Dairy cattle nutrition and feed calculator-an android application.

The dairy farmers in the tropical region have limitations regarding "feedstuffs" available. A software program is required to meet the nutrient requirement with the available feeds at the cheapest cost. There are many techniques/software that are implemented to meet dairy animal nutrient requirements. However, there are no specific techniques that are appropriate for formulating rations for dairy cattle in the least cost manner. An android application Dairy Cattle Nutrition and Feed Calculator (DCN & FC) is developed with an aim of least-cost feed balancing system which will help a farmer to choose feeds to meet the nutrient requirement set for ration. The quantity of feed, fed to the cattle to meet the required needs, is determined by nutrient content, dry matter intake (DMI), crude protein (CP) and total digestible nutrients (TDN) of the feed. This program works in three phases. The first phase consists of creating equations for the estimation of DMI, TDN and CP based on the nutrient tables provided by ICAR (2013) for different categories of cattle such as Milch cattle, dry cattle, male calves, female calves and pre-ruminant animals for different physiological stages such as body weight, average daily gain, fat and milk, using regression analysis. The second phase is the development of a linear programming (LP) model to solve different cases of nutrient requirements for least cost. The final phase is the use of the android framework that uses linear programming to suggest sufficient feed that meets the nutrient requirements. The developed application is user friendly and available in different languages. With the combination of linear programming and regression analysis, the ration can be effectively formed using available feeds, and control the cost of the feeds.

Management of Thoracic Insufficiency Syndrome in Patients With Jeune Syndrome Using the 70 mm Radius Vertical Expandable Prosthetic Titanium Rib.

BACKGROUND: Jeune syndrome (JS) often results in lethal thoracic insufficiency syndrome. Since 1991, vertical expandable prosthetic titanium rib Dynamic PosteroLateral Expansion Thoracoplasty was used at our institution for treatment of JS. This study assesses the safety and efficacy of this procedure. METHODS: Twenty-four JS patients were treated, 2 lost to follow-up, 17 with a minimum of 2-year follow-up retrospectively reviewed for clinical course: Assisted Ventilation Rate, respiratory rate, capillary blood gases, pulmonary function testings, and complications. Upright anteroposterior/lateral radiographs were measured for Cobb angle, kyphosis, lordosis, thoracic width, and thoracic/lumbar spinal height. Computed tomography scan lung volumes were obtained in 12 patients. RESULTS: Mean age at initial implant was 23 months (7 to 62 mo) with an average 8.4 years (2.3 to 15.6 y) of follow-up. Average chest width increased from 121 to 168 mm at follow-up (P<0.001). Preoperatively, 7/17 (41%) patients had scoliosis. The remainder developed scoliosis during treatment, 8 requiring additional implants. Thoracic and lumbar spinal height was normal preoperatively and stayed normal during treatment. Thoracic kyphosis/lumbar lordosis was stable. Average computed tomography scan total lung volumes increased 484 to 740 mm3 (P<0.001), and Assisted Ventilation Rate status tended to improve (P=0.07). Average forced vital capacity was 34% predicted at first test and 27% predicted at last follow-up. Early demise after surgery was common with multisystem disease. Mean respiratory rate decreased from 35 to 24 bpm at last follow-up (P<0.05). Survival rate of the 22 patients was 68%. Migration of the rib cradles/titanium slings occurred in 12 patients, superficial infections in 5 patients, deep infections in 4 patients, and wound dehiscence in 5 patients. Infection rate was 4.6% per procedure. CONCLUSIONS: The survival rate in JS with surgery was nearly 70% (compared with 70% to 80% mortality without treatment) with less ventilator dependence. Both C1 stenosis and scoliosis are common in JS. Spinal height in JS is normal. Complications are frequent, but tolerable in view of the clinical gains and increase in survival.

Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial.

Background: Single-visit pulpectomy (SVP) protocol with rotary files is highly recommended for the treatment of teeth with irreversible pulpitis. Various rotary endodontic files specially designed for use in the pediatric population are available. The aim is to clinically assess the parameters related to the time required for biomechanical preparation (TBMP) and quality of filling using a single file system vs a sequential multi-file system in infected primary mandibular molars. Materials and methods: A total of 45 infected primary molars were allocated to three groups (two experimental groups (n = 15) and a control group. The first experimental group was instrumented using NiTi K-Flex files, the second group with a single file rotary system with variably variable (VV) taper, and the third with a sequential multi-file system with constant taper. Biomechanical preparation time was recorded and standardized digital radiograph (RVG) were taken pre- and postinstrumentation. The data recorded was sent for statistical analysis. Conclusion: There is a substantial reduction of TBMP in primary molars using single file VV taper and multi-sequential file constant taper. Obturation time for all three file systems was comparable and there were no differences between the three file systems used (p > 0.05). Multi-sequential file constant taper files showed a higher probability of optimal obturations and minimal voids followed by NiTi "K-Flex" files and single file system but the difference was nonsignificant (p > 0.05). However, using a rotary in primary teeth results in better canal shape, and less TBMP leading to a better quality of treatment in less time. How to cite this article: Shetty B, Singh R, Patil V, et al. Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(S-3):S247-S252.

Comparative Evaluation of Fluoride Release from Four Commercially Available Pediatric Dental Restorative Materials.

Objectives: The aim of this study was to evaluate the fluoride-releasing abilities of commercially available restorative materials such as-Activa™ BioActive-restorative™ material, Zirconomer (Shofu Inc), Beautifil® II (Shofu Inc), GC Gold Label 9 high strength posterior restorative glass ionomer cement (GIC Corp). Materials and methods: A total of 40 disk specimens (10 of each material) were placed into distilled/deionized (DI) water and the fluoride release was measured for 30 days. Fluoride ion measurement was performed at the end of the 1st, 3rd, 7th, 15th, and 30th day under normal atmospheric conditions by fluoride ion selective electrode (F-ISE) (Orion 9609 BNWP, Ionplus SureFlow fluoride electrode, Thermo Scientific, United States of America) coupled to a benchtop analyzer (Hachsen Ion+). Results: All the materials included in the study exhibited fluoride release. Although there were differences in the amounts of fluoride released between Activa™, Zirconomer, and GC Gold Label 9 the mean difference between these three groups was not found to be statistically significant. Beautifil® II showed low amounts of fluoride released at all time intervals. Conclusion: Among the above-compared materials Activa™ and Zirconomer exhibit both improved mechanical properties as well as they have fluoride-releasing ability so can be preferred over conventional glass ionomer restorations. How to cite this article: Dhumal RS, Chauhan RS, Patil V, et al. Comparative Evaluation of Fluoride Release from Four Commercially Available Pediatric Dental Restorative Materials. Int J Clin Pediatr Dent 2023;16(S-1):S6-S12.

Congenital epulis in newborn. Case report.

Congenital granular cell lesion, or congenital epulis, is a rare lesion of the newborn. The sight of a newborn infant with congenital epulis can be startling for both parents and healthcare professionals. The lesion appears most commonly in the maxillary alveolar ridge, with predominance in females. The etiology and histogenesis of the lesion remain obscure. This lesion can pose a risk of airway obstruction or can interfere with feeding. The report presented here describes a case of congenital granular cell lesion in the left maxillary region. The lesion was causing a feeding problem and, hence, was excised under local anesthesia.

Can VEPTR(®) control progression of early-onset kyphoscoliosis? A cohort study of VEPTR(®) patients with severe kyphoscoliosis.

BACKGROUND: Kyphoscoliosis is considered a relative contraindication to treatment with the Vertical Expandable Prosthetic Titanium Rib (VEPTR(®); Synthes Inc, Paoli, PA). Nevertheless, patients do present with early-onset kyphoscoliosis and thoracic insufficiency syndrome, and no suitable alternative treatments are currently available. However, it is unclear whether VEPTR(®) is reasonable for treating patients with kyphoscoliosis. QUESTIONS/PURPOSES: We determined whether VEPTR(®) controls progression in patients with kyphoscoliosis and, if so, what methods might be used to improve control of deformity progression in these patients. PATIENTS AND METHODS: We retrospectively reviewed 14 patients who had VEPTR(®) treatment of early-onset kyphoscoliosis. Degrees of kyphosis and scoliosis before, during, and after treatment were measured, and levels of instrumentation, thoracic dimensions, and complications were recorded. Minimum followup was 1.7 years (average, 5.8 years; range, 1.7-12.8 years). RESULTS: While scoliosis was stabilized, kyphosis increased a mean of 22° at last followup. Supple kyphosis became rigid during treatment. Proximal cradle cutout was a recurring problem. Distal anchors placed too proximally had inadequate lever arms to control kyphosis. CONCLUSIONS: Progression of kyphosis can be minimized during VEPTR(®) treatment by early extension of the construct to the second ribs bilaterally, distal extension of hybrid constructs to the pelvis, use of bilateral hybrid VEPTR(®) implants, and use of redesigned VEPTR(®) constructs that enhance fixation at the upper end. While our early results suggest these devices control progression of kyphosis, longer followup with more patients will be required to confirm the concept in these patients.

Comparative Evaluation of Instrumentation Time, Obturation Time, and Radiographic Quality of Obturation Using Two Rotary Systems and Manual Technique for Primary Molar Pulpectomies - In vivo Study.

BACKGROUND: Ideal pulpectomy for primary dentition demands fast, simple procedures, with short treatment times and minimal appointments. Recently, exclusive pediatric rotary files are available for use in primary teeth. There is a paucity of literature on the clinical efficacy of pediatric rotary files. Hence, this study was planned to evaluate and compare pediatric rotary files and K-files. AIM: The aim of this study was to evaluate and compare instrumentation time, obturation time, and radiographic quality of obturation using rotary systems (Kedo-S; Pro-AF Baby GOLD files) and manual (K-files) technique in primary molar pulpectomies. MATERIALS AND METHODS: Forty-five primary mandibular molars from 42 children aged 5-9 were selected. Single-visit pulpectomy was performed after dividing selected teeth into three equal groups: (i) K-files, (ii) Kedo-S files, (iii) Pro-AF Baby GOLD files. Instrumentation and obturation times were recorded during the procedure. Immediate postoperative radiographs were taken and evaluated later for obturation quality by two independent evaluators blinded to the instrumentation technique. The results were then statistically analyzed. RESULTS: Kedo-S (Group II) files required the least instrumentation time followed by Pro-AF (Group III) and K-files (Group I). The superior quality of obturation in lesser time was achieved using Pro-AF files (Group III) followed by Kedo-S (Group II) and K-files (Group I). CONCLUSION: Pediatric rotary files are efficient alternatives to hand instrumentation and can be considered as the standard of care in pulpectomies of primary teeth.

Comparative evaluation of occlusal pits and fissures morphology modification techniques before application of sealants: An In vitro study.

BACKGROUND: Pits and Fissures are recognized as being highly susceptible to caries. Pit and fissure sealants are one of the best methods of preventing caries as it occludes the fissures and pits from the accumulation of plaque and cariogenic microflora. There are different methods of cleaning and preparing occlusal pits and fissures for preventing caries which helps in alleviating oral health status of paediatric population. AIM: The aim of the present study was to evaluate and compare the microleakage of pit and fissure sealants after using five different preparation techniques, namely: A) Conventional technique using pumice prophylaxis, B) enameloplasty with round carbide bur, C) enameloplasty with fissurotomy bur, D) air polisher, and E) air abrasion. MATERIALS AND METHODS: The study was conducted on 50 caries-free premolars extracted for orthodontic purpose. These teeth were randomly assigned to five groups, 10 teeth in each for receiving fissure sealant after different surface preparation; thermocycling and sectioning of samples were performed and microleakage was assessed under a stereomicroscope after methylene blue dye immersion. RESULTS: The results of air abrasion groups were significantly superior with "0" microleakage when compared to all other groups followed by round bur, fissurotomy bur, air polisher and pumice prophylaxis. CONCLUSION: To improve the marginal adaptation of the sealants, minimally invasive methods are the most favoured methods of occlusal preparation. This study promises to show positive results for fissure sealants which are likely to play an important role in caries prevention and techniques that are intended to protect caries susceptible surfaces.

An evaluation of halo pin insertion torque on outer table penetration in elderly patients.

STUDY DESIGN: An experimental anatomic study performed on elderly cadaveric skulls. OBJECTIVES: (1) To determine the pin penetration depths in outer table of skull at different torques in the elderly population during halo pin insertion and (2) to validate a safe range of torque for use in this population. SUMMARY OF BACKGROUND DATA: The elderly are at an increased risk of falls, which can lead to cervical fractures. The halo pins used to stabilize these injuries present unique problems in this population owing to osteoporosis, and intracranial pin penetration should always be avoided. METHODS: A halo ring was used to insert pins in 4 standard positions on 10 elderly cadaveric skulls. Incremental torques were used to drive the pin into the outer table, and the penetration of each pin was measured using computed tomography imaging at each stage. RESULTS: Eight to Twelve in-lb of torque was not sufficient to fully penetrate the outer table of the skull. Only at 16 in-lb of torque was the outer table penetrated, and only anterolaterally, hence the posterolateral outer table is more resistant to penetration than the anterolateral outer table. CONCLUSIONS: Despite age-related bone changes in the elderly, it is still safe to use 8 in-lb of torque when inserting pins for a halo vest. However, as the anterolateral outer table is weaker than the posterolateral outer table, a new pin design with broader shoulders should be used anterolaterally to ensure maximal patient safety.

Quantitative changes in the cervical neural foramen resulting from axial traction: in vivo imaging study.

BACKGROUND CONTEXT: Cervical traction has a long history as a method of conservative treatment for cervical spine diseases. However, information on quantitative changes in the cervical neural foramen resulting from axial traction in vivo is lacking. PURPOSE: To quantitatively evaluate the changes in the neural foramen of the cervical spine during axial traction in vivo. STUDY DESIGN: A prospective radiographic analysis of the cervical neural foramen of adult volunteers. PATIENT SAMPLE: Fifteen healthy volunteers (10 men, 5 women) without any history of cervical spine disease. OUTCOME MEASURES: The changes in cervical cross-sectional foraminal areas and heights were measured. METHODS: Cervical magnetic resonance (MR) images of the volunteers were taken at the neutral position and were reconstructed in the oblique plane perpendicular to the long axis of each neural foramen from the C2-3 to the C6-7 level. The changes in the neural foraminal dimensions at incremental axial traction forces (0, 5, 10, and 15 kg) were analyzed. RESULTS: After each 5-kg incremental increase in traction weight, there was a significant (p value less than .05) increase in area and height of the intervertebral foramen compared with the position in which no weight was applied. There was an average increase of 5.81%, 16.56%, and 18.9% in the foraminal area and an average increase of 3.75%, 8.67%, and 10.43% in foraminal height compared with the position with no weight at traction of 5, 10, and 15 kg, respectively. There was no statistically significant difference for the increase in foraminal area and height from 10 to 15 kg of traction (p value greater than .05). CONCLUSIONS: There was a significant increase in intervertebral foraminal area and height after each 5-kg increment in traction weight compared with the position in which no weight was applied. From 10 to 15 kg of traction, there was no significant change in the foraminal area and height.

Morphometric dimensions of the dorsal calcaneocuboid ligament.

BACKGROUND: An isolated injury to the calcaneocuboid joint is frequently unrecognized clinically. The possibility of an injured dorsal calcaneocuboid ligament (DCC) should be considered in all acutely swollen feet after trauma involving supination. Despite its significance, there is much confusion in the literature regarding nomenclature, morphology, and location. MATERIALS AND METHODS: To determine morphometric dimensions, dissection was performed on the feet of 30 adult preserved cadaveric limbs. RESULTS: The DCC was consistently present in all specimens in the form of either a solitary structure (66.6%) or 2 components (33.3%). For the solitary structures, the superior and inferior borders measured 18.6 +/- 2.8 mm and 17.3 +/- 2.5 mm, respectively. The widths of the calcaneal and cuboid sides were 13.8 +/- 2.2 mm and 12.4 +/- 2.1 mm, respectively. In the 2 component ligaments, the superior component had a superior and inferior length that averaged 16.9 +/- 2.1 mm and 16.4 +/- 2.8 mm, respectively. Its calcaneal and cuboid borders were 9.3 +/- 1.2 mm and 10.6 +/- 1.4 mm, respectively. The inferior component had superior and inferior sides that were 12.9 +/- 2.9 mm and 13.8 +/- 3.0 mm, respectively. The widths of the calcaneal and cuboid sides were 8.3 +/- 1.4 mm and 7.2 +/- 1.0 mm, respectively. CONCLUSION: We have demonstrated variations in the morphology of the DCC along with its morphometric dimensions. CLINICAL RELEVANCE: Knowledge of the morphologic variations and dimensions of the DCC can be of aid when planning for surgical management of the ruptured ligament.

Preservation of the spinous process-ligament-muscle complex to prevent kyphotic deformity following laminoplasty.

BACKGROUND CONTEXT: Long-term results of patients treated with conventional laminoplasty have shown a significant number of patients complicated with kyphotic deformity. The authors hypothesize that by maintaining the spinous process-ligament-muscle complex (SPLMC) during laminoplasty, followed by postoperative muscle strengthening exercises, the formation of kyphosis can be decreased. PURPOSE: To evaluate the incidence of kyphosis in a select patient group undergoing laminoplasty with preservation of the SPLMC followed by neck strengthening exercises. STUDY DESIGN/SETTING: A midterm retrospective study of 30 patients following laminoplasty with preservation of the SPLMC. PATIENT SAMPLE: Thirty consecutive patients with cervical myelopathy attributable to multilevel cervical spinal stenosis underwent laminoplasty with preservation of the SPLMC from April 1998 to July 2002. OUTCOME MEASURES: Preoperative and postoperative Japanese Orthopedic Association (JOA) scores, Guigui angles, and axial symptoms were measured. METHODS: Thirty patients with multiple-level cervical myelopathy were studied. Fourteen had a normal lordotic curve, whereas 16 had a straight curve. All these patients underwent laminoplasty with preservation of the SPLMC. For the first 6 months, isometric neck muscle exercises were performed. After this time, the intensity of the exercises was gradually increased. RESULTS: The average preoperative JOA score was 5.8+/-1.4. Mean JOA score at 3.8 years follow-up was 13.6+/-2.1. The recovery ratio was 69%. All 14 presurgical lordotic curves remained lordotic. Fourteen of the 16 straight spines improved to a lordotic configuration. Using the Guigui method, the preoperative lordotic angle was corrected by approximately 9 degrees (mean preoperative of 9.89+/-1.13 degrees, mean postoperative of 18.66+/-1.85 degrees), and the preoperative straight angle was corrected by approximately 15 degrees (mean preoperative of 0.91+/-2.14 degrees, mean postoperative of 15.88+/-1.71 degrees). CONCLUSIONS: Laminoplasty with preservation of the SPLMC followed by appropriate postoperative muscle exercises may be an encouraging way to maintain or restore the physiological curve and prevent kyphotic deformity at a medium term follow-up.

Evaluation of skull thickness and insertion torque at the halo pin insertion areas in the elderly: a cadaveric study.

BACKGROUND CONTEXT: The halo skeletal fixator provides the most rigid type of immobilization of all the orthoses that stabilize the cervical spine. Sometimes with older patients (>70 years old), the pin penetrates the cortical and cancellous bone of the skull and enters the intracranial space, which can result in serious complications such as brain injury, infection, hematoma, and loss of cerebrospinal fluid from the subarachnoid space. Currently, there is a lack of relevant literature that examines these concerns. PURPOSE: To evaluate the thickness of the outer table, diploe, and inner table at the anterolateral and posterolateral pin insertion areas of the skull in elderly cadavers by using computed tomography (CT) scans. In addition, insertion torques at the four standard pin insertion areas was determined by applying halo pins at incremental torque in an effort to suggest safe torque levels for the anterolateral and posterolateral pins. STUDY DESIGN/SETTING: A human cadaveric anatomical and biomechanical study relating to thickness and insertion torques at standard pin areas in the elderly. PATIENT SAMPLE: Twenty-one elderly cadaveric skull specimens. OUTCOME MEASURES: Thickness of cortices (tables) and diploe of skull and insertion torque at halo pin insertion areas. METHODS: Aquarius Image software at the CT scanner's TeraRecon Aquarius Workstation was used to make the necessary skull thickness measurements at the pin insertion areas. Six, 8, 12, 18, and 36 inch lb of torque were used to determine penetration of the pins through the inner table at each of the four locations (two anterolateral and two posterolateral). RESULTS: The mean anterolateral thickness was 7.36+/-1.57 mm. The average thickness of the outer table, diploe, and inner table were 2.24+/-0.44 mm, 1.52+/-0.41 mm, and 3.59+/-1.70 mm, respectively. The mean posterolateral thickness was 9.47+/-1.12 mm. The average thickness of the outer table, diploe, and inner table were 4.32+/-0.92 mm, 1.88+/-0.35 mm, and 3.27+/-1.21 mm, respectively. No pin penetration was seen at the traditional 8 inch lb of insertion torque in both the anterolateral and posterolateral pin insertion areas. Eighteen inch lb of torque resulted in penetration in 90.48% (19/21) and in 85.71% (18/21) of specimens in the left anterolateral and right anterolateral pin insertion areas, respectively. No penetration was seen even at 36 inch lb of torque in 80.95% (17/21) of the cadavers in both the left and right posterolateral pin insertion areas. CONCLUSIONS: The current study supported previous research that 8 inch lb of torque is safe for application of halo pins in the elderly. The posterolateral skull is thicker and stronger than the anterolateral skull. The safe maximum torque is 8 inch lb for anterolateral pin insertion area and 18 inch lb for the posterolateral pin insertion area.

Morphometric dimensions of the calcaneonavicular (spring) ligament.

BACKGROUND: The spring ligament complex (SLC) is a static support of the head of the talus and a major anatomical contributor to the integrity of the medial longitudinal arch, particularly if the dynamic support of the posterior tibial tendon is compromised. For this reason, we sought to further elucidate the anatomical components and dimensions of this ligamentous complex. METHODS: Dissection was performed on 30 adult cadaver feet disarticulated at the ankle joint that were preserved by embalming technique. RESULTS: The superomedial ligament (SML) averages 42.51 +/- 3.93 mm and 33.44 +/- 3.34 mm at the superomedial and inferolateral borders, respectively. The width at the level of sustentaculum tali and navicular tuberosity averaged 20.00 +/- 2.35 mm and 10.26 +/- 2.05 mm, respectively. The medioplantar oblique (MPO) ligament averaged 23.56 +/- 2.15 mm and 21.20 +/- 1.42 mm at the medial and the lateral borders, respectively. The widths at the navicular and calcaneal side were 2.71 +/- 0.39 mm and 8.14 +/- 0.56 mm, respectively. The inferoplantar longitudinal (IPL) ligament measured 4.26 +/- 0.43 mm and 2.66 +/- 0.42 mm at the medial and lateral borders, respectively. The width at the calcaneal and navicular insertions measured 5.21 +/- 0.53 mm and 3.39 +/- 0.39 mm, respectively. CONCLUSIONS: The distinction between the SML and MPO components of the spring ligament complex is difficult. This study tried to clarify the dimensions and configurations of these components of the SLC. CLINICAL RELEVANCE: This effort may aid surgeons who wish to repair this ligament with more precision.

Anatomical variations in the insertion of the peroneus (fibularis) longus tendon.

BACKGROUND: Multiple pathologies are associated with the peroneus longus tendon including traumatic injury, tendinitis, tenosynovitis, dislocation, acute rupture, chronic tear, and avulsion fractures. While the description of insertion points for the peroneus longus tendon exists in numerous texts and articles, none are consistent in describing the incidence of variation of the insertional slips. METHODS: Dissection was performed on the feet of 30 adult, embalmed cadaver limbs disarticulated at the knee and ankle joint. RESULTS: All 30 specimens had a consistent attachment to the base of the first metatarsal by a strong band. A slip to the medial cuneiform was observed in 26 specimens (86.6%). The anterior and posterior frenular ligaments were present in 25 (83.3%) and four (13.3%) specimens, respectively. Another thick and strong fibrous band, termed additional band (AB), was observed close to the metatarsocuneiform joint in nine specimens (30%). Additional slips to the neck of first metatarsal, bases of second, fourth, and fifth metatarsals also were noted. CONCLUSIONS: We have described the incidences of variations of the insertion of the peroneus longus tendon and an additional band, which gives rise to various muscles. CLINICAL RELEVANCE: The results of this study may be important to better understand the symptoms associated with peroneus longus tendon pathologies and the role played by the peroneus longus tendon in maintaining the arch of the foot.

Mini-external fixation of two- and three-part proximal humerus fractures.

A retrospective review of 64 patients (M 36, F 28, average age 55 years) with 29 two-part fractures and 35 three-part fractures of the proximal humerus was conducted at a Level 1 Trauma Center. All fractures were managed with the mini external fixator. Open reduction was performed in 11 cases, closed reduction in 53. The average follow-up was 21 months (range, 12-39). The final outcome, evaluated according to Neer's scoring system, was excellent in 63.4% of patients, good in 18.8%, fair in 12.7%, and poor in 5.1%. By 9 weeks, 85% of the fractures were healed and 97% by 12 weeks. Complications included nonunion, superficial infection and deep infection, in two cases for each. Bicipital tendonitis occurred in five cases and secondary displacement of the fragments in four others. The small diameter of the pins used in the mini external fixator has the advantage of allowing the orthopaedic surgeon to fix the fracture in more than one plane and achieve an early acceptable range of motion. This technique appears attractive especially in polytrauma patients, as the procedure can be performed in the supine position and causes no additional blood loss.

Management of thoracic insufficiency syndrome in patients with Jarcho-Levin syndrome using VEPTRs (vertical expandable prosthetic titanium ribs).

BACKGROUND: Jarcho-Levin syndrome represents a spectrum of clinical and radiographic irregularities including abnormal vertebral segmentation or formation defects, rib deformities, and short-trunk dwarfism. These abnormalities cause reduced thoracic capacity for lung development, resulting in thoracic insufficiency syndrome. In the present study, we reviewed outcome measures related to scoliotic curve correction, thoracic growth, and respiratory function following VEPTR treatment in patients with Jarcho-Levin syndrome. METHODS: Twenty-nine patients with Jarcho-Levin syndrome, subclassified as spondylocostal dysostosis (SCD) or spondylothoracic dysplasia (STD), were treated with VEPTR expansion thoracoplasty and followed for at least two years since the initial implantation. Spinal and respiratory measures were collected prior to the initial VEPTR implantation, immediately after implantation, and at the most recent follow-up. RESULTS: VEPTR treatment was associated with improved clinical respiratory function and with increases in thoracic height (by 50% in the SCD group and 42% in the STD group) and thoracic width (by 37% in the SCD group and 28% in the STD group). VEPTR treatment resulted in scoliosis curve correction (improvement in the Cobb angle of 41% [22°] in the SCD group and 26% [3.7°] in the STD group) and in improved thoracic symmetry in patients with SCD. Patients with SCD displayed increased lumbar lordosis, and both groups of patients developed increased thoracic kyphosis approaching normal. CONCLUSIONS: VEPTR treatment improved thoracic symmetry, controlled spinal deformity, and was associated with improved clinical respiratory function.

A comparison of the resin tag penetration of the total etch and the self-etch dentin bonding systems in the primary teeth: An in vitro study.

BACKGROUND AND OBJECTIVE: Restoration of carious lesions with a strong permanent bond would be a highly desirable requisite. Ultra morphological characterization shows that observing and understanding the interfacial phenomenon and its quality would be of great importance in the selection of a dental adhesive for its use in pediatric restorative dentistry. STUDY DESIGN: Human primary molars, indicated for extraction, for reasons like caries, normal exfoliation, pathological root resorption, over-retained and serial extraction, were collected. Teeth were then equally distributed into 2 subgroups each namely B1 - Prime and Bond NT & B2 - Xeno III. RESULTS: The resin tags seen in the samples of group B2 were both qualitatively and quantitatively advanced as compared to group B1. This reveals that the quality of the penetration of the resin was better in group B2. CONCLUSION: Reduction in the technique sensitivity of any bonding system would always be a preferred factor in pediatric restorative dentistry. Thus the inclination towards the selection of adhesive system may lean towards the self-etching bonding system at this juncture.

Comparative Evaluation of the Adhesive Properties of Two Generations of Dentin Bonding Agents by Checking the Microleakage in the Primary Teeth: An in vitro Study.

Early childhood caries is now affecting the children in dangerous proportions. There is a widespread loss of the tooth material irrespective of the type of the carious lesion. Restoration of such lesions with a strong permanent bond between the dental tissues and the restorative dental materials would be a highly desirable requisite of any restorative material. Ultramorphological characterizations show that the interfa-cial morphology and the chemical characterization of the bonding systems appear to be strongly associated with each other and, therefore, observing and understanding the interfacial phenomenon and its quality would be of great importance in the selection of a dental adhesive for its use in pediatric restorative dentistry.

Reattachment of a vertical complicated subgingival crown root fracture in a 10-year old child: a case report.

Functional, esthetic and biologic restoration of a fractured incisor often presents a daunting clinical challenge. The outcome of conventional composites, prosthodontic restorations in a young patients result in an uncertain longevity of the same. Reattachment of the fractured fragment of a tooth helps in maintaining both morphology and esthetics in a growing child until the permanent long lasting solution is sought after the complete development of the dentition and the jaws. Since fractured fragment exhibited no caries, not even negligible loss of tooth structure and was adapting well to the remaining tooth structure when tried in, the reattachment of fractured fragment was considered as a viable treatment option. This treatment option for complicated subgingival crown-root fracture depicts the involvement of periodontal surgical exposure, endodontic management and ultimately the fragment reattachment.