Evaluation of Achilles tendon thickening in type 2 diabetes mellitus

AIM

To investigate the effect of diabetes mellitus on the Achilles tendon, which may contribute to the long-term complications in the foot-ankle complex and to investigate the factors relating to its thickening.

METHODS

The study group included 55 patients (26 female and 29 male) with type 2 DM, while the control group included 34 non-diabetic people (13 female and 21 male). We matched the female and male DM patients with their respective control groups in terms of age, BMI, height and body weight. Clinical and biochemical tests, as well as ultrasonographic evaluations of the internal carotid artery and the Achilles tendon, were carried out to evaluate the complications of diabetes mellitus, and to compare the Achilles tendon thickness (ATT) between the study and the control groups.

RESULTS

In the female groups the Achilles tendon was significantly thicker in the diabetic patients than in their healthy controls (p<0.001). However, no difference was found in the ATT between the male diabetic patients and their male controls (p=0.74). The ATT correlated with the body mass index (BMI) (r=0.47, p=0.015) and body weight in diabetic female group (r=0.56, p=0.003). We also observed that the ATT values were higher in male DM patients with retinopathy (p=0.034) or neuropathy (p=0.019) compared to the male DM patients without these complications.

CONCLUSIONS

The ATT in type 2 female diabetic patients was found to be higher than their non-diabetic controls, but no significant difference could be found between type 2 diabetic male patients and their non-diabetic controls by US. Our results might indicate a possible impact of diabetes on the ATT depending upon gender, but other mechanisms may also contribute to thickening of Achilles tendon.

CYP17 genetic polymorphism in patients with endometrial hyperplasia and cancer

We investigated the association of CYP17 gene polymorphism with the risk of having endometrial cancer and a well-known precursor of it, endometrial hyperplasia. Group A (control group) consisted of 35 patients who had histologically proven normal endometrium. Group B and C consisted of 18 and 30 patients who had endometrial hyperplasia with and without atypia, respectively. Group D consisted of 57 patients who had endometrial cancer. Venous blood samples were collected from patients in groups, and polymerase chain reaction was performed to determine the CYP17 gene polymorphism. Significant increase of A1/A1 and a decrease of A1/A2 genotype frequencies have been determined in patients with endometrial cancer and with atypical endometrial hyperplasia. No significant differences were found between groups in the frequency of A2/A2 genotype. There was no significant difference between the groups in the meaning of allele distributions. CYP17 polymorphism had correlation with endometrial atypia and cancer. Related effects of different types of CYP17 gene variants on the progression of hyperplastic endometrial cells into carcinoma should be evaluated in further studies. Progress in this area would help us modulate preventive treatments used in those actual high-risk group patients.

The effects of propofol and ketamine on gut mucosal epithelial apoptosis in rats after burn injury

BACKGROUND AND OBJECTIVES

Apoptosis occurs after thermal injury and may result from either ischaemic intestinal insult or inflammatory mediators released after burn injury. The aim of the study was to investigate the effects of propofol and ketamine on gut epithelium apoptosis after burn injury.

METHODS

Sixty male Wistar Albino rats were randomly assigned into four groups. Anaesthesia was induced and maintained with propofol in Groups 1 and 2, and ketamine in Groups 3 and 4 over 12 h. Groups 2 and 4 received 30% total body surface area burn. Groups 1 and 3 had no burn injury. Mean arterial pressure was maintained within 10% of baseline levels in all animals. At 12 h postburn, animals were sacrificed and tissue samples were taken from small intestine for determination of lipid peroxidation, apoptosis and proliferation. Also blood samples were taken for measurement of serum tumor necrosis factor-alpha (TNF-alpha) levels.

RESULTS

Ileal malondialdehyde (MDA) concentration (extent of lipid peroxidation) increased significantly in Group 4 (112.4 +/- 10.2 nmol g-1) compared to Group 3 (48.4 +/- 5.6 nmol g-1) and Group 2 (59.8 +/- 3.2 nmol g-1). The mean TNF-alpha level in Group 4 (118.9 +/- 10.5 pg mL-1) at 12 h postburn was significantly higher than the mean in Group 2 (56.4 +/- 4.3 pg mL-1). Group 4 had the highest mean TUNEL index (terminal deoxyuridine nick-end labelling--an index of extent of apoptosis) of all the groups (265/10). Also the mean TUNEL index value in Group 2 (53/10) was higher than that of Group 1 (3/10) and Group 3 (5/10). The proliferating cell nuclear antigen index (extent of proliferation) remained unchanged among groups.

CONCLUSIONS

Propofol could offer a protection against apoptosis of enterocytes with a stable tissue MDA and serum TNF-alpha level compared to ketamine anaesthesia in an animal model of burn injury.

Open labeled phase II observation study of gemcitabine plus cisplatin plus trastuzumab (GCT) in metastatic breast cancer patients with prior anthracyclines and taxanes exposures: Preliminary results

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Background: Trastuzumab provides significant clinical benefit in HER2 positive metastatic breast cancer. Gemcitabine and cisplatin (GC) combination is attractive treatment options for anthracyclines-taxanes-pretreated metastatic breast cancer. These agents demonstrated synergistic activity and minimal overlapping toxicity. On the other hand, additional synergistic activity was observed with trastuzumab and GC. Methods: Histologically confirmed metastatic breast cancer patients with FISH positive tumors (HER2/choromosome 17 ≥2) were eligible if they were at least one measurable disease; ≥18 and ≤70 years; life expectancy >3 month; ECOG 0–2; prior anthracyclines and taxanes treatment but no prior trastuzumab therapy; adequate marrow, renal and hepatic function. Treatment schedule was as follows: Gemcitabine 1000 mg/m2 and cisplatin 30 mg/m2 d1, 8 every 3 weeks conjunction with trastuzumab 4 mg/kg d1 and 2 mg/kg for weekly. Chemotherapy was scheduled for up to eight cycles. Treatment was discontinued in case of progression or prohibitive toxicity. After progression additional regimen was administered with trastuzumab. Results: Eleven women were enrolled. All patients were eligible for toxicity and efficacy evaluations. Median age was 48 (range 28–64) years and median ECOG performance status was 0. Ten patients (90.9%) had visceral metastases, most commonly located in the liver (8 pts) and lung (4 pts). Estrogen receptor positivity was 63.6% (7 pts). A total of 80 cycles were delivered with a median of 8 cycles. Objective response rate was 54.5% (6 pts) with 27.2% (3 pts) complete response and 27.2% (3 pts) partial response. Stabile disease was achieved 36.3% (4 pts). Median time to progression and overall survival were 8 (95% CI: 3.97–12.02) and 18 months (95% CI: 15.89–20.10) respectively. Grade 3–4 toxicity was observed in 18.1% (2 pts). Treatment of one patient was discontinued due to grade 4 thrombocytopenia. Dose reductions due to myelotoxicity were performed in 1 (9.0%) patients. Conclusions: Our preliminary data shows that gemcitabine and cisplatin and trastuzumab combination regimen is effective and has manageable toxicity profile.

No significant financial relationships to disclose.

The mutagenic and anti-mutagenic effects of Ecballium elaterium fruit juice in human peripheral lymphocytes

The aim of this study was to investigate the mutagenic and anti-mutagenic effects of Ecballium elaterium (EE) fruit juice which has an anti inflammatory effect using in vitro human peripheral lymphocytes. For the investigating the mutagenic effects of EE fruit juice, human peripheral lymphocytes was treated with three doses (18, 36 and 72 microl/1) of fruit juice alone for 24 and 48 h. For the investigating the anti-mutagenic effects of the EE fruit juice, the human lymphocytes also treated with the mixture of the fruit juice and 0.25 microg/ml MMC. EE fruit juice induced the percentage of total CA when used alone (especially the percentage of structural CA than the percentage of the numerical CA) and synergically induced the percentage of total CA when used as a mixture with MMC. EE fruit juice did not affect the SCE frequency for 24 and 48 h treatment time. In contrast, EE and MMC as a mixture, sinergically induced the SCE frequency at the highest concentration for 48 h treatment time only. EE alone did not decrease the RI while it decreased the MI as a dose dependent manner. EE and MMC as a mixture have the higher cytotoxic effect than the cytotoxic effects of EE alone. As a result, it can be concluded that, EE had no anti-mutagenic effect while EE had a mutagenic and a cytotoxic effect in human peripheral lymphocytes.

CYP17 genetic polymorphism in patients with endometrial hyperplasia and cancer

We investigated the association of CYP17 gene polymorphism with the risk of having endometrial cancer and a well-known precursor of it, endometrial hyperplasia. Group A (control group) consisted of 35 patients who had histologically proven normal endometrium. Group B and C consisted of 18 and 30 patients who had endometrial hyperplasia with and without atypia, respectively. Group D consisted of 57 patients who had endometrial cancer. Venous blood samples were collected from patients in groups, and polymerase chain reaction was performed to determine the CYP17 gene polymorphism. Significant increase of A1/A1 and a decrease of A1/A2 genotype frequencies have been determined in patients with endometrial cancer and with atypical endometrial hyperplasia. No significant differences were found between groups in the frequency of A2/A2 genotype. There was no significant difference between the groups in the meaning of allele distributions. CYP17 polymorphism had correlation with endometrial atypia and cancer. Related effects of different types of CYP17 gene variants on the progression of hyperplastic endometrial cells into carcinoma should be evaluated in further studies. Progress in this area would help us modulate preventive treatments used in those actual high–risk group patients.

Postoperative hypofractionated radiotherapy in glioblastoma multiforme

PURPOSE

To evaluate the safety and efficacy of hypofractionated radiotherapy (HRT) in glioblastoma multiforme (GM) patients in terms of overall and progression-free survival.

PATIENTS AND METHODS

Adult patients with GM were prospectively treated with HRT after total, subtotal or partial tumor excision. HRT was applied 3 days a week with a tumor dose of 3.33 Gy per fraction. At the first phase of treatment 12 fractions and at the second phase 3 fractions with smaller fields were delivered. The total dose was 50 Gy/15 fractions/5 weeks. The results were compared with a historical control group of GM patients treated with conventional RT.

RESULTS

20 patients with GM were treated between 1997-2000 at our department. The tumor was multifocal in one (5%) case. The types of operations used were total tumor excision 10(50%) cases, subtotal excision 5 (25%) cases and partial excision 5 (25%) cases. For the historical control group the corresponding operations were 19 (56%), 6 (18%) and 9 (26%). In the study group one-year survival was 50% and median survival 12 months. Mean overall survival was 13.5 (11.3 months for the historical control group, p=0.16) and progression-free survival 6.8 months (5.6 for the historical control group, p=0.36). Treatment was well tolerated. Acute toxicity was minimal and only one HRT patient had late toxicity (brain necrosis).

CONCLUSION

The mean overall survival with HRT was better but statistically non significant compared with the historical control group. Our study supports that HRT can be used instead of conventional and hyperfractionated radiotherapy and studies of HRT with higher doses may be meaningful.

Optical Properties of the Poly(N-benzylaniline) Thin Film

The optical properties of the poly(N-benzylaniline) thin film were investigated by optical characterization. The optical constants such as refractive index and dielectric constant were determined from the transmittance and reflectance spectra of the film. The refractive index dispersion was analyzed by the Wemple-DiDomenico model. The n(infinity) values changed from 6.37 to 5.71 and these values did not show any certain trend with annealing temperatures. The average oscillator parameter So value, which is the strength of the individual dipole oscillator, was found to be in the range of 1.15 x 10(13) to 1.03 x 10(13) m(-2). The optical band was determined from the direct optical transitions in K space. The optical band Eg of the film decreases from 2.089 to 2.046 eV with increasing annealing temperatures while the Urbach energy Eu called the width of localized states in the optical band gap increases from 0.544 to 0.598 eV. Consequently, the optical constants and optical band gap of the poly(N-benzylaniline) change with the annealing temperatures.

The effects of rosiglitazone and metformin on insulin resistance and serum androgen levels in obese and lean patients with polycystic ovary syndrome

AIM

The aim of this study was to assess the effects of metformin and rosiglitazone on insulin resistance and serum androgen levels in both obese and lean patients with polycystic ovary syndrome (PCOS).

MATERIALS AND METHODS

Forty lean [body mass index (BMI) < 25 kg/m2] and 40 overweight and obese (BMI > 25 kg/m2) patients were included in the study. Waist and hip measurements, serum sex steroid levels, insulin response to 75-g oral glucose tolerance test, fasting insulin, fasting C-peptide levels and homeostasis model assessment of insulin resistance (HOMA-IR) were determined in all patients. The degree of hirsutism was determined by the Ferriman-Gallwey scoring system. Patients were divided into two groups, with 40 (20 overweight and obese; 20 non-obese) patients each. One group was treated with metformin (MET group) 850 mg bid while the other received rosiglitazone (ROSI group) 4 mg/day for 12 weeks. All measurements were repeated at the end of this period.

RESULTS

After the 12-week treatment period, HOMA-IR, area under the curve of insulin, fasting insulin and C-peptide levels were observed to have be decreased significantly in all groups. The decrease in the parameters mentioned above was similar in the four groups. The serum levels of free testosterone, androstenedione and DHEA-S decreased in all groups, but the decrease was statistically significant only in the ROSI groups. Within the lean MET group one patient became pregnant and was hence excluded from the final data analysis. Menstruations became regular after metformin therapy in 41.6% of lean and 35.7% of obese patients who had menstrual disturbance prior to the study. Rosiglitazone therapy improved menstrual disturbance in 61.5 % of lean and 53.8% of obese patients.

CONCLUSIONS

Our data showed that both metformin and rosiglitazone increased insulin sensitivity in obese patients with PCOS as expected, and in lean patients as well. Rosiglitazone seemed to be more effective in decreasing the androgen levels and in achieving slightly greater improvement in menstrual disturbance than metformin.

The pre-emptive analgesic effect of intra-articular bupivacaine in arthroscopic knee surgery

BACKGROUND

The purpose of this study was to determine whether intra-articular injection of bupivacaine prior to surgery provided better pain control after arthroscopic meniscectomy as compared with post-operative administration of bupivacaine.

METHODS

Forty patients of American Society of Anesthesiologists (ASA) class I or II undergoing arthroscopic meniscectomy were assigned in a randomized, double-blinded manner into two groups: Group I received 20 ml of 2.5 mg/ml bupivacaine without epinephrine 30 min before skin incision and 20 ml of saline immediately after skin closure. Group II received identical injections in reverse order. All patients received total intravenous anesthesia. Post-operative pain scores were evaluated at 1, 2, 4, 6, 8, 12 and 24 h at rest and movement of the knee, using a 10-cm visual analog scale (VAS). The time to first analgesic use and 24-h analgesic consumption were recorded.

RESULTS

Pain scores were lower in Group I compared with Group II at 1, 2, 4 and 6 h at rest and on movement (P < 0.05). The time to first analgesic use was longer in Group I, but there was no statistically significant difference in 24-h analgesic consumption.

CONCLUSION

Intra-articular bupivacaine administered before surgery provided a statistically significant reduction in post-operative pain scores compared with post-operative bupivacaine administration.