Hybrid coronary revascularization in high-risk patients

From January 2002 through June 2004, 17 patients (2% of all coronary cases) were treated with off-pump coronary artery bypass grafting combined with percutaneous coronary intervention. There were 13 men and 4 women, whose ages ranged from 54 to 78 years (mean, 63.1 +/- 20.9 yr). Preoperative angiography revealed 2-vessel coronary artery disease in 12 patients and 3-vessel disease in the remaining 5 patients. In all patients, extensive lesions (>50%) in the circumflex and right coronary arteries were treated first with a percutaneous intervention, followed by beating-heart coronary artery bypass grafting within 3 hours to treat the remaining obstructed vessels. Coronary angiography was performed 12 months after the operation to evaluate the effectiveness of the procedure. Procedure-related complications did not occur, and there was no in-hospital death. All patients underwent a successful left internal mammary artery-left anterior descending artery anastomosis with the exception of 1 patient, in whom we used a saphenous vein because of previous chest radiotherapy. The postoperative courses were uneventful, and no deterioration of preoperative organ dysfunction was noticed in any patient. There was no cardiac-related death or myocardial infarction. In follow-up angiography, all left internal mammary artery-left anterior descending artery anastomoses were patent. Three patients with restenosis were treated medically, which resulted in substantial reduction of angina. Hybrid coronary revascularization enables complete revascularization and may be an alternative method of treating selected patients who have concomitant disease.     

Fosfomycin in the treatment of extended spectrum beta-lactamase-producing Escherichia coli-related lower urinary tract infections

Fosfomycin tromethamine (FT) is effective in vitro in extended spectrum beta-lactamase (ESBL)-producing Escherichia coli strains. The aim of this study was to evaluate the effect of FT in the treatment of ESBL-producing E. coli-related lower urinary tract infection. All patients were aged >18; had dysuria or problems with frequency or urgency in passing urine; had >20leukocytes/mm(3) in urine sediment and an ESBL-producing E. coli urine culture (>10(5)cfu/mm(3)); no leukocytosis or fever; and were treated with FT between September 2004 and July 2006 in our outpatient clinic and hospital. ESBL detection was performed by double disk synergy tests. All patients had received FT (3gx1 every other night, three times) and had a control urine culture taken 7 to 9 days after this therapy. Clinical success was defined as resolution of symptoms on the control visit; microbiological success was defined as a sterile control urine culture. In all, 52 patients (aged 55.0+/-18.3, range 19-85; 25 males, 27 females) were included in the study. Overall clinical and microbiological success was 94.3% (49/52) and 78.5% (41/52), respectively. Although it is not a randomized controlled study, these data show that FT may be a suitable, effective and cheap alternative in the treatment of ESBL-producing E. coli-related lower urinary tract infection.     

Bolton tooth size discrepancies in skeletal Class I individuals presenting with different dental angle classifications

The objective of this study was to investigate the frequency and association of Bolton tooth size discrepancies with dental discrepancies. Forty-eight skeletal Class I, 60 Class II, and 44 Class III subjects with similar skeletal characteristics were included in this study. Analysis of variance was performed to compare the mean ratios of Bolton analysis as a function of the Angle classification and sex. To determine the prevalence of tooth size imbalances among the three groups of occlusions and the two sexes, chi-square tests were performed. To determine the correlation of tooth size imbalances with certain dental characteristics, Pearson's correlation coefficients were calculated. No statistically significant differences were determined for the prevalence of tooth size discrepancies and the mean values of Bolton's anterior and overall ratios among the occlusal groups and sexes. Bolton's anterior ratio discrepancies had significant correlations with midline shifts (P < .05) in Angle Class I cases, with U1-SN angle (P < .01) in Angle Class II cases, and with L1-APog distance (P < .05) in Angle Class III cases. Bolton discrepancies related to overall ratio had significant correlations with overjet (P < .05) in Class I cases, with overbite (P < .05) and U1-SN angle (P < .01) in Class II cases, and with IMPA (P < .01) in Class III cases. A high prevalence of tooth size discrepancies in an orthodontic patient population and the statistically significant correlation of some of these with some dental characteristics suggest that the measurement of interarch tooth size ratios might be clinically beneficial for treatment outcomes.     

A Case of HIV Infection with Thrombocytopenia: Assosiation of HIV,Thrombotic Thrombocytopenic Purpura and Brucellosis

To report a case of HIV infection presenting with thrombotic thrombocytopenic purpura (TTP) and brucellosis that responded well to plasmapheresis and anti-infective therapy. A 64-year-old woman with moderate confusion, fever and pancytopenia was admitted. HIV infection history was taken from her family and she was not receiving antiretroviral therapy last one year. She had generalized purpuric skin lesions. Wright tube agglutination test was found positive with a 1:160 dilution and the patient was diagnosed as brucellosis. Detailed literature search showed brucellosis as a possible cause of TTP. Patient was treated by plasma exchange/fresh frozen plasma and antimicrobials and the response was excellent. Although brucellosis seems to explain the clinical picture of this patient, it is revealed that broad differential diagnosis is needed to reach uncommon diagnosis like TTP particularly in HIV infected patients.     

Dysregulated dopamine storage increases the vulnerability to α-synuclein in nigral neurons

Impairments in the capacity of dopaminergic neurons to handle cytoplasmic dopamine may be a critical factor underlying the selective vulnerability of midbrain dopamine neurons in Parkinson's disease. Furthermore, toxicity of α-synuclein in dopaminergic neurons has been suggested to be mediated by direct interaction between dopamine and α-synuclein through formation of abnormal α-synuclein species, although direct in vivo evidence to support this hypothesis is lacking. Here, we investigated the role of dopamine availability on α-synuclein mediated neurodegeneration in vivo. We found that overexpression of α-synuclein in nigral dopamine neurons in mice with deficient vesicular storage of dopamine led to a significant increase in dopaminergic neurodegeneration. Importantly, silencing the tyrosine hydroxylase enzyme - thereby reducing dopamine content in the nigral neurons - reversed the increased vulnerability back to the baseline level observed in wild-type littermates, but failed to eliminate it completely. Importantly, TH knockdown was not effective in altering the toxicity in the wild-type animals. Taken together, our data suggest that under normal circumstances, in healthy dopamine neurons, cytoplasmic dopamine is tightly controlled such that it does not contribute significantly to α-synuclein mediated toxicity. Dysregulation of the dopamine machinery in the substantia nigra, on the other hand, could act as a trigger for induction of increased toxicity in these neurons and could explain how these neurons become more vulnerable and die in the disease process.     

Changes in oxidative stress and cellular immunity serum markers in attention-deficit/hyperactivity disorder

Aims: Attention‐deficit/hyperactivity disorder (ADHD) is a developmental disorder with an etiopathogeny not fully understood. According to the prevailing view, the main factors contributing to the disorder are prefrontal dopamine deficiency and central dopaminergic dysfunction, but the factors/mechanisms involved in the brain dysfunction and its consequences are not well known. We suggest that changes in oxidative metabolism and cellular immunity may be involved. In this study, we aimed to investigate whether there are associations between ADHD and changes in serum levels of nitric oxide synthase (NOS), xanthine oxidase (XO), glutathione S‐transferase (GST) and paraoxonase‐1 (PON‐1) activities, which are important markers of oxidative stress, and adenosine deaminase (ADA) activity, marker of cellular immunity. Methods: The study sample consisted of 35 child or adolescent patients diagnosed with ADHD according to DSM‐IV‐TR criteria. Thirty‐five healthy subjects were also included in the study as controls. Venous blood samples were collected, and NOS, XO, GST, PON‐1 and ADA activities were measured. Results: NOS, XO and ADA activities of the patients were significantly higher than those of the controls. GST and PON‐1 activities of the patients were significantly lower than those of the controls. Conclusions: Changes in oxidative metabolism and cellular immunity may have a role in the etiopathogenesis of ADHD.     

The role of DTI in early detection of cervical spondylotic myelopathy: a preliminary study with 3-T MRI

Introduction  

The radiological diagnosis of cervical spondylotic myelopathy (CSM) has to be made as soon as possible, since surgery performed in earlier stages during the course of CSM was reported to be more successful when compared with later stages. We hypothesized that diffusion tensor imaging (DTI) may detect CSM in earlier stages, before the appearance of signal increase in T2-weighted sequences.