Efficiency and clinical results of bleomycin injection in the treatment of lymphatic malformations.

Background: Lymphatic malformations (LMs) are rare congenital anomalies. The traditional treatment is surgical excision, but intralesional sclerosing agent injection is also preferred as the first-choice treatment because of postoperative frequent recurrences, poor cosmetic results, and high complication rate. We aimed to evaluate the efficacy of sclerosing agent injection used in the treatment of LMs in children. Materials and Methods: We retrospectively analyzed the children who were treated for LM between January 2011 and January 2022. The lesion sizes of the patients who were injected with sclerosant (Bleomycin) under sedation anesthesia, measured by ultrasound before and after the treatment, were recorded, and the difference between them was statistically evaluated. Results: Fifteen patients were retrospectively analyzed. The mean age was 45.2 ± 14.1 months. Of these, ten (66.6%) were male and five (33.3%) were female (F/M = 1/2). The mean age of male patients was 55 ± 20.1 months; the mean age of female patients was 25.8 ± 11. Seven patients had a single dose, two had twice, and six had three and more. The mean measurable size of macrocystic lesions before treatment was 55.2 ± 28.4 mm; after treatment, it was 23.8 ± 18.2 mm. Although no measurable shrinkage was detected in microcystic lesions, it was observed that the lesion shrank to allow surgical resection. With the statistical analysis, it was seen that there was a statistically significant difference between the dimensions before and after the treatment (P < 0.05) and the sclerosant injection had a great effect on the treatment (R: 0.89). Conclusion: Intralesional injection of bleomycin is less effective for microcystic or mixed-type LMs, but provides an effective reduction for a safe surgical procedure. It is an effective treatment for macrocystic lesions.

Guanidinoacetic acid supplementation is favourable to broiler diets even containing poultry by-product meal.

1. Two consecutive trials were conducted to evaluate the effects of guanidinoacetic acid (GAA) supplementation (a creatine precursor) and energy levels in broiler diets based on maize-soybean meal (Trial 1) or that additionally included poultry by-product meal (PBPM; Trial 2) on growth performance, carcass yield and breast meat quality to 41 days of age. 2. A total of 792, one-day-old male Ross 308 broiler chickens were randomly distributed into six treatments - three energy levels (sufficient AMEn or 0.2 and 0.4 MJ/kg reduced AMEn) and two GAA levels (0.00% or 0.06%) with eight replicates for each trial. 3. Reducing dietary energy resulted in poorer body weight gain (BWG) and feed conversion ratios (FCR) for each trial (P < 0.05). However, GAA supplementation improved FCR, BWG and European Production Efficiency Factor (EPEF) (P < 0.05). 4. Dietary energy level and GAA addition had no significant effect on carcass parameters, drip loss, pH and chemical composition of breast meat (P > 0.05), but decreased relative liver weight (P < 0.05). 5. It was concluded that, regardless of dietary energy levels, supplementation of GAA to plant-based diets or those including PBPM has the potential to improve growth performance in broilers.

Serum levels of endocan, claudin-5 and cytokines in migraine.

OBJECTIVE: Endothelial dysfunction is involved in inflammatory disorders, migration, angiogenesis, and tumor progression. There is a known relationship between migraine and inflammation; however, there are conflicting data as to whether there is a link between migraine and endothelial dysfunction. The current study aimed to determine the relationships between migraine and levels of serum Endocan (ESM-1), Claudin-5 (CLDN5), IL-1ß, IL-6 and TNF-α levels, which are proven indicators of endothelial dysfunction and inflammation in patients with migraine. PATIENTS AND METHODS: Thirty-one patients and 24 healthy subjects were included in this study. Participants underwent thorough physical and neurological evaluations, and levels of serum ESM-1, CLDN5, IL-1ß, IL-6 and TNF-α were measured for each patient. RESULTS: The levels of ESM-1, CLDN5, IL-1ß, IL-6, and TNF-α were significantly higher in the migraine attack group than in the control group (p: 0.006, p: 0.002, p: 0.002, p: 0.003, p: 0.036, respectively). Additionally, there were significant differences in the ESM-1 levels of the visual analog scale (VAS) subgroup (p = 0.041), and there were moderate differences in the CLDN5 levels of the VAS subgroup (p = 0.064). CONCLUSIONS: High serum levels of IL-1ß, IL-6 and TNF-α in the migraine attack group indicate that inflammation plays a major role in migraine pathogenesis. In particular, the high ESM-1 and CLDN5 levels in patients with migraine suggest that inflammation should be investigated further, it may be a useful tool in the differential diagnosis of migraine.

Protective effects of growth hormone on bacterial translocation and intestinal damage in rats with partial intestinal obstruction.

OBJECTIVE: One of the reasons of bacterial translocation (BT) is the complete or partial intestinal obstructions (PIO) of the gastrointestinal system. In this study, we aimed to investigate the effects of recombinant human Growth Hormone (rhGH) on BT in rats with partial intestinal obstruction (PIO). MATERIAL AND METHODS: The rats were randomly divided into the 4 groups: Group I: Sham-operated (SO) (n = 12), Group II control PIO (n = 12), Group III: PIO with rhGH treatment for 5 days (n = 12), Group IV: PIO with rhGH treatment 5 days before PIO and 5 days after PIO (a total of 10 days) (n = 12). In the groups III and IV, the effects of 5 and 10 days administered rhGH were examined. RESULTS: The level of serum and of intestinal fluid IgA was significantly higher in the Group IV compared to the Group I, Group II and Group III. In the Group IV, the number of small intestinal goblet and colonic goblet cells, and the lengths of intestinal mucosal villi and crypt depths were statistically significantly higher than in Groups II and III. The rate of bacterial translocation was higher in the Group II: 100 % in MLNs, 41.6 % in blood culture and 50.8 % in the liver cultures, it was significantly higher compared to the other groups (p < 0.01). CONCLUSIONS: The study results demonstrated that administration of rhGH to the rats with PIO for at least 10 days decreased bacterial translocation (Fig. 3, Ref. 25).

Bacterial translocation and intestinal injury in experimental necrotizing enterocolitis model.

OBJECTIVE: To study the occurrence of bacterial translocation and to assess the impact of breastfeeding on bacterial translocation in the animal model of necrotizing enterocolitis. METHODS: A total of 20 neonate Sprague-Dawley rats were enrolled in the study. Rats were randomly allocated into either control or study group just after birth. Ten newborn rats in the control group were left with their mother to be breast-fed. In contrary, necrotizing enterocolitis group consisted of neonates that were separated from their mothers, housed in an incubator and were gavaged with a special rodent formula three times daily. Survival rates, weight changes, and morphologic scoring obtained after microscopic evaluation were determined as microbiologic evaluation criteria. RESULTS: All the rats in the control group survived, while 1 (10 %) rat died in the necrotizing enterocolitis group. Mortality rates of the two groups were similar. All the formula-fed animals in the necrotizing enterocolitis group had significant weight loss compared to the breast milk-fed rats in the control group (p<0.05). A total of 7 (70 %) and 2 (20 %) E. coli growths were identified in the bowel lumen, liver, and spleen of necrotizing enterocolitis and control groups, respectively. This difference was statistically significant. In peritoneal smear cultures, a total of 3 (30 %) growths were detected in the necrotizing enterocolitis group and 1 (10 %) growth in the control group. CONCLUSION: As the result of a disturbance in the intestinal flora and impairment of the intestinal barrier in necrotizing enterocolitis, microrganisms in the bowel pass through the intestinal barrier and reach the liver and the spleen via the hematogenous route. This condition is closely related to the impairment of physiological and functional features of the intestinal barrier and is independent from the degree of intestinal injury. Bacterial translocation should be remembered in cases suspected of necrotizing enterocolitis, and a rapid and effective treatment algorithm should be applied in such circumstances (Tab. 3, Fig. 3, Ref. 21). Full Text in PDF www.elis.sk.

Is there any requirement for celiac disease screening routinely in postmenapausal women with osteoporosis?

Screening studies indicate a prevalence of celiac disease (CD) of up to 1% in populations of European ancestry, yet the majority of cases remain undiagnosed. One of the common complication of CD is intestinal osteopathy or osteoporosis [bone mineral density (BMD) based diagnosis]. Available data regarding the prevalence of CD in the patients with osteoporosis are limited and controversial. The objective of this study was to perform serological testing to screen for CD among postmenopausal women with osteoporosis. We studied 192 postmenopausal women with low BMD with a mean age of 62.75 +/- 8.58 years. Among the patients, a total of 137 had osteoporosis and 55 had osteopenia. Venous blood samples were obtained for serological screening of CD and evaluation of bone metabolism. The serological screening protocol consisted of determining serum level of IgA antigliadin antibodies (AGA), IgG-AGA, IgA endomysial antibody (EMA), IgG-EMA. Subjects who were positive for both IgA-AGA and IgA-EMA were classified as having CD. Bone metabolism was evaluated by serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, 25 (OH) vitamin D, osteocalcin, serum C-telopeptide cross-linked collagen type I levels. Of the 192 patients evaluated, only one (0.5%) was found to have positive for both IgA-AGA and IgA EMA tests and accepted as having CD. Prevelance of CD in postmenopausal women with low BMD (0.5%) did not differ from prevelance of CD in normal healthy population (0.3-1%). BMD values at proximal femur level were significantly lower in IgA-AGA (+) patients when compared to IgA-AGA (-) patients. However, the mean levels of bone metabolism markers were found similiar in both IgA-AGA (+) and (-) patients. In conclusion, the results of our study suggest that there is no need for routine screening of CD in postmenopausal women with osteoporosis.

[Investigation of hemodialysis patients in terms of the presence of occult hepatitis B]. / Hemodiyaliz hastalarinin gizli hepatit B varligi yönünden arastirilmasi.

The presence of hepatitis B virus (HBV) DNA in case of negative HBV surface antigen (HBsAg) in serum is known as "occult hepatitis B". There are many reports indicating that occult HBV infections are more frequently encountered in case of hepatocellular carcinoma, hemodialysis practice and co-infections with hepatitis C virus (HCV). The aim of this study was to investigate the presence of HBV-DNA in HBsAg negative hemodialysis. patients and subjects who had never experienced hemodialysis. A total of 226 HBsAg negative sera were included to the study, of which 153 were from hemodialysis patients (97 male, 56 female; mean age: 41.3 +/- 5.8 years), and 73 were from non-hemodialyzed individuals (46 male, 27 female; mean age: 36.5 +/- 6.9 years) who had serological evidence of previous HBV and HCV infections. Of these 73 subjects, 41 were anti-HCV positive, 22 were "anti-HBc IgG positive alone", seven were anti-HBc IgG and anti-HBs positive, and three were anti-HBc IgG and anti-HBe positive, while 40 of 153 (26.1%) hemodialysis patients were anti-HCV positive. HBV and HCV markers were detected by commercial enzyme immunoassays (bioMerieux, France and Murex, UK, respectively), and HBV-DNA testing was performed by a commercial real-time polymerase chain reaction (PCR; 5700 and 7700 Sequence Detection System, Applied Biosystems, UK) assay. Nineteen (12.4%) of HBsAg-negative hemodialysis patients and five (6.8%) of the non-hemodialyzed subjects were found positive for HBV-DNA (viral loads were > or =10(4) copies/ml, and 10(3)-10(4) copies/ml, repectively). The rates of occult HBV infection in the anti-HCV positive hemodialysis patients and anti-HCV positive non-hemodialyzed subjects were detected as 27.5% (11/40) and 2.4% (1/41), respectively. These rates in the other groups were found as follows; 7.1% (8/113) in the anti-HCV negative hemodialysis patients, 9.1% (2/22) in the "anti-HBc positive alone" subjects, and 20% (2/10) in the subjects positive for anti-HBc+anti-HBs or anti-HBe. The results of this study indicated that the prevalence of HBV viremia (12.4%) in hemodialysis patients being more prominent in those of anti-HCV positive patients (27.5%) should not be overlooked. In conclusion, the hemodialysis patients should be screened by sensitive PCR-based methods for occult HBV infections, even if they were negative for HBsAg, in order to prevent or at least to decrease the transmission risk of HBV infection which is still an important health problem in dialysis units.

Effects of dietary threonine and crude protein on growth performance, carcase and meat composition of broiler chickens.

1. The aim of the study was to investigate the effects of dietary threonine (Thr) and crude protein (CP) in maize-soybean meal based diets on the growth performance, carcase traits and meat composition of broiler chickens and to determine the dietary Thr requirement for optimum performance (weight gain and feed conversion efficiency (FCE)) at 0 to 3 weeks and 3 to 6 weeks of age. 2. Two basal diets that differed in CP (191.3 or 179.7 and 176.7 or 165.4 g/kg at 0 to 3 and 3 to 6 weeks, respectively) were formulated to have identical contents of Thr (6.0 and 5.4 g/kg), energy (12.97 and 13.39 MJ ME/kg) and other essential amino acids except for Gly + Ser. Basal diets were supplemented with L-Thr from 0.6 to 1.8 g/kg in 0.6 g/kg increments. Broiler chicks (540) were randomly allocated to 9 dietary treatments with 6 replicates of 10 (5 female, 5 male) chicks. 3. A significant interaction between dietary CP and Thr was found for feed intake, body weight (BW) gain and FCE. Increasing Thr supplementation improved feed intake, BW gain and FCE, especially in high CP diets in both feeding periods. 4. Incremental increases in dietary Thr increased breast yield at both CP levels and drumstick yield only on high CP diets. The proportion of thigh decreased with Thr concentration. Liver weight was significantly reduced by Thr supplementation; abdominal fat was not affected. 5. Estimated Thr requirements for FCE increased as dietary CP increased according to an exponential model. This model indicated higher Thr requirements than those of broken-line models for growth performance.

Effects of nitric oxide synthase inhibition on intestinal damage in rats with experimental necrotizing enterocolitis.

In the inflamed intestinal mucosa of necrotizing enterocolitis (NEC), nitric oxide (NO) generated by inducible nitric oxide synthase (iNOS) may contribute to the pathogenesis of local intestinal damage. To study the importance of iNOS for the pathogenesis of NEC, the effects of selective (aminoguanidine, AG) and nonselective (L-nitroarginine methyl ester, L-NAME) iNOS inhibitors on intestinal morphologic changes were assessed in neonatal rats with experimental NEC. The neonatal rats were randomized into one of the five treatment groups. The control group consisted of rats that were breast-fed. The NEC group, consisting of neonates separated from their mothers, were gavaged with a special rodent formula to produce NEC. Rats in the sham, the AG, and the L-NAME groups were gavaged in a similar fashion to those in the NEC group; in addition, they were treated with 0.9 % saline, 10 mg/kg/day AG, and 10 mg/kg/day L-NAME, respectively. The rats were sacrificed on day 4, and the last 4 cm of terminal ileum was harvested for morphological studies and detection of nitrite and nitrate levels in tissue. The animals in the NEC and sham groups showed various degrees of intestinal inflammatory changes and increased tissue levels of nitrite and nitrate compared to those in the control group. Both AG and L-NAME treatment decreased the tissue levels of these nitrogen oxides, but the inflammatory changes of the intestine appeared to be attenuated only in the AG treated animals. L-NAME treatment did not improve the intestinal damage and increased mortality. These results may indicate that NO synthesized by iNOS plays a pathogenic role in formula-fed induced NEC and that inhibition of iNOS improves intestinal inflammatory damage.

Dokuz Eylül University (DEU) orthosis: an orthotic method of preventing ankle equinus during tibial lengthening.

An orthosis developed in Dokuz Eylül University (DEU) at the School of Physical Therapy and Rehabilitation, Department of Orthotics and Prostheticsis is described. It is applied as a non-invasive device attached to the distal ring of the Ilizarov external fixator to keep the ankle joint in a neutral position and prevent ankle equinus during tibial lengthening with Ilizarov technique. This minimises additional invasive techniques such as heel cord release and prophylactic pinning of the heel and the foot, and manipulation under anaesthesia. It may also be detached by the physiotherapist or patient when physical therapy is needed during the lengthening procedure.

Detection of head and neck cancer with 99Tc(m) glutathione: a correlative study with tissue glutathione and glutathione S-transferase levels.

In this study glutathione (GSH), a natural tripeptide which plays an important role in detoxification reactions, protecting cells against damage from xenobiotics, has been labelled with 99Tc(m) for the demonstration of head and neck cancer. Twenty-eight patients (10 females and 18 males) with various malignancies of the head and neck were given 740 MBq of 99Tc(m)-GSH intravenously and single-photon emission computed tomography (SPECT) images were obtained at 3 h. Semiquantification was performed by drawing regions of interest on three consecutive transaxial slices and tumour to background ratios were calculated. In addition, GSH and glutathione S-transferase (GST) levels were measured in the tumour samples and in normal tissue which were obtained during surgery. Scintigraphic images showed that there was increased uptake in the tumour compared to the normal contralateral side (tumour/normal tissue (mean +/- SD) = 1.94 +/- 0.76). The tissue analyses revealed increased levels of GST in tumour tissues, but both GST and GSH levels in tumour were not statistically different from those in the normal tissue. We conclude that scintigraphic visualization of head and neck tumours can be attributed to increased demand for GSH in cancer. Protein binding might account for the prolonged retention of 99Tc(m)-GSH in the malignant tissue. Like other peptides, it is accumulated and excreted by the kidneys, which allows clear visualization of the abdomen without interference from gastrointestinal system activity.

Thyroid hemiagenesis.

Thyroid hemiagenesis is a rare congenital anomaly in which one thyroid lobe fails to develop. Tc-99m pertechnetate scintigraphy and ultrasonography can be used to visualize this anomaly. The authors evaluated four cases with Tc-99m pertechnetate scintigraphy and ultrasonography and confirmed thyroid hemiagenesis. In one case, a Tc-99m MIBI scan excluded the suppresssion of the contralateral thyroid lobe. Tc-99m MIBI can be used to confirm the diagnosis of thyroid hemiagenesis.

Comparison of 99mTc-methoxyisobutyl isonitrile and 201T1 scintigraphy in visualization of suppressed thyroid tissue.

UNLABELLED: Both (201)TI and (99m)Tc-methoxyisobutyl isonitrile (MIBI) have been used in the visualization of suppressed thyroid tissue in patients with autonomously functioning thyroid nodules (AFTNs). It has been suggested that thyroid-stimulating hormone (TSH) control is not a major determinant of both tracers. However, the mechanism of thyroid uptake of these agents is controversial. In this study, we compared (201)TI and MIBI in the visualization of suppressed thyroid tissue in patients with a solitary toxic AFTN. METHODS: Thirty-two patients (13 triiodothyronine [T3] and 19 T3 + levorotatory thyroxine [T4] hyperthyroid patients) with toxic AFTNs visualized on (99m)Tc-pertechnetate scanning were included in the study. All patients underwent MIBI and (201)TI thyroid scintigraphy within a 3-d interval. The scintigrams were analyzed both visually and semiquantitatively. For the semiquantitative analysis, regions of interest (ROIs) were generated over the nodule (N) and contralateral normal lobe (E), and the mean counts in each ROI were calculated. RESULTS: The N/E uptakes (mean +/- SD) for pertechnetate, MIBI, and (201)TI were 11.37 +/- 4.53, 4.76 +/- 1.38, and 1.63 +/- 0.15, respectively, in T3 + T4 hyperthyroid patients and 9.46 +/- 3.64, 2.73 +/- 0.63, and 1.57 +/- 0.23, respectively, in T3 hyperthyroid patients. Our results showed that (201)TI uptake of suppressed thyroid tissue compared with AFTN was more prominent and significantly higher than that of MIBI for both groups of patients (P = 1.08E-05 for T3 and 6.15E-09 for T3 + T4 hyperthyroidism). There was no significant difference for either pertechnetate or (201)TI (P > 0.05) when the N/E uptakes of both groups of patients were compared. However, the N/E uptake of MIBI in T3 + T4 hyperthyroid patients was significantly higher than that in T3 hyperthyroid patients (P = 6.69E-06). CONCLUSION: Clear visualization of suppressed thyroid tissue with both (201)TI and MIBI in patients with low serum concentrations of TSH suggests that TSH is not a major factor in the thyroid uptake of either agent. (201)TI is superior to MIBI in the visualization of suppressed thyroid tissue in patients with a toxic thyroid nodule. An increased rate of metabolism in the follicular cells of AFTNs in T3 + T4 hyperthyroid patients compared with that in T3 hyperthyroid patients might be responsible for the higher N/E for MIBI compared with that for (201)TI.

The relation between the degree of gastro-oesophageal reflux and the rate of gastric emptying.

In this study, we evaluated the relationship between the degree of gastro-oesophageal reflux and the rate of gastric emptying and determined the variability of gastric emptying in children. The reproducibility of radionuclide imaging for the presence and grading of gastro-oesophageal reflux was also examined. Twenty-eight children less than 2 years of age participated in the study. For assessment of variability, all subjects underwent two scintigraphic studies. For each study, the number of reflux episodes and gastric emptying half-times were recorded. The amount of reflux was graded according to the classification suggested by Blumhagen. Patients with grade 1 reflux were considered low-grade refluxers, while patients with grade 2 or 3 reflux were considered high-grade refluxers. The level of reflux for each patient was based on the highest reflux grade recorded in either study. Of the 28 patients, 19 had reflux in at least one study. Ten patients had high-grade and nine patients low-grade reflux. All patients but one with high-grade reflux had the same grade of reflux in both studies (90%). Of nine patients with low-grade reflux, three had the same grade in both studies. The mean half-time was significantly higher for high-grade than for low-grade refluxers (P < 0.05). For subjects with low-grade reflux, this value did not differ significantly from that of non-refluxers (P > 0.05). Our results show that patients with high-grade gastro-oesophageal reflux had prolonged gastric emptying. The inter- and intra-subject variability of gastric emptying in children appeared to be low. Reproducibility for the presence and grading of gastro-oesophageal reflux by the radionuclide method was good, with the highest value being for the diagnosis of high-grade gastro-oesophageal reflux.

Effect of an additional atropine injection during dobutamine infusion for myocardial SPET.

The aim of this study was to examine the value of an additional atropine injection in patients who do not achieve an adequate heart rate during dobutamine infusion for myocardial perfusion SPET (single photon emission tomography). Patients undergoing dobutamine myocardial SPET who failed to achieve > or = 85% of their age-predicted maximal heart rate at the end of dobutamine infusion (D protocol) had a second dobutamine myocardial SPET study on a separate day with the addition of an atropine injection during the dobutamine infusion (D + A protocol). Twenty-nine patients were studied. 201Tl was used in 27 patients and 99Tc(m)-MIBI in two patients. All patients underwent coronary angiography and significant coronary artery disease was found in 19 of 29 patients. The mean heart rate obtained at the peak of dobutamine infusion in the D + A protocol was significantly higher than that in the D protocol (153.8 +/- 13.8 vs 117.5 +/- 15.3 beats min[-1]). The D + A protocol resulted in a higher diagnostic sensitivity for the detection of stenosed coronaries compared with the D protocol (87 vs 80%, P > 0.05) without changing the specificity (89% for both protocols). On the other hand, the frequency of side-effects and ECG changes during the D + A protocol was higher than that with the D protocol (32 vs 47). In conclusion, the addition of an atropine injection during dobutamine infusion resulted in a higher diagnostic sensitivity for identifying stenosed coronaries compared to dobutamine alone.