Wednesday, 28 February 2018

Nasal Alar Hematoma: An Uncommon Case Report

A male child 6 year old presenting acutely, following trauma, with the clinical appearance of a right nasal mass appearance like ‘blueberry’ within the right nasal vestibule since 7 days. We recommend early surgical drainage and excision of this lesion, as delay in definitive treatment may give rise to a cosmetic deformity.

The nose is one of the body regions that most frequently experience trauma. For this reason, it is also the area of the face that most frequently experiences fractures. Although the fracture of nasal bones, simple or complex, is not the only consequence that can accompany trauma. among the most important secondary effects of nasal trauma is vascular damage without drainage, which is complicated by the formation of a hematoma. Nasal hematomas are principally found at the nasal septal level and, if not treated adequately, can present severe complications. Very few cases of nasal hematomas affecting other areas of the nasal septum have been reported. Till date only 8 to 10 cases were found in literature in which the lesion was present at the level of the alar cartilage and nasal tip. We present a case of a hematoma of the nasal alar cartilage and nasal tip, which appeared following a slight nasal trauma due to fall on ground in 7 year old child. Emphasis should be placed on the importance of early diagnosis and treatment in this type of lesion to maximally prevent aesthetic complications and alterations.

A 6year old child sought medical consultation for right sided nasal mass and swelling over right side of nasal tip since 7days following history of fall on ground . Seven days following the history of fall patient experienced progressive swelling of the right nasal cavity and over tip of nose without evident bleeding. Parents of patient sought consultation after 7th day of the incident. We saw the patient with a serious nasal respiratory obstruction from right nasal cavity and there was swelling over tip of nose on right side and nasal mass in right nasal cavity. 

Tuesday, 27 February 2018

Earwax Phenotype Related to A Risk Factor of Middle Ear Cholesteatoma


It has be known that ventilatory dysfunction of the eustachian tube and ear gas exchange failure in the middle ear are extrinsic factors in middle ear cholesteatoma. However, the relationship between human genes such as intrinsic factor and middle ear cholesteatoma are not well understood. Human earwax shows wet and dry types. Yoshiura reported that one single-nucleotide polymorphism (SNP) in the human ATP-binding cassette C11 (ABCC11) could be a determinant of the human ear wax type. The G/G and G/A genotypes correspond to wet earwax, whereas. The A/A genotype corresponds to dry earwax. Ishikawa demonstrated the allele frequencies of wet earwax with alleleG (Gly180) and dry earwax with alleleA (Arg 180) among different ethnic populations. Africans and Europeans showed a high frequency of 80-100% wet earwax. I n contrast, east Asians (Japanese, Chinese, Korean, Mongolian) showed a low frequency of 0-30%. The incidence of middle ear cholesteatoma in Europeans with a high frequency of wet earwax was higher than in Japanese with a low frequency of wet earwax. Therefore, wet considered that the earwax phenotype could be related to middle ear cholesteatoma in Japan.

The earwax phenotype of 40 patients with middle ear cholesteatoma were decided earwax in healthy side and distant location from cholesteatoma by inspection. (Figure1). The present research was approved by the Juntendo University Committee for the Ethical Issues of human genome.

In Table1, the frequencies of dry earwax and wet earwax were 62.5% (25/40) and 37.5% (15/40), respectively. The incidence of cases with bilateral middle ear cholesteatoma (including past history of surgery for middle ear cholesteatoma) in the group with wet earwax was 66.7% (10 /15), which was significantly higher than in the dry earwax group, 24.0% (6/25) P < 0.05. Clinically advance grades of middle ear cholesteatoma showed no difference between dry earwax cases and wet earwax cases. 

Friday, 23 February 2018

Forensic Engineering of Advanced Polymeric Materials

Polymers are everywhere, also inside of the human body. Why polymers are so important? The most general answer is: because they are solid. With the term “polymer” we describe long chains consisted with repetitive structure, and longer chains tend to be solid. Classical forensic polymer engineering concerns a study of failure in solid polymer products. This area of science comprises fracture of plastic products, or any other reason why such a product fails in service, or fails to meet its specification. Environmental stress cracking (ESC) is one of the most common causes of unexpected brittle failure of thermoplastic (especially amorphous) polymers. The rate of ESC is dependent on many factors, including, for example, the polymer’s chemical composition, bonding, crystallinity, surface roughness, molar mass and residual stress. It also depends on the chemical nature of liquid media and the temperature of the system.

The most familiar synthetic polymers include nylon, polyethylene, polyvinyl chloride, polytetrafluoroethylene and polyesters, whereas proteins, nucleic acids, cellulose, starch, glycogen, silk, wool and aliphatic biopoliesters (PHA) are the polymers occurring in nature. So far, most of the reported forensic polymer engineering case studies concern ex-post investigations of traditional polymeric materials or their thermoplastic composites. (Bio)polyesters are recently of particular importance due to their biodegradation opportunity and potential medical applications. When the development of biodegradable polymers was in its infancy the most crucial features were concentrated on the effect of macromolecular architecture, new monomer systems, polymerization mechanisms, and different polymerization techniques on the final biodegradable properties. Significant eforts have been directed towards specific areas, such as mechanisms of biodegradation, biocompatibility, processing conditions and potential applications in medicine, protection of environment and agro chemistry. However, such aspects like bio-safety of such advanced polymers or nano-safety of their composites were and still are frequently neglected. The knowledge and impetus for development of forthcoming advanced polymeric materials comes from identification of problems before they arise. 

This novel viewpoint focuses on prediction, evaluation and indication on potential complications arising from the use of advanced polymers. Associations between polymeric materials’ structures, properties and behaviors before, during and after practical applications can be evaluated by the use of the methodology developed by Forensic Engineering of Advanced Polymeric Materials (FEAPM). Optimization and characterization of the polymers’ properties are very important for their production, usage and utilization. The connecting of all these elements in the FEAPM methodology constitutes the novelty of this approach. This should help to project new advanced polymeric materials, avoiding the product defects generated during production and usage.  

Thursday, 22 February 2018

Some Pain Patients Can Cut Opioid Dose and Still Get Relief


Some conceivably uplifting news for people taking opioids for incessant torment: It's conceivable to gradually decrease the measurement without expanding inconvenience, new research proposes. That is even valid for individuals who've taken the medications for quite a while. One patient in the new investigation had utilized opioids for a long time, the specialists said. "For a few people, long haul opioids are vital, however it's truly outstanding that there has been a high rate of overprescribing of opioids for perpetual agony, and there are gigantic wellbeing dangers for opioids over the long haul," said the examination's lead creator, Beth Darnall. 

"Patients have a considerable measure of dread and worry around opioids. What's been missing is an approach to decrease these medications on an outpatient premise, and our investigation found a conceivably feasible arrangement," said Darnell, a clinical educator at Stanford University. That arrangement? "Collaborate with patients and let them feel in charge, enabling them to stop the decreasing of the opioid whenever," she clarified. However, the new investigation found that at any rate a few people taking the remedy torment drugs need to get off them, or to at any rate lessen the sum they take. 

The specialists asked individuals with non-disease torment who were going to a torment facility on the off chance that they might want to partake in a trial to decrease down their opioid use more than four months. Eighty-two consented to partake. Their normal age was 52. The specialists avoided anybody with a substance utilize scatter. The individuals who remained in the investigation gradually decreased their measurements of opioids. At to start with, they could decrease up to 5 percent of the measurement they were taking up to twice in a month. By going this gradually, the analysts said they could limit withdrawal side effects and any negative physical or passionate reaction. In months two to four, individuals were permitted to drop their measurements by as much as 10 percent for each week. Once more, it was up to the patients to choose how far down they needed to go.

Wednesday, 21 February 2018

The Cytomorphological Spectrum of Papillary Lesions in the Breast

The objective of this review is to illustrate the broad spectrum of papillary lesions that can be found in breast fine needle aspirations (FNAC). Papillary tumors of the breast comprise lesions of variable morphology and include entities ranging from benign to high grade malignant. Features of papillary neoplasms invariably describe branching three-dimensional papillary clusters with delicate fibrovascular cords. Cytomorphological criteria for benign and low-grade malignant entities overlap and a definite cytological diagnosis is not always possible. Cellular papillomas may harbor areas of ductal carcinoma in situ (DCIS), atypical ductal hyperplasia (ADH) or lobular neoplasia. DCIS can be both high grade and non-high grade. Immunocytochemistry (ICC) can be helpful, providing there is adequate material for ICC. Relatively high error rates, false negatives as well as false positive diagnoses can be found. In general, papillary lesions may be recognized as such. Reporting strategies will often recommend caution if trying to differentiate benign, cellular papillomas from low-grade carcinomas.

Papillary tumors of the breast comprise lesions of variable morphology and include entities ranging from benign to high grade malignant (table 1). A papillary neoplasm is histologically one that exhibits an arborescent epithelial proliferation with fibrovascular cores and is attached by a stalk to the wall of a dilated duct. They constitute < 2 % of all breast lesions.

Cytomorphological criteria for benign and low-grade malignant entities overlap and a definite cytological diagnosis is not always possible. Features of papillary neoplasms invariably describe branching three-dimensional papillary clusters with delicate fibrovascular cords. Additional features of papillary carcinomas include moderate to abundant cellular material small papillae arranged in cell balls, tall columnar cells, isolated naked nuclei and hemosiderin laden macrophages irregular groups of predominantly monolayered (two-dimensional) epithelium composed of small, polygonal or cuboidal cells with eosinophilic cytoplasm and rounded, eccentrically placed nuclei. Features indicating a benign papillary lesion include less cell material, papillae with cohesive stalks surrounded by columnar cells in a honeycomb pattern, apocrine metaplasia, bipolar naked nuclei as well as fewer small papillae and isolated columnar cells. Myoepithelial cells within clusters and inconspicuous naked, bipolar nuclei in the background also indicate a benign lesion.

Tuesday, 20 February 2018

Evolution of the Septoplasty: Maximizing Functional and Aesthetic Outcomes in Nasal Surgery

Correction of a severely deviated nasal septum remains one of the most challenging operations for the facial plastic surgeon. As understanding of nasal anatomy and physiology advanced over time, so have septoplasty techniques, which have evolved in sophistication and capability to correct increasingly complex nasoseptal deformities. Consequentially, the term “septoplasty” has become fraught with confusion, even among physicians, as it broadly encompasses a number of different surgical techniques that all attempt to correct septal deviations. Accurate pre-operative assessment of septal deformities and selection of the most appropriate surgical procedure can help maximize functional and aesthetic outcomes. In this article, we will review the evolution of septal surgery and the differences between the various surgical septoplasty techniques.

Septal deviation is one of the most common causes of nasal obstruction. In a cadaveric study of 2000 subjects, over 75% were found to have some degree of septal deviation. Approximately 33% of patients who visit an otolaryngologist report nasal obstruction, with up a quarter of these patients seeking surgical intervention. Septoplasty is the third most commonly performed otolaryngologic surgery in the United States, preceded only by ear tube placement and adenotonsillectomy. In the United States, 340,000 septoplasties were performed in 2006 alone. The term “septoplasty” is fraught with confusion, even among physicians, as it broadly describes any technique that attempts to correct a deviated septum, and these techniques may vary considerably in complexity and effectiveness. This confusion may contribute to the selection of inappropriate surgical techniques. Despite being one of the most commonly performed surgeries, septal deviations often persist following primary septoplasty, with persistent anterior septal deviation noted in 51-72% of revision septoplasties and patient dissatisfaction rates upwards of 35%. In this article, we will review the evolution of the nasal septal surgery and the examine the differences between the described septoplasty techniques. 

The nasal septum is a midline structure, composed of membranous, cartilaginous and bony components, which divides the nasal cavity into halves and provides structural support to the external nose. The membranous septum, comprised of fibrofatty tissue, is positioned between the medial crura of the lower lateral cartilages (LLC) anteriorly and the cartilaginous septum posteriorly. The cartilaginous septum articulates with the membranous septum anteriorly, nasal bones superiorly, maxillary crest inferiorly and bony septum posteriorly. 

Monday, 19 February 2018

Fentanyl Test Strips May Help Stem OD Deaths

A thin test strip - like a pregnancy test - can identify whether a road tranquilize contains the risky opioid fentanyl, as indicated by another report. Fentanyl - one of most grounded kinds of opioid painkillers - is frequently blended into road drugs, for example, heroin and cocaine. That makes it difficult for clients to survey the power of the medications and raises the hazard for overdose, as indicated by the report's creators. In any case, their exploration uncovered that numerous individuals who utilize road drugs said they'd be keen on utilizing such testing to help anticipate overdoses. 

The report was introduced as of late at a gathering at Johns Hopkins Bloomberg School of Public Health. Hopkins specialists, alongside those from Brown University and the Rhode Island Hospital, did the examination for the report. It was issued by the Bloomberg American Health Initiative, a push to address disturbing general medical problems. Fentanyl - which is 50 to 100 times more grounded than morphine - is the fundamental driver of a sharp ascent in overdose passings. It was connected to 20,000 of the more than 64,000 overdose passings in the United States in 2016, the specialists noted. 

"We are at a urgent minute in the overdose pestilence, and we have to grasp the full scope of mediations that can spare lives," think about co-creator Susan Sherman said in a Hopkins news discharge. She's an educator in the Bloomberg School's bureau of wellbeing, conduct and society. "Our discoveries convey to the table proof that can educate a general wellbeing way to deal with the fentanyl emergency," she said. "Brilliant techniques that decrease mischief can spare lives." To test a medication for fentanyl, you would blend an example with water, as indicated by a report in The Baltimore Sun. On the off chance that the medication contained fentanyl, two stripes would show up on the test strip. One stripe would show up if the strip didn't recognize fentanyl.

Friday, 16 February 2018

To Develop Iranians’ Social Functioning Conceptual Framework and Indicators: A Mixed Method Approach

In the new public health, the concept of “social functioning” has received particular attention as both a social health asset and a determinant of physical and mental health, in despite the fact that the concept primarily derived from the works of sociologists and psychiatrists. Seeking care for nonpsychotic mental disorders as a consequence of problematic social relationships was one of the first reasons of paying attention to the concept of social roles and similarly, social functions. Several countries, especially developed, and international organizations have made attempts to develop their special indicators of social function. Most of them have integrated social functioning indicators into their health programs such as Americans’ healthy people 2020 program; OECD (Organisation for Economic Co-operation and Development) framework of monitoring health; framework of CIHI (Canadian Institute for Health Information).

A recently developed framework for monitoring social well-being in Iran, has considered ‘social functioning’ as a main component but there is no detailed indicators to monitor social functioning. In Iran, as a middle-income country, with rapid social, cultural, and political changes, and improvement in social function was increasingly emphasized by government and policy-makers in recent twenty years, following the evidence-based reports of diminishing trend of social health and capital and increasing trend of social problems such as drug abuse, violence, depression, relationship and family breakdown. The last report of global burden of diseases study regarding Iran situation, which estimated burden of 289 diseases with 67 risk factors, ranked drug use, intimate partner violence, and children sexual abuse as 10th, 13th, and 16th risk factor, respectively; and ranked major depressive disorder, anxiety disorder, drug abuse disorder, self-harm, and interpersonal violence as 4th, 10th, 12th, 23th, 25th of diseases, respectively. In addition the trend of divorce and sexual dysfunction among Iranian spouses has been increasing during recent decades. Taken together, the weight of problems with social aspect in Iranian health system is dramatic. Iran Supreme-leader has recently alarm and concern at the impact of social problems and emergent need for governmental interventions. For this reason, policy-makers in different organizations such as Ministry of State, Ministry of Social Affairs and especially Ministry of Health (MOH) made several attempts to deal with the problems. 

Establishment of Social Health Unit in MOH, conducting the first round of “Iranians’ social health survey”, and implementing provincial community-based initiatives to reduce social problems were a number of good illustrations. Following the mentioned attempts, Social Health Unit of MOH decided to develop an evidence-based conceptual framework and indicators to monitor social functioning as a major aspect of social health in national and provincial level since there is no a consensus among sociologists and public health scientists on the concept of social functioning. Indeed, developed indicators would be a valuable instrument in hands of policymakers in different levels to make most effective and efficient attempts. Therefore, the aim of our study was to contribute to this growing area by exploring framework of social functioning, and develop and prioritize indicators through a consensus-building approach.  

Thursday, 15 February 2018

A New Mechanism of Cartilage Growth in mammals “Involvement of CD117 Positive Undifferentiated Cells in Interstitial Growth”

Two types of cartilages growth are commonly described; the appositional growth and interstitial growth. The manner of production of new cartilage matrix is different in both types. Appositional type relies on addition of peripheral matrix upon activation of the perichondrial stem cells and interstitial growth depends on secretion of new cartilage matrix by chondrocytes progeny. The current study described a different type of cartilage growth in different skeletal elements of camel embryos. Camel embryos were collected, fixed, dehydrated, and embedded in paraffin. Paraffin sections of the whole embryos were stained with H&E, Crossman trichrome and Mallory trichrome. Immunohistochemical staining for CD117 and type II collagen were used in embryonic cartilage. Other samples were processed to be examined by scanning electron microscopy. 

An Early Embryonic skeleton represented by cartilaginous elements. Undifferentiated cells continuing with the perichondrium penetrated the growing cartilage of ribs, pelvic bone, scapula, and sternum. The cells were CD117 positive and morphologically resembled the undifferentiated mesenchymal cells; they appeared spindle or flattened in shape with an oval nucleus and were connected by cytoplasmic processes. The orientation of the invaded cells could be as low or high cellular densities or as individual cells. The invaded mesenchymal cells transformed to chondrocytes and produce new cartilage matrix. They were immune-stained for Type II collagen The cellular penetration aimed to supply the developing cartilage by undifferentiated cells destined to become chondrocytes and involved in the interstitial growth of the fetal cartilage.

Cartilages growth occurs by secretion of new cartilage matrix. Appositional growth depends on activation of the perichondrial cells to secrete additional cartilage matrix encompassing the growing cartilage. Chondrocytes propagation and subsequent interstitial secretion of new cartilage matrix by chondrocyte progenies result in interstitial growth. Appositional growth commits growth of the cartilage width while the increase in cartilage length relies on interstitial growth. An Unusual mode of cartilage growth has been described in the cartilage of quail embryos and the air breathing organ of catfish in which the undifferentiated mesenchymal cells participate in the interstitial type of cartilage growth. The mesenchymal cells derived from the perichondrium invade the interior of the growing cartilage and transformed chondrocytes to secrete new cartilage matrix. In femur and tibia of quail embryos, the mesenchymal invasion is limited to the central hypertrophic zone to provide the cartilage templates by a large population of chondrogenic potential cells. In air-breathing organ of catfish, mesenchymal invasion occurs in multiple sites and involved in growth, renewal, and replacement of the existing cartilage. 

Wednesday, 14 February 2018

A Rare Tumor of Urinary Tract: Paraganglioma of Bladder

Paraganglioma is a rare tumor of the urinary bladder. The most affected organ is bladder in the urinary system. It accounts for about 0.5% of all bladder tumors. These tumors are mostly with benign but it would be malignant by 15-20%. Paraganglioma would be safely treated with surgical approach. In this study, we aimed to present a case of bladder paraganglioma that stone operation was planned but incidentally detected during percutaneous nephrolithotomy for renal stone.

A 57-year-old male patient was admitted to our clinic with left flank pain that was lasting for approximately 6 months. The biochemical analysis and urinalysis were normal. In the computerized tomography(CT) of the patient; there was 30 * 33 mm hemistaghorn stone in left kidney pelvis extending to the lower pole with a hyperdense appearance consistent with the stone enlarged in the middle and lower pelvis of the left kidney with 10mm diameter. There was mild dilatation in the upper urinary tract (Figure 1) Left percutaneous nephrolithotomy operation was planned for the patient Before the operation, cystoscopy was performed for the insertion of a ureteral catheter.

A 1.5cm-diameter solid lesion with a polypoid appearance was observed on the left ureteral orifice of the bladder and the lesion was resected. The percutaneous nephrolithotomy operation was postponed. The patient’s pathology was reported as paraganglioma. In addition, positive staining with S100 and negative staining with PanCK were detected (Figure 2). On the postoperative 2nd month, left percutaneous nephrolithotomy for left kidney stone was performed. A double J catheter was inserted. There were residual stones after operation and an additional operation was planned for residual stones.

Tuesday, 13 February 2018

Babies Face Higher SIDS Risk in Certain States


Sudden newborn child passing disorder (SIDS) kills approximately 3,500 infants in the United States every year, except its toll is far heavier in a few states than others, wellbeing authorities report. "Regardless of proceeded with updates and refinements to the American Academy of Pediatrics' protected rest suggestions, decreases in [SIDS] have impeded since 1999," said lead analyst Alexa Erck Lambert. "Our investigation likewise found that patterns in [SIDS] change by state," she included. "Albeit a few states have encountered outstanding decreases, wide varieties in [SIDS] rates by state still exist." 

Erck Lambert is with the maternal and newborn child wellbeing branch of the U.S. Habitats for Disease Control and Prevention's division of conceptive wellbeing. Despite the fact that the specialists couldn't clarify the patterns, one pediatrician proposed that shifting smoking rates, alongside racial and ethnic contrasts, might be at play. The best decreases in SIDS rates were found in California, Colorado, the District of Columbia, Florida, Kansas, Missouri, New York, Oregon, Washington and Wisconsin. 

Then again, the most noteworthy SIDS rates were found in Alaska, Arkansas, Alabama, Kentucky and Louisiana. Critical increments in SIDS cases were likewise found in these states between 2000-2002 and 2013-2015. As per Erck Lambert, newborn child passings dropped forcefully in the 1990s because of a battle got back to Sleep, which urges guardians to put their infants on their back to rest. In any case, since 1999 the drop in baby passings has essentially slowed down. The rate of SIDS cases dropped around 7 percent from 1999 to 2015. From 1990 to 1998, be that as it may, these passings fell about 45 percent, the investigation creators announced. The specialists can't state why there are state contrasts or why the quantity of SIDS cases has smoothed. "The purposes behind the patterns are outside the extent of this investigation and difficult to coax out from essential measurements information," Erck Lambert said. "Our objective was to light up the patterns and state variety."

Monday, 12 February 2018

Urology Education and Urology Practice: Trend Topics and the Needs

Urology education starts with medical faculty and it is a life-long education. The first rule to be a successful urologist is to like urology as a medical branch and to stay updated. Today urology education differs in European and Non-European countries as they have their own core education programmes. Education in European countries is almost similar as national societies prefer to use educational programme of European Board of Urology. Urology education must be standart in all countries because incidence and prevalance rates are similar for especially urooncologic diseases. Patients also deserve to have standart urological care. Unfortunately, after the urology education urologist do not have chance to have enough instruments and technologic devices in most of the hospitals to show their capabilities and their personal attributes. For this reason, quality of urological treatment and care decrease by time related with the personal motivation of urologists. In most of the European and Non-European countries, only university and research hospitals have standart devices to catch technologic standart care. For example, laparoscopic devices are missing in most of the peripheral hospitals and robot is only found in some big reference centers. This condition cause to be under the technologic and guideline standarts for the treatment of urologic diseases. 

Also in most of the countries, urologists pay less attention to some of the subbranches of urology and as a result there is lack of subspecialists in these subbranches such as pediatric urology, andrology and female urology. Diseases of these branches are unfortunately the ones that urologists ignore and avoid to have detailed knowledge. This negative condition causes the decrease in standart care of the diseases that these subbranches cover. There are official educational programmes or rotations in most of the countries related these subbranches and this must motivate junior urologists to have tendency to these branhes from the beginning. It is also important for senior urologists to motivate junior urologists for these branches. Trend topics of urology are always the urooncologic and endourologic diseases and interventions. Mainly most of the urologists likely to be involved in these subbranches to catch the trends and nearly all the urologists unfortunately define theirselves as endourologists even the ones that only perform cystoscopy. 

Technologic improvements for these branches are charming the urologists. Apart from these problems, urologists are lack of enough academic background because daily practice is taking most of the time and excessive work load causes tiredness. Most of the urologists are willing to deal with academic works but it is impossible for some reasons. This problem will lead bigger ones in the following time and there will not be enough academic urologists in the nearest future according to many studies. These basic problems must be solved as soon as possible at least the main ones. Urologists must have enough facilities, enough time to deal with academic work and enough time for theirselves. Solution of these main problems will also affect the quality of patient care and the mood of urologists. Better mood will result in better work and better careers.

Friday, 9 February 2018

A Complex Clinical Case with Retroperitoneal Fibrosis

Retroperitoneal fibrosis (RP) is an inflammatory tissue reaction characterized with fibrosis in the the retroperitoneum.There are different diagnostic radiologic studies used for the diagnosis of RP. The disease is also called ‘Ormond disease. In this study, we aimed to present the patient that was admitted to our clinic with bilateral hidronephrosis and diagnosed as retroperitoneal fibrosis, the surgical treatment of disease and persistent clinical situation.

54 year-old male patient admitted to emergency service with bilateral flank pain, nausea and vomiting. According to ultrasonography there was bilateral hydronephrosis. Creatine level increased and the patient was consulted to our clinic. Creatinine level was 6.2mg/dl and there was oliguria. Ultrasonography revealed right pelvicalyceal grade 3 hydronephrosis, and left pelvicalyceal grade 1 hydronephrosis. Computerised tomography was normal. Magnetic resonance revealed hypointense soft tissue formation compatible with retroperitoneal fibrosis that was in midline of abdomen and started form truncus choliacus and extended to iliac bifurcation level and through paraaortic and left pararenal space. Bilateral double J catheterization and steroid treatment was given.

In early postoperative period, creatinine level decreased to 2.1 mg/dl. In the following period, bilateral uretherolysis operation was performedin another clinic due to the increased creatinin levels and persistent bilateral hydronephrosis according to ultrasonography. On postoperative 6th month, patient admitted to our clinic again with bilateral flank pain and ultrasonography revealed right grade 3 hydronephrosis and left grade 1 hydronephrosis. After that we performed bilateral uretheral double J catheterization. But due to the persistent right hydronephrosis nephrostomy catheter was inserted On postoperative 3rd month Escherichia Coli was detected in urine culture and appropriate antibiotherapy was given. After treatment rightnephrostomy and left DJ catheter was removed and right metalic DJ catheterization was performed. On postoperative 3rd month creatinine level was 1.4 mg/dl. There wasn’t any urinary tract infection periodic dj catheter exchange operations planned for the patient. 

Thursday, 8 February 2018

Health Tip: Sleep Better


Poor rest expands your danger of medical issues, for example, cardiovascular illness, hypertension, diabetes, gloom and stoutness, the U.S. National Institute on Aging says. 

Poor rest additionally has been connected to memory issues and expanded danger of falls, the office includes. 

You should go for no less than seven hours of value rest every night. The establishment offers these recommendations for showing signs of improvement rest: 

Go to informal lodging up in the meantime every day, even on the ends of the week or while on an excursion. 

Abstain from utilizing PDAs, PCs and TVs in your room. 

Discover approaches to unwind before bed. 

Try not to eat enormous suppers, or drink caffeine or liquor late in the day. 

Exercise every day, except not just before sleep time. 

Maintain a strategic distance from rests of over 30 minutes.

Wednesday, 7 February 2018

Art of Salvaging: Bicuspidization and Bone Grafting with Platelet Rich Fibrin in Mandibular Left First Molar – A Case Report

The increased desire of patients to salvage and maintain their dentition has forced conservative and regenerative dentistry to conserve the teeth in the mouth which are planned to be removed. Thus periodontally compromised teeth with severe vertical bone loss and furcation invasion may well be retained of their roots. In this case report bicuspidization of the left first mandibular molar with bone graft and Platelet Rich Fibrin (PRF) membrane and subsequent prosthetic treatments are presented.

The treatment and management of mandibular molar teeth exhibiting furcation invasions (FI) may involve restorative dentistry, endodontics and periodontics, so that the teeth are retained in whole or in part. Such teeth can be useful as independent units of mastication or as abutments in simple fixed bridges. Thus tooth separation and resection procedures are used to preserve as much tooth structure as possible rather than sacrificing the whole tooth. The furcation defects vary from a subtle loss of attachment in the buccal furcation area, forming a shallow pocket, to advanced pathology with deep pockets > 10 mm, advanced bone loss and clinical exposure of the furcation. In the mandibular molars, grade III defects are managed by tunnelling procedures, hemisection and bicuspidisation along with open flap debridement. 

The ultimate goal of periodontal therapy is to regenerate the lost periodontal tissues caused by periodontitis. Various controlled clinical trials have demonstrated that some of the available grafting procedures may result in periodontal regeneration in intrabony defects, but complete and predictable reconstruction of periodontal tissues is still difficult to obtain. The reason is that periodontium, once damaged has a limited capacity for regeneration. The most positive outcome of periodontal regeneration procedures in intrabony defect has been achieved with a combination of bone graft and guided tissue regeneration REVIEW OF LITERATURE Bisection or bicuspidization is the separation of mesial and distal roots of mandibular molars along with their coronal portion, where both segments are then retained individually.

Endodontic therapy is performed initially, and during the open flap debridement procedure, the bicuspidization is done and the tooth is restored with a post-endodontic restoration, keeping in mind that the restoration allows for optimal plaque control in the space between the separated roots. A 31-year-old male presented with the complaint of pain of left mandibular first molar with slight mobility. On examination, the tooth was sensitive to percussion. On probing the area, there was a 9-mm-deep periodontal pocket around the mesial aspect of the furcation area. 

Tuesday, 6 February 2018

A Case of Adult Double-Chambered Right Ventricle Causing Severe Right Ventricular Outflow Tract Obstruction: A Perioperative Perspective


Double-chambered right ventricle (DCRV) is a rare, congenital heart disease often caused by anomalous muscle bands that can obstruct or even divide the right ventricle into high and low pressure chambers leading to progressive right ventricular outflow (RVOT) obstruction. It is seen in only 0.5-2% of all congenital heart diseases and associated with VSD in 75-90% of cases. DCRV is typically diagnosed and treated during childhood, with rare diagnoses made in adulthood. There does not appear to be a genetic component. It can be difficult to diagnose, especially in the adult patient, due to limitations in modern imaging of the right ventricle. We report a case of a 63-year-old female who returned to the United States for the first time since diagnosis of ventricular septal defect (VSD) at age three. Her symptoms of dyspnea on exertion and fatigue were attributed to right ventricular hypertrophy with obstruction. The patient was scheduled for VSD closure and myomectomy of RVOT utilizing cardiopulmonary bypass (CPB). 

The severe nature of her disease required careful planning of her perioperative management to maintain stable hemodynamics and prevent cardiovascular collapse. Intra-operatively the patient was found to have a myocardial morphology consistent with DCRV. Successful selection and timing of anesthetics, invasive monitoring, vasopressors, and inotropes facilitated an uneventful hospital course. Dis charge occurred on post-operative day four without adverse sequelae. While previous reports have focused on the surgical findings and procedures, very few case reports in the literature have concentrated on the anesthetic management of this complicated congenital condition. This is the only known case that did not require a significant fluid load following induction and initiation of positive pressure ventilation. With careful planning it was even possible to remove autologous blood to minimize transfusion requirements. This report will aid the perioperative team in recognition of characteristic findings in DCRV and offer insight into perioperative management. 

The patient is a 63-year-old female with a known history of uncorrected, congenital VSD who returned to the United States for evaluation of increasing shortness of breath during light activity. Her parents, both missionaries in Tanzania, brought the patient to the U.S. at age three for evaluation of a mur-mur noted at birth. At the time, it was deemed unnecessary to intervene, and the patient experienced a largely unrestricted life in Africa completing missionary work herself. Over the last few years the patient noted a few episodes of atypical non-exertional chest pain as well as progressive exertional dyspnea. The patient’s medical history included only known congenital VSD and right ventricular hypertrophy. She had not undergone prior surgeries. She did not use tobacco, alcohol or illicit drugs and her family history includes heart failure and stroke. The patient underwent extensive cardiac evaluation upon returning to the United States including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), cardiac magnetic resonance imaging (MRI), right and left heart catheterization with ventriculography, as well as electrocardiogram (ECG). The patient was noted to have severe narrowing of the RVOT (Figure 1) with severely increased velocity of 5.45 m/sec and severe pressure gradient of 119 mm Hg across the tract.

Monday, 5 February 2018

How to Protect Against Heart Disease


Coronary illness is a main source of death in the United States, yet there are various things you can do to ensure yourself, a cardiologist says. "Coronary illness slaughters countless Americans every year, except a significant number of these conditions are preventable," said specialist Dr. David Slotwiner, head of the division of cardiology at NewYork-Presbyterian Queens. "Exercise, an adjusted eating regimen and maintaining a strategic distance from high-hazard exercises like smoking are a portion of the most ideal approaches to keep your heart sound," he said in a healing facility news discharge. 

Slotwiner's cardiology group offered the accompanying tips on anticipating coronary illness, for February, which is Heart Health Month. Eat a lot of entire, plant-based sustenances, for example, natural products, vegetables, nuts and seeds. Cut down on refined or prepared sustenances, for example, white bread, wafers and treats, and also sugary refreshments, for example, pop and natural product juice. Stay away from trans fats, which are found in bundled heated merchandise, nibble nourishments, margarine and singed quick sustenances. Trans fats can expand your danger of coronary illness or stroke. 

Try not to smoke. Presentation to tobacco smoke adds to around 34,000 untimely coronary illness passings a year, as per the American Heart Association. Get enough rest - seven to eight hours every night. On the off chance that you have rest apnea, get it treated. The condition is connected to heart musicality issues and coronary illness. Have your circulatory strain checked each time you get a physical. Get general exercise (no less than 30 minutes every day, five days seven days) and control your worry through solid techniques, for example, contemplation, yoga, exercise or investing energy with loved ones. Deal with your teeth and gums. Individuals with gum infection frequently have a similar hazard factors for coronary illness.

Friday, 2 February 2018

Abolition of Ventricular Tachycardia by Revascularization: When Blood Flow is All You Need to Terminate a Recurrent Ischemic Ventricular Arrhythmia


Active vascular events such as spasm, plaque rupture or thrombosis in the setting of acute coronary syndromes precipitate fatal arrhythmias due to acute ischemia. Lethal ventricular tachycardia (VT) in the setting of ischemic heart disease (IHD) results either from acute ischemia or from chronic scar. Ischemia produces several intra, and extra-cellular changes in ionic concentration and acid-base balance. In this context, the surviving Purkinje fibers exhibit several electrophysiological changes, namely, abbreviated action potentials of reduced amplitude, and depolarized membrane potentials, and reduced conduction velocity. These biochemical and electrophysiological disturbances act in accordance with a number of probable genetic predispositions. 

The resultant ischemia-induced VT may be suppressed by revascularization of the occluded vessel ameliorating the ischemic tissue. Sustained VT in the peri-infarction period may develop due to transient arrhythmogenic phenomena in ischemic and infarcting tissue such as the following: abnormal automaticity, triggered activity, and re-entrant circuits created by heterogeneous conduction and repolarization. Combining different diagnostic techniques, a relation between myocardial ischemia and induction of ventricular arrhythmias can be demonstrated in patients with IHD. Coronary revascularization must be the main goal and may constitute definitive therapy in certain patients with ischemic ventricular arrhythmias. This pure anti-ischemic therapeutic strategy seems to be justified in certain cases of patients with preserved left ventricular function, demonstrable reversible ischemia and non-inducible VT pre and post revascularization. In all other instances an additional treatment with antiarrhythmic drugs and an implantable cardioverter defibrillator is paramount.

Ischemic heart disease (IHD) is the most common cause of sudden cardiac death (SCD) resulting from fatal ventricular arrhythmias, and some of these events occur in persons without any history of cardiac disease. Sustained ventricular tachycardia (VT) and, in particular, ventricular fibrillation (VF), are the immediate causes of cardiac arrest in the majority of the estimated 350,000 cases of SCD that occur annually in the USA. A major cause of SCD is acute myocardial infarction (AMI). Cardiac arrest secondary to AMI induced-VF occurs commonly without warning. Because spontaneous conversion of VF to non-lethal rhythms is rare, out-of hospital VF progresses to death within minutes in more than 95% of the victims. AMI induced-VF leads to SCD as the first manifestation of a preexisting coronary artery disease in about 80,000 people per year. Polymorphic VT in patients with a normal QT interval during sinus rhythm is most frequently seen in the context of acute ischemia. In addition, it may be also seen with other cardiac diseases such as cardiomyopathy, heart failure, and even in the absence of overt cardiac disease, namely, idiopathic polymorphic VT, catecholaminergic VT. Since the electrophysiological changes and ventricular arrhythmias induced by ischemia could be transient and temporary if the ischemic episode subsides, the suppression of ventricular arrhythmias and the ischemia-induced electrophysiological changes by coronary revascularization is the focus of this manuscript.  

Thursday, 1 February 2018

VA Health System Failing on Mental Health Care: Report


Numerous U.S. veterans of the Afghanistan and Iraq wars aren't getting required emotional well-being treatment for conditions, for example, post-awful pressure issue, sorrow or Substance manhandle, a national board of specialists says. Female vets might be at exceptional danger of passing up a major opportunity for administrations, the report found. The overview found that about portion of all veterans of the Iraq/Afghanistan clashes who may require emotional wellness mind don't utilize U.S. Bureau of Veterans Affairs (VA) or non-VA administrations, as per another report from the National Academies of Sciences, Engineering, and Medicine. 

The congressionally commanded report refers to two essential purposes behind this hole: The VA does not have adequate assets, or veterans don't know how to get to VA emotional wellness mind. "The VA needs to make astounding psychological wellness mind reliably and typically accessible at each office for all veterans," said report board of trustees seat Alicia Carriquiry in a National Academies news discharge. The board prescribed that the VA plan to end up "a solid supplier of astounding emotional wellness mind administrations" inside three to five years. The uplifting news: The VA gives emotional well-being care that is similar or superior to anything care offered by private and non-VA open suppliers, as indicated by the report. Be that as it may, it additionally says there is critical variety in openness and nature of administrations over the VA wellbeing framework. 

That leaves a considerable lot of the 4 million U.S. benefit individuals who've been in Afghanistan or Iraq without required psychological well-being administrations. The study likewise found that the greater part of veterans who screened positive for a psychological well-being issue did not trust they required emotional well-being treatment. For the individuals who could utilize VA emotional well-being care yet haven't looked for it, the report refers to absence of mindfulness as a key reason: They don't know how to apply for VA psychological well-being care benefits; they are uncertain whether they are qualified; or they are uninformed that VA offers these advantages. Contrasted with men, ladies veterans are considerably more prone to trust they are not qualified for VA psychological well-being administrations, as indicated by the report.