Morbidity of flank incision in 100 renal donors

Objective: The purpose of this study is to determine the morbidity of lumbotomy incision used in the last 100 living related donor nephrectomies retrospectively. Methods: Since March 1991, 100 donor nephrectomies were made to living donors with lumbar incision. Incisions made in lateral decubitus position, subcostally or by an 11th or 12th rib resection. Left nephrectomy to 83, and right nephrectomy to 17 donors was performed. In 2 patients, there had been a peritoneal defect which was closed with primary sutures. In 19 patients 3 cm or shorter and in 5 patients longer than 3 cm of pleural entry had occurred. In all of the patients laceration was repaired without placement of a chest tube, however a chest tube had to be placed in 2 donors after obtaining a control chest x-ray postoperatively. Results: All the patients mobilized and began to take orally in the first post-operative day. Wound infection, pneumonia and deep vein thrombosis had detected in none of the patients. The patients were discharged on the4th and 5th postoperative day. During their control after 1 month from the operation it was found that all of them had returned to their daily life. In the postoperative period incisional hernia occurred in 7 patients which didn't need surgical repair and none of them complained of cosmetic problem. There was no any other late term complication was seen due to flank incision. Conclusion: Lumbotomy incision in donor nephrectomy, either a rib resection or supracostal approach, is reliable, provides excellent exposure for surgeon and has minimal morbidity. This revised version was published online in June 2006 with corrections to the Cover Date.     

Influence of classical and rock music on red blood cell rheological properties in rats.

BACKGROUND: A number of studies have reported physiological effects of music. Different types of music have been found to induce different alterations. Although some physiological and psychological parameters have been demonstrated to be influenced by music, the effect of music on hemorheological parameters such as red blood cell (RBC) deformability and aggregation are unknown. This study aimed at investigating the effects of classical and rock music on hemorheological parameters in rats. MATERIAL/METHODS: Twenty-eight rats were divided into four groups: the control, noise-applied, and the classical music- and rock music-applied groups. Taped classical or rock music were played repeatedly for 1 hour a day for 2 weeks and 95-dB machine sound was applied to the noise-applied rats during the same period. RBC deformability and aggregation were measured using an ektacytometer. RESULTS: RBC deformability was found to be increased in the classical music group. Exposure to both classical and rock music resulted in a decrement in erythrocyte aggregation, but the decline in RBC aggregation was of a higher degree of significance in the classical music group. Exposure to noise did not have any effect on the parameters studied. CONCLUSIONS: The results of this study indicate that the alterations in hemorheological parameters were more pronounced in the classical music group compared with the rock music group.     

Hyperhomocysteinaemia is associated with uveitis but not with deep venous thrombosis in Behcet's disease.

Plasma homocysteine was assessed in Behcet's disease (BD) patients in order to determine the prevalence of hyperhomocysteinaemia in BD and to test its association with clinical manifestations of the disease. The study included 59 patients with BD and 118 age- and sex-matched healthy subjects. Plasma homocysteine, vitamin B(12) and folate were assessed by automated immunoassay methods. Hyperhomo-cysteinaemia was defined as plasma homocysteine >15 micromol/l. Plasma homocysteine concentrations and the prevalence of hyperhomocysteinaemia were significantly higher in BD patients than in controls [median (5th-95th percentile), 11.3 (6.6-28.1) vs. 10.6 (6.6-17.1) micromol/l, and 25.4% vs. 9.3%, respectively]. In BD patients, hyperhomocysteinaemia was related to male gender, disease severity and uveitis [odds ratio (OR), 5.32; 95% confidence interval (CI), 1.43-21.61; p = 0.008], but not to age, smoking, disease activity, deep venous thrombosis, arthritis or neurological involvement. The association between uveitis and hyperhomocysteinaemia persisted (multi-adjusted OR, 7.46; 95% CI, 1.03-54.3; p = 0.05) after adjusting for gender, age, disease activity and duration, smoking, deep venous thrombosis, and serum concentrations of creatinine, vitamin B(12) and folate. Plasma homocysteine should be measured in patients with BD, and the effect of B-vitamin supplementation should be tested in those with hyperhomo-cysteinaemia.     

Poisoning due to amatoxin-containing Lepiota species

Twenty-seven consecutive mushroom poisoning cases were followed up over a period of 14 days. Fourteen out of 27 died of liver failure. There were no deaths from renal failure. The mushrooms were identified as the amatoxin-containing Lepiota species. Therapeutic measures included nasogastric lavage, charcoal, vitamin C, vitamin B, penicillin G, corticosteroids, oral streptomycin and, in the case of a few patients, limited amounts of thioctic acid. Of the ten haemodialysed, nine died. Unfortunately charcoal haemoperfusion was not available. It appeared that therapeutic measures were ineffective and it also seemed that the amount of mushroom ingested was the determining factor for the prognosis. An important point to make is that renal failure does not occur and liver failure is always delayed (group II). For this reason all suspected cases of mushroom poisoning, regardless of absence of clinical signs and symptoms, must be hospitalised for a period of at least one week. The poisonous properties of wild mushrooms have been recognized since ancient times. However, despite awareness of their inherent dangers, serious poisoning continues to occur. Fatal intoxications can be attributed almost entirely to the amtoxin-containing species. Amanita phalloides have been blamed for over 90% of poisoning deaths in North America. There are reports of intoxications of other amatoxin-containing species in Europe, but fatalities due to Lepiota species are reported only rarely. It was previously acknowledged that the interval between ingestion of mushrooms and the onset of symptoms is longer than expected in serious poisonings.(ABSTRACT TRUNCATED AT 250 WORDS)     

螺旋CT诊断卵巢畸胎瘤的准确性评价

目的：分析卵巢畸胎瘤的螺旋CT影像特征。材料与方法：回顾性分析经手术及病理证实的卵巢畸胎瘤31例,均行螺旋CT检查。结果：31例卵巢畸胎瘤中,双侧附件的4例;右侧附件11例;左侧附件的15例：左侧附件伴有双角子宫畸形的1例。其特征性表现边界清楚,有完整包膜,以液性脂肪密度为主、漂浮物、钙化或牙齿和含有物质的混杂密度28例;液性脂肪密度和漂浮物为脂-液性面的2例;水样密度和极少量液性脂肪密度1例。结论：螺旋CT盆腔横断面平扫和增强诊断卵巢畸胎瘤具有特征性表现,有助于提高诊断的准确性。     

Progressive valgus deformity after juxta-epiphyseal fractures of the upper tibia in children

Four cases of progressive valgus deformity following a juxta-epiphyseal fracture of the proximal end of the tibia are presented. We suggest that the deformity is due to asymmetrical growth of the physis. Since this type of fracture tends to create a deformity, an anatomical or even overcorrected reduction is required. Long follow-up is necessary.     

Moderation analysis exploring associations between age and mucocutaneous activity in Behçet’s syndrome: A multicenter study from Turkey

The aim of the present study was to examine the effects of age on mucocutaneous activity by using moderation analysis in Behçet’s syndrome (BS). In this cross-sectional study, 887 BS patients (female : male, 481:406; mean age, 38.4 ± 10.9 years) followed in 13 tertiary centers in Turkey were included. Mucocutaneous activity was evaluated by using the Mucocutaneous Index (MI) according to sex and disease course. Moderation analysis was performed to test the effect of age on mucocutaneous activity. A moderator variable is a third variable and affects the relationship between independent and outcome variables. Age was chosen as a potential moderator variable (interaction effect), MI score as the outcome variable and sex as an independent variable in the analysis. The moderation analysis tested the effects of age in three steps: whole BS patient group, patients without systemic involvement and those with systemic involvement. The moderation model was only significant in BS patients with systemic involvement (P = 0.0351), and a significant relationship was observed between female sex and MI score (P = 0.0156). In addition, the interaction plot showed that female patients had increased MI scores compared with male patients, especially in the 28-year-old age group (P = 0.0067). Moreover, major organ involvement was newly diagnosed in the majority of these young female BS patients. Our results suggest that the relationship between sex and mucocutaneous activity was moderated by age in the systemic involvement group. Also, increased mucocutaneous activity may be associated with new major organ involvement in young female BS patients with systemic involvement.     

Oseltamivir-ribavirin combination therapy for highly pathogenic H5N1 influenza virus infection in mice

We studied the effects of a neuraminidase inhibitor (oseltamivir) and an inhibitor of influenza virus polymerases (ribavirin) against two highly pathogenic H5N1 influenza viruses. In vitro, A/Vietnam/1203/04 virus (clade 1) was highly susceptible to oseltamivir carboxylate (50% inhibitory concentration [IC₅₀] = 0.3 nM), whereas A/Turkey/15/06 virus (clade 2.2) had reduced susceptibility (IC₅₀ = 5.5 nM). In vivo, BALB/c mice were treated with oseltamivir (1, 10, 50, or 100 mg/kg of body weight/day), ribavirin (37.5, 55, or 75 mg/kg/day), or the combination of both drugs for 8 days, starting 4 h before virus inoculation. Monotherapy produced a dose-dependent antiviral effect against the two H5N1 viruses in vivo. Three-dimensional analysis of the drug-drug interactions revealed that oseltamivir and ribavirin interacted principally in an additive manner, with several exceptions of marginal synergy or marginal antagonism at some concentrations. The combination of ribavirin at 37.5 mg/kg/day and oseltamivir at 1 mg/kg/day and the combination of ribavirin at 37.5 mg/kg/day and oseltamivir at 10 mg/kg/day were synergistic against A/Vietnam/1203/04 and A/Turkey/15/06 viruses, respectively. These optimal oseltamivir-ribavirin combinations significantly inhibited virus replication in mouse organs, prevented the spread of H5N1 viruses beyond the respiratory tract, and abrogated the cytokine response (P < 0.01). Importantly, we observed clear differences between the efficacies of the drug combinations against two H5N1 viruses: higher doses were required for the protection of mice against A/Turkey/15/06 virus than for the protection of mice against A/Vietnam/1203/04 virus. Our preliminary results suggest that oseltamivir-ribavirin combinations can have a greater or lesser antiviral effect than monotherapy, depending on the H5N1 virus and the concentrations used.