The relation between tooth loss and bone mass in postmenopausal osteoporotic women in Turkey: a multicenter study

 The purpose of this study was to investigate the associations of tooth loss with skeletal bone mass, years since menopause, educational level, current smoking status, dietary calcium intake, and number of pregnancies in postmenopausal osteoporotic women in Turkey. The study population consisted of 1171 postmenopausal women aged 40–86 years (mean age, 61.19 ± 7.28 years). A detailed history was obtained from all women, including relevant lifestyle parameters, risk factors, and measurements of weight and height. Women were separated into three groups according to the number of teeth remaining as group 1 (edentulous, 457 women), group 2 (10 or fewer teeth, 232 women), and group 3 (more than 10 teeth remaining, 482 women). There was no significant difference among the three groups in mean age and menopausal age (P < 0.05). Body mass index of group 1 was significantly higher than that of group 2 (P < 0.01). Educational level was significantly different between three groups: groups 1 and 2 (P < 0.001), groups 1 and 3 (P < 0.0001), and groups 2 and 3 (P < 0.001). Educational level was lowest in group 1 and highest in group 3. Despite a low ratio of cigarette smoking in general, a smoking habit was most prevalent in group 3 and least in group 2. The ratio of women receiving adequate calcium was significantly lower in group 1 than in other groups (P < 0.001); mean calcium intake was similar in all groups. The number of pregnancies was significantly higher in group 1 than in other groups (P < 0.001). Lumbar bone mineral density (BMD) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001). Although no significant difference was found between groups 1 and 3, femoral neck BMD of group 2 was less than in others, and differences between groups 1 and 2 and between groups 2 and 3 (P < 0.001) were significant. Lumbar bone mineral content (BMC) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001), and lumbar BMC in group 2 was significantly higher than in group 3 (P < 0.05). Femoral neck BMC in group 1 was significantly higher than in groups 2 and 3 (P < 0.001). In conclusion, lumbar BMD and BMC in the edentulous group were significantly lower, whereas femoral neck BMD and BMC were significantly higher in edentulous group compared with the others. Our findings indicated that improvement in lifestyle factors and nutritional strategies for the treatment and prevention of osteoporosis may have additional benefit in reducing tooth loss. Received: February 18, 2002 / Accepted: June 21, 2002 Offprint requests to: A. Gur     

Effect of Fixation and Embedding on Raman Spectroscopic Analysis of Bone Tissue

Raman spectroscopy provides valuable information on the physicochemical properties of hard tissues. While the technique can analyze tissues in their native state, analysis of fixed, embedded, and sectioned specimens may be necessary on certain occasions. The information on the effects of fixatives and embedding media on Raman spectral properties is limited. We examined the effect of ethanol and glycerol as fixatives and a variety of embedding media (Araldite, Eponate, Technovit, glycol methacrylate, polymethyl methacrylate, and LR white) on Raman spectral properties (mineralization, crystallinity, and carbonation) measured from the cortical bone of mouse humeri. Humeri were fixed in ethanol or glycerol, followed by embedding in one of the media. Nonfixed, freeze-dried, and fixed but not embedded sections were also examined. Periosteal, endosteal, and midosteal regions of the intracortical envelope were analyzed. Raman spectra of fixative solutions and embedding media were also recorded separately in order to examine the specifics of overlap between spectra. We found significant effects of fixation, embedding, and anatomical location on Raman spectral properties. The interference of ethanol with tissue seemed to be relatively less pronounced than that of glycerol. However, there was no single combination of fixation and embedding that left Raman spectral parameters unaltered. We conclude that careful selection of a fixation and embedding combination should be made based on the parameter of interest and the type of tissue. It may be necessary to process multiple samples from the tissue, each using a combination appropriate for the Raman parameter in question.     

Surgical correction of hallux valgus deformity in children with cerebral palsy

Objective

This study aimed to present a treatment algorithm for the correction of the hallux valgus deformity in Cerebral Palsy (CP) patients and to discuss the outcomes based on our clinical and radiological results.

Survivin expression and its potential clinical significance in gastrointestinal stromal sarcoma

This study was designed to determine the level of survivin expression and its clinical significance as a prognostic factor in gastrointestinal stromal sarcoma (GIST). Twenty patients (12 males and 8 females) ranging in age from 25 to 72, with a median age of 53 were evaluated. Failure of TKI treatment was higher in the survivin-positive group (p = 0.06). The rate of metastasis was significantly higher in the survivin positive group vs. the negative group (80% vs. 30%, p = 0.18). The median overall survival (OS) time was 114 (range 29–199) months, and the median disease-free survival (DFS) time was 88 (range 40–135) months. The median progression-free survival (PFS) time was 40 (range 24–55) months. Further, a comparison of patients with survivin positive versus negative tumors, revealed no significant difference for OS, DFS, and PFS (p = 0.45, p = 0.19, p = 0.55, respectively), number of mitoses in 50 HPF (p = 0.14), and tumor size (p = 0.94).In conclusion, survivin was highly expressed in GISTs, although we found no correlation between survivin expression and PFS, DFS and OS, survivin may be a predictive marker in GISTs for disease progression. We believe that additional studies are warranted to determine the clinical significance of survivin expression as a prognostic or predictive marker in patients with GIST.     

Knotting of intracardiac flow-directed balloon catheter: A non-surgical technique for removal

A knot occurred in a flow-directed balloon tipped (Swan-Ganz) catheter inserted through the right internal jugulary vein. Knot was undone using right Judkins catheter introduced via left jugulary vein approach. By passing through the loop of knot, right Judkins catheter was used to stabilize the knotted segment and knot was unknotted by gently pulling the Swan-Ganz Catheter.     

Aortic valve lymphoma presenting as acute coronary syndrome

Primary cardiac lymphoma is a very rare tumor which commonly affects the right atrium, although any chamber may be affected. Over the past few decades, the incidence of the lesion has increased, due mainly to growing numbers of immunocompromised patients, either HIV-related or iatrogenic. Because of this rapid evolution, the situation represents an oncologic emergency, and therefore early diagnosis and treatment are crucial. Although MRI is the most sensitive modality, open biopsy remains the 'gold standard' for reaching the diagnosis. However, the overall prognosis is poor. Herein is presented a case of a large B-cell non-Hodgkin lymphoma involving only the aortic valve.     

Time interval from the initiation of the electrocardiographic P wave to the start of left atrial appendage ejection flow: A novel method for predicting atrial fibrillation recurrence

OBJECTIVE: The incidence of paroxysmal and persistent atrial fibrillation (AF) recurrence is high and unpredictable. In this study, a novel noninvasive method that was thought to reflect the interatrial conduction time was investigated to predict AF recurrence. This method was on the basis of the measurement of time interval from initiation of the electrocardiographic P wave to the start of left atrial (LA) appendage (LAA) ejection flow (P-LAA). Methods and Results: Forty-five consecutive patients (age, 61 +/- 11 years; 20 male) with newly diagnosed AF (mean duration, 132 hours; range: 6 hours-3 months) who converted to in sinus rhythm spontaneously or with cardioversion were studied prospectively. Transthoracic and transesophageal echocardiography were performed to measure LA size, mechanical functions, LAA ejection velocity, and P-LAA. Transesophageal echocardiography was performed for the measurement of P-LAA 1 to 2 days after conversion to in sinus rhythm. The patients were followed up for a period of 163 +/- 72 days for the recurrence of AF. AF recurred in 17 (38%) patients after a mean time of 81 +/- 67 days. P-LAA was significantly higher in patients with AF recurrence (123 +/- 36 vs 92 +/- 24 milliseconds, P =.0047) and multiple regression analysis indicated that P-LAA was an independent predictor of AF recurrence. Multiple regression analysis revealed no significant differences in LA size parameters, or in clinical and LA mechanical function parameters recorded after restoration of in sinus rhythm between patients with and without AF recurrence. CONCLUSION: P-LAA may be considered to be an independent predictor of recurrent AF.     

A population-based questionnaire study on the prevalence and epidemiology of burn patients in Denizli, Turkey.

Epidemiological investigations of burn patients help health services to identify the need for burn care and to plan burn care facilities. Various epidemiological studies on burn injury have been conducted, but they have usually covered major burn victims who required hospitalization or minor burn victims who were treated at health care centers. Few studies have included burn victims who were not admitted to any health care center. Through a population-based questionnaire, we studied the epidemiology of the entire population of burn victims, including those who did not seek medical attention. Thus, we identified the actual frequency of hospital admission and the frequency of sequelae. In total, 1068 persons from the city of Denizli, Turkey were questioned about burns in the last 10 years and the burn prevalence was found to be 12.6%. Only 33.3% of the burn victims were treated at a health care center; thus, 66.7% of the victims were treated at home with traditional burn wound care methods. Etiologic factors such as the age and sex of each victim, the cause and anatomic location of the burn, and location of the victim when burned were all investigated. The overall percentage of sequelae was 31.3%; of these, 89.5% were cosmetic problems, 7.9% were functional impairments, and 2.9% were physiological problems. The low percentage of health care center admissions and high incidence of sequelae suggest the need for professional burn care centers that can be easily reached by burn victims.     

Prevalence of congenital heart defects in monochorionic/diamniotic twin gestations: a systematic literature review.

OBJECTIVE: Congenital heart defects (CHDs) affect approximately 0.5% of all neonates. Recent literature points to a possible increase in the CHD prevalence among monochorionic/diamniotic (MC/DA) twin gestations. We hypothesized that MC/DA twin pregnancy is a risk factor for CHD. METHODS: A systematic review of all published English literature was conducted on MEDLINE (Ovid and PubMed) from January 2000 through April 2007 using the medical subject heading terms "congenital heart defect" and "monozygotic twins." Four observational studies were included in the final analysis. Published historical data were used for the population background risk of CHD. Relative risk (RR) estimates with 95% confidence intervals (CIs) were calculated by fixed and random effect models. RESULTS: We included a total of 40 fetuses with CHDs among 830 fetuses from MC/DA twin gestations. Compared with the population, CHDs were significantly more prevalent in MC/DA twins regardless of the presence of twin-twin transfusion syndrome (TTTS) (RR, 9.18; 95% CI, 5.51-15.29; P < .001). Monochorionic/diamniotic twin gestations affected by TTTS were more likely to be complicated by CHDs than those that did not have TTTS (RR, 2.78; 95% CI, 1.03-7.52; P = .04). Ventricular septal defects were the most frequent heart defects. Pulmonary stenosis and atrial septal defects were significantly more prevalent in pregnancies complicated with TTTS. CONCLUSIONS: Monochorionic/diamniotic twin gestation appears to be a risk factor for CHDs. Conditions that lead to abnormal placentation may also contribute to abnormal heart development, especially in MC/DA twin pregnancies complicated with TTTS. Fetal echocardiography may be considered for all MC/DA twin gestations because ventricular septal defects and pulmonary stenosis are the most common defects.     

Diagnostic Significance of Ultrasonographic Measurements and Median-Ulnar Ratio in Carpal Tunnel Syndrome: Correlation with Nerve Conduction Studies

MethodsThe pisiform CSA (CSA_pisiform), swelling ratio (SR), palmar bowing, and CSA_pisiform/ulnar CSA (CSA_ulnar) measurements made in two subgroups of CTS patients (having sensory affection alone or having both sensory and motor affection) were compared with controls. CSA_ulnar was measured in Guyon''s canal at the level of most-protuberant portion of the pisiform bone.ResultsThe values of all of the measured US parameters were higher in patients with CTS (n=50) than in controls (n=62). CSA_pisiform could be used to diagnose CTS of mild severity. All of the parameters were positively correlated with the distal latency of the compound muscle action potential, and all of them except for SR were negatively correlated with the sensory nerve conduction velocity. A CSA_pisiform/CSA_ulnar ratio of ≥1.79 had a sensitivity of 70% and a specificity of 76% for diagnosing CTS.ConclusionsOnly CSA_pisiform measurements were reliable for diagnosing early stages of CTS, and CSA_pisiform/CSA_ulnar had a lower diagnostic value for diagnosing CTS.