The effect of intraoperative colonic lavage withN G -nitro-l-arginine methyl ester (l-NAME) on anastomotic healing in the presence of left-sided colonic obstruction in the rat

-arginine methyl ester (L-NAME) on the healing of colonic anastomosis in the presence of a left-sided obstruction in the rat was investigated. Left-sided colonic obstruction was created in 144 Wistar rats. The obstruction site was excised 24 h later and anastomosis was performed after either no irrigation or colonic lavage with either saline, povidone iodine (PI), short-chain fatty acids (SCFA), L-NAME, or glutamine, in 24 animals each. Animals were killed on days 3 and 6, and a 4-cm colonic segment with the anastomosis at the center was excised. Bursting pressure (BP) and hydroxyproline (HP) content were measured. In the saline, PI, and SCFA groups, BP was higher (P < 0.05, P < 0.05, and P < 0.001, respectively) and HP concentration was similar compared with controls. Both the BP and HP concentrations were higher in the glutamine group compared with controls (P < 0.001). BP was lower (P < 0.05) and HP concentration was similar in the L-NAME group compared with the control group. Colonocyte nutrition and tissue perfusion are the mainstays of anastomotic healing. Intraoperative colonic lavage with L-NAME suppresses colonic anastomotic healing in the presence of a left-sided obstruction. (Received for publication on Mar. 29, 1999; accepted on Nov. 11, 1999)     

A comparative study of genotoxic effects in the treatment of trichomonas vaginalis infection: metronidazole or nalidixic acid

We performed a prospective randomized study to compare the potential genotoxic effects of metronidazole and nalidixic acid which they are used in the treatment of Trichomonas vaginalis infection. 20 patients with Trichomonas vaginalis infections participated in this study. 14 patients with vaginal trichomoniasis were treated with therapeutic doses of metronidazole 250 mg 3 times/d and six patients were treated with nalidixic acid 400 mg twice a day for 10 d. The genotoxic potential of a variety of mutagenic and carcinogenic agents can be evaluated by sister-chromatid exchange (SCE) test as a rapid cytogenetic test. An increased number of exchanges in lymphocytes reflects the influence of mutagens. No significant difference was observed in the SCE frequency of metronidazole treated patient however, a statistically significant increase (P<0.05) after nalidixic acid treatment could be described. We conclude that in spite of wide use of nalidixic acid for Trichomonas vaginalis infection, because of its potential genotoxic effect its usage must be individualized especially for pregnant women and small babies.     

The relationship between pain at IUD insertion and negative perceptions,anxiety and previous mode of delivery

Objective: The aim of the study was to better understand the relationship between pain during intrauterine device (IUD) insertion and anxiety, negative perceptions of IUDs and previous mode of delivery, in parous women.

Methods: We conducted a prospective cohort study between June and September 2018 in 210 women who opted for IUD placement for contraception. Sixty-six women who had previously had only vaginal delivery under epidural analgesia were allocated to the epidural delivery group; 60 women who had previously had at least one vaginal delivery without epidural analgesia were allocated to the vaginal delivery group; and 84 women who had previously had only caesarean delivery were allocated to the caesarean delivery group. Participants’ levels of anxiety before insertion were measured using the Beck Anxiety Inventory; participants’ levels of pain (anticipated pain and pain at the various stages of IUD insertion and 15?min after the procedure) were assessed using a visual analogue scale.

Results: While the experience of caesarean delivery and pre-procedure anxiety were found to be associated with higher pain scores, the presence of negative perceptions of IUDs was the most significant predictor of pain during IUD insertion (p?<?.001). Experience of vaginal delivery under epidural analgesia was associated with lower pain scores at IUD insertion (p?<?.001).

Conclusion: Fear of IUD insertion pain, pre-procedure anxiety and negative perceptions of IUDs may lead women to anticipate or feel a higher level of pain. Patient education to correct negative perceptions of IUDs and counselling to inform women of the true benefits and risks of IUDs and lower pre-procedure anxiety are a suggested strategy to manage IUD insertion pain in parous women.     

Pericardial involvement in familial Mediterranean fever

Two patients with familial Mediterranean fever showed the classic features of pericardial involvement and one of them (Case 2) had pericardial effusion detected by echocardiography. These and previously published cases show that familial Mediterranean fever should be considered as a cause of pericarditis and/or pericardial effusion.     

Mesenchymal hamartoma of the liver in adulthood: immunohistochemical profiles, clinical and histopathological features in two patients

Mesenchymal hamartoma is an uncommon cystic mass of the liver which occurs primarily in children. There are a few reports of its occurrence in adulthood. Here, we present two cases in female patients, 54 and 51 years old. Radiological examinations in both patients showed multiple cystic lesions in the liver. Surgically, total cystectomy was performed in the first patient, while an unroofing procedure was done in the second patient (due to misdiagnosis of the lesion as a simple cyst of the liver). On microscopic examinations of the lesion in each patient, a multilocular cyst was observed, lined by flattened epithelium and surrounded by a mesenchymal component composed of mature connective tissue, arterial and venous vascular structures, peripheral nerve bundles, and ductal structures. An immunohistochemical panel consisting of desmin, smooth-muscle actin, S-100, vimentin, CD34, carcinoembryonic antigen, pancytokeratin, cytokeratin 7, cytokeratin 8, cytokeratin 17, cytokeratin 18, cytokeratin 19, and cytokeratin 20 was applied to paraffin sections. Immunoreactivity for cytokeratin 7 and cytokeratin 19 was observed in cystic epithelium and ductal structures. Focal and patchy desmin immunoreactivity was observed in connective tissue. S-100 was positive only in peripheral nerve bundles. In conclusion, mesenchymal hamartoma of the liver in adulthood is a localized tumoral abnormality that precedes birth, and which has delayed clinical presentation. These lesions seems to be related to a maturation process. During this period of maturation, immature edematous stroma rich in mucopolysaccharides may convert to mature paucicellular hyalinized connective tissue. This maturation process may be also related to loss of premalignant potential of these tumors.     

Induction chemotherapy with cisplatin and 5-fluorouracil followed by chemoradiotherapy or radiotherapy alone in the treatment of locoregionally advanced resectable cancers of the larynx and hypopharynx: results of single-center study of 45 patients

BACKGROUND: Induction chemotherapy with cisplatin and fluorouracil and radiotherapy is an effective alternative to surgery in patients with carcinoma of the larynx and hypopharynx who are treated for organ preservation. METHODS: We designed a protocol to evaluate the possibility of organ preservation in patients with advanced, resectable carcinoma of the larynx and hypopharynx. Forty-five eligible patients who were followed up between April 1999 and May 2001 were enrolled. Initially, these patients were treated with two cycles of induction chemotherapy consisting of cisplatin, 20 mg/m2/day on days 1 to 5, and 5-fluorouracil, 600 mg/m2/day by continuous infusion on days 1 to 5. Patients who had a complete response to chemotherapy were treated with definitive radiotherapy; patients who had a partial response to chemotherapy were treated with chemoradiotherapy. Cisplatin, 35 mg/m2/week, was introduced throughout the duration of radiotherapy. Patients who had no response or progressive disease underwent surgery with postoperative radiotherapy. Patients with N2 or N3 positive lymph nodes underwent neck dissection after the treatment. RESULTS: The mean age was 56.6 years (range, 34-75 years). The overall response rate to induction chemotherapy was 71.1%, with a 17.8% complete response rate and 53.3% partial response rate. With a median follow-up of 13.7 months, 23 (51.1%) of all patients and 63.3% of surviving patients have had a preservation of the larynx or hypopharynx and remain disease free. The most common toxicities were nausea and vomiting and mucositis. CONCLUSION: Organ preservation, with multimodality treatment, may be achievable in some of the patients with resectable, advanced larynx or hypopharynx cancers without apparent compromise of survival.     

Immunohistochemical evaluation of p53 expression and proliferative activity in children with Helicobacter pylori associated gastritis

OBJECTIVES: The aim of this study was to evaluate the significance of p53 expression and proliferative activity of glandular epithelium and intestinal metaplasia in Helicobacter pylori associated gastritis of pediatric patients. METHODS: The study included endoscopic gastric biopsies of 54 children with dyspeptic complaints. Immunohistochemistry was performed for evaluation of p53 expression and Ki-67 labeling index, an indicator of proliferative activity. Grading of H. pylori density, intestinal metaplasia and inflammatory cell infiltration were performed in histologic tissue sections stained with hematoxylin-eosin, Giemsa and Alcian-blue. RESULTS: Of 54 children, 35 (64%) were infected by H. pylori. Positive immunostaining for p53 was observed in 11 of 54 cases (20.4%). H. pylori infection was found in 10 (91%) of the p53-positive patients. There was a positive correlation between H. pylori density and Ki-67 labeling index in H. pylori infected children. H. pylori density, Ki-67 labeling index and inflammatory cell infiltration in the p53-positive group were significantly higher than in the p53-negative group. Although intestinal metaplasia was more common in H. pylori infected children (n = 11; 31.4%), there was no difference in the rate of intestinal metaplasia between the p53-positive and p53-negative groups. CONCLUSIONS: The present study shows that p53 mutations and higher proliferative activity of glandular epithelium may be related to H. pylori associated gastritis in children. Because p53 mutation does not appear to be associated with intestinal metaplasia, a precursor for gastric cancer in adults, we think that H.pylori associated p53 alterations do not initiate and promote gastric cancer that may occur in adulthood.     

Antioxidant properties of propofol and erythropoietin after closed head injury in rats

Reactive oxygen species play a role during brain injury due to closed head trauma. Enzymatic or nonenzymatic antioxidants may protect brain tissue against oxidative damage. The present study was performed to assess the changes of endogenous indices of oxidative stress in serum from rats subjected to head trauma and whether treatment with propofol and/or erythropoietin (EPO) modifies the levels of endogenous indices of oxidative stress. For these purposes, female Wistar Albino rats were divided into five groups: non-traumatic sham group, trauma performed control, trauma with propofol (i.p.), trauma with EPO (i.p.) and trauma with propofol and EPO performed study groups. At the end of the experimental procedure, blood was taken by cardiac puncture to determine superoxide dismutase (SOD) and xanthine oxidase (XO) activities as well as malondialdehyde (MDA) and nitric oxide (NO) levels in serum. Serum MDA level of control traumatic brain injury (TBI) group was significantly higher than sham operation group (p<0.012). Serum MDA levels in propofol, EPO and propofol+EPO groups were found to be decreased in comparison with control group (p<0.039, p<0.030 and p<0.018, respectively). Serum NO level was found to be increased in TBI group, but difference was not statistically significant when compared to sham-operated group (p=0.092). Propofol, EPO and propofol+EPO administration efficiently reduced serum NO levels to reach sham-operated group (p<0.002, p<0.001 and p<0.015, respectively). These results suggested that acute administration of both propofol and EPO altered the indices of oxidative stress similarly against brain injury due to trauma.     

Contact sensitivity to preservatives in Turkey

This study was designed to evaluate the frequency of contact sensitivity to 14 common preservatives among patients with contact dermatitis in Turkey. From 2000 to 2004, 308 patients with the diagnosis of contact dermatitis were patch tested in the Department of Dermatology, Ankara University School of Medicine. All patients were patch tested with European standard series. In addition to the four preservatives included in the standard series, patients were also tested with DMDM hydantoin, imidazolidinyl urea, bromonitropropane diol, diazolidinyl urea, thimerosal, propylene glycol, chlorocresol, chloroxylenol, methyldibromoglutaronitrile/phenoxyethanol (MDBGN/PE) and benzalkonium chloride. Out of the 308 patients suspected of having contact dermatitis, 23 patients were found to have positive reactions to one or more preservatives. Preservatives that were the most frequent cause of positive reactions were thimerosal (1.6%), benzalkonium chloride (1.6%), formaldehyde (1.3%) and MDBGN/PE (0.9%). In our study, 65% of the positive reactions were caused by allergens not present in the standard series, such as thimerosal, benzalkonium chloride and MDBGN/PE. Although thimerosal caused a high rate of contact sensitivity, it may not be considered as an important allergen, because clinical relevance could not be found in any of the patients.