Re: "Percutaneous extra-articular excision of femoral neck osteoid osteoma: a report of a new method" by Chaarani et al J R Coll Surg Edinb 2002 Volume 47: 5; 705-08.
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Biopsy↗
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Shear bond strength of self-etching bonding systems in combination with various composites used for repairing aged composites.
PURPOSE: Repair of worn, broken or discolored composite restorations can be accomplished using new composite material and dentin bonding systems. The purpose of this study was to investigate the effectiveness of self-etching adhesive systems for composite re-bonding procedures onto different composite substrates that had been aged for 6 years prior to testing. MATERIALS AND METHODS: Two hundred cylinders (4 mm x 5 mm) of composite were fabricated using 4 hybrid composites [AeliteFil (Bisco), Prodigy (SDS Kerr), TPH (Dentsply Caulk), and Z100 (3M ESPE)] following manufacturers' directions and stored for 6 years in 1% NaCl solution. After aging, each specimen was wet polished through 600-grit SiC and randomly assigned to a self-etching bonding system (Adper Prompt L-Pop/Z100 [3M ESPE]; Tyrian One-Step Plus/AeliteFil [Bisco]; OptiBond Solo Plus SE/Prodigy [SDS Kerr], Xeno III/TPH [Dentsply Caulk]) or a total-etch control (Prime&Bond NT/TPH [Dentsply Caulk]) (n = 10 per group). Shear bond strengths (SBS) for repairs were evaluated after 48 h (crosshead speed = 0.5 mm/min) and were compared by two-way ANOVA (p = 0.05) with Tukey post-hoc tests. RESULTS: Significant differences (p < or = 0.05) were detected for the main effects (substrates and bonding systems), but the interaction was not significant. SBS for bonding systems were from highest to lowest: (1) Prime&Bond NT, (2) OptiBond Solo Plus SE, (3) Adper Prompt L-Pop, (4) Xeno III, (5) Tyrian One-Step Plus. SBS of the repair systems to Z100 were significantly lower than those to the other composite substrates. CONCLUSION: Self-etching systems can be used to repair aged composite, but the efficacy of repair of aged composite is system dependent.
Acid Etching, Dental↗
Thiopentone cerebral protection under EEG control during carotid endarterectomy.
Seventy patients who underwent a total of 77 consecutive carotid endarterectomies were given thiopentone (mean dose 19 mg/kg) under EEG control for cerebral protection during the period of carotid clamping. This technique was used instead of elective insertion of a temporary bypass shunt in response to adverse EEG changes occurring after clamping. The EEG was monitored continuously throughout operation. The EEG burst-suppression pattern with electrically inactive periods of 30-60 seconds was taken as indicating a depth of barbiturate anaesthesia adequate to provide brain protection. Patients exhibited a drop in blood pressure during barbiturate administration: in most the pressure recovered spontaneously but in twenty operations metaraminol was needed to re-establish an adequate pressure before clamping. No adverse cardiological effects were associated with the administration of thiopentone or metaraminol. There was no mortality and no neurological morbidity in this series.
Aged↗
Spontaneous programmed death (apoptosis) of B-chronic lymphocytic leukaemia cells following their culture in vitro.
When B-chronic lymphocytic leukaemia (B-CLL) cells derived from peripheral blood were cultured in vitro, a substantial proportion of them spontaneously died by apoptosis. This type of cell death is morphologically and biochemically distinct from necrosis and has previously been found to occur under physiologic and certain pathologic conditions where cell deletion appears controlled and biologically meaningful. By 30 h of culture, approximately 20% of the unfractionated B-CLL cells were affected. There was no significant difference in the incidence of apoptosis in T-cell depleted and undepleted cultures or when either autologous or normal human serum was used. Furthermore, seeding densities of 2 x 10(6) and 5 x 10(5) cells/ml resulted in a similar incidence of apoptosis, indicating that cell density was unlikely to be a contributing factor in producing the death. The finding that B-CLL cells spontaneously die in vitro has at least two important implications. Firstly, previous work relating to some of the functions of B-CLL cells and their interactions with T cells may require re-evaluation. Secondly, an understanding of the mechanisms involved in the induction of apoptosis in this disease may have therapeutic consequences.
Blood Cell Count↗
Spontaneous pneumothorax associated with expectoration of a lump of metastatic renal cancer.
The case report of a patient known to have metastatic renal cancer and right main bronchus obstruction is presented. During an episode of haemoptysis, the patient expectorated a large fragment of tissue, which proved to be metastatic renal cell cancer. This event produced a right-sided hydropneumothorax with partial re-expansion of the previously collapsed right lung. A chest tube was inserted producing a full re-expansion, following which pleurodesis with tetracycline was performed. To our knowledge, this is the first ever description of spontaneous clearance of a malignant bronchial obstruction.
Bronchial Diseases↗
Caval umbrella causing obstructive uropathy.
A 49-year-old woman had a vena caval filters inserted having suffered multiple pulmonary emboli and a large upper gastrointestinal bleed. She re-presented five years later with loin pain and obstructive uropathy. She was found to have a right pelvi-ureteric obstruction due to inferior vena caval wall perforation from the vena caval filter.
Female↗
Dynamic traction after extensor tendon repair in zones 6, 7, and 8: a retrospective study.
Review of the notes of 46 extensor tendon repairs in 21 patients treated by post-operative dynamic traction without an M.P. flexion block, no tendon ruptures or extensor lag and only one digit without full flexion after a mean follow-up of seven weeks. Re-examination of 26 treated repairs in nine patients for this study demonstrated a mean T.A.M. of 259 degrees at an average 14 months follow-up. No bow-stringing occurred because the extensor retinaculum was not excised, and no tenolyses were necessary.
Hand Injuries↗
Spirituality unplugged: a review of commonalities and contentions, and a resolution.
Spirituality is an important and essential component of occupational therapy, but recent publications in occupational therapy literature also raise questions about the adequacy of the Canadian Association of Occupational Therapists' definition of spirituality and the relationship of spirituality to occupational performance. Re-examination of spirituality and occupation is needed to better understand the role of occupational therapists with respect to spirituality. In this paper, the authors examine the common themes that are inherent in definitions of spirituality from diverse professional perspectives. The commonalities and contentions inherent in these definitions are then contrasted with the perspectives of occupational therapists. This discussion is followed by a challenge for re-examination of spirituality in the Canadian Model of Occupational Performance, and an argument that occupational identity rather than spirituality should have a central position. The implications of spirituality and occupational identity for evidence-based occupational therapy are considered.
Evidence-Based Medicine↗
Infective endocarditis: a lethal disease.
One-hundred-and-eighty-nine episodes of infective Endocarditis were seen in 177 patients in the Green Lane Cardiology Unit over a 18-year period. Hospital survival was 79% and 13-year actuarial survival was 47%. A number of factors including the underlying cardiac lesion, infecting organism, clinical features and surgical intervention were related to outcome. No patient with extreme heart failure survived without operation. Hospital survival in patients with severe heart failure was 69% (9/13 patients) where surgery was carried out before completion of antibiotic treatment, and 40% (6/15 patients) where the antibiotic course was completed. Survival was 53% in patients who still had a fever after one week of antibiotic treatment and 96% if the temperature was normal. In 61% of patients with a fever at one week, extended infected pannus was present compared with 6--10% where the temperature was normal. In patients undergoing operation before completion of antibiotics, the surgical mortality was higher but neither the incidence of recurrence of endocarditis nor the need for re-operation was increased. We believe that better results will be achieved with a policy of surgical intervention when signs of infection and heart failure have not settled within one week of treatment.
Actuarial Analysis↗
Limb salvage after bony and vascular gunshot injuries in a five-week-old infant.
Combined bony and vascular injuries present challenging problems to orthopaedic and vascular surgeons. The use of temporary intraluminal vascular shunts produces significant reductions in ischaemia time and allows fracture stabilisation to be performed before definitive, delicate vascular repair. We report our management of a five-week-old infant who sustained a comminuted fracture of the femur with arterial and venous injuries in a shooting incident. Paediatric nasogastric feeding tubes were used as temporary vascular shunts to re-establish the distal circulation. Stabilisation of the fracture was then followed by vascular reconstruction and soft-tissue surgery, with a good result. We emphasise the need for skills from several surgical disciplines in the management of complex combined injuries.
Blood Vessel Prosthesis↗
Immediate dentin sealing of onlay preparations: thickness of pre-cured Dentin Bonding Agent and effect of surface cleaning.
This study evaluated the thickness of Dentin Bonding Agent (DBA) used for "immediate dentin sealing" of onlay preparations prior to final impression making for indirect restorations. In addition, the amount of DBA that is removed when the adhesive surface is cleaned with polishing or air abrasion prior to final cementation was evaluated. For this purpose, a standardized onlay preparation was prepared in 12 extracted molars, and either OptiBond FL (Kerr) or Syntac Classic (Vivadent) was applied to half of the teeth and cured in the absence of oxygen (air blocking). Each tooth was bisected in a bucco-lingual direction into two sections, and the thickness of the DBA was measured under SEM on gold sputtered epoxy resin replicas at 11 positions. The DBA layer of each half tooth was treated with either air abrasion or polishing. The thickness of the DBAs was then re-measured on the replicas at the same positions. The results were statistically analyzed with non-parametric statistics (Mann-Whitney U test and Kruskal-Wallis test) at a confidence level of 95% (p=0.05). The film thickness of the DBA was not uniform across the adhesive interface (121.13 +/- 107.64 microm), and a great range of values was recorded (0 to 500 microm). Statistically significant differences (p<0.05) were noted, which were both material (OptiBond FL or Syntac Classic) and position (1 to 11) dependent. Syntac Classic presented a higher thickness of DBA (142.34 +/- 125.10 microm) than OptiBond FL (87.99 +/- 73.76 microm). The higher film thickness of both DBAs was at the deepest part of the isthmus (the most concave part of the preparation), while the lowest was at the line angles of the dentinal crest (the most convex part of the preparation). OptiBond FL presented a more uniform thickness around the dentinal crest of preparation; Syntac Classic pooled at the lower parts of the preparation. The amount of DBA that was removed with air abrasion or polishing was not uniform (11.94 +/- 16.46 microm), and a great range of values was recorded (0 to 145 microm). No statistically significant differences (p<0.05) were found either between different DBAs (OptiBond FL or Syntac Classic) or between different treatments (air abrasion or polishing). As far as the effect of different treatments at different positions, polishing removed more DBA from the top of the dentinal crest, but the difference was not statistically significant. Air abrasion removed less DBA from the corners of the dentinal crest (Positions 4 and 6) than the outer buccal part of the preparation (Positions 1 and 2). Neither air abrasion nor polishing removed the entire layer thickness of the DBA in the majority of the cases.
Acid Etching, Dental↗
Dialyzer reuse: interaction between dialyzer membrane, disinfectant (formalin), and blood during dialyzer reprocessing.
The growing practice of dialyzer reuse in recent years is mainly based on medical and economic considerations. However, adverse reactions such as immunohemolytic anemia due to anti-Nform antibody associated with dialyzer reuse have been reported. In this study, scanning electron microscopy and cytologic staining were used to evaluate the interaction between blood components and the reprocessed synthetic dialyzer membrane (polysulfone) after disinfectant (formaldehyde) treatment. The results showed that various blood components such as fibrin and blood cells still adhered to the dialyzer membrane after reprocessing. The study also demonstrated that the adhered denatured blood components could be detached by sonication and/or simulated hemodialysis and then gain access into the circulation. The re-entry of the denatured blood components to the patients exposed to reused dialyzers may result in an enhanced immunological response which may contribute to antibody formation (such as anti-Nform antibody) with a reused hemodialyzer.
Anemia, Hemolytic↗
Secondary achalasia in esophagogastric carcinoma:re-emphasis of a difficult differential problem.
Six cases of esophagogastric junction carcinoma are reviewed, with emphasis placed on differential diagnosis between achalasia and carcinoma. All six had abnormal motility with aperistalsis being the most common finding. Three patients demonstrated tapering of the distal esophagus simulating achalasia. Patients over 40 with recent onset of esophageal symptoms and radiographic signs suggesting achalasia should be suspected of harboring carcinoma.
Adenocarcinoma↗
Have boards refocused governance functions?
In a previous issue of Trustee the author wrote that hospitals must re-examine board structure, size, and composition, as well as management authority and CEO/board relationships if they are to emulate the business world. (See "If Boards Mean Business, They'll Refocus the Governance Function," April 1983.) This article brings the earlier work up to date and reports the results of a survey that shows the status of those changes in one major state: Ohio.
Governing Board↗
An audit of clinical practice in the management of head injured patients following the introduction of the Scottish Intercollegiate Guidelines Network (SIGN) recommendations.
A prospective study was conducted by the Scottish Trauma Audit Group (STAG) in A&E of Edinburgh Royal Infirmary to examine clinical practices in the management of head injured patients pre- and post-inception of the SIGN guidelines published in August 2000.1607 patients attended the department in two separate one month periods at equal intervals pre- and post-guidelines publication. The majority of patients with a SIGN indication for admission were admitted (93% pre- and 92% post-guidelines). For skull x ray (SXR) requests, in the pre-guidelines group, 92% of admitted patients with a SIGN indication for x ray had a SXR: this figure dropped to 79% post-guidelines. 36% of patients with a SIGN indication for CT actually had a scan pre-guidelines: this figure increased to 64% post-guidelines.57% of patients pre-guidelines and 44% of patients post-guidelines were discharged from A&E in accordance with the SIGN recommendations. Of patients admitted for neurological observations, this increased from 50% pre- to 88% post-guidelines. Of patients who were discharged "inappropriately", only one re-presented and was subsequently admitted but required no neurosurgical intervention. Despite publication of the SIGN guidelines and positive reinforcement in A&E and at ward level, practice has not changed significantly. Where our practice did not adhere to SIGN recommendations, there was no untoward sequelae. For published national guidelines to be effective, a formal audit structure with regular feedback is necessary to ensure a continued change in clinical practices.
Craniocerebral Trauma↗
Wartime Paris, cirrhosis mortality, and the ceteris paribus assumption.
OBJECTIVE: This article critiques the ceteris paribus assumption, which tacitly sustains the epidemiologic literature's inference that the sharp decline in cirrhosis mortality observed in Paris during the Second World War derived from a sharp constriction in wine consumption. Paris's wartime circumstances deviate substantially from the "all else being equal" assumption, and at least three other hypotheses for the cirrhosis decline may be contemplated. METHOD: Historical and statistical review. RESULTS: Wartime Paris underwent tumultuous changes. Wine consumption did decline, but there were, as well, a myriad of other changes in diet and life experience, many involving new or heightened hardships, nutritional, experiential, institutional, health and mortality risks. Three competing hypotheses are presented: (1) A fraction of the candidates for cirrhosis mortality may have fallen to more sudden forms of death; (2) alcoholics, heavy drinkers and Paris's clochard subpopulation may have been differentially likely to become removed from the city's wartime population, whether by self-initiated departure, arrest and deportation, or death from other causes, even murder; and (3) there was mismeasurement in the cirrhosis mortality decline. CONCLUSIONS: The alcohol-cirrhosis connection provided the template for the alcohol research effort (now more than 20 years old) aimed at re-establishing scientific recognition of alcohol's direct alcohol-problems-generating associations and causal responsibilities. In a time given to reports of weaker associations of the alcohol-cirrhosis connection, the place and importance of the Paris curve in the wider literature, as regards that connection, remains. For this reason, the Paris findings should be subjected to as much research scrutiny as they undoubtedly deserve.
Alcohol Drinking↗
The road to ovulation: the role of oestrogens.
Oestrogens have been known for many years to have a direct influence on folliculogenesis. Oestradiol-17beta (E2) and its analogues have both proliferative and differentiative effects on somatic cells of follicles. Nevertheless, definitive proof of an obligatory role for oestrogen in folliculogenesis and elucidation of the mechanisms subserving its different actions in follicular cells remains elusive. Several recent developments permit a re-examination of the roles and actions of E2 in the follicle. They are: (i) the discovery of a second form of the oestrogen receptor, ERbeta; (ii) the advent of genetically modified mice with deletions in the ERalpha (alphaERKO) ERbeta (BERKO) and the double ER deletions (alphabetaERKO); and (iii) a mouse model of oestrogen deficiency (ArKO) by targeted disruption of the cyp 19 gene encoding the aromatase enzyme. Recent information derived from these models is reviewed to re-assess the roles and actions of oestrogens in follicular dynamics and the phenotypic differentiation of ovarian somatic cells in the ovary. The data demonstrate that oestrogen is obligatory for normal folliculogenesis and that the phenotype of the ovarian somatic cells depends on the steroid milieu. The ArKO mouse provides a model to test the roles of the respective ERs in proliferation and differentiation using specific agonists and antagonists, and to study regulation of the differentiation of ovarian and testicular somatic cells.
Animals↗
Effect of dietary fiber or fat in low-crude protein, crystalline amino acid-supplemented diets for finishing pigs.
Three experiments were conducted to determine the effect of reducing NE, by adding dietary fiber in Exp. 1 and 2 and decreasing dietary fat in Exp. 3, of low-CP, crystalline amino acid (CAA)-supplemented diets for finishing pigs on growth performance and carcass characteristics. In Exp. 1 and 2, 64 barrows (Exp. 1) or gilts (Exp. 2) were allotted to four treatments with four replicates of four pigs each. Average initial and final BW were 74 and 117 kg in Exp. 1 and 74 and 102 kg in Exp. 2. The following diets were fed in Exp. 1: 1) corn-soybean meal (C-SBM); 2) low-CP (-3.5%), supplemented with CAA; 3) CAA + rice hulls (CAA+RH; NE equal to Diet 1); and 4) CAA+RH+OIL (NE equal to Diet 2). Experiment 2 was similar to Exp. 1, except RH were replaced with wheat middlings (WM), oil was replaced with dry fat, and the CP was decreased by 3.1% in the low-CP diets. In both experiments, serum urea-N (SUN, corrected for initial SUN by covariance analysis) was higher (P<.10) for pigs fed C-SBM than for pigs fed any other diet. In Exp. 1, barrows fed CAA+RH had lower hot carcass weight, percentage muscle, fat-free lean (FFLEAN), lean gain per day, retained energy (RE) in FFLEAN, and lean:fat ratio than barrows fed C-SBM, along with less FFLEAN than barrows fed CAA+RH+OIL. Barrows fed CAA+RH had smaller longissimus muscle areas than barrows fed any other diet, and barrows fed C-SBM had higher dressing percentage and lower percentage total fat than barrows fed any other diet. Barrows fed C-SBM had higher lean:fat ratio and lower total fat than barrows fed CAA. In Exp. 2, gilts fed CAA+WM+FAT had heavier heart weights than gilts fed C-SBM or CAA (P<.10). In Exp. 3, 702 gilts were allotted to six treatments with nine replicates of 13 gilts each. Average initial and final BW were 70 and 110 kg. Gilts were fed two levels of CP (15.5 or 11.7% plus CAA added to meet an ideal amino acid ratio) and three levels of NE (2,650, 2,617, or 2,584 kcal/kg), resulting in a 2x3 factorial arrangement of treatments. Gilts fed 15.5% CP had higher gain:feed ratio than gilts fed 11.7% CP (P<.01). Longissimus depth was greater for gilts fed 15.5% CP than for gilts fed 11.7% CP and was decreased as NE decreased only in gilts fed 11.7% CP (CP effect, P<.09; NE linear effect, P<.04; CP x NE effect, P<.01). Gilts fed the diet with 2,617 kcal NE had lighter carcasses and less total fat, fat gain per day, RE, and RE as fat regardless of protein level than gilts fed 2,650 or 2,584 kcal NE/kg (NE quadratic, P<.09). Loin color score increased as NE decreased (linear, P<.06), but longissimus fat depth was increased by the lowest level of NE (NE quadratic effect, P<.09). Overall, the reduction of NE in low-CP, CAA-supplemented diets did not affect growth performance and was not an effective means of reducing fat in finishing pigs.
Amino Acids↗