Comparison of changes in retentive force of three stud attachments for implant overdentures

PURPOSEThe aim of this study was to compare the changes in retentive force of stud attachments for implant overdentures by in vitro 2-year-wear simulation.RESULTSA comparison of the initial retentive force revealed the highest value for Kerator, followed by the O-ring and EZ lock attachments. However, no significant difference was detected between Kerator and O-ring (P>.05). After 2500 insertion and removal cycles, the highest retention loss was recorded for O-ring, and no significant difference between Kerator and EZ lock (P>.05). Also, Kerator showed the highest retentive force, followed by EZ lock and O-ring, after 2500 cycles (P<.05). Based on SEM analysis, the polymeric components in O-ring and Kerator were observed to exhibit surface wear and deformation.CONCLUSIONAfter 2500 insertion and removal cycles, all attachments exhibited significant loss in retention. Mechanism of retention loss can only be partially explained by surface changes.     

复方苦参灌肠剂急性毒性及直肠黏膜刺激实验研究

[目的]通过对复方苦参灌肠剂的急性毒性及直肠黏膜刺激性进行实验研究,为临床安全用药提供参考。[方法]应用可供灌肠最大浓度(0.7 g/mL)和最大容积(0.04 mL/g)复方苦参灌肠剂,24 h内重复给药两次,连续观察并记录给药后14 d内小鼠的中毒症状和死亡数,观察小鼠精神、活动状态、毛发色泽、饮食、排泄物、体质量变化及毒性反应,14 d后解剖观察心、肝、脾、肺、肾、结肠并进行病理学检查。对SD大鼠多次直肠给药进行直肠黏膜刺激实验,大鼠给药量为临床灌肠用药剂量,连续给药并观察7 d,第1次给药24 h后解剖1只大鼠,观察直肠黏膜充血水肿情况,以积分评价方法判断药物对直肠黏膜是否有刺激性,并进行病理检查,末次给药24 h后解剖5只大鼠,处理同前,其余大鼠停药观察1周,如果此病理检查结果有异常,则停药观察的动物需行组织病理学检查,否则只需解剖肉眼观察。[结果]急性毒性实验:实验组大鼠体质量增长趋势与对照组比较无统计学意义(P0.05)。实验组与正常对照组给药后30 min内出现倦怠懒动,2 h后恢复正常活动、饮食,随后14 d内各观察指标如外观、行为、饮食、排泄物均正常,无死亡小鼠,14 d后解剖所有小鼠,各内脏无肉眼可观察到的异常变化。直肠黏膜刺激实验:实验组与正常对照组体质量均有不同程度增长趋势,两组比较无统计学差异(P0.05)。动物解剖未见药物引起的直肠黏膜充血水肿等现象,积分评价法判断药物对直肠黏膜无刺激性,两次组织病理学检查未见明显病理改变,停药后的大鼠解剖无肉眼可见病理改变,无死亡大鼠。[结论]该实验条件下,小鼠灌肠最大给药量为56 g生药/kg,相当于人每日用量的14.6倍。实验表明临床拟用灌肠剂量是安全的。复方苦参灌肠剂多次大鼠直肠给药,对直肠黏膜无刺激性作用。     

种植磁性覆盖义齿的临床效果观察

目的探讨种植磁附着体全口义齿对下颌牙槽嵴重度吸收的无牙颌患者的修复效果。方法采用C D I C牙种植体及配套磁性附着体,为15例下颌牙槽嵴重度吸收的无牙颌患者在下颌两侧第一前磨牙区各植入1枚种植体,4～6个月后制作下颌全口义齿并在组织面粘固磁体。进行咀嚼效率和患者满意度测定。结果种植磁附着体全口义齿在粘固磁体后及粘固后2周的固位力和咀嚼效率均较放置磁体前明显提高,且患者满意度提高。结论磁性固位种植体覆盖义齿用于牙槽骨严重吸收的无牙颌患者修复治疗的临床效果好。     

保留根管治疗后纵折磨牙的疗效观察

目的：观察特殊固位型预备加树脂粘固全冠修复治疗根管治疗后纵折磨牙的临床治疗。方法：对60颗纵折磨牙进行全冠预备加辅助固位型预备,随机分为两组,实验组先对固位型树脂充填,再金属烤瓷全冠修复;对照组先用牙胶充填固位型,戴冠时去除牙胶,使粘接剂充满固位型,粘固金属烤瓷冠。结果：随访3到30个月评价预后效果。到术后30个月为止,共计60颗患牙成功48例,所占百分比80％,有效9例所占百分比15％,失败3例,所占百分比5％。此治疗方法得以保留的患牙占95％。结论：使用特殊固位型牙体预备加树脂粘固对保存根管治疗后纵折牙有较好疗效,且是否先充填固位型对临床效果并无明显影响,采用一次法直接粘固可节约临床操作时间及材料成本。     

Incomplete colonoscopy: Maximizing completion rates of gastroenterologists

BACKGROUND

Cecal intubation is one of the goals of a quality colonoscopy; however, many factors increasing the risk of incomplete colonoscopy have been implicated. The implications of missed pathology and the demand on health care resources for return colonoscopies pose a conundrum to many physicians. The optimal course of action after incomplete colonoscopy is unclear.

OBJECTIVES:

To assess endoscopic completion rates of previously incomplete colonoscopies, the methods used to complete them and the factors that led to the previous incomplete procedure.

METHODS:

All patients who previously underwent incomplete colonoscopy (2005 to 2010) and were referred to St Paul’s Hospital (Vancouver, British Columbia) were evaluated. Colonoscopies were re-attempted by a single endoscopist. Patient charts were reviewed retrospectively.

RESULTS:

A total of 90 patients (29 males) with a mean (± SD) age of 58±13.2 years were included in the analysis. Thirty patients (33%) had their initial colonoscopy performed by a gastroenterologist. Indications for initial colonoscopy included surveillance or screening (23%), abdominal pain (15%), gastrointestinal bleeding (29%), change in bowel habits or constitutional symptoms (18%), anemia (7%) and chronic diarrhea (8%). Reasons for incomplete colonoscopy included poor preparation (11%), pain or inadequate sedation (16%), tortuous colon (30%), diverticular disease (6%), obstructing mass (6%) and stricturing disease (10%). Reasons for incomplete procedures in the remaining 21% of patients were not reported by the referring physician. Eighty-seven (97%) colonoscopies were subsequently completed in a single attempt at the institution. Seventy-six (84%) colonoscopies were performed using routine manoeuvres, patient positioning and a variable-stiffness colonoscope (either standard or pediatric). A standard 160 or 180 series Olympus gastroscope (Olympus, Japan) was used in five patients (6%) to navigate through sigmoid diverticular disease; a pediatric colonoscope was used in six patients (7%) for similar reasons. Repeat colonoscopy on the remaining three patients (3%) failed: all three required surgery for strictures (two had obstructing malignant masses and one had a severe benign obstructing sigmoid diverticular stricture).

CONCLUSION:

Most patients with previous incomplete colonoscopy can undergo a successful repeat colonoscopy at a tertiary care centre with instruments that are readily available to most gastroenterologists. Other modalities for evaluation of the colon should be deferred until a second attempt is made at an expert centre.     

Rectal perforations and fistulae secondary to a glycerin enema: closure by over-the-scope-clip

Rectal perforations due to glycerin enemas (GE) typically occur when the patient is in a seated or lordotic standing position. Once the perforation occurs and peritonitis results, death is usually inevitable. We describe two cases of rectal perforation and fistula caused by a GE. An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE. Her case was further complicated by an abscess in the right rectal wall. The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE. In both cases, we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip (OTSC) procedure. These procedures resulted in dramatic improvement in both patients. Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure, respectively, in elderly patients who are in poor general condition. Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.     

西昌市社区美沙酮维持治疗病人保持治疗影响因素的前瞻性研究

目的对四川省西昌市社区美沙酮维持治疗(MMT)病人长期保持治疗的影响因素进行分析。方法应用前瞻性队列研究的方法,对280名2004年入组治疗病人进行为期6年的随访。采用Log-rank法、Cox比例风险模型等方法,对可能影响治疗保持的人口学特征、既往毒品滥用及治疗情况等因素进行分析。结果 280名研究对象随访期间治疗剂量为(56.7±34.6)毫克/天,治疗保持率为39.6%。不同性别、年龄、职业、居住状况、生活来源、家人关系、首次吸毒年龄、毒品滥用时间、是否注射、是否共针及不同居住地的研究对象,在治疗保持方面的差异无统计学意义。低、中、高剂量组保持率分别为9.1%、36.7%和65.7%(P<0.000 1);尿检阳性率10%及以下、11%-20%、20%以上的保持率分别为47.6%、43.9%和6.0%(P<0.000 1);有无家人也接受MMT的保持率分别为59.4%和33.2%(P<0.000 1)。Cox比例风险模型多因素分析结果显示,治疗剂量高(HR=0.15,P=0.002)、有家人接受MMT治疗(HR=0.61,P=0.024)的研究对象,退出治疗的风险低;尿检阳性率高(HR=2.83,P<0.000 1)者更容易退出治疗。结论高治疗剂量、偷吸毒品及有家人一同治疗等治疗特征,对长期治疗情况有较大影响。因此,通过改善MMT服务质量,提高治疗剂量、减少治疗期间偷吸毒品以降低病人退出治疗的风险,应成为MMT门诊的工作重点。     

结肠气钡双重造影和结肠CT应用价值的对比分析

目的 探讨结肠气钡双重造影和结肠CT在结直肠疾病诊断中的应用价值,并对比分析两种检查方法的优缺点.方法 回顾性分析2005年6月至2013年8月我院213例结肠气钡双重造影和结肠CT检查结果,对比观察两种检查方法所检出的病种、结直肠肿瘤和息肉的大小、部位及并发症发生情况.结果 结肠气钡双重造影对溃疡性结肠炎、慢性阑尾炎、憩室等疾病和近端结肠及小病灶的诊断能力优于结肠CT;结肠CT对结直肠肿瘤及远端结肠的诊断能力则优于结肠气钡双重造影.结论 结肠气钡双重造影和结肠CT各具优势,在临床工作中应视具体情况加以选择或联合应用.     

Retention of fiber posts to the optimally and over-prepared dowel spaces

PURPOSE

To assess the retention of glass fiber post cemented with self-adhesive resin cement into optimum and over-prepared root canals following obturation in the presence of either eugenol (EB) or calcium hydroxide (CB)-based sealers.

MATERIALS AND METHODS

Roots of extracted premolars were endodontically-treated in 5 groups (n = 10). Roots of Group 1 (control) were left with no obturation and then optimally prepared to receive endodontic dowels. Other root canals were obturated with gutta-percha in the presence of either eugenol-based (Groups 2 and 4) or calcium hydroxide-based (Groups 3 and 5) sealer. Dowel spaces were prepared with optimal diameter in Groups 2 and 3, one size larger in Groups 4 and 5. Standardized fiber posts were luted to the prepared spaces using self-adhesive resin cement and itsretention was then tested on an universal testing machine. Both one-way ANOVA and Tukey''s HSD comparisons (α=0.05) were used to identifythe significance of inter-group retention differences. Scanning electron microscopy (SEM) of both optimally and over-prepared dowel spaces was also considered to figure the nature of their interior out.

RESULTS

The post retention was significantly higher to the non-obturated, optimally-prepared dowel spaces of Group 1 compared to the obturated, optimally-prepared ones of Groups 2 and 3. For each dowel space diameter, root canals obturated using CB of Groups 3 and 5 showed significantly higher dowel retention compared to those obturated using EB of Groups 2 and 4. Post retention to the over-prepared dowel spaces of Groups 4 and 5 was significantly higher than that recorded for the optimally-prepared ones of Groups 1-3. SEM images revealed traces of endodontic sealer and gutta-percha on the walls of the optimally-prepared dowel spaces.

CONCLUSION

Despite the adverse effect of endodontic sealers on the retention of fiber posts, the over-preparation of dowel spaces helps to improve the retention.