OBJECTIVETo investigate the resistance to cyclic fatigue of maxillary incisors with flared canals restored with different post-and-core materials.

METHODSThirty human maxillary central incisors were assigned randomly to two main groups (non-ferrule and 1-mm ferrule) of 15. Each main group was then divided into 3 groups of 5 specimens and restored with custom cast post-and-core (MPC), resin composite post-and-core (RCP), and resin composite core combined with prefabricated carbon fiber post (FRC), respectively. Every group was subjected to a cyclic fatigue test, and recorded the numbers of load cycles that occurred tooth fracture. All data were analyzed with two-way ANOVA and the Tukey HSD test at alpha = 0.05.

RESULTSFRC revealed significantly higher fatigue strength than the other groups (P < 0.05). Preparing a dentin ferrule increased significantly fatigue resistance (P < 0.05). The favorable (retrieval) fracture pattern of the tested specimens was discovered only in RCP.

CONCLUSIONSUsing FRC may get a long fatigue life in restoring pulpless teeth with flared canals. Dentin ferrule preparation is necessary to enhance resistance of the restorations to cyclic fatigue.

Carbon ; Chromium Alloys ; Composite Resins ; Dental Materials ; Dental Pulp Cavity ; pathology ; Humans ; Materials Testing ; Post and Core Technique ; Tooth, Nonvital ; therapy

A 66-year-old, postmenopausal woman was referred to our hospital because of abnormal breast cancer screening results. A tumor was found in the upper outer part of the left breast. Biopsy revealed papillotubular carcinoma, ER (Allred score total score [TS] 3 = proportion score [PS] 2 + intensity score [IS] 1), PgR (Allred score TS 3 = PS 2 + IS 1), HER2 (2+), fluorescent in situ hybridization 1.1 (negative), and Ki-67 labeling index 15%. In diagnostic imaging, the tumor size was 35 mm. The diagnosis was T2N0M0 Stage IIA, luminal B-like breast cancer. First, letrozole 2.5 mg/day was administered as preoperative hormone therapy. After 2 months of treatment with letrozole, the tumor size had increased to 44 mm and preoperative hormone therapy was discontinued. She was started on preoperative chemotherapy (4 courses of epirubicin plus cyclophsphamide followed by 4 courses of triweekly docetaxel). The tumor size decreased, becoming undetectable. After these preoperative treatments, nipple-sparing mastectomy, sentinel lymph node biopsy, and breast reconstruction with a primary latissimus dorsi flap were performed. As of 3 years and 6 months after the operation, there has been no recurrence. At first, preoperative hormone therapy is performed for Luminal B-like breast cancer as in this case, if the response is insufficient, preoperative chemotherapy after hormone therapy may be a therapeutic option.

Context: Delirium in cancer is often difficult to control and refractory when haloperidol is invalid which is considered standard therapy. We need second and subsequent-line therapy to reduce hyperactivity and not to over-sedation for refractory delirium. Objectives: To investigate the efficacy and safety of continuous subcutaneous infusion chlorpromazine on delirium refractory to first-line antipsychiatric medications in advanced cancer palliative care setting. Method: The study population consisted of patients who received continuous subcutaneous infusion chlorpromazine for delirium at two certified PCU. Primary endpoint was the proportion of patients who showed improvements in delirium severity by Delirium Rating Scale Revised 98 score of less than 13 or decrease from baseline and maintained the ability to communicate coherently by Communication Capacity Scale Item-4 score of 2 or less. Secondary outcome were the Nursing Delirium Screening Scale subscale score, and injection site reactions evaluated according to the Common Terminology Criteria for Adverse Events. These outcome measures were assessed at baseline, 48 hours and 7 days after the start of the study. Result: Among eighty-four patients, sixty were positive responders (71.4%, 95% CI [61–80]). The mean CCS Item-4 scores significantly decreased from the baseline value of 1.48 (range 0–3) to 1.03 (range 0–3) at post-treatment (p<0.001). Grade 2 or higher injection site reactions were observed in 1 patient (1.2%, 95% CI [0–7]). Conclusion: Our study suggested that continuous subcutaneous infusion chlorpromazine could improve refractory delirium symptoms and patients’ communication capabilities. Although most of the skin disorders observed in association with chlorpromazine were mild, their incidence rates were relatively high, suggesting the need for careful monitoring.

Here, we report 3 cases of conservatively treated ischemic colitis with hepatic portal venous gas. In Case 1, an 84-year-old man visited the emergency department because of fatigue, vomiting, and upper abdominal pain. In Case 2, a 72-year-old man was hospitalized for rehabilitation in another hospital following cervical spine trauma. He had diarrhea and mesogastric pain for 2 days and was transferred to our hospital. In Case 3, an 89-year-old woman visited the emergency department because of upper abdominal pain and vomiting. In all cases, we diagnosed the illness as ischemic colitis with hepatic portal venous gas based on computed tomography findings, and the vital signs of all patients were stable. They were treated conservatively. They were able to resume oral intake and were discharged or transferred to another hospital. Hepatic portal venous gas has been considered a poor prognostic sign of severe diseases such as intestinal necrosis. However, recently, reports of cases treated conservatively have been increasing. Conservative treatment may be selected for ischemic colitis associated with hepatic portal venous gas taking into account the patient’s general condition.

A 14-year-old girl (Case 1) with respiratory distress during exercise was referred to our department after a pancreatic mass was detected by computed tomography (CT). Contrastenhanced CT scan showed a low-density mass measuring 2.5 × 2 cm in the body of the pancreas. Low signal intensity was seen on T1-weighted magnetic resonance imaging (MRI) and high signal intensity on T2-weighted MRI. We suspected solid-pseudopapillary neoplasm (SPN) of the pancreas and performed laparoscopy-assisted spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 13. A 15-yearold girl (Case 2) with abdominal pain and fever was referred to our department after an abdominal cystic mass was detected by ultrasound examination. Contrast-enhanced CT showed a 4-cm well-circumscribed mass. Higher signal intensity was seen on T2-weighted MRI. We suspected SPN of the pancreas and performed laparoscopic spleen-preserving distal pancreatectomy. The postoperative course was uneventful, and she was discharged on postoperative day 8. Laparoscopic or laparoscopy-assisted surgery should be considered for SPN of the pancreas.

Primary mesenteric neuroendocrine tumor is extremely rare. Here we describe 2 cases of this disease. Case 1 was a 66-year-old man with a working diagnosis of gastrointestinal stromal tumor or mesenteric tumor who underwent laparoscopic tumor resection. Immunohistochemically, the final diagnosis was primary mesenteric neuroendocrine tumor G1. There has been no recurrence as of 25 months after surgery. Case 2 was an 80-year-old man with a working diagnosis of gastrointestinal stromal tumor or mesenteric tumor who also underwent laparoscopic tumor resection. Immunohistochemically, the final diagnosis was primary mesenteric neuroendocrine tumor G1. This is recurrence-free as of 36 months after surgery. Several cases of primary mesenteric neuroendocrine tumor have been reported, but most have been treated with open surgery. To date, there has been only 1 case of primary mesenteric NET that was resected in a pure laparoscopic procedure. In all 3 cases (including our 2 cases), the largest tumor diameter was 4 cm. It appears that laparoscopic surgery can be used to treat primary mesenteric neuroendocrine tumor of small size (＜ 4 cm) with minimal invasion.