Influence of haematological parameters before coronary angioplasty on subsequent restenosis

OBJECTIVES: Restenosis is the major limitation of coronary interventions occurring in nearly a third of the patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with no single, definite predictor demonstrated in an individual patient. Platelets are known to play an important role in the pathogenesis of subsequent restenosis. METHODS AND RESULTS: In a prospective study, follow-up coronary angiographies were performed in 102 consecutive patients with stable angina who underwent a successful PTCA for single-vessel coronary artery disease. Demographics, baseline lipid profiles (total cholesterol, HDL- and LDL-cholesterol, triglycerides) and haematological parameters (red cell, white cell and platelet counts, haemoglobin concentration, haematocrite %, mean platelet volume, platelet mass and fibrinogen levels) were compared between patients with and without restenosis. In the restenosis group, mean platelet volume (8.82 +/- 0.78 fl vs. 8.13 +/- 0.64 fl, p < 0.001), white cell count (8673 +/- 322 x 10(3)/microl vs. 7513 +/- 232 x 10(3)/microl, p < 0.01) and fibrinogen level (4.2 +/- 1.4 g/l vs 3.6 +/- 1.1 g/l) were significantly higher. The relative odds for developing angiographically defined restenosis were 2.49 times greater in diabetics (p = 0.11) and 2.54 times greater in men (p = 0.13). It is 1.43 times greater in patients with higher fibrinogen levels (p = 0.16). But, the relative odds for developing restenosis were 10.43 times greater in patients with larger pre-procedural mean platelet volumes (p < 0.01). CONCLUSIONS: There was a positive correlation between mean platelets volume and loss in luminal diameter between post-angioplasty and follow-up angiographies (r = +2.345, p = 0.01). There was no association between restenosis and haemoglobin, haematocrit, red cell count, white cell count, platelet count, platelet mass and plasma fibrinogen level. The development of restenosis after successful coronary angioplasty may be mainly influenced by the platelet size.     

The distribution of symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder in school age children in Turkey

Abstract Objective The aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in school age children in Sivas province centre and to examine the distribution of symptoms according to subtypes. Method The study population was made up of 1425 children between the ages of 6 and 15 from eight primary schools selected by random sampling method in Sivas province centre. All students were given a questionnaire prepared according to DSMIV criteria that was completed by their parents or teachers. This form includes 18 symptoms of ADHD and eight symptoms of ODD. Students t-test and variance analysis were used for statistical evaluation. Results A prevalence of 8.1% was found for ADHD in our study. According to subtypes, 32.2% of these were inattentive, 40% were hyperactive and 27.8% were combined type. A prevalence of 11.5% was found for ODD. The boy/girl ratio was > 1 for both ADHD and ODD, and 52.2% of those with ADHD were established as having ODD at the same time. Conclusions The prevalence of ADHD and ODD in primary school children was not considered to be small. Studies concerning the distribution of symptoms in different societies, cultures, and viewpoints and identification of children with this type of problem are beneficial for early diagnosis and prophylactic treatment.     

Evaluation of bone mineral density in children with cerebral palsy

In the present study, bone mineral density of 40 children with cerebral palsy (study group) and the effects of various risk factors on bone mineralization in these children were investigated by comparing with 40 age-matched healthy children (control group). Weight, height, skinfold thickness, body-mass index measurements, and serum levels of calcium, phosphorus, alkaline phosphatase and 25 OH vitamin D were not significantly different between the study and control groups (p>0.05). The mean bone mineral density value of the study group measured by dual-energy X-ray absorptiometry method at L2-L4 levels of lumbar vertebrae was significantly lower than that of the control group (p<0.05). When the patients in the study group were assessed with respect to ambulation status, pattern of involvement, calcium and energy intakes, and whether or not they had taken and/or were taking a regular physical therapy program, there was a significant difference only between the hemiplegic and tetraplegic patients (p<0.05), while there were no significant differences among the patients who were ambulant versus non-ambulant, who had sufficient versus insufficient calcium and energy intakes, and who did and did not take a regular physical therapy (p>0.05). Although the ambulatory status, quantity of calcium and energy intakes, and the presence or absence of a physical therapy program had no effects on bone mineral density values of the children with cerebral palsy in this study, the exact factors and mechanisms responsible for the reduced bone mineral density in children with cerebral palsy should be investigated in further large-scale studies considering the increased risk of pathological fractures in these patients.     

Underlying causes of recurrent pneumonia in Turkish children in a university hospital

The aim of this study was to determine the relative frequency of underlying illnesses for recurrent pneumonia in children. Children who had two or more episodes of pneumonia per year, or three or more episodes in a lifetime were investigated retrospectively at Ankara University Medical School, Department of Pediatric Infectious Diseases, between January 1997 and October 2002. Out of 788 children hospitalized for pneumonia, 71 (9 per cent) met the criteria for recurrent pneumonia. An underlying illness was demonstrated in 60 patients (85 per cent). In this group, the underlying illness was diagnosed prior to pneumonia in 11 patients (18.3 per cent), during the first episode in 12 patients (20 per cent), and during recurrence in 37 patients (61.7 per cent). Underlying diseases were bronchial asthma (32 per cent), gastroesophageal reflux (15 per cent), immune disorders (10 per cent), congenital heart defects (9 per cent), anomalies of the chest and lung (6 per cent), bronchopulmonary dysplasia (4 per cent), cystic fibrosis (3 per cent), tuberculosis (3 per cent), and aspiration syndrome (3 per cent). No predisposing illness could be demonstrated in 11 patients (15 per cent). In conclusion, approximately one-tenth of hospitalized children with pneumonia in our hospital had recurrent pneumonia. Most of these children had an underlying illness, which was demonstrated by intensive investigation. Bronchial asthma in children aged more than 2 years and gastroesophageal reflux in children aged less than 1 year were the most common underlying illnesses for recurrent pneumonia.     

Adult type granulosa cell tumor causing precocious pseudopuberty in a 6 year-old girl

Malignant ovarian tumors are responsible for 2-3% of all cases of precocious pseudopuberty (PP) in girls. The most common forms of ovarian tumors presenting as PP are the granulosa cell tumors (GCT). The clinical and pathological features of granulosa cell tumors that occur frequently in young girls, so-called juvenile granulosa cell tumors (JGCT), differ histologically from those occurring in adults. As a cause of PP in young girls, adult type granulosa cell tumors (AGCT) are extremely rare. We report a 6 year-old girl presenting with early breast development and vaginal bleeding due to a well encapsulated ovarian tumor. Microscopic features of the resected tumor were characteristic of AGCT.     

Ligneous conjunctivitis,hydrocephalus, hydrocele,and pulmonary involvement in a child with homozygous type I plasminogen deficiency

Ligneous conjunctivitis is a rare and unusual form of chronic pseudomembranous conjunctivitis which usually starts in early infancy. Plasminogen deficiency has recently been associated with ligneous conjunctivitis. The disease may be associated with pseudomembranous lesions of other mucous membranes in the mouth, nasopharynx, trachea, and female genital tract and also with congenital hydrocephalus. In this report, a 1-month-old Turkish boy who had pseudomembranous conjunctivitis, occlusive hydrocephalus, and hydrocele is presented. After surgery for ventriculo-peritoneal shunt establishment, he developed inspiratory stridor, respiratory distress, and pulmonary atelectasis. Tracheal pseudomembranes were also demonstrated by bronchoscopy. Plasminogen antigen level and plasminogen activity were very low. Genomic DNA from the patient was screened for mutations in the plasminogen gene and a homozygous L650fsX652 mutation (deletion of 2081C) was detected. Both of his parents were heterozygous for this mutation. He died due to respiratory failure during follow-up. CONCLUSION: Ligneous conjunctivitis related to type I plasminogen deficiency is relatively common in the Turkish population, however, mutations are heterogeneous and a common founder is unlikely.     

Maternal mortality in developing countries

Of all health statistics mentioned by the World Health Organization (WHO), maternal mortality is unique in showing the largest discrepancy between developed and developing countries. Approximately 90% of maternal deaths (more than 0.5 million each year) occur in developing countries. Over the last century, almost all countries have accepted antenatal care principles. However, insufficiency of resources and lack of women's compliance were the main handicaps in developing countries and compelled these countries to apply various standard programs. Unfortunately, these programs are not sufficiently effective in the prevention and treatment of maternal mortality. Fixing the number (quantity) of antenatal visits and the static approach affect the "quality" of antenatal care. Bleeding, chronic anemia, hypertensive disorders, obstructed labor, unsafe abortions and infections are the main factors leading to maternal mortality. The majority of these factors are preventable. It is important to suspect the presence of any of these factors and to intervene promptly both during antenatal care and immediately after delivery. The evidence-based approach is a way of reaching this solution. Antenatal care is a concept that extends from pre-pregnancy to postpartum, leading to effective emergency care for unpredictable and predictable complications during pregnancy and childbirth. Worldwide policies are not always applicable to each country, coercing national policies. There is still a need for prospective randomized trials to clarify this concept and the relevant policies.     

The role of intra-peritoneal honey administration in preventing post-operative peritoneal adhesions

OBJECTIVE(S): The accelerative effect of honey in the wound healing process is known. This effect is related to its specific physical properties of hygroscopicity, hypertonicity, lower pH and complex chemical composition. Because peritoneal healing is a kind of wound healing process we hypothesised that post-operative peritoneal adhesions (PPA) may be reduced with intra-peritoneal honey administration. STUDY DESIGN: The study was conducted with 40, 6-month-old, out-bred female Wistar albino rats with a mean weight of 197 +/- 12 g. The rats were divided into two equal groups. An adhesion model was constituted in the cecum and terminal ileum of all rats in each groups. Later the adhesion areas were washed with 0.9% NaCl solution and 5 ml of the same solution was left in the peritoneal cavity in the control group. The same area in the rats in the other group was covered with honey and 5 ml of honey was left in the peritoneal cavity of each animals. Ten days later the rats were sacrificed and the adhesions were graded according to their degree of severity. Statistical analysis was performed with the non-parametric Mann-Whitney U-test. RESULTS: In the control group, there were no rats with grade-0 or grade-1 adhesions but in the honey administered group there were six rats (30%) with grade-0 and 12 rats (60%) with grade-1 adhesions. In the control group, there were six rats (30%) with grade-2 and 14 rats (70%) with grade-3 adhesions. In the honey administered group while two rats (10%) with grade-2 adhesions were present, no rat with grade-3 adhesions was seen. In the comparison, the difference between the groups was found to be highly significant (P < 0.001). CONCLUSION(S): The wound healing accelerative effect and the mechanical barrier formed by the honey, since, it has a high density and, thus, absorbed slowly from peritoneal cavity, may be the reasons for its inhibitory effect on the PPA. This study indicates that though the mechanism is not clear intra-peritoneal honey administration reduces PPA.     

Effects of electrohydraulic extracorporeal shock wave lithotripsy on submandibular gland in the rat: electron microscopic evaluation

OBJECTIVES: Extracorporeal shockwave lithotripsy (ESWL) has been applied in sialolithiasis as a new treatment modality. The aim of this experimental study is to investigate the local effects of electrohydraulic ESWL applied to the right submandibular gland of the rats. METHODS: This prospective study was conveyed in four groups; groups I, II, III and IV; each group consisting of 20, 20, 18 and 9 rats, respectively, with a randomized distribution. Groups I, II, III and IV received 250, 500, 1000 and 2000 shock waves at 14-16 kV (average 15.1 kV), respectively, to the right submandibular glands on the 0th day. In groups I, II, III, right submandibular glands of the rats were removed on the 0th, 1st, 7th and 15th days; in group IV, this procedure could be managed only on the 0th and 7th days. Light and electron microscopic evaluation were assessed. Using the light microscopic changes, severity of damage score of the glands (SDS) was found. Statistical analysis was done using SDSs. RESULTS: Light and electron microscopic observations have shown that the damage produced by the shock waves were confined to focal areas in the acinar cells (AC), granulated convoluted tubule (GCT) cells and blood vessels at all doses applied. Vacuolization in the cytoplasms of the AC and GCT cells, disintegration of membranes, alteration in the cytoplasmic organization, swelling of the mitochondria and loss of the features were observed on electron microscopy. Increase in the secretion rate; stasis and dilatation in the blood vessels; blebbing and loss of features in the cytoplasm of the endothelial cells were observed. According to the result of the statistical analysis using SDSs; at 250 shock wave dose, a statistically significant difference between the SDSs of the days (0th, 1st, 7th and 15th) was found (P<0.05). The SDS on the 0th day was found to have the lowest value among the other days. And also a statistically significant difference was found on the 0th day between the SDSs at doses of 250, 500, 1000 and 2000 shock waves (P<0.05). The SDS at 250 and 500 shock waves was found to have the lower value than the SDS at the 2000 shock wave. It was observed that produced damage was less prominent by small doses (250, 500 doses) initially (0th day). Electrohydraulic ESWL caused a "patchy type" generalized pathology on submandibular glands of the rats and damaged focal areas were widespread all through the gland from the 1st day on. CONCLUSION: Formation of the damage was concluded to be related to the direct effect of the shock waves rather than the dose used. Electrohydraulic lithotripters are not suitable for sialolithiasis because of the focus problems, local tissue damage and the risk of the damage to the adjacent structures.     

Interleukin-8 levels in children with bacterial,tuberculous and aseptic meningitis

Objective : Interleukin-8 (IL-8) is produced in monocytes and vascular endothelial cells in response to stimulation with bacteria or lipopolysaccharides, and is released from these cells into blood stream or tissue fluid.Methods Cerebrospinal fluid (CSF) levels of interleukin-8 in 56 children with nonbacterial, bacterial and tuberculous meningitis (TBM), and in 15 control subjects were analyzed to evaluate the involvement of this cytokine in the pathogenesis acute bacterial meningitis and their discriminative value between different etiologies of meningitis. The kinetics of IL-8 concentrations during the course of bacterial meningitis was also evaluated in patients. IL-8 levels were significantly higher in bacterial and TBM than in aseptic meningitis and in control subjects (p<0.0001).Results: There was no difference in the levels of IL-8 between the non-bacterial meningitis and control groups. The analysis of the kinetics of production of IL-8 in patients with bacterial meningitis showed that the SSF concentrations of this cytokine decreased to undetectable values in recovery stage. Conversely in patients with TBM the concentrations of IL-8 were elevated in two weeks after beginning the specific treatment.Conclusion : The results suggest that determining IL-8 levels may be useful in the differential diagnosis.