Pharmacokinetics of intravenous meloxicam, ketoprofen and tolfenamic acid in chukar partridge (Alectoris chukar).

1. The aim of this study was to determine the pharmacokinetics of meloxicam (MLX, 1 mg/kg body weight (BW)), ketoprofen (KETO, 2 mg/kg BW), and tolfenamic acid (TA, 2 mg/kg BW) in chukar partridge (Alectoris chukar) following intravenous (IV) administration.2. Twenty-four healthy chukar partridges were randomly divided into three equal groups (n = 8) as MLX, KETO and TA. Plasma concentrations of MLX, KETO and TA were measured using high-performance liquid chromatography-ultraviolet detection and analysed using non-compartmental analysis.3. No adverse effects were determined in chukar partridges after IV administration of MLX, KETO and TA. MLX, KETO and TA were detected in plasma up to 10, 12 and 12 h, respectively. The terminal elimination half-life of MLX, KETO and TA was 1.22, 1.77 and 1.95 h, respectively. MLX, KETO and TA exhibited volumes of distribution at a steady-state of 0.03, 0.23 and 0.41 l/kg BW, respectively. The total plasma clearance of MLX, KETO and TA was 0.02, 0.11 and 0.15 l/h/kg, respectively. The extraction ratios for MLX, KETO and TA were calculated as 0.002, 0.011 and 0.016, respectively.4. MLX, KETO and TA offer treatment in chukar partridges for various conditions with an absence of adverse reactions and properties such as short elimination half-life and low volume of distribution. However, there is a need to establish the safety and adverse effects of repeated administration, pharmacokinetics of other administration routes and pharmacological efficacy of MLX, KETO and TA in chukar partridges.

Results of modified Dufourmentel rhomboid flap in patients with extensive Sacrococcygeal pilonidal disease.

PURPOSE: The aim of our study was to assess our modified Dufourmentel flap outcomes in a standardized patient group (a symptom duration of equal to or greater than 60 months, presence of equal to or more than 3 sinus ostia or presence of sinus ostia fistulized equal to or greater than 2 cm laterally, and a normal body mass index) with extensive pilonidal sinus. METHODS: Patients who were diagnosed with chronic pilonidal sinus disease and gave consent to surgical repair with modified Dufourmentel flap were enrolled. Patients were assessed with respect to age, sex, body mass index, presenting symptom, symptom duration, number of previous operations, number of sinus ostia, length of flap rims, depth of intergluteal sulcus, distance of sinus from anus, duration of operation, time of drain removal, length of hospital stay, early postoperative complications, postoperative pain, loss of labor, length of follow-up, and recurrences. RESULTS: A total of 42 patients were enrolled. Average duration of presenting symptoms was 64.4 +/- 4.7 months and average length of follow-up was 29.4 +/- 3.6 months. Average length of hospital stay was 4.2 +/- 0.8 days, and time to return to work was 16.3 +/- 2.1 days. Two patients (4.7%) developed postoperative wound infection, one patient (2.4%) developed seroma, and three patients (7.1%) had wound dehiscence. There was no recurrence. CONCLUSION: Modified Dufourmentel flap application can be safely used in the treatment of extensive pilonidal sinus disease.

The effect on postoperative pain of pulling the rectus muscle medially during open appendectomy surgery.

AIM: We investigated whether pulling the rectus muscle medially during open appendectomy surgery had any effect on postoperative pain in this study. METHODS: This prospective study was performed on patients 6 years and older who were admitted for acute appendicitis. The patients were divided into two groups, open appendectomy was performed by pulling the rectus muscle medially in the first group and splitting the rectus muscle in the second group. Pain was evaluated in both groups at preoperative and 12 and 24 hour postoperative by using a visual analog scale graded. RESULTS: The first group consisted of 31 and the second group of 30 patients. The preoperative and 12 and 24 hour postoperative pain evaluation results were 8.25 ± 1.03, 2.96 ± 1.40 and 1.16 ± 0.93 in the first group and 8.36 ± 0.99, 4.90 ± 1.24 and 2.03 ± 1.06 respectively in the second group. There was no statistically significant difference between the two groups for age, gender, inpatient duration and preoperative pain scores while the 12 and 24 hour postoperative pain scores were lower in the first group than the second group. This difference was statistically significant (P<0.05). CONCLUSION: Performing the appendectomy by pulling the rectus muscle medially in clinics using open appendectomy will provide a more comfortable postoperative period for the children.

Defects in Na+/glucose cotransporter (SGLT1) trafficking and function cause glucose-galactose malabsorption.

Cotransporters harness ion gradients to drive 'active' transport of substrates into cells, for example, the Na+/glucose cotransporter (SGLT1) couples sugar transport to Na+ gradients across the intestinal brush border. Glucose-Galactose Malabsorption (GGM) is caused by a defect in SGLT1. The phenotype is neonatal onset of diarrhea that results in death unless these sugars are removed from the diet. Previously we showed that two sisters with GGM had a missense mutation in the SGLT1 gene. The gene has now been screened in 30 new patients, and a heterologous expression system has been used to link the mutations to the phenotype.

Sliding hernias in female children.

INTRODUCTION: Articles published in the English language report that 15-20% of the inguinal hernias in female children are sliding hernias. These studies do not specify the age at moment of surgery, neither the age distribution of sliding hernia. We retrospectively evaluated inguinal canal pathologies to answer these questions. MATERIAL AND METHOD: We retrospectively evaluated the records of the patients operated on at the Pediatric Surgery Clinics of the Ordu, Usak and Denizli State Hospitals and the Afyon Obstetrics and Gynecology Hospital. RESULTS: A total of 3105 cases had been operated on for an inguinal hernia between January 2008 and December 2010 and 673 (21.6%) were female. The most common age at surgery was between 0 and 1 years (26.5%). A sliding hernia was found in 22.4% (n = 151) of all cases. The sliding hernia rate was 45.8 (n = 82) and 14.9% (n = 69) in children younger and older than 1 year of age respectively (p < 0.05). The most frequently sliding organ in both groups was the ovary, followed by the fallopian tubes. CONCLUSION: A sliding hernia is more common in female children under the age of 1 year and surgical treatment should be planned within a short period once the diagnosis is made. In addition, this recent statistical value for subjects aged 0 to 1 year and over 1 year can be used in new clinical studies.

Sodium cotransport proteins.

Significant advances have been made in elucidating the structure of Na+ cotransport proteins. Some fifteen of these low-abundance proteins have been cloned, sequenced and functionally expressed. They are members of the 12 membrane-spanning superfamily and they segregate into two groups, the Na+/glucose (SGLT1) and Na+/Cl-/GABA (GAT-1) families. SGLT1 transporters are expressed in bacteria and animal cells, while GAT-1 transporters are mostly expressed in the brain. None have yet been found in plants.

Sodium cotransporters.

Recent studies of cloned mammalian sodium cotransporters in heterologous systems have revealed that these integral membrane proteins serve multiple functions as cotransporters, uniporters, channels and water transporters. Some progress has been gained in understanding their secondary structure, but information on helical bundling and tertiary structure is lacking. Site-directed mutagenesis and the construction of chimeras have resulted in the identification of residues and domains involved in ligand binding, and natural mutations have also been found that are responsible for human genetic diseases. Major factors in the short-term regulations of cotransporter function by protein kinases are exocytosis and endocytosis.

Automatic brain tissue segmentation in fetal MRI using convolutional neural networks.

MR images of fetuses allow clinicians to detect brain abnormalities in an early stage of development. The cornerstone of volumetric and morphologic analysis in fetal MRI is segmentation of the fetal brain into different tissue classes. Manual segmentation is cumbersome and time consuming, hence automatic segmentation could substantially simplify the procedure. However, automatic brain tissue segmentation in these scans is challenging owing to artifacts including intensity inhomogeneity, caused in particular by spontaneous fetal movements during the scan. Unlike methods that estimate the bias field to remove intensity inhomogeneity as a preprocessing step to segmentation, we propose to perform segmentation using a convolutional neural network that exploits images with synthetically introduced intensity inhomogeneity as data augmentation. The method first uses a CNN to extract the intracranial volume. Thereafter, another CNN with the same architecture is employed to segment the extracted volume into seven brain tissue classes: cerebellum, basal ganglia and thalami, ventricular cerebrospinal fluid, white matter, brain stem, cortical gray matter and extracerebral cerebrospinal fluid. To make the method applicable to slices showing intensity inhomogeneity artifacts, the training data was augmented by applying a combination of linear gradients with random offsets and orientations to image slices without artifacts. To evaluate the performance of the method, Dice coefficient (DC) and Mean surface distance (MSD) per tissue class were computed between automatic and manual expert annotations. When the training data was enriched by simulated intensity inhomogeneity artifacts, the average achieved DC over all tissue classes and images increased from 0.77 to 0.88, and MSD decreased from 0.78 mm to 0.37 mm. These results demonstrate that the proposed approach can potentially replace or complement preprocessing steps, such as bias field corrections, and thereby improve the segmentation performance.

Brain and CSF Volumes in Fetuses and Neonates with Antenatal Diagnosis of Critical Congenital Heart Disease: A Longitudinal MRI Study.

BACKGROUND AND PURPOSE: Fetuses and neonates with critical congenital heart disease are at risk of delayed brain development and neurodevelopmental impairments. Our aim was to investigate the association between fetal and neonatal brain volumes and neonatal brain injury in a longitudinally scanned cohort with an antenatal diagnosis of critical congenital heart disease and to relate fetal and neonatal brain volumes to postmenstrual age and type of congenital heart disease. MATERIALS AND METHODS: This was a prospective, longitudinal study including 61 neonates with critical congenital heart disease undergoing surgery with cardiopulmonary bypass <30 days after birth and MR imaging of the brain; antenatally (33 weeks postmenstrual age), neonatal preoperatively (first week), and postoperatively (7 days postoperatively). Twenty-six had 3 MR imaging scans; 61 had at least 1 fetal and/or neonatal MR imaging scan. Volumes (cubic centimeters) were calculated for total brain volume, unmyelinated white matter, cortical gray matter, cerebellum, extracerebral CSF, and ventricular CSF. MR images were reviewed for ischemic brain injury. RESULTS: Total fetal brain volume, cortical gray matter, and unmyelinated white matter positively correlated with preoperative neonatal total brain volume, cortical gray matter, and unmyelinated white matter (r = 0.5-0.58); fetal ventricular CSF and extracerebral CSF correlated with neonatal ventricular CSF and extracerebral CSF (r = 0.64 and 0.82). Fetal cortical gray matter, unmyelinated white matter, and the cerebellum were negatively correlated with neonatal ischemic injury (r = -0.46 to -0.41); fetal extracerebral CSF and ventricular CSF were positively correlated with neonatal ischemic injury (r = 0.40 and 0.23). Unmyelinated white matter:total brain volume ratio decreased with increasing postmenstrual age, with a parallel increase of cortical gray matter:total brain volume and cerebellum:total brain volume. Fetal ventricular CSF:intracranial volume and extracerebral CSF:intracranial volume ratios decreased with increasing postmenstrual age; however, neonatal ventricular CSF:intracranial volume and extracerebral CSF:intracranial volume ratios increased with postmenstrual age. CONCLUSIONS: This study reveals that fetal brain volumes relate to neonatal brain volumes in critical congenital heart disease, with a negative correlation between fetal brain volumes and neonatal ischemic injury. Fetal brain imaging has the potential to provide early neurologic biomarkers.

Automatic extraction of the intracranial volume in fetal and neonatal MR scans using convolutional neural networks.

MR images of infants and fetuses allow non-invasive analysis of the brain. Quantitative analysis of brain development requires automatic brain tissue segmentation that is typically preceded by segmentation of the intracranial volume (ICV). Fast changes in the size and morphology of the developing brain, motion artifacts, and large variation in the field of view make ICV segmentation a challenging task. We propose an automatic method for segmentation of the ICV in fetal and neonatal MRI scans. The method was developed and tested with a diverse set of scans regarding image acquisition parameters (i.e. field strength, image acquisition plane, image resolution), infant age (23-45 weeks post menstrual age), and pathology (posthaemorrhagic ventricular dilatation, stroke, asphyxia, and Down syndrome). The results demonstrate that the method achieves accurate segmentation with a Dice coefficient (DC) ranging from 0.98 to 0.99 in neonatal and fetal scans regardless of image acquisition parameters or patient characteristics. Hence, the algorithm provides a generic tool for segmentation of the ICV that may be used as a preprocessing step for brain tissue segmentation in fetal and neonatal brain MR scans.

Natural and traumatic sports-related fatalities: a 10-year retrospective study.

OBJECTIVE: To identify the most common causes of death during sports activity in the population of Hamburg, Germany, and to identify which groups of sportspeople are particularly in danger of dying during sports and in which types of sport most fatalities occur. DESIGN AND SETTING: We performed a 10-year autopsy-based retrospective study of all 48,335 fatalities in Hamburg and the surrounding areas that were subjected to police investigations between 1997 and 2006 and screened for sports-related deaths. The main outcome measure was cause of death depending on form of sport, age and risk factors. RESULTS: Most of the fatalities were male. In natural deaths, cardiac causes were the most frequent causes found, with running and football being the most frequent forms of sport in which death had occurred. In some of the cases, sports medical examinations had been performed before death, certifying eligibility for the respective activity. Traumatic deaths were found in all age groups, with younger age groups more likely to have traumatic than natural deaths, and as expected, occurred more commonly in "risky" outdoor activities. CONCLUSIONS: Although exercise can have beneficial effects on health, fatalities related to sports activity occur. Cardiac disease is the main cause of sudden death from natural causes. In patients with pre-existing coronary heart disease, left ventricular hypertrophy constitutes a risk factor for exercise-related sudden death. Traumatic deaths often happen on holiday outside the person's country of dwelling, and are most commonly attributable to drowning and blunt trauma. Preparticipation medical screening cannot always prevent fatal incidents during sports activity. Postmortem macroscopic and histological examination can clarify the cause of death and legal issues.

Burns in Turkish children and adolescents: nine years of experience.

AIM: The aim of this study was to describe information about burns that occur in children and adolescents in Turkey. PATIENTS AND METHODS: The subjects were 362 patients whom were younger than 18 years who were treated at 3 burn centers in 2 different regions of Turkey between 1997 and 2005. The data collected for each case were age, gender, place of residence, cause and extent of burn, body sites affected, environment in which the injury occurred, interval from injury to arrival at a burn center, hospitalization status (inpatient versus outpatient), surgical treatment, and mortality. RESULTS: The 362 patients comprised 35.5% of all 1021 burn victims admitted during the study period. There were 183 boys and 179 girls (ratio 1:0.98) and the mean total body surface area burned was 17.7+/-16.5%. The highest proportion of patients were in the 1-6 years age group. Non-bath (not immersed) hot water scalding (216 cases, 59.7%) was the leading burn cause. The most common environment in which burn injury occurred was the home. The trunk was the body site most frequently affected (62.7%). 241 (66.6%) subjects lived in urban environments and 121 (33.4%) lived in rural areas. 171 patients (47.2%) were taken directly to the burn units, whereas the others (52.8%) were referred from other medical centers. 124 (34.3%) subjects were treated as outpatients and 238 (65.7%) were hospitalized. The overall mortality rate was 8.6% (31 deaths). Of the 238 inpatients, 92 (38.7%) were treated with daily dressings only, 128 (53.8%) required debridement, and 75 (31.5%) needed both debridement and grafting. CONCLUSION: Every country needs a nationwide public education system that is aimed at preventing burns and ensuring that burn victims receive proper first aid and age-appropriate, specialized burn care.

Preventable thermal burns associated with the ignition of paint thinner: experience of a burn care network in Turkey.

AIM: This retrospective study evaluated the epidemiology of burn injuries, due to paint thinner ignition, in patients treated at the burn units of a university hospital network. METHODS: From 1997 to 2005, 28 patients with thermal burns caused by ignition of paint thinner were admitted to our burn units. Age, sex, etiologic factors, extent and localization of burns, length of hospitalization, outcomes compared with other causes of thermal burns, and mortality rates were recorded for each patient. RESULTS: There were 25 males and 3 females. Mean age of the patients was 27.88+/-14.74 years. Two patients (7.4%) came from rural regions; the majority (92.9%; n=26) lived within city boundaries. The most common etiologic factor was attempting to start a fire in the stove with paint thinner. Mean extent of burns was 48.82+/-27.39% of the total body surface area. When compared with other flame burn causes, the extent of burns was significantly greater in paint-thinner burn patients. Affected body sites, in order of most affected to least affected, were the hands, feet, head and face, neck, and trunk and genital regions. Mean length of hospitalization for survivors was 39.65+/-37.83 days. The overall mortality rate was 39.3%. Sepsis (63.6%), excessive burns with inhalation injury (18.2%), pulmonary embolism (9.1%), and respiratory failure (9.1%) were the causes of the deaths. CONCLUSION: Paint thinner ignition may cause excessive burns with high mortality rates. Its common misuse in starting stove fires by persons living in urban areas should be prevented immediately.

Immunohistochemical detection of hemoglobin in frost erythema.

Reddish discoloration of exposed skin areas, called frost erythema, is an important criterion for the diagnosis of fatal hypothermia. In the present study, we used immunohistochemistry in a prospective trial to show that on the molecular level, the correlate of frost erythema is hemoglobin without hemorrhage. Furthermore, we compared routine histological and immunohistochemical features of frost erythema, hematoma and livor mortis and established some criteria for their histological differentiation.

Analysis of jumping/falling distance from a height.

The kinematic motion analysis of 50 jumps from a height of 5m demonstrated distinguishable maxima of jumping distances between passive and active jumps (1.0-3.4 and 3.7-7.1 m, respectively). The variation of several parameters concerning the 'take-off' mechanism showed less influence regarding the jumping distances. The congruence of the trajectory of the 'free-flight' domains of the jumps and the simple model for the parabola of an inclined throw has been proven. Thus, a prediction of the distance range for heights up to 20 m was extrapolated.

Missense mutations in SGLT1 cause glucose-galactose malabsorption by trafficking defects.

Glucose-galactose malabsorption (GGM) is an autosomal recessive disorder caused by defects in the Na+/glucose cotransporter (SGLT1). Neonates present with severe diarrhea while on any diet containing glucose and/or galactose [1]. This study focuses on a patient of Swiss and Dominican descent. All 15 exons of SGLT1 were screened using single stranded conformational polymorphism analyses, and aberrant PCR products were sequenced. Two missense mutations, Gly318Arg and Ala468Val, were identified. SGLT1 mutants were expressed in Xenopus laevis oocytes for radiotracer uptake, electrophysiological experiments, and Western blotting. Uptakes of [14C]alpha-methyl-d-glucoside by the mutants were 5% or less than that of wild-type. Two-electrode voltage-clamp experiments confirmed the transport defects, as no noticeable sugar-induced current could be elicited from either mutant [2]. Western blots of cell protein showed levels of each SGLT1 mutant protein comparable to that of wild-type, and that both were core-glycosylated. Presteady-state current measurements indicated an absence of SGLT1 in the plasma membrane. We suggest that the compound heterozygote missense mutations G318R and A468V lead to GGM in this patient by defective trafficking of mutant proteins from the endoplasmic reticulum to the plasma membrane.

Comparison of peritoneal closure techniques in laparoscopic transabdominal preperitoneal inguinal hernia repair: a prospective randomized study.

PURPOSE: We aimed to compare tacker and suture techniques for peritoneal closure with respect to patient outcomes. METHODS: A total of 64 patients were included in the study, 32 being in the tacker group and 32 in the suture group. All patients underwent laparoscopic TAPP inguinal hernia repair. Both groups were compared with respect to age, sex, duration of peritoneal closure and the operation, hernia type, the number of tackers used for mesh fixation, postoperative complication rate, visual analogue scale (VAS) scores on 1st, 7th, and 30th days, duration of follow-up, and recurrence rates. RESULTS: Duration of peritoneal closure and the operation was significantly shorter in the tacker group compared to the suture group (p < 0.001, p = 0.008, respectively). Statistical analysis with the two-way analysis of variance method revealed that mesh fixation with one or two tackers did not influence postoperative pain. VAS 1 was significantly lower in patients with peritoneal closure with suture compared to the patients undergoing peritoneal closure with tacker (p = 0.027). VAS 7 and VAS 30 were lower for peritoneal closure with suture versus tacker, although the difference did not reach statistical significance (p = 0.064, p = 0.294, respectively). We observed no recurrence at an average of 21-month follow-up. CONCLUSIONS: Tacker and suture appeared to have a comparable safety for peritoneal closure in laparoscopic TAPP inguinal hernia operation. It can be suggested that peritoneal closure with tacker increased short-term pain, independent of the number of tackers used for mesh fixation. Long-term pain was similar in both groups.

Acute renal failure and infectious mononucleosis.

Renal failure is a rare complication of infectious mononucleosis, and is usually due to acute interstitial nephritis. Outcome has been variable with spontaneous recovery, death, and chronic renal failure being described. Only two patients have been reported as requiring dialysis. In some cases the aetiology of the interstitial nephritis has been open to doubt and may have been drug-induced. The case of a patient with acute renal failure associated with infectious mononucleosis and in whom interstitial nephritis appears to have been totally related to the underlying disease is described. There was an excellent response to treatment with high doses of methyl prednisolone given intravenously.

Esophageal variceal hemorrhage presenting as sudden death in outpatients.

CONTEXT: Some autopsy studies have dealt with histologic features of esophageal varices after different therapeutic procedures. However, to the best of our knowledge, no reports have been published describing outpatient characteristics that are associated with fatal esophageal variceal hemorrhage in a medicolegal autopsy population. OBJECTIVES: To (1) assess the incidence of sudden deaths from esophageal variceal hemorrhage in an unselected medicolegal autopsy population and (2) determine demographics of outpatients dying from esophageal variceal hemorrhage with special reference to blood alcohol concentrations at the time of death. DESIGN: We performed a retrospective study of all autopsy cases of sudden death from esophageal variceal hemorrhage from a total of 6038 medicolegal autopsies performed over a 5-year period (1997-2001). We analyzed individual cases to determine gender, age, location and histology of bleeding esophageal varices, pathogenic mechanism for esophageal varices, concomitant underlying diseases contributing to fatal outcome, body mass index, circumstances at the death scene, and blood alcohol levels at the time of death. We reviewed the results of toxicologic analyses of alcohol concentrations in samples of femoral venous blood and urine obtained at autopsy; concentrations had been determined by gas chromatography with mass spectroscopy and enzymatic assays. RESULTS: We identified 45 cases of fatal esophageal variceal hemorrhage that occurred out of hospital and presented as sudden death; the corresponding 5-year incidence in this autopsy population was 0.75%. All of the deceased were white; the male-female ratio was 1.6:1, and the mean age was 50.6 years. Ruptured esophageal varices were located in the lower third of the esophagus in 44 cases. Cirrhosis of the liver was present in all cases (alcoholic cirrhosis of the liver in 42 cases), and a hepatocellular carcinoma was present in 3 cases. Alcohol-induced pancreatic tissue alterations were frequently found. The results of toxicologic analysis were positive for alcohol in femoral venous blood and urine in 30 cases. Blood alcohol levels at the time of death were less than 100 mg/dL (21.7 mmol/L) in 15 cases, between 100 and 200 mg/dL (21.7 and 43.4 mmol/L) in 8 cases, and greater than 200 mg/dL (43.4 mmol/L) in the remaining 7 cases. CONCLUSIONS: Apart from abnormalities in coagulation due to poor liver function in long-term alcohol users, acute alcohol intake may represent an important factor influencing mortality in individuals with esophageal variceal hemorrhage. Acute alcohol intake has transient effects on blood clotting time caused by ethanol and its main metabolites. In the present study, bloodstains at the death scene and unusual body positions of the deceased that aroused suspicion of a violent death were leading reasons for conducting a medicolegal autopsy. Apart from aspects of forensic pathology, the demographics of our study population are also noteworthy from the viewpoint of social medicine. The data we present stress the importance of fatal esophageal variceal hemorrhage as a relevant cause of sudden death occurring outside the hospital in socially isolated, alcohol-addicted individuals.

Planned complex suicide. Report of two autopsy cases of suicidal shot injury and subsequent self-immolation.

Two cases of planned complex suicide are presented. In both cases, the suicidal persons shot themselves after making sure that in the sequel their bodies would be burnt. In the first case, a 65-year-old man had shot himself in the mouth and consequently fell into a fire he had lighted before. In the second case, a 43-year-old man set fire to his flat and shot himself directly afterwards. On the basis of the reported cases, a short literature review on planned complex suicides is given.