The clinical evaluation of a single-bottle adhesive system with three restorative materials in children: six-month results

This study was designed to evaluate the clinical performance of a single-bottle adhesive system with three restorative materials placed in children using the total-etch technique. One hundred thirty restorations were placed on conservative preparations in 36 children using the incremental placement technique in a clinical environment. The restorations were evaluated within a week of placement (baseline) and again after six months. The criteria evaluated included retention, color match, marginal discoloration, marginal integrity, surface roughness, postoperative sensitivity, recurrent caries, and wear. Indirect evaluations of anatomical form, marginal adaptation, and wear also were conducted. Clinical evaluation demonstrated no significant differences between the three restorative materials. Five restorations had to be replaced: two compomer, two packable composite, and one amalgam. There was no clinically detectable wear in any of the restorations.     

Self‐management in temporomandibular disorders: a systematic review of behavioural components

The aim of this qualitative systematic review was to identify the behaviour change techniques most frequently employed in published temporomandibular disorder (TMD) self‐management (SM) programmes. The reviewers matched the components of SM programmes into the relevant behaviour change technique domains according to the definitions of the behaviour change taxonomy (version 1). Electronic databases were searched for randomised controlled trials assessing an SM programme for TMD. Manual searches were also conducted for potentially important journals. Eligibility criteria for the review included: the type of study, the participants, the intervention utilised and the comparators/control. Fifteen randomised controlled trials with 554 patients were included in this review. The review concludes a minority of the available behaviour change techniques are currently employed in SM programmes. Other behaviour change techniques should be examined to see whether there is a theoretical underpinning that might support their inclusion in self‐management programmes in TMD. Further trials are required to conclude that SM programmes are more effective than no treatment at all and or placebo. With more structured SM programmes, greater therapeutic benefits might be achieved, and certainly if SM programmes published in the literature define their components through use of the behaviour change taxonomy, it would be easier for clinicians to replicate efficacious programmes.     

Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis

Background The management of opiate-dependent intractable abdominal pain caused by chronic pancreatitis remains challenging. The published series on the role, safety, feasibility, and efficacy of thoracoscopic splanchnicectomy are reviewed. Methods The MEDLINE, EMBASE, and PREMEDLINE databases were searched, and relevant English language publications were systematically retrieved. Data were pooled by two independent reviewers. Results Between 1994 and 2006, 302 patients were featured in 16 reports. The reports described 202 procedures as bilateral and 100 as unilateral. These procedures were associated with rates of 16.6% for morbidity, 1.3% for conversion to thoracotomy, 1.3% for reoperation to manage complications, and 0% for mortality. The mean postoperative hospital stay was 2.7 days. The mean success rate was 90% up to 6 months of follow-up evaluation, 75% at >6 to 15 months of follow-up evaluation, and 49% at >15 months to 5.7 years of follow-up evaluation. Further intervention for pain relief was required for 12.9% of the patients. Conclusion Splanchnicectomy reduces pain and improves quality of life for patients with chronic pancreatitis. Patient selection determines success rates, but the early good results achieved decline with time elapsed after thoracoscopic splanchnicectomy.     

Chronic cases of tuberculosis in Casablanca, Morocco.

OBJECTIVE: To evaluate the prevalence and patterns of drug resistance of Mycobacterium tuberculosis isolates collected from patients with chronic tuberculosis in Casablanca, Morocco. METHODS: Between February 1996 and September 2001, 122 isolates were recovered from 112 different patients. The male to female ratio was 2.4. RESULTS: From February 1996 to May 1997, 77.5% of isolates were multidrug-resistant (MDR-TB), compared to 69.4% from February 1999 to May 2000 and 78.7% from June 2000 to September 2001. The prevalence of MDR-TB is similar from the initial to the last period of this study. Analysis of the 69 bp hypervariable region of the rpoB gene by DNA sequencing on 42 M. tuberculosis isolates (37 resistant, 5 sensitive) showed nine different types of mutations on codons rpoB 513, rpoB 516, rpoB 522, rpoB 523 and rpoB 526. A new point mutation was observed on codon rpoB 523 on one isolate. No mutation was detected on this rpoB region for four resistant isolates. CONCLUSION: The high rate of MDR-TB illustrates a serious problem. The public health authorities have introduced a new regimen protocol consisting of 3 months of kanamycin, ofloxacin, pyrazinamide and ethionamide, followed by 18 months of ofloxacin, pyrazinamide and ethionamide (3KOZEA/18OZEA) for this category of patients, and it is hoped that the additional use of ofloxacin during the intensive phase of treatment will reduce the rate of resistance.     

Results of the surgical closure of ventricular septal defects of various ages: report of 30 cases

OBJECTIVE: To appreciate short and midterm results of patients after surgical closure of the ventricular septal defect. MATERIAL AND METHODS: The study is retrospective and took place in the department of cardiovascular surgery "B", Ibn-Sina hospital, Rabat, Morocco. Between 1995 and 2005, 30 patients underwent a surgical closure of ventricular septal defect. Eighteen patients (60%) were males and twelve (40%) were females with a mean age of 10 years (18 months-36 years). Seven patients (23%) were older than 16 years. All of ventricular septal defects were type 2, unique and most of them perimembranous (70%). Four patients (13%), were older than 16 years, had a significant aortic insufficiency that has dictated the aortotomy for ventricular septal defect repair. The surgical approach through the right atriotomy was sufficient for complete repair in 22 patients (73%). Closure of the defect has been done using a pericardial autologous patch in 28 patients (93%). RESULTS: No operative mortality was observed. The mean follow-up was five years. Eight patients (26%) had a residual ventricular septal defect that progressed to spontaneous closure. Two patients (6%) had a residual pulmonary hypertension and two others a moderate aortic regurgitation. The four patients were older than 16 years. Echocardiography showed a significant reduction in left ventricular dimension and systolic pulmonary artery pressure. At last follow-up, 87% of the patients were in NYHA class 1. CONCLUSION: This study demonstrates that surgical closure of ventricular septal defect ensures a good outcome in short and midterm. Nevertheless, the risk of delayed complications justifies long-term and regular follow-up.