Blunt thoracic trauma in children: review of 137 cases.

OBJECTIVE: Thoracic injuries are uncommon in children and few report present on blunt ones. METHODS: Between 1994 and 2003, 137 children with blunt thoracic injury were reviewed. RESULTS: The mean age of children was 6.9+/-7.3 (1-16) years. Etiology was falls in 46.7%, traffical accidents in 51% and abuse in 2.2%. Average height in fallen-down cases was 6.4+/-2 (range: 3-11) m. Calculated mean kinetic energy transfer to body was 1923+/-1056 J. When first seen, 70% (82/117) of the patients had vital signs that were within normal limits. Forty-two (35.9%) children had isolated thoracic injury. Associated injuries were present in 75 (64.1%) children. Head injury was the most common associated injury present in 33 (28.2%). Pulmonary contusion was the most common thoracic injury with 68 (49.6%). Seventeen (12.4%) required surgery, 11 (8%) of them were thoracic (4 for diaphragmatic tear, 2 for flail chest, 2 for tracheobronchial injuries, 2 for laceration, 1 for esophageal rupture). Surgical group had higher ISS (26.8 vs 36.2, P = 0.001). Fifteen were lost (10.9%): There were lethal injuries in 7; chest tube treatment in 3; intensive care unit management in 2; mechanical support in 2 and observation in 1 patient. No death occurred for operations. Mortality rate was the lowest at injuries to chest alone and the highest for multi-system injuries (P < 0.05). The hospital length of stay for averaged 13.4+/-8.8 (range: 4-49) days. CONCLUSION: Associated injury is the most important mortality factor. Thoracic operations can be performed with minimal morbidity and without mortality in children with blunt thoracic trauma.     

Long-term aspirin pretreatment in the prevention of cerulein-induced acute pancreatitis in rats

AIM:To investigate the effects of long term pretreatment with low-,medium-and high-dose aspirin(acetylsalicylic acid,ASA) on a model of acute pancreatitis(AP) induced in rats.METHODS:Forty male Wistar rats were used.Three experimental groups,each consisting of eight animals,received low-(5 mg/kg per day),medium-(150 mg/kg per day) and high-dose(350 mg/kg per day) ASA in supplemented pellet chow for 100 d.Eight animals,serving as the AP-control group,and another eight,serving as reference value(RV) group,were fed with standard pellet chow for the same period.After pretreatment,AP was induced in the experimental animals by intraperitoneal administration of cerulein(2 × 50 μg/kg),while the RV group received saline in the same way.Twelve hours after the second injection,the animals were sacrificed.Pancreatic tissue and plasma samples were collected.One part of the collected pancreatic tissues was used for histopathological evaluation,and the remaining portion was homogenized.Cytokine levels [tumor necrosis factor,interleukin(IL)1β,IL-6],hemogram parameters,biochemical parameters(amylase and lipase),nuclear factor-κB,aspirin triggered lipoxins and parameters related to the antioxidant system(malondialdehyde,nitric oxide,hemeoxygenase-1,catalase and superoxide dismutase) were measured.RESULTS:Cerulein administration induced mild pancreatitis,characterized by interstitial edema(total histopathological score of 5.88 ± 0.44vs 0.25 ± 0.16,P < 0.001).Subsequent pancreatic tissue damage resulted in an increase in amylase(2829.71 ± 772.48 vs 984.57 ± 49.22 U/L,P = 0.001) and lipase(110.14 ± 75.84 U/L vs 4.71 ± 0.78 U/L,P < 0.001) in plasma,and leucocytes(6.89 ± 0.48 vs 4.36 ± 0.23,P = 0.001) in peripheral blood.Cytokines,IL-1β(18.81 ± 2.55 pg/μg vs 6.65 ± 0.24 pg/μg,P = 0.002) and IL-6(14.62 ± 1.98 pg/μg vs 9.09 ± 1.36 pg/μg,P = 0.04) in pancreatic tissue also increased.Aspirin pretreatment reduced the increase in the aforementioned parameters to a certain degree and partially improved the histopat     

The risk factors and symptomatology of perimenopausal depression

OBJECTIVES: The aim of this study is to determine if the depression in perimenopausal women is symptomatologically different than depression in premenopausal women, and if these depressive women are under more risk for depression when factors like premenstrual dysphoric syndrome, socio-economical status, vasomotor symptoms and familial inclination to depression are considered. METHODS: Fifty major depressive women with hormonally established perimenopause (follicle stimulating hormone (FSH) levels over 20IU/l and estrogen levels lower than 40IU/l) and who were not taking any psychotropic or hormone replacement therapy, were enrolled in the study. In order to investigate the characteristic clinical features of perimenopausal depression, a drug free control group consisting of 48 pre-perimenopausal women with a diagnosis of major depression was formed. Another control group was formed with 53 non-depressive perimenopausal women in order to investigate the risk factors of perimenopausal depression. RESULTS: The depressive and non-depressive groups did not differ from each other according to level of education, marital and economical status and comorbid physical problems. No major symptomatological difference between perimenopausal depression and pre-perimenopausal depression was found. No correlation was found between the severity of vasomotor symptoms and severity of depression. CONCLUSIONS: Findings of our study suggest that vasomotor symptoms and socio-economical status do not predict the severity and existence of perimenopausal depression. Episodes of major depression are not necessarily the normal result of such vasomotor symptoms. Therefore, the evaluation and management of perimenopausal depression should be carried out as carefully as is done in episodes of depression seen in the rest of women's life span.     

The effect of fiber insertion on fracture resistance of endodontically treated molars with MOD cavity and reattached fractured lingual cusps

In this study, the effect of flowable composite reinforced with a leno wave ultra high modulus (LWUHM) polyethylene fiber (Ribbond) on fracture resistance of endodontically treated molars with MOD cavity and lingual cuspal fracture was evaluated. Sixty sound extracted human mandibular molars were randomly assigned to six groups (n = 10). Group 1 served as control. Teeth in groups 2-6 received root canal treatment and a MOD cavity preparation. Teeth in group 2 were kept unrestored. Lingual walls of specimens in groups 3-6 were fractured at the CEJ and reattached (C&B Super-Bond). Group 3 was kept unrestored, and group 4 was restored with a composite resin (CR) (AP-X). In group 5, a flowable resin (FR, Protect Liner F) and in group 6, a Ribbond in combination with FR were inserted inside the cavity before CR restoration. After finishing and polishing, the specimens were subjected to compressive loading perpendicular to the occlusal surface at a crosshead speed of 1 mm/min. The mean load necessary to fracture were recorded in Newton and the results were statistically analyzed. MOD cavity preparation reduced fracture resistance of endodontically treated teeth (p < 0.05). Fracture resistance of rebonded fractured specimens was found to be similar to that of the nonfractured samples (p > 0.05). Use of LWUHM polyethylene fiber Ribbond increased fracture strength of endodontically treated molar teeth with MOD cavity preparation and cuspal fracture (p < 0.05). As a result, it was concluded that the insertion of Ribbond inside the cavity has a positive effect on fracture strength of endodontically treated molar teeth with MOD cavity preparation and cuspal fracture.     

A three-dimensional scapular motion analysis in patients with arthroscopic anterior capsulolabral repair of the shoulder: The effect of scapular stabilization taping

BackgroundThe aim of this study was to investigate the scapular kinematics during dynamic humeral movements in patients with arthroscopic anterior capsulolabral repair of the shoulder along with the potential biomechanical corrective effects of scapular stabilization taping.MethodsTwenty patients with unilateral traumatic anterior shoulder instability and arthroscopic anterior capsulolabral repair participated in the study. Dynamic shoulder kinematics were assessed during the scapular plane shoulder elevation for both the operated and non operated shoulders and also under two conditions: no-taping and taping. Statistical analysis to compare sides and conditions was performed with analysis of variance models.ResultsThe scapula was more internally rotated position in operated shoulders than in non operated shoulders. Furthermore, the scapula was less internally rotated and more downwardly rotated at 120° of elevation in the taping condition.ConclusionsOperated shoulders demonstrated kinematics alterations when compared to non operated shoulders underwent arthroscopic anterior capsulolabral repair. Additionally, changes in the scapular orientation with the taping was very small but followed a pattern, which would be suggested to be an orientation that potentially produce more scapular stability and to increase stress on the inferior glenohumeral ligament.     

Induction of apoptosis by metformin and progesterone in estrogen-induced endometrial hyperplasia in rats: involvement of the bcl-2 family proteins

This study compared the antiproliferative effects of metformin and progesterone, via examination of the Bcl-2/Bax-caspase apoptotic pathway in estrogen-induced endometrial hyperplasia (EH) in 40 rats. Two rats died after bilateral oophorectomy, and 1?week after surgery, the remaining 38 were randomly divided into three groups: the first (control, n?=?12) received 4?mg/kg 17β estradiol hemihydrate (E); the second (n?=?13) received 4?mg/kg 17β estradiol hemihydrate and 50?mg/kg metformin (E?+?M); and the third (n?=?13) received 4?mg/kg 17β estradiol hemihydrate and 1?mg/day medroxiprogesterone acetate (E?+?MPA). Histological markers and Bcl-2, Bax and caspase 9 expression were analyzed. Luminal epithelial thickness, density of gland and epithelial height was significantly higher in group E than in groups E?+?M and E?+?MPA. Histopathologic parameters were similar between the E?+?M and E?+?MPA groups. Bcl-2/Bax ratio was significantly decreased in the E?+?M and E?+?MPA groups and caspase 9 expression levels were significantly increased in the E?+?M and E?+?MPA groups, compared with the control group. In addition, Bcl-2/Bax ratio and caspase 9 expression were similar between the E?+?M and E?+?MPA groups. The data indicate that metformin reduces estrogen-induced EH in rats, via activation of the caspase-dependent mitochondrial apoptotic pathway, to the same degree as progesterone.     

Surgical treatment of thoracic outlet syndrome: effect and results of surgery

BACKGROUND: Because of the difficulty in diagnosis and different treatment options, debate on thoracic outlet syndrome (TOS) has continued. Our aim is to report our surgical experience. METHODS: Forty-seven patients with thoracic outlet syndrome were operated on between 1985 and 2000. Mean age was 37.9 years (range, 17 to 58 years); female/male ratio was 41/6. The most frequent symptom was paresthesia (72.3%). Seventeen patients (36%) had bilateral symptoms. Of all, 89.3% (42 cases) were neurologic thoracic outlet syndrome, and 10.7% (five cases) were vascular. Lower plexus (C8-T1/ulnar nerve) compression was present in 36 patients and upper plexus (C5-C7/median nerve) compression in 6 patients. Doppler ultrasonography in 11 patients, angiography in 8, and lymph node scintigraphy in 1 patient were also performed. Main operative indications were persistence of symptoms after conservative therapy and reduced (< 60 m/s) ulnar nerve conduction velocity. RESULTS: Fifty-five operations were performed on the 47 patients. First (59.6%) and cervical costae (21.3%) resections were the most frequent operations. Mean ulnar nerve conduction velocity was 54.8 m/s (range, 43 to 68 m/s) preoperatively and 69.4 m/s (range, 47 to 70 m/s) postoperatively (p < 0.05). The morbidity rate was 17% (8 of 47). No difference was observed between transaxillary and supraclavicular incisions. No brachial plexus injuries occurred. The most frequent cause of morbidity was incisional pain. Two reoperations were performed for recurrences. Follow-up was 4.6 years, and 75% of lower plexus and 50% of upper plexus compressions remained asymptomatic. Severe and long-term pain occurred in 1 patient. CONCLUSIONS: Surgical decompression for thoracic outlet syndrome is efficient and dependable, but results deteriorate over time.