Surgical treatment of axillary artery aneurysm

Aneurysms of the axillary artery are rare and dangerous lesions that threaten the upper extremities with vascular and neurologic compromise. Most can be treated effectively with surgical excision and vascular grafting. We retrospectively assessed 4 axillary artery aneurysms upon which we operated from February 1998 through March 2004. Three patients were admitted to our clinic for symptomatic axillary masses. The remaining patient was transported to our clinic emergently due to massive hemorrhage of an enlarging axillary mass that occurred during biopsy of the mass at another hospital. In this patient, the ruptured axillary artery aneurysm was diagnosed by means of emergent upper-extremity selective angiography. All patients were treated surgically by means of aneurysmectomy and graft interpositioning--with polytetrafluoroethylene grafts in 2 patients and saphenous vein grafts in the other 2. Surgical treatment of axillary artery aneurysms is of importance in avoiding thromboembolism and ischemia, which in turn can lead to gangrene and amputation of the affected extremity. For this reason, operative management of such cases should not be delayed.     

Metformin and oral contraceptive treatments reduced circulating asymmetric dimethylarginine (ADMA) levels in patients with polycystic ovary syndrome (PCOS)

There is a little information in literature about circulating asymmetric dimethylarginine (ADMA) concentrations in polycystic ovary syndrome (PCOS) and the results reported are discrepant. In this study, therefore, we aimed (1) to determine the circulating ADMA concentrations in 44 women with PCOS and 22 age- and BMI-matched healthy controls, (2) to evaluate its correlations with insulin resistance, gonadotrophins, and androgen secretion, and (3) to compare effects of metformin and ethinyl estradiol-cyproterone acetate (EE/CPA) treatments on circulating ADMA concentrations. In conclusion, our data indicate that circulating ADMA concentrations in non-obese, non-hypertensive and young women with PCOS are significantly higher than healthy controls and they improved by a 3-month course of metformin and oral contraceptive treatments.     

Semirigid thoracoscopy in the diagnosis of pleural effusion: first four cases in Turkey

Medical thoracoscopy is a valuable tool in the management and investigation of pleural diseases. It has advantages when compared to conventional closed pleural biopsy and video-assisted thoracoscopic surgery. However, the use of this technique is limited in Turkey. The present report is about the first experience with semi-rigid thoracoscope that was implemented in our country. Four patients underwent medical thoracoscopy in September 2009 with the new device. All patients were referred due to non-diagnostic closed pleural biopsy. The use of the device was simple and fabulous views were obtained. All biopsy specimens of the 4 patients were histologically adequate. Definite diagnosis was enabled in 3 of the 4 patients when clinical features and CT findings combined with thoracoscopic specimens. The design is similar to the fiberoptic bronchoscope, respiratory physicians can easily adapt to its use. It is also compatible with most video operating systems and light sources used in endoscopy suites. The convenient use and compatibility with most endoscopic systems are raising the importance of the device. However, biopsy size from semirigid thoracoscope might cause diagnostic difficulty when compared to rigid thoracoscope.     

Genetic polymorphism in the serotonin transporter gene-linked polymorphic region and response to serotonin reuptake inhibitors in patients with premature ejaculation

OBJECTIVES:

Serotonin plays a central role in ejaculation and selective serotonin reuptake inhibitors have been successfully used to treat premature ejaculation. Here, we evaluated the relationship between a polymorphism in the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and the response of patients with premature ejaculation to SSRI medication.

METHODS:

Sixty-nine premature ejaculation patients were treated with 20 mg/d paroxetine for three months. The Intravaginal Ejaculatory Latency Time and International Index of Erectile Function scores were compared with baseline values. The patients were scored as having responded to therapy when a 2-fold or greater increase was observed in Intravaginal Ejaculatory Latency Time compared with baseline values after three months. Three genotypes of 5-HTTLPR were studied: LL, LS and SS. The appropriateness of the allele frequencies in 5-HTTLPR were analyzed according to Hardy-Weinberg equilibrium using the χ²-test.

RESULTS:

The short (S) allele of 5-HTTLPR was significantly more frequent in responders than in nonresponders (p<0.05). Out of the 69 total PE patients, 41 patients (59%) responded to therapy. There was no significant difference in the International Index of Erectile Function score at the end of therapy between the responder and nonresponder groups. The frequencies of the L allele and S allele were 20% and 39%, respectively, in the responder group (p<0.05).

CONCLUSION:

We conclude that premature ejaculation patients with the SS genotype respond well to selective serotonin reuptake inhibitor therapy. Further studies with large patient groups are necessary to confirm this conclusion.     

Tissue distribution of cells derived from the area opaca in heterospecific quail-chick blastodermal chimeras

The objective of the current study was to determine the tissue distribution of cells derived from the area opaca in heterospecific quail-chick blastodermal chimeras. Quail-chick chimeras were constructed by transferring dissociated cells from the area opaca of the stage X–XII (EG&K) quail embryo into the subgerminal cavity of the unincubated chick blastoderm. The distribution of quail cells in embryonic as well as extra-embryonic tissues of the recipient embryo were examined using the QCPN monoclonal antibody after 6 days of incubation in serial sections taken at 100-μm intervals. Data gathered in the present study demonstrated that, when introduced into the subgerminal cavity of a recipient embryo, cells of the area opaca are able to populate not only extra-embryonic structures such as the amnion and the yolk sac, but also various embryonic tissues derived from the ectoderm and less frequently the mesoderm. Ectodermal chimerism was confined mainly to the head region and was observed in tissues derived from the neural ectoderm and the surface ectoderm, including the optic cup, diencephalon and lens. Although the possibility of random incorporation of transplanted cells into these embryonic structures cannot be excluded, these results would suggest that area opaca , a peripheral ring of cells in the avian embryo destined to form the extra-embryonic ectoderm and endoderm of the yolk sac, might harbor cells that have the potential to give rise to various cell types in the recipient chick embryo, including those derived from the surface ectoderm and neural ectoderm.     

Genome-wide analyses on loss of heterozygosity in head and neck squamous cell carcinomas

Head and neck squamous cell carcinoma (HNSCC) is a frequent malignancy with a poor survival rate. Identifying the tumor suppressor gene (TSG) loci by genomic studies is an important step to uncover the molecular mechanisms involved in HNSCC pathogenesis. We therefore performed comprehensive analyses on loss of heterozygosity (LOH) using a genome-wide panel of 191 microsatellite markers in 22 HNSCC samples. We found 53 markers with significantly high LOH (>30%) on 21 chromosomal arms; the highest values of those were observed on 3p, 9p, 13q, 15q, and 17p, corresponding to D3S2432 (67%), D9S921-D9S925 (67%) and GATA62F03 (86%), D13S1493 (60%), D15S211 (62%), and D17S1353 (88%), respectively. Fifteen hot spots of LOH were defined in 13 chromosomal arms: 2q22-23, 4p15.2, 4q24-25, 5q31, 8p23, 9p23-24, 9q31.3, 9q34.2, 10q21, 11q21-22.3, 14q11-13, 14q22.3, 17p13, 18q11, and 19q12 as loci reported previously in HNSCCs. Furthermore, we identified five novel hot spots of LOH on three chromosomal arms in HNSCC at 2q33 (D2S1384), 2q37 (D2S125), 8q12-13 (D8S1136), 8q24 (D8S1128), and 15q21 (D15S211). In conclusion, our comprehensive allelotype analyses have unveiled and confirmed a total of 20 possible TSG loci that could be involved in the development of HNSCC. These results provide useful clues for identification of putative TSGs involved in HNSCC by fine mapping of the suspected regions and subsequent analysis for functional genes.     

Desflurane anaesthesia in a patient with multiple sclerosis in total hip replacement

Multiple sclerosis (MS) is a progressive demyelinating disease presenting with a relapsing-remitting course and affects large areas of the brain and the spinal cord. Surgical stress often induces exacerbation of MS symptoms. It is mandatory to prepare the MS patient very carefully for the surgery and anaesthesia with an effective premedication and an effective postoperative analgesia following a safe and minimal-risk anaesthesia management. In recent reports, results of general and regional anaesthesia in MS patients have been discussed. To our knowledge this is the first case report of the use of desflurane anaesthesia in a patient with MS. In conclusion, desflurane anaesthesia is a safe and useful method for MS patients.