Evaluation of SCUBE-1 and sCD40L biomarkers in patients with hypothyroidism due to Hashimoto's thyroiditis: a single-blind, controlled clinical study.

OBJECTIVE: This study was performed to investigate the levels of platelet activation marker SCUBE-1 and sCD40L which plays some role in the progression of atherosclerosis, in patients with hypothyroidism due to Hashimoto's thyroiditis. PATIENTS AND METHODS: The cohort of this study includes 90 patients and 35 healthy volunteers, who admitted to the internal medicine out-patient. Simultaneously in the same samples; SCUBE-1 and sCD40L measurements were accomplished by enzyme-linked immunosorbent assay (ELISA). The data obtained were analyzed statistically. RESULTS: Hypothyroidism due to Hashimoto's thyroiditis in comparison to the control group that includes healthy volunteers; SCUBE-1 and sCD40L, were increased. And these results were statistically significant (p < 0.05). CONCLUSIONS: SCUBE-1 and sCD40L levels were increased in Hashimoto's hypothyroidism patients. This may indicate an increased endothelial dysfunction, platelet activation and cardiovascular risk in hypothyroidism. SCUBE-1 and sCD40L may be helpful in cardiovascular risk assessment of hypothyroid patients.

Comparison of colorectal neoplastic polyps and adenocarcinoma with regard to NLR and PLR.

OBJECTIVE: Cancer-related inflammation affects many aspects of malignancy, including proliferation and survival of malignant cells, angiogenesis, and therapeutic response. Some biomarkers representing the degree of systemic inflammation, such as the Glasgow prognostic score, NLR and PLR, have been shown to have prognostic value in many kinds of cancer patients. Aim of this study to investigate to compare neutrophil/leukocyte (NLR) and platelet/lymphocyte (PLR) ratios of the patients with colorectal neoplastic polyps and colorectal cancer (CRC) and tried to determine whether this could be used as a biomarker in follow up of the patients with neoplastic polyps. PATIENTS AND METHODS: A total of 100 colorectal polyps, 113 colorectal cancers and 124 healthy controls were included in the study. Exculusion criteria were endocrinologic or metabolic diseases, acute or chronic diseases, hypertension and atherosclerotic heart diseases, renal diseases. Blood count parameters of the patients were measured. The NLR was calculated as a simple ratio between the absolute neutrophil and the absolute lymphocyte counts. The PLR was defined as the platelet counts to lymphocyte ratio. RESULTS: A statistically significant difference was not detected between Group A and C with regard to NLR and PLR. NLR and PLR were found statistically significantly high in Group B (CRC), Group A (colorectal polyp) and Group C (healthy individuals) (p < 0.001 and p < 0.001). Our study showed that the optimum NLR cut-off point for neoplastic polyps was 2.28 (sensitivity: 68.7%, specificity: 42.3%). When the sensitivity and specificity levels of the PLR were assessed, they were 68.7% and 46.5% for neoplastic polyps, 80% and 68.9% for colorectal cancer. CONCLUSIONS: NLR and PLR may be used for follow up conversion of colonic and rectal neoplastic polyps to invasive tumor.

The effect of high altitude commercial air travel on oxygen saturation.

Air travel has increased steadily over the last decade, and its effect on the health of passengers has been the subject of much debate. There is a paucity of evidence on the effects of air travel on oxygen saturation in general populations. The peripheral oxygen saturation and pulse rate of 84 passengers, aged 1-78 years, were measured by pulse oximetry at round level and altitude during air travel. There was a statistically significant reduction in oxygen saturation in all passengers travelling long haul and short haul flights (p < 0.05). The mean [range] (SD) SpO(2) for all flights at ground level was 97% [93-100] (1.33) and at cruising altitude 93% [85-98] (2.33). Fifty-four per cent of passengers had SpO(2) values of 94% or less at cruising altitude. This is a value which may prompt physicians to administer supplemental oxygen in hospital patients.

[Clinical aspects of the diagnosis and treatment of infectious mononucleosis in primary care and in departments of infectious diseases]. / A mononucleosis infectiosa diagnózisának és ellátásnak gyakorlata az alapellátásban és az infektológiai osztályokon.

Medical documentation of the 342 patients hospitalised for infectious mononucleosis at the departments of infectious diseases of two county hospital was retrospectively reviewed between 1990 and 1996 and the most important clinical data were recorded. In order to document the effect of control measures, which were taken for the improvement diagnosis and therapy, data of the 105 infectious mononucleosis patients at one of the mentioned departments were also recorded in 1997 and 1998. The length of the time before the hospital admission (avg. 10.3 days), the length of the hospital stay (avg. 9.2 days) and the respectable amount of antibiotics taken for this indication show that this disease has great cost effect. High rate of classical clinical signs (fever, pharyngitis, lymphadenopathy, atypical cells) indicates, that the majority of the patients consulting their doctors presented the well-known signs of the disease. Only 43.6% of the patients were diagnosed as infectious mononucleosis by the G. P. s. Majority of the cases were treated for tonsillitis. 90.7% of the patients were given antibiotics before the hospital admission (avg. 1.6 antibiotics/person). 43.3% of the patients left the hospital without serologic diagnosis. After drowning lesson from the first part of this study, there was significant decrease in the rate of lack of serologic diagnosis and in the amount of consumption of antibiotics for this indication in the hospital, but there was no change at the level of G. P. s. The results of this paper demonstrate that the daily routine diagnosis and treatment of a well-known diseases differs remarkably from optimal practice. The fact is, that even if the physician has knowledge of a certain disease, does not necessarily mean that he uses it in his routine work. In order to reduce this failure, authors propose introduction of protocols and regular review of the practice.

Tracheal intubating conditions after induction with sevoflurane 8% in children. A comparison with two intravenous techniques.

We studied tracheal intubating conditions in 120 healthy children, aged 3-12 years, in a blinded, randomised clinical trial. Children were randomly allocated to one of three groups: group PS, propofol 3 mg.kg-1 and succinylcholine 1 mg.kg-1 (n = 40); group PA, propofol 3 mg.kg-1 and alfentanil 10 microg.kg-1 (n = 40); group SF, sevoflurane 8% in 60% nitrous oxide in oxygen for 3 min (n = 40). Tracheal intubating conditions were graded according to ease of laryngoscopy, position of vocal cords, coughing, jaw relaxation and movement of limbs. Overall intubating conditions were acceptable in 39 of 40 children in the propofol/succinylcholine group, 21 of 40 children in the propofol/alfentanil group and 35 of 40 children in the sevoflurane group. Children receiving propofol and succinylcholine or sevoflurane had better intubating conditions overall than those given propofol and alfentanil (p < 0.01). In conclusion, anaesthetic induction and tracheal intubation using sevoflurane 8% for 3 min is a satisfactory alternative to propofol with succinylcholine in children.

Untoward incident reporting in obstetric anaesthesia: a 6-month prospective study in Northern Ireland.

The marked reduction in the number of cases related to the provision of anaesthesia, included in the triennial Reports on Confidential Enquiries into Maternal Deaths in the UK, may limit the educational value of such reports for anaesthetists in the future. The collection, analysis and reporting of untoward events related to obstetric anaesthesia may provide an additional method of highlighting areas of clinical practice that could be improved. We report on a prospective study to identify such untoward incidents related to obstetric anaesthesia in the well circumscribed population of anaesthetists involved in this specialty in Northern Ireland. In total, 22 incidents were reported during the 6-month period of the study. A brief summary of each event is included along with a more detailed description from a sample of the reports. The advantages and disadvantages of untoward incident reporting are discussed, with recommendations made for a future survey.

[Serologic signs of Epstein-Barr-virus infections in various patients without infectious mononucleosis]. / Aktuálisan zajló Epstein-Barr-Vírusinfekció szerológiai jelei különbözö, nem mononucleosisos betegekben.

The authors detected Epstein-Barr virus (EBV) virus capsid (VCA) antibodies of IgM and IgG type together with EBNA and heterophil antibodies in the sera collected from 1882 unselected patients without infectious mononucleosis. Out of them IgM type antibodies were found in 123 cases and in an additional group of 30 patients heterophil antibodies were detected together with EBV specific virus markers. Altogether 153 patients were considered as cases of primary EBV infection, or reinfection. Comparing the distribution of age groups of the 1729 and the 153 patients, the author observed the increased incidence of elderly cases among patients with actual EBV infection, particularly above 60 years of age (P < 0.001). The 1729 patients were composed of 141 main diagnostic groups and the 153 patients with actual EBV infection consisted of 30 main diagnostic groups of which more than one third (53 cases) were of alcoholic liver diseases and patients of HBsAg carriers. The authors suppose, that in the cases of alcoholic liver diseases and of HBsAg carriers the suspected "immunocompromised" condition of those patients resulted the actual EBV infection, or reinfection. In other cases, like virus infection or meningitis serosa, it is suspected that the EBV can be responsible producing the symptoms.

[Serologic signs of Epstein Barr virus activity in acute viral hepatitis, symptomless HbsAg carriers as well as in alcoholic liver diseases]. / Az Epstein-Barr-vírus aktivitásának szerológiai jelei akut virushepatitisekben, tünetmentes HbsAg hordozókban és alkoholos eredetü májbetegségekben.

The authors, based on their previous observations, analysed the serological incidence of the EBV infection in patients with viral hepatitis, HBsAg carriers and alcoholic liver diseases compared to control group. For the better statistical comparison they have selected the patients of 20-60 years of age and by using Khi-square probe, compared the incidence of IgM and IgG type antibodies against EBV in the samples. Significantly higher incidence (P < 0.05) of IgM antibodies were found in the samples of patients with alcoholic liver disease and of HBsAg carriers compared to the patients of viral hepatitis and control group. No similar distribution was observed related to the IgG type antibodies. Certain degree of "immunocompromised" condition is suspected in the cases of patients with HBsAg carrier state and with alcoholic liver disease known from the literature as the main reason behind the relatively more frequent Epstein-Barr virus infection.

[Sero-epidemiologic study of Epstein-Barr virus markers in patients without mononucleosis at a department for infectious diseases]. / Epstein-Barr-vírus markerek szeroepidemiológiai vizsgálata infektológiai osztály nem mononucleosisos beteganyagában.

The authors have screened sera samples of 1817 unselected patients of not having infectious mononucleosis, admitted to their department, for Epstein-Barr virus (EBV) viruscapsid (VCA) IgM and IgG type antibody to detect the actual situation of EBV infection. The results were evaluated in age groups and in serological patterns. Their results indicated, that 80% of children became seropositive by 5-10 years of age and after 20 years, the rate of seropositivity was over 90% comparable to the reports from "developing" countries. IgM VCA antibodies were found in 103 samples (5.66%). The relatively high rate of only IgG VCA antibody-containing samples (480 cases, 26.41%) might indicate a previous EBV infection or the weakness of the cellular immunity of the given subject. Further studies are necessary to elucidate the problem.

Epidural infusion of alfentanil or diamorphine with bupivacaine in labour--a dose finding study.

Following induction of epidural analgesia with 0.375% bupivacaine, 120 healthy parturients were randomly assigned in a double blind fashion to one of eight infusion groups. All received 8 ml.h-1 of 0.125% bupivacaine either alone (control group), or with alfentanil at 133, 266 or 400 micrograms.h-1 (groups A1-A3) or with diamorphine at 133, 266, 400 or 533 micrograms.h-1 (groups D1-D4). Significantly longer top-up intervals were achieved with the two highest doses of both alfentanil and diamorphine when compared with bupivacaine alone (p < 0.01), making the minimum effective doses 266 micrograms.h-1 of alfentanil and 400 micrograms.h-1 of diamorphine. Perineal analgesia was better in all the opioid groups compared with the control group (p < 0.05). The intensity of motor block was greater in the control group (p < 0.05). The incidence of pruritus did not differ between groups. The highest dose of diamorphine caused significantly more nausea. No significant neonatal side-effects were demonstrated.

Penectomy in diabetic patients undergoing maintenance dialysis.

Penectomy was performed to sustain life in 2 patients with insulin-dependent and non-insulin-dependent diabetes mellitus, respectively, who were undergoing maintenance hemodialysis. Both patients previously had manifested a series of serious macro- and microvascular diabetic complications. The histopathologic findings in both cases included gangrenous necrosis of penile tissue, while case 2 also evinced calcification of penile arteries. Penectomy has been reported as the result of penile malignancy, anticoagulant toxicity, self-inflicted injury, and criminal assault. Other reports document penectomies attributed to perineal infection (Fournier's syndrome) in diabetic patients with uremia. In five previously reported cases of penectomy in diabetic patients undergoing dialysis, systemwide arteriopathy was present in all. There is an association between uremia in diabetics and predisposition to an ischemic-infectious lesion of the penis that fails to respond to antimicrobial therapy.

Epidural analgesia for labour using a continuous infusion of bupivacaine and alfentanil.

Seventy women who requested epidural pain relief in labour received a continuous epidural infusion at 8 ml h-1, which contained either 0.25% bupivacaine (n = 29), or a mixture of 0.125% bupivacaine and 0.005% alfentanil (n = 31), assigned randomly. Increments of 4 ml 0.25% bupivacaine were given on demand to prevent residual pain from uterine contractions. The two groups were compared for motor block of the lower limbs, number of increments required, type of delivery and neonatal Apgar scores. The group of women receiving the mixture of bupivacaine and alfentanil required between them seven increments; the group receiving bupivacaine alone required 15. One of the women receiving the mixture and eight of the women receiving bupivacaine alone had almost complete motor block. There were no differences in the mode of delivery or in the neonatal Apgar scores.

Anaesthetic monitoring: clinical practice in anaesthetic rooms and theatres.

Twenty anaesthetic rooms and operating theatres in Northern Ireland were visited in both 1990 and 1992. Data was collected on the availability and use of anaesthetic monitoring. In the anaesthetic rooms there were few pulse oximeters. In the theatres more monitors were available and in use. Some change in practice had occurred between 1990 and 1992, notably an increase in the monitoring of ventilation, and in the availability of printer facilities for documentation of anaesthetic records.

[Ruptured retroperitoneal bile duct cyst. An extremely rare injury after blunt abdominal trauma]. / Rupturierte retroperitoneale Gallengangszyste. Eine extrem seltene Verletzung nach stumpfem Bauchtrauma.

Management of a retroperitoneal extrahepatic bile duct cystenteric tear at a cystenteric malformation of the intra- and extrahepatic ducts (Todani IV-A) discovered during an emergency surgical procedure following an accident is presented and the problems associated with bile duct cysts are discussed. It is pointed out that acute treatment with a simple and safe method (external Kehr-T drainage) can be successful when injuries are present, although most trauma surgeon are seldom, and many never, directly confronted with injuries attributable to these extremely rare malformations.

[The role of SPECT-supported three-phase scintigraphy of red blood cells in the diagnosis of liver hemangioma]. / SPECT-tel támogatott háromfázisú vértartalom szcintigráfia szerepe a májhaemangioma specifikus diagnózisában.

The roles of planar and SPECT 99mTc labeled red blood cell (RBC) scintigraphy in the diagnosis of hepatic cavernous hemangioma were evaluated. Out of the 29 patients with various focal intrahepatic lesions 13 were diagnosed as having hemangiomas: 6 proven by surgery, and 7 proven by maintaining stable clinical course ranging from 6 to 12 month with no change in the size or appearance of the lesion on US. In the 13 patients a total of 16 hemangiomas were found. 12 of these detected by planar imaging, 2 detected by SPECT only. The sensitivity of planar RBC scintigraphy was 75%, the specificity was 100%. Although planar imaging is probably sufficient for all large or superficial hemangioma, delayed SPECT should be used with small (2-3 cm) or deeply seated lesions.

[Ultrasonic diagnosis of kidney injuries]. / Vesesérülések ultrahang-diagnosztikája.

The authors analyse on the basis of a one-year patient material the significance and primary role of ultrasonography of renal injuries in the diagnostic tactics. The importance of follow-up examination is emphasized and the ultrasonographic signs of different types of renal injuries are characterized. The attention is drawn to the ultrasonographic technique which is indispensable in the emergency attendance, quick, inexpensive, non-invasive means little stress for the patient and replaces other methods too.

[Accurate detection of hemangioma of the liver by SPECT]. / Májhaemangioma specifikus kimutatása SPECT-tel.

The hemangioma cavernosum is a frequent, benign tumor of the liver. Generally the hemangioma becomes suspected during the US examination as a secondary result. From the point of view of the differential diagnostics the three-phase blood-pool scintigraphy, a new very sensitive isotope diagnostic method, has a great importance in these cases. The images taken at the beginning, the early and the late-phase show the kind of alteration unambiguously. Since the conventional planar scintigraphy is not always able to detect the small (1-2 cm in diameter) lesions and the lesions surrounded by intact parenchyma, the SPECT has big advantage increasing the resolution of images and introducing the three-dimensional imaging. The authors illustrate the possibility of specific detection of liver hemangioma in a case by SPECT.