Histopathological efficiency of amifostine in radiation­induced heart disease in rats.

OBJECTIVE: Amifositine is a phosphorylated thiol that holds its radioprotective actions by several indirect mechanisms. The purpose of this study was to evaluate histopathologically whether amifositine administration prior to irradiation would have a long­term protective effect on heart tissue in an experimental rat model. METHODS: Single dose of 18 Gy radiation and sham radiation exposure were used in related groups. A dose of 200 mg/kg of amifostine was injected intraperitoneally 30 min prior to radiation exposure. Analyses were performed 6 months after irradiation. RESULTS: Vascular damage and vasculitis were significantly decreased in amifositine treatment group. At the same time, significant thickening of the medial layer was accompanied by vascular damage in irradiated groups. The number and severity of myocyte necrosis were diminished with amifostine.Nevertheless, it could not prevent epicardial and myocardial fibrosis. Severe myocardial fibrosis was observed prominently in three regions, particularly on the apex, tips of papillary muscles and in sites adjacent to the atrioventricular valves. The anti-inflammatory effect of amifostine was not seen. CONCLUSION: The development of vascular damage and vasculitis were prevented by the use of amifostine. There was a correlation between vascular damage and fibrosis development. According to histopathological results, amifostine could be used as a protective agent against the side effects of radiotherapy (Tab. 4, Fig. 2, Ref. 22).

The prognastic efficiencies of modified early warning score and mainz emergency evaluation score for emergency department patients.

BACKGROUND: Recently, there is an increasing interest for scoring systems to evaluate the critically ill patients by means of the severeness of their disease and their availibility for discharge in the emergency departments and intensive care units. Our aim in this study is to evaluate the efficiency of the mEWS and MEES scoring systems in assessing the severeness of the disease and predicting the mid term prognosis of the patients hospitalized following their emergency care in our emergency room. MATERIAL AND METHOD: Patients, who attended to Inonu University Department of Emergency Medicine and hospitalized following their emergency care were included to our study. The effects of age, sex, triage categories, mEWS and MEES scores on the site of hospitalization and mortality was evaluated. Statistical analyses were performed by SPSS for Windows version 16.0. The data was summarized as means, standart deviation and percents. Univariate and multiavriate analyses were performed for risk factor calculations. RESULTS: The mean age of the patients was 58±19 and 584 (56%) were male. Triage group 1 patients accounted for 21 of all (2%), while 646 (61%) were in group 2 and 384 (37%) were in triage group 3. Of all patients, 341 (32%) were hospitalized to ICU. While discharged patients accounted for 89% (935 patients) of the study group, 116 patients (11%) died at the hospital. The GCS, AVPU and mEWS values were statistically significant by means of patient mortality (P < 0.0001), but the delta MEES value was not (P < 0.127). CONCLUSION: The results of our stuy suggests that mEWS evaluation is an effective and reliable tool for predicting outcome and hospitalization areas of ED patients. Our results also displayed that the easily available GCS and AVPU scales are reliable guides in patient management. MEES values, on the other hand, are not convenient for ED use.

Investigation of in vivo radioprotective and in vitro antioxidant and antimicrobial activity of garlic (Allum sativum).

OBJECTIVE: In this study, we aimed to assess the in vivo antioxidant potential via evaluating radioprotective effects in kidney and liver tissues of rats and in vitro antimicrobial and radical scavenger activity of garlic extract. MATERIALS AND METHODS: Thirty-two mature female Wistar rats were divided into four groups, each consisting of eight rats. Experimental groups were control group (1), GE group (2), irradiation group (3) and both GE and irradiation group (4). For the rats in two groups (group 3 and 4), irradiation was performed on a Cobalt-60 unit using a single fraction of 20 Gy. The GE was given to rats once a day during the month before irradiation and continued for five days after irradiation. The garlic cloves were peeled on crushed ice and 50 g of garlic was cut into small pieces and homogenized in 75 mL of 0.9% NaCI. The concentration of this garlic preparation was considered to be 500 mg/mL on the basis of weight of the starting material (0.5 g/mL). This extract was administered to rats by oral gavage. RESULTS: Our findings suggest that the use of garlic extract could be useful for addressing the limited therapeutic gain due to the radiation sensitivity of normal tissues adjacent to the tumour which are exposed to radiation, by strengthening the antioxidant system. In vitro and in vivo experiments seem to yield similar conclusions. CONCLUSIONS: It can be stated that garlic is may be recommended to be sufficiently included in the diets of radiotherapy patients considering its antioxidant and antimicrobial efficacy.

Effect of uterine artery blood flow on recurrent pregnancy loss.

We investigated the effect of uterine artery blood flow on recurrent pregnancy loss. One hundred and twelve patients admitted to our clinic were included in the prospective study. The study group consisted of 28 cases with a history of three miscarriages before the 20th gestational week, and the control group consisted of cases with at least one prior live birth without any history of miscarriage or poor obstetric outcome. The mean pulsatility index (PI) , resistance index (RI) and systolic/diastolic ratio (S/D ratio) values of the uterine artery were measured between the 18th and 23rd days of the menstrual cycle via transvaginal Doppler ultrasonography. No statistically significant difference could be detected regarding uterine artery PI (p=0.703), RI (p=0.333), and S/D (p=0.403) values between the study group and the control group (p>0.05). In order to clearly determine etiologic causes of recurrent pregnancy loss, new randomized and controlled clinical trials with large patient populations are needed.

Characteristics of the admissions of cancer patients to emergency department.

PURPOSE: To identify the characteristics of admission of patients with cancer in the emergency department of a university hospital. METHODS: The medical records of 468 emergency department admissions of 336 cancer patients due to medical conditions that were related either to their cancer or its treatment were reviewed and retrospectively analysed. RESULTS: There were 226 (67%) males and 110 females (37%), with a median age of 60 years (range 17-93). Regarding cancer staging, 156 (46%) patients had locoregional disease and 180 (54%) metastatic disease. Regarding performance status (PS), 321 (69%) were Eastern Cooperative Oncology Group (ECOG) 1-2, and 147 (31%) were ECOG 3-4. The main causes of emergency department admission were cancer progression in 188 (40%) patients, cancer-related signs and symptoms in 203 (43%) and treatment-related complications in 77 (16%). The most common primary cancer sites were the thorax, the gastrointestinal system and the genitourinary system. The medical condition necessitating emergency department admission was local tumor compression in 144 (31%) admissions, infection in 86 (19%) and end-of- life support in 63 (13%). CONCLUSION: Cancer patients seeking nonscheduled medical care and admitting to emergency departments present many challenges to the emergency physician. Due to the associated high morbidity and mortality, initial evaluation of the patient in the emergency department and therapy have utmost importance in the outcome of the patient. Accurate diagnosis and appropriate treatment of cancer-related problems can improve the quality of life dramatically in patients with cancer.

Nutritional evaluation of non-traumatic patients admitted to the hospital from Emergency Department.

OBJECTIVE: Malnutrition is a common condition, especially among hospitalized patients which are overlooked by many clinicians. Malnutrition was found to be associated with increased hospitalization duration, increased admission frequency, increase in infection frequency and severity, bad wound healing, gait disturbances, fallings, and fractures. In this study, we aimed to determine malnutrition frequency in patients who were admitted to the emergency department for non-trauma causes and hospitalized. PATIENTS AND METHODS: 245 patients were admitted to the Emergency Department for non-trauma causes and hospitalized and 245 control group patients were included in this study. Hospitalized patients were assessed with NRS-2002 (Nutritional Risk Screening) and Mini Nutritional Assessment (MNA). Age, gender, height, weight, body mass index (BMI), malnutrition status, and wards of the patients were screened. RESULTS: 140 (57.1%) of the hospitalized patients had malnutrition according to NRS-2002 and MNA. There was a statistically significant difference between the control group and the hospitalized patients who were malnourished (Pearson chi-square test; p<0,001). There was a significant relation between hospitalized departments and malnutrition (p<0.05). There was a significant difference in age and height between hospitalized patients and the control group (p<0.0001) whereas no significant difference was found between the height and BMI (p>0.05). There was a significant relationship in terms of hospitalization and malnutrition. CONCLUSIONS: The nutritional state of the patients admitted to the emergency department for non-trauma conditions is an important factor and should not be overlooked.

Curcumin protects against testis-specific side effects of irinotecan.

OBJECTIVE: Irinotecan (IR/CPT-11) is a semisynthetic, water-soluble derivative of the alkaloid camptothecin. It is a topoisomerase I group antineoplastic drug commonly used for the treatment of many cancer types, although it has side effects in tissues such as the testis. Curcumin (CRC) is a polyphenol compound produced from the Indian saffron root; it is used as food colouring and food flavouring. This study examined the testis-specific side effects of IR and the ability of CRC to protect against these side effects. MATERIALS AND METHODS: Forty male Sprague-Dawley rats were used in our study (n = 10). The rats were randomly divided into the following four groups: control, IR, IR + CRC, and CRC. IR 10 mg/kg/day was administered intraperitoneally and CRC 100 mg/kg was administered orally. Blood and testicular samples were collected from rats in all four groups on day 30 after drug administration. Histological, biochemical, and spermatological analyses were conducted. RESULTS: Testis tissue and blood samples were collected from the four groups. Tissue samples from the control and CRC groups demonstrated normal histological appearance on light microscopy. The IR group exhibited the following findings: vascular congestion in the tunica albuginea layer; tubular degeneration and vascular congestion in the interstitial area; oedema, vacuolisation, and luminised cells in the seminiferous tubule; and cells that temporarily stopped dividing at any stage of division in the seminiferous tubule epithelium. In the IR+CRC group, histopathological damage was significantly reduced by CRC treatment. Biochemical analysis showed that the level of thiobarbituric acid reactive substance (TBARS) was significantly increased in the IR group, compared with the other groups. CRC treatment significantly decreased this IR-mediated increase in TBARS level, and the TBARS level in the IR + CRC group approached the level observed in the control group. IR treatment caused significant decreases in glutathione (GSH), superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) levels. However, CRC administration tended to ameliorate the decreases in GSH, SOD, CAT, and GPx levels. CONCLUSIONS: In this study, IR had some toxic effects in rat testis tissue; these effects were ameliorated by CRC treatment. Further studies are warranted to confirm our results.

[Multiple femur and tibia shaft fractures in the severely injured. A therapeutic challenge]. / Multiple Femur- und Tibiaschaftfrakturen des Mehrfachverletzten. Eine therapeutische Herausforderung.

Nowadays, there is a trend towards the concept of damage control in the management of multiple trauma patients. However, the question remains whether all patients benefit from this concept. We report the primary total definitive treatment of a patient with multiple fractures of the lower extremities. Postoperative respiratory insufficiency was treated successfully by non-invasive ventilation.

A probable outbreak of toxoplasmosis among boarding school students in Turkey.

In total, 171 students from a boarding school in Izmir, Turkey, with mild and non-specific symptoms of toxoplasmosis, were screened during September-October 2002. All 171 students were seropositive for Toxoplasma gondii IgG and IgM. Of 43 students tested, 40 (93%) had low IgG avidity. None showed evidence of ophthalmic involvement. The data suggest that T. gondii may spread rapidly in close living conditions, possibly following exposure to cat litter. This is the largest recent outbreak of toxoplamosis described in the medical literature.

A note on the incidence and antibiotic resistance of Staphylococcus aureus isolated from meat and chicken samples.

One hundred and fifty samples of raw calf/lamb meat samples (mince and chunks) and chicken parts (giblets, carcass) were analysed for the presence of Staphylococcus aureus. Eighty S. aureus strains were isolated and identified. Resistance of the strains to methicillin and other antibiotics was determined by the Kirby-Bauer disc diffusion test. The overall methicillin resistance rate for S. aureus was 67.5%. Of S. aureus strains, 87.5% were resistant to bacitracin. A high prevalence of penicillin G resistance was detected for S. aureus (53.8%). Few of the strains were resistant to erythromycin (7.5%). All strains were susceptible to vancomycin, sulbactam-ampicillin, ciprofloxacin and cefaperazone-sulbactam. This study confirmed the presence of S. aureus, especially antibiotic-resistant strains, in the foods examined, indicating poor sanitary conditions during processing which may create a health risk for consumers.

Kidney Transplantation Is Superior to Hemodialysis and Peritoneal Dialysis in Terms of Cognitive Function, Anxiety, and Depression Symptoms in Chronic Kidney Disease.

BACKGROUND: Cognitive impairment, anxiety and depression are important problems for patients with chronic kidney failure. Cognitive impairment, anxiety, and depression may be related to various factors, such as complications of hemo/peritoneal dialysis, uremic encephalopathy, psychosocial burden of the disease, and various comorbidities in patients with chronic kidney failure. Successful kidney transplantation (KT) improves kidney, endocrine, metabolic, and vascular systems, mental functions, and the quality of life of the patients. METHODS: A total of 181 patients with chronic kidney failure were studied: 54 currently on hemodialysis, 58 on peritoneal dialysis, and 69 with KT. All participants were given a detailed sociodemographic form, including data about the reason of kidney failure, duration of treatment (hemodialysis, peritoneal dialysis, and KT), and comorbid illnesses. Participants were evaluated with the use of the Hospital Anxiety and Depression Scale (HADS) for evaluating depressive and anxiety symptoms and the Brief Cognitive State Examination (BCSE) for detecting possible cognitive impairment. RESULTS: Patients with KT had lower levels of anxiety and depression symptoms than patients with hemodialysis and peritoneal dialysis. The KT group scored better than the hemodialysis and peritoneal dialysis groups on the BCSE. The peritoneal dialysis group scored higher on the BCSE than the hemodialysis group. The hemodialysis group scored higher on the HADS than the peritoneal dialysis group. CONCLUSIONS: In this study it was found that KT patients have better cognitive and mood regulation outcomes than hemodialysis and peritoneal dialysis patients with chronic kidney failure. With this knowledge we suggest that patients with kidney failure should have KT for having better cognitive functions and mood state as soon as possible.

Laparoscopic gastric bypass for morbid obesity with linear gastroenterostomy.

BACKGROUND: Laparoscopic gastric bypass (LGBP) is a well-established procedure for the surgical management of morbid obesity. Most surgeons create the gastroenteral anastomosis by using the circular EEA stapler. We describe an alternative laparoscopic anastomotic technique using the EndoGIA linear stapling device. METHODS: The stomach was proximally transected with a linear stapler (45 mm, Endo-GIA) to create a 15 to 20 ml pouch. Next, an antecolic Roux-en-Y gastroenterostomy was performed, using the 45 mm Endo-GIA. The proximal loop of the intestine was then separated from the anastomotic site by the Endo-GIA. Finally, the Endo-GIA was used for the intraabdominal creation of a side-to-side enteroenterostomy. RESULTS: Between June and August 2001, 5 patients with mean BMI 56.7 kg/m(2)+/-7.3 underwent LGBP. All patients were seen 6 months post-surgery. Operating time was 7.5 and 6.5 hours for the first 2 operations, but was under 4.5 h for the next 3 cases. 1 patient suffered from perioperative hypoxia leading to long-term artificial respiration. 6 weeks after surgery, 1 patient developed obstruction due to torsion of the enteroenterostomy and required open revision. The 3 remaining patients made an uneventful recovery. All patients lost considerable weight (mean 36.5 kg; [range 32 to 45] after 6 months). No stenosis or anastomotic leakage was noted. CONCLUSIONS: A linear stapled anastomosis is an alternative to the use of the circular stapler.

Pharmacokinetics of the antimicrobial agents rifampicin and miconazole released from a loaded central venous catheter.

The time course of rifampicin and miconazole concentrations after insertion of a polyurethane catheter loaded with these antibiotics were studied. Data from controlled release experiments in vitro were used, and the concentration time courses of the antimicrobials in serum were calculated by pharmacokinetic simulations. Systemic therapy using typical dosages (rifampicin 600 mg/day iv, miconazole 3 x 200 mg/day iv) results in rifampicin concentrations between 54 and 8424 microg/L, and miconazole concentrations between 3567 and 4676 microg/L. After insertion of a polyurethane catheter loaded with these antibiotics, the maximal concentrations after catheter placement were determined as 6 microg/L at 10.7h for rifampicin, and 13 microg/L at 28.6 h for miconazole. Assuming that the total amount of antibiotics incorporated in the catheter matrix were bioavailable ('worst case'), the resulting maximal concentrations calculated by simulation are 10 microg/L for rifampicin and 65 microg/L for miconazole. Maximal concentrations of rifampicin or miconazole resulting from the insertion of a polyurethane catheter loaded with these antibiotics are, therefore, far below the concentrations resulting from a systemic therapy with the same antimicrobial agents. Even in the worst case, the danger of selecting resistant bacterial strains seems remote because the systemic drug levels are magnitudes of order below subinhibitory concentrations.

Port function after laparoscopic adjustable gastric banding for morbid obesity.

BACKGROUND: Laparoscopic adjustable gastric banding (LGB) has gained wide popularity, but information on port function is limited. METHODS: In a prospective nonrandomized study, we analyzed port function and related symptoms in 50 consecutive patients with severe obesity. All patients underwent LGP in a five trocar technique. In 11 patients, the port was placed subcutaneously in the subxiphoid region. In 39 patients, the port was implanted in the left upper abdomen. Mean duration of follow-up was 2.8 years. RESULTS: Patients (12 males and 38 females) had an initial body mass index (BMI) of 47.1 kg/m2. Puncturing the subxiphoidal port was without problems in all 11 patients. However, seven women reported pain and inconvenience when wearing a brassiere. Two underwent port reimplantation in the left upper abdomen (one due to infection; one due to pain). Among the 39 patients with abdominal port implantation, nine patients required port correction (two of them twice). The causes were port dislocation (four cases), difficult puncturing (three), tube leakage (three), and infection (one). CONCLUSION: The high number of complications suggests that the port is the Achilles' heel of LGB. Ports at the subxiphoid site were easier to puncture, but frequently caused pain in female patients.

Endobronchial low-grade MALT lymphoma causing unilateral hypertranslucency.

Mucosa-associated lymphoid tissue-derived lymphoma (MALT lymphoma) arises not only from the stomach but also from various non-gastrointestinal sites. A thirty two year old woman, suffering from breathlessness for one year, had been treated for bronchial asthma. A chest radiograph showed a mediastinum and heart transposition to the right side and emphysema of the left lung. In the thorax spiral tomography, a mass narrowing left main bronchi, five centimeters in length from the carina, was seen. A fiberoptic bronchoscopy revealed millimetric polypoid lesions those nearly totally obstructed the left main bronchi. The bronchoscopic biopsy showed a diagnosis of MALT lymphoma. She was seen for check-ups following chemotherapy but no further treatment has been carried out.

[Psoas abscesses. Genesis, diagnosis, and therapy]. / Psoasabszesse. Entstehung, Diagnostik, Therapie.

BACKGROUND: A psoas abscess is a rarely encountered entity with various etiologies and nonspecific clinical presentation, frequently resulting in delayed diagnosis, increased morbidity, and prolonged or recurrent hospitalization. PATIENTS AND METHODS: Between January 1996 and January 2002 we treated ten patients (approximately 54.8, 5 males,5 females). These cases were analyzed retrospectively relative to a review of the literature. RESULTS: CT scanning was decisive in the final diagnosis of psoas abscess. Primary psoas abscess occurred in four cases and six patients had secondary abscesses. In all except one case, the psoas abscess was located on the right side. The causes of primary abscesses were retroperitoneal perforated appendicitis, paravertebral injections for lumboischialgia, Pott's disease, and repeated intravenous drug application in the groin. Five patients underwent retroperitoneal open drainage and four patients CT-guided drainage. One patient with retroperitoneal perforated appendicitis was treated by laparotomy. Staphylococcus aureus, Bacteroides fragilis, and Escherichia coli were the most common infective agents. There was no postoperative mortality and no cases of abscess recurred. CONCLUSIONS: CT scan is a diagnostic "gold standard" for psoas abscess. CT-guided drainage is the method of first choice, but is not possible in all cases. Open retroperitoneal drainage is a standard method of treatment. Postoperative antibiotic therapy is obligatory and should be adapted individually.

The isolation of certain pathogen microorganisms from raw milk.

In this research, a total of 211 raw milk samples in different areas of Ankara were collected from various dairy plants. Each of these samples was tested for the presence of Yersinia enterocolitica, Listeria monocytogenes and Campylobacter spp. From a total of 14 (6.63%) Y. enterocolitica and Y. enterocolitica-like organisms were isolated. 8 (3.79%) of the total isolation were identified as Y. enterocolitica whereas 6 (2.84%) of these were found to be Y. enterocolitica-like organisms. In addition L. monocytogenes and Campylobacter were detected in 2 (0.94%) and 17 (8.05%) same raw milk samples. Distribution of these patogenic microorganisms was evaluated according to the season. 6 of a total 14 Yersinia spp. were isolated in winter, eight in spring and summer. One of the L. monocytogenes was isolated in winter whereas the other one was isolated in spring 7 of a total of 17 Campylobacter were isolated in the summer months.

[Use of various cell culture antigens in the indirect fluorescent antibody test for the detection of antinuclear antibodies]. / Indirekt fluoresan antikor test ile antinükleer antikor saptanmasinda çesitli hücre kültürü antijenlerinin kullanilmasi.

Cell culture antigens were prepared from Vero, BHK-21 and Hep-2 cells which were propagated on slide, for detection antinuclear antibody (ANA) in sera with indirect fluorescent antibody test (IFAT). ANA were investigated in 55 sera which were positive at 1/20 titer with KB IFAT ANA test kits (Virgo), by using these cell culture antigens. 50 sera (91%) with Vero antigens, 46 sera (83%) with BHK-21 antigens and 44 sera (80%) with Hep-2 antigens were found positive at 1/20 titer. As conclusion Vero cell culture which is propagated on slide can be used as antigen for detection of ANA with IFAT.

[Rubella virus IgG and IgM antibody levels in 17-20 year old female students using ELISA and fluorescent antibody tests]. / 17-20 yas grubundaki kiz ögrencilerde rubella virus IgG ve IgM antikor düzeylerinin ELISA ve fluoresan antikor testleriyle arastirilmasi.

In this study Rubella virus antibody levels were investigated by using ELISA and IFAT in 94 sera obtained from girl students in Gülhane Military Medical Academy nursing college. We have propagated Rubella virus in BHK-21 cell line for production Rubella virus antigen in order to use IFAT. 81 sera IgG (86.2%) and 29 sera IgM (30.9%) were found positive in ELISA. However 76 sera (80.9%) IgG and 27 sera (28.7%) were positive in IFAT. On the other hand we have obtained suspected results in 8 sera (8.5%) with 1/10 dilution in IgG ELISA and in 3 sera (3.2%) with the same dilution in IgM ELISA. One of 29 sera which are ELISA IgM positive have established 80 IU/ml RF. We can say that ELISA is more reliable sensitive and practical than IFAT. It may be considered 29 student who have Rubella IgM antibody may be infected or reinfected by Rubella virus with in the last six months. On the other hand they may also infected with Parvovirus or some other viruses. We believe that the causes of false positive Rubella IgM antibody results should be investigated well enough.