Effect of chronic arsenic exposure from drinking waters on the QT interval and transmural dispersion of repolarization

This study investigated the effects of chronic arsenic exposure on QT- and QTc-interval prolongation, QTc dispersion (QTcd) and transmural dispersion of repolarization (TDR). We compared cardiac parameters from 40 male subjects chronically exposed to arsenic (group A) with those of 40 male subjects not exposed to arsenic (group B). Although subjects in both groups had non-corrected QT intervals within normal limits, subjects in group A had significantly longer QTc and QTcd intervals compared with group B. A total of 70% of group A compared with 10% of group B had QTcd values > 50 ms. The mean TDR value was also significantly higher in group A compared with group B. Although non-corrected QT intervals were within normal limits, those subjects chronically exposed to arsenic had a slight QT prolongation and a higher prevalence of subtle repolarization abnormalities, which might be clinically relevant.

Does the copper intrauterine device affect serum cancer antigen 125 levels?

PURPOSE

This study aimed to reveal the effect of the copper IUD, if any, on serum CA-125 levels in patients who use the device as a contraceptive.

METHODS

Blood samples were obtained two times from 20 healthy volunteers before and after IUD insertion, and sera were isolated. The sera, centrifuged at 2000 G and kept at -70 degrees C in a deep freezer until analyzed, were processed for CA-125 levels by the CA-125 kit using VIDAS PC analyzer (Biomerieux, France) and results were compared.

RESULTS

The CA-125 level of the serum obtained from the first blood samples was significantly higher than that of the second sample (24.63 +/- 25.40 mIU/ml and 14.44 +/- 10.08 mIU/ml, respectively) (p < 0.05).

CONCLUSION

The results of this study indicate that the serum level of CA-125 may be lower in patients using copper IUDs which may be helpful in evaluation of ovarian masses in women in reproductive age.

Comparison of lornoxicam with tramadol in patient-controlled analgesia after gynecological surgery

BACKGROUND

The aim of this study was to compare the effects of lornoxicam and tramadol in patient-controlled analgesia (PCA) after gynecological surgery.

METHODS

Forty-four patients were randomly allocated to one of two groups after elective gynecological surgery. Patients in group I (n = 22) received IV tramadol, and group II patients (n = 2) received IV lornoxicam with a PCA pump. A visual analogue scale (VAS) (0 = no pain, 10 = worst pain), hemodynamic parameters and side-effects were assessed before starting the infusion (baseline), at the 15th and 30th min, 1st, 2nd, 3rd, 4th, 6th, 8th, 12th, 18th, 24th, 36th and 48th hour thereafter, and results were compared.

RESULTS

Adequate analgesia was achieved in both groups. VAS values in the tramadol group were lower than those of lornoxiacam at the 15th and 30th minute, 1st, 2nd, 4th, 6th, 8th and 12th hour measurements (p < 0.05). Eight patients (36.3%) in group I and six patients (27.2%) in group II suffered from nausea (p > 0.05).

CONCLUSIONS

Tramadol and lornoxicam may be used for pain control after gynecological surgery via PCA. However, we conclude that tramadol has better analgesic efficacy than lornoxicam during the first 12 hours postoperatively.

Cyproterone acetate and ethinylestradiol-induced pill oesophagitis: a case report

Although there are many cases of oesophagitis related to pill in medical literature, there are only a few reports concerning oesophagitis related to oral contraceptives, and none about cyproterone acetate and ethinylestradiol combination (Diane-35). In this report, we describe a female patient who suffered from odynophagia and retrosternal pain after taking Diane-35 for hirsutism. The endoscopic examination revealed two well-demarcated circumferential ulcers of 1 cm diameter surrounded by relatively normal mucosa in mid-oesophagus. The patient had gone to bed immediately after taking the pill. Oral intake was stopped, and intravenous fluids and omeprazole were administered as part of treatment. The patient benefited from this approach very quickly and was discharged from hospital in 5 days. The oesophagus was completely normal in control endoscopy after 2 months. Diane-35 should be added to the list of drugs causing pill oesophagitis, and physicians should inform the patients that the pills should be taken with enough water and they should not lie down right after ingesting the pills.

Comparison of clinical diagnosis and microbiological test results in vaginal infections

Lower genital tract infections continue to be a problem due to the fact that the clinical diagnosis is usually inadequate, and subsequent care is suboptimal. This study aimed at evaluating the accuracy of clinical diagnosis by comparing it with microbiologic test results, and to determine the causative agents of vaginal infections. Sixty-seven nonpregnant women (18-45 years of age) with the clinical diagnosis of lower genital tract infection were enrolled in the study. Patients were not included if they had a history of vaginal infection during the previous three-month period or intrauterine device. The clinical diagnosis was based on the combinations of symptoms, direct observation of wet mount, homogeneous discharge, vaginal pH > 4.5, and detection of the amine odor after exposure of vaginal secretions to 10% KOH. Vaginal samples were taken with two cotton swabs, one was used for pH determination, and the second was utilized for microbiological tests. Gram staining and cultures with Sabouraud agar and chocolate agar were performed for microbiological diagnosis, and the results were compared. The clinical diagnoses included 26 (38.8%) candidiasis, 18 (26.8%) bacterial vaginosis, three (4.5%) trichomoniasis, and 20 (29.9%) mixed vaginal infections. Of the 26 patients with clinical diagnoses of candidiasis, 12 (46.1%) revealed Candiada albicans, nine (34.6) patients revealed microorganisms other than candida species, and five (19.2%) patients had no growth. Five (27.8%) bacterial vaginosis patients revealed Gardnarella vaginalis and 12 patients (66.6%) did not grow any microorganism. The overall rate of accurate clinical diagnoses confirmed by microbiological test results was 43.2%. Seventeen (43.6) of the 39 microbiological test results correlated with clinical diagnosis, and no growth was observed in 28 (41.8%) cultures. We conclude that the clinical diagnosis of vaginal infection is inadequate and should be confirmed with microbiological testing if the resources are avaliable.

Effect of hysterosalpingography on serum cancer antigen (CA-125) levels

OBJECTIVE

The aim of our study was to detect any rise in serum levels of CA-125 after hysterosalpingography (HSG) as a result of irritation of the peritoneum.

STUDY DESIGN

Serum levels of CA-125 were assessed before HSG and at the 2nd and 6th hours after HSG in 32 infertile patients who were admitted to our clinic from April 2002 to September 2002. Patients who showed tubal occlusion or Asherman Syndrome were excluded from the study. The levels of serum CA-125 were compared statistically. Statistical analysis was performed with SPSS 10.0 statistical software and the paired-sample t-test was applied.

RESULTS

The mean levels of serum CA-125 before HSG, and at the 2nd and 6th hours after HSG were; 14.11 +/- 5.97 mIU/ml, 13.96 +/- 5.80 mIU/ml, and 14.06 +/- 5.80 mIU/ml, respectively. There was no statistically significant difference between serum levels of CA-125 before HSG and at the 2nd or 6th hours after HSG, and also between the 2nd and 6th hours after HSG (p > 0.05).

CONCLUSION

We have not found any reports up to date about the levels of serum CA-125 after HSG. In our study we did not detect any increase in levels of serum CA-125 at the 2nd and 6th hours after HSG in spite of peritoneal irritation. We propose that this finding is because leakage of radioopaque material to the abdominal cavity is minimal during the HSG procedure.

Proliferation of ovarian theca-interstitial cells is modulated by antioxidants and oxidative stress

BACKGROUND

Maintenance of ovarian homeostasis requires precise regulation of proliferation of thecal- interstitial (T-I) cells. Recent evidence indicates that oxidative stress and antioxidants modulate proliferation of various tissues under both physiological and pathological conditions. This study evaluated the effects of oxidative stress and antioxidants on T-I proliferation.

METHODS

Rat T-I cells were cultured in serum-free medium and proliferation was assessed by determination of DNA synthesis using the thymidine incorporation assay, by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay and by direct counting of steroidogenically active cells and steroidogenically inactive cells.

RESULTS

Antioxidants and reactive oxygen scavengers induced a dose-dependent decrease of T-I proliferation. Vitamin E succinate was inhibitory at 10-100 micro mol/l, ebselen was inhibitory at 0.3-30 micro mol/l, and superoxide dismutase was inhibitory at 300-1000 IU/ml. In contrast, oxidative stress resulted in a biphasic effect. Modest oxidative stress induced by 1 mmol/l hypoxanthine and xanthine oxidase (3-30 micro U/ml) stimulated proliferation of T-I cells, while greater oxidative stress induced by xanthine oxidase (1 mU/ml) profoundly inhibited proliferation. Direct cell counting demonstrated comparable effects on steroidogenically active and inactive cells.

CONCLUSIONS

Reactive oxygen species may play a role in the regulation of growth of ovarian mesenchyme. Under pathological conditions, such as those encountered in polycystic ovary syndrome, excessive oxidative stress and depletion of antioxidants may contribute to ovarian mesenchymal hyperplasia.

Postoperative patient-controlled analgesia with intravenous tramadol, intravenous fentanyl, epidural tramadol and epidural ropivacaine+fentanyl combination

PURPOSE

The aim of this study was to compare the effects of IV tramadol, IV fentanyl, epidural tramadol, and an epidural ropivacaine+fentanyl combination in patient-controlled analgesia (PCA) after lower abdominal surgery.

METHODS

Eighty adult patients undergoing lower abdominal surgery were randomly allocated to one of four groups to receive analgesics with PCA pumps. Patients in group I received IV tramadol, group II patients IV fentanyl, group III patients epidural tramadol, and group IV patients an epidural infusion of 0.125% ropivacaine + 2 microg ml(-1) fentanyl combination. Analgesic effectiveness and side-effects were assessed at 1, 2, 3, 4, 5, 6, 8, 12, 16, 20, and 24 hours after surgery.

RESULTS

Adequate analgesia was achieved in all groups. The analgesia was highest in group IV (p < 0.05), and lowest in group III patients (p < 0.05). Eleven patients (55%) in group I and eight patients (40%) in group II suffered from nausea/vomiting.

CONCLUSION

Although adequate pain relief was achieved with all regimens that were used in the study, intravenous tramadol and intravenous fentanyl are associated with a high incidence of nausea and vomiting.

Left anterior descending coronary artery occlusion after left lateral free wall accessory pathway ablation: what is the possible mechanism?

We describe a complication after radiofrequency (RF) ablation of a left free wall accessory pathway that resulted in acute occlusion of proximal left anterior descending (LAD) coronary artery in a 32-year-old male non-cocaine abuser. An interesting feature is the site of coronary artery occlusion which is remote from the RF application site. The RF energy applications were performed in the left lateral annulus remote from the LAD. The occlusion was successfully treated with placement of an intracoronary stent.

The effects of add-back therapy with tibolone on myoma uteri

In this prospective, randomized, double-blind study, we evaluated the effects of tibolone therapy in association with preoperative gonadotropin releasing hormone agonist (GnRHa) therapy on the reduction of myoma volume. Twenty patients with myoma uteri were divided into two groups. Group I was given monthly triptoreline (3.75 mg every 28 days IM) treatment for six months. As for group II, tibolone was added on to this treatment. For all of the patients, physical examinations, pelvic ultrasonography, and hormone analyses were carried out and the myoma volume was measured by ultrasonography. The patients were called every month and physical examination, ultrasonography and hormone analyses were repeated. Side-effects were recorded. The SPSS/PC 6.0 program was used for statistical analysis. Statistical significance was defined as a p < 0.05. The results are expressed as means +/- SD. While the average volume of myoma was 72.97 +/- 68.5 cm3 in group I, 78.83 +/- 74.1 cm3 in group II before treatment; it was reduced to 29.91 +/- 27.8 cm3 in group I at the end of six months of treatment. Reductions of 59.6% in group I and 63.9% in group II were determined, however the difference was not statistically significant (p > 0.05). At the beginning the level of serum estradiol was 65.4 +/- 22.3 pg/ml in group I which decreased to 37.2 +/- 4.2 pg/ml by the end of the first month. Amenorrhea occurred in six patients after the second injection and four patients after the third injection in group I. Whereas the level of estradiol was 60.9 +/- 19.5 pg/ml in group II at the beginning, it was reduced to 40.5 +/- 6.2 pg/ml by the end of the first month. Amenorrhea occurred in four patients after the second injection and four patients after the third injection in group II. In group I the patients had the problem of flushing (80%), vaginal dryness (50%), and night sweats (30%). In group II these rates were 30%, 20%, and 20%, respectively. Triptoreline is a GnRHa which has been found to be effective in reducing myoma volume, but this effect could not be deactivated with tibolone. However, a decrease was observed in the side-effects resulting from hypoestrogenism.

A ruptured ovarian endometrioma mimicking ovarian malignancy: case report

A 24-year-old single woman was referred to our department due to intermittent abdominal pain. Because her serum CA 125 concentration was extremely elevated an ovarian malignancy was suspected. At the laparoscopic examination, it was determined to be a ruptured endometrioma and serum CA 125 concentrations rapidly decreased after surgery.

Simple sequence repeat (SSR) markers linked to the Ligon lintless (Li(1)) mutant in cotton

Ligon lintless (Li(1)) is a monogenic, dominant mutant in cotton, whose expression results in extreme reductions in fiber length on mature seed. The objectives of this research were to compare fiber initiation between the Li(1) mutant and TM-1 to reveal the fiber initiation differences between normal and mutant phenotypes, to develop a linkage map of simple sequence repeat (SSR) markers with the Li(1) locus, and to identify the chromosomal location of the Li(1) locus. Comparative scanning electron microscopy studies of fiber development in a normal TM-1 genotype and the near-isogenic Li(1) mutant at 1 and 3 days postanthesis revealed little differences between the two during early stages of development, suggesting that Li(1) gene expression occurs later, probably during the elongation phase. Thirty-eight SSR loci were found to be polymorphic between TM-1 and Li(1) and were used for mapping in an F(2) population. Twenty-two SSR loci, along with Li(1), were located on eight linkage groups, covering a total genetic distance of 218.3 cM. Analysis of individual monosomic and monotelodisomic plants indicated that two SSR loci (MP4030 and MP673) from the Li(1) linkage group were located on chromosome 22.

HOXA10 expression is repressed by progesterone in the myometrium: differential tissue-specific regulation of HOX gene expression in the reproductive tract

HOX genes are essential regulators of development in all multicellular organisms, including humans. We have previously shown that HOXA10 is expressed in the developing uterus and later in the adult human endometrium. HOX genes regulate endometrial development in response to sex steroids. Here, we demonstrate that HOXA10 is expressed in the myometrium as well. In situ hybridization reveals abundant HOXA10 expression, and Northern analysis demonstrates differential HOX gene expression in the myometrium throughout the menstrual cycle. HOXA10 expression decreases in the midsecretory phase, coinciding with high serum progesterone levels. Treatment of primary myometrial cell cultures with progesterone decreases HOXA10 expression in vitro-paralleling the expression seen in vivo. Despite the presence of progesterone receptors in the endometrium and myometrium, HOXA10 is differentially regulated in each tissue by progesterone. HOXA10 expression is induced in the stroma and decreased in the myometrium by progesterone. The differential tissue-specific response of this gene in response to progesterone is likely mediated by sex steroid receptor coactivators or corepressors. Decreased myometrial expression of developmental regulatory genes such as HOXA10 in the nonpregnant uterus may dedifferentiate the myometrium and allow growth in preparation for pregnancy.

Genetic line and major histocompatibility complex effects on primary and secondary antibody responses to T-dependent and T-independent antigens

The effects of MHC and nonMHC (background) genetics on the kinetics of primary and secondary antibody responses to T-cell-dependent (SRBC) and T-cell-independent [Brucella abortus (BA)] antigens were investigated. Eight genetic groups were represented, with four homozygous MHC haplotypes [B1-IrGATlow (IrGAT = immune response to GAT locus); B1-IrGAThigh; B19-Ir-GATlow; B19-IrGAThigh] on two genetic backgrounds, the S1 and G lines. Birds were injected simultaneously with BA and SRBC at 4 and 7 wk of age, and blood samples were taken weekly from 4 to 10 wk of age for measurement of total agglutinating serum antibody levels. A quadratic equation and its first derivative were computed for each bird to approximate individual curve parameters: y max, the maximum titer; t max, the time required to achieve y max; and c coefficient, the rate of decline in the titer. Curve parameters of birds from different lines were analyzed separately by using the General Linear Model procedure. A second analysis that included line effect evaluated the nonMHC gene effects and their interactions with erythrocyte antigen B locus (Ea-B) or IrGAT. In the S1 line, there was an interaction (P < 0.05) between MHC haplotypes and sex for primary response to BA. In contrast, there were no significant main effects nor interactions in the G line background for primary and secondary responses to BA and SRBC. There was an effect (P < 0.05) of line background on y max for primary BA and for secondary SRBC responses. A positive correlation (P < 0.05) was found between the c coefficients of BA and SRBC secondary responses, suggesting that the rate of decline in the secondary response is similar between these T-dependent and T-independent responses. The overall results of this study indicate complex interactions between specific MHC alleles and the nonMHC background of the lines in which they are studied.

Dimethly sulphoxide lowers ICP after closed head trauma

Ten patients with closed head trauma and elevated intracranial pressure (ICP) ranging from 40-127 mm Hg were treated with intravenous dimethyl sulphoxide (DMSO) every 6 h for 1-10 days. Four patients received DMSO and intermittent oxygen. All patients showed a reduction of ICP after 24 h and 7 had normal ICP after 6 days of treatment. Two patients died of their injuries. Neurological assessment at the time of discharge showed 2 patients with severe neurological deficits and 6 patients with mild to no deficit. After a 3 month follow-up, 1 patient remained severely impaired and 7 patients showed mild to no deficit. It appears that intravenous DMSO can rapidly reduce elevated ICP in severe closed-head injury and that it improves neurological outcome.

Laser or razor? A novel experimental peripheral nerve repair technique

An operative repair technique for crushed sciatic nerve in the rat was used to examine whether removal of the damaged tissue could be better achieved with a low wattage CO2 laser or a blade. This approach was compared to results in rats undergoing conventional end-to-end nerve anastomosis using a microsurgical approach. Crushed sciatic nerves were exposed bilaterally 24 hours after injury and treated as follows. A longitudinally split polyethylene catheter was placed under the nerve, which was fixed to the catheter with 9-0 stitches placed away from lesion area; the nerve was bathed in ice-cold polyvinyl alcohol/chlorpromazine (PVA/CPZ) solution. After the nerve was crushed, the lesioned tissue was removed using laser pulses or a thin blade. A collagen matrix was used to fill the gap, and the preparation was covered and allowed to recover for 6 weeks. End-to-end anastomosis was done following same parameters, but with omission of the nerve catheter, PVA/CPZ solution, and collagen matrix; these nerves were reunited using epineurial stitches. High performance liquid chromotography (HPLC) analysis of each group showed that the laser approach reduced the levels of norepinephrine distal to the lesion, least, suggesting better regeneration of proximal axonal growth. Morphological and neuroelectric findings, although suggestive, showed no significant differences between laser and blade repair, a finding that reinforces the idea that such endpoints are not as sensitive as chemical assays of tissue transmitter levels such as HPLC. Laser or blade repair using nerve-catheter fixation and collagen bridge matrix was superior to end-to-end nerve anastomosis when morphological, neuroelectric, and HPLC values were compared in this model.(ABSTRACT TRUNCATED AT 250 WORDS)