Ventral hernia repair in conjunction with LIPO-ABDOMINOPLASTY in overweight patients: A comprehensive approach.

Repair of large midline ventral hernias still represents a challenge for general surgeons. As obesity is a key factor of this type of hernias, usually the patients are presented with abdominal wall laxity, excess skin and subcutaneous fat. Combined procedures has evolved over the last six decades to repair the hernias and to improve the shape of the abdomen, but was associated with high rate of wound complications. The components separation technique for ventral hernia repair was introduced in 1990 by Ramirez et al to avoid mesh repair was associated with a high rate of success. Until recently, the convenience of simultaneously performing ventral hernia repair and abdominal contouring surgery remains controversial. The aim of this study is to present our experience in the integration of the anterior component separation technique for repair of midline wide ventral defects, with the lipoabdominoplasty in selected patients with high body mass index, to achieve a functional abdominal wall repair and to provide a better aesthetic outcome. In this prospective case-control study, 15 adult female multiparous women, all were overweight and obese, presented with midline ventral hernias and abdominal deformity was operated upon where a comprehensive technique in the form of herniorapphy, anterior component separation technique and lipoabdominoplasty were performed. The patients were followed up for 3-6 months period to monitor incidence of complications, hernia recurrence and to assess the aesthetic outcome. All the 15 patients were overweight and obese with BMI ranged between 26.5 and 39.6 kg/m2 . The mean operative time was 184 ± 28.8 minutes (range 150-240 minutes). The mean postoperative length of hospital stay was 3 days ranging from 1 to 5 days. In addition to the hernia, all the patients suffered from diastasis of recti ranged from 9 to 15 cm in the transverse dimension. No mortality or major complications encountered, no hernia recurrence, only minor complications occurred in four patients (26.8%). Two patients developed seroma which resolved by aspiration, one patient suffered wound infection with partial loss of the umbilicus and one developed superficial skin necrosis at the central area of the flaps which healed uneventfully by secondary intention. All the patients were satisfied with the cosmetic outcome. In conclusion, this comprehensive approach is effective technique for reconstruction of large midline ventral defects and provide a good aesthetic appearance of the anterior and lateral abdomen in appropriately selected obese patients.

Comparative evaluation of caries prevalence among group of Egyptian adolescents using DMFS and ICDASII methods: a cross-sectional study.

BACKGROUND: Limited data is available regarding the prevalence of dental caries as a chronic disease among adolescents using different caries assessment indices. The aim of this study was to compare and describe the prevalence of dental caries among group of Egyptian students using two caries assessment indices; DMFS and ICDAS II. METHODS: This descriptive, cross-sectional epidemiological study included 2760 public secondary school students with age range from 15 to 18 years with permanent dentition and good general health. Presence of; retained teeth, congenital or developmental anomalies in the permanent dentition, orthodontic treatments, systematic conditions, smoking and general health problems were considered the exclusion criteria in this study. Participants were selected randomly from 8 public secondary schools in the Great Cairo, Egypt. The examination was achieved by 6 trained and previously calibrated examiners using sets of diagnostic mirrors, compressed air, a WHO probe and cotton rolls. DMFS index and ICDAS II system were used as caries detection methods. In DMFS index; the number of decayed (D), missing (M) and filled (F) surfaces was recorded, while in the ICDAS II index, the assessment of both cavitated and non-cavitated carious, missed and filled teeth with restorations /sealants was recorded. The examiners performed the oral examination using both scoring systems in an alternating manner. The collected data were explored for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests. Chi square test was used to analyze the frequencies. RESULTS: There was a statistical significant difference between the DMFS and ICDAS II methods results regarding the recorded number of caries affected teeth and cavitated teeth surfaces. The prevalence of dental caries among the investigated secondary school students was (69.56%) and (78.29%) for DMFS and ICDAS II, respectively. CONCLUSIONS: The prevalence of dental caries among Egyptian adolescent is high. ICDAS scoring system revealed higher caries prevalence values than DMFS method. ICDAS method is the best choice for the preventive goals, while DMFS is sufficient for clinical purposes.

Nasobiliary guided laparoscopic cholecystectomy following endoscopic retrograde cholangiopancreatography, randomized controlled trial.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) is the most common management of gallstones combined with common bile duct (CBD) stones. This study aims to evaluate the impact of routine insertion of nasobiliary catheter during ERCP in cases of difficult LC. PATIENTS & METHODS: From total 110 patients who underwent ERCP followed by LC in the period from April 2019 to April 2020, nasobiliary (NB) catheter was inserted during ERCP in 55 patients after CBD clearance (NB group). In the other 55 patients, only CBD clearance was done (Control group). In the NB group, dynamic trans-nasobiliary intraoperative cholangiography (TN-IOC) was done during dissection of Calot's triangle. At the end of the procedure, trans-nasobiliay methylene blue (MB) test was done to detect any missed biliary injury. The primary outcome to be analyzed was the incidence and severity of bile duct injury (BDI), secondary outcomes were the operative time, conversion to open surgery, and hospital stay. RESULTS: Of the 110 patients, 57 patients (51.8%) were males and 53 (48.2%) were females. Median age was 55 years. One case of biliary leak was reported in the NB group (1.8%), while 2 cases (3.6%) were reported in the Control group. The average operative time in the NB group was 115 min versus 128 min in the Control group (P value < 0.001). No cases were converted to open cholecystectomy in the NB group (0%) with 5 cases (9.1%) converted to open in the Control group. The average postoperative hospital stay was 2 ± 0.1 days in the NB group versus 3.6 ± 5.3 days in the Control group (P value = 0.037). CONCLUSION: Routine insertion of nasobiliary tube during ERCP, in patients with combined gallbladder and CBD stones, is a simple, safe and dynamic method for IOC. This maneuver does not statistically decrease the incidence of BDI but can diagnose, minimize and treat BDI with shorter operative time and hospital stay.

Influence of Thermomechanical Treatment on the Mechanical Behavior of Protaper Gold versus Protaper Universal (A Finite Element Study).

AIM: To compare and evaluate the influence of thermomechanical treatment of Protaper Gold file versus Protaper Universal file during testing of bending and torsion using finite-element analysis. METHODS: Two nickel-titanium NiTi rotary files (ProTaper Gold and ProTaper Universal) were used in this study. The files were imaged using stereomicroscope to produce 3D models. The behaviour of the instrument during bending and torsion was numerically analysed in CAD/CAM software package. RESULTS: Under bending, ProTaper, Gold showed higher flexibility and flexural resistance than ProTaper Universal. The highest stress was related at the cutting edge of both files. While during testing of torsion, the maximum amount of stresses was related to the base of the flutes in both files. ProTaper Gold showed higher torsional resistance than the ProTaper Universal file. CONCLUSION: Thermomechanical treatment improved the mechanical response (bending and torsional resistance) of NiTi files.

In Vivo Comparative Evaluation of Periapical Healing in Response to a Calcium Silicate and Calcium Hydroxide Based Endodontic Sealers.

BACKGROUND: The composition of the root canal filling materials together with the apical limit of the root canal obturation affect the complete periapical healing after root canal therapy. AIM: This study was performed to evaluate and compare the periapical healing in response to calcium-silicate (iRoot SP) and calcium-hydroxide (Apexit) based-sealers. MATERIAL AND METHODS: Seventy-two upper premolars root canals of six dogs were used. The teeth were randomly assigned to four groups: Group one: roots were obturated using gutta-percha and Apexit-sealer; Group two: roots were obturated using gutta-percha&iRoot SP-sealer; Group three: the teeth were left open without obturation; Group four: where healthy teeth were used as a negative control. Teeth were evaluated after one, two and three months. The newly formed mineralised apical tissue and the periapical inflammatory infiltrate of the obtained photomicrographs were evaluated, and scorings were statistically-analysed. RESULTS: The mean percentage of the periapical inflammatory infiltrates and mineralisation scoring after one, two and three months evaluation period were not significantly different among the four groups (P > 0.05). CONCLUSIONS: Regardless of the sealer used, iRoot SP and Apexit promote healing of periapical tissues. IRoot SP sealer showed early insignificant more partial and almost full healing after two and three months.

Assessment of Photodynamic Therapy and Nanoparticles Effects on Caries Models.

AIM: To assess the antibacterial competence of 650 nm diode laser, Methylene Blue (MB) and Silver Nano-Particles (Ag NPs) on Streptococcus mutans in biofilm-induced caries models. MATERIAL AND METHODS: One hundred eighty specimens were prepared and equally divided into 6 groups. One group was untreated (control), and the others were subjected to either MB, laser, Ag NPs, the combination of MB and Laser or MB, laser and Ag NPs. RESULTS: Comparison of the log10 mean Colony Forming Units per millilitre (CFU/ml) values of each of the treated 5 groups and the control group was found statistically significant (P-value < 0.05). The combination of MB, laser and Ag NPs recorded the greatest reduction (95.28%). MB alone represented the least capable (74.09%). The efficiency differences among the Ag NPs treated group; the Laser treated group and the combined MB/Laser treated group were found statistically insignificant. CONCLUSION: The combination of MB, 650 nm diode laser and Ag NPs may be among the highly effective modern antimicrobial therapeutics in dentistry.

Effect of resin thickness, and curing time on the micro-hardness of bulk-fill resin composites.

BACKGROUND: Bulk-fill resin composite has been introduced, their manufacturers claimed that they can be applied in bulks of 4mm, without necessitating a prolonged curing time, or a light curing unit with increased irradiance. Thus this study was conducted to evaluate the effect of resin thickness, and curing time on the micro-hardness of two bulk -fill resin composites; Tetric Evo-Ceram [TE], and X-trafil [XF]. MATERIAL AND METHODS: 120 cylindrical specimens were prepared, and divided into 24 groups (n=5/group), representing the two bulk-fill resin composites, three different material thicknesses (2, 3 and 4 mm) and the four curing times used in the study (10, 20, 40, and 60 seconds). The specimens were light-cured from the top surface only. Specimens were stored in light proof containers in complete darkness at 37°C for 24 hours. Micro-hardness test was conducted on both top and bottom surfaces using Vickers micro-hardness tester with 500 g load and a dwell time of 15 seconds. Data were statistically analyzed by Four-way ANOVA of Variance. The significance level was set at P ≤ 0.05. Pearson Correlation used to determine significant correlations between mean micro-hardness (top) and (bottom) surfaces. RESULTS: Four way-ANOVA shows that different tested materials produce a statistically significant effect on mean micro-hardness (VHN) at p≤0.001, while thickness, curing time, and surface revealed statistically non significant effect on mean micro-hardness (VHN) at p≥0.05. [XF] (92.01±3.15 VHN) showed statistically significant higher mean micro-hardness than [TE] (54.13±4.96 VHN). Pearson Correlation revealed that there was a significant direct correlation between micro-hardness (bottom) and mean micro-hardness (top) (mm), r = 0.985, p (2-tailed) ≤0.001. CONCLUSIONS: Within the limitations of this study, the bulk-fill resin composites used in this study can be placed and cured properly in the 4 mm bulk. KEY WORDS: Bulk-fill resin composite, micro-hardness, thickness, curing time.

Injectable nanoamorphous calcium phosphate based in situ gel systems for the treatment of periapical lesions.

Nonsurgical local treatment of a periapical lesion arising from trauma or bacterial infection is a promising innovative approach. The present study investigated the feasibility of developing injectable amorphous calcium phosphate nanoparticles (ACP NPs) and ACP NPs loaded with an anti-inflammatory drug; ibuprofen (IBU-ACP NPs) in the form of thermoreversible in situ gels to treat periapical lesions with the stimulation of bone formation. NPs were produced by a spray-drying technique. Different formulations of Poloxamer 407 were incorporated with/without the produced NPs to form injectable gels. A drug release study was carried out. A 3 month in vivo test on a dog model also was assessed. Results showed successful incorporation of the drug into the NPs of CP during spray drying. The particles had mean diameters varying from 100 to 200 nm with a narrow distribution. A drug release study demonstrated controlled IBU release from IBU-ACP NPs at a pH of 7.4 over 24 h. The gelation temperature of the injectable in situ gels based on Poloxamer 407 was measured to be 30 °C. After 3 months of implantation in dogs, the results clearly demonstrated that the inclusion of ACP NPs loaded with IBU showed high degrees of periapical bone healing and cementum layer deposition around the apical root tip.

Repair Bond Strength of Aged Silorane-based Composite Using Intermediate Adhesive Systems Based on Different Monomers.

PURPOSE: To investigate the effect of pre-repair aging periods and intermediate adhesive systems based on different monomers on the repair bond strength of silorane-based resin composite. MATERIALS AND METHODS: A total of 32 Filtek P90 (3M ESPE) substrate specimens (4 mm diameter and 4 mm height) were made. Substrate specimens were grouped according to the pre-repair time periods into four groups (n = 8/group): 15 to 30 min, 24 h, 1 month, and 3 months. All substrate specimens were ground flat using a diamond stone and were etched using Scotchbond phosphoric acid etchant (3M ESPE). The specimens of each pre-repair time period were equally distributed among the two repair groups, using either silorane-based (P90 System Adhesive) or acrylamide-based (AdheSE One F, Ivoclar Vivadent) intermediate adhesive systems. Specimens of P90 System adhesive received Filtek P90 as the repair resin composite, and Tetric N-Ceram (Ivoclar Vivadent) was used with AdheSE One F specimens. Additional specimens were made from the repair resin composite materials to study the cohesive strength. Specimens were sliced into sticks (0.6 ± 0.01 mm2) for microtensile bond strength testing (µTBS). Modes of failure were determined. RESULTS: Two-way ANOVA with repeated measures revealed no significant effect for the pre-repair aging periods, intermediate adhesive systems based on different monomers, or their interaction on repair bond strength of silorane-based resin composite. CONCLUSION: Up to 3 months of pre-aging the repaired silorane-based resin composite had no negative effect on its repair bond strength, even when an intermediate adhesive system based on a different monomer (acrylamide) was used.

Impact of laparoscopic Nissen fundoplication on non-complicated Barrett's esophagus.

BACKGROUND/AIM: Laparoscopic fundoplication can alter the natural course of Barrett's esophagus (BE). This study was undertaken to assess this role in patients with non-complicated BE. MATERIALS AND METHODS: From October 2004 to October 2009, 43 patients with BE (32 men and 11 women) underwent laparoscopic Nissen fundoplication surgery in the Department of Surgery at Minia University Hospital. The median age of these patients was 46 years (range: 22-68 years). Patients with high-grade dysplasia, invasive cancer, or previous antireflux surgery were excluded. All 43 patients had gastroesophageal reflux symptoms. Heartburn was present in all patients, regurgitation in 41 (95.3%), dysphagia in 8 (18.6%), retrosternal pain in 30 (69.8%), upper gastrointestinal hemorrhage in 6 (13.9%), and respiratory symptoms in 19 (44.2%). Nissen fundoplication was performed in all patients. Thirty-four patients (79.1%) had concomitant hiatal hernia and nine patients (20.9%) had low-grade dysplasia. RESULTS: The median follow-up period was 25.6 months. There was significant improvement of symptoms after surgery (P<0.05). Eight (18.6%) of those with short-segment BE had total regression and four (9.3%) of those with long-segment BE had a decrease in total length. Among the nine patients with preoperative low-grade dysplasia, dysplasia disappeared in seven, remained unchanged in one, and progressed to in situ adenocarcinoma in one patient. CONCLUSIONS: laparoscopic fundoplication succeeded in controlling symptoms but had unpredictable effect on dysplasia and regression of BE. Laparoscopic fundoplication does not eliminate the risk of developing esophageal adenocarcinoma and therefore, endoscopic follow-up should be continued in these patients.

Blunt abdominal trauma requiring laparotomy in poly-traumatized patients.

OBJECTIVE: To investigate the impact of associated extra-abdominal injury on morbidity and mortality in poly-traumatized patients with blunt abdominal trauma. METHODS: This analysis included poly-traumatized patients with blunt abdominal trauma treated at the Emergency Unit of Minia University Hospital and Misr University for Science and Technology Hospital, Minia, Egypt, between March 2006 and March 2008. This study included patients aged 4-73 years with injury severity score (ISS) more than 18 and indicated for surgical intervention. Data were analyzed with details of injury, treatment, complications, and mortality. RESULTS: Inclusion criteria were met by 94 patients with mean ISS of 29.3 6.4. Most frequent injuries were seen in the spleen (61.7%) and liver (47.9%). Chest trauma represents most common extra-abdominal trauma (67%). Thirty-six patients (38.3%) died during their hospital stay. Most frequent reasons for death were hemorrhagic shock (27.8%), acute respiratory distress syndrome (27.8%), and head trauma (22.2%). There was a positive relationship between liver injury and mortality, which was not found in splenic injuries. Significantly more deaths were attributed to primarily extra-abdominal injuries (66.7%) and then to intra-abdominal injuries (19.4%). In 5 patients (13.9%), a combination of intra- and extra- abdominal injuries caused post-traumatic death. CONCLUSION: Extra-abdominal injuries add to the morbidity and mortality from blunt abdominal trauma in poly-traumatized patients. Routine computerized tomography scanning can minimize negative abdominal exploration and facilitate better management of extra-abdominal injuries.