The effect of pretreatment submucosal injections of tramadol and dexamethasone on post-endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized controlled clinical trial.

AIM: To establish the effects of submucosal single doses of two medicines on postoperative pain after root canal treatment in mandibular molar teeth with symptomatic irreversible pulpitis. METHODOLOGY: In this randomized controlled, double-blind clinical trial, 90 patients with the diagnosis of symptomatic irreversible pulpitis in their mandibular first or second molars were included and randomly divided into three groups (n = 30): a control group that received normal saline and two experimental groups that received a single dose of either tramadol (100 mg 2 mL-1 ) or dexamethasone (8 mg 2 mL-1 ). After local anaesthesia and before treatment, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars, and a routine single-visit root canal treatment procedure was performed in all groups. After the root canal treatments, the patients were asked to score their pain level using the Heft-Parker visual analogue scale (0-170 mm) at 6, 12, 24, 48 and 72 h. The experimental groups were compared using one-way anova or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using Student's t-test or the Mann-Whitney U-test. The findings were expressed as the mean ± standard deviation or median (min-max). The categorical variables were tested using the chi-square test or Fisher's exact chi-square test, and the results were expressed as counts and percentages. RESULTS: At the 6-h and 48-h time intervals, the intensity of pain was significantly less in both the dexamethasone and tramadol groups than in the control group (P < 0.0167). At the end of 12 h, the pain level in the dexamethasone group was significantly less compared to the other groups (P < 0.0167). CONCLUSIONS: Pretreatment submucosal dexamethasone and tramadol injections significantly diminished post-treatment endodontic pain of patients with symptomatic irreversible pulpitis following single-visit root canal treatment. However, dexamethasone was more effective than tramadol in pain reduction in the first 12 h.

Evaluation of patient perceptions after frenectomy operations: A comparison of neodymium-doped yttrium aluminum garnet laser and conventional techniques in the same patients.

BACKGROUND: The aim of the present study was to compare the level of postoperative discomfort between labial frenectomy done by neodymium-doped yttrium aluminum garnet (Nd: YAG) laser and the conventional technique and evaluate the differences in the levels of postoperative pain and functional complications such as eating and speaking between these two methods. MATERIALS AND METHODS: Forty patients requiring labial frenectomy in both jaws were included in the study. One side of each patient was treated with laser, whereas the other side was treated with the conventional technique and all surgeries were performed by the same surgeon. Postoperative pain and functional complications were evaluated for each patient and recorded using a visual analog scale on the operation day and postoperative 1, 3, 7 and 10 days. RESULTS: The results indicated that patients treated with the Nd: YAG laser had lower levels of postoperative pain and were more comfortable while chewing and speaking at the operation day and postoperative 1st day (P < 0.05). CONCLUSION: The results suggest that Nd: YAG laser application during oral soft-tissue surgery provides better patient perceptions and less postoperative pain compared to conventional surgery.

Hybrid seton for the treatment of high anal fistulas: results of 128 consecutive patients.

BACKGROUND: The aim of this study was to evaluate our experience in managing high anal fistulas with a simple modification of the cutting seton. METHODS: We performed a retrospective review of standardized patient charts and of prospectively collected scores and questionnaires. Surgical outcomes of 128 consecutive, well-documented patients with high anal fistulas, including anterior transsphincteric fistulas in females, treated using a hybrid seton, were analyzed. RESULTS: No significant complications occurred. The mean postoperative pain scores on a visual analog scale were 3.23 and 0.61, on days 1 and 7, respectively. Complete healing was achieved in 67 cases (52.3 %) at 1 month and in all cases (100 %) at 3 months. Recurrent fistula was noted in 2 patients (1.5 %) at 6 and 12 months. The mean postoperative incontinence scores at 3 and 12 months did not differ significantly from the preoperative score (p = 0.061, Wilcoxon's test). The depression, life style, and embarrassment item scores of the fecal incontinence quality of life index improved significantly after surgical treatment. CONCLUSIONS: The results of this series suggest that the hybrid seton might be a valid alternative for the treatment of high anal fistulas, eliminating the need for postoperative adjustments. The slow and stable cutting of the sphincter seems to have a positive effect on the maintenance of continence. The successful outcome is associated with significant improvement in quality of life.

Treatment for horseshoe fistula with the modified Hanley procedure using a hybrid seton: results of 21 cases.

BACKGROUND: The aim of the present study was to document our recent experience in managing horseshoe fistula of cryptoglandular origin with a modification of the Hanley procedure using a hybrid elastic one-stage cutting seton. METHODS: Surgical outcomes of the modified Hanley procedure for horseshoe fistulae using a seton from 2004 through 2010 were analyzed. The seton fashioned from a surgical glove was tied around the sphincter under less tension than a traditional cutting seton, hence the definition of "hybrid seton". In addition to excision of the superficial segments of the lateral tracts, deeper extensions into the ischiorectal spaces were curetted, and Penrose drains were placed. RESULTS: All of the patients were discharged on the first postoperative day. None required readmission or needed narcotic analgesics after discharge. Complete healing was achieved in all 21 cases at 8.0 ± 3.22 weeks postoperatively. Patients were able to return to regular work activity in 3.5 ± 1 weeks. The postoperative Cleveland Clinic Incontinence Score did not differ significantly from the preoperative score (p = 0.317, Wilcoxon's test). Recurrent fistula was noted in a single patient (4.8 %) after a mean follow-up of 20.9-months. CONCLUSIONS: The use of the hybrid elastic seton is a useful and safe additional modification for the treatment of horseshoe fistulae with the Hanley technique.

Comparison of two different suture knot techniques on postoperative morbidity after impacted mandibular third molar surgery.

INTRODUCTION: In third molar surgery, one of the most important factors is how the wound was closed. Tight suturing of the wound commonly gives more discomfort to the many patients in terms of postoperative pain, swelling and trismus. The purpose of this study is to investigate the effects of two different knot techniques in suturing after extraction of impacted mandibular third molars (IMTM) on quality of life and postoperative complications such as pain, swelling and trismus. MATERIAL AND METHODS: This study was conducted with a randomized and split-mouth design and included 50 patients over the age of 18 in the ASA I group who had bilateral horizontal impacted mandibular third molars. In all patients, the wounds were closed by simple sutures by applying two different knot techniques as locked (GroupL, n=50) and unlocked (Group UL, n=50) knots. In the postoperative period, pain, swelling, trismus, chewing activity and quality of life were examined. RESULTS: In the group where the unlocked knotting technique was used, significantly better results were obtained in comparison to the group where the locked knotting technique was used for all values (P<0.05). CONCLUSION: In preventing postoperative complications that are observed after impacted mandibular third molar surgery and affect the quality of life of patients negatively, suturing of the wound by the method of unlocked knotting is a useful technique that may be preferred.

Impact of body mass index on cancer development.

PURPOSE: To determine the impact of body mass index (BMI) on cancer in a hospital-based Turkish population. PATIENTS AND METHODS: The study group consisted of 2015 (1172 females: 423 pre- and 749 postmenopausal; and 843 males) patients with histologically proven cancer who applied to Marmara University Medical School, Medical Oncology Clinic. The control group included 305 healthy caregivers (192 females: 110 pre- and 82 postmenopausal; and 113 males). RESULTS: Mean BMI of the patients with breast, ovarian and cervical carcinoma was significantly higher than that of the healthy female controls (p<0.001, 0.003, <0.001, respectively). Postmenopausal breast cancer patients had significantly higher BMI than postmenopausal female controls (odds ratio [OR] 1.3; 95% confidence interval [CI], 1.06-1.6; p=0.012), while this was not seen in premenopausal patients. When compared with controls obese postmenopausal female patients had 3.26-fold (95% CI 1.54-6.90) increased risk for breast cancer (p=0.002). Mean BMI of lung, stomach, esophagus, pancreas and head and neck carcinoma patients was significantly lower than that of the healthy controls. Female patients with lung and colorectal carcinoma had higher BMI than female controls. CONCLUSION: Elevated BMI might be a risk factor for breast cancer in postmenopausal women. Case-control studies may not show the actual association between BMI and cancers that present with pre-diagnosis weight loss and advanced stage.

Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia.

AIM: To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia. SUBJECTS AND METHOD: Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptive meloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded RESULTS: No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti-inflammatory drug was also found to be significantly lower (p = 0.0001). CONCLUSION: Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia. It thereby improves patients comfort and should be considered for use in outpatient surgery.

Paraoxonase and acetylcholinesterase activities in humans exposed to organophosphorous compounds.

Different kinds of organophosphorous compounds (OP) are used as pesticides in Turkish agriculture. Suicidal, accidental, or occupational exposure may occur in developing countries. OP inhibit acetylcholinesterase (AChE) activities; on the other hand, serum paraoxonase (PON1) hydrolyzes the toxic metabolites of a variety of OP. In recent years, some studies have shown that PON1 activity is an important marker in individuals who are exposed to OP. Both serum cholinesterase and PON1 activities were measured spectrophotometrically from 18 male agricultural workers who were chronically exposed to azinphos methyl, chlorpyriphos, or malathion and other pesticides during cereal spraying, transportation, and storage. The individuals were classified according to PON1 phenotypes using the antimode 60% stimulation method to determine the dividing point between non-salt-stimulated, A type (homozygotes for the low-activity allele), and salt-stimulated AB (heterozygotes) and B types (homozygotes for the high-activity allele). A positive correlation was found between AChE activities and percent of PON1 stimulation. The individuals with phenotype A had the lowest enzyme activities. This study suggests that individuals with phenotype A might be more sensitive to OP-induced toxicity.

Human serum paraoxonase (PON1) activity in acute organophosphorous insecticide poisoning.

Human serum paraoxonase (PON1) and perhaps other mammalian paraoxonases catalyzes the hydrolysis of certain organophosphorus (OP) insecticides and nerve gases and so may alter significantly an individual's susceptibility to the toxicity of these chemicals. Serum PON1 exhibits a substrate dependent polymorphism and this polymorphism shows great interethnic variability. This study focused on the investigation of PON1, arylesterase and cholinesterase activities in 28 acute OP insecticide poisoning cases. Insecticide analysis were performed by GC-NPD and activities of enzymes were measured by using spectrophotometer. The activity levels for salt stimulated PON1, basal PON1 and arylesterase were found as 78.83 (35.39-186.13), 39.97 (2.49-80.43) micromol/min/l and 126.26 (36.34-288.24) mmol/min/l respectively. On the other hand the activity levels for butyrylcholinesterase (BTC) and acetylcholinesterase (AchE) were found as 797.23 (106.3-3823)U/l and 4.65 (0.21-30.29)U/ml. There was a correlation between percent stimulation of PON1 and BTC activities (r=0.446, P<0.05), but this correlation was lower than in cases who exposed to OP insecticides chronically. As a conclusion, in chronic and acute OP exposure, both PON1 level and phenotype must be taken into consideration.

Congenital heart disease and Robinow syndrome.

We present a 6-month-old infant with Robinow syndrome and tricuspid atresia (type Ia). Up to now, at least 67 cases of Robinow syndrome have been published including nine cases with a congenital heart defect (CHD). As in our case, the majority of the CHD were right ventricular outflow obstruction. Robinow syndrome with CHD is not rare and in all cases of Robinow syndrome detailed cardiologic evaluation and echocardiography should be performed.

Screening for diabetic retinopathy using computer based image analysis and statistical classification.

Diabetic retinopathy is one of the most common causes of blindness in Europe. However, efficient therapies do exist. An accurate and early diagnosis and correct application of treatment can prevent blindness in more than 50% of all cases. Digital imaging is becoming available as a means of screening for diabetic retinopathy. As well as providing a high quality permanent record of the retinal appearance, which can be used for monitoring of progression or response to treatment, and which can be reviewed by an ophthalmologist, digital images have the potential to be processed by automatic analysis systems. We have described the preliminary development of a tool to provide automatic analysis of digital images taken as part of routine monitoring of diabetic retinopathy in our clinic. Various statistical classifiers, a Bayesian, a Mahalanobis, and a KNN classifier were tested. The system was tested on 134 retinal images. The Mahalanobis classifier had the best results: microaneurysms, haemorrhages, exudates, and cotton wool spots were detected with a sensitivity of 69, 83, 99, and 80%, respectively.

Using the internet in patient-centred diabetes care for communication, education, and decision support.

The New England Journal of Medicine 329 (1993) 977- The present paper describes two systems for communication, education, and decision support in patient-centred diabetes care. Both systems are developed under the assumption that while the clinical resources in the health care sector are limited, patients' resources and new information technology may be able to play a much more central role. With DiasNet patients can experiment with their own data. They can, retrospectively, adjust insulin doses or meals sizes, and thereby learn how to cope with various situations. DiabVision, brings together algorithms for detection of retinal lesions in digital images and for aligning time series of retinal images. While the former algorithms are aimed at automated procedures for screening for diabetic retinopathy, the latter can be used to enable motivated patients to see the actual retinal lesions in their own eyes, illustrating how the changes appear, and perhaps disappear, as a consequence of changes in lifestyle and glycaemic control. One of the long-term goals of our work is to assess the potential of integrating all health related information for patients with diabetes and other major chronic diseases. One solution to these problems would be to organise data and information as one virtual database, which then could be accessed by both health professionals and by patients. This structure would facilitate easy access, a clear overview, and quality control. A web site taking the first step in this process has been launched.

The relation between pure papillary and follicular variant in papillary thyroid carcinoma.

OBJECTIVE: Pure papillary thyroid carcinoma and the follicular variant papillary thyroid carcinoma are the most common subtypes of papillary thyroid carcinoma. The aim of this study was to investigate the effects of prognostic factors of these two subgroups in our series. PATIENTS AND METHODS: Histopathological type of carcinoma was retrospectively revised in 199 patients who were then divided according to such type. Patients' age and gender as well as the size and multicentricity of tumor, association with Hashimoto's thyroiditis, serum thyroglobulin and anti-thyroglobulin antibodies levels, metastatic lymph node and distant metastases status for both groups were evaluated. RESULTS: Gender, size, multicentricity of tumor, serum thyroglobulin and anti-thyroglobulin levels were similar in both groups. It was found that, although the tumor size of pure papillary thyroid carcinoma was smaller than that of follicular variant papillary thyroid carcinoma, lymph node metastases occurred more frequently when both subgroups were examined. CONCLUSION: The pathological and clinical signs of pure papillary thyroid carcinoma and follicular variant papillary thyroid carcinoma were found similar. According to these results, this study does not support the literature which claims that follicular variant papillary thyroid carcinoma is more aggressive than pure papillary thyroid carcinoma. Moreover, it could be assumed that the number of patients who are diagnosed as pure papillary thyroid carcinoma may be higher when associated with Hashimoto's thyroiditis.

Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia

Aim: To investigate the effect of the administration of a single dose of meloxicam pre-emptively on postoperative pain management in patients who underwent inguinal hernia repair under local anaesthesia. Subjects and Method: Fifty patients who underwent inguinal hernia repair under local anaesthesia during the period November 2005 to May 2006 were recruited into the study prospectively. The patients were randomized to two groups regarding administration and non-administration of pre-emptivemeloxicam. The postoperative visual analogue pain scale (VAS) values at 4, 8, 12 and 24 hours and analgesic needs of the patients were recorded. Results: No difference was found between the groups in terms of age, gender, hernia localization and type. The VAS values of the patients regarding their pain severity were evaluated at 4, 8, 12 and 24 hours and were significantly lower in the group which received meloxicam pre-emptively (p = 0.001, 0.0001, 0.003 and 0.0001 respectively). The need for non-steroidal anti- inflammatory drug was also found to be significantly lower (p = 0.0001). Conclusion: Postoperative pain severity and hence analgesic requirement were significantly decreased in the patients who received meloxicam pre-emptively. Single dose pre-emptive meloxicam seems to be an effective analgesic therapy for patients undergoing inguinal hernia repair under local anaesthesia.It thereby improves patients comfort and should be considered for use in outpatient surgery.

Objetivo: Investigar el efecto de la administración de una dosis de meloxicam de forma preventiva enel tratamiento del dolor postoperatorio en pacientes sometidos a una reparación quirúrgica de hernia inguinal bajo anestesia local. Sujetos y Métodos: Cincuenta pacientes que tuvieron una reparación de hernia inguinal bajo anestesia local durante el período de noviembre de 2005 a mayo de 2006, fueron reclutados para el estudio demodo prospectivo. Los pacientes fueron divididos aleatoriamente en dos grupos, partiendo del criterio de la administración o no administración de meloxicam de modo preventivo. Se registraron los valores de la escala visual-analógica (EVA) para el dolor postoperatoria a las 4, 8, 12 y 14 horas, así como las necesidades analgésicas de los pacientes. Resultados: No se hallaron diferencias entre los grupos en relación con la edad, el género, lalocalización y el tipo de hernia. Los valores de la EVA de los pacientes con respecto a la severidad de su dolor, fueron evaluados a las 4, 8, 12 y 24 horas, y resultaron ser significativamente más bajos en el grupo que recibió meloxicam de forma preventiva (p = 0.001, 0.0001, 0.003 y 0.0001 respectivamente). También se halló que la necesidad de un medicamento anti-inflamatorio no ester-oidal era significativamente más baja (p = 0.0001). Conclusión: La severidad del dolor postoperatorio y por lo tanto la necesidad de analgésicos, experimentaron una disminución significativa en los pacientes que recibieron meloxicam de forma preventiva. La dosis sencilla de meloxicam de forma preventiva parece ser una terapia analgésica efectiva para pacientes que han sido sometidos a reparación quirúrgica inguinal con anestesia local. Su aplicación mejora el alivio de los pacientes, y debe tenerse en cuenta su uso para la cirugía ambulatoria.