Relevance between clinical status and exhaled molecules related to neutrophilic inflammation in pediatric cystic fibrosis.

INTRODUCTION: Cystic fibrosis (CF) is characterized with chronic inflammation with neutrophil and related cytokines in airway secretions. We aimed to measure the levels of neutrophil related inflammatory markers as nitric oxide, IL-8, IL-17, leukotriene B4 and neutrophil elastase as well as e-cadherin in exhaled breath condensate (EBC), and to determine their relation with clinical findings. METHODS: We consecutively enrolled cystic fibrosis patients into our clinics between the age of six and eighteen years who could cooperate for exhaled breath condensate to this case-control study (n = 30). The age and sex matched control group (n = 26) was enrolled. Spirometry was performed during the stable period and EBC samples were obtained for measurement of the markers. RESULTS: The mean age of the subjects enrolled was 12.1(4.2) years and 40% were positive for P.Aeruginosa in sputum. Subjects who had P.Aeruginosa in sputum cultures had significantly lower FEV1, FVC and FEF 25/75 values compared to the ones without P.Aeruginosa (p = 0.002, p = 0.002 and p = 0.005 respectively). EBC neutrophil elastase levels were significantly higher in the CF patients compared to non-CF controls (3.11 ± 4.71 versus 0.90 ± 2.68, p = 0.04). Nitric oxide, IL-17, IL-8, e-cadherin, neutrophil elastase or leukotriene B4 levels in EBC of CF patients were not related to P.Aeruginosa s infection, FEV1 levels or hospital admission in the last year. CONCLUSION: In our study, neutrophil elastase levels in EBC are higher in CF patients compared to non-CF controls. This is independent of acute infection and is evidence to the persistence of neutrophilic lung injury. However, EBC NO, IL-8, IL-17, e-cadherin, neutrophil elastase and leukotriene B4 levels as inflammatory markers, are not correlated with disease progression or clinical findings.

Morphometric comparison of the human corpus callosum in deaf and hearing subjects: an MRI study.

Auditory cortices are interconnected to each other by fibers passing through the corpus callosum (CC). In totally deaf persons no auditory impulses are conveyed to the auditory cortices, hence the auditory pathways become nonfunctional. It was reported that there has been cross-modal plasticity between auditory, visual, and somatosensory cortices. In this study, our aim was to make a comparison in the CC morphometry in hearing subjects and in a selected group in which the auditory system was deprived before the age of 2. 18 deaf and 18 hearing male, handedness matched volunteers, ages varying between 28 and 56 years old were examined. Audiometrical tests were applied to both groups and then T1-weighted midsagittal MR images were obtained. Certain dimensions and areas were measured on these images. There were no statistically significant difference between deaf and hearing subjects, either when dimensions and areas were analyzed by multivariate analysis of variance or when areas were analyzed by univariate analysis of variance. Absence of any significant morphometric difference in the CC of deaf subjects could be thought as an evidence of reflection of functional cortical plasticity.

Efficacy and safety of reuse of disposable laparoscopic instruments in laparoscopic cholecystectomy: a prospective randomized study.

BACKGROUND: The aim of this prospective randomized study was to investigate the efficacy and safety of the reuse of disposable laparoscopic instruments (DLI) in laparoscopic cholecystectomy. METHODS: A total of 125 consecutive patients with symptomatic cholelithiasis were randomly assigned to undergo laparoscopic cholecystectomy with single-use DLI (group 1, n = 62) or DLI that were reused (group 2, n = 63) after high-level disinfection by alkalinized 2% glutaraldehyde. Operative and postoperative outcomes were investigated. RESULTS: There was no significant difference between group 1 and group 2 in mean operating time, linear analogue pain scale score, duration and amount of analgesic administration, or hospital stay. Total incidence of complications (3.2% vs 4.8%, p = 0.50) and infection rates (1.6% vs 3.2%, p = 0.57) were also similar when group 1 was compared to group 2. CONCLUSION: This study showed that reusing DLI did not change the operative and postoperative outcomes or the infection rate for laparoscopic cholecystectomy when strict rules for disinfection were followed.

Evaluation of cerebral maturation by visual and quantitative analysis of resting electroencephalography in children with primary nocturnal enuresis.

This study was undertaken to evaluate resting electroencephalographic (EEG) changes and their relations to cerebral maturation in children with primary nocturnal enuresis. Cerebral maturation is known to be important in the pathogenesis of this disorder. Twenty-five right-handed patients with primary nocturnal enuresis, aged 6 to 14 years, and 23 age- and sex-matched healthy children were included in this cross-sectional case-control study. The abnormalities detected using such techniques as hemispheral asymmetry, regional differences, and hyperventilation response in addition to visual and quantitative EEG analysis were examined statistically by multivariate analysis. A decrease in alpha activity in the left (dominant hemisphere) temporal lobe and in the frontal lobes bilaterally and an increase in delta activity in the right temporal region were observed. We concluded that insufficient cerebral maturation is an important factor in the pathogenesis of primary nocturnal enuresis, and EEG, as a noninvasive and inexpensive method, could be used in evaluating cerebral maturation.

Comparison of in vitro dissolution profiles by ANOVA-based, model-dependent and -independent methods.

In this study, the aim was to apply different comparison methods to dissolution profiles of immediate release commercial film-coated tablets of naproxen sodium in order to (1) evaluate each method in terms of easy application and usefulness and (2) identify the advantages and disadvantages of each method. Dissolution testing was conducted using the USP monograph of naproxen sodium. The applied methods for the comparison of in vitro dissolution profiles are ANOVA-based methods, model-dependent methods, and model-independent methods including difference factor, f(1), and similarity factor, f(2). All the methods appear to be applicable and useful in comparing dissolution profiles. The results show that ANOVA-based methods and model-dependent methods are more discriminative than the f-factors. f-Factors seem to be easier to apply and interpret; only one value is obtained to describe the closeness of the two dissolution profiles. However, a last point for dissolution had to be determined, since the values of the f-factors depend on this point. The application and evaluation of model-dependent methods are more complicated; these methods present an acceptable model approach to the true relationship between percent dissolved and time variables, including statistical assumptions which could be checked. Dissolution profiles can be tested for differences in both level and shape by ANOVA-based methods and these methods provide detailed information about dissolution data which can be useful also in formulation development to match release to a reference product.

Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease.

BACKGROUND: The purpose of the study was to compare the outcome of excision and primary closure with that of rhomboid excision and the Limberg flap procedure in patients with primary sacrococcygeal pilonidal disease (SPD). METHODS: Two hundred consecutive patients with SPD were randomly allocated to undergo either excision and primary closure (group 1, n = 100) or rhomboid excision and the Limberg flap procedure (group 2, n = 100). Duration of operation, postoperative pain, time to first mobilization, length of hospital stay, postoperative complications, time to resumption of work, recurrence and time to recurrence were recorded for all patients. RESULTS: : Duration of operation was longer in group 2 than in group 1 (P = 0.001). However, postoperative pain was less (P < 0.001), mobilization earlier (P < 0.001), duration of hospital stay shorter (P < 0.001), time to resumption of work shorter (P < 0.001) and postoperative complications fewer (P < 0.001) in group 2. During a median follow-up of 28 months, no recurrence was detected in patients in group 2 versus 11 patients in group 1 (P = 0.001). CONCLUSION: Because of its low complication rate and acceptable long-term results, rhomboid excision and the Limberg flap procedure is preferable to simple excision and primary closure in the treatment of SPD.

Role of oxidative stress enzymes in open-angle glaucoma.

PURPOSE: To investigate the role of oxidative stress and lipid peroxidation in the pathogenesis of primary open-angle glaucoma (POAG). MATERIALS AND METHODS: The activities of myeloperoxidase (MPO), catalase (CAT), and the levels of plasma malondialdehyde (MDA) were measured in 40 (15 men and 25 women) patients with POAG and 60 (30 men and 30 women) healthy controls. RESULTS: There was no significant difference in the activities of CAT and MPO between the POAG patients and the controls. However, the plasma MDA level was significantly higher in patients than the controls. CONCLUSION: The results of this preliminary study suggest that the possible alterations of plasma MDA levels may be associated with the pathogenesis of POAG, but further research is needed to understand the role of oxidative damage in this important disorder of aging.

Does hyaluronan affect inflammatory cytokines in knee osteoarthritis?

Our aim was to investigate the effects of hyaluronan on inflammatory cytokines in the synovial fluid of patients with knee osteoarthritis. The study was single blind, placebo-controlled, and randomized. We administered hyaluronan to 22 patients in the study group and placebo to 19 in the control group. Enzyme-linked immunosorbent assay was used to determine the levels of cytokines. Both HA and placebo caused a significant decrease in interleukin (IL)-6 levels (P=0.0001 and P=0.04, respectively). But it was more significant in the study group. However, IL-8 and tumor necrosis factor alpha (TNF-alpha) levels did not change in either group (P>0.05). The amount of effusion decreased significantly in the study group (P=0.001) but not in the control group (P=0.133). It can be concluded that hyaluronan considerably decreased IL-6 levels, which correlated with clinical improvement, but had no effect on IL-8 and TNF-alpha levels in synovial fluid. However, larger studies with longer follow-up periods are needed to explain the effect of hyaluronan on cytokines.

The respiratory effects of occupational polypropylene flock exposure.

The present study evaluated the possible effects of exposure to polypropylene flock on respiratory health and serum cytokines in a cross-sectional study of workers from a plant in Turkey. A total of 50 polypropylene flocking workers were compared to a control group of 45 subjects. All subjects filled out a respiratory questionnaire and underwent a physical examination, a chest radiograph and pulmonary function testing, including single breath carbon monoxide diffusing capacity (DL,CO). Serum interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF-alpha) were measured. Additionally, high resolution computed tomography (HRCT) of the chest was performed in 10 exposed workers with low DL,CO. Work-related respiratory symptoms were reported in 26% of the exposed subjects and in 13.3% of the controls. Logistic regression analysis showed that the risk of respiratory symptoms increased 3.6 fold in polypropylene flocking workers when compared to controls. Parameters of the study group, including per cent predicted: forced vital capacity, forced expiratory volume in one second, forced mid-expiratory flow 25-75% and DL,CO, were significantly lower than in controls. Multivariate analyses showed that being a polypropylene flocking worker was a predictive factor for impairment of pulmonary function. Serum IL-8 and TNF-alpha levels were increased in the study group compared with the controls. HRCT revealed peribronchial thickening and diffuse ground glass attenuation in some subjects. The present study suggests the presence of subtle or the beginning of interstitial lung disease in these polypropylene flocking workers.

The role of oxygen saturation measurement and body mass index in distinguishing between non-apnoeic snorers and patients with obstructive sleep apnoea syndrome.

The aim of this study was to examine the role of oxygen saturation (SaO2) measurement in identifying apnoeic snorers from non-apnoeic snorers and in the assessment of the severity of obstructive sleep apnoea. Ninety-two patients with clinically suspected obstructive sleep apnoea syndrome (OSAS) were assessed, using overnight polysomnography. The patients were classified as follows: 14 patients were non-apnoeic snorers, 27 patients had mild OSAS, 31 patients had moderate OSAS and 20 patients had severe OSAS. Minimum SaO2 level, mean SaO2, time below 85% of SaO2, the ratio between the time SaO2 and total sleep time and body mass index (BMI) were assessed retrospectively. There was a statistically significant difference between the non-apnoeic group and OSAS patients in Min SaO2 (P = 0.03). Patients who had Min SaO2 above 85% could be evaluated as non-apnoeic snorers; however, SaO2 and BMI were not found to be useful in the assessment of the severity of OSAS.

Penile verrucous carcinoma in a 37-year-old circumcised man.

Squamous cell carcinoma of the penis is almost exclusively a lesion of uncircumcised older men. It represents about 1% of cancers in men in the United States and 11% to 12% of all cancers in men in countries where circumcision is not routinely practiced. Verrucous carcinoma is an uncommon variant that accounts for only 5% to 16% of all penile squamous cell carcinomas. We describe penile verrucous carcinoma in a 37-year-old white man who had been circumcised in infancy. To our knowledge this is the first case report of verrucous carcinoma in a circumcised man without any predisposing penile anatomic abnormalities.

[Familial hypoadrenalism]. / Rodzinnie wystepujaca niedoczynnosc nadnerczy.

Congenital hypoadrenalism was diagnosed in a 18-month boy. It is suspected that hypoplasia of the adrenals is determined genetically due to the similar course and the results of autopsy in his deceased sister.

Cellular angiolipoma.

A 25-year-old man had a 5-year history of multiple tender lesions of both extremities and trunk. Biopsy found an encapsulated subcutaneous nodule composed of numerous small, well-formed blood vessels, some filled with fibrin thrombi. This lesion was made up > 99.9% of blood vessels with only a minimal amount of adipose tissue. We believe our case is in the spectrum of angiolipoma even though it is made up almost entirely of a vascular component. These tumors may be confused with other multiple or eruptive vascular lesions that have a more ominous clinical course. This case is being reported to stress that multiple or eruptive "vascular" lesions do not always reflect an underlying immunosuppression or malignancy.

Eruptive epithelioid hemangioendothelioma with spindle cells.

A 39-year-old white man presented with four discrete dermal nodules in his right upper arm. Biopsy revealed superficial dermal well-circumscribed nodules composed of solid areas and vascular spaces lined by epithelioid endothelial cells and a similar nodule composed of spindle and epithelioid cells. A moderate mitotic count of 3-4 mitoses/10 hpf was present. Multiple lesions erupted 1 month later distally and proximally to the original lesions. Magnetic resonance imaging of the right arm demonstrated a lesion in the humerus. Biopsy of the humerus showed a vascular tumor with similar histologic features to the overlying skin lesions. The differential diagnosis included epithelioid vascular tumors, bacillary angiomatosis, pyogenic granuloma, and Kaposi sarcoma. Vascular lesions containing epithelioid and spindle cells span a spectrum from benign to malignant. We believe these tumors belong in the category of hemangioendothelioma and propose the name eruptive epithelioid hemangioendothelioma with spindle cells. Our case emphasizes that eruptive cutaneous vascular lesions do not always suggest immunosuppression or malignancy. Additionally, it highlights the association between epithelioid vascular lesions of the skin and bone.

Disseminated cutaneous epithelioid hemangioma.

Epithelioid vascular tumors are a heterogeneous group characterized by epithelioid-appearing endothelial cells. Included are benign vascular tumors (epithelioid hemangioma), borderline tumors (epithelioid hemangioendothelioma), and malignant tumors (epithelioid angiosarcoma). We describe a case of multiple epithelioid hemangiomas.

p75 nerve growth factor receptor staining helps identify desmoplastic and neurotropic melanoma.

Melanoma is a malignant tumor with a varied histologic appearance. Melanoma composed of spindle cells may include desmoplastic and neurotropic melanoma. The histologic diagnosis of desmoplastic and neurotropic melanoma can be difficult. Although S100 protein stains a majority of these melanomas, the staining may be weak or focal. HMB-45, a more specific marker of melanoma, is frequently negative in desmoplastic and neurotropic melanoma. In order to aid the identification of desmoplastic and neurotropic melanoma, we stained 13 spindle cell melanomas (5 neurotropic melanomas, 5 desmoplastic melanomas, 3 spindle cell melanomas without either desmoplasia or neurotropism) with p75 NGF-R and compared the staining results with S100 and HMB-45. p75 NGF-R is the low affinity nerve growth factor receptor reported to be present on the surface of neural-crest-derived cells. Conventional melanoma as well as neurotized nevi, neurofibroma, spindle squamous carcinoma, atypical fibroxanthoma, dermatofibroma and scars were also stained with p75 NGF-R. p75 NGF-R stained all of the desmoplastic and neurotropic melanomas tested. In each of these cases, negative HMB-45 staining of the spindle cells was seen. In many cases the number and intensity of the spindle cells staining with p75 NGF-R was greater than with S100. Neurofibroma, neurotized nevi and focal cells in round cell melanoma also were stained with p75 NGF-R. All the squamous cell carcinomas, atypical fibroxanthomas, dermatofibromas and scars were negative for p75 NGF-R. Based on our results, p75 NGF-R may be useful as an additional confirmatory antibody in a melanoma panel, especially in differentiating desmoplastic and neurotropic melanomas from non-neural-crest-derived spindle cell lesions. We feel it also can be helpful in better identifying margins of excision of these melanomas. p75 NGF-R, like S100 protein, will not differentiate desmoplastic and neurotropic melanomas from other neural-crest-derived lesions.

Effects of X-rays and cigarette smoking on leukocyte, lymphocyte and mitotic index values and SCE rates: the relationship between mitotic index and lymphocyte count.

Many previous studies revealed that smoking increases leukocyte and lymphocyte counts while exposure to X-rays decreases these counts. However the relationships between lymphocyte life span and smoking as well as X-rays were not well documented. The primary aim of this study was to determine relationships between smoking X-rays (in combination and individually) and life span of lymphocytes. Blood samples from 200 healthy individuals, half of which were X-ray exposed individuals, were collected. Half of X-ray exposed and of non-X-ray exposed individuals were smokers. There were equal numbers of male and female participants. Two lymphocyte cultures, one for the sister chromatid exchange (SCE) analysis and the other for the determination of mitotic index values were prepared using one part of the blood samples collected from the individuals. From the other part of the blood sample leukocyte and lymphocyte counts were determined with a haemogram device. Evaluation of the findings suggested that leukocyte count, lymphocyte count, mitotic index were relatively lower for the X-ray exposed individuals. In addition these values were higher for smokers than nonsmokers in general. The highest SCE rates were recorded for smoking radiology technicians. The most important finding is that lymphocyte life span is relatively low in smokers and in X-ray exposed males.

Acute electrophysiological effect of pulsed gallium-arsenide low-energy laser irradiation on isolated frog sciatic nerve.

We evaluated the acute electrophysiological effects of low-energy pulsed laser irradiation on isolated frog sciatic nerve measured by extracellular recording technique. A pulsed gallium-arsenide (GaAs) laser (wavelength: 904 nm, pulse duration 220 ns, peak power per pulse: 27W, spot size: 0.28 cm(2), total applied energy density: 0.005-2.5J/cm(2)) was used for the experiment. Sixty isolated nerves were divided into six groups (n=10), each of which received a different laser dose. In each group, action potentials were recorded before laser irradiation which served as the control data. The extracellular action potentials were recorded for each combination of 1, 3, 5, 7, 10, 13 and 15 minutes of irradiation time and 4, 8, 16, 32, 64 and 128 repetition frequency by using a BIOPAC MP 100 Acquisition System Version 3.5.7 (Santa Barbara, USA). Action potential amplitude, area, duration and conduction velocity were measured. Statistical evaluation was performed using repeated measures variance analysis by SPSS 9.0. There were no statistically significant differences for action potential amplitude, area and conduction velocity among the laser groups and control data (p>0.05). The study showed that low-energy GaAs irradiation at 4-128 Hz repetition frequencies administered for irradiation times of 1-15 min generates no effect on action potential amplitude, area, duration and conduction velocity in isolated frog sciatic nerve.

Effects of heparin on hypertonic potassium chloride-induced bronchoconstriction.

BACKGROUND: Changes in bronchial osmolarity is a well-known factor for bronchoconstricion. Recenty, nonisotonic aerosols have begun to be used for the assessment of bronchial hyperreactivity. Hypertonic KCl can cause bronchoconstriction even in non-symptomatic asthmatic patients. OBJECTIVE: To evaluate the protective role of heparin on hypertonic KCl-induced bronchospasm in asthma. METHODS: Thirty-eight asthmatic patients were included in this double-blind, placebo-controlled study. On day 1 of the study, after performing the respiratory function test (RFT), patients had inhaled KCl 10% and RFTs were done after 20 minutes. On day 2 of the study, after the basal RFT, 18 patents inhaled NaCl 0.9% 0.2 mLkg solution. After the completion of this procedure, patients waited for 20 minutes and inhaled KCl 10% 10 mL, and RFTs were repeated 20 minutes later. The second group consisted of 20patients who inhaled heparn 1,000 units/kg after the RFTs were performed. Twenty minutes later, they inhaled KCl 10% and waited for 20 minutes. Finally, RFTs were done and compared with those from the other group. RESULTS: In the control group, forced expiratory volume in one second (FEV1) decreased 17.4% on day 1 and 16.4% on day 2. In the heparin-treated group, FEV1 decreased 18.6% on day 1, but almost no change occurred after this group was treated with heparin before inhalation of hypertonic KCl on day 2. CONCLUSIONS: Heparin was found to be highly protective against hypertonic KCl induced bronchospasm in bronchial asthma.

Exteroceptive suppression patterns of masseter and temporalis muscles in central and peripheral headache disorders.

The objective of this study was to compare the exteroceptive suppression patterns of masseter and temporalis muscles in patients with primary and secondary headache disorders originating from peripheral joint dysfunction. We accomplished the temporalis and masseter exteroceptive suppression in 28 patients with migraine, 25 patients with chronic tension-type headache (CTH), 22 patients with temporomandibular joint (TMJ) dysfunction and 18 healthy controls. The onset latencies and duration of the first suppression period (S1) was not significantly different between the patients and controls. The duration of the second suppression period (S2) was shorter in patients with CTH, migraine (analysed during attack) and TMJ dysfunction than those obtained from controls. A distinctive finding was significantly prolonged onset latency in patients with TMJ over those obtained from patients with CTH and migraine. We concluded that the onset latency of the S2 period is a useful parameter in the differential diagnosis of primary and peripheral headache disorders.