Coronary artery bypass grafting in idiopathic myelofibrosis: a case report

The concomitant presence of myeloproliferative disorders and the need for coronary artery bypass surgery is a surgical dilemma. Thrombosis and hemorrhage can cause difficult problems and might require different approaches during and after surgery. We report a patient who had idiopathic myelofibrosis and underwent a successful coronary artery bypass surgery.     

Relação entre o Índice Imune-inflamação Sistêmico e Circulação Colateral Coronariana em Pacientes com Oclusão Total Crônica

BackgroundInflammation plays a key role in the initiation and progression of coronary artery disease (CAD). The systemic immune-inflammation index (SII) is a novel inflammatory parameter that has been shown to be associated with CAD.ObjectiveThis study aimed to investigate the relationship between SII and coronary collateral circulation (CCC) in patients with stable CAD and chronic total occlusion (CTO).MethodsThe patients were divided into two groups, with poor CCC and good CCC, according to the Rentrop Classification. Ninety-four patients had poor CCC, and 81 patients had good CCC. Inflammation parameters were calculated from the laboratory results. The statistical significance level applied was 0.05.ResultsHigh SII level (OR: 1.003, 95% CI: 1.001-1.004, p<0,001), absence of CTO in RCA (OR: 0.204, 95% CI: 0.096-0.436, p<0,001) and low Gensini score (OR: 0.980, 95% CI: 0.962-0.998, p=0,028) were significantly associated with poor CCC. The cutoff value of SII was 679.96 for the highest predictive power of poor CCC, with a sensitivity of 74.5% and specificity of 43.2%. Mortality rates were similar between the two groups during a mean follow-up of 21.5±10.8 months (p=0.107).ConclusionsHigh SII level, the absence of CTO in the right coronary artery, and low Gensini score were significantly related to poor CCC. The rapid and cost-effective use of new inflammatory markers in clinical practice guides the prognosis of CAD.     

Potential Animal Reservoirs of Toscana Virus and Coinfections with Leishmania infantum in Turkey

Toscana virus (TOSV), a sandfly-borne phlebovirus, is an important agent of human meningoencephalitis in the Mediterranean region, for which vertebrates acting as reservoirs have not yet been determined. This study investigates TOSV and Leishmania infections in dogs, cats, sheep, and goats from Adana and Mersin provinces in southeastern Turkey. TOSV neutralizing antibodies were demonstrated in 40.4% of the dog and 4% of the goat samples. TOSV RNA was detected in 9.9% of the 252 samples that mainly comprise dogs (96%). Thus, canine species can be suggested as the candidate reservoirs of TOSV. Partial sequences revealed the activity of TOSV genotypes A and B. In two dogs presenting with symptoms of canine leishmaniasis, infections of TOSV genotype B and Leishmania infantum have been documented, describing the first report of coinfections with these agents.     

Implant‐Supported Oral Rehabilitation of a Patient with Pemphigus Vulgaris: A Clinical Report

Pemphigus vulgaris (PV) is a rare mucocutaneous vesiculobullous disease characterized by the development of autoantibodies against the desmosomal proteins. Current treatment is largely based on systemic immunosuppression using systemic corticosteroids. Immunosuppressive drugs used in the treatment of the disease may increase the risk of infection and delayed healing, which are of concern in dental treatment procedures in this group of patients. The clinical outcomes of implants in PV have not been investigated. We present a case of PV rehabilitated with an implant‐supported prosthesis with a 32‐month follow‐up and discuss the important points in the surgical and prosthodontic phases.     

Gallstones at chronic spontaneous urticaria patients: A retrospective clinical study

Chronic spontaneous urticaria (CSU) is a chronic, inflammatory skin disease can be triggered by many factors such as inflammatory process. To assess accompanying gallstone in CSU patients and to evaluate laboratory test results. We retrospectivelyscanned the files of the 108 patients with CSU who had been diagnosed CSU in September 2017–September 2019. Accompanied gallstone cases by detecting transabdominal ultrasound (TUS) or were 11 patients. Nine patients had also had cholecystectomy history. We seperated these 20 patients as Group A than the rest. WBC count is 9.38 ± 2.37 in Group A and 8.03 ± 2.04 in Group B. Platelet count was also differ between two groups significantly (Group A = 328.70 ± 85.62 × 10³/mm³ vs. Group B = 287.12 ± 72.77 × 10³/mm³). Neutrophil count was more in Group A (5.87 ± 1.65) than Group B (4.76 ± 1.75). Gallstone history of family was significantly higher in Group A (n = 12 positive/8 negative) than Group B. These findings were significant statistically p < .05. CSU can be associated with inflammation and gallstones. It is needed to perform further investigations to detect these relations and pathways.     

A reverse-flow composite flap in the rat.

Reverse-flow flaps are currently particularly used for the reconstruction of defects of the distal part of the extremities. Despite their common usage there have been many reports of postoperative complications, especially resulting in partial or total flap necrosis. There is insufficient knowledge of flap haemodynamics, physiology and wound healing properties in reverse-flow flaps. Development of the proper experimental models is needed to investigate these issues. The purpose of this study was to describe a new reverse-flow flap model in the rat. A total of 20 adult Wistar rats weighing 200-250 g were used in this experiment. In five rats, the vascular anatomy of the auricle of the rat was determined by anatomic dissection and microangiography. In the experimental group (N=5), 1x1 cm reverse-flow composite flaps were harvested as a semi-island shape, based on the distal course of the medial branch of the anterior auricular artery. In the control group, consisting of five rats, the flap was designed and raised based on the proximal course of the medial auricular artery, again in a semi-island shape. In the remaining five animals, a square-shaped composite tissue of the whole layer of the auricle, 1x1 cm in size, was harvested dividing all the bases circumferentially. The composite tissue was replaced in situ. While the former was considered a conventional antegrade-flow flap subgroup, the latter was designated as a graft subgroup. All flaps were replaced in situ. The survival of the flap was evaluated on postoperative day 7 by direct observation and microangiography. The skin island of all the reverse-flow flaps and conventional antegrade-flow flaps survived completely giving a success rate of 100%, whereas all grafts in the control group underwent complete necrosis. Microangiographic studies revealed the vascularity of the reverse-flow and antegrade-flow flaps, identifying the course of the auricular arteries. In conclusion, with its evident advantages of easy to design and harvesting, reliable survival pattern and consistent vascular structure, our new flap model will provide a means for future studies on flap haemodynamics, physiology in reverse-flow flaps.     

Celiac disease screening in 100 Turkish children with Down syndrome

The aim of this study was to screen a group of children with Down syndrome (DS) for celiac disease, and to define future strategies for screening the patients followed at our center. One hundred children over the age of two years with Down syndrome were serologically screened using antiendomysium antibody (EMA) IgA and serum IgA in order to exclude a concomitant IgA deficiency. Clinical assessment included detailed physical examination, measurement of weight and height plotted on growth charts for DS children followed by an interview of the patients and parents about gastrointestinal symptoms. Only one patient out of 100 (1%) was detected to be EMA IgA-positive. The child's family refused consent for the biopsy procedure. None of the patients had IgA deficiency. Abdominal distention was present in 13 (13%) patients, and anorexia in 9 (9%), vomiting in 7 (7%) and alopecia areata in 2 (2%) patients were also noted. Despite the small number of patients in our group, this result yielding 1% EMA-positivity is the lowest yet determined among DS patients. It has led us to discuss whether or not a change in our screening strategy is necessary.     

iNOS Expression in Oral and Gastrointestinal Tract Mucosa

It is known that the overproduction of nitric oxide (NO) by nitric oxide synthase (NOS) occurs during the progression of various inflammatory diseases in intestinal tract. NOS inhibitors or inducible nitric oxide synthase (iNOS) gene expression inhibitors should be considered as potential anti-inflammatory agents, as NO synthesized by iNOS is related to various pathophysiological processes including inflammation. In order to understand the relationship between iNOS and pathological reactions such as the inflammatory process and malign transformation clearly, the existence and amount of constitutive expression should be determined. It is crucial to comprehend the harmful and protective amounts of iNOS expressions in order to clarify the relationship between iNOS and pathological processes. Evidently, only after this inspection is it possible to utilize iNOS as a marker and treatment instrument during the diagnosis and treatment of malign transformation and the inflammatory process.     

The acute effects of acetate-balanced colloid and crystalloid resuscitation on renal oxygenation in a rat model of hemorrhagic shock

IntroductionFluid resuscitation therapy is the initial step of treatment for hemorrhagic shock. In the present study we aimed to investigate the acute effects of acetate-balanced colloid and crystalloid resuscitation on renal oxygenation in a rat model of hemorrhagic shock. We hypothesized that acetate-balanced solutions would be superior in correcting impaired renal perfusion and oxygenation after severe hemorrhage compared to unbalanced solutions.MethodsIn anesthetized, mechanically ventilated rats, hemorrhagic shock was induced by withdrawing blood from the femoral artery until mean arterial pressure (MAP) was reduced to 30 mmHg. One hour later, animals were resuscitated with either hydroxyethyl starch (HES, 130/0.42 kDa) dissolved in saline (HES-NaCl; n = 6) or a acetate-balanced Ringer's solution (HES-RA; n = 6), as well as with acetated Ringer's solution (RA; n = 6) or 0.9% NaCl alone (NaCl; n = 6) until a target MAP of 80 mmHg was reached. Oxygen tension in the renal cortex (CμPO₂), outer medulla (MμPO₂), and renal vein were measured using phosphorimetry.ResultsHemorrhagic shock (MAP = 30 mmHg) significantly decreased renal oxygenation and oxygen consumption. Restoring the MAP to 80 mmHg required 24.8 ± 1.7 ml of NaCl, 21.7 ± 1.4 ml of RA, 5.9 ± 0.5 ml of HES-NaCl (p < 0.05 vs. NaCl and RA), and 6.0 ± 0.4 ml of HES-RA (p < 0.05 vs. NaCl and RA). NaCl, RA, and HES-NaCl resuscitation led to hyperchloremic acidosis, while HES-RA resuscitation did not. Only HES-RA resuscitation could restore renal blood flow back to ～85% of baseline level (from 1.9 ± 0.1 ml/min during shock to 5.1 ml ± 0.2 ml/min 60 min after HES-RA resuscitation) which was associated with an improved renal oxygenation (CμPO₂ increased from 24 ± 2 mmHg during shock to 50 ± 2 mmHg 60 min after HES-RA resuscitation) albeit not to baseline level. At the end of the protocol, creatinine clearance was decreased in all groups with no differences between the different resuscitation groups.ConclusionWhile resuscitation with the NaCl and RA (crystalloid solutions) and the HES-NaCl (unbalanced colloid solution) led to hyperchloremic acidosis, resuscitation with the HES-RA (acetate-balanced colloid solution) did not. The HES-RA was furthermore the only fluid restoring renal blood flow back to ～85% of baseline level and most prominently improved renal microvascular oxygenation.