A clinical classification of the status of the pulp and the root canal system

Many different classification systems have been advocated for pulp diseases. However, most of them are based on histopathological findings rather than clinical findings which leads to confusion since there is little correlation between them. Most classifications mix clinical and histological terms resulting in misleading terminology and diagnoses. This in turn leads to further confusion and uncertainty in clinical practice when a rational treatment plan needs to be established in order to manage a specific pathological entity. A simple, yet practical classification of pulp diseases which uses terminology related to clinical findings is proposed. This classification will help clinicians understand the progressive nature of the pulp disease processes and direct them to the most appropriate and conservative treatment strategy for each condition. With a comprehensive knowledge of the pathophysiology of pain and inflammation in the pulp tissues, clinicians may accomplish this task with confidence.     

联合抗击输血相关的GVHD

输血相关的GVHD(TA-GVHD)从发病率极低的意义上来说它是不常见的,但是从它是个值得我们协作的全球性问题的意义来说,它又是不容忽视的。本期本栏目刊登了两篇TA-GVHD文章:Aoun等报告贝鲁特美国大学医学中心(AUBMC,黎巴嫩)对10年记录回顾性研究10例GVHD病例,Leitman等报告美国4例自身免疫性疾病的患者用氟达拉     

Surgical hypothermia in a patient with a cold agglutinin. Management by plasma exchange

Cold agglutinins are a potential danger to patients who must be subjected to hypothermia. A patient with a cold agglutinin of moderate titer but broad thermal amplitude was to undergo hypothermia during aortic valve replacement. He was managed preoperatively with an eight- liter plasma exchange by continuous-flow centrifugation to remove the cold agglutinin. There were no adverse effects during or after hypothermia.     

Bacterial contamination of the fitting surfaces of restorations in teeth with pulp and periapical disease: a scanning electron microscopy study

Background : The aim of this study was to evaluate the fitting surfaces of restorations in teeth with infected root canal systems and apical periodontitis to determine whether the restoration‐tooth interface is a potential pathway for bacterial penetration. Methods : Thirty clinically satisfactory restorations were sectioned and removed from teeth that had infected root canal systems and apical periodontitis. In the control group, three clinically satisfactory restorations were sectioned and removed from extracted teeth with clinically healthy pulps. In order to confirm the clinical diagnosis of a healthy pulp, histological examination was performed. All restorations were placed in 10% formalin immediately and then prepared for examination using scanning electron microscopy. The degree of bacterial contamination on each restoration was recorded as low, moderate or high. The morphotypes observed were classified as cocci, filaments, rods or spirochaetes. Results : The fitting surfaces of all restorations in both experimental and control groups showed signs of bacterial contamination. Conclusions : This study has demonstrated the presence of bacteria on the fitting surfaces of restorations that were judged to be clinically satisfactory in teeth with infected root canal systems. The restoration‐tooth interface is a potential pathway for bacteria to enter teeth and infect the root canal systems.     

Dietary nutrient intake comparisons for rural and urban Russian boys,ages 6, 9, and 15 years,living in St. Petersburg and surrounding areas

Dietary intake data were gathered on 123 rural and 111 urban males, ages 6, 9, and 15 years, living in and near St. Petersburg, Russia. Data were analyzed to estimate intakes of kilocalories, protein, calcium, iron, vitamin A, thiamin, riboflavin, niacin, vitamin C, and percentage of kilocalories from protein, carbohydrate, and fat. Comparisons were made between nutrient intakes of urban and rural subjects; intakes were also compared with the Recommended Dietary Intakes (RDI) of the USSR Research Institute of Nutrition. There were no significant differences between rural and urban boys in energy intake at any age. Urban boys consumed more vitamin C at ages 6 and 9, had higher intakes of protein, calcium, and niacin at age 9, and consumed more protein at age 15. Rural boys had higher intakes of riboflavin and calcium than urban boys at age 6. Urban boys consumed larger proportions of energy as carbohydrate at age 6, protein at age 9, and both protein and fat at age 15 than rural subjects. Rural boys had higher proportions of kilocalories from fat at age 6 and carbohydrate at age 15 than urban boys. Mean nutrient intakes below the RDI were: energy for rural boys at 9 and 15 years; iron for rural subjects at ages 6 and 9 and urban boys at age 6; calcium for rural and urban boys at all ages; vitamin C for rural subjects at ages 6 and 9; vitamin A for rural and urban boys at age 15; and protein for rural boys at age 15. At age 6, rural boys had nutrient intakes superior to those of urban boys; urban nutrient intakes were better than rural at ages 9 and 15. © 1994 Wiley-Liss, Inc.     

Pain Management in Pediatric Age Group

The management of pain in palliative care of children is somewhat different from that in adults. The use of opioids in pediatric palliative care presents some unique challenges. Confident and rational use of opioids, illustrated by WHO Guidelines is essential for adequate management of pain in children with life limiting conditions.