Correction of camptodactyly with an external fixator

Camptodactyly is a flexion deformity of the proximal interphalangeal joint. Because of unsatisfactory results, treatment is not recommended for mild deformities, and in severe deformities surgery has been disappointing. A specially designed external fixator providing gradual distraction was used in a severe case. With this mildly aggressive method, an acceptable result was obtained. Received: 5 June 1997/Accepted: 2 February 1998     

Antioxidant enzymes and paraoxonase show a co-activity in preserving low-density lipoprotein from oxidation

Oxidative modification of low-density lipoprotein in the artery wall plays a crucial role in the development of atherosclerosis. This physiopathological mechanism is clearly inhibited by high-density lipoprotein possibly via paraoxonase enzyme activity, present in high-density lipoprotein. In this study we determined the in vitro susceptibility of low-density lipoprotein to oxidation and the effect of various factors, such as paraoxonase phenotypes, on this process. Low-density lipoprotein from healthy volunteers (n=66) was isolated using the precipitant reagent and the oxidation was evaluated by measuring the malonyl dialdehyde and diene levels. Low-density lipoprotein cholesterol and phospholipid, vitamin E, serum cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol levels, and erythrocyte antioxidant enzymes were also determined. There was no difference among the parameters with regard to gender. Low-density lipoprotein samples obtained from subjects with the AA allele were more prone to oxidation, as observed by their higher stimulated conjugated diene (P=0.041) and thiobarbituric acid-related substance (P=0.042) levels, than samples from subjects with AB or BB alleles. The subjects with the BB allele had higher superoxide dismutase (P=0.021) and catalase (insignificant increase) activities, while their conjugated diene (P=0.000) levels were lower. In conclusion, our results revealed that the high low-density lipoprotein oxidation is related to the high low-density lipoprotein cholesterol content and low phospholipid content. The present study demonstrated an increase in superoxide dismutase and catalase activities, asl well as PON1 activities, in subjects with the BB allele. Since these enzymes all show activity against low-density lipoprotein oxidation, we propose that future investigations on atherosclerotic processes should address PON1 polymorphism as well as PON1 and other antioxidant enzymes. Received: 7 May 2001 / Accepted: 14 December 2001     

A large primary malignant melanoma of the female urethra

We present a case of large, primary malignant melanoma of the female urethra with poor prognosis in this case report. Malignant melanoma is one of the rare tumors of the female urethra and accounts for 0.2% of all malignant melanoma cases. Large (5.6 cm in diameter), primary malignant melanoma of the female urethra is exceedingly rare.     

The best management of superficial bladder tumours: Comparing TUR alone versus TUR combined with intravesical chemotherapy modalities?

To compare retrospectively the recurrence rates of TUR alone versus different intravesical chemotherapy modalities in superficial bladder cancer cases, 187 patients with stage Ta and T₁ bladder tumours were treated with transurethral resection followed by adjuvant intravesical chemotherapy with mitomycin, BCG or epirubicin or by transurethral resection alone. All patients in this study had historically proven transurethrally resectable primary, category Ta and T₁ transitional cell carcinoma (TCC) of the bladder. Group I included transurethral resection alone, and the other groups included intravesical mitomycin-C(Group II), BCG (Group III) and epirubicin (Group IV) therapies after transurethral resection. 146 male and 41 female patients (78% male and 22% female patients) in this study were diagnosed as primary TCC bladder tumours. Only 52 of them were stage Ta and 135 of them were stage T₁ bladder tumours. Examining the histological grade of the bladder tumours, 88 (47%) of the patients had grade I, 53 (28%) had grade IIa, 30 (16%) had grade IIb and remaining 16 (9%) had grade III bladder cancers. The recurrence rates were 25% for Group I, 23.8% for Group II, 26.2% for Group III and 22.7% for Group IV. These values were given with disregarding the grade and volume of the bladder tumours. For solitary, less than 3 cm low grade tumours (grade I, IIa) recurrence rates were 16% for Group I, 15.4% for Group II, 17.8% for Group III, 17.2% for Group IV (p> 0.05). As a result of this retrospective study, for patients with low grade, stage Ta and T₁ tumours TUR alone may be the best treatment modality. Although intravesical chemotherapy is effective in decreasing short-term incidences of tumour recurrence, it has not decreased long-term incidences of tumour recurrence. The high cost and adverse side effects of intravesical chemotherapy should also be taken into consideration in superficial, single, low grade tumours of bladder. This revised version was published online in August 2006 with corrections to the Cover Date.     

Hereditary pancreatitis: Report of a family from Turkey

Chronic pancreatitis is a rare disease in children and is usually secondary to underlying diseases such as hereditary pancreatitis, cystic fibrosis, hyperlipidemia, prolonged malnutrition, gallstones or anomalies of the biliary-pancreatic duct system. Hereditary pancreatitis is a common cause of chronic pancreatitis in children but is often unrecognized until months or years later. We report here a family with hereditary pancreatitis in which four members are affected.     

Predicting Factors for Mortality in the Penetrating Abdominal Trauma

Purpose: penetrating abdominal trauma (PAT) is still a serious problem all over the world. This study was made to define and discuss the factors that could affect mortality in the PAT.

Methods: the records of 1048 patients hospitalized and operated for PAT at Dicle University Hospital (DUH) between January 1990 and December 2001 were retrospectively reviewed. Patients (n = 1048) were divided into two groups: “Healthy Group” (HG) (n = 942) and “Deathly Group” (DG) (n = 106). The epidemiological and clinical features were evaluated as probable risk factors for mortality. The risk factors for mortality were revealed using univariate and multi-variate analyses.

Results: a total of 1048 patients [937 (89.4%) male, 111(10.6%) female] with PAT were included in this study. The mortality rate (22.5%) of female patients was significantly higher than (8.6%) that of male patients (p = 0.000). The mean age was 30.01 ± 63.9 (14–74) years and 30 ± 12.5(15–71) years in the HG and DG consecutively (p = 0.85). The average interval between injury and operation (IBIO) was 2.09 ±1.3 (0.5–3) and 6.9 ±11.4 (1–6.1) hours in the HG and DG respectively (p = 0.000). Presence of shock on admission (PSDA) was determined in 87 patients and in 96 patients in the HG and DG respectively (p = 0.000). The mortality rate (14.9%) in patients presenting gunshot wounds (GSW) was significantly higher than (2.7%) that of patients with stab wounds (SW) (p = 0.000). The average number of injured intraabdominal organs (NIAOI) was 1.98 ±1.08 (1–7) and 4.67 ±1.99 (1-13) in the HG and DG respectively (p = 0.000). Mortality rates were 72.7% in cardiac injury, 30% in great vessels injuries, 32.6% in cranial injury, and 21.5% in major extremity and pelvic injury (p = 0.000). The average penetrating abdominal trauma index (PATI) was 11.78 ± 9.44 (158) and 46.24 ± 22.18 (15-119) in the HG and DG respectively (p = 0.000).

In multivariate analyses, female gender [Odds Ratio (OR) = 10.74, 95% Confidence Interval (CI) = 3.03–38.12, P = 0.000], the long IBIO (OR = 1.82, CI = 1.39–2.40, P = 0.000), PSDA (OR = 94.45, CI = 28.32–314.95, P = 0.000), presence of cranial injury (OR = 0.03, CI = 0.002–0.363, P = 0.006) and high PATI (OR = 1.14, CI = 1.09–1.19, P = 0.000), were found significantly important for mortality.

Conclusion: we determined that conditions such as, female gender, long interval between injury and operation, presence of shock on admission, presence of cranial injury and high PATI were predicting factors for mortality in PAT.     

Minimally Invasive Treatment of Pilonidal Disease: Crystallized Phenol and Laser Depilation

Pilonidal disease has been treated surgically and by various other methods for many years. The most important problem associated with such treatment is recurrence, but cosmetic outcome is another important issue that cannot be ignored. Today, crystallized phenol is recognized as a treatment option associated with good medical and cosmetic outcomes. We hypothesized that the addition of laser depilation to crystallized phenol treatment of pilonidal disease might increase the rate of success, and this study aimed to determine if the hypothesis was true. Patients who were treated with crystallized phenol and 755-nm alexandrite laser depilation were retrospectively analyzed. In total, 42 (31 male and 11 female) patients were treated with crystallized phenol and alexandrite laser depilation and were followed up between January 2009 and January 2012. In all, 38 patients (90.5%) had chronic disease and 4 (9.5%) had recurrent disease. Among the patients, 26 (61.9%) recovered following 1 crystallized phenol treatment, and the remaining patients had complete remission following repeated treatment. Some patients needed multiple treatments, even up to 8 times. None of the patients had a recurrence during a mean 24 months (range, 6–30 months) of follow-up. Whatever method of treatment is used for pilonidal disease, hair cleaning positively affects treatment outcome. The present results support the hypothesis that the addition of laser depilation (which provides more permanent and effective depilation than other methods) to crystallized phenol treatment (a non-radical, minimally invasive method associated with very good cosmetic results) can increase the effectiveness of the treatment and also reduce the recurrence rate of the disease.     

Protective effects of resveratrol on small intestines against intestinal ischemia–reperfusion injury in rats

Background and Aim:  The aim of this study was to determine whether resveratrol could prevent intestinal tissue injury induced by ischemia–reperfusion (I/R).
Methods:  Intestinal I/R was induced in rats' intestines by 60-min occlusion of the superior mesenteric artery, followed by a 60-min reperfusion. Thirty rats were divided into three groups as follows: sham (group 1), control (group 2), and the treatment groups (group 3). The rats in the treatment group received resveratrol both before ischemia and before reperfusion. In all groups, serum aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase levels were determined. Total antioxidant capacity (TAC), catalase, total oxidative status (TOS), oxidative stress index (OSI), and myeloperoxidase (MPO) in the intestinal tissue were measured. Intestinal tissue histopathology was also evaluated by light microscopy.
Results:  The levels of liver enzymes in group 3 were significantly lower than those in group 2 ( P  < 0.05). TAC in the intestinal tissue was significantly higher in group 3 than in group 2 ( P  < 0.05). TOS, OSI, and MPO in the intestinal tissue were significantly lower in group 3 than in group 2 ( P  < 0.05 for all). Histological tissue damage was milder in the resveratrol treatment group than in the control group.
Conclusions:  The results of this study indicated that resveratrol treatment limits the oxidative injury of the small intestine induced by I/R in rats. However, more precise investigations are required to evaluate the antioxidative effect of resveratrol on small intestine tissue damage in clinical and experimental models.     

Association between osteoporosis and polymorphisms of the IL-10 and TGF-beta genes in Turkish postmenopausal women

Osteoporosis is a multifactorial disease in which genetic determinants are modulated by hormonal, environmental and nutritional factors. The balance between bone resorption and bone formation seems to be regulated by a variety of growth factors and cytokines. An important clinical risk factor in the pathogenesis of osteoporosis is the presence of genetic polymorphisms in susceptibility genes. In this study, we investigated the association between osteoporosis and interleukin 10 (IL-10) −597 C>A and transforming growth factor β1 (TGF-β1) T869C (also named Leu10>Pro) polymorphisms in Turkish postmenopausal women. Genomic DNA obtained from 255 individuals (152 osteoporotic and 103 healthy controls). The DNA sample was isolated from peripheral bloods by salting-out method and analyzed by the techniques of PCR-RFLP. Genotype and allele frequencies were calculated and data were analyzed using the χ² test. We found a statistically significant difference between the groups with respect to IL-10 genotype distribution (p = 0.001) and allele frequencies (p < 0.0002). However, we did not found any difference between the groups with regarding TGF-β1 genotype distribution and allele frequencies (p > 0.05). In the combined genotype analysis, IL-10/TGF-β1 CCCC combine genotype was also estimated risk factor for osteoporosis in Turkish postmenopausal women (p = 0.026). To our knowledge, this is the first report to examine IL-10 gene −597 C>A polymorphism and osteoporosis in Turkish population.