Gastric,duodenal, and pancreatic somatostatin-like immunoreactivity during hypovolemic shock

Because hypovolemic shock is known to cause gastric ulcers in animals and human beings, we investigated the tissue levels of somatostatin-like immunoreactivity (SLI) in the gastric corpus and antrum, duodenum, and pancreas during hypovolemic shock in rats. We studied male Wistar rats (N=10 each) 15 min, 2 hr, and 12 hr after hypovolemic shock and compared results to a control group (N=15).Two rats in both 2-hr and 12-hr groups showed gastric ulcers: three corporal and one antral. One animal developed multiple ulcers. In the gastric corpus and antrum and in the duodenum, tissue SLI showed significant decrease 15 min and 2 hr after shock. Gastric SLI remained low, whereas duodenal SLI recovered and rose above control level at 12 hr. Pancreatic SLI showed no significant changes during hypovolemic shock. Gastric tissue SLI levels that were significantly lower after shock than those of normal controls may have contributed to the peptic ulcer disease induced by hypovolemic shock in this experimental model.This study was performed upon approval by Tulane University School of Medicine, Advisory Committee for Animal Resources (Project 0172-4-03-096) and supported by the Gastroenterology Research Fund 530569.The results of this study were presented in part at the 88th Annual Meeting of the American Gastroenterological Association, May 9–15, 1987, Chicago, Illinois.     

Scintigraphy in the detection of gastro-oesophageal reflux in children with caustic oesophageal burns: a comparative study with radiography and 24-h pH monitoring

Background: Caustic injury of the oesophagus not only causes luminal narrowing but is also responsible for longitudinal contraction, resulting in gastro-oesophageal reflux (GOR), which leads to failure of conventional therapy. Therefore, the development of GOR should be investigated periodically to direct appropriate management of these patients. Purpose: To determine the ability of scintigraphy to detect GOR in children with caustic oesophageal strictures in comparison with barium study and 24-h pH monitoring. Materials and methods: Seventeen children with caustic oesophageal injury underwent scintigraphy, an upper GI barium study and 24-h pH monitoring within the same week. Five patients were also investigated post-operatively for the assessment of surgical outcome after antireflux surgery. Results: On the whole, there was good correlation (r = 0.78, P < 0.00 l) between scintigraphy and 24-h oesophageal pH monitoring. Scintigraphy detected all but one (9/10) refluxing patients and also correctly identified all (7/7) non-refluxing patients. Barium studies demonstrated 6 out of 10 refluxing patients. There were no false-positive barium studies in non-refluxing patients. Post-operative studies demonstrated no evidence of GOR in surgically treated patients. Conclusions: Our results indicate that, by comparison with barium studies, scintigraphy is useful in the detection of GOR in cases with caustic oesophageal strictures and may be used as a screening modality for those under clinical follow-up. Received: 25 January 2000 Revised: 26 June 2000 Accepted: 5 March 2001     

Evaluation of the effects of nasal septal deviation and its surgery on nasal mucociliary clearance in both nasal cavities

BACKGROUND: In this study the effects of nasal septal deviation (NSD) and its surgery on nasal mucociliary clearance velocity (NMCV) in both nasal cavities were evaluated. METHODS: This study included 20 patients with NSD and 20 healthy subjects as a control group who had no complaint related to the nose. NMCV was measured with rhinoscintigraphy using technetium-99m-macroaggregated albumin (Tc-99m-MAA). RESULTS: Before the septal surgery, the NMCV of concave (10.24 +/- 3.96 mm/minute) and convex sides (10.78 +/- 3.53 mm/minute) of the patients were significantly lower than the control group (17.94 +/- 2.89 mm/minute). There is no statistically significant difference between the NMCV of the concave and convex sides. After septal surgery, the NMCVs of the concave (16.34 _ 4.40 mm/minute) and convex sides (17.21 +/- 3.43 mm/minute) were not significantly different from control groups (17.94 +/- 2.89 mm/minute). Postoperative NMCVs of the concave and convex sides was significantly better than preoperative NMCVs. CONCLUSION: The results of this study showed that NSD significantly impaired NMCVs in both sides and that septoplasty significantly improved NMCVs in both sides.     

Surgeon-performed ultrasound-guided thyroid fine-needle aspiration biopsy: Evaluation of 470 biopsies

Background

Ultrasound-guided FNAB of thyroid nodules is considered to be the most reliable and feasible test for the diagnosis of thyroid malignancy. We aimed specifically to assess the accuracy of surgeon-performed ultrasound (SPUG)-guided FNAB on a per-nodule basis, with a subanalysis of nodule size and on-site evaluation.

Materials and Method

During the study period, 470 thyroid FNABs were performed. In the first 155 biopsies, the attending pathologist determined the adequacy of the specimen based on the number of cells. Nodules were categorised as group A: nodule size <1.99 cm and group B: nodule size >2 cm in width. The FNAB results were classified and described according to the Bethesda system.

Results

The overall non-diagnostic rate of ultrasound-guided thyroid FNAB in this study was 10% (47 of 470). The percentage of non-diagnostic cases was 12.06% (38 of 315) in patients without on-site evaluation and 5.8% (9 of 155) in patients with on-site evaluation; this difference did not reach statistical significance (p = 0.051). The nondiagnostic FNAB rates were 10.6% (42 of 395) and 6.6% (5 of 75) with respect to nodule sizes <1.9 cm and >2 cm. Although nodules smaller than 1.9 cm had higher non-diagnostic FNAB rates, these results were not statistically significant (p = 0.401).

Conclusion

In conclusion, this study demonstrates that ultrasound-guided FNAB in the hands of an experienced surgeon can be performed with a low non-diagnostic FNAB rate.     

老年男性勃起功能及迟发性性腺功能减退症状与下尿路症状严重性的关系

本文旨在研究土耳其爱琴海地区的老年男性下尿路症状（LUTSs）、勃起功能障碍（ED）和有症状的迟发性性腺功能减退症（SLOH）三者间的关系。符合以下标准的500名男性患者被纳入该研究：40周岁以上;过去6个月内有稳定的性关系;在六个泌尿外科诊所之一进行过就诊登记。每位患者均行血清PSA、睾酮水平及尿流率的检测,并填写国际前列腺症状评分和生活质量评分（IPSS-QoL）量表、国际勃起功能指数（IIEF）问卷和老年男性症状（AMS）量表。在所有的研究对象中,23．9％的患者有轻度LUTSs,53．3％有中度LUTSS,22．8％有重度LUTSS。每组间总睾酮水平无明显差异。除此之外,69．6％的病人患有ED,且ED的发生率与LUTS严重性呈正相关。71．2％的患者出现SLOH（AMS〉27）,且IPSS评分越高,严重的性腺功能减退症状的发生率也越高。相关性分析显示以上三种问卷分数之间有显著关联。总之,LUTS严重性是ED和SLOH的非年龄依赖性危险因素,LUTS严重性和SLOH症状之间似乎有显著的相关性,但还需要从病因学和生物学角度进行深入阐明。     

Relationship between different body size indicators and hernia development in CAPD patients

AIMS: A small body size may increase the risk for hernia development in patients on continuous ambulatory peritoneal dialysis (CAPD). The present study investigates whether there is a relationship between body size and hernia development in CAPD patients. MATERIAL AND METHODS: The records of 78 patients on CAPD were reviewed retrospectively. Body mass index (BMI), body surface area (BSA) and total body water (TBW) were calculated in all patients. Correlations between different body size indicators (BMI, BSA and TBW) and hernia development were assessed using analysis of covariance in which we adjusted for sex. RESULTS: A total of 14 patients (17.9%) with no physical evidence of hernia before catheter insertion developed hernias. Body size was significantly lower in CAPD patients with hernias than those without hernias when adjusted for sex. CONCLUSIONS: We conclude that patients with small body size tend to have an increased risk for hernia development. A simple estimation of patients' height, weight, body surface area and total body water would be helpful to predict development of hernias or other complications related to increased intraperitoneal pressure in CAPD patients.     

Effect of 2-Octyl-Cyanoacrylate on Ischemic Anastomosis of the Left Colon

Introduction: 2-octyl-cyanoacrylate may be a good alternative in ischemic colon anastomosis without impairment of tissue perfusion. Methods: Forty male Wistar albino rats were randomized into four experimental groups (n = 10 in each group). In group 1 (control), a well-perfused left colonic segment was transected, and free ends were anastomosed by propylene sutures. In groups 2, 3, and 4, the animals underwent a standardized surgical procedure to induce ischemic left colon anastomosis. In group 2, an end-to-end anastomosis was created using six interrupted 6-0 polypropylene sutures between ischemic edges. In group 3, after approximating the mesenteric and antimesenteric edges of the anastomosis with two 6-0 polypropylene sutures, 2-octyl-cyanoacrylate was applied between the edges. In group 4, anastomosis was created by the same technique as described in group 2, and additionally 2-octyl-cyanoacrylate was applied on suture line. Rats were killed on day 4 following operation. Anastomotic integrity, intraperitoneal adhesion scores, anastomotic bursting pressures, and tissue hydroxyproline levels were recorded. Histopathological examination of the anastomosis was also performed. Results: There were no statistically significant differences among groups with respect to anastomotic integrity (p =.142). The mean bursting pressure values were 81.1 ± 23.83, 43.3 ± 26.06, 15.8 ± 11.3, and 17.6 ± 18.02 in groups 1, 2, 3, and 4, respectively. There were no statistically significant differences among groups 2, 3, and 4 with respect to tissue hydroxyproline levels and bursting pressure levels. The highest adhesion scores were observed in groups 3 and 4. Discussion: 2-octyl cyanoacrylate does not have additional advantages in the healing of experimental ischemic colon anastomosis.     

Conversion to Sirolimus in Renal Transplant Recipients: A Single‐Center Experience

Maintenance immunosuppression with calcineurin inhibitors (CNI) following renal transplantation is associated with nephrotoxicity and accelerated graft loss. Sirolimus (SRL) is a nonnephrotoxic immunosuppressive agent. We retrospectively analyzed our experience with kidney transplant recipients who were converted from CNI to SRL. A total of 58 renal transplant recipients were converted from CNI to SRL. SRL was started at a dose of 0.075 mg/kg and, at the same time, CNI dose was reduced by 50% daily for 3 days. SRL trough levels were targeted between 8 and 12 ng/mL. When target trough levels were achieved, CNI was withdrawn. The main indications for switching were posttransplant malignancies (n = 32) and chronic allograft nephropathy (CAN) (n = 10). The mean time from transplantation to conversion was 84 ± 71 months. Mean serum creatinine level was 1.63 ± 0.52 mg/dL before conversion. Serum creatinine levels at the 1, 3, 6 months, and 1, 2, 3 years after conversion were 1.64 ± 0.58 mg/dL (P = 0.67), 1.52 ± 0.53 mg/dL (P = 0.414), 1.62 ± 0.62 mg/dL (P = 0.734), and 1.48 ± 0.58 mg/dL (P = 0.065), 1.58 ± 0.53 mg/dL (P = 0.854), 1.88 ± 0.77 mg/dL (P = 0.083), respectively. Daily proteinuria levels increased from 0.04 ± 0.11 g/day at baseline to 0.55 ± 1.33 g/day (P = 0.037) after conversion, in the responders group. In the nonresponders group, baseline proteinuria was 0.13 ± 0.25 g/day, and increased to 1.44 ± 2.44 g/day after conversion (P = 0.008). SRL was discontinued in 16 patients (31%) because of the occurrence of severe side effects. The proportion of patients remaining on SRL therapy over time was 43.1% at 1 year, 15.5% at 2 years after conversion, and 10.3% at 3 years after conversion. SRL conversion may be very useful in patients suffering from neoplasia; however, frequent side effects related with this intervention should be considered, and routine conversion from CNI to SRL to reduce nephrotoxicity should be discouraged.     

Corona mortis: incidence and location

The right hemipelvis of 98 patients was examined by angiography to determine the occurrence and location of the corona mortis artery. This arterial anastomosis was found in 28.5% (28 of 98). Its incidence was 30.5% (18 of 59) in men and 25.6% (10 of 39) in women; this difference was not significant ( p>0.05). The distance from the symphysis pubis to the anastomotic artery averaged 33.4 mm (range 21.4-41 mm). It was 31.8 mm (range 21.4-39.3 mm) in men and 36.2 mm (range 25-41 mm) in women; this difference was significant ( p<0.05).