bluuebunny/crossref_metadata_2025 huggingface dataset:
A Study on Metal-Ceramic Interface on Metal Base Dental Alloys
Authors: Miculescu Marian , Bane Marin , Miculescu Florin , Ciocan Lucian Toma , Preda Oana , Antoniac Iulian Vasile
Published: March 2015

Although the literature describes many studies that attempt to define and interpret the interaction between the metal component and overlying sintered ceramic mass, researchers still have conflicting opinions. It is not yet fully understood the hybrid layer occurrence phenomenon that rises by diffusion at the sintering temperature between the compositional elements of the alloy and the ceramic mass. Also, there isn’t a standardized technology test for the compatibility between the alloy for this technology and a specific plating ceramic mass, from the strength of the bond between the two components at the interface point of view.This paper aims to present the composition, properties and the interaction between the two materials that participates in obtaining metal-ceramic fixed prostheses, and tries to expose a possible method for analysing the bonding strength and compatibility between dental alloys and ceramic masses. However, the mechanical surface contamination by the migration of the chemical elements it is possible, due to the mechanical stresses during cutting and polishing due to the hardness differences between the prosthesis components.Electron microscopy analysis allows the diffusion phenomenon evaluation and of the fact that the elements with reduced concentration within the ceramic have a higher diffusivity (Al as compared with Si), and that metallic elements diffuse in the ceramic mass. The extent of this interdiffusion is probably the degree of adhesion between the two components of the mixed metal-ceramic crown.
Investigation of the Mechanical Behavior of Mandibular Overdentures Using Finite Element Method
Authors: Vlasceanu Daniel , Marin Mihaela , Petrescu Horia Alexandru , Preoteasa Elena , Gheorghiu Horia Miron
Published: March 2015

The purpose of this paper is to analyze the overdenture fixed on two mandibular implants anchored on staples, determining the behavior of the prosthesis. It‘s consider this ansamble must operate under of occlusal forces present during various functional activities such as mastication proccess. To analyze the stresses induced by masticatory forces on the anchoring system and mandibular overdenture retention using two implants by type staple system, and its displacement, was built, using the finite element method, a three-dimensional numerical model of a mandibular overdenture with mixed support: implant and mucosa. Geometrical model was developed having as reference a real mandibular complete denture that was 3D scanned previously. These images, which contains three-dimensional size of the prosthesis was imported into a CAD program (Computer Analysis Design) for obtaining geometrical model consisting of lines, surfaces and volumes. The numerical model designed examines various cases of arrangement of total prosthesis implant support in relation to the median axis of the mandible in order to determine the best case form for fixing the prosthesis. Numerical analyzes were performed using Ansys software, a program that uses the finite elements method.
Simulation of Bone Mechanical Adaptation in a 3D Model of the Proximal Femur Using the Stanford Strain Energy Density Approach
Authors: Nuțu Emil , Tarcolea Mihai
Published: March 2015

The mathematical theories of bone mechanical adaptation are based on a nonlinear ordinary differential equation which governs the evolution of bone density with respect to the applied loads. If the density distribution achieved within a certain bone model resembles the expected distribution observed in the real bone, then the mathematical theory is usually thought to be suited for such simulations. As test problem, it was extensively used the coronal section of the proximal femur. This section inspired the very creation of the mathematical models following Wolff’s observations regarding trabecular architecture. However, the lack of quantitative data when using the bi dimensional femur model prevents the quantitative validation of the adaptation mathematical models. Using computed tomography is now possible to reconstruct the three dimensional geometry of bones and also to estimate the apparent density based on correlations with the Hounsfield units. This method was already used to quantitatively validate the simulation of bone remodeling into different bones and proved to be efficient. The paper presents the apparent density distributions achieved into the 3D model of the proximal femur by coupling the finite element method with the Stanford bone adaptation equation. The densities obtained in this manner are compared by those determined from the tomographic data of the same bone. The purpose relies on establishing whether the three dimensional end proximity of the femur bone can be used for quantitative validation of remodeling simulations.
Simulation of Bone Mechanical Adaptation Using Different Mathematical Models: A Comparative Numerical Study
Authors: Nuțu Emil , Gheorghiu Horia Miron
Published: March 2015

The adaptation of bones to mechanical loads or bone remodeling can be simulated using specific mathematical models in conjunction with the finite element method. There are several theories proposed within the literature for the prediction of the bone behavior under mechanical loads and all have been used successfully, within certain limits of prediction details, but no unanimous acceptance have been reported yet. Within this context, it is important to know the differences and similarities between the results which these theories can produce, in order to improve their interpretation. On the basics of the above observation, the paper presents the comparison between density distributions achieved using three different models of bone remodeling: the original strain energy density equation developed at the University of Nijmegen, the principle of cellular accommodation incorporated into the Nijmegen model and the variant developed at the University of Manchester obtained by adding the quadric term which eliminates the density accumulation at physiologically unrealistic high loads. It is shown, using a suggestive test problem, that the three models generate significantly different results.
Advanced Polymeric Biomaterials - An Integrated Solution for Plastic, Reconstructive and Aesthetic Surgery
Authors: Jecan Cristian Radu , Filip Cristina Iulia , Răducu Laura , Hernic Daniel
Published: March 2015

Biomaterials have upgraded the field of plastic surgery to an impressive level. In this article attention is focused on the biomaterials that have allowed major advances in plastic, reconstructive and aesthetic surgery and the possible future prospects in this field. Consequently, we highlight surgical applications of polymer biomaterials like silicone, polymethylmethacrylate, polyester, nylon, polyethylene, polypropylene, cyanoacrylate and polytetrafluoroethylene, currently in use all over the world.
Alginate Used to Develop Bio-Inspired Composite Microparticles for Bone Regeneration
Authors: Cecoltan Sergiu , Petre Daniela G. , Stan Eliza Georgeta , Vasile Eugeniu , Cioflan Horia Emil , Istodorescu Mircea , Cristescu Ioan , Marinescu Rodica , Laptoiu Dan , Stancu Izabela Cristina
Published: March 2015

This work describes the synthesis of composite particles for bone regeneration. The developed method is based on a bio-inspired approach starting from the composition, properties and hierarchical organization of bone extracellular matrix (ECM). The composite material was designed as spherical particles able to ensure interconnected porosity through their assembling inside the bone defect. nanohydroxyapatite was generated in the organic matrix in order to mimic the composition and the organization of the mineral phase in bone tissue. A collagen derivative was used as main natural polymer of the organic matrix of the composite material, in order to mimic the composition of bone ECM. Alginate represents the second organic polymer due to its recognized capacity to easily generate spherical particles in divalent cations solutions. The combination of this polysaccharide with the two previously mentioned components simultaneously responds the architectural and compositional constraints of this approach. The particles were obtained using a modular electrostatic bead generator developed in our laboratory. Briefly, a solution containing the biopolymers was extruded into a mineralisation solution. Spherical particles with diameters of about 500 μm were obtained. They were characterised by scanning electron microscopy, X-ray diffraction, stability in aqueous media. The obtained results confirmed the importance of alginate to generate spherical particles and the potential of such materials to successfully serve the targeted application.
Bleeding Disorders – A Frequent Complication Related to the Use of Intrauterine Device with Low Dose Hormonal Mechanism of Action
Authors: Cîrstoiu Monica , Cirstoiu Catalin , Antoniac Iulian Vasile , Munteanu Octavian
Published: March 2015

Due to fact that an intrauterine device with low dose hormonal mechanism of action - the 13.5 mg levonorgestrel-releasing intrauterine system has been just launched in Romania, the undesirable reactions have not been studied and reported. This system has a hormonal mechanism of action, releasing progesterone, with a particular delivering rate of levonorgestrel. Bleeding irregularities are among the very common adverse reactions reported by phase II and III studies. We performed this study in order to determine a profile of bleeding disorders after 2 months of therapy with the 13.5 mg levonorgestrel-releasing intrauterine system.
Correlation between the Used Polymeric Biomaterials, Implant Design and Clinical Performance of the Mammary Implants
Authors: Carantino Andrei
Published: March 2015

Based on different statistics, we could consider that the most frequent operation in plastic surgery is breast surgery with the support of mammary implants. Some women have from the beginning those aesthetic features to seduce the audience but others need some improvements by using artificial implants and surgical techniques to obtain similar results. In the last time, specialists from medicine and engineering try to find out technical solutions to obtain good quality mammary implants using advanced polymeric biomaterials or surface modifying techniques, in order to assure more time lasting for these implants and less reactivity from the human body. Today, the mammary implants are manufactured currently by a silicone elastomer shell filled with cohesive silicone gel or with saline liquid. In this paper we present aspects from our experience in which we operated more than 500 patients who need aesthetic improvements with mammary implants for different clinical situation like breast augmentation, breast reconstruction after oncologic surgery and breast asymmetry.
Esthetic Build-Up Achievement of Dental Ceramics in Posterior Restorations
Authors: Rîcă Radu , Rîcă Ana Maria , Manolea Horia Octavian , Opri Mirela , Stroie Cristina
Published: March 2015

In the past the porcelain building technique was as follows: applying the opaque, building the dentin, layering the enamel and adding the translucent material [1]. But when one talks about dental restorations the only role model to think of is the corresponding natural tooth. The demands of today’s dentists and patients have spurred the authors to seek new ceramic systems [2]. A bioesthetic restoration is only possible when the dental technician bases its build-up technique on precise observations of the natural teeth in order to create the most exact copy possible [3]. The case study here was to try and achieve a high level of esthetic restoration in the posterior area using a complex build-up technique and compare the results with the natural teeth. We have granted sufficient time to analyze the layering of the dentition enamel and translucency and tried to correctly match the surface texture. The technician has focused his attention especially on the occlusal surface because of its morphologic complexity.The conclusion is that a high level of esthetic restoration can be obtained with a very good color match if instructions are followed and close attention to details is being paid. The abrasion and wear over time causes the transparent layer covering the dentin to diminish and easily trick an inexperienced eye. Surface characterization using whitish opaque enamel for the cusp ridges, edges and grooves and the use of individually stained opaque on the metal frame for the natural color impression effect coming from the inside are efficient solutions for achieving close to nature esthetics.
Stimuli Responsive Matrices for Medical Applications
Authors: Dumitriu Raluca Petronela , Pamfil Daniela , Nistor Manuela Tatiana , Vasile Cornelia
Published: March 2015

Different types of stimuli responsive polymers that respond with a property change to a variation in the environmental conditions are an attractive class of materials for advanced applications in biomedical or pharmaceutical fields. Three types of responsive biocompatible and biodegradable polymer matrices are presented as potential biomaterials for medical application as carriers for various drugs and tissue engineering substitutes. Hybrid hydrogels based on collagen/ N-isopropyl acrylamide containing montmorillonite nanoparticles are promising materials for tissue engineering and also as carriers for norfloxacin, a chemotherapeutic antibacterial agent. Semi-interpenetrated hydrogels based either on substituted anhydride modified collagen and 2-hydroxyethyl methacrylate or on alginate and poly (N-isopropylacrylamide) were tested as matrices for the controlled delivery of bisoprolol fumarate, an antihypertensive drug and respectively of ketoprofen, a non-steroidal anti-inflammatory drug.
The Assessment of Enamel Demineralisation by Fluorescent Light in Fixed Orthodontics
Authors: Galuscan Atena , Jumanca Daniela , Podariu Angela C. , Dumitrache Adina , Popovici Ramona A. , Rusu Laura Cristina , Ștefănescu Teodora , Tudor Anca
Published: March 2015

The brackets collating technique and microbial factors increase the risk for enamel demineralization in patients with fixed orthodontic appliance. The aim of this study was to determine the risk level of enamel demineralization in fixed orthodontic device bearers. The enamel demineralization was assessed in 187 patients by measuring dental structure by fluorescent light. The measurements were performed with the DIAGNOdent Pen 2190 (KaVo, Biberach, Germany). Except canines which remain in the risk 1 category, without enamel demineralization, the other investigated teeth may have a medium demineralization degree The values recorded with fluorescent light on canine enamel showed low and insignificant differences (p>0.05) as a result of fixed orthodontic appliances, classifying these teeth as healthy teeth with enamel integrity or with low enamel demineralization. The molars presented significantly increased values in the study group as compared to the control group (p<0.05). 6 years molars had a marked predisposition to demineralization and caries as compared to frontal group teeth, after fluorescent light measurements. The measurements include these teeth in the medium to high risk for dental caries. The DIAGNOdent, due to its capacity to determine the demineralization degree of dental surfaces, may be used to monitor patients and to prevent the occurrence of dental caries during fixed orthodontic treatments.
Cellulose Derivatives Based Membranes for Biomedical Applications
Authors: Voicu Stefan Ioan , Muhulet Alexandru , Antoniac Iulian , Corobea Marijana Simina
Published: March 2015

This paper presents a comparative study of cellulose acetate membranes, respectively nitrocellulose membranes, synthesized under the same conditions for the retention of proteins from aqueous solutions. It has also been studied the hydrodynamic behavior of the membranes, measuring water, respectively ethanol flow rates, and the retention of proteins. The membranes have been characterized by scanning electron microscopy in order to study the morphological differences.
The Use of Bone-Like Materials in Skull Base Traumatology
Authors: Ilea Aranka , Butnaru Anca , Sfrângeu Silviu , Dudescu Mircea Cristian , Câmpian Radu Septimiu , Tombitaș Veronica Elena , Albu Silviu
Published: March 2015

Introduction The mastoid has many functional roles that are well known in the literature. Less studied is the role of the mastoid in kinetic energy absorption during head trauma. The work hypothesis of this study was the question whether the mastoid obliteration with bone-like material plays a role in skull base traumatology during occipital trauma. Materials and methods The study was approved by the Ethics Committee of the University of Medicine and Pharmacy "Iuliu Haţieganu" from Cluj-Napoca and was performed on a formolized cephalic extremity. The calvaria was removed through a horizontal section in the upper third of the lambdoid suture, and the brain was also removed. The mastoid cells of the left temporal bone were removed by external approach. The resulting neocavity was filled with a mixture of calcium carbonate, white gypsum and hydroxyapatite. The mastoid cells of the right temporal bone remained intact. The occipital region of the cephalic extremity was impacted by a spherical object attached to a pendulum arm. Temporal bone fractures were evaluated by CT examination. Results The cephalic extremity was initially impacted at a speed of 3.55 m/s, with a kinetic energy of 56.71 J, which caused a fracture with depression in the occipital region, without causing temporal bone fracture. Subsequently, the same cephalic extremity was impacted at a speed of 4.13 m/s, with a kinetic energy of 76.75 J, which produced occipital comminuted fracture and right petrous apex fracture. Conclusions During the occipital impact on the studied cephalic extremity, the obliterated mastoid may play a higher role in protecting vital structures than the native mastoid.
BMAC-HARVEST: Innovational Method in Osteoarticular Pathology Using Autogenous Stem Cells
Authors: Árpád Sólyom , Ildikó Király , Csaba Benedek , Ors Nagy , Reka Solyom , Voicu Bogdan
Published: March 2015

Introduction: BMAC-Harvest is an innovational method regarding autogenous stem cell treatments in various fields of medicine. In osteoarticular pathology it is used for treating chronic pathology cases as well as acute and traumatic ones. Purpose: The purpose of this study was to represent the clinical and imaging results of the patients presented to the Ist Orthopedic and Traumatology Clinic of Targu Mures. The results were obtained in the period 2012-2014 after using BMAC-Harvest autologous stem cells. Material and method: For this study the authors have included 28 patients from the Ist Orthopaedic and Traumatology Clinic of Targu Mures, suffering from different musculoskeletal pathologies. The method used on these patients was a surgical treatment, which consisted of injecting BMAC-Harvest autogenous stem cells in a unique dosage. The procedure was conducted in the operating room in sterile conditions. These cells were extracted from the iliac crest after appropriate preparation and general anesthezia. Patients were evaluated from a clinical and imaging point of view at periods of 3, 6 and 12 months after treatment. In the evaluation the following aspects were monitorized in the form of questionnaires: level of satisfaction, mobility and the daily activities of patients. The pain intensity of the patients was measured by using the VAS scale (visual analog scale). For imaging representations the authors used standard radiography and IRM in 2 occurrences and have taken into account every sign which appeared after the treatment.Results: The satisfaction level of the patients was significantly increased after the 12th month evaluation compared to results after 3rd month. The pain got considerably reduced and most of the patients could resume their activity from before the treatment. 4 patients have reported mild and medium pain 12 months after the treatment. Conclusion: Autogenous stem cell treatment is an innovational technique with satisfying results for short and medium periods. The BMAC-Harvest autogenous stem cells can be used with clear indications in locomotor organ pathology and it can help in the recuperation of the patient after a trauma. The BMAC-Harvest autogenous stem cells increase the formation of callus after a fracture or pseudoarthrosis. This is an innovational procedure and it can be used successfully in osteoarticular pathology both chronic and acute.
Bisphosphonates vs. Atypical Femur Fractures - Influence on Bone Resorption
Authors: Adam Razvan , Orban Carmen , Gheorghiu Nicolae , Orban Horia , Antoniac Iulian Vasile
Published: March 2015

Bisphosphonates currently represent the main therapy in the fight against osteoporosis. This is a serious condition, with an increasing incidence, presently affecting about 12 million people in the U.S. mostly women aged over 50 years. Thus, approximately 40% -50% of them suffer an osteoporotic fracture. Bisphosphonates mechanism of action consists in reducing osteoclast-mediated bone resorption, modifying bone turn over, leading to an increase in bone density. This dramatically reduces the risk of fracture. Although bisphosphonates shows a good safety profile, lately emerged some alarm signals that link their long management to some unusual side effects. Bisphosphonates is an effective therapy to combat osteoporosis, their causal relationship with FAF production not being shown. In the absence of other evidence, it is unclear whether BF therapy is directly involved in producing FAF or only a component of a combination of factors, in reality being just an indicator of a severe degree of osteoporosis. In the same time, we must not forget that the FAF are very rare compared to the number of patients in therapy with BF and the number of typical femur fractures, and the risk / benefit ratio it is definitely in favor of the benefit.
Failure Analysis of a Metallic Component Used in Hospital Cooling Equipment
Authors: Coman George , Ciuca Sorin , Sohaciu Mirela , Matei Ecaterina , Predescu Andra , Berbecaru Andrei , Predescu Cristian
Published: March 2015

The paper presents the investigations made on samples taken from the related rotor blade of an hospital cooling equipment.The failure analysis was made in order to find if the failure appear because the metallic material used or was functional problem.The objectives of our analysis and techniques used are described below:determining the chemical composition by optical emission spectrometry;determining the hardness of the material;metallographic analysis by optical microscopy;micro compositional and microstructural analysis by scanning electron microscopy (SEM) and by microanalysis, energy dispersive X-ray (EDAX). Research has highlighted the quality of piece elaboration and casting, which led to a long life of its use.
Metallurgical Characterization of the Failed Motor Shaft Component from an Electric Surgical Motor used in Orthopedic Surgery
Authors: Berbecaru Andrei , Ciuca Sorin , Predescu Andrei , Coman George , Sohaciu Mirela , Anton Marius Gheorghe , Predescu Cristian
Published: March 2015

The paper presents the results of research conducted to determine the causes that led to the fracture of a motor shaft component from an electric surgical motor used in orthopedic surgery.The chemical and structural analysis emphasized a structure rich in complex silicate and sulfides inclusions. They form areas of weakness, acting like stress concentrators which induce fatigue shaft breakage. Their high density and non-uniform shape and distribution suggest a non-adequate technology of making and casting of steel, destinated to work in difficult conditions and having an important operational role.
Structural Modification of α-Ti Based Alloy after Submission to Open Flame Thermal Shock
Authors: Istrate Bogdan , Crimu Carmen Iulia , Munteanu Corneliu , Biniuc Carmen , Pintilei Laura Geanina , Strugaru Sorin Iacob , Avram Petru , Earar Kamel
Published: March 2015

Ti alloys are applied extensively in several fields, particularly in the aerospace, chemical, dental and medical industries, due to their outstanding properties. Microstructure changes in commercial-purity titanium (CP-Ti) during open flame thermal shock and X-ray analysis were investigated. Water quenching of compact Cp-Ti has yielded martensitic-type laths and fishbone-type twinned microstructures. The microstructure of cast samples displays a martensitic structure and heat-treated samples shows a microstructure composed of α/α‘phase. Several types of phases and crystallographic lattice were detected using XRD. Samples investigated were supposed to a heating over than 1500°C and cooled in two ways: by air and by water. SEM images are taken in comparison for studying the morphology and microstructure of alloys.
Laser Sinterization Aspects of PA2200 Biocompatible Powder - Spinal Cage Application
Authors: Stoia Dan Ioan , Vigaru Cosmina , Rusu Lucian
Published: March 2015

The paper presents the dimensional aspects of a generic spinal cage build up from PA2200 powder. The cage was manufactured by means of selective laser sintering (SLS) technology, on Formiga P100 machine. The geometric model of spinal cage was designed in SolidWorks by taking into account the requirements that have to be fulfilled by such an implant. The dimensional aspects refer to geometric dimensions along X, Y and Z axes measured on sample parts, when these were placed on a 4x4 matrix on the building plane. The measurements were conducted using a digital caliper having a precision of 0.01, and were presented together with the nominal dimension of the CAD model. In conclusion, some qualitative aspects regarding the setting of the scaling factors were underlined.
Gelatin-PVP Hydrogels with Potential Skin Grafts Applications
Authors: Serafim Andrada , Petre Daniela G. , Moraru Lavinia , Cioflan Horia Emil , Vasile Eugeniu , Mastalier-Manolescu Bogdan , Petrutescu Marius , Stancu Izabela Cristina
Published: March 2015

This work presents the synthesis and characterization of natural-synthetic hydrogels based on gelatin (Gel) and polyvinylpyrrolidone (PVP), with potential for skin grafts applications. The natural component, Gel insures the biocompatibility and biodegradability of the bicomponent system [1], while the synthetic counterpart, PVP, is a physiologic inert component, extensively used in medicine due to its water affinity and due to its capacity of confer elasticity to films and membranes with potential applications in skin grafts [2]. The obtained hydrogels were subjected to morpho-structural analysis and rheological and mechanical tests (traction). The water affinity of the systems was estimated and their capacity to generate porous substrates through freeze-drying was evaluated.
New Flexible Cyanoacrylate Tissue Adhesive Adhflex®: Adhesion and Performance in Inguinal Hernia Repair
Authors: Villarreal-Gómez Ana M. , Martínez-Paíno Manuel , Martín-Martínez José Miguel
Published: March 2015

Sutures and cyanoacrylate high strength tissue adhesives are commonly used for wound closure in several surgical applications. Although effective for closing simple and small incisions, cyanoacrylate adhesives were limited by compromising adhesion and stiffness, i.e. cyanoacrylates with short alkyl chain length showed higher adhesion but lower flexibility than the ones with long alkyl chain length. In this paper, a new concept of flexible and high strength tissue cyanoacrylate based adhesive - Adhflex®- is presented. The balance between adhesion and flexibility in Adhflex® was achieved by adding an inert (i.e. non-reactive) chemical to a short alkyl chain length cyanoacrylate able to partially inhibit its polymerization in presence of moisture. Adhesion properties of Adhflex®were superior as compared to other commercial cyanoacrylate tissue adhesives (i.e. higher traction and shear strength). Furthermore, Adhflex®has been successfully used in a clinical trial for inguinal hernia repair (case study) as the surgery time with respect to suturing was reduced substantially, the comfort of the patient was improved (i.e. reduced tension after surgery, reduced allergic reaction) and the scare was minimal.
The Hybridization of Multi-Walled Carbon Nanotubes with Various Drugs
Authors: Duma Voiculet Adriana , Prodana Mariana , Demetrescu Ioana
Published: March 2015

Functionalized multiwalled carbon nanotubes (MWCNTs) by various groups (carboxyl or amino) can improve the properties of anti-tumoral drugs (cisplatin, docetaxel, zometa). Functionalization was evidenced by infrared spectroscopy (FTIR) and transmission electron microscopy (TEM). Platinum ions released in simulated body fluid (SBF) were measured by inductively coupled plasma ion spectrometry (ICP-MS).
Requirements for reflection in the critical care environment
Authors: Filmalter Celia J. , Heyns Tanya
Published: March 2015

Background: Reflection is recognised as an important method for practice development. The importance of reflection is well documented in the literature, but the requirements for reflection remain unclear.Objectives: To explore and describe the requirements for reflection in the critical care environment as viewed by educators of qualified critical care nurses.Method: A focus group interview was conducted to explore and describe the views of educators of qualified critical care nurses regarding requirements for reflection in the critical care environment.Results: The themes that emerged from the focus group were buy-in from stakeholders –management, facilitators and critical care nurses, and the need to create an environment where reflection can occur.Conclusion: Critical care nurses should be allowed time to reflect on their practice and be supported by peers as well as a facilitator in a non-intimidating way to promote emancipatorypractice development.
A Randomized Controlled Study to assess the Role of Routine Third Trimester Ultrasound in Low-risk Pregnancy on Antenatal Interventions and Perinatal Outcome
Authors: Dhumale Hema , Pujar Yeshita , Revankar Komal Gurunath
Published: March 2015

Objective

To assess the role of routine third trimester ultrasound in low-risk pregnancy on antenatal interventions and perinatal outcome.

Design

Randomized controlled study.

Setting

KLES Dr Prabhakar Kore Hospital and Medical Research Center, Belgaum.

Subjects

A total of 290 low-risk pregnant women between 34 and 37 weeks attending antenatal clinic and fulfilling inclusion criteria were allotted using computer-generated randomization numbers into study and control groups.

Intervention

In study group, third trimester ultrasound was performed to assess fetal growth, amniotic fluid index (AFI), malpresentations, and late onset fetal anomalies. In control group, no routine ultrasound was performed, unless indicated by clinical suspicion during subsequent visits. High-risk fetuses identified were managed as per the standard protocol. All women were followed to assess antenatal interventions, intrapartum events and perinatal outcome.

Results

Detection of high-risk fetuses antenatally in study and control groups was 17.25 and 2.07% respectively. This difference was statistically significant (p = —0.0001). Rates of antenatal interventions among study and control were 24.8 and 4.44% respectively. Prevalence of small for gestational age (SGA) fetuses among study and control was 6.9 vs 11.03% respectively. This difference was not statistically significant (p = —0.253). There was no statistical difference in adverse intrapartum events, cesarean section rate for nonreassuring cardiotocography (CTG), low Apgar score and neonatal intensive care unit (NICU) admissions among study and controls.

Conclusion

Routine third trimester ultrasound is a logical solution for detection of high-risk fetuses in low-risk pregnancies which would otherwise be missed by clinical examination. However, this leads to an increase in antenatal interventions without significantly influencing the perinatal outcome.

How to cite this article

Revankar KG, Dhumale H, Pujar Y. A Randomized Controlled Study to assess the Role of Routine Third Trimester Ultrasound in Low-risk Pregnancy on Antenatal Interventions and Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(3):139-143.
Intrapartum Amniotic Fluid Volume Estimation in Low-risk Pregnancy as a Predictor of Perinatal Outcome
Authors: Jeanet J , Benjamin Santosh Joseph , Mathews Jiji Elizabeth , Rathore Swati , Sebastian Ajit , Thomas Elsy
Published: March 2015

Objectives

The study was undertaken to determine the efficacy of routine estimation of amniotic fluid volume using the amniotic fluid index (AFI) as a means of predicting an adverse perinatal outcome in low-risk pregnancies.

Materials and methods

Five hundred and three singleton lowrisk pregnancies with cephalic presentation between 37 and 40 weeks and 6 days of gestation with intact or ruptured membranes had AFI estimations within 36 hours of delivery.

Results

The frequency of nonreassuring fetal heart patterns and perinatal outcomes among patients with oligohydramnios (<5 cm), borderline oligohydramnios (5 to 8 cm) and normal (>8 cm) liquor were compared and not found to be different. Cesarean section for nonreassuring fetal status was also similar in the three groups.

Conclusion

This study suggests that AFI estimation during labor in low-risk pregnancies does not predict adverse perinatal outcomes. Further studies are needed to verify this impression.

How to cite this article

Jeanet J, Benjamin SJ, Mathews JE, Rathore S, Sebastian A, Thomas E. Intrapartum Amniotic Fluid Volume Estimation in Low-risk Pregnancy as a Predictor of Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(3):156-158.
Surprise in Pandora Box: Spontaneous Intra-abdominal Hematoma in Pregnancy
Authors: Sreedhar Shruthi , Rajeswari KS , Sivasundari M
Published: March 2015

Spontaneous intraperitoneal hemorrhage is a rare medical condition associated with high mortalities. It was first described in pregnancy by Barber in 1909. Approximately in an average of 30% of reported cases, the source of bleeding was not identified. Most patients with spontaneous hemoperitoneum frequently presented with acute abdominal pain and might present a wide variety of other clinical presentations.

How to cite this article

Sreedhar S, Rajeswari KS, Sivasundari M. Surprise in Pandora Box: Spontaneous Intraabdominal Hematoma in Pregnancy. J South Asian Feder Obst Gynae 2014;6(3):171-172.
Recurrent Aggressive Angiomyxoma
Authors: Shetty Prashanth , Sulochana B , Francis Lakra Alma Juliet , Noronha Judith Angelitta
Published: March 2015

Aggressive angiomyxoma is a rare, slow-growing myxoid neoplasm that occurs almost exclusively in the genital, perineal and pelvic regions of adult women. Aggressive angiomyxoma mostly occurs during the reproductive years.1 It carries a high risk for local relapse. Long term follow up of cases is very essential. We describe a case of a 42-year-old woman presenting with a large swelling on the posterolateral aspect of labia major diagnosed to have aggressive angiomyxoma.

How to cite this article

Sulochana B, Francis LAJ, Noronha JA, Shetty P. Recurrent Aggressive Angiomyxoma. J South Asian Feder Obst Gynae 2014;6(3):176-177.
Placenta Percreta: An Unusual Etiology for Spontaneous Rupture of Uterus Near Term
Authors: Varshney Anupam , LNU Neerja , Varma Manju , Thakral RK
Published: March 2015

Uterine rupture is a life-threatening complication in pregnancy with an incidence of 0.07%, out of which 80% are spontaneous rupture. Placenta percreta is the rarest form of placental implantation abnormalities, with an incidence 1 in 2500 pregnant women.1,2 Spontaneous uterine rupture due to placenta percreta is very rare, with an incidence of 1 in 4,366 pregnant women.3 It often occurs in patients with a history of scar in the uterus.4 Placenta percreta-induced spontaneous uterine rupture at term with previous lower segment cesarean section (LSCS) is difficult to diagnose. A 25-year-old pregnant woman, with history of one incomplete abortion treated by dilatation and curettage followed by a vaginal delivery with stillbirth and one LSCS again with stillbirth at term, was admitted in the emergency ward with history of approx 9 months amenorrhea, breathlessness, pain in abdomen (unable to lie down or even sit), vomiting and loss of fetal movements for last 24 hours. O/E: GC fair, afebrile, Pallor +++, pedal edema +, pulse 100/minutes regular, resp. rate; 40/minutes, thoracic, BP 110/70 mm Hg, lung fields clear with no abnormality detected in heart. On P/A: skin was stretched and a Pfannensteil scar healed by primary intention was present Abdomen tense, tender therefore fundal height could not be assessed. Fetal parts were not palpable and lie/presentation could not be made out. FHS were absent. On P/V; os closed with uneffaced cervix, presenting part could not be made out and was high. No bleeding or leaking per-vaginum was present. Hb 6.7 gm%, TLC 15600, DLC P90, L8, E2, M0. Ultrasound done on 27.5.12 (one month back) outside revealed 32.3 weeks gestation with normal scar thickness, placenta located in upper segment, grade I. No comment was made on the interface between placenta and myometrium in ultrasound report.

Patient was subjected to emergency laparotomy, massive hemoperitoneum was found. Examination of uterus revealed an intact previous scar. A full term male stillborn baby was delivered by uterine scar (LSCS) on 21.6.2012, at 10.30 pm The placenta could not be delivered as there was no plain of cleavage between placenta and myometrium. Uterus was exteriorized and to surprise there was a rent of about 3 × 2 cm at left cornua, placental tissue peeping out on removing the clots. Subtotal hysterectomy was performed. Three units blood were transfused. Postoperative period was uneventful and the patient was discharged in satisfactory condition on 9th day. Histopathological examination of the uterine specimen revealed placenta percreta. To conclude uterine rupture should be considered in the differential diagnosis in pregnant women who present with acute abdomen with or without shock.

How to cite this article

Neerja, Varma M, Thakral RK, Varshney A. Placenta Percreta: An Unusual Etiology for Spontaneous Rupture of Uterus Near Term. J South Asian Feder Obst Gynae 2014;6(3):180-182.
Primary Extranodal Hodgkin's Lymphoma presenting with a Single Pelvic Mass
Authors: Kiran Gurkan , Canaz Emel , Sayar Hamide , Serin Salih , Balakan Ozan
Published: March 2015

Introduction

Although lymphomas can arise from a wide variety of tissues, primary extranodal presentation is predominantly a feature of non-Hodgkin's lymphomas. Primary pelvic extranodal Hodgkin's lymphoma is a rare malignancy. We presented a case of primer retroperitoneal Hodgkin's lymphoma initially presumed gynecologic malignancy. We discussed its rarity, staging and management.

Case Report

A 75-year-old woman was referred to our hospital with persisting pelvic mass. Pelvic examination revealed an ill-defined immobile mass with hard in consistency. The mass 100 × 75 mm in diameter, invading right parametrium, perivesical space and bladder wall was detected in CT and there were no signs of metastases or enlarged lymph nodes. Diagnostic laparoscopy was suggested but the patient refused the surgery due to her advanced age. One year later, she presented with the symptoms of fever, sweats and fatigue. Hodgkin's lymphoma was diagnosed via laparoscopic biopsy of the mass located at retroperitoneal space anteriorly to the uterus. CT examination revealed multiple swollen lymph nodes and a pulmonary nodule; thus, stage 4 disease was established. International prognostic score was 2, indicating 67% progression free survival; however, patient died due to respiratory failure after the first course of ABVD chemotherapy.

Conclusion

Although gynecologists rarely experience primary extranodal lymphomas particularly Hodgkin's disease, lymphoid malignancies should be kept in mind in differential diagnosis of pelvic masses. This disease can rarely arise adjacent to gynecologic organs in retroperitoneal space, and this presentation can be misinterpreted as a gynecological malignancy.

How to cite this article

Kiran G, Canaz E, Sayar H, Serin S, Balakan O. Primary Extranodal Hodgkin's Lymphoma presenting with a Single Pelvic Mass. J South Asian Feder Obst Gynae 2014;6(3):183-186.
Acute Pancreas to a Cute Pancreas
Authors: Thirugnanasambandam Ram Prakash , Palaniappan Narayanan , Narayanan CD , Radha Vembu
Published: March 2015

Acute pancreatitis in pregnancy is rare, with the incidence being 3 in 10,000 pregnancies. Its occurrence is of great concern to clinicians as they are dealing with two lives and increased incidence of morbidity.

Here, we report two unique cases of acute pancreatitis in the 3rd trimester. Both presented with symptoms of vomiting and pain abdomen. One patient was a primi at 35 weeks with gestational hypertension on tablet labetalol 50 mg tds, tablet metformin for polycystic ovarian syndrome (PCOS) and thyroxine replacement for hypothyroidism. Her baseline amylase and lipase values were 157 and 475 respectively. She had emergency lower segment cesarean section (LSCS) for severe oligohydramnios. Intraoperative period was uneventful. The second patient was a primi at 34 weeks and 4 days and preterm premature rupture of membranes (PPROM). Her baseline amylase and lipase values were 1449 and 550. Patient was induced with prostaglandin E2 (PGE2) gel and delivered normally. Both patients were managed conservatively with a multidisciplinary team approach.

How to cite this article

Thirugnanasambandam RP, Palaniappan N, Narayanan CD, Radha V. Acute Pancreas to a Cute Pancreas. J South Asian Feder Obst Gynae 2014;6(3):187-190.
A Unique Case of Nonradical Management of Retained Placenta Accreta
Authors: Ghoshal Soma , Mittal Anushree , Manjula BC
Published: March 2015

Retained placenta is a serious cause of postpartum hemorrhage and maternal mortality. The optimal management of placenta accreta remains a topic of debate.

We report here a 37-year-old woman with previous two cesareans and two curettages, with postdelivery retained placenta accreta who was diagnosed properly and underwent successful conservative treatment with hysteroscopic resection, with conservation of uterus.

Placental tissue invasion at the scar site was diagnosed by ultrasound and MRI in a relatively asymptomatic patient. β-hCG value was on lower side and with a differential diagnosis of placental site trophoblastic tumor (PSTT). Hysteroscopic tissue biopsy was done and a ball of tissue approximately 655 cm invading the previous cesarean scar was visualized. Biopsy report came out to be retained placental tissue. Hysteroscopic resection was done with laparoscopic guidance. Patient followup done with repeat ultrasound and β-hCG.

How to cite this article

Ghoshal S, Manchanda R, Manjula BC, Mittal A. A Unique Case of Nonradical Management of Retained Placenta Accreta. J South Asian Feder Obst Gynae 2014;6(3):195-198.
A Case of Amniotic Fluid Embolism Postdelivery: Catastrophe averted Successfully
Authors: Vasanthalakshmi Gonnabaktula Naga , Vijayaraghavan Jaya , Devadason Lalitha
Published: March 2015

Amniotic fluid embolism (AFE) is a rare and often fatal obstetric condition, characterized by sudden cardiovascular collapse, altered mental status, and disseminated intravascular coagulation (DIC). The disease is rare, with an incidence ranging from one in 600 to one in 80,000, perhaps because there is no established laboratory marker diagnostic suitable for both survivors and fatalities alike. We present a case of AFE in a low-risk primigravida which was successfully managed by a multidisciplinary team.

How to cite this article

Mehta P, Devadason L, Vijayaraghavan J. A Case of Amniotic Fluid Embolism Postdelivery: Catastrophe averted Successfully. J South Asian Feder Obst Gynae 2014; 6(3):199-201.
Krukenberg Tumor in Adolescent: A Rare Occurrence
Authors: Nandini G , Umadevi K , Padma K , Uday Rajini
Published: March 2015

Krukenberg tumors classically refer to secondary ovarian malignancy. The primary is mostly from female genital tract, breast and gastrointestinal tract. Krukenberg tumors account for 30 to 40% of metastatic cancers to the ovaries. The average age of occurrence is 45 years. Most of the Krukenberg tumors are histopathological diagnosis done postoperatively. We do report a case of Krukenberg tumor in an adolescent girl.

How to cite this article

Nandini G, Umadevi K, Padma K, Uday R. Krukenberg Tumor in Adolescent: A Rare Occurrence. J South Asian Feder Obst Gynae 2014;6(3):202-204.
Investigations on automatically measured feed intake amount in dairy cows during the oestrus period
Authors: Halli K. , Koch C. , Romberg F.-J. , Hoy S.
Published: March 2015

Abstract. The aim of this study was to determine whether feed intake amount and feed intake behaviour could be related to oestrus in dairy cows. Furthermore, we investigated whether oestrus had an effect on daily milk yield. A total of 138 oestrus cycles, leading to conception of 100 cows, were analysed. The parameters "daily fresh matter intake amount (kg)", "daily number of visits to the feeding trough" and "time spent feeding per day (min)" were electronically measured and recorded. For a sub-quantity of all animals, daily milk yield (kg) was recorded continuously and stored in the herd management software. Special attention was given to the day of oestrus, which was defined as the day of successful insemination. All remaining days of the oestrus cycle were considered as the reference period. Among all animals and cycles, fresh matter intake amount per day, number of visits per day, and time spent feeding per day were reduced by 10.3, 9.1 and 20.8 %, respectively, on the day of oestrus. Fresh matter intake was significantly lower in primiparous cows than in multiparous cows. However, number of visits to the trough and time spent feeding per day were significantly higher in primiparous cows compared to multiparous cows. Day of oestrus did not have a significant effect on daily milk yield, as this parameter was characterized by high variation among all days of the oestrus cycle. In conclusion, if an RIC system is used, monitoring of feeding behaviour appears to be a potential auxiliary aid in oestrus detection.