Laparoscopic versus open cholecystectomy in children.

Twenty-one consecutive laparoscopic cholecystectomies (LC) were compared with 29 consecutive open cholecystectomies (OC). Sickle-cell disease (SCD) was the most common reason for cholecystectomy in both groups. The average length of operative time for LC was significantly longer than that of OC (P=0.0149). In 1 patient there was conversion from LC to OC due to severe adhesions. Common bile duct (CBD) stones were diagnosed in 8 (27.6%) of the OC group; in 4 of them the diagnosis was made preoperatively by ultrasound, in 4 by intraoperative cholangiogram. All 8 patients required CBD exploration, and 2 had additional transduodenal sphincteroplasties. In the LC group 5 patients (23.8%) had CBD stones. All had (ERCP) endoscopic retrograde cholangiopancreatography sphincterotomy, and stone extraction followed by LC. ERCP is a necessary adjunct to treatment if LC is to be contemplated. Six patients in the OC group developed complications, while only 4 patients in the LC group developed minor complications. The length of hospitalization after LC was significantly shorter than after OC (P=0.0150). LC is the procedure of choice in the management of cholelithiasis in children, especially those with SCD.

Sequential endoscopic/laparoscopic management of cholelithiasis and choledocholithiasis in children who have sickle cell disease.

BACKGROUND/PURPOSE: Cholelithiasis and choledocholithiasis are common complications of sickle cell disease (SCD). With the recent advances in laparoscopic cholecystectomy (LC), which has been used successfully for the management of cholelithiasis in children who have SCD, exclusion of choledocholithiasis before LC is of great importance. METHODS: Eighteen children who had SCD, cholelithiasis, and choledocholithiasis were treated at our hospital. Seven were treated with open cholecystectomy (OC) and common bile duct (CBD) exploration, and two were treated with transduodenal sphincteroplasty. The remaining 11 patients underwent endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, and stone extraction followed by laparoscopic cholecystectomy (LC). RESULTS: A dilated CBD noted on ultrasound, elevated alkaline phosphatase, elevated total bilirubin of more than 5 mg/dL, history of pancreatitis, either singly or in combination, should raise suspicion of choledocholithiasis, and these patients together with those who have choledocholithiasis detected on ultrasound should undergo ERCP to confirm and extract the stones before LC. CONCLUSION: This sequential approach of endoscopic sphincterotomy and stone extraction followed by LC is a safe and effective approach for the management of cholelithiasis and choledocholithiasis in children who have SCD.

Marginal adaption of two esthetic complete crowns.

In an in-vitro study twenty artificial crowns were fabricated. A hardened stainless steel five piece die assembly was used to construct uniformed wax patterns and to record all measurements. The fit of ten PFM crowns before and after the application of porcelain using the porcelain but margin technique was compared to that of ten Dicor crowns. The results of this study indicated best fit with the metal crowns before the application of porcelain, while the PFM crowns were oversized and the Dicor crowns were undersized.

Prevalence of signs and symptoms of temporomandibular disorders in a young male Saudi population.

The aim of the present study was to investigate the prevalence of temporomandibular disorders (TMD) in a selected young male Saudi population. The material comprised 105 dental students having a mean age of 23 years within the range of 20-29 years. A functional evaluation of the stomatognathic system was performed using the Helkimo anamnestic and clinical dysfunction index. Almost two-thirds of the individuals had no signs and symptoms of TMD. Thirty per cent of the individuals reported mild dysfunction (Ai I) and 6% had severe symptoms (Ai II). Thirty-three per cent showed mild clinical signs of dysfunction (Di I) and 3% had signs of moderate dysfunction (Di II). Only 1% exhibited severe clinical signs (Di III). While the individuals represented a non-Western population, the prevalence of signs and symptoms of temporomandibular disorders compared favourably to that found in Western countries, at least as regards to reported symptoms.

Marginal castability of two different materials (a comparative study).

Achieving a clinically acceptable margin is a conspicuous objective to any practicing dentist. The main concern is the space existing between the margin of the prepared tooth and that of the final restoration. Marginal fit has been measured and evaluated in a variety of methods., and a gap of approximately 50 microns is usually considered acceptable. While inlay wax is the material commonly used in the wax-up stage when fabricating crowns and bridges, Duralay (methylmethacrylate) is a material widely used nowadays in the field of fixed prosthodontics. Due to the ease of using this material intra-orally to form margins, an attempt is made to compare the castability of margins made out of inlay wax to the ones made out of Duralay.