Influence of oval and circular post placement using different resin cements on push-out bond strength and void volume analysed by micro-CT.

AIM: To evaluate the percentage volume of voids within cement layers, to determine the push-out bond strength of circular and oval fibre posts luted with different commercial resin cements in oval cross-sectional root canals, and to correlate push-out bond strength values and volume of voids of circular and oval fibre posts. METHODOLOGY: Seventy-two mandibular premolars with oval-shaped root canals were selected. The specimens were divided into two main groups according to the post type (oval and circular). Groups were further divided into three subgroups (n = 24) according to resin cement type: Maxcem Elite, Rely-X Unicem and Duo-Link. The volumes of voids within the cements were analysed by micro-computed tomography (micro-CT). The bond strength was then measured using a push-out test with an Instron universal testing machine. The failure modes were evaluated. Statistical analyses were performed using a three-way anova, Tukey's post hoc, Pearson's correlation and chi-square test (P = 0.05). RESULTS: The push-out bond strength values were significantly affected by root canal region, post type and cement type (P < 0.001). Root canal region, post type and cement type also significantly affected void volume (P < 0.001). There was a significant interaction between post type and cement type (P < 0.001). The most frequent failure type was adhesive failure in all the groups. There was no significant correlation between the push-out bond strength and void volume (P > 0.05). CONCLUSIONS: Void volume did not affect push-out bond strength of oval and circular posts luted in oval canals.

Recurrent increased nuchal translucency: a first trimester presentation of familial 13p satellite deletion.

Chromosome 13 is one of the acrocentric chromosomes of the human karyotype. Acrocentric chromosomes are the most variable chromosomes in the human karyotype and these variations appear to have no clinical consequences. To the best of our knowledge, this is the first reported case of a first trimester presentation of a 13 short arm satellite deletion with markedly increased nuchal translucency (NT). In this case, the 13p short arm satellite deletion was associated with increased NT in two pregnancies from the same couple.

Apical extrusion of debris using reciprocating files and rotary instrumentation systems.

BACKGROUND: To compare the preparation time and amount of apically extruded debris after the preparation of root canals in extracted human teeth using the reciprocating files and rotary nickel-titanium systems. PROCEDURE: Sixty extracted human mandibular premolars were used. The root canals were instrumented using reciprocating (WaveOne, Reciproc, SafeSider) or rotary motion (Typhoon, ProTaper Universal, Mtwo), and the debris produced was collected in glass vials. The remaining debris was assessed using a microbalance and statistically analyzed using the one-way ANOVA and Duncan multiple range tests at a significance level of P < 0.05. The time required to prepare the canals with different instruments was also recorded. RESULTS: The Reciproc group produced significantly less debris when compared to the Typhoon group (P < 0.05), and instrumentation with the single-file systems was significantly faster than in the multi-file systems (P < 0.05). The WaveOne group extruded significantly more debris per unit of time than the other groups, with the exception of the Typhoon group (P < 0.05). CONCLUSION: According to our study, all systems caused apical debris extrusion. However, the Reciproc group was associated with less debris extrusion when compared to the other groups.

A retrospective analysis of prevalence and characteristics of pre-eruptive intracoronal resorption in unerupted teeth of the permanent dentition: a multicentre study.

AIM: This multicentred study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) in unerupted teeth of the permanent dentition using a large sample of panoramic radiographs of a Turkish population. METHODOLOGY: Records of 28 612 patients from three cities in the different regions of Turkey were screened retrospectively in this multicentred study. Patient records and panoramic radiographs were evaluated by three oral and maxillofacial radiologists in the sites. The following data were recorded: age, gender, number of unerupted teeth, number of teeth showing intracoronal resorption, affected tooth type and number of intracoronal resorptions in each case. RESULTS: Overall, 5554 patients had at least one unerupted tooth in 28 612 patients, with a prevalence of 19.4%. Of the 5554 patients screened, 2267 were female and 3287 were male. Intracoronal resorption was observed in 40 of 5554 subjects, with a frequency of 0.7%. The mean age of the patients was 35.9 years. CONCLUSION: Pre-eruptive intracoronal resorption defects occurred in 40 subjects. Increased awareness and careful radiographic examination of unerupted teeth may improve early detection and treatment of PIR defects.

Fatal pulmonary thromboembolism.

OBJECTIVE: Venous thromboembolism is a complex, multifactorial disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors, such as trauma and surgery. This study investigated the clinical features and most important risk factors of fatal pulmonary thromboembolism (PTE). MATERIALS AND METHODS: Forensic records stored at the Council of Forensic Medicine, Ministry of Justice in Istanbul, Turkey, from January 2010 to December 2014 were screened for deaths of confirmed PTE based on autopsy or computed tomography (CT). Massive pulmonary embolism was the main cause of death in all patients. RESULTS: The 51 cases with PTE comprised 22 (43.2%) males and 29 (56.8%) females. A diagnosis of PTE was established by autopsy in 76.6% (39/51) of the cases. Overall, 23 (45%) suffered multiple trauma and 14 (27.5%) underwent surgery. The mean time from surgery to death was 10.2 ±6.8 days. Of the trauma cases, 78% (18/23) comprised orthopaedic trauma. Death occurred in 74% of the cases after the second week following trauma. Of the trauma and surgery cases, 95.6 and 71.4% were outpatients at the time of death, respectively. The origin of the PTE was known in 34.8% and 57% of the trauma and surgery cases, respectively. The mean Injury Severity Score (ISS) was 11.3 ± 7.6. An abbreviated injury score (AIS) extremity ≥3 was seen in 23% (4/18) of the extremity trauma cases. The time to death of the patients who underwent surgery was shorter than in the patients who experienced trauma (p=0.001). CONCLUSIONS: A high ISS is not a determinant of fatal PTE. Immobilization is important in the occurrence of PTE, especially in trauma patients. Frequent follow-up after discharge should inquire about complaints related to PTE and the use of protective precautions.

Morphology and morphometry of the ulnar head of the pronator teres muscle in relation to median nerve compression at the proximal forearm.

INTRODUCTION: The pronator syndrome is a rare compression neuropathy of the median nerve. Ulnar head of the pronator teres muscle may cause compression at proximal forearm. HYPOTHESIS: Detailed morphologic and morphometric studies on the anatomy of the ulnar head of pronator teres is scarce. MATERIAL AND METHODS: We dissected 112 forearms of fresh cadavers. We evaluated the morphology and morphometry of the ulnar head of pronator teres muscle. RESULTS: The average ulnar head width was 16.3±8.2mm. The median nerve passed anterior to the ulnar head at a distance of 50.4±10.7mm from the interepicondylar line. We classified the morphology of the ulnar head into 5 types. In type 1, the ulnar head was fibromuscular in 60 forearms (53.6%). In type 2, it was muscular in 23 forearms (20.5%). In type 3, it was just a fibrotic band in 18 forearms (16.1%). In type 4, it was absent in 9 forearms (8%). In type 5, the ulnar head had two arches in 2 forearms (1.8%). In 80 forearms (71.5%: types 1, 3, and 5), the ulnar head was either fibromuscular or a fibrotic band. DISCUSSION: Although the pronator syndrome is a rare compression syndrome, the ulnar head of pronator teres is reported as the major cause of entrapment in the majority of the cases. The location of the compression of the median nerve in relation to the ulnar head of pronator teres muscle and the morphology of the ulnar head is important for open or minimally-invasive surgical treatment. TYPE OF STUDY: Sectional study. LEVEL OF EVIDENCE: Basic science study.

Expression analysis and clinical correlation of aquaporin 1 and 4 genes in human hippocampal sclerosis.

Mesial temporal sclerosis (MTS) is the most frequent cause of drug resistant symptomatic partial epilepsy. The mechanism and genetic background of this unique pathology are not well understood. Aquaporins (AQP) are regulators of water homeostasis in the brain and are expressed in the human hippocampus. We explored the role of AQP genes in the pathogenetic mechanisms of MTS through an evaluation of gene expression in surgically removed human brain tissue. We analyzed AQP1 and 4 mRNA levels by quantitative real-time polymerase chain reaction and normalized to ABL and cyclophilin genes, followed by immunohistochemistry for AQP4. Relative expressions were calculated according to the delta Ct method and the results were compared using the Mann-Whitney U test. Brain specimens of 23 patients with epilepsy who had undergone surgery for MTS and seven control autopsy specimens were investigated. Clinical findings were concordant with previous studies and 61% of the patients were seizure-free in the postoperative period. AQP1 and 4 gene expression levels did not differ between MTS patients and control groups. Immunofluorescence analysis of AQP4 supported the expression results, showing no difference. Previous studies have reported contradictory results about the expression levels of AQP in MTS. To our knowledge, only one study has suggested upregulation whereas the other indicated downregulation of perivascular AQP4. Our study did not support these findings and may rule out the involvement of AQP in human MTS.

A reminder of the anatomy of the recurrent artery of heubner.

Previous accounts of the recurrent artery of Heubner show serious inconsistencies concerning the origins, dimensions and numbers of the artery. In the present study, based on 54 (38 male, 16 female) human autopsy brains the common type of the recurrent artery of Heubner was present bilaterally in 46 cases (85.2%), while in 6 (11.1%) cases it was present only on one side (4 on the right, 2 on the left). Unilateral vessels were seen only in the male autopsy brains. The recurrent artery of Heubner could not be identified in 2 brains (3.7%). Multiple Heubner arteries were not observed in the present study. No gender differences were observed regarding the origin and dimensions of the recurrent artery of Heubner. 76 recurrent arteries of Heubner arising from the junction of the anterior cerebral artery (ACA) and anterior communicating artery (ACoA) (79.2%) had a mean diameter of 0.66+/-0.11 mm. In 14 arteries the artery derived from the A2 segment of the ACA (14.6%) and the mean diameter was 0.66+/-0.17 mm; in 6 arteries it originated from the A1 segment of the ACA (6.2%) and the mean diameter was 0.47+/-0.15 mm. The average diameter was calculated as 0.67+/-0.12 mm and ranged between 0.40 and 0.90 mm, irrespective of sex or side. A detailed anatomical knowledge of the recurrent artery of Heubner is important when considering vascular surgery in this area.

Morphometric measurements of the caudal cranial nerves in the petroclival region.

OBJECTIVE: The dural zone of entry or exit of the caudal cranial nerves in the petroclival region does not have a constant localization. The present study aimed to measure the clival length, the distances between cranial nerve dural openings and the distance of cranial nerves from the mid-clival line in 30 human autopsy cases. MATERIAL AND METHODS: Thirty autopsy specimens (8 female, 22 male) from persons aged between 20-76 years (mean age 38.9 years) were studied. Autopsies with intracranial lesions were not included in the study. RESULTS: The average distances between the right and left dural openings of caudal cranial nerves in the petroclival region were as follows (mean+/-sd): trigeminal, 32.17+/-5.41 mm; abducent, 20.04+/-3.23 mm; facial and vestibulocochlear, 50.97+/-5.86 mm; glossopharyngeal, vagus, accessory, 41.59+/-6.46 mm and hypoglossal 26.8+/-4.33 mm. The measurements of the distances of the cranial nerve exits to the mid-clival line showed considerable asymmetries for the left and right trigeminal nerves. Furthermore, the distances between the trigeminal and the abducent nerves on the right and left differed significantly (p<0.029). The average distance between these two cranial nerves on the left was 8.44+/-3.66 mm and on the right was 7.31+/-2.41 mm. In addition, the average clival length was 56.96+/-5.91 mm (range: 42-71 mm). CONCLUSIONS: Most of the surgical procedures performed in this area are to remove tumors which significantly modify the local anatomy. Knowledge of morphometric variations can increase the success of cranial nerve preservation during surgical procedures of the posterior cranial fossa.

The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery.

The carotico-clinoid foramen is the result of ossification either of the carotico-clinoid ligament or of a dural fold extending between the anterior and middle clinoid processes of the sphenoid bone. It is anatomically important due to its relations with the cavernous sinus and its content, sphenoid sinus and pituitary gland. In this study the ossification state of the carotico-clinoid ligament, the diameter of the internal carotid artery and the carotico-clinoid foramen has been studied on 50 autopsy cases. Of the 100 carotico-clinoid foramina examined, in 27 sides (15 right, 12 left) the carotico-clinoid ligament was completely ossified, in 18 sides (9 right, 9 left) the carotico-clinoid ligament was incompletely ossified and in 55 sides (26 right, 29 left) it was a ligamentous structure. The correlation of the dimensions of the carotico-clinoid foramen and the internal carotid artery showed no statistical significance, except between the carotico-clinoid foramen with a fibrous carotico-clinoid ligament and the internal carotid artery on the right side (p=0.007, r=0.51). The existence of a bony carotico-clinoid foramen may cause compression, tightening or stretching of the internal carotid artery. Further, removing the anterior clinoid process is an important step in regional surgery; the presence of a bony carotico-clinoid foramen may have high risk. Therefore, detailed knowledge of the type of ossification between the anterior and middle clinoid processes can be necessary to increase the success of regional surgery.

Navigation for ankle arthroscopy: anatomical study of the anterolateral portal with reference to the superficial peroneal nerve.

We aimed to navigate the surgeon regarding the localization of the main anatomical structures at the anterior part of the ankle joint, in order to find easily the safest anatomical points with reference to the superficial peroneal nerve (SPN), in particular for anterolateral portal placement in ankle arthroscopy. Sixty-three ankles in 36 fresh cadavers were dissected. In all specimens we examined (1) the distance between the SPN bifurcation and the most distal point of the lateral malleolus; and at the level of ankle joint, (2) the number of SPN, (3) the distance between the medial and intermediate dorsal cutaneous nerves, which are branches of the SPN, (4) the localization of the peroneus tertius (PT) tendon in relation to the lateral malleolus, (5) the width of the extensor digitorum longus (EDL) tendon, (6) the relationship of the PT tendon and (7) the relationship of the extensor hallucis longus (EHL) tendon with the SPN. The results were as follows: (1) In 41 ankles with bifurcation (65%) the average distance was 71.8+/-35.3 mm. (2) There were two SPN branches in 39 (62%), three branches in seven (11%) and one branch in 17 (27%) cases. (3) In 39 ankles with two branches of the SPN, the mean distance was 15.2+/-7.1 mm. (4) The lateral border of the PT tendon was positioned a mean distance of 20.8+/-3.3 mm proximal and 25.2+/-5.8 mm medial to the reference points. (5) The mean width was 10.1+/-2.9 mm. (6) In 42 ankles (67%) the distance between the lateral border of the PT tendon and the SPN was a mean of 6.2+/-6.6 mm, median of 3 mm (range 0-22 mm lateral to the tendon). (7) In 56 cases (89%) a branch of the SPN was found a mean of 6.6+/-4 mm and a median of 6 mm lateral to the EHL tendon, and in seven cases (11%) on the tendon. According to our study, in ankle arthroscopy the risk of the SPN injury is maximal in the 0-3 mm lateral to the PT tendon. To avoid injury to the SPN, the safest placement of the anterolateral portal is 4 mm lateral to the PT tendon.