Increased serum sialic acid levels in primary osteoarthritis and inactive rheumatoid arthritis

Accumulation of oxidized proteins and impaired antioxidant system have been shown to be associated with arthritis. Serum sialic acid (SA) is known as a parameter of inflammation. In the present study, to explore the potential role of SA in arthritis, we measured serum SA levels, plasma protein oxidation, and antioxidant status in patients with primary osteoarthritis (POA) and inactive rheumatoid arthritis (RA). Inactive RA (iRA) was defined upon the American College of Rheumatology criteria for clinical remission of RA. A total of 40 patients (20 POA patients, including 4 male subjects, and 20 iRA female patients) and 20 healthy female subjects were included in this study. SA, antioxidants, and protein oxidation levels were determined spectrophotometrically in serum or plasma samples. Serum SA levels were significantly increased in POA (3.34 +/- 0.37 mM, p < 0.0001) and iRA (3.11 +/- 0.47 mM, p < 0.05), compared with healthy controls (2.41 +/- 0.16 mM). Plasma total antioxidant activity, plasma superoxide dismutase activity and serum reduced glutathione levels were significantly decreased in patients with POA and those with iRA, whereas plasma carbonyl content and serum total protein were increased in those patients. Moreover, plasma total thiol levels were significantly increased in iRA and decreased in POA. Thus, increased SA and protein oxidation levels are associated with the decreased antioxidant levels in POA and iRA patients. These results suggest that SA may be considered as a potent defense molecule against oxidative damage in arthritis. Antioxidant therapy may halt or ameliorate the progression of arthritis.     

Intravenous dexmedetomidine for treatment of intraoperative penile erection

Background  

Intraoperative penile erections following the initiation of either regional or general anaesthesia is rare; however, when it occurs in patients undergoing urologic procedures it may delay, or even cancel the planned surgery. The aetiology is unclear. Various treatments proposed for producing detumescence are not always effective. Use of intracavernous alpha-adrenergic agonists is an efficient and rapid but short-lasting treatment. Furthermore, repeated intracavernous injections of vasoactive drugs may be harmful. Dexmedetomidine is a potent, selective α₂-adrenoreceptor agonist. In our study, we evaluated the effect of dexmedetomidine on intraoperative penile erection.     

Candida albicans endocarditis and a review of fungal endocarditis: case report

Endocarditis due to fungal etiology is rare, but it is the most severe form of infective endocarditis. Fungal endocarditis is commonly complicated by systemic embolizations, and the difficulty in isolating the fungi with routine blood cultures complicates the diagnostic process. In these culture-negative cases of endocarditis, etiologic diagnosis is made with histopathologic examination of the cardiac valve, embolic materials, and systemic ulcers. In this case report, the presented patient with fungal endocarditis and its neurologic complications was treated with a surgical and medical approach.     

Noninvasive assessment of left-to-right shunting in ventricular septal defects by the proximal isovelocity surface area method on Doppler colour flow mapping

BACKGROUND AND AIM: The proximal isovelocity surface area (PISA), which is the zone of flow convergence appearing on the left ventricular septal surface where flow approaching the defect accelerates, allows quantitative estimation of ventricular septal defect (VSD) flow and defect area on colour Doppler imaging. In the present study, the clinical applicability and reliability of the PISA method in assessing the amount of left-to-right shunting in patients with VSDs were evaluated. PATIENTS AND METHODS: Fifty-eight patients aged 0.25 to 15 years (mean age 4.3+/-4.4 years) with VSDs were prospectively studied. Maximum PISA radius in peak systole (r), peak velocity (V(max)) and velocity time integral (VTI(VSD)) of flow through the VSD were measured. In addition, peak VSD flow (2pir(2) Nyquist limit [NL]), amount of left-to-right shunting (Qp-Qs = heart rate x [2pir(2) x NL x VTI(VSD)]/V(max)) and defect area ([2pir(2) x NL]/V(max)) were calculated. RESULTS: There were significant positive correlations between Qp-Qs values calculated by PISA and other spectral Doppler methods using the cross-sectional area, as well as the VTI of pulmonary-aortic (r=0.73, P<0.001) or mitral-tricuspid (r=0.58, P<0.001) flows and cardiac catheterization (20 patients, r=0.82, P<0.001). PISA-derived left-to-right-shunting discriminated moderate to large defects from small defects, which were classified according to the catheter-derived Qp/Qs ratio (2 or greater versus less than 2; P=0.001) or clinical evaluation (P<0.001). CONCLUSIONs: The present study demonstrated that the PISA method is a reliable semiquantitative method to determine the amount of left-to-right shunting of VSDs and to discriminate moderate to large defects from small defects. Consequently, this method may serve as a simple and useful adjunct to conventional spectral Doppler methods in the noninvasive assessment of patients with VSDs.