Objective
To evaluate, through microcomputed tomography (μCT), the cement film thickness of veneers and crowns made with different provisional materials.
Material and Methods
A veneer and a crown ...preparation were performed on a central incisor and a second molar of a dental model, respectively, scanned with an intraoral scanner, and the .stl files were exported to an LCD‐based SLA three‐dimensional (3D)‐Printer. Twenty‐four preparations were 3D‐printed for each veneer and crown and divided into four groups (n = 6/group): (a) Acrylic resin (Acrílico Marche); (b) Bisacrylic resin (Protemp 4); (c) PMMA computer‐aided design and computer‐aided manufacturing (CAD‐CAM) (Vipiblock); and (d) 3D‐printed resin for provisional restorations (Raydent C&B for temporary crown and bridge). Veneers and crowns restorations were performed and cemented with a flowable composite. Each specimen was scanned with a μCT apparatus, files were imported for data analysis, and cement film thickness was quantitatively measured. Data were analyzed by 2‐way ANOVA and Tukey post‐hoc tests (α = .05).
Results
Crowns presented a thicker cementation film than veneers (P < .05).The bisacrylic resin showed the smallest veneer film thickness, similar to the acrylic resin (P = .151), which was not significantly different than the PMMA CAD/CAM material (P = .153). The 3D printed provisional material showed the thicker film, different than all other materials (P < .05). The bisacrylic resin showed a cement film thickness with a high number of voids in its surface. For crowns cementation, the 3D printed provisional material showed the thicker cementation film, different than all other materials (P < .05).
Conclusions
Different provisional materials present different film thicknesses. The 3D printed provisional material showed the highest veneer and crown film thicknesses. Veneers film thicknesses were smaller than crowns for all provisional materials.
Clinical Significance
The 3D printed provisional material studied can be satisfactorily used, presenting appropriate adaptation with the tooth preparation, however, it shows the highest cement film thickness for both veneers and crowns cementations when compared with other provisional materials. A better internal fit, or smaller cement film thickness is obtained by CAD/CAM materials, acrylic and bisacrylic resins. Veneer cementation showed a smaller cement film thickness compared with crown cementation for all provisional materials.
Brain cancer and leukemia are the most common cancers diagnosed in the pediatric population and are often treated with lifesaving chemotherapy. However, chemotherapy causes severe adverse effects and ...chemotherapy-induced peripheral neuropathy (CIPN) is a major dose-limiting and debilitating side effect. CIPN can greatly impair quality of life and increases morbidity of pediatric patients with cancer, with the accompanying symptoms frequently remaining underdiagnosed. Little is known about the incidence of CIPN, its impact on the pediatric population, and the underlying pathophysiological mechanisms, as most existing information stems from studies in animal models or adult cancer patients. Herein, we aim to provide an understanding of CIPN in the pediatric population and focus on the 6 main substance groups that frequently cause CIPN, namely the vinca alkaloids (vincristine), platinum-based antineoplastics (cisplatin, carboplatin and oxaliplatin), taxanes (paclitaxel and docetaxel), epothilones (ixabepilone), proteasome inhibitors (bortezomib) and immunomodulatory drugs (thalidomide). We discuss the clinical manifestations, assessments and diagnostic tools, as well as risk factors, pathophysiological processes and current pharmacological and non-pharmacological approaches for the prevention and treatment of CIPN.
Objectives sCJD is a neurodegenerative prion disease characterised by rapidly progressive neuropsychiatric symptoms and movement disorder. Seizures are an uncommon first presentation of sCJD. We ...present a case of a 71 year-old female in whom presented in NCSE.MethodsSingle Case Report.ResultsA 71-year-old female initially presented with higher cortical impairment characterised by visuospatial deficits and apraxia suggestive of parietal lobe dysfunction. Subsequent MRI showed multifocal patches of gyriform diffusion restriction – cortical ribboning – predominantly in the right parietal cortex. Autoimmune and metabolic cerebrospinal fluid (CSF) testing were unremarkable for markers of autoimmune or infectious encephalitis. EEG demonstrated NCSE arising from this right hemisphere lesion, with severe diffuse encephalopathy. A ward-based anti-epileptic drug regime was instituted without success. ICU management with midazolam infusion and intubation for NCSE was required. Clinically and electrographically the patient improved over a two-week period, with resolution of NCSE on repeat EEG. Unfortunately however a repeat MRI on Day 17 of admission demonstrated progression of cortical ribboning beyond the initial focus across hemispheres. This in combination with a positive 14-3-3 and tau protein on CSF, raised the likelihood of sCJD. Marked clinical deterioration followed extubation, with palliative care involvement and end of life planning. The diagnosis of sCJD was confirmed with brain biopsy at autopsy.ConclusionThe case is notable as it is rare for sCJD to present early with NCSE1 and reinforces the need for atypical presentations to prompt exploration of a broader differential diagnosis in the context of unexpected investigation findings.ReferenceEspinosa PS, Bensalem-Owen MK, Fee DB. Sporadic creutzfeldt–jakob disease presenting as nonconvulsive status epilepticus case report and review of the literature. Clinical Neurology and Neurosurgery 2010 July 1;112(6):537–40.
ObjectivesPyomyositis is a purulent infection of skeletal muscle, most commonly resulting from haematogenous spread of Staphylococcus aureus infection in immunocompromised individuals1. Early ...recognition and management is important to prevent dissemination of infection and associated complications, including death.MethodsSingle case report.Results63year old female represented to the emergency department with a three day history of a painful left arm, radiating from the neck. More recently, she had developed proximal left arm weakness and paraesthesia. She had suffered from a self-resolving diarrhoeal illness in the 48hours prior. Clinical examination confirmed a proximal left arm weakness of lower motor neuron pattern. Initial investigations demonstrated a normal creatinine kinase (CK) and white cell count, but elevated inflammatory markers. MRI cervical spine imaging excluded degenerative disease but raised suspicion of oedema within the left sided posterior cervical musculature. Subsequent blood cultures isolated methicillin sensitive Staphylococcus aureus. The patient developed lower back pain and fevers prompting further imaging, demonstrating multifocal epidural abscesses. There was no evidence of infective endocarditis. She received six weeks of intravenous flucloxacillin, followed by oral therapy, resulting in normalization of her inflammatory markers. Delayed repeat MRI imaging confirmed resolution of the epidural infection and improvement in left shoulder musculature oedema and hyperenhancement, which correlated with marked clinical improvement.ConclusionPyomyositis is increasingly recognised in temperate climates and immunocompetent individuals. Pain is an early feature, with CK often remaining normal throughout the disease.1 2 Pyomyositis should be considered as a differential diagnosis in all patients with new onset painful weakness.ReferencesCrum. Bacterial pyomyositis in the United States. The American Journal of Medicine 2004;117:420–428.Bickels, Ben-Sira, Kessler, Wientroub. Primary pyomyositis. The Journal of Bone and Joint Surgery 2002;84:2277–2286.
Background:
The management of nondisplaced femoral neck fractures (FNFs) has evolved, with emphasis in radiographic features such as posterior displacement. However, the role of advanced imaging in ...this scenario is still not well defined. Therefore, our objective is to assess the impact of a computed tomography scan (CT) on interobserver agreement (IA) of fracture classification, posterior tilt measurement, and treatment decisions in nondisplaced FNF in elderly patients.
Methods:
Eleven patients with a nondisplaced (Garden 1–2) FNF were assessed by six hip surgeons. On a first stage, fracture classification, posterior tilt, and treatment plan (fixation/arthroplasty) were determined only with clinical information and X-rays. On a second stage, a CT was added. The kappa coefficient (κ) and intraclass correlation coefficient (ICC) were used to determine IA.
Results:
IA for Garden classification was only slight in X-rays and with the addition of a CT, with a κ = 0.13 (0–0.28) and 0.18 (0.03–0.33), respectively. Conversely, posterior tilt measurement agreement was excellent in both schemes, with an ICC = 0.92 (0.83–0.98) and 0.92 (0.82–0.98). The IA for the proposed treatment was slight with X-rays (κ = 0.44; 0.29–0.6), but moderate with the addition of a CT scan (κ = 0.67; 0.52–0.82). Changes in surgical decision where made in 14 of 66 evaluations with an OR = 1.4 (0.62–3.2) for choosing an arthroplasty if a CT was used.
Conclusion:
IA for fracture classification and posterior tilt evaluation in nondisplaced FNF was not altered by the usage of a CT. There is improvement in treatment agreement when a CT scan is added to conventional imaging, with changes in treatment in 21% of cases.
Digital dental radiographic imaging is considered to be as diagnostically accurate as conventional film-based radiography. In addition, many digital radiographic systems offer various image ...enhancements that may aid in image interpretation. However, neither type of radiographic imaging technique perfectly correlates radiographic diagnoses with clinical findings. Moreover, visual digital enhancements may provide information that is diagnostically misleading. This report presents a completed patient treatment evaluation with both enhanced and unenhanced digital radiography. The outcome suggests that clinicians should be careful with the interpretation of digital radiographic images, as this can potentially result in false-positive diagnoses. (J Prosthet Dent 2010;103:326–329)
Introduction:
Hip fracture patients have been severely affected by the COVID-19 pandemic; however, the sub acute effects of a concomitant SARS-CoV-2 infection and the outcomes in highly exposed ...developing countries are still unknown. Our objective is to describe the morbidity and mortality of elderly patients admitted for a hip fracture during the COVID-19 pandemic in Chile, with a minimum 90-day follow-up. Also, to elucidate predictors for mortality and to compare mortality results with the pre-pandemic era.
Material and Methods:
Multicentric retrospective review of patients admitted for a fragility hip fracture in 3 hospitals during the COVID-19 pandemic, and during the same time in 2019. All clinical information and images were recorded, and patients were followed for a minimum of 90-days. Morbidity and mortality were the primary outcomes. Uni/multivariable models were performed to elucidate predictors for mortality utilizing the Weibull’s regression.
Results:
Three hundred ninety-one cases were included. From the 2020 cohort (162 patients), 24 (15%) had a concomitant SARS-CoV-2 infection. Fourteen patients (58%) tested positive after admission. The COVID-19(+) group had a higher risk of in-hospital, 30-day, and 90-day mortality (p < 0.001). They also had a prolonged hospital stay and presented with more complications and readmissions (p < 0.05). Only COVID-19(+) status and older age were independent predictors for mortality with a HR = 6.5 (p = < 0.001) and 1.09 (p = 0.001), respectively. The 2020 cohort had twice the risk of mortality with a HR = 2.04 (p = 0.002) compared to the 2019 cohort. However, comparing only the COVID-19 (-) patients, there was no difference in mortality risk, with a HR = 1.30 (p = 0.343).
Discussion:
The COVID-19 pandemic has significantly affected healthcare systems and elderly patients.
Conclusions:
Hip fracture patients with a concomitant SARS-CoV-2 virus infection were associated with increased morbidity and mortality throughout the first 3 months. COVID-19 status and older age were significant predictors for mortality. Efforts should be directed into nosocomial infection reduction and prompt surgical management.
Level of evidence:
Level III
Background:
Surgical dislocation of the hip remains an important alternative in hip preservation surgery, especially when a dynamic access to the hip is needed and arthroscopy is not a suitable ...option. We describe a novel technique for operative dislocation of the hip without trochanteric osteotomy and the clinical results of our patients.
Methods:
Surgical dislocation of the hip without trochanteric osteotomy was done through a modified lateral approach in all of the cases. A review of demographic, clinical, and radiological data was done in all of the patients operated with this technique between 2010 and 2015. Complications, walking aids, weight-bearing status, and modified Harris Hip Score (mHHS) were also recorded.
Results:
Six surgical dislocations of the hip were carried out. Indications were tumor resection in five and bulletectomy in one hip. There were two women (four hips) and two men. Mean age was 19 ± 3.8 years. Median follow-up was 2.5 years (range 2–4.5 years). Median mHHS was 92 (90–96). There were no intraoperative nor postoperative complications.
Conclusions:
Surgical dislocation of the hip without trochanteric osteotomy through a modified lateral approach appears to be a safe, simpler, and effective alternative.
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