Clinical and Radiographic Evaluation of Third-Generation Pericardium Membrane for the Treatment of Grade II Furcation Defect in Stage III Periodontitis Patients.

Background and Objectives: Guided tissue regeneration, with or without a bone graft, is a modality for the treatment of furcation involvement. Because the direct application of a bone graft into the periodontal defect has drawbacks, such as the risk of microbial contamination and/or graft containment, a new modality of directly loading bone graft particles over the barrier membrane is now used. This study aimed to evaluate clinically and radiographically the effects of a two-layered membrane consisting of a layer of nanohydroxyapatite particles on a pericardium membrane in the treatment of stage III periodontitis, compared with direct application of a nanohydroxyapatite bone graft. Materials and Methods: Forty individuals with grade II furcation involvement were divided into two groups. Group I was treated with a two-layered membrane consisting of a pericardium membrane with nanohydroxy particles loaded onto its surface; group II was treated with direct application of a nano bone graft covered with pericardium membrane. Clinical and cone beam computed tomography (CBCT) radiographic assessments of the two groups were carried out after a 6-month follow-up period. Results: Clinically, the results showed a significant reduction in furcation involvement (F). The CBCT assessment also revealed reductions in depth (D), height (H), width (W), and 3D radiographic volume of furcation involvement in all study groups at baseline and at 6 months postoperative (p < 0.05) with no significant differences between groups. Conclusions: According to the results of the current study, a two-layer membrane formed by direct loading of bone graft particles onto a pericardium membrane can be used as an effective, reliable, and easy-to-use substitute for direct bone graft application into periodontal defects.

Natural History of Incidental Enhancing Nodules on Cone-Beam Computed Tomography during Transarterial Therapy of Hepatocellular Carcinoma.

PURPOSE: To evaluate the natural history of incidental enhancing nodules (IENs) on contrast-enhanced cone-beam computed tomography (CT) during transarterial treatment of hepatocellular carcinoma (HCC). MATERIAL AND METHODS: A single-center retrospective analysis of 100 patients with HCC who underwent contrast-enhanced cone-beam CT prior to transarterial treatment from August 2015 to June 2019 was performed. Inclusion criteria were patients with segmental distribution sublobar HCC, contrast-enhanced cone-beam CT of the target lesion and nontarget liver parenchyma, and follow-up cross-sectional imaging. Patients with IENs ≥3 mm that did not meet imaging criteria for HCC were analyzed. Exclusion criteria included biphenotypic tumors and IEN present inside the treated area of the liver. RESULTS: Fifty-six patients demonstrated 154 IENs on contrast-enhanced cone-beam CT, of which 13 IENs (8.5%) progressed to HCC. The mean primary tumor size was 29 mm (range: 10.2-189 mm). Ten patients had ≥4 IENs, and 46 patients had 1-3 IENs. The mean IEN size was 6.8 mm (range: 3.0-16.3 mm). The median follow-up interval after contrast-enhanced cone-beam CT was 282 days (interquartile range: 143-522). Increased alpha-fetoprotein before treatment (≥15.5 ng/mL, P = .035), having ≥4 IENs (P = .020), and hepatitis C virus (P = .015) were significantly correlated with IEN progression to HCC. No statistically significant differences were identified in baseline neutrophil-to-lymphocyte ratio, targeted HCC characteristics (size, macrovascular invasion, infiltrative pattern, enhancement pattern, and satellite lesions), and IEN size between those with IEN progression to HCC and those without. CONCLUSIONS: Most IENs of ≥3 mm on contrast-enhanced cone-beam CT in patients with segmental distribution sublobar HCC do not progress to HCC. Patients with segmental distribution sublobar HCC with ≥4 IENs, alpha-fetoprotein elevation (≥15.5 ng/mL), or hepatitis C virus have an increased risk of IEN progression to HCC.

Comparison of perceived masticatory ability in completely edentulous patients treated with thermoplastic complete denture versus single implant-retained mandibular overdenture: a single-center prospective observational study.

Background: This study aimed to compare the perceived masticatory ability (PrMA) in completely edentulous patients (EDPs) with thermoplastic conventional complete dentures (CDs) versus single implant-retained mandibular overdentures. Methods: The current study was conducted in the outpatient Prosthodontic Clinic, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt. PrMA was evaluated in 45 completely edentulous patients (46% males, mean age 50.4 ± 4.7 years). Each patient received a thermoplastic PMMA complete denture (Polyan IC TM Bredent GmbH & Co.KG, Germany). The PrMA was evaluated at one-month and six-month intervals of denture use. An immediate loading single implant was placed into the mid-symphyseal for each patient, and the denture was adjusted. Subsequently, the PrMA was reevaluated after one month and six months. The data were collected and statistically analyzed using the SPSS@V25 to assess the changes in PrMA. Results: The PrMA demonstrated improvement after six months of thermoplastic conventional denture use. However, this improvement was not statistically significant (p = 0.405). In addition, the PrMA showed a substantial increase following a single implant placement at one and six months (p < 0.001) of the overdenture use compared to the conventional denture. The PrMA insignificantly improved (p = 0.397) after six months of the single implant retained overdenture use. Discussion: The study's findings indicate that using immediate loading single implant-retained mandibular overdentures significantly improved PrMA in completely edentulous patients.

Histologic Findings of Sinusoidal Dilatation and Congestion in Liver Grafts Do Not Correlate with Hepatic Venous Anastomotic Gradients.

PURPOSE: Hepatic venous transplant anastomotic pressure gradient measurement and transjugular liver biopsy are commonly used in clinical decision-making in patients with suspected anastomotic hepatic venous outflow obstruction. This investigation aimed to determine if sinusoidal dilatation and congestion on histology are predictive of hepatic venous anastomotic outflow obstruction, and if it can help select patients for hepatic vein anastomosis stenting. MATERIALS AND METHODS: This is a single-center retrospective study of 166 transjugular liver biopsies in 139 patients obtained concurrently with transplant venous anastomotic pressure gradient measurement. Demographic characteristics, laboratory parameters, procedure and clinical data, and histology of time-zero allograft biopsies were analyzed. RESULTS: No relationship was found between transplant venous anastomotic pressure gradient and sinusoidal dilatation and congestion (P = 0.92). Logistic regression analysis for sinusoidal dilatation and congestion confirmed a significant relationship with reperfusion/preservation injury and/or necrosis of the allograft at time-zero biopsy (OR 6.6 [1.3-33.1], P = 0.02). CONCLUSION: There is no relationship between histologic sinusoidal dilatation and congestion and liver transplant hepatic vein anastomotic gradient. In this study group, sinusoidal dilatation and congestion is a nonspecific histopathologic finding that is not a reliable criterion to select patients for venous anastomosis stenting.

Clinical and radiographic study of the use of cross-linked gelfoam matrix in the treatment of dehiscence-like defects in Stage III periodontitis.

Background: This clinical study aimed to overcome the difficulty of graft fixation and limited blood supply for dehiscence defects regeneration by using a cross-linked gelfoam matrix jointly with collagen membrane and xenograft. Materials and Methods: The study included twenty dehiscence-like defects in maxillary anterior teeth with ≥4 mm facial bone loss and ≥5 mm clinical attachment loss (CAL) in patients suffering from Stage III periodontitis. Sites were treated with regenerative surgery using a cross-linked gelfoam matrix with glutaraldehyde, xenograft, and collagen membrane. The recorded parameters were: CAL, probing pocket depth (PPD), and radiographic three-dimensional (3D) volume for dehiscence-like defects (3D volume of facial bone defects) and 3D volume of interproximal defects using cone-beam radiographs. Data of these parameters were collected at both baseline and 6 months postsurgery. "Paired t-test" was used to assess the two variables." Results: Both CAL and PPD showed statistically significant reductions and there was a significant bone gain at 6 months postsurgery in comparison to baseline (P ≤ 0.05). Conclusion: Using a cross-linked gelfoam matrix with glutaraldehyde in combination with xenograft and collagen membrane could enhance the outcome of periodontal regeneration, especially in the treatment of challenging dehiscence defects.

Clinical and Radiographic Evaluation of Locally Delivered Plant Stem Cells for Treatment of Periodontitis: Randomized Clinical Trial.

Background: Periodontitis causes the destruction of soft and hard tissues. Stem cells have immense potential in regenerative cellular therapy. This clinical trial aimed to evaluate clinically and radiographically the effectiveness of the local application of Edelweiss stem cells as a nonsurgical treatment for stage III periodontitis. Materials and Methods: The trial included 40 periodontal pockets in participants who have stage III periodontitis with probing pocket depth (PPD) ≥5 mm and clinical attachment loss (CAL) ≥5 mm. Pockets were randomly divided into two groups Group 1: was given oral hygiene instruction, scaling, root planing, and subgingival application of plant stem cells on gel foam carrier after that a periodontal dressing was applied. The procedures were repeated after 2 weeks. Group 2: was treated only by scaling and root planing. Gingival index, CAL, and PPD were measured at baseline and 3 months' posttherapy. The radiographical evaluation was done by digital long-cone parallel periapical radiographs at baseline and 6 months posttherapy. Results: Clinical parameters for both groups showed a statistically significant improvement. Regarding radiographic evaluation, there was a significant increase in bone density in favor of the study group. Conclusions: Locally applied Edelweiss stem cells can be considered a promising nonsurgical treatment modality for periodontal regeneration.

Preference Signaling for the Diagnostic Radiology Match: A Single Institution Experience.

The Association of American Medical Colleges announced the addition of preference signaling to the 2022-2023 residency match cycle for Diagnostic and Interventional Radiology. This new offering provided applicants the option to indicate their specific interest in up to 6 residency programs during initial application submission. Our institutional diagnostic radiology residency program received a total of 1294 applications. One hundred and eight applicants signaled the program. Interview invitations were sent to 104 applicants, 23 of which signaled the program. Out of the top 10 ranked applicants, 6 applicants signaled the program. Out of the 5 matched applicants, 80% used the program signal, and 100% did the geographic preference. Opting to signal programs during the initial application submission may be beneficial for both the applicants and the programs in finding the optimal match.

The Impact of Maxillary Sinus Pneumatization on the Quality of the Alveolar Bone in Dentated and Edentulous Patients: A Cone-Beam Computed Tomography Radiographic Analysis.

Background This study aimed to describe the morphometric differences of maxillary alveolar bone's height, width, and densitometric differences in the posterior region where maxillary sinus pneumatization occurred. Methodology A cross-sectional, cone-beam computed tomography (CBCT) study used 123 CBCT images as a non-randomized convenient sample of sinus pneumatized cases. Bone height, bone width (in mm), and average density of the remaining ridge of all patients were used as study variables. Analysis of the qualitative variables were as frequency and percentages. Parametric Student's t-test and non-parametric chi-squared tests were used to compare the groups. The significance level was set at a p-value ≤0.05. Results The sample included CBCT radiographs for patients who had a mean age of 42.79 ± 12.32 with males constituting 69 (56.1%) of the patients. There was no gender difference between the present and missing teeth at the measured sites of the first premolar, second premolar, first molar, and second molar (p > 0.05). The mean measurements of height and average bone density were significantly higher in the dentate sites; however, the mean width was higher in the edentulous sites (p = 0.001). Conclusions Average bone height and density were significantly decreased at the edentulous sites of sinus pneumatized cases than the dentate sites with no gender difference.

Work-Up of Lower Extremity Swelling in a Patient With Ehlers-Danlos Syndrome.

A 36-year-old woman with Ehlers-Danlos syndrome (EDS) presents with a painful and enlarging right lower extremity mass prompting imaging work up. Herein we present a case report of an uncommon complication and a unique treatment option of a large right anterior tibial artery pseudoaneurysm caused by repetitive microtrauma in a patient with EDS and a congenital club foot.

Morphometric Analysis of the Midline Mandibular Lingual Canal and Mandibular Lingual Foramina: A Cone Beam Computed Tomography (CBCT) Evaluation.

BACKGROUND: This study aimed to evaluate the midline mandibular lingual canals and foramina and their anatomic variations using CBCT scans. METHODS: This study used retrospective analysis. A total of 320 CBCT scans were used to evaluate the study parameters, which comprised the presence or absence of the mandibular lingual foramen (MLF)/mandibular lingual canal (MLC) and its category, the distance between the buccal cortex and the start of the MLC, the distance between the inferior border of the mandible and the superior border of the foramen at its lingual and buccal terminals. The length and diameter of each canal at its lingual and buccal terminals. RESULTS: MLC was found in all included CBCT scans. Out of 320 included CBCT scans, a single canal was represented by 30.9%, double canals (Supra with Infra -spinosum) configuration appeared in 54.7%, and triple canals (Supra-Inter-Infra) represented 14.7%. The supraspinosum canals averaged 5.81 ± 2.08 mm in length and 0.87 ± 0.30 mm in diameter at the lingual terminal. In terms of the number of canals, there was a significant difference between men and women (p ≤ 0.001), with 60% of the men in the sample having double canals and 43.1% of the women having single canals. Moreover, the male gender had a higher prevalence of triple canals (21.3% vs. 8.1%) than females. Males and females were distributed equally among the supraspinosum canals, with no statistically significant difference (p ≤ 0.7). A considerable increase in the finding of interspinosum and infraspinosum canals was seen in the male sample (p ≤ 0.001). CONCLUSIONS: midline mandibular canals were found in all investigated CBCTs of the sample of both sexes; however, the anatomy and location of the MLF and canals varied significantly among the Saudi population.

Stevens-Johnson syndrome post second dose of Pfizer COVID-19 vaccine: a case report.

Coronavirus disease 2019 (COVID-19) began in December 2019 and has affected millions of people all over the world. Respiratory illness in the form of severe pneumonia, in addition to multiorgan failure and death, is the clinical spectrum of COVID-19. Although there are no specific therapeutic agents for COVID-19 infection, the COVID-19 vaccine reduces morbidity and mortality associated with COVID-19 infection and is generally well tolerated. We report one potential complication of the Pfizer COVID-19 vaccine: a known case of Stevens-Johnson syndrome (SJS) that occurred after the second dose of the Pfizer COVID-19 vaccine alone without exposure to any other drug. Despite the initial severe adverse reaction, the patient showed a full recovery. Although SJS can be associated with COVID-19 vaccination, it is rare, and the benefits of receiving the vaccination outweigh the potential harms.

Iliocaval reconstruction of chronically thrombosed cylindrical inferior vena cava filters with balloon expandable covered stent-grafts.

The use of a Viabahn VBX endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) to exclude chronically thrombosed inferior vena cava (IVC) filters refractory to exclusion with self-expanding stents was evaluated. The mean duration of TrapEase IVC (Cordis, Milpitas, Calif) implantation was 7.6 years (range, 2-11 years). Symptoms included leg pain, edema, color changes, and back pain. The mean Villalta score and venous clinical severity score were 17 (range, 13-23) and 13 (range, 11-15), respectively. Indirect ultrasound evidence of stent patency was demonstrated at a mean of 8 months after intervention. The mean Villalta score and venous clinical severity score had decreased by 13 and 10, respectively, at a mean of 9.5 months after intervention. Iliocaval reconstruction with Viabahn VBX balloon expandable stent-graft exclusion of chronically thrombosed TrapEase IVC filters is safe, with favorable short-term results.

Transchondral access for irreversible electroporation of hepatocellular carcinoma.

Ablative treatment for hepatocellular carcinoma is standard of care in selected settings and is endorsed by international societal guidelines. Centrally located hepatocellular carcinoma are difficult to treat due to their proximity to vasculature and central bile ducts. Irreversible electroporation is a nonthermal ablation modality that has been shown to preserve the extracellular matrix and is less likely to damage structures such as bile ducts and is not susceptible to vascular heat sink. Successful irreversible electroporation requires the parallel placement of probes which can be prevented by ribs or the sternum. This case report describes the use of the coaxial bone biopsy system to enable transchondral access and facilitate parallel placement of probes during irreversible electroporation IRE for the treatment of hepatocellular carcinoma.

Immediate and Delayed Reconstruction after Excision of Axillary Hidradenitis Suppurativa Using a Propeller Flap.

The chronic inflammatory skin condition hidradenitis suppurativa (acne inversa), characterized by hair follicle or apocrine gland infection, causes recurrent superficial nodules and abscesses in axillary, mammary, and perianal regions. Chronic reoccurrence results in fistula formation, causing scarring and fibrosis. Surgical excision of affected skin tissue with adequate free margins is the gold standard treatment to prevent recurrence. This case series describes 6 cases of radical excision of localized axillary hidradenitis suppurativa, with immediate or delayed perforator-based propeller flap defect closure. METHODS: All patients presenting for surgical treatment of hidradenitis suppurativa between 2016 and 2018 were identified from the hospital database. Only patients with hidradenitis suppurativa confined to the axilla were included. Patients with simple abscess incisions, recurrence after previous grafting/flap surgery, and extension of the disease outside the axilla region were excluded. Patient demographics, size of defect, complications, time of follow-up, recurrences, and level of patient satisfaction were documented. RESULTS: Six patients with localized axillary hidradenitis suppurativa were identified, with 8 propeller flap surgeries performed. Defect size was assessed by pathologic examination of excised specimens, ranging from 11-18 cm × 6-14 cm × 0.5-2 cm (length × width × depth). Seven of the eight wounds healed primarily. Functional and aesthetic results were satisfactory and there were no recurrences. The only observed complication was venous congestion following 1 flap procedure. CONCLUSION: These findings confirm that the propeller flap procedure can be effective for immediate or delayed defect closure after radical excision of localized axillary hidradenitis suppurativa, providing that no perifocal signs of infection are present after debridement.

Organizing Pneumonia Induced by Ablative Radioembolization for the Treatment of Hepatic Metastatic Renal Cell Carcinoma.

Organizing pneumonia is a recognized complication after external beam radiotherapy of breast and lung cancer but has not been described after radioembolization. A 67-year-old female who underwent ablative trans-arterial radioembolization for the treatment of hepatic metastatic renal cell carcinoma adjacent to the diaphragm presented with computed tomography findings of asymptomatic organizing pneumonia in the lower lobes. A follow-up computed tomography 8 months after conservative management demonstrated near-total resolution of the previous pulmonary parenchymal disease. The patient continues to remain asymptomatic and shows no evidence of residual tumor 10 months after radioembolization.

Individualized Ablation of Hepatocellular Carcinoma: Tailored Approaches across the Phenotype Spectrum.

Ablation is now recommended by international guidelines for the definitive treatment of hepatocellular carcinoma (HCC). Extensive clinical studies have demonstrated outcomes comparable to surgical resection with shorter hospital stays, decreased costs, and improved quality of life. Successful ablation requires complete treatment of both tumor and margin while preserving critical adjacent structures. HCC exhibits highly variable presentations in both anatomic involvement and biology which have significant implications on choice of ablative therapy. There are now abundant ablation modalities and adjunctive techniques which can be used to individualize ablation and maximize curative results. This article provides a patient-centered summary of approaches to HCC ablation in the context of patient performance, hepatic reserve, tumor phenotype and biology, intra- and extrahepatic anatomy, and ablation technology.