Criteria for judging the improvement in subclinical rheumatic valvitis

Recent technical improvements in cross-sectional echocardiography have made it possible to detect even mild organic regurgitation of the mitral and aortic valves in patients with acute rheumatic fever. To determine the prevalence and prognosis of subclinical valvitis, we have analyzed 104 patients with acute rheumatic fever referred to our institution. Of 53 patients who had no murmur, 22 of them with polyarthritis, 29 with chorea, and 2 with polyarthritis and chorea, 23 (43.4%) had subclinical valvitis. Isolated mitral regurgitation was the most common valvar lesion, seen in 82.6% of the patients. Isolated aortic regurgitation was detected in 4.4% of the cases, and combined mitral and aortic regurgitation in the remaining 13%. During follow-up, the degree of mitral regurgitation improved in 59.1%, decreased in 18.2%, and increased or remained unchanged in 22.7% according to the length of colour jet. According to criterions of velocity, mitral regurgitation improved in 86.4% of the patients, and increased or unchanged in the remaining 13.6%. Mitral regurgitation disappeared completely in 6 of the patients (27.3%) as judged according to both the length of colour jet and the velocity of regurgitation. Aortic regurgitation improved in all the patients with this problem, disappearing completely in two of the four. Based on this experience, we suggest that not only the disappearance of regurgitation, but also improvements in the echocardiographic diagnostic criterions of regurgitation, such as the length of the colour jet less than 1 cm, or velocity less than 2.5 m/s, or indicative of regurgitation that is either intermittent or of short duration, should also be considered as criterions indicating improvement in valvar regurgitation in patients with subclinical rheumatic valvitis.     

An unusual auricular malformation accompanied by accessory tragus: macrotragus

Definition of malformations of the tragus is important for terminology and treatment. Most common entities are the skin tag, accessory tragus, preauricular sinus, and cyst, whereas macrotragus is an uncommon and unaddressed deformity that should be distinguished from these. In this report, three cases with diagnosis of the macrotragus are presented. The tragus was uniformly large and displaced anteriorly, and external auditory meatus was not obliterated in all cases. For correction, excision of the excess tragal cartilage and skin was performed. In all cases, bilaterally symmetric tragus was achieved. There were no complications in the early postoperative period and there was no enlargement after 6 months of observation. Macrotragus and accessory tragus are different entities that should be distinguished for accurate diagnosis. They have similar histopathological but distinct anatomical characteristics. Although both are treated by a simple excision, in the case of macrotragus, special effort should be taken to leave enough cartilage to restore normal tragal contours. Presented at the 5th Congress of the Balkan Association for Plastic, Reconstructive Aesthetic Surgery, Kuşadası, Turkey, May 22–26, 2007.     

Investigation of histopathological and cytogenetic effects on Lepomis gibbosus (Pisces: Perciformes) in the Cine stream (Aydin/Turkey) with determination of water pollution

Water quality and the distribution of some heavy metals in three different organs of Lepomis gibbosus from the Cine Stream were studied. Also, histopathological changes in gill, liver, and muscle tissue were examined at light microscopical level. Micronucleus (MN) formation in fish erytrocytes, as an indicator of chromosomal damage, has been increasingly used to detect the genotoxic potential of environmental contaminants. The frequency of MN was examined from samples of fish from the Cine Stream and a control group. MN frequency was higher in fish samples caught from the Cine Stream than that in the control group. The chemicals ammonia, nitrite, nitrate, orthophosphate, and sulphate were determined as parameters that possibly affect the gill, liver, and muscle morphology. Zn was the most accumulated metal in tissues as well as in water. Maximum metal accumulation occurred in both liver and gills. For histopathological examinations, samples of gills, liver, and muscle tissues of L. gibbosus were studied by using light microscopy. In this study, a significant decrease in mean length of primary and secondary lamellae were observed. Moreover, cellular proliferation developed with secondary lamellae fusion, ballooning degenerations or club deformation of secondary lamellae, as well as distribution of necrotic, hyperplastic and clavate secondary lamellae. In the liver, altered staining, swollen and ruptured parenchymal cells, loss of cord structure, reduce of glycogen in hepatocytes, and vacuolar structure filled with cellular debris and many dark particles were seen. In muscle tissue, focal necrosis, cellular dissolution, and a decline or loss of striation in muscle fibres were found.     

Detrimental effects of immobilization on functional recovery after sciatic nerve crush

Peripheral-nerve trauma has been a challenge to surgeons, with significant advances in the surgery of repair. Immobilization of the injured limb after repair has been the traditional method of treatment. Although peripheral-nerve regeneration has been studied extensively, the correlation between functional recovery and the immobilization period has not been well-documented. In the present study, the authors studied the effects of immobilization on axonal regeneration after sciatic crush injury. They found a detrimental effect of immobilization on the functional recovery.     

Interleukin-1alpha, interleukin-1beta, and interleukin-1Ra polymorphisms in febrile seizures

Febrile seizures are the most common form of childhood seizures. The exact mechanism promoting convulsions during a common febrile illness remains unknown, but it is accepted that genetic influences are likely to account for at least some of the cases. Previous studies reported high interleukin-1beta levels in the cerebrospinal fluid of patients with febrile seizures. Recently, an association between a regulatory polymorphism in the genes encoding interleukin-1beta and interleukin-1Ra and febrile seizures was reported. In this study, we attempted to confirm these findings. We analyzed the cytokine gene polymorphisms of interleukin-1beta, interleukin-1alpha, and interleukin-1Ra of 73 children with febrile seizure and 152 healthy controls. The distribution of interleukin-1beta -511, interleukin-1alpha -889, and interleukin-1Ra genotypes and alleles did not differ significantly between cases and controls. Our data suggest that the studied gene polymorphisms of interleukin-1beta, interleukin-1alpha, and interleukin-1Ra do not have a significant role in the pathogenesis of febrile seizures.     

Renal resistive index in healthy children

OBJECTIVE: The objective of the study was to investigate the relationship between age and renal resistive index (RI) and to determine the normal values and ranges of RI in intrarenal arteries in healthy children. MATERIALS AND METHOD: Color duplex Doppler sonography of interlobar or arcuate arteries was performed in 115 children without clinical or laboratory pathologic changes of the urinary tract. Of these 115 healthy children, 23 were under 12 months of age (group 1), 24 between 12 and 35 months (group 2), 23 between 36 and 71 months (group 3), and 45 between 72 months and 16 years (group 4). Normative data for RI were established for each age group. RESULTS: When age groups were compared, statistically significant differences were observed between age groups 1 and 2 (P=0.007), 1 and 3 (P=0.00), 1 and 4 (P=0.00) and 2 and 4 (P=0.00). No significant differences were observed between age groups 2 and 3 (P=0.452), and 3 and 4 (P=0.078). There was no significant difference between mean RI values of right and left kidney within any age group (P=0.315). CONCLUSION: Results obtained in this study demonstrates that RI is age dependent; it is the highest at birth, from birth declines gradually with increasing age and stabilizes in a certain range (mean RI range regarded as normal for adults) by reaching adult levels.     

Combined prosthodontic and orthodontic treatment of a patient with a Class III skeletal malocclusion: a clinical report

This clinical report describes a multidisciplinary approach for the treatment of a patient with Angle Class III skeletal malocclusion and decreased occlusal vertical dimension. An overlay removable partial denture (ORPD) was used to reestablish the occlusal vertical dimension (OVD). After the trial and adjustment period, the reduced lower anterior dentofacial height was orthodontically increased and the negative horizontal overlap was corrected. A maxillary precision attachment RPD and a mandibular fixed partial denture and metal ceramic crowns were fabricated to satisfy esthetic and functional requirements.     

Plasma testosterone response at 1st and 4th day after short- and long-term hCG stimulation test

Human chorionic gonadotropin (hCG) stimulation test is a reliable dynamic test for the evaluation of testicular function during childhood. Several protocols have been recommended but their reliability is controversial. In order to decide the best timing to measure stimulated testosterone levels in short- and long-term hCG protocols, we evaluated 83 prepubertal patients in two group. In group A, 34 patients with isolated micropenis and in group B, 49 inguinal cryptorchidic patients were enrolled. In group A short-term hCG protocol (3000 IU/m2/im/3 days) and in group B long-term hCG protocol (1500 IU/m2/im; thrice a week for 3 weeks) was administered. Blood samples were drawn at the initiation of the test and then at the 1st and 4th days after the last hCG injection. Each case's peak stimulated testosterone (Tmax) and the incremenet in plasma testosterone (deltaT) were calculated and compared with the 1st and 4th day responses within the group. In the short-term protocol the 4th day responses were higher than the 1st day responses (p<0.01). Interestingly, while four patients had insufficient responses at the 1st day, three had sufficient Leydig cell response at the 4th day. In the long-term protocol group, in contrast to the short-term group, the 1st day responses were higher than the 4th day (p<0.01). According to our results, while performing hCG test in a patient, if a short-term protocol is planned, it is more convenient to check the 4th day testosterone response. On the other hand, in a long-term protocol it is best to check the 1st day response. We suggest that even if a patient's 1st day response is inadequate, the 4th day response should be checked in order to avoid misdiagnosis.