Introduction:The design of an appliance for retraction of six anterior teeth using orthodontic mini-implant (OMI) anchorage and sliding mechanics must take into account the position and height of the mini-implant and the height of the anterior retraction hook, we used finite element analysis to examine effective en masse retraction with orthodontic mini-implant anchorage and sought to identify a better combination of the above factors.Materials and methods: Base models were constructed from a measurements given in the Wheeler's dental anatomy book. The center of resistance for the 6 anterior teeth in the base model was calculated. The working archwires were assumed to be 0.019" × 0.025" in stainless steel. The amount of tooth displacement after finite element analysis was measured. Results and conclusions:In low OMI (6 mm) anteriors showed tipping movement. Mid implant condition (8 mm) showed more of bodily movement during retraction as the force passes near or through the CRs of all the six anterior teeth. In high OMI (10 mm) and 0 mm ARH condition, all the six anterior teeth showed intrusion with retraction.

Background:When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations.Materials and Methods:Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery.Results:All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture.Conclusions:Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

No abstract

Editor-We would like to highlight an infrequent but serious adverse effect of tramadol. We report a case of generalized tonic-clonic seizure associated with sympathetic nervous system hyperactivity, which included profuse diaphoresis, tachycardia (HR: 136 beats min 21), hypertension (BP: 160/110 mm Hg), and widespread erythema after the administration of tramadol. A healthy 49-yr-old male was admitted to hospital for management of a fractured humerus. The only medication the patient received was morphine 30 mg followed by oral tramadol 100 mg approximately 40 min before the grand mal seizure. Tramadol can precipitate seizures in epileptic patients 1-3 by lowering the seizure threshold. There have been several case reports of tramadol precipitating a seizure in non-epileptic patients. However, our patient had a more complicated seizure presentation, which included generalized erythema, and profuse sustained diaphoresis. Tramadol increases cerebral serotonin activity by partial inhibition of its uptake, particularly when it is given in combination with other drugs including morphine. This increased serotonin activity can produce serotonin syndrome which is characterized by disorders in cognitive-behavioural, neuromuscular, and autonomic function. 4 5 To qualify for the diagnosis, it has been suggested that a patient should have at least one or two manifestations from each of these functional categories. There is no formal test for the diagnosis of serotonin syndrome. The onset of clinical effects is relatively rapid (minutes to a few hours). Management is discontinuation of the causative agents with supportive treatment and the clinical symptoms and signs usually resolve within 24 h. Hyperthermia should be treated with active cooling. Rigidity, seizures, and agitation should be treated with benzodiazepines. Severe symptoms have been treated successfully with cyproheptadine-a 5-HT2 antagonist.

Objective: The objective of this study was to evaluate the effect of intravenous fluid supplementation in healthy term neonates with non-hemolytic hyperbilirubinemia receiving phototherapy. Study Design: Randomized controlled trial conducted in a tertiary level neonatal care unit of a teaching institute in North Karnataka. Methods: A total of 60 healthy term neonates with non-hemolytic hyperbilirubinemia (total serum bilirubin [TSB] >15 mg/dL [256 ?mol/L]–<25 mg/dL [428 ?mol/L]) were randomized to two groups. Group I (case group, n=30) received 1/3rd the maintenance intravenous fluid in addition to breastfeeding and phototherapy. Group II (control group, n=30) received only breastfeeding and phototherapy. The duration of phototherapy and rate of fall of bilirubin was compared. Results: Both the groups were comparable with respect to mean birth weight, gestational age, gender, mode of delivery, age at admission, admission weight, percentage of weight loss at admission, and TSB at inclusion. There was a significant difference in the duration of phototherapy between the two groups (mean [standard deviation (SD)] Group I, 39.6 [7.8] h and Group II, 45.2 [10.22] h, p<0.05). Percentage of fall in bilirubin was not significant at 4, 12, 48, and 60 h but was significant at 24 and 36 h. Conclusion: Intravenous fluid supplementation in healthy breastfed term neonates with non-hemolytichyperbilirubinemia significantly reduces the duration of phototherapy.