Uncovering the Unknown: Granulomatous Peritonitis After Right Ovarian Cystectomy at a Tertiary Care Center in South India-A Case Report.

Background. Granulomatous peritonitis is a rare postoperative complication caused by a delayed hypersensitivity reaction to foreign substances. It can be challenging to diagnose owing to its vague presentations, and its possibility is often overlooked. Tubercular peritonitis and peritoneal carcinomatosis are the 2 crucial differential diagnoses that need to be taken into account. However, making a clinical differentiation between these 2 entities is challenging and necessitates a careful histopathological and microbiological analysis. Case Presentation. In this report, we present the case of a 28-year-old female who developed granulomatous peritonitis following a right ovarian cystectomy. The diagnosis was confirmed by histopathological examination. Conclusion. We must be aware of this rare entity, which, if left untreated, could have serious consequences, and consider its possibility in cases where the patient complains of abdominal pain after any abdominal procedure. We hope to provide insights into the importance of histopathological examination in aiding a confirmatory diagnosis of this entity.

An in vitro comparative evaluation of intraorifice barriers and bleaching agents on the fracture resistance of the endodontically treated anterior teeth.

Aim: This study aimed to evaluate and compare the impact of different bleaching agents on the fracture resistance of endodontically treated teeth when using either GC Fuji type 2 glass ionomer cement (GIC) or Shofu Glass Ionomer RX EASE as intraorifice barriers (IOB). Materials and Methods: A total of 80 single-rooted human maxillary central incisors were prepared and obturated. Three millimeters of gutta-percha was then removed from the orifice. The specimens were divided into two primary groups based on the type of IOB material used: GC Fuji type 2 GIC and Shofu Glass Ionomer RX EASE (n = 40). Each group was further divided into four subgroups based on the bleaching agent used: Carbamide peroxide (CP) 37%, sodium perborate (SP), hydrogen peroxide (HP) 35%, and distilled water used as the control (n = 10). The teeth were subjected to fracture resistance testing. Results: The study found that the order of root fracture resistance was control > CP > SP > HP. There was no statistically significant difference in fracture resistance between GC Fuji type 2 GIC and Shofu Glass Ionomer RX EASE when used as IOB materials. Conclusion: The study concluded that the choice of bleaching agent significantly affects the fracture resistance of endodontically treated teeth. It was observed that fracture resistance is lowest with HP, followed by SP and CP. Both GC Fuji type 2 Glass Ionomer and Shofu Glass Ionomer RX EASE are effective as IOB.

Primary ovarian leiomyoma: Imaging in a rare entity.

Primary ovarian leiomyoma is a very rare benign mesenchymal tumor arising from the smooth muscle of walls of ovarian blood vessels. It is usually seen between 20 65 years of age. Being asymptomatic in many patients, these are incidentally detected. Ultrasonography and magnetic resonance imaging are preferred modality while imaging these lesions. Hereby we present a case of a 35-year-old female with incidentally detected right ovarian mass lesion which was hypointense on ultrasonography, hypointense on both T1W and T2W images, and on histopathology confirmed as primary ovarian leiomyoma. T1- and T2-weighted hypointensity on MRI with early homogenous postcontrast enhancement help in its diagnosis, though many a time it is difficult to differentiate it from other mesenchymal fibrous tumors such as fibroma and fibrothecoma. Histopathology and immunohistochemistry remain the mainstay in final confirmatory diagnosis. It is important to keep this entity in the differential diagnosis of solid T1 and T2 hypointense lesions of the ovary.

A comparison of two pulp revascularization techniques using platelet-rich plasma and whole blood clot.

AIM: The aim of this preliminary study was to compare outcomes of two regenerative endodontic protocols in necrotic teeth with open apices. METHODOLOGY: Forty teeth with open apices in patients with an age range of 15-54 were randomly distributed in two groups: group 1, with whole blood clot in the canal (n=20) and group 2, whole blood with Platelet rich plasma (PRP) in the canal (n=20). Clinical and radiological follow up assessments were undertaken over a period ranging from 6 months to one year. Radiographic Root Area (RRA) was measured using the freeware ImageJ. Statistical analysis was performed using the independent samples t test and the Chi-squared test, the significance level was set at p=0.05. RESULTS: There was no difference in the percentage change in RRA between the PRP group and whole blood-clot + PRP group. CONCLUSION: Whole blood clot and PRP are comparable on the grounds of percentage change in RRA and there is no statistically significant difference between the two in a follow-up period of up to one year.

Assessment of malocclusion status, dentition status, and treatment needs among 15-year-old school children of Mangalore.

BACKGROUND AND OBJECTIVES: Dental caries and malocclusion are common dental public health problems. Surveys provide us with an insight into the oral health status and treatment needs and also help in proper treatment planning. Hence, the objective of this study was to assess the malocclusion status, dentition status, and treatment needs of 15-year-old school children of Mangalore. METHODOLOGY: A cross-sectional study of 1001 school children aged 15-year-old was conducted in Mangalore. Their malocclusion status, dentition status, and treatment needs were recorded using the WHO oral health assessment pro forma. Statistical analysis was done using Statistical Package for Social Sciences version 17. Descriptive statistics was obtained and Chi-square test was used. The level of significance was set at 0.05. RESULTS: Decayed teeth were prevalent in 45.5% of the study subjects. Malocclusion was present in 30% of the study subjects. Teeth missing due to caries and those requiring extraction and prosthetic rehabilitation were significantly higher in government schools (P < 0.05). Malocclusion and treatment need was significantly higher in government schools (P < 0.05). CONCLUSION: From the present study, we can conclude that the school children aged 15 years of Mangalore had varied malocclusion status, dentition status, and treatment needs with significantly higher treatment needs and malocclusion among children of government school.

An In vitro Study to Compare the Effect of Different Types of Tea with Chlorhexidine on Streptococcusmutans.

INTRODUCTION: Tea is the second most commonly consumed beverage in the world after water. The leaf and bud of the plant Camellia sinensis produces tea. The different forms of tea are 'non-fermented' green tea, 'semi-fermented' oolong tea and 'fermented' black tea according to the manufacturing process. Streptococcus mutans is the main causative organism in dental caries and plaque formation. AIM: The present study was undertaken to determine the antibacterial effectiveness of aqueous and ethanol extracts of green tea, black tea and oolong tea against S. mutans in comparison with 0.2% chlorhexidine. MATERIALS AND METHODS: An in vitro study was conducted to compare the effectiveness of aqueous and ethanol extracts of green tea, black tea and oolong tea with 0.2% chlorhexidine against S. mutans. Chlorhexidine 0.2% commercially available as mouthwash was used as such for comparison. The antimicrobial activity was determined using agar well diffusion method. About 50 µl of the aqueous and ethanol extracts of tea and 0.2% chlorhexidine were inoculated into the wells prepared on blood agar plates smeared with S. mutans. The agar plates were incubated for 24 hours after which the diameter of the zone of inhibition was measured. Analysis of Variance (ANOVA) followed by Tukey's post hoc test were used for statistical analysis. RESULTS: The mean zone of inhibition of the aqueous extracts of green tea, black tea, oolong tea and chlorhexidine was found to be 16.33 mm, 10.33 mm, 19.66 mm and 22 mm respectively. The mean zone of inhibition of the ethanol extracts of green tea, black tea, oolong tea and chlorhexidine was found to be 14 mm, 9 mm, 20.66 mm and 22 mm respectively. The study result state that the inhibitory effect of chlorhexidine is almost similar to that of oolong tea followed by green tea and black tea. CONCLUSION: From the present study, it can be concluded that the aqueous and ethanol extracts of oolong tea showed highest antimicrobial activity compared to green tea and black tea.

An interdisciplinary approach for the management of noncarious lesions.

Miller's class III gingival recession is a common entity observed in individuals, posing a difficult situation for the clinicians to treat. Large fenestration defects with cervical abrasion compromise the esthetics resulting in poor prognosis. Obtaining predictable and esthetic root coverage has become an integral part of periodontal therapy. The present case report describes a situation where class III gingival recession with cervical abrasion was seen in the lower central incisors. The patient was successfully treated with a combination of restorations (Filtek Z350(®) composite resin) to fill the defect, followed by fenestration procedure to increase the vestibular depth and subsequently with grafting procedure (soft tissue autograft with bovine-derived xenograft collagen [Bio-oss]). Though the results were not tangible esthetically, it was functionally successful as evidenced during the follow-up period.

Working length changes in curved canals after coronal flaring by using rotary files and hand file: An in vitro study.

AIM: This in vitro investigation examined the effect of early coronal flaring (CF) and late CF on the working length (WL) in curved root canals. BACKGROUND: The objective of this study was to determine if canal length is altered as a result of CF in curved canals of molar roots. STUDY DESIGN: The conditions compared were combinations of (a) stainless steel hand files using Gates Glidden (G. G.) drills (SS) versus nickel-titanium rotary files (Ni-Ti); and (b) early CF (flaring completed before WL determination) versus late CF (flaring completed after WL determination). Selected were 90 canals of extracted maxillary or mandibular first molars (mesial root of mandibular molars and the mesiobuccal root of the maxillary molars) from three groups. CF was accomplished for the SS group using G. G. drills and for the Ni-Ti group using rotary ProTaper and Hero Shaper files. WL was determined by a digital vernier caliper before CF, immediately after CF, and again after canal preparation. STATISTICAL ANALYSIS: A repeated measures analysis of variance (ANOVA) test and a Tukey's multiple prosthoc test were used for this study. RESULTS: Results indicated that WL decreased for all canals as a result of canal preparation. The mean decrease in WL was significantly greater for the SS group (-0.77 ± 0.42 mm) than for the Ni-Ti groups (-0.33 mm ± 0.44). Less change in WL occurred in all groups when initial WL was determined after CF. CONCLUSION: WL in curved canals consistently decreases during the course of instrumentation. Clinician should keep this in mind for better treatment outcome.

Ectopic anus with barrel gun perineum rare type of anorectal anomaly.

Perineal ectopic anus in female infants is not a very uncommon congenital anorectal anomaly with opening into the low vaginal or vulvar region. However, ectopic anus with barrel gun perineum is a less common variety. Patients generally present with frequent history of constipation, but may seek medical help for just aesthetic reasons. We present here one such case of an asymptomatic seven years old female with the rare form of anterior ectopic anus with barrel gun perineum without any fistulous communications with an innovative method of demonstration of the anomaly by using ultrasound gel as rectal contrast in MRI pelvis.

Imaging of serous psammomacarcinoma of ovary with subcutaneous deposits: A case report.

Serous psammomacarcinoma of ovary is a rare ovarian carcinoma. We present the imaging features of this condition in a patient with a probable metastatic subcutaneous nodule.

Technical note: MRI lymphangiography of the lower limb in secondary lymphedema.

We would like to describe a case of MRI lymphangiography of the left leg, performed by subcutaneous injection of gadopentetate in the foot, followed by serial acquisitions of images, in a 52-year-old female, who presented to us with progressive leg swelling following total hysterectomy and radiation therapy. Successful demonstration of lymphatic channels, along with faint visualization of the venous system, was achieved. This technique allows excellent visualization of lymphatic channels.

Laparoscopic anterior resection and total mesorectal excision for rectal cancer: a prospective nonrandomized study.

BACKGROUND: The purpose of this study was to present our experience of laparoscopic total mesorectal resection, including ultralow resection and coloanal anastomosis. MATERIALS AND METHODS: Between 1993 and 2005, patients fit for general anesthesia, with resectable cancers, and with lower edge of tumor beyond 5 cm of the anal verge were subjected to laparoscopic anterior resection with sphincter preservation. Double stapling technique is used to establish bowel continuity. RESULTS: A total of 170 patients, 88 males and 82 females, were subjected to successful laparoscopic anterior resection, which included high anterior resection (n=90), low anterior resection (n=52), ultralow anterior resection (n=20), and coloanal anastomosis (n=8). The average age of patients was 58.4 years (12-90 years). Mean operating time was 130 min and mean hospital stay was 7 days. The morbidity was 13.5% with nil mortality. With an average follow-up of 49 months (range 9 years to 3 months), 9 patients developed local recurrence and 45 patients developed distant metastasis. CONCLUSION: In selected cases, laparoscopic anterior resection is possible for all levels of rectal tumors, allowing sphincter preservation and maintaining oncological safety.

Early ligation of the splenic artery in the leaning spleen approach to laparoscopic splenectomy.

BACKGROUND: A variety of approaches have been proposed for laparoscopic splenectomy, including the anterior approach, the lateral approach (hanging spleen technique), and the semilateral approach (leaning spleen technique). We advocate a leaning spleen approach with early ligation of the splenic artery. MATERIALS AND METHODS: Since 1997, we have performed 120 laparoscopic splenectomies using the leaning spleen approach along with early ligation of the splenic artery. The patient is placed in a 70-degree semi-right lateral position. The operative steps are: exposure of the lesser sac, control of the splenic artery, mobilization of the splenic flexure, division of the splenocolic ligament, division of the splenophrenic ligament, hilar mobilization, mobilization of the upper pole of the spleen, and removal of the specimen. RESULTS: The most common indication for surgery was autoimmune hemolytic anemia (35.8%). One patient had severe perisplenitis with extensively vascularized adhesions, which led to oozing during surgery obscuring the laparoscopic view, requiring conversion to open surgery. The mean spleen diameter was 22.8 cm (range, 12.5-37.0 cm) on imaging. The mean operative time was 85 minutes (range, 54-124 minutes). Concomitant laparoscopic cholecystectomy for pigment stone cholelithiasis was performed in 8.3% of the patients. Accessory splenic tissue was found in 4.2%. The average hospital stay was 3 days (range, 1-6 days). There were no significant postoperative complications. The average follow-up has been 5.4 years (range, 1 month-9 years). CONCLUSION: In adopting the modification of early ligation of the splenic artery in the leaning spleen approach, we believe we have helped to advance laparoscopic splenectomy.

Late rejection after transabdominal pre-peritoneal inguinal repair: laparoscopic extraction of mesh.

We report a 29-year-old man who developed mesh rejection 3 years after laparoscopic transabdominal pre-peritoneal inguinal repair. The mesh, which was lying in a fluid cavity adherent to the urinary bladder and right iliac vessel, was removed laparoscopically.

Laparoscopic inguinal hernia repair in children.

BACKGROUND: This study aimed to document the authors' experience with laparoscopic inguinal hernia repair in children. METHODS: Ninety-three hernia repairs were performed in 64 children. The neck was closed with a purse string suture by using 4-0 absorbable suture. RESULTS: Ninety-three indirect inguinal hernial sacs were closed in 64 children. Nine percent of children had an ectopic testis. The mean operating time for laparoscopic ring closure was 25 minutes (range, unilateral 21 to 35; bilateral, 28 to 50). The contralateral processus vaginalis was patent in 20% of children. In 24% of children, the final procedure was modified based on the findings of a dilated internal ring. A laparoscopic ilio-pubic tract repair was done in these cases. Laparoscopic mobilization, orchiopexy followed by ilio-pubic tract repair was done in 9% of children. Scrotal swelling occurred in one child. Hydrocoele occurred in one patient. Recurrence rate was 3.1%. CONCLUSION: Laparoscopic inguinal hernia repair in children can be offered, as it is safe, reproducible, and technically easy for experienced laparoscopic surgeons. Ilio-pubic tract repair may be added in cases with dilated internal ring. Recurrence following laparoscopic ring closure can be managed with laparoscopic ilio-pubic tract repair. The long-term follow-up of laparoscopic ilio-pubic tract repair is awaited.