Evaluating the relation between the elongated styloid process and the ponticulus posticus using cone-beam computed tomography.

BACKGROUND: Ponticlus posticus (PP) as a one of the cervical vertebra variations brings about symptoms similar to Eagle syndrome. This study aimed to determine the relationship between elongated styloid process (ESP) and PP in a group of Iranian patients using cone-beam computed tomography (CBCT) images. MATERIALS AND METHODS: The CBCT images of 349 patients (118 males and 231 females; mean age: 32.53 ± 14.143) were involved in this study. The atlas vertebra was investigated for the presence and classification of PP (partial or complete) in sagittal views. Also, the styloid process was evaluated for the presence of ESP in reconstructed panoramic and three-dimensional images. Data were analysed using Mann-Whitney test, Fisher's exact test, and Chi-square test to assess the relationship between the presence of PP and ESP with regard to age and gender. RESULTS: Ponticulus posticus was observed in 24.5% of patients with ESP and 31.98% of patients without ESP. There was no significant relationship between the presence of PP and ESP (p = 0.198). Twenty-five patients with ESP showed PP; cases of ESP with either side and opposite side PP were 7.84% and 1.96%, respectively. Cases of bilateral ESP and PP were predominant (14.70%). The mean age of patients with bilateral ESP and PP was higher than others. There was no significant difference between males and females (p = 0.456). CONCLUSIONS: Considering the prevalence and characteristics of PP in the case and control groups, there was no significant relationship between PP and ESP.

Experiences in academic publication among ENT trainees in the UK: results from a national survey.

OBJECTIVE: This study aimed to provide an objective means of identifying patterns in academic publication among ENT trainees during their higher surgical training. METHOD: A cross-sectional survey was distributed to ENT higher surgical trainees. RESULTS: A total of 153 ENT specialty trainees participated, giving a response rate of 46.5 per cent. Across all years of training, the mean number of first author publications was three and the mean number of non-first author publications was two. For trainees at specialty trainee year 8 level, these figures were nine and five, respectively. Participants with doctoral degrees and those in academic programmes published more papers but the mean difference was only significant for the doctoral subgroup (p < 0.0001). Those with additional undergraduate degrees and those in less than full-time training had an overall lower number of publications. CONCLUSION: Participants in the current survey achieved a higher average number of academic publications than is presently required to successfully complete higher surgical training in ENT. It is hoped that these results act as a guide for trainees planning the research component of their training to ensure that they remain competitive at consultant interview.

The use of modified Silastic nasal splints as frontal sinus stents: a technical note.

BACKGROUND: Endoscopic frontal sinus surgery is frequently complicated by post-operative stenosis and obstruction of the frontal sinus outflow tract, resulting in recurrent disease. Frontal sinus stents may help prevent re-occlusion of the frontal neo-ostia. OBJECTIVE: This paper presents a simple and cost-effective approach to frontal sinus stenting using modified Silastic nasal splints. RESULTS AND CONCLUSION: The current technique provides an effective, reliable and inexpensive method for achieving post-operative frontal sinus outflow tract patency.

Low vs. high haemoglobin trigger for transfusion in vascular surgery: protocol for a randomised trial.

BACKGROUND: In patients with cardiovascular disease, guidelines for administration of red blood cells (RBC) are mainly based on studies outside the vascular surgical setting with the recommendation to use a haemoglobin (hb) trigger-level lower than by guidelines from The European Society for Vascular Surgery. Restricting RBC transfusion may affect blood O2 transport with a risk for development of tissue ischaemia and postoperative complications. METHODS: In a single-centre, open-label, assessor blinded trial, 58 vascular surgical patients (> 40 years of age) awaiting open surgery of the infrarenal aorta or infrainguinal arterial bypass surgery undergo a web-based randomisation to one of two groups: perioperative RBC transfusion triggered by hb < 8 g/dl or hb < 9.7 g/dl. Administration of fluid follows an individualised strategy by optimising cardiac stroke volume and near-infrared spectroscopy determines tissue oxygenation. Serious adverse event rates are: myocardial injury (troponin-I ≥ 45 ng/l or ischaemic electrocardiographic findings at day 30), acute kidney injury, death, stroke and severe transfusion reactions. A follow-up visit takes place 30 days after surgery and a follow-up of serious adverse events in the Danish National Patient Register within 90 days is pending. DISCUSSION: This trial is expected to determine whether a RBC transfusion triggered by hb < 9.7 g/dl compared with hb < 8 g/dl results in adequate separation of postoperative hb levels, transfusion of more RBC units and maintains a higher tissue oxygenation. The results will inform the design of a multicentre trial for evaluation of important postoperative outcomes.

Effects of thermal processing by nanofluids on vitamin C, total phenolics and total soluble solids of tomato juice.

In this research, our main idea was to apply thermal processing by nanofluids instead of conventional pasteurization processes, to shorten duration of thermal procedure and improve nutritional contents of fruit juices. Three different variables of temperature (70, 80 and 90 °C), nanofluid concentration (0, 2 and 4%) and time (30, 60 and 90 s) were selected for thermal processing of tomato juices by a shell and tube heat exchanger. The results demonstrated that 4% nanofluid concentration, at 30 °C for 30 s could result in 66% vitamin C retention of fresh juice while it was about 56% for the minimum nanofluid concentration and maximum temperature and time. Higher nanoparticle concentrations made tomato juices that require lowered thermal durations, because of better heat transfer to the product, and total phenolic compounds dwindle less severely; In fact, after 30 s thermal processing at 70 °C with 0 and 4% nanoparticles, total phenolic compounds were maintained by 71.9 and 73.6%, respectively. The range of total soluble solids for processed tomato juices was 5.4-5.6, meaning that nanofluid thermal processing could preserve the natural condition of tomato juices successfully. Based on the indices considered, a nanofluid thermal processing with 4% nanoparticle concentration at the temperature of 70 °C for 30 s will result in the best nutritional contents of final tomato juices.

Clinical surface modification process using the nitrogen plasma and its anti-bacterial efficiency.

In this research, the cotton fabrics were treated with nitrogen plasma for the clinical and anti-bacterial purposes. Turmeric was used a as a natural dye. Some part of both untreated and plasma treated samples was immersed in silver nitrate as a mordant before dyeing. Effect of plasma and silver nitrate on dye ability of cotton samples was compared and studied. Samples were analyzed with different experimental methods, such as scanning electron microscopy (SEM), Reflection spectro-photometry and antibacterial test. Results showed that, turmeric dye have anti-bacterial efficiency and good antibacterial activity achieved by plasma treatment of fabrics. In case of AgNO3 treatment, samples showed 100% antibacterial activity. It also concluded that, nitrogen plasma has synergic effect on antibacterial activity of turmeric as natural dye on cotton fabrics.

Risk of early recurrent stroke in symptomatic carotid stenosis after best medical therapy and before endarterectomy.

BACKGROUND: The early recurrence of neurological symptoms (NR) after urgent aggressive best medical therapy (BMT) in symptomatic carotid stenosis is not well documented. AIMS: To investigate the risk of ipsilateral NR after urgent aggressive BMT in patients with symptomatic (50-99%) carotid stenosis up to carotid endarterectomy (CEA), with emphasis on the first 14 days after index-event. METHODS: Prospective population based study, covering a period of 4½ years. NR rate was determined after initiation of urgent aggressive BMT and until CEA and compared to NR up to 90 days prior to index-event. Urgent BMT consisted of loading dose aspirin and clopidogrel thereafter therapy with aspirin and clopidogrel together with a statin. RESULTS: Of 8200 symptomatic patients (ischemic stroke, transient ischemic attack and ocular events), 250 (3%) patients underwent CEA, 47% within 14 days of the index-event and 99% within 14 days of surgical referral. The overall NR from index-event to CEA in symptomatic patients was significantly lower 1.6% (95% CI 0.5-4%) after BMT when compared with NR in the 90 days prior to referral to a stroke clinic 25% (95% CI 20-30%, p < 0.00001). Peri-operative bleeding 5% (95% CI 3-8%) was comparable with other studies. CONCLUSION: Urgent aggressive BMT after index-event is associated with a significant reduction in the risk of early NR in CEA candidates. The early risk of recurrent stroke in patients with symptomatic significant carotid stenosis is dramatically reduced after urgent aggressive BMT in specialised stroke clinics.

Does platelet-rich plasma enhance healing in the idiopathic bone cavity? A single-blind randomized clinical trial.

The presence of an idiopathic bone cavity (IBC) is usually identified during routine dental radiographic examinations. The purpose of this study was to investigate the effect of platelet-rich plasma (PRP) on bone healing in the idiopathic bone cavity. This was a single-blind randomized clinical trial. Twenty-four subjects were assigned randomly to two groups. Subjects in group 1 received PRP through a buccal window approach, and those in group 2 underwent conventional management via the creation of a window on the buccal wall and curettage of the walls of the defect. Subjects were followed up at 3, 6, and 9 months after the intervention. The amount of bone formation as determined on panoramic radiographs was divided into four categories: stage 1: ≤25% of the defect showed opacity; stage 2: 25-50% of the defect showed opacity; stage 3: 50-75% of the defect showed opacity; and stage 4: >75% of the defect showed opacity. There was a significant difference between the two groups with regard to the various healing stages at the three time points (P<0.05). When compared with conventional management of the idiopathic bone cavity, the use of PRP may enhance bone formation.

Medial cortex fracture patterns after sagittal split osteotomy using short versus long medial cuts: can we obviate bad splits?

The aim of the present study was to evaluate the lingual fracture patterns after sagittal split osteotomy (SSO) using short and long medial osteotomy cuts, via three-dimensional (3D) cone beam computed tomography (CBCT). Forty-six subjects participated in this prospective study. Two types of medial osteotomy line were made: for type I, the medial osteotomy line was finished just before the lingula; for type II, the medial osteotomy line was extended 3-4mm beyond the lingula. Three fracture patterns were observed after SSOs. There were no significant differences in the medial fracture patterns between the two medial osteotomy types (P=0.16). The buccolingual thickness of the ramus was lower in fractures with pattern 3 (bad split) than in the two other fracture patterns. The length of the medial osteotomy line - short or long - did not alter the prevalence of a bad split. The bone thickness of the ramus may affect the type of fracture pattern on the medial side of the ramus.

Comparison of vascular access use in hemodialysis patients in Isfahan in 2003 and 2013.

Vascular access (VA) complications are the leading cause of morbidity in the hemodialysis (HD) population and responsible for high health care costs. This study was designed to compare the profile of VA use for HD in Isfahan dialysis units in 2003 and 2013. A cross-sectional observational study was conducted between January and March 2013 on 536 HD patients in seven units. The patients data about VA type, number, survival, and demographic characteristics were collected and compared with the data collected in year 2003 on 320 patients in the same city units. The mean age of patients increased from 51 ± 17 to 58 ± 15 years (P < 0.001). The most common etiology of end-stage renal disease was diabetes mellitus, but the percentage increased in 2013 (P = 0.001).The use of an arteriovenous fistula (AVF) as a first dialysis access fell from 60.6% in 2003 to 35.4% in 2013 (P < 0.001). At the time of study, AVFs were used in 92.2% of patients in 2003 versus 56.5% in 2013 (P < 0.001). The 1, 2, 3 and 5 years AVF survival was 80%, 78%, 73%, and 69%, respectively in 2003 versus 79.4%, 61.2%, 47.3%, and 31.5% in 2013. The AVFs proportions decreased and the tunneled catheters proportions increased while the proportion of temporary catheters decreased in 2013 compared with 2003.

Dimensional stability ofautoclave sterilised addition cured impressions and trays.

The aim of this study was to investigate the dimensional accuracy of impressions following sterilisation by autoclaving. Dental impressions (75) were of a dentoform containing 6 reference points. The impressions were split into 5 groups of 15, each group used a different impression technique. Groups were divided into 3 subgroups with 5 impressions as control, 5 for disinfection by Perform-ID and 5 being autoclaved. Measurements were made using a travelling light microscope. A minimal significant dimensional difference (0.010.05). The trays and materials tested were suitable for the autoclave sterilisation.

The ventricular system of the brain: a comprehensive review of its history, anatomy, histology, embryology, and surgical considerations.

INTRODUCTION: The cerebral ventricles have been recognized since ancient medical history. Their true function started to be realized more than a thousand years later. Their anatomy and function are extremely important in the neurosurgical panorama. METHODS: The literature was searched for articles and textbooks of different topics related to the history, anatomy, physiology, histology, embryology and surgical considerations of the brain ventricles. CONCLUSION: Herein, we summarize the literature about the cerebral ventricular system.

Effects of image enhancement on reliability of landmark identification in digital cephalometry.

INTRODUCTION: Although digital cephalometric radiography is gaining popularity in orthodontic practice, the most important source of error in its tracing is uncertainty in landmark identification. Therefore, efforts to improve accuracy in landmark identification were directed primarily toward the improvement in image quality. One of the more useful techniques of this process involves digital image enhancement which can increase overall visual quality of image, but this does not necessarily mean a better identification of landmarks. The purpose of this study was to evaluate the effectiveness of digital image enhancements on reliability of landmark identification. MATERIALS AND METHODS: Fifteen common landmarks including 10 skeletal and 5 soft tissues were selected on the cephalograms of 20 randomly selected patients, prepared in Natural Head Position (NHP). Two observers (orthodontists) identified landmarks on the 20 original photostimulable phosphor (PSP) digital cephalogram images and 20 enhanced digital images twice with an intervening time interval of at least 4 weeks. The x and y coordinates were further analyzed to evaluate the pattern of recording differences in horizontal and vertical directions. Reliability of landmarks identification was analyzed by paired t test. RESULTS: There was a significant difference between original and enhanced digital images in terms of reliability of points Ar and N in vertical and horizontal dimensions, and enhanced images were significantly more reliable than original images. Identification of A point, Pogonion and Pronasal points, in vertical dimension of enhanced images was significantly more reliable than original ones. Reliability of Menton point identification in horizontal dimension was significantly more in enhanced images than original ones. CONCLUSION: Direct digital image enhancement by altering brightness and contrast can increase reliability of some landmark identification and this may lead to more accurate cephalometric analysis.

Accuracy of computerized automatic identification of cephalometric landmarks by a designed software.

OBJECTIVES: The purpose of this study was to design software for localization of cephalometric landmarks and to evaluate its accuracy in finding landmarks. METHODS: 40 digital cephalometric radiographs were randomly selected. 16 landmarks which were important in most cephalometric analyses were chosen to be identified. Three expert orthodontists manually identified landmarks twice. The mean of two measurements of each landmark was defined as the baseline landmark. The computer was then able to compare the automatic system's estimate of a landmark with the baseline landmark. The software was designed using Delphi and Matlab programming languages. The techniques were template matching, edge enhancement and some accessory techniques. RESULTS: The total mean error between manually identified and automatically identified landmarks was 2.59 mm. 12.5% of landmarks had mean errors less than 1 mm. 43.75% of landmarks had mean errors less than 2 mm. The mean errors of all landmarks except the anterior nasal spine were less than 4 mm. CONCLUSIONS: This software had significant accuracy for localization of cephalometric landmarks and could be used in future applications. It seems that the accuracy obtained with the software which was developed in this study is better than previous automated systems that have used model-based and knowledge-based approaches.

Effect of magnetic resonance imaging on microleakage of amalgam restorations: an in vitro study.

OBJECTIVES: The technique of MRI, using powerful magnets, plays an important role in the diagnosis of diseases of the head and neck without any ionizing radiation. Because of the potential hazard imposed by the presence of ferromagnetic metals, patients with implanted metallic objects are excluded from MRI. However, amalgam restorations seem to be safe. The purpose of this study was to evaluate microleakage of amalgam restorations following MRI. METHODS: 63 human freshly extracted premolars were divided into 3 groups based on 3 high-copper amalgams used to restore standard class V preparations on both buccal and lingual surfaces. Three different amalgam materials were used: Cinalux, GS-80 and Vivacap. The teeth were transferred into saline solution for 2 months at room temperature and then sectioned mesiodistally. MRI was randomly applied to one half of each section, and the other half was kept as a control. Following MRI, all specimens were immersed in a dye solution, sectioned and scored for any microleakage using a stereomicroscope. RESULTS: Differences in microleakage within each group following MRI were significant in the GS-80 and Vivacap groups but not in the Cinalux group. However, there was no significant difference between the three groups regarding the microleakage score. CONCLUSIONS: The results of this study suggest that MRI is not a completely safe technique in patients with amalgam restorations. It was shown that the main effect of fields led to the appearance of thermoelectromagnetic convection, which is responsible for the enhancement of the diffusion process, grain boundary migration and vacancy formation resulting in microleakage.

Evaluation of carotid calcification detected using panoramic radiography and carotid Doppler sonography in patients with and without coronary artery disease.

OBJECTIVES: Carotid artery calcification is responsible for an estimated 5% of ischaemic strokes. Carotid doppler sonography (DS) is a frequently used non-invasive method for assessing carotid artery stenosis and calcification. This study assessed the utility of panoramic radiography to detect any carotid artery calcification in patients with and without coronary artery disease, as well as the level of agreement between panoramic radiographs and DS findings. METHODS: Ninety subjects who underwent coronary angiography for any reason in Namazi Hospital, Shiraz University of Medical Science during an 11 month period received a DS assessment and panoramic radiograph. The radiopacities adjacent to the cervical vertebrae at or below the intervertebral space between C3-C4 were diagnosed as carotid artery calcifications. Carotid calcifications were scored as present or absent and pattern of calcification was noted by a maxillofacial radiologist who was blind to the angiogram and sonogram results. The final sample population was 84 subjects, providing data on 168 carotid arteries. RESULTS: The panoramic radiograph had a sensitivity of 66.6% and a positive predictive value of 45% for detecting carotid artery calcifications in patients whose angiograms confirmed the coronary artery disease. It had 50% sensitivity in patients with normal angiogram. The level of agreement between panoramic radiographs and DS results was weak. CONCLUSION: Because of low sensitivity and positive predictive value, the panoramic radiograph can not be considered an accurate or reliable method for detecting carotid artery calcification.

Outcome and survival of patients aged 75 years and older compared to younger patients after ruptured abdominal aortic aneurysm repair: do the results justify the effort?

We evaluated early mortality (<30 days) rates, cost analyses, and preoperative variables that may be predictive of 30-day mortality in elderly patients compared to younger patients after emergency open repair of ruptured abdominal aortic aneurysm (RAAA). The survey is a retrospective analysis based on prospectively registered data. The protocol was an "all-comers" policy. Seventy-two patients, who were operated on for RAAA in our department from January 1, 2005, to December 30, 2005, are included in this study. The follow-up time of survivors was 1 year. We defined 75-year-old patients as elderly because of the increased incidence of surgical risk factors and hospital mortality in this subset of patients (cut-off age). Demographic, clinical, and operative factors were analyzed together with 30-day mortality. Univariate analysis was performed with the chi-squared test. Multivariate analyses were also performed with the variables that were found to be significant in the univariate analysis. Health economy and cost analysis for the two groups were estimated. Out of 72 open repairs of RAAA, 44 patients (61%) were under 75 years of age and 28 (39%) were 75 years or older. The average age of the patients was 71 years (confidence interval [CI] 69.2-73.7, range 53-87). Twenty-five patients (35%, CI 27.6-51.2) died within 30 days in the postoperative period. The 30-day mortality for the 28 elderly patients who underwent open operative repair was 16 (57%, CI 48%-72%) compared to 9 (20%, CI 12%-33%) of 44 younger patients (p < 0.001). An age of 75 years or older and a serum creatinine >or=0.150 mmol/L in elderly patients with RAAA (p < 0.01) were identified to be significant risk factors for operative mortality. We did not encounter significant differences in the distribution of other risk factors in the group of elderly patients compared to the younger group. Between the survivors of the two groups, there were no significant differences in the total length of stay (LOS) and the LOS in the intensive care unit. Advanced age (>or=75) and the combination of this advanced age and serum creatinine of >or=0.150 mmol/L were the only significant (p < 0.05) preoperative risk factors in our single-center study. However, we believe that treatment for RAAA can be justified in elderly patients. In our experience, surgical open repair has been life-saving in 33% of patients aged 75 years and older, at a relatively low price for each life, estimated at euro 40,409.

Serum pepsinogen I, pepsinogen II, and gastrin 17 in relatives of gastric cancer patients: comparative study with type and severity of gastritis.

BACKGROUND & AIMS: First-degree relatives of gastric cancer patients are at risk for developing precancerous conditions. The aim of this study was to investigate the potential of biomarkers pepsinogen I (PGI), pepsinogen II (PGII), their ratio (PG I:II), as well as gastrin 17 for screening of precancerous conditions and corpus predominant gastritis. METHODS: First-degree relatives of gastric cancer patients underwent endoscopy. Three biopsy specimens from the antrum and 3 from the corpus were evaluated according to the Sydney classification. Serum was taken for the measurement of fasting PGI, PGII, and gastrin 17 by enzyme-linked immunosorbent assay kits. RESULTS: A total of 481 patients were examined (age, 47.8 +/- 6.7 y). With the extension of gastritis, PGII was increased up to 2.5 times (6.6 +/- 2.8 microg/mL in normal mucosa, 9.5 +/- 6.7 microg/mL in antral gastritis, and 16.9 +/- 12.4 microg/mL in corpus-predominant gastritis; P < .01), PGI increased slightly (88.3 +/- 29.4 microg/mL in normal mucosa and 111.2 +/- 71.4 microg/mL in corpus-predominant gastritis), and gastrin 17 was increased substantially in corpus-predominant gastritis (15.3 +/- 19.5 pmol/mL vs 3.8 +/- 5.7 pmol/mL in normal mucosa). By using a cut-off value of 7.5 microg/mL for PGII, any type of gastritis from normal mucosa can be diagnosed with a sensitivity and specificity of 80%. The sensitivity and specificity of the PG I:II ratio (< or =3) and gastrin 17 (>17 pmol/mL) together were 9.4% and 99% for screening corpus-predominant gastritis and 14.8% and 97.8%, respectively, for screening intestinal metaplasia in the corpus. CONCLUSIONS: PGII is a suitable marker for screening any gastritis from normal mucosa, but neither PGI, the PG I:II ratio, gastrin 17, nor their combination were able to select those with precancerous conditions and corpus-predominant gastritis among the first-degree relatives of gastric cancer patients.

Recurrent multiple myeloma following renal transplantation: a case report.

Renal transplantation is generally not considered for patients with multiple myeloma (MM) because of their extremely poor prognosis. However, for patients in remission, it offers an alternative to dialysis. There are few reports of MM recurrence among kidney transplant recipients. We report a 57-year-old white man with end-stage renal disease (ESRD) and known multiple myeloma in remission who underwent kidney transplantation. Eighteen months after transplantation upon routine follow-up, he was observed to have an elevated creatinine with no evidence of recurrence of myeloma upon bone marrow aspiration. Light microscopy and immunofluorescence of a renal biopsy showed chronic scarring of the kidney owing to cast nephropathy consistent with MM recurrence. Repeat bone marrow aspiration 1 week later confirmed this diagnosis. A review of the literature of prior studies suggested that it is reasonable to perform renal transplantation in patients with ESRD due to MM in remission, but large prospective studies would help to develop a strategy for prevention of multiple myeloma recurrence.