Objective: A powder jet deposition (PJD) process can be used to create a thick hydroxyapatite (HA) layer on the human tooth surface. The purpose of this exploratory trial was to evaluate the safety and efficacy of the hydroxyapatite layer formed by a new dental treatment system for cases of caries, dentin hypersensitivity, or discolored teeth. Methods: A single facility, non-blinded study comparing before and after treatment interventions, without a comparative control, was conducted. A rubber dam was attached to the teeth followed by the application of Vaseline to the gingival margins. Extra-and intra-oral vacuums and a saliva discharge tube were used to spray HA powder over the target site with the PJD equipment. Results: The formation of an HA layer tended to reduce pain on exposure to cold water and air in the cases with caries, and increase brightness and satisfaction in the cases with tooth discoloration. The pain on exposure to air was significantly reduced in the cases with dentin hypersensitivity. PJD was not observed to cause any inflammation of the surrounding gingiva or pulpal symptoms. Conclusions: HA is anticipated to reduce the need for repeat treatment by offering superior compatibility with the tooth substance when compared with other dental materials.

A very elderly age should not preclude a patient from undergoing distal bypass surgery. A history of coronary artery disease, a nonambulatory status, and hypoalbuminemia, along with the Wound, Ischemia, and foot Infection classification for patients with tissue loss, should be carefully considered to obtain the most benefit from distal bypass surgery.

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A 73-year-old man underwent a pylorus-preserving Whipple's procedure for distal cholangiocarcinoma. His postoperative course was complicated by the formation of a pancreatic fistula, which was initially managed conservatively. On postoperative day (POD) 86, he lost 100 ml of blood from the site of the pancreatic fistula. Contrast-enhanced computed tomography (CT) showed a pseudoaneurysm, 12 mm in diameter, in the common hepatic artery. The diameter of the pseudoaneurysm increased to 15 mm on POD 89, so we implanted coronary covered stents to prevent massive bleeding from rupture and to retain hepatic arterial flow. Six days after implantation, computed tomography findings confirmed a thrombosed pseudoaneurysm as well as patent hepatic arterial flow. Follow-up CT 18 months after surgery showed patent hepatic arterial flow. There have been no signs of rebleeding or abnormal liver function.

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