Mediastinitis as complication of odontogenic infection: A case report.

Odontogenic infections are one of the most common dental problems, which affect 80%-90% of the population. Untreated odontogenic infections can cause life-threatening complications such as necrotizing fasciitis, descending necrotizing mediastinitis, internal jugular vein thrombosis, cavernous sinus thrombosis, carotid artery pseudoaneurysm or rupture, and systemic inflammatory response syndrome. This report aims to present a mediastinitis case, in a 22-year-old healthy male patient, which originated from an odontogenic infection. The patient was hospitalized because of worsening general health status, despite the antibiotherapy. Computed tomography (CT) scan revealed that periapical abscess was spreading to the mediastinum through retropharyngeal space. The patient was successfully treated by IV antibiotherapy, transcervical drainage, and extraction of tooth.

Harmful effects of formaldehyde and possible protective effect of Nigella sativa on the trachea of rats.

OBJECTIVE: We aimed in this study to investigate the harmful effects of formaldehyde (FA) inhalation and possible protective effects of Nigella sativa (NS) on rats' trachea. MATERIALS AND METHODS: In this study, 63 adult male rats were used. Animals were divided into nine groups. Group I was used as control group. All other groups were exposed to FA inhalation. Group III, V, VII, and IX were administered NS by gavage. Tissues were examined histologically, and immunohistochemical examination for Bax and caspase-3 immunoreactivity was carried out. RESULTS: Our study demonstrated that FA caused apoptosis in the tracheal epithelial cells. The most apoptotic activity occurred at a 10 ppm dose in a 13-week exposure. Distortion of tracheal epithelium and cilia loss on epithelial surface was present in all groups. However, NS treated Groups VII and IX had decreased apoptotic activity and lymphoid infiltration and protected the epithelial structure, despite some shedded areas. Difference of tracheal epithelial thickness and histological score was statistically significant between Group VI-VII and VIII-IX. CONCLUSION: FA induces apoptosis and tracheal epithelial damage in rats, and chronic administration of NS can be used to prevent FA-induced apoptosis and epithelial damage.

Investigation of short- and long-term effects of ovarian hyperstimulation syndrome on ovarian reserve: an experimental study.

PURPOSE: To investigate the short and long-term effects of ovarian hyperstimulation syndrome (OHSS) on serum levels of vascular endothelial growth factor (VEGF) and endothelin-1 and ovarian follicular reserve (OFR). MATERIALS AND METHODS: An experimental case-control study was conducted on a university animal laboratory with 20 immature (22-day-old) virgin female Wistar Albino rats. Firstly, rats were divided into two groups. Group 1 (n = 10): control and Group 2 (n = 10): experimental OHSS induced rats. Secondly, Group 2 was randomly divided into two groups on the day of OHSS development (27th day) as follows: Group 3 (n = 5): 27-day-old OHSS induced rats and Group 4 (n = 5): 27-day-old OHSS induced rats supervised for seven days. Group 1 was divided into two groups to constitute age-matched controls as follows: Group 5 (n = 5): 27-day-old rats, Group 6 (n = 5): 35-day-old rats. The comparisons of Group 3 vs Group 5 and Group 4 vs Group 6 were performed. Main outcome measures were OFR, serum levels of VEGF, and endothelin-1. RESULTS: While the OFR and primordial follicle number (PFN) of Group 3 were significantly lower than those of Group 5 (p < 0.05); VEGF and endothelin-1 levels and atretic follicle number (AFN) were significantly higher in Group 3 compared to Group 5 (p < 0.05). In Group 4, PFN was significantly lower (p < 0.05) and AFN was significantly (p < 0.05) higher than Group 6. However, there were no statistically significant difference between Group 4 and Group 6 regarding the parameters of OFR, serum levels of VEGF, and endothelin-1. CONCLUSION: This experimental OHSS model revealed increased serum VEGF and endothelin-1 levels and decreased OFR during short-term of OHSS. OHSS showed detrimental effect on PFN of rats during long-term.

Melatonin use in unilateral total salpingectomy in rats.

OBJECTIVE: To investigate the effects of melatonin use in unilateral total salpingectomy on ovarian histology in rats. SETTING: Firat University, Medical School, Obstetrics and Gynecology Department, Elazig. MATERIAL AND METHOD: Thirty adult, female rats of Wistar albino species with regular cycles were randomly allocated to three groups in the estrus phase. G1 (n: 10): The group where the abdomen was opened and closed, and left oophorectomy was performed six months later. G2 (n: 10): The group where left total salpingectomy was performed and followed by left oophorectomy six months later. G3 (n: 10): The group where the abdomen was opened, left total salpingectomy was performed 15 min after 10 mg/kg/IP melatonin administration, and left oophorectomy was performed six months later. Samples of the left ovary were fixed in formaldehyde. The preparations were stained with hematoxylineosin, and primordial, primary, secondary and tertiary follicles were counted. All the numbers were added up to determine the ovarian follicle reserve. Atretic follicles were counted. Corpus luteum and corpus albicans were counted. Number of total corpuses was calculated. Regression of the presence of angiogenesis within the corpus luteum was examined. Presence of fibrosis on the ovarian stroma was examined. An ordinal scale was formed for the presence of regression of angiogenesis within the corpus luteum and presence of fibrosis (none: 0p, present: 1p, markedly present: 2p). Follicle cysts in the ovary were counted. Kruskal Wallis variance analysis was used in the statistical analysis of data; p < 0.05 was considered significant. RESULTS: Primordial follicle count, ovarian follicle reserve and regression of angiogenesis in the corpus luteum were found to be significantly lower (p < 0.05, Mann-Whitney U test), and atretic follicle count, microscopic follicle cyst and fibrosis development were found to be significantly higher in G2, when compared to G1 and G3 (p < 0.05, Mann-Whitney U test). None of the rats in G1 and G3 had ovarian cysts, whereas five rats in G2 were identified as having macroscopic follicle cysts. Other data were found to be similar in G1, G2, and G3 (Kruskal Wallis variance analysis). CONCLUSION: Left total salpingectomy reduces primordial follicles, ovarian follicle reserve and regression of angiogenesis in the corpus luteum, while increasing atretic follicles, microscopic ovarian cysts and fibrosis development. It leads to the development of macroscopic follicle cysts in the ovary at a high rate (50%) in the sixth month. Melatonin use eliminates these harmful effects. Melatonin can be used to avoid the unfavorable effect of total salpingectomy on the ovary.

Examination of the effect of melatonin use in Pomeroy method of tubal ligation on ovarian histology in rats.

OBJECTIVE: To examine the effects of melatonin use in the unilateral Pomeroy method of tubal ligation on ovarian histology in rats. SETTING: Firat University Medical School, Obstetrics and Gynecology Department, Elazig. MATERIAL AND METHOD: Thirty adult, female rats of Wistar albino species with regular cycles were randomly allocated to three groups in the estrus phase: G1 (n: 10): The abdomen was opened and closed. G2 (n: 10): The group where the abdomen was opened, and the Pomeroy method of tubal ligation was performed. G3 (n: 10): The group where the abdomen was opened, and Pomeroy method of tubal ligation was performed 15 min after 10 mg/kg/ip melatonin administration. Abdomens of all rats were opened six months later and left oophorectomy was performed. Samples of the left ovary were fixed in formaldehyde. The preparations were stained with hematoxylin eosin, and primordial, primary, secondary and tertiary follicles were counted. All the numbers were added up to determine the ovarian follicle reserve. An atretic follicle count was made. The corpus luteum and corpus albicans were counted, and the number of total corpuses were calculated. Regression of angiogenesis within the corpus luteum was examined. Presence of fibrosis on ovarian stroma was examined. An ordinal scale was formed for the regression of angiogenesis within the corpus luteum and presence of fibrosis (none: 0p, present: 1p, markedly present: 2). Follicle cysts in the ovary were counted. Kruskal Wallis variance analysis was used in the statistical analysis of data; p < 0.05 were considered significant. RESULTS: The comparison between G1 and G3 showed that all values were similar (p > 0.05, Kruskal Wallis variance analysis). When G2 was compared with G1 and G3, regression of angiogenesis in the corpus luteum was found to be significantly lower (p < 0.05, Mann Whitney U test), while atretic follicle count and fibrosis were significantly higher in G2 (p < 0.05, Mann Whitney U test). CONCLUSION: The Pomeroy method of tubal ligation reduces regression of angiogenesis in the corpus luteum, and increases atretic follicles and fibrosis development. Melatonin use restores these harmful effects. Melatonin can be used to refrain from this negative effect of the Pomeroy method of tubal ligation on the ovary.

Comparison of diclofenac sodium with indomethacin suppositories for mediolateral episiotomies.

OBJECTIVE: The study was carried out to compare the analgesic effect of diclofenac sodium and indomethacin suppositories for management of right mediolateral episiotomy repair. METHOD: A total of 70 patients who gave birth vaginally with right mediolateral episitomy were randomly assigned to receive 100 mg diclofenac sodium suppositories/day (G1, n = 35) or 100 mg indomethacin supposotories/day (G2, n = 35) after episiotomy repair and postpartum for three days. Pain ratings were recorded before, the first hour and 24 hours after medication. The verbal rating scale (VRS) and visual analog scale (VAS) were used for pain recording. The independent T test, Mann-Whitney U and Wilcoxon rank test were used for statistical analysis and Spearman correlation analysis was used for comparison between VRS and VAS. RESULTS: Diclofenac sodium was a more effective analgesic than indomethacin suppositories for right mediolateral episiotomy pain. For G1 the first hour VRS was 2.6 +/- 0.5 points and VAS 4.9 +/- 0.8 points; for G2 the first hour VRS was 3.4 +/- 0.6 points VAS 6.6 +/- 1.2 points; this difference was statistically significant (p < 0.05, Mann-Whitney U test). For G1 at the 24th hour VRS was 1.2 +/- 0.4 points and VAS 2.4 +/- 0.9 points; for G2 at the 24th hour VRS was 2 +/- 0.7 points and VAS was 3.4 +/- 1.3 points; the difference was statistically significant (p < 0.05, Mann-Whitney U test). The first and 24th hour pain scores (VAS1-VAS24, VRS1-VRS24) were decreased dramatically for both groups (p < 0.05, Wilcoxon rank test). A positive correlation was obtained between the first and 24th hour VRS and VAS by Spearman correlation analysis (r(s) = 0.9, n = 70, p = 0.000). CONCLUSION: The two analgesics were effective after episiotomy repair, however diclofenac sodium suppositories may be the preferred choice because they were more effective.

Surgical management of bronchiectasis: a collective review of 339 patients with long-term follow-up.

OBJECTIVE: The incidence of bronchiectasis has decreased significantly in developed countries due to successful control of childhood infections. However, the surgical treatment of this disease still plays an important role in thoracic surgical practice in underdeveloped and developing countries. The aim of this retrospective study was to present our surgical experience in patients with bronchiectasis, including our surgical treatment strategies and the results of long-term follow-up. METHODS: A retrospective chart review was conducted of 339 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2009. The patients' demographic features, the symptoms, etiologies and resection types, morbidity, mortality and outcomes after surgical management were analyzed. RESULTS: There were 301 (88.8 %) male and 38 (11.2 %) female patients; the average patient age was 22.4 years (range 15-50 years). The most common presenting symptoms were productive cough in 197 (58.1 %) patients. There were 21 (6.2 %) asymptomatic patients. Two hundred and thirty of the 339 patients (67.8 %) had had previous medical therapy before admission to our department. The most common etiology of bronchiectasis was childhood infections in 101 (29.8 %) patients. In most patients, bronchiectasis was found on the left side (n = 225, 66.4 %). Thirty-five patients underwent a second operation for bilateral disease. There were two (0.6 %) early postoperative mortalities including one myocardial infarction and one respiratory insufficiency. Complications occurred in 43 patients (12.7 %). The median follow-up was 13.6 months. Symptoms disappeared in 201 patients (71 %), and 66 patients (23.3 %) experienced an improvement, while 16 patients (5.7 %) continued to be symptomatic. CONCLUSION: Although improvements in medical treatment have resulted in a significant decrease in the number of patients with bronchiectasis, surgical management is still very important in developing countries. Surgical resection can be performed with acceptable morbidity and mortality rates. The aim should be the resection of all involved bronchiectatic sites, even in patients with bilateral disease, if the pulmonary reserve is adequate.

Parenchyma-saving surgical treatment of giant pulmonary hydatid cysts.

OBJECTIVE: The purpose of this study was to review 97 patients with giant pulmonary hydatid cysts and assess the clinical features and results of different operative techniques over a 27-year period. MATERIAL AND METHODS: Between January 1981 and December 2007, 590 patients were operated on for pulmonary hydatidosis and 97 (17 %) of these patients had giant pulmonary hydatid cyst. We retrospectively reviewed the medical records of these 97 patients. The diameter of the hydatid cysts were measured using radiological methods and intraoperatively. RESULTS: Seventy-eight patients were male (80 %) and 19 were female (20 %). The median age was 23.4 years (range: 15-63 years). The most common symptoms were chest pain (54 %), cough (43 %) and dyspnea (41 %). Fourteen patients were asymptomatic (14 %). The diameters of the cyst ranged between 10 and 25 cm (mean 13.8 cm). The cysts were located in the right hemithorax in 52 (54 %) patients, in the left hemithorax in 44 (45 %) patients and bilaterally in one patient (1 %). Five patients had more than one cyst. The procedures consisted of cystotomy and capitonnage in 53 patients, enucleation and capitonnage in 27 patients and simple cystotomy or enucleation in 8 patients. Anatomical resection was performed in 9 patients. Prolonged air leakage of more than 7 days occurred in five patients; one patient underwent an operation and a Heimlich valve was placed in two patients. There was no postoperative mortality. Recurrence was not detected at follow-up after 6 months and 27 months. CONCLUSION: The higher lung tissue elasticity and delayed symptoms due to localizations of the cyst are the reasons for the occurrence of giant hydatid cysts in the lung. A parenchyma-saving operation should be performed instead of anatomical resection because of the low complication rates and because most complications can be treated conservatively.

Diagnosis and surgical treatment of pulmonary sequestration.

BACKGROUND: Pulmonary sequestration is the term used to describe a rare embryonic mass of lung tissue which has no bronchial communication with the normal tracheobronchial tree. METHODS: In this study, we reviewed the medical records of 14 patients who underwent surgical resection for pulmonary sequestration between January 1992 and December 2006. RESULTS: Nine patients were symptomatic with recurrent respiratory tract infections and five patients were asymptomatic with a suspected lesion revealed incidentally during imaging investigations for other indications. Pulmonary sequestration was diagnosed with preoperative diagnostic procedures in eight patients and the other six cases were diagnosed after histopathological examination of the resected specimen. All patients were treated surgically. No postoperative complications were observed. CONCLUSIONS: We conclude that the optimal treatment of pulmonary sequestration is surgical resection to avoid infection and destruction of the normal pulmonary parenchyma, even in asymptomatic cases. Moreover, in the case of pulmonary infection and the destruction of normal tissue, major resection such as lobectomy or pneumonectomy may be considered, instead of limited resection.

Effects of erythromycin on stretch-induced contractile activity of isolated myometrium from pregnant women.

BACKGROUND: Despite the fact that preterm labor and birth account for the vast majority of neonatal morbidity and mortality the currently available treatment options are still far from satisfactory. The aim of this study was to investigate the effects of erythromycin on stretch-induced contractions of pregnant human myometrial strips, obtained at cesarean section. METHOD: Myometrial strips were suspended in an organ bath under 3 g tension and the effects of erythromycin (0.1, 0.2, 0.5, 1.0 mM) on stretch-induced isometric contractions were evaluated. Results were statistically analyzed using Kruskal Wallis analysis of variance and Wilcoxon Rank tests where appropriate. RESULTS: Erythromycin caused a significant decrease in the peak amplitude, while causing an increase in frequency of stretch-induced myometrial contractions in a dose dependent manner in vitro. CONCLUSIONS: Results from this preliminary study suggest that erythromycin may have additional beneficial effects in infection related preterm labor cases, however, further studies are needed for clarifying the usefulness of erythromycin as a tocolytic agent.

Differential regulation of preovulatory luteinizing hormone and follicle-stimulating hormone release by opioids in the proestrous rat.

We have investigated the role of mu- and kappa-opioid receptors in the central control of preovulatory LH and FSH release in the proestrous rat. Animals were anesthetized with chloral hydrate at 14:00 h on proestrus day. Following femoral artery cannulation, they were mounted in a stereotaxic apparatus. Morphine and U-50488H (benzene-acetamide methane sulphonate) were infused intracerebroventricularly either alone or in combination with naloxone and MR1452, respectively. Controls received sterile saline alone. Blood samples were obtained at hourly intervals between 15:00 h and 17:00 h. Plasma LH and FSH levels were measured by radioimmunoassay. Morphine did not significantly change plasma LH levels at 15:00 h and 16:00 h sampling intervals. A significant increase was observed at 17:00 h compared to the controls (p<0.05). U-50488H significantly increased LH levels at 16:00 h and 17:00 h (p<0.05). The co-administration of naloxone and MR1452 with mu- and kappa-agonist had no significant effect on LH levels at any sampling interval. In all groups, LH levels showed a linear rise over the sampling period between 15:00 h and 17:00 h. None of the treatments significantly altered plasma FSH levels which however, declined towards the end of the afternoon surge. In conclusion, we suggest that the secretion of LH and FSH is differentially regulated by mu- and kappa-opioid receptors. It is thought that in all groups chloral hydrate interfered with the LH surge secretory systems.