Effect of the Gupta Score on Pre-operative Cardiology Consultation Requests in Noncardiac Nonvascular Surgery

Objective

Cardiologists are the most frequently consulted specialists during pre-operative evaluations. However, unnecessary cardiology consultations (CC) can increase cardiologists' workload without impacting anaesthesia practice, resulting in delayed surgeries and additional financial burdens. We hypothesize that using Gupta during the preoperative period can reduce these adverse effects.

Methods

This prospective study included patients scheduled for elective noncardiac, nonvascular surgeries who underwent pre-operative assessment. Patients who had no specific risk index used for preoperative cardiac risk evaluation were classified as Group I, and those evaluated using the Gupta scale were classified as Group II. The study compared preoperative CC, diagnostic tests, surgical delays, major adverse cardiac event (MACE), length of hospital stay and intensive care unit (ICU) stay, mortality, and costs.

Results

A total of 898 patients were included in the study, with 487 in Group I and 411 in Group II. The Gupta group reduced the demand for preoperative CC (P<0.001) and preoperative non-invasive diagnostic testing (n = 107, 21.9% vs. n = 36, 8.75%). The time from the anaesthesiology outpatient clinic to surgery was 15 days in Group I and 14 days in Group II (P=0.132). The length of ICU stay was higher in Group I (P=0.019). MACE was 15 patients (3.08%) in Group I and 9 patients (2.19%) in Group II (P=0.076). The cost of patients in Group I was higher than that in Group II (P=0.019).

Conclusion

Using Gupta in preoperative evaluation may reduce unnecessary preoperative resource usage, surgical delays, ICU hospitalization rates, additional costs, and mortality.

Comparison of Two Different Methods for ProSealTM Laryngeal Mask Fixation

Objective

This prospective randomized study compared 2 different methods for ProsealTM Laryngeal Mask Airway (PLMA) fixation.

Methods

Patients scheduled for ureterorenoscopic lithotripsy surgery in the lithotomy position were included in the study. General anaesthesia with PLMA was administered to the patients. To achieve PLMA fixation, patients were randomly assigned to either adjustable elastic band (Group I) or adhesive tape fixation (Group II). Fiberoptic bronchoscope (FOB) evaluation and glottic image grading (grade 1-4) and lip margin distances of PLMA (M1 and M2) were evaluated before and after the surgical procedure.

Results

We enrolled 116 patients. Surgery of 7 patients was postponed. PLMA dislocated in 2 patients in group II during positioning. For another patient who used adhesive tape in Group II, it was removed because it could not adhere to properly, and a new sticking plaster was used. The study was completed with 106 patients. In FOB evaluation, the number of patients with optimal FOB grade (FOB grade 1) after PLMA was inserted and fixed was more in Group I than in Group II (P = 0.01). FOB evaluation was repeated at the end of the operation, and the number of patients with the worst FOB grade (FOB grade 4) was 0 (0%) and 11 (10.5%) in Groups I and II, respectively. PLMA displaced more than 1 cm in 10 (18.9%) patients in Group I and in 30 patients (56.6%) in Group II.

Conclusion

The adjustable elastic band method is simple, easy, and convenient and can be used in any surgical procedure for PLMA fixation.

A prospective study for an alternative probe site for pulse oximetry measurement in male patients with severe burn trauma: penile shaf

BACKGROUND

Authors widely use pulse oximetry in clinical monitoring of heart rate (HR) and peripheral oxygen saturation (SpO2) by attachment to the fingers; however, there can be a need for an alternative attachment site, especially for burned patients. We investigate the availability of a pulse oximeter probe attached to the penile shaft as an alternative site in pediatric male patients if all extremities became unavailable for pulse oximetry measurement due to severe burn and/or trauma.

METHODS

We designed a prospective comparative study in a training and research hospital. After local ethical committee approval, pediatric male cases eligible for penile and extremity pulse measurements were evaluated during general anesthesia for medical dressing and/or grafting due to severe burns. One probe was attached to the fingers of the unburned extremity, and the other was to the penile shaft. Furthermore, we recorded SpO2and HR values at 5-min intervals; 0th (baseline), 5th, 10th and 15th minutes. We compared HR and SpO2values measured by the finger probe with those measured by the penile probe.

RESULTS

Data of 51 patients (median age, 2.9 years (interquartile range, 2.0-5.0 years)) in whom the duration of dressing was at least 15min were analyzed. There was no significant difference either in comparisons of hemodynamic measurements (HR and SpO2 ) obtainedby finger probe and by a penile probe for each measurement time. The Bland-Altman plot analysis reveals agreement for penile and finger probes with a mean bias value between 0.20 and 0.37 on HR and between 0.43 and -0.20 on SpO2.

DISCUSSION

This clinical trial demonstrated that pulse oximetry measurement under nonhypoxic conditions we could perform confidently using penile probes in pediatric male patients whose extremities are unavailable for measurement.

Analysis of risk factors of mortality for pediatric burned patients with inhalation injury and comparison of different treatment protocols

BACKGROUND

We present our approach of pediatric burned patients with the suspicion of inhalation injury.

METHODS

This retrospective study was conducted on children with the suspicion of inhalation injury admitted to our burn center from December 2009 to December 2019. We collected data on patient demographics, total burn surface area (TBSA), presence of inhalation injury, level of carboxyhemoglobin, grade of inhalation injury, duration of mechanical ventilation, reintubation rate, total length of hospital stay, and the mortality rate. We also reviewed the required treatment of patients with inhalation injury.

RESULTS

A total of sixty pediatric burn patients were suspected inhalation injury were included in this retrospective study. 40 pa-tients included in the study were male. Age average of the patients was 87.7 months. Total burned surface area average was 32%. 46 of these patients had inhalation injury. Patients with larger cutaneous burn and needed early intubation have a higher risk of inhalation injury. There was no significant relation between inhalation injury grades and mortality and treatment protocols. Higher levels of car-boxyhemoglobin and larger TBSA are the risk factors for mortality at univariate analysis. Pediatric patient with inhalation injury whose TBSA is higher than 47.5% has a 5 times higher risk of mortality at multivariate analysis.

CONCLUSION

This study demonstrated that TBSA is the risk factor that independently affects the mortality in pediatric patients with inhalation injury. Among the patients with higher than 47.5% burn surface area, the mortality rate rises 5 times.

Effects of 5 µg/kg intrathecal morphine for postoperative analgesia in pediatric patients undergoing major surgery

BACKGROUND

The effects and analgesic adequacy of intrathecal morphine (ITM) administration have been studied less frequently than other regional analgesia techniques in pediatric surgical procedures.

OBJECTIVE

To evaluate the efficacy and adverse event rate of 5 µg/kg ITM administration for postoperative analgesia according to age group.

METHODS

We retrospectively evaluated the medical records of patients who underwent major pediatric surgery and were administered ITM for postoperative analgesia. Patients were divided into three age groups: ≤ 5 years (group I), 5.1-13 years (group II) and > 13 years (group III). All patients received ITM 5 µg/kg (max 300 μg) through the L_4-5 or L₅-S₁ interspace. Postoperative pain (modified pediatric objective pain score > 4), need for rescue analgesics, sleep interruption due to pain, sedation (Ramsay sedation scale score > 3), opioid-related postoperative adverse events (at 0, 4, 8, 12, and 24 h after intervention), hemodynamic data and nurse satisfaction with the analgesic method were compared between groups.

RESULTS

The analysis included 100 children (47 girls, 9 ± 5.4 years). Groups were similar regarding postoperative rescue analgesia consumption and sleep interruption (p = 0.238, p = 0.958), 96% of the children did not require rescue analgesia, and sleep interruption was not observed in 97%. Postoperative adverse events were pruritus in 14 and nausea/vomiting in 9 patients (p = 0.052). Overall, nurses were satisfied or very satisfied in 99% of the cases.

CONCLUSION

Administration of 5 µg/kg ITM can be used for postoperative analgesia in pediatric surgery in all age groups, with no severe adverse events and high nurse satisfaction with analgesic management.

FRI0490 INVESTIGATING THE ROLE OF IL-1THETA IN PATHOGENESIS OF BEHÇET’S DISEASE

Background:

Behçet’s disease (BD) is a chronic inflammatory disease that may involve many systems including mucocutaneous, vascular, articular, gastrointestinal, neurological and cardiopulmonary systems. Although the pathogenic mechanisms of BD remain unclear, increased release of proinflammatory cytokines and chemokines may play a role in inflammatory stages of the disease.

Objectives:

IL-1 theta is a member of IL-1 family. A variety of tissue cells, such as endothelial cells, keratinocytes, dendritic cells macrophages, B cells can produce IL-1 theta under the stimulation of pro-inflammatory factors. Several studies have shown that IL-1 theta can promote the production of proinflammatory cytokines. In this study, we investigated the relationship between serum IL- 1 theta levels and disease activity and clinical findings of BD.

Methods:

59 patients with BD (48 female, 11 male) and 20 healthy controls (17 female, 3 male; mean age 41.0 ± 9.3 years) were enrolled in this study. Thirty five patients were in active stage (mean age; 40.3 ± 11.0 years, median disease duration 7 years) and 24 patients were in inactive stage (mean age; 42.9 ± 13.2 years, median disease duration; 8 years). Serum IL-1 theta levels were evaluated by ELISA.

Results:

The mean serum IL-1 theta levels were 8.65 ± 4.41 pg/ml in patients with BD and 3.9 ± 2.54 pg/ml in healthy controls. The mean serum IL-1 theta levels were 10.34 ± 5.52 pg/ml in active patients with BD and 6.92 ± 2.43 pg/ml in inactive patients with BD. Serum IL-1 theta levels were significantly high in active Behçet’s patients compared with in inactive Behçet’s patients (p<0.01) and the controls (P<0.001).

Serum IL-1 theta levels were significantly higher in the presence of neurological, vascular and mucocutaneous involvement in subgroup analysis according to the clinical findings of Behçet’s patients. IL-1 theta levels were negatively correlation with Platelet count and ESR (r=0.332 p=0.050, r=0.382 p=0.024 respectively). There was no statistically significant difference between IL-1 theta levels disease duration, and CRP.

Conclusion:

In this study, we demonstrated that serum IL-1 theta levels were significantly elevated in patients with BD. The high levels of serum IL-1 theta, in active and inactive patients with BD suggest that IL-1 theta may play a significant role of in the pathogenesis of BD.

References:

[1]Salmaninejad, A., et al. Genetics and immunodysfunction underlying Behçet’s disease and immunomodulant treatment approaches. Journal of immunotoxicology, 2017.14(1): 137-151.

[2]Nara, K., et al. Involvement of innate immunity in the pathogenesis of intestinal Behcet’s disease. Clin Exp Immunol, 2008.152(2): 245-51.

[3]Dalghous, A.M., et al. Expression of cytokines, chemokines, and chemokine receptors in oral ulcers of patients with Behcet’s disease (BD) and recurrent aphthous stomatitis is Th1-associated, although Th2-association is also observed in patients with BD. Scand J Rheumatol, 2006.35(6):472-5.

[4]Uzkeser, H., et al. Is mean platelet volume a new activity criteria in Behçet’s disease? Blood Coagulation & Fibrinolysis, 2015.26(7): 836-839.

Disclosure of Interests:

None declared

Survival of avulsed permanent incisors in children following delayed replantation

Background

Replantation of avulsed teeth is an invasive treatment approach where patient cooperation is required after the risks are explained to the patient or family. Although replantation of an avulsed permanent teeth is an accepted treatment approach, the long-term prognosis of the replanted teeth is still controversial. This report describes the survival of delayed replanted 15 incisors that was stored in unfavorable conditions after avulsion.

Materials and Methods

Nine patients, aged 8-12 years, were referred to the Inonu University, Pediatric Dentistry Department with traumatically avulsed incisors. The parents were informed about the possible complications of a delayed replantation.

Results

Forty percent of the teeth were splinted with flexible orthodontic wire and composite. The follow-up periods were varied from 24 to 48 months. The mean follow-up periods were 33.3 ± 8 months. 40% of the teeth were retained in the mouth for at least 3 years and contributed to alveolar bone development. In these cases, the most common complication (9 teeth, 60%) was replacement root resorption. Two of the 15 teeth which had wide open apices, continued to the root development.

Conclusion

In this study, replanted teeth were retained in the mouth for at least 2 years and contributed to the patient's development. Therefore, this study has shown that delayed replantation of an avulsed tooth for a child is still worthwhile, even in cases of poor prognosis where the tooth had extended extra-alveolar dry storage. We believe that delayed replantation should be done because of its importance for the child's jaw and facial development.

A new method for left carotid angiography: use right judkins 4 guiding (6f) catheter with 2 side holes

OBJECTIVE

To introduce a rapid and simple technique to engage and localize through left common carotid (LCCA) artery during selective carotid angiography using the same type of catheter (6F Medtronic™/launcher Judkins Right Guide Catheter, 4.0 Tip,2 Side holes, U.S.A.).

METHODS

Patients were divided into two groups as new method and conventional method group including 295 and 292 prior to carotid angiography, respectively. The primary endpoints of this study included an analysis of total procedure time, time required for cannulation of left common carotid artery, fluoroscopy time and selective imaging success for left common carotid artery, feasibility, safety, amount of radio opaque agent and radiation exposure.

RESULTS

Our novel method applied using a single catheter shortened total procedure time (5.41 ± 1.56 min. vs. 7.52 ± 2.48 min., respectively, p<0.001), fluoroscopy time (98 ± 9 sec. vs. 210 ± 19 sec., respectively, p<0.001), duration of left carotid artery cannulation (15 ± 1.2 sec vs. 42 ± 1.9 sec, respectively, p< 0.001). Use of our method reduced radiation exposure (120 ± 17 mGy vs. 217 ± 11 mGy, respectively, p<0.001), amount of contrast agent (44.99 ± 12.84 ml vs. 59.89 ± 18.93 ml, respectively, p<0.001). Aortic arch angiography was not needed in the first group compared with the conventional method group (0% vs. 29%, respectively, p<0.001). Also a higher success was achieved in cannulation of left common carotid artery using an identical catheter compared with application of conventional methods requiring use of different types of catheter (100% vs. 60%, respectively, p<0.001). No major complication and mortality was found due to use of both methods. However, a statistically insignificant elevation in minor complication was encountered in the patient group who underwent coronary angiography by the conventional method (3% vs. 7%, respectively, p<0.064).

CONCLUSIONS

This new method is more easily applicable with a shorter duration for cannulation and localization of LCCA, safer for the patients with use of a limited amount of radio-opaque agent and finally cost-effective by requiring only one type of catheter and a limited.

Homocysteine Levels in Plasma and Sensorineural Hearing Loss in Patients with Pseudoexfoliation Syndrome

PURPOSE

To determine the incidence and severity of hearing loss in different frequencies in patients with pseudoexfoliation. Furthermore, possible links between homocysteine and pseudoexfoliation were evaluated.

METHODS

Seventy-five consecutive patients with pseudoexfoliation and 75 sex- and age-matched subjects without pseudoexfoliation as control group were included in this prospective case-control study. Pure-tone audiometry was obtained in all subjects in both groups. Blood samples were obtained from 70 patients with pseudoexfoliation after overnight fasting for levels of homocysteine and analyzed by routine laboratory measurements.

RESULTS

Fifty-two (69%) patients with pseudoexfoliation and 39 (52%) controls had sensorineural hearing loss in speech frequencies. The difference between pseudoexfoliation and control group with regard to the frequency of sensorineural hearing loss in speech frequencies was statistically significant (p=0.03). No relationship was found between the degree of glaucomatous damage and hearing threshold variables in the patients with pseudoexfoliation glaucoma. Plasma homocysteine levels showed no significant difference when patients with pseudoexfoliation and hearing loss were compared with patients with pseudoexfoliation and normal hearing threshold (p=0.5). Hyperhomocysteinemia was found in 58% (29/50) of pseudoexfoliation patients with hearing loss, and 55 % (11/20) of pseudoexfoliation patients with normal hearing threshold (p=0.8). No statistically significant correlation was found between plasma homocysteine and hearing loss in patients with pseudoexfoliation.

CONCLUSIONS

These findings suggest an association between sensorineural hearing loss and pseudoexfoliation in patients with pseudoexfoliation and glaucoma. The severity of hearing loss was not correlated with the degree of glaucomatous damage. There is no association between increased homocysteine levels and hearing loss in patients with pseudoexfoliation.

Prevention of Withdrawal Movement Associated with the Injection of Rocuronium in Children: Comparison of Paracetamol and Lidocaine

OBJECTIVE

Pain from rocuronium injection is observed in 50%-80 % of patients. This study aimed to compare the effectiveness of pretreatment with paracetamol and lidocaine in preventing pain-induced withdrawal caused by the intravenous injection of rocuronium during the induction of general anaesthesia in paediatric patients.

METHODS

Ninety children were randomized into two groups using a simple drawing from the box method: a paracetamol group (Group P, n=45) and a lidocaine group (Group L, n=45). After anaesthesia induction, venous occlusion was applied by a paediatric cuff inflated to a pressure of 75 mmHg and by 50 mg paracetamol and 0.5 mg kg(-1) lidocaine was injected in Groups P and L, respectively. Venous occlusion was then released, followed by rocuronium injection (0.6 mg kg(-1)). Withdrawal was evaluated using a 4-point scale (1, no response; 2, movement at the wrist only; 3, movement/withdrawal involving arm only (elbow/shoulder) and 4, generalized response, movement/withdrawal in more than one extremity).

RESULTS

The incidence of withdrawal movement was 42% and 26% in the Groups P and L, respectively (p=0.120). Although no significant differences were noted in the number of patients who had no withdrawal movement and mild withdrawal movement in Groups P and L, compared with Group L, the incidences of moderate withdrawal movement were significantly higher in Group P (p<0.05). No patient in either group revealed generalized movement.

CONCLUSION

Using a venous occlusion technique, pretreatment with 50 mg paracetamol can prevent withdrawal movement caused by rocuronium injection in children but is not as effective as lidocaine to prevent moderate withdrawal movement.

Acupuncture as an Antiemetic in Children who Underwent Adenoidectomy and/or Tonsillectomy

OBJECTIVE

Postoperative vomiting (POV) is one of the most common problems following general anaesthesia, and many factors, either solely or in combination, may play a role in aetiology. Acupuncture is a technique that the World Health Organization has accepted as a complementary treatment. This study presents our experience with acupuncture for POV treatment in a study of paediatric tonsillectomy cases.

METHODS

The study included ASA I-II patients (n=70) aged 2-14 years who underwent tonsillectomy and/or adenoidectomy under general anaesthesia. The patients were randomly divided into the following two groups: control and study group. In the study group, an acupuncture needle was intraoperatively applied to the P6 acupuncture point for 20 min. Antiemetics were not administered to either group because of the standard applications in the preoperative period. The patients were postoperatively evaluated by nurses who were unaware about the techniques used in either group.

RESULTS

No statistically significant difference was determined between the groups with regard to age, sex, nature of the operation, duration of anaesthesia, duration of the operation, surgical method and ASA scores. A statistically significant difference was determined between the groups with respect to vomiting rates. The acupuncture group presented with 0.28-times fewer vomiting episodes than the control group.

CONCLUSION

The results of the study demonstrate that acupuncture has an apparent antiemetic efficacy in POV. Its routine use for POV may improve postoperative comfort and reduce drug use for prophylactic or therapeutic purposes.

Serum angiostatin levels in patients with Behçet's disease: does angiogenesis play a role in the pathogenesis of Behçet's disease?

Angiogenesis plays an important role in the pathogenesis of inflammatory diseases, but the possible role of angiogenesis in Behçet's disease (BD) has not yet been studied. The aim of this study was to determine angiostatin levels in patients with BD and the role of angiogenesis in the pathogenesis of the disease. Thirty-seven patients with BD (mean age: 28·6±5·4 years, mean disease duration: 9·3±3·7 years) and 18 healthy controls were enrolled to the study. Twenty-four patients were in active and 13 patients were in inactive stage of the disease. The mean serum angiostatin level of patients with BD was 113·9±53·2 and 60·7±20·1 ng/ml in healthy controls. The mean serum angiostatin level was 142·7±43·1 ng/ml in active and 86·9±15·5 ng/ml in inactive patients with BD. Serum angiostatin levels were significantly high in patients with BD compared with healthy controls (P<0·001) and it was significantly high in active patients compared with inactive patients with BD (P<0·001). In inactive patients with BD, serum angiostatin concentrations were found to be higher compared with healthy controls (P<0·01). In active BD patients, the mean serum angiostatin level was correlated with the deep vein thrombosis (r = 0·482, P = 0·05), uveitis (r = 0·582, P = 0·01), and arthritis (r = 0·492, P = 0·05). According to these results; elevated serum angiostatin levels in patients with BD suggest the possible role of angiogenesis in the pathogenesis of the disease and its high levels in inactive Behçet's patients is related with the continuous activation of the disease even in the subclinical period.

Dental findings in Hamamy syndrome

This paper highlights features of dental rehabilitation of patients with Hamamy syndrome. A 10-year-old boy patient with Hamamy syndrome reported pain in the maxillary left central incisor, and all mandibular incisors. Intraoral clinical and radiographical examination showed enamel hypoplasia, severe dilacerated maxillary left central incisor and mandibular incisors, malocclusion, delayed eruption of teeth, taurodontism, and loss of lamina dura. Root canal treatment, strip crown and composite restorations were performed.

Evaluation of embryo transfer time (day 2 vs day 3) after imposed single embryo transfer legislation: when to transfer?

To determine whether the timing of embryo transfer (day 2 or day 3) affects pregnancy outcome in IVF patients, receiving single or double embryo transfer, 380 patients were included in this retrospective study. All patients underwent GnRH antagonist protocol. When stratified by number of transferred embryos, single embryo transfer (SET) patients undergoing a day 2 embryo transfer (ET) had similar biochemical pregnancy (25% vs 20.4%; p > 0.05) and clinical pregnancy (16.6% vs 14.6%; p > 0.05) rates to SET patients that were undergoing a day 3 ET. A similar observation was again noted in double embryo transfer (DET) patients undergoing a day 2 ET, with similar biochemical pregnancy (35% vs 29.8%; p > 0.05) and clinical pregnancy (25% vs 15.5%; p > 0.05) rates to DET patients undergoing a day 3 ET. Women, despite age, number of transferred embryos and ET timing, have similar reproductive outcomes. Shortening or lengthening the duration of in vitro culture provides no obvious benefit.

Eating attitude in the obese patients: the evaluation in terms of relational factors

ACCESSIBLE SUMMARY

• Obesity has become an important health problem because of the gradually increasing incidence seen within all age groups. People with obesity problems are affected lifespan and health negatively. • Obesity can be described as disease that affects lifespan and health negatively, because of body fat deposition. • The eating attitudes, body perception, strategies for coping with stress in patient being treated for obesity and investigated the relationship between their eating attitudes and socio-demographic characteristics, body perceptions and strategies of coping with stress. • Misperception of the body and the ability to solve the problem increased as eating attitude defects increased. A positive correlation was between the eating attitude defects and habitude of pursing social support and ability of coping.

ABSTRACT

Obesity, a complex disease, involves many psychological problems besides eating disorders. In this study, we aimed to examine the relationship between the eating attitude and body perception, which is thought to affect the eating attitude in the patients diagnosed as obese, the ability to solve the problem, the strategy of coping with stress and some socio-demographic features. A total of 99 adults aged between 20 and 68 years, who were examined in the Polyclinic of Endocrinology and Metabolism Diseases, Ege University, Türkiye, constituted the sample of the study. Eating Attitude Test, The Body Perception Scale and The Scale of Coping with Strategies were used in order to collect the data. Misperception of the body and the ability to solve the problem increased as eating attitude defects increased. A positive correlation was determined between the eating attitude defects and the habitude of pursuing social support and the ability of coping.

Anger and alexithymic characteristics of the patients diagnosed with insomnia: a control group study

The research was designed with a descriptive purpose to compare the alexithymic characteristics, trait anger and anger expression styles of those who are diagnosed with insomnia with those who are not. It was conducted with 96 patients who applied to Department of Sleep Disorders and were diagnosed with insomnia and 96 volunteers were not diagnosed with any psychiatric diagnosis and had not any sleep disorders in two Medical Faculty Hospitals in west of Turkey. Three types of forms were used to collect research data. The first form is the Sociodemographic Characteristics Form, the second one is The Toronto Alexithymia Scale and the third one is the Trait Anger-Anger Expression Scale. It was determined that the patients diagnosed with insomnia had displayed much more alexithymic characteristics than control group. Insomniac patients had higher level of anger and anger expression-in than the control group was found. In accordance with the findings, it is suggested that more comprehensive data should be obtained from the patients having sleeping problems and, that the nursing interventions on the patients' recognition, expression and anger management should be reflected on the nursing holistic care.

Adolescents' strengths and difficulties: approach to attachment styles

This research is a descriptive field study conducted in order to investigate the relationship between adolescent difficulties and the attachment style. The study aims to investigate the relationship between adolescent attachment style and strength and difficulties in Turkey. Children attachment style and difficulties pattern in the group of adolescents aged 11-16 years old were compared with each other. Several different questionnaires, including The Strength and Difficulties Questionnaire, The Relationship Scale Questionnaire were applied to 384 (mean age 12.10 +/- 1.4 years) adolescents. The data were analysed using descriptive statistics, Pearson correlation coefficients, anova, t-test, Kruskall Wallis and effect sizes. The adolescent secure attachment style was associated with increased levels of prosocial behaviour, decreased levels of emotional symptoms, hyperactivity/inattention, peer relationship problems, conduct problems, total difficulties scores. The adolescent fearful attachment style was associated with increased levels of emotional symptoms, and total difficulties scores. The adolescent dismissing attachment style was significantly associated with higher levels of emotional symptoms, hyperactivity/inattention, total difficulties scores and lower levels of prosocial behaviour. Adolescent strengths and difficulties are associated with their attachment style. Insecure attachment styles of dismissing and fearful were associated with increased mental symptom reporting. It is suggested that further studies may illuminate the clinical value of the attachment disorder and quantify parental contribution to psychopathology. Giving the therapeutic, structured mental support programme to adolescents that have attachment problems could be beneficial in improving mental status of these individuals.

Actinomycosis of the tongue: a diagnostic dilemma

Actinomycotic infections of the cervicofacial region are not uncommon. However, actinomycosis of the tongue is rare. A mass that may mimic both benign and malignant neoplasms can be seen at clinical presentation and may mislead the diagnosis. We report a patient who presented with a tumour-like tongue mass causing speech disturbance, diagnosed as actinomycosis.

Agenesis of sphenoid sinuses

We present a 50-year-old woman with agenesis of the sphenoid sinuses. She was referred for evaluation of the aeration status of the sphenoid sinus and related nasal structures before endoscopic transsphenoidal hypophysectomy for pituitary microadenoma. Axial and coronal computed tomography (CT) scans revealed absence of the sphenoid sinuses and the right posterior ethmoidal cell. Agenesis of sphenoid sinuses documented using CT scans is uncommon. One case with a history of Hand-Schuller-Christian disease has been reported in the English language literature. In the case reported here agenesis of the sphenoid sinuses was not accompanied by craniofacial anomaly or skeletal disease.

Phagocytic activity in familial Mediterranean fever

Familial Mediterranean fever (FMF) is an autosomal recessive disease. Although the possibility of multiple immunologic mechanisms have been studied, the actual mechanism is still unresolved. Forty-one patients with FMF (24 males and 17 females with a mean age and disease duration of 17.8 +/- 4.1 and 4.7 +/- 2.3 years, respectively) and 14 healthy controls (10 males and 4 females with a mean age 23.2 +/- 5.1) were involved in the study. A phagotest was studied in both the patients and control groups with a FACScalibur Flow. All patients were in the acute stages of the disease and had not undergone colchicine treatment for 2 months. The percentage blood phagocytic activity of both granulocytes and monocytes were 84.23 +/- 8.76 and 67.28 +/- 10.15 in the patient group and 94.68 +/- 3.24 and 76.23 +/- 5.7 in the control group, respectively. There was no statistically significant difference in the percentage of phagocytic activity of the granulocytes and monocytes between the FMF patients and healthy controls (p > 0.05 and p > 0.05, respectively).

Serum IFN-gamma and IL-10 levels before and after specific immunotherapy in patients with allergic rhinitis

Although a detailed explanation of the mechanism of immunotherapy is not known, several immunologic explanation have been proposed. It's said that T cell-cytokine profile changed with allergen immunotherapy. In our study we evaluated IFN-* and IL-10 levels before and after immunotherapy in patients with allergic rhinitis. Twenty patients (mean age; 27.3 +/- 4.84), 8 male, 12 female with allergic rhinitis, mean duration of disease was 5.55 +/- 1.23 years and 13 healthy controls, 5 male, 8 female (mean age: 28.38 +/- 5.61) were enrolled in the study. Immunotherapy was performed for grass pollen allergen extract to patients with allergic rhinitis for 31.5 +/- 4.98 months. Serum IL-10 and IFN-* levels were evaluated with ELISA. Serum IL-10 levels were significantly high before and after immunotherapy compared to controls. There was no difference in IFN-* levels before and after SIT compared to controls. According to this study, in patients with allergic rhinitis after immunotherapy serum IL-10 levels are decreased but IFN-* no change.

Soluble intercellular adhesion molecule-1 (sICAM-1) in patients with allergic rhinoconjunctivitis

Intercellular adhesion molecule-1 (ICAM-1), a member of immunoglobulin supergene family with a five-domain structure, is known to play an important role in inflammatory disease. We measured levels of soluble ICAM-1 in sera of 25 patients with allergic rhinoconjunctivitis (7 male, 18 female: age range 14-47 years, mean 29.8 +/- 9.2) and 20 healthy subjects (11 male, 9 female: age range 22-48 years, mean: 33.3 +/- 7.6). All allergic patients had positive history, positive skin prick test and conjunctival provocation test, and radioallergosorbent test for specific allergens. Soluble ICAM-1 in serum samples was determinated by ELISA. The mean serum sICAM-1 levels, in healthy subjects was 193.3 +/- 68.8 ng/ml and in patients with allergic rhinoconjunctivitis was 212.6 +/- 50.9 ng/ml. There were no difference in sICAM-1 levels in both of the groups (P > 0.05). In male patients with allergic rhinoconjunctivitis, sICAM-1 levels (mean: 234.5 +/- 55.0 ng/ml) were higher compared to female patients with allergic rhinoconjunctivitis (mean: 204.1 +/- 48.1 ng/ml) and control group (P < 0.05 and P < 0.05 respectively). Soluble ICAM-1 levels were high in patients with allergic rhinoconjunctivitis who had high level of symptom score.

Effects of carbamazepine and valproate on brainstem auditory evoked potentials in epileptic children

Brainstem auditory evoked potentials (BAEPs) were recorded in 18 epileptic children receiving carbamazepine and 10 epileptic children receiving valproate. BAEPs were recorded before the administration of antiepileptic drugs (AEDs) and 13 months later during which the children received AEDs. Statistical analysis of peak latencies and interpeak intervals of waves I-III-V were made. Carbamazepine treatment resulted in prolongation of peak latencies of waves I-III-V and interpeak intervals I-III and I-V. Valproate monotherapy, on the other hand, caused no consistent changes on BAEP. On the basis of these results we suggest that chronic carbamazepine therapy exerts a suppressive influence on the auditory pathways, both peripherally at the level of the cochlea and/or auditory nerve, and centrally at the brainstem.