Effect of Vitamin D on Canine Distalization and Alveolar Bone Density Using Multi-slice Spiral CT: A Randomized Controlled Trial.

AIM: The aim of this split-mouth, blinded randomized controlled trial was to evaluate the clinical and radiographic effects of locally delivered 1,25 dihydroxycholecalciferol (1,25 DHC) on the amount of canine distalization. MATERIALS AND METHODS: Fifteen patients between age groups of 15 years to 30 years willing to undergo orthodontic treatment in a dental college participated in the study. A computer-generated randomization list was generated to divide the maxillary arch into experimental side and control side. Allocation concealment was applied. Canine distalization was initiated using nickel-titanium (NiTi) closed coil springs delivering a force of 150 g per side, which was attached to the maxillary first molar tube and canine hook. Local periodontal gel injection of 1,25 DHC was given on the experimental side and placebo gel on the control side at distal side of the maxillary canine at monthly interval, respectively. Patients were evaluated from beginning (T0), 4 weeks (T1), 8 weeks (T2), and 12 weeks (T3). CT scans were taken at T0 and T3 to measure the changes in bone density. The difference in amount of canine distalization and the changes in bone density were assessed on the experimental and control sides, respectively. Descriptive statistics and paired t test were used to determine any differences. RESULTS: The results showed statistically significant increase in the amount of canine distalization and decrease in cancellous bone density on the experimental side when compared to control side. CONCLUSION: The active form of vitamin D can be an effective agent to accelerate orthodontic tooth movement (OTM). CLINICAL SIGNIFICANCE: This study provides a new insight into the scope of vitamin D in clinical orthodontics and its innovative method of application to accelerate tooth movement in patients will revolutionize treatment as well as open newer boundaries in orthodontic research at a biomolecular level.

A critical appraisal of complications of percutaneous nephrolithotomy in paediatric patients using adult instruments.

OBJECTIVE: To evaluate the complications (using the CROES Clavien scoring system) and various factors affecting them in children undergoing percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: We analysed prospectively maintained data of paediatric PCNL (patients ≤17 years) from January 2008 to December 2012. Stone complexity was defined according to validated Guy's stone score (GSS). Procedures were performed in the prone position by experienced urologists. The tract was dilated (24-30F) under fluoroscopic guidance, and an adult rigid nephroscope complemented with a cystoscope/ureteroscope were used. Complications were recorded according to the CROES-Clavien score, recently defined by the Clinical Research Office of the Endourological Society (CROES) Study Group. RESULTS: The study group comprised 158 procedures performed in 153 children (98 boys and 55 girls), with a mean (range) age 10.03 ± 4.51 (2-17) years. The mean (range) stone burden was 376.68 ± 265.23 (150-2400) mm(2) . The distribution of cases according to the GSS was 31% grade I, 35.4% grade II, 19% grade III, and 14.6% grade IV. The stone-free rate of PCNL monotherapy was 85.4%, which increased to 93.7% after relook PCNL/extracorporeal shock wave lithotripsy. In all, 62 children (39.2%) had operative complications; 84% were minor, i.e. Clavien grade 1/2, and managed conservatively. Stone size, GSS, tract size, number of punctures and operation duration were significantly associated with complications on univariate analysis (P < 0.05). However, on multivariate logistic regression analysis, operation duration was the only independent risk factor associated with complications (95% confidence interval: 1.013-1.065, odds ratio = 1.04; P = 0.038). CONCLUSIONS: Percutaneous nephrolithotomy in children using adult instruments is an effective and safe procedure for managing simple as well as complex renal calculi. Assignment of specific Clavien scores to all possible PCNL complications by the CROES PCNL Study Group have improved precision in reporting complications in a standard objective format, including the minor ones. Such models are very useful for making inter-observer comparisons to obtain clinically relevant inferences. Mean operation duration is the only independent factor affecting complications of the procedure.

Magnetic resonance-retrograde pyelography: A novel technique for evaluation of chyluria.

There are no standardized radiological investigations in a patient with chyluria. Retrograde pyelography (RGP) is usually done to demonstrate pyelo-lymphatic reflux before invasive therapy in the form of sclerotherapy and surgery. We describe magnetic resonance-RGP using gadolinium to demonstrate pyelo-lymphatic reflux in addition to the other intra-abdominal details provided by MRI. The advantages of this technique include avoidance of ionic contrast media and radiation exposure and possibility of better understanding of the disease pathophysiology.

Factors affecting response to medical management in patients of filarial chyluria: A prospective study.

INTRODUCTION: Filarial chyluria is a common problem in filarial endemic countries. Its management begins with medical therapy but some patients progress to require surgery. The present study aimed to determine factors affecting response to medical management in patients of filarial chyluria. MATERIALS AND METHODS: This prospective study conducted between August 2008 and November 2012, included conservatively managed patients of chyluria. Demographic profile, clinical presentation, treatment history and urinary triglycerides (TGs) and cholesterol levels at baseline were compared between the responders and non-responders. Apart from the clinical grade of chyluria, hematuria was evaluated as an independent risk factor. RESULTS: Out of the 222 patients (mean age, 37.99 ± 13.29 years, 129 males), 31 patients failed to respond while 35 had a recurrence after initial response; the overall success rate being 70.3% at a mean follow-up of 25 months. No difference was observed in demographics, clinical presentation, presence of hematuria, disease duration and mean urinary TGs loss between responders and non-responders. On multivariate analysis, patients with treatment failure were found to have a higher-grade disease (14.3% Grade-I, 36.6% Grades-II and 60% Grade-III), higher number of pretreatment courses (1.59 ± 1.08 vs. 1.02 ± 0.79) and heavier cholesterol (26.54 ± 23.46 vs. 8.81 ± 8.55 mg/dl) loss at baseline compared with responders (P < 0.05). CONCLUSION: Conservative management has a success rate in excess of 70%, not affected by the disease chronicity, previous episodes and recurrent nature. However, higher-grade disease, extensive pre-treatment with drugs and higher urinary cholesterol loss at baseline are the predictors of poor response. Hematuria is not an independent poor risk factor for conservative management.

Our experience with genitourinary fistulae.

INTRODUCTION: Our objective was to analyze the incidence, etiopathology, diagnosis and therapeutic aspects of the genitourinary fistula in an Indian population. METHODS: This is a retrospective analysis of the genitourinary fistulae repaired at the Department of Urology, Institute of Medical Sciences, Banaras Hindu University, between January 1990 and December 2006. The surgical approach varied in each patient. Interposition grafts or flaps were used as and when required. The main outcomes analyzed were the incidence, etiology, surgical approaches, accessory procedure required, need for tissue interposition, cure rate per repair and overall success rate. RESULTS: Out of 558 cases, 403 were vesicovaginal, 84 ureterovaginal, 43 urethrovaginal and 28 vesicouterine fistulae. The most common etiology was obstructed labor (72.2%), followed by hysterectomy. The transvaginal route was preferred for repair wherever possible. The transabdominal route was adopted for the repair of supratrigonal vesicovaginal, ureterovaginal and vesicouterine fistulae and if bladder augmentation was required. Conservative management was successful in 1.9% of the vesicovaginal fistulae and in 8 cases of ureterovaginal fistula. The remaining cases were managed surgically with excellent results. CONCLUSION: Genitourinary fistulae are not life-threatening but are socially debilitating. Surgical repair provides the definitive cure, but expectant treatment can be tried in selective patients.

Effects of amine fluoride and probiotic mouthwash on levels of Porphyromonas gingivalis in orthodontic patients: A randomized controlled trial.

INTRODUCTION: Porphyromonas gingivalis is one among the major etiological agent in periodontal diseases and has been proved to cause gingival inflammation under orthodontic appliances. AIM: To assess the effect of amine fluoride and probiotic mouthwashes on levels of P. gingivalis during orthodontic treatment, using real time-polymerase chain reaction (RT-PCR). MATERIALS AND METHODS: A randomised controlled trial was performed including 45 patients. There were three groups: Group A (control group), Group B (patients using Amflor mouthwash) and Group C (patients using probiotic mouthwash). During the treatment, all the 3 groups were advised to brush twice a day using Colgate tooth paste and Group B patients were advised to swish 15 ml fluoridated mouthwash (Amflor) and Group C advised to swish probiotic for 60 s before swallowing, once in the morning and once before sleep. After gently removing supragingival plaque, subgingival plaque samples were collected by inserting a sterile dental curette into the bottom of the gingival crevice around 31, 32, 41, and 42 at two different intervals: T1 at start and T2 after 6 months of fixed orthodontic treatment. Sub-gingival plaque samples collected were transferred to laboratory within 48 h for RT-PCR analysis in Tris-buffer solution, to maintain the integrity of bacterial DNA. RESULTS: The levels of P. gingivalis were significantly decreased with probiotic mouth wash. CONCLUSIONS: Probiotic mouth wash can be used as an adjunctive measure along with regular brushing to improve periodontal status during fixed orthodontic treatment.

Urethral reconstruction in balanitis xerotica obliterans.

OBJECTIVES: To review the results of utilizing different grafts for substitution urethroplasty for anterior urethral stricture caused by balanitis xerotica obliterans (BXO). METHODS: 153 patients who underwent substitution urethroplasty for anterior urethral strictures were included in this study. The stricture length varied from 3.8 to 16.4 cm (mean 10.2 cm). In 32% of the patients (49), local genital, penile (18), perineal (16) and scrotal (15) skin grafts were used. Over the 3 years our standard treatment policy has been to utilize a free mucosal graft from a non-genital area. Buccal mucosa was the most preferred, utilized in 74 (48.3%) patients and bladder mucosa in 12 (7.8%). Recently we have used lingual mucosal grafts in 18 (11.7%) patients for substitution urethroplasty. RESULTS: The overall success rate for non-genital mucosal graft was 92.2%. The remaining 8 patients required more than one supplementary procedure postoperatively but none required a second urethroplasty. Of 49 patients who underwent substitution urethroplasty utilizing genital skin, the success rate was only 4%. 16.3% required one and 14.3% required multiple auxiliary procedures postoperatively. 34 patients (69.4%) required subsequent urethral reconstruction. CONCLUSIONS: A free graft urethroplasty using non-genital skin is recommended for anterior urethral stricture related to BXO.

Oral complications after lingual mucosal graft harvest for urethroplasty.

BACKGROUND: The aim of this study was to assess the complications at donor site after lingual mucosal graft harvesting for urethroplasty. METHODS: From March 2006 to December 2006, 30 patients of anterior urethral stricture underwent lingual mucosal graft urethroplasty. The site of the harvest graft was lateral mucosal lining of the tongue. Donor site complications, that is, pain, slurring of speech, pain during speech, salivatory changes and difficulty in protrusion of tongue were noted. RESULTS: The mean (range) age of patients was 36.2 years (22-52 years). The mean (range) stricture length was 8.4 cm (4.8-16 cm) and graft length was 8.5 cm (4.2-16.2 cm). Mean duration of follow up was 3.8 months. At the first postoperative day, 90% of the patients experienced pain at donor site and 20% had slurring of speech. Pain was mild to discomforting in 80% and distressing to horrible in 13% of the patients. By third postoperative day, two-thirds were pain free, one-thirds had mild pain only and none had slurring of speech. By day 6 of surgery, all patients were pain free. Six per cent of the patients reported numbness over ventral aspect of anterior half of tongue, which persisted in the first follow up and subsided by second follow up. There was no bleeding, haematoma or infection at donor site. All patients were able to resume oral fluid within 24 h, eat soft solid diet in 48-72 h and return to normal diet after 4-5 days of surgery. No patient complained of difficulty in opening the mouth, salivation disturbances, perioral numbness or difficulty in protrusion of tongue. No long-term functional or aesthetic complications were reported. CONCLUSION: Lingual mucosal graft harvesting is feasible, provides a long graft, is easy to carry out and is the least morbid procedure.

Surgical complications of radical retropubic prostatectomy: A single institutional experience of seven years.

AIM: To determine the surgical complications of open retropubic radical prostatectomy. MATERIALS AND METHODS: Fifty-nine cases of localized prostate cancer underwent retropubic radical prostatectomy in our department in the last seven years. Standard technique of open retropubic radical prostatectomy as described by Walsh was used. During follow-up cancer control and quality of life indices (potency and urinary continence) were noted. RESULT: Postoperative recovery of all patients except one was excellent. This patient required cardio-respiratory support and nine units of blood transfusion. Forty-nine out of 52 patients were continent, two had stress incontinence and one was totally incontinent at one year. Bladder neck contracture was present in eight out of 52 patients at one year. Forty-five patients were impotent at one year with or without oral tablet sildenafil. Cancer control was present in 45 out of 52 cases. Seven cases had biochemical failure at one year. CONCLUSION: Though retropubic radical prostatectomy is the standard treatment for early prostate cancer it is not without complications. It has a steep learning curve. More number of cases and refinement in technique is required to achieve world-class results.

Prediction of biochemical failure in localized carcinoma of prostate after radical prostatectomy by neuro-fuzzy.

OBJECTIVE: To predict biochemical failure in localized prostate cancer after radical prostatectomy using preoperative variables. MATERIALS AND METHODS: Twenty-six patients of early carcinoma of prostate underwent open retropubic radical prostatectomy from June 2002 to June 2006. Preoperative variables included age, family history, digital rectal examination, serum prostatic specific antigen (S. PSA), prostate biopsy Gleason score, MRI of pelvis variables like periprostatic extension, seminal vesical invasion, weight of gland and pathological stage. With application of neuro-fuzzy, these variables were fed into system as input and output, that is S. PSA at six months (predicted value) was calculated. Neuro-fuzzy system is a system to combine fuzzy system with learning techniques derived from neural networks. Here, we applied Takagi Sugeno Kang model (TSK) due to its close solution to our aim. All the patients were followed up for a minimum of six months. At six month S. PSA of all patients was done (observed value). Predicted and observed values were compared. RESULT: Predicted and observed values were plotted on 1:1 slop line. Coefficient of correlation was 0.9935. CONCLUSION: Coefficient of correlation is close to one. It indicates that the neuro-fuzzy is accurate in predicting biochemical failure in localized carcinoma of prostate after radical prostatectomy.

Xanthogranulomatous pyelonephritis: our experience with review of published reports.

BACKGROUND: The aim of this study was to analyse the cases of xanthogranulomatous pyelonephritis with review of published reports. METHODS: We retrospectively reviewed all nephrectomy specimens during February 1995 to January 2006. We found 26 cases of xanthogranulomatous pyelonephritis. We prepared a chart of these cases consisting of preoperative symptoms, laboratory findings, radiological imaging results and preoperative diagnosis. Open nephrectomy was carried out in all cases. RESULTS: Age group of the patients was 6-65 years and male : female ratio was 1.6:1. Twenty-two patients presented to us with intermittent high-grade fever, 21 with flank pain, 18 with loin mass, 2 with haematuria and 1 was detected during screening of vague gastrointestinal symptoms. Twenty-five patients had pyuria and only 10 had sterile urine culture. In all patients, only one kidney was affected. All patients had renal calculi 10-42 mm in size with bilaterally enlarged kidneys. Ipsilateral kidney was enlarged because of hydronephrosis or pyonephrosis in all cases and contralateral kidney was enlarged because of compensatory hypertrophy in 13 cases. Ipsilateral kidney had severely compromised renal function in all cases. Associated psoas abscess was present in one and tuberculosis in another. CONCLUSION: Xanthogranulomatous pyelonephritis is a relatively rare entity that is associated with obstruction, stones and infection of the urinary tract. Late presentation leads to loss of renal parenchyma. It cannot be differentiated preoperatively with renal tumours (renal cell carcinoma and Wilms' tumour), pyonephrosis, infected hydronephrosis and renal lymphoma. Nephrectomy and antibiotics are the treatment of choice.

Maxillary haemangioma.

Maxillary haemangioma is a rare entity. It presents with a painless, slow-growing swelling and if it involves the paranasal sinuses it may present with severe epistaxis, mimicking a malignancy. A case of haemangioma arising in the bony maxilla and causing a cosmetic problem is presented here.