Indirect measurement of the temporomandibular joint disc elasticity with magnetic resonance imaging

OBJECTIVES

The radiological evaluation of the temporomandibular joint (TMJ) consists of demonstrating the morphological features of the disc and the condyle in closed and open mouth positions using MRI. We aimed to determine elasticity of the disc by measuring the amount of elongation during mouth opening.

METHODS

The study population included 49 patients. Coronal T(1) and multiplane oblique T(2) weighted gradient recalled echo sequences were acquired in open and closed mouth positions. Biconcave TMJ disc lengths were measured on sagittal oblique images in both positions. Elongation ratio (ER) was calculated for each patient. According to the findings, TMJs are classified into subgroups: normal (N), dislocated with reduction (DWR), pure DWR (p-DWR), DWR with additional findings (DWR-a) and dislocated without reduction (DWOR). Statistical analysis was performed using the χ(2) test and receiver operating characteristic analysis.

RESULTS

Out of 98 discs, 22 of them were evaluated as N, 60 as DWR (28 p-DWR, 32 DWR-a) and 16 as DWOR. There was no significant difference among the disc lengths in three subgroups at the closed mouth position (P = 0.15), whereas there was significant difference in the open mouth position (P = 0.0001). There was significant difference among subgroups as far as ER is concerned (P < 0.05).

CONCLUSIONS

ER is a strong indicator of elasticity. Compared with the N group, elasticity of the disc was not significantly different in the p-DWR group but the disc elasticity was very degraded in DWR-a and in DWOR. A negative conversion or one smaller than 1.4 mm means a compromised disc, although sometimes it will possess normal anatomical configurations or signal characteristics.

Alien marine fishes deplete algal biomass in the Eastern Mediterranean

One of the most degraded states of the Mediterranean rocky infralittoral ecosystem is a barren composed solely of bare rock and patches of crustose coralline algae. Barrens are typically created by the grazing action of large sea urchin populations. In 2008 we observed extensive areas almost devoid of erect algae, where sea urchins were rare, on the Mediterranean coast of Turkey. To determine the origin of those urchin-less ‘barrens’, we conducted a fish exclusion experiment. We found that, in the absence of fish grazing, a well-developed algal assemblage grew within three months. Underwater fish censuses and observations suggest that two alien herbivorous fish from the Red Sea (Siganus luridus and S. rivulatus) are responsible for the creation and maintenance of these benthic communities with extremely low biomass. The shift from well-developed native algal assemblages to ‘barrens’ implies a dramatic decline in biogenic habitat complexity, biodiversity and biomass. A targeted Siganus fishery could help restore the macroalgal beds of the rocky infralittoral on the Turkish coast.

Clinical and magnetic resonance imaging findings of the temporomandibular joint and masticatory muscles in patients with rheumatoid arthritis

The aim of this study was to investigate the clinical, radiographic, and magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) and masticatory muscles in rheumatoid arthritis (RA) patients. Twenty-eight RA patients and 29 healthy subjects were participated in the study. The patient underwent clinical and laboratory investigation. DAS28 scores were calculated. Lateral panoramic radiography was performed to evaluate condylar erosion and condylar movement. Craniofacial MRI was performed to evaluate TMJ and masseter, medial and lateral pterygoid muscles' thickness, and cross-sectional area. It was found that the mean maximal interincisal distance, range of lateral, retrusive (P < 0.05) and protrusive motion were all lesser in RA group. Lateral panoramic radiography revealed a distinct erosion in 10.7% (3/28) and restricted condylar movement in 53.6% (15/28) of RA patients. Two RA patients demonstrating marked condylar erosion in lateral panoramic radiographs were RF negative and had DAS28 scores 3.41 and 4.61. MRI findings revealed condylar erosion and effusion in one RA patient and atrophic changes of masticatory muscles in another patient. There was no statistical significance between RA and healthy groups for the thickness and cross-sectional areas of the masticatory muscles. RA group revealed a strong linear relationship for the right and left muscle thickness and cross-sectional areas in regression analysis. TMJ symptoms are frequent findings and thought to be affected from mean disease duration in RA. Laboratory findings should be considered for disease activity-related TMJ involvement. RA patients did not present muscular atrophy or hypertrophy.

Bio-element status in children with acute rheumatic fever: before treatment and after clinical improvement

Acute rheumatic fever (ARF) is an autoimmune multisystem disease. Bio-elements are required in different quantities by an organism to maintain its physiologic function. Monitoring the status of bio-elements is critical in human health. This study aimed to determine possible changes in levels of bio-elements in children with ARF before and after treatment. Levels of trace and major elements in children with ARF were investigated. The study included 33 children with ARF (17 boys and 16 girls) and 20 healthy control children (11 boys and 9 girls). The ages ranged from 5 to 16 years (mean 11.4 ± 3.82 years) in the study group and from 6 to 15 years (mean, 10.7 ± 3.22 years) in the control group. Trace and major element concentrations (total of 14 elements) in the serum were measured by inductively coupled plasma-optical emission spectroscopy. Before treatment, the levels of the major elements potassium (K) and magnesium (Mg) in children with ARF were higher than in the control group, whereas the calcium (Ca) level was lower. Before treatment, the levels of trace elements iron (Fe), selenium (Se), zinc (Zn), aluminum (Al), and barium (Ba) were lower, whereas the copper (Cu), beryllium (Be), cadmium (Cd), chromium (Cr), gallium (Ga), and strontium (Sr) levels were higher in the serum of the patients with ARF than in the control patients. The major findings show that the homeostasis of some trace and major elements were altered in the children with ARF and that these alterations may be a contributing factor in the pathogenesis of this disease.

Early Diagnosis of Oral Cancer

Survival rates for oral cancer are very poor, at approximately 50% overall, and have not improved markedly in recent decades despite advances in therapeutic interventions. Detecting oral cancer at an early stage is believed to be the most effective means of reducing rates of death, morbidity and disfigurement from this disease. Tobacco and alcohol consumption and pre-malign lesions are the most common aetiological factors. The proportion of patients presenting with oral cancer at an advanced stage is troubling. Early diagnosis is the most effective way of reducing the individual burden of the disease, decreasing morbidity and mortality and improving quality of life. For early diagnosis, healthcare providers should perform oral cancer examinations as part of their patient care regime, and need to be knowledgeable about early signs of oral carcinoma. Oral cancer awareness among the public should also be improved.

Bullying among nurses and its effects

BACKGROUND

The victims of bullying are subjected to being terrorized, annoyed, excluded, belittled, deprived of resources, isolated and prevented from claiming rights. The victims of bullying have decreased job satisfaction, work performance, motivation and productivity. Bullying also negatively affects victims' social relationships inside and outside the institution.

OBJECTIVES

This study was conducted as a cross-sectional and descriptive study for the purpose of assessing the workplace, bullying of nurses in Turkey and the effects it has on nursing practices.

METHOD

The sample was composed of 286 nurses, and all of the respondents were female. The research instrument was a questionnaire in five parts. The first section included the participants' demographic information; the other variables were measured in four categories: psychologically violent behaviours, workload, organizational effects and depression.

FINDINGS

Thirty-seven per cent of the nurses participating in the research had never or almost never encountered workplace bullying behaviour in the last 12 months, 21% of the nurses had been exposed to these behaviours. There were no differences between position and educational level in workplace bullying. Workplace bullying leads to depression, lowered work motivation, decreased ability to concentrate, poor productivity, lack of commitment to work, and poor relationships with patients, managers and colleagues.

CONCLUSION

Workplace bullying is a measurable problem that negatively affects the psychology and performance of the nurses in this study.

Garlic burn in a patient with trigeminal neuralgia: a case report

Garlic is an herb which has been used by many cultures for treating various health problems for centuries. Uncontrolled use of herbal remedies, known as alternative treatment methods, may lead to side effects and serious treatment complications. This study aimed to draw attention to complications related to alternative treatment methods and to review the literature in the light of this case.A female patient who had been treated for trigeminal neuralgia was admitted to our clinic complaining of severe pain on the left side of her face. In anamnesis, the patient reported that she had applied garlic topically to this region. Extraoral examination revealed a broad cutaneous burn on the same region. According to a dermatology consultation, a treatment for cutaneous burns was applied and severe trigeminal neuralgia pain was eliminated with glycerol injection by an oral and maxillofacial surgeon.

Do contraceptive choices of Turkish married adolescents differ from those of older women?

OBJECTIVE

To compare contraceptive choices of Turkish married adolescents to those of women of reproductive age and perimenopausal women.

METHODS

Demographic variables, fertility goals and contraceptive choices of adolescents (Group A, n = 95) were compared with those of women of reproductive age (Group B, n = 5224) and perimenopausal women (Group C, n = 2208).

RESULTS

All women in the study group were married and had delivered at least once. A past history of voluntary terminations of pregnancy (TOPs) was reported often, although significantly less so by adolescents (43.1%) than by women belonging to the other two groups (66.5 and 77.4%, respectively). The percentage of women who applied no contraception was significantly higher in Group A (p < 0.05). The rate of use of withdrawal, oral contraceptives and intrauterine devices did not differ significantly between the three groups. The percentage of women who were indecisive about future pregnancy or wanted to have more children was greatest in Group A (87.4, 46.9 and 25.7%, respectively; p < 0.05).

CONCLUSION

The distribution of contraceptive methods used was similar among the three age groups, but the absence of contraception was most frequent in the adolescent group. The adolescents we assessed, being married and having delivered at least once, are a highly selected group and not representative of adolescents in general. Nevertheless, their contraceptive choices did not differ from those of older women. The incidence of TOPs among them was quite high. Minimization of the frequent neglect of application of contraceptive measures by adolescents requires improvement of family planning services for this age group.

Lower extremity venous pathology mimicking deep vein thrombosis: 2 case reports

We report two cases of lower extremity venous pathology mimicking deep vein thrombosis (DVT). The first case was a 20-year-old male with swelling in the left leg. Colour Doppler ultrasound (CDUS) demonstrated a continuous flow pattern, and computed tomography (CT) revealed compression of the dilated left common iliac vein by the right common iliac artery (May-Thurner syndrome). This dilatation of the vein was caused by overload due to the drainage of the gluteal arteriovenous malformations into this vein. The second case was a 55-year-old female with swelling and pain of the left leg persisting for a year following an operation of a herniated lumbar disk. She was diagnosed as DVT and treated accordingly. Control CDUS performed in our department demonstrated a left iliac arteriovenous fistula and a pulsatile flow pattern in the left femoral vein. CT also confirmed this arteriovenous fistula. We suggest that if not all criteria for the diagnosis of DVT are fullfilled by CDUS, another imaging modality such as multidetector CT should be used.

Dacryolith: two case reports

Dacryolith is a concretion within the nasolacrimal system. Dacryoliths may cause intermittent epiphora without inflammation, or recurrent dacryocystitis may develop. In this report, we present two patients with dacryoliths. The first patient had presented with a complaint of swelling and epiphora and had been told that she had lacrimal canal obstruction. This patient was unaware of the cause of obliteration and was asymptomatic. The second patient complained of headache, eye swelling and inflammation; dacryolith was diagnosed by clinical examination and dacryocystography. Dacryoliths were detected on the panoramic radiographs as small, rounded, radiopaque calcifications located in the inner aspect of the medial wall of the orbit. The image of dacryoliths must be differentiated from radiographic artefacts and foreign objects, and it is important to recognize dacryoliths on panoramic radiographs and to refer the patients for medical care, if necessary.

Incidence of canine impaction and transmigration in a patient population

In this study, 4500 consecutive panoramic radiographs were prospectively reviewed. The incidence of canine impaction was found to be 3.58% and the incidence of canine transmigration was 0.31%. There were six maxillary and eight mandibular transmigrant canines. The incidence of impacted canine teeth and transmigration of maxillary and mandibular canines may be more frequent than was previously thought, at least in some populations.

Multiple impacted permanent and deciduous teeth

Multiple impacted teeth may be related to syndromes and metabolic disorders. In some cases, however, impaction of multiple teeth is not accompanied by a fixed complex of symptoms. A 55-year-old woman attended our clinic, as she was not comfortable with her prosthetic appliances because of erupted teeth. Panoramic and occlusal radiographs revealed 13 impacted teeth (12 permanent and 1 deciduous) in the maxilla and 15 impacted teeth (11 permanent and 4 deciduous) in the mandible. In total the patient had 28 impacted teeth. In our case, medical and family history and extraoral examination were not suggestive of any syndrome or metabolic disorder. In conclusion, radiographic examination may reveal multiple impactions in clinical absence of teeth. Lack of eruptive force and rotation of tooth buds may cause multiple impactions and additional examinations may be necessary to exclude systemic and metabolic conditions.

An investigation of the antiinflammatory effects of an extract from Cladonia rangiformis HOFFM

In this study, the antiinflammatory effects of 50, 100 and 200 mg/kg doses of extract obtained from Cladonia rangiformis, so-called C-1, were investigated. The effects of C-1 on the acute phase of inflammation were studied in formaldehyde-induced edema. A cotton-pellet granuloma test was used to investigate the effects of C-1 on chronic inflammation. The antiedema potency of C-1 was compared with indomethacin. C-1 at the doses mentioned above showed 33.8% (p<0.005), 36.1% (p<0.005), 43.1% (p<0.001) inhibition, respectively. The corresponding antiinflammatory effect for indomethacin was determined as 72% (p<0.001). 200 mg/kg C-1 and 10 mg/kg indomethacin decreased the formation of granuloma tissue induced by cotton-pellet method at a rate of 57.3% (p<0.005) and 52.1% (p<0.005), respectively. It was seen that C-1 was more effective on chronic inflammation than on acute inflammation.