Eosinophil cationic protein: A new diagnostic biomarker in coronary slow flow phenomenon.

AIM: This study has investigated the role of eosinophil cationic protein (ECP), released by eosinophils, in the coronary slow flow phenomenon. METHODS: This study included sixty patients with coronary slow flow (CSF) and sixty patients with normal coronary flow. The coronary flow rate was evaluated with TIMI frame count (TFC). ECP level, blood count and biochemical parameters were assessed. RESULTS: The ECP levels (18.9±7.5 vs 13.1±6.4 ng/ml, p<0.001) and eosinophil counts (0.25±0.14 vs 0.18±0.09 10³/mm³, p=0.001) were higher in the CSF group. Multivariable regression analysis showed that ECP level and eosinophil counts were independent predictors the presence of CSF (p=0.003 and p=0.006). There was a weak but important correlation among the ECP level, eosinophil count and mean TFC (p=0.001, p=0.003, respectively). The ROC analysis showed a cut off value of 14.05 ng/ml for ECP level to diagnose CSF with 73.3 % sensitivity and 66.7 % specificity, and area under the ROC curve was 0.745 (95% CI: 0.657-0.833, p<0.001). CONCLUSION: ECP levels were increased in CSF patients and this increasing correlated with coronary artery flow rates. The ECP level was independent predictor for the presence of SCF and it may be use as suitable diagnostic biomarker for CSF (Tab. 3, Fig. 3, Ref. 30).

A rare complication of pica: Stone aspiration with severe respiratory distress.

Tracheobronchial foreign body aspiration (FBA), a common pediatric presentation to emergency departments, is still a public healthcare problem affecting children all over the world. There are several types of foreign bodies reported from different parts of the world, including both organic or nonorganic substances. Pica, another interesting clinical entity, is characterized by persistent eating of nonnutritive substances, which is inappropriate for the maturation stage of the individual. A 3-year-old pediatric patient was admitted to our emergency department with a 3-day history of coughing and new onset respiratory distress. A chest X-ray was performed and it showed a suspicious radiopaque foreign body in the localization of left bronchi. Urgent rigid bronchoscopy was performed. The foreign body in the left main bronchi was, surprisingly, a 0.5-1 cm diameter, irregularly shaped stone particle. The laboratory evaluations and patient history revealed the diagnosis of severe iron deficiency anemia and accompanying pica. Stone aspiration, as an FBA, is a rare but potentially life-threatening complication of pica. Iron deficiency anemia accompanied by pica should be diagnosed and treated in the early stage of the disease because of their complications. According to our knowledge and literature search, this is the first case of stone aspiration as a complication of severe iron deficiency anemia and pica.

The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis.

BACKGROUND: An accepted comprehensive clinical approach to the deformed spine with tuberculous infection is still lacking. We aimed to determine the usage of a staged algorithm in the treatment of kyphotic spine with tuberculous infection and to present the clinical results of the patients treated with the help of this protocol. MATERIALS AND METHODS: 54 patients (28 females, 26 males) with a mean age of 39.2 (22-76) years. Preoperative, early postoperative, and followup clinical and radiologic results were evaluated retrospectively. The patients were classified into Kaplan A (kyphotic deformity <30°), Kaplan B (kyphotic deformity 30°-60°) and Kaplan C (kyphotic deformity >60°). They were operated by posterior instrument with anterior debridment (Kaplan A), debridment with anterior bone grafting (Kaplan B) and anterior column resection and bone grafting in Kaplan C. RESULTS: Tuberculous involvement were seen at more than one level in 40 patients and paraspinal abscess were detected in 31. Preoperative focal kyphotic deformity was reconstructed with an average of 19 (9-38) degrees. Twenty-six patients had neurologic compromise with different severities and 12 of them improved after the surgical intervention. Improvement in work ability and pain status was detected in 52% and 61% of the patients, respectively. Wound complications responding to medical care were detected in nine patients. Initial kyphotic deformity was found as an important parameter in selecting the surgical procedure. CONCLUSION: Regarding resected amount of infected osseous material, as planned preoperatively, have resulted with better concordance between anterior and posterior column heights and better sagittal alignment. We could correct kyphosis and improve sagittal balance with staged algorithm as used by us.

The diffusion of nimesulide gel into synovial fluid: a comparison between administration routes.

BACKGROUND: Nimesulide is available in gel formulation and applied mainly for topical pain management. However, its passage to the synovial fluid is not yet clear. The aim of this study was to evaluate if topical administered nimesulide passes into the synovial fluid and to compare its concentration with the oral nimesulide administration regimen. METHODS: Synovia and plasma nimesulide concentrations were investigated in patients after topical (Sulidin gel 1%) and oral (Mesulid tablet) drug administration. 34 adult outpatients who were scheduled to have an arthroscopic knee examination for mainly meniscal tears repair and who had knee pain during this period were enrolled in the first part of the study. One group received topical nimesulide gel to the skin of the knee whereas the second group received oral 2 x 100 mg nimesulide tablets, 4-7 days before the planned arthroscopy. Synovial fluid and plasma samples were taken simultaneously during the arthroscopy and analyzed using HPLC. In addition, an open-label pilot study was performed to investigate the efficacy and safety of 1-week administration of nimesulide gel. 63 knee osteoarthritis patients were asked to complete the WOMAC Osteoarthritis Index questionnaire before and 1 week after use of Sulidin gel applied 3 times daily. RESULTS: Synovia and plasma nimesulide concentrations were 19.7 +/- 8.6, 11.8 +/- 3.0 and 1958.8 +/- 397.5, 3631.9 +/- 799.3 ng/ ml for topical and oral administration groups, respectively. There was a significant (paired Student's t-test) improvement after 1 week nimesulide treatment in all WOMAC Osteoarthritis Index parameters measured. CONCLUSION: Nimesulide passes into the synovial fluid after topical administration and may have potential benefits in knee osteoarthritis treatment. The actual efficacy and safety of topical nimesulide gel administration should be investigated in a long-term, randomized, placebo-controlled clinical trial.

Effect of fluorosis on dentine shear bond strength of a self-etching bonding system.

The purpose of this study was to investigate the effect of dental fluorosis on shear bond strength of a composite material to dentine. Forty human premolar teeth were classified according to the severity of fluorosis using the Thylstrup and Fejerskov index and were divided into four groups (TFI scores of 0, 3, 4 and 5) of 10 teeth. Non-fluorosed teeth (TFI score of 0) served as the control group. A self-etching light-cured bonding system, Clearfil SE Bond, and a micro-hybrid light-cured composite, Clearfil AP-X were selected for the study. Buccal surfaces of mounted teeth were ground flat to expose the dentine. Composite cylinders, 4 mm diameter and 4 mm length, were bonded to the treated dentine surfaces. Shear bond strength was measured with an universal testing machine at a cross-head speed of 0.5 mm min-1. After failure, the fracture surfaces were examined under a stereo microscope. The mean bond strength was 24.37 +/- 3.54 MPa for non-fluorosed teeth and varied between 22.72 +/- 3.52 and 27.02 +/- 5.91 MPa for fluorosed teeth. The difference between the mean values for bond strength was not statistically significant (P > 0.05). Adhesive mode of failure was most prevalent in non-fluorosed teeth. It can be concluded that fluorosis does not affect the shear bond strength of composite material to human dentine.

Delayed replantation of avulsed mature teeth with calcium hydroxide treatment.

Three avulsed teeth that were replanted and splinted after approximately a 200-min dry extraoral period in two patients are presented. In case 1 calcium hydroxide treatment was performed 1 month after replantation, because the patient did not come for endodontic treatment on the day after replantation as requested. In case 2, calcium hydroxide treatment was initiated on the day after replantation. Calcium hydroxide treatment was used to prevent or treat inflammatory root resorption. During the follow-up periods the teeth reported in these cases have remained in a stable, functional position and did not reveal clinical ankylosis or replacement resorption.

An investigation of temperature and stress distribution on a restored maxillary second premolar tooth using a three-dimensional finite element method.

This paper presents the stress analysis of the maxillary second premolar tooth under thermal loading as a result of hot/cold liquid in the mouth using the three-dimensional (3D) finite element method (FEM). The tooth was considered to be in a restored state with composite resin and amalgam on glass-ionomer as the base material. In the first step of the study, the temperature changes as a result of hot/cold liquid in the mouth were calculated. The thermal stress distributions owing to the temperature changes were then obtained. All calculation programs were prepared by the authors using FORTRAN 77. The tooth was assumed to be isotropic, homogeneous, elastic and unsymmetric. The distribution of temperature and stress were plotted for some critical points.

Evaluation of the effects of different biomaterials on bone defects.

Studies concerning natural and synthetic graft materials that have been used in different medical procedures have focused on freeze-dried bone, coral, hydroxylapatite, and tricalcium phosphate. This study histologically investigates the effects of these materials on the healing of bone defects. The experiments were performed on 30 albino rabbits. Cavities were drilled in the posterior right tibias of rabbits and were filled with coral, freeze-dried bone, hydroxylapatite, or calcium hydroxide. One cavity was left unfilled as a control. The bone in which the materials were implanted was excised at 7, 15, 30, 45, and 60 days. After the histological staining procedures, the prepared materials were observed using a light microscope. Although all materials showed good bone remodeling at the end of 60 days, coral and hydroxylapatite materials could be seen in the bone structure. The most effective materials within bone defect improvement were freeze-dried bone and calcium hydroxide.

An investigation of the stress values on a tooth restored by amalgam.

The study was carried out in two stages: (1) MOD amalgam cavities were prepared on maxillary second premolars and three strain gauges were attached to the palatal surface of each tooth. The teeth were filled using amalgam with and without base material (glass-ionomer). Stresses occurred during the hardening phase and also through mastication and were measured by strain-gauge rosettes. (2) The stresses which occurred at the same points were calculated by the finite element method and compared with the values obtained experimentally. The highest stress values were observed when no base material was used.

Analysis of a restored maxillary second premolar tooth by using three-dimensional finite element method.

In the first part of this study some physical properties of restorative materials, amalgam, glass-ionomer and composite resin were measured experimentally. In the second part a numerical study was carried out, for which the maxillary second premolar tooth was used. The tooth model was restored with composite resin and amalgam on glass-ionomer, which was used as the base material. The stress distribution investigated was the resultant of the stresses which come from the mastication force and those resulting from the contraction and expansion of restorative materials. All calculations were carried out using the finite element method and programs were written using FORTRAN 77. A load of 450 N, at an angle of 45 degrees to the longitudinal axis was applied on the occlusal margin of the tooth. The tooth was assumed isotropic, homogenous, elastic and unsymmetrical. The distribution of compressive, tensile and shear stresses were plotted for the whole tooth structure.