Change in dental caries status over 2 years in children of Panchkula, Haryana: A longitudinal study.

BACKGROUND: Despite credible scientific advances and the fact that it is preventable, dental caries continues to be a major public health problem in developing countries like India. The first step toward disease prevention at community level is assessment of the disease activity. AIM: Hence this study was conducted to evaluate the change in dental caries status over 2 years in children of Panchkula, Haryana. MATERIALS AND METHODS: 207 school children having mixed dentition (age 7-8 years) and 103 children (age 12-13 years) were assessed for change in their dmf/DMF status over 2 years. RESULTS AND CONCLUSION: Results revealed that 81% of 7-8-year-old children and 83 % 12-13-year-olds had caries. There was a statistically significant increase in DMFT score of children over 2 years; thus necessitating implementation of rigorous preventive strategies at community level.

Does retrograde balloon dilation compromise outcome of secondary open pyeloplasty: 17 years' experience at a single center.

OBJECTIVES: To determine whether the outcome of secondary open pyeloplasty is compromised by previous retrograde balloon dilation. METHODS: Patients undergoing secondary open pyeloplasty after retrograde balloon dilation (n = 25) were compared with a similar group undergoing primary open pyeloplasty (n = 25) at the same institution. Patients were assessed by renography before and after surgery, and postoperative success was determined by the complete absence of pain. RESULTS: In the primary pyeloplasty group, the success rate was 96%, with a mean follow-up of 33 months (range 17 to 53). In the secondary pyeloplasty group, the success rate was 88%, with a mean follow-up of 20 months (range 9 to 32). No statistically significant difference was found in the success rates between the two groups (P = 0.6). CONCLUSIONS: Treatment failures after retrograde balloon dilation can be salvaged by secondary pyeloplasty with no detriment to the chance of long-term success compared with primary pyeloplasty.

Temporary abdominal closure: a prospective evaluation of its effects on renal and respiratory physiology.

This study prospectively analyzed outcomes in 49 consecutive patients undergoing temporary abdominal closure (TAC) between 1993 and 1996 at a single university hospital. There were 37 males and 12 females, mean age was 57 years (range, 25-79 years), mean Acute Physiology and Chronic Health Evaluation score was 27 (+7.8 SD), and mean Simplified Acute Physiology II score was 53.0 (+/-15.4). The reason for TAC was decompression in 22 patients, inability to close the abdomen in 10 patients, to facilitate reexploration for sepsis in 8 patients, and multifactorial in 9 patients. After TAC, there was a significant reduction in intra-abdominal pressure from 24.2+/-9.3 to 14.1+/-5.5 mm Hg and improvement in lung dynamic compliance from 24.1+/-7.9 to 27.6+/-9.4 mL/cm H2O (p < 0.05). Although 10 patients experienced brisk diuresis, there was no significant improvement in renal function; in fact, serum creatinine increased. The median length of stay was 35 days (range, 1-232 days). The mean number of abdominal operations after mesh insertion was 2.6+/-2.4. There were 21 deaths, for a standardized mortality rate of 0.80. Although it achieved significant reductions in abdominal pressures and improved lung dynamic compliance, TAC did not result in improved renal function or patient oxygenation.

Prospective evaluation of early missed injuries and the role of tertiary trauma survey.

BACKGROUND: This study prospectively evaluated the prevalence, clinical significance, and contributing factors to early missed injuries and the role of tertiary survey in minimizing frequency of missed injuries in admitted trauma patients. Missed injury, clinically significant missed injury, tertiary survey, and contributing factors were defined. Tertiary survey was conducted within 24 hours. RESULTS: Of 206 patients, 134 patients (65%) had 309 missed injuries composing 39% of all 798 injuries seen. Tertiary trauma survey detected 56% of early missed injuries and 90% of clinically significant missed injuries within 24 hours. Clinically significant missed injuries occurred in 30 patients with complications in 11 patients and death in two patients. Of 224 contributing errors, 123 errors were in clinical assessment, 83 errors were in radiology, 14 errors were patient related, and four errors were technical. The missed injury rate was significantly higher in patients with multiple injuries and in those involved in road crashes. CONCLUSIONS: Secondary trauma survey is not a definitive assessment and should be supplemented by tertiary trauma survey.

Boerhaave's syndrome.

Boerhaave's syndrome or spontaneous oesophageal perforation, is a potentially lethal and frequently elusive medical condition which presents not only a diagnostic but also a therapeutic challenge. It is insufficiently considered in diagnostic hypotheses, yet may be confirmed or excluded by simple methods such as an erect chest film and a contrast study of the oesophagus. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations or failure to consider its possibility in acute cardiothoracic and upper gastrointestinal conditions. Early aggressive surgical intervention in the form of open and wide mediastinal and chest drainage, with or without oesophageal repair, resection or exclusion, offers the patient the best chance of survival against this otherwise invariably fatal event. Nonoperative therapy consisting of antibiotics, nil oral regimen, nasogastric tube suction, pleural drainage, H2 receptor blockers and either a feeding enterostomy or total parenteral nutrition, may also be appropriate in selected patients. It is probable that the condition is more common than is generally supposed. All clinicians need to be aware of this lethal disease, its frequently unusual presentations and the importance of early diagnosis.

Whiplash injury associated with acute bilateral internal carotid arterial dissection.

Internal carotid arterial occlusion, being a rare occurrence following whiplash injury, is frequently missed. We report an unusual case of a 41-year-old woman driver who was involved in a head-on collision with a truck. On admission she was noted to have sustained closed head and neck trauma with a severe whiplash injury and lower limb paraparesis. Subsequent investigations showed a right parietal lobe infarct and bilateral internal carotid arterial dissection. We conclude that acute whiplash injury can result in bilateral internal carotid arterial dissection and that clinicians treating these patients should be aware of this complication.