Comparison of The Kois Dento-Facial Analyzer System with an Earbow for Mounting a Maxillary Cast

Statement of problem: The Kois Dento-Facial Analyzer System (KDFA) is used by clinicians to mount maxillary casts and evaluate and treat patients. Limited information is available for understanding whether the KDFA should be considered as an alternative to an earbow. Purpose: The purpose of this study was to evaluate maxillary casts mounted using the KDFA with casts mounted using Panadent\u27s Pana-Mount Facebow (PMF). Both articulation methods were compared against a lateral cephalometric radiograph. Material and methods: Fifteen dried human skulls were used. Lateral cephalometric radiographs and 2 maxillary impressions were made of each skull. One cast from each skull was mounted on an articulator by means of the KDFA and the other by using the PMF. A standardized photograph of each articulation was made, and the distance from the articular center to the incisal edge position and the occlusal plane angle were measured. The distance from condylar center to the incisal edge and the occlusal plane angle were measured from cephalometric radiographs. Finally, the 3-dimensional position of each articulation was determined with a Panadent CPI-III. A randomized complete block design analysis of variance (RCBD) and post hoc tests (Tukey-Kramer HSD) (α=.05) were used to evaluate the occlusal plane angle and axis-central incisor distance. A paired 2-sample t test for means (α=.05) was used to compare the X, Y, and Z distance at the right and left condyle. Results: The KDFA and PMF mounted the maxillary cast in a position that was not statistically different from the skull when comparing the occlusal plane angle (P=.165). Both the KDFA and the PMF located the maxillary central incisor edge position in a significantly different position compared with the skull (P=.001) but were not significantly different from each other. The 3-dimensional location of the maxillary casts varied at the condyles by approximately 9 to 10.3 mm. Conclusion: The KDFA mounted the maxillary cast in a position that was not statistically different from the PMF when comparing the incisal edge position and the occlusal plane angle. Both the KDFA and the PMF located the maxillary incisal edge position in a significantly different position compared with the anatomic position on dried human skulls

Antegrade coeliac axis reconstruction for Chronic Mesenteric Ischaemia : a case series

The management of chronic mesenteric ischaemia remains a compelling challenge for many vascular surgeons. Over the past four decades, several reports have demonstrated encouraging results following revascularisation of the splanchnic arteries. To this date, due to limited numbers, there have been no randomized trials on which we can base our current practise. In this series, we have demonstrated the benefits of a left thoracoabdominal approach for performing an antegrade bypass graft to the coeliac axis, in patients with severe mesenteric angina. Its low complication rate and excellent aortic vessel exposure make it a procedure of choice in expert centres.peer-reviewe

Is cytomegalovirus reactivation increasing the mortality of patients with severe sepsis?

Cytomegalovirus (CMV) is a ubiquitous virus present in approximately two-thirds of the healthy population. This virus rarely causes an active disease in healthy individuals, but it is among the most common opportunistic infections in immunocompromised patients such as solid organ transplant recipients, patients receiving chemotherapy for cancer or patients with human immunodeficiency virus. Critically ill patients who are immunocompetent before intensive care unit admission may also become more prone to develop active CMV infection if they have prolonged hospitalizations, high disease severity, and severe sepsis. The development of active CMV infection in these critically ill patients has been associated with a significantly higher risk of death in several previous studies. The present issue of Critical Care brings a new study by Heininger and colleagues in which the authors found that patients with severe sepsis who developed active CMV infection had significantly longer intensive care unit and hospital stays, prolonged mechanical ventilation, but no changes in mortality compared to patients without CMV infection. We discuss the possible reasons for their findings (for example, selection bias and low (20%) statistical power to detect mortality endpoints), and also perform an update of our previous meta-analysis with the addition of Heininger and colleagues' study to verify whether the higher mortality rate with CMV holds. Our updated meta-analysis with approximately 1,000 patients shows that active CMV infection continues to be associated with a significant 81% higher mortality rate than that in critically ill patients without active CMV infection

Myocardial dysfunction after out-of-hospital cardiac arrest: predictors and prognostic implications.

We aim to determine the incidence of early myocardial dysfunction after out-of-hospital cardiac arrest, risk factors associated with its development, and association with outcome. A retrospective chart review was performed among consecutive out-of-hospital cardiac arrest (OHCA) patients who underwent echocardiography within 24 h of return of spontaneous circulation at three urban teaching hospitals. Our primary outcome is early myocardial dysfunction, defined as a left ventricular ejection fraction \u3c 40% on initial echocardiogram. We also determine risk factors associated with myocardial dysfunction using multivariate analysis, and examine its association with survival and neurologic outcome. A total of 190 patients achieved ROSC and underwent echocardiography within 24 h. Of these, 83 (44%) patients had myocardial dysfunction. A total of 37 (45%) patients with myocardial dysfunction survived to discharge, 39% with intact neurologic status. History of congestive heart failure (OR 6.21; 95% CI 2.54-15.19), male gender (OR 2.27; 95% CI 1.08-4.78), witnessed arrest (OR 4.20; 95% CI 1.78-9.93), more than three doses of epinephrine (OR 6.10; 95% CI 1.12-33.14), more than four defibrillations (OR 4.7; 95% CI 1.35-16.43), longer duration of resuscitation (OR 1.06; 95% CI 1.01-1.10), and therapeutic hypothermia (OR 3.93; 95% CI 1.32-11.75) were associated with myocardial dysfunction. Cardiopulmonary resuscitation immediately initiated by healthcare personnel was associated with lower odds of myocardial dysfunction (OR 0.40; 95% CI 0.17-0.97). There was no association between early myocardial dysfunction and mortality or neurological outcome. Nearly half of OHCA patients have myocardial dysfunction. A number of clinical factors are associated with myocardial dysfunction, and may aid providers in anticipating which patients need early diagnostic evaluation and specific treatments. Early myocardial dysfunction is not associated with neurologically intact survival

La transformation des territoires en grande hydraulique : les impacts du projet Sebou, Maroc

Dans les années 1960, le schéma directeur de la mise en valeur de la plaine du Gharb tracé par l'équipe du projet Sebou a suscité de nombreux espoirs concernant le développement de l'agriculture. Trente ans plus tard, les premiers aménagements réalisés et le recul pris, les déçus sont nombreux et les critiques des aménagements, déjà lancées dès les débuts du programme et renforcées au cours du temps, se poursuivent. Ce bilan semble cependant devoir être révisé, ou tout au moins tempéré, quand on distingue deux échelles, globale et locale, de résultats techniques et économiques du programme. Ainsi, l'étude de la transformation des territoires à partir de l'évolution de la situation des douars met en évidence comment les agriculteurs se sont approprié de manière différenciée ces aménagements, aboutissant à une diversité de situations dans la plaine du Gharb. Cet article reprend les premiers résultats de l'approche adoptée, qui se concentre à l'échelle des douars pour comprendre la transformation des territoires, utilisant pour cela les outils dégagés pour l'étude des systèmes agraires ainsi que pour l'étude des réseaux. Des premiers remembrements à l'expérience de l'irrigation, aussi bien à partir d'ouvrages de grande hydraulique que privée, nous verrons que, la maille hydraulique ne correspondant pas au territoire de douar, l'aménagement a été approprié de manière variée. La différenciation est aussi due aux changements et aux différents vecteurs, notamment la main-d'oeuvre, qui les introduisent dans les différents territoires. (Résumé d'auteur

EFFECT OF ORAL MOXONIDINE IN THE ATTENUATION OF THE HAEMODYNAMIC RESPONSES SEEN DURING LAPAROSCOPIC SURGERIES

ABSTRACTObjective: During laparoscopic surgeries, pneumoperitoneum can lead to various pathophysiologic changes in the cardiovascular system resulting inhypertension and tachycardia. Search for ideal drug to prevent this hemodynamic response goes on. The aim of our study was to evaluate the effect oforally administered moxonidine in attenuating the hemodynamic responses that occur during the laparoscopic surgeries.Methods: A total of 50 adult acetylsalicylic acid I and II patients scheduled for elective laparoscopic surgeries were selected for this prospectiverandomized double-blinded study. They were randomly allocated into two groups: moxonidine group (M) and placebo group (P). M group receivedoral moxonidine 0.3 mg at 8 pm on the day before surgery and at 8 am on the day of surgery. P group received a placebo at the same timing as that ofthe M group.Results: Following pneumoperitoneum rise in systolic blood pressure (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and heart rate (HR)was higher in P group in comparison to M group which was statistically significant.Conclusion: Significant rise in HR, SBP, DBP, and mean BP was noted in the P group in comparison to moxonidine group. Moxonidine provided betterperioperative hemodynamic stability in patients undergoing laparoscopic surgeries.Keywords: Moxonidine, Stress response, Laparoscopic