Uncommon Causes of Acute Abdominal Pain - A Pictorial Essay.

Acute abdomen is one of the most common clinical conditions requiring a radiological investigation. Ultrasound is the primary modality of choice which can diagnose some of the common causes of acute abdomen. However, sometimes the underlying cause for the pain is far more complicated than expected mandating a high degree of suspicion to suggest further investigation with contrast enhanced computed tomography or magnetic resonance imaging. Here, we have compiled a comprehensive series of selected cases to highlight the conditions which can be easily overlooked unless carefully sought for. This article also emphasizes the importance of multimodality approach to arrive at the final diagnosis with an increased overall diagnostic accuracy which in turn improves patient management and prognosis.

A Comparative Study of Three Types of Rapid Maxillary Expansion Devices in Surgically Assisted Maxillary Expansion: A Finite Element Study.

OBJECTIVES: The aim of this study was to analyze the displacement pattern and stress distribution during surgically assisted rapid maxillary expansion (RME) with three different types of RME devices by constructing a finite element model. MATERIALS AND METHODS: A finite element model is constructed from the computerized tomography scans. According to the type of RME device, 3 groups were simulated on this mesh model. The experimental groups were as follows; Group I (tooth borne appliance), Group II (bone borne appliance), and Group III (hybrid appliance). A Le fort I osteotomy with bilateral pterygomaxillary disjunction and midpalatal split osteotomy cuts were incorporated in all the groups. The displacement pattern and stress distribution for each 1 mm of activation of appliance up to 10 mm is noted and analyzed. The data were analyzed using Student's t-test, Analysis of Variance and Duncan new multiple range test. RESULTS: Tooth borne appliance has more rotational tendencies. The bone borne and the hybrid appliance exhibited similar stress patterns for the dissipation of the forces produced by RME appliances. The pivoting effect decreased with the hybrid and the bone borne appliance and can be utilized in patient with hyper divergent growth. CONCLUSION: The pivoting effect is least with the hybrid appliances.

Establishing Cephalometric Norms using Sagittal and Vertical Occlusal Cephalometric Analysis of Pancherz for Dakshina Kannada Children.

BACKGROUND: The purpose of this study was to establish norms for the sagittal occlusal (SO) and vertical occlusal (VO) cephalometric analyses of Pancherz for Dakshina Kannada children and to analyze and compare the difference between boys and girls of same age group (10-14 years). MATERIALS AND METHODS: Two hundred and sixty-three (132 boys and 131 girls) children of Dakshina Kannada were included in this study. Lateral cephalometric radiographs of children belonging to the age group of 10-14 years were taken. Dental lateral cephalometric radiographs were obtained and these cephalometric radiographs were then manually traced. All the parameters considered in the Pancherz analysis were considered while establishing the norms for Dakshina Kannada children. RESULTS: Statistically significant sex differences were found for 9 of 11 parameters in the sagittal occlusal analysis, and 10 of 10 in the Vertical occlusal analysis. CONCLUSIONS: For the sagittal and Vertical occlusal analyses of Pancherz a separate sex-specific standards are needed for Dakshina Kannada children.

Evaluation of nasal morphology in predicting vertical and sagittal maxillary skeletal discrepancies'.

OBJECTIVE: The purpose of this prospective observational study was to evaluate the relationship between nasal morphology and maxillary skeletal pattern. The clinical significance was to emphasize the importance of role of nasal pattern in diagnosis and treatment planning. MATERIALS AND METHODS: The sample included the pre-treatment lateral cephalometric radiographs of 180 South Indian adults (94 women, 86 men), aged 18 to 28 years. Six maxillary and six nasal soft tissue parameters were measured. Pearson correlation coefficients and Analysis of variance were used for statistical analyses. RESULTS: There were significant correlations between maxillary vertical and sagittal, skeletal and soft tissue parameters. The Mean and standard deviations were correlated between low insignificant range to high significant levels with nasal length, nasal depth and columella convexity. Nasal length also showed significant correlation with inclination of palatal plane. Significant influence of gender was seen on nasal length, nasal depth, columella convexity and nasal tip angle. A statistically significant difference was seen regarding nasal length between males and females, with nasal length being more in males (50.26 ± 4.18) than in females (48.86 ± 3.45), nasal depth being more in males (18.64 ± 2.56) than in females (16.63 ± 2.16), columella convexity being greater in males (4.31 ± 1.26) than in females (3.41 ± 1.13), nasolabial angle decreased in males (87.26° ±13.79°) than in females (89.38° ±15.72°) and nasal tip angle being more in females (80.18° ±9.44°) than in males (73.60° ±10.24°). There was no statistically significant difference in nasal hump between males (-2.01 ± 1.76) and females (-2.02 ± 1.62). CONCLUSION: Long nose with increased nasal prominence were seen with increase in the anteroposterior length and vertical height of maxilla. Male and female genders had a varied amount of nasal length, nasal depth and columella convexity along with nasal tip angle.

Effect of moisture, saliva, and blood contamination on the shear bond strength of brackets bonded with a conventional bonding system and self-etched bonding system.

BACKGROUND: The success of bonding brackets to enamel with resin bonding systems is negatively affected by contamination with oral fluids such as blood and saliva. The new self-etch primer systems combine conditioning and priming agents into a single application, making the procedure more cost effective. OBJECTIVE: The purpose of the study was to investigate the effect of moisture, saliva and blood contamination on shear bond strength of orthodontic brackets bonded with conventional bonding system and self-etch bonding system. MATERIALS AND METHODS: Each system was examined under four enamel surface conditions (dry, water, saliva, and blood), and 80 human teeth were divided into two groups with four subgroups each of 10 according to enamel surface condition. Group 1 used conventional bonding system and Group 2 used self-etched bonding system. Subgroups 1a and 2a under dry enamel surface conditions; Subgroups 1b and 2b under moist enamel surface condition; Subgroups 3a and 3b under saliva enamel surface condition and Subgroup 4a and 4b under blood enamel surface condition. Brackets were bonded, and all the samples were then submitted to a shear bond test with a universal testing machine with a cross head speed of 1mm/sec. RESULTS: The results showed that the contamination reduced the shear bond strength of all groups. In self-etch bonding system water and saliva had significantly higher bond strength when compared to other groups. CONCLUSION: It was concluded that the blood contamination showed lowest bond strength from both bonding systems. Self-etch bonding system resulted in higher bond strength than conventional bonding system under all conditions except the dry enamel surface.

A comparison between cervical vertebrae and modified MP3 stages for the assessment of skeletal maturity.

OBJECTIVE: Evaluation of skeletal maturity in human individuals is an important aspect in orthodontics and dentofacial orthopedics because, growth guidance and fundamental structural changes are essential for treatment of skeletal discrepancies in all the three planes. Among various growth assessment methods, cervical vertebra maturation stages and hand wrist have been correlated with the individual growth changes during puberty. The purpose of this study is to determine correlation of the CVM index with the modified median phalanx index (MP3) as described by Rajagopal and Kansal. MATERIALS AND METHODS: 200 subjects (100 males and 100 females) of Nellore, Indian origin boys aged between 10 to 19 years and girls of 8 to 16 years were selected for the study. The subjects are selected randomly from patients visiting the Departments of Orthodontics and Dentofacial Orthopedics, Pediatric dentistry and Oral medicine and Radiology at Narayana Dental College and Hospital. Nellore. Radiographs of left hand MP3 and lateral cephalogram were taken. RESULTS: Cohen's kappa statistic was used to assess the agreement between the two measurements based on categorical variables. CONCLUSIONS: There was a good concordance between 6 stages of CVMI (Hassel and Farman) and the 6 stages of MP3 (Rajagopal and Kansal). Physiological maturity was earlier in females than in males when compared to the individuals of opposite sex of same chronological age. Chronological age was not a valid predictor of assessing the skeletal maturity because of significant variations in the distribution of CVMI and MP3 stages with respect to individual chronological age distribution.

Evaluation of arch width variations among different skeletal patterns in South Indian population.

BACKGROUND: Anterior cranial base can be taken as a reference line (SN) to determine the steepness of mandibular plane. Subjects with high mandibular plane angle tend to have a long face and one with low MP-SN angle has a shorter face. OBJECTIVE: This study was done to investigate if dental arch widths correlated with vertical facial types and if there are any differences in arch widths between untreated male and female adults in South Indian population. MATERIALS AND METHODS: Lateral cephalogram and dental casts were obtained from 180 untreated South Indian adults (90 males and 90 females) above 18 year old with no cross bite, minimal crowding and spacing. The angle between the anterior cranial base and the mandibular plane was measured on lateral cephalogram of each patient. Dental casts were used to obtain comprehensive dental measurements including maxillary and mandibular inter canine, inter premolar and inter molar widths, as well as amount of crowding or spacing. RESULTS: The results showed that male arch widths were significantly larger than those of females (P < 0.05) and there was a significant decrease in inter arch width as the MP-SN angle increased in untreated adult South Indian population. The results obtained in our study when compared with studies done in other population groups showed that there is difference in inter arch widths according to ethnicity and race. CONCLUSION: It was concluded that the dental arch width is associated with gender, race and vertical facial morphology. Thus using individualized arch wires according to each patient's pre treatment arch form and width is suggested during orthodontic treatment.