Incidental appendectomy in donors undergoing hepatectomy for living-donor liver transplantation

BACKGROUND

The aim of this study was to investigate the morbidity associated with appendectomy in living liver donors undergoing hepatectomy.

METHODS

The medical records of 338 donors who underwent hepatectomies for living-donor liver transplantation between 2008 and 2010 were reviewed retrospectively. The patients were divided into 2 groups on the basis of appendectomy: patients in group A (n = 126) received incidental appendectomies in conjunction with donor hepatectomy, and those in group B (n = 212) underwent hepatectomy alone.

RESULTS

No significant difference in age, gender, or body mass index was found between groups. The wound infection rate (P = .037) and length of hospital stay (P = .0038) were higher in group A than in group B. Intraoperative findings in 126 donors in group A were subserosal (n = 4), retrocecal (n = 6), or hard nodular (n = 11) appendix; hyperemic appendix with edema (n = 9); appendix length ≥ 8 cm (n = 18); and palpable fecalith (n = 78). Histopathologic examination of appendix specimens revealed lymphoid hyperplasia with a fecalith (n = 32), fecalith only (n = 32), acute appendicitis (n = 20), normal anatomy (n = 18), fibrous obliteration (n = 9), lymphoid hyperplasia (n = 9), Enterobius vermicularis (n = 3), appendiceal neuroma (n = 1), carcinoid tumor (n = 1), and mucoceles (n = 1).

CONCLUSION

Although incidental appendectomy increased the wound infection rate and length of hospital stay, this procedure is necessary for the prevention of potential complications due to appendicitis when the exploration of the ileocecal region in patients undergoing donor hepatectomy reveals one or more of the following: appendix length ≥ 8 cm; dropsical, hyperemic, subserosal, nodular, and/or retrocecal appendix; and/or palpable fecaloma.

Treatment of pilonidal disease by combination of pit excision and phenol application

AIM

To examine the results of our minimal invasive treatment for pilonidal disease.

METHODS

Total 83 patients treated by pit excision and consecutive phenol applications on an outpatient setting. All procedures were performed under local anesthesia, without any preoperative testing, colon cleansing, prophylactic antibiotics or sedation. A pit excision (mean length 1.3 ± 0.5 cm) including several close midline orifices was done. Separated pit excisions were done to the remaining midline and lateral orifices. Sinus cavity was cleared of hair and debris, and the walls of the cavity were sclerosed using a cotton bud dipped in 80% liquid phenol. Phenolization was repeated twice on day one and seven.

RESULTS

Mean procedure time was 22.2 ± 7.4 min. Rates of patients who did not required analgesics at first, second, third and fourth days after surgery were 58, 85, 91 and 100%, respectively. All the patients returned to work/school after 3 days. Mean wound closure time was 28.5 ± 14.9 days. Total 86.7% of the patients were asymptomatic after a mean 25.7 ± 8.5 months follow-up.

CONCLUSION

Simple pit excision and sclerosing the pilonidal sinus cavity consecutively was an effective and minimal invasive method for relief of pilonidal symptoms.

Novel truncating and missense mutations of the KCC3 gene associated with Andermann syndrome

Background: Andermann syndrome (OMIM 218000) is an autosomal recessive motor-sensory neuropathy associated with developmental and neurodegenerative defects. The cerebral MRI reveals a variable degree of agenesis of the corpus callosum. Recently, truncating mutations of the KCC3 gene (also known as SLC12A6) have been associated with Andermann syndrome.

Methods: The authors assessed clinically and genetically three isolated cases from Germany and Turkey with symptoms consistent with Andermann syndrome.

Results: The authors detected four novel mutations within the KCC3 gene in their patients: two different truncating mutations in the first patient, a homozygous truncating mutation in the second, and a homozygous missense mutation in the third patient. In contrast to the classic phenotype of the Andermann syndrome linked to truncating KCC3 mutations the phenotype and the course of the disease linked to the missense mutation appeared to be different (i.e., showing additional features like diffuse and widespread white matter abnormalities).

Conclusions: Not only truncating but also missense mutations of the KCC3 gene are associated with Andermann syndrome. Different types of KCC3 mutations may determine different clinical phenotypes.

Further clinical and genetic characterization of SPG11: hereditary spastic paraplegia with thin corpus callosum

Hereditary spastic paraplegias (HSPs) are a heterogeneous group of neurodegenerative disorders leading to progressive spasticity of the lower limbs. Clinically, HSPs are divided into "pure" and "complicated" forms. In pure HSP, the spasticity of the lower limbs is the sole symptom, whereas in complicated forms additional neurological and non-neurological features are observed. Genetically, HSPs are divided into autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL) forms. Up to date, 30 different HSPs are linked to different chromosomal loci and 11 genes could be defined for AR-HSP, AD-HSP and XL-HSP. SPG11, an AR-HSP (synonym: HSP11), is a complicated HSP associated with a slowly progressive spastic paraparesis, mental impairment and the development of a thin corpus callosum (TCC) during the course of the disease. SPG11 has been previously linked to chromosomal region 15q13 - 15. First, we applied rigid diagnostic criteria to systematically examine 20 Turkish families with autosomal recessive HSP for characteristic features of SPG11. We detected four large Turkish families with AR-HSP and TCC consistent with SPG11. Subsequent genetic linkage analysis of those 4 families refines the SPG11 locus further down to a small region of 2.93 cM with a maximum lod score of 11.84 at marker D15S659 and will guide further candidate gene analysis.

Effect of LED and halogen light curing on polymerization of resin-based composites

The clinical performance of light polymerized resin-based composites (RBCs) is greatly influenced by the quality of the light curing unit (LCU). A commonly used unit for polymerization of RBC material is the halogen LCUs. However, they have some drawbacks. Development of new blue superbright light emitting diodes (LED LCU) of 470 nm wavelengths with high light irradiance offers an alternative to standard halogen LCU. The aim of this study is compared the effectiveness of LED LCU and halogen LCU on the degree of conversion (DC) of different resin composites [two hybrid (Esthet-X, Filtek Z 250), four packable (Filtek P60, Prodigy Condensable, Surefil, Solitaire), one ormocer-based resin composite (Admira)]. The DC values of RBCs polymerized by LED LCU and halogen LCU ranged approximately from 61.1 +/- 0.4 to 50.6 +/- 0.6% and from 55.6 +/- 0.7 to 47.4 +/- 0.5%, respectively. Significantly higher DC of RBCs except Surefil and Filtek Z 250 was obtained for LED LCU compared with halogen LCU (P < 0.05). Surefil and Filtek Z 250 exhibited no statistically significant difference values between LED LCU and halogen LCU (P > 0.05). As a result, it was observed that the performance of LED LCU used in the study was satisfactory clinically and had sufficient irradiance to polymerize RBCs (hybrid, packable and ormocer based) at 2 mm depth with a curing time of 40 s.

Congenital hydrocephalus as a rare association with ligneous conjunctivitis and type I plasminogen deficiency

Severe type I plasminogen deficiency is the underlying cause of ligneous conjunctivitis (LC). Furthermore, pseudomembranes may also be found on other mucous membranes (gastrointestinal tract, bronchial system, genital tract). In very rare cases, congenital hydrocephalus has been associated with the more severe forms of the disease and may even precede LC. The pathophysiological mechanism is unclear at present. It is advisable to look for plasminogen deficiency in patients with congenital hydrocephalus, because obstruction of ventriculoperitoneal shunts is possible when such a condition is overlooked. Here, we report a case of LC with hydrocephalus. This report reemphasizes the association of LC with hydrocephalus which is not well known.

Effects of carbamide peroxide containing bleaching agents on the morphology and subsurface hardness of enamel

The purpose of this study is to evaluate the effects of nightguard bleaching agents (Karisma and Yotuel) on the enamel surface of forty anterior teeth. Ten teeth of each group were evaluated with SEM and ten teeth of each group were tested with a microhardness tester Morphologic alterations were observed on the enamel surfaces with SEM. Karisma group showed a significant decrease in enamel hardness (p<0.05) and microhardness values of enamel were increased significantly in Yotuel group (p<0.05).

Microleakage of resin composite restorations with glass-ceramic inserts

OBJECTIVE

The purpose of this study was to evaluate the effects of glass-ceramic inserts and different application techniques of resin composites on marginal leakage.

METHOD AND MATERIALS

Three groups of 10 standardized, round, Class V cavities were prepared on the buccal surface of 30 extracted human molar teeth. Group 1 received resin composite restorations, placed in one increment (bulk). Group 2 received resin composite restorations that were placed in two increments, and group 3 received resin composite restorations with beta-quartz ceramic inserts. After the teeth were thermocycled and placed in 0.5% basic fuchsin for 24 hours, they were sectioned and examined for microleakage.

RESULTS

On the occlusal margins, there was no statistically significant difference between the restorations placed with the incremental technique and the restorations with beta-quartz inserts. The restorations placed with the bulk technique had significantly more microleakage than did the others. On the gingival margins, the restorations with beta-quartz inserts exhibited significantly less microleakage than did the other groups. The restorations placed with the bulk technique showed significantly more dye penetration than did the others.

CONCLUSION

The use of a glass-ceramic insert reduced the marginal leakage of Class V resin composite restorations.

Effect of an alum-containing mouthrinse in children for plaque and salivary levels of selected oral microflora

The purpose of the study was to assess the effect of daily supervised rinsing with a specially formulated, alum-containing mouthrinse on plaque and salivary levels of S. mutans, S. mitis and S. salivarius in caries susceptible children (12-14 years old) and to monitor the effect on the oral tissues and acceptability to subjects. Forty-five subjects were divided into 3 groups (n = 15). Group I received an experimental group with a mouthrinse containing hydrated aluminum potassium sulfate (alum). Group 2 received a vehicle control group containing the same mouthrinse, but without alum and Group 3 had a treatment control with distilled water. All subjects continued normal oral hygiene habits during the study. Salivary and plaque levels were obtained at base line, 2 weeks and 4 weeks and evaluated for microbiologic procedures. Also, potential adverse effects on oral tissues were performed during every visit. The mean plaque and salivary levels of oral Streptococcus (S. mutans, S. mitis, S. salivarius) for the experimental group were significantly reduced after 2 weeks and 4 weeks compared with baseline. The plaque and salivary levels of oral Streptococcus of experimental and vehicle control group differed statistically from each other after 4 weeks, with the strongest reduction in the experimental group and there was statistically difference between treatment control and vehicle control or experimental groups at each time interval. No evidence of deleterious effects to the oral tissues was observed. Daily use of an alum-containing mouthrinse was safe and produced significant reduction effect on plaque and salivary levels of oral Streptococcus and can be used in children for the preventive dentistry.

Comparison of the resin-dentin interface in primary and permanent teeth

The purpose of the present study was to compare primary and permanent teeth in terms of the thickness of the hybrid layer developed with two bonding systems: Syntac (multi step) and Syntac Single Component. Fourteen sound primary first molars and 14 sound permanent first bicuspids, were removed for orthodontic reasons, and divided into 4 groups: 7 primary and 7 permanent teeth were restored with Syntac adhesive resin system (multi step); and 7 primary and 7 permanent teeth were restored with Syntac Single Component adhesive resin system. Measurements of hybrid layer thickness were performed by means of SEM and two teeth in each group were evaluated on TEM for further confirmation of resin-dentin interface. The result of this study indicated that the hybrid layer was significantly thicker in primary than in permanent teeth (p < 0.05). No difference was observed in the hybrid layers produced by two dentin bonding systems (p < 0.05).

The effect of cavity disinfectants on microleakage in dentin bonding systems

The purpose of this study was to determine the effect on microleakage of two disinfectants, one a chlorhexidine based and the other alcohol based, used as cavity washes prior to the application of one step dentin bonding systems Syntac and Prime & Bond in Class V composite restorations. Children between 10-12 years old, with noncarious second primary molars about to exfoliate, were selected for this study. Cavity preparations were treated with either Syntac or Prime & Bond, combinations of one of the two disinfectants washes with Syntac or Prime & Bond or with one of the disinfectants only and filled with Tetric composite resin. All teeth were extracted one month later, stained and sectioned to evaluate dye penetration. As a result, focal dry disinfectant when used as a cavity wash prior to the use of Prime & Bond did not effect the ability of dentin bonding agents to prevent microleakage. Chlorhexidine solution had an adverse effect on Syntac and Prime & Bond and produced significantly higher microleakage when used with these bonding systems. The use of cavity disinfectants with composite resin restorations appears to be material specific regarding the interactions with various dentin bonding systems and the ability to seal dentin.

A histopathologic study of direct pulp-capping with adhesive resins

OBJECTIVE

The purpose of this study was to evaluate the histologic pulp responses of Optibond and Syntac adhesive resin systems placed directly on exposed pulp tissues.

STUDY DESIGN

Class V facial cavities with pulpal exposures were prepared in dogs. After acid etching of enamel margins, the cavities were restored with a composite resin after pulp-capping with one of the dentin bonding agents. The remaining exposures were capped with calcium hydroxide and amalgam as controls. The animals were killed after 7, 21, and 90 days and the pulps were evaluated histologically. Statistical analysis was carried out with the chi-square test.

RESULTS

There was no statistically significant difference with respect to inflammatory cell response, fibrosis, bleeding, or bacterial staining criteria over the time intervals of evaluation among the Optibond, Syntac, and calcium hydroxide groups. New dentin formation was also observed for all of the groups at the end of 90 days.

CONCLUSION

The results of direct pulp-capping with a dentinal adhesive and composite resin appear promising but further in vivo studies are recommended.

Clinical evaluation and marginal leakage of Amalgambond Plus: three-year results

Amalgambond Plus with a high-performance additive was evaluated for its ability to bond a resin composite or an amalgam alloy to deep dentin in primary teeth with nonretentive cavity preparations. The clinical performance of amalgam and resin composite mesio-occlusodistal restorations bonded with Amalgambond Plus was evaluated at 15 months and 2 and 3 years. There was no statistically significant difference in the retention, marginal adaptation, secondary caries, and post-operative sensitivity over the times of the evaluation or between amalgam and resin composite restorations. After 3 years, most of the teeth were extracted because it was their exfoliation time, and 29 restorations limited within buccal and lingual cusps were evaluated for marginal leakage. There were no significant differences in microleakage between amalgam and resin composite restorations lined with Amalgambond Plus. Amalgambond Plus has the potential for serving successfully as a cavity liner with either amalgam or resin composite restorations.

Clinical evaluation of transcutaneous electronic nerve stimulation for pain control during tooth preparation

The purpose of this study was to evaluate the effectiveness of a transcutaneous electrical nerve stimulation unit. The effects of electronic dental anesthesia and local anesthesia for deep cavity preparations in primary molars were compared in children aged 7 to 9 years by using the Eland Color Scale. The patients had symmetric teeth requiring Class I cavity preparation. One of the teeth was treated with electronic anesthesia and the other with local anesthesia. The tooth and method were selected randomly. Both restorations were finished at the same visit. There was no statistically significant difference between the groups in the perception of pain. Fifty-six percent of the children preferred transcutaneous electrical nerve stimulation, while 36% of them preferred local anesthesia.

Apical microleakage of primary teeth root canal filling materials by clearing technique

The purpose of this study was to evaluate apical leakage of primary teeth root canals sealed with four different root canal filling materials by clearing technique. Dye penetration ratios of all groups were measured by light microscopy. The mean dye penetration was determined in the group of ZOE to be 0.57 mm. This ratio was 1.05 mm in the group of ZOE + glutaraldehyde (GA). In the groups of Kri I and Ca(OH)2, dye penetrations were 0.47 mm, 0.56 mm respectively. The highest apical leakage value was evaluated in the glutaraldehyde + ZOE group (p<0.05), whereas, no statistical difference was found between the other groups.

Bond strength and clinical evaluation of a new dentinal bonding agent to amalgam and resin composite

Amalgambond Plus with HPA (high-performance additive) was evaluated for its ability to bond a resin composite and an amalgam to deep primary dentin. Tensile bond strengths for resin and amalgam were 6.40 +/- 2.17 MPa and 2.95 +/- 0.92 MPa, respectively. There was a statistically significant difference between the groups. The modes of failure of the specimens were 100% adhesive for amalgam and 76% adhesive-cohesive and 24% adhesive for resin composite. The clinical performance of amalgam and resin composite mesio-occlusodistal restorations bonded with Amalgambond Plus was also evaluated over 15 months. Periapical radiographs were taken to support the clinical examination. The following parameters were assessed: marginal adaptation, secondary caries, postoperative hypersensitivity, and retention. Both types of restoration exhibited excellent marginal adaptation and retention and no secondary caries or hypersensitivity.