Overcoming the obstacles of visualization in robotically assisted abdominal cerclage using indocyanine green

Abdominal cerclage is found to have success rates of 85–95 % with lower incidence of preterm delivery and preterm premature rupture of membranes when compared to the vaginal approach. However, since it is more invasive, its use has been limited to selected cases. Robot-assisted abdominal cerclage is a relatively new minimally invasive technique that gives the opportunity for less invasive procedures when compared to the open technique and, when compared to conventional laparoscopy, has the advantages of 3D visualization and endowristed instrumentation. The distinctive feature of our case is the use of near infrared camera system, which is a relatively new modality in robotics and, to the best of our knowledge, this is the first report in the literature that indocyanine green dye was used to help to visualize vascular anatomy during a robotic cerclage procedure in a pregnant patient.     

Treatment protocol and relapses of brucella endocarditis; cotrimoxazole in combination with the treatment of brucella endocarditis

Antibiotic treatment, surgical intervention and postoperative antibiotic regimens are recommended for the treatment of brucella endocarditis (BE). Our clinical antibiotic regimens involve a triple antibiotic regimen for treating BE before the operation. The combination of three antibiotics is continued for at least six months and until the titres of the Wright serologic test are diminished to 1:160 levels. In this study, our aim was to evaluate the effects of combined medical and surgical treatments on survival and relapse rates in the periods of mid to late terms. We investigated 13 patients who were treated between January 1993 and June 2009. Our clinical observations led us to use a combination of rifampicin (900 mg twice a day), streptomycin (12 to 16 mg/kg/24 h intramuscularly) and doxycycline (200 mg/kg twice a day); rifampicin, tetracycline (8 mg/kg three times a day) and cotrimoxazole (15 mg/kg twice a day) or rifampicin, doxycycline and cotrimoxazole regimen for treating BE before the operation. This treatment should be continued for at least six months after surgery in order to prevent relapses.     

Granulocyte-colony stimulating factor decreases the extent of ovarian damage caused by cisplatin in an experimental rat model

Objective

To investigate whether granulocyte-colony stimulating factor (G-CSF) can decrease the extent of ovarian follicle loss caused by cisplatin treatment.

Methods

Twenty-one adult female Sprague-Dawley rats were used. Fourteen rats were administered 2 mg/kg/day cisplatin by intraperitoneal injection twice per week for five weeks (total of 20 mg/kg). Half of the rats (n=7) were treated with 1 mL/kg/day physiological saline, and the other half (n=7) were treated with 100 µg/kg/day G-CSF. The remaining rats (n=7, control group) received no therapy. The animals were then euthanized, and both ovaries were obtained from all animals, fixed in 10% formalin, and stored at 4℃ for paraffin sectioning. Blood samples were collected by cardiac puncture and stored at -30℃ for hormone assays.

Results

All follicle counts (primordial, primary, secondary, and tertiary) and serum anti-Müllerian hormone levels were significantly increased in the cisplatin+G-CSF group compared to the cisplatin+physiological saline group.

Conclusion

G-CSF was beneficial in decreasing the severity of follicle loss in an experimental rat model of cisplatin chemotherapy.     

High-output cardiac failure in a fetus with thanatophoric dysplasia associated with large placental chorioangioma: case report

Placental chorioangioma is an angioma arising from chorionic tissue. Fetal thanatophoric dysplasia is a lethal skeletal dysplasia due to mutation of fibroblast growth factor receptor 3 gene. These two conditions are rare and their coexistence in a given fetus is even rarer. We present a case of a fetus with thanatophoric dysplasia having high-output cardiac failure due to a large placental chorioangioma.     

Optimal timing of adjuvant treatment in patients with early breast cancer

It is well established that adjuvant treatment reduces mortality after early breast cancer. However, the optimal timing of adjuvant treatment is not well described. To determine the optimal timing of adjuvant treatment, 402 breast cancer patients who received adjuvant treatment at Ankara Oncology Research and Training Hospital between January 1995 and August 2002 were evaluated retrospectively. Three hundred and fifty-seven (88.8%) patients received adjuvant chemotherapy, 204 (50.7%) of these patients received only adjuvant chemotherapy and 153 (38%) patients received tamoxifen following chemotherapy. Remaining 45 (11.2%) patients received only adjuvant tamoxifen. The median time to start adjuvant treatment after surgery was day 21 (range, days 4 to days 258), and the median follow-up was 50 months (range, 6–105 months). The patients were divided into 5 groups according to starting time of chemotherapy (shorter than 14 days, between days 15–29, between days 30–44, between days 45.?59 and more than 59 days). Overall survival (OS) and disease-free survival (DFS) were not shown significantly different between for 5 groups (P > 0.05). Secondly, patients were divided into two groups as starting adjuvant treatment equal to or shorter than 44 days and longer than 44 days (n = 344, 85.6% and vs. n = 58, 14.4%, respectively). OS was significantly better in patients who started to receive adjuvant treatment within 44 days after surgery compared to patients who received adjuvant treatment after 44 days (92 vs. 83.3%, P = 0.03) for 5 years, but DFS was not significantly different between two groups (83.4 vs. 82.2%, P > 0.05). According to our study, adjuvant treatment of breast cancer should be initiated earlier after surgery.     

Taurine Ameliorates Water Avoidance Stress–Induced Degenerations of Gastrointestinal Tract and Liver

We investigated the role of taurine, is a potent free radical scavenger, on water avoidance stress (WAS)-induced degeneration of the gastric, ileal, and colonic mucosa and liver parenchyma. Wistar albino rats were exposed to chronic WAS (WAS group) 2 hr daily for 5 days. After exposing animals to chronic WAS (WAS + taurine group), 50 mg/kg taurine was injected IP for 3 days. Control animals received vehicle solution only. The stomach, ileum, colon, and liver samples were investigated under light microscope for histopathologic changes. To demonstrate the topography of the luminal mucosa of the stomach, ileum, and colon, scanning electron microscope was used and for hepatocyte ultastructure transmission electron microscope was used. Malondialdehyde (MDA, a biomarker of oxidative damage) and glutathione (GSH, a biomarker of protective oxidative injury) levels were also determined in all tissues. In the WAS group, the stomach epithelium showed ulceration in some areas, dilatations of the gastric glands, and degeneration of gastric glandular cells; prominent congestion of the capillaries was apparent. In the WAS group, severe vascular congestion was observed along with degeneration of ileal and colonic epithelium. Prominent vascular congestion and dilated sinusoids, activated Kupffer cells, dilated granular endoplasmic reticulum membranes, and focal pyknotic nuclei were observed in liver parenchyma. MDA levels (stomach, P < 0.01; ileum, colon, and liver P < 0.05) were increased and GSH levels (P < 0.01) were decreased in all tissues in the WAS group compared with the control group. The morphology of gastric, ileal, and colonic mucosa and liver parenchyma in the WAS + taurine group (stomach and ileum, P < 0.05; colon and liver, P < 0.01) showed a significant amelioration when compared to the WAS group. Increased MDA and decreased GSH levels in the WAS group were ameliorated with taurine treatment. Based on the results, taurine supplementation effectively attenuates the oxidative damage of gastrointestinal mucosa and liver because of WAS induction possibly by its antioxidant effects.     

A prospective study on the clinical performance of polysiloxane soft liners: one-year results

OBJECTIVE: The aim of the present study was to evaluate the clinical performance of four denture soft liners up to 12 months. MATERIALS AND METHODS: Thirty-three edentulous patients who experienced difficulties when using hard denture bases because of changes in denture-supporting tissues were accepted for the study and randomly received Molloplast B, GC Reline Soft, Silagum Comfort, or Mollosil Plus relines. Performance of the materials was evaluated using nine criteria at 3, 6, and 12 months: physical integrity, surface detail, adhesion, color, odor, plaque accumulation, resilience, hygiene, and mucosal condition. A four-point categorized scale (1=poor, 2=fair, 3=good, 4=excellent) was used. Unscheduled maintenance events and the presence of fungal colonization were also recorded. RESULTS: The percentage of patients available at 3, 6, and 12 months were 91%, 91%, and 66%. Main reasons for dropouts and discontinuation were fractured dentures and patient dissatisfaction. At 6 months, 96% of the performance scores were good or excellent and the largest changes were observed for physical integrity, surface detail, color, and fungal colonization. Fungal colonization was the most commonly observed problem and was the only reason of failure at 12 months. CONCLUSIONS: The clinical performance of all soft liners was slightly impaired over the 12-month observation. Except for cases showing extensive fungal colonization, the observed changes in clinical performance did not necessitate remaking of the dentures. Mollosil Plus showed a performance comparable to that of Molloplast B, and the other materials had slightly lower performance especially in terms of fungal colonization.     

Chloral hydrate and/or hydroxyzine for sedation in pediatric EEG recording

Purpose: To evaluate and compare the success of chloral hydrate (CH) and hydroxyzine on sedation and assess the changes of these drugs on sleep EEG recordings. Method: Three hundred and forty-one patients (mean age: 60.92 ± 53.81 months) that were uncooperative with the EEG setup or referred for sleep EEG were enrolled in the study. Patients, partially sleep-deprived the night before, were firstly tried to fall on sleep without any medication, the patients who could not sleep spontaneously were randomly divided in two groups of hydroxyzine and chloral hydrate. Results: In 147 (43%) of cases, CH was given for sedation. In 112 (32%) hydroxyzine and in 8% of cases CH and hydroxyzine were given. 17% of children had spontaneous sleep. The doses of drugs prescribed were as follows: hydroxyzine 1.43 ± 0.74 mg/kg CH 38 ± 14.73 mg/kg. The time to go on a sleep was 34.68 ± 30.75 min in hydroxyzine and 32.34 ± 26.83 min in CH group (p > 0.05). Eighty-nine percent of cases who were sedated with CH and 89.6% of cases who sedated with hydroxyzine were able to sleep (p > 0.05). The background rhythm was faster with CH compared to hydroxyzine (p < 0.05). There were no association between the occurrence of fast background rhythm and the doses of CH. Conclusion: The study described the clinical practice of sedation with CH and hydroxyzine on EEG recording. Data suggest that CH with low doses and hydroxyzine is equally effective for sleep induction, but the side effects of CH on the sleep EEG is much more prominent.     

Contact sensitisation in patients with chronic leg ulcers

The aim of our study is to identify the allergens in patients with leg ulcers who have contact dermatitis surrounding the skin of the ulcer and compare them with a control group consisting of patients with lower extremity contact dermatitis. A total of 40 patients with chronic leg ulcers (CLU) and contact dermatitis around the skin of ulcer were included in the study. As a control group, 20 patients with contact dermatitis of lower extremity without leg ulcers were included. The patient and control groups were patch tested with 37 allergens of the European Standard Series. Of the 40 patients, 31 (77·5%) had positivity to one or more allergens, and 10 (50%) of the control group patients had positivity to one or more allergens. The number of patients who had positivity to at least one allergen was significantly higher in the patient group (P < 0·05). Positivity to the balsam of Peru and benzocaine was significantly higher in the patient group than that in the control group (P < 0·05). Contact sensitisation to benzocaine and balsam of Peru was found to be associated with the presence of CLU. The efficacy of therapy in patients with leg ulcers might be increased by avoiding these allergens.