The effect of hyperbaric oxygen therapy on hematological indices and biochemical parameters in patients with diabetic foot

BACKGROUND

Diabetes Mellitus (DM) is a metabolic disease with a high morbidity and mortality and increasing in prevalence all over the world. Due to the hypoxic, ischemic, inflammatory, and infective environment in DM, diabetic foot ulcers have been treated with medico-surgical interventions and adjuvant hyperbaric oxygen Therapy (HBOT). The purpose of this study was to evaluate the effects of HBOT on hematological indices and biochemical parameters in patients with diabetic foot.

METHODS

The study group was formed from the file records of 103 male patients who applied to Yunus Emre State Hospital HBOT Center between September 1, 2016 and December 31, 2020, and were treated HBOT with a multidisciplinary approach.

RESULTS

There were negative low correlations between number of HBOT sessions and Mean Corpuscular Hemoglobin (MCH) (P = .037, r = -0.207) and Blood Urea Nitrogen (BUN) (P = .037, r = -0.222). White Blood Cell Count (WBC), Neutrophils (NEU), Monocytes (MON), Platelet Count (PLT), and Plateletcrit (PTC) parameters were found to be decreased, and an increase in lymphocytes (LYM), Eosinophils (EOS), Mean Corpuscular Hemoglobin Concentration (MCHC), and Red Cell Distribution Width (RDW) parameters were detected after the treatments (P < .05). Again, after the treatment, glucose (Glu), C-Reactive Protein (CRP), direct bilirubin, and total protein (TP) levels were decreased, and uric acid (UA) levels increased (P < .05).

CONCLUSION

HBOT improved hematological indices in patients and had a beneficial effect on biochemical parameters, particularly Glu and CRP levels. Adjuvant HBOT alleviates diabetic inflammation and has a beneficial effect on diabetic patient treatment.

Functional evaluation of physical performance, gait, balance and activities of daily living in older individuals with long COVID syndrome

OBJECTIVE

The aim of our study was to evaluate the physical performance, balance, gait and activities of daily living (ADL) of older individuals with long COVID syndrome (LCS).

METHODS

A total of 124 individuals (49% women) with a mean age of 71.8 ± 5.8 years were included in the study. Participants were divided into two groups, older individuals with LCS in the LCS group and older individuals who were not diagnosed with COVID-19 in the CON (control) group. Physical performance of participants was evaluated with the Alusti Test, balance and gait assessment was evaluated with the Tinetti Balance and Gait Assessment (TBGA), and ADL were evaluated with the Barthel Index (BI).

RESULTS

In the evaluations between groups, the mean score of active muscular mobility of right and left upper extremities, transfer supine position to sitting, trunk in sitting position and standing, which are among the subparameters of the Alusti Test, were statistically significantly lower in LCS compared to CON (p < .05). TBGA total score and gait section mean score of TBGA were statistically significantly lower in LCS than in CON (p < .05). There was no significant difference between the groups in the balance section of the TBGA and the mean BI scores (p > .05).

CONCLUSIONS

It was concluded that physical performance parameters related to active muscular mobility of the upper extremity, transfer supine position to sitting, trunk in sitting position and walking in LCS were negatively affected by the disease, but this did not affect the level of balance and independence in ADL.

The relationship between inspiratory muscle strength, venous refilling time, disease severity, and functional capacity in patients with chronic venous insufficiency

BACKGROUND

Our aim is to evaluate the relationship between inspiratory muscle strength and venous refilling time, disease severity, and functional capacity in patients with chronic venous insufficiency (CVI).

METHODS

Sixty-one patients (49 female, aged 20-65 ) were enrolled in the study. The demographic characteristics of the patients were questioned. All patients were assessed with maximum inspiratory and expiratory pressure (MIP/MEP) for inspiratory and expiratory muscle strength, photoplethysmography for venous refilling time (VRT), venous clinical severity score (VCSS) for disease severity, and 6-min walk test (6-MWT) for functional capacity.

RESULTS

The mean age of the patients was 49.48 ± 13.19 years, and the mean duration of disease was 9.18 ± 6.57 years. There was statistically significant positive association between MIP and VRT(r: 0.331, p: 0.009), 6-MWT (r: 0.616, p < 0.001) values, and there was negative association between MIP and VCSS(r: -0.439 p < 0.001) scores.

CONCLUSION

Evaluation of inspiratory muscle strength and elimination of its deficiency, providing interventions to approach normative values have the potential to contribute positively to the treatment of the patient.

Gastric intestinal metaplasia: Long-term follow-up results

Baackground

Precancerous lesions are the most commonly cited factor in gastric cancer etiology. The sequence of events in intestinal-type gastric carcinogenesis is considered to be chronic gastritis, atrophy, intestinal metaplasia (IM), dysplasia, and carcinoma, respectively. Early diagnosis and treatment of advanced precursor lesions and gastric cancer is possible by identifying and monitoring patients with such premalignant lesions.

Aim

In our study, we aimed to evaluate the long-term follow-up results of intestinal metaplasia in our hospital and the rate of progression to malignancy by comparing these patients with patients who have undergone gastroscopy without a diagnosis of intestinal metaplasia.

Material and Method

One hundred and fifty-six followed-up patients out of 700 between the ages of 18 and 85 who were admitted to our hospital between 2009 and 2019, who were diagnosed with IM by pathological examination from biopsy material, and 150 patients who were not diagnosed with IM between 2009 and 2011 were included. The results of the cases were evaluated first retrospectively; then, the patients who were invited for control and underwent endoscopy were evaluated prospectively. IM and control groups were compared in terms of dysplasia and gastric cancer development. In addition, the IM group was compared in terms of 5 and 10 years of follow-up, extensive or local involvement, and complete and incomplete involvement in terms of dysplasia and cancer development.

Results

The follow-up period of the patients ranged from 1 to 10 years, and the mean follow-up interval was 4.2 ± 2.8 (min: 1; max: 10) years. Age, gender, and pathology results of the patients were examined in terms of IM type, localization of IM, pathology accompanying IM, and presence of Helicobacter pylori (Hp) infection and compared with the control group. While gastric carcinoma was detected in three of 156 patients in the IM group, gastric carcinoma was not detected in the follow-up of 150 patients in the control group. IM was most common in the antrum. Incomplete IM was detected in 89 patients, and complete IM in 69 patients. While two of the three patients with gastric carcinoma were localized to the antrum, one patient had incomplete-type IM and two patients had complete-type IM, and Hp was positive in two patients. While dysplasia was detected in nine of the patients diagnosed with IM, it was detected in two patients in the control group. A statistically significant difference was found between the IM and control groups in terms of dysplasia positivity (p = 0.037). On the other hand, no statistically significant difference was found between the IM and control groups in terms of age-group, gender, follow-up time group, and Hp positivity (p > 0.05). There was no significant difference between those who were followed up for 5 and 10 years in the IM group in terms of dysplasia and cancer development.

Conclusion

Therefore, it is considered that patients with intestinal metaplasia may be followed up at longer intervals, except for patients with race, ethnicity, incomplete type, extensive involvement, and a family history of gastric cancer.

AB0960 RELATIONSHIP BETWEEN THE CAREGIVER BURDEN AND UPPER LIMB-NECK DISABILITY AND PAIN IN BABY CAREGIVERS

Background:

Although caregiving is a normal part of being a parent of a young child, it is still unclear whether caregiving causes upper limb or neck disability in the caregiver.

Objectives:

The aim of this study was to investigate the relationship between caregiver burden and upper limb-neck disabilities and pain in baby caregivers.

Methods:

Sixty caregivers who are responsible for the caregiving of a 0-2 year old healthy baby, were included in this study. Physical characteristics and the gender of the caregivers were recorded. Caregiver burden was assessed by the Zarit Burden Interview; upper limb problems by DASH and neck problems by the Neck Disability Index and Neck Bournemouth Questionnaire. In addition, pain severity related to neck and upper limb was evaluated by using Visual Analog Scale over a 10 level scale.

Results:

The mean age of the caregivers was 30.96 ± 6.43 year. The mean body mass index of the caregivers was 23.34 ± 3.29 indicating normal body composition. Height and weight were 163.75 ± 6.01 and 62.55 ± 8.98, respectively. Ninety-five percent of the caregivers were mother and the others were the babysitter. A weak relationship was determined between the Zarit Burden Interview and DASH (p=0.02, r=0.2), while no relationship was found between caregiver burden and other assessments. Caregivers were found to have very low pain severity in the upper limb and neck.

Conclusion:

It has been previously reported that caregiving for a disabled child or adult causes care burden and various musculoskeletal disorders1-4. Current study demonstrated that giving care for a healthy child did not create care burden, and caused lower levels of pain in the upper limb and neck.

References:

[1]Santos, M. T. B. R., Biancardi, M., Guare, R. O., & Jardim, J. R. (2010). Caries prevalence in patients with cerebral palsy and the burden of caring for them.Special Care in Dentistry,30(5), 206-210.

[2]Sharan, D., Ajeesh, P. S., Rameshkumar, R., & Manjula, M. (2012). Musculoskeletal disorders in caregivers of children with cerebral palsy following a multilevel surgery.Work,41(Supplement 1), 1891-1895.

[3]Akosile, C. O., Okoye, E. C., Adegoke, B. O. A., Mbada, C. E., Maruf, F. A., & Okeke, I. A. (2013). Burden, health and quality of life of Nigerian stroke caregivers.Health Care Current Reviews,1(1), 105.

[4]Darragh, A. R., Sommerich, C. M., Lavender, S. A., Tanner, K. J., Vogel, K., & Campo, M. (2015). Musculoskeletal discomfort, physical demand, and caregiving activities in informal caregivers.Journal of Applied Gerontology,34(6), 734-760.

Disclosure of Interests:

None declared

Comparative analysis of MACROD1, MACROD2 and TARG1 expression, localisation and interactome

The posttranslational modification ADP-ribosylation is involved in many cellular processes, with distinct roles for poly- and mono(ADP-ribosyl)ation (PAR- and MARylation, respectively). Reversibility of intracellular MARylation was demonstrated with the discovery of MACROD1, MACROD2 and TARG1, three macrodomain-containing enzymes capable of reversing MARylation of proteins and RNA. While the three enzymes have identical activities in vitro, their roles in cells are unclear and published data are partially contradictory, possibly due to a lack of validated reagents. We developed monoclonal antibodies to study these proteins and analysed their tissue distribution and intracellular localisation. MACROD1 is most prevalent in mitochondria of skeletal muscle, MACROD2 localises to nucleo- and cytoplasm and is found so far only in neuroblastoma cells, whereas the more ubiquitously expressed TARG1 is present in nucleoplasm, nucleolus and stress granules. Loss of MACROD1 or loss of TARG1 leads to disruption of mitochondrial or nucleolar morphology, respectively, hinting at their importance for these organelles. To start elucidating the underlying mechanisms, we have mapped their interactomes using BioID. The cellular localisation of interactors supports the mitochondrial, nucleolar and stress granule localisation of MACROD1 and TARG1, respectively. Gene ontology analysis suggests an involvement of MACROD1 and TARG1 in RNA metabolism in their respective compartments. The detailed description of the hydrolases’ expression, localisation and interactome presented here provides a solid basis for future work addressing their physiological function in more detail.

Ruptured cystic teratoma associated with mucinous cystadenoma in a pregnant woman

Mature cystic teratoma is the most common ovarian neoplasm. However, mucinous cystadenoma with teratoma has been very rarely reported in literature. This case report, which is very rare, describes a clinical entity not previously reported in literature. A 34-year-old pregnant woman presented in the 23rd gestational week with severe right lower quadrant pain. She was diagnosed with acute abdomen and was then treated surgically. During the surgical intervention, a spontaneously ruptured mass was detected in the right ovary. This was reported histopathologically as a mature cystic teratoma in collision with mucinous cystadenoma. To the best of our knowledge, this case report is the first to have identified a ruptured mature cystic teratoma in collision with mucinous cystadenoma in a pregnant woman.

Combining clinical predictors to better predict for the no-reflow phenomenon

OBJECTIVE

We aimed to determine whether the combination of a CHA2DS2-VASc score (C: Congestive Heart Failure, H: Hypertension, A2: Age ≥ 75 years, D: Diabetes mellitus, S: Stroke history, V: Vascular disease, A: Age ≥ 65 years, Sc: Sex category) and pre-percutaneous coronary intervention (PCI) thrombus load score was more sensitive at detecting the no-reflow phenomenon compared to the CHA2DS2-VASc score alone or to the thrombus load score alone in patients with acute ST-elevation myocardial infarction (STEMI) who had underwent primary PCI (PPCI).

PATIENTS AND METHODS

497 patients with acute STEMIs were divided into two groups: no-reflow group (n: 194) and control group (n: 303). The Thrombolysis In Myocardial Infarction (TIMI) flow grading and Myocardial Blush Grade (MBG) were used together to define angiographic no-reflow as TIMI flow < 3 (with any MBG grade) or TIMI flow 3 with MBG 0 or 1. Successful reperfusion was defined as TIMI flow 3 with MBG 2 or 3.

RESULTS

CHA2DS2-VASc score was significantly higher in the no-reflow group than in the control group (2 [1-4] vs. 1 [0-3], p < 0.001]. Compared with the control group, the no-reflow group had a higher pre-PCI thrombus score (5 [4-5] vs. 4 [3-5], p = 0.001). Compared with the CHA2DS2-VASc score alone, the combined use of the pre-PCI thrombus score and the CHA2DS2-VASc score was associated with significant improvements in the ability to predict no-reflow (AUC) (0.65 vs. 0.60, p < 0.05). The addition of the pre-PCI thrombus score to the CHA2DS2-VASc score was related to a significant net reclassification improvement of 6.7% (p = 0.047) and an integrated discrimination improvement of 0.036 (p < 0.05).

CONCLUSIONS

We have found that the combination of a CHA2DS2-VASc score and a pre-PCI thrombus load score was more sensitive in detecting the no-reflow phenomenon than only a CHA2DS2-VASc score in patients who underwent PPCIs for STEMIs.

Investigation of biochemical and histopathological effects of Mentha piperitaLabiatae and Mentha spicata Labiatae on liver tissue in rats

The plant Mentha piperita, or peppermint, is commonly used in the treatment of loss of appetite, common cold, bronchitis, sinusitis, fever, nausea and vomiting, and indigestion as a herbal agent. In this study, we aimed to investigate biochemical and histological effects of M. piperita Labiatae, growing in the Yenisar Bademli town of Isparta city, and Mentha spicata Labiatae, growing in the Anamas high plateau of the Yenisar Bademli town, on the rat liver tissue. Forty-eight male Wistar albino rats weighing 200-250 g were used for this study. Rats were divided into four groups of 12 animals: Group I received no herbal tea (control group); Group II received 20 g/L M. piperita tea; Group III received 20 g/L M. spicata tea; and Group IV received 40 g/L M. spicata tea. Herbal teas were prepared daily and provided at all times to the rats during 30 days as drinking water. Liver function tests, including aspartate aminotransferase (AST/GOT) and alanine aminotransferase (ALT/GPT) activities were measured. To evaluate liver antioxidant defences, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), cata lase (CAT) and thiobarbituric acid reactive substance (TBARS) activities were determined in the homogenates of liver tissue. In addition, liver tissues were submitted for histopathologic examination. AST and ALT activities were increased in Group II, Group III and Group IV gradually when compared with the control group. The difference between Group II and the control group was not statistically significant (P > 0.016). Increases in AST and ALT activities of Group III and Group IV were statistically significant when compared with the control group. SOD, GSH-Px and CAT activities were increased in Group II when compared with the control group but the difference was not statistically significant (P > 0.016). However, SOD, GSH-Px activities and the TBARS level were significantly increased, and CAT activity was significantly decreased in Group III when compared with the control group. In Group IV, while SOD, GSH-Px and CAT activities were decreased, the TBARS level was increased as compared with the control group (P < 0.0016). Histopathological evaluation of experimental groups revealed a mild to severe degree of hepatic damage when compared to the control group. In Group II, there was only minimal hepatocytes degeneration. In Groups III and IV, there were granular or ballooning hepatocyte degeneration and necrosis, sinusoidal and central vein dilatation. It was concluded that lipid peroxidation and hepatic damage occurs after M. piperita and M. spicata administration in rat liver and the damage seems to be dose dependent.

Dosimetric comparison of robotic and conventional linac-based stereotactic lung irradiation in early-stage lung cancer

We aimed to compare dosimetric characteristics of conventional linear accerator-based treatment plans to those created using the robotic CyberKnife® (CK) treatment planning system for patients with early-stage lung cancer. Eight early-stage lung cancer patients treated with stereotactic body radiotherapy (SBRT) using a conventional linac-based (LIN) system were included in this study. New treatment plans were created for the patients with the CK treatment planning system in order to compare the two platforms' dosimetric characteristics. Planning computed tomographies (CT) were obtained in three phases: free-breathing, full exhalation and inhalation. The three GTVs were then added together for internal target volume (ITV) with LIN, whereas no ITV was used for CK. Planning target volumes (PTV) were constituted by adding 5-mm margin to GTV and ITV. Treatment plan was 54 Gy in three fractions. Five-field, seven-field, and dynamic-conformal arc planning techniques were used in LIN plans. Plans were compared according to dose heterogenity (D(max)-maximum dose), volume of 54 Gy (V54) and 27 Gy isodose (V27), conformity index (CI(54) and CI(27)) and lung volumes. PTVs were significantly smaller in CK plans (p=0.012). D(max) was significantly lower in ARC plans (p=0.01). Among all plans, CK had significantly tightest isodose shell received 54 Gy and 27 Gy (p=0.0001). Among LIN plans, V54 was significantly (p=0.03) smaller in ARC plans; but no difference was observed for V27 values. LIN plans have better plan quality (CI(27) and CI(54)) than CK. No statistically significant difference was observed for lung volumes. CK plans had superior V54 and V27 values compared to LIN plans due to smaller PTV. LIN plans had better CI(27) and CI(54) values. Advantages of LIN treatment were no neccessity for fiducial marker use, which may cause pneumothorax, and significantly shorter beam-on treatment times. Both CK and LIN methods are suitable for lung SBRT.

Evaluation of erythrocyte deformability in experimentally induced osteoporosis in female rats and the effects of vitamin C supplementation on erythrocyte deformability

OBJECTIVE

The aim of this study was to evaluate the possible variations in antioxidant enzymes, lipid peroxidation and erythrocyte deformability in experimentally induced osteoporosis in female rats and to assess the effects of vitamin C supplementation on those variations.

MATERIAL

A total of 20 female Wistar Albino Rats were randomized into the three groups as controls (Group C, n = 6), ovariectomized rats (Group O, n = 7) and ovariectomized rats receiving vitamin C supplementation (Group OVC, n = 7). After the surgical procedure of ovariectomy, group OVC received 1 g ascorbic acid in 500 mL water daily. After 100 days following the ovariectomy, bone mineral density (BMD) was measured by using dual-energy X-ray absorptiometry.

RESULTS

BMD was significantly lower in the group O than in the group C (p = 0.015), whereas it was significantly higher in the group OVC than in the group O (p = 0.003). MDA activity was significantly higher in the group O than in the group C (p = 0.032), whereas it was significantly lower in the group OVC than in the group O (p = 0.025). SOD activity was significantly higher in the group O than in the group C (p = 0.032). Erythrocyte deformability was significantly higher in the group O than in the group C and OVC (p = 0.008, p = 0.021, respectively).

CONCLUSION

Erythrocyte deformability may show negative variations, suggesting a causative role in disruption of blood flow and tissue perfusion, which also negatively affect bone metabolism. Vitamin C supplementation seems to reverse those negative effects of variations in erythrocyte deformability. However, our preliminary results should be confirmed in more experimental studies and clinical trials (Tab. 3, Ref. 28).

TWO CLINICAL PROBLEMS IN ELDERLY MEN: OSTEOPOROSIS AND ERECTILE DYSFUNCTION

Seventy-six of 108 random men aged 50 years or over were evaluated for erectile dysfunction with interviews of patients using the International Index of Erectile Function Form and minimal evaluation. Serum hormone concentrations were measured. Bone mineral density was measured using dual energy x-ray absorptiometry. Hormone levels did not show significance in terms of erectile dysfunction or bone mineral density results. Erectile dysfunction was determined in 57 (75%) of 76 patients. Ten (13.2%) patients had osteoporosis and 45 (59.2%) had osteopenia at the bone mineral density measurements. The distribution of bone mineral density groups relating to erectile dysfunction did not show significance. The frequencies of osteoporosis and erectile dysfunction increased with age, but the association of these conditions seems to be independent of each other and hormonal changes appear not to be the major determinants for both conditions in elderly men.

Electrophysiological evaluation of cremasteric reflex in experimental testicular torsion

AIM

The aim of the study was the electrophysiological evaluation of the cremasteric reflex after experimental testicular torsion.

MATERIAL AND METHODS

Ten male Wistar rats were enrolled into the study. Genitofemoral nerve (GFN) motor conduction and cremasteric reflex (CR) responses were evaluated electrophysiologically after being subjected to anesthesia with intramuscular ketamin hydrochloride. Testicular torsion was performed by rotating the right testicle 720 degrees in a clockwise direction from a midscrotal incision. Electrophysiological evaluations were repeated in the early (30 minutes) and late (90 minutes) periods of testicular torsion. Subsequently, detorsion of the testicles was performed and electrophysiological recordings were completed after 60 minutes of detorsion. The CR was also evaluated clinically before each electrophysiological evaluation. The latency and duration of GFN motor conduction and CR responses was compared for base, early torsion, late torsion and detorsion recordings. Friedman's test for repeated measurements was used for statistical analysis.

RESULTS

The CR, which was detected clinically before torsion and after detorsion, was not detected during torsion. When base, early torsion, late torsion and detorsion recordings were compared, there was no statistical difference with respect to both latency and duration of GFN motor conduction and CR responses (p > 0.05).

CONCLUSION

Although CR was not detected clinically during testicular torsion, the electrophysiological parameters of the reflex did not differ in the early and late periods of torsion in rats. The GFN motor conduction parameters also showed no differences. In conclusion, the absence of the CR after testicular torsion could not be confirmed by electrophysiological studies.

Brucellar spondylodiscitis: a case report

Brucellosis is a common zoonosis which still remains as a major health problem in certain parts of the world. Osteoarticular involvement is the most frequent complication of brucellosis, in which the diagnosis of brucellar spondylodiscitis is often difficult since the clinical presentation may be obscured by many other conditions. Herein, we reported an uncommon case of spondylodiscitis due to brucella in an elderly male who had diabetes mellitus and degenerative spinal disease as underlying conditions. The diagnosis was established by using magnetic resonance imaging after the brucella-agglutination test was found to be positive. The diagnosis was also confirmed by positive blood culture. A high degree of suspicion in the diagnosis of brucellar spondylitis is essential to reduce the delay for the treatment. Thus, it should be essentially included in the differential diagnosis of longstanding back pain particularly in regions where brucellosis is endemic. Screening serologic tests for brucella should be used more widely in cases with low index of suspicion, especially in endemic areas.

Crusted scabies in a healthy infant

Crusted scabies is generally seen in mentally retarded and immunosuppressed individuals. We report the case of a patient with crusted scabies with neither systemic disease nor immunosuppression; all the lesions were cured with applications of 5% permethrin lotion.

Dynamics of Mast Cells in Lymph Node Following Antigenic Stimulation

Dynamics of mast cells in rat cervical lymph nodes were examined using conventional histological techniques after injection of Salmonella paratyphi B-H antigen. There was no significant change in the number of mast cells at sixth hour and on the first day of stimulation compared with the controls. The number of mast cells was increased in all lymph node compartments on the second day of stimulation, which continued in the following 3 days. On the eighth day of stimulation, although the mast cell number decreased in the subcapsular area, it was still high in the paracortical area and medullary sinuses of the lymph nodes. On the second day of stimulation, the mast cell number was apparently increased in the subcapsular area than those of the other compartments. In the following days of stimulation, the highest number of mast cells was seen in the medullary sinuses. The highest paracortical mast cell number was determined on the third day of stimulation and some mast cells were observed near the high endothelial venules (HEVs). The changes of mast cell number among the lymph node compartments after antigenic stimulation support the hypothesis that the migration of mast cells occurred. This migration pattern indicates that mast cells enter the lymph node via afferent lymphatics and migrate to the lymph node compartments following antigenic stimulation.

Histopathologic changes in liver and renal tissues induced by Ochratoxin A and melatonin in rats

Nephrotoxicity and hepatotoxicity induced by Ochratoxin A (OTA) and ameliorating effects of melatonin were investigated in rats exposed to OTA. Experimental groups were as follows: control; OTA-treated; and OTA plus melatonin (MEL)-treated (OTA+MEL). The rats in the control group were administered with only a daily oral administration of 0.5 M NaHCO3. OTA was administered with a dose of 289 microg/kg in the same way. OTA and MEL were administered orally with OTA (289 microg/kg) and melatonin (10 mg/kg) in two different periods of time during the same day. The histopathologic changes in the liver and kidney tissues of control, OTA and OTA+MEL-treated rats were examined. There were no significant changes in the kidney and liver tissues of the control rats. Significant histopathologic changes were found in the kidney and liver tissue of rats treated with OTA. These were granular or vacuolated degeneration and necrosis of the liver cells, sinusoidal and central vein dilatation, bile duct proliferation, enlargement of periportal areas with mononuclear cell inflammatory infiltration and mild degree fibrous tissue proliferation, tubular epithelial cells degeneration, necrosis, proliferation and karyomegaly in the epithelial cells nuclei and peritubular and periglomerular lymphocyte infiltration, stromal fibrous tissue proliferation, hyperemic vessels. The severity of the lesions was significantly reduced by administration of melatonin. These results revealed that OTA induced significant histopathologic changes in liver and kidney tissue advocating OTA toxicity (P < 0.001), and administration of MEL+OTA significantly reduced the toxic effect of OTA on kidney and liver tissue of rats (P > 0.05).

Polyunsaturated phosphatidylcholine lowers collagen deposition in a rat model of corrosive esophageal burn

Esophageal strictures are characterized by excess deposition of collagen in the esophageal wall. Polyunsaturated phosphatidyl-choline (PPC) stimulates collagen breakdown in experimental models of liver cirrhosis and colitis. This study was done in order to investigate the therapeutical effect of PPC in preventing esophageal strictures due to alkali-induced esophageal burns in rats. Fifty-five albino rats were divided into four groups as follows: control group (Group A, 10 rats), rats with sham operation and treated with saline (Group B, 15 rats), rats with esophageal burns only (Group C, 15 rats), and PPC-fed rats with esophageal burns (Group D, 15 rats). A standard esophageal burn was produced as described by Gehanno. PPC was administered orally to Group D rats in doses of 100 mg/day for four weeks. All animals were sacrificed on the 28th day of the experiment. Hydroxyproline levels in esophageal tissue was determined in each rat, and histopathologic evaluation was performed for each group. Hydroxyproline levels were significantly lower in the PPC-fed rats than in the rats with pure esophageal burns (p < 0.001). Histopathologically, collagen deposition in the submucosa and tunica muscularis was lower in Group D rats (PPC-fed rats with esophageal burn) than Group C rats (pure esophageal burn) (p < 0.05). As a result of our study, we concluded that PPC has an ameliorating effect on stricture formation after alkali-induced corrosive esophageal burns in rats.

Effect of diclofenac sodium administration during pregnancy in the postnatal period

OBJECTIVE

The present study aimed to investigate the possible postnatal effects on the liver, kidney and testicular tissues of the offspring of rats given diclofenac sodium (DS) during pregnancy.

METHODS

At the beginning of the experiment, 80 rats (20 males and 60 females) were raised together for mating purposes. At the end, 50 pregnant rats were obtained and used as the experimental subjects. All pregnant rats were divided into 2 groups, each with 25 rats. The rats of the control group received physiological serum, 1 cm3/kg live weight per day, and the rats of the treatment group were injected with DS, 1 mg/kg live weight per day from the 5th to the 20th day of pregnancy. Four weeks after birth, tissue samples were obtained under anesthesia by perfusion fixation from a total of 40 offspring, 20 (10 males, 10 females) from the control group and 20 (10 males 10 females) from the DS group. Paraffin sections were dyed with hematoxylin eosin and examined under light microscopy.

RESULTS

The gestation period was significantly prolonged with DS-treated rats (p < 0.001). A moderate significant enlargement in the periportal area (p < 0.05), sinusoidal dilatation (p < 0.001), bile duct proliferation (p < 0.001), pyknosis in the nucleus of hepatocytes, and vacuolar degeneration in parenchymal cells (p < 0.001) were observed in DS-treated rats. Morphological changes in the liver were found to be similar both in female and male rats. Under light microscopy a similar morphological structure was observed in the kidney and testicular tissues of both the DS-treated and control rats.

CONCLUSION

Significant morphological changes were observed in the livers of the offspring whose parents had been treated with DS. No significant differences were observed in liver morphology between the female and male offspring. There were no significant effects of DS on the morphology of the kidney and testis in all offspring.

Outcomes of one-stage techniques for proximal hypospadias repair

OBJECTIVES

To evaluate the success of three preputial flap techniques in the one-stage correction of proximal hypospadias.

METHODS

From 1993 to 1999, 43 children underwent one-stage proximal hypospadias repair using preputial flaps, which were performed by a single surgeon. Of the 43 patients, 21 (48.8%), 10 (23.2%), and 12 (27.9%) underwent tubularized island flap urethroplasty, double-faced tubularized island flap urethroplasty, and onlay island flap urethroplasty, respectively. The age range of the patients at surgery was 18 months to 14 years (mean 3.4). Dorsal plication was required for chordee repair in 12 patients (3 in tubularized island flaps, 3 in double-faced tubularized island flaps, and 6 in onlay island flaps). In addition to the dorsal plication, posterior dissection of the urethral plate without division was performed on 3 of the 6 patients with mild to severe chordee in the onlay island flap group. The incidence of complications requiring repeated surgery was evaluated for each group.

RESULTS

The follow-up was 8 months to 7 years (mean 4.1 years). The overall complication rate was 90% for the double-faced tubularized island flap repair, 38% for the tubularized island flap repair, and 33% for the onlay island flap repair. Recurrent chordee was observed in 2 (66.6%) of the 3 patients who underwent onlay island flap repair with urethral plate dissection.

CONCLUSIONS

The use of a tubularized island flap is suggested for one-stage repair of proximal hypospadias, especially in the patients with severe chordee. Because of the high complication rates, the double-faced tubularized island flap technique is not advocated. The onlay island flap may also be used for proximal hypospadias repair if mild chordee is present. Because of the high recurrent chordee rate, dissection of the urethral plate without division is not suggested in the onlay island flap technique.

Hydatid disease of the liver in childhood: the success of medical therapy and surgical alternatives

Hydatid liver disease in children is a serious problem where the parasite is endemic. Although surgery is considered the treatment of choice, medical therapy is an alternative, but its curative efficacy is controversial. The aims of this study were to evaluate the curative efficacy of medical treatment and compare the results of surgical techniques with respect to postoperative complications in 102 consecutive children (64 male and 38 female, aged 4 to 15 years, mean 8.15 years) treated in two children's hospitals between 1988 and 1997. In 67, medication with albendazole was used as the initial therapy; 17 had multiple hepatic cysts and 8 had coexisting cysts in the lung. Success was defined as progressive shrinkage and solidification of the cyst. The overall success of medical therapy was approximately 27%: 18 of the 67 patients were cured with albendazole (15 had a single cyst, 3 multiple cysts) and 1 recurrence (6%) was observed. Age, sex, and the size, location, and number of cysts did not show any relationship to the response to medical therapy. After 12 to 14 weeks of medical treatment, a viable cyst on ultrasonography and/or computed tomography was accepted as a sign of treatment failure and these patients were scheduled for surgery. A total of 84 patients (35 primarily, 49 after unsuccessful medical therapy) were treated surgically. Procedures included cystectomy and tube drainage in 11 patients, cystectomy in 17, cystectomy and capitonnage in 24, and cystectomy and omentoplasty in 32. The incidence of early postoperative complications was 55% for tube drainage, 18% for cystectomy, 13% for capitonnage, and 0% for omentoplasty. During the follow-up period, 2 surgical patients (2%) developed recurrent disease. Medical treatment with albendazole resulted in fewer curative successes than expected. A longer period of medical treatment may increase the success rate; this question requires further study. Omentoplasty decreased the rate of early postoperative complications, especially cavity abscess and biliary fistula, after surgical treatment and should be recommended in this setting.

Histopathological changes of chorda tympani in chronic otitis media

OBJECTIVE

To investigate whether histopathological changes of chorda tympani might exist in patients with chronic otitis media without facial paralysis.

STUDY DESIGN

The study was designed as a prospective trial.

METHODS

Twenty of 107 patients with chronic otitis media, in whom the chorda tympani were injured inadvertently during middle ear surgery, were enrolled into the study. The cases were divided into two groups based on the activity of chronic infection at the time of surgery. Twelve cases with suppurative disease were included in group I, and 8 cases with dry ear in group II.

RESULTS

Histopathological examinations of the specimens revealed findings such as thickening of perineural and epineural connective tissue, vacuolar degeneration of Schwann cells, and proliferation of fibroblasts in endoneurium. Disorganization of the axons of some nerve fibers was also determined.

CONCLUSION

Based on the histopathological changes of chorda tympani in chronic middle ear disease, it is postulated that chronic otitis media may give rise to functional loss of the nerve.

Chemically induced intestinal de-epithelialization using silver nitrate for bladder augmentation

The use of bowel segments for bladder augmentation has been associated with metabolic complications, infections, stones, and cancer at the vesicoenteric anastomosis. The establishment of a transitional epithelium over the de-epithelialized surface of a segment of intestine might alleviate these complications. In this study, chemical de-epithelialization and urothelial re-epithelialization were attempted using silver nitrate (AgNO3) solutions at different concentrations. Augmentation cystoplasty was performed in 55 female Swiss-Albino rats using a 1.5-cm detubularized segment of sigmoid. Forty-one rats survived and were killed 12 weeks postoperatively. There were four groups, including one group of eight rats that underwent augmentation alone (group 1, control), while the other three groups were treated with 1 g/100 ml (11 rats), 5 g/100 ml (10 rats), and 10 g/100 ml (12 rats) AgNO3 solutions, respectively, before augmentation. Histopathological analysis demonstrated almost complete de-epithelialization and urothelialization of the sigmoid segment treated with 10 g/100 ml AgNO3 solution, which did not occur in the other groups. Postoperative bladder capacities were increased in all groups. There was no obvious histological difference in the level of collagen deposition and/or fibrosis in the augmented tissues in any of the experimental groups. We conclude that 10 g/100 ml AgNO3 solution can be successfully used for chemical de-epithelialization and urothelial re-epithelialization of augmented intestinal segments, and are worthy of further investigation.

Characteristics of penetrating abdominal firearm injuries in children

Penetrating injuries of the abdomen which occur primarily from gunshots and stabbing become increasingly prevalent in children. Our purpose is to assess the presentation, management and outcome of children with penetrating abdominal firearm injuries (PAFI) and to evaluate the value of Injury Severity Score (ISS) for predicting injury severity and eventual morbidity and mortality in children with PAFI. Between 1985 and 1997, 69 children < or = 15 years of age with PAFI were hospitalized at our institution. Their hospital records were reviewed retrospectively. Of the 69 children with PAFI, 53 were boys and 16 were girls. The mean age was 9.6. The causes of PAFI were explosives (44%), gunshot (39%) and shotgun injuries (17%). The most common organ injured was the small bowel followed by colon and liver respectively. Postoperative complications were seen in 12 children. The mean value of ISS was 16.8; 41 children had an ISS value of > or = 16. The value of ISS was significantly higher in children with complication than in those without complication. The children with ISS value > or = 16 were hospitalized significantly longer than those with < or = 15 of ISS. Particularly shotgun injuries were commonly associated with severe morbidity. ISS can be useful for predicting the severity of injury and the occurrence of morbidity.

Brown midrib sorghum in diets for lactating dairy cows

In Experiment 1, 16 Holstein cows were assigned to one of four diets in replicated 4 x 4 Latin squares with 4-wk periods to measure dietary effect on short-term lactational performance. Additionally, 3 fistulated cows were assigned to the same diets in a 3 x 4 Youden square design with 4-wk periods to measure ruminal rate and extent of fiber digestion, fractional passage rate of fiber, ruminal pH, and concentration of volatile fatty acids. Diets comprised 65% of brown midrib (BMR) forage sorghum, standard forage sorghum, alfalfa or corn silages and 35% concentrate. Experiment 2 was conducted with 30 Holstein cows in early lactation to evaluate the same BMR sorghum hybrid in a 10-wk study with 35.3% standard sorghum, BMR sorghum, or corn silages as dietary treatments. Milk production was significantly higher for brown midrib than for standard sorghum in Experiment 1. Ruminal pH and acetate to propionate ratio did not differ among diets. The fractional passage rate of silage was not significantly different among the forages. In situ extent of ruminal fiber digestion was significantly higher for BMR than for standard sorghum, but rate of fiber digestion was not different. Similarly, in Experiment 2, in vitro extent of fiber digestion was significantly higher for BMR sorghum than for standard sorghum. Dry matter intake and body condition score were not significantly different between cows fed BMR and standard sorghum, but cows fed BMR sorghum resulted in long-term milk production greater than cows fed standard sorghum and similar to cows fed corn silage.

Prevalence of latex sensitivity among patients with chronic renal failure: a new risk group?

Latex has been documented as causing immediate hypersensitivity reactions in forms ranging from contact urticaria to severe anaphylaxis. The prevalence of latex allergy appears to be higher in certain risk groups as a result of increased exposure or an increased intrinsic predilection for atopy. The purpose of the present study was to assess latex sensitivity in a large group of patients who are undergoing regular dialysis because of chronic renal failure (CRF) and to evaluate the relationship between latex sensitivity and skin prick test (SPT) responses to fruit allergens. Of the 268 patients tested, 3 subjects (1.1%) were found to have latex sensitivity via SPT. Although atopy was not demonstrated in any SPT positive subjects, there appears to be a considerable degree of crossreactivity between latex and certain fruit allergens which can be suggested as one subtext in the SPT positive patients. In conclusion, CRF patients with no history of hypersensitivity reactions should not be considered at risk for developing latex sensitization despite their frequent exposure.

Seromuscular gastrocystoplasty in rats

Long-term results of seromuscular gastrocystoplasty have not been reported in the literature. In the presented study, a seromuscular gastrocystoplasty technique in rats and related biochemical, physiological, and histopathologic results are discussed. Fifty rats were grouped as follows: control and sham (group A), animals with gastrocystoplasty (group B), and animals with seromuscular gastrocystoplasty (group C). Urine pH, blood pH, and bicarbonate levels, bladder capacity, and end filling pressures were evaluated in all groups. After gastrocystoplasty and seromuscular gastrocystoplasty both group B and C showed a statistically significant increase in bladder capacity. Aciduria developed in 22% of rats in group B. In group A and C aciduria was not noted. No statistically significant difference was observed in blood pH, bicarbonate levels, and end-filling pressure measurements in each group of rats. Significant histopathologic changes of bladder occurred in the gastrocystoplasty group. In the 13 bladders examined histologically in group B, 2 had a papilloma on the mucosal surface of the transplanted gastric patch. The bladder mucosa adjacent to the transplanted gastric patch had pronounced hyperplastic and squamous metaplastic changes. In the 15 bladders examined histologically in group C none had a papilloma on the gastric segments. Squamous metaplasia in the bladder mucosa adjacent to the transplanted gastric patch was noted only in 2 rats of this group. Two rats also had bladder calculi in the lumen. Possible etiologies and differences of gastrocystoplasty and seromuscular gastrocystoplasty related pathological changes between two groups are discussed.

Does treatment with human chorionic gonadotropin induce reversible changes in undescended testes in boys?

Between May 1993 and November 1995, 71 cryptorchid boys were treated with human chorionic gonadotropin (hCG); 42 were operated upon following unsuccessful hCG treatment. A routine orchiopexy was performed in each case. In 10 cases a testicular biopsy was made during orchipexy within 3 days following hCG treatment; in another 10 biopsies were taken 6 to 9 months after treatment. Testicular biopsies were taken at the time of orchiopexy in 5 cryptorchid boys who were not treated with hCG as a control group. A mild, inflammation-like reaction was found in the cryptorchid testes in the period immediately following the last hCG injections, but those studied 6 to 9 months after the last injection there were no apparent such reactions. In contrast to the inflammation-like reaction, the volume density of blood vessels, interstitial bleeding, and diameter of the seminiferous tubules had not regressed. The numbers of spermatogonia per tubular transverse section and the percentage of tubular transverse sections containing spermatogonia (the fertility index) were increased.

Failure of inosine to prevent ischemic damage in the canine and rat kidney models

Intravenous, renal artery, and intraperitoneal administration of inosine at dosages of 100 to 200 mg/kg, 160 mg/kg, and 200 mg/kg, respectively, in the dog and rat was used to test its efficacy in preventing ischemic damage after 60 min of warm ischemia in an in situ solitary renal model. No improvement of renal function as compared with a control and a conventional mannitol/furosemide treatment group was detected. Rather, inosine at dosages of greater than or equal to 160 mg/kg resulted in significantly impaired renal function in the experimental groups of the dog model; no improvement was observed in the rat model. These results suggest that the use of inosine in human renal surgery and preservation should be approached cautiously.

A comparative study of several agents alone and combined in protection of the rodent kidney from warm ischaemia: methylprednisolone, propranolol, furosemide, mannitol, and adenosine triphosphate-magnesium chloride

The effect of 60 min of in situ warm ischaemia (37 degrees C) on renal function was investigated in the rat model. In addition, the effect of pretreatment with intravenously administered furosemide, mannitol, propranolol, methylprednisolone, and adenosine triphosphate-magnesium chloride (ATP-MgCl2), singly or in combination, was studied. The ischaemic kidney was effectively protected by the administration of methylprednisolone alone but not by furosemide, mannitol, ATP-MgCl2, or propranolol singly or in combination. These results demonstrate that rat kidneys subjected to 60 min of warm ischaemia can be safely protected with methylprednisolone pretreatment (3 mg/100 g of body weight) 30 min before warm ischaemia.

In vitro alteration of canine renal allografts with cyclophosphamide metabolites

4-Hydroxycyclophosphamide (4-HCY) is generated spontaneously in cryoprecipitated plasma from synthesized 4-hydroperoxycyclophosphamide (4-HPCY); its immunosuppressive and cytotoxic effects seem to depend on milieu, temperature, time, and dosage. Our preliminary results suggest that prolonged canine renal allograft survival can be achieved with grafts exposed to CY metabolites (4-HPCY and PM) in vitro for 24 hr. Further studies with larger dosages (greater than or equal to 100 micrograms/ml of 4-HPCY) are indicated to test these suggestions conclusively.

Successful 24-hour preservation of the ischemic canine kidney with Euro-Collins solution

The effect of 35 minutes of warm ischemia (37C) on renal function and adenine nucleotide content of canine kidneys preserved for 24 and 48 hours in Euro-Collins (EC) solution was investigated. In addition, the effect of donor pretreatment with intravenous mannitol, furosemide and methylprednisolone and the addition of adenosine triphosphate (ATP/MgCl2) to the EC flush and storage solution was studied. Donor pretreatment or the addition of ATP/MgCl2 to the flushing and storage solution did not significantly affect postautotransplant renal function of kidneys stored for 24 hours, although it improved tissue adenine nucleotide levels. Results after 48-hour preservation were significantly poorer. These experiments demonstrate that canine kidneys subjected to 35 minutes of warm ischemia time can be stored for 24 hours in EC solution and thereafter provide immediate life-sustaining function.

Simple renal cysts in children

Simple renal cysts in childhood are uncommon and often are confused with duplication anomalies or renal malignancy. A review of 20 children with simple renal cysts at our institution has documented the spectrum of clinical presentations and radiographic findings of this unusual renal mass. Surgical exploration and marsupialization of the cyst wall were done in 12 patients, 4 underwent nephrectomy earlier in our series and 4 have been followed conservatively by ultrasonography or computerized tomography scanning. Although equivocal cases necessitate surgical intervention, we advocate conservative therapy with diagnostic ultrasonography with or without cyst puncture in asymptomatic and normotensive children with simple renal cysts.

Chordee without hypospadias in children

We discuss 20 children who have undergone surgical correction of chordee without hypospadias. In 9 patients ventral curvature was demonstrated secondary to corporeal disproportion, 8 had chordee secondary to deficiency of the dartos fascia (skin chordee) and 3 had deficiency of the dartos and Buck's fasciae. Eight patients underwent excision of dorsal ellipses according to the Nesbit principle, 8 had lysis of the dartos fascia using the Allen-Spence technique, 2 underwent mobilization of the urethra with excision of underlying fibrous tissue and 2 had division of the urethra with a staged urethroplasty. The majority of cases of chordee without hypospadias are a result of anomalies of the tissue layers of the penis, and adequate straightening can be achieved by excision of underlying abnormal fascial tissue. All patients have achieved a satisfactory cosmetic and functional result with a straight penis and a urethral meatus positioned distally at the glans tip.