Evaluation of Effectiveness of Two Different Endodontic Retreatment Systems in Removal of Gutta-percha: An in vitro Study.

AIM: To determine the effectiveness of two different endodontic retreatment systems for the removal of laterally compacted gutta-percha (GP). MATERIALS AND METHODS: Sixty-three freshly extracted human maxillary central incisors were used for the study. The teeth were instrumented with K-flex files and obturated using lateral condensation technique with GP and AH Plus sealer. The teeth were divided into three retreatment groups, each group consisting of 21 teeth. Group I: D-RaCe desobturation files (D-RaCe); group II: ProTaper Universal retreatment files (PTUR); group III: Hedstrom files (H-file). After removal of GP, the teeth were split longitudinally and divided into three equal parts: Cervical, middle, and apical third. The middle and apical thirds of all root halves were examined using scanning electron microscope (SEM). The total surface area covered by the residual debris was evaluated using Motic Image plus 2.0 software. Statistical analysis was done by one-way analysis of variance (ANOVA) test with a p-value <0.05 used to determine significance and Tukey's multiple post hoc tests used for comparison between the groups, and 't' test was done for comparison between the thirds within the same group. RESULTS: The PTUR retreatment files showed overall better performance compared with D-RaCe files and H-files. The PTUR files performed better at middle third compared with others. The PTUR files and D-RaCe files performed equally at apical third better than H-files. CONCLUSION: ProTaper retreatment files are better compared with D-RaCe files and H-files for the retreatment of the previously endodontically treated teeth. CLINICAL SIGNIFICANCE: Highest efficacy for the removal of GP was shown by ProTaper Universal System followed by D-RaCe and H-file.

Results of AlloDerm use in abdominal hernia repair.

BACKGROUND: AlloDerm (decellularized human cadaveric dermis) is increasingly being used for tissue reconstruction and hernia repairs. This article presents the results of AlloDerm use in treating abdominal wall hernias by analyzing all patients who underwent repair with AlloDerm at our institution. METHODS: A series of 70 consecutive patients starting in October 2003 with abdominal wall hernia repair using AlloDerm was studied. This study began as a retrospective chart review, which included subsequent postoperative follow-up. SPSS version 11.5 was used for statistical analysis, and parametric tests were conducted. Various technical variables (type of AlloDerm placement, mesh-suture technique, suture type) and nontechnical variables (steroids use, obesity, smoking status, diabetes, prior surgeries, number of comorbidities) were evaluated. RESULTS: Of 70 study patients, 31 were men and 39 were women, with a mean age of 58 (range 25-88) years. Fifty-six patients (80%) had no complications, whereas 14 (20%) suffered one or more complications. Of those patients with complications, there was one rejection, two infections, and 14 hernia recurrences. The overall complication rate was 24%. Of patients with hernia recurrences, one had the initial repair with AlloDerm implant of <1.8-mm thickness (thick) and 13 patients had their initial repair with AlloDerm implant of >1.8-mm thickness (ultrathick). The 14 patients with recurrences include three who had a prior AlloDerm repair with ultrathick implant. Two of these three patients reported abdominal wall protrusion, and one had a recurrence between two pieces of AlloDerm used in the initial repair. Of these 14 patients, nine had subsequent repair of their recurrence with synthetic mesh, and four had subsequent repair with AlloDerm with satisfactory outcomes; one patient was yet to have a repair at the time of this paper. Recurrence rates with ultrathick and thick AlloDerm were 23% and 6%, respectively. None of the patients who were on steroid therapy had complications. Mesh-suture technique had no effect on recurrence. Type of placement was positively correlated with infection (Pearson's R 0.575, p 0.05), showing that onlay mesh is better than underlay/interpositional mesh in having a lower infection rate. Diabetes was associated with mesh infection (Pearson's R 0.548, p 0.05), and redo hernia repair was associated with longer length of hospital stay (LOS). The average number of comorbidities was five for the series. LOS positively correlated with presence of comorbidities. CONCLUSIONS: Early results in repair of abdominal hernia with AlloDerm appear to have a complication rate of 24%. Recurrence is the most common complication. Thinner AlloDerm use has better outcomes with less recurrence. Careful analysis regarding the technical aspects and presence of comorbidities may be explored to improve the present outcomes to prevent recurrences.

Bone impregnated hip screw in femoral neck fracture: Clinicoradiological results.

BACKGROUND: Femoral neck fractures are treated either by internal fixation or arthroplasty. Usually, cannulated cancellous screws are used for osteosynthesis of fracture neck of femur. The bone impregnated hip screw (BIHS) is an alternative implant, where osteosyntehsis is required in femoral neck fracture. MATERIALS AND METHODS: The BIHS is a hollow screw with thread diameter 8.3 mm, shank diameter 6.5 mm and wall thickness 2.2 mm and holes in the shaft of the screw with diameter 2 mm, placed in a staggered fashion. Biomechanical and animal experimental studies were done. Clinical study was done in two phases: Phase 1 in a group of volunteers, only with BIHS was used in a pilot study and phase 2 comparative study was done in a group with AO cannulated screws and the other group treated with BIHS. RESULTS: In the phase 1 study, out of 15 patients, only one patient had delayed union. In phase 2, there were 78 patients, 44 patients in BIHS showed early union, compared to the rest 34 cases of AO cannulated screws Out of 44 patients with BIHS, 41 patients had an excellent outcome, 2 had nonunions and one implant breakage was noted. CONCLUSIONS: Bone impregnated hip screw has shown to provide early solid union since it incorporates the biomechanical principles and also increases the osteogenic potential and hence, found superior to conventional cannulated cancellous screw.

Laparoscopic cholecystectomy: fundus-down approach.

BACKGROUND AND PURPOSE: Laparoscopic cholecystectomy (LC) is the primary treatment of gallstone disease. Although refinements have made it safer, bile duct injury remains more common than with the open approach. The major difference in these techniques is that open cholecystectomy approaches the gallbladder from the fundus downward, whereas conventional laparoscopic cholecystectomy proceeds in the reverse direction. A handful of fundus-down techniques appear in the literature. The use of special instruments or port sites is common. We present a technique that is safe and utilizes instruments familiar to the surgeon performing conventional LC. PATIENTS AND METHODS: Fifty consecutive LCs were included in the study. The variables monitored were age, comorbidities, postoperative diagnosis, pathologic diagnosis, length of operation, hospital length of stay, and complications. RESULTS: The average operating time for chronic cholecystitis was 1 hour, and the average time for acute cholecystitis was less than 2 hours. Except for one early case of bleeding, in which the procedure was completed using the familiar conventional method, no complications and no unusual technical difficulties were encountered. There were no differences between conventional and fundus-down LC with regard to time and complications. CONCLUSIONS: This technique is safe and has several benefits: (1) standard trocar sites that offer the surgeon flexibility in the approach; (2) the ability to resect as much cystic duct as desired; and (3) utilization of standard instruments familiar to the surgeon, thus avoiding costly special instruments. The approach may offer the benefit of reducing the rate of common bile duct injury to that of open cholecystectomy.

Laparoscopic cholecystojejunostomy: a technical application in unresectable biliary obstruction.

Laparoscopic cholecystojejunostomy was accomplished utilizing an endoscopic gastrointestinal stapler in 2 patients with biliary obstruction and jaundice secondary to inoperable pancreatic carcinoma. This technique was performed on patients judged to be poor candidates for an open resection, due to medical conditions and associated comorbidities. The actual operating time, taking into account delays not related to the operation or technique, was 45-60 min. Both patients experienced immediate significant overall clinical improvement with minimal operative sequelae. The first patient was eating and ready for discharge in 4 days, and the second was prepared for discharge in less than 24 h. This operative procedure offers the patient excellent palliation with many advantages over traditional open surgery.

Laparoscopic management of pseudomyxoma peritonei secondary to adenocarcinoma of the appendix.

Pseudomyxoma peritonei is a rare disease in which the abdominal cavity fills with thick mucoid material secondary to either benign or malignant conditions. We discuss a case where pseudomyxoma peritonei secondary to adenocarcinoma of the appendix was diagnosed and managed laparoscopically. The laparoscopic approach allows thorough exploration of the abdomen, as well as irrigation and aspiration of the thick mucinous material using a 10-mm suction cannula and the instillation of mucolytic agents such as 5% dextrose solution. Appendectomy or right hemicolectomy can be performed with minimal disturbance of the anterior abdominal wall, thus minimizing future adhesions as well as possible tumor-cell implantation. Intraperitoneal catheters for chemotherapy can be placed easily through the port sites. These measures offer an alternative to radical peritoneal dissection and can be accomplished during the initial laparoscopic exploration.

Intussusception of the appendix.

Two cases of intussusception of the appendix are reported--one caused by adenocarcinoma and adenomatous polyp and the other by an endometrioma. Appendiceal intussusception and adenocarcinoma are both uncommon entities and this is the first report of the two occurring concomitantly. Due to variable symptoms, the correct diagnosis of appendiceal intussusception has rarely been made preoperatively. Classification, symptoms, radiographic appearance, and differential diagnosis are discussed, and the authors suggest a new classification for intussusception of the appendix.