The effect of Er,Cr:YSGG laser, fluoride, and CPP-ACP on caries resistance of primary enamel.

The aim of this in vitro study was to determine the effect of different remineralization agents and laser on caries resistance of primary enamel. In the study, 150 sound primary molars were used. The initial microhardness values were measured and the teeth were randomly assigned to ten treatment groups (n = 15): no treatment/negative control (C), NaF, APF, fluoride varnish (FV), CPP-ACP, laser (L), L + NaF, L + APF, L + FV, L + CPP-ACP. The microhardness values were measured after the treatments and the pH cycle. The obtained data were analyzed statistically. One sample from each group was examined before treatment, after treatment, and after the pH cycle with a scanning electron microscope. While microhardness values after treatment compared to baseline increased, microhardness after the pH cycle decreased compared to after treatment values in all experimental groups (p < 0.05). In regard to the difference in microhardness after the pH cycle and baseline, there were no statistically significant differences between groups C and NaF and between C and CPP-ACP (p > 0.05). There was a significant difference between groups L and L + FV (p < 0.05), while no significant difference was noted between groups L and L + NaF, L + APF, L + CPP-ACP (p > 0.05). As a conclusion, FV is more effective when used in combination with laser than laser alone. NaF, CPP-ACP, and laser may be insufficient in protecting the primary teeth against acid attacks compared to FV used with laser.

Development of a new instrument for determining the level of chewing function in children.

This study aimed to develop a chewing performance scale that classifies chewing from normal to severely impaired and to investigate its validity and reliability. The study included the developmental phase and reported the content, structural, criterion validity, interobserver and intra-observer reliability of the chewing performance scale, which was called the Karaduman Chewing Performance Scale (KCPS). A dysphagia literature review, other questionnaires and clinical experiences were used in the developmental phase. Seven experts assessed the steps for content validity over two Delphi rounds. To test structural, criterion validity, interobserver and intra-observer reliability, two swallowing therapists evaluated chewing videos of 144 children (Group I: 61 healthy children without chewing disorders, mean age of 42·38 ± 9·36 months; Group II: 83 children with cerebral palsy who have chewing disorders, mean age of 39·09 ± 22·95 months) using KCPS. The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was used for criterion validity. The KCPS steps arranged between 0-4 were found to be necessary. The content validity index was 0·885. The KCPS levels were found to be different between groups I and II (χ(2) = 123·286, P < 0·001). A moderately strong positive correlation was found between the KCPS and the subscales of the BPFAS (r = 0·444-0·773, P < 0·001). An excellent positive correlation was detected between two swallowing therapists and between two examinations of one swallowing therapist (r = 0·962, P < 0·001; r = 0·990, P < 0·001, respectively). The KCPS is a valid, reliable, quick and clinically easy-to-use functional instrument for determining the level of chewing function in children.

Clinical performance of aesthetic restorative materials in primary teeth according to the FDI criteria.

AIM: The purpose of this study is to evaluate the clinical performance of three different restorative materials in primary teeth according to the FDI criteria. MATERIALS AND METHODS: Resin-modified glass ionomer cement, compomer and composite resin restorations (n=93) were made in 31 patients. The restorations were clinically evaluated at baseline, 6th, 12th and 18th month with the FDI criteria. RESULTS: The cumulative survival rate after 18 months was found to be 90.3% for resin modified glass ionomer cement restorations, 100% for compomer restorations and 80.6% for composite resin restorations. Statistically significant increase in surface roughness, colour mismatch, anatomic form loss and marginal deterioration were detected in resin- modified glass ionomer group (p<0.05). The most frequent reason for restoration failure in composite resin group was restoration fractures. CONCLUSIONS: The resin-modified glass ionomer restorations necessitates close follow-up because of the risk of increase in surface roughness, changes in colour and loss in anatomic form and marginal adaptation. The clinical performance of compomer restorations is superior to resin-modified glass ionomer and composite resin restorations in primary teeth.

The relationship between tongue brushing and halitosis in children: a randomized controlled trial.

OBJECTIVE: The study aimed to investigate the clinical and microbiological effects of tongue brushing on malodour in children. SUBJECTS AND METHODS: One hundred and fifty-one caries-free children were included. After clinical evaluation, halitosis was determined by organoleptic assessment and sulphide monitoring. Then, 69 children with high levels of volatile sulphur compounds (VSC) were randomly assigned into two groups (group 1: scaling-polishing + tooth brushing + tongue brushing and group 2: scaling-polishing + tooth brushing), and tongue coating samples were collected for microbiological analysis. After 2 weeks, VSC measurements, organoleptic assessment, clinical evaluations and sample collection were repeated. RESULTS: In both groups, organoleptic scores, VSC levels, gingival index, plaque index (PI), bleeding on probing and Winkel tongue coating index (WTCI) scores decreased after 15 days. However, only the change in WTCI and PI scores showed a statistically significant intergroup difference. The most prevalent anaerobic bacteria were Veillonella spp., Prevotella spp., Fusobacterium spp., and no intergroup difference was observed in terms of colony counts of bacteria. CONCLUSIONS: Tongue brushing did not provide an additional benefit to the treatment for malodour. According to the microbiological culture results, a specific bacterium responsible for halitosis in children could not be identified and more sensitive methods might be used for this purpose.

Assessment of skin photoaging with reflectance confocal microscopy.

BACKGROUND/PURPOSE: Increased interest in antiaging methods, mandates a development of reliable noninvasive technique to assess skin aging. In this study, we aimed to determine the effects of photoaging at histopathologic resolution by means of reflectance confocal microscopy. METHOD: The sun-exposed malar area, the anterior aspect of ear lobule, and the sun-protected posterior aspect of ear lobule had been evaluated in 120 volunteers from different age groups over 10 previously reported and new confocal parameters for skin aging. RESULT: The sun-exposed areas revealed more frequent irregular honeycomb pattern, polycylic papillary contours, coarse collagen, huddled collagen, curled bright structures with higher epidermal thickness, and furrow depth values. However, the incidence of thin reticulated collagen and the number of dermal papillae were statistically higher on the sun-protected posterior aspect of ear lobule. CONCLUSION: Reflectance confocal microscopy is a reliable diagnostic technique for evaluation of skin photoaging with objective criteria. With the new emerging compact models it is possible to scan even the least accessible body parts with no discomfort to the patient, which offers the possibility to assess the effect of antiaging applications and to identify early signs of solar damage in cosmetically sensitive areas.

Incomplete endochondral ossification of the otic capsule, a variation in children: evaluation of its prevalence and extent in children with and without sensorineural hearing loss.

BACKGROUND AND PURPOSE: Endochondral ossification of the otic capsule is a process that continues postnatally; hence, incomplete endochondral ossification is seen as pericochlear hypoattenuation on temporal bone CT scans of children. We determined the prevalence and extent of this entity in a large series and assessed its relation to age and underlying sensorineural hearing loss. MATERIALS AND METHODS: Initially, temporal bone CTs of 40 children with sensorineural hearing loss were retrospectively assessed and compared with those of a control group scanned for non-sensorineural hearing loss reasons to assess any difference in the prevalence or extent of incomplete endochondral ossification. Then the CT scans of 510 children (age range, 17 days to 17 years) were retrospectively reviewed, and any observed endochondral ossification areas were classified as mild, moderate, or extensive, according to their extent. RESULTS: Neither the presence nor degree of incomplete endochondral ossification had any significant correlation with the presence of sensorineural hearing loss (P = .08 and P = .1, respectively). Incomplete endochondral ossification was more frequently seen (62% of cases) than complete ossification. There was no statistically significant correlation between incomplete endochondral ossification and sex (P = .8), but an inverse correlation was found between the presence of incomplete endochondral ossification and increasing age (P < .001). Overall, mild incomplete endochondral ossification was the most frequent involvement pattern (44.4%). CONCLUSIONS: The pericochlear hypoattenuation in the otic capsule representing incomplete endochondral ossification is a normal finding in children and can be seen as a marked curvilinear hypoattenuation at younger ages in the absence of any clinical disorder.

Valve repair for rheumatic mitral disease.

BACKGROUND AND AIM OF STUDY: Mitral valve repair is the standard reparative technique for degenerative mitral disease, but results of valve repair in rheumatic disease are also encouraging. The outcomes after mitral valve repair for rheumatic disease at young age was evaluated for suitability of repair. METHODS: A total of 319 patients (246 females, 73 males; mean age 31.3+/-0.5 years) underwent mitral valve repair for rheumatic mitral disease at the authors' institution between 1991 and 1998. Mean follow up was 51.9+/-1.2 months (range: 9-98 months), and was 88.7% complete. RESULTS: Preoperatively, 47.6% of patients were in NYHA classes III and IV. Mitral stenosis was present in 87.5%, insufficiency in 5.3%, and stenosis/insufficiency in 7.2%. Concomitant procedures were performed in 32% of patients who had associated cardiac lesions. The intraoperative mortality, reoperation and reoperation mortality rates were 0.9%, 6.7% and 0%, respectively. During follow up there were 10 late deaths (3.5%), six of which were cardiac disease-related (2.1%). Postoperatively, 98% of patients were in NYHA classes I and II. CONCLUSION: Valve repair in mitral disease is a standard technique, with low mortality, complication and reoperation rates, and good cardiac function and late survival. This approach is equally applicable to rheumatic mitral valve repair; hence, rheumatic mitral valves should also be repaired.

Clinical results of the ATS prosthetic valve in 240 implants and review of the literature.

BACKGROUND AND AIM OF THE STUDY: Despite having been used in many thousands of implants, few published data exist concerning the ATS valve. Clinical data from ATS valve implants are presented, and the first two cases of mitral valve thrombosis with the ATS valve reported. Published data are also reviewed comparatively. METHODS: Between September 1998 and July 2000, 240 ATS valve prostheses were implanted in 199 patients, of whom 88 (36.6%) had mitral (MVR), 70 (29.1%) aortic (AVR), and 41 (17.1%) double valve replacements (DVR). Additional procedures were performed in 31 patients (15.6%). Transvalvular gradients and effective orifice areas were measured by transthoracic echocardiography. Total cumulative follow up of all patients was 241.6 patient-years (pt-yr); mean (+/-SE) follow up was 1.25+/-0.51 years. RESULTS: There were six early deaths (3.0%). Overall and event-free survival rates during follow up were 98.96+/-0.73% and 97.90+/-1.22%, respectively. Anticoagulant-related hemorrhage occurred in one patient. The global incidence of hemorrhagic complications was 0.41 per 100 pt-yr. One patient with AVR was reoperated on for periprosthetic leakage in the first postoperative week. Valve thrombosis occurred in two patients with MVR at 12 and 14 months postoperatively. The incidence of valve thrombosis in MVR patients was 1.84 per 100 pt-yr (0.82 per 100 pt-yr overall). Hemolysis was seen only in one patient, echocardiographic examination revealing periprosthetic leakage. CONCLUSION: The short-term outcome in 240 implants showed the ATS valve to be safe, to have a low incidence of complications, and to provide excellent hemodynamic performance.

Surgical management of chronic total occlusion of abdominal aorta.

AIM: The surgical management of the totally occluded abdominal aorta is highly complex and possible complications are more likely to be seen. We reviewed our experience to make a base for future endoluminal procedures. METHODS: Seventy-one patients with totally occluded abdominal aorta were operated between 1985 and 1998 in a main referral hospital of the social security organization and the results of vascular interventions were evaluated retrospectively. Juxtarenal aortic occlusion was seen in 52% of these patients. All the patients were operated using the transperitoneal approach and adequate dissection to control renal arteries. Limited thrombectomy through infrarenal aortotomy without transecting the aorta was done and continued with standard aortic graft insertion except for 1 patient with porcelain aorta. RESULTS: Follow-up was 76.9+/-41.9 (SD) months. Fourteen patients had concurrent femoro-distal bypass and 2 patients had concurrent renal bypass. Perioperative mortality was 5.6% and 26.5% of patients needed a second intervention during follow-up. Five-, 10- and 13-year survival and freedom from secondary operation was as follows: 84%, 56% and 44%, 81%, 54% and 42%. Cumulative primary and secondary graft patencies at 5- and 10-years were 68%, 63% and 92%, 92%, respectively. CONCLUSIONS: Surgical intervention is beneficial for patients with totally occluded aorta even if ischemic complaints are relatively mild and stable. Acceptable mortality rates and long-term results form a basis for future endovascular interventions.

Primary muscular hydatid cyst causing arterial insufficiency: case report and literature review.

Hydatid disease, though known to occur in most organs and areas of the body, is extremely rare in skeletal muscle. In this article the authors present a case of a primary muscular hydatid cyst, originating from the adductor muscle group, causing obstruction of the femoral artery and vein.

Assessment of whole-brain white matter by DTI in autosomal recessive spastic ataxia of Charlevoix-Saguenay.

BACKGROUND AND PURPOSE: Extension and characteristics of WM involvement other than the brain stem remain inadequately investigated in ARSACS. The aim of this study was to investigate whole-brain WM alterations in patients with ARSACS. MATERIALS AND METHODS: Nine Turkish unrelated patients with ARSACS and 9 sex- and age-matched healthy control participants underwent neurologic examination, molecular studies, electrophysiologic studies, and DTI of the brain. TBSS was used for whole-brain voxelwise analysis of FA, AD, RD, mean diffusivity of WM. Tractographies for the CST and TPF were also computed. RESULTS: Molecular studies revealed 8 novel mutations (3 nonsense, 4 missense, and 1 frameshift insertion) and a missense variation in the SACS gene. Thick TPF displaced and compressed the CST in the pons. The TPF had increased FA, decreased RD, and increased AD, which may be attributed to hypertrophy and/or hypermyelination. Widespread decreased FA and increased RD, suggesting demyelination, was found in the limbic, commissural, and projection fibers. In addition to demyelination, CST coursing cranial and caudal to the pons also showed a marked decrease in AD, suggesting axonal degeneration. Electrophysiologic studies revealed findings that concur with demyelination and axonal involvement. CONCLUSIONS: In addition to developmental changes of the TPF and their effects on the CST in the brain stem, axonal degeneration mainly along the pyramidal tracts and widespread demyelination in WM also occur in patients with ARSACS. Widespread tissue damage may be associated with extensive loss of sacsin protein in the brain and may explain a wide range of progressive neurologic abnormalities in patients with ARSACS.

Effect of patient sex on white matter alterations in unilateral medial temporal lobe epilepsy with hippocampal sclerosis assessed by diffusion tensor imaging.

BACKGROUND AND PURPOSE: Studies shows ictal behavior and symptoms are affected by patient sex in temporal lobe epilepsy. The purpose of our study was to determine whether alterations in the WM as assessed by DTI display different patterns in male and female patients with unilateral HS. MATERIALS AND METHODS: Patients with unilateral HS were categorized as women with right HS (n=12), men with right HS (n=10), women with left HS (n=12), and men with left HS (n=10). DTI of the brain along 64 noncollinear directions was obtained from 44 patients and 37 sex-matched control participants. We used TBSS to analyze whole-brain WM. Regions with significant changes of FA and MD, and their mean FA, MD, total number of significant voxels, and asymmetry indices were determined for each group. RESULTS: All groups showed bilateral and extensive reductions of FA and elevated MD in the WM, more prominent ipsilateral to the affected hippocampus. The total number of voxels with decreased FA in patients compared with that of control participants was higher in women with right HS (24,727 vs 5,459) and in men with left HS (27,332 vs 14,013) than in their counterparts. Changes in MD associated with right HS were more extensive in both men and women (right vs left HS, women: 16,926 vs 5,458; men: 5,389 vs 4,764) than in those with left HS. In patients with right HS, the ipsilateral cingulum, uncinate fasciculus, internal and external capsules, and right acoustic radiation were involved extensively in women. CONCLUSIONS: Women and men showed different patterns in extent of WM alterations associated with HS.

Diagnostic accuracy of the constructive interference in steady state sequence alone for follow-up imaging of vestibular schwannomas.

BACKGROUND AND PURPOSE: Vestibular schwannoma (VS) is a benign, slow-growing tumor, and radiologic monitoring is an acceptable alternative to surgery in small lesions and in elderly patients. MR imaging with contrast is the study of choice in the follow-up of these lesions. However, gadolinium-based contrast agents have side effects and should be used only when definitely indicated. The purpose of this study was to evaluate the diagnostic accuracy of the constructive interference in steady state (CISS) sequence used without postcontrast sequences for the follow-up imaging of VS. MATERIALS AND METHODS: MR imaging examinations of 18 patients were retrospectively evaluated by 2 radiologists. VS masses were measured on both CISS and the postcontrast images by each observer. For each patient, the masses were also assessed qualitatively for possible progression between every consecutive study. RESULTS: Fifty MR images of 18 patients were evaluated. Patients had 1-5 follow-up studies. The mean time interval between the consecutive studies was 23 months (6-55 months). The sensitivity, specificity, and accuracy of the CISS sequence for the detection of progression were 100%. There was good interobserver and intraobserver (CISS and postcontrast) correlation. The CISS sequence had, however, limited sensitivity for the detection of changes in the internal architecture. CONCLUSIONS: Noncontrast CISS-only technique may be a viable alternative to routine contrast-enhanced sequences for the follow-up of overall lesion size in patients with VS; however, treatment-related changes internal to the tumor are less noticeable using the CISS sequence.