Hyperbaric oxygen therapy affects insulin sensitivity/resistance by increasing adiponectin,resistin, and plasminogen activator inhibitor-I in rats

Background/aim Hyperbaric oxygen therapy (HBOT) causes insulin sensitivity, but the reason for this is not known yet. The aim of the present study was to investigate the effect of HBOT on insulin sensitivity via resistin, plasminogen activator inhibitor-I (PAI - I), and adiponectin.Materials and methods The study was designed using HBOT and control groups, with eight rats in each group. After 20 days of HBOT under 2.5 atmospheres for 90 min, the fasting insulin (FI), resistin, PAI-I, homeostatic model assessment of insulin resistance scores (HOMA–IR), quantitative insulin sensitivity check index (QUICKI), fasting plasma glucose (FPG), triglyceride, and high-density lipoprotein cholesterol (HDL-C) in the plasma were measured. The resistin, PAI-I, and adiponectin mRNA expression levels were also measured in the adipose tissue.ResultsCompared to the control group, the FI, FPG, and HOMA-IR scores were significantly lower in the HBOT group, whereas the HDL-C and QUICKI scores were found to be higher. In addition, the resistin, adiponectin, and PAI-I mRNA expression levels were also higher in the HBOT group.ConclusionThe present study demonstrated that the HBOT had regulated the FI, FPG, and HDL-C associated with metabolic syndrome and diabetes mellitus. Moreover, the study showed that HBOT causes insulin sensitivity by raising adiponectin.     

Huge intradiploic epidermoid cyst

A 60-year-old man presented with an occipital mass under the scalp and complained of headache, nausea, and dizziness. Magnetic resonance imaging showed a well-defined mass in the occipital scalp extending from the scalp through the cranium and several centimetres into the posterior fossa. There were well-defined margins in the deep portion and the mass was totally removed. Histological examination showed that the cystic structure was lined by squamous epithelium containing laminated keratin material. The pathological findings were consistent with the diagnosis of an epidermoid cyst. The patient was discharged free of symptoms.     

Measurement of Vascular Input Impedance in Infrainguinal Vein Grafts

n = 40) or claudication (n= 17) were prospectively studied. At the time of revascularization, simultaneously acquired intraluminal pressure and blood flow waveforms were digitized at 200 Hz and subjected to Fourier transformation in near real-time. Input impedance was calculated at baseline (immediately after unclamping) and after stimulation with either papaverine or completion arteriography. Resistance (R _in) was calculated as mean pressure divided by mean blood flow (Q). Characteristic impedance (Z ₀) was calculated as the mean of harmonics 3–10. Intraoperative data acquisition required approximately 5 min, utilized the completion angiography cannula already in place, and was uncomplicated in all patients. Stimulation with either papaverine or arteriography resulted in increased Q (72 ± 7 to 146 ± 11 ml/min, p < 0.001), decreased R _in (126 ± 13 to 52 ± 4 × 10³ dyne · s · cm⁻⁵, p < 0.001), and slightly decreased Z ₀ (18 ± 2 to 15 ± 1, p = 0.002). After a mean follow-up of 20 months, the 2-year primary patency, secondary patency, limb salvage, and survival rates were 61 ± 8%, 74 ± 7%, 76 ± 6%, and 86 ± 6%, respectively. Primary patency was not associated with any of the clinical variables studied including age, sex, smoking history, history of previous vascular surgery, hypertension, coronary artery disease, diabetes mellitus, creatinine, indication for revascularization (claudication versus limb salvage), anesthesia (general versus regional), or level of distal anastomosis (popliteal versus infrapopliteal). Furthermore, there was no association between primary patency and baseline Q, baseline R _in, or stimulated Z ₀. However, using univariate analysis, patency was positively associated with decreased stimulated R _in (p= 0.002), elevated stimulated Q (p= 0.006), and decreased baseline Z ₀ (p= 0.02). Multiple regression analysis identified stimulated R _in as the only independent predictor of primary patency (p= 0.002). Stimulated R _in≥ 50 × 10³ dyne · s · cm⁻⁵ was 71% sensitive and 65% specific for graft failure. It is concluded that 1) vascular input impedance can be simply and reliably measured in the operating room, and 2) elevated stimulated R _in is an independent predictor of primary patency.     

The efficacy of paracetamol in the treatment of ankle sprains in comparison with diclofenac sodium

OBJECTIVE: To assess the efficacy of paracetamol in comparison with diclofenac sodium. METHODS: Between February - November 2006, a prospective, double blinded, parallel group study of 100 patients suffering from first or second degree lateral ankle sprain within 48-hours of admission in Tepecik Education and Research Hospital, Izmir, Turkey. Patients with bilateral injury, ipsilateral knee injury, third degree sprain, previous sprain within 6 months, and ankle pain less than 45 according to visual analogue score (VAS) were excluded. Patients rated pain on a 100 VAS, representing 0 no pain, 100 maximal pain. After enrollment, patients were randomized (1:1) with diclofenac sodium 150 mg/day or paracetamol 1500 mg/day for 5 days. Clinical assessments were carried out at baseline; on second, tenth days, and sixth week (end of study). In each visit, VAS and adverse effects of medication were questioned. RESULTS: The mean VAS of the diclofenac group was 81 and 82.3 with paracetamol group at the first visit. These scores decreased to 20.7, 9.9, 4.6 in diclofenac group and 11.9, 6.3, 3 in paracetamol group at the second, tenth days and last examination. Similar reductions in pain were observed at the end of study (p>0.05) in both groups. However, cases treated by paracetamol group showed accelerated decrease in VAS at day 2 and 10 in comparison with diclofenac group (p<0.05). Of the ankle range of motion, there was a similar improvement in both groups (39.6 degrees, 37.5 degrees) (p>0.05). The incidence of gastrointestinal adverse effects on diclofenac group was much more than the paracetamol group, however, there was no significant difference (p>0.05). CONCLUSION: It was concluded that diclofenac sodium and paracetamol are effective and well tolerated as a short term treatment alternatives for acute ankle injuries.     

Carotid CT-angiography: low versus standard volume contrast media and low kV protocol for 128-slice MDCT

Availability and utilization of computed tomography angiography has been increasing recently. We aimed to assess the effectiveness of low amount of contrast media and low kV value in order to reduce possible side effects of contrast media and to provide optimization of kV value in the evaluation of the carotid artery with multi-detector computed tomography angiography. Forty one patients were randomized into two groups. Contrast media was administered at a dose of 1 ml/kg in group A patients and of 0.5 ml/kg in group B patients. kV value of 120 in group A and 100 in group B were chosen. Bolus tracking technique was used. Attenuation values of certain arterial segments were measured, and values over 200 HU were considered as significant. North American Symptomatic Carotid Endartherectomy Trial criteria were utilized in the evaluation of stenosis. Image quality in arterial segments of all cases was found to be sufficient for diagnosis. Arterial attenuation values were found to be higher in group B than group A. When compared separately in all arterial segments, there was no statistically significant difference between the groups. For stenosis, 615 arterial segments were evaluated. Moderate stenosis in eight segments and severe stenosis in three segments were identified in group A. Occlusion in three segments, severe stenosis in three segments, and moderate stenosis in 25 segments were detected in group B. Better image quality can be obtained, and the amount of contrast media can be reduced using low kV technique in carotid artery multi-detector computed tomography angiography examination.     

Results of total knee arthroplasty in patients with gonarthrosis resulting from the delayed diagnosis of PVNS: a case series

Pigmented villonodular synovitis (PVNS) is a benign tumor that affects synovial lined joints, tendon sheaths and bursae. It is most commonly seen in one knee joint. The recommended treatment is total synovectomy, while radiotherapy can be used as adjuvant therapy for patients at risk for recurrence. The aim of our study was to show that the devastating effects of inactive diffuse PVNS may not be recognized for years and to evaluate the efficiency of aggressive total synovectomy on patients with PVNS during a follow-up period of 5 years. In the present study, 5 knees of four patients who had been previously followed due to gonarthrosis and diagnosed with PVNS during total knee arthroplasty (TKA) were followed and evaluated for a mean duration of 68 months. Mean age of the patients was 61.2 (52–66). All patients were women. One patient had right knee involvement, two had left knee involvement, and one had both knees involved. All patients had diffuse PVNS. Total synovectomy was performed in all patients in addition to TKA. During the follow-up, recurrence was not seen in any of the patients and prosthesis loosening was not detected. The aim of the present study was to evaluate the effectiveness of total synovectomy over the 5 years following the operation and to show that the devastating effects of inactive PVNS may sometimes be overlooked for years before being recognized during the treatment of the gonarthrosis that develops due to the disease. Although the disease is generally monoarticular, the study also presents a patient with bilateral PVNS.