The effects of periodontal therapy on intracrevicular prostaglandin E2 concentrations and clinical parameters in pregnancy

BACKGROUND: The increase in circulating levels of progesterone during pregnancy stimulates production of prostaglandins, especially prostaglandin E2, possibly resulting in pregnancy gingivitis. The purpose of this study is to evaluate the influence of prostaglandin E2 concentrations on gingival tissues in pregnancy and to assess its relationship to clinical parameters. METHODS: This study evaluates the effects of periodontal treatment on clinical indices including plaque index, gingival index, probing depth, and gingival crevicular fluid prostaglandin E2 levels of 22 pregnant women in their first, second, and third trimesters. Initial periodontal therapy consisting of scaling, root planing, and oral hygiene instruction was performed at the beginning of the first trimester and repeated each trimester. Prostaglandin E2 concentrations in gingival crevicular fluid were determined using a commercially available enzyme immunoassay kit. The statistical tests used were paired sample test and correlation analysis. RESULTS: The results of the study show that periodontal therapy has resulted in an improvement in clinical parameters (P<0.05). There is also a statistically significant decrease in levels of prostaglandin E2 at the second and third trimesters following periodontal therapy (P <0.001). The correlation between prostaglandin E2 concentrations and clinical parameters is found to be non-significant (P >0.05). CONCLUSIONS: Our data indicate that levels of prostaglandin E2 in gingival crevicular fluid may be used as a marker of gingival inflammation in order to determine the effects of periodontal therapy in pregnancy. Periodontal therapy that is performed throughout the entire pregnancy period may help prevent the threat of pregnancy gingivitis.     

Effect of ProTaper Universal,Endoflare, Revo-S,HyFlex Coronal Flaring Instruments,and Gates Glidden Drills on Crack Formation

Introduction

The aim of the present study was to evaluate crack formation after flaring root canals with Gates Glidden drills and ProTaper Universal (SX; Dentsply Maillefer, Ballaigues, Switzerland), Endoflare (MicroMega, Besançon, France), Revo-S (MicroMega), and HyFlex (Coltene-Whaledent, Allstetten, Switzerland) flaring instruments.

Methods

One-hundred eight mandibular molars were selected. Eighteen teeth were left unprepared to serve as negative controls; the experimental groups consisted of the mesiobuccal and mesiolingual root canals of the remaining 90 teeth, which were instrumented with the following coronal flaring instruments: Gates Glidden drills and ProTaper Universal SX, Endoflare, Revo-S SC1, and HyFlex 25.08 instruments. All roots were then sectioned perpendicular to the long axis at 1, 2, 3, 4, 6, and 8 mm from the cementoenamel junction. The sections were inspected under a stereomicroscope, and any crack formations were recorded. The data were analyzed using the chi-square test (P = .05).

Results

The Gates Glidden drills resulted in a higher rate of crack formation than that noted in the control group (P < .05). Flaring of the root canals using the ProTaper Universal, Endoflare, Revo-S, and HyFlex instruments resulted in crack formation similar to that of the control group (P > .05).

Conclusions

The use of the Gates Glidden drills resulted in the formation of the most cracks. However, the results for the ProTaper Universal, Endoflare, Revo-S, and HyFlex flaring instruments were similar to those of the control group in terms of crack formation.     

Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report

INTRODUCTION

To present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS.

PRESENTATION OF CASE

Twenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman''s procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up.

DISCUSSION

Management of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period.

CONCLUSION

Combination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula.     

Emergency thyroidectomy: Due to acute respiratory failure

INTRODUCTION

Giant cervical and mediastinal goiter may lead to acute respiratory failure caused by laryngotracheal compression and airway obstruction. Here, we present a case admitted to the emergency service with a giant goiter along with respiratory failure and poor general health status, which required urgent surgical intervention.

PRESENTATION OF CASE

A 71-year-old female admitted to the emergency room with shortness of breath and poor general health status resulting from a giant cervical swelling progressively increased during the last 7 years and constituted severe respiratory failure which has become severe in the last one month. A giant nodular goiter of the left thyroid lobe extending retrosternally, causing tracheal compression, limiting the neck movements was detected with clinical examination and bedside ultrasound. Emergency thyroidectomy was planned. Fiberoptic-assisted awake nasal intubation was performed in the operating room. Emergency total thyroidectomy was performed for the life-threatening respiratory failure. Postoperative period was uneventful. She was transferred from intensive care unit to the ward on postoperative day 3 and was discharged from the hospital on the postoperative 7th day. Benign multinodular hyperplasia was reported on the histopathological report. Patient was included in routine follow-up.

DISCUSSION

In the present case tracheal destruction due to compression of the giant goiter was found in agreement with previous reports. Emergency thyroidectomy was performed after awake intubation since it is a common surgical option for the treatment of giant goiter causing severe airway obstruction.

CONCLUSION

Respiratory failure due to giant nodular goiter is a life-threatening situation and should be treated immediately by performing awake endotracheal intubation following emergency total thyroidectomy.