A rare case of concurrent pulmonary and hepatic hydatid cysts treated by single‐stage surgical management

A 37‐year‐old woman was diagnosed with concurrent pulmonary and hepatic hydatid cysts. We performed simultaneous resection of hydatid cysts in the liver and right lung using a single‐stage surgical procedure. The patient completely recovered.     

Prognostic value of nm23 in gastrointestinal stromal tumors

Aim/Background: nm23 is suggested to represent a new class of metastasis suppressor genes. An inverse correlation between nm23 expression level and metastatic potential has been demonstrated in different malignancies. This study evaluated the prognostic value of nm23 in gastrointestinal stromal tumors (GISTs). Methods: Immunohistochemical expression level of nm23 was studied in a total of 32 patients with localized GISTs. The relationship between the expression level of nm23 and patient outcome was investigated. Results: A tumor size of 10 cm or more and a mitotic rate of 10 or more per 50 high-power fields were not significantly associated with the metastasis risk (p=0.60 and 0.55, respectively). Tumors with high expression of nm23 tended to have significantly lower metastatic potential (p= 0.02). The median survival was significantly longer in patients with high expression of nm23 (p=0.007). Conclusion: These results suggest that expression level of nm23 may be considered as a prognostic predictor in GISTs. Future studies with larger patient numbers will be essential to confirm the prognostic significance of nm23 in patients with GIST.     

Neuropsychological state of the population living in the Aral Sea region (zone of ecological crisis)

Background: The Aral Sea crisis has led to harmful effects on human habitat. In recent years, mild cognitive impairment is a growing problem.

Objectives: This article provides the results of studying the neuropsychological state of residents living in the crisis zone of the Aral Sea region in the case of Shalkar city. We have provided an assessment of the neuropsychological state of examined population and determined the leading pathology in this region.

Methods: The survey sample included 344 persons of reproductive age from 21 to 45 years. We have obtained results in biochemical studies, indicating perturbations of proteometabolism and lipid metabolism.

Results: A correlation analysis showed dependence between a decrease of albumin and high-density lipoproteins, an increase of low-density lipoproteins and parameters of cognitive function.

Conclusions: The research suggests a high prevalence of cerebrovascular pathology among the population, changes in cognitive function parameters, long-term and short-term memory problems and high levels of depression.     

Postoperative osteomyelitis following implant arthroplasty of the foot: diagnosis with indium-111 white blood cell scintigraphy

Many complications can occur following insertion of silicone elastomer implants into the foot. Postoperative infection may be difficult to distinguish from other conditions such as dislodgment, fracture, ectopic and heterotopic new bone formation, synovitis, and bursitis. White blood cell scintigraphy, in conjunction with the clinical scenario, may prove to be an invaluable tool in the diagnosis of postoperative osteomyelitis, subsequent to implant arthroplasties.     

Modification of the total first metatarsophalangeal joint implant arthroplasty

The Swanson Silastic HP 100 Flexible Hinge Toe Implant (Dow Corning Wright, Arlington Tennessee) displays superior tensile, elongation and tear propagation strength in comparison to other silicone implant materials. It is, however, subject to many factors which may shorten its life-span. One reason for such failure has been attributed to the irregular contour of bone ends created after metatarsophalangeal joint arthroplasty, resulting in abrasion shards and shearing fractures of the implant stems and hinge. Titanium grommets were developed to alleviate this factor. This case report demonstrates a complication subsequent to total first metatarsophalangeal joint implant arthroplasty and the effectiveness of the Swanson Flexible Hinge Toe Joint Grommet. (Dow Corning Wright, Arlington, Tennessee).     

Sinus tarsi syndrome: a postoperative analysis

A more thorough understanding of sinus tarsi syndrome has been attempted by a postoperative survey of patients who have undergone sinus tarsi decompression. An analysis of 22 cases of sinus tarsi syndrome that were operated on between 1980 and 1984 at Kern Hospital was made. In each case a surgical procedure similar to that described by O'Connor and Brown was utilized. It was concluded that sinus tarsi syndrome is a distinct clinical entity--a sequela of ankle injury that is easily diagnosed. It responds well to surgical intervention and offers little chance of postoperative complication.     

Is daytime insulin more physiologic and less atherogenic than bedtime insulin?

The question is whether bedtime insulin, one of the standard therapy regimens of type 2 diabetes, can be more atherogenic than daytime insulin. There is no study to answer this question. However, pharmacokinetics of drugs and physiopathology of type 2 diabetes are considered, we can assume that daytime OAD plus bedtime insulin therapy might be more atherogenic than daytime insulin plus bedtime OAD therapy. The rationale for combination therapy is based on the assumption that, if evening insulin lowers the fasting glucose concentration to normal, then daytime oral agents will be more effective in controlling postprandial hyperglycemia. However, exogenous insulin administration is not a convenient way to inhibit hepatic glucose production which determines fasting plasma glucose because in post absorptive period, hepatic glucose production is determined by high glucagon and low insulin levels. In postprandial period, beta cell-originated insulin inhibits glucagon synthesis by paracrine effect and also inhibits hepatic glucose production by using half of its concentration that administered to portal system. Since half of insulin that found in portal system is exposed to hepatic clearance to inhibit hepatic glucose production, portal insulin concentration is 2-4-folds higher than peripheral insulin concentration. But, exogenous insulin neither inhibits glucagon synthesis via paracrine effect, nor reaches desired portal concentrations because it has a short half-life and in opposition to physiologic states it is not administered to the portal system. On the contrary, its peripheral concentration is higher than portal one. Thus, exogenous insulin that is used to inhibit hepatic glucose production requires higher concentrations than physiologic values. Eventually, peripheral hyperinsulinemic state which is a risk factor of CVD is created iatrogenically. Bearing in mind that PI3K pathway, working synchronously with the diurnal rhythm of other metabolic hormones, is more active during daytime especially in postprandial period when aminoacids and glucose exist in the environment, and that decreased insulin response in PI3K pathway in diabetics, we may propose iatrogenically created hyperinsulinemia can cause more atherogenic effects via MAPK pathway. For that reason, using OAD instead of bedtime insulin may be a more convenient way to inhibit hepatic glucose production. Thus, glucagon synthesis inhibition can be achieved via paracrine effect of OAD-induced insulin secretion, as well as required portal insulin concentration can be reached by the direct secretion of insulin to the portal system. Moreover, lower peripheral hyperinsulinemia state can be provided.     

The effects of allopurinol on rat liver and spleen tissues in a chronic hyperammonemia animal model

OBJECTIVE: To investigate whether hyperammonemia can lead to any structural change in liver and spleen tissues or biochemical changes in blood and if allopurinol (ALLO) has a protective effect in hyperammonemia. METHODS: This study was conducted between April and May 2006. Thirty-six females Wistar Albino rats were randomly divided into 3 equal groups: Controls, administered with ammonia (NH3) and administered with NH3 + ALLO groups. Ammonium acetate (2.5 mmole/kg/day) was injected to NH3 group intraperitoneally (IP) for 28 days. The other group received ammonium acetate (2.5 mmole/kg) plus ALLO (50 mg/kg) IP for 28 days. After finishing the study, blood and tissue samples were collected to perform histopathological and biochemical analysis. RESULTS: Liver and spleen tissues were normal in the control group. In NH3 group, liver tissues were minimally vacuolar and granular degenerations and moderate mononuclear cell infiltration. However, there was no histopathological change in NH3 + ALLO group. Spleen tissues were normal in NH3 group. In biochemical analysis, there was no significant difference between the groups (p>0.05). CONCLUSION: The ammonium acetate may cause minimal structural changes in rat liver and ALLO can prevent this. We found that biochemical parameters do not necessarily correlate with the histopathological findings.