Global fibrinolytic capacity in children on dialysis

Disturbances of coagulation and fibrinolysis have been reported in patients with chronic uremia. Studies of different coagulation and fibrinolysis parameters in regularly dialyzed patients have yielded conflicting results. Global fibrinolytic capacity (GFC) examines the function of the entire fibrinolytic system. This assay is a sensitive and reliable method for evaluating the fibrinolytic function of plasma in vitro. In this study, GFC was used as a screening test to investigate the effects of two different dialysis modalities on the fibrinolytic system on children on long-term dialysis. MATERIALS AND METHODS: The study included 12 children (age range, 11-20 years; mean age, 15.9+/-3.3 years) who were undergoing regular hemodialysis (HD) and 12 children (age range, 10-15 years; mean age, 13.1+/-1.7 years) who were undergoing continuous ambulatory peritoneal dialysis (CAPD). Thirteen healthy age- and sex-matched subjects served as controls. Each sample was investigated for complete blood count and serum levels of C-reactive protein, serum electrolytes, total cholesterol, triglyceride, fibrinogen, total protein and albumin. A GFC assay was also done in each case. RESULTS: The mean GFC in the CAPD group was lower than that in the HD and control groups (p<0.05). There was no significant difference between the mean GFC values of HD patients and controls. The mean serum albumin level was lower in CAPD patients than in HD patients (p<0.05), and there was also a positive correlation between serum albumin level and GFC in patient groups(r=0.52, p<0.05). Global fibrinolytic capacity was positively correlated with hemoglobin level and negatively correlated with weekly erythropoietin dose per kg body weight (r=0.56 and r=-0.49, respectively; p<0.05). CONCLUSION: The results suggest that CAPD patients have decreased fibrinolytic capacity compared to HD patients. Hypoalbuminemia and erythropoietin treatment may contribute to suppression of fibrinolytic function CAPD patients.     

Cerebrospinal fluid superoxide dismutase and serum malondialdehyde levels in patients with aneurysmal subarachnoid hemorrhage: preliminary results

OBJECTIVES: Experimental studies provide evidence that oxidative damage plays a role in the development of vasospasm after aneurysmal subarachnoid hemorrhage (SAH) but data from human studies is still limited. The purpose of this study was to investigate the time course of cerebrospinal fluid (CSF) superoxide dismutase (SOD) and serum malondialdehyde (MDA) changes in patients with aneurysmal SAH. METHODS: SOD in CSF and MDA in the serum were detected on days 1-3, 5 and 7 after aneurysmal SAH in 21 patients, and the results were compared with 15 patients with hydrocephalus. The results were also compared with those of clinical parameters including the patient's outcome at 6 months. RESULTS: The mean CSF SOD levels were lower and serum MDA levels were higher than the controls. Patients with a high amount of blood within the cisterns had a trend to decreased SOD while increasing MDA levels. CONCLUSION: These preliminary results suggest that the levels of antioxidants are decreased after the onset of SAH in the early period, possibly because of increased oxidative stress. Reactive oxygen-mediated oxidative damage may play an important role in inflammation after SAH.     

Inflammatory pseudotumour of the sigmoid colon mesentery: US and CT findings (2004:12b)

The concept of inflammatory pseudotumor has evolved from meticulous pathological studies; some of its histological features resemble a spindle-cell sarcoma. Despite the fact that it usually affects children and young adults, only limited numbers of childhood cases have been reported in the pediatric literature. Recognition of this rare entity is important because the clinical manifestations and radiological features may be indistinguishable from a malignant lymphoproliferative disorder. This entity has been reported to be anywhere in the body, including a variety of intra-abdominal organs. Although one of the most common intra-abdominal sites is the mesentery, localization within the mesentery of the sigmoid colon is particularly rare. We present a case of abdominal inflammatory pseudotumor of the sigmoid colon mesentery, defining its radiological and primarily ultrasound and Doppler ultrasound findings, with a review of additional examples from the literature.     

Reference Values for Valve Circumferences and Ventricular Wall Thicknesses of Fetal and Neonatal Hearts

To evaluate valvular stenosis, cardiac dilation, and/or cardiac hypertrophy, measurements of valve circumference and ventricular wall thickness are of importance. To establish reference values in fetuses and neonates, we reviewed pathology reports at Women and Infants Hospital from 1978 through 2002 and found measurements in 776 cases that were suitable for analysis. Gestational ages (GA) ranged from 15 to 42 wk. The tabulated data include the mean, standard deviation, and 10th and 90th percentile values for foot length, body weight, body length, heart weight, valve measurements, and ventricular wall thicknesses for each week of GA. In cases in which clinical dating is not reliable, we estimated the GA by the mean value nearest that of the observed foot length. All linear measurements increased in a linear fashion throughout the second and third trimesters of development. The circumferences of cardiac valves at all ages, in descending order of magnitude, are: tricuspid, mitral, pulmonary, and aortic. Mean left ventricular (LV) wall thickness is greater than mean right ventricular (RV) wall thickness throughout gestation. The tables offer a means of determining valvular stenosis, or cardiac dilation and/or hypertrophy, based on various gestational ages.     

Experimental sinusitis in a rhinogenic model

OBJECTIVES/HYPOTHESIS: The objectives were to determine the optimal sinusitis induction period and to examine microbiological and histopathological changes of sinusitis recovery stage in a rhinogenic sinusitis model. METHODS: A synthetic sponge was inserted into the right-side nasal cavities of rabbits. The sponge was impregnated with a Streptococcus pneumoniae strain in group 1 and with sterile saline solution in groups 2 and 3. After the fourth day of sponge insertion, sinuses were examined by coronal computed tomography scans at two-day intervals until any radiological evidence of sinusitis was observed. When sinusitis was detected radiologically, five rabbits each from groups 1 and 2 were killed for histological examination. To determine the recovery period of sinusitis, sponges were removed from the rest of the rabbits in groups 1 and 2. Rabbits were selected randomly and killed on the 15th and the 30th days of the recovery period, immediately after radiological examinations. Group 3 was considered a sham group. RESULTS: Sinusitis induction was performed in all rabbits in groups 1 and 2 until the 8th day. After the sponges were removed, inflammation persisted until the 30th day of the study. CONCLUSION: In a rhinogenic sinusitis model, although histological features of sinusitis were demonstrated, further studies are required to standardize this model and to examine whether or not the studied bacterial strain spreads from nasal cavity into sinus.     

Efficacy of intraperitoneal cisplatin as consolidation therapy in patients with pathologic complete remission following front-line therapy for epithelial ovarian cancer. Consolidative intraperitoneal cisplatin in ovarian cancer

OBJECTIVE: The aim of this study is to evaluate the efficacy of intraperitoneal cisplatin as consolidation treatment in epithelian ovarian cancer patients with complete pathologic response following front-line platin-based chemotherapy. PATIENTS AND METHODS: Thirty patients who had no evidence of disease as assessed by second-look laparotomy following chemotherapy for stage III epithelial ovarian cancer were given three courses of intraperitoneal cisplatin (100 mg/m(2)) with three weekly intervals as consolidation therapy. RESULTS: Median age was 50 years. After a median follow-up period of 37 months, 16 patients are being followed with no evidence of disease. Eleven patients developed recurrent disease. Median disease-free survival was 50 months. Median overall survival is not reached. WHO grades 3-4 toxicity criteria were emesis in 19 patients (63.3%), abdominal pain in 5 (16.7%) and nephrotoxicity in 2 (6.7%) patients. Catheter-related complications were infection/peritonitis in one and catheter malfunction in one patient. There were no serious hematologic side effects that required transfusions or caused treatment delays. None of the patients developed serious neurologic toxicity. Treatment had to be stopped early in four patients who refused further treatment due to abdominal pain, nausea ::and vomiting. Dose reductions were required in five patients.CONCLUSION: Our results suggest that intraperitoneal cisplatin is a feasible regimen that may provide a favorable outcome in terms of progression-free survival in patients with a complete pathologic response following front-line treatment for ovarian cancer. Further randomized trials are required to evaluate the role of consolidation treatment in this setting.     

Pregnancy after preimplantation genetic diagnosis for Sanjad-Sakati syndrome

Sanjad-Sakati syndrome (SSS) is an autosomal recessive disorder characterized by congenital hypoparathyroidism, growth and mental retardation. In Saudi Arabia, the disease is caused by a deletion of 12 bp (155-166nt) in the tubulin-specific chaperone E gene. In a family with two affected siblings with SSS, preimplantation genetic diagnosis (PGD) was performed. Fluorescent PCR (F-PCR) was utilized to check the heterozygosity and the homozygosity status of the parents and the affected children, respectively. F-PCR was then optimized for single-cell analysis by using peripheral blood lymphocytes. The patient underwent a cycle with intra-cytoplasmic sperm injection. A total of 11 embryos were obtained and biopsied. There were five heterozygous, three homozygous affected and three normal embryos. One heterozygous and one normal embryo were transferred because of their very good quality (morula). A singleton pregnancy was obtained, and amniosynthesis confirmed the presence of the heterozygous fetus. These results show for the first time, the feasibility of PGD for SSS.     

Hormonal regulation of implantation

Implantation is a complex process that requires synchronization between the embryo and a receptive endometrium. Hormones, such as the female sex steroids, prostaglandins, and peptide hormones, regulate the cellular and molecular mediators of endometrial receptivity, which include pinopodes, cell adhesion molecules, cytokines, homeobox genes, and growth factors. These mediators can be altered, despite the presence of normal hormone levels and endometrial histology; this limits the usefulness of the luteal phase endometrial biopsy. Therefore, analysis of markers of endometrial receptivity may predict successful implantation better. Elevated androgen and estrogen levels, as seen with polycystic ovary syndrome and controlled ovarian hyperstimulation, respectively, also can have detrimental effects on the endometrium, and therefore, implantation.     

Gamma probe localization of cranial bone lesions: technical note

BACKGROUND: Intraoperative localization of cranial bone lesions may be challenging especially when the lesion is not well demonstrated on computed tomography (CT) scan but solely on a radio-isotope bone scan. We hereby demonstrate a technique for localizing such lesions using an intraoperative gamma probe reader and summarize the relevant literature. METHODS: A case report of a temporal osteoid osteoma causing local pain and unresponsive to conservative treatment is presented. The lesion was demonstrated preoperatively solely on a bone scan, and was intra-operatively localized by a gamma probe reader. RESULTS: The lesion was totally excised with normal background readings after lesion removal. Six months after total removal of the osteoid osteoma, the patient is asymptomatic. CONCLUSION: Intraoperative gamma probe reader is a simple, effective, and safe method for intra-operative localization of bone lesions, which are positive on bone scans. It is especially useful for skull lesions that are not demonstrated by other imaging methods.     

Chest wall lipoblastoma in a seven-month-old girl: a case report

Lipoblastoma is a rare benign tumor of adipose tissue seen almost always in infanthood and early childhood. It is typically located in the extremities and the trunk and less frequently in the head-neck region, mediastinum, and retroperitoneum. However, cases of pleural, thoracic wall, and pulmonary lipoblastoma have also been reported in the literature. Lipoblastoma is a tumor with good prognosis despite its potential for local invasion and rapid growth. Our patient is a 7-month-old girl who was brought to our clinic for a rapidly growing mass in the right hemithorax. With the aim of both diagnosis and treatment, the mass was removed by thoracic wall resection and the resultant defect covered with an absorbable polyglactine mesh. The excised mass was diagnosed pathologically as a benign lipoblastoma. In the postoperative period, the thorax wall was stable, and after 24 months of follow-up no recurrence was observed. In the literature, 4 types of thoracic wall lipoblastomas have been reported, but thoracic wall resection has not been applied in any benign lipoblastoma case. To the best of our knowledge, the only benign lipoblastoma case in which a thoracic wall resection was carried out, with its clinical and histopathologic specifications alongside that in the literature, is presented here for the first time.