Treatment of auricular seroma: a conservative, innovative, and effective approach.

OBJECTIVE: Auricular seroma is a cystic swelling filled with serous fluid. It occurs spontaneously or following trauma. Successful treatment of the seroma remains a challenge because this disease has a high propensity for recurrence. The aim was to study the results of the Plaster of Paris (POP) cast in treatment of seroma in terms of complete resolution of swelling, recurrence, and auricular aesthesis. STUDY DESIGN: Prospective. SETTING: Smt. Kashibai Navale Medical College and General Hospital. MATERIALS AND METHODS: A total of 48 patients with auricular seroma were studied. They were treated with aspiration of the cyst followed by compression dressing with a POP cast, taking the contour of the pinna. The POP cast was kept for 3 days. The patients were followed up for 6 months for recurrence. RESULTS: Out of 48 patients, 43 patients had complete resolution of the swelling in a single application of the POP cast. Five patients needed 2 applications of the POP cast. Not a single patient had recurrence. Temporary discoloration or thickening of the pinna was noted in 8 patients. No major complications like perichondritis were noted. CONCLUSION: Aspiration and contour dressing using POP is an innovative and effective treatment for management of auricular seroma as it prevents surgical trauma and recurrence and gives cosmetically excellent results.

A Comparative Evaluation of the Remineralization Potential of Two Contemporary Bioactive Glass-containing Dentifrices on Artificially Demineralized Human Enamel: An In Vitro Study.

Background: There is limited literature comparing the remineralization potential of these two dentifrices, Elsenz™, which contains fluoro calcium (Ca) phosphosilicate, and Shy-NM™, which contains Ca sodium phosphosilicate, are a few of the remineralizing agents. Aim: To assess and compare the remineralization potential of Elsenz™ and Shy-NM™ dentifrices on artificially induced carious lesions on permanent teeth, using the Vickers microhardness measuring method and scanning electron microscope (SEM) connected to energy dispersive X-ray analysis after laboratory stimulation of the oral environment employing the pH cycling model. Materials and methods: A total of 30 sound human premolar teeth were divided into six groups for both parameters. Group I-Elsenz™ dentifrice, group II-Shy-NM™ dentifrice, and group III-control. The surface microhardness (SMH) of the test specimens was evaluated followed by a scanning electron microscope with energy dispersive analysis (SEM-EDAX). The specimens were tested at baseline, demineralization, and remineralization. The collected data were subjected to statistical analysis. Results: Surface microhardness following remineralization with Elsenz™ was 359 Vickers hardness number (VHN), and with Shy-NM™ was 312 VHN. Elsenz™ showed significantly higher remineralization compared to Shy-NM™ (p = 0.002). The SEM-EDAX of the tooth specimens after remineralization revealed an increase in the Ca weight percentage (wt%) compared with demineralization values, which was statistically significant for both Elsenz™ (45.95 ± 3.55%) and Shy-NM™ (47.24 ± 1.99%), along with an increase in the phosphorus wt%, which was statistically significant for Elsenz™ (20.25 ± 0.95%) compared to Shy-NM™ (19.95 ± 0.59%). Conclusion: Within the scope of this study, the incorporation of fluoride in bioactive glass (BAG) in Elsenz™ had the potential to remineralize enamel better than Shy-NM™ dentifrice. It can, therefore, be concluded that Elsenz™, when compared with Shy-NM™, would be effective in inhibiting demineralization. How to cite this article: Thoutam SV, Kumar S, Naidu J. A Comparative Evaluation of the Remineralization Potential of Two Contemporary Bioactive Glass-containing Dentifrices on Artificially Demineralized Human Enamel: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(4):451-455.

The effect of urea infusion on the urinary concentrating mechanism in protein-depleted rats.

To explore the role of urea in the urinary concentrating mechanism, the contents of vasa recta, Henle's descending limbs and collecting ducts were sampled by micropuncture of the renal papilla before and after infusion of urea in 10 protein-depleted rats. Eight protein-depleted rats not given urea were similarly studied as a control group. After urea administration, osmolality and the concentrations of urea and nonurea solute of urine from both exposed and contralateral kideny increased significantly. The osmolality and urea concentration of fluid from the end of Henle's descending limb and vasa recta plasma and the tubule fluid-to-plasma inulin ratio in the end-descending limb all increased significantly after urea infusion. We interpret these observations to indicate that urea enhances urinary concentration by increasing the abstraction of water from the juxtamedullary nephron (presumably the descending limb), in agreement with the prediction of recent passive models of the urinary concentrating mechanism. However, the concentration of urea in fluid from the descending limb after urea infusion was high (261 plus or minus 31 mM) and the difference in solium concentration between descending limb fluid and vasa recta was small and statistically insignificant.

Multidrug resistant Mycobacterium tuberculosis in patients with human immunodeficiency virus infection.

Multidrug resistant Mycobacterium tuberculosis (MDR-MTB) infection has not been recognized as a serious problem in patients with human immunodeficiency virus (HIV) infection. Multidrug resistance (MDR) has appeared in our medical center in 24 out of 72 patients between January 1990 and May 1991 compared to 8 out of 132 patients within the period from 1982 to 1987 (relative risk 5.50 with 95 percent confidence interval 2.61 to 11.61). We describe 19 patients with MDR in MTB (isoniazid and at least one additional first line drug), who had serologic evidence of HIV infection, 13 of whom were diagnosed with acquired immunodeficiency syndrome (AIDS). The MTB cultures from 10 out of 19 patients with MDR were resistant to three or more drugs. Fifteen patients died although 9 out of these 15 had received at least a four-drug regimen for a mean time of seven weeks (range 2 to 12). This increase in MDR was seen in ten homosexuals and nine intravenous drug users. This rapid appearance of MDR-MTB strains is worrisome. New strategies for empiric therapy of such patients while awaiting sensitivity data are needed.

Lichen simplex chronicus - A Psychocutaneous disorder?

Lichen simplex chronicus is classified as a skin disorder determined or influenced by emotional factors. This study was conducted to determine the involvement of the psyche in this psychocutaneous disorder. Forty six patients of lichen simplex chronicus were chosen for this study. The severity of pruritus was rated on a 10 point scale. They then underwent a psychiatric interview using the Hamilton anxiety-depression scale to quantitate their mental state. The numerical values of anxiety and depression did not exceed 50% of the measuring scale. This could be due to the 'venting' or exteriorisation of the inner turmoil, in this case by itching. The correlation between anxiety and pruritus and that of depression and pruritus was studied and it was surmised that depression may be related to pruritus compared to anxiety.

Post-thyroidectomy early serum ionic calcium level: predictor of prolonged hypocalcemia.

One of the more common complications of thyroid surgery is postoperative hypocalcemia, which is potentially serious. Its clinical manifestations range from minimal twitching to life-threatening tetany. Affected patients might require a prolonged hospital stay and supplementation with calcium and vitamin D. In cases of post-thyroidectomy hypocalcemia, it is not always easy to predict which patients will require close monitoring of serum calcium levels. We conducted a study to determine whether early (<24 hr) measurement of serum ionic calcium (SiCa) levels can predict the development of post-thyroidectomy hypocalcemia. We retrospectively analyzed the charts of 150 adults (144 women and 6 men) who had undergone total or partial thyroidectomy, and we identified 42 patients (all women) who had either transient (<1 mo; n = 27) or prolonged (1 to 6 mo; n = 15) temporary hypocalcemia. We found that the patients who turned out to have prolonged hypocalcemia had significantly lower early levels of SiCa than did the patients who later developed only transient hypocalcemia (p = 0.000002). Also, patients with prolonged hypocalcemia had a significantly higher incidence of serious sequelae, including carpopedal spasms and signs of tetany. We conclude that early measurement of SiCa is a reliable predictor of prolonged temporary hypocalcemia following total or partial thyroidectomy.

Primary extra-cranial meningioma in the right submandibular region of an 18-year-old woman: a case report.

INTRODUCTION: Extra-cranial meningioma or ectopic meningioma is a rare tumor. This tumor has been reported in various anatomic sites in the head and neck, mediastinum, skin and soft tissues. We report a rare case of ectopic meningioma in the submandibular region detected by using fine-needle aspiration cytology, histopathology and immunohistochemistry. This case represents another unusual site for extra-cranial meningioma, which prompted us to report it. CASE PRESENTATION: An 18-year-old Dravidian woman presented with swelling in the right submandibular region. The computed tomographic scan findings were suggestive of a neoplastic mass lesion in the right submandibular region. Fine-needle aspiration cytology led to the differential diagnosis of a monomorphic adenoma of a salivary gland or an ectopic meningioma. The patient underwent excision of the submandibular gland and tumor. The histological examination and immunohistochemistry studies confirmed that the lesion was an extra-cranial meningioma. At her two-year follow-up examination, there was no recurrence of the tumor. CONCLUSION: Our experience with this case indicates that, although rare, meningioma should be entertained in the differential diagnosis of a mass lesion in the head and neck region.

Cardiopathia fantastica and arteritis factitia as manifestations of Munchausen syndrome.

We describe three patients, each with a cardiovascular presentation of Munchausen's syndrome. Two patients' symptoms masqueraded as unstable angina (cardiopathia fantastica); one required intra-aortic balloon counterpulsation, while repeated cardiac catheterizations revealed normal coronary arteries. The third patient, with at least 27 documented hospital admissions, first presented as the cardiopathia fantastica variety and progressed to recurrent thromboembolism and limb amputations as a result of iatrogenic complications induced by angiographic and surgical procedures (arteritis factitia).

Water extraction from the inner medullary collecting tubule system: a role for urea.

Recent examinations of the inner medullary collecting tubule membrane in vitro have demonstrated that its reflection coefficient to urea (sigma urea) is significantly less than unity and less than sigma NaClhe presence of antidiuretic hormone. Fluid entering the inner medullary collecting tubule has a higher urea concentration and lower NaCl concentration than does the medullary interstitium, although total osmolarity is nearly equal on either side of the membrane. The transtubular difference in solute composition, together with the difference between sigma urea and sigma NaCl, should result in a driving force for extraction of water from the tubule. This hypothesis was examined in a differential analysis of water and solute fluxes across the collecting tubule epitheliu. The results indicate that this driving force contributes significantly to water extraction from the inner medullary collecting tubule.

Potassium secretion by the decending limb or pars recta of the juxtamedullary nephron in vivo.

Potassium reabsorption by the juxtamedullary nephron up to the hairpin turn was studied by the micropuncture technique in the exposed renal papilla of rats. In 18 nondiuretic rats, the fraction of filtered potassium remaining at the end of the desdending limb averaged 113 +/- 9%, indicating either that potassium is not reabsorbed by the juxtamedullary proximal tubule and descending limb or that potassium is reabsorbed and secreted in those segments. Furosemide, a drug which inhibits NaCl reabsorption in the ascending limb downstream from the descending limb, significantly decreased the potassium remaining at the end of the descending limb from 106 +/- 12 to 72 +/-11% in seven rats. Benzolamide, a drug which inhibits reabsorption of NaHCO3 and water in the proximal tubule upstream from the descending limb significantly increased the potassium remaining from 103 +/- 13 to 177 +/- 32% in eight rats. These findings support the hypothesis that in the rat, potassium is normally reabsorbed by the proximal convoluted tubule and secreted in the pars recta or descending limb of the juxtamedullary nephron.

An examination of transcapillary water flux in renal inner medulla.

We recently demonstrated that net fluid uptake occurs in the capillary system of the inner medulla. To define the site of fluid uptake, the concentration of protein was determined in plasma from descending vasa recta at the base and tip of the exposed papilla in Munich-Wister rats. The vasa recta plasma-to-arterial plasma protein concentration ratio (VR/P) was 1.43 +/- 0.09 at the base and 1.66 +/- 0.09 at the tip. These results, which indicate fluid loss from the descending vasa recta, are difficult to explain on the basic of hydraulic and oncotic forces alone. The osmolality of the contents of descending vasa recta increased between base and tip (delta = 72 +/- 30 mosmol/kg H2O). If the increase in osmolality of plasma in descending vasa recta lags behind that of the adjacent medullary interstitium, a transcapillary osmotic driving force exists favoring water loss from descending vessels. It is concluded that fluid uptake by the inner medullary circulation occurs beyond descending vasa recta in interconnecting capillaries or ascending vasa recta. In our view the most likely interpretation of these results is that fluid movement across vasa recta in the inner medulla is influenced by three forces: those owing to transcapillary differences in osmotic, oncotic, and hydraulic pressures.

Hydraulic and oncotic pressure measurements in inner medulla of mammalian kidney.

The vasa recta are thought to play an important role in the transfer of water andsolutes within the renal medulla. Hydraulic pressures were measured in vasa recta onthe surface of the exposed papilla in young Munich Wistar rats, and blood was collected from these microvessels for determination of total protein concentration and calculation of colloid oncotic pressure. In descending vasa recta at the base of the exposed papilla, mean hydraulic pressure was 9.2 plus or minus 0.4 (SE) mmHg and plasma protein concentration averaged 7.1 plus or minus 0.4 g/100 ml. Corresponding valuesin ascending vasa recta at the same level were 7.8 plus or minus 0.4 mmHg and 5.6 plusor minus 0.3 g/100 ml. respectively. The protein concentrations correspond to calculated oncotic pressures of 26 and 18 mmHg in descending and ascending vasa recta, respectively. We interpret these findings as evidence for net water uptake by the vasa recta in the renal inner medulla for which the driving forces are the transcapillary hydraulic and oncotic pressure differences.