A scanning electron microscopic study of hypercementosis

The purpose of this study was to evaluate morphological characteristics of teeth with hypercementosis that are relevant to endodontic practice. Twenty-eight extracted teeth with hypercementosis had their root apexes analyzed by scanning electron microscopy (SEM). The teeth were divided according to tooth groups and type of hypercementosis. The following aspects were examined under SEM: the contour and regularity of the root surface; presence of resorption; presence and number of apical foramina, and the diameter of the main foramen. The progression of club shape hypercementosis was directly associated with the presence of foramina and apical foramen obstruction. Cases of focal hypercementosis presented foramina on the surface, even when sidelong located in the root. Circular cementum hyperplasia form was present in 2 out of 3 residual roots, which was the highest proportion among the tooth types. The detection of a large number of foramina in the apical third of teeth with hypercementosis or even the possible existence of apical foramen obliteration contributes to understand the difficulties faced during endodontic treatment of these cases

The health care setting rather than medical speciality impacts on physicians adherence to guideline-conform anticoagulation in outpatients with non-valvular atrial fibrillation: a cross sectional survey

BACKGROUND: In patients with non-valvular atrial fibrillation (NVAF) at high risk for stroke guidelines consistently recommend long-term oral anticoagulation (OAC) with a vitamin K antagonist. However recommendations remain ambiguous in respect to the precise OAC initiation regimens. Based on the clinical observation, that the initiation of OAC for NVAF varies considerably in daily practice, we aimed to assess the current practice in Switzerland. METHODS: Cross-sectional survey of randomly selected general practitioners, internists and cardiologists from different health care settings in an urban Swiss region that covers 1.4 million inhabitants. The main outcome measures were the preferred antithrombotic initiation regimen and long-term treatment in patients with newly diagnosed NVAF at high risk for stroke. RESULTS: We received 226 out of 388 (58.2%) surveys. Compared to physicians working in a hospital setting (33.6% of respondents) physicians in ambulatory care reported more years of experience and claimed lower-use (never or seldom) of guidelines in general (47.6 vs. 12.2%). Regarding long-term thromboembolic prophylaxis 93.7% of all responders followed current recommendation by choosing an OAC. When focussing on guideline-consistent correct OAC initiation (either low-dose initial OAC or a combination of LMWH and OAC) adherence dropped to 60.6% with hospital physicians demonstrating a significantly higher use of guideline-conform OAC regimens (79.7 vs. 51.0%). Medical speciality in non-hospital physicians was not related to correct guideline-use. Hospital setting remained independently associated with a guideline-conform OAC initiation regimen (OR 2.8, p = 0.023) when controlled for medical speciality, physicians' characteristics and clinical experience. Problems when starting an anticoagulation treatment were seldom reported (never or seldom accounting for 94.1% of all responses). CONCLUSIONS: The guideline adherence with respect to OAC initiation regimens in NVAF was significantly lower when compared to long-term treatment and health care setting rather than medical speciality explained guideline-conform OAC initiation. The majority of the physicians did not consider the initiation of anticoagulation to be a major obstacle in outpatient care

Isolated Gastrocnemius Recession for Plantar Fasciitis

Category: Hindfoot Introduction/Purpose: Plantar fasciitis is a debilitating problem that can cause long-term pain. Multiple different studies with various modalities have been suggested to treat the inflammation of the plantar fascia. None of them have provided a cause for the inflammation. A few recent studies have shown gastrocnemius equinus to be a driving factor in foot pain, which includes plantar fasciitis. Our belief is that the inflammation is due to a stretch placed on the plantar fascia due to a gastrocnemius equinus contracture and the beginning of an arch collapse per the Grand Rapids arch collapse model. As such, we wanted to review our results with an isolated gastrocnemius recession for the treatment of plantar fasciitis. Methods: We retrospectively reviewed patient data collected by isolating ICD-9 and ICD-10 codes for plantar fasciitis. These patients presented to the senior author’s office with a complaint of plantar heel pain, were diagnosed with a gastrocnemius equinus contracture and plantar fasciitis, failed conservative treatment, and opted for an isolated gastrocnemius recession as a definitive treatment of the fasciitis. From the timeframe of 1/1/2015 to 6/12/17, there were 68 out of 97 patients who qualified for the study based on the necessary criteria: an initial consultation pain score, initial post-operative pain score at two weeks, and second post-operative pain score at eight weeks. These patients did not have coexisting surgeries at the time of the gastrocnemius recession or prior surgery to the area in discussion. Results: For the 68 patients (five of which underwent bilateral procedures at a minimum of six weeks apart), who elected to have a gastrocnemius recession for plantar fasciitis, the average initial presenting pain was a 7.4 on a scale of 0 to 10. The average initial post-operative pain score was 2.8 and the average second post-operative pain score was 3.3. The average number of days from initial to second post-operative appointment was 136 days. Of the 68 patients, 21 returned after their eight-week post-operative visit for evaluation. Only 3 returned with recurrent plantar heel pain, 4 more presented with new onset tarsal tunnel syndrome, three more with heel pain different from their pre operative pain and the remaining patients had new onset unrelated pain. Conclusion: We have demonstrated that an isolated gastrocnemius recession can decrease the pain score in patients with recalcitrant plantar fasciitis. Follow up care beyond eight weeks post operation is not routinely performed due to the limited nature of the procedure. The improvement demonstrated in the VAS scores of the patients included in this study show a definite improvement and as such, we believe that an isolated gastrocnemius recession should be considered as a definitive treatment of plantar fasciitis. Future prospective randomized studies will need to be completed to further evaluate the effectiveness of this procedure

Electroweak parameters of the z0 resonance and the standard model

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