Impact of right ventricular diastolic dysfunction on clinical outcomes in inferior STEMI.

BACKGROUND: The aim of this study was to investigate the prognostic value of restrictive right ventricular filling pattern (RRVFP) in patients with the first acute inferior wall myocardial infarction (IWMI) complicated by right ventricular myocardial infarction (RVMI) undergoing primary percutaneous coronary intervention (p-PCI). METHOD: A total of 152 patients with acute IWMI complicated by RVMI undergoing p­PCI were divided into two groups according to the presence of RRVFP. RRVFP was defined as tricuspid diastolic early/late flow velocities (Et/At) > 2 and Et deceleration time (DT) < 120 ms. RESULTS: There were 23 patients with RRVFP in the study cohort. At, DTt, isovolumetric relaxation time (IVRT), and tissue Doppler tricuspid annular late velocity (A't) were reduced significantly in patients with RRVFP than in those without RRVFP (At 19.6 ± 2.7 vs. 39.1 ± 7.4 cm/s, p < 0.001; DTt 106 ± 13 vs.156 ± 21 ms, p = 0.001; IVRT 59 ± 6.7 vs. 62 ± 7.4 ms, p = 0.01; A't 4.6 ± 1.1 vs. 8.6 ± 1.05, p = 0.001). Et/At ratios were higher in patients with RRVFP than in those without RRVFP (Et/At 2.20 ± 0.2 vs. 1.15 ± 0.37, p < 0.001). Et, tissue Doppler tricuspid annular early velocity (E't), E't/A't ratio, and Et/E't ratio were not significantly different between groups (Et 43.3 ± 5.4 vs. 40.7 ± 9.2 cm/s p = 0.18; E't 8.8 ± 1.4 vs. 9.5 ± 2.3, p = 0.15; E't/A't 1.08 ± 0.24 vs. 1.13 ± 0.30, p = 0.52; Et/E't ratio 5.0 ± 1.1 vs. 4.5 ± 1.5 p = 0.09). Presence of E't/A't > 2, short DTt, RRVFP, unsuccessful p­PCI, and cardiogenic shock on admission were independent predictors of in-hospital mortality (p < 0.05) in multivariable logistic regression analysis. CONCLUSION: Presence of RRVFP is associated with in-hospital mortality in patients presenting with their first IWMI complicated by RVMI.

Evaluation of mandibular asymmetry in angle malocclusion samples by posterioanterior cephalometric radiography: A preliminary study.

OBJECTIVES: The aim of this study was to evaluate the effect of different occlusion types on mandibular asymmetry in different anatomical points using posteroanterior cephalometric radiography. MATERIALS AND METHODS: This study was retrospectively conducted on 100 patients whose posteroanterior images and malocclusions were registered in a patient database. Asymmetry indices were determined using four linear measurements on images, and the effect of malocclusions, age, and gender on these asymmetry indices was investigated. P <0.05 was considered statistically significant. RESULTS: Right and left horizontal plane gonion distance values varied according to gender, right vertical plane condylar distance and left horizontal plane gonion distance values varied according to age, and right vertical plane condylar distance and left horizontal plane gonion distance values varied according to malocclusions. CONCLUSION: The measured values of some parameters varied according to age, gender, and malocclusion. Although vertical plane gonion asymmetry index and horizontal plane condylar asymmetry index values varied according to gender, there was no relationship between asymmetry index values of all parameters with age and malocclusion.

Investigation of prevalence of dental anomalies by using digital panoramic radiographs.

BACKGROUND: This study was performed to evaluate the prevalence of all types and subtypes of dental anomalies among 6- to 40-year-old patients by using panoramic radiographs. MATERIALS AND METHODS: This cross-sectional study was conducted by analysing digital panoramic radiographs of 1200 patients admitted to our clinic in 2014. Dental anomalies were examined under 5 types and 16 subtypes. Dental ano-malies were divided into 5 types: (a) number (including hypodontia, oligodontia and hyperdontia); (b) size (including microdontia and macrodontia); (c) structure (including amelogenesis imperfecta, dentinogenesis imperfecta and dentin dys-plasia); (d) position (including transposition, ectopia, displacement, impaction and inversion); (e) shape (including fusion-gemination, dilaceration and taurodontism). RESULTS: The prevalence of dental anomalies diagnosed by panoramic radiographs was 39.2% (46% in men and 54% in women). Anomalies of position (60.8%) and shape (27.8%) were the most common types of abnormalities and anomalies of size (8.2%), structure (0.2%) and number (17%) were the least in both genders. Anomalies of impaction (45.5%), dilacerations (16.3%), hypodontia (13.8%) and taurodontism (11.2%) were the most common subtypes of dental anomalies. Taurodontism was more common in the age groups of 13-19 years. The age range of the most frequent of all other anomalies was 20-29. CONCLUSIONS: Anomalies of tooth position were the most common type of dental anomalies and structure anomalies were the least common in this Turkish po-pulation. The frequency and type of dental anomalies vary within and between populations, confirming the role of racial factors in the prevalence of dental ano-malies. Digital panoramic radiography is a very useful method for the detection of dental anomalies. (Folia Morphol 2018; 77, 2: 323-328).

Effect of sodium-glucose co-transporter-2 inhibitors on coronary blood flow in patients with type 2 diabetes mellitus.

OBJECTIVE: Type 2 diabetes mellitus (T2DM) is known to be associated with endothelial dysfunction (ED). Reducing ED can attenuate the occurrence of cardiovascular diseases. One of the indicators of ED is decreased coronary blood flow (CBF). Sodium-glucose co-transporter 2 inhibitors (SGLT-2is) are known to directly improve ED in both euglycemic and hyperglycemic conditions and have been shown to decrease the incidence of major cardiovascular events. We aimed to investigate whether SGLT-2is improves CBF in patients with T2DM, who have angiographically normal or nearly normal coronary arteries. PATIENTS AND METHODS: In this single-center retrospective study, all patients who underwent coronary angiography between January 2017 and September 2022 were screened. We designed the study by dividing the patients into two groups - those who used conventional antidiabetic medications (CAM) together with SGLT-2is (patients using an SGLT-2 inhibitor for at least 3 months) and those who used only conventional antidiabetic medications. Of the 18,205 patients who underwent coronary angiography, 5,040 patients had T2DM. After exclusion, 288 patients were divided into two groups - those who used CAM together with SGLT-2is and those who used only CAM. CBF was assessed by thrombolysis in myocardial infarction (TIMI) frame counting. RESULTS: Two hundred eighty-eight patients who had T2DM and met the inclusion criteria were included in our study. The patients were divided into two groups - those who used CAM together with SGLT-2is (n = 75) and those who used only CAM (n = 213). The median age in the group that used CAM together with SGLT-2is was 55 (51-64), where 52 (69.3%) patients were female. The mean TIMI frame count (TFC) was 23.5 in the group using CAM + SGLT-2is and 27.5 in the group using only CAM. In the multivariable linear regression analysis, the mean TFC was significantly lower in the group using CAM together with SGLT-2is compared to the group using only CAM [ß-coefficient = -12.766, 95% Cl: -5.304; -3.887, p < 0.001]. Moreover, there was a statistically significant correlation between an increase in BMI and hemoglobin with an increase in the mean TFC [ß-coefficient = 3.018, 95% Cl 0.037-0.175, p = 0.003 and ß-coefficient = 2.316, 95% Cl 0.033-0.405, p = 0.021, respectively]. CONCLUSIONS: We have demonstrated that the use of SGLT-2is improves coronary artery blood flow in patients with T2DM who have normal or nearly normal coronary angiography.

Evaluation of the effect of bun/albumin ratio on in-hospital mortality in hypertensive COVID-19 patients.

OBJECTIVE: The impact of COVID-19 infection still continues all over the world and is an important cause of mortality. The mortality rate due to infection varies between 1-5%. The mortality rate is higher in those with cardiovascular risk factors, especially in cases with hypertension. Some studies have shown that blood urea nitrogen (BUN) and albumin levels are associated with worse prognosis in patients with COVID-19. In our study, we aimed to investigate whether the BUN/albumin (BAR) ratio has an effect on in-hospital mortality in hypertensive COVID-19 patients. PATIENTS AND METHODS: A total of 800 hypertensive COVID-19 patients, (618 of whom were alive and 182 died) were included in our study. Patients with a history of heart failure, malignancy, acute coronary syndrome, and myocarditis were excluded. RESULTS: The median age of the study population was 69 (60-77 IQR) years, and 305 (38%) of these patients were men. There was no statistically significant difference between the patients who died during follow-up and cases that remained alive in terms of comorbidities except chronic obstructive pulmonary disease (COPD) which was significantly lower in surviving group (p=0.014). Multivariable logistic regression analysis revealed that age [OR: 1.04, CI (1.01-1.06); p=0.002], male gender [OR: 1.85, CI (1.13-3.02); p=0.010], lymphocyte count [OR: 0.63, CI (0.40-0.98); p=0.038], SaO2 [OR: 0.82, CI (0.79-0.85); p<0.001] and BAR level [OR: 1.09, CI (1.04-1.16); p=0.001] were independent predictors of in-hospital mortality. ROC analysis yielded that BAR is a better predictor of in-hospital mortality compared to albumin and BUN alone. CONCLUSIONS: BUN, albumin, and BAR levels were found to be reliable predictors of in-hospital mortality in COVID-19 patients, and BAR was also found to be a more reliable predictor than BUN and albumin levels. Hypertension is one of the major risk factors for morbidity and mortality in COVID-19 and, BAR presents additional prognostic data in hypertensive COVID-19 patients that may direct physicians for treatment intensification.

Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection.

PURPOSE: The aim of this study is to report the outcomes of the treatment of talar osteochondral lesions with arthroscopic microfracture technique and postoperative intra-articular hyaluronan injection. METHOD: Fifty-seven patients (29 men, 28 women) with osteochondral lesions of the talus were included in this prospective randomized clinical study between the years 2003 and 2009. The patients were treated with arthroscopic debridement and microfracture technique. Randomly selected 41 patients were injected intra-articular hyaluronan (injection group). The remaining 16 patients did not receive postoperative injection (non-injection group). Assessment of the pain and functional outcomes was performed using the Freiburg and AOFAS ankle/hindfoot scoring systems. RESULTS: In the injection group, the mean postoperative Freiburg functional and pain scores were significantly higher compared to preoperative functional and pain scores (P < 0.001). Similarly, for the patients in non-injection group, the mean postoperative Freiburg functional and pain scores were significantly higher compared to preoperative functional and pain scores (P < 0.001). The AOFAS functional and pain scores of the patients in the injection group were significantly higher (P < 0.001) postoperatively compared to preoperative scores. Scoring the patients in the non-injection group according to AOFAS system also revealed significantly higher (P < 0.001) postoperative functional and pain scores over preoperative scores. The increase in the postoperative scores was found to be significantly higher in the injection group compared to non-injection group in both Freiburg and AOFAS systems (P < 0.001). CONCLUSION: Treatment of osteochondral lesions of the talus using microfracture technique significantly improved functional and pain scores postoperatively. Additional treatment with intra-articular hyaluronan injection as an adjunct to microfracture technique may offer better clinical outcomes over microfracture technique alone. LEVEL OF EVIDENCE: Randomized, controlled trial, Level I.

Development of a Risk Behavior Diagnosis Scale for E-cigarette Use.

Objectives: Adolescent use of electronic cigarettes has risen dramatically, prompting concerns about the health effects. There is need for brief measures to assess adolescents' perceived threat and efficacy related to e-cigarette use and cessation. A 12-item Likert-type scale was modeled after the Risk Behavior Diagnosis Scale and designed to assess threat (ie, severity and susceptibility of threat) and efficacy (ie, self-efficacy and response efficacy) as they relate to e-cigarette use. Methods: The scale was administered online to a developmental sample of 674 adolescents to examine internal consistency and factor structure. Participants (52.1% female, M age = 14.6) were representative of the surrounding community (60% non-Hispanic white; 27% non-Hispanic black; 8% Hispanic). Results: Factor analysis and Velicer's minimum average partial test revealed 2 factors (as expected), which explained 68% of the variance. Analyses revealed strong internal consistency, with Cronbach's alpha of .93 overall and alphas of .92 and .87 for threat and efficacy subscales, respectively. The measure also exhibited good convergent and discriminant validity with other constructs. Conclusions: The measure demonstrates strong preliminary reliability and validity for a developmental sample of adolescents.

Malignant phaeochromocytoma with cavoatrial extension: transcaval removal of tumor without cardiopulmonary bypass A case report.

Adrenal carcinoma is a rare tumor and with metastasis usually in lungs, lymph nodes, liver, and bones. However, intracaval invasion extending into the right atrium is very rare. The surgical approach to adrenal tumor extending into the vena cava is challenging. The optimal surgical approach of tumor with inferior vena cava extension depends on the level of vena cava involvement. This article reports a case of malignant pheochromocytoma extending into the cavoatrial junction in a young man.

Intraductal papillary mucinous neoplasm of the pancreas associated with neuroendocrine tumor: A case report.

INTRODUCTION: Intraductal papillary mucinous neoplasm is an uncommon cystic tumor of pancreas that can be associated with ductal adenocarcinoma. Coexistence of pancreatic IPMN and neuroendocrine tumor is very rare. Here, we report the imaging features of mixed type intraductal papillary mucinous neoplasia of the pancreas with high grade dysplasia together with neuroendocrine carcinoma and perform review of the literature. PRESENTATION: A 68-year old patient has been evaluated for possible IPMN that was suspected during ultrasound. MRI revealed main and side branch duct dilatations. At the head, a contrast enhancing nodular lesion was identified. Due to the presence of high risk stigmata according to guidelines, surgery was performed. Histopathological examination revealed an unusual association, including mixed type IPMN and neuroendocrine carcinoma. DISCUSSION: The concomitant occurrence of pancreatic IPMN and neuroendocrine tumor has been reported in case studies and brief reviews. Yet, the imaging findings and underlying molecular mechanisms of this entity has not been fully understood. In addition to this unusual association, pancreatic intraepithelial neoplasia was also detected in the present case. Although majority of neuroendocrine tumor associated IPMNs were reported to be having low grade dysplasia, our patient had high grade dysplasia. Further studies and reviews with larger groups are needed to establish imaging features and underlying molecular mechanisms of this rare association. CONCLUSION: Although the major concern during work-up of IPMN is presence of associated pancreatic ductal adenocarcinoma, the possibility of neuroendocrine tumor, in the presence of a hypervascular solid foci on imaging studies should be kept in mind.

Case report: Foreign body granuloma mimicking liver metastasis.

In this study, foreign body granuloma mimicking liver metastasis diagnosed on routine follow-up examination in a 41-year-old woman with rectal adenocarcinoma is reported. To our knowledge, this is the first study in English-language literature reporting foreign body granuloma indistinguishable from liver metastasis on radiological examination.

Long-term results of surgery for liver hemangiomas.

BACKGROUND: Elective surgery for liver hemangiomas is still controversial. HYPOTHESIS: Long-term results show that elective surgery for liver hemangiomas is safe and effective. SETTING: A tertiary care university hospital in Istanbul, Turkey. PATIENTS: Forty-two patients underwent surgery for liver hemangiomas between January 1988 and December 1998; 41 were symptomatic. The primary indications for surgery were abdominal pain in 33 patients, diagnostic uncertainty in 6, and enlargement in 3. The median largest dimension of the major lesion was 10 cm (range, 7-45 cm). MAIN OUTCOME MEASURES: (1) Patients' assessment of the effects of surgery on preoperative symptoms, (2) determination of whether any other pathological conditions were missed in the preoperative evaluation, (3) operative mortality and morbidity, and (4) recurrences. DESIGN: Retrospective cohort study. RESULTS: Enucleation was the most frequent operation (33 patients). Hospital mortality and morbidity were 2.4% (bleeding from the biopsy site on a lesion evaluated as inoperable at laparotomy; 1 patient) and 12% (5 patients), respectively. Thirty-three patients could be followed up for a median of 53 months (range, 6-135 months). Of the 32 preoperatively symptomatic patients, surgery was successful in symptom control in 28 (88%) (complete resolution or significant amelioration). No other cause of pain could be identified during follow-up in the other patients. Control ultrasonography revealed no recurrences. CONCLUSIONS: Elective surgery is indicated in a small subset of patients with hemangiomas because of abdominal pain, enlargement, and diagnostic uncertainty. The results of surgery in symptom control are gratifying in approximately 90% of patients. Recurrences are rare. Enucleation can be performed rapidly and safely in most patients and should be preferred to resection.

Estimation of increased hospital stay due to nosocomial infections in surgical patients: comparison of matched groups.

An investigation, using a prospective cohort study, was performed to estimate the prolongation of hospital stay caused by nosocomial infections in surgical patients. An evaluation of the one-to-one matching method, as a model for similar studies was also undertaken. Between 1992 and 1994, 225 of 1482 surgical patients (15%) developed infection. Of these, 223 evaluable patients were compared with 1256 uninfected cases, in an unmatched analysis. In a further analysis, 151 infected cases were matched one-to-one with uninfected controls, and other factors such as age, length of preoperative stay, presence of malignancy or diabetes and presence of foley catheters or drains, were evaluated. Patients with infection were hospitalized for 10.6 days longer than the matched controls. In the unmatched analysis, infected patients appear to remain in hospital for a further 17 days. The difference in the prolongation of stay between matched and unmatched groups indicates the importance of matching as an essential model for such studies. In cases where matching cannot be performed, the median can be a good alternative measure to the arithmetic mean.

Mesoatrial shunt in Budd-Chiari syndrome.

BACKGROUND: The operations with proven effects on survival in Budd-Chiari syndrome are shunt operations and liver transplantation. PATIENTS AND METHODS: Between 1993 and 1999 (June), 13 cases of Budd-Chiari syndrome have been treated surgically. Four cases had concomitant thrombosis of the inferior vena cava; the others had marked narrowing of the lumen due to the enlarged caudate lobe. Mesoatrial (n = 12) or mesosuperior vena caval (n = 1) shunts were constructed with ringed polytetrafluoroethylene grafts. RESULTS: The median portal pressure fell from 45 (range 32 to 55) to 20 (range 11 to 27) cm H(2)O (P <0.001). Two patients died in the early postoperative period. One patient who did not comply with anticoagulant treatment had a shunt thrombosis in the second postoperative year. The other 10 patients are alive without problems during a median 42 (range 1 to 76) months of follow-up. CONCLUSION: Mesoatrial shunt with a ringed polytetrafluoroethylene graft is effective in Budd-Chiari syndrome cases with thrombosis or significant stenosis in the inferior vena cava.

Elective repair of abdominal wall hernias in decompensated cirrhosis.

BACKGROUND/AIMS: Abdominal wall hernia is a common feature of decompensated cirrhosis. However, literature on elective hernia repair in these patients is limited. Here we report the experience of our center. METHODOLOGY: Eleven hernias (seven umbilical, three inguinal and one incisional) in nine patients with decompensated cirrhosis were repaired. The indication for operation was repeated incarceration in two patients and significant pain in four; three patients with umbilical hernias had ulceration and necrosis of the overlying skin. Pre-operatively, medical therapy of ascites was conducted at the hepatology unit. Umbilical hernias were treated with the classic Mayo repair; in all cases but two, this was buttressed with a prolene graft. One inguinal hernia was repaired with the plication-darn technique; the other two and the incisional hernia were repaired with prolene grafts. RESULTS: There was no mortality. One patient had a scrotal hematoma; two patients had leakage of ascites into the wound. Seven patients were followed up. Four patients died without recurrence after a median period of 12 months (range 6-22). The other patients have no recurrence at 1, 10 and 40 months post-operatively. CONCLUSIONS: Umbilical and inguinal hernias in patients with decompensated cirrhosis may be repaired safely on an elective basis. Control of ascites is vital for success.

Multiple bilateral dens invaginatus and an impacted cuspid in the maxillary incisor region. Case report.

A case of multiple bilateral dens invaginatus in the maxillary incisor teeth and an impacted cuspid has been presented. The impacted cuspid was removed surgically.

Ectodermal dysplasia. A case with impacted permanent teeth.

An unusual case of ectodermal dysplasia is presented. Besides the main symptoms of ectodermal dysplasia, congenitally missing teeth and the impaction of all the other existing permanent teeth make this case interesting.

Adenomatoid odontogenic tumour (adenoameloblastoma). Case report and review of the literature.

An adenomatoid tumour was found in the anterior maxillary region of a 15 year old female patient. Two impacted teeth were found in the tumour. The lateral incisor found in the tumour was dilacerated, and the roots of the first premolar were resorbed. A review of the English literature indicated that 294 similar cases have been reported.

[Are devascularization-transsection operations in treatment of bleeding esophageal varices still indicated?]. / Sind Devascularisations-Transsektionsoperationen bei der Behandlung von Oesophagusvaricenblutungen noch indiziert?

Sugiura procedure and its modifications were performed in 43 patients who were not suitable for shunt surgery. Four types of devascularisation-transection procedures on the technical basis of Sugiura operation were carried out. Thirteen patients died in the early postoperative period. Highest mortality was recorded in the standard Sugiura procedure (4/8 or 50%) and the lowest in modified Sugiura III (1/7 or 14%) which is the simplest form of all. Mortality in the early postoperative period was higher in emergency procedures. No variceal hemorrhage and hepatic encephalopathy were recorded in the early postoperative period. Based on our experience in relatively limited number of cases, the Sugiura operation and its modifications are not advantageous in emergency conditions and patients with poor liver function. However, these procedures can be performed in Child A-B cases. Limiting the extent of the operation by modifications affects the outcome positively.

Central mucoepidermoid carcinoma of the jaws. Review of the literature and case report.

A CMEC which occurred within the right maxillary canine-third molar region of a 34-year-old male was presented. The clinical symptoms were swelling and pain. Radiologically the lesion looked like an ameloblastoma or residual cyst. Hemimaxillectomy was the treatment. No evidence of recurrence has been observed for ten months after the operation.