Assessment of pulp vitality: a review

Background.  One of the greatest diagnostic challenges in clinical practice is the accurate assessment of pulp status. This may be further complicated in paediatric dentistry where the practitioner is faced with a developing dentition, traumatized teeth, or young children who have a limited ability to recall a pain history for the tooth in question. A variety of pulp testing approaches exist, and there may be confusion as to their validity or appropriateness in different clinical situations.
Aim.  The aim of this paper is to provide the clinician with a comprehensive review of current pulp testing methods. A key objective is to highlight the difference between sensitivity testing and vitality testing. A biological basis for pulp testing is also provided to allow greater insight into the interpretation of pulp testing results. The rationale for, and methods of, assessing pulpal blood flow are described.     

Right Coronary Artery Occlusion During RF Ablation of Typical Atrial Flutter

RCA Occlusion During RF Ablation . Right coronary artery (RCA) occlusion and acute myocardial infarction are rare during radiofrequency (RF) ablation of the cavotricuspid isthmus. Ventricular fibrillation (VF) or cardiac arrest in the periprocedural period may be the initial or only clinical manifestation. Septal or lateral RF delivery may increase the risk. We report 2 cases of RCA occlusion during ablation of typical atrial flutter (AFL). Angiographic and anatomical correlations are illustrated. One patient was ablated with a septal approach, the other with a lateral approach, and in each instance the RCA occluded near the ablative lesions. If septal or lateral ablation lines are contemplated during ablation of isthmus‐dependent atrial flutter, fluoroscopic or electroanatomic confirmation of catheter position is pivotal. Smaller tipped catheters, energy titration (to minimally effective dose), saline irrigation, or cryoablation should also be considered to help avoid this serious complication. (J Cardiovasc Electrophysiol, Vol. pp. 818‐821, July 2010)     

Water-Soluble Contrast CT Cisternography in CSF Fistulas

High resolution C.T. cisternography with water-soluble contrast media was performed in eight patients with C.S.F. rhinorrhea and suspected C.S.F. fistula. This technique, aided by video fluoroscopy, proved successful in documenting the precise anatomical localisation of the fistulous track in all eight patients. Surgical exploration and correction was done in every case with confirmation of the radiological findings.     

PREVENTING A HIGH RISE IN INTRAOCULAR PRESSURE AFTER LASER TRABECULOPLASTY

The high rise in pressure which sometimes follows laser trabeculoplasty is a serious and sight-threatening complication in patients with advanced glaucoma. In a previous study we found that patients undergoing laser trabeculoplasty were very unlikely to have a high rise in pressure if the initial pressure was less than 20 mmHg. In the present study a series of patients was given acetazolamide 500 mg immediately before laser trabeculoplasty if their pressures were greater than 20 mmHg. All patients were then monitored to see if this regime was effective in preventing a serious rise in intraocular pressure. Some of the patients with an initial pressure less than 20 mmHg still sustained a high rise in pressure after laser trabeculoplasty. A further series of patients was then given acetazolamide preoperatively and the postoperative rise in pressure was monitored two and 24 hours after trabeculoplasty. The acetazolamide prevented a high rise in pressure after laser trabeculoplasty in the majority of patients .