Propolis and commonly used intracanal irrigants: comparative evaluation of antimicrobial potential.

UNLABELLED: The objective of endodontic therapy is not just simple cleaning and filling of root canals, but successful treatment requires the establishment of a sufficient level of disinfection. AIM: To evaluate, in vivo, the antimicrobial and inflammatory/irritant potential of Propolis against mixed endodontic aerobic and anaerobic bacteria. METHOD: An in vivo randomized controlled trial was conducted in a group of 60 children aged 6-12 years presenting with an acute apical abscess of the maxillary primary molars. Fifteen children each were divided randomly into four groups where irrigation during pulpectomy was performed using either 2% chlorhexidine, 4% calcium hydroxide or 4% Dimethyl Sulfoxide (DMSO) extract of propolis with normal saline as the control irrigant. Microbiological samples were taken from the disto-buccal root canal before initiating the pulpectomy as well as after 3 days later and for mixed aerobic and anaerobic bacterial cultures. RESULTS: In all the four groups, a significant decrease in mean aerobic colony forming units (cfu) count was seen. Maximum change in anaerobic cfu count was seen with 2% chlorhexidine. CONCLUSIONS: Chlorhexidine proved to be superior antimicrobial agent against both endodontic aerobes and anaerobes. Calcium hydroxide was found to be least effective.

[ACE procedure for life long constipation in adult]. / ACE operace pro dlouhodobou obstipaci u dospelého.

AIM: The authors present a possibility of Malon Operation in adult patients with chronic constipation. They determine the quality of life at a pre-operative time and 3 months post-operatively after ACE operation. MATERIAL AND METHOD: ACE is an "antegrade continent enema "operation carried out via a short laparotomy or laparoscopy creating appendicostomy. It serves as a port for enema delivery after catheter access. It is performed for constipation commonly in children and extremely rarely in adults. 46 years old lady has had a severe constipation (1x > 6 weeks) since her early childhood. The usage of laxatives had been progressively increased to achieve the best result. The patient experienced left iliac fossa pain, cramp, spurious diarrhea, anal seepage, spoilage of undergarments, tenesmus, urge incontinence, and social impairment as well. Other features included fibromyalgia and a very strong family history of colorectal cancer. She was examinated according to the guidelines for chronic constipation. Colonic transit study revealed a slow-colonic time and a global inertia of colon. ACE operation was performed in June 2006. RESULTS: The result at 3 months after surgery was frequency 2x/week within 10/30 minutes after self administrated ACE (PO4 + 100ml saline) with very occasional soilage. The progressive resistance in track at 8-10cm from skin level occurred 2 months after surgery. Contrast appendiculogram revealed an angulation and a very mild stenosis at appendico-caecal junction. Radiological balloon dilatation to 14F followed with effect. The quality of life assessment at pre-operative and 3 months post-ACE procedure revealed no difference. On specific questioning the predictability of bowel motion was found as a sole benefit. CONCLUSION: A non-resective appendicostomy for ACE for severe life-long constipation showed no improvement on QoL instrument. However, it resulted in improvement of the predictability of bowel action. ACE technique - Malon Operation can be used as a treatment method for selected adult patients with severe constipation.

Adult intussusception--a surgical dilemma.

BACKGROUND: Adult intussusception is rare. It is expected to be found in 1/30,000 of all hospital admissions, 1/1300 of all abdominal operations, 1/30-1/100 of all cases operated for intestinal obstruction and one case of adult intussusception for every 20 childhood ones. METHODS: The authors encountered 4 cases of adult intussusception. M:F ratio was 1:1. Mean age was 47years. Small bowel obstruction was documented in all. They were investigated by radiographs, ultrasound exam, barium studies, endoscopy and CT scan. RESULTS: All however were diagnosed at operation although some pre-operative suspicion was raised in one case. All had a laparotomy. Two were ileo-ileal and two ileo-caecal intussusceptions. One was chronic intussusceptions and three sub-acute. One intussusception had a malignancy (lymphoma) as a lead point. Two had a submucous lipoma at the apex. In an interesting case the suture knot from a recent small bowel anastomosis (2-3 weeks prior) was forming the lead point of the intussusception! The 2 ileo-ileal intussusceptions had segmental resection. Right hemicolectomy was done for the 2 ileo-caecal cases. "Target lesion" and leumen-within-leumen were the CT hallmarks on review. Retrospective barium enema review failed to show the intussusception. This may suggest the intussusception may have been recurrent or chronic. All 4 recovered uneventfully and remained well. One patient was referred for chemotherapy for intestinal lymphoma. CONCLUSION: Adult intussusception remains a rare cause of abdominal pain. The treatment almost always is surgical.