Shear bond strength of a novel porcelain repair system for different computer-aided design/computer-assisted manufacturing ceramic materials.

OBJECTIVES: The purpose of this study was to compare the shear bond strength of a novel repair system, Nova Compo SF with Ceramic Repair, Ivoclar, to computer-aided design/computer-assisted manufacturing (CAD/CAM) restorative materials (IPS e.max CAD and Empress CAD). MATERIALS AND METHODS: The specimens of each CAD/CAM restorative material were randomly divided into two subgroups of nine specimens, using one of two repair systems. All specimens were etched with hydrofluoric acid and rinsed under a water spray for 10 s, then air-dried for 10 s. Next, repair systems were applied according to the manufacturer's instructions. All specimens were stored in distilled water at 37°C for 24 h and then additionally aged for 5000 thermal cycles. A shear bond strength test was performed using a universal testing machine. Each fracture type was examined under a stereomicroscope at ×12.5 magnification. A two-way ANOVA test was used to detect significant differences between the CAD/CAM restorative materials and the composite repair systems. Subgroup analyses were performed using Tukey's honest significant difference. RESULTS: No statistically significant differences were observed between the repair systems (P = 0.9). The bond strength values from Empress CAD were statistically higher than those from e.max CAD (P < 0.05). CONCLUSIONS: Within limitations, SuperFlow may be an alternative to the ceramic repair materials we routinely used in the clinic. Empress CAD can be preferable to e.max CAD in terms of esthetically suitable clinical indications.

Recurrence Pattern of Pulmonary Langerhans Cell Histiocytosis After Lung Transplantation: A Case Report.

Pulmonary Langerhans cell histiocytosis is an uncommon indication for lung transplantation. The recurrence of the primary pathology after transplantation is rare. Extra-pulmonary involvement of Langerhans cell histiocytosis before transplantation and resuming of smoking after transplantation are risk factors for recurrence. Herein, we present a 48-year-old woman with a recurrence pattern 24 months after bilateral sequential lung transplantation. On thoracic computed tomography, progressive parenchyma infiltrates were present without clinical symptoms. Infiltrations regressed and respiratory status of the patient was improved with steroid therapy. No events had occurred at follow-up of 31 months.

Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres.

Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. In total 56 patients met the inclusion criteria. The number of patients without additional injury was 22 out of which according to the Robert's criteria, 15 children (68%) had an excellent, four (18%) a good, one (5%) a fair, and two (9%) a poor outcome. From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes.

Analysis of the effects of heparin and enoxaparin on degloving injuries.

BACKGROUND: Heparin and low molecular weight heparin are the most frequently used antithromboembolic drugs in fractures. OBJECTIVES: We aimed to compare the effects of heparin and enoxaparin, which are used as standard treatment, on viability in degloving injuries. METHODS: Thirty rats were used in the study. Three groups were composed including 10 rats in each group. Degloving injuries were formed in the tails of the rats. Enoxaparin was injected subcutaneously to the rats in group 1. Standard heparin was injected subcutaneously to the rats in group 2. Serum physiologic solution was injected subcutaneously to the rats in group 3. The experiment was ended on day 15. The tails of the rats were evaluated clinically and histopathologically. RESULTS: There was a statistically significant difference in the clinical results (p < 0.05). There was a statistically significant difference in the histopathological results (p < 0.05). CONCLUSIONS: We encountered positive effects of both heparin and enoxaparin on the treatment of degloving injuries in this experimental study. However, the findings of this study should be supported and improved by new experimental and especially clinical studies (Fig. 3, Ref. 18).

Surface roughness and morphologic changes of zirconia following different surface treatments.

OBJECTIVE: The aim of this study was to evaluate the roughness and morphology of zirconia after air abrasion and erbium:yttrium-aluminum-garnet (Er:YAG) laser application of different intensities. BACKGROUND DATA: Although surface roughness is important to obtain micromechanical retention, it is unclear which surface treatment is most appropriate for zirconia. METHODS: Fifty sintered zirconia specimens were divided into five groups (n=10). The following treatments were applied: control, Er:YAG laser irradiation with different energy intensities (200, 300, and 400 mJ), and air abrasion with aluminum oxide (Al(2)O(3)) particles (110 µm). Morphologic changes after surface treatments were examined in microscope analyses. Then, the surface roughness (Ra in µm) of the specimens was evaluated using a surface texture measuring instrument. Roughness data were analyzed using one-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) test (p=0.05). RESULTS: Results of microscope analyses revealed changes in surface morphology after surface treatments, including the formation of rare pits in the 400 mJ laser group and the formation of microretentive grooves in the air abrasion group. According to the results of the statistical analysis, the mean surface roughness value for the air abrasion group was significantly higher than that of the other groups (p<0.001). Except for the air abrasion group, there were no statistically significant differences within other groups (p>0.05). CONCLUSIONS: According to the results of the statistical and microscopic analyses, 400 mJ Er:YAG laser energy or air abrasion can be used to obtain micromechanical retention prior to luting; however, air abrasion is the most effective surface treatment method.

The use of self-expandable metallic stents for palliative treatment of inoperable esophageal cancer.

Most patients with esophageal carcinoma present in the advanced stage die from tumor invasion and widespread metastases. Because radical regimens are not appropriate for the majority of patients, and their expected survivals are as short as to be measured by months, the main aim of therapy is palliation with minimum morbidity and mortality. Among the palliative modalities are surgery, external radiotherapy or brachytherapy, dilatation, laser, photodynamic therapy, bipolar electrocoagulation tumor probe, and chemical ablation. The placement of self-expandable metallic stents is another method that improves dysphagia for these patients. In this study, the aim was to evaluate retrospectively the effectiveness of metallic stents deployed because of inoperable malignant esophageal stenosis and esophagotracheal fistulas. The results of 170 patients with 202 stents administered because of inoperable malignant esophageal stenosis and esophagorespiratory fistula between January 2000 and October 2008 at the Ataturk University, Department of Thoracic Surgery, were investigated. Despite epidemiological and clinical data, information regarding relief of dysphagia and quality of life were also examined. One hundred seventy patients with stents were between 28 and 91 years old (mean age 63.7 years+/-11.4 years). Ninety-seven were male and 73 were female. Stent indications were advanced tumors with distant metastasis (82 cases, 48.2%), unresectable tumors (51 cases, 30%), patients who cannot tolerate surgery or chemoradiotherapy (18 cases, 10.5%), local recurrence after primary therapy (1 case, 0.5%), esophagorespiratory fistulas from tumor or therapy (14 cases, 8.2%), and refusal of surgery (4 cases, 2.3%). Dysphagia scores evaluated by a modified Takita's grading system improved from 3.4 before the procedure to 2.6 afterward. The overall complication rate without chest pain was 31.7% (occurring in 64 cases). Mean survival was 177.7 days+/-59.3 days (2-993 days). Quality-of-life scores (The European Organization of Research and Treatment of Cancer QLQ C30) improved from 73+/-10.3 (57-85) to 112+/-12.6 (90-125). In therapy of malignant esophageal obstructions, metallic stents provide a significant improvement in dysphagia and require less frequent re-intervention according to other methods of dysphagia palliation such as dilatation, laser, and photodynamic therapy, nearly completely relieve esophagotracheal fistulas and improve quality of life to an important degree.

Using a similarity measure for credible classification.

This paper concerns classification by Boolean functions. We investigate the classification accuracy obtained by standard classification techniques on unseen points (elements of the domain, {0, 1}(n), for some n) that are similar, in particular senses, to the points that have been observed as training observations. Explicitly, we use a new measure of how similar a point x in {0, 1}(n) is to a set of such points to restrict the domain of points on which we offer a classification. For points sufficiently dissimilar, no classification is given. We report on experimental results which indicate that the classification accuracies obtained on the resulting restricted domains are better than those obtained without restriction. These experiments involve a number of standard data-sets and classification techniques. We also compare the classification accuracies with those obtained by restricting the domain on which classification is given by using the Hamming distance.

Intramural esophageal bronchogenic cysts: a review of the literature.

Bronchogenic cysts are rare congenital cystic lesions mostly located in the middle and superior mediastinum. Esophageal bronchogenic cysts are extremely rare. We review here 23 cases reported in English in the literature to date of intramural esophageal bronchogenic cyst and their features, including our patient. Although they are extremely rare, intramural esophageal bronchogenic cysts should be kept in mind in the differential diagnosis of benign esophageal lesions. With accurate diagnosis and treatment the prognosis is excellent and serious complications may be prevented.

Penetrating type intraosseous ganglion cyst of the lunate bone / Ganglión intraóseo penetrante del semilunar

Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.

Los gangliones intraóseos de los huesos carpianos localizados en el semilunar, constituyen una de las condiciones patológicas más raras que puedan verse. Aquí presentamos un caso del tipo penetrante de ganglión intraóseo, localizado en el semilunar como causa poco común del dolor de muñeca. El paciente fue tratado exitosamente mediante una intervención quirúrgica. El quiste ganglionar intraóseo debe ser considerado en el diagnóstico diferencial de dolores de muñeca sordos que se han hecho sentir por mucho tiempo, y se han vuelto crónicos.

Macular retinitis as a first sign of subacute sclerosing panencephalitis: the importance of early diagnosis.

PURPOSE: Subacute sclerosing panencephalitis (SSPE) is a subacute inflammatory and neurodegenerative encephalitis related to the measles (rubeola) virus and usually affecting children and young adults. The overwhelming majority of cases follow a progressive downhill course leading to death, although there have been a few case reports of patients who have apparently gone into remission. Ocular changes occur in up to 50% of SSPE cases. Visual complaints, if present, generally antedate the onset of neurological symptoms by a few weeks or months. Here, we report two cases of SSPE presenting with ocular findings and their prognoses. METHODS: Case reports. In the first case, a 17-year-old male presenting with macular retinitis, the macular findings were mistaken for a heredodegenerative disorder and diagnosis was postponed until neurological findings took place. He died six months after the appearance of his first ophthalmic symptoms despite intravenous immune globulin and isoprinosine therapy. The second case was a 14-year-old male, who presented with only ophthalmological complaints. His diagnosis was based on both ophthalmological findings and high doses of measles IgG in the cerebrospinal fluid (CSF); isoprinosine and intramuscular beta-interferon therapy was started before the onset of neurological findings and in the follow-up time of about 18 months, neurological findings consistent with SSPE did not develop. RESULTS: The characteristic finding of macular retinitis in SSPE patients is rapid recovery in about one month without therapy. After improvement, neurological findings take place. Once suspected, the diagnosis of SSPE is easily established by the demonstration of high levels of measles antibody in the serum and CSF. Early diagnosis can be made with typical ocular findings and high IgG titers for rubeola in CSF. CONCLUSION: We suppose that ophthalmic manifestations, especially macular retinitis, may be useful in the diagnosis and management of SSPE cases with elevated IgG titers for rubeola in CSF. The typical clinical findings must be familiar to every ophthalmologist so that diagnostic pitfalls can be prevented and early therapy started. It may be discussed if early diagnosis and therapy will be possible before neurological signs appear, the prognosis of this relentless disease may show a more favorable course.

Penetrating type intraosseous ganglion cyst of the lunate bone.

Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.

Lower limb landmine injuries.

The medical records of 186 patients seeking treatment for landmine injuries in the authors' region between 1993 and 2001 were evaluated. Of these patients 13 died of accompanying complications. Ten (10) patients with general body trauma and upper limb trauma were excluded from the study. Of 163 patients with lower-limb injuries included in the study, 21 with traumatic amputation underwent surgical amputation at different levels. Patients without traumatic amputation were divided into 2 groups. There were 41 patients (29%) in Group I who were treated by limb salvage procedures. Treatments used in Group I including wound debridement, tendon repair, skin approximation, minimal osteosynthesis, external fixation of long bones and secondary wound coverage. In Group II, there were 101 patients (71%) with primary amputation. Trans-tibial amputation was performed in 52 cases (51.4%), ankle disarticulation in 24 (23.7%), trans-femoral amputation in 9 (8.9%), partial foot amputation in 8 (7.9%), knee disarticulation in 7 (6.9%) and hip disarticulation in 1 case. In Group I, there was infection in 21 patients (51.2%), revision in 27 (65.8%), and amputation in 15 (36.5%). In Group II, there was infection in 28 patients (27.7%), revision in 17 (16.8%), and amputation at a higher level in 8 (7%). In crush injuries such as those resulting from landmines, soft tissue, vascular, and neurological assessment must be performed with utmost care. Even so, the desired success in interventions intended to save a limb is complicated by a high infection rate, soft tissue complications, and high revision amputation rates. Therefore, a decision to amputate in the early term based on an accurate preoperative assessment is crucial.

Distraction osteotomy for malunion of the distal end of the radius with radial shortening.

The treatment and outcomes of distraction osteotomy in 9 patients with malunion of the distal radius with radial shortening are presented. The patients had an average age of 32 years (range: 14 to 36 years) and comprised 7 males and 2 females. Ulnar inclination was below normal in all patients, volar inclination was below normal in 8 patients, and the average radial length discrepancy was 7.6 mm (range: 4 to 16 mm). Angulations in the distal radius were corrected by manipulation after osteotomy, and shortening by callus distraction. In order to achieve normal radial length, distraction was performed for an average of 10.2 days (range: 7 to 19 days), and union occurred in an average of 10.7 weeks (range: 9 to 13 weeks). During the waiting period between distraction and consolidation, impairment of ulnar and volar inclination recurred in 3 patients, and translation of the distal fragment necessitating correction occurred in 3 patients. No cases of nonunion or malunion were observed. In all patients, there was a decrease in cosmetic and pain-related complaints, and improvement in wrist movements. Distraction osteotomy is a simple and effective treatment for malunion of the distal radius with concurrent radial shortening. However, the position of the distal fragment should be followed up until consolidation.

The effects of osteoporosis on distraction osteogenesis: an experimental study in an ovariectomised rabbit model.

The effects of oestrogen deficiency-associated osteoporosis on callus distraction were investigated in rabbits. Twenty-four female New Zealand rabbits 5 to 6 months old were used. Ovariectomy was performed on 12 rabbits, which composed the osteoporotic model group. Six weeks later, osteotomy was carried out and Ilizarov external fixators were applied to the right proximal tibial metaphyses in both the osteoporotic model group and the control group. Beginning one week postosteotomy, the metaphyses were distracted 0.35 mm twice daily for 3 weeks, and the average length increase obtained for both groups was 17.2 mm (minimum: 16.8, maximum: 19 mm). Following a postdistraction waiting period of 6 weeks for newbone formation, the subjects were sacrified and specimens were examined histopathologically. Radiography was carried out at one-week intervals during the distraction period and at 2-week intervals during the waiting period, and scintigraphy was performed at the end of each period. On histopathologic examination, a significant difference in callus remodeling was observed between the control and osteoporotic model groups. On radiologic evaluation it was observed that, while both groups had inadequate callus tissue at the end of the waiting period, callus formation and remodeling occurred later in the model group than in the control group, and the new bone was more osteoporotic. Osteoporosis associated with estrogen deficiency adversely affects the outcome of callus distraction. Nonetheless, radiographic findings in rabbits indicate that the effects may not be so great as to preclude clinical procedures. It was concluded that these results should be supported with clinical studies.

Ophthalmological findings in elite amateur Turkish boxers.

OBJECTIVE: To evaluate the nature and incidence of pathological ocular conditions in boxing. METHODS: A group of 20 active, elite, amateur, asymptomatic Turkish boxers were examined and compared with a control group composed of 20 age matched sportsmen who were not boxers. The boxers had been actively boxing for 5-20 years (mean 9.65), were aged 16-34 (mean 22.25), and weighed 51-91 kg (mean 73.07). They had been involved in 67-500 fights (mean 143.8), with 5-40 losses (mean 17.75). All were championship title holders at the national, European, Olympic, or World level. RESULTS: An atrophic retinal hole was found in one boxer, which was treated with laser prophylaxis. In this series, the incidence of traumatic eye injuries was much lower than in the literature. Possible reasons are their young age, their division being mainly lightweight or middleweight, few fight losses, being elite boxers, their fighting distance being near or distant, protective methods, and racial factors. CONCLUSION: Boxing does not appear to be as hazardous to the eyes as previously reported, but prospective, longitudinal studies need to be carried out, including boxers of all divisions, ages, boxing experience, and level, and using various methods of fighting and protection. It should be made mandatory for all boxers to have a complete ophthalmological examination at the beginning of their careers and periodically thereafter.

Treatment of multifragmentary fractures of the femur by indirect reduction (biological) and plate fixation.

We present a retrospective review of the results of 43 multifragmentary femur fractures treated under the principle of indirect reduction (biological) and plate fixation. Fractures were caused by high-energy trauma in all patients. Sixteen were subtrochanteric, 14 diaphyseal and 13 supracondylar. There were 13 open fractures. In six of the patients with diaphyseal fractures, a plate was inserted through isolated proximal and distal incisions only, deep to the vastus lateralis. None of the fractures was treated with bone graft. The mean follow-up time was 28.3 months. Union was achieved in 41 patients within a mean period of 4.25 months. There was delayed union in one patient (subtrochanteric), non-union in two, infection in three, malunion in three, leg shortening in six and mild knee stiffness in seven. In eight patients with diaphyseal fractures in whom a single incision was performed, the average time for fracture healing was 4.14 months in seven and non-union developed in one. In six patients with diaphyseal fractures, in whom proximal and distal incisions were performed, the average time for fracture healing was 4 months. There was no difference (P>0.05) between single and double incision with reference to infection and time to union, but the indirect reduction methods must be meticulously implemented. The implants we used are cheaper and more easily supplied than many others. The success rate is high when the technique is correctly implemented. We believe that this is a treatment of choice in countries with low socioeconomic status, no efficient health insurance system and no intraoperative image intensification.

Supracondylar process of the humerus.

Four cases of supracondylar process of the humerus in three patients are presented. The main features of a supracondylar process as compared with an osteochondroma are reviewed. The three patients had pain and one had signs indicating median nerve compression. One had a supracondylar process together with an osteochondroma in the contralateral supracondylar region. One patient with a bilateral supracondylar process refused an operation. The other two patients underwent surgical treatment. The symptoms disappeared in the two patients who were operated.

Treatment of humeral diaphyseal nonunions by interlocked nailing and autologous bone grafting.

Twenty seven patients with humeral diaphyseal nonunion treated with interlocked nailing and autogenous bone grafting were retrospectively assessed. The mean age was 37 years (28 to 59 years). There were 16 women and 11 men. An average of 11 months (8 to 36 months) had elapsed between the initial trauma or treatment and presentation in our clinic. The nonunion site was in the distal third of the humerus in 18 patients (66%) and in the middle third in 9 (34%). Seventeen (73%) had hypertrophic and 10 (37%) atrophic nonunion. Patients were treated with locked intramedullary nailing and autogenous cancellous bone grafting. The mean follow-up was 42 months (28 to 62 months), and the mean time to union was 4.8 months (2.5 to 11 months). Three patients developed superficial infection. Union was achieved in all cases but one, in which there was multiple nerve injury. According to Steward and Hundley's scoring, results were good in 24 patients, fair in 2, and poor in one. Interlocked nailing and autologous bone grafting has a good rate of union provided nails of appropriate diameter are used and distal and proximal locking is performed correctly. We think that its low rate of infection, low risk of injury to the radial nerve, and low requirement for soft tissue dissection make it a suitable choice in the treatment of nonunions of the humeral diaphysis.

Treatment of traumatic bone defects by bone transport.

This study retrospectively evaluates the results of the management using the callus distraction method, of 19 patients who had developed bone defects following acute trauma. Sixteen patients were males, with a mean age of 19.4 years (6-41 years). Thirteen patients developed bone defects as a result of high-velocity gunshot injuries, and six had defects caused by traffic accidents. The location of 12 fractures was the tibia, and seven were in the femur. The mean follow-up period was 23.6 (12-40) months. The mean length of the bone defect was 6.8 cm (4-16 cm), the distraction index was 13.3 days/cm (7.5-18 days/cm) and the external fixation index was 36.6 days/cm (32.5-46 days/cm). Fifteen (9%) pintract infections were observed among those who underwent circular external fixation and four (10%) in cases who underwent unilateral external fixation. There were no deep infections. Refracture was noted in one patient (5%), and two (11%) had delayed union at the target site. One patient developed nonunion at the target site. For the treatment of large bone defects, the callus distraction method may be an alternative option to conventional treatment methods.