Lack of correlation between tubular dentine cement penetration, adhesiveness and leakage in roots filled with gutta percha and an endodontic cement based on epoxy amine resin

Objective

To analyze possible correlations among tubular dentine cement penetration, adhesiveness and apical leakage in fillings performed with gutta percha and an endodontic cement based on epoxy amine resin.

Material and Methods

Sixty similar, extracted human mandibular central incisors were irrigated, instrumented and filled following the same protocol. First, apical leakage was quantified by fluid filtration tests. Then, these same specimens were sectioned for analysis of tubular dentine cement penetration and the middle thirds were submitted to push-out tests to analyze the adhesiveness of the fillings.

Results

In brief, the means and standard deviations with a confidence interval of 95% were as follows: tubular dentine cement penetration (8.875±4.540), adhesiveness (4.441±2.683) and apical leakage (0.318±0.215). The data were confronted using the Pearson''s test (P>0.05), and it was possible to prove that there was no correlation between (1) tubular dentine cement penetration and apical leakage (r²: 0.08276), (2) tubular dentine cement penetration and adhesiveness (r²: -0.2412) and (3) adhesiveness and apical leakage (r²: 0.1340).

Conclusion

After analysis of these data, it could be observed that there exists no correlation among the variables analyzed in this study.     

硅胶薄膜囊预防椎体后凸成形术中骨水泥渗漏的实验研究

目的探讨硅胶薄膜囊预防椎体后凸成形术中骨水泥渗漏的可能性和有效性。方法取6具甲醛固定的老年女性脊柱标本(T12～L5)制成36个单椎体,刮匙在椎体前3/4制成体积约为6ml单侧或双侧空腔,分别直接注入骨水泥和先置入壁厚100μm、200μm的硅胶薄膜囊后再注入骨水泥。结果壁厚100μm的硅胶薄膜囊包裹骨水泥可控制骨水泥在椎体内的分布,和直接注入骨水泥一样能较好地嵌入到周围骨小梁内,不形成界面。而壁厚200μm的硅胶囊虽能控制骨水泥在椎体内分布,但会在骨小梁间形成界面。结论球囊扩张椎体后凸成形术中置入壁厚100μm的硅胶薄膜囊包裹骨水泥可控制椎体内骨水泥分布,并能嵌入到骨小梁间隙,不形成界面,有效预防球囊扩张椎体后凸成形术并发症的出现。     

经皮椎体强化术中骨水泥渗漏与否对患者凝血功能变化的影响

目的 利用前瞻性研究探讨骨质疏松性椎体压缩骨折（OVCF）患者行经皮椎体强化术时是否发生骨水泥渗漏对凝血功能变化的影响.方法 本研究选取2009年10月至2010年4月在我科确诊为OVCF并行椎体强化术的45例患者（59个椎体）进行前瞻性研究.测定其注入骨水泥前后不同时间点凝血四项和纤溶组合的值,术中透视及术后行X线和（或）CT检查,将患者分为骨水泥渗漏组与非骨水泥渗漏组,分析两组患者骨水泥注入后凝血功能变化的异同.结果 在所有时间点,渗漏组及非渗漏组患者的APTF、PT、PT-INR、FIB数值、3P值均在参考值范围内,各时间点的数值间无统计学差异（P＞0.05）,两组间亦无统计学差异（P＞0.05）.在注入骨水泥后,两组的D-Dmier值均有逐渐升高的趋势,其中渗漏组在骨水泥注入后不同时间点的D-Dmier值均要比注入前的D-Dmier值显著增高（P＜0.05）,与非渗漏组同一时间点的D-Dmier值相比也有统计学差异（P＜0.05）,在非渗漏组中,骨水泥注入后3 min的D-Dmier值与注入前无统计学差异（P＞0.05）,但在骨水泥注入后1h及3h均显著增高（P＜0.05）.结论 椎体强化术注入骨水泥可引起D-Dmier值升高,骨水泥渗漏可能会加速D-Dmier的升高,并可能加大其升高的幅度,骨水泥渗漏可能会影响患者的凝血功能.     

腰椎间盘手术致脑脊液漏的防治

分析腰椎间盘手术中硬脊膜损伤的原因,探讨了后脑脊液漏的防治。方法回顾１９９０年至１９９８年间４３例腰椎间盘手术致硬脊膜损伤的临床资料。结果经切口放置引流管的１２例病人,有８例于拔术后生了切口脑脊液漏,经切口旁皮肤,椎旁肌置管的３１例病人,拔管后无一例发生切口脑脊液漏。     

Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method

BACKGROUND: Conservative treatment of anastomotic leakage after anterior resection of the rectum seems to be possible in patients who have no occurrence of generalized peritonitis. This report describes a new method of endoscopic management of large anastomotic leakage in these patients. METHOD: The main feature of this new method is the endoscopically assisted placement of an open-cell sponge connected to a vacuum device into the abscess cavity via an introducer device. The sponge system is changed every 48-72 h. RESULTS: Twenty-nine patients with an anastomotic leakage after anterior resection were treated with the endoscopic vacuum therapy. The total duration of endovac therapy was 34.4 +/- 19.4 days. The total number of endoscopic sessions per patient was 11.4 +/- 6.3. In 21 of the 29 patients, a protecting stoma was created at the primary operation. Four patients were treated successfully without the need of a secondary stoma. Definitive healing was achieved in 28 of the 29 patients. CONCLUSIONS: Endoscopic vacuum-assisted closure is a new efficacious modality for treating anastomotic leakage following anterior resection due to an effective control of the septic focus. Further studies will show if it is possible to reduce the high mortality rate of patients with anastomotic leakage through the avoidance of surgical reinterventions while at the same time preserving the sphincter function.     

冷牙胶侧方加压和高温热塑充填技术根尖封闭性体外实验研究

目的：比较冷牙胶侧加压充填技术与高温热塑充填技术根尖封闭效果。方法：选取离体颌牙40颗,随机分为A组（16颗牙）、B组（16颗牙）、实验阳性组（4颗牙）、实验阴性组（4颗牙）,A组采用冷牙胶侧加压充填技术,B组采用高温热塑充填技术,比较分析不同组剐渗漏现象、顺应性、封闭性能。结果：高温热塑充填技术组渗入长度[（1．01±0．16）mm]明显少于冷牙胶侧方加压充填组;1．5、3．5mm横截面封闭能力、顺应性（0．9448±0．0221、0．9543±0．0200;0．9558±0．0164、0．9722±0．0142）、1．5、3．5mm横截面100～250封闭能力（0．9496±0．0168、0．95884-0．0176）、≥250封闭能力（0．9421±0．0165、0．9516±0．0214）明显高于冷牙胶侧方充填技术（P均〈0．05）。结论：高温热塑充填技术可以增强填充材料的顺应性,减少渗漏现象,提高封闲效果。     

胰十二指肠切除术后胰胆漏的预防

目的探讨胰十二指肠切除后胆胰漏的预防措施。方法对2000年1月-2006年11月间49例胰十二指肠切除术的临床资料进行回顾性分析。结果49例中胰头癌17例,壶腹癌15例,胆总管中下段癌6例,胆总管下段神经纤维瘤1例,慢性胰腺炎致胆总管胰腺段狭窄（术前不能排除肿瘤）2例,十二指肠肿瘤3例,胃窦癌侵及胰头1例,肿块型慢性胰腺炎4例。均做PPPD或标准Whipple术式,49例全部治愈,发生胰漏1例,4例出现其他并发症。结论完善的术前准备及术后处理、相对固定的术式和规范的手术操作,是预防胆胰漏的重要措施。     

一起110kV高压电缆金属应力锥户外终端漏油原因分析

上世纪九十年代投运的110kV电缆线路金属应力锥户外终端运行年数较长,近年来各类事故频发。针对一起该类型户外终端漏油事故,通过外观检测、局放测试、红外测温、解剖检查、取样试验等方法对其运行的内外环境进行分析,探究引起该类型终端漏油事故的原因。分析表明,外部环境温度的变化、线路负载的变化、设计的不合理、安装工艺的不足、材料的老化是该类型终端漏油的重要因素。     

肝移植术后胆道并发症的诊断与治疗

目的 探讨肝移植术后胆道并发症的诊断与治疗.方法 分析2007-2009年肝移植术后不同类型胆道并发症的患者的临床资料,评价胴道并发症的类型,处理方式及术后恢复情况.结果 肝移植术后胆道并发症患者23例,包括胆漏患者12例,计胆管吻合口漏7例,肝断面胆管漏3例,胆囊管漏1例,迷走胆管漏1例;移植术后胆管狭窄患者11例,其中吻合口狭窄4例,非吻合口性狭窄7例.7例吻合口漏患者中,胆管重建2例(Roux-en-Y吻合和胆肠襻式Warren吻合);胆道吻合口修补1例;单纯依靠外引流管引流1例,活体双供肝肝移植的患者剖腹探查纠正胆漏失败后行再次肝移植1例;行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)植入支架2例.肝断面胆管漏3例中,行肝断面胆管缝扎1例,ERCP联合B超引导下穿刺引流2例,引流2个月后胆漏闭合,拔除引流管,但是随后又出现胆道狭窄,ERCP术后,病情好转.胆囊管漏1例,行胆囊管缝扎.迷走胆管漏1例,行胆囊床缝扎.吻合口狭窄的患者4例,3例经ERCP治愈,1例行胆肠吻合重建胆道后治愈.非吻合口性狭窄的7例,行ERCP治疗3例,ERCP失败后,行经皮肝穿刺胆管引流(percutaneous transhepatic cholangiographic drainage,PTCD)1例;再次肝移植3例,2例患者术后恢复良好,1例死于严重感染.结论 肝移植术后胆道并发症危害大,关键在于预防.     

Non-steroidal anti-inflammatory drugs in colorectal surgery: A risk factor for anastomotic complications?

In a recent article, Gorissen et al report on 795 patients with primary colorectal anastomosis operated on during the period 2008-2010 for different colorectal conditions at two centres. The leakage rate was significantly higher among patients who were administered non-steroidal anti-inflammatory drugs (NSAIDs) in the perioperative course. A dose-response relationship could also be traced, where longer NSAID use yielded a higher risk of anastomotic breakdown. However, as this study is observational in design, confounding by indication may be present and there is also a risk of residual confounding from unmeasured covariates. Moreover, the question whether different affinity for the cyclooxygenase enzyme is important in different NSAIDs seems to be largely unanswered. The results, conclusions and clinical relevance of the aforementioned study, including the possible effects of different types of NSAIDs, are discussed. While acknowledging that this study represents the best attempt so far in establishing the causal relationship between perioperative NSAID use and anastomotic leakage, the need for further research in this important area is underlined.