Importance of knowledge of the management of traumatic dental injuries in emergency departments.

BACKGROUND: Hospital emergency departments (EDs) are confronted with managing dental emergencies of both traumatic and non-traumatic origin. However, the literature suggests inadequate knowledge of the management of traumatic dental injuries (TDIs) among medical professionals. The aim of this study was to investigate the knowledge and attitudes regarding management of TDIs among Istanbul ED physicians. METHODS: Surveys were distributed to emergency departments (ED) directors and their physicians. The survey contained questions about their characteristics and tested their knowledge of managing dental trauma. RESULTS: A total of 126 surveys (13 ED directors and 113 physicians) were returned and included in the analysis. ED physician's knowledge of the appropriate management of crown fractures and avulsion was generally good (p=0.221), but poor for luxation injuries (p=0.0001). Physicians were more likely to have a better knowledge about permanent teeth than about primary teeth (p=0.027). CONCLUSION: Education, monitoring, improved availability of resources, and disciplinary measures in cases of poor compliance are necessary to improve TDI management in hospitals, especially among physicians.

Multiple plastic biliary stent placement in the management of large and multiple choledochal stones: single center experience and review of the literature.

INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is the first step treatment modality of choledocholithiasis. In spite of an extended sphincterotomy, 10-15% of complex choledochal stones (larger than 15 mm and/or more than 3 stones) cannot be removed and recurrent ERCP procedures may be needed. AIM: To evaluate the role and efficiency of multiple biliary stent application in the treatment of large and multiple choledochal stones. MATERIAL AND METHODS: Patients with complex choledochal stones and patients with inadequate choledochal clearance during ERCP were included in the study. The study group was divided into 2 groups as the placement of single (n = 27 patients) or multiple stents (n = 58 patients). After a mean time interval of 21 days (10-28), the ERCP procedure was tried for the second time and a stent was placed in case of recurrence. RESULTS: Successful biliary drainage was provided in both groups. The decrease in the longitudinal or transverse size of the stones after stent placement was found to be statistically significant in both groups (p = 0.001). Cholestatic enzymes (alkaline phosphatase (ALP), γ-glutamyltransferase (GGT)) and bilirubin levels decreased significantly in both groups following stenting (p = 0.001). Additionally, multiple stents functioned as a bridge starting from the first ERCP to full clearance in patients with large and multiple stones which could not be removed at once and saved them from the possible morbidities of an invasive operation. CONCLUSIONS: Endoscopic multiple biliary stent placement should be preferred in the treatment of patients with complex choledochal stones and high rates of co-morbidity, as a safe alternative to surgery.

Comparison of oxidant/antioxidant, detoxification systems in various tissue homogenates and mitochondria of rats with diabetes induced by streptozocin.

OBJECTIVE: Oxidative stress is considered to be the main factor in the development of diabetic complications and tissue injury. our objective was to investigate and compare the oxidant/antioxidant conditions and detoxification mechanisms of the liver, lung, kidney, cardiac tissues, and mitochondria of rats with diabetes induced by streptozocin (STZ). METHODS: Rats with diabetes induced by streptozocin were anesthetized by administering 90 mg/kg ketamine hydrochloride and 3 mg/kg xylazine hydrochloride. Thoracic cavities were incised open; liver, lung, kidney, and cardiac tissues were removed and stored at -70°C. All samples were homogenized and mitochondrial fractions were separated. Total Antioxidant Status (TAS), Total Oxidant Status (TOS), Oxidative Stress Index (OSI), Paraoxonase (PON), Arylesterase, Catalase (Cat), Malondialdehyde (MDA), and Glutathion-S-transferase were measured in each fraction. RESULTS: MDA and TOS levels were significantly increased in liver tissues, and T OS and OSI were increased in the mitochondrial fractions of diabetic rats. These increases were not statistically significant compared to the control group. No significant differences were determined in the antioxidant and GST activities. CONCLUSION: According to our results, oxidative stress has not developed in rats with diabetes induced by streptozocin. The detoxification system was induced; however, this induction did not differ significantly from the controls.

Histological findings of long-term healing of the experimental defects by application of a synthetic biphasic ceramic in rats.

Calcium phosphate ceramics are generally biocompatible and can develop interactions with human recipient bone. Therefore, they can be widely used in the field of periodontology and dentistry. The purpose of this investigation was to assess the long-term histological bone healing results of experimentally created critical size parietal bone defects in rats. Twelve Wistar rats were used in this investigation. Two 6-mm wide, symmetrical, and circular critical size defects were created in each parietal bone of the animals. While the right defects filled with granular implant (Ceraform), the symmetrical defects were taken as controls. Eighteen months after implantation, rats were killed and defects including the biomaterial with surrounding bone was taken for histological examination. Serial histological sections were cut across the defects and stained for the histological analysis. Both control and Ceraform implanted regions contained dense collagenous tissue. In the implantation site, multinuclear giant cells were observed around the material. On the other hand, there were no necrosis, tumour, and infection in the implantation region. There was no statistical difference between the control and ceraform implanted groups when the bone formation results were compared (p > 0.05). In conclusion, the results revealed that this material is biocompatible and does enhance the new bone building despite the long-term observation period. Although this biphasic ceramic shows within the limits of the study as a less resorptive and not osteoconductive properties, it can be considered as a biocompatible bone defect filling material having a limited application alternative in dentistry and medicine.