Biomineralization of Dental Tissues Treated with Silver Diamine Fluoride.

Silver diamine fluoride (SDF) is a dental biomaterial used to arrest dental caries. To better understand SDF's mechanism of action, we examined the localization of silver within the tissues of SDF-treated teeth. Carious primary teeth fixed within 2 min of SDF application (SDF-minutes, n = 3), at 3 wk after SDF application in vivo (SDF-weeks, n = 4), and at 2 y after multiple SDF applications in vivo (SDF-multiple, n = 1) were investigated in this study. Carious primary teeth without SDF application (no-SDF, n = 3) served as controls. Mineral density and structural analyses were performed via micro-X-ray computed tomography and scanning electron microscopy. Elemental analyses were performed through X-ray fluorescence microprobe and energy-dispersive X-ray spectroscopic techniques. SDF-treated teeth revealed higher X-ray-attenuated surface and subsurface regions within carious lesions, and similar regions were not present in no-SDF teeth. Regions of higher mineral density correlated with regions of silver abundance in SDF-treated teeth. The SDF penetration depth was approximated to 0.5 ± 0.02 mm and 0.6 ± 0.05 mm (mean ± SD) for SDF-minutes and SDF-weeks specimens, respectively. A higher percentage of dentin tubular occlusion by silver or calcium phosphate particles was observed in primary teeth treated with SDF-weeks as compared with SDF-minutes. Elemental analysis also revealed zinc abundance in carious lesions and around the pulp chamber. SDF-weeks teeth had significantly increased tertiary dentin than SDF-minutes and no-SDF teeth. These results suggest that SDF treatment on primary teeth affected by caries promotes pathologic biomineralization by altering their physicochemical properties, occluding dentin tubules, and increasing tertiary dentin volume. These seemingly serendipitous effects collectively contribute to the cariostatic activity of SDF.

Salvaging the chemoport using catheter-assisted deflection during stenting of the superior vena cava.

Patients with malignancy who develop superior vena cava (SVC) obstruction may require stenting to relieve their symptoms. Some of these individuals also have an indwelling chemoport for concomitant chemotherapy. We present a case where stenting was accomplished after catheter-assisted deflection of the chemoport catheter tubing via a single groin access. It can save procedure time whilst salvaging the device.

Tunneled catheter (PleurX) for long-term chest and abdominal drainages from 2012-2017 in a tertiary institution.

The PleurX catheter was developed to facilitate long-term intermittent drainage of malignant pleural effusion or ascites. For palliation, it is important that the process of insertion is safe and that this catheter remains complicationfree so as to improve end-of-life quality. We show that this catheter can be safely inserted and discuss methods to reduce infection, which was the most common complication. Our article hopes to enlighten clinicians, patients and their caregivers of this device as a treatment option in palliative patients. Proper case selection and caregiver training are essential in ensuring a successful outcome.

Gasless single-incision laparoscopic inguinal hernia repair: initial experience.

PURPOSE: Laparoscopic hernioplasty has been gaining its popularity in the past decade for its rapid recovery. Single-incision surgery, as its possible advancement, has also received more attention. Traditional laparoscopic surgery with carbon dioxide insufflation precluded patients with underlying cardiovascular or pulmonary disease from minimal invasive surgery. We report our early experience with gasless single-incision laparoscopic inguinal hernia repair via totally extraperitoneal (TEP) approach. METHODS: Between 2010 and 2012, 15 consecutive patients underwent gasless laparoscopic inguinal hernia repair by the same surgeon, using abdominal wall lifting technique with a self-tailored device. Patient demographics, hernia characteristics, operative findings and postoperative outcomes were analyzed prospectively. RESULTS: Of the 15 patients, all had unilateral hernia. Two presented with acute incarceration, in which one required bowel resection. There was no conversion to open surgery or insertion of additional ports. The median operating time was 80 min (range 51-130) for elective repair and 178 min (range 135-220) for emergency repair. The median hospital stay was 1 day (range 1-6) with minimal requirement of analgesics. Median time taken to resume normal activity was 2 days (range 1-6). No major medical complications or mesh infection was encountered. One patient developed hematoma and was successfully managed by salvage laparoscopic reoperation. During a median follow-up of 54 months (range 38-60), none experienced recurrence. CONCLUSION: Gasless single-incision TEP is feasible with favorable results, even in high-risk patients with compromised cardiorespiratory status. This technique can also be applied to emergency setting in patients with incarcerated inguinal hernia requiring bowel resection. Future large scale randomized study is needed to verify the effectiveness of this technique.

Thymic carcinoma presenting with an unusual and delayed metastasis to the neural foramen, mimicking thoracic spinal radiculopathy.

We report a case of metastatic thymic carcinoma which presented as an enhancing mass located in the neural foramen of the thoracic spine. More common tumours which arise in the neural foramen would include a neurogenic tumour or developmental anomalies such as a foregut duplication cyst. This case is singular firstly because the lesion present as radiculopathy which mimics a neurogenic tumour. Secondly, the presentation was unusually delayed as the patient presented to our centre more than a decade after the resection of the primary tumour in another institution.

Cystic pancreatic lesions: a pictorial review and management approach.

The majority of cystic pancreatic lesions are incidental findings, especially with the increasing use of advanced imaging modalities for non-related conditions. Most of these lesions were previously attributed to pseudocysts, although cystic neoplasms are now an important differential to be considered and excluded. This article aims to describe the types of cystic pancreatic lesions, demonstrate their imaging findings and discuss the management of these conditions.

Florid polypoid endometriosis of the cervix with left ureteric obstruction: a mimic of cervical malignancy.

Polypoid endometriosis, in contrast to typical (non-polypoid) endometriosis, presents as masses that project from a serosal or mucosal surface or from the lining of an endometriotic cyst. Generally large, these masses can simulate a malignant tumor on imaging and at surgery. We report a case of florid polypoid endometriosis arising from the cervix with extension into the left parametrium and involving the left ureter, mimicking a locally advanced cervical malignancy on ultrasound and magnetic resonance imaging.

Imaging appearance of severe subcapsular hepatic steatosis: mimicking hepatic embolic infarcts.

We report a case of severe subcapsular hepatic steatosis in a middle-aged woman with diabetic nephropathy requiring continuous ambulatory peritoneal dialysis (CAPD). The CT appearances of the liver were initially suspected to be due to embolic infarcts. However, an accurate diagnosis was made only after a history of intraperitoneal insulin administration was elicited, and this was confirmed on MRI with chemical shift gradient-echo pulse sequences. Haemodialysis was recommenced, and follow-up imaging 4 years later showed complete resolution of subcapsular hepatic steatosis.

Persistent left superior vena cava: a possible site for haemodialysis catheter placement.

Persistent left superior vena cava (PLSVC) is a congenital variant of the thoracic venous system, which is associated with other congenital abnormalities. Asymptomatic cases are often diagnosed incidentally during invasive cardiovascular procedures such as the deployment of central venous access devices. It is important to be aware of the existence of a PLSVC and the clinical implications that it may pose to the proceduralist during catheter placement. We describe our experience and the lessons learnt during the placement of a haemodialysis catheter via the left internal jugular venous route in a patient with unsuspected PLSVC.

Perineural (Tarlov) cysts mimicking adnexal masses: a report of three cases.

Perineural (Tarlov) cysts are usually incidental findings during magnetic resonance imaging (MRI) performed for low back pain. However, in a tertiary women's hospital, they may present as incidental findings on gynecological ultrasound imaging. Approximately 40,000 pelvic scans are performed annually in our department. Tarlov cysts were identified in three women between August 2007 and September 2008. In two patients (Cases 1 and 3), these cysts were initially misdiagnosed as hydrosalpinges on ultrasound examination, the latter having a differential diagnosis of an ovarian cyst. Two patients (Cases 1 and 2) were symptomatic, although Case 2 had symptoms that could not entirely be accounted for by the location of the cyst. Although asymptomatic, Case 3 underwent laparoscopy with a view to salpingectomy/cystectomy. In these patients, confirmation of Tarlov cysts was subsequently made on either computed tomography (CT) or MRI. All three patients were managed conservatively. Here we describe their clinical presentation, the appearance of the cysts on ultrasound imaging and on CT or MRI, and their eventual outcomes.

Cystic degeneration of ductal adenocarcinoma of the pancreatic tail.

We present a 54-year-old Chinese man with a tumour at the pancreatic tail associated with a presumed cystic splenic lesion. Histological examination showed a pancreatic ductal adenocarcinoma with extensive cystic degeneration and invasion of the spleen, a rare imaging presentation for such a tumour.

Paget's disease of the bone in a Chinese woman.

Paget's disease, otherwise known as osteitis deformans, is an unusual condition in the Oriental population. We report a case of Paget's disease in a Chinese woman, incidentally diagnosed on a bone scan. This was confirmed by clinical history, biochemistry and imaging findings using other modalities. Although bone scans are commonly performed to diagnose traumatic occult fractures and bone metastases, they can also be used to diagnose metabolic bone diseases, such as osteoporotic fractures, and to evaluate Paget's disease. It can also diagnose acute fractures secondary to renal osteodystrophy and osteomalacia.

Spontaneous choledochoduodenal fistula secondary to long-standing ulcer disease.

There are several varieties of bilioenteric fistulae. They are usually incidental findings, but once detected, various modalities can then be employed to further delineate the fistula. The fistulae usually arise as a complication of chronic duodenal ulcer disease, cholelithiasis or previous instrumentation to the biliary system. The presence of a fistula per se does not immediately equate to necessity for surgery. The treatment is dependent on its aetiology.

Perceived outcomes and parental satisfaction following dental rehabilitation under general anesthesia.

PURPOSE: The objective of this study was to evaluate parents' perceptions of their child's quality of life following dental rehabilitation under general anesthesia and to assess their satisfaction with that treatment modality. METHODS: A survey was sent to 400 parents of patients who had undergone dental rehabilitation. Quality of life outcomes, such as continued presence of pain and inability to eat or sleep, were assessed. Additionally, parental satisfaction with outcomes and processes was evaluated, as was outcome expectation. Descriptive statistics were collected on outcome measures. Contingency testing was employed to compare outcomes by medical or developmentally compromising conditions, gender, or continued use of the initial treatment facility for routine care. RESULTS: Fifty seven percent of parents returned surveys. A descending hierarchy of improved treatment outcomes was noted, with improvement in pain the predominant outcome, followed by improved abilities to eat and sleep, reported by 86, 69, and 41% of parents, respectively, 72% perceived an improvement in their child's health. Children with medically or developmentally compromising conditions were significantly more likely to have improved abilities to eat and sleep, and had a significantly improved overall health status. Satisfaction and expectations were consistently achieved and were not related to continued use of the initial treatment facility. CONCLUSIONS: Children with early childhood caries receiving comprehensive treatment under general anesthesia achieved improvements in their quality of life as well as overall health. A hierarchy of improvement was noted, with the greatest improvement noted in pain experience followed by improved abilities to eat and sleep. Parents were overwhelmingly satisfied with outcomes and the process of care, and reported that their expectations had been met.

A 20-year perspective on the changing use of hand over mouth (HOM) and restraint in postdoctoral pediatric dental education.

PURPOSE: This study assessed the current teaching and utilization of the hand over mouth technique in advanced educational programs in pediatric dentistry and compared these results to previous surveys. METHODS: A survey, identical to those used in 1979 and 1989, was sent to pediatric dentistry program directors. Descriptive and comparative statistics evaluated the use of HOM, HOMAR, and restraint. Additionally, changing patterns of responses for programs and directors that responded to both the 1989 and 1999 surveys were assessed. RESULTS: Eighty-seven percent of directors returned surveys. There was a significant decrease in the number of programs utilizing the HOM technique in the past 10 years (P< 0.0001). Among respondents that returned surveys in 1989 and 1999, 50% of the previous HOM users discontinued its use (P<0.03). Technique non-users were significantly less likely to describe the technique consistent with AAPD guidelines (P

The influence of medical history on restorative procedure failure rates following dental rehabilitation.

PURPOSE: This study evaluated the association between patient medical history and the outcomes of restorative procedures performed under general anesthesia. METHODS: The dental records of patients who had dental rehabilitation under general anesthesia at Children's Hospital in Boston (1990-1992) and Children's National Medical Center in Washington, DC (1994-1998) were examined. Data regarding restorative outcomes and the association between patient medical history and restorative failures were assessed using chi-square tests with correction for continuity. T-tests were performed on parametric data. RESULTS: Significantly higher stainless steel crown failure rates were found in young patients diagnosed with developmental disabilities when compared to patients without such disabilities (p<0.025, x2 = 5.50). However, there was no difference in the failure rates of SSCs in young patients with significant medical histories compared to patients without significant medical histories. Regarding amalgam and composite restorations, there were no differences in failure rates among patients with and without significant medical histories, including developmental disabilities. CONCLUSIONS: SSC failures were higher in young children with developmental disabilities compared to children without these disabilities.

The effect of dental rehabilitation on the body weight of children with early childhood caries.

PURPOSE: The purpose of this study was to determine the effect of comprehensive dental rehabilitation on the percentile weight and percentile growth velocity of children with early childhood caries (ECC). METHODS: The percentile weight categories of children with noncontributory medical histories and ECC were compared to caries free comparison patients, before and after comprehensive dental treatment under general anesthesia. RESULTS: Prior to dental rehabilitation, test subjects' percentile weight categories were significantly less than that of comparison counterparts (P < 0.001). Of the ECC patients, 13.7% weighed less than 80% of their ideal weight, thereby satisfying one of the criteria for the designation of failure to thrive, while none of the comparison patients did so (P < 0.05). Following therapeutic intervention, ECC children exhibited significantly increased growth velocities through the course of the follow-up period (P < 0.001), reflecting the phenomenon of catch up growth. The average length of follow-up for the test and comparison groups were 1.58 and 1.36 years, respectively. At the end of the follow-up period there were no longer any statistically significant differences noted in the percentile weight categories of the test and comparison groups. CONCLUSION: Comprehensive dental rehabilitation resulted in catch-up growth, such that children with a history of nursing caries no longer differed in percentile weights from comparison patients.