Effects of parenteral fish-oil emulsion (Omegaven) on cutaneous wound healing in rats treated with dexamethasone

BACKGROUND: The aim was to assess wound healing when parenteral fish-oil emulsion is given to rats receiving dexamethasone. METHODS: For 5 days after skin wounding, group S (control; n = 7) received saline 1 mL/kg intraperitoneal (IP); group D (n = 7), dexamethasone 0.2 mg/kg IP; and group DO (n = 9), dexamethasone 0.2 mg/kg IP plus 1 mL/kg Omegaven (Fresenius Kabi, Austria). Wound specimens were assessed for hydroxyproline level, wound depth, histology (epidermal/dermal regeneration, granulation tissue thickness, and angiogenesis), and expression of transforming growth factor-beta (TGF-beta) and platelet-derived growth factor-AA (PDGF-AA). RESULTS: Compared with D and DO specimens, controls had higher hydroxyproline (p < .01), deeper wounds (p < .05), and better histologic scores (p < .01 angiogenesis; others p < .05). There were no significant differences between the group D and DO means for hydroxyproline level, wound depth, or histologic scores (p > .05 for all). Controls had higher TGF-beta expression scores than the other groups (p < .01 for both) and a higher PDGF-AA expression score than group DO (p < .01). Groups D and DO had statistically similar TGF-beta scores, but group D had a higher PDGF-AA score (2.71 +/- 0.75 vs 1.55 +/- 0.72, respectively; p < .05). CONCLUSIONS: According to the parameters we studied, adding parenteral omega-3 and omega-6 fatty acids to the nutrition regimen of rats treated with dexamethasone does not seem to have adverse effects on wound healing, and effects on wound healing may not need to be considered when determining if these agents should be supplemented in nutrition support regimens.     

Solitary fibrous tumor of the kidney. Case report

Solitary fibrous tumors are rare spindle cell neoplasms usually arising in the pleura. They have, however, also been reported at extrapleural locations. Solitary fibrous tumor (SFT) of the kidney is rare. Despite its rarity, histological diagnosis of solitary fibrous tumor is crucial to avoid misdiagnosis with other more aggressive tumors arising in the kidney. We report a solitary fibrous tumor of the left kidney that presented as a malignant tumor in a 51-year-old woman, and include clinical and radiographic findings. The tumor was well circumscribed and composed of spindle cells in a collagenous stroma. Immunohistochemistry showed reactivity for vimentin, CD 34, BCL-2 protein and CD99. Immunohistochemical stains for cytokeratin, S-100, desmin, alpha-smooth muscle actin and HMB-45 were negative. A diagnosis of SFT was made based on light microscopy and immunohistochemistry.     

Carotid Endarterectomies With PTFE Patch Angioplasty

Surgical treatment of carotid stenosis has proved to be superior to medical treatment in many studies. However, debate continues on the issue of surgical techniques. Closure of the arteriotomy site remains to be one of these concerns. This study aims to evaluate the results of CEA with PTFE patch angioplasty in a prospective non-randomized way. Reports on 22 patients who had undergone CEA with PTFE patch angioplasty between January 1999 and September 2000 in the Medical Faculty of Istanbul University were reviewed. Follow-up studies with Duplex ultrasonography were completed. One of the patients (5%) suffered from a TIA and another one (5%) from wound haematoma. The mean operation time was 83.64 ± 34.07 min (45–160 min). No restenosis was detected during the follow-up period. Although PTFE patch angioplasty prolongs the operation period in CEA procedures, it is a safe method, which prevents the restenosis of the operated carotid artery that might make reintervention necessary.     

Collagen ultrastructure and TGF-beta1 expression preserved with aminoguanidine during wound healing in diabetic rats

Advanced glycoxidation end products have been implicated in delayed diabetic wound healing. In this study, we evaluated the effects of aminoguanidine, which is an advanced glycation and nitric oxide (NO) synthase inhibitor, on extracellular matrix protein expression, collagen configuration, and nitrite/nitrate levels in wounds of diabetic rats. Sixteen Wistar male rats were made diabetic by streptozotocin. Of these, eight rats were given AG (aminoguanidine bicarbonate (AG) (group DAG) in their drinking water, and eight rats were followed as diabetic paired controls (group D). Eight healthy rats were followed as the healthy control group (group H). At the eighth week, a 2 x 2 cm area full-thickness skin defect was created. The degree of contraction of the open wounds was evaluated for 2 weeks duration. On the 15th postoperative day, wound surface areas were measured, and wound specimens and blood samples were collected. The shrinking percentage of the wounds was small in both groups H and DAG compared with group D (p < 0.05). Similar to healthy rats, the aminoguanidine-treated diabetic rats had very strong transforming growth factor (TGF)-beta1 expression in granulation tissue and intact skin in comparison with diabetic controls. In the diabetic group, the intact skin demonstrated sparsely distributed regular collagen fibers in the granulation zone, and the regular pattern of collagen fibers was lost. In conclusion, aminoguanidine improves wound healing, restores growth factor TGF-beta1 expression, and preserves collagen ultra structure, whereas it has no prominent effect on NO levels within wound tissue in diabetic rats.     

Prevalence and risk factors of female urinary incontinence in eastern Turkey

Objectives:   To evaluate the prevalence of urinary incontinence (UI) and determine risk factors for its development in women living in eastern Turkey.
Methods:   A cross-sectional study was conducted on 2275 women aged between 17 and 80 years. A questionnaire examining demographic characteristics, parity and pelvic organ prolapse was given. Presence and types of incontinence were examined using a validated form of the Turkish version of the urogenital distress inventory questionnaire-short form (UDI-6).
Results:   A total of 1054 (46.3%) women reported involuntary loss of urine. Stress UI was present in 46% of women, whereas urge UI was detected in 43% of them. Mean age of patients with and without UI were 44.57 + 11.04 and 35.04 + 9.51, respectively. Age, total number of pregnancies and number of deliveries were shown to be significantly different in patients with and without any type of UI. Multiple logistic regression analysis of the factors revealed that age, total delivery number, pelvic organ prolapse and difficult labor were significantly associated with the presence of UI.
Conclusions:   This is the first study examining the prevalence of UI in women living in eastern Turkey. By using a validated questionnaire, several risk factors for the development of UI were determined. Pelvic organ prolapse and increased number of births were found to be two most significant ones.     

Gastroenteropancreatic neuroendocrine tumors: 10-year experience in a single center

Neuroendocrine tumors originate from neuroendocrine cells and occur in a wide spectrum from carcinoid tumors to small cell carcinomas. Although the World Health Organization determined clinical and histological features to predict prognosis for such tumors, they may not be valid on an individual basis. This study investigates the clinical, pathologic and prognostic characteristics of gastroenteropancreatic neuroendocrine tumors that presented to the Medical Oncology Outpatient Clinic, ?stanbul University, Cerrahpa?a School of Medicine from 1995 to 2006 (n = 86). The mean age of the patients was 52 ± 14 and the male-to-female ratio was 0.87. The most common site of involvement was the stomach. Midgut intestinal tumors seemed to have significant female predominance compared to hindgut intestinal tumors (P = 0.016). Most of the patients had metastatic disease with a prevalence of 34.9%. Poorly differentiated tumors and mixed neuroendocrine carcinomas were significantly larger than 2 cm (P = 0.0001). The median survival was 139 months and the highest mortality was for colorectal tumors (36%). While univariate analysis revealed that the number of lymph nodes (P = 0.008), multiple foci (P = 0.034), metastases (P = 0.022) and stage (P = 0.034) correlated significantly with survival, there was no independent variable in the multivariate analysis. Hindgut tumors had significantly more Ki-67, mitosis and necrosis compared to others (P ≤ 0.05). In this retrospective study, the clinical, pathologic and prognostic characteristics of gastroenteropancreatic tumors from a single center from Turkey were analyzed and compared with the current medical literature.     

Observer Variability of the Breast Imaging Reporting and Data System (BI-RADS) Lexicon for Mammography

AIM: We aimed to determine the inter- and intra-observer variabilities between breast radiologists and a general radiologist in categorizing mammographic lesions using the Breast Imaging Reporting and Data System (BI-RADS), and to evaluate the effects of the histopathologic results on the variability. METHODS: Mammograms from 142 women who underwent biopsy were evaluated. 3 breast radiologists (2 with >10 years experience and 1 with 1 year experience) and 1 general radiologist retrospectively reviewed mammograms twice within an 8-week interval. Inter- and intra-observer variabilities were assessed with Cohen's kappa statistic, and the positive predictive value for final assessments was calculated. RESULTS: The intra-observer variability for mass and calcification assessments was moderate to almost perfect (kappa values: 0.41-1) for breast imagers and was fair to substantial for the general radiologist (kappa values: 0.21-0.8). Inter-observer agreement between the breast imagers was higher than between the breast and general radiologists. There was no apparent difference in agreement between observers for malignant and benign subgroups. CONCLUSIONS: The differences in intra- and inter-observer agreement between the breast imagers and the general radiologist affirm the utility of the BI-RADS lexicon. The histopathologic results of the lesions do not affect the agreement. BI-RADS is a simple and adequate tool for assessing mammograms, even after only 1 year of training.     

Topographic abnormalities in event-related potentials in children with monosymptomatic nocturnal enuresis

AIMS: A functional maturational delay in the central nervous system is dwelled upon in the pathogenesis of monosymptomatic nocturnal enuresis (MNE). In this study we studied whether according to controls N200 and P300, components of the event-related potential (ERP), which is related to aspects of cognitive processing, showed any difference in its topographic distribution in children within the age group 10-13 with monosymptomatic nocturnal enuresis and discussed its relation to the pathogenesis of MNE. METHODS: We performed P300 in 18 patients with MNE and in 16 age-matched healthy subjects. P300 were evoked by an auditory oddball paradigm consisting of 150 tone bursts (80% 1 kHz; 20% 2 kHz). The latencies of the N200 and the P300 waves and the amplitude of the P300 wave were measured. RESULTS: There was no statistical difference between the enuretic group and the controls in N200 and P300 latency and amplitude in the midline frontal (Fz), central (Cz), and parietal (Pz) recording site of the 10-20 International System. In the enuretic group while P300 amplitude in the Fz site was significantly less than the P300 amplitude in the Cz site, there was no statistical difference between the Fz and Pz P300 amplitude values. CONCLUSIONS: When different levels of maturational delay are considered in MNE, it may be claimed that maturational delay in children whose enuresis lasts until older ages will be different from those whose enuresis ends at an early age. The determination of P300 amplitude in parietal records being less in enuretics when compared to the controls may show that there are regional differences in stimuli processing rate/quality.     

Is every chronic low back pain benign? Case report

BACKGROUND: There is a well-recognized association between chronic back pain and the existence of an AAA. In literature, there are few reported AAA cases that describe patients with extensive pressure erosion of the vertebral body. CASE DESCRIPTION: The authors present the case of a 38-year-old woman with chronic low back pain for the last 2 years in whom an AAA was formed during the follow-up period. The patient presented with an episode of low back pain following hard work 2 years ago. MR imaging of the lumbar spine was reported as disc degeneration at the L4-5 and L5-S1 levels. She was given medical treatment and was doing well with occasional back pain for a year. One year later, she suffered another disabling pain attack, and MR imaging revealed an additional focal disc protrusion at the L4-5 level. She was again medically treated. In August 2004, she presented with severe low back pain, and this time, MR imaging showed edema and erosion at the anterior part of L3 vertebra body. MR imaging studies (2- and 3-dimensional) depicted AAA as the cause. She was operated on, and the aneurysm was resected with graft repair of the site. She was pain-free in the postoperative period. CONCLUSIONS: The evaluation of a patient with chronic back pain needs a thorough clinical and radiological workup. Limited evaluation of the bony and nervous structures of the spinal canal radiologically is insufficient. Pre- and paravertebral structures as well as vertebral body should carefully be evaluated to diagnose other causes of pain.