Calcaneal Avulsion of an Ochronotic Achilles Tendon: A Case Report

Alkaptonuria is a hereditary disorder of phenylalanine and tyrosine, with an incidence of approximately 1/200,000 to 1/1,000,000. Ochronosis is the accumulation of homogentisic acid and its metabolites in connective tissues such as the tendons, cartilage, and skin. In the present case study, a 50-year-old male presented with a nontraumatic calcaneal avulsion without a previous diagnosis of ochronosis. To the best of our knowledge, little information has been reported of this pathology in the Achilles tendon and the surgical management.     

Curcumin prevents shock-wave lithotripsy-induced renal injury through inhibition of nuclear factor kappa-B and inducible nitric oxide synthase activity in rats

Shock wave lithotripsy (SWL) is commonly used for treatment of renal stones. Free oxygen radicals are involved in the pathophysiology of renal injury due to SWL. We investigated the protective effects of curcumin, which is an antioxidant and nuclear factor kappa-B (NF-κB) inhibitor, against renal injury. Forty-eight rats were included and divided into four groups: group 1, control; group 2, SWL (15 kW-1,500 shocks); group 3, SWL + curcumin (curcumin orally 75 mg/kg/day dissolved in 10% ethyl alcohol, 1 day before and 5 days after SWL); and group 4, SWL + vehicle (10% ethyl alcohol). The kidneys were removed on days 7 and 35 after SWL. A sample was fixed in formaldehyde solution. Renal tissues were examined for proximal tubular injury under light microscope. iNOS activity and active subunit of NF-κB, p65, were evaluated immunohistochemically using rat monoclonal antibodies interpreting results semiquantitatively. There were significant differences between SWL and control groups on days 7 and 35, considering histological changes under light microscope (P < 0.02). There was a significant decrease in necrosis and fibrosis in the curcumin group as compared to the SWL group. Expressions of iNOS and p65 on days 7 and 35 were at basal levels with immunohistochemical staining. These parameters had high levels in the SWL group (P < 0.02). No significant difference was present between the control and the curcumin groups (P > 0.02). Curcumin, decreasing expressions of iNOS and p65 and serum nitric oxide levels prevented interstitial, glomerular, tubular epithelial and endothelial cellular injuries. We suggest that curcumin, could be used, especially in high-risk patients, as a protective agent to prevent renal injury due to SWL.     

Early Decision for Precut Sphincterotomy: Is It a Risky Preference?

The aim of this prospective study was to evaluate the results and the complications at a tertiary referral center which frequently uses precutting techniques for biliary cannulation. Four hundred seventy patients with naive papilla for whom biliary intervention was planned were included in the study. If the selective cannulation was not achieved after a few trials, precutting sphincterotomy was performed. The results were evaluated for the frequency, success, and complication rates of precutting. Precutting was performed on 238 (50.6%; 117 male, 121 female; mean age, 58.5±16.2 years) of 470 patients. Total success rate of endoscopic retrograde cholangiopancreatography (ERCP) was 99.2% (236/238). The rate of complications in patients with versus without precutting was 7 (2.9%) versus 3 (1.3%) for pancreatitis, 2 (0.8%) versus 1 (0.4%) for perforation, and 7 (2.9%) versus 3 (1.3%) for bleeding. The differences between the rates were not significant. Early precutting can be preferable in prolonged cannulation trials of therapeutic ERCP.     

Rare clinical presentation of nonobstructive hypertrophic cardiomyopathy: apical aneurysm with thrombus

Hypertrophic cardiomyopathy patients rarely have left ventricular apical aneurysms without coronary artery disease and the pathophysiological processes responsible for apical wall thinning and aneurysm formation are not known exactly today. Here we present a rare nonobstructive hypertrophic cardiomyopathy case with an apical thrombotic aneurysm.     

Endothoracic papaverine application for internal thoracic artery harvest

This study compared the effects of different methods of papaverine application on free blood flow and harvesting time of the internal thoracic artery for coronary bypass grafting. Patients were randomly divided into 3 groups of 25 each: group 1 had papaverine injected into the endothoracic tissue around the internal thoracic artery before dissection, group 2 had papaverine injected into the periarterial tissues of the internal thoracic artery pedicle, and group 3 had intraluminal papaverine applied retrogradely into the internal thoracic artery. Mean blood flow was 56.3 +/- 21.3, 21.1 +/- 13.2, and 20.9 +/- 9.1 mL x min(-1) in groups 1, 2, and 3, respectively, immediately after harvesting. Flow in group 1 was significantly better than that in groups 2 and 3. Immediately before anastomosis, mean flow was 89.8 +/- 19.1, 97.6 +/- 35.4, and 95.9 +/- 19.9 mL x min(-1) in groups 1, 2, and 3, respectively, with no significant difference among groups. Internal thoracic artery harvesting times were shorter in group 1 than in groups 2 and 3. Administering papaverine into the endothoracic fascia of the internal thoracic artery bed prior to dissection is a reliable method that facilitates rapid harvesting of the graft without causing trauma and consequent spasm.     

Aspergillus spp. isolations from respiratory tract samples in Trakya University Hospital

The characteristics of cases diagnosed as aspergillosis and Aspergillus spp. strains isolated from the respiratory tract samples in Mycology Laboratory of Trakya University Hospital between January 2002 and May 2006 were investigated. In this period, 137 bronchoalveolar lavages, 95 sputum, nine tracheal aspirates, three lung biopsies and one bronchial biopsy of 85 patients were processed. The samples were incubated in 25 degrees C and 35 degrees C media by culturing on brain heart infusion agar with blood and Sabouraud dextrose agar. Presence of leucocytes and fungal structures were searched in the smear stained by Gram and Giemsa. The patient was defined as probable aspergillosis case, if he/she patient had clinical findings, lung infiltration or fungus ball radiologically, at least one risk factor predisposing to aspergillosis and isolation of Aspergillus spp. in lower respiratory tract samples without finding of other nonmycotic infection. Of 22 patients isolated Aspergillus spp., 13, six, two, one were internalized in chest diseases, haemotology, neurosurgery and oncology clinics, respectively. Seven positive cultures were considered as findings of aspergillosis. Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger were isolated in three, two, and two patients, respectively. Fungal structures were detected in only one sample in the direct microscopical examination. Ages of seven patients, five were males and two were females, were between 15 and 60. Predisposing risk factors were acute leukemia in six patients and lung cancer in one patient. Five patients were neutropenic and one was neutrophylic. Fungus ball was detected in radiological imaging of one patient, had a pulmonary cavitary lesion. Conventional amphotericine B was used in their therapies. Antifungal agents were switched to caspofungin and itraconazole in two and one patients, respectively. Three patients died in four weeks after isolation of Aspergillus spp. Aspergillosis cases were not high in our hospital because of absence of transplantation center for bone marrow or solid organ.     

Duodenal duplication cyst: a rare cause of acute pancreatitis in children

Duodenal duplication is a rare cause of acute pancreatitis in children. We report a case of acute pancreatitis in which abdominal sonography revealed an enlarged hypoechoic edematous pancreas with mildly dilated main pancreatic duct and a cystic structure with layered wall in the second part of duodenum. Abdominal CT yielded similar findings. The diagnosis of duodenal duplication was confirmed at surgery and subsequent histopathologic examination.