The design of the mini-implant can influence its insertion torque and horizontal pull-out strength. In our findings, the horizontal pull-out strength of all mini-implants placed in the infrazygomatic crest was significantly greater than the orthodontic force applied.

Background/purpose: New modified mini-implants are used in orthodontic practice to reinforce palatal anchorage. The aim of this study was to evaluate the anchorage strengths of palatal mini-implants in terms of their vertical and horizontal pullout strengths. Materials and methods: Thirty palatal mini-implants (2 mm in diameter) of three brands (Absoanchor, Bio-Ray, and Lomas) were manually driven into artificial bone (Sawbones) to a depth of 5 mm. Their vertical and horizontal pullout strengths were measured using a material testing machine. The KruskaleWallis test was used to assess differences among brands (P < 0.05). Results: The pullout strengths of all the brands were significantly greater than routine orthodontic forces. The vertical pullout strength of the Absoanchor mini-implants was the lowest among the tested brands, and the horizontal pullout strengths of the Lomas and Absoanchor mini-implants were significantly higher than that of the Bio-Ray mini-implant. There was no significant relationship between the insertion torque and pullout strength in the vertical or horizontal directions. Conclusion: The pullout strengths of mini-implants were significantly greater than normal orthodontic forces. Moreover, no significant correlation was found between the insertion torque and pullout strength.

Miniplate and screw devices are widely used for fracture repair and fixation of osteotomies. Currently, these miniplate systems are being used as orthodontic treatments for skeletal anchorage. However, despite the widespread use of these treatments, patients are apprehensive when they need to undergo miniplate procedures. Recently, we assessed pain perception using the visual analog scale (VAS) score (0-100 mm) in patients who had undergone miniplate procedures. Thirty miniplates were positioned in the maxilla as skeletal anchors for orthodontic treatment. On the first day after insertion of the fixed orthodontic appliances, the mean VAS score was 36.3 mm. The mean VAS score at 24 hours after insertion of the miniplate was 58 mm. Three months after orthodontic force was applied to the miniplate, the mean VAS scores during eating and speaking gradually decreased to 20 mm and 15 mm, respectively. The mean VAS score at 24 hours after removal of the miniplate was 41.3 mm. Three months after removal of the skeletal anchors, the VAS score decreased to 5 mm. Eighty-eight percent of patients stated that they would be prepared to undergo these new and more efficient treatment modalities in the future. The miniplate system was successfully used in this study as a skeletal anchor, and the patients could endure the pain and discomfort of this orthodontic treatment.

Question: A 76-year-old woman presented to the emergency department with a palpable mass and tenderness in the right lower quadrant of the abdomen for 10 days. The pain was dull, constant, nonradiating, nonmigrating, and associated with loss of appetite. She also had change in bowel habits and pencil-thin stool recently. Her past medical history included hypertension and type 2 diabetes mellitus. There was no history of fever, blood in stools, or weight loss.On physical examination, her vital signs were normal. A tender 7-cm mass without rebound tenderness or guarding was located on the right lower quadrant of her abdominal wall. The remainder of the physical examination was unremarkable. Laboratory studies showed leukocytosis with a shift to the left (a white blood cell count of 17,540 cells/mL with 88.1% segmented neutrophils), normocytic normochromic anemia (hemoglobin, 9.9 g/dL), elevated levels of carcinoembryonic antigen (524.5 ng/mL), and carbohydrate antigen 125 (45.8 U/ mL). A contrast-enhanced computed tomography scan of the abdomen showed a 9-cm heterogeneous enhanced mass involving the ascending colon and cecum, marked pericolic peripheral fat stranding, pericolic lymph nodes, and mesenteric lymphadenopathy (Figure A). The patient underwent a colonoscopy, which revealed a 5-cm protruding mass, ulcerated mucosa with friability, and obstructing the lumen of the colon in the ascending colon (Figure B).What is the diagnosis? See the Gastroenterology web site (www.gastrojournal. org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

Background/purpose: The concept of miniscrews-miniplates has been used in orthodontic practice to reinforce skeletal anchorage. The aim of this study was to evaluate the mechanical strength of miniplates in vertical and horizontal pull-out tests. Materials and methods: The insertion torques and pull-out strengths of 10 miniscrewe miniplate orthopedic sets (five for the vertical and five for the horizontal pull-out tests) within synthetic bone were determined. Each miniscreweminiplate orthopedic set was composed of one miniplate and two 7-mm miniscrews, which were manually driven into the artificial bone. Insertion torque values and the vertical and horizontal pull-out strengths were measured. The Kruskal-Wallis test was used to test for significant differences. Results: The horizontal pull-out strength (mean, 233.1 N cm) was significantly greater than the vertical pull-out strength (mean, 106.8 N cm). The mean peak level of breaking force of the power chain was only 21.9 N cm. There was no significant relationship between the insertion torque and pull-out strength. Conclusions: Successful outcomes were confirmed for the skeletal anchorage concept for orthodontic treatment using miniscrews and miniplates. The mechanical strength of the