Accuracy of IOS in Full-Arch Dentate Patients Compared to CBCT Cast-Scanning. An In-Vivo Study.

Twenty fully-dentate patients were enrolled in the study.Full-arch maxillary and mandibular PVS impressions were acquired using stock metal trays and the dual mix technique. A full-arch maxillary and mandibular intraoral scanner (IOS) was also obtained using the Trios IOS. The impressions were cast and subsequently scanned using a Planmeca Promax cone beam computed tomography (CBCT) scanner. The casts were also scanned in a Desktop Scanner for reference(7series Dental Wings). DICOM files from the CBCT device were converted into stl files. The.stl files from the CBCT and IOS devices were compared for accuracy against the reference files from the Desktop Scanner using a 3D surface measurement software. Statistical analysis was carried out using SPSS software. Trios had a smaller error (median = 39µm) than CBCT (median = 62µm),a statistically significant difference between the 2 modalities (z=-4.6, p⟨0.005).Concerning the IOS, the anterior teeth presented with a smaller error (42±16µm) as opposed to the posterior teeth (47±16µm), a significant difference (t(39)=-2.4, p=0,019). There were no significant differences in IOS mean accuracy between maxilla and mandible or between left and right quadrants. Fullarch digitization using the Trios IOS is significantly more accurate compared to CBCT scanning of the relevant plaster models. Anterior teeth Trios IOS is statistically more accurate compared to posterior teeth IOS.

Differential localization profile of Fras1/Frem proteins in epithelial basement membranes of newborn and adult mice.

The Fras1/Frem gene family encodes for structurally similar proteins of the extracellular matrix, functionally correlated with embryonic dermal-epidermal adhesion as deduced from the appearance of sub-epidermal blisters in mouse mutants compromising the function of Fras1, Frem1 and Frem2 proteins. Mutations in the human counterparts FRAS1 and FREM2 have been detected in patients suffering from Fraser syndrome. So far, Fras1/Frem proteins have been shown to be strictly colocalized in the sublamina densa of mouse epithelial basement membranes during development. Here, we focused on the characterization of the localization pattern of the aforementioned proteins, in various parts of the adult mouse skin as well as a range of organs and tissues. Frem3 was present in a broad range of epithelial basement membranes where Fras1, Frem1 and Frem2 were missing. The localization profile of Frem3 coincided with that of collagen VII in all skin basement membranes but differed in that Frem3 was additionally found in the basement membrane of several internal epithelia, where collagen VII was absent. Fras1 and Frem2 were colocalized with Frem3 in the basement membrane of certain skin parts, underlying the thin-layer, of rapidly proliferating keratinocytes, whereas Frem1 was detected only in the basement membrane of the tail. The localization pattern of Fras1 and Frem2 was indistinguishable, while both proteins along with Frem3 could be detected even in the absence of Frem1.

Spiral computerized tomography : a diagnostic aid in patients with atypical acute appendicitis.

This retrospective study aimed to estimate the value of spiral Computerized Tomography (sCT) in patients with suspected appendicitis who remained undiagnosed after 48 hours of expectant management. We assessed a cohort of 150 patients by focused unenhanced sCT. According to the clinical scenario we occasionally employed contrast media and extended the scanned area. The major radiological signs were appendiceal enlargement and inflammatory changes of periappendiceal tissue and mesenteric fat. Regarding acute appendicitis the examination was 95.8% sensitive, 97.4% specific, had a positive predictive value of 97.18%, a negative predictive value of 96.2% and an accuracy of 96.7%. It also provided alternative diagnoses in 55 patients leading correctly 31 of them to the theatre for a variety of abdominal surgical diseases. For abdominal surgical pathology in general, sCT was 97.1% sensitive, 95.7% specific, had a positive predictive value of 98% and a negative predictive value of 93.8%. The importance of good communication between the clinicians and radiologists was pointed out by the correct alternative diagnoses set by imaging in the 55 patients after modifying the sCT protocol and was highlighted by the unnecessary appendectomy of three patients with negative imaging. Our results verify the accuracy and value of unenhanced sCT in patients with a clinical picture which remains inconclusive after an initial period of expectant management.

Clinical presentations and surgical management of liver hydatidosis: our 20 year experience.

BACKGROUND: Hydatidosis/echinococcosis of the liver is a very old problem in Greece and still exists, although it is declining. We have reviewed our 20 years' experience, and here we report the various clinical presentations of the disease and evaluate the clinical outcome of the surgical procedures performed. PATIENTS AND METHODS: We conducted a retrospective analysis of the past 20 years' medical records; 35 patients (males 34%, females 66%, mean age 58 years) were treated surgically. Results. The presenting symptoms or findings leading to the diagnosis of liver echinococcosis were jaundice (six cases, 17%), abdominal pain (five cases, 14%), gastrointestinal discomfort of the upper abdomen (e.g. nausea, vomiting, distention, anorexia) (two cases, 6%), acute pancreatitis (one case, 3%) and portal hypertension (one case, 3%). The rest of the cases were diagnosed incidentally (20 cases, 57%). External drainage and cystectomy with omentoplasty was performed in 21 cases (60%) and pericystectomy in 14 cases (40%). The mean hospital stay was 16.8 days. Morbidity and mortality were 18% and 3%, respectively, with no statistically significant differences between the two surgical approaches. The recurrence rate averaged 3%. DISCUSSION: A high index of suspicion is recommended when variable clinical manifestations of the upper abdomen are present. Meeting all criteria for surgical treatment of hydatid disease, external drainage and cystectomy should be the standard surgical procedure. Pericystectomy could be used for peripherally located liver cysts that are only partially surrounded by parenchyma. Resection procedures are considered too radical for a benign disease. Appropriate randomized controlled studies are needed to establish the definite surgical management of liver hydatidosis, including modern techniques such as laparoscopy and transcutaneous puncture under US guidance (PAIR technique).

Alternative interventional multimodality therapies for the management of liver malignancies.

Primary and secondary liver tumors are highly malignant with a very high morbidity and mortality. Although surgical resection is generally accepted as the mainstay of treatment, only a small number of patients are suitable for curative resection. Interventional multimodality therapies provide an alternative to liver resection with minimal morbidity and mortality and quite promising outcomes. These include transcatheter arterial chemoembolization (TACE), percutaneous ethanol (PEI) or other injection techniques, radiofrequency ablation (RFA), microwave coagulation therapy (MCT), cryoablation and interstitial laser photocoagulation (ILP). Techniques, indications and outcomes are discussed.

The treatment of chronic anal fissure with botulinum toxin.

BACKGROUND/AIMS: The aim of this study was to evaluate the effectiveness of botulinum toxin for the treatment of uncomplicated dorsal chronic idiopathic anal fissure. MATERIAL AND METHODS: Forty-five patients who reported post defecatory anal pain since two months or more were given a total of 20U botulinum toxin in the anal sphincter apparatus on both sides as well as below the anal fissure. RESULTS: Thirty-seven patients received a second session of 25U botulinum toxin injection. Thirty-five patients (78%) presented completely healed anal fissure, while ten needed lateral internal sphincterotomy. All patients were followed up for 8-36 months. Two patients relapsed. CONCLUSION: Local injection of botulinum toxin is a new and safe treatment; however, two sessions of injections are necessary to be effective and long-term follow-up to assess the recurrence rate of fissure is needed to evaluate further this method of treatment. Partial internal lateral sphincterotomy is no more the treatment of choice for chronic anal fissure.

Aortic transsection after blunt chest trauma.

We report a case of an 18-year-old female who developed an extensive hemothorax after blunt chest trauma. Transesophageal echocardiography (TEE) showed transsection of the aorta at the level of the isthmus and turbulent flows in several places around the aorta. We discuss the contribution of TEE for detecting traumatic injuries to the thoracic aorta.

Presentation of blunt small intestinal and mesenteric injuries.

During the 10 year period from 1988 to 1997, 64 patients with blunt small bowel and mesenteric injuries were treated at two trauma centres. The majority (52 cases) were victims of motor vehicle accidents, and 54% of them wore seat belts at the time of the accident. There were 22 small bowel injuries (17 full-thickness and 5 seromuscular) and 42 mesenteric injuries (7 with and 35 without a devascularised bowel segment). Shock on admission was present in 34% of the patients and generalised abdominal tenderness in 75%. Diagnostic peritoneal lavage was positive for blood in 25 out of 36 cases in which it was performed (69%), and positive for bowel content in 4/6 patients (67%) with full-thickness bowel perforations or transactions. Emergency room ultrasound was positive for blood in 13/25 cases (52%), and CT scan in 7/17 (41%). It is concluded that blunt small bowel and mesenteric injuries including patients with perforated or ischaemic bowel are difficult to diagnose using currently available diagnostic tools, and require a low threshold for exploration based on clinical suspicion in order to reduce the complications following delayed treatment of these injuries.

Correlation of histoenzymological studies with the response to chemotherapy and survival in breast cancer patients.

The enzyme activity of cancerous tissue and the adjacent normal epithelium of 40 patients with breast cancer was determined. This enzymatic activity was correlated with the responsiveness of those tumors to the chemotherapy. It was found that the presence of cytochrome oxidase and alkaline phosphatase and the absence of leucine aminopeptidase, beta-glucuronidase and dehydrogenases in cancerous tissues was related to good response. On the contrary, the absence of alkaline phosphatase and cytochrome oxidase and the presence of leucine aminopeptidase, beta-glucuronidase and dehydrogenases in the cancerous tissues was related to poor response and therefore to poor survival.

Immunological characterization of an ocular adnexal lymphoid T tumor by monoclonal antibodies.

The phenotype of a lymphoid orbital tumor is described, using monoclonal antibodies of the OKT series. The majority of tumor cells lacked surface immunoglobulins and bound OKT3, hence they arose from the T lineage. These cells belonged to the mature helper T cell subpopulation since a great proportion was recognized by OKT4 antibody. In contrast, a decrease in the peripheral blood OKT4+ pool was observed. The results demonstrate the importance of using a panel of markers, such as monoclonal antibodies, for the identification of cell derivation of lymphomas.