Determination of SARS-CoV-2 IgG antibody levels in hematology-oncology patients after COVID-19 vaccination

OBJECTIVE

Cancer patients are among the high-risk groups where COVID-19 infection tends to be severe and can lead to increased mortality. Therefore, they are included in the priority groups for COVID-19 vaccination. This study aimed to compare the levels of SARS-CoV-2 immunoglobulin G (IgG) antibodies following two different COVID-19 vaccinations between hematology-oncology patients and healthcare personnel and to identify factors associated with these antibody levels.

PATIENTS AND METHODS

A prospective study was conducted with 91 hematology-oncology patients (cancer group) and 75 healthcare personnel (control group) from January 2020 to June 2023. The cancer and control groups comprised adults who had received a booster dose, with either a single dose of BNT162b2 or two doses of CoronaVac™ spaced one month apart, following their primary vaccination with two doses of either CoronaVac™ or BNT162b2. Four weeks after the administration of the booster dose, levels of SARS-CoV-2 IgG antibodies were assessed using an ELISA kit. Antibody levels above 50 AU/mL were accepted as signifying seropositivity.

RESULTS

The median SARS-CoV-2 IgG antibody level was lower in the cancer group compared to the control group (4,509 vs. 7,268, p = 0.004), while the rate of seroconversion was similar between the groups (97.8% vs. 100%, p = 0.564). In the cancer group, no association was found between SARS-CoV-2 IgG antibody levels and age, sex, comorbidity, type of malignancy, stage and duration, or type of vaccine.

CONCLUSIONS

In cancer patients, the seroconversion positivity rate was about 98%. However, antibody responses were still lower compared to the control group. No difference was detected in antibody levels among cancer patients based on the type of vaccine.

Presence of melamine in human milk and the evaluation of the effects on mother–infant pairs in a cohort study

Melamine contamination is a recent public health problem emerging globally. Present study aimed to detect the rate of melamine presence in human milk in a cohort study and to evaluate any possible differences in maternal–infant pair characteristics such as breastfeeding status, crying and sleep problems of infants, maternal postpartum depression, maternal–infant bonding, infant and maternal anthropometry, and maternal complete blood count caused by the melamine exposure. Mothers of infants born in Şanlıurfa were invited to participate in ‘Urfa Child Cohort Survey’. Overall, two breast milk samples were taken between 5 days and 15 days postpartum and between 4 weeks and 10 weeks. Randox Food’s InfiniPlex array was used to analyse the presence of melamine. Melamine was detected in 32.2% and 24.4% of the first and the second milk samples; 16.7% of mothers had two positive samples. z Scores for birth weight and z scores for height for age were detected to be significantly lower in cases with two positive samples compared to cases with negative samples. Mean maternal white blood cells counts were found to be lower in cases with repeated melamine contact. Melamine might have a detrimental effect on birth weight, infant height and maternal blood count. Further studies should be done to detect environmental contamination in different regions and countries.

The Evaluation of Results of Repair using All-Soft Suture Anchor in the Treatment of Chronic Tendinous Mallet Finger Surgery

PURPOSE OF THE STUDY The purpose of this study is to evaluate the results of chronic tendinous mallet finger repair with all soft suture anchors. MATERIAL AND METHODS In this retrospective study we evaluated 14 patients. Data included age, side of surgery, the degree of extensor lag, the ratio of the damaged articular surface, postoperative recovery period and time to return to work. We recorded extensor lag and Crawford scores of all patients at the last follow-up. RESULTS Mean follow-up period was 22.07 months. The preoperative and postoperative extensor lags were 27.2 (15-35) and 3 (0-19), respectively. Crawford scores of patients were moderate in 1 patient, fair in 2 patients and excellent in 10 patients. We observed only one skin complication in the postoperative period. CONCLUSIONS All-soft suture anchors have high patient satisfaction rates and functional results. Thus, they could be used in the treatment of patients with chronic tendinous mallet finger. The low complication rate is a major advantage. Key words: tendinous mallet finger, hand surgery, all-soft anchor. Level of evidence: Level-4, Retrospective case-control study.

Orthopedics and Traumatology Residency - Working Conditions, Training, and Psychological Stress

PURPOSE OF THE STUDY The specialty of orthopedics and traumatology that is completed in the 5 years period in our country is a challenging educational process and our purpose in this study is to demonstrate through a survey training conditions of the orthopedic assistants in our country and the effects of this process on assistants. MATERIAL AND METHODS 524 (70.05%) of 748 assistants who receive specialization training in Turkey were reached. There were 20 multiple choice questions ( 1 mark each) and 3 questions (more than 1 mark each) in the survey consisting of twenty-three questions. Our study group was formed by doctors who have still worked as assistant in our country and have accepted to participate in the study. The doctors who finished assistantship with any reason and did assistantship for time less than 6 months and did not exactly fill the questionnaire form were excluded from the study. RESULTS 524 (71.97%) of 728 assistant who are in 40 (100%) of 40 provinces where assistant training given in Turkey were reached. 474 (90.45%) participants were satisfied to do orthopedic specialization. When considering working hours, it was observed that 337 (64.31%) participants had over 90 hours weekly including night shift and 521 (99.42%) participants had to work after night shift. The majority of participants (361 persons 68.89%) were receiving salaries between TL 4000-6000. When looking at the entire working group, the rate of participants who said that scientific training is weak or there is no scientific training was 427 (81.48%). CONCLUSIONS Our survey study is one of the first statistical study which investigating professional and social problems of orthopedic assistants. Some of important problems as training satisfaction, abuse by patients and/or manager, the average monthly income and psychological status assessment is emphasized. Orthopedics and Traumatology assistantship is a challenging process to cause physical and psychological problems with the hard working conditions in our Turkey. Key words:residency training, orthopedic surgery, life quality, salary.

Is Kinesiotherapy Effective in Relieving Pain and Reducing Swelling after Shoulder Arthroscopy?

PURPOSE OF THE STUDY The purpose of this study is to investigate the acute and long term effectiveness of kinesio taping applied following shoulder arthroscopy in relieving pain and reducing swelling. MATERIAL AND METHODS This study included 50 patients undergone shoulder arthroscopy between June 2016 and December 2017 in our clinic. Patients were randomly assigned into two groups. Group I consisted of patients who had kinesiotherapy; while Group II consisted of control patients whom we applied sham taping with no effect. Pre and postoperative pain and swelling status of patients were recorded and groups were compared. RESULTS Comparing two groups, we found that kinesio taping significantly reduced pain levels in the early post-operative period. However, we didn't detect any significant difference in reduction of shoulder swelling between two groups. CONCLUSIONS Kinesio taping could be an alternative treatment in relieving pain after shoulder arthroscopy. However, we didn't find a significant reduction in swelling in shoulder. Key words:kinesio taping, arthroscopy, shoulder.

Kinesiotaping Reduces Knee Diameter but Has No Effect on Differences Pain and Edema Following Knee Artroscopy

PURPOSE OF THE STUDY Investigating the efficacy of kinesiotaping for the reduction of postoperative pain and swelling after invasive knee arthroscopy, which tend to develop in almost every patient undergoing this procedure. MATERIALS AND METHODS Kinesiotaping or sham taping was performed in a total of 42 patients who underwent invasive knee arthroscopy. Pain intensities; mid-thigh, knee, mid-calf, and ankle diameters; and VAS (Visual Analogue Scale) were recorded preoperatively and postoperatively. RESULTS However knee diameter was significantly greater in the control group compared to the group there is no significant differences were observed between the two groups' pain scores at the postoperative period. There were also no significant statistical differences between the two groups with respect to mid-thigh, calf, and ankle diameters. CONCLUSIONS Kinesiotherapy could be used as an effective treatment method to relieve knee effusion after knee arthroscopy. However, both groups did not have significant differences with respect to pain and edema levels. Key words:knee arthroscopy, kinesiotaping, pain control, edema.

Arthroscopic Excision of Tendinous Giant Cell Tumors Causing Locking in the Knee Joint

PURPOSE OF THE STUDY Non-osseous giant cell tumors are locally aggressive tumors arising around joints. They are commonly located around synovial joints such as wrist and knee and occasionally cause mechanical symptoms. MATERIAL AND METHODS This retrospective case series includes 7 patients operated due to intraarticular lesion. The mean age of the patients was 28.7 (range 22-37) years. Mean follow-up period was 12 months. RESULTS All patients underwent arthroscopic debridement. They were followed monthly with clinical examination and magnetic resonance imaging (MRI) was obtained at third month for all patients. Patients were contacted through phone call and evaluated with the WOMAC score retrospectively. No recurrence was detected in any patient. CONCLUSIONS Arthroscopic debridement is a safe surgical technique that may replace open surgery in the treatment of intraarticular tendinous giant cell tumors. Key words:tendinous giant cell tumor, arthroscopy, knee locking.

Evaluation of a stress model induced by dietary corticosterone supplementation in broiler breeders: effects on egg yolk corticosterone concentration and biochemical blood parameters

1. This study aimed to evaluate a stress model induced by corticosterone (CORT) supplementation in the diet of broiler breeder hens. 2. A total of 60 Ross broiler breeder hens at 29 weeks of age were randomly divided into 4 groups with 15 hens each. The first group served as the control. The rest of the hens were given 1, 1.5 or 2 mg of CORT/hen/d (CORT1, CORT1.5 and CORT2, respectively) for 7 d. Concentrations of yolk CORT, plasma uric acid, glucose, cholesterol, creatine kinase, heterophil (H):lymphocyte (L) ratio and duration of tonic immobility (TI) were measured at d 3, 5 and 7 of CORT supplementation. The same measurements were repeated at 3, 5 and 7 d after CORT was withdrawn from the diet. 3. There were no significant CORT dose effect on yolk CORT and plasma glucose concentrations. Higher plasma uric acid and H:L ratio was obtained for CORT1.5 and CORT2 than for CORT1. From 3 to 7 d of dietary CORT supplementation, yolk CORT and plasma uric acid concentrations and H:L ratio increased whereas plasma glucose concentration decreased. After CORT was withdrawn from the diet, the H:L ratio remained elevated. The duration of TI and plasma creatine kinase concentration did not change during and after CORT supplementation. 4. Yolk CORT concentration was correlated with plasma uric acid concentration during CORT supplementation. 5. The results suggest that dietary CORT supplementation could be used as a stress model and to evaluate hormone-mediated maternal effects in broiler breeder hens.

Exposure of embryos to cyclically cold incubation temperatures durably affects energy metabolism and antioxidant pathways in broiler chickens

Cyclically cold incubation temperatures have been suggested as a means to improve resistance of broiler chickens to ascites; however, the underlying mechanisms are not known. Nine hundred eggs obtained from 48 wk Ross broiler breeders were randomly assigned to 2 incubation treatments: control I eggs were incubated at 37.6°C throughout, whereas for cold I eggs the incubation temperature was reduced by 1°C for 6 h daily from 10 to 18 d of incubation. Thereafter, chickens were reared at standard temperatures or under cold exposure that was associated or not with a postnatal cold acclimation at d 5 posthatch. At hatch, hepatic catalase activity and malondialdehyde content were measured. Serum thyroid hormone and triglyceride concentrations, and muscle expression of several genes involved in the regulation of energy metabolism and oxidative stress were also measured at hatch and 5 and 25 d posthatch. Cold incubation induced modifications in antioxidant pathways with higher catalase activity, but lower expression of avian uncoupling protein 3 at hatch. However, long-term enhancement in the expression of avian uncoupling protein 3 was observed, probably caused by an increase in the expression of the transcription factor peroxisome proliferator activated receptor-γ coactivator-1α. These effects were not systematically associated with an increase in serum triiodothyronine concentrations that were observed only in chickens exposed to both cold incubation and later acclimation at 5 d with cold rearing. Our results suggest that these conditions of cyclically cold incubation resulted in the long-term in changes in antioxidant pathways and energy metabolism, which could enhance the health of chickens reared under cold conditions.

Anesthetic management in hydatid disease: a review of 435 cases

BACKGROUND AND AIMS

Hydatid cyst diseases are still a problem in Turkey, especially in the east and southeast of Anatolian Region, as well as in many other places in the world. In this study a retrospective review was made of the anesthetic management for surgical and interventional treatment of 435 patients with hydatid cysts. The study data were collected between January 1997 and December 2012 at Harran University Hospital, Sanliurfa, Turkey.

MATERIALS AND METHODS

Patients' demographics and localization of the cysts were recorded. Suitable anesthetic and surgical management were performed to the cysts according to their locations. Four hundred thirty-five patients had general anesthesia with a midazolam premedication and one of them was treated by sedation.

RESULTS

Of the 435 patients, 251 were females (57.7%) and 184 males (42.3%) and ages ranged from 1 to 74 years (mean: 36.3 ± 25.4). These include; preoperative using of steroids and antihistamines to prevent the allergy possibility, intraoperative hypotension and tachycardia and administration of colloids, and improvement of postoperative anaphylaxis. Anaphylaxis was observed in only two patients who undertook percutaneous aspiration. Also bronchospasm was developed in four patients during the postoperative period and successfully treated with standard bronchodilatators.

CONCLUSIONS

Anaphylactic reaction during operation is a serious complication, but a very rare one. Prophylactic use of antihistamine and steroid drugs were reduced allergy and anaphylaxis.

The impact of metabolic syndrome on carotid intima media thickness

OBJECTIVES

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities involving several cardiovascular risk factors. Carotid intima media thickness (CIMT) is an important early screening tool to assess subclinical manifestation of cardiovascular and metabolic diseases. We aimed to investigate the impact of MetS on CIMT in a large scaled community based study.

METHODS

The study was conducted on 2102 participants. Carotid intima media thickness was measured in all of the participants. The study sample was divided into 4 groups; Group 1 subjects with a body mass index (BMI) < 25.0 kg/m2 [n = 499 (MetS- = 488, MetS+ = 11)], Group 2 BMI between 25.0 and 29.9 kg/m2 [n = 693 (MetS- = 559, MetS+ = 134)], Group 3 BMI between ≥ 30 kg/m2 and 39.9 kg/m2 [n = 822 (MetS- = 375, MetS+ = 477)], and Group 4 BMI ≥ 40 kg/m2 [n = 88 (MetS- = 27, MetS+ = 61)].

RESULTS

Carotid intima media thickness was higher in the individuals with MetS compared to their normal counterparts. Furthermore, the subgroup analysis showed that CIMT values in Group 1 (0.55±0.18 vs 0.82±0.70; p < 0.001), Group 2 (0.59±0.20 vs 0.68±0.18; p < 0.001) and Group 3 (0.61±0.15 vs 0.65±0.18; p < 0.001) were significantly higher in subjects with MetS compared to their normal counterparts, whereas the values were similar in Group 4 (0.62±0.13 vs 0.65±0.17; p = 0.363).

CONCLUSIONS

Carotid intima media thickness of overweight, obese and normal weight individuals without MetS were lower than their counterparts with MetS. MetS had no impact on CIMT in morbid obese individuals possibly due to established insulin resistance earlier than MetS.

Effect of manipulation of incubation temperature on fatty acid profiles and antioxidant enzyme activities in meat-type chicken embryos

Eggs (n = 1,800) obtained from Ross broiler breeders at 32 and 48 wk of age were incubated at either a constant temperature of 37.6°C throughout (T1), or the temperature was reduced for 6 h to 36.6°C each day during embryonic age (EA) 10 to 18 (T2). Yolk sac, liver, and brain fatty acid profiles and oxidant and antioxidant status of liver and brain were measured at EA 14, 19, and day of hatch (DOH). Fatty acid profiles of yolk sac, liver, and brain were influenced by age of breeder with significant breeder hen age × incubation temperature interactions. At EA 14, higher levels of 20:4n-6 and 22:6n-3 had been transferred from the yolk sac to T2 embryos from younger than older breeders, whereas for T1 and T2 embryos, yolk sac 20:4n-6 and 22.6n-3 values were similar for older breeders. Accumulation of 20:4n-6 and 22:6n-3 fatty acids in the liver of T1 and T2 embryos from younger breeders was similar; however, T2 embryos from older breeders had higher liver levels of 20:4n-6 and 22:6n-3 than T1 embryos. At EA 19, liver nitric oxide levels were higher for T2 embryos from younger breeders than those from breeders incubated at T1. Brain catalase levels of T2 embryos from younger breeders were higher than those from older breeders at DOH. Thus, changes in fatty acid profiles and catalase and nitric oxide production of brain and liver tissues resulting from 1°C lower incubation temperature from EA 10 to 18 reflect adaptive changes.

Interaction of transport distance and body weight on preslaughter stress and breast meat quality of broilers

1. The objective of the study was to investigate the effect of transport distance on blood metabolites and breast meat quality of broilers slaughtered at different weights. 2. The study was conducted on Ross 308 broilers from 27 different flocks reared under similar conditions. Slaughter weight was classified as <2·0 kg, 2·0-2·4 kg, and >2·4 kg. Transport distance was categorised as short (65 km), medium (115 km) and long (165 km) distance representing 90, 155 and 220 minutes at an average 45 km/h speed, for each slaughter weight. 3. Higher heterophils and heterophil:lymphocyte (H/L) ratios were obtained for broilers transported over a long distance. Long distance transport increased blood albumin, glucose, and triglycerides levels for <2·0 kg broilers, which did not differ from broilers slaughtered at >2·4 kg after long-distance transport. 4. Broilers slaughtered at >2·4 kg after long-distance transport had lower pH(u), and paler and tougher breast meat, than those broilers slaughtered at <2·0 kg after long-distance transport. 5. A negative correlation was obtained between pH(u) and L*, thawing loss and texture. The L* value was negatively correlated with a*; and positively correlated with b*, thawing and cooking losses. 6. It was concluded that the effect of transport distance could not be evaluated independently of slaughter weight. The interaction between transport distance and slaughter weight contributes to preslaughter stress and meat quality.

A unique case of magnet ingestion with respect to presentation and management

Magnet ingestion may lead to serious complications with delay in diagnosis and treatment. The forceful attraction between magnets, with gastric and/or intestinal wall entrapped between them, can cause injury through pressure necrosis. The radiological appearance of more than one magnet on X-ray can be easily misinterpreted as belonging to only one rod-like radiopaque foreign body, even if the magnets are located in different parts of the gastrointestinal tract, thus delaying the management up to the onset of emergent surgical complications. A 17-month-old female with ingestion of a pair of magnets is presented, together with introduction of the clinical picture and therapeutic approach, which differed from the other previously reported cases. The ovoid shape of the magnets, their localization in the gastrointestinal tract (leading to entrapped gastric and intestinal wall between them), absence of any complication, and the therapeutic approach of endoscopic retrieval are the main distinguishing features of this case from those previously reported.

Why gastric perforation occurs in patients with isolated esophageal atresia: more vulnerable stomach?

Gastric perforation (GP) in patients with isolated esophageal atresia (EA) is seen more than expected. The etiology of the perforation may be vulnerability of these immature stomachs. Gastrostomy operation should be performed by gentle handling. The volume of gastrostomy feedings should be increased incrementally. The early diagnosis of perforation is only possible with a high index of suspicion. The stomach should be visualized by gastrography with soluble contrast material as soon as the perforation is suspected.

Effects of hen production cycle and egg weight on egg quality and composition, hatchability, duckling quality, and first-week body weight in Pekin ducks

This study was conducted to determine the effect of hen production cycle (HPC) and the effect of egg weight (EW) at the same egg production level on egg quality, egg composition, hatchability, duckling quality, and first-week BW in Pekin ducks. For HPC, hatching eggs were obtained from different Pekin-duck breeder flocks, aged 31 wk for the first production cycle (HPC1) and 78 wk for the second production cycle (HPC2). For EW, there were 3 categories: heavy (H), medium (M), and light (L). Ten eggs from each HPC and EW group were analyzed for the determination of egg quality, and albumen and yolk compositions. Ninety eggs from each HPC and EW group were incubated for the determination of hatchability, and duckling weight and quality. After quality scoring, 20 ducklings (10 male and 10 female) from each group were weighed, and reared to 1 wk of age in a brooder machine to determine relative growth (RG). The results showed that the albumen index; Haugh unit; shell percentage; yolk moisture, ash, protein, lipids, and triglycerides; albumen moisture, ash, and protein; yolk fatty acid contents; hatching weight; duckling weights at 1 wk of age; and RG were significantly affected by HPC. Egg weight affected shell thickness, yolk and albumen indices, Haugh unit, yolk and albumen percentages, yolk to albumen ratio, shell percentage, yolk fatty acid content, hatching weight, duckling weight at 1 wk of age, and RG.

The association of adrenocortical carcinoma and thyroid cancer in a child with Peutz-Jeghers syndrome

Peutz-Jeghers syndrome (PJS) is a rare, dominantly inherited disorder characterized by gastrointestinal hamartomatous polyps, mucocutaneous hyperpigmentation, and an increased risk of cancer. We present a 16-month-old child diagnosed with PJS, who had distinguishing features compared with the previously reported cases with respect to her clinical presentation, associated malignancies, and genetic analysis. To our knowledge, this is the first report of adrenocortical carcinoma in association with PJS, as well as the first instance of associated thyroid cancer in a child with PJS. We briefly review the relevant literature and highlight the recent progress achieved in the investigation of the syndrome.

Clitoral epidermoid cyst secondary to blunt trauma in a 9-year-old child

Epidermoid cysts are slowly growing tumors arising from invagination of the epidermis into the dermis traumatically or spontaneously. This implantation in the clitoris is most commonly induced by female genital mutilation. The reported cases with spontaneous onset of this clitoral lesion are scarce. Trauma other than female circumcision predisposing to the onset of the cyst has not been mentioned before. A nine-year-old girl was presented for swelling in the pubic region with the onset following an accidental trauma; the diagnosis was determined to be epidermoid cyst of the clitoris after a brief preoperative evaluation and an accurate surgical management.

Brooding temperatures for chicks acclimated to heat during incubation: effects on post-hatch intestinal development and body weight under heat stress

1. The objective was to evaluate the effects of brooding temperature on intestinal development, oxidative organ damage, and performance of chicks acclimated to high temperature during incubation. The effects of acclimation and brooding temperatures on slaughter weights of broilers under heat stress were also investigated. 2. Eggs were incubated at either 378 degrees C (INC(Cont)) or heat-acclimated at 395 degrees C for 6 h daily from d 10 to d 18 of incubation (INC(H)). Brooding temperatures at floor level were set at 32, 335 and 35 degrees C (Bt(32), Bt(335), Bt(35), respectively) for the first 5 d. The temperature was reduced gradually to 30 degrees C from d 6 to d 10. From 21 to 42 d, broilers from INC(Cont) Bt(32) and INC(H) Bt(32) and Bt(35) were divided into two groups; half from each group was exposed to daily cyclic higher ambient temperatures, while the other half was reared at control temperature. 3. INC(H) chicks had lower jejunum, but greater liver and residual yolk sac weights than INC(Cont) chicks on the day of hatching. Although INC(H) chicks from Bt(335) and Bt(35) had lighter body weights than Bt(32) on d 5, no significant differences were observed in the body weight of broilers among treatments at 10 and 21 d. 4. Similar jejunum protein, alkaline phosphatase, maltase, glutathione, and malondialdehyde contents of chicks from INC(Cont) and INC(H) suggested that heat acclimation during incubation has no effect on jejunum enzyme activity or oxidative status of chicks. 5. Taking into account INC(H) Bt(35) chicks having lower T(3) levels on d 5, lower heterophil/lymphocyte (H/L) ratios and similar weights at 42 d under heat stress compared with control broilers, the results suggested that although higher brooding temperatures had no effect on body weights of INC(H) chicks during the brooding period, those broilers may able to cope better with heat stress.

Effects of supplementary iodine on the performance and egg traits of laying hens

1. This experiment was carried out to determine the effects of dietary iodine supplementation on the performance and egg traits of laying hens. A total of 600 SHSY type brown layers aged 21 weeks of age were chosen at random from a large flock. They were randomly distributed into 30 pens at 20 hens per pen. Each treatment comprised 6 replicates of 20 layers in groups of 5 birds. The diets were supplemented with 0, 3, 6, 12 and 24 mg/kg iodine as calcium iodate. The experimental period lasted 30 weeks. 2. There were no significant differences among the groups in body weight, food consumption, egg production, food consumption per kg eggs, eggshell index, eggshell breaking strength, shell thickness or egg yolk index. 3. Supplementation of the diet with 12 mg/kg iodine increased food consumption per dozen eggs compared to the groups fed on diets supplemented with 0 and 6 mg/kg iodine. 4. Egg weight was less in groups fed on diets supplemented with 12 and 24 mg/kg iodine than in the group receiving no iodine supplementation. 5. Iodine supplementation to provide 12 and 24 mg/kg reduced egg albumen index and egg Haugh units. 6. There were no significant differences among the groups in egg cholesterol and egg yolk cholesterol contents. 7. The iodine concentrations in egg yolk, egg albumen and whole egg increased with increased iodine supplementation. 8. As a result, the 3 and 6 mg/kg iodine supplementation of diet could be used to enrich the eggs with iodine without any adverse effect on performance and egg traits.

Effects of early feed restriction on live performance, carcass characteristics, meat and liver composition, some blood parameters, heterophil-lymphocyte ratio, antibody production and tonic immobility duration

The aim of this study was to determine the effects of early feed restriction on performance, carcass characteristics, meat and liver composition, some blood parameters, H-L ratio, antibody titers against SRBC and tonic immobility duration in broilers. One hundred ninety male chicks (Ross 308) were randomly allocated into two treatment groups each of 95 chicks. Broilers in one treatment fed ad libitum until 42 day of age, however in other treatment, broilers were deprived of feed for 4 h per day from 7 to 21 day. Body weight, feed consumption, feed to gain ratio, carcass characteristics and the percentage of examined organs except heart were not statistically significant in groups. Percentage of heart was higher (p < 0.05) in broilers fed ad libitum. At 41 d of age, H-L ratio (p < 0.05) and TI duration (p = 0.001) were higher, serum glucose (p < 0.05) and triglyceride (p < 0.001) levels were lower in broilers fed ad libitum. Chemical composition of breast and thigh and also fat and ash of liver were not affected by early feed restriction. Moisture of liver (p = 0.001) was lower and protein of liver (p < 0.01) was higher in broilers fed ad libitum.

Acclimation to heat during incubation. 1. Embryonic morphological traits, blood biochemistry, and hatching performance

Eggs obtained from broiler breeders at 32 (young), 42 (middle aged), and 65 wk (old) were used to measure the effects of heat acclimation during incubation on morphological, physiological, and metabolic traits at internal pipping (IP) and at hatch. All eggs were from the same stock, and hatching performance was also evaluated. Eggs from each breeder age were incubated at control (CONT) or 38.5 degrees C for 6 h daily from d 10 to 18 of incubation (HA). On d 10 after heat exposure and on d 14, absolute and proportional weights were significantly lower for HA than CONT embryos. By the time of hatching, HA chicks were heavier than CONT chicks, which suggested accelerated growth. This effect was consistent across ages. Liver and heart weights were lower for HA than CONT chicks. At IP, pH was similar for HA and CONT embryos, whereas pO(2) and Na(+) were significantly higher and pCO(2), HCO(3)-, and K(+) significantly lower for HA than CONT embryos. Blood pH was higher in embryos from older than for younger and mid-aged parents at IP. At hatch there was no effect of heat acclimation for blood HCO(3)-, Na(+), and K(+) levels, whereas plasma triglyceride and T(3) levels were higher and plasma uric acid, glucose, and lipid peroxidation levels were lower for HA than CONT chicks. Embryonic mortality was similar among parental ages for CONT. In contrast for HA, embryonic mortality from older parents was higher than for younger and middle-aged parents. A delay in external pipping and hatching time with high incubation temperature was consistent across the breeder ages. It was concluded that lower blood pCO(2), HCO(3)-, K(+), and higher pO(2) at IP stage, plus increased plasma triglyceride concentrations at hatch, indicate adaptive responses of embryos.

Do radiologic studies correlate with each other and with surgical findings in intussusception?

In this research, we aimed to evaluate the accordance of radiologic study results with each other and with surgical findings with regard to presence and/or absence of intussusception. One hundred and seventy-nine patients treated for intussusception between 1993 and 2003 inclusive were retrospectively reviewed to compare results of initial ultrasonography, colonography, followup ultrasonography after conservative management (reduction with barium enema and/or air insufflation) and surgical findings to determine their accordance within each other with regard to diagnosis of intussusception. Results of initial ultrasonography were not in accordance with results of colonography. There was accordance between conservative management and follow-up ultrasonography results. Conservative management results were not in accordance with surgical findings. There was no accordance between followup ultrasonography results and surgical findings. Discordance of radiologic examination results with each other and with surgical findings indicates that intussusception is still a clinical diagnosis and clinical parameters deserve more importance in surgical decision-making. Radiologic examinations should be considered as complementary studies, not as definitive discriminators of childhood intussusception to achieve appropriate diagnosis and treatment.

Clinical presentation and management of gastroesophageal reflux disease in a referral center in Turkey

PURPOSE

The aim of this study was to analyze the characteristics of the pathway from the onset of clinical findings related to gastroesophageal reflux disease (GERD) until the surgical therapy to achieve a better organization of the multiple disciplines and create the best management scheme in a referral center in Turkey.

PATIENTS AND METHODS

All patients who underwent anti-reflux surgery for GERD in our unit between 2000 - 2006 were retrospectively reviewed. Information on their past medical follow-up, the clinical findings, diagnostic evaluation and the therapeutic approach was recorded.

RESULTS

There were 24 girls and 40 boys with a median age of 36 months (3 - 192 months). Of the 64 cases, 36 (56.3 %) had a history of past medical follow-up. Of these 36 patients, 20 had received medical and/or surgical therapy for GERD without any standardization. The remaining 16 were treated supportively for neurological, respiratory and metabolic problems without having had a diagnosis of GERD. The median duration of symptoms in 28 patients without a past medical history was shorter than that in the remaining 36 patients (p = 0.03). Of the 64 patients at presentation, 35 had neurological, 4 had metabolic, and 3 had a respiratory pathology; the other 4 had a history of esophageal atresia and tracheoesophageal fistula operation; 5 had been operated in another center for GERD and only 13 cases had isolated GERD. The most commonly used diagnostic methods were contrast study (n = 52) and pH monitoring (n = 36). Forty-one of the 64 had anti-reflux surgery primarily after presentation, in addition to selection of medical therapies and/or other surgical interventions as a first step in the remaining 23. Reevaluation of those 23 patients after a median period of 7 months (1 - 36) finally led to anti-reflux surgery (ARS). Patients presenting with a stricture due to GERD (n = 13) underwent ARS, either as a primary procedure (n = 3) or after a course of dilatations (median period of time: 8.5 months) (n = 10).

CONCLUSIONS

Extended nonresponsive medical therapy is as harmful as needless surgical therapy performed prior to appropriate medical management. Our experience emphasizes that guidelines on the use of a multidisciplinary approach is the first step for successful GERD treatment. ARS in early infancy should only be justified in the presence of severe neurological and/or respiratory pathologies. If there is any doubt about the diagnosis of GERD with preliminary methods, endoscopic and pathological confirmation of the disease is mandatory for a correct management.

Management of pancreatic lithiasis in a 5-year-old girl

Pancreatic lithiasis causing chronic pancreatitis is a very rare entity in childhood. A five-year-old girl presenting with pancreatic lithiasis was treated successfully with a well-organized diagnostic and therapeutic algorithm. The authors emphasize that early diagnosis followed by appropriate therapeutic pancreatographic procedures instead of primary invasive surgical approach can certainly ameliorate progressive and irreversible pancreatic damage. The clinicopathologic features of this rare entity are discussed, with emphasis on diagnosis and treatment.

Effect of temperature during the incubation period on tibial growth plate chondrocyte differentiation and the incidence of tibial dyschondroplasia

Tibial dyschondroplasia (TD) is one of the most prevalent skeletal abnormalities in avian species, causing enormous economic losses and major animal welfare problems. Irregular cell differentiation of the chondrocytes that populate the growth plate has been hypothesized to be involved in the etiology of the disease. We evaluated the effect of incubation temperature at various stages of embryo development and bone formation on growth plate chondrocyte differentiation and the incidence of TD. Eggs were incubated either at a control temperature of 37.8 degrees C, or at 36.9 or 39 degrees C, each for 6 h/ d, during early (0 to 8 d) or late (10 to 18 d) embryo development. At 14 d of incubation and at hatch, tibias were collected and weighed, and their ash and calcium contents were determined. Growth plate chondrocyte differentiation was evaluated by alkaline phosphatase activity and collagen type II and osteopontin gene expression. In addition, the level of the heat-shock protein 90 (Hsp90) was evaluated by immunohistochemistry. The rest of the chicks were raised to 49 d and the incidence of TD was recorded. The incidence of TD increased only when the temperature was altered at the early stages of embryo development, and it was correlated with an increase in tibia ash but not with tibia weight or calcium content. Moreover, increased TD incidence was correlated with delayed chondrocyte differentiation. Early changes in incubation temperature caused an increase in the level of Hsp90 in articular and differentiated chondrocytes of the hypertrophic zone and in the numbers of distinct undifferentiated chondrocytes arranged in columns in the proliferative zone of the growth plate. In summary, the early stages of embryo development and bone formation are of utmost importantance for appropriate growth plate chondrocyte differentiation, and any temperature deviation will increase the subsequent incidence of TD. The increase in TD incidence is probably the result of delayed Hsp90-driven chondrocyte differentiation, supporting the hypothesis that TD is the result of abnormal chondrocyte differentiation.

Foreign body ingestion in children: an analysis of pediatric surgical practice

Ingestion of a foreign body (FB) is a prevalent condition among children. The type of FB varies according to the feeding habits and sociocultural features of communities. The management modality differs also between disciplines due to use of conventional techniques. We aimed to picture the general characteristics of FB ingestion and treatment alternatives, to mention the indications of open surgery in an advanced pediatric surgical center. The records of patients who were hospitalized for FB ingestion between 1973 and May 2005 were evaluated retrospectively. One hundred and twelve patients were enrolled into the study. The mean age was 2.27 +/- 2.84 years with a M/F ratio of 59/53. The history was suggestive of ingestion in 92% of patients. The age did not differ significantly whether the history was positive or negative (3.6 years vs. 4.8 years and P = 0.19). Most common presenting symptom was vomiting (28.6%). The duration of symptoms was longer in patients with negative history (median 47.7 h vs. 28.1 h and P < 0.002). Physical examination was normal in 89.3% of cases. Most common localization of the FB shown in plain X-ray was the esophagus (67%). Esophagography revealed nonopaque FB in the esophagus in 4.4%. X-ray was normal in 6.3% of the patients. The age of patient did not determine the localization of FB on admission (P = 0.436). Endoscopic removal was attempted in 75% and was successful in 68% of patients in which FB was extracted by using laryngoscope and Magill forceps (12%), rigid esophagoscope with FB forceps (51%), and flexible endoscope with FB forceps (5%). FB could not be found in 32% of patients at initial rigid esophagoscopy or flexible endoscopy. FB was eliminated spontaneously (n = 19) or extracted surgically (n = 8). Follow-up was preferred in 21% of patients on initial admission. FB proceeded uneventfully in 15 patients or was extracted by flexible endoscopy or surgery in one and eight patients, respectively. Surgery was performed in 4% on admission. Surgery or endoscopy were essentially required in cases whose follow-up period exceeded 4 days when compared with patients who eliminated FB spontaneously within 4 days, independent to the location of FB. The metallic objects were the frequently ingested FBs (83.8%) in which the safety pins (SPs) (n = 53) and coins (n = 25) were the most frequent. The type of FB did not affect the FB localization on admission (P = 0.38). The duration of hospitalization was longer in patients with delayed admission; 2.46 +/- 3.51, 3.80 +/- 8.17, and 5.72 +/- 4.24 days for the admissions within first, second-fifth days, and sixth or later days after ingestion, respectively (P = 0.000). Pediatric surgery has the largest spectrum of duty in the treatment of FB ingestion in children. Negative history, normal physical examination findings and absence of symptoms do not exclude the possibility of FB ingestion. Presentation with isolated respiratory symptoms is an enigma that can lead to misdiagnoses. The mode of management should be selected according to the patient's condition, surgeon's experience, and available technical equipment as well as the location and type of ingested FB. Especially, SPs should be treated by experienced surgeons. Simple extraction techniques and both rigid and flexible endoscopies with appropriate forceps as well as surgery can be used for the extraction of FBs lodged in the alimentary tract. Surgery can be expected especially in asymptomatic cases that have been followed up for more than 4 days irrespective of the location of FB.

Effects of Temperature During Rearing and Crating on Stress Parameters and Meat Quality of Broilers

Two trials were conducted to study the effects of heat stress during rearing (trial 1) and crating (trial 2) on broiler stress parameters and fear, breast meat quality, and nutrient composition. The relationships between stress parameters and meat quality traits were also determined. Trial 1 consisted of 3 temperature treatments from 3 to 7 wk: control (temperature was 22 degrees C); diurnal cyclic temperature (temperature was 28 degrees C from 1000 to 1700 h and 22 degrees C from 1700 to 1000 h); and constant high temperature (34 degrees C; temperature was 34 degrees C). In trial 2, broilers from the control and 34 degrees C groups in trial 1 were used. Broilers in each group were placed in transport cages. The 9 cages from the control group were divided into 3 groups and placed into 3 rooms at 15, 22, or 34 degrees C for 2 h. The 3 cages from the 34 degrees C group were also held in the room at 34 degrees C (34-34 degrees C). Diurnal cyclic temperature had no effect on BW up to 5 wk of age. The effect of 34 degrees C constant temperature on BW of broilers increased with age. Plasma levels of glucose and albumin increased by 34 degrees C, but no dramatic change in levels occurred when those broilers were crated at 34 degrees C. The heterophil:lymphocyte (H:L) was higher for the 34-34 degrees C broilers and the control broilers in the 34 degrees C room than those from the 22 and 15 degrees C room. Breast muscle glycogen level decreased in broilers reared under diurnal cyclic or high temperatures. A lower pH and higher lightness (L*) and redness values and redness:yellowness were found in meat for broilers from both 34 degrees C and 34-34 degrees C groups. Higher H:L was associated with breast muscle pH according to first-order polynomial regression. The H:L had a significant effect on L* values, which were described by a second-order polynomial regression. Blood glucose level was positively correlated with L* and redness values. Duration of tonic immobility was neither influenced by rearing and crating temperatures nor associated with meat quality parameters.

An unusual penetrating injury in an infant: straight-pin migration from the back to the stomach

Sharp foreign bodies reach into the abdomen frequently by ingestion and may lead to various complications including perforation. An 11-month-old infant is presented for straight-pin migration into the abdomen with penetration from the back and through the left diaphragm, spleen, and stomach. The infant was treated successfully with a well-organized diagnostic and therapeutic algorithm.

The Impact of Daily Sodium Intake on Posttransplant Hypertension in Kidney Allograft Recipients

INTRODUCTION

Posttransplant hypertension is a well-known risk factor for long-term allograft failure and mortality in kidney recipients. Although dietary sodium restriction is a widely recommended nonpharmacological measure for control of blood pressure (BP), no detailed investigation has been conducted regarding the impact of dietary sodium restriction on this condition.

METHODS

Thirty-two patients on antihypertensive treatment completed the study. They were randomly divided into two groups: controls (group 1) versus strict sodium diet (group 2; 80 to 100 mmol sodium daily). After randomization, 24-hour urine for sodium measurement, BP, and allograft functions were recorded at baseline and after 3 months. BP treatment was reevaluated at each visit throughout the study.

RESULTS

At baseline, there was no significant difference in age, sex, serum creatinine, systolic and diastolic BP, antihypertensive drugs, or 24-hour urinary sodium levels between the groups. After 3 months, daily urinary sodium excretion (from 190+/-75 to 106+/-48 mEq/d, P<.0001), systolic BP (from 146+/-21 to 116+/-11 mm Hg), and diastolic BP (from 89+/-8 to 72+/-10 mm Hg) had significantly decreased in group 2, while no significant changes were observed in group 1.

CONCLUSION

Low sodium intake in combination with antihypertensive treatment appears to efficiently control BP in kidney allograft recipients with hypertension. Twenty-four-hour urinary sodium excretion should be checked regularly in these patients as a useful marker to indicate whether the patient complies with low sodium intake.

Pediatric diffuse lipoblastomatosis of the foot -- a case report and review of the literature

Diffuse lipoblastomatosis is a rare lipomatous tumor of infancy that derives from fetal-embryonal fat. It usually affects infants and children and presents as a superficial mass that extends from the subcutis to the underlying muscle in the upper or lower extremities. In spite of its benign nature, the tumor may behave in a locally aggressive manner and invade the surrounding tissues. A case of isolated diffuse lipoblastomatosis of a 5-year-old boy in the plantar aspect of his right foot that has not been documented in that area before is described. The clinical and radiological presentation and histologic evaluation of diffuse lipoblastomatosis are discussed, in order to make a differential diagnosis between this rare tumor and other soft tissue tumors. In addition, the treatment principles of the tumor are described. This case demonstrates that diffuse lipoblastomatosis can be difficult to diagnose without histologic evaluation and, once diagnosed, should be treated by adequate surgical excision in order to prevent recurrence.

Exposure to cold or heat during incubation on developmental stability of broiler embryos

An experiment was conducted to measure the effects of exposure to heat or cold during incubation on the size of skeletal bilateral traits (face, wings, shank, tibia, and femur) and weights of heart and lungs of broiler embryos. Measurements were obtained at 10 and 18 d of incubation and at hatch on d 21. Treatments consisted of eggs incubated at 37.8 degrees C throughout (control; C), cooled to 36.9 degrees C for 6 h daily from d 0 to 8 (C0-8), heated to 39.6 degrees C for 6 h daily from d 0 to 8 (H0-8), cooled to 21.0 degrees C for 24 h on d 14 (C14), cooled to 36.9 degrees C for 6 h daily from d 10 to 18 (C10-18), and heated to 39.6 degrees C for 6 h daily from d 10 to 18 (H10-18). Although cooling and heating of eggs during incubation influenced growth of the skeletal traits on d 10 and 18, compensation generally occurred by the time of hatch. The developmental stability of bilateral traits varied with the specific trait, with those observed earlier in incubation tending to decrease by hatch.

Squamous cell carcinoma of the tongue in a patient with Fanconi's anemia: a case report and review of the literature

Fanconi's anemia (FA) is an autosomal recessive disorder characterized by constitutional aplastic anemia and congenital abnormalities. Patients with this disorder are prone to develop leukemia. Besides the risk of squamous cell carcinoma (SCC), development especially in the head and neck region is also increased. Up to now 40 patients with FA have been reported to develop SCC, and in 14 of them the tongue was the primary site. All of the reported SCC in FA patients originated in mucosal and mucocutaneous sites, especially oral (n=25) and anogenital sites (n=8) and the esophagus (n=6), with the exception of two patients with multiple cutaneous involvement. We report a new case of SCC of the tongue in a patient with FA and review the previous SCC cases.

A phase II study of paclitaxel and cisplatin combination chemotherapy in recurrent or metastatic head and neck cancer

The taxanes are the most active new agents for squamous-cell carcinoma of the head and neck (SCCHN) since the discovery of cisplatin. Our aim was to define the therapeutic efficacy and toxicity of paclitaxel and cisplatin combination therapy in patients with recurrent SCCHN. Patients with locally recurrent or metastatic SCCHN were enrolled in the study. Patients were required to be chemotherapy-naive, and should have completed radiation therapy at least 6 weeks prior to enrollment. A World Health Organization (WHO) performance status of less than 3 was required. Paclitaxel (Taxol, Bristol Myers Squibb Company, Princeton, NJ) and cisplatin therapy (PC) consisted of prophylaxis with pheniramine 50 mg i.v., ranitidine 150 mg i.v. and dexamethasone 20 mg i.v. given prior to paclitaxel 175 mg/m2 as a 3-hour i.v. infusion, followed by cisplatin 75 mg/m2 as a 1-hour infusion with an additional 3000 cc of saline for hydration. This treatment was repeated every 3 weeks for a maximum of six cycles. Patients were evaluated for response after the third and sixth cycles, or at the time of clinical progression. Fifty patients were enrolled in the study. The overall response rate was 32% with a 10% complete response rate. Forty-eight patients were assessable for toxicity. A total of 221 cycles of chemotherapy was given and the most common toxicity was myelosuppression; 7.7% of cycles had grade III-IV neutropenia. Severe neuropathy, nephropathy, mucositis, and emesis were uncommon (<10 %). At a median follow-up period of 25 months, the median overall survival was 10 months and the 1-year progression-free and overall survival rates were 16.7% and 35.2%, respectively. We conclude that patients with recurrent SCCHN have a moderate response to combination chemotherapy with cisplatin and paclitaxel. Given this moderate response rate, it is unlikely that this combination (PC) might ultimately prove to be superior to standard treatment regimens in terms of significant survival advantage.

Role of free oxygen radicals in noise-related hearing impairment

This study was aimed at defining the relationship between noise-related hearing impairment in industrial workers exposed to continuous noise. For this malondialdehyde and glutathione peroxidase were analyzed as free radical form and antioxidant form. A total of 60 patients working in the units of a hydroelectric power plant were included in the study. This experimental group was further divided into three subgroups of 20 workers, each group exposed to a different noise level. The control group consisted of 20 male volunteers employed in the Medical Centre where the study was carried out. A standard ascending/descending method was applied to the subjects of the experimental and the control groups in order to determine their hearing thresholds at seven different frequencies between 250 and 8000 Hz. Then, 10 ml blood was collected from each person to measure the malondialdehyde values in plasma and glutathione peroxidase activity in erythrocytes. Slight sensorineural hearing impairment was found in group I beginning at 4 kHz and in group II beginning at 6 kHz. Statistically significant differences were observed in group I and II when compared to the control group (P<0.05). It was found that malondialdehyde levels increased in the experimental groups more than in the control groups. However, this increase was only significant in group I (P<0.05). Erythrocyte glutathione peroxidase activity significantly increased in group I and II compared to the other groups (P<0.05), also, the difference was significant between group I and II (P<0.05). Accordingly, it is suggested that free oxygen radicals may take a role in noise-related hearing impairment.