Bilateral sagittal split ramus osteotomy using a conventional osteotome-hammer and a magnetic mallet device: an in vitro comparison

OBJECTIVE

The conventional chisel osteotome technique (CCOT) and the magnetic mallet osteotome technique (MMOT) with a newly manufactured custom osteotome tip for the magnetic mallet device (MMD) were compared to determine whether magneto-dynamic osteotomies are as reliable for orthognathic surgery as the conventional method.

MATERIALS AND METHODS

A custom osteotome tip compatible with a magnetic mallet device was manufactured. Thirty-two fresh 1-year-old sheep hemi-mandibles were chosen for osteotomy procedures to achieve the most human-like results. Sagittal split ramus osteotomies were performed, and lingual fracture pattern (LFP), basis split pattern (BSS), duration of sagittal split osteotomy, and alveolar inferior nerve injury were investigated macroscopically.

RESULTS

Six of the defined fracture schemes were observed out of the 27 lingual split patterns. After LFP and BSS evaluation, the unfavorable fracture counts for MMOT and CCOT are 3 and 4, respectively. The macroscopic nerve damage assessment for both groups is 2 for MMOT and 1 for CCOT. Although the average durations are similar in both groups, the difference between MMOT samples is closer. None above showed a significant difference.

CONCLUSIONS

MMOT was evaluated as a reliable alternative to CCOT in bilateral sagittal split ramus osteotomy based on the lingual and basis split patterns, duration, and nerve damage findings.

Evaluation of inter-maxillary fixation techniques for multi-piece Le Fort I osteotomies using finite element analysis

OBJECTIVE

A strong postoperative occlusal relationship is essential for the long-term stability of the jaw relations post orthognathic surgery. In multi-piece Le Fort I osteotomy, obtaining a satisfactory inter-maxillary fixation (IMF) of the mobilized segments in the correct position and according to the preoperative plan is difficult. Herein, we aimed to evaluate three different IMF techniques (tooth-supported, bone-supported, or hybrid IMF) using finite element analysis (FEA) of the occlusal surfaces of four models: three multi-piece (lateral incisor-canine, central incisor-central incisor, and canine-first premolar) and a single one-piece Le Fort I osteotomy scenario.

MATERIALS AND METHODS

Three different IMF techniques were applied separately to three different multi-piece models and a single one-piece Le Fort I model designed using related software. Simulation brought the lower and upper jaw models to the planned occlusion. Each model's occlusal force was applied to determine their distributions under 100 N, 300 N, and 800 N loads. Forces on the maxilla and mandible during fixation, the effect of these forces on the force distribution in the occlusion, and the accumulated stresses in these regions were determined with Algor Fempro and Rhinoceros software to determine the ideal fixation method. Data obtained were interpreted and evaluated according to the advantages and disadvantages of the actual surgical scenario.

RESULTS

In all four models studied, the hybrid IMF technique was found to be the ideal IMF technique, followed by the teeth- and bone-supported IMF techniques.

CONCLUSIONS

FEA allows the manipulation of single parameters, which clinical methods cannot obtain, thereby allowing each to be examined separately. Further clinical trials are required to validate these findings.

Lupeol inhibits pesticides induced hepatotoxicity via reducing oxidative stress and inflammatory markers in the rats

The present study was aimed at investigating the toxicity of various pesticides on rat liver. It also aimed to show whether this toxicity could be avoided using lupeol. Adult male Wistars albino rats were randomly divided into nine groups. Control groups were given saline, corn oil, and lupeol; pesticide groups were given malathion, chlorpyrifos, and tebuconazole; in the other three treatments, same doses of pesticides and lupeol were given to the rats for ten days. Histopathological examination showed severe degenerative changes in the pesticide groups. Serum AChE activities, liver GSH, total antioxidant capacity levels, AChE, CAT, SOD, GPx, GR, Na⁺/K⁺-ATPase, ARE, and PON were decreased, while serum TNF-α, liver LPO, HP, NO, AOPP, total oxidant status, ROS, and oxidative stress index levels as well as AST, ALT, ALP, GST, arginase and xanthine oxidase activities were increased in the pesticides administered groups. It was observed that the PCNA levels determined by the immunohistochemical method increased in the pesticide groups. Also, the results Raman spectroscopy suggest that the technique may be used to understand/have an insight into pesticide toxicity mechanisms. The administration of lupeol demonstrated a hepatoprotective effect against pesticide-induced toxicity.

Relapsing hydatid disease involving the vertebral body and paravertebral soft tissues

Hydatid disease involving the vertebral body and paravertebral soft tissues is rare even in rural areas where echinococcosis is endemic. We report a case with hydatid disease in the T11-L1 vertebral bodies and involvement in bilateral psoas muscles.

Intrusion of a Liquid Droplet into a Powder under Gravity

Intrusion of a liquid droplet into a hexagonal close-packed array of spheres under gravity is investigated using analytical methods and volume-of-fluid simulations. Four regimes of ultimate fluid behavior are identified: (A) no liquid imbibition into the bed, (B) trapping of liquid high in the bed, (C) liquid descending to the bottom of the bed, and (D) liquid spreading around the surface of all particles. These regimes are mapped based on the contact angle and Bond number of the system. Many aspects of the dynamics and ultimate liquid behavior are captured using a simplified model of a mass of liquid moving under gravity in a vertical capillary of undulating cross-sectional area. This simplified model is used to form momentum transport equations with four forms of nondimensional time, which are shown to collapse the simulation data with different fluid parameters in different regimes.

The value of transvaginal sonography in detecting endometrial pathologies in postmenopausal women with or without bleeding

AIM

The aim of this study was to estimate the incidence of endometrial pathologies and compare the findings in postmenopausal women with or without bleeding who had endometrial thickness ≥5 mm.

METHODS

Between January 2010 and December 2012 medical records of postmenopausal patients who underwent endometrial biopsy were reviewed retrospectively. 91 patients who presented with postmenopausal bleeding (Group A) with an endometrial thickness equal to or greater than 5 mm and 44 patients with an incidental finding of increased endometrial thickness (≥5 mm) on ultrasound without bleeding (Group B) were included in the study.

RESULTS

The mean endometrial thickness of patients in group A (9.3±4.6) was significantly lower than women in group B (11±4.6). Seven (7.7%) cases of endometrial hyperplasia and 6 (6.6%) cases of endometrial carcinoma were detected in women with bleeding, 2 (4.5%) cases of endometrial hyperplasia and no cases of endometrial carcinoma were diagnosed in group B women. The prevalence of endometrial carcinoma associated with endometrial thickness in group A women whereas we cannot see this relation in group B women. The mean endometrial thickness was highest in women with the histopathologic diagnosis of polyps in this group.

CONCLUSION

In postmenopausal women with bleeding, the risk of endometrial carcinoma increases with increasing endometrial thickness; however, the use of endometrial thickness as a screening test for endometrial carcinoma may not be effective in women without bleeding. 6.5 mm cut-off seems to be acceptable thickness for polyp detection in postmenopausal women with bleeding.

Granular cell tumor of the breast

Granular cell tumor is a rare benign soft-tissue neoplasm, usually appearing in the tongue, the oral cavity and subcutaneous tissue. Examples of granular cell tumor of breast are encountered in 30-50-year-old women. Herein, we report ultrasonographic and mammographic imaging findings of a 59 years old woman presented with a painless palpable mass, which was diagnosed as granular cell tumor on histopathological analysis.

US and MDCT diagnosis of a rare cause of haematuria in children: Posterior nutcracker syndrome

Posterior nutcracker syndrome is caused by compression of the left renal vein between the abdominal aorta and the vertebral column. We present the case of a 14-year-old girl with vague left loin pain, mild haematuria and proteinuria. Diagnosis of this rare syndrome was achieved using color Doppler US and multidetector computed tomography (MDCT) angiography.

Comparison of computed tomography histogram analysis and chemical-shift magnetic resonance imaging for adrenal mass characterization

BACKGROUND

Computed tomography (CT) histogram analysis and chemical-shift magnetic resonance imaging (MRI) are currently used modalities for adrenal mass characterization. However, it is not yet clear which modality can be regarded as most sensitive in terms of adrenal mass characterization.

PURPOSE

To prospectively compare CT histogram analysis and chemical-shift MRI in the characterization of adrenal masses.

MATERIAL AND METHODS

Between May 2007 and November 2008, 93 patients (45 males, 48 females; mean age 56.7 years, range 22-85 years) with 109 adrenal masses prospectively underwent both unenhanced CT and chemical-shift MRI examinations. These masses consisted of 67 adenomas and 42 metastases. Histogram analysis was applied with a circular region of interest (ROI) that recorded mean attenuation, total number of pixels, number of negative pixels, and the percentage of negative pixels on unenhanced CT images for each adrenal mass. In the CT histogram analysis, a 10% negative pixel threshold for unenhanced CT was calculated. In chemical-shift MRI, signal intensity drop between in-phase and opposed-phase images was quantitatively calculated so that adrenal-to-spleen chemical-shift ratios and adrenal signal intensity indexes were determined for each of the adrenal masses. A mass was regarded as an adenoma if it contained more than 10% negative pixels by CT histogram analysis, showed an adrenal-to-spleen chemical-shift ratio of less than 0.71, and had an adrenal signal intensity index of more than 16.5% by chemical-shift MRI. The results were compared to reveal which method was most sensitive in the diagnosis of adrenal masses and whether or not a correlation exists between these two modalities. Final diagnoses were based on imaging follow-up of minimum 6 months, biopsy, surgery, and adrenal washout study.

RESULTS

On unenhanced CT examinations, all of the 67 adenomas and 21 out of 42 metastases exhibited negative pixels. None of the metastases showed more than 10% negative pixels on CT histogram analysis. An increase in the percentage of negative pixels correlated well with a decrease in the mean CT attenuation. CT histogram analysis using a 10% negative pixel threshold gave a 91% sensitivity and 100% specificity for the diagnosis of an adenoma. On chemical-shift MRI, for an adrenal-to-spleen chemical-shift ratio of less than 0.71, a 97% sensitivity and 100% specificity were achieved, while a 97% sensitivity and 93% specificity were obtained for an adrenal signal intensity index of more than 16.5% for adenoma diagnosis.

CONCLUSION

CT histogram analysis method using a 10% negative pixel threshold on unenhanced CT had a good sensitivity and perfect specificity for the differentiation of adrenal adenomas from non-adenomas. In spite of the good results obtained with the CT histogram analysis method, chemical-shift MRI using adrenal-to-spleen chemical-shift ratio and adrenal signal intensity index formulas had a higher sensitivity and could help in the characterization of adrenal masses appearing indeterminate by CT histogram analysis.

Cysts of the canal of Nuck: ultrasound and magnetic resonance imaging findings

Cyst of the canal of Nuck is a rare cause of inguinal swelling in woman. We report a case of a cyst of the canal of Nuck in which sonography showed a tubular cystic structure with internal septae localized within the inguinal canal. Magnetic resonance examination demonstrated that the mass was hypointense on T1-weighted and hyperintense on T2-weighted series and that there were fine hypointense septae inside the mass on the T2-weighted sequence. Diagnosis of cyst of the canal of Nuck was confirmed by surgery and subsequent histopathologic evaluation.

US, CT and MRI findings in a case of diffuse lymphangiomatosis and cystic hygroma

Lymphangiomatosis is a rare disease with multifocal lymphatic proliferation that typically occurs during childhood and involves multiple parenchymal organs including the lung, liver, spleen, bone, and skin. Lymphangiomatosis may occur synchronously or metachronously with cystic hygroma of the neck. We present US, CT, and MRI findings of cystic hygroma of the neck associated with generalized lymphangiomatosis affecting bones and spleen in a 2-year-old girl.

Acute orbital effects of retrobulbar injection on optic nerve head topography

AIM

To assess the effects of acute orbital volume changes after retrobulbar injection on optic nerve head topography.

METHODS

The study population consisted of 95 patients with type 2 diabetes mellitus with clinically significant macular oedema who required focal pattern laser photocoagulation therapy in one eye. Before each laser treatment, 49 patients required a retrobulbar injection (approximately 7 ml of a mix of lidocaine 2% with epinephrine and bupivacaine 0.75% in equal volumes) to provide ocular akinesia. Both eyes of all patients underwent optic nerve head topographic analysis once before laser treatment (within 30 minutes), and repeated within 1 hour, 1 day, 1 week, 2 weeks, and 4 weeks after treatment, respectively. Topographic analyses were performed using a confocal scanning laser ophthalmoscope, HRT-II. The disc area, topography standard deviation, and a total of 12 topographic parameters were calculated by HRT-II.

RESULTS

The mean age of the patients was 37.9 (SD 3.2) years. The mean disc area of the subjects was 2.12 (0.44) mm(2). Fellow eyes which were not treated with laser, and those treated eyes which did not receive retrobulbar injection before therapy were found not to reveal significant changes in disc topography in any of the examinations (all p values >0.05). In the topographic examinations in the first hour, first day, and first week, laser treated eyes which underwent retrobulbar injection demonstrated significant increase in the disc area, rim area, rim volume, rim area/disc area, and cup shape measure parameters while optic cup parameters significantly decreased (all p values <0.05). In the second week examinations, they did not show significant difference in disc area measurements (p>0.05). By the fourth week, all of the optic nerve head topographic variables were not significantly different from the pre-injection values (all p values >0.05). Colour stereoscopic photographs did not reveal any differences in optic disc appearance.

CONCLUSION

Acute orbital volume change following retrobulbar injection may cause significant topographic evidence of optic disc oedema lasting approximately 1 week. Significant changes in optic rim and cup area may last for 2 weeks after injection, with all topographic changes returning to baseline by 1 month after injection. The present findings could be a model to reflect the pathological processes that occur in cases of acute orbital volume changes such as retrobulbar haemorrhage.

The effect of plantation age on the yield of some mint (Mentha spp.) varieties

This study was conducted to determine the productivity of aging plantation of some mint varieties (Mentha spp.) in Sanliurfa in the south-east of Turkey. The trial was carried out between 1994 and 1998 (5 years) and was designed as a split-plot study, with 3 replications. The M. piperita L. (Mitcham), M. piperita L. (Prilubskaja) and M. spicata (Urfa Local) varieties were used as plant material. Results obtained showed that the fresh herb yield (t/ha), dry herb yield (t/ha), dry leaf yield (t/ha), essential oil yield (L/ha) and essential oil content (%) were significantly affected by the plantation age in all varieties investigated. The yields of fresh herbs, dry herbs, dry leaves and essential oils decreased dramatically in the fourth and fifth years of harvest from the plantation as only 1 harvest could be achieved during these years.

Magnetic resonance imaging in amyotrophic lateral sclerosis

OBJECTIVE

We aimed to investigate the importance of magnetic resonance imaging for the diagnostic process of the upper motor neuron involvement.

MATERIAL AND METHODS

Fifteen patients (Group 1) who were diagnosed with amyotrophic lateral sclerosis in the neurology department of the Sisli Etfal Hospital and 20 controls (Group 2) entered the study. Magnetic resonance imaging examinations were performed in the radiology clinic of the same hospital. T2 and proton density weighted axial images were obtained. These images were evaluated by two blind radiologists. The radiologists looked for two signs: the presence of a low signal intensity at the precentral cortex and the presence of symmetrical rounded foci of high signal intensity within the internal capsule on both T2 and proton density weighted images.

RESULTS

For the first sign there was no statistically significant difference between the two groups but for the latter one there was a statistically significant difference.

CONCLUSION

We think that the presence of the latter sign may make it possible for the radiologists to help the clinicians further in this difficult and confusing diagnosis.

Renal function in children with sickle cell anemia

BACKGROUND

Patients with sickle cell anemia have various forms of renal dysfunction.

SUBJECTS, MATERIALS AND METHODS

The purpose of this study is to demonstrate the abnormalities of HbSS patients' renal function in childhood. Renal function studies were performed in 55 patients with homozygote sickle cell anemia and compared with 13 healthy children. The blood and timed urine samples were obtained for hematological and biochemical determinations.

RESULTS

Mean serum creatinine, sodium, phosphorus and calcium levels were not statistically different between patients and controls. Mean serum potassium and uric acid levels were significantly higher in patients than in controls. Mean tubular phosphate reabsorption (p < 0.001) and fractional excretion of potassium (p < 0.05) were lower in patients than in the control. There were no significant differences in fractional excretion of sodium and uric acid between patients and controls. Patients had significantly higher urine pH and significantly lower specific gravity and osmolality than controls. Also, there were no significant differences in urinary protein/ creatinine, urinary N-acetyl-beta-D-glucosaminidase/creatinine and urinary malondialdehyde/creatinine between patients and controls.

CONCLUSION

Thus, significant proximal tubular dysfunction is not a common feature but distal tubular abnormality is the most consistent renal functional derangement of patients with SCA in childhood.

Continuous cervical epidural anesthesia in hand surgery

Regional anesthesia, with its known benefits such as increased blood flow, reduced cost, and security, is a method of choice for hand surgery. Recently, the authors have switched from axillary block to continuous cervical epidural anesthesia, which has several advantages such as low cost, a pain-free postoperative period, better control of tourniquet pain, and the avoidance of a motor block so that early active motion is possible. Continuous cervical epidural anesthesia is a safe and reliable method, providing a sensory block with an infusion rate of 4 ml/hr ultracaine (articaine 2 percent), and a motor block when the dosage is increased to 8 ml/hr ultracaine (articaine 2 percent). Postoperatively, only 4 ml/hr ultracaine (articaine 2 percent) is sufficient to provide a sensory block. The method provides both good perfusion and a lower local anesthetic drug dosage than axillary block.

HLAs in children with minimal change disease and other types of nephrotic syndrome in the southern part of Turkey

The aim of this study was to investigate the human leukocyte antigen (HLA) profile of children with nephrotic syndrome in the southern part of Turkey. Seventy-eight children with nephrotic syndrome were studied for the frequency of class I and class II human leukocyte antigens. Forty-seven of them were steroid sensitive nephrotic syndrome (minimal change disease-MCD) and 31 were other types of nephrotic syndrome. The results were compared with 133 healthy subjects for HLA groups. HLA B13, Cw5, Cw7, DR4, DR7, DRw10, Drw15(2) and DQ2 in the MCD group and HLA A31, B8, B13, B17, Cw2, Cw6, Cw7, DRw10 and DRw12 in the non-MCD group were found significantly increased when compared to healthy controls. MCD patients with frequent relapses had higher frequencies of both Cw6 and DR1 (p < 0.005) and MCD patients with infrequent relapses had a higher frequency of Cw7 (p < 0.05). In conclusion, HLA groups may help in the early diagnosis of these variants.

Renal function in pediatric patients with beta-thalassemia major

In patients with beta-thalassemia major, the most important cause of mortality and morbidity is organ failure due to deposits of iron. In this study, the nature of the kidney injury and possible pathogenetic factors were investigated. Seventy children with beta-thalassemia major and 14 age and sex-matched healthy children were involved in the study. Blood and timed urine samples were obtained for hematological and biochemical tests. The mean values of blood urea nitrogen (BUN), serum creatinine, creatinine clearance, serum sodium, urine osmolality, fractional excretion of sodium, potassium, and uric acid were not statistically different between the groups. Serum levels of potassium, phosphorus, and uric acid and the urine volume, high urinary protein to creatinine (UP/Cr), urinary N-acetyl-beta-D-glucosaminidase to creatinine (UNAG/Cr), and urinary malondialdehyde to creatinine, (UMDA/Cr) and the tubular phosphate reabsorption (TRP) values were statistically different between two groups (P<0.05). Increased serum levels of potassium, phosphorus, and uric acid in the patient group were attributed to the rapid erythrocyte turnover. The presence of high UP/cr, UNAG/Cr and UMDA/Cr ratios shows that in these patients with proximal renal tubular damage may be secondary to oxidative lipid peroxidation mediated by the iron overload.

Gangrene after penicillin injection (a case report)

A patient with right lower limb gangrene that developed after penicillin injection is presented. Accidental intraarterial administration of penicillin may cause gangrene necessitating amputation. To avoid this severe complication, every intramuscular injection should be given with meticulous attention to proper technique, with adequate restraint of the patient, and with full knowledge of local anatomy and potential complications.

[The effectiveness of various disinfection methods on the surface of gloved hands]

The gloved hands were contaminated by using E.coli and Pseudomonas aeruginosa Brain Heart Infusion broth cultures and the efficacy of tap water, unmedicated bar soap, benzalkonium chloride 1% (Zefiran), Na-hypochloride 1% and 5%, alcohol 70%, hexachlorophene 3%, hexachlorophene 3% liquid soap (Solu-heks), chlorhexidine 1.5% liquid soap (Savlon), chlorhexidine 4% liquid soap (Hibiscrub), povidone-iodine 10% solution (Betadine and polyod), povidone-iodine 7.5% liquid soap (Betadine and Polyod) were compared onto the gloved hands. Disinfectants were applied for 30, 45 and 60 seconds. It was found that washing time of 30 seconds with chlorhexidine 4% (Hibiscrub) liquid soap or povidone-iodine 7.5% liquid soap (Betadine and Polyod) was required to eradicate all the organisms inoculated from both glove surfaces. Povidone-iodine and chlorhexidine were more effective washing agents than the other disinfectants. In underdeveloped or developing countries and areas where gloves can not easily supplied, it has been suggested that gloved hands could be washed between patient treatments and gloves re-used in dentistry, gynecology and like the other areas of medicine. Chlorhexidine 4% and povidone-iodine 7.5% liquid soaps are recommended as a hand-washing agents in these areas.