The frequency of thyroid dysfunction in patients with a diagnosis of depressive disorder

Objective

Thyroid dysfunctions are among the most common endocrine disorders in society. An increase or decrease in thyroid hormone levels may present with neurological and/or psychiatric symptoms. In this study, we aimed both to determine the prevalence of this disorder in our region by determining the frequency of thyroid dysfunction in patients diagnosed with major depressive disorder in our outpatient clinic and to raise awareness during the evaluation process of patients.

Material and Method

Thyroid-stimulating hormone (TSH) levels of 1035 patients diagnosed with major depressive disorder in our hospital between January 2020 and January 2022 were retrospectively scanned from the hospital information management system and those outside the reference ranges (0.38-5.33 mIU/L) were determined.

Results

It was observed that TSH was not within the reference ranges in approximately 7% of the patients diagnosed with depressive disorder. 1035 patients were included in the study. When the blood results of 1035 patients included in the study were examined retrospectively, 32 of them had TSH values below 0.38 mIU/L. TSH value was found to be above 5.33 mIU/L in 44 of them.

Conclusion

Obtained data have shown that thyroid dysfunctions can be encountered frequently in patients presenting with depressive complaints. It is thought that the evaluation of patients with depressive complaints in terms of thyroid dysfunction, and the treatment of the underlying thyroid dysfunction will contribute to the regression of psychiatric symptoms.

Characteristics of maxillary sinus ostia and their correlation with anatomic variations of the osteomeatal complex: Indications for sinus floor elevation

Background

Knowledge of the anatomy and variations of the maxillary sinus is essential for reducing oral surgery complications, such as sinus floor elevation, and increasing surgery success. The CBCT images of 385 patients were examined.

Materials and Methods

The prevalence, localization, and height of PMO (Primer Maxillary Ostium) and AMO (Accessory Maxillary Ostium) were evaluated with respect to sex, dentition, dental treatment, Schneiderian membrane (SM) thickness, concha bullosa, Haller Cells, and septal deviation.

Results

The PMO was present in 87.3% of all patients. Further analysis showed that the mean PMO diameter was 1.42 ± 0.62 mm. Although 11.6% of the PMO was in the inferior region, 60.4% was in the middle and 28% in the superior region. The effect of age and SM on the height and diameter of the PMO was found to be statistically significant. An AMO was present in 20% of the CBCT images. The mean AMO diameter was 2.55 ± 1.25 mm. Although 45.4% of the AMO was in the inferior region, 48% was in the middle and 6.6% was in the superior region. Moreover, SM thickness seemed to influence the height. A significant positive relationship was found between the PMO and AMO height. Also, a significant relationship was observed between the presence of the AMO and septum deviation.

Conclusion

The presence of the AMO, PMO diameter, and height should be added to the preoperative evaluation criteria for the success of sinus floor evaluation. Specifically, sinonasal and demographic conditions should be carefully examined preoperatively for the long-term success of the surgery.

Modulation of cigarette smoke extract-induced human bronchial epithelial damage by eucalyptol and curcumin

Smoking is one of the most important leading death cause worldwide. From a toxicological perspective, cigarette smoke serves hazards especially for the human being exposed to passive smoke. Over the last decades, the effects of natural compounds on smoking-mediated respiratory diseases such as COPD, asthma, and lung cancer have been under investigation, as well as the mechanistic aspects of disease progression. In the present study, the protective mechanism of eucalyptol (EUC), curcumin (CUR), and their combination on BEAS-2B cells were investigated in vitro to understand their impact on cell death, oxidative cell injury, and inflammatory response induced by 3R4F reference cigarette extract (CSE). According to the present findings, EUC, CUR, and their combination improved cell viability, attenuated CSE-induced apoptosis, and LC3B expression. Further, CSE-induced oxidative damage and inflammatory response in human bronchial epithelial cells were remarkably reduced by the combination treatment through modification of enzymatic antioxidant activity, GSH, MDA, and intracellular ROS levels as well as nitrite and IL-6 levels. In addition, nuclear translocation of Nrf2, a regulatory protein involved in the indirect antioxidant response, was remarkably up-regulated with the combination pre-treatment. In conclusion, EUC and CUR in combination might be a potential therapeutic against smoking-induced lung diseases through antioxidant and inflammatory pathways and results represent valuable background for future in vivo pulmonary toxicity studies.

The relationship between neutrophil/lymphocyte ratio and uric acid levels in multiple sclerosis patients

BACKGROUND

In this study, we aimed to determine whether neutrophil / lymphocyte ratio (NLR), obtained by dividing the number of neutrophils by the number of lymphocytes, and uric acid (UA) levels in multiple sclerosis (MS) patients vary compared with healthy controls and to establish correlations among these changes themselves as well as between such changes and MS subtypes, immunomodulatory drug use, the duration of the disease and prognosis.

METHODS

150 patients who presented to our hospital and were diagnosed with MS and 150 healthy volunteers were retrospectively included in our study. EDSS score (Expanded Disability Status Scale) was used to assess the disability of the patients.

RESULTS

Compared to healthy volunteers, MS patients had lower UA levels (p < 0.001) and higher NLR values (p = 0.02). In addition, UA levels were higher in patients with a low EDSS score or those on immunomodulating drugs (p < 0.001, p = 0.04, respectively). NLR value was lower in patients with a low EDSS score (p < 0.001). There was a negative correlation between NLR value and UA (r = ‒0.23, p = 0.003). Similarly, UA level decreased with increasing EDSS score and duration of disease (r = ‒0.38, p < 0.001; r = ‒0.17, p = 0.02, respectively).

CONCLUSION

Evaluating the NLR value, recognized as a new marker for inflammation in MS, together with the UA value, thought to be protective in MS, might be more effective than evaluating these parameters alone in demonstrating disability in patients (Tab. 4, Ref. 28). Text in PDF www.elis.sk Keywords: neutrophil/lymphocyte ratio, uric acid, multiple sclerosis, inflammation, Expanded Disability Status Scale.

Shared decision making in implantable cardioverter-defibrillator patients

Background

Implantable cardioverter-defibrillators (ICD) are effective in the prevention of sudden cardiac death and treating life-threatening arrhythmias. As the number of older patients increases, the number of implanted devices does as well. Evidence for current guidelines is mostly derived from trials conducted decades ago, in selected patient groups. Communicating the risks and benefits of an ICD to patients can be challenging. Shared decision making with the use of a decision aid has proven to result in more active patient participation and improved outcomes in several fields.

Purpose

The aim of our study is to evaluate the effect of an ICD specific decision aid in clinical practice.

Methods

We developed an evidence based decision aid according to the Delphi method. The decision aid was tested in 6 Dutch centres within a stepped wedge clustered randomized trial. We compared pre-procedural counselling with and without the use of a decision aid. Level of shared decision making was measured with the SDM-Q-9 in patients and SDM-Q-doc in caregivers. Additionally, we measured decisional conflict in patients with the decisional conflict scale questionnaire (DCS). This includes a subscore on how informed patients deemed to be. We included a set of 4 knowledge questions in our questionnaire. Differences between scoresbetween groups were analysed using the Mann-Whitney U test or One-way ANOVA. For categorical variables, we used the Chi-square test or Fishers Exact test accordingly.

Results

In total, we retrieved questionnaires from 234 caregivers and 150 patients. The majority of the patients were male (75%) and the mean age was 70±9 years. Levels of shared decision making were marked high in all groups. With the use of a decision aid, caregivers experienced significantly more shared decision making (median 78 (IQR 62–84) versus 81 (IQR 71–87) in the decision aid group (p=0.002)). Patients reported low levels of decisional conflict in both groups. There were also no differences for the subscales of the DCS (median 17 (IQR 6–25) in the control group vs 14 (IQR 5–23) in the decision aid group (p&gt;0.05)). Patients reported to be very well informed (DCS subscale score of 0 in the control group vs 8 with a decision aid, p&lt;0.05), although they answered the knowledge quiz poorly in both settings, with only 1 patient (0.067%) answering all the four question correctly (p&lt;0.05).

Conclusions

Patients and caregivers report high levels of shared decision making. This is likely due to a bias associated with the study design, in which all participating centres were required to conduct elaborate pre-implantation counselling with patients as standard care, which is different from current clinical practice. Despite the implications of an ICD procedure, there was no decisional conflict and patients report to be well informed. This is in spite of low scores on the knowledge quiz. This illustrates the phenomenon of the unconsciously uninformed patient.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Federation of Medical Specialists (SKMS), Utrecht, The Netherlands

Abstract P3-03-10: Pre-operative lymphoscintigraphy for sentinel lymph node localisation: Is it necessary?

Introduction

Sentinel lymph node biopsy (SLNB) has replaced lymph node clearance for staging of the axilla in patients with early invasive breast cancer and no evidence of lymph node involvement on ultrasound or needle biopsy. It is recommended that a dual technique, using isotope and blue dye, is used to locate the sentinel lymph node (SLN) intra-operatively. Often, at the time of radioisotope injection, a lymphoscintigram (nuclear medicine scan) is obtained to demonstrate the 'hot' sentinel lymph node with or without skin marking of its anatomical position.

Performing a lymphoscintigram adds time and cost to the localisation process. In our centre, this investigation costs £899-999 (˜US $1180-1300).

Aims

The aim of this study is to find out whether obtaining a pre-operative lymphoscintigram aids the surgeon in the localisation of the SLN or affects the number of sentinel lymph nodes biopsied in the axillary staging of patients with early invasive breast cancer.

Methods

We carried out a retrospective study of patients who underwent SLNB for breast cancer in our hospital Trust between March 2012 and November 2017. We identified those patients who had a lymphoscintigram performed pre-operatively for SLN localisation. We recorded the number of SLNs identified on imaging and compared this with the number of SLNs biopsied during the operation.

Results

349 patients underwent 354 SLNBs during the study period. One patient was male, the remainders were female. The mean age of patients was 57.2 years (range 25 to 98 years).

In 295 (83.3%) cases, a lymphoscintigram was obtained prior to SLNB for node localisation, and 268 (90.8%) of these scans were able to identify one or more SLNs. In 173 (58.6%) scans, a single SLN was identified. In 27 (9.1%) scans it was either unclear how many SLNs were demonstrated or no SLNs were seen (16/295 no SLN identified, 11/295 unclear how many SLNs).

In 102 (34.6%) cases, the number of SLNs biopsied matched the number of SLNs identified on imaging. Of those that did not match, 76.2% had more and 15.0% fewer SLNs excised than shown on imaging. In 8.8% it was unknown if the number of SLNs matched that seen on imaging due to lack of histopathology results.

Conclusion

Lymphoscintigraphy for SLN localisation is costly and time consuming. In a high proportion of cases, number of SLNs identified on imaging does not match the number biopsied and thus, we suggest, that it is not required prior to SLNB and should be removed from practice.

Citation Format: Clark SL, Yilmaz D, Arun K, Javadzadeh S, Saeed S, Ullah MZ. Pre-operative lymphoscintigraphy for sentinel lymph node localisation: Is it necessary? [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-10.

Outpatient Treatment of Pulmonary Embolism: sPESI Score and Highly Sensitive Troponin may Prove Helpful

Introduction

Despite advances in therapeutic and diagnostic options, acute pulmonary embolism (PE) is associated with high morbidity and mortality. Risk classification is important in deciding how and where to treat patients This study aimed to investigate simplified pulmonary embolism severity index (sPESI) scores and highly sensitive troponin levels to predict 30-day clinical outcomes.

Methods

Patients with the symptoms of dyspnoea, chest pain, and haemoptysis were included in the study. Multiple detector computed tomography (CT) examinations were performed. If the patients' glomerular filtration rate levels were less than 60 ml/min/1.73 m2, then the ventilation/perfusion (V/Q) scan was the preferred imaging modality. Venous blood samples were collected to test for highly sensitive troponin T levels (Elecsys troponin T high sensitive, Roche diagnostics). All patients were examined by two-dimensional bedside echocardiography for detection of right ventricular dilatation. Patients' baseline characteristics (sex, ages, etc.) were recorded along with co-morbidities, symptoms, haemodynamic conditions, all-cause mortality rates during hospitalisation, the duration of hospital stay, radiographic test results, and laboratory findings, and electrocardiography were also obtained during emergency department admission. Primary outcome measure was defined as death in a month. Logistic regression model was created to reveal the associated parameters related to mortality within a month of the emergency department visit.

Results

One hundred and seventy patients suspected of PE underwent either a CT angiogram or pulmonary V/Q scan. In total 70 patients were diagnosed with PE and included in the study. The logistic regression model was created in order to assess poor prognosis markers. In addition to the troponin levels and sPESI scores commonly used for pulmonary embolism prognosis, right ventricular dilatation, heart rate, systolic blood pressure and oxygen saturation using logistic regression models were created. Positive troponin level (odds ratio: 5.23 and 95% confidence interval [CI] 1.03 to 26.51) and negative sPESI score (odds ratio 2.14 and 95% CI 1.00 to 4.60) were found to be significant.

Conclusions

Some scoring systems, including PESI and sPESI score, can be used for predicting mortality in patients with pulmonary embolism. If sPESI score is zero, and troponin levels are negative, the patient can be discharged safely.

Investigation of the effects of propofol and vitamin C administration on erythrocyte deformability in rats with streptozotocin-induced diabetes mellitis

PURPOSE

In the current study we aim to investigate the effects of vitamin C and profol on red blood cell deformability in diabetic rats.

MATERIALS AND METHODS

Twenty- eight Wistar Albino rats were included in the study after streptozocin (60 mg/kg) treatment for 4 weeks of observation for diabetes presence. Twenty-eight rats were allocated to 4 groups. In group DP (n = 7) 150 mg.kg-1 of propofol was injected intraperitoneally. In group DP-vit C (n = 7) rats 100 mg/kg of vitamin C (Ascorbic acid, Redoxon® 1000 mg/5 mL - Roche) were applied one hour before administrating 150 mg.kg-1 of propofol, while rats in control group (n = 7), and diabetic control group (n = 7) received intraperitoneally physiological saline. Deformability measurements were achieved by using erythrocyte suspensions with hematocrit level of 5 % in PBS buffer.

RESULTS

Erythrocyte deformability was significantly higher in diabetic control group than in control and vitamin C plus propofol groups (p = 0.00, p = 0.025, respectively). Erythrocyte deformability indexes were found similar in control group and vitamin C plus propofol group (p = 0.949). Relative resistance was increased in diabetic rat model.

CONCLUSIONS

Erythrocyte deformability was damaged in rats with diabetes. This injury might lead to further problems in microcirculation. Application of propofol did not alter red cell deformability in diabetic rats. Vitamin C supplementation seems to reverse those negative effects and variations in erythrocyte deformability (Fig. 2, Ref. 57).

Asymmetric light propagation in chirped photonic crystal waveguides

We report numerical and experimental investigations of asymmetric light propagation in a newly designed photonic structure that is formed by creating a chirped photonic crystal (PC) waveguide. The use of a non-symmetric distribution of unit cells of PC ensures the obtaining of asymmetric light propagation. Properly designing the spatial modulation of a PC waveguide inherently modifies the band structure. That in turn induces asymmetry for the light's followed path. The investigation of the transmission characteristics of this structure reveals optical diode like transmission behavior. The amount of power collected at the output of the waveguide centerline is different for the forward and backward propagation directions in the designed configuration. The advantageous properties of the proposed approach are the linear optic concept, compact configuration and compatibility with the integrated photonics. These features are expected to hold great potential for implementing practical optical rectifier-type devices.

The evaluation of effects of lornoxicam on blood flow and erythrocyte deformability in comparison with iv paracetamol in rats

BACKGROUND

Lornoxicam and iv paracetamol are commonly preferred to be used for postoperative analgesia. Although Aspirin is a well known non-steroid anti-inflammatory drug that decreases the erythrocyte deformability, there is no study comparing lornoxicam and iv paracetamol regarding their effects on erythrocyte deformability recorded in literature. The aim of this study was to compare the effects of lornoxicam and IV paracetamol on blood perfusion and erythrocyte deformability on rats.

METHODS

Twenty male Wistar Albino rats were randomly divided into three groups as Lornoxicam group (Group L), IV paracetamol group (Group P), and control group (Group C). Intraperitoneal administrations were done in all groups except Group C. Liver and renal blood flows were conducted by laser Doppler and euthanasia was performed via intraabdominal blood uptake. Erythrocyte deformability was measured using a constant flow filtrometer system.

RESULTS

Lornoxicam increased the relative resistance which shows the erythrocyte deformability in rats (p<0.05). The comparison of Groups C and P revealed no statistically different results (p=0.731) while Group L revealed statistically higher results than Group C (p=0.022). No statistically significant differences were found between groups L and P (p=0.073). Liver and renal blood flow values in Group L were just numerically decreased not statistically whilst no statistically significant difference was found between the three groups.

CONCLUSIONS

Lornoxicam have lead to functional disorders related to tissue perfusion as a result of both decreased blood flow and erythrocyte deformability (Fig. 3, Ref. 21). Full Text in PDF www.elis.sk.

Complete clinical recovery of a central pontine and extrapontine myelinolysis delayed onset in a child with acute myeloblastic leukemia

Central pontine myelinolysis (CPM) is a demyelinating disease of the pons often associated with the demyelination of extrapontine areas of the central nervous system. It typically occurs 0.5-7 days after a rapid increment in serum Na level in hyponatremic patients and may lead to death. A 2.5-year-old child with a diagnosis of acute myeloblastic leukemia developed febril neutropenia, diarrhea, gastrointestinal hemorrhage followed by pulmonary aspergillosis. He could not tolerate enteral nutrition. He was given broad spectrum antibiotics and antifungal treatment. Laboratory tests showed electrolyte abnormalities including hyponatremia, hypokalemia and hypophosphatemia in a chronic course. Twenty three days after a rapid correction of hyponatremia (16 mEq/L/24 h) he revealed flask quadriparesis, disphagia, mutism, irregular respiratory pattern and loss of cough and gag reflex. Cranial magnetic resonance showed central pontine and extrapontine myelinolysis. He required mechanical ventilation and then he regained his neurologic functions. He completed chemotherapy protocol and underwent hematopoietic stem cell transplantation. After 2.5 years of the occurrence of CPM he is in completely normal physical and neurological status. CPM is a very severe but rare disorder in children with underlying disease. In the presence of multiple etiologic factors it may reveal a delayed onset and optimum outcome can be seen even in the severe clinical presentation with adequate intensive support.

Appendicular tuberculosis: review of 155 published cases and a report of two cases

PURPOSE

This paper provides an overview of the literature on appendicular tuberculosis (ATB) between 1909 and 2010.

METHODS

We present two cases of primary ATB and a literature review of studies on ATB published in English and accessed via the Pubmed and Google Scholar databases.

RESULTS

One hundred fifty-five published cases of ATB were reviewed, and two patients with primary ATB, treated and followed in our clinic, were reported. The age range of the patients (62 females, 60 males and 33 with unnoted gender) was between 2 and 60 years, with a mean age of 27.1 ± 10.6 years. Of the patients who had applied to hospital, 59 had acute right lower quadrant pain, 46 had recurrent right lower quadrant pain, 19 had generalized pain, and 10 had chronic abdominal symptoms suggestive of subacute intestinal obstruction, while 47 patients were operated on with a diagnosis of acute appendicitis, 24 with recurrent appendicitis, 19 with TB peritonitis, 14 with mass in the right lower quadrant, 13 with subacute intestinal obstruction, and 7 with ATB. While appendectomy was not performed on 4 patients, one or more of the following procedures were done in the other 151 cases: appendectomy, hemicolectomy, ileocecal resection, or cecectomy. Different anti-tubercular treatment regimens with durations varying from 3 weeks to 18 months were applied to 60 patients. During the follow-up period of 3 weeks to 15 years, mortality occurred in 14 patients, sinus in five, and fistula in one patient. Secondary ATB was detected in 86 patients, primary ATB in 50, and no differential diagnosis could be made in 19 cases.

CONCLUSIONS

Tuberculosis is a systemic disease with localized manifestations; therefore, anti-TB therapy must be initiated in any patient whose pathologic specimen reveals tuberculosis.

The effect of clotting factor concentrates on the immune system in HIV-negative haemophilics

Immune abnormalities have been reported in patients with haemophilia. Although infections with HIV and hepatitis viruses contribute to these abnormalities, chronic exposure to extraneous proteins in clotting factor concentrates (CFC) may also play a role. A number of studies suggest that the degree of immunological abnormalities correlates with the amount of intermediate purity CFC administered over time. The purpose of this study was to investigate whether there were cellular and humoral immunological abnormalities in haemophilics receiving intensive factor replacement therapy with intermediate purity CFC. For this purpose 48 severe haemophilics and 33 healthy controls were enrolled in this study. T and B lymphocytes, CD4+ and CD8+ cell counts, CD4/CD8 ratio, natural killer cells, active T cells were studied in prophylaxis group, on-demand therapy group and healthy controls. In the percentages and absolute counts of lymphocyte subgroups, no significant difference was found between three groups. We also investigated serum antitetanus IgG levels in these 48 haemophilics and the controls to evaluate the specific antibody response. Antitetanus IgG levels were significantly lower in haemophilics compared to healthy controls (P < 0.001). Additionally we evaluated the response to tuberculin skin test in 45 of 48 haemophilics vaccinated with BCG. The response to PPD test was significantly lower in haemophilics compared to the controls (P = 0.037). There was no response to tuberculin test, which is the best marker of delayed type hypersensitivity (DTH) reactions in 24% of haemophilics. In conclusion, although there was no significant change in the ratio of CD4/CD8 and lymphocyte subgroups, specific antibody responses and DTH tests were partially impaired in haemophilic patients receiving intermediate purity CFC.

Outcome of primary peritoneal drainage for perforated necrotizing enterocolitis: comparison between laparotomy and drainage

Perforation of the gastrointestinal tract in neonates is still associated with high mortality rates. Laparotomy is usually required to treat gastrointestinal perforation, however peritoneal drainage under local anesthesia has been also described as an alternative mode of treatment. In our institute, laparotomy was the first choice for the management of gastrointestinal perforation in neonates until 1999. Because of the high mortality rates in this group of patients, our policy has since changed to the use of primary peritoneal drainage instead. The aim of this study is to compare the effectiveness of primary peritoneal drainage (PPD) and primary laparotomy (PL) procedures in the management of gastrointestinal perforation due to necrotizing enterocolitis in neonates. Between 1994 - 1998, ten babies with intestinal perforation underwent PL, whereas fifteen newborns with similar findings were treated with PPD between 1999 and 2003. Eight (80 %) of the patients died in the PL group prior to 1999. In the PPD group 8 (53.3 %) of babies required no further treatment and were discharged without any complications. Four (26.7 %) patients in this group needed laparotomy later, and three (75 %) of them survived. In conclusion, we believe that PPD is more effective than PL for the management of perforated necrotizing enterocolitis in neonates. Laparotomy can be used in particularly unresponsive cases after primary peritoneal drainage.

Unusual presentation of brucellosis in a child: acute blindness

In brucellosis, visual impairment due to optic nerve involvement is rare, and acute onset visual loss is an unusual presenting feature. We report a 15-y-old girl who had pancytopenia and who was admitted to our hospital with acute onset of bilateral blindness and fever. There was no light perception, and anterior segment and fundus examination were normal in both eyes. No other abnormal neurological findings were detected. Increased latencies and decreased amplitudes were found in visual evoked potentials. Cranial MR and CT revealed no abnormality. Blood culture was found to be positive for Brucella melitensis. Anti-Brucella treatment and high-dose metil prednisolon were given. Pancytopenia completely resolved 5 d after anti-Brucella treatment, and at the end of the third month her complaints about impaired vision were resolved.

CONCLUSION

Brucellosis may present with uncommon symptoms in children. Physicians, particularly in areas where the disease is endemic, must consider this in differential diagnosis of a child with acute blindness and pancytopenia.

A single institutional experience: is epoetin alpha effective in anemic children with cancer?

The authors aimed to investigate the efficacy of epoetin-alpha on hemoglobin levels and red cell transfusion requirement in children with both hematologic malignancy (HM, n = 27) and solid tumors (ST, n = 14). Epoetin-alpha was given (150 U/kg or 250 U/kg, thrice weekly) for 12 weeks. Epoetin alpha significantly increased the hemoglobin levels at the 2nd and 3rd months of therapy (p <.05). At the 3rd month, the patients required less red cell transfusion. At the dose of 150 U/kg, only three patients with HM, but none of the ST patients, required red cell. However, none required red cell transfusion after 2nd month on epoetin alpha 250 U/kg. Epoetin-alpha administration increases hemoglobin levels and decreases red cell transfusion requirement in children with malignancy.

Clinical evaluation of class II Targis inlays: preliminary results after 1 year

The aim of this study was to evaluate the clinical performance of a new generation of restorative resin, Targis (Vivadent), in class II inlay restorations. Forty class II Targis inlays were placed (18 premolars, 22 molars) in 26 patients (mean age=25.5). All test teeth were vital. All restorations were in occlusion and were placed adhesively using Variolink II high viscosity (Vivadent) in combination with Syntac adhesive system under rubber-dam by the same operator. The restorations were evaluated at baseline and after 6 months and 1 year, according to modified United States Public Health Service (USPHS) criteria by two examiners. The parameters evaluated were: anatomical form, marginal adaptation, marginal discoloration, colour match, surface finish, gingival index and secondary caries. Post-operative sensitivity was determined by direct questioning. Regarding all of the clinical evaluation criteria all 40 inlays exhibited clinically acceptable scores after 1-year evaluation period. Relying on these early 1-year results, the new restorative material (Targis) seems to be promising in class II inlays.

Delays in the diagnosis and treatment of hospitalized patients with smear-positive pulmonary tuberculosis

The aim of present study was to investigate whether there was any delay in the diagnosis and treatment of inpatients with smear-positive pulmonary tuberculosis followed-up in our centre. We reviewed clinical records in February 1999 and identified 134 hospitalized patients with smear-positive pulmonary tuberculosis. Clinical files of the patients were analysed and a questionnaire was completed. Several intervals and delays were calculated. Median application interval was 17.5 days [95% confidence interval (CI) 21.3-32.4 days], median referral interval was 3.5 days (95% CI 6.8-11.4 days), median diagnosis interval was 3 days (95% CI 3.3-4.5 days) and median initiation of treatment interval was 1 day (95% CI 1.1-1.6 days). Patients delay was present in 28.4% of cases. The referral interval was longer than 2 days in 82 patients (institutional delay). Ninety-three patients (69.4%) had delays in the diagnosis and 34 patients (25.4%) had delays in the treatment. There was a doctor's delay in 119 of 134 patients (88.8%) and clinic's delay in 98 patients (73.2%). Our results have suggested that hospitalized patients with smear-positive pulmonary tuberculosis experience several delays. These delays may result in increased risk for transmission of infection. Decrease in the risk of infection for community and medical personal may only be obtained by preventing these delays.

Antioxidant defense systems in newborns undergoing phototherapy

This paper was designed to investigate whether phototherapy is an oxidative stress in newborn infants undergoing phototherapy. A day-light continuous phototherapy was given to jaundiced 20 term and 16 preterm newborns for 72 hours. We measured serum vitamin E and the activities of red blood cell anti-oxidation enzymes (superoxide dismutase, catalase and glutathione peroxidase) before and after 72 h of phototherapy. Serum vitamin E levels were not different before and after 72 h of phototherapy in both preterm and term infants. In several studies, antioxidant enzyme activities have been shown to increase in response to oxidative stresses. In this study, however, the antioxidant enzyme activities in the hemolysate were similar before and at the end of the phototherapy in both preterm and full term. In conclusion, the results of our in vivo study do not confirm the thesis that phototherapy is an oxidative stress in newborn infants. Therefore, phototherapy would preferably seem to be safe and efficient method of treatment for all neonates presenting with hyperbilirubinemia.

Statistical report from Uludag Poison Information Center--34-month experience

Management of poisoned patient requires accurate knowledge of intoxication. Uludaŏ Poison Information Center (UPIC), founded in January 1996, provides acquired information 24 hours a day 7 days a week for physicians and consultants. We received 2270 phone calls since January 1996 till October 1998 and evaluated the cases statistically regarding "distribution of age and gender", "calling time after poison exposure", "source of poisoning", "reason for intoxication" and "source of calls" to reveal the distinguishing features of intoxication. Intoxication was mostly seen between 14-25 years of age (964 cases, 42.46%) and in females (1367 cases, 60.22%). Drugs (1400 cases, 61.67%) were the main source and suicide attempts (930 cases, 40.9%) were the main reason of poisoning. Most of the calls were from healthcare professionals (1347, 59.33%).

Subcutaneous granuloma annulare and IgA-IgG2 deficiency

Subcutaneous granuloma annulare (SGA) is a benign granulomatous disease occurring in childhood, with lesions most commonly located about the elbow, knee and scalp. the etiology of SGA remains obscure. We present a typical case with SGA also showing laboratory findings of IgA and IgG2 deficiency. Histologic findings of the lesions on the scalp were characterized by multiple large foci of complete collagen degeneration with a peripheral pallsade of histiocytes; the foci of degeneration was edematous basophilic. In contrast to current literature, an abnormality in the cellular immune system was not found. However, immune defects (IgA and IgG2 deficiency) related to the humoral immune system were observed.

[Schwannoma (neurilemmoma): a case report]

Neurilemmoma, neurofibroma and neuroma are benign neoplasms of nerve tissue. These arise from components of the peripheral nerves. They are extremely rare within the jaws. Schwannoma or neurilemmoma may occur along the route of any of the peripheral cranial or sympathetic nerves. The source of origin is thought to be the schwann cells. Its appearance in oral and paraoral regions is not rare. Treatment is surgical and the prognosis is excellent. It has no tendency toward recurrence. Our schwannoma case is found noteworthy because of its localisation and subsequent complications and is presented to your concern.