Autotransplantation of an inverse impacted dilacerated incisor: a case report with 11-year follow-up.

BACKGROUND: Dilaceration can lead to impaction of maxillary incisors, resulting in both aesthetic and functional problems. This case report presents the multidisciplinary approach to managing an inverse impacted dilacerated left lateral incisor in a 9-year-old male patient. CASE REPORT: The orthodontic alignment of the remaining three incisors was achieved within six months. After using the diode laser to remove the gingiva covering the right lateral incisor during alignment process, a lingual button was bonded. The primary left canine and the impacted permanent left lateral incisor were extracted by raising the full-thickness mucoperiosteal flap, followed by the transplantation of the dilacerated lateral incisor into its correct position, splinted to the adjacent central incisors using composite resin. Root canal treatment was performed after the apical plug was created with mineral trioxide aggregate. The composite splint was removed after three weeks, and a new bracket was bonded to the left lateral incisor. It was left passively for 18 months until the permanent canines started to erupt. Light orthodontic forces were then applied for six months, and a passive eruption was expected over three months to properly position the canines within the dental arch. After an 11-year follow-up, the incisor displayed no clinical symptoms, although radiographic examination revealed external resorption in the long-term. CONCLUSION: This case demonstrates the successful and fast autotransplantation of an immature inverse impacted dilacerated incisor, highlighting the long-term clinical success and favorable aesthetic outcomes.

Microhardness evaluation of enamel adjacent to an improved GIC sealant after different enamel pre-treatment procedures.

AIM: This in vitro study was carried out to evaluate the microhardness of enamel adjacent to a glass ionomer cement (GIC) with high fluoride content used as a sealant (Fuji Triage, GC Corp., Japan) after laser, bur or air abrasion treatment procedures. STUDY DESIGN: 200 freshly extracted non-carious human molars were divided into 10 experimental groups according to the enamel pre-treatment method: A air abrasion (Mach 4.1 Kreativ Inc., USA); AP, Air abrasion + conditioning with 20% polyacrylic acid (GC cavity conditioner); L, Er,Cr:YSGG laser application (Waterlase, Biolase Technology, Inc., San Clemente, USA); LP, Er,Cr:YSGG laser application and fissure conditioning; B, ameloplasty carried out with a diamond bur especially designed for preparing fissures (Komet #8833); BP, ameloplasty + fissure conditioning; P, application of 20% polyacrylic acid and all fissures sealed with GIC; C, no fissure treatment, the material was applied directly to the fissures (control); R, application of 37% orthophosphoric acid and fissures sealed with a resin-based sealant (Fissurit; Voco, Germany) (control); N, no treatment (control). Half of each group of teeth were left in artificial saliva for one month and the rest for three months. The teeth were then sectioned and microhardness was measured using a Vickers test apparatus. Kruskal-Wallis, Mann-Whitney U and Dunn's multiple comparison tests were carried out (5% significance). RESULTS: After one month results regarding hardness at the base and lateral walls of fissures were significantly higher in groups A, AP, L, LP, B, BP, P and C than in groups R and N (p<0.01), but no difference was seen between the treatment procedures. The results after three months produced similar findings with evenly increased values for all groups. CONCLUSION: The results of this study showed that the tested GIC with a higher fluoride content seemed to improve the enamel hardness of the fissure enamel and could be regarded as an alternative material in cases where resin sealant applications are questionable.

Nontraumatic giant fat necrosis of the breast presenting as a rapidly growing tumor.

Nontraumatic rapid growing giant fat necrosis of the breast mimicking breast tumors is a rare clinical manifestation. The imaging features of the fat necrosis which range from benign to malign findings may be better explained with associated aetiology. The present paper reports a 54-year old woman with a rapid growing, fibrous, and hard giant mass originating in the subareolar region of the left breast. Mammography and magnetic resonance imaging demonstrated a heterogeneous, well circumscribed mass in 12 × 12 cm size in the left breast. The lesion was suspected as a malignant tumor and underwent core biopsy. The histopathology examination of the biopsy revealed mononuclear cells, foamy, vacuolated, and bubbly cells containing fat. Excision biopsy of the mass was performed and the final pathological diagnosis was confirmed as fat necrosis. The wide clinical and radiologic manifestations of fat necrosis are still difficult to diagnose even with the new diagnostic modalities and a great proportion of these lesions need a biopsy to diagnose.

Bioembolisation for unresectable hepatocellular carcinoma: preliminary results of a translational research study.

Lack of effective treatment for surgically unresectable hepatocellular carcinoma has made this disease dismal. Although, systemic and/or locoregional chemotherapy and chemo-embolization are among the established treatment options, the results of these modalities are still far from being satisfactory. Systemic interferon administration is also used for the treatment of this disease however it has high toxicity rates. We conducted a pharmacology guided phase I/II study with the aim to explore the effect of hypoxy and interferon alpha-2a in vitro using the HepG2 Hepatoma cell line. We then translated the in-vitro results to the clinical setting and designed a treatment protocol. This schema consisted of lipiodol embolisation via a hepatic artery port in between two sets of seven loco-regional injections of IFNalpha-2a, 3 MU every other day. The in-vitro study revealed the best sequence of hypoxy and IFN as IFN-Hypoxy-IFN. Based on this finding, ten patients with HCC were treated with loco-regional IFN and lipiodolisation. Seven of them achieved partial response and the mean duration of response was 10 months. There was no Grade 4 toxicity. In conclusion, our preliminary clinical results suggest that the combined use of IFN and lipiodolisation in the optimal sequence may provide a new therapeutic option for patients with HCC.

pH changes in dental plaque after using sugar-free pediatric medicine.

The aim of this study was to compare the pH changes in the dental plaque after rinsing with sugared- (sucrose) or sugar-free (saccharine, cyclamate and sorbitol) versions of the same pediatric acetaminophen solution (ekosetol) up to one hour. Twenty-nine undergraduate dental students (17 girls and 12 boys) collected plaque for 48 hours by abstaining from oral hygiene, during which period they maintained normal dietary habits. Plaque sampling was done in two subsequent days before and 2, 5, 10, 15, 20, 25, 30, 40, 50 and 60 minutes after rinsing with both solutions. Measurements of pH were done within one hour using a micro pH electrode and a pH meter. All experiments were finished in 6 days by dividing the group to three. Results showed a significant difference between groups in respect to pH values and pH drops after rinsing. Mean pH values were below 5.70 for one hour in sugared solution, whereas no mean pH value was detected below 5.80 for one hour with the sugar-free solution. Minimum pH values (sugar-free: 5.62+/-0.36; sugared: 5.00+/-0.33, p<0.001) and maximum pH drops (sugar-free: -0.57+/-0.26; sugared: -1.16+/-0.44, p<0.001) were also significantly different. No difference was found between genders. We concluded that changing of sucrose to non-acidogenic sweeteners was essential to prevent the cariogenic potential of the pediatric medicines.

Correlative CT, MRI and histological findings of hepatic Echinococcus alveolaris: a case report.

Diagnosis of liver infestation by Echinococcus alveolaris (EA) is based on serologic, sonographic and CT findings. Literature review yielded only one report discussing the MRI findings of hepatic EA infestation. In this report, we present a case of hepatic EA infestation with its correlative CT, MRI and histological findings. CT showed hypodense mass involving more than half of the liver with rim and central calcifications. MRI revealed hypointense signal of the infiltrative mass on both T1- and T2-weighted images. On MRI, the portal vein branches were seen coursing through the lesion. Neither CT nor MRI demonstrated any contrast enhancement of the mass. On the histological examination, abundant fibrous and hyalinized tissue surrounding multiple small cysts were observed. MRI may provide invaluable information in the diagnosis of EA infestation of the liver, either by disclosing the infiltrative pattern of infestation without significant effect to vascular structures, or by the signal characteristics.

Transcatheter arterial embolization of internal mammary artery in a hepatocellular carcinoma with abdominal wall invasion.

Transcatheter arterial embolization (TAE) is alternatively employed to surgical resection in the management of hepatocellular carcinoma (HCC). TAE through the hepatic artery is sometimes insufficient since the blood supply to HCC may be from the collateral vessels as well. We report a case of HCC with abdominal wall invasion who underwent TAE through the right internal mammary artery after insufficient embolization of the tumor through the hepatic artery.

Partially thrombosed hepatic artery aneurysm mimicking pancreatic head carcinoma.

A 43-year-old man with hepatic artery aneurysm which mimicked pancreatic head carcinoma on computed tomography (CT) was studied with B-mode ultrasonography, color doppler ultrasonography, and angiography and the findings are discussed comparing the imaging modalities.

Hydatid acute pancreatitis: a rare complication of hydatid liver disease. Report of two cases.

Acute pancreatitis (AP) is known to be a rare complication of hydatid disease. We present two cases of AP due to intrabiliary ruptured hydatid cysts of the liver. High serum and urine amylase levels and ultrasonographic findings, compatible with AP, were detected. On ultrasonography and computed tomography dilated bile ducts and cystic masses in the liver were seen. A communication between the bile ducts and a cyst in one case, and a total common bile duct obstruction with hydatid material in the other case, were seen on endoscopic retrograde cholangiopancreatograms. The patients were treated surgically with mainly omentoplasty. Recovery was uneventful. A diagnosis of AP should be kept in mind in patients with hydatid liver disease presenting with upper abdominal pain.

Hydatid liver disease: a perspective in treatment.

Hydatid liver disease caused by Echinococcus granulosus is a serious problem in regions where the parasite is endemic. The treatment of choice is surgery, however, it is associated with recurrence rates of up to 30%. Medical treatment with benzimidazole derivatives has limited success. The treatment modalities for hydatid liver disease are reviewed in detail and are evaluated in terms of radical treatment.

The acute effects of pancreaticopyelostomy on the pancreas and kidney. A preliminary study.

A modified canine pancreaticopyelostomy model with an intact kidney was constructed. The effects of this procedure on the pancreas and kidney were examined in five dogs by monitoring the serum and urine levels of pH, bicarbonate, chloride, glucose, urea, creatinine and amylase in 24-h periods for up to 72 h. The contralateral kidney served as controls. The pancreas and kidney were removed and examined under light microscopy after the animals were sacrificed. Both of the organs had maintained their normal histological architecture. The serum and urine glucose levels were consistent with a normal response after the initial elevation immediately following the surgical trauma. The urine urea concentrations from both kidneys were similar, as were the creatinine excretion trends throughout the 72 h, except for a significant rise in the creatinine excretion on the pancreaticopyelostomy side at 24 h. The pH, bicarbonate, chloride, and amylase values revealed a normal and functioning exocrine pancreas. It is concluded from this preliminary study that pancreaticopyelostomy with an intact kidney does not have acute adverse effects, either on the pancreas or on the kidney. This procedure may be an alternative method for pancreatic exocrine drainage if similar results are obtained in chronic models.

Omentoplasty versus introflexion for hydatid liver cysts.

Forty-three patients with unilocular hydatid cyst of the liver were divided into three groups. Omentoplasty (n = 15) was performed in group 1, introflexion (n = 18) in group 2 and a combination of both (n = 10) in group 3. Patients with omentoplasty developed fewer complications and had a significantly shorter hospitalization than those with introflexion. The results indicate that omentoplasty is superior both to introflexion and to introflexion plus omentoplasty for the management of hydatid liver cysts.

Osteoclast-type giant cell tumor of the pancreas associated with mucinous cystadenoma.

Osteoclast-type giant cell tumor of the pancreas is a rare form of pancreatic malignancy. This present case is the first instance where an osteoclast type giant cell tumor is reported in association with a pancreatic mucinous cystadenoma.

The effect of a sealant on the microleakage of composite resin restorations: an in vivo study.

The aim of this study was to evaluate the effect of sealant application in reducing microleakage of the composite resin restorations under in vivo conditions. Occlusal composite resin restorations were made in 24 caries-free primary molars which were about to exfoliate, in children aged between 10 and 13 years. Of these restorations, 12 were sealed with a fissure sealant whereas the others were kept unsealed as controls. After 1 month, the teeth were extracted and immersed in a 2% methylene blue dye solution. The dye penetration alongside the restorations was evaluated using a stereo-microscope. The findings indicated that sealant application significantly (p < 0.05) reduced the microleakage of composite restorations but did not eliminate it completely.

Parietal cell vagotomy and dilatation for peptic duodenal stricture.

Gastric outlet obstruction due to peptic duodenal stricture (pyloric stenosis) was treated with parietal cell vagotomy and dilatation of the stricture in 32 patients. Follow-up is in the range of 5 years in 37.4% of the patients, while 6 to 10 years follow-up is available in 62.4% of the patients. At their last follow-up, 74.9% of the patients were in either Visick 1 or 2 clinical status. Recurrence rates have been 3.1% at 1 year, 9.3% at 5 years, and 21.8% after 6 to 10 years follow-up. There has been only one instance (3.1%) of restenosis. Two patients required reoperation because of recurrence and one of them died.

The postoperative appearance of the liver on ultrasonography following hydatid cyst surgery.

The postoperative ultrasound pattern in 33 patients with previous surgery for unilocular hydatid disease of the liver was investigated. Each patient was submitted to liver scanning with 99mTc pertecnate, as well as to real time ultrasound examination. The patients were divided into three groups according to the type of surgery performed, namely; omentopexy, introflexion and omentoplexy with introflexion. Postoperative liver scans revealed defects similar to those detected during initial diagnosis in 88% of the patients, regardless of the surgical procedure performed. On the contrary, ultrasonography gave separate specific patterns for each surgical procedure.

Fluoride in dental plaque after a single toothbrushing with monofluorophosphate dentifrice.

Many studies have shown that topical fluoride applications can produce a fluoride reservoir in dental plaque. Since the most common topical fluoride application is via toothbrushing with fluoridated dentifrices, the aim of this study was to measure fluoride uptake by dental plaque after a single toothbrushing with monofluorophosphate (MFP) toothpaste and to follow the plaque until its fluoride concentration returned to the prebrushing levels. In a fluoridated area, plaque samples were collected from 26 children who brushed with MFP toothpaste, 22 children who brushed with a fluoride-free control toothpaste, before brushing and at intervals of 10 minutes, 1 hour and 2 hours after brushing. A combination fluoride electrode was used to determine the fluoride content of the samples. In conclusion, our study has shown that brushing with fluoridated water has a positive effect on the fluoride level of the plaque and the addition of MFP did not make a significant change, although it had a short term effect. A negative correlation was established between plaque wet weight and its fluoride content whenever the plaque equilibrated.

Pancreatitis as a complication of a hydatic liver cyst--a case report.

A 56 year old patient who developed acute pancreatitis following intrabiliary rupture of a hydatic cyst of the liver is reported herein. Hepatic hydatic disease is a very rare cause of acute pancreatitis for which the surgical treatment consists of evacuation of the cyst material and biliary drainage. Cystoenteric drainage is not mandatory.

The effect of bile on the gastric mucosal barrier in the presence and after blockade of normal gastric acidity.

Induced physiologic changes in the gastric mucosa was investigated both in the presence of normal gastric acidity and after parietal cell vagotomy (PCV), in dogs. Cholecystogastrostomy and common bile duct ligation was performed in eleven and PCV was added to this procedure in five dogs. During histopathological examination, 70 days after the procedure, both groups proved to have superficial gastritis. The most prominent changes occurred at the anastomotic site and at the gastric antrum. Bile had broken down the gastric mucosal barrier and the Na+ flux roughly paralleled the H+ back diffusion. Potassium had taken part in the bi-directional movement of ions in the gastric mucosa, as well as the sodium flux, and in the late phase it accompanied the action of sodium ions. The destruction of the K+-H+ pump, possibly located in the plasma membrane, may be the responsible mechanism of this flux.