Comparison of Man Hours Utilized for Mandibluar Overdenture Treatment Retained by Single Implant with Bar Fabricated by CAD-CAM Process and Conventional Casting Processs - An Vivo Study

Introduction

Both the population's average life expectancy and the number of patients without teeth are rising. A 2012 epidemiological survey in India found that 30% of the population is edentulous. The rehabilitation process with a set of removable maxillary and mandibular complete dentures is the standard treatment for patients who are edentulous. This study is the first to incorporate and compare a novel approach to a single implant-retained mandibular overdenture with a bar attachment fabricated by CAD-CAM and a casting process on a single implant in the symphysis region.

Method

Five maxillary and mandibular completely edentulous patients were enrolled in the study.

Results

Significant difference was seen in the conventional laboratory time and CAD-CAM time as P < 0.05.

Conclusion

Compared to the conventional casting process, the single implant-supported bar mandibular overdenture (SISBOD) with a novel bar required fewer man hours and was more convenient.

Comparison and Evaluation of Fracture Toughness of Milled, 3D-Printed, and Conventional Polymethyl Methacrylate: An In Vitro Study

Introduction

Dentures aim to replicate natural dentition's esthetics and functions as much as possible. With computer-aided design/computer-aided manufacturing (CAD/CAM) technology, dentistry had a new renaissance with workflow and materials.

Aim

The aim is to compare the fracture toughness of the milled, 3D-printed, and conventional polymethyl methacrylate (PMMA) to those processed conventionally.

Materials and Methods

10 CAD MILLED PMMA BLOCKS, 10 3D PRINTED PMMA BLOCKS, and 10 CONVENTIONAL (HEAT CURE) PMMA BLOCKS.

Results

A significant difference was seen in the mean flexural module when compared among three study groups as P < 0.05. It was found to be maximum in CAD/CAM PMMA, followed by conventional heat cure and 3D-printed PMMA.

Conclusion

Formlabs and Dentca (3D-printed) were significantly weaker in fracture toughness compared to Leucitone 199 (conventional) (P < 0.05). Leucitone 199 (conventional) was significantly weaker in fracture toughness compared to Avadent (CAD CAM) (P < 0.05).

Congenital Tuberculosis in a Neonate: A Diagnostic Dilemma

Though tuberculosis (TB) among pregnant women is not unusual in our country, documented cases of congenital tuberculosis are rare. Diagnosis is often difficult as signs and symptoms in a neonate are non- specific. Maternal history of tuberculosis is often missed, as many of them are asymptomatic. Here we present a neonate who was operated in view of intestinal obstruction which intra operatively showed disseminated abdominal tuberculosis with infected ascites.

Hereditary Multiple Gastrointestinal Atresia associated with Choledochal Cyst: A Rare Entity with Management Dilemma

Multiple intestinal atresias are rare and its treatment is challenging. Here, we present a case of multiple gastrointestinal atresia associated with choledochal cyst posing us a surgical challenge.

Perils of Total Colonic Aganglionosis Presenting in Neonatal Age

Background: The purpose of this study is to review the cases of total colonic aganglionosis seen in the span of ten years at a pediatric surgery unit of a tertiary care public hospital in New Delhi.Methods: Medical records of eleven patients with total colonic aganglionosis were retrieved.Results: Ten out of the twelve patients were males; seven were of the Muslim community. Average recorded birth weight was 2.2 kg. Ten patients presented with features of intestinal obstruction, while two presented with perforation peritonitis. Among the cases of obstruction, Hirschsprung's disease was suspected in eight cases (one was associated with Shah-Waardenburg syndrome), one case each was preoperatively diagnosed as ileal atresia and meconium ileus. Abdominal X-rays at presentation of all the neonates except in one with Shah-Waardenburg syndrome showed multiple air fluid levels. Contrast enema was done in five patients. It showed micro-colon in two patients, and typical question mark sign, dilated small bowel with transition zone in hepatic flexure and normal caliber colon in one each. All the patients underwent exploratory laparotomy. Intra-operatively, the transition zone was seen at distal ileum in ten cases and at hepatic flexure and transverse colon in one each. Biopsies of all the twelve patients eventually showed absence of ganglion cells in entire colon. Ileostomy was done in nine cases, colostomy in two and primary Kimura's procedure in one (this patient was discharged and lost to follow up). Left colonic patch with Swenson’s pull through with ileostomy was done for one patient on colostomy. His stoma was closed; he was eventually discharged and lost to follow up. In the other patient with colostomy, the stoma was closed and an ileostomy was created. Of all the patients on ileostomy, three expired in the immediate postoperative period. Four were lost to follow up. Two underwent Kimura's procedure; and expired few months later. One patient on ileostomy is awaiting further treatment.Conclusion: Management of total colonic aganglionosis is still in its infancy in the developing world. There is a lot of scope for improvement in the management. There is a need to have a stringent follow up of patients in order to know the long-term outcomes of the disease.

Protective effect of embelin against acetic acid induced ulcerative colitis in rats

The aim of the present study is to evaluate the effect of embelin isolated from Embelia ribes on acetic acid induced colitis in rats. Experimental animals received embelin (25 and 50 mg/kg, p.o.) and sulfasalazine (100mg/kg, p.o.) for five consecutive days before induction of colitis by intra-rectal acetic acid (3% v/v) administration and the treatment continued up to 7 days. The colonic mucosal injury was assessed by clinical, macroscopic, biochemical and histopathological examinations. Embelin treatment significantly decreased clinical activity score, gross lesion score, percent affected area and wet colon weight when compared to acetic acid induced controls. The treatment also reduced significantly the colonic myeloperoxidase activity, lipid peroxides and serum lactate dehydrogenase and significantly increased the reduced glutathione. The histopathological studies also confirmed the foregoing findings. The protective effect may be due to its antioxidant and anti-inflammatory activities.

Application of radiofrequency treatment in practical pain management: state of the art

Many therapeutic interventions for chronic pain are available, and decisions about optimal management are not easy to make. Radiofrequency (RF) treatment is classified as a percutaneous minimal invasive procedure for patients who do not respond to appropriate medical and physical therapy. Although RF treatment is widely used differences in current practice exist due to ongoing controversies.

Role of skeletal scintigraphy in advanced retinoblastomas

PURPOSE

To document the incidence of skeletal metastases exclusively in advanced cases of retinoblastoma and to rationalize the use of preoperative skeletal scintigraphy in such patients.

MATERIAL AND METHODS

Preoperative bone scans of 36 consecutive patients with advanced retinoblastoma who underwent skeletal scintigraphy during 1998 to 2003 were analyzed retrospectively. Bone scans were classified as: Grade 1 (high probability scan for skeletal metastases), Grade 2 (equivocal malignant or benign abnormalities), or Grade 3 (normal or certainly benign lesions).

RESULTS

Grade 1 scan was found in 3 (8.33%) patients; bone metastases were confirmed by additional investigations. Grade 2 scan was found in 5 (13.88%) patients; bone metastases were excluded in all by additional investigations. Grade 3 scan was found in the remaining 28 (77.77%) patients. Extraorbital extension of disease was demonstrated by fine needle aspiration of lymph nodes in five patients, which included all three patients with Grade 1 scan. In addition to lymph node metastases, two patients had intracranial extension of the disease; demonstrated by contrast-enhanced magnetic resonance imaging of the head. One patient had liver metastases detected on abdominal ultrasound. None of the patients had skeletal metastases only.

CONCLUSION

Routine preoperative bone scan is not justified in patients with locally advanced retinoblastoma. Bone scan should only be performed in patients with documented extraocular metastatic disease.

Bilateral cortical blindness: an unusual complication following unilateral neck dissection

We present the case of a 50-year-old man who developed bilateral cortical blindness and confusion following a seemingly uneventful right-sided radical neck dissection. Computed tomography (CT) scans confirmed bilateral occipital lobe infarctions. To our knowledge, there are no previously documented reports of this clinical event following head and neck surgical procedures. Although this is a rare occurrence, otolaryngologists should be aware of this potential post-operative complication. The possible aetiologies of this condition are discussed.

Subdural Blood Patch for the Treatment of Persistent CSF Leak After Permanent Intrathecal Catheter Implantation: A Report of Two Cases

A CSF leak that persists despite conservative therapy may significantly increase the morbidity associated with implantable intrathecal drug delivery systems. This report presents 2 cases where the application of a subdural blood patch led to the satisfactory resolution of a persistent CSF leak after previous epidural blood patches had failed.

Laparoscopic cholecystectomy in patients with early cirrhosis

Traditionally, cholecystectomy in cirrhotic patients has been reserved for patients with severe biliary disease, because of the high morbidity and mortality in cirrhotic patients undergoing this procedure. Laparoscopic cholecytectomy (LC) was originally contraindicated in cirrhotic patients because of the associated portal hypertension and coagulopathy. This study examined the safety of LC in Child's class A patients.A review was conducted of all patients with cirrhosis who underwent cholecystectomy at our hospital between 1990 and 1998.Fifteen patients with cirrhosis had their gallbladder removed laparoscopically during that time period. All patients were Child's class A. The average age was 59 (range, 36-85). The operative indications included acute cholecystitis (5 patients), biliary pacreatitis (4 patients), biliary colic (5 patients), and cholangitis (1 patients). Six patients had known cirrhosis, and 9 were examined intraoperatively. The average operative time was 105 minutes. None of the patients required a blood transfusion. No intraoperative or postoperative complications occurred. No deaths occurred. Postoperative stay was 3 days or less in all but 3 patients.These results compare favorably to other published studies from outside of the United States. Based on our findings, we believe LC can be performed safely in patients with class A cirrhosis.

Minimising radiation dose to the lens in axial computed tomography of the temporal

In this study, 25 randomly selected CT scans of temporal bones performed in a busy radiology department were retrospectively analysed with particular attention paid to the number of sections passing through the orbits. Thirteen examinations were found to include sections through the eyes, thereby resulting in unnecessary radiation to the lens. The importance of proper scanning technique is therefore emphasised. The mean radiation dose to the eyes in axial CT examination of the temporal bones was determined by the use of thermoluminescent dosimeters taped to the eyelids. The authors concluded that appropriate scanning techniques can reduce the radiation dose to the orbit whilst imaging the temporal bone. All the relevant information can usually be obtained without any of the sections passing through the lens. The radiation dose to the lens was increased when additional sections were performed to obtain information about the jugular fossa.

De novo laryngeal carcinoma in childhood

Numerous factors contribute towards a late diagnosis of laryngeal malignancy in childhood. These include its rarity, the similarity of its early symptoms to those of other benign, common childhood conditions as well as the relative difficulty encountered during paediatric laryngeal examination. We believe that these cases are of sufficient interest when they occur to warrant reporting since the consequences of late diagnosis in these young patients can be serious. We present a case of an 11-year-old boy with advanced squamous cell carcinoma of the larynx (T3N0M0), who was successfully treated with primary total laryngectomy and bilateral selective neck dissections to avoid the potential additional morbidity of radical radiotherapy.

A prospective study of nasal disease in adult cystic fibrosis

Twenty-six adult cystic fibrosis patients were studied to compare nasal disease with their laboratory correlates including skin testing, immunoglobulin and Aspergillus fumigatus precipitin levels, saccharin testing and sputum cultures. Six patients were asymptomatic and all of these had negative skin tests, normal IgE levels and negative Aspergillus fumigatus precipitins. Thirteen patients had rhinitis, 12 had positive skin-testing for common allergens, 10 elevated IgE levels and nine positive Aspergillus fumigatus precipitins. Seven patients had polyps, all had normal IgE levels and negative Aspergillus fumigatus precipitins, six had positive skin testing for common allergens. There also appeared to be a relationship between Pseudomonas spp. colonization and positive skin testing.

Primary leiomyoma of the liver

This case report describes a primary hepatic leiomyoma presenting as a mass lesion detected on ultrasonography of the abdomen in an asymptomatic hepatitis B carrier on routine surveillance. Primary leiomyomata of the liver are rare occurrences, with only 9 cases reported in the literature. The presenting features of primary hepatic leiomyomata and diagnostic approach towards such lesions are discussed. The significance of such tumours in the immunocompromised is also mentioned.

Nasal non-Hodgkin's lymphoma causing mucocele of the maxillary antrum

The authors report a case of an antral mucocele secondary to obstruction of the antral ostium by a non-Hodgkin's lymphoma. Antral mucoceles are rare, and this is the first report of one such caused by a nasal lymphoma.

Nasal haemophilic pseudotumour

Haemophilic pseudotumour or haemophilic cyst is a rare complication of haemophilia, occurring in one to two per cent of individuals with a severe factor VIII or IX deficiency. We report a case of a haemophilic pseudotumour in a hitherto unreported site, the bony nasal pyramid, and believe this case is also unique on account of it having occurred in a patient with mild haemophilia. The diagnosis and treatment of this rare condition is also reviewed.

Percutaneous epidural neuroplasty: prospective evaluation of 0.9% NaCl versus 10% NaCl with or without hyaluronidase

BACKGROUND AND OBJECTIVES

Percutaneous epidural neuroplasty (epidural neurolysis, lysis of epidural adhesions) is an interventional pain management technique that has emerged over approximately the last 10 years as part of a multidisciplinary approach to treating radiculopathy with low back pain. In addition to local anesthetic and corticosteroid, hypertonic saline (10% NaCl) and hyaluronidase are used for the technique. The objective of this study was to determine if hypertonic saline or hyaluronidase influenced treatment outcomes.

METHODS

Eighty-three subjects with radiculopathy plus low back pain were assigned to one of four epidural neuroplasty treatment groups: (a) hypertonic saline plus hyaluronidase, (b) hypertonic saline, (b) isotonic saline (0.9% NaCl), or (d) isotonic saline plus hyaluronidase. Subjects in all treatment groups received epidural corticosteroid and local anesthetic.

RESULTS

Twenty-four subjects did not complete the study. Most of the other 59 subjects receiving any of the four treatments as part of their pain management obtained significant relief immediately after treatment. Visual analog scale (VAS) scores for the area of maximal pain (VASmax; back or leg) were reduced in 25% or more of subjects in all treatment groups at all post-treatment follow-up times (1, 3, 6, 9, and 12 months). A smaller fraction of subjects treated with hypertonic saline or hyaluronidase and hypertonic saline required more additional treatments than did subjects receiving the other treatments.

CONCLUSIONS

Percutaneous epidural neuroplasty, as part of an overall pain management strategy, reduces pain (sometimes for over one year) in 25% or more of subjects with radiculopathy plus low back pain refractory to conventional therapies. The use of hypertonic saline may reduce the number of patients that require additional treatments.

Complex Regional Pain Syndromes: guidelines for therapy

This report aims to present an orderly approach to the treatment of Chronic Regional Pain Syndrome (CRPS) types I and II through an algorithm. The central theme is functional restoration: a coordinated but progressive approach that introduces each of the treatment modalities needed to achieve both remission and rehabilitation. Reaching objective and measurable rehabilitation goals is an essential element. Specific exercise therapy to reestablish function after musculoskeletal injury is central to this functional restoration. Its application to CRPS is more contingent on varying rates of progress that characterize the restoration of function in patients with CRPS. Also, the various modalities that may be used, including analgesia by pharmacologic means or regional anesthesia or the use of neuromodulation, behavioral management, and the qualitatively different approaches that are unique to the management of children with CRPS, are provided only to facilitate functional improvement in a stepwise but methodical manner. Patients with CRPS need an individual approach that requires extreme flexibility. This distinguishes the management of these conditions from other well-described medical conditions having a known pathophysiology. In particular, the special biopsychosocial factors that are critical to achieving a successful outcome are emphasized. This algorithm is a departure from the contemporary heterogeneous approach to treatment of patients with CRPS. The underlying principles are motivation, mobilization, and desensitization facilitated by the relief of pain and the use of pharmacologic and interventional procedures to treat specific signs and symptoms. Self-management techniques are emphasized, and functional rehabilitation is the key to the success of this algorithm.

Successful treatment of rhinocerebral mucormycosis by a combination of aggressive surgical debridement and the use of systemic liposomal amphotericin B and local therapy with nebulized amphotericin--a case report

A case of mucormycosis involving the nose and paranasal sinuses in a 55-year-old man with recently diagnosed acute promyelocytic leukaemia is reported. It was successfully treated with a combination of aggressive surgical debridement and systemic amphotericin B. In addition, local nebulized amphotericin B was used as an adjunct to therapy. We believe this is only the second documented use of nebulized amphotericin in the management of sinonasal mucormycosis. The need for a high index of suspicion and early aggressive management is emphasized.

Microwave fixation of rabies specimens for fluorescent antibody testing

An adaptation of the conventional procedure for fixation of brain impressions prior to rabies testing was developed using a microwave oven to fix slides in less than 1 min. A total of 2394 routine specimens were examined to evaluate the efficacy of microwave fixation of brain impressions as an aid to shortening the turnaround time for reporting. Slides were fixed for 55-60 s in a standard household microwave oven at 50%, power using phosphate buffered saline supplemented with 3% Tween 20 as a fixative medium. They were then stained using the standard rabies immunofluorescent staining procedure with minor modifications. This process potentially could allow results to be reported to submitters within 1.5 h after specimens arrive in the laboratory. Microwave fixation was in complete agreement with conventional acetone fixation for detection of positive rabies specimens.

Molecular diagnosis of infectious diseases

The Polymerase Chain Reaction (PCR) is a revolutionary new means of amplifying, i.e., replicating, selected DNA sequences in vitro. This procedure is highly sensitive and rapid, requiring few hours for detection of amplified target DNA whereas it often takes several weeks for the identification of many fastidious organisms by culture. Studies have shown that as few as one microorganism can be detected by PCR. Therefore, it is revolutionizing our ability in the diagnosis of infectious diseases. Currently, this technique is very expensive and complex which will probably restrict its immediate role for diagnosing infections where the causative organism is impossible to culture or untypeable by conventional means. As further progress occurs, however, this powerful technique will be applied as a major new tool to diagnose infections and to the study of individual genome variations.

Laparoscopic management of appendiceal intussusception associated with villous adenocarcinoma

The authors present a case of appendiceal intussusception, a rare finding that can be associated with appendiceal neoplasms. A 74-year-old woman with right lower quadrant abdominal pain was found to have an appendiceal intussusception associated with a villous adenocarcinoma and was managed with a laparoscopic assisted right hemicolectomy. This case is presented along with a review of the symptoms, diagnosis, classification, and appropriate management of this entity via laparoscopy.

Cystic duct stabilization during laparoscopic exploration and stone removal

A modification of the standard method for cystic duct stabilization is presented. A percutaneously placed suture is used to loop and stabilize the cystic duct. The suture is secured outside the abdominal wall at the skin level using a clamp. Percutaneous suture stabilization of the cystic duct provides an alternative method of common bile duct stabilization when laparoscopic choledochotomy is required. By using this method, we can easily stabilize the cystic duct without the need for additional trocars and simplify the use of the choledochoscope.

Synthesis and biological studies on some organo-tin and lead halo and mixed halo-pseudohalo anionic complexes

Some new anionic complexes of organo-tin(IV) and lead (IV) isolated in combination of tetraorgano-ammonium phosphonium and stibonium cation(s). L[R4-nMXnY] and L2[R2MX2Y2], where R = C2H5, C4H9 or C6H5; M = Sn or Pb; X = Y = Cl = Br, I, N3, NCS; n = 1, 2 and L = R4M1 (M1 = N, P, Sb), whose structures were confirmed by correct elemental analyses, molar conductance values, van't Hoff factor and IR spectral studies, were synthesized and evaluated for anti-convulsant activity in vivo and antiviral and antibacterial activity in vitro. A few of them exhibited promising activity. In addition, the toxicity (ALD50) and effects on the central nervous system of these complexes have been studied in mice.

Characterization of serum antibody responses to natural rotavirus infections in children by VP7-specific epitope-blocking assays

Knowledge of the immune response to rotavirus is crucial for vaccine development. We compared an epitope-blocking assay (EBA) that uses VP7-specific monoclonal antibodies with neutralization assays (NAs) with polyclonal antisera for detecting serum antibody responses after natural rotavirus infection in children. Twenty-six serum pairs from children living in an orphanage with and without symptoms during two rotavirus outbreaks were evaluated for VP7 type 1-, 2-, 3-, and 4-specific antibody responses. In the first outbreak, which was caused by a VP7 type 3 strain, homotypic antibody responses were detected in 11 of 11 symptomatic children by NA and in 10 of 11 symptomatic children by EBA. Heterotypic antibody responses were detected more frequently (12 of 15 children) by NA than by EBA, and the heterotypic epitope-blocking antibody responses occurred in children older than 14 months of age. Antibody responses in asymptomatic children were more commonly detected by EBA than by NA. EBA results from the sera of children in the second outbreak indicated that it was caused by VP7 type 4, whereas NA results suggested it was caused by VP7 type 3. Our results confirm that EBA is a sensitive and specific method for determining VP7 type-specific immune responses after natural rotavirus infections.

Comparisons of rotavirus VP7-typing monoclonal antibodies by competition binding assay

Three sets of neutralizing monoclonal antibodies (MAbs) used to type the outer capsid protein VP7 of four group A rotavirus serotypes (1 through 4) were compared in competition immunoassays. Reciprocal competition was observed for each of the VP7 type 2-, 3-, and 4-specific MAbs. The VP7 type 1 MAbs exhibited variable competition patterns with other VP7 type 1 MAbs. MAb RV4:3, which has been used to recognize antigenic variants within VP7 type 1 strains, showed reciprocal competition with the four VP7 type 3 MAbs (RV3:1, YO-1E2, 4F8, and 159) using a VP7 type 3 virus (SA11) as antigen. MAb 2C9, also prepared against VP7 type 1, reacted with VP7 type 3 strains and competed with a VP7 type 3 MAb, 159, using RRV as antigen. Use of the different sets of VP7 type-specific MAbs in the enzyme-linked immunosorbent assay permitted the recognition of six antigenic variants within VP7 types 1, 2, and 3 among specimens whose VP7 type could not be determined previously with only one set of typing MAbs. These results demonstrate differences of typing ability among these VP7-specific MAbs and emphasize the need to improve the sensitivity of typing systems by incorporating panels of MAbs reacting with several neutralizing epitopes.

Rotavirus-specific antibody response in saliva of infants with rotavirus diarrhea

The reliability of saliva as an indicator of rotavirus infection was assessed among 15 infants (3-12 months) with rotaviral and 15 with nonrotaviral diarrhea. Paired salivary samples collected during acute and convalescent phases were tested for rotavirus-specific IgA and IgM by an ELISA. The sensitivity of IgA or IgM alone to predict infection was 53.3% and 46.6%, respectively; used in conjunction, the sensitivity rose to 80%. It seems that infants with rotaviral diarrhea mount mucosal antibody responses as reflected in their saliva; possibly salivary antibodies could be used to evaluate vaccine "take" in rotavirus vaccine trials.

Human enterocyte adhesion of enteroadherent Escherichia coli

Esch. coli strains manifesting localised (17), diffuse (8) or aggregative (17) phenotypes of adherence to HEp-2 cells were tested for their ability to adhere to human enterocytes isolated from duodenal biopsies of adult volunteers to obtain further evidence of their enteropathogenecity. Esch. coli strains H10407+; CFAI+ and LT+ STp+ STh+, F 294 B; a localised adherent strain positive with entero-adherent factor probe reported previously to attach to small intestinal enterocytes and F 582 C; LT- STp+ STh+ were the positive controls: H10407P (CFAI- mutant of H10407+) and K12 served as negative control strains. Adherence of variable degree was seen with 35.3 per cent of enteroaggregative Esch. coli (EAggEc) and with 58.8 per cent of enteroadherent Esch. coli localised (EAEC-L); EAEC-diffuse (EAEC-D) did not adhere to the human enterocytes. The possibility that EAgg EC and diffuse phenotypes may adhere better to lower small intestine or the large intestine, needs to be investigated.