Simultaneous Evaluation of Creep Deformation and Recovery of Bulk-Fill Dental Composites Immersed in Food-Simulating Liquids.

The aim of this study is to compare the creep/recovery behavior of bulk-fill dental composites after storage in various food simulating organic solvents. For this purpose, five different resin-composites (four bulk-fills and one conventional) were used. A total of 20 rectangular specimens (14 mm × 3 mm × 0.7 mm) were prepared by filling the resin-composites in Teflon mold. All of the specimens for each material (n = 5) were divided into four groups namely dry (control), distilled water (DW), artificial saliva, and absolute ethanol. The specimens were subjected to three-point bending creep test during immersion directly. A constant load of 2 N was used for each specimen with loading and unloading time 2 h each. RESULTS: SF2 and XF showed a lower creep strain % after immersion, ranging from 0.44 (dry) to 0.75 (saliva) and 0.43 (dry) to 0.80 (ethanol), respectively. TNC BF depicts the maximum creep strain % ranging from 1.24% (dry) to 2.87% (ethanol) followed by FBF ranging from 1.17 (dry) to 2.59 (ethanol). However, the conventional material (GR) showed lower creep strain after immersion ranging from 0.28 to 0.54. Moreover, SF2 resulted in the highest creep recovery in all of the composites groups, as well as conventional material. The other composite groups showed lower creep recovery as compared to the conventional material (GR). The creep strain % for all the bulk-fill composites materials were increased during immersion in the liquids. However, for the conventional material, the creep deformation is decreased after immersion. SF2 showed the highest percentage of creep recovery among the bulk-fill composites, followed by XF.

Influence of tooth brushing on adhesion strength of orthodontic brackets bonded to porcelain.

BACKGROUND: Adhesive resin composite, which is used to bond orthodontic bracket to tooth surface is exposed to the influence of wear by tooth brushing and wear may influence loosening of the bracket. OBJECTIVE: The aim of this study was to evaluate in vitro the effect of tooth brushing on the adhesion strength of orthodontic brackets bonded to surface treated porcelain. METHOD: A total of 90 glazed porcelain fused to metal facets (PFM) were randomly assigned into 3 groups according to the surface treatment to be received. Group 1 was conditioned with hydrofluoric acid (HF), group 2 conditioned with grit-blasting (GB) and group 3 conditioned with tribochemical silica coating (RC). The groups were evaluated for surface roughness (Ra) before and after surface treatment. Next, 15 samples from each group were subjected to brushing and remaining 15 samples served as the baseline (n=15). Adhesion strength (shear bond strength)was recorded using a universal testing machine. Data collected were analyzed by ANOVA and Tukey's multiple comparison post hoc analysis. RESULTS: Tooth brushing decreased the bond strength in all groups. The highest adhesion strength (baseline and after brushing) was observed in group 3 (26.8 ± 1.77 MPa and 23.57 ± 1.02 MPa) and the lowest was found in group 1 (9.6 ± 1.5 MPa and 5.87 ± 0.77 MPa). Group 3 specimens exhibited the highest Ra (1.24 ± 0.08). CONCLUSION: It was found that tooth brushing of the exposed adhesive resin composite at the bracket-bonding substrate interface lowers the bonding strength regardless of the surface treatment of the substrate.

Durability of aneurysm treatments in patients with active Behcet's disease.

OBJECTIVE: Aneurysms in Behcet's disease are rare, serious, and recurrent. To achieve durable treatment, patients should receive immunosuppressive therapy before intervention to induce remission. We present early and long-term results of emergency cases of active Behcet's disease, which did not permit waiting for suppressive treatment. PATIENTS AND METHODS: The study was undertaken on all cases admitted to the vascular unit, King Fahd Hospital of University for aneurysm treatment in patients with active Behcet's disease over about 10 years. All patients had exclusion of the aneurysm either by open surgery or endovascular intervention. Morbidities and mortality were recorded within the hospital admission and on the follow-up. RESULTS: During the study period, three cases were included. All interventions were successful and lifesaving. However, two cases, treated with surgical interposition grafts, were blocked in the intermediate term follow-up (2-12 months) and one case, treated with endovascular treatment, complicated with pseudoaneurysm at femoral puncture site after six months. CONCLUSION: Although early results were good, intermediate ones were not satisfactory because of progressive graft thrombosis and formation of new aneurysms. Awareness of these rare cases help for early identification and proper immunosuppressive before emergency vascular intervention is warranted.

Effect of solvent/disinfectant ethanol on the micro-surface structure and properties of multiphase denture base polymers.

AIM OF THE STUDY: The aim of this study was to evaluate the effect of solvent/disinfectant ethanol on the surface of denture base polymers. Changes in surface roughness, topography and some nanomechanical properties were assessed by SEM and nanoindentation plotted against different concentrations of ethanol on heat cured and autopolymerized polymetyl methacrylate based acrylic denture base polymers. MATERIALS AND METHODS: Test specimens (10×10×3mm(3)) of heat-curing (HC) and auto-polymerizing (AP) acrylic resin were prepared and polished to obtain uniform smoothness which were further grouped into 3 sub-groups HC1, HC2, HC3 and AP1, AP2, AP3 respectively 10 specimens (n) in each group. HC1 and AP1, HC2 and AP2, HC3 and AP3 were treated with 99.9%, 70% and 40% respectively for 30, 60 and 120s followed by analysis of surface roughness (Sa), topographical changes and some nanomechanical properties. RESULTS: Both HC and AP resins showed changes in their Sa and nanomechanically measured modulus of elasticity and surface hardness after being treated at different concentrations of ethanol and at different lengths of time. Surface changes were most clearly seen in autopolymerizing denture base polymer, especially at the interface region between the PMMA polymer bead and polymer matrix. There was a correlation (R2=0.83, r=0.91, P<0.001) between the time of treatment by ethanol and thickness of the affected area of denture base polymer. CONCLUSION: The present study demonstrated that denture base polymers, especially autopolymerized denture base polymer is prone for surface crazing and dissolving by solvent/disinfectant ethanol. The interphase region between the PMMA polymer bead and the polymer matrix was most affected by the ethanol.

Comparison of Angioseal and Manual Compression in Patients Undergoing Transfemoral Coronary and Peripheral Vascular Interventional Procedures.

Vascular closure devices (VCDs) were introduced in the early 1990s with the goal of limiting the time, labor, bed rest, and patient discomfort associated with manual compression (MC) for hemostasis after cardiovascular interventions. However, its advantage over MC has not been extensively studied after interventional procedures. The aim of this study was to do prospective, randomized study comparing the safety and efficacy of the Angio-Seal (AS) to that of MC in patients undergoing transfemoral coronary and peripheral vascular interventional procedure. A prospective, randomized trial was undertaken on consecutive series of patients admitted to King Fahd Hospital of the University for transfemoral coronary and peripheral vascular interventional procedures over 1 year. The study was designed to compare the hemostasis time in minutes and the incidence of vascular complications in patients receiving AS with those undergoing MC. All patients were on antiplatelets and received heparin during the procedure. During the study period, 160 patients were included, 80 in each group. There was a significant difference in mean time to hemostasis in minutes (15.83 ± 1.63 minutes for MC and 0.42 ± 0.04 minutes for the AS; p < 0.001), time to ambulation in minutes (280 ± 15 for MC and 120 for AS; p = 0.04) and in minor complications (33.8% in MC vs. AS 5%; p < 0.001). However, the major complication rate did not significantly differ between the two groups (0% in AS vs. 2.5% in MC; p = 0.15). AS was found to achieve rapid closure of the femoral access site safely in patients undergoing coronary and peripheral vascular interventional procedures under antiplatelets and systemic heparinization.

Extensive vascular occlusions as initial presentations of systemic lupus erythematosis. A case report and review of literature.

Widespread arterial and venous thrombosis is a very rare initial presentation of systemic lupus erythematosus (SLE). We report a case with extensive vascular occlusion as the initial manifestation of SLE. Although these cases have high morbidity and mortality, yet our patient recovered with minimal complications.

A comparative finite elemental analysis of glass abutment supported and unsupported cantilever fixed partial denture.

OBJECTIVE: The purpose of this study was to investigate and compare the load distribution and displacement of cantilever prostheses with and without glass abutment by three dimensional finite element analysis. Micro-computed tomography was used to study the relationship between the glass abutment and the ridge. METHODS: The external surface of the maxilla was scanned, and a simplified finite element model was constructed. The ZX-27 glass abutment and the maxillary first and second premolars were created and modified. The solid model of the three-unit cantilever fixed partial denture was scanned, and the fitting surface was modified with reference to the created abutments using the 3D CAD system. The finite element analysis was completed in ANSYS. The fit and total gap volume between the glass abutment and dental model were determined by Skyscan 1173 high-energy spiral micro-CT scan. RESULTS: The results of the finite element analysis in this study showed that the cantilever prosthesis supported by the glass abutment demonstrated significantly less stress on the terminal abutment and overall deformation of the prosthesis under vertical and oblique load. Micro-computed tomography determined a gap volume of 6.74162 mm(3). SIGNIFICANCE: By contacting the mucosa, glass abutments transfer some amount of masticatory load to the residual alveolar ridge, thereby preventing damage to the periodontal microstructures of the terminal abutment. The passive contact of the glass abutment with the mucosa not only preserves the health of the mucosa covering the ridge but also permits easy cleaning. It is possible to increase the success rate of cantilever FPDs by supporting the cantilevered pontic with glass abutments.

Management of sizeable carotid body tumor: Case report and review of literature.

Carotid body tumor is a paraganglioma derived from the neural crest. It arises from the carotid body which acts as a vascular chemoreceptors and is usually located at the carotid bifurcation. Sizeable (Shamblin III, >5 cm size) tumors are large and typically encase the carotid artery requiring vessel resection and replacement. Management of such tumors carries a high risk of postoperative mortality and morbidity rates specially with regards to neurovascular complications. We report a case of sizeable tumor which was surgically removed with minimal complications.

Limb salvage in a child with severely injured mangled lower extremity and muscle rigor.

Most surgeons make their decision to amputate or perform limb salvage of a mangled extremity based on scoring systems and grading of acute ischemic limb. We report on a child in whom limb salvage was achieved in spite of a clinical picture of irreversible ischemia with high mangled severity scores. Attempts to revascularize the mangled extremity of children are recommended, regardless of their severity scores and condition of the foot.

Topical application of Sadat-Habdan mesenchymal stimulating peptide (SHMSP) accelerates wound healing in diabetic rabbits.

OBJECTIVE: Diminished wound healing is a common problem in diabetic patients due to diminished angiogenesis. SHMSP was found to promote angiogenesis. The present study was carried out to examine the effect of this peptide in healing of wounds in diabetic rabbits. MATERIALS AND METHODS: Twenty male New Zealand rabbits were used in this study. Diabetes mellitus was induced and the rabbits were randomly divided into two equal groups: control group and peptide group. A-full thickness punch biopsy was made to create a wound of about 10 mm on the right ears of all rabbits. Every day, the wound was cleaned with saline in control groups. In the peptide group, 15 mg of SHMSP was applied after cleaning. On day 15th, all animals were sacrificed, and the wounds were excised with a rim of 5 mm of normal surrounding tissue. Histo-pathological assessment of wound healing, inflammatory cell infiltration, blood vessel proliferation, and collagen deposition was performed. RESULTS: There were no deaths among the groups. There was significant increase in wound healing, blood vessel proliferation and collagen deposition, and significant decrease in inflammatory cell infiltration in the peptide group compared to the control group. CONCLUSION: Topical application of SHMSP improves wound healing in diabetic rabbits.

Screening of diabetic foot in surgical inpatients: a hospital-based study in saudi arabia.

Previous reports found that identification of diabetic patients at high risk of foot ulcers, and managing the risk factors early, lower extremity amputations could be prevented. The aim of this study is to determine the value of screening diabetics in estimating the risk of foot ulceration among surgical inpatients. This is a prospective study on all diabetic patients admitted to the surgical department, King Fahd Hospital of the University, Saudi Arabia, during the year 2011. Patients were screened for the presence of diabetic foot. They were classified according to the international working group on the diabetic foot into four grades [0 (lowest risk patients), 1, 2, 3 (highest risk patients)]. During the study period, 391 patients had diabetes mellitus (DM), of these 73 (19%) had active ulcer and were excluded from the study and the rest were screened. Grade 0 was in 174 (54.5%) patients, the rest were grades 1, 2, and 3. There was significant difference between low-risk groups (grades 0, 1) and high-risk groups (grades 2, 3) as regards age, smoking and duration of DM. This study indicates that prevalence of diabetic patients with risk of foot ulceration in surgical inpatients was high. Routine screening of diabetic foot is recommended specially in old patients.

Human CD34+ stem cells promote healing of diabetic foot ulcers in rats.

OBJECTIVE: Diabetic patients with foot ulcers usually manifest with high amputation and mortality rates. Preliminary evidence supports the effectiveness of stem cell (St) therapy on diabetic foot ulcers. The objective of this study was to evaluate the efficacy of stem cells in the healing of wounds among streptozotocin-induced diabetic albino rats. METHODS: Thirty male albino rats were divided into three groups each of 10 rats: control group, diabetic control (DC) group and St group. Diabetes was induced by intra-peritoneal injection of streptozotocin. A full thickness circular wound of ∼10 mm in diameter was performed on the front of right legs of all rats. In the diabetic St group, the wounds were treated by injection of umbilical cord blood-derived CD34+ stem cells into the wound bed. Half of each group rats were sacrificed after 1 week and the rest after 2 weeks. The wound areas were used for histopathology, immunohistochemistry and transmission electron microscope studies. Assessment of wound surface area, epidermal thickness, blood vessel proliferation and collagen deposition were performed. RESULTS: There was a significant decrease in mean wound surface area, increase in mean epidermal thickness, blood vessel proliferation and collagen deposition in the St group compared with the DC group. CONCLUSION: Treatment with CD34+-enriched cells decreased wound size, accelerated epidermal healing and dramatically accelerated revascularization of the wounds compared with the DC group.

Outcome of midfoot amputations in diabetic gangrene.

BACKGROUND: Persistent high incidence of limb loss resulting from advanced foot gangrene in patients with diabetes prompted an aggressive foot salvage surgery as a final attempt before below-the-knee amputation (BKA). The aim of this study was to evaluate the role of transtarsal amputations in achieving limb salvage at our vascular surgery unit, King Fahd Hospital of the University, Saudi Arabia. METHODS: A prospective study was performed on all patients with diabetes who were admitted to the vascular surgery unit, and underwent transtarsal amputation between November 2005 and October 2010. Patients who had their forefoot removed at the tarsometatarsal level (Lisfranc amputation) or at the midtarsal joint (Chopart amputation) were included in the study. Patient factors, operative complications, operative mortality, wound healing, limb salvage, functional status, and survival rates were evaluated. RESULTS: Over the past 4 years, 32 patients with diabetes were included in this study. Of these, 24 had Lisfranc and 8 had Chopart amputations for advanced gangrene of the foot. A total of 28 patients had evidence of arterial occlusive disease. In all, 24 patients had concomitant revascularization (bypass grafting or percutaneous transluminal angioplasty). Two patients died in the perioperative period (operative mortality: 6%). The stump did not heal in 8 patients (27%) and BKAs had to be performed. Four BKAs and 2 above-the-knee amputations were required 3-28 months later. Functional ambulation at 6 months was achieved in 20 (67%) of 30 patients. CONCLUSION: Aggressive attempts at foot salvage are justified in patients with diabetes with advanced foot gangrene after assuring adequate arterial perfusion. Transtarsal amputations salvaged about two-thirds of the limbs studied.

Does regional anesthesia influence early outcome of upper arm arteriovenous fistula?

To assess the effect of regional anesthesia on the outcome of elbow arteriovenous fistula (AVF), prospectively studied consecutive patients with end-stage renal disease referred for permanent vascular access to the Vascular Unit of King Fahd University Hospital between September 2004 and September 2007. The patients were divided into 2 groups: Group 1: patients who underwent the construction of the AVF under regional anesthesia and Group 2: patients who were operated under general anesthesia, indicated by their preferences or failure of regional anesthesia. Data including patient characteristics and type of AVF were recorded. The internal diameter of the vein and the artery and intra-operative blood flow were measured. The complications of both types of anesthesia were recorded. The patients were followed up for three months. Eighty four cases were recruited in this study. Complete brachial plexus block was achieved in 57 (68%) patients. Seven patients were converted to general anesthesia and 20 patients had AVF under general anesthesia from the start. There were no significant differences between the 2 groups with regard to basic characteristics or operative data. There were no instances of systemic toxicity, hematomas, or nerve injury from the regional block. No major complications were reported from the general anesthesia. There was no significant difference between both groups regarding early failure of AVF (Group 1, 14% vs. Group2; 11%. P= 0.80). No significant advantage of regional over general anesthesia in terms of early outcome of AVF was seen in this study.

Effect of anastomotic length on the development of intimal hyperplasia in the distal anastomosis of bypass graft.

Many hemodynamic factors have been shown to be associated with increased intimal hyperplasia at the distal anastomosis of arterial bypass graft. However, the relationship between the length of anastomosis and the development of such a complication has not been studied before. The aim of this study was to assess this relationship at the distal anastomosis with a Dacron graft. Iliofemoral bypass using 6 mm Dacron grafts was performed in 10 German shepherd dogs. In accordance with preoperative randomization to individual animal legs, distal anastomoses were reconstructed using four different groups (A, B, C, and D), depending on the length of the arteriotomy: 3.0, 3.5, 4.0, and 4.5 times the internal diameter of the artery, respectively. The vessels were harvested 6 months after the operation, and specimens were processed for histologic and transmission electron microscopic (TEM) studies. Quantitative analysis was performed to assess the extent of intimal hyperplasia at three zones (heel, toe, and midzone of the arterial bed) of the distal anastomosis. Sixteen arterial bypasses were included in this study. Both light and TEM studies revealed evidence of intimal hyperplasia in the four groups. Quantitative analysis showed a significant decrease in intimal hyperplasia with increasing the length of the anastomosis at the heel, toe, or midzone of the arterial bed. Mean (mum +/- SD) intimal hyperplasia of the three zones together was significantly higher in group A than group B (585 +/- 106 vs 423 +/- 8.6, p < .001) and in group B than group C (423 +/- 8.6 vs 202 +/- 15, p < .001). However, the difference between group C and group D (202 +/- 15 vs 162 +/- 8.6; p = .13) was statistically insignificant. The present study showed that the length of the anastomosis is one of the hemodynamic factors involved in the development of intimal hyperplasia. Anastomotic techniques that resulted in the least intimal hyperplasia were end to side, with length 4 or 4.5 times the internal diameter of the artery.

Carotid endarterectomy in high-risk Arab patients.

OBJECTIVES: Carotid artery angioplasty and stenting (CAS) has developed quickly and has started to replace carotid endarterectomy (CE) in high-risk cases. However, there are conflicting reports about the results of CAS in such cases. The current study was undertaken to assess the results of CE in high-risk Arab patients over two years at a single center. PATIENTS AND METHODS: The study was performed on all Arab patients referred to King Fahd Hospital of the University for CE with high risk for surgery from August 2004 to August 2006. High-risk factors were recorded. The primary end points were the occurrence of stroke, myocardial infarction and death in the first 30 postoperative days and in follow-up for one year. RESULTS: Thirty-one CE procedures were performed in 29 high-risk Arab patients. Twenty-five patients had severe ischemic heart disease and were prepared for coronary artery bypass grafting. One patient (3%) had preoperative cardiac arrest and after resuscitation developed stroke. One patient died (3%) suddenly nine months after surgery. No recurrence or stroke was recorded over a one-year follow-up period. CONCLUSION: This short report showed that CE can be performed safely in high-risk Arab patients.

Atherosclerosis in sickle cell disease - a review.

Acute, vaso-occlusive crises are the most common and earliest clinical manifestations of sickle cell disease. Recent thoughts about development of atherosclerosis as a result of this disease are presented. Current insights into the pathogenesis of atherosclerosis in sickle cell disease are reviewed, in particular the role of endothelial dysfunction, homocysteine and platelets. Common and uncommon sites of atherosclerosis are described. Radiological assessment and potential therapeutic agents to slow the progression of atherosclerosis are discussed. Finally, treatment of atherosclerosis in certain sites is evaluated and reviewed.

Unusual case of left iliac vein compression secondary to May-Thurner syndrome and crossed fused renal ectopia.

External compression of the left iliac vein against the fifth lumbar vertebra by the right iliac artery May and Thurner syndrome is a well-known anatomic variant. We identified a rare case of May-Thurner syndrome associated with crossed fused renal ectopia on the left side. The patient presented with complete thrombosis of the left common iliac vein down to the popliteal vein. He was treated with catheter directed thrombolysis followed by anticoagulant therapy.

Impact of atherosclerosis risk factors on the clinical presentation of arterial occlusive disease in Arabic patients.

BACKGROUND: Although the risk factors for atherosclerosis have been identified, their impact on the presentation of arterial occlusive disease has not been studied among Arabs. OBJECTIVE: To determine the correlation between atherosclerotic risk factors and the extent and presentation of atherosclerotic disease in different arterial systems. METHODS: The present case-control study was performed on a consecutive series of Arabic patients over one year. There were two groups - an atherosclerotic group, which included patients with peripheral arterial disease, extracranial cerebrovascular disease or coronary artery disease (CAD), and the control group, which included patients admitted to one of the general surgical units who were free from atherosclerotic disease. All patients underwent evaluation of risk factors (diabetes mellitus [DM], smoking, dyslipidemia and hypertension) for atherosclerosis and systemic assessment of the vascular tree. RESULTS: Two hundred fifteen patients in the atherosclerotic group and 191 patients in the control group were included in the study. There were positive correlations between the prevalence of DM, smoking, dyslipidemia and the severity of presentation of peripheral arterial disease, and the extent of CAD. The correlation between the incidence of DM and the severity of presentation of CAD was also significant. The correlation was also positive between the incidence of ex-smoking and hypertension, and the severity of presentation of extracranial cerebrovascular disease. CONCLUSION: Different risk factors may interact in different ways in the clinical presentation of atherosclerotic disease in different arterial systems.

Handlebar hernia: a rare type of abdominal wall hernia.

Handlebar hernias are abdominal wall hernias resulting from direct trauma to the anterior abdominal wall. They usually result at weak anatomic locations of the abdominal wall. Such traumatic hernias are rare, requiring a high index of suspicion for a clinical diagnosis. We report the case of a handlebar hernia resulting from an injury sustained during a vehicular injury, and discuss the management of such injuries.