Effect of cement type on vertical marginal discrepancy and residual excess cement in screwmentable and cementable implant-supported monolithic zirconia crowns

The purpose of this study was to investigate the vertical marginal discrepancy (VMD) and residual excess cement (REC) of cementable and screwmentable monolithic zirconia crowns cemented with different types of cement. Abutments were attached to 40 implant analogues. Crowns were created using computer-aided design/computer-aided manufacturing technology from monolithic zirconia blocks, either with or without a screw access hole (SAC). Crowns created both ways were split into two groups and cemented with resin and zinc polycarboxylate cement under a 5-kg weight. VMD and REC values were evaluated using an X20 zoom stereomicroscope. Data were analysed using two-way ANOVA and the Bonferroni test. According to the two-way ANOVA results, REC measurements differed significantly in the crown design and cement groups. However, whilst VMD values were significantly different in both crown design groups, there was no significant difference in the cement groups. According to the Bonferroni test results, the highest REC (157.241 ± 44.29 µm) and VMD (68.052 ± 16.19 µm) values were found in the crowns without SAC and cemented with zinc polycarboxylate. Screwmentable crowns are more effective than cementable crowns in reducing REC and VMD. Whilst polycarboxylate cement reduces VMD in screwmentable crowns, resin cement is more suitable for cementable crowns.

Do mouthwashes affect the optical properties of resin cement?

OBJECTIVES

The objective of this study was to evaluate the effect of mouthwashes on the optical properties of resin cement.

MATERIALS AND METHODS

One hundred and 60 resin cement discs (6x2mm) were produced from 4 different brands of resin cement (Panavia V5, Estecem II, RelyX Veneer, NX3) with the help of a Teflon mould. The discs were divided into 4 subgroups, 1 of which served as the control group, to be immersed in mouthwashes after measuring the initial L, a, and b values on white and black backgrounds. Colour measurements were repeated after the 1st and 7th days. The collected data were used to calculate the ∆E00 value to measure colour stability, the translucency parameter (TP00), and the contrast ratio parameter (CR) to compare translucency change. Data were statistically analysed using mixed-design analysis of ANOVA and the Bonferroni-Dunn test. Repeated measures ANOVA was used for dependent results (α = 0.05).

RESULTS

On the ∆E00, TP00, and CR parameters; the joint effect of resin groups, mouthwash groups, and measurement times were found to be statistically significant. The ∆E00 (colour difference) parameter; the joint effect of resin groups, mouthwash groups, and measurement times was found to be statistically significant. The TP00; the joint effect of resin groups, mouthwash groups, and measurement times were found to be statistically significant. The CR parameter; the joint effect of resin groups, mouthwash groups, and measurement times was found to be statistically significant. In the Estecem II (Tokuyama) group, the means of Listerine Cool Mint (Johnson & Johnson) was above acceptable limits in both time periods. In the Panavia V5 (Kuraray Noritake) group, the color change was above acceptable limits in all time periods and in all mouthwash groups. Among the resin materials used, Estecem II (Tokuyama) shows the most color change. Listerine Cool Mint (Johnson & Johnson) caused more color change than other mouthwashes at all times.

CONCLUSIONS

Within the limitations of this study; the colour stability and translucency value of resin cement depend on both the resin cement content and the mouthwash. Long-term use of mouthwash may adversely affect the optical properties of the resin cement.

CLINICAL RELEVANCE

Clinicians should take into account the fact that mouthwash use and the composition of the resin cement employed will have an impact on the colour of laminate veneers.

A comparative study of translucency and color perception in monolithic zirconia and lithium disilicate veneers

Ceramic laminate veneers which are a conservative approach to restoring anterior teeth, combining minimal preparation and esthetics. This study aims to evaluate the impact of the thickness of monolithic zirconia laminate veneers on their optical properties and color perception, comparing them to lithium disilicate. A total of 60 laminate veneers were prepared using two ceramic materials, divided into three groups for each material (n = 10) with thicknesses of 0.5, 0.7, and 1.0 mm. CIELab color parameters of the veneers were measured using a spectrophotometer and translucency parameters were calculated. The veneers were cemented onto uniform dies and final L, a, b values of the restorations were measured. The color difference between the different thicknesses was calculated using the CIEDE2000 formula. Two-way ANOVA and Bonferroni HSD post hoc tests were conducted to compare the color parameters (α = 0.05). The results showed that both material type (p < 0.001) and thickness (p < 0.001) influenced translucency values. The translucency values of zirconia veneers were significantly lower than those of lithium disilicate. The color differences (ΔE00) resulting from thickness changes (0.5-1.0 mm) were near or below the perception threshold for lithium disilicate, but distinct for zirconia restorations. In conclusion, monolithic zirconia veneers demonstrated lower translucency compared to lithium disilicate. Changing the material thickness affected the translucency of both materials, but not the color perception only for zirconia.

Transvaginal natural orifice endoscopic surgery (vNOTES) for elderly patients

OBJECTIVES

To evaluate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in patients 70 years and over.

MATERIAL AND METHODS

The study consisted of eleven patients aged 70 and over who underwent vNOTES for a variety of gynaecological indications at a tertiary referral hospital. The medical and surgical data were noted: age, parity, history of comorbidity, number and type of previous surgeries, body mass index (BMI), operating time, the requirement of intraoperative conversion, the presence of intra- or postoperative complication, estimated blood loss, pre-and postoperative hemoglobin levels, visual analog scale (VAS) pain scores at 6th, 12th and 24th hours, length of hospital stay, and the final pathology results.

RESULTS

vNOTES surgery was performed safely and successfully in eleven patients. There were no intra- and postoperative complications or instances of conversions to conventional laparoscopy or laparotomy. The mean age of patients was 75.91 ± 6.47 (range 70-93), and the mean BMI was 42.49 ± 8.77 kg/m2 (range 30.2-56). Seven cases of endometrioid adenocarcinoma, two cases of uterine leiomyoma, one case of complex atypical hyperplasia, and one case of postmenopausal uterine bleeding due to atrophic endometrium were diagnosed. All endometrial carcinomas were early stage; no adjuvant therapy was needed.

CONCLUSIONS

vNOTES seems to be a safe and feasible approach for the treatment of gynecologic pathologies in elderly patients. This study suggests that vNOTES become a viable treatment option for existing minimally invasive procedures since it offers better surgical outcomes in various gynecologic surgeries.

Elderly idiopathic pulmonary fibrosis patients remain on therapy despite higher incidence of adverse events and dose reductions

BACKGROUND

Idiopathic pulmonary fibrosis (IPF) predominantly affects people over the age of 60 years and its incidence increases with age. Limited data is available on the use of antifibrotics in the elderly IPF population. We aimed to examine the tolerability and safety of antifibrotics (pirfenidone, nintedanib) in elderly patients with IPF in a real-world setting.

METHODS

Medical records of 284 elderly (≥75 years) and 446 non-elderly IPF patients (<75 years) were retrospectively analyzed in this multi-center study. Patient characteristics, treatments, adverse events (AEs), tolerability, hospitalizations, exacerbations, and mortality were compared between the elderly and non-elderly group.

RESULTS

In the elderly group, the mean age was 79 years and the mean antifibrotic treatment duration was 26.1 months. The most commonly reported AEs were weight loss, loss of appetite and nausea. Elderly IPF patients had a significantly higher incidence of AEs (62.9% vs. 55.1%, p = 0.039) and dose reductions (27.4% vs. 18.1%, p = 0.003) than the non-elderly did, but the rate of discontinuation of antifibrotics was not different between groups (13% vs. 10.8%, p = 0.352). In addition, the severity of the disease, frequency of hospitalizations, exacerbations, and mortality rates were higher in elderly patients.

CONCLUSION

The present study showed that elderly IPF patients experienced significantly increased AEs and dose reductions due to antifibrotic use, while the discontinuation rates of the drugs were similar to those of drugs used by non-elderly patients.

Investigation of the effect of different surface treatments for preventing detachment of polyetheretherketone and titanium attachment matrix housings in overdentures: An in vitro study

Aim

The attachment matrix housing (AMH) of implant overdentures is not chemically bonded with acrylic resins. Therefore, AMH may lose due to insertion and removal forces. This study aims to investigate the effects of different surface treatments to reduce the detachment of AMH and to compare the adhesion of the AMH used in implant-supported overdentures made of different materials with the reline acrylic resin.

Materials and Methods

Titanium and polyetheretherketone (PEEK) AMHs were separated into four surface treatment groups; no treatment, airborne-particle abrasion (APA) applied, universal bond (UB) applicated, APA, and UB applicated. Eight millimeters in diameter and ten millimeters tall straws were used to restrain the reline acrylic resin prepared according to the manufacturer's instructions and the resin was injected onto the surface-treated AMH. After the polymerization was completed, the universal testing machine performed the tensile bond strength (TBS) test with a fishing line passed through the acrylic resins.

Statistical Analysis Used

TBS data were analyzed with two and one-way ANOVA and Tukey HSD post hoc tests (α =0.05).

Results

According to the two-way ANOVA results, titanium AMHs (103.78 ± 45.98 N) showed higher TBS than PEEK AMHs (67.81 ± 28.61 N). UB applicated titanium groups showed significantly increased TBS values.

Conclusions

Using titanium AMHs may be a better choice in situations where clinical aesthetic expectations are unimportant for adhesion to reline acrylic resins. The UB resin significantly increased the bonding of the titanium AMHs with reline resins. The application of UB resin to titanium housings can be easily applied in a clinical situation and can reduce the detachment of the titanium AMHs.

Removal of lithium disilicate veneers with Er,Cr:YSGGL laser: now? Or after ageing?

This study was purposed to assess the impact of ageing and resin cements polymerized with different modes on the removal time of lithium disilicate (LiSi) ceramics using Er,Cr:YSGG laser. Ninety LiSi slabs (6 × 6 × 1 mm) were cemented to freshly extracted bovine teeth using cements polymerized with different modes (light-curing (LC), dual-curing (DC), self-curing (SC)). The specimens were divided into subgroups according to ageing conditions (no thermal cycling, 5000 or 30,000 thermal cycling). After that, Er,Cr:YSGG laser was applied until LiSi slabs were debonded; the removal time was recorded. Vickers microhardness test, SEM and EDS analyses were performed for specimens with the longest exposure time to laser application in the groups. One uncemented sample was also used as a control. Data were analyzed with two-way ANOVA and Tukey post hoc test. Ageing and cement polymerization mode significantly affected the removal time of LiSi specimens. The removal time for the self-curing resin cement group (22.67 ± 12.68 s) was significantly longer than for cements polymerized with other methods (LC = 10.833 ± 7.28 s, DC = 12.0 ± 7.96 s). Removal time was significantly reduced after ageing in all polymerization modes; however, there were no significant differences between 5000 (11.83 ± 7.52 s) and 30,000 (11.83 ± 7.26 s) thermal cycling groups. Self-curing resin cements had prolonged the laser-aided removal time for LiSi ceramics. It can be concluded that Er,Cr:YSGG laser-aided removal of LiSi veneers after clinical use can be done more faster than its immediate removal.

Eight-week exercise program improved the quality of life of Alzheimer's patients through functional, cognitive, and biochemical parameters

OBJECTIVE

In this study, it was aimed to examine the effect of 8-week exercise in Alzheimer's disease (AD) aged 65 and over through functional, cognitive, and biochemical parameters and irisin metabolism.

METHODS

Two groups consisting of healthy individuals and diagnosed with Alzheimer's over the age of 65 were followed up with a combined exercise program of 45-60 min, 3 days a week, for 8 weeks. At the end of the exercise period, various cognitive and functional tests were performed on the participants, and blood samples were taken for biochemical parameters and irisin level measurements.

RESULTS

In functional evaluations, while there was no difference in pre-exercise measurements of timed performance and quadriceps femoris muscle strength, there was a difference between groups in all other measurements (p < 0.05). Nutritional status increased significantly after exercise in AD individuals. Although there was an increase in mental score values after exercise, it was not statistically significant. Similar to the elderly with Alzheimer's, the improvements in functional tests in the healthy also led to improvements in activities of daily living and auxiliary activities of daily living. The exercise training did not have an effect on the lipid profile in AD patients, but showed an effect on glycemia and irisin levels (p < 0.05).

CONCLUSION

Changes in functional, cognitive, and biochemical parameters after the exercise program improved quality of life in Alzheimer's patients.

Hearing test results of newborns born from the coronavirus disease 2019 (COVID-19) infected mothers: A tertiary center experience in Turkey

Objective

Congenital infections can cause newborn hearing loss. Although vertical transmission of coronavirus disease 2019 (COVID‐19) infection is theoretically possible, this has not been proven yet. To our knowledge, there is no previous report on whether COVID‐19 infection during pregnancy can cause congenital hearing loss. This paper aimed to find an answer to this question.

Method

This retrospective, single‐center study was performed between April 2020 and May 2021 at a tertiary care referral center in Turkey. A total of 422 pregnant women who had coronavirus infection during pregnancy were followed and 203 of them gave birth in our institution. Results of hearing screening tests of 199 newborns were assessed retrospectively.

Results

Of patients included in the study, 23 (11.6%) had the disease in the first trimester, 62 (31.2%) in the second trimester, and 114 (57.3%) in the third trimester. In the first hearing test performed on newborns, unilateral hearing loss was observed in 21 babies (10.5%). Hearing tests of these newborns were found to be normal in the second test performed 15 days later.

Conclusion

Considering the incidence of congenital hearing loss, the absence of hearing loss in our newborn population does not confirm the argument that coronavirus infection does not cause congenital hearing loss. This issue should be evaluated with larger patient series. In addition, it should be kept in mind that hearing loss can occur at later ages as well.

Assessment of Subclinical Left Ventricular Systolic Dysfunction and Structural Changes in Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) can develop left ventricular (LV) systolic dysfunction and geometric changes due to several reasons. We investigated subclinical LV systolic dysfunction and structural features in patients with COPD, and its correlation with the severity of airway obstruction, identified by GOLD classification.

METHODS

We studied 52 patients with COPD and 29 age and sex-matched controls, without any cardiac disease. In addition to conventional echocardiographic evaluation speckle tracking echocardiography (STE) based strain imaging were performed to analyze sub-clinical LV systolic dysfunction. Also LV volumes were measured by using three dimensional real time echocardiography (3DRTE). All patients underwent spirometry.

RESULTS

Conventional echocardiographic parameters (LV wall thickness and diameters, LV EF) and LV volume measurements were similar between the groups. LV global longitudinal peak systolic strain (-14.76 ± 2.69% to -20.27 ± 1.41%, p < 0.001) and strain rate (0.75 ± 0.25 1/s to 1.31 ± 0.41 1/s, p < 0.001) were significantly impaired in patients, compared to controls demonstrating sub-clinical ventricular systolic dysfunction. Significant positive correlation was obtained between LV strain/strain rate and spirometry parameters (FEV 1, FEV%, FEV 1/ FVC, PEF %) (r = 0.78/0,68, p < 0.001; r = 0,83/0.70, p < 0.001); r = 0.74/0.55, p < 0.001; r = 0.72/0.65, p < 0.001, respectively). In addition, there was significant negative correlation between LV strain/strain rate and GOLD classification (r = -0.80/ -0.69, p < 0.001, respectively).

CONCLUSION

Subclinical LV systolic dysfunction can occur in COPD patients despite normal EF. STE is a technique that provides additional information for detailed evaluation of subtle changes in LV myocardial contractility, significantly associated with the severity of the disease in COPD patients. This article is protected by copyright. All rights reserved.

Effects of climate and air pollution factors on outpatient visits for eczema: a time series analysis

Eczema resulting from external and internal factors accounts for the biggest global burden of disability owing to skin disease. This study aimed to determine an association between environmental factors and outpatient clinic visits for eczema. We collected data on dermatology clinic outpatient visits for eczema between January 2013 and July 2019. Data concerning environmental factors during this period were collated using national air quality network and air monitoring measurement parameters, namely barometric pressure, relative humidity, air temperature, and air pollutant concentrations, such as sulfur dioxide (SO₂) and particulate matter (PM₁₀). A distributed lag nonlinear model was used to investigate the relationship among eczema, environmental factors, and lagged effects. In total, 27,549 outpatient visits for eczema were recorded. In both single-factor and multiple-factor lag models, the effects of a 10-µg/m³ increase in PM₁₀ and SO₂ values had significantly positive effects on the number of daily outpatient visits over a total 5 days of lag after adjusting for temperature, the number of daily outpatient visits increased with 0.87%, 7.65% and 0.69%, 5.34%, respectively. Relative humidity (RR = 1.3870, 95% CI 1.3117-1.4665) and pressure (RR = 1.0394, 95% CI 1.0071-1.0727) had significantly positive effects on the number of daily outpatients in single-factor lag models. However temperature had a significantly negative effect on them in the number of daily outpatients (RR = 0.9686, 95% CI 0.9556-0.9819). Exposure to air pollution exacerbated eczema. Outpatient visits for eczema were found to have strong positive associations with changes in PM₁₀ levels.

HLA-DQ2/DQ8 frequency in adult patients with celiac disease, their first-degree relatives, and normal population in Turkey

BACKGROUND/AIMS

Celiac disease is an autoimmune, familial disease that results in susceptibility to gluten in cereal and cereal products in genetically susceptible individuals. The aim of the present study was to investigate the presence of HLA-DQ2/DQ8 in patients with celiac disease, their first-degree relatives, and healthy community.

MATERIALS AND METHODS

HLA-DQ2/DQ8 analysis was performed in adult patients with celiac disease >18 years old (94 patients), their first-degree relatives (89 people), and healthy group (102 individuals). Anemia, osteoporosis, and diarrhea were interrogated in the celiac patient group and also anti-tissue transglutaminase, anti-endomysium, and anti-gliadin antibodies were recorded.

RESULTS

There was a significant relationship between HLA-DQ2/DQ8 presence in all groups, and the distribution of HLA-DQ2/DQ8 in all groups was different (p=0.000). No statistically significant correlation was found between the HLA tissue groups and diarrhea (p=0.087), osteoporosis (p=0.215), anemia (p=1.000), tissue transglutaminase antibodies (p=0.295), anti-gliadin antibodies (p=0.104), and anti-endomysium antibodies (p=0.243) in the celiac patient group.

CONCLUSION

HLA-DQ2/DQ8 can be used to diagnose celiac disease particularly when the tests are useless and to screen first-degree relatives.

Giant cell arteritis, polymyalgia rheumatica, and late-onset rheumatoid arthritis: Can they be components of a single disease process in elderly patients?

OBJECTIVE

To report two patients with giant cell arteritis (GCA) who developed rheumatoid arthritis (RA) and to review the literature in terms of coexistence of RA, GCA, and polymyalgia rheumatica (PMR).

METHODS

We conducted a comprehensive review of the English literature from 1980 to 2015 to analyze data on the coexistence of GCA and RA. The PubMed, Web of Science, Proquest, and Ovid databases were searched for articles using the term RA combined with temporal arteritis, GCA, and PMR.

RESULTS

We identified 17 other cases of coexistent GCA and RA reported in the English literature, together with our 2 cases (19 cases). They included 14 females and 5 males, with a mean age of 74.3 years (range: 57-84) at the time of GCA. The mean age at the time of RA diagnosis was 69.6 years (range 24-83). The average time elapsed between the onset of GCA and the development of RA was 6.7 years (range: 3 month-34 years). RA and GCA were reported as the first disease in 10 cases and 4 cases, respectively. The development of these 2 diseases in a narrow period of time appeared in 4 cases (3 months-19 months). PMR was the first disease in 1 case.

CONCLUSION

RA, GCA, and PMR may appear simultaneously or consecutively; therefore, we suggest that physicians should be alert about such a fact so that a proper diagnosis and treatment could be tailored accordingly.

The relationship between hyperemesis gravidarum and maternal psychiatric well-being during and after pregnancy: controlled study

OBJECTIVE

Psychiatric symptoms of varying degrees that accompany hyperemesis gravidarum (HG) may continue throughout the pregnancy or after, and these psychological problems may cause morbidity. In this study, we aimed to evaluate the relationship between the HG and psychiatric symptoms in the first trimester and postpartum depression.

METHODS

Two hundred and seven pregnant who were diagnosed as HG and 177 healthy pregnant women included in this prospective study. All cases were assessed with SCL-90-R in first trimester and with ED in postpartum period. Factors related to postpartum psychiatric symptoms were investigated with bivariate logistic regression analysis.

RESULTS

SCL-90-R and ED scores were statistically significant at HG group (p < 0.05). In cases who diagnosed as postpartum depression, the rates of HG and SCL-90-R results were higher (p< 0.05). In the bivariate analysis, the high rates of HG and high SCL-90-R scores were determined to be related to postpartum depression (p < 0.05).

CONCLUSIONS

The results show that mental health is negatively affected by HG at pregnancy, and in this case, psychiatric symptoms may continue even after discontinuation HG.

Mastalgia-Cancer Relationship: A Prospective Study

OBJECTIVE

Mastalgia is an important symptom affecting approximately 70% of women and it disrupts the quality of life especially due to the worry of having cancer. In our study, the type and severity of mastalgia symptom of patients who presented to the outpatient clinic with mastalgia complaint were assessed along with their physical examination findings and radiology results. The purpose of the study is to demonstrate the relationship between mastalgia and malignity when assessed in combination with the risk factors of patients.

MATERIALS AND METHODS

The age, family history, menopausal status, age at the first childbirth, menarche, presence/absence of hormone replacement therapy, type of mastalgia, comorbidities and examination findings of 104 patients, who presented to the General Surgery outpatient clinic with mastalgia symptom, were recorded and assessed in the light of radiological study results.

RESULTS

With respect to the mastalgia types of the patients, 38.5% had cyclic pain, 57.7% non-cyclic pain and 3.8% other types of pain. Mild mastalgia was present in 46.2% of the patients, moderate mastalgia in 24% and severe mastalgia in 29.8% of them. According to the BIRADS category, 48.1% of the patients were identified to have BIRADS 1 mass lesions, 39.4% BIRADS 2, 9.6% BIRADS 3 and 2.9% BIRADS 5 mass lesions. The patients who were identified to have BIRADS 5 mass lesions described non-cyclic and severe pain in the post-menopausal period. They had palpable masses along with the pain symptom.

CONCLUSION

Our study suggests that mastalgia symptom does not per se result in suspicion of malignancy, but physical examination and radiological imaging should also be used as needed for confirmation. Studies with a larger patient population are needed to shed light on the mastalgia epidemiology and its relationship with cancer.

The effect of CD14 and TLR4 gene polymorphisms on asthma phenotypes in adult Turkish asthma patients: a genetic study

BACKGROUND

Endotoxins stimulate T helper 1 cell maturation and send a negative signal to T helper 2 polarisation. This causes a decrease IgE levels and prevents atopy (Hygiene hypothesis). It is shown that this response is under genetic control by polymorphisms in CD14 and TLR4 genes in some researchs. We aimed to investigate the effects of genetic variants of CD14 (-) and TLR4 (Asp299Gly, Thr399Ile) genes on asthma phenotypes in adults with asthma.

METHODS

Asthma patients (n = 131) and healthy control cases (n = 75) were included in the study. Relations between CD14 C-159 T, TLR4 299 and TLR4 399 genotypes and duration of asthma history of allergic rhinitis-dermatitis, total IgE, eosinophil, skin prick test, forced expiratory volume 1 (FEV1) and severity of disease were evaluated. Real time PCR (RT-PCR) was used for genotyping.

RESULTS

For CD14-159, presence of the C allele (CC + CT) was more frequent among those with low median log (logarithm) IgE levels, but no statistically significant difference in all asthma group (p = 0.09). C allele was significantly correlated with low total IgE levels and T allele with high total IgE levels in atopics (p = 0.04). CC + CT genotype was more frequent in moderate and severe asthma group in atopics (p = 0.049). TLR4 299 and TLR4 399 genotypes and asthma phenotypes were not found to be significantly correlated (p > 0.05).

CONCLUSIONS

Total IgE levels were found to be low among patients with the CC + CT genotype, and high among patients with the TT genotype contrary to the results of many other studies, which is therefore an important finding. Another important finding was that the C allele is a risk factor for moderate and severe asthma.

Characteristics of endobronchial tuberculosis patients with negative sputum acid-fast bacillus

OBJECTIVE

Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence, with or without parenchymal involvement. In this study, clinical, radiological and bronchoscopic characteristics of cases diagnosed to have EBTB were evaluated.

METHODS

Sixteen patients with at least three negative sputum examinations for acid-fast bacillus (AFB) and diagnosed as having EBTB on the histopathological examination of bronchoscopically obtained specimens showing granulomatous structures with caseation necrosis and/or positive AFB-culture on the microbiological examination of bronchoscopically obtained specimens were included in our study. Age, sex, symptoms, tuberculin skin test (TST), microbiological examination results and radiological findings were recorded. Bronchoscopical lesions were classified according to Chung classification.

RESULTS

EBTB was found to be more common in females. Most common symptoms were cough (100%), sputum (75%), weight loss (62.5%), hemoptisis (37.5%), chest pain (25%) and dyspnea (12.5%). Radiological examination findings revealed consolidations/infiltrations (87.5%), nodular lesions (37.5%), cavitary lesions (25%), unilateral (43.7%) or bilateral hilar widening (31.2%) and atelectasia (25%). Middle lob syndrome was seen in three cases. Most common lesions observed bronchoscopically were active caseous lesions, granular lesions, edematous hyperemic lesions, tumorous lesions, fibrostenotic lesions respectively. In all cases "granulomatous inflammation showing caseation" was shown in the histopathological examination of biopsy specimens.

CONCLUSIONS

EBTB can cause various radiological and bronchoscopical findings. In most of the cases distinct response is seen to antituberculous treatment. Bronchial stenosis is an important complication. Treatment should be given as soon as possible to avoid it.

Distinctive biochemical changes in pulmonary tuberculosis and pneumonia

INTRODUCTION

We aimed to investigate the relationship between radiological extent and serum biochemical changes and body mass index (BMI) in patients with pulmonary tuberculosis (PTB) and pneumonia and to determine the usefulness of C-reactive protein (CRP) in clinical discriminative diagnosis.

MATERIAL AND METHODS

One hundred fifteen patients with tuberculosis (group 1), 70 patients with pneumonia (group 2) and 30 healthy controls (group 3) were included in this case-control study.

RESULTS

Total cholesterol (TC, p < 0.001 in group 1; p = 0.011 in group 2), high-density lipoprotein (HDL, p < 0.001), albumin (ALB, p < 0.001) and BMI (p < 0.001) values were significantly lower group 1 and group 2 than group 3. Erythrocyte sedimentation rate (ESR), leucocyte (LEU) and CRP were higher in group 2 than group 1 and group 3 (p < 0.001). As important point; triglyceride (TG) and BMI were significantly lower in group 1 than group 2 (p < 0.001). In group 1; BMI, HDL, TG, total protein (TP) and albumin were found to decrease, while CRP and ESR increased as the radiological stage increased (p < 0.05). But no significant difference was found in levels of TC and LDL (p > 0.05). In group 2; BMI, TC, HDL, LDL, TP and ALB were observed to decrease, while LEU, CRP and ESR increased as the radiological stage increased (p < 0.05). But no significant difference was found in levels of TG (p > 0.05). The best serum CRP cut-off value in differential diagnosis of tuberculosis and pneumonia was defined as 9.4.

CONCLUSIONS

The acute phase response occurring in tuberculosis and pneumonia determines the severity of the disease, leads to a decrease of serum levels of lipoproteins and BMI, and is correlated with the radiological extent. The CRP and ESR were found to be useful in differential diagnosis of tuberculosis and pneumonia.

Does Repeating CT-Guided Transthoracic Fine Needle Aspiration Increase Diagnostic Yield and Complication Rate? A Single Institution Experience

Background

Transthoracic fine needle aspiration biopsy is a well-established and safe technique for obtaining pulmonary tissue. However, there is very little data about repeating procedure.

Objectives

We aimed to investigate whether repeating CT-guided transthoracic fine needle aspiration (TFNA) increases diagnostic yield and complication rate.

Patients and Methods

Patients underwent TFNA and the final diagnoses achieved were included in the study. Consequently, 316 TFNA procedures performed in 240 patients were investigated retrospectively. A diagnosis was not reached in the first TFNA in 64 patients, then they underwent repeated TFNA. The factors that affected the diagnostic yield and complication rate were recorded.

Results

The final diagnoses of 199 (82.9%) patients were malignant and 41 patients were benign. One hundred seventy six patients underwent the TFNA procedure only once. Sixty-four patients underwent a second procedure, while 12 underwent a third one. The diagnosis rate in the first procedures (diagnosis obtained in 142 out of 240 patients) was 59%. With the repeated procedures, 30 other patients were diagnosed. The diagnosis rate increased to 72% (172 out of 240 patients) (P<0.001). Twenty-nine (9.2%) pneumothoraces in 26 patients were detected in 316 TFNA procedures. In the repeated TFNA group (64 patients) there were seven pneumothoraces (11%) in the first TFNA procedure and six pneumothoraces (9%) in the repeated TFNA procedures (P=0.41). In three patients, pneumothorax was detected in the first and repeated procedures. Pneumothorax was significantly associated with the maximum diameter of the lesion (P=0.003), distance to pleura (P=0.001), contact to the pleura (P=0.0001) and smoking history (pack/year) (P=0.04).

Conclusion

This study demonstrated that repeating the TFNA procedure in pulmonary lesions improves the diagnostic yield without an increase in the rate of pneumothorax.

[Inverse relation between atopic status and tuberculin response in adult asthmatics]

INTRODUCTION

We aimed to examine the relation between tuberculosis infection and both atopic and nonatopic asthma.

MATERIALS AND METHODS

Eighty six patients with asthma were included. These patients were divided into two groups according to atopic status. Seventy one patients with positive prick tests to at least one aeroallergen together with history of allergy were named as atopic asthma group, and the other 15 patients with negative prick tests, who do not have any history of allergy were named as nonatopic asthma group. Two different control groups similar in terms of age and gender were taken for each group. Tuberculin skin test was done.

RESULTS

As a different from most of the previous studies, we included nonatopic asthmatics besides atopic asthma group. PPD value in atopic asthma group was significantly lower (p< 0.001) than the control group. In nonatopic asthmatics, PPD value was also lower than the control group, but it wasn't statistically significant. When we take all patients and controls, negative correlation was seen between mean PPD value and total IgE levels.

CONCLUSION

PPD reactivity has been detected as remarkably suppressed in atopic asthma group while mildly suppressed in nonatopic asthmatics. The results may be affected by the fact that mycobacterium infection or BCG vaccination may have suppressive effect on atopic asthma development which comes out in early ages, but they don't have the same effect on nonatopic asthma development which comes out in elder ages.

Prominent features of platelet count, plateletcrit, mean platelet volume and platelet distribution width in pulmonary tuberculosis

Background

We aimed to investigate the relation of platelet count (PLT) and plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) with other acute phase reactants and radiological extent in pulmonary tuberculosis (PTB).

Methods

One hundred patients with PTB (Group 1), 50 patients with community-acquired pneumonia (Group 2) and 28 healthy control individuals (Group 3) were included in this analytic study.

Results

WBC (White Blood Cell), ESR (Eritrocyte Sedimentation Rate), CRP (C-Reactive Protein), PLT and PCT values were both in Group 1 and Group 2 than in Group 3. PDW values were significantly higher in Group 1 than Group 3. WBC, ESR and CRP values were lower, while PLT and PCT values were higher in the Group 1 compared to Group 2 (p < 0.001). PLT was positively correlated with CRP and ESR values in the tuberculosis group (p < 0.001), while it was not correlated with CRP and ESR in the pneumonia group (p > 0.05). ESR, CRP, PLT and PCT values were found higher in radiological advanced stage (Stage 3) patients with PTB, while hemoglobin (Hb) was found lower (p < 0.05). Higher WBC, ESR, CRP and PCT values as well as radiological advanced stage were more common in PTB patients with thrombocytosis compared to the patients with normal platelet count, whereas Hb was found lower in these patients.

Conclusions

This study indicates that reactive thrombocytosis and higher PCT and PDW develop frequently in PTB and there is a relation between thrombocytosis and acute phase reactants, that is the inflammatory response. In addition, tuberculosis with radiological advanced stage is seen more frequently in the patients with thrombocytosis and higher PCT, drawing attention to the possible role of platelets in the cell-based immune process of tuberculosis.

Prominent features of platelet count, plateletcrit, mean platelet volume and platelet distribution width in pulmonary tuberculosis

Background: We aimed to investigate the relation of platelet count (PLT) and plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) with other acute phase reactants and radiological extent in pulmonary tuberculosis (PTB). Methods: One hundred patients with PTB (Group 1), 50 patients with community-acquired pneumonia (Group 2) and 28 healthy control individuals (Group 3) were included in this analytic study. Results: WBC (White Blood Cell), ESR (Eritrocyte Sedimentation Rate), CRP (C-Reactive Protein), PLT and PCT values were both in Group 1 and Group 2 than in Group 3. PDW values were significantly higher in Group 1 than Group 3. WBC, ESR and CRP values were lower, while PLT and PCT values were higher in the Group 1 compared to Group 2 (p < 0.001). PLT was positively correlated with CRP and ESR values in the tuberculosis group (p < 0.001), while it was not correlated with CRP and ESR in the pneumonia group (p > 0.05). ESR, CRP, PLT and PCT values were found higher in radiological advanced stage (Stage 3) patients with PTB, while hemoglobin (Hb) was found lower (p < 0.05). Higher WBC, ESR, CRP and PCT values as well as radiological advanced stage were more common in PTB patients with thrombocytosis compared to the patients with normal platelet count, whereas Hb was found lower in these patients. Conclusions: This study indicates that reactive thrombocytosis and higher PCT and PDW develop frequently in PTB and there is a relation between thrombocytosis and acute phase reactants, that is the inflammatory response. In addition, tuberculosis with radiological advanced stage is seen more frequently in the patients with thrombocytosis and higher PCT, drawing attention to the possible role of platelets in the cell-based immune process of tuberculosis.

Two unusual clinical presentations of broad-ligament leiomyomas: a report of two cases

We report on two unusual clinical presentations of broad-ligament leiomyomas. The first case was a combination of broad-ligament leiomyoma and ectopic gestational sac at the same location. The other case was a broad-ligament leiomyoma presenting as an ovarian malignancy. The differential diagnosis of broad-ligament leiomyoma should be considered in cases of an adnexal mass. Additionally, a broad-ligament leiomyoma could be the reason for an ectopic pregnancy.