Usefulness of the tensile gallbladder fundus sign in the diagnosis of early acute cholecystitis.

OBJECTIVE: The purpose of this article is to evaluate the usefulness of the tensile gallbladder fundus sign on CT in diagnosing early acute cholecystitis. MATERIALS AND METHODS: The tensile gallbladder fundus sign on CT is defined as the absence of gallbladder fundus flattening by the anterior abdominal wall due to increased gallbladder pressures. Between October 2010 and March 2012, 222 patients with confirmed diagnoses of acute cholecystitis by surgery or follow-up imaging studies underwent CT scans in the emergency department because of right upper quadrant pain. Two radiologists retrospectively reviewed all CT images to determine the presence of the tensile gallbladder fundus sign and other CT findings previously reported to be suggestive of acute cholecystitis. Diagnostic performances were calculated and analyzed using pairwise comparisons of receiver operating characteristic curves. The kappa statistic was calculated to evaluate the interobserver agreement. RESULTS: Using the diagnostic criteria in which acute cholecystitis is defined as the presence of three or more classic CT findings, the addition of the tensile gallbladder fundus sign increased the area under the receiver operating characteristic curve (Az) value from 0.693 to 0.739 (p = 0.003). In the subgroup of 91 patients with no other CT features suggestive of acute cholecystitis, the sensitivity, specificity, and Az value of the tensile gallbladder fundus sign for acute cholecystitis were 74.1%, 96.9%, and 0.855, respectively. Interobserver agreement was good with the tensile gallbladder fundus sign (κ = 0.721). CONCLUSION: The tensile gallbladder fundus sign may be useful for diagnosing acute cholecystitis, especially in the early stage when other CT findings are absent.

Heat transfer to the implant-bone interface during preparation of a zirconia/alumina abutment.

PURPOSE: Excessive heat at the implant-bone interface may compromise osseointegration. This study examined the heat generated at the implant surface during preparation of a zirconia/alumina abutment in vitro. MATERIALS AND METHODS: Sixty zirconia/alumina abutments were randomized into 12 experimental groups. The abutments were connected to implants and embedded in an acrylic resin block in a 37 degrees C water bath. The abutments were reduced by 1 mm in height over a period of 1 minute with a high-speed handpiece and then polished for 30 seconds with a low-speed handpiece, both with and without an air/water coolant. Temperatures were recorded via thermocouples at the cervical, middle, and apical part of the implant surfaces. The Mann-Whitney rank-sum test was used to assess the statistical significance of the difference in temperature between the abutment/implant complexes altered with and without coolant. RESULTS: The 1-mm reduction with the high-speed handpiece without coolant resulted in a maximum temperature of 41.22 degrees C at the cervical portion of the implant. Three of four temperatures above 40 degrees C were observed at the cervical part of the implant following use of the high-speed handpiece without coolant. The temperature difference between "with coolant" and "without coolant" during both low-speed polishing and high-speed reduction was statistically significant at the cervical portion of the implant (P = .009). In contrast, the temperature difference between "with coolant" and "without coolant" during both low-speed polishing and high-speed reduction was not statistically significant at the middle and apical parts of the implant (P > .05). CONCLUSIONS: Preparation of a zirconia/alumina abutment caused an increase in temperature within the implant, but this temperature increase did not reach the critical levels described in the implant literature.

Retrospective multicenter cohort study of the clinical performance of 2-stage implants in South Korean populations.

PURPOSE: To evaluate long-term follow-up clinical performance of dental implants in use in South Korean populations. MATERIALS AND METHODS: A retrospective multicenter cohort study design was used to collect long-term follow-up clinical data from dental records of 224 patients treated with 767 2-stage endosseous implants at Ajou University Medical Center and Bundang Jesaeng Hospital in South Korea from June 1996 through December 2003. Exposure variables such as gender, systemic disease, location, implant length, implant diameter, prosthesis type, opposing occlusion type, and date of implant placement were collected. Outcome variables such as date of implant failure were measured. RESULTS: Patient ages ranged from 17 to 71.7 years old (mean age, 45.6 years old). Implants were more frequently placed in men than in women (61% versus 39%, or 471 men versus 296 women). Systemic disease was described by 9% of the patients. All implants had hydroxyapatite-blasted surfaces. Most of the implants were 3.75 mm in diameter. Implant lengths 10 mm, 11.5 mm, 13 mm, and 15 mm were used most often. Differences of implant survival among different implant locations were observed. Implants were used to support fixed partial dentures for the majority of the restorations. The opposing dentition was natural teeth for about 50% of the implants. A survival rate of 97.9% (751 of 767) was observed after 4.5 years (mean, 1.95 +/- 1.2 years). CONCLUSION: Clinical performance of 2-stage dental implants demonstrated a high level of predictability. The results achieved with a South Korean population did not differ from results achieved with diverse ethnic groups.

Cellular mesoblastic nephroma with liver metastasis in a neonate: prenatal and postnatal diffusion-weighted MR imaging.

Congenital mesoblastic nephroma (CMN) is the most common renal tumor in the first year of life. Here, we present unique findings of cellular variant CMN seen on prenatal and postnatal MRI with diffusion-weighted imaging (DWI).The mass was well-visualized on prenatal MR DWI with diffusion restriction in the solid portions. After excision of the mass, follow-up whole body MRI with DWI helped identify local tumor recurrence with suspicious liver metastasis. This hepatic lesion also showed diffusion restriction.