Efficacy of Radical Surgery in Preventing Early Local Recurrence and Cavity-Related Complications in Hydatic Liver Disease

Background Hydatic disease of the liver remains to be a complex worldwide problem especially in rural areas. Early local recurrence and cavity-related complications are still a matter of conflict in the management of hydatic liver disease. The aim of this study is to investigate efficacy of the type of surgical treatment in preventing early local recurrence and cavity-related complications of this disease. Here, we present the preliminary results of our study. Methods This study was performed prospectively including 32 patients who were operated for hydatic liver disease between January 2001 and January 2005. Patients were randomized into radical and conservative surgery groups. Recurrences at the primary surgical site in the first 2 years were considered as early local recurrence and biliary leakage, biliary fistula, cavity abscess, etc. were considered as cavity-related complications. Results Early local recurrences were observed only after conservative surgical procedures (p = 0.045). Recurrent cysts were found to be due to satellite cysts or pericystic disease. Cavity-related complications were seen in six patients in the conservative surgery group (p = 0.011). Conclusions In suitable patients, radical surgical resection provides an effective surgical management option in preventing early local recurrence and cavity-related complications when compared to conservative surgical approaches.     

Use of ultrasonography in ulnar nerve entrapment surgery—a prospective study

The purpose of our study is to assess the usefulness of high-resolution ultrasonography in observing the morphology and dynamics of the ulnar nerve in the cubital tunnel and also the efficacy of ultrasonography in a more accurate diagnosis and appropriate surgical treatment decision. Cross-sectional area of the ulnar nerves of 40 healthy volunteers in the control group were measured bilaterally at the level of the epicondyle, 2 cm proximal to and 2 cm distal to the epicondyle. Measurements were obtained for elbows both in extension and flexion. Then, we prospectively obtained the cross-sectional area values of 18 patients at the same levels, elbows in extension and flexion position, and compared the data obtained from the patient group and the control group. The differences between the cross-sectional areas of the ulnar nerves in extension and flexion were statistically significant in the patient population (p < 0.001). Mean cross-sectional area of the ulnar nerve in the patient population was calculated as 0.16 cm², and we accepted the cut-off point as 0.1 cm². This value for cross-sectional area yielded a sensitivity of 90% and a specificity of 100% in diagnosis of ulnar nerve entrapment. Results substantiated conspicuous morphological changes in ulnar nerve during flexion and extension of the elbow. We also observed that as the degree of the nerve displacement by virtue of elbow flexion that is discerned by ultrasonography increased, a more aggressive decompressive surgery was needed for an appropriate treatment.     

Public attitudes toward organ donation: A survey in a Turkish community

Abstract. A survey of public attitudes toward organ donation and transplantation was conducted in a Turkish community. The 1030 subjects were chosen using a random, stratified method. Some 50.5% of those interviewed were willing to donate their organs while 33.7% refused and 15.8% were uncertain. A total of 53.6% said they would consent to donate a deceased relative's organs. Reasons for refusal to donate organs were as follows: fear that their body would be cut into pieces (43.8%), religious beliefs (26.2%), no reason (23.1%) and the belief that they would need their body and organs for their second life (6.9%). Attitudes toward organ donation were clearly related to level of education, age, sex, and socioeconomic status.     

Preparation of sulfonated overoxidized polypyrrole film applicable as an SPME tool for cationic analytes

The use of a solid-phase microextraction (SPME) method with a new design of functionalized stable overoxidized sulfonated polypyrrole (OSPPy) film electrode to extract metal ions (Ni(II) and Cd(II)) without derivatization from water of high saline content is described. Different cation uptake behavior is obtained for OSPPy and overoxidized polypyrrole. The cation uptake and release properties of the OSPPy film electrode were examined under both open circuit and controlled potential conditions for prospective applications in electrochemically controlled solid-phase microextraction (EC-SPME). The cation uptake is enhanced if a positive potential is applied to the electrode. Accumulated cations are released rapidly from the film if the applied potential is switched to a negative value. The cation uptake and release mechanism is affected both by the cation exchange at the negative sulfonate and carboxylate groups on the film and by the altered solution pH occurring at the counter electrode caused by the applied potential. Scanning electron microscopy (SEM) and energy dispersive X-ray analysis (EDAX) measurements on the two films have confirmed the presence of a sulfur content in the films and shown that covalently bound sulfonate preferentially dopes the polymer even in the presence of a large excess of BF₄^? anions. Our preliminary fundamental results show that this new polymer offers a wide potential range for electroanalytical exploration from selective electrodes to separation and/or preconcentration sampling devices.     

V–Y advancement flap closures for complicated pilonidal sinus disease

Background and aims Hair entry into the midline is the generally accepted theory in pilonidal sinus formation. This theory is also involved in the pathogenesis of the recurrence after different types of operations for pilonidal sinus disease. The relationship of the suture lines and the midline was evaluated in this study.Patient and methods Thirty-four patients with stage 4 or recurrent pilonidal sinus disease who underwent V–Y advancement flap closure were randomized into two groups: vertical suture line unrelated to midline (VLUM, n=18) and vertical suture line related to midline (VLRM, n=16).Results None of the patients with or without a suction drain developed flap necrosis, local haematomas or seromas. The median length of the postoperative hospital stay was 3 days for theVLRM group and the VLUM group (p>0.05). The median follow-up period was 32 months. During the follow-up period, two recurrences were determined 22 and 15 months after operation in the VLRM group. Recurrences were situated in the scar tissue over the midline.Interpretation and conclusion Routine application of suction drains is not recommended after V–Y advancement flap closure. Avoidance of the relationship of the postoperative suture line and the midline, if possible, offers a safe method of definitive reconstruction.     

Two siblings with fulminant viral hepatitis A: case report

Fulminant hepatitis is a rare complication of acute hepatitis A infection. Nevertheless, the seroepidemiology of the infection is rapidly changing with the developing world, rendering more adults susceptible to the infection, in particular with more severe course. We report here fulminant hepatitis A infection with a mortal course during an epidemic period in two siblings. Although it causes a self-limited mild disease, hepatitis A virus may have a severe course including fulminant hepatitis and may lead to mortality, especially in older ages. Hence, the risk of hepatitis A virus infection and its complications should be reduced with measures of immunization and sanitation.     

Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in smokers

Introduction

The aim of this study was to evaluate the relationship between cigarette smoking and atrial rhythm disorders with the use of noninvasive methods.

Methods

The study population consisted of 50 healthy volunteer smokers and 40 healthy volunteer non-smokers who had normal echocardiographic parameters and similar sex and age profiles. P-wave dispersion (PWD) was calculated from the 12-lead surface ECG. Left ventricle (LV) end-systolic and end-diastolic diameters, LV ejection fraction, and interatrial and intraatrial electromechanical delay were measured by tissue Doppler imaging and conventional echocardiography.

Results

Isovolumetric relaxation time and deceleration time were significantly higher (91.5?±?11 vs. 82.35?±?8.6, p?p?p?=?0.003). There were no significant differences between the groups with respect to Sm and Em values, Am value, and E/A and E/Em ratios. However, the Em/Am ratio was significantly lower in smokers (1.28?±?0.21 vs. 1.44?±?0.33, p?p?p?r?=?0.567, p?r?=?0.653, p?=?0.001).

Conclusion

We have demonstrated the relationship between inter- and intraatrial electromechanical delay and PWD. These parameters may be useful predictive markers for the development of AF in the asymptomatic period before cardiac rhythm disturbances occur. This finding may indicate that smokers have an increased risk of developing atrial rhythm disturbances.     

Ghrelin expression in normal kidney tissue and renal carcinomas

Ghrelin expression in cancers is either reduced/absent or increased depending on the organs involved. The aims of this study were to investigate: (i) whether there are differences in ghrelin peptide expression between kidney tissues from a series of renal cell carcinoma cases, oncocytomas, and normal controls; (ii) whether there are correlations between tissue ghrelin levels in a series of renal carcinoma cases and normal controls; and (iii) how normal is kidney ghrelin expression per mg tissue as compared with the normal stomach tissue ghrelin level. We studied 7 normal stomach and 7 normal kidney samples, 21 clear cell renal carcinomas, 7 chromophobe type renal cell carcinomas (RCC), 7 papillary type RCC, and 7 oncocytoma samples. Tissue ghrelin expression was measured by RIA and immunohistochemistry. Grades 1–3 clear renal cell carcinomas, chromophobe type RCC, papillary type RCC, and oncocytomas expressed 88%, 94%, 95%, 51%, 75%, and 48% less ghrelin than the normal kidney, respectively. Overall, we concluded that ghrelin expression in renal cell carcinoma tissues is always lower than that in normal kidney or is absent. This low level or lack of ghrelin may play a role in the etiopathogenesis and progression of cancer.     

Psychiatric disorders and symptoms severity in patients with adenotonsillar hypertrophy before and after adenotonsillectomy

Objective

The objective of this study was to compare the frequency of psychiatric disorders and the severity of psychiatric symptoms in patients with adenotonsillar hypertrophy with a healthy control group and investigate the potential improvement after adenotonsillectomy.

Materials and methods

The study group consisted of 40 patients with adenotonsillar hypertrophy and a control group consisted of 35 healthy volunteers without adenotonsillar hypertrophy. A routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry were carried out. The same procedures were applied to the control group. The parents of all the participants were required to fill out the Early Childhood Inventory-4 form, the Strengths and Difficulties Questionnaire and a personal information form. At postoperative month six, the patients were re-examined, and their parents were required to fill out the same forms.

Results

Attention deficit hyperactivity disorders and sleep disorders determined with the Early Childhood Inventory-4 were more common in the patients with adenotonsillar hypertrophy than in the control group. There was a significant decrease in the rates of both types of disorders at postoperative month six. The total psychiatric symptom severity was higher in the patients with adenotonsillar hypertrophy and the following were more frequent: cases of attention deficit hyperactivity disorder, oppositional defiant disorder, symptom severity of anxiety disorders and sleep disorders determined with the Early Childhood Inventory-4, as well as emotional problems, attention deficit hyperactivity disorder problems, behavioural problems and peer problems determined with the Strengths and Difficulties Questionnaire parent-report form. There was a statistically significant decrease in all the other symptoms at postoperative month six, except for the severity of oppositional defiant disorder symptoms determined with the Early Childhood Inventory-4 and behavioural problems determined with the Strengths and Difficulties Questionnaire parent-report form. There were no differences in the severity of psychiatric disorders or symptoms between the adenotonsillar hypertrophy group and the control group at postoperative month six.

Conclusion

Adenotonsillar hypertrophy is associated with psychiatric disorders and symptoms. Adenotonsillectomy ameliorated the symptoms and the severity of these disorders in most cases.