The effect of 3 T MRI on microleakage of amalgam restorations

OBJECTIVES

To evaluate the effects of 3 T magnetic field on microleakage of amalgam restorations containing three different types of silver (Ag).

METHODS

60 extracted teeth were restored with three different types of amalgam filling materials. Restored teeth were sectioned mesiodistally and divided into experimental and control groups. Experimental groups were exposed to a magnetic field of 3 T for 20 min. All samples were plunged into 2% basic fuchsin solution and examined under a digital microscope by three different observers with regard to microleakage.

RESULTS

Statistical analysis showed significant differences in microleakage between the groups exposed to MRI and controls, whereas differences in microleakage between amalgam types were insignificant.

CONCLUSIONS

The primary risk of MRI systems arises from the effects of its strong magnetic field on objects containing ferromagnetic materials. An MRI of 1.5 T is known to be safe for amalgam restorations. However, our research indicates that MRI is not completely devoid of any effects on amalgam restorations.

Patient-driven assessment of disease activity in Behçet's syndrome: cross-cultural adaptation, reliability and validity of the Turkish version of the Behçet's Syndrome Activity Score

OBJECTIVES

The Behçet's Syndrome Activity Score (BSAS) is the first patient reported outcome measure developed to assess the global disease activity in patients with Behçet's syndrome (BS). We aimed to evaluate the reliability and validity of the Turkish version of BSAS for measuring disease activity in BS. We further investigated the performance of Routine Assessment of Patient Index Data (RAPID)3, a patient-reported index originally developed for rheumatoid arthritis, in BS patients.

METHODS

Patients seen consecutively at a tertiary Rheumatology Centre were requested to complete BSAS and multidimensional health assessment questionnaire (MDHAQ). Besides, all attending physicians filled the Behçet's Disease Current Activity Form (BDCAF). Descriptive statistics and Pearson correlation coefficients were calculated accordingly for the reliability and validity assessments of BSAS.

RESULTS

A total of 104 patients completed all three assessments. The test-retest reliability of BSAS has a good level (ICC=0.84, 95% CI [0.69-0.94]). The mean scores for BSAS, BDCAF and RAPID3 were 39±20.8, 3.2±1.4 and 9.2±5.6, respectively. BSAS was correlated with BDCAF moderately (r=0.587), while it was moderately correlated with RAPID3 (r=0.648). The correlation between the RAPID3 and BDCAF was moderate (r=0.403), but lower as compared to the correlations between the other instruments.

CONCLUSIONS

We found that the BSAS has modest correlation with BDCAF and is a reliable and valid patient reported measure of disease activity that can be used to assess patients with BS. An outcome score composed of only patient-derived observations may have the additional advantage of being easier to use in a routine care setting. Demonstration of a moderate level of correlation between RAPID3 and BDCAF (close to the level of weak relationship), suggests that RAPID3 likely needs more investigations before recommending its use in BS.

The expression of transmembrane and soluble CXCL16 and the relation with interferon-alpha secretion in patients with Behçet's disease

OBJECTIVES

CXCL16 is a member of CXC chemokine, which is synthesised in plasmacytoid dendritic cell as a transmembrane molecule. Transmembrane CXCL16 on plasmacytoid dendritic cell plays a role in binding, uptaking and accumulation of CpG D ODN in early endosomes rather then lysosomal vesicles, thereby causing a high level of interferon-alpha secretion. Previously, we disclosed pronounced interferon-alpha production from these cells in patients with Behçet's disease. The aim of this study was to investigate the relation between the secretion of IFN-α and the expression of CXCL16 on surface of plasmacytoid dendritic cell from patients with Behçet's disease, and compare it with patients with ankylosing spondylitis and healthy controls.

METHODS

The study population consisted of 73 cases (35 with Behçet's disease, 19 with ankylosing spondylitis and 19 controls). We investigated the expression of CXCL16 on surface of plasmacytoid dendritic cells by flow cytometry, and the serum levels of IFN-α and CXCL16 with ELISA.

RESULTS

Serum levels of IFN-α in patients with Behçet's disease were significantly higher than the controls (p=0.009), and than patients with ankylosing spondylitis, but not statistically significant (p=0.124). Serum levels of CXCL16 in patients with Behçet's disease and patients with ankylosing spondylitis were significantly higher than controls (p=0.009, p=0.003, respectively). We found no difference in the percentage and MFI of plasmacytoid dendritic cells and CD123+CXCL16+ cells determined by flow cytometry among the study and control groups. In patients with Behçet's disease, a positive correlation was found between the percentage of plasmacytoid dendritic cells and CD123+CXCL16+ cells (p<0.001). Furthermore, there was also a positive correlation between the percentage of plasmacytoid dendritic cells and serum levels of CXCL16 in patients with ankylosing spondylitis (p=0.001). In addition, there was a positive correlation between the percentage of CD123+CXCL16+ cells and serum levels of IFN-α in Behçet's disease group (p=0.034). We could not find any significant difference in other comparisons.

CONCLUSIONS

We suggested that the expression of transmembrane CXCL16 on surface of plasmacytoid dendritic cell might contribute to high serum IFN-α levels seen in patients with BD.

Transverse sinus thrombosis in a living donor: a case report

BACKGROUND

Liver transplantation is among the treatment options for end-stage liver disease. Limited organ donation in our country has resulted in an increased performance of living donor liver transplantations. This case report describes a left transverse cerebral venous sinus thrombosis diagnosed in a living donor hepatectomy patient.

PATIENT

A 45-year-old man underwent right lobe hepatectomy of a 330-g graft for living donor liver transplantation to his 55-year-old hepatitis B virus-positive brother. On the first postoperative day, without any surgical problems he presented with loss of consciousness. Previous medical history was unremarkable. Neurology consultation revealed lethargy and an acute confusional state. Cerebral magnetic resonance imaging venography showed signal alterations in the left transverse sinus wherein thrombosis was diagnosed. Heparin infusion initiated for antithrombotic treatment was adjusted to provide a 1.5 to 2-fold increased baseline activated partial thromboplastin time. On the second day of treatment has clinical status improved and he was discharged on the, fifth day on oral anticoagulant (warfarin) therapy for outpatient follow-up.

RESULTS

Cerebral venous sinus thrombosis is a rare disease with variable clinical onsets. Surgical procedures are among risk factors. An early diagnosis is essential to achieve low mortality and morbidity rates.

Apparent diffusion coefficients of sacroiliitis in patients with established ankylosing spondylitis

AIM

To compare apparent diffusion coefficients (ADCs) of sacroiliac joints (SIJs) in ankylosing spondylitis (AS) patients during advanced-active and advanced-nonactive stages.

MATERIALS-METHODS

AS patients with chronic-active (n=19), chronic-nonactive (n=6), and controls with normal SIJs (n=8) were included. Mean ADCs through 43 subchondral bone marrow edema lesions (SBMELs) were calculated.

RESULTS

Mean ADCs were 1.60+/-0.32 × 10-3 mm(2)/s over SBMELs, 0.57+/-0.23 × 10-3 mm(2)/s at periphery of SBMELs, 0.57+/-0.24 × 10-3 mm(2)/s in chronic-nonactive group, and 0.61+/-0.19 × 10-3 mm(2)/s for controls.

CONCLUSION

ADCs lower than 0.69 × 10-3 mm(2)/s, obtained at subchondral aspect of SIJs of established AS patients with chronic changes, which this number represents the receiver operating characteristic (ROC) best cutoff value, can be considered as normal without possible residual inflammation of concern.

Liver transplantation with piggyback anastomosis using a linear stapler: a case report

The so-called piggyback technique of liver transplantation (PB-LT) preserves the recipient's caval vein, shortening the warm ischemic time. It can be reduced even further by using a linear stapler for the cavocaval anastomosis. Herein, we have presented a case of a patient undergoing a side-to-side, whole-organ PB-LT for cryptogenic cirrhosis. Upper and lower orifices of the donor caval vein were closed at the back table using a running 5-0 polypropylene suture. Three stay sutures were then placed on caudal parts of both the recipient and donor caval with a 5-mm venotomies. The endoscopic linear stapler was placed upward through the orifices and fired. A second stapler was placed more cranially and fired resulting in a 8-9 cm long cavocavostomy. Some loose clips were flushed away from the caval lumen. The caval anastomosis was performed within 4 minutes; the time needed to close the caval vein stapler insertion orifices (4-0 polypropylene running suture) before reperfusion was 1 minute. All other anastomoses were performed as typically sutured. The presented technique enables one to reduce the warm ischemic time, which can be of particular importance with marginal grafts.

Liver transplant with a marginal donor graft containing a hydatid cyst--a case report

Liver transplantation has become the standard treatment for acute failure and end-stage liver disease, but there are fewer donor organs available than patients on the waiting list. The donor pool may be increased by using marginal donor candidates. Some infectious and metabolic diseases have been transmitted to the recipient via marginal donor grafts. Hydatid cyst disease is rarely transmitted to a recipient from the donor graft. A literature search showed only 2 previous cases of liver transplantation using a donor graft that contains a hydatid cyst. We treated a 19-year-old woman who experienced acute on chronic end-stage liver failure secondary to cryptogenic cirrhosis. The liver graft from a 97-year-old marginal cadaveric donor contained a calcified hydatid cyst. No complication was associated with the hydatid cyst at 3 years after transplantation. The present case shows that donor livers with an inactive, calcified hydatid cyst may be used for emergency liver transplantation after considering the location, size, and relation of the cyst to vascular and biliary structures. The cyst may be resected on the back table with a successful treatment outcome.

Impact of the intensity of microemboli on neurocognitive outcome following cardiopulmonary bypass

BACKGROUND

This study aimed to determine whether there was any association between the intensity of intraoperative gaseous microembolic signals (GME), neuropsychological testing and clinical outcome in high-risk patients undergoing coronary artery surgery (CABG).

METHODS

Over a 6-month period, GME activity was monitored in 102 Euroscore 6+ patients during cardiopulmonary bypass (CPB) with a conventional 32-micron arterial filter by non-invasive, real-time ultrasonic device. Cognitive tests; line bisection, the Stroop test, finger tapping, and the Rey Auditory Verbal Learning Test were performed at baseline, postoperative one week and postoperative one month.

RESULTS

The distribution of GME activity showed that there were three groups of patients: >500 total emboli (n = 38); 250 to 500 emboli (n = 30) and <250 emboli (n = 34) at a detection level of 2% of the circuit diameter on the arterial side. Line bisection, the Stroop test and finger tapping were impaired significantly in >500 emboli patients versus control (<250 emboli) in postoperative week one, but resolved in one month.

CONCLUSIONS

Correlation between intraoperative GME intensity and neurocognitive tests suggests that the level of GME might have a role in determining the psychological outcome after CABG with CPB.

Value of DWI in visual assessment of activity of sacroiliitis in longstanding ankylosing spondylitis patients

OBJECTIVE

To test contrast to noise ratios (CNRs) of both diffusion-weighted (DW) images and contrast enhanced images in terms of the visual assessment of activity in sacroiliitis of ankylosing spondylitis (AS) patients.

MATERIALS AND METHODS

The study included 21 patients with AS. All patients were examined with STIR, FST1/Gd and DWI (b = 0,600). A total of 54 hyperintense lesions on STIR were noted in their sacroiliac joints divided into four quadrants. CNRs were calculated for all of the sequences above. A second group of patients (n = 7) with normal sacroiliac joints (SIJs) served as controls. A total of 56 CNR measurements from apparently normal subchondral bone marrow in this control group were done as well. The differences between scores were tested for significance (SPSS version 17.0) using Wilcoxon's test in which p values lower than 0.01 were considered statistically significant.

RESULTS

In the first group with sacroiliitis, mean CNRs for STIR, FST1/Gd, DWI were 32.97, 30.16 and 24.47, respectively. Mean CNRs in the second group with normal SIJs were calculated as 3.52 , 2.99 and 3.96, respectively . There was a statistically significant difference between the CNR measurements of the first and the second group (p = 0.000). Hyperintense lesions on STIR were depicted as "active" in the first group. Except for four lesions that were not included into the study, all of these hyperintense lesions were enhanced after contrast media administration. All of the "active" lesions were observed on DWI as well, at b = 600. No statistically significant difference between CNRs of contrast enhanced images and DWI and of contrast enhanced images and fluid sensitive sequences were found in the first group with sacroiliitis (p > 0.01).

CONCLUSION

The CNRs are highest on STIR, followed by contrast enhanced images and DWIs. In terms of DWI and contrast enhanced images, there is no statistically significant difference between these two. Hence, contrast enhanced imaging can be replaced by DWI for visual analysis of active sacroiliitis, which is easy to apply without adverse affects of contrast media.

Liver transplantation following blunt liver trauma

Due to developing medical technology worldwide, an increasing number of liver transplantations are performed for various indications. Liver transplantation has a limited but important role in specific life-threatening liver trauma cases, when initial therapeutic options fail to control the bleeding or when liver failure ensues. Herein we have reported a patient who required liver transplantation at 18 days after blunt liver trauma with acute liver failure. This case report suggested that liver transplantation is a potential treatment modality for a selected group of patients including pedratric cases who experience acute or subacute liver failure secondary to blunt trauma.

Incidental appendectomy in donors undergoing hepatectomy for living-donor liver transplantation

BACKGROUND

The aim of this study was to investigate the morbidity associated with appendectomy in living liver donors undergoing hepatectomy.

METHODS

The medical records of 338 donors who underwent hepatectomies for living-donor liver transplantation between 2008 and 2010 were reviewed retrospectively. The patients were divided into 2 groups on the basis of appendectomy: patients in group A (n = 126) received incidental appendectomies in conjunction with donor hepatectomy, and those in group B (n = 212) underwent hepatectomy alone.

RESULTS

No significant difference in age, gender, or body mass index was found between groups. The wound infection rate (P = .037) and length of hospital stay (P = .0038) were higher in group A than in group B. Intraoperative findings in 126 donors in group A were subserosal (n = 4), retrocecal (n = 6), or hard nodular (n = 11) appendix; hyperemic appendix with edema (n = 9); appendix length ≥ 8 cm (n = 18); and palpable fecalith (n = 78). Histopathologic examination of appendix specimens revealed lymphoid hyperplasia with a fecalith (n = 32), fecalith only (n = 32), acute appendicitis (n = 20), normal anatomy (n = 18), fibrous obliteration (n = 9), lymphoid hyperplasia (n = 9), Enterobius vermicularis (n = 3), appendiceal neuroma (n = 1), carcinoid tumor (n = 1), and mucoceles (n = 1).

CONCLUSION

Although incidental appendectomy increased the wound infection rate and length of hospital stay, this procedure is necessary for the prevention of potential complications due to appendicitis when the exploration of the ileocecal region in patients undergoing donor hepatectomy reveals one or more of the following: appendix length ≥ 8 cm; dropsical, hyperemic, subserosal, nodular, and/or retrocecal appendix; and/or palpable fecaloma.

Adult onset Still's disease as a paraneoplastic syndrome--a case report and review of the literature

Adult onset Still's disease (AOSD) is a systemic inflammatory disease with unknown etiology and characterized by evanescent salmon pink rash, sore throat, liver dysfunction, lymphadenopathy, hepatosplenomegaly, arthritis, and leukocytosis. It is a diagnosis of exclusion; however, there are case reports in the literature about patients with malignancies and AOSD-like signs and symptoms. Here we report a patient with AOSD seems to be associated with sarcomatoid renal cell carcinoma. This phenomenon is not distinguishable from primary AOSD either in presentation or in treatment; except for the main purpose of the management should be targeted to the underlying malignancy.

Features and publication rates of scientific abstracts presented at a rheumatology congress--EULAR 2008

OBJECTIVE

Various types of scientific abstracts are selected and presented at meetings and listed in abstract books. Recently, a systematic review has shown that 45% of 30,000 abstracts were published in a journal. The aim of this study was to determine the features of abstracts selected to be presented at a EULAR meeting (2008) and the corresponding publication rates.

METHODS

The EULAR 2008 Abstract Book was extracted, presented abstracts were assessed, their publication status was checked, and features related with publication rate were determined. The publication status of abstracts as of January 20, 2011, was verified using PubMed.

RESULTS

A total of 1,732 abstracts were assessed. Median publication duration was 13 (range: 0 to 31) months. Most of the abstracts (N=339) were of multi-national origin. Sixty seven percent of abstracts were clinical and 563 (33%) abstracts were preclinical. We found that 601 of all abstracts (34.7%) had been published in a journal, and most of were published in a rheumatology journal. Fifty-seven percent of published abstracts were in journals with an impact factor higher than 4. The publication rate was correlated with presentation type, number of centers involved, trial design, and number of patients enrolled.

CONCLUSIONS

We found that the publication rate of EULAR 2008 abstracts at 30 months was approximately 35%. This is a high rate compared to a previously published systematic review that investigated the publication rate of studies initially presented as abstracts in medical meetings, which reported the publication rate at 24 and 36 months as 20.7% and 28.1%, respectively. More than half of the published abstracts were accepted by high-impact journals. Presentation type, number of centers, trial design, and enrolled patient numbers were all correlated with the rate of publication.

Tramadol or paracetamol do not effect the diagnostic accuracy of acute abdominal pain with significant pain relief - a prospective, randomized, placebo controlled double blind study

OBJECTIVES

To examine the effects of early administration of analgesics in patients with acute abdominal pain on pain severity, abdominal findings and diagnostic accuracy.

METHODS

210 patients with non-traumatic acute abdominal pain lasting less than 72 hours were enrolled to this trial. Patients were administrated by placebo, tramadol (1 mg/kg), or paracetamol (15 mg/kg) randomly after the first evaluation of pain severity scores (standard 100 mm visual analog scale) and abdominal findings (rebound, rigidity, tenderness). After 20 and 40 minutes of administrations, pain severity scores and abdominal findings were re-examined. Complete blood count, electrocardiography, plain abdominal x-ray, urine analysis and abdominal ultrasound were used for the initial diagnosis. The final diagnoses were decided after re-examinations, biochemical blood analysis, abdominal computed tomography in all patients and consultations or other diagnostic methods when necessary.

RESULTS

There were 70 patients in each group. Baseline pain severity scores and abdominal findings were similar at all groups. After 20 minutes, pain severity scores were decreased in tramadol and paracetamol groups compared with the placebo group as 55% and 45% vs 1% respectively (p < 0.001). After 40 minutes, decreases on pain severity scores were more significant at treatment groups, 67% and 60% vs 0 (p < 0.001). When compared to placebo tramadol and paracetamol increased the new onset or worsening nausea or vomiting. There was no difference on abdominal findings among the groups after 20 and 40 minutes examinations. Diagnostic accuracy of tramadol, paracetamol and placebo groups were 96%, 94% and 94% respectively.

CONCLUSIONS

Early administration of tramadol and paracetamol provided effective pain relief in patients with non-traumatic acute abdominal pain and those administrations did not interfere with diagnosis.