Surgical and prosthodontic treatment using alveolar distraction osteogenesis and implant placement for a patient with mandibular prognathism: a clinical report

A 49-year-old patient presented with an Angle Class III malocclusion with a partially edentulous mandible, as diagnosed by orofacial examination and radiographic and cephalometric analyses. The patient refused orthognathic surgery; therefore, the treatment plan included the preparation of all teeth and fabrication of provisional restorations to reestablish optimal occlusion. To allow for the placement of 3 implants, the edentulous posterior mandibular ridge was improved via alveolar distraction. The patient was recalled 3, 6, 12, and 24 months after prosthodontic treatment. The oral situation was stable and patient satisfaction was reported as high.     

Reconstruction of congenital and acquired columellar defects: clinical review of 38 patients

ABSTRACT: Reconstruction of columella presents certain difficulties and includes reconstruction of the cartilaginous strut and the overlying skin to obtain good results. We conducted a retrospective clinical review of 38 patients presenting with congenital and acquired columellar defects. Anatomic characteristics to be considered were defined and a classification method is proposed to more fully describe columellar defects. The columellar defects of the patients were classified into three groups as follows: type I, skin defect of columella and absence of medial crura of lower lateral cartilage; type II, type II + partial absence of caudal part of septal cartilage; and type III, complex defect of columella accompanying with the other nasal subunit defects. The patients chosen in this study were designed to describe a common approach for the choice of the reconstruction method that provides excellent aesthetic result while minimizing the extent of the surgery and maximizing patient acceptance.     

Comparison of the proliferative activity in gingival epithelium after surgical treatments of intrabony defects with bioactive glass and bioabsorbable membrane

Guided tissue regeneration is based on preventing the more rapidly proliferating epithelium from growing into the periodontal defect after surgical procedures incorporating barrier membranes. The aim of this study was to compare the proliferative activity of gingival epithelium using proliferating cell nuclear antigen (PCNA) as a marker of cell proliferation after surgical treatments with bioactive glass graft material and bioabsorbable membrane. Using split mouth design, 20 intrabony defects were randomly assigned treatments with bioactive glass (BG group) or bioabsorbable membrane (BM group). Gingival biopsies were taken at preoperative and postoperative 12 weeks. After histological processing, the number of the inflammatory cells was measured in hematoxylin and eosin-stained sections; PCNA expression was determined in immunohistochemically-stained sections. At postoperative 12 weeks, the number of the inflammatory cells was significantly decreased (p < 0.01), PCNA expression was significantly increased (p < 0.001) in both treatment groups compared to baseline data. There was no significant difference in PCNA expression between baseline values of two groups (p > 0.05), while at postoperative 12 weeks, increase in BG group was significantly greater than that in BM group (p < 0.001). These results suggest that epithelial cell proliferation is more prominent after treatment of intrabony defects with bioactive glass compared to the treatment with bioabsorbable membrane.     

β‐adrenergic Receptor Blocker ICI 118,551 Selectively Increases Intermediate‐Conductance Calcium‐Activated Potassium Channel (IKCa)‐Mediated Relaxations in Rat Main Mesenteric Artery

Endothelial IK_Ca and/or SK_Ca channels play an important role in the control of vascular tone by participating in endothelium‐dependent relaxation. Whether β‐AR antagonists, mainly used in hypertension, affect endothelial K_Ca channel function is unknown. In this study, we examined the effect of the β2‐AR antagonist and inverse agonist ICI 118,551 on the IK_Ca/SK_Ca channel activity by assessing functional relaxation responses to several agonists that stimulate these channels. Mesenteric arterial rings isolated from male Sprague Dawley mounted to organ baths. Acetylcholine elicited IK_Ca‐ and SK_Ca‐mediated relaxations that were abolished by TRAM‐34 and apamin, respectively. ICI 118,551, which did not dilate the arteries per se, increased the IK_Ca‐mediated relaxations, whereas SK_Ca‐mediated relaxations remained unaltered. Same potentiating effect was also detected on the IK_Ca‐mediated relaxations to carbachol and A23187, but not to NS309. Neither acetylcholine‐induced nitric oxide‐mediated relaxations nor SNP relaxations changed with ICI 118,551. The PKA inhibitor KT‐5720, the selective β2‐AR agonist salbutamol, the selective β2‐AR antagonist butoxamine, the non‐selective β‐AR antagonist propranolol, and the inverse agonists carvedilol or nadolol failed to affect the IK_Ca‐mediated relaxations. ICI 118,551‐induced increase was not reversed by salbutamol or propranolol as well. Besides, low potassium‐induced relaxations in endothelium‐removed arteries remained the same in the presence of ICI 118,551. These data demonstrate a previously unrecognized action of ICI 118,551, the ability to potentiate endothelial IK_Ca channel‐mediated vasodilation, through a mechanism independent of β2‐AR antagonistic or inverse agonistic action. Instead, the enhancement of acetylcholine relaxation seems likely to occur by a mechanism secondary to endothelial calcium increase.     

Comparison of magnesium versus titanium screw fixation for biplane chevron medial malleolar osteotomy in the treatment of osteochondral lesions of the talus

European Journal of Orthopaedic Surgery & Traumatology - This retrospective study aimed to compare the clinical and radiological outcomes of patients who underwent biplane chevron medial...     

Recurrence of left atrial myxoma mimicking a mitral annuloplasty ring thrombosis

Cardiac myxomas (CM) is by far the most common type of primary cardiac neoplasm that commonly arise within the left atria and is composed of primitive connective tissue cells and stroma. Despite the benign nature, the CMs are often surgically removed because they can lead to severe complications. Large, thin, and hypermobile forms are unusual. The frequency of recurrence is about 22% for complex forms and 12% for other familial forms and 1% to 3% for sporadic myxomas, which seldom recur after surgery. Although transesophageal echocardiography shows usually accurate imaging capabilities to detect the myxoma, further imaging methods including computed tomography, cardiovascular magnetic resonance imaging, and ¹⁸F-fluorodeoxyglucose positron-emission tomography/computed tomography may be useful to diagnosis for it. Surgery is the mainstay of treatment     

Coronary artery thromboembolism: Unexpected presentation of left atrial myxoma covered with thrombus

Cardiac myxomas are benign primer cardiac tumors of the heart. They can be fatal with a thromboembolic presentation. Myocardial infarction is one of these unusual thromboembolic presentations. We report a patient who presented with cardiac arrest due to ventricular fibrillation related to myocardial infarction. After successful resuscitation, coronary angiography and transthoracic echocardiography were performed. A left atrial mass was observed and interpreted as a possible cause of coronary embolism leading to myocardial infarction. After surgical excision, the pathological examination confirmed myxoma, which was the essential cause of the tendency to arterial embolism.     

The principles of mechanical ventilation in ARDS

Acute respiratory distress syndrome (ARDS) is a real challenge for the pulmonary and critical care physicians. Although it is quite frequently encountered in intensive care clinics, its diagnosis and treatment bare many variations among the clinicians. Since ARDS is a fully dynamic process, there is no uniform application of mechanical ventilation (MV) being one of the inevitable components of ARDS management. This situation makes the clinicians very prone to make mistakes during setting and subsequent adjustments of mechanical ventilation parameters. In this review, we aimed to clarify the most common issues of discussion by presenting the principles of MV in ARDS with regard to some recent modifications.     

Relation of insulin resistance and left ventricular function and structure in non-diabetic patients with essential hypertension

OBJECTIVE: Both left ventricular hypertrophy and insulin resistance (IR) have often been demonstrated in patients with essential hypertension (EH). Insulin may exert a direct growth-promoting effect on cardiomyocytes. The purpose of this study was to examine the relationship between left ventricular structure, function and IR in patients with EH. METHODS: We enrolled 73 patients (21 men, mean age 51.7 +/- 9.2 years) with untreated hypertension (BP > 140 and/or 90 mm Hg, fasting glycaemia < 110 mg/dl) and 64 healthy subjects without diabetes mellitus and hypertension (21 men, mean age 48.9 +/- 10.6 years) constituted the control group. In all subjects, transthoracic echocardiography was performed and blood samples were taken. Homeostasis model assessment (HOMA) was calculated by the formula: HOMA-index = fasting blood glucose (mg/dl) * immunoreactive insulin (microU/ml)/405 for the assessment of IR. Hypertensive patients were divided in two groups by mean HOMA index values. Each subject was examined for LV end-diastolic diameter, septal and posterior wall thickness, LV mass index (LVMI), fractional shortening (FS), mitral inflow velocity pattern, atrial filling fraction (AFF), left ventricular outflow velocity pattern and the total ejection isovolume index (TEI index). RESULTS: The HOMA index (p < 0.001), LVMI (p < 0.001), AFF (p < 0.0001), peak A velocity (p < 0.028), septal (p < 0.0001) and posterior (p < 0.0001) wall thickness were significantly higher and FS (p < 0.001), E/A ratio (p < 0.0001) were significantly lower in hypertensive patients than healthy controls. LVMI (p < 0.01) and septal wall thickness (p < 0.001) were significantly higher in those hypertensive patients with a higher HOMA index. The HOMA-index was univariately related to the TEI index (r = 0.27, p = 0.01) and septal wall thickness (IVS) (r = 0.29, p = 0.01) by Pearson correlation analysis in hypertensive patients. LVMI, FS and mitral inflow velocity pattern were not related to the HOMA index. The TEI index (R2 = 0.20, p = 0.0001) and IVS (R2 = 0.12, p = 0.002) were significantly related to the HOMA-index as an independent variable by stepwise regression analysis. CONCLUSIONS: These results demonstrated that hypertensive patients had both abnormal cardiac structure and function and higher IR index. In our study group, the effect of hypertension on cardiac structure and function was correlated with IR. Our results suggested that IR might be an important factor causing left ventricular dysfunction and wall thickness in non-diabetic patients with EH.     

The utility of serum receptor-binding cancer antigen expressed on SiSo cells in gastrointestinal tract cancers.

BACKGROUND: Receptor-binding cancer antigen expressed on SiSo cells (RCAS1) is a novel tumour marker that has been described in various kinds of cancer. The majority of observations include immunohistochemical studies; however, there are not enough data about the utility of this antigen as a serum tumour marker and its tumour specificity. AIM: To measure the serum levels of RCAS1 in patients with gastrointestinal (GI) tract cancers and compare them with other GI tract tumour markers. PATIENTS AND METHODS: Sera collected from patients with GI cancers (14 esophagus, 32 gastric and 36 colon) and from healthy volunteers (30 individuals) were analyzed for RCAS1 and compared with carcinoembryonic antigen (CEA) and cancer antigen 19-9. The relationship between serum RCAS1, tumour stage and tumour grade was also evaluated. RESULTS: Mean serum RCAS1 level was higher in patients with GI tract cancers compared with the control group (P=0.001). Among GI tract cancers, RCAS1 had lowest and highest sensitivity for esophagus and colon cancer diagnosis, respectively. Serum RCAS1 had a higher sensitivity for malignancy, except in the colon, and lower specificity in all groups compared with CEA. In comparison with cancer antigen 19-9, serum RCAS1 was more sensitive but less specific for all GI cancer groups. Mean serum RCAS1 levels were not statistically significant among histopathological tumour types (P>0.05). Although serum RCAS1 levels were significantly higher in cases with lymph node involvement compared with lymph node-negative cases (P=0.009), there was no difference between cases with and without serosal involvement, vascular invasion and distant metastasis; no correlation was found between tumour size and RCAS1 levels. CONCLUSIONS: RCAS1 may be used and combined with CEA as a tumour marker in GI tract cancers.