A descriptive analysis of 188 liver transplant patient visits to an emergency department

BACKGROUND

The aim of the study is to seek the causes of application, the demographic and clinical characteristics of liver transplant patients and to share the experiences of our Emergency Department.

MATERIALS AND METHODS

One hundred eighty-eight Emergency Department visits of ninety patients who underwent liver transplant operations between 2002 and 2009 were evaluated retrospectively.

RESULTS

The patients applied to the Emergency Department with the complaints of fever 28.2% and abdominal pain 30.9%. It was detected that the final diagnosis of 52.4% of the patient visits was associated with the gastrointestinal system. It was observed that the most common treatment was drug therapy by 45.2% and that antibiotics treatment was the most applied method in drug treatment. Alanine aminotransferase (ALT) median value of hospitalized patients (45.5 U/L) is significantly higher than that of discharged patients (35 U/L) (p = 0.04). From the records of the patients, positive correlations between the length of hospitalization and levels of total bilirubin, direct bilirubin, ALT and fever during the visit were detected (p = 0.001, p < 0.001, p = 0.01, p = 0.01, respectively).

CONCLUSIONS

Most frequently liver transplant recipients visited the Emergency Departments with the complaints of fever and abdominal pain. The diagnosis was generally associated with gastrointestinal system disorders. The percentage of hospitalization was high and the length of stay at the hospital was long. The treatment of these patients required a multidisciplinary approach and antibiotics constituted the most used drug treatment. Also, fever and liver function tests examined at the time of admittance to the Emergency Department affected the length of hospitalization.

Stability measurements of craniofacial implants by means of resonance frequency analysis: 1-year clinical pilot study

PURPOSE

The purpose of this pilot study was to apply resonance frequency analysis (RFA) to measure the clinical stability of craniofacial implants and compare the RFA measurements over a 12-month period.

MATERIALS AND METHODS

Patients with auricular or orbital defects were treated with prostheses retained by two or three implants. After healing periods of 3 months for auricular implants and 6 months for orbital implants, prostheses were fabricated. RFA measurements were performed immediately after implant placement, at abutment connection, and at 6 and 12 months. All stability measurements were repeated three times for each implant, and the mean value was used for analyses. For measurements performed after prosthesis delivery, connecting bars and abutments were removed prior to RFA. The stability of both types of implants was compared at different time intervals.

RESULTS

Fifty-four implants were placed in 10 patients with auricular defects (26 implants) and 10 patients with orbital defects (28 implants). All auricular implants survived, and four orbital implants in four different patients failed. For auricular implants, statistically significant differences in stability values were noted between implant placement, abutment connection, and 6 months; there was no significant difference between 6 and 12 months. For orbital implants, no significant differences were found between implant placement and abutment connection, a significant increase was observed at 6 months, and no significant difference was seen between 6 and 12 months. No significant differences were found for auricular versus orbital implants between placement and abutment connection, but auricular implants showed significantly higher stability values than orbital implants at 6 and 12 months.

CONCLUSIONS

The stability of surviving auricular and orbital implants increased with time according to RFA. Prior to failure, the failed implants showed RFA values that were below the mean.

Effect of oxygen supplementation in the hatcher at high altitude on the incubation results of broiler eggs laid at low altitude

1. The object of this research was to investigate the effects of high altitude with supplementary oxygen during the last stage of incubation of broiler eggs laid at low altitude and incubated at low and high altitude. We analysed thyroid hormones and haematological variables. 2. The treatment groups were: low altitude (LA), high altitude with oxygen supplementation in the hatcher (HA-OX) and high altitude non-oxygen-supplemented (HA-NOX). 3. High altitude affected relative egg weight loss and early embryonic mortality. The hatchability of fertile eggs was lower at high than at low altitude. 4. Oxygen supplementation into the hatcher cabinet during the last stage of incubation decreased late embryonic mortality ratio (LEM(1)) and improved survival rates of embryos incubated at high altitude. 5. Eggs incubated at low altitude had a higher hatched chick weight and relative chick weight than those incubated at high altitude. Hatched chick weight and relative chick weight did not change with oxygen supplementation at high altitude. 6. High altitude caused an increase in plasma T(3) and T(4) concentrations as well as in the ratio of T(3):T(4) in embryos. High altitude newly hatched chicks showed a higher T(3):T(4) ratio than low altitude chicks; this ratio decreased with oxygen supplementation at high altitude. Altitude and oxygen supplementation did not affect the mean plasma T(4). 7. Newly-hatched chicks incubated at high altitude showed a higher plasma haematocrit (PCV) than the newly-hatched chicks from eggs incubated at low altitude. High altitude without supplementation increased haemoglobin (Hb), while oxygen supplementation returned the value to low altitude values.

A method for fabricating an implant-retained orbital prosthesis using the existing prosthesis

This article describes a time-saving technique for fabricating a new implant-retained orbital prosthesis using the patient's existing prosthesis. The location of the ocular component is transferred; the position and openings of the palpebral anatomic structures and the precise anatomic details of the existing orbital prosthesis are duplicated. Making the impression, fabricating the definitive cast, alignment of the ocular component, and completing the wax sculpture of the prosthesis are accomplished in one appointment.

Chronic variable physical stress during the peripubertal-juvenile period causes differential depressive and anxiogenic effects in the novelty-seeking phenotype: functional implications for hippocampal and amygdalar brain-derived neurotrophic factor and the mossy fibre plasticity

Experimentally naive rats show variance in their locomotor reactivity to novelty, some displaying higher (HR) while others displaying lower (LR) reactivity, associated with vulnerability to stress. We employed a chronic variable physical stress regimen incorporating intermittent and random exposures of physical stressors or control handling during the peripubertal-juvenile period to assess interactions between stress and the LRHR phenotype in depressive- and anxiety-like behaviors on the forced swim and social interaction tests, respectively. A decrease in immobility in the forced swim test along with a decrease in social contact in the social interaction test were observed in the juvenile HRs, coupled with increases in brain-derived neurotrophic factor (BDNF) mRNA in the hippocampus and in the basolateral amygdala with chronic variable physical stress. In contrast, an increase in immobility in the forced swim test and a decrease in social contact was observed in the LR counterparts coupled with an increase in the BDNF mRNA in the basolateral amygdala following chronic variable physical stress. Furthermore, chronic physical stress led to increased H3 and H4 acetylation at the P2 and P4 promoters of the hippocampal BDNF gene in the HR rats that is associated with increased suprapyramidal mossy fibre (SP-MF) terminal field volume. In contrast, chronic variable physical stress led to decreased H4 acetylation at the P4 promoter, associated with decreased SP-MF volume in the LR rats. These findings show dissociation in depressive- and anxiety-like behaviors following chronic variable physical stress in the juvenile HR animals that may be mediated by increased levels of BDNF in the hippocampus and in the amygdala, respectively. Moreover, chronic variable physical stress during the peripubertal-juvenile period results in opposite effects in depressive-like behavior in the LRHR rats by way of inducing differential epigenetic regulation of the hippocampal BDNF gene that, in turn, may mediate mossy fibre sprouting.

Fistulisation of pyogenic liver abscess into the portal vein and bile ducts

We report pyogenic liver abscess complicated by fistulisation into the portal vein and bile ducts in a 58-year-old diabetic woman, who was admitted to the hospital with fever, chills and rigors. Abdominal ultrasonography and computed tomography demonstrated a 7-cm multiloculated abscess in segment III, close to the left branch of the portal vein. The abscess was drained under fluoroscopic guidance in a single pass. Pus was aspirated, and diluted water-soluble contrast was injected into the cavity. Early films revealed filling of the cavity. Later, the contrast appeared in the bile ducts and left branch of the portal vein. Radiological intervention was discontinued. Immediate surgery, including left lateral segmentectomy, was performed. The preoperative course was uneventful, except for superficial surgical site infection. We opine that a hepato-venous fistula is an indication for surgical intervention, and that early resection of the fistula can prevent severe septic complications.

Preoperative staging of colon cancer patients: ultrasound can be a valuable alternative to computed tomography

OBJECTIVE

The aim of this study was to compare the results of ultrasound and CT assessment in preoperative staging of colonic cancer, and to determine whether CT offers any benefits beyond ultrasound.

PATIENTS AND METHODS

Sixty-one cases of intraperitoneal colon cancer were assessed by preoperative abdominal ultrasound and CT. The ultrasound and CT findings were assessed for ascites, hepatic and peritoneal metastases, invasion of adjacent organs, and findings of other diseases.

RESULTS

The sensitivity rates of CT for liver metastases, adjacent organ invasion, ascites and peritoneal metastases were 81 %, 25 %, 29 % and 20 % respectively, while those of ultrasound were 69 %, 6 %, 43 % and 0%, respectively. Both methods had similar sensitivity, specificity and accuracy rates regarding the detection of all criteria. Ultrasound was more sensitive for detecting ascites and liver metastasis when compared to peritoneal metastasis and invasion (p<0.05). CT allowed the detection of liver metastasis to be more sensitive when compared to the other three criteria (p<0.05). In addition to ultrasound, CT gave no more additional knowledge indicating the necessity of altering the clinical management in patients.

CONCLUSION

The first-line scanning technique should be the ultrasound and there is no need for CT scan, should no abnormalities be found upon ultrasound examination. CT investigation plays a role in cases where the ultrasound findings are suspicious (Tab. 1, Ref. 16). Full Text in free PDF www.bmj.sk.

Remembering in contradictory minds: disjunction fallacies in episodic memory

Disjunction fallacies have been extensively studied in probability judgment. They should also occur in episodic memory, if remembering a cue's episodic state depends on how its state is described on a memory test (e.g., being described as a target vs. as a distractor). If memory is description-dependent, cues will be remembered as occupying logically impossible combinations of episodic states (e.g., as being a target and a distractor). Consistent with this idea, memory disjunction fallacies were repeatedly detected in a series of experiments, at the level of individuals as well as at the level of groups. Disjunction fallacies varied as a function of manipulations that should affect description-dependency, such as type of test cue, immediate versus delayed testing, word frequency, and emotional valence. Response bias, as well as description-dependency, contributed to disjunction fallacies, as predicted by fuzzy-trace theory's retrieval model. The significance of these findings for memory is that a new form of episodic distortion, description-dependent memory, has been added to the 2 traditional forms (forgetting and false memory). The significance for probability judgment is that disjunction fallacies, which have customarily been explained as by-products of memory retrieval, may be wholly or partly due to the uncontrolled influence of response bias.

Retrospective study of treatment outcomes with implant-retained extraoral prostheses: survival rates and prosthetic complications

STATEMENT OF PROBLEM

Implant-retained extraoral prostheses are an acceptable solution for patients with facial defects. However, these prostheses have a limited service life. Little has been reported on survival periods of implant-retained extraoral prostheses and prosthetic complications of this treatment modality.

PURPOSE

The purpose of this study was to estimate the survival rates of implant-retained extraoral prostheses and to analyze the frequency of prosthetic complications.

MATERIAL AND METHODS

Seventy patients were treated with implant-retained extraoral prostheses. Each patient was examined with respect to the prosthesis appearance and abutment and attachment component complications at 6-month intervals over a period of 10 to 46 months. The Kaplan-Meier survival estimation method was used for the first and subsequent prostheses. The reasons for remaking prostheses were recorded. Complications of the abutment and attachment components and the prostheses were recorded. Frequency of complications was evaluated. Data were analyzed using the Fisher exact test (alpha=.05).

RESULTS

Thirty-two auricular, 25 orbital, and 13 nasal prostheses were evaluated. The Kaplan-Meier analysis revealed an estimated mean survival time of 14.5 months for the patients' first prostheses. The survival times for the first implant-retained auricular, orbital, and nasal prostheses were 14.1, 13.4, and 17.6 months, respectively. The survival times for the second implant-retained auricular, orbital, and nasal prostheses were 14.4, 15.3, and 14.0 months, respectively.

CONCLUSIONS

Implant-retained extraoral prostheses had limited survival rates. The primary reasons for making new prostheses were discoloration, tearing, and mechanical failures of the acrylic resin substructure or retentive elements. Common complications were the need for clip activation, loosening of bar screws and abutments, and loss of attachment between silicone and the acrylic resin substructure. (J Prosthet Dent 2010;103:118-126).

Single-tooth zirconia implant located in anterior maxilla. A clinical report

Expectations regarding esthetics in dentistry are growing and research in the field of all ceramic materials for restoration of natural dentition and dental implants has intensified. Although the crown that covers the abutment of an implant may be esthetically optimal, the possibility exists that the grayish color of the titanium implant shines through the thin peri-implant mucosa and, because of the short peri-implant tissue recessions, impairs the entire esthetic result. To improve the esthetic aspect of dental implants, a ceramic material, zirconia, was introduced. We present a case in which a zirconia implant and an all-ceramic crown system were used for the maxillary anterior region and followed for 12 months.

Evaluation of stresses occurring on three different zirconia dental implants: three-dimensional finite element analysis

PURPOSE

The aim of this study was to evaluate the von Mises, compressive, and tensile stresses occurring on three different zirconia dental implants and surrounding bone with three-dimensional finite element analysis.

MATERIALS AND METHODS

Three different zirconia implants (Z-Systems, Ziterion, and White-Sky), 10 mm in length and 4 mm in diameter, and anterior maxillary bone were modeled using three-dimensional finite element analyses. Zirconia implants were placed into the maxillary left central incisor region. Loading was applied in horizontal and oblique axes (at angles of 90 and 30 degrees with respect to the implant long axes). Oblique loading was 178 N and horizontal loading was 25.5 N.

RESULTS

Under oblique loading, von Mises stresses for all implants were similar, and under horizontal loading conditions, the highest von Mises stress was found at the buccal and palatal neck region of the Ziterion implant (46.57 MPa). In cortical bone, the highest von Mises stresses were observed at the buccal region of the Z-Systems implant under oblique and horizontal loading conditions (26.65 MPa and 10.74 MPa, respectively). The highest compressive stresses were observed at the implant buccal neck region and cortical bone interface of the Z-Systems implant under oblique and horizontal loading conditions. For both loading conditions, the highest tensile stress values were observed at the implant palatal region and cortical bone interface of the Z-Systems implant.

CONCLUSION

The von Mises, compressive, and tensile stresses that occurred in cortical bone were higher than those observed in trabecular bone. Generally, the stresses in the Z-Systems implant were higher than in the other zirconia implants. The differences between the stress values occurring on the zirconia implants may be related to the different body and thread designs of these implants.

Histopathologic study of rat connective tissue responses to maxillofacial silicone elastomers

The aim of this histopathologic study was to assess and compare the subcutaneous connective tissue reaction to three different maxillofacial silicone elastomers (Cosmesil, Multisil, Episil). The test materials were directly inserted subcutaneously into the dorsal subcutaneous tissue of Wistar albino rats. Histopathological examinations were done at 7, 30, and 90 days after the implantation procedure. The presence of inflammation, presence of inflammatory giant cells, and the thickness of fibrous connective tissue adjacent to each inserted sample were recorded. Data was evaluated by analysis of variance, Wilcoxon signed ranks test and Kruskal Wallis test. Cosmesil, Multisil and Episil silicone elastomers at 7 days elicited a severe inflammatory reaction. However, these reactions decreased by the 30 and 90 days. All silicone elastomers elicited a moderate inflammatory reaction at 30 and 90 days. There were no significant differences in tissue reaction between the materials at 7, 30, and 90 days (P > 0.05). All the maxillofacial silicone elastomers evaluated can not be assigned a favorable biocompatibility level based on this study's histologic findings.

Assessment of left ventricular functions by tissue Doppler echocardiography in patients with Cushing's disease

OBJECTIVE

To verify whether tissue Doppler imaging (TDI) could contribute to a better understanding of the natural history of cardiomyopathy in active Cushing's disease (CD), through its enhanced sensitivity to diastolic dysfunction, and identifying preliminary regional signs of systolic dysfunction before the appearance of clinical symptoms of cardiac pathologies.

METHODS

Eleven women with newly diagnosed CD and 32 control cases, purposely matched for gender, age, body mass index and co-incidental diseases were enrolled in this study. Echocardiographic examinations were assessed by conventional echocardiography and tissue Doppler imaging. The peak systolic velocity (S'm), early diastolic myocardial peak velocity (E'm), late diastolic myocardial peak velocity (A'm), isovolumic acceleration (IVA), myocardial pre-contraction time (PCT'm), myocardial contraction time (CT'm) and myocardial relaxation time (RT'm) were measured at septal and lateral mitral anulus.

RESULTS

In TDI, E'm and, E'm/A'm ratio were significantly lower, and PCT'm/CT'm ratio was higher, S'm, A'm, peak early diastole/E'm ratio, PCT'm, and isovolumetric myocardial relaxation time values were similar at lateral and septal anulus in patients with CD than controls (p>0.05). Lateral and septal anulus IVA were significantly lower in patients with CD than the control group (p<0.05). Correlation analysis showed that IVA time at lateral anulus correlated positively with S'm at lateral anulus (r=0.58; p=0.002) and IVA time at septal anulus correlated positively with S'm at septal anulus (r=0.51; p=0.008).

CONCLUSION

Our study confirms that patients with CD have impaired diastolic function. More importantly, we also demonstrated an impairment of myocardial systolic function in patients with CD by TDI. We recommend using TDI in addition to conventional echocardiography parameters for the cardiovascular risk assessment of patients with Cushing' syndrome.

Effect of nitric oxide/cyclic guanosine mono-phosphate pathway on gallbladder relaxant response in bile duct-ligated guinea pigs

BACKGROUND/AIMS

Common bile duct ligation (CBDL) in the guinea pig is a well-defined model of acalculous cholecystitis. Nitric oxide (NO) mediates smooth muscle relaxation by stimulating the activity of soluble guanylate cyclase. The aim of this study was to determine whether the NO/cyclic guanosine monophosphate pathway plays a role in gallbladder relaxant response after CBDL.

METHODS

Relaxant response of gallbladder muscle strips from CBDL and sham-operated guinea pigs was studied in vitro. Animals were treated with saline, aminoguanidine or an aminoguanidine + L-arginine combination in vivo. Concentration-response curves of papaverine, diethylamine/NO, YC-1, sildenafil and amrinone were obtained and relaxations in each group were calculated as the percent of the contractions induced by carbachol (10(-6) M).

RESULTS

There was a significant decrease in the gallbladder muscle relaxant responses to these substances in CBDL and aminoguanidine groups compared with sham surgical controls. The decreased relaxant response was reversed by aminoguanidine + L-arginine but not by aminoguanidine alone.

CONCLUSION

Decreased relaxant responses might be due to the reduced guanylate cyclase enzyme activity, but further studies are required.

Survival rates and periimplant soft tissue evaluation of extraoral implants over a mean follow-up period of three years

STATEMENT OF PROBLEM

The use of implants with extraoral prostheses provides excellent support, stability, and retention, thereby offering the potential for improving a patient's appearance and quality of life. However, few studies have examined cumulative survival rates of extraoral implants, nor have these reports documented long-term aspects of treatment, such as soft tissue health around abutments.

PURPOSE

The purpose of this study was to evaluate the survival rates and the periimplant soft tissue responses of extraoral implants used to retain facial prostheses.

MATERIAL AND METHODS

Thirty-three patients with auricular, nasal, and orbital anatomical compromise were treated with 98 craniofacial and dental implants. Of the 33 patients, 14 had auricular, 9 had nasal, and 10 had orbital defects. After a 3-month osseointegration period, implant-retained prostheses were fabricated. Following completion of treatment, each patient was seen at 6-month intervals. These examinations were recorded for this patient cohort from 25 to 50 months. Data were analyzed using Kaplan-Meier survival analysis. A 5-point scale was used to record the health of periimplant soft tissues. The unit of measure as a visit/site unit was assigned for each instance and implant site. Periimplant soft tissue reactions were assessed for auricular, nasal, and orbital defects, for each implant site used for these patients' treatments.

RESULTS

The overall cumulative survival rates were 100% for auricular, 83.3% for nasal, and 77.4% for orbital implants, respectively. The survival rates of the implants were 72.7% for those placed in irradiated sites treated without adjunctive HBO therapy, and 93.4% for implants placed in nonirradiated sites. To evaluate the response of the periimplant soft tissues to the implants, a total of 524 visits/sites were recorded. Absence of inflammation (grade 0) of the periabutment soft tissues was observed in 73.3% of the visits/sites.

CONCLUSIONS

The anatomical site into which the implant is placed has an effect on success rate. The auricular site is the most predictable implant site. Survival rates of nasal and orbital implants were found to offer promising results in achieving reliable implant prognoses in these regions. Regardless of the implant site, a decreased survival rate was observed in the irradiated sites. Periimplant soft tissue reactions were most commonly associated with lapses in hygiene.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Perforated hepatic hydatid cyst into the peritoneum with mild symptoms

Rupture into the abdominal cavity is a rare but serious complication of hydatid disease that necessitates emergency surgical intervention. We present herein a case with mild abdominal symptoms due to hydatid cyst rupture into the peritoneum after trauma. A 24-year-old man was admitted to the emergency room with mild abdominal pain. His symptoms had started after a fall four days earlier. Ultrasonography and computed tomography showed cystic lesions in the liver and peritoneum with intraabdominal free fluid. He was treated surgically with partial cystectomy and falciformoplasty. Postoperative albendazole therapy was given for two months. There was not recurrence four months postoperatively at control computed tomography.

Erythrocyte potassium, sodium and glutathione concentrations and their relationship with reproduction, body weight and fleece weight traits in Awassi sheep

Abstract. Relationship between erythrocyte potassium (Ke), erythrocyte sodium (Nae) and blood glutathione (GSH) concentrations and production/ reproduction traits were investigated in Awassi sheep. Thirty healthy sheep subjected to analyze for phenotypic and gene frequencies of Ke, Nae and GSH concentrations. Correlation between these parameters and production/ reproduction traits such as greasy fleece weight, milk production, birth rate, single and twin birth rate and body weight were calculated. A positive correlation was found between birth rate and mean Ke concentration (r=0.481, P<0.008) and Nae concentration (r=−0.454, P<0.013). Another correlation between GSH concentration and greasy fleece weight (r=−0.368, P<0.049) and milk production (r=0.379, P<0.050) parameters was also evidenced. These suggest that Ke, Nae and GSH concentrations may be included in the metabolic profile testing parameters.

An impression technique for implant-retained orbital prostheses

This article describes an impression technique to transfer implant positions to the definitive cast using magnetic attachments splinted with acrylic resin for an implant-retained orbital prosthesis. The acrylic resin transfer device that incorporated the magnets was also used as the acrylic resin magnet substructure for the silicone orbital prosthesis.