Pulp treatment for extensive decay in primary teeth.

BACKGROUND: Dental decay in primary teeth remains a considerable health problem. Where decay extends to involve the dental pulp, pulp treatment techniques are often used to manage both symptomatic and symptom free teeth. OBJECTIVES: To assess the relative effectiveness of: various pulp treatment techniques in retaining primary molar teeth with decay involving the pulp for at least 12 months; pulp treatment techniques and extractions in avoiding long term sequelae. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (August 2002); the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to August 2002); EMBASE (1980 to August 2002); Science Citation Index Expanded (1981 to August 2002); Social Science Citation Index (1981 to August 2002); Index to Scientific and Technical Proceedings (1982 to August 2002); System for Information on Grey Literature in Europe (August 2002). Key journals were handsearched. There was no restriction on language of publication. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs) comparing different pulp treatment techniques (with each other, with extraction or with no treatment) for extensive decay in primary molar teeth. Primary outcomes were extractions following pulp treatment and long term effects. DATA COLLECTION AND ANALYSIS: Data extraction and quality assessment were carried out independently and in duplicate. Authors were contacted for additional information where necessary. MAIN RESULTS: Eighty-two studies were identified but only three were suitable for inclusion. Nine studies meeting the inclusion criteria but with inappropriate study design or analysis are also described. Included trials investigated formocresol pulpotomy, ferric sulphate pulpotomy, electrosurgical pulpotomy or zinc oxide eugenol pulpectomy in symptom free, cariously exposed teeth. Data were unavailable on long term effects. Data on extraction following pulp treatment was available in all three studies and in two studies there was no statistically significant difference between the treatments. The difference seen in the other study, where more teeth treated by ferric sulphate pulpotomy were extracted compared to zinc oxide eugenol pulpectomy, must be viewed with caution. REVIEWER'S CONCLUSIONS: Based on the available RCTs, there is no reliable evidence supporting the superiority of one type of treatment for pulpally involved primary molars. No conclusions can be made as to the optimum treatment or techniques for pulpally involved primary molar teeth due to the scarcity of reliable scientific research. High quality RCTs, with appropriate unit of randomisation and analysis are needed.

[Echography in renal tumors]. / L'ecografia nei tumori renali.

Echography is highly important today for the identification and differentiation of renal diseases. It also enable target biopsy of identified lesions to be carried out, thus making for precise histological diagnosis. Indications and results of echography in the diagnosis of 97 cases of suspect masses of renal origin consisting of cysts, hydropyonephrosis, tumours, multicystic and polycystic kidneys are considered. Overall diagnostic accuracy was 92.7%. The features pointing to differential diagnosis of individual lesions and the method of examination, based on the use A and B Scan with grey scale are described. It is concluded that, with their high diagnostic accuracy and non-invasivity, scanning techniques represent an indespensable tool for the diagnosis of renal masses.

Memory and midazolam conscious sedation.

OBJECTIVE: To investigate the degree of amnesia seen in patients undergoing minor oral surgery with intravenous midazolam sedation. SETTING: Hospital out-patients in the UK in 1995-6. SUBJECTS: 24 patients undergoing minor oral surgery procedures under local anaesthetic, with or without midazolam sedation, as determined by clinical need. METHOD: Picture cards were shown to patients before and during the procedure. Post-operatively, before discharge and 1 week later, the patients were questioned about their memory of both the pictures and procedure. RESULTS: The sedated group demonstrated more amnesia for the pictures shown after the start of treatment, but their memory of the pretreatment pictures was initially better than that of the non-sedated patients. The non-sedated patients exhibited no memory loss for the surgical procedure. Recall of the surgery was very variable among the sedated patients, from some remembering all aspects, to others with no recollection after the venepuncture. Overall, the sedated patients exhibited significantly greater amnesia for the surgical procedure. The degree of amnesia in the sedated group was also investigated with respect to pretreatment anxiety levels, sedation level achieved and the dose of midazolam administered. The first two variables did not exhibit any effect on the memory loss, but higher doses (> 5 mg) were associated with more consistent amnesia especially for the later stages of the procedure. CONCLUSION: Midazolam can produce useful amnesia in many patients and the memory loss can be high for both artificial and procedural stimuli. However this study suggests that the amnesia is not completely reliable, especially at lower doses.