Protective effect of ursodeoxycholic acid and resveratrol against tacrolimus induced hepatotoxicity

Tacrolimus (TAC) is a potent and well-tolerated immunosuppressive drug, but serious side effects including nephrotoxicity and hepatotoxicity have been reported. Ursodeoxycholic acid (UDCA) and resveratrol (RSV) exhibit hepatoprotective effects in liver diseases. We investigated the hepatoprotective effect of UDCA and RSV against TAC induced hepatotoxicity. We divided 40 male rats into five equal groups: A) control group, B) TAC group, C) TAC + UDCA group, D) TAC + RSV group, E) TAC + UDCA + RSV group. We administered 0.5 mg/kg TAC once daily, 25 mg/kg UDCA twice daily and 10 mg/kg RSV once daily. The drugs in the experimental groups were given by gavage from the first day of the study and continued for 21 days. Histopathologic and biochemical analyses were performed on day 22. In group B, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), tumor necrosis factor-alpha (TNF), interleukin-1 (IL-1), interleukin-6 (IL-6), total oxidative status (TOS) and malondialdehyde (MDA) levels were higher compared to group A, and catalase (CAT), superoxide dismutase (SOD) levels and total antioxidant status (TAS) were lower compared to group A. Severe cellular swelling, degeneration and focal necrosis were more evident in group B than in groups C-E. Histopathological improvement was observed in groups C-E, where UDCA and RSV were combined, compared to group B. We found that UDCA and RSV, together or separately, protected the liver against oxidative stress damage caused by TAC.

Insulin and Heparin Therapies in Acute Pancreatitis due to Hypertriglyceridemia

OBJECTIVE

To compare insulin infusion and heparin infusion, used to treat hypertriglyceridemia-induced acute pancreatitis in terms of efficacy.

STUDY DESIGN

Descriptive study.

PLACE AND DURATION OF STUDY

Department of Gastroenterology, Division of Internal Disease, Sivas Cumhuriyet University Hospital, Sivas, Turkey, from 1st January 2013 to 1st  January 2020.

METHODOLOGY

Patients who presented with abdominal pain and were found to have edematous pancreatitis on computed tomography imaging were retrospectively reviewed. Thirty-six patients with hypertriglyceridemia were included. Eighteen of the patients were given insulin infusion, while the other 18 were given heparin infusion therapy. The patients' gender, age, admission amylase values, AST, ALT, total cholesterol, glucose, lactate dehydrogenase (LDH), CRP, leukocyte, pre-treatment and post-treatment first, second, and third-day triglyceride levels were recorded from the files.

RESULTS

The post-treatment third-day triglyceride levels of the insulin therapy group were statistically significantly lower compared to the heparin therapy group (432.5; 984, p<0.001, respectively).   Conclusion: Insulin infusion, in addition to fluid therapy and electrolyte imbalance, was more effective than heparin therapy in patients with hypertriglyceridemia-induced acute pancreatitis. Key Words: Hypertriglyceridemia-induced acute pancreatitis, Insulin therapy, Heparin therapy.

Colonic fibronectin and E-cadherin in mild ulcerative colitis

BACKGROUND

Although fibronectin has an important role in wound repair, nearly no human studies to date have investigated its condition in ulcerative colitis (UC) histologically. E-cadherin plays a critical role in the repair of normal epithelial tissues. This study aims to find out the condition of these two molecules in UC.

MATERIAL AND METHODS

The records of 22 UC patients during the period of 2004‒2009 were retrospectively analyzed. We also included 24 patients with sporadic colorectal cancer (SCC) and 24 patients with normal colonoscopic biopsies who served as the control group. Colonoscopic biopsies were stained with E-cadherin and fibronectin.

RESULTS

The E-cadherin loss was significantly more prominent in the SCC group, followed by the UC group and control group. The situation was reverse for fibronectin. We also observed that while the E-cadherin loss was still ongoing in all of the endoscopically inactive cases, the fibronectin staining resembled the staining pattern of normal individuals in ten out of thirteen UC patients.

CONCLUSION

We suggest that the decrease in E-cadherin, even in the inactive period, might be the cause of why UC is not just a compensatory change in repair of inflammation. The results of staining with fibronectin in UC patients were between normal individuals and SCC patients. Further studies are necessary to confirm our results (Tab. 2, Fig. 6, Ref. 15). Text in PDF www.elis.sk Keywords: ulcerative colitis, fibronectin, E-cadherin.

Are clarithromycin, azithromycin and their analogues effective in the treatment of COVID19?

BACKGROUND

SARS-CoV-2, which started in Wuhan and later affected the whole world, is the most important disease of the world today. Many ways to inhibit SARS-CoV-2 virus are sought to prevent the spread of this virus. Azithromycin and clarithromycin are considered for the treatment of the SARS-CoV-2 virus, which has a high similarity to previous colonic diseases.

AIM

We aimed to determine whether azithromycin and clarithromycin, the RNA-dependent RNA polymerase protein inhibitor used in the treatment of COVID-19, is effective against SARS Cov-2 in silico.

RESULTS AND CONCLUSION

The 503 analogues of azithromycin and clarithromycin were studied to target SARS-CoV-2 the RNA-dependent RNA polymerase protein inhibition. Maestro program was used to compare the inhibition activities of these analogues. A detailed comparison was made using the numerical value of many parameters obtained. ADME / T properties were then examined to determine the effects and reactions of analogues on human metabolism. In this study, the SARS-CoV2 virus is 6NUR and 6NUS, which is the RNA-dependent RNA polymerase protein. Among these proteins, the best inhibitor among the 503 analogues according to the docking score parameter was 9851445 with a great difference. This analogue was an analogue of azithromycin (Tab. 3, Fig. 6, Ref. 58).

CNC router selection under dynamic fuzzy environment

To cut several types of hard materials in manufacturing, Computer Numeric Control (CNC) router machines are commonly used. The tasks to be done by different machines can be performed by a single CNC router machine. Production of parts with better quality is possible at lower costs by production with CNC router machines, and these machines improve the productivity of manufacturing system. For these reasons, determination of the appropriate CNC router machine for manufacturing systems is a crucial decision. Different factors related to properties of machines are effective on the decision. Therefore, decision makers must include different effective aspects into decision process. Under this consideration, an analytic selection procedure for CNC router machines by taking uncertain expressions of experts on the selection criteria and variable values occur over time is proposed in this study. In order to handle the modelling difficulty of uncertainty of the statements and the value changes by time, dynamic intuitionistic multi attribute decision making is used to select the best CNC router. Applicability of the proposed selection procedure is demonstrated on an application, and a comparative analysis with dynamic neutrosophic multi attribute decision making is presented.

Late referral of cancer patients with malnutrition to dietitians: a prospective study of clinical practice

PURPOSE

Malnutrition (MN) in cancer is common but underdiagnosed. Dietitian referrals may not occur until MN is established. We investigated cancer patient characteristics (demographics, nutritional status, and nutrition barriers) on referral to oncology dietitians. We also examined referral practices and prevalence of missed referral opportunities.

METHODS

This was a naturalistic multi-site study of clinical practice. Data from consecutive referrals were collected in inpatient and outpatient settings. Demographics, nutritional status (weight, body mass index (BMI), weight loss in the preceding 3-6 months, oral intake, nutrition barriers), referral reasons, and use of screening were recorded. Missed opportunities for earlier referral were also noted.

RESULTS

Two hundred patients were included (60% male, 51% inpatients). Half had gastrointestinal and hepatobiliary cancers. The majority were on antitumor treatment. Two-thirds had lost ≥ 5% body weight. Forty percent were overweight or obese. Seventy percent had ≥ 2 nutritional barriers. Most common nutrition barriers were anorexia, nausea, and early satiety. Greater weight loss and lower food intake were associated with ≥ 2 barriers. Weight loss was the most common referral reason. Screening was used in 35%. Referrals should have occurred sooner in nearly half (45%, n = 89).

CONCLUSIONS

Cancer patients were referred late to a dietitian, with multiple nutritional barriers. Most referrals were for established weight loss (WL). WL may be masked by pre-existing obesity. Almost half had missed earlier referral opportunities; screening was infrequent. Over one-quarter should have been re-referred sooner. There is a clear need for clinician education. Future research should investigate the optimal timing of dietitian referral and the best nutrition screening tools for use in cancer.

Comparison of the mechanical properties of platelet-rich fibrin and ankaferd blood stopper-loaded platelet-rich fibrin

Background and Aim

Platelet-rich fibrin (PRF) can be named as a natural fibrin-based biomaterial favorable to increasing vascularization and able to guide epithelial cell migration to its surface. The membrane has a significant positive effect on protecting open wounds and accelerating healing. Similar to PRF Ankaferd Blood Stopper (ABS) also has positive effects on wound healing. The aim of this study was to detect if we can improve known physical properties of PRF combining with ABS. This idea was based on the known mechanism of ABS in forming protein network without damaging any blood cells. Materials and Methods: A total of 25 adult rabbits used for collecting 5-7 ml of blood passively with the help of winged blood collection needle to the test tube. Collected samples were centrifuged at 3000 rpm for 10 min. Two similar samples obtained from each animal and one of the samples was placed in 20% ABS 80% saline solution for 5 min. Mechanical properties of the membrane samples were measured using Universal Testing Machine. Results: There is the statistically significant difference between PRF and ABS added PRF in elongation/mm (dL) and elongation/% at break values. Maximum force (fMax) and modulus values did not show any statistically significant differences.

Conclusion

ABS loaded PRF causes better physical properties. This combination seems to exhibit superior performance when used as a membrane barrier solely. Advanced studies can be done on biological properties of ABS loaded PRF, especially on tissue healing.

Recurrence rate of odontogenic keratocyst treated by enucleation and peripheral ostectomy: Retrospective case series with up to 12 years of follow-up

Background

Odontogenic keratocysts have been reported with high recurrence rates in the literature so various treatment modalities from simple enucleation to resection have been performed to achieve the cure. The purpose of this retrospective study was to investigate the recurrence rate of odontogenic keratocysts (OKCs) treated by enucleation and peripheral ostectomy.

Material and Methods

An electronic search of the database of the Hacettepe University, Faculty of Medicine, Department of Pathology, was undertaken to identify patients histologically diagnosed with OKCs treated at Department of Oral and Maxillofacial Surgery between 2001 and 2015.

Results

In total, 81 patients were studied. The mean age at the time of diagnosis was 42 years, and the male:female ratio was 1:0.7. OKCs were located primarily in the posterior mandibular region (41%). Twenty-seven patients were re-examined to determine the recurrence rate. The mean follow-up period was 5 years (range, 1–12 years). The recurrence rate was 14.8%. The relationship between location of the lesion and recurrence was not statistically significant (p = 0.559). There was also no statistically significant relation between the recurrence rate and treatment option of teeth involved in the lesion (p = 0.579).

Conclusions

The authors conclude that treatment of OKCs by enucleation with peripheral ostectomy is associated with minimal morbidity and is preferred over other aggressive treatment modalities. Meticulous radiographic examination and careful surgical resection may decrease the recurrence rate of OKCs.

Key words:Odontogenic keratocyst, recurrence rate, enucleation, enucleation plus peripheral ostectomy.

Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction?

BACKGROUND

Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies.

OBJECTIVES

The aim of this study was to determine whether there is an association between middle cerebral artery Doppler impedance and its ratio with the umbilical artery in relation to neonatal and 2 year infant outcome in early fetal growth restriction (26⁺⁰-31⁺⁶ weeks of gestation). Additionally we sought to explore which ratio is more informative for clinical use.

STUDY DESIGN

This is a secondary analysis from the Trial of Randomized Umbilical and Fetal Flow in Europe, a prospective, multicenter, randomized management study on different antenatal monitoring strategies (ductus venosus Doppler changes and computerized cardiotocography short-term variation) in fetal growth restriction diagnosed between 26⁺⁰ and 31⁺⁶ weeks. We analyzed women with middle cerebral artery Doppler measurement at study entry and within 1 week before delivery and with complete postnatal follow-up (374 of 503). The primary outcome was survival without neurodevelopmental impairment at 2 years corrected for prematurity. Neonatal outcome was defined as survival until first discharge home without severe neonatal morbidity. Z-scores were calculated for middle cerebral artery pulsatility index and both umbilicocerebral and cerebroplacental ratios. Odds ratios of Doppler parameter Z-scores for neonatal and 2 year infant outcome were calculated by multivariable logistic regression analysis adjusted for gestational age and birthweight p50 ratio.

RESULTS

Higher middle cerebral artery pulsatility index at inclusion but not within 1 week before delivery was associated with neonatal survival without severe morbidity (odds ratio, 1.24; 95% confidence interval, 1.02-1.52). Middle cerebral artery pulsatility index Z-score and umbilicocerebral ratio Z-score at inclusion were associated with 2 year survival with normal neurodevelopmental outcome (odds ratio, 1.33; 95% confidence interval, 1.03-1.72, and odds ratio, 0.88; 95% confidence interval, 0.78-0.99, respectively) as were gestation at delivery and birthweight p50 ratio (odds ratio, 1.41; 95% confidence interval, 1.20-1.66, and odds ratio, 1.86; 95% confidence interval, 1.33-2.60, respectively). When comparing cerebroplacental ratio against umbilicocerebral ratio, the incremental range of the cerebroplacental ratio tended toward zero, whereas the umbilicocerebral ratio tended toward infinity as the values became more abnormal.

CONCLUSION

In a monitoring protocol based on ductus venosus and cardiotocography in early fetal growth restriction (26⁺⁰-31⁺⁶ weeks of gestation), the impact of middle cerebral artery Doppler and its ratios on outcome is modest and less marked than birthweight and delivery gestation. It is unlikely that middle cerebral artery Doppler and its ratios are informative in optimizing the timing of delivery in fetal growth restriction before 32 weeks of gestation. The umbilicocerebral ratio allows for a better differentiation in the abnormal range than the cerebroplacental ratio.

Role of interlekin-35 as a biomarker in patients with newly diagnosed Hashimoto’s thyroiditis

Objective. Interleukin-35 (IL-35), an interleukin-12 (IL-12) cytokine family member, is shown to be a potent immunosuppressive and anti-inflammatory cytokine. Inducible regulatory T cells (Tregs) produce IL-35 that mediates the immune inhibitory function of Tregs. Growing evidence revealed that upregulation of IL-35 expression may play a critical role in the prevention of autoimmune diseases in various experimental autoimmunity models and vice versa. Hashimoto’s thyroiditis (HT) is considered to be a Treg cell-related autoimmune disease with loss of self-tolerance.

Methods. One hundred-twenty eight subjects, newly diagnosed hypothyroid HT patients [56 overt (Group 1), 72 subclinical hypothyroid (Group 2)] and 38 healthy controls (Group 3) were enrolled in the study. The levels of serum IL-35 were determined by enzyme-linked immunosorbent assay (ELISA).

Results. Serum IL-35 levels were lower in the HT group when compared with subclinical HT group [304.5 (834.6) pg/ml vs. 636.1 (1542.0) pg/ml, p=0.004] and control cases [304.5 (834.6) pg/ml vs. 1064.7 (2526.8) pg/ml, p<0.001]. Serum IL-35 levels were inversely associated with thyroid stimulating hormone (TSH; rs=-0.396, p<0.001) and anti-thyroid peroxidase antibodies (TPOAb; rs=-0.571, p<0.001) in whole group. Serum IL-35 were negatively associated with TSH (rs=-0.264, p=0.003) and TPOAb (rs=-0.735, p<0.001) in patients with Hashimoto’s thyroiditis (Group 1 + Group 2).

Conclusion. The results suggest that IL-35 may play a role in the pathogenesis of HT.

Aortic Elastic Properties and Myocardial Performance Index Are Impaired in Patients with Lichen Planus

OBJECTIVES

The aim of this study was to investigate the elastic properties of the aorta and the myocardial performance index of the left ventricle (LV) in patients with lichen planus (LP).

SUBJECTS AND METHODS

A total of 54 patients with LP and 50 controls were enrolled in the study. The 2 groups were well-matched regarding age, gender, body mass index, any smoking history, diabetes mellitus and systolic and diastolic blood pressure (SBP and DBP). The echocardiographic examination was performed on the study subjects and the controls. Aortic elasticity parameters and the myocardial performance index of the LV were calculated. The Student t test, the x03C7;2 test and multiple linear regression were used for the statistical analysis.

RESULTS

Aortic strain (AS, 4.77 ± 1.81 vs. 8.95 ± 2.22; p < 0.001) and aortic distensibility (AD, 0.25 ± 0.009 vs. 0.42 ± 0.120; p < 0.001) were significantly lower, and aortic stiffness index β (ASIβ, 3.65 ± 1.03 vs. 2.70 ± 0.91; p < 0.001) was significantly higher in the LP group than in the controls. The myocardial performance index (Tei index) was significantly higher in the LP group than in the control group (p = 0.001). The duration of the LP was negatively correlated with AS (r = -0.364, p < 0.001) and AD (r = -0.279, p = 0.006), and positively correlated with the Tei index (r = 0.324, p = 0.001) and ASIβ (r = 0.364, p < 0.001). After adjustment for relevant confounders (age, male gender, smoking, SBP, DBP, diabetes mellitus and low- and high-density lipoprotein cholesterol), LP and its duration were still associated with AS, AD and ASIβ.

CONCLUSION

In this study, AS and AD were lower and ASIβ and myocardial performance index higher in LP patients than in controls.

Methylenetetrahydrofolate Reductase gene polymorphism in children with allergic rhinitis

BACKGROUND

Methylenetetrahydrofolate Reductase (MTHFR) polymorphisms by impairing folate metabolism may influence the development of allergic diseases. The results of studies evaluating the relationship between MTHFR polymorphisms and atopic disease are controversial. The aim of this study was to investigate the association between the polymorphisms of C677T and A1298C for MTHFR gene and allergic rhinitis (AR) in children.

METHODS

Ninety patients followed up with diagnosis of allergic rhinitis in our clinic and 30 children with no allergic diseases were included in the study. All participants were genotyped for the MTHFR (C677T) and (A1298C) polymorphisms. Vitamin b12, folate and homocysteine levels were measured.

RESULTS

The mean age of patients was 9.2±2.9 years; 66.7% of the patients were male. There was no significant difference between patient and control groups regarding gender, age and atopy history of the family (p>0.05). The frequency of homozygotes for MTHFR C677T polymorphism in the patient and control groups was 3.3% and 10%, respectively. The frequency of homozygotes for MTHFR A1298C polymorphism among groups was 26.7% and 16.7%, respectively. The association between allergic rhinitis and polymorphisms of C677T and A1298C for MTHFR gene was not statistically significant in patients compared with controls (p>0.05). There were no statistically significant differences between the patients and the control group in terms of serum vitamin b12, folate and homocysteine levels (p>0.05).

CONCLUSION

We found no evidence for an association between allergic rhinitis and polymorphisms of C677T and A1298C for MTHFR gene in children. Further studies investigating the relationship between MTHFR polymorphism and AR are required.

Plasma GDF-15 levels and their association with hormonal and metabolic status in women with polycystic ovary syndrome aged 25-35

AIM

We aimed to determine plasma levels of growth differentiation factor (GDF)-15 and their possible association with hormonal and metabolic status as well as echocardiographic profiles and carotid artery intima-media thickness (CAIMT) measurements in patients with polycystic ovary syndrome (PCOS).

METHODS

Forty-two obese PCOS women aged 25-35 years, 23 women with idiopathic hirsutism and 20 healthy controls matched for age and body mass index were enrolled. Anthropometric, metabolic and hormonal patterns, plasma GDF-15 concentrations, CAIMT, and conventional echocardiographic parameters were measured.

RESULTS

Metabolic/lipid profiles as well as GDF-15 levels were similar across the three groups. CAIMT tended to be higher in PCOS group but did not reach statistical significance. No between-group differences were found in the conventional echocardiographic parameters. Analysis of PCOS patients showed a significant correlation of GDF-15 concentrations with age and homeostasis model assessment (HOMA) index (r=0.319, P<0.05, and r=0.312, P<0.05, respectively). In multiple linear regression analyses, GDF-15 was significantly associated with age (r2=0.102, P<0.05), and HOMA index (r2=0.10, P<0.05).

CONCLUSION

Plasma GDF-15 levels, CAIMT and conventional echocardiographic parameters in obese subjects with PCOS (25-35 yrs old) were comparable to those in either subjects with idiopathic hirsutism or healthy controls with similar anthropometric and metabolic profiles, suggesting that PCOS alone could not impart an early and higher risk independent of associated risk factors. GDF-15 might provide a link between future diabetes and cardiovascular risk in PCOS women.

Possible role of selective serotonin reuptake inhibitor sertraline on oxidative stress responses

The naphthylamine derivative sertraline is a potent and selective inhibitor of serotonin reuptake into presynaptic terminals and the most widely used that has been shown to have both antidepressant and antianxiety effects. In the present study the possible role of sertraline (acute and chronically doses) was evaluated on lipid peroxidation levels and antioxidant enzyme activities in plasma and brain tissues of (10, 40, 80 mg/kg) sertraline treated Wistar albino rats (n=48). Lipid peroxidation levels (MDA) of plasma and brain tissue increased in all acute and chronic sertraline treated rats (p < 0.05). According to results of present study superoxide dismutase (SOD) levels of brain tissue decreased while plasma levels increased (p < 0.05) as compared with vehicle group. Catalase (CAT) levels of plasma and brain tissue and paraoxonase (PON) levels of plasma decreased (p < 0.05) as compared with vehicle group. Based on the data, it can be concluded that high dose sertraline administration enhances oxidative stress. Therefore, dose adjustment in depression patients seems significant as it may help prevention of further prognosis of the diseases.

Search for lepton flavour violation in the eμ continuum with the ATLAS detector in [Formula: see text]pp collisions at the LHC

This paper presents a search for the t-channel exchange of an R-parity violating scalar top quark ([Formula: see text]) in the e±μ∓ continuum using 2.1 fb-1 of data collected by the ATLAS detector in [Formula: see text]pp collisions at the Large Hadron Collider. Data are found to be consistent with the expectation from the Standard Model backgrounds. Limits on R-parity-violating couplings at 95 % C.L. are calculated as a function of the scalar top mass ([Formula: see text]). The upper limits on the production cross section for pp→eμX, through the t-channel exchange of a scalar top quark, ranges from 170 fb for [Formula: see text] to 30 fb for [Formula: see text].

Resistin levels in preterms: are they influenced by fetal inflammatory course?

OBJECTIVE

Many different factors are involved in the pathogenesis of preterm deliveries and among them maternal or perinatal infections and inflammatory response have the major role. Researches were carried out about resistin, which is thought to have a role in inflammatory cytokine cycle and it was shown to be associated with growth in neonates. However, no research has been carried out showing its relationship with inflammation in neonates. In this study, we aimed to evaluate the resistin levels in premature neonates and the effect of events such as preterm prelabour rupture of the membranes (PPROMs) and the use of antenatal steroids on these levels.

STUDY DESIGN

The study included 118 preterm neonates. Their medical data together with their mothers' were recorded. Serum resistin levels together with interleukin (IL)-6, C-reactive protein (CRP) and procalcitonin were evaluated in the first 2 h of life.

RESULT

Mean gestational age and birth weight of babies included in the study were 29.6 ± 2.7 weeks and 1306.4 ± 393.4 g, respectively. Babies with PPROMs had significantly higher levels of resistin ((n=30); 70.7 (7.8 to 568.4) ng ml(-1)) than babies without PPROM ((n=88); 25.9 (5.5 to 528.9) ng ml(-1)) (P=0.005), and the babies of mothers who received antenatal steroids had significantly lower resistin levels ((n=44); 20.8 (5.5 to 159.9) ng ml(-1)) than the babies of mothers who did not ((n=66); 34.6 (7.2 to 568.4) ng ml(-1)) (P=0.015). There were significant correlations between resistin and IL-6 levels and between IL-6 and procalcitonin and CRP levels in babies whose mothers did not receive antenatal steroids. However, no correlation was found between these parameters in babies whose mothers received antenatal steroids.

CONCLUSION

Preterm delivery and PPROM involve complex cascade of events including inflammation, and steroids are potent anti-inflammatory agents. Elevated resistin levels in babies with PPROM and suppressed levels in babies whose mothers received antenatal steroids reported in this study might have been observed as a result of the effects of fetal inflammation on resistin levels.

Usefulness of hepatobiliary scintigraphy for the evaluation of living related liver transplant recipients in the early postoperative period

AIM

The aim of this study was to investigate the usefulness of hepatobiliary scintigraphy for the evaluation of liver grafts in the early postoperative period in patients receiving liver transplants from living related donors.

MATERIALS AND METHODS

Fifty-six liver transplant recipients who received grafts from living related donors were included in the study. We examined the hepatobiliary scintigraphies of all patients, which were performed 7 to 10 days after the transplantation. The scintigraphic images were evaluated visually in terms of hepatic parenchymal function and biliary and vascular complications.

RESULTS

In 44/56 recipients, hepatobiliary scintigraphy was completely normal in the early postoperative period. However, in 6/56 cases, scintigraphy was interpreted to show parenchymal dysfunction. In these patients, histopathologic confirmation by biopsies revealed four cases of hepatocellular damage/cholestasis, one acute rejection, and one cholangitis. In 3/56 patients, hepatobiliary scintigraphy demonstrated a hypoactive area in the liver graft; however, the other areas showed normal function. When the abdominal computed tomography (CT) and CT angiography were evaluated, these hypoactive areas were discovered to be related to minor vascular problems. In 3/56 liver graft recipients whose grafts showed normal parenchymal function scintigraphically, images were interpreted to indicate bile leak because accumulation of tracer was seen at an abnormal physiological site.

CONCLUSION

Hepatobiliary scintigraphy, which is a noninvasive and objective method, is useful to assess grafts in the early postoperative period among patients who received liver transplants from living related donors.

The effect of anesthetic technique on early postoperative renal function after donor nephrectomy: a preliminary report

General and regional anesthesia may both be used successfully in donor nephrectomy although the use of regional anesthesia is rare. We compared the remaining kidney function during general (n = 10) versus combined spinal-epidural (n = 10) anesthesia for donor surgery. Blood biochemistry data were collected preoperatively and postoperatively, while renal function was assessed by scintigraphy and urine levels of microalbumin, creatinine, Na, K, Ca and creatinine clearance rate were measured/calculated in 24-hour urine samples collected preoperatively and on postoperative day 2. There were no differences preoperatively and on postoperative day 2 with respect to glomerular filtration rate, microalbuminuria, or creatinine clearance rate (P > .05 for all). There were also no differences between the groups with respect to other scintigraphic findings preoperatively and on postoperative day 2 (P > .05 for all). The results suggest that general or combined spinal-epidural anesthesia for donor nephrectomy have similar effects on the remaining donor kidney function.

Treatment of viable cesarean scar ectopic pregnancy with suction curettage

OBJECTIVE

Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy. All reported cases in the literature that were treated with uterine curettage either become unsuccessful or complicated. We aimed to present a case of cesarean scar ectopic pregnancy that was successfully treated with suction curettage without any additional therapy.

CASE

A 32-year-old asymptomatic woman, gravida 2, para 1 was referred to our hospital with the possible diagnosis of cervical ectopic pregnancy. Transvaginal and transabdominal sonographic examination revealed the diagnosis of viable ectopic pregnancy in a previous cesarean scar. Suction curettage with carman canulles was performed under transabdominal ultrasonographic guidance. beta-hCG decreased progressively postoperatively.

CONCLUSION

Suction curettage under ultrasonography guidance can be used in termination of selected cases (early diagnosed, without symptoms that necessitates emergency intervention) of cesarean scar pregnancy.

Evaluation of glucose metabolism and reproductive hormones in polycystic ovary syndrome on the basis of peroxisome proliferator-activated receptor (PPAR)-γ2 Pro12Ala genotype

BACKGROUND

Peroxisome proliferator-activated receptor (PPAR)-gamma2 Pro12Ala polymorphism has been suggested as a protective factor for polycystic ovary syndrome (PCOS). In this study, we aimed to investigate metabolic features and reproductive hormones in women with PCOS and compare these features with control women on the basis of Pro12Ala genotype.

METHODS

This study involved 60 randomly selected women with PCOS and 60 controls. Main outcome measures were anthropometric measures, variables of glucose metabolism and reproductive hormones. All the patients were genotyped for Pro12Ala variant of PPAR-gamma2 gene.

RESULTS

Patients with Pro12Ala polymorphism were more obese in both groups. Furthermore, they had lower fasting insulin levels, were less insulin-resistant and were less glucose-intolerant as demonstrated by 2 h glucose concentrations. However, there was no difference in reproductive hormone levels on the basis of Pro12Ala genotype.

CONCLUSIONS

Both control women and women with PCOS had significant differences in glucose metabolism on the basis of PPAR-gamma2 Pro12Ala polymorphism. Pro12Ala variant may break the process that leads to PCOS in susceptible women, instead of being a direct causal relationship between Pro12Ala polymorphism and PCOS.

The importance of IRS-1 Gly972Arg polymorphism in evaluating the response to metformin treatment in polycystic ovary syndrome

BACKGROUND

Recent evidence suggests that one of the modes of action of metformin may be through phosphorylation of the insulin receptor and insulin receptor substrates. With this in mind, we supposed that the G972A variant of insulin receptor substrate-1 (IRS-1) may modulate the response to metformin treatment in women with polycystic ovary syndrome (PCOS).

METHODS

This preliminary study involved 60 randomly selected women with PCOS. All patients received dietary instructions and metformin 500 mg three times daily for 6 months. Main outcome measures were androgen levels, parameters of glucose and insulin metabolism and anthropometric variables. After a second evaluation of the patients at 6 months, they were genotyped for the Gly972Arg variant of the IRS-1 gene.

RESULTS

Metformin had differential effects on fasting insulin levels, insulin resistance as demonstrated by homeostasis model assessment (HOMA), LH, total testosterone, dehydroepiandrosterone sulphate and free testosterone index on the basis of IRS genotype. The response to metformin therapy in other parameters was not different according to IRS genotype.

CONCLUSION

There was a differential effect of metformin therapy in PCOS women on the basis of IRS genotype. This study may call attention to the importance of molecular markers in the management of women with PCOS.

Silent coronary artery disease in patients with type 2 diabetes mellitus

The purpose of this study was to estimate the prevalence and risk factors of silent CAD in asymptomatic type 2 diabetic patients aged over 40 years. A total of 172 asymptomatic type 2 diabetic patients, mean age 54.42 years, with normal resting electrocardiogram were included in the study. Technetium-99m (Tc-99m) tetrofosmin cardiac single photon emission computed tomography myocardial scintigraphy with exercise testing or dipyridamole injection was performed on all patients. If this test was positive, coronary angiography was carried out and was considered to be positive with a stenosis of > or =70%. Abnormal perfusion pattern was found in 14 patients (8.14%). Significant coronary artery stenosis was found in 13 subjects (7.56%), confirming a high positive predictive value (92.86%) of this diagnostic procedure. A significant correlation was observed between silent CAD and male sex, retinopathy, hypertension, post-prandial blood glucose level, and low HDL-cholesterol level. Sex (OR=4.026; 95% CI, 1.187-13.659), hypertension (OR=5.564; 95% CI, 1.446-21.400) and retinopathy (OR=3.766; 95% CI, 1.096-12.948) were risk factors for CAD. Overall, 14.06% of asymptomatic male patients with type 2 diabetes mellitus presented silent CAD with significant angiographically documented coronary stenosis. This finding, along with the high positive predictive value of a noninvasive technique, indicates that routine screening for silent CAD would be useful in this patient subgroup especially when they have retinopathy or hypertension.

Thirty-one cases of Marjolin's ulcer

Marjolin's ulcer is a rare and often aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. We reviewed 264 burns cases treated in our departments to assess the frequency and clinicopathological features of this malignant complication. We found 31 cases of Marjolin's ulcer and a further 14 cases of nonmalignant ulceration at previous burn sites. Eighteen Marjolin's ulcers were located on the extremities, six on the scalp, six on the trunk, and one on the nose. Most malignancies were squamous cell carcinomas. The average time lag between the burns and subsequent malignant ulceration was 19 years. Four of the malignant ulcers had spread to regional lymph nodes, but there were no distant metastases. This study emphasizes that Marjolin's ulcer should be considered as a significant postburn complication.

Thirty-one cases of Marjolin's ulcer

Marjolin's ulcer is a rare and often aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. We reviewed 264 burns cases treated in our departments to assess the frequency and clinicopathological features of this malignant complication. We found 31 cases of Marjolin's ulcer and a further 14 cases of nonmalignant ulceration at previous burn sites. Eighteen Marjolin's ulcers were located on the extremities, six on the scalp, six on the trunk, and one on the nose. Most malignancies were squamous cell carcinomas. The average time lag between the burns and subsequent malignant ulceration was 19 years. Four of the malignant ulcers had spread to regional lymph nodes, but there were no distant metastases. This study emphasizes that Marjolin's ulcer should be considered as a significant postburn complication.

A case of folliculitis decalvans involving the beard, face and nape

Folliculitis decalvans is a rare and chronic progressive hair disorder leading to scarring alopecia and atrophy. Its etiology is still unclear. It starts with areas of perifollicular erythema, and follicular papules and pustules spread peripherally, leaving central scarred patches of alopecia. We report a 27-year-old man who presented with folliculitis decalvans involving the scalp, face, nape, and beard. There were pustules, crusts, and scarring alopecia on the scalp and beard.

From donor to recipient. Doppler US, power US and scintigraphy of kidney perfusion before and after transplantation

PURPOSE

To follow kidneys from the donor to the recipient by assessing whether perfusion changes occur by using duplex Doppler US, power Doppler US and scintigraphy.

MATERIAL AND METHODS

The prospective study included 12 donors and their corresponding 12 recipients. For each donor, both donor kidneys were evaluated by duplex Doppler US, power Doppler US and scintigraphy 1 day before surgery. The same procedure was carried out on the renal allografts at days 1, 3, 5 and months 1 and 3 post-transplantation. Power Doppler findings were classified according to a grading system of 1 to 4. Resistive indices (RIs) were determined based on interlobar and segmental arterial flow. Peak systolic velocity and RIs of the main renal artery were also measured. A perfusion parameter named the peak-to-plateau ratio was calculated. Statistical analysis was performed using the paired-samples t-test.

RESULTS

Intrarenal RI elevation and decreased renal artery peak systolic velocity was observed in normally functioning recipient kidneys.

CONCLUSION

Duplex Doppler sonography demonstrated that transplanted kidneys had an increase in intrarenal vascular resistance at 1 month and a decrease in renal artery peak systolic velocity at 3 months post-transplantation. Scintigraphy and power Doppler US did not reveal any statistically significant perfusion change in normally functioning kidneys from donor to recipient.

Immediate thallium re-injection after stress imaging for the detection of myocardial viability

Myocardial perfusion imaging with thallium is an established method to assess the presence of ischaemic and viable myocardium. Using planar imaging, images acquired 1 h after immediate thallium re-injection have been shown to be comparable to those of 3 h redistribution. The aim of this study was to clarify this using SPET. Twenty patients with chronic coronary artery disease with at least two perfusion defects on post-exercise images participated in this study. All patients received thallium re-injection after post-stress SPET and all had 1 h, 3 h and 24 h redistribution imaging. The thallium myocardial tomograms were divided into 14 segments for each patient. A total of 78 segments were studied. When the frequency of reversibility on 1 h, 3 h and 24 h redistribution images is compared, of the 78 SPET defects 18 (23.1%) showed reversibility by 1 h, 34 (43.6%) by combined 1 h and 3 h imaging (P < 0.05) and 50 (64.1%) by combined 1 h, 3 h and 24 h imaging (P < 0.05). Our results show that, compared to 3 h images, images acquired 1 h after immediate thallium re-injection underestimate the extent of viable myocardial segments and the incidence of late reversibility was not reduced by the immediate re-injection of thallium.