Effects of methylphenidate on leptin and appetite in children with attention-deficit hyperactivity disorder: an open label trial

Appetite suppression is one of the most common side effects of methylphenidate (MPH), which is used for treatment of attention-deficit hyperactivity disorder (ADHD). Relation of appetite and leptin is well known but there is no report regarding MPH use and leptin. In this study we compared the baseline leptin levels of ADHD children with the controls and studied the interaction between MPH and leptin-insulin level in ADHD children under MPH treatment. The major finding of this study is that at a total daily dose of 0.6 mg/kg short-acting MPH treatment, one does not observe significant side effects related to appetite suppression and metabolic features as measured via body mass index, insulin and leptin levels. Thus this range seems to be safe in developing ADHD children with minimum side effects regarding appetite for short-term treatment.     

No effects of long-term sildenafil treatment on ocular functions

Purpose Sildenafil is a new and effective oral medication for the treatment of erectile dysfunction. The purpose of this study was to assess the long-term effects of sildenafil on visual acuity, color vision, intraocular pressure (IOP), electroretinography (ERG), blue-on-yellow and white-on-white Humphrey visual field (HVF), and tear functions. Methods Ten impotent patients ingested 50 mg of sildenafil one or more times a week for a minimum of 3 months. Ten age-matched subjects without any ophthalmological disorders other than refractive problems served as controls. Visual acuity (Snellen), color discrimination (Ishihara), and a slit-lamp examination were performed on the patients. Cotton thread and Schirmer I tests and tear break-up time were applied to random eyes of all subjects. IOP was measured in both eyes of the patients by Goldmann applanation tonometry. Both eyes of each subject were tested with white-on-white (fastpac 30-2, size 3 stimulus) followed by blue-on-yellow (fastpac 30-2, size 5 stimulus) HVF analyzer. ERG in scotopic (dark-adapted) condition was performed with unipolar corneal electrodes and rod response was recorded. Results In comparison with control, no clinically or statistically significant differences were detected in the patients ingesting sildenafil with regard to the visual acuity, color discrimination, IOP, mean deviation, cotton thread and Schirmer I tests, tear break-up time, amplitude, and implicit time of b-wave. Conclusion Long-term treatment with sildenafil did not produce any significant abnormality on ocular functions. Repeated exposures of ocular tissues to therapeutic doses of sildenafil are unlikely to impair their functions. The authors do not have any significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes, unlabeled, unapproved, or investigative products or devices.     

Prognostic Factors Effecting on Recurrence of Urinary Stone Disease: A Multivariate Analysis of Everyday Patient Parameters

Introduction: Since comprehensive urometabolic analyses are currently more preferred for the patients with recurrent stones and with high risk of stone recurrence, we have tried to determine simple patient data increasing stone recurrence to limit sophisticated analyses to certain cases at least in particularly deprivation districts. Materials and methods: For the study 173 with first-time or recurrent urinary stone were taken. After stone treatment, various empirical metaphylaxis methods were counselled to the patients. The parameters evaluated were (a) age at onset of the disease, (b) gender, (c) urinary pH and (d) specific gravity, (e) serum calcium and (f) uric acid, (g) stone burden, (h) side, and (i) location, (j) treatment modality and (k) recurrence history. New stone formation or growing of the existing stone was considered as stone recurrence. In statistics, independent samples t, chi-square test, Kaplan–Meier, Log rank and Cox regression tests were used. Results: The mean age was 35 years. The male to female ratio was 88/85. Recurrence occurred in 49 (28%) cases at a mean of 30 months. Stone burden was significantly larger in patients with recurrent stone. In subjects treated with open surgery and with previous recurrence history, stone recurrence rate was significantly higher. In survival analyses, higher serum calcium level, larger stone burden, renal stones and previous recurrence influenced stone prognosis poorly. However in multivariate analysis, none of them was the most significant independent factor. Conclusions: According to our study, detailed urometabolic analyses may be somewhat reserved for the patients with ordinary factors increasing risk of stone recurrence including relatively high serum calcium level, large stone burden, upper urinary stone, history of recurrence and open surgery. As a result, it has been thought that the stone risk evaluation guiding detailed laboratory examination may be partially performed with first-line clinical data under limited conditions.     

Spinal epidural abscess caused by brucellosis. Two case reports

Brucellosis is still an important public health problem in the Mediterranean countries, including Turkey, and is most probably underdiagnosed or underreported. Two rare cases of extradural brucellar granuloma causing spinal cord compression in the thoracic and cervical regions were identified by magnetic resonance imaging. The abscesses were totally excised surgically. Medical treatment was given immediately after diagnosis, but delayed neurosurgical intervention resulted in partial neurological recovery in one patient although the other showed complete neurological recovery. Abscess formation may cause myelopathy due to extradural compression of the spinal cord. Failure to correct this condition may cause irreversible impairment of motor functions. Magnetic resonance imaging should be performed periodically in patients with brucellosis and suspected vertebral involvement to monitor for epidural granuloma formation and prevent extradural cord compression.     

The effect of hyperbaric oxygen therapy on rhabdomyolysis-induced myoglobinuric acute renal failure in rats

Myoglobinuric acute renal failure (MARF) may develop after severe muscle injury. Heme oxygenase-1 (HO-1), a stress-response protein, has been implicated as a protective agent against MARF. We hypothesized that hyperbaric oxygen therapy (HBOT) may alleviate MARF by inducing renal HO-1 expression. Wistar-Albino rats were randomly assigned into three groups: Control (n?=?4), MARF (n?=?8), MARF?+?HBO (n?=?8). MARF was induced by intramuscular glycerol (50%, 8?mL/kg) injection. Saline (8?mL/kg) was injected into the hind limb of the animals in the control group. Animals in the MARF?+?HBO group received two sessions of HBO therapy (90?min at 2.5?atm) 2 and 18?h after glycerol injection. Serum and tissue samples were taken at 24?h. Serum urea and creatinine levels increased in the MARF and MARF?+?HBO groups confirming the development of MARF. But, serum urea and creatinine levels were similar in MARF and MARF?+?HBO groups. Oxidative stress parameters were similar among all groups. Histological renal injury score was similar in MARF and MARF?+?HBO groups. HO-1 level, determined by immunohistochemistry, was significantly higher in MARF and MARF?+?HBO groups, compared to the control group. Although HO-1 level in MARF?+?HBO group was higher than MARF group, it was not statistically significant. We found that HBOT did not reduce renal injury in experimental MARF model. HBOT is used to reduce the muscle damage after crush injury, which may be accompanied by MARF. Therefore, more studies are needed to understand the effects of HBO treatment on renal functions after MARF.     

Paraoxonase-1 activity in subfertile men and relationship to sperm parameters

Oxidative stress has been implicated in the pathogenesis of male infertility. Paraoxonase-1 (PON-1) is a high-density lipoprotein-associated antioxidant enzyme that prevents oxidative modification of low-density lipoprotein. Our aims in the study were to investigate 1) seminal PON-1 activity in subfertile men and 2) whether seminal PON-1 activity had any relationship to semen parameters. The study included 28 men with idiopathic subfertility, 32 subfertile men with abnormal semen parameters, and 30 fertile male volunteers. Seminal PON-1 activity was measured spectrophotometrically. Seminal total antioxidant status (TAS) and total oxidant status (TOS) were determined by using colorimetric methods. Oxidative stress index (OSI) was calculated as ([TOS/TAS] x 100). TOS and OSI were significantly higher and PON-1 activity and TAS were significantly lower in subfertile men with abnormal semen parameters than in men with idiopathic subfertility and fertile donors. PON-1 activity was also strongly correlated with sperm concentration (r = .68, P < .0001), motility (r = .58, P < .0001), and morphology (r = .62, P < .0001) in the overall group. The receiver operating characteristic curve analysis revealed a high diagnostic value for PON-1 activity with respect to male-factor subfertility, with an area under curve of .95 (95% confidence interval = 0.89-1.01), sensitivity = 97%, and specificity = 88%. Men with abnormal semen parameters have decreased levels of PON-1 activity in their seminal plasma. This may play an important role in the pathogenesis of male-factor subfertility.     

Thoracodorsal artery perforator flap: a versatile alternative for various soft tissue defects

Thoracodorsal artery perforator (TDAP) flap is a relatively new member of the perforator flap family. The objective of this study is to describe the use of pedicled and free TDAP flaps for various soft tissue defects. Fifteen patients underwent soft tissue reconstruction using 16 TDAP flaps. Twelve pedicled flaps were used for axillary, breast, and shoulder regions. Four free flaps were used for cheek, popliteal, hand, and foot reconstruction. The flaps were harvested based on the perforators, which were preoperatively located at or close to a point 8 cm below the posterior axillary fold and 2 cm behind the lateral border of the latissimus dorsi muscle. Early, late, major, and minor complications were documented. In 13 of the 16 flaps, perforators from the thoracodorsal artery were found in the circle 3 cm in diameter, centered on the anatomic landmark. Three other perforators were found outside this circle. One flap loss was considered the only major complication. Minor complications occurred in 12.5% of flaps. Although the vascular anatomy can be variable, free and pedicled TDAP flap is a versatile option in soft tissue reconstruction.     

An adjustable shoulder abduction orthosis for the post-operative management of tendon transfers: A preliminary study

Transfer of Musculus Latissimus dorsi/M. Teres major to the rotator cuff with or without M. Subscapularis/M. Pectoralis release is a widely used procedure for restoring shoulder abduction and external rotation in squeal of obstetric brachial plexus palsy. After the operation a shoulder abduction orthosis in maximal external rotation and 90 - 100 degrees abduction is utilized following six weeks of immobilization in a shoulder spica cast for protecting the newly transferred muscle from undue elongation. However this in turn may cause contracture of the external rotators. To overcome this problem, a modified shoulder abduction splint with adjustable internal-external rotation/abduction-adduction ranges was developed in the orthotics department of a rehabilitation center. The custom molded adjustable shoulder abduction orthosis is described and the preliminary results are compared with former applications.     

Isolated HAGL lesion after arthroscopic Bankart repair in a professional soccer player

Post-traumatic anterior shoulder instability commonly occurs following an avulsion of capsulolabral complex from glenoid (Bankart lesion) or rarely after humeral avulsion of the glenohumeral ligaments (HAGL lesion). Arthroscopic Bankart repair offers high success rates of healing. However, trauma following the treatment may cause implant failure or re-avulsion of the treated tissue. We aim to present the diagnosis and treatment of an isolated HAGL lesion in a professional soccer player who had previously undergone arthroscopic Bankart repair.     

卵巢交界性肿瘤复发和预后的影响因素

目的：本研究旨在对诊断为卵巢交界性肿瘤（BOT）患者的存活率及临床病理变量进行评估。方法：对诊断为BOT的患者进行回顾性分析。资料来源于医院档案和：等业妇科肿瘤管理机构。结果：共100例患者纳入研究。诊断时的平均年龄41.7岁（极差19—84岁）。71例（71％）进行了手术分期，其中49例（49％）广泛手术，22例（22％）保留生育力的手术。仅30例（30％）未进行分期。组织病理学诊断为浆液性、黏液性和其他类型的BOT分别为54例（54％）、39例（39％）和7例（7％）。ⅠA期患者70例（70％），ⅠB期10例（10％），ⅠC期9例（9％），ⅢA期3例（3％），ⅢC期8例（8％）。经过手术分期过程，仅4例患者分期由原来的局限于卵巢上调至ⅢC期。肿瘤复发率为3％（3例）。BOT的整体无瘤生存率在手术分期人群（广泛性手术、保守手术）及未手术人群中分别为97．92％、95．00％和96．30％。但是，年轻患者（年龄〈30岁）、行保留生育力手术及出现微小乳头状组织或腹腔种植的患者，其整体无瘤生存率显著降低。手术分期人群（广泛性手术、保守手术）及未手术人群的BOT总存活率分别为97．9％、100％和100％。结论：低度恶性潜能卵巢肿瘤的存活率较好，患者可以安全地进行保守的手术治疗。