice and applied as part of a normal oral hygiene routine.

Computerized occlusal analysis as an alternative occlusal indicator

BACKGROUND

All disciplines of dentistry require that clinicians assess the articulation of the teeth/prosthesis with respect to simultaneous contacts, bite force and timing.

AIMS

This article intends to describe the advantages and limitations of the data acquired when using a computerized occlusal analysis as a dynamic occlusal indicator.

METHODOLOGY

A search of the literature was completed (Medline, PubMed) using the keywords occlusion, occlusal registration, computerized occlusal analysis and T-Scan for dental.

RESULTS

According to the evidence available, the computerized occlusal analysis system is the only occlusal indicator that demonstrates the ability to provide quantifiable force and time variance in a real-time window from the initial tooth contact into maximum intercuspation.

CONCLUSION

The reported advantages to accurately indicate occlusal contacts make the computerized occlusal analysis system a better occlusal indicator when compared with other non-digital convention indicator materials available.

Measurement of compliance of infusion device consumable elements using an analytical weighing balance

The value of compliance of disposable elements such as infusion lines and syringes can significantly affect the performance characteristics of infusion devices. In a technique used to determine the compliance of infusion lines, the item under test is placed in a semi sealed water filled enclosure and the volume of fluid displaced is measured on an analytical weighing balance as set pressures are applied to the test item. Thermal drift of the measurement chamber was minimised by inclusion of discs of Invar alloy. Measurements were also made to determine the compliance of syringes used with syringe drivers where the volume of fluid displaced upon release of established pressure levels within a syringe was measured using a separate measurement configuration using again an analytical weighing balance. These techniques were used to determine the relative contributions to compliance of infusion lines and syringes to the dynamics of operation of syringe drivers. This indicated that contributions to compliance from syringes were significantly greater than that of connected infusion lines. Values of time to occlude, occlusion bolus and effects of height elevation for infusion devices with elements of varying compliance and line configuration are discussed.

Occlusal characteristics and prevalence of associated dental anomalies in the primary dentition

Introduction: Morphological variations in primary dentition are of great concern to a pediatric dentist as it may pose clinical problems like dental caries, delayed exfoliation and also anomalies in the permanent dentition, such as impaction of successors, supernumerary teeth, permanent double teeth or aplasia of teeth. The present study was conducted to investigate the presence of dental anomalies in the primary dentition of 1000 schoolchildren in the 3–5 year-old age group in Faridabad.

Materials and methods: One-thousand schoolchildren were examined using Type III examination (WHO, 1997) for primary molar relationship, occlusal characteristics, primate spaces, physiological spaces and other anomalies of teeth, including number and morphology.

Results and conclusions: The prevalence of physiological spaces in maxillary and mandibular arches was 50.9% and 46.7%, respectively, whereas primate spaces were found in 61.7% of the children in the maxillary arch and 27.9% in the mandibular arch. The prevalence of unilateral anterior and posterior cross-bite was 0.1% and 0.8%, respectively, in the present study. The prevalence of hypodontia in the primary dentition was found to be 0.4% and the prevalence of fusion and gemination in the present study was 0.5%. Double teeth (fusion and gemination) and hypodontia were the most common dental anomalies found in the primary dentition in the present study.

Fracture analysis of randomized implant-supported fixed dental prostheses

OBJECTIVE

Fractures of posterior fixed dental all-ceramic prostheses can be caused by one or more factors including prosthesis design, flaw distribution, direction and magnitude of occlusal loading, nature of supporting infrastructure (tooth root/implant), and presence of adjacent teeth. This clinical study of implant-supported, all-ceramic fixed dental prostheses, determined the effects of (1) presence of a tooth distal to the most distal retainer; (2) prosthesis loading either along the non-load bearing or load bearing areas; (3) presence of excursive contacts or maximum intercuspation contacts in the prosthesis; and (4) magnitude of bite force on the occurrence of veneer ceramic fracture.

METHODS

89 implant-supported FDPs were randomized as either a three-unit posterior metal-ceramic (Au-Pd-Ag alloy and InLine POM, Ivoclar, Vivadent) FDP or a ceramic-ceramic (ZirCAD and ZirPress, Ivoclar, Vivadent) FDP. Two implants (Osseospeed, Dentsply) and custom abutments (Atlantis, Dentsply) supported these FDPs, which were cemented with resin cement (RelyX Universal Cement). Baseline photographs were made with markings of teeth from maximum intercuspation (MI) and excursive function. Patients were recalled at 6 months and 1-3 years. Fractures were observed, their locations recorded, and images compared with baseline photographs of occlusal contacts.

CONCLUSION

No significant relationship existed between the occurrence of fracture and: (1) the magnitude of bite force; (2) a tooth distal to the most distal retainer; and (3) contacts in load-bearing or non-load-bearing areas. However, there was a significantly higher likelihood of fracture in areas with MI contacts only.

CLINICAL SIGNIFICANCE

Because of the absence of a periodontal ligament, this clinical study demonstrates that there is a need to evaluate occlusion differently with implant-supported prostheses than with natural tooth supported prostheses. Implant supported prostheses should have minimal occlusion and lighter contacts than those supported by natural dentition.

CLINICAL TRIALSGOV NO

K23 D2007-46.

Control of the vertebral artery from a posterior approach: a technical report

BACKGROUND CONTEXT

Vertebral artery (VA) injury is a rare but potentially devastating complication of cervical spinal fusion. The Magerl and Harms techniques are associated with a rate between 0% to 8% and 0% to 5%, respectively. Most of reported VA injuries are related to surgical exposure or screw placement, which in turn is likely due to variability in VA anatomy.

PURPOSE

The purpose of this report was to present the case of a 77-year-old woman, with a history of right VA occlusion, who sustained an intraoperative left VA injury during posterior cervical spine fusion and the subsequent intraoperative and postoperative management strategies.

STUDY DESIGN

This is a single-patient case report.

METHODS

The patient was placed prone and into Mayfield tongs. A midline incision was made, and dissection was carried down to the lamina and facet joints from occiput to T2. During dissection, she sustained a left-sided VA injury, which was subsequently controlled.

RESULTS

The patient was doing well at her 1-year postoperative visit without any residual neurologic deficits. Her severe neck pain had resolved.

CONCLUSION

A detailed understanding of VA anatomy of each individual patient is paramount. There are four types of anomalies: intraforaminal; extraforaminal; arterial; and anomalies of the surrounding bony and soft-tissue architecture. In the event of a posterior intraoperative VA injury, we outlined an algorithm to deal with this complication: control bleeding temporarily to gain visualization of the arterial injury; remove lateral masses and tissue to adequately visualize the arterial injury; once visualized, control the bleeding and see if there are any neuromonitoring changes as a result of the VA occlusion; and proceed with definitive control of the artery by either repair or ligation.

Influence of K-ras status and anti-tumour treatments on complications due to colorectal self-expandable metallic stents: a retrospective multicentre study

BACKGROUND

This study aimed to explore the relationship between K-ras status, anti-tumour treatments, and the complications of colorectal self-expandable metallic stenting in colorectal cancer.

METHODS

This is a retrospective, multicentre study of 91 patients with obstructive advanced colorectal cancer palliated with enteral stents between 2007 and 2011.

RESULTS

K-ras wild-type tumours were diagnosed in 44 patients (48.4%); 82 (90.1%) received chemotherapy and 45 (49.4%) had additional biological therapy (34 bevacizumab, 11 cetuximab). Twenty-one (23.1%) experienced stent-related complications: 11 (52.4%) occurred in the K-ras mutant group (P=0.9). K-ras wild-type patients were not less likely to develop adverse events than K-ras mutant patients (OR, 0.99; 95% CI: 0.4-2.7). Overall mean time to complication was 167.6 days (range 4-720 days), with no difference between the two groups (141 vs. 197 days; P=0.5). Chemotherapy did not influence the risk of complications (OR, 0.56; 95% CI: 0.14-2.9), and there was no evidence that patients treated with chemotherapy and cetuximab were more likely to experience stent-related complications than patients treated with chemotherapy alone, or untreated (OR, 1.2; 95% CI: 0.2-5.9). Although perforation rates were higher with bevacizumab-based treatment (11.8% vs. 7%), this result was not statistically significant (P=0.69).

CONCLUSIONS

K-ras mutation status, chemotherapy, and biological treatments should not influence colorectal stent-related complication rates.

Temporomandibular disorders with skeletal open bite treated with stabilization splint and zygomatic miniplate anchorage: a case report

This case report describes the treatment of a patient with temporomandibular disorder (TMD) and skeletal open bite. First, the patient was treated with a stabilization splint to stabilize the condyles in centric relation and to alleviate TMD signs and symptoms. After making a definitive diagnosis from postsplint records, orthodontic treatment was initiated. Titanium miniplates were placed at bilateral zygomatic buttresses and used as orthodontic anchorage for molar intrusion and distalization. The treatment was completed after 30 months. Satisfactory appearance and function were achieved for this patient.

Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine

BACKGROUND CONTEXT

Intravertebral cleft (IVC) associated with vertebral collapse is not uncommon in osteoporotic compression fracture. However, the pathomechanism of IVC is poorly understood. Bone ischemia is indicated in the current hypothesis.

PURPOSE

To clarify the pathomechanism of IVC in delayed posttraumatic vertebral collapse, referred to as Kummell's disease.

STUDY DESIGN

Magnetic resonance (MR) angiography and histology of segmental arteries and vertebral bodies in delayed posttraumatic vertebral collapse were investigated.

PATIENT SAMPLE

All elderly patients admitted to the authors' spine clinic of tertiary referral center for a 105-month period.

OUTCOME MEASURES

All imaging tests including plain radiographs, computed tomography, and MR angiography were reviewed by authors using a double-blind method. All operations were performed by one experienced surgeon. The statistical data were analyzed using SPSS program.

METHODS

Evaluations using MR angiography and computed tomography were performed in 22 patients. Twelve of the 22 patients underwent corpectomy and anterior interbody fusion. At operation, segmental artery and bone surrounding IVC were harvested and microscopically evaluated.

RESULTS

Magnetic resonance angiography showed occlusions of bilateral segmental arteries in nine of 22 patients. Seven patients had unilateral occlusion. In six patients, no occlusion was seen. Microscopically, the left segmental arteries of three patients were completely obstructed by thrombosis. Histologic examination of necrotic bone showed fragile trabecular bone and sparse osteocytes.

CONCLUSIONS

The findings of thrombosis of the segmental arteries of the vertebral body with IVC could suggest a mechanism by which IVC is formed, and the progressive collapse may develop following osteoporotic spinal fracture.

Sphenoid ridge meningioma presenting as acute cerebral infarction

A previously healthy 52-year-old man presented to the emergency room with acute onset left hemiparesis and dysarthria. Brain computed tomography and magnetic resonance examinations revealed acute cerebral infarction in the right middle cerebral artery territory and a sphenoid ridge meningioma encasing the right carotid artery terminus. Cerebral angiography demonstrated complete occlusion of the right proximal M1 portion. A computed tomography perfusion study showed a wide area of perfusion-diffusion mismatch. Over the ensuing 48 hours, left sided weakness deteriorated despite medical treatment. Emergency extracranial-intracranial bypass was performed using a double-barrel technique, leaving the tumor as it was, and subsequently his neurological function was improved dramatically. We present a rare case of sphenoid ridge meningioma causing acute cerebral infarction as a result of middle cerebral artery compression.

Effectiveness of 2.0 mm Standard and 2.0 mm Locking Miniplates in Management of Mandibular Fractures: A Clinical Comparative Study

To compare and evaluate the effectiveness of 2.0 mm locking miniplates versus 2.0 mm standard miniplates in treatment of mandible fractures. Sixty randomly selected patients who sustained mandibular fractures were selected for this study. The fractured fragments were stabilized using 2.0 mm locking miniplates in 30 cases and in the remaining 30 cases the fractured fragments were fixed with conventional 2.0 mm miniplates. Post-operative stability was assessed with radiographs at 7th day, 1st, and 3rd months. The stability of the reduced fracture was assessed clinically and both the types of plates were assessed with an OPG or conventional radiographs. This study shows favorable results on use of locking miniplates in mandibular fractures. The results show that there were no significant differences in the post-operative complications between the conventional and the locking plate/screw mandibular systems. The locking plate/screw system was more rigid than conventional plate/screw system, thereby reducing the need and duration of intermaxillary fixation (IMF).

Revascularization for symptomatic occlusion of the anterior cerebral artery using superficial temporal artery

Isolated symptomatic occlusion of the anterior cerebral artery (ACA) is a rare condition and until date, only few cases regarding the revascularization of the ACA have been reported. This paper reports on successful attempt to revascularize the ACA using superficial temporal artery (STA) in patient with isolated symptomatic occlusion of the ACA. A 69-year-old man presented with several episodes of transient weakness involving left lower extremity. Cerebral angiography showed occlusion of the right ACA at the A2 segment. After medical treatment failure, the patient underwent STA-ACA bypass surgery. Subsequent to surgery, there was immediate disappearance of transient ischemic attack and follow-up angiography showed favorable revascularization of the ACA territory. Bypass surgery can be considered in the patients with symptomatic occlusion of the ACA, who have experienced failure in medical treatment.

Depth perception of illusory surfaces

The perception of an illusory surface, a subjectively perceived surface that is not given in the image, is one of the most intriguing phenomena in vision. It strongly influences the perception of some fundamental properties, namely, depth, lightness and contours. Recently, we suggested (1) that the context-sensitive mechanism of depth computation plays a key role in creating the illusion, (2) that the illusory lightness perception can be explained by an influence of depth perception on the lightness computation, and (3) that the perception of variations of the Kanizsa figure can be well-reproduced by implementing these principles in a model (Kogo, Strecha, et al., 2010). However, depth perception, lightness perception, contour perception, and their interactions can be influenced by various factors. It is essential to measure the differences between the variation figures in these aspects separately to further understand the mechanisms. As a first step, we report here the results of a new experimental paradigm to compare the depth perception of the Kanizsa figure and its variations. One of the illusory figures was presented side-by-side with a non-illusory variation whose stereo disparities were varied. Participants had to decide in which of these two figures the central region appeared closer. The results indicate that the depth perception of the illusory surface was indeed different in the variation figures. Furthermore, there was a non-linear interaction between the occlusion cues and stereo disparity cues. Implications of the results for the neuro-computational mechanisms are discussed.

Blood monocyte count may be a predictor of vascular access failure in hemodialysis patients

It has been reported that an increase in the counts of white blood cells (WBC) and their subpopulations is an independent predictor of atherosclerotic events and mortality. On the other hand, vascular access (VA) stenosis is caused by a progressive development of neointimal hyperplasia. We examined the relationship between VA failure and counts of peripheral WBC and their subpopulations in hemodialysis (HD) patients. The study population consisted of 82 patients undergoing regular HD. Twenty-two patients, who were unstable, were excluded from the study. After one year, we examined the relationship between VA failure and the counts of peripheral WBC and their subpopulations. In the follow-up period, 21 patients had complicated VA failure. The counts of WBC, neutrophils, lymphocytes, eosinophils, and basophils did not show a significant difference, but a monocyte count of ≥ 400/μL was shown to indicate a high probability of VA failure. Logistic regression analysis revealed that monocyte count was an independent risk factor of VA failure. The peripheral blood monocyte count may be a predictor of VA failure in HD patients.

A comparative study of dermatoglyphics in individuals with normal occlusions and malocclusions

INTRODUCTION

Dermatoglyphics is the study on edpidermal ridges on the palmar and plantar surfaces of the feet and hand. Embryological development of orodental structures and these dermal patterns occur during the same period. The environmentally influenced genetic predisposition is found in different types of malocclusions. This malocclusion should also exhibit different dermal patterns which are unique for each class.

AIM OF THE STUDY

The present study was conducted to compare the Dermatoglyphics parameters of individuals with normal occlusions and various classes of malocclusions.

METHODOLOGY

The participants were divided into four groups; Group 1: class I ideal; Group 2: class I malocclusionl; Group 3: class II Div 1 and Div 2; Group IV: class III. The finger and palmar prints were obtained and they were analyzed for each type of pattern. The Total Finger Fridge Count (TFRC), a-b ridge count and the angle "atd" (angle formed by connecting lines from digital triradius 'a' to the axial triradius and from this triradius to the digital triradius 'd') were associated with particular groups.

RESULTS

The data was entered and analyzed by using Students t-test and ANOVA.

CONCLUSION

Particular predictive occurrence of patterns was not found to be associated with each group. However, some of the finger patterns, such as increase in twinned loops in class II malocclusions and absence of radial loops in class III malocclusions were found to be statistically significant (p<0.001). The parameters associated with palmar prints had no statistical significance. Further studies with more samples in each group should be carried out.

A Cephalometric Study on the Relationship Between the Occlusal Plane, Ala-Tragus and Camper's Lines in Subjects with Angle's Class I, Class II and Class III Occlusion

Considering the importance of the occlusal plane orientation in complete denture prostheses, a study was conducted on the relationship between this plane with ala-tragus and Camper's lines in soft tissue among individuals with class I, class II and class III occlusion. The aim of the present study was to define the best soft tissue index by which the location and inclination of the occlusal plane in complete dentures could be established. A total of 60 subjects were selected for the study. Lateral cephalograms of these subjects were obtained. Tracings and analysis was done to confirm to the skeletal relationship of subjects to be class I (normal), class II (prognathic maxilla) and class III (retrognathic maxilla). 20 Subjects of each group were screened for further analysis. Radiopaque markers were attached to the intended points on soft tissue and then standard lateral cephalograms were obtained from each subject. The angles between the following lines were measured: Occlusal line, Camper's line (ala-porion), AT1 (ala-superior border of tragus), AT2 (ala-mid-tragus) and AT3 (ala-inferior border of tragus). The mean values and standard deviations were calculated for all the groups. The mean values calculated were subjected to repeated ANOVA test and significance was evaluated. Comparison of the results by the ANOVA test exhibited a significant difference. In class I subjects, it was evaluated that in 75 % individuals, the posterior reference point was found to be the mid-tragus; of class II subjects, in 60 % individuals, the posterior reference point was found to be the mid-tragus; and of class III subjects, in 75 % individuals, the posterior reference point was found to be the inferior border of tragus.

Isolated gastric variceal bleeding caused by splenic lymphoma-associated splenic vein occlusion

Isolated gastric varices (IGV) can occur in patients with left-sided portal hypertension resulting from splenic vein occlusion caused by thrombosis or stenosis. In left-sided portal hypertension, blood flows retrogradely through the short and posterior gastric veins and the gastroepiploic veins, leading to the formation of an IGV. The most common causes of splenic vein occlusion are pancreatic diseases, such as pancreatic cancer, pancreatitis, or a pseudocyst. However, various other cancers, such as colon, gastric, or renal cancers, have also been known to cause splenic vein occlusion. Our patient presented with a rare case of IGV bleeding induced by splenic lymphoma-associated splenic vein occlusion. Splenectomy, splenic artery embolization, and stenting of the splenic vein are the current treatment choices. Chemotherapy, however, is an alternative effective treatment for splenic vein occlusion caused by chemotherapy-sensitive tumors. Our patient responded well to chemotherapy with a cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone regimen, and the splenic vein occlusion resolved after the lymphoma regressed.