Identification of bacterial species in milk by MALDI-TOF and assessment of some oxidant-antioxidant parameters in blood and milk from cows with different health status of the udder.

This study aimed to identify bacterial pathogens in milk samples from dairy cows with subclinical and clinical mastitis as well as to assess the concentrations of oxidant-antioxidant parameters [malondialdehyde (MDA), reduced glutathione (GSH), and total GSH levels] in both blood and milk samples. From a total of 200 dairy cows in 8 farms, 800 quarter milk samples obtained from each udder were tested in the laboratory for the presence of udder pathogens. Cultivated bacteria causing intramammary infection from milk samples were identified by Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF). In addition, from tested animals 60 cows were selected including 20 healthy cows that were CMT negative, 20 cows with subclinical mastitis (SM), and 20 cows with clinical mastitis (CM) for detection of MDA, GSH, and total GSH levels in blood and milk samples. Three hundred and eighty (47.5%; 380/800), 300 (37.5%; 300/800), and 120 (15%; 120/800) of milk samples, respectively were CMT positive or SM and CM, and those positives were cows from different farms. We observed that 87.4% (332/380), 25.3% (76/300), and 34.2% (41/120) of cows with CMT positive, CMT negative, and CM had bacterial growth. The most predominantly identified bacteria were Staphylococcus chromogenes (18.7%) obtained mainly from SM and Staphylococcus aureus (16.7%) as the most frequent cause of CM. According to our results, dairy cows with CM had the highest MDA levels, the lowest GSH, and total GSH levels in both blood and milk samples however, high MDA levels and low GSH levels in milk samples with SM were observed. Based on our results, lipid oxidant MDA and antioxidant GSH could be excellent biomarkers of cow's milk for developing inflammation of the mammary gland. In addition, there was no link between nutrition and MDA and GSH levels.

Texture features of primary tumor on 18F-FDG PET images in non-small cell lung cancer: The relationship between imaging and histopathological parameters. / Características de textura del tumor primario en imágenes de 18F-FDG PET en cáncer de pulmón de células no pequeñas: la relación entre parámetros de imágenes y parámetros histopatológicos.

OBJECTIVES: The aims of this study were to evaluate the relationships between textural features of the primary tumor on FDG PET images and clinical-histopathological parameters which are useful in predicting prognosis in newly diagnosed non-small cell lung cancer (NSCLC) patients. MATERIAL AND METHODS: PET/CT images of ninety (90) patients with NSCLC prior to surgery were analyzed retrospectively. All patients had resectable tumors. From the images we acquired data related to metabolism (SUVmax, metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) and texture features of primary tumors. Histopathological tumor types and subgroups, degree of Ki-67 expression and necrosis rates of the primary tumor, mediastinal lymph node (MLN) status and nodal stages were recorded. RESULTS: Among the 2histologic tumor types (adenocarcinoma and squamous cell carcinoma) significant differences were present regarding metabolic parameters, Ki-67 index with higher values and kurtosis with lower values in the latter group. Textural heterogeneity was found to be higher in poorly differentiated tumors compared to moderately differentiated tumors in patients with adenocarcinoma. While Ki-67 index had significant correlations with metabolic parameters and kurtosis, tumor necrosis rate was only significantly correlated with textural features. By univariate and multivariate analyses of the imaging and histopathological factors examined, only gradient variance was significant predictive factor for the presence of MLN metastasis. CONCLUSIONS: Textural features had significant associations with histologic tumor types, degree of pathological differentiation, tumor proliferation and necrosis rates. Texture analysis has potential to differentiate tumor types and subtypes and to predict MLN metastasis in patients with NSCLC.

Negative effect of feeding with high energy diets on testes and metabolic blood parameters of male Japanese quails, and positive role of milk thistle seed.

In this study, it was aimed to investigate the changes in testicular tissue and cell count, testicular oxidative stress and some metabolic blood parameters of male broiler Japanese quails fed with high energy diet and milk thistle (Silybum marianum) seed. One hundred-twenty male 15-day-old Japanese quail chicks were divided into 4 equal groups with 30 each. The applications in each group were repeated 3 times with 10 animals each. Control group was fed with basal diet. Milk thistle seed group was fed with diet including 1% milk thistle seed. High energy diet group was fed with high energy diet including 10% corn syrup. High energy diet + milk thistle seed group was fed with high energy diet including 10% corn syrup along with 1% milk thistle seed. The feeding period in all groups was 35 days. When the quails reached 50 days old, a total of 48, 12 from each group (4 from each replication) were euthanized and blood samples and testes were collected. Compared with the control group, significant increases in body weight, serum cholesterol and glucose level, aspartate aminotransferase activity and testicular malondialdehyde level; however, significant decreases in serum testosterone level, testicular glutathione peroxidase activity, counts of round and elongated spermatid and sperm as well as histopathologically, significant decreases in seminiferous tubular diameter and seminiferous epithelium thickness, and marked disorganization in germinal cells were determined in quails fed with high energy diet. It was observed that almost all of the disturbances in testicular tissue, cell number, oxidant-antioxidant balance and metabolic blood parameters caused by feeding with high energy diet were significantly prevented by supplementation of milk thistle seed to the diet with high energy. On the other hand, alone milk thistle seed and high energy diet + milk thistle seed administrations decreased body weight in comparison to control and high energy diet groups. As a result, feeding with high energy diet causes disturbances in testes of male quails by affecting liver metabolic functions and testicular oxidant-antioxidant balance, but milk thistle seed addition to diet plays a protective role.

EFFICACY OF INSULIN, HEPARIN AND FENOFIBRATE COMBINATION TREATMENT IN SEVERE HYPERTRIGLYCERIDEMIA: DOUBLE CENTER EXPERIENCE.

CONTEXT: Severe hypertriglyceridemia (SH), which calls for a triglyceride (TG) level above 1000 mg/dL, remains an important health issue. While some data exist to offer combination of heparin, insulin and fenofibrate as a reasonable treatment option, safety and benefits of this therapy have not been accurately weighted, largely due to the limited sample size of the relevant studies. AIM: Assess the efficacy and safety of the heparin, insulin and fenofibrate combination in the treatment of patients with SH. PATIENTS - METHODS: Patients aged ≥18 years with TG level above 1000 mg/dL and adequate organ function were included. Triglyceride levels were measured immediately before the treatment and on the 3rd and 6th days of the treatment. Treatment dosage, duration, response and side effects were assessed. Patients with hypertriglyceridemia presenting with acute pancreatitis were treated additionally with lipid apheresis. RESULTS: A total of 42 patients were included. Of these, 85.8% came to medical attention with some kind of secondary hypertriglyceridemia causes. The baseline median TG value of the cases was 2141.0 mg/ dL (1026-12250). There were 6 patients (14.3%) with acute pancreatitis at presentation. In patients without pancreatitis, with administration of insulin infusion, unfractionated heparin infusion and fenofibrate capsule, median TG values decreased to 921 mg/ dL (190-6400) on the 3rd day and to 437 mg/ dL (112-1950) on the 6th day of the treatment (p<0.0001, Friedman test). Potential toxicities related to insulin, heparin and fenofibrate combination treatment including hypoglycemia, hemorrhage, rise in creatine kinase levels, hepato - and nephrotoxicity were not observed. CONCLUSION: In this trial involving patients with SH, our data suggest that insulin, heparin and fenofibrate combination therapy was safe and effective.

Assessment of Palliative Care in Lung Cancer in Turkey.

OBJECTIVE: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

The efficacy and safety of capecitabine plus bevacizumab combination as first-line treatment in elderly metastatic colorectal cancer patients

Aim: The optimal treatment in older persons with metastatic colorectal cancer (mCRC) is complicated by a lack of general agreement. The aim of this study was to evaluate the activity of bevacizumab plus capecitabine combination in elderly mCRC patients who were not suitable for chemotherapy with irinotecan and oxaliplatin-containing regimens. Materials and methods: Seventy years and older patients with metastatic colorectal carcinoma were included in this retrospective study. Bevacizumab was administered at a dose of 7.5 mg/kg on day 1 as an intravenous (IV) infusion over 30-90 min every 21 days, and capecitabine was prescribed at 1000 mg/m2 twice daily on days 1-14 of the same 21-day schedule. Results: Eighty-two consecutive patients (47 men, 35 women) were included in the study. The mean age was 75.5 (SD 3.9, range 70-87). Half of the patients were older than 75 years. There were 55 patients (67.1 %) with a good Eastern Cooperative Oncology Group (ECOG) performance status (PS: 0-1) and the remaining 27 patients (32.9 %) had a poor ECOG performance status (PS: 2). With a median follow-up period of 18.5 months, the median progression-free survival (PFS) was 10 months (95 % CI, 7.8-12.1) and the median OS was 25 months (95 % CI, 18.6-31.3). The main toxicities recorded were non-hematological. Thirty-one patients (37 %) experienced grade 3/4 adverse events, the most common being hand–foot syndrome (9.8 %). No fatal toxicity resulting from this regimen was recorded. Conclusions: Considering the toxicity profile and survival outcomes, the combination regimen of capecitabine and bevacizumab is a potentially feasible treatment option in elderly mCRC patients (AU)

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The administration sequence of propofol and remifentanil does not affect the ED50 and ED95 of rocuronium in rapid sequence induction of anesthesia: a double-blind randomized controlled trial.

OBJECTIVE: The topic of drug administration sequence in rapid sequence induction (RSI) is still an object of interest in terms of rocuronium effectiveness. The aim of this prospective, randomized trial was to evaluate the effect of administration sequence of propofol and remifentanil on ED50 and ED95 of rocuronium in a RSI model. PATIENTS AND METHODS: Eighty-four patients were randomized into Group Remifentanil (Group R, n = 43), where induction of general anesthesia started with remifentanil (2 µg/kg) and followed by propofol (2 mg/kg) and rocuronium administrations; and Group Propofol (Group P, n = 41), where induction of general anesthesia started with propofol and followed by remifentanil and rocuronium. First patients in each group were paralyzed by 0.8 mg/kg rocuronium. In case of acceptable intubation as evaluated according to the criteria described by Viby-Mogensen et al, rocuronium dose was decreased by 0.1 mg/kg for the next patient; otherwise, rocuronium dose was increased by 0.1 mg/kg. After three crossover points, increments or decrements in rocuronium dosage were set to 0.05 mg/kg. The process was repeated until a total of ten crossover points were obtained. RESULTS: The ED50 and ED95 doses of rocuronium were similar in Group R (0.182 mg/kg, and 0.244 mg/kg, respectively) and Group P (0.121 mg/kg, and 0.243 mg/kg, respectively) according to 95% CI of the estimates. There was no statistically significant difference in terms of clinically acceptable intubation conditions between the two groups (56.1% in Group R vs. 59% in Group P, p = 0.795). CONCLUSIONS: The choice of administration sequence of propofol and remifentanil does not have an impact on estimated ED50 and ED95 of rocuronium in providing acceptable intubation conditions in the RSI technique.

The efficacy and safety of capecitabine plus bevacizumab combination as first-line treatment in elderly metastatic colorectal cancer patients.

AIM: The optimal treatment in older persons with metastatic colorectal cancer (mCRC) is complicated by a lack of general agreement. The aim of this study was to evaluate the activity of bevacizumab plus capecitabine combination in elderly mCRC patients who were not suitable for chemotherapy with irinotecan and oxaliplatin-containing regimens. MATERIALS AND METHODS: Seventy years and older patients with metastatic colorectal carcinoma were included in this retrospective study. Bevacizumab was administered at a dose of 7.5 mg/kg on day 1 as an intravenous (IV) infusion over 30-90 min every 21 days, and capecitabine was prescribed at 1000 mg/m(2) twice daily on days 1-14 of the same 21-day schedule. RESULTS: Eighty-two consecutive patients (47 men, 35 women) were included in the study. The mean age was 75.5 (SD 3.9, range 70-87). Half of the patients were older than 75 years. There were 55 patients (67.1 %) with a good Eastern Cooperative Oncology Group (ECOG) performance status (PS: 0-1) and the remaining 27 patients (32.9 %) had a poor ECOG performance status (PS: 2). With a median follow-up period of 18.5 months, the median progression-free survival (PFS) was 10 months (95 % CI, 7.8-12.1) and the median OS was 25 months (95 % CI, 18.6-31.3). The main toxicities recorded were non-hematological. Thirty-one patients (37 %) experienced grade 3/4 adverse events, the most common being hand-foot syndrome (9.8 %). No fatal toxicity resulting from this regimen was recorded. CONCLUSIONS: Considering the toxicity profile and survival outcomes, the combination regimen of capecitabine and bevacizumab is a potentially feasible treatment option in elderly mCRC patients.

Prognostic significance of ADAM17 expression in patients with gastric cancer who underwent curative gastrectomy

Backgrounds. A disintegrin and metalloproteinase (ADAM) 17 has been indicated to be an indispensable regulator of cellular events from proliferation to migration. Although prognostic importance of ADAM17 expression has been investigated in several tumours, its clinical utility as a useful prognostic molecular marker remains unclear in gastric cancer. In the current study, we evaluated the expression of ADAM17 and its prognostic significance in gastric cancer patients after curative gastrectomy. Methods. The prognostic significance of ADAM17 expression was analysed immunohistochemically in 156 patients with gastric cancer who had undergone curative gastrectomy, and the relationship between its expression and clinicopathological factors was also evaluated. Results. High ADAM17 expression was detected in 79 patients (51 %), whereas low expression was found in 77 cases (49 %). There was significant correlation between gender, histology, lymph node metastasis, vascular invasion, the presence of recurrence and high ADAM17 expression. Recurrence in patients with high ADAM17 expression was significantly higher than that for patients with low ADAM17 expression (p = 0.032). The median disease-free survival (DFS) time for patients with tumours with high ADAM17 expression was worse than that of patients with tumours with low ADAM17 expression (16.6 vs. 44.2 months, p = 0.004). In addition, patients with low ADAM17 expression had a higher median overall survival (OS) (49.6 vs. 26.9 months, p = 0.019) compared to those with high ADAM17 expression. Multivariate analysis indicated that the rate of ADAM17 expression was an independent prognostic factor for DFS, in addition to the already known important clinicopathological prognostic indicator. But the prognostic importance of ADAM17 expression could not be proved by multivariate analysis for OS. Conclusions. The potential value of ADAM17 expression as a useful molecular marker in gastric cancer progression should be evaluated comprehensively; it may predict recurrence and poor prognosis in patients with gastric cancer after curative resection (AU)

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Prognostic significance of ADAM17 expression in patients with gastric cancer who underwent curative gastrectomy.

BACKGROUNDS: A disintegrin and metalloproteinase (ADAM) 17 has been indicated to be an indispensable regulator of cellular events from proliferation to migration. Although prognostic importance of ADAM17 expression has been investigated in several tumours, its clinical utility as a useful prognostic molecular marker remains unclear in gastric cancer. In the current study, we evaluated the expression of ADAM17 and its prognostic significance in gastric cancer patients after curative gastrectomy. METHODS: The prognostic significance of ADAM17 expression was analysed immunohistochemically in 156 patients with gastric cancer who had undergone curative gastrectomy, and the relationship between its expression and clinicopathological factors was also evaluated. RESULTS: High ADAM17 expression was detected in 79 patients (51 %), whereas low expression was found in 77 cases (49 %). There was significant correlation between gender, histology, lymph node metastasis, vascular invasion, the presence of recurrence and high ADAM17 expression. Recurrence in patients with high ADAM17 expression was significantly higher than that for patients with low ADAM17 expression (p = 0.032). The median disease-free survival (DFS) time for patients with tumours with high ADAM17 expression was worse than that of patients with tumours with low ADAM17 expression (16.6 vs. 44.2 months, p = 0.004). In addition, patients with low ADAM17 expression had a higher median overall survival (OS) (49.6 vs. 26.9 months, p = 0.019) compared to those with high ADAM17 expression. Multivariate analysis indicated that the rate of ADAM17 expression was an independent prognostic factor for DFS, in addition to the already known important clinicopathological prognostic indicator. But the prognostic importance of ADAM17 expression could not be proved by multivariate analysis for OS. CONCLUSIONS: The potential value of ADAM17 expression as a useful molecular marker in gastric cancer progression should be evaluated comprehensively; it may predict recurrence and poor prognosis in patients with gastric cancer after curative resection.

The effect of Amifostine (Ethyol) on intestinal anastomosis in rats with radiation enteritis.

BACKGROUND: Preoperative radiotherapy in colorectal cancers is being used as an adjuvant therapy with increasing frequency. Postoperative complications in early and late periods in various ratios are reported. It has also been shown that radiation has a delaying effect on wound healing and this effect is dose-dependent. AIM: This study investigated the effects of the Amifostine on healing of the irradiated colonic anastomosis. MATERIALS AND METHODS: 30 female Wistar rats were divided randomly into three groups equally (n=10). Colonic anastomosis were performed to all rats. Group I served as a control. 800 rad abdominopelvic irradiation on the 5th day of preoperation was given to group II and III. Rats in the group III, prior to radiation, were given Amifostine at a dose of 200 mg/kg. On the 5th postoperative day all the rats were sacrificed and the healing of anastomosis was measured with bursting pressure, hydroxyproline levels and histopathological evaluations. Statistical analyses were expressed by analysis of variance (ANOVA) test and p < 0.05 was regarded as significant. RESULTS: In group II, all parameters were found lower compared with control group and Amifostine+Radiation group. As compared with hydroxyproline values and the anastomotic wound healing scores, except group II, no significantly difference were determined between the two other groups. In bursting pressure levels, Group I and III were higher than group II, but not statistically significant (p > 0.05). In group III (Amifostine+Radiation group), the hydroxyproline levels and anastomotic wound healing scores were found significantly higher than group II (p < 0.05), and no significant difference were found between the control group. CONCLUSIONS: It is determined that radiation given on the 5th preoperative day has a negative effect on anastomotic wound healing and administered Amifostine prevent this negative effect. In the light of these data, the Amifostine may have a positive effect on preoperative irradiated colonic anastomosis and may play an important role in future on the supporting of the colonic anastomosis.

Bovine tuberculosis in Burdur, southern Turkey: epidemiological, pathological and economic study.

SETTINGS: Burdur is the most important dairy cattle breeding and milk production area of Turkey, and Burdur slaughterhouse is one of the biggest slaughterhouses in the southern part of the country. No scientific information is available on the prevalence of tuberculosis (TB) in cattle in Burdur. A survey was therefore undertaken to determine the prevalence of disseminated TB infection in cattle in this district. OBJECTIVES: To implement a disease monitoring system in Burdur slaughterhouse to estimate the annual prevalence of disseminated TB in cattle slaughtered and inspected in 2003-2004. DESIGN: Epidemiological survey. RESULTS: Prevalence of bovine TB was investigated in Burdur slaughterhouse from January 2003 to December 2004. All of the affected animals were Holstein breed. The prevalence of disseminated TB in all slaughtered cattle was 0.38% in this period. The value of the condemned meat and organs was calculated to establish economic loss. CONCLUSION: Despite a strict eradication programme, bovine TB is still an important health issue among cattle and remains one of the greatest threats to cattle and human health in southern Turkey. Veterinarians and cattle producers in this region are encouraged to develop and work on herd plans aimed at controlling and eradicating TB.

In vivo antioxidant properties of vitamin E and chromium in cold-stressed Japanese quails.

An experiment was conducted to determine if vitamin E (alpha-tocopherol-acetate) and chromium (chromium picolinate, Cr Pic) supplementation attenuate the negative effects of cold stress on egg production, egg quality, serum metabolites, and antioxidant status in Japanese quails (Corurnix coturnix japonica). One hundred and fifty laying Japanese quails (50-day-old) were divided into five groups, 30 birds per group. The laying quails kept at 6 degrees C for 12 h/d (08.00 p.m. to 08.00 a.m.) were fed either a basal diet (low temperature-basal diet, CS group) or the basal diet supplemented with either 400 microg of Cr/kg of diet (Cr group), 250 mg of alpha-tocopherol-acetate per kg of diet (Vit. E group) or 400 microg of Cr plus 250 mg of alpha-tocopherol-acetate per kg of diet (Vit. E + Cr group) while quails kept at 18 degrees C were fed a basal diet (thermo-neutral-basal diet, TN group). Performance and egg quality were significantly reduced in CS group compared with TN group. Supplemental chromium and vitamin E significantly increased live weight change, egg production, and improved feed efficiency in cold-stressed laying hens compared with the group fed the basal diet at 6 degrees C. Egg production and egg weight were also greater (P < 0.05) in each supplemental group compared with the CS group. However, a combination of vitamin E and chromium, rather than each separately, provided the greatest performance. Supplemental vitamin E and chromium also increased serum vitamin C and E but, decreased malondialdehyde (MDA) concentrations (P < 0.05); the combination of vitamin E and chromium resulted in the highest levels of serum vitamin C and E within the cold-stressed quails. Results of the present study indicate that combined antioxidant supplements increased performance, egg quality and serum antioxidant levels while lowering MDA in cold-stressed quails.

Choledochal cysts in adults and the importance of differential diagnosis.

BACKGROUND/PURPOSE: Choledochal cysts, congenital cystic dilatations of the hepatobiliary tree, present diagnostic dilemmas. In countries where hydatid disease is endemic, this rare pathology may be overlooked. The importance of this issue led us to reexamine our clinical material to evaluate our findings and management. METHODS: This study examined 12 patients (11 females, 1 male) who were treated at the University of Istanbul, Cerrahpasa Medical Faculty, with the diagnosis of choledochal cyst between 1981 and 2000. The cases were examined retrospectively, and the complaints, diagnostic methods, findings, and management were discussed. RESULTS: Ten of the cysts were type I (83.3%), one was type II (8.3%), and one was type IV (8.3%). Three of the patients underwent operation with the diagnosis of liver hydatid cyst, but during the operation the cysts were found to be choledochal cysts. In six of the patients, the cysts were correctly diagnosed, and they were excised. CONCLUSIONS: Contemporary approaches to treating choledochal cysts focus on total removal of the cyst. In a country where hydatic diseases are endemic, hepatobiliary cystic lesions are often misdiagnosed clinically and radiologically as hydatid cysts. Considering that percutaneous and laparoscopic approaches are being increasingly adopted for treatment of hydatid cysts, the problematic area must be subjected to thorough examination for cystic lesions. The possibility of choledochal cysts must always be kept in mind; otherwise, an unfavorable process may begin for both patient and surgeon.

Origin of the radial and ulnar arteries: variations in 81 arteriograms.

In a retrospective review of 81 upper extremity arteriograms, 8 (9.8%) origin anomalies of the major arteries were detected. High origin of the radial artery from the brachial artery was the most frequent variation, found in 7 (8.6%) cases representing 87.5% of all variations in this series. In one case, the left ulnar artery originated from the axillary artery, accounting for 12.5% of the variations. These anomalous origins of the upper extremity arteries can be explained on the basis of the embryologic development. It is important for the surgeons and radiologists to be aware of the possible arterial variations in order to prevent complications during surgical and diagnostic procedures.

Variant origin of the ulnar artery.

Axillary origin of the ulnar artery was observed during an angiographic examination of the upper extremity. The ulnar artery originated from the axillary artery at the level of the anterior and posterior circumflex humeral arteries. No additional anomalies were observed. Accurate knowledge about unusual patterns of the arteries of the upper extremities is important in order to be aware of hidden hazards during diagnostic and therapeutic preparations.

The role of lactulose in the prevention of bacterial translocation in surgical trauma.

Surgical trauma (ST) is one of the causative factor of bacterial translocation. In this study we investigated the prevention of bacterial translocation with lactulose in a surgical trauma model. The study was designed in 3 experimental groups consisting of 15 rats in each. Group 1 was sham operated controls, group 2 was ST + physiologic saline treated and group 3 was ST + lactulose treated animals. Lactulose and physiologic saline were given by oro-gastric intubation in a dose of 2 ml of 33.5% solution/d and 2 ml/d respectively starting 3 days prior to surgery. Bacterial translocation was investigated 48 hours after the operations. In sham operated controls only 1 bacterial translocation to the mesenteric lymph nodes (MLN) was observed. In the ST + physiologic saline treated group bacterial translocation to the MLN and portal venous blood (PVB) were significantly increased compared with both sham operated controls and the ST + lactulose treated group (p < 0.001). In rats with lactulose treatment the results of caecal bacterial counts showed a significant decrease in the number of gram-negative aerobes and facultative anaerobe bacteria (p < 0.01) and a significant increase in the number of lactobacilli (p < 0.001) compared to the sham operated controls. Measurement of the mucosal height showed a significant increase at the terminal ileum and the caecum compared with the sham operated controls and the surgical trauma+physiologic saline treated group (p < 0.001). We conclude that oral lactulose treatment 3 days prior to the surgical trauma, reduced the incidence of bacterial translocation to the MLN and PVB.

Tracheal rupture during transhiatal esophagectomy and anaesthetic problems. A case report.

Tracheal rupture is a rare but potentially serious complication of transhiatal esophagectomy (THE). In this situation, ventilation of the patient can be extremely difficult, even impossible, due to excessive gas leakage from tracheal tear. In this case report, we present such a patient in whom emergency thoracotomy and patching of the trachea were performed in order to maintain ventilation and oxygenation.

Transhiatal esophagectomy for esophageal carcinoma in Turkey: with special reference to respiratory function.

Esophagectomy without opening the thoracic cavity--transhiatal esophagectomy--(THE) were performed in 47 patients with malignant tumors localized at various levels of the esophagus. Pulmonary function studies were performed in all patients and they are categorized as low, moderate, or high risk for probable postoperative pulmonary complications according to the risk category system. Nine of these patients were classified as high risk, seven as moderate risk, and the rest as low risk. In all patients but four, reconstruction was accomplished by using their stomachs as a substitute. In the remaining patient, intestinal continuity was established by a left and right colonic interposition. Three patients were lost in the early postoperative period. Two patients categorized as low risk died from pulmonary thromboembolism and cardiac failure, respectively. One patient categorized in the high risk group died of coronary thrombosis. Postoperative complications included transient hoarseness due to recurrent laryngeal nerve paresis in one patient, right pleural effusion in one patient, pneumothorax in two patients, and thrombophlebitis in one patient. In the high risk patient group, there were no pulmonary complications. This clinical study demonstrated the protective effect of THE in patients with serious pulmonary problems.