iosr-JDMS   Volume-9 ~ Issue-4

Abstract: Armored tubes are an integral part of the anaesthesiologist's arsenal of equipments. Its special quality to resist kinking makes it an extremely useful device for use in neurosurgical procedures where extreme positioning is needed. But incidences of tube kinking have been reported.Immediate diagnosis and management is essential in avoiding lethality. We describe a similar incidence of armored tube kinking and its successful management without re-intubation. We highlight the fact that just the use of armored tubes is not a fool-proof way of a secure and patent airway, extreme precaution has to be taken in patient positioning and vigilance throughout the procedure.

Keywords: Armored tube, Flexometallic tube, Kinking, Neurosurgery.

[1]. Fleisher LA. Peroperative myocardial ischemia and infarction. Int Anaesthesiol Clin. 1994;4:1-15.

[2]. Gill NP, Wright B, Reilly CS. Relationship between hypoxemia and cardiac ischemic events in the peroperative period. Br J Anaesth. 1992;68:471-473.

[1]. J M Porter, C Pidgeon, A J Cunningham The sitting position in neurosurgery: a critical appraisal.Br. J. Anaesth. (1999) 82(1): 117-128
[2]. Kie-ChulOhn, Wen-hsien Wu. Another Complication of Armored Endotracheal Tubes. A & A March 1980 vol. 59 no. 3 215-216.
[3]. Peter J. Wright, Janitha V. B. Mundy, Catherine J. Mansfield Obstruction of armoured tracheal tubes: case report and discussion Can J anaesth 1988 35(2): 195-197
[4]. Niu HH, Ho CT, Tsai PS Successful detection and management of unexpected endotracheal tube kinking during neurosurgery--a case report. ActaAnaesthesiol Taiwan. 2004 Jun;42(2):119-23
[5]. http://www.aic.cuhk.edu.hk/web8/Mech%20vent%20troubleshooting.htm
[6]. Gurumurthy T, Rammurthy K, Mahmood LS, Hegde R. An unusual complication of reinforced tube reuse. J AnaesthesiolClinPharmacol 2012;28:528-30
[7]. Balakrishna P S, Shetty A, Bhat G, Raveendra U S. Ventilatory obstruction from kinked armoured tube. Indian J Anaesth 2010;54:355-6

Abstract: Aim and objectives: To evaluate simple manoeuvres and techniques to control catastrophic bleeding from major abdomino-pelvic major vessels. Material and methods: This study was conducted between 2003 to 2013. A total of 15 cases were considered in this study. Patients had iatrogenic injuries during dissection or were diagnosed during operation, as sudden gush of profuse bleeding started in trauma patients. Simple indigenous techniques and manoeuvres are discussed to save life of patients, when operating room is not ready to deal with such surprising catastrophic events. Results: Bleeding was controlled effectively in all patients. All patients required ventilator and inotropic supports. We had one mortality. Remaining 14 patients did well and discharge on 13-18 days postoperatively. Conclusion: Simple manoeuvres and techniques to control catastrophic bleeding from major abdomino- pelvic major vessels are effective in emergency situations.

Keywords: Major vascular injuries, Abdomino-pelvic surgery, IVC injury, Aorta injury, Portal vein injury

[1]. Oderich GS, Panneton JM, Hofer J, Bower TC, Cherry KJ Jr, Sullivan T, Noel AA, Kalra M, Gloviczki P. Iatrogenic operative injuries of abdominal and pelvic veins: a potentially lethal complication. J Vasc Surg. 2004 May; 39(5):931-6.
[2]. David Bergqvist and Agneta Bergqvist Vascular Injuries During Gynecologic Surgery Acta Obstetricia et Gynecologica Scandinavica, 1987, Vol. 66, No. 1 : Pages 19-23
[3]. Champault G, Cazacu F, Taffinder N. Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc. 1996;6(5):367–370. The risk of great vessel injury associated with laparoscopy most frequently quoted is 0.5 injuries for every 1,000 procedures.
[4]. Jansen F, Kapiteyn K, Trimbos-Kemper T, et al. Complications of laparoscopy: a prospective multicentre observational study. Br J Obstet Gynecol. 1997; 104(5):595–600.
[5]. Roviaro GC, Varoli F, Saguatti L, et al. Major vascular injuries in laparoscopic surgery. Surg Endosc. 2002; 16(8):1192–1196.
[6]. Wu MP, Lin YS, Chou CY. Major complications of operative gynecologic laparoscopy in Southern Taiwan. J Am Assoc Gynecol Laparosc. 2001;8(1):61–67.
[7]. Mandolfino T, Canciglia A, Taranto F, D'Alfonso M, Tonante A, Mamo M, Sturniolo G. Outcome of iatrogenic injuries to the abdominal and pelvic veins. Surg Today. 2008; 38(11):1009-12. Epub 2008 Oct 29.
[8]. Oktar GL Iatrogenic major venous injuries incurred during cancer surgery. Surg Today. 2007; 37(5):366-9. Epub 2007 Apr 30.
[9]. Dalton JR, Mulholland SG. Venous injury in major urological surgeryJ Urol. 1979 Oct; 122(4):508-11.
[10]. Pálfalvi L, Bôsze P, Ungár L.Vascular injuries in the surgical management of gynaecological malignancies. Eur J SurgOncol. 1993 Dec; 19(6):601-3.

Abstract: Adenoma malignum is a rare variant of cervical adenocarcinoma. A woman of 26 years with complains of profuse mucoid discharge per vaginum on speculum examination per vaginum showed multiple cauliflowers like growth hanging within the introitus. Punch biopsy gave a report of endocervical glandular polyp with squamous metaplasia. On excision, the mass was found to arise from the cervix and external Os was separately identified. On histopathological examination the final diagnosis was adenoma malignum. Adenoma malignum of the uterine cervix is difficult to diagnose because of the deceptively benign appearance. To make a correct diagnosis, it is necessary to find a characteristic pathological feature such as multiple irregular lobulations of distorted glands demonstrating a ''hair-pin'' shape. Despite the presence of well-differentiated histopathological features, the prognosis of adenoma malignum is known to be poor because of early dissemination into the peritoneal cavity and early distant metastasis.

Key word: Adenoma malignum (AM)

[1]. Silverberg SG and Hurt WG. Minimal deviation adenocarcinoma (adenoma malignum) of the cervix. Am. J. Obstet. Gynecol. 1975; 23:971-975.
[2]. TA Steeper and MR Wick. Minimal Deviation Adenocarcinoma of the Uterine Cervix (""Adenoma Malignum ‟‟).An lmmunohistochemical Comparison with Microglandular Endocervical Hyperplasia and Conventional Endocervical Adenocarcinoma.Cancer (1986); 58:1131-1138.
[3]. Gilks CB, Young RH, Aguirre P, DeLellis RA, Scully RE .Adenoma malignum (minimal deviation adenocarcinoma) of the uterine cervix. A clinicopathological and immunohistochemical analysis of 26 cases. Am J Surg Pathol(1989);13(9):717-29.
[4]. Mulvany NJ, Monostori SJ. Adenoma malignum of the cervix: a reappraisal. Pathology (1997); 29: 17-20.
[5]. Sugiyama K and Takehara Y. MR findings of pseudoneoplastic lesions in the uterine cervix mimicking adenoma malignum. The British Journal of Radiology (2007); 80: 878–883.
[6]. Dui T, Yamashita Y, Yasunaga T, Fujiyoshi K, Tsunawaki A, Takahashi M et al. Adenoma malignum: MR imaging and pathologic study. Radiology (1997); 204:39–42.
[7]. Umesaki N, Nakai Y, Honda K, Kawamura N, KanaY.Power Doppler Findings of Adenoma malignum of Uterine Cervix.Gynecologic and Obstetric Investigation (1998); 45 (3): 213-216.
[8]. Lee JY, Dong SM, Kim HS, Kim SY, Na EY, Shin MS et al. A Distinct Region of Chromosome 19pl3.3 Associated with the Sporadic Form of Adenoma Malignum of the Uterine Cervix. Cancer Research (1998); 58: 1140-1143.
[9]. Hellier JB. Adenoma Malignum Cysticum Cervicis Uteri. Proc R Soc Med.(1910);3(Obstet Gynaecol Sect):100-3.
[10]. JL.Mckelvey and RR.Goodlin. Adenoma Malignum of the Cervix. A Cancer of deceptively innocent histological pattern. Cancer (1963); 16(5): 549-57.

Abstract: Non surgical therapy remains the cornerstone of periodontal treatment. Clinical trials are still needed to objectively evaluate adjunctive periodontal therapy. Frequent re-evaluation and careful monitoring allows the practitioner the opportunity to intervene early in the diseased state, to reverse or arrest the progression of periodontal disease with meticulous non-surgical anti-infective therapy. Keywords: Host modualation, Periodontal therapy, Lasers.

[1] Shklar G, Carranza FA. Carranza‟s Clinical Periodontology. 10th ed. Elsevier Saunders; 2006.
[2] Ryan ME. Non surgical approaches for the treatment of periodontal disease. DCNA. 2004;49:611-636.
[3] Pihlstrom BL, Mchugh RB, Oliphant TH, Campos CO. Comparison of Surgical and non surgical treatment of periodontal disease – A review of current studies and additional results after 61/2 years. J ClinPeriodontol. 1983;10:524-541.
[4] Claffey N, Polyzois N, Ziaka P. An overview of non surgical and surgical therapy. Periodontology 2000. 2004; 36:35-44.
[5] Page RC. Periodontal therapy: Prospects for the future. J Periodontol. 1993; 64:744-753.
[6] Ishikawa I, Baehni P. Non surgical periodontal therapy- where do we stand now. Periodontology 2000. 2004; 36:9-13.
[7] Jahn AC. Carranza‟s Clinical Periodontology 10th ed. Elsevier Saunders 2006.
[8] Hardy JH, Newman HN, Strahan JD. Direct irrigation and sub gingival plaque. J ClinPeriodontol. 1982; 9:57-65.
[9] Pistorius A, Willerhausen B, Stienmeir EM, Kreissler. Efficacy of sub gingival irrigation using herbal extracts on gingival inflammation. J Periodontol. 2003; 74:616-622.
[10] Ishikawa I, Aoki A. Recent advances in surgical technology. Carranza‟s Clinical Periodontology. 10th ed. Elsevier Saunders; 2006.

Abstract: Surgical endodontic therapy is done when non-surgical endodontic treatment is unsuccessful. Root-end resection is the most common form of periradicular surgery. The procedure involves surgical access or osteotomy to expose the involved area, root-end preparation, root-end resection, periradicular curettage and placement of a suitable root-end filling material. This article reviews the effectiveness of various available, time-tested and newer root-end filling materials including their biocompatibility, sealing ability, anti-bacterial effects and capacity to stimulate regeneration of normal periodontium.

Keywords: endodontic surgery, filling, retrograde, review, root-end

[1] Gutmann and Harrison, Gutmann's surgical endodontics, 1999.

[2] Grossman, Grossman's endodontic practice 12th edition, 2010. [3] R. Niedermann, J.N. Theodosopoulou, A systematic review of in vivo retrograde obturation materials, International Endodontic Journal, 36, 2003, 577-585

[4] Claudio Poggio, Marco Lombardini, Conti Alessandro, Rindi Simonetta, Solubility of Root-end filling materials: A comparative study, Journal of Endodontology, 33(9), 2007, 1094-1097.

[5] Anderson RW, Pashley DH, Pantera EA, Microleakage of amalgambond as retrograde fillings in endodontic therapy, Journal of Endodontology, (9), 1983, 551-553.

[6] B.S.Chong, T.R.Pitt Ford, S.P.Kariyawasam, Short term response to potential root-end filling materials in infected root canals. International Endodontic journal,(30), 1997, 240-249.

[7] Gene Norman Barry, Alan.G.Selbst, Erbert W.D'Anton, Richard M.Madden, Sealing quality of polycarboxylate cements when compared to amalgam as a retro-filling material, Journal of oral medical, oral surgery and oral pathology, 42(1), 1976, 109-116.

[8] Hatem A. Alhadainy, Van T. Himel, Evaluation of the sealing ability of amalgam, Cavit and Glass ionomer cement in the repair of furcation perforation, Journal of oral medicine, oral surgery and oral pathology, 75(3), 1993, 362-366.

[9] John.M.Yaccino, William.A.Walker, David.L.Carnes, William.G.Schindler , Longitudinal microleakage evaluation of Super-EBA as a root-end sealing material, Journal of Endodontics, 25(8), 1999, 552-554.

[10] Ayce Unverdi Eldeniz, Hasan Huseyin Hadimli, Hanife Ataoglu, Dag Orstavik, Antibacterial effect of Selected root-end filling materials, Journal Of Endodontology, 32(4), 2006, 345-349.

Abstract: An endodontic Flare-up is defined as an acute exacerbation of asymptomatic pulpal or periapical pathoses after the initiation or continuation of root canal treatment.Pain may be seen after initiating endodontic treatment for a previously asymptomatic tooth or during the course of treatment or after obturation. Establishing the cause of the flare-up is important to initiate the proper treatment. In the following article, the possible etiological factors and their mechanisms have been explored and discussed.

Keywords: Acute, endodontics, Exacerbation, flare-up, biofilm.y

[1] Iqbal M, Kurtz E, Kohli M, Incidence and factors related to flare-ups in a graduate endodontic programme, International Endodontic Journal, (42), 2009, 99-104.

[2] Morse DR, Koren LZ, Esposito JV, Goldberg JM, Belott RM, Sinai IH et al, Asymptomatic teeth with necrotic pulps and associated periapical radioluscencies: relationship of flare-ups to endodontic instrumentation, antibiotic usage and stress in three different time periods, International journal of Psychosomatic research, (33), 1986, 5-87.

[3] Sathorn C, Parashos P, Messer H, The prevalence of post-operative pain and flare-up in single- and multiple- visit endodontic treatment : A systematic review, Internayional Endodontic Journal, (41), 2008, 91-99.

[4] Dean Baugh, James Wallace, The role of apical instrumentation in root canal treatment: A review of the literature, Journal of Endodontology, 31(5), 2005, 333-340.

[5] J.F.Siqueira Jr, Aetiology of root canal treatment failure: why well-treated teeth can fail, International endodontic journal, (34), 2001, 1-10.

[6] Lin LM, Pascon EA, Skribner J, Gaengler P, Langeland K. 1991, Clinical, radiographic and histopathological study of endodontic treatment failures, Oral surg oral medicine oral pathology oral radiology and endodontics, (71), 603-611.

[7] Siqueira JF Jr, Uzeda M, Fonseca MEL. 1996, Scanning electron microscopic evaluation of in vitro dentinal tubules penetration by selected anaerobic bacteria, Journal of Endodontology, (22), 308-10.

[8] Atlas RM, Principles of microbiology. 2nd edition, 1977, Dubuque, IA, USA, WCB Publishers.

[9] Fabricius L, Dahlen G, Ohman AE, Moller AJR, predominant indigenous oral bacteria isolated from infected root canals after varied times of closure, Scandinavian journal of dental research, (90), 1982, 134-144.

[10] J.F.Siqueira Jr, microbial causes of endodontic flare-ups, International endodontic journal, (36), 2003, 453-463.

Abstract: The appearance of the dentition is of great importance to a large number of people. There is an increase in interest in treatment of tooth staining and discolouration in recent times. Correct diagnosis of the cause of tooth discolouration is important in determining the treatment outcome. In order to make a correct diagnosis and to prevent iatrogenic causes of tooth discolouration, it is imperative that we possess an adequate knowledge of the various sources of tooth discolouration, including those that occur due to the use of certain restorative and endodontic materials. This review article summarises the causes and mechanisms of tooth dicolouration and staining caused by various endodontic materials.

Keywords: discolouration, endodontic, material, staining, tooth.

[1] A.Watts, M.Addy, Tooth discolouration and staining: a review of the literature, British dental journal, 190(6), 2001.
[2] Matheus Souza, Doglas Cecchin, Joao V.B.Barbizam, Jose F.A.Almeida, Alexandre Augusto Zaia, Brenda P.F.A.Gomes, Caio C.R Ferraz, Evaluation of the colour change in enamel and dentine promoted by the interaction between 2% chlorhexidine and auxiliary chemical solutions, Australian Endodontic Journal, 2011.
[3] Akisue E, Tomita VS, Gavini G, Figueiredo JAP. Effect of the combination of sodium hypochlorite and chlorhexidine on dentin permeability and scanning electron microscope observation, Journal of Endodontology, (36), 2010, 847-50.
[4] Basrani BR Manek S, Sodi RNS, Fillery E, Manzur A, Interaction between sodium hypochlorite and chlorhexidine gluconate. Journal of endodontology, 33,2007, 966-969.
[5] Bui TB, Baumgartner C, Mitchell JC. Evaluation of the interaction between sodium hypochlorite and chlorhexidine gluconate and its effect on root dentin. Journal of Endodontology, 34, 2008, 181-185.
[6] Hitesh Gupta, D Kandaswamy, Saru Kumar Manchanda, Sippy Shourie, Evaluation of the sealing ability of two sealers after using chlorhexidine as a final irrigant : An in vitro study, Journal of Conservative dentistry, 16(1), 2013, 75-78.
[7] Kim HS, Zhu Q, Baek SH et al. 2012. The chemical interaction of alexidine and sodium hypochlorite. Journal of endodontics. 38. 112-116.
[8] Bradley Newberry, Shahrokh Shabahang, Neal Johnson, Raydolfo M. Aprecio, Mahmoud Torabinajed, The antibacterial effect of BioPure MTAD on eight strains of Enterococcus faecalis: An in vitro Investigation, Journal of endodontology,33(11), 2007, 1352-1354.
[9] Bjorvatn K, Skaug N, Selvig KA, Tetracycline-impregnated enamel and dentin : duration of anti-microbial capacity, Scandinavian journal of Dental Research, 93, 1985, 192-197.
[10] Tay FR, Mazzoni A, Pashley DH, Day TE, Ngoh EC, Breschi L, Potential iatrogenic tetracycline staining of endodontically treated teeth vis NaOCl/MTAD irrigation : Apreliminary report, Journal of Endodontology, 32(4), 2006, 354-358

Abstract: A study was performed to correlate the relationship between facial form and Maxillary central incisor tooth form among undergraduate dental students in our institution . Forty dental students comprising of 20 males and 20 females were randomly selected as study subjects. Two standardized photograph was taken for each individual ( Facial photograph , intraoral photograph ). Outlines were traced using Adobe photoshop .The mean values were evaluated and results were tabulated. Results failed to prove the Leon William's theory .

Key words: Leon William's theory, toothform, facial form

[1] Textbook of Prosthodontics –Deepak Nallaswamy
[2] Bell RA(1978).The geometric theory of selection of artificial teeth:J Am Dent Assoc97,637-640
[3] Pavan kumar Journal of oral science , A clinical study to evaluate the correlation of facial form and tooth form in indiaVol.54,No.3,273-278,2012
[4] Varajo FM, Nogueria SS Russi Correlation between maxillary central incisor form and face form in 4 racial groups.

Abstract: We operated 126 elderly osteoporotic patients with mean age of 65.5 years who sustained Comminuted Inter-trochanteric femur fracture treated with Cemented Bipolar hemiarthroplasty and Tension band wiring for Greater trochanter through transtrochanteric approach. Mean harris hip score at the mean follow up of 2.92 years was 80.76 and showed a statistically significant improvement as compared to pre-operative scores. Mean blood loss during the mean operative time of 61.35 min was 321 ml. In our case series we came across some serious complications like infection, dislocation, osteolysis, Non-union Greater trochanter, protusio and implant breakage but no fatalities were reported. 5 of our patient underwent repeat surgery in form of Total Hip Replacement and 1 Excision Arthroplasty. From our study we would like to suggest that Cemented Bipolar hemiarthroplasty is a viable technique for elderly osteoporotic patients with Comminuted inter-trochanteric femur fracture with no trauma to abductors or external rotators of hip and sciatic nerve as we approach the hip through the fracture site itself and not posteriorly as in Southern Moore's approach. It also helps in faster rehabilitation and recovery in elderly osteoporotic patients.

Keywords: Inter rochanteric fractures,comminuted, unstable, Elderly osteoporotic, cemented Bipolar, Hemiarthroplasty.

[1]. P. Haentjens, P. P. Casteleyn, H. De Boek, F. Handelberg and P. Opdecam, ―Treatment of Unstable Intertrochanteric and Subtrochanteric Fractures in Elderly. Primary Bipolar Arthroplasty Compared with Internal Fixation,‖ Journal of Bone and Joint Surgery, Vol. 71, No. 8, 1989, pp. 1214- 1225.
[2]. Eiskjaer S, Otsgard SE, Jakobsen BW, Jensen J, Lucht U. Years of potential life lost after hip fracture among postmenopausal women. Acta Orthop Scand 1992. 63(3): 293-296.
[3]. Evans Em- The treatment of trochanteric fractures of femur, J Bone J Surg AM,1949; 31:190-203.
[4]. Marsh JL, SlongoTF, Agel J et al- Fracture and Dislocation Classification compendium, Orthopaedic trauma association Classification, database and outcome committee;J Orthop Trauma 2007, 21:S 1-133 .
[5]. Thomas AP- Dynamic Hip Screw that fails. Injury 1991; 22;45-46.
[6]. Kouvidis G,Katonis P,Kampas D, et al- Dual Lag screw Ceplalomedullary nail versus the classic sliding hip screw For stabilization of inter-trochanteric fractures- A prospective randomized Study.-Strategies Trauma Limb Reconstr. 2012 November; 7(3): 155–162.
[7]. Madsen JE,Naess L,Aune AK et al- Dynamic hip screw with trochanteric stabilization plate in treatment of unstable proximal femoral fractures. Acomparative study with Gamma nail and Dynamic compression screw; J orthop Trauma, 1998:12:241-8.
[8]. Goldhagen PR, O'Connor DR, Schwarze D, Schwartz E- A prospective comparative study of gamma nail and Dynamic hip screw. J ortho Trauma 1994;8;367-72.
[9]. Chan KC, Gill GS- Cemented Hemiarthriolasty for elderly patients with Inter-trochanteric fractures. Clin Orthop relat Res, 2000;371; 206-15.
[10]. Stern MB and goldstein TB. The use of leinbach prosthesis in intertrochantric fractures of hip. Clin Orthop 1977; 128; 325-9.

Abstract: The purpose of this study was to compare the vertical dimensional changes in bialveolar dental protrusion patients undergoing extraction of all four first premolars between the preadjusted edgewise appliance(PEA)(MBT) and the Begg appliance. The cephalometric records of 40 patients with Class I bimaxillary protrusion were selected and devided in two groups i.e Begg or PEA mechanotherapy. The age group of 18-25 years was selected for both groups. Skeletal and dental changes were analysed in both groups on lateral cephalograms taken pre (T1)& post (T2) treatment. A student t-test was used to analyse the treatment changes.

[1]. Ahn J G, Schneider B J 2000 Cephalometric appraisal of post-treatment vertical changes in adult orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics 118: 378–384.
[2]. Barton J J 1973 A cephalometric comparison of cases treated with edgewise and Begg techniques. Angle Orthodontist 43: 119–146
[3]. Bijlstra R 1969 Vertical changes during Begg technique. Transactions of the European Orthodontic Society pp. 385–396
[4]. Chua A L 1993 The effects of extraction versus nonextraction orthodontic treatment on the growth of the lower anterior face height. American Journal of Orthodontics and Dentofacial Orthopedics 104: 361–368.
[5]. Cusimano C, McLaughlin R P 1993 Effects of first bicuspid extractions on facial height in high-angle cases. Journal of Clinical Orthodontics 27:594–598
[6]. Fischer J C 1974 A cephalometric comparison of vertical dimension changes in Begg v/s Edgewise cases during treatment. Thesis, St. Louis University
[7]. Hans M G, Groisser G 2006 Cephalometric changes in overbite and vertical facial height after removal of 4 first molars or first premolars.American Journal of Orthodontics and Dentofacial Orthopedics 130:183–188
[8]. Isaacson J R 1971 Extreme variation in vertical facial growth and associated variation in skeletal and dental relations. Angle Orthodontist 41: 219–229
[9]. James T A 1968 Changes in vertical relationships of teeth during and following use of the Begg light wire differential. American Journal of Orthodontics 54: 152
[10]. Kashani M A, Neishabori A 2003 The effect of quadrilateral first premolar extractions on vertical occlusal dimensions. European Journal of Orthodontics 25: 530–531

Abstract: Periodontal diseases are common chronic inflammatory diseases caused by pathogenic microorganisms which induce elevations of pro-inflammatory cytokines resulting in tissue destruction. Evolution of periodontal diseases is influenced by many local or systemic risk factors. Stress has been suggested as one of them and may negatively influence the outcome of periodontal treatment. The possible relationship between stress and increased susceptibility to periodontal disease is not completely understood.The aim of this review is to provide the relationship between psychological stress and periodontal diseases.

Key Words: Stress, Periodontal diseases, Immune system.

[1] Dorland. Dorland's Illustrated Medical Dictionary. Oxford, UK: WB Saunders, 2000.

[2] Ader RF, Cohen DLN. Psychoneuroimmunology. San Diego, CA: Academic Press, 2001.

[3] Deinzer R, Granrath N, Stuhl H, Twork L, Idel H, Waschul B, Herforth A. Acute stress effects on local Il-1beta responses to pathogens in a human in vivo model. Brain BehavImmun 2004: 18: 458–467.

4] Deinzer R, Hilpert D, Bach K, Schawacht M, Herforth A. Effects of academic stress on oral hygiene – a potential link between stress and plaque-associated disease?JClinPeriodontol 2001: 28: 459–464.

[5] Deinzer R, Kleineidam C, Stiller-Winkler R, Idel H, Bachg D. Prolonged reduction of salivary immunoglobulin A (sIgA) after a major academic exam. IntJPsychophysiol 2000: 37: 219–232.

[6] Deinzer R, Kottmann W, Forster P, Herforth A, Stiller- Winkler R, Idel H. After-effects of stress on crevicular interleukin-1beta. J ClinPeriodontol 2000: 27: 74–77.

[7] Deinzer R, Ruttermann S, Mobes O, Herforth A. Increase in gingival inflammation under academic stress. J ClinPeriodontol 1998: 25: 431–433.

[8] Furukawa H, del Rey A, Monge-Arditi G, Besedovsky HO. Interleukin-1, but not stress, stimulates glucocorticoid output during early postnatal life in mice. Ann N Y AcadSci 1998: 840: 117–122.

[9] Genco RJ. Current view of risk factors for periodontal diseases.J Periodontol 1996: 67: 1041–1049.

[10] Genco RJ, Ho AW, Kopman J, Grossi SG, Dunford RG, Tedesco LA. Models to evaluate the role of stress in periodontal disease.Ann Periodontol 1998: 3: 288–302.

Abstract: Adenomatoid odontogenic tumor(AOT)shows presence many calcifications like tumor droplets, enamaloid, dentinoid and tubular dentin. But this is first case reporting presence of psammoma bodies, which are extracellular calcifications seen in meningeal, ovarian and thyroid tumors. They are believed to be formed because of many different mechanisms. This is report of a case where 15 year old girl presented with swelling on maxilla. Clinically and radiographically it was presented as globulomaxillary cyst. Histopathologically it was proved to be AOT with numerous calcifications. These calcifications were extracellular containing many concentric lines resembling psammoma bodies.

[1] Unal T, Centingul E, Gunbay T, Peripheral Adenomatoid odontogenic tumor: Birth of a term J Clin Pediatr Dent 1995;19:139-142
[2] Phllipsen HP, Birn H. The adenomatoid odontogenic tumor. Ameloblastic adenomatoid tumor or adeno-ameloblastoma. Acta Pathol Microbial Scand 1969; 75:375-398.
[3] Marx and Stern. Odontogenic and nonodontogenic cysts. In: Marx and Stern (eds) Oral maxillofacial pathology A rationale for diagnosis and treatment Chicago: Quintessence 2004:609-612.
[4] Philipsen and Reichart. Adenomatoid odontogenic tumor. In: Philipsen and Reichart Odontogenic tumors and allied lesions. London: Quintessence 2004:105-120
[5] Mendis BRRN, MacDonald DG. Adenomatoid odontogenic tumor: A survey of 21 cases from Srilanka Int J Oral Maxillofac Surg 1990;19:141-143
[6] Toida M, Hyodo I, Okuda T, Tatematsu N. Adenomatoid odontogenic tumor: report of two cases and survey of 126 cases in Japan. J oral Maxillofac Surg 1990; 75:375-398.
[7] Moro I, Okamura N, Okuda S, Komiyama K, Umemura S. The eosinophilic and amyloid-like materials in adenomatoid odontogenic tumor. J Oral Path Med 2006 ; 11(2):138 - 150
[8] Matsumoto Y, Mizoue K, Seto K Atypical plexiform ameloblastoma with dentinoid: adenoid ameloblastoma with dentinoid J Oral Path Med 2001; 30(4):251-254
[9] Evans B, Carr R, Phillipe L. Adenoid ameloblastoma with dentinoid: A case report Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;98 (5):583- 588.
[10] Takeda Y, Shimono M Adenomatoid odontogenic tumor with extensive formation of tubular dentin. Bull Tokyo Dent Coll. 1996 Nov;37(4):189-93. 11. Takeda Y.Induction of osteodentin and abortive enamel in adenomatoid odontogenic tumor. Ann Dent. 1995;54(1-2):61-3.

Abstract: Mediastinal impalement is uncommon and often fatal injury. Patients with this injury has to undergo operative intervention regardless of the hemodynamic status or associated injury . Few cases have been reported in which the patient recovered without any sequelae. We present a case of mediastinal impalement injury in which a metallic foreign body entered through the right 5th intercostal space just lateral to sternal border. The patient became unconscious and then stabilised hemodynamically and neurologically .The foreign body penetrated pleura, lung of right side and right atrium. Right anterolateral thoracotomy was done for its retrieval. Follow-up of the patient was uneventful.

Key words: impalement injury, mediastinum, anterolateral thoracotomy

[1] Hyde MR, Schmidt CA, Jacobson JG, Vyhmeister EE, Laughlin LL. Impalement injuries to the thorax. Ann Thorac Surg 1987; 43:189–90.
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Abstract: Furcal perforation is usually an undesired complication that can occur during preparation of an endodontic access cavities or exploring canal orifice of multirooted teeth. Inadequacy of the repair materials has been a contributing factor to the poor outcome of repair procedures. On the basis of the recent physical and biologic property studies of the relatively new introduced mineral trioxide aggretate, this material maybe be suitable for closing the communication between the pulp chamber and the periodontal tissues. There are few reports on repair of furcal perforation with MTA in molar teeth. The purpose of this case report was to describe the treatment of furcal perforation using MTA in molar teeth. The perforations were cleaned with NaOCl and saline solution, the tooth was endodontically treated and perforation was sealed sealed with MTA and coronally restored with posterior high strength glass ionomer cement and metal veneer crown. After 6 months, the absence of any radiolucency in the furcation area, pain along with functional tooth stability indicated a successful outcome of sealing perforation in 1 case.

Keywords: Iatrogenic furcal perforation, Repair, MTA, Root canal treatment

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Abstract: This is a retrospective study of thyroid patients referred for ultrasound for the period of 2007to 2009 at different hospitals and dispensaries in the Kingdom of Saudi Arabia (Eastern area). Importance of the study is ; to create a reliable reference for the role of ultrasound in thyroid pathologies in King Saudi Arabia. Study aimed to detect the Ultrasonic Differential Diagnosis of Thyroid pathologies. This study was carried out on 303 patients of various types of thyroid diseases in King Saudi Arabia.232 (77 %) were female patients and 71(23 %) were males. Along this series there were 25 % of enlarged thyroid gland which act as the most common ultrasound findings of thyroid disorders followed by, 23 % solitary thyroid nodules, 10 % multinodular goiters, 8 % simple cyst, 7 % nonpalpable thyroid nodules, 4 % goiter and Hashimoto's thyroiditis. The most common ultrasound findings of thyroid gland enlarged of thyroid. The least common is nodal enlargement, adenoma, thyroiditis, microcalcifications, small size thyroid, multiple thyroid nodules, thyroglossal cyst and Graves disease. Out of this study we believe more that ultrasound should be the first-line test owing to its safety and availability.

Keywords- Sonographic ,Thyroid Gland, Thyroid Pathology , Ultrasound.

[1] http://www.thyroid.ca/Guides/HG01.html. [2]http://www.springerlink.com/content/3732n0ewhqb6amd7/

[3]http://jcem.endojournals.org/cgi/content/full/87/5/1938 [4]http://www3.interscience.wiley.com/cgi-bin/abstract/72514684/ABSTRACT
[5] http://www.ajnr.org/cgi/content/abstract/16/5/1117
American Journal of Neuroradiology, Vol 16, Issue 5 1117-1123, Copyright © 1995 by American Society of Neuroradiology.

[6] http://www.springerlink.com/content/4h43yxr7ay7xwna8/

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