Direct bladder hernia after indirect hernia repair in extremely low birth weight babies: two case reports and a review of the literature

BACKGROUND

Inguinal hernia repair is the most common surgical procedure in babies. Despite a meticulous technique, relapses may occur. The occurrence of a direct bladder wall hernia in relapses has never before been reported in the literature.

CASE PRESENTATION

Here, we report two cases of direct bladder herniation: a white baby boy born after 25 weeks of gestation and a white baby boy born after 26 weeks of gestation. Both of the formerly extremely low birth weight babies were affected after open bilateral hernia repair. Recurrent hernias developed on the right side, and direct bladder herniation was identified intraoperatively. In one case, laparoscopy was applied to identify a supravesical type of hernia. Immaturity and a difficult postnatal course might have contributed to hernia relapse in these cases.

CONCLUSIONS

Misinterpretation of bladder herniation might have disastrous consequences. Laparoscopy is a helpful tool in comparable cases.

The effect of autonomic nervous system dysfunction on oxygen consumption during daily living activities in patients with spinal cord injury

STUDY DESIGN

Case-control study.

OBJECTIVES

To investigate the level of autonomic nervous system dysfunction in patients with spinal cord injury and to determine its effect on the basal metabolic rate and oxygen consumption during daily living activities.

SETTING

Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.

METHODS

Thirty-six patients with chronic spinal cord injury (SCI) were allocated into two groups according to the presence of autonomic nervous system dysfunction. Autonomic nervous system dysfunction was investigated with the measurements of blood pressure and heart rate during urodynamic examination and several provocative maneuvers (standing at tilt table, forcing deep respiration and Valsalva). Groups were compared in terms of the basal metabolic rate and oxygen consumption during daily living activities. Measurement of the basal metabolic rate was determined by indirect calorimetry under standardized conditions. Total body fat mass and lean tissue mass were measured in all participants using dual-energy X-ray absorptiometry by standard methods. Telemetric intrapulmonary gas exchange analyzer was used to measure oxygen consumption during daily living activities.

RESULTS

There was no statistically significant difference between the groups in age, time since injury, body mass lean and fat rates, or sensory and motor scores (P>0.05). Basal metabolic rates and oxygen consumption during daily living activities were not different between the groups (P>0.05).

CONCLUSIONS

These results suggest that the presence of autonomic dysfunction does not change oxygen consumption at rest and during daily living activities.

Polymorphisms in the IL28B gene (rs12979860, rs8099917) and the virological response to pegylated interferon therapy in hepatitis D virus patients

AIM

Few data are available regarding the effects of interleukin 28B (IL28B) polymorphisms in chronic hepatitis D (CHD) patients. This study investigated the relationship between IL28B poly-morphisms and the response of patients with CHD infections to pegylated interferon (PEG-IFN) therapy.

MATERIALS AND METHODS

A total of 101 CHD patients were -selected, 80 of whom (46 males ; median age 41 years) satisfied the inclusion criteria and were enrolled in the study. Thirty-seven patients were treated with peg-IFNα for at least 12 months and were followed for a median of 18 months (range, 12-30 months). The primary treatment endpoint was the suppression of HDV replication, as documented by the loss of detectable HDV RNA in serum. Genotyping was used to analyse the IL28B polymorphisms rs12979860 and rs8099917 according to the virological response.

RESULTS

After treatment, a sustained viral response (SVR) was achieved in 19 (51%) of the patients treated with PEG-INF. The IL28B genotypes in the 80 patients were as follows : CC in 36 (45%), CT in 33 (41%) and TT in 11 (14%) for rs12979860, and GG in 4 (5%), GT in 27 (34%) and TT in 49 (61%) for rs8099917. SVR was achieved in 5 (26%), 10 (53%) and 4 (21%) patients with CC, CT and TT at rs12979860, respectively, and one (5%), nine (47%) and nine (47%) patients with GG, GT and TT at rs8099917, respectively. There were differences in the SVR among genotypes (rs12979860 and rs8099917 ; chi-squared test, p = 0.047).

CONCLUSION

IL28B predicts the PEG-IFN response in patients with CHD infection.

The effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in the first SCID-mouse endometriosis-model developed in Turkey

OBJECTIVE

To evaluate the effects of melatonin on endometriotic lesions induced by implanting human endometriotic cells in SCID mice.

MATERIALS AND METHODS

Prospective, randomized, controlled, experimental study. Experimental Research Center of Yeditepe University (YUDETAM). Thirty female, non-pregnant, nulligravid severe combined immunodeficient (SCID) mice. Endometriotic cells collected from patients with endometriosis were implanted subcutaneously in 30 SCID mice. These mice were randomized into two study groups: in the first group, mice were administered melatonin (20 mg/kg/day) following induction of endometriosis for four weeks; in the second group, nothing was administered. All the mice were given a high dose of exogenous estradiol (50 µg/kg/d, twice weekly). Four weeks after inoculation, necropsies were performed and endometriotic lesions were collected. All the lesions were evaluated histopathologically and the levels of SOD and MDA were assessed in the lesions.

RESULTS

Successful implantation was observed in the 28 mice that survived. Mean MDA level was 5.0 ± 1.7 and 8.8 ± 2.6 in the melatonin and control groups, respectively (p = 0.01); mean SOD level was 1.1 ± 0.1 and 1.0 ± 0.1 in the melatonin and control groups, respectively (p = 0.49). Mean histopathological score was lower in the melatonin group (p = 0.04).

CONCLUSIONS

Melatonin was effective in the treatment of experimental endometriosis induced in SCID mice.

Effects of caffeic acid phenethyl ester on cisplatin ototoxicity

PURPOSE

To report histological and electrophysiological data in rats treated with cisplatin and caffeic acid phenethyl ester.

METHODS

We randomly divided 28 Wistar rats into four groups of seven, to be treated as follows: control (saline), cisplatin, CAPE and cisplatin-CAPE. Distortion product otoacoustic emission (DPOAE) measurements were performed on day one (before drug administration) and day five under anaesthesia. All animals were killed under general anaesthesia on day five after the DPOAE measurement. The cochleae of each rat were histopathologically and immunohistochemically evaluated.

RESULTS

The outer hair cells were mostly preserved in the control and CAPE groups. Moderate-to-severe and mild-to-moderate hair cell losses were detected in the cisplatin and cisplatin-CAPE groups, respectively. DPOAE assessments revealed significant deterioration in the cisplatin group (P < 0.05). The difference between the cisplatin and cisplatin-CAPE groups was statistically significant (P < 0.05).

CONCLUSION

CAPE prevents cisplatin ototoxicity.

Chronic hepatitis B associated with hepatic steatosis, insulin resistance, necroinflammation and fibrosis

BACKGROUND

The effect of hepatitis B virus (HBV) infection on fatty liver disease is unclear.

OBJECTIVES

The aim of this study was to investigate the viral and host causes of fatty liver in chronic hepatitis B (CHB) patients. This study included 88 CHB patients of which 17 were not treated. Liver biopsy was performed in each patient. Group 1 included those with hepatic steatosis (n=28) and group 2 those without hepatic steatosis. The groups were compared in terms of age, body mass index (BMI), Homeostasis Model Assessment- Insulin Resistance (HOMA-IR), viral load, biochemical parameters and histological findings. Patients in group 1 were subdivided according to the degree of steatosis as follows: grade 1 (15 patients, 53.6%), grade 2 (6 patients, 21.4%), and grade 3 (7 patients, 25%).

RESULTS

In group 1 (n=28), mean age, BMI, cholesterol, and HOMA-IR were found to be significantly higher than in group 2 (n=60). There were no significant differences in the positivity of viral load, HbeAg, treatment, fibrosis and other laboratory parameters between the two groups. HOMA-IR was the only independent predictive factor of liver steatosis in patients with CHB in logistic regression analysis.

CONCLUSION

Hepatic steatosis in CHB patients was associated with host metabolic factors.

Serum levels of nitrate, nitrite and advanced oxidation protein products (AOPP) in patients with nonalcoholic fatty liver disease

BACKGROUND

Oxidative stress is increased and anti-oxidant defense mechanisms are impaired in patients with hepatosteatosis. The aim of the present study was to evaluate the serum levels of several oxidant and anti-oxidant markers in patients with nonalcoholic fatty liver disease (NAFLD).

PATIENTS AND METHODS

Thirty-four patients with NAFLD, and 19 healthy controls were included. In this study, we measured serum nitrate and advanced oxidation protein product (AOPP) as the oxidizing products and nitrite as the anti-oxidizing marker. Nitrate and nitrite levels were measured using a calorimetric method, and levels of serum AOPP were measured by a spectrophotometric method using a commercial ELISA kit.

RESULTS

Serum nitrate and AOPP levels were significantly higher in the NAFLD group compared to the control group. Serum nitrite and N-N levels were similar between the two groups. Serum nitrate and N-N levels were found to be significantly higher in patients with elevated ALT levels compared to patients with normal ALT levels. Serum nitrite and AOPP levels were comparable between these groups. Mean platelet volume (MPV) was significantly lower in the NAFLD group compared to the control group.

CONCLUSIONS

Serum levels of oxidizing agents including nitrate and AOPP increase in patients with NAFLD. In contrast, serum nitrite, an antioxidant agent, does not adequately increase to compensate for the oxidizing effects in these patients.

Evaluation of cognitive functions in gestational diabetes mellitus

OBJECTIVE

To evaluate the association between cognitive functions and metabolic status in cases with gestational diabetes mellitus (GDM).

METHODS

In this study 44 patients with GDM and 45 normal pregnant were included. Depression was evaluated with Beck's depression inventory (BDI). Cognitive functions were evaluated with Montreal cognitive assessment (MOCA), paced auditory serial addition test (PASAT), spatial recall test (SRT), symbol digit modalities (SDMT), and word list generation (WLG).

RESULTS

The mean gestational age, educational level and account of previous birth of the subjects in the study were not statistically different between the groups. The mean scores of BDI of the 2 groups were not statistically different. MOCA score and SDMT was significantly decreased in GDM in comparison to NP (p=0.005, p=0.04 respectively). Also, SDMT score was inversely correlated with number of pregnancies, postprandial blood glucose and HbA1c.The scores of PASAT, SRT, SPART and WLG were statistically similar between the groups.

CONCLUSIONS

Our findings may be a clue for early onset of impairment in cognitive functions in cases with new onset diabetes during pregnancy.

Bardet-Biedl syndrome with vulva carcinoma presented with acute renal failure: a case report

BACKGROUND

Bardet-Biedl syndrome is a rare disorder characterized by retinal dystrophy, obesity, kidney dysfunction, polydactyly, hypogonadism and cognitive impairment. It can be accompanied by systemic findings such as malignancy, hypertension, diabetes mellitus, constitutional and functional disorders of urogenital system and liver fibrosis.

CASE REPORT

A 35-year-old woman with Bardet-Biedl syndrome was referred to our outpatient nephrology clinic with dysuria, acute renal failure, and urinary tract infection. A sized 2 x 1 cm mass between labia major and minor was noted, while CT scan showed a lesion that encompassed uterus and extended to the posterior side of the bladder in the left adnexal region and a 3 cm lesion in the liver. Excisional biopsy of the mass revealed a well-differentiated, squamous cell carcinoma. Dysuria resolved with insertion of urinary catheter after bougie dilatation and the patient was referred for radiotherapy.

CONCLUSION

It should be kept in the mind that renal failure may develop due to constitutional urogenital anomalies such as vulva carcinoma. This can be an important cause of morbidity and mortality in patients with Bardet-Biedl syndrome.Hippokratia 2015; 19 (2):176-178.

Association of antepartum vitamin D levels with postpartum pelvic floor muscle strength and symptoms

INTRODUCTION AND HYPOTHESIS

Vitamin D affects skeletal muscle strength and functions via various mechanisms. Strength and/or functional dysfunctions of the pelvic floor muscles may be associated with the distortion of pelvic floor functions. We hypothesized that vitamin D deficiency may contribute to pelvic floor dysfunction (PFD) by affecting pelvic floor muscle strength (PFMS). The aim of this study was to assess the effect of vitamin D deficiency during pregnancy on postpartum PFMS.

METHODS

This cross-sectional study was conducted in a university hospital. One hundred and eighty pregnant women were admitted to our hospital in their third trimester and compared with 156 healthy nulliparous women. Venous blood samples for examining vitamin D levels were taken from each participant and stored at -80 °C. At 8-10 weeks postpartum, patients were invited to the hospital, asked about their PFD symptoms, and PFMS was measured using a perineometer.

RESULTS

There was no statistical significance among groups regarding mean age, maternal age, and weight at delivery. Postpartum PFMS and duration in vitamin D-deficient women were significantly lower than those without the deficiency. Vitamin D-deficient vaginal delivery cases (group I) had a postpartum PFMS average of 21.96 ± 7.91 cm-H₂O, nonvitamin D-deficient normal delivery cases (group III) had a PFMS of 29.66 ± 10.3 cm-H₂O (p = 0.001). In the cesarean delivery groups, vitamin D-deficient (group II) and nonvitamin D-deficient (group IV) cases had PFMS values of 32.23 ± 9.66 and 35.53 ± 15.58 cm-H₂O respectively (p = 0.258).

CONCLUSIONS

Lower vitamin D levels in the third trimester correlates with decreased PFMS.

Impact of allyl disulfide on oxidative damage and liver regeneration in an experimental hepatectomy model

BACKGROUND

We investigated the effects of allyl disulfide (agarlic extract) on tissue damage, regeneration, proliferation and oxidative damage in an experimental liver resection model.

MATERIALS AND METHODS

In the study, 24 female Wistar albinorats weighing approximately 200-250 g were used. Group 1:The rats in the experimental group all received a 70%hepatectomy and were fed an Allyl disulfide (30 μg kg day,Allyl disulfide, Sigma-Aldrich, formula: C6H10S2, CASNumber: 2179-57-9, formula weight: 146.27 g mol) in supplement to a regular diet for 1 week both preoperatively and postoperatively. Group 2: The rats in the control group also underwent a 70% hepatectomy and were given regular food and water for 1 week both preop and postop. Group 3: In the sham group, all rats were sacrificed 7 days after surgery. Forbiochemical evaluation, SGOT, SGPT, bilirubin, CRP and MDA were studied. In a histopathological examination, the fattening of the liver tissue, existence of (macro-micro vesicular),fibrosis, pleomorphism at hepatocyte nuclei, portal inflammation, existence of intralobular inflammatory cells,dilation at sinusoids, congestion, congestion at the central vein, regeneration, existence of Kupffer cells in the sinu soidallumen and ki-67 proliferation index at hepatocytes were examined.

RESULTS

A significant difference between group 1 and group2 was observed regarding the existence of regeneration,(p:0.06), the occurrence of nuclear pleomorphisms (p:0,001)and the fibroblast activity status (p:0.001). Significant differences were found between the experimental groups in regard to Kupffer cell increase and dilation and the hyperemiastatus in the sinusoid lumens (p:0.013 and p:0.001,respectively). In the Allyl disulfide group, the proliferation index was significantly higher than that of the other groups(p:0,001), while the average plasma MDA value was lower than that of the other groups (p: 0,042). No significant differences were found among the groups with respect to tissue MDA values (p:0,720). No significant difference was found for SGPT (ALT) and SGOT (AST) levels between Group 1 and the other groups (p:0.247 and p:0.539, respectively).The average total bilirubin (T. Bili) values were 0,12,0,08 and 0,04 in the allyl disulfide group, control group andSham group, respectively. This difference among the groups is statistically significant (p:0.001). The average direct bilirubin (D. Bili) values were 0,06, 0,02 and 0,02 in the allyl disulfide group, control group and Sham group, respectively.This variation among the groups is also statistically significant (0.001).

CONCLUSION

We observed that the use of Allyl disulfide supplementation after major hepatectomy has a positive impact on liver regeneration, proliferation and oxidative damage.

ABBREVIATIONS

Postop: post-operative, Preop: pre-operative,SGOT(AST): serum glutamic oxaloacetic transaminase,SGPT(ALT): serum glutamate-pyruvate transaminase, CRP:C- Reactive protein, MDA: Malondialdehyde, DAS: Garlicextract diallyl sulfide, AGE: aged garlic extract.

Determining the localization of premolar zenith positions according to the gingival line

BACKGROUND

The gingival zenith (GZ) positions according to a reference line in the premolar (PM) area remain concern, especially for the clinicians in placing the gingival contours during surgery.

OBJECTIVES

The objectives of this study are to determine the maxillary PM GZ positions according to GZ line (GZL).

MATERIALS AND METHODS

A sample population of 63 patients with healthy gingival tissue was studied. The GZ was determined at the most apical point of the gingival marginal scallop. A horizontal-zenith line (ZL) was drawn connecting the GZ from the ipsilateral canine (C) and central incisor teeth. Reference lines were drawn, and bilateral measurements were taken in the respective stone casts in the PM area.

RESULTS

No statistically significant differences were found between bilateral first premolars (FPM) and second premolars (SPM). When considering ipsilateral FPM and SPM, statistically significant differences were found between them. For all PM teeth, the mean distance value of GZ to GZL was approximately 1.32 mm.

CONCLUSIONS

The present study results showed that GZs of FPM and SPM teeth for both left and right sight was coronally located according to ZL.

Changing the bonding force of impression tray to edentulous maxillary jaw simulator with impression valve system: in vitro study

OBJECTIVE

The aim of this study was to evaluate the effect of an impression valve system (IVS) on the bonding force between an impression tray and an edentulous maxillary jaw.

MATERIALS AND METHODS

In this in vitro study, a polyether-coated maxillary jaw simulator (PM) was used to model an edentulous maxillary jaw. The IVS was placed into individual impression trays. An irreversible hydrocolloid impression was taken of the PM when the IVS was open and closed. The impression tray bonding force was measured using a digital dynamometer. Student's t-test was used to determine the significance of the difference between these two groups.

RESULTS

The impression tray was more easily separated from the PM when the IVS was open (108 ± 3.9 N). The separation was more difficult when the IVS was closed (153.7 ± 14.2 N). The difference between these two findings (P = 0.000) was significant.

CONCLUSION

The use of an IVS facilitates the removal of the impression tray from the mouth when taking impressions from an edentulous maxillary jaw.

Anodic oxidation of etodolac and its linear sweep, square wave and differential pulse voltammetric determination in pharmaceuticals

In this study, simple, fast and reliable cyclic voltammetry, linear sweep voltammetry, square wave voltammetry and differential pulse voltammetry methods were developed and validated for determination of etodolac in pharmaceutical preparations. The proposed methods were based on electrochemical oxidation of etodolac at platinum electrode in acetonitrile solution containing 0.1 M lithium perchlorate. The well-defined oxidation peak was observed at 1.03 V. The calibration curves were linear for etodolac at the concentration range of 2.5-50 μg/ml for linear sweep, square wave and differential pulse voltammetry methods, respectively. Intra- and inter-day precision values for etodolac were less than 4.69, and accuracy (relative error) was better than 2.00%. The mean recovery of etodolac was 100.6% for pharmaceutical preparations. No interference was found from three tablet excipients at the selected assay conditions. Developed methods in this study are accurate, precise and can be easily applied to Etol, Tadolak and Etodin tablets as pharmaceutical preparation.