Regenerative potential following revascularization of immature permanent teeth with necrotic pulps.

AIM: To assess the regenerative potential of immature teeth with necrotic pulps following revascularization procedure in dogs. METHODOLOGY: Necrotic pulps and periapical pathosis were created by infecting 108 immature teeth, with 216 root canals in nine mongrel dogs. Teeth were divided into three equal groups according to the evaluation period. Each group was further subdivided into six subgroups according to the treatment protocol including MTA apical plug, revascularization protocol, revascularization enhanced with injectable scaffold, MTA over empty canal. All root canals were disinfected with a triple antibiotic paste prior to revascularization with the exception of control subgroups. After disinfection, the root length, thickness and apical diameter were measured from radiographs. Histological evaluation was used to assess the inflammatory reaction, soft and hard tissue formation. RESULTS: In the absence of revascularization, the length and thickness of the root canals did not change over time. The injectable scaffold and growth factor was no more effective than a revascularization procedure to promote tooth development following root canal revascularization. The tissues formed in the root canals resembled periodontal tissues. CONCLUSION: The revascularization procedure allowed the continued development of roots in teeth with necrotic pulps.

Suppression of leopard moth (Lepidoptera: Cossidae) populations in olive trees in Egypt through mating disruption.

The leopard moth, Zeuzera pyrina (L.) (Lepidoptera: Cossidae), is a damaging pest for many fruit trees (e.g., apple [Malus spp.], pear [Pyrus spp.] peach [Prunus spp.], and olive [Olea]). Recently, it caused serious yield losses in newly established olive orchards in Egypt, including the death of young trees. Chemical and biological control have shown limited efficiency against this pest. Field tests were conducted in 2005 and 2006 to evaluate mating disruption (MD) for the control of the leopard moth, on heavily infested, densely planted olive plots (336 trees per ha). The binary blend of the pheromone components (E,Z)-2,13-octadecenyl acetate and (E,Z)-3,13-octadecenyl acetate (95:5) was dispensed from polyethylene vials. Efficacy was measured considering reduction of catches in pheromone traps, reduction of active galleries of leopard moth per tree and fruit yield in the pheromone-treated plots (MD) compared with control plots (CO). Male captures in MD plots were reduced by 89.3% in 2005 and 82.9% in 2006, during a trapping period of 14 and 13 wk, respectively. Application of MD over two consecutive years progressively reduced the number of active galleries per tree in the third year where no sex pheromone was applied. In all years, larval galleries outnumbered moth captures. Fruit yield from trees where sex pheromone had been applied in 2005 and 2006 increased significantly in 2006 (98.8 +/- 2.9 kg per tree) and 2007 (23 +/- 1.3 kg per tree) compared with control ones (61.0 +/- 3.9 and 10.0 +/- 0.6 kg per tree, respectively). Mating disruption shows promising for suppressing leopard moth infestation in olives.

Gunshot wound injuries to the male external genitalia.

OBJECTIVE: To identify the patterns of civilian gunshot wound (GSW) injuries to the male external genitalia, and to present our experience in the management of such injuries. METHODS: This descriptive study was carried out in the Urology and Nephrology Center, Al-Thawra Modern General and Teaching Hospital, Sanaa, Yemen from June 2005 to April 2008, and included 20 men that presented with GSW injuries to the external genitalia. After clinical and radiological evaluation with retrograde urethrography when indicated, early surgical repair was undertaken for all patients with evident, or suspected deep genito-urinary wounds. RESULTS: The mean age of the patients was 33.2 years. In 15 (75%) patients, injuries were inflicted by high-velocity weapons, and in 5 by low-velocity pistols, and 18 (90%) patients had other associated injuries. The penis was involved alone in 10 (50%), scrotum in 4 (20%), and the penis and scrotum in combination in 6 (30%) patients. In 5 patients, the lesions were superficial. Corporeal injuries were detected in 13 patients, and urethral injuries were detected in 6 patients. In post-repair, mild curvature during erection was experienced by 5 patients, severe angulation by one, and sexual dysfunction by 2 patients. We encountered 9 testicular ruptures, and our testicular salvage rate was 45.5%. CONCLUSION: Although the dominant inflicting weapons were high-velocity automatic rifles, the severity of injuries and their related outcomes were almost comparable to other low-velocity series. This is possibly due to the primary involvement of nearby bulky muscles in 90% of cases, which may absorb the blasts effect of the projectiles on the genitalia.

Polyphenon E: a new treatment for external anogenital warts.

Background External genital warts (EGWs, condylomata acuminata) are a common, highly contagious disease caused by human papillomavirus (HPV), predominantly HPV 6 and HPV 11. Green tea catechins have been identified for their immunostimulatory, antiproliferative and antitumour properties. Two phase III trials evaluated treatment of EGWs with ointment containing a mixture of green tea catechins (Polyphenon E), U.S. adopted name: sinecatechins). Objectives To obtain additional data on the efficacy and safety of Polyphenon E ointment in the treatment of EGWs from two randomized, double-blind, vehicle-controlled trials. Methods Men and women aged > or = 18 years (n = 1005), with two to 30 EGWs (12-600 mm(2) total area) applied vehicle (G(Veh); n = 207), Polyphenon E ointment 10% (G(10%); n = 401) or Polyphenon E ointment 15% (G(15%); n = 397) three times daily until complete clearance of all EGWs (baseline + new EGWs) or for a maximum of 16 weeks. Results A total of 1004 patients were evaluable for safety and 986 for efficacy; 838 completed treatment after 16 weeks. Complete clearance of all EGWs was obtained in 53.6% (G(10%)) and 54.9% (G(15%)) of patients with Polyphenon E vs. vehicle (35.4%) (P < 0.001). Statistically significant differences in clearance rates appeared after 6 weeks of active treatment. Odds ratios vs. G(Veh) for G(10%) [2.10; 95% confidence interval (CI) 1.49-2.98] and G(15%) (2.22; 95% CI 1.57-3.14) indicated about a twofold higher chance of complete clearance under active treatment. Time to complete clearance was shorter with active treatment (hazard ratios 1.57 and 1.87, respectively, for G(10%) and G(15%) vs. G(Veh) groups; P < 0.001). Recurrence rates during follow-up were low and similar across groups: 5.8%, 6.8% and 6.5% (G(Veh), G(10%) and G(15%) groups, respectively). Adverse events were evenly distributed across groups ( approximately 30% of patients). Severe local signs were more frequent but moderate in the active treatment groups (1.5%, 9.2% and 13.5% for G(Veh), G(10%) and G(15%) groups, respectively). Conclusions Polyphenon E ointment is effective and well tolerated in the treatment of EGWs.

Urethral stricture Yemen experience.

PURPOSE: In order to evaluate the etiology of urethral stricture in our society and outcome of different types of surgical reconstruction used to treat them. PATIENTS AND METHODS: This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra Modern General and Teaching Hospital, Sana'a, Yemen from July 2003 to July 2007 and included 62 male patients with complete urethral stricture whom underwent Urethral reconstructive surgery. The patients were evaluated by history, local and systemic physical examination, and radiological assessment according to each case. RESULTS: Patient's age ranged between 3 and 70 years (mean 25.31). Of 55 patients presented to the GER, 31 patients had car accident, 14 patients had gun shot injury, 9 patients fell from high, and one patient had bomb explosion. Five patients had history of traumatized catheterization and urethrocystoscopy, while two patients had history of urethritis. The site of the stricture was at the bulbomembranous area in 43 patients, in the penile urethra in 14 patients, and in bulbous urethra in 5 patients. The length of the urethral stricture was 10-30 mm in 39 patients (63%), <10 mm in 13 patients (21%) and of 30-70 mm in 10 patients (16%). A total of 15 patients (24%) with posterior urethral stricture of 10 mm or less (+2 patients with 1.2 and 1.5 cm), subjected to endoscopic treatment, 37 patients (60%) with stricture >10-30 mm, were underwent anastomotic urethral reconstruction and 10 patients (15%) with stricture >30 mm, were repaired utilizing tissue transfer technique. Follow-up period ranged from 3 months to 2 years (median 15 months), in which recurrent stricture was found in 11 patients (18%), wound dehiscence in 4 patients (6%) and fistula formation in 1 patient (1.5%), while no patient came with erectile dysfunction. CONCLUSION: Trauma is the commonest cause of urethral stricture in our country, therefore the control of it will decrease extremely the urethral stricture disease. No one technique is suitable for all types of the stricture, and the surgeon should be familiar with the different techniques and choose the most suitable one according to the case he deals with.

Topical Polyphenon E in the treatment of external genital and perianal warts: a randomized controlled trial.

BACKGROUND: Benign external genital and perianal warts (condylomata acuminata) are disfiguring, displeasing skin tumours caused by human papillomavirus that may vitally burden affected patients and their partners. Current treatment options are still unsatisfactory due to low efficacy, high recurrence rates or an unfavourable side-effect profile. Although most recently prophylactic vaccines have been recommended for adolescent women, appropriate treatment modalities for anogenital warts are still needed. Green tea catechins exert antiviral, antioxidative, antiproliferative and immunostimulatory activity. Polyphenon E (MediGene AG, Munich, Germany), a proprietary extract of green tea leaves, was therefore investigated for the topical treatment of this frequent viral disease. OBJECTIVES: To investigate Polyphenon E 15% and 10% ointment for efficacy and safety in the treatment of anogenital warts in immunocompetent men and women. METHODS: Five hundred and three patients were randomized to receive either Polyphenon E 15% or 10% ointment or matching vehicle. The topical treatment was self-applied by the patients three times daily to all warts. Assessment of response and of adverse events was performed biweekly until complete clearance of all (baseline and new) anogenital warts or for up to 16 weeks. Recurrence was evaluated during a 12-week treatment-free follow-up period for patients with complete clearance. RESULTS: About 53% of patients treated with Polyphenon E 15% ointment showed complete clearance of all baseline and new anogenital warts, 51% for Polyphenon E 10% ointment, and 37% for vehicle (P = 0.01 and P = 0.03, respectively; two-sided Fisher's exact test; intent-to-treat population, last observation carried forward analysis). Women responded better than men, with about 60% of women and 45% of men in both active groups achieving complete clearance of all warts. Time to complete clearance was comparable for both strengths of Polyphenon E ointment. About 78% of all patients treated with either Polyphenon E 15% or 10% ointment showed wart clearance rates of 50% or better. Less than 6% and 4% of patients in the Polyphenon E 15% and 10% ointment groups experienced wart recurrence during follow-up. Polyphenon E ointments demonstrated a good safety profile with the majority of all adverse events being local application site reactions assessed as mild or moderate. Local reactions declined during continued treatment. CONCLUSIONS: The results indicate that Polyphenon E ointment is an efficacious and safe patient-applied topical treatment for external genital and perianal warts. Its use in intra-anal, intravaginal and cervical condylomas and other intraepithelial lesions warrants further clinical investigation.

Detection of local failures after management of nasopharyngeal carcinoma: a prospective, controlled trial.

OBJECTIVES: To conduct a prospective study (1) to evaluate and compare the efficacies of nasopharyngeal endoscopy and computed tomography in the diagnosis of local failure of external beam radiotherapy for nasopharyngeal carcinoma, and (2) to assess whether multiple endoscopic nasopharyngeal biopsies are superior to a single, targeted biopsy, for the same purpose. METHODS: Forty-six patients who had been treated with external beam radiotherapy for primary nasopharyngeal carcinoma were enrolled in the study. For every patient recruited, computed tomography, rigid nasopharyngeal endoscopy and nasopharyngeal biopsies were performed 12 weeks after radiotherapy. RESULTS: Twelve weeks after treatment, six patients (13 per cent) had evident disease on histological examination of biopsies. Nasopharyngeal endoscopy showed a sensitivity, specificity, positive predictive value and negative predictive value of 66.6, 95, 66.6 and 95 per cent, respectively. There was statistically significant agreement between the endoscopic findings and the histological findings (Kappa reliability coefficient = 0.617, p < 0.01). Computed tomography showed a sensitivity, specificity, positive predictive value and negative predictive value of 50, 45, 12 and 85.7 per cent, respectively. There was no statistically significant agreement between the computed tomography findings and the histological findings (Kappa reliability coefficient = 0.021, p > 0.05). A targeted, single biopsy performed under endoscopic control demonstrated excellent sensitivity, specificity, positive predictive value and negative predictive value, being 83.3, 100, 100 and 97.5 per cent, respectively. The Kappa test showed a very statistically significant agreement between the histological findings for the single and the multiple endoscopic biopsies (Kappa reliability coefficient = 0.897, p < 0.001). CONCLUSIONS: Rigid nasopharyngeal endoscopy should be considered the primary follow-up tool after radiotherapy treatment of nasopharyngeal carcinoma, with computed tomography being reserved for patients with histological or symptomatic indications. Routine postnasal biopsies are not necessary, given the excellent specificity and negative predictive value of rigid nasopharyngeal endoscopy. Single, targeted endoscopic biopsy provides an excellent alternative to the usual multiple biopsies. In addition, it reduces cost, time, morbidity and patient discomfort.

Tubeless percutaneous neprolithotomy: the new gold standard.

PURPOSE: We present our experience with tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Between July 2004 and December 2006, 121 patients (82 males and 39 females) with 18-70 mm (mean 31.19 mm) renal stones underwent tubeless PCNL leaving only a 6 Fr externalized ureteric catheter. Their ages ranged between 4 and 80 years (mean 37.27). Two patients had bilateral disease, so a total of 123 renal units are included. The procedure was performed under general anesthesia in the prone (110 units) or supine position (13 units). A total of 133 punctures were performed. The punctures were single (114 units), double (8 units), or triple (1 unit). The approach was subcostal through the lower calyx (n=110) or middle calyx (n=10), or supracostal through the middle calyx (n=8) or upper calyx (n=5). RESULTS: Mean operative time was 46.30 min (range 15-100). Mean reduction in hemoglobin level was 1.57 g (range 0.3-4) with blood transfusion rate 4.13%. Complication rate was 9.9% in the form of perirenal collection (five patients), urinary leakage (two patients), fever (four patients), and hydrothorax (one patient). The ureteric catheter was left for 7-72 h (mean 45.67). Postoperative analgesia was required in 22 patients (18.2%) with mean 22.9 mg diclofenac sodium per patient. Mean hospital stay was 50.69 h (range 12-96) with 106 units (86.18%) rendered stone free, 13 (10.57%) with insignificant residuals, and four units (3.25%) were left with significant residual stones. CONCLUSIONS: Tubeless PCNL is a good option in non-complicated PCNL with the advantages of reduced hospital stay, low postoperative pain, and little need for postoperative analgesia.

A randomized, double-blind, four-arm parallel-group, placebo-controlled Phase II/III study to investigate the clinical efficacy of two galenic formulations of Polyphenon E in the treatment of external genital warts.

OBJECTIVE: Clinical efficacy and safety of Polyphenon(R) E, a defined green tea extract, in external genital warts. DESIGN: Randomized, double-blind, placebo-controlled study for up to 12 weeks with a 12-week treatment-free follow-up. SETTING: Twenty-eight hospitals and practices in Germany and Russia. PATIENTS: Two hundred forty-two outpatients (125 men, 117 women) with 2 to 30 warts (total wart area, 12-600 mm(2)). Intervention(s) Topical application of Polyphenon E 10% Cream, Polyphenon E 15% Ointment or placebo to all external genital warts three times a day. MAIN OUTCOME MEASURE(S): Measurement of total wart area and local reactions/adverse events. RESULTS: For 15% ointment, statistically significant differences to placebo were achieved regarding complete clearance of all baseline external genital warts (61.0% vs. 40.5% in males, 56.8% vs. 34.1% in females; combined gender: P = 0.0066) and 75% to 100% clearance (80.8% vs. 51.8%; P = 0.0001) in both the intent-to-treat and per-protocol populations. For 10% cream, 53.8% males and 39.5% females achieved complete clearance. Recurrence rates 12 weeks after end of treatment were 10.6%, 11.8% and 10.3% for 15% ointment, 10% cream and placebo, respectively. Adverse events were observed in only 7.9% of patients, with no serious adverse events or deaths reported. Local skin reactions were generally mild to moderate and resolved with continued treatment without sequelae. CONCLUSIONS: Polyphenon(R) E 15% ointment, composed of a defined green tea extract, proved to be efficacious and safe for both gender in the treatment of external genital warts.

Simultaneous bilateral multipuncture tubeless percutaneous nephrolithotomy in patient with orthotopic bladder substitution.

We report the successful treatment of a patient that presented with bladder tumor, bilateral multiple renal stones, right lower ureteral stone, and bilateral hydroureteronephrosis with progressively rising serum creatinine. Initially, he was managed by drainage of the upper tract by left percutaneous nephrostomy tube until serum creatinine dropped to normal value then he was managed by radical cystectomy and orthotopic bladder substitution. Three weeks later, he was subjected to simultaneous bilateral multi-puncture tubeless percutaneous nephrolithotomy. In addition, we report on the feasibility of opacification of the collecting system via ascending pouchogram by direct passage of the dye through the directly implanted ureters thus avoiding intravenous contrast injection.

Bovine pericardium as a wrapping for orbital implants.

PURPOSE: We report the use of bovine pericardium as an alternative wrapping for porous orbital implants after enucleation. METHODS: We retrospectively reviewed the records of all patients who received a bovine pericardium-wrapped orbital implant after enucleation by the authors between August 1, 1996, and December 1, 1999. RESULTS: Eighty patients underwent placement of bovine pericardium-wrapped orbital implants. The average age at the time of implantation was 49.3 years (range, 5 years to 83 years). The mean follow-up interval was 11.8 months (range, 2 to 41 months). There were no intraoperative complications. No patient had secondary systemic infection or showed evidence of rejection. There was no clinical evidence to suggest that vascularization of the porous implant was unusually delayed, and there were no complications after secondary drilling and placement of a coupling post. Four (5%) of 80 patients had complications requiring removal of the spherical implant. All 4 patients had hydroxyapatite implants. Two patients had significant exposure requiring removal of the implant at 2 months after surgery; 1 patient had a chronic fistulous tract with secondary infection 3 years after surgery: and 1 patient had chronic orbital pain requiring removal of the implant at 1 year after surgery. CONCLUSIONS: The incidence of implant exposure was less than 4%. This compares favorably to the incidence of exposure of 9% to 21% reported in recent literature. Other complications were few and of minimal clinical significance. The authors conclude that bovine pericardium is a viable option to sclera as a wrapping for porous orbital implants.

New scope in angiogenesis: role of vascular endothelial growth factor (VEGF), NO, lipid peroxidation, and vitamin E in the pathophysiology of pre-eclampsia among Egyptian females.

OBJECTIVES: The purpose of this study was to investigate the role of VEGF, NO, MDA, and Vitamin E in the pathophysiology of preeclampsia (PE) among Egyptian women. PATIENTS AND METHODS: Our study included 20 pregnant women with mild PE, 40 pregnant women with severe PE, 20 normal control women and 20 normal control pregnant women. Plasma from all women were subjected to estimation of VEGF using ELISA kit, estimation of nitrates (as end product of NO) and MDA by chemical methods and measurement of Vitamin E using HPLC. RESULTS: The obtained data from this study revealed that, VEGF may be used as a useful marker for PE which is elevated in plasma of women with PE (mild and severe) compared to controls. VEGF could differentiate between PE and controls at a cut-off value of: 70 ng/mL with a sensitivity of 95% and a specificity of 90%. Moreover, at a cut-off value of 250 ng/mL, VEGF could discriminate mild PE from severe PE with a sensitivity of 77.5% and a specificity of 85%. With respect to nitrate levels, they were significantly elevated in normal pregnant women compared with normal controls. Meanwhile, nitrate levels showed a highly significant decrease in PE in relation to both controls, explaining the vasoconstriction and high blood pressure occurring in preeclamptic women. Correlation analysis revealed significant inverse correlation between nitrate levels and VEGF. Lipid peroxidation as indicated by MDA was enhanced in preeclamptic women as compared to healthy controls. The increase in MDA levels was correlated to the severity of PE. A highly significant fall in vitamin E as an antioxidant-scavenging vitamin was seen in preeclamptic women as compared to the controls. Also, a significant drop in the vitamin level was found in severe PE in comparison to mild PE. The oxidant/antioxidant correlation was illustrated by the inverse correlation between vitamin E and MDA(r = -0.837, p = 0.000). CONCLUSION: The findings from this study indicated that VEGF may be used as a clinically useful biomarker for PE for better diagnosis, to differentiate between mild and severe PE, and may also be a target for therapeutic intervention of PE. The increase in levels of VEGF together with reduction in NO levels could confirm the existence of vascular reactivity and endothelial disturbance in PE. The decrease in the vasodilator, NO may in part lead to the vasospasm of preeclampsia, which consequently produces hypoxia. The latter may be a cause of an elevation of VEGF (angiogenic factor) levels in PE. Meanwhile, elevated levels of lipid peroxides together with impaired antioxidant defense mechanisms may play a role in the etiology of PE.

Multiple recurrences in malignant peripheral nerve sheath tumor of the orbit: a case report and a review of the literature.

PURPOSE: To report the onset of malignant peripheral nerve sheath tumor of the orbit 8 years after irradiation in a patient with neurofibromatosis type-1. METHODS: Case report of a young man with neurofibromatosis type-1 who received irradiation for presumed bilateral optic nerve and chiasmal gliomas and in whom a malignant peripheral nerve sheath tumor later developed. Exenteration with extirpation of the entire contents of the orbit was performed 6 times. RESULTS: Complete recurrence of the tumor occurred after each surgical procedure until the patient died of malignancy. CONCLUSIONS: Our case underscores the risk of irradiation, especially in children with neurofibromatosis type-1, and emphasizes that radiotherapy should never be given as an empirical therapy. The authors believe that irradiation and neurofibromatosis type-1 may, in combination, pose a significant risk for the development of malignancies. Clear-cut indications and a precise tissue diagnosis are desirable before the initiation of radiotherapy, particularly in the pediatric population. We recommend that if irradiation is necessary in persons with neurofibromatosis type-1, regular follow-up is imperative. In view of the hostile nature of malignant peripheral nerve sheath tumor, early aggressive treatment appears to be the only viable alternative at present.

Anterior tarsal V-wedge resection for cicatricial entropion.

PURPOSE: To determine the effectiveness of using a radiofrequency instrument to resect a V-shaped tarsal wedge for the correction of cicatricial upper eyelid entropion. METHODS: Prospective evaluation of 16 upper eyelids of 11 consecutive patients. RESULTS: The operation was successful in all 16 eyelids, with excellent cosmetic and functional outcomes. CONCLUSIONS: Tarsal V-wedge resection is an effective alternative to other complicated techniques in the management of upper eyelid cicatricial entropion.

Direct internal eyelash bulb extirpation for trichiasis.

PURPOSE: To evaluate the success of internal eyelash bulb extirpation in the management of trichiasis. METHODS: The procedure was performed on 26 consecutive eyelids. RESULTS: Our technique was successful in all cases, with no recurrence of signs or symptoms. CONCLUSIONS: Internal eyelash bulb extirpation is a safe and effective technique to remove trichiatic lashes, while avoiding injury to the conjunctiva.

Factors affecting the ability of dental cements to alter the pH of lactic acid solutions.

Two related studies have been carried out to determine the effect of (a) powder:liquid ratio and (b) relative amounts of cement on the extent of buffering of a lactic acid storage solution using zinc polycarboxylate and glass-ionomer cements (both water-activated). The effect of varying the powder:liquid ratio was found to be slight and not statistically significant. On the other hand, increasing the numbers of specimens in a given volume of storage solution was found to have a significant influence on the final pH (at the 0.0005 level of significance). The fact that powder:liquid ratio did not affect the final pH led to the conclusion that attack occurs mainly at the matrix of these cements, confirming previous findings about the acid erosion process. The finding that increasing the relative amount of cement to acid storage solution strongly influenced pH suggested that, under clinical conditions, buffering would be important. When five specimens were used, the final pH corresponded to that of arrested caries, from which it was concluded that these cements have the ability to be cariostatic in vivo.