A rare case liver hydatid cyst containing multiple calculi.

The hydatic cyst disease, caused by Echinococcus granulosus, is a potentially lethal, which can be found anywhere in the world, but especially in endemic areas such as the Mediterranean Basin, North Africa, Eastern Europe, the Balkans and Middle East. This parasite is mainly found in the liver (3/4 of the cases), being asymptomatic in most cases and discovered accidentally on a routine abdominal ultrasound or an ultrasound done for diagnosing other pathologies. Liver hydatid cyst threatment is multimodal, which includes medical, surgical, and interventional radiologic techniques. KEY WORDS: Complication, Echinococcus Granulosus, Lithiasis, Liver Hydatid Cyst.

The effect of tadalafil on anastomotic healing in ischemic small intestine in rats.

PURPOSE: To investigate the effect of tadalafil on anastomotic healing in an ischemic small intestine. METHODS: Standardized transection and anastomosis in the small intestine were performed in 48 male Sprague-Dawley rats divided into four equal groups (n = 12): group 1, normal anastomosis; group 2, ischemic anastomosis; group 3, normal anastomosis+tadalafil treatment; group 4, ischemic anastomosis+tadalafil treatment. Ischemia was established by ligating 2 cm of mesentery on either side of the anastomosis. Tadalafil was given to the rats once a day at dose of 5 mg/kg. The anastomotic bursting pressures and hydroxyproline concentrations were measured on postoperative day 4. A histopathological evaluation of the anastomoses was also performed. RESULTS: The bursting pressure and hydroxyproline concentration in group 2 were significantly lower than those in the other groups. There was no difference in the hydroxyproline concentration among groups 1, 3, and 4. While there was no difference between groups 3 and 4, the bursting pressures were significantly higher in groups 3 and 4 than in group 1. The histopathological evaluation revealed no significant differences in inflammatory cell infiltration, vascularization, or anastomotic collagen deposition among the groups. CONCLUSION: Tadalafil treatment improved the anastomotic bursting pressure and the hydroxyproline concentration in both normal and ischemic small intestine anastomosis.

Comparison of prolene and progrip meshes in inguinal hernia repair in terms of post-operative pain, limitation of movement and quality of life.

OBJECTIVES: The study aimed to compare the techniques applying prolene mesh and progrip-self fixating mesh in terms of post-operative pain, limitation of movement and quality of life. MATERIAL AND METHODS: The study was conducted from November 2014 to January 2016 in Department of Surgery, Manisa Celal Bayar University Hospital. The study recruited 50 male patients, aged 18 and over and was carried out as a double blinded procedure. Twenty-five patients were randomly selected to receive hernia repair by progrip self-fixating mesh and 25 patients were treated with hernia repair with suture fixation method by using prolene grafts, and patients' pain follow-up was performed with face-to-face or telephone interviews with VAS (Visual Analogue Scale) and return to daily routine activities were evaluated with SF-36 (Short Form-36) quality of life scale. Recurrent hernias and emergency cases were excluded. RESULTS: The pain scores were lower and a statistically significant difference was achieved in patients in whom progrip self-fixating mesh was used in the early postoperative period. Both methods gave statistically similar results in terms of pain and quality of life. CONCLUSION: In the literature, there are some evidence that the repair applied with progrip self-fixating graft has more positive outcomes compared to the repairs applied with suture fixation. It is concluded that there is a need for longer follow-ups and larger series of cases in order to achieve a definite result.

Retrospective radiographic evaluation of the anterior loop of the mental nerve: comparison between panoramic radiography and spiral computerized tomography.

PURPOSE: This study compares the prevalence and the length of mental loops, which were measured with panoramic radiographs and spiral computerized tomographs (SCT). MATERIALS AND METHODS: Seventy-three panoramic radiographs and 73 SCTs were taken for preoperative planning of implant placement in the interforaminal region of the anterior mandible. The bone quality of both mental regions in each patient was determined by 1 experienced calibrated clinician, and the cross-sectional images of the SCTs were evaluted for bone quality according to the Lekholm and Zarb classification. Panoramic radiographs and cross-sectional SCT images were examined carefully by the same calibrated clinician to determine the presence and to measure the length of the mental loop in each patient. The relationship between these radiographs was also examined and correlated with bone quality. Paired samples t test and Pearson's correlations were used to examine the agreement between 2 radiographic methods at each bone quality. A 5% level of significance was chosen. RESULTS: The prevalence of the mental loop in panoramic radiographs and spiral CT images was 28% and 34%, respectively. The mental loop was identified more frequently in spiral CT images regardless of bone quality. The demonstration of the mental loop between radiographic methods was more pronounced in poor bone quality. The mean length of the mental loop in panoramic radiographs was 3.71 +/- 1.35 mm and 3.00 +/- 1.41 mm in SCT. Measurements for panoramic radiographs were higher than those for spiral CT images. There was a correlation of r = 0.66 (P = .01) between the 2 radiographic methods, indicating agreement. CONCLUSIONS: SCT demonstrated a higher prevalence of mental loops than panoramic radiographs. SCT can be more useful to visualize and measure the mental loop in low bone qualities. Panoramic radiographs significantly overestimate (P = .02 in type 3, P = .01 in type 4) mental loop length, which were measured in spiral CT images in poor bone quality, but there is a close correspondence between these 2 radiographs in higher quality bone.

Treatment of complex dentoalveolar injury--avulsion and loss of periodontal tissue: a case report.

Dental avulsion is a common and complex injury which affects multiple oral tissues. In this case report, a 9-year-old girl patient with two traumatically avulsed maxillary central incisors with loss of periodontal tissue was presented. Treatment guidelines for avulsed permanent teeth with open apex were carried out. Bilateral laterally sliding flap procedure was performed, to repair loss of gingival soft tissue. Conventional immobilization was carried out for 6 weeks. Five months follow-up of the patient in whom replantation was performed resulted in positive sensitivity test, no symptoms of infection, pain or any discomfort and good periodontal wound healing. In conclusion, this report presents successful replantation and periodontal treatment of a patient with complex dentoalveolar injury.

Effects of silymarin and pentoxifylline on matrix metalloproteinase-1 and -2 expression and apoptosis in experimental hepatic fibrosis.

BACKGROUND: Many therapeutic strategies have been proposed to treat liver fibrosis, but no drugs have been proved effective. Matrix metalloproteinases (MMPs) have been reported to play a role in some cellular cascades of hepatic inflammation and fibrosis. OBJECTIVE: The purpose of this study was to investigate whether silymarin and pentoxifylline (PTX) have hepatoprotective and antifibrotic effects in experimental hepatic fibrosis. METHODS: Sprague-Dawley rats were divided into 4 groups: silymarin group (silymarin 4 mg/kg · d(-1) orally, common bile duct ligation [CBDL]); PTX group (PTX 2 mg/kg · d(-1) intraperitoneally, CBDL); sham group (common bile duct [CBD] exploration only); and control group (saline 1 mL/d orally, CBDL). The CBD was explored and dissected sufficiently to allow passage of a 3/0 silk suture via midline laparotomy. On day 10, all animals were euthanized via cervical dislocation. Then, 5-cm(3) liver samples from the right lobe were removed for histomorphologic evaluation and 3-mL blood samples were taken via cardiac puncture for biochemical analyses. Apoptosis was determined using the terminal deoxynucleotidyltransferase-biotin nick end-label (TUNEL) staining method. Plasma levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyltransferase; total and indirect bilirubin concentration; hepatic MMP-1 and -2 and tissue inhibitor of MMP (TIMP)-l and -2 activity; and transforming-growth factor (TGF)-ß1 concentration were measured. Collagen content was determined by measuring hydroxyproline in liver samples. Malondialdehyde (MDA) was used to estimate lipid peroxidation. RESULTS: Thirty-two adult male Sprague-Dawley rats were divided into 4 groups: silymarin group (n = 7), PTX group (n = 7), sham group (n = 9), and control group (n = 9). Compared with the control group (14.6 [2.44]), mean (SD) hepatocyte apoptosis (as measured by the ratio of TUNEL-positive cells) was significantly suppressed in the silymarin group (1.2 [0.13]; P = 0.001) and the PTX group (3.8 [0.34]; P = 0.001). Mean (SD) MMP-2 activity in the silymarin group (57.35 [9.89] µg/mL; P = 0.04) and the PTX group (46.88 [9.56] µg/mL; P = 0.04) was significantly lower than that observed in the control group (232.32 [79.76] µg/mL). Compared with the control group (1.37 [0.38] µg/mL), TIMP-2 activity was significantly lower in the silymarin group (0.55 [0.13] µg/mL; P = 0.04) and the PTX group (0.42 [0.09] µg/mL; P = 0.01). Compared with the control group (909.17 [117.35] µg/mL), TGF-ß1 was significantly lower in the silymarin group (518.24 [30.34] µg/mL; P = 0.01) and the PTX group (519.57 [47.27] µg/mL; P = 0.01). Histomorphologic changes were significantly greater in the sham group than in the silymarin and PTX groups: hemorrhage (2.44 [0.29] vs 1.29 [0.18] and 1.57 [0.20], respectively; both, P = 0.04); sinusoidal dilatation (2.22 [0.22] vs 1.57 [0.20] and 1.71 [0.18]; both, P = 0.04); presinusoidal polymorphonuclear cell infiltration (3-44 [0.24] vs 2.57 [0.20] and 2.14 [0.26]; P = 0.03 and P = 0.008, respectively); and inflammation (3.44 [0.24] vs 2.57 [0.20] and 2.14 [0.26]; P = 0.03 and P = 0.008, respectively). In the control group, all biochemical markers were elevated, supporting the presence of liver injury. Compared with the control group (630.00 [46.80] U/L), plasma AST activity was significantly lower in the silymarin group (443.11 [78.73]; P = 0.04) and the PTX group (349.42 [34.00]; P = 0.03). Compared with the control group (191.12 [32.93] U/L), plasma ALT activity was significantly lower in the silymarin group (86.14 [4.97]; P = 0.04) and the PTX group (84.14 [11.21]; P = 0.04). MDA concentration was significantly lower in the silymarin group compared with the control group (0.08 [0.01] vs 0.22 [0.03] nmol/mL; P = 0.004); MDA was also significantly lower in the silymarin group than in the PTX group (0.11 [0.02]; P = 0.03). CONCLUSIONS: Silymarin and PTX were associated with lower histopathologic liver damage, hepatocyte apoptosis, and regulation of extracellular matrix proteins. Lipid peroxidation in hepatocytes was significantly lower in the silymarin group compared with the PTX group. Silymarin and PTX appeared to have hepatoprotective effects in this experimental liver fibrosis model, but further clinical and experimental studies are needed.

Anxiety and depression in patients with sudden one-sided hearing loss.

Sudden sensorineural hearing loss is a hearing loss of >30 dB in at least three consecutive frequencies that occurs in 3 days. The aim of this study was to investigate anxiety and depression caused by sudden, idiopathic, one-sided hearing loss. The levels of anxiety and depression in patients with this type of hearing loss were determined using the Beck Anxiety Scale (BAS) and the Beck Depression Inventory (BDI) at the time of the patient's first visit. In total, 56 patients (32 men and 24 women) with a mean age of 32.8 ± 9.9 years (range: 20 to 58 years) were selected as the patient group and 45 individuals without symptoms of anxiety and depression were selected as the control group. The mean pretreatment air-conduction threshold and bone-conduction threshold were 61.1 ± 26.1 and 49.4 ± 13.8, respectively. In the patient group, the pretreatment mean anxiety, depression, and hopelessness scores were 19.5 ± 10.7, 11.6 ± 8.4, and 6.2 ± 4.7, respectively. The control group's mean anxiety, depression, and hopelessness scores were 4.1 ± 3.0, 3.8 ± 2.1, and 1.8 ± 1.0, respectively. For all the tests, the difference between the patient group and the control group was statistically significant (p < 0.001 for all). Hearing levels were not correlated with scores on the BAS, BDI, and Beck Hopelessness Scale (p = 0.1, p = 0.6, and p = 0.4, respectively). In conclusion, the results of this study show that sudden hearing loss can cause anxiety and depression. Questioning patients with sudden hearing loss about symptoms associated with anxiety and depression might be useful, and a psychiatric consultation should be requested if necessary.

A Descriptive, Cross-sectional Study to Assess Quality of Life and Sexuality in Turkish Patients with a Colostomy.

A stoma affects personality, self-esteem, and body image, inevitably impacting lifestyle and quality of life (QOL). A descriptive, cross-sectional study was conducted between May 1, 2015 and May 1, 2016 to evaluate the effect of a stoma on sexual function and QOL among patients receiving care in a general surgery clinic of a university hospital in the western region of Turkey.Eligibility requirements included patients willing to participate, >18 years of age, with a colostomy for at least 4 months, who were married and/or with a sexual partner and in otherwise good physical and mental health with no rectal nerve damage or receiving radio- or chemotherapy. Data were collected during face-to-face interviews. Demographic variables (age, gender, body mass index [BMI], educational status, income level); and clinical information (duration of the precipitating disease, and stoma duration, cause, and type) were collected, and the International Index of Erectile Function (IIEF) measure; the Index of Female Sexual Function (IFSF); and a Stoma Quality of Life Scale (SQOLS) were completed. Statistical analyses were performed using descriptive statistics, Spearman's correlation coefficient, and the Mann-Whitney U test. Of the 57 study participants, 57.9% were >60 years old (mean age: 59.81 ± 10.12), more than half (57.92%) were male, 33.3% had a permanent stoma, and the mean duration of the stoma was 9.60 ± 6.40 months. Scores for all 3 outcomes were low; mean IIEF score was 3.64 ± 2.47 (range 2-10), mean IFSF score was 13.04 ± 5.19 (range 9-29), and mean SQOLS was 45.10 ± 18.88 (range 0-100). Eighteen (18) of the 33 men (54.5%) had severe, 5 (15.2%) had moderate, and 9 (27.3%) had mild erectile dysfunction. The IFSF total score for all female patients was <30; all female patients experienced sexual dysfunction. A negative correlation between age and the SQOLS subscale sexuality/body image was found (rs = -0.305, P <.05). A positive correlation was found among BMI, erectile function (rs = 0.350, P <.05), sexual desire (rs = 0.474, P <.01), and intercourse satisfaction (rs = 0.385, P <.05). These study results provide reference data for future study and underscore the importance of assessing and addressing QOL and sexuality concerns among patients with a colostomy.

Effect of oncological treatment on serum adipocytokine levels in patients with stage II-III breast cancer.

Adipose tissue-derived hormones (adipocytokines), such as adiponectin, leptin, resistin and visfatin, and the pancreatic hormone insulin, have been suggested to play a role in carcinogenesis. we therefore hypothesized that the oncological treatment of breast cancer may alter the serum levels of these adipocytokines and insulin. In this study, we aimed to compare the serum levels of adipocytokines and insulin between the pre- and post-treatment period in patients with breast cancer. In this prospective study, 20 consecutive patients with stage II and III breast cancer underwent breast-conserving surgery or total mastectomy and/or axillary dissection. The patients received adjuvant chemotherapy and radiotherapy, if necessary. Blood samples were obtained during the preoperative period and postoperatively after completion of the adjuvant therapy. There was no statistically significant difference between the pre- and post-treatment levels of visfatin, adiponectin and leptin. However, the serum insulin and resistin levels and insulin resistance were found to be statistically significantly increased following treatment (P<0.05). Post-treatment resistin levels were positively correlated with insulin resistance (r=0.45, P<0.05). Therefore, oncological treatment of stage II and III breast cancer did not affect visfatin, adiponectin and leptin levels, but statistically significantly increased resistin levels and insulin resistance. In addition, the post-treatment resistin levels were positively correlated with insulin resistance, suggesting that resistin may be involved in the development of insulin resistance in breast cancer patients following treatment.

The effect of trimetazidine on liver regeneration after partial hepatectomy under hepatic blood inflow occlusion.

BACKGROUND/AIMS: It has been shown that hepatic blood inflow occlusion impairs liver regeneration. Our aim in this study was to investigate the effect of trimetazidine, known as an anti-ischemic and anti-oxidant agent, on liver regeneration after hepatic blood inflow occlusion. METHODOLOGY: Sprague-Dawley rats were randomized into three groups. Rats in group 1 underwent 65% hepatectomy. Rats in group 2 and 3 were subjected to 15 minutes of hepatic blood inflow occlusion during 65% hepatectomy. Rats were treated with saline (in group 1 and 2) or trimetazidine (in group 3) 30 minutes before operation. Serum level of aspartate transaminase, wet to dry liver weight ratio, and liver injury score in light microscopy were studied for the evaluation of liver injury. Liver regeneration was evaluated by PCNA-labeling index (the percentage of hepatocytes staining for proliferating cell nuclear antigen), mitotic index (the percentage of mitotic hepatocytes), and liver regeneration rate (the percentage of initial liver weight). RESULTS: Rats in group 2 and 3 had significantly higher serum aspartate transaminase level, wet to dry liver weight ratio and injury score than those in group 1 on day 1 posthepatectomy. Except for serum aspartate transaminase level on day 4, these parameters were significantly higher in group 2 than in group 1 and 3 on day 1 and 4. PCNA-labeling index and mitotic index were significantly less in group 2 and 3 than in group 1 on day 1. In contrast to liver regeneration rate, both indices in group 2 were significantly less than those in group 3 on day 1. There were no differences in regeneration parameters between the groups on day 4. Survival rate was significantly higher in group 3 than in group 2. CONCLUSIONS: Fifteen minutes of hepatic blood inflow occlusion caused an injury in the remnant liver, impaired liver regeneration, and decreased survival rate after partial hepatectomy. However, pretreatment with trimetazidine reduced liver injury, and improved liver regeneration and survival rate. For situations where hepatic blood inflow occlusion is planned in major liver resection, trimetazidine pretreatment would be useful strategy to improve postoperative outcome.

Intestinal ischemia-reperfusion impairs liver regeneration after partial hepatectomy in rats.

BACKGROUND/AIMS: The deleterious effects of intestinal ischemia-reperfusion on liver are realized, but its effect on the regenerative capacity of the liver has not been studied. Our aim in this study was to determine the effect of intestinal ischemia-reperfusion on liver regeneration. METHODOLOGY: Sprague-Dawley rats were randomly divided into six groups; two sham-operated, two hepatectomy, and two hepatectomy with intestinal ischemia-reperfusion groups. To create intestinal ischemia-reperfusion, the superior mesenteric artery and collateral arteries supplying the small intestine were occluded for 20 minutes. Partial hepatectomy was performed during the period of ischemia. Ischemia-reperfusion injury in the mucosal layer of the small intestine was scored in light microscopy. Liver regeneration parameters (proliferating cell nuclear antigen labeling index for hepatocytes and liver regeneration rate), and serum levels of aspartate aminotransferase and alanine aminotransferase were studied on day 1 or 4 after operation. RESULTS: Mucosal injury score was high in the hepatectomy with intestinal ischemia-reperfusion groups. Liver regeneration rate and proliferating cell nuclear antigen labeling index were less in these groups than the hepatectomy groups on day 1 and 4. There were no differences in the serum levels of aspartate aminotransferase and alanine aminotransferase between hepatectomy and hepatectomy with intestinal ischemia-reperfusion groups. The mortality rate was higher in the hepatectomy with intestinal ischemia-reperfusion groups than the other groups. CONCLUSIONS: Ischemia and reperfusion of the small intestine impaired liver regeneration with high mortality after partial hepatectomy in the rats.

Free oxygen radical-induced acute pancreatitis. A light and electron microscopic study.

BACKGROUND/AIMS: To date direct toxic effects of free oxygen radicals in vivo on pancreatic parenchyma have not been studied thoroughly. We aimed to study: 1) the detailed histopathological changes induced by free oxygen radicals in pancreas; and 2) the preventive effect of intraductal catalase in H2O2-induced acute pancreatitis. METHODOLOGY: Wistar Albine rats were randomized into six groups. 1) First experiment: Bile-pancreatic duct was cannulated close to the liver and perfused through the duodenum with (i) normal saline solution, (ii) iron sulfate (FeSO4), (iii) hydrogen peroxide (H2O2), (iv) hydrogen peroxide and iron sulfate simultaneously. 2) Second experiment: Bile pancreatic duct was perfused either with H2O2 or H2O2 + catalase. Serum amylase and pancreas malondialdehyde levels were measured in both experiments after 3 hours of perfusion period. Tissue samples were obtained for histopathological examinations. RESULTS: 1) First experiment: Intraductal perfusion of FeSO4 or H2O2 or H2O2 + FeSO4 induced acute edematous pancreatitis with focal parenchymal necrosis. At the ultrastructural level, intracytoplasmic formation of vacuoles. fusion of the vacuoles and zymogen granules, and autophagosomes containing cellular organelles were found. Serum amylase and pancreas malondialdehyde levels, and morphological score were significantly higher in these groups than control group (p < 0.001). 2) Second experiment: Catalase perfusion simultaneously with H2O2 decreased the serum amylase and pancreas malondialdehyde levels, and morphological score significantly (p < 0.001) and prevented the desquamation of the columnar epithelium and development of gross edema but not parenchymal necrosis. CONCLUSIONS: Intraductal perfusion of FeSO4 or H2O2 or H2O2 + FeSO4-induced acute pancreatitis with marked light and electronmicroscopic changes. Intraductal perfusion of catalase and H2O2 simultaneously did not prevent or lessen the parenchymal necrosis. These findings have suggested that another mechanism of injury may also play a role in parenchymal injury in oxygen radical-induced acute pancreatitis.

Inguinal keratotic Basal cell carcinoma mimicking giant solitary trichoepithelioma.

Keratotic basal cell carcinoma may not only clinically but also histologically share more or less the same features with giant solitary trichoepithelioma. It can be difficult to distinguish these two entities from each other, even for an experienced dermatopathologist. We present an unusual case of inguinal keratotic basal cell carcinoma mimicking giant solitary trichoepithelioma in a 56-year-old woman with a finger-like tumor of 20 years duration. The patient presented with an asymptomatic, skin colored, firm, nonulcerative, nodular lesion. Scanty mitotic activity and apoptotic cells were the histopathologic findings against basal cell carcinoma, whereas absence of papillary mesenchymal bodies, presence of peritumoral lacunae detected only around the solid areas, and accumulation of amyloid-like hyalinized material were the findings in favor of basal cell carcinoma. This case illustrates that keratotic basal cell carcinoma must be taken into account in the differential diagnosis of inguinally located solitary, polypoid masses, especially giant solitary trichoepithelioma.

Effects of rofecoxib, a selective cyclooxygenase-2 inhibitor, on endothelial dysfunction, lipid peroxidation, and hepatocyte morphology in rats with sepsis-induced liver damage.

BACKGROUND: Sepsis remains a difficult problem for clinicians, with its systemic effects and high morbidity and mortality rates. The roles of oxidative stress, endothelial dysfunction, and lipid peroxidation in sepsis-induced organ damage are being investigated. OBJECTIVE: The aim of this study was to investigate the effects of selective cyclooxygenase (COX)-2 inhibition on tissue lipid peroxidation, endothelial dysfunction, and hepatic cell morphology in a rat model of sepsis. METHODS: Thirty rats with sepsis induced by cecal ligation and puncture were divided equally into 3 groups: treatment group (rofecoxib 1 mg/kg PO), control group (saline 1 mL PO), and sham group (sham surgery only). All the rats were sacrificed 1 day after sepsis induction. The livers were removed using a median laparotomy for histopathologic and biochemical analysis. RESULTS: Histomorphologic hepatic damage and lipid peroxidation were significantly reduced in the rofecoxib treatment group compared with the control group (P < 0.05 and P = 0.001, respectively). Endothelial nitric oxide synthase and inducible nitric oxide synthase staining of liver samples was statistically significantly reduced in the treatment group compared with the control group (both, P < 0.001). The hepatic nitric oxide level and malonyldialdehyde activity decreased significantly (P < 0.001 and P = 0.001, respectively) in the rofecoxib group compared with the control group. Hepatic myeloperoxidase activity was similar between the treatment and control groups. CONCLUSION: Further investigation of selective COX-2 inhibition as an alternate therapeutic choice for sepsis-induced hepatic damage should be considered.

Hepatic perfusion changes in an experimental model of acute pancreatitis: evaluation by perfusion CT.

PURPOSE: It is known that acute pancreatitis may cause secondary changes in several organs. Liver is one of these involved organs. In different experimental studies hepatic damages were shown histopathologically in acute pancreatitis but there are a few studies about perfusion disorders that accompany these histopathologic changes. Perfusion CT (pCT) provides the ability to detect regional and global alterations in organ blood flow. The purpose of the study was to describe hepatic perfusion changes in experimental acute pancreatitis model with pCT. MATERIALS AND METHODS: Forty Sprague-Dawley rats of both genders with average weights of 250 g were used. Rats were randomized into two groups. Twenty rats were in control group and 20 in acute pancreatitis group. pCT was performed. Perfusion maps were formed by processing the obtained images with perfusion CT software. Blood flow (BF) and blood volume (BV) values were obtained from these maps. All pancreatic and liver tissues were taken off with laparotomy and histopathologic investigation was performed. Student's t test was used for statistical analyses. RESULTS: In pCT we found statistically significant increase in blood volume in both lobes of liver and in blood flow in right lobe of the liver (p<0.01). Although blood flow in left lobe of the liver increased, it did not reach statistical significance. CONCLUSION: The quantitative analysis of liver parenchyma with pCT showed that acute pancreatitis causes a significant perfusion changes in the hepatic tissue. Systemic mediators seem to be effective as well as local inflammatory changes in perfusion changes.

Clinical evaluation of Nd:YAG and 685-nm diode laser therapy for desensitization of teeth with gingival recession.

OBJECTIVES: The aim of this study was to evaluate the effectiveness of two types of lasers, the Nd:YAG laser and the 685-nm diode laser, as dentin desensitizers as well as both the immediate and late therapeutic effects on teeth with gingival recession. MATERIALS AND METHODS: The study was conducted on 56 teeth in 14 patients with Miller's class 1 and 2 gingival recession with clinically elicitable dentin hypersensitivity (DH). The patients were divided into two groups: a Nd:YAG-laser-treated group and a 685-nm diode laser-treated group. DH was assessed by means of an air stimulus, and a visual analog scale (VAS) was used to measure DH. The selected teeth in the two groups received laser therapy for three sessions. Teeth subjected to Nd:YAG-laser treatment were irradiated at 1 W and 10 Hz for 60 sec at 1064 nm, and those receiving 685-nm diode laser treatment were irradiated at 25 mW and 9 Hz for 100 sec. RESULTS: Significant reductions in DH occurred at all time points measured during the three treatment sessions in both treatment groups. Comparing the means of the responses in the three treatment sessions for the two groups revealed that the Nd:YAG laser group had a higher degree of desensitization compared to the other group (p<0.01). The immediate and late therapeutic effects of the Nd:YAG laser were more evident than those of the 685-nm diode laser. CONCLUSIONS: Both of these lasers can be used to reduce DH without adverse effects. Desensitization of teeth with gingival recession with the Nd:YAG laser was more effective than with the diode laser. The Nd:YAG laser appears to be a promising new tool for successfully reducing DH.

Gastric polypoid intramucosal carcinoma and an adjacently located leiomyoma at the cardia.

We report a 65-year-old patient with a gastric polyp of 2.5 cm in diameter located at the cardia on upper gastrointestinal (GI) endoscopy. Pathological examination of the excised polyp showed intramucosal carcinoma. Endoscopic ultrasonography (EUS) reported the lesion as early gastric carcinoma with probable submucosal involvement. On serial sections of the gastrectomy material, the lesion was an intramucosal carcinoma and surprisingly there was a leiomyoma located adjacently.

Abdominal insufflation-deflation injury in small intestine in rabbits.

OBJECTIVE: To investigate the effect of increased intra-abdominal pressure followed by abdominal deflation on small intestine with or without previous intestinal ischaemia. DESIGN: Randomised experimental study. SETTING: University hospital, Turkey. ANIMALS: 78 male New Zealand white rabbits. INTERVENTIONS: Experiment 1: 30 rabbits (10 in each group) were subjected to intra-abdominal pressure of 0 mmHg (controls), 15 mmHg or 25 mmHg for 60 minutes. Experiment 2: 48 rabbits were divided into four groups (n = 12 in each). The first comprised sham-operated controls. In the other 3, the superior mesenteric artery was occluded for 60 minutes. Reperfusion was started and maintained under intra-abdominal pressure of 0 mmHg, 15 mmHg, or 25 mmHg for one hour. Intestinal specimens were obtained five and 60 minutes after abdominal deflation in the pressure groups and at identical times in the other groups in both experiments. MAIN OUTCOME MEASURES: Intestinal malondialdehyde concentration, wet:dry intestinal weight ratio, and mucosal injury score under light microscopy. RESULTS: In experiment I the malondialdehyde concentration, wet:dry weight ratio, and mucosal injury scores were higher in the 25 mmHg group than in the other groups in both specimens. There was a significant increase in malondialdehyde concentration in the 15 mmHg group in only the 5-minute specimen. In experiment 2, except for the wet:dry weight ratio in the 5-minute specimen in the 15 mmHg group, there were significant increases in malondialdehyde concentration, wet:dry weight ratio, and mucosal injury score in all groups except controls in both specimens. Malondialdehyde concentration and wet:dry weight ratio were higher in the 25 mmHg group than in the 0 mmHg group in the 60-minute specimen, and higher than the 15 mmHg group in both specimens. Wet:dry weight ratio was less in the 15 mmHg group than the 0 mmHg group in both specimens. Mucosal injury score was higher in the 25 mmHg group than the other groups in both specimens. CONCLUSION: Increased intra-abdominal pressure for 60 minutes followed by abdominal deflation led to an ischaemia-reperfusion-like injury in normal small intestine in rabbits, and added to reperfusion injury in the ischaemic small intestine at an intra-abdominal pressure of 25 mmHg.

Increased intraabdominal pressure impairs liver regeneration after partial hepatectomy in rats.

BACKGROUND: There are many experimental studies showing that increased intraabdominal pressure (IAP) reduces liver blood flow, leading to ischemia and portal venous congestion. But, there is no study evaluating the effect of increased IAP on liver regeneration. It is well known that acute liver ischemia and portal venous congestion impair liver regeneration. We, therefore, aimed to determine the effect of increased IAP on liver regeneration in this study. METHODS: Sprague-Dawley rats underwent partial hepatectomy with or without IAP of 12-14 mm Hg for 24 h or sham operation. Rats were randomly divided into six groups: two sham-operated groups, two hepatectomy groups, and two hepatectomy with increased IAP groups. Mitotic index, proliferating cell nuclear antigen (PCNA)-labeling index, and liver regeneration rate as liver regeneration parameters were studied on day 1 or on day 4 after operation. Additionally, serum aspartate transaminase (AST) level and histopathological changes in intestinal mucosa were studied. RESULTS: Hepatectomy with/without increased IAP groups had significantly higher serum AST levels than the sham-operated group on day 1. Serum AST level was found to be significantly higher in the hepatectomy with increased IAP group than in the other groups on day 4. Intestinal mucosal injury was found in the hepatectomy with increased IAP groups on days 1 and 4. Mitotic index and PCNA-labeling index were markedly higher in all hepatectomy with/without increased IAP groups than in the sham-operated groups. However, together with liver regeneration rate, both indices were significantly less in the hepatectomy with increased IAP groups than in the hepatectomy groups both on day 1 and on day 4. CONCLUSION: Maintenance of IAP between 12 and 14 mm Hg for 24 h impaired liver regeneration after partial hepatectomy in rats.