Magnetic resonance imaging in osteomalacic insufficiency fractures of the pelvis

AIMS

To report the magnetic resonance imaging (MRI) findings of osteomalacic insufficiency fractures of the pelvis.

MATERIALS AND METHODS

In all, 12 persons presenting with chronic pelvic pain and with a definitive diagnosis of osteomalacia (OM) were enrolled in this study. Radiological work-up included direct radiographs (n = 12), computed tomography (n = 5), scintigraphy (n = 12) and MRI (n = 12). The location of the insufficiency fractures and corresponding MRI appearances were evaluated. Depending on the presence or absence of signal intensity around the fractures, the lesions were grouped into active and chronic forms.

RESULTS

A total of 34 insufficiency fractures were depicted on imaging studies. MRI demonstrated 33 of the lesions. All the insufficiency fractures were seen as a hypointense lines or fissures on T1- and T2-weighted and STIR MR images. There was a high frequency of insufficiency fractures at the sacrum and iliac bone (16/34, 47%). Overall, 11 chronic-type (no abnormal signal intensity around the fissure) and 22 active-type (abnormal signal intensity around the fissure) insufficiency fractures were detected by MRI. Follow-up MR examinations of 2 subjects showed that abnormal signal intensity had disappeared after appropriate treatment.

CONCLUSION

The results of this study showed that the iliac and sacral bones are frequently involved in patients with OM. MRI can determine the clinical activity of the disease, and can monitor the response to treatment of the active type of insufficiency fractures.

Prevalence of Beta Thalassemia Trait in Denizli

Beta thalassemia, characterized by the deficiency or the absence of beta globulin production, is the most widespread inherited disorder in the world and is also common in Turkey. To determine the prevalence of carriers for beta thalassemia, we screened the couples before their marriage. For this aim, from 1994 to 1999, a total of 14.200 people were screened. The complete blood count and red blood cell indices (hemoglobin: Hb, hematocrite: Hct, median corpusculer volume: MCV, median corpusculer hemoglobin: MCHb, median corpusculer hemoglobin concentration: MHbC, concentration were measured by automated cell counter on the same day of collection. Then for the samples with MCV values of 78 fL or below, hemoglobin electrophoresis were employed. Testing for beta thalassemia was carried out by the conventional cellulose asetate electropheresis at pH 8.4. People who have elevated HbA2 (≥ 3.5%) were accepted as beta-thalassemia carrier or patient. We detected 3300 people with MCV levels of 78 fL or below and 311 cases of beta thalassemia carrier and 11 cases of beta thalassemia. The prevalence of carriers for beta thalassemia in Denizli was 2.2%. This result indicated that the people with anemia in our region should be investigated for the existence of hemoglobinopathy.

Crossover clinical study comparing the pharmacokinetics of etoposide (75 mg) administered as 25-mg capsules three times a day versus once a day

Some investigators have postulated that a constant low blood level might be the ideal mode of treatment, while others have seen no reason to divide up the daily dose. To our knowledge, this study is the first to include crossover of subjects to eradicate individual differences. Our aim was to compare the pharmacokinetic effects of administering etoposide three times a day vs. once a day as 25 mg capsules. Two groups of four patients each received 75 mg/day oral etoposide for 2 days either as 75 mg once daily, or as 25 mg three times daily for 2 days. On days 8 and 9, the treatments were switched between groups. On the one-dose schedule, Cpeek (peak plasma concentration) was greater than 2 micrograms/ml in five patients and greater than 3 micrograms/ml in three patients, while in none of the patients on the three-dose schedule did the peak exceed 2 micrograms/ml. No significant difference was found in terms of Cmean (calculated by dividing the area under the curve by the observed time) between the two treatments. Variability of blood concentrations of etoposide over a 24 h period was high on the one-dose schedule (median 95%, range 54-148%) but it was lower on the three-dose schedule (median 39%, range 28%-55%). No significant differences were found between the two different dosing schedules in terms of the median duration of etoposide blood levels above 0.5 microgram/ml and above 1.0 microgram/ml. These results suggest that detailed clinical toxicity and efficacy data are needed to clarify the possible benefits of the fractionated administration of oral etoposide.

Premarital screening of beta-thalassemia trait in the province of Denizli, Turkey

A premarital screening program aiming at reducing the incidence of thalassemia major was started under the auspices of the Regional Health Administration in 1995 in the city of Denizli in the Aegean region of Turkey. In this report we assessed the 4-year results of the screening program. All couples who applied for marriage procedures were screened for beta-thalassemia trait by automatic red cell indices and Hb A(2) determination. The couples at risk were counseled and offered prenatal diagnosis and termination of pregnancy in case of an affected fetus. From October 1995 to August 1999, a total of 19,804 subjects (9,902 couples) were recruited for this study. The prevalence of beta-thalassemia trait with increased Hb A(2) was found to be 2.6% (514/19,804). In addition to the thalassemia trait, 22 patients (0.11%) had sickle trait. In 15 of the 9,902 couples, both partners were found to be carriers of the beta-thalassemia trait. After genetic counseling, 2 of the 15 planned carrier marriages were canceled. Seven couples declared that they do not want to have a child at present. Prenatal diagnosis was sought by 6 couples. One fetus was found to be normal, 4 had thalassemia minor and 1 had thalassemia major; this pregnancy was terminated by elective abortion. This study indicated that premarital screening is a very useful tool for detecting carrier couples and an effective way of controlling thalassemia major.

Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study

STUDY DESIGN

An epidemiological study conducted all over the country.

OBJECTIVE

The present retrospective study was conducted to survey the new traumatic spinal cord injury (SCI) cases during 1992 in Turkey.

SETTING

Intensive care units, emergency services and departments of orthopaedic surgery, neurosurgery and rehabilitation of state hospitals, rehabilitation centers, military and university hospitals.

METHODS

Postal questionnaires were used for data collection and the records from medical institutes nation-wide were reviewed for the analysis of the epidemiological factors.

RESULTS

Five hundred and eighty-one new traumatic SCI cases were reported in 1992. The annual incidence was found to be 12.7 per million population. Male to female ratio was 2.5:1 and the average age at injury was 35.5+/-15.1 (35.4+/-14.8 for males and 35.9+/-16.0 for females). The most common cause of injury was motor vehicle accidents (48.8%) followed by falls (36.5%), stab wounds (3.3%), gunshot injuries (1.9%) and injuries from diving (1.2%). One hundred and eighty-seven patients (32.18%) were tetraplegic and 394 patients (67.8%) were paraplegic. The most common level of injury was C5 among tetraplegics and T12 among paraplegics. The most prevalent associated injury was head trauma followed by extremity fractures. Severe head trauma resulting in death may obscure the real incidence of SCI and may cause underreporting of cases in epidemiological studies.

CONCLUSION

Considering that motor vehicle accidents and falls were found to be the leading causes of traumatic SCI, it was concluded that the prevention measures should be focused mainly on these in order to reduce the frequency of SCI in Turkey.

The effects of Brassica oleraceae var capitata on epidermal glutathione and lipid peroxides in DMBA-initiated-TPA-promoted mice

BACKGROUND

The objective of the present study was to determine if modulation of GSH-dependent antioxidant protective system by Brassica oleraceae var capitata might inhibit the molecular mechanism of skin tumor promotion.

MATERIALS AND METHODS

In a two stages skin carcinogenesis model, the protocol used included a single topical application of 200 nmol of the initiator 7,12-dimethyl-benz(a) anthracene (DMBA) to the backs of mice, followed 1 week later by promotion with 10 nmol of 12-O-tetradecanoyl-phorbol-13 acetate (TPA) twice weekly for 30 weeks. In addition to this regimen, 0.1 g/L brassica extract was added water week prior to the initiating dose of DMBA in the treatment group. Tissue glutathione (GSH) contents and levels of lipid peroxidation products (measured as thiobarbituric-acid (TBA)-reactive substances) were quantitated in the skin tumors generated by the initiation-promotion protocol.

RESULTS

It was observed that the tumor incidence and tumor multiplicity in the treatment group was highly significantly low compared to the first group of mice (p < 0.001 and p < 0.001, respectively). In the treatment group, GSH content in the papillomas was higher than in the non-involved skin surrounding the papillomas.

CONCLUSIONS

We suggest that the anticarcinogenicity of Brassica may be linked to its ability to facilitate or enhance the activity of the natural GSH-dependent antioxidant protective system of the epidermal cells during the later stages of skin tumor promotion.

Preventive effect of hesperidin against inflammation in CD-1 mouse skin caused by tumor promoter

Our earlier studies have shown that the flavonoid hesperidin inhibits tumor promotion in a two stage skin tumorigenesis protocol in CD-1 mice. In this study hesperidin's significant protection (p < 0.0001) against 12-0-tetradecanoylphorbol-13-acetate (TPA) induced edema in CD-1 mouse ear will be presented. Hesperidin also afforded significant protection against TPA induced hyperplasia in the dorsal skin through multiple application prior to TPA. Protection by hesperidin was 93% of the epidermal thickness and 100% of the vertical cell layers. The data also indicate the protective effect of hesperidin against TPA caused infiltration of neutrophils by 73%. These results suggest that hesperidin may possess potential as chemopreventive agent against tumor promoter induced inflammation and hyperplasia.

Inhibitory effect of Hesperidin on tumour initiation and promotion in mouse skin

A flavonoid, Hesperidin was evaluated for its ability to inhibit tumour initiation by a polycyclic aromatic hydrocarbon and tumour promotion by a phorbol ester in the skin of CD-1 mice. Subcutaneous application of Hesperidin did not inhibit 7,12-dimethylbenz(a)anthracene-induced tumour initiation but did inhibit 12-O-tetradecanoyl-13-phorbol acetate-induced tumour promotion. Results provide evidence for a potential chemopreventive activity of Hesperidin.

Chemoprevention of DMBA-induced mammary gland carcinogenesis--preventive effects of free oxygen radical scavengers

This study was carried out to determine the effects of Mangan-Desferrioxamine (Mn-DFX) and Verapamil (VRP) in 7,12-dimethyl-benz-[a]anthracene (DMBA) induced mammary carcinoma. 70 Spraque Dawley rats were divided into four groups; as DMBA alone, DMBA + Mn-DFX, DMBA + VRP, and control. Incidence, multiplicity, and size of tumors were evaluated in addition to analyses of DNA ploidy status and proliferation index by flow cytometric technique. The results revealed that Mn-DFX and VRP caused significant decreases in tumor incidence (p < 0.02 and p < 0.05), multiplicity (p < 0.02 and p < 0.05), size (p < 0.05 and p < 0.02), and proliferation index (p < 0.05 and p < 0.02) without any toxic effect. The appearance of first tumors in Mn-DFX and VRP groups was also later than in the DMBA alone group (10th and 11th week versus 6th week). In conclusion, Mn-DFX and VRP have offered prevention in experimental mammary carcinogenesis. These agents caused slower tumor growth, though they could not achieve a complete prevention.

Traumatic spinal cord injuries in southeast Turkey: an epidemiological study

In 1994, a retrospective study of new cases of traumatic Spinal Cord Injury (SCI) was conducted in all the hospitals in Southeast Turkey: 75 new traumatic SCI were identified. The estimated annual incidence was 16.9 per million population. The male/female ratio was 5.8/1. The mean age was 31.3, being 31.25 for male patients and 31.36 for female patients. 70.7% of all patients were under the age of 40. The major causes of SCI were falls (37.3%) and gunshot wounds (29.3%), followed by car accidents (25.3%), and stab wounds (1.3%). Thirty one patients (41.3%) were tetraplegic and 44 (58.7%) paraplegic. In tetraplegic patients the commonest level was C5, in those with paraplegia L1. The commonest associated injury was head trauma followed by fractures of the extremity(ies). Severe head trauma, being a major cause of death, may have obscured the actual incidence of SCI. Most of gunshot injured SCI patients were young soldiers fighting against the rebels. As there was no available data for the rebels with SCI, the actual incidence of SCI in Southeast (SE) Turkey should be higher than that found in this study.

The functional independence measure in spinal cord injured patients: comparison of questioning with observational rating

Functional independence measure (FIM) is becoming widely used for all aspects of disabling diseases including spinal cord injury (SCI). It is recommended that it is rated by trained clinicians familiar with the patients. We aimed to compare the ratings of those patients who were questioned with those who were observed in a simulated environment. Fifty patients with SCI were included in the study. They were all FIM rated by the same clinician, first by questioning and then by observation. Although observational rating took much more time than questioning there was a very strong correlation between these two different rating methods. We can conclude that questioning SCI patients could be used as a valuable and quick way to assess the functional level of such patients. Although this does not exclude observational scoring that was generally higher and more motivational for the patient.

Protective effect of desferrioxamin against TPA caused inflammation in CD-1 mouse skin

This study was planned to investigate the possible inhibitory effect of the oxygen radical scavenger agent desferrioxamin on 12-0-tetradecanoylphorbol-13-acetate (TPA) induced oedema and hyperplasia in the skin of 119 CD-1 mice. Topical application of different doses of desferrioxamin (20 ng, 200 ng, 2 microg, 20 microg and 200 microg per mouse) 10 min prior to 1 nmol TPA, inhibited oedema of mouse ears significantly (P < 0.02-0.001) except with the doses of 200 ng and 20 ng/mouse. The inhibitory effect of desferrioxamin (2 mg/mouse) in TPA induced mouse skin hyperplasia was also investigated in four groups of 20 CD-1 mice. Desferrioxamin produced an 83.7% reduction in epidermal thickness (P<0.0001) and an 85.8% reduction in the number of vertical cell layers (P <0.0001). Data also indicated the inhibitory effect of desferrioxamin against TPA caused infiltration of neutrophiles (P <0.02). These results suggest that the free oxygen radical scavenger agent desferrioxamin has a chemopreventive effect against TPA induced inflammation and hyperplasia.