Supracardiac total anomalous pulmonary venous connection with cor triatriatum sinister: A rare diagnosis confirmed by saline contrast echocardiography

In cor triatriatum sinister, the left atrium is divided by a membrane into a proximal and a distal chamber. Usually proximal chamber receives all the pulmonary veins and drains through an opening in the dividing membrane into distal chamber, which empties into left ventricle through the mitral valve. Rarely, the two chambers lack a communication and there is associated total anomalous pulmonary venous connection (TAPVC). We report a 1-month-old infant with cyanosis and heart failure, who had cor triatriatum sinister associated with supracardiac TAPVC. The case is reported for rarity of the association with a focus on contrast echocardiographic imaging.     

Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysis

Background

A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified.

Methods

We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensity-matched analysis with the propensity score built from a multivariable analysis using a generalized linear model.

Results

Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5–30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective.

Conclusion

We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed.     

Dental magnetic resonance imaging for periodontal indication – a new approach of imaging residual periodontal bone support

Objective: The standard imaging techniques used in dentistry consist of two-dimensional radiographic techniques like intraoral periapical (PA) radiographs, bitewings or extraoral panoramic X-rays. Three-dimensional methods, such as cone beam computed tomography (CBCT), are not standard procedures. In several fields of dentistry, such as oral surgery or implantology, dental magnetic resonance imaging (DMRI), a technique without radiation exposure, has already been introduced as a new promising diagnostic tool. The aim of this study was to compare the agreement of DMRI and PA radiographs in measuring residual periodontal bone support.

Material and methods: In this study, the residual periodontal bone support of 21 teeth was investigated and compared with DMRI and PA radiographs by two independent raters. Intra-class correlation coefficients (ICCs) were calculated using the software R to identify the intra-rater and inter-rater agreement of the two modalities. Bland–Altman plots were created to directly compare the two methods.

Results: Overall, all calculated ICC values showed an excellent intra-rater and inter-rater agreement (>0.9) for DMRI, as well as PA radiographs. Bland–Altman analysis also showed a strong agreement between both diagnostic methods in this study.

Conclusions: In conclusion, there was a strong agreement between DMRI and PA. Thus, DMRI proved to be a comparable method to PA radiographs for evaluating the proportion of residual periodontal bone support.     

Bromodeoxyuridine incorporation and Ki 67 expression in oral hairy leukoplakia

OBJECTIVES: Oral hairy leukoplakia (HL) is an acan-thotic, hyperparakeratotic lesion characterised by the presence of a replicative Epstein-Barr virus (EBV) infection in the superficial and adjoining layers of the epithelium. EBV or its gene products are capable of modifying epithelial differentiation. The aim of this study was to establish whether the presence of EBV was associated with an alteration in cell turnover by assessing bromodeoxyuridine (BrdU) incorporation and Ki 67 expression in lesional tissue and control mucosa.
METHODS: Biopsies of HL together with age, site and sex matched controls ( n = 7 and 8 respectively) were incubated in 200 μM BrdU in vitro , fixed in methacarn and processed to paraffin wax. Following acid hydrolysis, incorporated BrdU and Ki 67 were identified in serial 5 fim sections using a three-stage immunoperoxidase technique and cell density expressed as the number of positive cells per mm basement membrane length.
RESULTS: Overall, there was no difference in the number of BrdU positive cells per mm basement membrane length between control and HL tissue. However, within HL alone, the presence'of focal EBV replication was associated with a significant reduction in the number of basal cells incorporating BrdU compared to adjacent EBV free areas (P < 0.05). There was no significant difference between Ki 67 positive cells in control and HL tissue and no evidence of a reduction of Ki 67 positive cells in areas associated with EBV replication.
CONCLUSIONS: These results suggest that there is no evidence of a generalised alteration of the proliferative capacity of basal cells in HL, although the focal reduction in BrdU incorporation may reflect subtle changes on cell turnover by EBV infection.     

Determining replacement teeth position for the implant-retained prosthesis in the edentulous patient

A pleasing final appearance is vitally important for patients who undergo extensive oral rehabilitation. This applies equally to the fields of orthodontics, restorative, prosthetic, and implant dentistry. In the field of removable prostheses there are biometric guides that aid in the replacement of teeth especially when the anatomical ridges are severely resorbed. These guides should be considered when planning the appearance and function of prostheses. This paper suggests that in view of the fact that unfavourable placement of implant fixtures is not easily rectified, knowledge of biometric guides can be critical in the treatment planning of the implant supported prosthesis especially when there are large resorbed edentulous spans.