Digital imaging analysis with mathematical morphology and fractal dimension for evaluation of periapical lesions following endodontic treatment.

OBJECTIVE: To see if a method for digitizing trabecular pattern of bone could be used to quantitatively evaluate changes in bone pattern following endodontic treatment of teeth with periapical osteolytic lesions. STUDY DESIGN: Periapical radiographs were digitized and further processed with mathematical morphology operations known as skeletonization. The trabecular patterns resulting from this skeletonization process were further analyzed with fractal dimension analysis using box-counting. RESULTS: The periapical area in digitized radiographic images showed fractal behavior. Twenty-five of 27 patients showed increase of the fractal dimension after root canal treatment. Significant changes of the box-counting could be noted 3 months after root canal treatment (P < .05). CONCLUSIONS: Mathematical morphology operation and box-counting might be helpful in early detection of changes of periapical trabecular pattern after root canal treatment.     

Radiographic evaluation of periapical healing of permanent teeth with periapical lesions after extrusion of AH Plus sealer.

The aim of this study was to clinically and radiographically examine the effects of extrusion of AH Plus sealer on the healing of permanent teeth with apical periodontitis. A total of 87 root canals radiographically detected with apical periodontitis were included in the study. Posttreatment radiographs indicated sealer extrusion into 49 canals (Group 1) and no sealer extrusion into 38 canals (Group 2). Periapical treatment was judged as complete healing (CH), incomplete healing (IH) and no healing (NH) at the end of a 4-year follow-up period. Amounts of extraradicular sealer were recorded as "unchanged," "reduced," "almost absent," or "absent." The t test was used for the statistical analyses. In Group 1, CH was detected in 41 canals, IH in 4 canals, and NH in 4 canals. Differences between CH and both IH and NH were statistically significant (P < .001). In Group 2, CH was detected in 34 canals and NH in 4 canals. The difference between CH and NH was statistically significant (P < .001). A statistically significant difference (P < .05) between treatment groups was observed for CH at the 6-month follow-up appointment only; other than that instance, there were no statistical differences for CH or NH between the groups. In conclusion, extruded AH Plus does not prevent periapical healing, but can be a delaying factor for healing in children.     

The prevalence and treatment of end-stage renal disease in an Asian child population

Background: There are significant differences in the incidence aetiology of end-stage renal disease (ESRD) between the Asian and white adult population in the UK. The aim of this study as to determine if similar differences occurred in the paediatric ESRD population. Methods: A retrospective study of children with ESRD presenting between 1980 and 1995 in the population served by the Birmingham Children's Hospital. Results: Asian children comprised 7.4% of the total child population (0-13 years). ESRD developed in 165 children (138 white, 27 Asian). The prevalence of ESRD for whites was 15 per 10⁵ white child population and for Asians, 40 per 10⁵ Asian child population. A genetic aetiology was noted in 16 (19%) whites and 12 (44%) Asians (P <0.001). Of the 147 renal transplants, 22 (15%) were to Asian recipients. The distribution of blood groups in the two populations reflected the pattern in the respective general populations as a whole. There was no significant difference in time to transplantation for the two groups (whites, mean 6 months, 95% confidence interval 6-11 months; Asians, mean 7 months, 95% CI 4-12 months). Asian patients had significantly more mismatches (⩽3 or ⩽4) compared to white patients. Conclusion: Asian children had a higher prevalence of ESRD, with genetic disease predominating. Differences in ethnicity or blood group did not influence time to transplantation in those that received a transplant although Asians had more mismatches.     

The prevalence of wrist ganglia in an asymptomatic population: magnetic resonance evaluation

Magnetic resonance imaging (MRI) was performed on the wrists of 103 asymptomatic volunteers. The images were evaluated independently by two musculoskeletal radiologists and one orthopaedic surgeon. Wrist ganglia were identified in 53 out of the 103 wrists. The average long and short axes measurements were 8 mm (range 3-22) and 3 mm (range 2-10), respectively. Seventy per cent of the ganglia originated from the palmar capsule in the region of the interval between the radioscaphocapitate ligament and the long radiolunate ligament. Fourteen per cent of the ganglia were dorsal and originated from the dorsal, distal fibres of the scapholunate ligament. Two ganglia had surrounding soft tissue oedema and one had an associated intraosseous component. Unlike previous surgical and pathological series, our study showed that palmar wrist ganglia are more common than dorsal wrist ganglia. The vast majority of these asymptomatic ganglia occur without associated ligamentous disruption, soft tissue oedema or intraosseous communication.     

High prevalence of familial sarcoidosis in an Irish population.

Previous studies in the Republic of Ireland have demonstrated a high national prevalence of sarcoidosis. Observations in our sarcoid clinic suggested a high prevalence of the disease among siblings and prompted a survey to quantify this phenomenon. The study group comprised 114 index patients with biopsy proved sarcoidosis and a total sibling pool of 534 individuals. Eleven of the index patients (9.6%) were found to have at least one sibling with sarcoidosis. Of the 13 siblings thus identified, eight had biopsy proof of the disease, while the remaining five showed highly suggestive clinical and radiological evidence of sarcoidosis. There was no significant difference in the mode of presentation between the sibling pairs or between familial and non-familial cases and there was an equal distribution of like sex and unlike sex pairs. In only two instances was the temporal profile of onset of the disease suggestive of intrafamilial spread of a transmissible agent. The high prevalence of sarcoidosis among siblings reported here (2.4%) suggests that genetic factors significantly predispose to the development of sarcoidosis and that family members of affected patients should be screened for this disease.     

Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment

BACKGROUND: The Ponseti method for treatment of idiopathic clubfeet involves the use of serial casts, percutaneous Achilles tenotomy in most cases, and bracing with an abduction orthosis to prevent relapse. Although Ponseti recommended evaluation of the infant clubfoot strictly by palpation, many orthopaedic surgeons still rely on radiographs for decision-making during treatment. The aim of this study was to document with radiographs the effect of percutaneous Achilles tenotomy as described by Ponseti. METHODS: We conducted a study of idiopathic clubfeet treated, at two centers, with the Ponseti method, including percutaneous Achilles tenotomy. Cast treatment was started within three weeks after birth, and radiographs were made before and after the tenotomy. Lateral radiographs with the foot in maximal dorsiflexion at the ankle were made for all patients, and anteroposterior radiographs of the foot were made at one center. The lateral tibiocalcaneal angle, the anteroposterior talocalcaneal angle, and the lateral talocalcaneal angle were measured on the radiographs. Foot dorsiflexion at the ankle was evaluated clinically. The results from both centers were evaluated separately and in combination. RESULTS: Lateral dorsiflexion radiographs that showed the foot and ankle were evaluated for eighty-seven clubfeet, and anteroposterior radiographs that showed the foot were evaluated for sixty-five clubfeet. The mean improvement in the lateral tibiocalcaneal angle after the tenotomy was 16.9 degrees . The mean change in the anteroposterior talocalcaneal angle was 2.1 degrees , and the mean change in the lateral talocalcaneal angle change was 1.4 degrees . The mean increase in clinically measured dorsiflexion after the tenotomy (in sixty-five feet) was 15.1 degrees . Only the lateral tibiocalcaneal angle and dorsiflexion as measured clinically changed significantly after the Achilles tenotomy (p < 0.05). When the results at each center were analyzed separately, they were found to be nearly identical. CONCLUSIONS: The increase in the lateral tibiocalcaneal angle after Achilles tenotomy is essentially the same as the increase in ankle dorsiflexion seen on clinical examination. The anteroposterior and lateral talocalcaneal angles are not influenced significantly by the tenotomy. Radiographs confirmed that the additional dorsiflexion obtained from the percutaneous Achilles tenotomy is true dorsiflexion occurring in the ankle and hindfoot and not in the midfoot. LEVEL OF EVIDENCE: Therapeutic Level IV.     

Radiographic evaluation of transverse sacral fractures.

This study clarifies the pattern of fracture lines and facilitates diagnosis of transverse sacral fracture on plain radiographic images. Eight cadaveric sacra were used in this study. A U-shaped transverse sacral fracture at the S2-S3 level was created in all specimens. The fracture line was marked by painting with radio-opaque material and solder metal wires. The following radiographic views were taken: anteroposterior, lateral, AP with 35 degrees cephalad orientation, and inlet view. A double shadow in the upper sacral area can be identified in the plain AP view. As a consequence of the fracture, there are changes in the orientation of the planes of the foramina from the coronal to, more or less, axial plane. Anteroposterior with 35 degrees cephalad orientation radiographs provide good assessment for evaluation of the transverse sacral fracture.     

Labiomandibular paresthesia caused by endodontic treatment: an anatomic and clinical study.

Labiomandibular paresthesia after root canal treatment is an accident that is still too frequent despite the development of new endodontic techniques. The aim of this anatomical and clinical study is to advance the understanding of how accidents occur so as to avoid them. This anatomical study made it possible to determine the variability of proximity of the apex of the tooth root to the mandibular bundle, as well as the relationship between the nerve and its satellite artery, and to understand how endodontic filling material spreads into the cancellous bone. The clinical study, which included examination with conventional radiology as well as with imaging techniques, enabled us to identify the exact location of the filling material in relation to the mandibular bundle and to correlate this to the occurrence of clinical symptoms and their diverse manifestations.     

Socioeconomic status and microalbuminuria in an Asian population

Background. In studies from developed Western countries, lowersocioeconomic status (SES) has been reported to be associatedwith kidney diseases. However, this hypothesis has not beenexamined in populations from newly industrialized Asian countries.We evaluated the association between SES and micro/macroalbuminuriain a population-based sample in Singapore. Methods. We examined 920 participants of Malay ethnicity aged40–80 years (49.6% female). SES was defined through education,income and housing type of participants. The main outcome ofinterest was the presence of micro/macroalbuminuria definedas a urinary albumin-to-creatinine ratio (ACR) 17 mg/g for menand 25 mg/g for women. Results. Lower categories of SES were associated with micro/macroalbuminuria;compared to the higher categories of SES, the odds ratio (95%confidence interval) of micro/macroalbuminuria was 1.76 (1.23–2.52)for primary/lower education, 1.64 (1.16–2.31) for income<1000 Singapore dollars (SGD)/retired status, 1.44 (1.01–2.06)for small/medium housing type and 2.37 (1.56–3.60) forthe coexistence of all three low SES factors (primary/ beloweducation, income <1000 SGD/retired status and small/mediumhousing type) compared to 1 low SES factor. This pattern ofassociation was consistently present in subgroup analyses bygender and age. Conclusions. Lower SES is associated with the presence of micro/macroalbuminuriaindependent of age, gender, smoking, alcohol intake and bodymass index among Malay adults in Singapore.     

Estimating the prevalence of definitive chronic kidney disease in the Japanese general population

Clinical and Experimental Nephrology - Most data on chronic kidney disease (CKD) prevalence has been based on single measurements of renal function and proteinuria. The aim was to determine the...     

Nonsurgical endodontic treatments in molar teeth with large periapical lesions in children: 2-year follow-up.

Profound caries lesions may lead to invasion of microorganisms to the dental pulp, and periapical areas can promote the development of dentoalveolar abscess and periapical bone loss. Treatment options to manage large periapical lesions range from nonsurgical root canal treatment and/or apical surgical procedure to extraction. Young molar teeth with pulp necrosis and large periapical lesions in children are frequently treated with root canal treatment because the therapy is more difficult in multirooted teeth. In these case reports, nonsurgical endodontic treatments performed on 6 molar teeth with large periapical lesions, by repeated intracanal dressing with calcium hydroxide, are presented. Radiographs displayed significant bony healing at the end of the second year. In conclusion, large periapical lesions can respond favorably to nonsurgical treatment, and complex and difficult endodontic treatments in children might not be required.     

Nonsurgical retreatment of teeth with periapical lesions previously managed by either endodontic or surgical intervention.

OBJECTIVE: The purpose of this study was to evaluate the outcome of nonsurgical retreatment of teeth with periapical lesions, which had been previously managed by either endodontic or surgical intervention, and to identify factors that might influence the prognosis. STUDY DESIGN: Seventy-five endodontically and 11 surgically treated teeth with persisting periapical lesions ranging in size from 2 to 11 mm in diameter were included in this study. The teeth were nonsurgically retreated, using calcium hydroxide as intracanal medicament, and were followed for a period of 2 to 8 years. RESULTS: Clinical and radiographic assessment of retreatment showed that complete healing for all cases was 61.6% with an additional category of incomplete healing of 14%; 24.4% failed. The size of the periapical lesions and previous surgical treatment had marginally negative influences on the prognosis, but the differences were not statistically significant. CONCLUSION: The favourable results of this study demonstrated that nonsurgical root canal retreatment is an alternative to surgical intervention of postendodontic or postsurgical failure.     

Radiographic evaluation of renal excursion with respiration.

An unusual case stimulated investigation of radiographic changes in renal axis resulting from respiratory excursion. Prospective study of 20 "routine" excretory urograms revealed no statistically significant differences in renal axis whether the film was taken in full expiration or inspiration. Clinical implications and a review of pertinent literature are discussed.     

Radiographic evaluation of the degenerative cervical spine.

Despite some claims to the contrary, the use of plain film radiography can be an inexpensive initial means of evaluating the degenerative cervical spine if viewed in the context of the patient's clinical history and physical examination and may serve as a guide for further imaging techniques. This article presents a systematic approach for evaluating cervical spine radiographs for the spectrum of degenerative changes, followed by a brief discussion of differential diagnoses.     

Halothane reductive metabolism in an adult surgical population

The reductive metabolism of halothane was studied in 34 adult patients undergoing routine surgery. Reductive biotransformation of halothane was more extensive in females than males and was also enhanced in two patients treated preoperatively with phenytoin, an enzyme-inducing drug. Tobacco, ethanol and the patient's age, body weight and previous exposure to halothane did not influence reductive metabolism of halothane.     

The prevalence of urinary incontinence in a randomized population of 5247 adult finnish women

A randomized study of the prevalence of urinary incontinence was performed among adult Finnish females. In 1986, 5247 women (aged 25–55 years) who participated voluntarily in a gynecological health study, anonymously completed a questionnaire concerning subjective symptoms and experiences with urinary incontinence. One-fifth of the studied population (20.1%) reported that they were handicapped by incontinence. The number of incontinent women increased significantly with increasing age up to 45 years. Stress urinary incontinence alone was reported by 73% of the women experiencing incontinence. Surprisingly, only one-third of the women stated that they needed treatment, and less than one-fifth of all had sought help for this disorder.     

Prognostic factors and outcome after drowning in an adult population

Background: Drowning remains an actual problem. Although medical assistance has improved, it still has high rates of morbidity and mortality. We set out to explore the clinical characteristics and outcome of drowning patients admitted to the intensive care unit (ICU) of tertiary-care university hospital.
Methods: We designed a retrospective observational study to analyse all drowning patients admitted to our ICU after successful cardiopulmonary resuscitation. The study was conducted during 1 January 1992–31 December 2005. There was no exclusion. We used a univariate analysis to evaluate the effect on patient and management characteristics on survival.
Results: There were 43 patients (five children and 38 adults), with male predominance. Fifteen patients, all adults (34.9%), died. Submersion time, age, Glasgow Coma Score (GCS), pupillary reactivity and acute physiology and chronic health evaluation (APACHE II) at ICU admission were related to mortality. Non-survivors presented a higher glycaemia level at ICU admission than survivors ( P =0.005).
Conclusions: The outcome is closely related to the patient's clinical status on arrival to the hospital. We have found that submersion time, age, GCS, pupillary reactivity and APACHE II at ICU admission were related to mortality. Further research in prospective studies is needed.