The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

INTRODUCTION

Acute mesenteric ischemia (AMI) is an abdominal-vascular emergency which is rare and has high mortality rates (60-80 %) due to late diagnosis (1-3). Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1).

MATERIALS AND METHODS

In this study, we used male Wistar-Albino rats weighing 250-300 grams obtained from Pamukkale University Experimental Research Laboratory. Animals were exposed to light-dark cycles for 12 hours and had free access to food and water. They were kept in cages for 7 days to stabilise their intestinal flora. In animals of group I, nothing was made other than taking 0.5 ml blood intracardially. In other animals, abdomen was reached with midline laparotomy and superior mesenteric artery (SMA) was located. In group II (operative control group), SMA was isolated and manipulated but was not ligated. In Group III (intestinal ischemia group), SMAwas isolated and ligated with 3/0 silk tie distally to the aorta. After this process, intestinal ischemia was achieved which was confirmed by paleness and pulselessness of intestines, caecum and right colon. Later on, abdomen was closed with double 3/0 polyglactin sutures. At postoperative 1st, 4th and 6th hours 0.5 ml blood was taken intracardially from the animals in groups II and III in order to quantify D-dimer and L-lactate levels.

LABORATORY TESTS

D-dimer: Blood samples which were put into tubes containing sodium citrate, were seperated from plasma with centrifugation at 4000 rpm for 7 minutes.L-lactate: Blood L-lactate levels were determined from blood taken into capillary tubes with the help of immobilised enzyme electrode technology using YSI 1500 Sport portative lactate analyzer (Yellow Springs Instruments Inc., Ohio-USA).

HISTOPATHOLOGIC VERIFICATION

Two cm long intestinal samples were taken from animals in which SMA was ligated in order to achieve mesenteric ischemia and these samples were fixed in 10 % formol.

DISCUSSION

As a result, in rats with SMA occlusion serum D-dimer levels were not increased significantly when compared either in the group or with the basal values of the control group and values in operative control group. Therefore, it is concluded that D-dimer is not a useful marker for early diagnosis of AMI. On the other hand, it is revealed that blood L-lactate levels began to increase significantly following 4th hour of mesenteric ischemia and it is shown that this increase continued at the 6th hour. In addition, considering the utmost importance of the early diagnosis in patients with the clinical suspicion of AMI, L-lactate seems to be a suitable marker to use in emergency departments because it is achieved with a portable device that gives fast and accurate results. Nevertheless, our results are need to be supported by clinical studies with larger patient series (Tab. 2, Fig. 11, Ref. 39).

Circumferential Fence With the Use of Polyethylene Terephthalate (Dacron) Vascular Graft for All-in-One Hepatic Venous Reconstruction in Right-Lobe Living-Donor Liver Transplantation

Integration of hepatic vein tributaries with a diameter ≥ 5 mm into the drainage system in right-lobe living-donor liver transplantation (LDLT) is of vital importance for graft function. Recently, the most commonly emphasized hepatic venous reconstruction model is the all-in-one reconstruction model. In the final stage of this model that aims to form a common large opening, allogeneic vascular grafts are almost always used to construct a circumferential fence. To date, no other study has reported the use of polyethylene terephthalate (Dacron) vascular graft as a circumferential fence in LDLT. We aimed to present the 1st 4 cases of circumferential fences created with Dacron vascular graft. Four right-lobe grafts weighing 522-1,040 g were used. A polytetrafluoroethylene vascular graft was used for the integration of segment 5 vein and segment 8 vein into the drainage model, whereas a Dacron graft was used to creating a circumferential fence. The patency of hepatic outflow evaluated with the use of multidetector computerized tomography at postoperative day 7. Venous outflow obstruction was not detected in any cases. This study suggested that owing to its flexible structure the polyethylene terephthalate vascular graft can be an alternative to allogeneic vascular grafts in forming circumferential fence.

Histopathologic Findings of Cholecystectomy Specimens in Patients Who Underwent Donor Hepatectomy for Living Donor Liver Transplantation

BACKGROUND

The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors.

METHODS

The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers.

RESULTS

A total of 1009 donors aged 17 to 66 years (31.1 ± 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 ± 9.1 years [16-63 years]) and 422 were female (31.8 ± 9.8 years [18-66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other donors' biochemical tests were within normal ranges. The macroscopic examination of gallbladders revealed mean gallbladder wall thickness, length, and width of 1.82 ± 0.8 mm (1-10 mm), 72 ± 11.4 mm (40-120 mm), and 52.5 ± 14 mm (15-90 mm), respectively. The microscopic gallbladder examination showed that 740 donors had a normal gallbladder, 193 had chronic cholecystitis (1 donor had antral metaplasia and 1 had intestinal metaplasia), 40 had cholesterolosis (1 donor had both tubular adenoma and intestinal metaplasia), 15 had minimal chronic cholecystitis (1 donor had pyloric metaplasia), 14 had cholelithiasis, 2 had adenomyosis, 2 had muscular hypertrophy, 1 had papillary hyperplasia, 1 had microdiverticulitis, and 1 had mucosal lymphatic ectasia.

CONCLUSION

The results of this study reflect the actual gallbladder pathologies that can be detected in healthy people. Clearer conclusions can be reached about the epidemiological data on gallbladder as the number of living liver donors increases in the future.

Postoperative Pulmonary Complications After Liver Transplantation: Assessment of Risk Factors for Mortality

BACKGROUND

The aim of this study was to identify the risk factors related to mortality in liver transplant (LT) patients with post-transplantation pulmonary complications.

METHOD

Patients who underwent liver transplantation in our clinic between January 2010 and January 2012 were retrospectively reviewed for post-transplantation pulmonary complications. Demographic, clinical, radiologic, and postoperative chart data of 153 patients with pulmonary complications were analyzed using an independent samples Student t test, Pearson's χ(2) test, Fisher's exact test, and Yate's corrected χ(2) test. Mortality was analyzed using a multiple logistic regression model. The best-fit breakpoint resulting in a cut-off value for the variables of interest was determined using ROC curves and the Youden index.

RESULTS

The 153 patients with pulmonary complication were divided into 2 groups: mortality (n = 53) and survival (n = 100). Univariate analyses showed significant differences between these 2 groups with respect to MELD score (P = .035), duration of mechanical ventilation (P > .001), pneumonia (P = .01), and endotracheal culture results (P = .001). In the multivariate analysis, hemoglobin (P = .03, odds ratio [OR]: 1.239), MELD score (P = .027, OR: 1.064), duration of mechanical ventilation (P = .003, OR: 1.091), and age (P = .042, OR: 1.001) were significant risk factors for mortality. The best-fit breakpoint analysis yielded cut-off values for hemoglobin (>11.2, sensitivity: 50.9%, specificity: 70%), MELD score (>16, sensitivity: 73.6%, specificity: 42%) and duration of mechanical ventilation (>3, sensitivity: 62.3%, specificity: 76%).

CONCLUSION

Advanced age, high hemoglobin level, high MELD score, and long-term mechanical ventilation are significant risk factors for mortality in liver transplant patients with postoperative pulmonary complications.

Diabetes-resistant NOR mice are more severely affected by streptozotocin compared to the diabetes-prone NOD mice: correlations with liver and kidney GLUT2 expressions

Nonobese diabetic (NOD) mice are susceptible strains for Type 1 diabetes development, and Nonobese Diabetes-Resistant (NOR) mice are defined as suitable controls for NOD mice in non-MHC-related research. Diabetes is often accelerated in NOD mice via Streptozotocin (STZ). STZ is taken inside cells via GLUT2 transmembrane carrier proteins, the major glucose transporter isoforms in pancreatic beta cells, liver, kidneys, and the small intestine. We observed severe adverse effects in NOR mice treated with STZ compared to NOD mice that were made diabetic with a similar dose. We suggested that the underlying mechanism could be differential GLUT2 expressions in pancreatic beta cells, yet immunofluorescent and immunohistochemical studies revealed similar GLUT2 expression levels. We also detected GLUT2 expression profiles in NOD and NOR hepatic and renal tissues by western blot analysis and observed considerably higher GLUT2 expression levels in liver and kidney tissues of NOR mice. Although beta cell GLUT2 expression levels are frequently evaluated as a marker predicting STZ sensitivity in animal models, we report here very different diabetic responses to STZ in two different animal strains, in spite of similar initial GLUT2 expressions in beta cells. Furthermore, use of NOR mice in STZ-mediated experimental diabetes settings should be considered accordingly.

In vitro motility changes in Roux limb after Roux-en-Y reconstruction

BACKGROUND

The aim of this study is to compare the motility of Roux limb with that of normal segment.

MATERIALS AND METHODS

Rats were divided into 3 equal groups as control, Roux-en-Y (Group A) and Roux-en-Y with vagotomy (Group B). Only midline incision and manipulations were applied in control group. Following distal gastrectomy, Roux-en-Y reconstruction was applied in Group A, while vagotomy Roux-en-Y gastrojejunostomy was applied in Group B. Rats were sacrificed 1 month later by cervical dislocations under anesthesia. The obtained jejunal segments were cut into four equal parts. The bath was 37 °C warm while 95 % O2 and 5 % CO2 gases were supplied in 10 ml bicarbonate Krebs' solution.

RESULTS

KCl responses were similar in all three groups. Acetylcholine contraction responses in the vagotomy and non-vagotomy Roux-en-Y groups was higher than in those in control group significantly (p < 0.05). This response in vagotomy Roux-en-Y group was also higher than that in non-vagotomy group (p < 0.05). The induced electrical field stimulation contraction response in the vagotomy + Roux-en-Y group was lower than those in control group and non-vagotomy group (p < 0.05).

CONCLUSIONS

These results show that muscarinic receptor density and/or function may increase after vagotomy and non-vagotomy group operation, and vagotomy may contribute to this increase. The decrease in electrical signal response in vagotomy Roux-en-Y group may depend on the decrease in acetylcholine oscillation from the cholinergic nerve ending (Tab. 1, Fig. 5, Ref. 25).

Episodic ozone exposure in adult and senescent Brown Norway rats: acute and delayed effect on heart rate, core temperature and motor activity

Setting exposure standards for environmental pollutants may consider the aged as a susceptible population but the few published studies assessing susceptibility of the aged to air pollutants are inconsistent. Episodic ozone (O₃) is more reflective of potential exposures occurring in human populations and could be more harmful to the aged. This study used radiotelemetry to monitor heart rate (HR), core temperature (T(c)) and motor activity (MA) in adult (9-12 months) and senescent (20-24 months) male, Brown Norway rats exposed to episodic O₃ (6 h/day of 1 ppm O₃ for 2 consecutive days/week for 13 weeks). Acute O₃ initially led to marked drops in HR and T(c). As exposures progressed each week, there was diminution in the hypothermic and bradycardic effects of O₃. Senescent rats were less affected than adults. Acute responses were exacerbated on the second day of O₃ exposure with adults exhibiting greater sensitivity. During recovery following 2 d of O₃, adult and senescent rats exhibited an elevated T(c) and HR during the day but not at night, an effect that persisted for at least 48 h after O₃ exposure. MA was elevated in adults but not senescent rats during recovery from O₃. Overall, acute effects of O₃, including reductions in HR and T(c), were attenuated in senescent rats. Autonomic responses during recovery, included an elevation in T(c) with a pattern akin to that of a fever and rise in HR that were independent of age. An attenuated inflammatory response to O₃ in senescent rats may explain the relatively heightened physiological response to O₃ in younger rats.

Elastosonographic strain index in thyroid nodules with atypia of undetermined significance

AIM

In this study, we aimed to evaluate the diagnostic accuracy of elastosonography (ESG) scoring and strain ratio in patients who had atypia of undetermined significance (AUS) cytology and underwent surgery for thyroid nodules.

MATERIALS AND METHODS

250 patients were included in this study. They had at least one nodule in thyroid USG, underwent USG-guided FNAC according to the current guidelines and had AUS cytology according to the Bethesda system. Both elastosonographic color scoring and strain index were evaluated.

RESULTS

A total of 270 nodules in 250 patients were evaluated. Histopathologically, 81 (30 %) nodules were malignant and 189 (70 %) were benign. According to the ESG, 10 (3.7 %) nodules were assigned a score of 1, while 13 (4.8 %) nodules were assigned a score of 5. All of the nodules with an ESG score of 1 were histopathologically benign and 92.3 % of the patients with ESG score 5 were in the malignant group. Median SI in the benign histopathologic group was significantly lower compared to malignant group [(2.58 (IQR = 2.35) vs. 14.54 (IQR = 10.71)]. The optimal SI cut-off value to distinguish between the benign and malignant nodules was 6.66, with a sensitivity of 98.77 % and specificity of 96.30 %.

CONCLUSION

Our study is one of the first studies evaluating the role of SI for discriminating malignant and benign nodules with AUS cytology. Malignant nodules had a significantly higher stiffness compared to benign ones and SI had high sensitivity, specificity, positive predictive value, negative predictive value and accuracy for these nodules. We think SI may be helpful for the presurgical selection of nodules with AUS cytology.

Right-lobe living-donor liver transplantation in adult patients with acute liver failure

BACKGROUND

Right-lobe living-donor liver transplantation (RLDLT) is an excellent option to reduce donor shortages for adult patients with acute liver failure (ALF). The aim of this study was to evaluate the etiologies and outcomes of 30 consecutive adult patients who underwent emergency RLDLT for ALF.

METHODS

Between January 2007 and September 2011, we examined data from medical records of patients with ALF who underwent RLDLT.

RESULTS

Their mean age was 32.2 ± 13.05 years. The etiologies of ALF were acute hepatitis B (n = 11; 36.6%), hepatitis A (n = 4; 13.3%), drug intoxication (n = 4; 13.3%), pregnancy (n = 2; 6.7%), hepatitis B with pregnancy (n = 1; 3.3%), mushroom intoxication (n = 1; 3.3%), and unknown (n = 7; 23.3%). The mean hepatic coma grade (Model for End-Stage Liver Disease score) was 34.13 ± 8.72. The 43 (48.7%) postoperative complications were minor (grades I-II) and 44 (51.3%) were major (grades III-V). Reoperation was required in 14 of 30 (47%) recipients (grades IIIb-IVa). Deaths occurred owing to pulmonary (n = 2), cardiac (n = 1), septic (n = 2), or encephalopathic (n = 4) complications. The mean durations of intensive care unit stay and postoperative hospitalization were 3.2 ± 2.3 and 29.5 ± 23 days, respectively. The survival rate was 70%. The mean follow-up duration was 305 days (range, 1-1582).

CONCLUSION

Liver transplantation is potentially the only curative modality, markedly improving the prognosis of patients with ALF. The interval between ALF onset and death is short and crucial because of the rapid, progressive multiorgan failure. Thus, RLDLT should be considered to be a life-saving procedure for adult patients with ALF, requiring quicker access to a deceased-donor liver graft and a short ischemia time.

No difference in blood loss between posterior-cruciate-ligament-retaining and posterior-cruciate-ligament-stabilized total knee arthroplasties

PURPOSE

Posterior-cruciate-ligament-retaining (PCR) and posterior-cruciate-ligament-stabilized (PS) arthroplasties are two major common practices in total knee arthroplasty (TKA). The hypothesis of the present study was that compared with the PCR technique, the PS technique is associated with a higher amount of postoperative blood loss and greater need for blood transfusion in cemented TKA.

METHODS

In this prospective, randomized study, 100 patients diagnosed with primary knee osteoarthritis were randomly assigned to either the PCR group (Group I) or the PS group (Group II). The exclusion criteria were rheumatological joint disease, previous knee surgery, anticoagulant therapy and hypertension. There were no significant differences in age, body mass index and gender, between the groups. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on postoperative days 1, 3 and 5. The postoperative suction drainage and blood transfusion volumes were also recorded.

RESULTS

There were no statistically significant differences in haemoglobin or haematocrit levels between the groups on postoperative days 1, 3 and 5. There were also no statistically significant differences in the total measured blood loss volume, postoperative drainage amounts or transfusion rates between the groups.

CONCLUSION

Use of the PS technique during cemented TKA does not appear to influence the amount of perioperative blood loss or the need for postoperative blood transfusion in general. The clinical relevance of this study is that the difference in blood loss between the PCR and PS techniques does not need to be considered by surgeons when performing TKA.

Hepatic artery thrombosis-related risk factors after living donor liver transplantation: single-center experience from Turkey

AIM

The purpose of this retrospective study is to evaluate the risk factors hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT) in a consecutive series from a single center.

MATERIALS AND METHODS

Between January 2010 and May 2012, we performed 278 living donor liver transplantations, including 189 males and 89 females. We compared the risk factors between HAT and non-HAT groups according to the following variables: age, gender, body mass index (BMI), graft weight, use of graft, Child-Pugh and model for end stage liver disease score, level of hemoglobin, blood pressure, operation time, blood transfusion, presence of ascites, international normalized ratio (INR) level, and etiology.

RESULTS

Eighteen patients, including 15 males and 3 female, had HAT after the operation (mean age, 45.1 years; age range, 22-60 years). There were no pediatric patients in the HAT group. HAT rate was 6.5% in our series. Graft loss and retransplantation due to HAT was 38.7% in a 2-year period. Biliary leakage was observed in 72 (25.8%) living donor liver transplantations; this rate was higher in patients with HAT (n = 8; 44.4%). The infection rate was 50% (n = 9) in the HAT group and was 32.7% (n = 91) in the non-HAT group. Mean INR value was 2.15 in the HAT group and 1.72 in the non-HAT group. When we compared the groups according to use of graft for anastomosis, biliary lekage, infection, and INR value, the differences were statistically significant (P < .05).

CONCLUSION

Although the results of OLT have improved over the past years, HAT is still associated with substantial morbidity, high incidence of graft failure, and high mortality rates. The most important findings associated with HAT in our series were found as INR levels, bile leakage, and resistant infections. Use of vascular graft for hepatic artery anastomosis was found to increase HAT risk.

A new echocardiographic parameter of arterial stiffness in end-stage renal disease

BACKGROUND

Cardiovascular disease is the leading cause of death among patients with end-stage renal disease (ESRD). Arterial stiffness is an independent predictive parameter of overall and cardiovascular mortality in these patients. However, the defined procedures for the measurement of arterial stiffness are time consuming and not practical in daily practice.

METHODS

The study population included 50 patients with ESRD who were treated with hemodialysis (HD; n=23) or peritoneal dialysis (PD; n=27) and 70 age- and sex-matched control subjects. Aortofemoral pulse wave velocity (PWV), carotid intima-media thickness (CIMT), and color M-mode propagation velocity of the descending aorta (aortic propagation velocity, APV) were measured.

RESULTS

Compared to the control group, the patients with ESRD had significantly lower APV (46.4 ± 12.4 vs. 58.5 ± 8.5, p < 0.01) and higher PWV (10.5 ± 2.5 vs. 9.2 ± 1.2, p < 0.01) and CIMT (0.66 ± 0.15 vs. 0.43 ± 0.06, p < 0.01) measurements. There were significant correlations between APV and CIMT (r = - 0.769, p < 0.001), APV and PWV (r = - 0.682, p < 0.001), and PWV and CIMT (r = 0.564, p < 0.001). There were no significant differences in APV and PWV between the PD and HD patients.

CONCLUSION

Arterial stiffness is an important indicator of atherosclerosis and arterial aging in patients with ESRD. The measurement of APV is an easy and practical new echocardiographic method and may be used to identify arterial stiffness in these patients.

Quality of life of patients with implant-retained maxillofacial prostheses: a prospective and retrospective study

STATEMENT OF PROBLEM

Clinical studies on implant-retained maxillofacial prostheses have focused on biological outcomes. An assessment of the effect of prostheses on patients' quality of life (QOL) by using specific questionnaires developed for this patient population provides important information on treatment outcomes from the patients' perspectives.

PURPOSE

The purpose of this study was to report patient-based outcomes of implant-retained maxillofacial prostheses and to evaluate the effect of implant-retained maxillofacial prostheses on QOL of participants in a prospective study.

MATERIAL AND METHODS

Eighty-two participants were treated with implant-retained maxillofacial prostheses. Participants were divided into 2 groups: a retrospective group (participants treated and under care) and a prospective group (participants willing to be treated). The posttreatment patient satisfaction scores for each question were statistically analyzed by 2-way ANOVA with variables of defect type and retention type. The Student-Newman-Keuls test was used to determine any significant differences among the groups. In the prospective group, mean scores before and after prosthetic treatment were compared with the paired t test (α=.05).

RESULTS

The details of 54 retrospective and 28 prospective participants were reviewed. The posttreatment results of 82 patients showed that patient satisfaction with implant-retained maxillofacial prostheses was significantly different for cleaning the prostheses and recommending treatment to other people, depending on the defect and retention type. In the prospective group, participants reported significant increases in satisfaction for all questions.

CONCLUSIONS

Implant-retained prostheses were considered highly satisfactory, indicating good QOL for patients with maxillofacial defects. A comparison of pretreatment and posttreatment assessments revealed that implant-retained maxillofacial prostheses increased patient QOL.

Transverse sinus thrombosis in a living donor: a case report

BACKGROUND

Liver transplantation is among the treatment options for end-stage liver disease. Limited organ donation in our country has resulted in an increased performance of living donor liver transplantations. This case report describes a left transverse cerebral venous sinus thrombosis diagnosed in a living donor hepatectomy patient.

PATIENT

A 45-year-old man underwent right lobe hepatectomy of a 330-g graft for living donor liver transplantation to his 55-year-old hepatitis B virus-positive brother. On the first postoperative day, without any surgical problems he presented with loss of consciousness. Previous medical history was unremarkable. Neurology consultation revealed lethargy and an acute confusional state. Cerebral magnetic resonance imaging venography showed signal alterations in the left transverse sinus wherein thrombosis was diagnosed. Heparin infusion initiated for antithrombotic treatment was adjusted to provide a 1.5 to 2-fold increased baseline activated partial thromboplastin time. On the second day of treatment has clinical status improved and he was discharged on the, fifth day on oral anticoagulant (warfarin) therapy for outpatient follow-up.

RESULTS

Cerebral venous sinus thrombosis is a rare disease with variable clinical onsets. Surgical procedures are among risk factors. An early diagnosis is essential to achieve low mortality and morbidity rates.

Esthetic, functional, and prosthetic outcomes with implant-retained finger prostheses

BACKGROUND

Traumatic amputation of fingers results in a serious impairment of hand function and affects the psychological status of the patients. The implant-retained finger prostheses are an alternative treatment. The aim of this case report is to represent the use of osseointegrated implants for retention of finger prostheses in a patient with amputated thumb and index finger.

CASE DESCRIPTION AND METHODS

Dental implants were placed in the residual bone of the fingers using two-stage surgery. Custom-made attachments were used to provide retention between implants and silicone prostheses. Prosthetic fingernails were made of composite resin material.

FINDINGS AND OUTCOMES

After 6 months, implants were clinically successful, and the patient was satisfied with the appearance and the function of the prostheses. The complications of broken prosthetic nail and mild discoloration were observed.

CONCLUSION

Reconstruction of amputated fingers with implant-retained prosthesis is a worthwhile treatment providing esthetic, functional, and psychological benefits, although some complications might be experienced. Clinical relevance Implant-retained finger prostheses are an acceptable treatment modality for patients with amputated fingers. Evaluating implant prognosis, functional results and prosthetic results of the patients are necessary to address the benefits and complications of the treatment.

Treatment of pilonidal disease by combination of pit excision and phenol application

AIM

To examine the results of our minimal invasive treatment for pilonidal disease.

METHODS

Total 83 patients treated by pit excision and consecutive phenol applications on an outpatient setting. All procedures were performed under local anesthesia, without any preoperative testing, colon cleansing, prophylactic antibiotics or sedation. A pit excision (mean length 1.3 ± 0.5 cm) including several close midline orifices was done. Separated pit excisions were done to the remaining midline and lateral orifices. Sinus cavity was cleared of hair and debris, and the walls of the cavity were sclerosed using a cotton bud dipped in 80% liquid phenol. Phenolization was repeated twice on day one and seven.

RESULTS

Mean procedure time was 22.2 ± 7.4 min. Rates of patients who did not required analgesics at first, second, third and fourth days after surgery were 58, 85, 91 and 100%, respectively. All the patients returned to work/school after 3 days. Mean wound closure time was 28.5 ± 14.9 days. Total 86.7% of the patients were asymptomatic after a mean 25.7 ± 8.5 months follow-up.

CONCLUSION

Simple pit excision and sclerosing the pilonidal sinus cavity consecutively was an effective and minimal invasive method for relief of pilonidal symptoms.

Development of Dual-Retrieval Processes in Recall: Learning, Forgetting, and Reminiscence

We investigated the development of dual-retrieval processes with a low-burden paradigm that is suitable for research with children and neurocognitively impaired populations (e.g., older adults with mild cognitive impairment or dementia). Rich quantitative information can be obtained about recollection, reconstruction, and familiarity judgment by defining a Markov model over simple recall tasks like those that are used in clinical neuropsychology batteries. The model measures these processes separately for learning, forgetting, and reminiscence. We implemented this procedure in some developmental experiments, whose aims were (a) to measure age changes in recollective and nonrecollective retrieval during learning, forgetting, and reminiscence and (b) to measure age changes in content dimensions (e.g., taxonomic relatedness) that affect the two forms of retrieval. The model provided excellent fits in all three domains. Concerning (a), recollection, reconstruction, and familiarity judgment all improved during the child-to-adolescent age range in the learning domain, whereas only recollection improved in the forgetting domain, and the processes were age-invariant in the reminiscence domain. Concerning (b), although some elements of the adult pattern of taxonomic relatedness effects were detected by early adolescence, the adult pattern differs qualitatively from corresponding patterns in children and adolescents.