A comparison of three methods to accurately measure root length

Measuring the severity of root shortening after orthodontic treatment is a common problem in the dental fields as well as in litigation, legislation, and the ethics arena. The most common method to evaluate root length shortening is by using periapical radiographs. Surprisingly, root elongation after orthodontic treatment in adult patients was reported in the past. The aims of this study were to measure the effects of angular changes between the tooth and the film on the length of the image of a tooth model, to compare three methods to accurately measure root length in different films, and to find the most accurate reference points on the tooth for calculating root lengths. Five amalgam dots were placed on an acrylic model of a maxillary central incisor: ie, most apical, most incisal, mesial CEJ, distal CEJ, and most apical CEJ on the buccal side. The tooth model was placed in a special jig and radiographed at four different film-to-tooth angulations. Root and crown lengths were measured on both the model itself and on a computer monitor displaying the image that resulted from scanning the film into the computer. The results revealed that angular changes between the tooth and the film affect the measured tooth length. The midpoint between the mesial CEJ point and the distal CEJ point (median CEJ) was the best reference point for measuring root length. This was true when the calculations were done with the rule-of-three formula.     

The use of an individual jig in measuring tooth length changes

The parallel periapical radiographic technique hides several problems that might affect the image seen on the film. To overcome these problems a special jig with an external wire attached to the tooth surface and parallel to its long axis was suggested. This study examines the accuracy of using an external object for measuring root length differences due to angular changes between the tooth and the film. The rule of three was used for all calculations as a compensating formula. A human central incisor was placed in a special jig. Two different wire lengths (11.8 +/- 0.1 mm and 16 +/- 0.1 mm) were attached to the tooth in six different ways. The tooth was radiographed at four different film to tooth angulations. The tooth and wire lengths were measured on the model itself and directly on the scanned film on a computer monitor. The results reveal that a wire, placed nine mm from the crown and parallel to the long axis of the tooth was the best jig for accurately measuring tooth length changes. Neither palatal nor buccal metal wires, intimately attached to the crown of the tooth, can serve as a tool to measure tooth length changes. The study could not find a way to skip the need for a cephalometric radiograph to verify the parallelism between the wire and the long axis of the tooth for this matter.     

Clinical characteristics of unexpected death among young enlisted military personnel: results of a three-decade retrospective surveillance

STUDY OBJECTIVE: To explore the causes of sudden and unexpected death in a young and healthy military population, to examine the various patterns of diseases associated with these tragic events, and to investigate the factors found to be associated with this grave outcome. DESIGN: We retrospectively investigated 151 cases of Israeli military personnel who died unexpectedly over a 30-year period. We collected all the available medical records, autopsy results, and investigation committee reports. RESULTS: A total of 151 cases of sudden and unexpected death occurred among enlisted military personnel during the period. Cardiac disorders caused 47% of deaths, followed by neurologic causes (17%) and pulmonary causes (11%). In 30 events (20%), the cause of death remained undetermined. Symptoms (eg, syncope, chest pain, palpitations, and others) occurred prior to death in 52 cases (34%). Asthma was the most common risk factor in our study population having been previously recognized in 10 cases (6.7%). Eight of the 13 subjects with asthma died following an acute asthmatic attack. CONCLUSION: Cardiac events are the leading cause of unexpected death in young healthy people. The frequency of subjects with asthma was found to be higher than that in the general age-adjusted population.     

Active induction management of labor for diabetic pregnancies at term; mode of delivery and fetal outcome--a single center experience

OBJECTIVES: To evaluate the mode of delivery in diabetic pregnancies at term following induction of labor with vaginal application of prostaglandin E2 (PGE2), and to identify possible predictors of successful vaginal delivery. PATIENTS AND METHODS: The study group consisted of 105 women with diabetic pregnancies at term admitted for induction of labor; 84 (80%) had gestational diabetes (GDM) and 21 (20%) type 1 diabetes. Findings were compared with women who underwent elective induction of labor (n=115), and women with normal spontaneous onset of labor (n=510). Women with previous cesarean section (CS) were excluded from both study and control groups. RESULTS: Maternal age and gravidity were significantly higher in the study group than the control groups (age: 31.4+/-5, 28+/-5.0 and 28.1+/-4.8 years, respectively; gravidity: 3.0+/-1.9, 2.5+/-1.6, and 2.1+/-1.4, respectively; P<0.001 for both) and gestational age and nulliparity rate were significantly lower (gestational age: 38.6+/-1.1, 40.2+/-1.3 and 39.3+/-2.7 weeks, respectively; nulliparity: 34.6, 45.2, 51.6%, respectively; P<0.002 for both). There were no between-group differences in the incidence of oligohydramnios, number of PGE2 applications used, birth weight, rate of non-reassuring fetal heart rate pattern leading to CS, and rate of low 5 min Apgar score (<7). The rate of CS in the study group (18.2%) was significantly higher than in the spontaneous labor group (9%) but similar to the elective induction group (14.8%). On stepwise analysis, only nulliparity (OR 4.56, 95% CI 1.11-18.67, P=0.035) was independently and significantly associated with increased risk of CS. Within the study group (R2=0.257, P=0.002), type 1 diabetes (OR 2.4, 95% CI 1.04-5.51) was independently and significantly associated with increased risk of CS. CONCLUSION: In diabetic pregnancies, induction of labor at term with vaginal PGE2 is successful in approximately 82% of patients, but yields a significantly higher CS rate compared to uncomplicated pregnancies. Nulliparity and diagnosis of type 1 diabetes are independently and significantly associated with increased risk of CS. CONDENSATION: In diabetic pregnancies, induction of labor at term is successful in 82% of patients, but yields higher CS rates compared to uncomplicated pregnancies.     

Pregnancy outcome in women with heart disease undergoing induction of labour

OBJECTIVE: To examine the safety and outcome of induction of labour in women with heart disease. DESIGN: Prospective single-centre comparative study. SETTING: Major university-based medical centre. POPULATION/SAMPLE: One hundred and twenty-one pregnant women with heart disease. METHODS: The sample included all women with acquired or congenital heart disease who attended our High-Risk Pregnancy Outpatient Clinic from 1995 to 2001. The files were reviewed for baseline data, cardiac and obstetric history, course of pregnancy and induction of labour and outcome of pregnancy. Findings were compared between women who underwent induction of labour and those who did not. Forty-seven healthy women in whom labour was induced for obstetric reasons served as controls. MAIN OUTCOME MEASURES: Pregnancy outcome. RESULTS: Of the 121 women with heart disease, 47 (39%) underwent induction of labour. There was no difference in the caesarean delivery rate after induction of labour between the women with heart disease (21%) and the healthy controls (19%). Although the women with heart disease had a higher rate of maternal and neonatal complications than controls (17%vs 2%, P= 0.015), within the study group, there was no difference in complication rate between the patients who did and did not undergo induction of labour. CONCLUSION: Induction of labour is a relatively safe procedure in women with cardiac disease. It is not associated with a higher rate of caesarean delivery than in healthy women undergoing induction of labour for obstetric indications, or with more maternal and neonatal complications than in women with a milder form of cardiac disease and spontaneous labour.     

Acute gastric ulcer perforation in a 35 weeks' nulliparous patient with gastric banding

We present a case of a primiparous patient at 35 weeks' gestation who had had laparoscopic gastric banding, and who presented to labor and delivery with protracted vomiting followed by an acute abdomen and fetal distress. An emergency surgery revealed acute gastric ulcer perforation. This complication, although rare, should be considered.     

Mode of delivery in pregnancies with suspected fetal growth restriction following induction of labor with vaginal prostaglandin E2

BACKGROUND: Many fetuses below the 10th percentile for gestational age are uncompromised. We aimed to evaluate the mode of delivery and immediate neonatal outcome in pregnancies with suspected fetal growth restriction (FGR) and normal antenatal assessment following induction of labor with vaginal application of prostaglandin E2 (PGE2). METHODS: Ninety women with suspected FGR (sonographic estimated fetal weight < 10th percentile) with normal oxytocin contraction test (OCT), biophysical profile (BPP) and reassuring fetal heart rate underwent induction of labor with vaginal application of PGE2 tablets. The findings were compared with 115 women admitted for induction of labor because of decreased fetal movement (group 2) and with 510 women with normal spontaneous onset of labor (group 3). RESULTS: There were no between-group differences in mean maternal age, gravidity, parity, nulliparity rate, number of tablets used or rate of patients receiving more than one PGE2 application. The rate of cesarean section (CS) in the study group (8.9%) was similar to the rate in groups 2 and 3 (14.8% and 9.0%, respectively). The incidence of nonreassuring fetal heart rate pattern leading to cesarean delivery was higher in the study group, but the rate of low 5-min Apgar scores (< 7) was similar in all groups. A logistic regression model and forward likelihood analysis yielded no single significant variable associated with increased risk of cesarean delivery. CONCLUSIONS: In selected cases of suspected FGR with reassuring fetal heart rate and normal OCT and BPP, induction of labor with vaginal PGE2 may yield a similar immediate fetal outcome and CS rate as in uncomplicated, induced or spontaneous deliveries.     

Age-dependent differences in the efficacy of cancer immunotherapy in C57BL and AKR mouse strains

While tumor incidence increases with age, tumor growth and metastasis often proceed at a slower rate in aged organisms. The mechanisms underlying this age-related reduced tumor development may suggest therapeutic modalities appropriate for the aged. Decreased tumor aggressiveness in the old was shown to be related to altered immune response. Consequently, the aim of the present study was to assess whether cancer immunotherapy has an age-dependent effect. Only a few studies have compared cancer immunotherapy efficiency as a function of age, most showing lower inhibition in older animals. In the present study, we tested the effect of two immunomodulators, levamisole and BCG, on two tumors, B16 melanoma and AKR lymphoma, in mice of different ages. We demonstrated a higher efficiency of immunotherapy in aged as compared to young mice, particularly at low immunomodulator doses. While decreased T cell function during aging is apparently established, nonspecific immunity is more preserved or even enhanced in later life. We found an increased number of macrophages in tumors of old compared to young mice and an increase in MAC-1+ cells in old levamisole-treated compared to non-treated mice. The stronger therapeutic effect of this immunomodulator in old mice might thus be due to an increased macrophage-mediated anti-tumoral effect.