Intrathoracic Desmoid Tumor of the Posterior Mediastinum with Transdiaphragmatic Extension. Report of a Case

We report on a de novo desmoid tumor of the posterior mediastinum with transdiaphragmatic extension in a 40-year-old man. The tumor was inoperable because of its location and the invasion of adjacent structures. Although extremely rare, desmoid tumors of the posterior mediastinum should be considered in the differential diagnosis of posterior mediastinal masses.

Benefit of Adjuvant Radiotherapy in Surgically Staged Stage I-II Endometrial Carcinoma

AIMS AND BACKGROUND

This study was performed to determine the treatment outcomes and patterns of failure following external beam therapy in patients with pathological stage I-II endometrial carcinoma.

STUDY DESIGN

Eighty-three patients with stage I-II endometrial carcinoma surgically staged who were found to have high risk factors and who received postoperative radiation therapy are the subject of this report. High risk factors were: histologic grade II-III, depth of myometrial invasion (DMI) > or =1/2, stage II, poor prognostic histology (clear cell, papillary serous cell) and lymphovascular invasion.

RESULTS

Recurrences were observed in six patients. The recurrences were located in the vagina (1), lung (2), liver (1), and paraaortic lymph nodes (1). Five of the six recurrences were stage IC and II. The overall survival (OS), cause-specific survival (CSS) and disease-free survival (DFS) at five years were 82.9%, 85.0% and 81.3%, respectively. DMI, grade, age and cervical stromal invasion had a significant impact on CSS.

CONCLUSION

Adjuvant radiotherapy decreases the rate of relapse in pathologically staged high-risk stage I-II endometrial carcinoma patients. After reviewing the other studies on this subject we conclude that vaginal cuff brachytherapy alone could be used in stage IA grade III and stage IB grade I-II patients because the recurrence rate is low; pelvic radiotherapy + vaginal cuff brachytherapy should be used for stage IC-II disease. Distant metastases occurred in five of our patients and represent a significant type of failure.

Radiation Therapy for Stage I Primary Orbital Non-Hodgkin's Lymphomas

Aims and Background

The orbit is an uncommon primary site for non-Hodgkin's lymphomas (NHL), and it accounts for less than 1% of all sites of primary presentations. We report the experience of the Department of Radiation Oncology at Ankara University Faculty of Medicine with radiation therapy in treatment of patients with stage I primary orbital NHL.

Methods

From February 1978 through August 1993, 14 patients with stage I primary orbital NHL were treated with radiation therapy. According to the Working Formulation classification, 8 patients had low-grade and 6 had intermediate-grade lymphomas. The most commonly used radiation therapy technique was a single anterior field with a Cobalt-60 unit, delivering 40 Gy in 2 Gy daily fractions. Two patients with intermediate-grade lymphomas received the CHOP regimen following radiation therapy.

Results

Follow-up ranged from 0.8 to 18.3 years (median, 10.3 years). Local control was achieved in all patients. Two patients with low-grade lymphomas relapsed locally and were successfully salvaged with radiation therapy. Three patients with intermediate-grade lymphomas failed systemically. Salvage therapy consisted of combination chemotherapy for 2 of them but was unsuccessful. Overall survival probabilities at 2, 5 and 10 years were 78.6%, 61.1% and 52.4%, respectively, for the entire group of 14 patients. Overall, cause-specific and disease-free survival probabilities were higher for patients with low-grade lymphomas than for those with intermediate-grade lymphomas (P = 0.03, P = 0.03 and P = 0.06, respectively). Cataracts were observed in 9 and lacrimal disorders in 4 patients.

Conclusions

The study suggests that among stage I primary orbital NHL, low-grade lymphomas could be treated with radiation therapy alone, whereas combination chemotherapy could accompany radiation therapy for intermediate-grade lymphomas.

A review on the role of laparoscopy in pancreatic cancer

BACKGROUD

Pancreatic cancer is the fourth leading cause of cancer death in the United States and leads to an estimated 227,000 deaths per year worldwide. Palliative and curative treatments are used for pancreatic cancer by laparoscopic or open techniques. The role of laparoscopy in pancreatic cancer is evaluated in this study.

MATERIAL AND METHODS

Electronic databases, such as PubMed/MEDLINE and Google Scholar were searched to identify reports of trials for laparoscopic pancreatic surgery. Articles written in English including the maximum number of patients published -between 2010 and 2014 were included.

RESULTS

Recent reports on laparoscopic surgery of the pancreas are encouraging and support the advantages of laparoscopy. Although large series have been reported for benign pancreatic -tumors treated with laparoscopic procedures, only limited data are available for malignant lesions. Most of these studies are retrospective, but the results encourage laparoscopic procedures.

CONCLUSION

Over the last decade laparoscopic pancreatic surgery has emerged as an alternative to open surgery with many advantages. There are limited data on about laparoscopic approach for the treatment of malignant lesions. The results are in favor of laparoscopy.

Prevalence of IgE mediated cow's milk and egg allergy in children under 2 years of age in Sanliurfa, Turkey: the city that isn't almost allergic to cow's milk

AIM

Food allergy is a common problem in children and adults. The aim of this study was to determine the frequency of cow's milk and egg allergy based on skin prick test and oral food challenge results

METHODS

We recruited 614 children aged 1 month-2 years in from different areas of Sanliurfa. An interview was conducted with each parents and family demographic, and prenatal-antenatal-postnatal information was recorded, then skin prick test was applied to the children for egg white, egg yolk and cow's milk. Cases that are required, sIgE levels for cow's milk, egg white and egg yolk were measured and food challenge tests were applied.

RESULTS

Cow's milk and egg allergy was determined in 1 case (0.16%) and 8 cases (1.30%) respectively from the results of the tests applied. Six cases (0.97%) were accepted as sensitive to egg white and egg yolk. Within the factors which were questioned, (only the egg allergy evaluation was made without the cow's milk allergy case) of those with parental consanguinity was determined at a statistically significantly high level (OR=5.8, 95% CI: 1.2-27.2, P=0.01).

CONCLUSION

The prevalence of cow's milk allergy in Sanliurfa is the lowest reported prevalence rate to date in children under 2 years of age. When infants develop a food allergy, this takes the form of egg allergy. Within the several factors evaluated to explain this situation, a significant relationship was determined only with parental consanguinity. However, as reported above, to date there is no genetic or epidemiological study to explain this situation.

An Evaluation of Oxidative Status in Serum and Breast Milk of Mothers Giving Birth Prematurely and at Full-Term

Background:

Burning fat and carbohydrates to provide energy in biological systems causes the formation of free oxygen species.

Objectives:

This study aimed to evaluate the oxidative status of serum and breast milk of mothers giving birth prematurely and at full-term.

Materials and Methods:

The study comprised 50 mothers who gave birth at full-term at more than 38 weeks and 43 mothers who gave birth pre-term at below 32 weeks. On the postnatal 5th day, samples of the mother’s milk and serum were taken and stored at -80°C until the study day. On the study day, the total oxidant and total antioxidant levels were measured using the Erel method and the oxidative stress index (OSI) was calculated.

Results:

While the total oxidant level and total antioxidant level values of the milk of the premature birth mothers were found to be significantly high compared to those of the full-term birth mothers (P = 0.001), no statistically significant difference was found in the oxidative stress index values (P > 0.05). No statistically significant difference was found in the total oxidant level and oxidative stress index values of the serum of the premature birth mothers compared to those of the full-term birth mothers, while the total antioxidant level was found to be significantly low (P = 0.04).

Conclusions:

The oxidants and antioxidants in the milk of mothers giving birth prematurely were found to be significantly higher than those of full-term birth mothers. This can be evaluated as the milk of the premature birth mothers providing increased antioxidant defense to protect the infant.

Long-term sustainability of zero central-line associated bloodstream infections is possible with high compliance with care bundle elements

Central-line-associated bloodstream infection (CLABSI) is one of the most important problems in intensive care units (ICUs) worldwide. A bundle of CLABSI care measures was introduced at a 13-bed medical/surgical ICU in Kocaeli, Turkey in January 2010. Compliance rates with the bundle were measured at the beginning of the third quarter of 2010 until June 2013 and compared with CLABSI rates. During the post-intervention period, of 2196 ICU patients, 732 lines placed for 4366 line-days were monitored. Feedback to staff reinforced a culture of patient safety in the ICU. Infection rates remained zero for 38 months after the implementation. There was a strong negative correlation between bundle compliance rate and CLABSI rates. With the implementation of the central-line bundle of care, together with emphasis on high compliance with all its components and a culture of patient safety, it was possible to achieve and maintain a zero rate of CLABSI in this ICU.

Pancreas transplantation: experience of single center

BACKGROUND

Diabetes is the most common cause of renal failure. In patients with type I diabetes and renal failure,dialysis and insulin therapy can prevent a clinical context that causes rapid death, but they are insufficient to prevent longterm complications. Pancreas and islet cell transplantation inpatients with type I diabetes are the only curative treatment and have recently become more common.

METHODS

Between December 2006 and August 2010 a total of 10 patients underwent pancreas transplantation. The patient's data were analysed retrospectively.

RESULTS

10 patients and their data were included in this study. Six patients were male and 4 patients were female. All patients are still alive, with functional grafts.

CONCLUSIONS

Pancreas transplantation is the most effective treatment for patients with type I DM. This paper discusses the feasibility of this process and presents the experience of Ankara University in pancreas transplantation.

Single-port laparoscopic surgery by use of a surgical glove port: initial experience with 25 cases

BACKGROUND

single-port laparoscopic surgery has gained popularity over the last decade. This technique is used for several surgical procedures. This paper documents a new and cheaper access method known as "surgical glove port" or "homemade single-port", and describes our initial experience with 25 cases.

METHOD

Eleven cholecystectomies, eight totally extraperitoneal inguinal hernia repairs, three splenectomies, two gastric wedge resections, and one anti-reflux procedure were performed.

RESULTS

Twenty-four procedures out of twenty-five were completed without conversion to open or multiple port techniques. An individual patient who had both cholelithiasis and gastrointestinal stromal tumor underwent both cholecystectomy and gastric wedge resection in the same session with surgical glove port technique. In another case two additional 5-mm incisions were made for hemostasis. The additional operation was required and performed by using surgical glove port for a hiatal hernia repair case, because of postoperative hemorrhage.

CONCLUSION

Single-port laparoscopic surgery is an applicable technique for plenty of surgical procedures. Also, surgical glove port is a newer technique and some initial experience shave already published all over the world. Surgical glove port has advantages such as cost-effectiveness, easy and safe port implantation and specimen extraction. SGP can also be used for treating post-operative complications.

An evaluation of neuropeptide Y status in subacute sclerosing panencephalitis patients

AIM

This study aimed to evaluate the neuropeptide Y values of patients with subacute sclerosing panencephalitis.

MATERIALS AND METHODS

The study comprised 38 patients diagnosed with subacute sclerosing panencephalitis at our clinic, who were being routinely followed-up, together with a control group of 36. Using the Risk and Haddad classification for clinical staging, 16 patients were determined as Stage II and 22 patients as Stage III. Neuropeptide Y values were measured by Enzyme Immunoassay methods.

RESULTS

The neuropeptide Y values of the all patients with subacute sclerosing panencephalitis were found to be significantly high compared to the control group (p<0.01). The neuropeptide Y values of the Stage III group were found to be significantly high compared to the Stage II and control groups (p<0.05). The neuropeptide Y values of the Stage II group were not determined to be significant compared to the control group (p≤0.05).

CONCLUSIONS

Neuropeptide Y can be considered a useful parameter to confirm diagnosis at advanced stages and to establish differences between stages in patients with subacute sclerosing panencephalitis.

Comparison between the intraoperative use of polyvinyl chloride cover and surgical compresses for preventing postoperative adhesions

BACKGROUND/PURPOSE

Surgical compresses used for retraction during major abdominal and pelvic procedures lead to postoperative adhesion formation resulting from damage to the visceral peritoneum. This study investigates whether polyvinyl chloride (PVC) covers cause less postsurgical adhesion and inflammation than surgical compresses in an animal model.

METHODS

Female Wistar albino rats (n = 160) were divided into three groups (compress, PVC cover and control), which were then divided into 16 subgroups (n = 10/group). All animals underwent midline laparotomy and cecal abrasion. A metal retractor, which applies a constant force, was then placed on the small intestine for 2 h. In the control group, no material was placed under the retractor, whereas a surgical compress or PVC cover was placed in the experimental animals. Full-thickness small intestinal biopsies were obtained and examined by light and electron microscopy. The following parameters were evaluated: congestion, mesothelial proliferation, leukocyte migration and collagenization. Adhesions were scored according to the Nair, Knightly and Mazuji scoring systems.

RESULTS

All inflammation scores were significantly higher in the compress group than in the other two groups. However, no significant difference was observed between the PVC cover and control groups. Adhesions were more frequent in the compress group than in the other two groups, regardless of the scoring system used.

CONCLUSIONS

Surgical compresses used in abdominal and pelvic surgeries cause inflammation and adhesion. Contrary to surgical compresses, PVC covers do not cause inflammation and adhesion, which may considerably reduce adhesion-related complications in abdominopelvic surgeries.

The effect of age on the paraoxonase and arylesterase activity of pregnant mothers and their infants

AIM

The study aimed to research the effect of maternal age at pregnancy on the paraoxonase (PON) and arylesterase activity levels of mothers and infants.

METHOD

The study comprised 30 mothers aged more than 35 years and their infants, and 30 mothers aged under 25 years and their infants. All pregnancies had been of 38-42 weeks with normal spontaneous vaginal birth. PON and arylesterase activities were measured using paraoxon and phenylacetate substrates.

RESULTS

When the PON and arylesterase enzyme activities were compared, the PON and arylesterase activity of the mothers aged more than 35 years was found to be statistically significantly lower compared to that of the mothers aged under 25 years (P = 0.006 and P = 0.03, respectively), while there was no statistically significant difference in PON and arylesterase enzyme activity between the two groups of infants (P > 0.05).

CONCLUSION

While the PON and arylesterase enzyme activity of the mothers aged more than 35 years was found to be significantly lower compared to that of the mothers aged under 25 years, there was no statistical significance between the infants. This can be explained by the reduced PON and arylesterase enzyme activity during pregnancies at an older age, although this did not affect the PON and arylesterase enzyme activity of the infants.

Diffusion-weighted imaging of patients with neonatal bilirubin encephalopathy

PURPOSE

The aim of the study is to evaluate neonatal bilirubin encephalopathy in the acute period by the DWI.

MATERIALS AND METHODS

Thirty newborn babies with hyperbilirubinemia at the gestational age of 38-40 weeks, diagnosed with acute neonatal bilirubin encephalopathy as a result of clinical findings were included in the study, and a further 24 newborn babies, whose ages, weights and gestational ages were equalized, were regarded as a control group. DWI was performed on both patient and control groups.

RESULTS

When DWI apparent diffusion coefficients (ADC) of both neonatal bilirubin encephalopathy patients and the control group were compared, ACD values of neonatal bilirubin encephalopathy patients were found to be statistically significantly highly compared to that of the control group (p < 0.001). There was a significant correlation between bilirubin values and DWI findings (r = 0.41, p < 0.05).

CONCLUSION

The ADC measurement could be a promising parameter in detecting neonatal bilirubin encephalopathy.

Living-donor hepatectomy

BACKGROUND

Organ transplantation from deceased donors is still far below the need. Because of this deficiency, liver transplantations are performed mostly from live donors in many transplant centers in our country. Living-donor liver transplantation (LDLT) has evolved dramatically over the past decade. The aim of this study was to present our clinical experience with living-donor hepatectomy.

METHODS

We retrospectively analyzed all patients who underwent donor hepatectomy between March 2000 and September 2010. We reviewed demographic data, operation type, operation and cold ischemia times, duration of hospital stay, and postoperative complications.

RESULTS

During the study period, 140 living donors underwent operations for liver transplantation. We performed 108 right hepatectomies, 17 left hepatectomies, and 15 left lateral hepatectomies. The mean age of the donors was 30.8 years. There was no operative or postoperative mortality. Overall morbidity rate was 13.57% (n = 19). Nine patients had biliary leakages, 4 biliomas; 2 urinary tract infections, and 1 each inferior vena caval injury, pneumonia, portal vein thrombosis, and acute tubular necrosis. Reoperation was not required in any of these patients.

CONCLUSIONS

Living-donor liver transplantation is a valuable alternative for patients awaiting a cadaver organ. Live-donor hepatectomy can be performed with low morbidity. The greatest disadvantage of this procedure is the risk of the surgical operation for the individual who will experience no medical benefit from this procedure.

Pancreatic cancer complicated by splenic infarction and abscess

Pancreatic tail adenocarcinoma is both a diagnostic and therapeutic challenge. Despite technical and therapeutic advances, the prognosis remains dismal; the average survival time after diagnosis is characteristically only five to eight months. Both splenic infarction and abscess are very rare complications of pancreatic cancer. In this case of splenic infarction, the possible source of emboli should be carefully investigated. In addition, splenic abscess must be suspected in patients with splenic infarction, especially if the infectious signs persist despite appropriate treatment. Rapid diagnosis and treatment are essential as its course can prove fatal. The patient presented herein had a splenic infarct and abscess as complications of pancreatic tail carcinoma. The treatment of choice was splenectomy and distal pancreatectomy with resection of involved organs. The variability in clinical presentation and imaging studies warrants consideration of this entity in the differential diagnosis of many splenic and pancreatic lesions.

Harderoporphyria due to homozygosity for coproporphyrinogen oxidase missense mutation H327R

Hereditary coproporphyria (HCP) is an autosomal dominant acute hepatic porphyria due to the half-normal activity of the heme biosynthetic enzyme, coproporphyrinogen oxidase (CPOX). The enzyme catalyzes the step-wise oxidative decarboxylation of the heme precursor, coproporphyrinogen III, to protoporphyrinogen IX via a tricarboxylic intermediate, harderoporphyrinogen. In autosomal dominant HCP, the deficient enzymatic activity results primarily in the accumulation of coproporphyrin III. To date, only a few homozygous HCP patients have been described, most having Harderoporphyria, a rare variant due to specific CPOX mutations that alter enzyme residues D400-K404, most patients described to date having at least one K404E allele. Here, we describe a Turkish male infant, the product of a consanguineous union, who presented with the Harderoporphyria phenotype including neonatal hyperbilirubinemia, hemolytic anemia, hepatosplenomegaly, and skin lesions when exposed to UV light. He was homoallelic for the CPOX missense mutation, c.980A>G (p.H327R), and had massively increased urinary uroporphyrins I and III (9,250 and 2,910 μM, respectively) and coproporphyrins I and III (895 and 19,400 μM, respectively). The patient expired at 5 months of age from an apparent acute neurologic porphyric attack. Structural studies predicted that p.H327R interacts with residue W399 in the CPOX active site, thereby accounting for the Harderoporphyria phenotype.

Treatment of congenital ichthyosis with acitretin: a case report

The authors assessed the clinical efficacy, tolerability and safety of acitretin in a patient with ichthyosis. A newborn infant with ichthyosis who presented at birth with collodion baby appearance, was treated with acitretin. A moderate response to acitretin therapy (1 mg/kg/day) administered for 6 months was observed, with improvement in cutaneous lesions. Clinical improvement was achieved shortly after treatment. The treatment resulted in a satisfactory improvement in the skin condition of the case. The tolerance to the drug was good. Side effects were not observed. The oral acitretin treatment is efficient in severe congenital ichthyosis.

The relationship between carotid intima media thickness and oxidative stress in asthmatic children

BACKGROUND

Asthma and atherosclerosis are both chronic inflammatory diseases. The progression of the inflammation in asthmatic patients is known to be similar to the increased development of atherosclerosis.

OBJECTIVE

The aim of this study was to research the relationship between the difference in carotid intima media thickness (CIMT) and oxidative stress together with difference in CIMT in asthmatic children and control group.

METHODS

A total of 84 subjects between 6-15 years of age who had been attending the Pediatric Allergy Unit of the Medical Faculty were included in this study. Asthmatic patients and a control group were evaluated by ultrasonography for measurements of CIMT and oxidative status.

RESULTS

In the asthmatic patient group, the CIMT was 0.48 +/- 0.06 mm (right side) and 0.44 +/- 0.05 mm (left side). In the control group it was 0.42 +/- 0.05 mm (right side) and 0.42 +/- 0.04 mm (left side). This difference is statistically significant (p < 0.0001, p = 0.019 respectively). In the asthmatic group a positive correlation was determined between the total oxidant status (TOS) value and the right and left CIMT (p = 0.007, r = 0.44 and p = 0.001, r = 0.50 respectively).

CONCLUSIONS

A significant correlation was determined between an increase in oxidative stress and CIMT in asthmatic children. This indicates that atherosclerosis, which is known as an adult disease, may start in childhood. These findings show that it might be beneficial for children who are being followed-up from a diagnosis of asthma to also be evaluated in respect of the development of atherosclerosis.

Prolidase activity and oxidative status in patients with thalassemia major

AIM

Prolidase is a specific imidodipeptidase involved in collagen degradation. The increase in the enzyme activity is believed to be correlated with the increased intensity of collagen degradation. The study aimed to evaluate the relationship between prolidase activity and oxidative status in patients with thalassemia major.

METHODS

Comparison was made between 87 patients diagnosed with thalassemia major and 33 healthy children of similar age and gender. Mean age of the subjects was 7.5+/-4.3 years in the group of patients with thalassemia major and 8.9+/-3.1 years in the control group. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) measurement.

RESULTS

Prolidase activity was significantly increased in patients with thalassemia major (53.7+/-8.7 U/l) compared to the control group (49.2+/-7.2 U/l, P<0.001). TOS was significantly increased in the patient group (5.31+/-3.14 mmol H2O2 equiv./l) compared to the control group (3.49+/-2.98 mumol H2O2 equiv./l) and the OSI was also significantly increased in the patient group (3.86+/-3.28 arbitrary unit) compared to the control group (2.53+/-2.70 arbitrary unit) (P<0.0001 and P<0.001, respectively), while there were no significant differences between the patient (1.61+/-0.30 mumol Trolox equiv./l) and control (1.64+/-0.33 mumol Trolox equiv./l) groups with respect to TAC.

CONCLUSION

Significant increases in prolidase activity in patients with thalassemia major may constitute a key parameter in demonstrating a disorder of the collagen metabolism.

Primary biliary cystadenocarcinoma mimicking a complicated hydatid cyst

Cystadenocarcinoma of the liver is a rare neoplasm that originates from hepatobiliary epithelium. Primary location of this tumor is generally intrahepatic and most cases are in the right hepatic lobe. Herein we present a case of intrahepatic cystadenocarcinoma in a 53-year-old man who had been followed up for 8 years as hydatic cyst disease of the liver. He was admitted to our hospital with jaundice and loss of appetite. Ultrasound and computed tomography showed a cystic lesion that looked like type II cyst hidatic. Thereafter magnetic resonance imaging revealed a cystic lesion associated with biliary tree. On diagnostic laparotomy peritoneal infiltrations were observed and pathologic examination revealed a biliary cystadenocarcinoma and peritonitis carcinomatosa was diagnosed. Unfortunately correct diagnosis was extremely late and no curative management was possible.

Occlusion of the celiac trunk, the inferior mesenteric artery and stenosis of the superior mesenteric artery in peripheral thrombangiitis obliterans

Buerger's disease is an inflammatory occlusive disease which commonly involves medium-sized or smaller vessels of extremities. Mesenteric involvement in Buerger's disease is very rare. It can occur at any time during the course of the disease and presents with acute mesenteric ischaemia. In this study, a case of Buerger's disease with mesenteric involvement diagnosed before the onset of acute mesenteric ischaemia and managed endovascularly is reported.

The oxidative state of children with cyanotic and acyanotic congenital heart disease

OBJECTIVE

The type of congenital heart disease, early diagnosis, and treatment modality all play an important role in the morbidity and mortality of these diseases. This study examined the relationship between congenital heart disease and oxidative stress in children with cyanotic and acyanotic congenital heart disease.

METHODS

In this case-controlled cross-sectional study, the study groups consisted of 29 patients with cyanotic heart disease, 30 patients with acyanotic heart disease, and a control group of 32 healthy individuals. For all groups, the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) were calculated. Of the cyanotic group, 12 were diagnosed with tetralogy of Fallot, 7 with transposition of the great arteries, 4 with tricuspid atresia, 4 with double outlet right ventricle and 2 with truncus arteriosus. In the acyanotic group 19 patients had ventricular septal defect (VSD), 5 atrial septal defect (ASD) and 6 patent ductus arteriosus (PDA). Statistical analyses were performed using Chi-square, Mann-Whitney U and Kruskal-Wallis tests.

RESULTS

The plasma TAS, TOS, and OSI were significantly higher in the cyanotic group than in the acyanotic group (p<0.0001, p<0.01, and p<0.01, respectively) and controls (p<0.0001, p<0.0001, and p<0.0001, respectively). A comparison between the acyanotic and control groups showed no statistical differences.

CONCLUSION

The level of oxidative stress in patients with cyanotic congenital heart disease was significantly higher than in the acyanotic and control groups, which were similar.

Partial cholecystectomy is a safe and efficient method

AIM

When there is excess inflammation, fibrosis and portal hypertension around gall bladder or in presence of Mirizzi syndrome, bile ducts and hepatic artery may be possibly damaged during dissection of Calot triangle. In this study, we examined safety and efficiency of partial cholecystectomy operation which we perform when dissection of Calot triangle is challenging.

METHOD AND MATERIAL

Eighteen patients who were undergone partial cholecystectomy in our clinic between 1996 and 2008 were retrospectively evaluated. Mean age of patients was 66 years (range: 55-88 years) and ratio of male/female was 2/1 (12 men, 6 women). Fourteen patients were undergone general anesthesia, whereas 4 patients were operated under epidural anesthesia. Partial cholecystectomies were performed by right subcostal incision in 16 patients and by right paramedian incision in 2 patients.

RESULTS

No intra-operative or early post-operative mortality was found among patients. Post-operative subhepatic abscess occurred in one patient (5.5%) and superficial wound site infection occurred in 4 patients (22,2%). Controlled bile fistula occurred in early post-operative period in two patients (11.1%) and fistula spontaneously closed without requiring additional surgical procedure. Escherichia coli were most common microorganism found in bile culture. Mean hospitalization period of patients was 8 days (range: 15-14 days) and mean follow-up period was 80 months (8-150 months). During follow up, hepatobiliary ultrasonography could be re-performed in 8 patients and no new stone formation was observed. In 7 patients, it was understood verbally that no postoperative gastrointestinal symptoms were present.

CONCLUSION

Where dissection of Calot triangle is changeling, partial cholecystectomy can be safely and efficiently performed.

Oxidative status and paraoxonase activity in children with asthma

OBJECTIVE

To compare paraoxonase activity and changes in oxidative status in asthmatic children and healthy children by determining serum paraoxonase activity and total oxidative status, total antioxidant capacity and lipid hydroperoxidation.

METHODS

Forty two asthmatic children were compared with 32 healthy children of similar age and sex. To evaluate the paraoxonase and oxidative status, total antioxidant capacity and lipid hydroperoxidation were examined. Serum paraoxonase activity was evaluated by measuring the rate of paraoxon hydrolosis. Oxidative status was evaluated by the method developed by Erel. Lipid hydroperoxide was measured by an iodometric method.

RESULTS

In comparison with the healthy control group, the paraoxonase activity of the asthmatic children was found to be low (163.7 +/- 73.0 (U/L) and 349.2 +/- 153.9 (U/L), P = 0.002) and total oxidant status (9.0 +/- 3.5 micromol H2O2 Eq/L and 13.4 +/- 7.0 micromol H2O2 Eq/L, P =0.002), total antioxidant capacity (5.5 +/- 2.5 micromol Trolox Eq/L and 1.0 +/- 0.6 micromol Trolox Eq/L, P < 0.001), and lipid hydroperoxidation values (9.9 +/- 3.4 micromol H2O2 Eq/L and 4.4 +/- 1.5 micromol H2O2 Eq/L, P < 0.001) were found to be high. The high density lipoprotein (HDL) concentration of the asthmatic children was lower than that in the control group (40.1 +/- 9.2 mg/dl and 54.5 +/- 15.9 mg/dl, P < 0.001)

CONCLUSION

In asthmatic children, when total oxidant status, total antioxidant capacity and lipid hydroperoxidation levels increase, paraoxonase activity decreased.

Serum copper and zinc levels in mothers and cord blood of their newborn infants with neural tube defects: a case-control study

OBJECTIVES

To measure the cord blood and maternal serum levels of folic acid, vitamin B12, zinc, copper, selenium and lead in infants born with neural tube defect (NTD), and to examine a possible relationship between the nutriture of these micronutrients and occurrence of neural tube defect.

DESIGN

Case-control study.

METHODS

Maternal serum and cord blood samples were obtained at delivery from 70 healthy mothers and 74 mothers who had a newborn with NTD.

RESULTS

The mean (+/- SD) maternal serum zinc level in the NTD group was significantly lower than that of the control group (835.6 microg/L (+/- 333.8 /L vs. 1035.7 microg/L (+/- 299.8 g/ L, P=0.004, respectively). The mean maternal and cord serum copper levels in the NTD group were significantly higher when compared to the control group (2831.1 microg/L (+/- 1017 g/L vs. 2402 microg/L (+/- 744.2 microg/L; P=0.03; and 789.8 microg/L vs 517.2 microg/L, P < 0.001, respectively). There was a negative correlation between the cord levels of folic acid and copper in the NTD group with the respective maternal serum levels (r=-0.289; P=0.018).

CONCLUSIONS

High maternal serum levels of copper and lower level of zinc during pregnancy associated with NTD in newborn.

DNA damage in children with asthma bronchiale and its association with oxidative and antioxidative measurements

Increased production of reactive oxygen species leading to an imbalance between the oxidative forces and the antioxidant defense systems favoring an oxidative injury has been implicated in the pathogenesis of asthma. The aim of the study was to investigate the peripheral DNA damage, and its association with oxidative and antioxidative measurements in children with asthma bronchiale. The study population contained 42 children with asthma bronchiale and 32 healthy controls. DNA damage was assessed by alkaline comet assay in peripheral lymphocytes. Plasma levels of total antioxidant status (TAS), total peroxide concentration (LOOHs), and total oxidant status (TOS) were determined. In asthma bronchiale patients, DNA damage was significantly higher than in controls (17.9 +/- 11.8 AU vs. 1.2 +/- 2.0 AU, p < 0.001). Plasma TOS and LOOHs were higher in patients than in healthy controls (13.4 +/- 7.0 vs. 9.0 +/- 3.5, p = 0.002; 9.9 +/- 3.4 vs. 4.4 +/- 1.5, p < 0.001, respectively). Plasma TAS level in patients was higher than in healthy controls (5.5 +/- 2.5 vs. 1.0 +/- 0.6, p < 0.001). DNA damage was correlated with TOS (r = 0,616, p < 0.001). The findings indicated that lymphocyte DNA damage level increases in children with asthma bronchiale. Elevated DNA damage may be related to increased oxidative stress. However, the mechanism of this association, and whether it is direct or indirect, remains to be explored.

Phthiriasis palpebrarum in an infant

The authors describe a case of phthiriasis palpebrarum embedded in the right upper eyelid of a 9-month-old male infant. The patient was successfully treated with mechanical removal of all lice and nits from the eyelashes. In children, phthiriasis palpebrarum should be considered in the differential diagnosis of blepharoconjunctivitis that is resistant to treatment.

Serum prolidase activity and oxidative status in patients with bronchial asthma

Asthma is a disease where there is an accumulation of collagen in the reticular basal membrane of the airway leading to chronic inflammation. The enzyme prolidase plays an important role in the breakdown of collagen and the breakdown of intracellular protein especially in the final stage when peptides and dipeptides contain a high level of proline. To evaluate the relationship between prolidase activity and oxidative status in asthma patients. Comparison was made between 42 patients diagnosed with bronchial asthma and 32 healthy children of similar age and gender. Serum prolidase activity was measured spectrophotometrically. Oxidative status was determined using total antioxidant capacity (TAC) and total oxidant status (TOS) measurement. The prolidase activity of the asthma patient group was statistically significant compared with the control group (P< or =0.001). TAC and TOS levels in the asthma patient group were higher than the control group (P< or =0.001, P< or =0.002, respectively). No correlation was found between the prolidase and oxidative levels of the two groups. A positive correlation was determined between the prolidase activity and TAC in the asthma patient group (P< or =0.001, r=0.501). The prolidase enzyme activity, which plays a role in the collagen turnover, was low in the asthma patients; therefore, their collagen metabolism had undergone a change and this indicates that there may be an effect on the accumulation of collagen in the reticular basal membrane. Moreover, the high level of TOS indicates that these patients were exposed to severe oxidative stress with an increased TAC response.

Tick infestation of the eyelid: a case report in a child

A three-year-old girl presented with a small brown lesion on the right upper eyelid margin. Close examination revealed an insect body attached to the eyelid margin. Microscopic examination of the specimen identified the species of the organism as Ixodes ricinus. The tick was completely removed with blunt forceps. She was treated with lid toilet, irrigation, and application of topical 0.3% ciprofloxacin four times daily to the affected eye. The lesion healed without scarring after one week. No systemic symptoms were observed. Mechanical removal with blunt forceps may be a quick, easy, safe and effective treatment for ticks located on the eyelids.

Can haptoglobin be an indicator for the early diagnosis of neonatal jaundice?

Neonatal jaundice is the result of an imbalance between bilirubin production and elimination. Bilirubin conjugation in newborns is significantly impaired in the first few days; even a small increase in the rate of production can contribute to the development of hyperbilirubinemia. Hemolysis has a significant role in bilirubin increase in newborns. Intrauterine is tolerated by the maternal metabolism in life. When hemolysis takes place, a decrease is accepted in the haptoglobin and hemopoexin blood levels binding hemoglobin in the environment. Therefore, it may be considered that haptoglobin and hemopoexin from the early period umbilical cord (UC) blood in newborns may be an indicator in determining jaundice likely to develop in later stages. Babies were called to the control polyclinic in the third and fifth days. Eighty-four babies with normal term birth were included in the study. Gestational age of the mothers was 39.5+/-1.5 weeks in average. A significant negative correlation was found between the haptoglobin level from the UC taken during delivery and the bilirubin value in the fifth day (r=-0.345; P=0.001). The haptoglobin value from the blood of the UC can be used as a guiding indicator to demonstrate the future occurrence of jaundice in newborns. This way, the babies with high jaundice risk may be detected earlier and closer follow-up of these babies can be obtained. As a result, the haptoglobin level of the blood from the UC during delivery allows us to make an early prediction on whether neonatal jaundice will occur.

Dandy-Walker syndrome together with occipital encephalocele

Dandy-Walker malformation is an anomaly characterized by dysgenesis of the foramina of Magendie and Lushka in the upper 4(th) ventricle, hypoplasia of the cerebellar vermis and agenesis of the corpus callosum. Encephalocele is diagnosed from the calvarium defect, cerebrospinal fluid (CSF) and herniation of the meninges. It is the rarest neural tube defect. A 7 x 9 cm encephalocele was found on physical examination of a 6-day old baby boy patient. From cranial magnetic resonance, it was seen that the posterior fossa was enlarged with cysts and there was agenesis of the vermis. A connection was established between the ventricle and the development of cysts on the posterior fossa. These findings were evaluated as significant from the aspect of Dandy-Walker malformation. The extension of the bone defect in the left occipital area towards the posterior, and the cranio-caudal diameter reaching 9 cm was seen to be in accordance with encephalocele. It is rare for Dandy-Walker syndrome to occur together with occipital encephalocele. The authors present a case of Dandy-Walker syndrome together with occipital encephalocele.

Decreased thymus size in full-term newborn infants of smoking mothers

BACKGROUND

Prenatal exposure to tobacco can have significant effects on infants. The objective was to investigate whether maternal smoking affects the size of the thymus.

MATERIAL/METHODS

A group of 50 pregnant women who smoked throughout pregnancy and a control group of 92 non-smoking pregnant women were studied. The full-term newborn babies' length, weight, and head circumference were measured. The size of the thymus was assessed by sonography during the first six hours of life in both the study group and the control group newborns.

RESULTS

The results of the anthropometric measurements in respect of length (50.36+/-2.27, 50.15+/-1.40 cm, p=0.51), weight (3.43+/-5.13, 3.57+/-4.38 kg, p=0.07), head circumference (34.47+/-1.22, 34.57+/-0.93 cm, p=0.62), and head circumference/weight ratio ((9.94+/-1.40, 9.79+/-1.16 cm/kg, p=0.50) were not significantly different between the patient and control groups, respectively. The thymic index (Ti) and thymic index/weight ratio (Ti/w) of the newborns of the smoking group were lower than in the controls (8.70+/-5.80 vs. 13.26+/-5.46, p<0.001 and 2.47+/-1.55 vs. 3.69+/-1.43, p<0.001, respectively). Moreover, the birth weight, head circumference/weight ratio, Ti, and Ti/w of the newborns of those smoking more than 10 cigarettes per day were significantly lower than those smoking less than 10 (3.08+/-0.55 vs. 3.58+/-0.45, p<0.001; 10.65+/-1.84 vs. 9.67+/-1.11, p=0.03; 5.95+/-4 vs. 10.25+/-6.12, p=0.01; and 1.82+/-1.08 vs. 2.84+/-1.66, p=0.02, respectively).

CONCLUSIONS

These results show that smoking while pregnant has a significant effect on the general involution of the newborn and size of the thymus, which plays an important role in the immune system.

Comparative study between the Ves-matic and microerythrocyte sedimentation rate method

In this study, Ves-matic erythrocyte sedimentation rate and micro-erythrocyte sedimentation rate methods were compared on 96 subjects mean age 4.9+/-4.3 years. Ves-matic erythrocyte sedimentation rate an automated method, and micro-erythrocyte sedimentation rate method required minimal bloods are various approaches on the erythrocyte sedimentation rate. An important relationship between that the Ves-matic and micro-erythrocyte sedimentation rate was revealed. Although there was significantly correlation between these two methods, they are different to use interchangeably. Our study implies that "Micro-Automated Erythrocyte Sedimentation Rate Systems" could be developed which require a few amounts of blood and study automatically.

Association of Helicobacter pylori and giardiasis in children with recurrent abdominal pain

The aim of this study was to examine the frequency and the relationship of H. pylori infection and giardiasis in children with recurrent abdominal pain. The study group included 98 patients and 88 healthy controls. Patients' sera were examined for anti-H. pylori specific IgG antibodies using H. pylori IgG ELISA. Analysis of stool samples was carried out by the H. pylori stool antigen (HpSA) enzyme immunoassay. For the diagnosis of giardiasis, all stool samples were examined by saline-Lugol and formalin-ethyl-acetate sedimentation methods. H. pylori was detected in 40 (49.0%) patients and 40 (45.5%) controls. G. intestinalis was detected in 30 (30.6%) patients and 18 (20.4%) controls. There was no significant difference in frequency between the groups in the distribution of H. pylori (p=0.6) and giardiasis (p=0.4). The frequency of the combination of H. pylori infection and giardiasis in the patient groups was 22.4% compared to 6.8% in the control groups and this result was statistically significant (p=0.002). It seems that the relationship of H. pylori infection and giardiasis represent an important ethiologic factor in children with recurrent abdominal pain.

Phakomatous choristoma of the lower eyelid: a case study with a review of the literature

We report a case of phakomatous choristoma of the lower eyelid. A 2-week-old girl was referred with a tumor of the right lower eyelid near the inner canthus, present since birth. No other abnormalities were noted. The tumor was excised, and histopathologic examination of the tumor showed phakomatous choristoma of the eyelid. This is the first report of phakomatous choristoma of the eyelid in Turkey.

Incisional hernia treatment with polypropylene graft: results of 10 years

PURPOSE

To report herein our results of tension-free repair of large incisional hernia with polypropylene mesh using a modification of the method that was described by Usher.

METHOD

Two hundred ninety-one patients who were operated on between January 1994 and December 2004 were studied. Two hundred thirty-two patients were female (79.7%), and 59 were male (20.3%). The average follow-up period was 55 months. The patients were evaluated for infection, recurrences, hematoma and seroma formation, sinuses and enterocutaneous fistula formation.

RESULTS

Infection was observed in eight patients (2.7%). Graft removal due to infection was encountered only in two patients (0.6%). Recurrence was observed in six patients (2.1%). Two patients (0.6%) developed hematoma while another two developed seroma. No patient developed enterocutaneous fistula.

CONCLUSION

By using our modified technique we can decrease the expected complications after tension-free repair of large incisional hernias.

Surgical technique and postoperative complications in congenital cataract surgery

BACKGROUND

We evaluated cases that underwent congenital cataract surgery in terms of the surgical technique, post-operative complications, and visual prognosis.

MATERIAL/METHODS

We retrospectively evaluated 132 eyes in 76 patients with congenital cataracts who underwent cataract surgery between January 1995 and December 2000. The patient age at surgery, surgical technique, post-operative complications, and final visual prognosis were evaluated.

RESULTS

Thirty eyes underwent aspiration, posterior capsulotomy, and intraocular lens (IOL) implantation; 22 eyes underwent aspiration and posterior capsulotomy; 39 eyes underwent aspiration, posterior capsulotomy, and anterior vitrectomy; and 41 eyes underwent aspiration, posterior capsulotomy, anterior vitrectomy, and IOL implantation. The most frequent complications were secondary cataract (24.2%), posterior synechiae (9.1%), and glaucoma (3%). Groups were compared according to surgical technique and incidence of complications. Complications occurred most frequently with aspiration and posterior capsulotomy and occurred less frequently with aspiration, posterior capsulotomy, and anterior vitrectomy; these differences were statistically significant (p<0.05). The difference in the final visual prognosis was statistically significant in the aspiration, posterior capsulotomy, anterior vitrectomy, and IOL implantation groups as compared with the other groups (p<0.05). The mean follow up times was 15.5+/-1.78 months.

CONCLUSIONS

The most frequent complication of congenital cataract surgery is secondary cataract formation. Today, posterior capsulotomy with anterior vitrectomy is the preferred method for decreasing the incidence of this complication.

An investigation of the factors that affect surgical hand disinfection with polyvidone iodine

This study investigated the factors influencing the effectiveness of 7.5% polyvidone iodine as a surgical antiseptic. The study involved 100 operating staff (75 doctors and 25 nurses) from hospital surgical teams. Fingertips of both hands of the subjects were pressed on to agar culture before and after washing and after completion of surgery. Handwashing lasting for more than 3 min led to a significant decrease in the number of colonies compared with handwashing lasting for less than 3 min. Moreover, the number of colonies was significantly higher when surgery lasted for longer than 95 min. However, the handwashing style (with or without brushing) was not found to have a significant effect on the outcome of the disinfection procedure in terms of bacterial colonization. Subjects who had colonization of their hands after surgery were found to have significantly higher colony counts before handwashing compared with those who did not have any colonization on their hands after surgery. The results of this study revealed that in order to attain effective disinfection with polyvidone iodine, the duration of handwashing should be at least 3 min. The risk of recolonization increases when the duration of surgery exceeds 95 min.

Prevalence and distribution of tropical theileriosis in eastern Turkey

This study was carried out to determine the prevalence and distribution of tropical theileriosis in cattle in eastern Turkey by microscopical, serological and molecular methods. A total of 1561 whole blood, 1505 serum and 1483 blood smear samples were collected from cattle of various breeds and ages in 11 towns of Eastern Turkey. Theileria annulata piroplasm DNA extracted from cattle blood was amplified by polymerase chain reaction (PCR) using species-specific primers. Serum antibodies against T. annulata were investigated by indirect fluorescence antibody test (IFAT). Blood smears were examined for Theileria piroplasms by microscopical examination (ME). In the examination of DNA extracted from 1561 blood samples, an amplicon with the size of 721bp was obtained in 37.8% (590/1561) of these samples. Serum antibodies against T. annulata and piroplasm of Theileria spp. were detected in 34.9% (526/1505) and 19.7% (293/1483) of the samples, respectively. The differences between ME and PCR results and between ME and IFAT results were statistically significant (P < 0.05). In contrast, there was no significant difference between the PCR and IFAT results. A total of 179 ticks (136 female; 43 male) belonging to Hyalomma spp. were collected from cattle from three towns. Ticks were identified to be Hyalomma anatolicum anatolicum on the basis of morphological features.