Using two ipsilateral double j ureteral stents for extrinsic ureteral obstruction due to colon carcinoma

Although double J (DJ) ureteral stents are widely used in extrinsic ureteral obstruction, there are few studies using ipsilateral two DJ stents in the same ureter. We report using ipsilateral two ureteral DJ stents in the same ureter in a patient with extrinsic ureteral obstruction due to colon carcinoma.     

Relationship between sleep complaints and proinflammatory cytokines in haemodialysis patients

BACKGROUND: Sleep complaints are common in end-stage renal disease. We aimed to investigate the relationship between sleep-related complaints and inflammatory cytokines in haemodialysis (HD) patients, and also the effects of HD on sleep patterns and cytokine levels. METHODS: Predialysis serum interleukin-1beta (IL-1beta), interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha) levels in nine patients with sleep complaints were compared with those of nine patients without sleep complaints and nine healthy controls. Patients with sleep complaints underwent polysomnography the night after HD and the following night. RESULTS: Patients with sleep complaints had significantly higher predialysis IL-1beta levels compared with those without and healthy controls (P=0.004 and P=0.000, respectively). They also had higher predialysis IL-6 and TNF-alpha levels than those without sleep complaints; however, the difference was not significant. Patients without sleep complaints had higher mean IL-6 and TNF-alpha and similar mean IL-1beta levels compared with healthy controls (P=0.001, P=0.024, P=0.26, respectively). Obstructive sleep apnoea syndrome (OSAS) was found in six out of nine (66%) patients with sleep complaints. Sleep architecture and cytokine levels did not differ between the two nights. The mean serum IL-1beta, IL-6 and TNF-alpha levels did not differ in the pre- and post-polysomnographic samples. There was no correlation between IL-1beta, IL-6 or TNF-alpha levels and the apnoea-hypopnoea index. CONCLUSIONS: Proinflammatory cytokines, IL-1beta in particular, might be associated with sleep complaints in HD patients. OSAS is not uncommon in HD patients with sleep-related complaints and sleep architecture does not appear to be effected by the HD procedure itself.     

Use of fascia component of the anterolateral thigh flap for different reconstructive purposes

The anterolateral thigh flap is commonly used for reconstruction of soft-tissue defects located at various sites of the body. This versatile flap offers many advantages to the reconstructive microsurgeons for the treatment of difficult defects. From 2000 to 2005, 70 anterolateral thigh flaps were transferred to reconstruct soft-tissue defects. We retrospectively reviewed these patients and found that the fascia lata component of the flap was used for different purposes in 19 patients. The fascia lata component of the flap was used for suspension of the flap in lip reconstruction in 12 patients, for reconstruction of dural defect in the scalp in 2 patients, for reconstruction of tendon defects in the forearm in 3 patients, and for reconstruction of fascia defect in the abdominal wall in the remaining 2. Complete loss of the flap was seen in an anterolateral thigh flap (5.2%) that was used for lower lip reconstruction. One flap necrosed partially (5.2%), and it was treated with surgical debridement and transposition of latissimus dorsi musculocutaneous flap. The objective of this study is to focus on the reliability of the fascial component of the anterolateral thigh flap. Although many authors have described other advantages of the anterolateral thigh flap extensively, this peculiarity has not been stressed adequately. Anterolateral thigh flap offers a thick and vascular fascial component with large amounts that can be used for different reconstructive purposes, and it should be taken into consideration as an important advantage of the flap, together with other well-known advantages.     

Plasmodium falciparum transmission blocking immunity in three areas with perennial or seasonal endemicity and different levels of transmission

Plasmodium falciparum transmission blocking immunity (TBI) was investigated in 3 different endemic areas. Reared Anopheles gambiae s.s. were experimentally infected with the blood of gametocyte carriers, either in the presence of autologous plasma (OWN) or after replacement of the OWN plasma with a nonimmune serum of AB blood group (control). Transmission reduction was defined by a lower level of mosquito infection in the OWN batch compared with the control. After controlling for the effect of gametocytemia, the proportion of "transmission reducers" was lower in the town of Yaounde in Cameroon (UC), (14%, N = 75) than in the two rural areas of South Cameroon (RC) (29%, N = 31) and Sénégal (RS) (44%, N = 32). The contribution of TBI relative to the total inhibition of the parasite development (including human, parasite, and mosquito factors) was higher in RS (49.6%) than in RC (12.6%) and UC (9.5%).     

A procedure for the digital removal of faeces

This article describes the development of an evidence-based procedure for the digital removal of faeces (DRF) and the problems and barriers encountered--not least the absence of primary evidence. The procedure for DRF that evolved is based on the best evidence available. It sets out the criteria for performing DRF and directs the practitioner's actions, while still being adaptable to the individual patient's situation. It should help to ensure that nurses performing DRF do so within the remit of their professional and legal responsibilities, and that patients receive the most effective care grounded in the current state of knowledge.     

Menstrually related symptom changes in women with treatment-responsive bipolar disorder

OBJECTIVE: In the present study, we aimed to evaluate menstrually related symptom changes in euthymic women with treatment-responsive bipolar disorder (BD) compared with healthy control subjects and investigate the presence of premenstrual dysphoric disorder (PMDD). METHODS: Thirty-four euthymic women with treatment-responsive BD on mood-stabilizers (lithium and/or valproate) for at least 6 months and 35 control subjects with no history of medical/mental disorder between ages of 18 and 35 years with regular menstrual cycles were prospectively followed up for at least two consecutive menstrual cycles using the Daily Record of Severity of Problems-Short Form (DRSP). Each subject was administered the retrospective self-report questionnaire, Premenstrual Assessment Form (PAF), in the first postmenstrual phase of the menstrual cycle. Venous blood samples were collected between 19 and 22 days of menstrual cycle to evaluate ovulation by measuring the serum progesterone levels. RESULTS: The differences in mean age, age of onset of menses, cycle length and bleeding length did not appear to be significantly meaningful between groups. In the retrospective assessment of premenstrual symptom changes, controls complained more than women with BD. More controls showed a 30% change in DRSP and in depressive and physical sub-groups than the women with BD. Controls demonstrated a significant increase compared with treatment-responsive BD patients in total, depressive, anxiety and attention sub-group scores of DRSP from the postmenstrual to the premenstrual phase, whereas the scores of vegetative symptoms of controls and women with BD did not differ significantly during one cycle or both. Significant menstrual cycle effect was observed in both groups. CONCLUSION: Within the limitations of the study, the results suggest that ongoing mood-stabilizing treatment may have a prophylactic effect against premenstrual symptom changes in women with treatment-responsive BD.     

Serum, pleural effusion, and ascites CA-125 levels in ovarian cancer and nonovarian benign and malignant diseases: a comparative study

OBJECTIVES: Cancer antigen-125 (CA-125) is not a specific tumor marker and it is synthesized by normal and malignant cells of different origins. Recently it has been shown that various diseases are associated with increased CA-125 levels, especially in the presence of serosal fluid. The aim of this study is to investigate serum and fluid CA-125 levels in patients with different diseases. METHODS: A total of 133 patients and 23 healthy control cases were included in the study and divided into eight groups on the basis of disease and the presence of fluid in the serosal cavities. Serum and serosal fluid CA-125 levels were measured by a commercial enzyme immunoassay kit at the same time. Comparisons among the groups were made. RESULTS: Abnormal levels of serum CA-125 were observed in 76% of ovarian cancer patients; 96% in patients with ascites and 56% in patients without ascites. Moreover, elevated serum CA-125 levels were detected in 52% of patients with hepatic diseases, in 100% of patients with nongynecologic peritoneal carcinomatosis, and in 87% of patients with pleural effusion. Serum and fluid CA-125 levels were significantly higher in cases of ovarian cancer with ascites than in the other groups (P < 0.01). A positive correlation between serum CA-125 levels and ascites amounts was observed in cases of ovarian cancer with ascites (P < 0.01, r = 0.81). Furthermore, no correlation was observed between ovarian mass volume and serum CA-125 levels in ovarian cancer patients with stage I disease without ascites (P = 0.08, r = 0.48). CONCLUSIONS: Although CA-125 levels may be considered a sensitive tumor marker in patients with epithelial ovarian cancer, it was determined that high serum CA-125 levels were closely related to the presence of serosal fluids and serosal involvement, whatever the origin is. These results should be considered in the interpretation of CA-125 elevation in patients with ovarian cancer.     

Role of preoperative plasma CA 15-3 and carcinoembryonic antigen levels in determining histopathologic conventional prognostic factors for breast cancer

Abstract Breast cancer is one of the leading causes of cancer death among women all over the world, with about one million new breast cancer cases diagnosed per year. This large number of cases make the diagnosis, treatment, and determination of the factors affecting the survey extremely important. The aim of this study was to evaluate the importance of the preoperative plasma CA 15-3 and carcinoembryonic antigen (CEA) levels when determining the conventional histopathologic prognostic factors (tumor grade, lymphatic infiltration, stromal invasion, vessel invasion, tumor necrosis, elastosis, and number of positive lymph nodes in levels I and II). We believe that with this protocol doctors can add to their knowledge about the prognosis of patients. After examining the serum tumor marker levels and the histopathology results of 29 patients and submitting them to statistical calculations, we strongly believe that preoperative serum CA 15-3 levels can be taken into consideration when evaluating the prognosis because the CA 15-3 level is directly and positively correlated with the gold standard prognostic factor: the number of level I and II positive lymph nodes. Electronic Publication     

May cathepsin D immunoreactivity be used as a prognostic factor in endometrial carcinomas? A comparative immunohistochemical study

OBJECTIVE: To investigate the prognostic value of immunohistochemical detection of cathepsin D and the association between cathepsin D and established prognostic factors in endometrial carcinoma. METHODS: Cathepsin D immunoreactivity was determined by an immunohistochemical technique in a series of 79 patients with surgical stage I-III primary endometrial carcinoma. RESULTS: Of 79 tissue specimens, 48 (61%) showed a positive reaction for cathepsin D. A significant correlation between cathepsin D and histological grade was found (P < 0.05). The other established clinicopathological prognostic factors were not associated with cathepsin D. There was not any significant difference in prognosis between the positive cases and negative cases for cathepsin D (P > 0.05). In the univariate analysis cathepsin D immunoreactivity did not show significant prognostic value for overall survival (P > 0.05). The multivariate analysis also showed that cathepsin D was not related to patient outcome (P = 0.24, relative risk = 0.34, 95% confidence interval = 0.05-2.09). CONCLUSIONS: Our results suggest that cathepsin D immunoreactivity may not be of prognostic value but more studies are needed to evaluate the relationship between its immunoreactivity in tumor cells and in other cells.     

Effectiveness of Collagenase in the Treatment of Sacrococcygeal Pilonidal Sinus Disease

Purpose: Sacrococcygeal pilonidal sinus disease (SPSD) is a disease affecting young patients, which results in a long-term loss of productive power, and also tends to have high rates of morbidity since it has no ideal treatment. The main purpose of this study was to investigate the effectiveness of topical collagenase in the treatment of SPSD. Methods: In the present study, 40 patients admitted to our department were separated into two groups. Excision and marsupialization with dressing by bacterial collagenase was performed in the first group, while the treatment was excision and marsupialization without dressing by bacterial collagenase in the second group. Results: We determined that the healing in terms of the width and depth of the wound in the first week and in depth of wound in the second week was better in group 1 than in group 2 (P = 0.040, P = 0.020, P = 0.048, respectively). The duration of wound healing was 21.9 ± 1.3 days in group 1, and 28.1 ± 1.3 days in group 2 (P = 0.0001). The recurrence rate in the intergluteal area, which heals by granulation and has no hair follicles, tends to decrease when a partial closure is obtained. Conclusion: We therefore recommend an excision, marsupialization, and dressing with bacterial collagenase, in cases with noncomplicated SPSD. Received: March 25, 2002 / Accepted: July, 2, 2002 Reprint requests to: M. Aldemir, Dicle Universitesi, Tıp Fakültesi, İlk ve Acil Yardim Abd., 21280 Diyarbakır, Turkey