Is the Presence of 2 Renal Allograft Arteries Associated with Adverse Outcomes in Live Donor Kidney Transplantation?

OBJECTIVE

Although it was postulated that renal grafts with multiple arteries could lead to unfavorable recipient outcomes, this subject remains controversial. This study aimed to compare the outcomes of recipients receiving renal allografts with a single artery with those receiving renal grafts with two arteries.

MATERIALS AND METHODS

Adult patients who received live donor kidney transplantation in our center between January 2020 and October 2021 were included. Data including age, gender, body mass index, renal allograft side, pre-kidney transplantation dialysis status, human leukocyte antigen mismatch number, warm ischemia time, the number of renal allograft arteries (single/double), complications, duration of hospitalization, postoperative creatinine levels, glomerular filtration rates, early graft rejection, graft loss, and mortality were collected. Subsequently, patients who received single-artery renal allografts were compared with those who received double-artery renal allografts.

RESULTS

Overall, 139 recipients were included. The mean recipient age was 43.73 ± 13.03 (21-69). While 103 recipients were male, 36 were female. The comparison between the 2 groups revealed that mean ischemia time was significantly longer in the double-artery than in the single-artery group (48.0 vs. 31.2 minutes) (P=.00). In addition, the single-artery group had significantly lower postoperative day 1 and day 30 mean serum creatinine levels. Also, the mean postoperative day 1 glomerular filtration rates were significantly higher in the single-artery group than in the double-artery group. However, the 2 groups were similar concerning the glomerular filtration rates measured at other times. On the other hand, there was no difference between the 2 groups regarding duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates.

CONCLUSION

The presence of 2 renal allograft arteries does not have adverse effects on the postoperative parameters of the kidney transplantation recipients, including graft function, duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates.

Strain Echocardiographic Evaluation of Myocardial Involvement in Patients with Continuing Chest Pain after COVID-19 Infection

BACKGROUND

A new clinical manifestation called post or long coronavirus disease (p/l COVID) has walked into our lives after the acute COVID-19 phase. P/l COVID may lead to myocardial injury with subsequent cardiac problems. Diagnosing these patients quickly and simply has become more important due to the increasing number of patients with p/l COVID.

OBJECTIVES

We compared strain echocardiography (SE) parameters of patients who suffered from atypical chest pain and had sequel myocarditis findings on cardiac magnetic resonance (CMR). We aimed to investigate the value of SE for detection of myocardial involvement in patients with p/l COVID.

METHODS

A total of 42 patients were enrolled. Our population was separated into two groups. The CMR(-) group (n = 21) had no myocardial sequelae on CMR, whereas the CMR(+) group had myocardial sequelae on CMR (n = 21). The predictive value of SE for myocarditis was also evaluated by age-adjusted multivariate analysis. P values < 0.05 were considered statistically significant.

RESULTS

When compared with left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) had a stronger relationship (LVEF, p = 0.05; GLS, p < 0.001; GCS, p < 0.001) with p/l COVID associated myocardial involvement. GLS < 20.35 had 85.7% sensitivity and 81% specificity; GCS < 21.35 had 81% sensitivity and 81% specificity as diagnostic values for myocardial sequelae detected with CMR. While there was no difference between the groups in terms of inflammatory markers (C-reactive protein, p = 0.31), a difference was observed between biochemical markers, which are indicators of cardiac involvement (brain natriuretic peptide, p < 0.001).

CONCLUSION

SE is more useful than traditional echocardiography for making diagnosis quickly and accurately in order not to delay treatment in the presence of myocardial involvement.

Results of Using the Cystic Duct for Reconstruction of One of the Multiple Bile Ducts in Right Lobe Living Donor Liver Transplantation

BACKGROUND

In right-lobe liver grafts, variations in the biliary tree anatomy can result in multiple bile duct orifices. We present our experience of 10 patients in which biliary reconstruction was performed with the cystic duct for 1 of the anastomoses with 2 separated ducts. Also, we investigated whether the bile duct anastomosis technique, number of bile duct anastomoses, and use of biliary stents affect the rate of biliary complications.

METHODS

We evaluated patients who underwent right-lobe living donor liver transplantation (LDLT) at İstinye University Hospital and İstanbul Aydın University Hospital between December 2017 and June 2020. The patients were divided into 4 groups: duct-to-duct (D-D), duct-to-sheath, double duct-to-duct, and duct-to-duct plus cystic duct-to-duct. Biliary complication rates were compared among these 4 groups, between single- and double-duct groups, and between stent (+) and stent (-) groups.

RESULTS

Ninety-three patients who underwent right-lobe LDLT (60 men, 33 women) with a mean age of 51 ± 13 years were included. Mean follow-up time was 18.5 ± 8.3 months. The overall biliary complication rate was 17.2% for all patients, 12.1% for the D-D (single-duct) group (33 patients), 16.1% for the duct-to-sheath group (31 patients), 26.3% for the double duct-to-duct group (19 patients), 20% for the duct-to-duct plus cystic duct-to-duct group (10 patients), 20% for the double-duct group (60 patients), 14.5% for the stent (+) group (69 patients), and 25% for the stent (-) group (24 patients). There were no significant differences among these groups in terms of biliary complication rates. Bile stricture occurred in only 1 cystic duct anastomosis (10%), and no bile leakage was observed.

CONCLUSIONS

Multiple D-D biliary reconstruction using the cystic duct with external drainage tubes is feasible and safe for LDLT.

Evaluation of subclinical myocardial dysfunction using speckle tracking echocardiography in patients with radiographic and non-radiographic axial spondyloarthritis

OBJECTIVE

To evaluate whether there is any difference between radiographic axial spondyloarthritis (r-axSpA), also termed ankylosing spondylitis (AS), and non-radiographic (nr-) axSpA, with respect to subclinial myocardial dysfunction using speckle tracking echocardiography (STE).

METHODS

This was a cross-sectional case control study. We included 72 patients with AS, 38 patients with nr-axSpA, and 56 age-matched healthy subjects. Patients with cardiac disease and cardiac risk factors affecting STE were excluded. The disease burden evaluated by the BASDAI, BASFI, BAS-G, and ASAS-HI scores were comparable in both the r- and nr-axSpA groups. A detailed echocardiographic examination including the M-mode, Doppler, and STE was applied to whole study population.

RESULTS

Duration of the disease, the use of an anti-TNFα agent, and CRP levels were higher in patients with AS. Although the AS, nr-axSpA, and control groups had similar ejection fraction values (59±5.2, 60±4.6, 60±4.6, respectively, and p=0.499), the global longitudinal peak systolic strain (GLS) (20.5±3.3, 21.1±3.5, and 22.3±2.4, respectively, and p<0.05) was different between the groups. In a post-hoc analysis, GLS was not different between the nr-axSpA and control groups, and it was significantly lower in patients with AS. In the univariate analysis, peripheral arthritis (p=0.035) and age (p=0.032) were correlated with GLS. A multivariate regression analysis demonstrated that peripheral arthritis (p=0.009) was the only independent GLS predictor.

CONCLUSION

Subclinical myocardial dysfunction as assessed by GLS was present in AS, but not in nr-ax-SpA patients. Thus, GLS could be used as a differentiating factor between radiographic and nr-axSpA patients.

Evaluation of early myocardial dysfunction with strain echocardiography in chronic hepatitis B patients

INTRODUCTION

It is well known that chronic hepatitis B virus infection (CHBV) can be associated with cirrhosis and hepatocellular carcinoma but it can also be associated with extra-hepatic effects, of which cardiac manifestations are the one of the least known. There is a limited amount of data about myocardial dysfunction in CHBV and insufficient data of strain echocardiography in CHBV. The aim of this study was to detect early myocardial dysfunction in CHBV using strain echocardiography.

METHOD

This prospective study included 40 CHBV patients without anti-viral treatment, 40 CHBV patients under anti-viral treatment, and 40 healthy volunteers as control group from 2017 October to 2018 May. The patients in all groups were aged 30-60 years, with no co-morbid diseases. Any patients with pathologies that would cause myocardial dysfunction were excluded from the study. All patients were evaluated with transthoracic two-dimensional (2D), tissue Doppler, and strain echocardiography.

RESULTS

The mean age and gender distribution were similar in all groups (P = 0.677). A statistically significant difference was determined between the groups in respect of the global circumferential strain and global longitudinal strain values (P < 0.01). The difference in the mean lateral s' was of statistical significance between the CHBV patients and the control group (P = 0.035). No statistically significant difference was determined in respect of the other echocardiographic parameters.

CONCLUSION

As it is a chronic necro-inflammatory period, chronic HBV can affect myocardial functions. Traditional echocardiographic parameters may not be useful in the detection of early myocardial dysfunction. The results of this study showed that strain echocardiography may be more valuable in early myocardial dysfunction rather than routine 2D echocardiography in CHBV patients.

Role of calcium-sensing receptor, Galectin-3, Cyclin D1, and Ki-67 immunohistochemistry to favor in the diagnosis of parathyroid carcinoma

Background

As histopathological findings of parathyroid carcinoma are not certain, the diagnosis of tumors with degenerative changes may be difficult. In these cases, immunohistochemical markers are beneficial. We aimed to research the acceptability of calcium-sensing receptor (CaSR), Galactin-3, Cyclin D1, and Ki-67 as helpful markers in parathyroid tumors in cases which are difficult to diagnose.

Materials and Methods

Those cases who had been diagnosed with atypical parathyroid adenoma and parathyroid carcinoma between 2010 and 2015 were reevaluated. İmmunohistochemical markers were applied to this cases.

Results

About 21 cases were parathyroid adenoma, 14 were atypical adenoma, and 10 cases were parathyroid carcinoma. According to the immunohistochemical results, global loss of CaSR staining was seen in 50% (5/10) of the patients with carcinoma while there was no loss of staining in those with parathyroid adenoma (P = 0,001). Global loss of CaSR staining was found in only one out of 14 cases with atypical adenoma. The expression of Galactin-3 was found to be positive in 40% (4/10) of carcinoma cases, 71.4% (10/14) of those with atypical adenoma, and 14.3% (3/21) of those with adenoma (P = 0,002). Cyclin D1 expression was determined to be positive in 70% (7/10) of patients with carcinoma, 71.4% (10/14) of atypical adenoma cases, and 23.8% (5/21) of those with adenoma. The Ki-67 proliferation index was seen to be above 5% in 50% (5/10) of carcinoma cases and 35,7% (5/14) of those with atypical adenoma.

Conclusion

In these studies, it has been emphasized that the global loss of CaSR staining was used as a negative marker in the diagnosis of carcinoma. In this study, we have also confirmed that the global loss of CaSR staining is a useful marker to determine potential increased malignancy.

The Ameliorative Effects of Pycnogenol® on Liver Ischemia-Reperfusion Injury in Rats

Objectives

Pycnogenol^® (PYC^®), a standardized extract from the bark of Pinus maritima, consists of different phenolic compounds. PYC^® has shown to have protective effects on chronic diseases such as diabetes, asthma, cancer, and immune disorders. The aim of this study was to determine the effects of PYC^® against the DNA damage and biochemical changes in blood, liver, and lung tissues of ischemia-reperfusion (IR)-induced Wistar albino rats.

Materials and Methods

A sham group, IR injury-induced group, and IR+PYC^® group were formed. Ischemia was induced and sustained for 45 min, then the ischemic liver was reperfused, which was sustained for a further 120 min at the end of this period. After anesthesia and before the IR inducement, 100 mg/kg PYC^® was given to the IR+PYC^® group through intraperitoneal injections. The total oxidant (TOS) and total antioxidant status (TAS), total thiol levels (TTL), advanced oxidation protein products (AOPP), and biochemical parameters [myeloperoxidase (MPO), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH)] in the rats were analyzed using spectrophotometric methods and DNA damage was assessed using single-cell gel electrophoresis.

Results

The levels of TOS, TTL, MPO, AOPP, ALT, AST, and LDH were significantly decreased in the IR+PYC^® group compared with the IR group (p<0.05). The levels of TAS were significantly increased in the IR+PYC^® group compared with the IR group (p<0.05). PYC^® reduced the DNA damage when compared with the IR group (p<0.05).

Conclusion

The present results suggest that PYC^® treatment might have a role in the prevention of IR-induced oxidative damage by decreasing DNA damage and increasing antioxidant status.

Effect of Left Bundle Branch Block on Systolic and Diastolic Function of Left Ventricle in Heart Failure

This study was designed to examine the effect of left bundle branch block (LBBB) on systolic and diastolic function of the left ventricle (LV) in patients with heart failure and in normal subjects. Thirty-six patients with heart failure and LBBB (group I), 36 patients with heart failure with normal conduction (group II), and 41 subjects with isolated LBBB (group III) were compared. Coronary angiography was performed and LV end diastolic pressure was calculated. Echocardiography was performed on all patients. LV ejection fraction and mean rate of circum ferential shortening were calculated. The following Doppler parameters were evaluated: peak rapid filling velocity (E wave), peak atrial filling velocity (A wave), E- and A-wave integrals, E- wave acceleration time and deceleration time (EDT) and rates (EAR and EDR), the E/A ratio and its integral, and diastolic flow time (DT). The ejection time, isovolumetric relaxation time (IRT), and preejection period were measured using the aortic and mitral flow. LV end diastolic pressure was calculated as 28 ±4 mm Hg, 22 ±5 mm Hg, and 15 ±3 mm Hg in groups I, II, and III, respectively. Although the systolic function parameters in group III patients were different, the diastolic function parameters of group II were found to be quite similar to those of group III patients. Comparison of group I patients with group II patients showed that there was a similarity between LV systolic function parameters while the diastolic function parameters were different (E/A, p = 0.004; EAR, p<0.001; EDR, p<0.001; EDT, p<0.001; IRT, p = 0.024; DT, p=0.03). In conclusion, this study evaluating the effects of LBBB in normal subjects (isolated LBBB) and patients with heart failure showed that LBBB causes diastolic function impairment in normal subjects similar to those of patients with heart failure, and also increases impairment of diastolic function in patients with heart failure.

Effects of everolimus on a rat model of cerulein-induced experimental acute pancreatitis

OBJECTIVE

To analyze the biochemical and histopathological effects of everolimus in an experimental rat model of cerulein-induced acute pancreatitis. The aim of the present study was to determine the effects of everolimus on blood biochemical parameters and tissue histopathology in an experimental rat model of cerulein-induced acute pancreatitis.

MATERIAL AND METHODS

In 30 Wistar albino rats (male; 240-260 g), acute pancreatitis was induced by an intraperitoneal injection of cerulein (50 μg/kg) administered twice in 2 h. They were equally divided into the following three groups: 0.9% isotonic solution (Group 1; control), everolimus once (Group 2), and everolimus twice (Group 3) by oral gavage after cerulein injection. Thirty hours after the induction of pancreatitis, blood samples were collected by direct intracardiac puncture, rats were sacrificed, and pancreatic tissue samples were obtained.

RESULTS

Biochemical analyses of the blood samples showed statistically significant difference in red blood cell count as well as hemoglobin, hematocrit, urea, and alanine transaminase levels among the study groups (p<0.05 in all). Everolimus proved to significantly increase red blood cell count in a dose-independent manner. Hemoglobin and hematocrit levels significantly increased only after treatment with one dose of everolimus. Urea level was significantly different between the Groups 2 and 3; however, no change was observed in both groups when compared with the control. Alanine transaminase level significantly decreased only after treatment with two doses of everolimus. Histopathological analyses revealed that everolimus significantly decreased inflammation and perivascular infiltrate in a dose-dependent manner (35% in Group 2, 75% in Group 3; p=0.048).

CONCLUSION

Treatment with two doses of everolimus improved some biochemical and histopathological parameters of experimental rat models of cerulein-induced acute pancreatitis and implied the specific inhibition of inflammatory response pathways.

Local bupivacaine for postoperative pain management in thyroidectomized patients: A prospective and controlled clinical study

OBJECTIVE

We aimed to evaluate the effect of bupivacaine and to compare the routes of administration of bupivacaine in the management of postoperative incision site pain after thyroidectomy.

MATERIAL AND METHODS

Consecutive patients who were planned for thyroidectomy surgery were randomized into three groups of 30 patients each: Group 1 (control group): standard thyroidectomy surgery without additional intervention; Group 2 (paratracheal infiltration with bupivacaine): following thyroidectomy, 0.25% bupivacaine was applied on the surgical area; Group 3 (subcutaneous infiltration with bupivacaine): following thyroidectomy, 0.25% bupivacaine was injected into the cutaneous, subcutaneous region and fascia of the surgical area. Postoperative pain was evaluated by a visual analog scale (VAS) at 1(st), 4(th), and 12(th) hours after thyroidectomy. Total daily requirement for additional analgesia was recorded.

RESULTS

The mean age of 90 patients was 44.37±13.42 years, and the female:male ratio was 62:28. There was no difference between study groups in terms of age, thyroid volume, TSH and T4 levels. VAS score of patients in paratracheal infiltration with bupivacaine group was significantly lower than control group patients at 1(st), 4(th) and 12(th) hours following thyroidectomy (p=0.030, p=0.033, p=0.039, respectively). The need for analgesics was significantly lower in both paratracheal infiltration and subcutaneous infiltration groups than the control group (86.7%, 83.0%, and 73.3%, respectively, p=0.049).

CONCLUSIONS

Intraoperative local bupivacaine application is effective in decreasing postoperative pain in patients with thyroidectomy.

Interfacial Structure Dependent Spin Mixing Conductance in Cobalt Thin Films

Enhancement of Gilbert damping in polycrystalline cobalt thin-film multilayers of various thicknesses, overlayered with copper or iridium, was studied in order to understand the role of local interface structure in spin pumping. X-ray diffraction indicates that cobalt films less than 6 nm thick have strong fcc(111) texture while thicker films are dominated by hcp(0001) structure. The intrinsic damping for cobalt thicknesses above 6 nm is weakly dependent on cobalt thickness for both overlayer materials, and below 6 nm the iridium overlayers show higher damping enhancement compared to copper overlayers, as expected due to spin pumping. The interfacial spin mixing conductance is significantly enhanced in structures where both cobalt and iridium have fcc(111) structure in comparison to those where the cobalt layer has subtly different hcp(0001) texture at the interface.

A general consideration of the importance of nutrition for critically ill patients

BACKGROUND/AIM

Malnutrition is a common medical condition among intensive care unit patients. It should be monitored carefully, since early management of malnutrition can dramatically improve the medical condition of the patients. A general consideration of enteral feeding shows that it is much more useful than parenteral administration, because it is more physiological and poses a lower risk of hyperalimentation.

MATERIALS AND METHODS

In this retrospective study, we scanned all files and personal information of patients hospitalized in intensive care units between 2009 and 2012 due to various medical conditions. We evaluated the nutritional status of patients with biochemical parameters that were retrieved from the files.

RESULTS

In total, 198 patients were identified from hospital records. Almost every patient was given nutritional support either through enteral or parenteral feeding. The albumin levels of 56 patients did not increase, even when they were fed with calculated nutritional support (36.6%). The prealbumin levels of the patients had a tendency to increase after the provision of nutritional additives.

CONCLUSION

In appropriately selected critically ill patients, the role of nutritional support in the management of nutritional deficiencies is important. In order to calculate proper feeding goals, a full nutritional assessment is necessary.

Correlation between the serum and tissue levels of oxidative stress markers and the extent of inflammation in acute appendicitis

OBJECTIVES

To determine the serum and tissue levels of markers of impaired oxidative metabolism and correlate these levels with the histopathology and Alvarado score of acute appendicitis patients.

METHOD

Sixty-five acute appendicitis patients (mean age, 31.4±12.06 years; male/female, 30/35) and 30 healthy control subjects were studied. The Alvarado score was recorded. Serum samples were obtained before surgery and 12 hours postoperatively to examine the total antioxidant status, total oxidant status, paraoxonase, stimulated paraoxonase, arylesterase, catalase, myeloperoxidase, ceruloplasmin, oxidative stress markers (advanced oxidized protein products and total thiol level) and ischemia-modified albumin. Surgical specimens were also evaluated.

RESULTS

The diagnoses were acute appendicitis (n = 37), perforated appendicitis (n = 8), phlegmonous appendicitis (n = 12), perforated+phlegmonous appendicitis (n = 4), or no appendicitis (n = 4). The Alvarado score of the acute appendicitis group was significantly lower than that of the perforated+phlegmonous appendicitis group (p = 0.004). The serum total antioxidant status, total thiol level, advanced oxidized protein products, total oxidant status, catalase, arylesterase, and ischemia-modified albumin levels were significantly different between the acute appendicitis and control groups. There was no correlation between the pathological extent of acute appendicitis and the tissue levels of the markers; additionally, there was no correlation between the tissue and serum levels of any of the parameters.

CONCLUSIONS

The imbalance of oxidant/antioxidant systems plays a role in the pathogenesis acute appendicitis. The Alvarado score can successfully predict the presence and extent of acute appendicitis.

Evaluation of necessity for mechanical bowel preparation before Milligan-Morgan hemorrhoidectomy: a randomized prospective clinical study

AIM

In this randomized prospective clinical study, we aimed to evaluate the effect of mechanical bowel preparation (MBP) before Milligan-Morgan hemorrhoidectomy on intraoperative procedures and postoperative complication rates to determine whether MBP is adventageous or not before elective anorectal surgeries.

METHODS

Forty patients who had internal grade III or IV hemorrhoidal disease and who would underwent open hemorrhoidectomy were randomized into two groups: non-MBP group (female:male, 11:9; mean age, 33.8±9.57 years) that would not receive MBP before the surgery, and MBP group (female:male, 12:8; mean age, 34.7±11.37 years) that would be given one Fleet enema on the morning of Milligan-Morgan hemorrhoidectomy. Intraoperative variables and postoperative complications were compared between two groups.

RESULTS

MPB had no effect on both intraoperative and postoperative variables, such as operating time, intraoperative bleeding, visual analogue scale (VAS) score for the comfort of the surgeon during operation, the presence of stool or enema remnants in anal canal, the presence of mucosal edema of the anal canal intraoperatively, the rates of postoperative bleeding and infection, VAS score for the pain on third day postoperatively, time to first stool after the operation, VAS score for the pain during first stool after the operation, and number of analgesics during one week postoperatively (P>0.05 for all).

CONCLUSION

MBP performed before surgery does not provide introperative or postoperative benefit for Milligan-Morgan hemorrhoidectomy, thus MBP is not necessary before elective anorectal surgeries.

Patient and graft survival after pre-emptive versus non-pre-emptive kidney transplantation: a single-center experience from Turkey

OBJECTIVE

We sought to report the graft and patients survival of pre-emptive and non-pre-emptive kidney transplantations performed in our center.

METHODS

The 859 subjects showed a mean age of 36.1 years and included 64.6%; males, who received grafts from living (n = 665) or deceased (n = 194) donors between January 2008 and June 2011. We reviewed their medical records retrospectively, to separately pre-emptive versus non-pre-emptive recipients for year transplant outcomes.

RESULTS

Among the 859 patients, 153 (17.8%) underwent pre-emptive and 706 (82.2%), non-pre-emptive kidney transplantations. The rate of living donors was higher in the pre-emptive group (97.4% vs 73%, respectively). The 1-year graft survivals were 99.3% and 95.8% in pre-emptive and non-pre-emptive transplantation groups, respectively (P > .05). There was no significant difference between groups with respect to patient survival at 1 year (P > .05).

CONCLUSION

In conclusion, graft and patient survival rates between pre-emptive and non-pre-emptive kidney transplantation cases were comparable at 1 year. Pre-emptive kidney transplantation, which eliminates hemodialysis costs and complications, should be preferred as the optimal renal replacement therapy for end-stage renal disease patients.

Correlation of thyroid fine-needle aspiration with final histopathology: a case series

AIM

The aim of this study was to evaluate the correlation between preoperative thyroid fine-needle aspiration result and final histopathology in patients with thyroid nodules.

METHODS

The medical records of 298 patients (mean age, 47.7±12.3 years; 79.5% females) who underwent fine-needle aspiration for thyroid nodules and who were operated and have final pathological diagnosis were retrospectively reviewed. For reporting fine-needle aspiration specimen pathology, the Bethesda thyroid fine-needle aspiration classification was used. Tyroglobulin (Tg) and anti-Tg and anti-thyroid peroxidase (anti-TPO) antibody levels were determined preoperatively.

RESULTS

Thyroid nodules were non-diagnostic, benign or atypia (Bethesda groups 1-3) in 76.8% of patients; and follicular neoplasm, suspicious for malignancy or malignant (Bethesda groups 4-6) in 23.1% of patients. Final pathology of surgery specimen was most commonly nodular goiter (36.6%) and papillary carcinoma (35.6%). Nodular goiter was significantly more prevalent in Bethesda 1 group while papillary carcinoma was more common in Bethesda 3 group (P<0.05). Tg level is significantly higher in the nodular goiter group (90.49±126.93 ng/mL), while anti-Tg and anti-TPO levels are significantly higher in the lymphocytic thyroiditis goiter group (229.77±494.42 U/mL and 282.86±360.77 U/mL, respectively) than the other pathology groups (P<0.05 for all).

CONCLUSION

Papillary carcinoma is more common in Bethesda thyroid fine-needle aspiration classification 3 group. Therefore, preoperative fine-needle aspiration for thyroid nodules is predictive of final pathology and should be applied for diagnosis and follow-up.

Cortex sparing laparoscopic adrenalectomy in a patient with Conn's syndrome

Conn's syndrome, an aldosterone producing adenoma, is a surgically curable cause of primary aldosteronism, classically treated by unilateral adrenalectomy. With the advent of laparoscopic surgery in the recent decade, laparoscopic adrenalectomy is currently accepted as the gold standard of treatment for Conn's syndrome. Cortical sparing adrenalectomy is especially an ideal operation for patients with bilateral pheochromocytoma. This case report describes a successful laparoscopic adrenal cortex sparing surgery on the left side and anesthetic approach in a patient with Conn's syndrome, who had a history of previous right surrenalectomy. Laparoscopic surgery without dividing the central adrenal vein can also be performed successfully in patients with Conn's syndrome.

Antioxidant and antigenotoxic effects of lycopene in obstructive jaundice

BACKGROUND

Obstructive jaundice, a frequently observed condition caused by obstruction of the common bile duct or its flow and seen in many clinical situations, may end up with serious complications like sepsis, immune depression, coagulopathy, wound breakdown, gastrointestinal hemorrhage, and hepatic and renal failures. Intrahepatic accumulation of reactive oxygen species is thought to be an important cause for the possible mechanisms of the pathogenesis of cholestatic tissue injury from jaundice. Carotenoids have been well described that are able to scavenge reactive oxygen species. Lycopene, a carotenoid present in tomatoes, tomato products, and several fruits and vegetables, have been suggested to have antioxidant activity, so may play a role in certain diseases related to the oxidative stress. The aim of the present study was to determine the effects of lycopene on oxidative stress and DNA damage induced by experimental biliary obstruction in Wistar albino rats.

MATERIALS AND METHODS

Daily doses of 100 mg/kg lycopene were given to the bile duct-ligation (BDL) rats orally for 14 days. DNA damage was evaluated by an alkaline comet assay. The levels of aspartate transferase, amino alanine transferase, gamma glutamyl transferase, alkaline phosphatase, and direct bilirubin were analyzed in plasma for the determination of liver functions. The levels of malondialdehyde, reduced glutathione, nitric oxide, catalase, superoxide dismutase, and glutathione S transferase were determined in the liver and kidney tissues. Pro-inflammatory cytokine tumor necrosis factor-alpha level was determined in the liver tissues. Histologic examinations of the liver and kidney tissues were also performed.

RESULTS

According to this study, lycopene significantly recovered the parameters of liver functions in plasma, reduced malondialdehyde and nitric oxide levels, enhanced reduced glutathione levels, as well as enhancing all antioxidant enzyme activity in all tissues obtained from the BDL group. Moreover, the parameters of DNA damage in the liver and kidney tissue cells, whole blood cells, and lymphocytes were significantly lower in the lycopene-treated BDL group, compared with the BDL group.

CONCLUSIONS

Lycopene significantly reduced the DNA damage, and markedly recovered the liver and kidney tissue injuries seen in rats with obstructive jaundice.

Use of dynamic wound closure system in conjunction with vacuum-assisted closure therapy in delayed closure of open abdomen

AIM

Definitive abdominal closure may not be possible for several days or weeks after laparotomy in damage-control surgery, abdominal compartment syndrome and intraabdominal sepsis, until the patient has stabilized. Vacuum-assisted closure (VAC therapy(®), KCI, San Antonio, TX, USA) and abdominal re-approximation anchor system (ABRA, Canica, Almonte, Ontario, Canada) are novel techniques in delayed closure of open abdomen. Our aim is to present the use of these strategies in the management of 7 patients with open abdomen.

METHODS

Between August 2010 and December 2011, 7 patients with severe peritonitis were stabilized by laparotomy and treated with either ABRA system or ABRA system in conjunction with VAC dressing. VAC dressing applied to 4 patients initially and followed by ABRA. ABRA was applied alone to remaining 3 patients. Demographic data and patient characteristics, timing of VAC dressing and ABRA system were recorded. ICU and hospital stay and development of incisional hernia were also recorded. Stage of open abdomen, width of abdominal defect, extent to damage to fascia, and pressure sores were staged.

RESULTS

The mean duration with VAC dressing before ABRA application was 18 days. The mean duration of ABRA application was 53 days. The average width of the abdominal defect was 18 cm. The average length of defect was 20.8 cm. Delayed primary abdominal closure was accomplished in 6 patients without further surgery. Incisional hernia with a small abdominal defect developed in 2 patients.

CONCLUSION

Abdominal re-approximation anchor system and VAC dressing can be used separately or in conjunction with each other for closure of delayed open abdomen successfully.

Relationship between heart-type fatty acid-binding protein levels and coronary artery disease in exercise stress testing: an observational study

OBJECTIVE

Although, there has been great improvement on the diagnosis and early treatment of acute coronary syndromes, especially in terms of myocardial damage biochemical markers, we do not have a specific marker yet, for using the diagnosis of stable coronary artery disease (CAD). This study aimed to evaluate the relationship between CAD and the changes of heart-type fatty acid binding protein (H-FABP) levels before and after exercise stress testing (EST).

METHODS

A total of 47 patients were enrolled in this observational study. Of 47 patients, 21 had normal coronary anatomy; the remaining 26 patients had coronary lesions over 70% in at least one major coronary artery. All patients performed EST. Along with this, H-FABP levels before EST and at peak exercise, 1st hour, 3rd hour (3h), were measured in all patients. Differences among the measurements were evaluated through the Friedman test and Wilcoxon test, and the Bonferroni correction was applied to determine which measurement caused the difference.

RESULTS

Contrary to expectations, the means of the H-FABP values measured at particular intervals for each group tended to decline from the basal level to the 3h level. When the difference between the 3h measurement and the basal level was compared in each group, the decreasing was statistically significant in both groups (p<0.05). A statistically significant decrease at the 3h measurement compared to the basal level in the CAD group was more apparent than in the control group (2.790±2.569 ng/ml vs. 0.837±2.070 ng/ml, p=0.009).

CONCLUSION

We found that H-FABP levels did not increase during EST and contrary to expectation, were inclined to decrease. We thought that decreasing H-FABP levels likely resulted from exercise-induced proteinuria.

Diastolic functions and myocardial performance index in obese patients with or without metabolic syndrome: a tissue Doppler study

OBJECTIVES

This study was designed to evaluate left ventricular (LV) diastolic functions and myocardial performance index (MPI) in obese individuals with or without metabolic syndrome (MetS).

STUDY DESIGN

The study included 44 obese subjects with MetS (16 men; 28 women; mean age 46±7 years) and 32 obese subjects without MetS (16 men, 16 women; mean age 43±9 years). Diagnosis of MetS was based on the ATP III criteria. Obesity was defined with a body mass index (BMI) of ≥30 kg/m2. All the subjects underwent echocardiography and tissue Doppler imaging to determine LV diastolic functions and MPI. Clinical and echocardiographic characteristics of obese subjects were compared with those of a control group consisting of 21 healthy, nonobese individuals (10 men, 11 women; mean age 42±4 years).

RESULTS

Waist circumference, weight, and BMI were similar in the two obese groups. Control subjects and obese subjects without MetS had similar systolic and diastolic blood pressures, fasting blood glucose, triglyceride, and HDL cholesterol levels, but all these significantly differed in patients with MetS. Left ventricular mass, mass index, and diastolic parameters were similar in the two obese groups, but differed significantly from the controls (p<0.05). Body mass index was correlated with the LV mass (r=0.42, p=0.001) and mass index (r=0.33, p=0.001). Left ventricular MPI was similar in the two obese groups with (0.59±0.10) and without (0.59±0.11) MetS, but was higher compared to the control group (0.48±0.06, p<0.05). Left ventricular MPI was correlated with BMI, waist circumference, LV mass, and mass index (r=0.24, p=0.02; r=0.30, p=0.005; r=0.31, p=0.002; r=0.21, p=0.04, respectively).

CONCLUSION

Our findings demonstrate that obesity with or without MetS affects LV MPI. In addition, LV MPI showed significant correlations with BMI, waist circumference, and LV mass.

Platelet glycoprotein Ibalpha gene polymorphism and massive or submassive pulmonary embolism

OBJECTIVE

The -5T/C polymorphism in the Kozak sequence of glycoprotein Ibalpha, a component of the platelet glycoprotein Ib-IX-V receptor complex, is associated with an increase in this receptor density on the surface of the platelet. This study was designed to investigate the effect of platelet glycoprotein Ibalpha Kozak polymorphism on the clinical presentation of the patients with acute pulmonary embolism.

METHODS

Forty-two patients with pulmonary embolism were genotyped for Kozak polymorphism of the glycoprotein Ibalpha by polymerase chain reaction/restriction fragment length polymorphism.

RESULTS

Carriers of the -5T/C polymorphism of glycoprotein Ibalpha were significantly over-represented in the patient group with clinically massive or submassive pulmonary embolism (odds ratio 5.5, 95% confidence interval 1.4 to 22.2, P = 0.023). Also the association between this polymorphism and massive or submassive pulmonary embolism still existed even after being adjusted for conventional risk factors.

CONCLUSION

The -5T/C polymorphism in the Kozak sequence of glycoprotein Ibalpha may present as a risk factor for clinical manifestation of pulmonary embolism in which clot burden plays an important role.

The role of inflammation markers in triggering acute coronary events

Studies have shown disparate results in relation to the role of plasma concentrations of inflammation markers such as fibrinogen, cytokines, and cell adhesion molecules in acute coronary syndromes. The differentiation of primary versus secondary alterations of these markers in response to acute coronary syndromes is not clear. The aim of this study was to investigate the effect of soluble cell adhesion molecules and some inflammatory markers on coronary plaque instability. The prospective study consisted of 15 patients with stable angina pectoris (SAP), 16 with unstable angina pectoris (UAP), and 16 who had undergone percutaneous transluminal coronary angioplasty (PTCA). Blood samples were obtained from the SAP group on admission, from the UAP group at the early stage of pain onset within 6 h of pain, and again after 12 h of pain. Samples from the PTCA group were collected before, 2, 14 h after the procedure. Soluble vascular cell adhesion molecule-1 (VCAM-1), endothelial selectin, interleukin-1 beta (IL-1 beta) and interleukin-2 (IL-2), and C-reactive protein (CRP) were analyzed by enzyme-linked immunosorbent assay. CRP serum levels gradually increased although IL-2 gradually decreased in patients with UAP and PTCA. In addition, VCAM-1 levels were sharply decreased after the PTCA procedure. However, this value returned back to the preprocedure levels 14 h after PTCA. Both CRP and IL-2 are directly involved in the triggering mechanisms of acute coronary events.

Can P wave parameters obtained from 12-lead surface electrocardiogram be a predictor for atrial fibrillation in patients who have structural heart disease?

This study was planned to investigate the parameters detecting risk of developing atrial fibrillation (AF) in patients with sinus rhythm with structural heart disease. Forty-five patients with AF and 37 patients without AF but with structural heart disease (Group I) were included in this study. Thirty-eight patients (Group II) had successfully undergone medically or electrically cardioversion after transesophageal echocardiography. The restoration of sinus rhythm could not be achieved in 7 patients who were excluded from this study. After providing sinus rhythm, amiodarone was given orally to the patients to prevent recurrences. Left ventricular ejection fraction (LVEF) was calculated and left atrial diameter (LAD) was measured by echocardiography in group I and in group II after cardioversion. A 12-lead electrocardiography (ECG) was simultaneously obtained from all the patients. In these ECG recordings, maximum P wave duration (P max), minimum P wave duration (P min), and P wave dispersion (P dispersion) were calculated. P dispersion was expressed as "P max-P min." Also, the highest P wave voltage is expressed as P amplitude maximum (P amp max), the lowest P wave as P amplitude minimum (P amp min), and P amplitude dispersion (P amp dispersion) was calculated as the difference of both. In univariate analysis, P max, P dispersion, P amp max, P amp dispersion, LAD, LVEF, and old age were significant predictors of chronic AF (p < 0.001, p < 0.01, p < 0.01, p < 0.01, p = 0.003, p = 0.02, and p = 0.01, respectively). However, in multivariate analysis, P max and LAD were independent predictors of chronic AF in patients with structural heart disease (r = 0.39, p < 0.05; r = 0.34; p < 0.05, respectively). In conclusion, in estimating the risk of developing chronic AF, P max and LAD are predictive parameters in patients with sinus rhythm with structural heart disease.

Usefulness of peak mitral inflow velocity to predict severe mitral regurgitation in patients with normal or impaired left ventricular systolic function

BACKGROUND

The aim of this study was to evaluate the reliability of peak mitral inflow (E-wave) velocity, which was thought to be easier and more practical than qualitative and quantitative methods used to grade mitral regurgitation (MR) in patients both with normal and low left ventricular (LV) ejection fraction (EF). It is known that peak E-wave velocity increases in MR. But correlation of this increase with regurgitant fraction (RF), its usefulness in grading MR, and the effect of EF on peak E-wave velocity have not been studied in detail.

METHODS

We prospectively examined 135 consecutive patients with varying grades of MR with echocardiography. MR was evaluated both qualitatively and quantitatively, and concordance of these 2 methods was determined. Peak E-wave velocity, A-wave velocity, and E-wave deceleration time were measured and the E/A ratio was calculated. LV isovolumetric relaxation and contraction times were measured. Different MR groups classified by RF were compared with each other.

RESULTS

Concordance of quantitative and qualitative evaluation was low in patients with low EF (kappa 0.37 vs 0.65). Peak E-wave velocity and E/A ratio showed significant differences between MR groups. Peak E-wave velocity correlated with the RF and EF (r = 0.47, r = 0.33, respectively, P <.001). Sensitivity, specificity, and negative predictive value of peak E-wave velocity >1.2 m/s suggesting severe MR were found to be different in patients with normal and low EF (96% vs 66%, 78% vs 83%, 97% vs 78%, respectively). E-wave deceleration, LV isovolumetric relaxation, and contraction time did not show a correlation with RF.

CONCLUSION

Peak E-wave velocity is a screening method that could be used in common for determining severity of MR semiquantitatively, especially in patients with normal EF.

Effect of the isolated left bundle branch block on systolic and diastolic functions of left ventricle

BACKGROUND

We planned this study to evaluate the effects of left bundle branch block (LBBB) on systolic and diastolic functions of left ventricle (LV) that have not previously been investigated in detail.

MATERIAL AND METHODS

Forty-five cases diagnosed as isolated LBBB according to the standard electrocardiographic criteria (group I, mean age: 60 +/- 12 years) were taken as the case group and 65 cases with normal conduction system (group II, mean age 58 +/- 14 years) were taken as the control group. Echocardiography was performed to all patients and coronary angiography was performed to 21 patients in group I and 35 patients in group II. In addition to standard systolic and diastolic function parameters, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and ejection time (ET) were measured by echocardiography, and the myocardial performance index (MPI) [(IRT+ICT)/ET] was calculated. LV end-diastolic pressure was calculated for the patients undergoing coronary angiography.

RESULTS

In group I, LV end-systolic diameter was greater (3.1 +/- 0.4 cm vs 2.8 +/- 0.4 cm, P <.001) and ejection fraction was lower (64% +/- 6% vs 68% +/- 6%, P <.001) than those of group II. Rapid filling deceleration time and rate was markedly different in group I (respectively, 133 +/- 50 ms vs 166 +/- 24 ms, P <.001; 608 +/- 291 cm/s(2) vs 383 +/- 116 cm/s(2), P <.001). In addition, it was found that LBBB caused shortening of LV diastolic period and ET markedly (respectively, 347 +/- 116 ms vs 394 +/- 106 ms, P =.03; 255 +/- 40 ms vs 294 +/- 21 ms, P <.001) and prolongation of IRT and ICT (respectively; 124 +/- 36 ms vs 91 +/- 16 ms, 96 +/- 35 ms vs 38 +/- 9 ms, P <.001). The MPI was predominantly higher in group I (0.89 +/- 0.29 vs 0.40 +/- 0.06, P <.001). Invasively determined LV end-diastolic pressure was found higher in group I (14 +/- 3 mm Hg vs 10 +/- 3 mm Hg, P <.001).

CONCLUSION

A marked elevation of the LV MPI and end-diastolic pressure, parallel to changes of conventional echocardiographic parameters, in patients with isolated LBBB points out that LBBB causes marked deterioration on LV systolic and diastolic functions.

Usefulness of coronary angiography for assessing left ventricular systolic function

OBJECTIVE

In previous echocardiographic studies, a correlation between ejection fraction of the left ventricle and change in the movement of the mitral annular ring was found. In the light of these studies, we planned to investigate the relationship between systolic shortening (SS) and percent of systolic shortening (PSS), calculated from the long axis frame in coronary angiography and left ventricular systolic function.

METHODS AND RESULTS

One hundred and thirty-eight patients (40 men and 98 women; mean age 58 +/- 10 years) who had been referred for coronary angiography and left ventriculography were included in the study. Ejection fraction (EF) was calculated from left ventriculography obtained from 30 degrees right anterior oblique projection. Distance from the lower border of the ostium of the left coronary artery to the most apical border of the left anterior descending (LAD) artery was measured at end-systole (ES) and end-diastole (ED) using coronary angiography obtained from the same projection. SS as ED-ES and PSS as SS/ED were calculated. Correlation of SS and PSS with EF was calculated (EF = 13.7 + 4.8 x SS, r = 0.91, p < 0.001 and EF = 14.2 + 6.5 x PSS, r = 0.90, p < 0.01). SS < 7 mm (criterion A) and PSS < 6% (criterion B) suggested that left ventricle EF was less than 50%, with a sensitivity, specificity and diagnostic accuracy of 83%, 100%, 95%; 95%, 86% and 88%, respectively.

CONCLUSION

SS and PSS highly significantly correlate with left ventricular EF. Therefore, left ventriculography could be omitted in selected patients undergoing coronary angiography if it is not necessary to define the anatomic structure of the left ventricle.

[Dermatological diseases and treatment described in the Turkish manuscripts (XIV-XVth centuries) (part II)]

This study deals with skin diseases described in the earliest compiled or translated Turkish medical manuscripts of the 14th and 15th centuries in Anatolia. The manuscripts studied are: Müntehab-i Sifa, Edviye-i Müfrede, Tervihü'l-Ervah, Yadigâr, Cerrahiyyetü'l-Haniyye, Kamilü's-Sinaatü't-Tibbiye Tercü-mesi, Kitab-i Müntehab-i fi't-Tibb, Haza'inü's-Sa'adat, Akrabadin Tercümesi, Mücerrebname, Müfredât-i Ibn-i Baytar Tercümesi, Tuhfe-i Mübarizi and Tuhfe-i Muradi. The skin diseases known at that time are studied under the following topics: Cüderi (Ciçek, Variola, Small-pox); Hasbe (Kizamik, Rubeola, Measles); Cüzzam (Lepra, Leprosy, Hansen's disease); Demregü (Temriye, Dermatophtosis, Tinea corporis); Behak (There are two types: the white and the black; the black is Addison's disease); Baras (Ala, Vitilio); Nemle (Isirga, Makül); Ateş paresi (Nar-i farisi, frunculosis); Cemre (Kara kabarcik, Sirpençe, Karbonkül, Carbuncle); Caversiye (Kabarcik hastaliği, blisters disease); Sivilceler (Various types of pimples; Humre: Yilancik, Erizipel, Erysipelas, St. Anthony's fire; Başbert: Ciban, Fronkül, Boil, Fruncle; Dümmel: Kan çibani, Abse, Abscess); Abile (Kabarcik, Bule); Seretan (Kanser, Cancer); Hanazir (Siraca, Scrofuloderma); Akile (Yinürbaş, Gangren); Kurdeşen (Urtiker, Urticeria); Uyuz (Gale, Scabies); Giciyik (Kaşinti, Pruritus); Sa'fe (Konak, Seboreik dermatit, Scurf; Kel (Alopesi, Favus); Evram (Sişler, Urlar, Tumours); Yara (Karha, Cerahat, Wound). The terminology and symptoms of these diseases are studied and tried to find their equivalents of today. The causes and the treatment of the skin diseases known then are presented. The second part of Tokaç's article continues to deal with the etiology, symptoms and treatment of dermatological diseases.

[Dermatological diseases and treatment described in the Turkish manuscripts (XIV-XVth centuries) (part I)]

This study deals with skin diseases described in the earliest compiled or translated Turkish medical manuscripts of the 14th and 15th centuries in Anatolia. The manuscripts studied are: Müntehab-i Sifa, Edviye-i Müfrede, Tervihü'l-Ervah, Yadigâr, Cerrahiyyetü'l-Haniyye, Kamilü's-Sinaatü't-Tibbiye Tercü-mesi, Kitab-i Müntehab-i fi't-Tibb, Haza'inü's-Sa'adat, Akrabadin Tercümesi, Mücerrebname, Müfredât-i Ibn-i Baytar Tercümesi, Tuhfe-i Mübarizi, Tuhfe-i Muradi. The skin diseases known at that time are studied under the following topics: Cüderi (Ciçek, Variola, Small-pox); Hasbe (Kizamik, Rubeola, Measles); Cüzzam (Lepra, Leprosy, Hansen's disease); Demregü (Temriye, Dermatophtosis, Tinea corporis); Behak (There are two types: the white and the black; the black is Addison's disease); Baras (Ala, Vitilio); Nemle (Isirga, Makül); Ateş paresi (Nar-l farisi, frunculosis); Cemre (Kara kabarcik, Sirpençe, Karbonkül, Carbuncle); Caversiye (Kabarcik hastaliği, blisters disease); Sivilceler (Various types of pimples; Humre: Yilancik, Erizipel, Erysipelas, St. Anthony's fire; Başbert: Ciban, Fronkül, Boil, Fruncle; Dümmel: Kan çibani, Abse, Abscess); Abile (Kabarcik, Bule); Seretan (kanser, Cancer); Hanazir (Siraca, Scrofuloderma); Akile (Yinürbaş, Gangren); Kurdeşen (Urtiker, Urticeria); Uyuz (Gale, Scabies); Giciyik (Kaşinti, Pruritus); Sa'fe (Konak, Seboreik dermatit, Scurf); Kel (Alopesi, Favus); Evram (Sişler, Urlar, Tumours); Yara (Karha, Cerahat, Wound). The terminology and symptoms of these diseases are studied and tried to find their equivalents of today. The causes and the treatment of the skin diseases known then are presented.