Losartan-induced hepatic injury

Losartan, an angiotensin II receptor antagonist, is widely used for the treatment of hypertension. Clinical experience with this drug has demonstrated that it is safe. Losartan-induced hepatic toxicity is extremely rare. We report a case of severe hepatic toxicity and fibrosis caused by losartan use, and we review four previously reported cases. Drug-induced hepatic injury may be seen during the treatment of hypertension by losartan and the clinician should be aware of this toxicity, especially during the initial phase of treatment.     

Mechanisms of electrical defibrillation of the heart

This paper discusses the development of theoretical models of heart defibrillation by a bipolar impulse. These are based on theoretical mechanisms as well as our results obtained in a series of fibrillation/defibrillation experiments carried out in anesthetized mongrel dogs. The procedures for fibrillation and defibrillation have been previously described. During the experiments, blood pressure, ECG, and ventricular wall contraction strength are continuously recorded. The methods of recording have been previously described.     

Evaluation and compensation of lower limb length discrepancy after surgical treatment of developmental hip dysplasia

Summary The aim of this study was to find a solution for lower limb length discrepancy following surgical treatment of developmental hip dysplasia (DDH) in neglected cases. For this purpose, radiographic examination of 49 hips of 33 children with DDH was made. They were surgically treated by one-stage combined procedure that consisted of open reduction, modified innominate osteotomy and proximal femoral osteotomy. Mean age was 3.5 years and mean follow-up was 34.3 months. In bilateral cases this procedure did not cause notable lower limb length discrepancy. In unilateral cases, it was seen that limb length could be balanced by performing a modified innominate osteotomy producing transiliac lengthening in children older than 4 years. In children younger than 4 years there was no need to perform an acetabuloplasty producing transiliac lengthening because extensive femoral shortening was not needed and femoral overgrowth was sufficient to balance the length of lower limbs. Also avascular necrosis of the femoral head was observed as one of the important factors producing limb length discrepancy in variable degrees.This study was presented in part at the 20th World Congress of SICOT in Amsterdam, The Netherlands, 18–23 August 1996.     

Is laparotomy necessary in the diagnosis of fever of unknown origin?

Fever of unknown origin (FUO) is a diagnostic challenge for the practising physician. Detailed medical history, physical examination, non-invasive laboratory tests, and radiologic examinations compose the first level in the diagnostic approach to the FUO. When a diagnosis cannot be established with these procedures, some invasive diagnostic techniques and finally exploratory laparotomy are performed. Although advanced diagnostic measures and imaging-guided less invasive procedures have decreased the need, laparotomy remains as a final diagnostic method for FUO cases. In this study we evaluate the role and importance of laparotomy in the diagnosis of our FUO cases. In 17 out of 126 patients (8 male, 9 female, the median age 35.8 years) hospitalized in our clinic between 1982 and 2002 with the diagnosis of FUO, the diagnosis was established by laparotomy. The diagnosis was made directly in 13 patients, and indirectly (by excluding other diseases) in 2 patients. In several FUO series, the contribution of laparotomy to the diagnosis of FUO was reported as 27-100%. This rate was found to be 88% in the present study. During laparotomy on 17 cases, tissue samples were taken from spleen, liver, intra-abdominal and mesenteric lymph nodes. Pathologic examination of these tissue samples revealed miliary tuberculosis in 4; non-Hodgkin's lymphoma in 3; Hodgkin's lymphoma in 3; liver tumour in 1; hairy cell leukemia in 1; peritonitis carcinomatosis in 1. In the patients with miliary tuberculosis, the liver (3) and/or spleen (2), and/or lymph node (3) revealed caseating granulomas. Laparotomy diagnosed 3 of 5 cases whose abdominal ultrasonography and computerized tomography were normal. In conclusion, although advanced diagnostic methods decreased the need for laparotomy in FUO, if non-invasive and invasive diagnostic measures fail, laparotomy may contribute to the diagnosis. The selection of the patient and the timing are important for laparotomy.     

Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C Legg-Calvé-Perthes disease

Results from 26 hips of 24 Legg-Calvé-Perthes disease patients were evaluated retrospectively. There were 22 male and two female patients in the study group. The mean age of the patients was 8.3 years and the mean follow-up was 13.03 years. All the patients were older than 6 years of age and all of them had lateral pillar group C hips. The patients were treated with intertrochanteric uniplanar varus osteotomy. All the patients were mature at the time of the last evaluation. Radiological end results were evaluated according to Stulberg's classification. Six hips healed with spherical congruency (Stulberg class 1 or 2), 19 with aspherical congruency (Stulberg class 3 or 4) and one with aspherical incongruency (Stulberg class 5). Six of 14 hips treated before 9 years of age healed with spherical congruency but all hips treated after 9 years of age healed with Stulberg class 3, 4 or 5 results. Trochanteric overgrowth was evident in 20 hips. The results of this radiological outcome study showed that Herring class C hips treated with proximal femoral varus osteotomy had a poor outcome, especially after 9 years of age in this group of patients.     

Studies in plaque pathogenicity

A study was undertaken to assay and compare the pathological potential of loosely adherent plaque (LAP) with that of adherent plaque (AP) using the limulus lysate assay (LLA). A technique was devised for collection both AP And LAP from supra- as well as subgingival tooth areas under pyrogen-free conditions. Five supragingival samples (AP & LAP) were collected from teeth (G.I.= < 1) after subjects had abstained from tooth cleaning for two weeks. Five subgingival samples were collected from mylar strips one week after placement in periodontal pockets not less than 4 mm and not more than 7 mm in depth. All samples were lyophilized, recontituted and analyzed for plaque mass by the quantitative ninhydrin reaction (Moore and Stein, 1954). Samples were analyzed for limulus lysate activity by a modification of the LLA of Levin and Bang (1964).
Results from the five supragingival samples indicate that plaque mass, as determined by the ninhydrin reaction, was 4–5 fold greater in AP than in LAP. In the five subgingival samples, ninhydrin values for AP were two times higher than LAP. In spite of these differences in plaque mass, limulus activity in all LAP samples was consistently higher than in comparable AP samples when expressed as limulus activity per mole of amino acid. These preliminary findings suggest that subgingival LAP, situated in a position of strategic importance, is biologically active and deserves further study.     

Effects of diazeniumdiolates (NONOates) and methylene blue on the reduction of postoperative adhesion in rats

We investigated the effects of spermine NONOate (SPER/NO), diethylenetriamine NONOate (DETA/NO) and methylene blue for preventing postoperative adhesion in a rat uterine horn model. Before operations, rats were randomly assigned into 6 groups, each composed of 12 rats. These were the sham, control, normal saline, SPER/NO, DETA/NO and methylene blue groups. Each rat was anesthetized with ketamine hydrochloride (40 mg/kg i.v.). The abdominal wall was shaved; the surgical site was scrubbed with povidone iodine and rinsed with sterile saline 3 times before surgery. Under sterile conditions, a 3-cm vertical midline incision was made in all groups. In the sham group, we closed the abdominal wall without any procedure. In the other groups, a 2-cm segment of each uterine horn was injured in 10 spots on the antimesenteric surface using unipolar cautery. Before the final abdominal closure, no adjuvant therapy was administered intraperitoneally to the rats in the control group; 2 ml of normal saline solution, 1% methylene blue solution, SPER/NO (0.5 mg/ml) and DETA/NO (0.1 mg/ml) were instilled into the uterine horns of the rats in the respective groups. The incision was closed with a running 4-0 monofilament delayed absorbable suture in a single layer of muscle and fascia in a running pattern, excluding the peritoneum, and in the covering layer of skin in an interrupted pattern, in all groups. Two weeks after the surgery, all animals were killed, second laparotomies were performed, and the extent and severity of adhesions were determined by a blinded examiner. The adhesion scores of the sham group were significantly lower than those of the other groups (p < 0.05). In the methylene blue, SPER/NO and DETA/NO groups, adhesion scores were significantly lower than in the normal saline and control groups (p < 0.05). However, there were no significant differences related to the extent and severity scores of adhesions between the methylene blue, SPER/NO and DETA/NO groups (p > 0.05). This study showed that SPER/NO, DETA/NO and methylene blue administered at the end of surgery reduced the adhesion formation in a rat uterine horn model.