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Abstract Objective This is the first study to establish the utility of extended curettage with or without bone allograft for Grade II giant cell tumors GCTs around the knee joint with the aim of exploring postoperative functional outcomes. Methods We retrospectively reviewed 25 cases of Campanacci grade II GCTs undergoing extended curettage between January 2014 and December 2019. The participants were divided into two groups: one group of 12 patients underwent extended curettage with bone allograft and bone cement, while the other group of 13 patients underwent extended curettage with bone cement only. Quality of life was assessed by the Revised Musculoskeletal Tumor Society Score and by the Knee score of the Knee Society; recurrence and complications were assessed for each cohort at the last follow-up. The Fisher test and two-sample t-tests were used to compare the categorical and continuous outcomes, respectively. Results The mean age was 28.09 (7.44) years old, with 10 (40%) males and 15 females (60%). The distal femur and the proximal tibia were involved in 13 (52%) and in 12 (48%) patients, respectively. There was no significant difference in the musculoskeletal tumor society score (25.75 versus 27.41; p= 0.178), in the knee society score (78.67 versus 81.46; p= 0.33), recurrence (0 versus 0%; p= 1), and complications (25 versus 7.69%; p= 0.21). Conclusions Extended curettage with or without bone allograft have similar functional outcomes for the knee without any major difference in the incidence of recurrence and of complications for Grade II GCTs. However, surgical convenience and cost-effectiveness might favor the bone cement only, while long-term osteoarthritis prevention needs to be investigated to favor bone allograft.
Resumo Objetivo Este é o primeiro estudo a estabelecer a utilidade da curetagem estendida com ou sem enxerto ósseo em tumores de células gigantes (TCGs) de grau II na articulação do joelho com o objetivo de explorar os resultados funcionais pós-operatórios. Métodos Revisamos retrospectivamente 25 casos de TCGs de grau II de Campanacci submetidos a curetagem estendida entre janeiro de 2014 e dezembro de 2019. Os participantes foram divididos em 2 grupos: um grupo de 12 pacientes foi submetido a curetagem estendida com aloenxerto ósseo e cimento ósseo, enquanto o outro grupo, com 13 pacientes, foi submetido a curetagem estendida apenas com cimento ósseo. A qualidade de vida foi avaliada pela Pontuação Revista da Musculoskeletal Tumor Society (MTS, na sigla em inglês) e pela Pontuação da Knee Society (KS, na sigla em inglês), enquanto as taxas de recidiva e complicações foram avaliadas em cada coorte na última consulta de acompanhamento. O teste de Fisher e os testes t de duas amostras foram usados para comparação de resultados categóricos e contínuos, respectivamente Resultados A média de idade dos pacientes foi de 28,09 (7,44) anos; 10 (40%) pacientes eram do sexo masculino e 15 (60%) pacientes eram do sexo feminino. O fêmur distal e a tíbia proximal foram acometidos em 13 (52%) e 12 (48%) dos pacientes, respectivamente. Não houve diferença significativa na pontuação revista da MTS (25,75 versus 27,41; p= 0,178), na pontuação da KS (78,67 versus 81,46; p= 0,33) e nas taxas de recidiva (0 versus 0%; p= 1) e complicações (25 versus 7,69%; p= 0,21). Conclusões A curetagem estendida com ou sem aloenxerto ósseo tem resultados funcionais semelhantes em pacientes com TCGs de grau II no joelho, sem qualquer diferença importante na incidência de recidivas e complicações. No entanto, a conveniência cirúrgica e o custo-benefício podem favorecer a utilização apenas de cimento ósseo, enquanto a prevenção da osteoartrite em longo prazo precisa ser investigada para favorecer o enxerto ósseo.
Subject(s)
Humans , Bone Cements , Bone Transplantation , Curettage , Giant Cell Tumors , Knee/surgeryABSTRACT
BACKGROUND: Cement-augmented pedicle screw is an effective fixation for osteoporotic spine, and it is important to reduce the rate of cement leakage. OBJECTIVE: To evaluate the stability of cementing the apical and terminal pedicle screw applied in osteoporotic spine with lumbosacral degenerative disease by finite element analysis. METHODS: An intact finite element model of L2-5 segment was established by using CT scan data of one normal male volunteer. After verifying the validity of the intact model, the cementing apical and terminal pedicle screw and cement-augmented pedicle screw models of double/multi-level segment fixation were established, respectively. A 150 N vertical axial pre-load was imposed on the superior surface and a 10 N·m moment was applied on the superior surface along the radial direction to simulate six different physiological motions: flexion, extension, left bending, right bending, left rotation, and right rotation. The different of range of motion, cage stress, and pedicle screw stress on fixed segments were compared between models. RESULTS AND CONCLUSION: (1) The validity showed that the range of motion of the intact model was similar to cadaveric studies in all directions. (2) The range of motion of cementing the apical and terminal pedicle screw group was slightly larger than that of cement-augmented pedicle screw group and the difference between the two groups was less than 0.15°. The two fixation methods could maintain the similar stability of the operation segment. (3) The difference of the cage stress and instrument stress was also small between the two groups. (4) These results suggest that compare with cement-augmented pedicle screw, cementing the apical and terminal pedicle screw can increase the approximate stability in double-level and multi-level segment fusion. The cementing the apical and terminal pedicle screw procedure may reduce the risk of cement leakage and patient costs, and offer a useful alternative to the cement-augmented pedicle screw procedure.
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Abstract Introduction The attachment of fiberglass posts is achieved through an adhesive process. Failures in adhesion may occur due to the hydrolytic degradation of the adhesives, or to the degradation of the collagen fibres of the hybrid layer by intrinsic enzymes. Objective To evaluate the effect of chlorhexidine and sodium hypochlorite treatment on bond strength to dentin. Material and method Thirty bovine roots were randomly distributed into 3 groups (n=10): a) Control, b) 2% Chlorhexidine, and c) 5% Sodium Hypochlorite. Next, RelyX® ARC resin cement was used to cement the post. Each specimen resulted in samples from the three root thirds that were submitted to the pushout test (MPa) at 24 hours and 12 months. Bond strength values were analysed using the Kolmogorov-Smirnov, 3-way ANOVA and Tukey tests. The fracture mode of the pin was also analysed using stereomicroscopy. Result There were no significant differences between treatments at the immediate time (p=0.0644) or in the interaction of factors (p=0.1935). After one year, the experimental groups showed no significant differences in bond strength in relation to the control group, with the exception of the cervical third of the chlorohexidine group in which there was a significant loss of adhesion. As for the fracture mode, there was a predominance of the mixed type in all groups and thirds. Conclusion The use of chlorhexidine or hypochlorite provides neither benefits nor losses in the adhesive bond strength of fiberglass posts. However, there is an influence of the root thirds, with the worst bond strength in the apical third.
Resumo Introdução A fixação de pinos de fibra de vidro é realizada através de um processo adesivo. Falhas podem ocorrer na adesão devido à degradação hidrolítica dos adesivos, ou pela degradação das fibras colágenas da camada híbrida por enzimas intrínsecas. Objetivo Avaliar o efeito do tratamento com clorexidina e hipoclorito de sódio sobre a resistência de união adesiva à dentina. Material e método Trinta raízes bovinas foram distribuídas aleatoriamente em 3 grupos (n=10): a) Controle, b) Clorexidina 2% e c) Hipoclorito de Sódio 5%. Após, para a cimentação do pino radicular, utilizou-se o cimento resinoso RelyX® ARC. Cada espécime resultou corpos-de-prova dos três terços radiculares, os quais foram submetidos ao teste de pushout (MPa) nos períodos de 24 horas e 12 meses. Valores de resistência de união foram analisados pelos testes de Kolmogorov-Smirnov, ANOVA (three-way) e de Tukey. Analisou-se ainda o modo de fratura do pino, através de estereomicroscopia. Resultado Não houve diferenças significativas entre tratamento no tempo imediato (p=0,0644) ou na interação dos fatores (p=0,1935). Após um ano, os grupos experimentais não promoveram diferença significante na resistência de união em relação ao controle, com exceção do terço cervical do grupo clorexidina, onde houve uma perda significativa de adesão. Quanto ao modo de fratura, houve predominância do tipo mista em todos os grupos e terços. Conclusão O uso de clorexidina ou hipoclorito não promove benefícios ou prejuízos na resistência de união adesiva de pinos de fibra, mas há influência dos terços radiculares, sendo a pior resistência de união no terço apical.
Subject(s)
Sodium Hypochlorite , In Vitro Techniques , Chlorhexidine , Cementation , Dental Pins , Resin Cements , Dental Pulp Cavity , DentinABSTRACT
Resumen Introducción y objetivo: En la actualidad, la rehabilitación de dientes tratados endodónticamente representa una gran demanda para el ejercicio profesional del rehabilitador oral. Por esta razón, surge la necesidad de identificar y manejar los procesos básicos y los determinantes biológicos que influencian un buen proceso de adhesión dentinal. El objetivo de este estudio fue caracterizar la capa híbrida en dentina intraradicular pretratada con hipoclorito de sodio (NaClO) al 5,25% usando dos agentes cementantes con sistemas adhesivos de auto y grabado convencional. Materiales y métodos: Se seleccionaron 40 dientes premolares unirradiculares que fueron distribuidos aleatoriamente en 4 grupos. Grupo A (dentina pretratada con NaClO al 5,25% y cementado con cemento Relyx® Ultimate (3M), grupo B (control del grupo A, sin pretratamiento de dentina); grupo C (dentina pre-tratada con NaClO al 5,25% y cementado con cemento paraCore®) y grupo D: Control del grupo C, sin pretratamiento de dentina. Los dientes fueron seccionados transversalmente y se analizó la presencia de capa híbrida en los tercios cervical y medio radicular a través de microscopia electrónica de barrido. Resultados: Se encontraron diferencias estadísticamente significativas en el grosor de la capa híbrida de dientes pretratados con NaClO al 5,25% y cementados con paraCore® en comparación a los cementados con Relyx® ultimate valor p = 0,023 para la prueba de Anova.
Abstract Introduction and objective: At present, the rehabilitation of endodontically treated teeth is a huge demand for professional in oral rehabilitation. For this reason, the need to identify and manage the core processes and biological determinants that influence a good process of dentinal adhesion. The aim of this study was to characterize the hybrid layer in dentin intraradicular pretreated with sodium hypochlorite (NaClO) 5.25 % using two cementing agents with self adhesive systems and conventional etching. Materials and Methods: 40 single-rooted premolar teeth which were randomized into 4 groups were selected. Group A: dentin pretreated with 5.25% NaClO 5.25% and RelyX® Ultimate cemented with cement (3M). Group B: (control group A, without pretreated dentin). Group C: dentin pretreated with NaClO 5.25% and cemented with cement ParaCore® and group D: Control group, not pretreated of dentin. The teeth were transected and the presence of hybrid layer was analyzed in cervical thirds and root medium by scanning electron microscopy. Results: Statistically significant differences in the thickness of the hybrid layer of teeth pretreated with NaClO 5.25% met and bonded with paraCore® compared to cementated with RelyX® Ultimate value p = 0.023 Anova test.
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Objective To evaluate the effect of cementing ditch-based project on schistosomiasis control in the irrigation ar-ea of Dingshen River basin in Shitai County,Anhui Province.Methods The data of Oncomelania hupensis snail surveys from 2009 to 2015 and the data of schistosome infections in humans and livestock from 2009 to 2015 were collected,and the changes of the epidemic situation were analyzed and compared before and after the project.Results In the cementing ditches,the occur-rence rate of living snails decreased by 68.79% and the average density of living snails decreased by 97.78%,whereas in the control areas without ditch hardening,the occurrence rate of living snails increased by 72.49% and the average density of living snails increased by 37.16%.The infection rate in humans decreased by 100%.Of 161 bovines examined with the egg-hatching method during the period,no infections were found.Conclusion The cementing ditch-based project has a good effect on reduc-ing the density of snails and controlling schistosomiasis.
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Resumen Objetivo: Comparar la resistencia al desplazamiento de cuatro agentes cementantes. Material y métodos: Se realizó una investigación prospectiva, transversal y experimental en la que se evaluaron cuatro agentes cementantes, tres de ellos resinosos autoadhesivos de polimerización dual y con contenido de MDP (10-metacriloxidecil dihidrógeno fosfato) y un ionómero de vidrio convencional. Se realizaron 40 muestras de zirconia parcialmente estabilizada con itrio, se dividieron en cuatro grupos, cada uno de ellos fue tratado de acuerdo con las indicaciones del fabricante del cemento a estudiar, se realizaron las muestras, se almacenaron en humedad al 100% en una cámara a una temperatura de 37 °С durante 24 horas para después ser sometidas a pruebas mecánicas de desprendimiento por cizallamiento a una velocidad de 1 mm por minuto en la máquina universal de pruebas mecánicas. Resultados: La muestras de ionómero de vidrio fracasaron antes de ser llevadas a la maquina universal, entre los otros tres cementos no existe diferencia estadísticamente significativa. Conclusiones: La capacidad de adhesión de ionómero de vidrio a la zirconia es nula o muy baja. Igualmente los cementos resinosos que contengan en su fórmula MDP, ya sea en su agente de acoplamiento o en la fórmula misma de los cementos, son en la actualidad la mejor alternativa para incrementar la adhesión a una superficie de zirconia.
Abstract Objective: To compare displacement resistance of four cementing agents. Material and methods: An experimental, cross-sectioned prospective research was conducted to assess four cementing agents. Three agents were resinous, self-adhesive, dual polymerization cements containing MDP (10-metacryloxydecyl dihydrogen phosphate), and the remaining was a conventional glass ionomer cement. In the experiment, 40 samples of zirconia partially stabilized with yttrium were prepared. All samples were treated following their specific manufacturer's instructions. Samples were prepared, they were then stored at 100% humidity in a temperature chamber at 37 °С for 24 hours; after this, samples were subjected to shearing detachment mechanical tests at a 1 mm per minute speed in a universal machine for mechanical testing. Results: Glass ionomer samples failed before being taken to the universal testing machine. Remaining three cements did not show statistically significant differences. Conclusions: Adhesion capacity of glass ionomer to zirconia is nil or extremely low. Likewise, resinous cements containing MDP in their formula, either in their bonding agent or in the cement formulation itself, are presently the best alternative to increase adhesion to a zirconia structure.
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Objective: To know the finishing effect, in order to be able to safely proceed with the cores preparation in the daily clinic, without compromising the prosthetic restoration longevity. Methods: This study used 48 human single-rooted premolars, which after the section of its crowns, were endodontically treated, and its root canal prepared 8 mm deep to receive cores casting in cobalt-chrome alloy. Cementing was made with zinc phosphate and the tensile test performed at different preparation times: G1 - without re-preparation after cementation (control); G2 - re-prepared 24 hours after cementation, and G3 - re-prepared 15 minutes after cementation. Results: Statistical analysis showed no significant difference in the tensile strength values in the different groups (p = 0.233), in other words, the core re-preparation 15 minutes or 24 hours after the cementation caused no significant reduction in tensile strength between the core and the root remaining when using the zinc phosphate cement. Conclusion: The metallic core re-preparation cast 15 minutes or 24 hours after cementation caused no significant reduction in tensile strength between the cast metallic core and the root remaining, although in absolute values there was an important difference.
Objetivo: Saber o efeito desse acabamento, para que se possa prosseguir com a preparação desses núcleos na clínica diária de forma segura, sem comprometer a longevidade da restauração protética. Métodos: Utilizou-se neste estudo, 48 pré-molares unirradiculares humanos, que após a secção de suas coroas, foram tratados endodonticamente, e seus condutos radiculares preparados com 8 mm de profundidade para receber núcleos fundidos em liga de cobalto-cromo. A cimentação foi feita com fosfato de zinco e o teste de tração realizado em diferentes tempos de preparação: G1- sem repreparo após a cimentação (controle); G2- repreparados 24 horas após a cimentação e G3- repreparados 15 minutos após a cimentação. Resultados: A análise estatística revelou não haver diferença significativa nos valores de resistência à tração nos diferentes grupos (p = 0,233), ou seja, o repreparo do núcleo após 15 minutos ou 24 horas da cimentação não causou redução significativa na resistência à tração entre o núcleo e o remanescente radicular quando se empregou cimento de fosfato de zinco. Conclusão: o repreparo do núcleo metálico fundido após 15 minutos ou 24 horas da cimentação não causou redução significativa na resistência à tração entre o núcleo metálico fundido e o remanescente radicular, embora em valores absolutos tenha havido uma diferença importante.
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Objective: To present the histopathological and clinical correlation of mycetoma among patients attending King Abdulaziz University Hospital between 1998-2013. Methods: The data of all histopathologically diagnosed mycetomas in the period between January 1998 and January 2013 were collected through a computerized database search of the anatomic pathology archives at King Abdulaziz University Hospital. The collected data were analysed. Identification of species were performed for five patients using 16S ribosomal DNA and internal transcribed spacer 2. Results: There were 19 patients with mycetoma with an average age of 44.26 years and male: female ratio of 4:1. Actinomycetoma were 63.15% and eumycetoma were 36.84%. All patients presented with the classic lesions; presenting as painless subcutaneous mass, sinuses and discharge containing grains. The swellings were of slow evolution, with preferential foot localization. Species specification performed for samples from five patients with active lesions revealed species of Actinomyces israelii and Madurella mycetomatis in respective cases. Conclusions: Actinomycetoma is more common than eumycetoma in this region. The fact that one of the patients with eumycetoma was a Saudi national raises the possibility of an indigenous species similar to Maduraella mycetomatis to be further explored for characteristics and pathogenesis. The disease has to be prioritized again and more robust and quick molecular diagnostic tools should be made available in order to save patients form disfiguring amputations.
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Aim: The aim of this study was to evaluate the influence of different regions of dentin within the post space on the retention of fiber posts. Materials and Methods: Ten human incisors with straight roots were selected for this study. Endodontic treatment of the specimens was done. The post spaces were created immediately after obturation and the posts were luted with dual-cure resin cement. Approximately 2.5-mm-thick sections were made from the coronal, middle, and apical thirds of the post space and thus we had three groups: Group I: Cervical, Group II: Middle, Group III: Apical. The specimens were tested on a universal testing machine. Statistical analysis was done using the unpaired Student's t-test and one-way ANOVA test. Result: The best push-out strength was obtained with the apical sections (14.69±0.298 MPa), followed by the middle (10.66±0.34 MPa) and cervical sections (9.73±0.42 MPa). Conclusion: highest pust out strengths were obtained in apical sections followed by middle and coronal.
Subject(s)
Cementation , Composite Resins , Dental Bonding , Dental Cements/standards , Dental Materials/standards , Dental Prosthesis Retention/methods , Humans , Polymers , Resin CementsABSTRACT
PURPOSE: To analyze the effectiveness of a two-stage revision surgery for an infected total hip arthroplasty. MATERIALS AND METHODS: Between 1988 and 2005, twenty-four patients (24 hips, 18 males, 6 females) with documented infection of total hip arthroplasty were reviewed and followed for at least two years postoperatively. The preoperative and postoperative clinical and radiologic findings and blood laboratory work were compared. Eight arthroplasty cases were performed through retention of the femoral stem and removal of the acetabular cup with cementing by impregnated antibiotics in the first stage of the operation, and subsequent acetabular cup revision in the second stage of the operation. RESULTS: After the first stage of the operation, infectious organisms were cultured in 19 patients, and isolated Staphylococcus aureus was cultured in 14 patients. The mean follow-up period was 8.2 years, and the average Harris hip score improved to 88.4 points at last follow-up. Radiologic osteolysis was noted in 5 cases, and possible loosening was demonstrated in 1 case. The erythrocyte sediment rate (mm/hr) and C-reactive protein (mg/L) were 43.8/14.2 preoperatively and 17.9/8.3 postoperatively. There were 2 recurrences of infection, for an eradication rate of 91.7% (22 of 24). CONCLUSION: Two-stage revision for an infected total hip arthroplasty proved to be an excellent method with a high eradication rate.
Subject(s)
Humans , Male , Anti-Bacterial Agents , Arthroplasty , C-Reactive Protein , Erythrocytes , Follow-Up Studies , Hip , Osteolysis , Recurrence , Retention, Psychology , Staphylococcus aureusABSTRACT
Fifty-eight primary total hip arthroplasties with hyhrid cemented femoral component using contemporary cementing technique and cementless acctahular cup were followed for a minimum 3 year(ranged, 36 to 67 months, mean 4.1 years). Thc average age of the patients at the time of the operation was 54 years(ranged, 22 to 73 years). The preoperative common diagnosis were avascular necrosis of femoral head in 38 hips and miscellaneou. in 20 hips. The mean Harris hip score was 61 in preoperative and 91 in postoperative at last Follow-up. 5-1 hips(92%) were rated excellent and good clinically. One hip was revised for aseptic loosening of the femoral stem at 52 months follow-up. Radiographically no acetahular component was loose. Three femoral stems were definitely loose, one stem was classfied as prohahle loosenine and another one was ratde as possible loosening. There was no progressive radiolucent dermaation ol' cement-hone interf'ace in stable fermoral steni. Non progressive cement-bone radiolucency was lound seven hips in zone 1, two hips in zone 6, one hip in zone 2 and one hip in zone 7 at last follow-up. There were two postoperalive dislocations. Other complications included superficial infection(two hips) and sciatic nervc palsy(one hip). Our experience showed that the hyhrid hip replaccment with improved cementing technique provided satisfactory results at minimum 3 year follow-up study and emphasized the importantance of careful cementing techniques in survival ot cemented I'cmoral stem.
Subject(s)
Humans , Arthroplasty , Arthroplasty, Replacement, Hip , Diagnosis , Joint Dislocations , Dronabinol , Follow-Up Studies , Head , Hip , NecrosisABSTRACT
In the past 13 years period, authors experienced 14 cases of giant cell tumor, 3 of which were treated by bone cementing after curettage. The results of various methods of treatment applied were compared and literatures surveyed. The followings were noted: 1. The most efficient method of treatment for giant cell tumor is en bloc resection. 2. The method of bone graft after curettage has such disadvantages as high recurrence rate and sequelae due to long periods of immoblization, especially for the large lesion with severe bone destruction. 3. Bone cementing after curettage seemed to be a choice in the methods of primary treatment of long bone giant cell tumor, especially useful for the tumors near the knee joint; the main advantages over other methods of treatment were considered to be technical simplicity and lack of complications.