The clinical assessment of foreign body ingestions: Experience in a developing country

Foreign body (FB) ingestion is an important emergency in low- to middle-income countries. Our study sought to identify which clinical and radiological findings best predict upper gastrointestinal FB impaction. Amongst 149 adolescents and adults presenting to two Jamaican hospitals between 2018 and 2020, FB's were found at 31% of telescopic laryngoscopies and 60% of rigid oesophagoscopies. Commonest sites of impaction were the tonsils at laryngoscopy (15/46) and proximal oesophagus at oesophagoscopy (17/22). Odds of pharyngeal impaction were higher with fish bone ingestion, persistent discomfort, perceived location of discomfort above the cricoid cartilage and symptoms noted during a meal. Persistent discomfort and FB shadow on X-ray imaging produced higher odds of oesophageal impaction. Simple clinical and radiological assessments are useful in predicting FB impaction in resource-limited settings.

Novel endodontic sealers induce cell cytotoxicity and apoptosis in a dose-dependent behavior and favorable response in mice subcutaneous tissue

OBJECTIVES

The objective of the present study is to evaluate the in vitro cytotoxicity and in vivo biocompatibility of two novel endodontic sealers: RealSeal XT1 and Sealapex Xpress on the subcutaneous connective tissue of mice.

MATERIALS AND METHODS

The cytotoxicity was assessed by cell viability using the MTT assay (one-way ANOVA), trypan blue test (Mann-Whitney) and cell apoptosis by flow cytometer. For the subcutaneous study, polyethylene tubes filled with the sealers were implanted in 70 BALB/c mice: 6 experimental groups (n = 10/group) and 2 control groups with empty tubes (n = 5/group). At the end of experimental periods (7, 21, and 63 days), the tissue was removed and histotechnically processed. Angioblastic proliferation and edema (Fisher's exact test) were evaluated, besides thickness measurement (μm) of the reactionary granulomatous tissue and neutrophil counts (Kruskal-Wallis and Dunn's post test; Mann-Whitney) (α = 0.05).

RESULTS

MTT assay, trypan blue, and analysis of apoptotic cells showed a dose-dependent direct effect: the more diluted the sealer, the less cytotoxic. Regarding the angioblastic proliferation and edema, difference between the sealers at 7 and 63 days occurred (p < 0.05). Both endodontic sealers initially promoted perimaterial tissue reaction as a foreign body granuloma and thus stimulated favorable tissue responses.

CONCLUSIONS

Both sealers showed a dose-dependent effect and promoted satisfactory subcutaneous tissue response; the sealer Sealapex Xpress was less cytotoxic and more biocompatible than RealSeal XT.

CLINICAL RELEVANCE

The step of root canal filling during endodontic treatment is highly important for the preservation of the periapical tissue integrity. Subcutaneous reaction to endodontic sealers enables scientific basis for clinical use.

Adjuvant chemotherapy for stage II and stage III colon cancer—What is happening in routine practice?

e15046

Background: Randomised studies have defined adjuvant chemotherapy as standard treatment for stage III colon cancer (SIIICC), with multiple options available. For stage II (SII) disease, the selection of patients for adjuvant treatment remains controversial. There remains limited data on clinician decision making regarding adjuvant chemotherapy in routine clinical practice. Methods: A review of patients treated with SII & IIICC at 4 hospitals, utilising data from BioGrid Australia, where clinician choice and rationale were prospectively documented. Results: 372 patients (37%) with SII and 307 (30%) with SIIICC were identified from 1015 CC patients treated from January 2003 till November 2008. Median age was 68 years, 51% were male; 49% female. 66 (25%) of patients with SIIICC were not offered chemotherapy, predominantly due to advanced age or co-morbidity. Since oxaliplatin and capecitabine became widely available in 2005, 66% of treated patients have received oxaliplatin based therapy, 15% bolus 5-FU alone and 19% capecitabine. For SII disease, overall 81 (26%) pts received adjuvant chemotherapy. Age was the dominant influence on treatment choice with 41% aged 70 (p<0.001) receiving treatment. Patients with high risk features were also more likely to receive adjuvant therapy. (p= 0.006 for those with lymphovascular invasion and p= 0.0068 for those with T4 tumours). Dose reductions and completion rates were similar for SII and III disease, and for older and younger patients. Conclusions: Over 25% of patients with SIIICC do not receive adjuvant chemotherapy in routine practice, with physicians basing non-treatment recommendations predominantly on patient age and co-morbidity. Where treatment is used, oxaliplatin-based therapy is the dominant regimen, except in older patients. In SIICC, adjuvant chemotherapy is used in one in four patients, more frequently in younger patients and those with high risk features.

No significant financial relationships to disclose.

The use of lumbar spinal stabilization techniques during the performance of abdominal strengthening exercise variations

AIM

The lumbar spinal stabilization techniques in abdominal hollowing and bracing are known to facilitate the level of activity in the muscles transversus abdominis and obliquus internus (TA/OI). The relative timing of activation and the effect of combination with other tasks are currently unknown. The objective of this study was to determine whether the performance of abdominal hollowing and bracing could promote the voluntary preferential recruitment of TA/OI muscles when performed prior to abdominal strengthening exercise variations.

METHODS

The trunk muscles TA/OI, rectus abdominis and obliquus externus were investigated using surface EMG. A pressure transducer under the lumbar spine detected spinal movement. Eighteen male subjects performed a series of 4 abdominal strengthening exercise variations. Pressure cuff and electromyographic onset times were collected and analyzed.

RESULTS

TA/OI muscle site was recruited significantly earlier than the upper rectus abdominis site for the hollow with curl exercise. The TA/OI site was also ranked as first activated site in the majority of subjects during exercises where stabilization techniques of hollowing and bracing were used.

CONCLUSIONS

Abdominal hollowing was an effective method for selective preferential voluntary recruitment of TA/OI site prior to the performance of the curl type abdominal strengthening exercise variation. The other variations brace with curl and hold and hollow with rotation also tend to recruit TA/OI site first, however the timing was not significantly different.

Comparison of laterally condensed .06 and .02 tapered Gutta-Percha and sealer in vitro

The purpose of this in vitro study was to compare the quality of the seal in canals prepared in a standardized manner and obturated with a .06 or a .02 tapered gutta-percha master cone using lateral condensation. Forty-four extracted human anterior teeth with single, straight canals were divided into two experimental groups of 20 teeth each and two control groups of 2 teeth each. The teeth were instrumented with Series 29 Profile .06 tapered rotary nickel-titanium files to a master apical file of 0.46 mm. Teeth in group 1 were obturated with a .02 tapered master gutta-percha cone and Roth 801 sealer using lateral condensation. Teeth in group 2 were obturated similarly, except a .06 tapered master gutta-percha cone was used. The depth of spreader penetration was recorded in millimeters. Positive control teeth were instrumented but not filled. Negative control teeth were instrumented, obturated, and externally sealed. The teeth were placed into a coronal leakage apparatus that contained an upper and lower reservoir of trypticase soy broth separated by the tooth. A 24-h growth of Proteus vulgaris in 0.25 ml of trypticase soy broth was placed in the coronal reservoir every 7 days for 70 days and incubated at 37 degrees C. Student's t test was used to determine whether there was a difference in spreader penetration between the groups, and a Fisher's exact test was used to determine whether there was a difference in bacterial leakage. The positive and negative controls validated the testing model. When a .02 tapered master cone was used, the spreader penetrated significantly closer to working length than when a .06 tapered master cone was used (p < 0.05). The difference between the groups in the number of samples that demonstrated complete bacterial penetration was not significant (p > 0.05).

A turnover study in the male rat of plasma-bound 59Fe, 114Inm and 109Cd with particular reference to the gonad

After intravenous doses of the plasma-bound radionuclides 59Fe, 114Inm and 109Cd, only a minute percentage localizes in the rat testis and remains largely unchanged with time. Intratesticular injection of appropriately reduced volumes led to much higher proportionate percentage retention of 14, 65 and 11 for 59Fe, 114Inm and 109Cd, respectively. By this route, significant feedback of the elements escaping initial binding was prevented. Distinct but different testicular turnovers were now discernible. As a receptor of fluid and spermatozoa from the testicular tubules, the epididymis provides an indication of entry into and interaction of the metals with spermatogenic cells. For 59Fe no measurable changes were detected, whereas a progressive increase in epididymal 114Inm occurred, which had not reached a plateau by 70 days. 109Cd, now demonstrated within the testicular tubules by autoradiography, remained at constant organ level for upwards of 16 days but had declined by 25% by 57 days. At this point, the epididymis showed a five-fold increase in the radionuclide, declining to one-half this value by 126 days. Since 109Cd is carrier free, the data reflect a body turnover of dietary cadmium. These results, overall, are compatible with the entry of a proportion of each radionuclide into the seminiferous tubules and reaction with spermatogenic cells. Possible interpretations of the observed differences are presented.

Pulpal response to restorative procedures and materials

This paper reviews the pulpal response to common restorative procedures and dental materials. Pulpal inflammation and dentin hypersensitivity are commonly associated with routine restorative procedures. Although it is not possible to avoid injury to the pulp completely, in order to prevent unnecessary adverse effects, the practicing dentist should be aware of the potential dangers involved. This article provides a current review of recent findings of the pulpal response to glass ionomer cements and acid-etch composite resin materials.

Demonstration of Bacteroides intermedius in periapical tissue using indirect immunofluorescence microscopy

The presence of bacteria in periapical lesions of teeth with necrotic pulp has been demonstrated by microbiological sampling of periapical lesions during endodontic surgery. The purpose of this study was to confirm the presence of Bacteroides intermedius in a periapical granuloma using an indirect immunofluorescence technique. Histologic sections of a periapical granuloma were incubated with a rabbit antiserum to B. intermedius. After incubation with secondary antibody (fluorescein-conjugated goat anti-rabbit IgG), an intense fluorescent staining was observed in areas of the tissue sections. Control tissue sections that were incubated without the antibody remained unstained. The results obtained with the indirect immunofluorescence technique supported our cultural findings that microorganisms, e.g. B. intermedius, were present in the tissue of the periapical granuloma.

The complications of trabeculectomy (a 20-year follow-up)

The complications of trabeculectomy were studied in two groups of patients taken from a stable white population. The first group who had had their operation when it was first introduced 22 years ago, had been previously treated with prolonged medication, the second group had been operated upon recently and had had short-term pre-operative medication. This study confirmed that trabeculectomy predictably reduces the intraocular pressure to within the accepted normal range and that the pressure level below which the intraocular pressure could not be expected to fall was congruent to 14 mm/Hg. It also revealed that although some post operative abnormality was noted in two-thirds of the patients there were no long term problems which could be related to any operative or immediately post-operative complications, including shallow anterior chambers, uveitis and hyphaema. However, there was a long term reduction in the visual acuity and visual fields of about one-third of the patients, which was not related to cataract formation, macular problems, the height of the preoperative intraocular pressure, the amount by which this fell as a result of the surgery, or the amount, length or type of preoperative medication given before the operation. Although there was some increase in cataracts throughout the whole long term group this was mainly in those who had cataract prior to surgery; the increase was not related to operations or any other factor other than corneo-lenticular contact post-operatively.

Periapical bacterial plaque in teeth refractory to endodontic treatment

It has recently been found that bacteria are able to survive and maintain an infectious disease process in periapical lesions of nonvital teeth. The purpose of this study was to examine the surfaces of root tips removed during surgical-endodontic treatment for the presence of microorganisms. A full thickness flap was reflected under strict surgical asepsis and the periapical lesions were enucleated and removed. About 2-3 mm of the root was cut off, rinsed in sterile saline and placed in 10% neutral-buffered formalin. Upon fixation, the root tips were dehydrated, air-dried and given an electrically conducting coat of gold in a vacuum evaporator. The root tips were then studied in a Jeol, JSM-U3 scanning electron microscope, usually operated at 20 kV. The root surfaces were covered with soft tissue, except at the apex of the roots, where a continuous, smooth and structureless coating was seen, apparently adjacent to the apical foramen. At higher magnification a variety of bacterial forms were recognized in the smooth coating. A bacterial plaque was observed in irregularities of the surfaces between fiber bundles and cells and in crypts and holes. The bacteria were held together by an extracellular material and the plaque was dominated by cocci and rods. Fibrillar forms were recognized as well, often with cocci attached to their surfaces.

Differentiation of radicular cyst and granulomas using computerized tomography

The purpose of this investigation was to study periapical lesions by means of computerized tomography to ascertain if this noninvasive method could be of value in distinguishing between radicular cysts and granulomas. Periapical radiographs were taken of the teeth of 60 human cadavers. Periapical radiolucencies were seen in conjunction with 33 teeth. Based on the periapical radiographs, an oral radiologist (J.P.) attempted to select 4 granulomas and 4 cysts from the 33 radiolucencies. Computerized tomography was performed on the root tips and the periapical lesions of these 8 teeth. The roots and periapical lesions were then surgically removed and prepared histologically for microscopic examination. In the tomographs, 7 of the periapical lesions had a cloudy appearance with a density similar to each other and to the surrounding soft tissue. In the eighth lesion a homogeneous dark area with a distinctly lower density could be distinguished from surrounding cloudy areas. Histologically, the dark area was shown to be an epithelialized cyst cavity. The other 7 lesions were granulomas. Thus, a cyst could be differentiated from periapical granulomas by computerized tomography because of a marked difference in density between the content of the cyst cavity and granulomatous tissue.

In vivo sealing ability of calcium hydroxide-containing root canal sealers

It was the purpose of this study to determine the sealing ability of 2 commercially available calcium hydroxide-containing root canal sealers, CRCS and Sealapex. One hundred sixty single-rooted human teeth were used. The clinical crowns were removed and the roots were cleaned mechanically and by immersion for 24 h in 5% sodium hypochlorite. The root canals were then instrumented to size 80 at the apical foramen and the roots were sterilized by gamma-radiation. Under aseptic conditions the root canals were filled with a gutta-percha master cone size 70 and Sealapex (48 roots), CRCS (48 roots), and a zinc oxide-eugenol type sealer, Roth 801 (50 roots). The coronal aspects of the root canals were then sealed with zinc oxide-eugenol cement. In order to bring the roots and root filling materials in contact with tissue and tissue fluids, the roots were implanted subcutaneously in rabbits for 90 days and 1 year. Leakage as demonstrated by penetration of India ink was evaluated using a stereomicroscope. The best results were obtained with CRCS. Significantly less leakage occurred with both calcium hydroxide-containing sealers than with the traditional zinc oxide-eugenol sealer.

Fluorescent inhibitors of a cell surface protease used to locate leukaemia cells in kidney sections

Guanidinobenzoatase is a trypsin-like protease on the surface of cells capable of migration, for example leukaemia cells. We have used a number of fluorescent probes that are competitive inhibitors of guanidinobenzoatase to locate leukaemia cells in resin sections of kidney tissue obtained from leukaemic rats. We have demonstrated how this competitive inhibition system can be used to direct desired molecules (such as cytotoxic drugs) to these cells and to monitor the arrival of such compounds at the active site of guanidinobenzoatase. The principles developed in this study could equally well be applied to other enzymes on other cells provided suitable competitive inhibitors were designed. The presence of an enzyme on the surface of a cell can be used to direct molecules to that cell provided that these molecules contain a functional group that acts as an inhibitor for the chosen enzyme.

Is 2% hydroxypropylmethylcellulose a safe solution for intraoperative clinical applications?

We examined 2% hydroxypropylmethylcellulose prepared for clinical intraocular surgical procedures in various laboratories. Each sample contained a variety of particulate debris of botanical origin, although in varying amounts. The identified material was also seen in a sample of the raw material from which all the clinical material had been prepared. Our conclusion is that filtration methods, which are the physical methods used to purify the product, are at worst ineffective and at best inadequate. Until proper laboratory and clinical studies confirm an acceptable level of adverse reactions, we recommend that this material not be used clinically.

Tissue response to anodyne medicaments

The tissue-irritating effect of anodyne medicaments was studied via enzyme histochemical evaluation of muscle tissue (screening test) and pulp tissue (usage test). Of the medicaments tested, formocresol was the most irritating, followed by Cresatin, eugenol, and oil of pimenta leaf. The effects of Cresatin, eugenol, and oil of pimenta leaf were not statistically distinguishable.

Effectiveness of trabeculectomy in glaucoma

A follow-up study of 90 eyes in 60 patients subjected to trabeculectomy between 1967 and 1972 showed that intraocular pressure was controlled at the onset in 84% of the eyes, and eventually controlled in over 97%. Only 11% of the eyes required further medication and 5.5% further surgery. Subconjunctival drainage was established by means of a bleb in 91%. Trabeculectomy produced a high significant fall in intraocular pressure (P less than .001) and a parallel rise in aqueous outflow facility. The absolute fall in intraocular pressure was constant whether the preoperative pressure was high or low and whether or not the postoperative pressure remained above 20 mm Hg. This method was virtually free of major operative and postoperative complications when used appropriately; and it can be modified during the operation to deal with peripheral anterior synechiae. The anterior chamber remained formed or, if lost, was speedily re-formed. The anterior chamber rarely flattened postoperatively.