Double dose plateletpheresis by continuous and intermittent flow devices increases platelet-neutrophil complex formation in healthy donors without noticeable neutrophil activation.

Several reports have demonstrated that during a single plateletpheresis procedure, platelets may form heterotypic aggregates which may predispose certain donors to thrombotic complications. In this study, changes in the expression of neutrophil adhesion molecules (CD11b/CD18, CD50/54, CD62L) and platelet-neutrophil complex (PNC) formation were investigated by a flow cytometric method in healthy donors following a double dose plateletpheresis (DDP) procedure. Our results show that DDP which are carried out by the Fresenius AS.TEC 204 and Haemonetics MCS+ cause a significant increase in PNC formation in donors. Additionally, the Fresenius AS.TEC 204 device caused a decrease in CD62L expression which is a sign of mild neutrophil activation. Although the clinical significance of these laboratory changes is not clear, the occurrence of neutrophil activation and increased PNC formation might predispose certain donors to thrombotic complications following DDP.     

Surgical approach to thalamic tumors

INTRODUCTION: Thalamic tumors comprise 1-5% of all brain tumors. Recent improvements in therapeutic approaches and surgical techniques have allowed a more accurate approach to these lesions and a reduction in morbidity and mortality. DISCUSSION: In this article, the various surgical approaches for the resection of thalamic tumors are described. Each of these approaches has its own indications and risk of complications.     

Does a fibrin sheath formed around a catheter embolize upon removal of the catheter?

Sir, Central venous catheters (CVC) are commonly used in haemodialysispatients. Encasement of the catheter by a fibrin sleeve is awell known complication which can interfere with catheter functionand prevent effective haemodialysis [1]. These sleeves do notcome with the catheter upon removal, but remain in the vein.Although millions of CVC are inserted and removed every year,there are few clinical reports describing what happens to thesleeve remaining inside the venous lumen upon removal [2,3].We conducted a prospective study to assess whether fibrin sheathformed around a short-term haemodialysis catheter embolizes     

Elution characteristics and mechanical properties of calcium sulfate-loaded bone cement containing teicoplanin

Background Acrylic bone cement is the most widely used drug delivery system clinically. It has already been shown that antibiotic release is significantly increased when calcium sulfate-loaded acrylic bone cement is used. However, there is no information yet about the mechanical responses of these composite materials. Thus, the purpose of this study was to investigate the effect of calcium sulfate on the elution characteristics and mechanical behavior of teicoplanin-loaded acrylic bone cement. Methods Four groups of acrylic bone cements (GI, GII, GIII, GIV) were prepared using the same liquid/powder ratios. After mixing, the bone cement and additive mixtures were packed into different-type molds to prepare the specimens for the elution and mechanical tests. All of the specimens were tested for two conditions (dry and human plasma solution). The mechanical tests included the setting time (hardness) and tensile, bending, and compression strengths. The fracture surfaces of the failed samples were also examined by scanning electron microscopy. Results Teicoplanin release in the calcium sulfate powder added groups (GIII and GIV) was higher than that of GII. When the calcium sulfate and teicoplanin were added on acrylic bone cement, the compressive, bending and tensile strength, hardness values, and elastic modulus decreased. Also, further reductions were evident in human plasma solution. Conclusions Although mechanical properties of tested specimens decreased, all of the results obtained were higher than those required by the American Society for Testing and Materials Standards, but further investigations are necessary before making definitive statements for clinical applications.     

Protective effects of carvedilol on ischemia–reperfusion injury in rat epigastric island skin flaps

Carvedilol, a selective alpha-1 and nonselective beta-adrenoceptor antagonist and potent antioxidant, has been shown to provide a significant decrease in neutrophil-mediated tissue injury. Epigastric skin flaps were elevated in rats, rendered ischemic for 10 h, and subsequently reperfused for 12 h. Forty rats were divided into four equal experimental groups: 1—nonischemic group, 2—ischemic saline control group, 3—ischemic control group without any vehicle treatment, and 4—drug-administered ischemic group. The effects of carvedilol on flap necrosis, neutrophil infiltration, and levels of malondialdehyde and nitric oxide in the flap tissue and serum were examined. The authors found that neutrophil numbers were significantly higher in the saline and nontreated groups. Additionally, serum and tissue levels of malondialdehyde were lower in the carvedilol-treated group, and serum nitric oxide was highest in the carvedilol-treated group. Carvedilol-treated animals had significantly lower areas of necrosis compared with controls. We conclude that administration of carvedilol before ischemia and reperfusion can significantly reduce the extent of flap necrosis and flap neutrophil counts because of ischemia–reperfusion injury. This study was presented at the 28th National Congress of Turkish Plastic, Reconstructive and Aesthetic in Ankara, Turkey, September 20–23, 2006.     

The effect of Helicobacter pylori eradication on gastroesophageal reflux disease

BACKGROUND: The effect of Helicobacter pylori (H. pylori) eradication on gastroesophageal reflux disease is controversial. We aimed to investigate the effect of H. pylori eradication in this group of patients. MATERIALS AND METHODS: Thirty-four consecutive patients with H. pylori infection and reflux esophagitis (grade 1 or 2) were enrolled into the study. Twenty-four hour intra-esophageal pH recording and esophageal manometry were performed before and 3 months after eradication of H. pylori, which was achieved using lansoprazole 30 mg b.i.d., amoxycillin 1 g b.i.d., and clarithromycin 500 mg b.i.d. for 14 days. H. pylori was evaluated in biopsy specimens taken from the antrum and corpus by rapid urease test and by histopathologic examination before and 3 months after eradication. RESULTS: Eighteen patients (11 men and 7 women, median age 42 years) completed the study. Three months after the treatment, there was no significant change in any of the 24-hour esophageal pH recording parameters and mean lower esophageal sphincter resting pressure (P > 0.05). The percentage of total time esophageal pH <4 increased in 10 patients, and decreased in 8 patients. There was a significant decrease in the scores of heartburn and regurgitation (P < 0.01). Esophagitis persisted in 16 patients and disappeared in 2 patients. Esophagitis score decreased in 6 patients, and did not change in 12 patients (P < 0.05). CONCLUSION: H. pylori eradication does not have any effect on gastroesophageal acid reflux in patients with reflux esophagitis 3 months after eradication, but significant improvement is achieved in some reflux associated symptoms.     

Evaluation of insulin sensitivity in patients with Klinefelter's syndrome: a hyperinsulinemic euglycemic clamp study

Patients with Klinefelter’s syndrome have a higher incidence of diabetes mellitus and the percentage of insulin resistance was reported to be high in these patients. However, little is known about the insulin sensitivity assessed by the hyperinsulinemic euglycemic clamp in these patients. In the present study, subjects included 13 newly diagnosed patients with Klinefelter’s syndrome, and 9 age- and body mass index-matched healthy males. The hyperinsulinemic euglycemic clamp was performed in all patients and controls. Insulin resistance was present in five (38.5%) patients with Klinefelter’s syndrome. Compared with control subjects, patients with Klinefelter’s syndrome had elevated plasma concentrations of fasting insulin, follicle-stimulating hormone, luteinizing hormone, estradiol, and sex hormone-binding globulin, whereas they had reduced plasma free testosterone and total testosterone concentrations. The multivariate linear regression analysis showed that fasting glucose, fasting insulin, free testosterone, and total testosterone were independently associated with M-value. In conclusion, the present study by using hyperinsulinemic euglycemic clamp indicates the high prevalence of insulin resistance in Klinefelter’s syndrome patients. However, these patients did not have reduced mean M-values compared with the controls, although their plasma insulin levels were significantly elevated. It is possible that hyperinsulinemia may be the primary metabolic abnormality rather than insulin resistance.