Assessment of the Anterior Clinoid Process and Optic Strut in Chiari Malformation Type I: A Computed Tomography Study.

Objective This study aimed to evaluate morphological features of the anterior clinoid process (ACP) and the optic strut (OS) in Chiari malformation Type I (CM-I). Methods The study universe consisted of computed tomography images of 41 CM-I patients and 45 normal subjects. Comparison of the parameters for CM-I and the control group was performed with the Student's t -test. A " p < 0.05" was accepted as the significance level. Results ACP length was smaller in CM-I than the control group ( p < 0.001). In contrast to ACP length, ACP angle ( p < 0.001), OS length ( p = 0.022), and the distance between ACP and OS ( p = 0.020) were found greater in CM-I in comparison to the control group ( p < 0.05). ACP width ( p = 0.233) and OS width ( p = 0.376) were similar in both groups. ACP pneumatization in CM-I group was found as 12.20%, whereas in the control group as 8.90%. Two different types about the pneumatization were identified in CM-I group (Type 1: 4.9% and Type 2: 7.3%), whereas three different types in the control group (Type 1: 3.3%, Type 2: 4.4%, and Type 3: 1.1%). Relative to ACP, three different types about OS position were identified in CM-I group (Type C: 31.70%, Type D: 64.60%, and Type E: 3.70%) and the control group (Type C: 7.80%, Type D: 64.40%, and Type E: 27.80%). Conclusion Shorter ACP, wide-angled ACP, longer OS, and more anteriorly located OS were found in CM-I group compared with the normal group. Our findings showed that the pneumatization of ACP was not affected by CM-I.

Look after the COVID-19 pandemic: Mortality rates among patients with rheumatic diseases.

AIM: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection may have a more severe course in patients with underlying disease or who have had immunosuppression. In this study, it was aimed to determine the frequency of coronavirus disease 2019 (COVID-19) and the mortality rates related to COVID-19 among patients with rheumatic disease. METHODS: The patients who were followed up with rheumatic disease in the rheumatology outpatient clinic in a tertiary hospital were retrospectively assessed if they had COVID-19 infection or not between March 2020 and January 2022. RESULTS: A total of 10 682 patients were evaluated. There were 2928 (27.4%) COVID-19-positive and 7754 (72.6%) COVID-19-negative patients. The mean age of COVID-19-positive patients was 46.2 ± 14.6 years, and 65.8% were female. Forty-two (1.4%) patients died due to COVID-19. Among COVID-19-negative patients, 192 patients died. The most common rheumatic disease among patients with COVID-19 was spondyloarthritis (SpA) (30.4%). Corticosteroids were the most common treatment agent in COVID-19-positive patients regardless of mortality. Thirty-one (73.8%) patients were receiving corticosteroids, and 35 (83.3%) patients were receiving immunosuppressive agents among patients with mortality. According to the logistic regression analysis, older age, male gender, and receiving corticosteroid, hydroxychloroquine, mycophenolate mofetil, tofacitinib, rituximab, and cyclophosphamide were found to be related to increased mortality. CONCLUSION: COVID-19 is a serious infection and the current study emphasized that patients with rheumatic diseases had increased mortality rates, particularly in patients who were old, male, and on immunosuppressive treatments.

Consistent Value of Two-Stage Pedicle Flaps in the Age of Microsurgical Maxillofacial Reconstruction.

Introduction: Up to the second half of the twentieth century, pedicled flaps marked the gold standard in reconstructive surgery. Followed by the introduction of microsurgical techniques, these flaps were increasingly abandoned. We conducted a retrospective study to determine the value of two-stage pedicle flaps in modern maxillofacial reconstruction. Material & Methods: A chart review from October 2017 to November 2020 was performed to identify patients who were treated by a two-stage pedicle flap in our Department of Oral and Maxillofacial Surgery. Results: A total of 31 patients, 17 female and 14 males received 36 two-stage pedicle flaps. All patients were in noticeably impaired health condition with a majority of ASA-score 3. The defect location mainly contained extraoral resections (58.3%). A variety of flaps were harvested consisting of buccal flaps, Abbe flaps, forehead flaps, deltopectoral flaps, nasolabial flaps, and a tubed flap. Discussion: The study outlines two indications for the use of two-stage pedicle flaps. Firstly, as a back-up strategy in heavily pre-treated wound beds and secondly in an almost contrarily indication as a first-choice reconstructive option of the facial skin in esthetic demanding cases. Conclusion: The timesaving and straight forward surgical approach as well as their low postsurgical complications and strong long-time success rates secure the two-stage pedicle flap a justified niche role in times of microsurgical maxillofacial reconstruction. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-021-01635-9.

Effect of modified NaOCl irrigation solution on bond strength of bioceramic-based root canal sealer to dentin.

INTRODUCTION: Biomechanical shaping and hermetic obturation play an important role in the success of root canal treatment. AIMS AND OBJECTIVES: This study aimed to examine the bonding strength of the bioceramics sealer to the dentin surface with or without core when irrigated with conventional NaOCl, modified NaOCl, EDTA, MTAD and distilled water. Materials and Methods: 120 single-root teeth dissected at the level of enamel-cement junction were grouped according to different irrigation and filling techniques; each group consisted 12 teeth. After final irrigation with NaOCl, modified NaOCl, EDTA, MTAD or distilled water, the samples were filled with bioceramic sealer. Samples with or without core were obtained; then 2 mm-thickness horizontal sections were made in the middle coronal and the middle third of the dentin and subjected to a push-out test. Results: Although bonding strength was the lowest when modified NaOCl was used, the highest bonding strength was reported with NaOCl in the present study. Bond strength values determined in the coronal third were found to be high compared to the middle third, although the difference was not statistically significant. In the groups without core, the resistance of the connection was found to be higher than in the core with a filled root canal (P < 0.05). CONCLUSION: Because the connection value of the bioceramic root canal sealer to the dentin using modified NaOCl was lower,it is recommended not to use the monoblock effect in canal filling in cases anticipated to be problematic. It would be more appropriate to use bioceramic paste without core in cases where a high attachment to dentin is desired.

Effect of retreatment instruments on microcrack formation: a microcomputed tomography study.

INTRODUCTION: The purpose of this study was to compare the occurrence of microcracks in teeth prepared with different retreatment systems using microcomputed tomography (micro-CT). METHODS: Forty-two freshly extracted mandibular premolar teeth were used. The root canals were instrumented with stainless steel K-files to an apical size of 35/.02 using the balanced-force technique and were obturated using the passive compaction technique. The specimens were divided into 3 experimental groups according to retreatment system used (n = 14): ProTaper Universal retreatment (PTUR), Mtwo retreatment (MTR), or D-RaCe retreatment (D-RC) systems. Each specimen was scanned using a high-resolution micro-CT system before instrumentation, after obturation, and after the removal of the filling material. The images were evaluated, and the presence of microcracks was recorded. RESULTS: The PTUR system demonstrated the highest percentage, while MTR and D-RC retreatment systems resulted in similar numbers of microcracks. CONCLUSIONS: Clinicians should be aware that all retreatment systems may cause microcracks.

Multiple controlling mechanisms of FGF1 gene expression through multiple tissue-specific promoters.

We now know that fibroblast growth factor-1 (FGF1) transcription is controlled by at least four distinct promoters in a tissue-specific manner. Thus, promoter 1.A is active in the kidney, 1.B in the brain, and 1.C and 1.D in a variety of cultured cells including vascular smooth muscle cells. These promoters are separated from each other by up to 70 kbp. Multiple FGF1 transcripts arise from alternate promoter usage and alternative splicing of different 5'-untranslated exons. The 1.A and 1.B promoters are constitutively active in their respective cell types. In contrast, different biological response modifiers, including serum and transforming growth factor beta, can induce the 1.C and 1.D promoters. The 540-bp sequence upstream of the 1B transcription initiation site is sufficient to drive the expression of a heterologous luciferase reporter in cultured cells, and an 18-bp sequence within this region is important for the regulation of brain-specific gene expression. Furthermore, regulation occurs through the binding of the 18-bp sequence to a brain-specific 37-kDa protein and a ubiquitous basic helix-loop-helix protein, E2-2. We have produced transgenic mice bearing the brain-specific promoter of the human FGF1 gene joined to the SV40 immediate-early gene, which encodes the large T antigen. The resulting mice developed brain tumors that originated in the pontine gray, just rostral to the fourth ventricle. We have also identified a serum response element, comprising a CarG box and an Ets-binding site, in the 1.D promoter. Continued characterization of the mechanistic events that control the tissue-specific activation of FGF1 promoters will help us to understand the role of FGF1 in cancer, atherosclerosis, and neural development.

Apical transportation during removal of root canal filling with different retreatment systems.

INTRODUCTION: This study aimed to compare apical transportation during retreatment using ProTaper Universal retreatment (PTUR), Mtwo R and D-RaCe instruments in curved root canals. METHODS: 36 extracted mandibular molar teeth with curved mesiobuccal roots were selected. The teeth were embedded into acrylic blocks. The blocks were fixed on the experimental setup. After determining the working length (WL), mesiobuccal canals were prepared with ProTaper Universal rotary instruments to size F1 (20/0.06). After the obturation, the teeth were randomly divided into groups; the PTUR files were used as D1 (30/0.09) for coronal third and D2 (25/0.08) at WL. Mtwo R files, R1 (15/0.05) and R2 (25/0.05) were used at WL. D-RaCe files were used as DR1 (30/.10) in cervical third and DR2 (25/0.04) at WL. Image J analysis software was used to measure the apical transportation. Differences between the 3 groups were analyzed with a 1-way ANOVA or Kruskal-Wallis tests. RESULTS: There was no significant difference between groups in the apical transportation in either the mesiodistal (p = 0.166) or buccolingual (p = 0.518) direction. Among the 3 groups, the apical transportation was the greatest in the D-RaCe group. CONCLUSIONS: It can be concluded that all retreatment systems caused a similar level of apical transportation.

Prophylactic antibiotics in plastic and reconstructive surgery.

There is no consensus in the literature on the use of prophylactic antibiotics to prevent postoperative infection. This study was performed to investigate whether the use of prophylactic antibiotics has an effect on postoperative infection rates. A total of 1400 patients were classified into four groups based on their diagnosis. During the induction of anesthesia, half of each group received 2 g of a sulbactam-ampicillin combination and the other half received a placebo (saline solution) intravenously. Wound infection rates were observed in the postoperative period. Age, sex, and operative site of the patients with the same diagnosis were comparable in each group. The white blood cell count and the body temperature reading of each patient were recorded postoperatively. Wounds were observed daily in the postoperative period and graded according to a predetermined scale. Bacteriologic specimens were obtained from patients who had wound infections. According to our clinical experience, antibiotic prophylaxis is not necessary in plastic surgery. At the end of our 6-year study, a significant difference could not be found between the antibiotic prophylaxis and placebo groups.

Vascularized double-sided preputial island flap with W flap glanuloplasty for hypospadias repair.

Hypospadias surgery is one of the most challenging surgical interventions that still need further refinements for increased success rates. During the last 5 years, we operated on 26 mid-penile or proximal hypospadias cases by using vascularized double-sided preputial island flap and W flap glanuloplasty to achieve superior functional and aesthetic results. Follow-up period of the patients revealed a 92.3 percent success rate with a single operation. Two cases developed fistula, which was located at the proximal anastomosis site. However, they were repaired in a second sitting without any additional problem. The basic aim in hypospadias surgery is the correction of chordee, reconstruction of urethra, and sufficient ventral penile skin coverage in one stage with minimal complication. The use of vascularized tissue for urethral reconstruction and ventral coverage is believed to have a superior healing capacity with better functional and cosmetic outcome. On the other hand, adding W flap glanuloplasty to this technique avoids the risk of meatal stenosis. We conclude that by combining the two above-mentioned techniques, it is possible to cope better with this devastating congenital deformity.

Tangentially split gluteus maximus myocutaneous island flap based on perforator arteries for the reconstruction of pressure sores.

From 1995 to 1997, the authors used tangentially split gluteus maximus myocutaneous island flaps based on the musculocutaneous perforator arteries for the reconstruction of pressure sores located in the trochanteric, sacral, and ischial regions of 30 ambulatory and paraplegic patients. The postoperative follow-up period was 18 months. Postoperative electromyograms were performed on the ambulatory patients to compare the function of the gluteus maximus muscles on each side. There were one major and two minor postoperative complications. There was no total flap loss. The major advantage of this technique is the preservation of most of the gluteus maximus for stair climbing and single-limb support in the ambulatory patient. The tangentially split gluteus maximus myocutaneous island flap is recommended as the procedure of choice for closure of sacral, ischial, and trochanteric ulcers in both the ambulatory and nonambulatory patient.

Anatomicohistologic study of the retaining ligaments of the face and use in face lift: retaining ligament correction and SMAS plication.

Plastic surgeons have sought to improve nasolabial folds, jowls, jaw lines, and cervical contour with face-lifting procedures that are abundant in the literature. The retaining ligaments of the face support facial soft tissue in normal anatomic position, resisting gravitational change. As this ligamentous system attenuates, facial fat descends into the plane between the superficial and deep facial fascia, and the stigmata of facial age develop. In this study, surgical correction of the retaining ligaments and plication of the superficial musculoaponeurotic system (SMAS) to reposition the structures that have descended with gravitation are discussed. The anatomy of the facial retaining ligaments was studied in 22 half-faces of 11 fresh cadavers, and the localization, extension, and width of the ligaments were examined macroscopically and histologically. Surgical correction of the retaining ligaments and plication of the SMAS have been accomplished in 27 face-lift patients with this anatomicohistologic study taken into consideration. There was hematoma in one patient at the cheek region and a permanent dimple caused by postoperative edema in two patients, with a localization of one zygomatic and two parotidomasseteric ligaments. In one patient, hypesthesia in the mandibular nerve region was seen, which remitted at 14 weeks. There were no other complications, and with a follow-up of 24 months, excellent aesthetic results and a high level of patient satisfaction were encountered.

A new approach for the treatment of recurrent large abdominal hernias: the overlap flap.

In this article we report a new technique for the treatment of recurrent large abdominal hernias and skin laxity: the overlap flap. This technique combines abdominoplasty with hernia repair. Obese patients with recurrent large abdominal hernias and skin laxity could benefit from this operation. This operation could not be performed in patients with a wide absence of the abdominal wall. A total of six patients were treated with this technique in our clinic. Follow-up of the patients has ranged from 1 to 4 years. Cosmetic results were excellent in all patients. No recurrence of the hernias has been observed in any of the patients. Two flaps are prepared; the lower one is deepithelialized, and it is used as an autogenous mesh in place of a prosthetic material to reinforce the abdominal wall, and the upper flap is prepared and overlapped on this lower one.

Septo-orbitoperiostoplasty for the treatment of palpebral bags: a 10-year experience.

The orbital region is sensitive to the undesirable effects of any surgical intervention, because of its anatomical location and the importance of the eyelids in facial sign language. The procedures performed for correction of baggy eyelids may have remarkable undesired results. In recent years, we have made a special effort to analyze the causes, to minimize these undesirable effects, and to be able to offer patients more natural and safer results. We have designed a new technique called septo-orbitoperiostoplasty for the treatment of baggy eyelids, based on preservation of orbital fat and correction of the supportive layer. This technique consists of placing the orbital fat back into the orbital cavity and its retention by suturing the lax septum to the periosteum of the orbital rim. Neither an incision on the orbital septum nor an excision of the orbital fat is performed. It can be performed for both upper and lower eyelids. This paper describes the surgical procedure and shows the results obtained from 74 patients who had been treated with this technique over a 10-year period. All patients were followed up for an average of 5 years.

A new technique for distal hypospadias repair: advancement of a distally deepithelialized urethrocutaneous flap.

We report on a new modification technique and the latest results of a procedure for treating cases of distal hypospadias with minimal or no chordee called advancement of a distally deepithelialized urethrocutaneous flap. This procedure incorporates correction of chordee, mobilization of the urethrocutaneous flap, and advancement of the flap through a tunnel until it reaches the tip of the glans. A total of 30 children underwent treatment using this procedure in our clinic. Follow-up of the patients ranged from 2 months to 3 years. Cosmetic results were excellent in all the patients. Fistula formation has been observed in only one patient, possibly due to a surgical accident. This technique may only be applied in distal hypospadias patients with minimal or no chordee in whom the meatus is localized to the coronal level or 0.5 cm proximal to it. Patients with a short urethra or in whom the meatus is distally localized but with severe chordee are not candidates for this technique. In general, this technique is not applicable in patients with ventral penile curvature. We would like to emphasize that this repair technique allows for simple and safe dissection of the distal urethra composed of only mucosa without corpus spongiosum around it. This kind of distal urethra can be advanced easily to the tip of the glans penis with the help of the dermal component.

Combined chemical peeling and dermabrasion for deep acne and posttraumatic scars as well as aging face.

The combination of chemical peeling and dermabrasion for the improvement of facial wrinkles, acne, posttraumatic scars, and abnormal pigmentation was first described by Dupont in 1972 and Horton in 1984. We have been using the combined technique since 1972, and we have obtained more satisfying results than by using these techniques independently. The purpose of this paper is to summarize the results obtained using the combined technique of chemical peeling and dermabrasion and to emphasize a simple method of postoperative care that can be applied after any physical or chemical rejuvenation technique. Whereas the combined technique takes advantage of depth-controlled surgery, less bleeding, less postoperative pain, less risk of local and systemic complications, and longer lasting results, the covering of the wound with one layer of fine mesh gauze is another advantage that provides easy postoperative care.

Reconstruction of facial defects with superficial temporal artery island flaps: a donor site with various alternatives.

Color and texture match is crucial in reconstruction of facial tissue defects. Between March of 1997 and July of 2000, island flaps based on the parietal, anterofrontal, centrofrontal, posterofrontal, and superior auricular branches of the superficial temporal artery were used in the reconstruction of tissue defects localized on different regions of the face in 28 patients. According to the size and the location of the defect, the flap was selected. There were 15 male patients and 13 female patients, with ages ranging between 19 and 74 years. In six of the flaps, venous congestion was observed. Because of the elevation of the eyebrow on the flap side, three patients required a sling to the opposite eyebrow. Excellent color and tissue match and transfer of hair-bearing tissue to the eyebrow and beard areas were achieved with no other complications. Satisfactory aesthetic results were gained.

Effect of post-space treatments on the push-out bond strength and failure modes of glass fibre posts.

The aim of this study was to evaluate the effect of different post-space treatments on the push-out bond strength and failure modes of glass fibre posts. Forty mandibular premolar roots were cut and endodontically treated. Post spaces were prepared and roots were divided into four groups. In group 1 distilled water irrigation (control), in group 2 2.25% NaOCl irrigation, in group 3 2.25% NaOCl + 17% EDTA irrigation were done and in group 4 diode laser was applied to the prepared post spaces. Scanning electron microscope (SEM) analysis was made for each group. Fibre posts were then luted with resin cement. Each root was prepared for push-out test. Data were statistically analysed with anova (P = 0.05). After push-out test, the failure modes were observed but not statistically analysed. There were statistically significant differences between Group 3 and Group 2 in both regions (P < 0.05), also in the middle region of Group 4 and Group 2 (P < 0.05). Cervical root segments showed higher bond strengths than middle ones in all groups (P < 0.05). The highest bond strength values were obtained from NaOCl/EDTA and the lowest bond strength values were obtained from NaOCl for both regions.

Ventilatory volumes using mouth-to-mouth, mouth-to-mask, and bag-valve-mask techniques.

The volumes delivered to a resuscitation manikin were compared using four ventilatory techniques: mouth-to-mouth, mouth-to-mask, one-person bag-valve-mask, and two-person bag-valve-mask. The effects of experience and sex of the rescuer on the resuscitation volume delivered were also evaluated. The volume delivered using the one-person bag-valve-mask technique was significantly less than that using the other three techniques (P less than 0.001). The experience and sex of the rescuer made no significant difference in the volume delivered using any of the techniques. As compared with the one-person technique, bag-valve-mask ventilatory volume improved significantly when it was performed as a two-person technique. The mean volumes delivered using mouth-to-mouth and mouth-to-mask ventilation were lower than those recommended by the American Heart Association. Emphasis must be placed on ventilation with an adequate volume when these techniques are taught. When mouth-to-mouth and mouth-to-mask ventilation are taught, a spirometer should be used with the manikin so that the rescuer can learn how to estimate an adequate expired volume.

Unsatisfactory results of periareolar mastopexy with or without augmentation and reduction mammoplasty: enlarged areola with flattened nipple.

A method of repair is described for correction of abnormally enlarged nipple-areola complex following both periareolar mastopexy and pregnancy. Although during periolar mastopexy or reduction mammoplasty regular subcuticular dermal sutures may control the enlargement of nipple-areola complexes initially, the periareolar scar becomes hypertrophic and areolar spreading occurs to some extent. Periareolar mastopexy techniques are indeed advisable only for minimal hypertrophies or ptosis of the breast, especially for areolar asymmetry, if an acceptable, normal-size areola is expected. The authors believe that in periolar mastopexy or reduction mammoplasty cases resulting in enlarged nipple-areola complexes, the size of the areola can also be corrected by reduction mammoplasty or mastopexy using vertical bipedicle techniques. Although surgery results in an inverted T incision, the shape of the breast is more acceptable and the size of the areola does not enlarge with time.

Which dressing for split-thickness skin graft donor sites?

There are a variety of methods used for the postoperative management of the donor site created after harvesting a split-thickness skin graft. The authors compare three major groups of dressings-open, semiopen, and closed-performed on 60 patients divided into three groups. These different dressings were compared based on healing time, quality of the regenerated skin, and patient comfort. Biopsy specimens were obtained from the donor sites of each group for the assessment of healing quality and stage. An ideal donor site dressing method is one that affords protection from dehydration and prevention of wound and infection while also achieving rapid and painless healing of the donor site. The closed-dressing group had the shortest healing time, shown both clinically and histologically, and superior patient comfort was also documented in this group. The closed-dressing group showed qualitatively superior healing when compared with open and semiopen donor sites. This was attributed to protection from dehydration and mechanical trauma, and avoidance of exogenous contamination.