Evaluation of fracture strength and total void amount in composite restorations on endodontically treated teeth / Resistencia a la fractura y la cantidad total de burbujas en resinas compuestas de dientes tratados endodónticamente

ABSTRACT: The aim of the study was to investigate the fracture strength of different composite resins and the quantity of voids in conventional posterior composite, high- flow flowable composite, bulk-fill flowable composite, and fiber-reinforced composite. Forty-four caries-free, freshly extracted mandibular premolars were used for this study. Teeth were prepared for cavity and root canal treatment. Subsequently, root canal treatment was applied to the teeth and cavities in order to prepare them for restorations. The specimens were then divided into four groups: group-1: Estelite Posterior; group-2: Estelite Flow Quick High Flow; group-3: Estelite Bulk-fill Flow; group-4: everX Posterior. One specimen from each experimental group was examined using micro-CT to perform measurement of voids. The fracture strength values of high-flow flowable, bulk-fill flowable, fiber-reinforced, and conventional micro- hybrid composites were found to be similar (p=0.497). EverX Posterior showed the highest fracture strength values (841.1±149.4 N), followed by Estelite Bulk-fill Flow (822.8±170.8 N). Volume of voids (%) obtained from Micro-CT analysis revealed that restorations with high-flow liner or bulk-fill flowable exhibited more voids. The fiber-reinforced composite showed the lowest percentage volume of incorporating voids and the highest fracture strength results.

RESUMEN: El objetivo del estudio fue investigar la resistencia a la fractura de diferentes resinas compuestas y la cantidad de burbujas en resinas posteriores convencionales, resinas fluidas de alto flujo, resinas fluidas tipo bulk-fill y resinas reforzados con fibras. Cuarenta y cuatro premolares mandibulares libres de caries, recién extraídos, fueron usados para este estudio. Los dientes se prepararon para el tratamiento de conductos radiculares y las cavidades para prepararlos para las restauraciones. Los especímenes se dividieron en cuatro grupos: Grupo-1: Estelite Posterior; Grupo-2: Estelite Flow Quick High Flow; Grupo-3: Estelite Bulk-fill Flow; Grupo-4: everX Posterior. Un espécimen de cada grupo experimental fue examinado usando micro-CT para realizar la medición de las burbujas. Los valores de resistencia a la fractura de los compuestos de alto flujo, flujo de relleno, reforzados con fibra y microhíbridos convencionales fueron similares (p=0,497). EverX Posterior mostró los valores más altos de resistencia a la fractura (841,1±149,4 N), seguido de Estelite Bulk-fill Flow (822,8±170,8 N). El volumen de las burbujas (%) obtenido del análisis de Micro-TC reveló que las restauraciones con revestimiento de alto flujo o con flujo de relleno a granel presentaban más huecos. El compuesto reforzado con fibra mostró el menor porcentaje de volumen de incorporación de vacíos y los resultados más altos de resistencia a la fractura.

Microtensile Bond Strength Between Self-Adhesive Resin Cements and Resin Based Ceramic CAD/CAM Block / Resistencia adhesiva microtensil entre cementos de resina autoadhesivos y bloques de cerámica CAD/CAM a base de resina

Abstract: Purpose: The objective of this study is to evaluate and compare the microtensile bond strength (μTBS) of four different self-adhesive resin cements to a resin-based ceramic CAD/CAM block, at the baseline, and after subjecting them to 5,000 thermo-cycles.Materials and Methods: Four self-adhesive dual-cured resin cements; G-CEM LinkAce (GC EUROPE, Leuven, Belgium), RelyX U200 (3M ESPE, Seefeld, Germany), Maxcem Elite (Kerr, CA, USA), TheraCem (Bisco, Schaumburg, USA) were applied to Cerasmart CAD/CAM blocks (GC EUROPE, Leuven, Belgium). CAD/CAM blocks were sectioned into sticks and subjected to µTBS tests at 24 hours, and the other half were subjected to tests after 5000 thermo-cycles. The data were tested by one-way variance analysis (p<0.05). Results: The highest bond strength values were observed in TheraCem, followed by G-CEM LinkAce and RelyX U200, respectively (p<0.05). At the baseline, G-CEM LinkAce, RelyX U200, and Maxcem Elite showed statistically similar results. After 5,000 thermal-cycles, a significant decrease was observed in the bond strength values of G-CEM LinkAce (p<0.05). Conclusion: Between the adhesive cements used in the study, TheraCem showed the highest micro-tensile bond strength values both in the baseline (24h) results, and after the 5,000 thermal- cycle aging procedures.

Resumen: Propósito: Evaluar y comparar la resistencia adhesiva microtensil (μTBS) de cuatro cementos de resina autoadhesivos diferentes con un bloque CAD/CAM de cerámica a base de resina, antes y después de 5.000 ciclos de termociclado. Materiales y métodos: cuatro cementos de resina de doble curado autoadhesivos; G-CEM LinkAce (GC EUROPE, Lovaina, Bélgica), RelyX U200 (3M ESPE, Seefeld, Alemania), Maxcem Elite (Kerr, CA, EE. UU.), TheraCem (Bisco, Schaumburg, EE. UU.) fueron aplicados a bloques Cerasmart CAD/CAM (GC EUROPE, Lovaina, Bélgica). Los bloques CAD/CAM se seccionaron en barras y se sometieron a pruebas µTBS a las 24 horas, y la otra mitad se sometió a pruebas después de 5000 ciclos térmicos. Los datos fueron probados por análisis de varianza unidireccional (p<0.05). Resultados: Los valores más altos de fuerza de unión se observaron en TheraCem, seguido de G-CEM LinkAce y RelyX U200, respectivamente (p<0.05). En la línea de base, G-CEM LinkAce, RelyX U200, Maxcem Elite mostró resultados estadísticamente similares. Después de 5.000 procesos de ciclo térmico, se observó una disminución significativa en los valores de resistencia de la unión de G-CEM LinkAce (p<0.05). Conclusión: entre los cementos adhesivos utilizados en el estudio, TheraCem mostró los valores más altos de resistencia de la unión micro-extensible tanto en la línea de base (24 h) como después de 5,000 procedimientos de envejecimiento térmico.

A giant choledochal cyst in infancy: a case report.

Choledochal cyst is a dilation that encloses the intrahepatic or both extra- and intrahepatic portions of the biliary ducts. Postnatally, ultrasonography is the initial diagnostic modality of choice, allowing for precise measurements of intra- or extrahepatic duct dilatation and identification of stones and sludge. Symptoms depend on the age at presentation. Common bile duct malformations should be considered as a differential diagnosis of a cystic mass regardless of the cyst's size or patient's age, especially in children presenting with abdominal pain, jaundice, and palpable mass. To the best of our knowledge, we report the largest choledochal cyst in infancy.

Cutaneous Alternariasis in a Patient With Renal Transplant.

INTRODUCTION: Alternaria is a common saprophyte, which is usually not pathogenic in humans. Generally, local wounds infections of Alternaria occur with presence of immunosuppression factors such as HIV infection and renal transplant patients. CASE PRESENTATION: We reported a case of wound infection induced by Alternaria spp. in a renal transplant patients. The main interest in this case was the rareness of the cutaneous alternariasis, its clinical aspects and good response to therapy. Recognition of Alternaria spp. as potential opportunistic pathogens is important for differential diagnosis of dermatological lesions, such as granulomatous or ulcerative lesions in immunocompromised patients. CONCLUSIONS: Alternariasis or similar cases may be increased due to the increased number of immunosuppressed patients. From this point of view, skin lesions in these patients must be planned and microbiologically evaluated considering the molds.

[A case of leech infestation mimicking upper respiratory tract infection]. / Üst Solunum Yolu Enfeksiyonunu Taklit Eden Bir Sülük Enfestasyonu Olgusu.

Urban life and industrialization leads to a decrease in the incidence of many parasitic diseases. Especially, using the supervised water supplies in urban areas decreases the chance of such infestations and limits it in rural areas. However, the people who live in urban areas and have diseases such as kidney stones think that mountain waters may be beneficial for their illness. These types of water supplies are generally unsafe, uncontrolled and septic. That is why usage of them can cause some elusive parasitic infestations in people who live in urban areas. It is meaningful to submit the case described below to illustrate the possibility of parasitic infestations in patients who have upper respiratory tract infection symptoms who are admitted to the physician.

Primary hepatic Burkitt lymphoma in a child and review of literature.

Primary hepatic non-Hodgkin lymphoma is extremely rare in childhood and can be overlooked in differential diagnosis of liver masses. In this study, we describe an unusual case of primary hepatic Burkitt lymphoma in childhood.

Fasciola hepatica infection in echinococcosis suspected cases.

OBJECTIVE: Fasciola hepatica, a liver fluke of sheep and cattle, may accidentally infect humans. The main signs and symptoms of the fasciolosis are eosinophilia, abdominal pain and hepatomegaly and may also be attributed to Cystic Echinococcosis (CE) caused by Echinococcus granulosus, which is a prevalent infection in Turkey. METHODS: Sera samples of 226 CE suspected cases were tested for anti-F. hepatica antibodies by an excretory secretory ELISA (ES-ELISA) and for anti-E. granulosus antibodies by ELISA and indirect hemagglutination (IHA) tests. Cases which were seropositive for fasciolosis were further evaluated radiologically and examined for F. hepatica eggs. RESULTS: Five (2.2%) and 96 (42.4%) of the 226 CE suspected cases were found seropositive for fasciolosis and CE, respectively. Although the radiological findings strongly suggested that there was fasciolosis in three cases, F. hepatica eggs were detected in two patients only. CONCLUSION: These data suggest that human fasciolosis is not as rare as previously reported in Turkey. F. hepatica infection should be suspected especially in the presence of eosinophilia, abdominal pain and liver lesions.

A rare cause of intestinal obstruction: neonatal gastrointestinal stromal tumor.

Gastrointestinal stromal tumors (GISTs) are rare in the childhood period. The authors reported a case who was admitted to the neonatal intensive care unit (NICU) on a suspicion of intestinal obstruction. She was operated and a mass in a size of 6 x 4.5 x 4 cm was resected from the ileum. Histologic and immunohistochemical studies showed a GIST. CD34, small muscle actin (SMA), and desmin were positive. The baby was discharged on the 13th day after operation.

A retrospective chart review of evaluation of the cervical lymphadenopathies in children.

OBJECTIVE: Cervical lymphadenopathy is a common finding of physical examination in childhood. The aim of this study was to evaluate the etiology and treatment of cervical lymphadenopathy in children. METHODS: Two hundred eighty two patients' chart reviewed retrospectively who were referred to the Pediatric Oncology Department with cervical lymphadenopathy during the period of November 2007-2009. RESULTS: A total of 9 children had malignant and 273 children had benign disorders. Excisional biopsies were performed to 35 children. A specific etiology was found in 36% in the benign group. CONCLUSION: Primary diagnostic evaluation of childhood cervical lymph node enlargements is based mainly on clinical and physical examinations.

[Evaluation of eosinophil cationic protein levels with clinical symptoms and laboratory findings of patients with cystic echinococcosis]. / Kistik ekinokokkozisli hastalarda eozinofilik katyonik protein düzeylerinin klinik semptomlar ve laboratuvar bulgulariyla birlikte degerlendirilmesi.

Among proteins secreted from activated eosinophil granulocytes, eosinophil cationic protein (ECP) is the most useful tool for the follow-up of inflammatory diseases. Since ECP level reflects the eosinophil activation, it gives valuable information about disease activity. In this study, we aimed to investigate the possible relation between ECP levels and symptoms and laboratory findings of cystic echinococcosis (CE) and to evaluate the role of this protein in the diagnosis of CE. The study which was conducted at Clinical Microbiology Laboratory of Suleyman Demirel University Medical Faculty, Isparta, Turkey, included 58 patients with a pre-diagnosis of CE and 32 healthy individuals as control group. The diagnosis of CE was established serologically by modified enzyme-linked immunosorbent assay (ELISA) and indirect hemagglutination (IHA) test. The quantitative determination of ECP levels was done by fluoro-enzyme immunoassay (FEIA; Uni-CAP ECP, Pharmacia-Upjohn). The mean ECP level was 31.6 +/- 37 microg/ml in the patient group and 9.1 +/- 2.1 microg/ml in the control group, the difference being statistically significant (p = 0.001). Significant differences were also detected for erythrocyte sedimentation rate (ESR) (p = 0.001), total IgE level (p = 0.001), eosinophile count (p = 0.05) and CRP (p = 0.001) between the patient and the control groups. ECP was detected to be high in 35 (60%), IgE in 37 (63%), CRP in 29 (50%) and eosinophile count in 9 (15.5%) patients. While age, gender, ESR, IgE and CRP levels of patients with high ECP levels were not significantly different from levels of patients with normal ECP levels, significantly different eosinophil counts were detected among patients with high ECP values when compared to patients with normal ECP values. Furthermore, a correlation was detected between ECP levels and eosinophil rate, IgE and CRP levels of patients with CE (p = 0.01), while there was no correlation between ECP and ESR levels. Although high ECP level patients exhibited higher ALT and AST levels, no correlation was determined between liver enzyme levels and ECP levels (p > 0.05). The most common symtoms among CE patients were abdominal pain (41%), other gastrointestinal complaints (38%), shortness of breath (12%) and fever (10%). No statistically significant difference in terms of symptoms was detected between patients with high ECP levels and normal ECP levels. However, statistically significant difference was detected between ECP levels of patients with symptoms (except shortness of breath) and patients without symptoms (p < 0.05). In conclusion, ECP seems to be associated with the symptoms and signs of CE and it can be used as a valuable marker besides the other laboratory tests for the evaluation of patients with CE.

[Cystic echinococcosis in Turkey from 2001-2005]. / Türkiye'de 2001-2005 Yillari Arasinda Kistik Ekinokokkozis.

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. In the present study, CE cases were determined during 2001-2005 by investigating different hospital and health directorship documents and Health Ministry documents, retrospectively. Our results show that there were 2534 (13.13%) cases in the Marmara region; 2114 (16.94%), in the Aegean region; 2578 (16.09%), Mediterranean region; 5404 (38.57%), in the Middle Anatolian region; 428 (5.70%), in the Black Sea region; 844 (6.80%), in the eastern Anatolian region; and 887 (2.75%), in the southeastern Anatolian region making a total of 14,789 CE cases. Finally, it has been determined that the patients were hospitalized for a total of 149,464 days.

Adenosine deaminase activity in serum of patients with hepatitis -- a useful tool in monitoring clinical status.

BACKGROUND AND PURPOSE: The evaluation of adenosine deaminase (ADA) activity in sera of patients with hepatitis should be considered a useful tool in the monitoring of their clinical status. In this study, we aimed to determine the relationship between viral load, transaminase levels, and serum ADA levels in hepatitis B virus (HBV)- and hepatitis C virus (HCV)-infected patients. METHODS: Seventy three patients with hepatitis B, 71 patients with hepatitis C and 40 healthy individuals were included. Patients with HBV and HCV infections were classified into 3 groups according to viral load. Serum ADA levels were investigated by colorimetric assays. RESULTS: Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and ADA levels of HBV- and HCV-infected patients were higher than those of the control group. These differences were statistically significant for the levels of all enzymes in HCV-infected patients (p<0.05), and all except AST (p>0.05) in HBV-infected patients. ADA levels of HBV-infected patients with high viral loads were higher than those in HBV-infected patients with intermediate and low viral loads, and the difference was detectably significant between patients with high and intermediate viral loads. Evaluation of HCV-infected patients according to viral load showed no statistically significant relationship between viral load and serum ADA, ALT, and AST levels (p>0.05). HBV- and HCV-infected patients with high ALT and AST levels showed statistically significantly higher levels of ADA than patients with normal ALT and AST levels (p<0.001). CONCLUSIONS: We suggest that serum ADA levels are associated more with the level of serum transaminases than viral load in HBV- and HCV-infected patients. In the treatment of patients with hepatitis, serum ADA levels should be considered a useful tool for the monitoring of liver condition.

Microbiologic findings of sinusitis by a novel method for obtaining culture.

Many different methods have been described to obtain sinus culture from patients with chronic sinusitis. However, these methods presented limited information how they had prevented from the contamination with nasal flora. The purpose of this study is to demonstrate and describe a contamination-free technique to obtain culture from involved sinus during endoscopic sinus surgery (ESS). We prepared a cotton-tipped contamination-free swab. This applicator was inserted inside the sinus through ostium or inside the cavity directly established during ESS, and the swab was introduced directly into the implicated area. Thirty-five adult patients with chronic sinusitis who underwent ESS participated in the study. During ESS, the number of cultivated pathogenic microorganisms of the cultures obtained by our method was statistically significantly higher than the cultures obtained by the classic nasal cavity cultures (P = .0296). However, the number of cultivated bacteria (coagulase-negative Staphylococcus, alpha-hemolytic Streptococcus, and Corynebacterium spp.) after the contamination was lower than those of nasal cavity culture (P = .0296). During ESS, the identification of the pathogen in sinusitis with endoscopically guided narrow-bore sinus culture applicator is a reliable diagnostic method compared with the classic culture techniques.

The effect of topical corticosteroid on basic fibroblast growth factor in nasal polyp tissue.

BACKGROUND: The etiology of nasal polyposis and pathophysiological mechanisms of polyp formation is still poorly understood. Experimental models have suggested that nasal polyp growth requires extracellular matrix formation and is associated with fibroblast proliferation. Intranasal corticosteroids appear to be useful in reducing nasal polypoid lesions and the likelihood of polyp recurrence after surgery. Basic fibroblast growth factor (bFGF) is a potent angiogenesis factor and is mitogenic for a wide range of cell types. We investigated the alteration of bFGF levels in nasal polyp tissue after administration of topical corticosteroid. METHODS: Nasal polyp tissues were obtained from 36 patients with diffuse nasal polyposis before and after topical nasal steroid treatment. As a topical nasal steroid mometasone furoate was given for 4 weeks in a dosage of 200 microg/day. The bFGF levels were measured by competitive enzyme immunoassay method. RESULTS: The mean levels of tissue bFGF, before and after topical nasal steroid treatment, were 1485 +/- 826 ng/mg protein (range, 416-3434 ng/mg) and 1340 +/- 749 ng/mg protein (range, 330-3288 ng/mg), respectively. The levels of bFGF in nasal polyps were significantly lower than those before treatment after administration of topical nasal steroid (p = 0.011). CONCLUSION: Administration of topical nasal steroid decreases bFGF levels of nasal polyp. It may be suggested that one of the effects in diminishing the size of nasal polyps is by decreasing the bFGF.

[Toxoplasmosis in patients with lymphoid hyperplasia of the head and neck]. / Bas-boyun bölgesi lenfoid hiperplazisi olan olgularda toksoplazmosis.

OBJECTIVES: To investigate the incidence of toxoplasmosis in patients with lymphoid hyperplasia of the head and neck. PATIENTS AND METHODS: In this study, 53 patients (32 males, 21 females; mean age 11.2+/-4.3 years, range 5 to 22) were investigated. There were hypertrophic tonsillitis in 13 patients, hypertrophic tonsillitis and adenoid hyperplasia in 22 patients, adenoid hyperplasia in 10 patients, and lymphadenopathy of the neck in eight patients. In venous blood samples, IgM and IgG antibodies for Toxoplasma gondii were investigated with the enzyme-linked immunoabsorbent assay (Axsym, Abbott). RESULTS: Positive IgG was determined in 23 patients (48%) with hypertrophic tonsillitis (n=6), hypertrophic tonsillitis and adenoid hyperplasia (n=10), adenoid hyperplasia (n=3), and lymphadenopathy of the neck (n=4). Positive IgM was determined in 5 patients (9.4%) with hypertrophic tonsillitis (n=1), hypertrophic tonsillitis and adenoid hyperplasia (n=1), and lymphadenopathy of the neck (n=3). CONCLUSION: Toxoplasmosis, which is known to cause lymphadenopathy, may be a reason for lymphadenopathy of the neck. Toxoplasmosis should be considered in the differential diagnosis of untreated patients with tonsillitis, adenoid hyperplasia, and chronic neck lymphadenopathy.

New sinus culture applicator (Yariktas applicator).

Identification of the pathogen is crucial for the selection of an appropriate antibiotic in the management of sinusitis. We describe an original instrument that provides contamination-free culture from the sinus in endoscopic sinus surgery.

Serum iron, zinc and copper levels and lipid peroxidation in children with chronic giardiasis.

This study investigated the levels of iron, zinc, and copper and their demolishing effects against lipid peroxidation in chronic giardiasis. Serum iron, zinc and copper levels, erythrocyte cytosolic superoxide dismutase activity, and malondialdehyde levels were measured in 34 children with chronic giardiasis and were compared with controls. The serum iron and zinc levels and erythrocyte superoxide dismutase activity were significantly lower, and malondialdehyde levels were significantly higher among the children with chronic giardiasis compared to the control group (p < 0.001). There was no significant difference in copper levels between the two groups (p > 0.05). Consequently, the oxidant-antioxidant balance may tilt towards the oxidative side due to weakness of the antioxidant system in giardiasis. If early and proper treatment is not performed, free radical-mediated damage might occur in children with chronic giardiasis.

Autoimmune thyroid diseases in patients with chronic fasciolosis.

BACKGROUND: The prevalence of autoimmune thyroid diseases and autoantibodies in patients with chronic fasciolosis (CF) was investigated. METHODS: Thyroid function of 32 patients with CF and 72 patients without fasciolosis infection was evaluated biochemically. Thyroid hormones, antithyroglobulin antibodies (TgAb) and antithyroid peroxidase antibodies (TPOAb) were measured. RESULTS: In patients with CF, the prevalences of autoantibodies against thyroid peroxidase and thyroglobulin were 21.9% (7/32) and 15.6% (5/32) respectively. However, thyroid function disorder was identified in only 3 (9.4%) cases. In the control group, TPOAb and TgAb were determined in 2 (2.7%) cases, but no one had thyroid function disorder. The prevalences of thyroid autoantibodies (chi 2: 7.948, p < 0.01) and autoimmune thyroid diseases (chi 2: 4.007, p < 0.05) were significantly higher in the CF group. CONCLUSIONS: The high prevalence of TPOAb and TgAb in CF suggests that patients with CF should be evaluated for autoimmune thyroid disorders at the time of diagnosis and during the follow-up period.