Dimensional contour stability of acrylic resin bases for complete dentures before and after water sorption

PURPOSE: To evaluate the dimensional contour variations of acrylic resin denture bases before and after storage in water. MATERIALS AND METHODS: The fit of 40 bases was evaluated by measuring the thickness of a layer made with silicone placed between the bases and the casts. The measurements were repeated on a new set of silicone layers after having stored the bases in water for 42 days. RESULTS: Significant differences were found both for the maxillary and the mandibular bases. CONCLUSION: Water sorption had an important effect on the contour of the prosthetic bases.     

Habitual daily masseter activity of subjects with different vertical craniofacial morphology

Little is known about the habitual daily masticatory activity of subjects with different vertical craniofacial morphology. The purpose of the present study was to compare the daily long-term muscle activity of short-face subjects with that of long-face subjects as assessed in their natural environment. Digital photographs of the facial profile were obtained from a sample of 300 subjects and the ratio between anterior total and anterior lower facial height was assessed (Vertical Facial Index: VFI). Fourteen long-face and 16 short-face subjects were selected from the opposite tails of the frequency distribution of VFI. Long-term masseter activity was monitored for 8 h d(-1) in the natural environment by means of portable one-channel electromyograph recorders over three working days. Assessments included calculation of the number of activity periods (APs) per h (N/h), their mean amplitude (Amean), and their mean duration (Dur). The maximal electromyogram activity did not differ significantly between the short-face and the long-face subjects. There was no significant difference between the two groups investigated in N/h, in Amean and Dur. The findings suggest that habitual activity of masseter muscle in the natural environment was not influenced by the vertical craniofacial morphology as assessed in the present study.     

Multidose activated charcoal in the treatment of carbamazepine overdose with seizures: a case report

Serious complications after carbamazepine poisoning, such as coma, seizures, respiratory failure, cardiac conduction abnormalities, and death are more likely with serum levels greater than 170 micromol L(-1). We report a case of a single massive carbamazepine overdose in a 19-year-old male, following attempted suicide, without prior history of seizure disorder. On admission, three hours after ingestion, serum carbamazepine concentration was 179 micromol L(-1) and Glasgow Coma Scale scored 6. The patient was intubated and treated with multiple doses of activated charcoal for 48 hours. Twelve hours after ingestion, two repeated generalised myoclonic seizures were noted when serum carbamazepine levels peaked at 181 micromol L(-1), and were successfully treated with diazepam. Carbamazepine serum level fell within the therapeutic range 63 hours after ingestion and the patient was discharged without any long-term sequelae. As there is no antidote for carbamazepine poisoning, supportive treatment remains the only, but usually potent option.     

Duodenal perforation secondary to biliary stent dislocation: a case report and review of the literature

Gut perforation secondary to the insertion of a biliary stent is an uncommon but potentially life-threatening complication. Duodenal perforation has to be taken into consideration whenever the patient starts to suffer severe abdominal pain after the stenting procedure. An early diagnosis is fundamental in order to avoid further complications. Timely conservative treatment with nasogastric suction, nothing by mouth, antibiotics and stent replacement could prevent infection and consequent development of an abscess. We report a case of duodenal perforation secondary to biliary endoprosthesis dislocation in which, in spite of prompt diagnosis and treatment, a large retroperitoneal abscess developed and a CT-guided drainage proved necessary followed later by a surgical operation.     

Effects of race, neighborhood, and social network on age at initiation of injection drug use

OBJECTIVES: We investigated individual- and neighborhood-level factors associated with adolescent initiation of injection drug use. METHODS: Injection drug users (IDUs) who had been injecting 2 to 5 years underwent HIV testing and completed a sociobehavioral risk survey. Modeling techniques accounting for intraneighborhood correlations were used in data analyses. RESULTS: Adolescent-initiating IDUs were less likely than adult-initiating IDUs to report high-risk sex and injection behaviors and more likely to report high-risk networks. African American IDUs from neighborhoods with large percentages of minority residents and low adult educational levels were more likely to initiate injection during adolescence than White IDUs from neighborhoods with low percentages of minority residents and high adult education levels. CONCLUSIONS: Racial segregation and neighborhood-level educational attainment must be considered when drawing inferences about age at initiation of injection drug use and related high-risk behaviors.     

Is Contralateral Carotid Artery Occlusion a Risk Factor for Carotid Endarterectomy?

Occlusion of the contralateral internal carotid artery (ICA) is considered to have a significant impact on the outcome of carotid endarterectomy (CEA). The purpose of this study was to review one center’s experience concerning CEA opposite an occluded ICA, to see whether results differed from those obtained in patients with patent contralateral ICA in terms of relevant neurologic complication rate (RNCR, fatal + disabling stroke), stroke-free rate, and survival rate. From January 1997 to December 2002, 1,381 patients underwent a total of 1,445 CEAs at the Department of Vascular Surgery of Padua University. Patients were divided into two groups: group A included 144 patients with occlusion of the contralateral ICA and group B consisted of 1,237 patients with a patent contralateral ICA. There was no postoperative mortality in patients of group A, while in group B, two patients died as a result of myocardial infarction and cardiac failure and one died as a direct result of perioperative stroke. Postoperative disabling strokes occurred in one (0.7%) patient in group A and 10 (0.8%) patients in group B (p > 0.5). At 72 months, there were no statistical differences between the two groups in terms of RNCR, stroke-free rate, and late death. Our results show that contralateral carotid occlusion does not reduce the safety of CEA. The efficacy in terms of RNCR, stroke-free rate, and late survival is no different in patients with contralateral carotid occlusion.     

Uretero-neocystostomy in a swine model of kidney transplantation: a new technique

BACKGROUND: Swine constitute a well-characterized large animal model for kidney transplantation (K-Tx) although the uretero-neocystostomy represents a crucial aspect because of the very small caliber of the ureter and the mucosal susceptibility to the edema during surgical management. Besides infectious and occlusive complications limited the employment of a stent and the peculiar anatomy of the species prevents its removal without an operative approach. These features find an equivalent in children (<4 year old) candidates to urological surgery. We investigated an uretero-neocystostomy technique to be applied in case of narrow caliber without using endoluminal device. MATERIALS AND METHODS: Thirty unrelated large-white piglets, divided into three equal groups (n = 10) on the basis of the uretero-neocystostomy technique used, underwent K-Tx while receiving a double immunosuppressive regimen. We developed a direct uretero-neocystostomy (Direct) technique and compare this with the gold standard Lich-Gregoir (LG) and Leadbetter-Politano (LP) techniques. RESULTS: After 60 days, the ureteral complication rates were: group 1 (LG): 60% (6/10, three early and three late strictures); group 2 (LP): 40% (4/10, two leakages, one early stricture, and one isolated ureteral dilatation); group 3 (Direct): 10% (1/10, one isolated ureteral dilatation). No bacterial cystitis or nephritis occurred; retrograde cystograms were negative for refluxes in every group. CONCLUSIONS: The comparison between the old techniques and the new one (LG and LP versus Direct) showed a lower incidence of complications among the animals that underwent the new direct technique (P < 0.05). This technique could be applied clinically in selected pediatric cases either of transplantation or reflux.     

Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials

BACKGROUND: Uncontrolled bleeding is a leading cause of death in trauma. Two randomized, placebo-controlled, double-blind trials (one in blunt trauma and one in penetrating trauma) were conducted simultaneously to evaluate the efficacy and safety of recombinant factor VIIa (rFVIIa) as adjunctive therapy for control of bleeding in patients with severe blunt or penetrating trauma. METHODS: Severely bleeding trauma patients were randomized to rFVIIa (200, 100, and 100 microg/kg) or placebo in addition to standard treatment. The first dose followed transfusion of the eighth red blood cell (RBC) unit, with additional doses 1 and 3 hours later. The primary endpoint for bleeding control in patients alive at 48 hours was units of RBCs transfused within 48 hours of the first dose. RESULTS: Among 301 patients randomized, 143 blunt trauma patients and 134 penetrating trauma patients were eligible for analysis. In blunt trauma, RBC transfusion was significantly reduced with rFVIIa relative to placebo (estimated reduction of 2.6 RBC units, p = 0.02), and the need for massive transfusion (>20 units of RBCs) was reduced (14% vs. 33% of patients; p = 0.03). In penetrating trauma, similar analyses showed trends toward rFVIIa reducing RBC transfusion (estimated reduction of 1.0 RBC units, p = 0.10) and massive transfusion (7% vs. 19%; p = 0.08). Trends toward a reduction in mortality and critical complications were observed. Adverse events including thromboembolic events were evenly distributed between treatment groups. CONCLUSION: Recombinant FVIIa resulted in a significant reduction in RBC transfusion in severe blunt trauma. Similar trends were observed in penetrating trauma. The safety of rFVIIa was established in these trauma populations within the investigated dose range.