Enthesopathy in patients with familial Mediterranean fever: increased prevalence in M694 V variant

Enthesopathy is pathology of bony insertions of tendons, ligaments or joint capsules. It is a frequent finding in rheumatic diseases, like ankylosing spondylitis (AS) and Behçet’s disease. Musculoskeletal complaints are common in patients with familial Mediterranean fever (FMF), and these could be a clinical manifestation of enthesopathy. Hence, we investigated the possible association between FMF and enthesopathy. Fifty-six patients with FMF and 11 patients with FMF-associated spondyloarthropathy (FMFS) were enrolled. Forty-seven healthy individuals and 36 patients with AS formed the healthy and diseased control groups. Musculoskeletal complaints were meticulously questioned, and all patients underwent a detailed physical and ultrasonographic (US) examination of the lower limbs. US scorings of enthesopathy was performed according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). Demographic data, disease characteristics, MEFV genotypes and HLA B27 results were retrieved from the medical records. Patient-reported pain and physical examination findings consistent with enthesopathy were frequent in all groups with the highest prevalence in the FMFS group. Heel was the most common region affected in all patient groups. FMF patients harboring M694 V variant had higher GUESS scores compared to patients with other variants (2.78 ± 2.43 vs. 1.37 ± 1.67, p = 0.026). There was no statistically significant difference in the mean ± SD GUESS scores between healthy subjects and those FMF patients with genetic variants other than M694 V (1.38 ± 1.42 vs. 1.37 ± 1.67, p > 0.05). Enthesopathy may not be a feature of general FMF population; rather, it might be specifically associated with the presence of M694 V variant. Our results further support the previous evidence regarding M694 V mutation and spondyloarthropathy association.     

End-to-end microvascular anastomosis in the rat carotid artery using continuous horizontal mattress sutures

This paper reports a continuous horizontal mattress suture technique with advantages such as decreased time for anastomosis, minimized anastomotic leakage, eversion around the vessel edges, and other advantages which the continuous anastomosis technique has. This technique was compared with the classical interrupted and classical continuous suture techniques on a total of 59 Sprague-Dawley rat common carotid arteries: Group 1 (n = 19), interrupted suture technique; Group 2 (n = 20), standard continuous technique, and Group 3 (n = 20), continuous horizontal mattress technique. Early (30 min) and late (21 days) patency rates, anastomosis time, leakage on clamp release, oozing duration, additional sutures needed, and total number of sutures placed were statistically compared between groups. Specimens were taken at the 21st day randomly, and light microscopy (LM), scanning electron microscopy (SEM), and angiographic studies were performed. Results revealed that the continuous mattress suture technique has the advantages of providing a water-tight anastomosis with less suture materials in a shorter time, and minimal intraluminal suture material which can incite thrombosis. On the other hand, a tendency to anastomotic stricture was found to be the sole disadvantage of this technique.     

Melatonin protects myocardium from ischemia-reperfusion injury in hypertensive rats: role of myeloperoxidase activity

Increased levels of reactive oxygen species, alterations in nitric oxide synthesis, and increased migration of neutrophils to the ischemic tissue play an important role in the pathophysiology of myocardial ischemia-reperfusion (IR) injury. In this study, we have evaluated the effects of melatonin on myeloperoxidase (MPO) activity, tissue glutathione (GSH), lipid peroxidation levels, and blood pressure in L-NAME-induced hypertensive rats with or without IR. NOS inhibitor L-NAME was administrated before inducing cardiac ischemia for 15 days intraperitoneally. For the cardiac ischemia, the left coronary artery was ligated for 30 min, and reperfusion was performed for 120 min after the ischemia. L-NAME treatment in non-ischemic animals increased blood pressure and lipid peroxidation, and decreased glutathione level in myocardial tissue significantly as compared with non-L-NAME-treated animals. Melatonin reversed L-NAME-induced blood pressure elevation and oxidative changes. Cardiac IR increased MDA levels and MPO activity and decreased GSH levels as compared with non-ischemic animals. L-NAME treatment did not change in IR-induced MDA and GSH levels as compared with ischemic control animals. However, MPO activity was significantly higher than control ischemic animals. MDA levels and MPO activity resulting from ischemic injury in melatonin-treated animals were significantly less than L-NAME-treated animals. Taken together-the ischemic and non-ischemic control and melatonin-treated animals-this study shows that neutrophil migration plays an important role on the development of ischemic injury in hypertensive rats.     

WISC-R subtest differences for male and female LD children and youth

Investigated the performance on the WISC-R of 98 learning disabled children and youth (69 males/29 females), who ranged in age from 6-3 to 13-6 to determine whether there were any significant subtest scale score differences between sexes. A 2 × 10 analysis of variance was used to analyzed these data. Differences between the individual subtest means were analyzed by using Newman Keuls test for simple effects. Results indicated that males obtained higher (but not significant) scores on the six verbal subtests. Females scored significantly higher on coding than did their counterparts. In addition, the Verbal vs. Performance IQ dichotomy did not appear as useful evidence in the diagnosis of learning disabilities. Evidence from the investigation did not indicate that a significant interaction effect existed between sexes and WISC-R subtest scores.     

E-selectin ligand–1 regulates growth plate homeostasis in mice by inhibiting the intracellular processing and secretion of mature TGF-β

The majority of human skeletal dysplasias are caused by dysregulation of growth plate homeostasis. As TGF-β signaling is a critical determinant of growth plate homeostasis, skeletal dysplasias are often associated with dysregulation of this pathway. The context-dependent action of TFG-β signaling is tightly controlled by numerous mechanisms at the extracellular level and downstream of ligand-receptor interactions. However, TGF-β is synthesized as an inactive precursor that is cleaved to become mature in the Golgi apparatus, and the regulation of this posttranslational intracellular processing and trafficking is much less defined. Here, we report that a cysteine-rich protein, E-selectin ligand–1 (ESL-1), acts as a negative regulator of TGF-β production by binding TGF-β precursors in the Golgi apparatus in a cell-autonomous fashion, inhibiting their maturation. Furthermore, ESL-1 inhibited the processing of proTGF-β by a furin-like protease, leading to reduced secretion of mature TGF-β by primary mouse chondrocytes and HEK293 cells. In vivo loss of Esl1 in mice led to increased TGF-β/SMAD signaling in the growth plate that was associated with reduced chondrocyte proliferation and delayed terminal differentiation. Gain-of-function and rescue studies of the Xenopus ESL-1 ortholog in the context of early embryogenesis showed that this regulation of TGF-β/Nodal signaling was evolutionarily conserved. This study identifies what we believe to be a novel intracellular mechanism for regulating TGF-β during skeletal development and homeostasis.     

Right Atrial Appendage Function in Different Etiologies of Permanent Atrial Fibrillation: A Transesophageal Echocardiography and Tissue Doppler Imaging Study

Objectives: Several studies exist on the left atrial appendage function (LAA) in permanent atrial fibrillation (AF). However, knowledge about the right atrial appendage (RAA) function is limited. We investigated RAA function with TEE and tissue Doppler imaging (TDI) in permanent AF patients with different etiologies and evaluated predictive parameters of right atrial spontaneous echo contrast (SEC) and thrombi. Methods: Patients with permanent AF developed due to three different etiologies (20 mitral stenosis, 44 hypertension, 20 hyperthyroidism) and 23 subjects with sinus rhythm were included into the study. RAA was examined with TEE and pulsed‐wave and TDI velocities of RAA were measured. Results: Both PW‐Doppler and TDI velocities were significantly impaired in all AF groups compared to controls. The lowest velocities were recorded in mitral stenosis patients. Right atrial moderate–severe SEC was observed in 75% of the mitral stenosis patients, in 25% of hypertensive patients, and in 30% of hyperthyroidism patients. Right atrial thrombus was observed in 25% of mitral stenosis, 4.5% of hypertension, and in none of the hyperthyroidism patients. In the multivariate analysis, the most important parameter associated with the severity of RAA SEC was the percent change in RAA area (B =−0.034, P = 0.03). Conclusion: In patients with permanent AF, impairment of RAA function and development of right atrial SEC‐thrombus are closely related to the underlying etiology. These results suggested that evaluation of RAA functions may have an incremental value over the assessment of the LAA for determining thromboembolic risk. (Echocardiography 2010;27:384‐393)     

A simplified operative technique for single-staged resection of left-sided colon obstructions: report of a 9-year experience

Purpose: The operative strategy for left-sided large bowel obstruction remains controversial. Because a safe and definitive single-staged operation that avoided a colostomy would clearly be in the patients' best interest, we conducted a prospective study to compare the efficacy of single-staged surgery (SSS) supplemented by the milking and swabbing technique (MST), with the conventional Hartmann's procedure (HP). Methods: In group 1 (n = 37) we performed traditional HP by resecting the site of obstruction and constructing an end colostomy. In group 2 (n = 33), after resecting the site of obstruction, instead of on-table lavage, we cleaned out the fecal content from the proximal and distal parts of the obstruction by milking the colon with the fingers, then swabbing the proximal and distal 10 cm of lumen of the colonic anastomosis with povidone iodinized stick sponges. Finally, we performed a primary one-layer anastomosis without fecal diversion. Results: The mortality, morbidity, and postoperative hospital stay after emergency left-side colonic resection and primary anastomosis by MST was comparable with those after HP (P > 0.05). Conclusions: We believe that SSS with MST is a viable choice in the surgical management of selected patients with obstructing lesions of the left colon. The advantages of SSS with MST lie in its good long-term results, and short-term reduced surgical intervention and hospital stay. Received: November 12, 2001 / Accepted: May 7, 2002 Reprint requests to: M. Turan, Inonu Muzesi Yani, K. Kazancilar Sok. No 1/4, 58070 Sivas, Turkey     

Management of carotid artery invasion in advanced malignancies of head and neck comparison of techniques

The objective of this study was to retrospectively investigate a single institution's experience with carotid artery resection performed as part of an oncological procedure and to determine acute and convalescent complication and survival rates. We performed a record review of 28 patients with head and neck malignancy invading the carotid artery. Immediate carotid artery resection and ligation on an emergent basis was performed on 12 patients (group 1), elective resection and ligation was performed on 8 patients (group 2), and elective resection and revascularization was performed on 8 patients (group 3). In group 1, although 1 patient survived for 1 year and 1 patient survived for 2 years, 1 patient died of severe neurologic deficit, 2 patients experienced neurologic deficit with good recovery, and 1 patient was moderately disabled. In group 2, 2 patients survived without disease for 5 years, and 2 patients experienced neurologic deficit, 1 with good recovery and the other with complete recovery. In group 3, only 1 patient survived for 5 years, and within this group, 1 patient died of severe neurologic deficit, 1 patient had neurologic deficit with moderate recovery, and 1 patient had neurologic deficit with complete recovery. No significant difference in mortality and morbidity rate was observed between the "resection and ligation" group and the "resection and revascularization" group (p = .52, chi(2) = 0.79). We conclude that the surgical treatment of patients with an invaded carotid artery, including carotid resection, provides a small but real chance of 5-year survival. The methods of carotid resection and repair should be guided by clinical presentation and by preoperative and intraoperative investigations.