A non-classic form of McCune Albright syndrome with different presentations and review of the literatures

Background:

McCune Albright syndrome (MAS) is a rare heterogeneous clinical syndrome without any predilection for ethnic group. Classic form includes triad of fibrous dysplasia, café au late spots and autonomous hyper function of one or more endocrine pathways.

Case Report:

We report the case of an 18-year old girl with non-classic form of MAS .New aspect of this case report attributed to multiple sebaceous adenoma.

Conclusion:

The new finding of our case of MAS was not reported before. Periodic follow-up with different radiologic and laboratory tests should be considered after suspicion to MAS.

Gender difference and root canal morphology in mandibular premolars: A cone-beam computed tomography study in an Iranian population

BACKGROUND

Mandibular premolars are of the most difficult teeth to treat endodontically.

AIMS

To compare the root canal morphology of mandibular premolars between two genders in an Iranian population.

SETTINGS AND DESIGN

Totally, 230 cone-beam computed tomography images of the mandibles belonged to 115 males and 115 females were evaluated in the three spatial planes.

MATERIALS AND METHODS

The total number of roots and canals in the mandibular premolars was counted, and the difference between males and females were analyzed.

STATISTICAL ANALYSIS

Data were analyzed using Chi-square test. The significance level was set as P < 0.05.

RESULTS

The majority of mandibular first and second premolars had one root (85.7% and 94.8%, respectively) and one canal (63.9% and 78.3%, respectively). The number of roots in the mandibular first premolars had statistically significant difference between two genders (P = 0.001). There was no significant difference between two genders in the number of roots (P = 0.208) and canals (P = 0.498) in the mandibular second premolars.

CONCLUSION

According to the results of this study, the root canal morphology in the mandibular first premolars had statistically significant difference between two genders.

Impact of root canal preparation size and taper on coronal-apical micro-leakage using glucose penetration method

OBJECTIVES

The purpose of this in vitro study was to assess the effect of root canal preparation size and taper on the amounts of glucose penetration.

MATERIAL AND METHODS

For conducting this experimental study, eighty mandibular premolars with single straight canals were divided randomly into 2 experimental groups of 30 samples each and 2 control groups. Using K-files and the balance force technique, canals in group 1 were prepared apically to size 25 and coronally to size 2 Peesoreamer. Group 2 were instrumented apically and coronally to size 40 and size 6 Peesoreamer, respectively. Rotary instrumentation was accomplished in group 1; using size 25 and .04 tapered and in group 2, size 35 and .06 tapered Flex Master files. Canals were then obturated by lateral compaction of cold gutta-percha. Glucose penetration through root canal fillings was measured at 1, 8, 15, 22 and 30 days. Data were recorded as mmol/L and statistically analyzed with Mann-Whitney U test (P value=. 05).

RESULTS

In comparison to group 1, group 2 showed significant glucose leakage during the experimental period (P value < .0001). Also, in each experimental group, the amount of micro-leakage was significantly increased at the end of the study.

CONCLUSIONS

Under the condition of this study, the amounts of micro-leakage through root canal fillings are directly related to the size and taper of root canal preparation and reducing the preparation size may lead to less micro-leakage. Key words:Dental leakage, root canal preparation, endodontics.

The effect of retreatment procedure on the pH changes at the surface of root dentin using two different calcium hydroxide pastes

Aim:

To compare pH changes at the cervical, middle and apical surfaces of root dentin in retreated and non- retreated teeth, after canal obturation with two different calcium hydroxide pastes.

Materials and Methods:

After instrumentation of 55 extracted teeth, three cavities with 0.75 mm depth and 1.5 mm in diameter were drilled at buccal root surface. The teeth were randomly divided into five groups. Canals in the first two groups were filled with either mixture of calcium hydroxide and saline solution and calcium hydroxide and 2% chlorhexidine (CHX). In the third and fourth groups canals were first obturated with gutta-percha and AH26 sealer, and then materials were removed. After 2 days canals were filled with two different calcium hydroxide pastes similar to the first and the second groups. The pH was measured in the prepared cavities at 1, 3, 7 and 14 days.

Results:

In the non-retreated groups, pH at the surface of the roots was significantly higher in comparison to the retreated ones (P value < 0.001). pH values were significantly higher in the non-retreated teeth filling with calcium hydroxide and saline solution (P value < 0.001).

Conclusion:

Regarding to the little pH changes at the surface of dentin in retreated teeth, the hydroxyl ions cannot penetrate into the dentinal tubules. Thus, to achieve higher pH at the root surface in retreated teeth, it is clinically advisable to remove more dentin from the inner walls and to use normal saline as a vehicle for calcium hydroxide rather than acidic pH materials.

Autologous stem cell transplantation followed by consolidation chemotherapy for relapsed or refractory Hodgkin's lymphoma

Relapse remains a major cause of treatment failure after autotransplantation (auto-PBSCT) for Hodgkin's disease (HD). The administration of non-crossresistant therapies during the post-transplant period may delay or prevent relapse. We prospectively studied the role of consolidation chemotherapy (CC) after auto-PBSCT in 37 patients with relapsed or refractory HD. Patients received high-dose gemcitabine-BCNU-melphalan and auto-PBSCT followed by involved-field radiation and up to four cycles of the DCEP-G regimen, which consisted of dexamethasone, cyclophosphamide, etoposide, cisplatin, gemcitabine given at 3 and 9 months post transplant alternating with a second regimen (DPP) of dexamethasone, cisplatin, paclitaxel at 6 and 12 months post transplant. The probabilities of event-free survival (EFS) and overall survival (OS) at 2.5 years were 59% (95% CI=42-76%) and 86% (95% CI=71-99%), respectively. In all, 17 patients received 54 courses of CC and 15 were surviving event free (2.5 years, EFS=87%). There were no treatment-related deaths during or after the CC phase. Post-transplant CC is feasible and well tolerated. The impact of this approach on EFS should be evaluated in a larger, randomized study.

Disclosure of Huntington's disease to family members: the dilemma of known but unknowing parties

Predictive genetic testing presents unique issues in the legal and ethical debate concerning disclosure of information within the physician-patient relationship. A duty to disclose information to family members has been found when the disclosure is likely to result in the ability to mitigate the damaging effects of the disease. When evaluating the situation where a individual is at risk of Huntington's disease, the analysis must be different, as shown in this paper, and necessitates an ethical and legal examination of the consequences of receipt of the information on family members, those known but unknowing parties who are at risk of inheriting a genetic disease. This paper analyzes the potential legal duty of a physician to disclose or withhold genetic information from the family members of patients. Existing statutes governing genetic information do not directly address the interests of family members. Courts that have ruled on the duty to disclose medical or genetic information have analyzed these issues using traditional concepts of tort law. Yet the situation presented by Huntington's disease is unique and demands a different framework for analysis, given the late onset and lack of curative or ameliorative treatment. This paper also analyzes the ethical standards to be invoked when considering violating the privacy of a patient or a family member. The principles of autonomy and self-determination of family members are considered, versus the risk of harm and the privacy interest in not knowing potentially devastating information.

A survey of patients' rights representatives in Israeli Hospitals: 1999-2000

Israel's legislature enacted a Patients' Rights Act in 1996. The Act directed hospitals to designate a representative responsible for supervising protection of patients' rights under the new law, investigating complaints, and educating medical staff regarding the provisions of the Act. This survey was conducted in order to evaluate implementation of that section of the law pertaining to hospital representatives of patients' rights. The authors conducted interviews with responsible individuals at government hospitals in Israel, inquiring about their duties, training, complaint procedures, and practices. The authors found that while the representatives shared some basic knowledge of their legal duty, methods of implementation differed widely. It is recommended that a comprehensive program of training be devised for hospital patients' rights representatives, in order to realize the potential of the Act.