Effective anticancer agents based-on two Pillar[5]arene derivatives for pancreas cancer cell lines: synthesis, apoptotic effect, caspase pathway.

This study aimed to evaluate the possible anticancer effects of two different pillar[5]arene derivatives (5Q-[P5] and 10Q-P[5]) on two different pancreatic cancer cell lines in vitro. For this purpose, changes in the expression of major genes that play a role in apoptosis and caspase pathways were investigated. Panc-1 and BxPC-3 cell lines were used in the study and the cytotoxic dose of pillar[5]arenes was determined by the MTT method. Changes in gene expression after pillar[5]arenes treatment were evaluated by real-time polymerase chain reaction (qPCR). Apoptosis was studied by flow cytometry. As a result of analysis, it was determined that proapoptotic genes and genes involved in major caspase activation were upregulated and antiapoptotic genes were down-regulated in Panc-1 cell line treated with pillar[5]arenes. Flow cytometric apoptosis analysis also showed an increased apoptosis rate in this cell line. On the contrary, although MTT analysis showed cytotoxic effect in BxPC-3 cell line treated with two pillar[5]arene derivatives, the apoptosis pathway was not active. This suggested that it may activate different death pathways for BxPC-3 cell line. Thus, it was first determined that the pillar[5]arene derivatives reduced cancer cell proliferation on pancreatic cancer cells.

Estimation of the capacity of emergency surgery in Konya: Nine-year multicenter study.

OBJECTIVE: Although the number of surgical emergencies continues to increase, comprehensive data on emergency surgical admissions are scarce. The aim of this multicenter study was to evaluate the causes, management, and outcomes of the general surgical emergencies in the city of Konya, Turkey. MATERIAL AND METHODS: The relevant details of the cases admitted and considered to be general surgical emergencies in Konya over a nine-year period (January 2003-January 2012) were analyzed. All demographic data were analyzed statistically. RESULTS: The study group comprised 21954 cases from 4 hospitals in Konya: 7154 from Konya Numune Hospital, 6,654 from Konya Education and Research Hospital, 6,400 from Necmettin Erbakan University Meram Medical Faculty, and 1,390 from Baskent University Konya Education and Research Hospital. Their mean age was 59.6 years, and the average hospitalization time was 3.3 days. The diagnoses of the admitted patients were as follows: acute appendicitis (59.57%), bowel obstruction (11.12%), trauma (7.97%), strangulated inguinal hernia (5.46%), acute cholecystitis (4.87%), peptic ulcer perforation (4.09%), mesenteric ischemia (2.73%), necrotizing fasciitis (2.73%), gastrointestinal system bleeding (1.79%), and others (1.1%). CONCLUSION: The findings of the study indicate a steady increase in surgical admissions to emergency units. Non-traumatic acute abdomen was the most common reason for general surgical emergencies. Although the number of elderly patients increased, the hospital stay and mortality rates decreased over the study period.

Management of patients with retroperitoneal tumors and a review of the literature.

BACKGROUND: Retroperitoneal tumors (RTs) develop insidiously and are generally seen as large masses, and 50% of RTs are larger than 20 cm at the time of diagnosis. In this article, we share our experience of 5 years of surgical management of RTs. METHODS: We evaluated 28 RT cases operated on in three education hospitals in Turkey from January 2008 onwards, with regard to patients' demographic characteristics, complaints, weight loss figures, the location and size of the tumor, blood transfusion, intra-operational time, metastases (in malignant cases), additional organ resection, histological grade, local recurrences, average life expectancy, and post-operative treatment methods. RESULTS: The mean age of the patients was 49 years (range, 18 to 78 years). Twenty (71.43%) were female, and 8 (28.57%) were male. The primary complaint was abdominal pain in 18 patients (64.28%). CT scans were performed in 17 (61%) patients, 10 (35.4%) underwent abdominal MR imaging, and 1 (3.6%) underwent both abdominal CT and abdominal MR imaging. A mass was palpated in the pelvis (suprapubic region) in seven (25%) of the patients during physical examination. The largest tumors were detected in the left lumbar area. The mean tumor size was 12.78 cm (range, 2 to 30 cm). The mean intra-operational time was 192 min (range, 70 to 380 min). The mean hospitalization period was 11 days (range, 8 to 23 days). Seven (25%) patients were reported to have benign tumors, while 21 (75%) were reported to have malignant tumors. The most frequently seen malignant pathology was liposarcoma (eight cases; 38.09%) followed by leiomyosarcoma (five cases; 23.8%) and malignant fibrous histiocytoma (four cases; 19.04%). The earliest local recurrence was detected in the 12th month and the latest in the 28th month. A total of 11 (52.3%) of the total of 21 malignant cases experienced local recurrence within 3 years. The 3-year average life expectancy was 85.7% in the 18 malignant cases. CONCLUSIONS: Due to the low response rate of all but two types of RT to chemotherapy, the best remaining treatment option is surgery with wide resection margins, whereby all macroscopic traces of tumor are removed.

Review of our ileal pouch experience in the light of literature.

OBJECTIVE: Retrospective proctocolectomy is a distinguished, sphincter saving treatment used for the treatment of ulcerative colitis and FAP disease. We aimed to evaluate ileal pouch interventions performed at our clinic and their results in the light of literature. MATERIAL AND METHODS: Medical records of 35 restorative proctocolectomy and J pouch ileo-anal anastomosis surgeries performed at Necmettin Erbakan University, Meram School of Medicine between the years 2006-2013 were retrospectively examined. The patients were assessed according to their age, gender, length of hospital stay, diagnosis, follow-up duration and pouch-related complications. All patients were contacted by phone and they were scheduled for controls at the outpatient clinic. RESULTS: Nineteen patients were male (54%) and 16 were female (46%). Their mean age was 45 years (21-74). The mean length of hospital stay was 11 (5-20) days. Twenty two (63%) patients were operated on due to FAP, 12 (34%) due to synchronous rectum cancer and colon tumor or polyp, and one (3%) due to ulcerative colitis. All patients received J pouch and protective ileostomy. After the closure of ileostomy, two cases were identified to have J pouch fistulas. The patients were followed up for 6 months to 7 years. They were contacted by phone and they were questioned about their active complaints, number of defecations, urinary and sexual dysfunctions. It was identified that they had 5 (3-8) defecations per day on average and that 4 (11%) cases had one nocturnal defecation. No pouchitis was identified in the follow-up endoscopic examinations. CONCLUSION: Restorative proctocolectomy and ileo-anal anastomosis technique is a surgical procedure that can be performed with low rates of morbidity and mortality, including the elderly.

Bile duct ischemia developing after reconstruction of the hepatic artery during the Whipple operation.

A pancreaticoduodenectomy is a surgical procedure with a high morbidity and mortality rate. The injury of the hepatic artery may occasionally lead to intraoperative bleeding. Repair of the injured hepatic artery is of great importance in terms of maintaining the vascular supply of the liver. We report a case with an injury of the hepatic artery that was successfully reconstructed with the gastroduodenal artery and then developed a biliary leak due to bile duct ischemia at an early stage. A 33-year-old women complaining of right upper quadrant pain was found to have a solid pseudopapillary tumor of the pancreas. She underwent an immediate pancreaticoduodenectomy, and her hepatic artery was injured during the operation. The arterial ends were sutured with primary anastomosis, because they could be aligned without any tension. The biliary leak occurred on postoperative day 2. We detected bile duct ischemia and reanastomosed the artery. The patient was discharged on postoperative day 8. Surgeons should be prepared for anomalies of the peripancreatic vascular structures during pancreaticoduodenectomy. Computed tomography angiography should be considered to reveal these anomalies before the surgery. Insufficiency of the biliodigestive anastomosis due to bile duct ischemia in the postoperative period should be kept in mind, even in cases of successful repair.

Does endoscopic retrograde cholangiopancreatography have a negative effect on laparoscopic cholecystectomy?

OBJECTIVE: We have observed that patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) had some difficulties with laparoscopic cholecystectomy procedures. Through a retrospective study, we planned to compare the surgical procedures between patients who had undergone ERCP and those who had not in order to clarify this. MATERIAL AND METHODS: The results of 122 patients who had undergone ERCP because of choledocholithiasis before undergoing laparoscopic cholecystectomy procedures between 2008 and 2011 were compared to the values of 2140 patients operated because of cholelithiasis only within the same period. RESULTS: Among the patients who underwent surgical procedures following ERCP, 80 (65%) were female and 42 (35%) were male. The average age of the patients was 51.9 years (range: 20-83 years). The operation period after the procedure was 30.14 days (range: 1-93 days). Although the hospitalization period was 4.67 days (range: 1-22 days), the postoperative hospitalization period was 2.68 days (range: 1-15 days). Regarding the difficulty of operation, adhesion in 58 (47.5%) patients, bleeding in two (1.6%) patients, and conversion to open procedure in 12 (9.8) patients were observed. In two (1.6%) patients, bleeding and biliary fistula were the reasons for re-operation. CONCLUSION: Laparoscopic cholecystectomy is more complicated in patients who underwent ERCP.

Comparison of mammography sensitivity after reduction mammoplasty targeting the glandular and fat tissue.

OBJECTIVE: Mammography may have some limitations in the diagnosis and screening of breast cancer for women who have previously undergone breast reduction surgery. This study aimed to investigate how the structural defects in the breast tissue formed by postoperative changes are reflected on mammography. MATERIAL AND METHODS: The records of patients who had previously undergone breast reduction surgery and who were requested to undergo mammography for breast cancer screening by the general surgery clinic were retrospectively studied. The patients' ages, surgical procedures, postoperative follow-up periods, amount of removed material, and histopathological and mammographic results were studied. The patients were classified into 3 groups: those older than 40 years who underwent reduction mammoplasty targeting predominantly the glandular tissue (group 1), those younger than 40 years who underwent reduction mammoplasty targeting predominantly the fat tissue (group 2), and those older than 40 years who were diagnosed with breast hypertrophy and were not operated (group 3). RESULTS: The mean follow-up period of the patients was 6 (2-10) years. The mean value of resected tissue was 1120 g (680-2070) in group 1 and 1220 g (720-1980) in group 2. The mean age at the time of surgery was 45 (40-70) years for group 1 and 35 (24-40) years for group 2. All patients in group 1 were classified in Breast Imaging-Reporting and Data System (BI-RADS) category 1-2; 28 patients in group 2 were classified in BI-RADS 1-2, 4 were classified in BI-RADS 3, and 8 were classified in BI-RADS 0. In group 3, 35 patients were classified in BI-RADS 1-2, 4 were classified in BI-RADS 3, and 1 was classified in BI-RADS 0. CONCLUSION: We believe that breast reduction surgery targeting predominantly the glandular tissue in patients older than 40 years increases mammographic sensitivity.

Relationship of preoperative neutrophil lymphocyte ratio with prognosis in gastrointestinal stromal tumors.

OBJECTIVE: Gastrointestinal stromal tumors are believed to play a role in immunosuppression with their local effect. In some cancers with associated inflammation, an increased pretreatment neutrophil lymphocyte ratio is considered as an indicator of poor prognosis. The aim of our study was to assess the relationship of increased blood neutrophil lymphocyte ratio with disease prognosis in patients with gastrointestinal stromal tumors. MATERIAL AND METHODS: The data of 78 patients who underwent surgery with the diagnosis of primary gastrointestinal stromal tumor in our clinic were evaluated retrospectively. The preoperative neutrophil lymphocyte ratio in the peripheral blood was determined. The neutrophil lymphocyte ratio and its relationship with tumor risk and prognosis were compared. The data were evaluated by Pearson's correlation analysis and the Welch ANOVA test. RESULTS: The preoperative neutrophil lymphocyte ratio was significantly increased in the high-risk groups (p<0.05). An increased preoperative neutrophil lymphocyte ratio was associated with shorter survival (r=-0.32, p=0.009). In addition, an increase in the neutrophil lymphocyte ratio was associated with an increase in the mitotic activity of the tumor (r=-0.364, p=0.025). CONCLUSION: The preoperative neutrophil lymphocyte ratio in gastrointestinal stromal tumors can be used as an indicator of high-risk tumors and poor prognosis.

Gastric necrosis and perforation caused by acute gastric dilatation.

Acute gastric dilatation was first defined by Duplay in 1833. We herein present the case of a 55-year-old male patient diagnosed with gastric necrosis and perforation caused by acute gastric dilatation. Since the stomach has a rich blood circulation, necrosis and perforation are rarely seen. Clinically, more than 90% of cases have complaints of vomiting. The most useful method in revealing the diagnosis and aetiology is computerized tomography. Medical treatment is appropriate for cases where no necrosis and peritonitis findings are detected through endoscopy. Delays in surgical treatment increase the risk of mortality.

A case of multiorgan resection for locally advanced stomach cancer.

Extensive surgical resection may be required in locally advanced gastric cancers, with involvement of other organs. Our purpose was to present a case where vascular reconstruction was performed during multiple organ resections in a patient with locally advanced gastric cancer. An emergent laparotomy was performed on a patient who presented with upper gastrointestinal system hemorrhage; and he was diagnosed with locally advanced gastric cancer. Total gastrectomy, D II dissection, pancreaticoduodenectomy, transverse colectomy and end-to-end anastomosis were performed. Additionally, the superior mesenteric vein was partially excised and re-implanted to the portal vein. Neither recurrence nor distant metastasis was observed during the post-operative follow-up. Adjacent organ resections may be necessary for a curative treatment in locally advanced gastric cancer. In addition, partial resection and reconstruction may be required for extensive vascular invasion.

Investigation of the effect of ultrasonography-guided bilateral erector spinae plane block on postoperative opioid consumption and pain scores in patients undergoing hepatectomy: a prospective, randomized, controlled study.

BACKGROUND: There is still a debate about what constitutes effective and safe postoperative analgesia in hepatectomy surgery. Erector spinae plane (ESP) block may be an important part of multimodal analgesia application in hepatectomy surgery. OBJECTIVES: To compare the effects of ultrasound-guided bilateral erector spinae plane block combined with intravenous (iv) patient-controlled analgesia (iv PCA), in comparison with iv PCA alone, in hepatectomy surgery. DESIGN AND SETTINGS: Randomized prospective single-blinded study in a tertiary university hospital. METHODS: Fifty patients scheduled for elective hepatectomy surgery were included in the study. Patients were randomized into the ESP group or the control group. In the ESP group, bilateral ESP block was performed preoperatively and iv PCA was used. In the control group, only iv PCA was used. Numerical rating scale (NRS) scores at rest and coughing, analgesic requirements and occurrences of nausea and vomiting were recorded. RESULTS: Intraoperative and postoperative opioid consumption, rescue analgesia requirement and resting and dynamic NRS scores were significantly lower in the ESP group (P < 0.05). There was no significant difference between two groups in terms of the presence of dynamic pain after the first postoperative hour. While all patients in the control group had nausea and vomiting, 24% of the patients in the ESP group did not have nausea and vomiting. CONCLUSION: This study showed that ESP block can be used as a part of multimodal analgesia, with the benefit of reducing opioid consumption and postoperative nausea and vomiting in hepatectomy surgery. CLINICAL TRIAL REGISTRATION: ACTRN12620000466943.

Clinicopathological Characteristics of Gastroenteropancreatic Neuroendocrine Tumors: 10 Years of Experience From a Single Center.

OBJECTIVES: Gastorenteropancreatic neuroendocrine (GEP-NET) tumors are the second most common tumors of the gastrointestinal tract. We aimed to investigate the clinicopathological features and factors affecting the prognosis of patients with GEP-NET. METHODS: Clinicopathological features of 158 patients were evaluated, including tumor location, TNM stage and grade, pathological features, presence of lymph nodes and distant metastases at the time of diagnosis, maximum tumor diameter and treatment details. Also, follow-up information was analyzed to discover possible prognostic factors. RESULTS: The most common primary site is pancreas (45.6%, n = 72). Most of the GEP-NETs were nonfunctional (93.6%, n = 148). Of the 158 patients, 94 (59.5%) were grade 1, 46 (29.1%) grade 2, and 18 (11.4%) grade 3. The 1-year, 3-year, and 5-year survival rates were 82.3% (130/158), 61.4% (70/114), and 47.2% (35/74), respectively. In multivariate analysis, histological grade (P = 0.04) and TNM stage (P < 0.001) were independent prognostic factors for survival in patients with GEP-NET. CONCLUSIONS: They are increasing in frequency and are the most common tumors in the pancreas. Nonfunctional tumors made up the majority of cases. The main treatment was surgical resection. Histological grade and TNM stage are independent prognostic factors.

Liver transplantation as a treatment option for three siblings with homozygous familial hypercholesterolemia.

FH is a hereditary inherited disorder of cholesterol metabolism. Homozygous form of the disease associates severe form of atherosclerotic disease. Clinicians have been tried to inhibit the progression of the homozygous FH with medical and surgical treatment. We here present three siblings with homozygous FH who were successfully treated with liver transplantation.

Mechanical intestinal cleansing and antibiotic prophylaxis for preventing bacterial translocation during the Pringle maneuver in rabbits.

PURPOSE: We investigated the effectiveness of mechanical intestinal cleansing and antibiotic prophylaxis in preventing bacterial translocation (BT) during the Pringle maneuver in rabbits. METHODS: Forty-eight rabbits were allocated to one of the following four groups: a control group (group 1); an antibiotic group, given 100 mg/kg intravenous ceftizoxime (group 2); a mechanical intestinal cleansing group, given a Fleet enema (group 3); and a mechanical intestinal cleansing plus antibiotic group (group 4). After performing laparotomy, we dissected the portal region and turned the portal triad, using tape. Pringle maneuver was applied for 30 min in all groups. Blood samples were collected from the portal vein for blood culture before the Pringle maneuver. All groups underwent relaparotomy 30 min after the Pringle maneuver, to obtain portal blood, mesenteric lymph nodes (MLNs), and splenic tissue for culture. RESULTS: All cultures from the portal vein specimens taken before the Pringle maneuver were negative. The rate of bacterial isolation in the portal vein (P < 0.001), MLNs (P < 0.01), and splenic (P < 0.001) cultures was significantly lower in group 4 than in the other groups. It was also lower in group 3 than in groups 1 and 2 (P < 0.05 for all). CONCLUSIONS: The combination of mechanical intestinal cleansing and preoperative broad-spectrum antibiotics was most effective for preventing BT during the Pringle maneuver.

Comparison of primary repair and repair with polyglycolic acid coated tube in recurrent laryngeal nerve cuts (an experimental study).

BACKGROUND: Recurrent laryngeal nerve (RLN) injury is an important complication of thyroid surgery. In our study, we aimed to compare the effects of primary repair and polyglycolic acid (PGA) coated tube repair on nerve function and regeneration in RLN cuts in rats. METHODS: Twenty seven rats were used for the study. Group-1 with only nerve cuts, group-2 with primary repair, and group-3 with conduit repair. The study was planned over two-stage surgery. In the first step, nerve defect formation and nerve repair were performed in the same session. In the second step, samples were taken from the subjects for histopathological. RESULTS: Vocal cord mobility was proportionally higher in group-3 than other groups. However, there was no statistically significant difference between the groups (p < 0.239). The mean number of highest axons were detected the group-3. CONCLUSIONS: We think that PGA coated conduit can provide a more accurate orientation of nerve fibers by creating an isolated environment when compared to the primary repair. And this may be the cause of functional improvement in the nerve.

[Early laparoscopic cholecystectomy for acute cholecystitis]. / Akut kolesistit için erken laparoskopik kolesistektomi.

BACKGROUND: The aim of this study was to assess the clinical results of treatment by laparoscopic cholecystectomy (LC) in patients with acute cholecystitis. METHODS: Between 1994 and 2006, LC was performed in 3876 patients in Selcuk University Meram Medicine Faculty. The clinical, biochemical, radiologic, and operative data of 182 (101 F, 81 M) consecutive patients with acute cholecystitis operated 3 days after the onset of symptoms were analyzed retrospectively to determine the complications and morbidity after operation. RESULTS: The conversion rate was 31 (17.03%) in acute cholecystitis. Postoperative length of stay was found as 4 days in the successful LC group and 7 days in the conversion group. For acute cholecystitis, we found a statistical difference between the successful LC group and the conversion group in terms of length of postoperative hospitalization time and gallbladder wall thickness. We identified the following factors as associated with conversion: male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm. CONCLUSION: LC is a safe approach in selected patients with acute cholecystitis. Male gender, pericholecystic collection seen on ultrasound, gangrenous cholecystitis, and gallbladder wall thickness >1 cm are associated with a higher risk of conversion to open surgery.

Use of chorioamniotic membrane instead of bogota bag in open abdomen: how i do it?

It is one of the most important problems for general surgeons to decide which operation should be undertaken on patients with intra-abdominal infection, especially those with concomitant abdominal hypertension. Recently, closure techniques using prosthetic meshes in order to retain abdominal tension and to control sepsis have become very popular for patients with abdominal sepsis and hypertension. We used chorioamniotic membrane instead of plastic material to cover the open abdomen. We conclude that human chorioamniotic membrane prepared under sterile conditions may be an alternative to conventional plastic bags in daily practice, for preventing serosal erosion and fistulas in patients undergoing open abdominal surgery.

Effects of caffeic acid phenethyl ester (CAPE) on sepsis in rats.

Sepsis is still a major cause of the high mortality rate in the intensive care unit. Many studies have been published about the severity of sepsis, but the cause of mortality in sepsis and multiorgan failure is still obscure. This study investigated the effects of caffeic acid phenethyl ester (CAPE) particularly on the inflammatory and related histopathological changes in the lung, liver and kidney in an experimental sepsis model. Forty Sprague Dawley rats were used in this study, and were divided into four groups of ten rats each, as follows: Group I was given intraperitoneal saline infusion treatment. Group II was given intraperitoneal CAPE infusion treatment. Sepsis was induced in the animals in Group III (sepsis with saline infusion), while Group IV rats underwent induced sepsis plus CAPE infusion treatment (sepsis with CAPE infusion). Sampling was performed 48 h after treatment. The induction of sepsis resulted in a significant increase in serum glucose, leukocytes, urea, creatinine, LDH levels in BAL, plasma MDA, AST and ALT levels in the sepsis + saline group. The use of CAPE significantly decreased these parameters. Histopathological examination revealed less congestion, portal inflammation, and focal necrosis of the liver, and less congestion, edema, and emphysematous and inflammatory changes in the lung in the sepsis + CAPE group than in the other groups. These results support that CAPE may be used for the treatment of organ failure during sepsis.

Internal herniation as a major cause of intestinal obstruction.

OBJECTIVES: To evaluate internal herniation as a rare cause of intestinal obstruction. MATERIALS AND METHODS: Files of 18 cases, operated due to internal herniation between 2000 and 2006 at Selcuk University, Meram School of Medicine, General Surgery Department, were reviewed retrospectively. Sixteen patients (88.8%) were male (mean age: 58.2 years; range: 42-67) and 2 were female (mean age: 56.5 years; range: 52-61).Cases were grouped according to the location of internal herniation, and the clinical findings and applied treatment strategies were evaluated. RESULTS: All patients were taken into surgical operation after preoperative preparations were completed. Findings were as follows: 6 cases of paraduodenal internal herniation, 4 of internal herniation through a defect in the terminal mesoileum, 2 of herniation through a defect in the falciform ligament, 2 of herniation through a defect in the omentum majus, 1 of herniation to the recessus over the bladder, 2 of herniation through a defect in the transverse mesocolon and 1 iatrogenically caused internal herniation through a defect in the mesojejunum. CONCLUSION: In an adult patient with findings of intestinal obstruction, diagnosis is difficult. Most cases presented to date are incidental findings during laparotomy, and surgical treatment is necessary.

The effects of anti-adhesion materials in preventing postoperative adhesion in abdominal cavity (anti-adhesion materials for postoperative adhesions).

PURPOSE: The purpose of this study was to compare the effects of anti-adhesion materials in postoperative adhesions. MATERIALS AND METHODS: Rats were assigned to five groups: Group 1: Control. Group 2: chitin layers were used. Group 3: Na-hyaluronate / carboxymethylcellulose layers were used. Group 4: Na-hyaluronate gel was poured into the abdomen. Group 5: methylprednisolone was injected. The adhesion frequency and grade were scored according to Granat. Blood was taken for Hb, AST, BUN and albumin levels determination. FINDINGS: The adhesion frequencies (right and left) and grades were as follow in Groups; I: 82%, 91%, 2.63 +/- 1.22; II: 8.3%, 25%, 0.58 +/- 0.66; III: 17%, 33%, 1.08 +/- 1.08; IV: 50%, 58%, 1.41 +/- 1.44; V: 50%, 42%, 1.41 +/- 1.50. The adhesion phase in all study groups was found significantly low compared to control group, p < 0.05. No difference was observed among serologic and hematological parameters in all groups. CONCLUSION: All the materials used significantly lowered the adhesion frequency and grade.