Spinal cord stimulation may improve not only intractable pain but also necrotic wounds.

Spinal cord stimulation (SCS), an implantable neuromodulation modality, is one of the most exciting developments in chronic pain syndromes. In addition, SCS may improve intractable pain and may help ischemic wound healing. Herein, we report a 59-year-old female patient with persistent neuropathic pain and peripheral arterial disease in the lower limb which was treated successfully with SCS.

Systemic oxidant/antioxidant balance in human abdominal aortic aneurysm.

The aim of this study was to evaluate the oxidant-antioxidant balance in patients with abdominal aortic aneurysms (AAA). Forty-two consecutive patients with AAA and 46 control subjects were included. Total oxidant status (TOS) and total antioxidant status (TAS) levels were measured and the oxidative stress index (OSI) value determined. Serum TOS and OSI values in patients with AAA were higher than those in the controls (p < 0.001, p < 0.001, respectively). There was a positive correlation between abdominal aortic diameters, serum TOS levels (r = 0.592, p < 0.001) and OSI values (r = 0.598, p < 0.001). A cut-off value of 17.68 µmol H2O2equivalent/L for TOS was associated with 86% sensitivity and 83% specificity and a cut-off value of 1.77 for OSI was associated with 86% sensitivity and 81% specificity for predicting AAA. Systemic oxidative imbalance develops in patients with AAA, particularly as a result of an increase in TOS.

Comparison of perioperative oxidative stress in endovascular and open repair of abdominal aortic aneurysm.

BACKGROUND/AIM: To investigate the differences in perioperative oxidative stress (OS) in abdominal aortic aneurysm (AAA) patients treated with either endovascular repair (EVAR) or open repair (OR). MATERIALS AND METHODS: Twenty patients (11 OR, 9 EVAR) treated for AAA with no known malignant or inflammatory disease and an aneurysm diameter of over 5 cm and no rupture were included in the study. Blood samples were obtained preoperatively, during aortic occlusion, and 1 h and 24 h after reperfusion. Total antioxidant status (TAS), total oxidative stress (TOS), and malondialdehyde (MDA) levels were measured and oxidative stress index (OSI) was calculated. RESULTS: OSI at 1 h and 24 h after reperfusion was higher in the EVAR group (P = 0.004 and P = 0.002, respectively). TAS levels were higher (P = 0.001, P = 0,029). MDA levels showed no difference (P = 0.291, P = 0.076). TOS levels were lower 24 h after reperfusion in the EVAR group (P = 0.018). CONCLUSION: Markers of oxidative stress were lower in the EVAR group. This may be associated with advantages of EVAR. More studies are required for a clear-cut conclusion.

Oxidant-antioxidant balance during on-pump coronary artery bypass grafting.

BACKGROUND: The aim of this study was to evaluate the changes in perioperative oxidant-antioxidant balance in ONCABG. METHODS: Twenty-three patients were included in this study. Serum total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) values were assessed preoperatively, at 20 minutes after aortic clamping and at 30 minutes, 6 hours, and 48 hours after declamping (reperfusion). The patients were divided into 2 groups according to the median aortic cross clamping (XC) time: group 1 (XC time < 42 minutes) and group 2 (XC time ≥ 42 minutes). RESULTS: TOS and OSI values of whole patients at 30 minutes after reperfusion were higher than preoperative values (P = 0.045, P = 0.015), while perioperative TAS levels of the patients were similar to the preoperative levels (P = 0.173). XC time was correlated with TOS levels at 30 minutes after reperfusion (r = 0.43, P = 0.041). In group 2, TOS and OSI values at 30 minutes after reperfusion were higher than preoperative values (P = 0.023, P = 0.048), whereas a significant difference was not found in group 1 (P = 0.601, P = 0.327). CONCLUSIONS: Oxidative imbalance and increase in TOS at reperfusion in ONCABG may be associated with XC time.

Initial experiences of young cardiologists with balloon-expandable transcatheter aortic valve implantation in Turkey: a case series of eleven patients.

OBJECTIVE: Surgical aortic valve replacement is the gold standard of treatment for symptomatic severe aortic stenosis in all age groups. Transcatheter aortic valve implantation (TAVI), which is performed by senior interventional cardiologists in experienced centers, is an alternative therapy for patients considered to be at high risk for surgery. The aim of this study is to describe the procedural success and short-term results of TAVI performed by young interventional cardiologists in Trabzon, Turkey. MATERIALS AND METHODS: Eleven patients, 10 women and 1 man, who were treated by balloon-expandable TAVI through transfemoral access between January 2012 and April 2012, were included in the study. The clinical and echocardiographic parameters of the patients were compared before and three months after the procedure. RESULTS: The median calculated logistic EuroSCORE and Society of Thoracic Surgeons (STS) score of patients were 28% (24%-34%) and 14% (12%-18%), respectively. The median age of the patients was 83 years and ranged from 80-85 years. The mean aortic valve pressure gradient and the aortic valve area were significantly improved after TAVI. The mean aortic valve pressure gradient was 48 (46-53) mmHg before treatment and 20 (16-23) mmHg after treatment (p=0.003). The aortic valve area was 0.65 (0.55-0.70) cm(2) before treatment and 1.7 (1.6-1.8) cm(2) after treatment. The functional status of the patients improved from NYHA class 3-4 to NYHA class 1-2. Intraprocedural mortality was not observed, and the overall 3 month mortality was 9%. CONCLUSION: TAVI can be performed successfully by young cardiologists. In centers with high patient loads, we encourage young cardiologists to perform TAVI if they have received the appropriate training and to form specialized, cooperating teams with a focus on TAVI.

Prevalence of attention-deficit/hyperactivity disorder and co-morbid disorders among students of Cumhuriyet University

Background and Objectives: Most of the previous studies investigated prevalence of attention-deficit/hyperactivity disorder (ADHD) among university students with self report measures. Present study investigated actual prevalence of ADHD and comorbid disorders among university students in Cumhuriyet University of Sivas in Turkey. Methods: In the first stage, 980 university students filled in the Adult ADHD Self-Report Scale and socio-demographic form, 79 of whom were above the cut-off score of Adult ADHD Self-Report Scale, considered as possible ADHD. They were evaluated in the second stage via structured interview SCID I, SCID II, Adult ADHD Module of MINI Plus. In addition, subjects filled in the self report Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale. Results: The self report ADHD prevalence rate was 10.1% and the actual prevalence rate of ADHD among the university students was calculated 6.1%. The prevalence of ADHD was greater among male than female (7.0% vs. 5.5%). Among the male students inattentive subtype was 1.6%, hyperactive-impulsive 0.24%, combined 5.1%. Female students were found to be inattentive by 1.45%, hyperactive-impulsive by 0.56% and combined type by 3.48%. Most of the students with ADHD had Axis I (especially depressive disorders) and Axis II disorders (especially cluster B personality disorders). ADHD diagnosis was associated with more cigarette and alcohol use, academic failure, legal problems, somatic complaints and suicide attempts. Students with ADHD were spending more time on the Internet than students without ADHD. Only one student diagnosed with ADHD reported to have had previous ADHD diagnosis. Conclusions: ADHD is common among university students. Having a diagnosis of ADHD in early adulthood seems to be associated with psychological, social, and academic problems (AU)

Serum cortisol and dehydroepiandrosterone-sulfate levels in schizophrenic patients and their first-degree relatives.

AIMS: Alterations in cortisol and dehydroepiandrosterone sulfate (DHEA-S) levels are thought to play a role in the pathophysiology of neuropsychiatric disorders, including schizophrenia. The aim of this study was to investigate the role of serum cortisol and DHEA-S in the pathophysiology of schizophrenia. METHODS: Sixty schizophrenic patients, 70 healthy first-degree relatives, and 60 healthy volunteers were included. Sociodemographic characteristics, data regarding disease duration and severity, as well as ongoing and previous drug use were recorded. Serum cortisol and DHEA-S levels were measured. RESULTS: Serum cortisol and DHEA-S levels were significantly higher in the schizophrenia group compared with the first-degree relatives and controls (P < 0.05). Serum cortisol levels in the first-degree relatives were significantly higher than in the healthy controls (P < 0.05). There was no significant difference between the first-degree relatives and healthy-controls in terms of DHEA-S levels and between the three groups in terms of serum cortisol/DHEA-S ratios. CONCLUSIONS: Elevated serum cortisol levels in schizophrenic patients might be associated with the role of cortisol in the pathophysiology of schizophrenia. Also, the elevation of serum cortisol levels in first-degree relatives compared to controls suggests that similar pathophysiological processes might have a role in individuals without any disease symptoms, but with a genetic predisposition for schizophrenia. Elevated serum DHEA-S levels might be the result of a compensatory response to elevated cortisol levels. Serum cortisol and DHEA-S levels may be used as a biological marker for the diagnosis of schizophrenia; however, further studies with larger sample sizes are warranted to support this finding.

Peel bond strength of two silicone soft liners to a heat-cured denture base resin.

PURPOSE: This study investigated the peel strength of two different soft liners to a polymethylmethacrylate (PMMA) denture base resin before and after thermocycling. MATERIALS AND METHODS: The silicone-based soft liner materials tested were Molloplast B and Permaflex; the denture base material was a heat-cured acrylic resin, Meliodent. A total of 40 specimens was prepared using rectangular molds with dimensions of 100 x 10 x 2 mm for PMMA and 150 x 10 x 2 mm for soft liners, as described in ASTM-D903-93. For each of the liner materials, 10 specimens were packed against a cured PMMA denture base surface as recommended by the manufacturers. The other 10 specimens were packed against PMMA denture base dough and processed together. In each group, 5 of the specimens were tested directly, while the other 5 were thermocycled in a water bath (5°C to 55°C; 3000 cycles) before testing. Peel testing was performed using an Instron testing machine. RESULTS: The results revealed that peel strength values of the Permaflex specimens prepared according to the manufacturer's recommendations were significantly higher than those of Molloplast B (p < 0.05). However, when packing was done against uncured PMMA dough, the difference between the specimens of two liners was not significant. Thermocycling led to significant decreases in the peel strength of both Permaflex liner specimens packed against cured/uncured PMMA resin surfaces (p < 0.05), whereas this process did not affect the strength of Molloplast B specimens. CONCLUSION: Results indicated that the material Molloplast B was superior to the material Permaflex in terms of peel strength when the specimens were simultaneously polymerized with PMMA and thermocycled.

The bond strength of a highly cross-linked denture tooth to denture base polymers: a comparative study.

PURPOSE: This study compared shear bond strength and type of bond failure between a highly cross-linked tooth and different denture base polymers. MATERIALS AND METHODS: Cross-linked denture teeth were bonded to either a heat-, an auto-, a microwave-polymerized denture base resin or a relatively new injection-molded, microwave-polymerizable polyurethane-based resin. Six experimental groups were established for each of the shear and peel tests. In four of the groups, teeth were used as received and bonded to each of the denture base resins; in the remaining two groups, they were treated with dichloromethane to determine its effect on the bonding with heat or auto-polymerized denture base resins. Bond strength was determined by compressive load applied at 45 degrees on the palatal surface of each tooth until fracture; the type of bond failure was assessed by the peel test. RESULTS: The results showed that heat-cured PMMA groups failed cohesively and demonstrated significantly higher bond strengths than the other resins used. The application of dichloromethane on the ridge lap areas of teeth resulted in a significant improvement of bond strengths in heat- and auto-cured resins. CONCLUSION: Within the limitations of this experimental study, the results suggest that type of denture base material and processing methods may have an influence upon the bond strength between interpenetrating polymer network (IPN) denture teeth and base materials. Treatment of denture teeth with dichloromethane could provide substantial improvement in the bond strength of teeth with heat and auto-cured denture base resins; however, this finding should be validated in further investigations on the long-term effect of such treatment on the bond strength.

Effect of maleic anhydride pretreatment on tensile bond strength of a silicone soft liner to a denture base polymer.

PURPOSE: To determine the effect of resin surface treatment with dissolved maleic anhydride in butanone added into primer on the tensile bond strength between an acrylic denture base resin and a silicone soft liner. MATERIALS AND METHODS: To test tensile bond strength, standard dumbbell-shaped acrylic specimens were prepared. Five experimental groups, including the control, were tested (n = 5). Maleic anhydride solutions prepared in butanone at concentrations of 1%, 5%, 10% or 20% were then mixed with 1 ml of Primo adhesive and the mixtures were applied onto the resin bonding surfaces. Silicone liner material was applied to resin surfaces in the conventional manner. Tensile bond strength of the specimens was measured in a universal testing machine. Fractured surfaces were observed under the scanning electron microscope, and resulting chemical changes with the solutions used were analyzed spectroscopically. RESULTS: The highest bond strength value was obtained for the group treated with 5% maleic anhydride (2.53 ± 0.48 MPa); the lowest value was for the group treated with 20% maleic anhydride (1.59 ± 0.29 MPa). Mixed failure was the dominant type seen in the experimental groups. Spectroscopic analysis showed the interaction of the anhydride carbonyl groups with the Primo primer. CONCLUSION: The treatment of resin surfaces with maleic anhydride added to Primo adhesive effectively increased bond strength between silicone soft liner and denture base resin.

Delayed diaphragmatic hernia: an unusual complication of tube thoracostomy.

The nature of a tube thoracostomy -a blind maneuver- renders it subject to complications. Nevertheless, it is very uncommon to create a diaphragmatic hernia with this procedure. Herein, we present the occurrence of this complication after six months under emergency conditions that was treated by thoracotomy.

Temperature rise induced by various light curing units through human dentin.

This study investigated temperature rises caused by different light curing units (LCUs) in dentin of different thicknesses. The different LCUs tested in this study were namely: quartz-tungsten-halogen (QTH) (Heliolux DLX) LCU, plasma arc (PAC) (Apollo 95E Elite) LCU, and light emitting diode (LED) (Mini LED) in standard curing mode as well as pulse and soft-start modes. One hundred and forty dentin disks of 0.5, 1, 1.5, and 2 mm thickness were prepared from mandibular molars (n=7). Temperatures were recorded using a L-type thermocouple in direct contact with the light guide tip. For all curing units/modes, dentin thickness was inversely proportional to temperature rise and that QTH light gave significantly higher values compared to PAC and LED in all the test conditions. The highest temperature rise was observed under 0.5-mm-thick dentin disk with QTH, whereas the lowest temperature rise was registered with LED light in pulse mode under 2-mm-thick dentin.

The role of saliva in dental erosion and a prosthetic approach to treatment: a case report.

AIM: The aim of this report is to describe the relationship of some salivary parameters to dental erosion resulting from excessive citric acid consumption and present a description of a prosthetic approach used to restore the damaged dentition of a patient with severe erosion. BACKGROUND: The high consumption of dietary sources of acids can lead to erosion or the excessive wear of dental hard tissues. Erosion may be modified by salivary parameters such as flow rate, pH, and buffering capacity. Porcelain-fused-to-metal (PFM) restorations and composite resin veneers can be used successfully to restore impaired esthetics and eliminate tooth hypersensitivity in such cases. RESULTS: A 37-year-old woman with a history of excessive lemon consumption presented with a complaint of tooth hypersensitivity and the poor appearance of her dentition due to erosion. Stimulated and unstimulated salivary samples of the patient were evaluated for flow rate, pH, and buffering capacity before and after treatment. The pre-treatment values were found to be higher than post-treatment values. Stimulated samples showed an increase of salivary flow rate, pH, and buffering capacity. The measured parameters put forth the defensive potential of saliva against the acidic diet, and the salivary flow rate and buffering capacity decreased after reducing acidic consumption. The excessively eroded teeth were restored using PFM restorations whereas the superficially eroded teeth were restored with composite resins. SUMMARY: The introduction of acidic foods, beverages, or other agents can exceed the natural buffering capacity of saliva. The result is a lowering of the pH of the oral environment which can lead to erosion of enamel and dentin. Loss of tooth structure due to erosion can compromise the esthetics of the dentition and lead to hypersensitivity of the teeth. Teeth damaged by erosion can be successfully restored by composite resin or porcelain restorations and esthetics and function of dentition can be improved. CLINICAL SIGNIFICANCE: This report is a profound example of how the over consumption of acidic agents affect not only dental tissues but also the chemical balance of the oral environment as well as the oral habitat.

Prevalence of anxiety disorders among elderly people.

OBJECTIVES: The objectives of this study are to determine current and lifetime prevalence of anxiety disorders and also to explore the relationship, if any, between possible risk factors and anxiety disorders, amongst elderly people living in the Sivas province of Turkey. METHODS: The research sample consisted of 462 persons. A Socio-demographic Data Form was given to the participants and the Anxiety Module of SCID-I was applied. Chi-square and Fischer's exact tests were used to evaluate the data obtained. RESULTS: The current prevalence for all types of anxiety disorder was found to be 17.1% overall and the lifetime prevalence was found to be 18.6%. The current prevalence rates for particular disorders were found to be 0.4% for panic disorder, 3.2% for obsessive-compulsive disorder, 1.9% for post-traumatic stress disorder, 2.8% for social phobia, 11.5% for specific phobia, 6.9% for generalized anxiety disorder (GAD). Lifetime prevalence rates for these disorders (except GAD) were 1.1%, 3.2%, 3.0%, 2.85%, 11.5% respectively. CONCLUSIONS: Anxiety disorders are more common among elderly people than was previously thought. The lifetime prevalence of specific phobia amongst the elderly is higher than that of general population; the lifetime prevalence ratios of obsessive-compulsive disorder and social phobia are similar to that of the general population in Sivas. In order to improve the delivery of health services, it is recommended that further studies should be conducted among elderly people, both by applying standardized diagnostic tools, but also taking into account socio-economic factors and using convenient therapy methods developed specifically for this group.

The prevalence of conversion symptoms in women from a general Turkish population.

BACKGROUND: Conversion symptoms have historically be seen to be related to dissociative disorders and early trauma. OBJECTIVE: This study sought to determine the prevalence of conversion symptoms among women in the general Turkish population. METHOD: Participants (N=628) were administered The Dissociative Disorders Interview Schedule, the Borderline Personality Disorder section of the Structured Clinical Interview for DSM-III-R Personality Disorders, and the PTSD Module of the Structured Clinical Interview for DSM-III-R; 48.7% of participants had a lifetime history of a conversion symptom. They reported various types of childhood abuse and neglect more frequently than nonconversion subjects. RESULTS: Lifetime diagnosis of major depression, dissociative disorder, and childhood physical abuse predicted a conversion symptom. Effects of childhood neglect and emotional and sexual abuse among subjects with conversion symptoms were mediated by comorbid lifetime diagnosis of major depression and dissociative disorders. CONCLUSION: The authors suggest revisions to the DSM-V regarding conversion and somatization disorders.

Effects of light curing modes and resin composites on temperature rise under human dentin: an in vitro study.

The influence of three curing modes of a high-powered LED curing unit on temperature rise under 2-mm-thick dentin was investigated during the polymerization of resin composite samples of Admira, Filtek P60, Premise, Tetric Flow, Tetric Ceram, and Filtek Z250. Ninety standard specimens were prepared. The bonding agents and resin composites were cured with standard, pulse, or soft-start mode (n=5 for each curing mode). Temperature rise was measured using a type L thermocouple. Data were analyzed by two-way ANOVA and Tukey's test. Soft-start curing led to statistically higher temperature rises compared than the other two modes. The highest temperature rise was observed for Admira and Tetric Flow cured with soft-start mode. The lowest temperature rise was observed for Premise cured with pulse mode. However, temperature rise did not reach the critical value that can cause pulpal damage by virtue of a prominent safety feature of the high-powered LED LCU, which ensures that no excessive heat is produced by all the three curing modes.

Effect of bleaching on color change and refractive index of dental composite resins.

This study investigated the effects of three bleaching agents (Whiteness Perfect, Whiteness Super, and Whiteness HP) on the color change and refractive index of three dental composites (Admira, Durafill VS, and Gradia Direct). Twenty disk-shaped specimens (10 x 2 mm) of each composite were prepared and divided into four subgroups (n=5). An unbleached group was used as a control, while the remaining specimens in the three subgroups were bleached with one of the bleaching agents respectively. Color change was assessed according to CIELAB color system and refractive indices were determined by phase modulated spectroscopic ellipsometry. Color differences between bleaching and baseline value (DeltaE) were less than 3.3 for all groups. However, bleaching with Whiteness HP led to noticeable color changes for Admira and Durafill VS. While this agent had no effect on the refractive indices of these composites, the other two agents containing carbamide peroxide increased their refractive indices. Therefore, results suggested that replacement of such composite restorations may be required after bleaching.

The evaluation of some flexural properties of a denture base resin reinforced with various aesthetic fibers.

This study was performed to determine whether some flexural properties of a denture base resin material could be improved through reinforcement with five types of aesthetic fibers at 3% concentration by weight and in 2, 4, and 6 mm length. Five specimens of similar dimensions were prepared for each of the test groups; base resin and the same resin with glass, rayon, polyester, nylon 6 and nylon 6,6 fibers in three different lengths. Flexural properties were evaluated by using a 3-point bending test. A visual examination was also made to determine mode of fracture of the specimens. The incorporation of different fibers in varying lengths had no significant effect on flexural strength of the resin. The specimens reinforced with nylon 6,6 fibers of 6 mm length showed the highest flexural strength. Young's modulus and maximum load suggests that such reinforcement makes resin resistant to fracture.

Primary cardiac angiosarcoma: a case report.

Primary tumors of the heart are rarely seen. Cardiac angiosarcomas are malignant tumors that almost always have a poor prognosis. We describe a 29-year-old man with primary cardiac angiosarcoma with multiple site metastases. The therapeutic approach includes surgery, chemotherapy and radiotherapy alone or in combination. New techniques of radiotherapy and combined chemotherapeutic agents may relieve symptoms and prolong a patient's life. We discuss the diagnosis and treatment of cardiac angiosarcoma in the light of a case report.