Intraperitoneal hemorrhage in a patient with hepatic focal nodular hyperplasia

Focal nodular hyperplasia (FNH) is a common benign liver tumor that is often confused with hepatic adenoma. Despite the benign course of both lesions, hepatic adenomas are associated with rupture and bleeding, and suggested management often includes prophylactic surgical resection. FNH lesions are thought to not rupture or bleed, and traditional management does not include resection. We report the case of a woman with FNH who presented with intraperitoneal hemorrhage after the rupture of a FNH lesion. Only six previous documented cases of hemoperitoneum associated with FNH have ever been reported. This report reviews all previously recorded cases of FNH lesions that have resulted in intraperitoneal hemorrhage. We suggest that although FNH is a benign lesion and intervention is typically unnecessary, the potential for rupture requiring surgical resection should always be considered.     

Microleakage in endodontically treated teeth: influence of calcium hydroxide dressing following bleaching

AIM: The purpose of the present study was to evaluate microleakage of a fourth generation dentine-bonding agent and composite restoration during a walking bleach treatment. METHODOLOGY: Thirty extracted non-carious incisors were selected and conventional root canal treatment was performed. Teeth were randomly divided into 3 groups (n = 10): group A (control), access cavities were restored with a fourth generation dentine-bonding agent, and incrementally restored with composite resin; group B, a paste composed of sodium perborate and hydrogen peroxide was placed into the pulp chamber and sealed with glass ionomer cement for 7 days, teeth were then restored in the same manner as group A; group C, a paste of sodium perborate and hydrogen peroxide was placed in the pulp chamber for 7 days and then after removal of the bleaching mixture, pulp chambers were filled with a calcium hydroxide paste and cavities sealed with glass ionomer for 1 week. The cavities were then restored with bonded restorations as in groups A and B. Teeth were subjected to thermal cycling and immersed in methylene blue for 8 h. Teeth were sectioned from buccal to lingual, through the centre of the restoration, using a diamond disk. Leakage was assessed using a standard scheme, under magnification (x20). Data were submitted to statistical analysis using nonparametric Kruskal-Wallis test. RESULTS: Groups A and C exhibited similar leakage patterns, and both demonstrated less leakage values than group B (P < 0.05). CONCLUSIONS: It was concluded that bleaching with sodium perborate and hydrogen peroxide increases microleakage; short-term use of a calcium hydroxide medicament did not increase microleakage.     

Influence of different restorative techniques on microleakage in Class II cavities with gingival wall in cementum

This study compared marginal leakage of Class II cavities with gingival margin in cementum using different techniques. Twenty-four recently extracted third molars were used. Proximal standard box cavities were prepared in both mesial and distal surfaces. The gingival margin was located apical to the cemento-enamel junction. All the preparations and restorations were performed by the same operator. Standard cavities were randomly divided into three groups (n = 16) and restored as follow: Group 1-light-cured composite resin; Group 2-self-cured composite resin + light-cured composite resin and Group 3-amalgam + light-cured composite resin. After polishing, the teeth were thermocycled and their gingival margins exposed to dye. Specimens were sectioned and leakage scores observed in accordance with a standard ranking. Data were subjected to statistical analysis (Kruskal-Wallis). Results showed that the amalgam/resin composite combination demonstrated the least leakage.     

Angiogenic non-Hodgkin T/natural killer (NK)-cell lymphoma: report of three cases

Angiogenic T/natural killer (NK)-cell lymphoma is a non-Hodgkin lymphoma characterized by necrosis and vascular destruction that is strongly associated with Epstein-Barr virus and AIDS. Early diagnosis is essential to improve the chances of patient survival, but severe local inflammatory infiltrate impairs histologic diagnosis by obscuring neoplastic cells. The most common markers are CD2, CD56, cytoplasmic CD3, and CD43 EBV. We describe 3 cases of angiogenic T/NK-cell lymphoma that show the diverse presentation of the same disease. Patient 1 was HIV positive and had nasal obstruction, facial edema, and ulceration of the nasal mucosa. Patient 2 had fever, a sore throat, and weight loss. Patient 3 had facial edema, fever, proptosis, and rapid development of neurologic alterations. Several biopsies were needed for histologic confirmation in these patients, despite positivity for the CD3 and CD56 markers.     

Linguistic contextual influences on categorization skills after traumatic brain injury

Abstract

This study examined the effect of linguistic context on the graded structure representation of common categories in adults with traumatic brain injury (TBI). Graded structure indicates that all members of a category are not equally representative with some members being better examples than others. Ten adults who had suffered traumatic brain injuries as the result of motor vehicle accidents and 10 age- and gender-matched neurologically intact adults participated in the study. The experimental task consisted of presenting each participant with 20 contextual sentences and asking them to select the best example of a category label mentioned in each sentence. Each of the 20 sentences were followed by six exemplars: four exemplars of the common category label mentioned in the sentence and two exemplars that were members of other categories. The specific exemplar of the category label was inferred by the context meaning. The neurologically intact adults were significantly more accurate than the TBI adults in choosing the best category example. However, error patterns were similar for each group with both groups choosing a significantly higher proportion of true unrelated exemplars than any other type of error. Results are discussed relative to the process of restructuring common category graded structure as a result of semantic constraints imposed by linguistic context and limitations in cognitive flexibility observed in TBI adults.     

Robot-assisted laparoscopic ipsilateral ureteroureterostomy for ectopic ureters in children: description of technique

Abstract Purpose: We report our experience and present our technique with the robot-assisted laparoscopic ipsilateral ureteroureterostomy (IUU) in the management of ureteral duplication with ectopia in children. Patients and Methods: We reviewed our institutional experience for all patients who underwent a robot-assisted laparoscopic IUU at the University of Minnesota Amplatz Children's Hospital between December 2010 and October 2011. An intraoperative, three-port technique was used after a ureteral stent was placed into the ipsilateral lower pole. Demographic information, diagnosis, operative time, hospital course, complications, and follow-up were all evaluated. Results: Our series included four female patients and one male patient with a mean age of 61 months (6 to 182?mos). All five had a diagnosis of upper pole ectopic ureters, one of which was associated with an ureterocele. Mean total operative time was 225 minutes (181 to 253?min), and mean hospital stay was 1.2 days (1-2 days). There were no intraoperative complications. In follow-up, at the time of ureteral stent removal, pyelonephritis developed in one patient, but all patients had resolution of their presenting symptoms including urinary tract infections and incontinence. A significant reduction in upper pole hydronephrosis was seen in all patients. Conclusions: Our experience indicates that robot-assisted laparoscopic IUU is safe and effective in the management of ureteral duplication anomalies in children.     

Do socioeconomic determinants affect the quality of posterior dental restorations? A multilevel approach

Objectives

This study aimed to evaluate posterior restorations placed in young adults, investigating the association between social determinants experienced during the life course and the quality of tooth fillings.

Methods

A representative sample (n = 720) of all 5914 individuals who were born in Pelotas in 1982 was prospectively investigated, and posterior restorations were assessed at 24 years of age. Exploratory variables included demographic and socioeconomic, oral health and dental service payment mode during the life course. Tooth-related variables (type of tooth, material and size of cavity) were also analysed.

Results

Multilevel logistic regression models showed that individuals who were always poor from birth to age 23 [odds ratio (OR) 2.35 (1.38–4.00)] and whose mothers had less years of education at their birth (OR 2.60 (1.44–4.68)) were with unsatisfactory restorations in posterior teeth more often. In addition, caries presence at age 15 (high decayed, missing, filled teeth (DMFT) tertile) (OR 1.95 (1.25–3.03)) and cavities with four or more surfaces (OR 18.67 (9.25–37.68)) were associated with the outcome.

Conclusions

These results show that socioeconomic characteristics of the individuals play an important role in restoration failures, reinforcing the need for preventive dental strategies and public policies to reduce inequalities as a major topic of oral health. In addition, the size of cavity appears as the most important determinant for restoration failure.

Clinical significance

Individual socioeconomic characteristics were associated with failure in posterior restorations in detriment of other clinical variables such as restorative material and type of tooth.