Antibacterial and smear layer removal efficacy of moringa (Moringa oleifera): An in vitro study.

Objective: This study evaluated the effectiveness of moringa (Moringa oleifera) leaves decoction for removing a smear layer compared to sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA), as well as its antimicrobial activities. Methods: The moringa leaves were extracted using hot water decoction at two different concentrations (2.5% and 5.0% w/v). A total of 30 extracted human single-rooted teeth were prepared to assess the smear layer removal efficacy. The presence of a smear layer in the middle third of the root canal was detected by confocal microscopy. Then the antibacterial effects were assessed against Enterococcus faecalis and Streptococcus mutans bacteria using the agar diffusion method. Results: The 2.5% and 5.0% decoction were significantly more effective than 0.25% NaOCl in removing the smear layer (p < 0.05); however, no significant difference was observed compared to EDTA (p > 0.05). The in vitro antimicrobial assay showed that 5.0% decoction had higher antimicrobial activity against both of the test pathogens. Conclusion: The findings of this study suggest that moringa leaves decoction can be considered an effective irrigant in endodontics.

[Evolution of severe pain associated to spontaneous spinal epidural hematoma]. / Evolución del dolor severo asociado al hematoma espinal epidural espontáneo.

INTRODUCTION: Spontaneous spinal epidural hematoma is an infrequent disease, whose clinical presentation is very characteristic, with severe pain in region corresponding to the metameres affected, which orients its diagnosis and early treatment. CLINICAL CASES: Three clinical cases that occurred during 2003 and 2004 are presented. All three were middle- aged men, with spondyloarthrosis signs, posterolateral cervical location of hematoma, which debuted with severe cervical and cervicobrachial pain. This was followed by acute onset motor and sensory paralysis with spontaneous complete recovery in hours, only the pain persisting. The three patients were treated conservatively, pain being the main symptom. This pain only responded to intravenous steroids. CONCLUSIONS: The evolution of the pain and pathophysiological mechanism by which the corticoids could improve the pain associated to these diseases are discussed.

[Vascular hemichorea: clinical-radiological correlation]. / Hemicorea vascular: correlación clínico-radiológica.

INTRODUCTION: Hemichorea is uncommon in acute cerebrovascular accidents. Its appearance is in relation to the contralateral involvement of the basal ganglia, particularly the striate ganglion. With current neuroimaging techniques it is possible to identify the lesions responsible for these abnormal movements. Magnetic resonance (MR) is the technique of choice for detection of small sized lesions. OBJECTIVE: We have analysed our series of patients to try to relate the site of the lesion to the appearance of chorea. PATIENTS AND METHODS: We made a retrospective study of the cases of hemichorea of vascular origin admitted between January 1993 and April 1999. In all cases, cerebral CAT and/or MR had been done to find the site of the lesion. RESULTS: A total of 10 patients with an average age of 72.5 years (range: 55-85) was found. In eight of them (80%) lesions were found in the basal ganglia, half of which were of ischemic type and the other half hemorrhagic. The sites were: caudate nucleus in one case (10%), thalamus in two cases (20%) and capsulo-lenticular lesions in five cases (50%). All lesions were contralateral to the side of the body affected except in one case with a left thalamic haematoma and homolateral hemichorea. CONCLUSIONS: The lesions found were very varied in site. In 20% of the cases they were not detected by conventional neuroimaging techniques. This fact supports the concept of a functional global network of the basal ganglia which may be interrupted at several points and lead to the same clinical findings.

[Reference values for the central motor conduction time and silent period obtained by the transcranial magnetic stimulation]. / Valores de referencia para el tiempo de conducción motora central y período silente obtenidos por estimulación magnética transcraneal.

INTRODUCTION: Normal values of reference to transcranial magnetic stimulation for the motor central conduction time (CCT) and silent period (SP) is recorded in 30 healthy control subjects over abductor pollicis brevis. MATERIAL AND METHODS: We get for the CCT four measurements: two with low intensity of stimulus, 5% plus the motor threshold, with and without facilitation (CCT1 and CCT1 fac.); and two with high intensities of stimulus, elevating the magnetic stimulation intensity to 1.5 times the threshold (CCT2 and CCT2 fac.). RESULTS AND CONCLUSIONS: The mean and standard deviation of each measurement are: CCT1: 9.34 +/- 1.19, CCT1 fac.: 7.12 +/- 1.1. CCT2: 8.84 +/- 1.05 and CCT2 fac.: 6.57 +/- 1.05. Given that the CCT and SP doesn't follow a normal distribution, the medium and the 5-95% percentiles for the normal values of reference are calculated; there are: CCT1: 7.15-11.32, CCT1 fac: 5.27-9.42. CCT2: 7.05-10.73 and CCT2 fac: 4.91-9.14. For the silent period gets only one measurement employing high intensities. These last measurement were recorded in two localizations: on vertex and on motor area, selecting the greater duration. Given the great individual variability of this period in normal population absolute and ratio for the difference duration of SP between both sides are calculated. The latency of the SP is 50.2 +/- 5.99, 95 percentiles 39.1-64.63, the duration 151 +/- 32.51, 95 percentiles 102.63-239.55. The total SP measured from the discharge of the stimulus to the end of the silent period is 201.71 +/- 33.27; 95 percentiles: 151.39-296.4. The comparison of both hemispheres would give us pathological security for the 99.99% of the population for more than 14.94 ms of absolute difference, and for less of the 79.81% of ratio difference. A summary of the discoveries of the silent period in different pathologies is contributed in the discussion.

PET perfusion and vasodilator function after angioplasty for acute myocardial infarction.

UNLABELLED: The aims of this study were to validate invasive coronary Doppler flows against noninvasive PET assessments of myocardial perfusion and to examine the timing and degree of regional coronary vasodilator reserve recovery in patients who are successfully reperfused with primary angioplasty (PTCA) for acute myocardial infarction. METHODS: PTCA was performed in 21 consecutive patients with acute myocardial infarction; the final diameter stenosis was 25% +/- 7%. After restoration of TIMI Grade 3 flow, all patients underwent quantitative coronary angiography and distal Doppler coronary blood flow studies (basal and after adenosine-induced hyperemia) in the infarct and noninfarct vessels. Regional myocardial perfusion and vasodilator function were quantitated after intravenous adenosine infusion PET in all patients at 26 +/- 9 hr after acute PTCA. These were repeated in 17 patients 9 +/- 3 days later. RESULTS: Post-PTCA resting coronary flow was 35 +/- 15 ml/min in the infarct-related vessels and 50 +/- 24 ml/min during peak hyperemia (p < 0.05). Coronary flow reserve (CFR) was 1.48 +/- 0.34 and 2.08 +/- 0.62 in the infarct and noninfarct vessels, respectively (p < 0.001). Early (< 36 hr) PET myocardial perfusion reserves (MPR) in the infarct and noninfarct regions were 1.59 +/- 0.33 and 2.03 +/- 0.62 (p < 0.01). Doppler CFR and PET MPR were correlated in the infarct (r = 0.61, p < 0.01) and noninfarct (r = 0.77, p < 0.0001) regions. Follow-up PET studies demonstrated improved MPR in both infarct and noninfarct regions (1.93 +/- 0.52 versus 2.54 +/- 0.97, p < 0.01). The improvement in coronary vasodilator function from the time of acute PTCA to follow-up PET in the infarct region was significant (p = 0.005). CONCLUSION: After successful mechanical revascularization by PTCA after acute myocardial infarction, intracoronary Doppler blood flows and noninvasive PET regional myocardial perfusion are correlated within the wide range of reperfusion blood flows observed in patients with contrast angiographic TIMI Grade 3 flow. Serial PET studies demonstrated a trend towards continued improvement in the vasodilator response in infarct-related myocardial regions after the restoration of blood flow by PTCA. PET offers the potential for accurate noninvasive serial assessment of reperfusion blood flow after primary angioplasty for acute myocardial infarction.

Clinical outcome of patients evaluated with emergency centre myocardial perfusion SPET for unexplained chest pain.

The clinical outcome of 68 patients with unexplained chest pain triaged with emergency centre (EC) SPET myocardial perfusion imaging (MPI) was assessed at 9 month follow-up. Based on clinical presentation and EC-MPI, 63% (43/68) of patients were discharged from the EC; 84% (36/43) of these patients reported no further symptoms at follow-up. There were no adverse clinical events in patients with totally normal EC-MPI.

Cost-effectiveness of myocardial perfusion imaging with SPECT in the emergency department evaluation of patients with unexplained chest pain.

PURPOSE: To determine the cost-effectiveness of promptly performing myocardial perfusion (MP) imaging with single photon emission computed tomography (SPECT) in patients presenting to the emergency department with unexplained chest pain. MATERIALS AND METHODS: Fifty patients with unexplained chest pain underwent MP imaging with SPECT and technetium-99m sestamibi. The cardiologists' management plans before and after receipt of imaging findings were compared. Costs were determined from analysis of comparable admissions for the 6 months before the start of the study. RESULTS: The cardiologists' confidence in their clinical diagnosis significantly increased with use of MP imaging (P<.0001). MP imaging results altered management decisions in 34 patients. Twenty-nine patients were sent home on the basis of imaging findings. None of the patients with a normal MP image experienced a serious adverse cardiac event. The total savings to the hospital was $39,296, or $786 per patient. CONCLUSION: Performing MP imaging in patients with unexplained chest pain while in the emergency department is cost-effective.

Modified PIOPED criteria used in clinical practice.

UNLABELLED: To assess the use of modified PIOPED scintigraphic criteria for lung scan (V/Q) interpretation to detect pulmonary embolism (PE), we prospectively applied these criteria in suspected PE patients referred for V/Q from 9/1/92 to 2/7/94. PIOPED criteria were modified by placing a moderate segmental perfusion mismatch in the intermediate instead of low probability of PE category and using the "stripe sign." METHODS: Patients were studied by six-view V/Q imaging using 74 MBq (2 mCi) 99mTc-MAA followed by 148-370 MBq (4-10 mCi) 99mTc-DTPA aerosol, contrast pulmonary selective angiography and Doppler sonography with leg compression as needed. Patients underwent follow-up (mean 13.9 mo) to detect subsequent thromboembolic events. In this study group, 1000 patients were studied by V/Q followed by angiography in 133 patients. RESULTS: The distribution of V/Q-assigned PE probabilities was: high probability 5.7%, intermediate 17.4%, low 41.4% and normal 35.5%. Group A patients (133) underwent angiography, which resulted in the determination of a 27.1% PE prevalence. Group B patients (867) did not have angiograms; the clinical prevalence of PE was 7.5%. In the total study population, the positive predictive value of a high probability V/Q study for PE (10.1% prevalence) was 98.2%, intermediate probability V/Q study for PE was 24.1% and a low probability study for PE was only 0.5%. CONCLUSION: Modified PIOPED V/Q interpretation criteria afford better angioproven PE discrimination between intermediate (31.8% PE prevalence) and low (5.5% PE prevalence) probability V/Q results than reported for PIOPED intermediate (32.6% PE prevalence) and low (16.3% PE prevalence) probability V/Q interpretation criteria.

Quantitative myocardial SPECT for infarct sizing: feasibility of a multicenter trial evaluated using a cardiac phantom.

UNLABELLED: This study determined the feasibility of performing a multicenter trial using quantitative SPECT myocardial perfusion imaging in patients with acute myocardial infarction. The feasibility was assessed by a cardiac phantom. METHODS: Twenty-two gamma camera systems in 19 laboratories were evaluated. Each laboratory performed nine studies on the cardiac phantom and performed quality control tests of system uniformity, collimator quality and gantry alignment on their gamma camera system. Defects simulating "hypoperfused" myocardium of differing amounts were placed in the myocardium for eight of the nine studies. Measured defect size was compared to true defect size. RESULTS: A total of 198 studies from 22 systems were analyzed. Three studies were technically inadequate. For all 22 systems, the average correlation coefficient between true and measured defect size was 0.992 +/- 0.009, with a range from 1.00 to 0.97. Three systems were rejected due to slopes of the regression line outside the limits 1.00 +/- 0.10 and mean errors > 5% in estimating defect size. The remaining systems had a correlation coefficient of 0.995 + 0.008 with an average slope of 1.00 +/- 0.04 and an intercept of 0.11% +/- 1.57%. The mean error in estimating defect size was 2.08% +/- 0.69%. CONCLUSION: The small interlaboratory variation and the close correlation with true defect size observed in a cardiac phantom indicate the feasibility of quantitative myocardial SPECT as a useful tool in multicenter trials evaluating therapy in acute myocardial infarction. Preliminary objective testing is required, however, to identify systems with technical deficiencies.

Krukenberg tumor and lung metastases from colon carcinoma diagnosed with F-18 FDG PET.

The authors report a case of a patient with postsurgical colorectal carcinoma and metastatic disease to the ovaries (Krukenberg tumor), the lung, and the liver first revealed by F-18 FDG PET imaging. The value of PET in a patient with an unexplained rising CEA is cited.

Indium-111 OncoScint CR/OV and F-18 FDG in colorectal and ovarian carcinoma recurrences. Early observations.

Indium-111 satumomab pendetide (In-111 OncoScint) planar and SPECT imaging and F-18 FDG positron emission tomography (PET) have been found individually to be helpful in the detection of recurrent colorectal and ovarian cancer, but have not been compared. Twelve patients who were examined for recurrent colorectal or ovarian carcinoma underwent both In-111 OncoScint imaging and F-18 FDG PET imaging. All had normal or equivocal results of CT or MR studies. Tumor detection abilities were similar in most cases. However, Oncoscint demonstrated an advantage in the detection of carcinomatosis. PET demonstrated an advantage in detecting focal tumor recurrence in one case and, not unexpectedly, in detecting liver metastases. All positive nuclear studies for tumor were found to be true-positives at pathology (7 patients), or by diagnostic new CT changes (1 patient). Finally, unreported, bone marrow, bowel, and colostomy sites appear to be normal sites of localization of F-18 FDG 1 hour after injection.

Watershed ischemia demonstrated with acetazolamide enhanced Tc-99m HMPAO SPECT.

A 75-year-old man who had a small right parietal infarction 8 months earlier underwent baseline and acetazolamide enhanced Tc-99m hexamethylpropylene amineoxime brain SPECT imaging. The acetazolamide study demonstrated a bilaterally symmetric perfusion deficit posteriorly near the midline. The baseline study was essentially normal. This finding was felt to represent watershed ischemia at the junction of the anterior circulations (anterior cerebral and middle cerebral arteries) and the posterior circulation (posterior cerebral artery). Carotid arteriography subsequently demonstrated left subclavian steal syndrome with retrograde flow through the left vertebral artery.

Ventilation-perfusion scintigraphy in the PIOPED study. Part I. Data collection and tabulation.

The Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) study of more than 700 patients is the largest existing study of the accuracy of lung scintigraphy in the diagnosis of acute pulmonary embolism. Perfusion scans were obtained in all patients and ventilation scans in almost all, using standardized techniques. Chest radiographs were obtained in all patients within 12 hr of the lung scan. Most patients underwent pulmonary arteriography. The images were interpreted according to a set of interpretive criteria which remained constant throughout the trial. A standardized, detailed description of each image set was derived by consensus of teams of two readers blinded to clinical and arteriographic findings. This communication reports the methods used to describe and categorize the ventilation-perfusion scintigrams obtained in patients who were enrolled in the PIOPED study. Scintigraphic technique is reviewed briefly, probability assessment is described and the scan description is reviewed in detail. The form used to describe the findings on ventilation-perfusion scans is reproduced. Use of this standardized description permits retrospective evaluation of the PIOPED interpretive criteria. In addition, it represents a rigorous approach to scan analysis which could facilitate application of formal interpretive schemes and enhance the reproducibility of lung scan interpretations in the clinical setting.