Prevalence of Candida africana and Candida dubliniensis, in vulvovaginal candidiasis: First Turkish Candida africana isolates from vulvovaginal candidiasis.

INTRODUCTION: Candida africana and C. dubliniensis are closely related species of C. albicans. Current phenotypic methods are not suitable to accurately distinguish all the species belonging to the C. albicans complex. Several molecular-based methods have recently been designed for discriminating among closely related Candida species. The aim of this study was to establish the prevalence of C. dubliniensis and C. africana in vulvovaginal samples with phenotypic and genotypic methods. MATERIALS AND METHODS: We re-examined 376 vulvovaginal C. albicans complex isolates. All the isolates were identified with morphological features and HWP1 gene polymorphisms. ITS and D1/D2 sequencing, carbohydrate assimilation, MALDI-TOF MS profiles and antifungal susceptibilities were evaluated for C. africana and C. dubliniensis isolates. RESULTS: Of the 376 isolates, three C. africana and three C. dubliniensis isolates (0.8% and 0.8% prevalence, respectively) were identified by molecular methods (HPW1, ITS and D1/D2) Phenotypically, C. africana differed from C. albicans and C. dubliniensis by formation of no/rare pseudohyphae, absence of chlamydospores and, the development of turquoise green colonies on CHROMagar. MALDI-TOF MS and API ID 32C could not revealed C. africana isolates. C. africana and C. dubliniensis isolates showed very low MIC values for all the tested antifungals. DISCUSSION: This first report of C. africana from Turkey provides additional data for epidemiological, phenotypic features and antimicrobial susceptibility profiles. This study also highlights the importance of using genotypic methods in combination with phenotypic methods.

The angiogenic effects of ischemic conditioning in experimental critical limb ischemia.

OBJECTIVES: Ischemic conditioning (IC) is a method of angiogenic stimulus for limb ischemia. Here, we aimed to investigate the effects of short-term repeated ischemic stimulus on critical lower limb ischemic injury. METHODS: Rats were divided into four groups consisting of 40 animals in each group: sham, ischemia, local IC, and remote IC groups. Right-leg critical limb ischemia was achieved through ligation of the iliac artery and vein in male Sprague-Dawley rats except the sham group. Repeated transient ischemia using the tourniquet method was used for IC of lower extremities in the local and remote groups. IC was performed on the right leg for the local group and on the left leg for the remote group. Ten rats in each group were sacrificed for evaluation on days 1, 7, 14, and 30. Endothelial progenitor cell (EPC) counts were measured. Gastrocnemius muscles were evaluated for the degree of ischemia. Laser Doppler blood flow measurements were performed in order to make comparison between the blood flows of the limbs of the groups. RESULTS: The blood flow in the right limb of rats in the sham (1.65 perfusion units [PU]) and local IC (1.67 PU) groups was significantly higher than the ischemic group (1.17 PU) (p = .001 and p = .022 respectively). The levels of EPCs in the ischemia (1.09 ± 0.5) and remote IC groups (1.36 ± 0.8) were significantly higher than the sham (0.38 ± 0.2) group on day 7 (p = .026 and p = .002 respectively). Remote IC and local IC groups exhibited increased histopathological ischemia on day 7 when compared with sham group (p = .001, p = .01 respectively). The angiogenic scores on the 7th, 14th and 30th days for local IC and remote IC groups were significantly higher than sham and ischemia groups. CONCLUSIONS: IC seems to be the potent activator of angiogenesis in ischemic tissue. This study provides preliminary data showing that repeated short ischemic stimuli may reduce critical ischemic injury by promoting angiogenesis.

Single-incision laparoscopic cholecystectomy: a new retraction technique.

BACKGROUND: Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot's triangle. SURGICAL TECHNIQUE: Twelve patients underwent laparo-endoscopic single site laparoscopic cholecystectomy using this retraction technique. An intra-umbilical skin incision was made by pulling out the umbilicus. A SILS port was placed through an open approach. We inserted a 10-mm 30 degrees camera through the SILS port without using any trocar. One suture was knotted in the middle of the gallbladder. Gallbladder retraction was achieved by the use of an EndoClose needle that was inserted into abdominal cavity at the subcostal border. The floppy knot was held by the notched end of the EndoClose needle. This device provided retraction of the gallbladder in every direction. CONCLUSIONS: Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.

Intestinal intussusception as a complication of typhoid fever.

Typhoid fever is a severe febrile illness caused by Salmonella typhi. Although ileal perforation and bleeding are seen more frequently, intestinal intussusception is a very rare complication of typhoid fever. A male patient was admitted to hospital due to abdominal distension and pain. Abdominal computerised tomography revealed ileal intussusception. The patient underwent exploratory laparotomy. Ileal intussusception was determined and segmental ileal resection was performed. Examination of the resected ileal segment revealed multiple ulcerous lesions that led to intussusception. The postoperative course was uneventful. The operative treatment is the subject of debate because of insufficient evidence. We recommend segmental bowel resection because of the underlying pathology.

Ileo-ileal intussusception due to inverted Meckel's diverticulum.

Meckel's diverticulum is the most common congenital anomaly of the gastro-intestinal tract. It is generally asymptomatic. Occasionally, it may cause some complications such as bleeding, obstruction, diverticulitis and intussusception. We present a case of a 21-year-old female with intussusception due to inverted Meckel's diverticulum. Diagnosis and therapy of inverted Meckel's diverticulum is a subject of debate because of its rarity and the limited number of reports in the literature.

Optimal spread spectrum watermark embedding via a multistep feasibility formulation.

We consider optimal formulations of spread spectrum watermark embedding where the common requirements of watermarking, such as perceptual closeness of the watermarked image to the cover and detectability of the watermark in the presence of noise and compression, are posed as constraints while one metric pertaining to these requirements is optimized. We propose an algorithmic framework for solving these optimal embedding problems via a multistep feasibility approach that combines projections onto convex sets (POCS) based feasibility watermarking with a bisection parameter search for determining the optimum value of the objective function and the optimum watermarked image. The framework is general and can handle optimal watermark embedding problems with convex and quasi-convex formulations of watermark requirements with assured convergence to the global optimum. The proposed scheme is a natural extension of set-theoretic watermark design and provides a link between convex feasibility and optimization formulations for watermark embedding. We demonstrate a number of optimal watermark embeddings in the proposed framework corresponding to maximal robustness to additive noise, maximal robustness to compression, minimal frequency weighted perceptual distortion, and minimal watermark texture visibility. Experimental results demonstrate that the framework is effective in optimizing the desired characteristic while meeting the constraints. The results also highlight both anticipated and unanticipated competition between the common requirements for watermark embedding.

A case of acute pancreatitis in a patient with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an auto-immune disease which can affect multiple organs. It may also involve the pancreas and in rare cases may cause acute pancreatitis. The etiology of acute pancreatitis in SLE is a matter of controversy. We present a case diagnosed with SLE that developed acute pancreatitis while being treated with corticosteroids. During the course of the disease, pancreatic pseudocysts developed and were treated by percutaneous drainage. There are few reports in the literature about the therapy of acute pancreatitis and percutaneous drainage of pseudocysts in SLE. We discuss the pathogenesis and therapy for acute pancreatitis in SLE patients.

Laparoscopic cholecystectomy for renal transplants.

The diagnosis and management of cholelithiasis in renal transplant patients are subjects of debate. The purpose of this study was to evaluate the outcomes of laparoscopic cholecystectomy in renal transplant patients with symptomatic gallstone disease. The records of 155 kidney transplant patients were reviewed, including 16 patients who, underwent laparoscopic cholecystectomy. Shortest interval time between transplantation and cholecystectomy was 2 years. Surgical morbidity were seen in two patients (12.5%) with no mortality and no graft loss. In conclusion, laparoscopic cholecystectomy can be performed safely with low morbidity in renal transplant patients who have symptomatic gallstone disease. The morbidity rate is comparable to nontransplant patients.

Hyperfunctioning parathyroid cysts: a case report.

Parathyroid cysts are infrequent lesions of which most are non-functional. They are often misdiagnosed as thyroid cysts. Pre-operative diagnosis and differentiation from thyroid cysts is generally difficult. We hereby report a case that was admitted to the emergency room and was diagnosed as hypercalcemic crisis. The mass found during the neck examination was thought to be a thyroid nodule. A right total and left subtotal thyroidectomy was performed. Palpable thyroid nodule was diagnosed as cystic parathyroid adenoma postoperatively. When a cystic lesion is found in the neck of a patient, a pararthyroid cyst should be considered.

Evaluation of leukocyte arylsulfatase-A activity in patients with breast cancer and benign breast disease.

This study was planned to evaluate the feasibility of using the assay of leukocyte arylsulfatase-A (AS-A) activity as a non-invasive diagnostic tool in patients with benign and malignant breast disease. The leukocyte AS-A activity of a total of 81 women was analyzed, including 28 healthy women, 29 women with benign breast disease (BBD) and 24 patients with primary breast cancer (BC). The mean leukocyte AS-A activity in patients with BBD was slightly higher (14.3%) that observed in the healthy subjects, but the difference was not statistically significant. In patients with BC the enzyme activity was significantly higher than in the healthy subjects (60.3%, P<0.05) and in the benign group (40.2%, P<0.05). In addition, since no significant differences have been observed between premenopausal patients and their controls, it is suggested that the measurement of leukocyte AS-A activity may not be a reliable test for differential diagnosis of benign and malignant proliferation in mammary glands due to the possible interfering effect of gonadal hormones on AS-A activity. In contrast, since peri- and postmenopausal BC patients have negligible or no gonadal activity function, the elevation in the activity of leukocyte AS-A in these age groups of patients may only be expected to originate from malignant proliferation. Based on our results, it is concluded that in patients in whom high leukocyte AS-A activities were observed the possibility of the presence of malignancy might also be high. Therefore, this test might be valuable as a non-invasive biochemical technique in combination with other established markers for the identification of masses in the breast.

Validation of MPI and PIA II in two different groups of patients with secondary peritonitis.

BACKGROUND/AIMS: There are several scoring systems designed to predict mortality in patients with peritonitis, which need validation in different patient populations. Our aim was to evaluate Mannheim Peritonitis Index (MPI) and Peritonitis Index of Altona (PIA II) in patients with postoperative peritonitis and other causes of secondary peritonitis. METHODOLOGY: The records of patients operated for intraabdominal infection between 1987-1996 in Hacettepe University Department of General Surgery, were reviewed retrospectively. A total of 473 patients were included in the study; 75 of them had postoperative peritonitis (POSTOP group) and the remaining 398 had secondary peritonitis due to other causes (OTHER group). Using multiple logistic regression, MPI and PIA II were combined in an equation and this new variable was called combined peritonitis score (CPS); CPS = -9 + (0.3 x MPI) + (-1.2 x PIA II). All patients were scored according to MPI, PIA II and CPS. Receiver-operator characteristic (ROC) curves and sharpness of scores were compared. Also mean scores in both groups, proportions of correct predictions of outcome according to scores and correlation of scores with mortality were compared. RESULTS: Overall mortality was 17.8% in OTHER group and 33.3% in POSTOP group (P = 0.0018). Higher MPI scores, lower PIA II scores and higher CPS scores were associated with higher mortality in both groups (P < 0.0001). Mean MPI values were higher, mean PIA II values were lower and mean CPS values were higher in POSTOP group (P < 0.001). The areas under ROC curves of CPS were bigger than MPI and PIA II in both groups. Sharpness of CPS was higher in both groups compared to MPI and PIA II (P < 0.05). Proportion of correct predictions of outcome was highest in CPS among the three scores (P = 0.0074). CPS had the best correlation with observed mortality. CONCLUSIONS: POSTOP group patients had higher MPI, lower PIA II and higher CPS values ending up with higher mortality. This may be because of the delay in diagnosis and treatment, resulting with higher organ failure rates. Generally the results of evaluations for MPI and PIA II are similar. When these two peritonitis scores are combined and used together in the form of CPS, all the parameters improve.