Sealing ability and adaptation of root-end filling materials in cavities prepared with different techniques.

The aim of this study was to evaluate the sealing ability and marginal adaptation of calcium silicate-based cements (CSCs) in root-end cavities prepared by ultrasonic and laser tips. A total of 72 extracted human maxillary incisor teeth were randomly divided as 60 teeth in experimental groups and 6 teeth each for positive and negative control groups. Specimens in experimental groups were obturated, their root-end resections were performed and randomly divided into six groups (n = 10) as follows: G1: Ultrasonic retrotip + MTA, G2: Ultrasonic retrotip + Calcium Enriched Mixture (CEM), G3: Ultrasonic retrotip + Biodentine, G4: Er:YAG laser tip + MTA, G5: Er:YAG laser tip + CEM, G6: Er:YAG laser tip + Biodentine. The sealing ability was measured by fluid transport method. Six specimens from each experimental group were randomly selected to analyze marginal adaptation and prepared for scanning electron microscopy (SEM) analysis. Micrographs were scored and also analyzed using Image J software. Data were analyzed with; two-way ANOVA, Bonferroni, Kruskall-Wallis, Mann-Whitney-U, Siegel & Castellan, and Spearman correlation coefficient tests. No significant difference was found between materials regarding the sealing ability and marginal adaptation (p > 0.05). Significantly greater fluid movement and poor marginal adaptation were seen for materials placed in cavities prepared by laser tips (p < 0.05). Positive correlation was found between the results of scoring and Image J analysis of SEM images (r = 0.596, p < 0.001). Fluid transport method and SEM analysis gave similar results suggesting the use of ultrasonic-retrotips for preparing root-end cavities which are going to be filled with one of these CSCs.

The Role of Fecal Calprotectin in Evaluating Intestinal Involvement of Behçet's Disease.

One of the regions of involvement of Behçet's disease (BD), a systematic inflammatory vasculitis with unknown etiology, is the gastrointestinal (GI) tract. Upper GI endoscopy, colonoscopy, and capsule endoscopy are frequently used methods to diagnose the intestinal involvement of BD. The aim of this study was to investigate the role of fecal calprotectin (FC) in the evaluation of intestinal involvement in BD. Material and Method. A total of 30 patients who were diagnosed with BD and had no GI symptoms and 25 individuals in the control group were included in this study. Results. Levels of FC were statistically significantly higher in patients with BD compared to the control group (p < 0.001). The correlation analysis performed including FC and markers of disease activity revealed a positive and statistically significant correlation between FC level and CRP and erythrocyte sedimentation rate (r: 0.255, p < 0.049, and r: 0.404, p < 0.001, resp.). FC levels in patients who were detected to have ulcers in the terminal ileum and colon in the colonoscopic examination were statistically significantly higher compared to the patients with BD without intestinal involvement (p = 0.01). Conclusion. The measurement of FC levels, in patients with BD who are asymptomatic for GI involvement, may be helpful to detect the possible underlying intestinal involvement.

Laboratory markers has many valuable parameters in the discrimination between acute appendicitis and renal colic.

BACKGROUND: Only one diagnostic parameter is not available for acute appendicitis. For the establishment of diagnosis, combination of medical history, clinical, laboratory tests, and radiological imaging modalities are used so as to decrease the rates of negative laparotomy and morbidity secondary to delay in diagnosis. Thepresent study aimed to determine haematological and inflammatory markers which will be used in the discrimination of acute appendicitis (AA) and renal colic which are the most frequent and indistinguishable causes of abdominal pain in patients applying to the emergency service. METHODS: A total of 215 patients who presented with abdominal pain and who were histopathologically diagnosed as AA, and 200 patients who presented with abdominal pain and who were diagnosed as renal colic were included into the study. Control group consisted of 61 patients without any complaints who came to the outpatient clinics of internal medicine only for blood counts. Analyzed blood samples were WBC, RDW, Hb, MCV, MPV, neutrophil, lymphocyte, NLR and PLR. All differences associated with a chance probability of.05 or less were considered statistically significant. RESULTS: A statistically significant intergroup difference was seen between AA and renal colic groups as for age, WBC, Hb, MCV, neutrophil, lymphocyte, NLR and PLR. A statistically significant intergroup difference was seen between AA and control groups regarding age, WBC, Hb, RDW, MPV, neutrophil, lymphocyte, NLR and PLR. A statistically significant intergroup difference was seen between renal colic and control groups as for age, WBC, RDW, MPV, neutrophil and NLR. In ROC curve analysis, the area under AUCs for WBC, neutrophil, NLR and PLR were 0.896, 0.916, 0.888 and 0.725, respectively (p≤0.05). CONCLUSION: In the discrimination between patients with renal colic and those without any illness, WBC, RDW, MPV, neutrophil and NLR; in the differentiation between the patients with AA and healthy individuals, WBC, RDW, MPV, neutrophil, lymphocyte, NLR and PLR; and more importantly in the discrimination between patients with AA and those with renal colic who presented to emergency services with abdominal pain WBC, neutrophil, lymphocyte, PLR and NLR can be useful parameters.

Factors affecting survival in acute leukemia with donor lymphocyte infusion in the first relapse after allogeneic stem cell transplantation.

PURPOSE: Relapse of leukemia relapsing after allogeneic (allo) stem cell transplantation (SCT) remains an important problem. Cytoreductive chemotherapy followed by donor leukocyte infusion (DLI) is one of the treatment modalities in relapsed patients. The current study evaluated the factors affecting overall survival (OS) in allo-SCT patients who received DLI after the first relapse. METHODS: In this retrospective study 54 patients (26 with acute myeloid leukemia [AML] and 28 with acute lymphoblastic leukemia [ALL]) in their first relapse after allo-SCT who received fludarabine-based chemotherapy followed by DLI were evaluated. RESULTS: The relative risk for mortality was significantly higher in patients with acute leukemia (AL) within the high-risk group who went through transplantation (risk ratio: 4.866; 95% CI: 2.029-11.670;p<0.001) and in transplants performed in the remission phases following the first complete remission (risk ratio: 2.371; 95% CI: 1.154 - 4.872; p=0.019). Additionally, the relative mortality risk of transplantation in patients with acute leukemia (AL) with a number of DLIs applied (risk ratio: 0.456; 95% CI: 0.29 - 0.717; p=0.001) nd non-myeloablative regimen (risk ratio: 0.229; 95% CI: 0.053-0.992; p=0.049) was significantly lower. CONCLUSION: Efforts to enhance the number of DLIs, thus the number of infused cells, may result in better OS in cases with AL with relapse.

Predictors of slow flow in angiographically normal coronary arteries.

INTRODUCTION: Slow coronary flow (SCF) is a well-known angiographic finding; however, the pathophysiology of SCF remains only partially understood. In this study, we have examined the risk factors of slow coronary flow. METHODS: Seventy patients with angiographically proven SCF were studied along with 60 control participants. Patients were divided into 2 groups based on the angiographic findings as with or without SCF. In both groups, clinical information was collected and laboratory parameters were measured and compared. RESULTS: Patients with SCF had higher serum uric acid, creatinine and hemoglobin levels. They also more commonly had a history of smoking. On the other hand, C-reactive protein and hematologic parameters such as mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil to lymphocyte (N/L) ratio did not differ significantly between the two groups. In the logistic regression analysis, only uric acid (odds ratio [OR]=1.583, 95% confidence interval [CI]=1.011-2.349, P=0.034) was found as an independent correlate of SCF. CONCLUSIONS: This study demonstrates that serum uric acid level is significantly correlated with SCF and may play a role in the development of the condition. These findings provide impetus for additional studies to confirm these results and treatment of SCF.

Evaluation of Low-Level Laser Therapy in TMD Patients.

Light amplification by stimulated emission of radiation (laser) is one of the most recent treatment modalities in dentistry. Low-level laser therapy (LLLT) is suggested to have biostimulating and analgesic effects through direct irradiation without causing thermal response. There are few studies that have investigated the efficacy of laser therapy in temporomandibular disorders (TMD), especially in reduced mouth opening. The case report here evaluates performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in two cases of TMD patients. First patient had a history of limited mouth opening and pain in temporomandibular joint (TMJ) region since nine months. Second patient's main complaint was his restricted mouth opening, which was progressed in one year. LLLT was performed with a 685 nm red probed diode laser that has an energy density of 6.2 J/cm(2), three times a week for one month, and application time was 30 seconds (685 nm, 25 mW, 30 s, 0.02 Hz, and 6.2 J/cm(2)) (BTL-2000, Portative Laser Therapy Device). The treatment protocol was decided according to the literature. One year later patients were evaluated and there were no changes. This application suggested that LLLT is an appropriate treatment for TMD related pain and limited mouth opening and should be considered as an alternative to other methods.

Measurement of hair iron concentration as a marker of body iron content.

The aim of the present study was to define the possible association between blood parameters and hair iron concentration in patient groups showing a difference in body iron content. The study population comprised subjects with iron deficiency anaemia and transfusion-related anaemia with different body iron contents and a healthy control group. All the cases included in the study were examined with respect to hair iron concentration, serum iron, total iron-binding capacity (TIBC), transferrin saturation and erythrocyte markers in the total blood count with ferritin values. Differences in hair iron concentration were evaluated between the groups. Correlation analysis was applied to define the association between the laboratory values used as markers of body iron content and hair iron concentration. A statistically significant difference was determined in hair iron 56Fe and 57Fe concentrations between the group with transfusion-related anaemia, the iron deficiency anaemia group and the healthy control group (P<0.001). In addition, a positive correlation was determined between hair iron 56Fe and 57Fe concentrations and serum iron, ferritin level, transferrin saturation, mean erythrocyte volume and mean erythrocyte haemoglobin values and a negative correlation with TIBC. In conclusion, the results of the present study showed a statistically significant difference in the hair iron concentrations of the patient groups with different body iron content and these values were correlated to the laboratory markers of body iron content.

Intestinal invagination secondary to intestinal adenocarcinoma in coeliac disease.

Invagination is defined as a medical condition in which a part of the gastrointestinal tract has entered into another section. Intestinal invagination is a rare clinical entity among adults and there is an underlying structural lesion in most of the cases. Coeliac disease is considered as a risk factor for intestinal invagination, because of the associated inflammatory processes and motility disorders as well as the increased risk for secondary malignancies. We report a case of intestinal invagination secondary to intestinal adenocarcinoma in a woman with coeliac disease, whose adherence to a gluten-free diet was poor.

Weight loss at the time of diagnosis is not associated with prognosis in patients with advanced-stage non-small cell lung cancer.

PURPOSE: To investigate the prognostic value of weight loss before diagnosis in patients with advanced stage non-small cell lung cancer (NSCLC) treated with first-line chemotherapy. METHODS: A total of 81 NSCLC patients with stages IIIB/IV were included in this retrospective cross-sectional study. Study variables were weight loss in the last 3 months before diagnosis, patient demographic, clinical and laboratory characteristics and histological features of the tumor before administering first-line chemotherapy. Then, the patients were stratified into 4 groups based on their weight loss before being diagnosed with NSCLC. RESULTS: The patients were predominantly male (68%), with a smoking history (62%), 5 to 10 kg weight loss in the last 3 months (31%), and had metastatic disease (64%) and adenocarcinoma (40%) at the time of diagnosis. On the other hand, most of the patients with 5 to 10 kg weight loss in the last 3 months before diagnosis had squamous cell carcinoma (44%), stage IV disease (56%), and the first disease progression was in the brain (64%). Pre-diagnosis weight loss had a negative impact on progression-free survival (PFS), independent from weight loss during first-line chemotherapy, but no such effect was noticed on overall survival (OS). CONCLUSIONS: Pre-diagnosis weight loss was found to have a negative impact on PFS in patients with NSCLC treated by first-line chemotherapy. Similar studies in larger patient series are warranted.

Contribution of involved-field radiotherapy to survival in patients with relapsed or refractory Hodgkin lymphoma undergoing autologous stem cell transplantation.

OBJECTIVES: To assess the outcomes of overall survival and posttransplantation survival in patients with Hodgkin lymphoma (HL) undergoing autologous stem cell transplantation (ASCT) because of the development of relapse or resistance after chemotherapy (CT) or CT plus radiotherapy (combined modality treatment, CMT). METHODS: Forty-five patients undergoing ASCT because of the development of relapse or resistance after CT or CMT for HL were enrolled in the study. Radiotherapy was given as involved-field radiotherapy. Patients were treated with CT alone (n=25) or CMT (n=20). These 2 groups were further divided into 2 subgroups: the patients with early-stage (I to II) and advanced-stage (III to IV) HL. RESULTS: Median patients age was 29 years (range, 16 to 60 y) and the median follow-up was 60 months (range, 12 to 172 mo). In the patients with advanced-stage HL, there was no statistically significant difference in overall survival between irradiated and nonirradiated patients (n=18, irradiated n=4 and nonirradiated n=14). However, in the patients with early-stage disease, there was a significant difference in 5- and 10-year overall survival between the irradiated and nonirradiated groups (81% vs. 48% and 66% vs. 24%, respectively, P=0.045; n=26, irradiated n=16 and nonirradiated n=10). In the univariate analysis, irradiated group and involvement of 1 to 2 nodal regions were found to be significant for overall survival, whereas irradiated group, early stage, and involvement of 1 to 2 nodal regions were found to be significant for posttransplantation survival. However, only irradiated group was found to be significant for posttransplantation survival in multivariate analysis (P<0.05). CONCLUSIONS: Addition of involved-field radiotherapy to CT in patients undergoing ASCT after relapse or recurrence failed to provide survival benefit in patients with advanced HL, while a survival benefit was observed in patients with early-stage HL. Radiotherapy should be considered as part of CMT in the patients with early-stage HL, which should not be neglected.

An ECG changed the life of a young boy: a case of arrhythmogenic right ventricular dysplasia.

Arrhythmogenic right ventricular dysplasia (ARVD) is a progressive condition with the right ventricular myocardium being replaced by fibrofatty tissue. It is a hereditary disorder mostly caused by desmosome gene mutations. The prevalence of arrhythmogenic right ventricular cardiomyopathy is about 1/1000-5000. Clinical presentation is usually related to ventricular tachycardias, syncope, presyncope or ventricular fibrillation leading to cardiac arrest, mostly in young people and athletes. We report a case of a 17-year-old boy from Turkey, who was referred to our cardiology department for an ECG, required of him prior to joining a football team.

EDTA-induced pseudothrombocytopenia in association with bladder cancer.

Pseudothrombocytopenia is the detection of low platelet counts by an autoanalyser despite lack of shortage in platelets. EDTA-induced pseudothrombocytopenia, the most frequently seen form in clinical practice, occurs mainly due to reaction of antiplatelet antibodies. Pseudothrombocytopenia is not only seen in healthy individuals but it is also reported in association with autoimmune, cardiovascular and liver parenchyma diseases and malignancy. We aimed to review approaches to pseudothrombocytopenia by presenting a case in which EDTA-dependent thrombocytopenia in association with bladder tumour was detected during examination for haematuria.

Plummer-Vinson syndrome with pectus carinatum mitral valve prolapsus and exotropia in an 18-year-old boy.

The Plummer-Vinson syndrome is a clinical syndrome characterised by dysphagia, web or webs in upper oesophagus and iron-deficiency anaemia. The syndrome is often seen in women of age 40-70 years and rarely in adolescents. Plummer-Vinson syndrome might be associated with malignancy, myeloproliferative disorder and autoimmune diseases including coeliac disease, rheumatoid arthritis and Sjögren syndrome. However, according to our literature search, there are no reports of such case associated with thorax deformity, cardiac pathology and ocular findings. We present a case of an 18-year-old boy with a rare presentation of this syndrome including pectus carinatum, exotropia and mitral valve prolapsus.

Improvement of dilated cardiomyopathy with methylprednisolone in a patient with multiple fibrosclerosis.

Multifocal fibrosclerosis is a rare syndrome of unknown cause that is characterized by fibrosis involving multiple organ systems. Definitive diagnosis can only be made based on biopsy findings. In this case, the biopsy specimen of the patient demonstrates pulmonary hyalinated granuloma or sclerosing mediastinitis. There are few reports of multiple fibrosclerosis with heart failure. Here, we reported a case of retroperitoneal fibrosis with massive mediastinal involvement extending to pleura and pericardium causing pleuro- pericardial effusion with dilated cardiomyopathy. Systolic dysfunction was improved and pericardial effusion disappeared with methylprednisolone treatment.

Sealing efficiency of BeeFill 2in1 and System B/Obtura II versus single-cone and cold lateral compaction techniques.

OBJECTIVE: The objective of this study was to investigate the sealing properties of 2 warm vertical compaction techniques (BeeFill 2in1, System B/Obtura II) in comparison with single-cone and cold laterally compacted gutta-percha. STUDY DESIGN: The root canals of single-rooted human teeth were prepared by using Mtwo rotary files and divided into 4 groups (n = 10/group) with respect to the filling technique tested: Group 1, cold laterally compacted gutta-percha + AH-26; Group 2, single-cone tapered Mtwo gutta-percha + AH-26; Group 3, System B/ObturaII + AH-26; Group 4, BeeFill 2in1 + 2seal. The leakage of specimens was measured using a fluid-filtration method after 1 and 2 weeks. The data were analyzed statistically with 2-way repeated measures ANOVA (P = .05). RESULTS: After 1 week, the System B/Obtura II group showed the greatest amount of leakage(P < .05) compared with the other test groups that had similar levels of fluid conductance(P < .05). By the end of the second week, the BeeFill group yielded the greatest amount of leakage (P < .05). Compared with their 1-week values, the fluid conductance of all test groups decreased significantly (P < .05). CONCLUSION: The apical sealing efficiency of System B/Obtura II and BeeFill were inferior to the other obturation techniques after 2-week fluid conductance testing in vitro.

Effects of different irrigation regimens on the sealing properties of repaired furcal perforations.

OBJECTIVE: The pulp chamber is inevitably exposed to irrigants during endodontic therapy. This study aimed to investigate whether different irrigation regimens would alter the sealing ability of repaired furcal perforations. STUDY DESIGN: Pulp chambers of 90 extracted human molars were accessed, after which standardized diamond bur-cut perforations were created in the center of the pulp chamber floor. The canal orifices and the apical end of roots were sealed with acid-etch composite resin. Eighty teeth were randomly divided into 2 groups (n = 40/group) according to the material used for repairing the perforation defects: (1) Mineral trioxide aggregate (MTA), (2) Super-EBA. The remaining teeth (n = 10) served as controls. The specimens were further subgrouped according to the irrigation regimens applied over the repair site (n = 10/group): (a) 5.25% NaOCl, (b) 5.25% NaOCl + EDTA, (c) 5.25% NaOCl + MTAD, and (d) No irrigation. Coronal leakage was measured by the fluid-filtration method at 1 day and 1 week. RESULTS: Fluid conductance was not affected by the type of repair material (P = .964) or time (P = .726), but was affected significantly by the irrigation regimens in the following ranking: (P < .001): NaOCl < or = No Irrigation < NaOCl + MTAD < or = NaOCl + EDTA. CONCLUSION: The sealing ability of furcal perforations repaired with MTA or Super-EBA were differentially affected by exposure to the tested irrigation regimens.

Sealing properties of different obturation systems applied over apically fractured rotary nickel-titanium files.

This study investigated the sealing properties of cold laterally compacted gutta percha and Thermafil applied over different apically fractured rotary nickel-titanium files. Extracted human premolars were prepared by using ProTaper (Dentsply-Maillefer, Ballaigues, Switzerland) or ProFile (Dentsply-Maillefer) systems (n = 40 for each), after which half of the specimens in each subgroup were subjected to instrument separation at the apical level. For each rotary system, roots with and without apically separated instruments (n = 10 for each) were filled with the two obturation systems and the levels of fluid conductance were recorded. In the absence of instrument separation, the leakage of Thermafil (Dentsply Maillefer) was significantly less than that achieved with cold lateral compaction (p < 0.05), whereas Thermafil yielded similar amounts of leakage in roots prepared with the ProTaper and ProFile systems (p < 0.05). Roots with fractured ProTaper instruments displayed significantly less leakage than those filled without ProTaper fragments, regardless of the obturation technique used (p < 0.05). However, intracanal separation of ProFile instruments increased the leakage (p < 0.05), but the obturation method did not influence fluid conduction (p > 0.05). These results reveal the variability of leakage associated with apically fractured ProFile and ProTaper files and different obturation methods used.