[Giardia muris infection in laboratory rats (Rattus norvegicus) and treatment with metronidazole]. / Laboratuvar Siçanlarinda (Rattus norvegicus) Giardia muris Enfeksiyonu ve Metronidazol ile Sagaltimi.

OBJECTIVE: This study was conducted to determine the effectiveness of metronidazole for treatment of Giardia muris infection in laboratory rats. METHODS: The feces of rats was yellow watery diarrhea and brought to the surgery research center of University of Ondokuz Mayis in order to be a study. Stool samples were examined by native examination, evaluation of infection rates was done with an X40 lens, and results were recorded as positive from 1 to 4. Metronidazole was administered to infected animals orally for 5 days with a 20 mg/kg dose. RESULTS: As a result of fecal examination of 64 rats held in groups of four in cages, 15 of the cages (60 rats) were found to be infected with G. muris. While agents were not observed in collected stool samples following 5, 7, and 14 days of drug administration of 14 groups, trophozoite density in one cage was decreased (75%), and adverse effects were not seen in rats. CONCLUSION: Metronidazole was found to be an effective drug for the treatment of giardiasis.

Effect of free creatine therapy on cisplatin-induced renal damage.

Abstract Cisplatin is one of the commonly used anticancer drugs and nephrotoxicity limits its use. The aim of this study is to investigate the possible protective effect of creatine supplementation on cisplatin-induced nephrotoxicity. Sixty male Sprague-Dawley rats were divided into three groups: Group I: Cisplatin (n=20) (7 mg/kg cisplatin intraperitoneal (i.p.) single dose), group II: Cisplatin+creatine monohydrate (n=20) (7 mg/kg cisplatin i.p. single dose and 300 mg/kg creatine p.o. daily for 30 days starting on first day of cisplatin injection), group III: Control group (n=20) (Serum physiologic, 2.5 mL/kg i.p.). Sacrifications were performed at first week and 30th day. Blood urea nitrogen (BUN) and serum creatinine levels, histopathological evaluation, mitochondrial deoxyribonucleic acid (mtDNA) common deletion rates, and body weights of rats were evaluated. A significant decrease in body weight, higher values of kidney function tests, histopathological scores, and mtDNA deletion ratios were observed in group I compared to control group at days 7 and 30 (p<0.05). In group II, there was a slight decrease in body weight at same days (p=0.931 and 0.084, respectively). Kidney function tests, histopathological scores, and mtDNA common deletion ratios were statistically better in group II than group I at 7th and 30th day (p<0.05). Although creatine significantly reversed kidney functions and pathological findings, this improvement was not sufficient to reach normal control group's results at days 7 and 30. In conclusion, the present study demonstrates that creatine administration is a promising adjuvant protective drug for reducing nephrotoxic effect of cisplatin.

[Strongyloides stercoralis in a patient with ankylosing spondylitis: case report]. / Ankilozan Spondilitli Bir Hastada Strongyloides stercoralis: Olgu Sunumu.

Strongyloidiasis is a nematode-borne disease caused by several Strongyloides species. This case was presented in order to indicate Strongyloidosis in immunocompromised patients with several clinical findings. A fifty-five year old male patient on corticosteroid medication for a long time because of ankylosing spondylitis was on infliximab medication for 5 years. He presented with swelling of his right foot for ten days, right shoulder stiffness and low back pain. The presence of anaemia was remarkable. S. stercoralis was reported in histological examination of endoscopic duodenal biopsy specimen. Peripheral blood smear showed 68.4% neutrophils, 17% lymphocytes, 7.5% monocytes, and 6.7% (normal range 2%-6.2) eosinophils. The level of IgE was raised: 285IU/mL (normal range 5-120IU/mL). A large number of S. stercoralis larvae were detected upon stool examination with saline and iodine mounts and the formaldehyde ether concentration method. After treatment with two cure albendazole 400 mg/day for 7 days, S. stercoralis larvae were not detected in stool examination. It is interesting that response to treatment was not observed on the first cure and the recovery was seen on the second cure. We suggest that hyperinfections should be taken into consideration in the diagnosis and treatment of immunocompromised patients with several complaints so that life-threatening effects of the nematode may be prevented.

[Evaluation of materials sent due to suspected cystic echinococcosis to the parasitology laboratory of Ondokuz Mayis University Medical School between the Years 2005-2011]. / Kistik Ekinokokkozis Süphesi ile 2005-2011 Yillari Arasinda Ondokuz Mayis Üniversitesi Tip Fakültesi Parazitoloji Laboratuvarina Gönderilen Örneklerin Degerlendirilmesi.

OBJECTIVE: Cystic echinococcosis (CE) is an important health problem common in our country. In this study, anti-Echinococcus granulosus IgG antibodies were investigated in the serum samples of 454 patients who attended the Ondokuz Mayis University, Faculty of Medicine, Department of Parasitology between 2005 and 2011. METHODS: IHA (Fumouze, France) and ELISA (R-Biopharm, Germany) tests were performed at the same time. RESULTS: While serum samples from 328 patients (72%) were negative with both tests, 81 samples (18%) were found to be positive with both tests. Forty (49%) cases were female, 41 (51%) cases were male who were positive by both tests. 25 (31%) positive cases were between 31 and 50 years old. While IHA was negative for 33 patients (7%) ELISA was positive for the same samples. In 2 patients (0.4%), both tests revealed low-positivity. CONCLUSION: Using these two tests together for serologic detection of cystic echinococcosis could be recommended because of the high sensitivity and specificity ratios.

In Vitro Effects of Ivermectin and Sulphadiazine on Toxoplasma gondii.

OBJECTIVE: Ivermectin and sulphadiazine were tested individually to determine their in vitro effects on Toxoplasma gondii grown in human epidermoid larynx carcinoma (Hep-2) cell culture. STUDY DESIGN: In-vitro study. MATERIAL AND METHODS: Toxoplasma growth was quantities by an enzyme immunoassay performed directly on the fixed cultures, using a rabbit anti-T. gondii immunoglobulin G as the first antibody and a phosphatase-labeled anti-rabbit immunoglobulin G as the second antibody. For each drug, regression models were used to quantify the relationship between optical density values and antimicrobial agent concentrations in the cultures. RESULTS: The 50% inhibitory concentrations (IC50) of ivermectin and sulphadiazine were found to be 0.2 µg/mL and 7.3 µg/mL after 48 h of exposure, respectively. None of the concentrations tested for each drugs demonstrated toxicity to Hep-2 cells after 72 h of incubation. CONCLUSION: These results indicate that ivermectin significantly inhibited replication of the tachyzoites of T. gondii RH strain.

Strongyloides stercoralis hyperinfection in a patient with rheumatoid arthritis and bronchial asthma: a case report.

OBJECTIVE: Strongyloides stercoralis is a soil-transmitted intestinal nematode that has been estimated to infect at least 60 million people, especially in tropical and subtropical regions. Strongyloides infection has been described in immunosupressed patients with lymphoma, rheumatoid arthritis, diabetes mellitus etc. Our case who has rheumatoid arthritis (RA) and bronchial asthma was treated with low dose steroids and methotrexate. METHODS: A 68 year old woman has bronchial asthma for 55 years and also diagnosed RA 7 years ago. She received immunusupressive agents including methotrexate and steroids. On admission at hospital, she was on deflazacort 5 mg/day and methotrexate 15 mg/week. On her physical examination, she was afebrile, had rhonchi and mild epigastric tenderness. She had joint deformities at metacarpophalengeal joints and phalanges but no active arthritis finding. RESULTS: Oesophagogastroduodenoscopy was performed and it showed hemorrhagic focus at bulbus. Gastric biopsy obtained and showed evidence of S.Stercoralis infection. Stool and sputum parasitological examinations were also all positive for S.stercoralis larvae. Chest radiography result had no pathologic finding. Albendazole 400 mg/day was started for 23 days. After the ivermectin was retrieved, patient was treated with oral ivermectin 200 µg once a day for 3 days. On her outpatient control at 15th day, stool and sputum samples were all negative for parasites. CONCLUSION: S.stercoralis may cause mortal diseases in patients. Immunosupression frequently causes disseminated infections. Many infected patients are completely asymptomatic. Although it is important to detect latent S. stercoralis infections before administering chemotherapy or before the onset of immunosuppression in patients at risk, a specific and sensitive diagnostic test is lacking. In immunosupressed patients, to detect S.stercoralis might help to have the patient survived and constitute the exact therapy.

[Cystic echinococcosis in Turkey from 2001-2005]. / Türkiye'de 2001-2005 Yillari Arasinda Kistik Ekinokokkozis.

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. In the present study, CE cases were determined during 2001-2005 by investigating different hospital and health directorship documents and Health Ministry documents, retrospectively. Our results show that there were 2534 (13.13%) cases in the Marmara region; 2114 (16.94%), in the Aegean region; 2578 (16.09%), Mediterranean region; 5404 (38.57%), in the Middle Anatolian region; 428 (5.70%), in the Black Sea region; 844 (6.80%), in the eastern Anatolian region; and 887 (2.75%), in the southeastern Anatolian region making a total of 14,789 CE cases. Finally, it has been determined that the patients were hospitalized for a total of 149,464 days.

A case of orbital dirofilariasis in Northern Turkey.

A 29-year-old male patient presented with complaints of a localized mass behind his right lower eyelid that had been present for the last 6 months. Ophthalmologic examination was completely normal except for a 2 cm x 2 cm painless mass localized on the inferior orbital rim behind the right lower eyelid. An excisional biopsy was planned, and an anterior orbitotomy was performed by a lateral canthotomy and inferior cantholysis. Premature rupture of the cyst occurred during dissection, disclosing a thin white parasite surrounded by copious purulent material. The parasite and surrounding cyst were submitted to laboratory for evaluation. The parasite was typed as Dirofilaria repens (13 cm, female). The patient remained symptom-free over the 4 months of postoperative follow-up. Detection of the first human case of orbital dirofilariasis in Northern Turkey, in a patient with no history of travel to any endemic areas, has raised questions about the parasite's zoonotic characteristics.

Videolaparoscopic treatment of hepatic hydatid cyst.

BACKGROUND/AIMS: Unroofing, cystopericystectomy, or cystic evaluation and omentoplasty have been used in videolaparoscopic treatment in hepatic hydatidosis since 1992. Currently it is shown that videolaparoscopic treatment has been carried out successfully in selected cases. METHODOLOGY: Fifteen hepatic hydatid cysts in 12 cases were treated by videolaparoscopic methods. Formerly in the 5 cases, the cysts were aspirated with a needle designed for a 5-mm trocar, leaving a cystic cavity that was tension-free, then scolicidal solution was injected and aspirated. In the last 7 patients an aspirator-grinder apparatus was used. Intraoperative ultrasonography was applied in all patients. RESULTS: All the cysts were treated by drainage and omentoplasty. In one case cystic cavity infection was diagnosed in the 2nd postoperative month (morbidity rate 8.33%). Another patient died due to cerebral hydatid cyst and multiple organ failure after the postoperative first month (mortality rate 8.33%). Operative mortality was not seen. CONCLUSIONS: Videolaparoscopic treatments of hepatic hydatid cysts may be carried out successfully in selected cases.

Results of alcohol and albendazole injections in hepatic hydatidosis: experimental study.

BACKGROUND: Percutaneous drainage with alcohol injection for hydatid cysts has been commonly used in the last two decades. Albendazole is the drug of choice in the medical treatment of hydatidosis, and has also been used as an intraoperative scolicidal solution. The side-effects of its local application are not well known and have not been investigated. The purpose of the present study was to investigate the effects of the intracystic injections of alcohol and albendazole solutions on the hydatid cysts and hepatobiliary system of rabbits. METHODS: There were three groups of eight rabbits: a control group, an alcohol group and an albendazole group. In all groups hepatic hydatidosis was obtained. The control group received no therapeutic procedure. Cyst liquid was aspirated, and alcohol or albendazole solutions were injected in the other two study groups. alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) levels, echinococcus indirect hemagglutination (IHA) tests, and the size and volume of the residual cysts were investigated. Liver was histopathologically evaluated. RESULTS: The ALT, AST, GGT, and alkaline phosphatase (ALP) levels were significantly higher in the alcohol group, whereas echinococcus IHA level was highest in the control group than in the study groups. Albendazole had similar effects but of a lesser degree (P < 0.01). After therapy, the cyst volume was greater in the control than in the albendazole group (P < 0.01). In histopathological evaluation hepatocellular necrosis, portal inflammation and fibrosis were most severe in the alcohol group (P < 0.01). CONCLUSIONS: Alcohol and albendazole solutions are effective as scolicidal solutions. Higher scolicidal effect and lesser side-effects on hepatobiliary system are the advantages of albendazole solution.

Intrabiliary rupture: an algorithm in the treatment of controversial complication of hepatic hydatidosis.

AIM: Intrabiliary rupture (IBR) is a common and serious complication of hepatic hydatid cyst. The incidence varies from 1% to 25%. The treatment of IBR is still controversial. We aimed to design an algorithm for the treatment of hepatic hydatidosis with IBR by reviewing our cases. METHODS: Eight cases of IBR were analyzed retrospectively. Patients were evaluated according to age, sex, clinical findings, cyst number and stage, abdominal ultrasonography and CT-scan, surgical methods, complications, results and coincidental diseases. RESULTS: Female/male ratio was 1/7. Mean age was 52.12+/-18.26 years (range 24-69 years). Right upper quadrant pain, flatulence, palpable hepatic mass were symptoms common in all patients. Cholestatic jaundice was found in four cases. In all patients, cyst evacuation and omentoplasty were performed, followed by either choledochoduodenostomy, T-tube drainage, intracavitary suturing of the orifice, two cases in each. Whereas in two patients diagnosed post-operatively percutaneous drainage of biliary collection or ERCP and sphincteroplasty were added. Morbidity and hospital stay were higher in these cases. CONCLUSION: When the diagnosis of IBR can be done pre- or intra-operatively, morbidity decreases. If a biliary fistula is seen post-operatively, endoscopic procedures such as ERCP, sphincteroplasty or nasobiliary drainage can be applied.

Dual treatment of albendazole in hepatic hydatidosis: New therapeutic modality in 52 cases.

BACKGROUND: Hepatic hydatidosis still remains as a serious problem in general surgery. Recurrence and/or secondary hydatidosis rates are up to 25% in the cases treated with surgery alone. Albendazole is the most commonly used drug in the medical treatment of echinococcosis. The aim of the present study was to evaluate the effect of albendazole using the intraoperative and perioperative periods as dual therapy. METHODS: Fifty-two cases of hepatic hydatidosis were evaluated and treated by dual treatment of albendazole together with surgery. Perioperative albendazole treatment was given in a dose of 12-15 mg/kg per day in four divided doses. The treatment started 2-28 days before the surgery when the diagnosis was established and continued for 2-24 months (4.76 +/- 3.25) postoperatively in a cyclic monthly form. A total of 1.7 microg/mL albendazole solution was used as a protoscolicidal agent in the cystic cavity intraoperatively. In the postoperative period serology, ultrasonography and computed tomography evaluations were done. The follow-up period was 5-92 months (mean: 62.48 months). RESULTS: There was no recurrence in the present study. One patient died in the 6th postoperative week due to cerebral hydatidosis and multiple organ failure. Early and late morbidity rates were 7.69 and 9.61%, respectively. CONCLUSIONS: Dual albendazole treatment is effective in the prevention of recurrences and/or secondary hydatidosis.

Multiple organ involvement hydatid cysts in a 2-year-old boy.

The cerebral hydatid cysts caused by Echinococcus granulosus are rare and occur mostly during childhood in endemic areas. A 2-year-old boy was admitted with focal neurological signs in the left extremities. Magnetic resonance imaging of the brain showed a cyst lying from right parietooccipital region to the lateral ventricle. There were also multiple cysts in his lung and liver. The cerebral hydatid cyst was surgically extracted without complications. We suggest that a differential diagnosis of hydatid cyst should be considered when a brain mass is found in a patient, even 2 years old, from an endemic area of echinococcosis.

[A practical volume controlled bleeding method in animal hemorhagic shock model]. / Deneysel hemorajik sok modelinde hacim kontrollü pratik bir kanatma yöntemi.

The bleeding method is the most widely used technique in volume controlled hemorrhagic shock model that was described as withdrawing blood by an heparinized syringe from veins of laboratory animals. However the difficulty in establishing a constant bleeding rate and volume at a desired time is the major disadvantage of this technique. This disadvantage may also lead to the mortality during the exsanguinating phase due to inconstant bleeding rate. Reversely connected infusion pump that was described in this report is a useful and practical method to withdraw blood with predetermined bleeding volume and rate. The described method can easily be applied to various pathophysiological and metabolic studies on acute blood loss.

Should intraoperative ultrasonography be used routinely in hepatic hydatidosis?

BACKGROUND/AIMS: Recurrent or secondary hydatidosis are the most important problems of hepatic hydatidosis in the late postoperative period. The spread of cystic liquid, overlooked centrally located or pericystic satellite cysts that are inconspicuous during operation are the basic reasons for the problem. METHODOLOGY: In order to prevent the risk of recurrent or secondary hydatidosis, 22 liver hydatid cystic patients were taken for a prospective study. Beyond the routine investigations and researches, after the completion of conventional surgical procedures, intraoperative ultrasonography was applied to all patients. RESULTS: In three patients the existence of cysts were not found by conventional research (13.63%), in another patient (4.54%) cysto-biliary communication which had been determined clinically but was invisible due to difficulty in anatomic localization was verified by means of intraoperative ultrasonography. CONCLUSIONS: Intraoperative ultrasonography has been thought to be beneficial to find centrally localized cysts which may be inconspicuous especially in cases of multiple cysts.

Ivermectin used in percutaneous drug injection method for the treatment of liver hydatid disease in sheep.

BACKGROUND & AIMS: Ivermectin is a macrocyclic lactone (avermectins) produced by the actinomycete Streptomyces avermitilis. In this experimental study, the effectiveness of intracystic injection of ivermectin was studied as a new approach of percutaneous treatment of cystic echinococcosis. METHODS: Twelve naturally infected sheep were selected and divided into 2 subgroups: treatment group (n = 9) and control group (n = 3). In the treatment group, approximate volume of ivermectin solution needed to achieve an intracystic concentration of 10 microg/mL was injected into cysts, but in the control group, sterile distillated water was applied. No reaspiration was performed at all. RESULTS: In the following period of 6 months, repeated sonography revealed a significant decrease in cyst sizes and progressive solidification of the cysts in the treatment group. In the control group, volumes of the cysts were increased. No major complications occurred during or after the procedure. After 6 months, all sheep were killed and examined for macroscopic and microscopic changes. Pathologic examination in the treatment group showed pericyst hyalinization, inflammatory cells in the cyst wall, degeneration of laminated and germinal membrane, and necrotic material in the cyst cavity. No viable protoscolices or daughter cysts were observed. CONCLUSIONS: Percutaneous treatment of cystic echinococcosis with ivermectin as a scolicidal agent seems to be effective in this animal model.