Comparison of surgical techniques used in adult varicocele

Background: A varicocele is an abnormal dilatation of veins in the pampiniform plexus of the spermatic cord. Several methods have been used for its treatment including open surgical ligation of the spermatic vein as well as laparoscopic and microsurgical varicocelectomy

Objective: To compare laparoscopic varicocelectomy with open varicocelectomy techniques in patients of varicocele in terms of operative time, duration of hospital stay, recurrence rate and effect on semen parameters

Methodology: Study Design: Randomized clinical trial Setting: Punjab Medical College and affiliated hospitals. Duration: 27 September 2014 to 26 September 2016. A total of 129 patients of varicocele were included in the study. All patients were diagnosed clinically as having varicocele. 43 patients underwent laparoscopic varicocelectomy [group A], 43 open varicocelectomy using retroperitoneal approach [group B] and 43 underwent open inguinal approach[group C]. Outcome in terms of operative time, duration of hospital stay, recurrence rate and impact on semen parameters, was compared in three groups. The data was entered and analyzed by using SPSS version 20

Results The operative time and hospital stay in the laparoscopic group were significantly shorter than in retroperitoneal and inguinal groups [P < 0.01]. Recurrence rate was 18.6% in the open inguinal group, 16.27% in the retroperitoneal group, and 4.65% in the laparoscopic group. This lower rate of recurrence was statistically significant in the laparoscopic group [P < 0.05]. Among the three groups, comparisons between preoperative and postoperative semen parameters revealed improvements in sperm concentration and motility [P < 0.01]

Conclusion: Outcome of laparoscopic varicocelectomy is better than open varicocelectomy techniques in patients of varicocele

in-vitro evaluation of microleakage at the cervical margin between two different class ii restorative techniques using dye penetration method

Objective: To evaluate the coronal microleakage of packable composite using conventional incremental and posterior bulk fill flowable composite using Smart Dentine Replacement Single Step technique in the cervical margins of class II cavities in dentine using the dye penetration method

Study Design: In-vitro Interventional study

Place and Duration of Study: Department of Operative Dentistry, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences [DIKIOHS], Karachi, from November 2012 to April 2013

Methodology: One hundred and twenty extracted teeth [molars and premolars] were collected and randomly divided into two experimental groups [n=60 each] and were stored in normal saline until used. Fractured samples were excluded. Standardized class II proximal box only cavities were prepared and restored with conventional methacrylate based composite using incremental technique [Group A, n=40] and low stress methacrylate resin based composite SDR using single step technique [Group B, n=40]. Samples were sectioned horizontally below the cervical margins and specimen disks were prepared. The specimens were thermocycled and sealed with acid resistant varnish leaving a 1-mm interface around cervical margin and immersed in 2% methylene blue buffered solution for 24 hours. Leakage was scored 0 - 4 and measured in mm. It washed and sectioned to evaluate under stereomicroscope

Results: Mean penetration was 2.4280 +/-0.79 mm for Group A and 1.015 +/-0.45 mm for Group B [p < 0.001]. Maximum dye penetration score for group A was 4 and group B was 3

Conclusion: SDR technique in combination with total etch technique at the cervical margin of class II restorations improved the marginal seal, when were placed in dentine and thermocycled

Micromechanical intervention in sandwich restoration

Objective: To evaluate the sealing ability of two different types of Glass Ionomer Cements [GICs] used for sandwich restorations and assess the effect of acid etching of GIC on microleakage at GIC-resin composite interface

Study Design: Experimental study

Place and Duration of Study: Department of Operative, DIEKIOHS [DUHS] and NED University, Karachi, from February to June 2011

Methodology: Eighty cavities were prepared on the proximal surfaces of 40 permanent human premolars [2 cavities per tooth], assigned to 4 groups [n=20] and restored as follows: Group CIE - Conventional GIC [CI] was applied onto the axial and cervical cavity walls, allowed setting for 5 minutes and acid etched [E] along the cavity margins with 37% phosphoric acid for 15 seconds, washed for 30 seconds and dried; the adhesive system was applied and light cured for 10 seconds, completing the restoration with composite resin light cured for 40 seconds; Group CIN - same as Group CIE, except for acid etching of the CI surface; Group RME - same as CIE, but using a resin modified GIC [RMGIC]; Group RMN - same as Group RME, except for acid etching of the RMGIC surface. Specimens were soaked in 1% methylene blue dye solution at 37[degree]C for 24 hours, rinsed under running water for 15 minutes, bisected mesiodistally and dye penetration was measured following the ISO/TS 11405-2003 standard. Kruskal Wallis and post Hoc tests significant differences in the microleakage among all the four groups

Results: There was a significant difference between the two groups of GICs [RMGIC and CI, p=0.001]. There was no significant difference in between the two sub-groups that is between CIN and CIE [p=0.656], and between Groups RME and RMN [p=0.995]

Conclusion: Phosphoric acid etching of GIC, prior to the placement of composite resin, does not improve the sealing ability of sandwich restorations. RMGIC was more effective in preventing dye penetration at the GIC-resin composite dentine interfaces than CI

Overhanging amalgam restorations by undergraduate students

To determine the frequency of overhanging margins in amalgam restorations done by undergraduate students at Fatima Jinnah Dental College Hospital, Karachi. Observational study. Department of Operative Dentistry, Fatima Jinnah Dental Hospital, Karachi, from January to June 2009. Patients aged 20 - 45 years attending the Department of Operative Dentistry requiring class-II restorations were included in the study. Whereas, third molars, overlapped proximal surfaces, teeth adjacent to edentulous spaces and pregnant females were excluded. One hundred and fifty patients were selected randomly aged between 20 - 45 years requiring class-II restorations. Posterior Bitewing radiographs were taken and 1600 surfaces were examined. Restorations were done by undergraduate students at Fatima Jinnah Dental College Hospital, Karachi. Chi-square test was utilized to analyze the relationship between location and surface of overhang. Overhanging amalgam restorations were common in the restorations done by undergraduate students [58%]. The occurrence of overhangs was more frequent on the distal surfaces [56%]. Although the association of amalgam overhangs with the surfaces of the teeth was significant [p < 0.0001], overhangs were not significantly associated with the location of the teeth [p < 0.063]. Overhanging restorations were present in approximately 58% of all proximal amalgam restorations done by undergraduate students

Effectiveness of commonly available surface protecting agents in maintaining microhardness of two cements

To estimate the microhardness of glass ionomer cement [vitrofil] and resin modified glass ionomer cement [vitremere] in the presence and absence of different surface protections. An in-vitro experimental study. The Department of Operative Dentistry, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences and the Department of Material Sciences, NED University, Karachi, from August 2011 to January 2012. Seventy-two discs of each material were made in polytetrafluoroethylene mold which was 10 mm in diameter and 2 mm in thickness. Four groups were made for each material containing 18 discs; G1/G5 [control group], G2/G6 [solid petroleum jelly], G3/G7 vernal [resin varnish], G4/G8 [nail varnish]. After initial setting reaction surface protection was applied to discs. Once the surface protection was dried, discs were stored in deionized water at 37°C for 24 hours. After 24 hours, the discs were polished. Microhardness test were performed in digital microhardness tester. The results were statistically analyzed with the help of two-way ANOVA. For glass ionomer cement the only G4 [nail varnish] differed from the G1 [control group] [p < 0.05], No significant difference was seen with other surface protection agents. For resin modified glass ionomer cement, the G7 [resin varnish] and G8 [nail varnish] gave better result from the G5 [control group]. Nail varnish and resin varnish showed better surface protection for GIC and RMGIC. The presence of toluene in nail varnish have harmful effects so should not be preferred if resin varnish is available

Effect of different tetra pack juices on microhardness of direct tooth colored-restorative materials

To examine the effect of apple and orange juices on the surface h ardness of direct tooth-colored restorative materials. The materials included resin-modified glass ionomer cement [Vitremer 3M[tm] ESPE[tm] Core buildup restorative] and composite resin [Filtek[tm] 3M[tm] ESPE[tm] Z350]. A total of 45 disks of each restorative material were prepared. The disks were divided into groups of 15, which were immersed for 7 days in deionized water [G1/G4, control group], apple juice [G2/G5], or orange juice [G3/G6]. The pH of the apple juice was approximately 4.8 and the pH of the orange juice was approximately 4.9. Surface hardness tests were performed before immersion and at various times following immersion. Statistical analysis included two-way ANOVA with repeated measurement and Tukey's test. Exposure to juices significantly reduced the hardness of both materials [p < 0.05], while deionized water did not affect the surface hardness of either material. The ionomer cement experienced a greater reduction than the composite resin [p = 0.000]. There was no significant difference in the effect of apple and orange juices. Juice box-type fruit juices reduced the hardness of direct tooth-colored restorative materials. Material selection should be considered when planning restorations in patients who have experienced tooth surface loss. In terms of the materials evaluated in this study, the composite material provides greater durability under acidic conditions

Effect of different irradiation times on microhardness and depth of cure of a nanocomposite resin

To determine the microhardness and depth of cure of nanocomposite using different irradiation times on both upper and lower surfaces of composite material. In-vitro experimental study design. Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences and NED University of Engineering and Technology, Karachi, from March to May 2010. Total 120 cylinder shaped specimens; 60 specimens for depth of cure test and 60 specimens for micro hardness test were fabricated using A3 shade of nanocomposite [Filtek Z350 XT, 3M ESPE]. For each irradiation time four groups were made [Group 1 = 20s] [Group 2 = 30s], [Group 3 = 40s] and [Group 4 = 60s]. For each group fifteen specimens were used. The resin was placed and polymerized into a cylindrical plastic mold. Depth of cure was measured by using micrometer. Micro Vickers hardness was measured on both top and bottom surfaces. SPSS-16.0 was used for statistical analysis. There was statistically significant difference in the depth of cure between all groups showing the highest value in group 4 [p < 0.001]. For hardness on top surface, there was a statistically significant difference in between groups 1 and 2 [p=0.001], groups 1 and 3 [p < 0.001], groups 1 and 4 [p < 0.001] There was no statistically significant difference between groups 2 and 3, groups 2 and 4 and in between groups 3 and 4. For hardness on bottom surface, there was statistically significant difference in between all groups showing the highest value in group 4 [p < 0.001]. Depth of cure and hardness was increased by increasing irradiation time. Hardness on the top surface was higher than bottom surface values

Pattern of intestinal obstruction in children - a review of 200 consecutive cases

To identify the various causes of intestinal obstruction in children. Retrospective study. Department of Paediatric Surgery, Allied Hospital, Faisalabad from July 1995 to June 2009. The record of all children, between the age of 1 to 14 years, who presented with intestinal obstruction during the study period was reviewed. Two hundred children presented with intestinal obstruction. It was not an uncommon cause for admission from the emergency department [12.1%] and constituted 7.4% of the children operated in the unit. They were predominantly males [75%]. Average duration of symptoms was 3 days. The commonest causes were adhesions [31%], Meckel's diverticulum with band [15.5%], volvulus [12%] and incarcerated inguinal hernia [11.5%]. Wound infection [11%] and wound dehiscence [4%] were the common complications. Mortality rate was 2.5%. Intestinal obstruction is seen not infrequently in children and is associated with significant morbidity. Adhesions especially post operative have emerged as a leading cause. Early recognition and prompt treatment are needed

Unusual rootless eruption of a permanent maxillary central incisor: a case report

This report presents a case of rootless eruption of permanent central incisor following an intrusion injury to the primary teeth

Ultrasonics in endodontics

Ultrasonics have been widely used in many disciplines of dentistry. They have found indispensable applications in a number of dental procedures in periodontology, to a much lesser extent in restorative dentistry, while being very prominently used in endodontics. Ultrasonics in endodontics have enhanced the quality of treatment and represents an important adjunct in the treatment of difficult cases. This clinical article presents a few cases focusing on some of the applications of ultrasonics in endodontics

Hemisection: a case of external invasive cervical resorption

This report presents a case of external invasive cervical resorption of the distal root of lower right first molar tooth which was treated by hemisection. This report illustrate the importance of hemisection as a treatment option other than extraction

Moxonidine-in mild to moderate systemic hypertension

We have recently concluded a nation wide post marketing study on efficacy and safety of Moxonidine in mild to moderate hypertensives. In all 97 patients were enrolled and out of these 87 completed a 12 weeks trial. There was an average drop of 12.9 mmHg in the DBP and 16.5 mmHg in SBP. 80% patient required a daily dose of 0.2 - 0.4 mg of Moxonidine for control of their BP In 84% of the patients completing the trial the BP changed from moderate to mild or normal or from mild toonormal. The drug was well tolerated, only 2.3% having adverse effects. We conclude that the drug studied is an effective alternate for the control of hypertension