Fluorosis. Antivet contra ácido clorhídrico / fluoride. Antivet vs hydrochloric acid

Introducción: La fluorosis dental es una hipomineralización del esmalte producida como respuesta a la ingesta de fluor por un periodo prolongado durante la formación del esmaltado. Es una alteración irreversible, que clínicamente se caracteriza por la presencia de delgadas líneas blanquecinas distribuidas en el esmalte dental correspondientes a la disposición de las periquimatías, y en grados más avanzados de la enfermedad se odservan cambios en toda la superficie del esmaltado que adquiere un aspecto opaco, como de piedra caliza. En los niveles más severos de flurosis dental, la presencia de hipomineralización, y el aumento en la porosidad del esmalte dental propicia la pérdida de porciones importantes de su estructura, produciendo fracturas, por lo que se deteriora la apariencia y funcionalidad de los dientes afectados. (1) La OMS recomienda que el valor de referencia para el fluoruro en el agua potable es de 1,5 mg /1.(2) El flúor es un gas halógeno, el más electronegativo de los elementos de la tabla periódica, con número atómico 19, prácticamente no existe libre en la naturaleza, sino asociado a otros elementos como: calcio y sodio. La principal vía de incorporación del flúor en el organismo humano es la digestiva. Es absorbido rápidamente en la mucosa del intestino delgado y del estómago, por un simple fenómeno de difusión. Una en los tejidos, depositándose preferentemente en los tejidos duros; se elimina por todas las vías de excreción, principalmente por orina. La cantidad de flúor en el organismo es variable y depende de la ingestión, inhalación, absorción y eliminación, así como de las características de los compuestos. Generalmente se concentra en huesos, cartílagos, dientes y placa bacteriana. El depósito de flúor varía con la edad y la excreción. En los niños, el 50% se fija en huesos y dientes en formación; en adultos, se deposita básicamente en huesos. (3) Existen diversos métodos para su eliminación. En esta investigación se realizaron 18 procedimientos a pacientes de ambos sexos. La metodología fue dividir en dos grupos de 8 personas cada uno, en el cual se utilizó Antivet en el primer grupo y ácido clorhídrico al 18% en el segundo grupo. Los casos fueron seleccionados al azar y posteriormente se observaron los cambios clínicos con cada grupo. En el primer grupo de personas que utilizaron Antivet, se mostró que en casos severos de fluorosis no era un método tan eficaz, ya que no elimina por completo las manchas marrones, sin embargo, es un procedimiento muy bueno para uso clínico cuando los grados de fluorosis son menores. En el segundo grupo de personas que utilizaron ácido clorhídrico al 18% se demostró la eficacia del tratamiento en fluorosis de grados avanzados, donde el esmalte está más del 50% dañado, por lo que es un excelente método de tratamiento con el debido control en su manipulación. Objetivo: Saber diferenciar los tipos de materiales y conocer los diferentes métodos para eliminación de flúor así como mostrar la diferencia entre tratamientos. Metodología: El tipo de estudio es explicativo y con el cual se espera contribuir al desarrollo del conocimiento científico. Su realización supone el ánimo de contribuir al desarrollo del saber científico. Consistió en seleccionar 16 pacientes, masculinos y femenonos y de distintas edades de entre 15 y 40 años. Se dividieron al azar, en 2 grupos de 8 personas cada uno para tratarlos con 2 productos diferentes. El primer grupo fue tratado con ácido clorhídrico al 18% y el segundo grupo con la marca comercial Antivet. Resultado y conclusión: La fluorosis dental es causada por ingestas excesivas de flúor. El uso del ácido clorhídrico es corrosivo, su aroma es penetrante y los cuidados con el paciente son mayores, ya que un mal uso al tener contacto con piel o mucosa creará necrosis. El Antivet tiene desventajas de costo y disponibilidad, pero su ventaja es que brinda más seguridad en su manipulación.

Introduction: Dental fluorosis is a hypomineralization of the enamel produced due to fluoride intake for a prolonged time during enamel formation. It is an irreversible alteration, which is clinically characterized by the presence of thin whitish lines distributed in the dental enamel corresponding to the disposition of the perikymata. In more advanced degrees of the disease, changes are observed in the entire enamel surface, which acquires an opaque appearance, like limestone. In the most severe levels of dental fluorosis, the presence of hypomineralization and increased porosity of the dental enamel leads to the loss of essential portions of its structure, producing fractures, thus deteriorating the appearance and functionality of the affected teeth. (1) The WHO recommends that the reference value for fluoride in drinking water is 1.5 mg/l. (2) Fluoride is a halogen gas, the most electronegative of the periodic table elements, with atomic number 19. It practically does not exist free in nature but is associated with other elements such as calcium and sodium. The primary way of incorporating fluorine into the human organism is through the digestive system. It is rapidly absorbed in the mucosa of the small intestine and stomach by a simple phenomenon of diffusion. Once absorbed, fluoride passes into the blood and is distributed in the tissues, preferentially deposited in hard tissues; it is eliminated by all excretion routes, mainly by the urine. The amount of fluoride in the body is variable and depends on ingestion, inhalation, absorption, elimination, and the characteristics of the compounds. It is generally concentrated in bones, cartilage, teeth, and bacterial plaque. Fluoride deposition varies with age and excretion. In children, 50% is fixed in bones and teeth information; it is basically deposited in bones in adults. (3) There are various methods for its elimination. In this research, 18 procedures were performed on patients of both sexes. The methodology was divided into two groups of 8 persons each, in which Antivet was used in the first group and 18% hydrochloric acid in the second group. The cases were randomly selected, and subsequently, the clinical changes were observed in each group. In the first group of people who used Antivet, it was shown that in severe cases of fluorosis, it was not such an effective method since it does not completely eliminate the brown stains. However, it is a very effective method for clinical use when the degrees of fluorosis are lower. In the second group of people who used 18% hydrochloric acid, the effectiveness of the treatment was demonstrated in advanced degrees of fluorosis, where the enamel is more than 50% damaged, making it an excellent method of treatment with due control in its manipulation. Objective: To differentiate the types of materials and to know the different methods for fluoride elimination as well as to show the difference between treatments. Methodology: The type of study is explanatory, and it is expected to contribute to the development of scientific knowledge. It was carried out to contribute to the development of scientific knowledge. It consisted of selecting 16 patients of both sexes and of different ages between 15 and 40 years old. They were randomly divided into two groups of 8 persons, each to be treated with two different products. The first group was treated with 18% hydrochloric acid, and the second group with the comercial brand Antivet. Result and conclusion: Dental fluorosis is caused by excessive fluoride intake. Hydrochloric acid is corrosive, its aroma is penetrating, and the care with the patient is greater since a wrong use when in contact with skin or mucosa will create necrosis. Antivet has disadvantages of cost and availability, but its advantage is that it provides more safety in its handling.

Cultured versus freshly isolated adipose-derived stem cells in improvement of the histopathological outcomes in HCL-induced cystitis in a rat model.

Interstitial cystitis (IC) is an incurable chronic disease. The etiology of IC is unclear, and no effective therapies have been established. Here, using a hydrogen chloride (HCL)-induced IC in a rat model, the therapeutic potency of stromal vascular fraction (SVF) and Adipose-derived stem cells (ADSCs) was studied. Thirty-six female Sprague Dawley rats were divided into four groups: the sham, HCL, (HCL+SVF) group, and (HCL+ADSCs) group (9 for each). Cystitis was induced by transurethral instillation of HCL, while PBS was used for the sham group. A single dose of SVF or ADSCs was injected into the submucosa of the rat bladder in HCL-induced IC groups. The bladder tissues were analyzed for Toluidine Blue, Masson Trichrome, CD3, and CD34 to evaluate mast cell activation, fibrosis, inflammatory cells, and bladder regeneration, respectively. Compared to HCL-induced IC, SVF or ADSCs injection into IC bladder dramatically decreased mast cell infiltration, T-cell activation, and fibrosis. Taken together, administration of SVF cells or cultured ADSCs improves the histopathological outcomes of HCL-induced bladder injury in a time-dependent manner. Of note, SVF injection into the bladder submucosa was estimated to have the most potent therapeutic efficacy and may represent an essential component in future clinical applications.

Efficacy of surfactant therapy of ARDS induced by hydrochloric acid aspiration followed by ventilator-induced lung injury - an animal study.

The development of acute respiratory distress syndrome (ARDS) is known to be independently attributable to aspiration-induced lung injury. Mechanical ventilation as a high pressure/volume support to maintain sufficient oxygenation of a patient could initiate ventilator-induced lung injury (VILI) and thus contribute to lung damage. Although these phenomena are rare in the clinic, they could serve as the severe experimental model of alveolar-capillary membrane deterioration. Lung collapse, diffuse inflammation, alveolar epithelial and endothelial damage, leakage of fluid into the alveoli, and subsequent inactivation of pulmonary surfactant, leading to respiratory failure. Therefore, exogenous surfactant could be considered as a therapy to restore lung function in experimental ARDS. This study aimed to investigate the effect of modified porcine surfactant in animal model of severe ARDS (P/F ratio

Effect of hydrochloric acid commercial presentation for microabrasion technique on loss of enamel structure and surface / Efeito da apresentação comercial de ácido clorídrico para técnica de microabrasão na perda de estrutura e superfície do esmalte

Introdução: A técnica de microabrasão pode ser realizada através de pasta pronta para uso, disponível comercialmente, ou o profissional pode manipulá-la no consultório. Objetivo: Verificar o efeito da apresentação comercial do ácido clorídrico a 10% na manipulação de pasta para microabrasão sobre a superfície do esmalte. Metodologia: Foram selecionados incisivos bovinos e divididos em dois grupos, de acordo com a apresentação comercial do ácido clorídrico (líquido ou em gel). O tratamento foi realizado através de dez aplicações com 10s de duração cada, intercaladas por lavagem de 10s. Vinte incisivos (n=10) foram utilizados para se determinar a perda de estrutura do esmalte. Cada amostra foi pesada, em balança analítica, antes e após submissão à microabrasão. Outras 20 amostras (n=10) foram utilizadas para determinação da rugosidade superficial média (Ra) utilizando-se um rugosímetro. Três amostras de cada grupo do experimento anterior foram selecionadas, aleatoriamente, e outras três amostras adicionais foram preparadas como controle (baseline) para análise em MEV. Resultados: Verificou-se diferença estatística significativa entre a massa final e a inicial e rugosidade superficial das amostras, independente da apresentação comercial do ácido. Nas imagens de MEV observou-se presença de superfície regular para o grupo controle (baseline). Nas demais imagens verificou-se superfície com considerável irregularidade e dissolução discreta do esmalte. Conclusões: O tratamento realizado causou perda significativa de estrutura e aumentou a rugosidade superficial dos espécimes, independente da apresentação comercial do ácido e sem apresentar diferença entre os grupos ao final. A apresentação comercial do ácido não parece ser um fator a interferir no tratamento. (AU)

Introduction: The microabrasion technique can be performed using a commercially available paste, or the dentist can prepare it in his office. Objective: To verify the effect of hydrochloric acid commercial presentation in the handling of microabrasion paste on the enamel surface. Methodology: Bovine incisors were divided into two groups, according to the commercial presentation of 10% hydrochloric acid (liquid or gel). The treatment was carried out through ten applications of 10 s duration each, intercalated with a 10s wash. Twenty teeth (n=10) were used to determine the loss of enamel structure. Each sample was weighed on an analytical balance before and after submission to microabrasion. Another 20 teeth (n=10) were used to determine the average surface roughness (Ra) using a rugosimeter. Three samples from each group of the previous experiment were selected, randomly, and another three additional samples were repared as a control (baseline) for SEM analysis. Results: There was a statistically significant difference between the final and initial mass and the surface roughness of the samples, regardless of the acid commercial presentation. In the SEM images, a regular surface was observed for the control group (baseline). In the other images, there was a surface with considerable irregularity and a slight dissolution of the enamel. Conclusions: The treatment carried out. (AU)

Investigation of anti-inflammatory effects of oxygen nanobubbles in a rat hydrochloric acid lung injury model.

Aim: To investigate the anti-inflammatory effect of oxygen nanobubbles (ONBs) in an acute lung injury rat model. Materials & methods: In a rat hydrochloric acid lung injury model, ONB fluid was administered intravenously in the ONB group (n = 6) and normal saline was administered in the control group (n = 6). 4 h later, arterial partial pressure of oxygen (PaO2), mean arterial pressure and plasma inflammatory cytokines were measured. Results: There were no significant differences in the PaO2, mean arterial pressure or TNF-α and IL-6 levels between the two groups. Conclusions: No anti-inflammatory effect could be confirmed at the present ONB dose in the rat model of acute lung injury.

Pain Bloc-R Alleviates Unresolved, Non-Pathological Aches and Discomfort in Healthy Adults-A Randomized, Double-Blind, Placebo-Controlled, Crossover Study.

The lack of effective treatment for chronic discomfort without negative side effects highlights the need for alternative treatments. Pain Bloc-R is a natural health product composed of vitamins B6, B12, D, white willow bark extract, Angelica root extract, acetyl L-carnitine HCl, caffeine, L-theanine, Benfotiamine, and L-tetrahydropalmatine. The objective of this study was to compare the effects of Pain Bloc-R, acetaminophen, and placebo on unresolved aches and discomfort as assessed by the brief pain inventory (BPI) and modified Cornell musculoskeletal discomfort questionnaires. This randomized, double-blind, placebo-controlled, crossover study consisted of three 7-day periods with Pain Bloc-R, acetaminophen, or placebo, each separated by a 7-day washout. Twenty-seven healthy adults (ages 22-63 years) were randomized to receive the three interventions in different sequences. The BPI "pain at its worst" scores were significantly lower when participants took Pain Bloc-R than when they took acetaminophen (21.8% vs. 9.8% decrease, p = 0.026) after seven days of supplementation. Pain Bloc-R achieved a significant improvement in the "pain at its least" score, significantly decreased the interference of discomfort in walking, and significantly decreased musculoskeletal discomfort total scores (34%, p = 0.040) after seven days. In a post hoc subgroup analysis based on age and gender, male participants ≤45 years taking Pain Bloc-R reported significant reductions in pain severity and pain interference vs. acetaminophen. Pain Bloc-R performed as well as acetaminophen in managing unresolved non-pathological pain in otherwise healthy individuals.

Increasing radiofrequency ablation volumes with the use of internally cooled electrodes and injected hydrochloric acid in ex vivo bovine livers.

PURPOSE: We used an impedance-controlled generator with an internally cooled electrode to perform radiofrequency ablation (RFA) in ex vivo bovine livers, with a single injection of either 38.5% sodium chloride (NaCl) or 10% hydrochloric acid (HCl), to determine the relative effects of these two solutions on tissue impedance, temperature and ablation volume. MATERIALS AND METHODS: We performed 10 ablations each with injections of NaCl (NaCl-RFA), HCl (HCl-RFA) or nothing (RFA-alone), with a power setting of 200 W for 15 minutes. We recorded tissue impedance before and after injection. We logged temperatures obtained from thermocouple probes positioned 5, 10, 15 and 20 mm from the internally cooled RF electrode. After ablation, we measured ablation zone longitudinal and transverse diameters, and we calculated a spherical ratio (SR) for each ablation. RESULTS: Mean post-injection impedance of 30.3 (standard deviation [SD] 2.5) ohms for HCl was significantly lower than that of 55.4 (SD 3.5) ohms for NaCl (p < .001). Mean maximum temperatures recorded at each respective distance from the RFA electrode were all highest for HCl-RFA and lowest for RFA-alone (p < .001). Mean longitudinal and transverse diameters after HCl-RFA (5.50 [SD 0.25] cm and 5.28 [SD 0.22] cm, respectively) were significantly larger than those after NaCl-RFA (4.24 [SD 0.35] cm and 3.55 [SD 0.43] cm, respectively) and after RFA-alone (3.60 [SD 0.10] cm and 2.70 [SD 0.13] cm, respectively) (p < .001). Mean SR after HCl-RFA (0.93, SD 0.02) was significantly higher than mean SR after NaCl-RFA (0.76, SD 0.06) and RFA-alone (0.72, SD 0.04) (p < .001). CONCLUSION: Monopolar, impedance-controlled RFA, with an internally cooled electrode and a single 10% HCl injection may allow larger tumors to be treated, potentially resulting in improved patient outcomes.

Safety and effect on ablation size of hydrochloric acid-perfused radiofrequency ablation in animal livers.

PURPOSE: Our objective was to determine the safety and ablation size of hydrochloric acid-perfused radiofrequency ablation (HCl-RFA) in liver tissues, prospectively using in vivo rabbit and ex vivo porcine liver models. MATERIALS AND METHODS: The livers in 30 rabbits were treated in vivo with perfusions of normal saline (controls) and HCl concentrations of 5%, 10%, 15%, and 20%, during RFA at 103 °C and 30 W for 3 min. For each experimental setting, six ablations were created. Safety was assessed by comparing baseline weight and selected laboratory values with those at 2, 7, and 14 days' post-ablation, and by histopathological analysis. The livers in 25 pigs were treated ex vivo with the same five perfusions during RFA at 103 °C, at both 30 W and 60 W, for 30 min. Ablation diameters and volumes were measured by two examiners. RESULTS: Rabbit weights and selected laboratory values did not differ significantly from baseline to 7 and 14 days' post-ablation, liver tissues outside the ablation zones were normal histologically, and adjacent organs showed no macroscopic damage. The mean ablation volumes in the porcine livers treated with HCl-RFA were all larger than those treated with normal saline perfusion during RFA (NS-RFA), at both 30 W and 60 W (p < 0.001). The largest ablation volume and transverse diameter were observed in the porcine livers during 10% HCl-RFA at 60 W, measuring 179.22 (SD = 24.79) cm3 and 6.84 (SD = 0.36) cm, respectively. CONCLUSIONS: Based on our experiments, HCl-RFA in the liver appears to be as safe as NS-RFA while also resulting in larger ablation zones.

Hydrochloric acid-enhanced radiofrequency ablation for treating a large hepatocellular carcinoma with spontaneous rapture: a case report.

BACKGROUND: A ruptured hepatocellular carcinoma (HCC) is often fatal. In addition to surgery and transarterial embolization, radiofrequency ablation (RFA) might be another option for treating a ruptured HCC. Unfortunately, conventional RFA has a limited ablation zone; as such, it is rarely used to treat ruptured tumors. CASE PRESENTATION: This case was a 60-year-old man who had a large, ruptured HCC in which hydrochloric acid (HCl)-enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic. CONCLUSION: Considering the effectiveness of HCl-enhanced RFA in achieving hemostasis and tumor ablation, it might be a new option for treating large, ruptured HCCs.

Effect of Hydrochloric Acid Decalcification on Expression Pattern of Prognostic Markers in Invasive Breast Carcinomas.

CONTEXT: In the United States, it is estimated that 100,000 people are living with metastatic breast cancer (BC) with bone representing the most common site of involvement. However, patients with isolated bone metastasis at presentation may have a longer survival. Therapeutic options for BC bone metastases often include systemic anticancer therapy (endocrine, chemotherapy, monoclonal antibodies, and/or other targeted therapies), which is largely dependent on the immunohistochemical (IHC) repertoire of the cancer for the prognostic markers [estrogen (ER) and progesterone receptors (PR), Ki-67, p53, and Her-2/neu] at its osseous metastatic site. Traditionally, specimens obtained from the bone metastasis require decalcification, which may affect the immunoreactivity of these prognostic markers. To the best of our knowledge, limited studies describe the effect of decalcification on immunoexpression of the above-mentioned markers. A detailed illustration of the effect of decalcification on BC specimens in a real-time manner is lacking in the literature. OBJECTIVE: Herein, we sought to determine the impact of decalcification on the IHC expression pattern of the above listed markers on BC tissue following decalcification. DESIGN: After Institutional Review Board approval, sections from the residual tumor specimens were collected prospectively from 15 BC excision specimens and 1 curetting from a BC bone metastasis. The sections (3 to 6 sections/case) for decalcification were collected following routine submission for pathologic evaluation. The sections were subjected to hydrochloric acid (HCl)-based Decal Stat decalcifying solution for 2, 12, 18, and 24 hours in each case. IHC studies for ER, PR, Ki-67, p53, and Her-2/neu were performed on 1 representative section of the regularly processed tumor block and 1 decalcified tumor block from each time point. Scoring of ER and PR were performed according to the Allred scoring system. Scoring of Her-2/neu was performed according to CAP/ASCO guidelines. RESULTS: The tumors comprised 11 grade 3 invasive ductal carcinomas, 2 grade 2 invasive ductal carcinomas, 2 grade 3 invasive lobular carcinoma, and 1 metastatic BC to bone. Nine cases showed Allred score 8 for ER, 1 case showed Allred score 4, 1 case showed Allred score 2, and the remaining 5 were ER negative. For PR, 1 showed Allred score 8, 2 Allred score 7, 4 Allred score 6, 1 each Allred score 5 and score 2 with the remainder negative for PR. Ki-67 ranged from 5% to 95%. Five cases showed p53 overexpression ranging from 35% to 95%. Five cases each showed 3+, 6 cases showed 2+ Her-2/neu, 3 cases showed 1+ Her-2/neu, and the remaining 2 were negative. All specimens demonstrated decline in ER, PR, Ki-67, and p53 immunoreactivity after 2 hours of decalcification, with additional decline up to 24 hours. The most significant declines in immunoreactivity occurred with Ki-67 and p53. Most of the Her-2/neu cases with an equivocal score declined to zero after 24 hours of decalcification. However, 3 out of 11 cases showing Her-2/neu overexpression remained at the baseline scoring even after extended (24 h) decalcification. CONCLUSIONS: Our results demonstrated that the decalcification process affects the immunoreactivity of the prognostic BC markers. There is progressive loss of reactivity at 2 hours and beyond for markers with lower degrees of expression. In addition, heterogeneity in marker distribution progressed from diffuse to more focal beyond 1 hour.

Enamel surface alterations after repeated conditioning with HCl.

BACKGROUND: The aim of this study was to investigate the influence of etching time with 15% hydrochloric acid (HCl) on the enamel surface destruction by studying the resulting roughness and erosion depth. METHODS: The vestibular surfaces of 12 extracted, caries free human incisors were divided into four quadrants, and each quadrant was etched with 15% HCl for different numbers of etching cycles (1×2, 2×2, 3×2 and 4×2 min). Surface roughness and erosion depth were measured quantitatively with optical profilometry, and the surface morphology was imaged with scanning electron microscopy (SEM). RESULTS: After two minutes of 15% HCl application a median enamel substance loss of 34.02 µm was observed. Lengthening of etching time (2×2, 3×2 and 4×2 min) resulted in significantly increase in erosion depth to each additionally, between 13.28 -15.16 µm (p < 0.05) ending up in a total median enamel surface loss of 77 µm. Regarding surface roughness no significant (p > 0.05) difference was found between unetched enamel and the etched enamel surfaces. CONCLUSION: Repeated 15% HCl conditioning of the enamel surface increases the depth of the etched surface erosion. However, the total erosion depth is rather shallow and therefore negligible.

pH manipulation as a novel strategy for treating mucormycosis.

Mucormycosis is a fatal fungal disease caused by several organisms within the order Mucorales. In recent years, traumatic injury has emerged as a novel risk factor for mucormycosis. Current antifungal therapy is ineffective, expensive, and typically requires extensive surgical debridement. There is thus a pressing need for safe prophylactic treatment that can be rapidly and easily applied to high-risk patients, such as those with major trauma injuries. Acetic acid has been used as a topical treatment for burn wounds for centuries and has proven activity against Gram-negative bacteria. Here, we demonstrate that acetic acid is also highly effective against major pathogenic groups of Mucorales, even at very low concentrations (0.3%). This antifungal effect is not seen with other acids, such as hydrochloric and lactic acid, suggesting that acetic acid activity against Mucorales spores is not solely evoked by low environmental pH. In agreement with this, we demonstrate that the antifungal activity of acetic acid arises from a combination of its ability to potently lower intracellular pH and from pH-independent toxicity. Thus, dilute acetic acid may offer a low-cost, safe, prophylactic treatment for patients at risk of invasive mucormycosis following traumatic injury.

Comparison of relative efficacy of two techniques of enamel stain removal on fluorosed teeth. An in vivo study.

OBJECTIVE: The present study was conducted to compare and evaluate the relative efficacy of enamel microabrasion (using 18% HCl) and bleaching with McInnes solution in the esthetic improvement of fluorosed teeth and to check postoperative sensitivity. STUDY DESIGN: 30 children aged between 9-14yrs with a mild or moderate grade of fluorosis as classified according to Dean's fluorosis index and who complained of objectionable esthetics were selected. Split mouth study design was selected in our study. Each subject had one of their maxillary central incisor randomly selected for Enamel microabrasion and the contra lateral maxillary central incisor for McInnes bleaching. Esthetic improvement was assessed by comparing the pre and postoperative digital photographs. During the evaluation session, the pre and postoperative photographs of 30 subjects were incorporated into a power point presentation and were projected side by side in a darkened room. Four calibrated and blinded examiners, including a layman rated the photographs under standardized viewing conditions. Esthetic improvement was assessed for both short and long term improvement. The postoperative sensitivity was recorded for both the procedures immediately after treatment and at one, three and six months interval. RESULTS: The results proved that both immediate and long term (6 month) esthetic improvement achieved by McInnes bleaching were superior to enamel microabrasion. There is a reduction in aesthetics of teeth in both the procedures after six months, which was very minimal in McInnes procedure and significant in enamel micro abrasion. Postoperative sensitivity in both techniques were negligible. The sensitivity observed were transient and subsided within an one-month post operatively. None of the subjects reported sensitivity at one, three and six months intervals. CONCLUSION: McInnes bleaching is a better procedure compared to enamel microabrasion in improving the appearance of fluorosed teeth. Both techniques are conservative and safe.

Microabrasion: a treatment option for white spots.

The aim of the present study was to describe a clinical protocol for the treatment of white spots with the use of an abrasive material. A four-year-old patient presented with a white spot on tooth 51 and a white spot associated with a carious lesion in the cervical region of tooth 52. Treatment was planned with microabrasion and restoration of the upper right lateral incisor. Prophylaxis was first performed, followed by protection with a dental dam and the application of the abrasive material (silicon carbide and hydrochloric acid 6%). Five applications were needed to remove the spots. The restoration of the upper right lateral incisor was then performed with a resin composite. A good esthetic outcome was achieved and both the patient and her guardians were satisfied with the results. Microabrasion is a conservative treatment option that achieves satisfactory results with regard to tooth color.

Tratamento de fluorose dentária moderada com a técnica de microabrasão de esmalte com ácido clorídrico 6 por cento e carbeto de silício: relato de caso clínico / Treatment of moderate dental fluorosis with enamel microabrasion using a 6% hydrochloric acid and silicon carbide: a clinical case report

Objetivo: O objetivo desse artigo é relatar um caso clínico apresentando a técnica de microabrasão de esmalte como opção eficaz de tratamento de fluorose dentária moderada. Relato de caso: O paciente de 12 anos de idade, sexo masculino, exibia graus TF=5 nos incisivos superiores e TF=4 nos demais dentes. O tratamento consistiu de três sessões, com intervalo de 1 semana, de aplicação da pasta microabrasiva contendo ácido clorídrico 6% e carbeto de silício como meio abrasivo, seguido da aplicação de fluoreto de sódio neutro 1,23%. Os resultados estéticos foram clinicamente satisfatórios com notável clareamento das superfícies dentáriasafetadas e remoção do esmalte fluorótico com perda de estrutura focal. Além disso, como a queixa principaldo paciente foi a insatisfação com a aparência dos seus dentes e as consequências causadas por esse fator, ao término do tratamento o paciente demonstrou muita satisfação com o resultado obtido. Conclusão: A técnicade microabrasão favorece a estética do sorriso e contribui para a melhora da auto-estima e o convívio social.

Reconditioning of an injured lung graft with intrabronchial surfactant instillation in an ex vivo lung perfusion system followed by transplantation.

BACKGROUND: We tested whether an injured lung graft from category-3 donation after cardiac death donor could be reconditioned with an ex vivo lung perfusion (EVLP) system by intrabronchial diluted surfactant lavage before transplantation. METHODS: In a pig model, cardiac arrest was induced by deconnecting from the ventilator. Left lung injury was done by intrabronchial instillation of 1 mL/kg pepsin + HCl. After retrieval, the heart-lung block was stored at 4°C for 2 h. In the treated group, transplantation was performed after reconditioning with intrabronchial diluted surfactant lavage in EVLP system. RESULTS: During EVLP, surfactant group showed better oxygenation and lower pulmonary vascular resistance. After transplantation, better oxygenation, lower mean pulmonary artery pressure, and lower lung edema were observed in surfactant group. Lower blood IL-1 beta and IL-6 cytokine levels were measured in the surfactant group. In bronchoalveolar lavage, the percentage of neutrophils, IL-1 beta and IL-6 cytokine levels, amount of protein, and neutrophil infiltration in the lung tissue at the end of the experiment were significantly lower in the surfactant group. CONCLUSIONS: Our data demonstrate the feasibility of reconditioning and transplantation of an acutely damaged lung graft due to aspiration from a category-3 DCD donor. Implementation of an EVLP system is an efficacious tool to recondition and assess a questionable graft before transplantation.

Hydrochloric acid treatment of tunneled central venous catheter infections in children with cancer.

BACKGROUND: Long-term tunneled central venous catheters (CVCs) are often the source of catheter-associated bloodstream infections (CABSIs), which may be difficult to eradicate and may lead to premature catheter removal. PROCEDURE: This prospective controlled study used instillation of 2 M hydrochloric acid (HCl) as an adjuvant to the intravenous antibiotic treatment of children with bacteremia and compared the results with those from the immediate preceding period. The primary outcome variable was infection-related CVC removal within 100 days of bacteremia. Only patients with double lumen Hickman CVC with external tubings were included. RESULTS: During a period of 36 months, 109 episodes of bacteremia were treated, 51 during the period where HCl was not used and 58 during the period where HCl was used. Forty-two out of 58 bacteremias were treated with HCl during the "HCl period." An intention-to-treat analysis showed that the median time to infection-related CVC removal was significantly longer during the HCl period compared with the non-HCl period (94 d vs. 12.5 d). At day 100 significantly more CVCs remained in place compared with the non-HCl period. Of the 42 CVCs treated with HCl, 2 had to be removed because of infection before day 30 and further 7 CVCs were removed before day 100. There was no difference in the occurrence of new bacteremias within the first 30 days of bacteremia in the 2 groups. CONCLUSION: HCl may successfully supplement intravenous antibiotics in the treatment of CABSI and contribute to CVC salvage.

A minimally invasive procedure for esthetic achievement: enamel microabrasion of fluorosis stains.

Esthetic alterations (such as fluorosis) that result from intrinsic dental staining in enamel and dentin can be controlled or softened by noninvasive methods such as dental bleaching or enamel microabrasion. Part of the enamel is removed during microabrasion; however, this wear is clinically insignificant and does not harm the dental structure. This article presents a case in which the microabrasion technique was used to remove fluorosis staining. Based on the results of this case report, it can be concluded that this technique is efficient and can be considered a minimally invasive procedure.