Atrioventricular Nodal Reentrant Tachycardia with Paroxysmal Atrial Fibrillation: Clinical and Electrophysiological Features and Predictors of Atrial Fibrillation Recurrence Following Elimination of Atrioventricular Nodal Reentrant Tachycardia

Introduction: Clinical and electrophysiological characteristics of patients with atrioventricular nodal reentrant tachycardia (AVNRT) and paroxysmal atrial fibrillation (AF) have not been studied in a large patient cohort. We aimed to define the clinical features and cardiac electrophysiological characteristics of these patients, and to examine the incidence and identify predictors of AF recurrences after elimination of AVNRT. Methods and Results: Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) and 497 patients with AVNRT alone undergoing ablation in the same period (Group 2) were studied. There were no significant differences between groups regarding clinical features, except age, which was higher in Group 1 (p < 0.001). Presence of atrial vulnerability (induction of AF lasting > 30 seconds) and multiple AH jumps (≥50 ms) before ablation were significantly more prevalent in Group 1 (p < 0.001, p = 0.010 respectively). During follow-up of 34 ± 11 months, AF recurred in 10 patients (28%) in Group 1, while 2 patients in Group 2 (0.4%) developed paroxysmal AF (p < 0.001). Univariate predictors of AF were: left atrial diameter > 40 mm (p = 0.001), presence of mitral or aortic calcification (p = 0.003), atrial vulnerability after ablation (p = 0.015) and valvular disease (p = 0.042). However, independent predictors of AF recurrences were left atrial diameter > 40 mm (p = 0.002) and the presence of atrial vulnerability after ablation (p = 0.034). Conclusion: In patients with both AVNRT and paroxysmal AF, the recurrence rate of AF after elimination of AVNRT is 28%. Left atrial diameter greater than 40 mm and atrial vulnerability after elimination of AVNRT are independent predictors of AF recurrences in the long term.     

Improved edge strength in a facial prosthesis by incorporation of tulle: a clinical report

This clinical report describes the use of tulle for increasing the tear resistance of a facial prosthesis. By incorporating tulle, a prosthesis' margins may be more stable, more resistant to tearing, and less likely to deform while adhesive, cosmetics, and cleaning agents are applied and removed.     

Applicability of zirconia dental prostheses for metal allergy patients

The aim of this study was to investigate the applicability of zirconium dioxide (zirconia) as a substitute for metal alloys in a group of metal allergy patients. Fourteen patients (eight women, six men) who had been restored with porcelain-fused-to-metal fixed partial dentures (FPDs) and had exhibited hypersensitivity lesions to dental alloys were enrolled in this study. Patients were previously patch-tested using standard testing substances authorized by the International Contact Dermatitis Research Group. Patients received FPDs with zirconia frameworks and occurrences of oral symptoms were evaluated. No hypersensitivity lesions in the mouth or on the skin were encountered during the follow-up period of 3 years. Zirconia FPDs may be an alternative to porcelain-fused-to-metal FPDs in patients with metal allergies.     

Comparative study of the effect of tube drainage versus methylprednisolone after third molar surgery.

OBJECTIVE: The purpose of this study was to compare the effects of tube drainage versus a single dose of methylprednisolone (MP) on maximal mouth opening, facial swelling, and pain after third molar surgery. STUDY DESIGN: Twenty-two patients requiring extraction of bilaterally impacted mandibular third molars were selected. Each patient had 2 operations. In the first operation, a drainage tube was inserted into the buccal fold after the suture procedure and left there for 3 days. In the second operation 1 month after the first surgery, 1.5 mg/kg intravenous methylprednisolone was administered 1 hour before the surgery. The patients were evaluated by the same person for maximal mouth opening, facial swelling, and pain in the immediate preoperative time point and on the second, fifth, and seventh days after surgery. RESULTS: There was a statistically significant difference in mouth opening on fifth and seventh days but none in facial swelling and pain between MP group and drain group. CONCLUSION: We conclude that the use of a drain or methylprednisolone is useful in reducing postoperative discomfort after third molar surgery.     

Left ventricular apical aneurysm as a consequence of diffuse type congenital nonfamilial supravalvular aortic stenosis in a 30-year-old female

Congenital nonfamilial supravalvular aortic stenosis (SVAS) is relatively rare, its diffuse type being the least common. We present a 30-year-old woman with diffuse SVAS complicated with left ventricular apical aneurysm. We believe that subtle left ventricular myocardial ischemia or infarction and long-lasting severe pressure overload to the apical chamber caused LV apical aneurysm in our case. Acquired LV apical aneurysm secondary to supravalvular aortic stenosis, in the absence of atherosclerotic coronary artery disease and hypertrophic obstructive cardiomyopathy, has not been described before.     

Prevalence of Nocturnal Enuresis and Related Factors in Children Aged 5-13 in Istanbul

Objective

Enuresis is a health problem frequently encountered in childhood. This study was carried out in two socio-demographically different districts of the province of Istanbul, for the purpose of determining the relationship between the prevalence of primary nocturnal enuresis and certain demographic characteristics.

Methods

The study design is a cross-sectional carried out on 420 children (5 to 13 yr old) through random sampling. The research was conducted at two health centers in two different districts in the province of Istanbul. Data was collected with a questionnaire created by the researchers. Diagnosis of enuresis considered nocturnal voiding twice a week for at least three consecutive months.

Findings

Enuresis was a complaint expressed by 16.2% of the cases in the study group; 8.3% reported intermittent bedwetting. The data collected in the two districts pointed to a significant difference in terms of the frequency of enuresis in favor of the district where socio-demographic features were inferior (P<0.005). When family histories were explored in cases of children with enuresis, it was found that the mothers of 76.2% had the problem of enuresis while 14.9% had enuretic fathers. Thus statistically, the presence of enuresis in the family history was seen to have had a markedly significant impact on the occurrence of enuresis in the child (P<0.001).

Conclusion

It was concluded that familial predisposition to the condition constituted a more significant risk factor for enuresis compared to socio-demographic or economic characteristics.     

Management of pain in TMD patients: Bio-oxidative ozone therapy versus occlusal splints

Objective: To compare the effects of bio-oxidative ozone application with occlusal splints in temporomandibular disorder (TMD) patients with pain.

Methods: Forty participants were selected after the diagnosis of TMD and randomly divided into two groups: ozone group (OG, n = 20) and occlusal splint group (OCSG, n = 20). Ozone was applied to patients three times per week, for a total of six sessions. Patients in the OCSG were instructed to use occlusal splints every night over a period of four weeks.

Results: Mandibular movements showed significant differences for the time factor in OG and OCSG. Pressure pain thresholds of the temporal and masseter muscles at follow-up were significantly higher in the OCSG group. Both treatments statistically decreased the visual analog scale (VAS) scores. However, no statistically significant difference was observed between groups after the application of treatments.

Discussion: Occlusal splint treatment is still the gold treatment modality for objective pain relief in patients with TMD pain.     

Absence of posterior mitral leaflet with secundum atrial septal defect

A rare case of a 54-year-old woman with absence of congenital posterior mitral leaflet, moderate mitral insufficiency, and large secundum-type atrial septal defect is reported. Two-dimensional color Doppler and transesophageal echocardiography revealed complete absence of the posterior mitral leaflet, a thick muscular formation replacing the posterior leaflet, a 3.3-cm secundum type atrial septal defect, and severe pulmonary hypertension. This report describes the rare case of congenital absence of posterior mitral leaflet associated with secundum type large atrial septal defect in a middle-age woman.