Ovarian Dermoid Cyst Causing Distal Ureteral Obstruction.

A case of a 45-year old woman with an ovarian dermoid cyst causing ureteric colic secondary to distal ureteral obstruction is reported. The dermoid cyst was observed on computed tomography to be adjacent to and compressing the distal left ureter and this was confirmed at surgical exploration. Following oophorectomy, the patient's symptoms completely resolved and the excised ovarian cyst was confirmed on pathological evaluation to be a dermoid cyst. This appears to be the first reported case of ureteral obstruction caused by an ovarian dermoid cyst in the English medical literature.

Radical prostatectomy outcomes at the University Hospital of the West Indies: 2000-2007.

OBJECTIVES: Prostate cancer is the commonest cancer in Jamaican men with an age-specific incidence of 65.5 per 100 000 and also the commonest cause of male cancer death. This study reports on the oncological outcome and morbidity after radical retropubic prostatectomy. SUBJECTS AND METHODS: The records of 116 patients with clinically localized prostate cancer (cT1c- T2) who underwent radical retropubic prostatectomy at the University Hospital of the West Indies from January 2000 to December 2007 were examined. Preoperative Prostate specific antigen (PSA), clinical stage and Gleason score were recorded. Operative time, blood loss, hospital stay and complications were assessed. Oncological outcome was assessed using biochemical progression. Disease progression was defined by PSA value of 0.4 ng/ml or greater. RESULTS: Mean patient age was 61 (43-75) years. The mean presenting PSA was 10.1 (2-25.1) ng/ml. Mean Gleason score on preoperative biopsy was 6. The commonest clinical stage was T1c (68%). Nodal involvement was seen in only one patient. The positive surgical margin rate was 15.5%. Mean operating time was 246 minutes and mean estimated blood loss was 1.44 L. The mean hospital stay was 6.9 days and 17% of patients developed minor complications, with no treatment or disease related deaths. Five-year biochemical-free survival was 78.4%. CONCLUSIONS: Oncological outcomes after radical retropubic prostatectomy in Jamaica appear to meet global standards with acceptable morbidity.

Radical prostatectomy outcomes at the university hospital of the West Indies: 2000-2007 / Evolución clínica de la prostatectomía radical en el hospital universitario de West Indies: 2000-2007

OBJECTIVES: Prostate cancer is the commonest cancer in Jamaican men with an age-specific incidence of 65.5 per 100 000 and also the commonest cause of male cancer death. This study reports on the oncological outcome and morbidity after radical retropubic prostatectomy. SUBJECTS AND METHODS: The records of 116 patients with clinically localized prostate cancer (cT1c-T2) who underwent radical retropubic prostatectomy at the University Hospital of the West Indies from January 2000 to December 2007 were examined. Preoperative Prostate specific antigen (PSA), clinical stage and Gleason score were recorded. Operative time, blood loss, hospital stay and complications were assessed. Oncological outcome was assessed using biochemical progression. Disease progression was defined by PSA value of 0.4 ng/ml or greater. RESULTS: Mean patient age was 61 (43-75) years. The mean presenting PSA was 10.1 (2-25.1) ng/ml. Mean Gleason score on preoperative biopsy was 6. The commonest clinical stage was T1c (68%). Nodal involvement was seen in only one patient. The positive surgical margin rate was 15.5%. Mean operating time was 246 minutes and mean estimated blood loss was 1.44 L. The mean hospital stay was 6.9 days and 17% of patients developed minor complications, with no treatment or disease related deaths. Five-year biochemical-free survival was 78.4%. CONCLUSIONS: Oncological outcomes after radical retropubic prostatectomy in Jamaica appear to meet global standards with acceptable morbidity.

OBJETIVOS: El cáncer de la próstata es el cáncer más común entre los hombres jamaicanos con una incidencia específica por edad de 65.5 por 100 000, y es también la causa más común de la muerte por cáncer entre los hombres. Este estudio reporta la evolución clínica oncológica y la morbilidad tras la prostatectomía radical retropúbica. MÉTODOS: Se examinaron las historias clínicas de 116 pacientes con cáncer de próstata clínicamente localizado (cT1c - T2), sometidos a prostatectomía radical retropúbica en el Hospital Universitario de West Indies de enero de 2000 a diciembre 2007. Se registraron el antígeno específico de próstata (AEP) preoperativo, la etapa clínica y la puntuación de Gleason. Se evaluaron el tiempo operativo, la pérdida de sangre, la estadía hospitalaria, y las complicaciones. Se evaluó la evolución clínica oncológica usando la progresión bioquímica. La progresión de la enfermedad se definió por el valor del AEP de 0.4 ng/ml o mayor. RESULTADOS: La edad promedio de los pacientes fue 61 (43-75) años. El AEP promedio fue PSA 10.1 (2-25.1) ng/ml. La puntuación promedio Gleason en la biopsia preoperativa fue 6. La etapa clínica más común fue T1c (68%). Se observó compromiso de nódulos en sólo un paciente. La tasa de márgenes quirúrgicos positivos fue 15.5%. El tiempo promedio de operación fue 246 minutos y la pérdida de sangre promedio estimada fue 1.44 L. La estadía hospitalaria promedio fue de 6.9 días y 17% de los pacientes desarrollaron complicaciones menores, sin tratamiento o enfermedad relacionados con muertes. La supervivencia quinquenal libre del uso de productos bioquímicos fue 78.4%. CONCLUSIONES: Los resultados oncológicos después de la prostatectomía retropúbica radical en Jamaica muestran estar en correspondencia con los estándares globales con una morbilidad aceptable.

Leiomyoma: an unusual bladder neoplasm.

The authors present a case of a 42-year-old lady who visited her gynaecologist with dysuria and a sensation of incomplete voiding for 2 weeks. Urine culture grew Escherichia coli and blood studies were normal. Pelvic ultrasound revealed a smooth well-defined mass arising from the bladder wall. She was referred to the urologist who requested CT and MRI for further evaluation. These modalities confirmed an intramural bladder mass with normal overlying mucosa. The mass was deemed contributory to her symptoms and a decision was made to excise the mass surgically. Via a transurethral approach, cystoscopy revealed a smooth well-circumscribed intramural mass. This was partially excised. The mass was found to be a leiomyoma. Except for an uncomplicated urinary tract infection, her postoperative course has been uneventful.

Body mass index and prostate specific antigen levels in Jamaican men.

OBJECTIVE: To investigate the relationship between body mass index (BMI) and prostate specific antigen (PSA) levels in Jamaican men. METHODS: Men, 40-79 years old, attending public and private urology clinics in Kingston, Jamaica were recruited to a case-control study on the role of dietary and lifestyle factors on prostate cancer. Trained interviewers administered questionnaires and measured weight and height using standardized techniques. Blood samples for PSA were measured at a central laboratory using a micro-particle enzyme immunoassay method. Prostate biopsy was used to confirm prostate cancer. Multivariable linear regression was used to examine the relationship between BMI and PSA separately in the cases and controls. RESULTS: Data from 501 men (233 cases and 263 controls) were assessed. Thirty-five per cent of subjects were overweight and 13% were obese. Among cases, the median PSA was 35.3 ng/dL in normal weight, 26.1 ng/dL in overweight and 14.5 ng/dL in obese men (p = 0.02). For controls, median PSA was 2.0 ng/dL in normal weight, 1.3 ng/dL in overweight and 1.1ng/dl in obese men (p = 0.01). Among cases, BMI was negatively associated with PSA (B(SE) per 5 kg/m2 (BMI difference = -0.51 (0.13); p < 0.01) and remained significant after adjustment for age, sexual activity, smoking, use of statins and tumour grade. For controls, the BMI was also inversely related to the PSA (B(SE) per 5 kg/m2 difference -0.17 (0.07)) but the effect became of borderline significance after adjusting for age. CONCLUSIONS: Prostate specific antigen was inversely related to body mass index in Jamaican men with prostate cancer. Clinicians should consider this association when interpreting PSA results.

Quality of obturation in student cases instructed by endodontic versus general dentistry faculty.

Endodontic literature suggests that only about 60% of endodontic therapy meets current technical standards and that general dentists may be making a significant contribution to this compromised care. If so, where in the continuum of dental education does this begin. This study evaluated the quality of obturation in mandibular molars provided on the one hand by 3rd year dental students instructed by endodontic faculty, and on the other hand by 4th year students instructed by general dentistry faculty, versus the quality of obturation achieved by endodontic residents who served as a control for both groups. Final radiographs were chosen from students in all three groups so that there were 22 samples per group. Three evaluators rank-ordered the radiographs. In order of excellence, the results were: (a) residents, (b) 3rd year students, and (c) 4th year students. There was no significant difference between the 3rd year students or the residents, only between residents and 4th year students (p < 0.05). The reasons for this outcome may range from dental school objectives to the private practice procedures of the general dentists who instructed the 4th year students.

Association of occlusal, periodontal, and dietary factors with the presence of non-carious cervical dental lesions.

PURPOSE: To investigate in vivo the relationship of occlusal stress factors, periodontal health status, and acidic dietary patterns to the presence of non-carious cervical lesions (NCCL) in a convenience sample of undergraduate clinic, adult dental patients. MATERIALS AND METHODS: Forty three subjects who met the entry criteria were admitted into the study; 178 teeth exhibiting NCCL were evaluated. A dietary assessment focusing on acidic food/beverage intake was used to evaluate nutritional intake over the most recent 24-hour period. Periodontal evaluation included intraoral measurement of gingival attachment loss, assessment of tooth mobility, and radiographic interpretation of percent bone loss using the Schei ruler method. Among the occlusal factors evaluated were shape and orientation of NCCL, presence and location of wear facets, and symptoms and characteristics of centric and eccentric occlusal function. RESULTS: 95% of teeth examined exhibited functional wear facets, indicating a systematic relationship with presence of NCCL (Chi Square = 16.9, P < 0.0001); 48% displayed buccal or incisal facets; 64% were accompanied by balancing interferences in lateral excursion; 98.3% had mobility scores < or = 1; there was no significant association between mobility and facets present (Chi Square = 3.04, P = 0.21); and, no relationship with dietary patterns was found. Group function, that may evolve with age, and/or traumatic occlusion factors may be related to etiology of NCCL. Longitudinal controlled clinical trials are needed to confirm suspected etiologies and establish treatment guidelines for non-carious cervical lesions.

Review of current tenure policies and their relation to junior dental faculty.

The nature of tenure eligibility requirements for faculty has changed in recent years. The purpose of this study was to review the current tenure policies among U.S. dental schools. A five-page, sixteen-item survey was mailed to fifty-three U.S. dental schools. The survey produced thirty-seven completed questionnaires for a response rate of 70 percent. Among the results of the survey were: a) the most prevalent probationary period was seven years; b) faculty were expected to have a minimum of six to 15 publications to obtain tenure; c) only 39 percent of schools were perceived to offer a financial guarantee along with the award of tenure; and d) 69 percent of the schools offered an alternative track for selected full-time faculty.

Safe storage times for sterile instrument packs.

Military health care facilities are required to place expiration dates on sterile instrument packs. There are few scientific guidelines for determining these dates. This article reports the findings of two studies conducted at Wilford Hall USAF Medical Center, which investigated the potential shelf-life of three packaging materials for sterile instruments. The results of the studies indicate that sterility is maintained for at least 1 year with all three materials. The maximum storage times allowed for sterile instruments at most military facilities appear to be overly restrictive.

Duration of anesthesia using the periodontal ligament injection: a comparison of bupivacaine to lidocaine.

The purpose of this study was to compare the duration of pulpal anesthesia obtained with 0.5% bupivacaine HCl with 1:200,000 epinephrine to 2% lidocaine HCl with 1:100,000 epinephrine, using the periodontal ligament (PDL) injection. Twenty-four subjects received bilateral PDL injections using mandibular premolar teeth and a double-blind research design. Anesthesia was defined as no response to maximum output of an electric pulp tester. An overall success rate of 35.4% was achieved. Duration of anesthesia obtained with bupivacaine HCl ranged from 4 minutes 59 seconds to 16 minutes 37 seconds with a mean duration of 10 minutes 24 seconds. Excluding one instance in which the duration was three orders of magnitude beyond the norm, duration of anesthesia obtained with lidocaine HCl ranged from 1 minute 43 seconds to 16 minutes 16 seconds with a mean duration of 7 minutes 10 seconds. Postoperatively, all experimental teeth tested vital with no clinically apparent pulpal or periodontal damage. Some postoperative discomfort was experienced at 16.6% of the injection sites.

Evaluation of the shelf life of sterile instrument packs.

No published studies have specifically addressed the shelf life of sterile packaging materials commonly used in dentistry. This study examined the effect of time on the sterile integrity: paper envelopes, peel pouches, and nylon sleeves. Seven thousand two hundred sample packs, each containing three glass rods, were prepared and steam sterilized. After sterilization, half the packs (control packs) were immediately opened and the contents were analyzed for bacterial contamination. The other half (test packs) were randomly sorted and stored in dental treatment operatories. At monthly intervals for 12 months, 100 packs of each type were similarly opened and analyzed. The contamination rates between the control packs were not significantly different from one another. Differences in contamination rates between control packs and test packs for both the paper envelopes (0.4% and 0.7%) and the peel pouches (0.2% and 0.2%) were also insignificant. However, a significant difference (p less than 0.01) between control and test packs (0.3% and 1.5%) was found for the nylon sleeves. This increase was not time related and was attributed to difficulty in removing the glass rods from the nylon packs in a sterile manner. The most important finding was the absence of a trend toward an increased rate of contamination over time for any pack type. This indicates that when these materials are placed in covered storage in dental operatories, a 12-month storage period is not detrimental to their sterile integrity.

Infection control in the dental laboratory: a review of the literature.

The dental laboratory has been shown to be an area of potential disease transmission between patients and to laboratory personnel. This paper reviews pertinent literature on the subject and describes the "Barrier System," a proven infection control protocol to manage dental prostheses in the laboratory.

Incidence of hepatitis B exposure among USAF dental laboratory technicians.

The purpose of this study was to survey, serologically, the exposure history of USAF dental laboratory technicians to hepatitis B virus (HBV), and to compare the incidence to that found in the general military population. Blood samples from 145 technicians, with an average age of 26.9 (S.D. = 6.9) in four locations in the USA and Europe, were tested for the presence of HBV core antibody using a standard enzyme immunoassay (EIA) procedure. These results were compared against 397 military members in non-medical fields of equivalent age and rank. The binomially distributed data was converted to a z distribution and a statistically significant difference was found in a comparison of the probability of detecting anti-HBc in each population (P = 0.034) where the incidence among the technicians was 2.7% and the military population 0.76%. Use of a "barrier system" in the laboratory, and vaccinations, could prevent any increase in this incidence from an occupational source.

Effect of a ZOE temporary cement on the bond strength of a resin luting cement.

This study was conducted to determine if a eugenol-based temporary cement affected the bond strength of a dual-cure cement to etched enamel. Dicor buttons were cemented to etched enamel surfaces after pretreatment with a non-eugenol containing cement, a eugenol containing cement and a control. This study concluded that shear bond strengths were unaffected by the temporary cement, provided the enamel surface was cleaned with pumice and etched with 37% phosphoric acid.

Evaluation of the barrier system, an infection control system for the dental laboratory.

An experimental system of laboratory infection control was tested, using 76 dentures from 40 volunteer patients. The dentures were cleansed on entering and again on leaving the laboratory. To evaluate the effectiveness of disinfection, the dentures were cultured as they were received from the patient, after the first cleansing, after polishing, and after the second cleansing. The disinfection of the prostheses involved scrubbing them with Hibiclens skin cleanser, rinsing, disinfection in one of three disinfectants (1:16 Sporicidin solution, full-strength Sporicidin solution, and 5.25% sodium hypochlorite [undiluted Clorox]), and finally rinsing. Full-strength Sporicidin solution was significantly more effective than diluted Sporicidin solution, but no statistically significant difference was found between full-strength Sporicidin solution and sodium hypochlorite, or between sodium hypochlorite and 1:16 Sporicidin solution. All three solutions were effective in reducing or eliminating culturable aerobic bacteria.