Clinical Evaluation of Early Loaded and Unloaded Implants in Edentulous Mandible

Objectives  

The aim of this study is to compare and evaluate the clinical outcome of early loaded and unloaded implants in the interforaminal region of anterior mandible.     

(+/-)-3-allyl-7-halo-8-hydroxy-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepines as selective high affinity D1 dopamine receptor antagonists: synthesis and structure-activity relationship.

Substituted 1-phenyl-3-benzazepines form a class of compounds possessing potent and selective affinity for the D1 DA receptor. 7,8-Dihydroxy-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine (SKF 38393) and its 6-halo analogues are potent and selective D1 receptor agonists. Recently, the 3-allyl derivatives of SKF 38393 and its analogues were described as selective D1 agonists with higher D1 efficacy and CNS potency. In order to extend these results to compounds in the 7-halo-8-hydroxy-substituted antagonist series, we have synthesized and pharmacologically characterized 3-allyl analogues of 7-substituted (Cl, Br, H) 8-hydroxy-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepines. These 3-allyl derivatives were compared with their 3-methyl and 3-unsubstituted analogues in terms of their D1 receptor affinity and selectivity. The results have been used to generate structure-affinity relationships. The D1 receptor affinity, for 3-substitution, is found to be in the order: methyl greater than allyl greater than H. For 7-substitution, the affinity is in the order: Cl = Br greater than H. The 3-allyl compounds show affinity close to that of the parent (3-methyl) compounds while exhibiting a slightly diminished D1 selectivity. However, the greater lipophilicity of the 3-allyl compounds may enable them to cross the blood-brain barrier more readily and thereby exhibit higher in vivo CNS potency. Thus 3-allylbenzazepines have potential as high affinity selective D1 antagonists.     

Fluorescent probes for dopamine receptors: synthesis and characterization of fluorescein and 7-nitrobenz-2-oxa-1,3-diazol-4-yl conjugates of D-1 and D-2 receptor ligands

Fluorescent probes have been designed and developed for dopamine D-1 and D-2 receptors. Fluorescein and/or NBD (7-nitrobenz-2-oxa-1,3-diazol-4-yl) derivatives of PPHT (D-2 agonist), spiperone (D-2 antagonist), SKF 38393 (D-1 agonist), and SKF 83566 (D-1 antagonist) were synthesized via their amino-functionalized analogues and all ligands were pharmacologically evaluated by measuring their ability to displace [3H]SCH 23390 and [3H]spiperone from D-1 and D-2 receptor sites in caudate putamen of monkeys (Macaca fascicularis). The fluorescein derivatives of PPHT and SKF 83566 and the NBD derivatives of spiperone and SKF 83566 retained the high affinity and selectivity of the parent ligands. The NBD derivatives of PPHT showed higher D-2 receptor affinity and selectivity than their parent ligands. The enantiomers of the fluorescent derivatives of PPHT were also synthesized and were found to exhibit stereoselectivity in binding to the D-2 receptor, with the S enantiomers having a considerably higher affinity than their R analogues. In contrast to these results, the fluorescein derivative of SKF 38393 showed only a low affinity for the D-1 receptor. These fluorescein- and NBD-coupled D-1 and D-2 receptor ligands have considerable significance as potential probes in the study of distribution of the receptors at the cellular/subcellular level and of their mobility in membranes in normal/diseased states by use of fluorescence microscopic and fluorescence photobleaching recovery techniques, respectively. The development of these novel fluorescent probes should also provide new leads for the design and synthesis of additional fluorescent ligands with better fluorescent properties and/or higher affinity/selectivity for the DA receptors.     

Intravascular hemolysis in patients with normally functioning mechanical heart valves in mitral position

Objective Traumatic intravascular hemolysis has been recognized as a potentially serious problem after heart valve replacement. Chronic subclinical hemolysis in these patients with normally functioning valvular mechanical or biologic prostheses rarely develop decompensated anemia. This prospective study evaluates the presence and severity of hemolysis in patients with normally functioning mitral prosthetic valves. Methods In this prospective study 78 patients with normally functioning mitral prosthetic valves were evaluated for hemolysis postoperatively on 7^th,30^th and 180^th days by clinical evaluation, transthoracic echocardiography, hemoglobin, serum lactic dehydrogenase (LDH), and reticulocyte count. Data was statistically analysed with paired t test and variance test. Results LDH was elevated in almost all the patients with mechanical valve replacement. None had significant anemia. All the evidence of hemolysis was not observed in any of the recipients. There was no statistically significant difference in the degree of hemolysis among the recipients of various tilting disc valves. There was no significant correlation between the severity of hemolysis and cardiac rhythm or the size of valve. The recipients of bileaflet valve had significantly more severe hemolysis than those of tilting disc valves. Conclusions Almost all the recipients of mechanical mitral valves had increased LDH values at the follow up. However none had decompensated anemia during 180 days follow up. Bileaflet valves cause more hemolysis than tilting ones. Recipients of Chitra TTK valve prosthesis showed least hemolysis.     

Prehospital transport practices prevalent among patients presenting to the pediatric emergency of a tertiary care hospital

Background and Objectives:

Prehospital transport practices prevalent among children presenting to the emergency are under-reported. Our objectives were to evaluate the prehospital transport practices prevalent among children presenting to the pediatric emergency and their subsequent clinical course and outcome.

Methods:

In this prospective observational study we enrolled all children ≤17 years of age presenting to the pediatric emergency (from January to June 2013) and recorded their demographic data and variables pertaining to prehospital transport practices. Data was entered into Microsoft Excel and analyzed using Stata 11 (StataCorp, College Station, TX, USA).

Results:

A total of 319 patients presented to the emergency during the study period. Acute gastroenteritis, respiratory tract infection and fever were the most common reasons for presentation to the emergency. Seventy-three (23%) children required admission. Most commonly used public transport was auto-rickshaw (138, 43.5%) and median time taken to reach hospital was 22 min (interquartile range: 5, 720). Twenty-six patients were referred from another health facility. Of these, 25 were transported in ambulance unaccompanied. About 8% (25) of parents reported having difficulties in transporting their child to the hospital and 57% (181) of parents felt fellow passengers and drivers were unhelpful. On post-hoc analysis, only time taken to reach the hospital (30 vs. 20 min; relative risk [95% confidence interval]: 1.02 [1.007, 1.03], P = 0.003) and the illness nature were significant (45% vs. 2.6%; 0.58 [0.50, 0.67], P ≤ 0.0001) on multivariate analysis.

Conclusions:

In relation to prehospital transport among pediatric patients we observed that one-quarter of children presenting to the emergency required admission, the auto-rickshaw was the commonest mode of transport and that there is a lack of prior communication before referring patients for further management.     

Pretransplant laparoscopic nephrectomy in adult polycystic kidney disease: a single centre experience

OBJECTIVE

To report our experience with pretransplant laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD), as ADPKD often progresses to end‐stage renal disease and most azotaemic patients with ADPKD have enlarged kidneys, making graft placement difficult.

MATERIAL AND METHODS

We retrospectively reviewed the medical records of 13 patients with renal failure attributable to ADPKD who underwent pretransplant laparoscopic nephrectomy (21 renal units) from August 2002 to December 2006. Five patients had a unilateral nephrectomy, seven had a staged bilateral nephrectomy, and one had a simultaneous bilateral nephrectomy. All patients underwent subsequent living‐related renal transplantation. The operative duration, haemoglobin decrease, blood transfusion, hospital stay, analgesic requirement and time to receipt of a transplant were compared with those of patients who underwent open pretransplant nephrectomy (14 patients) from 1984 to 2001.

RESULTS

Kidneys of a size to interfere with graft placement were the commonest indication for surgery (eight patients). In comparison with open surgery, the mean (sd ) hospital stay at 9.26 (2.9) vs 4.86 (0.9) days, analgesic requirement at 320 (120) vs 221 (120.5) mg of tramadol, blood transfusion rate at 1.3 (0.5) vs 0.9 (0.6) units, period to receive a graft kidney at 29.77 (4.6) vs 9.14 (3.38) days, were significantly less with laparoscopy. The complications noted were single instances of splenic capsular tear, pleural tear, sub‐acute intestinal obstruction and vena caval injury.

CONCLUSION

Pretransplant laparoscopic nephrectomy in patients with ADPKD has all the benefits of minimally invasive surgery such as reduced intraoperative blood loss and minimal postoperative pain leading to early and faster convalescence. These benefits help in decreasing the period between nephrectomy and transplantation. The surgeon needs to have considerable experience in laparoscopy before embarking on laparoscopic pretransplant nephrectomy.     

Posterior reversible encephalopathy syndrome following cardiopulmonary bypass–a case report

A case of Posterior Reversible Encephalopathy Syndrome is reported in a child following surgery under cardio pulmonary bypass. This syndrome is described as a neurotoxic state with a unique imaging appearance which involves the posterior regions of the brain but resolves completely leaving no residual symptoms. Relevant literature is briefly reviewed. The pathogenesis of the syndrome with cardiopulmonary bypass as a potential risk factor for this condition is described.     

Rehabilitation of a Maxillectomy Case with Telescopic Crowns: A Case Report

Prosthodontic rehabilitation of acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. Most of the times these goals are met by means of obturator prosthesis. Preservation of the remaining hard and soft tissues in such patients is very much essential in order to have a good retention, stability and support for the prosthesis. It is very much imperative to fabricate a prosthesis to provide proper function to the patient. Various techniques have been developed to enhance the retention and stability of the prosthesis, some of them being extension of the obturator bulb into the undercuts within the defect, use of magnets, implants etc. Telescopic crowns have been an adjunctive utility to prosthetic dentistry since a very long time. The biomechanics of telescopic crowns aid in providing a good retention and stability to the prosthesis. In the following clinical report a patient with a status of Subtotal Hemi Maxillectomy is presented in whom telescopic copings were incorporated into the cast hollow bulb obturator to enhance the retention and stability of the prosthesis.     

Comparative Study of Free Omental Sheet Graft and Other Operative Procedures of Enteric Perforation Repair

Background/Aim

In developing countries, enteric perforation due to typhoid continues to have very high morbidity and mortality rates irrespective of the type of operative procedure performed. The aim of the present study was to evaluate the effectiveness of a free omental sheet graft in perforated typhoid enteritis, in comparison to other methods of enteric perforation repair in terms of decreased morbidity, mortality and cost-effectiveness.

Method

A non-randomized study of 114 patients with enteric perforations was carried out over a period of 4.5 years. The study was divided in two groups; group I includes 38 cases in which a free omental sheet graft was used in typhoid enteritis with perforation and group II includes 76 cases in which other surgical procedures for enteric perforation repair were used. The outcomes were measured in relation to postoperative complications and mortality.

Results

The incidence of complications including faecal fistula was 2.6 % in group I (free omental sheet graft group) versus 32.89 % in group II. The mortality rate of 2.6 % was also lower in group I versus 19.7 % in group II.

Conclusion

This study concludes that the use of free omental sheet graft on typhoid enteric perforation site is effective in lowering the repair leak rate and thereby decreases the morbidity and mortality associated with these procedures. By lowering the complication rates, it also entails reduction in financial burden.