Ultra thin needle histology may have impact in diagnosing chronic pancreatitis

OBJECTIVE: Diagnosis of chronic pancreatitis is usually based on symptoms, ductal or parenchymal changes in imaging studies and function tests, but seldom on histology. Because the diagnosis of mild chronic pancreatitis is especially difficult, better tools to distinguish between chronic pancreatitis and normal pancreas are needed. Nowadays, cutting needles as thin as the widely used puncture needles are available. Using resected specimens, our aim was to evaluate whether these ultra-thin needles can take samples for histology that would allow verification of the diagnosis of chronic pancreatitis, with reference to a pancreatic wedge biopsy as the "gold standard". MATERIAL AND METHODS: Fifty patients underwent pancreatic resection for various reasons. Two 20 G needle biopsies (outer diameter 0.8 mm, study biopsies) and a 5 x 5-mm wedge biopsy (reference biopsies) were taken from the same site of the specimen, avoiding possible neoplastic areas in the specimen. The samples were analyzed for the presence inflammation and fibrosis, both graded 0-3, as well as for any neoplastic changes without knowledge of the medical history, operative findings or final histology. RESULTS: The reference biopsy showed normal tissue in 19 (38%) patients, chronic pancreatitis in 29 (58%) and only mild fibrosis (Grade 1) in 2 (4%) patients. In one patient the needle biopsy was insufficient for analysis. There was agreement between ultra-thin needle histology and the control specimen in 45/49 (92%) patients (correlation coefficient 0.9). Two biopsies of chronic pancreatitis and one mild fibrosis were misclassified as normal tissue, while one chronic pancreatitis biopsy was misclassified as an adenocarcinoma. The sensitivity of needle biopsy for chronic pancreatitis was 89%, specificity 100% and accuracy 94%. CONCLUSIONS: Ultra-thin needle histology correlates well with the pancreatic wedge biopsy. Thus, these encouraging results warrant further clinical studies of different grades and types of chronic pancreatitis.     

The effect of chronic antidepressant treatment on serum brain-derived neurotrophic factor levels in depressed patients: a preliminary study

Recent studies suggested a role of brain-derived neurotrophic factor (BDNF) in depression. While BDNF levels are lower in depressed patients, antidepressant treatment increases serum BDNF levels of depressed patients. Our study aims to test the effect of chronic venlafaxine treatment on serum BDNF levels in patients with a major depressive disorder. Ten patients diagnosed as major depressive disorder according to DSM-IV are included in the study. Two of the patients had their first episode and were drug-naive, the other eight patients were drug-free for at least 4 weeks. The severity of depression was assessed with Hamilton Depression Rating Scale (HDRS). The control group consisted of ten age- and sex-matched subjects without any psychiatric disorder. Blood samples were collected at the baseline and after 12 weeks of antidepressant treatment (during remission). At the baseline the mean serum BDNF level was 17.9+/-9.1 ng/ml and the mean HDRS score was 23.2+/-4.6. Serum BDNF levels of the study group were significantly lower than in the control group (31.6+/-8.6 ng/ml). At the end of the study, the mean serum BDNF level was 34.6+/-7.1 ng/ml whereas the mean HDRS score was 8.2+/-3.9. From the baseline to the remission after 12 weeks of treatment, the increase in serum BDNF level and the decrease in HDRS score were statistically significant, respectively. When we compared the serum BDNF level of depressed patients at remission to that of the controls, there was no statistically significant difference. This study shows that venlafaxine treatment of depression improves serum BDNF level which may be considered as a nonspecific peripheral marker of depression.     

Biochemical analysis of urethral collagen content after tubularized incised plate urethroplasty: an experimental study in rabbits

The aim of the present study was the biochemical analysis of tissue hydroxyproline levels in incised urethral plates in order to show the total collagen content after the Snodgrass operation in the hypospadiac rabbit model. The study comprised 21 male New Zealand rabbits, (2.2–2.4 kg). The animals were randomly allocated to three groups each containing seven rabbits as follows: group 1, the ventral urethra was completely excised and a model of hypospadias formed. A full-thickness incision was made on the distal dorsal urethra, a feeding tube was placed as an urethral catheter and both urethral wings were sutured ventrally. Group 2, inserting an iris knife into the urethra, the ventral wall was incised mimicking an urethrotome. Group 3 consisted of normal control rabbits to determine the basal tissue hydroxyproline level. A slight increase in the hydroxyproline level was observed in the ventral part of the urethral tissue compared to the dorsal part in both groups 1 and 2; however, these differences were not significant. After the Snodgrass operation in the rabbit model, no significant differences were observed in the hydroxyproline levels of the dorsal and ventral parts of the urethra or between these and of the controls. Further studies are required in order to determine the mechanism underlying urethral healing through normal re-epithelization without excess collagen deposition after incised urethral plate urethroplasty.     

Glycemic control, oxidative stress, and lipid profile in children with type 1 diabetes mellitus

BACKGROUND: In diabetes mellitus, persistence of hyperglycemia was reported to cause increased production of oxidative parameters including malondialdehyde (MDA). In the present study, the effect of glycemic control on oxidative stress and the lipid profile of pediatric type 1 diabetes mellitus (DM) patients were investigated. METHODS: Serum total cholesterol, HDL cholesterol, VLDL cholesterol, apolipoprotein A, apolipoprotein B, lipoprotein a, HbA(1c), and MDA levels were assessed in 96 children with type 1 DM. Study cases were evaluated in two groups in view of their mean HbA(1c) values, as metabolically well controlled (HbA(1c) < or =8%) and poorly controlled (HbA(1c) >8%) patients with DM. Fifty healthy children were included as normal controls. RESULTS: Total cholesterol, LDL cholesterol, apolipoprotein A, apolipoprotein B, and MDA levels of total diabetic patients were significantly (p<0.05) higher than those of the control group. Serum MDA levels and MDA/LDL cholesterol index were significantly increased in metabolically poorly controlled in relation to metabolically well-controlled DM patients and were similar in metabolically well-controlled DM patients with relation to control group and in metabolically poorly controlled patients with relation to control group. CONCLUSIONS: In the present study, increased levels of MDA, MDA/LDL index, and dyslipoproteinemia showed that especially metabolically poorly controlled DM children are at high risk of atherosclerosis and vascular complications of DM and that there is a significant relationship between the lipid profile and oxidative stress. Thus, it may be appropriate to evaluate MDA in addition to routine laboratory assessments in evaluation of type 1 DM pediatric patients.     

Modification of meatal advancement and glanuloplasty for correction of distal hypospadias

OBJECTIVE: The meatal advancement and glanuloplasty (MAGPI) technique is still successfully used for the repair of distal hypospadias. The technique has been modified considerably since it was first described in 1981. The primary drawbacks of the procedure are the complications of meatal regression and meatal stenosis. The aim of this study was to present a modification of MAGPI for correction of distal hypospadias. MATERIAL AND METHODS: Ten cases with distal hypospadias were operated on using our modified MAGPI procedure. The modification involves excision of a pull-out, tag-shaped piece of glanular tissue through the vertical incision in the meatoplasty section of the original operation. By means of this excision, burying of the meatus into the glans was eased without inducing extra mobilization of the glans wings. As less glans tissue was left at the dorsal urethra the urethral meatus could be replaced in the center of the glans and better anatomic reconstruction could be attained. RESULTS: After 1-3 years of follow-up, all the operated cases showed functionally and cosmetically satisfactory results. The cosmetic appearance achieved with our modified technique was better than that obtained with the classical MAGPI procedure. CONCLUSIONS: Using our MAGPI modification, the urethra was localized deeper in the glans and an elliptical (slit-like), wide meatus was obtained, the cosmetic appearance of which was more acceptable than that achieved with classical MAGPI.     

Safety and immunogenicity of three doses of an eleven-valent diphtheria toxoid and tetanus protein – conjugated pneumococcal vaccine in Filipino infants

Background  

An 11-valent pneumococcal conjugate vaccine could provide significantly larger reduction in pneumococcal disease burden than the currently available 7-valent vaccine formulation in many countries.     

Serum androgen bioactivity during 5alpha-dihydrotestosterone treatment in elderly men

The androgens used in the treatment of age-related androgen decline have different bioactivities that cannot be evaluated with conventional detection methods for serum steroids. We have recently developed a recombinant cell bioassay for the determination of androgen bioactivity in human serum that is based on androgen-specific interaction between the ligand-binding domain (LBD) and the N-terminal region of the androgen receptor (AR). In this work, we examined the effect of topically applied 5alpha-dihydrotestosterone (DHT; 7.5-10 g of 2.5% DHT gel daily for 6 months) on circulating androgen bioactivity in 14 men (age range, 51-63 years) with symptoms of andropause and pretreatment serum testosterone less than 15 nM, or serum sex hormone-binding globulin concentration greater than 30 nM, or both. The mean (+/-SEM) pretreatment androgen bioactivity was 3.3 +/- 0.3 nM testosterone equivalents, and the levels correlated with serum testosterone concentration (r =.55, P <.05). DHT gel treatment induced a sixfold increase (from 1.5 +/- 0.1 nM to 9.0 +/- 0.7 nM) in mean serum DHT level, whereas endogenous testosterone and estradiol levels measured with radioimmunoassays were suppressed by approximately 70% and approximately 50%, respectively (P <.0001). Concomitantly, serum androgen bioactivity increased by sevenfold (from 3.3 +/- 0.3 to 23.6 +/- 2.8 nM testosterone equivalents; P <.0001). We conclude that DHT gel therapy in elderly men significantly increases their circulating androgen bioactivity as measured with a mammalian cell bioassay. An androgen-specific bioassay such as ours may enable investigation of other androgens with different bioactivities, such as selective AR modulators.     

Tenascin and fibronectin isoforms in human renal cell carcinomas,renal cell carcinoma cell lines and xenografts in nude mice

We studied the expression of tenascin (Tn) and isoforms of fibronectin (Fn) in human renal cell carcinomas (RCC) and oncocytomas, in RCC cell lines and in their s.c. implanted xenografts in nude mice. In well-differentiated RCCs and oncocytomas extra-domain A (EDA)-Fn and Tn immunoreactivities were confined to the basement membranes and blood vessels, while in less-differentiated RCCs they were also widely seen in the stroma, correlating with the morphological differentiation of the tumor. Expression of EDB-Fn and oncofetal (onc)-Fn was very scarce in most of the RCCs and oncocytomas. Western blotting results demonstrated the predominance of the M_r 190,000 Tn subunit in most RCCs. Among the 4 RCC cell lines, 3 showed Tn in the extracellular matrix. As xenografts, they formed moderately or poorly differentiated tumors, with abundant Tn. Three of the RCC cell lines also showed secretion of EDA-Fn and 2 of them secretion of onc-Fn and EDB-Fn into the culture medium, while in xenografts there was a strong expression of all Fn isoforms. In xenografts, the expression of Tn closely recapitulated that seen in clinical tumors and in the cell lines in vitro, while the expression of Fn isoforms in cultured cells and their xenografts was highly discordant.     

A new suture material for repair of the injured spleen

Parenchyma-Set, a new absorbable collagen-tape suture material, was used in the present study for the repair of experimentally injured spleens and the results compared with polyglactin. Standard splenic injuries were produced in ten mongrel dogs. The spleens of five (group I) were repaired with Parenchyma-Set and those of the other five (group II) with polyglactin. Isotope uptakes of the spleens performed on the 30th postoperative day showed varying degrees of scintigraphic defects in group II in comparison with group I. The histopathologic examinations revealed better healing in group I with better preservation of the splenic architecture. We conclude that Parenchyma-Set appears to be the suture material of choice for repair of the injured spleen.Presented at the 5th Pediatric Surgical Research Workshop, 29–30 May, 1992, Ferrara, Italy     

High-pressure oxygen insufflation to facilitate submucosal dissection in Soave's operation

The aim of the present study is to demonstrate a new, simple method of facilitating the submucosal dissetion that is the most difficult and timeconsuming part of Soave's operation. For rectal submucosal dissection, oxygen under high pressure is insufflated via a needle inserted into the submucosal space at a level just above the peritoneal reflection of the rectum down to the anal canal. The technique has been successfully used in 35 cases of Hirschsprung's disease. A considerable reduction in the operating time and the incidence of iatrogenic mucosal perforations could be achieved. We conclude that the method is time-saving and provides safety during a period of the operation where scrupulous care is needed.Presented at the 12th Annual Congress of Turkish Association of Pediatric Surgeons, Kuadasi, Turkey, November 3–6, 1992