Comparative study of the osteoblastic activity of two implant systems (Endopore versus Entegra) utilizing single photon emission computed tomography (SPECT): experimental study in pigs model / Estudio comparativo de la actividad osteoblástica de dos sistemas de implantes (Endopore versus Entegra) utilizando tomografía computarizada por emisión de fotones individuales: estudio experimental en modelos porcinos

Implantology has been an important component of dental management for over forty years, and during that period, many configurations of implant materials and methods have been developed. As empirical and clinical research yield new implant materials, there has been need to test and compare these materials to provide the most cost-effective and efficient implants. Evaluation of efficiency of implants has relied heavily on histological and radiological methods, but these one-dimensional measurement methods fail to evaluate the osteoblastic activity and osseointegration properties of putative implants. In this report, we describe the use of a quantitative single photon emission computed tomography (SPECT) as a tool for comparing the osseointegrating capabilities of two types of implants.

La implantología ha sido un componente importante del tratamiento odontológico durante más de cuarenta años, y durante ese período, se han desarrollado muchas configuraciones de materiales y métodos de implante. A medida que la investigación empírica y clínica proporciona nuevos materiales de implante, ha surgido la necesidad de probar y comparar estos materiales para lograr que los implantes sean lo más costo-efectivos y eficientes posible. La evaluación de la eficiencia de los implantes ha dependido considerablemente de los métodos histológicos y radiológicos, pero estos métodos de medición unidimensional no son útiles a la hora de evaluar la actividad osteoblástica y las propiedades osteointegradoras de los implantes putativos. En este reporte, describimos el uso de la tomografía computarizada por emisión de fotones individuales (SPECT) como herramienta para comparar las capacidades osteointegradoras de dos tipos de implantes.

Prevalence and antimicrobial susceptibility pattern of pathogens isolated from patients with juvenile periodontitis in Jamaica: a prospective multi-centre study of 15 cases over a 15-year period / Prevalencia y patrón de susceptibilidad antimicrobiana de patógenos aislados de pacientes con periodontitis juvenil en Jamaica: estudio prospectivo multicentro de 15 casos por un período de más de 15 años

Prevalence and antimicrobial susceptibility pattern of most frequent pathogens isolated from patients treated with juvenile periodontitis at three separate dental centres in Jamaica from 1989 to 2003 were studied. Swabs were taken from these patients periodontal pathologic pocket or root of most of their teeth with active disease processes. These swabs were processed at the microbiology department of the University Hospital of the West Indies Kingston, Jamaica and the Microbiology laboratory, School of Veterinary Medicine, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago. The identification of the microorganisms from positive cultures and their antimicrobial susceptibility profile were performed using standard microbiological procedures and dick diffusion (KirbyBauer) methods. Over 80% of the patients were females. The most frequent microorganisms isolated were Enterobacter (40.5%), followed by Klebsiella species (19%) and Acinetobacter species (10.8%).Actinobacillus actinomycetemcomitans, a widely known key pathogen in juvenile periodontal diseases was encountered only in 5.4% (2/37) of the cases in this study. The most frequent organism isolated were still highly susceptibility to the commonly used and available antimicrobials such as amoxycillin/clavulanate,trimethoprim/sulphamethoxazole, chloramphenicol and aminoglycosides. The most frequent pathogens encountered in this study were totally different from what obtains in other places. There is the need to be aware of microbes in other countries during the microbiology investigations of juvenile periodontitis and that the antimicrobial chemotherapy should always be based on susceptibility test results. Surgical treatment for mechanical debridement of the site and bone grafting with guided tissue regeneration should be mandatory in conjunction with specific antimicrobial chemotherapy.

Se estudió la prevalencia y el patrón de susceptibilidad antimicrobiana de los patógenos más frecuentemente aislados de los pacientes tratados por periodontitis juvenil en tres diferentes centros odontológicos en Jamaica de 1989 a 2003. Se tomaron muestras de las bolsas patológicas periodontales de estos pacientes, o de la raíz de la mayor parte de sus dientes, en medio del proceso activo de la enfermedad. Las muestras fueron procesadas en el departamento de Microbiología del Hospital de la Universidad de West Indies, Kingston, Jamaica, y en el laboratorio de Microbiología, Escuela de Medicina Veterinaria, Facultad de Ciencias médicas, Universidad de West Indies, San Agustín, Trinidad y Tobago. La identificación de los microorganismos a partir de cultivos positivos y su perfil de susceptibilidad antimicrobiana, se realizaron mediante procedimientos microbiológicos estándares y métodos de difusión por disco (KirbyBauer). Más del 80% de los pacientes eran mujeres. Los microorganismos más frecuentemente aislados fueron Enterobacter (40,5%), seguido por especies de Klebsiella (19%) y Acinetobacter (10,8%). Actinobacillus actinomycetemcomitans - un patógeno clave ampliamente conocido en enfermedades periodontales juveniles - se encontró sólo en 5,4% (2/37) de los casos en este estudio. Los organismos más frecuentemente aislados mostraban todavía una alta susceptibilidad frente a los antimicrobianos comúnmente usados y disponibles, tales como amoxicilina/clavulanato, trimetoprima/sulfametoxazol, cloranfenicol y los aminoglicósidos. Los patógenos más frecuentemente encontrados en este estudio fueron totalmente diferentes de lo que se obtiene en otros lugares. Es necesario tomar conciencia de los microbios en otros países durante las investigaciones de microbiológicas de la periodontitis juvenil, y no perder vista que la quimioterapia antimicrobiana debe basarse siempre en las pruebas de susceptibilidad. El tratamiento quirúrgico para el desbridamiento mecánico del sitio, así como el injerto óseo con regeneración tisular guiada debería, deben ser obligatorios en conjunción con la quimioterapia antimicrobiana específica.

Single photon emission computerized tomography in the evaluation of the osteoblastic activities of a new bone regeneration technique: analysis of 12 mandibular sites in six experimental pigs / La tomografía computarizada por emisión de fotón único en la evaluación de las actividades osteoblásticas de una nueva técnica de regeneración ósea: análisis de 12 sitios mandibulares en seis cerdos experimentales

OBJECTIVES: To utilize single photon emission computerized tomography performed in sequence to determine the osseo-integrating capabilities and osteoblastic activities of a new bone regeneration technique called the membrane - sandwich technique (Ogunsalu sandwich bone regenerating technique) and to compare the quality and quantity of bone formed by this bone regeneration unit to bone regeneration obtained by using the same particulate bone grafting material covered with interceed® (another type of bio-resorbable membrane). DESIGN AND METHOD: Single photon emission computerized tomography bone imaging was performed in sequence on the mandible of a total of 6 pigs on both the right and left side (total of 12 sites) at two and a half hours following the injection of technetium 99m methylene diphosphate. Imaging was performed using a Siemen Orbitar II gamma camera. The projection data was acquired in a 128 x 128 matrix over 180 arc and SPECT reconstruction was performed using a filtered back projector method with a Shepp-Logan Hanning filter and a cut-off frequency of 0.4. The surgical defect on one side of the jaw was treated with the sandwich unit with Bio-oss particulate bone within it, while the other side contained the same quantity of Bio-oss as in the left side but just covered with interceed® membrane. The osteoblastic uptake on the side with the classical sandwich was compared to the side with the particulate bone covered with interceed® membrane for dynamic physiological activities. The average activity for both sides was calculated and compared. RESULT: For all the 12 sites, osteoblastic activities were recorded and indicated that vascularized bone was formed at all the experimental sites. Autogenous bone graft was confirmed to be superior to xenograft using this sandwich technique. Furthermore, the osteoblastic activities on the sandwich side were seen to be more when compared with the control side (Interceed® side). CONCLUSION: The Ogunsalu sandwich bone regeneration technique has been successfully evaluated with SPECT which shows osteoblastic activity with formation of vascularized bone which integrates with the surrounding bone.

OBJETIVOS: Utilizar la tomografía computarizada por emisión de fotón único (TCEFU) realizada en secuencia, a fin de determinar la capacidad óseo-integradora y las actividades osteoblásticas de una nueva técnica de regeneración del hueso, denominada técnica de membrana-sándwich, y comparar la calidad y cantidad de hueso formado por esta unidad de regeneración ósea con la regeneración ósea obtenida mediante el mismo material de injerto de hueso particulado cubierto con interceed® (otro tipo de membrana bioreabsorbible). DISEÑO Y MÉTODO: Mediante TCEFU, se realizó un estudio de imágenes óseas en secuencia, de la mandíbula de un total de 6 cerdos, a los lados izquierdo y derecho (un total de 12 sitios) a las dos horas y media, luego de una inyección de difosfato de metileno marcado con tecnecio 99 m. El examen de imágenes fue realizado usando una cámara gamma Siemens Orbiter tipo II. Los datos de la proyección fueron adquiridos en una matriz de 128 x 128 sobre un arco de 180 y la reconstrucción con TCEFU se realizó usando un método de retroproyección filtrada, con un filtro Shepp-Logan-Hanning y una frecuencia de corte de 0.4. El defecto quirúrgico en un lado de la mandíbula fue tratado con la unidad de sándwich con hueso particulado bio-oss dentro, mientras que el otro lado contenía la misma cantidad de Bio-oss del lado izquierdo, pero cubierto con una membrana de interceed®. La respuesta osteoblástica en el lado con el sándwich clásico fue comparada con el lado del hueso particulado cubierto con la membrana de interceed® en cuanto a actividades fisiológicas dinámicas. La actividad promedio de ambos lados fue calculada y comparada. RESULTADO: En los 12 sitios, las actividades osteoblásticas fueron registradas de forma indicando que se formó hueso vascularizado en todos los sitios experimentales. Se confirmó que el injerto óseo autógeno es superior al xenoinjerto que usa esta técnica de sándwich. Además, se observó que las actividades osteoblásticas en el lado del sándwich eran más en comparación con el lado control (lado del interceed®). CONCLUSIÓN: La técnica de Ogunsalu para la regeneración ósea por "sándwich" o membrana inter-posicional, ha sido exitosamente evaluada mediante TCEFU, concluyéndose que la misma consiste en la actividad osteoblástica con formación de hueso vascularizado que se integra al hueso circundante.

Single photon emission computerized tomography and histological evaluation in the validation of a new technique for closure of oro-antral communication: an experimental study in pigs / Tomografía computarizada mediante emisión de fotones simples y evaluación histológica en la validación de una nueva técnica para el cierre de la comunicación oroantral: un estudio experimental en cerdos

Various bone regeneration techniques have evolved recently but controversies regarding vascularization and integration of such bone grafting techniques have led occasionally to animal experiment to validate such techniques. The objective of this study was to evaluate the evidence of vascularization and osseo-integration of a new bone regeneration technique utilized for the closure of oro-antral communication (OAC) by an experimental model in which Single Photon Emission computerized Tomography and histological studies were conducted in pigs. We conclude that the sandwich technique used for the closure of OAC results in a vascularized new bone formation which eventually osseo-integrate with the surrounding bone. Also, this experimental study confirmed that autogeneous bone graft was superior to xenografts when used within the sandwich unit.

Varias técnicas de regeneración de huesos han sido desarrolladas recientemente, pero las controversias con respecto a la vascularización e integración de tales técnicas de injerto de hueso han llevado de vez en cuando a la experimentación con animales, a fin de validar estas técnicas. El objetivo de este estudio fue evaluar la evidencia de vascularización e integración ósea de una nueva técnica de regeneración de hueso utilizada para el cierre de la comunicación oro-antral (COA), mediante un modelo experimental en el que se practicó la tomografía computarizada mediante emisión de fotones simples y se realizaron estudios histológicos en cerdos. Concluimos que la técnica de sándwich usada para el cierre de COA da lugar a una formación ósea vascularizada que acaba produciendo una oseointegración con el hueso circundante. Asimismo, este estudio experimental confirmó que el injerto óseo antólogo es superior a los xenoinjertos cuando se usa dentro de la unidad de sándwich.

A new radiological classification for ameloblastoma based on analysis of 19 cases / Nueva Clasificación Radiológica del Ameloblastoma Basada en el Análisis de 19 Casos

OBJECTIVE: To describe ameloblastoma of the jawbone in young Jamaicans, with special emphasis on radiological findings, and to introduce a radiological classification which could assist in the categorization of these cases according to their biological behaviour and hence their subsequent surgical and medical management. SUBJECTS AND METHODS: The series comprised all the 18 cases of ameloblastoma of the jaw seen in patients under the age of 20 years in the two major hospitals in Jamaica with an oral and maxillofacial surgery department from 1980 to 1995. Radiological and histological diagnosis was confirmed in all. A case of maxillary ameloblastoma in a 13-year old girl seen in the year 2000 was also included in this study. This last case had special attributes. RESULTS: All 19 patients had primary lesions of ameloblastoma. The mean age was 16.1 years with a mode of 18 years and a range of 13 to 19 years. The male to female ratio was 1.1:1. Eighteen cases were seen in the mandible and one case in the maxilla. Of these, 42were unilocular and 58were multilocular radiologically. Thirty-two per cent of cases had unerupted teeth associated with the lesions and 32had root resorption. Based on our new radiological classification, the most predominant radiological type was IIb2 with root resorption (42). There was no radiological type classically simulating dentigerous cyst (Ia2). CONCLUSION: Ameloblastoma in young Jamaicans presented more in the adolescent period and are predominantly unicystic and rare in the maxilla. A new classification for ameloblastoma based solely on radiological presentation is adopted.

Suicide by poisoning

An epidemiological evaluation was conducted on 270 patients who died at the General Hospital, Port-of-Spain after presenting with deliberate self-poisoning between January, 1986 and June, 1990. The cause of death was confirmed by autopsy and toxicological analysis. Epidemiological variables of age, sex, race, precipitating factors and types of poison used were assessed. It was found that the male to female ratio was 2.7:1. East Indians accounted for 54.4%, Africans 42.0%, people of mixed ethnic origin 3% and Caucasians 0.6%. The majority of cases (52.6%) were seen in the age group 11-34 years. "Lovers' quarrels" (35.4% of cases), psychiatric illness (27.8% of cases) and family disputes (27% of cases) were reported as the most frequent precipitating events in suicide. East Indians predominated in those suicides precipitated by "lovers' quarrels" and family disputes, accounting for 63.2% and 58.9% of these cases, respectively; while for those suicides in which psychiatric illnesses were the main precipitating event, Africans were represented by 53.3% and East Indians 45.3%. Depression was the most common psychiatric illness diagnosed. Paraquat was the most popular poison used in 63.7% of the suicidal cases, and other agrochemicals were used in 20% of the cases.

Spontaneous pneumothorax in acute paraquat toxicity

Spontaneous pneumothorax as a presenting feature of acuteparaquat toxicity is as yet unreported. A review of the literature has shown that there has been one reported case of spontaneous pneumothorax occurring after paraquat (Nakaoka et al, 1987). The two cases of paraquat ingestion presented in this report are associated with spontaneous pneumothorax in the acute phase. A proposed mechanism for the development of the pneumothorax is discussed

Pulmonary embolism as a cause of death

To investigate the present status of pulmonary embolism as the cause of death in a general hospital population, the author reviewed 610 autopsy reports, and associated hospital records for the period 1985-1989. Pulmonary embolism was the major contributing factor to the cause of death in 61 (10%) of the 610 autopies performed. Of the patients dying from major pulmonary embolism, in only 12 (19.7%) was the diagnosis suspected antemortem; and in 44 (72%) deep vein thrombosis was detected in the femoral-popliteal vein at autopsy. The mean age of patients dying fron major pulmonary embolism was 52.2 years, and 31 (50.8%) victims were under the age of 50 years. Fifty-six (92%) of patients dying from pulmonary embolism were of African descent while 5 (8%) were of East Indian descent. Without autopies, 49 (80.3%) patients dying of pulmonary embolism would have been incorrectly certified and registered in death statistics based on clinical certification only

Ectopic pregnancies in Trinidad: a clinico-pathological study of 154 consecutive surgically treated cases

A prospective study was conducted during the period August 1, 1985 to July 31, 1986 from ten hospitals in Trinidad and Tobago to determine the incidence and aetiology of ectopic gestations. One hundred and fifty-four cases ectopic gestations were diagnosed in 153 patients, durign the period of study,with eight patients having a previous ectopic gestation. The incidence of ectopic gestation was 9.02 per 1,000 births. Ectopic pregnancies were more common in women of African descent (64,29%) as compared to East Indian women (27.27%) and were most often seen in the 21 to 35-year-old age group where they accounted for 72.07% of the total. There were 16.23% ectopic gestation in the 36 to 42-year-old age group. Fifty-six per cent of the ectopica gestations occurred in the right fallopian tube. Ninety-one per cent were ruptured and 80.13% had histological evidence of chronic salpingitis. The maternal mortality from ectopic gestations was 1.3%. One primary ovarian ectopic gestation (0.65%) and one twin ectopic pregnancy were seen during the period os study

Sudden cardiac death caused by coronary ostial compression by an aneurysm of the sinus of valsalva

A 22-year-old man was asymptomatic until he died suddenly after being starled. Post-mortem examination was normal except for aneurysmal dilatation of the left Sinus of Valsalva, the upper margin fo which formed a flap-like ridge, partially occluding the ostium of the left main coronary artery which arose immediately above it. Further compression of this "slit-like" orifice by aneurysmal distention was the proposed cause of myocardial ischaemia and arrhythimic death

Chroriocarcinoma presenting as a ruptured tubal ectopic pregnancy

A case of a choriocarcinoma of the fallopian tube presenting as a ruptured tubal ectopicpregnancy is described. The patient's satisfaactory clinical course over a twelve-month period is docimented, and factors that govern the prognosis of this once rapidly fatal disease are discussed

Adenomyosis uteri: a prospective study in Trinidad & Tobago, January-May, 1986

A prospective study of the incidence of adenomyosis uteri encountered in 200 consecutive hysterectomies and 21 consective myomectomies was conducted at the Port-of-Sapin General Hospital during the period January to May, 1986. The observed incidence of adenomyosis was 47%. Adenomyosis uteri was commonest amongst the most highly fertile group of women, namely the East Indian group. There was no case of adenomyosis uteri amongst the Caucasians in this study. Adenomyosis uteri was seen most often in women in their fifth decade of life; 62.8% of the patients had menorrhagia and or dysmenorrhea. The average dimension of the corpus uteri with classical adenomyosis uteri was 10 x 8 x 4 cm which corresponded to a uterus of 8 - 10 week sixe gestation. Basal and proliferative glands were seen in 53.9% of the adenomyotic foci. Hyperoestrogenic lesions had a 53.9% association with adenimyosis uteri which was diagnosed in only 4.8% of cases pre-operatively

Leiomyioma of the nasal cavity

Leiomyoma of the nasal cavity is described in a 32-year-old Trinidadian woman. This is the first such case to be reported in the Commonwalth Carbbean, and the world literature

Primary ovarian ectopic pregnancy with the use of an intrauterine contraceptive device

A case of a primary ovarian ectopic pregnancy occuring in a 33-year-old Trinidadian woman who was using an intra-uterine contraceptive device is presented. This rare type of ectopic gestation is the first such case to be documented and reported from Trinidad