Late presenting partially displaced atrial septal closure device: Surgical vs percutaneous correction? A case report.

INTRODUCTION: Atrial Septal Defect (ASD) is one of the most common congenital cardiac defect. Even though surgical repair of ASD is the current method of choice but percutaneous device closure is rapidly gaining popularity as it is less invasive. Dislodgment and embolization of the device may occur requiring urgent surgical retrieval. CASE PRESENTATION: We report a case of 54-years-old female patient with a history of ASD device closure 4 years ago, presenting with progressive shortness of breath for past 2 months. She had a partial dehiscence of an ASD device causing a residual ASD of 17 mm. She underwent urgent surgical repair of an ASD with a bovine pericardial patch without ASD device being explanted. CLINICAL DISCUSSION: Management of a dislodged ASD device may be percutaneous or surgical. Dislodged ASD devices that present months after deployment may become fibro-adhered to the site of embolization. Hence its retrieval can be challenging even via open surgical method. Our case describes a novel method to repair a residual ASD and prevent complications associated with dislodgement of device without completely explanting the device. CONCLUSION: In this case, the late presentation of the patient with a partially dehisced device makes it a distinctive case with a novel way on how to treat such a presentation surgically, ensuring that the device doesn't embolize further causing fatal complications.

To Evaluate Effect of Airborne Particle Abrasion using Different Abrasives Particles and Compare Two Commercial Available Zirconia on Flexural Strength on Heat Treatment.

BACKGROUND AND OBJECTIVE: The popularity of ceramic restorations can be attributed to its life-like appearance, durability and biocompatibility and therefore ceramic restorations have been widely used for anterior and posterior teeth. Ceramic restorations have esthetic and biocompatible advantages but low fracture resistance. Since it has high flexural strength and fracture resistance, yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) is the dental material most commonly used for the core of ceramic crowns and fixed dental prosthesis. In spite of improved mechanical properties, acceptable marginal adaptation and biocompatibility the whitish opacity of zirconia is an obvious esthetic disadvantage. The zirconia framework is often veneered with conventional feldspathic porcelain to achieve a natural appearance. However it is difficult to achieve sufficient bond strength between zirconia and the veneering material. Achieving sufficient bond strength between the veneering ceramic and the zirconia core is a major challenge in the long term clinical success of veneered zirconia restorations. The main objective of this study is to evaluate the effect of different surface treatments on the fracture strength of the two commercially available Zirconia namely Ceramill and ZR-White (AMANNGIRRBACH and UPCERA) respectively. METHOD: Two commercially available pre-sinteredyttrium stabilized Zirconia blanks (ZR-White and Ceramill) from AMANNGIRRBACH and UPCERA respectively are used to produce the disc shaped specimens of size (15.2 ± 0.03 mm in diameter and 1.2 ± 0.03 mm thick) from each Zirconia blank. All disc shaped specimens are heated at 1200°C in a furnace for 2 hours to form homogenous tetragonal ZrO2. The dimensions of the specimens are measured with a digital caliper (aerospace). The thickness and diameter of each specimen are calculated as the means of 3 measurements made at random sites. 80 discs from each Zirconia blank are divided into ten groups of 8 specimens each. Heat treatment after airborne-particle abrasion using 50 µm Al2O3 particles and 50 µm silica coated Al2O3 are applied to the upper and lower surfaces of the specimens. Each specimen is held under a pressure of 30 psi for 15 seconds at a direction perpendicular to the surface and at a distance of 30mm with an airborne particle abrasion device for the specimens in the airborne particle abraded groups. Heat treatments were performed at a starting temperature of 500°C, heating rate of 100°c/ min, ending at a temperature of 1000°C and 15 minutes holding time without vacuum for the specimens in the group 4, 5, 9 and 10. Airborne-particle abrasion mimicking the preparation for cementation was applied to the lower surfaces with 50 µm alumina and silica coated alumina particles for the specimens in the groups 6, 7, 8, 9 and 10. The specimens were cleaned for 15 minutes in an ultrasonic bath containing distilled water. To determine the fracture strength, a disc of 10 mm diameter was used to place 3 hardened steel balls of 3 mm diameter separated each other by 120 degrees (described in the ISO standard 6872 for dental ceramics). Each specimen was centrally placed on this disc. The lower surface mimicking the internal surface of zirconia was the tension side, facing the supporting device testing, while the upper surface mimicking the external surface of the zirconia core was loaded with a flat punch (1 mm in diameter). A universal testing machine was used to perform the test at a cross head speed of 1mm/min. The failure stress was calculated with the equation listed in ISO 6872. The results were then statistically analyzed. A post hoc test was used for pair wise comparisons. RESULT: The mean fracture strength of commercially available Zirconia Ceramill (AMANNGIRBACH) showed a significant higher value compared to the ZR-White (UPCERA) Zirconia (P<0.001), Airborne abrasion treatment to the specimens showed a significant difference between the abraded groups and the control group (P<0.001); further AMANNGIRRBACH specimens gave a higher value compare to the UPCERA specimens. The study also revealed that the heat treatment of the specimens gave significant value (P<0.001) compared to the control group, but heat treatment following the air abrasion reduces the fracture strength of the sample than the air abraded group. CONCLUSION: Within the limitation of this study, it is concluded that, the in vitro fracture strength of Zirconia specimens treated with an airborne abrasion both on the veneering surface (50 µm silica coated Al2O3) and the cementing surface (50 µm Al2O3) was significantly higher than the heat treated and the control group. Airborne particle abrasion followed by the heat treatment reduces the fracture strength of the specimen than that ofthe group treated only by the air abrasives. The fracture strength of a commercially available Ceramill (AMANNGIRRBACH) is greater than that of a Zirconia from ZR-White (UPCERA) variety.

Evaluate the Effect of Commercially Available Denture Cleansers on Surface Hardness and Roughness of Denture Liners at Various Time Intervals.

BACKGROUND AND OBJECTIVE: Chemical cleansing by denture cleansers is first choice for denture plaque control. The most common problems while using denture cleansers are hardening, porosity, odor sorption, water sorption, solubility, and colour change, bacterial and fungal growth. Chemical cleansing procedures have been found to have an effect on the physical and mechanical properties of denture liners. Thus, this study was conducted to evaluate the effect of commercially available denture cleansers on surface hardness and roughness of acrylic and silicon based denture liners at various time interval. METHOD: Two autopolymerising denture liners Kooliner (acrylic) and GC reline soft (silicon) were tested with two commercially available denture cleansers, polident and efferdent plus. Total of 120 specimens were prepared and all the specimens were divided into six groups based on the relining materials and denture cleansers used. Surface hardness and surface roughness was tested using Shore A durometer and profilometer respectively at the end of day 1, day 7, day 30 and day 90. All the specimens were stored in artificial saliva throughout the study. Cleanser solution was prepared daily by adding Polident and Efferdent plus denture cleanser tablet into 250ml of enough very warm (not hot) water. Acrylic and silicon liner groups were cleansed in a solution of denture cleanser and water for 15 minutes daily, rinsed with water and stored in artificial saliva at room temperature. The data was analyzed with one way ANOVA and independent t-test. RESULT: The acrylic soft lining showed gradual hardening and increase in surface roughness after immersion in denture cleanser and also with time. Acrylic liner material showed maximum hardness and roughness with Polident followed by Efferdent plus and water (control group). Silicone lining material showed a slight difference in hardness and roughness between the test group and control group. There was a slight increase in hardness in all the groups with time. Very slight increase in mean surface roughness of all the silicon liner groups from day 1 to day 90 was observed. A statistically significant change was noted between and within the all silicon liner groups on day 7, day 30 and day 90. CONCLUSION: The average surface hardness and surface roughness were lower in silicon liner material than acrylic liner material. Maximum surface roughness was noted by Polident followed by Efferdent Plus and Water for both acrylic liner group and silicon liner group.

Bomb blast injuries: Tertiary care hospital in-patient experience over the last 20 years.

OBJECTIVE: To examine the distribution and nature of limb injuries in young bomb blast victimsand their management in a tertiary healthcare setting. METHODS: The retrospective study was conducted at the Aga Khan University Hospital, Karachi and data was searched using the University Medical Record Database with International Classification of Diseases-Ninth Revision-Clinical Modification codes for injuries and terrorism between 1990 and 2012. Data regarding injuries, including admission time, hospital stay duration, interventions and mortality, was collected and classified as per the New Injury Severity Score. RESULTS: There were 22 patients in the study; 19(86.3%) males and 3(13.7%) females. The mean age of the sample was 13.1±4.1 years. Median length of hospital stay was 9 days (range: 2-42 days). Sixteen (72.7%) patients required operative intervention. Patients rarely had accompanying injuries with limb injuries. Four (18%) patients needed open reduction and internal fixation. Two (9%) patients needed open reduction and external fixation. One (4.5%) patient required a limb amputation. One (4.5%) patient required ileal resection with ileoileal anastomosis due to shrapnel perforations. There was no mortality. CONCLUSIONS: The young age group was not severely affected by limb trauma. Injuries sustained were infrequently accompanied by severe/critical injury severity scores.