Is there any relation between insulin resistance and cognitive function in the elderly?

BACKGROUND: Vascular risk factors are blamed as being involved in the pathogenesis of cognitive dysfunction in the elderly. Alzheimer's disease or vascular-type dementia could be part of a metabolic syndrome. The aim of this study was to evaluate whether there is any relation between insulin resistance and cognitive status of the elderly regarding normal, mild cognitive impairment (MCI), Alzheimer's disease (AD), vascular dementia (VaD) and mixed dementia.METHODS: 267 elderly patients admitted to an outpatient geriatrics clinic were evaluated medically and cognitively in this study. The patients were diagnosed using ARDRA and DSM-IV criteria for AD; NINDS-AIREN and DSM-IV criteria for VaD; and Petersen criteria for MCI. Insulin resistance was calculated using both the homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) formulas.RESULTS: The mean values of HOMA and QUICKI scores were 2.79 (SD+/-3.56) and 0.346 (SD+/-0.036) for the normal group, 2.81 (SD+/-3.06) and 0.354 (SD+/-0.047) for AD group, 2.20 (SD+/-1.82) and 0.360 (SD+/-0.048) for VaD group, 2.87 (SD+/-1.81) and 0.339 (SD+/-0.038) for mixed dementia group, 2.79 (SD+/-2.81) and 0,349 (SD+/-0.042) for MCI group, respectively. There were no statistically significant differences between HOMA and QUICKI scores of all the groups.CONCLUSION: This is the first study of the possible relation between insulin resistance and cognitive function in people categorized according to five forms of cognitive status. Unfortunately the results do not allow generalizations. Further prospective cohort studies that follow a normal cognitive group and MCI patients with and without insulin resistance are necessary.     

Total antioxidant capacity and total oxidant status in patients with major depression: Impact of antidepressant treatment

Aim:  The purpose of the present study was to investigate whether total antioxidant capacity (TAC) and total oxidant status (TOS) are associated with major depressive disorder (MDD) and to evaluate the impact of antidepressant treatment on TAC and TOS in MDD.
Methods:  Fifty-seven MDD patients and 40 healthy controls participated in the study. Serum TAC and TOS were measured both in patients and controls using Erel's methods. Patients were treated with antidepressant drugs for 12 weeks. The treatment course was evaluated using the Montgomery–Asberg Depression Rating Scale (MADRS) in all patients.
Results:  TOS and oxidative stress index (OSI) were higher ( P  = 0.0001 for both) and TAC was lower ( P  = 0.0001) in the MDD group compared with those of the controls. After 3 months of antidepressant treatment, TOS and OSI were decreased and TAC was increased compared with the pretreatment values ( P  = 0.0001, for all). Furthermore, there were significant positive correlations between the severity of the disease and serum TOS and OSI (r = 0.584, P  = 0.0001; r = 0.636, P  = 0.0001, respectively). A negative correlation was found between the severity of the disease and serum TAC (r = −0.553, P  = 0.0001) at the pre-treatment stage.
Conclusion:  Treatment administered for 3 months to MDD patients increases TAC while decreasing TOS and OSI.     

Subacute effects of methyl parathion on antioxidant defense systems and lipid peroxidation in rats

In this study we aimed to examine how methyl parathion (MP) at sublethal dosages affects on malondialdehyde (MDA) content and antioxidant defense system (ADS) such as reduced glutathione (GSH), glutathione reductase (GR), superoxide dismutase (SOD) and glutathione-S-transferase (GST) in various tissues of rats exposed to 19 and 38 millimole (mM) MP dosages as drinking water ad libitum for 28 days continuously. MDA significantly increased in all the tissues except for in the lungs of rats treated with both dosages of MP. With regard to the ADS, SOD significantly decreased in the lungs tissue whereas increased in the erythrocytes with two dosages of MP. GR activity significantly decreased in the erythrocytes treated with both dosages of MP, but decreased in the lungs and liver tissues with 38 mM MP treatment. GST activity significantly elevated in all the tissues except for in the liver treated with 38 mM dosage but did not change with 19 mM. Meanwhile, GSH depletion in all the tissues except lungs of rats treated with both dosages of MP was found to be significant. The observations presented led us to conclude that after the administrations of MP promote MDA content and fluctuate in the ADS in rats.     

A life-threatening infection: Fournier's gangrene

Fournier's gangrene is a life-threateningdisorder in which infection of the perineum andscrotum spreads along fascial planes, causingsoft tissue necrosis. If urgent surgery isdelayed, the disease will soon result in septicshock, multiorgan failure, and death. In thisstudy, we present 21 patients with Fournier'sgangrene who were treated in period between1994 and 2001. Patients' charts were reviewedretrospectively and are discussed in the lightof literature.All patients received aggressive surgicaldebridment. Penicillin or Ceftriaxone,aminoglicoside and metronidazole wereadministered intravenously. Of the 21 patients,5 had scrotal carbuncle, 1 had urethralstricture, 1 had chronic indwelling urethralcatheterization, 2 had perirectal abscess, and1 had hemorrhoidectomy. In eleven patients wecouldn't identify any cause. Twelve patientshad diabetes mellitus, and two had chronicalcoholism. Escherichia coli was isolatedin 12 purulent tissue cultures, and Bacteroides fragilis in eight. Seventeenpatients survived, whereas four died.Fournier's gangrene is considered a surgicalemergency. Early surgical intervention isessential, as the gangrene can spread rapidlyat rates reaching 2 mm per hour. So thatFournier's gangrene is an abrupt, rapidlyprogressive, gangrenous infection of theexternal genitalia and perineum and is a realurologic emergency.     

The effects of the incision types in myringoplasty operations on cosmesis

There is no study based on objective measurements about the cosmetic results of myringoplasty operation in medical literature. This study aims to show the differences in the auriculomastoid angle between the operations which were done with postauricular and endaural incisions. The auriculomastoid angle of 20 patients having had postauricular myringoplasty operation were measured both preoperative and postoperative periods. The auriculomastoid angles of 17 patients having had endaural myringoplasty operation were also measured in both preoperative and postoperative periods. Also, the patients were asked whether there was a change in the shape of their ears. It was observed that the increase of the auriculomastoid angles of the patients who had myringoplasty by postauricular incision was statistically significant when compared to the ones having had the operation by endaural incision. Also, the patients who had myringoplasty operation by postauricular incision realized the change in their ears significantly when compared to the other group. In this study, esthetically better results were observed in the myringoplasty operations done by endaural incision than the ones done by postauricular incision. When deciding on the incision type, this should be considered.     

Ethmomaxillary sinus

Ethmomaxillary sinus is a variation of the posterior ethmoid cells. It is formed by the extension of the posterior ethmoid cells into the maxillary sinus and drains into superior nasal meatus. It is incidentally seen on paranasal sinus computerized tomography (CT) scans. Its prevalence has been reported as 0.7 and 2% in two studies. In this study, paranasal CT scans of 466 patients were investigated for the presence of ethmomaxillary sinus. The patients had paranasal CT with the preliminary diagnoses of septal deviation, chronic inflammatory paranasal sinus disease and nasal turbinate disorders. The ethmomaxillary sinus was present in nine of those patients (1.93%). It was septated in one of them. The CTs were further investigated for other anatomical variations and co-existent mucosal disease of the paranasal sinuses.     

The effects of intratracheal dexamethasone on acute lung injury in rabbits--experimental study

BACKGROUND AND OBJECTIVE: The aim of our study was to investigate, in rabbits with hydrochloric (HCl) acid-induced Acute Lung Injury (ALI), the effects of intra-tracheal (i.t.) dexamethasone administration on neutrophil and platelet counts, plasma malonyl dialdehyde (MDA) level, histopathology, and arterial blood gases. METHODS: Twenty-eight New Zealand rabbits were randomly divided into a control (n = 14) and dexamethasone groups (n = 14). Anesthesia was applied with ketamine (50 mg kg(-1) h(-1), i.m.) and tracheostomy was performed. Both groups received 2 ml kg(-1) HCl (hydrochloric acid) i.t.. Five minutes later, 0.9% saline was given to the controls while the other group received i.t. dexamethasone. MDA levels of the plasma, neutrophil and platelet counts, and arterial blood gases were recorded at the beginning of the study and then at two and five hours. The rabbits were ventilated in pressure control mode for 5 hours. At the end of the study, the lungs were examined by light microscopy and the changes evaluated on a scale of 0 to 4. RESULTS: Neutrophil and platelets counts (p < 0.01) and PaO2 (p < 0.05) were greater in the dexamethasone group than the controls at five hours. Plasma MDA level (p < 0.01) and PaCO2 (p < 0.01) were greater in the control group. Histopathological changes were less severe in the dexamethasone group. CONCLUSION: Giving dexamethasone i.t. may have beneficial effects on the development of ALI.     

Granulocyte Macrophage-Colony Stimulating Factor Improves Impaired Anastomotic Wound Healing in Rats Treated with Intraperitoneal Mitomycin-C

Purpose Intraperitoneal chemotherapy (IPCT) delivers higher local concentrations of cytotoxic drugs than intravenous (IV) chemotherapy, but it can adversely affect the healing of intestinal anastomoses if given in the early postoperative period. Intestinal anastomotic leakage is a serious surgical complication. Experimental and clinical studies have shown that the local administration of granulocyte macrophage-colony stimulating factor (GM-CSF) improves would healing. Therefore, we evaluated the effects of locally applied GM-CSF on anastomotic wound healing in rats treated with intraperitoneal mitomycin-C immediately after surgery.Methods We performed colon anastomoses in albino rats, which were then divided into three treatment groups. Group A was a control group that received no treatment, Group B was given intraperitoneal mitomycin-C postoperatively, and Group C was given intraperitoneal mitomycin-C with a local injection of GM-CSF postoperatively. We measured bursting pressures and hydroxyproline content, and histologically examined the resected anastomoses on postoperative day (POD) 3.Results Anastomotic healing was impaired after intraperitoneal mitomycin-C, but this was overcome by the injection of GM-CSF into the perianastomotic area.Conclusion Local GM-CSF administration counteracts the detrimental effects of intraperitoneal mitomycin-C treatment on intestinal anastomoses in rats.     

An Assessment of the Effects of Two Types of Bioresorbable Barriers to Prevent Postoperative Intra-Abdominal Adhesions in Rats

Purpose This study assessed and compared the efficacy of two types of bioresorbable membranes in the prevention of postoperative adhesion under clean contaminated and bacterial peritonitis conditions using a cecal ligation and puncture model in rats. Methods Wistar albino rats (n = 72) were divided into six groups. Bacterial peritonitis was induced using a cecal ligation and puncture model in groups 2, 4, and 6. Groups 1, 3, and 5 served as controls for clean contaminated procedures in the absence of bacterial peritonitis. Groups 1 and 2 were the untreated clean contaminated and bacterial peritonitis groups and served as controls for the effect of the bioresorbable membranes in each condition. In groups 3 and 4, a 1.5 × 3 cm USP glycerol/sodium hyaluronate/carboxymethylcellulose membrane was wrapped around the cecal resection area and a 2 × 4 cm membrane was left under the incision. The oxidized regenerated cellulose membrane was similarly applied in groups 5 and 6. Four weeks later, the adhesions were evaluated. In addition, fibrosis and inflammation were observed histopathologically. Results Adhesion development (P = .008), fibrosis (P = .008), and inflammation (P = .0001) differed among the groups. Both materials increased adhesion formation in the bacterial peritonitis condition. Increased fibrotic activity was detected in all material-applied groups under both conditions. In addition, more inflammation was detected in the groups that received the application of a material, especially in the presence of bacterial peritonitis. Conclusion Neither material prevented adhesions in clean contaminated conditions. Moreover, they increased adhesion formation in bacterial peritonitis.