An international survey on the use of calcium silicate-based sealers in non-surgical endodontic treatment.

OBJECTIVES: To gain insight on the current clinical usage of bioceramic root canal sealers (BRCS) by general dental practitioners (GDPs) and endodontic practitioners (EPs) and to determine if BRCS clinical application is in accordance with the best available evidence. MATERIAL AND METHODS: An online questionnaire of 18 questions addressing BRCS was proposed to 2335 dentists via a web-based educational forum. Participants were asked about socio-demographic data, clinical practice with BRCS, and their motivation for using BRCS. Statistical analysis (chi-squared test or Fisher's exact test) was applied, as appropriate, to assess the association between the variable categories (p value < 0.05). RESULTS: The response rate was 28.91%. Among respondents, 94.8% knew BRCS (EPs more than GDPs, p < 0.05) and 51.70% were using BRCS. The primary reason for using BRCS was their belief of its improved properties (87.7%). Among BRCS users, single-cone technique (SCT) was the most employed obturation method (63.3%) which was more applied by GDPs (p < 0.05); EPs utilized more of the thermoplasticized obturation techniques (p < 0.05). A proportion of 38.4% of BRCS users indicated the usage of SCT with BRCS regardless of the root canal anatomy (GDPs more than EPs p < 0.05) and 55.6% considered that BRCS may influence their ability to re-establish apical patency during retreatment (GDPs more than EPs p < 0.05). CONCLUSIONS: This study highlights wide variation in the clinical use of BRCS which is not in accordance with the current literature. CLINICAL RELEVANCE: This inconsistency among EPs and GDPs on BRCS clinical application requires further clarifications to better standardize their use and improve their future evaluation.

Endodontic-related inferior alveolar nerve injuries: A review and a therapeutic flow chart.

INTRODUCTION: Inferior alveolar nerve (IAN) lesions related to endodontic treatments can be explained by the anatomical proximity between the apices of the mandibular posterior teeth and the mandibular canal. The aim of this article is to review the management of inferior alveolar nerve lesions due to endodontic treatments and to establish a therapeutic flow chart. METHODS: A review of publications reporting IAN damage related to endodontic treatment over the past 20 years has been conducted, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist; it combines an electronic search of the Pubmed® and Google Scholar® databasis. Forty-two full-text articles corresponding to 115 clinical cases have been selected. Two personal clinical cases were additionally reported. RESULTS: IAN lesions due to endodontic treatments require urgent management. Early surgical removal of the excess of endodontic material, in contact with the nerve allows the best recovery prognosis (72h). Beyond this delay, irreversible nervous lesions prevail and a medical symptomatic treatment, most of the time with pregabalin, must be/can be carried out. A delayed surgical procedure shows some good benefits for patients. However, the healing prognosis remains poorly predictable.

[Antoine-Joseph Jobert de Lamballe 1799-1867; or the impetus of modern surgery]. / Antoine-Joseph Jobert de Lamballe 1799-1867; ou l'essor de la chirurgie moderne.

Jobert de Lamballe was a famous French surgeon who lived from 1830 to 1867. Born at Matignon, in France, (Cotes d'Armor country) in a poor family, he became Clinical Surgery Professor at Paris Faculte de Medecine and was known throughout the world for his works about intestinal suturing which, today, is remaining the visceral surgery basis. He was also acknowledged as the originator of plastic surgery, chiefly for the slipping flap regarding to vesico-vaginal fistulas which, before him were assessed as incurable. His success brought him fame and fortune in France, Europa and the U.S.A. Finally, he was the first in Europa to bring general anaesthesia into his hospital (December 1846). Remarkable surgeon in Saint-Louis and Hotel-Dieu Paris hospitals, he was, also, known for his surgical animal's experimentation, but he was a mediocre speaker. He was King Louis-Philippe and Napoleon III's surgeon till his death on April the 19th, 1867, at Dr. Blanche's Clinic for mental diseases after he was falling into a painful depression.

[Analysis of the drainage fluid after cephalic duodenopancreatectomy: a reliable clinical criterion]. / Analyse du liquide de drainage après duodénopancréatectomie céphalique: un critère de surveillance fiable.

The authors have retrospectively analysed the drainage fluid of 39 patients undergoing Whipple's operation over a 18-year period. The aim of the study was to assess whether the volume and amylase concentration of the drainage fluid were good criteria of healing of the pancreatico-jejunal anastomosis. The patients have been divided into two groups: Group I (30 patients) with no complications at the pancreatico-jejunostomy--Group II (9 patients) with a pancreatic leak. The analysis of the volume, amylase concentration and amylase index (Log of the amylase concentration x volume) showed that the groups had clearly different profiles: in group I all three criteria were rapidly decreasing, while they remained abnormally high in group II. Those criteria may help the clinician in the monitoring of individual patients; they also may prove useful in prospective studies evaluating new means of prevention of this anastomosis.

[Ischemic colitis. A surgical series of 88 cases]. / Colites ischémiques. Une série chirurgicale de 88 cas.

We report our experience in 88 cases of ischemic colitis including 76 cases of gangrene with 17 perforations, 6 cases with stenosis and 6 cases which regressed. The left colon was involved in 59 cases with extension to the transverse colon in 20 the right colon in 10 and global involvement in 18. Abdominal pain, diarrhea, and meteorism occurred in 81, 62 and 78% of the cases respectively. Coloscopy was performed in 61 cases, a barium study in 27. A colectomy was required in 77 patients: 50 left colectomies with 16 extensions to the transverse colon, 17 total colectomies and 10 right colectomies. Morbidity was 53% in cases with perforated gangrene and 28% without perforation. There was no morbidity in stenosis and regressive forms. Normal tube flow was conserved or reestablished in 51 of the 62 survivors. The 88 patients were referred from cardiovascular units (36%), intensive care (28.5%), or internal medicine (22%). All had intramural ischemia due to local or general lesions which progressed to parietal gangrene in 76 cases. The diagnosis was based on clinical signs and confirmed by coloscopy which determined the stage and extension. Stage II ischemia required rapid colectomy adapted to the endoscopic lesions and not the exterior aspect of the colon; immediate anastomosis is usually not used.

[Hematoma of the iliac psoas muscle. 29 cases]. / Les hématomes du psoas iliaque. 29 observations.

We present 29 cases of haematoma of the iliac psoas muscle, following anticoagulant treatment and review 158 cases so far published. In 60 p. 100 of cases, the anticoagulant was some form of intravenous or subcutaneous heparin; prescribed in 40 p. 100 of cases for venous thrombosis followed rapidly by pulmonary embolism, in half the cases between the 3rd and the 14th day. Hypocoagulation was excessive in 64 p. 100 of the cases. Clinically the onset is marked in all cases by a violent pain in the territory of femoral nerve, anaemia (40 p. 100) psoïtis (32 p. 100) and iliac mass (51 p. 100), ecchymosis (13 p. 100) and particularly 23 among 29 cases an early or late femoral paralysis. The clinical diagnosis has been confirmed by echography 21 cases an or CT scan (7 cases). Our approach has been definitely surgical. The surgical procedure carried out in 20 p. 100 of the cases published, and in 23 of our ones, relieves the pain, provides for an early efficient physiotherapy, and a regression of the femoral paralysis, much more rapidly and completely than in the absence of surgery. The anatomical lesions, and the condition of the femoral nerve are described in the operative records, account for that evolution and explain our position. Traumatic and hemophilic have evocated.

[37 so-called biliary cysts of the liver in adults]. / 37 kystes dits biliaires du foie chez l'adulte (KBF).

Clinical manifestations, clinical course and therapeutic schemes were studied in 37 patients with a surgical indication for biliary cysts of the liver observed in a surgery unit over 25 years. Cyst size varied from 2 to 30 cm and was greater than 10 cm in 12 cases. Yellowish-clear contents were observed in 23 cases and purulent or hemorrhagic contents in 3 each. Twenty-three patients were asymptomatic, 14 had pain and/or complications (hemorrhage 3, infection 3, compression 3, rupture 1). Therapy was abstention in 7 cases, puncture in 5, resection of the protruding dome in 17, complete exeresis in 5, and hepatectomy in 3. There were no deaths and morbidity reached 7%. Biliary cysts of the liver can be discovered fortuitously at surgery or imagery or in patients with abdominal pain, an abdominal mass or complications including compression, intraperitoneal rupture, intracystic hemorrhage, hemobilia, acute infection, torsion, cancerization. Diagnosis requires sonography and computed tomography. Therapeutic indications are: abstention for small asymptomatic cysts. For voluminous cysts, with complications or confirmed during a supramesocolic operation, the risk of recurrence or aggravation of the complications excludes puncture or injection of a sclerosing agent. Wide resection of the protruding part of the cyst with histology resection can be performed although prospective assessment is needed. Cystectomy is not indicated if there is a diagnostic doubt. Hepatectomy is an exceptional indication retained for patients with uncontrolable hemorrhage, intra-cystic tumors or voluminous cysts destroying the lobe.

Protective transverse loop colostomy associated with low colo-rectal anastomoses.

A transverse loop colostomy to protect a low colorectal anastomosis should be carried out with minimal morbidity and mortality related to its creation and closure. A modification of the conventional technique is described.

[Ogilvie's syndrome or colonic pseudo-obstruction. Apropos of 26 cases]. / Syndrome d'Ogilvie ou de pseudo-obstruction colique. A propos de 26 observations.

From twenty six personal cases, the authors make a review of the literature. 92% of their cases are met in a post operative (28%), neurological (28%), general (24%) context, or in intensive care with assisted ventilation (36%). The major symptom is the meteorism (100%) with in one out of three cases, abdominal pain, vomiting, right iliac defense, absence of bowel sounds. Radiological distension involves mostly the right colon and the coecum (28%), right and transverse colon (40), sometimes the whole colon (32%). The mean diameter of the coecum reached 12 cm (9 to 25 cm). Early coloscopy was mandatory in 20 patients, of which 14 were cured, 13 patients were operated on, for suspicion of ischemia or perforation, because incertain diagnosis, or failure of colonoscopy. Ceocostomy or right hemicolectomy (55%) were performed rather than transverse colostomy. The surgical approach must be adapted to the anatomical lesions. Total mortality was 4% in this series. Early diagnosis of pseudo obstruction, early colonoscopy with intubation must allow to avoid surgery.

[Evolution of Hartmann's procedure. 249 interventions]. / Evolution de l'intervention de Hartmann. 249 interventions.

A retrospective study of 249 patients undergoing Hartmann's procedure over twenty-five years was undertaken to analyse the evolution of indications and results. Patients were divided into three time period groups: from 1969 to 1978, 1979 to 1990 and 1991 to 1994. Mean age was 68 years old. Major indications were complicated diverticular disease (42.9%), colo-rectal malignancies (35.7%) and ischemic colitis (14%). Operative mortality is 10.8%, higher in ischemic colitis (20%) than in complicated diverticulitis (6.5%) and cancer (13.4%). Overall morbidity has significantly reduced, from 65.51% to 17.24%. General complications have changed a little, while local and/or inherent operative complications have reduced from 22.4% to 1.72. Restoration of colorectal continuity was done in 59.54% of patients, increasing from 36% to 71% during the three periods. This is variable depending on initial disease: 92% in diverticular disease, 69% in ischemic colitis but remains stable for carcinoma at 33%. Overall mortality since 1981 is 2.5% and morbidity is 19.13%. Mean Hospital stay was 20 days for the initial operation and 15 days for secondary restoration of colorectal continuity. Hartmann's procedure is well indicated as emergency surgery in colonic perforations, abscessus and ischemia. Progressive improvement of its results is essentially due to persistent attention to indications and technical details.

A 270 degree laparoscopic posterior fundoplasty in the treatment of gastroesophageal reflux.

BACKGROUND: The aim of this prospective study was to evaluate the results of laparoscopic treatment of gastroesophageal reflux using a posterior fundoplasty. STUDY DESIGN: Fifty-one patients with gastroesophageal reflux or paraesophageal hernia, or both, documented by fibroscopy, acid reflux monitoring, and manometry were evaluated. The operative technique consisted of abdominal esophagus mobilization, approximation of the crura, and construction of a 270 degree posterior gastric valve, 5 to 7 cm in height. A clinical examination was performed after two weeks, four months, one year, and two years, and fibroscopy, acid reflux monitoring, and manometry were done at four months. RESULTS: One patient required a conversion to laparotomy. One opening of the gastric valve was repaired laparoscopically. There was no perioperative death. Morbidity was limited to one case of pulmonary aspiration of gastric juice. All patients but one who were operated on laparoscopically have been clinically evaluated between four and six months after surgery. There was no dysphagia, diarrhea, or gas bloating reported after two months. Four patients without clinical symptoms refused to go through postoperative explorations. Among the 45 remaining patients, one had a reflux recurrence and another only an abnormality on acid reflux monitoring. There was no degradation of the clinical result among the 26 and 12 patients seen at one and two years, respectively. CONCLUSIONS: A 270 degree posterior fundoplasty can be performed laparoscopically without major morbidity. A short follow-up examination confirms the efficacy of the procedure and the absence of specific morbidity. If these results are confirmed, they could be an argument to broaden the indications of the antireflux procedure as compared to prolonged medical treatment.

[Post-surgical or traumatic anal incontinences. Prospective study in 40 patients explorated by endorectal ultrasonography and electromyography]. / Incontinences anales post-chirurgicales ou traumatiques. Etude prospective de 40 malades explorés par échographie endorectale et électromyographie.

OBJECTIVES: Anal endosonography is used to assess anal canal structure and external anal sphincter. The purpose of this study was to compare findings at anal endosonography with electromyographic tests in patients with faecal incontinence. METHODS: Fourty patients (31 women; median age: 47 years) were referred for exploration of the anal sphincter: 15 patients had previous anal surgery, 16 patients had obstetrical trauma, 3 patients had accidental trauma, 6 women had obstetrical trauma and previous anal surgery. RESULTS: Anal endosonography demonstrated an external sphincter defect in 19 patients (partial n = 4, complete n = 15); 18 of these patients had an electromyographic study: an external sphincter defect was demonstrated by mapping in 15 cases; 3 partial defects were not found. Eight patients had associated pudendal nerve terminal motor latency delayed due to neuropathic impairment of pudendal nerve. Surgery was performed in 12 patients; external sphincter lesion was confirmed in all cases. CONCLUSIONS: Anal endosonography and electromyography mapping easily recognize external sphincter disruption with high concordance. Partial defects are better diagnosed by anal endosonography. A study of pudendal nerve terminal motor latency is useful in the exploration of faecal incontinence because pudendal neuropathy occurs frequently in association with a sphincter defect.

[Intercostal abdominal hernias. Apropos of 2 cases with right hernia]. / Les hernies intercostales abdominales. A propos de deux cas de hernie droite.

Two patients presented with abdominal wall hernia in the 9th intercostal space on the right. Such localizations are extremely rare, occurring after closed or open chest or abdominal trauma producing two contiguous orifices in the diaphragm and the intercostal chest wall. The diaphragmatic orifice is due to a low lateral disinsertion and the intercostal orifice is situated in the 7th to 11th space, occurring immediately or later. Intercostal abdominal hernias are sometimes discovered due to pain or digestive or respiratory disorders. Clinical diagnosis is simple. CT scan confirms the clinical diagnosis and give a precise description. A direct or abdominal surgical approach is used to close the diaphragmatic orifice and the intercostal space with an unabsorbed suture. Muscle plasty or a unabsorbable prosthesis may be necessary. Early recurrence may occur if the orifice in the diaphragm is ignored.

[Stenosis caused by mechanical colorectal anastomosis. Technique of plasty]. / Sténose d'anastomose colorectale mécanique. Technique de plastie.

Stenosis occurs in 1.2 to 4% of the cases after colorectal anastomosis, especially after stapling. Ischaemia may have been favoured in our two cases. Treatment requires endoscopic dilatation or section of a sclerous diaphragm and may entail reconstruction of the anastomosis. The Kraske plasty is a simple and rapid procedure (case n. degree 1) and can be performed via endoluminal access (case n. degree 2) using a linear suture.

[Tumors of the mesentery. Apropos of 102 cases]. / Les tumeurs du mésentère. A propos de 102 cas.

One hundred and two mesenteric tumours or masses are reported, and their histologic, clinical and therapeutic aspects are described: 28 cystic tumours, 38 mesenchymatous and 3 neurogenic tumours, 27 miscellaneous tumours, including 17 lymphomas, 2 hematomas and lymphoid or inflammatory masses. Seventy-four patients presented with an abdominal mass, 41 with pain and 28 with acute abdominal syndrome, including 16 with intestinal obstruction. Ultrasonography and computerised tomography were performed in 31 patients, RMI in 8 patients: these investigations are useful in establishing the diagnosis but surgical exploration and biopsies remain necessary for the pathology. One hundred and one patients required operation: 45 biopsies with 5 by-passes, and 56 resections, 32 localized tumour resections and 24 extended to the small bowel. Radiotherapy and chemotherapy have little or no effect.