One-year clinical evaluation of a flowable resin liner associated with a microhybrid resin in noncarious cervical lesions

The aim of this study was to compare the clinical performance over 1 year of a microhybrid composite resin for class V restorations both lined and not lined with a flowable composite resin. Nineteen patients having at least two pairs of cervical noncarious lesions under occlusion were enrolled in this study. A total of 38 restorations were placed, half for each group (Single-Bond + Filtek-Flow + Filtek Z250, and Single-Bond + Filtek Z250). Two calibrated operators placed all restorations according to the manufacturers instructions. Two other independent examiners evaluated the restorations at baseline and after a 12-month period according to the USPHS criteria and modified criteria for color match. The classic alpha score was divided into A1 for not detectable and A2 for slightly discernible filling. Statistical analysis was conducted using Fishers exact test and McNemars test (P=0.05). One restoration was lost after 12 months for each group (retention rate 95% for each group). After 12 months, 18 restorations showed a trend towards dark yellowing (color match A2). The use of Filtek Flow as a liner under Filtek Z250 restorations did not improve the clinical performance of class V restorations after 6 and 12 months of evaluation.     

Clinical evaluation of a nanofilled composite in posterior teeth: 12-month results

This study compared the clinical performance of a nanofilled resin composite for posterior restorations with 2 microhybrid and 1 packable composite after 12 months of clinical service. Forty-two patients with at least 5 Class I or II restorations under occlusion were enrolled in this study. A total of 148 restorations were placed, 25% for each material (Filtek Supreme, Pyramid, Esthet-X or Tetric Ceram). Two calibrated operators placed all restorations, according to the manufacturers' instructions. One week later, the restorations were finished/polished. Two independent examiners evaluated the restorations at baseline and after 12 months according to the USPHS modified criteria. All patients attended the 12-month recall and 148 restorations were evaluated. Friedman repeated measures analysis of variance by rank and Wilcoxon sign-ranked test for pair-wise comparison was used for data analysis (alpha=0.05). All materials showed only minor modifications, and no differences were detected between their performance at baseline and after 12 months. After 1 year, the nanofilled resin composite showed similar performance to the other packable and microhybrid resin composites.     

Pustular drug hypersensitivity syndrome due to allopurinol

Allopurinol hypersensitivity syndrome (AHS) is a severe drug reaction. It is characterized by rash, fever, and internal organ involvement. It may present in different clinical forms. We present a case of acute generalized exanthematous pustulosis occurring as a manifestation of AHS.KEY WORDS: Allopurinol, hypersensitivity syndrome, pustulosis     

Artificial neural networks assessing adolescent idiopathic scoliosis: comparison with Lenke classification

Background contextVariability in classifying and selecting levels of fusion in adolescent idiopathic scoliosis (AIS) has been repeatedly documented. Several computer algorithms have been used to classify AIS based on the geometrical features, but none have attempted to analyze its treatment patterns.PurposeTo use self-organizing maps (SOM), a kind of artificial neural networks, to reliably classify AIS cases from a large database. To analyze surgeon's treatment pattern in selecting curve regions to fuse in AIS using Lenke classification and SOM.Study designThis is a technical concept article on the possibility and benefits of using neural networks to classify AIS and a retrospective analysis of AIS curve regions selected for fusion.Patient sampleA total of 1,776 patients surgically treated for AIS were prospectively enrolled in a multicentric database. Cobb angles were measured on AIS patient spine radiographies, and patients were classified according to Lenke classification.Outcome measuresFor each patient in the database, surgical approach and levels of fusion selected by the treating surgeon were recorded.MethodsA Kohonen SOM was generated using 1,776 surgically treated AIS cases. The quality of the SOM was tested using topological error. Percentages of prediction of fusion based on Lenke classification for each patient in the database and for each node in the SOM were calculated. Lenke curve types, treatment pattern, and kappa statistics for agreement between fusion realized and fusion recommended by Lenke classification were plotted on each node of the map.ResultsThe topographic error for the SOM generated was 0.02, which demonstrates high accuracy. The SOM differentiates clear clusters of curve type nodes on the map. The SOM also shows epicenters for main thoracic, double thoracic, and thoracolumbar/lumbar curve types and transition zones between clusters. When cases are taken individually, Lenke classification predicted curve regions fused by the surgeon in 46% of cases. When those cases are reorganized by the SOM into nodes, Lenke classification predicted the curve regions to fuse in 82% of the nodes. Agreement with Lenke classification principles was high in epicenters for curve types 1, 2, and 5, moderate in cluster for curve types 3, 4, and 6, and low in transition zones between curve types.ConclusionsAn AIS SOM with high accuracy was successfully generated. Lenke classification principles are followed in 46% of the cases but in 82% of the nodes on the SOM. The SOM highlights the tendency of surgeons to follow Lenke classification principles for similar curves on the SOM. Self-organizing map classification of AIS could be valuable to surgeons because it bypasses the limitations imposed by rigid classification such as cutoff values on Cobb angle to define curve types. It can extract similar cases from large databases to analyze and guide treatment.     

Constipated children

A large number of children suffer habitually from constipation, a problem which bears considerable repercussions on the physical and emotional well-being of the patient and causes tensions in their family environment. From 1996 to 1999, the authors studied the clinical and epidemiological data from patients in a Primary Health Care Pediatrics. Ward at which the main reason for consultation, or at least one of the main reasons, was chronic constipation. In this article, the authors evaluate the clinical and epidemiological characteristics of 68 children whose ages vary from 3 to 13 out of a total of 1368 who were diagnosed with functional constipation as well as the results obtained from a plan to assess, care for and treat these patients.     

Transfusion-associated graft-versus-host disease in immunocompetent patients: report of a fatal case associated with transfusion of blood from a second-degree relative, and a survey of predisposing factors

A patient without evident immune deficiency who received a transfusion of blood from a second-degree family member developed fatal transfusion- associated graft-versus-host disease (TA-GVHD). The donor was homozygous for an HLA haplotype for which the recipient was heterozygous (one-way HLA match). All 39 reported cases of TA-GVHD in immunocompetent patients were reviewed to ascertain the predisposing factors and to define the indications for irradiating blood for this population. HLA typing was described in 15 cases; in 13, including seven related and six unrelated donors, a one-way HLA match was present. Thirty-one (79%) of the 39 cases were reported from Japan (and 196 other cases are cited in the Japanese literature), but a one-way HLA match among unrelated donors at HLA-A, -B, -DR loci is only approximately two to four times more likely in Japanese persons than in whites. Fresh blood (< 96 hours old) was used in 29 (94%) of the 31 cases reported from Japan and in 33 (87%) of 38 cases overall (in one case, the age of the blood used was not reported). Thus, factors that appear to predispose to TA-GVHD in immunocompetent patients are a one- way HLA match, fresh blood, and, possibly, Japanese ancestry. Irradiating cellular blood components from all blood relatives of transfusion recipients will not completely eliminate the risk of TA- GVHD.