Three-dimensional modelling of the femur and humerus in adult male guinea pigs (guinea pig) with computed tomography and some biometric measurement values

BACKGROUND

Guinea pig is a species belonging to the Caviidae family of the Rodentia order and is frequently used in experimental studies. Biomedical imaging methods are used in the diagnosis and treatment of many diseases in medicine. Among these methods, computed tomography (CT) is one of the most important imaging methods. In this study, it was aimed to perform the three-dimensional (3D) modelling of the CT images, obtained from the humerus and femur in the guinea pigs, via the MIMICS programme, and to make some biometric measurements regarding the bones over these models.

MATERIALS AND METHODS

In the present study, 12 male adult guinea pigs were used. The soft tissue on the humerus and femur bones of the guinea pigs was removed. After this procedure, CT images at a 0.5 mm-thickness were obtained from the animals. The images were recorded in DICOM format. Then, the reconstruction process was performed from the images by using the 3D modeling programme MIMICS® 13.1. On the 3D model of the humerus and femur (right-left), volumes, surface areas and lengths as well as other biometric parameters were measured separately, and the values were recorded. In addition, measurements of the bones were made with the help of a digital calliper.

RESULTS

Among the parameters obtained from 3D models, a statistical difference was observed between the right and left cortical thicknesses of the femur from the measurements of calliper and the right and left humerus volumes (p < 0.05); whereas, no statistical difference was found in other parameters of both measurements (p > 0.05).

CONCLUSIONS

It can be stated that CT and 3D modelling can be used for the measurement of some parameters in the long bones of the guinea pigs.

Association of epicardial fat thickness with TIMI risk score in NSTEMI/USAP patients

BACKGROUND

The association of epicardial adipose tissue (EAT) with coronary artery disease has been shown in previous studies. Furthermore, the relationship between EAT and acute coronary syndrome was studied recently. Herein, we investigated the relationship between EAT thickness and the thrombolysis in myocardial infarction (TIMI) risk score for non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris (USAP).

PATIENTS AND METHODS

The study included 144 patients with NSTEMI/USAP. The study population was divided into two subgroups according to TIMI risk scores as group I (≤ 4, n = 86) and group II (> 4, n = 58). Stepwise multivariable logistic regression analysis was used to assess the independent association of clinical parameters with TIMI risk score.

RESULTS

EAT thickness was higher in group II than in group I (8.2 ± 2.1 vs. 6.2 ± 2.2, p < 0.001). Moreover, patients in group II had higher rates of multivessel disease and Gensini score (p < 0.001). In univariate linear regression analysis, EAT was positively correlated with TIMI risk score and Gensini score. Multivariate regression analysis showed that EAT thickness (OR: 1.56, 95 % CI: 1.17-2.08, p = 0.003), LVEF (OR: 0.93, 95 % CI: 0.85-0.98, p = 0.03), and Gensini score (OR: 1.36, 95 % CI: 1.24-1.98, p = 0.002) were independently associated with a higher TIMI risk score.

CONCLUSION

In conclusion, EAT thickness is independently associated with TIMI risk score and may be an emerging risk factor for adverse events in NSTEMI/USAP patients.

Long-term evaluation of radioisotope synovectomy with Yttrium 90 for chronic synovitis in Turkish haemophiliacs: Izmir experience

Since 2001 we have performed 105 radioisotope synovectomy (RS) in 65 children and young adults, age ranging from 3 to 25 years with a average of 15 years in Ege University Hospital, Izmir, Turkey. One fourth of cases were below 10 years of age. All patients had severe haemophilia A and B. Ten patients (17 joints) had high responder inhibitor. We prefer to use Yttrium 90 for all joints (5 mCi for knees; 2 mCi for others). The knees were injected in 56 cases, elbows in 24 cases, ankles in 23 cases and shoulders in two cases. Steroid injections were not preferred as the principle drug of choice. Mean follow-up period after procedure was 2 years (range: 6 months to 3.5 years). All inhibitor patients had satisfactory results. The best results were obtained in elbows than knees and ankles. Excellent rates (no bleeding) were observed in grade-II synovitis 84% for knees, 93% for elbows and 50% for ankles. Because of the excellent and good response (bleeding reduction to 75%), rates were 100% for knees and elbows and 92% for ankles. In six cases, repeated injections were given at 6-month interval and all of them had good results. The grading of synovitis seems to be an important parameter than the age of the patient. Even in patients below 10 years of age, outcomes are not satisfactory in all joints with grade-III vs. grade-II synovitis (12% vs. 73%). No serious complications were observed during and after procedure except two cases. A mild and transient inflammatory reaction was observed in the ankle. There was a minimal radioisotope leakage to superficial skin in the elbow. RS seems to be a safe and effective treatment for chronic synovitis causing recurrent joint bleedings.

Frequency of gastroesophageal reflux disease in nonatopic children with asthma-like airway disease

Gastroesophageal reflux disease (GERD) is commonly associated with asthma; however, frequency in nonatopic children with asthmatic symptoms is unknown. The aim of this study was to determine the frequency of gastroesophageal reflux (GER) in nonatopic children with asthma-like airway disease that recur despite conventional asthma treatment and to evaluate the clinical response to lansoprazole treatment. Twenty-five nonatopic children aged between 1 and 16 years who have asthma-like airway disease and 25 healthy children were included in the study. All cases underwent 24 h pH monitoring with dual sensor catheters. Additionally, acid suppressor treatment was administered to patients diagnosed as having GERD and clinical response was evaluated. Major symptoms encountered in the patient group included wheezing and cough (88%, and 32%, respectively). Reflux episodes were more common in distal esophagus during the prone position (reflux index (RI) of 11.5+/-10.3 vs. 16.2+/-9.4 during supine vs. prone). All distal esophageal parameters were significantly higher in the patient group except number of reflux episodes lasting longer than 5 min (RI of 13.3+/-13.1 vs. 3.9+/-2.9 in the patient vs. control groups, respectively). There was a significant improvement in symptoms and requirement for medication with treatment (number of systems decreased from 2.3+/-0.6 to 0.4+/-0.6, P=0.00). In conclusion, GERD is significantly more common in nonatopic children with asthma-like airway disease compared to the controls and clinical improvement is significant after acid suppressor treatment. Thus, we suggest that children followed-up with the diagnosis of nonatopic asthma with recurrent exacerbations despite adequate asthma treatment have a high frequency of GER and that lansoprazole treatment may be considered early in management.

Evidence of increased oxidative stress by simple measurements in patients with dilated cardiomyopathy

The heart cannot supply sufficient blood for tissue metabolic needs in patients with congestive heart failure. Hypoxia and organ hypoperfusion increase oxidative activity. It has been reported that free radicals are involved in the genesis of heart failure. The aim of this study was to assess the status of oxidative stress by simple measurements in patients with dilated cardiomyopathy of ischemic or idiopathic etiology. Eleven patients (8 M, 3 F, age range 32 to 65 years) with dilated cardiomyopathy of ischemic etiology and 12 patients (8 M, 4 F, age range 31 to 66 years) with dilated cardiomyopathy of idiopathic etiology were included in the study. A control group included 21 healthy subjects (12 M, 9 F, age range 25 to 67 years). Levels of thiobarbituric acid-reactive substances, total thiols, and fluorescent products of lipid peroxidation were measured in plasma/serum samples of patients and controls. No statistically significant differences were found between the two patient groups for the parameters studied (p>0.05). Levels of thiobarbituric acid-reactive substances and fluorescent products of lipid peroxidation were higher in both patient groups than in controls (p<0.05), whereas concentrations of total thiols were decreased (p<0.05). In conclusion, in patients with idiopathic or ischemic dilated cardiomyopathy, there are associated abnormalities of a range of markers of increased oxidative stress and lipid peroxidation. The plasma/serum constituents studied can be routinely measured in order to monitor patients during antioxidant therapy.

Low plasma apolipoprotein A-I level: new prognostic criterion in childhood cirrhosis?

Apolipoprotein A-I (apo A-I) has been found to be decreased in adults with cirrhosis, but it has not been routinely used for prognostic purposes thus far. This study was performed to determine apo A-I levels in childhood cirrhosis and to establish some prognostic cut-off values. Apo A-I levels of 78 children with chronic liver disease, 38 of whom had cirrhosis as well, were studied. Mean values of cirrhotic, non-cirrhotic and healthy children were not different (p > .05). However, in cirrhotic children, the highest value was detected in the Child-Pugh A group, and it was different from those of the B and C groups (p < .05 and p < .001, respectively). Apo A-I was the lowest in the moderate risk group of Malatack's model, and was significantly different from the low risk group (p < .05). Apo A-I was inversely correlated with Malatack score, Child-Pugh score, total bilirubin, conjugated bilirubin, and prothrombin time (p < .01, p < .01, p < .01, p < .01, p < .05, respectively). In cirrhotic children with cholestasis, apo A-I was lower than in non-cholestatic children (p < .05). Apo A-I value < 80 mg/dl had 84% specificity and 84% negative predictive value for the high risk group of Malatack's model. Similarly, Apo A-I value < 83 mg/dl had 95% specificity and 87% negative predictive value for the Child-Pugh C group. We concluded that Apo A-I is a sensitive and specific parameter of poor prognosis in childhood cirrhosis.

Chronic inflammatory bowel disease in a patient with common variable immunodeficiency

Common variable immunodeficiency (CVID) is a primary defect of the immune system involving an increased risk of respiratory and digestive tract infections and autoimmune diseases. Recently, it has been reported that chronic inflammatory bowel disease (CIBD) might occur with increased frequency (20%) in patients with CVID. A nine-year-old boy with CVID developed CIBD during follow-up and periodic intravenous immunoglobulin administration. Serum tumor necrosis factor-a concentration, which is suggested to show disease activity in CBD, was very high. The patient's radiological evaluation, both in active and remission periods, had characteristic features of CBD. We herewith present and discuss this case with both diseases, CVID and CIBD.

Increased nitric oxide in exhaled air in patients with rheumatic heart disease

BACKGROUND

Endogenous production of nitric oxide and its presence in exhaled air was observed in humans. Prior studies have yielded contrasting information about the production of nitric oxide in patients with heart failure.

AIMS

The aim of this study was to measure nitric oxide in the exhaled air of patients with chronic rheumatic heart disease with and without pulmonary hypertension.

METHODS

Seventy-four patients (6 patients had isolated mitral stenosis; 13 patients had combined mitral stenosis and mitral regurgitation; 1 patient had isolated mitral regurgitation; 54 patients had combined mitral and aortic valve disease) and 27 healthy subjects were entered in the study. The nitric oxide concentration in exhaled air was determined with a chemiluminescence analyser. Echocardiography was performed in all patients to assess the severity of the valve disease and for the measurement of pulmonary artery pressure.

RESULTS

The level of exhaled nitric oxide was significantly greater in patients with rheumatic heart disease than in controls. The value of nitric oxide concentration in exhaled air was significantly increased in patients with pulmonary hypertension, as compared with patients who had normal pulmonary artery systolic pressure.

CONCLUSION

We found increased nitric oxide in the exhaled air in patients with rheumatic heart disease, especially in those with pulmonary hypertension, compared with healthy patients.

Cementless total knee arthroplasty in ochronotic arthropathy: a case report with a 4-year follow-up

Alkaptonuria is an inherited metabolic disorder characterized by the absence of the enzyme homogentisic acid oxidase, which leads to the accumulation of homogentisic acid, produced during normal metabolism of phenylalanine and tyrosine. Ochronosis, which is the dark pigmentation of connective tissues in patients with long-lasting alkaptonuria, can cause severe cartilage destruction in large joints and the vertebral column. Knee joint involvement, which occurs at relatively early ages, can be quite restrictive. Arthroplasty may be the treatment of choice in these patients because of limited mobility and diffuse involvement of the joint. We report a 48-year-old man who had been treated with cementless total knee arthroplasty. Theoretically, there are no bone ingrowth deficits that might be detrimental for the stabilization of cementless prostheses in ochronotic arthropathy because the bone tissue is not primarily affected by the disease. The 4-year follow-up of cementless total knee arthroplasty was satisfactory without any evidence of loosening.

Dynamic left ventricular outflow tract obstruction in a patient with pheochromocytoma

Symmetric left ventricular hypertrophy or asymmetric septal hypertrophy associated with pheochromocytoma simulating hypertrophic obstructive cardiomyopathy have been rarely reported. In this report, we present a case with pheochromocytoma that had dynamic left ventricular outflow tract obstruction without asymmetric septal hypertrophy. A surface echo revealed resolution of the systolic anterior motion of the mitral valve and all Doppler evidence of left ventricular outflow tract obstruction following removal of the tumor. Dynamic left ventricular outflow tract obstruction seen in this patient was probably due to excessive secretion of cathecolamines by the tumor.

Blood levels of leukotrienes (LTC4, D4, E4, B4) and synthesis of leukotriene B4 by peripheral leukocytes in children with acute A and B hepatitis

Leukotrienes (LTs) are cell-membrane derived lipid inflammatory mediators, synthesized and eliminated by the liver. LTs have effects on liver cells in some pathological conditions. In this study, we measured plasma endogenous and liberated leukotriene (LT) concentration in peripheral blood leukocytes stimulated in vitro by the calcium ionophore (CaA23187) and platelet-activating factor (PAF). Production of LTs was measured in type A (n=37) and type B (n=10) acute hepatitis patients and control subjects (n=10). LTs levels were measured by high performance liquid chromatography (HPLC) and radioimmunoassay (RIA). The concentration of LTB4 measured in plasma and stimulated peripheral blood leukocyte supernatants of children with hepatitis A infection was found to be statistically elevated and in positive correlation with serum alanine aminotransferase (ALT) levels. In plasma samples of hepatitis B patients, LTC4 and LTE4 were measured in significantly elevated concentrations. These results suggest that LTB4 may be a critical mediator of hepatitis A virus-induced hepatocellular injury.

QT dispersion. Is it an independent risk factor for in-hospital mortality in patients with intracerebral hemorrhage?

Electrocardiographic repolarization changes, comprising QT prolongation, are most commonly seen after intracerebral hemorrhage. In this study in patients with intracerebral hemorrhage (ICH), QT dispersion and its daily changes were examined and the relation between QT dispersion and in-hospital mortality assessed. In 28 patients with intracerebral hemorrhage, diagnosed by computerized tomographic scanning, an ECG was obtained on the day of admission to hospital and then serial ECGs were recorded on the following four consecutive days. Blood electrolytes (K, Ca, Mg) were also analysed. The patients with intracerebral hemorrhage were followed until discharge or death (mean 14 +/- 4 days). QT, QT peak, and QT-QT peak dispersion were measured on simultaneous twelve lead electrocardiograms. Also, in 29 healthy subjects as a control group, five consecutive day serial electrocardiograms were recorded. There were no statistically significant differences between the study and control groups in terms of gender and age. During the five days, QT, QT peak, and QT-QTpeak dispersion values were significantly higher in patients with intracerebral hemorrhage than in the control subjects (p < 0.001). There were no statistically significant differences in two patient groups with intracerebral hemorrhage who died and who were discharged in terms of mean QT, QTpeak, and QT-QTpeak dispersion values. In conclusion, QT, QT peak, and QT-QTpeak dispersion values were significantly greater in patients with intracerebral hemorrhage than in the control subjects, but QT, QT peak, and QT-QT peak dispersions were not independent risk factors for in-hospital mortality in patients with intracerebral hemorrhage.

Dispersion of repolarization in paroxysmal atrial fibrillation

Widened dispersion of refractoriness has been considered to lead to an increase in atrial vulnerability. In this study, we obtained simultaneous monophasic action potential recordings by 2 special catheters from 2 different loci in the right atrium in 9 normal subjects (Group 1) and in 7 patients with paroxysmal atrial fibrillation (Group 2). We measured action potential duration at 50% (APD50) and 90% (APD90) repolarization from both loci in the right atrium during steady-state through one of the two catheters. The differences between APD50 and APD90 recorded by the two catheters were designated as dispersion of APD50 and dispersion of APD90, respectively. While, the mean APD50 and APD90 were 149.7+/-16.9 and 228.3+/-44.7 ms respectively in Group 1, the corresponding values for Group 2 were 145.7+/-33.5 and 213.5+/-53.1 ms. The difference between the 2 groups was not statistically significant. However, the dispersion of APD50 and APD90 were 13.8+/-13.8 and 10.0+/-9.7 ms in Group 1 and 42.8+/-19.6 and 57.1+/-32.4 in Group 2, respectively and the difference between the 2 groups for both measurements was statistically significant (P<0.01). Another finding was a high correlation between age and dispersion of APD90 in the whole population studied (r=0.82, P<0.001). With these findings, although one can not derive the conclusion that patients with paroxysmal atrial fibrillation have a greater dispersion of repolarization, our finding of increasing dispersion of repolarization with age could be an explanatory factor for the increased prevalence of atrial fibrillation with advanced age.

[High tibial osteotomy for varus deformity of more than 20 degrees]

INTRODUCTION

This study was undertaken to evaluate the results of high tibial osteotomies on varus gonarthrosis, on which a mechanical angular correction of more than 20 degrees was performed.

MATERIAL AND METHODS

This retrospective study concerned 46 knees in 38 patients. The average patients age at operation was 60 (min. 51, max. 71). All the patients were evaluated clinically according to the Knee Society Scoring System and radiologically (standing AP, lateral views and monopodal whole leg weight bearing X-Rays) both pre and post operatively. 3 knees have been excluded because of various reasons. The average follow up of the remaining 43 knees was 50.3 months (min. 24, max. 109 months). The preoperative mechanical axis deviation was 22.8 degrees (min. 16, max. 36 degrees).

RESULTS

Postoperatively an optimum valgus alignment was obtained in 31 knees. In 12 knees, the peroperative correction decreased and the mechanical axis was again in varus but with less deformity. According to The Knee Society Scoring System at the last follow-up, the Knee Score was 83, and the Knee Functional Score was 81 (54 and 55 respectively preoperatively). Three cases were reoperated. One internal fixation and bone grafting for nonunion, one reosteotomy for recurrence of the deformity and one total knee replacement for persisting pain were performed. The most frequent complication was the loss of correction which was encountered in 12 knees. Age, follow-up period and alignment were not found to influence significantly the results. Only the arthritis stage, according to Ahlback's radiographic evaluation, was found to be an important factor influencing the results.

DISCUSSION

Dome shaped osteotomy's results were surprisingly good in these patients. This technique, performed with a cheap fixator, allowed an operatively exact correction of the deformity, an early active mobilization and progressive weight bearing. The dome shaped osteotomy displaces the tibial tuberosity medially and if needed anteriorly, treating effectively the patello-femoral arthrosis which is frequently present in these highly deformed knees.

CONCLUSION

Chosen because of necessity by the authors, the dome shaped osteotomy stabilized by a Charnley fixator, performed on knees needing an important angular correction, has given surprisingly good mid term results. Furthermore the good results obtained support our belief of not enlarging the arthroplasty indications against those of the osteotomies, even in severe gonarthrosis.

Increased oxidative stress in dilated cardiomyopathic heart failure

In the present study, we assessed oxidative stress in patients with dilated cardiomyopathy of ischemic or idiopathic etiology. For this reason we measured whole blood reduced glutathione, erythrocyte superoxide dismutase, susceptibility of erythrocyte membranes and erythrocytes to peroxidation, and SH content of erythrocyte membranes in 12 patients (8 men and 4 women, ages 31 to 66 years) with idiopathic dilated cardiomyopathy, in 11 patients (8 men and 3 women, ages 32 to 65 years) with ischemic dilated cardiomyopathy, and in 21 healthy volunteers (12 men and 9 women, ages 25 to 67 years). There was no statistically significant difference between the two patient groups for the indicators studied (P >0.05). Blood glutathione, erythrocyte superoxide dismutase, and membrane SH content of both groups of patients was decreased compared with controls (P <0.05), whereas erythrocyte and membrane susceptibility to peroxidation were increased (P <0.05). We conclude that patients with idiopathic or ischemic dilated cardiomyopathy exhibit abnormalities of a range of markers of increased oxidative stress. These abnormalities may contribute to contractile dysfunction, increased incidence of fatal arrhythmias, and sudden death.

Prophylactic therapy for hemophilia in a developing country, Turkey

Prophylaxis has been practiced for many years in Europe and is gaining acceptance worldwide with current viral inactivation procedures. Unfortunately, the high cost of prophylaxis is currently the major obstacle to its implementation in developing countries such as Turkey. The aim of this controlled preliminary study is to evaluate the efficacy, safety, and feasibility of prophylaxis. Seven boys aged 1.5-7 years (5.0 +/- 1.8), who had severe hemophilia (six A, one B) received 20-50 IU/kg factor twice weekly and were followed up for 6-24 months (14.5 +/- 6.6). Intermediate concentrates have been used in hemophilia A and ultrapure product for hemophilia B. The data obtained for the same group of patients before prophylaxis were used as a control group. Another control group was selected in another group of 10 hemophiliacs, mean age 12.5, and received treatment on demand. During prophylactic treatment, the episodes of bleeding were decreased (from 10.5 +/- 3.2 to 4.5 +/- 3.6). Orthopedic and radiologic joint scores were stable (from 0 to 1 and from 1.1 +/- 1.2 to 1.0 +/- 1.5). The patients spent significantly fewer days in the hospital (from 18 +/- 12 to 0.7 +/- 0.6). None of the patients was infected with hepatitis A, hepatitis B, or human immunodeficiency virus. One patient was seroconverted with anti-hepatitis C virus in the third month of prophylaxis. Mean consumption of concentrates for prophylaxis was 3489 +/- 960 IU/kg per year compared with 2073 +/- 1302 in conventional therapy. Prophylaxis was superior to treatment on demand even when given in a twice-weekly period with intermediate concentrates. In Third World countries, prophylaxis should be tried at least in selected severely hemophilic children in order to prevent disabilities.

Can isolated, symptomatic, frequent ventricular premature depolarizations be a predictor of an inducible ventricular tachycardia? Treatment by radiofrequency catheter ablation

In this report, we describe a case of sustained ventricular tachycardia of right ventricular outflow tract origin, induced by dobutamine infusion in a patient with symptomatic, frequent ventricular premature depolarizations but no documented clinical ventricular tachycardia. Radiofrequency catheter ablation abolished not only the ventricular tachycardia itself, but also the frequent ventricular premature depolarizations responsible for all the symptomatology. In conclusion, provocation by catecholamine infusion may have a place in the search for an alternative to antiarrhythmic therapy in patients with isolated, frequent and symptomatic ventricular premature depolarizations.

Effect of tibial tubercle elevation on patellofemoral compressive force in patellofemoral arthrosis

In this study, the effect of tibial tubercle elevation on the patellofemoral compressive force (PFCF) was investigated in patients with patellofemoral arthrosis. Fifteen (11 women and 4 men) patients who had undergone tibial tubercle elevation were included in the study. The average follow-up was 4.5 years. The mean age of the patients was 59 years (range 34-71 years). They were able to maintain a normal pain-free daily life. Maximal isometric quadriceps force (Q) was calculated by equating the moment generated by this force to the moment of the force measured at the ankle by a modified hand dynamometer. PFCF was calculated from the quadriceps and patellar tendon forces. Statistical analyses were then applied to the measured and calculated quantities. The mean quadriceps force in the operated knee decreased by 20%. Likewise, the mean PFCF was found to be reduced by 30% in the operated knees as compared with the asymptomatic contralateral knees. The above differences in Q and PFCF between the operated knee and the asymptomatic knee were statistically significant (P < 0.05). Therefore, the results of this study do not agree with the previously held view that Q and PFCF increase due to the removal of pain after the elevation operation. It is our contention that comparison of the forces measured preoperatively in a painful joint with the forces that can be attained postoperatively in the pain-free joint can lead to errors in biomechanical evaluations.

alpha-Interferon-2b treatment for chronic hepatitis-B infection in children with cancer

We have evaluated the efficacy of treatment with recombinant Interferon-2b (IFN-2b) in 12 children with cancer who developed chronic hepatitis-B infection. Seven of them had lymphoblastic leukaemia and others had solid tumours. Seven cases were male. Mean age was 10.5 years with a range of 5-16 years. Chronic Hepatitis B was diagnosed biochemically, serologically and histopathologically. They were HBsAg(+), HBV-DNA(+), and HCV(-), HIV(-). Seven cases were HBeAg(+) and two of them were anti-Delta IgG(+). Liver biopsy revealed chronic active hepatitis in six cases and persistent hepatitis in three cases. IFN was given at the dose of 5 MU/m2 three times a week, subcutaneously for 6 months. It was well tolerated. After IFN therapy, ALT levels returned to normal in seven cases. All cases were still HBsAg(+). Four of them seroconverted to anti-HBe antibody. Loss of serum HBV-DNA in three cases, but 11 cases showed a marked decrease after IFN. The control liver biopsies showed that histopathological activity index was diminished in five cases. Other 16 patients, serving as control, received no therapy. Five of them were leukaemia and others were solid tumours. Twelve cases were male. Mean age was 9.3 years with a range of 4-19 years. After 6 months, only one patient lost HBV-DNA and three of them seroconverted to anti-HBe with normalization of ALT values. In our study, IFN treatment favourably influenced the progress of chronic hepatitis B in children with cancer.

Peroneal nerve dysfunction after high tibial osteotomy. An anatomical cadaver study

An anatomical cadaver study was carried out on 13 human cadavers to disclose the close anatomical relationship between the peroneal nerve and the surgical area of the high tibial osteotomy techniques. The common peroneal nerve passes within 3 to 6 mm. of the posterior aspect of the fibular head and neck and divides into its superficial and deep branches, 22 to 28 mm. distal to the fibular apex. Generally the extensor hallucis longus (EHL) muscle is innervated by one of the motor branches of the deep peroneal nerve which is anatomically located 74 to 82 mm. distal to the fibular apex. To avoid neurological complications with a high tibial osteotomy, fibular osteotomy should be carried out at the junction of the middle and distal thirds of the fibula without excessive medial and anterior displacement of fragments; a small fibular segment should be resected in knees which have a severe deformity and need a significant angle correction.

Fistulous connection between the left pulmonary artery and the innominate vein

A 66-yr-old woman was admitted to our clinic with signs and symptoms suggesting either pulmonary embolism or pneumonia. Subsequently she was diagnosed as having pneumonia, but since pulmonary artery pressure was high on echocardiography, pulmonary angiography was performed to exclude the possibility of pulmonary embolism. No findings suggestive of pulmonary embolism were evident on pulmonary angiogram, but there was a fistulous connection between the left pulmonary artery and the innominate vein. To our knowledge, this report represents the first case of a fistula between the pulmonary artery and a systemic vein.

Four siblings with achalasia, alacrimia and neurological abnormalities in a consanguineous family

Four siblings with achalasia, alacrimia and other problems involving the autonomic nervous system involvements are reported. Achalasia and alacrimia were present in all of them. Their parents are first cousins and have four other healthy children. Electrophysiological tests showed that autonomic dysfunction has progressed with age. Blood cortisol levels were normal in all four affected children. Depending on those findings of our case and previous reports, we conclude that triple-A syndrome and achalasia, alacrimia with or without neurological abnormalities could be variable manifestations of the same autosomal recessive gene defect.

Cystic fibrosis patients from the Black Sea region: the 1677delTA mutation

A 2 bp deletion in exon 10 of the CFTR gene, 1677delTA, which is very rare among CF chromosomes worldwide, was found to be a relatively common cause of cystic fibrosis in countries located in the region of the Black Sea. The frequency of the mutation was compared among cystic fibrosis patients from several populations, namely Bulgarians, Turks, Greek-Cypriots, Georgians, and Russians. The deletion is most common among Georgian CF patients and gradually declines in frequency in neighbouring populations. It is invariably related to a common polymorphic haplotype which is rare among normal chromosomes in Bulgaria but was found to be common in Turkey. The geographic gradient in the frequency of the mutation, along with findings on polymorphic haplotype distribution, suggest that the mutation is relatively young in evolutionary terms and spread as the result of west and south-bound migrations originating from Georgia. The 1677delTA mutation is related to a severe clinical phenotype with a high early mortality rate among homozygotes and possibly to an increased risk of meconium ileus.

[Parasite prevalence in schools with different socioeconomic status and evaluation of methods for diagnosing intestinal parasitic diseases]

In this study; the parasite prevalence of schools with different socio-economical status and three methods for diagnosing intestinal parasitosis were evaluated. Children from two primary schools and one junior high school with different socio-economical status participated in the study. The three method used for diagnosing parasitosis in this study were direct wet mounts, concentrated saline flotation technique, and zinc sulfate centrifugal flotation method. Parasitosis was found in 69 fecal samples (18%). The distribution of the parasites found were Hymenolepis nana (29%), Ascaris lumbricoides (26%), Enterobius vermicularis (23%), Trichirus trichiura (18%), taenia saginata (4%). The parasite prevalence in schools with low and high socioeconomical status differed significantly (27% vs. 5% respectively). Combined methods were superior to single methods. The combined method of direct wet mounts and zinc sulfate centrifugal flotation was the most sensitive method (diagnosis rate 90%). But we think that the combined method of direct wet mounts and concentrated saline flotation technique is a simpler method with almost equal results (86%).