Comparison of tympanometric volume measurement with temporal bone CT findings in the assessment of mastoid bone pneumatization in chronic otitis media patients

OBJECTIVE

Since mastoid bone aeration is a pressure buffer for the middle ear, it can be accepted as a prognostic factor for tympanoplasty. Temporal bone computed tomography (TBCT) is a primary method for estimating mastoid aeration. However, due to the risk of radiation and its high cost, there is a need for a more straightforward, faster, and more reliable method in non-complicated chronic otitis media cases (COM). Tympanometric volume measurement might be used for this purpose. This study investigated tympanometric volume measurement's reliability in showing mastoid bone aeration by comparing tympanometric volume measurement with TBCT aeration grading.

PATIENTS AND METHODS

Preoperative tympanometric volume measurements were performed in patients who underwent audiological examination and temporal computerized tomography (CT) with the diagnosis of COM and sequela of COM without discharge for the last three months and were indicated for surgery. CT was classified into six grades: grade 0: there is no aeration, sclerotic mastoid; grade 1: pneumatization only in the mastoid antrum; grade 2: <25% pneumatization; grade 3: 25-50% pneumatization; grade 4: >50 pneumatization, grade 5: full pneumatization. Averages of tympanometric volume values were determined according to CT degrees.

RESULTS

48 left and 52 right ears (n: 100) of 81 patients, 24 females and 57 males, were included in the study. The mean age was 37.69±13.38. Mastoid pneumatization grades of patients were 32 grade 0, 23 grade 1, 16 grade 2, 14 grade 3, 11 grade 4, and 4 grade 5, respectively. Each grade's mean tympanometric volume (mL) was grade 0: 1.1594, grade 1: 1.6991, grade 2: 2.2250, grade 3: 3.0471, grade 4: 4.0327, and grade 5: 2.9775.

CONCLUSIONS

There is a statistically significant relationship between tympanometrically measured ear volume and mastoid degrees of pneumatization on temporal bone tomography. As the degree of mastoid aeration increases, the tympanometric volume also increases. According to the results of this study, tympanometric air volume can be used reliably in the preoperative evaluation of mastoid bone aeration in cases of simple COM without ear drainage.

Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study

BACKGROUND AND PURPOSE

Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes.

MATERIALS AND METHODS

A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals.

RESULTS

A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34).

CONCLUSIONS

This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.

Carbon-oxygen surface formation enhances secondary electron yield in Cu, Ag and Au

First-principles calculations coupled with Monte Carlo simulations are used to probe the role of a surface CO monolayer formation on secondary electron emission (SEE) from Cu, Ag, and Au (110) materials. It is shown that formation of such a layer increases the secondary electron emission in all systems. Analysis of calculated total density of states (TDOS) in Cu, Ag, and Au, and partial density of states (PDOS) of C and O confirm the formation of a covalent type bonding between C and O atoms. It is shown that such a bond modifies the TDOS and extended it to lower energies, which is then responsible for an increase in the probability density of secondary electron generation. Furthermore, a reduction in inelastic mean free path is predicted for all systems. Our predicted results for the secondary electron yield (SEY) compare very favorably with experimental data in all three materials, and exhibit increases in SEY. This is seen to occur despite increases in the work function for Cu, Ag, and Au. The present analysis can be extended to other absorbates and gas atoms at the surface, and such analyses will be present elsewhere.

The unilateral frontotemporal approach for large and giant olfactory groove meningioma: Experience with 18 consecutive patients

AIM

Although the bifrontal approach used to be recommended for large olfactory groove meningioma (OGM), recent studies showed that large OGMs can also be resected safely via unilateral approaches. The present study aimed to discuss reasons for preferring a unilateral frontotemporal approach (UFTA), and the technical nuances and results of the UFTA, based on 18 cases.

MATERIAL AND METHODS

The clinical and surgical data of patients who had been operated on for large (4-6cm) or giant (>6cm) OGM via a UFTA between 2011 and 2018 were retrospectively collected.

RESULTS

In all, 18 patients were included. All tumors were compatible with a diagnosis of OGM in the light of peri-operative examinations. 11 cases (61%) were large and 7 (39%) giant OGM; mean diameter was 6.1cm (range, 4-10cm). Resection extent was Simpson grade II in 14 cases (78%), grade III in 1 (5%), and grade IV in 3 (17%). Sixteen cases (89%) had no peri-operative complications, while 2 patients (11%) showed cerebrospinal fluid leakage and hemorrhagic deposition in the surgical area. There were no new neurological deficits nor deaths.

CONCLUSION

The UFTA for OGM is a relatively safe and effective approach, ensuring a high total removal rate with low mortality and morbidity. This study, with a reasonable number of patients, is one of the few in the literature on the outcome of this approach.

Occurrence of a human-associated microbial source tracking marker and its relationship with faecal indicator bacteria in an urban estuary

One of the main impacts of urban sprawl in rapidly growing countries has been contamination of coastal environments by waterborne pathogens, posing a critical risk to ecosystem and human health. Microbial source tracking (MST) has been a robust tool to identify the origin of these pathogens globally. This study compared the occurrence of a human-associated Bacteroides marker (BT-α) with faecal indicator bacteria (FIB) in an urban estuary (Golden Horn, Istanbul, Turkey). Faecal coliform (culture method), enterococci (both culture and qPCR method) concentrations and physicochemical variables were compared with the BT-α concentrations in monthly collected samples for a year (n = 108). Enterococci concentrations detected by culture and qPCR were positively correlated (r = 0·86, P < 0·01) suggesting that qPCR can be an alternative method for monitoring. BT-α marker was positive for 30% of the samples and positively correlated with enterococci (r = 0·61 and r = 0·64 for culture and qPCR methods respectively, P < 0·01). Rainfall had a moderate positive correlation with all faecal/MST indicators suggesting combined sewer overflows also severely impacted estuarine water quality. The high FIB and BT-α concentrations at upper estuary suggested that faecal pollution mainly originated from the peri-urban settlements around two creeks entering the estuary.

Effectiveness and safety of ferric carboxymaltose to treat iron deficiency anemia in cancer patients

e23153

Background: Most cancer patients are faced with anemia during the disease course. Iron deficiency (ID) is one of the major causes of anemia in cancer patients.Bleeding, malabsorption and organ dysfunction may cause iron deficiency in cancer patients. Anemia may result in a decrease in the patient's performance and delayed chemotherapy. Administration of intravenous (IV) iron is a therapeutic option in cancer patients with iron-deficiency related anemia. In this study we analyzed effectiveness and tolerability of ferric carboxymaltose in cancer patients with iron deficiency anemia Methods: This is a retrospective analysis of 603 cancer patients who were treated with ferric carboxymaltose for anemia and iron-deficiency between October 2014 and April 2017 in a tertiary cancer clinic. Demographic data, cancer diagnoses, pre- and post-treatment hemoglobin levels, pre-treatment ferritin, serum iron, and transferrin saturation (TSA) levels were recorded. Results: The median age of the population was 55 (22-90) years, and 52% were male. Of 603 patients, 47.9% (n = 289) had gastrointestinal malignancies and 17% (n = 103) had breast cancer. A total of 331 patients (55%) received cytotoxic chemotherapy and 272 patients (45%) were not on anti-cancer treatment. Median dose of the ferric carboxymaltose is 1000 mg (500-2000). The median baseline hemoglobin, ferritin and TSA were 10.7 (7-13) g/dl, 28 (2.9-2200) ng/ml and 9.3 (1-19) %, respectively. The median hemoglobin level at the 12th week of treatment was 12.7 g/dl. The median increase in hemoglobin was 2.9 (-0.10-6.9) g/dl in patients whom received cytotoxic chemotherapy. Only 2 patients had allergic reaction during IV ferric carboxymaltose administration and treatment was discontinued. Conclusions: Intravenous-iron improved hemoglobin levels both in actively treated and not-actively treated cancer patients. The effect has been shown in the first 3 months after injection. This approach is safe and tolerable. However, the impact of tumor progression on IV iron replacement is unclear, further studies are required.

DIAGNOSTIC VALUE OF DUPLEX DOPPLER ULTRASOUND PARAMETERS IN PAPILLARY THYROID CARCINOMA

Context

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer due to its high fibrotic content; it can affect the blood flow resistance.

Objective

To introduce duplex Doppler ultrasonography (DDUS) parameters of papillary thyroid carcinoma (PTC) and their correlation with size.

Design

The study was designed as a prospective study.

Subjects and Methods

Thyroid nodules of the patients who were already scheduled for thyroid surgery either for malignant thyroid nodules or multinodular goiter were evaluated for DDUS parameters. Size, systolic to diastolic flow velocity (S/D) ratio, pulsatility index (PI), and resistive index (RI) of each nodule were recorded. Nodules were diagnosed as PTC or benign nodules based on histopathology. DDUS parameters were compared between PTCs versus benign nodules and micro PTCs (≤ 10 mm) versus large PTCs (> 10 mm). A correlation analysis was performed between the size and DDUS parameters.

Results

140 thyroid nodules (30 PTCs, 110 benign nodules) were obtained. The mean S/D ratio, PI, and RI values were significantly higher in PTC than in benign nodules (p values were 0.0001, 0.0003, and 0.0001 respectively). The optimal cut-off values of S/D (0.732), PI (0.732), and RI (0.738) had accuracy rates of 71%, 69%, and 69%, respectively. There was no statistically significant difference between micro PTC and large PTC with regards to DDUS parameters. The size and DDUS parameters of PTC showed no significant correlation.

Conclusions

PTC has a high resistive flow pattern regardless of its size; however the clinical utility of DDUS to differentiate a PTC from benign nodule is limited.

Nodular lymphocyte predominant Hodgkin's lymphoma in daily practice: A multicenter experience

Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin's lymphoma. In this study, we aimed to investigate the clinical features and therapeutic outcomes of patients with NLPHL who were diagnosed at different institutes in Turkey. We retrospectively reviewed the records of the patients diagnosed with NLPHL. Adult patients who were diagnosed after 2005 with histological confirmation were selected for the study. Forty-three patients were included in the study. Median age of patients was 37.5 years (18-70) at the time of diagnosis. About 60.5% patients were diagnosed as stage I and II NLPHL, and remaining 39.5% had stage III and IV disease. Median follow-up was 46 months. During follow-up, none of the patients died. Seven patients relapsed or progressed after initial therapy at a median of 12 months. Five of 7 relapsed/refractory patients (71.4%) were salvaged with chemotherapy only (DHAP, ICE), and the remaining 2 (28.6%) were salvaged with chemoimmunotherapy. All of relapsed/refractory patients were able to achieve complete remission after salvage therapy. Lactate dehydrogenase levels were significantly higher in patients with progressive disease compared with nonprogressive disease. Our study showed an excellent outcome with all patients alive at last contact with a median follow up of 46 months despite a wide range of different therapeutic approaches. All relapsed and refractory patients were successfully salvaged despite a low frequency of patients received immunotherapy in conjunction with chemotherapy. Our results suggest that immunotherapy may be reserved for further relapses.

Comparison of prognosis and clinical features between synchronous bilateral and unilateral breast cancers

PURPOSE

The clinical significance of synchronous bilateral breast cancer (SBBC) is unclear and its influence on prognosis is controversial. Our study objective was to determine the epidemiological features, tumor characteristics, and prognosis of SBBC in comparison with those of unilateral breast cancer (UBC).

METHODS

A total of 3675 breast cancer patients diagnosed and treated between 2000 and 2014 were evaluated. Of these patients, 132 (3.6%) had bilateral breast cancer, including 55 patients (1.5%) with SBBC and 77 (2.1%) with metachronous bilateral breast cancer (MBBC). The patient demographic characteristics, including survival data and clinicopathological tumor characteristics, were obtained from medical charts and compared between the patients with SBBC and those with UBC.

RESULTS

The median age in the SBBC group was 51 years (range 32-77). The mastectomy rate was higher in the SBBC group (72.7%) than in the UBC group (66.6%) (p=0.08). In both the SBBC and UBC groups, the baseline clinicopathological features and the history of treatment with radiotherapy and chemotherapy were similar. Infiltrating ductal carcinoma was the most common histology in both groups. Lobular histology was more frequent in the SBBC group (36.3%) than in the UBC group (17.1%; p<0.001). Stage IV disease at initial presentation was more frequent in the SBBC group than in the UBC group (34.5 vs 8.7%, p<0.001). The 5-year disease-free survival (DFS) rates were 90% and 82% in the SBBC and UBC groups, respectively (p=0.99). The 5-year overall survival (OS) rates were 83% and 88%, respectively (p=0.357). The multivariate Cox regression analysis, including stage, hormone receptor status, grade, and SBBC, revealed that the presence of SBBC was not associated with OS (hazard ratio 0.929; 95% confidence interval, 0.455-0.1894, p=0.839).

CONCLUSION

Despite the differences in histology, initial stage, and other characteristics, the prognoses of UBC and SBBC were similar.

Determination of self-attenuation correction factor for lichen samples by using gamma-ray spectrometry

In this study, we determine the self attenuation correction factor for lichen samples collected from Erzurum, a city located in the eastern region of Turkey by using gamma-ray spectrometry. The self attenuation correction factor is calculated for 17 lichen samples with densities ranging from 0.683 g/cm3 to 0.886 g/cm3. The transmission method has been used to obtain self-attenuation correction factors. Self attenuation correction factor versus energy fit curve is presented. It is observed that self attenuation correction factor changes with density. At lower energies the self-attenuation correction factor has higher values. At higher energies it has smaller values and tends to become stable.

The short-term safety of adjuvant paclitaxel plus trastuzumab - A single centre experience

PURPOSE

HER2-amplified breast cancer (BC) has a poor prognosis. The combination of trastuzumab with chemotherapy in the adjuvant setting decreases recurrence and improves overall survival in HER2-positive BC. However, the role of adjuvant treatment in patients with HER2-amplified small BC without lymph node involvement is still under debate. The purpose of this study was to investigate the safety of adjuvant paclitaxel and trastuzumab (APT) in this group of patients.

METHODS

A total of 87 operated early BC patients without lymph node involvement (N0) were treated with APT for 12 weeks followed by trastuzumab alone for a total of 9 months. Clinicopathological features and adverse events were analyzed.

RESULTS

The median patient age was 50 years (range 28- 82), and 51% of them were postmenopausal. The median tumor diameter was 2.4 cm (range 0.5-6), with 51% of the patients having tumor size between 2 and 3 cm. Eighty-one percent of patients had invasive ductal carcinoma (IDC), and 64% had grade 3 tumors. Adjuvant hormone therapy and adjuvant radiotherapy were administered to 65 and 54% of patients, respectively. At a median follow up of 13 months (range 6-38), one patient (1.1%, 95% CI 0-3.4) experienced an asymptomatic decrease in left ventricular ejection fraction (LVEF) and 3 patients (3.4%, 95% CI 0-6.9) experienced grade 3 neuropathy.

CONCLUSIONS

APT appears to be a safe combination in early-stage, HER2-amplified and node-negative BC.

Bilateral inguinal hernia with an uncommon content : A case report

Here we present a sixty-two year old man with bilateral swellings palpated in inguinal areas on physical examination. Ultrasonography and abdominal multi-detector computed tomography revealed a bladder herniation through the right inguinal canal and a sigmoid colon herniation through the left inguinal canal. Radiologic imaging methods are important and can guide clinicians for preemptive or emergent surgery. (Acta gastroenterol. belg., 2016, 79, 495-496).

The protective roles of some lichen species on colloidal bismuth subcitrate genotoxicity

Medicinal plants are increasingly being projected as suitable alternative source for the treatment of various diseases. However, toxic effects resulting from therapeutic bismuth compounds are still documented in animals and humans. This study described the genetic effects of five common lichen species and compared their activities on the genotoxicity induced by the colloidal bismuth subcitrate. After the application of colloidal bismuth subcitrate and lichen extracts, separate and together, human whole blood cultures were assessed by sister-chromatid exchange (SCE) and micronucleus tests. According to our results, the frequencies of SCE and micronucleus rate in peripheral lymphocytes were significantly increased by colloidal bismuth subcitrate (at dose 5 μg/mL) compared with controls. However, lichen extracts had no genotoxic effect. The order of anti-genotoxicity efficacy against colloidal bismuth subcitrate was Pseudevernia furfuracea, Dermotocarpon intestiniforme, Ramalina capitata, Parmelia pulla, respectively. However, Rhizoplaca melanophthalma did not show any effect against colloidal bismuth subcitrate genotoxicity. Present findings showed that the protective roles of lichens studied were dose related. In conclusion, this is the first study report describing the therapeutic potential of lichens against drug genotoxicity in human blood.

Evaluation of antioxidant and cytotoxic effects of olivetoric and physodic acid in cultured human amnion fibroblasts

It is known that lichens are utilized for the treatment of many diseases including ulcer, diabetes, and cancer for many years. Secondary metabolites in the structure of the lichens provide various activity properties for them. In the present study, cytotoxic and oxidative effects of main constituents of Pseudevernia furfuracea (L.) Zopf (Parmeliaceae), olivetoric acid (OA), and physodic acid (PA) were investigated on cultured human amnion fibroblasts (HAFs). OA and PA were isolated from P. furfuracea using column chromatography and their structures were determined by proton nuclear magnetic resonance and carbon-13 nuclear magnetic resonance. HAFs were incubated during 48 h in the presence of OA and PA, at different concentrations from 6.25 mg/L to 200 mg/L. OA showed higher cytotoxicity than PA. In fact, median inhibitory concentration values of OA and PA were 571.27 and 3373.69 mg/L, respectively. The lower concentrations (<50 mg/L) of OA and PA did not cause oxidative stress and genotoxicity; furthermore, they supported anti-oxidative capacity of HAFs. Therefore, all these data suggested that both tested metabolites, especially PA might be developed as natural health medicine to protect human body against oxidative stress and genotoxicity. As far as we know, this is the first report on the cytotoxic and anti-oxidative activities of OA and PA on HAFs.

The utility of 18F-FDG PET/CT in solitary fibrous tumors of the pleura

OBJECTIVE

To demonstrate the utility of (18)F-FDG PET/CT in the differentiation of benign and malignant solitary fibrous tumors of the pleura (SFTP).

MATERIALS AND METHODS

A retrospective review was performed on the (18)F-FDG PET/CT data from 17 patients with histopathologically diagnosed benign or malignant SFTP. The size, side of SFTP, presence of necrosis, calcification, pleural effusion, hilar lymphadenopathy (LAP), density on CT images (Hounsfield unit-HU), and (18)F-FDG uptake (SUVmax) were recorded and compared in order to detect malignant SFTP. Statistical significance was set as p<0.05.

RESULTS

The difference in size, presence of necrosis, and hilar LAP on CT images were statistically significant (p=0.004, p<0.001, p=0.015, respectively) in a comparison of benign and malignant SFTPs. The mean HU of benign SFTP was 46.16±5.52HU, and for malignant SFTP it was 35.03±4.61HU (p=0.003). The mean SUVmax was 3.02±1.02 for benign SFTP and 4.89±2.12 for malignant SFTP (p=0.021). A cut-off value of ≥7cm for size, ≤39.81HU for density, and ≥3.47 for SUVmax was obtained by ROC analysis for detecting malignant SFTP.

CONCLUSIONS

(18)F-FDG PET/CT may have a limited role in diagnosing malignant SFTP in suspected patients.

Abdominal cocoon with imaging findings: Importance of radiology

Abdominal cocoon is a rare disease characterized by a thick fibrous membrane surrounding and compressing the small intestines completely or partially, which results in mechanical small bowel obstruction. The clinical findings of the disease include recurrent ileus and subileus episodes, colicky abdominal pain, weight loss, and abdominal distension. The etiology and pathogenesis of abdominal cocoon is not clearly defined. Detection of the disease is essential for accurate treatment. Imaging modalities come into prominence due to the nonspecific clinical findings of the disease.

Chemotherapy might not be beneficial in lymph node- negative, hormone-positive, and HER2-negative breast cancer patients: a long-term retrospective analysis

INTRODUCTION

In lymph node-negative, hormone-positive, and Her2-negative breast cancer patients, the benefits of adding adjuvant chemotherapy to hormonal therapy continue to be debated, especially for low to intermediate grade and small tumors.

METHODS

Excluding patients with T4 disease, we retrospectively reviewed the records of patients with long-term follow-up at our center between 2003 and 2014. Among node-negative, hormone-positive and HER2-negative breast cancer patients, we compared two groups of patients: those given both chemotherapy (doxorubicin+cyclophosphamide) and hormonotherapy, and those prescribed hormonotherapy alone. The primary endpoints were progression-free (PFS) and overall survival (OS).

RESULTS

Overall, no difference was observed between these two treatment groups in either DFS or OS. However, for both outcomes, there was a trend towards improved DFS and OS favoring the hormone-only group.

CONCLUSIONS

In selected subgroups of breast cancer patients, administering adjuvant hormonal therapy alone seems to be at least as good if not better than combining hormonotherapy and chemotherapy.

Molecular subtypes in patients with inflammatory breast cancer; a single center experience

PURPOSE

The purpose of this study was to investigate the frequency and prognosis of inflammatory breast cancer (IBC) according to molecular subtypes.

METHODS

Demographic data were examined for 78 patients diagnosed with IBC among breast cancer patients monitored in our clinic. Patients were staged according to the 2010 AJCC guidelines. Physical examination and radiographic findings classified on the basis of Response Evaluation Criteria in Solid Tumors (RECIST) guidelines were employed in the evaluation of clinical response to systemic therapy. Subtype analysis was performed in patients with IBC and subtypes were compared. Patients were divided on the basis of metastatic or non metastatic status and survival analysis was performed on the basis of molecular subtypes.

RESULTS

Distribution analysis of molecular subtypes revealed a lower incidence of luminal A and a higher incidence of both HER 2 (+) and triple negative breast cancer in IBC. Molecular subtypes had no effect on survival in the non metastatic (p=0.61) and metastatic patient group (p=0.08).

CONCLUSION

This study showed that IBC frequency is higher in HER2 overexpressing and triple negative subtypes. No survival differences were noticed in relation to molecular subtypes in IBC patients.

A retrospective analysis of adjuvant CAF, AC-T and TAC regimens in triple negative early stage breast cancer

PURPOSE

To compare the effectiveness of adjuvant chemotherapy regimens in triple negative breast cancer (TNBC) for which no protocol has been determined to be treatment of choice.

METHODS

In this single-center retrospective trial, we analyzed the adjuvant regimens of 164 TNBC patients among 3253 breast cancer patient records. Adjuvant TAC (docetaxel, doxorubicin, cyclophosphamide), CAF (cyclophosphamide, doxorubicin, 5fluorouracil), and AC-T (doxorubicin, cyclophosphamide followed by docetaxel) regimens were compared in terms of disease free survival (DFS) and overall survival (OS).

RESULTS

In terms of both DFS and OS TAC was significantly superior to AC-T in node positive TNBC. When node negative and positive patients were analyzed together, TAC was still significantly superior to AC-T in terms of DFS and OS. There was a trend favoring CAF over AC-T, however, it was only significant in terms of OS when all node negative and positive TNBC patients were incorporated together.

CONCLUSION

In the adjuvant setting, especially in node positive patients, TAC should be the treatment of choice in TNBC patients. CAF is probably better than AC-T in TNBC.

The association of molybdenum cofactor deficiency and pyloric stenosis

Molybdenum cofactor deficiency (MoCD) is a rare autosomal recessive disorder that may present during the neonatal period with intractable seizures. Co-existence of MoCD and pyloric stenosis is previously reported as a coincidence or common etiology. The etiology of the two conditions is unclear; however, reports demonstrate neuronal deficiency in both. We report a neonate who was diagnosed with MoCD and hypertrophic pyloric stenosis.

An antidote for imazalil-induced genotoxicity in vitro: the lichen, Dermatocarpon intestiniforme (Körber) Hasse

Imazalil (IMA), a commonly used fungicide in both agricultural and clinical domains, is suspected to produce serious toxic effects in vertebrates. In recent years, a number of studies have suggested that lichens might be easily accessible sources of natural drugs that could be used as a possible food supplement. Extensive research is being performed to explore the importance of lichen species, which are known to contain a variety of pharmacological active compounds. In this context, the antigenotoxic effect of aqueous Dermatocarpon intestiniforme (Körber) Hasse. extract (DIE) was studied against the genotoxic damage induced by IMA on cultured human lymphocytes (n = 6) using chromosomal aberration (CA) and micronucleus (MN) as cytogenetic endpoints. Human peripheral lymphocytes were treated in vitro with varying concentrations of DIE (0, 25, 50 and 100 μg/ml), tested in combination with IMA (336 μg/ml). DIE alone were not genotoxic and when combined with IMA treatment, it reduced the frequency of CAs and the rate of MNs. A clear dose-dependent decrease in the genotoxic damage of IMA was observed, suggesting a genoprotective role of DIE. The results of the present study suggest that this plant extract per se does not have a genotoxic potential, but can alleviate the genotoxicity of IMA on cultured human lymphocytes. In conclusion our findings may have an important application for the protection of cultured human lymphocyte from the genetic damage and side effects induced by medical and agricultural chemicals hazardous for people.

Nimodipine can diminish oxidative stress in patients with severe head trauma

AIM

Antioxidative effect of nimodipine was investigated in patient with severe head trauma.

METHODS

The patients in group A were treated according to the standard procedures without nimodipine. Other patients in group B were treated with standard procedures plus intravenous nimodipine for a week. Three times per day, blood samples were taken from internal jugular venous saturation probe and central venous catheter for a week. The levels of malondialdehyde (MDA), reduced glutathione (GSH), nitrite, and nitrate, ascorbic acid, retinol and β-carotene in the serum were measured.

RESULTS

MDA levels in group B were significantly lower than those in the group A (P<0.05). As for GSH levels, it was observed that there was a significant increase in GSH levels in group B when compared to those in group A (P<0.01). Comparison of nitrate and nitrite levels in the serum of patient groups showed that these parameters were significantly higher in group B than those in group A (P<0.01). It was seen that there were a significant increase in ascorbic acid (P<0.01) and β-carotene (P<0.05) levels in group B when compared to those in group A. Values of retinol levels were slightly higher in group B than that of group A, and there was no significant difference between the groups.

CONCLUSION

Severe head trauma may increase oxidative stress. Administration of nimodipine may prevent the oxidative stress and may augment endogenous antioxidative defense systems in patients with severe head trauma.

Mutagenic and antimutagenic properties of some lichen species grown in the Eastern Anatolia Region of Turkey

All the methanol extracts did not show mutagenic activity in Ames/Salmonella and Z. mays MI test systems. Furthermore, some extracts showed significant antimutagenic activity against 9-AA in Ames test system. Inhibition rates for 9-AA mutagenicity ranged from 25.51% (P. furfuracea - 0.05 microg/plate) to 66.14% (C. islandica - 0.05 microg/plate). In addition, all of the extracts showed significant antimutagenic activity against sodium azide (NaN3) mutagenicity on MI values of Z. mays.

Comparison of Color Flow Doppler Sonography (CFDS) and immunohistologic detection of microvessels for the assessment of the malignancy of thyroid nodules

The assessment of tumor vascularization by color flow Doppler sonography (CFDS) has been suggested for the distinction between benign and malignant thyroid nodules. Our objective was to investigate if the CFDS results reflect the percentage of histologically determined microvessels in adenomas (As), adenomatous nodules (ANs), and papillary carcinomas (PCs). Tissue sections from 10 adenomas, 8 ANs and 13 PC and surrounding tissue of 10 PCs and 2 benign nodules were immunostained for CD34. A computerized image analysis was used to determine the microvessel density in four hot spots and ten systematically selected fields. Preoperatively CFDS was performed and classified according to Frates et al. We found a consistent percentage increase of CD34 stained microvessels in PCs (83 and 96%) as compared to adenomas and ANs (38 and 49%) determined by the hot spot analysis and systematic field analysis. A ROC analysis on the basis of the histologically determined number of microvessels demonstrated 70% microvessels as an optimal cut point for the diagnosis of PC with the highest sensitivity of 92% and highest specificity of 89%. The analysis of the CFDS-classification IV for the distinction between PCs and adenomas and ANs showed a sensitivity of 62% with a specificity of 100%. The lower sensitivity of the CFDS classification as compared with the immunohistologic determination of the microvessel density indicates that the CFDS classification detects the pathognomonic intranodular microvessels only incompletely. The higher CFDS specificity is most likely due to the detection of other vascular aspects of malignancy in addition to intranodular microvessels.

The relationship between mortality and inflammation in patients with gastrointestinal bleeding

The objective of this study was to investigate the association between mortality and inflammation in patients who were admitted to the emergency room with gastrointestinal bleeding. Patients (n = 96) managed at two medical centres were included in the study. Initial levels of serum C-reactive protein (CRP), haemoglobin and albumin, and leucocyte and thrombocyte counts for 28 patients who died were compared with those for the 68 patients who survived and were successfully discharged. The data were analysed using the chi(2)-test. Serum levels of CRP and leucocyte counts were significantly higher, and albumin and haemoglobin were significantly lower in patients who died compared with patients who survived. The increased levels of serum CRP and leucocyte counts, and decreased levels of albumin and haemoglobin were found to be independent risk factors for mortality. It is concluded that increased serum CRP levels and leucocyte counts combined with decreased albumin and haemoglobin levels on admission to the emergency room may be used as predictive factors of mortality in patients with gastrointestinal bleeding.

A novel technique of sutureless colorectal anastomosis by bipolar coagulation

AIM

Aim of the study was to test the safety and efficacy of sutureless colorectal anastomosis using bipolar coagulation.

MATERIAL AND METHODS

Thirty-six Wistar albino rats were used. The rectum just proximal to the peritoneal reflection was transected in 22 rats (Group 1), and the bowel ends were anastomosed or welded end-to-end using bipolar coagulating forceps (Scoville-Greenwood, 60-1765-001, ConMed, USA). Coagulation using 60 milliamperes took one second for each weld. In 14 rats (Group 2), bowel anastomosis was carried out by hand-sewn sutures. The animals were followed up for general condition and body weight, and were sacrificed at six weeks. The anastomoses were studied with regard to burst pressure, stenosis and histopathology.

RESULTS

All rats survived, and body weight gain was significant (p<0.01 for Group 1, p<0.05 for Group 2). There were no intraabdominal complications (leakage, obstruction, etc.), except in one rat (in Group 2), who had intraabdominal abscess. Although intraluminal pressure was increased to 40 cm H2O with extensive stretching of the colorectal segment, the anastomoses did not burst or open in either the sutureless or sutured groups. The bowel diameter 1 cm distal and 1 cm proximal to the anastomoses did not show any difference between both groups. Neomucosa completely covered 78% of sutured anastomoses and 36% of sutureless anastomoses (p<0.05). Inflammation developed in 78% of sutured anastomoses and 36% of sutureless anastomoses (p<0.05). Edema, giant cell and mast cell infiltration were equivalent in both anastomoses. Lymphoid tissue hyperplasia markedly appeared in the sutureless anastomoses (p<0.01).

CONCLUSION

This simple technique of sutureless colorectal anastomosis may be useful and offer an alternative to other colorectal anastomosis techniques.

Orbital lymphangioma and its association with intracranial venous angioma

Orbital lymphangioma is an uncommon, benign cystic lesion, generally manifest in childhood. It usually presents with a slowly progressive proptosis, displacement of the globe, ptosis and restriction of eye movements. Occasionally, focal lesions may remain asymptomatic. Spontaneous intraorbital haemorrhage may cause acute proptosis, compressive optic neuropathy and loss of vision. An 8-year-old girl presented with progressive left proptosis and a unilateral soft tissue mass at the supraorbital frontal region. Multiple intracranial venous angiomas were seen on MRI. Surgical decompression of the optic nerve was performed because of progressive decrease in visual acuity. We review the relevant literature; rarity of the orbital lymphangioma and its association with non-contiguous intracranial vascular anomalies were emphasized.

Lichens from Antalya, Cankiri, Konya and Nevsehir Provinces (Turkey)

A contribution to the lichen flora of Turkey is performed. A total of 171 lichen taxa (including 2 subspecies and 2 varieties) and 1 lichenicolous fungus are determined from 14 localities in Antalya, Cankiri, Konya and Nevşehir provinces of Turkey. Caloplaca scrobiculata H. Magn. is new to Turkey. Besides Caloplaca scrobiculata H. Magn. and Xanthoria sorediata (Vain.) Poelt were found for the second time in Asia. Carbonea vitellinaria (Nyl.) Hertel was found to grow on Candelariella vitellina (Hoffm.) Müll. Arg. while Muellerella pymaea (Körb.) D. Hawksw. var. athallina (Müll. Arg.) Triebel (lichenicolous fungus) on Tephromela atra (Huds.) Hafellner as parasitic. All lichen taxa found in Cankiri are new to this province (92 intraspecific taxa), while 39 new to Nevşehir, 8 new to Konya and 5 new to Antalya provinces. For every each taxon, the habitat pattern and distribution data are presented.

Intestinal prostaglandin E2 expression in rats with obstructive jaundice

AIM

How obstructive jaundice causes the intestinal barrier to be injured is still controversially discussed. In this study, we hypothesize that intestinal prostaglandin E (2), a cytoprotective factor, may be affected by the bile duct obstruction.

MATERIALS AND METHODS

Four groups of Wistar-Albino rats were used: in Groups 1 and 3, the rats underwent a sham operation. In Groups 2 and 4, the common bile duct was doubly ligated. Relaparotomy was performed after one week in Groups 1 and 2, and after two weeks in Groups 3 and 4, and specimens of the jejunum, ileum and liver were obtained for intestinal PGE (2) analysis and histopathological evaluation.

RESULTS

Jejunal and ileal PGE (2) levels had significantly decreased in two-week bile duct-ligated rats compared to one-week ligated rats and the sham group (p < 0.01). Tissue injury scores (Chiu score) of the ileum were significantly higher in the two-week and one-week ligated rats than in the controls (p < 0.01 and p < 0.05, respectively). The jejunal injury score was significantly higher in the two-week ligated rats compared to controls (p < 0.05). The ileal and jejunal injury scores were higher in the two-week ligated rats than in the one-week ligated rats (p < 0.01 and p < 0.05, respectively). Precirrhotic fibrosis was detected in all two-week ligated rats, but in only 7 of 10 one-week ligated rats.

CONCLUSIONS

Obstructive jaundice associated with intestinal tissue injury and precirrhotic changes leads to reduced intestinal PGE (2)-levels, suggesting an adverse effect on the intestinal cytoprotective process.