Battery-induced Esophageal Foreign Body Injury, Complications and Treatment Outcome

ABSTRACT Objective: To assess the severity caused by button batteries in esophagus. Methods: A total of 32 patients admitted with ingesting button batteries were retrospectively evaluated. Chest X-ray was ordered for diagnosis. Hospital stays, interventions, complications and mortality of the patients were collected. The time between the patients ingested the buton battery and its removal was defined as its duration in esophagus. All the patients underwent rigid esophagoscopy under general anaesthesia. Buton batteries at the first narrowing were removed by magyl clamp. Results: Of 32 patients, 21 were females, with a mean age of 22 months. The mean duration of ingestion was 17 hours. The mean hospital stay was 10 days. Of the patients, 75% were admitted within 24 hours. Complication rate was 19% and mortality rate was 6%. There was a strong correlation among the number of the cases and the coming years (p < 0.001). The regression was between the number of cases per year (outcome variable) and the years of the study (explanatory variable), (p< 0.001, R = 0.644, Figure 3). There was a significant finding that more cases (90%) were admitted in the last 12 years compared with the number in first 12 years (p < 0.001). There were no complications in cases in which the button battery was impacted in esophagus for less than 24 hours; however, eight cases whose duration was more than 24 hours resulted in complications in six patients and fatality in two patients (p < 0.001). Conclusion: Batteries should be removed upon its diagnosis. Otherwise, the injury in the esophageal mucosa may be caused by delay and can cause an increase in morbidity and mortality.

The effect of humic acid substances on the thyroid function and structure in lead poisoning

Lead (Pb) is a heavy metal, which adversely affects thyroid gland function and structure. Due to its high molecular weight and abundant functional groups, humic acid substances (HAS) can form chelates with heavy metals. The experiment was conducted to evaluate the prophylactic effect of HAS on thyroid hormone levels and histopathological lesions of laying hens exposed to lead (Pb) poisoning. After a week of adaptation, 192 Lohmann White laying hens (25 weeks of age) were fed one of four diets: a basal diet (BD) or the BD with HAS (0.15%), with Pb (0.3 g/kg), or with both. Experimental groups were replicated in 12 cages, with four hens each. Pb poisoning did not alter triiodothyronine (FT3; 3.22 ± 0.20 ng/dL) or thyroxine (FT4; 0.71 ± 0.08 ng/dL) concentrations, but caused a 167% increase in thyroid stimulating hormone (TSH) concentration. HAS supplementation returned the high TSH levels of hens exposed to Pb poisoning to normal values. Degenerative changes in the epithelial cells of the thyroid gland of the hens exposed to Pb poisoning were evidenced. Connective tissue cells in the interfollicular area and total amount of colloids with partially atrophic follicles were observed. These histopathological findings were less severe when HAS was added to the diet. In conclusion, HAS alleviates the effects of Pb poisoning on thyroid gland function and structure, possibly preventing its internalization by the tissue by forming chelates and exerting anti-inflammatory effects.

The effect of humic acid substances on the thyroid function and structure in lead poisoning

Lead (Pb) is a heavy metal, which adversely affects thyroid gland function and structure. Due to its high molecular weight and abundant functional groups, humic acid substances (HAS) can form chelates with heavy metals. The experiment was conducted to evaluate the prophylactic effect of HAS on thyroid hormone levels and histopathological lesions of laying hens exposed to lead (Pb) poisoning. After a week of adaptation, 192 Lohmann White laying hens (25 weeks of age) were fed one of four diets: a basal diet (BD) or the BD with HAS (0.15%), with Pb (0.3 g/kg), or with both. Experimental groups were replicated in 12 cages, with four hens each. Pb poisoning did not alter triiodothyronine (FT3; 3.22 ± 0.20 ng/dL) or thyroxine (FT4; 0.71 ± 0.08 ng/dL) concentrations, but caused a 167% increase in thyroid stimulating hormone (TSH) concentration. HAS supplementation returned the high TSH levels of hens exposed to Pb poisoning to normal values. Degenerative changes in the epithelial cells of the thyroid gland of the hens exposed to Pb poisoning were evidenced. Connective tissue cells in the interfollicular area and total amount of colloids with partially atrophic follicles were observed. These histopathological findings were less severe when HAS was added to the diet. In conclusion, HAS alleviates the effects of Pb poisoning on thyroid gland function and structure, possibly preventing its internalization by the tissue by forming chelates and exerting anti-inflammatory effects.(AU)

Is the TSHR D727E polymorphism a genetic predisposition for multinodular goiter in the Turkish population?

The D727E germline polymorphism in the thyroid-stimulating hormone receptor gene (TSHR) may cause genetic susceptibility to the development of goiter. Therefore, in this study we investigated allele frequencies and genotype distributions of the TSHR D727E polymorphism, their association with clinical parameters, and the development of goiter in the Turkish population. We investigated the TSHR D727E polymorphism in 123 patients and 97 healthy subjects using the polymerase chain reaction-restriction fragment length polymorphism technique. Peripheral blood was used for DNA extraction. Although no significant difference was found in TSHR D727E polymorphism frequencies between the patients with nodular goiters (26/123 patients, 21.1%) and the controls (12/97 patients, 12.4%) (P = 0.107), the frequency of the TSHR D727E polymorphism in the hyperthyroid+subclinical hyperthyroid patient groups (23%) was significantly higher than in the control subjects (12.4%) (P = 0.024). In this study, nodular goiter presented significantly earlier in GC genotype patients (mean age 35 years) than in CC genotype patients (mean age 42 years) in the hyperthyroid group (P = 0.009). More importantly, TSH levels in the GC variant controls were closely significant lower (1.26 ± 0.49) than in the CC variant controls (1.74 ± 0.84) (P = 0.053). The TSHR D727E polymorphism might be involved in the pathogenesis of toxic multinodular goiter (TMNG). Moreover, this polymorphism might be an indication of early-onset TMNG. However, development of MNG is multifactorial. Therefore, further case-control studies with larger populations are required to verify these observations.

Can Mean Platelet Volume Be a Surrogate Marker of Inflammation in Rheumatic Diseases?

BACKGROUND: In humans, it has been suggested that low-level mean platelet volume (MPV) may be related to secondary thrombosis due to inflammation. For this reason, MPV can be used as a marker showing inflammation in the body. OBJECTIVES: To evaluate the association of MPV with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Disease Activity Score-28 (DAS-28), and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with rheumatic diseases. METHODS: The study consisted of 261 patients with rheumatoid arthritis (203 females, 77.8%; 58 males, 22.2%), 85 patients with ankylosing spondylitis (57 males, 67.1%; 28 females, 32.9%), 56 patients with familial Mediterranean fever (32 females, 57.1%; 24 males, 42.9%) and 194 patients (139 females, 71.6%; 55 males, 28.4%) with other rheumatic diseases (Behçet's disease, psoriatic arthritis, spondyloarthropathy, systemic lupus erythematosus, systemic sclerosis, or undifferentiated connective tissue disease). RESULTS: There was an inversely significant correlation between MPV and ESR and CRP in patients with rheumatoid arthritis (r = -0.164, p = 0.008). Mean platelet volume was negatively correlated with DAS-28-ESR/CRP (r = -0.393, p < 0.001) in rheumatoid arthritis. Mean platelet volume was inversely correlated with BASDAI (r = -0.580, p < 0.001) in ankylosing spondylitis. In the group with familial Mediterranean fever (especially M694V homozygous), there was a negative correlation between MPV and ESR and CRP (p < 0.001). Mean platelet volume and CRP were negatively correlated in psoriatic arthritis (r = -0.599, p = 0.011). Mean platelet volume and ESR were inversely related in patients with systemic lupus erythematosus (r = -0.421, p = 0.045). There was a negative correlation between MPV and ESR (r = -0.219, p = 0.002), and between MPV and CRP (r = -0.208, p = 0.004) in other rheumatic diseases. CONCLUSIONS: The lower MPV level surrogates active and/or chronic inflammatory state in the body. Thus, MPV may be used as a negative acute-phase reactant in rheumatic diseases.