Stentless heterograft conduits for pulmonic ventricle to pulmonary artery connection: is it the right option?

BACKGROUND AND AIM OF THE STUDY: A variety of stentless heterograft conduits has been developed as alternatives for pulmonary outflow reconstruction. Herein are reported the authors' results with four different types of stentless heterograft conduit implanted during the past nine years. METHODS: Between January 1996 and March 2005, stentless heterograft conduits were used in 54 patients (mean age 9.9 +/- 7.5 years; median age 7 years; range: 1-32 years) to reconstruct the pulmonary outflow tract. The main pathologies were tetralogy of Fallot, transposition of the great arteries and aortic valve disease (Ross operation). A Baxter-Edwards Prima valve (EP) was used in three patients, a Medtronic Freestyle bioprosthesis (MF) in 27, a Cryolife Ross pulmonic heterograft (CR) in 14, and a Medtronic Contegra bovine jugular vein conduit (MC) in 10. The mean conduit diameter was 20.4 +/- 1.7 mm (range: 16-23 mm). RESULTS: Early mortality was 5.5%. Mean intensive care unit and hospital stays were 4.3 +/- 4.8 days and 11.7 +/- 7.2 days, respectively. Clinical follow up was complete for 92.1% of patients; the mean follow up period was 45.6 +/- 20 months. Excluding early deaths, the probability of patient survival (Kaplan-Meier) was 97.9% and 74.6% at one and five years, respectively. Transconduit gradients increased significantly in all conduit types during follow up. Conduit failure occurred in 15 patients (two EP, nine MF, three CR, one MC) at a median duration of 70 +/- 7 months (range: 56-84 months). To date, nine patients have undergone conduit re-replacement, without mortality and major morbidity. The probability of freedom from conduit failure was 91.6%, 66.4% and 27.9% at three, five and seven years, respectively. CONCLUSION: Stentless heterograft conduits are suitable alternatives to homografts, with acceptable early and mid-term results. However, they do not offer any significant advantage over homografts or other conventional Dacron or pericardial conduits.     

Seroprevalence of hepatitis B and C among oncology patients in Turkey

Hepatitis B virus (HBV) is one of the public-health issues worldwide. Approximately two billion people are infected with HBV, and about 350 million people are chronic carriers globally. About 3% of the world population is infected with hepatitis C virus (HCV). Oncology patients receiving packed red blood cell suspensions and other blood products usually are in the high-risk group for infections due to these viruses. The aim of the study was to detect the seroprevalence of hepatitis B and hepatitis C among chemotherapy patients at the Oncology Department of the Tepecik Education and Research Hospital. HBsAg, anti-HBs, anti-HBcIgM, anti-HBc total and anti-HCV assays were studied by enzyme immunoassay method (Diasorin, Italy) in serum samples of patients (n = 448) referred to the Department of Oncology of the Tepecik Education and Research Hospital during 1 June 2006-1 January 2007. Of the 448 patients, 19 (4.2%) were HBsAg-positive, and three (0.7%) had anti-HCV positivity. In this study, the seroprevalence of HBV was similar to previous data in Turkey. This could be due to widespread vaccination programmes. The seroprevalence of low anti-HCV may be because of controlled blood transfusion. Oncology patients should be monitored for their protective antibody levels against HBV, and they must be included in the vaccination programme. Their anti-HCV status should also be checked as well.     

Localization of an absorber in a turbid semi-infinite medium by spatially resolved continuous-wave diffuse reflectance measurements

A method to locate an absorber embedded in a semi-infinite turbid medium by spatially-resolved continuous-wave (SRCW) diffuse reflectance measurements is introduced. The depth of the absorber is assessed by single wavelength SRCW diffuse reflectance measurements by two detectors in a radial row. The ratio of perturbations introduced by the defect at two detectors is used to be matched with the ratio-versus-depth curve, which are generated by approximate formulas of continuous wave diffuse reflectance. The error due to approximation and the error in depth assessment are studied for different cases revealing favorable source-detector placements with respect to planar position of the defect. The effect of lateral displacement of the source with respect to defect is studied. A strategy to overcome errors introduced by erroneous prediction of background medium optical properties is suggested. Theoretical results indicate that the depth of the absorber can be obtained with 0.1 mm precision independent of its absorption coefficient and its size for the values chosen in the study. The approach is tested experimentally and it is observed that theoretical results fit with experimental data.     

Protective Effects of Caffeic Acid Phenethyl Ester on Intestinal Ischemia-Reperfusion Injury

Aim Intestinal ischemia reperfusion (IR) causes tissue injury in two ways, starting a pro-inflammatory cascade and oxidative stress. The aim of this study was to investigate the possible protective effects of caffeic acid phenethyl ester (CAPE), which has antioxidant and anti-inflammatory properties, against intestinal IR injury in rats. Materials and Methods Forty male Wistar-Albino rats were divided into five groups: Sham, IR, IR plus ethanol (vehicle), IR plus 10 mg/kg (IR + 10CAPE), and 30 mg/kg CAPE (IR + 30CAPE) at the 30-min ischemic period. Intestines were exteriorized and the superior mesenteric artery was occluded for 45-min ischemia and then the clamp was removed for 120-min reperfusion. After the experiment, the intestines were removed for biochemical and light microscopic examinations. Additionally, blood samples were taken for plasma TNF-α measurement. Results The TBARS levels of the IR and IR + Ethanol groups were higher than the Sham group (P < 0.05). Both CAPE treatments decreased TBARS levels in comparison with the IR group (P < 0.05). In both CAPE-treated groups, while the superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities were increased compared to all other groups, which was similarly the case for the CAT activity compared to the Sham and IR + Ethanol groups (P < 0.05). There were no significant differences between GSH levels of all study groups. The TNF-α levels of the IR and IR + Ethanol groups were non-significantly increased compared to the Sham group (P > 0.05). The TNF-α levels of 10 and 30 mg/kg CAPE groups were non-significantly decreased compared to the IR group (P > 0.05). The tissue MPO activities of the IR and IR + Ethanol groups were higher than the Sham group (P < 0.05). The MPO activities of the IR + 10CAPE and IR + 30CAPE groups were not significantly different from the Sham group (P > 0.05). There was necrosis of mucosa in the IR and IR + Ethanol groups in light microscopic evaluations. Those changes were significantly reversed by 30 mg/kg CAPE treatment. Conclusion The intestinal IR injury may be reversed by anti-inflammatory and antioxidant actions of the CAPE. However, 30 mg/kg CAPE treatment may be more efficient in preventing intestinal IR injury in rats.     

Relationship between limited joint mobility syndrome and duration, metabolic control, complications of diabetes as well as effects of the syndrome on quality of life

Aim of this study was to examine relationship between Limited Joint Mobility syndrome (LJM) in patients with type-1 and type-2 diabetes and duration, metabolic control and other complications of diabetes, and to assess effects of the syndrome on hand functions and quality of life. Demographic characteristics, and micro-macrovascular and hand complications were recorded. Level of fasting blood sugar and HbA1c, superficial, pain, temperature, vibration and cortical senses, and deep tendon reflexes were measured. Hand dexterity was evaluated with nine-hole peg test. Grip and pinch strengths were recorded. Functionality of the hand with Hand Functional Index (HFI) and quality of life were evaluated with Short Form 36. Group 1 included 37.8% (n?=?130) of 344 hands of 172 patients with LJM according to Rosenbloom classification, group 2 included 44.8% (n?=?154) according to the same, and group 3 included 17.4% (n?=?60). In the comparison between groups, deterioration correlating with the increase in LJM stage was found in terms of duration of disease, level of fasting blood sugar and HbA1c, frequency of retinopathy and nephropathy, diabetic foot involvement, Dupuytren contracture, presence of CTS, superficial, pain, temperature and cortical senses, DTR, hand dexterity, grip strengths and function of the hand and quality of life except pain. In patients with long-term DM with poor metabolic control, presence of LJM can make contribution to prevent morbidity, mortality and functional disabilities of these patients.     

Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005

OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer‐generation antidepressants. DESIGN: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005. SETTING: Community, usual care. PARTICIPANTS: Older Medicare fee‐for‐service beneficiaries. MEASUREMENTS: Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers. RESULTS: The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan‐area residents, and 55% greater for nonmetropolitan‐area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses. CONCLUSION: Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more‐prominent and psychotherapy a less‐prominent role. These shifts are most pronounced in groups with less‐severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.