The conditions for which the geometric mean method revealed a more accurate calculation of relative renal function in 99mTc-DMSA scintigraphy

AIMS: (1) To compare the results of calculating relative renal function (RRF) by using only posterior images (POST) with the geometric mean (GM) through both anterior and posterior imaging on dimercaptosuccinic acid (DMSA) scintigraphy. (2) To determine whether there was an age-related difference between them and whether some renal pathologies or asymmetrical renal function cause an error in the RRF calculation by using posterior images only. METHODS: Eight hundred and ninety-one DMSA scans were studied retrospectively. The patients were divided into five age groups: group I, < or =2 years; group II, >2 to < or =5 years; group III, >5 to < or =10 years; group IV, >10 to < or =18 years; and group V, >18 years. The RRF of the right kidney (RKF) was calculated from the POST and GM counts. The differences between RKFGM and RKFPOST were calculated in all the patients. RESULTS: Among the 891 patients, nine had malrotated or malpositioned kidneys, 373 had renal pathologies of pyelonephritis, hydronephrosis, cortical scarring and atrophy, 247 had asymmetrically functioning kidneys and 509 had normal kidneys. When the patients were analysed according to different age groups, significant differences were found between all groups (P<0.05) except groups I-II and IV-V (P>0.05) with the F-test. The clinically meaningful RRF variance (> or =5% difference between two methods) rate differed significantly between groups I, II and III, and groups IV and V (chi-squared test, P<0.05). In patients aged < or =10 years, a clinically meaningful RRF variance (> or =5%) rate was significantly higher in the groups with pathological or asymmetrically low (< or =40% RRF) functioning kidneys than in the groups without pathological or asymmetrically low functioning kidneys, respectively (P<0.05). CONCLUSIONS: According to our findings, the calculation of RRF using the GM method differs significantly from that using posterior images. Calculation of the GM can effectively correct the RRF measurement not in only adults, but also in the patient population musical #10 years of age. In addition, a significant correction can be made in patients aged musical #10 years who have a renal pathology or an asymmetrically low functioning kidney.     

Hospital-acquired infections in elderly patients: results of a West Anatolian University Hospital surveillance

The objective of this study was to determine the frequency and the pattern of hospital-acquired infections (HAIs) in elderly (age over 65) patients, using routine surveillance data collected by the infection control committee in Dokuz Eylül University Hospital. In this study, 199 elderly patients diagnosed with HAIs in the years of 1999-2000 were included. During this period, 22.7% of all patients who had HAI were over 65 years old. The incidence rate of HAI in elderly patients was 1.2%, increasing with age. The most common types of HAIs were surgical site infections, septicemia, lower respiratory tract infections and urinary tract infections.     

Genetically heterogeneous selective intestinal malabsorption of vitamin B12: founder effects, consanguinity, and high clinical awareness explain aggregations in Scandinavia and the Middle East

Selective intestinal malabsorption of vitamin B(12) causing juvenile megaloblastic anemia (MGA; MIM# 261100) is a recessively inherited disorder that is believed to be rare except for notable clusters of cases in Finland, Norway, and the Eastern Mediterranean region. The disease can be caused by mutations in either the cubilin (CUBN; MGA1; MIM# 602997) or the amnionless (AMN; MIM# 605799) gene. To explain the peculiar geographical distribution, we hypothesized that mutations in one of the genes would mainly be responsible for the disease in Scandinavia, and mutations in the other gene in the Mediterranean region. We studied 42 sibships and found all cases in Finland to be due to CUBN (three different mutations) and all cases in Norway to be due to AMN (two different mutations), while in Turkey, Israel, and Saudi Arabia, there were two different AMN mutations and three different CUBN mutations. Haplotype evidence excluded both CUBN and AMN conclusively in five families and tentatively in three families, suggesting the presence of at least one more gene locus that can cause MGA. We conclude that the Scandinavian cases are typical examples of enrichment by founder effects, while in the Mediterranean region high degrees of consanguinity expose rare mutations in both genes. We suggest that in both regions, physician awareness of this disease causes it to be more readily diagnosed than elsewhere; thus, it may well be more common worldwide than previously thought.     

Bcl-2, iNOS,p53 and PCNA expression in normal,disordered proliferative,hyperplastic and malignant endometrium

We attempted to determine Bcl-2, inducible nitric oxide synthase (iNOS), p53 and proliferating cell nuclear antigen (PCNA) expression, and the relationships between them, in endometrioid adenocarcinomas and precursor lesions. Expression of Bcl-2, iNOS, p53 and PCNA were investigated immunohistochemically in 91 samples from benign (proliferative (pEM), secretory (sEM), disordered proliferative (dEM), inactive/atrophic (aEM), hyperplastic endometrium) and malignant endometrial tissue. Staining scores for Bcl-2 in the dEM, endometrial hyperplasia (EMH) and endometrioid cancer (ECA) groups were higher than in the pEM group (P = 0.004; P = 0.036 and P = 0.020, respectively). A significant difference in proliferating cell nuclear antigen staining was found between simple and complex EMH samples (P = 0.000). An inverse relationship was found between iNOS and p53 in the hyperplasia group (r = -0.533, P = 0.019). While a significant difference was found in p53 staining in ECA between the pEM, dEM and EMH groups, no such difference was found in iNOS staining. In addition, there was no direct relationship between iNOS and p53 in the ECA group. It was concluded that the interaction between iNOS, p53 and Bcl-2 in proliferative processes in the development of type 1 endometrioid adenocarcinomas is different from that in tumors originating in other organs.     

Coexistence of chronic neutrophilic leukemia with multiple myeloma

A case report of simultaneous presentation of chronic neutrophilic leukemia and multiple myeloma (IgG kappa) in a 71-year-old male is described. The patient showed mature neutrophilic leukocytosis, hepatosplenomegaly, high neutrophil alkaline phosphatase score, hyperuricemia, neutrophils with toxic granulation and D?hle bodies, absence of Philadelphia chromosome and of the bcr-abl fusion gene. Moreover, a monoclonal IgG kappa paraproteinemia (36.93 g l(-1)) was detected. Bence-Jones proteinuria was 3.84 g l(-1). The bone marrow was grossly hypercellular with marked myeloid hyperplasia and aggregates of plasma cells. The patient died of severe bronchopneumonia after the transformation of chronic neutrophilic leukemia to acute myelomonocytic leukemia, 1.5 years following diagnosis.     

Comparison of the efficacy of local corticosteroid injection and physical therapy for the treatment of adhesive capsulitis

Adhesive capsulitis is a common musculoskeletal disorder mainly affecting middle aged adults. It is associated with generalized pain and tenderness in the shoulder joint with severe loss of active and passive ranges of motion in all planes. The aim of this study was to compare the efficacy of local steroid injection and physical therapy measures for treating this disorder. Ten male and 10 female patients were enrolled in the study. The patients were divided randomly into two groups and treated with either 40 mg methylprednisolone acetate injection with local anesthetic (group A) or physical therapy measures plus nonsteroidal anti-inflammatory drugs (group B). The mean ages of the patients were 55.6+/-12.2 years in group A and 56.4+/-7.1 years in group B. Clinical assessment was performed on initial visit and at the 2nd and 12th weeks. Active and passive range of motion was recorded and the visual analogue scale was used to evaluate pain intensity. At initial visit, these data in both groups of patients were not statistically different. Although both treatment regimens resulted in significant improvement in range of motion, the differences between mean external rotation at the 2nd and 12th weeks were not statistically significant in either group. The improvement in range of motion at the end of the study was similar in both groups (P>0.05). All patients reported improvement during the study. The differences between mean VAS scores at the 2nd and 12th weeks were statistically significant in both groups. In conclusion, local steroid injection therapy was found to be as effective as physical therapy for the treatment of adhesive capsulitis.