Evaluation of abnormal radiological findings in children aged 2 to 36 months followed by recurrent urinary tract infection: a retrospective study

Our aim is to determine the rational usage of imaging techniques in order to prevent or minimize permanent renal damage in recurrent urinary tract infections (UTIs). This study was enrolled children aged between 2 and 36 months, following-up with the diagnosis of recurrent UTI. All children had ultrasonography (USG) and dimercaptosuccinic acid scanning, 39 of them had underwent on voiding cystourethrography. There were 133 children (87 girls, 46 boys) with the mean age of 32.82?±?38.10 months included into the study. Forty-three kidney units were normal in ultrasonogram of which seven units had reflux whereas among 35 units with hydronephrosis 22 units had reflux. Sensitivity and specificity presence of hydronephrosis in ultrasonogram for prediction of reflux was 75.9% and 73.5%, respectively. There were 19 dilated ureters in ultrasonogram, and among them 14 had reflux. Sensitivity and specificity of presence with ureteral dilatation in ultrasonogram for prediction of reflux was found as 48.3% and 89.8%, respectively. The sensitivity of parenchymal thinning seen in ultrasonogram for the evaluation of renal parenchyma was 15.9%, whereas specificity was 98.2% .Sensitivity and specificity of dimercaptosuccinic acid for prediction of reflux was 51.6% and 72.3%, respectively. The normal ultrasonogram findings cannot rule out neither possibility of reflux presence nor development of renal scarring. Therefore, DMSA scanning has major role both in determination of parenchymal damage and prevention of scarring. Also we get an important result as ureteral dilatation seen in USG, related to presence of reflux.     

Evaluation of Choroidal Thickness in Non-arteritic Anterior Ischaemic Optic Neuropathy at the Acute and Chronic Stages

The objective of this study was to evaluate the measurements of choroidal thickness (CT) in patients with non-arteritic anterior ischaemic optic neuropathy (NAION) at the acute and chronic stages. This case-control study compares three groups: Group 1 included 23 eyes of 23 patients with chronic NAION, Group 2 consisted of 24 eyes of 24 patients with acute NAION, and Group 3 included 24 eyes of 24 age-matched control subjects. The average CTs for Group 1, Group 2, and Group 3 were 261.24 ± 50.04, 280.05 ± 74.94, and 254.74 ± 50.11 µm, respectively. For all measurements, no statistical significance was found between the groups (p = 0.319, 0.357, 0.680, and 0.178 for the CTs as average, foveal, superior, and inferior, respectively). Similarly, there was no difference between the CT measurements of the affected and unaffected eyes in Group 1 and Group 2 (p = 0.571, 0.741 for average, respectively). The amount of time after the onset of the disease ranged from 6.0 to 48 months (23.86 ± 16.70 months) in Group 1 and from 1 to 30 days (7.45 ± 8.86 days) in Group 2. There was no correlation between the CTs and follow-up times in Group 1 (p = 0.768 for average) and no association between the CTs and the thicknesses of the retinal nerve fibre layers in Group 2 (p = 0.453 for average). CT is not directly influenced by NAION at either the acute or the chronic stage of the disease. These results may also demonstrate that the changes of CT do not increase the risk of experiencing a NAION attack.     

The Harvard Medical School-Cambridge integrated clerkship: an innovative model of clinical education.

The Harvard Medical School-Cambridge Integrated Clerkship (HMS-CIC) is a redesign of the principal clinical year to foster students' learning from close and continuous contact with cohorts of patients in the disciplines of internal medicine, neurology, obstetrics-gynecology, pediatrics, and psychiatry. With year-long mentoring, students follow their patients through major venues of care. Surgery and radiology also are taught longitudinally, grounded in the clinical experiences of a cohort of patients and in a brief immersion experience working directly with an attending surgeon. Students participate in weekly, case-based tutorials integrating instruction in the basic sciences with training to address the common and important issues in medicine, as identified by national organizations. In addition, they participate in a social science curriculum that focuses on self-reflection, communication skills, ethics, population sciences, and cultural competence. In the pilot year (July 2004 to July 2005), HMS-CIC students performed at least as well as traditional students in tests of content knowledge and skills, as measured by National Board of Medical Examiners (NBME) Subject Exams and the fourth-year Objective Structured Clinical Exam, and they scored higher on a year-end comprehensive clinical skills self-assessment examination, suggesting that they retained content knowledge better. From surveys, HMS-CIC students were much more likely to see patients before diagnosis and after discharge and to receive feedback and mentoring from experienced faculty than were their traditionally educated peers. HMS-CIC students expressed more satisfaction with their curriculum and felt better prepared to cope with the professional challenges of patient care, such as being truly caring, involving patients in decision making, and understanding how the social context affects their patients.     

The diagnostic value of skin lesions in split cord malformations.

Split cord malformations (SCMs) are rare congenital anomalies of the spine which are usually diagnosed and treated in early childhood. Asymptomatic patient can appear in adult life without diagnosis. Cutaneous signs are often the initial marker of congenital spine abnormalities, especially SCMs. Although numerous cutaneous lesions have been described that may occur with SCMs including abnormal hair growth, hemangiomas, telengiectasias, pigmentation anomalies, subcutaneous mass lesions, and dermal sinus tracts, there is no study demonstrating a correlation between skin lesions and the type of SCM. We reported the cutaneous findings of 14 adult patients who were investigated clinically and radiologically with a diagnosis of SCM. Hypertrichosis was the most common cutaneous lesion (79%) and faun tail was observed among six (55%) of the 11 patients who had hypertrichosis. The SCM was type I in all of the patients with faun tail. Silky down was observed among 5 (45%) patients as a solitary skin lesion or associated with dysplastic skin or capillary hemangioma. A statistically significant correlation between the skin markers and the type of SCM was found, and this correlation can help physicians weigh their diagnostic considerations in SCM.     

Ventricular injury following cranial gunshot wounds: clinical study

Gunshot wounds to the head are usually fatal injuries, despite all medical and surgical interventions. Ventricular injury is a poor prognostic factor-for penetrating cranial gunshot wounds. Intraventricular hemorrhage and ventricular lacerations are the main components of such injuries. The incidence, management, and outcomes of cases of ventricular injury secondary to cranial gunshot wounds that were treated during a 9-year period at Gülhane Military Medical Academy were examined. The study group consisted of 67 consecutive patients who were admitted to the Department of Neurosurgery with the diagnosis of ventricular injury, with different penetration sites. The patients had been injured by either bullets or shrapnel. Surgical treatment was performed for all patients with ventricular injuries and 22 (32.8%) died. Ventricular injury in cranial gunshot wounds is a complex severe type of trauma that requires serious treatment. Early radiological diagnosis and accurate treatment frequently had lifesaving roles for these patients.     

Serum concentrations of galectin-3 in patients with cardiac syndrome X

Objective: Microvascular dysfunction has been reported in cardiac syndrome X (CSX), even though the underlying mechanisms still remain uncertain. Galectin-3 has been recently recognized as a biomarker of cardiovascular fibrosis and inflammation. We sought to investigate the role of galectin-3 in the CSX. Methods: We studied 115 consecutive CSX patients (mean age 55.43 ± 8.71 years, 36 men) and 74 healthy controls (mean age 54.53 ± 10.07 years, 31 men). Serum concentrations of galectin-3 and high-sensitive C-reactive protein (hs-CRP) were measured on the blood samples. Results: Galectin-3 concentrations were significantly higher in patients with CSX compared to controls (0.90 ng/ml; IQR, 0.40–1.70 ng/ml vs 0.40 ng/ml; IQR, 0.36–0.44 ng/ml, p < 0.0001). Although, the prevalence of diabetes mellitus, hypertension and family history of coronary artery disease (CAD) were significantly higher among patients with CSX, following adjustment for diabetes mellitus, hypertension, and family history of CAD, serum galectin-3 concentrations were still found significantly increased in patients with CSX. Galectin-3 concentrations correlated positively with hs-CRP (r = 0.16, p = 0.03). In addition, concentrations of galectin-3, hs-CRP, fasting glucose, uric acid and family history of CAD were determined as independent predictors of the CSX. Conclusion: It was found that galectin-3 serum concentrations are higher in patients with CSX compared to healthy controls. Further studies on larger population are needed to confirm the relation between the fibrosis and the CSX, as well as to explore the potential role of galectin-3 in the CSX.     

Hepatoprotective Effect of 17β-Estradiol as Antioxidant Modulators Against Stress Damage

Background:

Liver is one of the most important organs affected by exercise. According to the literature a few study to date has investigated the effects of estrogen supplementation on exercise-induced oxidative stress in liver tissue of rats.

Objectives:

We aimed to investigate the effects of estrogen supplementation on oxidative stress markers in liver tissue of exercised rats.

Materials and Methods:

Male rats (n = 35) were divided as estrogen supplemented (n = 18) and non-supplemented groups (n = 17); these groups were further divided as rest and eccentric exercised groups. Eccentric exercise groups were further divided as rats killed after 1 hour and 48 hours of eccentric exercise. Estrogen (10 mg/kg) was administered subcutaneously for 30 days. Eccentric exercise was applied as treadmill run (15° downhill, 20 m/min) consisting of periods of "5 min" run and 2 min rest repeated 18 times. The rat liver was examined biochemically and histologically. Activities of GST, GSH-Px, CAT, SOD and MDA concentration were also measured spectrophotometrically.

Results:

Some disruptions were detected in experimental groups compared with the control group. Additionally, exercise training caused an increase in SOD and decrease in GSH-Px activities in some experimental groups. SOD activities increased significantly in group 3 (Estrogen (-), eccentric exercise (+) killed (after 1 h), compared with group 5 (Estrogen (-), eccentric exercise (+) killed (after 48 h). On the other hand, GSH-Px activities were also significantly decreased in groups 3, 4 and 5 compared with the control group. Leukocyte infiltration in liver increased after 48 hours compared with after 1 hour and estrogen supplementation was not able to prevent this infiltration.

Conclusions:

Estrogen seemed to be not very effective to prevent eccentric exercise-induced liver damage.