Utility of Chemical Shift Imaging and Diffusion-weighted Images/Apparent Diffusion Coefficient Maps as a Tool for Evaluation of Solid Renal Tumors.

OBJECTIVES: To study the utility of chemical shift imaging (CSI) and diffusion-weighted images (DWI)/apparent diffusion coefficient (ADC) maps for the evaluation of solid renal tumors. METHODS: Magnetic resonance imaging (MRI) has an equivalent application as computerized tomography (CT) in the characterization of renal masses. It offers a radiation-free imaging technique and has a better soft tissue contrast than CT. Also, MRI is favored in patients with chronic kidney disease. MRI is useful when findings on CT are equivocal. The role of DWI in characterizing solid renal lesions as malignant is encouraging, and DWI can be particularly useful when gadolinium is contraindicated. CSI is useful in differentiating angiomyolipoma (AML) from clear cell (cc) renal cell carcinoma (RCC). We did a cross-sectional study on 24 patients with solid renal masses. MRI of the upper abdomen (from the dome of the diaphragm to the iliac crest) will be done on an MRI machine in our department (1.5T, ACHIEVA, Phillips medical system) using the torso coil. RESULT: There was no significant association seen in terms of ADC values and histological subtypes (χ2 = 11.222, p = 0.082). In our study, 50% (one out of two) of AML showed a signal drop, whereas 40% of cases (6 out of 15) of ccRCC and 66% (two out of three) of papillary RCC showed a signal drop. CONCLUSION: In this article, we concluded CSI, although a useful tool to look for microscopic fat, can't be used as a reliable marker to rule in cc-carcinoma as both AML and papillary cell carcinoma have microscopic fat. Further, no histological classification can be done on the basis of DWI/ADC images.

Pulmonary Radiological Manifestations of Paraquat Poisoning: A Pictorial Essay.

Paraquat (1,1'-dimethyl-4,4'-dipyridylium) is a liquid herbicide, linked to both accidental and intentional ingestion, which can result in severe and frequently lethal poisoning. It has been known to cause injury to the lungs, kidneys, and liver. We retrospectively reviewed five cases over the last 4 years with a history of paraquat ingestion. The time duration between ingestion and high-resolution computed tomography (HRCT) was assessed. HRCT chest scan was variable, ranging from 4 to 18 days postexposure. The follow-up of the patients was also reviewed.

Malignancy around implants in patients with a history of a potentially malignant or malignant lesion: a systematic review.

The majority of problematic conditions resulting from dental implant treatment are inflammatory in character, but certain isolated occurrences of primary oral squamous cell carcinoma (OSCC) have been discovered in the area of implants. The goal of this study was to examine whether there is a link between dental implants and the development of OSCC in patients who have a history of a potentially malignant lesion (PML) or malignancy. Using the keywords "carcinoma" AND "dental implants," a search was conducted in the MEDLINE (PubMed), National Center for Biotechnology Information, and Google Scholar databases for case reports and case series in which OSCC was discovered as a primary cancer in the region of dental implants. An initial search identified 260 articles, 247 of which were excluded based on study inclusion or exclusion criteria, leaving 13 articles chosen for inclusion and a total of 30 patients who developed primary oral cancer surrounding osseointegrated titanium-based dental implants. In the studies included in the present review, 22 (73%) of 30 patients with peri-implant cancer had a history of PML or carcinoma. There is no statistical evidence of a direct association between dental implants and OSCC in patients with a history of a PML or malignant lesion. There have been some case reports of OSCC in the region of dental implants in patients with a history of a PML or malignant lesion, but further studies are needed to prove a definitive relationship.

Effect of a centric stabilization splint on masticatory muscles in patients with temporomandibular disorders: An electromyographic study.

AIM: Occlusal splint treatment is commonly used to treat a variety of temporomandibular disorders (TMDs), with efficacy ranging between 70% and 90%. Centric splints are effective in relieving muscular soreness in individuals with TMD. Electromyography (EMG) quantifies muscle activity and can be used as an accessory diagnostic tool to evaluate the efficiency of the splint on the masticatory complex. Electromyography is used for assessing patients with TMD and observing muscle electromyography. TMD patients have altered electromyographic (EMG) masticatory muscle activity because of its change in electrical activity index or because of the compensatory mechanism for the disorder. Therefore, this study serves to evaluate the efficacy of the centric stabilization splint on TMD using EMG. SETTINGS AND DESIGN: This cross-sectional study enrolled Ten TMD Patients with TMD, who underwent treatment with centric stabilization splint. MATERIALS AND METHODS: The study involved ten young adults with TMD aged 18-45 years who were recruited without regard to sex, religion, caste, or socioeconomic background. The participants were randomized to receive a flat-contact upper stabilization splint and pregelled EMG electrodes to assess the immediate impact of centric splints on TMDs. After 3 months of follow-up, muscle activity and muscle symmetrical activity were measured to assess improvement in the symptoms of TMD. STATISTICAL ANALYSIS USED: The Shapiro-Wilk test was used to assess the normality of the variables' distribution using SPSS 26.0. Symmetrical activity and treatment response were investigated using the Wilcoxon signed-rank test. RESULTS: It showed an improvement in the temporalis, masseter, and sternocleidomastoid muscles' resting EMG activity. A statistically significant improvement was seen in the EMG activity of the bilateral temporalis, right masseter, right sternocleidomastoid, and left digastric muscles while clenching. The masseter, sternocleidomastoid, and digastric muscles all displayed significantly enhanced symmetrical activity (P < 0.05). CONCLUSIONS: This research concludes that a centric stabilizing splint assists in relieving TMD symptoms. There was enhanced masticatory muscle activity both at rest and during function. Furthermore, there was an improvement in symmetrical activity of the masticatory muscles, which improved balance and enhanced the effective functioning of the masticatory complex.

A modified technique of using digital technology to fabricate surgical obturator in patients with limited mouth opening.

This article presents a digital technique for the fabrication of an immediate surgical obturator for a patient with decreased mouth opening planned for maxillectomy. The amalgamation of pre-operative Cone Beam Computed Tomography (CBCT) data and 3D printing allowed for the fabrication of the immediate surgical obturator without conventional pre-surgical diagnostic impression. The surgical obturator was placed in position intraorally post tumor resection to complete the obturation. The procedure followed led to an accurate fit of the prosthesis without any need for relining during surgery.

Hypoalbuminemia: incidence and its impact on acute respiratory distress syndrome and 28-day outcome in trauma patients.

OBJECTIVE: This prospective observational study explored the effect of early onset hypoalbuminemia (EOH) on the development of adult respiratory distress syndrome (ARDS) in orthopedic trauma victims. METHODS: Serum albumin levels were measured for the initial 7 days of injury for adult trauma patients (18-65 years). Patients were recruited into group A (any serum albumin value < 3.5 mg/dl) and group B (all serum albumin ≥ 3.5 mg/dl), based on serum albumin values. Patients were followed for the development of ARDS and outcome until 28 days. The primary outcome of the study was to explore the effects of EOH on ARDS. RESULTS: EOH (any serum albumin value < 3.5 g/dl within 7 days of injury) was present in 205/386 (53.1%) patients. The majority of 174/205 (84.9%) patients had EOH by the fourth day after the injury, with the mean time for development of EOH being 2.15 ± 1.87 days. ARDS manifested in 87/205 (42.4%) and 15/181 (8.3%) patients in group A and group B, respectively (p < 0.001). EOH had 8.2 times greater odds of ARDS (OD 8.2 95% CL 4.7-14.0, p = 0.000). The mean time for the onset of ARDS was 5.63 ± 2.62 days. No statistically significant causal relationship occurred between the onset of EOH and the development of ARDS (Pearson's correlation coefficient = 0.14, p = 0.16). At serum albumin cutoff concentrations of 3.4 gm/dl on D1 (AUC 0.68, 95% CI: 0.61-0.74, p = 0.000), ARDS may be anticipated in 62.8% of patients. The commencement of ARDS was independently correlated with EOH (p = 0.000), Respiratory rate on admission (p = 0.000), inotrope use (p = 0.000), and soft tissue injury (p = 0.000) (R2 = 0.466). The odds of 28-day all-cause death were 7.7 times higher in EOH (OD 7.7 95% CL 3.5-16.7, p = 0.00) and 9 times higher in ARDS (OD 9 95% CL 4.9-16.16, p = 0.00). CONCLUSION: EOH is a frequent occurrence and has a strong influence development of ARDS and 28-day mortality in trauma patients.

Impact of Trainee Involvement on Pediatric ERCP Procedures: Results From the Pediatric ERCP Initiative.

This study examines the role of trainee involvement with pediatric endoscopic retrograde cholangiopancreatography (ERCP) and whether it affects the procedure's success, post-procedural adverse outcomes, and duration. A secondary analysis of the Pediatric ERCP Database Initiative, an international database, was performed. Consecutive ERCPs on children <19 years of age from 18 centers were entered prospectively into the database. In total 1124 ERCPs were entered into the database, of which 320 (28%) were performed by trainees. The results showed that the presence of trainees did not impact technical success ( P = 0.65) or adverse events rates ( P = 0.43). Rates of post-ERCP pancreatitis, pain, and bleeding were similar between groups ( P > 0.05). Fewer cases involving trainees were in the top quartile (>58 minutes) of procedural time (19% vs 26%; P = 0.02). Overall, our findings indicate trainee involvement in pediatric ERCP is safe.

Application of Polyvinyl chloride sheet as delayed surgical obturator in maxillectomy defects secondary to mucormycosis- A case series.

It was a great challenge for the prosthodontist to rehabilitate and sustain the prosthesis in patients with bilateral maxillectomy defects due to mucormycosis seen with Covid-19 during second wave in India. In such extensive defects there was difficulty in retaining the obturator due to the absence of soft tissue or anatomical undercuts, condition of existing dentition, retained inferior turbinates and limitation in taking retention from defect side during healing phase. In such extensive maxillectomy defects, retention, stability and support can be enhanced by maximum preservation of hard and soft tissues, skin grafting and removal of inferior turbinates to provide a larger surface area for stress distribution. But here, in this case series, maxillectomy defects with retained inferior turbinates presented a problem in retaining the obturator prosthesis due to limitation in taking retention from the defect side. The conventional method of fabrication of obturator using autopolymerizing acrylic failed in terms of weight of the prosthesis and in gaining retention from the defect side during healing phase. Therefore, thermoplastic vacuum pressed Polyvinyl chloride sheet (PVC) was used for fabrication of delayed surgical obturator due to many merits conferred by it. Its light weight, non porous nature, easy adaptability, patient comfort, efficient undercut engagement, hygienic nature makes it a good treatment option. The main cocern was to close oro-nasal communication to eliminate the need of nasogastric tube and to prevent nasal regurgitation. In all cases, patients were comfortable with the obturator prosthesis in terms of adaptation and function.

3D face scan for fabrication of cranioplast: An applied innovative technique.

Cranial defects are repaired for esthetics, functional, morphological and psychological benefit of the affected patients. Purpose of a cranioplast is to prevent trauma to brain tissue, improve the cranial contour, symmetry and esthetics along with pain reduction. This technique describes the innovative use of a multicamera 3D face scanning software for obtaining a 3D face model of a road traffic accident patient for cranioplast fabrication. Advantage of this technique is that it is quick and easy and allows complete face scan under 10 s.

Effectiveness of Vitamin D along with Splint therapy in the Vit D deficient patients with Temporomandibular disorder-A Randomized, double-blind, placebo-controlled clinical trial.

Aim: The purpose of this study is to comparatively evaluate the Vitamin D supplementation and stabilization splint therapy in patients exhibiting temporomandibular disorders (TMD). Settings and Design: The study design was double-blinded, parallel-group, randomized and placebo-controlled trial conducted in patients with low Vitamin D and TMDs, which were allocated to two groups, Study group S + D (Stabilization splint with Vitamin D supplementation) and Control Group S (Stabilization Splint with placebo drug). Subjects and Methods: Thirty-six participants of 18-45 years of age gap with Vitamin D deficiency and TMD were included in the study. Preoperative values of Vitamin D levels in ng/ml, comfort mouth opening (CMO) in mm, maximum mouth opening (MMO) in mm, temporomandibular joint (TMJ) tenderness (grading 0-3), Visual analog scale score (VAS Score 0-10 cm), and total energy (TE) integral values of both left and right TMJ's in Hertz (Hz) were recorded using joint vibration analysis All the values of CMO, MMO, TMJ Tenderness and VAS were recorded at each follow-up at 1st week, 1st month, 2nd month, and 3rd month, respectively. Postoperative Vitamin D levels and TE of both TMJs were recorded at end of 3 months. Statistical Analysis Used: For intergroup comparison, Mann-Whitney U-test and Pearson Chi-square tests were done. For Intragroup comparison, Wilcoxon signed rank test was used for comparison. Results: In Intergroup comparison, a significant difference was seen in CMO, VAS score and MMO (P < 0.05) but not among mean values of TE of right and left TMJ, and Vitamin D levels (P < 0.05). In both groups, there were significant statistical variations in CMO, VAS score, MMO, and TE integral before and after treatment in the right and left TMJs (P < 0.05). Conclusions: The study concludes centric stabilization splint helps in improving symptoms of TMD patients and Vitamin D supplementation provided faster relief in those cases.

Intraoral customized Z-spring-retained delayed surgical obturator for rare cases of bilateral subtotal maxillectomy.

While dealing with a grave second wave of ongoing pandemic COVID-19, India also saw a surge in cases of COVID-19-associated mucormycosis, a systematic fungal infection caused by the Mucorales species. Mucormycosis is a highly angioinvasive, rapidly spreading fungal infection. In numerous cases of mucormycosis, bilateral subtotal maxillectomy was performed due to unpredictable and indefinable advancement of fungus clinically. Effective obturation of bilateral maxillectomy defect is a difficult task and as this is a relatively uncommon surgical problem, insufficient data are available on the construction of delayed surgical obturator for such cases. The aim of this article is to discuss the design of Z-spring-retained delayed surgical obturator which is easy to fabricate, easy to rectify, cost-effective, and comfortable for the patients compared to previous spring-retained obturators. This surgical obturator is retained through Z-spring made of 1.02 mm thick wire. Due to the thick gauge, this spring counters postsurgery trismus and develops the seal between the acrylic plate and dorsum of the tongue during deglutition thus helps the patient in taking a soft diet initially. Novelty in this case is the design of the spring, which makes it beneficial for both patient and prosthodontist.

Radiological and Audiological Assessment in Patients with Adenoid Hypertrophy Undergoing Adenoidectomy.

Enlarged adenoids in children can lead to obstruction of the ET, leading to negative intratympanic pressure and development of Otitis media effusion. Adenoid-nasopharyngeal ratio (ANR) on lateral radiograph of nasopharynx, is one of the most reliable and cost-effective ways of determining the size of adenoids with respect to the nasopharyngeal space. Patients who were clinically diagnosed with adenoid hypertrophy, above the age of 5 years, undergoing adenoidectomy were included in the study. Lateral nasopharynx radiograph, Pure tone audiometry (PTA) and tympanometry were performed. The ANR calculated, graded, and compared with the PTA, tympanograms and size on endoscopic assessment. Taking 0.835 as cut-off value, significant correlation of ANR with PTA and impedance (p = 0.002) was found. 71% abnormal PTA and tympanogram was found with ANR > 0.835 whereas 30.8% with ANR < 0.835. ANR is a useful adjunct as a pre-operative tool for determining the need for adenoidectomy in paediatric patients who are not easily willing to undergo endoscopic evaluation. A major drawback is the lack of identification of lateral extent of adenoids.

Effect of add-on Gabapentin premedication on hemodynamic response to skull pin insertion.

Background and Aims: Effectiveness of oral gabapentin premedication in suppressing response to laryngoscopy and tracheal intubation suggests its potential for attenuating skull pin insertion response. The present study was therefore planned to evaluate the effect of add-on oral gabapentin premedication to local anesthetic injection at pin insertion site in obtunding hemodynamic response. Material and Methods: Sixty adult patients posted for elective craniotomy were enrolled for a prospective, randomized and double-blinded study. Group I patients received gabapentin 900 mg orally as premedication whereas Group II patients received oral placebo. Both groups were administered subcutaneous (s.c.) injection (Inj) 2% lignocaine 2 mL at all four pin insertion sites. Mean arterial pressure (MAP) and heart rate (HR) were measured every 30 s for the initial 10 min. Increases in HR beyond 20% and MAP 30% above baseline were treated with bolus intravenous (IV) Inj propofol 30 mg. Quantitative data was compared using Student's t-test and Mann Whitney U test, while categorical data was compared using Chi-square (χ2) test. Results: The increase in HR and MAP from baseline was significantly greater and it remained above baseline levels longer in Group II as compared to Group I. Twenty-one patients (70%) received rescue boluses of propofol with a mean dose of 45.00 ± 39.98 mg in Group II as compared to nine (30%) patients receiving mean of 18.20 ± 29.04 mg in Group I. (P = 0.015). The mean emergence time and sedation scores in both the groups were statistically similar (P = 0.060).The incidence of adverse effects like hypotension, bradycardia, nausea/vomiting, sedation or dry mouth were similar in both the groups. Conclusion: Add-on oral gabapentin premedication potentiates the effect of s.c. lignocaine Inj for suppression of skull pin insertion response.

Multisegment Extradural Tuberculoma Masquerading as a Spinal Tumor.

We report a case of a man who presented with features of spinal cord compression, and imaging showed an L3-S2 space-occupying lesion that mimicked a spinal tumor. The patient underwent L3 to S2 laminectomy and a fibrous, thick sheet-like, poorly vascular lesion was observed macroscopically. The histopathological examination of the lesion showed caseous necrosis and epithelioid giant cells. This raised suspicion of tuberculosis and which was later confirmed on a polymerase chain reaction. The present case illustrates that tuberculosis is a disease that should not be ignored, particularly considering its ability to resemble other types of mass lesions.

Comparative Evaluation of Load-Bearing Capacity and Fracture Analysis of PEEK and Zirconia Three-Unit Fixed Dental Prostheses: An In Vitro Study.

PURPOSE: The purpose of this exploratory in vitro study was to compare and evaluate the load-bearing capacity (LBC) of ceramic-veneered zirconia and composite-veneered polyetheretherketone (PEEK) three-unit fixed dental prostheses (FDPs) with and without thermocycling (TC). MATERIALS AND METHODS: The study included 40 samples of three-unit FDPs replacing mandibular first molars. The four groups included were: ceZIR (feldspathic ceramic-layered zirconia), ceZIR TC (feldspathic ceramic-layered thermocycled zirconia), cPEEK (composite-layered PEEK), and cPEEK TC (composite-layered thermocycled PEEK) (n = 10 per group). All frameworks were CAD/CAM milled. Ten PEEK and 10 zirconia samples were subjected to TC (6,000 cycles). All 40 FDP specimens were loaded by applying static load, using a universal testing machine. The maximum load required to fracture the specimens denoted the LBC. The comparison of LBC between the four groups was done by using two-way ANOVA with Tukey's post-hoc analysis (α = .05). RESULTS: There was no statistically significant difference between LBC of cPEEK and ceZIR (P > .001) without thermal aging. LBC values decreased considerably for thermally aged specimens. Statistically significant differences were observed between LBC of cPEEK TC and ceZIR TC (P < .001), cPEEK TC and cPEEK (P < .001), and ceZIR TC and ceZIR (P = .001). On fracture analysis, cPEEK showed delamination failures whereas ceZIR displayed catastrophic connector fractures. CONCLUSION: This comparative evaluation offers preliminary data highlighting substantial depreciation in the LBC of layered PEEK under simulated intraoral conditions, thus raising a question regarding the clinical longevity of layered PEEK multi-unit restorations. In contrast, feldspathic-layered zirconia can be suitable for use in posterior FDPs.

A challenging journey of maxillofacial implants placement and rehabilitation in an irradiated exenterated socket.

Rehabilitation of a post-exenterated orbital defect is a necessity, to restore a patient's esthetic appearance and help overcome the associated psychosocial stigma. An implant supported prosthesis enjoys a better patient acceptance due to its superior retention and stability. This clinical report highlights the challenges faced in planning, designing and placement of maxillofacial implants in the supra-orbital rim of an exenterated socket post-radiotherapy along with the management of the unexpected complications which developed subsequently. Administration of hyperbaric oxygen therapy, fabrication of a digitally designed surgical guide to ensure predictable implant placement, selection of surface treated implants for better biomechanical anchorage, and a gentler surgical technique for recovery of irradiated hard and soft tissues were measures undertaken during the treatment phase. An effort has been made to point-out the fact that despite the various approaches adopted in an irradiated patient, success of implant placement in such a situation remains a challenge.

Aneurysmal Oscillation of the Capnogram: A Case Report.

Variations in the alveolar plateau phase of the capnogram are often confused with spontaneous breathing efforts in an intubated patient. The oscillations in the capnogram due to a large ascending thoracic aneurysm are a separate entity from cardiogenic oscillations, and can be an indicator of underlying bronchial or lung compression.

Giant Epidermoid Cyst of the Posterior Fossa.

Epidermoids are rare intracranial neoplasms that grow slowly and present in the third to fifth decade of life. Giant epidermoid cysts are infrequent, and their occurrence in the posterior fossa is rare. We describe a similar case, where a patient presented with a long-standing history of headache, imbalance, and progressive weakness in the arms. Imaging revealed a giant space-occupying lesion in the posterior fossa measuring 6.25 cm x 7.56 cm x 6.8 cm, which was confirmed on histopathology to be an epidermoid cyst. The patient underwent suboccipital craniotomy extending up to the rectosigmoid junction to remove the same and was on a follow-up to check for recurrences.