Endemic Molar Incisor Hypomineralization: a Pandemic Problem That Requires Monitoring by the Entire Health Care Community

Purpose of Review

This review brings a major, previously under-recognized dental and general health problem to the attention of the medical and scientific community. The goals are to help clinicians make early diagnoses, thereby improving treatment outcomes, and to stimulate increasing research efforts to understand the etiology and ultimately prevention.

Recent Findings

There are two recent systematic reviews of molar incisor hypomineralization (MIH). One reveals the global burden of the condition; mean global prevalence is 13% with 878 million people affected, with 4.8 million cases per year requiring treatment. The review into etiology found a lack of definitive knowledge, but that it is likely to be multifactorial, with childhood illness including fever possibly implicated.

Summary

The review presents details of MIH sufficient to enable clinicians to recognize it and understand its impact on affected children, its management, and the importance of early intervention. Much further research is needed.

     

Left Retroperitoneal Approach Using a Retractor to Repair Abdominal Aortic Aneurysms: A Comparison with the Transperitoneal Approach

Abstract. Purpose: The purpose of this study was to compare the effectiveness of the retroperitoneal approach (RP) using a Thompson retractor with the conventional transperitoneal approach (TP), to repair infrarenal abdominal aortic aneurysms (AAA). Methods: A total of 91 consecutive patients were divided into two groups; group A (n= 21) underwent surgery using the TP, and group B (n= 70) underwent surgery using the RP with a Thompson retractor. Results: There were no significant differences in the operation time, aortic cross-clamp time, incidence of postoperative cardiac events, or the development of wound complications; however, a significantly higher rate of postoperative respiratory complications and ileus was observed in group A. Moreover, oral feeding was commenced later and the hospital stay was prolonged in group A (P < 0.01). Conclusion: These findings clearly demonstrate that our RP method, especially when using a Thompson retractor, is a preferable alternative to TP for AAA surgery. Received: February 26, 2001 / Accepted: January 8, 2002     

Bilateral Trans-Septal Approach to Right Lung Cancer Invading the Left Atrium

We describe a 69-year-old woman with primary lung cancer in the right lower lobe invasive to the left atrium (LA) via the pulmonary vein (PV). The tumor in the LA measured 30 × 26 mm, and to avoid critical embolism preoperative induction therapy was not performed. The patient underwent right thoracotomy under cardiopulmonary bypass (CPB), and the atrial septum was incised via the right atrium. The tumor was placed out of the LA, followed by lobectomy. For right lung tumors invading the LA, the bilateral trans-septal approach is useful for confirming the surgical margin.     

Quantitative Approach to Determine the Application Time of the Left Ventricular Assist Device

Abstract: This study was designed to establish a method for determining the optimal time of the application of the left ventricular assist device from the viewpoint of the metabolism of the vital organs. Quantitative systemic low flow states were made utilizing goats with total artificial hearts. During these experiments, arterial lactate and pyruvate values were sequentially measured. The behavior of anaerobic metabolism during low cardiac output states and in the recovery process following normalization of the cardiac output was quantitatively described and evaluated. The experimental results are summarized as follows: If a time when the decay of arterial lactate ceases at a level above the normal level by >30 mg/dl is observed despite the use of intraaortic balloon pumping, that time is the exact optimal time for application of the left ventricular assist device. There is a great possibility that circulatory failure will be irreversible if left ventricular assist pumping is not initiated before the arterial lactate value increases to >140 mg/dl. The method of evaluating the alteration of anaerobic metabolism described in this study is useful for determining the application time of the left ventricular assist device.     

Attenuation of the Circulatory Response to Laryngoscopy and Intubation by Fentanyl

The effects of fentanyl on arterial pressure and heart rate increases during laryngoscopy and intubation were studied in 45 normotensive, surgical patients, who were randomly allocated to three groups receiving 2 or 6 μg/kg of fentanyl or saline in a double-blind fashion before anaesthetic induction with thiopental. Fentanyl supplementation with 2 μg/kg significantly attenuated the arterial pressure and heart rate increases during laryngoscopy and intubation, and fentanyl, 6 μg/kg, completely abolished these responses. Moreover, fentanyl given during the induction decreased the amount of fentanyl needed during the operation. Respiratory depression was not observed during recovery.     

Intrahepatic Glissonian Approach to the Ventral Aspect of the Arantius Ligament in Laparoscopic Left Hemihepatectomy

Background

Laparoscopic left hemihepatectomy using the Glissonian approach is technically challenging secondary to a thick Glissonian pedicle and limited maneuverability of laparoscopic instruments. This procedure demands extreme caution owing to the high risk of bile leakage associated with left hemihepatectomy. We describe the technical details and surgical outcomes of the intrahepatic Glissonian approach to the ventral aspect of the Arantius ligament in laparoscopic left hemihepatectomy.

Methods

After detachment of the left side of hilar plate, the meticulous dissection was performed in the liver capsule above the left Glissonian pedicle. Dissection of the ventral aspect of the Arantius ligament creates the space between the liver parenchyma and the left Glissonian pedicle. The left Glissonian pedicle was isolated and encircled using the long curved laparoscopic instrument. During the parenchymal transection, the left Glissonian pedicle was transected using lateral to the Arantius ligament.

Results

Between February 2013 and July 2018, 13 consecutive patients underwent pure laparoscopic left hemihepatectomy. The median operation time was 230 min (range 180–300 min), and the median estimated blood loss was 300 mL (range 100–600 mL). Two patients (15%) required transfusion. The median tumor size was 40 mm (range 10–105 mm). All patients showed negative resection margins. The median postoperative hospital stay was 8 days (range 6–15 days). Major postoperative complications occurred in 1 patient (7.7%). No perioperative deaths occurred.

Conclusion

An intrahepatic Glissonian approach to the ventral aspect of the Arantius ligament is a feasible and effective technique in laparoscopic left hemihepatectomy.

     

Repair of Left Atrial Abnormalities in Children by the Superior Approach

We have used the superior approach through the dome of the left atrium to repair cardiac lesions in the left atrium in 15 children ranging from 3 months to 17 years old. The single hospital death occurred in a 16-month-old infant with levo (L) transposition of the great arteries, Ebstein's malformation of the left atrioventricular valve, and ventricular septal defect. Exposure of the intraatrial structures was excellent, injury to adjacent cardiac structures did not occur, and hemorrhage from the left atrial suture line was not a problem. Though a few transient arrhythmias were seen, all survivors are in sinus rhythm without evidence of sick sinus syndrome, except 1 patient in whom atrial flutter associated with cardiomyopathy developed 1 year after operation. The excellent surgical exposure obtained of the interior of the left atrium and the absence of important complications related to the incision cause us to recommend this approach in children.