Gender difference in tooth autotransplantation with complete root formation: a retrospective survey

Gender-related risk factors in the survival of transplanted teeth with complete root formation have not yet been identified. The purpose of this study was to investigate gender differences in tooth autotransplantation at dental clinics. We asked participating dentists to provide information on transplantations they had undertaken from 1 January 1990 to 1931 December 2010. The data were screened to exclude patients who underwent more than one transplantation, smokers or those whose smoking habits were unknown, patients under 30 or who were 70 years old and over, cases where the transplanted teeth had incomplete root formation or multiple roots and those with fewer than 20 present teeth post-operation. We analysed 73 teeth of 73 males (mean age, 47.2 years) and 106 teeth of 106 females (mean age, 45.3 years) in this study. The cumulative survival rate and mean survival time were calculated using the Kaplan-Meier method. The cumulative survival rate for males was 88.3% at the 5-year mark, 64.8% at 10 years and 48.6% at 15 years; for females, it was 97.2% at the 5-year mark, 85.9% at 10 years and 85.9% at 15 years. A log-rank test indicated the difference between males and females to be significant (P = 0.011). There was also a significant difference in the main causes for the loss of transplanted teeth: males lost more transplanted teeth due to attachment loss than females (P < 0.05). These results indicate that males require more attention during the autotransplantation process, particularly at the stage of pre-operation evaluation and that of follow-up maintenance.

Risk factors affecting third molar autotransplantation in males: a retrospective survey in dental clinics

The aim of this study was to investigate the risk factors affecting long-term prognosis of autotransplantation of third molars with complete root formation in males at dental clinics. Participating dentists were requested to provide information on transplantations they had undertaken from 1 January 1990 to 31 December 2010. Data on a total of 708 teeth from 637 patients were collected. After data screening and elimination, participants of this study consisted of 183 teeth of 171 males ranging from 20 to 72 years of age (mean age, 44·8 years). The cumulative survival rate was 86·0% at the 5-year mark, 59·1% at 10 years and 28·0% at 15 years. The mean survival time was 134·5 months, as calculated by the Kaplan-Meier method. Single factor analysis using the log-rank test showed that the following factors had significant influence (P < 0·05) on survival of transplanted teeth: periodontal disease as the reason for recipient site tooth extraction, fewer than 25 present teeth and Eichner index Groups B1 to C. Cox regression analysis examined five factors: age, smoking habit, recipient site extraction caused by periodontal disease, fewer than 25 present teeth and Eichner index. This analysis showed that two of these factors were significant: fewer than 25 present teeth was 2·63 (95% CI, 1·03-6·69) and recipient site extraction caused by periodontal disease was 3·80 (95% CI, 1·61-9·01). The results of this study suggest that long-term survival of transplanted teeth in males is influenced not only by oral bacterium but also by occlusal status.

Long-term site-related differences in the progression and regression of the idiopathic mitral valve prolapse syndrome

The natural history of uncomplicated mitral valve prolapse (MVP) is not clearly understood. To determine the site-related differences in regression and progression of MVP, 112 patients with idiopathic MVP were enrolled in this echocardiographic follow-up study. Cardiovascular complications, including dysarrhythmias (n = 3, 2.7%), overt congestive heart failure (n = 4, 3.6%), progression of mitral regurgitation over one grade (n = 28, 25.0%), newly confirmed chordal rupture (n = 1, 0.9%), and surgical repair (n = 2, 1.8%), were observed in these patients during a follow-up period of 1-13 years (mean, 4.0 +/- 2.8 years). Multivariate analysis and Kaplan-Meier analysis revealed that posterior leaflet prolapse and significant mitral regurgitation (grade >/=2) were considerable risks for cardiovascular complications. Regression of MVP was seen in 17 (18.7%) of the anterior prolapse patients; however, new prolapse was observed in 40 (35.7%) patients, mainly in posterior prolapse patients. These results suggest that site-related differences exist in uncomplicated MVP prognosis and that MVP in the posterior leaflet has a poor outcome compared to that in the anterior leaflet.

[A case of intra-ventricular dissociation with dual ventricular tachycardia]

A 63 year old woman with chronic heart failure was admitted to our hospital for palpitation attack on 26th Apr 1988. The patient was died by cardiogenic shock and recurrent ventricular fibrillation 12-hours after admission. The autopsy revealed diffuse myocardial fibrosis and disarray which was compatible with dilated cardiomyopathy. The electrocardiogram on admission showed a peculiar wide QRS tachycardia with atrioventricular dissociation. After intravenous injection of 400 mg of procainamide, the QRS was separated into two types. The one type was left bundle branch block (LBBB) type with right axis deviation (type A), which was similar as that documented on Jan 1985, and the other was LBBB with normal axis (type B). Each wide QRS tachycardias were sustained independently and simultaneously either with RR 440 msec. or with RR 600 msec as if they were dissociated intraventricularly. The different wide QRS tachycardia documented on Feb 1986 was suspected as the fusion beats with type A and the QRS resembling type B. Although ventricular tachycardia with beat-to-beat changes of QRS morphology was generally regarded as bidirectional tachycardia, double foci were considered as origins of the two types of wide QRS tachycardia simultaneously observed in this patient.

[A case of WPW syndrome with slow Kent documented by ATP injection]

A 46-year-old woman with chest tightness and palpitation at exercise was admitted to Sapporo Medical College Hospital for the evaluation of the ST-T changes on stress electrocardiogram. In this patient, PQ time was 0.14 second and pre-exitation was not clearly documented on electrocardiogram at rest. Bolus injection of 10 mg of adenosine-5'-triphosphate (ATP) demonstrated deltawave through the elongation of antegrade conduction of atrio-ventricular (AV) node. Electrophysiological study also showed left lateral accessory pathway with slow antegrade conduction, slow Kent. Stress 201-T1 myocardial scintigraphy using bicycle ergometer did not show the existence of ischemic region in spite of the ST-T changes on electrocardiogram. In this case, it seemed that a false positive ST-T changes might be caused by ventricular pre-exitation through slow Kent fiber. From these findings, it was suggested that the transient interruption on conduction through AV node by ATP bolus injection may be a useful diagnostic method in borderline pre-exitation syndrome.

[The systolic slipping mechanism of the anterior mitral leaflet in patients with the straight back syndrome]

The systolic slipping mechanism of the anterior mitral leaflet in patients with the straight back syndrome (SBS) was evaluated by two-dimensional echocardiography in 16 SBS patients and 11 normal subjects. Doppler echocardiography was performed in all subjects to detect mitral regurgitation. The site of the mitral slipping was identified in a centromedial region of the anterior mitral leaflet in these patients. The ellipsoidal index (long axis/short axis) of the left ventricle was greater in SBS patients than in normal subjects. The left ventricular wall had a characteristic motion in SBS. The lateral wall contracted well, while the posterior septum and inferoposterior wall were hypokinetic. Moreover, the anterolateral papillary muscle moved horizontally during systole, while the posteromedial papillary muscle moved anteriorly. There was a significant correlation between the distance of slipping of the anterior mitral leaflet and the PL/PM ratio (r = -0.39, p less than 0.001), where PL is the distance from the gravity point of the left ventricle to the midpoint of the anterolateral papillary muscle, and PM is that from the gravity point of the left ventricle to the posteromedial papillary muscle. Mild mitral regurgitation was identified in four cases with SBS by Doppler echocardiography, and this regurgitant jet was directed from the posterior mitral leaflet to the posterior wall of the left atrium. These results suggest that the systolic slipping of the anterior mitral leaflet in SBS might be caused by asynchronous papillary muscle motion. This might be based on the ellipsoidal left ventricle due to the short internal dimension of the thorax.(ABSTRACT TRUNCATED AT 250 WORDS)