Frequency of functional gastrointestinal disorders in children with familial Mediterranean fever

Clinical Rheumatology - Familial Mediterranean fever (FMF) is characterized by self-limiting fever episodes usually accompanied by serositis, arthralgia, and arthritis. Functional gastrointestinal...     

Reconstruction of the Fibrous Trigone

A 48-year-old man with a history of infective endocarditis and severe aortic regurgitation had undergone prosthetic aortic valve replacement at another institution. Two months later, the patient developed prosthetic valve endocarditis with an aortic root abscess and an aorto–left atrial periprosthetic valvular fistula through the detached posterior annulus of the mitral valve. We repaired the fistula by constructing a fibrous trigone made of bovine pericardium. We also replaced the prosthetic aortic valve with another prosthetic valve, while protecting the native mitral valve.Key words: Aortic valve replacement, endocarditis/complications/surgery, fistula/etiology/surgery, heart valve prosthesis/adverse effects, mitral valve repair, prosthesis-related infections, reoperationThe incidence of prosthetic valve endocarditis (PVE) within 12 months after heart valve replacement is between 1% and 3.1%.^1,2 In the largest PVE case series to date, 20.1% of the cases of infective endocarditis were due to PVE³—a severe and life-threatening infection, particularly when accompanied by a paraprosthetic abscess and progression of fistulous communication.Aorto–left atrial fistula, a rare complication of PVE, is surgically challenging. We report the successful surgical repair of an aorto–left atrial periprosthetic valvular fistula in concordance with re-replacement of the aortic valve, while protecting the native mitral valve.     

Evaluation of Coagulation Profile in Children with Type 1 Diabetes Mellitus Using Rotational Thromboelastometry

The prothrombotic state in type 1 diabetes mellitus (T1DM) has been reported as a plausible cause of vascular complications. Rotational thromboelastometry (ROTEM) assay enables the global assessment of coagulation status. This study aimed to assess hypercoagulability in children with T1DM using ROTEM. A total of 43 T1DM children (20 females and 23 males) aged 2–18 years and age- and sex-matched 30 healthy control subjects were enrolled in the study group. ROTEM assays [intrinsic TEM (INTEM) and extrinsic TEM (EXTEM)] were used to measure and analyze coagulation time (CT), clot formation time, maximum clot firmness (MCF). Glycated hemoglobin levels (HbA1c), diabetic complications, platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and dimerized plasmin fragment D (D-dimer) were determined in the study group. The mean duration of T1DM diagnosis was 3.15 ± 2.49 years, and the mean HbA1c level was 8.94 ± 1.88% (74.29 ± 20.59 mmol/mol). None of the patients had macrovascular complications. Nephropathy was present in five patients. In the T1DM group, EXTEM-CT [80.00 (66.75?108.50)] was significantly lower, and EXTEM-MCF [65.00 (64.00?70.00)] and INTEM-MCF [65.00 (62.00?68.00)] were significantly higher than in the controls (p < 0.001, p = 0.026, and p = 0.004, respectively). However, the duration of T1DM and the degree of metabolic control had no influence on these parameters. Platelet count, PT, aPTT, fibrinogen and D-dimer levels were comparable between the diabetic patients and the control group. There were statistically significant correlations between fibrinogen level and INTEM-MCF and EXTEM-MCF (p < 0.001, p = 0.002 and r = 0.545, r = 0.454, respectively) This study shows that decreased levels of CT and increased levels of MCF suggest hypercoagulability in patients with T1DM. Further studies are needed to confirm our findings on a larger number of diabetic patients.     

The effect of three human recombinant hematopoietic growth factors (granulocyte-macrophage colony-stimulating factor, granulocyte colony- stimulating factor, and interleukin-3) on phagocyte oxidative activity

Hematopoietic growth factors not only modulate blood progenitor cell activity but also alter the function of mature phagocytes. Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF; 1 ng/mL for 60 min) did not stimulate luminol-enhanced chemiluminescence of polymorphonuclear leukocytes (PMNs) in suspension but primed PMN for as much as a 15-fold increase in chemiluminescence in response to f-met- leu-phe (fMLP). Mixed mononuclear leukocytes (monocytes [approximately 20%] and lymphocytes [approximately 80%]; MNL) chemiluminescence was very low even after rhGM-CSF priming, but MNLs added to the PMNs (PMN- MNL) resulted in near doubling of rhGM-CSF-primed PMN fMLP-stimulated chemiluminescence. The enhancing factor(s) from MNLs were inherent rather than induced by the GM-CSF, and purified lymphocytes increased GM-CSF-primed PMN chemiluminescence equal to mixed MNLs. We could not detect cell-free "enhancing factor(s)," but cell-to-cell contact further enhanced rhGM-CSF-primed fMLP-stimulated PMN-MNL oxidative activity by 40%. Polyclonal rabbit anti-tumor necrosis factor (TNF) (but not preimmune serum) decreased both fMLP-stimulated rhGM-CSF- primed PMNs and PMN-MNL chemiluminescence, suggesting that TNF on the PMN surface is enhancing GM-CSF-primed chemiluminescence. GM-CSF priming markedly increased PMN superoxide release (sevenfold), but PMN superoxide release was not further enhanced by the presence of MNLs. Recombinant human granulocyte colony-stimulating factor (rhG-CSF) and interleukin-3 (rhIL-3) displayed much smaller effects on pure PMNs and mixed PMN-MNL chemiluminescence and superoxide release than rhGM-CSF. rhGM-CSF primes PMNs for increased oxidative activity more than rhG-CSF and rhIL-3. Maximal oxidative activity was observed when mixed PMN-MNL were primed with GM-CSF in a cell pellet-promoting cell-to-cell contact. This enhanced activity can be attributed, in part, to both inherent enhancing factor(s) on lymphocytes and PMN-associated TNF induced by GM-CSF.     

Effects of rheumatoid factor isotypes on disease activity and severity in patients with rheumatoid arthritis: a comparative study

The value of rheumatoid factor (RF) isotypes for assessing rheumatoid arthritis (RA) remains debatable. In this study, we have examined the relationships between RF isotypes and disease activity and severity in RA patients. Sixty-two patients with RA, 48 women and 14 men, were studied. RF was measured by nephelometry (RF–N) and IgG–, IgA–, and IgM–RF isotypes were measured using enzyme-linked immunosorbent assay. Serum C-reactive protein and erythrocyte sedimentation rate were also determined. The patients were classified according to disease activity, joint damage, functional status, and presence of pulmonary involvement, rheumatoid nodule, and secondary Sjögren’s syndrome. Although the patients with active disease had significantly higher IgA–RF and IgM–RF levels compared to inactive patients, IgA–RF and IgM–RF were not found to be independently associated with disease activity in multivariate analysis. In patients with severe joint damage, IgA–RF and RF–N were significantly higher than those of the other patients. Multiple regression analysis showed that IgA–RF was the unique variable independently associated to severe joint damage. The patients with class III and IV functional index had significantly higher IgM–RF, IgA–RF, and RF–N levels compared to the patients with class I and II functional index; however, RFs were not significantly associated with functional status in multivariate analysis. IgA–RF and IgM–RF were significantly associated with pulmonary involvement and rheumatoid nodule, respectively. No significant associations were found between RF isotypes and secondary Sjögren’s syndrome. Our results suggest that the clinical usefulness of IgA and IgM isotypes is better than RF–N. Elevated IgA–RF may be a marker of erosive disease. The usefulness of RF isotypes for monitoring disease activity or functional status appears to be limited.     

Efficacy of topical nitroglycerin and transcutaneous electrical nerve stimulation on survival of random-pattern skin flaps in rats.

We compared the efficacy of topical nitroglycerin and transcutaneous electrical nerve stimulation (TENS) on the survival of random-pattern skin flaps in rats. Thirty Wistar albino rats were used and a dorsal, cranially-based random-pattern flap was raised. The rats were divided into three groups of 10 rats each. The first group had only the flap raised while the second and third groups were given topical nitroglycerin 5 mg or TENS for one hour a day for seven days. The amount of flap necrosis was measured on the seventh postoperative day. The mean area of necrosis in the flaps were 726.2, 544.2, and 150.0 mm2 in the control, nitroglycerin, and TENS groups, respectively. The mean percentage of flaps that necrosed were 51.9, 38.9, and 10.7 in the corresponding groups. The TENS group had significantly higher percentage area of flap surviving than the control (p < 0.0001) and nitroglycerin groups (p = 0.002). TENS, with its efficacy on survival and with negligible side-effects, could be a reliable treatment. Clinically, it can easily be used postoperatively when flaps become ischaemic, and will be tolerated well by patients.     

End-to-side anastomoses in small arteries with partial lateral clipping. An experimental study.

The problem of total therapeutic occlusion of the cranial arteries remains a relatively important area of concern for neurosurgery, neurology, neuroradiology and neuroanesthesia as well as for the patients. Cerebral revascularization procedures require total occlusion of the cranial arteries for a while. End-to-side anastomoses with partial lateral clipping were done in 20 cadaver arteries and then, in one rat common carotid artery. The results of the study were compared with the current cerebrovascular bypass procedures on a theoretical basis and possible clinical implications of the method were suggested. All the anastomoses were found to be open. As conclusions; 1) End-to-side anastomosis with partial lateral clipping and along with this technique the maintenance of blood flow in the target vessel during the anastomosis procedure are experimentally possible. 2) Although the available aneurysm clips may be used in the bigger vessels (> 2.5 mm), currently, the exclusive clips for the technique are not available commercially. 3) Further clinical implications of the technique may be investigated.     

Continuous neural monitoring in lumbar spine surgery: experience with 101 patients.

The first report about lumbar spinal surgery under epidural anesthesia has been published in 1958. The aim of this study was assess to epidural anesthesia as a regional operative anesthesia in lower lumbar spine surgery and to use the opportunity of verbal interaction with the patient who is able to move her/his lower extremities voluntarily during surgery. We called this simultaneous clinical assessment process as continuous neural monitoring. Established pathologies in the patients were as follows; lumbar herniated intervertebral disc disease (n = 95), lumbar spondylolisthesis (n = 4), lumbar lamina fracture (n = 1) and lumbar dumbbell Ewing's sarcoma (n = 1). Preoperative findings, operative findings, operative complications, postoperative complications and short-term results were assessed by the surgeon-anesthesiologist team. The patients, 99 out of 101, were followed-up for more than 15 months (mean 21.2 months). Fair and failure results were assessed in 7.0 % of the patients. Even though epidural anesthesia is almost equal to general anesthesia in terms of anesthetic complications, surgical complications and surgical results in uncomplicated lumbar spinal surgery cases, it has the advantage of being able to simultaneously evaluate motor results of surgical maneuvers and/or manipulations on the neural structures. This advantage, which is not available at the same accuracy with other neurophysiologic monitoring modalities, would be valuable in complex lumbar spine surgery cases.     

烯丙胺类抗真菌药物比较分子力场分析(CoMFA)的研究

本实验采用“活性类似物法”确定了烯丙胺类抗真菌化合物的药效构象,采用比较分子力场分析法(CoMFA)拟合了48个烯丙胺类抗真菌化合物对6种常见致病真菌的3D-QSAR方程,并比较了2种不同叠合规则对模型的影响,最后,用5个新合成化合物对所拟合的抗石膏样毛癣菌、抗烟曲霉菌的CoMFA模型的预测能力进行了检验,得到比较满意的结果。