Clinical evaluation of bulk-fill resins and glass ionomer restorative materials: A 1-year follow-up randomized clinical trial in children

Objective

This prospective study aimed to evaluate the clinical performance of different restorative materials in primary molars with class II carious lesions.

Materials and Methods

A total of 160 class II carious lesions (with radiographic involvement of the outer half of dentin) in 30 patients were randomly divided into four groups and restored with a glass ionomer restorative system (Equia™), two different bulk-fill composites (Sonicfill™ and X-tra fil™), and a nanohybrid composite (Filtek Z550™). The restorations were clinically and radiographically evaluated at the baseline, and 3, 6, and 12 months according to the modified United States Public Health Service criteria. Statistical analyses were performed using Pearson's Chi-square and McNemar tests.

Results

After 1 year, 134 restorations were evaluated in 26 patients. Equia was statistically less successful than the other restorative materials in marginal adaptation and retention criteria (P < 0.05). However, no material was found to be superior to the others over the study period in marginal discoloration, color matching, secondary caries, anatomical form, and postoperative sensitivity (P > 0.05).

Conclusion

The bulk-fill and conventional composites exhibited good clinical performance, and Equia exhibited minor changes over the 1-year trial period.

Imatinib response of gastrointestinal stromal tumor patients with germline mutation on KIT exon 13: A family report

Familial gastrointestinal stromal tumor (GIST) is a rare autosomal dominant disorder associated with mutations in the KIT gene in the majority of cases. Although, exon 11 appears to be the hot spot region for approximately 95% of germline mutations, pathogenic variations have also been identified in exon 8, 13 and 17. Exon 13 germline mutations are extremely rare amongst familial GISTs and seven families with a germline mutation have been reported to date. Moreover, the role of imatinib mesylate in this rare familiar settings is not completely known so far. We describe here clinical, imaging, pathological and genetic findings of a family with four affected members; grandmother, his son and two grand-sons having a germline gain-of-function mutation of KIT in exon 13 and discuss the imatinib mesylate treatment surveillance outcomes towards disease management.

Electrophysiological evaluation of cremasteric reflex in experimental testicular torsion

AIM

The aim of the study was the electrophysiological evaluation of the cremasteric reflex after experimental testicular torsion.

MATERIAL AND METHODS

Ten male Wistar rats were enrolled into the study. Genitofemoral nerve (GFN) motor conduction and cremasteric reflex (CR) responses were evaluated electrophysiologically after being subjected to anesthesia with intramuscular ketamin hydrochloride. Testicular torsion was performed by rotating the right testicle 720 degrees in a clockwise direction from a midscrotal incision. Electrophysiological evaluations were repeated in the early (30 minutes) and late (90 minutes) periods of testicular torsion. Subsequently, detorsion of the testicles was performed and electrophysiological recordings were completed after 60 minutes of detorsion. The CR was also evaluated clinically before each electrophysiological evaluation. The latency and duration of GFN motor conduction and CR responses was compared for base, early torsion, late torsion and detorsion recordings. Friedman's test for repeated measurements was used for statistical analysis.

RESULTS

The CR, which was detected clinically before torsion and after detorsion, was not detected during torsion. When base, early torsion, late torsion and detorsion recordings were compared, there was no statistical difference with respect to both latency and duration of GFN motor conduction and CR responses (p > 0.05).

CONCLUSION

Although CR was not detected clinically during testicular torsion, the electrophysiological parameters of the reflex did not differ in the early and late periods of torsion in rats. The GFN motor conduction parameters also showed no differences. In conclusion, the absence of the CR after testicular torsion could not be confirmed by electrophysiological studies.

A double-blind comparison of intrathecal S(+) ketamine and fentanyl combined with bupivacaine 0.5% for Caesarean delivery

BACKGROUND

In this prospective, randomized, double-blind, controlled study, we investigated the sensory, motor and analgesic block characteristics of S(+) ketamine, fentanyl and saline given intrathecally (IT) in addition to 0.5% plain bupivacaine (10 mg) for spinal analgesia.

METHODS

Ninety ASA I or II adult patients undergoing Caesarean section were randomly allocated to receive 1.0 mL of 0.9% saline in Group S (n = 30), 0.05 mg kg-1 of S(+) ketamine (1.0 mL) in Group K (n =30) or 25 microg (1.0 mL) of fentanyl in Group F (n =30) following 10 mg of plain bupivacaine 0.5% IT. We recorded onset and duration of sensory and motor block, time to reach the maximal dermatomal level of sensory block and duration of spinal analgesia.

RESULTS

The onset time of sensory and motor block was significantly shorter in Groups K and F than in Group S (P < 0.014). Their duration was significantly longer in Group F than in Groups K and S (P < 0.009). The time to reach the maximal dermatomal level of sensory block was significantly shorter in Groups K and F than in Group S (P < 0.001). The duration of spinal analgesia was significantly longer in Group F than in Groups K and S (P < 0.001).

CONCLUSION

In patients undergoing Caesarean section with spinal analgesia, the addition of S(+) ketamine (0.05 mg kg-1) IT to 10 mg of spinal plain bupivacaine (0.5%) led to rapid onset of both sensory and motor blockade and enhanced the segmental spread of spinal block without prolonging the duration of spinal analgesia, whereas fentanyl provided prolonged analgesia.

An investigation of the factors that affect surgical hand disinfection with polyvidone iodine

This study investigated the factors influencing the effectiveness of 7.5% polyvidone iodine as a surgical antiseptic. The study involved 100 operating staff (75 doctors and 25 nurses) from hospital surgical teams. Fingertips of both hands of the subjects were pressed on to agar culture before and after washing and after completion of surgery. Handwashing lasting for more than 3 min led to a significant decrease in the number of colonies compared with handwashing lasting for less than 3 min. Moreover, the number of colonies was significantly higher when surgery lasted for longer than 95 min. However, the handwashing style (with or without brushing) was not found to have a significant effect on the outcome of the disinfection procedure in terms of bacterial colonization. Subjects who had colonization of their hands after surgery were found to have significantly higher colony counts before handwashing compared with those who did not have any colonization on their hands after surgery. The results of this study revealed that in order to attain effective disinfection with polyvidone iodine, the duration of handwashing should be at least 3 min. The risk of recolonization increases when the duration of surgery exceeds 95 min.

A comparative study of continuous positive airway pressure (CPAP) and intermittent positive pressure ventilation (IPPV) in patients with flail chest

INTRODUCTION

The role of non-invasive positive pressure ventilation delivered through a face mask in patients with flail chest is uncertain. We conducted a prospective, randomised study of continuous positive airway pressure (CPAP) given via a face mask to spontaneously breathing patients compared with intermittent positive pressure ventilation (IPPV) with endotracheal intubation (ETI) in 52 patients with flail chest who required mechanical ventilation.

METHOD

The 52 mechanically ventilated patients were randomly divided into two treatment groups: the ET group (n = 27) received mechanical ventilation with ETI, whereas patients in the CPAP group (n = 25) received CPAP via a face mask with patient controlled analgesia (PCA). Major complications, arterial blood gas levels, length of intensive care unit (ICU) stay and ICU survival rate were recorded.

RESULTS

Nosocomial infection was diagnosed in 10 of 21 patients in the ET group, but only in 4 of 22 in the CPAP group (p = 0.001). Mean PO(2) was significantly higher in the ET group in the first 2 days (p<0.05). There were no significant differences in length of ICU stay between groups. Twenty CPAP patients survived, but only 14 of 21 intubated patients who received IPPV (p<0.01).

CONCLUSION

Non-invasive CPAP with PCA led to lower mortality and a lower nosocomial infection rate, but similar oxygenation and length of ICU stay. The study supports the application of CPAP at least as a first line of treatment for flail chest caused by blunt thoracic trauma.

Investigation of OH-proline contents of hernia sacs in children and comparison with adults

PURPOSE

One of the factors suggested to be causative in hernia formation is defective collagen metabolism. In this study, we investigated whether there is any relationship between the collagen contents of indirect hernial sacs and certain demographic and anatomic parameters.

METHODS

Hernial sac hydroxyproline levels were measured in 100 pediatric and 23 adult indirect inguinal hernia cases as indicators of collagen concentrations. Hydroxyproline levels were compared between boys and girls, right and left sided hernias, unilateral and bilateral cases, children and adults. Whether there was any relationship between patient age and hydroxyproline level was also investigated.

RESULTS

No difference was found between males and females (p > 0.05), right and left sided hernias (p > 0.05) or unilateral and bilateral cases (p > 0.05). Hydroxyproline levels of adults were found to be significantly higher than those of children (p = 0.000). There was also a positive correlation between age and hydroxyproline levels of boys (r = 0.285, p = 0.023).

CONCLUSION

Although a relationship between direct inguinal hernia and collagen structure has been shown by some investigators, we were unable to point to any significant findings which would indicate such a relationship in indirect inguinal hernia cases. Further studies on hydroxyproline levels in peritoneal samples will be necessary to understand the role of peritoneal hydroxyproline levels in hernia formation.

Computed tomographic evaluation of lumbar spinal structures during traction

In the previous studies, it is reported that traction diminishes the compressive load on intervertebral discs, reduces herniation, stretches lumbar spinal muscle and ligaments, decreases muscle spasm, and widens intervertebral foramina. The aim of this study was to evaluate the effects of horizontal motorized static traction on spinal anatomic structures (herniated area, spinal canal area, intervertebral disc heights, neural foraminal diameter, and m.psoas diameter) by quantitative measures in patients with lumbar disc herniation (LDH). At the same time the effect of traction in different localizations (median and posterolateral herniation) and at different levels (L4-L5 and L5-S1) was assessed. Thirty two patients with acute LDH participated in the study. A special traction system was used to apply horizontally-motorized static lumbar traction. Before and during traction a CT- scan was made to observe the changes in the area of spinal canal and herniated disc material, in the width of neural foramina, intervertebral disc heights, and in the thickness of psoas muscle. During traction, the area of protruded disc area, and the thickness of psoas muscle decreased 24.5% (p = 0.0001), and 5.7% (p = 0.0001), respectively. The area of the spinal canal and the width of the neural foramen increased 21.6% (p = 0.0001) and 26.7% (p = 0.0001), respectively. The anterior intervertebral disc height remained unchanged with traction however the posterior intervertebral disc height was significantly expanded. This study is the first to evaluated in detail and quantitatively the effect of motorized horizontal lumbar spinal traction on spinal structures and herniated area. According to detailed measures it was concluded that during traction of individuals with acute LDH there was a reduction of the size of the herniation, increased space within the spinal canal, widening of the neural foramina, and decreased thickness of the psoas muscle.

Can computed tomography scout radiography replace plain film in the evaluation of patients with acute urinary tract colic?

PURPOSE

To determine the sensitivity of computed tomography (CT) scout view in detecting ureteral stones and whether CT scout radiography can replace plain film in the evaluation of patients with acute urinary tract colic.

MATERIAL AND METHODS

Between January 2000 and 2002, 110 patients with ureterolithiasis were prospectively evaluated for the detection of ureteral stones on CT scout radiographs. The findings were compared with those of plain films. All patients were examined with plain film, CT scout radiography, and unenhanced helical CT. CT scans were performed within 24 h of plain films. Each CT scout radiograph was interpreted without knowledge of the findings on plain film.

RESULTS

111 stones were detected by unenhanced helical CT. Mean stone size was 3.9 mm (range 1-10 mm). Of all stones, 57 (52%) were visible on plain film; 44 (40%) were seen on CT radiographs. The sensitivity of 79 small stones (< 5 mm) on CT scout radiography was 29% and of abdominal radiography 37%. For 32 big stones (> 5 mm), the sensitivity of CT scout radiography was 66% and of abdominal radiography 87.5%.

CONCLUSION

In this study, plain film was more sensitive than CT scout radiography in revealing ureteral calculi. However, the detection of stones 5 mm or larger had a sensitivity of 66% on CT scout radiographs; 77% (44/57) of the stones visible on plain films were also seen on CT scout radiographs. We therefore believe that CT scout radiography can be used as a baseline study in most patients with big ureteral stones.

[Spontaneous rupture of mediastinal cystic teratoma (case report)]

Teratomas are rare tumors in the mediastinum. Benign cystic teratomas of anterior mediastinum are rarely complicated by rupture into an adjacent body cavity. Such rupture, however, is usually associated with life-threatening complications. We present a case with spontaneous rupture of mediastinal cystic teratoma. The patient was evaluated with chest radiograph, computed tomography (CT) and magnetic resonance imaging (MRI). A complex mass including predominantly cystic components was detected in the left anterior mediastinum. After surgery, pathologic diagnosis was reported as mature cystic teratoma. High levels of amylase and lipase were detected in both the cystic fluid and serum. This finding supported the hypothesis of autolysis for the explanation of rupture. In addition, carbohydrate antigen (CA) 19-9, CA 125 and carcinoembryonic antigen (CEA) levels were high in the cystic fluid.

Acute Ureterolithiasis: Incidence of Secondary Signs on Unenhanced Helical CT and Influence on Patient Management

AIM

The purpose of this study was to determine the incidence of secondary signs associated with ureteral stones on unenhanced helical computed tomography (CT) of patients with acute renal colic, and to correlate these with patient management and outcome.

MATERIALS AND METHODS

One hundred and ten patients with ureterolithiasis were evaluated prospectively for the secondary signs of obstruction on unenhanced helical CT. Our attention was focused primarily on the presence or absence of seven secondary signs on unenhanced helical CT, including hydronephrosis, unilateral renal enlargement, perinephric oedema, unilateral absence of the white pyramid, hydroureter, periureteral oedema and lateroconal fascial thickening.

RESULTS

Of the 110 patients, 91 (82.7%) had hydroureter, 88 (80%) had hydronephrosis, 65 (59%) had periureteric oedema and 63 (57.2%) had unilateral renal enlargement. Ninety stones passed spontaneously and 21 required intervention.

CONCLUSION

Secondary signs of urinary tract obstruction are useful and supportive findings in interpretation of the CT examination. In our experience, the most reliable signs indicating ureteral obstruction are hydroureter, hydronephrosis, periureteral oedema and unilateral renal enlargement, respectively. In addition, stones larger than 6 mm, located within the proximal two thirds of the ureter, and seen associated with five or more the secondary signs of obstruction, are more likely to require endoscopic removal and/or lithotripsy.

Incidental Bilateral Leydig Cell Tumor of the Testes

Testis tumors are extremely rare tumors, especially if they are bilateral, interstitial tumors. We present a case with bilateral Leydig cell tumors, which were detected incidentally. First, radical left orchiectomy was performed and pathologic diagnosis was Leydig cell tumor. One week later, partial right orchiectomy was done. The diagnosis was the same. After the 12-month follow-up, no recurrence or metastasis was detected. We suggest organ-sparing surgery as an alternative in the treatment of bilateral Leydig cell tumors especially for young males, since this surgical approach prevents hormonal replacement therapy and maintains fertility and potency.

[Case report: Sublingual dermoid cyst]

Dermoid and epidermoid cysts are developmental lesions that occur in the head and neck with an incidence ranging from 1.6 to 6.9%, and they represent less than 0.01% of all oral cavity cysts. We present a case of sublingual dermoid cyst in a 19-year-old male with ultrasound and MRI features and review the literature.

Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis

Clinical diagnosis of appendicitis is usually made on the basis of history, physical examination and laboratory studies. Approximately 30-45% of patients with suspected appendicitis present with atypical clinical and laboratory findings. Recently graded compression ultrasound and thin section unenhanced helical CT have been used to establish diagnosis for patients with suspected acute appendicitis. The purpose of this study was to determine the diagnostic accuracy of thin section unenhanced helical CT protocol in adult patients with suspected acute appendicitis. CT scans obtained when patients presented with right lower quadrant pain and the clinical impression was equivocal for appendicitis were evaluated. Of 296 patients referred for CT, 123 patients subsequently underwent surgery. Appendicitis had been correctly predicted in 104 of 108 patients surgically proven to have appendicitis. Unenhanced helical CT in the diagnosis of acute appendicitis had a sensitivity of 96%, specificity of 98%, positive predictive value of 97% and negative predictive value of 98%. If no definite inflammatory changes are detected, on the basis of our experience we recommend that the patient be monitored clinically, and that thin section unenhanced helical CT is the optimal technique to detect acute appendicitis in adult patients.

A comparative study on the analgesic effect of tramadol, tramadol plus magnesium, and tramadol plus ketamine for postoperative pain management after major abdominal surgery

BACKGROUND

We tested whether, after major abdominal surgery, the addition of magnesium or ketamine to tramadol for intravenous (IV) patient-controlled analgesia (PCA) improved analgesia and lowered pain scores, compared to a PCA containing only tramadol.

METHODS

Sixty-six patients were allocated randomly to receive a PCA with tramadol alone (T), tramadol plus magnesium (TM) or tramadol plus ketamin (TK), in a double-blind randomized study. Postoperative analgesia was started when the verbal rating scale (VRS) score was 2 or more. Following a loading dose of the study solution (which contained 1 mg/kg tramadol), a background infusion of 0.4 mg/kg/h was started. Patients were allowed to use bolus doses of 0.2 mg/kg every 20 min without a time limit. Discomfort, sedation, pain scores, total and bolus PCA tramadol consumption, and side-effects, were recorded for up to 24 h after the start of PCA.

RESULTS

Pain and discomfort scores were lower (P < 0.01) in groups TM and TK at 15, 30, 60 and 120 min than in group T. The addition of magnesium or ketamine significantly reduced the consumption of tramadol at 6, 12 and 24 h (P < 0.01). The incidence of nausea did not differ between the groups.

CONCLUSION

Adding magnesium or ketamine to tramadol improved analgesia and patient comfort and decreased the amount of tramadol required for postoperative pain management after major abdominal surgery.

Mesenteric panniculitis associated with abdominal tuberculous lymphadenitis: a case report and review of the literature

Mesenteric panniculitis is a rare disease characterized by chronic non-specific inflammation of the mesenteric adipose tissue. The specific aetiology of the disease is previously unknown. A case diagnosed as mesenteric panniculitis is presented. The cause was biopsy-proved abdominal tuberculous lymphadenitis. To our knowledge, mesenteric panniculitis associated with tuberculosis infection has not been reported previously in the literature. Thus, we would like to present the first case and describe CT features of the disease.

Effects of ketamine on different types of anxiety/fear and related memory in rats with lesions of the median raphe nucleus

The aim of the present study was to determine the involvement of the median raphe serotonergic system in the effects of ketamine on anxiety behaviours and related memory. The effects of ketamine pretreatment (3 and 10 mg/kg, i.p.) on three types of fear-motivated behaviours, unconditioned one-way escape, conditioned avoidance and freezing were tested. Experiments were performed with the inhibitory avoidance apparatus in rats with ibotenic acid lesions of the median raphe nucleus. It was found that 10 mg/kg ketamine had an anxiogenic-like effect on one-way escape type of fear and anxiolytic-like effect on conditioned freezing-related fear; these effects were unaffected by median raphe lesions. Both ketamine doses impaired freezing-related fear memory. Ketamine (10 mg/kg) also produced an anxiolytic-like effect on avoidance type of fear and impaired avoidance memory. The median raphe lesions attenuated the anxiolytic action of the drug on the avoidance type of fear and prevented ketamine-induced avoidance memory impairment. These results suggest that the anxiolytic-like effect of ketamine on avoidance-type fear is mediated through the median raphe serotonergic system.

[Knee injuries: MRI findings]

PURPOSE

The knee is the most frequently injured joint that physical examination and plain radiographies are limited to diagnose precisely the knee injuries. Magnetic resonance imaging (MRI) has been contributed great benefits to the accurate diagnosis by determining the injuries of menisci and ligaments in addition to bone structures. We evaluated MRI findings in traumatic knees and compare them to literature.

MATERIALS AND METHODS

The patients with the knee injury who were admitted to orthopedic surgery service were reviewed. Of them, 49 patients (50 knees) correlated operatively, arthroscopically and clinically were included in our study population. If the diagnosis was not sufficient by using plain films and clinical evaluation, the patients underwent MRI examination.

RESULTS

Bone contusions were the most common finding in the injuries (n:33). The other findings were respectively, the anterior cruciate ligament injuries in 17 patients, meniscal tears in 12 patients, osteochondral fractures in 9 patients, collateral ligament injuries in 7 patients and bone fractures in 5 patients.

CONCLUSION

MR imaging-plays a major role in decisions on evaluation and management of traumatic knees, improves clinician diagnostic certainty and reduces the need for arthroscopy.

[Traumatic lesions of the corpus callosum]

AIM

To determine the diagnostic values of magnetic resonance imaging and computed tomography and characteristics of the lesions in traumatic lesions of the corpus callosum.

CASES AND METHODS

In 49 cases with traumatic lesions of the corpus callosum whose Glasgow Coma Scale (GCS) scores were 12 or under, presence and characteristics of the lesions of corpus callosum were evaluated retrospectively. All of the cases had both of MRI and CT scans at early posttraumatic periods.

RESULTS

In 20 patients (40.8%) there were 31 lesions. There were lesions in only 7 of 20 patients that had lesions in MRI. Despite most of lesions (87%) were nonhemorrhagic in MRI, 3 of 7 lesions (42.8%) were nonhemorrhagic in CT. Lesions were limited to the splenium in 7 of 20 patients (35%). In other cases there were lesions at anterior regions of corpus callosum with or without splenial lesions. There were more lesions of brain stem and subcortical white matter in patients with corpus callosum trauma than ones without, but differences were not statistically significant.

CONCLUSIONS

Traumatic lesions of the corpus callosum are frequently seen in moderate and severe head injury. Most of the lesions are nonhemorrhagic and localized in splenium. The diagnostic value of MRI is rather high than of CT in traumatic lesions of corpus callosum.

A possible central antinociceptive effect of dipyrone in mice

The antinociceptive effect of dipyrone, a nonsteroidal and inflammatory drug, was studied in a series of experiment employing tail-flick and hot-place models and the abdominal constrictor test. The drug was given via intracerebroventricular (i.c.v.), intrathecal (i.t.) or subcutaneous (s.c.) routes. Dipyrone exhibited no analgesic activity in the tail-flick and hotplate tests while it inhibited the number of stretches in a dose-dependent manner. The antinociceptive effect of dipyrone administered by the i.c.v. and i.t. routes was almost complete reversed by naloxone treatment. The same procedure attenuated but not completely inhibited the dipyrone action induced by s.c. administration. Histopathological examination revealed that i.t. dipyrone application produces no significant lesion in the spinal cord. The results suggest that dipyrone may exert a central antinociceptive action reversed by naloxone.