Comparative Evaluation of Apically Extruded Debris During Root Canal Preparation Using Three Different File Systems Applied Under 2.5% Sodium Hypochlorite or 2% CHX Irrigation.

The chemomechanical cleaning of the root canal system is performed using manual and rotary files. This study aimed to compare the effect of ProTaper, Reciproc and HyFlex rotary files considering 2.5% sodium hypochlorite and 2% chlorhexidine (CHX) as irrigating solutions on apical extrusion of intracanal debris. Single-canal mandibular premolars (N=165) were evaluated. The teeth were divided into 6 experimental groups (N=25) for root canal instrumentation using 3 file systems, (Reciproc, HyFlex and ProTaper) and two irrigation solutions, namely 2.5% sodium hypochlorite or 2% CHX. Fifteen teeth were also assigned into three control groups (n=5) with saline as irrigation solution. Eppendorf tubes were weighed and the teeth were placed inside. The canals were instrumented and the tubes weighed to determine the dry weight of extruded debris. Data were analyzed using one-way ANOVA and Bonferroni test (α=0.05). The mean amount of extruded debris using the sodium hypochlorite solution was significantly higher than other irrigating solutions (p⟨0.001). The mean amount of extruded debris using the Reciproc file system was significantly higher compared to ProTaper and HyFlex (p⟨0.001). The use of the sodium hypochlorite solution, single-file systems and reciprocal movement are associated with higher debris extrusion and might be associated with higher risk of postoperative pain.

Serotonin syndrome presenting with migrainelike stroke.

UNLABELLED: Serotonin syndrome is the result of the drug interaction that enhances serotonergic tone in the central nervous system. The neurological manifestations are transient in most of the reported cases with rare fatality. CASE DESCRIPTION: A 30-year-old woman developed ischemic infarction of the right temporoparietal and cerebellar hemispheres 48 hours after administration of a large dose of clomipramine. This drug was given within 24 hours of discontinuation of high-dose fluoxetine, both of which are known to enhance serotonergic tone in the central nervous system. The distribution of the ischemic infarction in this case did not respect the major territorial arteries and was similar to spreading oligemia/ischemia that is described in migraine. A similar pathogenesis may exist for stroke in serotonin syndrome and in migraine.

Psychogenic events presenting as parasomnia.

A 10-year-old child suddenly developed nocturnal enuresis and nocturnal behaviors similar to parasomnia that were occasionally violent. The child had no recollection of the events. Continuous video/electroencephalograph monitoring revealed the episodic nocturnal events with bizarre behaviors during what was perceived to be sleep, but in fact, the child was fully awake with his eyes closed, prior to and during the events. The attacks ceased with individual psychotherapy and family counseling.

Effect of epilepsy and sleep deprivation on the rate of benign epileptiform transients of sleep.

Seventy-eight individuals with EEG records containing benign epileptiform transients of sleep (BETS) were identified among 7,400 records reviewed in our laboratory in a 6-year period. The records contained no other abnormality in 51 patients (65%). Genuine epileptiform discharges were found in the records of 19 patients; 14 had a history of epilepsy. Thirty-five patients (45%) had a proven history of epilepsy with antiepileptic drug (AED) therapy. In the records of these patients, the mean number of BETS per unit of time was significantly higher (11.88 +/- 2) than in the record of the rest of the laboratory population with BETS (6.89 +/- 0.9) (p less than 0.02). Among five conventional surface montages, ipsilateral ear referential montage (IERM) showed a significantly higher number of BETS per unit of time than did any other surface montage used in the study. Thirty-nine records (50%) were performed after sleep deprivation (SD). When only IERM was considered, SD records showed a significantly higher number of BETS per unit of time (7.36 +/- 1.1) than did non-SD records (3.89 +/- 0.69) (p less than 0.01). Our findings support the general consensus that individual BETS may be normal variants, but a high occurrence of BETS in the record should raise suspicion of underlying epilepsy.

Effect of naloxone infusion on the rate of epileptiform discharges in patients with complex partial seizures.

In experimental studies, endogenous opioids have shown protective effects on seizure recurrence and facilitatory effects on postictal inhibition that were reversed by the opioid antagonist, naloxone. We evaluated the effect of all-night continuous infusion of 10 mg naloxone on the rate of focal interictal epileptiform discharges (FIEDs) during sleep in eight men with complex partial seizures (CPS) during 2 consecutive nights. Patients with abundant FIEDs during the control night showed a mean increase of 39% in the rate of FIEDs per unit of time during the naloxone infusion night. During the naloxone infusion night, mean nocturnal plasma prolactin (PRL) concentrations in this group of patients showed significant elevation, which was correlated with increased density of FIEDs. All-night infusion of naloxone failed to show any effect on the remaining three patients with minimal or no FIEDs during the control night. Mean nocturnal plasma PRL concentrations in this group of patients was significantly lower than in the former group. Our data support the notion that, in response to interictal or ictal discharges, endogenous opioid peptides may exert an inhibitory action that is reversible by administration of naloxone.

The effect of sleep deprivation on the rate of focal interictal epileptiform discharges.

Eight men with complex partial seizures who had frequent focal interictal epileptiform discharges (FIEDs) during routine EEGs were selected for all-night EEG recording before, and after 36 h of sleep deprivation. After sleep deprivation 6 of 8 patients showed increased FIEDs. The pooled mean number of FIEDs was greatest during light non-REM stages of sleep, especially stage II. Thus sleep deprivation is an effective activation method in medicated patients with complex partial seizures. However, a significant activation requires recording stage II sleep after sleep deprivation.

The effect of epileptiform discharges on neurohormonal release in epileptic patients with complex partial seizures.

We compared the nocturnal plasma prolactin (PRL) and beta-endorphin (B-E) concentrations prior to and after sleep deprivation (SD) in eight epileptic patients with complex partial seizures. After the period of SD (1) the mean number of interictal epileptiform discharges and the mean plasma PRL levels showed a significant rise during light non-REM stages of sleep, and (2) mean nocturnal plasma PRL and B-E concentrations showed a moderate rise during the first few hours of sleep, significant only for plasma PRL. In a patient with multiple complex partial seizures during sleep, the levels of plasma PRL and B-E concentrations were closely related to ictal discharges. The data obtained in this stress-free environment suggest a centrally mediated interaction between the release of PRL and B-E, in relation to epileptic discharges.

Systemic noninflammatory vasculopathy with prominent CNS involvement--a case report.

This is a case report of a thirty-seven-year-old man with systemic noninflammatory vasculopathy who developed a slowly progressive dementia with multiple sites of stroke. Cerebral angiography revealed abnormal terminal vasculature with beading and occlusions. Brain biopsy confirmed a noninflammatory vascular pathology. We have also reviewed the world literature relevant to this clinicopathologic entity and have discussed its relationship to thromboangiitis obliterans cerebri.

Nocturnal plasma prolactin and cortisol levels in epileptics with complex partial seizures and primary generalized seizures.

The nocturnal pattern of plasma prolactin (PRL) and cortisol in male epileptics with complex partial seizures and primary generalized seizures was studied by all-night polygraphic recordings with continuous video monitoring and sequential blood sampling at 30-minute intervals. Mean nocturnal plasma PRL concentrations in both groups of epileptics were significantly elevated when compared with nonepileptic control subjects studied in a similar fashion. Eight subclinical and three clinical partial seizures were recorded during sleep. Although a tenfold increase of plasma PRL level occurred following a short brief clinical complex partial seizure, there was no direct correlation between single subclinical partial seizures and nocturnal fluctuations of plasma PRL concentrations. We did not observe recognizable plasma cortisol changes following partial seizures during sleep, nor significant differences of mean nocturnal plasma cortisol levels between epileptics and controls. The data obtained in this environmentally controlled study indicate that postictal elevation of plasma PRL is a specific phenomenon related to seizure discharges; however, failure of such a rise does not exclude partial seizures.

Scalp-recorded short and middle latency peroneal somatosensory evoked potentials in normals: comparison with peroneal and median nerve SEPs in patients with unilateral hemispheric lesions.

Peroneal somatosensory evoked potentials (SEPs) were performed on 23 normal subjects and 9 selected patients with unilateral hemispheric lesions involving somatosensory pathways. Recording obtained from right and left peroneal nerve (PN) stimulations were compared in all subjects, using open and restricted frequency bandpass filters. Restricted filter (100-3000 Hz) and linked ear reference (A1-A2) enhanced the detection of short latency potentials (P1, P2, N1 with mean peak latency of 17.72, 21.07, 24.09) recorded from scalp electrodes over primary sensory cortex regions. Patients with lesions in the parietal cortex and adjacent subcortical areas demonstrated low amplitude and poorly formed short latency peroneal potentials, and absence of components beyond P3 peak with mean latency of 28.06 msec. In these patients, recordings to right and left median nerve (MN) stimulation showed absence or distorted components subsequent to N1 (N18) potential. These observations suggest that components subsequent to P3 potential in response to PN stimulation, and subsequent to N18 potential in response to MN stimulation, are generated in the parietal cortical regions.

Effect of interictal epileptiform discharges on nocturnal plasma prolactin concentrations in epileptic patients with complex partial seizures.

To investigate the effect of interictal epileptiform discharges (IEDs) on plasma prolactin (PRL) level, we studied 18 epileptic patients with complex partial seizures (CPS) who did not experience clinical or subclinical ictal events during all-night monitoring with polygraphic recording and video imaging. The density of IEDs peaked during non-REM stages and was significantly reduced during REM stage. Mean plasma PRL concentrations in epileptic patients, when sampled at 30-min intervals, showed a moderate but significant elevation during non-REM (p less than 0.001) and awake stages (p less than 0.005), but not during REM stage, when compared with 10 nonepileptic control subjects studied in a similar fashion. The data obtained in this physiologically controlled environment indicate that the cumulative effect of IEDs may modify PRL regulatory mechanisms, resulting in a modest elevation of plasma concentrations independent of ictal discharges.

False negative intraoperative somatosensory evoked potentials with simultaneous bilateral stimulation.

A 43 year old man underwent spinal cord surgery for removal of filum terminale lipoma. Intraoperative somatosensory evoked potentials (SSEP) monitoring showed a transient loss of response on simultaneous bilateral posterior tibial nerve (PTN) stimulation that recovered within 20 minutes. The patients exhibited paralysis and abnormal proprioceptive perception in the right leg postoperatively, when SSEP recordings revealed abnormal response to right PTN and normal response to bilateral PTN stimulation. In order to avoid false negative intraoperative responses, stimulation of each leg independently in an alternative fashion is recommended.

Nocturnal plasma prolactin rise in patients with complex partial seizures.

We measured plasma prolactin and cortisol concentrations in 12 epileptic men with complex partial seizures during all-night polygraphic recording, with continuous video monitoring and sequential blood sampling at 30-minute intervals. There was a significant but moderate elevation of all-night mean plasma prolactin concentration (p less than 0.001), but not of cortisol, in epileptics when compared with normal subjects studied in a similar fashion. The data obtained in this environmentally controlled study of males with complex partial seizure disorder indicate a disruption of prolactin regulatory mechanisms resulting in a modest elevation of plasma concentrations independent of ictal electrographic discharges.

Mid-line epileptiform activity in adult electroencephalograms.

Nine cases among 1000 adults referred to our EEG Laboratory were found to have epileptiform discharges at the C-Z area, predominantly in the awake state. These were in the form of isolated spike and wave complexes in five cases (0.5%), and Mu-like rhythms in four (0.4%). In all cases, variable degrees of dementia were found, and the CT scan of the head revealed mild to moderate cerebral atrophy and ventricular enlargement, confirmed by quantitative measurement. It is postulated that diffuse cortical and subcortical structural alteration is a factor responsible for the genesis of mid-line epileptiform activity in adult EEG's.