An Assessment of the Effects of Two Types of Bioresorbable Barriers to Prevent Postoperative Intra-Abdominal Adhesions in Rats

Purpose This study assessed and compared the efficacy of two types of bioresorbable membranes in the prevention of postoperative adhesion under clean contaminated and bacterial peritonitis conditions using a cecal ligation and puncture model in rats. Methods Wistar albino rats (n = 72) were divided into six groups. Bacterial peritonitis was induced using a cecal ligation and puncture model in groups 2, 4, and 6. Groups 1, 3, and 5 served as controls for clean contaminated procedures in the absence of bacterial peritonitis. Groups 1 and 2 were the untreated clean contaminated and bacterial peritonitis groups and served as controls for the effect of the bioresorbable membranes in each condition. In groups 3 and 4, a 1.5 × 3 cm USP glycerol/sodium hyaluronate/carboxymethylcellulose membrane was wrapped around the cecal resection area and a 2 × 4 cm membrane was left under the incision. The oxidized regenerated cellulose membrane was similarly applied in groups 5 and 6. Four weeks later, the adhesions were evaluated. In addition, fibrosis and inflammation were observed histopathologically. Results Adhesion development (P = .008), fibrosis (P = .008), and inflammation (P = .0001) differed among the groups. Both materials increased adhesion formation in the bacterial peritonitis condition. Increased fibrotic activity was detected in all material-applied groups under both conditions. In addition, more inflammation was detected in the groups that received the application of a material, especially in the presence of bacterial peritonitis. Conclusion Neither material prevented adhesions in clean contaminated conditions. Moreover, they increased adhesion formation in bacterial peritonitis.     

Histologic characteristics of the human prepuce pertaining to its clinical behavior as a dual graft

The aim of this study was to investigate the unique histologic structure of the normal human prepuce, paying particular attention to the resemblance and dissimilarities between the inner (ie, mucosa) and outer (ie, skin) layers. Histologic sections were stained using hematoxylin-eosin and Van Gieson stains. Transmission electron microscopy was used to evaluate the ultrastructure. Dense capillary networks can be observed in both the upper and lower dermal zones. The dermis lacks a dense collagenous zone. Melanocytes could not be observed in the mucosa. Elastin fibers and bundles were very abundant and dense. Early edema formation can be explained by the loose character of the dermal structure. Better graft "take" in mucosal grafts may be the result of the dense vascular dermal network. Mild hyperpigmentation can be explained by the limited number of melanocytes. However, this can also be observed in mucosal grafts, despite the absence of melanocytes. This may be solely the result of inflammatory hyperpigmentation, which can be seen in skin grafts. The abundance of elastin fibers in the prepuce may be the reason behind the superior wound contraction inhibition.     

Correlation between the tissue Doppler, strain rate, strain imaging during the dobutamine infusion and coronary fractional flow reserve during catheterization: a comparative study

Coronary fractional flow reserve (FFR) as an invasive, and dobutamine stress echocardiography (DSE) as a noninvasive technique were used to detect critical coronary stenosis. This study was undertaken to assess correlation between these two techniques by using tissue Doppler, strain rate (SR), and strain imaging (S). METHODS: In 17 patients (aged 54.9+/-12.6, 4 F), a total of 22 vessels were studied. On dobutamine stress echocardiography, baseline and peak systolic (Sm), early (Em) and late (Am) diastolic myocardial velocities, SR and S were recorded from parasternal view (mid-posterior segment) for radial and apical view (mid-septum) for longitudinal deformation. Then coronary FFR was performed by using intracoronary adenosine infusion, and the value of < or = 0.75 was accepted as critical coronary stenosis. RESULTS: FFR was found to be significant in 10 vessels (FFR critical). Baseline Sm, Em/Am, SR, S values, and peak Em/Am, SR, S values were similar between critical or noncritical FFR groups. Baseline Sm and Em, and change between baseline and peak Sm and S were significantly higher in noncritical FFR group (p < 0.01, < 0.05, < 0.001, < 0.001, respectively). In all vessels, FFR after adenosine infusion showed a poor correlation with WMSI, Em, Am, Em/Am values, and the change in SR values (r = -0.22, 0.16, -0.14, 0.21, 18, respectively) showed a good correlation with the change in S (r = 0.51; p = 0.014), and a very good correlation with the change in Sm values (r = 0.77; p < 0.001) during DSE. When FFR values at left coronary system were analyzed for longitudinal SR and S values, it had a mild correlation with SR (r = 0.47, p = 0.044) and a good correlation with S (r = 0.66, p = 0.002). CONCLUSION: The quantification of regional myocardial deformation by using DSE rather than the motion would be more appropriate in detecting the ischemic dysfunctional segment supplied by the critical coronary stenosis. Strain measurement during the dobutamine infusion may provide an information on the FFR results of the culprit vessel.     

The office hysteroscopic evaluation of postmenopausal patients

Objective The objective was to characterize postmenopausal women with endometrial polyps and to evaluate their significance.Methods The study population included all consecutive postmenopausal patients with a diagnosis of endometrial polyps. Demographic, medical and gynecological data were assessed with regard to the endometrial histologic findings.Results Of the 181 eligible patients, 34 had endometrial hyperplasia (4 cases of them had endometrial carcinoma). The 144 patients using hormone replacement therapy had significantly higher rate of endometrial hyperplasia than non-hormone users (p<0.006). No differences were observed among the endometrial histological categories for any of the presenting symptoms and signs, ultrasonographic findings, or medical histories.Conclusion Postmenopausal endometrial polyps is a common, mostly benign entity. However, the relatively high rate of concomitant endometrial hyperplasia, especially in patients receiving hormone replacement therapy, dictates a thorough histological evaluation in all cases.     

Ordinary glass spheres as an alternative injectable material for endoscopic correction of vesicoureteral reflux

PURPOSE: Although they are therapeutically effective, injectable materials for urinary tract are associated with various disadvantages, precluding their universal acceptance. In this study we investigated glass spheres (GSs) as an alternative injectable substance to correct vesicoureteral reflux (VUR) in an animal model. MATERIALS AND METHODS: We used 150 to 300 micro GSs suspended in agarose gel to form the injection paste. GS paste was injected into the rectus muscle and submucosa of the bladder in 8 adult New Zealand male rabbits. As a control group, vehicle only was injected into 4 rabbits. The rabbits were sacrificed to harvest the bladder, pelvic lymph nodes, kidney, liver, brain, spleen and lung at month 1 and year 1 of injection. A VUR model was then created by unroofing the 2 ureteral orifices of 12 adult sheep. GS paste was injected into the right subureter and vehicle only was injected into the left subureter. Cystourethrographies were performed at month 3 and year 1 of injection. The sheep were sacrificed at cystourethrography to harvest the bladder, lymph nodes, kidney, liver, brain, spleen and lung. RESULTS: At month 3 and year 1 of injection into rabbit tissues nodule formation was stable in position and volume. Histopathological studies of local and distant organs of the rabbit did not show any granuloma formation or migration of GS. GS paste injection corrected VUR in sheep. Re-injection of GS into still refluxing left units corrected VUR. Local and distant organs harvested from sheep did not demonstrate distant migration. CONCLUSIONS: When injected into bladder submucosa and rectus muscle, GS appears to be inert, biocompatible and efficient. Similarly it is effective for correcting VUR in an animal model. We present our data on GS, encouraging further investigation to develop an alternative injectable material for endoscopic VUR correction.     

Using cuffed and tunnelled central venous catheters as permanent vascular access for hemodialysis: a prospective study

BACKGROUND: Adequate care of a hemodialysis patient requires constant attention to the need to maintain vascular access (VA) patency. VA complications are the main cause of hospitalization in hemodialysis patients. The native arteriovenous fistula (NAVF), synthetic arteriovenous grafts fistula (GAVF) and silastic cuffed central venous catheters (CVCs) are used for permanent vascular access (PVA). CVCs are primary the method of choice for temporary access. But using this access modality is increasing more and more for PVA in elderly hemodialysis patients and when other PVA is not possible. The primary aim of this study is to investigate survivals and complications of the CVCs used for long-term VA. METHODS: We prospectively looked at 92 CVCs (Medcomp Ash Split Cath, 14 FR x 28 cm (Little, M.A.; O'Riordan, A.; Lucey, B.; Farrell, M.; Lee, M.; Conlon, P.J.; Walshe, J.J. A prospective study of complications associated with cuffed, tunnelled hemodialysis catheters. Nephrol. Dial. Transplant. 2001, 16 (11), 2194-2200) with Dacron cuff) inserted in 85 (50 females, 35 males) chronic hemodialysis patients (the mean age: 56.6 +/- 14.1 years) from July 1999 to January 2002. The overall survival and complications were followed up. Furthermore, the patients were evaluated for demographic and clinical characteristics. Data were analysed by chi-square, Wilcoxon rank and Kaplan-Meier survival tests. RESULTS: The median duration of CVC survival was 289 days (range: 10-720). Eleven (11.9%) CVCs were removed due to complications. In 79 (92.9%) patients, 1, in 5 (5.8%) patients, 2 and in 1 patient, 3 CVCs were inserted. Of the 85 patients, 56 have CVCs functioning. In addition, 27 (31.76%) patients have CVCs functioning for over 12 months, 17 (20%) patients have CVCs functioning for 6 months. The total incidence of CVC related infections was 0.82 episodes/1000 catheter days. Besides, thrombosis was occurred in 10 (10.8%) CVCs. The most frequent indications for CVC removal were patient death (69.4%), thrombosis (16.6%) and CVC-related infections (13.8%). CONCLUSIONS: CVCs are primarily used for temporary access. But this study indicates that CVC may be a very useful alternative permanent vascular access for hemodialysis patients when other forms of vascular access are not available.     

Surveillance of Haemophilus influenzae among respiratory tract samples of Turkish children

We conducted three prospective studies of Haemophilus influenzae in different groups of children. Pharyngeal swab samples were taken (i). from 1382 healthy infants and children between 0 and 10 years of age (group 1), attending well child clinics (n=438), day care centres (n=440) and elementary schools (n=504), and (ii). from 322 children aged 2-10 years (group 2), clinically diagnosed as having upper respiratory tract infection. Pharyngeal swab samples and sinus aspirates were obtained from 49 children between 2 and 9 years of age (group 3), clinically diagnosed as having sinusitis. H. influenzae was isolated in similar rates from 315 (22.7%) of children in group 1, 72 (22.3%) of children in group 2 and 12 (24.4%) of children in group 3. Serotype b comprised 7, 5.2 and 2% of all H. influenzae isolates for group 1, 2 and 3, respectively. Production of beta-lactamase was detected in 1.0% of H. influenzae type b isolates in group 1, 1.2 and 6.1% of all isolates in group 2 and 3, respectively. There were no beta-lactamase negative ampicillin-resistant strains.     

The effect of high dose losartan on erythropoietin resistance in patients undergoing haemodialysis

AIM: In some of the patients undergoing haemodialysis, (HD) resistance might develop against recombinant human erythropoietin (rHuEPO) used for treatment of anaemia. Recently, angiotensin-converting enzyme (ACE) inhibitors that are used to treat hypertension and congestive heart failure in HD patients have been suggested to contribute to anaemia as well by inhibiting erythropoiesis. Our purpose in this study is to investigate whether or not losartan, an angiotensin II (ATII) receptor antagonist, is causing rHuEPO resistance. METHODS: In this prospective study of 12 months, we compared the effects of high dose losartan (100 mg/day) and amlodipine (10 mg/day) on rHuEPO requirement in 40 hypertensive patients receiving rHuEPO for more than 12 months on maintenance HD. Twenty normotensive rHuEPO dependent patients served as control group. Iron deficiency, hyperparathyroidism, aluminium intoxication, infections and inflammations were excluded in all patients. RESULTS: The mean haemoglobin level was found >8 g/dl in all groups. The mean weekly rHuEPO dose increased in the losartan group (p<0.0001 vs before) and remained constant in the other groups. No significant differences were found with PTH, iron status, aetiologies of renal failure in all groups. CONCLUSION: High-dose losartan increases rHuEPO requirement and should be reserved for dialysis patients with hypertension uncontrollable with other antihypertensive medications.