Left Bundle Branch Block, an Old–New Entity

Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction, but also in comparison to right bundle branch block which is generally considered to be benign in the absence of an underlying cardiac disorder like congenital heart disease. LBBB may be the first manifestation of a more diffuse myocardial disease. The typical surface ECG feature of LBBB is a prolongation of QRS above 0.11 s in combination with a delay of the intrinsic deflection in leads V5 and V6 of more than 60 ms and no septal q waves in leads I, V5, and V6 due to the abnormal septal activation from right to left. LBBB may induce abnormalities in left ventricular performance due to abnormal asynchronous contraction patterns which can be compensated by biventricular pacing (resynchronization therapy). Asynchronous electrical activation of the ventricles causes regional differences in workload which may lead to asymmetric hypertrophy and left ventricular dilatation, especially due to increased wall mass in late-activated regions, which may aggravate preexisting left ventricular pumping performance or even induce it. Of special interest are patients with LBBB and normal left ventricular dimensions and normal ejection fraction at rest but who may present with an abnormal increase in pulmonary artery pressure during exercise, production of lactate during high-rate pacing, signs of ischemia on myocardial scintigrams (but no coronary artery narrowing), and abnormal ultrastructural findings on myocardial biopsy. For this entity, the term latent cardiomyopathy had been suggested previously

Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

Effect of glass-ionomer cement lining on postoperative sensitivity in occlusal cavities restored with resin composite - A randomized clinical trial

This study investigated the ability of a glass-ionomer cement (GIC) lining to reduce postoperative sensitivity in occlusal cavities restored with resin composite. In addition, the effects of a total-etch and self-etch adhesive on postoperative sensitivity were also compared. Patients who had moderate to deep occlusal caries of at least one molar were recruited. Overall, 103 restorations were placed in 70 participants, with an average age of 22.8 ± 3.8 years. Preoperatively, each tooth was evaluated for cold-stimulated tooth sensitivity using a visual analog scale. If present, tooth sensitivity induced by cold/hot drinks or occlusal function was also noted. Caries was stained with a caries detector dye, then removed using slow-speed burs and hand excavators. The cavity was restored with one of four randomly allocated restorative procedures: 1) bonded with a two-step, total-etch adhesive (Single Bond 2); 2) lined with a resin-modified GIC liner (Fuji Lining LC), then bonded with total-etch adhesive; 3) bonded with a two-step, self-etch adhesive (Clearfil SE Bond) and 4) lined with the GIC liner, then bonded with self-etch adhesive. The cavities were incrementally filled with a nanofilled hybrid resin composite. At recall, postoperative sensitivity was evaluated at one week and one month. Overall, postoperative sensitivity in daily function was rare. No significant difference in postoperative sensitivity, either in daily function or in response to a cold stimulus, was observed between the restorative procedures with or without the GIC liner, regardless of the adhesive used (pgt;0.05). In addition, no difference in postoperative sensitivity was noted between use of the self-etch and total-etch adhesive.link_to_subscribed_fulltex

Fluid flow after resin-composite restoration in extracted carious teeth

The aim of this study was to investigate fluid flow in dentin after restoration of carious teeth with resin composite bonded with a total-etching adhesive, with or without glass-ionomer cement lining. The roots of extracted third molars were removed and the crowns were connected to a fluid flow-measuring device. Each carious lesion was stained with caries detector dye and caries was removed using slow-speed burs and spoon excavators. Caries-excavated teeth were divided into two groups for restoration with resin composite bonded with a total-etch adhesive: (i) without lining; and (ii) lined with glass-ionomer cement before bonding. In non-carious teeth, cavities of similar dimensions were prepared, divided into two groups, and restored in the same manner. Fluid flow was recorded, after restoration, for up to 1 month. Caries-affected dentin was examined by scanning electron microscopy (SEM), and the bonded interfaces were observed using a confocal laser scanning microscope. No significant difference in fluid flow was observed between the two restorative procedures or between the carious and non-carious groups. The SEM images showed that the dentinal tubules of acid-etched, caries-affected dentin were usually still occluded, while some were patent. Limited penetration of fluorescent dye into dentin and into the bonded interfaces of restored carious teeth was observed. © 2009 Eur J Oral Sci.link_to_subscribed_fulltex