Is amygdala size correlated with stress?

BACKGROUND: One of the important mechanisms that regulate the stress response of the body is hypothalamic pituitary adrenal axis. One of the structures activating this axis is amygdala. We have seen people around who react calmer and cooler to very stressful situations. Are people with smaller amygdala really calmer? Or, can we say that the bigger the amygdala, which is the trigger of the body's response to stress, the more a person panics? Aim of the study is to compare the saliva cortisol levels and amygdala volume. MATERIALS AND METHODS: Study conducted with 63 male students. Magnetic resonance images of students were taken before their final exam to calculate amygdala volumes. Saliva samples of all students were taken two times to detect cortisol levels in saliva. First one was 20 days before the final exam and second one was on the exam day. We assumed that the students were stressful on exam day. RESULTS AND CONCLUSIONS: No statistically significant correlation was found between saliva cortisol levels and amygdala volume in the study.

Reconstruction of axillary contractures with thoracodorsal perforator island flap.

The axilla is one of the most frequently sites affected by contractures after severe burns. These contractures often cause cosmetic problems and functional deficiency. A variety of therapeutic methods such as skin grafting, Z-plasties, local flaps, island flaps, and free flaps, have been reported for treatment of the contractures. Each has its own advantages and drawbacks. In this clinical study we report 15 cases of post burn axillary contractures treated with thoracodorsal perforator-based cutaneous flaps. The flaps were harvested in range of sizes up to as large as 27 cmx15 cm. All flaps survived completely without even marginal necrosis. The donor sites were closed primarily except in one case who needed a small skin graft. Satisfactory improvement in shoulder abduction was obtained. The range of abduction was on average 46.6+/-19.3 degrees before the operations and 159+/-12.4 degrees after the operations. Cosmetic results were satisfactory from the patient's point of view. The thoracodorsal perforator flap can be safely raised to meet any size required even in the most severe contractures. The donor site scar may be considered as acceptable considering the advantages of the flap. We strongly recommend this flap as the treatment of choice in releasing challenging axillary contractures.

Treatment outcome of adolescents with acute lymphoblastic leukemia.

Despite intensified chemotherapy, adolescents with acute lymphoblastic leukemia (ALL) still have lower rates of survival than younger children. The purpose of our study was to compare the treatment outcome and presenting clinical and laboratory features of adolescent and younger children with newly diagnosed ALL who were treated at our pediatric hematology department. Between April 1991 and February 2000, 42 children up to 18 years of age who were newly diagnosed with ALL and treated adequately with modified ALL Berlin-Frankfurt-Münster (BFM) 90 or 95 protocols were included in this study. The patients were examined in two groups according to their ages: the first group consisted of children who were <14 years old and the second group consisted of adolescents who were >14 years old. The median age of 42 patients was 6.5 years (range: 1-16.5 years); 26% of the patients were adolescents. The results of this study demonstrated that after a median observation time of 6 years the overall survival (OS) and event-free survival (EFS) of patients who were <14 and >14 years of age were 75% vs 49% and 70% vs 40%, respectively. When adolescent and younger patients were compared to each other according to gender, WBC count at administration, French-American-British (FAB) classification, immunophenotypes, risk groups, early deaths, and relapse rates, there were no statistically significant differences. Comparative data from other studies and data from this study indicate that adolescents with ALL still have shorter OS and EFS than younger children and a steady improvement in treatment outcome for adolescents with ALL over time suggests that more intensive therapy favorably influences prognosis.

Autoimmune hemolytic anemia occurring with myelodysplastic syndrome: report of a pediatric case and review of the literature.

In this case report, we present a child who was admitted to hospital with the features of autoimmune hemolytic anemia (AIHA) and was diagnosed with myelodysplastic syndrome (MDS)-related AIHA. A 14-year-old female patient was admitted to our hospital with the chief complaints of palpitation, icterus, and fatigue for 2 months. She was pale and icteric. Diffuse hepatosplenomegaly was palpated. Hematological examination revealed a hemoglobin of 3.4 g/dl, red blood cell count of 2x10(12)/l, white blood cell count of 3x10(9)/l, platelet count of 14x10(9)/l, and reticulocyte count of 1.7%. Blood smear examination revealed significant anisocytosis, poikilocytosis, and tear drop cells. The direct Coomb's test was positive. Bone marrow aspirate showed hypercellularity, micromegakaryocytes, dyserythropoiesis, and dysmyelopoiesis with 2% blasts. The patient was diagnosed with MDS-refractory anemia and AIHA secondary to MDS. Rarely, AIHA can occur secondary to MDS. To our knowledge, this patient is the first pediatric case with MDS and AIHA reported in the literature.

Mutational analysis of beta-thalassemia cases from the Aegean region of Turkey using an allele-specific oligonucleotide hybridization technique.

The aim of the present study was to evaluate the point mutations of beta-thalassemia patients from the Aegean region of Turkey by using an allele-specific oligonucleotide hybridization technique. DNA isolated from peripheral blood samples of 75 children with beta-thalassemia major or intermedia was analyzed using a Bio-Rad mD(x)(TM)-Be Tha Gene 1 kit. We determined mutations in 56 (74.6%) patients. The allelic frequency of mutations in 150 chromosomes was as follows: IVS-I-110 (G-A) 44.1%, IVS-I-1 (G-A) 28.2%, IVS-I-6 (T-C) 13.3%, IVS-II-745 (C-G) 9.3%, IVS-II-1 (G-A) 2.7%, Cd 39 (C-T) 2.4%, -87 (C-G) 0% and Cd 6 (-A) 0%. The distribution of the mutation types was consistent with the findings of other research groups.

Corporal reactivity to adenosine and prostaglandin E1 in alloxan-induced diabetic rabbit corpus cavernosum, and the effect of insulin therapy.

OBJECTIVE: To investigate the changes in corporal reactivity to adenosine and prostaglandin E1 (PGE1 ) in corpus cavernosal strips from alloxan-induced diabetic rabbits and to determine the effects of insulin therapy. MATERIALS AND METHODS: Twenty-four New Zealand white rabbits were studied in three equal groups: group 1, control; group 2, diabetes induced by the administration of alloxan hydrochloride intravenously; group 3, as group 2 but with insulin administered after the induction of diabetes. At the end of 8 weeks, the reactivity of corpus cavernosal strips from the animals was assessed in organ chambers. RESULTS: The relaxation responses of corpus cavernosal strips to adenosine were similar in all groups, but the response to PGE1 was impaired in groups 2 and 3 compared with that in controls. CONCLUSION: If vasoactive drugs are to be used for the diagnosis or treatment of diabetic erectile impotence, direct-acting vasodilators, e.g. adenosine, must be used. In alloxan-induced diabetes, the corporal reactivity to PGE1 was impaired and insulin therapy did not restore the relaxation responses.

Effect of insulin therapy for diabetic cystopathy--urodynamic and histological findings in a rabbit model.

OBJECTIVE: To investigate the efficacy of insulin therapy in preventing cystopathic changes in diabetes using a rabbit model. MATERIALS AND METHODS: Twenty-four New Zealand white rabbits were studied in three groups: eight in group 1 as control, eight in group 2 with diabetes by administration intravenously alloxan hydrochloride and eight in group 3 administered insulin therapy after induction of diabetes. Urodynamic investigations were carried out in three groups at the end of 8 weeks. Tissue sections prepared from all groups were studied histologically. RESULTS: Bladder capacity and compliance increased in diabetic non-treated group. There was no significant difference between the control group and the diabetic group treated with insulin. The neuropathic changes were observed in the diabetic group, whereas the findings of the histological study were similar in the control and in the insulin treatment group. CONCLUSIONS: This animal model indicates that insulin therapy can prevent or delay urodynamic and histopathological changes in diabetes mellitus. These results must be supported by in vitro pharmacological studies.

An evaluation of the effectiveness of a videotape programme on interobserver reliability in outcome assessment for ankylosing spondylitis.

AIMS: A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used obsever dependent outcome measures in patients with ankylosing spondylilis (AS). METHODS: During a single day, six third-year medical students independently examined five patients with AvS in predetermined order using a Latin Square design, before and after viewing a standardized videotape demonstrating 14 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. RESULTS: Prestandardization reliability coefficients were < 0.80 for three measures. Following standardization 12 reliability coefficients exceeded 0.80. For the majority of measures prestandardization reliability coefficients were high and no further improvement in reliability could be demonstrated. CONCLUSIONS: High levels of interobserver agreement were noted prior to viewing the instructional videotape. This may represent the success of undergraduate clinical skills training programmes, or it may be the result of having reviewed an illustrated instructional text just prior to the initial patient examinations. With the exception of chest excursion, high levels of prestandardization reliability, by necessity, precluded the demonstration of significant effects from viewing the videotape. Nevertheless, the data indicate that senior medical students arc capable of reliably performing quantitative measurement in AS. Recent surveys in Canada and Australia, showing a general lack of quantitative clinical measurement in the longitudinal follow up of AS outpatients by rheumatologists, suggest that the lack of quantitation is not due to inability to reliably perform the measurements.

Prevention of painful neuromas by epineural ligatures, flaps and grafts.

Neuroma formation at the proximal end of a divided nerve is a common problem in peripheral nerve surgery. Forty-eight nerve endings in 23 patients with traumatic or post-elective surgery amputation stumps were capped with either an epineural ligature, epineural flaps or an epineural graft. Each technique was used on 16 nerve endings. After at least 6 months follow-up, pain at the nerve endings was assessed by tapping the treatment sites and asking the patients to score their pain on a visual analogue scale (VAS) from 0 to 10. The mean VAS scores were 5.18 for epineural ligatures, 4.25 for epineural flaps and 2.06 for epineural grafts. Epineural grafts were significantly more effective in preventing neuroma pain (ANOVA: F = 11.4, P < 0.05).

Penile strangulation injuries.

Penile tourniquet injury is probably not a rare entity. Various objects can cause penile strangulation, which may lead to severe injury. Three penile strangulation injuries are presented, one due to thread and two to hair. There were urethral fistulas in two cases. All patients were circumcised and had enuresis nocturna. They were treated successfully. In enuretic patients, it should be kept in mind that there may be a strangulation that can cause penile edema or ulceration and even a urethral fistula.