Short-term effect of simvastatin treatment on inflammatory parameters in peritoneal dialysis patients

OBJECTIVE: Increased serum pro-inflammatory cytokine levels are associated with an increased mortality rate in end-stage renal disease (ESRD) patients. Statins decrease cardiovascular mortality and serum C-reactive protein (CRP) levels in hemodialysis patients. As the anti-inflammatory effect of statins has not previously been studied in peritoneal dialysis (PD) patients with a non-inflammatory status, we wanted to investigate the anti-inflammatory effect of simvastatin in these patients. MATERIAL AND METHODS: Forty-eight PD patients were randomly allocated to either simvastatin treatment (n=25) or placebo (n=23). Patients in the active-treatment group received simvastatin 20 mg/day for 1 month. At baseline and after 1 month of treatment, blood samples were drawn and high-sensitivity CRP, interleukin-6, tumor necrosis factor (TNF)-alpha and plasma lipid profiles were determined. These parameters were compared between the groups at baseline and at the end of the study period. RESULTS: Twenty-five subjects in the treatment group and 20 in the placebo group completed the study. Three patients in the placebo group were excluded from the study due to the occurrence of bacterial peritonitis during the study period. Clinical characteristics and baseline parameters were similar in both groups. Serum total and low-density lipoprotein cholesterol levels, and triglyceride and serum TNF-alpha levels decreased significantly compared to baseline in the treatment group; there were no corresponding differences in the placebo group. CONCLUSIONS: Simvastatin decreased the serum TNF-alpha level in PD patients with a non-inflammatory status. A decrease in the TNF-alpha level could be one of the possible mechanisms of the anti-atherogeneic effect of simvastatin. We suggest that different treatment strategies aimed at decreasing serum cytokine levels could be evaluated to decrease cardiovascular morbidity and mortality in the dialysis population.     

The role of omentectomy during the surgical staging in patients with clinical stage I endometrioid adenocarcinoma

OBJECTIVE: The aim of this study was to evaluate whether omentectomy should be a routine part of staging surgery in endometrioid adenocarcinoma. METHODS: A retrospective study was performed on 65 patients who were primarily treated by total abdominal hysterectomy, salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy, infracolic omentectomy and peritoneal cytology for clinical stage I endometrial carcinoma between January 2002 and December 2005. Data on 65 patients who had been diagnosed with clinical stage I endometrial carcinoma were reviewed. Associations in the data obtained, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, vascular invasion, adnexal involvement, positive peritoneal cytology, lymph node metastasis, cervical stromal invasion, and tumor size, were investigated. The Chi-square (chi(2)) test was used for statistical analysis. Multivariate analysis was performed with logistic regression analyses. RESULTS: Four (6.2%) of 65 patients had omental metastasis, which was microscopic in two patients. As for extrauterine spread, the positivity rate of lymph node metastases was 10/65 (15.38%), peritoneal cytology was 7/65 (10.76%), and adnexal metastases was 10/65 (15.38%). Of those patients with omental metastasis, 2/10(20%) had positive nodes, 2/10(20%) had adnexal metastases, and 3/7(42.8%) had positive peritoneal cytologic findings. These four patients with omental metastasis had significantly higher rates of positive cytology (P = 0.003). Multivariate analysis revealed omental metastasis (P = 0.002; OR 46.5, CI 95% 3.899-554.575) to be significantly associated with positive peritoneal cytology CONCLUSIONS: We conclude that despite the presence of normal-appearing omentum, omentectomy should be performed as a component of surgical staging in the presence of positive peritoneal cytology.     

Quality of life in young fibromyalgia patients and effect of depression

Aim: The purpose of this study was to compare the depression and quality of life (QOL) scores of fibromyalgia (FM) patients and control subjects. We also aimed to detect relationships between different QOL scales, depression and clinical symptoms. Method: Ninety‐eight fibromyalgia patients and 48 healthy volunteers were included in the study. Depression was evaluated by a psychiatrist according to the Hamilton Depression Rating Scale and Diagnostic and Statistical Manual for Mental Disorders Edition 4 (DSM‐IV) criteria. QOL of the FM patients was assessed according to the Nottingham Health Profile (NHP), Health Assessment Questionnaire (HAQ), and Fibromyalgia Impact Questionnaire (FIQ). Results: We found significantly higher scores of depression, NHP, FIQ and HAQ in FM patients compared with controls (P < 0.000). Pain, tender point count (TPC), pain intensity, skinfold tenderness, FIQ, HAQ, and NHP scores were higher in patients with depression than in those without depression. Depression scores correlated with FIQ (r = 0.39, P < 0.01), HAQ (r = 0.35, P < 0.01), NHP (r = 0.55, P < 0.01) scores, TPC (r = 0.34, P < 0.01) and duration of disease (r = 0.21, P < 0.05). Fibromyalgia Impact Questionnaire scores correlated with HAQ scores (r = 0.45, P < 0.01), NHP scores (r = 0.49, P < 0.01) and TPC (r = 0.21, P < 0.05). HAQ scores correlated with NHP scores (r = 0.40, P < 0.01) and TPC (r = 0.29, P < 0.05). Nottingham Health Profile scores correlated with TPC (r = 0.43, P < 0.01) and duration of disease (r = 0.22, P < 0.05). Conclusion: We found higher scores of TPC, pain intensity, skinfold tenderness, NHP, FIQ, and HAQ in depressive FM patients as compared with non‐depressive FM patients. Our study indicates that there is an important relationship between pain, depression and QOL scales in young FM patients. Therefore; these patients should be managed using a multidisciplinary approach including psychiatric support.     

Quantitative evaluation of the amount of apically extruded debris using 3 different rotary instrumentation systems.

OBJECTIVE: To comparatively evaluate the amount of apically extruded debris when ProTaper, ProFile, and HERO Shaper were used for the instrumentation of root canals. STUDY DESIGN: Sixty human mandibular central incisor teeth were randomly assigned to 3 groups, 20 teeth in each. The teeth in the 3 groups were instrumented according to the manufacturers' instructions until the working length, with ProTaper, ProFile, and HERO Shaper rotary instruments respectively. The debris produced was collected in polyethylene tubes. The liquid inside the tubes was removed by lyophilization and the remaining debris was calculated for each group and compared. RESULTS: All instruments tested produced a measurable amount of debris. No statistically significant difference was observed between ProTaper and HERO Shaper in terms of debris extrusion (P > .05). Similarly, no statistically significant difference was observed between ProFile and HERO Shaper even though HERO Shaper extruded a relatively higher amount of debris (P > .05). On the other hand, ProTaper extruded significantly more amount of debris compared to ProFile (P < .001). CONCLUSIONS: ProTaper caused a significantly higher amount of debris extrusion compared to ProFile. No statistically significant difference was observed among the other groups tested. As the quantity of debris extrusion is not the only factor responsible for acute exacerbations, future studies can be planned that focus on the types of bacteria causing flare-ups and methods for their elimination.     

Power Doppler ultrasound studies of ovarian, uterine, and endometrial blood flow in regularly menstruating women with respect to luteal phase defects

The menstrual cycle outcome of 71 regularly menstruating women was ovulatory in 60.5% of the cases, luteal phase defect in 25.3%, luteinized unruptured follicle in 11.2%, and anovulatory in 2.8%. Significantly lower resistance indices were seen in the uterine, arcuate, radial, and spiral arteries of the ovulatory group in the midluteal phase, which was inversely related to the P level.     

Clinical application of distal ulnar artery perforator flap in hand trauma

The clinical value of distal ulnar artery perforator flap in composite defects of the hand is demonstrated in a case series of nine patients with severe injuries of the hand. Soft tissue loss with a mean diameter of 3?×?4 cm on the dorsum of the hand, volar and dorsal side of the wrist and palm was reconstructed with this flap. The mean size of flaps was 5.2?×?5.2 cm. Tendon and nerve injuries, and metacarpal fractures accompanied the soft tissue loss in seven patients. Subsequent reconstructive procedures were; Hunter rod placement and tendon grafting in two patients, nerve grafting in one, primary extensor or flexor tendon repair in three, and metacarpal bone fixation in one patient. The mean follow-up period was 18 months. No complications related to the flap were observed. In this article, the advantage and disadvantages of distal ulnar artery perforator flap in hand and wrist reconstruction is discussed together with a review of literature.     

Superior and inferior gluteal artery perforator flaps in reconstruction of gluteal and perianal/perineal hidradenitis suppurativa lesions

Background: Hidradenitis suppurativa is a debilitating disease with a tendency to form abscesses, sinus tracts, and scar formation. In this report, our experience with reconstruction of hidradenitis lesions of the gluteal and perianal/perineal area using superior and inferior gluteal artery perforator flaps (SGAP and IGAP) are discussed.Patients: A prospective study was conducted in collaboration with the general surgery department for patients with gluteal and perianal/perineal hidradenitis suppurativa between December 2005 and May 2010. Data of each patient included age, sex, disease localization, duration of symptoms, comorbidities, size of defect after excision, perforator flap chosen, complications, and postoperative follow‐up.Results: Eleven SGAP and six IGAP flaps were used in 12 patients with gluteal and perianal/perineal involvement. There was one flap necrosis for whom delayed skin grafting was performed. The mean follow‐up period was 20 months without recurrences.Conclusion:Patients with gluteal and perineal/perianal hidradenitis suppurativa are usually neglected by surgeons because of lack of collaboration of general and plastic surgery departments. Most surgical treatment options described in the literature such as secondary healing after excision and skin grafting prevent patients from returning to daily life early, and cause additional morbidities. Fasciocutaneous flaps other than perforator flaps may be limited by design such that both gluteal regions may have to be used for reconstruction of large defects. SGAP and IGAP flaps have long pedicles with a wide arc of rotation. Large defects can be reconstructed with single propeller flap designs, enabling preservation of the rest of the perforators of the gluteal region. © 2011 Wiley‐Liss, Inc. Microsurgery, 2011.     

Effect of N-acetylcysteine on oxidative stress and ventricular function in patients with myocardial infarction

Recent evidence suggests that postischemic myocardial dysfunction (“stunning”) may be mediated by oxygen free radicals. Various studies have reported the beneficial effects of antioxidants in ischemia–reperfusion injury. The aim of this study was to assess the effect of N-acetylcysteine (NAC) treatment on oxidative stress, infarct size, and left ventricular (LV) function, as adjunct therapy in myocardial infarction (MI). Patients with acute MI received either 15 g NAC infused over 24 h (n = 15) or no NAC (n = 15), combined with streptokinase. Peripheral venous blood was serially sampled to measure creatine kinase (CK)-MB levels. Plasma malondialdehyde (MDA) level was measured at admission and after 4 and 24 h. Echocardiography was performed within 3 days of MI and after 3 months. At admission, plasma MDA levels were not different between the groups. In the NAC-treated patients plasma MDA levels decreased, whereas in the nontreated NAC patients MDA levels increased at 4 and 24 h (P < 0.01 and P < 0.001, respectively). Left ventricular ejection fraction was higher (P < 0.05) and LV end-systolic and end-diastolic diameters were lower (P < 0.001 and P < 0.001) in patients receiving NAC on day 3. Left ventricular wall motion score index was significantly lower in patients treated with NAC on day 3 (P < 0.05). Left ventricular diastolic parameters were not different whether patients were treated with NAC or not. No difference in reduction of infarct size was detected between the groups according to CK-MB levels. It was thus demonstrated that administration of NAC in combination with streptokinase significantly diminished oxidative stress and improved LV function in patients with acute MI. These encouraging results would justify the performance of a larger controlled study.