Radiological Evaluation of the Recesses on the Posterior Wall of the Nasopharynx with Cone-beam Computed Tomography.

BACKGROUND: The posterior wall of the nasopharynx is composed of loose connective tissue that includes many important anatomical structures. Various structures, such as the opening of the Eustachian tube (ET), the Rosenmüller fossa (RF), and the pharyngeal bursa (PB) are found here. AIM: To evaluate the nasopharynx posterior wall anatomic structures, including the Eustachian tube, Rosenmüller fossa, and pharyngeal bursa with cone-beam computed tomography. MATERIALS AND METHODS: The depth, width, and length of the Eustachian tube, Rosenmüller fossa, and pharyngeal bursa were measured in 150 patients using axial-sagittal cone-beam computed tomography. The Eustachian tube and Rosenmüller fossa distance to the midsagittal plane, the coronal region passing through the posterior end of the nasal septum, the superior-inferior extremity of the recesses, and the nasal floor plane distance were measured. The relationship between Rosenmüller fossa types and other parameters were evaluated. RESULTS: The incidence of right Rosenmüller fossa types 1, 2, and 3 were 16%, 18%, and 66%, respectively, and that of the left Rosenmüller fossa types 1, 2, and 3 were 16%, 19.3%, and 64.7%, respectively. The mean pharyngeal bursa width, length, and depth were 10.8, 5.7, and 4.0 mm, respectively; those of the Eustachian tube were 5.6, 7.1, and 7.3 m, respectively; those of the right Rosenmüller fossa were 4.0, 12.4, and 10.5 mm, respectively; and those of the left Rosenmüller fossa were 3.8, 12.5, and 10.9 mm, respectively. CONCLUSIONS: The posterior wall of the nasopharynx contains several important anatomical structures. Evaluation of these using cone-beam computed tomography has many clinical and radiological advantages. To understand and interpret the coincidental findings in CBCT, dental radiologists should have access to more detailed information concerning the anatomy of the nasopharynx.

Biomechanical evaluation of caudally and buccally screwed customised reconstruction plates for lateral segmental defects of mandible.

The aim of this study was to compare locking reconstruction plates with caudobuccally screwed custom mandibular reconstruction plates in bridging lateral mandibular segmental defects. The in vitro study was conducted on 13 polyurethane mandibles. A total of 7 mandibles with lateral segmental defects were bridged with locking reconstruction plates in group I, 6 mandibles with the same standard defect were bridged with caudobuccally screwed customised reconstruction plates in group II. Mean yield displacement, yield load, and displacement at 80 N (Newtons), 100 N, 200 N, 300 N loading were compared among the 2 groups. The mean (SD) displacement for Group I was 11.27 (3.6) mm, Group II was 21.08 (2.5) mm. Group II had significantly greater (p=0.0001) displacement when compared with Group I. The mean (SD) force before failure for Group I was 638.4 N (127.2), Group II was 1398. 3 N (162.7). Group II withstood significantly greater force than Group I (p=0.0001). The study reveals that the caudobuccally screwed custom reconstruction plates can significantly enhance yield load as preserving the preoperative shape of the face and mandible.

Plasmid stability of potential probiotic Lactobacillus plantarum strains in artificial gastric juice, at elevated temperature, and in the presence of novobiocin and acriflavine.

In this study, the presence of plasmids responsible for carbohydrate fermentation and antibiotic resistance and the stability of these plasmids in artificial gastric juice were investigated in 20 Lactobacillus plantarum strains with probiotic properties. Plasmid curing was performed with novobiocin, acriflavine and elevated incubation temperature to identify plasmids encoded with carbohydrate fermentation and antibiotic resistance genes and to compare them with artificial gastric juice. Plasmid profiling of the strains revealed that 100% of the strains were harbouring plasmids in varying sizes and numbers. The plasmid number of the potential probiotic strains ranged between 1 and 4, and the plasmid size ranged between 5.779 and 16.138 kb. The potential probiotic strains could not survive in the artificial gastric juice at pH 2.0. Although the strains maintained their viability in an artificial gastric juice at pH 2.5 and 3.0, and their derivatives lost their plasmids at a high rate (100%). Similarly, high levels of cured derivatives were obtained with 8 µg/mL novobiocin and 100 µg/mL acriflavine applications, and 24 h incubation at 43 °C. All the experiments were also performed to compare with two L. plantarum-type strains containing plasmids responsible for tetracycline and tetracycline + erythromycin resistances. Artificial gastric juice and other plasmid curing treatments caused a high-frequency loss in the antibiotic resistances of type strains. Determining plasmid stability in artificial gastric juice is a novel approach. Plasmid stability in the gastrointestinal tract is important for maintaining the plasmid-encoded probiotic properties.

Evaluation of strain values of critical anatomic regions for two different pterygomaxillary approaches in Le Fort I osteotomy: An experimental study.

BACKGROUND: The purpose of this experimental study was to measure stresses both on the pterygoid plates and the skull base following two different pterygomaxillary approaches in Le Fort I osteotomy. MATERIAL AND METHODS: The prepared skull models were randomly divided into 2 groups of 7. In the first group (A), the pterygomaxillary area was left intact. In the second group (B), pterygomaxillary separation was performed with a fine bur. The stresses were measured by using strain gauges. These strain gauges were attached to 6 different anatomical sites. The skull models were mounted on a servo-hydraulic testing unit. Each model was then subjected to a continuous linear tension until a plastic deformation was seen. RESULTS: The statistical analyses showed that there were no significant differences (p>.05) between the 2 groups regarding the strain values. Moreover, no statistical differences (p>.05) were found between the two groups in terms of maximum applied forces. CONCLUSIONS: Considering the clinical conditions, the present study shows that when Le Fort I osteotomy performed without pterygomaxillary separation, there is no significant stress on the skull base during the downfracture. Moreover, it is considered that there is no need for an excessive force applied to perform downfracture in Le Fort osteotomies without pterygomaxillary separation.

Preclinical impairment of myocardial function in rheumatoid arthritis patients. Detection of myocardial strain by speckle tracking echocardiography.

OBJECTIVES: The incidence of heart failure is higher in patients with rheumatoid arthritis (RA) than in the general population and contributes to elevated cardiovascular mortality and morbidity rates. Impaired myocardial function can be detected by a novel echocardiographic method, speckle tracking echocardiography (STE), when conventional methods have yielded normal findings. The aim of our study was to investigate the effect of disease duration on myocardial strain and strain rate parameters in patients with RA. METHODS: This cross-sectional study included 37 RA patients [n=16, female gender n=16, mean age, 45.7 ± 9 years in the early-stage disease (ESD); n= 21, female gender n=19, 45.7 ± 16.8 years in the advanced-stage disease (ASD) group] who were compared according to early disease duration and advanced-stage disease (2.8 ± 1.2 vs. 14.6 ± 6.8 years, respectively). Hypertension, diabetes mellitus, and other cardiovascular risk factors were excluded. Offline analysis of STE was performed and data between the two groups were compared. RESULTS: RS, RSR-E, and RSR-E/A values were statistically significantly lower in patients with ASD. Circumferential strain and strain rate were similar between the two groups. Except for LSR-E/A values, LS, LSR-S, LSR-E, and LSR-A values were decreased in patients with ASD. CONCLUSION: RA patients without clinical evidence of cardiovascular disease and in the absence of traditional cardiovascular risk factors can be followed up with STE. In this way, early impairment of myocardial deformation can be detected before the appearance of any clinical evidence of cardiac involvement.

Impact of D-dimer level on postinterventional coronary flow and in-hospital MACE in ST-segment elevation myocardial infarction.

OBJECTIVE: Preintervention thrombus burden in the infarct-related artery is an independent predictor of no-reflow and adverse outcomes in coronary artery disease. The role of D-dimers in the acute phase of ST-elevated myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) has not been fully elucidated. We aimed to investigate the predictive value of serum D-dimer levels on the outcome of patients with STEMI. METHODS AND RESULTS: A total of 266 consecutive patients presenting with STEMI within the first 12 h of symptom onset were included in this study. Patients were divided into two groups based on the postinterventional Thrombolysis In Myocardial Infarction (TIMI) flow grade score. Postinterventional TIMI grades of 0, 1, or 2 were defined as no-reflow (group 1) and angiographic success was defined as TIMI 3 flow (group 2). D-dimer levels were significantly higher in patients with postinterventional no-reflow than in patients with postinterventional TIMI grade 3 flow (686 ± 236 µg/ml-418 ± 164 µg/ml, p < 0.001). Multivariate logistic regression analysis showed that D-dimer level was an independent predictor of postinterventional no-reflow (OR: 1.005; 95 % CI: 1.003-1.007; p < 0.001) and in-hospital major adverse cardiovascular events (MACE; OR: 1.002; 95 % CI: 1.000-1.004; p = 0.029). Receiver operator characteristics analysis provided a cut-off value of 549 µg/ml for D-dimer for predicting no-reflow with an 83 % sensitivity and an 81 % specificity, and 544 µg/ml for predicting in-hospital MACE with a 69 % sensitivity and a 67 % specificity. CONCLUSION: In conclusion, D-dimer levels measured on admission may be an independent predictor of no-reflow, which is also a predictor of adverse outcomes in patients with STEMI.

The use of complementary and alternative medicine in patients with common variable immunodeficiency.

OBJECTIVES: Complementary and alternative medicine (CAM) usage is a reality in patients with chronic diseases, but there are no data on CAM usage in immunodeficiency diseases necessitating intravenous immunoglobulin (IVIG) therapy.The aim of this study was to investigate the rate of CAM usage in patients with common variable immunodeficiency (CVID). METHODS: Forty-three patients (29 boys and 14 girls) with CVID and receiving IVIG every 3 weeks were included. Data were collected through a questionnaire completed by the parents. Those using treatments other than their medical therapies that were defined as CAM by the National Center for Complementary and Alternative Medicine were classified as CAM users. RESULTS: The mean (SD) age at diagnosis was 7.56 (9.44) years (range, 6 months to 44 years) and the mean IVIG treatment duration was 6.02 (3.84) years (range, 1 to 20 years). Thirty-six (83.7%) of the 43 patients analyzed had used at least 1 CAM approach. The most common modalities were herbal medicines (65.1%), dietary supplements (62.8%), vitamins (46.5%), and religion (34.9%). Only 11% of those interviewed had informed their doctor that they were using CAM. The most common reason for CAM usage was the desire to improve body resistance. Eighteen parents (50%) claimed that their children had benefited from CAM. CONCLUSION: Our findings reveal that there is a remarkably high tendency to use CAM in patients with CVID. Although no side effects were reported by the families, potential drug interactions should be considered.

Clozapine plasma level monitoring for prediction of rehospitalization schizophrenic outpatients.

INTRODUCTION: The aim of this naturalistic exploratory study was to examine whether blood antipsychotic drug concentrations can predict rehospitalizations in chronically medicated patients. METHODS: The study included schizophrenic outpatients under clozapine (CLZ) maintenance treatment, supervised by therapeutic drug monitoring (TDM). Patients were observed for a period of 21 months. Their on average monthly measured plasma levels and the date of rehospitalizations were recorded. The variability of the first 3 CLZ plasma levels, measured in 3.6 months, was compared between patients with and without rehospitalization. RESULTS: 23 patients participated of which 6 patients were rehospitalized. Mean plasma concentrations of CLZ were similar in patients without (471 ± 180 ng/mL) and with rehospitalization (446 ± 266 ng/mL). However; coefficients of variation (CV) of plasma concentrations in the first 3 blood samples differed significantly between the rehospitalized and non-rehospitalized groups (37.1% vs. 13.0%, respectively, P = 0.012). A CV ≥ 19.8% was predictive for later rehospitalization with 100% sensitivity and 70.6% specificity. DISCUSSION: Variability in CLZ plasma concentrations may be useful in identifying patients at risk of relapsing under maintenance therapy. Because of the small number of patients the findings need to be confirmed in a larger study.

Is valproate promising in cardiac fatal arrhythmias? Comparison of P- and Q-wave dispersion in bipolar affective patients on valproate or lithium-valproate maintenance therapy with healthy controls.

Autonomic nerve system is considered to be involved in bipolar affective disorder (BAD) or to be influenced by valproate monotherapy or valproate plus lithium combination. We planned to assess the effects of medication on atrial and ventricular conduction. The electrocardiography records were performed with eligible 15 patients with valproate, 20 patients with lithium-valproate combination use in euthymic phases of BAD and 20 healthy participants. The blood valproate and lithium concentrations in groups were in normal range. The difference in P maximum, P minimum, maximum QTc were statistically insignificant. Minimum QTc (F = 6.36; df = 2; P = 0.003) and QT dispersion (QTD) (F = 5.57; df = 2; P = 0.006) were statistically significant among the groups. There were no significant differences between patient groups among ECG parameters. Minimum QTc was significantly longer in combination group than healthy controls, whereas the QTD values in both patient groups were significantly lower than controls'. Valproate might have some preventive effects on ventricular electrical conduction because of lower QTD in both patient groups. Thus, valproate seems to have cardiac conduction stabilizing effect beside its mood stabilizing aspect. However, this finding needs replication and further corroboration in well-designed studies.

Reference values for neonatal thyroid volumes in a moderately iodine-deficient area.

BACKGROUND: The reference ranges of thyroid volumes in neonates vary according to the iodine status of a specific region. In different studies, it ranged between 0.47 and 1.62 ml. It has been previously shown that Bursa city was a moderately iodine-deficient area. We therefore aimed at determining normal reference ranges of neonatal thyroid volumes in our moderately iodine-deficient area. METHODS: In this cross-sectional study, thyroid volumes of 100 healthy fullterm neonates (51 boys and 49 girls; mean gestational age 38.9+/-1.1 weeks; and mean birth-weight 3370+/-446 g) were measured during the first week of life using thyroid ultrasonography. These data were compared with the gestational age, birth weight, gender, and TSH values of neonates as well as with maternal factors such as gestational diabetes, preeclampsia, smoking, medication use, and heart disease. RESULTS: All blood samples for TSH were taken during the first 5 days (mean 1.09+/-0.9 days). The mean TSH levels in all male and female neonates were 3.77+/-3.71, 4.57+/-3.61, and 2.93+/-3.66 mIU/l, respectively. This difference was statistically significant (p=0.006). Mean thyroid volumes for all male and female neonates were calculated as 0.82+/-0.18 (range 0.51-2.04), 0.84+/-0.21 (range 0.51-2.04), and 0.80+/-0.14 ml (range 0.58-1.30), respectively. There were no statistically significant differences in thyroid volumes with respect to gestational age, birth weight, gender, TSH values of neonates and maternal factors. CONCLUSION: Normal thyroid volumes in neonates vary between different regions. Local reference values should be used in thyroid volume assessment. Our results are in concordance with the literature and can be used as reference values for our region.

Association of left ventricular diastolic function abnormalities with aortic elastic properties in asymptomatic patients with type 2 diabetes mellitus. A tissue doppler echocardiographic study.

BACKGROUND: The aim of this study was to investigate the association between the aortic elastic properties and the left ventricular diastolic function measured by tissue Doppler echocardiography (TDE) in asymptomatic type 2 diabetes mellitus. METHODS: Fifty-seven asymptomatic patients with type 2 diabetes (33 women, mean age: 49 +/- 6 years) and 25 healthy control subjects (19 women, mean age: 46 +/- 7 years) were included in the present study. Diastolic filling indices were measured by conventional (CE) and tissue Doppler echocardiography. The aortic elastic properties [Aortic stiffness index (ASI), aortic distensibility and strain] were measured as previous definition. RESULTS: Compared with control subjects, the ratio of LV diastolic abnormalities measured by CE and TDE were found higher in patients with type 2 diabetes (36% and 73.6%, p = 0.001, respectively, and 52% and 89.4%, p < 0.001, for septal annulus; 48% and 89.4%, p < 0.001 for septal basal respectively). The ASI was significantly higher (p < 0.001), aortic distensibility and aortic strain were also significantly lower in patients with type 2 diabetes than control subjects (p < 0.001 and p < 0.001 respectively). In the regression analysis, Ao distensibility was correlated to age (beta = -0.299, p = 0.004), septal basal Em/Am ratio (beta =0.543, p < 0.001) and HDL-cholesterol (beta = 0.192, p = 0.039). ASI was also correlated only to age (beta = 0.255, p = 0.044), the presence of diabetes mellitus (beta = 0.304, p = 0.009), mitral A wave (beta = 0.322, p = 0.013) and mitral annulus Em wave (beta = -0.505, p < 0.001). CONCLUSION: The aortic elastic function is impaired in asymptomatic patients with type 2 diabetes. Increased ASI and decreased Ao distensibility are closely associated with diastolic filling indices measured by CE and TDE.

Extended pedigree with multiple cases of XX sex reversal in the absence of SRY and of a mutation at the SOX9 locus.

It is well established that testicular differentiation of the human embryonic gonad depends on the action of the Y-chromosomal gene SRY. However, exceptional cases such as SRY-negative cases of 46,XX testicular disorder of sexual development (DSD), and of 46,XX ovotesticular DSD document that testicular tissue can develop in the absence of the SRY gene. These SRY-negative XX sex reversal cases are very rare and usually sporadic, but a few familial cases have been reported. We present a large, consanguineous family with nine affected individuals with phenotypes ranging from 46,XX testicular DSD to 46,XX ovotesticular DSD, with predominance of male characteristics. Absence of SRY in peripheral blood was documented by fluorescence in situ hybridization (FISH) and PCR analysis in all nine affected individuals, and by FISH analysis on gonadal sections with testicular tissue in four affected individuals. By quantitative PCR, a duplication of the SOX9 gene was excluded. In addition, as linkage analysis showed that the nine affected members of the family do not share a common SOX9 haplotype, any mutation at the SOX9 locus could be ruled out. Together, these findings implicate a mutation at a sex-determining locus other than SRY and SOX9 as the cause for the XX sex reversal trait in this family.

A new prenylated arylnaphthalene lignan from Haplophyllum myrtifolium.

A novel prenylated arylnaphthalene lignan, 7-O-(3-methyl-2-butenyl)isodaurinol, was isolated from Haplophyllum myrtifolium and identified on the basis of detailed spectral analyses, including 2D-NMR spectrometry. The known furoquinoline alkaloids, dictamnine, robustine, gamma-fagarine and skimmianine, the aryltetralin lignan (-)-1beta-polygamain and the flavone chrysosplenetin were isolated from the same source.

Cytotoxic activity and quality control determinations on Chelidonium majus.

The quality control determinations on herba and radix Chelidonii prepared from Chelidonium majus L., growing wildly in Bursa, Uludag surroundings, have been conducted according to DAB 9. Ash, humidity and total alkaloidal content have been carried out. LC(50) value of chelidonine and protopine, the most important alkaloids, and the alcoholic and water extracts of herba Chelidonii were determined using brine shrimp (Artemia salina) lethality bioassay.

Perception of angular head position during attempted alignment with eccentric visual objects.

The perception of angular head position with respect to a visual object was investigated using three different methods: Pointer indication (P); in the dark, subjects' (Ss') heads were horizontally turned to various positions (range +/- 54 degrees); Ss then rotated a pointer carrying a light emitting diode (LED) so as to align it with head position. Active head pointing (A); again in darkness, the pointer was rotated to various positions; Ss then turned their heads so as to align them with the pointer. Reading from visible scale (V); Ss viewed a degrees scale on a circular screen; Ss' heads were turned as in P, and Ss reported head position in terms of this scale. The results obtained with all three methods indicate that head position is overestimated with respect to the visual object (LED, scale mark): object position exceeded head position by 6, 18, and 7% when measured with the P-, A-, and V-methods, respectively (median values). The observed misalignment between head and object suggests that subjective primary eye position is shifted in the direction of head rotation by a cross-talk of head position. Whether a functional advantage or merely a tolerated side-effect of other constraints, this behavior confers the impression of looking "straight ahead" in the literal sense when gaze is shifted by coordinated eye-head movements with a 10% eye and a 90% head share in total lateral displacement. In an attempt to probe a hypothesized internal representation of head position implied in head-to-object alignment, Ss were also to estimate head position in space using only neck proprioceptive information. In complete darkness, responses were often non-linear functions of head position with overestimation of large eccentricities. When a head-centered LED was added (which conveyed no position information), responses became more linear, suggesting that the mere presence of visual afferents may improve the perceptual interpretation of proprioceptive information.

Erectile dysfunction in premature ejaculation.

Between October 1993 and December 1995, 45 patients with premature ejaculation were included in this study. The patients were divided into two groups etiologically, as having primary or secondary ejaculation. After a complete laboratory evaluation all patients underwent papaverine tests color Doppler ultrasonography pharmacocavernosometry-cavernosography and consequently organic etiology were investigated. Venous leakage was found in 5 (22,7%), arterial or mix insufficiency in 2 (9%) of the patients with primary premature ejaculation. In secondary premature ejaculation group, venous leakage was encountered in 9 patients (39,1%), arterial insufficiency in 2 patients (8,6%). In conclusion, investigation of organic etiology for the patients with premature ejaculation, particularly with secondary premature ejaculation, seems to be beneficial for correct diagnosis.

Comparative early results of transurethral electroresection and transurethral electrovaporization in benign prostatic hyperplasia.

OBJECTIVE: To compare the results of conventional transurethral electroresection of the prostate (TURP) and transurethral electrovaporization (TUEP) in patients with symptomatic benign prostatic hyperplasia. PATIENTS AND METHODS: The study comprised 46 patients with moderate or severe symptoms of prostatism and a maximal flow rate of < 15 mL/s. Pre-operatively, all patients underwent a digital rectal examination and the determination of prostatic volume by ultrasonography, and a symptom score, the maximal flow rate, post-void residual urine, routine biochemical variables and serum prostate specific antigen were measured. The haematocrit and blood Na+ levels were also determined pre-operatively and again 24 h after the operation. Patients were divided randomly into two groups: the first underwent a conventional TURP and the second TUEP using 240-300 W of cutting current. Three months after operation, all the variables were remeasured and the values compared with those before treatment and between the groups. RESULTS: The improvements in symptom score, maximum flow rate and residual urine were slightly better after TURP than after TUEP but the differences between treatments were not statistically significantly different. However, TUEP used slightly less irrigant solution, allowed earlier removal of the urethral catheter, required no blood transfusions and was easier to perform. CONCLUSION: Although the improvements in the objective variables 3 months after TUEP were almost the same as after TURP, there were advantages in using less resources: further studies with more patients and a longer follow-up are required to determine the efficacy and safety of this procedure.

Two serious complications of circumcision. Case report.

Twins aged 19 years presented having been circumcised by an unqualified "itinerant circumciser" at the age of 2 1/2. In one the glans penis and corpus cavernosum were invisible, and the external urethral meatus was at the level of the mons pubis; the other had defects of the glans and corpus, iatrogenic hypospadias, and the end of the penis was protruding only 1.5 cm from the mons pubis. Both underwent successful reconstruction, and are normally sexually active.

Results of selected Zeiss basket applications during transurethral interventions and open surgery.

Between 1981 and 1990, 151 patients with lower ureteral calculi received 163 applications of Zeiss basket (ZB) transurethrally. In the mean time we employed ZB in 17 patients who were operated for various causes. The success rate of 163 ZB applications was 88% and of 17 open surgical applications 94%.