Do Mean Values of the Peak Inspiratory Nasal Flowmeter Vary According to the Severity, Direction and Type of Nasal Septum Deviation?

The aim is to investigate the contribution of the PNIF test in daily clinical practices in the objective evaluation of the early postoperative functional results of septoplasty and the effect of the severity, direction, and type of nasal septum deviation on mean PNIF values. Nasal septum deviation (NSDs) of the cases were grouped according to the Mladina classification and the severity of NSDs. An objective evaluation of the nasal airway was conducted via a peak flowmeter device in the preoperative and postoperative first month. When examining the mean PNIF values according to genders, it was observed that the values determined in male cases in the preoperative and postoperative period were higher. In the intragroup evaluation performed according the Mladina classification, a statistically significant increase was observed in the preoperative and postoperative PNIF values of the cases in Types 1-4. In the intragroup evaluation performed according to the severity of NSD, there was a significant increase in the preoperative and postoperative PNIF values of the mild and moderate cases. When comparing the preoperative and postoperative PNIF values of the groups in terms of the severity of NSD, it was observed that there was a significant difference. The PNIF can be used in routine clinical practices to evaluate the septoplasty results objectively. In the evaluation of functional results, the change in the mean PNIF values may also vary according to the direction and severity of septum deviation and the Mladina classification other than age, gender and ethnic origin.

Significant worsening sperm parameters are associated to testicular hypotrophy in patients with a high grade varicocele

OBJECTIVE

To investigate the relationship between testicular volume and semen parameter sin patients with unilateral high grade left varicocele.

MATERIAL AND METHODS

One hundred eighty seven patients who had left high grade varicocele aged 19-to-25 years were included in this study. All patients underwent a standard evaluation, including medical history and physical examination. The percentage testicular volume difference between the right and left testicles was calculated. The patients were divided into the following three groups; Group 1 (n=72) testicular volume difference <10%, testicular volume difference 10%-20% Group 2 (n=74) and testicular volume difference >20% Group 3 (n=41).

RESULTS

The mean age and BMI of the patients were 21.5 years and 23.1kg/m(2), respectively (P=.596, P=.943). The semen parameters and testicular volumes of the three groups were compared. The total motile sperm count, percentage of motile sperm, percentage of normal morphology sperm were found to be lower in Group 3 (P=.011, P=.012, P=.029 respectively). The mean testicular volumes for the left and the right testis were found to be 15.2cm(3) and 17.7cm(3) (P<.001), respectively. No significant difference was found in the right testicular volumes between groups (17.4, 17.7 and 18.1cm(3), P=.573).

CONCLUSIONS

A high grade left testicular varicocele is associated with ipsilateral testicular hypotrophy and parallel to worsened sperm parameters.

A 45 X male patient with 7q distal deletion and rearrangement with SRY gene translocation: a case report

Here we present a male newborn with multiple congenital anomalies who also has an extremely rare form of testicular disorder of sex development (DSD). His karyotype was 45X, without any mosaicism. SRY gene was positive by polymerase chain reaction (PCR), and rearranged on distal part of the 7th chromosome by fluorescence in situ hybridization (FISH) analysis. SRY, normally located on the Y chromosome, is the most important gene that plays a role in the development of male sex. SRY gen may be translocated onto another chromosome, mostly X chromosome in the XX testicular DSD. On the other hand very few cases of 45 X testicular DSD were published to date. Other clinical manifestations of our patient were compatible with distal 7 q deletion syndrome. To the best of our knowledge this is the first case of 45 X testicular DSD with SRY gene rearranged on the 7th autosomal chromosome.

Universal newborn hearing screening; automated transient evoked otoacoustic emissions

OBJECTIVE

The purpose of this study is to describe the results of universal newborn hearing screening (UNHS) in 2229 newborns and to assess the effectiveness of a two-stage automated transient evoked otoacoustic emission (a-TEOAE) test protocol.

MATERIALS AND METHODS

Between May 2007 and January 2008, a universal newborn hearing screening program, instituting two-stage a-TEOAE, was evaluated. The hearing status of the newborns who failed the two-stage screening tests were evaluated with the auditory brainstem response (ABR) test during the diagnostic stage. The risk factors for hearing loss determined by the Joint Committee on Infant Hearing Loss (JCIH) and prematurity, consanguineous marriage, and birth type as presumptive risk factors were recorded.

RESULTS

During the study period, 2229 newborns were screened. Sensorineural hearing loss (SNHL) was identified in 8 newborns. Fourteen newborns were lost to follow-up. One hundred thirty six newborns were high-risk neonatal intensive care unit (NICU) patients. The prevalence of SNHL was 2.9% (4/136) in NICU newborns, and 0.19% (4/2079) in the well-baby nursery. SNHL prevalence in the study group overall was found to be 0.36% (8/2215). Craniofacial anomalies and family history of hearing loss were found to be significantly related to SNHL in newborns. Prematurity and consanguinity that are not listed among JCIH risk factors were also found to be statistically significantly related with SNHL.

CONCLUSIONS

This is the first report of a universal hearing screening program in the Eastern Black Sea region of Turkey. Two-stage a-TEOAE is an efficient and feasible hospital-based screening protocol in newborns.

Autosomal recessive multiple pterygium syndrome: a new variant?

Multiple pterygium syndromes include at least 15 different entities characterized by multiple pterygia or webs of the skin and multiple congenital anomalies. We describe a female infant who presented with a distinct constellation of multiple anomalies consisting of pterygia of the inguinal, intercrural and popliteal areas, flexion contractures and arthrogryposis of some joints, craniofacial anomalies including ectropion, medial canthal web, blepharophimosis, hypoplasia of nose, oral and nasopharyngeal cavities, vocal cords and tongue, micrognathia, orolabial synechiae secondary to pterygia, low set ears, alopecia, sad and expressionless face, short neck, asymmetric nipples, anal stenosis, rectal polyp, hypoplastic labia majora, complete syndactyly of all fingers and toes, pes equinovarus, bandlike web between feet, and absence of the nails and phalangeal-palmar creases. Radiological examination showed synostosis, absence or hypoplasia of metacarpal, metatarsal and phalangeal bones on feet and hands, and hypoplasia of pelvic bones and scapulae. This pattern of anomalies does not fit entirely any of the known multiple pterygium syndromes. Autosomal recessive inheritance is most likely due to the presence of three similarly affected siblings and normal parents.

Bilaminar dual-purpose stent for placement of dental implants

Proper placement of implants in the posterior maxillary region with poor bone density is essential to obtain long-term success. In this article, the fabrication of a bilaminar dual-purpose stent that facilitates ease in implant placement with improved verification of implant positioning is described. The outer lamina is designed for use in the computed tomography evaluation, using radiopaque markers. The verification of implant alignment and positioning, according to the determined prosthesis, is also performed with this template after modifying it for surgery. The inner lamina is designed to accept 2 removable surgical acrylic resin stents with different guide channels that avoids the risk of surgical malpractice.

Congenital primary hypoparathyroidism presented with extensive cutaneous and subcutaneous calcifications

Congenital primary hypoparathyroidism is very rare in infancy. It may be isolated or associated with other developmental defects, arising from the third and fourth pharyngeal pouches such as DiGeorge syndrome. Initial symptom of isolated primary hypoparathyroidism in an infant is usually generalized convulsion due to hypocalcemia. However, the clinical spectrum of DiGeorge's anomaly is highly variable. We report a two-hour-old neonate with congenital hypoparathyroidism presenting with extensive cutaneous and subcutaneous calcifications. To our knowledge, extensive calcification of the skin and subcutaneous tissue as a presenting feature of congenital primary hypoparathyroidism in an infant is reported for the first time.

Gastric perforation presenting as bilateral scrotal pneumatoceles

Although processus vaginalis is patent in the majority of newborn infants, the expression of an intraabdominal pathology such as gastrointestinal perforation or bleeding in the scrotum is very rare. In a large percentage of neonates with the gastrointestinal perforation, pneumoperitoneum is absent. In any case, it may not be detected in early radiographs. We report a newborn baby who presented with bilateral scrotal pneumatoceles as a first sign of pneumoperitoneum due to gastric perforation. Plain x-ray of the abdomen was normal except for pneumoscrotum, but contrast study revealed gastric perforation.

Occult pneumococcal septicemia and pneumococcal pneumonia complicating pneumatoceles in a previously healthy child

Fulminating pneumococcal septicemia without an obvious focus of infection is very rare in previously immunocompetent children older than two years. Furthermore, pneumatocele formation in pneumococcal pneumonia is uncommon. The majority of pneumatoceles are self-limited and disappear spontaneously. Here, we report a six-year-old healthy child with occult pneumococcal septicemia and pneumococcal pneumonia secondary to septicemia. Giant pneumatoceles causing respiratory insufficiency formed secondary to the pneumococcal pneumonia and were aspirated via needle under fluoroscopic guidance.

Plasma soluble interleukin-2 receptor levels in patients with idiopathic thrombocytopenic purpura

Soluble interleukin-2 receptor (slL-2R) was measured in the plasma of 31 patients with idiopathic thrombocytopenic purpura (ITP) and 22 normal controls. When thrombocytopenia persisted longer than 6 months, the diagnosis of chronic ITP was made. Twenty patients had acute ITP, 11 patients had chronic ITP, and all patients received high-dose methylprednisolone (HDMP) (30 mg/kg/d for 3 days, 20 mg/kg/d for 4 days). The sIL-2R levels of the patients were determined before being giving HDMP and 14 days after the end of HDMP therapy. Platelet counts were determined before administration of HDMP, one day after the end of HDMP therapy, and once every 28 days for 7 months thereafter. There was not a significant difference between the mean pre-treatment plasma sIL-2R levels of both acute and chronic ITP groups (P > 0.05), and these were higher than that of the control group (P < 0.001). The mean post-treatment sIL-2R level of the chronic ITP group was significantly higher than those of both the control and post-treatment acute ITP groups (P < 0.001). There were negative correlations between the plasma sIL-2R levels and platelet counts of both group patients in the pre-treatment period and between post-treatment sIL-2R levels and platelet counts in chronic ITP group (P < 0.05). We think that there was a good correlation between prognosis of ITP and sIL-2R levels after HDMP therapy, and platelet counts in patients with ITP are linked to sIL-2R levels.

Multiple intracranial hemorrhages at the time of a transiently prolonged activated partial thromboplastin time in an infant with congenital factor VII deficiency

Factor VII (FVII) deficiency is a rare autosomal recessive hereditary disorder characterized by a normal partial thromboplastin time and a prolonged prothrombin time. For definitive diagnosis, the specific FVII level should be investigated. We report on a 7-month-old boy with congenital FVII deficiency suffering from convulsions and intracerebral hemorrhage. Hematologic tests revealed prolonged prothrombin time associated with a decreased FVII level of 1.7%. Computerized tomography of the brain revealed multifocal hemorrhagic lesions. To our knowledge, multifocal intracranial hemorrhages at the time of a transiently prolonged partial thromboplastin time of unknown origin in a child with congenital FVII deficiency of about 2% has not been reported so far.

Absorption of iron from grape-molasses and ferrous sulfate: a comparative study in normal subjects and subjects with iron deficiency anemia

We compared the absorption of iron from grape molasses (GM) and ferrous sulfate (FS) using the post-absorptive serum iron increase method (non-radioactive). The study involved 56 subjects, aged 6-36 months. Group I consisted of 30 subjects with iron deficiency anemia (IDA) and group II, 26 non-anemic subjects. Each group was subdivided randomly into two equal subgroups to be given either GM or FS. The absorption of the iron from GM was monitored in 15 infants with IDA and in 13 non-anemic infants, and the absorption of iron from FS was tested in the rest of the subjects in each group. In those infants in each group given GM or FS, there was no significant difference in before-test values for serum iron (SI) and total iron binding capacity (TIBC) (p > 0.05). In the group with IDA, the mean after-test SI value in FS-given infants was higher and the mean TIBC value lower than those of GM-given infants (p < 0.05). However, in the non-anemic group, there was no significant difference in the mean after-test SI and TIBC values in either GM- or FS-given infants (p > 0.05). The mean increase of serum iron in GM-given infants with IDA was 27.0 +/- 13.4 micrograms/ dl and in FS-given infants, 60.6 +/- 17.0 micrograms/dl (p < 0.05). In the non-anemic group, the mean increase of serum iron of GM-given infants was 23.0 +/- 4.3 micrograms/dl, and that of FS-given infants, 23.8 +/- 10.0 micrograms/dl (p > 0.05). We determined that in non-anemic subjects, the absorption of iron from GM was comparable to that from FS. Furthermore, we believe that grape molasses is an effective iron source in preventing iron deficiency anemia in infancy.

Serum granulocyte-macrophage colony-stimulating factor and interleukin-1 levels in patients with repeated and non-repeated pulmonary infections

Granulocyte-macrophage colony-stimulating factor (GM-CSF) has a stimulating effect on erythroid, megakaryocytic and granulocyte-macrophage progenitors. Activated T lymphocytes, monocytes, fibroblasts and endothelial cells release GM-CSF after stimulation by endotoxin and cytokines such as interleukin-1 (IL-1) and tumor necrosis factor. IL-1 is also released in response to bacterial infections and inflammation by phagocytic mononuclear cells. GM-CSF and IL-1 levels were examined in 10 patients with recurrent pulmonary infection (repeaters) and in 10 patients with acute pulmonary infection (non-repeaters) in the acute and recovery periods of infection. The mean serum GM-CSF and IL-1 levels of non-repeaters were significantly higher than those of repeaters in the acute period of infection (p < 0.002), but the same parameters of both groups were not different in the recovery period (p > 0.05). In addition, both the serum GM-CSF and IL-1 levels of repeaters and non-repeaters in the acute period of infection were higher than those in the recovery period (p < 0.05). There was a positive correlation between serum IL-1 and GM-CSF levels in non-repeaters (r = 0.746, p = 0.013), but no significant correlation between the same parameters in repeaters (r = 0.395, p = 0.259). In this study, we could not explain why the serum GM-CSF and IL-1 levels in repeaters did not increase as they did in non-repeaters; moreover, there was no significant correlation between serum IL-1 and GM-CSF levels in repeaters during the acute period of infection. These findings may be due to microenvironmental factors in bone marrow and/or other factors.

Intracerebral hemorrhage: a rare late manifestation of vitamin-K deficiency in a breastfed infant. A case report

Late hemorrhagic disease of the newborn (HDN) is a rare complication of vitamin-K deficiency and is especially associated with intracranial hemorrhage. It may also occur in infants who received vitamin-K prophylaxis at birth. Here, we reported a case of late HDN with frontal lobe hemorrhage due to vitamin-K deficiency. This form of intracranial hemorrhage of late HDN has been reported in the literature very rarely. We conclude that the efficiency of single-dose vitamin-K prophylaxis should be revaluated.

Multiple vertebral segmentation defects. Brief report of three patients and nosological considerations

Multiple vertebral segmentation defects i.e. multiple malformations of vertebrae and ribs are characterized by short neck, scoliosis, short trunk and deformity of the ribcage. There are three major subtypes; Jarcho-Levin syndrome, spondylothoracic dysostosis and spondylocostal dysostosis, with different inheritance patterns, survival rates and associated malformations. We describe three cases of multiple vertebral segmentation defects, two with familial spondylothoracic dysostosis and one with sporadic spondylothoracic dysostosis, and anomalies i.e. super-numerary breast, clubfeet deformity, myelomeningocele, intradural lipoma, and Arnold-Chiari malformation.

Serum interleukin-1 and granulocyte-macrophage colony-stimulating factor levels in protein malnourished patients during acute infection

OBJECTIVE

To investigate the response of serum interleukin-1 (IL-1) and granulocyte-macrophage colony-stimulating factor (GM-CSF) to infection of malnourished patients.

DESIGN

Prospective observational study.

SETTING

Paediatric clinics of Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey.

SUBJECTS

13 protein-depleted (kwashiorkor marasmic kwashiorkor), 15 marasmic nutritionally repleted kwashiorkor (NRK), and 12 well-nourished control subjects.

INTERVENTIONS

Clinical and laboratory data, and serum IL-1 and GM-CSF levels during acute infections were examined.

MAIN OUTCOME MEASURES

White blood cell count, pc of circulating neutrophils (%PNL), serum total protein, albumin (ALB), IL-1 and GM-CSF levels.

RESULTS

Fever, pcPNL, serum IL-1 and GM-CSF levels of kwashiorkor patients were lower than those of marasmic and control patients (p < 0.005). Fever, neutrophil pc(PNLpc), serum IL-1 and GM-CSF levels of NRK patients during further acute infection were not significantly different from those of marasmic and control patients, but higher than those of the kwashiorkor patients. Although there were positive correlations between serum IL-1 and ALB levels (r = 0.922, p < 0.001), and between serum GM-CSF and ALB levels (r0.730, p = 0.005) in the kwashiorkor group, there were not significant correlations between the same parameters in the other groups (r < 0.5, p > 0.05). And also, although there was not significant correlations between PNL% and IL-1 levels in the kwashiorkor group (r0.312, p = 0.299), there were significant positive correlations between the same parameters in the other groups (r < 0.5, p > 0.05). However, significant positive correlations were found between fever and IL-1 levels, and between IL-1 and GM-CSF levels in all groups (r > 0.5, p < 0.05).

CONCLUSION

The responses of serum IL-1 and GM-CSF to acute infection of kwashiorkor patients are defective, and nutritional-repletion therapies restore the production of these cytokines.

Asymmetric crying facies: an index of other malformations

Congenital hypoplasia or absence of the depressor anguli oris muscle is a minor congenital anomaly causing asymmetrical crying facies (ACF). The interesting aspect of this abnormality lies in the frequently associated abnormalities. Cardiac, urogenital, musculoskeletal, respiratory and cervicofacial defects have been described in cases with ACF. Therefore it is suggested that ACF can be used as an index of other congenital malformations. We report three cases with ACF who had varied congenital anormalites.

Relationships between serum free fatty acids and zinc, and attention deficit hyperactivity disorder: a research note

The purpose of this study is to evaluate the relationships between serum free fatty acids (FFA) and zinc, and attention deficit hyperactivity disorder (ADHD). Forty eight children with ADHD (33 boys, 15 girls) were included in the patient group and 45 healthy volunteer children (30 boys, 15 girls) constituted the control group. The mean serum FFA level in the patient group was 0.176 +/- 0.102 mEq/L and in control group, 0.562 +/- 0.225 mEq/L (p < .001). The mean serum zinc level of patient group was 60.6 +/- 9.9 micrograms/dl and that of the control group, 105.8 +/- 13.2 micrograms/dl (p < .001). A statistically significant correlation was found between zinc and FFA levels in the ADHD group. These findings indicate that zinc deficiency may play a role in aetiopathogenesis of ADHD. Although we observed decreased FFA levels in ADHD cases, it is necessary to determine whether this condition is a principal cause of ADHD or is secondary to zinc deficiency.

The role of high dose methylprednisolone and splenectomy in the accelerated phase of Chédiak-Higashi syndrome

The Chédiak-Higashi syndrome (CHS) is a rare autosomal recessive immunodeficiency disorder. Some cases with CHS develop the accelerated phase characterized by pancytopenia, high fever and lymphohistiocytic infiltration of liver, spleen and lymph nodes. The treatment of the accelerated phase of CHS is difficult. We describe a case with CHS in the accelerated phase who had multiple polyposis and pulmonary infiltration that was probably due to involvement of CHS. She was successfully treated with high-dose methylprednisolone at her first admission. At her second admission, splenectomy was performed to remove hypersplenism, and her clinical, radiological and hematological findings improved significantly.

Langerhans cell histiocytosis associated with recurrent pneumothorax: a case report

Pulmonary involvement of Langerhans cell histiocytosis (LCH) is an uncommon but important cause of pulmonary fibrosis and honeycombing in young adults. Rarely, pulmonary LCH may be complicated by spontaneous pneumothorax. It may be isolated or associated with multiple organ involvement. We describe here a case of LCH with diabetes insipidus, skin lesions and pulmonary involvement in a 15-year-old boy. The case was complicated by four episodes of spontaneous pneumothorax with typical radiologic findings of pulmonary LCH. His presentation, radiologic findings, treatment and clinical course during three-years of follow-up are discussed.

Primary Burkitt's lymphoma of the cranial vault in a child

Non-Hodgkin s lymphoma in the cranial vault is rare, particularly in children. This report describes a 12-year-old boy who had a palpable and painless occipital skull mass and left hypoglossal nerve paralysis as the initial manifestations of Burkitt s lymphoma. Plain radiography, computed tomography and magnetic resonance imaging findings are presented.

The role of high-dose methylprednisolone therapy in paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired disorder characterized by intermittent hemolytic anemia. High-dose methylprednisolone (HDMP) was administered in two patients, eight- and 16-year-old females, with PNH. This drug produced a dramatic improvement in the hemoglobin level, leukocyte and platelet counts. No side effect was observed in either patient during the treatment period. The patients were followed up on an outpatient basis for six and 16 months. In conclusion, HDMP therapy for PNH appears to be more effective and safe than previously reported therapies.

Various clinical aspects of DIDMOAD (Wolfram) syndrome

The association of juvenile diabetes mellitus (DM), diabetes insipidus (DI), optic atrophy (OA) and sensorineural deafness (D) is known as DIDMOAD or Wolfram syndrome. Aside from these four cardinal features, a wide variety of abnormalities of the nervous system, urinary tract and endocrine glands have been described in this syndrome. In this report, the clinical features of six patients with DIDMOAD syndrome are presented. All six patients had DM. Five of the six patients had DI, five OA and five displayed abnormal audiogram findings. In addition, two had goiter, two delayed puberty, one seizure and one mental retardation with depression attacks. Urinary tract dilatation was recorded in five patients. Four patients developed typical complications of DM. One of them had overt nephropathy and arthropathy despite the short duration of DM. In addition, this patient had diabetic retinopathy, which is considered to be rare in this syndrome.

Marginal reservoirs for multiunit castings

This study measured the distortion of one-piece base metal four-unit fixed partial dentures and recorded the effect of positioning "marginal reservoirs" on the wax patterns. Standard wax patterns were made in a special three-piece stainless steel mold. Twenty anterior prostheses were cast: 10 for the experimental group and 10 for the control group. The prostheses were cast in a nickel-chromium alloy and were measured with a traveling microscope with a micrometer scale. Premarked points were designated on gingivoaxial line angles for buccolingual and mesiodistal distances and diameters to record marginal discrepancies of specimens with or without marginal reservoirs. Castings with marginal reservoirs distorted significantly less than did the control fixed partial dentures.

Measuring pressures under maxillary complete dentures during swallowing at various occlusal vertical dimensions. Part II: Swallowing pressures

The swallowing pressures of seven edentulous patients were measured at seven different occlusal vertical dimensions. In addition, the projection surfaces of the maxillary dentures were measured and the forces on the maxillary denture-bearing surfaces were calculated. The swallowing pressures were measured from the maxillary denture base-mucosal surface interface by means of a "closed" hydraulic system described in Part I. The mean values of swallowing pressures increased from 7.95 +/- 2.25 to 10.18 +/- 3.42 kPa as the occlusal vertical dimension increased, and then decreased to 8.38 +/- 3.55 kPa at the highest occlusal vertical dimension. The results of a two-way analysis of variance showed significant differences of swallowing pressures between patients (p less than 0.001) and between different occlusal vertical dimensions (p less than 0.001). The projection surfaces of maxillary denture bases were measured and ranged from 21.65 to 27.78 cm2. The forces exerted on these surfaces during swallowing were also calculated and ranged from 12.5 to 47.7 N.

Measuring pressures under maxillary complete dentures during swallowing at various occlusal vertical dimensions. Part I: A new hydraulic pressure measuring system

This study presents a "closed" hydraulic pressure measuring system capable of measuring pressures at the denture base-mucosal surface interface. Two pressure receptors are made in the denture base of a maxillary denture. The receptors are covered with a flexible membrane and are connected to pressure transducers by means of polyethylene tubes. The transducers convert the hydraulic pressures coming from the receptors to electrical signals. A polygraph is used to amplify and record the electrical signals. It is assumed that complete contact can be obtained between mucosa and the flexible membranes, which is the advantage of this system.

Monopoly coating on acrylic resin surfaces: a bacteriologic study

In an open bulb of a buccal flange obturator, it is almost impossible to polish the inner surface of the bulb. Because it cannot be cleaned easily, oral and nasal secretions lead to odors. To obtain a smoother surface, it is suggested that monopoly be painted on the unpolished surface of the open bulb. In this study, the effect of a monopoly coating on bacteria retention and washability of acrylic resin surfaces was investigated. Coated and uncoated acrylic resin samples were prepared and both were contaminated with Escherichia coli. After standard washing, the remaining viable E. coli colonies were counted. The statistical results showed that the difference in the number of E. coli colonies between coated and uncoated groups was highly significant (p less than 0.001). It was suggested that monopoly should be applied to the acrylic resin surfaces where mechanical polishing cannot be done.

[Speech and prostheses for congenital cleft palate patients in adulthood]

The surgical treatment should be preferred for cleft palate patients in childhood. However, a prosthesis is favorable for some adult patients. The construction of prostheses are rather complicated for patients who require pharyngeal speech aid in addition to anterior prosthesis. Sound prosthodontic rules are valid in designing a speech aid prostheses. Often stability and retention increase is required for these prostheses. Furthermore, the velar and the pharyngeal sections should not interfere with the muscular activity of pharynx and/or tongue movements during speech and deglutition. This article describes the prosthodontic habilitation of congenital cleft palate patients by means of pharyngeal speech aid prosthesis.

Prosthodontic rehabilitation for glossectomy patients

Patients with oral carcinomas often have resection of the tongue, the floor of the mouth, or the bone of the mandible. Postoperatively, these patients encounter chewing, swallowing, and speech problems. Oral rehabilitation through prosthetic management can aid in alleviating these problems. Designs of the prosthesis vary according to patient needs. A "snap-on" tongue prosthesis or palatal augmentation prosthesis can be constructed. Total glossectomy patients require prosthetic intervention on a mandibular framework. Partial glossectomy patients require prosthetic augmentation on a maxillary framework. Through prosthetic management of this type, articulation and resonance are improved, food is more easily directed into the esophagus, tissues are protected and socialization is enhanced through improved appearance.