Value of Preoperative Indocyanine Green Clearance Test for Predicting Post-Hepatectomy Liver Failure in Noncirrhotic Patients

BACKGROUND Liver failure is the most feared complication following hepatectomy. Post-hepatectomy liver failure (PHLF) is closely related to the remnant liver volume, and functional reserve. There are several methods for predicting PHLF prior to liver resection. The indocyanine green (ICG) clearance test was popularized in patients with hepatocellular cancer (HCC). We aim to demonstrate the value of preoperative ICG clearance measurement via pulse spectrophotometer (LIMON®) in prediction of PHLF in noncirrhotic patients prior to liver resection. MATERIAL AND METHODS Fifty-three noncirrhotic patients who underwent liver resection due to different pathologies were included. Retrospectively collected clinical data, including the preoperative ICG clearance measurements and remnant liver volumes of the patients, were statistically evaluated according to the PHLF criteria of the International Study Group of Liver Surgery. RESULTS Four (7.5%) patients with PHLF were observed. There was no significant difference between PHLF and non-PHLF groups regarding ICG clearance measurements with cut-off values of 5% and 9.5%. CONCLUSIONS The ICG clearance test does not satisfy our expectations in noncirrhotic patients in predicting PHLF. We believe that the ICG clearance test should be reserved for patients with cirrhosis and/or HCC. This test could be an option for noncirrhotic patients with chronic active hepatitis, advanced-grade fatty livers, or for patients who received long-term preoperative chemotherapy, and also for patients who underwent single or multiple sessions of TACE or TARE prior to liver resection. If the routine selection criteria have been fulfilled, there is no further need to perform the ICG clearance test for living liver donors.

The Effect of Simvastatin on Pulmonary Damage in Experimental Peritonitis in Rats

Statins are widely used in the treatment of hyperlipidemia, as they inhibit cholesterol synthesis. They also have anti-inflammatory, antioxidant, immunomodulatory, and positive endothelial-functional effects. It is hypothesized that simvastatin ameliorates pulmonary damage secondary to peritonitis in rats. Forty Wistar albino rats were divided into four groups. In sham group, laparotomy was the standard procedure. In simvastatin group, simvastatin was given perorally before laparotomy. In sepsis group, peritoneal sepsis was constituted by cecal ligation and puncture technique. In sepsis + simvastatin group, the procedures of simvastatin and sepsis groups were applied together. After sacrification at the 72nd hour, tissue samples from lungs were harvested for histopathological examination, wet and dry weight measurements, and tissue culture, tissue malondialdehyde, and nitric oxide tests. Blood samples were taken for C-reactive protein and whole blood count. While the malondialdehyde levels were found to be significantly higher in sepsis group, nitric oxide levels were found to be significantly lower in simvastatin + sepsis group. Alveolar hemorrhage was highest in simvastatin + sepsis group. There was no difference for C-reactive protein, leukocyte levels, and histopathological examination between any groups. The ratios of wet and dry lung weights were higher in simvastatin-given groups. Simvastatin has no positive effect in terms of lung dysfunction on experimental sepsis model. For a better understanding of the effects of simvastatin on lung injury in peritoneal sepsis, experimental models of longer duration that enable to search the effects of simvastatin beyond 3 days will be more useful.

[The evaluation of abstracts presented at the 5th Congress of National Trauma and Emergency Surgery]

BACKGROUND

The aim of this study was to evaluate demographics, methodological data and writing style of abstracts presented at the 5th Congress of National Trauma and Emergency Surgery.

METHODS

Study design, institutions and number of authors, appropriateness of the title, use of a structured abstract, word count, fluency, accuracy of the statistical evaluation, and conclusionabstract accordance were assessed in 451 abstracts.

RESULTS

Nearly 49% of abstracts were retrospective and 29% were case reports in design. 33%, 26%, and 24% of abstracts were related to isolated organ, single system and multi-system injuries, respectively. Approximately two-fifths of presentations were university-based. Approximately one-third of presentations were multidisciplinary in origin. The mean number of authors was 5.6+/-1.8, and a statistical significance was found between abstract contributions from university versus other hospitals (p=0.001). Three-fourths of the abstracts had an appropriate title and 91% were structured. Word count was 100-250 in 57% and 250-500 in 42% of abstracts. Statistical analysis was used in only 19% of abstracts. Most of the abstracts were fluent. Conclusion-abstract accordance was present in 71% of the abstracts.

CONCLUSION

Our results indicate there are some deficiencies in the abstract writing process. The use of a structured abstract may intensify fluency and compliance to abstract writing guidelines. Clinical studies regarding multi-traumatized patient groups and experimental studies should be encouraged.

Determination of malondialdehyde, reduced glutathione levels and APOE4 allele frequency in late-onset Alzheimer's disease in Denizli, Turkey

OBJECTIVES

The aim of the present study was to determine the Apolipoprotein E (APOE) 4 allele frequency of patients with late-onset Alzheimer's disease (AD) and to determine the effects of oxidant-antioxidant balance on AD.

DESIGN AND METHODS

PCR-RFLP was undertaken in 62 cases with AD and 56 aged-matched controls. Activities of reduced glutathione (GSH) and malondialdehyde (MDA) concentration were measured in same groups.

RESULTS

Patients with at least one E4 allele genotype were significantly different in patients with AD (21%) than controls (9%) (p=0.01). Serum MDA levels were significantly different between AD patients and Control group (p=0.0001). There was no significant difference in serum GSH levels between AD patients and C groups.

CONCLUSION

These results confirmed that the APOE4 allele occurs frequently in late onset AD compared with normal controls. Also elevated MDA levels are likely an essential factor in the pathogenesis and neuronal damage of AD.

Cost of Alzheimer's disease in a developing country setting

PURPOSE

To evaluate the economic impact of AD in Denizli, Turkey.

DESIGN AND METHODS

This observational study was conducted with 42 AD patients and their primary caregivers. During the initial interview, demographic data and medical histories were collected with questionnaires. For an observational period of 15 days, data on time spent for patient care were collected using standard forms. Calculations on direct cost (e.g. per day medication, outpatient physician visits during the last 3 months), indirect cost (e.g. time spent for care by caregiver for daily living (ADL) and instrumental activity of daily living (IADL)) were made by summing up and taking averages of the appropriate items. ANOVA, and linear regressions were the methods for comparisons.

RESULTS

The primary caregivers of the patients mainly were their children and/or spouses. The maximum mean time spent (h/week) was 21.0 (17.5) for severely damaged cognition. The average annual cost per case was between $1,766 [95% Confidence Intervals (CI); 1.300-2.231] and $4,930 (95% CI; 3.3714-6.147). The amount of caregiver cost was the most significant item in the overall cost and it showed an increase with the declining cognitive function of patients. Daily medication cost reflected the same pattern. In contrast, cost of outpatient physician was the lowest among the patients with the worst cognition.

CONCLUSIONS

These results suggest that recently AD has become a significant cost for developing countries. This pilot study gives an idea of the cost of AD in developing countries where determining the actual cost can be difficult.

Nerve conduction parameters during ischemia-reperfusion in the rat sciatic nerve

We investigated the duration of electrophysiological alterations in the rat sciatic nerves during ischemia-reperfusion. Motor nerve conduction velocities were lower than the control group in 1- and 2-hour ischaemia groups after one day while there was no reading for the 3-hour ischaemia group till the seventh day, which was lower than control group. In the 1-hour ischaemia group, all parameters returned to normal on the seventh day but motor nerve conduction velocity decreased again on the 14th day and then returned to a normal level once again on the 21st day. All parameters were found to return to normal levels in the 2-hour ischaemia group on the 30th day and the 3-hour ischaemia group on the 60th day.

Lower motor neuron disease associated with myelofibrosis

We present a patient who has signs pointing to the involvement of lower motor neurons and myelofibrosis. To our knowledge, unlike lymphoproliferative disorders, co-occurrence of myelofibrosis and lower motor neuron disease (MND) has not been reported so far. A 64-year-old male patient was admitted to our hospital with the complaint of painful cramps in his neck and forearms. On physical examination marked hepatomegaly and splenomegaly were found. On neurologic examination nasal quality of the voice and slight palatal weakness were detected. There were generalised slight weakness and atrophy in both proximal and distal muscle groups. Fasciculations were observed especially in forearm muscles and it was observed that he had been avoiding head movements because of painful muscle cramps. Deep tendon reflexes were hypoactive. Nerve conduction studies were normal. By needle electromyography, giant motor unit action potentials (amplitudes up to 8 mV), fibrillation potentials, positive sharp waves and fasciculation potentials were detected in all muscles which were investigated. A hypercellular bone marrow (100%) was determined by bone marrow biopsy. In addition to increased production of the myeloid and megakaryocytic lines, abnormal aggregation and grouping of megakaryocytes were seen. Reticular fibers were increased. He had some benefit of dyphenilhydantoin treatment given for the painful cramps in his neck and forearm muscles. Hydroxyurea treatment was started for myelofibrosis. Six months later, his general condition was better, and the painful cramps were completely resolved. No marked deterioration has been detected in neurologic examination and electromyography for 1 year.

Prostate electromyography: a new concept

Knowledge of the pharmacological and electrophysiological properties of prostatic smooth and striated muscle myofibres are necessary in order to determine whether the dynamic component of benign prostatic hyperplasia (BPH). To our knowledge prostate electromyography have not previously been applied in any type of prostate disorder. The purpose of the present study is to evaluate the electrical activity of the prostatic muscle fibers. We were able to evaluate the features of prostatic muscle action potentials (PMAP) in 15 of the 16 patients from the area around the prostate capsule. Prostate was palpated in the knee-chest position then concentric needle electrode was inserted into the prostate tissue under digital guidance. Needle tip position in the prostate was confirmed with transabdominal ultrasonography. PMAPs were analysed with multi-motor unit action potential analysis (MMA) algorithm. Whenever the PMAPs were unsuitable for analysing with MMA software the amplitude trigger line method was used. Further studies with a large number of patients are needed to establish the correlation between the electrical activity of prostatic muscle fibers and dynamic component of patients with symptomatic BPH.

Auditory evoked potentials in vitiligo patients

There is convincing evidence that vitiligo is a systemic disorder influencing the whole pigmentary system, including melanocytes in the inner ear. Cochlear melanocytes and also melanin-containing cellular elements of the auditory system may be affected in vitiligo and interfere with the conduction of action potentials. We conducted a prospective clinical trial to determine hearing status and auditory evoked potentials in 50 patients affected by vitiligo and compared the results with those of 50 healthy controls. I, III, V latencies and amplitudes and I-III, III-V, I-V interpeak latencies were compared with each group. Statistical evaluation was accomplished using the t-test. With the exception of two subjects, all patients demonstrated normal audiological results. No statistically significant difference was noted between the study group and controls in regard to latencies, interpeak latencies and amplitudes. We conclude that auditory investigations supported by postmortem histopathological studies of the inner ear and brainstem may provide more accurate knowledge in vitiligo patients.

The effects of postmenopausal hormone replacement therapy on sympathetic skin response

OBJECTIVES

To determine the effects of postmenopausal hormone replacement therapy on 'sympathetic skin response' test which is one of the tests to evaluate autonomic functions.

METHODS

Sixty postmenopausal women, 30 of whom taking hormone replacement therapy and the remaining 30 without hormone replacement therapy, were enrolled in this study. Sympathetic skin responses were recorded in each subject by Medelec Premiere electromyograph. Latency and amplitude of sympathetic skin response and area under the negative component of sympathetic skin response were measured and the groups were compared statistically regarding these results.

RESULTS

Latency values of the groups were not significantly different, whilst the difference between the sympathetic skin response amplitudes of the groups, as well as the difference between the measurements of area under the negative component of sympathetic skin response of the groups were statistically significant.

CONCLUSION

The results of the current study seem to indicate that estrogen has a significant inhibitory effect on the sympathetic neuron pool at the spinal cord level.