An alternative method of transperitoneal graft introduction in aortobifemoral bypass surgery

Aorto-iliac occlusive (AIO) disease is one of the most common forms of arteriosclerosis obliterans (ASO).1 The gold-standard treatment of this disease is aortofemoral bypass surgery, according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) study.1-3Surgeons have performed this procedure for many years with good long-term results. Vascular damage, bleeding, intestinal damage, ileus, myocardial infarction and renal failure are considered short-term complications. Secondary aorto-enteric fistula, sexual dysfunction, infection, graft thrombosis and anastomotic pseudo-aneurysm may be considered long-term complications.4-6 Among these complications, vascular damage, intestinal damage and aorto-enteric fistulae usually occur while introducing the graft into the femoral area.If the tunneller, which was specifically designed for aortofemoral bypass procedures, is not available for some reason, long, blunt-tipped tunnelling forceps are used instead. A nylon tape is taken through the tunnel with the tunnelling forceps after the tunnel is created. Aortic anastomosis is performed after heparinisation.Connecting the distal ends of the graft to the femoral area is performed in the conventional method by introducing the forceps into the tunnel a second time and pulling the graft through the tunnel. In an alternative method, the nylon tape that is taken through the tunnel with the tunnelling forceps is tied to the graft, which is pulled through into the femoral area. By not introducing the forceps a second time into the tunnel, complications caused by the forceps may be reduced. The results of both methods were analysed for postoperative bleeding, vascular injury and intestinal complications.     

Unique presentation of blastic plasmacytoid dendritic cell neoplasm: a single‐center experience and literature review

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and highly aggressive hematological malignancy derived from precursors of plasmacytoid dendritic cells. Very few cases of BPDCN have been described with lack of skin manifestations at the time of diagnosis. Here we report two rare non‐cutaneous presentations of BPDCN without obvious skin lesions at our institution and also the literature review. Our first patient had a unique presentation of BPDCN confined to the sinonasal region with central nervous system involvement. The second patient we report is also atypical with regard to widespread disease that uncharacteristically spared the skin and bone marrow. BPDCN is a rare hematological malignancy involving immature plasmacytoid dendritic cells. It poses a diagnostic challenge requiring multidisciplinary approach to manage this disease. It is important to identify effective therapies for both cutaneous and non‐cutaneous presentations of BPDCN, since most cases are uniformly fatal with conventional chemotherapy alone. High‐dose induction therapy based on acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) regimens, to achieve complete remission followed by allo‐hematopoietic stem cell transplantation from related or unrelated donors is recommended to improve long‐term survival in these patients. Larger scale studies are warranted to understand the pathophysiology of the disease and the important prognostic indicators for optimal management. Copyright © 2014 John Wiley & Sons, Ltd.     

Association of tumour necrosis factor-alpha -308 G/A polymorphism with primary open-angle glaucoma

Background: Tumour necrosis factor‐alpha (TNF‐α) is an important proinflammatory cytokine driving axonal degeneration and retinal ganglion cell apoptosis in glaucoma. The aim of the study was to evaluate the association of TNF‐α ‐308 G/A and ‐238 G/A polymorphisms with primary open‐angle glaucoma (POAG). Design: A prospective, case–control study, university hospital setting. Participants: Eighty‐six POAG patients and 193 healthy unrelated controls. Methods: TNF‐α polymorphisms were screened by using direct gene sequencing. Main Outcome Measures: Frequency of TNF‐α ‐308 G/A and TNF‐α ‐238 G/A promoter polymorphisms in glaucoma and healthy subjects. Results: The frequencies of TNF‐α ‐308 GA genotype and ‘A’ allele were higher in patients with POAG (22.1% and 12.2%, respectively) in comparison with the control group (10.9% and 6%, respectively) (P = 0.046 and 0.02, respectively), with odds ratios of 2.45 (P = 0.01, 95% CI = 1.23–4.87) and 2.19 (P = 0.013, 95% CI = 1.18–4.08), respectively. Genotype distribution of the TNF‐α ‐238 variants did not yield a statistically significant difference between the two groups (P = 0.87). Conclusion: TNF‐α ‐308 G/A polymorphism seems to be associated with POAG in Turkish population. However, population‐based studies with large number of subjects and long‐term follow‐up are needed to verify the association of TNF‐α ‐308 G/A polymorphism with glaucoma susceptibility.     

Evaluation of serum interleukin-6 (IL-6), IL-13, and IL-17 levels and computed tomography finding in interstitial lung disease associated with connective tissue disease patients

Objective

Interstitial lung disease (ILD) is one of the most severe complications which is associated with connective tissue disease (CTD) and causes to morbidity and mortality. So, we aimed to determine serum levels of interleukin-6 (IL-6), IL-13, and IL-17, to investigate whether these cytokines are related to CTD-ILD, and to find their possible contribution to determining the prognosis of the disease.

Methods

A total of 150 participants, 80 patients diagnosed with CTD-ILD (mean age, 58.21?±?12.36) and 70 healthy controls (mean age, 57.07?±?9.60) were recruited from the rheumatology department between January 2016 and June 2019 in the study. High-resolution computed tomography (HRCT) findings were scored as similarly to previous studies. Serum IL-6, IL 13, and IL-17 levels were measured by ELISA test kits.

Results

The levels of IL-6, IL-13, and IL-17 in CTD patients were significantly higher than the healthy individuals (p?<?001), but the HRCT score’s relation were not determined. IL-6 was associated with disease duration and disease activity scores of DAS28, ESDAII, and dSSc. There was a significant relation between dSSc, HCRT fibrosis, and total score.CRP, hemoglobin, and platelets were associated with the HRCT inflammation pattern.

Conclusion

At the study, it has been observed that serum IL-13, IL-6 and IL-17 levels are increased in patients with CTD-ILD. Besides, IL-6 was associated with disease activity scores of DAS28, ESDAII, and dSSc. Also, HRCT fibrosis score is associated with dSSc. Further and comprehensive studies are needed to understand better the complex intersection of lung disease with systemic autoimmunity.

Cold restraint stress-induced gastric mucosal dysfunction role of nitric oxide

The objectives of this study were to determine the cold restraint stress-induced changes in gastric mucosal permeability and to assess whether nitric oxide synthesis inhibition affects gastric mucosal integrity after cold-restraint administration. Cold-restraint stress caused multiple gastric lesions in 90% of animals. The lesion index was found to be 3.87 ± 0.97 mm. Gastric mucosal permeability to the [⁵¹Cr]EDTA molecule was significantly elevated in the cold-restraint group compared to control. In order to evaluate the role of nitric oxide in cold restraint stress-induced gastropathy,l-arginine analogN ^G-nitro-l-arginie methyl ester (l-NAME) was given as a bolus (10 mg/kg, intravenously) and infused at a rate of 2 mg/ml/hr for 2 hr after cold-restraint administration.l-NAME greatly exacerbated gastric mucosal dysfunction associated with cold-restraint stress.d-NAME, the biologically inactive enantiomer, did not enhance mucosal dysfunction, whereasl-arginine, the substrate for nitric oxide, reversed the effect ofl-NAME. In an additional group of experiments, effects of cold-restraint stress andl-NAME on net transmucosal fluid flux as well as tissue myeloperoxidase activity (MPO) were assessed. Cold-restraint stress administration significantly reduced the absorptive capacity of stomach, whereasl-NAME treatment did not affect the stress-induced alterations on net fluid absorption. Furthermore,l-NAME treatment did not affect the cold restraint stress-induced changes in tissue MPO activity. Our results suggest that gastric barrier function is altered after cold-restraint stress and nitric oxide production is important in minimizing mucosal barrier dysfunction associated with cold-restraint stress administration. Our results also indicate thatl-NAME-induced alterations on mucosal permeability are not related to net transmucosal fluid flux and tissue neutrophils.Supported by a grant from the Turkish Scientific and Technical Research Council (TÜBITAK, TAG 1209).     

Increased P Wave Dispersion and Maximum P Wave Duration after Hemodialysis

Background: Atrial fibrillation is a frequent arrhythmia in patients undergoing hemodialysis. The consequences of hemodialysis on P wave durations and P wave dispersion have not been fully understood. The objective of this study was to study the effect of dialysis on P wave maximum (P_max), P wave minimum (P_min), and P wave dispersion (P_d). Methods: We studied P_max, P_min, and P_d in 32 patients (17 men and 15 women, mean age 54 ± 18 years) with chronic renal failure undergoing hemodialysis. The difference between maximum and minimum P wave duration was calculated and defined as P wave dispersion (P_d= P_max? P_min). Results: There was a significant increase in P_max at the end of dialysis compared to the beginning (98 ± 13 ms vs. 125 ± 12 ms, P < 0.001). P_min did not show any significant change (71 ± 11 ms vs. 73 ± 10 ms, P = 0.42). P_d was significantly increased at the end of dialysis (27 ± 9 ms vs. 52 ± 11 ms, P < 0.001). There was a negative correlation between serum potassium, magnesium, phosphate, blood urea nitrogen, and creatinin at the end of dialysis and P_max and P_d, respectively (P < 0.05). A weak positive correlation was found between serum calcium, bicarbonate at the end of dialysis and P_max and P_d (P < 0.05). Conclusion: Hemodialysis ends with significant increase in P wave maximum duration and P wave dispersion, which might be responsible for the increased occurrence of atrial fibrillation in these groups of patients.     

Spindle cell metaplasia in follicular adenoma of the thyroid gland: case report and review of the literature

Spindle cell tumors and reactive proliferations of the thyroid gland are rarely reported. In this report, we described a case of follicular adenoma with spindle cell component. The spindle cell proliferation constituted more than 90% of the 4.0 cm lesion and showed fascicular pattern with focal areas of collagenous stroma and hyalinized blood vessels. There was a transition from follicle like glandular structure to fascicular pattern. There was no mitosis and necrosis. Immunoreactivity with thyroglobulin proved that the spindle cell proliferation is of follicular origin. Also strong thyroglobulin and cytokeratin positivity of glandular areas and the gradual decrease in positivity of spindle cells showed epithelial-mesenchymal transformation/spindle cell metaplasia of the thyroid. We thought that it is important to differentiate spindle cell metaplasia in follicular lesions, especially follicular adenoma, from malignant thyroid neoplasms.     

Gamma knife radiosurgery for jugular foramen schwannomas

Jugular foramen schwannomas are very rare tumors. Advances in skull base surgery have led to more aggressive resection of these tumors, but surgery may associate with development of new neurological deficits. In this report, we analyze the long-term results for 17 patients with newly diagnosed or residual/recurrent jugular foramen schwannoma who underwent gamma-knife treatment. During a mean 64?months of follow-up, magnetic resonance imaging revealed reduced tumor size in 13 cases and no size change in four cases. The tumor growth control rate was 100% and only one patient had transient hoarseness. For patients who have small- to moderate-sized jugular foramen schwannomas, gamma-knife radiosurgery is associated with good tumor control and carries minimal risk of adverse radiation effects.