Histoacryl blue versus sutured left colonic anastomosis: experimental study

BACKGROUND: Cyanoacrylates have been advocated as a protective seal in colonic anastomosis to prevent leakage. In order to assess the effects of n-butyl-2-cyanoacrylate on left colonic anastomosis it was compared to the sutured anastomosis in the rat. METHODS: Forty male Wistar albino rats were divided into two groups of 20 each. On days 3 and 7, 10 animals in each group were killed. The comparisons between n-butyl-2-cyanoacrylate and sutured groups were made with respect to outcome measures including anastomotic leakage, anastomotic stricture, peritonitis and wound infections, and adhesion formation, anastomotic bursting pressure, histological appearance of the anastomotic area. RESULTS: Although the adhesion formation was significantly more extensive in the n-butyl-2-cyanoacrylate group on day 3 (P < 0.001), there was no significant difference between the groups on day 7. The more inflammatory reaction also occurred in the n-butyl-2-cyanoacrylate group. The mean +/- SD anastomotic bursting pressure was significantly higher in the suture group than in the n-butyl-2-cyanoacrylate group (63 +/- 14 mmHg vs 43 +/- 8 mmHg) on day 3. The bursting pressure was also found to be higher on day 7 in the suture group (187 +/- 26 mmHg vs 49 +/- 12 mmHg, P < 0.0001). The suture group had a significantly higher bursting pressure on day 7 compared to day 3 (P < 0.05). CONCLUSIONS: Left colonic anastomosis with n-butyl-2-cyanoacrylate in rats does not improve the healing process; on the contrary, it has a negative influence during the first week. As a consequence, the routine use of n-butyl-2-cyanoacrylate in colonic anastomosis in the clinical situation does not appear to be justifiable.     

Antiaggregatory activity of hypoglycaemic sulphonylureas

AIMS/HYPOTHESIS: Vascular complications observed in diabetes are often related to altered platelet functions. The most widely used hypoglycaemic drugs for treating Type II (non-insulin-dependent) diabetes mellitus are sulphonylurea derivatives. The purposes of this study were to evaluate the inhibitory effects of hypoglycaemic agents on platelet aggregation, to measure their lipophilicity and identify their structural parameters which assess their antiaggregatory activity. METHODS: An antiaggregatory test in vitro was carried out for 13 sulphonylurea derivatives. Aggregation of platelets, incubated with the agents at concentrations varying from 7.5 to 480 micromol/l, was induced by 10 micromol/l ADP. Drug lipophilicity parameter, log k(w), was measured by gradient HPLC and the agents were subjected to molecular modelling. RESULTS: The most pronounced inhibition of platelet aggregation was by glimepiride, gliclazide, gliquidone, glibenclamide and compound 2A. The IC(25) values were 15.9, 18.6, 20.4, 28.5 and 34.7 micromol/l, respectively. Quantitative structure-activity relationships indicate that antiaggregatory activity is mainly affected by electronic and not by lipophilic properties of the agents. CONCLUSION/INTERPRETATION: Glimepiride appeared to be a more potent ADP-induced platelet aggregation inhibitor in vitro than gliclazide. Antiaggregatory activity was shown for gliquidone and confirmed for glibenclamide. The QSAR analysis supports the hypothesis of a free radical mechanism of action of sulphonylurea derivatives previously suggested for gliclazide.     

Long-term effects of beta blocker therapy on P-wave duration and dispersion in congestive heart failure patients: a new effect?

Atrial fibrillation (AF) is associated with heart failure in approximately 20%-50% of patients with increased morbidity and mortality. P-wave maximum duration (PWM) and P-wave dispersion (PWD) are recent ECG markers and reflect increased risk of AF. The aim of our study was to investigate the long-term effects of metoprolol on atrial conduction abnormalities as estimated by PWM and PWD, which were calculated on 12-derivation surface ECG in heart failure patients. Forty-two NYHA class 3 to 4 patients (23 males, 19 females and aged 52.9 +/- 11.2) were enrolled in the study. At the end of the 6 months, PWM and PWD values were significantly decreased (for PWM: from 115.2 +/- 12.6 to 105.4 +/- 13.5; for PWD: from 39.3 +/- 9.1 to 28.6 +/- 10.5; P <.001 for both). Metoprolol treatment is associated with a decreased duration of PWM and PWD and this may reflect a reduction in the probability of atrial fibrillation in heart failure patients.     

Clinical significance of acute traumatic intracranial pneumocephalus

Among 1142 patients with head injuries hospitalized in the Neurosurgery Department of Gazi University Medical School during the period between 1979 and 1992, 583 had initial CT scans. A retrospective analysis of these initial CT images revealed intracranial air on admission in only 21 cases. These were classified as acute traumatic intracranial pneumocephalus: a potentially serious complication of head injury.CT scans were re-evaluated so as to reveal whether air was situated in the epidural, subdural, or subarachnoid spaces or intracerebrally; whether associated space-occupying lesions were present; and whether the air bubbles were single or multiple. Clinical data such as the presence of persistant rhinorrhea and/or otorrhea, tension pneumocephalus, severity and type of trauma, and outcome were also assessed to determine the significance of this rare finding.     

Misoprostol moistened with acetic acid or saline for second trimester pregnancy termination: a randomized prospective double-blind trial

BACKGROUND: This study was conducted to evaluate the efficacy and side effects of a new regimen of 800 microg misoprostol administered intravaginally every 6 h up to a maximum of three doses in 24 h for second trimester pregnancy termination. METHODS: A total of 66 women seeking termination of second trimester pregnancy (30 fetal structural anomaly, six chromosomal abnormality and 30 fetal death) were randomly assigned to one of two treatment groups: (i) intravaginal misoprostol moistened with 3 ml of 5% acetic acid in group A (n = 33); or (ii) intravaginal misoprostol moistened with 3 ml of saline in group B (n = 33). RESULTS: The overall median (range) induction-abortion interval was 10 h (2-46) [10 h (4-35) in 36 live fetuses and 9 h (2-46) in 30 dead fetuses, P = 0.515]. All of the patients in both groups aborted within 48 h (100% success rate). The median (range) induction-abortion interval revealed a significantly faster delivery time (P < 0.001) in group A [8 h (2-24)] than in group B [14 h (3-46)]. CONCLUSIONS: This new regimen of 800 microg of vaginal misoprostol every 6 h for a maximum of three doses in 24 h was an effective alternative method for second trimester abortion. In addition, misoprostol moistened with acetic acid was significantly more effective than misoprostol moistened with saline.     

Effect of exercise on blood pressure in rats with chronic NOS inhibition

Regular training lowers blood pressure in hypertensive humans and other animals. We investigated the response to 4 weeks of treadmill exercise training in hypertensive male Wistar rats receiving the nitric oxide synthase inhibitor N ^ω-nitro-L-arginine methyl ester (L-NAME). The rats were on either a short- (4 weeks) or long-term (10 weeks) L-NAME treatment protocol and were subjected to running exercise that started concomitantly in the short-term group and in the 6th week in the long-term group. Four weeks of exercise training induced a fall in mean arterial pressure in both the short- [mean (SEM) 137.6 (4.0) mmHg] and long-term hypertensive groups [161.4 (2.3) mmHg] compared to their sedentary hypertensive controls [160.4 (3.3) mmHg and 176.8 (8.9) mmHg, respectively]. Exercise also increased muscle nitric oxide synthase activity in both of the trained hypertensive groups. Muscle nitrite levels were higher in the exercising short-term hypertensive group compared to both the sedentary control and the sedentary hypertensive groups, and were not different between the sedentary and exercising long-term hypertensive groups. Increased wall thickness of the aortic and mesenteric vessels was observed in the hypertensive groups, but was prevented in the exercising long-term hypertensive group. In rat, exercise reduces the elevated blood pressure in L-NAME-induced hypertension via increasing nitric oxide synthase activity. Changes in vessel structure with exercise training may also be involved in the blood-pressure-lowering effects. Electronic Publication     

Additive effects of dexamethasone in nebulized salbutamol or l-epinephrine treated infants with acute bronchiolitis

BACKGROUND: Although it is the most common lower respiratory infection of infancy, the optimal treatment for acute bronchiolitis is still controversial. The aim of this study was to compare the early and late effects of nebulized L-epinephrine (EPI) and intramuscular dexamethasone (DEX) combination therapy with nebulized salbutamol (SAL) and dexamethasone combination and bronchodilators alone in outpatients with acute bronchiolitis. METHODS: A total of 69 infants aged 2-21 months who were admitted to the Pediatrics Department of the Faculty of Medicine, Mersin University, with acute bronchiolitis were included in a randomized, placebo-controlled, prospective trial study. Patients were assigned to receive either nebulized L-epinephrine (3 mg) or salbutamol (0.15 mg/kg) and 15 min later, either dexamethasone 0.6 mg/kg or placebo (PLA), intramuscularly, in a double-blind randomized fashion. The study groups were: epinephrine + dexamethasone group (group 1, n=23), salbutamol + dexamethasone group (group 2, n=23), epinephrine + placebo group (group 3, n=11), and salbutamol + placebo group (group 4, n=12). The outcome measures were heart rate, respiratory rate and Respiratory Distress Assessment Instrument (RDAI) score determined at 30, 60, 90 and 120 min, 24 h, and 5 days after the first therapy. Patients were then followed-up during the subsequent 2 months for the prevalance of respiratory complaints regarding bronchial hyperreactivity. RESULTS: There were no significant differences between the outcome variables of the four groups within the first 120 min and at 24 hours, or between the rates of requirement of a second dose of the same bronchodilator. However, fifth day RDAI score values of both DEX groups were significantly lower than that of SAL + PLA group (P=0.000 and P=0.01, respectively). The fifth day score value of group 1 was also significantly better than that value of EPI + PLA group but not different from group 2. CONCLUSIONS: A single dose of intramuscular dexamethasone added to nebulized L-epinephrine, or salbutamol therapies resulted in better outcome measures than bronchodilators alone in the late phase (fifth day) of mild to moderate degree bronchiolitis attack. However, effects of EPI + DEX combination was not different from SAL + DEX combination.     

Isolated fetal intracardiac hyperechogenic focus associated with neonatal outcome and triple test results

Objective To investigate the relationship between isolated intracardiac hyperechogenic focus (IHF) in the mid trimester of pregnancy with neonatal outcomes and triple test results. Materials and methods The study included low-risk pregnant women who came for routine follow-up to our antenatal clinic between years 2000 and 2005. A detailed structural survey by ultrasound (USG) of the fetal heart was performed on each fetus in the mid-trimester of pregnancy. All patients had mid-trimester triple tests performed between the 16th and 18th weeks’ of pregnancy. We recruited a total of 40 pregnancies that had fetal IHF in the level II USG examination and a control group of 100 healthy pregnant women those which were followed-up during the same period. Twenty-nine fetuses (72.5%) had left, 8 (20%) had right whereas 3 (7.5%) had bilateral ventricular IHF. We compared the perinatal and neonatal outcomes and triple test results of the fetuses that had right and left IHF, and the controls. Results Cytogenetic amniocentesis was performed to 6 (15%) women in the study and 5 (5%) in the control group and all were normal. During follow-up IHF spontaneously disappeared in 30 fetuses [right (n: 5), left (n: 23) or bilateral (n: 2)]. We did not observe any cardiac problem in the postnatal period in all newborns. Only one infant (2.5%) in the study group was admitted to neonatal intensive care unit because of prematurity. Median delivery weeks (P = 0.023), head circumference (P = 0.013), 5-min Apgar score (P = 0.021] and apnea (P = 0.042) were significantly higher in fetuses with right IHF. Compared to the controls, median delivery weeks (P = 0.038) was significantly higher in fetuses with right IHF, but head circumference (P = 0.004), 1-min (P = 0.003) and 5-min (P < 0.001) Apgar scores were lower in fetuses with left IHF. However no difference was observed in second-trimester serum human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP) and estriol (E₃) levels, in the three groups. There was no correlation between serum HCG, AFP and E₃ levels and the presence of IHF. Conclusions Isolated IHF in the fetal heart in the mid-trimester of pregnancy seems not associated with adverse neonatal outcome and does not correlate with triple test results.     

Do routine preoperative imaging techniques facilitate the operation in endometrial cancer?

Objective  To assess the role of routine intravenous pyelography (IVP), rectoscopy and additional imaging techniques like computed tomography (CT) and abdominal ultrasonography (USG) for the evaluation of patients with endometrial cancer. Materials and methods  A total of 97 women with endometrial cancer (82 endometrioid and 15 non-endometrioid type) of all stages (Stage I = 65, II = 14, III = 13, IV = 5) were included in the study. Of these, 50 women were admitted because of postmenopausal bleeding, 24 with irregular vaginal bleeding and 7 with pain and leucorrhea, whereas the others had no complaints. Only one patient had symptoms related to the gastrointestinal system, but none for the urinary system. Preoperative CT (n = 45), IVP (n = 78), rectoscopy (n = 46), and USG or colonoscopy (n = 37) were performed on our patients. All the women had total abdominal hysterectomy and bilateral salpingo-oophorectomy, with/without pelvic (n = 81) and paraaortic (n = 34) lymphonodectomy, and omentectomy (n = 35). Results  In 39 of 45 women who had CT, it had no effect on the operation and did not facilitate the operation. In two women there were pathological findings on CT and some interventions (resection and anastomosis) were performed on the gastrointestinal tract in these patients. However, CT had overcome pathological findings related with the gastrointestinal or urinary systems in four women, who needed interventions to these systems during the operation. CT was not performed on six women who needed interventions to the gastrointestinal system during the operations. Three patients had pathological findings (fissure, external compression) in rectoscopy, but only one patient had ileo-transverstomy, in which rectoscopic finding had not predicted the necessity of that procedure. Out of 78 IVP, the only finding was external compression to the bladder in 38 patients, and this finding had no contribution to the operation. Among women who had USG or colonoscopy (n = 37) performed, five had pathological findings that contributed to the extensiveness or the mode of the operations (liver nodules, polyps in the colon). Conclusions  Routine preoperative computed tomography, intravenous pyelography, rectoscopy or abdominal USG and colonoscopy have little impact on the decision and the prediction of the extensiveness of the operation. Presented as a “poster presentation” at the 7th International Turkish–German Gynecological Association Congress, Antalya, 16–20 May 2007.