Papillon lefevre: syndrome: reconstruction of severly atrophic maxilla and mandible using iliac bonely by interpositional and onlay bone graft

Papillon-Lefevre syndrome is a rare autosomal recessive genetic disorder characterized by palmar-plantar hyperkeratosis, with rapidly progressive periodontitis and premature loss of both deciduous and permanent teeth. This article presents the reconstruction of jaws of a patient with Papillon-Lefevre syndrome with Iliac bone graft. Interpositional graft with Lefort I surgery in maxilla and Onlay bone graft in mandible in a 20-year-old female patient with Papillon-Lefevre syndrome was done. In our follow-up the bone grafts is clinically stable and no pain or infection was found. The patient continues to be seen at regular follow-up visits. Lefort I procedure and interpositional bone graft for reconstruction of maxillary in Papillon-Lefevre syndrome, make better profile in patients. We not only successfully treated our patient functionally and esthetically in first stage of treatment plane by bone grafting, but also provided psychological benefits to the patient

[Reconstruction and rehabilitation of a patient with mandibular ameloblastoma by resection and reimplantation: a case report]

One of the significant aspects in the treatment of extensive pathological bone lesions is the reconstruction of the created defect due to lesion resection. This article is a report of the defect reconstruction which was created in the mandible due to resection of an ameloblastoma using a two-stage procedure which was carried out at first by freezing the mandibular bone segment in liquid nitrogen followed by reimplantation of the mandibular body in its bed. This case is a 18-year-old man with mandibular ameloblastoma which was treated by hemimandibulectomy. The segment was immersed in liquid nitrogen and freezed for 4 months before reimplantment in the defect place in order to freeze and kill the residual tumor cells and as the framework after being filled with the patient's autogenous bone and bone marrow was consequently fixed in its place with miniplate. The grafts conformed to the receiving site thoroughly and there was minimum asymmetry in the face. The use of autogenous bone from the same region for reconstruction had a positive effect on the patient psychologically. The bone constructed with the best quantity and quality where the implants were inserted. This technique may be used as an alternative method for reconstruction of bone defects due to resection of mandibular pathological lesions together with other methods such as the free iliac crest graft or the fibula graft and also other methods

Comparing the effects of hands-on and hands-off breastfeeding methods on self-efficacy in primiparous mothers

Background and Purpose: Self-efficacy is a modifiable psychological variable in sustained breastfeeding that is defined as a mother's confidence in her perceived ability for successful and exclusive breastfeeding. Therefore, the present study was conducted in order to compare the effectiveness of "Hands on" and" Hands off" methods on breastfeeding self-efficacy in primiparous mothers

Materials and Methods: In this experimental single-blind study, 124 primiparous women were randomly assigned to one of the three groups. Participants in the experimental group received one of the structured one-on-one educational sessions [i.e., hands-off or hands-on] within the first two hours of giving birth to her child. Mothers in control group received usual postpartum care. Follow-up assessments were conducted one, four, and eight weeks after the birth. Data collection was done through interview forms, examination and observation, checklist of breastfeeding status, breastfeeding self-efficacy and dailyfeeding form. The obtained data were analyzed in SPSS using one-way ANOVA, Kruskal Wallis and correlation coefficient [p<0.05 was considered as significance level and test power of 80% was estimated]

Results: Mean score of self efficacy in the first week of handsoff and hands-on groups were 59.9 +/- 4.78 and 54.59 +/- 7.55 respectively; it was 56.6+/-8.93 in the routine care participants. In the fourth week, the figure amounted to 63.28 +/- 6.63 and 58.78 +/- 9.05 respectively; also, in the routine care participants it was 56.1 +/- 9.04. But in the eighth week, the figures were 66.7 +/- 5.3 and 61.7 +/- 8.4 respectively; it was 60.9 +/- 6.2 in the routine group. A statistically significant difference was demonstrated the three between treatment durations [p=0.000]

Conclusion: The hands-off education increased breastfeeding self efficacy in the first eight weeks after birth

[Effect of vitamin E on primary dysmenorrhea]

Dysmenorrhea is a common problem in young women. Although dysmenorrhea is not life threatening, it can have adverse effects on quality of life. Various treatments are offered for dysmenorrhea including vitamin E supplements. This study investigated the effect of vitamin E on primary dysmenorrhea. In this before-after clinical trial, 200 female students who suffered from primary dysmenorrhea were recruited to the study at Mashhad University of Medical Sciences. First, they filled a questionnaire including demographic characteristics and the pain measurement chart [duration and severity]. Then, they were divided into three groups: low, moderate and severe dysmenorrhea groups. Vitamin E [200 mg] tablets were administered to them and they were requested to have them once/day for five days [two days before and three days after the beginning of the menstruation]. They filled the pain measurement chart [duration and severity] after two treatment periods. Data were analyzed using t-student, chi-square, and variance analysis tests in SPSS software. The age of the students ranged 19-26 years old. The severity of dysmenorrhea was mild, moderate, and severe respectively in 28%, 60%, and 14% of the students. The mean of painful menstrual days was 2.05 in the first month, and 2.08 in the second month before using vitamin E. After using vitamin E, painful menstrual days were 1.63 in the first month and 1.64 in the second month. Regarding duration of painful days, all of the participants felt pain in the first day of menstruation. After using vitamin E, about one sixth of the participants in the first month and one fifth of them in the second month had no pain at first day. The severity of pain was 5.18 before using vitamin E that decreased to 3.40 after the intervention. Vitamin E administration in women, who suffer from primary dysmenorrhea, significantly reduces the severity and duration of pain. It can be used as an alternative treatment method in affected women

[Evaluation of the methods of placental removal during cesarean section and their postpartum complications]

Considering increasing rate of cesarean section [C/S] and post operative infection as its consequence, we presumed that manual removal of placenta is associated with increased rate of infection. The aim of this prospective study was to investigate the effect of placental removal methods on the amount of bleeding and development of post operative fever. In this study six hundred patients who needed C/S were assigned randomly into two groups, one group had spontaneous placental delivery [300 patients] and in the other group manual placental removal delivery [300 patients] was performed. All of caesarean sections were done by the same surgeon and after delivery of the neonate and clamping of umbilical cord placenta was either removed manually or spontaneously while massaging uterus and pulling umbilical cord slightly. The amount of bleeding during operation was estimated by measuring blood suctioned and weight of sponges before and after operation. Hct was measured 24 and 48 hours after operation and a 3% decrease of Hct was considered significant. Temperature of each patient was checked orally every four hours after operation. Diagnosis of endometritis was made based on two high temperatures higher than 38 centigrade degree, presence of suprapubic tenderness and alterations in the quality and quantity of lochia. Using SPSS software version 11, sstatistical analysis was performed by means of T test and chi square test. Mean age of the patients was 24.56 +/- 5.56 years. Two groups were evaluated and compared for decrease of Hct [>3%] during 24 and 48 hours after surgery which revealed a significant difference [P<0.001]. Fever was detected in 27 patients with spontaneous placental delivery [9%] and 44 patients with manual placental delivery [14.7%]. The difference between two groups was significant [P<0.05]. Comparison of the mean amount of bleeding during operation, measured based on the minimum and maximum weight of sponges and suctioned bloody amniotic fluid, showed a significant difference between two groups [P<0.001]. Duration of C/S in two groups showed no significant difference

Effect of gum chewing on prevention of post cesarean ileus

Post cesarean ileus is a common complication that induces abdominal distention, delays feeding, and increases hospitalization. Multiple studies showed that false nutrition increases the bowel movement. This study aimed to investigate the effect of gum chewing as false nutrition on the bowel movement and prevention of post cesarean ileus. In this randomized controlled trial, a total of 400 patients who were hospitalized in Mashhad Zeinab hospital were divided into two 200-patient groups. The groups were matched for age, gravity and duration of surgery. In the intervention group, gum chewing was started after surgery, 3 times/day until the regular diet was initiated. In the control group, patients underwent routine care by restricting oral intake until the bowel function was returned. The outcomes were time of the first bowel sound, flatus passage, defecation, ambulation of patients post cesarean, initiation regular diet, and hospitalization. Statistical analysis was performed using unpaired t-test and fishers exact probability test. The mean age, parity and operation time were similar in the two groups. All patients in the intervention group tolerated gum chewing immediately after surgery. The results showed the followings among the intervention group vs. control group, respectively: post operative time intervals to bowel sounds [14.7 hours vs. 16.6 hours; P=0.569], time intervals between surgery and abdominal distention [16.59 hours vs. 14.21 hours; P=0.01], first post operative defecation [28.16 hours vs. 32.21 hours; P<0.000], post operative time interval to onset diet [19.3 hours vs. 16.54 hours; P=0.000], post operative time interval to ambulation [20.14 hours vs. 17.58 hours; P=0.000], post operative lengths of ileus [31.13 hours vs. 30.35 hours; P=0.5], hospitalization [1.84 days vs. 1.92 days; P=0.02]. Gum chewing after cesarean section is safe and well tolerated and reduces post operative ileus, shortens mean duration of first defecation, decreases the time of returning to regular oral diet, shortens the time of patient ambulation and hospital discharge. Gum chewing is offered as a physiologic and inexpensive method to prevent or reduce post cesarean ileus

Study of nasal tip dropping after rhinoplasty

Since tip projection is an important factor for the nose esthetics, one of the results in rhinoplasty is maintenance, increase or decrease of nasal tip. The aim of this research was to measure nasal tip dropping in profile after rhinoplasties done on Maxillofacial Department of Taleghani Hospital, Tehran in 2003-2004. In this quasi experimental study, nasal tip dropping 2 months and 6 months after surgery in comparison with 20 days post operation in 28 patients were measured via profile photographs. Various variables such as tip projection, nasal length [NL], nasolabial angle [NLA] and [nose+upper lip length]/projection [N+UL/P] were calculated by computer software with accuracy of 0.01 mm and 0.1 degree. Paired T and ANOVA tests were used to compare the changes. Tip projection diminished slightly within 20 days to 6 months after rhinoplasty which means the tip had a little posterior movement. Nasolabial angle showed significant decrease [P<0.001] and increase in nose length was apparent [P<0.001]. Changes indicated the inferior dropping of nasal tip. Nose tip change were seen after 2 months and continued 6 months postoperatively. The postoperative changes between 20 days and 2 months, 2 and 6 months, and 20 days and 6 months for NL, NLA, N+UL/P were significant in all cases [P<0.05]. Nasal tip changes were greater in male than female but patient's age seemed not important. Septoplasty and tip graft did not have significant effect on nose tip. Nose tip moved inferiorly and posteriorly within 20 days and 6 months after surgery but inferior movement was more than posterior movement