Search

Aim: To evaluate the role of laparoscopic cholecystectomy (LC) in the management of cholelithiasis in children. Materials and Methods: A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and March 2009 was done. Data points reviewed included patient demographics, clinical history, haematological investigations, imaging studies, operative techniques, postoperative complications, postoperative recovery and final histopathological diagnosis. Results: During the study period of 36 months, 22 children (10 males and 12 females) with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3 to 18 years). Twenty-one children had symptoms of biliary tract disease and one child was incidentally detected with cholelithiasis during an ultrasonogram of the abdomen for an unrelated cause. Only five (22.7%) children had definitive etiological risk factors for cholelithiasis and the remaining 13(77.3%) cases were idiopathic. Twenty cases had pigmented gallstones and two had cholesterol gallstones. All the 22 patients underwent LC, 21 elective and one emergency LC. The mean operative duration was 74.2 minutes (range 50-180 minutes). Postoperative complications occurred in two (9.1%) patients. The average duration of hospital stay was 4.1 days (range 3-6 days). Conclusion: Laparoscopic chloecystectomy is confirmed to be a safe and efficacious treatment for pediatric cholelithiasis. The cause for an increased incidence of pediatric gallstones and their natural history need to be further evaluated.

Aim: To evaluate the role of laparoscopy in complicated appendicitis in children. Materials and Methods: A total of 119 children were operated for appendicitis between October 2005 and May 2008 at SRMC, Chennai. Forty-one patients underwent open appendicectomy (OA), and 71 patients underwent laparoscopic appendicectomy (LA). Twenty-six cases among the LA group and 16 among the OA group had complicated appendicitis. Twenty-six cases were completed laparoscopically, and 2 needed conversion to OA. Results: Out of 26 patients in the LA group, 23 made an uneventful recovery without any complications. One had minor port site infection, and 2 had prolonged loose stools. Out of 16 in the OA group, 7 had complications. Three had wound infection, 2 had loose stools, 1 had fecal fistula and another required subsequent surgeries. Operative duration in LA was 86.7 min (range: 75 to 120 min) and 90.3 min (range: 70 to 150 min) in OA. Oral feed resumption in LA was done at average of 2.7 days and in OA at 4.3 days. IV antibiotics were administered for an average of 3.6 days in LA and 4.8 days in OA, parenteral analgesic for 2.7 days in LA and 4.2 days in OA. The length of hospital stay was 5.4 days in LA and 7.3 days in OA. Conclusion: LA is a favorable alternative in children with complicated appendicitis in view of less postoperative pain, fewer postoperative complications and quicker return to normal activity.

The clinician′s quest for time-saving and technique-insensitive technology has led to the development of simplified self-etch adhesives that are predominantly water or solvent based. Several studies have shown that conventional air-drying procedures are incapable of eliminating all the residual water in the adhesive and that it may even cause collapse of the underlying collagen matrix. We hypothesized that heat from a light source may be effective in removing water from these adhesives. The aim of this study was, therefore, to evaluate the effectiveness of heat vs conventional air drying in eliminating water droplets from self-etch adhesive. A self-etch adhesive was applied to bur-cut dentin surfaces, which were then allotted to one of two treatment procedures for eliminating residual water from the adhesive: conventional air drying or the experimental heat application. Specimens were then prepared and analyzed using SEM. Specimens in the experimental group showed no evidence of water treeing within the adhesive layer. Thus, it was concluded that heat radiation was an effective method to remove residual water from simplified adhesives.

Background: Effective removal of smear layer aids in penetration of intra-canal medicaments into the dentinal tubules and also enhances the adaptation of root canal sealers with the radicular dentin. Various irrigating solutions are used in the effective removal of the smear layer. To compare the efficacy of 5% NaOCl, 17% ethylenediaminetetraacetic acid (EDTA) followed by 5% NaOCl solution and mixture of citric acid, doxycycline (MTAD) as a final rinse on the root dentinal surface using scanning electron microscope (SEM). Materials and Methodology: In this study, distal roots of 60 freshly extracted human mandibular molars were used. Protaper rotary systems were used for cleaning and shaping with Glyde File Prep and NaOCl as a working solution. The samples were divided into three groups and subjected to final irrigation protocol with different irrigants, Group 1: 5% NaOCl for 5 min: Group 2: 17% EDTA at pH 9 for 1 min followed by 5% NaOCl for 1 min: Group 3: MTAD for 5 min. The teeth were split longitudinally into two halves and then these sections were observed under SEM for evaluation of smear layer and erosive effects on underlying dentin structure. Results: Results were tabulated and statistically analyzed using Kruskal--Wallis test and multiple comparison between each group was carried out using Mann--Whitney U-test. Significantly effective removal of smear layer was present in specimens irrigated with 17% EDTA followed by 5% NaOCl and MTAD as compared to the specimens where 5% NaOCl is used as final irrigant. High degree of dentinal erosion was observed in Group 2 where 17% EDTA was used as irrigant. Conclusion: In this study, it was observed that MTAD was effective in removing the smear layer without detrimentally affecting the dentin. The combined use of EDTA followed by NaOCl effectively removed the smear layer but had a detrimental effect on the dentinal wall. Use of NaOCl alone was in effective in removing the smear layer. [ABSTRACT FROM AUTHOR]

An ingested foreign body lodged in the esophagus is common in children. Button batteries impacted in the esophagus need early diagnosis and intervention to avoid complication. We report a case of neglected button battery impacted in the upper esophagus in a 15-month-old female child. The problems encountered during the course of management have been discussed along with the review of the literature. Button battery ingestions in children need to be considered as an emergency and prompt endoscopic removal should be advocated. Rigid esophagoscopy is the gold standard technique of removing esophageal foreign bodies. Complication must be anticipated and managed at the earliest. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study is to assess the microhardness of resin-based composites (RBCs) cured with ultrafast curing mode at two different exposure durations., Study Design: This is an experimental in-vitro study. Forty-five cylindrical composite specimens were prepared to a dimension of 5 mm height and 4 mm diameter. Curing was done using three different exposure modes and duration with dual mode LED curing light as follows: Group I: Ultrafast curing mode for 1 second at 2300 mW/cm2 (n = 15); Group II: Ultrafast curing mode for 3 second at 2300 mW/cm2 (n = 15) and Group III: Standard exposure mode for 20 second at 1000 mW/cm2 (n = 15). Vicker's microhardness measurement was done on both the curing and non-curing sides of the specimen using a motorised diamond-faced micro-indenter (Wilson Wolpwert, Germany) using a load of 50 gram and a dwell time of 30 second., Statistical Analysis: Kruskal Wallis ANOVA was used to test for difference between the three groups followed by Mann-Whitney U test for post-hoc analysis., Results: The microhardness values of the composite cured with a conventional curing unit were significantly higher than the ultrafast cured specimens., Conclusion: Low-intensity conventional curing lights were found to perform better than the high-intensity ultrafast curing units., (Copyright © 2024 Copyright: © 2024 Indian Journal of Dental Research.)

Chimeric antigen receptor (CAR) T cells have demonstrated remarkable anti-tumor efficacy against hematological malignancies, such as leukemia and lymphoma. However, patients treated with CAR-T cells frequently experience cytokine release syndrome (CRS), one of the most life-threatening adverse events of the therapy induced by systemic concentrations of pro-inflammatory cytokines throughout the body. Immunosuppressants such as tocilizumab are currently administered to treat the onset and progression of CRS symptoms. In order to reduce the risk of CRS, newly designed next-generation CAR-T treatments are being developed for both hematopoietic malignancies and solid tumors. In this review, we discuss six classes of interesting approaches that control cytokine production of CAR-T cell therapy: adaptor-based strategies, orthogonal cytokine-receptor pairs, regulation of macrophage cytokine activity, autonomous neutralization of key cytokines, kill switches and methods of reversible suppression of CARs. With these strategies, future CAR-T cell therapies will be designed to preemptively inhibit CRS, minimize the patients' suffering, and maximize the number of benefiting patients.