The effect of four different irrigation systems in the removal of a root canal sealer.

OBJECTIVES: The aim of this study was to compare the efficiency of sonic, ultrasonic, and hydrodynamic devices in the removal of a root canal sealer from the surface and from simulated irregularities of root canals. MATERIALS AND METHODS: Fifty-three root canals with two standardized grooves in the apical and coronal parts of longitudinally split roots were covered with AH Plus root canal sealer. Compared were the effects of (control) syringe irrigation, (1) CanalBrush, (2) passive ultrasonic irrigation, (3) EndoActivator, and (4) RinsEndo on the removal of the sealer. The specimens were divided into four groups (N = 12) and one control group (N = 5) via randomization. The amount of remaining sealer in the root canal irregularities was evaluated under a microscope using a 4-grade scoring system, whereas the remaining sealer on the root canal surface was evaluated with a 7-grade scoring system. RESULTS: Passive ultrasonic irrigation is more effective than the other tested irrigation systems or syringe irrigation in removing sealer from root canal walls (p < 0.01). None of the techniques had a significant effect on cleaning the lateral grooves. CONCLUSIONS: Within the limitations of this study protocol ultrasonic irrigation shows a superior effect on sealer removal from the root canal surface during endodontic retreatment. Cleaning of lateral grooves seems not to be possible with one of the techniques investigated. CLINICAL RELEVANCE: Incomplete removal of root canal sealer during re-treatment may cause treatment failure. Passive Ultrasonic irrigation seems to be the most effective system to remove sealer from a root canal.

Prognostic marker for liver disease due to alpha1-antitrypsin deficiency.

BACKGROUND: Only some Alpha1-antitrypsin deficiency (A1ATD) PiZZ patients develop liver cirrhosis and portal hypertension. Aim of the study was to investigate the course of liver disease associated with PiZZ A1ATD and to determine prognostic factors. PATIENTS: We retrospectively reviewed the clinical and laboratory data of all PiZZ children up to 18 years of age admitted to our centre since 1978. 53 patients (age at first visit 2 days to 12 years) met our criteria. METHODS: The children were divided into 2 groups: group 1 'bad prognosis', meaning the patients which were on the waiting list for liver transplantation (LTx), had a liver transplantation or had died, and group 2 'good prognosis', containing the patients they were living with their own liver. We analysed family history including smoking, gestational age, maternal age at delivery, date of birth, sex, neonatal history, breast-feeding, symptoms at presentation, clinical and laboratory data and date of LTx and/or death. RESULTS: Various anamnesis parameters such as manifestation of neonatal cholestasis showed no prognostic significance. In contrast the laboratory parameters thrombocytes (p=0.008), bilirubin (p<0.001), prothrombin time (p<0.001), choline-sterase (p<0.001), gamma-GT (p=0.001) and GOT (p=0.002) showed a correlation with a liver transplantation and/or death. CONCLUSION: Prognosis is difficult to determine at an early stage of this disease, but various laboratory parameters can help to predict an outcome. Therefore a regular follow-up is necessary for the children.

Prevalence and prognostic impact of comorbidities in amyotrophic lateral sclerosis.

BACKGROUND AND PURPOSE: Amyotrophic lateral sclerosis (ALS) is characterized by rapidly progressive paralysis of striated muscles due to the loss of upper and lower motor neurons. The disease leads to death within 2-5 years, mainly due to respiratory failure. The pathogenesis of ALS is still unexplained for the most part. In this study, we aimed to determine the prevalence of different cardiovascular, metabolic, and neuropsychiatric comorbidities in a large ALS cohort and to evaluate their influence on the disease course. METHODS: A cohort of 514 patients with ALS of our ALS outpatient clinic was investigated retrospectively with reference to known prognostic factors and comorbidities. The prevalence of concomitant diseases was compared with the data from the German general population. Uni- and multivariate survival analyses were performed using the Cox proportional hazards model and Kaplan-Meier analysis. RESULTS: The prevalence of cardiovascular diseases and cardiovascular risk factors was significantly lower in patients with ALS compared to the German general population, whilst the prevalence of dementia, parkinsonism, and depressive symptoms was significantly higher in the ALS cohort. None of the investigated comorbidities had an influence on the disease course or on the survival of patients. CONCLUSIONS: Persons with cardiovascular diseases or risk factors seem to be at lower risk of ALS. Although these diseases are apparently somehow protective regarding ALS susceptibility, their presence did not modify disease progression and survival in patients with ALS. Our study further confirms the well-known continuum between ALS and dementia. It also suggests a link with other neurodegenerative diseases such as Parkinson's disease.

[Analysis of work flow in a radiology center using multi-moment-analysis: methodical principles]. / Analyse der Arbeitsabläufe eines radiologischen Zentrums mittels Multimoment-Häufigkeits-Studie: Methodische Grundlagen.

Radiology departments at hospitals are closely watched for their economy. The introduction of fast scanner technology usually triggers questions about simultaneously reducing final report times. The aim of the present study was first to examine, if the multi-moment analysis (MMH) is an appropriate method for structural and quantitative analysis of complex work flows in Radiology, and second, if factors negatively influencing the core processes can be quantitatively evaluated. The study was performed in the Departments of Radiology and Neuroradiology at a major University Hospital in Northern Germany. Randomized monitoring of the workflow of more than 80 doctors and radiology technicians assistants resulted in 800 observations per workplace. The high observation rate yielded a high accuracy (95% confidence interval width of less than +3,5%) to determine the proportion of different work patterns. MMH proved to be an appropriate means to analyze and quantify complex work flows at a university radiology centre. Different workplaces could be compared and total daily labor time could be derived from the observations. Circadian variabilities could be differentiated. The potential of the MMH to guide workflow optimization was identified. On the basis of data collected, MMH restructuring and control systems can be planned.