Effect of final irrigation protocols with chitosan nanoparticle and genipin on dentine against collagenase degradation: An ex-vivo study.

AIM: Endodontic irrigants may affect the mechanical and chemical properties of dentine. This study evaluated the effects of various final irrigation protocols including the use of chitosan nanoparticle (CSnp) and cross-linking with genipin on the (1) mechanical and (2) chemical properties of dentine against enzymatic degradation. METHODOLOGY: CSnp was synthesized and characterized considering physiochemical parameters and stability. The root canals of 90 single-rooted teeth were prepared and irrigated with NaOCl. Dentine discs were obtained and divided into groups according to the following irrigation protocols: Group NaOCl+EDTA, Group NaOCl+CSnp, Group NaOCl+EDTA+CSnp, Group NaOCl+CSnp+Genipin, Group NaOCl+EDTA+CSnp+Genipin and Group distilled water. (1) Mechanical changes were determined by microhardness analysis using Vickers-tester. (2) Chemical changes were determined by evaluating molecular and elemental compositions of dentine using Fourier transform infrared spectroscopy (FTIR) analysis and scanning electron microscope (SEM)/energy dispersive X-ray spectroscopy (EDS) analysis, respectively. All analyses were repeated after the discs were kept in collagenase for 24 h. Data were analysed with repeated measures analysis of variance and Bonferroni correction for microhardness analysis, and Kruskal-Wallis and Wilcoxon tests for FTIR and SEM/EDS analyses (p = .05). RESULTS: (1) Collagenase application did not have a negative effect on microhardness only in Group NaOCl+EDTA+CSnp+Genipin when compared with the post-irrigation values (p > .05). Post-collagenase microhardness of Group NaOCl+EDTA+CSnp and Group NaOCl+CSnp+Genipin was similar to the initial microhardness (p > .05). (2) After collagenase, Amide III/ PO 4 3 - ratio presented no change in Group NaOCl+EDTA+CSnp, Group NaOCl+CSnp+Genipin and Group NaOCl+EDTA+CSnp+Genipin (p > .05), while decreased in other groups (p < .05). Collagenase did not affect CO 3 2 - / PO 4 3 - ratio in the groups (p > .05). There were no changes in the groups in terms of elemental level before and after collagenase application (p > .05). CONCLUSIONS: CSnp and genipin positively affected the microhardness and molecular composition of dentine. This effect was more pronounced when CSnp was used after EDTA.

Clinical applications of calcium silicate-based materials: a narrative review.

Calcium silicate-based materials are hydrophilic materials with biocompatibility and bioactivity properties. Despite many advantages, they might present some problems related to discolouration, setting time, manipulation and solubility depending on the composition of the product and the type of clinical application. Calcium silicate-based materials can be evaluated under two types according to their intended use: calcium silicate-based cements (CSCs) and calcium silicate-based sealers (CSSs). CSCs can be used in many endodontic procedures including perforation repair, resorption repair, apical barriers, guided endodontic repair, vital pulp treatment, endodontic surgery, root fractures and root canal filling as a core obturation material. CSSs are available for use with gutta-percha to obturate root canals using cold and warm techniques, including the sealer-based obturation technique. The purpose of this review is to evaluate the available literature on CSCs and CSSs and to provide up-to-date information and recommendations for their clinical applications.

The value of potential immunohistochemical biomarkers and clinicopathological findings in predicting response to neoadjuvant chemotherapy in breast cancer.

OBJECTIVE: Following neoadjuvant chemotherapy (NAC) in breast cancer (BC), complete treatment response is achieved in some patients, while treatment response is limited in others. Predicting non-responder patients can prevent exposure to adverse effects associated with chemotherapeutic agents and delays in selecting other treatment modalities. In this study, we aimed at identifying predictive factors related to tumor regression in patients with BC who received NAC. PATIENTS AND METHODS: This single-center cohort included 91 patients with BC who underwent surgery following NAC based on pretreatment tumor biopsy. According to BC molecular subtype, tumor regression grade (TRG) was determined using the Miller-Payne scoring system in patients who received standard NAC. Immunohistochemical stainings for VEGFR3 and CD44 were applied to needle core biopsies obtained prior to NAC in these patients. RESULTS: Pathological complete response (pCR) was achieved in 20 patients (22%). In univariate analysis, high Ki-67 expression, ER negativity, and HER2 positivity were determined to be predictive factors of TRG (p < 0.05). In multivariate analysis, Ki-67 was the single independent predictor of TRG, with a 1.05-fold effect size. CD44 and VEGFR3 levels did not affect TRG or survival (p > 0.05). There was a significant difference in TRG according to molecular subtype of BC (p < 0.001). The treatment response was 5.5-fold higher in HER2-positive patients compared with HER2-negative patients. CONCLUSIONS: pCR rates were significantly higher in TNBC, HER2, and luminal HER2+ subtypes when compared with luminal HER2- subtype. Ki-67 >25% and ER negativity had a favorable effect on TRG after NAC. CD44 and VEGFR3 were not effective in predicting treatment response.

Comparison of clinical features and the impact of reproductive factors on by age at diagnosis young and elderly breast cancer patients in the middle Anatolian region of Turkey.

OBJECTIVE: Reproductive risk factors have been shown to influence breast cancer etiology for women of different origin worldwide; most studies in young/older patients have been limited to analyzing survival or tumor characteristics within their age group. This study aimed to compare the clinicopathological characteristics, treatment regimens, survival outcomes, and the impact of reproductive risk factors on young and elderly breast cancer patients. PATIENTS AND METHODS: The data were collected retrospectively between October 2015 and March 2021, where 77 young patients (≤ 40 years) and 107 elderly patients (>65 years) were included out of a total of 567 patients undergoing treatment at Kayseri City Training and Research Hospital General Surgery Clinic, Turkey. Logistic regression analysis was performed to assess the impact of risk factors according to age. RESULTS: Luminal-like tumors were in the majority in both age groups; there was no difference in diagnostic stages and survival between groups. The nulliparity ratio, total breastfeeding duration, number of biological children, first full-term pregnancy age, body mass index (BMI), and breast density distribution were significantly statistically different between groups. According to the multiple binary logistic regression analysis results for age, the most significant factors with risk effects were variables age of menarche OR= 3.36 (95% CI: 1.44-7.86) and child number OR= 2.58 (95% CI: 1.75-3.79), respectively. CONCLUSIONS: The importance of looking at the impact of different risk factors on breast cancer risk lies in the potential to develop valid risk prediction models that can allow targeted screening and preventive interventions for high-risk women. By identifying more influential risk factors in different geographical profiles, risk-based screening, and targeted prevention efforts can be encouraged, and these factors can be included in risk prediction models.

Determination of anomalous pulmonary venous return with high-pitch low-dose computed tomography in paediatric patients.

BACKGROUND: In this study, we aimed to image pulmonary venous return anomalies and associated cardiovascular and pulmonary abnormalities by high-pitch low-dose computed tomography (CT) in children. MATERIALS AND METHODS: Forty-one patients with total or partial anomalous pulmonary venous return anomalous between May 2012 and June 2019 were retrospectively reviewed. The anomalies were determined using high-pitch low-dose CT. The patients' mean age was 3 years (6 months to 15 years), and 24 of them were female. RESULTS: There were 10 patients with total pulmonary venous return anomalies (TPVRA) and 31 patients with partial pulmonary venous return anomalies (PPVRA). Six (60%) patients with TPVRA had the supracardiac type, 2 (20%) had the cardiac type, and 2 (20%) had the mixed type. All patients with TPVRA had a large atrial septal defect (ASD), 1 patient also had patent ductus arteriosus, and 1 patient had right cardiac hypertrophy. Forty cases of PPVRA were found in 31 patients. Twenty-seven (67%) of them were right-sided, and 13 were left-sided (33%). Twenty (65%) patients also had an additional cardiovascular anomaly (ASD in 12 patients, persistent superior vena cava in 4 patients, patent ductus arteriosus in 3 patients, and aortic coarctation in 2 patients). Of the 27 patients with right-sided PPVRA, it drained into the superior vena cava in 19 patients, the right atrium in 5 patients, and the inferior vena cava in 3 patients. In left-sided cases, the anomalous pulmonary vein drained into the left innominate vein in 9 patients, and in 4 patients, there were accessory pulmonary veins that drained into the left innominate vein. Many of the patients had additional lung anomalies, including pneumonic infiltration (n = 12), atelectasis (n = 8), and lobar emphysema (n = 5), and some of these findings coexisted. CONCLUSIONS: Anomalous pulmonary venous drains and associated cardiac and extra-cardiac anomalies can be detected reliably and quickly with high-pitch low-dose CT without sedation in paediatric patients.

Micro-CT evaluation of the removal of root fillings using the ProTaper Universal Retreatment system supplemented by the XP-Endo Finisher file.

AIM: To compare the removal of root fillings in extracted teeth using the ProTaper Universal Retreatment system (PTUR) followed by a supplementary preparation with the XP-Endo Finisher file. METHODOLOGY: The mesiobuccal root canals of 30 extracted mandibular first molars were instrumented with ProTaper Universal NiTi files up to F2 and filled with one of the following sealers using a single-cone technique (n = 10): AH Plus, NeoMTA Plus and EndoSequence BC. The root fillings were removed using the PTUR system with additional apical preparation using ProTaper F2 and F3 files. Then, an additional preparation with an XP-Endo Finisher file was performed. The samples were scanned using micro-CT before and after retreatment and again after the use of the XP-Endo Finisher to assess the volume of remaining filling material. Data were analysed by Kruskal-Wallis and Friedman's two-way analysis of variance tests with Bonferroni correction. RESULTS: No significant difference in the initial filling volume was observed amongst the groups (P > 0.05). The amount of filling materials in each group decreased significantly after retreatment with rotary files (P < 0.05). After initial retreatment, the volume of the remaining filling amongst the groups was similar (P > 0.05). Additional preparation with the XP-Endo Finisher improved the removal of filling materials regardless of the sealer type (P < 0.05). CONCLUSIONS: In the mesiobuccal root canals of extracted mandibular first molars, additional preparation using an XP-Endo Finisher file, after using the PTUR system and F3 ProTaper instruments, enhanced the removal of filling materials from root canals.

Effect of perforation size and furcal lesion on stress distribution in mandibular molars: a finite element analysis.

AIM: To compare the effect of furcal perforations of various sizes on the biomechanical response of mandibular first molars with or without periodontal bone loss at the furcal region via three-dimensional (3D) finite element analysis (FEA). METHODOLOGY: The 3D geometric basic model was reconstructed from the micro-computed tomographic images of an extracted mandibular first molar. Five different models were constructed from this molar in group 1 as follows: intact molar model, root filled (RCF) model and three models with furcal perforations (1, 2 and 3 mm in diameter) repaired with a calcium silicate-based cement (CSC). In group 2, a lesion simulating bone resorption at the furcal region was modelled on the models in group 1. A force of 200 N was applied to simulate normal occlusal loads. Static linear FEA was performed using the Abaqus software (Abaqus 6.14; ABAQUS Inc., Providence, RI, USA). The maximum principal stresses (Pmax ) and maximum displacement magnitude were evaluated. RESULTS: The range of Pmax values of the models in group 1, from high to low, was as follows: RCF + 3 mm perforation > RCF + 2 mm perforation > RCF + 1 mm perforation > RCF > intact model, and the range of Pmax values of the models in group 2 was as follows: RCF + 3 mm perforation + furcal lesion > RCF + 2 mm perforation + furcal lesion > RCF + 1 mm perforation + furcal lesion > RCF + furcal lesion > intact model + furcal lesion. All of the models in group 2 exhibited lower Pmax values and higher maximum displacement magnitude than their counterparts without lesions in group 1. CONCLUSIONS: The size of the furcal perforation affected the accumulation and distribution of stress within the models. Mandibular molar teeth with large furcal perforations treated with a calcium silicate-based cement may be associated with an increased risk of fracture whether or not accompanied by bone resorption.

Effect of Various Bleaching Agents on the Surface Composition and Bond Strength of a Calcium Silicate-based Cement.

This study aimed to evaluate the morphological and elemental changes that occur on the surface of calcium silicate-based cement (CSC) and to analyze the bond strength of composite resin to CSC after application of various bleaching agents. One hundred twenty-five CSC blocks (Biodentine) were prepared and randomly divided into five groups according to the bleaching agent applied over the material surface (n=25): SP-DW (sodium perborate-distilled water mixture), SP-HP (sodium perborate-3% hydrogen peroxide [H2O2] mixture), CP (37% carbamide peroxide gel), HP (35% H2O2 gel), and a control group (no bleaching agent). After 1 week, scanning electron microscopy provided an analysis of the surface morphology and elemental composition for 10 specimens from each group. Composite resin was placed at the center of each cement surface in the remaining specimens (n=15). A universal testing machine determined shear bond strength (SBS) and fracture patterns were identified with a dental operating microscope. Data were analyzed using one-way analysis of variance and Tukey HSD tests. The cement surface in the CP and HP groups presented changes in structure and elemental distribution compared with the remaining groups. The former groups exhibited a decrease in the calcium level and an increase in the silicon level and presented significantly fewer SBS values than the remaining groups ( p<0.05). Most failures were adhesive in the CP and HP groups, while they were predominantly cohesive in the remaining groups. The bleaching agents with higher concentration induced deterioration of the cement surface and negatively affected the bond strength of the composite resin to CSC. The use of CSC is recommended as a cervical barrier when intracoronal bleaching is performed with a mixture of sodium perborate with water or 3% H2O2.

In vitro fracture strength and patterns in root-filled teeth restored with different base materials.

BACKGROUND: There is little research on the effects of an intermediate base on the fracture strength of root-filled teeth. This study compared the fracture strengths and patterns of root-filled teeth restored with intermediate bases of glass-ionomer cement (GIC), zinc polycarboxylate cement (ZPC), dual-cured resin composite (DCRC) and Biodentine® under resin composite. METHODS: Standardized cavities were prepared in 100 extracted human maxillary and mandibular premolars, and root canal treatment was performed. The teeth were stratified and randomly allocated to five groups (n = 20): (i) GIC; (ii) ZPC; (iii) DCRC; (iv) Biodentine; and (v) prepared but unrestored (control). The teeth were subjected to an oblique, ramped load until fracture. The fracture loads, level, mode and location were recorded. RESULTS: Mean fracture strengths of all restored groups were not significantly different amongst the groups. There were significant overall effects on mean fracture strength for tooth type (P = 0.002) and buccolingual width of the crown (P = 0.001). CONCLUSIONS: The four materials were appropriate intermediate bases. The laminate restorative technique promoted fracture strengths that are likely to withstand normal and maximum masticatory function. The base material can influence failure mode, which may have implications for the clinical presentation of fractures of root-filled teeth.

Correlation of Otorhinolaryngologic Symptoms with Physical Findings in Behçet's Disease.

OBJECTIVE: Behçet's disease is a chronic systemic inflammatory disease of unknown etiology. We examined the correlation between otorhinolaryngologic symptoms and otorhinolaryngologic physical findings in patients with Behçet's disease, in search of strategies to reduce the morbidity rates. METHODS: Seventy-two patients diagnosed with Behçet's disease were included. After giving a detailed history of oropharyngeal, nasal, laryngeal, and otic symptoms, patients were examined endoscopically by an otolaryngologist, and the findings were recorded. RESULTS: Thirty-nine of the patients were male, and thirty-three were female. The mean age was 39.2 ± 3.4, and the mean disease duration was 8.24 ± 4.2 years. Statistically significant correlations were observed between ear lesions and ear symptoms (crusting and otic pain), nasal lesions and nasal symptoms (crusting and nasal pain), oropharyngeal lesions and oropharyngeal symptoms (pain and difficulty in swallowing), and laryngeal lesions and laryngeal symptoms (hoarseness, difficulty in swallowing, and pain). CONCLUSION: The results demonstrated a positive correlation between symptoms and otorhinolaryngeal examination findings in Behçet's disease. Potential morbidities can be prevented by routine endoscopic otorhinolaryngeal examinations and symptom screening of patients with Behçet's disease and arranging the therapy accordingly.

Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra- and Suprasellar Carotid Artery Aneurysm.

Pituitary insufficiency secondary to internal carotid artery (ICA) aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001). We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL) level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others.

Analgesic effect of magnesium in post-tonsillectomy patients: a prospective randomised clinical trial.

The aim of this study was to assess the analgesic, bleeding and nausea/vomiting effects of magnesium with and without metamizol on post-tonsillectomy patients. This prospective and randomised clinical trial included 54 patients aged 18-63 years who were scheduled for elective tonsillectomy. The patients were randomly divided into two groups and administered either magnesium with metamizol or only metamizol. They had been classified as physical status class I and II using the American Society of Anesthesiologists guidelines. All patients underwent the same surgical procedure performed by a single surgeon. The groups did not differ according to age, sex, or duration of anaesthesia or surgery. Postoperative pain, bleeding and nausea/vomiting were evaluated using the VAS and bleeding and nausea/vomiting scores on the first, fifth and tenth days. On the first, fifth and tenth postoperative days, the VAS scores of the magnesium with metamizol group were significantly lower than those of the metamizol-only group (p1 = 0.001; p5 = 0.015; p10 = 0.015). There were no significant differences in postoperative bleeding and nausea/vomiting scores between the two groups (p = 0.425 and p = 0.258, respectively). This study showed that magnesium enhanced the analgesic effect on post-tonsillectomy pain. Use of magnesium with an analgesic drug may be beneficial for management of post-tonsillectomy pain.

Surgical outcome of bronchiectasis in children: long term results of 60 cases.

BACKGROUND: Bronchiectasis is described as destruction and the irreversible dilatation of bronchial structure. We wanted to demonstrate our surgical practice and outcome of surgical treatment in bronchiectasis. METHODS: We studied records of 60 pediatric patients who underwent surgical resection in our clinic between January 2000 and January 2013. The results were analyzed regarding factors influencing the outcome. RESULTS: There were 32 boys and 28 girls with a mean age of 9.45 years (range 2-15). The most common cause was childhood infection in 25 (41.66%). The mean duration of the symptoms was 42.93 months. Patients underwent 64 operations including 2 staged thoracotomies and 2 re-thoracotomies. Atelectasis was the most frequent complication. Longer duration of symptoms related to postoperative complication. The morbidity and mortality rates were 20% and 3.33%, respectively. The outcome was optimal in 92%. Forced expiratory volume in 1 s less than 60% of the predicted value, hemoptysis and duration of symptoms were found prognostic variables for postoperative morbidity with high ratios of odds coefficients by using Binary Logistic Regression Method. CONCLUSIONS: Complete and early resection of bronchiectasis provides a successful outcome. Duration of symptoms and timely intervention have a major impact on the management and prognosis.

Can biliary-cyst communication be predicted by Gd-EOB-DTPA-enhanced MR cholangiography before treatment for hepatic hydatid disease?

AIM: To evaluate the role of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance cholangiography (MRC) in the evaluation of biliary-cyst communication (BCC) before treatment for hepatic hydatid disease (HHD). MATERIAL AND METHODS: Thirty-one patients with clinical and laboratory follow-up for HHD with suspected diagnosis of BCC underwent three-dimensional (3D) T2-weighted MRC and T1-weighted contrast-enhanced MRC, dynamic 3D gradient echo (GRE) sequences, using Gd-EOB-DTPA to identify the presence or absence of BCC. A total of 45 hepatic hydatid cysts in the 31 patients were evaluated for cyst diameter, BCC, and the time to contrast-enhancement of the hydatid cyst after Gd-EOB-DTPA injection. The surgical and interventional radiological procedures and imaging findings were compared. The sensitivity, specificity, and accuracy of both techniques in identification of BCC were calculated. RESULTS: The accuracy of contrast-enhanced MRC for identifying BCC was superior with a sensitivity of 87.4% and accuracy of 90.5% (p < 0.05). A diameter of ≥10 cm was associated with significantly increased risk of BCC on contrast-enhanced MRC images (p < 0.05). CONCLUSION: The use of Gd-EOB-DTPA-enhanced MRC yields information that complements T2-weighted MRC findings and improves identification of BCC. The use of T2-weighted MRC, in addition to contrast-enhanced MRC, is recommended to increase preoperative accuracy of identifying BCC.

Diagnostics to look beyond the normal appearing brain tissue (NABT)? A neuroimaging study of patients with primary headache and NABT using magnetization transfer imaging and diffusion magnetic resonance.

OBJECTIVE: Novel diagnostics can allow us to "look beyond" normal-appearing brain tissue (NABT) to unravel subtle alterations pertinent to the pathophysiology of primary headache, one of the most common complaints of patients who present to their physician across the medical specialties. Using both magnetization transfer imaging (MTI) and diffusion weighted imaging (DWI), we assessed the putative microstructural changes in patients with primary headache who display the NABT on conventional magnetic resonance imaging (conventional MRI). METHODS: Subjects were 53 consecutive patients with primary headache disorders (40 = migraine with aura; 9 = tension headache; 4 = cluster headache) and 20 sex- and age-matched healthy volunteers. All subjects underwent evaluation with MRI, MTI, and DWI in order to measure the magnetization transfer ratio (MTR) and the apparent diffusion coefficient (ADC), respectively, in eight and six different regions of interest (ROIs). RESULTS: Compared to healthy controls, we found a significant 4.3 % increase in the average ADC value of the occipital white matter in the full sample of patients (p = 0.035) and in patients with migraine (p = 0.046). MTR values did not differ significantly in ROIs between patients and healthy controls (p > 0.05). CONCLUSIONS: The present study lends evidence, for the first time to the best of our knowledge, for a statistically significant microstructural change in the occipital lobes, as measured by ADC, in patients with primary headache who exhibit a NABT on MRI. Importantly, future longitudinal mechanistic clinical studies of primary headache (e.g., vis-à-vis neuroimaging biomarkers) would be well served by characterizing, via DWI, occipital white matter microstructural changes to decipher their broader biological significance.

Coagulopathy parameters in patients with Crimean-Congo hemorrhagic fever and its relation with mortality.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is an acute illness affecting multiple organ systems and characterized by ecchymosis, visceral bleeding, and hepatic dysfunction. In this study, we aimed to investigate the profile of coagulopathy markers (platelet count, activated partial tromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), fibrinogen, protein C, protein S, antithrombin III, activated protein C resistance (APCR), and D-dimer) and their clinical significance in 83 CCHF-infected patients. SUBJECTS AND METHODS: We studied 83 CCHF patients who were admitted to Ankara Numune Education and Research Hospital during the spring and summer of2007. We compared the coagulopathy markers of fatal CCHF patients (n=9) with nonfatal cases (n=74). RESULTS: Platelet count, PT, aPTT, INR, and fibrinogen were prognostic factors associated with mortality for CCHF. Especially, platelet count<20 x 10(9) cells/l and aPTT>60 sec were important. Protein C, protein S, APCR, and antithrombin III levels were not associated with mortality. CONCLUSION: Laboratory tests including classical parameters (platelet count, PT, aPTT, INR, and fibrinogen) of coagulopathy seem to be enough for the followup of CCHF. Protein S, protein C, APCR, and D-dimer levels were not associated with mortality.

Pelvic ganglioneuroma.

Ganglioneuroma is a rare benign neurogenic tumor originating from the sempathoadrenal nervous system and is considered the benign counterpart of neuroblastoma, lacking the immature neuroblastic cells. A case of pelvic ganglioneuroma is described.

A sporadic abdominal desmoid tumour case presenting with intermittent intestinal obstruction.

Desmoid tumours, also known as aggressive fibromatosis, are rare lesions with an intermediate biological behaviour between benign fibrous lesions and fibrosarcomas. Although abdominal desmoids have an increased incidence in Gardner's syndrome, they are rarely found in an isolated form. We report the findings of a barium study, ultrasound, computed tomography and magnetic resonance imaging in a nine-year-old boy with intermittent nausea and vomiting, diagnosed as having a desmoid tumour. Although intra-abdominal desmoids are usually detected as a solitary lesion in sporadic cases, the presented case had two mesenteric lesions in the left upper quadrant. There was intestinal obstruction and the masses had invaded the colon wall.

Analysis of risk-factors among patients with Crimean-Congo haemorrhagic fever virus infection: severity criteria revisited.

The aim of this study was to determine the predictors of mortality among patients infected with Crimean-Congo haemorrhagic fever (CCHF) virus. Among patients with acute febrile syndrome, characterised by malaise, bleeding, leukopenia and thrombocytopenia, who were admitted to hospital during the spring and summer of 2002-2004, 54 had positive IgM and/or PCR results for CCHF virus in blood or tissue. The overall case fatality rate was 7.4%. Among the fatalities, haematemesis (p 0.009), melaena (p 0.001) and somnolence (p 0.022) were more common, the median platelet count was significantly lower (10,600/mL vs. 20,000/mL; p 0.038), the mean prothrombin time (27 s vs. 16 s; p 0.002) and mean activated partial thromboplastin time (73 s vs. 44 s; p < 0.001) were longer, and the mean alanine transferase (ALT) level (1,125 vs. 331; p < 0.001), the mean aspartate transferase (AST) level (3,118 vs. 913; p 0.004) and the mean fibrinogen level (119 vs. 340; p 0.012) were higher. Serum IgM and IgG against CCHF virus was detected in 25% and 0%, respectively, of fatal cases, compared with 94% and 62%, respectively, of cases with favourable outcomes. Oral ribavirin was prescribed to 22 (41%) patients. Of the four fatal cases, it was the intention to prescribe ribavirin to three patients, but this was not possible because of haematemesis and melaena. Higher levels of AST (>or= 700 U/L) and ALT (>or= 900 U/L) are suggested for use as severity criteria. Oral ribavirin was not effective for patients with haematemesis, and intravenous ribavirin is necessary for treatment of CCHF.