Determining the minimum inhibitory concentration of Tetraclean against Candida albicans.

The purpose of the present study was to determine the minimum inhibitory concentrations of Tetraclean, chlorhexidine, hydrogen peroxide, and sodium hypochlorite against Candida albicans.Amphotericin B was used as positive control and RPMI plus 1 ml Candida suspension was used as negative control. Serial dilution method was used to determine MIC of the irrigants. Findings showed that all positive controls demonstrated complete inhibition of C. albicans at concentration of 0.78 microg mL(-1). On the other hand, all negative controls were positive for fungal growth which confirms the methodology of the study. Findings showed that the MIC of CHX was significantly lesser than other tested irrigants (p < 0.05). The MICs of other groups in an ascending order were as follows: Tetraclean, NaOCl, and H2O2. However, the difference betweenTetraclean and NaOCI was not significant (p > 0.05). It can be concluded that MIC of CHX was significantly lower than other irrigations solutions which confirms its strong antifungal activity.

The effect of ascorbic Acid on the substantivity of tetraclean in sodium hypochlorite-treated bovine dentin.

OBJECTIVE: The purpose of this study was to assess the in vitro effect of ascorbic acid on the antibacterial substantivity of Tetraclean in bovine root dentin pretreated with sodium hypochlorite (NaOCl). MATERIALS AND METHODS: Eighty dentin tubes prepared from bovine incisor teeth were infected with Enterococcus faecalis for 14 days. The specimens were divided into five groups as follows: Tetraclean; 5.25% NaOCl/Tetraclean; 5.25% NaOCl/ascorbic acid/Tetraclean; infected dentin tubes (positive control); and sterile dentin tubes (negative control). At experimental times of 0, 7, 14, 21 and 28 days, dentin chips were removed from the canals by sequential sterile low-speed round burs with increasing diameters of 025, 027, 029, 031 and 033 ISO sizes, respectively. After culturing, the number of colony-forming units (CFU) was counted. RESULTS: In all experimental groups, the number of CFU was minimum in the first cultures and the results obtained were significantly different at any time period (p < 0.05). The Tetraclean group showed the most effective antibacterial action at all five experimental periods (p < 0.05). NaOCl/Tetraclean group showed the least antibacterial activity at all time periods. The NaOCl/ascorbic acid/Tetraclean group showed similar antibacterial substantivity to the Tetraclean group at all time periods (p> 0.05). CONCLUSION: Ascorbic acid prevents the decrease of residual antibacterial activity of Tetraclean in dentin samples pretreated with NaOCl.

Comparison of the surface tension of 5.25% sodium hypochlorite solution with three new sodium hypochlorite-based endodontic irrigants.

AIM: To investigate the surface tension characteristics of 5.25% sodium hypochlorite and three recently introduced sodium hypochlorite solutions, which had been modified to reduce their surface tension: Chlor-Xtra, Hypoclean A and Hypoclean B. METHODOLOGY: Freshly produced MilliQ water was used as a reference liquid. All measurements of surface tension were taken by the Wilhelmy plate technique, using a Cahn DCA-322 Dynamic Contact Angle Analyzer at the temperature of 22 °C. A glow-discharge cleaned glass slide was immersed in 5 mL of the test liquid in a beaker cleaned with hot chromic acid, rinsed with MilliQ water and finally air plasma-cleaned in a glow-discharge reactor. The force on the glass slide was recorded continuously by the instrument software as the beaker was raised and withdrawn at the constant speed of 40 micron/s, until at least 1 cm of the glass slide was immersed. The typical accuracy was 0.5 mJ m(-2). For each sample, fifteen measurements were taken, and mean values were calculated. A Kruskal-Wallis anova analysis, followed by Mann-Whitney's U rank sum test for pair-wise comparisons, was used to compare surface tension values. Statistical significance was set at α = 0.05. RESULTS: MilliQ water (72.13 mJ m(-2)) and 5.25% sodium hypochlorite (48.90 mJ m(-2) ) had the highest surface tension values (P < 0.01) compared to Chlor-Xtra (33.14 mJ m(-2)), Hypoclean B (30.00 mJ m(-2) ) and Hypoclean A (29.13 mJ m(-2)). Hypoclean A had the lowest surface tension (P < 0.01). CONCLUSIONS: The new 5.25% sodium hypochlorite solutions modified with surfactants, Hypoclean A and Hypoclean B, had surface tension values that were significantly lower (P < 0.01) than Chlor-Xtra and 5.25% NaOCl. Because of their low surface tension and increased contact with dentinal walls, these new irrigants have the potential to penetrate more readily into uninstrumented areas of root canal system as well as allow a more rapid exchange with fresh solution, enabling greater antimicrobial effectiveness and enhanced pulp tissue dissolution ability.

Substantivity of three concentrations of tetraclean in bovine root dentin.

In the present study, the residual antibacterial activity, or substantivity, of three concentrations of Tetraclean (Ogna Laboratori Farmaceutici, Muggiò, Italy) was assessed in bovine root dentin in vitro. One hundred ten dentin tubes prepared from bovine incisor teeth were infected in vitro for 14 days with Enterococcus faecalis. Thereafter, the specimens were divided into five groups as follows: 100% Tetraclean, 10% Tetraclean, 1% Tetraclean, sterile dentin tubes (negative control), and infected dentin tubes (positive control). Dentin chips were collected with round burs into tryptic soy broth and, after culturing, the number of colony-forming units (CFU) was counted. The number of CFU was minimal in the first cultures in all experimental groups, and the results obtained were significantly different in the different groups at all time periods (p<0.05). At all five experimental periods, the 100% Tetraclean group showed the most effective antibacterial action (p<0.05). In each group, the number of CFU increased significantly with time (p<0.05). There was a direct relationship between the concentration of Tetraclean and its substantivity. In conclusion, under the conditions of the study presented here, the substantivity of 100% Tetraclean was significantly higher than that of lower concentrations.

Laser application in tooth bleaching: an update review.

Since the development of laser, a variety of potential applications for lasers in endodontics such as pulp diagnosis, disinfection of the root canal system, canal shaping, obturation of the root canal, apicoectomy, treatment of dentin hypersensitivity, and tooth bleaching have been proposed. The aim of this paper was to review the benefits and drawbacks of laser tooth bleaching.

Elective surgery in patients with congenital coagulopathies and inhibitors: experience of the National Haemophilia Centre of Venezuela.

Elective surgery in patients with congenital haemophilia with inhibitors carries a high risk of bleeding. However, inhibitor patients also have a high risk of haemarthroses and other orthopaedic complications, and surgery could improve their quality of life. Successful elective surgery has been reported in inhibitor patients under haemostatic cover with plasma-derived activated prothrombin complex concentrate (pd-aPCC) or recombinant activated factor VII (rFVIIa). Recombinant FVIIa has recently become available in Venezuela and, unlike pd-aPCC, has not been associated with an anamnestic response. The aim of this study was to assess our experience using rFVIIa as a first-line and sustained treatment in elective invasive surgical procedures at the National Haemophilia Centre in Venezuela. Surgical procedures were classified as major or minor, under haemostatic cover with rFVIIa. A total of 13 patients (12 with haemophilia A with high-responding inhibitors and one with von Willebrand's disease type 3) underwent a total of 19 surgical procedures under rFVIIa cover. Thirteen procedures were classified as major surgeries. Intraoperative haemostasis was achieved in the majority of patients. Only two patients required an additional dose of rFVIIa, at 30 min and 75 min, respectively, with good results. Postoperative haemostasis was considered effective in 16 of 18 (89%) of the procedures in haemophilia A patients. Treatment was considered to be ineffective in two patients because of excessive postoperative bleeding. Data from the study provide no safety concerns, and demonstrate that rFVIIa provides effective haemostatic cover in elective surgery in patients with inhibitors; research is ongoing to determine the optimal dose for such procedures.

Chemical synoviorthesis with oxytetracycline clorhydrate (Emicine) in recurrent haemarthrosis.

This is a non-controlled experimental prospective clinical study that evaluates the satisfactory results in the chemical synovectomy (synoviorthesis) with oxytetracycline clorhydrate (Emicine, Lab. Pfizer Ltda, Guarulhos, Sao Paulo, Brazil) in recurrence haemarthrosis in different joints, demonstrating that it is an effective method in the treatment of these recurrent haemarthrosis in haemophilia. 84 patients of whom 77 concluded the full course of treatment. 82 joints were injected. The dosage injected was 5 cm(3) of the drug (25 mg) in 5 cm(3) of anaesthesia for the knee, 2 cm(3) with 1 cm(3) of anaesthesia for the elbow and 1 cm(3) plus 1 cm(3) of anaesthesia for the ankle. These injections were administered once weekly with a reinforcement in 1 month. In case of failure the same can be administered repeatedly. Subjective parameters included pain, range of movement and use of the joint involved. Pain decreased from a mean of 6.5 to 0.9 (Likert scale). Range of movement increased from 5.9 to 9 and joint use increased from 5.9 to 9.2. Objective parameters included joint diameter and range of movement. Range of movement for flexion and extension improved from 72.2 and 149.2 to 73.7 and 167, respectively, for the knees. From 57.3 and 160 to 66.6 and 170, respectively, for the shoulder. And, from 22.7 and 10.8 to 34 and 18.6, respectively, for the ankle. This procedure has multiple advantages such as immediate therapeutic effect, short period of treatment, easy technique, much less AHF coverage (30% above coagulation level), less costly than radiocolloid treatment, which make it a perfect alternative treatment for developing countries.

Evaluación de la radiografía de cadera frente a la tomografía tridimensional en pacientes con parálisis cerebral / Hip X-rays versus 3-D CAT scans in patients with cerebral palsy

Introducción. Se estudiaron 17 pacientes con diagnóstico de parálisis cerebral, para evaluar la utilidad de los rayos X de cadera frente a la tomografía 3D. Material y método. Se compararon 3 parámetros radiológicos con 4 parámetros tomográficos tridimensionales. Resultados. Se obtuvieron resultados que correlacionan significativamente a los estudios radiológicos con los tomográficos. El ángulo CE de Wieberg mostró 28 caderas displásicas y 6 normales. El índice de Reimers 29 caderas displásicas y 5 dentro de límites normales. El índice acetabular 4 caderas normales y 30 caderas subluxadas. En los parámetros tomográficos el ángulo cérvico-diafisiario femoral presentó una media de 147,09° con un rango entre 127° y 175°, lo que demuestra un promedio más alto de lo normal. El ángulo de anteversión femoral obtuvo los siguientes resultados: media de la muestra 33,43°, rango superior 50°, rango inferior 9°. Se observa un valor aumentado de la anteversión. El índice acetabular axial mostró un promedio de índice axial acetabular de 120,29°, siendo el valor normal 101,6° para los 9 años de edad, lo que se asocia con aplanamiento del acetábulo. El ángulo de anteversión acetabular presenta una media de 13,11° con un rango entre 24° y 7°, lo que representa una paridad en los resultados. Conclusiones. La indicación de radiografías está justificada para el diagnóstico y pronóstico de displasia de cadera. La cobertura acetabular y las evaluaciones para cirugías deben estudiarse y programarse con tomografías tridimensionales

Introduction. Seventeen patients diagnosed with cerebral palsy were studied to assess the results of X-rays vs. 3D CAT scans of the hip. Materials and methods. 3 X-ray parameters were compared with 4 3D CAT scan parameters. Results. The results obtained showed a significant correlation between X-rays and CAT scans. According to the assessment of the Weinberg Central Edge (CE) angle there were 28 dysplastic hips and 6 normal hips. According to the Reimers index there were 29 dysplastic hips and 5 normal hips. According to the acetabular index there were 30 subluxated hips and 4 normal hips. Using CAT scan parameters the mean value of the femoral neck-shaft angle was 147.09° (range: 127°-175°), a higher-than-normal figure. The mean value of the femoral anteversion angle was 33.43° (range 9°-50°), also higher than usual. The mean axial acetabular index was 120.29°, with a normal value of 101.6° at 9 years of age associated with acetabular flattening. The mean acetabular anteversion angle was 13.11° (range 7°-24°), which indicated a parity of results. Conclusions. X-rays are necessary for the diagnosis and prognosis of hip dysplasia. Acetabular coverage and pre-surgery assessment and planning must be done based on 3D CAT scans

Intra-articular hyaluronic acid in the treatment of haemophilic chronic arthropathy.

We report our preliminary experience with the use of hyaluronic acid (Synvisc) in 29 joints from 25 different haemophilic patients (17 knees, six shoulders, four ankles, one elbow and one hip). All the joints were grade III of our classification, characterized by synovial thickening, axial deformities and muscle atrophy (chronic arthropathy). In view of the very satisfactory results obtained with this procedure, we have substituted Synvisc for the previous use of intra-articular long-standing corticosteroids that we had been used for some years. This method is theoretically more physiological and does not destroy the joint cartilage further, as corticosteroids can.

Haemophilic pseudotumours of the limbs and their percutaneous treatment.

The percutaneous treatment of limb pseudotumours is a nonaggressive method of treating haemophilic pseudotumours. However, efforts should be directed to the prevention of such pseudotumours by ensuring that all patients receive adequate treatment of their bleeding episodes through education and the elimination of geographical or social barriers that prevent access to such treatment. Prevention of pseudotumours by means of early substitution treatment of muscular bleeding episodes is the best treatment.

Chemical synoviorthesis with rifampicin in haemophilia.

Rifampicin is an antibiotic that has been currently used for the treatment of noninfectious articular lesions with satisfactory results. The first experience was performed with patients who presented rheumatoid arthritis, and later with haemophilic patients. The clinical experience of three haemophilia centres which used rifampicin for the treatment of chronic haemophilic synovitis is presented here. The protocols were different. It was observed that rifampicin is more effective when it is used in small joints (elbows and ankles), than when used in bigger ones (knees), and that a high number of injections predicts failure. Mention is also made of experimental studies in animals where it was shown that the healing pattern of rifampicin is similar to that of NSAIDs.

On the safety of synoviorthesis in haemophilia.

One of the best procedures to prevent haem-arthrosis has been radioactive synovectomy (synoviorthesis). Since the first report of radioactive synovectomy in haemophilia of Ahlberg in 1971 [1], many centres adopted this procedure as the one of choice, through fibrosing the synovial membrane, prevent further haemarthrosis. Since 1976 we have performed 104 such radioactive synoviorthesis in 97 patients, age ranging from 6 to 40 years with a mean of 10 years. Sixty-five of these patients were under 12 years of age. The knees were injected in 61 cases, elbow in 26 cases, ankles in 14 cases and shoulders in three cases. The clinical results of this procedure show 80% of excellent results with no further bleeding. In case of failure, a new injection can be given in the same joint at a 6-month interval, or an injection for the same purpose in other joint. One of the criticisms against this method is the possible chromosomal damage induced by the radioactive material. In our centre, four studies have been carried out in order to see whether these changes, when they occur, are everlasting; all have demonstrated that chromosomal changes are reversible. The radioactive material used in the two first studies was Gold-189 (189Au). In 1978, 354 metaphases were studied with 61 ruptures, 17.23% (nonpremalign) and six structural changes, considered premalign (1.69%). Any number below 2% is considered not to be dangerous. A further study was done in 1982, in the same group of patients with a result of 21 ruptures (3.34%) and no structural changes. This demonstrated that the possible premalign changes disappeared with time. A third study was performed in a series of 13 patients that sustained radioactive synoviorthesis with Rhenium-186 (186Re) in November 1991. For comparison, we carried out a chromosomal study just before and 6 months after the radioactive material injection. The results confirmed that changes that could be linked to the radiation, appeared equally in nonirradiated patients, and those changes due to the radiation disappear with time, never reaching the dangerous zone of 2%. In the group treated with 186Re we studied an additional number of 130 metaphases with identical results and no structural changes. In a study on patients where 90Y was the radiocolloid, no premalign change was found before or after the synoviorthesis. It seems, in view of these results, that radioactive synovectomy is safe and gives great benefits to the haemophilic patients.

Problemas ortopédicos del niño hemofílico / Orthopaedic problems of hemophilic children

En este artículo se revisan los principales problemas del niño hemofílico, especialmente los hemartros, los hematomas musculares y los quistes hemofílicos (pseudotumores). La sinoviortesis con rifampicina y el tratamiento percutáneo de los pseudotumores son dos de los métodos fundamentalmente analizados en este artículo (AU)

Synovectomy with rifampicine in haemophilic haemarthrosis.

The purpose of this paper was to assess the effectiveness of intra-articular injected rifampicine in haemophilic patients in order to achieve synovectomy by preventing repeated intra-articular bleeding. We have used this technique in haemophilic patients previously and reported our results on 13 cases [1]. Two hundred and fifty milligrams of rifampicine was injected into the elbow and ankle joints and 500 mg was injected into knee joints with 3-10 mL of lidocaine, depending on the joint size. The injections were repeated once a week for 7 weeks. Patients were only covered with antihaemophilic factor on the day of the injection at 30% above their coagulation level. We evaluated the results using two measures: subjective reports from the patient and objective assessment by the examiner. In the subjective reports the patient graded the results from their own perspective from 1 (poor) to 10 (excellent): 1-3, poor; 4-6, fair; 7-8, good; and 9-10, excellent. In the objective reports the grading was: excellent ('dry joint', full function, no haemarthrosis, no synovitis); good (clinical improvement, synovitis, reduction of haemarthroses, full function); fair synovitis (reduction of haemarthroses, no change in function); poor synovitis (persistent haemarthroses). This paper reports on the results of 38 patients with 39 joints with more that 3 years follow up, mean 1.8 years. There were 22 knees, nine elbows and eight ankles. Subjectively, there were excellent results in 21 joints (11 knees, six elbows and four ankles) good results in 15 joints (eight knees, three elbows and four ankles), fair results in two knees and a poor result in one knee. Objectively, results obtained were excellent in 20 joints (11 knees, six elbows and three ankles); good in 17 (nine knees, three elbows and five ankles); fair in one knee and poor in one knee.

Cytogenetic studies in patients with hemophilic hemarthrosis treated by 198Au, 186Rh, and 90Y radioactive synoviorthesis.

This study assesses chromosomal structural changes (CSCs) studied by conventional lymphocyte cultures and banding techniques in 79 hemophilic patients with hemarthrosis treated with radioactive synoviorthesis, 31 hemophilic patients with hemarthrosis not treated by this procedure, and 110 nonhemophilic patients matched by age and sex (control group). In 14 patients treated with 198Au (group A), premalignant CSCs and nonspecific CSCs were found, respectively, in 1.69% and 17.23% of metaphases. The former disappeared, but 1.7% of the nonspecific changes persisted 2 years after injection. In 31 patients treated with 186Rh (group B), CSCs were not found previous to radioactive synoviorthesis but were present as nonspecific changes in 1.25% of metaphases 6 months later; they disappeared 1 year after injection. In 34 patients treated with 90Y (group C), CSCs were not found previous to radioactive synoviorthesis but were present as nonspecific changes in 0.89% of metaphases 6 months later; they disappeared 1 year after injection. Only nonspecific CSCs were found in 0.79% of metaphases in patients not treated with radioactive synoviorthesis (group D). CSCs were not present in control subjects. The authors conclude that in some hemophilic patients with hemarthosis treated with radioactive synoviorthesis using 198Au, 186Rh, or 90Y, reversible premalignant or nonspecific CSCs could be present; nonspecific CSCs may persist in a low proportion of metaphases up to 2 years after injection when 198Au is used as the radioactive agent. Radioactive synoviorthesis seems to be from a cytogenetic point of view a safe alternative for these patients.

Non-operative treatment of flexion contracture of the knee in haemophilia.

For the non-operative treatment of flexion contracture of the haemophilic knee we have used serial casting and wedging in 58 patients, and extension/de-subluxation orthoses in 13 patients. On average it was possible to achieve -5 degrees of extension by 4 weeks, with only a little improvement in the following 4 weeks. The short--to medium-term results using either the extension/de-subluxation hinges or serial casting were similar. Both methods have been shown to result in significant improvement in joint contracture.

Congenital deficiency of the tibia: a report on 22 cases.

Congenital deficiency of the tibia (tibial hemimelia, aplasia, or dysplasia) is very rare, with an incidence of approximately 1 per 1 million live births. The disorder usually is accompanied by other congenital anomalies on the same limb or other parts of the body. A report is made of 22 limbs observed in 18 patients from 1970 to 1987 at San Juan de Dios Hospital in Caracas, Venezuela, with more than a 5-year follow-up. The report includes 11 girls and 7 boys, with observations of 11 left and 11 right tibiae. Familial antecedents were present in four patients: brother and sister and two brothers. According to the classification by Jones, Barnes, and Lloyd-Roberts, there were nine cases of type Ia, four of type Ib, three of type II, two of type III, and four of type IV. The foot of the affected limb was normal in only 12 cases. Treatment, always surgical, consisted of T/K amputation in 10 cases of types Ia and Ib, fibula pro tibia and B/K amputation in 1 case of type II, Syme amputations in 2 cases of type III, and astragalectomy and closure of diastasis in 4 cases of type IV deformity. Patients in five cases refused treatment. The sooner the amputation is performed, the easier and faster the rehabilitation and adaptation to the prosthesis. An early amputation is accepted by the child as a "congenital amputation."

Treatment of acute and chronic synovitis by non-surgical means.

This paper reviews personal experience in the treatment of recurrent haemarthrosis and chronic synovitis by non-surgical means. Experience with synoviorthesis with rifampicine and radioactive colloids is analyzed, and a multiple chromosomal study to demonstrate safety of radioactive injections is described. The results obtained are so very satisfactory as to recommend non-aggressive synoviorthesis as the treatment of choice to prevent recurrence of bleeding. Long experience in the treatment of chronic arthropathy with intrarticular corticosteroids and hyaluronic acid has shown very promising results.

Intraarticular dexamethasone in advanced chronic synovitis in hemophilia.

From 1988 to 1966, 34 patients with advanced chronic hemophilic synovitis (25 Grade III and nine Grade IV) were treated with intraarticular injections of long acting dexamethasone (sodium phosphate of dexamethasone plus acetate of dexamethasone) in cycles of three injections with 3-week intervals between each injection with 6-month rest intervals between cycles for as many as three cycles, depending on the evolution of each case. All patients had chronic severe synovitis, axial deformity, muscular atrophy, and diminution of range of movement. There were 31 knees, two ankles, and two shoulders. Subjective and objective evaluations were done grouping the results in good, fair, and poor according to grade of patient satisfaction, presence of synovitis and pain, range of movement, and limitation of activities of daily living. In the subjective results there were 19 good results, 12 fair results, and four poor results, and in the objective evaluation there were 22 good results, nine fair results, and four poor results at an average followup of 1.5 years. The use of intraarticular dexamethasone as an alternative in the short to medium term for treatment of advanced chronic hemophilic synovitis with pain and limitation of function before doing an invasive surgical treatment is proposed.