Association between red cell distribution width and mean platelet volume with appendicitis: a myth or a fact?

OBJECTIVES: The aim of our study was to identify if there was a relation between red cell distribution width, mean platelet volume, platelet distribution width, leukocyte count and thrombocyte count at the time of presentation to hospital and acute appendicitis. BACKGROUND: Acute appendicitis is one of the most common surgical emergencies. Misinterpretation of symptoms and findings in acute appendicitis may lead to removal of normal appendix and delayed diagnosis can result in perforation and peritonitis. Many studies tried to delineate the relation between acute appendicitis and laboratory findings. Latest studies focused on components of complete blood count such as red cell distribution width and mean platelet volume. METHODS: This was a retrospective clinical study that enrolled 638 patients with abdominal pain and open appendectomy for acute appendicitis. Complete blood count results including red cell distribution width were retrieved from medical charts of patients and analyzed. RESULTS: There was no statistically significant difference between appendicitis, non pathological appendix and perforated appendicitis in terms of red cell distribution width or other blood count components except leukocyte level. CONCLUSION: Despite current findings in medical literature indicating predictive value of red cell distribution width in acute appendicitis; its utility for differential diagnosis might be overestimated (Tab. 1, Ref. 22).

Red cell distribution width, gamma glutamyl transpeptidase and anticoagulant use affect mortality in acute arterial mesenteric ischemia.

BACKGROUND: Despite advances in surgery and intensive care, mortality in acute mesenteric ischemia remains between 50% and 90%. In this study, we evaluated factors affecting mortality in acute arterial mesenteric ischemia. METHODS: This is a retrospective cohort study involving 73 patients with an initial diagnosis of arterial acute mesenteric ischemia admitted to Ankara Numune Teaching Hospital between January 2008 and December 2013. We retrospectively collected data about demographic variables, co-morbidities, medications, extent of surgical resection, laboratory values, pathology results and outcome. RESULTS: The mean age of the patients was 69.3±12.6. Thirty one patients were female (42.46%) and 42 (57.53%) were male. We divided the patients into two groups: Group 1 (n=40); those who died and Group 2 (n=33); those who were discharged. In multivariate analysis of high gamma glutamyl transpeptidase and red cell distribution width levels, the presence of anticoagulant use was statistically significant (p<0.05) in favor of Group 1. CONCLUSION: High red cell distribution width and gamma glutamyl transpeptidase levels and anti-coagulant use are factors affecting mortality in arterial acute mesenteric ischemia. The assessment of these variables could help predict the extent of arterial acute mesenteric ischemia and the mortality associated with it.

Inguinal mass due to an external supravesical hernia and acute abdomen due to an internal supravesical hernia: a case report and review of the literature.

Although supravesical hernias were described as early as 1804, there have been fewer than 100 cases reported in the literature. The supravesical fossa is a triangular area bounded laterally and above by median and medial umbilical ligaments, and below by the peritoneal reflection that passes from the anterior abdominal wall to the dome of the bladder. A hernia starting in this fossa usually protrudes through the abdominal wall as a direct inguinal hernia (external supravesical hernia). Less commonly, it remains within the abdomen, passing into spaces around the bladder (internal supravesical hernia). A 43-year-old mill worker presented with an enlarged painful mass in the left groin. He underwent a surgical repair of a direct inguinal hernia without addressing an unrecognized supravesicular component. Eight hours after his discharge next morning, he presented with acute abdomen, nausea, vomiting, and abdominal distention. The second surgery revealed the presence of a left lateral internal supravesical hernia with incarcerated small bowel. This was also repaired, and the patient was discharged in stable condition. This report aims to review and discuss the surgical anatomy of these rare supravesical hernias and calls attention to this type of hernia as an unusual cause of small bowel obstruction.

Diagnosis and laparoscopic management of a fallopian tube torsion following Irving tubal sterilization: a case report.

Tubal torsion is a very rare but serious clinical entity. Its occurrence has been reported following Pomeroy tubal ligation and laparoscopic tubal cauterization. The following case report will be the first one describing a tubal torsion after an Irving tubal ligation in a patient who also had a history of pelvic inflammatory disease (PID). This study includes the presentation of a case of tubal torsion that is diagnosed and managed laparoscopically and the review of the literature through a computerized search of MEDLINE for relevant cases in the English literature published between January 1966 and July 1999. The patient is a 26-year-old woman with a history of PID and Irving tubal ligation. She presented with a second episode of acute right lower quadrant pain. The patient underwent a diagnostic laparoscopy and was found to have a 6 x 5 cm hemorrhagic and necrotic fallopian tube consistent with torsion of the right tube. A right salipingectomy was done laparoscopically. Combination of PID and tubal sterilization in the medical history of a patient presenting with acute or intermittent pelvic pain may suggest tubal torsion.

Effect of gonadotropin-releasing hormone agonists on monocyte chemotactic protein-1 production and macrophage infiltration in leiomyomatous uterus.

OBJECTIVE: The level of monocyte chemotactic protein-1 (MCP-1), a potent chemoattractant for monocytes, is fivefold higher in myometrium than in leiomyoma. We have previously shown that myometrium from women using GnRH agonists (GnRH-a) express the highest levels of MCP-1, which has antiproliferative effects on leiomyoma cells. We hypothesized that MCP-1 may have a direct paracrine effect in leiomyomatous uterus rather than acting by way of chemoattraction of macrophages. DESIGN: Cross-sectional study. SETTING: University medical center. PATIENT(S): Women with leiomyoma (n = 32). INTERVENTION(S): Immunohistochemical analysis performed in the myometrium and leiomyoma of women receiving (n = 11) and not receiving (n = 21) GnRH-a treatment. MAIN OUTCOME MEASURE(S): The MCP-1 levels and macrophage counts determined by immunohistochemistry in the myometrium and leiomyoma of women receiving GnRH-a were compared to the levels and counts in women not receiving GnRH-a. RESULT(S): Samples from all 11 patients using GnRH-a revealed strong MCP-1 staining, whereas staining was only weakly present in 11 and absent in 10 samples from patients not receiving GnRH-a, revealing a significant difference in MCP-1 expression between GnRH-a users versus nonusers (P=.006). The number of tissue macrophages between GnRH-a users and nonusers was not significantly different. CONCLUSION(S): We found that there is an increase in the MCP-1 protein expression in the myometrium of women receiving GnRH-a treatment. On the other hand, we have not observed a difference in the macrophage count and distribution with GnRH-a treatment, suggesting a potentially direct antiproliferative role for MCP-1 rather than acting by means of chemoattraction of macrophages.

Interleukin 8 production and interleukin 8 receptor expression in human myometrium and leiomyoma.

OBJECTIVE: Interleukin 8 is a potent chemoattractant cytokine that is expressed in a variety of human tumors and is known to induce mitogenesis. We aimed to investigate the production of interleukin 8 and the expression of its receptor in myometrium and leiomyoma, in which we hypothesized that interleukin 8 may contribute to cellular proliferation. STUDY DESIGN: Myometrial and leiomyoma tissue pairs (n = 14) were obtained from human uteri after hysterectomy conducted for leiomyomatous uterus. Expression of interleukin 8 and interleukin 8 receptor type A was identified in the leiomyomatous myometrium by means of specific antibodies directed against interleukin 8 and interleukin 8 receptor type A for immunohistochemical detection. Interleukin 8 production by cultured cells was measured by enzyme-linked immunosorbent assay. The regulation of interleukin 8 messenger ribonucleic acid expression was assessed by means of the Northern blot analysis after treatment of myometrial cells with interleukin 1alpha and tumor necrosis factor alpha. Myometrial cell proliferation was determined by means of colorimetric assay after cells were treated with interleukin 8 and antihuman interleukin 8 neutralizing antibody. RESULTS: Immunostaining for both interleukin 8 and interleukin 8 receptor type A was stronger in the myometrium adjacent to leiomyoma compared with leiomyoma itself (2-fold, P <.05). Compared with samples from nonusers, samples from patients who had used gonadotropin-releasing hormone agonists revealed a trend for decreased staining for both interleukin 8 and interleukin 8 receptor type A. Interleukin 1alpha and tumor necrosis factor alpha caused a time- and dose-dependent increase in interleukin 8 production by myometrial cells (P <.001). There was a dose-dependent inhibition of cell proliferation with antihuman interleukin 8 antibody to 55% of the control (P <.001). CONCLUSION: Our demonstration of high levels of interleukin 8 and its receptor in myometrium immediately surrounding leiomyoma and the inhibition of cell proliferation when interleukin 8 is blocked by a neutralizing antibody suggest a potential role for interleukin 8 in the growth of myometrial tissue surrounding leiomyomatous tissue. This study could lead to a better understanding of potential involvement of cytokines in leiomyoma growth and in gonadatropin-releasing hormone agonist-induced regression.

Hyperinsulinism and its interaction with hyperandrogenism in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. It has become increasingly evident that insulin resistance plays a significant role both as a cause and result of the syndrome. The purpose of this review is to summarize the possible mechanisms leading to insulin resistance and resultant hyperinsulinism (HI) and their interaction with hyperandrogenism (HA) in PCOS. We conducted a computerized search of MEDLINE for relevant studies in the English literature published between January 1966 and January 2000. We reviewed all studies that investigated the roles of insulin, insulin receptor, and insulin gene in insulin resistance and its interaction with hyperandrogenism in PCOS. Insulin resistance in PCOS seems to involve a postbinding defect in the insulin receptor and/or in the receptor signal transduction. Current research has focused on identifying a genetic predisposition for insulin resistance in this syndrome. The answer to the question whether HI or HA is the initiating event is still unclear inasmuch as there are clinical and molecular evidences to support both of these approaches. Our view is that whichever is the triggering insult, a vicious cycle is established where HI acts to aggravate HA and vice versa. In this model, obesity and genetic predisposition seem to be the independent factors that can give rise or contribute to HI, HA, or both simultaneously. It seems that "hyperinsulinemic hyperandrogenism" represents a significant subgroup of PCOS, which probably needs to be renamed and reclassified in the light of this new approach.

Transforming growth factor-beta3 is expressed at high levels in leiomyoma where it stimulates fibronectin expression and cell proliferation.

OBJECTIVE: To investigate the expression of TGF-beta3 in leiomyoma and myometrium as well as the effect of TGF-beta3 on the expression of fibronectin and on the proliferation of leiomyoma and myometrial cells. DESIGN: Observational and in vitro experimental study. SETTING: University medical center. PATIENT(S): Women with (n = 18) leiomyoma. INTERVENTION(S): First TGF-beta3 mRNA and protein levels in myometrium and leiomyoma were measured, and then myometrial and leiomyoma cells in culture were treated with TGF-beta3. MAIN OUTCOME MEASURE(S): TGF-beta3 and fibronectin mRNA were evaluated by Northern analysis. Myometrial and leiomyoma cell proliferation was assessed with use of [(3)H]thymidine incorporation. RESULT(S): The TGF-beta3 mRNA level in the leiomyoma samples was 3.5-fold higher than in the myometrial samples. The highest TGF-beta3 mRNA level was observed in leiomyoma samples from midsecretory phase and was 5-fold higher than in proliferative phase samples. Fibronectin mRNA expression also was higher in the leiomyoma than in the myometrium. TGF-beta3 induced fibronectin expression in leiomyoma cells and directly stimulated myometrial and leiomyoma cell proliferation in cultures. CONCLUSION(S): These findings suggest that TGF-beta3 may be mediating the growth-promoting effects of sex steroids on leiomyomas by playing a role in the fibrogenic process and cell proliferation that characterize these tumors.

Expression and hormonal regulation of monocyte chemotactic protein-1 in myometrium and leiomyomata.

OBJECTIVE: The pathogenesis of leiomyoma likely involves interactions of sex steroids with paracrine growth factors or cytokines resulting in modulation of local immunity. Monocyte chemotactic protein-1 (MCP-1) is a chemotactic and activating factor for monocytes and is produced by multiple tumors and has antitumor effects. We investigated the expression of MCP-I in leiomyoma and myometrium as well as the regulatory role of steroid hormones and cytokines on MCP-1 expression and the effect of MCP-1 on the proliferation of leiomyoma cells. DESIGN: Prospective study. SETTING: University medical center. PATIENT(S): Women with (n = 20) or without (n = 11) leiomyoma. INTERVENTION(S): First. MCP-1 messenger RNA (mRNA) levels in myometrium and leiomyoma were measured, and then myometrial and leiomyoma cells in culture were treated with steroid hormones and cytokines. MAIN OUTCOME MEASURE(S): The MCP-1 mRNA was evaluated by Northern analysis. Immunoreactive MCP-1 in cell cultures was quantified by ELISA. Leiomyoma cell proliferation was assessed with [3H]thymidine incorporation. RESULT(S): The MCP-1 mRNA levels in myometrial samples were 4.7-fold higher than in the leiomyoma samples. Myometrial MCP-1 mRNA levels were 2.4-fold higher in secretory than in proliferative phase samples. The highest MCP-1 levels were observed in samples from women using GnRH analogues. Estradiol and progestins, alone or in combination, resulted in a decrease in MCP-1 protein production. There was an increase in the proliferation of leiomyoma cells treated with anti-MCP-1 neutralizing antibody. CONCLUSION(S): These findings suggest that MCP-1 may have antineoplastic activity in leiomyomata and that sex steroids may be exerting their growth stimulatory effect in leiomyomata through down-regulation of MCP-1.