Differentiation of radicular cyst and granulomas using computerized tomography

Abstract The purpose of this investigation was to study periapical lesions by means of computerized tomography to ascertain if this noninvasive method could be of value in distinguishing between radicular cysts and granulomas. Periapical radiographs were taken of the teeth of 60 human cadavers. Periapical radiolucencies were seen in conjunction with 33 teeth. Based on the periapical radiographs, an oral radiologist (J.P.) attempted to select 4 granulomas and 4 cysts from the 33 radiolucencies. Computerized tomography was performed on the root tips and the periapical lesions of these 8 teeth. The roots and periapical lesions were then surgically removed and prepared histologically for microscopic examination. In the tomographs, 7 of the periapical lesions had a cloudy appearance with a density similar to each other and to the surrounding soft tissue. In the eighth lesion a homogeneous dark area with a distinctly lower density could be distinguished from surrounding cloudy areas. Histologically, the dark area was shown to be an epithelialized cyst cavity. The other 7 lesions were granulomas. Thus, a cyst could be differentiated from periapical granulomas by computerized tomography because of a marked difference in density between the content of the cyst cavity and granulomatous tissue.     

Is repeat head CT necessary in patients with mild traumatic intracranial hemorrhage

BackgroundPatients with traumatic intracranial hemorrhage (TIH) frequently receive repeat head CT scans (RHCT) to assess for progression of TIH. The utility of this practice has been brought into question, with some studies suggesting that in the absence of progressive neurologic symptoms, the RHCT does not lead to clinical interventions.MethodsThis was a retrospective review of consecutive patients with CT-documented TIH and GCS ≥ 13 presenting to an academic emergency department from 2009 to 2013. Demographic, historical, and physical exam variables, number of CT scans during admission were collected with primary outcomes of: neurological decline, worsening findings on repeat CT scan, and the need for neurosurgical intervention.ResultsOf these 1126 patients with mild traumatic intracranial hemorrhage, 975 had RHCT. Of these, 54 (5.5% (4.2–7.2 95 CI) had neurological decline, 73 (7.5% 5.9–9.3 95 CI) had hemorrhage progression on repeat CT scan, and 58 (5.9% 4.5–7.6 95 CI) required neurosurgical intervention. Only 3 patients (0.3% 0.1–0.9% 95 CI) underwent neurosurgical intervention due to hemorrhage progression on repeat CT scan without neurological decline. In this scenario, the number of RHCT scans needed to be performed to identify this one patient is 305.ConclusionsRHCT after initial findings of TIH and GCS ≥ 13 leading to a change to operative management in the absence of neurologic progression is a rare event. A protocol that includes selective RHCT including larger subdural hematomas or patients with coagulopathy (vitamin K inhibitors and anti-platelet agents) may be a topic for further study.     

The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review

Context Computerized physician order entry (CPOE) with clinical decision support (CDS) has been promoted as an effective strategy to prevent the development of a drug injury defined as an adverse drug event (ADE). Objective To systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure. Data Sources PUBMED versions of MEDLINE (from inception through March 2007) were searched to identify relevant studies. Reference lists of included studies were also searched. Methods We searched for original investigations, randomized and nonrandomized clinical trials, and observational studies that evaluated the effect of CPOE with CDS on the rates of ADEs. The studies identified were assessed to determine the type of computer system used, drug categories being evaluated, types of ADEs measured, and clinical outcomes assessed. Results Of the 543 citations identified, 10 studies met our inclusion criteria. These studies were grouped into categories based on their setting: hospital or ambulatory; no studies related to the long-term care setting were identified. CPOE with CDS contributed to a statistically significant (P ≤ .05) decrease in ADEs in 5 (50.0%) of the 10 studies. Four studies (40.0%) reported a nonstatistically significant reduction in ADE rates, and 1 study (10.0%) demonstrated no change in ADE rates. Conclusions Few studies have measured the effect of CPOE with CDS on the rates of ADEs, and none were randomized controlled trials. Further research is needed to evaluate the efficacy of CPOE with CDS across the various clinical settings.     

Severe episodic headache as the sole presenting ictal event in patients with a solitary cysticercus granuloma

OBJECTIVES: Most patients with a solitary cysticercus granuloma present with seizures and severe episodic headache as the sole presenting symptom is rare in these patients. We report the clinical features, evolution and outcome of the disease in patients with a solitary cysticercus granuloma who had severe headache alone without seizures as the sole presenting event. MATERIAL AND METHODS: This was a prospective study which included all patients who presented with severe episodic headache alone and had a diagnosis of a solitary cysticercus granuloma based on CT imaging and follow-up and were managed in our department between June 1, 1991 and May 31, 1998. RESULTS: Out of nearly 550 patients diagnosed to have a solitary cysticercus granuloma during the period of the study, 15 patients (2.5%) presented with severe episodic headache alone. While 9 patients had 1 episode of headache, 6 patients had 2 to 5 episodes. Patients were managed with conservative symptomatic therapy (13 patients) and albendazole therapy (2 patients). Follow-up scans showed complete or partial resolution of the granuloma in 8 patients and a lesion of the same size in 4 patients. None of the patients with complete resolution of the granuloma reported further episodes of headache. CONCLUSIONS: It is important to recognize this presentation of a solitary cysticercus granuloma as it could be confused clinically with other acute central nervous system illnesses such as subarachnoid haemorrhage and meningitis. In regions endemic for cysticercosis a contrast enhanced CT scan of the brain should be performed in patients presenting with sudden onset of severe headache when a plain scan does not reveal intracranial haemorrhage as only a contrast enhanced scan will reveal the granuloma.     

计算机体层血管成像联合IL-6、TNF-α水平检测对颅内动脉瘤的诊断价值

目的  探讨采用计算机体层血管成像（CTA）与白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）联合检测对颅内动脉瘤的诊断鉴别价值。 方法  选取本院2019年3月~2022年3月收治的108例颅内动脉瘤疑似病例,采用CTA联合IL-6、TNF-α检测分析其对颅内动脉瘤的诊断价值。 结果  108例疑似患者经数字减影血管造影检测发现93例确诊为颅内动脉瘤,CTA诊断为87例,CTA诊断的Kappa值为0.669,准确性为90.74%,敏感度为0.914,特异性为0.867;颅内动脉瘤患者机体血清IL-6、TNF-α水平高于非颅内动脉瘤患者（P < 0.05）;Spearman相关性分析显示：IL-6、TNF-α与患者颅内动脉瘤的发生呈正相关关系（r=0.377、0.453,P < 0.05）;ROC曲线显示,CTA与IL-6、TNF-α联合诊断指标曲线下面积为0.974,高于各单项指标曲线下面积（P < 0.05）。 结论  CTA联合IL-6、TNF-α检测对颅内动脉瘤具有较高的诊断价值。     

Telenurses' experiences of working with computerized decision support: supporting, inhibiting and quality improving

Title.  Telenurses' experiences of working with computerized decision support: supporting, inhibiting and quality improving.
Aim.  This paper is a report of a study conducted to describe telenurses' experiences of working with computerized decision support systems and how such systems could influence their work.
Background.  Telenursing is an expanding service in many Western countries, and in recent years centralization of telenursing services has occurred in Sweden. In connection with this, the use of computerized decision support has increased.
Method.  Eight Registered Nurses from three telephone advice call centres in Sweden who were using computerized decision support took part in semi-structured interviews in 2006. The data were analysed using qualitative content analysis.
Findings.  The findings are presented as one theme and three categories. Telenurses experienced their work with a decision support system as supporting, inhibiting and quality improving. Based on two of the categories –'supporting' and 'inhibiting'– a theme was revealed: being strengthened, but simultaneously controlled and inhibited . This theme represents the individual level . The telenurses found that the decision support system simplified their work, complemented their knowledge, gave them security and enhanced their credibility. They also described experiencing the system as incomplete, sometimes in conflict with their own opinions and controlling. The third category referred to the organizational level: the decision support system ensured the quality of telenursing.
Conclusions.  Although the telenurses experienced computerized decision support as both supporting and inhibiting, they preferred working with it. They also described how a computerized decision support system cannot replace telenurses' knowledge and competence, and that it should be considered as complementary.     

Gingivomorphometry – esthetic evaluation of the crown–mucogingival complex: a new method for collection and measurement of standardized and reproducible data in oral photography

Objectives: A new method is introduced for the esthetic evaluation of the periimplant mucogingival complex through collection of standardized oral photographs and computer-assisted measurement of reproducible data. Using this method, different soft tissue and crown parameters in the dentogingival complex can be measured and the esthetic outcome monitored.
Material and methods: A photographic device for standardized oral photography and a standard protocol for the esthetic evaluation of the crown–mucogingival complex is presented, comprising six soft tissue parameters: (1) mesial and (2) distal papilla areas, (3) mesial and (4) distal papilla heights, (5) soft tissue–crown perimeter, and (6) gingival recession. In order to demonstrate the reproducibility of standardized oral photographs and the accuracy of the measurement of the six parameters, the data obtained in each of two such standardized clinical photographs, taken at 10–14 days intervals, of the anterior maxillary region from 10 patients with no apparent dental disease were compared. For the statistical analysis of the reproducibility of these dependent data the 95% confidence interval and the coefficients of variation were calculated from measurement means and ranges of each of the above parameters, pooled from all 10 patients.
Results: Statistical analysis revealed high reproducibility with no significant differences between the range of mean values of all six parameter measurements on the first and second standardized oral photograph of the same patient, respectively.
Conclusion: Gingivomorphometry on standardized oral photographs can be considered to be an accurate and reproducible method for the evaluation and measurement of different dentogingival and periimplant parameters.     

网络化口腔正畸电子病历管理系统的研制与应用

目的 基于口腔专科医院信息化建设需要,结合新一代口腔医院信息管理系统的开发,研制网络化口腔正畸电子病历管理系统,实现口腔正畸病历的信息化管理.方法 在新一代口腔专科医院信息化管理系统上,采用面向对象技术,在Windows 98/2000/XP平台上用C#语言,应用计算机网络技术、数据库技术及IC卡技术开发出面向正畸医师的电子病历网络管理系统.结果 经过初步临床实践,该系统功能强大,具有快捷、准确、全面的采集资料和强大的资料编辑、存贮、统计、查询、管理功能,为口腔正畸临床工作者提供了一种计算机化的崭新的病案管理模式,提高了口腔正畸专科医疗质量和医疗效率.结论 该系统的临床应用为正畸病历资料的信息化管理提供了可靠、有效的信息化平台,能够满足现有临床需要,并为正畸临床教学、科研创造了良好的条件.     

硬膜外持续泵注罗哌卡因阻滞的临床研究

目的:探讨硬膜外持续泵注新型长效酰胺类局麻药罗哌卡因的可行性.方法:将60例拟行妇产科手术的患者随机分为0.75%罗哌卡因组持续泵入给药组(A组)和0.75%罗哌卡因组间断给药组(B组).两组均在L2～3硬膜外穿刺成功并给予实验量后,A组(30例)硬膜外注入0.75%罗哌卡因12mL,然后以6mL/h的速度用微泵持续输入;B组(30例)注入0.75%罗哌卡因15mL,在80min后时追加6mL.分别测定麻醉前及硬膜外给药后的平均动脉压(MAP)、心率(HR);首次注药后至手术结束时针刺皮肤测阻滞平面,同时记录改良Bromage评分,术中肌松质量由手术者评定(手术者为同一组人),分为很满意、满意和不满意;记录术中麻黄素使用情况.结果:B组在90min左右时血压出现明显下降,与A组比较差异有统计学意义(P＜0.05),A组术中麻黄素使用病例数较少(P＜0.05).两组间皮肤阻滞平面、Bromage评分和术中肌松情况比较差异无统计学意义(P＞0.05).结论:硬膜外微泵持续泵入罗哌卡因的给药方法既可以达到间断给药法同样的麻醉效果,又避免了间断法造成血压大幅波动的缺点,是一种较为安全的给药方法.