Prosthetic and Surgical Reconstruction of the Atrophic Anterior Maxilla with Iliac Bone Grafting and Malo Bridge Design: A Case Report.

Alveolar bone loss subsequent to long-term edentulism and trauma may be severe and treatment plan is always an esthetic and functional challenge. Implant supported hybrid prosthesis is widely regarded as an effective treatment option for patients with excessive and irregular bone loss. However, implant placement is occasionally impossible without surgical procedures in such cases. This case report presents rehabilitation of 19-year-old maxillary anterior edentulous male patient with maxillary anterior bone defect and excessive cross-bite anterior closure with multidisciplinary approach. The patient was rehabilitated with implant supported hybrid prosthesis with Malo Bridge design following autogeneous iliac bone augmentation, teeth leveling with orthodontic treatment, and surgical placement of three implants. Esthetics, pleasing phonetics and function were achieved as desired with this treatment option and no complications were observed.

Incidence of aplastic anemia in Turkey: a hospital-based prospective multicentre study.

The incidence of aplastic anemia among hospitalized adult patients was prospectively determined in this first study in Turkey. New cases of aplastic anemia among patients 14 years and older who were admitted to the study centers were included in a 3 year survey. Seventy-three patients fulfilled the diagnostic criteria, yielding a mean annual incidence rate of 1.14 cases in 10(3) admissions. The male-to-female ratio of the cases (1.6:1) differed from the almost equal ratio of the larger population of Turkey. The median age was 30 years and females were younger at diagnosis. The age distribution of the cases was different from that of the population; showing two incidence peaks in both sexes. The majority of the patients (89%) had severe disease.

Bone marrow necrosis in antiphospholipid syndrome.

Bone marrow necrosis (BMN) is a relatively rare entity and has been associated with a poor prognosis. It is most commonly found in patients with neoplastic disorders, severe infections and sickle cell anemia. An unusual case of antiphospholipid syndrome (APS) with extensive bone marrow necrosis is described in a 27 year old woman. The patient presented with severe pancytopenia, some cognitive impairment resulting from a previous cerebrovascular accident, fever, hypertension, dyspnoea, tachycardia, hepatosplenomegaly, and vaginal bleeding. Her laboratory findings included a strongly positive Coombs' test (anti-IgG and anti-C3d), a prothrombin time of 23 seconds and an activated partial thromboplastin time of 45 seconds. Anticardiolipin antibody tests were positive. Antinuclear and anti-DNA antibodies were negative but the anti-SM test was positive. A bone marrow biopsy specimen was reported as showing extensive necrosis. The patient was treated with steroids, transfusion, and plasma exchange with some clinical improvement but her pancytopenia did not respond and necessitated frequent transfusions. This case lends further support to the association between APS and BMN.

Pernicious anemia in Turkey.

Pernicious anemia patients who were diagnosed during a 5-year period in Cukurova University Hospital, Adana, Turkey were reviewed. Of approximately 200 new patients per year accepted by the Hematology Unit 44 were diagnosed as having pernicious anemia. There were 30 males and 14 females. The mean age for men was 49.14 +/- 18.11 and that for women was 40.00 +/- 14.05. Both values and the mean age overall were lower than the reported mean age for Whites, Blacks and Latin Americans living in the United States.

Spectral pulsed Doppler sonography of renal vascular resistance in sickle cell disease: clinical implications.

The major complications in sickle cell disease (SCD) are microcirculation lesions and impairment of renal function. The aim of this study was the evaluation of renal vascular resistance by means of spectral pulsed Doppler sonography and its relationships with haematological and clinical features in patients with SCD. 40 patients with SCD (mean age 22.4 +/- 7.0) and 14 age and sex matched healthy subjects (mean age 25.7 +/- 9.5) were included into the study. Spectral Doppler sonography of main renal, segmental and interlobar arteries were performed on both kidneys in all patients and controls. Peak systolic, end diastolic and mean velocities through the entire cardiac cycle were obtained, with calculation of the resistive (RI) and pulsatility (PI) indices. All the patients were investigated in stable state conditions and had not been transfused within a month before investigation. Patients were followed for up to 6 months. Patients with SCD had higher values of RIs and PIs than control subjects (p < 0.0001, p < 0.0001, respectively). Patients with high value of RIs (RI > 0.70) had more pronounced disturbances of blood parameters (all p < 0.05), than patients with normal RIs (RI < 0.70). Significant positive correlation existed between RIs and ISC number, MCHC level (r = 0.52, p < 0.001 and r = 0.42, p < 0.01), while RBC count and Hb level correlated inversely with RIs (r = -0.39, p < 0.01 and r = -0.42, p < 0.01). During follow-up, nine patients (33.3%) with high RIs and only one patient (5.5%) with normal RI developed painful crises. In conclusion, renal vascular resistance, assessed by Doppler sonography was raised in SCD patients as compared with age matched apparently healthy persons. These changes were more pronounced in those with more severe manifestations of disease and correlated with haematological and clinical features of sickle cell disease.

The effect of carbimazole following radioiodine therapy on radiation dose to the thyroid.

Radioiodine in the thyroid gland after a therapy dose of 131I was measured serially in 7 patients without Carbimazole, and in 11 patients starting Carbimazole 60 mg daily fourteen days after the therapy dose. Effective half-life for radioiodine in the gland initially 5.53 plus or minus 1.08 days fell to 4.26 plus or minus 1.12 days (p less than 0.01) during Carbimazole, and returned to 5.83 plus or minus 1.21 days (NS) after stopping the drug. The radiation dose to the thyroid from a given therapy dose of 131I followed by Carbimazole was calculated to be 97% of that without Carbimazole when he drug was started after 14 days, and 90% and 75% when the drug was started after 7 days and 1 day respectively.

Two cases of organophosphate poisoning with development of intermediate syndrome.

Two cases of intermediate syndrome caused by organophosphorus poisoning are reported. Trichlorfon, propoxur (a carbamate pesticide) and fenthion were ingested in both attempts at suicide. After successful conventional therapy during the cholinergic phase, but before the time when the onset of delayed neuropathy might be expected, an intermediate syndrome developed. It affected the proximal limb muscles, neck flexors and respiratory muscles 2 d after pesticide ingestion. The two patients needed respiratory support. Recovery from the intermediate syndrome was complete in both patients, although one subsequently developed delayed neuropathy.

Lead poisoning from contaminated flour in a family of 11 members.

Eleven members of a family living in southeastern Turkey are presented. They were diagnosed as suffering from 'lead poisoning' with typical clinical manifestations and high blood lead concentrations. Contaminated flour (665 micrograms Pb/g) was the cause of poisoning, by oral ingestion. The source of contamination was sought and it was found that the stone of the mill had been repaired with molten lead on the same day that the wheat of the family had been ground; while grinding the wheat some lead was mixed into the flour.

The frequency of anaemia, iron deficiency, hemoglobin S and beta thalassemia in the south of Turkey.

A survey on the prevalence of anemia, iron deficiency, and hemoglobinopathies (Hb S and beta thalassemia) was carried out in an ethnically mixed and carefully registered population of 45,000 living in an area in the Southern Turkey. A total of 1223 subjects (representing the population with respect to sex and age group) were surveyed. The rate of anemia was found to be 16.9% overall with a highest prevalence of 18.3% in the children (0-2 ages) and 16.3% in the 14+ age group. The prevalence of iron deficiency using low transferrin saturation as criteria was found to be 17.2% overall, being 48.0% in the infant group, 19.6% in the children, and 14.7% in the 14+ age group. The rate of Hb S using the sickling test was found to be 3.9% in the entire population without separating for ethnic groups. It was more prevalent (9.6%) in the Arabic speaking and not found at all in the Kurdish speaking people. The rate of beta thalassemia with a high HbA2 was 3.4% overall and highest (7.1%) in the Kurdish speaking people.

Bencyclane as an anti-sickling agent.

A vasodilating Ca2+ channel blocker, bencyclane, was used in 18 patients with homozygous sickle cell anaemia (SCD) to test the possible anti-sickling effect. With bencyclane intervention the Na(+)-K+ ATPase activity increased from 256 +/- 29 to 331 +/- 37 nmol Pi/mg protein/h (P < 0.0001) and the Ca(2+)-Mg2+ ATPase level increased from 172 +/- 12 to 222 +/- 44 nmol Pi/mg protein/h (P < 0.0001). The intracytoplasmic Ca2+ concentration reduced from 3.5 +/- 0.6 to 2.7 +/- 0.25 mumol/l (P < 0.0001). The patient's blood contained fewer irreversibly sickled cells (ISCs) (a reduction from 21.4% to 14.4%) (P < 0.05). At the same time MCHC of the erythrocytes decreased from 34.5 to 33.0 g/dl (P < 0.05). Bencyclane appears to be a promising anti-sickling agent that can be used orally in SCD.

Poisoning due to amatoxin-containing Lepiota species.

Twenty-seven consecutive mushroom poisoning cases were followed up over a period of 14 days. Fourteen out of 27 died of liver failure. There were no deaths from renal failure. The mushrooms were identified as the amatoxin-containing Lepiota species. Therapeutic measures included nasogastric lavage, charcoal, vitamin C, vitamin B, penicillin G, corticosteroids, oral streptomycin and, in the case of a few patients, limited amounts of thioctic acid. Of the ten haemodialysed, nine died. Unfortunately charcoal haemoperfusion was not available. It appeared that therapeutic measures were ineffective and it also seemed that the amount of mushroom ingested was the determining factor for the prognosis. An important point to make is that renal failure does not occur and liver failure is always delayed (group II). For this reason all suspected cases of mushroom poisoning, regardless of absence of clinical signs and symptoms, must be hospitalised for a period of at least one week. The poisonous properties of wild mushrooms have been recognized since ancient times. However, despite awareness of their inherent dangers, serious poisoning continues to occur. Fatal intoxications can be attributed almost entirely to the amtoxin-containing species. Amanita phalloides have been blamed for over 90% of poisoning deaths in North America. There are reports of intoxications of other amatoxin-containing species in Europe, but fatalities due to Lepiota species are reported only rarely. It was previously acknowledged that the interval between ingestion of mushrooms and the onset of symptoms is longer than expected in serious poisonings.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of infiltrating lipomatosis with diffuse, symmetrical distribution.

Infiltrating lipomatosis represents a distinct clinicopathological entity characterised by collections of non-encapsulated, mature lipocytes that infiltrate local tissues. The lesions are usually first observed during the first three decades of life, but congenital types exist. Although a predilection for the lower extremity exists in approximately 80% of patients, they can affect a multitude of anatomic sites. Infiltrating lipomatosis of the face, head and neck, upper and lower extremities, trunk and abdominal cavity and pelvis have all been reported. The patient presented here had symmetrical, diffuse infiltrating lipomatosis involving almost the whole body, sparing only the head, neck, fingers and toes.