Forces that fracture teeth during extraction with mandibular premolar and maxillary incisor forceps.

Our aim was to measure the forces that fracture teeth during extraction based on the effectiveness of the extraction forceps, and to compare them with data collected about forces applied to extracted teeth that did not fracture. We studied 208 patients whose teeth fractured during both the standard and our new method of extraction: maxillary incisors (n=79) extracted with forceps 1 (maxillary incisor forceps), and both maxillary (n=95) and mandibular incisors (n=34) extracted with forceps 13 (mandibular premolar forceps). Forces needed to fracture were assessed with a specially-designed instrument for measuring pressure and rotation. Mean (SD) pressure at the fracture site was significantly higher in maxillary incisors extracted with forceps 1 (1.26 (0.26) bar) then in both maxillary and mandibular incisors extracted with forceps 13 (0.96 (0.19) and 0.98 (0.16), p<0.001). Pressure at dislocation and both left and right rotation showed similar patterns. Pressure correlated to root surfaces of teeth ranging from r=0.35-0.54 but the correlation coefficients did not differ significantly between the teeth-forceps groups. Pressure was higher in fractured than in extracted teeth, and this varied from 3%-48%. In conclusion, forces that break teeth during extractions are sometimes only slightly higher than the extraction forces, so caution is needed during extraction.

Effect of root canal sealers on mouse peritoneal macrophage functions.

Three root canal filling materials, viz. calcium hydroxide-based cement (Apexit, resin-based cement (AH-plus) and glass-ionomer based material (Ketac Endo) were tested for their influence on several functions of peritoneal macrophages from Balb/c mice. Macrophage functions were evaluated by the adherence, phagocytic, candidacidal and Nitro blue tetrazolium-dye assays. Ketac-Endo enhanced all macrophage functions in the first 2 d (p < or = 0.05), when compared to the positive control, but this effect had changed after 7 and 14 d, causing inhibition of these functions. Other materials suppressed substrate adherence capacity and phagocytosis, while significantly stimulating macrophage microbicidal activity (p < or = 0.05) in a time-dependent manner.

Sonographic detection of multiple brain abscesses in a newborn with IgA deficiency.

We report the case of a neonate with selective IgA deficiency and multiple brain abscesses diagnosed with sonography. Brain sonography revealed multiple abscesses in the left hemisphere; the abscesses ranged from 10 to 20 mm. Cultures obtained from the cerebrospinal fluid and blood were positive for Proteus mirabilis. The neonate responded promptly to broad-spectrum antibiotic therapy and had no neurologic sequelae. Because IgA deficiency is associated with infections, we believe it was a predisposing factor for the brain abscesses.

[Intra-abdominelle Lymphangiome]. / Intra-abdominal lymphangioma - Case Report.

Intra-abdominal lymphangiomas are very rare. We report the unusual case of a 4-year-old boy, who presented with acute abdominal symptoms due to intracystic hemorrhage following a blunt abdominal trauma. After the diagnostic management, the radical resection was done with a good outcome.

Congenital tracheal stenosis treated with dilatation.

Congenital tracheal stenosis is a rare anomaly characterized by a broad spectrum of variations. Affected segments differ in the grade extent of stenosis, from thin webs to more severe stenoses such as short-segmental, funnel-like, or long-segment tracheal stenosis. A 5-month-old infant with persistent congenital stridor and acute respiratory distress is presented. Radiographic and tracheobronchoscopic investigations confirmed the diagnosis of congenital tracheal stenosis without associated vascular, pulmonary or gastrointestinal anomalies. The stenosis was of a fibrous nature and segmental morphology affecting the initial tracheal section. Dilatation was performed by a rigid tracheobronchoscope with favorable outcome. The reported case was classified into class 1 lesions, which are associated with low mortality and good prognosis. Dilatation performed with a rigid bronchoscope proved to be a rational therapeutic approach in this case. The possible diagnostic and other therapeutic approaches to congenital tracheal stenosis are also discussed.

Right atrial reduction for tachyarrhythmias in Ebstein's anomaly in infancy.

A 20-month-old girl with Ebstein's anomaly developed supraventricular paroxysmal tachycardia, which seemed to be a result of the wall tension of the giant right atrium. Right atrial resection reduced the wall tension and overall dimensions of the right atrium and finally resolved the tachycardia and ectopic electrical conduction. Six-year follow-up electrocardiograms confirmed continuing normal sinus rhythm without occurrence of supraventricular paroxysmal tachycardia or other ectopic electrical activity The follow-up echocardiograms showed the size of the right atrium to be unchanged from the time of operation. There are few data in the available literature about performing right atriotomy to resolve a tachyarrhythmia associated with Ebstein's anomaly and none, to the best of our knowledge, about performing right atrial resection for this purpose.

Primary bronchomalacia and patent ductus arteriosus: simultaneous surgical correction in an infant.

We report the clinical course of a 6-month-old girl with recurrent infection of the left lung, persistent wheezing, and a suspected congenital heart anomaly (patent ductus arteriosus. Chest radiography revealed hyperinflation and slight inflammation of the left lung. Tracheobronchoscopy and left-sided bronchography showed a collapsed segment of the left main bronchus, 3 cm long. Computed tomography confirmed hyperinflation of the left lung and atelectasis of the superior lobe. There were no signs of extramural compression. Color-flow Doppler echocardiography confirmed the suspicion of patent ductus arteriosus. To the best of our knowledge, there is no other report in the literature of a patient with this combination of anomalies. After receiving 2 weeks of antibiotic treatment, the patient underwent surgical repair The patent ductus arteriosus was closed by means of a triple-ligature procedure, and during the same operation a bronchopexy was performed, securing the left main bronchus to the closed ductus tissue by means of sutures. There have been no complications in the postoperative period. Clinical follow-up, as well as echocardiography and bronchoscopy, have yielded normal results 14 months after surgery.

Fetal tachydysrhythmia associated with nonimmune hydrops.

A case of fetal tachydysrhythmia with intermittent episodes of bradycardia associated with severe nonimmune hydrops was detected at 36 weeks of pregnancy. Paroxysms of supraventricular tachycardia were documented postnatally. Induction of labor and postnatal administration of digoxin showed to be a rational therapeutic approach in this case. In spite of some unfavorable clinical predictors the treatment resulted in a benign course of the disease.

Naphazoline nasal drops intoxication in children.

Naphazoline, a sympathomimetic and an imidazoline derivative, is used as 0.05-0.1% solution for local decongestion of the nasal and ocular mucosa. In excessive dosage, or if ingested by accident, may cause depression of the central nervous system (disturbances of consciousness progressing to coma), hypothermia, bradycardia and sweating. These naphazoline effects are particularly strongly pronounced in children. Anglo-Saxon pharmacotherapy excludes the application of naphazoline nasal drops in children younger than six years, whereas the Croatian pharmacotherapeutic literature (and practice) allows its use even in infancy. At the Kantrida Paediatric Clinic, Clinical Hospital Centre in Rijeka, 11 children with signs of intoxication with naphazoline nasal drops were hospitalized from 1990 to 1992. The symptoms pertaining to the central nervous system i.e. disturbances of consciousness in the form of somnolence were clearly marked in all children. Some children developed skin pallor, bradycardia, bradypnoea and hypothermia. Resolution occurred within 24 hours and the findings returned to normal values. Clinical picture followed by rapid resolution and normal findings, with a personal history of drug taking, is a safe indication for diagnosis. There are several reasons to account for intoxication (drops difficult to use with children, containers inadequate for proper dosage), but the major factor is the age of the patient--all hospitalized children were younger than six years. It is pointed out that administration of naphazoline drops at an early age is not advisable.

[Determination of the optimal dose of aminophylline in children with severe asthmatic attacks]. / Odredivanje optimalne doze aminofilina u djece s tezim astmaticnim napadajima.

The therapeutic effect of aminophylline in children having severe asthmatic attacks with a special emphasis on an appropriate dose, adequate administration and measurement of serum aminophylline concentrations is presented. The study group consisted of 24 patients with severe asthmatic attacks. The patients were assigned to three groups according to the dosage of aminophylline administered. Patients in Group 1 received a dose of 7 mg/kg body weight, those in Group 2 5 mg/kg body weight and those in Group 3 (previously treated with theophylline) 4 mg/kg body weight. For each patient, clinical and laboratory parameters were followed. The results demonstrated that adequate therapeutic response and optimal serum theophylline concentrations were achieved only in Group 1. Patients in which lower doses of aminophylline were employed (Group 2 and Group 3) showed neither the adequate therapeutic response not did achieve the adequate serum theophylline concentrations, and administration of aminophylline had to be repeated. In the majority of patients, mild hyperglicemia was noticed. The mechanism and the sequence of events how it occurred was not determined. In conclusion, this data show that aminophylline, if administered in an adequate dose, is a drug of choice in the treatment of children with severe asthmatic attacks.