Alveolar Ridge Splitting Versus Autogenous Onlay Bone Grafting: Complications and Implant Survival Rates.

PURPOSE: To compare the complications and implant survival rates of localized alveolar ridge deficiencies in the horizontal dimension reconstructed by alveolar ridge splitting (ARS) or autogenous onlay bone grafting (OBG). MATERIALS AND METHODS: Twenty-eight ARS and 28 OBG were performed. The survival rate of the all included implants was evaluated using the clinical and radiographical evaluation criteria of Misch et al. Temporary exposure of graft, mild infection, temporary paresthesia, and bad split were defined as minor complications; permanent exposure of graft, loss of graft, and permanent paresthesia were defined as major complications. Major and minor complications of ARS and OBG groups were statistically compared. RESULTS: When the minor and major complication rates are considered, there was not any statistically significant difference between OBG (P = 0.099) and ARS (P = 0.241) groups. The satisfactory survival rate of OBG group was 92% and was 100% in the ARS group, and the difference was not statistically significant (P = 0.116). CONCLUSION: When reconstructing vertically sufficient but horizontally insufficient alveolar ridges, ridge splitting technique could shorten the treatment period, decrease postoperative swelling and pain, eliminate the need for a second surgical site, reduce the treatment cost, and ease the patient cooperation to the surgery.

New homozygous SPINK5 mutation, p.Gln333X, in a Turkish pedigree with Netherton syndrome.

Netherton syndrome (NS) is a rare autosomal recessive genodermatosis caused by loss-of-function mutations in the SPINK5 gene. The clinical features include congenital ichthyosis, trichorrhexis invaginata and atopy. In this study, we report a new homozygous SPINK5 mutation, p.Gln333X, responsible for NS in affected members of two closely related Turkish families, and provide an overview of the genotype-phenotype correlation in this condition.

Partial trisomy 3q in a child with sacrococcygeal teratoma and Cornelia de Lange syndrome phenotype.

Partial duplication of 3q is a rare chromosomal disorder that leads to multiple congenital abnormalities such as growth retardation, microcephaly and characteristic facial features. Although the phenotype of the patient has similarities with Cornelia de Lange Syndrome they are etiologically different. We report here a 9 months old baby boy with partial duplication of 3q and features similar with Cornelia De Lange syndrome. Conventional cytogenetic analysis revealed a derivative chromosome 21. In order to determine the origin of this chromosome region we used subtelomeric FISH technique. Based on the results of all these cytogenetic studies and the physical examinations, the diagnosis is partial 3q duplication.

RLIP76 Gene Variants are not Associated with Drug Response in Turkish Epilepsy Patients.

Approximately 30% of epileptic patients remain untreated, in spite of trials with maximum tolerable doses of more than one drug. The RalA binding protein 1 (RALBP1/RLIP76), a multifunctional, anti-apoptot-ic, multidrug transporter protein, has been proposed as being responsible for the drug resistance mechanism in epilepsy. We have investigated polymorphic differences in the coding regions and exonintron boundaries of the RLIP76 gene, between 146 refractory and 155 non refractory epileptic patients in Turkey, using denaturing high performance liquid chromatography (HPLC) and sequencing analysis techniques. We have detected the following sequence variants: c.160-4G>A, c.187C>G, c.1562-38G>A, c.1670+107G>A, c.1670+93G>A, c.1670+96G>A, c.1670+100C>T, c.1670+130C>T, c.1670+131G>C, c.1670+140 G>C, and found no statistically significant correlation between allele frequencies and drug response status. We conclude that sequence variants of this gene are not involved in drug resistance in epilepsy.

Experimental assessment of histological and biological properties of the induced membrane and the membrane formed around the d-PTFE membrane: A pilot study.

BACKGROUND: The aim of this prospective pilot study is to find answers to the following question: In the treatment protocol of open membrane technique defined by Funakoshi, do the histological and biological properties of the tissue that has already covered the graft surface following the removal of the d-PTFE membrane resemble those properties of induced membrane? MATERIAL AND METHODS: 4 male, white Vienna rabbits were used for experiments. Bicortical and 10mm in diameter four bone defects were created on each calvarial bone. 2 rabbits (8 defects) were accepted as group I and other 2 rabbits (8 defects) were accepted as group II. Bone cement was placed into the all-defect in group I. 8 defects were filled with Bi-Oss graft material and covered with d-PTFE membranes in group II. After 8 weeks, sacrifice of the rabbits was performed. In group I, without damaging the formed membrane around it, the bone cement was removed from the defects and the achieved membrane was sent to the pathology department. In group II, the thin film layer that formed under the d-PTFE membrane was sent for histological evaluations. Inflammation, edema, foreign body reaction, synovial-like epithelium existence, thickness, vascularisation (CD31, VEGF), fibrosis were assessed. RESULTS: Inflammation, fibrosis and thickness measurements are significantly different between the groups (P<0,05) and for these parameters, the mean of d-PTFE group (Group II) is significantly higher than the mean of the induced-membrane group (Group I). There isn't any significant difference for other parameters. CONCLUSION: The morphological characteristics of membranes of the two groups were similar. There was a cell-rich, vascularised tissue with fibrous structures; fibroblasts, myofibroblast, and collagen, orientated parallel to the cement.

Kindler syndrome: a focal adhesion genodermatosis.

Kindler syndrome (OMIM 173650) is an autosomal recessive genodermatosis characterized by trauma-induced blistering, poikiloderma, skin atrophy, mucosal inflammation and varying degrees of photosensitivity. Although Kindler syndrome is classified as a subtype of epidermolysis bullosa, it has distinct clinicopathological and molecular abnormalities. The molecular pathology of Kindler syndrome involves loss-of-function mutations in a newly recognized actin cytoskeleton-associated protein, now known as fermitin family homologue 1, encoded by the gene FERMT1. This protein mediates anchorage between the actin cytoskeleton and the extracellular matrix via focal adhesions, and thus the structural pathology differs from other forms of epidermolysis bullosa in which there is a disruption of the keratin intermediate filament-hemidesmosome network and the extracellular matrix. In the skin, fermitin family homologue 1 is mainly expressed in basal keratinocytes and binds to the cytoplasmic tails of beta1 and beta3 integrins as well as to fermitin family homologue 2 and filamin-binding LIM protein 1. It also plays a crucial role in keratinocyte migration, proliferation and adhesion. In this report, we review the clinical, cellular and molecular pathology of Kindler syndrome and discuss the role of fermitin family homologue 1 in keratinocyte biology.

Histological evaluation of combined platelet-rich fibrin membrane and piezo-incision application in orthodontic tooth movement.

The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) membrane on tooth movement in comparison with shunt control and piezoelectric surgery. Sixteen White Vienna rabbits were included in the study and divided into two groups. Reciprocal forces (20 g) were applied on the maxillary incisors by an orthodontic appliance. In group 1, PRF membrane was placed sub-periosteally on the distal alveolar bone surface of the right central incisors and the left side was kept as control. In group 2, piezo-incisions 3 mm in depth were performed and combined with PRF membrane on the distal alveolar bone surface of the right central incisors, while the left side was kept as control. All rabbits were euthanized on day 21 and bilateral alveolar bone segments from the distal regions were removed for histological evaluation. Isolated PRF membrane application increased the blood vessel (8.3 ± 1.0; P = 0.026), osteoblast (6 ± 0.8; P = 0.027), and osteoclast (2.3 ± 0.8; P = 0.026) counts significantly compared to shunt control. Combined application of PRF membrane + piezo-incision increased the blood vessel (15.3 ± 0.8; P = 0.027), osteoblast (9.8 ± 1.4; P = 0.026), and osteoclast (3.3 ± 0.8; P = 0.024) counts significantly compared to shunt control. The increases in blood vessel count and osteoblast cell count were more evident in the combined application group (both P = 0.002). PRF membrane application significantly increased bone turnover, and the combined application of PRF membrane + piezo-incision was found to be the best method for increasing bone turnover.

Loxosceles reclusa bite to the eyelid.

PURPOSE: The authors report a case of Loxosceles reclusa infestation on the eyelid. METHODS: The specimen collected by swabbing the lesions with gauze was tested by using a venom-specific enzyme-linked immunosorbent assay. Loxosceles venom was detected in specimen. The patient was managed with conservative therapy that included saline compresses and ocular lubrication. RESULTS: The case presented with severe edema and necrosis on the left upper eyelid. On laboratory examination, a significant left shift of white blood cell count was detected. Although residual scar of the eyelid and punctate epitheliopathy on the inferior of cornea was detected, vision was not impaired. CONCLUSIONS: Supportive therapy may be reasonable treatment for Loxosceles reclusa infestation on the eyelids. The presence of venom proteins detected with an enzyme-linked immunosorbent assay technique is beneficial for supporting the diagnosis of Loxosceles envenomatio.

Low rate of contrast-induced Nephropathy after CT perfusion and CT angiography in acute stroke patients.

BACKGROUND: The aim of the study was to assess (i) the rate of contrast-induced nephropathy (CIN), (ii) the amount and time course of renal dysfunction, (iii) the identification of risk factors and calculation of a risk score for CIN in acute stroke patients after CT perfusion (CTP) and CT angiography (CTA). METHODS: 162 patients were investigated,who had received 140 ml of non-ionic low osmolar contrast agent (300 mg iodine per ml, Ultravist 300, Schering AG) for CTA and CTP. We assessed electrolytes, creatinine, and creatinine clearance before and up to 7 days after administration of contrast agent. In addition, the risk factors for CIN were recorded and a previously validated risk score for CIN was calculated. We also assessed the amount of crystalloid fluid substitution and newly prescribed drugs. CIN was defined as an increase of the serum creatinine-level of > 0.5 mg/dl or > 25% above baseline within 48 hours after contrast agent administration. RESULTS: 154 patients (94 %) received crystalloid fluid substitution (mean 6.1 l) within 48 h after contrast agent administration. During follow-up the creatinine values and the creatinine clearance remained stable while sodium and potassium increased significantly (p < 0.0001) after contrast agent administration. In patients with a pathological creatinine value on admission (n = 40), the creatinine clearance did not decrease significantly (p = 0.18). The risk score for developing a CIN was low in the majority of stroke patients. A manifest CIN occurred in 3 patients (2 %). No patient had to be hemodialysed. CONCLUSION: CIN is a rare complication in acute stroke patients examined by multimodal contrast-based CT due to the low prevalence of risk factors associated with CIN. In conjunction with appropriate fluid substitution, low osmolar nonionic contrast agents seem to be safe in clinical routine.

Changes in the lower lip soft tissue after bone graft harvesting from the mandibular symphysis.

Following the surgical release of the mentalis muscle, lip incompetence and/or an increase in lower incisor exposure may be seen due to undesirable attachment of the muscle fibres. The aim of this study was to evaluate the extent of lip ptosis, lower incisor exposure, and other soft tissue changes following bone graft harvesting from the mandibular symphysis when the mentalis muscle is reapproximated precisely to its original position. Seventeen consecutive patients who underwent bone graft harvesting from the mandibular symphysis were included in this study. The mentalis muscle was isolated, identified, marked, and reapproximated precisely during the bone harvesting operation. Digital lateral cephalograms obtained preoperatively and at 6 months postoperative were analyzed and compared by paired samples t-test to determine the horizontal and vertical soft tissue changes in the lower lip and chin. Although the soft tissue thickness at soft tissue point B and at soft tissue pogonion had increased significantly at 6 months after chin bone graft harvesting, there were no significant changes in lower incisor exposure or other positional alterations of the lower lip (P<0.05). Precise reattachment of the mentalis muscle in its original position helps to avoid significant vertical positional changes in the lower lip. Increases in soft tissue thickness can be observed following bone graft harvesting from the mandibular symphysis.

Evaluation of benign paroxysmal positional vertigo following Le Fort I osteotomy.

The Le Fort I osteotomy is widely used to correct dentofacial deformities. Benign paroxysmal positional vertigo (BPPV) is a common vestibular end organ disorder characterized by short, often recurrent episodes of vertigo. Head trauma is one of the known causes of BPPV. During pterygoid osteotomy, the surgical trauma induced by percussion with the surgical mallet and osteotomes can displace otoliths into the semicircular canal, resulting in BPPV. The aim of this study was to evaluate the potential risk of occurrence of BPPV in individuals undergoing Le Fort I osteotomy. Twenty-three patients were included in this study. The Dix-Hallpike manoeuvre, positional tests using electronystagmography, and vestibular evoked myogenic potential (VEMP) tests were performed 1 week before surgery (T0), 1 week after surgery (T1), and 1 month after surgery (T2). The results were compared statistically. BPPV was observed in three patients. Eleven patients had nystagmus at the T1 evaluation and seven at the T2 evaluation. The difference between the T0 and T1 time points was statistically significant (P=0.001). BPPV is a possible complication of Le Fort I osteotomy. Surgeons should be aware of this complication, and the diagnosis of BPPV should be considered in patients who have undergone Le Fort I osteotomy.

Comparison of the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia.

The aim of this study was to compare the effect of closed versus open endotracheal suction systems on the development of ventilator-associated pneumonia (VAP). A prospective, randomized, controlled trial was performed in a medical intensive care unit (MICU) of a university hospital in patients who received mechanical ventilation for more than 48 h. Patients were randomized to receive endotracheal suction with either closed catheters (closed suction group; N-41) or single-use catheters (open suction group; N=37). Cultures were taken from the ventilator tubing of 42 patients to determine the rate of colonization. There was no difference between the groups in terms of the frequency of development of VAP, mortality in the MICU, length of MICU stay and duration of mechanical ventilation. Thirteen patients in the open suction group and 16 patients in the closed suction group became colonized (P=0.14). The colonization rates by Acinetobacter spp. and Pseudomonas aeruginosa were more frequent in the closed suction group than in the open suction group (P<0.01 and P=0.04, respectively). In conclusion, closed endotracheal suction resulted in increased colonization rates of ventilator tubing with multi drug-resistant micro-organisms but did not increase the development of VAP and MICU outcome compared with open endotracheal suction.

Ochronosis: a case of severe ochronotic arthropathy.

Ochronosis involves primarily the large cartilaginous joint surfaces, ribs, intervertebral discs, ear cartilage etc. We report on a 53-year-old woman with typical alkaptonuric ochronosis with dark urine, blue-black pigmentation of the auriculae and hands, focal brown hyperpigmentation of the sclera, spondylarthropathy and severe shoulder joint involvement.

Cervical biopsy specimens and human papilloma virus positivity in patients with external genital warts.

Cervical biopsy specimens were taken from 16 women with external genital warts in order to diagnose concomitant cervical human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) according to pathology. Positive HPV infection was detected 56% (9/16) of the patients. Among those patients 66% (6/9) had concurrent subclinical low-grade CIN lesions. One of those patients had a high-grade CIN lesion. It is concluded that cervical HPV infection was rather common in women with external genital warts and it is valuable to examine cervical HPV infection by biopsy to detect concomitant CIN.

Teratogenic effects of propineb on rat skin.

The dithiocarbamates are known to cause dermatitis, conjunctivitis, rhinitis, pharyngitis and bronchitis in humans. The experimental group received Propineb (obtained from Bayer) concentrations of 400 ppm in distilled water five days a week (treatment time three weeks) administered orally by gasric pit. Acute oral LD50 for male rats has been found to be 8,500 mg/kg (Worthing, 1983). The control group (n = 10) received only distilled water. At ultrasonographical examination, there were no resorbed fetuses or stillborns during or after propineb administration. It can be clearly seen that the body weights of the experimental group of litters are lower than those of the control group (p < 0.001). However, the mean length of the experimental litters was identical to the control group of litters (p > 0.05). Under microscopical examination, increased keratinization and hyperplasia were observed in the epidermal cells.

The management of lichen planus with low-molecular-weight heparin (enoxaparin).

The aim of this study is to evaluate the efficiency of low-dose, low-molecular-weight heparin (enoxaparin) in the treatment of lichen planus (LP). Twenty-four patients clinically and histopathologically diagnosed as LP with intense pruritus were treated with 3 mg of enoxaparin (Clexane), subcutaneously once a week for 4-14 weeks. Complete remission was observed in 20 of 24 patients (83%) who had widespread cutaneous involvement, but no or minimal effect was observed in four of 24 patients, three of whom had chronic hypertrophic LP. Low-dose enoxaparin was observed to be effective in the treatment of LP without any side-effects. Enoxaparin may be an effective and simple alternative therapy for LP.

Tinea capitis in Diyarbakir, Turkey.

The incidence and types of tinea capitis in 234 children aged 1-12 referred to our laboratory with a preliminary diagnosis of tinea capitis infection in the past 5 years were investigated. Tinea capitis was determined in 149 (63.7%) of these patients, of which agents grew in culture in 124 (83.2%). The most frequently isolated agents, in order of frequency, are as follows: Trichophyton violaceum (43.6%), Microsporum canis (37.9%), T. mentagrophytes (8.1%) and T. verrucosum (4.8%).

Mycosis fungoides with involvement of the oral cavity.

Mycosis fungoides rarely involves the oral cavity. To our knowledge only 29 cases of oral cutaneous T-cell lymphoma have been described up to 1994. This report presents a case of mycosis fungoides with involvement of the oral cavity in a 57-year-old man who died from septicemia 7 months after the onset of oral involvement.

An epidemiological study of pityriasis rosea in the Eastern Anatolia.

The purpose of this study was to investigate the epidemiological features of pityriasis rosea (PR) in the Eastern Anatolia, Turkey. Three hundred ninety-one patients (214 females, 177 males) with PR seen during the years 1992-1995 were analyzed for annual incidence among dermatologic outpatients, sex, age, and distribution by month and year. The average annual incidence was 0.75 per 100 dermatologic patients. PR was reported to be slightly more common in women by margin of 1.2:1.0. Eighty-seven percent of the cases were between the ages of 10 and 39 years, with a peak in the 20-29 age group. The incidence of the disease was much higher in the rainy and snowy months. No declining incidence was observed over the years. Changes in incidence from year to year, though not great, were statistically significant.

Atypical familial Papillon-Lefèvre syndrome.

The Papillon-Lefèvre syndrome is a rare autosomal recessive disorder. Consanguinity seems a notable prerequisite. Papillon-Lefèvre syndrome manifests in the first 6 months of life with rapidly progressive periodontitis and severe alveolar bone destruction leading to early loss of both the deciduous and permanent teeth in association with palmo-plantar hyperkeratosis. We present two unusual cases of familial Papillon-Lefèvre syndrome, one of whom has only late onset of mild skin lesions and the other has severe skin lesions and relatively mild periodontal disease. A number of other cases recently described have also had atypical features.