Effects of varying mandibular protrusion and degrees of vertical opening on upper airway dimensions in apneic dentate subjects.

INTRODUCTION: Despite numerous studies investigating the dimensional and therapeutic effects of mandibular advancement splints (MASs), data regarding the effects of differently designed individual and non-adjustable MASs on the upper airway in fully dentate apneic subjects in the sagittal plane including comparison of these effects with a placebo device are sparse. The present study aimed to determine the dimensional changes in the sagittal plane created by differently designed MASs in the upper airway in fully dentate apneic subjects and to compare these changes with the effects of a placebo device. MATERIALS AND METHODS: Magnetic resonance (MR) images of 9 dentate apneic subjects with 5 differently designed MASs and without a MAS were obtained. We measured the area of the entire pharynx (velopharynx, oropharynx, hypopharynx) on these MR images and compared the dimensional changes. RESULTS: The dimensional changes triggered by two specific MASs (75% of the maximum mandibular protrusion with 5 mm vertical opening, and 75% of the maximum mandibular protrusion with 10 mm of vertical opening) in the entire pharynx in the sagittal plane were statistically significant compared to the other MASs (p < 0.05). The MAS effecting 75% of the maximum mandibular protrusion and 10 mm of vertical opening created a significant dimensional increase only in the velopharyngeal area among the three pharyngeal sites (p ≤ 0.003). CONCLUSION: While the degree of mandibular protrusion created by the MAS affects the dimensions of the upper airway, the degree of the vertical opening exerts no significant dimensional effect in the sagittal plane in fully dentate apneic patients. The mandibular protrusion effect is comparatively larger in the velopharyngeal region.

Use of the Berlin Questionnaire to screen at-risk patients for obstructive sleep apnea.

OBJECTIVE: To investigate the value of the Berlin Questionnaire (BQ) for screening at-risk patients for obstructive sleep apnea (OSA). MATERIALS AND METHODS: This study included 217 subjects who were referred to a Department of Otolaryngology, Head and Neck Surgery for evaluation of suspected OSA. The subjects were classified as being at high or low risk of OSA according to their BQ score. The apnea hypopnea index (AHI), body mass index (BMI), Epworth sleepiness score, and BQ results were compared in the two risk groups, and the correlation of BQ with AHI was analyzed. The predictive accuracy of risk grouping was assessed for AHI > 5 and AHI > 15. RESULTS: The BQ identified 82.03% of the subjects as being at high risk of sleep apnea and 17.9% as being at low risk. Using a cut-off point of AHI > 5, the sensitivity was 83.4% and the specificity was 22.2%; the positive predictive value was 76.4% and the negative predictive value was 30.8%. Using a cut-off point of AHI > 15, the sensitivity was 89.3% and the specificity was 22.6%; the positive predictive value was 42.1% and the negative predictive value was 76.9%. CONCLUSIONS: These findings indicate that BQ is a poor predictor of OSA in patients who are at high risk of OSA. The BQ does not appear to be an appropriate screening tool for determining the risk of sleep apnea in this population.

Hepatic microcirculation in inflow and inflow-outflow occlusion of the liver.

BACKGROUND: Total vascular exclusion (TVE) causes warm liver ischemia. The aim of this study was to investigate the patterns of injury caused by inflow-outflow obstruction in the rat liver. MATERIALS AND METHODS: Twenty-four Wistar-Albino rats were divided into three groups: liver inflow occlusion (Group A), inflow-outflow occlusion (Group B) and intermittent inflow-outflow occlusion applied for 15 minutes. Microcirculation was measured with laser Doppler flowmetry during the procedure. Samples for biochemical and histopathological analyses were collected at the end of the ischemia period. RESULTS: Significant alterations in microcirculation were determined by application of vascular control maneuvers. Microcirculation in the central and dome segments were affected adversely compared with the dome segments in all experimental groups. TVE induced severe disturbances in hepatic microcirculation with more prominent hepatocellular damage. Damage to central segments of the rat liver was more prominent with inflow occlusion; whereas inflow-outflow occlusion produced more prominent damage to dome segments. Intermittent application of TVE clamping was associated with more hepatocellular damage compared with continuous TVE. CONCLUSION: Our mapping methodology within the liver parenchyma suggested that hepatovenous back-perfusion is a principle source of continuity of microcirculation in the rat liver during inflow occlusion. Inflow-outflow occlusion caused more tissue damage compared with inflow occlusion. Ischemic preconditioning during TVE did not increase the tolerance of the liver against ischemia.

Evaluation of Candida albicans adherence on the surface of various maxillofacial silicone materials.

OBJECTIVES: Fungal infection resulting from Candida adherence on material surface is one of the most important medical risks for maxillofacial prosthesis wearers. Despite wide usage, there is a sparse data evaluating C. albicans adherence on various commercial maxillofacial silicone materials that have different surface contact angles. The objective of this study was to investigate the relationship between surface contact angle and fungal adherence on widely used maxillofacial silicone materials. MATERIALS AND METHODS: Three maxillofacial silicone materials titled VST-50, A-2006, and A-2186F were used for fabrication of disc-shaped specimens. Surface contact angle of specimens were measured by the goniometric method. Adhesion quantity of two different C. albicans strains was evaluated with a colorimetric method using XTT/Coenzyme Q0. The Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis of data. RESULTS: The lowest surface contact angle values with the highest Candida adhesion quantity were measured on the specimens fabricated with A-2006 silicone material. Statistically significant differences were found among three maxillofacial silicone materials in terms of both surface contact angle values and adhesion quantity (P<0.01). CONCLUSION: There is a close relationship between surface contact angle and quantity of Candida adherence. However, it should be noted that various factors arising from material properties may affect the complex nature of the Candida adhesion process.

Use of an individual mandibular advancement device for an?obstructive sleep apnoea patient with facial paralysis: a short-term follow-up case report.

This case report aimed to describe the fabrication procedure and treatment efficacy of an individual, one-piece, non-adjustable mandibular advancement device (MAD) for a moderate obstructive sleep apnoea patient with facial paralysis (FP). Mandibular advancement device was fabricated with autopolymerising acrylic resin. The intermaxillary relations were recorded such as to fix the mandible at a protruded position with increased vertical dimension. Initial evaluation of the MAD was made with axial magnetic resonance imaging and polysomnography on the first day of usage. Following evaluations were made on the third and sixth month. After a follow-up period of 6 months, Apnoea/Hypopnea Index (AHI) significantly decreased from 26·7 to 3·0. However, the average oxygen saturation did not improve as expected initially. The MAD therapy decreased the AHI scores of a patient with FP. At the end of a follow-up period of 6 months, the patient did not report any serious complaint except temporary tooth pains.

The effect of spreader size on fracture resistance of maxillary incisor roots.

AIM: To assess the effect of spreader size used during cold lateral compaction of gutta-percha on fracture resistance of roots in maxillary incisor teeth. METHODOLOGY: The crowns of 50 human maxillary incisor teeth having no carious lesions, no fracture or crazing were resected 2 mm coronal to the cemento-enamel junction. The root canals of the teeth were prepared as follows: Group 1: No canal preparation. Group 2: Preparation using the stepback technique to a size 40 master apical file. Group 3: Canal preparation to size 40 and filling with laterally compacted gutta-percha; the first spreader used was equal to size 40. Group 4: Same as group 3 except the first spreader was equal to size 35. Group 5: Same as group 3 except the first spreader was equal to size 25. For each root, a simulated periodontal ligament was prepared. The roots were than mounted in polyester resin and fractured vertically on a universal testing machine (Shimadzu, Tokyo, Japan). The fracture values of teeth were analysed using Kruskal-Wallis and Mann-Whitney U-tests (P = 0.05). RESULTS: The uninstrumented group had the highest fracture resistance; instrumented, but unfilled roots, demonstrated the lowest resistance values (P = 0.009). There were no differences between the uninstrumented group and group 5 in which a size 25 spreader was used during filling. Use of spreaders larger than size 25 caused a significant reduction in fracture resistance of roots (P < 0.05). CONCLUSION: Spreader size used during lateral compaction of gutta-percha can affect the fracture resistance of roots in extracted teeth.

Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy.

BACKGROUND: Technical modifications and methods for gallbladder dissection to minimize the risk of gallbladder perforation during laparoscopic cholecystectomy (LC) are described. The authors aimed to investigate the effects of gallbladder aspiration during LC on the operative and postoperative course of patients. METHODS: For this study, 200 patients undergoing LC for symptomatic cholelithiasis were randomly divided into two groups. Gallbladders were aspirated before dissection in group A (n = 100), and they were not aspirated in group B (n = 100). Operative and postoperative data on the patients were collected. RESULTS: The rate of gallbladder perforation was significantly lower in group A than in group B (p = 0.0003). The operative time was significantly shorter in group A (46.70 +/- 15.93 min) than in group B (60.75 +/- 22.09 min) (p = 0.047). Postoperative complications were more numerous in group B. The hospital stay was significantly longer in group B (1.55 +/- 0.81 days) than in group A (1.3 +/- 0.5 days; p = 0.004). CONCLUSION: The findings demonstrate the advantages of gallbladder aspiration in elective cases.

Laparoscopic abdominal observation method without anesthesia for preventing unnecessary second-look procedures: short report.

Second-look operations after massive intestinal resections secondary to mesenterovascular occlusion are a frequent practice. In about one half of patients who undergo second-look procedures, no intraabdominal intervention is necessary. We present a laparoscopic abdominal observation method to prevent unnecessary laparotomies. In the first operation, two laparoscopic trocars, 5 and 10 mm in diameter, were left in the abdominal wall. After an appropriate time interval, the abdomen was explored laparoscopically through these trocars without anesthesia. If obvious intestinal gangrene and anastomotic leaks were observed laparoscopically, the patients were reoperated on while under general anesthesia; otherwise, the procedure was terminated with removal of the trocars. This method was performed on six patients. Unnecessary relaparotomies were prevented in four patients; intestinal gangrene and anastomotic leaks were not missed in the remaining two patients. A larger patient sample is needed to assess the advantages of this method in preventing unnecessary laparotomies.

Complications of 867 thyroidectomies performed in a region of endemic goiter in Turkey.

This article aims to define the incidence of complications in 867 thyroidectomies performed by residents with attending surgeons' supervision as part of a training programme, in a region of endemic goiter. Seven hundred and nine patients were female and 158 were male. The age of the patients ranged between 6 and 76 and mean age was 32.5. Cases were divided into two groups according to their disease nature. Group 1 included 805 patients with nodular colloidal goiter (NCG) and adenomas. The remaining 62 cases, 25 with recurrence of goiter (RG), 21 with thyroid malignancy (TM) and 16 with thyroiditis formed group 2. While the overall complication rate was 11.3% (93 cases) in group 1, it was 20.9% (13 cases) in group 2. The mortality rate was zero in both groups. The incidence of complications of 867 thyroidectomies performed by residents with the attending surgeons' supervision was within acceptable limits especially as far as group 1 was concerned. However we suggested that attending surgeons themselves, disregarding residents training, should perform the operation in special cases such as recurrent goiters, thyroid carcinomas with positive regional lymph nodes and thyroiditis with regional adhesions.

The effect of tubular penetration of root canal sealers on dye microleakage.

An in vitro study of a possible correlation between penetration of dentinal tubules by four root canal sealers and microleakage of external fluids into the canal was done using a dye leakage method and scanning electron microscopy. The root canals of 45 teeth were instrumented and the smear layer removed prior to obturation of root canals with gutta-percha and one of four sealers: Diaket, Endomethasone, CRCS or Ketac-Endo. The extent of leakage was scored after immersion in India ink for 72 h. The same specimens were also used for scanning electron microscopic evaluation. There was a statistical difference in leakage patterns between the groups (P < 0.05). Diaket had lower microleakage scores than the other sealers (P < 0.05). When the scores for penetration of sealers into the tubules were analysed, Ketac-Endo demonstrated the least penetration (P < 0.01). There appeared to be a converse relation between tubular penetration and dye leakage, but the correlation was not statistically significant (P > 0.05).

Stability of various sodium hypochlorite solutions.

Although the manufacturers use at least a 2-yr expiration date for sealed undiluted NaOCl solutions, chemical stability of NaOCl may be adversely affected by many factors. The purpose of this study was to investigate the effects of storage temperature, concentration, and time on the stability on three different brands of commercial household bleaching agents as a source of NaOCl, and to compare the stability of these brands. All solutions showed degradation versus time; however, this degradation occurred very slowly except for the group of solutions containing 5% available chlorine stored at 24 degrees C. Solutions containing 0.5% available chlorine stored at 4 degrees C and 24 degrees C and 5% solutions stored at 4 degrees C showed satisfactory stability at 200 days. No significant difference was found among three brands in respect to their chemical stability.

Observation of bacteria and fungi in infected root canals and dentinal tubules by SEM.

The aim of this study was to observe the root canal flora and possible penetration of microorganisms into dentinal tubules in teeth with necrotic pulps. Ten infected maxillary and mandibular molars with periapical lesions were extracted and fixed in 2.5% phosphate-buffered glutaraldehyde solution for nine days. After separation from the crowns, longitudinal grooves were cut in the roots, and they were split into two halves. The specimens were prepared for SEM. The root canals and the dentinal tubules of the fractured dentin were scanned systematically from the cervical to the apical area of the root. Cocci and rods were seen in 6 specimens. Penetration of bacteria into the dentinal tubules ranged from 10 to 150 microns. In 4 specimens, the root canals were heavily invaded by yeasts. The antimicrobial effect of routinely used endodontic disinfectants also on yeasts may be considered in persistent root canal infections.

A modified technique for performing anterior gastropexy in Stamm gastrostomies.

We describe herein a new modified technique for performing the anterior gastropexy step of the Stamm gastrostomy procedure. In this method, anterior gastropexy was carried out with four 2-0 silk or propylene sutures. These sutures were secured through the whole layer of the abdominal wall from out to within. Then, after passing the seromuscular layer of stomach, they return to skin through the abdominal wall from within to out and tied over the skin surface. This modified technique which provided better exposure and an excellent seal of the stomach and parietal peritoneum, was successfully performed on 23 patients, none of whom developed any peritoneal leakage and peritonitis. The only complications that arose were wound infection in one case and skin excoriation in two others, and these were easily managed.

Neural changes in ulcerative and hyperplastic pulpitis: a transmission electron microscopic study.

The purpose of this study was to examine at ultrastructural level the neural changes in human apical pulps of teeth clinically diagnosed as having ulcerative or hyperplastic pulpitis. Seventeen specimens were prepared from six teeth with ulcerative or hyperplastic pulpitis and four specimens from two sound teeth. After routine procedures the specimens were examined under an electron microscope for changes in the structure of myelinated and unmyelinated nerve fibres. Although the teeth used in this study responded positively to vitality test, the results revealed that moderate to severe degenerative changes occurred in the nerve fibres of the apical pulps of the teeth showing these two diseases.

Internal resorption occurring after accidental extrusion of iodoform paste into the mandibular canal.

The precise etiology of internal resorption is unknown but it is generally believed that triggering factors are infection and persistent chronic pulpitis. A case is presented with internal resorption, which developed subsequent to extrusion of iodoform paste from the adjacent tooth into the mandibular canal. According to clinical and radiographic examinations made after 7 years, the tooth was clinically asymptomatic, vital and the internal resorption was arrested without treatment.

Volvulus of the sigmoid colon.

Between 1983 and 1986, 18 patients with colonic volvulus (94.4% sigmoid, 5.6% caecal) were seen at Karadeniz Medical Faculty. There were 11 male and 7 female patients, with a mean age of 68 years. In 66.6% and 22.2% of patients respectively a palliative procedure or a Hartmann operation were performed. The recurrence rate in the palliative group was 30%. The mortality rate for all patients with volvulus was 16.8%. The palliative procedures were successful in patients in good general condition and without bowel necrosis, whereas the Hartmann operation gave successful results in patients with bowel necrosis.

Aneurysmatic dilatation of popliteal and femoral artery due to long-standing traumatic arteriovenous fistula.

A 65-year-old woman presented with an extensive femoropopliteal aneurysm discovered after a long-standing (24 years) post-traumatic arteriovenous fistula (AVF). Her complaints began after trauma. All arterial dilatations discovered during the course of an AVF must be treated because of the risk of rupture. With the advent of arterial reconstructive procedures, the surgical approach to popliteal aneurysm became and remains excision and graft interposition or by-pass graft with concomitant aneurysm ligation. Of all available graft material the autogenous saphenous vein remains the best material for arterial reconstruction. The diagnostic technics, therapeutic procedures and possible complications are discussed with literature review. The etiology of aneurysm that develop proximal to AVF is reviewed.

Effect of testicular torsion on the contralateral testis.

It has been previously shown that unilateral testicular torsion can cause disruptive anatomic changes in the contralateral testis in rats. In this experimental study plasma and urine prostaglandin E2 levels were studied correlatively with testicular histopathology in acute testicular torsion cases. As a result of this study, necrobiotic morphologic alterations causing testis necrosis and significant increase in plasma prostaglandin E2 levels were observed. Contralateral testicular histology was analyzed in all dogs. None of them showed abnormal tubular architecture.