Magnetic resonance visualization of iron-loaded meshes in patients with pain after inguinal hernia repair.

PURPOSE: Chronic post-operative inguinal pain (CPIP) is defined as pain lasting more than 3 months and the incidence is less than 4% after laparoscopic hernia repair. CPIP can have several causes. In this study, we aimed to show that 3D-iron loaded mesh preparations are useful in radiological evaluation of post-operative complications, especially patients with chronic pain and the mesh status of operated inguinal hernia cases. METHODS: A total of 450 cases who had been operated for inguinal hernia with 3D-iron loaded mesh and who had ongoing pain at the post-operative period were included in this study. MRI (Magnetic Resonance Imaging) was performed at the post-operative 90th day of the seven symptomatic (groin pain, limitation of movement) cases which were operated using a 3D-iron loaded mesh, 10 × 15 cm in size, (DynaMeshEndolap visible with 25% MRI-visible filaments, FEG TextiltechnikmbH, Aachen, Germany) for inguinal hernia repair to evaluate mesh status, localization, and local complications. Gradient echo sequences in the sagittal, axial, and coronal sections on MRI were discussed by two radiologists. Mesh localizations, their relationship with surrounding structures and their complications related with mesh were evaluated by two radiologists (D.Y, D.E.T.S). RESULTS: No significant radiological findings related to defined anatomical structures were found in the MRI images of the study group. The dimensions measured on the sagittal, axial and coronal images were correlated with original mesh sizes and no significant shrinkage was detected. CONCLUSION: Mesh position and deformation as shrinkage can be the mesh-related cause of pain. The incidence of CPIP in our patients is less than 2%. 3D-iron loaded meshes were monitored with MRI in CPIP patients and there was no mesh-related changes found in our study. The use of MRI-visible meshes will most likely help us to monitor mesh preparations and show potential time-dependent changes in mesh characteristics and consequent complications. In case of doubtful clinical postoperative hernia recurrence or chronic groin pain, mesh position can be identified by MRI and unnecessary surgical intervention can be avoided.

Turkish Transplant Registry: a comparative analysis of national activity with the EBMT European Activity Survey.

SCT is a curative approach using chemo-, radio- and immunotherapy for malignant and non-malignant hematological disorders. The European Group for Blood and Marrow Transplantation (EBMT) has been collecting yearly data on a survey basis since 1990. The variables within the survey are limited to detailed indications, number of patients, transplant type, stem cell source, type of conditioning regimen and donor type. The transplant rates in certain indications, patterns of stem cell source selection and donor availability and alternative donor use were analyzed in detail. The Turkish transplant registry data within EBMT-European Activity Survey (EBMT-EAS) were delivered by the EBMT Activity Survey Office. We compared the national data with the international EBMT-EAS data pool.

The association between high parity and obesity in women living in South-eastern Turkey.

BACKGROUND AND AIM: One of the major public health problems in Turkey is the high prevalence of obesity, which is particularly frequent among women. As it has been reported that parity affects body fat and BMI, the aim of this study was to evaluate the association between parity number, socioeconomic status and obesity. SUBJECTS AND METHODS: The study involved 286 married or divorced women aged 28- 80 years (mean age: 46.7+/-9.7), who were divided into two groups depending on whether they had experienced three or fewer pregnancies (group 1) or four or more pregnancies (group 2). We measured their body weight and height, and waist and hip circumferences, calculated their BMI, and determined their body fat percentage and fat mass by means of bioelectric impedance. RESULTS: The women in group 2 had a higher BMI, a greater fat percentage and fat mass, a larger waist circumference and higher waist/hip ratio values than those in group 1, and their mean age and illiteracy ratio were also higher. There was a significant correlation between parity number and body weight, BMI and hip circumference. CONCLUSIONS: Among other risk factors, a high parity number and socioeconomic indices may be associated with obesity in women.

[RuII(tpy)(bpy)Cl]+-Catalyzed reduction of carbon dioxide. Mechanistic insights by carbon-13 kinetic isotope effects.

In this work, we examine the use of competitive 13C kinetic isotope effects (13C KIEs) on CO2 reduction reactions that produce CO and formic acid as a means to formulate reaction mechanisms. The findings reported here mark a further advancement in the combined 13C KIE measurements and theoretical calculations methodology for probing CO2 conversion reactions.

Spigelian hernias: a prospective analysis of baseline parameters and surgical outcome of 34 consecutive patients.

Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective multicenter study, we aimed to outline the specific features of spigelian hernias and patients' characteristics more clearly. Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34 patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications and is very well tolerated by the patient.

Clinico-epidemiologic study of cutaneous leishmaniasis in Diyarbakir Turkey.

Cutaneous leishmaniasis (CL) is a zoonotic disease, endemic and notifiable in southeastern Turkey. We investigated clinical features, individual characteristics, and environmental factors of affected patients, and identified additional patients with CL in Diyarbakir. In 2002 we studied the epidemiology of CL in Dedeköy and Durabeyli towns in Diyarbakir Province. We evaluated patients with any skin lesions. A questionnaire including demographic details was completed by each patient. Clinical details of lesions and other dermatological findings were recorded. We walked around the town and surveyed it for environmental factors. CL was diagnosed in 78 individuals aged 1-85 years (mean age of 20). Although all age groups were affected, the majority of patients were under age 20. The lesions ranged from approximately 0.5 to 20 cm. They were located on the face (46.7 %), upper extremity (23.2 %), lower extremity (5.1 %), and other sites. Different types of lesions were observed such as nodule with crust, nodule with osseous crust, violaceous infiltrative plaque with vegetative nodule, erysipelas-like plaque verrucous annular plaque, and eczema-like plaques. The incidence of CL is increasing in Dicle and Durabeyli towns and the clinical appearance may vary greatly.

Brucellosis transmitted by bone marrow transplantation.

We report a unique case of brucellosis transmitted by BMT. An 8-year-old boy with the diagnosis of Fanconi's anemia received an allogeneic BMT from his HLA-identical sibling. Routine culture from the infused marrow suspension grew Brucella abortus on day +4 post BMT. Spiking fevers occurred on days +2 and +16. The first febrile episode responded to broad-spectrum antibiotic therapy. However, the second episode did not. B. abortus was isolated from blood cultures taken during the second febrile episode. The Brucella agglutination titer was negative. Antibiotic therapy with oral doxycycline and i.v. gentamycin was successful with no recurrence of infection during 13 months of follow-up. The donor's blood culture was also positive for B. abortus and Brucella antibodies were detectable at 1:320 titer when he presented with fever and hepatosplenomegaly on day +32. We emphasize the need to consider brucellosis in patients undergoing BMT. We suggest that donor and recipient be evaluated for brucellosis especially in countries where the incidence of this infection is relatively high.

An intensive approach to the treatment of disseminated BCG infection in a SCID patient.

There is an appreciable mortality associated with BMT in patients with SCID and advanced BCG infection. We present a girl with T-B+ SCID complicated by spina ventosa and disseminated BCG osteitis after receiving a fully matched sibling marrow transplant. Considerable progression characterised by two clinical activations and multiple pleural and perivertebral abscess formations occurred with conventional anti-mycobacterial chemotherapy. She finally recovered with full immune reconstitution after BMT and intensive treatment comprising five conventional and alternative agents that she received for 36 months. No side-effects and/or complications have been seen other than hearing loss.

Laparoscopic enucleation of giant liver hemangioma.

The cavernous hemangioma is the most common benign tumor of the liver. It usually becomes symptomatic as it reaches a certain size. A 49-year-old man was admitted with a 1-year history of epigastric pain, which was not relieved by regular analgesic intake, and nausea. The results of physical examination, routine laboratory tests, and upper gastrointestinal tract endoscopy were normal. Ultrasonography showed a 10-cm mass in the left hepatic lobe. Magnetic resonance imaging (MRI) showed a 90-mm hemangioma at left hepatic lobe. Selective celiac arteriogram was performed, and polyvinyl alcohol particles were used as an embolizing agent. After the embolization, the patient underwent laparoscopic enucleation of the liver hemangioma. No blood transfusion was needed during the operation. The operative time was 75 min. The patient was allowed to take a clear liquid diet on the postoperative day 1. The postoperative course of the patient was uneventful, and he was discharged on the postoperative day 2. Enucleation is the best surgical technique for the management of symptomatic giant hemangiomas. It can be performed with no mortality or morbidity, with preservation of all normal liver parenchyma. Enucleation also has been associated with significantly fewer intraabdominal complications than anatomic resection. The laparoscopic approach for enucleation requires patience and careful dissection to prevent bleeding. In conclusion, laparoscopic enucleation of hemangiomas is safe and easy to perform in selected cases.

Mitomycin C primary trabeculectomy with releasable sutures in primary glaucoma.

PURPOSE: To evaluate the effects of mitomycin C and a releasable suture technique on outcomes of primary trabeculectomy in primary glaucoma patients. METHODS: A prospective analysis of patients who underwent primary trabeculectomy with a mitomycin C concentration of 0.2 mg/mL for 2 minutes. For closing the scleral flap, releasable sutures were used in 18 patients (17 eyes), Group 1, or permanent sutures in 18 patients (20 eyes), Group 2. Clinical outcome factors including postoperative intraocular pressure (IOP), visual acuity, and incidence of complications were determined. RESULTS: The mean follow-up periods were 8.1 +/- 1.3 months in Group 1 and 8.3 +/- 1.3 months in Group 2. The postoperative reduction in IOP was highly significant (P <.0001) at all time intervals in both groups. In all measurement of IOP before the second week, mean IOP in Group 2 was found significantly lower than the mean IOP in Group 1 (P =.01). No statistically significant differences were found between the groups at later mean IOP measurements. At the last visit, the complete success rate was 88.8% in Group 1 and 85.0% in Group 2. No serious complications such as hypotonous maculopathy were observed in any patient. CONCLUSION: Primary trabeculectomy with mitomycin C in eyes with primary glaucoma showed effective IOP pressure reduction. There were no cases of serious complications. In the early postoperative period IOP was controlled better in the releasable suture group.

A comparative study of a gonadotropin-releasing hormone agonist and finasteride on idiopathic hirsutism.

OBJECTIVE: To compare the efficacy of finasteride and GnRH agonist in the treatment of idiopathic hirsutism. METHODS: Sixty women with hirsutism were randomly assigned to receive either 5 mg of finasteride or long-acting GnRH agonist (depot leuprolide 3.75 mg) intramuscularly monthly for six months. MAIN OUTCOME MEASURES: Hirsutism scores were measured according to the Ferriman-Gallway scoring system, and side-effects were monitored for six months of treatment. Blood samples were taken at each visit for assessment of endocrine (FSH, LH, estradiol, progesterone, total and free testosterone, androstenedione, DHEAS-S, 17-OH-P. SHBG), biochemical, and hematologic para- meters. RESULTS: All of the patients treated with finasteride or GnRH agonist showed neither menstrual abnormalities nor side-effects. The mean percent change (+/- SD) in hirsutism scores in the GnRH and finasteride groups was 36% +/- 14% and 14% +/- 11% at six months, respectively. Serum total testosterone, free testosterone, androstenedion and DHEA-S showed a meaningful decrease in patients treated with GnRH agonist. On the other hand, only serum total testosterone and free testosterone levels decreased with finasteride treatment (p < 0.05 and p < 0.0001, respectively).

[Complicated hydatid cysts of the liver]. / Les kystes hydatiques compliqués du foie.

In 328 cases of hydatid disease of the liver operated between 1979 and 1989, 51 (15.8%) had complicated cysts. The most frequent complication was intrabiliary rupture (2/3 of all complications). The others were intraperitoneal rupture in 7 cases (13.8%), suppuration in 7 cases (13.8%) and intrathoracic rupture in 3 cases (5.8%). Among the intrabiliary ruptured cysts, T-drainage was performed in 15 cases, choledochoduodenostomy was performed in 12 cases, and sphincteroplasty was performed in 7 cases. The cases of intraabdominal rupture were operated immediately. The suppurated cysts were marsupialized in 3 cases and drained in 4 cases. The 3 cases of bronchobiliary fistula were treated by T-tube drainage of the common bile duct, drainage of the pleural space, repair of the diaphragm and closure of the communicating bronchus. In this series, the mortality rate was 7.8% and the recurrence rate was 9.8%.

Significant loss of hepatitis A Ab after allogeneic hematopoietic SCT in pediatric patients.

Loss of specific immunity after hematopoietic SCT (HSCT) is well documented for polio, measles, mumps and tetanus. There are limited studies reporting the loss of Hepatitis A virus immunity and no reports evaluating the effect of donor immunity on Hepatitis A virus (HAV) immunity loss after HSCT. A total of 49 of the 81 patients who received HSCT at the Ankara University Pediatric HSCT Unit from January 1997 to December 2006 had HAV serology tested before HSCT and were evaluated for seroprevalence, and 30 of 49 patients were evaluated for the loss of Ab and for the effect of donor immunity on the loss of HAV Abs. The seroprevalence before HSCT was 75.5%. Loss of Ab was detected in 43.5% (10/23) of the patients. The median time to loss of Ab was 12 months (12-32 months), and 60% of these patients were seronegative at 12 months after HSCT. After HSCT, 46.7% of the patients were seronegative. Loss of Ab was higher in the seronegative donor group (75 vs 26%). The loss of HAV Ab is high after allogeneic HSCT for pediatric patients. Reimmunization should be considered for the continuation of individual and community immunity. Further studies with larger study groups are warranted to clarify the role of donor immunity on the loss of HAV immunity.