Occlusion and occlusal characteristics of primary dentition in North Indian children of East Lucknow region.

AIM: To determine occlusion and occlusal characteristics of the primary dentition in North Indian school-going children of East Lucknow region. STUDY DESIGN: A cross-sectional study was conducted on 453 participants in the age group of 3-6 years. METHODS: Participants were selected randomly and occlusal relationship was assessed based on Baume's classification. Various other occlusal characteristics were also recorded and assessed based on clinical and photographic evaluation. The data were then subjected to statistical analysis. RESULTS: Out of 453 participants examined, results revealed 62.3% had flush terminal plane; 31.3% mesial step molar relationship and 6.4% distal step molar relationship. It was also observed that 91.6% had Class I canine relationship, 93.4% primate spaces, 69.5% physiologic spaces. Amongst other occlusal characteristics, increased overbite and crowding were prevalent. Association of various occlusal characteristics and oral habits with respect to primary molar relation was also assessed. STATISTICS: Chi-square test was performed to carry out statistical analysis. p value <0.05 was taken as statistically significant. CONCLUSION: It was found that flush terminal plane relationship with spacing and Class I canine relationship predominated. Further prospective studies are required to provide an insight into patterns of occlusal relationship and its changes in Indian children.

'Artery-first' approaches to pancreatoduodenectomy.

BACKGROUND: The technique of pancreatoduodenectomy (PD) has evolved. Previously, non-resectability was determined by involvement of the portal vein-superior mesenteric vein. Because venous resection can be achieved safely and with greater awareness of the prognostic significance of the status of the posteromedial resection margin, non-resectability is now determined by involvement of the superior mesenteric artery (SMA). This change, with a need for early determination of resectability before an irreversible step, has promoted the development of an 'artery-first' approach. The aim of this study was to review, and illustrate, this approach. METHODS: An electronic search was performed on MEDLINE, Embase and PubMed databases from 1960 to 2011 using both medical subject headings and truncated word searches to identify all published articles that related to this topic. RESULTS: The search revealed six different surgical approaches that can be considered as 'artery first'. These involved approaching the SMA from the retroperitoneum (posterior approach), the uncinate process (medial uncinate approach), the infracolic region medial to the duodenojejunal flexure (inferior infracolic or mesenteric approach), the infracolic retroperitoneum lateral to the duodenojenunal flexure (left posterior approach), the supracolic region (inferior supracolic approach) and through the lesser sac (superior approach). CONCLUSION: The six approaches described provide a range of options for the early determination of arterial involvement, depending on the location and size of the tumour, and before the 'point of no return'. Whether these approaches will achieve an increase in the proportion of patients with negative margins, improve locoregional control and increase long-term survival has yet to be determined.

Using the ovarian vein to find the ovary.

Computed tomograms of 68 adult women who had undergone contrast-enhanced, 5-mm helical computed tomography of the abdomen and pelvis were retrospectively reviewed to determine whether the ovarian vein could be used to locate the ovary. Subjects were 17 to 84 years of age (mean 45 years); 31 scans were normal, and 37 showed pelvic masses. Both ovarian veins were identified at their termination and were followed into the pelvis by scrolling through the set of venous phase images with a manual cine-paging tool. All 68 left ovarian veins and 67 of 68 right ovarian veins were identified. All visualized ovarian veins led to a normal ovary or to an ovarian mass. There were no anatomic variations. In 13 ovaries displaced by pathology in the pelvis, the ovarian vein was correspondingly displaced and indicated the altered ovarian position. In all 14 patients with non-ovarian pelvic masses, ovarian veins led to the normal ovary; the vein and ovary were markedly displaced in three of these patients. On computed tomography, the ovarian vein can be consistently identified. By tracing the vein into the pelvis, the ovarian or non-ovarian nature of a pelvic mass can be determined.

Pancreatico-pericardial fistula: a rare complication of chronic pancreatitis.

A 16-year-old boy presented with pericardial effusion, bilateral pleural effusion and mediastinal fluid collection. CT scan of abdomen revealed pancreatic calcification and a fistulous tract from a pseudocyst going along the inferior vena cava wall up to the pericardial cavity. After initial pericardiocentesis and pleurocentesis, lateral pancreatico-jejunostomy with Roux-en-Y loop was performed. The patient is well at 6 months follow up.

Adrenal histoplasmosis: clinical presentation and imaging features in nine cases.

BACKGROUND: We describe a retrospective analysis of the clinical presentation and imaging features in nine patients with adrenal histoplasmosis in nonimmunocompromised patients from a nonendemic region. METHODS: Clinically, a tuberculosis-like presentation in four patients and a tumor-like presentation in five patients were seen. All patients were seronegative for the human immunodeficiency virus. Ultrasound (US) in all patients, computed tomography (CT) in six, and magnetic resonance imaging (MRI) in three showed suprarenal masses. CT-guided (in five) and US-guided (in four) biopsy and fine-needle aspiration cytology established a definite diagnosis. The work-up for malignancy and tuberculosis was negative. RESULTS: On cross-sectional imaging, eight patients had bilateral adrenal masses and one had a unilateral adrenal mass. Imaging features were variable. All adrenal masses were hypoechoic on US, homogeneous in five, and heterogeneous in four patients. All adrenal masses were hypodense on CT, homogeneous in four, and heterogeneous in two. Heterogeneous enhancement was seen in three, homogeneous enhancement in two, and no enhancement in one patient. MRI in three patients showed that the masses were of variable signal intensity on all pulse sequences. CONCLUSION: Our case series showed that adrenal histoplasmosis does occur in immunocompetent persons living in areas not endemic for the disease. The imaging features were variable.

Relationship of hairless mouse skin surface temperature to wound severity and maturation time.

Skin surface temperature (SST) changes measured on live hairless mice are presented as a simple means of following wound healing. SST is generally determined by 3 factors which are the ambient temperature, the rate of water loss from the surface of the skin and the diffusion of thermal energy from the body's core. The SST increase immediately after a burn injury reflects the amount of thermal energy absorbed by the skin surface. For burns and other injuries, the drop in SST following injury, but after thermal equilibrium has been established, provides an early indication of the degree of impairment of the skin's barrier. Three kinds of mouse skin wounds, mechanical (tape stripping), thermal and chemical (phenol application), were investigated. SST nadirs ranged from 2.1 to 4.4 degrees C with mild to full-thickness burns, respectively. Except for the earliest moments after wounding, striking parallels were noted between SST and transepidermal water loss profiles for these injuries. The SST profile over the full course of wound healing clearly indicates the severity of the injury, the stages of wound maturation and the time to complete skin healing.

Pneumothorax preceding pulmonary blastoma in a child.

Serial plain radiographic, ultrasound and CT findings of an unusual case of pulmonary blastoma are described with a review of the literature.

Value of splenic preservation during distal pancreatectomy for chronic pancreatitis.

BACKGROUND: Pain relief after distal pancreatectomy for chronic pancreatitis is reportedly satisfactory in 50-80 per cent of patients. This study attempted to determine clinical and radiological features that might select patients likely to benefit from distal pancreatectomy, and whether splenic preservation influenced the outcome. METHODS: Thirty-eight patients with chronic pancreatitis, who underwent distal pancreatectomy between 1982 and 1998, were reviewed retrospectively. The outcome of surgery was correlated with the aetiology of pancreatitis and radiological appearance on endoscopic retrograde cholangiopancreatography and computed tomography. RESULTS: Good results were achieved in 23 of 36 patients for whom follow-up (median 48 months) was available, including all 11 with obstructive pancreatitis. The spleen was preserved in 22 patients. Twelve patients became diabetic after surgery: three of 20 in whom the spleen was preserved and nine of 16 who underwent splenectomy. CONCLUSION: Non-alcoholic patients with a normal pancreas proximal to a dominant ductal stricture had a consistently good outcome from surgery. Spleen-preserving distal pancreatectomy, although technically demanding, can be performed safely with results equivalent to those of distal pancreatectomy with splenectomy or autotransplantation. Splenic preservation, apart from preventing postsplenectomy sepsis, might also delay the onset of diabetes.

Efficacy of non-breath-hold magnetic resonance cholangiography at midfield strength.

The efficacy of non-breath-hold magnetic resonance (MR) cholangiography at mid-field strength (0.5 Tesla) was evaluated for delineating biliary anatomy and the cause and extent of biliary obstruction. We performed 65 MR cholangiograms on a mid-field 0.5 Tesla MR unit and correlated them with contrast cholangiography and/or surgery. MR cholangiography was found to be both sensitive and specific in the detection of biliary obstruction and in the definition of its cause (sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 85.7%, accuracy 98%). MR cholangiography accurately predicted the level of obstruction in 94 per cent of strictures. Normal caliber intra-hepatic biliary radicles were visualised in only 6 per cent of the MR cholangiograms. In contrast, 94 per cent of dilated intrahepatic biliary radicles were demonstrated. The confluence, and right and left hepatic ducts were visualized in 98 per cent; the gall bladder in 65 per cent; the cystic duct in 45 per cent and the cystic duct insertion in 25 per cent. The extrahepatic bile duct was seen in 82.7 per cent. A normal caliber pancreatic duct was seen in 18 per cent while a dilated pancreatic duct was seen in 86 per cent. The pancreatico-biliary junction was visualised in 7 per cent. Non-breath-hold MR cholangiography at midfield strength is a highly accurate method of evaluating the cause and level of biliary obstruction, comparable to high-field MR cholangiography. The spatial resolution however is inadequate for the detection of variations in biliary or pancreatic ductal anatomy when the ducts are of normal caliber.

Problem in diagnostic imaging: pancreaticoduodenal arcade in splanchnic arterial stenosis.

This paper features a problem in diagnostic imaging in which a pre-transplant abdominal angiogram of a potential liver recipient shows filling of the hepatic artery via the superior mesenteric artery and the pancreaticoduodenal arcade. The routing of this unusual supply to the liver is explained by careful study of abdominal aortic angiograms and a sagittal MRI made through the aorta.

Choledochal cysts: evaluation with MR cholangiography.

BACKGROUND: To determine where magnetic resonance (MR) cholangiography can accurately demonstrate the presence, extent, and type of choledochal cysts. METHODS: Ten patients with sonographically suspected choledochal cysts were evaluated with a non-breath-hold MR cholangiography technique. The presence, extent, and type of choledochal cyst were determined. Visualization of the pancreatobiliary junction was recorded. MR cholangiographic findings were correlated with the gold standard of surgery in six patients, endoscopic retrograde cholangiography in two, and a 99mTc hepatobiliary scintigram in one. Three patients underwent intraoperative cholangiography. RESULTS: All MR cholangiograms were correlated with findings at surgery, endoscopic retrograde cholangiography, or 99mTc hepatobiliary scintigraphy. There were seven Todani type 1 and two Todani type 5 choledochal cysts (Caroli's disease). The extent of involvement was correctly demonstrated on all MR cholangiograms. The pancreatobiliary junction could not be identified in any of the cases. Calculi and sludge were correctly identified on the MR cross-sectional images in three patients but were not seen on MR cholangiograms in two. In one patient with an initially misinterpreted choledochal cyst, MR sectional images showed the typical appearance of a hydatid cyst, which was confirmed at surgery. CONCLUSION: MR cholangiography can be used to confirm the diagnosis of choledochal cysts and define the extent of involvement preoperatively. The pancreatobiliary junction, however, is difficult to visualize. Non-biliary cysts such as a hydatid cyst can mimic a choledochal cyst on the MR cholangiogram and should be correlated with the MR cross-sectional images to avoid misinterpretation.

Transjugular liver biopsy: a comparison of aspiration and trucut techniques.

The results of 67 transjugular liver biopsies are described. Two failures were encountered due to inability to pass the needle into acutely angulated hepatic veins. Thirty-four patients underwent a liver aspiration biopsy using a Colapinto needle, while the remainder were biopsied using a trucut needle. The success rate with the Colapinto needle was 68% and with the trucut model, 97%. Capsular perforation occurred in three cases, but without significant morbidity or mortality. It is concluded that the trucut needle biopsy is more reliable than aspiration biopsy, when the transjugular approach is mandated, in obtaining optimal liver tissue for histopathological diagnosis.

A neural-network learning theory and a polynomial time RBF algorithm.

This paper presents a new learning theory (a set of principles for brain-like learning) and a corresponding algorithm for the neural-network field. The learning theory defines computational characteristics that are much more brain-like than that of classical connectionist learning. Robust and reliable learning algorithms would result if these learning principles are followed rigorously when developing neural-network algorithms. This paper also presents a new algorithm for generating radial basis function (RBF) nets for function approximation. The design of the algorithm is based on the proposed set of learning principles. The net generated by this algorithm is not a typical RBF net, but a combination of "truncated" RBF and other types of hidden units. The algorithm uses random clustering and linear programming (LP) to design and train this "mixed" RBF net. Polynomial time complexity of the algorithm is proven and computational results are provided for the well known Mackey-Glass chaotic time series problem, the logistic map prediction problem, various neuro-control problems, and several time series forecasting problems. The algorithm can also be implemented as an online adaptive algorithm.

Choledochal cysts in adults.

The clinical features and management of 14 adults with choledochal cysts who presented to our hospital are discussed. There were 10 Todani type I, and four type IV cysts. The cysts were fusiform in all but three cases. The pancreatobiliary junction was abnormal in only two patients. Ten patients had cystolithiasis. Six patients had undergone previous biliary surgery, three of whom presented with biliary strictures. We recommend that choledochal cyst be considered as a differential diagnosis in all patients with dilated bile ducts, especially when symptoms persist after biliary surgery. In two patients who had undergone endoscopic sphincterotomy and stone clearance, and in whom the diagnosis was still in doubt after cholangiography, hepatic iminodiacetic acid (HIDA) scan confirmed the diagnosis of choledochal cyst by showing persistent biliary stagnation despite free flow of bile across the sphincter of Oddi. Complete resection of the cyst was achieved in all cases with one postoperative death. A modification of the standard surgical technique is described which makes mobilisation of the cyst easier. The need to demonstrate the pancreatobiliary ductal confluence as an aid to complete excision of the cyst is emphasised.