Domain-specific improvement of cognition on memantine in patients with Alzheimer's disease treated with rivastigmine

OBJECTIVE: Cholinergic therapy is used in mild-to-moderate Alzheimer's disease (AD) and antiglutamatergic therapy in moderate-to-severe AD. Global scales, as commonly used in clinical trials, blur specifics of disease progression and drug effects. The objective was to assess combination therapy of rivastigmine plus memantine by specific neuropsychological tests in patients with mild-to-moderate AD. METHODS: 12-week-short multicenter open-label pilot study. Ninety patients with mild-to-moderate AD already on stable medication with rivastigmine (3-6 mg b.i.d.) additionally received memantine for 12 weeks. Subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini-Mental State Examination (MMSE) and additional neuropsychological tests (e.g. span tasks, semantic fluency) were assessed. RESULTS: The scores in the ADAS-cog memory subscale, the MMSE score, and digit span and semantic fluency significantly improved on combination therapy. CONCLUSION: Memory improvement was correlated with ADAS-cog memory score at baseline and inversely with age at onset of treatment. The data suggest that improvement on combination therapy results from an improvement of attention/executive function with secondary memory improvement, which will need to be confirmed in a subsequent double-blind study on a larger number of patients.     

Surgical treatment of osteoblastoma : a report of 20 cases

Osteoblastoma is a locally aggressive osteoblastic lesion of bone with rare malignant transformation. We retrospectively evaluated 20 patients who were diagnosed and surgically treated for osteoblastoma in our institution. Their mean age was 22.5 years (range: 10 to 34). The most frequent location was in the posterior elements of the spine, followed by the long bones of the extremities and the talus. Intralesional curettage was the most common modality of treatment; it was used in 11 patients, with a 13% recurrence rate. This series demonstrates that osteoblastoma may be locally aggressive and may recur after removal. Although it is usually treated successfully with curettage, wide excision should be considered along with careful follow-up over the long term owing to the possibility of recurrence or malignant transformation.     

Evaluation of fractal-coated temporary pacing leads in the early postoperative course

Background: The performance of temporary pacing wires is still limited by capture and sensing problems. Fractal coating can enhance electrical properties and reliability. We therefore investigated fractal-laminated wires in comparison with conventional wires.
Methods: In 21 patients two unipolar, fractal-coated pacing wires (fe) and one conventional bipolar electrode (se) were implanted in ventricular position. Afterward pacing threshold (V), R-wave sensing (mV), lead impedance (ohm), and slew-rate (mV/s) were measured. Loss of capture or sensing and dislocation was documented. fe wires were examined with energy dispersive x-ray diffraction (EDX)-analysis and scanning electrode microscopy (SEM).
Results: Failure in pacing was less frequent in fe wires. Also fe leads had lower pacing thresholds at implantation (0.76 ± 0.15 V vs 1.51 ± 0.95 V, P< 0.0001) and afterward. Furthermore fe wires showed lower increase of pacing threshold/time (0.25 V/day vs 0.42 V/day). R-wave sensing and slew-rate values in the fe group on day of operation (5.81 ± 4.80 mV; 0.63 ± 0.71 V/s) were lower than in the se group (10.37 ± 6.89 mV; 1.85 ± 1.71 V/s P< 0.0001) and afterward. Nevertheless, decrease of amplitude/time was lower in fe wires (0.17mV/day vs 0.46 mV/day). fe wires always had lower impedance values.
Conclusions: Lower pacing threshold and increase of threshold/time in fe wires indicate more reliable function. Initial lower sensitivity values are still not understandable and must be investigated. However, fe wires, constancy of sensing and impedance values was more stable, so fe epicardial wires can be recommended for safe and feasible use.     

The use of fibular autograft and ankle arthrodesis for aggressive giant cell tumor in the distal tibia: a case report

The case describes successful distal tibial resection, fibular autograft, and ankle arthrodesis in two patients who had giant cell tumor in the distal tibia. At long-term followup, the patients had no pain and no limitation in daily or low-impact recreational activities. In conclusion, due to the large resection that is often necessary for aggressive tumors, fibular autograft and ankle arthrodesis may be a useful method in the distal tibia.     

Association between mild renal dysfunction and insulin resistance or metabolic syndrome in a random nondiabetic population sample

AIMS: The association of mild renal dysfunction (estimated glomerular filtration rate [eGFR] 60-89.9 ml/min/1.73 m(2)) with insulin resistance (IR) or metabolic syndrome (MS) needs be investigated in a population in which MS prevails. METHODS: After excluding subjects with diabetes mellitus, 1,678 subjects from a representative cohort (median age 52 years) were studied cross-sectionally. eGFR was based on serum creatinine concentrations using the quadratic GFR equation and categorized by 90 and 60 ml/min/1.73 m(2) as limits. MS was identified using the modified criteria of the Adult Treatment Panel-III. RESULTS: In men, whereas MS was not significantly associated with a reduced eGFR category when controlled for homeostatic model assessment (HOMA), HOMA adjusted for MS or for its components was significantly associated with the likelihood of a reduced eGFR. This likelihood was increased by 14% with a doubling of HOMA in men. Age was the dominant correlate of reduced eGFR in women, whereby an association with HOMA was not significant. CONCLUSION: Mildly impaired kidney function is common in nondiabetic adults among whom MS prevails, and in men it is mainly associated with IR but not with central obesity and MS-related dyslipidemia. The quadratic GFR equation enables an acceptable estimation of GFR in a general population.     

Association between MEFV gene mutations and recurrent aphthous stomatitis in a cohort of Turkish patients

Recurrent aphthous stomatitis (RAS) has a multifactorial etiopathogenesis, an interaction between predisposing factors and/or systemic conditions and immunological components in genetically predisposed subjects. The Mediterranean fever (MEFV) gene has already been identified as being responsible for familial Mediterranean fever. Because the association between MEFV gene mutations and Behçet's disease has been reported before in several studies, we considered that the role of MEFV gene mutations should be studied in patients with RAS, because of the clinical similarities of both diseases. The aim of this study was to explore the frequency and clinical significance of MEFV gene mutations in a cohort of Turkish patients with RAS. The study population comprised 100 unrelated patients with a clinical diagnosis of RAS and 156 healthy controls. Genomic DNA was isolated and genotyped using polymerase chain reaction and restriction fragment length polymorphism for the four MEFV gene mutations (M694V, M680I, V726A and E148Q). There were statistically significant differences of the MEFV gene mutation carrier rates and allele frequencies between RAS patients and healthy controls (P = 0.042, odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.01–3.41; and P = 0.039, OR = 1.8, 95% CI = 1.02–3.14, respectively). Even if it is not statistically significant, the E148Q allele frequency was higher in patients with RAS than the control group. A statistically significant increased prevalence of MEFV variants in RAS patients was found. This is the first study to report that missense mutations of MEFV is associated with RAS in the Turkish population.     

Results of the Probe Technique for Transatrial Repair of Tetralogy of Fallot

Abstract Objective: Total correction of classical tetralogy of Fallot (TOF) by transatrial approach has become a standard procedure in the goal to minimize structural damage to the pulmonary pump. The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to the right ventricular approach. However it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. Methods: Nineteen patients who had repair of isolated TOF using this technique from 1993 to 2001 were reviewed. The mean age of patients were 5 ± 2 years. Transatrial‐transpulmonary approach were performed for all patients. To make easier the infundibular muscle bundles resection and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. To improve exposure, tricuspid valve detachment was performed in 11 patients. All patients were followed‐up in our clinic every 6 months using echocardiography. Results: There were no early or late deaths, and no reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA Class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. Conclusion: On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases shows excellent early and mid‐term results.     

Do not underestimate atrial septal defect!

Atrial septal defect (ASD) is one of the simplest cases among the surgically correctable congenital cardiac diseases. Easiness of the correction usually causes underestimation of the pathology. Angiography as well as echocardiography might be misleading in some cases. The preliminary diagnosis of the presented case was secundum ASD. During operation an unusual type of partial anomalous pulmonary venous connection (PAPVC) was noticed. Pulmonary veins of the entire left lung were draining to the right atrium directly. There was no other coexisting cardiac pathology including atrial septal defect. To our knowledge, there is no similar case in the literature. ASD is a well known congenital cardiac disease. Coexisting anomalies increase the surgical importance of the defect. Cardiologists should suspect and search for even the rarest pathologies during preoperative evaluation to prevent diagnostic misinterpretations and surgical surprises. Trying to explore the relations of cardiac chambers and define the pathology during extracorporeal circulation is time consuming. Despite this, a routine and meticulous exploration should not be neglected to prevent unexpected results.