Cartilage defects of the knee joint: evaluation, classification, and natural course

Cartilage defects of the knee joint may be either isolated or in conjunction with various disorders of the knee. There are no clinical complaints and physical findings specific for joint defects. In addition, except for some magnetic resonance imaging techniques, there are no specific imaging methods for diagnosis. Therefore, arthroscopic evaluation is the gold standard for the diagnosis. Although there are many studies on the treatment of cartilage defects, natural course of the defects has been evaluated in only a few studies. Furthermore, controversy exists as to how and in which direction different treatment methods affect the natural course of cartilage defects. This review addresses factors affecting the natural course of cartilage defects; yet, the exact indications, timing, and methods of treatment, and whether any treatment is necessary remain unclear. Prospective, randomized, and controlled studies are needed to evaluate the results of different treatment methods on the natural course of cartilage defects.     

Risk factors for vancomycin-resistant enteroccocci colonization in infants in neonatal intensive care unit

We aimed to evaluate the risk factors for VRE colonization in neonatal intensive care units. In December 2007, we identified a neonate with VRE infection (urinary tract infection and we performed blood and stool cultures for VRE until the last colonized patient was discharged from our clinic. All the neonates hospitalized in NICU during December 2007 to January 2008. Active surveillance cultures for VRE fecal carriage was carried out in neonatal intensive care unit. Resistance to vancomycin was detected by the E-test method. Epidemiological data was recorded for all patients included in the study and was used for the risk factors. Totally 54 infants in NICU were screened for VRE colonization. Totally 11 infants (20%) were colonized with vancomycin-resistant enterococci. The average duration of all antimicrobial therapy was significantly longer in colonized patients. The infants who were hospitalized for more than 10 days were found to be significantly more colonized with VRE when compared to the infants with shorter hospital stay (p<0.05). There were no statistically significant differences between VRE colonized and non-colonized infants in respect to sex, to third generation cephalosporin usage, glycopeptide usage, presence of prematurity, presence of mechanical ventilation(p> 0.05). The premature infants and the mature infants were under risk of VRE colonization. Longer duration of hospitalization and antimicrobial usage were the prominent risk factors. Since infants in neonatal intensive care units were under risk of infections, periodic active surveillance cultures should be combined with logical antimicrobial therapy.     

Primary sternal osteomyelitis in a healthy child due to community-acquired methicillin-resistant Staphylococcus aureus and literature review

Primary sternal osteomyelitis is a rare condition. Most of the recent cases have been reported in intravenous drug abusers. A 4-y-old male case of primary sternal osteomyelitis due to community-acquired methicillin-resistant Staphylococcus aureus with no apparent risk factors is reported. The diagnosis should be suspected in a young patient presenting with acute inflammatory swelling over the sternum. While bacteriological culture results are pending, antibiotic therapy with Staphylococcus aureus coverage should be initiated empirically and the possibility of community-acquired methicillin-resistant S. aureus must be borne in mind. In this report we also review the literature of paediatric primary sternal osteomyelitis.     

Short-term effects of smoking cessation on blood antioxidant parameters and paraoxonase activity in healthy asymptomatic long-term cigarette smokers

The aim of this study was to compare short-term effects of smoking cessation on blood oxidant/antioxidant status, cholesterol levels, and paraoxonase activity. Sixteen healthy, asymptomatic long-term cigarette smokers (mean age: 35 +/- 9 yr) participated in the study in the smoking cessation program. After and before smoking cessation, subjects were examined for oxidant/antioxidant status, cholesterol level, paraoxonase activity, breath carbon monoxide levels, and blood carboxyhemoglobin values. When compared to previous values, subjects were revealed statistically significant decreases in malondialdehyde and carbon monoxide levels 4 wk after smoking cessation. The ratio of high-density lipoprotein (HDL) low-density lipoprotein (LDL) cholesterol was found to be increased. Significantly increased to paraoxonase activity was also observed in the blood samples obtained after cigarette cessation period. It was concluded that all these changes observed after smoking cessation might be of importance in the reduction of cardiovascular risk parameters in the smokers.     

Autophagy as a cell death and tumor suppressor mechanism

Autophagy is characterized by sequestration of bulk cytoplasm and organelles in double or multimembrane autophagic vesicles, and their delivery to and subsequent degradation by the cell's own lysosomal system. Autophagy has multiple physiological functions in multicellular organisms, including protein degradation and organelle turnover. Genes and proteins that constitute the basic machinery of the autophagic process were first identified in the yeast system and some of their mammalian orthologues have been characterized as well. Increasing lines of evidence indicate that these molecular mechanisms may be recruited by an alternative, caspase-independent form of programmed cell death, named autophagic type II cell death. In some settings, autophagy and apoptosis seem to be interconnected positively or negatively, introducing the concept of 'molecular switches' between them. Additionally, mitochondria may be central organelles integrating the two types of cell death. Malignant transformation is frequently associated with suppression of autophagy. The recent implication of tumor suppressors like Beclin 1, DAP-kinase and PTEN in autophagic pathways indicates a causative role for autophagy deficiencies in cancer formation. Autophagic cell death induction by some anticancer agents underlines the potential utility of its induction as a new cancer treatment modality.     

Unilateral perirenal fibrosis

A case of multifocal fibrosclerosis with an extremely unusual unilateral perirenal involvement is reported. Computed tomography and magnetic resonance imaging findings of unilateral perirenal fibrosis are discussed.     

Celiac ganglia block

Pain occurs frequently in patients with advanced cancers. Tumors originating from upper abdominal viscera such as pancreas, stomach, duodenum, proximal small bowel, liver and biliary tract and from compressing enlarged lymph nodes can cause severe abdominal pain, which do not respond satisfactorily to medical treatment or radiotherapy. Percutaneous celiac ganglia block (CGB) can be performed with high success and low complication rates under imaging guidance to obtain pain relief in patients with upper abdominal malignancies. A significant relationship between pain relief and degree of tumoral celiac ganglia invasion according to CT features was described in the literature. Performing the procedure in the early grades of celiac ganglia invasion on CT can increase the effectiveness of the CGB, which is contrary to World Health Organization criteria stating that CGB must be performed in patients with advanced stage cancer. CGB may also be effectively performed in patients with chronic pancreatitis for pain palliation.     

Multiple time-frequency components account for the complex functional reactivity of P300

Consecutive and overlapping time-frequency (TF) components of auditory event-related brain potentials (ERPs) were analyzed to examine whether multiple co-existing components may account for the complex functional reactivity of P300. Auditory ERPs of 14 adult subjects were decomposed by means of the wavelet transform (WT), and TF components within P300 were tested in a systematic manner for the effects of major P300 determinants: stimulus probability, active discrimination, and mental count task. The results demonstrated that several partly or fully simultaneous delta, theta, and alpha TF components significantly depend on the factors eliciting P300, and also manifest distinct patterns of task reactivity and scalp distribution. Thus, specific functional processes that underlie the P300 ERP can be distinguished that help to account for its responsiveness to task variables.     

Mesenchymal stem cells in iatrogenic facial nerve paralysis: a possible role in the future

Iatrogenic facial nerve paralysis is one of the major and drastic complications of ear surgery. We report a case of a 20-year-old female patient with simple chronic otitis media who underwent mastoidectomy and tympanoplasty. During the mastoidectomy process the facial nerve was unintentionally destroyed, leaving a gap of 8–10 mm in the third segment of the intratemporal facial nerve. The nerve was repaired with a nerve cable graft obtained from the vicinity. On the 42nd day, autologous mesenchymal stem cell transplantation was performed after facial nerve trauma. The patient’s facial nerve paralysis has recovered from House-Brackmann grade VI to IV within a week and then to III in the fifth month. The rapid, postoperative progress, and the early follow-up results are discussed. This case represents the first bone marrow stem cell application in a peripheral nerve, namely the facial nerve.This case was presented at the XXXth World Congress of the International Society of Hematology, Istanbul, 28 September–2 October 2005.