Pre-endodontic restoration of structurally compromised teeth: current concepts.

Teeth that require endodontic treatment are often structurally compromised and this considerably complicates endodontic procedures. Therefore, pre-endodontic restoration is a key approach that dentists should consider for such teeth. This article discusses current concepts of pre-endodontic restoration, with a focus on adhesive restorative methods and surgical/orthodontic techniques, and provides a relevant decision-making flowchart.

The intraoperative management of patients with pericardial tamponade.

The anesthetic management of patients with pericardial tamponade is challenging, as they present with not only the cardiovascular compromise that defines pericardial tamponade, but often have comorbid conditions that increase the complexity of their management. This review describes the pathophysiology, etiology, clinical presentation, and anesthetic management of patients with pericardial tamponade, with an emphasis on the intraoperative period and the management of pericardial window procedures, the most common clinical scenario where anesthesiologists will encounter pericardial tamponade.

Use of lighted stylets to facilitate insertion of double-lumen endobronchial tubes in patients with difficult airway anatomy.

Placement of double-lumen endobronchial tubes (DLTs) into the trachea can be difficult because of their size and configuration. For patients with abnormal airway anatomy and anticipated difficult tracheal intubation, DLT placement can be extremely challenging. We present our experience using lighted stylets to facilitate insertion of DLTs in a series of patients with difficult airway anatomy.

Identification of endotracheal tube malpositions using computerized analysis of breath sounds via electronic stethoscopes.

Endotracheal tube (ETT) malpositioning into a mainstem bronchus or the esophagus may result in significant hypoxemia. Current methods to determine correct ETT position include auscultation, radiography, and bronchoscopy, although the current acceptable standard procedure for proper endotracheal (versus esophageal) intubation is detection of end-tidal carbon dioxide (ETco(2)) by capnography, capnometry, or colorimetric ETco(2) devices. Unfortunately, capnography may be unavailable or unreliable in nonhospital/emergency settings or in low cardiac output states, and it does not detect endobronchial intubation. The purpose of this study was to quantify and assess breath sound characteristics using electronic stethoscopes placed over each hemithorax and epigastrium to determine their ability to detect ETT malposition. We recorded breath sounds in 19 healthy, non-obese adults before general surgical procedures. After intubation of the trachea, the ETT was bronchoscopically positioned 3 cm above the carina, after which 3 breaths of 500 mL were given and breath sounds were recorded. A second ETT was placed in the esophagus and the same series of breaths and recordings were performed. Finally, the tracheal ETT was advanced into the right mainstem bronchus and breath sounds were recorded. Using computerized analysis, breath sounds were digitized and filtered to remove selected frequencies, and acoustic signals and energy ratios were obtained for all 3 positions. Total energy ratios using band-pass filtering of the acoustic signals accurately identified all esophageal and endobronchial intubation (P < 0.001). These preliminary results suggest that this technique, when incorporated into a 3-component, electronic stethoscope-type device, may be an accurate, portable mechanism to reliably detect ETT malposition in adults when ETco(2) may be unavailable or unreliable.

Development of a real-time PCR-based system targeting the 16S rRNA gene sequence for rapid detection of Alicyclobacillus spp. in juice products.

The thermophilic, aciduric Alicyclobacillus spp. are becoming an increasing spoilage concern in the beverage industry. Rapid methods to detect their presence in both raw materials and final products are desirable for industrial quality control. The objective of this study was to develop a real-time TaqMan-based polymerase chain reaction (PCR) system for rapid and specific detection of thermophilic spoilage bacteria, mainly Alicyclobacillus spp., for food industry applications. Two primers and a fluorogenic probe targeting 16S rRNA encoding gene sequences, capable of detecting the genus Alicyclobacillus and a few other closely related thermophiles, were developed, and the efficiency of the detection system was evaluated in both bacterial medium and juice products. Using this system, the presence of less than 100 Alicyclobacillus cells could be detected without cross-reactivity with other common food-borne bacteria.

Severe myxedema after cardiopulmonary bypass.

IMPLICATIONS: We report a case illustrating the serious perioperative consequences that can potentially result from failure to provide adequate thyroid hormone therapy for severe hypothyroidism before cardiac surgery.