Digital radiograph registration and subtraction: a useful tool for the evaluation of the progress of chronic apical periodontitis

The purpose of this study was to evaluate the suitability of a digital radiograph registration and subtraction software for a sensitive and reliable assessment of the progress of chronic apical periodontitis. Ninety cases of teeth with chronic apical periodontitis have been studied. In each case, a preoperative radiograph was taken, root canals were prepared, and a Ca(OH)2 paste was placed in the root canals. Radiographic control and replacement of Ca(OH)2 paste took place at 15-day intervals. The root canals were obturated 1.5 months after the first appointment. Recall radiographs were taken 0.5, 1.5, 3, 6, and 12 months after the obturation. All radiographs were taken for each case under constant conditions by using a direct digital radiography system. In each case, the preoperative, postoperative, and control and recall radiographs were digitally registered and pairwise subtracted. The resulting images were further processed by using contrast enhancement and pseudocoloring methods. Changes to the periapical tissue structure were easily detectable by using the above-mentioned methodology, even during short time intervals.     

Pregnancy after liver transplantation. How safe? A retrospective case-series study in a large tertiary hospital

Objective: To study pregnancies achieved after liver transplantation in terms of obstetric complications, maternal, neonatal outcomes and post-pregnancy allograft function.

Methods: A retrospective study of prospectively collected data was conducted, enrolling women with a history of liver transplantation performed in the Transplantation Unit of our hospital that delivered in our department. Obstetric characteristics and antenatal complications were reviewed. Apgar score, admission to Neonatal Intensive Care Unit (NICU) and need for emergency intubation were analyzed. Outcomes of regular follow-up concerning all complications of allograft function observed after pregnancy were also studied.

Results: There were five cases of allograft recipients delivering their pregnancies during the study period. Mean maternal age was 32.2?±?5 years. Interval from transplantation to delivery ranged from 40 to 219 months. Mean gestational week at delivery was 34.4?±?2.5 weeks. Antenatal complications observed were pre-eclampsia (3 of 5 cases) and vaginal bleeding (1 of 5 cases). All preterm neonates were admitted to NICU, but no emergency intubation was demanded. One patient died a month after delivery, while three others were complicated by implant dysfunction up to 5 years after the delivery.

Conclusion: Pregnancy in a liver transplant recipient is associated with complications for mother and infant.     

Acidic pH Is Required for the Multilamellar Assembly of Skin Barrier Lipids In Vitro

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Signs and Symptoms of Temporomandibular Joint Disorders Related to the Degree of Mouth Opening and Hearing Loss

Background

The temporomandibular joint is a unique bi-condylar joint involved in mastication and speech. Temporomandibular joint disorders (TMD) have a range of symptoms, including aural symptoms, and are present in approximately 75% of normal populations. The present study examined the relationship between signs and symptoms of TMD and mouth opening, gender, joint and aural symptoms, and hearing loss.

Methods

The study involved 464 healthy Greek university students (156 men and 308 women) with a mean age of 19.6 years. Age, gender and maximum mouth opening was recorded. Mouth opening was measured using Vernier calipers. An anamnestic questionnaire was used to stratify the subjects into four groups based on TMD severity. Aural symptoms and an audiogram were recorded for each subject too. Data were analyzed using multifactor ANOVA, chi-square, t-test, Mann-Whitney and Kruskal-Wallis tests.

Results

The overall incidence of TMD signs and symptoms was 73.3%. The incidence and severity was greater in females than males (p-value 0.0001 < 0.05). The number of aural symptoms was associated to the TMD severity (p-value 0.0001 < 0.05) as well as maximum mouth opening (p-value 0.004 < 0.05). Audiometry showed that moderate and severe TMD was associated with hearing loss of median and low tones respectively (p-value 0.0001 < 0.05). TMJ pain (p-value 0.0001 < 0.05), TMJ ankylosis (p-value 0.0001 < 0.05), bruxism (p-value 0.0001 < 0.05) and ear itching (p-value 0.0001 < 0.05) were also found to be statistically different between TMD and non-TMD subjects.

Conclusions

TMD signs and symptoms were more common and severe in females than males. TMD severity is correlated with the degree of mouth opening and the number of aural symptoms. The absence or presence of mild TMD are associated with normal audiograms while moderate and severe TMD are related to hearing loss in median and low tones respectively. Bruxism, joint ankylosis, joint pain and ear itching were more common in TMD than non-TMD patients.     

Use of annual ABPM, and repeated carotid scan and echocardiography to monitor cardiovascular health over nine yr in pediatric and young adult renal transplant recipients

In adult hypertensive patients, increased cIMT and LVH are independent risk factors for cardiovascular events. We have previously observed that in pediatric RTRs with tight control of BP, cIMT did not progress over time. This investigation is an extension of the aforementioned study aimed at re-examining cIMT and also reporting serial echocardiography results. Twenty-two RTRs aged 9.4 ± 3.3 yr at their baseline carotid scan underwent two additional vascular ultrasounds during a follow-up of 9.1 ± 0.9 yr. Carotid scan and echocardiography examinations were carried out simultaneously with ABPM. Antihypertensive therapy was determined according to the recipient's ABPM results, which were performed at yearly intervals. Baseline cIMT was significantly greater in RTRs than in healthy controls. There was no statistical evidence of systematic changes in cIMT over time. At the last examination, 14 of 17 RTRs with treated hypertension had controlled hypertension (prevalence 82%; 95% CI, 56.5-96.2), and the overall prevalence of LVH was 4.5% (95% CI, -0.01 to 23.5). The lack of progression of cIMT over time and the low prevalence of LVH might reflect the effect of long-standing BP control.     

Inner ear anatomy in Waardenburg syndrome: Radiological assessment and comparison with normative data

Objective

As patients with Waardenburg syndrome (WS) represent potential candidates for cochlear implantation, their inner ear anatomy is of high significance. There is an ongoing debate whether WS is related to any inner ear dysplasias. Our objective was to evaluate radiologically the inner ear anatomy in patients with WS and identify any temporal bone malformations.

Methods

A retrospective case review was carried out in a tertiary, referral center. The high resolution computed tomography (HRCT) scans of the temporal bone from 20 patients (40 ears) with WS who were managed for deafness in a tertiary referral center from 1995 to 2012 were retrospectively examined. Measurements of 15 different inner ear dimensions, involving the cochlea, the vestibule, the semicircular canals and the internal auditory meatus, as well as measurements of the vestibular aqueduct, were performed independently by two neuroradiologists. Finally, we compared the results from the WS group with a control group consisting of 50 normal hearing subjects (100 ears) and with previously reported normative values.

Results

Inner ear malformations were not found in any of the patients with WS. All measured inner ear dimensions were within the normative values compiled by our study group as well as by others.

Conclusions

Inner ear malformations are not characteristic for all types of WS; however, certain rare subtypes might be related to inner ear deformities. Normative cochleovestibular dimensions that can help in assessing the temporal bone anatomy are provided.     

Arthroscopic treatment of recurrent acetabulum osteoid osteoma

In this case report, arthroscopic treatment of a recurrent osteoid osteoma in the posterior column of the pelvis extending to the acetabular fovea in a young adolescent is being presented. Level of evidence IV.