Endoscopic treatment of primary sclerosing cholangitis.

BACKGROUND/AIMS: Dominant stricture of an extrahepatic bile duct is responsible for symptoms and an exacerbation of cholestasis in 15-20% of patients with primary sclerosing cholangitis. The aim of this study was to evaluate the efficacy and safety of endoscopic treatment in this selected patient group. METHODS: Retrospectively, we evaluated 16 patients who were treated endoscopically due to elevation of serum biochemical liver tests and symptoms which were attributable to dominant bile duct strictures during the period 1990 to 2003. Symptoms and biochemical liver tests were compared before and after treatment. RESULTS: Sixteen patients underwent a total of 58 therapeutic endoscopic retrograde cholangiopancreatographies (ERCP). Sixteen endoscopic sphincterotomies, 15 balloon dilatations, 6 bougie dilatations, 3 stone/sludge extractions and 8 stentings were performed. Endoscopic therapy was technically successful in all patients (100%). Biochemical liver tests were significantly improved when compared with pretreatment values (p<0.001). Patients have been followed-up without stents except for the patients who had cholangiocarcinoma and cirrhosis at the beginning. Procedure-related early complications occurred in 8.6% of therapeutic endoscopic biliary procedures. There was no mortality due to endoscopic treatment. Two patients whose stents were changed every two to three months had cholangitis due to stenting during 13 stent periods. Four patients whose stents were changed in seven to 10 days developed suppurative cholangitis (total 6 stent periods). CONCLUSIONS: Endoscopic therapy of symptomatic dominant strictures in primary sclerosing cholangitis is safe and effective. The cholangitis seen in long-term stenting seems to be solved by short-term stenting.     

QT dispersion. Is it an independent risk factor for in-hospital mortality in patients with intracerebral hemorrhage?

Electrocardiographic repolarization changes, comprising QT prolongation, are most commonly seen after intracerebral hemorrhage. In this study in patients with intracerebral hemorrhage (ICH), QT dispersion and its daily changes were examined and the relation between QT dispersion and in-hospital mortality assessed. In 28 patients with intracerebral hemorrhage, diagnosed by computerized tomographic scanning, an ECG was obtained on the day of admission to hospital and then serial ECGs were recorded on the following four consecutive days. Blood electrolytes (K, Ca, Mg) were also analysed. The patients with intracerebral hemorrhage were followed until discharge or death (mean 14 +/- 4 days). QT, QT peak, and QT-QT peak dispersion were measured on simultaneous twelve lead electrocardiograms. Also, in 29 healthy subjects as a control group, five consecutive day serial electrocardiograms were recorded. There were no statistically significant differences between the study and control groups in terms of gender and age. During the five days, QT, QT peak, and QT-QTpeak dispersion values were significantly higher in patients with intracerebral hemorrhage than in the control subjects (p < 0.001). There were no statistically significant differences in two patient groups with intracerebral hemorrhage who died and who were discharged in terms of mean QT, QTpeak, and QT-QTpeak dispersion values. In conclusion, QT, QT peak, and QT-QTpeak dispersion values were significantly greater in patients with intracerebral hemorrhage than in the control subjects, but QT, QT peak, and QT-QT peak dispersions were not independent risk factors for in-hospital mortality in patients with intracerebral hemorrhage.     

Gamma knife radiosurgery for jugular foramen schwannomas

Jugular foramen schwannomas are very rare tumors. Advances in skull base surgery have led to more aggressive resection of these tumors, but surgery may associate with development of new neurological deficits. In this report, we analyze the long-term results for 17 patients with newly diagnosed or residual/recurrent jugular foramen schwannoma who underwent gamma-knife treatment. During a mean 64?months of follow-up, magnetic resonance imaging revealed reduced tumor size in 13 cases and no size change in four cases. The tumor growth control rate was 100% and only one patient had transient hoarseness. For patients who have small- to moderate-sized jugular foramen schwannomas, gamma-knife radiosurgery is associated with good tumor control and carries minimal risk of adverse radiation effects.     

The effect of hyperbaric oxygen therapy on the survival of random pattern skin flaps in nicotine-treated rats

Previous studies have shown that nicotine increases the risk of necrosis in skin flaps. We investigated the effect of hyperbaric oxygen (HBO(2)) treatment on the survival of random skin flaps in nicotine-treated rats. Thirty-two Sprague-Dawley rats were divided into four groups with eight rats in each group. Group 1 (n=8) was the control, group 2 (n=8) received HBO(2) treatment without being exposed to nicotine, group 3 (n=8) received nicotine and group 4 (n=8) received HBO(2) treatment with exposure to nicotine. The rats in the nicotine-treated groups were prepared by treating them with nicotine for 28 days. At the end of the 28th day, standard McFarlane-type random skin flaps were lifted from the backs of all the rats. In groups 2 and 4, HBO(2) treatment started at the 30th min following the surgery and continued once a day for 7 days. The flap survival rates and histopathological evaluation results related to neovascularisation and granulation tissue formation were significantly better in the HBO(2)-treated groups (groups 2 and 4) than in the groups that did not receive HBO(2) treatment (groups 1 and 3) (p < 0.05). The flap survival rates, neovascularisation and granulation tissue formation were highest in group 2 and lowest in group 3 (p ≤ 0.001). No significant difference was observed between group 4, which received HBO(2) treatment with nicotine exposure, and the control group (group 1) (p > 0.05). In conclusion, our study demonstrates that HBO(2) treatment has a positive effect on flap survival in nicotine-treated rats.     

H-FABP, cardiovascular risk factors, and functional status in asymptomatic spinal cord injury patients

Background

This was a cross-sectional study in the setting of a rehabilitation hospital.

Objective

The aim of the study was to determine the serum levels of heart-type fatty acid-binding protein (H-FABP) in patients with spinal cord injury (SCI). A further goal was to examine whether there is a relationship between H-FABP levels and Functional Ambulation Classification (FAC) scale, Functional Independence Measure (FIM) score, American Spinal Injury Association (ASIA) status, and metabolic syndrome (MetS).

Methods

The study included 56 SCI patients and 37 age- and sex-matched healthy control subjects who had not been diagnosed with coronary artery disease in the past.

Results

Serum H-FABP levels were significantly higher in patients with SCI than in control subjects: paraplegia group, 18.5?±?11.4; tetraplegia group, 16.3?±?9.1; control group, 6.7?±?5.1 ng/ml (p?<?0.001). There was no difference between the other cardiac enzymes (troponin I, AST, ALT, CK, CK-MB, and LDH) among the groups. The relationship between the serum H-FABP levels and FAC status was examined. There was a negative correlation between FAC status and H-FABP levels (p?<?0.001, r?=???0.581). Patients with complete SCI were divided into two groups according to the level of the lesion: (lesion levels in C6–T6, n?=?25; lesion levels in T7–L2, n?=?11). In patients with complete motor injury, H-FABP levels were higher in subjects with injuries above T6 than in those with injuries below T6 (24.21?±?10.1 and 14.1?±?10.4, respectively; p?=?0.011). Serum levels of H-FABP were higher in SCI patients with MetS (n?=?10) than in those without MetS (n?=?46; 25.8?±?11.6 ng/ml vs. 16.42?±?10.3 ng/ml, respectively; p?=?0.014). Patients were then divided into two groups according to SCI duration: <?12 months (n?=?27) and >?12 months (n?=?29). H-FABP levels showed statistically significant differences between the two groups (14.8?±?11.7 ng/dl and 20.9?±?9.9 ng/dl, respectively; p?=?0.036).

Conclusion

H-FABP is related to MetS and FAC status in asymptomatic SCI patients.     

Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthrosis of the knee

OBJECTIVE: To compare the effects of concentric and coupled concentric-eccentric isokinetic resistance training on functional capacity and symptoms of patients with osteoarthrosis (OA) of both knees. DESIGN: Repeated measures. SETTING: A university exercise physiology laboratory. PARTICIPANTS: Twenty-three volunteers, ages 41 to 75 years. Patients were randomly assigned to 3 groups: concentric (CON, n = 9), concentric-eccentric (CON-ECC, n = 8), and nontreatment (NONTX, n = 6). INTERVENTIONS: The CON group performed 12 concentric contractions of each knee extensor and flexor muscles; the CON-ECC group performed 6 concentric and 6 eccentric contractions of each knee muscle group by using a spectrum of angular velocities ranging from 30 degrees/s to 180 degrees/s with 30 degrees/s intervals, for both sides, 3 days a week for 8 weeks. MAIN OUTCOME MEASURES: Functional capacity (rising from a chair, walking, stair climbing and descending) and pain during rest and activities, peak torque, and cross-sectional area (CSA) of knee muscle groups of subjects were tested before and after training. RESULTS: Both training groups showed marked decreases (P <.001) in pain scores and increases (P <.001) in functional capacity together with increases (P <.05--.01) in peak torque and CSA of knee muscles. However, the NONTX group did not display these marked changes after the 8-week period. The results also indicated that concentric-eccentric training has a greater influence on functional capacity, especially stair climbing and descending, than that of concentric training when compared with NONTX group; however, the improvements in pain measurements were better in the CON group compared with the CON-ECC group after the training. CONCLUSIONS: The results suggest that with the isokinetic resistance training used in this study, it is possible to improve functional capacity and decrease pain in patients with OA of the knee. The results also showed that extensive training involving a high number of repetitions and eccentric contractions was safe, effective, and well tolerated for the patients with knee OA.