Accuracy of the Raypex-4 and Propex apex locators in detecting horizontal and vertical root fractures: an in vitro study.

Unforeseen root fractures during endodontic therapy are often difficult to diagnose and treat. Apex locators have been shown to be accurate in measuring the working lengths of root canals, and it was postulated whether they could also be used to determine the position of root fractures. This study was undertaken to assess the accuracy of two different apex locators in determining the position of fractures. One hundred single rooted teeth were randomly divided into two groups. One group had simulated horizontal fractures cut into them and the other group had vertical fractures. All fractures were detected in both groups using both a Propex (third generation) and a Raypex-4 (fourth generation) apex locator. The actual lengths of the fractures were then measured under 2.5 times magnification, and the results subjected to statistical analysis. Both locators produced similar results and were found to be very accurate, with measurements that correlated closely to the actual lengths. Clinically, treatment options for root fractures vary depending on their location. Thus apex locators may be a valuable aid in not only determining the presence of a root fracture, but also its exact location, which will help the clinician decide on the most appropriate management.

A prospective, longitudinal study of the renin-angiotensin system, prostacyclin and thromboxane in the first trimester of normal human pregnancy: association with birthweight.

BACKGROUND: Very early human pregnancy is a state of cardiovascular underfilling. The renin-angiotensin system (RAS) is directly concerned with sodium and water homeostasis. Angiotensinogen is known to be the rate-limiting component in the generation of angiotensin I, and hence angiotensin II, in pregnancy. The usual measurement of 'renin activity' does not differentiate between enzyme and substrate. We hypothesized that the RAS is activated from the start of pregnancy; plasma renin concentration (PRC) and angiotensinogen will show differential regulation and might stimulate the rise in prostacyclin. METHODS: A prospective study of 12 nulliparous normal women. PRC and angiotensinogen and excretion of prostacyclin and thromboxane metabolites were measured pre-pregnancy and four to six times after conception to 13 weeks. RESULTS: By 6 weeks gestation, mean PRC was markedly raised and remained stable to 13 weeks. The initial angiotensinogen response varied, but rose consistently after 6-8 weeks. Regression analysis showed angiotensinogen in the first trimester to be strongly associated with corrected birthweight centile (P < 0.001). Excretion of eicosanoid metabolites was very variable, but rose significantly from 6 weeks; the ratio between prostacyclin and thromboxane excretion did not alter over this time. There was no correlation between the various hormones measured. CONCLUSION: Angiotensinogen is known to be rate-limiting in pregnancy. Its association with birthweight may be through effects on early plasma volume expansion and may have implications for intrauterine growth restriction and pre-eclampsia.

Endoscopic suspension of bladder neck for treatment of female stress urinary incontinence.

Between the years 1984 and 1993, a total of 72 female patients underwent endoscopic suspension of bladder neck for treatment of stress urinary incontinence at the King Hussein Medical Center and Hamad General Hospital, Amman, Jordan. The age of the study patients ranged between 32 and 75 years (mean: 46.5 years). Fifteen (20.8%) had history of previous operations for incontinence. The overall success rate achieved was 93.1%. Post-operative complications were encountered in seven (9.8%) patients within follow-up period of 4 to 43 months. Treatment failure occurred in five patients (6.9%). Our experience further confirms that endoscopic suspension of the bladder neck is a simple and reliable procedure in the treatment of female stress urinary incontinence.

Gangrene of the penis due to strangulation by a metallic ring.

We present a case of a 32-year-old crippled patient who presented with gangrene of the penis due to strangulation by a magnetic metallic ring which is used to increase potency and prolong erection. The ring was removed and conservative treatment was tried for eight days but failed. Amputation of the penis was done was refashioning of the urethra at the tip of the stump.