Factors affecting dural penetration and prognosis in patients admitted to emergency department with cranial gunshot wound.

PURPOSE: To explore the effect of admission physical examination findings, anamnesis, and computed tomography on dural penetration and prognosis in patients with cranial gunshot wound (CGW). METHODS: In this study, the medical data of 56 subjects who were admitted to the Emergency Department of Dicle University Hospital with CGWs between January 2011 and December 2013 were retrospectively reviewed. The effects of type of incident (suicidal vs non-suicidal), pupil diameter and light reflex, hemodynamic status, type (bullet or pellet), velocity, trajectory of foreign material, trauma scores, and imaging findings on dural penetration and mortality were explored. RESULTS: The mean age of the study population was 24.8 ± 13.50 years. Thirty (53.6 %) patients had penetrating injuries and 26 (46.4 %) had non-penetrating injuries; 9 (16.1 %) patients died and 47 (83.9 %) survived. Suicidal injury, pupil diameter and light reflex, bullet as foreign material, and high velocity and lateral trajectory of foreign material significantly affected dural penetration and mortality (p < 0.05). In addition, dural penetration, bilobar, multilobar, or bihemispheric involvement of brain parenchyma, presence of intracranial hemorrhage, subarachnoid hemorrhage, ventricular hemorrhage, fracture, shift, edema, and trauma scores significantly affected mortality (p < 0.05). CONCLUSIONS: In CGWs, dural penetration and prognosis can be predicted by physical examination findings and patient characteristics on initial admission.

Management of high-grade renal injury in children.

INTRODUCTION: The management of severe renal trauma is disputable. Herein, we present diagnosis and treatment of patients with high-grade renal injury (grades IV and V). MATERIALS AND METHODS: The records of 31 patients with severe renal trauma who were treated between 2009 and 2014 were analyzed retrospectively. All patients' CT results were evaluated by two radiologists and assigned grades of IV or V in accordance with the American Association for the Surgery of Trauma Organ Injury Severity Scale. All hemodynamically stable renal trauma patients were treated conservatively. Patients with renal traumas of grade IV and V were evaluated statistically via the SPSS 15.0 software program. Chi-square and Mann-Whitney U tests were used to evaluate the categorical data. RESULTS: Thirteen (42 %) of 31 patients had grade IV, and 18 (58 %) had grade V renal traumas. Twenty-seven (87 %) of the patients had suffered blunt trauma, and four (13 %) had sustained penetrating injuries. Additional organ injuries were seen in 16 patients (52 %), and 15 (48 %) had no concurrent injuries. Twenty-five patients (89 %) were monitored conservatively, three (10 %) underwent surgery, and three patients with grade V renal trauma and additional organ injuries died. There was no statistically significant difference between the grade IV and grade V groups, except in hemoglobin values and the affected kidney (P = 0.07 and P = 0.02, respectively). CONCLUSIONS: Computerized tomography can help to grade renal injury and assess additional organ injuries quickly. Most children with high-grade renal injury can be managed conservatively. However, conservative management of renal traumas relies on a multidisciplinary approach. Additionally, surgical intervention is generally required in the face of hemodynamic instability or other concurrent organ injuries.

Gastrointestinal tract duplications in children.

AIM: Gastrointestinal tract duplications (GTD) are rare congenital abnormalities that can occur anywhere along the gastrointestinal tract. These anomalies may present as a single, multiple, or a vague pathologies. Diagnosing and treating these diseases may be difficult in some patients. We aimed to present 32 patients who were followed and treated in our clinic. PATIENTS AND METHODS: This study included the patients between 2000 and 2013. Evaluations included clinical presentations, diagnostic strategies and algorithms, surgical procedures and associated anomalies, and presence of ectopic tissue, complications, and prognosis. RESULTS: Common clinical presentations included vomiting (n=8; 25%), palpable abdominal mass (n=4; 13%). Twenty-eight patients (2 of them antenatally) were diagnosed preoperatively while four of them were diagnosed at surgery. Ileal duplications constituted the most common type (34%) while the least common ones were located in appendix, thoracoabdomen and rectum. One of our patients was present with a gastric duplication which was closely interconnected to a tubular duplication of esophagus, which had never been encountered in the literature before. CONCLUSIONS: It is crucial to note that duplications are likely to occur in various types and numbers and also may accompany other anomalies. Computed Tomography (CT) remains the method of choice since Magnetic Resonance (MR) is likely to cause the use of sedation and analgesia at very young ages and it may also be relatively costly despite being more sensitive in soft tissues. Mucosal stripping is an ideal method for the patients requiring restricted surgery. The antenatal asymptomatic cases can be operated after their 6th months of age.

Effects of erbium,chromium:YSGG laser irradiation on root canal walls: a scanning electron microscopic and thermographic study.

The present study evaluates the morphological changes in root canal walls and temperature changes at root surfaces as a result of intracanal irradiation by erbium,chromium:YSGG laser under various conditions in vitro. Sixty single-rooted human teeth were examined. Root canals were prepared, and laser irradiation was performed using an optic fiber at output powers ranging from 1 to 6 W with or without water spray cooling. Specimens were evaluated by stereoscopy, scanning electron microscopy, and thermography. Carbonization and cracks were observed in all samples irradiated without cooling, whereas little or no carbonization and no smear layer or debris were observed in samples irradiated with cooling. Maximum temperature rise at irradiation without cooling was above 37 degrees C, whereas that at irradiation with cooling was 8 degrees C. Results of the present study indicate that erbium,chromium:YSGG laser irradiation with water spray cooling is a useful method for removal of smear layer and debris from root canals.

Effects of pulsed Nd:YAG laser irradiation on smear layer at the apical stop and apical leakage after obturation.

AIM: This study evaluated the removal of smear layer at the apical stop by pulsed Nd:YAG laser irradiation with or without black ink, and the degree of apical leakage after obturation in vitro. METHODOLOGY: Sixty extracted human single-rooted teeth were used in this study. The teeth were instrumented up to a size 40 K-file, and then divided into three groups of 20 teeth each: group 1 was unlased as a control group; group 2 was treated with a laser; group 3 was treated with a laser and black ink. The laser was operated at 2 W and 20 pp for 2 s, and irradiation was performed twice with a 30-s interval. In each group, 10 teeth for the leakage study were obturated and immersed in rhodamine B solution for 48 h at 37 degrees C, and the others were used for evaluation of remaining smear layer. All teeth were bisected longitudinally and observed by stereoscopy or scanning electron microscopy. RESULTS: The smear layer in the laser-treated groups almost melted or evaporated, and was removed significantly compared with the control group (P < 0.05). Leakage was observed in 60% of samples in group 1 and in 20% of samples in group 2. No leakage was observed in group 3, which was significantly different from the control (P < 0.05). CONCLUSIONS: These results suggest that pulsed Nd:YAG laser irradiation with black ink increases the removal of smear layer compared with that without black ink, and reduces apical leakage after obturation significantly.

A comparative study on the effects of three types of laser irradiation at the apical stop and apical leakage after obturation.

OBJECTIVE: The purposes of this study were to determine the degree of apical leakage using a dye penetration method after argon, pulsed Nd:YAG with or without black ink, or Er:YAG laser treatment and obturation, and to compare the results of three types of laser irradiation in vitro. SUMMARY BACKGROUND DATA: There have been only a few reports of the laser effect on apical leakage after laser treatment and obturation. METHODS: Seventy-five human extracted single root teeth were divided into five groups of 15 teeth each and prepared up to a #60 K-file size. One group served as the control and was not irradiated. The other four groups were irradiated with an argon laser at 0.3 W for 3 seconds at continuous mode, pulsed Nd:YAG laser at 2 W and 20 Hz for 4 seconds with or without black ink, and Er:YAG laser at 50 mJ per pulse and 4 Hz for 5 seconds. In each group, ten teeth for the apical leakage study were obturated and immersed in rhodamine B solution for 48 hours at 37 degrees C, and the others were used for the observation by scanning electron microscopy (SEM). All teeth were longitudinally bisected and observed by stereoscopy or SEM. RESULTS: After pulsed Nd:YAG laser treatment with black ink and obturation, the apical leakage degree (mean score: 0) was reduced compared to that in the control (mean score: 1.2) significantly (p < 0.05). SEM findings showed that specimens irradiated by pulsed Nd:YAG laser with black ink presented clean root canal walls with debris and smear layer evaporated, melted, fused, and recrystallized in most cases. CONCLUSION: These results suggest that pulsed Nd:YAG laser irradiation with black ink at the apical stop is useful for the reduction of apical leakage after obturation.

Study on apical leakage of the teeth after argon laser treatment and obturation.

OBJECTIVE: This study was performed to compare the apical leakage degree after laser treatment and obturation with that without laser treatment, and to evaluate the efficiency of argon laser irradiation in removing debris and smear layer from the prepared root canal walls in vitro. SUMMARY BACKGROUND DATA: There has been no report of laser effect on apical leakage after laser treatment and obturation. METHODS: Fifty-six human extracted single root teeth were used in this study. Teeth were divided into four groups of 14 teeth each and prepared up to a #60 K-file size at 1 mm short of the apical foramen using a step-back technique. Argon laser at the wavelength of 470 nm and at the output of 0.3 W was irradiated at apical stop for 1, 2, or 3 seconds at the continuous mode. In each group, ten teeth for the microleakage study were obturated and immersed in rhodamine B solution for 48 hours at 37 degrees C, and the others were used for the observation by scanning electron microscopy (SEM). All teeth were bisected longitudinally and observed by stereoscopy or SEM. RESULTS: The apical leakage degree after laser treatment and obturation was reduced compared to that in the control, but not significantly (p > 0.05). However, debris and smear layer in the laser-treated groups were removed from apical stop even at low energy density. CONCLUSIONS: These results suggest that apical leakage after argon laser treatment is not reduced significantly, but that argon laser is useful for removing debris and smear layer from root canals.

Secuelas oculares debidas a infección herpética en un grupo de niños chilenos / Ocular sequels caused by herpetic infection in chilean children

Estudio prospectivo, multicéntrico, en el cual investigadores entrenados seleccionaron y siguieron clínica y virológicamente (aislamiento viral, anticuerpos monoclonales y PCR) pacientes de 0 a 18 años de edad con diagnóstico clínico de infección ocular por HSV. Se efectuó determinación de la agudeza visual (AV) por el Test de Mirada Preferencial, HOTV, E Snellen u optotipos de Snellen, con la mejor corrección óptica, examen refractivo bajo cicloplegia, estudio completo de estrabismo, topografía, paquimetría y fotografía. Se enrolaron entre 1993 a 1997 16 niños, dos de ellos con compromiso bilateral (18 ojos). En todos salvo un niño, se identificó HSV tipo I. Mediana de edad 5 años. El diagnóstico de ingreso fue el edema disciforme en 45 por ciento y en 33 por ciento de los casos una queratitis epitelial dendrítica. El 87,5 por ciento de los pacientes con edema disciforme presentó al menos una recurrencia por año. Los pacientes con compromiso epiteliar presentaron en todos los casos AV > 20/40, a diferencia de los pacientes con edema disciforme en que 71,4 por ciento presentaron AV final < de 20/50. El leucoma corneal fue severo en 62,5 por ciento de los ojos con edema disciforme y desarrollaron estrabismo 50 por ciento de los casos. En tres casos se requiere trasplante corneal. La enfermedad ocular herpética afecta principalmente a población joven y sana. El diagnóstico más frecuente fue el edema disciforme que presentó evolución crónica, requirió un gran número de consultas médicas y de tratamiento prolongado (entre 3 y 6 meses) y presentaron la mayor frecuencia de secualas. En general, el 78 por ciento de los pacientes estudiados desarrolló algún tipo de secuela visual