Characteristics of traumatic spinal cord injuries in south-eastern Anatolia, Turkey: a comparative approach to 10 years' experience

The purpose of this study was to determine the demographic and epidemiological characteristics of traumatic spinal cord-injured patients. The hospital records of 539 patients (416 men, 123 women) with spinal cord injuries (SCIs) admitted to four hospitals that were major referral centers for trauma in the south-eastern region of Turkey from 1990 to 1999 were reviewed retrospectively. The patients with SCI were investigated for two periods; the first period covered patients admitted between 1990 and 1994 during which time an influx of people from rural to urban areas occurred and firearm injuries were common. In the second period (1995-1999) the influx of people declined and firearm injuries were reduced. The most common causes of injuries were road traffic accidents (200, 37.12%), followed by falls (172, 31.90%) and bullet wounds (115, 21.34%). In the first period, incomplete paraplegia was encountered more often than in the second period (P<0.001). In conclusion, in our series, while the leading cause of SCI for the two time periods was road traffic accidents, firearm injuries for the first period and falls for the second period were second-most frequent causes of SCI. In addition, the present study suggests that demographic and epidemiological factors may affect the characteristics of SCI in a region-based population even in a 10-year period of time.     

Magnetic resonance spectroscopy of premalignant and malignant endometrial disorders: a feasibility of in vivo study

OBJECTIVE: To assess the potential clinical utility of in vivo proton magnetic resonance spectroscopy (MRS) in patients with various endometrial lesions. METHODS: Twelve patients with untreated uterine bleeding were included in this study. In-vivo proton MRS was performed using a 1.5 T MR scanner. The metabolite levels were classified into three classes in comparison with the noise level by visual examination. All the patients have endometrial biopsy. For each type of lesions, chemical compound were described. RESULTS: Pathological examination resulted in three endometrial cancer, two simple hyperplasias, one complex hyperplasia, two partial hydatiform mole, two proliferative endometrium and two secretory endometrium. In women with endometrial carcinoma, high choline and lipid signals were detected, whereas no creatine and no lactate signals were found. In women with endometrial hyperplasia, choline signal was detectable in all cases but one case showed lactate signal in addition to choline. In women with partial hydatidiform mole, the only detectable signal was choline. Lipid signals were detected in none of the cases with endometrial hyperplasia and partial hidatidiform mole. In women with either secretory or proliferative endometrium, choline and lactate signals were detectable in all cases but one case showed solely choline. Lipid signals were not detected in any of subjects with secretory or proliferative endometrium. CONCLUSION: The observed difference is the presence of lipid signal only in endometrial carcinoma.     

Metabolic changes in pelvic lesions: findings at proton MR spectroscopic imaging

OBJECTIVE: The purpose of this study is to investigate the in vivo magnetic resonance spectroscopic (MRS) features of pelvic lesions using long echo time and to characterize the spectral patterns of various pathological entities. MATERIALS AND METHODS: 17 patients with surgically and histopathologically confirmed pelvic lesions underwent long echo-time MRS, and the results obtained were analyzed. Before laparotomy, choline (Cho), lactate, lipid and creatine (Cr) levels of all lesions were measured by single voxel MRS (point-resolved spectroscopy technique, TE 136 ms). Voxels were placed in the center of the lesions. The MRS results of lesions were compared with the final histopathological diagnoses. RESULTS: Spectroscopy analysis of serous, mucinous and undifferentiated carcinoma of the ovary revealed Cho, lactate and lipid signals, but granulosa-theca cell tumor showed only a lipid signal. The Cho signal was obtained from only 3 patients with mature cystic teratoma but none of the other benign ovarian tumors and pelvic abscesses. A lipid signal was detected in 3 patients diagnosed with pelvic abscess and all benign ovarian tumors. In addition to the lipid signal, a lactate signal was detected in the spectra of two pelvic abscesses. One case of endometrioma and 1 case of teratoma did not show any signal. CONCLUSION: MRS demonstrates significant differences in metabolite concentration between benign and malignant ovarian tumors and pelvic abscesses. MRS may therefore be helpful in the differential diagnosis of adnexal lesions.     

Effect of the dentin cleansing techniques on dentin wetting and on the bond strength of a resin luting agent

STATEMENT OF PROBLEM: Remnants of the provisional cement on prepared teeth may have an adverse effect on the performance of the definitive luting agent. PURPOSE: This in vitro study investigated the effect of different dentin cleansing techniques on the bond strength of a resin luting agent and dentin wetting. MATERIAL AND METHODS: Sixty buccal or lingual coronal portions of human molar teeth were mounted, with the buccal or lingual surfaces up, in acrylic resin blocks. The specimens were prepared until the dentin was exposed and a eugenol-containing provisional cement (Temp Bond) was applied to the dentin surfaces. After mechanical removal of the cement with a carving instrument, specimens were divided into 6 groups of 10 specimens each. The dentin surfaces of the specimens were treated with 1 of 5 cleansing techniques: Group S, cleansing agent (Sikko Tim); Group C, cleansing agent (Cavity Cleanser); Group O, rotary instrumentation (OptiClean); Group OS, rotary instrument preceding Sikko Tim; and Group OC, rotary instrumentation preceding Cavity Cleanser. The remaning 10 specimens were untreated and served as controls (CT). An adhesive resin luting agent (Variolink II) was applied to all specimens. Shear bond strength (MPa) was measured using a universal testing machine at a 0.5 mm/min crosshead speed. To measure the contact angle, another 6 groups (n=5) were prepared using the same methods. Contact angle measurements were performed to assess wettability using the Axisymmetric Drop Shape Analysis-Contact Diameter (ADSA-CD) technique. Wettability measurements were made with water. Data were statistically analyzed by 1-way analysis of variance with Tukey HSD tests (alpha=.05). The effect of the dentin cleansing techniques on removing the provisional cement from the dentin surface was examined with scanning electron microscope (SEM). RESULTS: Specimens cleaned with all techniques showed stronger shear bond strength values than control specimens (P<.001), with the exception of C specimens. The surface cleansing techniques tested affected the dentin wetting significantly in comparison with the control group (P<.001), except for the C and the O groups. There was no significant difference in wetting between the groups C and O. The SEM observations demonstrated that the dentin cleansing techniques left differing amounts of provisional cement remnants. CONCLUSION: Specimens treated with only the cleansing agent Sikko Tim showed the highest bond strength, likely due to the solvent effect of Sikko Tim on the removal of provisional cement. The lowest bond strength was obtained with the rotary instrument. It was concluded that the provisional cement could plug the dentinal tubules into which the resin luting agent penetrates.     

Contemporary management of wartime vascular trauma

OBJECTIVE: The treatment of wartime injuries has led to advances in the diagnosis and treatment of vascular trauma. Recent experience has stimulated a reappraisal of the management of such injuries, specifically assessing the effect of explosive devices on injury patterns and treatment strategies. The objective of this report is to provide a single-institution analysis of injury patterns and management strategies in the care of modern wartime vascular injuries. METHODS: From December 2001 through March 2004, all wartime evacuees evaluated at a single institution were prospectively entered into a database and retrospectively reviewed. Data collected included site, type, and mechanism of vascular injury; associated trauma; type of vascular repair; initial outcome; occult injury; amputation rate; and complication. Liberal application of arteriography was used to assess these injuries. The results of that diagnostic and therapeutic approach, particularly as it related to the care of the blast-injured patient, are reviewed. RESULTS: Of 3057 soldiers evacuated for medical evaluation, 1524 (50%) sustained battle injuries. Known or suspected vascular injuries occurred in 107 (7%) patients, and these patients comprised the study group. Sixty-eight (64%) patients were wounded by explosive devices, 27 (25%) were wounded by gunshots, and 12 (11%) experienced blunt traumatic injury. The majority of injuries (59/66 [88%]) occurred in the extremities. Nearly half (48/107) of the patients underwent vascular repair in a forward hospital in Iraq or Afghanistan. Twenty-eight (26%) required additional operative intervention on arrival in the United States. Vascular injuries were associated with bony fracture in 37% of soldiers. Twenty-one of the 107 had a primary amputation performed before evacuation. Amputation after vascular repair occurred in 8 patients. Of those, 5 had mangled extremities associated with contaminated wounds and infected grafts. Sixty-seven (63%) patients underwent diagnostic angiography. The most common indication was mechanism of injury (42%), followed by abnormal examination (33%), operative planning (18%), or evaluation of a repair (7%). CONCLUSIONS: This interim report represents the largest analysis of US military vascular injuries in more than 30 years. Wounding patterns reflect past experience with a high percentage of extremity injuries. Management of arterial repair with autologous vein graft remains the treatment of choice. Repairs in contaminated wound beds should be avoided. An increase in injuries from improvised explosive devices in modern conflict warrants the more liberal application of contrast arteriography. Endovascular techniques have advanced the contemporary management and proved valuable in the treatment of select wartime vascular injuries.     

Percutaneous Right Portal Vein Embolization with Polyvinyl Alcohol Particles in Gastric Cancer Metastasis: Report of a Case

Polyvinyl alcohol (PVA) particles are used for the embolization of various vascular tumors. They are also used before hepatic resection to embolize the ipsilateral portal vein, causing hypertrophy of the remaining liver. We report our first experience with portal vein embolization (PVE) with PVA particles to treat gastric cancer metastasis to the liver. PVE with PVA is a safe interventional radiologic procedure, which does not cause problems during surgery and can improve the outcome of hepatic resection.     

Bone mineral density and cytokine levels during interferon therapy in children with chronic hepatitis B: does interferon therapy prevent from osteoporosis?

Background  

Our aim was to determinate bone mineral density (BMD), levels of biochemical markers and cytokines in children with chronic hepatitis B treated with interferon (IFN)-alpha and to investigate effect of IFN-alpha therapy on these variables. To the best of our knowledge, this is first study carried out about BMD and cytokine levels in pediatric patients with chronic hepatitis B treated with IFN-alpha.