Serum oxidized low density lipoprotein levels in preeclamptic and normotensive pregnants.

UNLABELLED: BACKGROUNDS/AIM: The aim of the study was to determine serum lipids and oxidized low density lipoprotein (ox-LDL) levels in preeclamptic pregnants and compare with those of normotensives. MATERIALS AND METHODS: Ox-LDL levels were determined by enzyme linked immunosorbent assay (ELISA); total cholesterol, hight density lipoprotein (HDL)-cholesterol and triglyceride levels were measured by enzymatic colorimetric assay in 26 normotensive and 27 preeclamptic pregnants. LDL and very low density lipoprotein (VLDL) cholesterol was calculated by Friedwald formula. RESULTS: Serum levels of Ox-LDL (U/L), total-cholesterol (mg/dL), HDL-cholesterol (mg/dL), LDL-cholesterol (mg/dL), triglyceride (mg/dL), and VLDL-cholesterol (mg/dL) in normotensive and preeclamptic pregnants were found as 130±60 and 133±69; 248±49 and 248±81; 67±14 and 61±16; 147±61 and 135±59; 207±76 and 256±87; 41±15 and 50±17, respectively. Mean values of Ox-LDL and other lipid parameters were higher than the upper limits of their reference ranges in both of groups. However no significant differences were found in Ox-LDL, total, HDL and LDL-cholesterol levels between two groups. However, the levels of triglyceride and VLDL-cholesterol were significantly higher in preeclampsia group. CONCLUSIONS: The present results suggest that the levels of serum Ox-LDL and other lipid parameters rise as a result of pregnancy rather than as a result of preeclampsia.

Role of nuclear factor kappa-B in phenytoin-induced gingival overgrowth.

OBJECTIVE: This study investigates the expression of transcription factor nuclear factor-kappa B (NF-κB) and its relation to various cellular mediators that act in the pathogenesis of phenytoin-induced gingival overgrowth. MATERIALS AND METHODS: Eighteen epileptic patients had phenytoin-induced gingival overgrowth (PHT-GO), 20 patients with plaque-induced gingivitis (Gingivitis), and 20 periodontally and systemically healthy individuals (Control) were included in this study. The expression of activated NF-κB subunits (p50 and p65), IL-1ß, TNF-α and TGFß-1 levels were examined in the gingival sections obtained from each participant. RESULTS: The results demonstrated a significantly higher expression of p65 in fibroblasts in PHT-GO group with respect to Gingivitis (P < 0.05) and control groups (P < 0.01). However, we found no statistically significant differences between PHT-GO and Gingivitis groups according to the immunohistochemical staining in macrophages (P > 0.05). Immune-reactive TGFß-1 levels in the gingival connective tissue cells were statistically higher in PHT-GO group with respect to Gingivitis group(P < 0.05). Statistically significant correlations were found between the HI and activated TGFß-1 and p65 levels in PHT-GO group. CONCLUSION: The results of this study showed that NF-κB is activated in PHT-related gingival overgrowth. This study may provide a basis for future research into specific NF-κB inhibition for preventing of the side effects of this drug.

Increased serum resistin levels in patients with coronary slow-flow phenomenon.

BACKGROUND: Slow coronary flow (SCF) is an angiographic finding characterized by delayed opacification of the epicardial coronary arteries without obstructive coronary disease. Resistin, an adipocytokine, plays a major role besides low-grade inflammation in atherosclerotic vascular processes and may be of importance in other coronary pathologies such as SCF. METHODS: The present study was cross-sectional and observational, consisting of 70 individuals who underwent coronary angiography and had angiographically normal coronary arteries of varying coronary flow rates. The study included 50 patients with isolated SCF and 20 control participants with normal coronary flow (NCF). RESULTS: There were no statistically significant differences between the SCF and NCF groups with respect to age, gender, presence of hypertension or diabetes mellitus, and smoking habit, except for increased creatinine levels (p = 0.014). The serum resistin level was significantly higher in the SCF group than in the NCF group (8.4 ± 7.2 vs. 5.4 ± 2.6 ng/ml, p = 0.014). Ln-transformed resistin levels correlated positively with left anterior descending (LAD) coronary artery TIMI frame count (TFC) (r = 0.408, p < 0.001) as well as with glucose (r = 0.340, p = 0.004), creatinine (r = 0.248, p = 0.044), and C-reactive protein (CRP; r = 0.283, p = 0.023) levels, and negatively with LAD coronary flow velocity (r = - 0.314, p = 0.009). When multivariate analyses were performed, in linear regression analysis, ln-resistin was associated with a longer TFC [beta (standardized regression coefficient): 0.404, p = 0.001] and lower coronary flow velocity (beta: - 0.280, p = 0.035); in logistic regression analysis, ln-resistin was an independent predictor of the presence of SCF (OR: 6.692, 65 %CI: 1.117-40.1, p = 0.037). CONCLUSION: We demonstrated, for the first time, a significant increase in serum resistin levels in patients with SCF compared to subjects with NCF. We believe that further studies are needed to clarify the role of resistin in patients with SCF.

Comparision of inflammatory biomarkers for detection of coronary stenosis in patients with stable coronary artery disease.

BACKGROUND: The objective of the current study was to evaluate the role of various inflammatory biomarkers in detection of coronary stenosis in patients with stable coronary artery disease (CAD) and healthy people. METHODS: A total of 111 patients with stable coronary artery disease, and 66 healthy subjects were enrolled in the study. Serum levels of lipoprotein-associated-phospholipase A2 (Lp-PLA2), high-sensitivity C-reactive protein (hs-CRP), and myeloperoxidase (MPO) were measured to compare patient and control groups. RESULTS: Baseline characteristics were similar between healthy and patient groups, with the exception of age. ANCOVA and log-transformed data of inflammatory biomarkers revealed that, Lp-PLA2 (p < 0.001) and hs-CRP (p < 0.05) levels in all patient groups were significantly higher than in the control group. Conversely, there was no significant difference in MPO levels among groups. CONCLUSIONS: In stable CAD patients, serum Lp-PLA2 levels are more compatible than hs-CRP and MPO levels in the detection of coronary stenosis.      

Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study.

Roughness on tooth surfaces is reported to facilitate the reestablishment of microbial dental plaque. Hence, the main goal of dental scaling is to remove bacterial plaque and obtain smoother tooth surfaces. This study was aimed to assess the influence of tip wear of ultrasonic scaler inserts on root surface roughness at different working parameters. Twenty piezoelectric ultrasonic scaler inserts (10 worn/10 new) were selected to examine the erosion ratio (ER) on the scaler tips and to assess the influence of tip wear on root surface roughness. Erosion on the tip surfaces was evaluated under atomic force microscopy (AFM). Root samples were prepared and instrumented by new (Group I) and worn (Group II) inserts at different working parameters. Roughness change (Rc) on root surfaces after instrumentation was examined under profilometer and compared between and within the groups. Statistically significant differences were found between the mean ERs of new and worn tips (P < 0.01). The results of this study showed that tip angulation and instrument power strongly influenced the Rc values on instrumented samples (P < 0.05). It was also revealed that tip wear influenced the Rc values on root surfaces especially at 45° tip angulation (P < 0.05). Therefore, tip wear should also be considered as much as the other parameters to minimize the surface roughness during ultrasonic treatment.

Late results of patients undergoing remedial operations for alkaline reflux gastritis syndrome.

PURPOSE: Many different remedial operations for alkaline reflux gastritis have been described. Analysis of their efficacy is difficult, because while many of the procedures have good early results, there are long-term failures due to their own complications. The aim of this study is to evaluate our experience with patients undergoing remedial operations for alkaline reflux gastritis syndrome. MATERIAL AND METHODS: The clinical features and results of remedial operations of 65 patients with alkaline reflux gastritis syndrome were reviewed retrospectively. Data on the hospital course were collected by interviewing patients directly or by telephone contact. An assessment of each patient's response to remedial operation was then made and a Visick score assigned. RESULTS: All patients had been tried on a medical treatment and dietary restriction or both prior to remedial operation. Long-term follow up was possible in 46 patients. Seventy-six percent of patients who at the final state had a truncal vagotomy, distal gestrectomy and Roux-en-Y gastrojejunostomy have been found to show satisfactory results (Visick-I/Visick II). Three patients who had previously undergone a Roux-en-Y conversion later required re-operation for Roux-stasis syndrome and a near-total gastrectomy was performed on these patients. Other operations performed for alkaline reflux gastritis were converted to "uncut" Roux-en-Y in five patients and dismantling of gastrojejunostomy in two patients. CONCLUSIONS: For patients unresponsive to medical treatment, we reccommend the following strategy: a) for patients with truncal vagotomy plus gastrojejunostomy, dismantling of gastrojejunostomy should be the first choice b) for patients with prior Billroth-II gastrectomy, Roux-en-Y conversion is the most effective corrective operation, although it has its proper including Roux statis syndrome.

Relationship between periodontal parameters and Behçet's disease and evaluation of different treatments for oral recurrent aphthous stomatitis.

BACKGROUND AND OBJECTIVE: The highest prevalence of Behçet's disease (BD) has been reported in Turkey, and therefore research of relations between BD and other disorders have become important in the Turkish population. Since oral aphthous ulcers impair tooth brushing, reducing complaints about aphthous ulcers will motivate the patient to maintain better oral hygiene performance and will thus reduce plaque accumulation and periodontal scores. The purpose of this controlled case study was to evaluate the relationship between the severity of periodontal scores and Behçet's disease, and to compare the treatment modalities with neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and medication on the recurrent aphthous ulcers in BD patients by considering the degree of pre- and post-treatment pain, discomfort and functional complications. MATERIAL AND METHODS: The periodontal status of 28 BD patients was evaluated according to periodontal indices. The BD patients were also assessed for clinical severity score as described previously. Levels of pre- and post-treatment pain and functional complications were assessed at patient visits on days 1, 4 and 7. RESULTS: Periodontal indices, the number of oral ulcers and the daily frequency of tooth brushing were related to the severity scores of BD (p < 0.001). The results indicated that BD patients treated with the Nd:YAG laser had less post-treatment pain and fewer functional complications and reported immediate relief of pain and faster healing (p < 0.001). CONCLUSION: Our results suggest that periodontal status is worse in BD patients and is associated with disease severity; also, the Nd:YAG laser has better patient acceptance, shorter treatment time and lower rates of pain and post-treatment adverse events among BD patients with oral recurrent aphthous stomatitis.

The comparison of the effects of three types of piezoelectric ultrasonic tips and air polishing system on the filling materials: an in vitro study.

AIM: The aim of this study was to evaluate the effect of air polishing and different ultrasonic scaler inserts on dental fillings, such as amalgam, composite and porcelain. MATERIALS AND METHODS: This study was performed on amalgam, composite and porcelain samples. The surfaces of the samples were exposed to different type of piezoelectric ultrasonic scaler inserts and air-abrasive unit. The scaler inserts were Instrument A, Instrument PS and PI. The roughness of the surfaces of each sample were measured with a profilometer and observed by stereomicroscope. RESULTS: The stereomicroscopic images and profilometric values showed that Instrument A and PS resulted in rough surfaces, such as chips, nicks and scratches on the amalgam, composite and porcelain surfaces. The Instrument PI roughened the amalgam surface, but it did not roughen the porcelain or composite surfaces. The profilometric measurements (Ra) showed that the roughness of the surfaces depending on air polishing was less than the ultrasonically scaled surfaces. CONCLUSION: The wrong tip applications during dental scaling procedure cause roughness, such as scratches, nicks or chips, not only on the teeth surfaces but also on the filling materials. Thus, dental scaling procedure on the restorations should be performed carefully and the roughness sites on the restorations have to be re-polished after scaling to prevent plaque accumulation.

Sonic and ultrasonic scalers in periodontal treatment: a review.

Periodontal therapy aims at arresting periodontal infection and maintaining a healthy periodontium. The periodic mechanical removal of subgingival microbial biofilms is essential for controlling inflammatory periodontal disease. Mechanical periodontal therapy consists of scaling, root planing and gingival curettage. The sonic and ultrasonic scalers are valuable tools in the prevention of periodontal disease. The vibration of scaler tips is the main effect to remove the deposits from the dental surface, such as bacterial plaque, calculus and endotoxin. However, constant flushing activity of the lavage used to cool the tips and cavitational activity result in disruption of the weak and unattached subgingival plaque. The aim of the study was to review the safety, efficacy, role and deleterious side-effects of sonic and ultrasonic scalers in mechanical periodontal therapy.

Reactive oxygen species and human inflammatory periodontal diseases.

Reactive oxygen species (ROS) have emerged as important signaling molecules in the regulation of various cellular processes. They can be generated by the mitochondrial electron transport chain in mitochondria and activation of polymorphonuclear leukocytes (PMN) during inflammatory conditions. Excessive generation of ROS may result in attack of and damage to most intracellular and extracellular components in a living organism. Moreover, ROS can directly induce and/or regulate apoptotic and necrotic cell death. Periodontal pathologies are inflammatory and degenerative diseases. Several forms of periodontal diseases are associated with activated PMN. Damage of tissues in inflammatory periodontal pathologies can be mediated by ROS resulting from the physiological activity of PMN during the phagocytosis of periodontopathic bacteria.

Is laparotomy necessary in the diagnosis of fever of unknown origin?

Fever of unknown origin (FUO) is a diagnostic challenge for the practising physician. Detailed medical history, physical examination, non-invasive laboratory tests, and radiologic examinations compose the first level in the diagnostic approach to the FUO. When a diagnosis cannot be established with these procedures, some invasive diagnostic techniques and finally exploratory laparotomy are performed. Although advanced diagnostic measures and imaging-guided less invasive procedures have decreased the need, laparotomy remains as a final diagnostic method for FUO cases. In this study we evaluate the role and importance of laparotomy in the diagnosis of our FUO cases. In 17 out of 126 patients (8 male, 9 female, the median age 35.8 years) hospitalized in our clinic between 1982 and 2002 with the diagnosis of FUO, the diagnosis was established by laparotomy. The diagnosis was made directly in 13 patients, and indirectly (by excluding other diseases) in 2 patients. In several FUO series, the contribution of laparotomy to the diagnosis of FUO was reported as 27-100%. This rate was found to be 88% in the present study. During laparotomy on 17 cases, tissue samples were taken from spleen, liver, intra-abdominal and mesenteric lymph nodes. Pathologic examination of these tissue samples revealed miliary tuberculosis in 4; non-Hodgkin's lymphoma in 3; Hodgkin's lymphoma in 3; liver tumour in 1; hairy cell leukemia in 1; peritonitis carcinomatosis in 1. In the patients with miliary tuberculosis, the liver (3) and/or spleen (2), and/or lymph node (3) revealed caseating granulomas. Laparotomy diagnosed 3 of 5 cases whose abdominal ultrasonography and computerized tomography were normal. In conclusion, although advanced diagnostic methods decreased the need for laparotomy in FUO, if non-invasive and invasive diagnostic measures fail, laparotomy may contribute to the diagnosis. The selection of the patient and the timing are important for laparotomy.

Gingival necrosis following the use of a paraformaldehyde-containing paste: a case report.

AIM: To report on an unusual case of gingival necrosis following the use of a paraformaldehyde-containing paste in root canal treatment. SUMMARY: Paraformaldehyde preparations are toxic to hard and soft tissues. In an era of effective local anaesthesia, toxic devitalizing preparations have few applications. However, in a mobile world population, severe tissue injury may occasionally be encountered after the use of paraformaldehyde or other toxic agents in some parts of the world. Dentists should avoid such preparations and be alert of the features and management of local toxicity if they encounter it in practice. KEY LEARNING POINTS: Paraformaldehyde-containing pastes have no application in contemporary dentistry. Dentists should avoid toxic preparations for pulp devitalization. Dentists should be aware of the features and management of tissue necrosis resulting from the use of toxic dressing materials.

Analysis of clinicopathological prognostic parameters in adenocarcinoma of the gastric cardia.

BACKGROUND: The optimal extent of resection for carcinoma of gastric cardia remains a subject of controversy. Although both total gastrectomy (TG) and proximal gastrectomy (PG) have their own advantages, similar survival rates were given for both. The main aim of this study is to investigate whether the extent of resection is an important prognostic factor in carcinoma of the gastric cardia. METHOD: Records of 60 patients with carcinoma of gastric cardia, operated on between the January 1989-January 1993 at Istanbul University, Cerrahpasa Medical Faculty Department of General Surgery, were reviewed retrospectively. The relationship between clinico-histopathological variables and 5-year survival was retrospectively analysed. RESULTS: Of the 14 clinico-histopathological variables, eight (age, local invasion, grade, lymphatic micro-invasion, depth of penetration, lymph node involvement, type of operation and stage of disease) were found to have a significant influence on survival. Among those clinico-histopathological variables that influenced 5-year survival on univariate analysis, only age (p = 0.0029) and depth of tumour penetration (p = 0.008) independently affected survival. CONCLUSION: According to our results, depth of tumour penetration and age are the only variables which were found to independently affect 5-year survival. Depth of tumour penetration may serve as a potential marker for a biologically more aggressive tumour. The extent of resection (TG vs. PG) does not affect the long-term survival of the adenocarcinoma of the cardia.

Evaluation of gingival recession in left- and right-handed adults.

Recession is the exposure of the root surface by an apical shift in the position of the gingiva. Several factors have been implicated in the etiology of gingival recession. The aim of this study was to assess the relationship between gingival recession and the hand, right or left, duration, frequency, and technique of tooth brushing in left- and right-handed adults in Erzurum, Turkey. Fifty five left-handed (35 female and 20 male) and 55 right-handed (35 female and 25 male) subjects were included in the study. The left and right hand positions of the subjects were determined by using Oldfield's Edinburg Inventory Index, and they were divided into two groups as left-handed and right-handed. The amount of gingival recession and localization, oral hygiene situations, gingival bleeding, toothbrushing duration, frequency, and techniques of subjects were evaluated. The relationship between the amount of gingival recession and localization and the subjects' hand, duration, frequency and technique of tooth brushing were examined. The data were evaluated with variance analysis and student's t test. The oral hygiene situations in right- and left-handed subjects were determined. On comparing the left-handed subjects with the right-handed ones, it was observed that the left-handed subjects had better oral hygiene than the right-handed. But, this case was not statistically significant (p > .05). In both right-handed and left-handed subjects, women had better oral hygiene than men (p < .01). The rate of gingival recession was found more in the left-handed than in the right-handed (p < .05). In the right-handed subjects, gingival recession was found in the premolar and canine regions of upper right and lower right jaw. A similar result was also observed in the left-handed subjects, because gingival recession was seen on their upper left and lower left jaw. Incisive teeth were affected at the same rate in the left-handed and right-handed. The gingival recession was seen more in maxillary jaw than in mandibular jaw in both groups. A statistically significant relationship between gingival recession and frequency duration, and technique of tooth brushing was found. While the greatest amount of gingival recession was found in horizontal scrub technique, gingival recession increased with increasing tooth brushing duration and frequency. The relationship between gingival recession and hand using in tooth brushing was determined.

Colorectal cancer in patients younger than forty years of age.

The records of the General Surgery Department of the Cerrahpasa Medical Faculty of 10 years duration (1981-1991) were studied retrospectively to determine prognostic factors in colorectal cancer patients younger than 40-year old. Fifty patients between the ages of 10-39 were identified. The family history was positive in 7 of the 50 patients. We found Hematochezia (60%), abdominal pain (64%), alterations in bowel movements (60%) among the presenting symptoms. The pathologic examination revealed no patients in Dukes Stage A, 14 patients in stage B (28%), 36 patients in stage C and D (72%). Distant metastases were present in 10%. Mucinous adenocarcinoma was found in 40% of the patients in whom an histological differentiation could be made. The 5-year survival rate was 25.7% and the 5-year disease free survival rate was 17.1% in the patients who were followed up. The mean survival was 30 months. Poor prognostic factors were Dukes Stages C and D, sex, age, mucinous/nonmucinous histology, tumour differentiation and grade. Patients presenting with one or more of the symptoms above should be carefully examined for colorectal cancer regardless of age because of the importance of delay and presentation with progressive disease on survival. Colorectal cancer is the second leading cause of cancer in the U. S. A. Although colorectal cancer is a disease of older group of patients, the incidence of colorectal cancer in younger patients is being increasingly reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Intestinal perforation due to phytobezoar obstruction.

Phytobezoars are rare causes of acute abdomen cases. Here we are reporting two cases which were presented with acute abdomen symptoms and later were found to be small intestinal perforation due to bezoar.