John D. Regan

Retrospective Analysis of Open Apex Teeth Obturated with Mineral Trioxide Aggregate

This study is a retrospective analysis of the outcome of initial nonsurgical root canal treatment of teeth with open apices, obturated with mineral trioxide aggregate when no apical barrier existed. One hundred sixteen patients from a single private endodontic office were treated between 1999 and 2006. Treatments on 144 teeth were completed either in one (92/144) or two visits with an interim calcium hydroxide interappointment medication (52/144). Fifty-four percent (78/144) of the teeth were available for recall (60.3% one visit and 39.7% two visits). The maximum time to recall was 4.87 years. The mean time to recall was 19.4 months. Of the cases recalled for period of 1 year or longer, 93.5% of teeth treated in 1 visit healed, and 90.5% of teeth treated in 2 visits healed.

Infected renal artery pseudoaneurysm and mycotic aortic aneurysm after percutaneous transluminal renal artery angioplasty and stent placement in a patient with a solitary kidney

Endovascular infections after percutaneous transluminal renal angioplasty with stenting (PTRAS) are rarely reported. Because strict longitudinal follow-up of patients undergoing PTRAS is lacking, the true incidence of such complications remains obscure. We report the first case of a patient with an infected renal artery pseudoaneurysm and de novo mycotic aortic aneurysm after PTRAS. This case serves to illustrate several important points, including (1) the retrieval of renal function in patients with renal artery occlusion, (2) the pathogenesis of infection after PTRAS, (3) the diagnosis and management of endovascular infection after percutaneous vascular intervention, and (4) recommendations for periprocedural antibiotic prophylaxis during PTRAS.

Effect of storage media on human periodontal ligament cell apoptosis

The ability of storage media to preserve periodontal ligament (PDL) cell vitality has been previously evaluated. However, the mechanisms by which different storage conditions alter the functional status of PDL cells have not been determined. The purpose of the present study was to investigate, in vitro, the level of programed cell death or apoptosis in a population of PDL cells following storage under different conditions. Primary human PDL cells were plated into 24-well-culture plates and allowed to attach for 24 h. Cells were then exposed for 1 h to milk, Hanks balanced salt solution (HBSS), Soft Wear contact lens solution or Gatorade at room temperature or on ice. Culture medium was used as a negative control. Apoptosis was evaluated at 24, 48, and 72 h after treatment on quadruplicate samples by using the ST 160 ApopTag Fluorescein Direct In Situ Detection Kit. The total number of cells and the total number of apoptotic cells were counted. The results indicated that at 24 and 72 h, PDL treated with Gatorade and the contact lens solution displayed the highest percentages of apoptotic cells when compared with the other treatment groups at room temperature. Overall, cells treated on ice showed significantly lower levels of apoptosis when compared with treatments at room temperature. In conclusion, the results indicated that apoptosis plays a major role in cell death in cells treated with Gatorade and contact lens solutions in comparison to other storage solutions and that storage on ice can inhibit programed cell death.

Clinical significance of cerebrovascular gas emboli during polidocanol endovenous ultra-low nitrogen microfoam ablation and correlation with magnetic resonance imaging in patients with right-to-left shunt

BACKGROUNDnFoam generated by manual agitation of liquid sclerosant with air or gas is routinely utilized to treat refluxing veins. Although generally well tolerated, serious neurological events have been reported. The composition and properties of the foam, including bubble size and gaseous components, may contribute to the potential for microcirculatory obstruction and cerebral ischemia. We tested an ultra-low nitrogen polidocanol endovenous microfoam with controlled bubble size and density and hypothesized that patients at risk due to the presence of middle cerebral artery (MCA) bubble emboli during microfoam injection would not demonstrate evidence of clinical or subclinical cerebral infarction.nnnMETHODSnPatients with great saphenous vein incompetence were treated with ultra-low nitrogen (≤ 0.8%) polidocanol endovenous microfoam injected under ultrasound guidance. Patients with right-to-left shunt were included to evaluate the safety of cerebral arterial bubbles. All patients with MCA emboli detected by transcranial Doppler during endovenous microfoam ablation received intensive surveillance for microinfarction, including brain magnetic resonance imaging and measurement of cardiac troponin-I.nnnRESULTSnMCA bubble emboli were detected in 60 of 82 treated patients; 22 patients had no detectable emboli. Among patients with MCA bubbles detected, 49 (82%) had ≤ 15 bubbles. No patients developed magnetic resonance imaging abnormalities, neurological signs, or elevated cardiac troponin.nnnCONCLUSIONSnPatients treated with foamed liquid sclerosants are commonly exposed to cerebrovascular gas bubbles. In this series of 60 high-risk patients with MCA bubble emboli during or after treatment with ultra-low nitrogen polidocanol endovenous microfoam, there was no evidence of cerebral or cardiac microinfarction. The results of this study cannot be generalized to foams compounded using bedside methodologies, since the composition of these foams is substantially different.

Non-surgical salvage of thrombosed arterio-venous fistulae: a case series and review of the literature.

Attempts to salvage thrombosed hemodialysis arterio‐venous fistulae (AVF) using interventional techniques are not universally performed. Patients often require temporary dialysis catheters pending creation of a new vascular access. We determined the long‐term outcome of interventional (non‐surgical) repair of completely thrombosed AVF in 49 consecutive accesses (22 radio‐cephalic, 1 radio‐basilic, 19 brachio‐cephalic, and 7 brachio‐basilic) referred for an intervention within 48u2003hours of thrombosis. Subjects were 65% male (32), with meanu2003±u2003SD age 63.7u2003±u200313.5u2003years (range 33–91), 51% African‐American (25), 47% Caucasian (23) and 65% had diabetes (32). Overall, 96% (47/49) of thrombosed AVF were salvaged with complications observed in four cases (two extravasations of contrast; two radial artery emboli), with no serious long‐term sequelae. Interventional procedures included 34 venous angioplasties, 11 venous angioplasties with stenting and two combined venous and arterial angioplasties. The primary and secondary patency rates for all salvaged AVF were 50.5u2003±u20038.7%, 72.5u2003±u20037.8% at 1u2003year, and 43.3u2003±u200310%, 55.4u2003±u200312.7% at 2u2003years, respectively. The median estimate to first intervention after the declot procedure was 14.7u2003months. The median estimate for continued function exceeded 23.1u2003months. There was no significant statistical difference in the primary (pu2003=u20030.73) and secondary patency rates (pu2003=u20030.057) for forearm vs. upper arm AVF. We conclude that interventional repairs should routinely be employed to salvage newly thrombosed AVF. The vast majority of these individuals can avoid receiving dialysis catheters or placement of a new dialysis vascular access.

Long‐term outcomes of transposed basilic vein arteriovenous fistulae

The need for reliable, long‐term hemodialysis vascular access remains critical. To determine the long‐term outcomes of transposed basilic vein arteriovenous fistulae (BVT) and their comparability with other vascular accesses, we determined retrospectively the primary and secondary patency rates in 58 BVT and in a total of 58 arteriovenous fistulae (AVF) and arteriovenous grafts (AVG) at a single center. Fifty‐eight BVT were placed in 57 individuals, 69% after prior vascular access failure. Ten BVT failed before initial use and 2 patients expired with functioning accesses before dialysis initiation. In all 58 BVT, 46.8±10.8% functioned at 3 years, with median survival 30.8 months. Limiting analyses to the 46 BVT that were ultimately accessed, 3‐year primary and secondary patency rates were 38.3±7.7% and 56.5±12.6%, respectively. Lower ejection fraction (p=0.054) and greater numbers of prior permanent dialysis catheters (p=0.005) were present in those with failed BVT. Compared with AVF, BVT had similar 3‐year primary and secondary patency rates. The secondary patency rate was significantly better for BVT vs. AVG over the observation period; at 3 years, the rates were 56.5±12.6% vs. 9.1±6.0% (p=0.002), respectively. Basilic vein arteriovenous fistulae are valuable hemodialysis accesses. Although nearly 20% of newly placed BVT will not function before first use, those that are functional have median survivals exceeding 6 years, and 38% will not require intervention within 3 years of initial use.

Infected Renal Artery Pseudoaneurysm and Mycotic Aortic Aneurysm After Percutaneous Transluminal Renal Artery Angioplasty and Stent Placement in a Patient With a Solitary Kidney

Endovascular infections after percutaneous transluminal renal angioplasty with stenting (PTRAS) are rarely reported. Because strict longitudinal follow-up of patients undergoing PTRAS is lacking, the true incidence of such complications remains obscure. We report the first case of a patient with an infected renal artery pseudoaneurysm and de novo mycotic aortic aneurysm after PTRAS. This case serves to illustrate several important points, including (1) the retrieval of renal function in patients with renal artery occlusion, (2) the pathogenesis of infection after PTRAS, (3) the diagnosis and management of endovascular infection after percutaneous vascular intervention, and (4) recommendations for periprocedural antibiotic prophylaxis during PTRAS.