Giant arteriovenous malformation of the floor of the mouth presenting with dysarthria and difficulty in swallowing

Arteriovenous malformation (AVM) is a vascular abnormality resulting in the development of abnormal connection between an artery and vein without capillary connections. An AVM develops mainly intracranially. Extracranial AVMs are rarely seen. Cheek, ear, nose, auricle, and forehead are the more common sites in the extracranial involvement. They cause cosmetic problems when located in the head and neck region. We report a case of a giant AVM in the floor of the mouth, which has not been specified and has not been reported until now. The lesion, in an elderly man, was supplied by multiple vessels and caused difficulty in speaking and swallowing. The lesion was totally excised after embolization of feeding vessels.     

Two-suture fish-mouth end-to-side microvascular anastomosis with fibrin glue

The most decisive step during free tissue transfers and replantation surgery may be respected as microvascular anastomosis. The conventional end-to-side anastomosis technique with simple interrupted sutures is well established and proven to be successful. On the other hand, conventional technique can be time consuming and can cause vascular thrombosis, vessel narrowing, and foreign-body reactions. Search for a more rapid and secure alternative to conventional technique is carried on. In this study, we defined a new technique for end-to-side anastomosis with fish-mouth incisions and application of fibrin glue and compared our results with those we obtained with conventional end-to-side anastomosis. We evaluated end-to-side anastomosis of carotid arteries of a total number of 64 Wistar-Albino rats. In control group (n = 32), conventional anastomoses with 8 to 10 sutures were performed. In experimental group (n = 32), fish-mouth incisions were applied first on the recipient artery, followed by performing anastomosis with only 2 corner sutures and applying commercially available fibrin glue. Time taken to perform the anastomosis was significantly shorter with the experimental group (P = 0.001), whereas early and late patency and aneurysm rates were comparable to those achieved with control group. Histological evaluation did not point out any significant differences between the groups. We have defined a rapid and safe alternative technique of end-to-side anastomosis with the use of fibrin glue. This method may be an alternative especially where multiple anastomoses are required or where it is difficult to approach anastomotic line, as it is easily performed, rapid, safe, and not involving any complex equipments.     

Higher expression of the novel gene upregulated gene 4 in two acute lymphoblastic leukemia patients with poor prednisolone response

Elucidation of the molecular mechanisms of leukemogenesis is important for a better understanding of the prognosis of acute lymphoblastic leukemia (ALL). Studies have shown that the expression of upregulated gene 4 (URG4), which promotes cell growth and survival, is increased in different types of carcinomas including hepatocellular carcinoma, gastric cancer and osteosarcoma. Similarly, higher expression of URG4 and cyclin D1 gene might promote proliferation of the blast cells by causing escape from the G1 checkpoint and entry into the S phase. This study reports the high expression level of URG4 in 2 high-risk ALL patients for the first time in the literature. In conclusion, the higher expression of URG4 in our 2 patients suggests that URG4 might be involved in leukemogenesis. Future studies with a large number of high-risk ALL patients and cell culture studies are needed to demonstrate the exact role of URG4 in leukemogenesis.     

Transcatheter Aortic Valve Implantation through a Left Aortoiliac Graft

The indications for transcatheter aortic valve implantation have been increasing with the development of new-generation valves and delivery systems. Our patient, an 81-year-old man with aortic stenosis, had an existing coronary artery bypass graft and bilateral aortoiliac bypass grafts. We used the transfemoral approach through the left femoral artery and the left aortoiliac graft to successfully deploy a new-generation Edwards SAPIEN valve.Key words: Aortic stenosis, arterial disease, peripheral, heart valve prosthesis implantation/methods, transcatheter aortic valve implantationTranscatheter aortic valve implantation (TAVI) has emerged as a promising alternative to conventional aortic valve replacement for patients whose severe, symptomatic aortic stenosis is otherwise left untreated due to comorbidities and to the high operative mortality rates associated with open-heart surgery under those circumstances.¹ The first application of this method in human beings was performed in 2002 by Cribier and colleagues.² Today, there are 2 widely used valve types. These are the balloon-expandable Edwards SAPIEN transcatheter valves (Edwards Lifesciences LLC; Irvine, Calif) and the self-expanding CoreValve® valves (Medtronic CV Luxembourg S.a.r.l.; Luxembourg). The first-generation Edwards SAPIEN valve is approved for use in the United States, but the latest generations of both valves are awaiting approval.     

In Vitro Fracture Resistance of Endodontically Treated Roots Filled with a Bonded Filling Material or Different Types of Posts

AimThis study aimed to compare the fracture resistance of roots filled with a bonded material, fiber posts, or titanium post systems.MethodsCanals in the first group were filled with AH Plus and gutta-percha cones, and roots in the second group were filled with Epiphany sealer and Resilon cones. The root fillings (60 roots) were removed up to 4 mm from the canal apex to obtain 10-mm-deep post spaces, and posts were cemented. The groups were as follows: AH Plus control group, Epiphany control group, AH Plus fiber post group, AH Plus titanium post group, Epiphany fiber post group, and Epiphany titanium post group. Fracture tests were performed by using an Instron testing machine. The force was applied at a 45° axial angle with a constant speed of 1 mm/min. For each sample, the force at which fracture occurred was recorded in units of newtons. Statistical analysis was carried out by using analysis of variance test.ResultsThere was no statistically significant difference between all groups (P > .05).ConclusionsTitanium posts, fiber posts, and Epiphany root canal filling systems were found to have no reinforcing effect on endodontically treated roots.     

Assessment of the Effectiveness of Silver-Coated Dressing,Chlorhexidine Acetate (0.5%), Citric Acid (3%), and Silver Sulfadiazine (1%) for Topical Antibacterial Effects Against the Multi-Drug Resistant Pseudomonas Aeruginosa Infecting Full-Skin Thickness Burn Wounds on Rats

The aim of this study was to compare the effects of four different topical antimicrobial dressings on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model. A total of 40 adult male Wistar albino rats were used. The control group (group 1), silver sulfadiazine (1%) group 2, chlorhexidine acetate (0.5%) group 3, citric acid (3%) group 4, and silver-coated dressing group 5 were compared to assess the antibacterial effects of a daily application to a 30% full-skin thickness burn wound seeded 10 minutes earlier with 10⁸ CFU (colony forming unit)/0.5 mL of a multi-drug resistant Pseudomonas aeruginosa strain. Five groups (1 control group and 4 treatment groups) were compared. The administration of third-degree burns to all rats was confirmed based on histopathologic data. The tissue cultures from groups 2 and 5 exhibited significant differences compared to those of the other 3 groups, whereas no significant differences were observed between groups 1, 3, and 4. The effectiveness of the treatments was as follows: 1% silver sulfadiazine > silver-coated dressing > 3% citric acid > 0.5% chlorhexidine acetate > control group. Our results supported the efficacy of topical therapy by silver sulfadiazine and silver-coated dressing on infections caused by multi-drug resistant Pseudomonas spp.     

Unusual Traumatic Midthoracic Spondyloptosis and Its Surgical Management: Case Report

Posttraumatic spondyloptosis develops as a result of complete subluxation of the vertebral bodies and causes complete transection of the spinal cord. Severe trauma-related spondyloptosis of the upper-mid thoracic region is a rare form of spinal trauma. Traumatic midthoracic spondyloptosis is quite rare, and radiology plays an important role in the diagnosis and treatment of this condition. Surgical reconstruction and stabilization are required for early mobilization and rehabilitation of patients with this injury. Here, we report the clinical features, radiographic findings, and management of an unusual case of traumatic midthoracic spondyloptosis that showed complete spinal cord transection and was operated.     

Ameliorative Effects of Proanthocyanidin on Renal Ischemia/Reperfusion Injury

Introduction. Several natural products have been reported to have beneficial effects on ischemia/reperfusion (I/R) injury, particularly from a preventative perspective. Therefore, this study was designed to investigate the efficiency of proanthocyanidin (PA), a natural product derived from grape seed, on renal dysfunction and injury induced by I/R of rat kidney. Materials and Methods. Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, I/R, I/R+PA. Rats were given PA (100 mg/kg/day peroral) 7 days prior to I/R. All rats except sham-operated underwent 60 min of bilateral renal ischemia followed by 6 h of reperfusion. After reperfusion, kidneys and blood were obtained for evaluation. Superoxide dismutase, glutathione peroxidase, malondialdehyde, protein carbonyl content, and nitrite/nitrate level (NO_x) were determined in the renal tissue. Serum creatinine (S_Cr), blood urea nitrogen (BUN), and aspartate aminotransferase (AST) were determined in the blood. Additionally, renal sections were used for histological grade of renal injury. Results. PA significantly reduced the I/R-induced increases in S_Cr, BUN, and AST. In addition, PA markedly reduced elevated oxidative stress product, restored decreased antioxidant enzymes, and attenuated histological alterations. Moreover, PA attenuated the tissue NO_x, levels indicating reduced NO production. Conclusions. The pretreatment of rats with PA reduced the renal dysfunction and morphological changes, ameliorated cellular injury, and restored renal antioxidant enzymes caused by renal I/R.