Remineralization potential of grape seed extract hydrogels on bleached enamel compared to fluoride gel: An in vitro study.

BACKGROUND: Remineralizing of bleached enamel is a common procedure that aims to compensate enamel mineral lose. This study aimed to evaluate the remineralization effectiveness of experimentally prepared grape seed extract hydrogels (GSE) compared to fluoride gel on bleached enamel. MATERIAL AND METHODS: Thirty extracted maxillary incisor were bleached using white smile bleaching agent. Bleached specimens were divided into three groups (10/group) according to the remineralizing agents tested: [GSE 6%, GSE 10%, or fluoride gel]. After bleaching and remineralization procedure, the specimens were stored in artificial saliva at 37°C. Micro-hardness and Energy-Dispersive X-ray and ultra-morphological evaluation were tested at baseline, after bleaching and after remineralization. RESULTS: Statistical significant decrease on mean micro-hardness values had resulted after bleaching procedure compared to baseline, followed by a significant increase in GSE (10%) and fluoride groups. GSE (6%) application showed the least statistical significant mean micro-hardness, which was statistically insignificant different compared to bleaching procedure. Elemental analysis results revealed a statistical significant decrease on Ca, and Ca/P ratios (At%) values after bleaching compared to baseline, followed by a significant increase after treatment with all tested remineralizing gels. SEM photomicrograph of sound enamel shows smooth uniform appearance with few pores. Bleached enamel showed irregular pitted disorganized enamel surface. Bleached enamel exposed to GSE and fluoride gel showed occlusion of enamel surface porosities and precipitates of different sizes. CONCLUSIONS: The specially prepared GSE hydrogels has positive effects on the remineralization process of bleached enamel making it an effective natural agent with remineralizing potential. Key words:Remineralization, bleaching, grape seed extract, fluoride, enamel.

Factors determining the amount of residual urine in men with bladder outlet obstruction: Could it be a predictor for bladder contractility?

OBJECTIVE: To determine from urodynamic data what causes an increased postvoid residual urine volume (PVR) in men with bladder outlet obstruction (BOO), urethral resistance or bladder failure, and to determine how to predict bladder contractility from the PVR. PATIENTS AND METHODS: We analysed retrospectively the pressure-flow studies (PFS) of 90 men with BOO. Nine patients could not void and the remaining 81 were divided into three groups, i.e. A (30 men, PVR < 100 mL), B (30 men, PVR 100-450 mL) and C (21 men, PVR > 450 mL). The division was made according to a receiver operating characteristic curve, showing that using a threshold PVR of 450 mL had the best sensitivity and specificity for detecting the start of bladder failure. RESULTS: The filling phase showed an increase in bladder capacity with the increase in PVR and a significantly lower incidence of detrusor overactivity in group C. The voiding phase showed a significant decrease in voided volume and maximum urinary flow rate (Q max) as the PVR increased, while the urethral resistance factor (URF) increased from group A to B to C. The detrusor pressure at Q max (PdetQ max) and opening pressure were significantly higher in group B, which had the highest bladder contractility index (BCI) and longest duration of contraction. Group C had the lowest BCI and the lowest PdetQ max. CONCLUSIONS: In men with BOO, PVR results from increasing outlet resistance at the start and up to a PVR of 450 mL, where the bladder reaches its maximum compensation. At volumes of >450 mL, both the outlet resistance and bladder failure are working together, leading to detrusor decompensation.

Different urodynamic patterns in female bladder outlet obstruction: Can urodynamics alone reach the diagnosis?

OBJECTIVE: To define the different urodynamic patterns in female bladder outlet obstruction (BOO) and to assess whether urodynamics alone can be relied on for the diagnosis. PATIENTS AND METHODS: This prospective study included 60 clinically obstructed women and 27 with stress urinary incontinence as a control group. All patients had pressure-flow studies and were divided into four groups. Group A (control group, 27 patients) and group B (22) had a maximum urinary flow rate (Q max) of >15 mL/s and a detrusor pressure at Q max (P det Q max) of <30 or >30 cm H2O, respectively. Group C (20 patients) and group D (18) had a Q max of <15 mL/s and a P det Q max of >30 or <30 cm H2O, respectively. RESULTS: The mean Q max for groups A, B, C, and D were 21.8, 21.9, 10.8 and 9.9 mL/s, respectively, while the mean P det Q max was 20.8, 40.4, 48.7, and 18.7 cm H2O, respectively. The residual urine volume was <100 mL in groups A and B but >100 mL in groups C and D. When compared with group A, groups B-D had a significant difference in vesical pressure, groups B and C had a significant difference in P det Q max, while Q max, the maximum voided volume and residual urine volume were significantly different in groups C and D. Group A was obviously unobstructed, group B might have early obstruction, group C had compensated obstruction, while group D can be considered to have late de-compensated obstruction. CONCLUSIONS: BOO in females has three different urodynamic patterns, i.e. early, compensated and late obstruction. However, urodynamics should be combined with the clinical presentation and residual urine volume for an accurate diagnosis.

Do women have realistic expectations of treatment for stress urinary incontinence?

AIMS: Our objective was to determine what women find acceptable regarding treatment and outcomes for treatment of stress urinary incontinence (SUI), and correlate this to age, distress and quality of life (QOL). MATERIALS AND METHODS: This prospective cross-sectional IRB-approved study evaluated women with primary SUI. One hundred sequential women (mean age, 53.8 years) answered questionnaires on initial interview, including the Urogential Distress Inventory (UDI-6), the American Urologic Association QOL questionnaire, as well as other validated questions regarding treatment options and possible outcomes. Statistical analysis was performed using Chi Squared, Fisher Exact, and t tests as well as the Wilcoxon Rank Score. RESULTS: Of the 100 women who submitted questionnaires, 22% overall expected a complete cure, 57% a good improvement, 12% to be able to cope better, and 9% expected any improvement at all. We found this to be a realistic expectation of possible outcomes of treatment, with 79% expecting a good improvement or cure for their SUI. The women were also asked what type of treatment they found acceptable for their SUI: 22% found a major surgery acceptable, 39% found a minor surgery acceptable, 32% found a clinical procedure acceptable, and 7% found medication acceptable. The majority of women (71%) found a minor surgery, like a transobturator tape, or a clinical procedure, like collagen injection, most desirable. These results were then analyzed for correlation to age, degree of distress (measured by UDI-6), and QOL (measured by AUA QOL score). CONCLUSIONS: Overall women have realistic expectations of treatment for SUI. They are willing to accept varied results depending on their distress regarding incontinence. Choices regarding treatments are influenced by age, severity and quality of life. It may be beneficial to include the UDI-6, age and QOL score as a part of the work up and planning for treatment of SUI to better meet patient's expectations.