The Relationship between Cardiac Troponins and Left Ventricular Mass Index in Patients with Chronic Renal Failure

The abstract of this study was accepted as an oral presentation in the 10^th Annual Meeting of the ESC Working Group on Echocardiography, December 6–9, 2006, Prague, Czech Republic     

A technique for fabrication of an extracoronal attachment-retained removable partial denture to fit an existing fixed partial denture

Precision attachments have been used for many years to retain removable partial dentures (RPDs). Common reasons for a failed attachment-retained RPD are fracture of the framework, fracture of the roots or teeth, and irretrievable decrease of retention. When an RPD framework major connector has been fractured, it should be remade. This article describes a technique to remake a fractured mandibular RPD using cast round profile attachment analogs without the need for replacement of the fixed partial denture.     

Prolene mesh migration into the rectum after sacral colpopexy presented with frozen pelvis

INTRODUCTIONPelvic organ prolapse (POP) is a common gynecological problem. Repair with synthetic materials such as prolene mesh has become a popular approach in prolapsus surgery. Migration of synthetic materials can cause serious complications.PRESENTATION OF CASEA 69-year-old woman was admitted to the hospital with a complaint of sensation of fullness and a feeling of a foreign material protruding during defecation. The patient underwent exploratory laparotomy. Prolene mesh was detected in sacral region but resection of the mesh could not be conducted because of dense adhesions causing frozen pelvis. The migrated prolene mesh was resected transanally.DISCUSSIONGenital prolapse or genital hernia is described as the protrusion of pelvic organs along the vagina. It is one of the common gynecological conditions that affect the quality of life in women. Mesh migration is a well-known clinical pathology.CONCLUSIONMesh migration is a serious complication after sacral colpopexy. Surgical resection of migrated mesh can be difficult due to dense adhesions.     

Serum-Starved Adipose-Derived Stromal Cells Ameliorate Crescentic GN by Promoting Immunoregulatory Macrophages

Mesenchymal stromal cells (MSCs) derived from adipose tissue have immunomodulatory effects, suggesting that they may have therapeutic potential for crescentic GN. Here, we systemically administered adipose-derived stromal cells (ASCs) in a rat model of anti-glomerular basement membrane (anti-GBM) disease and found that this treatment protected against renal injury and decreased proteinuria, crescent formation, and infiltration by glomerular leukocytes, including neutrophils, CD8⁺ T cells, and CD68⁺ macrophages. Interestingly, ASCs cultured under low-serum conditions (LASCs), but not bone marrow-derived MSCs (BM-MSCs), increased the number of immunoregulatory CD163⁺ macrophages in diseased glomeruli. Macrophages cocultured with ASCs, but not with BM-MSCs, adopted an immunoregulatory phenotype. Notably, LASCs polarized macrophages into CD163⁺ immunoregulatory cells associated with IL-10 production more efficiently than ASCs cultured under high-serum conditions. Pharmaceutical ablation of PGE₂ production, blocking the EP₄ receptor, or neutralizing IL-6 in the coculture medium all significantly reversed this LASC-induced conversion of macrophages. Furthermore, pretreating LASCs with aspirin or cyclooxygenase-2 inhibitors impaired the ability of LASCs to ameliorate nephritogenic IgG-mediated renal injury. Taken together, these results suggest that LASCs exert renoprotective effects in anti-GBM GN by promoting the phenotypic conversion of macrophages to immunoregulatory cells, suggesting that LASC transfer may represent a therapeutic strategy for crescentic GN.Mesenchymal stromal cells (MSCs; formally known as mesenchymal stem cells) derived from cord blood, bone marrow, connective, and adipose tissues have the capacity to differentiate into multiple mesenchymal lineages, including osteoblasts, chondrocytes, and adipocytes.^1,2 Apart from the classic regenerative property of MSCs, mounting evidence from studies focusing on bone marrow–derived MSCs (BM-MSCs) suggests that MSCs can modulate inflammatory immune responses.^3–8 This effect is currently believed to be mediated through MSC-derived growth factors, cytokines, and PGs, which negatively regulate inflammatory immune responses and the proliferation of leukocytes and resident cells that are systemically or locally activated.^9–14As a potential clinical therapeutic agent, ASCs may have a number of practical advantages over BM-MSCs relating to their abundance and availability.^15,16 Several studies have demonstrated ASC-mediated immunomodulation of particular leukocyte subsets, including lymphocytes and dendritic cells.^14,17,18 This immunomodulatory property of ASCs has already been exploited for therapeutic intervention in inflammatory diseases. A number of clinical trials are underway in which ASCs have been administered to patients with autoimmune disorders, including graft versus host disease, Crohn’s disease, multiple sclerosis, and SLE.^19–21 However, the precise mechanism of ASC-mediated immunomodulation is unclear, and a direct comparison of the efficacy of ASCs versus that of BM-MSCs has not been undertaken.For cell transfer therapy, a reduction in the concentration of serum in MSC cultures is beneficial for recipients because this reduces concerns about infection with microorganisms or pathogenic proteins originating from culture media. However, the concentration of serum in culture media influences MSC expansion ex vivo, and thus affects cell proliferation. Moreover, the serum concentration modulates regeneration and immunomodulation.^14,15 For instance, the proliferation rate of rat BM-MSCs in low-serum media is significantly lower than in high-serum media.^14,15 In contrast, human ASCs grown under low-serum conditions (LASCs) display comparable growth to human BM-MSCs cultured in high-serum media.^14,15 Of further interest, human LASCs more effectively suppress phytohemagglutinin-stimulated T cell proliferation in vitro than ASCs grown under high-serum conditions (HASCs), despite a similar ability of the two cell types to differentiate into the mesenchymal cell lineage.¹⁴ Therefore, LASC-mediated immunomodulation may have great potential as a cell-based therapy.Anti-GBM GN is characterized by poor prognostic GN with crescent formation (crescentic GN [CGN]), which rapidly results in renal failure after onset of the disease.²² This is characteristic of Goodpasture’s disease in humans, in which patients may also occasionally present with pulmonary hemorrhage, with dire consequences. Although effector responses by neutrophils, macrophages/monocytes, T lymphocytes, and immune regulation by regulatory T cells and alternatively activated macrophages have been extensively investigated as part of efforts to understand the distinct mechanisms that cause glomerular crescent formation,^23–29 a potent and feasible therapeutic strategy to inhibit leukocyte effector functions and/or augment their regulatory functions has not emerged for CGN patients. Thus, in this study, we investigated the potential of ASCs to exert immunomodulatory functions in anti-GBM GN.     

Assessment of urinary incontinence in the women in Eastern Turkey

Introduction and hypothesis

The aims of the present study were to determine the types of UI among women visiting the urology department, to identify the potential risk factors associated with each type of UI, and to identify healthcare-seeking behaviors of affected women in our region.

Methods

The data of 617 community-dwelling women, who were at least 18 years of age or older and who presented with a complaint of UI ongoing over a year, and those without UI, who were admitted for any other reason, from June 2010 to April 2012, were evaluated.

Results

Mean age was 51.29 years (range 18–110 years); median parity was 3.54 (range 0–11) and 88.2 % of the women were married. Mean BMI was 28.01 kg/m². Very few women (18.5 %) accepted UI as a disease and searched for medical help by themselves; however, the remaining women (81.5 %) were brought or directed for evaluation by someone else. Stress UI was reported by 43 women (10.5 %), urge UI and mixed UI were noted by 153 (37.5 %) and 212 (52 %) women respectively.

Conclusions

The most frequent type of UI was mixed UI in our region. Age, BMI, multiparity, and hypertension were identified to have a different importance for each type of UI, but diabetes mellitus, birth trauma, gynecological surgery, lumbar disc hernia (LDH), and multiple sclerosis (MS) were the other important related factors. However, a small number of patients accepted UI as a disease and searched for therapy. This reveals that the public should be informed in detail about female UI in developing countries.     

Prevalence of sacrococcygeal pilonidal sinus as a silent disease

Purpose

The aim of this research was to determine the prevalence of sacrococcygeal pilonidal sinus disease (SPSD) based on clinical examination and histopathological evaluation.

Methods

Between January 1, 2010 and December 30, 2010, 432 corpses were evaluated in the Istanbul Central Office of Forensic Medicine Institute of the Turkish Ministry of Health.

Results

41 of the 432 cases (9.4 %) had SPSD-related findings. 20 (4.6 %) had at least one sinus tract (clinical SPSD) and all of them had at least three positive histopathologic parameters. 16 of 41 cases (3.7 %) were clinically normal but had at least three positive histopathologic parameters (silent SPSD).

Conclusion

Prevalence of SPSD with clinical examination is 4.6 %. These data are according to the literature. But with inclusion of the silent cases, the prevalence rate increases to 8.3 %. We conclude that inflammatory process does not result in SPSD in nearly half of the cases.