Mandibular dental arch changes with active self-ligating brackets combined with different archwires.

OBJECTIVE: The aim was to compare mandibular arch and incisor inclinational changes by comparing active self-ligating brackets used with different forms of archwires with a control group in nonextraction cases. MATERIALS AND METHODS: The sample of 50 patients with Class I malocclusion was divided into three groups: Group I was treated with active self-ligating brackets (Nexus, Ormco/Orange, CA, USA) used with Damon arch form copper nickel-titanium (Cu-NiTi) and stainless steel (SS) wires; Group II was treated with interactive self-ligating bracket system (Empower, American Orthodontics, Sheboygan, Wis, USA) used with standard Cu-NiTi and SS wires; and Group III was treated with Roth prescribed conventional brackets (Forestadent, Pforzheim, Germany) with standard Cu-NiTi and SS wires which was designed as a control group. Changes in dimension of mandibular arch and inclination of incisors were assessed on dental models and lateral cephalometric radiographs at pretreatment (T1) and posttreatment (T2) periods. Paired-t test and one-way analysis of variance were used to perform intragroup and intergroup comparisons, respectively. RESULTS: In all groups, an average increase of transversal distances occurred from pretreatment to the posttreatment period (P < 0.05). However, mandibular arch length increase was significantly different among the Groups I-III (P = 0.008) and I-II (P = 0.006). No significant intergroup difference was found with regard to incisor inclinational changes. CONCLUSIONS: Bracket type had no significant effect on the mandibular dimensional or incisor inclination changes. Besides this, archwire type had only little effect on the treatment results as active self-ligating bracket with Damon archwires increased mandibular arch length greater than other groups.

Characterization of immunohistochemical markers in triple negative breast carcinomas.

PURPOSE: Triple negative (TN) breast carcinomas (estrogen receptor/ER, progesterone receptor/PR and HER-2/neu negative) constitute 15-25% of all breast carcinomas and have been correlated with aggressive behavior and poor prognosis. Our aim was to describe and characterize the immunophenotype of these tumors in a group of patients from Turkey. METHODS: We used the immunohistochemical markers CK5/6, CK14, EGFR, E-cadherin, p53 and androgen receptor. Formalin-fixed, paraffin-embedded tissues from 51 breast carcinoma patients (36 TN and 15 non TN) were included into this study. RESULTS: The mean values of the distribution of immunohistochemical markers in TN vs non-TN groups were as follows: CK5/6 78.4 vs 5.3%, CK14 84.8 vs 8%, EGFR 87.2 vs 8%, E-cadherin 96.9 vs 53.2%, p53 87.3 vs 7.3% and androgen receptor 89.5 vs 33.3% (all p-values<0.001). CK5/6 stained significantly different in the grade 2 and 3 cases (p=0.035) in the TN group.The other markers demonstrated no significant differences between grades. CONCLUSION: TN breast carcinomas in Turkish patients express basal cytokeratins, and have high levels of p53 compared to non-TN breast carcinomas.

The neuroprotective and anti-inflammatory effects of diltiazem in spinal cord ischaemia-reperfusion injury.

The protective effects of diltiazem were examined in a rabbit model of spinal cord ischaemia-reperfusion induced by infrarenal aortic occlusion for 30 min. In the diltiazem group (n = 6), an intravenous infusion (2 microg/kg per min) was started 10 min before ischaemia induction; normal saline solution was infused in the control group (n = 6). Neurological function was assessed using modified Tarlov criteria 24 h after surgery. Plasma samples were analysed for interleukin (IL)-6 and IL-10. Spinal tissue was analysed for malondialdehyde, nitric oxide and reduced glutathione activities. Tarlov scores of the diltiazem-treated rabbits indicated significantly improved hind-limb motor function compared with the control group. The diltiazem group also had better quantitative and qualitative histopathological findings. Diltiazem infusion significantly reduced IL-6 levels 3 and 24 h after reperfusion compared with the control group. The mean IL-10 level in the diltiazem group was significantly higher than in the control group 24 h after reperfusion. It is concluded that diltiazem has cytoprotective and anti-inflammatory properties, leading to reduced spinal cord injury.

A technique for correction of truncus arteriosus types I and II without extracardiac conduits.

A new corrective operation for truncus arteriosus without the use of an extracardiac conduit was performed in seven patients with truncus type I (six patients) or type II (one patient) aged from 2 to 9 months. The common truncus arteriosus was septated with a patch into aortic and pulmonary segments and the ventricular septal defect was closed through a ventriculotomy. A direct anastomosis between the pulmonary arteries and the right ventricle was performed, the anterior wall being constructed with a patch with a monocusp valve. There was one death in the immediate postoperative period. In the surviving six patients the postoperative right ventricular/left ventricular peak systolic pressure ratio was less than 0.51 in five and 0.60 in one with a residual ventricular septal defect. All are in functional class I between 1 and 14 months after the operation. On the basis of these results, we propose this technique for patients with truncus type I or II in the first year of life.

Intraventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect: advantages of multiple patches.

OBJECTIVE: The objective of this paper is to report our experience with biventricular repair of double-outlet right ventricle with noncommitted ventricular septal defect by means of multiple patches that simplify and render feasible the intraventricular correction of this complex anomaly. METHODS: From April 1987 to April 1999, in 18 patients with double-outlet right ventricle and noncommitted ventricular septal defect, a technical modification that used multiple patches of bovine pericardium was used to construct an intraventricular tunnel connecting the left ventricle to the aorta. Ages ranged from 2 months to 13 years (mean age 4.73 +/- 3.41 years). RESULTS: The early mortality was of 11.1% (2 patients). Surviving patients were followed up for a mean of 2.65 years. Three late deaths (16.6%) occurred: 5 months, 7 months, and 7 months after the operation. All but 1 patient are in New York Heart Association class I. CONCLUSION: The use of multiple patches for biventricular correction of this anomaly simplifies and renders feasible the intraventricular repair in cases in which the 1-patch technique was deemed impossible.

Reconstruction of stenotic or nonconfluent pulmonary arteries simultaneously with a Blalock-Taussig shunt.

Stenosis or discontinuity of the pulmonary arteries associated with congenital cardiac defects was repaired in 12 patients, in conjunction with the Blalock-Taussig shunt. This approach was based on the following concepts: (1) The shunted blood is more uniformly distributed to both lungs, which avoids predominance of flow to the ipsilateral lung and long-term pulmonary vascular damage; (2) because adequate blood flow is maintained, the contralateral lung growth will be near normal; (3) the possibility of future surgical correction is enhanced. The ages of the patients ranged from 2 to 24 months. Five had a primary diagnosis of tetralogy of Fallot, three had double outlet of the right ventricle, three had single ventricle, and one had a truncus type anomaly. All operations were performed without cardiopulmonary bypass. Dilation of the stenotic segment was performed in two patients, enlargement of the stenotic segment in three, and resection of the segment and end-to-end anastomosis in four. Nonconfluent pulmonary arteries were corrected in three patients. In one, the stenotic segment was resected and an anastomosis was made between the left pulmonary artery and pulmonary trunk. In another patient, a segment of the right subclavian artery was interposed between the pulmonary trunk and intrahilar left pulmonary artery. In the third patient, the right pulmonary artery was disconnected from the aorta and a tube was interposed between the right and left pulmonary arteries. There were no intraoperative or late deaths, and postoperative angiographic evaluations were satisfactory. We believe that in infants needing a Blalock-Taussig shunt the pulmonary artery anomalies, if present, should be corrected simultaneously.

Intrapulmonary balloon for temporary relief of pulmonary hypertension.

In this report, we shall describe a case of interventricular septal defect with severe cardiac and respiratory insufficiency unresponsive to clinical treatment. The critical condition of the patient prompted us to introduce an obstructive balloon into the pulmonary artery with the objective of reducing pulmonary flow and improving respiratory insufficiency. The mean pressure was reduced from 45 to 19 mm. Hg, and the infant's cardiopulmonary status improved dramatically. After 36 hours, during which the clinical picture stabilized, a banding operation was performed with success.

Left ventricular apical approach for the surgical treatment of congenital mitral stenosis.

From June 1987 to October 1991, 12 patients with congenital mitral valve stenosis underwent surgical correction. Their ages ranged from 2 to 74 months. Nine patients were less than 22 months of age. Five patients were in New York Heart Association functional class IV, and seven patients were in class III. In nine, parachute-type mitral stenosis was clearly definite. In three, a complex congenital valvular and subvalvular stenosis was found. Associated anomalies were present in every patient; five had undergone previous operations. Correction of the mitral stenosis was done through an apical left ventriculotomy. The removal of the mitral obstruction starts from below; the papillary muscle was split and the chordae were divided or fenestrated. The commissurotomies were performed from the ventricular aspect of the mitral valve. Associated anomalies were corrected simultaneously. The operative mortality rate was zero. There was one late death, which was unrelated to cardiovascular status. The echocardiographic serial postoperative studies (up to 52 months) showed no significant residual mitral stenosis and normal global and regional function of the left ventricle in all but one patient.

Transxiphoid approach without median sternotomy for the repair of atrial septal defects.

BACKGROUND: Interest in minimally invasive procedures has recently increased because it results in less surgical trauma, decreased patient discomfort, short hospital stay, reduced costs, and better cosmetic appearance. Based on these facts, we have been using the transxiphoid process approach without sternotomy for the correction of atrial septal defects. METHODS: From July 1996 to January 1997, the xiphoid process window approach was performed in 10 patients with ostium secundum atrial septal defect. Ages ranged from 6 months to 14 years (mean, 5.3 years). In all patients, extracorporeal circulation was carried out by means of cannulation of the femoral artery and both caval veins and of aortic cross-clamping. Videothoracoscopy was used to improve visualization of the aorta. RESULTS: There were no intraoperative or postoperative complications, and in all but 1 patient, extubation was possible while in the operating room. CONCLUSIONS: The xiphoid process window, with no median sternotomy, permitted closure of the atrial septal defects with good results and could be used as a less invasive technique for their correction.

Common arterial trunk associated with absence of right atrioventricular connexion.

Common arterial trunk is a rare congenital anomaly, usually found in the setting of a concordant atrioventricular connexion. The association of a common arterial trunk with absence of the right atrioventricular connexion is very rare, having, as far as we know, been reported only twice in the literature. In the case reported here the pulmonary arteries originated separately from the posterior wall of the arterial trunk, and the trunk overrode the septum between the dominant left- and the right-sided rudimentary right ventricle. We discuss the electrocardiographic features which can help in the diagnosis of this malformation.

Aortic atresia with aortopulmonary window and interrupted aortic arch, simulating common arterial trunk: a case report.

The authors describe the cross-sectional echocardiographic and angiographic features besides the postmortem findings of a newborn with aortic atresia associated with the aortopulmonary window and an interrupted aortic arch, as the third known similar case reported in the literature. Anatomical and clinical similarities with common arterial trunk are emphasized and a more correct management is established to avoid risks, in which Norwood-type techniques would be preferable.

Cross-sectional echocardiographic features of "absent" pulmonary valve. Report of two cases.

"Absence" of the pulmonary valve was recognized by cross-sectional echocardiography in two infants having relatively atypical clinical manifestations for this cardiac malformation. Both had associated lesions: tetralogy of Fallot and ventricular septal defect, respectively, which were also detected by this non-invasive technique. The findings which strongly suggested the diagnosis were the presence of a ridge of rudimentary pulmonary valvular tissue at the level of the pulmonary annulus and the aneurysmal dilation of the pulmonary arteries. The short axis view at the level of the great arteries was the best approach for visualization of these anatomical abnormalities. The parasternal long axis and sub-costal four-chamber views were also helpful in detecting the associated lesions. In both cases the diagnoses were confirmed at autopsy.

Atresia of the left atrioventricular valve with patency of the aorta: anatomico-functional analysis of 23 patients.

We analyzed the findings in 23 patients with atresia of the left atrioventricular valve and a patent aorta seen in the period from January 1980 to July 1989. Having divided the cases according to the anatomical findings, we made a subsequent analysis of the clinical and surgical results with the aim of establishing the management most likely to diminish risks, still high, in treatment of this complex anomaly. From the anatomical viewpoint, three variants were observed. In the first, made up of 15 cases, there was absence of the left atrioventricular connexion. The characteristic finding in the second group, with five cases, was an imperforate left atrioventricular valve in the setting of concordant atrioventricular connexions. The third group, of these cases, was dominated by the presence of isomerism of the atrial appendages, both appendages being of left morphology in one case, and of right morphology in the other two. Further anatomical variation was then found in each group. Nine of the 15 with absence of the left atrioventricular connexion had the right atrium connected to a dominant left ventricle in presence of a rudimentary and incomplete right ventricle associated with discordant ventriculo-arterial connexions, all of them being in usual atrial arrangement and three with pulmonary stenosis. The remaining six in this first variant had the right atrium connected to a dominant right ventricle. In the five patients with imperforate left atrioventricular valves, two had discordant and three had concordant ventriculo-arterial connexions. In the three cases with isomerism, two had absence of the left atrioventricular connexion, with a dominant right ventricle. The last patient had an imperforate left atrioventricular valve and a discordant ventriculo-arterial connexion. From the functional viewpoint, there were 14 patients (10 with absence of an atrioventricular connexion, four with imperforate atrioventricular valve) with congestive heart failure and nine patients (five from the first, one from second, and three from the third variant) with hypoxia. Long-term follow-up (median 16.4 months--varying from 1 to 41 months--in the group with congestion and 27.7 months--varying from 12 to 57 months--in those with hypoxia) showed favorable clinical evolution in 11 (91%). We conclude that an anatomico-functional division can point towards the most appropriate management in this complex anomaly.

Choreoathetosis after cardiac surgery with hypothermia and extracorporeal circulation.

Eleven children, 4-48 months old, with congenital cyanotic heart defects developed choreoathetoid movements 2-12 days after cardiac surgery with hypothermia and extracorporeal circulation (ECC). The abnormal movements mainly involved the limbs, facial musculature, and tongue, leading to a severe dysphagia. The symptoms had an acute onset, after a period of apparent neurologic normality, and had a variable outcome. Of the nine children that survive, three had abnormal movements when last seen (41 days to 12 months of follow-up). The other six children had a complete regression of the choreoathetoid movements 1-4 weeks after onset. No specific finding was observed in the CT scans, cerebrospinal fluid examination, or EEG that could be related to the abnormal movements. Symptomatic therapy with haloperidol with or without benzodiazepines led to symptomatic improvement in six children, although there was no evidence that this treatment modified the evolution of the disease. The authors conclude that the choreoathetoid syndrome after cardiac surgery with deep hypothermia and ECC is an ill-defined entity requiring additional study to better understand its pathogenesis so that preventive measures can be taken to avoid a condition that can lead to permanent and incapacitating neurologic sequelae.

Echocardiographic routine analysis of the coronary sinus by an apical view: normal and abnormal features.

The echocardiographic aspects of the coronary sinus have not received much attention in the literature. In the few published articles about anomalous venous connection to the coronary sinus, the parasternal long axis view has been suggested as ideal for its visualization. More recently, it has been suggested that the coronary sinus in normal hearts is best visualized from the apical transducer position. The purpose of this study was to assess the appearance of the coronary sinus from an apical view in a group of 400 consecutive patients with ages varying from 5 days to 80 years. In ten patients with persistent left superior vena cava, the coronary sinus was markedly dilated throughout its extension. All cases were confirmed either by angiography or surgery. In another three patients with Ebstein's anomaly studied postoperatively, it was observed that the coronary sinus was abnormally draining into the right ventricle below the prosthesis plane. These findings were confirmed by the surgical reports. The routine evaluation of the coronary sinus was better performed by an apical view, which provided detailed information not only of normal, but also abnormal anatomy of this segment of the heart. We speculate that it could be especially useful in diagnosing coronary sinus atresia and thrombosis, and coronary ostium atresia, as well as total anomalous intracardiac pulmonary venous drainage.

Detection and genotyping of Epstein-Barr virus by polymerase chain reaction in tissues obtained from cases with Hodgkin's disease in Turkey.

In order to determine the positivity rate and genotype of Epstein-Barr virus (EBV) in cases with Hodgkin's disease (HD) in Turkey, 40 tissue specimens from HD patients were analysed. Ten non-lymphoid tissue samples from individuals without any evidence for lymphoma were used as controls. The cases with HD included 33 males and 7 females with a mean age of 28 years. Nodular sclerosis was the most prevalent histological subtype (16/40) followed by mixed cellularity (10/40), lymphocyte predominance (9/40), and lymphocyte depletion (5/40). After histopathological evaluation, deparafinisation and lysis of the specimens, one-stage polymerase chain reaction (PCR) and two-stage (nested) PCR assays were performed with the primers common for both EBV genotypes and the primers specific for EBV types 1 and 2, respectively. EBV DNA was detected in 22 of 40 (55%) cases with HD and in 1 of 10 (10%) control specimens. The distribution of EBV DNA positivity according to the histological subtypes was as follows: 10 of 16 (62.5%) for nodular sclerosis, 3 of 5 (60%) for lymphocyte depletion, 5 of 9 (55.6%) for lymphocyte predominance, and 4 of 10 (40%) for mixed cellularity. Although most of the HD patients were males of 15-34 years of age, there were no significant differences between EBV positivities obtained from different sex and age groups. The rates of EBV genotypes were 82% for type 1, 9% for type 2, and 9% for both types, respectively.

The Laugier-Hunziker syndrome.

Laugier-Hunziker syndrome is a rare, acquired, benign hyperpigmentation of the lips, oral mucosa and nails. Although it is a benign disorder, other pigmentary disorders affecting the oral mucosa and nails must be considered in the different diagnosis. We presented a case of Laugier-Hunziker syndrome, showed clinical and histopathologic features of the disease.

Absence of the aortic valve associated with hypoplastic left-sided heart syndrome.

In this report we describe the twelfth case in the literature of absence of the aortic valve cusps, associated with hypoplastic left-sided heart syndrome in a neonate. Clinical and hemodynamic conditions in our patient resemble the classical features of this syndrome except for a greater development of the ascending aorta and the left ventricular cavity, due to aortic insufficiency. A patch was unsuccessfully inserted at the aortic annulus to exclude the left ventricle from the circulation. In addition the Norwood operation was performed.

Uhl's anomaly. Differential diagnosis and indication for cardiac transplantation in an infant.

We report the case of an 8-month-old female infant with Uhl's anomaly, who underwent successful cardiac transplantation. The clinical findings, complementary laboratory tests, anatomic findings, and differential diagnosis of the anomaly are discussed.

[Origin of left coronary artery from right and left pulmonary arteries--clinical, anatomico surgical and follow-up evaluation of 3 cases]. / Origem da artéria coronária esquerda das artérias pulmonares, direita e esquerda--avalia ção clínica, anatomocirúrgica e evolutiva de três casos.

Three infants with anomalous origin of left coronary artery, being two from the right pulmonary artery and one from the left, without other congenital defects, ages of 5, 15 and 3 months old, presented with early congestive heart failure due to anterolateral myocardial infarction. Anatomical characteristic was peculiar in two cases since the left coronary artery, before the anastomosis with the right pulmonary artery, presented a wy, 15 mm extension path within the aortic wall which has facilitated the surgical correction by the proximity of these structures. In the third case, the left coronary artery was anastomosed with the left pulmonary artery, 2 cm from its origin and anterior to the left atrium being the surgical correction by direct implant at the ascending aorta. Post-operative follow-up, 36, 30 and 33 months respectively, showed clinical and laboratorial normalization except for the second case in which ST segment remained upward due to ventricular aneurysm. Myocardial recovery, even after extensive infarction, in this anomaly, emphasizes the need for earlier diagnosis and management.