Fractal analysis of the effects on mandibular bone of botulinum toxin therapy of the masseter muscle in patients with bruxism.

OBJECTIVE: We examined changes in the mandibular angle, ramus, and condylar neck of patients with bruxism after botulinum toxin-A (BTX-A) injection into the masseter muscle as calculated with fractal analysis (FA) on panoramic radiographs (PRs). METHODS: We examined the PRs of 3 groups of 22 patients each (n = 66) obtained upon presentation and 6 months later. One group included healthy controls without bruxism, one group included patients with untreated bruxism, and one group included patients with bruxism who had undergone BTX-A injection into the masseter muscle. We performed FA of the bilateral angle, ramus, and condylar neck of the PRs to calculate fractal dimension (FD). RESULTS: The FD values of the angle on the second PRs of the untreated bruxism group were significantly higher than those of the other groups (P = .026), specifically when compared to the BTX-A injection group (P = .017). The FD values in the angle and ramus of the bruxism group were significantly higher on the second PRs (P ≤..005)) Conversely, the FD values in the angle of the BTX-A injection group were significantly lower on the second PR (P = .039). CONCLUSIONS: Masseter muscle hyperactivity due to bruxism increases bone density in masseter muscle attachment regions. BTX-A injection restricts muscle activity, thereby chnging bone structure and decreasing FD.

TWO DIFFERENT MUTATIONS OF GL13 GENE IN TWO DIFFERENT SYNDROMES.

Polydactyly is among comnion extremity abnormalities. Mutations of GLI3 gene have been reported commonly in Greig Cephalopolysyndactyly Syndrome (GCPS) and Pallister-Hall Syndrome (PHS). We have determined two different mutations of GLI3 gene in two different cases, one of which is with GCPS and the other one is with PHS. A deletion mutation was detected in the proband with GCPS and his mother. Otherwise, we found that, unlike the previously reported, the mutation c.2437C>T, p.Q813X which was detected in the GLI3 gene caused typical PHS. We are in thought of that our cases will contribute to understanding of phenotypic variability leading to GLI3 mutations.

Assessment of blood mercury levels in practicing Turkish clinicians, dental students, and dental nurses.

OBJECTIVES: Potential sources of exposure of the dental health team and their patients to mercury vapor in the dental clinic include accidental spillage of elemental mercury, use of mechanical amalgamators, and dry cutting of old amalgam restorations using high-speed instrumentation. The purpose of this study was to evaluate the extent of mercury exposure in Turkish dental staff by cold-vapor atomic absorption spectrometry. METHOD AND MATERIALS: A total of 211 clinicians, dental students, and dental nurses answered a questionnaire concerning sex, age, occupation, number of amalgam restorations performed per week, number of amalgam restorations removed per week, methods of trituration, number of amalgam restorations present in their own mouths, frequency of fish consumption, smoking, vitamin intake, and bruxism. For each subject, a 5-mL sample of whole blood was drawn and frozen until the time of analysis. Blood mercury levels were measured by means of cold-vapor atomic absorption spectrometry. Blood mercury levels were also analyzed in a control group of 58 non-dental-staff blood donors. RESULTS: Normal blood mercury values are considered to be in the range of 0 to 5 ng Hg/mL. Of the dental staff evaluated, 51.7% had a blood concentration of mercury less than 5 ng Hg/mL, and 33.6% had a blood concentration above 5 ng Hg/mL. The difference between the test and control groups was statistically significant (P < .01). CONCLUSION: Mercury is being absorbed as a result of dental practice but that although there is, in general, a low level of mercury contamination in the dental operatory because of amalgam work, sufficient care is being taken to prevent higher levels of contamination with an increased use of mercury.

Dexmedetomidine causes prolonged recovery when compared with midazolam/fentanyl combination in outpatient shock wave lithotripsy.

BACKGROUND AND OBJECTIVES: Analgesia and sedation are usually required during extracorporeal shock wave lithotripsy. In the present study, the recovery time and effectiveness of sedation and analgesia of dexmedetomidine was compared with a midazolam/fentanyl combination in outpatient extracorporeal shock wave lithotripsy. METHODS: Forty-nine patients scheduled for outpatient extracorporeal shock wave lithotripsy were randomly assigned to two groups: a dex group (n = 25; dexmedetomidine 1 microg kg(-1) loading dose followed by dexmedetomidine 0.2 microg kg(-1) h(-1) and a control group (n = 24; midazolam 0.05 mg kg(-1) and fentanyl 1 microg kg(-1)). Recovery time, rescue analgesics (fentanyl 25 microg) and sedatives (midazolam 1 mg), and patients' satisfaction rates were recorded. RESULTS: The two groups were similar regarding patient characteristics and procedure-related details (P > 0.05). Recovery time was significantly prolonged in the dex group when compared with the control group (116.4 +/- 39.3 vs. 50.8 +/- 19.8 min, respectively, P < 0.001). The percentage of patients requiring rescue doses of fentanyl and the applied doses were significantly higher in the dex group than in the control group (96% vs. 67%, P = 0.01; and 69.0 +/- 31.7 vs. 38.8 +/- 42.9 microg, respectively, P = 0.007). More patients in the dex group received rescue midazolam (96% vs. 58%, P = 0.002). More patients in the control group were highly satisfied with their sedation/analgesia (83% vs. 56%, P = 0.038). CONCLUSION: Dexmedetomidine was associated with a longer recovery time than a midazolam/fentanyl combination when used for sedation and analgesia during outpatient extracorporeal shock wave lithotripsy in this study. The incidence of rescue sedative and analgesic need was also significantly higher when dexmedetomidine was used.

Assessment of bone density differences between conventional and bone-condensing techniques using dual energy x-ray absorptiometry and radiography.

OBJECTIVES: We used dual energy x-ray absorptiometry (DEXA) and periapical radiography to assess bone density differences after conventional and bone-condensing dental implant techniques. STUDY DESIGN: Single-tooth dental implants were placed by both conventional and bone-condensing techniques in 14 patients with bilateral missing teeth. Dual energy x-ray absorptiometry was used to calculate bone mineral density (BMD) and bone mineral content (BMC) before and 6 and 12 months after implant placement. Furthermore, photodensitometry of periapical radiographs was also assessed. RESULTS: The success rate was 92.9% for the conventional technique and 71.5% for the bone-condensing technique. The BMD was observed to be significantly higher 6 and 12 months after implant placement. The BMC and photodensitometry were significantly increased 6 months after implant placement but showed no further after 12 months. CONCLUSIONS: There were no significant differences in BMD, BMC, and photodensitometry between the two implant placement techniques. However, success rate of the conventional technique was greater than the bone-condensing technique, which may be the result of trabecular fracture associated with the bone-condensing.

Temporal variation of oxidant stress in critically ill patients.

AIM: Our aim was to investigate indicators of lipid peroxidation via observing temporal changes or daily fluctuations in cytoprotective enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX), and serum components possessing antioxidant activity against free radicals and malondialdehyde (MDA) such as uric acid. This study was conducted in a small number of critically ill patients versus healthy volunteers in order to design an effective antioxidant therapy regimen under oxidative stress. METHODS: Six critically ill patients and 6 young healthy volunteers were recruited. Blood samples were collected 6 times a day with 4 h intervals starting from 8 a.m. From the blood samples, SOD and GSH-PX activities and uric acid and MDA levels were determined. One-way ANOVA and unpaired t-test were used to assess differences within and between the groups, respectively. A two dimensional table curve cosine formulation was performed to elucidate rhythmycity. RESULTS: No significant differences were found in SOD and GSH-PX activities or uric acid levels within the 24 h period or between the groups. MDA levels were significantly higher in the study group at 8 p.m. than that of control group (P<0.05), but no significant difference was found within the 24 h period. We showed that GSH-PX activities in control and study groups revealed temporal variation, whereas uric acid levels varied temporally only in the study group. CONCLUSION: We concluded that there are signs of oxidative stress in ICU patients that vary in time but further studies are required in order to design appropriate antioxidant treatments.

Respiratory problems in renal transplant recipients admitted to intensive care during long-term follow-up.

Cardiovascular disease, malignancies, and infectious complications are major causes of morbidity and mortality of renal transplant recipients. Mortality rates vary between 16% and 40% in an intensive care unit (ICU). The aims of this study were to identify the types incidences of respiratory problems that affected renal transplant recipients admitted to the ICU during long-term follow-up thereby determining the impact of respiratory problems on mortality. We reviewed the data for 34 recipients who had 39 ICU admissions from January 2000 through December 2003. Twenty-four admissions (61.5%) had at least one respiratory problem at admission or developed at least one during the ICU stay. The most frequent problem was pneumonia (n=18, 46.2% of the 39 readmissions), followed by acute respiratory failure (n=10, 25.6%), atelectasis (n=9, 23.1%), pleural effusion (n=8, 20.5%), and pulmonary edema (n=2, 5.1%). The patients who had respiratory problems showed a significantly higher mortality rate than those who did not have respiratory problems (66.6% versus 26.6%, respectively; P<.05). The overall mortality rate was 58.8% (20 patients). Thus, infectious and respiratory problems are the most frequent indications for admission and the most common problems during an ICU stay. The prognosis for patients who either have a respiratory problem upon admission to the ICU or develop one during the ICU stay is poor.

Successful treatment of a child with fulminant liver failure and coma due to Amanita phalloides poisoning using urgent liver transplantation.

Intoxication due to eating wild mushrooms presents with a variety of signs, ranging from mild diarrhea to severe organ failure. We present the case of an 11-year-old boy with fulminant liver failure and hepatic coma due to Amanita phalloides poisoning treated with an urgent pediatric orthotopic liver transplantation. Successful treatment of patients with fulminant liver failure and hepatic coma caused by Amanita phalloides poisoning is possible using urgent orthotopic liver transplantation when conservative medical treatment modalities are ineffective.

Rhinolithiasis: an uncommon entity of the nasal cavity.

Rhinoliths are uncommon foreign bodies of the nose formed by in situ calcification of intranasal endogenous or exogenous foreign material. They are often an asymptomatic condition diagnosed accidentally during a routine examination. Although nasal foreign bodies are more frequently seen in children, and appear to be more common in women, they have been reported in patients of all ages. This article describes a case of rhinolith involving a 38-year-old male. The etiology, thin-sectioned microscopic findings, differential diagnoses, and treatment are also discussed.

Internal jugular versus subclavian vein catheterization for central venous catheterization in orthotopic liver transplantation.

The aim of this study was to compare incidence rates of mechanical and infectious complications associated with central venous catheterization via the internal jugular vein (IJV) versus the subclavian vein (SV) among 45 consecutive patients undergoing orthotopic liver transplantation (OLT) between January 2000 and June 2004. The subjects were divided into two groups according to the site of central venous catheterization (IJV or SV). We recorded each patient's physical characteristics, international normalized ratio (INR), partial thromboplastin time, platelet levels, number of puncture attempts, success/failure of central venous catheterization, duration of catheter placement, occurrence of catheter tip misplacement, arterial puncture, incidence of hematoma or pneumothorax, catheter-related infection, or bacterial colonization of the catheter. Senior staff anesthesiologists performed 22 SV and 23 IJV catheterizations for the 45 OLT procedures. The SV and IVJ groups both had minor coagulation abnormalities with slightly increased INR values at the time of catheterization. There were no significant differences between the groups with respect to success of central venous catheterization (100% for both), numbers of attempted punctures, duration of catheter placement, and incidence rates of mechanical and infectious complications. Both groups showed high frequencies of catheter tip misplacement, with right atrium as the site of misplacement in all cases. Two patients in the IJV group (8.7%) developed hematomas after accidental carotid artery puncture. The results suggest that, when performed by experienced anesthesiologists, central venous catheterization via the SV is an acceptable alternative to IJV catheterization for patients undergoing OLT.

Risk factors for postoperative respiratory complications in adult liver transplant recipients.

To determine the types and the incidence of as well as risk factors for early postoperative (<30 days) respiratory complications in adult liver transplant (LT) recipients, we reviewed The data of 44 consecutive adult LT recipients who received their grafts from January 1995 through December 2002. The data included demographic features; primary diagnosis; number of intraoperative transfusions; preoperative and postoperative laboratory values; intraoperative and postoperative characteristics; and early postoperative (<30 days) mortality. Pulmonary atelectasis, pleural effusion, pneumonia, respiratory failure, and pulmonary edema were the respiratory complications investigated. Twenty-six patients (59.1%) developed at least one respiratory complication during the early postoperative period. The most frequent complication was pleural effusion (n = 18, 40.9%), followed by atelectasis (n = 13, 29.5%), pneumonia (n = 10, 22.7%), acute respiratory failure (n = 5, 11.4%), pulmonary edema (n = 3, 6.8%), and pneumothorax (n = 2, 4.5%). Compared to the patients who did not develop these problems, the affected cohort was significantly older (27 +/- 12 years vs 36 +/- 14 years, respectively; P =.039) and required more intraoperative transfusions (P =.005). Among the overall mortality rate of 15.9%, patients who developed pneumonia showed a significantly higher mortality (40.0% vs 8.8%, respectively; P =.037). Pleural effusion, atelectasis, and pneumonia are the main respriatory complications that occur in adult LT recipients. Patient age and intraoperative transfusion requirements are important predictors of early postoperative complications. Pneumonia is associated with a poor prognosis in this patient group.

Percutaneous dilational tracheotomy in solid-organ transplant recipients.

Pulmonary complications, such as pneumonia and respiratory failure, are important contributors to posttransplantation morbidity and mortality among solid-organ transplant recipients. Percutaneous dilational tracheotomy (PDT) is cost-effective in critically ill patients who require prolonged mechanical ventilation; however, the literature lacks reports about the effectiveness of this procedure in organ transplant recipients. Between August 2001 and February 2003, five recipients underwent PDT in our intensive care unit: two kidney, two liver, and one heart transplant recipient. The respective mean values for age, weight and APACHE II score were 41 +/- 7 yrs (range, 33-51 years), 63 +/- 14 kg (range, 40-80 kg), and 23 +/- 9 (range, 15-35). All PDTs were performed at the bedside by an experienced staff anesthesiologist under endoscopic guidance using the Griggs forceps dilational technique. The mean interval from transplantation to PDT was 58 +/- 56 months (range, 8 days to 132 months). In all cases, the indication for PDT was prolonged mechanical ventilation due to acute respiratory failure. The mean duration of endotracheal intubation before PDT was 4 +/- 3 days (range, 1-8 days). Transient hypoxemia (n = 1) and mild extratracheal bleeding (n = 1) were the only early complications. There were no late complications (including peristomal infection) or deaths associated with the procedures. Among the two patients who survived their stay in the intensive care unit, the functional and cosmetic outcomes of PDT were excellent. We recommend this technique for prolonged airway management in solid-organ transplant recipients.

Protective role of antioxidant vitamin E and catechin on idarubicin-induced cardiotoxicity in rats.

Idarubicin is an anthracycline antibiotic extensively used in acute leukemia. In the present study we investigated whether vitamin E and catechin can reduce the toxic effects of idarubicin. Vitamin E (200 IU kg(-1) week(-1)), catechin (200 mg kg(-1) week(-1)), idarubicin (5 mg kg(-1) week(-1)), idarubicin + vitamin E (200 IU kg(-1) week(-1)), and idarubicin + catechin (200 mg kg(-1) week(-1)) combinations were given to male Sprague-Dawley rats weighing 210 to 230 g (N = 6/group). Idarubicin-treated animals exhibited a decrease in body and heart weight, a decrease in myocardial contractility, and changes in ECG parameters (P<0.01). Catechin + idarubicin- and vitamin E + idarubicin-treated groups exhibited similar alterations, but changes were attenuated in comparison to those in cardiac muscle of idarubicin-treated rats (P<0.05). Superoxide dismutase and catalase activity was reduced in the idarubicin-treated group (P<0.05). Glutathione peroxidase levels were decreased in the idarubicin-treated group (P<0.05) and reached maximum concentrations in the catechin- and catechin + idarubicin-treated groups compared to control (P<0.01). Malondialdehyde activity was decreased in the catechin + idarubicin-treated groups compared to control and increased in the other groups, reaching maximum concentrations in the vitamin E-treated group (P<0.01). In electron microscopy studies, swelling of the mitochondria and dilatation of the sarcoplasmic reticulum of myocytes were observed in the idarubicin-treated groups. In groups that were given idarubicin + vitamin E and idarubicin + catechin, the only morphological change was a weak dilatation of the sarcoplasmic reticulum. We conclude that catechin and vitamin E significantly reduce idarubicin-induced cardiotoxicity in rats.

Protective role of antioxidant vitamin E and catechin on idarubicin-induced cardiotoxicity in rats

Idarubicin is an anthracycline antibiotic extensively used in acute leukemia. In the present study we investigated whether vitamin E and catechin can reduce the toxic effects of idarubicin. Vitamin E (200 IU kg-1 week-1), catechin (200 mg kg-1 week-1), idarubicin (5 mg kg-1 week-1), idarubicin + vitamin E (200 IU kg-1 week-1), and idarubicin + catechin (200 mg kg-1 week-1) combinations were given to male Sprague-Dawley rats weighing 210 to 230 g (N = 6/group). Idarubicin-treated animals exhibited a decrease in body and heart weight, a decrease in myocardial contractility, and changes in ECG parameters (P<0.01). Catechin + idarubicin- and vitamin E + idarubicin-treated groups exhibited similar alterations, but changes were attenuated in comparison to those in cardiac muscle of idarubicin-treated rats (P<0.05). Superoxide dismutase and catalase activity was reduced in the idarubicin-treated group (P<0.05). Glutathione peroxidase levels were decreased in the idarubicin-treated group (P<0.05) and reached maximum concentrations in the catechin- and catechin + idarubicin-treated groups compared to control (P<0.01). Malondialdehyde activity was decreased in the catechin + idarubicin-treated groups compared to control and increased in the other groups, reaching maximum concentrations in the vitamin E-treated group (P<0.01). In electron microscopy studies, swelling of the mitochondria and dilatation of the sarcoplasmic reticulum of myocytes were observed in the idarubicin-treated groups. In groups that were given idarubicin + vitamin E and idarubicin + catechin, the only morphological change was a weak dilatation of the sarcoplasmic reticulum. We conclude that catechin and vitamin E significantly reduce idarubicin-induced cardiotoxicity in rats

Effects of amrinone on bilateral renal ischemia/reperfusion injury.

Renal ischemia/reperfusion injury could arise as a consequence of clinical conditions such as renal transplantation, shock, cardiac arrest, hemorrhage and renal artery surgery. In this experimental study, we aimed to determine the preventive effects of amrinone on bilateral renal ischemia/reperfusion injury in rats. A total of 60 Wistar-albino rats were divided into six groups ( n=10). Midline laparotomies were made under ketamine anesthesia. In the sham, amrinone1 and amrinone2 without ischemia (AWI1 and AWI2) groups saline, 5 and 10 mg/kg of amrinone was infused, respectively. In the ischemia, ischemia plus amrinone1 (IPA1) and ischemia plus amrinone2 (IPA2) groups, saline and 5 and 10 mg/kg of amrinone was infused, respectively, at the beginning of reperfusion, subsequent to 45 min of bilateral renal artery occlusion. Following 6 h of reperfusion, blood was drawn to study serum BUN and creatinine and a bilateral nephrectomy was done to determine tissue malonyldialdehyde ( MDA) and myeloperoxidase (MPO) levels. The results were analysed by Mann-Whitney U-test. The parameters studied were statistically higher in the ischemia group compared with the other groups ( P<0.05 for each comparison), indicating renal I/R injury. These parameters were lower in the amrinone without ischemia groups (AWI1 and AWI2) than in the sham group, however there were no significant differences between the groups ( P>0.05, for each comparison). The treatment groups IPA1 and IPA2 had statistically similar results compared with the sham group, showing the preventive effect of amrinone on renal I/R injury at the given doses. We conclude that amrinone prevented experimental renal ischemia/reperfusion injury in rats, independently of the administered doses. This preventive effect of the agent could depend on its effect of regulating the microcirculation, in decreasing intracellular calcium and in preventing neutrophil activation. We propose that this preventive effect of amrinone - which has gained clinical application especially in cases of cardiac insufficiency - could also be exploited in clinical conditions related with renal ischemia/reperfusion.

Plasma copolymer surfaces of acrylic acid/1,7 octadiene: surface characterisation and the attachment of ROS 17/2.8 osteoblast-like cells.

The purpose of this study was: (a) to examine the effect of plasma-gas composition on plasma polymer oxygen/carbon (O/C) ratio, functional group composition and stability in water, and then (b) to examine cell attachment to surfaces containing different concentrations of O/C and functional groups. Oxygen-functionalised surfaces were deposited by means of the plasma copolymerisation of acrylic acid/1,7-octadiene. The use of a diluent hydrocarbon allowed the deposition of surfaces with a range of O/C concentrations. Plasma copolymer surfaces were characterised by X-ray photoelectron spectroscopy (XPS). Changes in functional group composition with % acrylic acid monomer and the non-dispersive and dispersive parts of the surface energy of these plasma copolymers were measured. The solubility of the plasma copolymers was assessed by means of XPS. The degree of attachment of ROS 17/2.8 osteoblast-like cells to plasma copolymer surfaces deemed to be 'stable' in aqueous medium was measured. Tissue culture polystyrene (TCPS) was included as a control. Attachment was found to be greatest to the plasma copolymer surface with an O/C of 0.11. This surface had a carboxylic acid concentration of ca. 3%. Attachment did not correlate with increased surface wettability (i.e. the non-dispersive component of the surface energy).

Bilateral facial paralysis secondary to lymphoma.

We report a patient with bilateral facial palsy due to a non-Hodgkin lymphoma. He was initially diagnosed to have a facial paralysis of unknown aetiology. Three months after this original diagnosis, he developed a non-Hodgkin lymphoma which was treated successfully with chemotherapy, and his palsy consequently returned to normal.