Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis

The purpose of this study was to determine the anesthetic efficacy of a supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in teeth diagnosed with irreversible pulpitis. Fifty-one patients with symptomatic, vital maxillary, and mandibular posterior teeth diagnosed with irreversible pulpitis received conventional infiltrations or inferior alveolar nerve blocks. Pulp testing was used to determine pulpal anesthesia after "clinically successful" injections. Patients who were positive to the pulp tests, or were negative to the pulp tests but felt pain during endodontic access, received an intraosseous injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The results demonstrated that 42% of the patients who tested negative to the pulp tests reported pain during treatment and required supplemental anesthesia. Eighty-one percent of the mandibular teeth and 12% of maxillary teeth required an intraosseous injection due to failure to gain pulpal anesthesia. Overall, the Stabident intraosseous injection was found to be 88% successful in gaining total pulpal anesthesia for endodontic therapy. We concluded that, for posterior teeth diagnosed with irreversible pulpitis, the supplemental intraosseous injection of 2% lidocaine (1:100,000 epinephrine) was successful when conventional techniques failed.     

Diagnosis and management of tuberculosis

PURPOSE: To establish a new method for dental imaging using magnetic resonance tomography named Dental-MRT and to demonstrate its usefulness in diagnosing dentogen pathologies of the mandible and maxilla. METHODS: Seven healthy volunteers, three patients with pulpitis, two patients with dentigerous cysts, two patients after tooth transplantation, and three patients with atrophic mandibles have been evaluated. Optimized axial T1- and T2-weighted gradient echo and spin echo sequences in 2D and 3D technique have been established to perform studies of the jaws. The acquired images were reconstructed with a standard dental software package on a work-station as panorama and cross-sectional views of the mandible or maxilla. RESULTS: The entire maxillo-mandibular bone, teeth, dental pulp, and the content of the mandibular canal were well depicted. Patients with pulpitis demonstrate bone marrow edema in the periapical region. Dentigerous cysts and their relation to the surrounding structures are clearly shown. After contrast media administration marked enhancement of the dental pulp can be demonstrated. CONCLUSION: Dental-MRT promises to provide a new tool for visualization and detection of dental diseases.     

Combination therapy: advantages and disadvantages of first-line fixed dose therapy

Phytotherapy is a medicinal and ancestral practice in Africa. It deals with all the fields of human pathology. We wanted to ascertain the efficacy of some plants used in odontology as Euphorbia balsamifera traditionally used as antalgic treatment of acute dental pulpitis. The latex of the plant was caught and treated as to get enough stable paste. We used that paste in the same conditions we use arsenical nerve caustics, a pulpal devitalizer widely used in dental offices. The study carried out on 37 teeth has shown that latex of Euphorbia balsamifera is an effective pulpal devitalizing in contact with the pulp. Its lifetime action was comparable to that of the pulpal nerve caustics. The active principles are not known, however the product seems attractive as a pulpal devitalizing agent.     

Barodontalgia among flyers: a review of seven cases

Once referred to as "flyer's toothache," barodontalgia is defined as tooth pain occurring with changes in ambient pressure. It usually occurs in people who fly or dive. It can develop in conjunction with sinusitis, and in teeth experiencing pulpitis after restorative treatment, new and recurrent caries, intra-treatment endodontic symptoms, dental and periodontal cysts, or abscesses. Although the causal process of barodontalgia is not well understood, it may be related to pulpal hyperemia, or to gases that are trapped in the teeth following incomplete root canal treatment. Patients who are frequently exposed to changes in ambient pressure should be encouraged to follow good oral health practices, attend regularly-scheduled dental recall examinations and accept the timely completion of restorative treatment to minimize the possibility of developing barodontalgia. By employing a classification system to document cases of barodontalgia, dentists will be better prepared to provide appropriate and successful treatment. Seven case reports of barodontalgia are presented and compared to previously documented cases. The author also reviews the reasons why military flyers are more likely to develop barodontalgia than others, although the passengers and crews of commercial airliners may also suffer from this condition.     

Toothache with a multifactorial etiology: a case report

A case report of orofacial pain originating from both dental and nondental conditions is presented. The spontaneous throbbing pain initiated from the left maxillary second premolar and spread throughout the entire upper part of the face to the frontoparietal area. Root canal treatment of the maxillary second premolar did not resolve the chief complaint. Magnetic resonance imaging examination revealed hypertrophy of the left inferior turbinate and soft tissue haziness in the left maxillary sinus floor. After antrostomy, submucosal turbinectomy, and endodontic treatment, the patient was free from pain. The final diagnosis of this case, in addition to pulpitis, was maxillary sinusitis with chronic rhinitis. The multiple factors associated with the etiology made the diagnosis difficult. The mechanism of referred pain from the maxillary sinus and paranasal mucosa to the maxillary teeth and face is discussed.     

Hand and foot infections in children

Hand and Foot anatomic and physiologic characteristics make the infections, located there, acquire specific aspects. Seventy seven in-patients admitted and/or with follow-up at the out-patient clinic of Dona Estef?nia Hospital with Hand (25) and Foot (52) infections, were reviewed during the period between January 1991 and January 1994. We treated, out-patients with paronychia (7 of the hand and 42 of the foot), one patient with hand pulpitis, and one with dorsum hand cellulitis. The remaining 16 with hand infection (64%) and 15 with foot infection (29%) were being treated with splint in the position of rest, elevation of the affected limb and endovenous antibiotic therapy. In all abscess cases, surgical drainage was conducted, 16 the of hand and 22 of the foot. There were no sequels in hand infection. In foot infection there was one osteitis of the first metatarsus and a cutaneous fistula.     

Epidural scar tissue formation after spinal surgery: an experimental study

The bone-resorptive cytokines interleukin 1 (IL-1) and tumor necrosis factor (TNF) have been implicated in the pathogenesis of many chronic inflammatory diseases, including pulpitis and apical periodontitis.To further elucidate their role in these disorders, we have identified cells that express IL-1 alpha and TNF alpha in infected pulps and in developing rat periapical lesions after surgical pulp exposure. As detected by immunohistochemistry, IL-1 alpha- and TNF alpha-positive cells were present as early as 2 days after pulp exposure in both the pulp and periapical region. The numbers of cytokine-expressing cells increased up to day 4 in the pulp and up to day 30 in the periapex. In contrast, cells expressing IL-1 beta and TNF beta, the homologous forms of these mediators, were not found in pulp or periapical lesions during this period. Cells expressing IL-1 alpha and TNF alpha were identified primarily as macrophages and fibroblasts, with occasional staining of polymorphonuclear leukocytes. Osteoblasts and osteoclasts were also positive, whereas lymphocytes were negative. In general, cytokine-expressing cells were located proximal to abscesses and the root apex. These findings demonstrate that cells that express bone-resorptive cytokines IL-1 alpha and TNF alpha are present immediately after pulp exposure in this model, which supports the hypothesis that these mediators play a key role in pulpal and periapical pathogenesis, including the concomitant bone destruction. They also indicate that both resident connective tissue cells as well as infiltrating cells express bone-resorptive cytokines in response to infection in these lesions.     

New ideas and advancing technology in prevention and non-surgical treatment of periodontal disease

Analytical, oral epidemiological studies in adult 'toothbrushing' populations show that the highest prevalence of missing teeth is for molars and maxillary premolars ('key-risk' teeth). The highest prevalence of subgingival microflora, gingivitis (CPITN-1), plaque retentive factors, such as subgingival calculus and restoration overhangs (CPITN-2), and diseased pockets > 3 mm (CPITN-3-4) is found on the approximal surfaces of the same teeth ('key-risk' surfaces). Primary and secondary prevention, as well as treatment of periodontal disease should be focused on these 'key-risk' surfaces. One single, well-executed subgingival scaling and root-planning procedure in deep, diseased periodontal pockets, followed by oral hygiene training and professional mechanical tooth-cleaning (PMTC) at need-related intervals, will prevent further loss of periodontal attachment. However, if the root cementum is removed during instrumentation, and the post-treatment plaque control programme fails, microorganisms will recolonize and invade the rough exposed root dentine, resulting in recurrence of periodontitis and possibly, root caries and pulpitis. Some of these problems may be overcome by the application of new instruments and methods for self-care, PMTC, removal of overhangs, scaling and root-planing without removing 'non-diseased' cementum.     

On the possibilities of self-control in man and animals.

Considers that basic motivational procedures are 2-organism procedures in which an organism is observed and judged by a 2nd organism which then acts on the 1st. The transfer of supervision to superstition, religion, conscience, peers, and spouse in adulthood is discussed. Difficulties in obtaining data on the functioning of external contingencies in the ecology are noted. One-organism or self-control is discussed as based on self-denial as well as self-reward. A 2-stage procedure by which an organism learns the self-denial which makes self-reward possible is outlined: (a) attachment to the mother and (b) judgments of the S's responses as good or bad with different outcomes. Transfer occurs with rule learning of those responses which reduce negative consequences (e.g., withdrawal of the mother or electric shock). Moral systems are regarded as an example of rule induction of motivations. Data from a series of experiments with rats are presented with supporting data from studies with monkeys and man. Problems in generalizing from studies with rats are noted, but it is suggested that, if socialization can be proved in rats, the process must be real. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ability of trainee general practitioners to identify psychological distress among their patients

It is argued that a general practitioner's ability to make accurate ratings of psychological distress is partly determined by the rate at which patients emit cues that are indicative of such distress. This study addresses the behaviours of doctors which influence the rates at which patients emit such cues. Consultations were videotaped involving six General Practice Vocational Trainees, three of them poor, and three of them able identifiers of emotional illness. Consultations were selected so that each trainee was rated interviewing 4 patients with low GHQ scores, and 4 patients with high scores. Behaviours are described which lead to increased cue emission and which are also practised more frequently by able identifiers, while other behaviours reduce cue emission and are practised less frequently by them. Another set of behaviours is no more frequent among the able identifiers, but when practised by able identifiers is associated with increased cue emission by the patients, and when practised by poor identifiers with unaltered or decreased cue emission. Interviews that are 'patient-led' are associated with increased rates of cue emission, while those that are 'doctor-led' are associated with lower rates. The implications of these findings for training doctors working in general medical settings are discussed.     

Epidemiology training for primary health care: the use of computer-assisted distance learning

The Liverpool Epidemiology Programme, based in the Liverpool School of Tropical Medicine, has designed a series of computer-based modules for use in distance learning. The purpose of this paper is to highlight the role of computers in training health workers in epidemiology in developing countries. The aim of the modules is to provide health workers with solutions to problems which they face in their everyday work. The modules are written in hypertext software for IBM compatible machines and interact with the epidemiological software Epi Info. Four modules are described: LEP-Nut which deals with nutritional surveillance, LEP-Ref which looks at the role of epidemiology within a refugee health care programme, LEP-Surv dealing with health surveillance and LEP-Rap which introduces the concept of rapid appraisal. They are also easily distributed, particularly with the development of the Internet. The modules are carefully evaluated before and after distribution. Issues related to their evaluation and subsequent revision are discussed, in particular is the content important, adequate, communicated and useful? A major advantage of computer-based learning materials is that they can be easily updated with new advancements of knowledge and experience from the field.     

On Confidence Intervals for Within-Subjects Designs.

Confidence intervals (CIs) for means are frequently advocated as alternatives to null hypothesis significance testing (NHST), for which a common theme in the debate is that conclusions from CIs and NHST should be mutually consistent. The authors examined a class of CIs for which the conclusions are said to be inconsistent with NHST in within-subjects designs and a class for which the conclusions are said to be consistent. The difference between them is a difference in models. In particular, the main issue is that the class for which the conclusions are said to be consistent derives from fixed-effects models with subjects fixed, not mixed models with subjects random. Offered is mixed model methodology that has been popularized in the statistical literature and statistical software procedures. Generalizations to different classes of within-subjects designs are explored, and comments on the future direction of the debate on NHST are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug therapy of early-childhood minimal brain damage

Drug therapy in a child with juvenile psychoorganic syndrome is only one part of a comprehensive therapeutic program in which the main emphasis is on training and education, which are sometimes accompanied by psychotherapy. In many cases drug therapy is totally unnecessary. It may however provide essential support for the efforts of educators and therapists and is sometimes the factor which renders these possible at all. Not all symptoms respond equally well: the best results are obtained in disorders of drive and often in psychogenic disorders which have developed on the basis of the psychoorganic syndrome. Promotion of personality development, which is virtually always retarded in the child with psychoorganic syndrome, remains the exclusive preserve of training. Drug administration has psychogenic as well as chemical effects. It depends to a large extent on the reaction of the environment to the fact that drugs are being given at all, and to the behavioral changes exhibited by the treated child. Drug effects are thus modified, and, with time, determined by the environment, and thus in many cases treatment is possible only on a short-term or (sometimes) periodic basis. Where treatment is on a long-term basis the danger of drug dependency must be borne in mind, since patients with psychoorganic syndrome are particularly exposed to the risk of addiction. For this reason care is necessary in administering amphetamine-type substances. These drug should not be prescribed from puberty onwards; previously initiated treatment with them should be terminated before purberty. It should however be pointed out that the results registered with amphetamines and drugs with similar effect can usually be obtained equally with drugs involving fewer risks in this respect.     

A retrospective evaluation of traumatized permanent teeth

Seclusion is one of several possible interventions with which patients and health care professionals can be confronted on units for admission and crisis intervention in mental health care institutions. The way in which psychiatric nurses shape their practice with regard to seclusion and how they experience this intervention is unclear. The goal of this study is to describe this practice. The results render insight in the motives and reasons of nurses for use of seclusion, the content of the term emergency situation, the way in which decisions to seclude are taken and which interventions can be labelled as preventive. Finally conclusions are given and the questions raised in this study are discussed.     

An algorithm for the identification of proteins using peptides with ragged N- or C-termini generated by sequential endo- and exopeptidase digestions

We have developed an algorithm (MassDynSearch) for identifying proteins using a combination of peptide masses with small associated sequences (tags). Unlike the approach developed by Matthias Mann, 'Tag searching', in which the sequence tags are generated by gas phase fragmentation of peptides in a mass spectrometer, 'Rag Tag' searching uses peptide tags which are generated enzymatically or chemically. The protein is digested either chemically or with an endopeptidase and the resultant mixture is then subjected to partial exopeptidase degradation. The mixture is analyzed by matrix assisted laser desorption and ionization time of flight mass spectrometry and a list of intact peptide masses is generated, each associated with a set of degradation product masses which serve as unique tags. These 'tagged masses' are used as the input to an algorithm we have written, MassDynSearch, which searches protein and DNA databases for proteins which contain similar tagged motifs. The method is simple, rapid and can be fully automated. The main advantage of this approach is that the specificity of the initial digestion is unimportant since multiple peptides with tags are used to search the database. This is especially useful for proteins like membrane, cytoskeletal, and other proteins where specific endopeptidases are less efficient and lower specificity proteases such as chymotrypsin, pepsin, and elastase must be used.     

SNAREs and membrane fusion in the Golgi apparatus

Soluble factors, NSF and SNAPs, are required at many membrane fusion events within the cell. They interact with a class of type II integral membrane proteins termed SNAP receptors, or SNAREs. Interaction between cognate SNAREs on opposing membranes is a prerequisite for NSF dependent membrane fusion. NSF is an ATPase which will disrupt complexes composed of different SNAREs. However, there is increasingly abundant evidence that the SNARE complex recognised by NSF does not bridge the two fusing membranes, but rather is composed of SNAREs in the same membrane. The essential role of NSF may be to prime SNAREs for a direct role during fusion. The best characterised SNAREs in the Golgi are Sed5p in yeast and its mammalian homologue syntaxin 5, both of which are predominantly localised to the cis Golgi. The SNARE-SNARE interactions in which these two proteins are involved are strikingly similar. Sed5p and syntaxin 5 may mediate three distinct pathways for membrane flow into the cis Golgi, one from the ER, one from later Golgi cisternae, and possibly a third from endosomes. Syntaxin 5 is itself likely to cycle through the ER, and thus may be involved in homotypic fusion of ER derived transport vesicles. In all well characterised SNARE dependent membrane fusion events one of the interacting SNAREs is a syntaxin homologue. There are only eight members of the syntaxin family in yeast. Besides Sed5p two others, Tlg1p and Tlg2p, are found in the Golgi complex. They are present in a late Golgi compartment, but neither is required for transit of secreted proteins through the Golgi. We suggest that these observations are most compatible with a model for transit through the Golgi in which anterograde cargo is carried in cisternae, the enzymatic composition of which changes with time as Golgi resident enzymes are delivered in retrograde transport vesicles.     

Uncertainty, variability, and sensitivity analysis in physiological pharmacokinetic models

Physiologically based pharmacokinetic (PBPK) models are now commonly used to predict the dose of toxic metabolites of chemical substances reaching target tissues. A typical PBPK model can involve 20 or more physiological, physiochemical, and biochemical parameters, each of which is estimated with some degree of error. In this article, methods for assessing the impact of uncertainty in the parameter values on prediction of tissue dose are proposed, along with methods for identifying those parameters to which predictions of tissue doses are most sensitive. Many of the model parameters are related to body weight, which is assumed to vary in accordance with a doubly truncated normal distribution. The application of the proposed methods is illustrated using a PBPK model for benzene.     

Quasi-Conservative Formulation of the One-Dimensional Saint-Venant–Exner Model

Coupling the Saint-Venant equations with the Exner equation a morphodynamic model is produced, which can be used to describe flow and bed evolution in natural rivers. The system of governing equations is hyperbolic and is expressed in nonconservative form. For this reason, fully primitive formulations of the model are often adopted for the solution, which however are known to incorrectly compute strength and celerity of shock waves (bores). In the present work a quasi-conservative formulation of the differential system is proposed, which aims at reducing these errors to a minimum. The performances of the model are assessed by comparison with primitive formulations applied to some schematic cases and with experimental observations obtained on a physical model of a river reach. Results are satisfactory and overcome predictions based on fully primitive formulations.     

Hypodense meningioma. A care report

INTRODUCTION: Meningiomas are benign tumours which originate in the arachnoid layer and are characterized by being iso- or hyper-dense on computerized axial tomography (CAT). Hypodense meningiomas are relatively infrequent and normally behave thus because of their fat content. A hypomeningioma is almost entirely composed of adipose tissue. However, a meningiotheliomatous meningioma with fatty degeneration, which is the case being considered, is characterized by zones of meningiotheliomatous cells together with zones of adipocytes. CLINICAL CASE: We present the case of a 73 year old woman with a meningiotheliomatous meningioma with extensive fatty degeneration which on CAT scan showed as a hypodense lesion, with well-defined edges, which took up contrast heterogeneously and produced a hyperosfosant reaction. On magnetic resonance (RMN) it gave signals of heterogeneous intensities. Up to the present time, only four cases of pure lipomeningiomas have been described in the literature. CONCLUSIONS: However, meningiomas with fatty degeneration are much more frequent. In this paper we discuss aspects of the differential diagnosis of meningiomas which behave as hypodense lesions on CAT scans.     

Water and potassium metabolism changes]

The disturbances of water and electrolyte metabolism in the body can be subdivided into three large groups: 1) disturbances of free water which are related to the whole body water and are always coupled with changes in the osmolality of the internal environment and also of the interior of the cells (hypertension due to loss of water, hypotension in water intoxication); 2) isotonic changes of the volume of the extracellular fluid-oedema or extracellular dehydration. The latter are always coupled with a hypovolaemia and with a danger to the circulation which may end in shock. There is also a cumulative loss of potassium as a result of the dehydration reaction; 3) disturbances of the intracellular water metabolism which are associated with disturbances of the potassium metabolism. These may have grave consequences for the function of striated and smooth muscles, for the function of the nerves and various enzyme systems. Since the disorders of the extracellular water balance are generally best known, the attention is principally drawn in this paper to the hypertonic dehydration and the status of the potassium metabolism. The symptomatology of both conditions is discussed, and also their diagnosis with the simplest laboratory effort not associated with great loss of time (which is essential if valuable time is not to be lost before the laboratory results can be obtained). The theoretical considerations are supplemented with clinical examples and explanations of the treatment.