Short-term levosimendan treatment protects rat testes against oxidative stress

The objective of this study was to evaluate the effect of short-term levosimendan exposure on oxidant/antioxidant status and trace element levels in the testes of rats under physiological conditions. Twenty male Wistar albino rats were randomly divided into two groups of 10 animals each. Group 1 was not exposed to levosimendan and served as control. Levosimendan (12 µg/kg) diluted in 10 mL 0.9% NaCl was administered intraperitoneally to group 2. Animals of both groups were sacrificed after 3 days and their testes were harvested for the determination of changes in tissue oxidant/antioxidant status and trace element levels. Tissue malondialdehyde (MDA) was significantly lower in the levosimendan group (P < 0.001) than in the untreated control group and superoxide dismutase and glutathione peroxidase (GSH-Px) levels were significantly higher in the levosimendan group (P < 0.001). Carbonic anhydrase, catalase and GSH levels were not significantly different from controls. Mg and Zn levels of testes were significantly higher (P < 0.001) and Co, Pb, Cd, Mn, and Cu were significantly lower (P < 0.001) in group 2 compared to group 1. Fe levels were similar for the two groups (P = 0.94). These results suggest that 3-day exposure to levosimendan induced a significant decrease in tissue MDA level, which is a lipid peroxidation product and an indicator of oxidative stress, and a significant increase in the activity of an important number of the enzymes that protect against oxidative stress in rat testes.     

Replacing the diseased aortic valve and the proximal aorta in the elderly patient.

Subcoronary implantation of the Medtronic stentless bioprosthesis and an extension using a vascular tube prosthesis provide a safer alternative to the more invasive conventional composite graft replacement or a full root replacement using a homograft or a stentless valve. The advantage lies in eliminating the need for coronary mobilisation and anastomosis which actually lead to the increased risk in those procedures.     

Subconjunctival antibiotics in the treatment of endophthalmitis managed without vitrectomy

PURPOSE: To determine if the treatment outcomes for endophthalmitis are influenced by subconjunctival antibiotics. METHODS: A retrospective, nonrandomized consecutive series of patients with clinically diagnosed bacterial endophthalmitis confirmed with positive cultures who presented between December 1, 1995, and February 28, 2002, was studied. Patients with cataract surgery, glaucoma filtering blebs, or trauma who presented with visual acuity of hand motions or better were included. All patients received intravitreal and topical antibiotics. Management by pars plana vitrectomy or vitreous tap and use or nonuse of subconjunctival antibiotics were at the discretion of the treating physician. RESULTS: There were 59 patients identified; 54 met the follow-up criteria. These patients were divided into two groups based on whether subconjunctival antibiotics were used (group ABX; n = 21) or not used (group noABX; n = 33). The median pretreatment visual acuity was hand motions in both groups. The median age in both groups was 74 years. Etiology, duration of symptoms, vitreous culture organisms, percentage of cases with wound complications such as leaks or vitreous incarceration, and intraocular lens type were similar in the two study groups. Intravitreal and topical antibiotics and corticosteroids used were not significantly different in the two groups, except that topical ceftazidime was used less frequently in group ABX than in group noABX (43% vs. 82%, respectively; P = 0.007). The median follow-up was 13 months in both groups (range: 3-87 months for group ABX and 3-63 months for group noABX). Final visual acuity in groups ABX and noABX was at least 20/50 (33% vs. 39%, respectively), 20/60 to 5/200 (29% vs. 39%, respectively), 4/200 to better than hand motions (0 vs. 3%, respectively), or hand motions or worse (38% vs. 18%, respectively). These differences were not significant (P = 0.37). Reinjection rates (14% vs. 15%, respectively) were also similar in groups ABX and noABX. The additional procedures rate was significantly higher in group ABX than in group noABX (P = 0.024), with cumulative rates of 33% and 3%, respectively, at the 12-month follow-up. CONCLUSIONS: These data suggest that subconjunctival antibiotics may not be necessary to treat infectious endophthalmitis managed with otherwise standard tap and injection techniques and topical antibiotics.     

Shoulder function after accessory nerve-sparing neck dissections

BACKGROUND: This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function. METHODS: Fifty-seven patients with head and neck cancer who had undergone primary tumor resection and various types of NDs were enrolled in this prospective study. Postoperative shoulder joint range of motion was evaluated by goniometry, and muscle strength was measured manually. SAN function was evaluated with electromyography (EMG) with respect to percentage of denervation and presence of neurogenic involvement. Patients were grouped by treatment as follows: radical ND (RND) versus modified radical ND (MRND)/selective ND (SND) and ART versus no ART. RESULTS: Shoulder joint range of motion and shoulder muscle strength were significantly better in the MRND/SND group than in the RND group. However, EMG findings were similar in the RND and MRND/SND groups. When all patients who underwent ND, RND, or MRND/SND were compared with the control group, statistically significant changes in shoulder joint range of motion and shoulder muscle strength were found. Also, denervation and neurogenic involvement of the SAN were significantly higher after all NDs than in the control group. ART did not affect range of motion of the shoulder joint, shoulder muscle strength, or the degree of denervation and neurogenic involvement in any of the ND groups. CONCLUSIONS: ART does not have a negative effect on shoulder function after ND. SAN is always functionally impaired even if we preserve it macroscopically during ND.     

Developmental absence of the premolar teeth: dental management

Summary. A boy aged 11 years presented with dental pain, several carious teeth and a localized area of acute necrotizing ulcerative gingivitis (ANUG). Developmental absence of the premolar teeth was notable and additional anomalies included mid-facial hypoplasia, mandibular prognathism, transposed teeth and delayed exfoliation of the deciduous teeth. These abnormalities have significant oral, dental, orthodontic and orthognathic implications.     

Familial infantile bilateral striatal necrosis: clinical features and response to biotin treatment

BACKGROUND: Infantile bilateral striatal necrosis (IBSN) encompasses several syndromes of bilateral symmetric, spongy degeneration of the caudate nucleus, putamen, and globus pallidus. The familial form of IBSN is rare, and inheritance is either autosomal recessive or maternal. METHOD: The authors describe an Israeli Bedouin kindred in which 15 children born to consanguineous parents were affected with familial IBSN. They evaluated the clinical and radiologic evolution of the disease in 11 patients and the cerebral pathologic findings in one patient. Three of the children were treated with oral biotin 100 mg/day. RESULTS: Inheritance was apparently autosomal recessive. The untreated children had a similar clinical picture including developmental arrest beginning at the age of 7 to 15 months, choreoathetosis, and dysphagia. Pendular nystagmus appeared at a late stage. MRI, performed at various stages of the disease, showed severe basal ganglia atrophy. Postmortem study in one patient showed severe atrophy of the lenticular nuclei with gliosis and loss of neurons. Biotin, 100 mg/day, administered to the proband over a period of 15 months, may have slowed progression. In two other children treatment was initiated earlier and appeared to arrest or improve disease. CONCLUSIONS: Familial infantile bilateral striatal necrosis was inherited as an autosomal recessive trait. Clinical features included developmental arrest, dysphagia, and choreoathetosis. Imaging and pathology showed atrophy and degeneration of the basal ganglia. Oral biotin may have benefited three children.     

A Vanishing Cardiac Mass

The prevalence of extrapulmonary tuberculosis (TB) is very common in the Middle East; however, myocardial involvement is among the most infrequent manifestations of extrapulmonary TB. We present a young adult who was incidentally found to have a large right atrial tuberculoma, diagnosed by non-invasive cardiac imaging and effectively treated with standard first-line anti-TB treatment, steroids, and anticoagulation. This case is a classical presentation of nodular myocardial involvement of TB, highlighting advantages of advanced imaging, e.g., cardiac magnetic resonance (CMR) and multidisciplinary treatment.     

Survival of Prosthodontic Restorations Luted with Resin-Based versus Composite-Based Cements: Retrospective Cohort Study

The purpose of this study was to evaluate clinical performance, survival, and complications of indirect composite inlays, onlays, and overlays on posterior teeth. Digital records of 282 patients treated between 2014 and 2018 were accessed and analyzed retrospectively. The included patients received 469 composite restorations luted with seven different resin-based types of cement, i.e., Filtek Ultimate Flow, Enamel Plus, Relyx Ultimate, Harvard Premium Flow, Relyx Unicem, Filtek Bulk Fill Flowable, and Filtek Ultimate. The restorations had been clinically and radiographically evaluated annually. The mechanical and clinical complications, e.g., debonding, fracture, and secondary caries, were evaluated and recorded. The examined restorations exhibited a high survival rate (84.9%), and failure was found in only 71 cases. Fracture was the most common cause (n = 36), followed by prosthetic work release (n = 19) and secondary caries (n = 16). There was a statistically significant difference between failure and cement material (Sig. < 0.001); the composite-based cements (87.2%) had a high survival rate compared to the resin-based cement (72.7%). Similarly, the cements with high viscosity (90.2%) had significantly higher survival rates than the low-viscosity cements (78.9%). Moreover, onlays showed higher longevity compared to overlays (Sig. = 0.007), and patients aged under 55 years showed less complications (Sig. = 0.036). Indirect composite restoration was a successful solution to tooth structure loss. The material of the cementation is an important part of the success. Higher survival rate was found in our study when the fixation materials with high viscosity were used, thus suggesting using these materials with indirect restorations. Composite-based cements had significantly higher survival rate than resin-based cements.     

Primary reservoirs of Streptococcus mutans and their relationship to caries experience in adults with good oral hygiene

Primary reservoirs of Streptococcus mutans were identified in a group of 21 adults with intact dentitions and good oral hygiene by obtaining multiple plaque samples from all available tooth surfaces. Routine cultural methods and a rapid plate scoring method employing a 7-point ordinal scale were used to assess S. mutans levels. Oral hygiene status (DI-S) and caries experience (DMFT and DMFS) were determined clinically. Primary S. mutans reservoirs (high scores) were restricted essentially to the posterior interproximal areas and occasionally in the occlusal pits and fissures of partially erupted mandibular third molars. An anterior to posterior gradient of increasing S. mutans scores was observed for interproximal sites. Oral hygiene scores correlated poorly with DMFT, DMFS and the S. mutans scores obtained for different anatomic locations.