A cadaver with azygos lobe and its clinical significance

Although an azygos lobe is a rare anomaly of the lung, its radiological appearance has been well defined. Clinically, the azygos lobe has been accepted as a normal variation that can simulate various diseases. However, on chest roentgenograms, this anomaly may appear to be present if there are any other pathological conditions. So, the detection of this anomaly and clarification of its precise anatomical features are important not only to differentiate this anomaly from other pathological conditions, but also to alert the surgeon to potential problems during surgery. In the present study, an azygos lobe was observed on the right lung of a 56-year-old male cadaver. Because of the clinical importance and rare occurrence, this anomaly was compared and discussed with other related articles.     

Factors affecting risk of anxiety and depression among diabetic and hypertensive patients who refer to family health centers

This cross-sectional study was carried out to investigate the factors which influence risk of anxiety and depression among diabetic and hypertensive patients who refer to family health centers. The Hospital Anxiety and Depression Scale (HADS) was applied for assessment of emotional status of the patients and the Hypertension Compliance Assessment Scale (HCAS) was applied for assessment of adherence to anti-hypertensive therapy. Of a total of 380 patients, 170 had hypertension (HT), 83 had type 2 diabetes mellitus (T2DM), and 127 had both HT and T2DM. According to HADS, 18.7% of the patients had risk of anxiety, 24.7% had risk of depression, and 12.6% had both risk of anxiety and depression. Mean HAD-Anxiety (HADS-A) score and HADS-Depression (HADS-D) score were significantly lower in the patients who had an adequate compliance to medication therapy (5.1 ± 4.1 and 3.8 ± 3.4, respectively) compared to the patients who had a low compliance to therapy (7.6 ± 4.3 and 5.8 ± 4.0, respectively) according to the Hypertension Compliance Assessment Scale (χ ² = 15.26, p < 0.01 and χ ² = 13.80, p < 0.01). Mean HADS-D score was found significantly lower among the diabetic patients with good glycemic control (3.7 ± 2.9) compared to the patients with poor glycemic control (4.5 ± 3.7) (χ ² = 25.00, p < 0.05). Anxiety and depression are among the most frequent disorders as hypertension and diabetes in primary care setting. We revealed that risk of anxiety and/or depression was greater among hypertensive and diabetic patients, consistently with the previous studies. Our study also revealed that this condition negatively affected treatment compliance in hypertensive patients and glycemic control in diabetic patients.     

Which imaging method should be used for genicular nerve radio frequency thermocoagulation in chronic knee osteoarthritis?

This study aimed to perform genicular nerve RF neurotomy using two different imaging methods, fluoroscopy and ultrasound, and to compare the clinical effects and reliability of the two methods. Fifty patients with osteoarthritis were included in this study. Patients were randomly allocated into group 1 (fluoroscopy imaging) and group 2 (ultrasound imaging). Outcomes were measured using a pain scale (visual analog scale; VAS) and the Western Ontario and McMaster Universities (WOMAC) Index of Osteoarthritis. The application time in the ultrasound group (20.2 ± 6.4 min) was shorter than in the fluoroscopy group (25 ± 4.8 min) (p < 0.05). There was no difference in pain relief and functional status between the ultrasound and fluoroscopy groups. Decrease in VAS score and WOMAC total score in the first and third months was significant in both groups (p < 0.001). GNRFT under ultrasound guidance was easily applicable, safe and dynamic, and required no radiation to achieve the same benefit as the fluoroscopy-guided interventions.     

Pregnancy and Delivery in the Sequel of Kidney Transplantation: Single-Center Study of 8 Years' Experience

Background

Depending on hyphothalamic, hyphophyseal, and gonadal axis dysfunction, anovulatory irregular cycles occur and the probability of pregnancy decreases in the patients with chronic kidney disease (CKD). Maternal mortality and morbidity rates are increased in CKD patients; the risk of premature delivery is 70% and the risk of preeclampsia is 40% more than normal among those with a creatine level of >2.5 mg/dL.

Changes in immunological recovery in patients who received post-transplant G-CSF or GM-CSF after autologous peripheral blood stem cell transplantation (PBSCT)

In this prospective study, the effects of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) on immunological reconstitution after autologous peripheral blood stem cell transplantation (PBSCT) were investigated for 6 months. Thirty-five patients received G-CSF 5 microg/kg per day and 26 patients received GM-CSF SC 5 microg/kg per day from day 1 to leukocyte engraftment (>1000 per mm3). Peripheral blood samples were obtained on 14, 28, 100, and 180 days after transplantation for immunological evaluation. CD3+, CD4+, CD8+, CD19+, and CD56+ cells were analysed by flow cytometry. Immunoglobulin levels (IgG, IgA, and IgM) and complement levels (C3c and C4) were measured by nephelometry. Both G-CSF and GM-CSF groups were comparable with respect to age, sex, the period from diagnosis to transplantation, total nucleated cells infused, the number of CD34+ cells, conditioning regimens (TBI and non-TBI), and post-transplant infection. CD3+ and CD8+ cells on day 14 following autologous PBSCT + G-CSF were significantly higher than following autologous PBSCT + GM-CSF (p = 0.008 and p = 0.021, respectively). The number of CD4 cells and the CD4/CD8 ratio were not different at several time points between the two groups. CD19+, CD56+ cells and immunoglobulin levels showed a faster recovery pattern in the autologous PBSCT + G-CSF group. The effect of G-CSF on immune reconstitution after autologous PBSCT is more prominent than that of GM-CSF. The possible role of haematopoietic growth factor on immune recovery and its clinical importance should be investigated in further studies.     

Possible association between cockroach allergy and HLA class II antigens.

BACKGROUND: Susceptibility to the development of allergic diseases is known to be associated with genetic components, as well as environmental factors. Although the genetics of immunoglobulin E, atopy, and asthma are complex, genetic markers are needed to identify populations at risk and to plan intervention studies. OBJECTIVE: Human leukocyte antigen (HLA) class II genes play a major role in the control of immune response. We investigated the association between HLA class II alleles of DRB1 and DQB1 and the expression of atopy in cockroach-sensitive patients. METHODS: Levels of total and specific immunoglobulin E were determined. Skin prick tests were performed. HLA class II typing was performed by the Polymerase chain reaction with sequence-specific primers. Distribution of the HLA genotypes of 32 cockroach-positive atopic patients from the inner city were compared with those of 32 healthy, nonatopic controls of Turkish Caucasian origin. RESULTS: HLA class II gene analysis showed an increase of the HLA-DRB1*0701 and HLA-DQB1*02 alleles in atopic patients compared with nonatopic controls (31.3% vs 3.1% and 50% vs 15.6%, Pc < 0.036 and Pc < 0.021, respectively). Conversely, HLA-DRB1*15 allele was encountered more frequently in the control subjects. An association between cockroach sensitivity and cutaneous reactivity to other aeroallergens was observed (P < 0.001). CONCLUSIONS: It is suggested that the higher frequencies of HLA-DRB1*0701 and HLA-DQB1*02 alleles are probably related to atopy rather than an association between class II antigens and cockroach allergy in this group of polysensitized, atopic individuals. Further studies may lead to a better understanding of the genetically determined susceptibility, and evaluate the individual effects of each locus (or allele) on sensitivity to specific allergens in the Turkish population.     

A granulomatous conjunctivitis associated with Morexella phenylpyruvica in an ostrich (Struthio camelus).

The aim of study was to evaluate a case of granulomatous conjunctivitis, clinically and pathologically, in the right eye of a 2-year-old, female ostrich. A mass measuring 5 cm x 3 cm x 4 cm was removed surgically from the eye of the ostrich. Morexella phenylpyruvica was recovered from the mass. On histopathological examination, hyperplasia or squamous metaplasia in some area of conjunctival palpebra, and a granulomatous inflammation in the submucosa were observed. The lesion was described as a granulomatous conjunctivitis caused by M. phenylpyruvica. The lesion was located in the lower eyelid conjunctiva and was not only restricted to the gl. lacrimalis, but also present in the connective tissue. After excision of the mass, the ostrich was treated with topical and systemic antibiotics and corticosteroid. The ostrich recovered fully and the function of the eye appeared to be normal.     

Expression of housekeeping and immunoproteasome subunit genes is differentially regulated in positively and negatively selecting thymic stroma subsets

The expression of housekeeping and/or immunoproteasomes in isolated thymic stroma subsets has so far not been analyzed but may have important consequences for self peptide repertoires presented by MHC class I molecules during positive and negative thymic selection. Here we determined the expression of housekeeping and immunoproteasome beta subunits and of PA28 in positively and negatively selecting stroma subsets. Positively selecting cortical thymic epithelial cells (cTEC) expressed only housekeeping but no immunoproteasome beta subunit mRNA and proteins. However, immunoproteasome beta subunits could be induced in cTEC by infection with Listeria monocytogenes or injection of IFN-gamma. In negatively selecting stroma including medullary epithelial cells and dendritic cells, incomplete and low representation of housekeeping beta subunit proteins but high and complete expression of immunoproteasome beta subunit proteins suggests absence of proper housekeeping proteasomes and predominance of immunoproteasomes. Expression of immunoproteasome beta subunits in negatively selecting stroma was independent of IFN-gamma receptor as shown in knockout (KO) mice. Absence of LMP2 altered thymic selection of the MHC class I-restricted transgenic P14 TCR in KO mice. The data suggest that negative selection may primarily involve immunoproteasome peptide repertoires and that peripheral infection may influence peptide repertoires involved in positive selection.     

Electroencephalograms in Children of Alcoholic Fathers

The present study tested the hypothesis that 12-yr-old sons of alcoholic fathers will evidence an excess of fast EEG activity. Such sons have been shown to be at high risk for alcoholism. In this study, EEGs were recorded on a sample of 265 subjects who had been selected to maximize risk for deviant behavior (children of schizophrenics and children of psychopathic or character disordered parents) or selected as controls (children of normal parents). The sample included 27 children of alcoholic fathers and 258 children of non-alcoholic parents. The hypothesis was confirmed, suggesting that the biological risk for alcoholism in sons of alcoholics may relate to biological factors predisposing to alcoholism.     

Microbubbles associated with mechanical heart valves: their relationwith serum lactic dehydrogenase levels

BACKGROUND: There has been no consensus about the prevalence and mechanism of generation of microbubbles in mechanical prosthetic heart valves (PHV). The aim of this study was to determine the prevalence of microbubbles in PHV and their relation to serum lactic dehydrogenase (LDH) levels. METHODS AND RESULTS: We prospectively studied 150 normally functioning mitral PHV (98 bileaflet and 52 monoleaflet) in 150 patients with the use of transesophageal echocardiography with a multiplane 5-MHz probe. None of the patients had an aortic prosthetic valve. Blood was drawn to determine serum LDH level. None of the patients had any factors that might affect the LDH level other than the PHV-related hemolysis. Patients with spontaneous echo contrast in the left atrium that might affect the assessment of the microbubbles were excluded. We devised a method to determine the amount of microbubbles for each PHV. Microbubbles were detected in 118 (79%) of 150 PHV, including 97 (99%) of 98 bileaflet valves and 21 (40%) of 52 monoleaflet (tilting disk) valves (P <. 0001). Intraobserver variability was not statistically significant for the determination of the amount of microbubbles (z = 1.7, P =. 08). There was a strong correlation between serum LDH levels and the amount of microbubbles (rs = 0.69, P <.001). CONCLUSIONS: Microbubbles were detected in more patients than reported previously. They were found to be associated more with the bileaflet than the monoleaflet PHV. Sorin monoleaflet valves were associated with microbubbles significantly less often than the others. There was a strong correlation between serum LDH levels and microbubble counts, which suggests that hemolysis may be related to microbubble formation.