Effects of intranasal 17beta-estradiol and raloxifene on lipid profile and fibrinogen in hypercholesterolemic postmenopausal women: a randomized, placebo-controlled clinical trial.

AIM: To compare the effects of 17beta-estradiol given intranasally (intranasal E2) and raloxifene on serum lipid profile and fibrinogen in hypercholesterolemic postmenopausal women. METHODS: The study population consisted of 46 women after menopause. The placebo group (n = 11) was given calcium, while the intervention groups were given intranasal E2 (Aerodiol; Servier, Chambray-les-Tours, France) (n = 16) or raloxifene (Evista; Lilly SA, Madrid, Spain) (n = 19). Blood lipids and fibrinogen were compared between groups at baseline and after 3 months of treatment. RESULTS: The group receiving intranasal E2 showed a significant decrease in triglyceride levels (p<0.05) and a marked increase in high-density lipoprotein cholesterol levels (p<0.05). No changes in lipid profile were observed in the raloxifene and placebo groups. Raloxifene caused a significant decrease in fibrinogen levels (p<0.05). CONCLUSION: Intranasal E2 exerts significant effects on lipid profile in hypercholesterolemic postmenopausal women. Raloxifene has a greater impact on fibrinogen than intranasal E2 application.     

The role of nebulised budesonide in the treatment of exacerbations of COPD.

The present study was designed to evaluate the hypothesis that nebulised budesonide (NB) might be an alternative to systemic corticosteroids (SC) in the treatment of patients with exacerbations of chronic obstructive pulmonary disease (ECOPD). Patients hospitalised with ECOPD (n = 159) were randomised into three groups. Group 1 received only standard bronchodilator treatment (SBDT), group 2 received SC (40 mg prednisolone) plus SBDT, and group 3 received NB (1,500 microg q.i.d.) plus SBDT. Improvement during 10-day hospitalisation was compared with exacerbation and rehospitalisation rates after discharge. While mean+/-sd age was 64.1+/-8.9 yrs (female/male = 0.1), mean forced expiratory volume in one second (FEV(1)) at admission was found to be 37.2+/-12.2% predicted. Arterial blood gases and spirograms recovered faster in groups 2 and 3. While improvements in arterial oxygen tension (P(a,O(2))) and forced vital capacity (FVC) in group 2, and improvements in P(a,O(2)), FVC and FEV(1) in group 3, became significant at 24-h control, the first significant improvement in group 1 appeared in arterial oxygen saturation at 72-h control. The mean improvement of P(a,O(2)) after 10 days was 1.20 and 1.06 kPa (9 and 8 mmHg) higher in group 2 and 3, respectively, than in group 1. Blood glucose exhibited an upward trend only in group 2. The study demonstrates that nebulised budesonide may be an effective and safe alternative to systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease.     

Amyloidaceous ulcerated gingival hyperplasia: a newly described entity related to ligneous conjunctivitis

Gingival hyperplasia may be genetic, may be acquired as a consequence of exposure to drugs and other agents or may appear as part of a more widespread disorder. Five patients who acquired gingival hyperplasia due to amyloidaceous deposits staining only for fibrin are presented. This appears to be a new entity related to ligneous conjunctivitis.     

Effect of surface conditioning methods on the bond strength of luting cement to ceramics

OBJECTIVES: This study evaluated the effect of three different surface conditioning methods on the bond strength of a Bis-GMA based luting cement to six commercial dental ceramics. METHODS: Six disc shaped ceramic specimens (glass ceramics, glass infiltrated alumina, glass infiltrated zirconium dioxide reinforced alumina) were used for each test group yielding a total number of 216 specimens. The specimens in each group were randomly assigned to one of the each following treatment conditions: (1) hydrofluoric acid etching, (2) airborne particle abrasion, (3) tribochemical silica coating. The resin composite luting cement was bonded to the conditioned and silanized ceramics using polyethylene molds. All specimens were tested at dry and thermocycled (6.000, 5-55 degrees C, 30 s) conditions. The shear bond strength of luting cement to ceramics was measured in a universal testing machine (1 mm/min). RESULTS: In dry conditions, acid etched glass ceramics exhibited significantly higher results (26.4-29.4 MPa) than those of glass infiltrated alumina ceramics (5.3-18.1 MPa) or zirconium dioxide (8.1 MPa) (ANOVA, P<0.001). Silica coating with silanization increased the bond strength significantly for high-alumina ceramics (8.5-21.8 MPa) and glass infiltrated zirconium dioxide ceramic (17.4 MPa) compared to that of airborne particle abrasion (ANOVA, P<0.001). Thermocycling decreased the bond strengths significantly after all of the conditioning methods tested. SIGNIFICANCE: Bond strengths of the luting cement tested on the dental ceramics following surface conditioning methods varied in accordance with the ceramic types. Hydrofluoric acid gel was effective mostly on the ceramics having glassy matrix in their structures. Roughening the ceramic surfaces with air particle abrasion provided higher bond strengths for high-alumina ceramics and the values increased more significantly after silica coating/silanization.     

Middle ear pathology in day-care centre children

BACKGROUND: Middle ear pathology, either otitis media with effusion or tubal dysfunction, is frequently seen in day-care centre children. Recognition and early treatment of this condition is crucial to the prevention of chronic otitis media, which is a major cause of hearing loss in later life. OBJECTIVES: We aimed to reveal the incidence of silent otitis media in day-care centre children and to determine the predisposing factors, risk factors and the awareness of the parents of the middle ear disease of their children. METHOD: Two hundred and thirteen children, aged 3-6 years, were screened in four daycare centres. A questionnaire was prepared that would reveal the predisposing factors. Information was gathered from both the parents and teachers. Children were examined by otoscopy, pneumotoscopy, tympanometry and X-rays for sinus pathology. RESULTS: Forty-three of 213 children had middle ear pathology; 39 of them were confirmed by tympanometry; 56.1 % of children had some degree of sinus pathology. We revealed that, although most of the children do not have the risk factors, they develop middle ear pathology. Among the parents, 81.4% of them were unaware of the condition. CONCLUSION: Early diagnosis of middle ear pathologies is necessary for prevention of future complications. In early stages the condition is silent. We emphasize the importance of the primary care physician's role in diagnosing the early stages of middle ear pathologies and recommend that teaching of otoscopic and pneumotoscopic skills should be part of the training for family physicians.      

Assessment of changes in penile sensation by electrophysiological study after radical prostatectomy: A pilot study

Background:To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction.Materials and methods:Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months.Results:Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p < 0.05). The IIEF-5 scores in the nerve sparing-RP (NS-RP) group were significantly higher than the non-nerve sparing-RP (NNS-RP) group in the postoperative period. Nerve conduction velocity values in the NS-RP group were also higher than the NNS-RP group at the postoperative 3rd and 6th months. However, these changes were not statistically significant (p > 0.05).Conclusions:Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.     

Effect of aluminum adjuvants on safety and immunogenicity of Haemophilus influenzae type b-CRM197 conjugate vaccine

OBJECTIVE: The present study was carried out to evaluate the safety and immunogenicity of the Haemophilus influenzae type b-CRM197 (Hib-CRM197) conjugate vaccine in relation to the change of adjuvant from aluminum hydroxide to aluminum phosphate (AlPO4). METHODS: The present study was a clinical phase II, observer-blind, randomized, multicenter, controlled study. Subjects were healthy infants aged 6-12 weeks, eligible for expanded program of immunization (EPI) routine vaccination and admitted to Hacettepe University Department of Social Pediatrics and Gülveren Health Center, Ankara. A total of 520 healthy infants were randomized in a 2:2:1 ratio to receive at either Chiron Hib/AlPO4 vaccine or VaxemHib (aluminum hydroxide adjuvant) vaccine or HibTiter (no adjuvant). Vaccines were administered simultaneously with routine diphtheria, tetanus and pertussis (DTaP) and oral polio vaccine (OPV) vaccines at 2, 4 and 6 months of age. Blood samples for anti-plain polysaccharide (PRP) antibody measurement were collected before the first vaccination and 1 month after the last vaccination. After each vaccination parents filled out a diary for 7 days. RESULTS: Out of 520 subjects enrolled, 514 received three doses and were included for safety analysis. Local and systemic reactions occurred with low and similar frequencies in all groups. Only erythema was more common in Chiron Hib/AlPO4 vaccine (19, 10, 11% in Chiron Hib/AlPO4, VaxemHib and HibTiter, respectively, P < 0.05). Nine serious adverse events were reported in seven cases of which none were related to vaccines. A total of 504 subjects were included in the immunogenicity analysis. The three vaccines were highly immunogenic and equivalent in terms of percentage of acquisition of long-term protective levels. The anti-PRP geometric mean titers were 9.9, 8.3 and 5.14 micro g/mL, respectively (P < 0.05). CONCLUSIONS: The use of aluminum compounds adjuvants in Hib-CRM197 conjugate vaccines does not impact the safety profile, while it does increase the magnitude of anti-PRP antibody titers.     

Preliminary traction as a single determinant of avascular necrosis in developmental dislocation of the hip

The role of preliminary traction before closed reduction in the treatment of developmental dysplasia of the hip has been questioned by many authors lately. However, the studies advocating or opposing the use of this treatment modality include several other parameters besides traction. Thus, it is unclear whether the affection is the result of preliminary traction or concurrent variables such as the "human position." This study aimed to put forward the effect of preliminary traction as a single determinant of avascular necrosis. We had two groups of patients who had developmental dislocation of the hip. The first group consisted of 52 patients treated with preliminary traction before closed reduction and the other group comprised 40 patients treated with closed reduction without preliminary traction. Both groups were similar in age, gender, side, level of dislocation, and method and duration of immobilization. Three patients from the first group developed avascular necrosis, which was not statistically significant. Preliminary traction did not affect the rate of avascular necrosis.