Management of complicated crown root fracture using pizeo surgery, fiber post and fragment reattachment: A case report

A common type of fracture involving tooth is complicated crown root fracture of anterior teeth. The reattachment of the coronal fragment to the remaining tooth will provide better and long-lasting aesthetics, improved function and a positive psychological reaction. It is a simple and less difficult procedure if the original tooth fragments are retained after fracture. This paper reports about a case of complicated crown root fracture that was treated successfully using broken fragment adhesive reattachment and post placement.

Oncologic Panendoscopy: Description of an Optimized Procedure Based on Our Experience

Introduction All patients with a new head and neck squamous cell carcinoma (HNSCC) undergo diagnostic panendoscopy as part of the screening for synchronous second primary tumors. It includes a pharyngolaryngoscopy (PLS), a tracheobronchoscopy and esophagoscopy, and a stomatoscopy. Rigid techniques are risky, with long learning curves. Objective We propose a precise description of the panendoscopy protocol. We include an optimization of the PLS technique that completes the flexible esophagoscopy when rigid esophagoscopy isn't performed. Methods The present retrospective observational study includes 122 consecutive patients with a new primary HNSCC who underwent traditional panendoscopy and the new PLS technique between January 2014 and December 2016. A two-step procedure using a Macintosh laryngoscope and a 30° telescope first exposes panoramically the larynx, the upper trachea, and the oropharynx; then, in a second step, the hypopharynx is exposed down to the upper esophageal sphincter. Broncho-esophagoscopy is performed with a rigid and flexible scope. Results In total, 6 (5%) patients presented synchronous tumors (3 in the esophagus, 2 in the oral cavity, and 1 in the larynx 1). Rigid endoscopy was complicated by 2 (1,6%) dental lesions, and had to be completed with a flexible scope in 38 (33%) cases for exposition reasons. The two-step PLS offered a wide-angle view of the larynx, upper trachea, and oro- and hypopharynx down to the sphincter of the upper esophagus. The procedure was easy, reliable, safe, repeatable, and effectively completed the flexible endoscopies. Conclusion Rigid esophagoscopy remains a difficult procedure. Two-step PLS combined with flexible broncho-esophagoscopy offers good optical control.

Endorobots for Colonoscopy: Design Challenges and Available Technologies

Colorectal cancer (CRC) is the second most common cause of cancer death worldwide, after lung cancer (Sung et al., 2021). Early stage detection is key to increase the survival rate. Colonoscopy remains to be the gold standard procedure due to its dual capability to optically inspect the entire colonic mucosa and to perform interventional procedures at the same time. However, this causes pain and discomfort, whereby it requires sedation or anaesthesia of the patient. It is a difficult procedure to perform that can cause damage to the colonic wall in some cases. Development of new technologies aims to overcome the current limitations on colonoscopy by using advancements in endorobotics research. The design of these advanced medical devices is challenging because of the limited space of the lumen, the contorted shape, and the long tract of the large bowel. The force applied to the colonic wall needs to be controlled to avoid collateral effects such as injuries to the colonic mucosa and pain during the procedure. This article discusses the current challenges in the colonoscopy procedure, the available locomotion technologies for endorobots used in colonoscopy at a prototype level and the commercial products available.

Bone Lesions in Children with Neurofibromatosis

Neurofibromatosis is often related with severe orthopaedic disorders in children. Bone lesions are rare but pose severe difficulties in management. It affects the spine and long bones. Lesions are associated either from enlargement of neurofibromas that affect the normal growth or from primary neurofibromatosis of long bones. Dystrophic scoliosis appears with short curves, with kyphosis and rotation of the apical vertebrae. Usually affect the thoracic spine, with penciling of the ribs. Surgical treatment is challenging in cases of rapid progression. Scoliosis may appear with curvatures similar to those in idiopathic scoliosis, without dysplastic changes of the vertebrae. Anterior bowing of the tibia is manifestation of NF and is distinguished from the benign posterolateral bowing. Evaluation of the medullary canal and presence of cystic lesions in the tibia is essential. Progression to pseudoarthrosis or pathologic fracture is common. Surgical management of tibial pseudoarthrosis remains a difficult procedure. Pseudoarthrosis may appear in fibula, radius or ulna but are extremely rare. Irregular eccentric bone cysts in long bones that are commonly diagnosed after a pathologic fracture, must be differentiated for NF. Malignant transformation of neurofibromas must be considered when there is rapid progression of the lesion.

Transseptal Access for Catheter Ablation of Left-Sided Atrioventricular Accessory Pathways in Children

Introduction. Puncture of the atrial septum for access to the left atrium is often used for cardiac interventions in adults. In children, transseptal puncture is a less common, technically more difficult procedure, and the frequency of its complications is not well described in the literature. Objective. Our aim was to study the feasibility and safety of transseptal puncture in children through retrospective analysis of 208 consecutive radiofrequency catheter ablations (RFCA) for left-sided atrioventricular accessory pathways (AP). Results and discussion. Successful transseptal puncture was possible in 100% of cases, ablation in 97%. The mean time, including mapping and radiofrequency ablation, was 40 ± 22 minutes, and the mean fluoroscopy time was 3.8 ± 1.9 minutes. There were no complications associated with transseptal puncture. Recurrence of AP was reported in 6 (2.9%) children. Residual atrial septal defects 1 year after the procedure were detected by echocardiography in 5 (2.4%) children. The transseptal access ensures successful and effective ablation of the left-sided accessory pathways in the vast majority of children. RCA with transseptal access has a total operative time and fluoroscopy time comparable to those described in the literature for RCA with retrograde access. The reduced duration of the procedure and the fluoroscopy time are of great importance in the pediatric age group, which is most vulnerable to drug and radiation exposure. However, transseptal puncture in children remains a technically complex intervention with the possibility of corresponding complications. It should be performed by an experienced electrophysiologist who has experience in pediatric catheter ablation. Conclusions. Transseptal puncture is a feasible and reasonably safe procedure for children. It can be considered as the first choice approach in children with left-sided accessory pathways.

Dividing line between organ donation and euthanasia in a combined procedure

In this article, we want to reply to the recent article by Buturovic, to be able to correct some statements and allegations about this combined procedure. Organ donation after euthanasia is an extremely difficult procedure from an ethical point of view. On the one hand, we see a suffering patient who wants to die but who also wants to make an altruistic effort to donate his organs. On the other hand, we visualise a patient in need of an organ but who is wary of the fact that someone else needs to die in order to potentially receive a transplant organ. Healthcare professionals seem to walk a tightrope when balancing between the interests of the patients at these two extremes: while facilitating the dying patient’s last wish on the one hand and abiding by all regulations regarding donation and transplantation on the other. Yet, these physicians, nurses and transplant coordinators do their utmost best to keep a strict line between euthanasia and organ donation, to avoid any external pressure on the patient, and to respect his autonomy. They really make an utmost attempt to make the process bearable for the donating patient. However, undeniably the patient who is about to undergo organ donation after euthanasia is nevertheless confronted with dozens of feelings and thoughts. However, this does not imply that procedural safeguards are failing to disentangle organ donation from euthanasia.

Heel Pressure Sore: Surgical treatment with the Cone Flap

Introduction: The patients with paraplegia may present pressure sores in the heel because is an area offriction and shearing with a thin and insensible tigth skin. The treat ment include many flaps but ussually they are of difficult procedure. The Cone flap, described in PRS, is a good, reliable aneasy flap for treatment of the pressure sore in the heel. Objetive: Show the casuistic of the Cone flap for repair of the pressure sore of the heel in paraplegic patients. Material and Method: Since 2016 through 2019 we operated on ten paraplegics patients with pressure sore in the heel with espoesedcal caneous bone. The flap chosen was the Cone flap that combine a rotation and a V-Y fasciocutaneousone. Both flap are taken from the sole of the foot and transferred to the ulcer. Discussion and Conclusion: The treatment of pressure sores of the heel in paraplegic patients is very difficult because of the low blood supply of this area with a tight and thin skin. The Cone flap is an easy, reliable and sure one with good results giving blood supply to the area.

Methods of translating non-equivalent legal vocabulary

The article touches upon a subject of non-equivalent vocabulary. Translating legal terms, which primarily include legal realias, denoting concepts, that are not present in the target language, is a rather difficult procedure.

A Study Assessing Gender Distribution Using Maxillary Sinus

INTRODUCTION: Corpse recognition is a difficult procedure. Comparison of both ante mortem and post-mortem records is essential and assists in identification of corpses. Typical methods of identification however sometimes may be inconclusive. Gender determination is an important aspect in identification of corpses. Previously skull, pelvis and the long bones have been used in gender determination. It has been reported earlier that maxillary sinus remains intact even when skull and long bones may be badly disfigured in incarnated victims.AIM: The aim of this study was to examine whether the measurements of the maxillary sinuses may possibly be used for gender determination.MATERIAL AND METHODS: Computed tomography scans of total of 50 Adults patients within the age range of 25 to 65 years from the previous dental records were taken. Sample comprised of 25 (50%) males and 25 (50%) females. The width, height and length was measured in all cases using CT images.RESULTS: Maxillary sinus exhibits anatomic variability between genders. A significant difference in the length and height of maxillary sinus was observed with respect to males and females. (p<0.005)CONCLUSION: We conclude from the present study that the height and length of maxillary sinuses together with other bones can be used for gender determination when skeleton is not available.