Silymarin, the antioxidant component of Silybum marianum, prevents sepsis-induced acute lung and brain injury

BACKGROUND: Sepsis is associated with enhanced generation of reactive oxygen species, which leads to multiple organ dysfunctions. Based on the potent antioxidant effects of silymarin, we investigated the putative protective role of silymarin against sepsis-induced oxidative damage in lung and brain tissues. MATERIALS AND METHODS: Sepsis was induced by cecal ligation and perforation (CLP). Sham and CLP groups received either vehicle or silymarin (50 mg/kg, p.o.) or 150 mg/kg i.p. N-acetylcysteine (NAC) for 10 days prior and immediately after the operation. Six hours after the surgery, rats were decapitated and blood was collected for the measurement of proinflammatory cytokines (tumor necrosis factor-alpha, interleukin-1 beta [IL-1 beta], and IL-6) levels, lactate dehydrogenase activity, and total antioxidant capacity. Lung and brain samples were taken for the measurement of malondialdehyde and glutathione levels, myeloperoxidase activity, thromboplastic activity, and also for histological assessment. Formation of reactive oxygen species in tissue samples was monitored by using chemiluminescence technique with luminol and lusigenin probe. RESULTS: Sepsis increased serum TNF-alpha, IL-1 beta, IL-6 levels, and lactate dehydrogenase activity and decreased total antioxidant capacity. On the other hand, tissue glutathione levels were decreased while malondialdehyde levels and myeloperoxidase activity were increased in both the lung and the brain tissues due to CLP. Furthermore, luminol and lucigenin chemiluminescence were significantly increased in the CLP group, indicating the presence of the oxidative damage. Silymarine and NAC treatment reversed these biochemical parameters and preserved tissue morphology as evidenced by histological evaluation. CONCLUSIONS: Silymarin, like NAC, reduced sepsis-induced remote organ injury, at least in part, through its ability to balance oxidant-antioxidant status, to inhibit neutrophil infiltration, and to regulate the release of inflammatory mediators.     

A typical low-back pain caused by an atypical etiology

OBJECTIVE: Pain arising in the lumbar spine can have many etiologies, nearly 80% of which cannot be established with certainty. We present a very rare cause of back pain. CASE REPORT: A 54-year-old woman presented with a 2-month history of low-back pain and right-sided sciatica. Conventional analgesics, physiotherapy, and epidural steroid application had failed to provide relief. She had tenderness of the right sacroiliac joint. Diagnostic fluoroscopic-guided sacroiliac-joint injection with lidocaine did not produce symptomatic relief. Pelvic ultrasonography and magnetic resonance imaging showed septated multilocular hydatic cysts along the sciatic nerve. Surgical exploration noted multicystic lesions along the sciatic nerve woven to the nerve. Her low-back pain disappeared completely after the operation. She received oral albendazole for 6 months to prevent any recurrence of the disease and remains asymptomatic. CONCLUSION: Hydatid cyst can be included in the differential diagnosis of lumbar back pain, especially in the endemic areas.     

Turkish military personnel's expectations for health care services provided to them

OBJECTIVE: The goal was to determine the expectations of patients using the health care services provided in the health care institutions of Turkish Armed Forces (TAF). METHODS: This study was performed between August 2002 and March 2003, with an open-ended question placed on the World Wide Web site of TAF Health Command. The framework was an intranet, which is a special Internet structure across the TAF institutions. Eight hundred four TAF personnel answered by typing their own words in response to the open-ended question. RESULTS: In the data obtained from this study, the participants' expectations focused more on the behaviors they encountered during utilization of the services, the health care personnel-patient relationship, and the services provided by the personnel, rather than the technical options and opportunities presented by the hospitals. CONCLUSIONS: In addition to the efforts and financial resources dedicated to improving the medical technology used in the health care institutions, providing information to the health care personnel about ethically appropriate behavior and patient-health care professional communication and designing new regulations concerning these issues should contribute greatly to the satisfaction of the people receiving health care services and their relatives.     

Optochiasmatic cavernous angioma: unexpected diagnosis. Case report

A 15-year-old boy presented with an extremely rare optochiasmatic cavernous angioma. He was admitted to a special hospital with the complaint of blurred vision persisting for 1 month. Magnetic resonance imaging and biopsy of the lesion were inconclusive. He was admitted to our neurosurgical clinic after worsening of the visual symptoms 9 months later. Repeat magnetic resonance imaging showed optochiasmatic cavernous angioma which had doubled in size. The lesion was removed completely without any problem. Postoperatively his visual complaints remained stable, but had improved after 1 year. Optochiasmatic cavernous malformation should be treated by surgical excision, whereas biopsy is useless and may result in enlargement.     

Comparison of sciatic psoas compartment block and sciatic femoral 3-in-1 block for knee arthroscopy

STUDY OBJECTIVES: To compare the clinical effectiveness of two peripheral nerve block techniques combined with sciatic nerve block: sciatic psoas compartment (SPC) and sciatic femoral 3-in-1 (SF 3-in-1) block. DESIGN: Prospective, randomized study. SETTING: Military medical academy hospital. PATIENTS: Thirty-six ASA physical status I patients, aged 20 to 33 years, undergoing elective knee arthroscopy. INTERVENTIONS: Patients having SPC block (n = 19) or SF 3-in-1 block (n = 17) received 40 mL of a mixture of solution containing 15 mL of 0.5% bupivacaine, 15 mL of 2.0% prilocaine, and 10 mL of 0.9% sodium chloride. In both groups, the sciatic nerve was blocked with 20 mL of the same solution. An intravenous bolus injection of fentanyl 0.1 mg was used if patients complained of pain. MEASUREMENTS AND MAIN RESULTS: None of the patients in the SPC group experienced pain owing to the applied tourniquet during the operation, whereas 7 patients from the SF 3-in-1 group (41.2 %) reported tourniquet pain. All SF 3-in-1 group patients but only 5 patients (26.3 %) in the SPC group required fentanyl during the operation. In addition, 7 patients in the SF 3-in-1 group required second doses of fentanyl. Patient satisfaction was significantly higher in the SPC group than in the SF 3-in-1 block group (P < 0.0001). CONCLUSIONS: Both SPC and SF 3-in-1 provided sufficient anesthetic efficacy for knee arthroscopy. However, SPC may be preferable to SF 3-in-1 block owing to better patient satisfaction and less requirement for opioid analgesics.     

Ligaments of the knee

The ligaments of the knee can be divided into four groups. Ventral reinforcements are the patellar retinaculae. The posteromedial complex stabilizes the valgus stress. It consists of the medial collateral ligament, the thickened posteromedial capsule and a branch of the tendon of the semimembranosus muscle as well as the oblique popliteal ligament. On the lateral side the posterolateral complex protects the knee against varus stress. Here the lateral collateral ligament, the tendon of the popliteus muscle and the so-called popliteofibular fibres work together. The cruciate ligaments control the contact between femoral condyles and tibial plateau during flexion-extension of the knee. They course between the two layers of the capsule, the membranous and the synovial layer.     

Clinical and CT findings of epiploic appendagitis within an inguinal hernia

Epiploic appendagitis is a rare condition resulting from an acute inflammation of an appendix epiploica. Epiploic appendagitis is frequently misdiagnosed as either acute appendicitis or acute diverticulitis, and the diagnosis is usually made during surgery. Epiploic appendagitis is a rare, self-limiting condition, which can be easily diagnosed with computed tomography (CT). Imaging with CT may suggest the diagnosis thus preventing unnecessary surgery. Medical management of symptoms is usually sufficient. Herein, we present CT findings of an epiploic appendagitis case that developed in a left inguinal hernia, which is a very rare entity.