A single-center study on the biochemical effect and clinical effectiveness of liraglutide in Turkish patients.

OBJECTIVE: The approval of liraglutide as a treatment option for obesity is a significant development in addressing the major health concerns of diabetes and obesity in recent years. Considering the duration of liraglutide use, pancreatic and hepatic enzymes, weight loss, homeostatic model assessment of insulin resistance (HOMA-IR), discontinuation rationales, and adverse events were studied. PATIENTS AND METHODS: From September 2019 to October 2022, 201 participants (125 females and 76 males) aged 18 to 75 were recruited from a single medical facility. The inclusion criteria were a body mass index (BMI) of ≥ 27 with comorbidities or a BMI of ≥ 30. A retrospective analysis evaluated demographic profiles and clinical/biological data collected at 3, 6, 9, and 12 months of continuous liraglutide usage. RESULTS: The study participants experienced weight loss of > 5% at 3, 6, 9, and 12 months compared to baseline. The baseline HOMA-IR values were significantly higher than those at months 3, 6, 9, and 12 (p = 0.0001). Participants who adhered to the drug regimen for 6 months showed a statistically significant increase in lipase levels compared to baseline, followed by a decline at 9 and 12 months. Amylase levels steadily increased until month 9 and then declined. Liver enzymes, particularly alanine aminotransferase (ALT), consistently decreased in patients on liraglutide treatment over the 12-month period. 41.29% had no adverse events, while 58.71% experienced adverse events, with nausea being the most prevalent (20%). CONCLUSIONS: Liraglutide showed significant weight loss and improved liver enzyme levels. It did not cause a clinically significant increase in pancreatic enzyme levels. However, monitoring pancreatic enzyme levels during liraglutide treatment could be helpful to minimize the risk of pancreatitis.

Case report: multiple keratocystic odontogenic tumour in a non-syndromal pediatric patient.

BACKGROUND: Keratocystic odontogenic tumour (KCOT) is an odontogenic tumour which stems from the odontogenic organs mostly localised in the lower jaw, particularly posterior body and ascending ramus of the mandible. The majority of these tumours are single lesions. When detected in the jaw in multiple forms, these cysts are seen in association with Gorlin Goltz/Basal cell naevus syndrome. However a few cases of non-syndromal multiple keratocystic odontogenic tumour have been reported in the literature. CASE REPORT: We report a case of multiple keratocystic odontogenic tumour in a 13-year-old girl demonstrated by panoramic radiography and cone beam computed tomography (CBCT). The differential diagnosis, treatment and imaging modalities are also discussed.

Who is responsible for inadequate lymph node retrieval after colorectal surgery: surgeon or pathologist?

BACKGROUND: Many factors have been described influencing survival of patients with colorectal cancer. The most important prognostic factor is lymph node involvement. The National Comprehensive Cancer Network indicates that at least 12 lymph nodes (LN12) must be retrieved for proper staging and treatment planning. The surgeon and the pathologist influence the number of retrieved lymph nodes. METHODS: We retrospectively reviewed all patients with diagnosis and subsequent surgery for colorectal cancer from January 2004 to January 2010 at Gulhane Military Medical Academy in Ankara, Turkey. We investigated the relationship between LN 12 and the independent variables of tumour size, lymph node involvement, metastasis, age, gender, surgeon, pathologist, surgical specimen length, tumour stage, and localization. Statistical analysis utilized the Shapiro-Wilk test, interquartile range, Mann-Whitney test, chi-square and chi-square likelihood ratio tests, and Kruskal-Wallis nonparametric variance analysis. In order to identify influencing factors for retrieval of lymph nodes, multiple linear regression was performed. In order to identify the direction and extent of effects of these influencing factors, logistic regression was performed. OR (Odds Ratio) and 95% CI (Confidence Interval) of the OR were calculated. RESULTS: There were 223 study patients, 134 with colon cancer and 89 with rectal cancer. There was no statistical significance in terms of age, gender, cancer type and postoperative tumour size, number of metastatic lymph nodes > 4, or LN12 (p > 0.05). Statistical significance was found between surgeons and LN12, the number of operations and LN12 (p < 0.001), and pathologists and LN12 (p = 0.049). CONCLUSIONS: Harvesting an adequate number of lymph nodes is crucial for patients with colorectal cancer in terms of staging and planning further treatment modalities such as adjuvant chemotherapy. Multidisciplinary collaboration between surgeons and pathologists is vital for optimal patient outcomes.

Outcomes of moderate sedation in paediatric dental patients.

BACKGROUND: The aim of this study was to evaluate the outcomes of moderate sedation with nitrous oxide/oxygen (N(2) O/O(2)) alone or combined with different dosages and administration routes of midazolam in uncooperative paediatric dental patients using the Bispectral Index System (BIS). METHODS: This one-year clinical study examined first-visit moderate sedation performed in 240 healthy children aged 4-6 years. Subjects were randomly divided into four groups according to drug, route and dosage, as follows: Group 1 - 0.20 mg/kg midazolam (40 mg/ml) delivered intranasally; Group 2 - 0.75 mg/kg midazolam (15 mg/3 ml) delivered orally; Group 3 - 0.50 mg/kg midazolam (15 mg/3 ml) delivered orally. All children in these three groups also received inhalation sedation with 50%-50% N(2) O/O(2), whereas children in Group 4 received inhalation sedation with 50%-50% N(2) O/O(2) only. The outcome of sedation was evaluated as either 'successful', 'failed' or 'not accepted'. RESULTS: The highest success rate was found in Group 1 (0.20 mg/kg intranasally, 87%), followed by Group 2 (0.75 mg/kg orally, 79%). The overall mean success rate for all groups was 73%. CONCLUSIONS: Moderate sedation can be successfully used in the clinical management of paediatric dental patients, with both intranasal and oral sedation using midazolam in conjunction with nitrous oxide found to be effective methods.

Association between Obsessive Compulsive Disorder and Tumor Necrosis Factor-α Gene -308 (G>A) and -850 (C>T) Polymorphisms in Turkish Children.

Obsessive compulsive disorder (OCD) is a neurobiological disease characterized with obsessions and compulsions. Obsessive compulsive disorder occurs with an autoimmune mechanism after Group A ß hemolytic streptococcus (GABHS) infection. Tumor necrosis factor (TNF) is an important cytokine, as well as having an important role in the apoptosis mechanism of autoimmune diseases. It is expressed by the TNF-α gene. The aim of this study was to examine the relationship between the TNF-α gene promoter region -308 (G>A) and -850 (C>T) polymorphisms and OCD. In this study, ages of the OCD patients and the control group ranged between 4 and 12 years. We studied two patient groups, one included childhood onset OCD patients (n = 49) and the control group was composed of healthy children (n = 58). Patients were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) criteria and with Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (KSAD-S-PL) version. For identifying the polymorphisms, polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP) and polyacrylamide gel electrophoresis (PAGE) methods were used. For the -308 polymorphism, 45 of 49 OCD patients' results were completed, and for the -850 polymorphism, 47 of 49 OCD patients' results were completed. According to our statistical results, there is a positive relationship between OCD and the -308 polymorphism (p <0.001) but no association between OCD and the -850 polymorphism (p = 0.053). There is no positive relationship between antistreptolysin O (ASO) titers and the -308 polymorphism (p = 0.953) but there is an important significance between the -850 polymorphism and ASO (p = 0.010). There is no positive relationship between gender of patients and OCD (p = 0.180) and no positive association between ASO and gender (p = 0.467). According to our results, we hypothesize that we can propose the mutant AA genotype for the -308 polymorphism, and that the mutant CT genotype for the -850 polymorphism may be used as molecular indicators for OCD.

Is removal of the stent at the end of 2 weeks helpful to reduce infectious or urologic complications after renal transplantation?

OBJECTIVE: Ureteral stents are used to reduce urologic complications after renal transplantation. However, they predispose to infection. The optimal time to keep them in the urinary tract has not yet been defined. The aim of this study was to evaluate the effect of early removal at the end of 2 weeks on urinary tract infections and early urologic complications (within 3 months), such as ureteroneocyctostomy leakage as well as ureteral anastomosis stricture or obstruction. METHODS: We retrospectively analyzed the medical records of 48 patients who underwent renal transplantation using a ureteral stent. The patients were divided into two groups according to the time of stent removal: at the end of 2 weeks (group A; n = 10) versus at a later time (group B; n = 38). RESULTS: The urologic complication rate was 0% in group A and the urinary tract infection rate, 2%. The urologic complication rate was 0% in group B and the urinary tract infection rate, 35%. CONCLUSION: Early removal of the stent at the end of 2 weeks after renal transplantation is decreased the rate of urinary tract infections.

The effect of gained experience on postoperative complications and mortality in cadaveric liver transplantation: a single-center experience.

AIM: Liver transplantation (OLT) has become the treatment of choice for end-stage liver failure, as well as for selected cases of malignancies and metabolic disorders. Decreased postoperative complications and mortality rates are expected to correlate with improvements in the interdisciplinary team approach, the perioperative anesthesiologic and intensive care management, and careful follow-up after transplantation. In this study, we have evaluated the effect of gained experience on postoperative complications and mortality in cadaveric OLT performed in our institution. MATERIALS AND METHODS: Data from cadaveric OLT patients (n = 34) since 2003 were retrospectively evaluated. Patients were divided into 2 groups: Early (2003-2006; n = 15) and late (2007-2010; n = 19). Age, gender, cold and warm ischemia times, intraoperative transfusion rates, infectious complications, biliary and vascular complication rates, and early and late postoperative mortality rates were compared in the 2 groups. RESULTS: The age and gender distribution was similar among both groups. Mean cold and warm ischemia times, intraoperative transfusion rates, and operative times were significantly lower in the late period group (P = .004, .012, and 0.008, respectively; CI=%95). T-tube usage was also significantly lower in the late period group (P < .001). There was no significant change for postoperative intensive care period (P = .404), but the overall length of stay in hospital was shorter for the patients in the late period group (P = .019). The nonsurgical early postoperative complication rate was lower (P = .001) and early postoperative mortality was nearly significant (P = .06) in patients who comprised the late period group. There was no difference in terms of biliary and vascular complication rates and overall survival rates between patients in the early and late groups (P = .664, .264, and .107, respectively). CONCLUSION: Our results indicate that the institutional improvements toward an interdisciplinary team approach in cadaveric OLT correlate with better results in ischemia and operative times and lower intraoperative transfusion rates and hospital stays. Early postoperative complication and mortality rates were found to decline in parallel to the team experience.

Analysis of peripheral blood T-cell subsets, natural killer cells and serum levels of cytokines in children with Down syndrome.

The objective of this study was to evaluate the relationship between humoral and cell-mediated immune response parameters and impairment of immune functions in children with Down syndrome (DS). The patient group was consisted of cytogenetically documented 32 children with DS. Lymphocyte subsets and natural killer cells were counted by flow-cytometry system. Levels of interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-8, IL-10 and tumour necrosis factor-alpha (TNF-alpha) were detected by enzyme-linked immunosorbent assay method. Serum IgG, IgM, IgA levels were measured by turbidimetric methods. The percentage of CD8+ lymphocytes and CD56+ cells of patients with DS were significantly higher, whereas CD20+ lymphocytes were lower than that of controls (P < 0.05). The percentage of CD2 and CD4 levels and CD4/CD8 ratio of patients with DS and normal controls were similar (P > 0.05). Levels of IL-4 and IL-10 were significantly increased, but IL-6 and TNF-alpha levels were decreased in children with DS (P < 0.05). Levels of other studied cytokines between patients with DS and controls were not statistically different (P > 0.05, for all). Serum IgG, IgM and IgA levels were found to be similar between the groups (P > 0.05). It has been known that IL-4 and IL-10 are anti-inflammatory molecules which inhibit the synthesis of proinflammatory cytokines such as IL-6 and TNF-alpha. In this study, levels of IL-4 and IL-10 were significantly increased, but IL-6 and TNF-alpha levels were decreased in children with DS. These results may suggest that continuing anti-inflammatory state in DS and this process may explain the cause of recurrent infection of the disease. On the other hand, in contrast to the low percentage of CD20+ cells, high percentage of CD8+ and CD56+ cells were found. Our findings may demonstrate that the cell-mediated and humoral immune system parameters in children with DS were altered according to healthy children.

Gelling agents and culture vessels affect in vitro multiplication of banana plantlets.

Agar is the most commonly used gelling agent in media for plant tissue culture. Because of the high price of tissue-culture-grade agar, attempts have been made to identify suitable alternatives. The type of culture vessel and lid also affects the gaseous composition inside the vessel as well as light penetration. In turn, the vessel affects growth parameters, such as shoot elongation, proliferation and fresh weight, as well as hyperhydric degradation processes. We examined the effects of different culture vessels, including commercial glass jars, magenta boxes, and disposable containers, as well as different gelling agents (agar-agar, Agargel, Phytagel, and plant agar) on the micropropagation of Dwarf Cavendish bananas in an effort to find a combination that yields large numbers of high-quality seedlings. The different culture vessels did not significantly affect seedling culture success. The medium significantly affected shoot weight. Phytagel resulted in the highest shoot weight (overall mean = 2.4 g), while agar, Agargel and plant agar resulted in 1.7, 2.2 and 2.2 g, respectively. Disposable container/Phytagel and Magenta/Agargel combinations yielded the highest shoot weights (2.9 and 3.0 g, respectively). Mean shoot length increased progressively with subculture (four subcultures were made). The highest mean shoot length was obtained with Phytagel and Agargel media (6.4 and 6.3 cm, respectively). Shoot number was significantly affected by medium only at subculture 4. Overall, the highest mean shoot length was obtained with the Magenta/Agargel combination (8.5 cm). Phytagel and plant agar gave higher mean shoot number than agar and Agargel (2.1, 2.1 and 1.7 and 1.9, respectively). The costs of the media and of the culture vessels need to be taken into account for final choice of the banana shoot culture system.

A rare complication after thyroidectomy: perforation of the oesophagus: a case report.

Perforation of the cervical oesophagus after thyroidectomy is an exceptionally rare complication. Total thyroidectomies, particularly for recurrent cases might possess an increased risk. Although rare, it has high mortality and morbidity. A patient that developed oesophagus perforation after a total thyroidectomy in a peripheral hospital for recurrent nodular goitre was treated and followed-up in our clinic. This well-documented case is discussed in conjunction with the information presented in the literature.

Geochemical and radionuclide profile of Tuzla geothermal field, Turkey.

Tuzla geothermal basin is situated in north-western Turkey on the Biga Peninsula, which is located at the west end of the Northern Anatolian Fault system. Soil and water samples were collected between August 2003 and June 2004 to initiate development of a geochemical profile of surface and subsurface waters in the geothermal basin and radionuclide concentrations in soils. All water samples were found to fall within Turkish Water Quality Class 4, meaning they were remarkably contaminated for any water consumption sector (industrial, human use or agricultural) based on sodium and chloride ions. Such waters could be used only after appropriate water treatment. The water samples are of the chloride type in terms of geochemical evaluation. Preliminary geochemical evidence shows that the N-S flowing part of the Tuzla River acts as a natural barrier within the basin. Heavy metal concentrations in the soil samples show slight elevations, especially those obtained from the east part of the basin where thermal springs are dominant. Geochemical calculations were carried out with PHREEQC software to determine equilibrium concentration of chemical species and saturation indices, by which it is suggested that chloride is the most important ligand to mobilize the heavy metals in the studied system. In addition, the activity concentration and gamma-absorbed dose rates of the terrestrial naturally occurring radionuclides were determined in the soil using gamma-ray spectrometry. The soil activity ranged from 42.77 to 988.66 Bq kg(-1) (averaging 138 Bq kg(-1)) for ( 238 )U, 13.27 to 106.31 Bq kg(-1) (averaging 32.42 Bq kg(-1)) for ( 232 )Th, and 99.28 to 935.36 Bq kg(-1) (averaging 515.44 Bq kg(-1)) for ( 40 )K. The highest value of ( 238 )U was found in the soil samples obtained from an area close to the hot spring.

A randomized controlled study evaluating the effects of the temperature of insufflated CO2 on core body temperature and blood gases (an experimental study).

BACKGROUND: Heated carbon dioxide (CO2) was used for pneumoperitoneum (Pp) to prevent hypothermia. This study aimed to investigate the relationship between the temperature of the insufflated CO2 and blood gases together with the core body temperature (CBT). METHODS: A prospective controlled study was performed with 24 pigs weighing approximately 20 kg randomized into four groups of 6 pigs each. A pneumoperitoneum at 12 mmHg of pressure was applied for 60 min with the pig under general anesthesia. The CO2)temperature was 22 degrees C in group 1, 37 degrees C in group 2, and 7 degrees C in group 3. In the "sham" group, pneumoperitoneum was not applied. Arterial blood pH and partial pressure of CO2 (PaCO2) were analyzed before insufflation, every 15 min during the pneumoperitoneum, and 15 min after the desufflation. The CBT was recorded before the insufflation, every 20 min during pneumoperitoneum, and 20 min after the desufflation. Blood gas analyses and CBT records for the "sham" group were performed at the same intervals. RESULTS: Arterial blood pH gradually decreased during pneumoperitoneum. At the 60th minute of pneumoperitoneum, a minimum decrease in arterial blood pH (0.04; p = 0.027) and a minimum increase in PaCO2 (3.67; p = 0.027) were recorded in group 3, whereas a maximum decrease in arterial blood pH (0.18; p = 0.027) and a maximum increase in PaCO2 (17.17; p = 0.027) were recorded in group 2. There was a significant negative correlation between PaCO2 and arterial blood pH in all the groups (r = -0.993; p < 0.01). The mean values of CBT decreases were statistically significant in all the groups: group 1 (p = 0.023), group 2 (p = 0.026), group 3 (p = 0.026), and "sham" group (p = 0.024). CONCLUSIONS: The changes in PaCO2 were directly proportional and the changes in pH contrarily proportional to the temperature of the insufflated CO2. Significant differences in CBT decreases were found between the groups receiving heated gas and room temperature gas and the groups receiving heated gas and gas below room temperature.

Treatment of pilonidal sinus by phenol application and factors affecting the recurrence.

BACKGROUND: Phenol injection, a less invasive method, has become more popular for the treatment of sinus pilonidalis. Recurrence rates after the use of phenol have been reported to be less than those after other surgical methods. METHODS: In this study, we applied 80% phenol to 143 patients with sinus pilonidalis. Patients were reevaluated at 1, 3, 6, 12 and 24 months after the phenolization procedure to search for any recurrences. Age, sex, skin color, occupation, hair distribution, complaints, macroscopic characteristics of the lesion, pouch volume, microbiological yield, complications of phenol injection, healing time, and recurrences were determined. RESULTS: The mean follow-up period was 24 months and the recurrence rate was 8.3% (12 of 143 patients). Volume of the sinus tract and number of sinus orifices were determined to be the factors significantly affecting recurrences (p<0.05). CONCLUSIONS: Injection of 80% phenol is an ideal approach for the conservative treatment of sinus pilonidalis. This study confirms that this is an effective and costless method with low recurrence rates.

[Gastrointestinal hemorrhage due to traumatic superior mesenteric artery aneurysm (case report)]. / Travmatik süperior mezenterik arter anevrizmasina bagli gastrointestinal kanama (olgu sunumu).

We report the case of a 21-year-old male patient with superior mesenteric artery aneurysm due to missed arterial injuries, its complications of enteric fistula and results of surgical treatment. The aneurysm was excised, enteric fistula was closed and aorta-mesenteric bypass using saphenous vein graft was performed. The hemorrhage became masked because of the tamponade in the mesentery during penetrating abdominal injury and initial surgery, and the late complication of false aneurysm came on the scene in follow up. Aorta-mesenteric bypass by a transmesenteric approach provides successful result in surgical treatment of superior mesenteric artery aneurysm.

Lymphocyte subsets in patients with idiopathic dilated cardiomyopathy.

OBJECTIVE: Although chronic myocardial inflammatory process mediated by viral and autoimmune factors has been postulated in the pathogenesis of idiopathic dilated cardiomyopathy (IDC), the role of autoimmune mechanisms still remains unclear. The aim of the present study was to investigate the rates of various T cell subsets and natural killer (NK) cells in peripheral blood in order to see whether they had a role in the immunoregulation of IDC. METHODS: The surface markers of peripheral T and B lymphocytes were detected and percentages of pan T and B cells as well as helper (CD4+) and suppressor (CD8+) T lymphocytes subsets in the peripheral blood and their ratio (CD4+/CD8+) were determined in 27 patients with IDC and in 20 healthy controls. NK cell percentage was also studied. RESULTS: There were no significant differences between IDC and control groups with respect to T and B cell percentages. The percentages of CD4+ T cell subsets were similar in both groups (48.7 +/- 8.7% vs. 43.5 +/- 9.7% respectively; p = 0.107). CD8+ T cell percentage was significantly decreased in patients with IDC than in controls (22.6 +/- 7.7% vs. 28.2 +/- 8.2%, respectively; p = 0.044). CD4+/CD8+ ratio was markedly higher in patients with IDC than controls (2.6 +/- 1.8 vs. 1.6 +/- 0.6, respectively; p = 0.006). There was no significant difference in the NK cell percentage between groups. CONCLUSION: Decreased CD8+ T cell subset is the cause of increased CD4+/CD8+ ratio, which may imply decreased self-tolerance and an immunoregulatory defect in the pathogenesis of IDC.

Disturbances in oral and dental structures in patients with pediatric lymphoma after chemotherapy: a preliminary report.

OBJECTIVE: The purpose of this study was to evaluate the effects of chemotherapy on oral and dental structures and craniofacial growth in 30 survivors of childhood lymphoma. STUDY DESIGN: Eruption status, root malformations, premature apexification, agenesis, crown anomalies, soft tissue abnormalities, gingival and periodontal status, enamel defects and discolorations, and craniofacial growth status of the subjects were documented and compared with findings in 20 healthy children who served as controls. RESULTS: Statistically significant (P < .05) differences between the study and control groups were found for plaque index, enamel hypoplasias, discolorations, and agenesis. CONCLUSIONS: The results of the study suggest that antineoplastic therapy and/or childhood cancer can result in a higher prevalence of various malformations in teeth. Children treated in the early years of their lives displayed the most severe dental defects, suggesting that immature teeth are at a greater risk of developmental disturbances than fully developed teeth.

Percutaneous treatment of hydatid cysts of the liver: long-term results.

OBJECTIVE: The purpose of the study was to present the long-term results of percutaneous treatment of liver hydatid cysts. SUBJECTS AND METHODS: Seventy-two patients (44 male and 28 female, ranging in age between 10 and 69 years; mean age, 35 years) with 106 liver hydatid cysts underwent percutaneous treatment with albendazole prophylaxis. Puncture, aspiration, injection, and reaspiration (PAIR) were used for hydatid cysts smaller than 6 cm (n = 66). Larger cysts (n = 40) were treated by catheterization. Hypertonic saline solution and absolute alcohol were used as the cytotoxic and sclerosing agents. Sonographic guidance with or without fluoroscopy was used in all patients. Follow-up was mainly by sonography every third month of the first year, every sixth month of the second year, and once a year thereafter. The mean follow-up time was 37 months. RESULTS: The mean reduction in volume at the time of the first follow-up was 87.0% and 73.5% in catheterization and PAIR patients, respectively. The immediate sonographic changes after treatment were detachment of the endocyst and disappearance of the regular endocyst, with a reduction in the fluid component. The solid appearance of the cyst remnant indicated complete cure as the cyst wall became irregular and thicker. The average time for development of a solid appearance was 19 months in PAIR patients and 26 months in catheterization patients. Seventy of 72 patients were cured, whereas two recurrences (2.8%) were observed. No mortality, abdominal dissemination, or tract seeding occurred. Minor complications were urticaria and fever in eight patients (11.1%). Major complications were infection of the cyst cavity in two patients (2.8%) and development of biliary fistula in four patients (5.6%). Mean hospitalization times were 17 days for complicated cases and I day for uncomplicated cases. CONCLUSION: The long-term results of percutaneous liver hydatid cyst treatment accord with short-term results, indicating that the procedure is efficient and safe and offers complete cure in selected patients with a short hospitalization.

The results of surgical treatment and percutaneous drainage of hepatic hydatid disease.

BACKGROUND: Hydatid disease of the liver remains an important and challenging problem in rural areas. Although, surgery is considered the treatment of choice for hydatid disease of the liver, percutaneous drainage is an alternative treatment method for selected cases. The purpose of this study was to evaluate the results of percutaneous drainage and surgery. METHODS: A total of 66 patients underwent surgery; 36 cases had percutaneous drainage and were evaluated preoperatively for treatment choice according to localization, multiplicity, echographic type and size of the cysts in the liver. The patients were also evaluated postoperatively for systemic complications, e.g. fistula formation, infection of residual cyst, recurrence and hospitalization period for each group. RESULTS: Two groups, those with multiple cysts and cysts bigger than 5 cm, were treated by surgery. At the end of two treatment modalities, systemic complications, biliary fistulizations, recurrence and infection of cyst's cavity were seen more frequently in the surgery group and caused a longer hospital stay. CONCLUSIONS: Percutaneous drainage plus medical treatment can be successfully done for type I, type II and some selected type III hydatid cysts of the liver giving less complications, lower recurrence and shorter hospitalization periods. But, surgery is the primary treatment for big, multiple, complicated and recurrent hydatid cysts of the liver.

Serum tumor necrosis factor-alpha in neonatal sepsis.

Tumor necrosis factor-alpha (TNF-alpha) is thought to be an important mediator in the pathogenesis of neonatal septicemia. To assess the role of TNF-alpha in neonatal sepsis, serum levels of TNF-alpha were measured in a group of neonates with septicemia and compared with the levels of gestational-postnatal, age-matched healthy controls. The relationships between severity of infection, the nature of causative microorganisms, and TNF-alpha levels were also investigated in this prospective study. A total of 49 infants (25 full-term, 24 preterm) with proven sepsis and 40 healthy infants (20 full-term, 20 preterm) were included. Serum TNF-alpha levels were measured using the TNF-alpha immunoradiometric assay. The median level of TNF-alpha was found to be significantly higher in infants suffering from sepsis (154 pg/mL) particularly in those with septic shock (242.5 pg/mL) as compared to healthy controls (61.5 pg/mL) (p < 0.001). No correlation was found between TNF-alpha and postnatal ages, gestational ages or birth weights of the infants. TNF-alpha levels were not different in surviving and terminal neonates. Although serum, TNF-alpha levels were found to be slightly higher in gram-negative septicemia, the difference was not significant. These findings suggest that TNF-alpha plays an important role in the pathophysiology of neonatal septicemia, but its importance as a prognostic factor is not yet clear.