Right-sided Bochdalek hernia with intrathoracic ectopic kidney in an advanced-age adult: a case report.

Ectopic intrathoracic kidney is an extremely rare congenital anomaly and it is often asymptomatic and discovered incidentally on chest radiography. Although congenital thoracic kidney is mostly seen in infants, it can be diagnosed in neonatal age and adults as well. Herein, we present a 72-year-old woman who had a right-sided Bochdalek hernia with intrathoracic ectopic kidney. In contrast to the usually young patients with thoracic hernia, the presented case was the oldest female patient having thoracic kidney accompanied with Bochdalek hernia with clinical symptoms among those reported in the literature.

Renal papillary attenuation differences between primary and recurrent idiopathic calcium stone disease patients.

AIM: The aim of this paper was to investigate whether renal papillae of patients with nephrolithiasis are more radiodense than that of control patients and to evaluate the predictability of urolithiasis using papillary density differences between stone and non-stone formers. METHODS: Renal papillary Hounsfield Unit (HU) measurements were conducted at the level of upper pole, middle region and lower pole of both kidneys in a total of 126 primary (group 1), 133 recurrent (group 2) stone disease patients and 108 controls (group 3). RESULT: Mean patient age did not differ significantly between groups (P>0.05). Mean stone diameters (±SD) were 5.0±3.1 mm (3-9 mm) and 6.1±3.3 mm (3-15 mm) for primary and recurrent groups, respectively and group distributions and variances were similar (P>0.05). Mean papillary attenuation values (±SD) were 27.26±9.30 (4.00-56.00) in group 1, 30.42±9.88 (12.00-64.00) in group 2 and 25.83±2.72 (20.30-32.56) in the control group. The difference between the mean papillary attenuation value of the primary stone disease group and the control group was statistically insignificant (P=0.104). When the control group and the recurrent stone group was compared without variances, in terms of the mean renal papillary attenuation value, a statistical significance was achieved (P=0.000). CONCLUSION: With increasing renal papillary HU values, the risk of recurrent calcium stone disease is increased.

Significance of bacteriuria and leukocyturia in the outpatients with heart failure.

AIM: To investigate the relationship between severity of illness and hospitalization with the presence of leukocyturia and bacteriuria in outpatients with heart failure (HF). PATIENTS AND METHODS: Four hundred three patients admitted with the diagnosis of HF to cardiology outpatient clinic were included in this study. According to New York Heart Association (NYHA) classification, the patients were divided into two groups to be group A (decompensated) as stage 3 or 4 and group B as stage 1 or 2 (compensated HF). All subjects underwent standard 12-lead ECG and echocardiography. In all patients, full blood, biochemical tests as liver and kidney function tests, full urinary analysis (FUA) and thyroid function tests were analyzed. Mid-stream urine for culture was taken for the leukocytes number > or =5 mm3. RESULTS: The mean leukocyte number (MLN) in urine of patients was 16.56 +/- 13.63 in Group A and was 3.74 +/- 5.31 in Group B (p < 0.000). The moderately positive correlation was found between the MLN and NHYA class in all patients (r = 0.526; p < 0.000). In receiver operating characteristic (ROC) curve analysis, the optimal cut-off value of leukocytes in urinalysis to predict hospitalization of CHF was > or =5, with 76.1% sensitivity and 75.7% specificity (area under the curve 0.825, 95% confidence interval 0.781 to 0.862, p = 0.000). CONCLUSIONS: We found that the numbers of leukocytes in urinalysis of hospitalized patients with HF were significantly higher than non-hospitalized persons. Also, number of leukocyte in urinalysis was positively correlated with NYHA class of HF patients. Namely, leukocyturia may be an indicator of decompensations in HF patients.

Preauricular sinus, nephrolithiasis, infantine eczema and natal tooth: a new association.

Preauricular sinuses (ear pits) are common congenital abnormalities. The incidence of preauricular sinus is widely varied. Usually asymptomatic, they manifest as small hollows adjacent to the external ear near the anterior margin of the ascending limb of the helix, most frequently on the right side. Preauricular sinuses can be either inherited or sporadic. They may be bilateral, increasing the likelihood of being inherited, in 25-50% of cases. Preauricular sinuses are features of other conditions or syndromes in 3-10% of cases, primarily in association with deafness and branchio-oto-renal (BOR) syndrome. When other congenital anomalies coexist with these sinuses, auditory testing and renal ultrasound should be considered. A girl, who was three months and 20 days old, was presented because of the co-existence of a right infected preauricular sinus, nephrolithiasis, infantile eczema and a natal tooth.

Effect of different growth conditions on biomass increase in kefir grains.

Kefir is a functional dairy product and the effects of kefir consumption on health have been well documented. Kefir grains have naturally high numbers of lactic acid bacteria and yeasts and are used in manufacturing kefir. The biomass of kefir grains slowly increases after successive fermentations. The effects of adding whey protein isolate, modified whey protein (MWP, fat replacer; Carbery Inc., Cork, Ireland), or inulin to milk and different atmospheric conditions (ambient or 6% CO(2)) during fermentation on the increase in biomass of kefir grains were investigated. Reconstituted milks (10% milk powder) enriched with whey protein isolate (2%), MWP (2%), and inulin (2%) were inoculated with kefir grains and fermented in ambient and 6% CO(2) incubators at 25°C until a final pH of 4.6 was reached. Biomass increments of kefir grains were determined weekly over 30 d. Lactic acid bacteria and yeast contents of kefir grains were also determined. The highest biomass increase (392%) was found in kefir grains grown in milk supplemented with whey protein isolate under ambient atmospheric conditions. Application of CO(2) did not provide a significant supporting effect on the biomass of kefir grains. Addition of MWP significantly accelerated the formation of kefir grain biomass (223%). The use of whey protein isolate, MWP, or inulin in milk did not cause any adverse effects on the microbial flora of kefir grains.

Evaluation of activatory and inhibitory natural killer cell receptors in non-segmental vitiligo: a flow cytometric study.

BACKGROUND: Recent observations established the role of altered cellular immunity and autoimmune hypothesis in the pathogenesis of vitiligo. There have been several reports discussing T-cell and natural killer (NK) cell populations, but NK cell receptors were not evaluated in vitiligo. OBJECTIVE: The purpose of this investigation was to assess the role of T and NK cells as well as activatory and inhibitory NK cell receptor alterations in the pathogenesis of vitiligo and whether any aberrations were correlated with clinical findings of the disease. PATIENTS/METHODS: Fifty-three patients with non-segmental vitiligo and 45 age- and sex-matched healthy controls were enrolled in the study. The percentages of lymphocytes, granulocytes, monocytes and CD3, CD4, CD8, CD14, CD16, CD56, CD45, CD45RA, CD54RO, CD28, CD80, CD94, CD158a, KIR3DL-1 receptors as well as CD94, CD158a, KIR3DL-1 receptors on CD16(+) cells were detected by using flow cytometry. The patient and control groups were compared in terms of the results of flow cytometric analysis, and the results were assessed regarding the type and activity of vitiligo. RESULTS: The percentages of CD16(+)CD56(+), CD3(+)CD16(+)CD56(+), CD8(+) and CD45RO(+) cells were significantly increased in vitiligo group compared with the controls. No difference was detected between the patients and control groups in percentages of CD3(+), CD4(+), CD3(-)CD16(+)CD56(+), CD28(+), CD45(+), CD45RA(+), CD94(+), CD158a(+) and KIR3DL-1(+) cells. The percentage of CD16(+)CD158a(+) cells was significantly decreased in a randomized selected group of vitiligo patients. There were no differences in percentage expression of studied cell surface antigens between patients in the active or stable period. CD3(+) cells were significantly increased in generalized form, and CD45RO(+) cells were significantly increased in acral/acrofacial form when compared with the other types of vitiligo. CONCLUSIONS: These results indicate further evidence for T and NK cell abnormalities in non-segmental vitiligo. The present data show that NK cell activation may be responsible in the pathogenesis of vitiligo in conformity with decreased inhibitory and increased activatory NK cell receptors.

[Bacteraemia in a patient with a central venous line is not a reason for immediate removal of the line]. / Bij bacteriëmie hoeft een diepe lijn niet meteen te worden verwijderd.

Fever and the presence of a central venous catheter is a frequent combination in (critically) ill patients, but has a low predictive value for catheter-related sepsis. Therefore, the immediate removal of a central venous line is often unnecessary, even if there is fear for endocarditis when Staphylococcus aureus is present. Recent studies have shown that the odds ratio for this complication is rather low.

Evaluation of lipid peroxidation and total antioxidant status in plasma of rats following thermal injury.

Thermal injury initiates systemic inflammatory reactions producing burn toxins, an inflammatory response, oxygen radicals and finally peroxidation. The relationship between the amount of products of oxidative metabolism and natural scavengers of free radicals determines the outcome of local and distant tissue damage, and further organ failure in burn injury. To determine the relationship between the level of total natural scavengers of the body, the place of superoxide dismutase in this capacity, and its relation with lipid peroxidation, malondialdehyde, superoxide dismutase levels and total antioxidant status were measured in plasma. Animals were subjected to 30 per cent full thickness body surface area burn, and their blood was collected at 24 h postburn. Plasma malondialdehyde levels were significantly elevated above the level of controls (P < 0.02). Burn injury caused a remarkable decrease in superoxide dismutase (45 per cent decrease, P < 0.0001) and total antioxidant status (14 per cent decrease, P < 0.01) when compared to control.

Protective effect of 3-aminobenzamide, an inhibitor of poly (ADP-ribose) polymerase in distant liver injury induced by renal ischemia-reperfusion in rats.

BACKGROUND AND AIMS: Renal ischemia followed by reperfusion causes remote liver injury. This research was planned to investigate whether 3-aminobenzamide (3-AB), has any preventive effect against distant liver injury triggered by renal IR. MATERIALS AND METHODS: Twenty four rats were randomly divided into three different groups Each group has 8 rats. The groups were as follows: (1) Sham operated group; (2) Renal ischemia-reperfusion (IR) group; (3) Renal IR+ 3-AB group. 3-AB (10 mg/kg) was given intraperitoneally 10 minute before reperfusion. At the end of study, the rats were sacrificed. Their liver tissues and serum samples were collected for measurement of malondialdehyde (MDA) levels, total oxidant status (TOS), total antioxidant status (TAS), paraoxonase (PON-1) activity and nitric oxide (NO). RESULTS: Renal IR injury significantly increased Oxidative stress index (OSI) and MDA, TOS levels and significantly decreased PON-1 actvity and TAS, NO levels in serum and liver tissue (p < 0.05). Despite that, changes in these biochemical parameters related with IR injury were diminished by 3-AB administration (p < 0.05). CONCLUSIONS: The inhibition of PARP [Poly(ADP-Ribose)Polymerase] by 3-AB showed protective effects against distant liver injury triggered by renal ischemia-reperfusion by the ameliorating effects of 3-AB on oxidative stress.

Prophylactic anticoagulation decreases catheter-related thrombosis and occlusion in children with home parenteral nutrition.

BACKGROUND: Home parenteral nutrition (PN) has improved the survival of children with intestinal failure. Important complications include catheter-related thrombosis, occlusion, and infection. This study evaluated the efficacy and safety of prophylactic anticoagulation in the prevention of these complications. METHODS: Medical records were retrospectively reviewed of all children (0-18 years) with PN between January 1994 and March 2007 in 1 tertiary center. After introduction of prophylactic low molecular weight heparin or vitamin K antagonists in March 2007, all patients were prospectively followed until March 2010. RESULTS: In sum, 14 patients did not receive prophylaxis; 13 switched from no prophylaxis to prophylaxis in March 2007; and 5 directly received prophylaxis. Median age of PN onset was 4 months (range, 0.1-202) in the nonprophylaxis group (n = 27) and 25 (range, 2-167) in the prophylaxis group (n = 18); 16 children received low molecular weight heparin and 2, vitamin K antagonists. Catheter-related thrombosis developed in 9 patients with no prophylaxis (33%) and 1 with prophylaxis (6%) (P = .034). Cumulative 5-year thrombosis-free survival was 48% and 93% in the nonprophylaxis and prophylaxis groups, respectively (P = .047). Per 1,000 PN days, the nonprophylaxis and prophylaxis groups had 2.6 and 0.1 occlusions (P = .04) and 4.6 and 2.1 infections (P = .06), respectively. Cumulative infection-free survival after 3 years was 19% and 46% in the nonprophylaxis and prophylaxis groups, respectively (P = .03). Bleeding complications did not occur. CONCLUSION: Thromboprophylaxis significantly decreased catheter-related thrombosis and occlusion in children with PN without complications.