Effect of Low pH Dietary Supplements on Discoloration of Resin Composites.

AIM: This study aimed to evaluate the impact of the consumption of low pH dietary supplements on the color stability of different resin composites. MATERIALS AND METHODS: Three different restorative materials were used for this in vitro study: Filtek One Bulk-Fill (FOB), Filtek Z550 (Z550), and Fill-Up (FUP). Samples fabricated from each composite group were divided into four subgroups, and color measurements were performed at baseline. The control subgroup was stored in distilled water, and the other three subgroups were immersed in acidic dietary supplement solutions (Redoxon, Supradyn, and Voonka Collagen Shake) for 2 minutes daily for 28 days. Color measurements were obtained using a digital spectrophotometer. Color change values (ΔE1) were calculated after each color measurement. Next, all samples were immersed in a coffee solution for 7 days and repeat color measurements were taken to determine ΔE2 values. The study groups were compared using the Kruskal-Wallis test (α =0.05). RESULTS: ΔE1 values were significantly different among the groups (P < 0.05). While Voonka Collagen Shake produced the greatest discoloration in FOB (1.67 ± 1.08) and Filtek Z550 (3.59 ± 1.90) materials, Fill-Up showed the highest discoloration (3.14 ± 0.37) with Supradyn. Analysis of ΔE2 values demonstrated a significant difference only for the Filtek Z550-Redoxon group versus the control group (P < 0.05). CONCLUSION: Acidic dietary supplements not only produce color alterations in resin composites but also reduce the staining resistance of the composite further, depending on the type of composite and dietary supplement. Consumption of staining food after taking Redoxon effervescent tablets produces greater discoloration in Filtek Z550 restorations compared with other restorative materials.

Tunnel widening after single- versus double-bundle anterior cruciate ligament reconstruction: a randomized 8-year follow-up study.

OBJECTIVE: The purpose of this study was to compare the single-bundle (SB) and double-bundle (DB) surgical techniques for anterior cruciate ligament (ACL) reconstruction with regard to tunnel widening, isokinetic muscle strength, and clinical outcomes over an 8-year follow-up period. METHODS: This study included 31 patients with ACL injury who underwent ACL reconstruction via the SB (n = 16) or the DB (n = 15) technique. Isokinetic and concentric strength measurements of the quadriceps and hamstring muscles were conducted at postoperative 6 months and postoperative 8 years, and 3D-CT scans of the knee joints were performed on the 2nd, 3rd and 6th month, and the 8th year postoperatively. Clinical evaluations were performed at 8 years postoperatively with the International Knee Documentation Committee (IKDC), Tegner, and Lysholm knee scoring systems. RESULTS: There was marked widening of the parts of the femoral tunnel close to the knee joint in both the SD and the DB groups. There was no difference between the two groups in terms of clinical results and isometric muscle strength at postoperative 8 years; however, there was a significant difference between the preoperative and 6 months postoperative clinical and strength results in both group (P < 0.05). There was no difference between the groups in IKDC score, Lysholm score, Tegner activity scale, and anterior drawer test at postoperative 8 years. On evaluation of the anteromedial bundles alone, the DB group had greater widening than the SB group. CONCLUSION: In this study, we have found that the tunnels continue to enlarge after 6 months. However, that has no impact in patients comfort and that did not made any change in our daily routine. On the other hand, we found that the reconstruction of the double-band ligament technique is useless for non-professional athletes.

CLINICAL VARIABILITY IN TWO SISTERS WITH KEUTEL SYNDROME DUE TO A HOMOZYGOUS MUTATION IN MGP GENE.

Keutel syndrome (KS) is an autosomal recessive disease characterised by abnormal cartilage calcification, brachytelephalangism, peripheral pulmonary artery stenosis, hearing loss and midface retrusion. KS is caused by homozygous mutations in MGP, a gene encoding Matrix Gla protein which acts as a calcification inhibitor in extracellular matrix. We present two Turkish sisters (22 and 13 years old) who had abnormal cartilage calcification, brachytelephalangism, congenital heart defect and chronic asthmatic bronchitis. The patients were homozygous for c.62-2A>G (IVS1-2 A>G) mutation in MGP gene. Abnormal cartilage calcification, brachytelephalangism and midfacial retrusion are the hallmarks of KS. It was observed that the younger sister had striking cartilaginous calcifications, midfacial retrusion and severe brachytelephalangism while her older sister had mild costal cartilaginous calcifications and brachytelephalangism without any midfacial retrusion. Intrafamiliar clinical variability for KS has not been described previously.

Intra-articular zoledronic acid in a rat osteoarthritis model: significant reduced synovitis may indicate chondroprotective effect.

PURPOSE: The aim of this experimental study was to evaluate the effect of intra-articular application of zoledronic acid (ZA) on joint cartilage and synovial tissue following induction of knee osteoarthritis (OA) in a rat model. METHODS: An OA model was created by anterior cruciate ligament transection (ACLT) in the right knees of 48 adult Wistar albino rats. The rats were randomized into a study and control groups, each including 24 rats, and 10 µg of ZA was injected in 0.1 ml of sterile saline to 24 animals in the study group on the first day to operation and was repeated weekly until the rats were killed. The same volume of sterile saline was injected with the same schedule to the control group. Eight rats from both the study and control groups were killed, each time, on the 4th day, the 3rd week, and the 6th week after the operation. The groups were compared based on the histological scores of synovitis and cartilage destruction and the evaluation of serum markers. RESULTS: Histological score indicates progression of synovitis was significantly less in the study group (p = 0.047). There was significant increase in the mean Mankin cartilage damage score in the control group (p = 0.021), while no significant change was found in the study group. When the two groups were compared over time, no statistically significant difference was detected in total histological scores, although there was a 47 % less incidence of cartilage tissue damage in the study group and better cartilage structure and tide mark integrity scores were also detected in the study group (p = 0.017 and p = 0.021, respectively). CONCLUSION: Intra- articular zoledronic acid may suppress synovial inflammation. Furthermore, Zoledronic Acid does not reduce cartilage degeneration in early osteoarthritis models, but may provide some chondroprotective effect in ACLT- induced knee osteoarthritis model in rats.

Evaluation of VOR function with vHIT in unilateral pediatric cochlear implant users.

OBJECTIVE: The changes in the inner ear affect both the cochlea and the vestibule and these effects are observed after cochlear implantation surgery. The aim of the current study is to evaluate the effect of unilateral cochlear implant use on vestibulo-ocular reflex (VOR) in children. METHODS: In the current study, 29 cochlear implanted children, aged 7-18 years, were include as the study group and 32 children, in the same age range, were included with normal-hearing as the control group. vHIT was used to evaluate VOR and the results of unilateral CI users were compared with the control group. The study group was evaluated in two different situations: cochlear implant sound processor on (CI-ON) and cochlear implant sound processor off (CI-OFF). The data obtained in the evaluations were compared between the implanted ear and the non-implanted ear between the CI-ON and CI-OFF states within the study group and between the study group and the control group. RESULTS: When the CI-ON and CI-OFF conditions in the study group were compared, no significant difference was found (p > 0.05). Similarly, no significant difference was found between the implanted ear and the non-implanted ear (p > 0.05). Also, there was no significant difference in the comparisons between the study group and the control group (p > 0.05). CONCLUSION: vHIT is a functional test method that can be used in children to test vestibular function after cochlear implant. vHIT is a comfortable test to use after cochlear implantation to demonstrate the functionality of the vestibular system. And it provides consistent results regardless of whether the speech processor is on or off.

Cognition as a parameter in monitoring the effect of multiple sclerosis relapse treatment: A prospective controlled study.

BACKGROUND: Cognitive evaluation was considered to be very important in the relapse period, on the basis of the presence of isolated cognitive attacks and the necessity of monitoring the patient both physically and cognitively. MATERIALS AND METHODS: People with MS (pwMS) who were hospitalized during relapse were included in the study. All MS patients were evaluated by the neurologist with Expanded Disability Status Scale (EDSS), The 9 Hole Peg Test (9HPT) and the Timed 25-Foot Walk Test (T25-FWT). Additionally, all participants were examined cognitively with the Turkish version of the Brief International Cognitive Assessment for MS (BICAMS) battery. Also, schedules were indicated as during relapse before the treatment (pre-treatment) and the first month after relapse (1-month follow-up). RESULTS: A total of 140 MS patients (mean age; 34.98±10.09, mean disease duration; 6.05±5.29 years) and 86 healthy controls (mean age; 36.94±10.83) were included to the present study. The mean EDSS scores in pre-treatment in MS patients was 2.74±1.14 and decreased significantly in the 1-month follow-up (1.74±1.24; p<0.001). The mean SDMT score was lower by 8.76 points in MS patients than in HCs) in pre-treatment and 7.66 points in 1-month follow-up (p<0.001). The mean SDMT scores of all participants increased with measurement time gradually (p<0.001). CONCLUSION: In this study, it was detected which cognitive domains were affected after relapse treatment and cognitive changes in pwMS during relapse and remission periods compared to the healthy controls. All three BICAMS test scores significantly increased in one-month follow-up than the pre-treatment period. The results showed that CVLT-II and BVMT-R scores improved more in pwMS than in HCs, and also SDMT scores of pwMS showed a trend of increase, but was not a significant improvement.

Staged hybrid approach to chronic type B aortic dissection involving the distal arch associated with aortic root aneurysm.

Open surgical repair of complex aortic pathologies using cardiopulmonary bypass and deep hypothermic circulatory arrest still carries a substantial rate of mortality and morbidity. Endovascular stent-graft placement has developed as a safe and effective treatment modality for various diseases of the aorta. We report on the case of a 65-year-old female presenting with symptomatic type B aortic dissection with aneurysm of the ascending aorta and the aortic root. The patient was treated with a flanged composite graft custom made from a branched 24-mm Dacron graft for entire prosthetic transposition of the supra-aortic branches. Metachronously, the patient underwent endovascular stent-grafting of the descending aorta. She was discharged free of complications on day 10.

Inner-ear malformations as a cause of single-sided deafness.

OBJECTIVE: To determine the prevalence and distribution of inner-ear malformations in congenital single-sided deafness cases, as details of malformation type are crucial for disease prognosis and management. METHODS: A retrospective study was conducted of 90 patients aged under 16 years with congenital single-sided deafness. Radiological findings were evaluated using computed tomography and magnetic resonance imaging. Inner-ear malformations were identified and cochlear nerve status was determined in affected ears. RESULTS: Out of 90 ears, 42 (46.7 per cent) were found to have inner-ear malformation. Isolated cochlear aperture stenosis was the most common anomaly (n = 18, 20 per cent), followed by isolated cochlear aperture atresia (n = 11, 12.2 per cent) and cochlear hypoplasia (n = 7, 7.8 per cent). Cochlear nerve deficiency was encountered in 41 ears (45.6 per cent). The internal auditory canal was also stenotic in 49 ears (54.4 per cent). CONCLUSION: Inner-ear malformations, especially cochlear aperture anomalies, are involved in the aetiology of single-sided deafness more than expected. The cause of single-sided deafness differs greatly between congenital and adult-onset cases. All children with single-sided deafness should undergo radiological evaluation, as the prognosis and management, as well as the aetiology, may be significantly influenced by inner-ear malformation type.

Twenty years of experience in revision cochlear implant surgery: signs that indicate the need for revision surgery to audiologists.

OBJECTIVE: To report device failures, audiological signs and other reasons for revision cochlear implant surgery, and discuss indications for revision surgery. METHODS: Revision procedures between November 1997 and August 2017 were retrospectively analysed. Over 20 years, 2181 cochlear implant operations were performed, and 114 patients underwent 127 revision operations. RESULTS: The revision rate was 4.67 per cent. The full insertion rate for revision cochlear implant surgery was 88.2 per cent. The most frequent reasons for revision surgery were: device failure (59 per cent), wound breakdown (9.4 per cent) and electrode malposition (8.7 per cent). The device failure rate was: 2.78 per cent for Advanced Bionics, 1.82 per cent for Cochlear and 5.25 per cent for Med-El systems. The number of active electrodes was significantly increased only for Med-El devices after revision surgery. The most common complaints among 61 patients were: gradually decreased auditory performance, sudden internal device shutdown and headaches. CONCLUSION: The most common reason for revision surgery was device failure. Patients should be evaluated for device failure in cases of: no hearing despite appropriate follow up, side effects such as facial nerve stimulation, and rejection of speech processor use in paediatrics. After revision surgery, most patients have successful outcomes.

Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy.

OBJECTIVE: Data on long-term outcome of pericardiectomy are limited. This retrospective study aimed to investigate risk factors and early and late outcomes of pericardiectomy for constrictive tuberculous pericarditis. DESIGN: Seventy patients with chronic constrictive pericarditis who underwent pericardiectomy between January 1990 and August 2005 were reviewed for perioperative and long-term survival. RESULTS: Patients (49 males; median age 40 years) had a median duration of symptoms of 24 months (range 8-72) before surgery. Perioperative mortality was 8.6%. During follow-up (mean 66.4 +/- 56.4), late mortality rates at 5 and 10 years were 1.6% and 9.7%, respectively. The mean censored survival in all patients was 155.2 months (SEM 8.3, 95%CI 138.8-171.6). Readmission-free survival was 68.6% over 10 years (mean 125.4 months, SEM 10.3, 95%CI 105.2-145.6). Ascites and duration of symptoms were found to be predictors of perioperative mortality (P = 0.047 and 0.036, respectively). CONCLUSIONS: The optimal time of pericardiectomy is most important in its management. Total or near-total pericardiectomy should always be performed as early as possible.

Abdominal aortic aneurysm surgery: retroperitoneal or transperitoneal approach?

AIM: Mortality and morbidity of abdominal aortic aneurysm surgery have decreased significantly in time and transperitoneal approach (TPA) still preserves its popularity although retroperitoneal approach (RPA) is known to cause lower incidence and shortened duration of ileus, shorter intensive care unit (ICU) and hospital stay, earlier oral intake and less patient discomfort or pain. METHODS: One hundred and fifty patients that underwent abdominal aortic aneurysm repair at our Cardiovascular Surgery Center between January, 1990 and March, 2000 were reviewed and analyzed based on the elective/emergent nature of the surgery and the type of the incision as either TPA or RPA. RESULTS: Significantly shorter mechanical ventilation (15.2+/-3.8 vs 10.1+/-2.3 hours) and nasogastric decompression periods (40.6+/-10.7 vs 9.1+/-2.2 hours), less need for intravenous fluid supplementation and shorter ICU stay (29.5+/-14.8 vs 18.6+/-1.9 hours) were observed with the retroperitoneal approach (P<0.001). Need for allogeneic blood transfusion was, similar (1.3+/-1.4 vs0.9+/-0.4, P>0.05). Analysis of mortality and morbidity revealed bleeding as the major cause of mortality for ruptured aneurysm. A similar comparison between TPA and RPA groups, however, revealed no significant difference (P>0.05). CONCLUSIONS: | Retroperitoneal approach is a reliable technique causing less fluid-electrolyte imbalance with rapid restoration of gastrointestinal physiology. It causes less discomfort to patients with reduced need for analgesia. A shorter weaning period from mechanical ventilation is among the benefits for patients with co-morbid states.

A randomized trial of intravenous iloprost (a stable prostacyclin analogue) versus lumbar sympathectomy in the management of Buerger's disease.

AIM: The aim of this study was to compare the effects of iloprost and lumbar sympathectomy (LS) in the treatment of Buerger's disease. METHODS: Two hundred patients with rest pain and/or ischemic ulcers were randomized to undergo LS or 28-day intravenous treatment of iloprost. The primary endpoint was complete healing without pain or major amputation at 4 and 24 weeks. The secondary endpoints were analgesic requirement, reduction in the ulcer size, 50% reduction of the ulcer, and shift in the modified SVS/ISCVS clinical status grading scale. RESULTS: The comparison was carried out in 162 patients (iloprost: n=84; LS: n=78). Complete healing rate was 61.9% in the iloprost group, but 41% in the LS group at the 4th week (P=0.012); respective values for the 24th week were 85.3%, 52.3%, P<0.001. Analgesic requirement was lower in the iloprost group at the 4th and 24th weeks (P=0.01, and P=0.098, respectively). The size of the ulcers decreased more in the iloprost group than the LS group (P=0.044 and P=0.035 at 4th and 24th weeks); 50% reduction in the ulcer size in the iloprost group was greater than in the LS group (P=0.001 and P=0.009 at 4th and 24th weeks). SVS/ISCVS grading scale demonstrated a better clinical benefit in patients treated with iloprost (P<0.001 at 4th week, and P<0.001 and at 24th week). CONCLUSIONS: The results of this independent study indicate that using iloprost relieves ischemic symptoms better than LS. In the era of stable prostacyclin analogues, there is no reliable evidence to support the use of LS in Buerger's disease.

Androgen receptor mediates the reduced tumor growth, enhanced androgen responsiveness, and selected target gene transactivation in a human prostate cancer cell line.

The growth and development of the prostate gland are regulated by the androgen and the androgen receptor (AR). Despite our molecular understanding of the roles of the AR regulating; a downstream target gene transcription, the direct or indirect (stromally mediated) actions of the androgen in controlling prostate cell growth and differentiation are still unclear. In this report, an invasive; and metastatic human prostate tumor cell line, androgen-repressed human prostate cancer cell line (ARCaP), either transduced with wild-type human AR (hAR) or a control neomycin-resistant plasmid DNA, was used to evaluate the direct role of AR in regulating prostate tumor cell growth and gene transcription. Results showed that: (a) introduction of wild-type hAR to ARCaP cells restored positive androgen regulation of prostate tumor cell growth in vitro through an enhanced cell-cycle progression from G(0)/G(1) to S and G(2)-M phases; (b) hAR was shown to transactivate glucocorticoid-responsive element but not prostate-specific antigen promoter-directed reporter gene expression; and (c) hAR-transduced ARCaP cells exhibited reduced growth, invasion, and migratory behavior in vitro and tumor growth in vivo. These results suggest that the introduction of hAR into the invasive human prostate cancer ARCaP cell line restored its androgen-regulated cell growth, decreased the rate of tumor growth, and selectively activated AR target gene expression. These cellular functions in response to androgen are commonly associated with increased differentiation of prostate epithelial cells.

Identification and characterization of estrogen receptor variants in prostate cancer cell lines.

A sensitive semi-nested reverse transcriptase-polymerase chain reaction (RT-PCR) amplification was performed to evaluate estrogen receptor-alpha (ER-alpha) mRNA expression in prostate cancer cell lines. We demonstrated the presence of wild-type ER-alpha (wt ER-alpha) and five ER-alpha variants, designated ER-alphaA, B, C, D, and E. Unlike ER-alphaA and D, ER-alphaB, C, and E were not previously reported in normal or cancerous mammalian cells. DNA sequencing analysis of these ER-alpha variants revealed the genetic changes to be either in-frame or out-of-frame deletions. The expression of each ER-alpha variant differs significantly depending on the androgen responsiveness, tumorigenic and metastatic potentials of each prostate cancer cell line. The potential functional significance of ER-alpha variants was assessed in yeast two-hybrid and ERE promoter-reporter mammalian transcription assay systems. The results of these studies indicated that none of the ER-alpha variants can form homo- or heterodimers either with wt ER-alpha or among themselves in vivo, and that these ER-alpha variants have no demonstrable transcriptional or dominant-negative activity, as assessed in vitro.

Scaffold attachment factor B1 regulates the androgen receptor in concert with the growth inhibitory kinase MST1 and the methyltransferase EZH2.

The androgen receptor (AR) is a transcription factor that employs many diverse interactions with coregulatory proteins in normal physiology and in prostate cancer (PCa). The AR mediates cellular responses in association with chromatin complexes and kinase cascades. Here we report that the nuclear matrix protein, scaffold attachment factor B1 (SAFB1), regulates AR activity and AR levels in a manner that suggests its involvement in PCa. SAFB1 mRNA expression was lower in PCa in comparison with normal prostate tissue in a majority of publicly available RNA expression data sets. SAFB1 protein levels were also reduced with disease progression in a cohort of human PCa that included metastatic tumors. SAFB1 bound to AR and was phosphorylated by the MST1 (Hippo homolog) serine-threonine kinase, previously shown to be an AR repressor, and MST1 localization to AR-dependent promoters was inhibited by SAFB1 depletion. Knockdown of SAFB1 in androgen-dependent LNCaP PCa cells increased AR and prostate-specific antigen (PSA) levels, stimulated growth of cultured cells and subcutaneous xenografts and promoted a more aggressive phenotype, consistent with a repressive AR regulatory function. SAFB1 formed a complex with the histone methyltransferase EZH2 at AR-interacting chromatin sites in association with other polycomb repressive complex 2 (PRC2) proteins. We conclude that SAFB1 acts as a novel AR co-regulator at gene loci where signals from the MST1/Hippo and EZH2 pathways converge.

Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies.

OBJECTIVES: The purpose of this study to compare clinical and isokinetic results of patients who underwent biceps tenotomy or tenodesis for chronic tenosynovitis. METHODS: Arthroscopic biceps tenotomy, arthroscopy assisted or arthroscopic biceps tenodesis were done in 20 patients who had diagnosis of chronic tenosynovitis and in whom conservative treatment was not helpful. Rotator cuff repair and acromioplasty was performed in 18 patients and acromioplasty alone in two patients in addition to biceps surgery. Arthroscopic biceps tenotomy was done in 10 patients (5 female, 5 male; mean age 63, range 53-75), 10 patients underwent tenodesis out of which arthroscopy assisted biceps tenodesis was done in 8 patients and all arthroscopic biceps tenodesis was done in 2 patients (4 female, 6 male; mean age 57, range 49-66). All patients were evaluated with Constant and UCLA scores preoperatively and postoperatively. The average follow-up of the patients 3,1 years (between 1-8 years). Isokinetically elbow flexion and forearm supination were compared using the Cybex (Biodex 3, Cybex Biomedical System, NY, USA) machine. Pre-operative results of each group were compared with the postoperative results, using Mann-Whitney U test. RESULTS: Preoperative average constant scores of tenotomy group were 64.40, whereas postoperative scores were 89.50 (p=0.002), and preoperative average constant scores of tenodesis group were 62.80, whereas postoperative scores were 86.70 (p=0.003). Preoperative average UCLA scores of tenotomy group were 23.20 whereas postoperative UCLA scores 22.60 (p=0.003), preoperative average UCLA scores of tenodesis group were 30.00 whereas postoperative UCLA scores was 29.20 (p=0.004). In both groups statistically significant improvement of UCLA and Constant scores was detected. Comparison between Constant, UCLA scores and isokinetic measurements of both groups showed no statistically significant difference (p>0.05). No complication was noted. CONCLUSION: In the treatment of chronic tenosynovitis, biceps tenodesis and tenotomy of long head of biceps showed similar clinical, functional, isokinetic and cosmetic results. No Popeye deformity was seen in the tenotomy group.

[Unicondylar knee arthroplasty in medial unicompartmental osteoarthritis: technical faults and difficulties]. / Diz medial osteoartritinde unikondiler diz protezi: Teknik hatalar ve sorunlar.

OBJECTIVES: The aim of this study is to evaluate both the technical problems of surgery and the clinical and radiologic outcomes of patients treated with unicondylar knee arthroplasty. PATIENTS AND METHODS: Forty-one unicondylar knee prosthesis were performed in 40 patients (3 males, 37 females; mean age 58.2 years; range 44 to 76 years) diagnosed with unicompartmental knee osteoarthritis. Technical problems encountered during surgery were noted. For evaluation of clinical outcomes, the Hospital for Special Surgery (HSS) knee score and WOMAC score were used. Radiologic evaluations were performed using the Oxford Knee Group criteria. RESULTS: The radiologic evaluation determined there was more than 10 degrees varus-valgus malposition in eight patients, more than 2 mm medial tibial overhang in seven patients, the insertion of a femoral component in extension in one patient, and joint distraction in one patient. The patient with joint distraction underwent a total knee replacement after six months because of progressive pain. The mean HSS knee score improved 21 points; perfect results were obtained in 33 patients and good results in seven patients. The mean postoperative WOMAC score was reduced by 18 points, with perfect results in 33 patients, good results in six patients and a moderate result in one patient. The mean follow-up was 19 months (range 9-42). CONCLUSION: Unicondylar knee arthroplasty is a surgical treatment method with a long-term recovery and high frequency of technical faults. Minor errors diagnosed on radiographs do not have an effect on early clinical results. Unicondylar knee arthroplasty is a good alternative surgical technique for appropriately selected patients with medial unicompartmental knee osteoarthritis.

True aneurysm of extracranial internal carotid artery in a 10-year-old.

INTRODUCTION: In this report, we describe a very unusual case, true aneurysm of the internal carotid artery, in a child. REPORT: A 10-year-old boy with a pulsating mass on his right neck was admitted with the diagnosis of a 25 mm by 50 mm true aneurysm of the right internal carotid artery, which was resected, and a 5-mm ePTFE graft was interposed. He was discharged on day 3 without complications. CONCLUSIONS: Prompt differential diagnosis of this pathology is crucially important. Open surgery yields acceptable results depending on the size, extension and the type of the aneurysm.

Determinants of hospital mortality after repeat mitral valve surgery for rheumatic mitral valve disease.

OBJECTIVE: The aim of this study is to detect the risk factors for hospital mortality in patients who underwent reoperative mitral valve replacement. METHODS: Rheumatic mitral valve patients who underwent primary mitral valve replacement (386 cases) and repeat mitral valve replacement (94 cases) were analysed retrospectively. The incremental effects of the reoperative procedure on hospital mortality were studied by comparing primary and reoperative procedures and analyzing a series of possible predisposing factors. RESULTS: Operative mortality for repeat procedures was found significantly higher than the first operations (respectively 12.8% versus 4.3%, p=0.022). Risc factors affecting the hospital mortality in reoperation group were determined as advanced age, diameter of left atrium, prolonged bypass time and development of postoperative low output state. The indication for surgery also had a significant role in patients' outcome. Mortality found significantly higher in cases operated due to endocarditis or mitral mechanical valve thrombosis compared to other reoperation groups. CONCLUSION: Patients over age of 70 years, with a left atrial diameter over 60 mm, reoperated due to endocarditis and mechanical valve thrombosis, should be reevaluated for risk assessment while giving the decision of optimal operation timing. Especially patients with left ventricular hypertrophy and decreased myocardial reservoirs, efficient myocardial protection during the operation had an important role.