Assessment of valvulopathy in Parkinson's disease patients on pergolide and/or cabergoline

OBJECTIVE: To assess the effect of ergot derivatives on cardiac valves in patients with Parkinson's disease (PD). MATERIALS AND METHODS: Echocardiography was performed on 46 PD patients who used either pergolide or cabergoline (MonoPD) or both (MixPD) for a minimum of 1 year and 49 age-matched healthy controls. Valvular regurgitation was graded as mild, moderate and severe. MonoPD and MixPD groups were compared with regard to demographic features, drug profile and valvulopathy. RESULTS: The PD group had a mean age of 63 years, agonist duration of 3.8 years and agonist equivalent dose of 3.5mg/day. Moderate regurgitation in all three valves was significantly more common in the PD group than the controls. Severe valvular regurgitation was not observed in either group, with the exception of one PD patient. The frequency of valvulopathy and doses of agonists did not differ between MixPD and MonoPD groups. CONCLUSION: PD patients on dopamine ergot agonists are prone to moderate valvular regurgitation more than age-matched controls. However, the frequency of valvulopathy was similar in patients who used either one or more agonists.     

The effect of chronic cadmium toxicity on blood pressure and plasma viscosity

Cadmium (Cd) is a heavy metal which affects many systems in humans and animals as a consequence of environmental and industrial pollution. The aim of this study was to investigate the effect of chronic Cd toxicity on blood pressure and plasma viscosity. Experimental group rats were given doses that contained 15 ppm CdCl(2) in drinking water for 8 weeks. The systolic blood pressure and heart rate were measured from rats' tails and recorded by plethysmography every two weeks. Blood samples were drawn, Cd levels were determined by atomic absorption spectrophotometer and plasma viscosity values by viscometer. Blood Cd levels were found to be significantly higher in the experimental group compared to the control group (p < 0.001). The whole blood analysis was made by an analyzer. Polymorphonuclear leukocytes and monocytes increased (p < 0.01) and lymphocyte number (p < 0.05) decreased in the experimental group. Viscosity values were 2.21 ± 0.54 and 1.62 ± 0.31 centipoises in the experimental and control groups, respectively (p < 0.001). In the experimental group, changes in systolic blood pressure between weeks were significant (p < 0.001) and were found to be correlated with plasma viscosity (p < 0.001). In the experimental group, changes in heart rate between weeks were significant (p < 0.001). According to our findings, Cd toxicity may lead to an increase in blood pressure by increasing plasma viscosity.     

Giant pedunculated liposarcoma of the esophagus

European Surgery - Liposarcoma is a&nbsp;common soft tissue neoplasm but its presence within the gastrointestinal system, especially the esophagus, is quite rare. It usually presents as an...     

Delay in neurovenous flaps: experimental and clinical experience

The objective of this study was to examine the effects of the standard surgical delay in the flaps based on the cutaneous branches of the vascular axis around a superficial sensory nerve. The delay procedure was experimentally tested in rats and subsequently used in patients.In the experimental study, the survival of a delayed inferior epigastric neurovenous flap was compared with that of a nondelayed inferior epigastric neurovenous flap. One type of clinically applicable delay pattern (standard bipedicled technique) was employed. A 3 x 3 cm flap was raised in 20 female Wistar rats assigned randomly to 2 groups. Each group consisted of 20 flaps. The standard bipedicled delay pattern increased the percentage survival of the delayed inferior epigastric neurovenous flap. The survival percentage of the delayed flaps was 59.8 +/- 185.0 (P < 0.5). The histologic findings of the skin revealed that our delay procedure enhanced the perfusion of the flap by dilating the arterial network.Stimulated by our experimental findings, we used the island bipedicled surgical flap delay or combined strategic-standard delay in the distally pedicled sural flap successfully on 9 cases.     

Trace elements and superoxide dismutase in benign and malignant breast diseases

This study was planned to determine the probable changes in trace elementlevels and superoxide dismutase (SOD) activity in women with neoplasticbreast diseases. Measurements were performed in three different groups. Thefirst group consisted of 20 healthy women, control group, the second groupcontained 16 patients with benign breast disease and the third groupcontained 39 patients with malignant breast disease. The trace elementconcentrations were determined by using atomic absorption spectrophotometryand SOD activity by using spectrophotometry. When compared with the controlvalues, the plasma copper levels were slightly increased in the second groupand significantly in the third group (p < 0.001). The difference betweenthe benign and malignant groups was also significant (p < 0.001). The redcell copper values showed a marked decrease in both groups (p < 0.001).Although there were increases in the plasma zinc levels of both patientgroups, the differences were not significant statistically. But, the redcell zinc values showed an significant increase in benign and malignantpatients compared to the control group (p < 0.001) (p < 0.001). Theplasma magnesium and red cell magnesium values did not show significantdifferences. The red cell SOD activity showed an significant increase in thebenign and malignant patient groups (p < 0.001). The results of thisstudy suggested that reactive oxygen metabolites may play a pathogeneticrole in both benign and malignant tumor development, which is reflected bythe change in SOD activity, and in trace element concentrations.     

Laparoscopy in Turkish Bariatric Surgery: Initial Experience

Background: The recent application of the laparoscopic method combines minimal invasiveness with reversibility, adjustability and shorter hospital stay. The first laparoscopic bariatric operation in Turkey was performed by us in 1998. Methods: We report the results in 50 consecutive patients who underwent the laparoscopic application of SAGB between April 1998 and April 1999.The operation setting was the same as for the laparoscopic antireflux procedure. After a closed CO pneumoperi2 toneum (16-18 mmHg), in the first 20 cases five and in the remaining 30 cases four trocars were inserted. A 30°laparoscope was placed on the line between the umbilicus and the xiphoid through a 10 mm trocar.We followed and respected the main steps of the operation as well. Pre and postoperative body weight (BW), body mass index (BMI) and percent excess weight (%EW) values were calculated and compared. Results: Our early results were quite satisfactory and promising. After an average follow-up period of 1 year (range 6-18 months), the 50 patients of our laparoscopic series showed a BW of 74 kg (range 56- 112), a BMI of 29 (range 21-40), and an EW of 62% (range 22-86). Conclusion: With its lower morbidity rate, shorter hospital stay and better cosmetic results, the laparoscopic approach may be considered the first choice in bariatric surgery.     

Floating Aortic Thrombus: A Rare Cause of Acute Ischemic Stroke Necessitating Modification of Access Route for Thrombectomy

We report 2 patients with acute occlusion of middle cerebral artery successfully treated by mechanical thrombectomy performed via transbrachial access. Both patients had floating aortic arch thrombi precluding safe transfemoral access due to risk of further iatrogenic embolization. Moreover both patients were diagnosed with hypercoagulopathy secondary to lung malignancy (paraneoplastic etiology, Trousseau's syndrome) as the cause of both aortic thrombi and acute ischemic stroke. Mechanical thrombectomy in the setting of a floating aortic thrombus has been mentioned only once as part of general management of floating aortic thrombi in the whole body. To the best of our knowledge, it has never been described previously in the literature in the context of cerebral mechanical thrombectomy technique. However, the diagnosis of this entity bears clinical importance for it can modify the treatment approach. A modified transbrachial approach allowed us to treat both patients without neurologic complications and resulted in modified Rankin scores of 1 on follow-up. We advise that the cross-sectional imaging of acute stroke patients should include an evaluation of the aortic arch and should be scrutinized in detail especially in patients with possible hypercoagulable state. Flat panel computed tomography technology allowed us to obtain such an imaging study in the angiography suite.     

Detection of pulmonary nodules by multislice computed tomography: improved detection rate with reduced slice thickness

The purpose of this study was to find out if the use of 1.25-mm collimated thin-slice technique helps to detect more small pulmonary lung nodules than the use of 5 mm. A total of 100 patient examinations that allowed a reconstruction of 1.25-mm slice thickness in addition to the standard of 5-mm slices were included in a prospective study. Acquisition technique included four rows of 1-mm slices. Two sets of contiguous images were reconstructed and compared with 1.25- and 5-mm slice thickness, respectively. Two radiologists performed a film-based analysis of the images. The size and the confidence of the seen nodules were reported. We did not perform a histological verification, according to the normal clinical procedure, although it would be optimal regarding research. Statistical analysis was performed by using longitudinal analysis described by Brunner and Langer [10]. In addition, sensitivity, specificity, negative predictive value and positive predictive value were calculated for each reader using the 1.25-mm sections as the gold standard. As an index for concordance the kappa value was used. A value of p<0.05 was regarded as significant. In 37 patients pulmonary nodules were detected. Twenty-four patients showed more than one nodule; among these, 7 patients had disseminated disease and were excluded from the study. Pulmonary nodules larger than 10 mm in size were equally well depicted with both modalities, whereas lesions smaller than 5 mm in size were significantly better depicted with 1.25 mm (p<0.05). Using 1.25 mm as the gold standard, sensitivity for 5-mm reconstruction interval was 88 and 86% for observers A and B, respectively. No false-positive results were reported for 5-mm sections. Interobserver agreement for nodule detection determined for 1.25-mm reconstruction intervals showed a k value of 0.753, indicating a good agreement, and 0.562 for 5-mm reconstruction intervals, indicating a moderate agreement. Brunner and Langer [10] analysis showed significant differences for slice thickness and no significant difference between the observers. Reduced slice thickness demonstrated an improvement of small nodule detection, confidence levels, and interobserver agreement. Application of thin-slice multidetector-row CT may raise the sensitivity for lung nodule detection, although the higher detection rate of smaller nodules has to be evaluated from a clinical perspective and remains problematic about how the detection of small nodules will effect patient outcome.