Curcumin prevents shock-wave lithotripsy-induced renal injury through inhibition of nuclear factor kappa-B and inducible nitric oxide synthase activity in rats

Shock wave lithotripsy (SWL) is commonly used for treatment of renal stones. Free oxygen radicals are involved in the pathophysiology of renal injury due to SWL. We investigated the protective effects of curcumin, which is an antioxidant and nuclear factor kappa-B (NF-κB) inhibitor, against renal injury. Forty-eight rats were included and divided into four groups: group 1, control; group 2, SWL (15 kW-1,500 shocks); group 3, SWL + curcumin (curcumin orally 75 mg/kg/day dissolved in 10% ethyl alcohol, 1 day before and 5 days after SWL); and group 4, SWL + vehicle (10% ethyl alcohol). The kidneys were removed on days 7 and 35 after SWL. A sample was fixed in formaldehyde solution. Renal tissues were examined for proximal tubular injury under light microscope. iNOS activity and active subunit of NF-κB, p65, were evaluated immunohistochemically using rat monoclonal antibodies interpreting results semiquantitatively. There were significant differences between SWL and control groups on days 7 and 35, considering histological changes under light microscope (P < 0.02). There was a significant decrease in necrosis and fibrosis in the curcumin group as compared to the SWL group. Expressions of iNOS and p65 on days 7 and 35 were at basal levels with immunohistochemical staining. These parameters had high levels in the SWL group (P < 0.02). No significant difference was present between the control and the curcumin groups (P > 0.02). Curcumin, decreasing expressions of iNOS and p65 and serum nitric oxide levels prevented interstitial, glomerular, tubular epithelial and endothelial cellular injuries. We suggest that curcumin, could be used, especially in high-risk patients, as a protective agent to prevent renal injury due to SWL.     

Concomitant Laparoscopic Adjustable Gastric Banding and Laparoscopic Cholecystectomy in a Super-Obese Patient with Situs Inversus Totalis Who Previously Underwent Intragastric Balloon Placement

Laparoscopic adjustable gastric banding has been increasingly performed since its introduction in 1990. Situs inversus totalis is a rare anomaly in which transposition of organs to the opposite side of the body occurs. Laparoscopic gastric banding in such few patients has been reported in the literature. We discuss a super-obese patient with situs inversus totalis and asymptomatic cholelithiasis who previously underwent endoscopic intragastric balloon placement in preparation for bariatric surgery. Afterwards, laparoscopic cholecystectomy and laparoscopic adjustable gastric banding were performed in the same session. Special attention is paid to the literature review and the mirror-image modification of the laparoscopic cholecystectomy and laparoscopic gastric banding procedures. With preoperative assessment, modifications in the surgical team, and equipment, the operation can be performed safely.     

The role of standing flexion-extension radiographs for spondylolisthesis following single level disk surgery

OBJECTIVES: Spondylolisthesis is the forward displacement of a lumbar vertebra relative to the adjacent vertebra, occurs as result degeneration or surgery and is a special type of lumbar instability. There is no consensus about which radiologic modality or findings truly reflect the lumbar instability and the exact incidence after single level disk surgery is unknown. METHODS: In this prospective study, we have included 90 patients who were operated by the same surgeon with single level disk herniation. We aimed at evaluating the post-operative lumbar spondylolisthesis, with flexion and extension lateral radiographs in addition to standard magnetic resonance imaging (MRI). RESULTS: We have seen spondylolisthesis in six of 90 cases with standing lateral flexion-extension radiographs, which were undefinable with MRI. Pain intensity and functional-economic rating scale (Prolo scale) were unremarkable. DISCUSSION: We have concluded that standing flexion-extension radiographs should be routinely combined in patients with failed back surgery syndrome and even if lumbar instability is clinically suspected, especially when conventional MR examination is normal. When the MR examination showed spondylolisthesis, standing flexion-extension radiographs could not give additional information.     

CT and MRI findings in calvarial non-infectious lesions

Differential diagnosis of the calvarial lesions is important in order to decide whether biopsy, surgical intervention, or follow-up is required for further management. In this pictorial essay on calvarial lesions, lytic or sclerotic patterns, contours of the lesions, calcifications, soft tissue components, inner and outer table localizations were evaluated with computed tomography (CT). On magnetic resonance imaging (MRI) signal characteristics and contrast enhancement of the lesion, relation to brain parenchyma and soft tissue were evaluated. CT scan is considered to be the best examination to characterize bone alterations whereas MRI depicts bone marrow abnormalities and invasion of adjacent tissues.     

Disseminated Fusariosis Caused by Fusarium verticillioides in an Acute Lymphoblastic Leukemia Patient after Allogeneic Hematopoietic Stem Cell Transplantation

Fusarium species are saprophytic molds which cause disseminated or localized infections in humans. Disseminated Fusarium infection can cause significant morbidity and mortality in immunocompromised patients. We present a case of disseminated fusariosis caused by Fusarium verticillioides in a patient with acute lymphoblastic leukemia and successfully treated using both liposomal amphotericin B and voriconazole.     

Expanding the phenotypic spectrum of lupus erythematosus in Aicardi‐Goutières syndrome

Objective

Aicardi‐Goutières syndrome (AGS) is an early‐onset encephalopathy resembling congenital viral infection that is characterized by basal ganglia calcifications, loss of white matter, cerebrospinal fluid (CSF) lymphocytosis, and elevated interferon‐α levels in the CSF. Studies have shown that AGS is an autosomal‐recessive disease linked to mutations in 5 genes, encoding the 3′‐repair DNA exonuclease 1 (TREX1), the 3 subunits of ribonuclease H2 (RNASEH2A–C), and sterile alpha motif domain and HD domain–containing protein 1 (SAMHD1). In this study we further characterized the phenotypic spectrum of this disease.

Methods

Clinical and laboratory data were obtained from 26 patients fulfilling the clinical diagnostic criteria for AGS. Genomic DNA was screened for mutations in all 5 AGS genes by direct sequencing, and sera were analyzed for autoantibodies.

Results

In 20 patients with AGS, 20 mutations, 12 of which were novel, were identified in all 5 AGS genes. Clinical and laboratory investigations revealed a high prevalence of features (some not previously described in patients with AGS) that are commonly seen in patients with systemic lupus erythematosus (SLE), such as thrombocytopenia, leukocytopenia, antinuclear antibodies, erythematous lesions, oral ulcers, and arthritis, which were observed in 12 (60%) of 20 patients with AGS. Moreover, the coexistence of AGS and SLE, was for the first time, demonstrated in 2 patients with molecularly proven AGS.

Conclusion

These findings expand the phenotypic spectrum of lupus erythematosus in AGS and provide further insight into its disease mechanisms by showing that activation of the innate immune system as a result of inherited defects in nucleic acid metabolism could lead to systemic autoimmunity.

     

Supraclavicular artery flap

Supraclavicular artery-based flaps provide aesthetic and functional coverage for the head and neck region. Fourteen formalin-fixed cadavers were dissected bilaterally, and 28 supraclavicular arteries were evaluated. The origin of the supraclavicular artery was transverse cervical artery in 62.9% and suprascapular artery in 37.1% of the cases. The origin of the artery was at the level of the medial third of the clavicle in 3.7%; 3.7% of the cases were at the junction of medial and middle third of the clavicle, 33.3% at the level of middle third of the clavicle, 11.1% at the junction of middle and lateral thirds, 44.4% at the level of lateral third, and 3.7% at the level of acromioclavicular joint. The mean values of the results were as follows: The diameter of the artery was 1.0 mm at the origin. The distance of the origin of the artery from sternoclavicular joint and from the upper border of the clavicle was 76.4 and 22.2 mm, respectively. The average length of the artery was 70.8 mm. In all dissections, the artery was deep to the platysma muscle. Forty-one percent of supraclavicular arteries accompanied the middle supraclavicular nerve, whereas 59% of the arteries run with lateral supraclavicular nerve. The supraclavicular artery had a parallel course to the 2 horizontal imaginary lines passing from the coracoid process and acromion in 63% of the cases; 18.5% of the arteries were oblique, and 18.5% were vertical to the imaginary lines. The venae comitantes were double in all dissections.     

Anatomy of gracilis muscle flap

Gracilis muscle flap is commonly used in reconstructive surgery. The gracilis muscles of 15 formalin-fixed adult cadavers (30 cases) were dissected with 4× loupe magnification. The most proximal pedicle of gracilis muscle was the deep branch of the medial circumflex femoral artery. It was located 60 mm from the pubic tubercle and had a diameter of 0.9 m on the average. The second pedicle was the medial circumflex femoral artery. It was the dominant pedicle in 13% of the cases. The mean diameter of the artery was 1.2 mm, and it entered the muscle 98 mm from the pubic tubercle. The third artery that nourished the muscle was deep femoral artery. It was the dominant pedicle in 87% of the cases. It had a mean diameter of 1.6 mm with a length of 54 mm. The most distant pedicles originated from the superficial femoral artery. They were present in all cases and were double in 77% of the cases. Mean diameter and length of the artery were 1.4 and 52 mm, respectively. They entered the muscle 266 mm from the pubic tubercle. These distal pedicles seem to be large enough to elevate the middle part of the muscle as a free flap.