Repair of newly condensed amalgam restorations

This study investigated the tensile strength of the newly condensed amalgam repaired with newly triturated amalgam in different times. A separable plexiglass mold with a dumbbell shape "cavity" was prepared. Amalgam was condensed in the "cavity" and allowed to set for one hour before it was removed from the mold and used for control. Five controls were prepared. Five groups with five samples in each group were prepared. Amalgam was condensed in the first half of the "cavity" and 5, 15, 30, 60 minutes and 24 hours later newly triturated amalgam was condensed in the second half of the "cavity" for the 5, 15, 60 minutes and 24 hour group samples. All samples were allowed to set in the mold for one hour then removed and stored in 100% humidity condition at room temperature for 24 hours. Tensile strength was tested on the Instron testing machine. It was found that when the newly condensed amalgam was repaired in five minutes, it has 84% of the tensile strength and was not significantly different from the controls. When it was repaired in 15, 30, 60 minutes and 24 hours, the tensile strength was significantly lower than the controls and significantly different from the controls.

High casein-lactalbumin diet accelerates blood coagulation in rats

This study investigates the influence of a high protein intake on normal hemostasis, fluid balance and organ growth. Adult rats were fed semipurified diets that contained either 18 or 56 g/100 g casein-lactalbumin for 2 wk, and the following functions were measured: food and water intake, weight gain, blood pressure, bleeding and clotting time, ADP-stimulated platelet aggregation, thrombin time, prothrombin time and partial thromboplastin time. Although food intake was depressed by the high protein diet, weight gain was not affected by the regimen. Water consumption, 24-h urine excretion and kidney weight were significantly greater in rats fed the high protein diet than in controls. High protein intake resulted in shorter barbiturate-induced sleeping time. Bleeding time and clotting time were significantly lower in rats fed the high protein diet for 7 d. However, heart rate, mean arterial pressure, plasma protein and osmolarity, platelet aggregation, prothrombin time, partial thromboplastin time and thrombin time did not differ significantly. Because a high protein intake caused rapid coagulation of blood in rats without affecting the activity of clotting factors, we suggest that this diet sensitized rats to factors that initiate clotting in vivo.

Radiofrequency-assisted balloon dilatation in patients with pulmonary valve atresia and an intact ventricular septum

OBJECTIVE

To investigate the efficacy and safety of transcatheter radiofrequency-assisted valve dilatation for infants with pulmonary valve atresia and intact ventricular septum as an alternative to the use of laser heated wires.

DESIGN

Prospective clinical study.

SETTING

Three paediatric cardiology centres.

PATIENTS

Four children (aged 5-101 days, weight 2.8 kg) with pulmonary valve atresia and intact ventricular septum underwent percutaneous radiofrequency-assisted valve dilatation.

METHODS

After delineating the atretic valve by angiography, 0.020 inch or 0.018 inch radiofrequency wires were used to perforate the atretic valve. The valve was then dilated with conventional balloon dilatation catheters up to the valve annulus diameter.

RESULTS

In all four cases the radiofrequency wire perforated the atretic pulmonary valve and balloon dilatation was successful. In one patient the radiofrequency wire also passed through the anterior wall of the pulmonary artery causing tamponade which required surgical repair shortly afterwards. This patient died from sepsis six days later. One patient died three weeks after the procedure from septicaemia and a paradoxical coronary embolus. Two patients were discharged after 4 and 14 days respectively.

CONCLUSIONS

Radiofrequency-assisted valve dilatation is a promising alternative to the recently developed laser wire technique. The major advantages are a reduction in cost and improved safety for the staff performing the procedure.

Morphological variations of fossa ovalis atrial septal defects (secundum): feasibility for transcutaneous closure with the clam-shell device

OBJECTIVE--To assess the morphology of fossa ovalis atrial septal defects (FOASD; secundum atrial septal defect) to determine in what proportion percutaneous closure with the clam-shell device might be feasible. DESIGN--Review of the intraoperative description of the morphology and size of FOASD. PATIENTS--106 consecutive patients with FOASD. SETTING--A regional children's cardiac referral centre. MAIN OUTCOME MEASURES--Determination of morphology and size of FOASD. RESULTS--Morphological variations in the FOASD were found: (1) central FOASD, 70 (66%); (2) superior FOASD, 4 (3.7%); (3) inferior FOASD, 8 (7.6%); (4) posterior FOASD, 2 (1.9%); (5) subtotal absence of atrial septum, 3 (2.8%); (6) completely fenestrated FOASD, 10 (9.4%); (7) partially fenestrated FOASD, 9 (8.5%). Depending on its site, the edge of the FOASD may be close to important atrial structures such as the orifices of the superior and inferior caval veins, coronary sinus, and right pulmonary veins. The shape of the FOASD was usually oval with the major diameter ranging from 10 to 50 mm with a mean (SD) of 27.8 (0.93) mm. The minor diameter ranged from 4 to 30 mm with a mean (SD) of 15.3 (5.9) mm. The ratio of the major to minor diameter ranged from 1.0 to 5.0 with a mean of 2.01. Based on intraoperative measurement and description, it is postulated that it should be possible to close about 50% of these defects with the clam-shell device.

Salvage of postoperative pulmonary hypertensive crisis using ECMO via cervical cannulation in a case of truncus arteriosus

The survival of patients with truncus arteriosus beyond one year of age is rare without surgical treatment [3 . Early surgery may be associated with a mortality but is still preferable, as the risks of established pulmonary hypertensive disease complicate delayed surgery [2]. We report the successful salvage of a pulmonary hypertensive crisis 24 h after corrective surgery in a late presenting patient using extracorporeal membrane oxygenation (ECMO) via cervical cannulation. Post-operative pulmonary hypertensive crises may present a difficult management problem. Extracorporeal membrane oxygenation is therapeutic in these circumstances in addition to providing life support. Cervical cannulation remains the method of choice in the postoperative cardiac patient.

Fetal and neonatal outcome of exposure to anticoagulants during pregnancy

We studied fetal and neonatal outcome of women maintained on anticoagulants (warfarin and/or heparin) during pregnancy. Among 22 Chinese families, 13 mothers (59%) had a history of recurrent abortion or stillbirth while being maintained on warfarin treatment. Twenty-nine liveborn children (17 boys, 12 girls), ages 0.6-11.3 years at follow-up, were analysed for evidence of embryopathy. These were subdivided into 2 groups. Group 1 consisted of 18 children (12 boys, 6 girls) whose mothers were only given warfarin during pregnancy. Five were small for gestational age, and 12 had features of warfarin embryopathy such as nasal hypoplasia. One had subependymal intraventricular hemorrhage shown on neonatal ultrasonography. Group 2 consisted of 11 children (5 boys, 6 girls) whose mothers were maintained on warfarin and heparin during pregnancy. Three were premature deliveries, and 4 had nasal hypoplasia. One had cleft lip, cleft palate, cataract, microphthalmia, intraventricular hemorrhage, and hydrocephalus. We found that despite the high risk of fetal wastage, there was a relative lower risk of major complications, except for some minor cosmetic defects such as nasal hypoplasia. This might lead to readjustment of advice concerning contraception given to pregnant women who were maintained on anticoagulant therapy.

Continuous wave Doppler echocardiography after surgical repair of coarctation of the aorta

OBJECTIVE

To find how closely pressure gradients across the aortic arch derived from Doppler echocardiography reflect gradients measured by catheter after surgical repair of coarctation of the aorta.

DESIGN

Pressure drop across the aortic arch was measured simultaneously by continuous wave Doppler and double lumen catheter in 20 patients with repaired coarctation of the aorta.

RESULTS

The peak pressure drop estimated by Doppler was almost invariably higher than the peak to peak gradient measured by catheter, as might be expected. Wide variation was seen between the Doppler measured pressure drop and instantaneous peak gradient measured by catheter, ranging from +22 to -17 mm Hg. The reasons for these differences are unclear but are probably related to a combination of complex flow dynamics in the aortic arch, difficulty in closely aligning the Doppler beam with flow, and inability to measure flow velocity immediately proximal to the site of the surgical repair with continuous wave Doppler.

CONCLUSIONS

Continuous wave Doppler echocardiography may significantly overestimate or underestimate the pressure drop after repair of coarctation and it should be interpreted with caution in individual patients. Catheterisation with angiography remains the reference standard for assessment of surgical repair of the aortic arch.

Microleakage between glass-ionomer cement and composite resins

This study investigated the microleakage between glass-ionomer cement and Silux or Herculite with and without Scotchbond 2. Cavities were prepared in polymerized composite resin samples and "restored" with a glass ionomer cement with and without Scotchbond 2. The samples were thermocycled and immersed in 0.05% crystal violet solution for 2 hours, then embedded in clear casting resin, sectioned, and examined with an optical microscope. The results indicated that a high degree of dye penetration was found in samples of GC and Silux, and GC and Herculite without Scotchbond 2. The use of Scotchbond 2 significantly reduced the degree of dye penetration, but did not completely eliminate dye penetration.

Effects of 'resin-compatible' cavity varnishes on composite resin microhardness

Although the use of cavity varnishes with composite resins has traditionally been discouraged, several "resin-compatible" varnishes are currently available. This in vitro study evaluated the effects of resin-compatible cavity varnishes on a hybrid composite resin. The results of the study indicate that these varnishes soften the composite resin in contact with varnished dentin.

Microleakage between different types of base materials

This study investigated the sealing properties of various combinations of base materials. Three chemically cured and three light-activated base materials were combinationally used to make 15 sample groups. The samples were thermocycled and immersed in 0.05% crystal violet solution for 1 hour. They were then embedded in clear casting resin, sectioned, and photographed. The interfaces of the samples were digitized. The ratio of the total interface length to the penetration of leakage was calculated and compared. The results indicated that the combination of Cavalite and VLC Dycal materials had the least microleakage and was significantly different from the other 14 groups.

Microleakage between composite resin and basing materials

This study investigated the microleakage between a composite resin restorative material and six basing materials. Cavities were prepared in polymerized composite resin samples and "restored" with Cavitec, Life, Ketac-Bond, BaseLine, Cavalite, and VLC Dycal. The samples were thermocycled and immersed in 0.05 percent crystal violet solution for 2 hours, then embedded in clear casting resin, sectioned and examined with an optical microscope. Our results indicated that Cavalite and VLC Dycal allowed no dye penetration. Cavitec and Life had a moderate degree of dye penetration and Ketac-Bond and BaseLine had a relatively high degree of penetration.

Leakage of a light-activated base: effect of dentin bonding agents

This study investigated the sealing properties of Cavalite light-activated base material in conjunction with various dentin bonding agents. Thirty extracted molars were selected and cleaned. Slot preparations with standard dimensions were made. The prepared cavities were filled with Cavalite material after application of the dentin bonding agents Gluma, Prisma Universal Bond, Scotchbond 2, and Tenure. Samples were thermocycled for 180 cycles between 3 degrees C and 60 degrees C, then immersed in 0.05% crystal violet solution for 2 hours. The samples were embedded in clear casting resin, sectioned, and examined with a light microscope. Results indicated that Cavalite material used alone, without a dentin bonding agent, allowed the greatest degree of dye penetration. Cavalite material with Tenure bonding agent had the lowest degree of leakage. Cavalite material used with Scotchbond 2, Gluma, or Prisma Universal Bond bonding agents allowed an intermediate degree of dye penetration. According to an analysis of variance, however, there was no statistical difference in the effects of Tenure, Scotchbond 2, and Gluma bonding agents.

Effect of varnishes on surface microhardness of basing materials

This study investigated the surface microhardness of five basing materials with four varnishes applied to them. Ten Plexiglass molds with 7-mm diameter holes were prepared. Basing materials of Cavitec, Life, Ketac Bond, TimeLine, and Cavalite were placed in the molds to produce 20 samples each. Copalite, Universal, Contact, and Barrier varnishes were applied to the top and bottom surfaces of the base material samples at 1 hour and 24 hours. After air drying, the surface microhardness of the samples was tested with a Micromet II microhardness tester. The surface microhardness of all the basing materials tested was reduced when varnishes were applied to them. Contact and Barrier reduced surface microhardness value more than Copalite and Universal.

Effect of the tenure dentin bonding system on leakage of light-activated liners

This study investigated the effect of the Tenure dentin bonding system on the sealing properties of four light-activated liners. Dentinal slot preparations were made in extracted human molars and "restored" with Cavalite, TimeLine, VLC Dycal, and Zionomer liners. Samples were immersed in 0.05 percent crystal violet solution for 2 hours, then embedded in clear casting resin, sectioned, and examined with an optical microscope. Our results indicated that the Tenure dentin bonding system reduced dye penetration around each of the light-activated liners tested. The Tenure/VLC Dycal system provided a more effective seal than the other liners.

Microleakage of seven dentin bonding agents

The purpose of this study was to evaluate the ability of seven dentin bonding agents to reduce dye penetration at the margins of microfill composite restorations in dentinal cavities. Forty extracted molars were selected and cleaned. Cavity preparations were made in dentin with #55 carbide burs. The preparations were restored with Silux after application of one of the following dentin bonding agents: Gluma, Scotchbond 2, Tenure, Prisma Universal Bond 2, Mirage-Bond, XR Bond, and All-Bond. Samples were thermocycled for 200 cycles between 3 degrees C and 60 degrees C, then immersed in a 0.05 percent crystal violet solution for 2 hours. The samples were embedded in clear casting resin, sectioned, and examined with a light microscope. Our results indicated that the dentin bonding systems reduced, but failed to totally eliminate, microleakage around the composite resin restorations.

Cardiovascular malformations in Malaysian neonates with Down's syndrome

A prospective study was done to determine the incidence of cardiovascular malformations in neonates with Down's syndrome. 17/34 (50%) of the babies with Down's syndrome born at the Maternity Hospital, Kuala Lumpur, Malaysia had congenital heart defects. These included 7 cases of ventricular septal defect (VSD), 3 cases of patent ductus arteriosus (PDA), 2 cases of atrio-ventricular canal defect, 2 cases of ventricular septal defect with patent ductus arteriosus, 1 case of hypertrophic cardiomyopathy, 1 case of hypertrophic obstructive cardiomyopathy and 1 case of complex cyanotic heart. Only 8/17 (47%) of these babies had any clinical signs suggesting underlying cardiac defects. In view of the common occurrence of cardiac anomalies, it is recommended that echocardiographic screening should be carried out on all neonates with Down's syndrome.

Sequential Forearm Intravenous Regional and Infiltration Anaesthesia: Value for Haemostasis

Intravenous regional anaesthesia using 0.5% lignocaine with a forearm tourniquet is a satisfactory technique for operations on the distal forearm, wrist and hand. Since recovery of pain sensation is rapid, haemostasis after release of tourniquet becomes difficult and sometimes impossible. Local wound infiltration or metacarpal block with 1% lignocaine just before release of the tourniquet can allow subsequent haemostasis and wound closure to be carried out without causing pain. 55 patients received this sequential forearm intravenous regional and infiltrative anaesthesia. Subsequent haemostasis and wound closure could be carried out without pain in 51 patients (92.7%); three patients (5.5%) noticed mild discomfort but the operations could be finished without any additional anaesthetic agent. No complications were encountered with this modified technique.

Sequential forearm intravenous regional and infiltration anaesthesia: value for haemostasis

Intravenous regional anaesthesia using 0.5% lignocaine with a forearm tourniquet is a satisfactory technique for operations on the distal forearm, wrist and hand. Since recovery of pain sensation is rapid, haemostasis after release of tourniquet becomes difficult and sometimes impossible. Local wound infiltration or metacarpal block with 1% lignocaine just before release of the tourniquet can allow subsequent haemostasis and wound closure to be carried out without causing pain. 55 patients received this sequential forearm intravenous regional and infiltrative anaesthesia. Subsequent haemostasis and wound closure could be carried out without pain in 51 patients (92.7%); three patients (5.5%) noticed mild discomfort but the operations could be finished without any additional anaesthetic agent. No complications were encountered with this modified technique.

Surgical correction of tetralogy of Fallot in the presence of Ebstein's anomaly of the tricuspid valve

The combination of tetralogy of Fallot and Ebstein's anomaly of the tricuspid valve is extremely rare. We report the case of a child with such anatomy, who underwent successful repair of tetralogy in infancy despite the tricuspid valve abnormality.

Functional aortic atresia in congenitally corrected transposition

An infant with congenitally corrected transposition and severe regurgitation through the left atrioventricular valve presented with clinical and Doppler echocardiographic features of aortic atresia. This eventually proved to be functional. This clinical situation had not, to the best of our knowledge been previously reported before.

Leakage of chemical and light-cured basing materials

This study investigated the sealing properties of chemical and light-cured basing materials in dentin. Fifty extracted molars were selected and cleaned. Slot preparations with standard dimensions were made. The prepared cavities were filled with Cavitec, Life, Ketac-Bond, VLC Dycal, and Cavalite materials. Samples were immersed in 0.05% crystal violet solution for 2 hours. The samples were then embedded in clear casting resin, sectioned, and examined with a microscope. Results indicated that Cavalite and Ketac-Bond materials allow a greater degree of dye penetration that the three other materials. Cavitec, VLC Dycal, and Life materials were similar to each other in degree of dye penetration.