Persistent subumbilical discharge associated with actinomycosis caused by intrauterine contraceptive device: a case report

Intrauterine devices are a very effective form of contraception used worldwide for more than 2 centuries. One of the serious, but rare, complications of intrauterine contraception is perforation through the uterine wall into the pelvic or abdominal cavity. In this report we describe, persistent periumbilical discharge associated actinomycosis caused by migration of a copper intrauterine contraceptive device. To our knowledge, this is the first report of persistent periumbilical discharge caused by migration of a copper intrauterine contraceptive device. We recommend consideration of this minor possibility during evaluation of women with chronic abdominal discharge.     

Pattern VEP is a useful technique in monitoring the effectiveness of occlusion therapy in amblyopic eyes under occlusion therapy

Purpose To evaluate the effectiveness and clinical significance of pattern visual evoked potential (P-VEP) parameters on visual acuity in amblyopic patients under occlusion therapy.Methods A total of 34 consecutive children with anisometropic amblyopia were included in this study. All patients underwent a full initial ophthalmologic and orthoptic evaluation. P-VEP test was performed in all cases and binocular vision was tested and recorded with Worths four-dot test and Bagolini striated glasses at each visit. Part-time occlusion therapy was performed by using adhesive patches.Results The mean (±SEM) cycloplegic refractive error was +5.6± 0.6 diopters (D) in the amblyopic eyes and +1.8±0.2 D in the normal eye. The mean levels of best-corrected visual acuity were statistically differed between each measurement for occlusion therapy (for each, p<0.05). The ratio of the patients with binocular vision increased after 6months occlusion therapy and the difference was statistically significant (p<0.05). In addition, P100 amplitude improved at each visit and the difference was significant when compared with baseline values (for each,p<0.05).Conclusions P100 amplitude of the P-VEP test parallels the improvement in subjective visual acuity in amblyopic eyes under occlusion therapy. Therefore, this test may be useful in monitoring the visual acuity in the preverbal or non-verbal patched patients.     

Determining of metastatic lymph node ratio in patients who underwent D2 dissection for gastric cancer

The purpose of this study was to determine outcome of the ratio of metastatic lymph nodes to the total number of dissected lymph nodes (MLR) in patients with gastric cancer. We retrospectively analyzed 111 patients who underwent D₂ lymph node dissection. The prognostic factors including UICC/AJCC TNM classification and MLR were evaluated by univariate and multivariate analysis. The MLR was significantly higher in patients with a larger tumor, lymphatic vessel invasion, blood vessel invasion and perineural invasion, and advanced stage. Moreover, the MLR was significantly associated with the depth of invasion and the number of lymph node metastasis. The univariate analysis revealed for overall survival (OS) that stage of disease, lymphatic vessel invasion, blood vessel invasion, perineural invasion, lymph node metastasis (UICC/AJCC pN stage) and MLR were relevant prognostic indicators. Furthermore, both UICC/AJCC pN stage and MLR were detected as prognostic factor by multivariate analysis, as was perineural invasion. Our results indicated that MLR and UICC/AJCC pN staging system were important prognostic factors for OS of patients with D₂ lymph node dissection in gastric cancer in a multivariate analysis. MLR may be useful for evaluating the status of lymph node metastasis in gastric cancer.     

Evaluation of the accuracy of dental casts manufactured with 3D printing technique in the All-on-4 treatment concept

PURPOSEThe aim of this study is to compare the casts obtained by using conventional techniques and liquid crystal display (LCD) three-dimensional (3D) print techniques in the All-on-4 treatment concept of the edentulous mandibular jaw.MATERIALS AND METHODSIn this study, a completely edentulous mandibular acrylic cast (typodont) with bone-level implants placed with the All-on-4 technique served as a reference cast. In this typodont, impressions were taken with the conventional technique and dental stone casts were obtained. In addition, after scanning the acrylic cast in a dental laboratory scanner and obtaining the Standard Tessellation Language (STL) data, 3D printed casts were manufactured with a 3D printing device based on the design. The stone and 3D printed casts were scanned in the laboratory scanner and STL data were obtained, and then the interimplant distances were measured using Geomagic Control X v2020 (3D Systems, Rock Hill, SC, USA) analysis software (n = 60). The obtained data were statistically evaluated with one-way analysis of variance (ANOVA) and Tukey’s pairwise comparison tests.RESULTSAs a result of the one-way ANOVA test, it was determined that the stone casts, 3D printed casts, and reference cast values in all distance intervals conformed to the normal distribution and these values had a significant difference among them in all distance intervals. In Tukey pairwise comparison test, significant differences were found between casts at all distance intervals. In all analyses, the level of significance was determined as .05.CONCLUSION3D printed casts obtained with a 3D LCD printing device can be an alternative to stone casts when implants are placed in edentulous jaws.     

Serum ischemia-modified albumin as a novel marker of ovarian torsion: An experimental study

Objective

To evaluate the effect of ovarian torsion on serum levels of ischemia-modified albumin (IMA) in an experimental model.

Study design

Sixteen female adult Sprague–Dawley rats were involved in the study. Rats were allocated randomly to group I or group II on the day of the experiment. Group I (eight rats) comprised the control (sham operated) group. In group II (eight rats), a torsion model was created by using atraumatic vascular clips just above and below the right ovary. At the end of a 3-h period of ischemia, the ovaries were removed. Blood was sampled before and after operation to assess serum IMA levels. Serum IMA levels (absorbance units) and histopathologic damage scores were evaluated.

Results

Initial serum IMA levels were similar in both groups. After the operation, significant elevation was observed in group II in contrast to group I (0.191 ± 0.034 and 0.277 ± 0.089 ABSU, p = 0.05). Histologic specimens of the ovaries in group II had higher scores of follicular cell degeneration, vascular congestion, hemorrhage and inflammatory cell infiltration than those in group I (p < 0.001).

Conclusions

The elevated serum IMA levels observed in the ovarian torsion model seem to have a potential role as a serum marker in the early diagnosis of ovarian torsion.     

Intra-abdominal Pressure Monitoring in Open Abdomen Management with Dynamic Abdominal Closure

The importance of elevated intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have been recognized in critical care for its potential damaging effects. But, quantification of IAP values may be useful as a clinical tool for determining efficacy of coughing and straining for functional recovery of OA patients. We would like to evaluate IAP generated in an OA patient and the effect of negative pressure therapy (NPT) and dynamic abdominal closure systems (ABRA) on the IAP values at rest and during coughing and straining and compare those with IAP measurements of closed abdomen after standard open elective colorectal surgery (non-OA). Eight OA and eight non-OA patients were included in this study. OA patient with NPT and ABRA (OA + NA), OA patient without NPT and ABRA completely unbraced (OA-NA) (NA stands for NPT and ABRA), and non-OA patients underwent IAP measurements at rest, during coughing, and during straining via transurethral catheter. There was no difference in the mean of IAP measurement at rest in OA-NA (6.1 mmHg), OA + NA (6.5 mmHg), and non-OA (6.0 mmHg) patients. During coughing, IAP of OA-NA, OA + NA, and non-OA patients were 11.5, 19.1, and 22.0 mmHg and during straining, IAP of OA-NA, OA + NA, and non-OA patients were 11.5, 17.5, and 23.5 mmHg, respectively. Application of NPT in conjunction with ABRA did not increase IAP at rest but provided significant IAP increase in OA + NA patients, when compared to OA-NA patients during coughing and straining. NPT in conjunction with ABRA offers the advantage of increase of IAP during coughing and straining.     

Hyperuricemia and acute renal failure in a newborn

Indian Journal of Pediatrics -