New generation of abdominal surgery: the Natural Orifice Transluminal Endoscopic Surgery

Minimal invasive surgical techniques, namely laparoscopic procedures to the abdominal surgery have been introduced more than 20 years ago. In view of clinical results, the majority of these are considered as routinely performed procedure today. Natural Orifice Transluminal Endoscopic Surgery can be considered as a new generation of abdominal surgery. It means a method directed through natural orifices, and abdominal surgery operated by transluminal endoscopic techniques (transgastric, transcolonic, transvaginal) to reach diagnostic and therapeutic goals. Theoretically, this method allows the possibility to decrease invasiveness and postoperative pain, to prevent postoperative hernias and to improve cosmetic results. At present numerous researchers work worldwide to receive scientifically based answers to arising questions (surgical technique, indication, contraindication, complications, monitoring) and concerns in this area. The present paper gives an overview of the national and international literature on experimental results and clinical approaches in the field of this new surgical technique.     

Radical vs conservative surgery for hydatid liver cysts:Experience from single center

AIM:To compare the efficacy and safety of radical and conservative surgical interventions for liver hydatid disease.METHODS:The study comprised 59 patients in two groups who had undergone radical and conservative surgical procedures for liver hydatid disease in our department between 2004 and 2009. Preoperative diagnostic tools,medical treatments,demographic and clinical characteristics,postoperative follow-up,and recurrence were compared in both groups. RESULTS:This non-randomized retrospective studyinclud...     

Effectiveness of laser-assisted subepithelial keratectomy without mitomycin-C for the treatment of high myopia

PURPOSE: To evaluate the effectiveness and therapeutic range of laser-assisted subepithelial keratectomy (LASEK) without mitomycin-C (MMC) to treat high myopia. SETTING: Isik Eye Clinic, Ankara, Turkey. METHODS: This study comprised 31 highly myopic eyes (19 patients) that had LASEK. Before primary LASEK treatment and 1, 3, 6, 12, and 24 months after, all patients had a complete ophthalmic examination including visual acuity, refractive outcomes, and biomicroscopy. RESULTS: The mean spherical equivalent (SE) was -9.01 diopters (D) +/- 2.66 (SD) preoperatively and -1.00 +/- 1.15 D at the end of follow-up. At 24 months, the mean SE was within +/-1.00 D of the intended correction in 23 eyes (74.19%). The median uncorrected visual acuity (UCVA) increased from 20/606 preoperatively to 20/28.6 at 24 months and the median best corrected visual acuity, from 20/25 to 20/22, respectively. Total higher-order and spherical aberrations increased significantly at the end of follow-up. All 14 eyes that had ablations greater than -8.62 D developed varying degrees of haze. Significant myopic regression (>1.00 D) leading to UCVA loss occurred in all eyes with a preoperative SE of -12.00 D or greater. CONCLUSIONS: The results of LASEK without MMC were excellent in eyes with up to -8.6 D of SE. All eyes with a preoperative SE between -8.6 and -12.0 D developed haze but had acceptable refractive and visual outcomes. Haze and myopic regression limited the success of LASEK in eyes with a preoperative SE of -12.0 D and greater.     

Molecular Study of Deletional and Nondeletional Mutations on the α-Globin Locus in the Azeri Population of Northwestern Iran

The aim of this study was to determine the molecular spectrum and frequency of deletional and nondeletional α-thalassemia (α-thal) mutations and the genotype–phenotype correlation in common mutations in the Azeri population of Northwestern Iran. A total of 1256 potential carriers with microcytic and hypochromic anemia and normal Hb A₂ levels (<3.5%) and without iron deficiency anemia plus three fetuses were identified. Multiplex gap-polymerase chain reaction (gap-PCR) and sequencing for α-thal mutations were carried out. In 606 individuals, the α-globin gene was normal, but in 650 persons (51.6%) and three fetuses, 10 different mutations were detected. The most frequent deletional genotypes were as follows: αα/–α^3.7 (61.7%), –α^3.7/–α^3.7 (11.9%), αα/–α^4.2 (4.6%), αα/– –^MED (4.3%) and αα/–(α)^20.5 (3.8%). The most frequent nondeletional genotypes were αα/α^{IVS-I (–5?nt)}α (HBA2: c.95+2_95+6delTGAGG) and αα/α^{Poly A2}α [polyadenylation signal (polyA2) (AATAAA>AATGAA); HBA2: c.*96G>A] with frequencies of 1.08% and 0.92%, respectively. Meanwhile, 7.71% of individuals with a proven β-thalassemia (β-thal) mutation were found to also carry an α-thal mutation. Persons having two functional α-globin genes showed lower mean corpuscular volume (MCV) and mean corpuscular hemoglobin (Hb) (MCH) values compared to those with one mutated α-globin gene, provided that they had normal β-globin genes. Overall, the incidence of α-thal was 2.7% in the Azeri population in Northwestern Iran. Our results showed that the variability of α-thal mutations are high in the Azeri population and that α-thal mutations are highly heterogeneous in both deletional and nondeletional genotype aspects.     

Metal dust exposure and lung function deterioration among steel workers: an exposure-response relationship

Background: Metallic dust is a heterogeneous substance with respiratory sensitizing properties. Its long term exposure adversely affected lung function, thus may cause acute or chronic respiratory diseases.

Methods: A cross-sectional study was conducted in a steel factory in Terengganu, Malaysia to assess the metal dust exposure and its relationship to lung function values among 184 workers. Metal dust concentrations values (Co, Cr, and Ni) for each worker were collected using air personal sampling. Lung function values (FEV₁, FVC, and %FEV₁/FVC) were determined using spirometer.

Results: Exposure to cobalt and chromium were 1–3 times higher than permissible exposure limit (PEL) while nickel was not exceeding the PEL. Cumulative of chromium was the predictor to all lung function values (FEV₁, FVC, and %FEV₁/FVC). Frequency of using mask was positively associated with FVC (Adj b = 0.263, P = 0.011) while past respiratory illnesses were negatively associated with %FEV₁/FVC (Adj b = –1.452, P = 0.026). Only few workers (36.4%) were found to wear their masks all times during the working hours.

Conclusions: There was an exposure-response relationship of cumulative metal dust exposure with the deterioration of lung function values. Improvement of control measures as well as proper and efficient use or personal protection equipment while at work could help to protect the respiratory health of workers.     

Sublingual versus vaginal misoprostol for second trimester termination: a randomized clinical trial

Purposes

To evaluate the efficacy of two routes of administration of misoprostol (sublingual and vaginal) for medical termination of second trimester pregnancies.

Methods

One hundred and thirty-four women referred for second trimester termination were enrolled in this randomized clinical trial. They were divided to receive 400 μg every 6 h misoprostol either sublingually or vaginally. They were followed for 48 h, at which point they underwent D&C if the termination was not complete. Efficacy was defined as successful termination without the need for interventions.

Results

There were no differences between the vaginal and sublingual groups in terms of tablets mean dose of misoprostol applied (1360 ± 2.4 vs. 1320 ± 2.3) or endometrial thickness after termination of pregnancy (13.02 ± 5.2 vs. 13.3 ± 6.6 mm). The success rate was 61.2 % (n = 41) in the vaginal group versus 70.1 % (n = 47) in the sublingual group (p = 0.3). Twenty-six patients (38.8 %) in the vaginal group underwent D&C due to retained tissue, compared with 20 patients (29.8 %) in the sublingual group. In primigravids, the success rate was significantly higher in the sublingual group than vaginal group. There was no significant difference with regards to complications between the two groups.

Conclusion

The sublingual route of misoprostol administration has the same efficacy as the vaginal route and can be applied for second trimester pregnancy termination in primigravid women in outpatient settings due to its simple administrations.     

Paederus dermatitis in northern Iran: a report of 156 cases

BACKGROUND: Paederus dermatitis develops when beetles of the genus Paederus (often called rove beetles) are crushed on the skin, releasing the vesicant pederin. These beetles are found in many tropical and subtropical habitats. METHODS: We describe 156 patients who presented to a dermatology clinic in the Guilan province of northern Iran during a 6-month period (May-October 2001). RESULTS: The peak time of presentation was in September, and the face and neck were the most common sites of involvement. Clinically, the most common presentation comprised geographic erythematous plaques with micropustules. In three-quarters of patients, more than one lesion was present. Kissing lesions were seen in 5% of cases, and 15% of patients developed diffuse desquamation. The majority of patients resided within 1 km of rice fields and used fluorescent lighting at home. In half of the cases, another family member was also affected. CONCLUSIONS: Paederus dermatitis is a common skin condition in northern Iran. We believe that increased public awareness of this condition can decrease mucocutaneous exposure to pederin.     

Effects of erytropoietin treatment and hemodialysis on the serum endothelin level and intraocular pressure of hemodialysis patients

Aim The aim of this study is to evaluate the effect of erythropoietin and hemodialysis (HD) on serum Endotheli-1 (ET-1) and intraocular pressure (IOP) levels in HD patients. Methods The study group was composed of 34 chronic HD patients undergoing erythropoietin (EPO) treatment, while the control group was composed of 16 chronic HD patients without EPO treatment. Serum samples for measuring levels of ET-1 were taken 1 h before and after HD. Endothelin-1 levels were determined using a commercially available Elisa kit. IOP was measured with a calibrated Goldmann applanation tonometer in the right eyes of patients 1 h before and after HD just after blood samples were taken. Results In the EPO group, serum ET-1 levels were significantly higher than those of the control group both before and after HD. Despite increased ET-1 levels in the EPO group, there was no statistically significant difference in pre- and post-dialysis IOP measurements between the erythropoietin and control groups (P > 0.05). In both the HD and control groups, the IOP levels significantly decreased following HD (P < 0.05). Conclusion EPO treatment caused an increase in plasma ET-1 concentration compared to the control group, while there was no related increase in IOP with EPO treatment. The role of ET-1 in glaucoma development must involve a mechanism other than increased IOP.     

Aqueous humor and serum concentration of hydroxyproline in pseudoexfoliation syndrome

PURPOSE: To determine the concentration of hydroxyproline (Hyp) in aqueous humor and serum samples of patients with and without pseudoexfoliation (PEX). PATIENTS AND METHODS: Aqueous humor and serum Hyp levels were measured in cataract patients. Patients were divided into PEX and control groups. Samples were obtained from 27 cataract patients with PEX and 25 cataract patients without PEX. Patients had no elevated intraocular pressure or glaucoma. Hyp concentration was determined spectrophotometrically. RESULTS: Mean Hyp concentration in the PEX aqueous (0.86+/-0.27 mg/L) and serum (40.8+/-6.14 mg/L) samples was significantly higher than that measured in the control aqueous (0.56+/-0.2 mg/L) and serum (34.51+/-6.82 mg/L) samples, respectively (P<0.001, P=0.001). No significant correlation could be found between aqueous humor and serum Hyp concentrations. CONCLUSIONS: The higher levels of Hyp could be a sign of increased collagen turnover in PEX syndrome.