Investigation of the incidence of stylohyoid ligament calcifications with panoramic radiographs

Aim: This study examined and classified patients who were treated at the Faculty of Dentistry at Ankara University Dentistry to determine the incidence of different types of stylohyoid ligament calcification (SLC) using panoramic radiographs. In addition, it also assessed the possible causative symptoms and Eagle’s syndrome in cases of styloid process elongation. Methods: The study consisted of 2000 patients (1161 females and 839 males), aged 3–88 years, who were treated at our clinic. The panoramic radiographs were evaluated as part of this study. Results: Panoramic radiography examination revealed SLC in 1350 patients. Both‐sided (right and left), type 1 SLC was observed in 345 patients, while types 2–4 were found in 203, 418, and 384 patients, respectively. Conclusion: The incidence of SLC was found to be higher in female patients when compared to male patients. In addition, calcifications were seen more often at age 50–59 years, and the incidence of calcification was found to increase with age. Two Eagle’s syndrome cases were diagnosed among a total of 2000 patients. Finally, it was determined that the incidence of calcified stylohyoid ligament is higher in patients with systemic diseases.     

Comparison of microscopic (pT3a) and gross extravesical extension (pT3b) in pathological staging of bladder cancer: analysis of patient outcomes

Objective

To determine the prognostic value of pT3 bladder urothelial carcinoma substaging in patients without lymphatic involvement.

Patients and methods

Pathologic and clinical data were reviewed on patients who underwent radical cystectomy for urothelial carcinoma between 1991 and 2010. Of the 460 reviewed patients, 74 patients were diagnosed with pathologic T3No urothelial carcinoma of the bladder. The impact of pathologic substaging (pT3a vs. pT3b) was examined to determine the effect on overall and disease-specific survival.

Results

Five years disease-specific and overall survival rates were 46.9 % and 39.6 % for patients with pT3aNo tumor, whereas these ratios were 34.4 and 30.3 %, respectively, for patients with pT3bNo tumor (p > 0.05). Mean disease-specific survival time was 43.94 ± 6.50 months for pT3aNo, while it was 39.01 ± 7.19 months for pT3bNo (p = 0.539). In multivariate cox regression analysis, age (p = 0.459), gender (p = 0.710), urinary diversion type (p = 0.088), and pT3 substaging (p = 0.554) were not noticed as an independent predictive factor for survival.

Conclusion

Macroscopic extravesical extension (pT3b) is not associated with a worse outcome than pT3a disease in lymph node-negative cases of bladder urothelial carcinoma.     

Oral manifestations of 17 patients affected with mucopolysaccharidosis type VI

Objective

To assess oral manifestations of 17 patients with mucopolysaccharidosis type VI (MPS VI) or Maroteaux-Lamy syndrome.

Methods

We performed comprehensive oral examinations in 17 patients with MPS VI. Panoramic radiographs was performed only in 14 patients. All patients were of Thai, Turkish, and Indian origins. Ten of 17 patients had enzyme replacement therapy (ERT) (Naglazyme). Most Turkish patients (10/11) were on ERT. The Thai and Indian patients have never had ERT.

Results

Oral and radiographic examinations showed that hypoplastic mandibular condyles (93.3 %), malposition of unerupted teeth (92.9 %), large dental follicles (92.3 %), anterior open bite (86.7 %), maxillary constriction (56.3 %), and taurodontism (53.8 %) were common among patients with MPS VI. Newly recognized oral findings found in our study included taurodontism, long tooth roots, abnormal frenum, missing teeth, supernumerary teeth, and microdontia. Two patients who started ERT prior to 3 years old did not develope anterior open bite and one of them had mildly affected mandibular condyles.

Conclusion

Our study provides the most comprehensive study of oral manifestations in patients with MPS VI. Receiving ERT at very young ages may lessen craniofacial malformations including hypoplasic mandibular condyles and anterior open bite. Oral manifestations can be used as diagnostic features for MPS VI prior to assessing leukocyte ARSB activity or urinary excretion of dermatan sulfate.     

Extent of coronary collateral vessel decrease with advanced age

OBJECTIVE: Animal experiments show that angiogenesis, responsible for the development of collaterals, impairs with increasing age. We retrospectively investigated the relationship between the extent of coronary collaterals and age in patients who had total occlusion in at least one of their epicardial coronary arteries. METHODS AND RESULTS: The records of 2160 consecutive patients who had undegone coronary angiography were examined. The coronary collaterals of the 720 patients who had total occlusion in at least one epicardial artery were evaluated according to the Rentrop scoring system. The patients were divided into four groups according to age: age < 50 years (group 1), > or = 50 years and < 60 years (group 2), > or = 60 years and < 70 years (group 3) and > 70 years (group 4). A Rentrop score of 1 to 3 was accepted as a reliable measure of presence of coronary collaterals. The gender distribution was statistically comparable among the groups. The percentage of the coronary collaterals was as follows: 67% in group 1, 47% in group 2, 48% in group 3 and 28% in group 4. The extent of coronary collaterals was significantly lower in group 4 compared with group 1 (p < 0.01). CONCLUSION: The extent of coronary collaterals seems to decrease significantly with advanced age.     

Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study

BackgroundInternalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons'' illness, has not been studied previously in pediatric psoriasis patients.ObjectiveWe aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients.MethodsThis multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study.ResultsThe mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores.ConclusionInternalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.     

Tombstoning ST-Elevation Myocardial Infarction

Tombstoning ST elevation myocardial infarction can be described as a STEMI characterized by tombstoning ST-segment elevation. This myocardial infarction is associated with extensive myocardial damage, reduced left ventricle function, serious hospital complications and poor prognosis. Tombstoning ECG pattern is a notion beyond morphological difference and is associated with more serious clinical results.Despite the presence of a few reports on tombstoning ST elevation, there is no report which reviews STEMI demonstrating this electrocardiographic pattern.     

Giant adrenal cyst in a pregnant woman: a case report

In this case report, a rare example of a pregnant woman with a huge adrenal cyst is reported. No other published reports were found to have an outcome like the present case. A 27-year-old primiparous patient admitted to our clinic with complaints of gaining weight, abdominal distension and dyspnea. On physical examination abdominal distension was prominent. She weighed 78 kg. At abdominal ultrasonography, there was an 11 week, single live fetus within the uterine cavity. There was also an approximately 30 x 40 cm sized cyst. The origin of the cyst could not be detected by ultrasonography and magnetic resonance imaging. It was suspected to originate from the ovaries. Tumor markers and other laboratory tests were normal. Laparotomy was planned. During laparotomy, it was observed that there was a huge, thin capsulated cystic lesion filling the abdomen. The uterus and bilateral ovaries were normal. Eleven liters of yellow-colored fluid was drained from the cyst. At exploration, the cyst capsule was originating from a right adrenal lodge and was extirpated. The postoperative weight of the patient decreased to 67 kg. On the third postoperative day, the patient was discharged without any problems. The pathology result of the patient was reported as an epithelial adrenal cyst. The patient did not have any problems on antenatal follow up and had a cesarean delivery at term for cephalopelvic disproportion. A 3500 g, healthy female fetus was delivered.     

Primary complete repair of partial double aortic arch and Kommerell diverticulum

Tracheal and esophageal stenosis caused by double aortic arch and Kommerell diverticulum is a rare but important pathologic entity in adult patients. Clinical symptoms are caused by esophageal or tracheal stenosis, or both. The present article describes a surgical method of complete repair with division of the rudimentary left arch, resection of the diverticulum, and transposition of the left subclavian artery. This method was transferred from pediatric patients and led to excellent clinical results in 2 consecutive adult patients compared with the previous technique with division of the left arch alone.     

Lost in transition: A review of the unmet need of patients with attention deficit/hyperactivity disorder transitioning to adulthood

This review discusses the unmet needs of patients with attention deficit/hyperactivity disorder (ADHD) who are transitioning into adulthood. Although awareness and recognition of ADHD in children, adolescents, and adults have improved in recent years, there is often an interruption in management of the disorder when adolescent patients transition to adult health care services. This review has the following objectives: (1) to identify key issues patients with ADHD (with or without an early diagnosis) face during transition into adulthood; (2) to review the current clinical practice and country‐specific approaches to the management of the transition into adulthood for patients with ADHD; (3) to discuss challenges facing clinicians and their patients when drug treatment for ADHD is initiated; (4) to review current ADHD guidelines on transition management in Hong Kong, Singapore, South Korea, Turkey, and Africa; and (5) to examine economic consequences associated with ADHD. The review suggests that the transition period to adult ADHD may be an underresearched and underserved area. The transition period plays an important role regarding how ADHD symptoms may be perceived and acted upon by adult psychiatrists. Further studies are needed to explore the characteristics of the transition period. If only a fraction of adolescents go on to have mental disorders during adulthood, especially ADHD, it is crucial to identify their characteristics to target appropriate interventions at the beginning of the course of illness. There continues to be low recognition of adult ADHD and a severe lack of medical services equipped to diagnose and care for patients with ADHD transitioning from child to adult services.