The adequacy of laparoscopy for continuous ambulatory peritoneal dialysis procedures

The aim of this study was to determine the safety and efficacy of diagnostic/therapeutic laparoscopy in the management of peritoneal Tenchoff catheter placement in end-stage renal disease patients who had previous abdominal surgery and malfunctioning peritoneal dialysis catheters. From 1999 to 2004, 16 videolaparoscopic procedures were performed in 16 patients who had previous laparotomies. Laparoscopy was performed before peritoneal catheter placement in seven (group 1) and in 9 patients with peritoneal dialysis catheters in place, laparoscopy was performed for the management of catheter dysfunction (group 2). All laparoscopic procedures were performed under general anesthesia. The mean follow-up was 31.5 (range, 11 to 60) months. In group 1, six patients (85.7%), and in group 2, seven patients (77.7%) are still on peritoneal dialysis. Laparoscopy resulted in the placement/salvage of peritoneal dialysis catheter dysfunction. Placement of catheter was accomplished in patients who would have been previously designated as unsuitable candidates. Laparoscopy is a useful tool in every step of a peritoneal dialysis program.     

Increasing tendency in caustic esophageal burns and long-term polytetrafluorethylene stenting in severe cases: 10 years experience

In recent years, lye products have come into common household use in Turkey. Unfortunately, we have noted more cases of serious corrosive esophagitis owing to accidental caustic agent ingestion. The aims of this study were to (1) evaluate our experience with these cases and (2) investigate the effects of long-term intraesophageal polytetraflourethylene stenting on esophageal remodeling and its impact upon the need for esophageal replacement. Between 1997 and 2006, 68 patients (44 males and 22 females) with accidental caustic agent ingestion were admitted to our department, the only tertiary care referral center for the Turkish Army. Once stabilized, esophagoscopy was performed for injury grading (grades 0, 1, 2a, 3b, 3a, or 3b) as described by Millar and Cywes (Pediatric surgery. 1998;969-979). Esophagogram was performed 3 weeks after injury to assess healing. At presentation, the injury grade for 24, 31, 11, and 1 cases were 0 or 1, 2a, 2b, and 3a, respectively. One case had gastric outlet obstruction. All cases of grade 0 or 1 injuries had a normal esophagogram at 3 weeks postinjury. For the remaining 44 patients, several treatment modalities have been applied, including antegrade and retrograde dilatations in 31 grade 2a patients, intraluminal stenting in 11 grade 2b patients, esophageal reconstruction in 1 grade 3a patient, and gastroenterostomy in 1. Of the 11 patients with esophageal stenting, 8 patients have resumed a normal diet after 9 to 14 months of stenting. Mean follow up duration is 3.5 years (1-6 years) after stent removal. In the remaining 3 cases, treatment is still ongoing. Esophagitis and esophageal structuring because of caustic agent ingestion is a major public health problem in Turkey. Our small uncontrolled pilot series suggests that intraluminal polytetraflourethylene stenting may be an effective treatment method to reduce the need for major surgical reconstruction of recalcitrant esophageal strictures.     

Closed perforation of the small bowel secondary to a phytobezoar: imaging findings

Small bowel perforation secondary to phytobezoars is a rare clinical entity, which is not well-documented in the radiological literature. Sonographic and computed tomography (CT) findings of a case of closed small bowel perforation secondary to phytobezoars in a patient with previous gastric surgery are presented. Both abdominal ultrasound and CT examinations revealed a collection containing air at the left lower quadrant as well as neighboring intraluminal masses suggestive of bezoars. We propose that appropriate CT examination is a very useful imaging modality for evaluating this kind of bowel perforation.     

Combination of myotonic dystrophy and hereditary motor and sensory neuropathy

Myotonic Dystrophy Type 1 (DM1) in combination with demyelinating neuropathy is very rare in literature. In this study, DM1 and demyelinating neuropathy were demonstrated clinically and electromyographically in a 43-year-old female patient from Turkey. In the patient an expanded CTG repeat in the Myotonic Dystrophy Protein Kinase (DMPK) gene was confirmed in combination with a duplication in the Charcot-Marie-Tooth Disease (CMT1A) gene. DM1 was also determined in her 25-year-old son.     

Prevalence of migraine diagnosis using ID Migraine among university students in southern Turkey

In this prospective study, we aimed to determine the prevalence of migraine and non-migraine headaches using a questionnaire, including ID Migraine, for university students. The study was designed cross-sectionally and a questionnaire consisting of 43 questions was applied to 1,256 students. The questionnaire consisted of questions related to demographic, social, curriculum, housing and headache characteristics of the subjects. Three-item screening questions of the ID Migraine test were included at the end of the questionnaire aimed at migraine diagnosis. The mean age of 1,256 students (529 females and 727 males) enrolled in this study was 21.9 +/- 2.1 years (17-31 years). Migraine-type headache was detected in 265 subjects (21.9%) based on the ID Migraine evaluation. Of these, 145 (54.7%) were female and 120 (45.3%) were male (female/male ratio: 1.2/1). Non-migraine-type headache was identified in 864 subjects, with 357 females and 507 males. As a conclusion, ID Migraine screening test might be practical and beneficial when a face-to-face interview is not possible or to pre-determine the subjects for a face-to-face interview for migraine diagnosis in larger populations.     

Clematis vitalba L. aerial part exhibits potent anti-inflammatory, antinociceptive and antipyretic effects

Extracts obtained from the dried aerial parts of Clematis species are used as folk remedy worldwide for the treatment of various inflammatory ailments such as rheumatism and to reduce fever. In order to test the effectiveness of extracts, fractions and subfractions from dried Clematis vitalba L. (Ranunculaceae) aerial parts were studied on mice. Extracts are shown to have a potent effect on carrageenan-induced hind paw edema and acetic acid-induced increased vascular permeability models. Through bioassay-guided fractionation procedures a new C-glycosylflavon, 4′-O-coumaroyl-isovitexine (vitalboside) was isolated as the main active ingredient of the aerial parts. Vitalboside showed a potent and dose-dependent (in 75 and 150 mg/kg does, per os) in vivo anti-inflammatory activity against acute (carrageenan-, serotonin- and PGE₂-induced hind paw edema model, castor oil-induced diarrhea), subacute (subcutaneous air-pouch) and chronic (Freund's complete adjuvant-induced arthritis) models of inflammation. The same compound was also isolated as the main antinociceptive principle which was assessed by using the models based on the inhibition of p-benzoquinone-induced writhings, as well as antipyretic activity against Freund's complete adjuvant-induced increased body temperature. Acute and subchronic toxicity studies were also performed.     

Importance of MutL homologue MLH1 and MutS homologue MSH2 expression in Turkish patients with sporadic colorectal cancer

AIM: To assess the incidence of MLH1 (the human MutL homologue) and MSH2 (the human MutS homologue) protein expression in Turkish patients with sporadic colorectal cancers and to compare their survival and clinicopathological features. METHODS: We validated the tissue microarray technology in 77 colorectal carcinomas by analyzing the immunohistochemical expression of proteins involved in two main pathways of colorectal carcinogenesis: p53 protein for loss of heterozygosity tumors; MLH1 and MSH2 proteins for microsatellite instability (MSI). RESULTS: Our analysis showed that 29 (39.2%) had loss of MLH1 expression, 5 (6.8%) had loss of MSH2 expression and 2 cases had loss of expression of both proteins. We found that 60% of MSH2-negative tumors were located in the right side of the colon; all MSH2-negative cases were women. In addition, the loss of MSH2 expression was correlated with low p53 expression. Neither MLH1 nor MSH2 expressions were associated with prognosis, although there seemed a tendency of longer survival (71.7 ± 8.65 mo vs 47.08 ± 5.26 mo) for the patients with MLH1-negative versus MLH1-positive carcinomas. There were not significant differences in overall and recurrence-free survival among MLH1/MSH2-positive and -negative cases.CONCLUSION: Our data supports that Turkish patients with MLH1- and MSH2-defective tumors have some distinct features from each other. Although prognostic importance remains controversial, immunohistochemical analysis of mismatch repair genes may be used as a routine histopathological examination of sporadic colorectal carcinomas.     

Association between serum uric acid levels and coronary flow reserve in hypertensive patients without concomitant risk factors

BACKGROUND: Hyperuricemia is associated with hypertension, vascular disease and cardiovascular (CV) disease. However, the role of serum uric acid (SUA) level as an independent risk factor for CV and renal morbidity in hypertension remains controversial. Accordingly, we aimed to determine whether SUA levels are independently and specifically associated with coronary flow reserve (CFR) impairment in hypertensive patients. METHODS: We examined 80 never treated and newly diagnosed hypertensive individuals. The hypertensive individuals were divided into two groups based on CFR values. RESULTS: Subjects with altered CFR (<2) had significantly higher SUA levels compared with those with normal CFR (> or = 2) (346.0 +/- 98.1 vs 260.7 +/- 75.6 micromol/l, p<0.0001). After adjusting for potential confounders, including age, sex, body mass index, blood pressure, lipids and creatinine, we found that SUA levels were independently associated with CFR impairment (beta = -0.417, p<0.0001). We also found that SUA levels were a good predictor of low CFR at the receiver-operating characteristic curve. Area under the curve was 76% (95% CI 0.64-0.88), and SUA levels were significantly predictive of low CFR (p<0.0001). CONCLUSIONS: These results support a role for SUA level as an independent marker of target organ damage in hypertension.     

Independent value of echocardiography and N-terminal pro-natriuretic Peptide for the prediction of major outcomes in patients with suspected heart failure

N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and echocardiography have been shown to have diagnostic and prognostic value for the assessment of heart failure (HF) in the community. This study evaluated whether echocardiography and serum NT-pro-BNP estimation have independent value for the prediction of major outcome in patients with suspected HF from the community. Accordingly, 137 patients with suspected HF referred from the community were followed up after undergoing clinical assessment, electrocardiography, NT-pro-BNP estimation, and echocardiography. Abnormal echocardiogram was defined as visual left ventricular ejection fraction 26 ml/m(2) or presence of left ventricular hypertrophy or significant valvular heart disease. Data were obtained in 132 patients (96%) over a mean follow-up period of 26 +/- 7 months during which 19 (14%) developed major cardiac events (14 deaths and 5 HF admissions). Univariate predictors for major cardiac event were age (p = 0.05), male gender (p = 0.007), presence of clinical signs of HF (p = 0.02), NT-pro-BNP level >/=50 pmol/L (p <0.001), abnormal electrocardiogram (p = 0.02), and abnormal echocardiogram (p = 0.004). However, the only independent predictors were male gender (odds ratio 3.09, 95% confidence interval 1.01 to 9.46, p = 0.05), NT-pro-BNP level >/=50 pmol/L (odds ratio 5.78, 95% confidence interval 1.63 to 20.5, p = 0.007), and abnormal echocardiogram (odds ratio 11.1, 95% confidence interval 1.43 to 85.6, p = 0.02). In conclusion, NT-pro-BNP and abnormal echocardiogram provided independent information for predicting adverse outcome in patients with suspected HF referred from the community.