Unilateral lacrimal fistula in a patient with uterus didelphys and renal agenesis

A 30-year-old female patient presented to our clinic because of lacrimation from an orifice close to the left lower eyelid. Ocular examinations and analyses revealed uterus didelphys and unilateral renal agenesis associated with a left lacrimal fistula. The patient underwent fistulectomy and external dacryocystorhinostomy. We decided to report on this patient owing to the unusual concurrent systemic abnormalities.     

The acute effect of tropisetron on ECG parameters in cancer patients

OBJECTIVES: The 5-hydroxytryptamine 3 receptor antagonists, including tropisetron, ondansetron, granisetron, and dolasetron are agents used effectively for supportive care. They are used for the prevention and treatment of chemotherapy and radiotherapy-induced emesis. Despite their overall excellent safety profile, some electrocardiographic changes related to heart rate and repolarization were reported. Ondansetron, granisetron, and dolasetron were studied on this manner. But to our knowledge, there is no information about the cardiac side effects of tropisetron. In this study, we aimed to determine the acute effects of tropisetron on ECG parameters related to repolarization, heart rate, and systemic blood pressure. MATERIALS AND METHODS: Fifty-five cancer patients who received tropisetron for the prevention of acute chemotherapy-induced nausea and vomiting were enrolled into this single center, prospective study. Standard 12-lead ECG recordings were performed at baseline and 30 min after tropisetron (5 mg given over 1 min IV bolus) administration. P wave durations and corrected QT intervals were measured; P wave dispersion and QTc dispersion were calculated. RESULTS: In comparison with baseline, mean heart rate significantly decreased 30 min after administration of tropisetron. Tropisetron did not result in a significant change in P wave duration, corrected QT interval, P dispersion, and QTc dispersion. CONCLUSION: In this study, tropisetron did not show any ventricular and atrial arrhythmogenic effect because of repolarization abnormalities. Only it may cause a slight decrease in heart rate.     

The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease

OBJECTIVE: To detect the effectiveness of incremental speed-dependent treadmill training on postural instability, dynamic balance and fear of falling in patients with idiopathic Parkinson's disease. DESIGN: Randomized controlled trial. SETTING: Ankara Education and Research Hospital, 2nd PM&R Clinic, Cardiopulmonary Rehabilitation Unit. SUBJECTS: Fifty-four patients with idiopathic Parkinson's disease in stage 2 or 3 of the Hoehn Yahr staging entered, and 31 patients (21 training, 10 control) had outcome data. INTERVENTIONS: Postural instability of patients with Parkinson's disease was assessed using the motor component of the Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. Twenty-one patients with Parkinson's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training. Before and after the training programme, balance, gait, fear of falling and walking distance and speed on treadmill were assessed in both Parkinson's disease groups. MAIN MEASURES: Walking distance and speed on treadmill, UPDRS, Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. RESULTS: Initial total walking distance of the training group on treadmill was 266.45 +/- 82.14 m and this was progressively increased to 726.36 +/- 93.1 m after 16 training session (P < 0.001). Tolerated maximum speed of the training group on treadmill at baseline was 1.9 +/- 0.75 km/h and improved to 2.61 +/- 0.77 km/h (P < 0.001). Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme (P < 0.01). There was no significant improvement in any of the outcome measurements in the control group (P > 0.05). CONCLUSIONS: Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility, reduce postural instability and fear of falling in patients with Parkinson's disease.     

Effects of some hematological parameters on whole blood tacrolimus concentration measured by two immunoassay-based analytical methods

OBJECTIVES: Tacrolimus (FK506) is a potent immunosuppressive drug used for prevention of rejection following transplantation. Several methods including immunoassays have been used for monitoring tacrolimus levels. The purpose of the present study was to compare the effects of various hematological parameters on whole blood tacrolimus concentrations which were measured with two different analytical methods, namely the microparticle enzyme immunoassay (MEIA II) and enzyme multiplied immunoassay technique (EMIT). DESIGN AND METHODS: The effects of hematological variables, namely hematocrit (Htc), hemoglobin (Hb), red blood cell (RBC), mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), red cell distribution width (RDW) and platelet (PLT) counts on tacrolimus concentrations (n = 2430 measurements) measured with EMIT (n = 1171) and MEIA II (n = 1259) methods in whole blood samples from kidney or liver or combined kidney-pancreas transplant patients (n = 162) during a 2-year post-transplantation period were compared. RESULTS: The whole blood tacrolimus concentrations measured with MEIA II method were affected much more significantly by hematological parameters than those measured with EMIT method. In MEIA II method, RDW (r = 0.479, P < 0.01) showed a stronger correlation with tacrolimus concentration than Htc (r = -0.239, P < 0.01) in all patients. A negative significant correlation (r = -0.468, P < 0.01) was also observed between the Htc and tacrolimus concentration in patients with Htc values < or =25% in MEIA II method. CONCLUSIONS: The results of the present study suggest that EMIT method might be preferred to MEIA II in determination of whole blood tacrolimus concentrations in anemic transplant patients. For better therapeutic drug monitoring, physicians should be aware of these assay differences. Evaluation of hematologic factors that affect the whole blood concentrations of tacrolimus may be helpful in deciding the dosage of this drug.     

The effect of intrafollicular IGF 1 and IGFBP 3 on IVF outcome in patients using different gonadotropins: a prospective study

Aim  

To investigate follicular fluid IGF 1, IGFBP 3 and their effects on IVF outcome in patients using different gonadotropins.     

Assessment of tissue repair in full thickness chondral defects in the rabbit using magnetic resonance imaging transverse relaxation measurements

The purpose of this study was to determine if the noninvasive and nondestructive technique of magnetic resonance imaging could be used to quantify the amount of repair tissue that fills surgically-induced chondral defects in the rabbit. Sixteen 4-mm diameter full-thickness chondral defects were created. A photopolymerizable hydrogel was used to seal the defects as a treatment modality. At 5 weeks, the animals were sacrificed and the distal femur was subjected to MRI analyses at high field (9.4 T). The transverse relaxation time (T(2)) in each defect was measured. Histology and histomorphometric analysis were used to quantify the amount of repair tissue that filled each defect. The relationship between T(2) and percent tissue fill was found to fit well to a negatively sloped, linear model. The linear (Pearson's product-moment) correlation coefficient was found to be r = -0.82 and the associated coefficient of determination was r(2) = 0.67. This correlation suggests that the MRI parameter T(2) can be used to track changes in the amount of repair tissue that fills cartilage defects. This would be especially useful in in vivo cartilage tissue engineering studies that attempt to determine optimal biomaterials for scaffold design.     

Living-donor hepatectomy

Background

Organ transplantation from deceased donors is still far below the need. Because of this deficiency, liver transplantations are performed mostly from live donors in many transplant centers in our country. Living-donor liver transplantation (LDLT) has evolved dramatically over the past decade. The aim of this study was to present our clinical experience with living-donor hepatectomy.

Methods

We retrospectively analyzed all patients who underwent donor hepatectomy between March 2000 and September 2010. We reviewed demographic data, operation type, operation and cold ischemia times, duration of hospital stay, and postoperative complications.

Results

During the study period, 140 living donors underwent operations for liver transplantation. We performed 108 right hepatectomies, 17 left hepatectomies, and 15 left lateral hepatectomies. The mean age of the donors was 30.8 years. There was no operative or postoperative mortality. Overall morbidity rate was 13.57% (n = 19). Nine patients had biliary leakages, 4 biliomas; 2 urinary tract infections, and 1 each inferior vena caval injury, pneumonia, portal vein thrombosis, and acute tubular necrosis. Reoperation was not required in any of these patients.

Conclusions

Living-donor liver transplantation is a valuable alternative for patients awaiting a cadaver organ. Live-donor hepatectomy can be performed with low morbidity. The greatest disadvantage of this procedure is the risk of the surgical operation for the individual who will experience no medical benefit from this procedure.     

Socioeconomic conditions of elderly people in Kosovo: a cross-sectional study

ABSTRACT: BACKGROUND: Kosovo is the newest state in Europe facing a particularly difficult socioeconomic and political transition. The available evidence on socioeconomic conditions and quality of life of elderly people in Kosovo is scarce notwithstanding the ageing trend due to lowering of fertility rates and a higher life-expectancy. In this context, the aim of our study was to assess the socioeconomic conditions of elderly people in post-war Kosovo. METHODS: A cross-sectional study was conducted in Kosovo in January-March 2011 including an age- sex-and residence (urban vs. rural)-stratified sample of 1,890 individuals (83.5% response) aged 65 years and over. A structured questionnaire included assessment of socio-demographic and socioeconomic characteristics including educational level and self-perceived poverty. Binary logistic regression was used to assess the association of self-perceived poverty with socio-demographic and socioeconomic factors. RESULTS: The educational level in this representative sample of elderly people in Kosovo was quite low, particularly among women. About 47% of respondents perceived themselves as poor, or extremely poor (41% of men and 52% of women). In multivariable-adjusted models, self-perceived poverty was higher among older women, low educated individuals, urban residents, and elderly individuals living alone. CONCLUSIONS: Findings from this study indicate that the socioeconomic situation of the elderly population in Kosovo is rather challenging. Demographic trends coupled with the economic and political transition raise serious concerns about increasing needs for socioeconomic support of elderly people in Kosovo. Specific policies and actions should be considered by a number of stakeholders, including government and civil society in transitional Kosovo.     

Prevalence and Demographic Correlates of Overweight and Obesity Among Children in a Transitional Southeastern European Population

Our aim was to assess the prevalence and demographic correlates of overweight and obesity among children in Albania, a transitional country in Southeastern Europe. A nationwide survey was conducted in Albania in 2013 including a representative sample of 5,810 schoolchildren aged 7.0–9.9 years (51.5 % boys aged 8.5 ± 0.6 years and 49.5 % girls aged 8.4 ± 0.6 years; overall response: 97 %). All children were measured height and weight, based on which the body mass index (BMI) was calculated. The criteria of the World Health Organization (WHO) and the International Obesity Task Force (IOTF) were used to describe the distribution of BMI among children. Overall, mean value of BMI was 16.4 ± 2.4 (16.7 ± 2.5 in boys vs. 16.2 ± 2.4 in girls, P < 0.001). As per WHO criteria, 9.8 % of the boys were obese versus 5.5 % of the girls (P < 0.001). The prevalence of both overweight and obesity were remarkably higher among urban children compared with their rural counterparts (17.9 vs. 10.5 and 11.9 vs. 4.0 %, respectively, P < 0.001). As per IOTF criteria, 3.8 % of the boys were obese compared with 2.8 % of the girls (P < 0.001). The prevalence of overweight and obesity were similarly higher among urban children than in rural children (15.6 vs. 7.3 and 5.5 vs. 1.4 %, respectively, P < 0.001). Our findings indicate that Albania is in the middle of nutritional transition with a high prevalence of overweight and obesity among children aged 7.0–9.9 years. This is particularly evident in urban areas of the country. Conversely, our data do not indicate a double burden of malnutrition among children in Albania.     

The influence of cervical spinal cord stimulation on induced epileptic discharges in rats

Spinal cord stimulation (SCS), also known as dorsal column stimulation, is a novel technique used widely in pain surgery. However, its effect on other pathologies such as epileptic disorders is unknown. The aim of this study is to evaluate the influence of electrical epidural stimulation of the upper cervical region on epileptic cortical discharges. The long term goal is to elucidate and evaluate a therapeutic central nervous system (CNS) electrical stimulation methodology to treat epilepsy. Twelve Wistar female rats were randomly divided into two groups. In group 1 (six rats under general anesthesia), C2-3 laminectomies were performed and epidural electrodes were placed to perform SCS. To induce epileptic discharges, 1 ml (200 IU) penicillin G was microinjected into the left somatomotor cortex via left stereotactic parietal craniotomies, 0.01 to 0.1 mA at 2 Hz was used to stimulate the spinal cord. In group 2 (the control group, six rats under general anesthesia), C2-3 laminectomies were performed without electrode placement and epileptic discharges were induced with penicillin G microinjections, as described above. Both groups were monitored with digital electroencencephalography (EEG) for 70 min in seven stages and recordings analyzed with power spectral analysis. Spinal cord stimulation decreased penicillin-induced median values of epileptic discharges. Epileptic wave frequencies decreased significantly with increasing intensities of SCS. The results of this study suggest that SCS used for drug resistant epilepsies may be a viable alternative treatment modal.