Inadvertent injection of sodium hypochlorite into the maxillary sinus

A previously undocumented complication of root canal therapy is reported. A dilute solution of 5-10 mls sodium hypochlorite was inadvertently injected into the maxillary sinus during root canal therapy of a right upper second premolar (5). The patient developed acute, sudden, severe facial pain and swelling necessitating emergency admission to hospital and operative intervention under general anaesthesia. A diagnosis of acute chemical sinusitus was made, further management and discussion follow.     

Periradicular curettage

Periradicular curettage is a part of the treatment procedure of periradicular surgery. Its main purpose is to remove pathological periradicular tissues for visibility and accessibility to facilitate the treatment of the apical root canal system, or sometimes for the removal of harmful foreign materials present in the periradicular area. Inflammatory periradicular lesions (granuloma and cysts) are the responses of the periradicular tissues to irritants from the root canal and not from the periradicular area unless medicaments and/or filling materials have been forced through the apical foramina or perforations into the periodontium. Histologically, the inflammatory periradicular lesion is similar to healing granulation tissue, which is composed of cells which have natural and specific immunological defence capability and cooperate by means of cytokines to amplify the protective mechanisms of the host. Accordingly, it is not necessary to completely curette out all the inflamed periradicular tissues during surgery, since this granulation-like tissue will be incorporated into the new granulation tissue as part of the healing process. To control the source of irritants in the root canal is far more important than to remove all periradicular tissues affected by the irritants. The successful removal of all irritants from the root canal system results in resolution of pulpally induced periradicular lesions. In the case where the periradicular lesion is caused by endodontic instruments or cytotoxic filling materials placed in the periradicular tissues, removal of these foreign objects is required for resolution of the lesion.     

Holmium: YAG laser resection of prostate (HoLRP) for patients in urinary retention

The differing morphological manifestations of the root canal system have been the subject of research, and the incidence of various shapes of root canal systems has been classified. The present case describes the root canal treatment of a rare morphological pattern, namely a mandibular permanent canine with three root canals. No report of a similar case has been published previously.     

Reversible oligohydramnios in a pregnancy with angiotensin-converting enzyme inhibitor exposure

The use of angiotensin-converting enzyme inhibitors during pregnancy has been associated with poor fetal outcomes, including oligohydramnios, renal tubular dysplasia, cranial malformations, and fetal death. A 35-year-old woman with chronic hypertension was treated with the angiotensin-converting enzyme inhibitor benazepril until 27 weeks' gestation, when severe oligohydramnios was noted. After hospitalization for bed rest, fetal surveillance, and discontinuation of the agent, amniotic fluid rapidly reaccumulated, and a healthy infant was delivered at term. Although the use of angiotensin-converting enzyme inhibitors should be avoided during pregnancy, patients whose fetuses are inadvertently exposed in utero need not be given a uniformly poor prognosis. Oligohydramnios induced by the use of angiotensin-converting enzyme inhibitors during pregnancy may be reversible if the agent is discontinued. This case underscores the need for obstetricians to review carefully the medication regimens of all pregnant women and to be familiar with generic and proprietary names of medications to avoid the use of potentially harmful agents during pregnancy.     

Automatic Downstream Water-Level Feedback Control of Branching Canal Networks: Theory

Most of the research on the design of feedback controllers for irrigation canals has been concentrated on single, in-line canals with no branches. Because the branches in a network are hydraulically coupled with each other, it may be difficult to automatically control a branching canal network by designing separate feedback controllers for each branch and then letting them run simultaneously. Thus feedback control of an entire branching canal system may be more efficient if the branching flow dynamics are explicitly taken into account during the feedback controller design process. This paper develops two different feedback controllers for branching canal networks. The first feedback controller was developed using linear quadratic regulator theory and the second using model predictive control. Both algorithms were able to effectively control a simple branching canal network example with relatively small flow changes.     

Coronal leakage: endotoxin penetration from mixed bacterial communities through obturated, post-prepared root canals

Coronal leakage has been considered as one of the major causes of failure in root canal treatment. Bacteria have been shown to penetrate the root canal obturating materials and influence the periapical tissues. Endotoxin, a component of Gram-negative bacteria, is a potent inflammatory agent and may be able to penetrate obturating materials faster than bacteria. This in vitro study examined the possible penetration of post-prepared canals by endotoxin and bacterial cells derived from mixed bacterial communities. Results showed that both bacteria and endotoxin were able to penetrate the obturating materials in post-prepared canals; however, endotoxin penetration was faster than bacterial. If one speculates that a similar sequence of events occurs clinically, then such a rapid penetration of endotoxin could lead to an early periapical reaction, with subsequent treatment failure and need for retreatment or periapical surgery. The need for an immediate and proper coronal restoration after root canal treatment is therefore reinforced.     

Lumbar spinal canal stenosis associated with progressive degenerative changes of the spine. A case report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of spinal canal stenosis associated with progressive degenerative changes of the lumbar spine. SUMMARY OF BACKGROUND DATA: As far as the authors are aware, there has been no similar case reported. METHODS: The clinical features of the case are reported, and the pathology is discussed. RESULTS: In a 40-year-old man, spinal canal stenosis developed, associated with progressive degenerative changes of the lumbar spine. The man underwent posterior decompression and fusion using pedicle screws. The surgical results were satisfactory at the time of writing this report. CONCLUSIONS: This case presented a peculiar clinical course, which could not be categorized under previously reported disorders. It may be a new disease entity of spinal canal stenosis. The surgical outcome was satisfactory 2 years, 6 months after surgery.     

Migration of bullet in the spinal canal: a case report

As the spinal canal expands at T10 level naturally, it has been thought that the migration of a bullet within the spinal canal above this level is prevented and the migration of a bullet may only occur between T10 and S1 level. Here, a very rare case of a bullet traversing the length of the spinal canal is reported.     

Scrotal perforation by a ventriculoperitoneal shunt

A case is reported of an adult male in whom the distal ventriculoperitoneal shunt tip migrated through the right inguinal canal into the scrotum. It perforated the scrotal skin, leading to an infection of the still draining shunt. Migration of ventriculoperitoneal shunts into the scrotum occurs occasionally in children but until now has not been reported in an adult with perforation of the scrotum.     

Inadvertent implantation of an ICD lead in the great cardiac vein

We report an implantable cardioverter defibrillator (ICD) implanted with a single lead inadvertently introduced in the great cardiac vein. No venous lesion was caused by the shocks and the position of the lead remained stable. This case emphasizes the usefulness of different fluoroscopic views during ICD implantation.     

Giant spinal extradural cyst

A case of giant extradural cyst in a 13-year-old girl is described. The cyst was formed by the arachnoid membrane which extruded through a wide lumbar dural defect. It extended from the midthoracic region down to the sacral canal. At operation a large portion of the cystic wall was removed, but the dural defect was not repaired. Two spino-peritoneal shunts were left in place to drain both the intradural and the extradural spaces. The treatment has proved successful during the 20 months that the patient has been observed.     

Secondary hypertension and clinical genetics: usual presentation with unusual diagnosis

A transjugular central venous catheter was inadvertently sutured to the wall of the right atrium in a 63-year-old female during coronary bypass surgery. Using two nitinol Goose Neck snares via a transfemoral and a transjugular approach the catheter was severed into two pieces and retrieved percutaneously.     

Cardiovascular risk reduction in a community setting: some comments

Four case reports are presented of patients who ate the meat of a hog inadvertently fed seed treated with fungicides containing ethyl mercury chloride. The clinical, electrophysiological, and toxicological, and in two of the patients the pathological data, showed that this organic mercury compound has a very high toxicity not only for the brain, but also for the spinal motoneurones, peripheral nerves, skeletal muscles, and myocardium.     

Herniation of the singular nerve into the round window niche

We report two cases of herniation of the singular nerve into the round window niche and one case of bony dehiscence without herniation between the round window niche and the posterior canal ampulla. It is believed that the middle ear and the inner ear are completely separate. However, in the temporal bone of a 10- to 15-week-old human fetus, a communication between the round window niche and the posterior canal ampulla is observed. Later, the mesenchymal tissue in the communication is replaced by cartilage from near the posterior canal ampulla. If the communication does not fill with cartilage, ossification is not able to begin behind the posterior canal crista. When there is bony dehiscence behind the crista, the singular nerve fibers are easily pressed out by ossified endosteal bone and herniated into the round window niche.     

Accidental intramuscular vincristine: lack of untoward effects and recommendations for management

Vincristine was inadvertently injected into a thigh of three children. In each case the accident occurred as a result of the mixing of a syringe containing vincristine with a syringe of L-asparaginase which the patient was scheduled to receive on the same day. Within minutes, each patient was treated topically with cold compresses and the area was infiltrated with a solution of 8.4% sodium bicarbonate. Only one patient had discomfort of the thigh after the injection, none of the patients have had any sequelae, either acute or delayed. Measures to avoid mistaken injection of vincristine for asparaginase are readily achievable and have prevented recurrences of intramuscular vincristine administration at the institutions where they have been implemented. Nonetheless, other instances of intramuscular vincristine injection are anticipated and should be rapidly recognized and quickly managed with local applications of cold and sodium bicarbonate.     

Comprehensive Design of Minimum Cost IrrigationCanal Sections

Design of a minimum cost canal section involves minimization of the sum of costs per unit length of the canal, subject to uniform flow condition in the canal. Essentially it is a problem of minimization of a nonlinear objective function subject to a nonlinear equality constraint. In this investigation, the objective function has been expressed as the cost per unit length of the canal for lining, the depth-dependent unit volume earthwork cost, and the cost of water lost as seepage and evaporation losses. A general resistance equation has been used as an equality constraint. Using a nonlinear optimization technique on an augmented function, generalized empirical equations and section shape coefficients have been obtained for the design of minimum cost irrigation canals of triangular, rectangular, and trapezoidal shapes. The optimal dimensions for any shape can be obtained from the proposed equations along with tabulated section shape coefficients. The equation for optimal cost along with the corresponding section shape coefficients is useful during the planning of a canal project. A design example with sensitivity analysis has been included to demonstrate the simplicity of the present method.     

Fibrous dysplasia of the temporal bone: reversal of sensorineural hearing loss after decompression of the internal auditory canal

When fibrous dysplasia affects the temporal bone, it most often presents with conductive hearing loss attributable to stenosis of the external auditory canal. Sensorineural hearing loss has usually been attributed to involvement of the otic capsule. We present a patient with bilateral fibrous dysplasia of the temporal bones who complained of unilateral hearing loss, facial tingling, and facial twitching. The audiogram showed severe sensorineural hearing loss. The hearing markedly improved and facial twitching and tingling ceased after decompression of the internal auditory canal via a middle fossa approach. This is the only case of which we are aware showing reversal of sensorineural hearing loss caused by fibrous dysplasia.     

The University of Tennessee, College of Dentistry philosophy and technique for cleaning and shaping root canal systems

The introduction of nickel titanium files has caused what the author believes to be revolutionary changes in the cleaning and shaping of root canal systems. New materials and file designs are constantly being evaluated and considered for introduction in the dental school curriculum. It is the purpose of this paper to review the techniques currently being taught and introduce some new ideas and techniques which are being evaluated for introduction into the curriculum in the future. Techniques using hand and rotary files will be presented in addition to a review of nickel titanium files.     

Sinus aspergillosis after an endodontic treatment. Presentation of a clinical case

Aspergillosis is an opportunistic deep mycosis that occurs in immunocompromised patients, often in the paranasal sinuses. However, it sometimes occurs in healthy subjects, producing symptoms similar to those of a chronic sinusitis that is unresponsive to conventional treatment. A possible entry point for Aspergillus is the oroantral communication originated by perforation of the dental root cavity during root canal of a molar with penetration of material. We report the clinical case of a patient with symptoms of chronic sinusitis who was diagnosed as sinus aspergillosis after radiological and histological study. The origin may have been a third upper molar in which a root canal was performed.