Does Unilateral Cleft Lip and Palate Affect the Maxillary Sinus Volume?

OBJECTIVE: The purposes of this study were to evaluate and compare the maxillary sinus volume (MSV) of patients with a unilateral cleft lip and palate (UCLP) between the cleft side and noncleft side and between adolescent patients with UCLP and a control (noncleft) group using cone beam computed tomography (CBCT). METHODS: CBCT images of 44 UCLP patients (29 males and 15 females, with a mean [SD] age of 13.5 [5.0] years) and 44 (22 males and 22 females, with a mean [SD] age 14.9 [4.2] years) age- and sex-matched controls were evaluated in this study. Each maxillary sinus was assessed 3-dimensionally, segmented, and its volume was calculated. RESULTS: There were no statistically significant differences between the age and gender distributions of the groups. There was a statistically significant difference in the MSVs of the cleft (10996.78±3522.89 mm3) versus the noncleft side (10382.3±3416.2 mm3; P < .05)] but no significant difference between the MSVs of the right and left sides ( P > .05). In the intergroup comparison, the mean MSVs of the UCLP patients (10701.52±3369.33 mm3) were significantly smaller than those of the control group (16054.08 ± 5293.96 mm3; P < .001). CONCLUSIONS: The MSVs of the UCLP patients showed a statistically significant decrease compared to those of the controls ( P < .001). There was also a significant difference in the MSVs of the cleft and noncleft sides of the UCLP patients ( P < .05).

Evaluation of overactive bladder and nocturia as a risk factor for hip fracture in climacteric women: a matched pair case control study.

The aim of this study was to investigate whether overactive bladder (OAB) influences hip fractures in climacteric women by comparing the frequency of OAB and nocturia symptoms in patients with hip fractures and their age-matched controls in pre-fracture period. A total of 30 climacteric patients with a history of hip fracture were compared to a control group of 51 women in terms of OAB, nocturia and nocturia-QoL. A questionnaire composed of structured questions and Turkish validated versions of the specific questionnaires for OAB, OAB-Quality of Life (OAB-q) and nocturia-QoL was directed to the two groups. We did not detect statistically relevant differences between the groups for the presence or severity of OAB and OAB-q (p > .05). However, Nocturia-QoL was worse in the group with hip fracture (p = .022). Overactive bladder has no contribution to the overall risk of hip fracture, whereas, the severity of nocturia seems to play a role as a risk factor in the formation of hip fracture. Impact statement What is already known on this subject: Hip fracture is associated with high morbidity, mortality and the cost. Prevention of hip fracture is a high priority for the patients, physicians and the public health. Several studies and consensus opinions have investigated the risk factors for the hip fractures. What the results of this study add: Although urinary symptoms were not evaluated in previous studies as a risk factor, desire of urination makes people stand up and move to their toilet, and may put them in a hurry if it is sudden and uncontrollable one. Therefore, we hypothesised that overactive bladder (OAB) and nocturia may be a risk factor in the formation of hip fractures. Our study showed that Nocturia Quality of Life is worse in patients with the hip fracture. Therefore, overactive bladder may not have a role on the overall risk of hip fracture, but the severity of nocturia seems as a risk factor in the fracture process. What the implications are of these findings for clinical practice and/or further research: The getting up from the bed would probably be harder than getting up from a chair in elderly, and life style modifications such as illumination bedroom and organisation of living place may be helpful to minimise the risks.

Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions.

OBJECTIVE: To assess the learning curve for total laparoscopic hysterectomy. METHODS: This study was a retrospective analysis of the learning curve for two surgeons during their first 257 consecutive cases of total laparoscopic hysterectomy at a teaching hospital. Patients were divided sequentially into groups comprising the first 75 patients, the next 75, and the final 107 patients. Age, body mass index, gestational parity, indications for laparoscopic hysterectomy, previous pelvic surgery, operating time, haemoglobin decline, complications, need for transfusion, and length of hospital stay were evaluated. RESULTS: The mean operating time for total laparoscopic hysterectomy reduced significantly from 76.2 min to 68.9 min (p = 0.001) between the first and second 75-patient groups. Linear regression analysis showed a plateau was reached on the learning curve after 71-80 cases. The rate of all complications started at 8% in the first group of 75 patients, reduced to 6.7% in the next group, and decreased further in the final group to 4.7%. The decline was not statistically significant (p = 0.6). The difference in the need for transfusion was statistically significant between the first 75 patients and the second group of 75 (p = 0.04). Conversion from laparoscopy to laparotomy was required in five patients, four in the early group and one in the final group. Age, body mass index, parity, previous pelvic surgery, decline in haemoglobin, and length of hospital stay were similar among the three groups. CONCLUSIONS: A plateau in the learning curve for TLH was reached after the first 75 cases. We can infer that there is a learning curve for TLH as confirmed by the decrease in operating time (accompanied by no change in complications) correlated to gain in experience. On the other hand, one should not disregard the fact that laparoscopy is not a complication-free surgery and achievement of the learning curve does not exclude complications. Gynaecological surgeons can perform TLH securely during the learning curve.

A comparison of the use of cone-beam computed tomography and panoramic radiography in the assessment of pre-eruptive intracoronal resorption.

OBJECTIVE: This study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) using cone beam computed tomography (CBCT) and panoramic radiography and to compare the findings of these imaging techniques. METHODS: This retrospective study consisted of 733 patients who had at least one unerupted tooth and had undergoneimaging with both three-dimensional (3D) CBCT and two-dimensional (2D) panoramic radiography. In all the images, the number of teeth with intracoronal resorption, affected tooth type and number, and size and location of the PIR defects were recorded. The McNemar test was used to compare the prevalence of PIR in the CBCT and panoramic images. RESULTS: Fewer PIR defects were detected in the panoramic images (3.1% of the patients) than in the CBCT images (9.5% of the patients) (p< .001). According to the CBCT images, the distribution of PIR defects was as follows: third molars (59.5%), canine teeth (11.4%), second molars and premolars (7.6% for both), supernumerary teeth (5.1%), second molars (3.8%), central incisors (2.5%), and first premolar and primary second molar teeth (1.5% for both). According to the scoring classification system for PIR defects, PIR 1 defects were the most common (65.8%), followed by PIR 3 (24.1%) and PIR 2 (10.1%). Of these defects, 69.6% were located in the central aspect of the crown. Ectopically positioned teeth showing intracoronal resorption accounted for 51.9% of the cases of PIR. CONCLUSIONS: CBCT detected more cases of PIR than panoramic radiography. The mandibular third permanent molar was the most commonly affected tooth.

Evaluation of pre-eruptive intracoronal resorption on cone-beam computed tomography: A retrospective study.

OBJECTIVES: This retrospective study aimed to investigate the prevalence of pre-eruptive intracoronal resorption (PIR) in unerupted permanent teeth in a Turkish population using cone beam computed tomography (CBCT). METHOD: A total of 1,317 CBCT images were screened. In all the images, the following were recorded: the number of unerupted teeth, number of teeth with intracoronal resorption, affected tooth type and number, and location of radiolucent defects. Demographic data were also obtained. RESULTS: The prevalence of intracoronal resorption in the study group was 15.1%, with a prevalence in teeth of 3.5%. The prevalence of intracoronal resorption using CBCT was much higher than that recorded previously using panoramic or bitewing radiographs intracoronal resorption was more common in males (57%) than females (43%). Twenty-three cases were located in the maxilla (48%), and 25 were located in the mandible (52%). The mandibular third molar was the most affected tooth type, followed by maxillary third molars and supernumerary teeth. CONCLUSION: CBCT can be useful for diagnosing PIR defects because it provides an accurate representation of internal dental anatomy. SCANNING 38:442-447, 2016. © 2016 Wiley Periodicals, Inc.

Vitamin D deficiency in pregnancy is not associated with diabetes mellitus development in pregnant women at low risk for gestational diabetes.

OBJECTIVE: We aimed to investigate the effect of vitamin D deficiency as a risk factor for the development of gestational diabetes mellitus (GDM) among pregnant women without known risk factors. MATERIALS AND METHODS: The study was conducted on pregnant women who had been under regular follow-up and had low risk for GDM development. The patients were divided into two groups according to the presence of GDM; GDM and no GDM (control) group. Body mass index (BMI), sociodemographic data including level of education and nutritional habits were recorded. Serum 25 (OH) vitamin D3 levels, hemoglobin, hematocrit, and mean corpuscular volume (MCV) values were measured. An oral glucose tolerance test was performed, between 24 and 28 weeks of pregnancy. RESULTS: GDM ratio was calculated as 4.6%. The false positive rate of 50 g oral glucose load screening test was found to be 16.5%. The BMI levels of women diagnosed as having GDM and those with no GDM group at the beginningof the pregnancy period were calculated as 24.3±2.6 and 22.8±1.6 kg/m2 respectively, exhibiting a statistically significant difference between the two groups (p=0.001). Hemoglobin, hematocrit, and MCV values did not show a statistically significant difference between the two groups (p>0.05). The levels of 25 (OH) vitamin D3 of the study groups were found comparable in both groups (p=0.13). CONCLUSION: Plasma levels of vitamin D may not be a contributing factor for the development of GDM in women with a low risk for GDM.

A rare and unexpected case of retained foetal bone after an unsafe abortion.

Unsafe abortion is one of the most neglected healthcare problems in developing countries. One of the rare complications of unsafe abortion is retained foetal bone. Prevalence of disease is around 0.15% among patients undergoing diagnostic hysteroscopy. Patients have no specific symptoms. Case reports have focused on subfertility, abnormal uterine bleeding, lower abdominal pain, abnormal vaginal discharge, dyspareunia, dysmenorrhoea and spontaneous passage of bony fragments. Retained foetal bone fragments may cause acute pelvic inflammatory disease in rare cases regardless of the time interval after abortion. This condition can also present as recurrent vagitinis or endometritis refractory to ampirical antimicrobial treatment. In such cases, foreign body in uterine cavity should be kept in mind. Such patients should primarily be evaluated by ultrasonography which has substantial clinical importance in differential diagnosis of these cases. We present a case of misdiagnosed retained foetal bone complicated with recurrent vaginal discharge and acute pelvic inflammatory disease.

Evaluation of hearing and cochlear function by audiometric testing in patients with hyperemesis gravidarum.

INTRODUCTION: The aim of this study was to investigate cochlear functions in patients with hyperemesis gravidarum (HG). METHODS: Twenty-nine HG patients (58 ears) and 31 healthy control subjects (62 ears) were included. Audiometry testings at 250 and 500 Hz and 1, 2, 4, 8, 10, 12, 14, 16 kHz were performed to the patients and controls. RESULTS: Mean age of patients with HG was 26,5 ± 4,4 years and the mean age of control group was 28,0 ± 4,2 years. At the time of the tests mean gestational age of the HG group and controls were 9 and 11 weeks respectively. No differences were observed between the groups in tympanic membrane status, or other otolaringological evaluations. No significant differences were observed in audiometric tests at any frequencies between the groups (p values for all > 0.05). CONCLUSION: There was not a difference between pregnant cases with HG and cases with normal pregnancy in terms of audimetric tests. Cochlear functions are not affected remarkably in women with HG.

Relationships among the metabolic syndrome, bone mineral density, bone turnover markers, and hyperglycemia.

BACKGROUND: This study investigated the possible effects of metabolic syndrome on bone mineral density (BMD) and bone turnover markers in Turkish postmenopausal women. METHOD: This prospective case-control study included a total of 230 postmenopausal women, between 45 and 65 years old, including 63 with metabolic syndrome and 167 without metabolic syndrome on the basis of the International Diabetes Federation criteria. The height, weight, body mass index (BMI), waist circumference, hip circumference, and waist-to-hip ratio of each subject were measured. Fasting and nonfasting blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), parathyroid hormone (PTH), thyroid-stimulating hormone (TSH), calcium, phosphorus, glycated hemoglobin (HbA1c), bone-specific alkaline phosphatase (ALP), 25-hydroxyvitamin D3 [25(OH) D], osteocalcin, and the ß-isomerized form carboxy-terminal telopeptide of type I collagen (ß-CTx) were measured. Bone mineral densities in the lumbar spine and femoral neck were measured by dual energy X-ray absorptiometry. RESULTS: The mean age was 58.49±5.7 years in metabolic syndrome patients and 56.13±5.0 years in patients without metabolic syndrome. There was a statistically significant difference in the age of the patients. The mean BMI was 33.96±5.3 and 30.867±3.8 kg/m(2) in metabolic syndrome patients and patients without metabolic syndrome, respectively, indicating a statistically significant difference. Serum calcium, osteocalcin, and ß-CTx were statistically significantly lower in metabolic syndrome patients. There was no significant difference in the levels of phosphorus, 25-hydroxyvitamin D3, and bone-specific ALP, TSH, and PTH among the patients with metabolic syndrome and without metabolic syndrome. The statistical analysis, after adjusting for age and BMI, revealed no significant difference between the two groups in terms of lumbar and femoral BMD. When the patients in the metabolic syndrome group were split into two groups on the basis of those with a T score -2.5 or less and those with a normal score, a statistically significant difference was identified between the two groups in terms of the fasting blood glucose (FBG) and HbA1c values (P<0.05). Furthermore, a negative correlation was identified between the lumbar T score and the FBG and HbA1c values (P<0.05). CONCLUSION: After adjusting for age and BMI in a comparison of BMD between postmenopausal women with and without metabolic syndrome, it was revealed that metabolic syndrome has no positive or negative effect on BMD. In contrast, a negative correlation was identified between FBG and HbA1c levels and lumbar BMD, suggesting that poor glycemic control may have a negative effect on lumbar BMD in this group of patients.

The value of uterine artery Doppler and NT-proBNP levels in the second trimester to predict preeclampsia.

OBJECTIVE: To determine the maternal serum N-Terminal proBNP levels in predicting development of preeclampsia. METHOD: Sixty-eight patients were included in the study. The study group consisted of patients with the finding of diastolic notch with abnormal pulsatility index (PI) between 21-24 weeks gestation and the control group consisted of patients without diastolic notch and normal PI. The study included high-risk patients who did not have a history of hypertensive disorder before pregnancy, heart failure, recurrent pregnancy loss, autoimmune disorder or diabetes. The groups were compared in terms of NT-ProBNP levels, development of preeclampsia, obstetric and neonatal problems. RESULTS: There was no significant difference between groups in terms of age, gravidity, parity, uric acid levels, and NT-proBNP levels. There was significant difference between the groups in terms of week of birth, rate of cesarean section and fetal weight. Furthermore, there were significant differences between the two groups when compared in terms of obstetric and neonatal problems (p < 0.05). Obstetric and neonatal problems were more common in the notch with abnormal (PI) group. The NT-pro BNP levels were found to be comparable among groups. Preeclampsia was the most common obstetric problem (11.7%). We were unable to document significant difference in patients who developed preeclampsia. CONCLUSION: Bilateral notch together with abnormal PI measurements in the uterine artery Doppler screening during the second trimester was associated with poor perinatal outcomes. Such an association was not significant in the NT-proBNP measurements. Larger trials focused on late-onset preeclampsia are needed to draw definitive conclusions.

Rudimentary horn pregnancy in the first trimester; importance of ultrasound and clinical suspicion in early diagnosis: A case report.

We aimed to present 7-8 weeks rudimentary horn pregnancy detected preoperatively. A 37-year-old woman, gravida 3, para 2, at 7-8 weeks' gestation referred to our clinic with a complaint of abdominal pain. The patient was primarily infertile, and she had unicornuate uterus detected during infertility investigation. Due to abnormal ultrasonographic image, rudimentary horn pregnancy was considered. Accurate diagnosis was made by laparoscopy, and rudimentary horn excision was performed. Prerupture diagnosis is very difficult in rudimentary horn pregnancies. The key role in preoperative diagnosis is suspicion. Ultrasonographic examination and clinical suspicion are sufficient in most cases.

Radiation-modifying abilities of Nigella sativa and thymoquinone on radiation-induced nitrosative stress in the brain tissue.

To investigate Nigella sativa oil (NSO) and Thymoquinone (TQ) for their antioxidant effects on the brain tissue of rats exposed to ionizing radiation. Fifty-four male albino Wistar rats, divided into six groups, were designed as group I (normal control group) did not receive NSO, TQ or irradiation; group II (control group of TQ) received dimethyl sulfoxide and sham irradiation; group III (control group of NSO) received saline and sham irradiation; group IV (irradiation plus NSO group) received both 5 Gray of gamma irradiation to total cranium and NSO; group V (irradiation plus TQ group) received both irradiation and TQ; group VI (irradiation alone group) received irradiation plus saline. Alterations in nitric oxide (NO·) and peroxynitrite (ONOO(-)) levels, and nitric oxide synthase (NOS) enzyme activity were measured by biochemical methods in homogenized brain tissue of rats. Levels of NO· and ONOO(-), and enzyme activity of NOS in brain tissue of the rats treated with NSO or TQ were found to be lower than in received IR alone (p<0.002) Nigella sativa oil (NSO) and its active component, TQ, clearly protect brain tissue from radiation-induced nitrosative stress.

Acute pelvic pain: evaluation of 503 cases.

AIM: The aim of this study was to investigate the etiology according to the age groups (adolescent, reproductive, and perimenopausal / menopausal periods) of women who were admitted with complaints of acute pelvic pain (APP). MATERIALS AND METHODS: Data from 503 patients diagnosed with APP were evaluated retrospectively. The patients were divided into three groups according to their ages. The adolescent group consisted of patients who were 19 years of age and under (Group A), the reproductive age group consisted of patients who were between the ages of 20 and 44 years (Group B), and the perimenopausal / menopausal group consisted of patients who were at the age of 45 and above (Group C). The most common causes of APP among the three groups were investigated. RESULTS: The mean age was 29.9 ± 6.01 years. Gynecologic factors were present in 469 cases, APP was nongynecologic in nature in 24 cases, while the cause was unknown in 10 cases. The patients were evaluated in terms of APP duration, accompanying symptoms, and pain localization. There were 36 cases in the adolescent group, 361 cases in the reproductive age group, and 72 cases in the perimenopausal / menopausal group. Adnexal pathologies were the most commonly observed APP factor in all three groups. CONCLUSION: APP was most commonly observed in the reproductive period, and adnexal pathologies and infections were etiologically prominent. Early and accurate diagnosis of APP will often enable more effective and conservative treatment methods for life-threatening pathologies.

A clinico-pathological evaluation of 194 patients with ovarian teratoma: 7-year experience in a single center.

OBJECTIVES: To evaluate patients diagnosed with teratoma over a period of seven years with regard to their general characteristics and treatment methods. MATERIAL AND METHODS: A total of 194 patients histologically diagnosed with ovarian teratoma (mature or immature) in the years 2005-2012 at the Ege University Gynecology and Obstetrics Department were evaluated. RESULTS: Average patient age was 34.3 +/- 2.16 years. Of these, 169 (86.3%) were premenopausal and 27 (13.7%) postmenopausal; average cyst diameter, measured during the surgery was 6.9 +/- 0.63 cm. While the teratoma had been an asymptomatic finding in 148 (75.5%) patients, 48 (24.5%) were symptomatic. In 107 patients (54.5%) a laparotomy and in 89 (45.5%) a laparoscopy were performed. The presence of torsion was observed during surgery in 9 (4.5%) patients. The 49 (55%) patients who underwent laparoscopic cystectomy experienced a rupture during the intervention, with no cases of clinical chemical peritonitis following the surgery CONCLUSION: Caution must be exercised with regard to possible cyst rupture in elderly patients and those with large dermoids; an laparoscopic approach may be reserved for younger patients. In case a rupture occurs during the operation, abundant peritoneal lavage is indicated; in order to limit risks during the controlled excision of the cyst an Endobag should be used if possible.

The role of the serum inflammatory markers for predicting the tubo-ovarian abscess in acute pelvic inflammatory disease: a single-center 5-year experience.

OBJECTIVE: To compare patients with tubo ovarian abscess (TOA) and non-TOA acute pelvic inflammatory disease (PID) and to determinate admitted day laboratory cut-off values for the TOA. MATERIALS AND METHODS: Files of inpatients admitted to our clinic with the diagnoses of PID and/or TOA between the years of 2006 and 2011. Laboratory and culture results were obtained from the database of hospital. A total of 73 patients diagnosed with PID and/or TOA were evaluated. Patients who were diagnosed with TOA and PID by physical and sonographic examination were assigned to group 1 and group 2, respectively. Both groups were compared in terms of laboratory, clinical, and epidemiological parameters. RESULTS: Of 73 patients admitted with the diagnosis of PID, 44 (60.3 %) were found to have TOA, and 29 (39.7 %) were not found. Mean age of patients was determined as 41.4 ± 7.7 in group 1 and as 35.1 ± 6.8 in group 2. Abscess was detected more frequently in patients with low socio-cultural level, and this was found to be statistically significant. The diameter of abscess was found to be ≥5 cm in 39 (88.6 %) patients and <5 cm in 5 (11.4 %) patients. The average length of hospital stay was statistically significantly increased in patients with an abscess of ≥5 cm in size compared to patients with an abscess of <5 cm. When C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), leukocyte counts were statistically evaluated by ROC curves, diagnostic ability of CRP, ESR and leukocyte count was found to be 73, 87, and 58 %. CRP has a specificity of 63 % and a sensitivity of 72 % if cut-off value is considered as 11.5 mg/L whereas ESR has a specificity of 83 % and a sensitivity of 79 % if cut-off value is considered as 19.5 mm/1/2 h. CONCLUSION: ESR >19.5 mm/1/2 h and CRP >11.5 mg/L were the best predictors of TOA. The high level of CRP and ESR was associated with longer duration of hospitalization and disease severity, and these levels were statistically significantly associated with TOA size of ≥5 cm.