Adrenomedullin and non-dipping circadian pattern in newly diagnosed essential hypertension.

OBJECTIVE: There is frequently a relationship between nocturnal hypertension and non-dipping pattern and endothelial dysfunction. Studies conducted previously have indicated that adrenomedullin (AM) (a potent, long-lasting, vasodilatory peptide) is capable of regulating endothelial cell function. The aim of the current research is to investigate the association between absolute night-time blood pressure (BP) and circadian BP pat-tern with serum AM and high-sensitivity C-reactive protein (hsCRP) levels in cases in whom untreated arterial hypertension has been newly diagnosed. METHODS: Ambulatory BP monitoring was performed in 100 individuals with hypertension (50 dippers,50 non-dippers) and 50 healthy controls for 24 hours. Measurement and recording of AM and hsCRP serum levels were performed. RESULTS: A strong correlation between night-time BP levels and AM and hsCRP levels was determined(p<0.001). On the contrary, higher AM levels were determined in the non-dipper group compared to the dipper and normotensive groups (non-dipper group, 258±27 pg/mL; dipper group, 199±30 pg/mL; normotensive group, 150±11 pg/mL; p<0.001). The non-dipper group exhibited significantly higher hsCRP levels in comparison with the remaining two groups (p=0.017). An independent association was determined between AM (p=0.014) and hsCRP (p=0.032) and a non-dipping pattern in a multivariate logistic regression analysis. CONCLUSIONS: The nocturnal hypertensive and non-dipper groups exhibited increased AM levels. An independent association was identified between AM and hsCRP and a non-dipping pattern. It is implied that increased AM levels in individuals with non-dipper hypertension may be related to a longer exposure time to high BP. The mentioned findings indicate a potential future part of AM in identifying patients with hypertension that are at higher risk of target organ damage (Tab. 3, Fig. 4, Ref. 41).

Steroids originating from bacterial bile acid degradation affect Caenorhabditis elegans and indicate potential risks for the fauna of manured soils.

Bile acids are steroid compounds from the digestive tracts of vertebrates that enter agricultural environments in unusual high amounts with manure. Bacteria degrading bile acids can readily be isolated from soils and waters including agricultural areas. Under laboratory conditions, these bacteria transiently release steroid compounds as degradation intermediates into the environment. These compounds include androstadienediones (ADDs), which are C19-steroids with potential hormonal effects. Experiments with Caenorhabditis elegans showed that ADDs derived from bacterial bile acid degradation had effects on its tactile response, reproduction rate, and developmental speed. Additional experiments with a deletion mutant as well as transcriptomic analyses indicated that these effects might be conveyed by the putative testosterone receptor NHR-69. Soil microcosms showed that the natural microflora of agricultural soil is readily induced for bile acid degradation accompanied by the transient release of steroid intermediates. Establishment of a model system with a Pseudomonas strain and C. elegans in sand microcosms indicated transient release of ADDs during the course of bile acid degradation and negative effects on the reproduction rate of the nematode. This proof-of-principle study points at bacterial degradation of manure-derived bile acids as a potential and so-far overlooked risk for invertebrates in agricultural soils.

Comparison of pentraxin-3 and ischemia-modified albumin with troponin in early diagnosis of acute coronary syndrome.

INTRODUCTION: In this study, our aim was to evaluate clinical utilities of Pentraxin 3 (PTX3) and Ischemia-modified Albumin (IMA) in diagnosis of acute coronary syndrome (ACS) and compare these two biomarkers with a conventional diagnostic marker, cardiac troponin I (cTnI). MATERIALS AND METHODS: Sixty adult patients with ACS diagnosis were involved into this prospective study. Additionally, 20 healthy subjects were determined as control group (Group IV). Patients were divided into 3 groups as follows: Patients with Acute Myocardial Infarction (STEMI Group, n=20, Group I), patients without ST elevation but with elevated cTnI levels (NSTEMI Group, n=20, Group II), and patients with unstable angina pectoris (USAP Group, n=20, Group III). Blood measurements were obtained for each marker at admission and in the 4th hour. RESULTS: Troponin level was significantly different between groups I and II at both admission and in the 4th hour. Additionally, PTX 3 level was significantly different at admission and 4th hour between groups II and III. CONCLUSION: This study revealed that cTnI is the most sensitive test in ACS diagnosis at the admission to Emergency Department. Our results also revealed that PTX 3 may be a useful diagnostic tool for ACS at admission, however, IMA alone cannot be used for diagnosis of ACS. Similarly, in the 4th hour, cTnI was found to be the most useful marker in ACS diagnosis, however, PTX 3 and IMA were found to be inadequate for diagnosis of ACS (Tab. 3, Ref. 19).

Cleavage of poly(cis-1,4-isoprene) rubber as solid substrate by cultures of Gordonia polyisoprenivorans.

Potential biotechnological recycling processes for rubber products include the bacterial degradation of poly(cis-1,4-isoprene) (IR) in order to achieve its total biodegradation or its biotransformation into useful products. The actinomycete Gordonia polyisoprenivorans strain VH2 catalyzes the degradation of IR and enables its use as a sole carbon source via ß-oxidation. The initial cleavage reaction is catalyzed by the extracellular latex clearing protein (Lcp). This dioxygenase is the key enzyme for the formation of oligo(cis-1,4-isoprene) molecules with different lengths, i.e., numbers of isoprene units. For the first time, IR was used as a solid substrate in 2-l fermenters. Two different particle size fractions (63-500 and 500-1000 µm) and three stirring rates (300, 400 and 500 rpm) were evaluated in the process. An increase of the cell concentration was achieved by using smaller particles and by using lower stirring rates, reaching a final biomass concentration of 0.52 g l-1 at 300 rpm after 12 days of cultivation. In order to enhance the formation of oligo(cis-1,4-isoprene) molecules, a transposon insertion mutant (TH5) of G. polyisoprenivorans strain VH2 that has lost the ability to transport the partial degradation products into the cells was used, thereby allowing the accumulation of the degradation products in the culture supernatants. Propionate, glucose and glycerol were evaluated as additional carbon sources besides IR, and the highest yields were observed on propionate. In 2-l bioreactors with pH control, different feeding regimes were performed during cultivation by the addition of propionate every 24 or 48 h for 16 days. After liquid-liquid extraction and a derivatization with Girard's T reagent, the oligo(cis-1,4-isoprene) molecules were detected by ESI-MS. The mass distribution of the degradation products was affected by the selection of the extraction solvent, but no influence of longer cultivation periods was detected.

Association of soluble ST2 with functional capacity in outpatients with heart failure.

BACKGROUND: Biomarkers play an important role in the risk stratification of patients with heart failure (HF). Recent studies have shown that soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin 1 receptor family, is associated with disease prognosis in acute and chronic HF. In this study we aimed to investigate the relation between sST2 level and functional capacity in outpatients with systolic HF. PATIENTS AND METHODS: This study included 120 HF patients with reduced ejection fraction (HFrEF; EF ≤ 40%). The mean age of patients was 66 ± 11 years. Advanced HF (New York Heart Association [NYHA] functional class III-IV) was observed in 35 patients (29%). RESULTS: sST2 levels were on average higher in patients with NYHA functional classes III and IV than in patients with NYHA functional classes I and II (51 [9-198] vs. 25 ng/ml [9-118], p < 0.001). In a multiple logistic regression model, sST2 level (OR: 1.044, p = 0.004, 95% CI: 1.014-1.075), hemoglobin level (OR: 0.590, p = 0.001, 95% CI: 0.433-0.805), total cholesterol level (OR: 0.977, p = 0.004, 95% CI: 0.962-0.993), and age (OR: 1.066, p = 0.047, 95% CI: 1.001-1.136) were associated with poor functional capacity. In receiver operating characteristic (ROC) curve analysis, the optimal cut-off value of sST2 for predicting poor functional capacity was >42 ng/ml, with 63% sensitivity and 88% specificity (AUC: 0.810, 95% CI: 0.728- 0.875). CONCLUSION: Higher sST2 levels were strongly associated with poor NYHA functional class, independent of cardiac risk factors, in outpatients with HFrEF.

Clinical characteristics and prognostic factors of scleral rupture due to blunt ocular trauma.

PurposeTo describe and identify ocular and wound characteristics, and prognostic factors associated with final visual acuity (VA) in patients with scleral rupture due to blunt ocular trauma.MethodsThe medical records of 61 patients with globe rupture due to blunt ocular trauma who underwent primary repair were reviewed retrospectively. The data recorded included demographic characteristics, initial and final VA, ocular signs, wound characteristics, and surgeries. Initial VA, ocular signs, wound characteristics, and surgeries were analyzed to determine the association with the final VA.ResultsForty three women and 18 men with a mean age of 43.6±23.5 years were included in the study. The locations of scleral wounds were mostly in the superonasal quadrant (41.0%) and zone 2 (75.4%). In eyes with hyphema (P=0.009), vitreous hemorrhage (P=0.001), and retinal detachment (P=0.004), final VA was statistically worse than eyes without these signs. A moderate positive correlation was found between the initial and final VA (P<0.001). Final VA was statistically worse in eyes with horizontal midline wounds than in eyes with vertical midline wounds (P=0.002). A moderate negative correlation was found between scleral wound length and final VA (P<0.001). Patients who underwent cataract surgery had statistically better final VA (P=0.002).ConclusionsScleral rupture was detected mostly in females, superonasal quadrant and zone 2. Poor final VA was significantly associated with poor initial VA, longer wound length, horizontal midline wound, presence of hyphema, vitreous hemorrhage and retinal detachment at presentation, and cataract surgery not performed during follow-up period. Scleral ruptures have different demographic, ocular and wound characteristics than other open globe injuries.

Ultrasonographic evaluation of Achilles tendon in children with flatfoot: A case-control morphometric study.

PURPOSE: The purpose of this study was to investigate whether any relationships exist between the presence of flatfoot and ultrasonographic morphometric findings of Achilles tendon in children. MATERIALS AND METHODS: The study included 30 pediatric patients with a mean age of 11.96±2.44 (SD) years (range: 9-16 years) with flexible flatfoot and 29 healthy pediatric controls who were matched for age and served as a control group. Demographic data of both groups such as age, height and weight, and anthropometric measurements including leg length and, length and cross-sectional area of the Achilles tendon on ultrasonography were tabulated. Relationships between the cross-sectional area of Achilles tendon and flatfoot and the other parameters were searched for using backward multiple regression analysis. RESULTS: No associations between flatfoot and length and cross-sectional area of the Achilles tendon, age, height, leg and foot length were found. A negative correlation was found between the cross-sectional area of Achilles tendon and presence of flatfoot (Beta=-4.93, P=0.01) and age (Beta=-1.96, P=0.04). A positive correlation was found between the cross-sectional area of Achilles tendon and shoe size (Beta=2.13, P=0.007). CONCLUSIONS: Flatfoot, shoe size, age and weight must be kept in mind as a clue for a thinner Achilles tendon morphometry which can be a risk factor in lower limb pathologies.

Results of CAM therapy in amblyopic patients.

AIM: to evaluate changes in visual acuity and compliance after CAM therapy in patients that initially failed to respond to occlusion or were non-compliant. MATERIAL AND METHODS: Twenty nine patients aged 4-10 years that failed to improve under occlusion therapy were included in this prospective study. Patients were divided into two groups according to the age (16 patients of 4-7 years of age and 13 patients of 8-10 years of age) and two other groups according to the type of amblyopia (15 anisometropic and 14 strabismic cases). CAM stimulation was prescribed to all patients for six days. Occlusion therapy was then recommenced. Best corrected visual acuity was measured before the CAM course, immediately after, at 3- and 6-month follow-ups, and on the last visit. RESULTS: Visual acuities in all study groups increased significantly immediately after the CAM therapy with further improvement during the follow-up period. CONCLUSION: CAM therapy for amblyopia is helpful in improving visual acuity as well as patients' compliance to subsequent occlusion therapy.

Neutrophil to lymphocyte ratio is superior to platelet to lymphocyte ratio as an early predictor of moderate/severe ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is a state of exaggerated inflammatory response during controlled ovarian hyperstimulation (COH). Neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR) are known to reflect systemic inflammation. The aim of this study was to investigate whether these inflammatory markers could be used as reliable markers in the early prediction of moderate-to-severe OHSS. The study group consisted of 54 patients who developed moderate-to-severe OHSS and the control group was 54 patients who did not develop OHSS undergoing IVF/ICSI. NLR and PLR were calculated from complete blood counts before the COH. NLR and PLR were significantly elevated in the OHSS group compared with the controls (3.2 ± 0.9 and 182.9 ± 49.8 vs 1.8 ± 0.5 and 160.6 ± 48.5, respectively) (p < 0.05, for all). However, only NLR had positive associations between OHSS risk factors (p < 0.05, for all). NLR was superior to PLR as an early predictor of OHSS with an area under the ROC curve of 0.91 (sensitivity = 85% and specificity = 78%). In conclusion, we found that NLR can be used as an early marker of OHSS.

Association of interleukin-1 beta (+3954) gene polymorphism and gingival crevicular fluid levels in patients with aggressive and chronic periodontitis.

BACKGROUND AND OBJECTIVE: The immune mechanisms and genetic variations that regulate genetic expression, production and biological activity of IL-1beta, are thought to play an important role in the pathogenesis of periodontal disease. The aims of the present study were to analyse interleukin (IL)-1beta (+3954) genotype and allele frequency in both chronic and aggressive periodontitis patients, and also to investigate whether this polymorphism is associated with gingival crevicular fluid (GCF) IL-1beta levels, periodontal disease severity and clinical parameters in subjects of Turkish origin. METHODS: A total of 147 individuals were enrolled in the study including 56 aggressive periodontitis (AP), 44 chronic periodontitis (CP) patients and 47 healthy controls (C). Single nucleotide polymorphism at IL-1beta (+3954) is analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). GCF samples were analyzed for IL-1beta, using enzyme linked immunosorbent assay (ELISA). RESULTS: The distribution of genotypes and allele frequencies for IL-1beta (+3954) were similar among the groups, in spite of a trend toward a higher frequency of allele 2 in the patient groups. The genotype distribution and allele frequencies were also not different after stratification of subjects according to the clinical attachment level (CAL < 4 mm and CAL > 4mm). No differences were found between the GCF IL-1beta levels of the different genotypes. Allele 2 was associated with increased bleeding on probing (BOP) sites in chronic periodontitis patients. CONCLUSION: The results of this study do not support that genetic polymorphism in the IL-1beta (+3954) could be identified as a susceptibility or severity factor in aggressive periodontitis, in the present population. The association of allele 2 frequency and higher percentage of BOP sites in chronic periodontitis suggest that IL-1beta (+3954) potentially play a significant but not major role in the clinical outcome.

Acute heart failure with accompanying chronic obstructive pulmonary disease: should we focus on beta blockers?

BACKGROUND: Acute heart failure (AHF) with systolic dysfunction is associated with increased morbidity and mortality, and optimal therapy is not well established, despite the findings of evidence-based medicine. Beta blockers provide a mortality and morbidity benefit in patients with chronic systolic HF, and are currently indicated in all stages of patients with systolic HF. We evaluated therapies before discharge, in particular beta blockers, in patients hospitalized with AHF with and without accompanying chronic obstructive pulmonary disease (COPD). METHODS: The hospital discharge records of 959 consecutive de novo AHF patients, hospitalized and treated for systolic HF (ejection fraction < 45%), were retrospectively reviewed in three cardiovascular institutions. RESULTS: The presence of accompanying COPD was associated with significantly lower prescription of beta blockers before discharge (p < 0.001). Furthermore, with regard to the type of beta blocker, patients with accompanying COPD were less frequently prescribed nonselective beta blockers (29% vs. 48%, p < 0.001). The presence of accompanying COPD among AHF patients increased the risk of omitting (not prescribing) beta blockers before discharge by a factor of 1.785. CONCLUSION: Beta blockers, a proven life-saving therapy in the setting of chronic systolic HF, were found to be less frequently prescribed before discharge in the presence of de novo AHF with accompanying COPD.

Real-time measurement system for tracking birefringence, weight, thickness, and surface temperature during drying of solution cast coatings and films.

This paper describes the design and performance of a new instrument to track temporal changes in physical parameters during the drying behavior of solutions, as well as curing of monomers. This real-time instrument follows in-plane and out-of-plane birefringence, weight, thickness, and surface temperature during the course of solidification of coatings and films through solvent evaporation and thermal or photocuring in a controlled atmosphere. It is specifically designed to simulate behavior of polymer solutions inside an industrial size, continuous roll-to-roll solution casting line and other coating operations where resins are subjected to ultraviolet (UV) curing from monomer precursors. Controlled processing parameters include air speed, temperature, initial cast thickness, and solute concentration, while measured parameters are thickness, weight, film temperature, in-plane and out-of-plane birefringence. In this paper, we illustrate the utility of this instrument with solution cast and dried poly (amide-imide)∕DMAc (Dimethylacetamide) solution, water based black paint, and organo-modified clay∕NMP (N-Methylpyrrolidone) solution. In addition, the physical changes that take place during UV photo polymerization of a monomer are tracked. This instrument is designed to be generic and it can be used for tracking any drying∕swelling∕solidification systems including paper, foodstuffs such as; grains, milk as well as pharmaceutical thin paste and slurries.

Diagnosis and follow up of patients with primary cardiac tumours: a single-centre experience of myxomas.

OBJECTIVE: In this study, 12 patients who were diagnosed as having cardiac tumours and were operated on in the Department of Cardiovascular Surgery following referral from the Department of Cardiology were enrolled between January 1995 and October 2007. METHODS: The symptoms, clinical findings, diagnostic methods, localisation of masses and surgical applications were recorded retrospectively. RESULTS: There were 10 female (83%) and two (17%) male patients; their ages ranged from 35 to 70 years (mean 68.7 years). Twelve patients were diagnosed with myxomas, nine of which were located within the left atrium and three in the right atrium. The most common symptoms at clinical presentation were those associated with heart failure or embolisation. Diagnosis of the tumours was made by echocardiography in all patients. The masses were completely resected in eight patients and the interatrial septae were partially excised with mass resection in two patients. The defect was reconstructed with a pericardial patch in one of the patients, and primarily reconstructed in the other. We carried out debridement with mass resection in another case. Femoro-popliteal aorto-iliac thrombo-endarterectomy was performed with mass resection in a further case. CONCLUSION: Atrial myxomas are the most common primary cardiac tumours. They can cause valvular or inflow-outflow tract obstruction, thrombo-embolism, arrhythmias, or pericardial disorders. Most atrial myxomas are benign but due to non-specific symptoms, early diagnosis may be a challenge and they must be removed by surgical resection. Diagnosis and follow up with the collaboration of cardiology and cardiovascular surgery departments is important for meticulous care of these patients.

Effects of human amniotic fluid on costal cartilage regeneration (an experimental study).

OBJECTIVE: After surgical correction of thoracic wall deformities, promoting neochondrogenesis in the perichondrial bed is very important for obtaining a flexible chest wall. In this experimental study, we aimed to investigate the effects of human amniotic fluid on cartilage regeneration in the costal perichondrial bed in a rabbit model. METHODS: Fifty-four adult New Zealand rabbits were divided into three groups, with 18 rabbits in each group. The third and fifth costal cartilages were excised totally on the right side and partially excised on the left side in all groups. Group 1 served as controls. All rabbits in group 1 underwent closure of the perichondrium of the third costal cartilage and closure of the perichondrium of the fifth costal cartilage with reimplantation of reshaped cartilage into the fifth costal perichondrial bed. Rabbits in group 2 underwent closure of the perichondrium of the third and fifth costal cartilages after the administration of human amniotic fluid into the perichondrial bed. Group 3 rabbits received both human amniotic fluid and underwent cartilage reimplantation. The third and fifth costal perichondriums in group 3 rabbits were closed after the administration of human amniotic fluid and the reimplantation of reshaped cartilages. Rabbits were sacrificed at two, eight and 12 weeks after operation. RESULTS: Numerical scores for the right perichondrial bed were significantly higher for group 2 compared to group 1 ( P < 0.05). But the difference was not significant for the left perichondrial bed ( P > 0.05). The diameter of chondrogenesis also did not differ significantly between left and right perichondrial bed for all groups. CONCLUSION: Our study shows that administration of human amniotic fluid into the perichondrial bed increases chondrogenesis in adult rabbits, an important finding which may contribute to improving chest wall flexibility after the surgical correction of pectus excavatum.

Assessment of myocardial ischaemia using tissue Doppler imaging in pseudoexfoliation syndrome.

PURPOSE: Pseudoexfoliation (PEX) syndrome is characterized by the widespread deposition of abnormal extracellular fibrillary material on many ocular and extraocular tissues. We aimed to investigate the association between PEX syndrome and subclinical myocardial ischaemia, using tissue Doppler echocardiography. METHODS: Thirty-two patients with pseudoexfoliation syndrome (mean age: 66±9 years, 22 men) and 25 healthy individuals (mean age: 67±8 years, 13 men) were included in the study. Patients with overt coronary artery disease, congestive heart failure, valvular heart disease, cardiomyopathy, and left ventricular hypertrophy were excluded from the study. Tissue Doppler imaging was performed at the septal, lateral, anterior, and inferior mitral annuluses. Differences between the groups were evaluated by the unpaired t-test and the Mann-Whitney U-test, with a P-value of <0.05 considered significant. RESULTS: Baseline clinical characteristics, two-dimensional, and Doppler echocardiography parameters were similar in the PEX and control groups. Peak systolic velocities at the septal, lateral, anterior, and inferior annuluses were significantly lower in patients with PEX syndrome (P<0.001, 0.01, 0.02, and 0.02, respectively). The early diastolic velocity at the septal annulus, and the ratio of early/late diastolic velocity at the lateral annulus were significantly lower in the study group (P=0.03). CONCLUSION: PEX syndrome is a common disorder of extracellular matrix. Our data suggest that there may also be an association between PEX syndrome and subclinical myocardial ischaemia in patients who have no signs and symptoms of ischaemia. Thus, we think that ophthalmologists should consider informing their PEX syndrome patients' general practitioners about a possible cardiac risk.

Surgical management of bronchiectasis: a collective review of 339 patients with long-term follow-up.

OBJECTIVE: The incidence of bronchiectasis has decreased significantly in developed countries due to successful control of childhood infections. However, the surgical treatment of this disease still plays an important role in thoracic surgical practice in underdeveloped and developing countries. The aim of this retrospective study was to present our surgical experience in patients with bronchiectasis, including our surgical treatment strategies and the results of long-term follow-up. METHODS: A retrospective chart review was conducted of 339 patients who underwent surgical resection for bronchiectasis between January 1992 and December 2009. The patients' demographic features, the symptoms, etiologies and resection types, morbidity, mortality and outcomes after surgical management were analyzed. RESULTS: There were 301 (88.8 %) male and 38 (11.2 %) female patients; the average patient age was 22.4 years (range 15-50 years). The most common presenting symptoms were productive cough in 197 (58.1 %) patients. There were 21 (6.2 %) asymptomatic patients. Two hundred and thirty of the 339 patients (67.8 %) had had previous medical therapy before admission to our department. The most common etiology of bronchiectasis was childhood infections in 101 (29.8 %) patients. In most patients, bronchiectasis was found on the left side (n = 225, 66.4 %). Thirty-five patients underwent a second operation for bilateral disease. There were two (0.6 %) early postoperative mortalities including one myocardial infarction and one respiratory insufficiency. Complications occurred in 43 patients (12.7 %). The median follow-up was 13.6 months. Symptoms disappeared in 201 patients (71 %), and 66 patients (23.3 %) experienced an improvement, while 16 patients (5.7 %) continued to be symptomatic. CONCLUSION: Although improvements in medical treatment have resulted in a significant decrease in the number of patients with bronchiectasis, surgical management is still very important in developing countries. Surgical resection can be performed with acceptable morbidity and mortality rates. The aim should be the resection of all involved bronchiectatic sites, even in patients with bilateral disease, if the pulmonary reserve is adequate.

A 6.2-cm tracheal segment resection for tracheal post-intubation stenosis.

Post-intubation tracheal stenosis is a clinical problem caused by regional ischemic necrosis of the airway. The outcome of a long tracheal segment resection (6.2 cm) in a patient with post-intubation stenosis is presented.

Parenchyma-saving surgical treatment of giant pulmonary hydatid cysts.

OBJECTIVE: The purpose of this study was to review 97 patients with giant pulmonary hydatid cysts and assess the clinical features and results of different operative techniques over a 27-year period. MATERIAL AND METHODS: Between January 1981 and December 2007, 590 patients were operated on for pulmonary hydatidosis and 97 (17 %) of these patients had giant pulmonary hydatid cyst. We retrospectively reviewed the medical records of these 97 patients. The diameter of the hydatid cysts were measured using radiological methods and intraoperatively. RESULTS: Seventy-eight patients were male (80 %) and 19 were female (20 %). The median age was 23.4 years (range: 15-63 years). The most common symptoms were chest pain (54 %), cough (43 %) and dyspnea (41 %). Fourteen patients were asymptomatic (14 %). The diameters of the cyst ranged between 10 and 25 cm (mean 13.8 cm). The cysts were located in the right hemithorax in 52 (54 %) patients, in the left hemithorax in 44 (45 %) patients and bilaterally in one patient (1 %). Five patients had more than one cyst. The procedures consisted of cystotomy and capitonnage in 53 patients, enucleation and capitonnage in 27 patients and simple cystotomy or enucleation in 8 patients. Anatomical resection was performed in 9 patients. Prolonged air leakage of more than 7 days occurred in five patients; one patient underwent an operation and a Heimlich valve was placed in two patients. There was no postoperative mortality. Recurrence was not detected at follow-up after 6 months and 27 months. CONCLUSION: The higher lung tissue elasticity and delayed symptoms due to localizations of the cyst are the reasons for the occurrence of giant hydatid cysts in the lung. A parenchyma-saving operation should be performed instead of anatomical resection because of the low complication rates and because most complications can be treated conservatively.

Treatment of penetrating hepatic injuries: a retrospective analysis of 50 patients.

AIM: The aim of this study was to determine the possibility of non-operative treatment via retrospective analysis of our patients. METHODS: Fifty patients with penetrating hepatic injuries were examined retrospectively with respect to trauma scores, associated injuries, complications, and mortality parameters. RESULTS: Thirteen injuries were caused by firearms, whereas 37 injuries were caused by stab wounds. Forty-three patients (86%) underwent laparotomy and 7 patients (14%) were monitored by CT and clinical findings (nonoperative group, NO group). The laparotomies were evaluated as non-therapeutic in 11 patients (22%) (NTL group) and therapeutic in 32 patients (64%) (TL group). The morbidity and mortality rates were 40 and 10%, respectively. RTS and ISS scores of the nonsurviving and the surviving patients were significantly different. The rates of major venous, grade IV-V hepatic injuries, and gunshot wounds were significantly higher in the nonsurviving patients when compared to the surviving patients. CONCLUSION: Major venous and grade IV-V hepatic injuries were the primary factors determining mortality and these injuries generally occurred as a result of firearm injuries. NTL occurring at a rate of 22% would decrease to 2% if 'RTS <7' criteria was added to the hemodynamic instability and/or peritoneal irritation findings determining surgical candidacy.