Use of a modified anterior inclined plane in the treatment on the dentoskeletal Class II division 2 patient

Class II malocclusions are seen due to the underdevelopment of the mandible in most of the cases. To compensate for the mandible retrusive position, there is flaring of the lower anterior teeth or retroclination of the central incisors as a compensatory mechanism seen in Class II division 2 type of malocclusion. This case report evaluates the skeletal and dental changes when a 12-year-old female patient with Class II div 2 malocclusion was treated with a modified anterior inclined plane. The postreatment data suggested that there were no significant changes in the vertical skeletal parameters. The upper central incisors were significantly realigned by proclination along with retroclination of the lateral incisors. There was significant increase in the mandibular length. The results revealed that the modified anterior inclined plane showed good results in the treatment of a case of Class II div 2 malocclusion.

Quality of life after accelerated partial breast irradiation in early breast cancer: matched pair analysis with protracted whole breast radiotherapy

AIMS

To compare the quality of life of women with early breast cancer treated with either accelerated partial breast irradiation (APBI) or whole breast radiotherapy (WBRT).

MATERIALS AND METHODS

After matching for the American Brachytherapy Society criteria, the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the breast cancer-specific BR23 modules were given to 48 women (23 APBI and 25 WBRT) who attended the radiotherapy clinic between May 2006 and December 2006 at Tata Memorial Hospital.

RESULTS

The median follow-up of patients in both groups was 3 years. The reliability and validity of the English and translated versions of the questionnaires were tested by Cronbach alpha (0.67-0.96) and Pearson's correlation for scale-scale correlation statistic (0.013-0.505). The scores for social functioning and financial difficulties in QLQ-C30 showed a trend towards a better outcome in the APBI group (P=0.025 and 0.019, respectively) and body image in BR23 was significantly better in the APBI group as compared with the WBRT group (P=0.005). When the analysis was restricted to women receiving chemotherapy in order to eliminate the confounding effect of the heterogeneous use of chemotherapy in the WBRT group, the difference in social functioning was not significant. However, financial difficulties and body image showed a trend towards a worse outcome in the WBRT group.

CONCLUSION

Favourable long-term results of APBI in terms of superior body image perception and lesser financial difficulties compared with WBRT need to be confirmed in larger prospective studies investigating the effect of APBI on quality of life and health economics in different ethnic groups and health care set-ups.

Results of liver resection in combination with radiofrequency ablation for hepatic malignancies

INTRODUCTION

Liver tumors should be surgically treated whenever possible. In the case of bilobar disease or coexisting liver cirrhosis, surgical options are limited. Radiofrequency ablation (RFA) has been successfully used for irresectable liver tumors. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with liver metastases and hepatocellular carcinoma (HCC).

PATIENTS AND METHODS

RFA was performed with two different monopolar devices using ultrasound guidance. Intraoperative use of RFA for the treatment of liver metastases or HCC was limited to otherwise irresectable tumors during open surgical procedures including hepatic resections. Irresectability was considered if bilobar disease was treated, the functional hepatic reserve was impaired or appraised marginal for allowing further resection.

RESULTS

Ten patients with both liver metastases and HCC, and two patients with cholangiocellular carcinoma were treated. Complete initial tumor clearance was achieved in all patients. Two patients of the metastases group and five patients of the HCC group suffered from local recurrence after a median of 12 months (1-26) (local recurrence rate 32%). Five patients of the metastases group and six patients of the HCC group developed recurrent tumors in different areas of the ablation site after a median time of 4 months (2-18) (distant intrahepatic recurrence in 55%). Survival at 31 months was 36%.

CONCLUSION

RFA extends the scope of surgery in some candidates with intraoperatively found irresectability.

Evaluation of caries experience in 3-6-year-old children, and dental attitudes amongst the caregivers in the Ludhiana city

Early Childhood Caries (ECC) is a lifestyle disease that begins when the child's teeth erupt in the oral cavity. The distinctive pattern of decay rapidly spreads from one tooth to another and involves the surfaces of teeth that are usually not at risk. Detection of disease is crucial to control the oral condition using preventive and therapeutic regimes. The aim of this study was to determine the prevalence of caries in children of age 3-6 years in Ludhiana and to examine the relationship between age and caries experience. A total of 609 children in the age group of 3-6 years were examined using def index. To determine dental care seeking attitude, 105 caregivers were interviewed. Results revealed that 52.87% of children in the age group of 3-3.11 years, 45.1% of children in the age group of 4-4.11 years and 58.55% of children in 5-5.11 age groups suffered from caries. The mean def index was 1.82, 1.57 and 2.21, respectively. Interview of caregivers of children revealed that out of 105 only 12 (11.4%) children had previously been to a general dentist. None of them knew about Pedodontics as a specialty. The results of the present study can be used mainly for screening child populations in need of treatment, helping public workers and planners to develop dental health programs to aid early intervention and prevention.

Role of intraventricular sodium nitroprusside in vasospasm secondary to aneurysmal subarachnoid haemorrhage: a 5-year prospective study with review of the literature

OBJECTIVE

Cerebral vasospasm remains an important cause of permanent neurological injury and death following aneurysmal subarachnoid haemorrhage, despite the best current medical therapy. Sodium nitroprusside was recently suggested as a treatment option for cerebral ischaemia in patients with severe medically refractive vasospasm after subarachnoid haemorrhage.

METHODS

Twenty patients of aneurysmal SAH with severe vasospasm, corroborated on transcranial Doppler (TCD), were included in this prospective study. The neurological condition of all patients was classified as Hess and Hunt grade II or higher. The diagnosis of severe delayed cerebral vasospasm refractory to conventional treatment (HHH therapy and nimodipine) was established before treatment. Ten patients received intraventricular sodium nitroprusside (SNP), while the other 10 had either major systemic illness or did not consent, formed the control group of the study. SNP was instilled in escalating doses with a starting dose of 4 mg/mL and reversal of vasospasm was monitored on neurological examination along with TCD in a basic ICU setting without the need for neurophysiological or invasive monitoring.

RESULTS

All patients in the study group showed an improvement in TCD velocities post-SNP instillation. Adverse effects were vomiting and hypotension in the SNP group which responded to medical management. The overall neurological outcome was good or excellent in 7/10 patients in the SNP group. Comparison between the two groups revealed improvement in TCD velocities and GCS in the SNP group thus affecting the long-term prognosis.

CONCLUSION

Intraventricular sodium nitroprusside represents a promising method of treatment for established delayed cerebral vasospasm and cerebral ischaemia refractory to conventional treatment.

Selective cervical nerve root blockade: prospective study of immediate and longer term complications

BACKGROUND AND PURPOSE

Selective cervical nerve root blockade (SCNRB) is a useful procedure for evaluating and treating patients with cervical radiculopathy. Reports of complications related to injections within the cervical nerve root foramen have raised serious doubts regarding the safety of this procedure. This study was performed to prospectively evaluate the safety of fluoroscopically guided outpatient diagnostic and therapeutic SCNRB.

MATERIALS AND METHODS

Eight hundred two consecutive fluoroscopically guided diagnostic and/or therapeutic SCNRBs in 659 patients were performed during a 14-month period (November 2006-December 2007) at affiliated outpatient imaging centers. Each examination was performed by 1 of 8 experienced procedural radiologists by using an anterior oblique approach, with the needle position confirmed with radiographic contrast before injection of an admixture of local anesthetic and steroid. All patients were assessed immediately and at 30 minutes following the procedure. Additionally, 460 patients were called by telephone 30 days following the procedure. All complications were recorded.

RESULTS

Of the 802 attempted procedures, 799 were successfully completed. Three procedures were aborted due to anxiety, challenging body habitus, or persistent venous opacification observed during contrast injection and despite needle repositioning. There were no serious complications, such as stroke, spinal cord insult, permanent nerve root deficit, infection, or significant hematoma. There were 33 minor complications occurring within 30 minutes of the procedure; the most common was vasovagal symptoms. Three hundred forty-five patients were successfully contacted by telephone at 30 days postinjection, 9 of whom reported increased or new pain symptoms.

CONCLUSIONS

With our technique, fluoroscopically guided SCNRB is a safe outpatient procedure with a low immediate and delayed complication rate.

Syndromes associated with labiopalatine clefting: a report of three cases

Clefts of the lip and palate are a common craniofacial anomaly, The etiology is thought to be multifactorial, with both genetic and environmental factors playing a role. Because of the frequent manifestation of cleft lip and palate in association with some syndromes, it is essential that a detailed examination of these patients be carried out. This facilitates early formulation of preventive and treatment advice and aids in overcoming gross deformities in the early stages of development. In this paper, we review three such patients who presented with cleft lip and palate in association with a syndrome.

Intestinal toxicity of non-steroidal anti-inflammatory drugs with differential cyclooxygenase inhibition selectivity

The present study was designed to investigate the gastrointestinal side effects of cycloxygenase (COX) inhibitor with varying selectivity, called the non-steroidal antiinflammatory drugs (NSAIDs) viz., non-selective COX-1 & 2 inhibitor--aspirin, prefentially selective COX-2 inhibitor--nimesulide and highly selective COX-2 inhibitor-celecoxib. Treatment with NSAIDs exhibited a decrease in the activity of rat intestinal brush border membrane associated enzymes such as sucrase, lactase, maltase and alkaline phosphatase as compared to the control in the duodenum, jejunum and ileum. The uptake of D-glucose and L-histidine in the everted intestinal sac was found to be decreased. Also the decease of glucose and histidine uptake was found to be dependent on the substrate concentration, temperature and the time interval of incubation. The physical state and composition of brush border membrane was found to be altered as evident in the FTIR spectrum, by appearance of new peaks while disappearance of certain peaks occurred which were characteristics of the control membrane. The changes in wave number as well as peaks height were also noticed. Alterations in protein profile of the membrane were demonstrated using SDS-PAGE analysis where disappearance of few bands and change in the relative intensities of the bands were noticed and correlated with the alterations that have taken place at the molecular level. Histological studies have depicted a marked decrease in the absorption surface area such as the villi height of the intestinal segment. In addition, crypt number also deceased in the treated animals, an indication that such changes also correlate well with the changes in the transport of the end product nutrients.

Huge placental myxoid chorangioma presenting with severe antepartum hemorrhage

A 2nd gravida presented at 27 weeks with antepartum hemorrhage. Ultrasound showed a single live fetus (parameters approximately 23 weeks) and a huge placenta with multiple cystic areas extending into the lower uterine segment; some of which showed increased vascularity on colored doppler. A diagnosis of low lying placenta with a possibility of chorangioma or a partial mole was made. The next bout of antepartum hemorrhage was severe necessitating an emergency cesarean. Histopathology of the placenta (weighing 2240 grams) revealed a myxoid chorangioma. All features in this woman are uncommonly reported in literature (large size, myxoid degeneration and severe antepartum hemorrhage necessitating a cesarean).

Breast movement during normal and deep breathing, respiratory training and set up errors: implications for external beam partial breast irradiation

This study was designed to evaluate interfraction and intrafraction breast movement and to study the effect of respiratory training on respiratory indices. Five patients were immobilized in supine position in a vacuum bag and three-dimensional set up errors, respiratory movement of the breast during normal and deep breathing, tidal volume and breath hold time were recorded. All patients underwent respiratory training and all the respiratory indices were re-evaluated at the end of training. Cumulative maximum movement error (CMME) was calculated by adding directional maximum set up error and maximum post training movement during normal breathing. The mean set up deviation was 1.3 mm (SD +/- 0.5 mm), 1.3 mm (SD +/- 0.3 mm) and 4.4 mm (SD +/- 2.6 mm) in the mediolateral, superoinferior and anteroposterior dimensions. Pre-training mean of the maximum marker movement during normal breathing was 1.07 mm, 1.94 mm and 1.86 mm in the mediolateral, superoinferior and anteroposterior dimensions. During deep breathing these values were 2 mm, 5.5 mm and 4.8 mm. While respiratory training had negligible effect on breast movement during normal breathing, it resulted in a modest reduction during deep breathing (p = 0.2). The mean CMME recorded for these patients was 3.4 mm, 4.5 mm and 7.1 mm in the mediolateral, superoinferior and anteroposterior dimension. Respiratory training also resulted in an increase in breath hold time from a mean of 31 s to 44 s (p = 0.04) and tidal volume from a mean of 560 cm(3) to 1160 cm(3) (p = 0.04). With patients immobilized in the vacuum bag the CMMEs are relatively less. Individualized directional margins may aid in reduction of planning target volume (PTV).

Killed Mycobacterium vaccae suspension in children with moderate-to-severe atopic dermatitis: a randomized, double-blind, placebo-controlled trial

BACKGROUND

The hygiene hypothesis is often proposed to explain the high prevalence of atopy in the western world. Dysregulation of the immune system may result from inadequate exposure to micro-organisms such as mycobacteria. A small trial suggested that a killed extract of Mycobacterium vaccae ameliorates atopic dermatitis (AD).

OBJECTIVES

To confirm in a large clinical trial whether killed M. vaccae ameliorates AD in 5-16-year-old children.

METHODS

This was a randomized, placebo-controlled, double-blind, multi-centre study of the effect of intradermal injection of killed M. vaccae (0.1 or 1 mg) on patients, aged 5-16, with moderate-to-severe AD. Patients were followed up for 24 weeks. The primary end point was the change in severity of AD at 12 weeks, assessed using the six area, six-sign, atopic dermatitis (SASSAD) score. Secondary end points included changes in disease extent, patient's global assessment and children's dermatology life quality index.

RESULTS

There were 166 patients randomized. The mean SASSAD score fell to a similar degree at week 12 in all treatment arms: from 33 to 24, (26%) in the high-dose group, from 30 to 23 (25%) in the low-dose group and from 36 to 27 (24%) in the placebo group (P>0.05). Secondary end points followed the same trend. Adverse events were generally those expected to occur in this population. Injection site reactions occurred in 32 patients at week 4.

CONCLUSIONS

M. vaccae was no more effective than the placebo in ameliorating the severity of AD.