Ultrasound-guided botulinum toxin type A injection to the iliopsoas muscle in the management of children with cerebral palsy

OBJECTIVE

To determine the effect of botulinum toxin type A (BTX-A) on spasticity and functional development in children with cerebral palsy (CP) in conjunction with a physiotherapy program.

METHOD

In this prospective study, 18 CP patients were evaluated. Multilevel BTX-A injection was applied to children at a dose of 15 U/kg. Children were assessed before and at the 5th and 12th week post-injection using Thomas test, Duncan-Ely test, passive range of motion (pROM) measurement, Distance Between Knee (DBK), Selective Motor Control (SMC) scale, modified Ashworth Scale (MAS) and modified Physician Rating Scale (mPRS). To assess functional improvement, Gross Motor Function Measure (GMFM) and Functional Independence Measure for Children (WeeFIM) were used before and at the 12th week post-injection.

RESULTS

At 5th week post-injection, a statistically significant decrease was determined in spasticity (p < 0.01). Improvement was observed in mPRS and pROM, but not in SMC. At the 12th week post-injection, GMFM (p< 0.001) and WeeFIM improved significantly (p< 0.001). The improvement in pROM and mPRS (p< 0.01) lasted until the 12th week post-injection, but the improvement in MAS (p > 0.05) and in the Tardieu test of hip adductors (p > 0.05) did not last after the 5th week.

CONCLUSION

BTX-A injection enhances functional and motor abilities in the development process.

An increased frequency of gallbladder stones in rheumatoid arthritis patients. Factors related to gallbladder stone formation

OBJECTIVE

In this study, we determined the frequency of gallbladder stone (GBS) in rheumatoid arthritis (RA) patients and evaluated factors which could affect the formation of GBS--such as lipids and the GB motilities of the patients.

METHODS

One hundred and thirteen RA patients (92F, 21M, mean disease duration: 8.9 years) and 117 healthy controls (94F, 23M) were included. In all RA patients, the clinical findings were recorded down; biochemical parameters and body mass index (BMI) were determined; and, abdominal ultrasonography was performed. In addition, 16 RA patients and 20 controls who were age-matched were randomly chosen for GB emptying monitored by ultrasound at 30-minute intervals for 2 hours after a mixed meal. Fasting volume (FV), residual volume (RV) and ejection fraction (EF) for all GBs were assessed.

RESULTS

There was a tendency towards a higher frequency of GBS including cholecystectomy (11 GBS, 11 cholecystectomy, 19.5%) in RA patients when compared to controls (8 GBS, 5 cholecystectomy, 11.1%) (p = 0.08). The frequency of GBS plus cholecyctectomy in female RA patients (22.8%) was significantly higher than the control group (11.7%, p = 0.044). Logistic regression analysis showed that only older age was significantly associated with the presence of GBS in RA (OR:1.05, p = 0.048). There was no difference between the 2 groups in FV (p > 0.05). RV, PRV and EF were significantly higher in RA patients than in the control group (p < 0.05).

CONCLUSION

We diagnosed a higher frequency of GBS in female RA patients when compared to controls. Impaired GB motility in RA patients might contribute to an increased incidence of GBS development.

Dynamic postural balance in ankylosing spondylitis patients

OBJECTIVES

In this study, our objectives were to investigate whether patients with ankylosing spondylitis (AS) have a poorer dynamic balance than normal subjects, and to study the relationship between balance and posture.

METHODS

Seventy patients (57 men, 13 women) with AS and 35 (31 men, 4 women) controls matched for age, weight, height and body mass index were tested using the Biodex Stability System. Anteroposterior (AP), mediolateral (ML) and overall (OA) indices were obtained with bilateral stance at platform stabilities of 8 and 4. Subjects were tested with 'eyes open' at all times. Correlation analyses were performed between stability indices (OA, AP, ML) and disease duration, cervical rotation (CR), tragus to wall distance (TWD), lumbar side flexion (LSF), lumbar flexion (LF), intermalleolar distance (IMD) and Bath Ankylosing Spondylitis Metrology Index (BASMI) total score.

RESULTS

No significant difference was found between the AS patients and healthy subjects with respect to all three stability indices at levels 4 and 8. A positive correlation was found only between ML stability index and TWD at level 8 (r, 0.249; P = 0.038). No other positive correlation was detected between stability indices and CR, TWD, LSF, LF, IMD, total BASMI score and disease duration.

CONCLUSIONS

AS has no negative effect on postural stability. The only clinically significant association was found between dynamic postural balance and TWD.

An interesting presentation of intrathoracic extramedullary hematopoiesis in a patient with thalassemia intermedia

Extramedullary hematopoiesis (EMH) occurs as a compensatory mechanism for bone marrow dysfunction in severe thalassemia. In addition to the more common locations, such as liver, spleen and lymph nodes, a mass of EMH may occasionally occur in the thorax. Intrathoracic EMH is usually asymptomatic. A 69-year-old woman who initially presented with hematuria, dysuria, and left inguinal pain was found to have paravertebral masses in the thorax. Histopathologic examination of a CT-guided needle aspiration biopsy of the masses showed the presence of trilineage hematopoiesis. We present this unusual case, in which EMH was diagnosed by chance in an elderly patient with no symptoms related to thalassemia.

Histopathology of gills in mosquitofish, Gambusia affinis after long-term exposure to sublethal concentrations of malathion

The histopathological effects of malathion, an organophosphate pesticide, on the gill tissues in mosquitofish, Gambusia affinis, were determined by light microscope. The fish were exposed to sublethal concentrations (0.01 and 0.02 mg/L) of malathion for 10, 20 and 30 days. Histological examination of the gills treated with malathion showed a variety of histopathological effects. The gill lesions included necrosis and desquamation of secondary lamellar epithelium, lifting up of epithelium, intraepithelial oedema, fusion of adjacent secondary lamellae, haemorrhage at primary lamellae, disorganization and rupture in seconder lamellae, hypertrophy and hyperplasia of epithelial cells. These alterations were time- and dose-dependent.

Transdiaphragmatic intercostal hernia following a penetrating thoracoabdominal injury: report of a case

Intercostal hernias with abdominal viscera have rarely been reported following penetrating accidental or surgical trauma. We report herein a case of a traumatic rupture of the left hemidiaphragm, presenting as an intercostal hernia 2 years after a penetrating thoracoabdominal injury. The diaphragmatic rupture had been initially very small and could not be detected in the serial chest films and abdominal computed tomographic scans. The injury was also missed during an exploratory lateral thoracotomy. The patient was admitted with the chief complaint of a painful and gradually enlarging left-sided chest wall bulge of 8 months' duration. Surgery via an anterolateral thoracotomy along the axis of the intercostal hernia was performed, and the omentum and splenic flexura of the colon were reduced.

Phylogeny and biogeography of the family Cyprinidae in the Middle East inferred from cytochrome b DNA- evolutionary significance of this region

The phylogenetic relationships of cyprinid species from the Middle East and neighboring biogeographical areas were investigated using cytochrome b sequence variation in order to test hypotheses that consider the Middle Eastern area as an important interchange area or a center of speciation for the freshwater fauna. A total of 62 cyprinid species were analyzed over the complete cytochrome b fragment (1140 bp); 28 belong to the Leuciscinae subfamily and 34 to the Cyprininae. All the Leuciscinae lineage fish recorded in the Middle East are also found in Europe, which was interpreted as an important Palearctic influence in the Middle Eastern ichthyofauna consistent with the Lago Mare dispersion. However, it has also been suggested that several Danube species have their origins in the Middle East. In contrast, the Cyprininae subfamily showed three highly divergent lineages, one shared with the Euro-Mediterranean area (Barbus/Luciobarbus genus) relict of the Lago Mare dispersion, one shared with Africa (Carasobarbus/Varicorhinus subgenus), and the third shared with Asia (Garra genus). Furthermore, clades observed in the phylogenetic reconstructions are not consistent with morphometric or karyological data and disagree with previous taxonomic assumptions. Lastly, the dispersion history in the Middle East of this subfamily appears much more complicated and ancient than that of the Leuciscinae. However, taking into account Cyprininae and Leuciscinae distribution, the Middle East appears more like an important interchange area for the freshwater ichtyofauna than a center of speciation.

The histopathological effects of thiodan on the liver and gut of mosquitofish, Gambusia affinis

Thiodan (33.7% endosulfan), a polychlorinated cyclodiene insecticide, was evaluated for its histopathological effects on mosquitofish, Gambusia affinis, by light microscopy. Fish were exposed to doses of 0.00 (control), 1.00, 2.50, and 5.00 microg/L on days 7, 14, 21, and 30. No histopathological effects were apparent at control group. The histopathological alterations were characterized as oedema, degeneration, accumulation of lymphocytes in the lamina propria, disintegration of villuses, pycnotic state of nuclei, and necrosis in gut; degeneration, hypertrophy, sinusoids enlargement, hemorrhage, pycnosis position of nuclei, vacuolization of cell cytoplasm, infiltration of mononuclear lymphocyte, and congestion in liver. These alterations were time- and dose-dependent.

Concentrations of some heavy metals in water, sediment and fish species from the Atatürk Dam Lake (Euphrates), Turkey

Concentrations of heavy metals (Cd, Co, Cu, Fe, Hg, Mn, Mo, Ni, Pb and Zn) were measured in the water, sediment and fish species (Acanthobrama marmid, Chalcalburnus mossulensis, Chondrostoma regium, Carasobarbus luteus, Capoetta trutta and Cyprinus carpio) from the Atatürk Dam Lake, Turkey. Among the heavy metals studied Cd, Co, Hg, Mo and Pb were not detected in water, sediments and fish samples, while Ni was undetectable levels in fish samples. Levels of Cu, Fe, Mn and Zn varied depending on different tissues. The results of this study indicated that a general absence of serious pollution in the dam lake is due to heavy metals, where as the concentrations of elements found could mainly be attributed to geological sources.

Origin, radiation, dispersion and allopatric hybridization in the chub Leuciscus cephalus

The phylogenetic relationships of 492 chub (Leuciscus cephalus) belonging to 89 populations across the species' range were assessed using 600 base pairs of cytochrome b. Furthermore, nine species belonging to the L. cephalus complex were also analysed (over the whole cytochrome b) in order to test potential allopatric hybridization with L. cephalus sensu stricto (i.e. the chub). Our results show that the chub includes four highly divergent lineages descending from a quick radiation that took place three million years ago. The geographical distribution of these lineages and results of the nested clade analysis indicated that the chub may have originated from Mesopotamia. Chub radiation probably occurred during an important vicariant event such as the isolation of numerous Turkish river systems, a consequence of the uplift of the Anatolian Plateau (formerly covered by a broad inland lake). Dispersion of these lineages arose from the changes in the European hydrographic network and, thus, the chub and endemic species of the L. cephalus complex met by secondary contacts. Our results show several patterns of introgression, from Leuciscus lepidus fully introgressed by chub mitochondrial DNA to Leuciscus borysthenicus where no introgression at all was detected. We assume that these hybridization events might constitute an important evolutionary process for the settlement of the chub in new environments in the Mediterranean area.

Heavy metal pollution in water, sediment and fish from the Tigris river in Turkey

Some heavy metals (Co, Cu, Mo, Ni, Pb, V and Zn) were determined in water, sediments and some fish species (Cyprinion macrostomus and Garra rufa) from the Tigris River. Mo and V were not detected in water and Co, Cu, Ni, Pb, Zn were found low values. Co, Cu, Ni, Pb, V and Zn were found very high levels in the sediments. All the fish samples contain high concentrations of Cu, Ni and Zn, while Co, Mo, Pb and V were not detected. The high concentrations of heavy metals may be directly related to the contamination of the Tigris River by Ergani Copper Plant and the geochemical structure of this region.