Viscocanalostomy with Mitomycin-C: A Preliminary Study

Purpose

To compare the results of viscocanalostomy with and without mitomycin-C (MMC).

Methods

Retrospective results of 15 standard viscocanalostomy (VCO) operations (Group 1) were compared with the prospective results of 15 VCO operations performed with intraoperative adjunctive MMC (Group 2). MMC (0.2 mg/mL) was applied over and under the superficial scleral flap for 3 minutes in Group 2 before the deep flap was prepared. Each patient was followed up for at least 1 year, and results of examinations in the first 12 months were used in the statistical comparison of the two groups. Surgical success was defined as intraocular pressure (IOP) ≤ 18 mmHg.

Results

Pr eoperative mean intraocular pressures (IOP) in Group 1 and Group 2 wer e 35.3±11.0 and 39.1±8.9, respectively. Mean IOP levels at the 12th month were 14.4±2.6 and 11.9±4.0, respectively, showing a significant decrease in both groups (p<0.001). Postoperative IOP course appeared to be lower in the MMC group, however, the difference was not statistically significant (p=0.554). Complete success rates without medications were 40% in Group 1 and 67% in Group 2. No significant difference was found between the two groups in terms of early and late postoperative complications, pre- and postoperative number of antiglaucoma medications, and surgical success rates at the end of the study period (p>0.05 for all). A significant difference was verified between the two groups of eyes considering the conjunctival bleb types, as low-lying, localized blebs were the most frequent type in Group 1 and thin-walled, avascular blebs were more predominant in the MMC group (p=0.004).

Conclusions

Intraoperative adjunctive MMC use might improve the long-term results of viscocanalostomy by facilitating subconjunctival filtration and might widen the indication range of the technique.

Average Tacrolimus Trough Level in the First Month After Transplantation May Predict Acute Rejection

BACKGROUND

Although tacrolimus is one of the essential drugs used for the prevention of rejection in kidney recipients, target trough levels are not well established. In this study, we aimed to investigate the association between average tacrolimus trough levels (TTLs) of the first month after transplantation and biopsy-proven acute rejection (BPAR) during the first 12 months after transplant.

METHODS

A total of 274 patients who underwent kidney-alone transplantation between 2002 and 2014 were enrolled in the study. Average TTLs of the first month were assessed by means of receiver operating characteristic (ROC) curve analysis to discriminate patients with and those without BPAR. Univariate and multivariate Cox proportional hazards models were used to determine the effect of average TTLs of the first month on BPAR.

RESULTS

According to ROC curve analysis, the highest area under the curve (AUC) was obtained from 8 ng/mL (AUC = 0.73 ± 0.11; 95% confidence interval [CI], 0.62-0.84). Forty-two (31.8%) of the 132 patients with average TTLs <8 ng/mL and 13 (9.1%) of 142 patients with ≥8 ng/mL had BPAR during the first 12 months after transplant (P < .001). In univariable analysis, average TTLs of the first month <8 ng/mL were associated with higher risk of BPAR (P < .001), and the significance remained in Cox multivariable analysis (hazard ratio, 2.79; 95% CI, 1.76-3.82; P = .001). No significant differences were observed in the glomerular filtration rate, cytomegalovirus, BK viremia, or BK nephropathy between groups at post-transplant month 12.

CONCLUSIONS

Keeping the average TTLs of the first month after transplantation at ≥8 ng/mL not only prevents BPAR occurrence but also minimizes the toxic effects of the use of a single-trough level.

Long-term entecavir or tenofovir disoproxil fumarate therapy in treatment-naïve chronic hepatitis B patients in the real-world setting

The aim of this study was to determine the long-term efficacy of entecavir (ETV) and tenofovir disoproxil fumarate (TDF) on the natural course of disease in chronic hepatitis B patients (CHB) with/without cirrhosis in clinical practice. A total of 355 treatment-naïve CHB patients were enrolled into the study. The primary outcome measure was viral suppression as defined by serum HBV DNA level <20 IU/mL. A secondary outcome measure was to determine the development of Hepatocellular carcinoma (HCC). Virological and biochemical responses were similar between the two treatment groups over time. The presence of cirrhosis and hepatitis B e antigen (HBeAg) positivity did not appear to impact viral suppression. The cumulative probability of HBeAg loss was 41% at 4 years of therapy. Hepatitis B surface antigen (HBsAg) loss occurred in four patients. Model for End-Stage Liver Disease score was significantly improved from baseline to week 48 and 96 under antiviral therapy (P = 0.013, P = 0.01). HCC was diagnosed in 17 patients (4.8%). The cumulative probability of the development of HCC was 3.3% at 1 year and 7.3% at 4 years of therapy. The development of HCC was independently associated with older age (P = 0.031) and the presence of cirrhosis (P = 0.004). Serum creatinine levels and creatinine clearance remained stable over time. ETV and TDF effectively maintained virological and biochemical responses in long-term follow-up of CHB patients with/without cirrhosis. HCC may still develop, although at a lower rate, and is more likely to develop in patients with cirrhosis, especially in older patients.

Quality of life measures in Islamic rectal carcinoma patients receiving counselling

AIM

This prospective study was conducted to compare changes in the health-related quality of life (HRQoL) and religious practices of patients who underwent surgery for rectal cancer.

METHOD

We prospectively followed 93 Muslim patients after surgery for colorectal carcinoma: abdominoperineal excision (APE, n = 50), sphincter-saving resection (LAR, n = 22) or anterior resection including sigmoid colectomy (AR, n = 1). The HRQoL was measured pre- and postoperatively at 15-18 months with the Medical Outcomes Study Short Form 36 Health Survey (SF-36) and a modified version of the American Society of Colorectal Surgeons (ASCRS) Fecal Incontinence questionnaire. Life standards, including religious practice, were measured using the Ankara University Life Standard Questionnaire.

RESULTS

No difference was detected in any SF-36 Health Survey HRQoL domain among the groups, although there were differences within groups before and after surgery. The ASCRS Fecal Incontinence questionnaire scales of lifestyle, coping/behaviour and depression/self-perception were similar in the APE and AR groups and were significantly worse than in the AR group (P ≤ 0.004). The embarrassment scale was worse in the APE than in the LAR and AR groups (P < 0.001). Religious worship (praying alone, praying in mosques, fasting during Ramadan and purifying alms) was not significantly different among the groups.

CONCLUSION

HRQoL measured by the SF-36 questionnaire and religious practices were not significantly different after APE compared with AR. Ostomy support and pre- and postoperative health-related and religious counselling may have had beneficial effects.

Body mass index percentile curves for predominantly breastfed children aged 0-2 years from Ankara, Turkey

OBJECTIVE

The percentiles of weight, height and body mass index (BMI) change markedly from one country to another and also from one city to another, particularly in childhood. The aim of the present study is to construct BMI percentile curves for predominantly breastfed Turkish children aged 0-2 years from Ankara, Turkey.

METHODS

The study population consisted of healthy boys and girls aged 0-2 years from the middle-high socioeconomic status between 2002 and 2004 in well child clinic of Gazi University School of Medicine, Ankara, Turkey. The BMI values for boys and girls were calculated from the height and weight measurements, and BMI percentile values and curves were obtained separately for boys and girls by the LMS method.

RESULTS

The current findings indicate that the BMI percentile values for boys are higher than those for girls in general. The estimated curves for BMI showed that there was a constant increase in BMI values towards 7th or 8th month and a slight decrease until 24th month in both boys and girls.

CONCLUSIONS

The current study presents percentile curves for BMI values in predominantly breastfed Turkish children aged 0 to 2 years living in Ankara, Turkey. To our knowledge, this is the first study considering BMI percentiles for predominantly breastfed Turkish children aged 0-2 years. However, WHO multicenter growth reference study curves can be used until constructing multicenter BMI reference curves representing Turkey (Fig. 2, Tab. 3, Ref. 19).

Telomerase activity could be used as a marker for neoplastic transformation in gastric adenocarcinoma: but it does not have a prognostic significance

Telomerase activity is responsible for telomere maintenance and is believed to be crucial in most immortal cells and cancer cells; however, its clinicopathological significance in gastric cancer remains to be clarified. The aim of the present study was to assess whether malignant progression of gastric adenocarcinoma correlates with telomerase activity. We also investigated the correlation between telomerase activity and histopathological findings. We examined telomerase activity in tumor specimens and adjacent normal tissues from 43 patients with gastric adenocarcinoma. Telomerase activity was measured quantitatively by the TRAPEZE Gel Based Telomerase Detection Kit. Approximately 98% of the tumor tissues were telomerase positive, but telomerase activity was detected not only in tumor tissues but also in normal gastric mucosa. Although telomerase activity was found to be higher in tumor samples than normal tissue for each subject, we could not find a general cut-off level for telomerase activity in gastric adenocarcinoma. In addition, telomerase activity was not correlated with tumor invasion, lymph node involvement and histological stage. Our results support the idea that telomerase reactivation is a common event in gastric adenocarcinoma and it is not related to histopathological parameters. Since it is difficult to set a cut-off level for this type of cancer, we suggest that the prognostic utility of telomerase assay has not yet reached the clinic in terms of predicting outcome for patients with gastric adenocarcinoma. For the assessment of gastric carcinoma, telomerase activity should be evaluated in both tumor and normal tissues, because normal gastric mucosa samples show appreciable telomerase activity.

The value of the levels of acute phase reactants for the prediction of familial Mediterranean fever associated amyloidosis: a case control study

In order to determine the role of levels of acute phase proteins (APPs) for the development of amyloidosis in familial Mediterranean fever (FMF) patients, the levels of serum amyloid A (SAA), C reactive protein (CRP), fibrinogen and erythrocyte sedimentation rate were measured in paired sera of 36 FMF patients during and in between acute attacks, 39 of their healthy parents (obligate heterozgotes), and 15 patients with FMF associated amyloidosis. To compare the levels of APPs, 39 patients with chronic infections or inflammatory diseases who may develop secondary amyloidosis, 20 patients with acute infections who are known to have elevated acute phase response but will never develop amyloidosis and 19 healthy controls were included. The median levels of all APPs are increased in the patients with FMF during attacks and a significant decrease was observed after the attack was over. The level of SAA was above reference range in all FMF patients during the attack free period and the level of at least one other APP was also above normal in 64% of the patients. Both CRP and SAA levels were found to be higher in obligate heterozygotes compared to controls. The levels of SAA in patients with FMF during the attack-free period, obligate heterozygotes and patients with FMF-amyloidosis were found to be similar. The levels in each group were found to be higher than SAA levels found in healthy controls yet lower than the levels measured in the patients with acute infections and patients with chronic inflammation or chronic infections. In conclusion, our results show that SAA level reflects subclinical inflammation with high sensitivity but its value for the prediction of amyloid formation process seems to be low.

Diagnostic value of leptin in tuberculous pleural effusions

It is suggested that leptin may be involved in inflammation. Although relation between leptin levels and active pulmonary tuberculosis has been studied, there is no information about relation between leptin levels and tuberculous pleural effusions (TPE). We evaluated the diagnostic value of pleural fluid and serum leptin levels in TPE and compared them with adenosine deaminase (ADA). Forty-five patients, 17 tuberculous effusion and 28 nontuberculous effusion, with exudative pleural effusions were included. Leptin and ADA levels were measured from serum and pleural fluid in all patients. There were no statistically significant differences between tuberculous and nontuberculous groups with respect to the serum ADA activity and pleural fluid/serum leptin ratio. On the contrary, pleural fluid leptin level, pleural fluid ADA activity, serum leptin level and pleural fluid/serum ADA activity ratio were statistically different between tuberculous and nontuberculous groups. When leptin levels were corrected for body mass index, serum leptin levels did not reach statistical significance. Cut-off points to predict tuberculosis were calculated as 9.85 ng/ml and 35.55 U/l for pleural fluid leptin level and pleural fluid ADA activity, respectively. Sensitivity, specificity and area under the curve +/- standard error were 82.4%, 82.1%, 0.83 +/- 0.07 for pleural fluid leptin levels and 100%, 100%, 1.00 +/- 0.00 for pleural fluid ADA activity, respectively; the difference between these curves was significant (p = 0.01). Pleural fluid leptin levels were lower in tuberculous effusions than in other exudates. Pleural fluid leptin has a diagnostic value for TPE but not as good as that of ADA.

Morphology of corneal nerves and corneal sensation in dry eye: a preliminary study

PURPOSE

To evaluate the corneal sensitivity and nerve morphology in dry eyes.

METHODS

A total of 32 eyes of 16 patients (10 Sjogren's syndrome and six non-Sjogren's syndrome) and 19 eyes of 10 age-matched controls were studied. Sensitivity of the central cornea was measured by the Cochet-Bonnet aesthesiometer. The morphology of corneal nerves was studied by in vivo confocal microscopy (ConfoScan 2.0, Fortune Technologies Srl, Vigonza (PD), Italy). Sub-basal epithelial nerve plexus, subepithelial nerve plexus, and stromal nerves were localized and evaluated for the number of nerves, thickness, reflectivity, and tortuosity for each frame.

RESULTS

The mean corneal sensitivity of dry eye patients (5.6 mm/grs/S) was found significantly lower than that of the control (5.0 mm/grs/S) group (P<0.01). Although the subepithelial nerves were thicker in dry eyes (mean: 6.38+/-1.18 microm) than control eyes (mean: 5.72+/-1.27 microm), this difference was not significant (P>0.05).

CONCLUSION

Decreased corneal sensitivity is not associated with morphological changes of corneal nerves in dry eyes.

[Human leukocyte antigens A and B in Turkish patients with sarcoidosis]

OBJECTIVE

Associations between human leukocyte antigens (HLA) and sarcoidosis have been reported in several studies. We aimed to investigate these associations in Turkish patients.

PATIENTS AND METHOD

We performed HLA-A, HLA-B, HLA-C, and HLA-D typing in 83 patients with sarcoidosis and in 250 healthy controls using a microlymphocytotoxicity method to investigate genetic susceptibility to the disease.

RESULTS

Because of significant violation of Hardy-Weinberg equilibrium at HLA-C and HLA-DQB1 loci, only results obtained at other HLA loci were used. Although HLA-A9, HLA-B5, and HLA-B8 allele frequencies were significantly higher in the patient group compared to the controls (odds ratio [OR]= 21.8, P= .015; OR= 9.34, P= .049; OR= 2.26, P= .031, respectively), none of the differences remained significant after applying the Bonferroni correction. HLA-A24, HLA-A26, and HLA-B62 alleles were significantly less frequent in the patient group compared to the controls (OR= 0.48, P= .018; OR= 0.19, P= .003; OR= 0.11, P= .044, respectively). However, the differences also failed to remain significant after Bonferroni correction.

CONCLUSIONS

These results suggest that both HLA may play significant roles (either increasing or reducing risk) in the pathogenesis of sarcoidosis and in its distinct clinical forms and laboratory findings.

The effectiveness of omeprazole versus lansoprazole along with amoxicillin and clarithromycin in Turkish population with duodenal ulcer

AIM

To compare the effectiveness of omeprazole versus lansoprazole with amoxicillin and clarithromycin in the Turkish populations with duodenal ulcer.

METHODS

Helicobacter pylori positive 108 patients with active duodenal ulcer randomized double blindly into 2 groups. In the group of omeprazole, amoxicillin and clarithromycin (OAC), 54 patients; 34 male, 20 female, average age (+/-SD) 43.89+/-11.77 years. Omeprazole was given 20 mg b.i.d, half an hour before meals for 14 days and then 20 mg preceeding breakfast for 6 weeks along with 1 g amoxicillin and 500 mg clarythromycin b.i.d. for both antibiotics for 14 days while lansoprazole 30 mg b.i.d. was administered half an hour preceeding food intake for 14 days and then 30 mg prebreakfast for 6 weeks with concordant 1 g b.i.d. amoxicillin and clarythromycin 500 mg, b.i.d. for 14 days in the group of lansoprazole with amoxicillin and clarithromicin (LAC) (54 patients; 31 male, 23 female, average age (+/-SD) 40.85+/-12.80 years. The patients were evaluated in clinical terms and by endoscopic parameters for healing, H. pylori eradication and drug side effects before and after 8 weeks of treatment.

RESULTS

There were no significant differences in age, sex and smoking between the 2 groups (p=0.20, p=0.56, p=0.85), respectively. In the LAC group, the ulcer healing rate was 94.4% (51 out of 54 patients). H. pylori was eradicated in 49 patients out of 54 (90.7%). The H. pylori eradication rate was 89.7% (26 out of 29) among the smokers. In the OAC group the ulcer healing rate was 90.7% (49 out of 54 patients). H. pylori was eradicated in 43 patients out of 54 (79.6%). The H. pylori eradication rate was 80.0% (24 out of 30 patients) among the smokers. There was no statistical difference between the 2 groups for ulcer healing (p=0.72). There was also no statistical difference for H. pylori eradication between the LAC and OAC groups (p=0.10). Although mild side effects were observed in both groups, there was no indication for stopping the therapy.

CONCLUSIONS

This study has shown that the 2 regimens (LAC and OAC) are highly effective in healing duodenal ulcers and eradicating H. pylori. Lansoprazole does not appear to have a significant advantage over omeprazole either in ulcer healing or in H. pylori eradication. Both lansoprazole and omeprazole are well tolerated, but with mild adverse effects.

Antistreptococcal response is exaggerated in children with familial Mediterranean fever

Familial Mediterranean fever (FMF) is an autosomal recessive disorder. Although the pathogenesis of the disease is not yet completely understood, enhanced acute-phase responsiveness is considered to be one of the most important mechanisms. The presence of high levels of antistreptolysin O (ASO) antibodies and streptococcus-associated diseases, such as acute poststreptococcal glomerulonephritis (AGN) and acute rheumatic fever (ARF), has been reported in patients with FMF. In order to better understand the effect of FMF on antistreptococcal antibody response, we measured ASO and antideoxyribonuclease B (anti-DNAse B) levels in patients with FMF and compared them with those in healthy controls. The study consisted of two parts. In the first step, antistreptococcal antibody levels were analysed in 44 patients with FMF and 165 healthy children who had no history or clinical evidence of upper respiratory tract infection (URTI) for the last 4 months. In the second step, antistreptococcal antibody levels were measured in 15 patients with FMF and 22 healthy controls in response to documented group A beta-haemolytic streptococcal pharyngitis. In the first part of the study, ASO and anti-DNAse B levels in patients with FMF were found to be significantly higher than those in healthy controls (P<0.001). In the second part, ASO and anti-DNAse B titres were found to be significantly higher in patients with FMF than in controls (P<0.001 and <0.05, respectively) 4 weeks after a positive throat culture. We concluded that patients with FMF have an exaggerated response to streptococcal antigens and might be prone to poststreptococcal non-suppurative complications, such as ARF.

Validation of the Turkish version of the Roland-Morris Disability Questionnaire for use in low back pain

STUDY DESIGN

A reliability and validity study of a previously translated version of the Roland-Morris Disability Questionnaire (RMDQ).

OBJECTIVES

To validate the Turkish version of the RMDQ for use in low back pain.

SUMMARY OF BACKGROUND DATA

Clinical and epidemiologic research related to low back pain in the Turkish population would be facilitated by the availability of well-established outcome measures.

METHODS

A total of 81 outpatients with low back pain, 64 of whom were followed up on a second occasion, were assessed by the RMDQ. Reliability was assessed using internal consistency and the intraclass correlation coefficient. Internal construct validity was assessed by Rasch analysis; external construct validity was assessed by association with pain and spinal movement. Responsiveness was tested by both the nonparametric and parametric effect sizes.

RESULTS

Internal consistency of the RMDQ is found to be adequate (>0.85) at both times, with high intraclass correlation coefficient also at both time points. Internal construct validity of the scale is good, indicating a single underlying construct. Expected associations with pain confirm external construct validity. There is little evidence of differential item functioning. The scale is at the ordinal level. Responsiveness of the RMDQ is good and greater than observed change in spinal movement.

CONCLUSIONS

The RMDQ is a robust unidimensional ordinal measure, largely free of differential item functioning, which works well in the Turkish population. Nonparametric effect sizes of ordinal scales are found to overestimate or underestimate the true effect size depending on the nature of the scale and the distribution of patients at baseline.

Oral melanin pigmentation related to smoking in a Turkish population

OBJECTIVE

Besides genetic factors, tobacco smoking has been found to be the major cause of oral melanin pigmentation. The purpose of the present study was to evaluate the frequency of oral melanin pigmentation in a Turkish population and to present its correlation with clinical parameters relevant to periodontal status in current smokers, non-smokers, former smokers.

METHOD

A sample of 496 patients was randomly selected. The subjects were interviewed regarding their smoking habits. They were clinically examined by a single examiner for the presence of oral melanin pigmentation in different oral mucosal regions. The same examiner recorded the clinical parameters including GI (gingival index), PI (plaque index), BOP (bleeding on probing), PD (probing depth) and GR (gingival recession). Examiner 2 completed a questionnaire concerning skin color and smoking habits.

RESULTS

In the study group, 41% were current smokers, 46% nonsmokers and 13% former smokers. The frequencies of pigmented areas were significantly higher in current smokers than in those without any smoking habits. The clinical parameters revealed similar findings for all groups. Low GI and BOP values were observed for current smokers when compared with non-smokers and former smokers, respectively. GI values were significantly associated with the pigmentations in gingiva.

CONCLUSIONS

The results of our study show that smokers in a Turkish population had significantly more pigmented oral surfaces than nonsmokers.

Adaptation of the Functional Independence Measure for use in Turkey

OBJECTIVE

To adapt the Functional Independence Measure (FIM) for use in Turkey and to assess its validity and reliability.

DESIGN

After the translation procedure, reliability was assessed using internal consistency, inter-rater reliability (kappa) and the intraclass correlation coefficient (ICC). Construct validity was tested by association with impairments and by fit of data to the Rasch model.

SETTING

The study was undertaken in an inpatient rehabilitation unit of the Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ankara.

SUBJECTS

Consecutive stroke (n = 51) and spinal cord injury (SCI) (n = 62) patients admitted for rehabilitation over a period of three years were assessed at admission and discharge.

RESULTS

Internal consistency was good for stroke, and for SCI. The level of agreement between two raters was sufficient with kappa levels of above 0.48 for SCI and above 0.44 for stroke. Minimum ICC found was 0.90. Construct validity showed expected associations with the impairment scales. However, Rasch analysis showed that bladder and bowel items compromise unidimensionality in the motor scale.

CONCLUSION

Adaptation of the FIM has been successful and it can be used in Turkey as long as the limitations are recognized.

Computed tomographic evaluation before cranial bone harvesting to avoid unexpected hazards during aesthetic procedures

Nowadays, cranium is the preferred bone-graft donor site for facial aesthetic operations. Preoperative information about the quality of cranial bone, such as bone thickness or presence of the diplopic space, can be useful to minimize intracranial complications. This fact is neglected in reconstructive and aesthetic surgery. The aim of this study is to assess the reliability of Computed Tomography (CT) to determine cranial bone quality. Sixty-four cadaver parietal bones, the preferred site for bone-graft harvesting, were used in this study. In the first stage, posterior parietal bone thickness, which is accepted as the thickest part of cranium, was measured at specially determined points using a micrometer and the results were recorded. Bone thickness was then measured again in the same points with CT. The two methods were compared statistically. The measurements were not found to be statistically different. The similar values obtained with CT and micrometers suggest that CT can accurately and reliably determine cranial thickness. Preoperative CT can be a significant guide for the harvest of cranial bone grafts without any intracranial complications in aesthetic surgery.

Effects of factor V gene G1691A, methylenetetrahydrofolate reductase gene C677T, and prothombin gene G20210A mutations on deep venous thrombogenesis in Behçet's disease

OBJECTIVE

Behçet's disease (BD) is a multisystemic disease of unknown etiology, characterized by aphthous ulcerations and uveitis, that is common in the Turkish population. Venous involvement is observed in 25% of the cases. While superficial thrombophlebitis is the most common finding, deep venous thrombosis (DVT) follows it. Hyperactivity in the coagulation pathway, hypoactive anticoagulation mechanisms, or faulty fibrinolysis generate a tendency for thrombogenesis. Mutations of the genes involved in these pathways may cause predisposition to thrombosis.

METHODS

Possible roles of methylenetetrahydrofolate reductase (MTHFR) gene C677T, factor V (FV) gene G1691A (Leiden), and prothrombin gene G20210A polymorphisms in venous thrombogenesis were evaluated in patients with BD; 100 healthy people, 30 BD patients without DVT, 30 BD patients with DVT, and 30 patients with idiopathic DVT were studied with the restriction fragment length polymorphism method for these 3 polymorphisms. The frequencies of these mutations for each group, separately and in combinations, are described.

RESULTS

Among the 3 mutations, FV Leiden mutation was found to be a risk factor for DVT. An association between FV Leiden mutation and BD was likely, but FV Leiden mutation did not increase the risk for deep venous thrombogenesis in BD patients. MTHFR gene C677T mutation does not increase risk of DVT in BD either alone or combined with FV Leiden mutation.

CONCLUSION

Although a thrombotic tendency is one of the major characteristics of BD, we found no association between these 3 thrombogenetic mutations and BD patients with thromboses.

High levels of binocular function are achievable after removal of monocular cataracts in children before 8 years of age

OBJECTIVE

To investigate the visual acuity and binocular function results achieved in children who had monocular cataracts removed before 8 years of age.

DESIGN

Retrospective, noncomparative case series.

PARTICIPANTS

Clinical records of 171 patients who underwent a unilateral cataract removal between January 1986 and 1996 were reviewed retrospectively. Seventy-four eyes were included in the study: 19 congenital, 11 developmental, 19 posterior lenticonus, 19 traumatic, and 6 complicated cataracts. Patients with less than 2 years of follow-up; eyes with cataracts resulting from retinoblastoma; prematurity; and those associated with dense corneal scars, lens dislocation, and persistent hyperplastic primary vitreous were excluded.

INTERVENTION

Visual acuity was measured by means of age-appropriate tests such as the fixation pattern, Allen object recognition cards, isolated optotypes with the Sheridan Gardiner test, and Snellen letters. Sensory fusion was assessed with the Worth 4-dot test, and stereo acuity was assessed with the Titmus stereo test.

MAIN OUTCOME MEASURES

Cataracts were classified regarding type, extent, age at onset, duration of the opacity, age at surgery, method of removal, development of secondary membrane, form of optical rehabilitation, and presence of strabismus. Visual acuity levels between 6/6 and 6/12 were considered "good." Fusion of the Worth 4-dot test at distance and near, and presence of stereo acuity of 100 seconds of arc or better were considered "good" binocular function. Multiple logistic regression analysis was used to define factors that correlated with achieving good visual outcome.

RESULTS

Visual acuity was 6/12 or better in 27 (36.5%) eyes. However, good binocular function was achieved in only 11 of these 27 patients. Results of univariate analysis showed that later age at onset of cataract and absence of strabismus were significant for good visual acuity and binocular function. The presence of strabismus increases the risk of not achieving good visual acuity by 5.45-fold.

CONCLUSIONS

Good visual acuity and binocular function can be achieved after removal of monocular cataracts in visually immature children. Patients with strabismus at presentation or during the follow-up period have the least chance of achieving a good sensory result.

Clinical and histopathological evaluation of sucralfate in prevention of oral mucositis induced by radiation therapy in patients with head and neck malignancies

Forty-four patients with head and neck malignancies were included in a prospective, randomized, double-blind, placebo-controlled study for evaluation of sucralfate in prevention of oral mucositis induced by radiation therapy. Patients were randomized to receive oral suspensions of either sucralfate (n = 23) or placebo (n = 21) in six daily doses of 1 g. The primary tumors were treated with portals covering at least one-third of the oral mucosa to a minimum dose of 60 Gy. Drug therapy was not associated with significant adverse effects and compliance was satisfactory. Daily inspection of the oral mucosa and questionnaires for oral mucositis-related items demonstrated reduction in oral mucositis scores and oral pain scores and biopsies obtained from the buccal mucosa demonstrated reduction in evidence of altered vascular calibration, altered vascular permeability and leukocyte emigration with sucralfate. Clinical and histopathological demonstration of reduction in oral mucositis with sucralfate suggests that sucralfate might be recommended in the prevention of oral mucositis induced by radiation therapy in patients with head and neck malignancies.

Genotype-phenotype correlation in a large group of Turkish patients with familial mediterranean fever: evidence for mutation-independent amyloidosis

OBJECTIVES

Differences in clinical manifestations of familial Mediterranean fever (FMF) between different ethnic groups have been documented. The FMF gene was recently cloned and four missense mutations (Met694Val, Met680Ile, Val726Ala, and Met694Ile) that account for a large percentage of the patients were identified. The results of initial mutation studies have led to the hypothesis that phenotypic variation of the disease may be attributable to the existence of some of these mutations. The purpose of this study was to evaluate whether this phenotypic variation is associated with the existence of particular mutations in Turkish FMF patients living in Turkey.

METHODS

Four missense mutations and genotype-phenotype correlation were investigated in 167 Turkish FMF patients. The patients were grouped according to the presence of the Met694Val and the Met680Ile mutations, and 12 clinical parameters were compared between the groups.

RESULTS

The presence of the Met694Val mutation was not found to be associated with a severe form of the disease or the development of amyloidosis. Arthritis frequency was found to be lower in the patients with homozygous Met680Ile mutation.

CONCLUSIONS

None of the four missense mutations is associated with a severe disease or the development of amyloidosis in Turkish FMF patients living in Turkey. The influence of unknown environmental factors and/or the presence of other genetic changes are necessary to explain the phenotypic variation of the disease and the development of amyloidosis.

Nasopharyngeal carcinoma in childhood and adolescence

BACKGROUND

This study reviews the authors' experience from 1979 through 1996 in the management and outcome of 56 patients with nasopharyngeal carcinoma who were under 20 years of age.

PROCEDURE

There were 33 males and 23 females, their ages ranging from 7 to 19 years (median: 16 years). Forty patients had World Health Organization type III carcinomas, 16 had T4 tumors, 41 had metastatic cervical lymph nodes, and 50 were at stage III or stage IV. Thirty-two patients were treated with radiation therapy alone and 24 with the addition of chemotherapy. Cumulative radiation dose to the primary tumor ranged from 18 to 70 Gy (median: 66 Gy) and radiation dose to metastatic cervical lymph nodes ranged from 18 to 70 Gy (median: 66 Gy).

RESULTS

Follow-up ranged from 0.1 to 16.8 years (mean: 9 years). Locoregional tumoral complete response was achieved in 49 patients. Locoregional tumoral failure was observed in 12 patients and systemic failure in 11. Overall, locoregional failure-free, metastases-free, and disease-free survival rates at 5 years were 49%, 62%, 79%, and 47%, respectively, for the entire group of patients, 42%, 61%, 72%, and 42%, respectively, for patients treated with radiation therapy alone, and 58%, 63%, 87%, and 54%, respectively, for patients treated with the addition of chemotherapy. Advanced T-stage and lower radiation doses worsened locoregional failure-free survival, whereas advanced N-stage and exclusion of chemotherapy worsened metastases-free survival.

CONCLUSIONS

In children and adolescents with nasopharyngeal carcinoma, radiation therapy alone results in an improved locoregional tumoral response rate and a reduced locoregional tumoral failure rate at higher radiation doses, while the addition of chemotherapy results in a reduced systemic failure rate.

Reperfusion injury delays healing of intestinal anastomosis in a rat

BACKGROUND

Revascularization of ischemic bowel may induce further local tissue damage due to reperfusion injury. Therefore, we aimed to investigate the effect of ischemia-reperfusion injury on the healing of intestinal anastomosis in experimental models.

METHODS

One hundred and two male Wistar rats were divided into three groups: a control group (group I, n = 23); an ischemia group (group II, n = 32), in which only the superior mesenteric artery (SMA) was occluded for 30 minutes; and a profound ischemia group (group III, n = 47), in which SMA was occluded as well as collateral vessels for 30 minutes. The pulsations were seen to return to marginal vessels and the bowels began to appear pinker and healthier in all groups following the restoration of arterial flow. Then, all animals underwent a 3-cm ileal resection and primary anastomosis, 10 cm proximal to the ileocecal valve. Within each group, animals were anesthetized either on the third or seventh postoperative days. Abdominal wound healing, intraabdominal adhesions, anastomotic complications, anastomotic bursting pressure measurements, and bursting site were recorded.

RESULTS

Statistically significant differences were detected in intraperitoneal adhesion scores in group II and III (P <0.001). Anastomotic dehiscence was found in 2 of 23 (9%) in group I, 5 of 32 (16%) in group II, and 16 of 47 (34%) in group III (P <0.001). On the third and seventh days, the median bursting pressures of the anastomosis were determined to be 42 mm Hg and 250 mm Hg in group I, 46 and 253 in group II, and finally 19 and 90 mm Hg in group III (P <0.01). The burst occurred at the anastomoses in all animals tested on the third postoperative day, none in group I, 4 (28%) in group II, and 8 (67%) in group III on the seventh postoperative day (P <0.005).

CONCLUSION

The present study demonstrated that ischemia-reperfusion impairs anastomotic healing. Despite the fact that the intestines are well perfused and viable after revascularization, one must bear in mind that intestinal reperfusion may compromise anastomotic healing.

An assessment of fertility in boron-exposed Turkish subpopulations

Relationships between elevated boron intake and fertility were sought by comparing reproduction in the residents of two Turkish villages with high levels of boron in their drinking water (one with 8.5 to 29 mg B/L and the other with 2.05 to 2.5 mg B/L), with three nearby villages with more typical low boron levels (0.03 to 0.40 mg B/L). The two high boron villages were designated as Region I, and the three villages with low boron in the drinking water were designated Region II. In addition to exposure to elevated boron in drinking water, 28.3% of the probands in Region I were employed in borate mining or processing, whereas in Region II, 11.7% were so employed. An observational study was carried out in which the authors compared the reproductive history of families living in Region I with families living in Region II by identifying married adults (referred to as probands) who were able to provide information about their and their spouses' family pedigrees covering three generations. Probands were identified by home visits and, if ever married, accepted for ascertainment. Evidence of fertility was birth of a living child, and data were obtained about the fertility of the proband generation, their parents' and also their childrens' generations. In high-boron villages (Region I), 159 three-generation kindreds containing 1068 families were ascertained and, in low-boron villages (Region II), 154 three-generation kindreds containing 610 families were ascertained. In Region 1, 96% of marriages produced at least one child, with primary infertility estimated at 2.34% compared with 96% and 2.62%, respectively, for Region II. There was no significant difference in fertility either between Region I and Region II or between the villages within the Regions. The fertility figures are not different from similar measures of fertility in other parts of Turkey. In Region I, the gender ratio (M:F) of offspring was 0.89, whereas in the Region II villages the gender ratio was 1.04 (NS, chi2 = 1.335, P > 0.05). It is concluded that at the elevated boron drinking water levels studied, a boron-related effect on reproduction was not found.

Comparison of infertility rates in communities from boron-rich and boron-poor territories

As a part of a large-scale work aimed at studying the health effects of boron (B) in residents of a country with the world's largest supply, developmental effects of B are presented. Spontaneous abortions, stillbirths, and congenital malformations in addition to early infant mortality were questioned in the field by home visits. Although the number of families so far ascertained is rather small, the rates related to spontaneous abortions and stillbirths from high B exposure vs low B exposure subpopulations revealed no differences of significance, providing no evidence that B affects human development adversely.

Squamous cell carcinomas of the head and neck: descriptive analysis of 1293 cases

Medical reports of 1293 patients with squamous cell carcinoma (SCC) of the head and neck were retrospectively evaluated. The patients were classified according to their age, sex, primary tumour localization and tumoral stage. There were 1181 males (91.3 per cent) and 112 females (8.7 per cent), with a male to female ratio of 10.5:1. The peak incidences for all primary tumour localizations were observed in the fifth decade. Most common primary tumour localizations were the larynx (71.1 per cent), the nasopharynx (10.1 per cent) and the oral cavity (8.8 per cent). Of all patients in whom staging was complete, 43.1 per cent presented at early and 56.9 per cent at advanced stages. The proportion of patients presenting with metastatic neck nodes was 34.4 per cent and the incidence of metastatic neck nodes increased with increasing T stage. The supraglottic region was the most common primary site among all laryngeal SCC, with a supraglottic to glottic SCC ratio of 1.5:1. Glottic SCC presented at earlier stages compared to supraglottic SCC. The incidence of nodal metastases increased with increasing T stage for SCC of the larynx, the oral cavity and the oropharynx.