A primary double molar tooth in a child with Russell-Silver syndrome.

The prevalence of double teeth in the primary dentition, for the British schoolchild, is 1.6%. Although primary double teeth in the anterior region of the mouth are not uncommon, double teeth in the primary molar region are rare. This case report describes the intra-oral findings, and in particular a case of a primary molar double tooth, in a young child who has Russel-Silver syndrome.     

Periodontal bone level and gingival proteinase activity in gnotobiotic rats immunized with Bacteroides gingivalis

Bacteroides gingivalis is associated with various forms of periodontal disease. To assess the role of the immune response in modulating B. gingivalis-associated periodontal disease, the effect of immunization of B. gingivalis-induced periodontal bone loss was evaluated in gnotobiotic rats. Male Sprague-Dawley rats immunized with various doses of whole cells or sham-immunized with incomplete Freund's adjuvant were monoinfected with B. gingivalis in carboxymethylcellulose by gavage. Two additional groups served as either sham-immunized or untreated germ-free controls. Forty-two days after infection, all rats were killed, periodontal bone level was assessed morphometrically and radiographically, and gingival proteinase (mammalian collagenase and acid cathepsin) activity was assessed biochemically. B. gingivalis was present in oral samples from all monoinfected rats, and no contaminating bacteria were detected in any oral or fecal sample. Animals immunized with B. gingivalis cells had elevated serum and saliva antibodies to whole cells and partially purified fimbriae from B. gingivalis. Infected sham-immunized rats had significantly more periodontal bone loss than noninfected controls, whereas the periodontal bone level in infected rats immunized with 10(10) B. gingivalis cells was similar to that of the noninfected controls. The activities of gingival collagenase and cathepsin B and L were high in sham-immunized infected rats and low in all other animal groups. In conclusion, it is possible to reduce B. gingivalis-induced periodontal tissue loss in gnotobiotic rats by immunization.     

Editorial Commentary: Buckle Up Surgeons: “Safety Belt” Reinforcement of Knee Anterior Cruciate Ligament Reconstruction Grafts

Safety belt, or cerclage, reinforcement of anterior cruciate ligament (ACL) grafts may protect against various modes of failure including creep and irreversible stretch, traumatic tearing, and slippage of the tendon-bone interface. A time-zero, biomechanical study shows that suture reinforcement may protect small and vulnerable hamstring ACL reconstruction grafts from these various modes of failure. Thus, in vivo comparative outcome analysis is indicated to determine if the benefits of reinforcement translate from the benchtop to the operating room.     

Effects of proximal gastric vagotomy (PGV) followed by total vagotomy (TV) on postprandial and fasting myoelectrical activity of the canine stomach and duodenum.

Experiments were designed to study the effect of proximal gastric vagotomy (PGV) followed by total vagotomy (TV) on the myoelectrical activity of the canine stomach and duodenum after a meat meal and during fasting. Dogs were prepared with chronically implanted Ag-AgCl-electrodes on the stomach and duodenum. Recordings of electrical activity were made for one hour after the ingestion of a meat meal and records of four to six hours were taken on the fasting animals. In the postprandial records no effect on co-ordination of antral and duodenal myoelectrical activity was found after either PGV or TV. These results suggest that the co-ordinating mechanism is not dependent on vagal innervation. Impairment of gastric emptying after TV does not appear to be due to disturbance of antral-duodenal conduction. Normal patterns of fasting activity were found in control and after PGV. They were grossly disturbed after TV, probably because of delayed gastric emptying. These findings suggest that PGV does not delay gastric emptying as does TV, and that the proximal vagal supply to the stomach is unimportant in the control of fasting activity.     

Combined Procedures with Laparoscopic Cholecystectomy

With advancement in laparoscopic surgery a number of surgical procedures can be performed combined with laparoscopic cholecystectomy in a single surgery. We evaluate the safety & efficacy of such surgeries. A retrospective review of all patients who had undergone combined procedures with laparoscopic cholecystectomy during January 2005 to June 2009 was performed. 3144 laparoscopic cholecystectomies were performed in the period from January 2005 to June 2009. Of these, 401 cases were combined with another procedure. The mean operative time was 80 min (range 50–270 min). The mean hospital stay was 3.2 days (range 1–5 days). The mean no. of days injectable analgesics was required was 2 days (range 1 day–4 days). Combined procedures provide patients with all the benefits of minimal invasive surgery and also give the benefit of single time anaesthesia without adding to post operative morbidity & hospital stay.     

Does questionnaire-based patient feedback reflect the important qualities of clinical consultations? Context, benefits and risks

Objective

To explore perceptions of clinical consultations and how they relate to questionnaire-based patient feedback.

Methods

Telephone interviews with 35 junior doctors and 40 general practice patients who had used the Doctors’ Interpersonal Skills Questionnaire (DISQ).

Results

Doctors and patients had similar views of ‘good consultations’ as relying on doctors’ listening and explaining skills. Preferences for a consultation style focused on an outcome or on the doctor-patient relationship may be independent of informational and/or affective consultation content. Respondents felt the important consultation elements were similar in different contexts, and so DISQ feedback would be useful in different settings. Benefits of feedback were identified in the form of patient empowerment and doctors’ learning. Risks were identified in the inappropriate use of feedback, both inadvertent and deliberate.

Conclusion

The style and content of consultations may be considered as separate dimensions, an approach that may help doctors adapt their communication appropriately to different consultations. Patient feedback focused on communication skills is appropriate, but there are potential risks.

Practice implications

Doctors should consider the transactional or relational preference of a patient in approaching a consultation. Patient feedback can deliver benefits to doctors and patients, but risks must be acknowledged and mitigated against.