Failure rates of miniscrews inserted in the maxillary tuberosity

ABSTRACT Introduction: Anchorage conservation in orthodontics has always been a challenge. Objective: The aim of this current study was to find out the failure rate of miniscrews inserted in the maxillary tuberosity (MT) region. Methods: This pilot study consisted of 40 patients (23 female, 17 male; mean age = 20.1±8.9 years) that had received 60 MT miniscrews for orthodontic treatment. Clinical notes and pictures were used to find out the primary outcome of miniscrew failure. Independent failure factors were also investigated. Logistic regression analysis was done for predictor's relation with MT miniscrews failure. Results: There was no significant correlation in failure rate according to various predictor variables, except for miniscrews installed by lesser experienced operators, which showed significantly more failure. The odds ratio for miniscrew failure placed by inexperienced operators was 4.16. Conclusion: A 26.3% failure rate of mini-implants inserted in the MT region was observed.

RESUMO Introdução: a manutenção da ancoragem sempre foi um desafio na Ortodontia. Objetivo: o objetivo do presente estudo foi descobrir a taxa de falhas dos mini-implantes instalados na região da tuberosidade maxilar (TM). Métodos: o presente estudo piloto avaliou 40 pacientes (23 mulheres, 17 homens; idade média = 20,1 ± 8,9 anos) que receberam 60 mini-implantes na TM durante o tratamento ortodôntico. Anotações clínicas e fotografias foram usadas para investigar o principal motivo para a falha do mini-implante. Fatores de insucesso independentes também foram investigados. Uma análise de regressão logística foi realizada para medir o impacto de cada fator preditivo sobre a falha na instalação dos mini-implantes na TM. Resultados: as diferentes variáveis preditivas não demonstraram correlação significativa com a taxa de falhas, com exceção da instalação dos mini-implantes realizada por operadores inexperientes, que mostrou quantidade significativamente maior de falhas. A razão de chances para a falha dos mini-implantes instalados por operadores inexperientes foi de 4,16. Conclusão: observou-se uma taxa de falhas de 26,3% para os mini-implantes instalados na região da TM.

Routine or selective histopathology of gallbladder specimen after cholecystectomy for gallstone diseases

Objectives: To determine the incidence of incidental gallbladder cancer [IGBC] and to assess the need of routine histopathological examination of all gallbladder specimens after cholecystectomy for benign gallstone diseases Design: Retrospective study Setting: Department of Surgery, College of Medicine, King Saud University, KSA

Subjects: This study included all the patients who underwent elective or emergency cholecystectomy for gallstone disease at King Saud Medical City, Riyadh, Saudi Arabia between January 2012 and September 2015. Patients with preoperative suspicion of gallbladder cancer on imaging, or underwent cholecystectomy for gallbladder polyps or porcelain gallbladder were excluded from the study. Medical record of all the selected patients was reviewed and the data were collected. Interventions: Histopathological examination of gallbladder Main outcome measures: IGBC, routine histopathological examination of all gallbladder

Results: A total of 2396 patients underwent cholecystectomy for gallstones disease. All gallbladder specimens were sent for histopathological examination. IGBC was detected in nine gallbladder specimens [0.4%]. Out of 2396 patients, morphologic abnormalities were observed in 518 specimens [22.6%]. There was no reported case of IGBC with normal appearance of gallbladder specimen. Five patients underwent simple cholecystectomy for stage T1b, three patients of stage T2 tumor had further liver resection and one patient received only palliative care

Conclusions: The incidence of IGBC was 0.38%. All cases of IGBC were detected in abnormal looking thick wall gall bladder. Therefore, selective histopathology of abnormally looking specimen is recommended to reduce the cost and work load of pathologists

Comparison of harmless acute pancreatitis score with Ranson's score in predicting the severity of acute pancreatitis

Objective: To determine the predictability of harmless acute pancreatitis score [HAPS] in determining the severity of acute pancreatitis [AP] and compare it with Ranson's score

Study Design: Prospective cohort study

Place and Duration of Study: King Saud Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2012 and December 2015

Methodology: All patients admitted with AP at King Saud Medical City, Riyadh, during 2012 - 2015 were studied prospectively. Patients were assessed by HAPS and Ranson's score. Predictability values of the two systems were analysed and compared

Results: Out of 116 patients studied, 104 [89.6%] were HAPS positive and predicted to have mild disease. Pancreatitis was mild in 101 [87%] but severe in 3 [2.6%] patients who scored >/= 3 Ranson's criteria. Among 12 HAPS negative patients, 10 scored >/= 3 Ranson's criteria and developed severe pancreatitis while 2 [1.7%] with 2 positive Ranson's criteria developed mild pancreatitis. HAPS correctly predicted the disease severity in 101 [87%] patients, a sensitivity of 98% specificity of 77% and accuracy of 96%. Ranson's system predicted correctly in all but took 48 hours for assessment. Statistical analysis showed moderate agreement [Kappa = 0.776, p < 0.001], and positive relation [rs = 0.777, p < 0.001] between the two scores

Conclusion: HAPS is effective in rapid identification of patient who will run non-severe course of AP. Assessment can be completed within one hour from presentation. Ranson's score, although more accurate, takes 48 hours to complete

Acute appending: diagnostic algorithm using routine ultrasonography and optional computed tomography

Objective: to access the algorithm in diagnosis of acute appendicitis, using routine ultrasonography and optional computed tomography [CT]

Material and Methods: it was prospective study of 128 patients presenting in emergency department with complaint of pain right lower quadrant of abdomen. After clinical evaluation and lab investigations, ultrasonography abdomen was done for all patients. If provisional diagnosis was made on these bases, treatment was started. If ultrasonography findings were negative or inconclusive, CT was done with intravenous contrast. The final diagnosis was made by ultrasonography/CT report, operative findings, histopathology report of the removed specimen and outcome of the treatment

Results: after completion of initial clinical workup and ultrasonography, we were able to make provisional diagnosis in 90 patients. Ultrasonography showed inflamed appendix in 76 patients, alternate diagnosis in 14 patients and in 38 patients report was normal or inconclusive. CT was done in these 38 patients. CT scan showed inflamed appendix in 15 patients and alternative diagnosis in 4 patients. In 19 patients CT report was normal. 91 patients were operated for open appendectomy. In 85 patients, inflamed appendix was proved on histopathology and in 6 patients, appendix was normal. Accuracy of clinical diagnosis alone was 81 %, with Ultrasonography was 85%, with CT was 97% and accuracy of whole diagnostic pathway was 95%

Conclusion: in suspected case of acute appendicitis, diagnosis algorithm using routine ultrasonography and optional CT yields high diagnostic accuracy. Patients with normal ultrasonography and CT findings can be safely observed