Laparoscopic management of gallbladder duplication

Gallbladder duplication is a rare condition. Because laparoscopic cholecystectomy is the primary treatment modality for the diseased single gallbladders, it should be the choice of treatment for double gallbladders. However, preoperative imaging methods may be unsatisfactory for the correct diagnosis. As a result, incomplete resections may be performed. Intraoperative cholangiography should be performed in suspected cases to prevent inadvertent injury to the biliary system. In this report, we present a symptomatic patient with double gallbladders with separate cystic ducts in whom the gallbladders were successfully resected as a single specimen by laparoscopic means. The pitfalls of diagnostic modalities and surgical strategy are discussed in the context of the available literature.     

Statistical shape analysis of the rat hippocampus in epilepsy

In this study, we aimed to (1) propose landmarks for the hippocampus in a rat brain using an experimental study and (2) investigate hippocampus shape changes in a rat brain with epilepsy using the statistical shape analysis method. We have used the statistical shape analysis method to illustrate hippocampal shape deformation due to epilepsy. Statistical shape analysis is of increasing interest to the neuroimaging community because of its potential for locating morphological changes. Nineteen rat brains (ten healthy and nine epileptic) with hematoxylin and eosin images of the hippocampus were used. The results strongly indicated that the normalized hippocampal shape of the epileptic group was different from the nonepileptic group; deformation was seen most significantly in the medial regions of the cornu ammonis (CA1 and CA3) of the hippocampus. In conclusion, our landmark-based methodology detected regional differences in the hippocampus in epilepsy. This study may serve as an initial reference for future studies on shape alteration of the hippocampus associated with certain medical conditions.     

Sexual problems in a sample of the Turkish psychiatric population

Introduction

Sexual functioning has received little attention as an important aspect of patient care for those who have severe mental disorders.

Aim

The aim of this study is to compare sexual difficulties seen in Turkish psychiatric patients and healthy control subjects.

Methods

Study group consisted of outpatients in remission with schizophrenia (n = 84), bipolar affective disorders (n = 90), heroin addiction (n = 88), and healthy control group (n = 98). A sociodemographical data form and the Golombok Rust Inventory of Sexual Satisfaction were applied to all groups (N = 360).

Results

Half of the patient groups and 72.8% of control subjects reported that they had regular sexual life. The patients with heroin addiction complained about more problems in their sexual life than in the other groups. Controls (86.2%) felt more satisfied with their sexual life. Female patients with heroin addiction had statistically significant higher scores in nonsensuality subscale of Golombok Rust Inventory of Sexual Satisfaction. Female patients with schizophrenia and bipolar disorder had statistically significant higher scores in vaginismus subscale than in control group. Between the groups, male patients with bipolar disorder had higher score in most of the items except noncommunication and erectile dysfunction and also had higher total score than in the controls. More men (especially with heroin addiction) thought that their illness and drugs were responsible for their sexual problems, knew the effect of the illness and drugs on their sexual life, and asked questions to their psychiatrists about the problems more than women.

Conclusion

Patients with bipolar disorders and schizophrenia were unaware of effects of their medication on their sexual life. Finally, it was also found that clinicians in our country do not pay sufficient attention to the sexual problems of psychiatric patients.     

The impact of gallbladder aspiration during elective laparoscopic cholecystectomy: a prospective randomized study

BACKGROUND: The aim of this prospective randomized study was to investigate the effect of gallbladder aspiration during elective laparoscopic cholecystectomy on the operative and postoperative course of patients. METHODS: Between August 2005 and February 2007, 160 consecutive patients with symptomatic cholelithiasis were randomized into 2 clinically comparable groups. Gallbladders were aspirated before dissection in group A (aspiration, n = 80), and they were not aspirated in group C (control, n = 80). Patients' characteristics and general operative outcomes were compared and analyzed. RESULTS: The mean dissection time (P = .45), amount of gas used (P = .49), and liver bed bleeding (P = .30) were not significantly different between group A and group C. Similarly, there were no differences between the groups regarding gallbladder perforation (P = .12), spillage of gallstones into the abdominal cavity (P = 1.00), or wound infection (P = 1.00). CONCLUSIONS: The findings suggest that routine gallbladder aspiration is unnecessary in elective laparoscopic cholecystectomy.     

Live donor liver transplantation for acute liver failure

BACKGROUND: Acute liver failure (ALF) carries a high mortality unless urgent orthotopic liver transplantation (OLT) is performed on time. Live donors are utilized to treat this irreversible condition first in pediatric cases and then in adults. Herein, we aimed to report our experience with live donors for ALF in a country of a deceased donor organ donation rate is only 1.5 per million people. METHODS: Among the 245 live donor liver transplantations (LDLT) performed from June 1999 to December 2005, 14 of them (6%) were performed for ALF in 8 pediatric and 6 adult cases. Right lobes were harvested for the adult cases whereas left lateral segments were harvested for pediatric cases, except one child transplanted with a right lobe graft. The etiology of the disease was; acute hepatitis B in four cases, hepatitis A in three cases, Wilson disease two cases, autoimmune hepatitis in two cases, and was unknown in three cases. RESULTS: Three-year graft and patient survival is 79% for these series. Five of the six adult patients and six of the eight pediatric cases survived after transplantation. There was not any donor mortality or major morbidity. CONCLUSIONS: LDLT offers a safe and effective modality of treatment for ALF for both pediatric and adult patients to overcome the problem of organ shortage especially in countries where the chance of receiving an organ from a deceased donor is low.     

Risky sexual behavior among patients in Turkey with bipolar disorder, schizophrenia, and heroin addiction

AimRisky sexual behavior associated with such sexually transmitted infections (STIs) as hepatitis B and C, herpes, Treponema pallidum, and Neisseria gonorrhoeae, is more frequent among psychiatric patients and parenteral drug abusers than the general population. The aim of this study was to investigate risky sexual behavior in psychiatric outpatients diagnosed with schizophrenia (SCH), bipolar disorder, and heroin addiction (HA), and to compare them with those observed in healthy controls.MethodsThe study group (N = 485; 234 females and 251 males) consisted of patients that consecutively presented to Bak?rkoy State and Training Hospital for Psychiatric and Neurological Diseases in Istanbul and normal healthy controls.Main Outcome MeasuresThe chi‐squared test was used for comparisons between groups and categorical variables. One‐way analysis of variance (post‐hoc Bonferroni test) was used for demographic data. A 22‐item questionnaire for collecting demographic, illness history, and sexual activity data, and a structured 23‐item form for collecting data on risky sexually behavior were administered to the participants.ResultsIn all, 10% of the participants had a positive history for STIs. The majority of risky sexual behaviors was observed among the HA patients. The frequency of being sexually assaulted and having homosexual acts among the SCH group were higher. None of the patients had a positive human immunodeficiency virus (HIV) test result. The frequency of positivity for hepatitis B and C markers was highest among the HA patients.ConclusionsThe provision of information and training about all STIs and risky sexual behavior should become routine in the treatment of mentally ill patients, especially those that abuse drugs. Hariri AG, Karadag F, Gokalp P, and Essizoglu A. Risky sexual behavior among patients in Turkey with bipolar disorder, schizophrenia, and heroin addiction. J Sex Med 2011;8:2284–2291.     

The role of BDNF and HPA axis in the neurobiology of burnout syndrome

Chronic stress is known to affect the HPA axis. The few clinical studies which have been conducted on HPA-axis function in burnout have produced inconsistent results. The etiological relationship between sBDNF and burnout has not yet been studied. The aim of the current study was to investigate the role of BDNF and HPA axis in the neurobiology of burnout. In the current study 37 clinically diagnosed burnout participants were compared with 35 healthy controls in terms of BDNF, HPA axis, burnout symptoms, depression, anxiety and psychosomatic complaints. Basal serum cortisol, sBDNF and cortisol level after 1 mg DST was sampled. We found no significant differences in terms of HPA-axis function (for basal serum cortisol, p=0.592; for cortisol level after 1 mg DST, p=0.921), but we did find lowered sBDNF levels in burnout group (88.66+/-18.15 pg/ml) as compared to healthy controls (102.18+/-20.92 pg/ml) and the difference was statistically significant (p=0.005). Logistic Regression Analysis revealed that emotional exhaustion (p=0.05), depersonalization (p=0.005) and depression (p=0.025) were significantly associated with burnout. sBDNF levels correlated negatively with emotional exhaustion (r=-,268, p=0.026), depersonalization (r=-,333, p=0.005) and correlated positively with competence (r=0.293, p=0.015) sub-scales of burnout inventory. However, there were no significant relationships between cortisol levels and sBDNF levels (r=0.80, p=0.51), depression, anxiety, psychosomatic complaints and burnout inventory. Our results suggest that low BDNF might contribute to the neurobiology of burnout syndrome and it seems to be associated with burnout symptoms including altered mood and cognitive functions.     

Retroviral WASP gene transfer into human hematopoietic stem cells reconstitutes the actin cytoskeleton in myeloid progeny cells differentiated in vitro

OBJECTIVE: Wiskott-Aldrich syndrome (WAS) is a primary immunodeficiency disorder characterized by recurrent infections, autoimmunity, microthrombocytopenia, and susceptibility to malignant tumors. Compared with the conventional treatment using allogeneic bone marrow transplantation, hematopoietic stem cell gene therapy might offer more specific and less toxic therapeutic options. METHODS: We investigated retroviral WAS protein (WASP) gene transfer to assess functional correction and potential toxicities in human CD34(+) cells from WAS patients and healthy individuals, respectively. RESULTS: WASP mRNA and protein levels were restored in CD14(+) cells derived from WASP-transduced hematopoietic stem cells. Functional reconstitution in WASP-transduced myeloid cells was documented by podosome formation and Fc gamma R-mediated phagocytosis. Importantly, overexpression of WASP in CD34(+) cells from healthy donors did not cause any discernible toxic effects. CONCLUSIONS: Our studies document the feasibility of WASP gene transfer into human CD34(+) cells and suggest that the phenotype of WASP-deficient myeloid cells can be restored upon retroviral gene transfer.