Replacement of a congenital bicuspid aortic valve in a patient with left ventricular noncompaction.

Left ventricular noncompaction is a congenital cardiomyopathy, which is often first diagnosed in adults. The condition can be found in isolation, but it has also been described in association with other cardiac anomalies. We report here the 4th documented case of left ventricular noncompaction associated with a bicuspid aortic valve and the 1st of these cases in which the patient underwent aortic valve surgery.

Vitamin D receptor polymorphism (-1056 Taq-I) interacts with smoking for the presence and progression of periodontitis.

AIM: The aim of this analysis was to investigate the relationship between a vitamin D receptor (VDR) polymorphism and the diagnosis and progression of periodontitis. MATERIAL AND METHODS: Data were derived from two different studies, including 231 subjects with healthy periodontium, 224 aggressive periodontitis and 79 chronic periodontitis (CP) patients in a case-control investigation. Sixty-one of these CP patients also took part in an observational study with a 1-year follow-up, in which progression of periodontitis was determined at the subject level. All 534 subjects provided a blood sample from which genomic DNA was extracted to study VDR -1056 TaqI polymorphism. RESULTS: The interaction between smoking and VDR polymorphism was associated with the diagnosis of periodontitis in Caucasians [p=0.001, odds ratio (OR)=1.33, 95% confidence intervals (CI)=1.12-1.57] and all subjects (p=0.033, OR=1.60, 95% CI=1.04-2.48). In the longitudinal study, subjects were divided into two clusters at 1 year according to the median number of progressing sites (Delta cumulative attachment loss >2 mm). Logistic regression analysis revealed that the interaction between VDR Taq-I polymorphism and smoking showed limited evidence of association with the "severe progression" cluster (p=0.033, OR=15.24, 95% CI=1.24-187.42). CONCLUSIONS: Vitamin D receptor Taq-I TT polymorphism was moderately associated with both the presence and the progression of periodontitis in smokers, while no association was detected in non-smoking individuals. VDR genetic factors may interact with smoking in the pathogenesis of periodontitis.

Left ventricular diastolic collapse and late regional cardiac tamponade postcardiac surgery caused by large left pleural effusion.

Cardiac tamponade is a well-recognized early complication (ie, within 15 days) of cardiac surgery usually a result of the development of a pericardial effusion postoperatively. However, left ventricular diastolic collapse as a result of the presence of a large pleural effusion, but in the absence of any pericardial effusion, is rare, particularly late (ie, after 15 days) after cardiac surgery. We present the echocardiographic findings of a man presenting with recurrent exertional breathlessness, after elective tissue aortic valve replacement, and demonstrate, by echocardiography, the mechanism of left ventricular diastolic collapse and late regional cardiac tamponade, after cardiac surgery, as a result of the effects of a large pleural effusion but in the absence of any pericardial effusion. We discuss and review the literature on this phenomenon.

A multipractice clinical evaluation of an ORMOCER restorative--2-year results.

OBJECTIVES: This ongoing prospective study evaluates the clinical performance of an ORMOCER restorative material (Definite; Degussa) in combination with a self-conditioning adhesive (Etch & Prime 3.0; Degussa). METHOD AND MATERIALS: Three hundred fifty-six restorations (48 Class I, 150 Class II, 63 Class III, 32 Class IV, and 63 Class V) in 117 patients (17 to 65 years) were placed by 5 operators at 5 centers. Fillings were placed with cotton roll isolation using clear matrix bands for Classes III and IV and metal matrix bands for Class II restorations. Follow-ups took place after 6, 12, and 24 months whereby modified Ryge criteria were recorded. With 33 randomly selected Class I and II restorations, measurements of occlusal wear (3-dimensional laser scanner) and marginal analyses (scanning electron microscope) were done using replicas. RESULTS: At 24 months, 307 restorations were available for evaluation. The cumulative number of losses in the 5 cavity classes (I, II, III, IV, and V) and the percentages of scores for the clinical parameters in the 4 categories (Alfa, Beta, Charlie, and Delta) of the retained restorations were loss (1/ 6/ -/ 2/ 7), marginal integrity (93.1/ 6.9/-/-), marginal discoloration (73.5/ 25.5/ 1/ -), anatomic form (82.8/17.2/-/-), and fracture (93.1/ 6.9/-/ -). Marginal analysis showed 48.7% "continuous margin" initially and 13.2% at 24 months (difference statistically significant, a = 0.05). Occlusal wear at 24 months was 12.3 Microm for premolars and 21.4 Microm for molars. CONCLUSIONS: The overall clinical performance of the ORMOCER restorative over 24 months was acceptable with concerns related to marginal quality and to retention of Class V restorations.

Comparison of K hand files and ProFiles 0.06/0.04 in simulated curved root canals prepared by students.

OBJECTIVES: The objective of this study was to compare the step-down technique in simulated curved root canals using K hand files (VDW) and ProFiles 0.06/0.04 (Dentsply Maillefer). METHOD AND MATERIALS: A total of 72 canals were blindly prepared by instructed students: 1 block with K files and a second one with ProFiles 0.06/0.04 in connection with the EndoStepper (SET). Postoperative images of the canals were taken, and an independent dentist assessed preparations for amount and position of material removed during preparation. Efficacy of the instruments is described in terms of canal shape, instrument failure, canal blockages, and preparation time. RESULTS: ProFile instrumentation provided well-centered and tapered preparations while maintaining the apical foramen; in contrast, the use of K files resulted in frequent alterations of the root canal. In the apical portion, both techniques showed unprepared areas. The coronal diameter in hand-instrumented canals was more irregular and wider than in those mechanically prepared. There was no separation of a ProFile instrument. Hand instrumentation was faster than mechanical, but the difference was not statistically significant. CONCLUSION: Under the conditions of the study, the ProFile rotary system was simple and safe to use and created better preparations than hand instrumentation.

The predictors and outcome of recidivism in cardiac ICUs.

OBJECTIVE: Reinstitution of step-up care (recidivism) following cardiac surgery may be associated with increased mortality. This has, however, not been widely reported. METHODS: We, therefore, studied 8113 consecutive patients who underwent coronary artery bypass grafting (CABG), valve replacement/repair or combined valve+CABG surgery between January 1996 and December 2003 to determine the reasons for readmission to the intensive care unit (ICU) and their outcomes in terms of length of stay in (i) the ICU (ii) hospital and (iii) the in-hospital mortality following recidivism. RESULTS: Of the 7717 patients discharged out of the ICU, 2.3% (182) of patients [mean age 70.4+/-8.35 years (range 30-90 years); 65.4% (119) males] required step-up care. Recidivism was 1.8% (101 of 5633) following coronary artery by-pass grafting (CABG) and 3.9% (81 of 2084) following valve replacement/repair+/-CABG (P<0.05). The mean interval from ICU discharge to ICU recidivism was 6.6+/-8.4 days (range 6h to 28 days). The principal reasons for recidivism were (i) respiratory failure requiring reintubation and ventilation in 54.9% (n=100) of patients (ii) cardiovascular instability (including that secondary to dysrhythmias) and heart failure in 23.1% (n=42) (iii) renal failure requiring haemofiltration in 6.6% (n=12) (iv) sepsis in 1.1% (n=2) (v) cardiac tamponade/bleeding requiring re-exploration in 7.7% (n=14) and (vi) gastro-intestinal complications requiring laparotomy in 6.0% (n=11) patients. Multivariate analysis showed that, during primary ICU stay, respiratory complications, low cardiac output state, dysrhythmias, renal failure requiring haemofiltration and re-exploration for bleeding were independent predictors of recidivism. Following recidivism (i) the mean length of stay in the ICU was 6.65+/-6.2 days (range 4h to 51 days), (ii) mean hospital stay was 19.2+/-17.3 days (10-60 days) and (iii) the 30-day in-hospital mortality was 32.4%. CONCLUSIONS: Patients are more likely to require recidivism following valve surgery+/-CABG than CABG alone. Whilst respiratory complications were the most common reasons for recidivism in our study, patients who required mechanical supports to maintain vital functions following surgery were most prone to recidivism. Hence, efforts should be made to treat cardio-respiratory problems early in this group of patients to reduce ICU recidivism.

Aspire porcine bioprosthesis: ten years' experience.

BACKGROUND AND AIM OF THE STUDY: Clinical results of this multicenter study of the Aspire porcine valve were reported previously at eight years; the present report provides an update of valve performance to 10 years postoperatively. METHODS: A total of 749 patients (60% males; mean age 73+/-7 years) underwent implantation with the Aspire (Tissuemed) porcine bioprosthesis between 1991 and 2002, at three institutions. Follow up was complete for 98% of the cohort. The mean follow up period was 51.6+/-39.6 months (range: 0-181 months); total follow up was 3,159 patient-years (pt-yr). RESULTS: There were 617 aortic valve replacements (AVR), 96 mitral valve replacements (MVR) and 32 double valve replacements. There were 62 deaths (8.3%), one of which was valve-related. The late mortality rate was 9.3% per pt-yr (1.2%/pt-yr valve-related). Actuarial freedom from complications at 10 years was: thromboembolism 76+/-4% (2.6%/pt-yr); hemorrhage 73+/-4% (2.8%/pt-yr); structural valve deterioration (SVD) 96+/-2% (0.2%/pt-yr); non-structural deterioration 99+/-1% (0.1%/pt-y); prosthetic valve endocarditis 97+/-1% (0.3%/pt-yr); and reoperation 97+/-1% (0.4%/pt-yr). In patients aged >70 years, the 10-year actuarial freedom from SVD was 98+/-2% for AVR and 93+/-7% for MVR. Preoperative atrial fibrillation (AF) was a significant predictor of late mortality (p <0.001), thromboembolism (p = 0.05) and hemorrhage (p = 0.01). CONCLUSION: The Aspire porcine bioprostheses is a reliable choice for a tissue valve, for both the aortic and mitral positions, especially in patients aged >70 years. In elderly patients the presence of AF is a significant predictor of early and late mortality and morbidity.

An unusual cause of breathlessness after lobectomy for lung cancer.

Localized bronchomalacia as a cause of breathlessness after lobectomy is an unusual complication. This condition was diagnosed with bronchoscopy and delineated by spiral computed tomographic scan. Stenting the lesion resulted in a successful outcome.

One-year evaluation of an Ormocer restorative-a multipractice clinical trial.

The purpose of this ongoing prospective long-term study was to evaluate the clinical performance of Ormocer restorative material in combination with a self-conditioning adhesive. Five operators at five clinics placed 356 restorations (48 class I, 150 class II, 63 class III, 32 class IV, and 63 class V) in 117 patients aged 17 to 65 years. All fillings were placed with cotton roll isolation and clear matrix bands for class III and IV restorations, and metal matrix bands and an incremental placement technique were used for class II restorations. In follow-up examinations after 6 and 12 months, modified Ryge criteria were recorded on all restorations. With 33 randomly selected class I and II restorations, measurements of occlusal wear (via 3D laser scanner) and qualitative and quantitative marginal analysis (via scanning electron microscope) were performed using a replica technique. After placing the fillings, patients reported postoperative hypersensitivity corresponding to B scores in 19 cases and to C scores in four cases. At 12-month recall, 328 restorations were available for evaluation. Losses in the five cavity classes (I, II, III, IV, V) numbered 0, 2, 0, 1, and 6, respectively. The percentages of retained restorations for clinical parameters in four categories (Alpha, Beta, Charlie, Delta) were: 94.7, 5, 0.3, and 0 (marginal integrity), 81.2, 18.8, 0, and 0 (marginal discoloration), 75.2, 24.8, 0, and 0 (anatomic form), and 95, 4.7, 0.3, and 0 (fracture), respectively. Marginal analysis showed 48.7% "continuous margin" initially and 17.7% at 12 months (difference statistically significant, P=0.05). The occlusal wear at 12 months was 10.0 microm (SD 11.6) for premolars and 22.0 microm (SD 24.1) for molars. Over the 12-month observation period, the Ormocer restorative was clinically effective in combination with a self-conditioning adhesive, and concern persists related to the marginal quality and retention of class V restorations.

In vitro assay for the screening of the plaque-reducing activity of antimicrobial agents.

Bacteria grown in biofilms are less susceptible to antimicrobial agents than planktonic bacteria. One of the most common biofilms in humans is dental plaque. To investigate the antimicrobial activity against dental bacteria grown in biofilms, biofilms were generated with Streptococcus sanguis on hydroxyapatite disks to mimic the tooth surface. After 48 h of aerobic incubation at 37 degrees C in a continuous flow culture, a biofilm consisting of Streptococcus sanguis became visible on the surface of the disks. The disks were removed from the growth chamber and placed in different vessels containing either chlorhexidine digluconate (CAS 55-56-1, 0.1% or 1.0%), polyvinylpyrrolidone iodine (1.5% or 7.5%), or octenidine dihydrochloride (CAS 70775-75-6, 0.05% or 0.1%) for 5 or 30 min. In addition, the antiseptics were applied to the bacterial suspension in the growth chamber. A significant difference was observed in the antimicrobial activity against bacteria in the suspension liquid compared to the bacteria grown in biofilms. The best reduction factors were obtained with chlorhexidine (1.0%, 30 min) for either sessile (3.97 Ig) or planktonic bacteria (> or = 5.58 Ig). Clear relationships between the doses and times of action were found for the assessed agents. Therefore, the authors conclude that the present in vitro assay is a quick and cost-effective model to screen the activity of antimicrobial agents against bacteria grown in biofilms.

Comparative tests of arbitrary and kinematic transverse horizontal axis recordings of mandibular movements.

STATEMENT OF PROBLEM: The reliability of recording maxillomandibular relationships for articulator programming with a transverse horizontal axis determined arbitrarily with an arbitrary face-bow has not been verified against a kinematically determined and recorded transverse horizontal axis in an in vivo study. PURPOSE: The goal of this study was to determine the measuring accuracy of the Cadiax Compact system in a clinical series of tests and to determine whether there is a clinically significant difference between the 3-dimensional measurements recorded from kinematically and arbitrarily determined transverse horizontal axes. MATERIAL AND METHODS: Thirty subjects (11 women, 19 men; ages 21 to 26) participated in this study. Mandibular movement, the sagittal condylar inclination (SCI) angle, and the transversal condylar inclination (TCI) angle were recorded in each subject with the Cadiax Compact system, by use of first an arbitrarily and second a kinematically determined transverse horizontal axis. A subset of 10 subjects was examined with another computerized axiograph, the Gamma Cadiax system. Measurements were made and recorded twice, on different days under similar circumstances. To compare the systems and measurement methods, the SCI measurements taken at 3- and 5-mm sagittal protrusion and the TCI taken at 3- and 5-mm mediotrusion were used. The lengths and characteristic curvatures of protrusion, opening, and mediotrusion tracings were determined for the evaluation as follows: tracing lengths (<8 mm, 8 to 12 mm, and >12 mm); degree of overlap of the excursive and incursive tracing; and tracing curvature. The intraclass correlation was used to compare angle values at the 95% confidence interval. To assess the track progression, kappa values were calculated. RESULTS: Repetition of the mandibular track inclination angles and the condylar movement pattern was highly reliable (intraclass correlation of >0.8) with the Cadiax Compact system. When the mandibular track inclinations determined kinematically and arbitrarily by the Gamma Cadiax and Cadiax Compact systems were compared, both systems demonstrated high reliability (ICC>0.8). The congruence results of the protrusion tracings from kinematic and arbitrary measurements with the Cadiax Compact system were as follows: strong congruence in quantity, characteristics, and horizontal tracing; only the quality diminished slightly (Kappa 0.46 in the first measurement, which still represented a clear congruence). The opening and mediotrusion tracings demonstrated fair to almost complete congruence in all parameters. CONCLUSION: Within the limitations of this study, the kinematic and arbitrary measurements of the Cadiax Compact system could be reliably used for articulator programming. The results suggest that arbitrarily determined posterior reference points may be comparable to a kinematically determined transverse horizontal axis.

The effect of a SCN-/H2O2 toothpaste compared to a commercially available triclosan-containing toothpaste on oral hygiene and gingival health -- a 6-month home-use study.

OBJECTIVES: The aim of the study was to compare the gingival health benefits of a thiocyanate/carbamide peroxide toothpaste to that of a triclosan toothpaste in home use. MATERIALS AND METHODS: The study was a two-centre, randomised, double-blind, parallel-group clinical trial, and consisted of a 2-week pre-experimental phase, followed by an experimental period of 6 months. A total of 140 healthy male and female volunteers (70 per group) who had at least 20 natural teeth with no probing depths greater than 5 mm and a mean gingival index (GI) of 1 or more at screening were admitted to the study. The two products were the test toothpaste (RCP) containing 0.5% SCN- (rhodanide), carbamide peroxide (equivalent 0.1% H2O2), and 1450 p.p.m. fluoride, and a control toothpaste (Colgate Total) containing 0.3% triclosan, 2.0% polyvinyl methyl ether maleic acid (PVM/MA), and 1450 p.p.m. fluoride (Triclosan). In the pre-experimental phase, all subjects used a fluoride toothpaste. Plaque (Turesky et al. 1970) and gingivitis (Löe & Silness 1963) were scored prior to beginning the pre-experimental phase, at baseline, and after 6 weeks and 3 and 6 months. RESULTS: In both the RCP and the Triclosan group, gingival health improved significantly between baseline and the following examinations. Plaque scores decreased significantly between baseline and 6 months in both groups. There were, however, no significant differences between the groups for either gingival index or plaque index. CONCLUSION: To conclude, this study seems to verify that in normal home use, a toothpaste containing a combination of thiocyanate and carbamide peroxide is as effective in reducing gingival inflammation and supragingival plaque formation as a benchmark control product.

The effect of a polyhexamethylene biguanide mouthrinse compared to an essential oil rinse and a chlorhexidine rinse on bacterial counts and 4-day plaque regrowth.

OBJECTIVES: For various clinical applications, polyhexamethylene biguanide hydrochloride (PHMB) has been used for many years as an antiseptic in medicine. Recently, a 0.04% PHMB mouthwash was shown to inhibit plaque regrowth and to reduce oral bacterial counts. In this study, a 0.12% PHMB mouthrinse (A) was compared with a negative control placebo rinse (10% ethanol, flavour) (B), a positive control 0.12% chlorhexidine rinse (C), and a commercially available mouthrinse containing essential oils (Listerine) (D). MATERIALS AND METHODS: The study was a double-blind, randomised 4-replicate 4 x 4 Latin square cross-over design in which plaque regrowth was measured. The in vivo antibacterial effect was assessed by taking bacterial counts from the tooth surface and mucosa 4 h after the first rinse with the preparations on day 1 and prior to the clinical examination on day 5. 16 volunteers participated and, on day 1 of each study period, were rendered plaque-free, ceased toothcleaning, and rinsed 2x daily with the allocated mouthrinse. On day 5, plaque was scored and smears were collected according to the protocol. Washout periods were 9 days. Data were analysed using ANOVA with Bonferroni HSD adjustment for multiple comparisons (significance level alpha=0.05). RESULTS: The 0.12% PHMB mouthrinse (A) was significantly more effective in inhibiting plaque than the placebo (B) but no significant differences could be observed between A and 0.12% chlorhexidine (C), or between A and Listerine (D). Bacterial count reductions on the tooth surface with PHMB (A) were significantly greater compared to the placebo (B) after 4 h and significantly greater compared to B and D after 5 days. Chlorhexidine (C) was more effective than A after 5 days. On the mucosa, chlorhexidine (C) was significantly more effective in reducing bacterial counts than the other 3 treatments at both time points investigated. PHMB (A) was significantly more effective in reducing bacterial counts than the placebo (B) after 4 h and after 5 days, and than D after 4 h. CONCLUSION: Consistent with a previous study, a PHMB mouthrinse was shown to inhibit plaque recolonisation and to reduce oral bacterial counts, indicating that PHMB may find applications in the prevention of plaque-associated diseases.

Methodology of three-dimensional determination of root surface roughness.

In comparing and evaluating the instruments that are used in root debridement, roughness constitutes a standard variable that is assessed. The purpose of this study was to describe the conditions and requirements for the three-dimensional roughness measurements of tooth roots using a laser profilometer. Impressions were made of 60 instrumented and 12 untreated root surfaces, which were then measured using a dynamically focussing optical profilometer (Mikrofocus, UBM, Karlsruhe, Germany). To separate roughness from the form of the tooth, a low pass filter was applied. This meant that the longer wavelengths - which roughly approximated the root forms - were subtracted from the measured profile. We then used an individualized Fourier transformation to define the threshold at which roughness becomes waviness. Roughness parameters were Ra (average roughness) and Rz (average roughness in the z dimension) for two- and three-dimensional measurements. To describe the requirements for the measurement, we studied the effect of pixel density and the field size on the average roughness value, Ra. We found that Ra increases with pixel density until 400 per mm is reached, after which it does not change meaningfully. Furthermore, Ra is highly dependent upon the area of the field to be scanned, increasing in line with the area, and does not approach one value within the surface available on one tooth. The correlation coefficients between the two-dimensional and three-dimensional Ra and Rz values ranged from 0.7 to 0.8. We conclude that roughness values are strongly dependent on the measurement conditions and the results of one study cannot be directly compared to another. In addition, it was found that two-dimensional measurements are sufficient for characterizing root surfaces.