Use of multiparametric magnetic resonance imaging as a screening tool for the determination of acute ischemic stroke duration.

OBJECTIVE: This study aimed to assess the usability of magnetic resonance imaging (MRI) parameters in the treatment of stroke patients whose symptom onset time is unknown. PATIENTS AND METHODS: We evaluated MRI of the patients whose stroke symptoms began within 12-hours. For quantitative analysis, fluid-attenuated-inversion-recovery (FLAIR) and diffusion-weighted-imaging (DWI) signal-intensity-ratios (SIR) of the lesions were computed. For qualitative analysis, 'mismatch' between visibility of lesion on DWI-FLAIR was evaluated. Patients were analyzed according to the first 4.5/6 hours of stroke onset time. RESULTS: There was a moderate (r=0.569, p<0.001) correlation between symptom MRI time and FLAIR SIR and a weak correlation with DWI SIR (r=0.355, p=0.001). A FLAIR SIR threshold of ≤1.18 for predicted symptom onset 4.5 hours increased specificity (0.77 vs. 0.74) and sensitivity (0.77 vs. 0.69) as compared with visual analysis. A FLAIR SIR threshold of ≤1.19 for predicted symptom onset 6 hours increased sensitivity (0.76 vs. 0.67) and equal specificity (0.75 vs. 0.75) as compared with visual analysis. CONCLUSIONS: In hyperacute ischemic stroke, lesion age can be determined more accurately by the FLAIR SIR analysis than visual analysis. In patients whose stroke onset time is unknown, the FLAIR SIR can be used as a biomarker in the management of stroke patients.

Magnesium efficacy in magnesium deficient and nondeficient patients with rapid ventricular response atrial fibrillation.

We assessed the effect of magnesium sulphate (MgSO4) on lowering the rate in ventricular atrial fibrillation (AF), and evaluated the effect of this therapy in magnesium (Mg) deficient and nondeficient patients. This experimental clinical study was performed on 34 patients with rapid AF (ventricular rate [VR] > 120/minute) presenting to the emergency department of a tertiary care university hospital. Patients with systolic blood pressure < or = 100 mmHg, Hb level < or = 11.8, saO2 of < or = 96%, BUN > or = 40 or creatine > or = 1.8 were excluded (n = 15). Nineteen patients were given an initial 2 g MgSO4 bolus i.v. and a 1 g/hour continuous infusion over 6 hours. To evaluate the presence of Mg deficiency, urine was collected from the onset of treatment and continued for the next 24 hours, and the excretion rate of administered Mg was calculated. Ventricular rates were obtained at baseline, after MgSO4 bolus, and every 15 minutes for the first hour. The decrease in the VR was statistically significant at 15, 30 and 60 minutes after Mg therapy (p = 0.0025, p < 0.001, p > 0.001). There was no difference in the response to Mg therapy between Mg deficient and nondeficient patients at 15, 30 or 60 minutes after therapy (p = 0.41, p = 0.28, p = 0.08). It is concluded that i.v. MgSO4 has a statistically significant but clinically limited effect on VR and this effect did not differ between patients with and without Mg deficiency.

Predictors of success in the conversion of new-onset atrial fibrillation using oral propafenone.

We have investigated the relationship of clinical variables to successful cardioversion of atrial fibrillation (AF) to sinus rhythm using an oral loading dose of propafenone. Fifty consecutive patients with recent onset (< 72 hours) atrial fibrillation of various aetiologies were included in the study cohort. All patients were given the study medication while in the emergency department and then monitored for 8 hours. All patients converting to sinus rhythm (39 out of 50, 78%) were discharged and re-evaluated at 24 hours and 30 days. We investigated the effect of clinical factors such as age, sex, presence of hypertension (HT), chronic obstructive lung disease (COPD), diabetes mellitus (DM), mitral stenosis (MS), congestive heart failure (CHF), coronary artery disease (CAD) and the duration of atrial fibrillation on conversion to sinus rhythm. Of these factors, univariate and multivariate analysis showed that only the duration of atrial fibrillation was a significant predictor of conversion (p = 0.002). Our results suggest that most patients with new-onset AF can be converted successfully to sinus rhythm with a low incidence of adverse reactions using oral propafenone in the emergency department.

A randomized prospective placebo-controlled study of intravenous magnesium sulphate vs. metoclopramide in the management of acute migraine attacks in the Emergency Department.

The objective of this randomized, placebo-controlled, double-blind study was to determine the effectiveness of intravenous magnesium sulphate and intravenous metoclopramide in the treatment of acute migraine attacks in the Emergency Department when compared with placebo. Adult patients who presented to the Emergency Department with a headache that met International Headache Society (IHS) criteria for acute migraine were infused with either 10 mg of intravenous metoclopramide, 2 g of intravenous magnesium sulphate or normal saline over 10 min. At 0, 15, and 30 min, patients were asked to rate their pain on a standard visual analogue scale. At 30 min, patients were asked in a standard manner about the need for rescue medication. Adverse affects were also recorded. Patients were followed up by telephone within 24 h for any recurrence after discharge. The primary endpoint of the study was the difference in pain relief between the groups at 30 min. Of the 120 patients who met IHS criteria, seven were excluded from the study due to insufficient data. The number of patients, gender, age and initial visual analogue scale (VAS) scores were comparable between groups. Each group experienced more than a 25-mm improvement in VAS score at 30 min. However, there was no significant difference detected in the mean changes in VAS scores for pain. The rescue medication requirement was higher in the placebo group. The recurrence rate in 24 h was similar between the groups. Although patients receiving placebo required rescue medication more than the others, metoclopramide and magnesium have an analgesic effect similar to placebo in migraine attacks.

Immunoglobulin and haematocrit values of dental pulp showing hyperaemia and acute serious pulpitis.

In this study, we examined how the pulpal immune systems differ in children who suffer from hyperaemia and acute serous pulpitis. The Radial Immune Diffusion (RID) method was used to measure the IgA, IgG and IgM levels in pulpal blood in hyperaemia and acute serous pulpitis cases. The patient's own peripheral blood was used as the control group. The peripheral blood was taken with a capillary tube from the finger tip. The immunoglobulins and the Htc values of the blood were measured by the radial immune diffusion method. In our research, the immunoglobulin and hematocrit values of the blood (pulpal and peripheral) of 39 patients between the ages 6 to 13 years were measured. No significant difference was found between the IgA, IgG and IgM levels of pulpal and peripheral blood in hyperaemia and acute serous pulpitis cases. In the same patients, a significant difference was noted between the Htc values of the pulpal and peripheral blood.

The relationship between periodontitis and tooth decay in juvenile diabetes mellitus cases and in healthy children.

Children diagnosed as having juvenile diabetes mellitus have been compared with healthy children of the same age, with respect to decayed, filled primary teeth (df), decayed, missing, filled permanent teeth (DMF), Gingival index (GI), Periodontal index (PI), Oral hygiene index (OHI). These parameters have been evaluated according to WHO criteria. Corresponding parameters have been statistically evaluated. When experimental and control groups were compared statistically, a highly significant difference was seen between df and DMF indexes of diabetic and healthy children. In the periodontal evaluation, a significant difference was found in the gingival index, but no such significance was seen in the periodontal index. From the results of this study it can be seen that children with juvenile diabetes mellitus had less caries incidence compared with the control group. Even though gingival destruction had already started in this study group, intense periodontal damage was not observed at this particular age level.

The effect of a sealant on the microleakage of composite resin restorations: an in vivo study.

The aim of this study was to evaluate the effect of sealant application in reducing microleakage of the composite resin restorations under in vivo conditions. Occlusal composite resin restorations were made in 24 caries-free primary molars which were about to exfoliate, in children aged between 10 and 13 years. Of these restorations, 12 were sealed with a fissure sealant whereas the others were kept unsealed as controls. After 1 month, the teeth were extracted and immersed in a 2% methylene blue dye solution. The dye penetration alongside the restorations was evaluated using a stereo-microscope. The findings indicated that sealant application significantly (p < 0.05) reduced the microleakage of composite restorations but did not eliminate it completely.

Fluoride in dental plaque after a single toothbrushing with monofluorophosphate dentifrice.

Many studies have shown that topical fluoride applications can produce a fluoride reservoir in dental plaque. Since the most common topical fluoride application is via toothbrushing with fluoridated dentifrices, the aim of this study was to measure fluoride uptake by dental plaque after a single toothbrushing with monofluorophosphate (MFP) toothpaste and to follow the plaque until its fluoride concentration returned to the prebrushing levels. In a fluoridated area, plaque samples were collected from 26 children who brushed with MFP toothpaste, 22 children who brushed with a fluoride-free control toothpaste, before brushing and at intervals of 10 minutes, 1 hour and 2 hours after brushing. A combination fluoride electrode was used to determine the fluoride content of the samples. In conclusion, our study has shown that brushing with fluoridated water has a positive effect on the fluoride level of the plaque and the addition of MFP did not make a significant change, although it had a short term effect. A negative correlation was established between plaque wet weight and its fluoride content whenever the plaque equilibrated.

[The role of computed tomography for minor head injury]. / Minör kafa travmasi olan hastalarda bilgisayarli beyin tomografisinin rolü.

Head trauma is a major health problem which affects young people, especially young males and also causes serious economic losses. Although major head injuries are cause greater morbidity and mortality, minor head injuries are more common presentations to emergency departments. In this study our goal is to determine the prevalence of CT usage in minor, adult head injury patients and determine clinical variables for the use of head CT scans. In our study we retrospectively examined 230 adult head injury patients who were presented to the Dokuz Eylül University Medical School Hospital Emergency Department. We recorded age, gender, symptoms of nausea, vomiting, headache, alcohol use, physical examination findings, history of loss of consciousness prior to presentation, concurrent injuries, and Glasgow Coma Scale (GCS) scores. Head CT ordering and abnormal findings were correlated with the above clinical variables. We ascertained that all variables affected the ordering of CT scans except age, gender and alcohol use. The prevalence of abnormal head CT in all patients were 21.7%. We found that GCS is only one clinical variability of which statistically significant relationship to acquaint abnormal CT findings.

Intravenous single-dose tramadol versus meperidine for pain relief in renal colic.

BACKGROUND AND OBJECTIVE: Comparison of the effectiveness of tramadol with meperidine given intravenously to emergency patients with suspected renal colic. METHODS: A double-blind, randomized clinical trial was performed in the Emergency Department of a tertiary-care university hospital. Consecutive patients with suspected renal colic (n = 47) were randomized to receive intravenously an initial dose of tramadol 50 mg (n = 23) or meperidine 50 mg (n = 24). After 30 min, additional doses of meperidine 50 mg were given intravenously as a rescue medication in an open fashion. Pain relief was assessed using a 10 cm visual analogue scale, the primary outcomes being pain relief at 15 and 30 min after the analgesics. Secondary outcomes were the frequency of rescue meperidine use and the development of side-effects. RESULTS: Visual analogue scale pain scores after 15 and 30 min decreased in both tramadol and meperidine groups (P < 0.05). However, pain relief was better in the meperidine group at the 15 and 30 min evaluations (P < 0.05). Only 11 patients (48%), initially receiving meperidine, needed more meperidine compared with 16 patients (67%) initially receiving tramadol. Both drugs were well tolerated with no adverse effects occurring in either group. CONCLUSIONS: Meperidine 50 mg was superior to tramadol 50 mg for acute pain relief in patients with suspected renal colic when given intravenously. Because many patients in both groups received supplemental meperidine and the response to tramadol alone cannot be predicted, clinicians may want to choose higher doses of meperidine alone or other alternative combinations.

Must antidysrhythmic agents be given to all patients with new-onset atrial fibrillation?

We investigated the spontaneous conversion rate of new-onset atrial fibrillation (AF) in emergency department patients and the recurrence rate of AF during a 1 month follow-up period. Sixty-six consecutive hemodynamically stable patients presenting to a university hospital emergency department with new-onset atrial fibrillation (less than 72 hours duration) comprised the study population. Patients were initially monitored for 8 hours and observed for spontaneous conversion of AF to sinus rhythm. If conversion did not occur in the first 8 hours, an oral loading dose (600 mg) of propafenone was given, and patients were observed for an additional 8 hours. All patients were reevaluated at 24 hours and at 1 month. The spontaneous conversion rate in patients presenting within 6 hours of AF onset during the initial 8-hour observation period was 71%. The spontaneous conversion rate for all patients during the initial observation period was 53%. The conversion rates between patients presenting "early" (less than 6 hours) and "late" (7-72 hours) were significantly different (P < 0.001). Many patients with new-onset AF, especially those with atrial fibrillation duration less than 6 hours, may need observation only, rather than immediate intervention, to treat their dysrhythmia.

[Is seat belt sign a predictor for physicians in management of trauma patients in emergency settings?]. / Acil servis travma hastalarinda "emniyet kemeri izi" tedaviyi belirleyici bir klinik bulgu mudur?

Seat belt sign (SBS) is frequently seen as a clinical finding in motor vehicle accidents. The purpose of this study is to determine the diagnostic value of SBS. All adult patients presenting with an history of motor vehicle accident to a tertiary care university hospital emergency department was included in this prospective, observational study covered the time period between July 01, 1999 and February 01, 2000. 213 patients were included in this study; 135 (63.4%) were male, and 76 patients (35.7%) were seat-belted. SBS was seen on 27 (35.5%) belted patients. Fourteen of seat-belted had rib fractures nine of those patients with rib fractures were found to have SBS. There was a statistically significant difference between the patient groups with or without SBS in rib fractures (p = 0.0128) While no significant differences were detected between groups regarding the frequency of intra-cranial, intra-thoracic, intra-abdominal and extremity injuries three of four patients who had sternum and clavicular fractures took place in SBS(+) group (p = 0.090). The presence of SBS in trauma patients may create a high index of suspicion for thoracic injuries, especially for rib fractures. It is widely accepted that any delay in the diagnosis may increase morbidity and mortality following thoracic injuries. Further studies are needed to investigate the possible role of SBS in the prediction of the severity of injuries following thoracic trauma.