The prevalence and clinical features of tuberculous peritonitis in CAPD patients in Turkey, report of ten cases from multi-centers

OBJECTIVE: To determine the rate, risk factors and outcome of Tuberculous Peritonitis (TBP) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) in our units. DESIGN: Retrospectively, we reviewed the medical data of all CAPD patients from 12 centers for TBP, covering the period between 1986 and December 2002. SETTING: All patients were from 12 renal clinics at tertiary-care university hospitals. RESULTS: Ten cases of TBP were identified among the CAPD patients in our centers. There were five male and five female patients with a mean age of 37.2 years. None of the patients had tuberculosis history, 6 patients had predominance of PNL. One patient had coincidental bacterial peritonitis. Two patients were successfully treated without the removal of the Tenckhoff catheter. CONCLUSION: TBP in CAPD patients is a very rare complication. In contrast to predominance of lymphocytes in nonuremic patients with tuberculous peritonitis, CAPD patients with tuberculous peritonitis may have predominance of PNL on examination of the peritoneal fluid. Since TBP has high morbidity and mortality, early diagnosis and treatment of disease are extremely important for improving outcome.     

Lipoma arborescens; successfully treated by yttrium-90 radiosynovectomy

Although radiosynovectomy (RS) applications have been carried out for many years, clinical indications of this non-invasive procedure is thought to be limited probably due to the lack of information of clinicians. Clinicians' preferential indication for RS is the treatment-resistant synovitis of individual joints, i.e. despite systemic pharmacotherapy and intra-articular steroid injections. We present here a case of "lipoma arborescens" treated by yttrium-90, which is a rare intra-articular lesion characterized by villous proliferation of the synovial membrane and hyperplasia of subsynovial fat. The results of clinical, biochemical and hematological examinations, magnetic resonance (MR) imaging, arthroscopy and histological analysis have shown that the etiology was lipoma arborescens in a female patient, aged 36 having swelling and sometimes associating pain at her right knee for 4 years. We have applied to our patient's right knee RS with 185 MBq yttrium-90 colloid together with 40 mg of methylprednisolone acetate, although in our literature survey we have not met any similar case being treated with such indication. Even a year after the application, the patient has absolutely benefited from the treatment clinically, and this was also confirmed by comparative MR images (pre- and post-treatment). Consequently, we consider that Y-90 treatment might be applicable in suitable cases with lipoma arborescens.     

Prognostic significance of microvessel density and vascular endothelial growth factor (VEGF) expression in non-Hodgkin's lymphoma

Angiogenesis has a major role in the pathogenesis of malignancies. Studies involving the role of angiogenesis have been most commonly performed in solid tumors. However, studies related to hemapoietic neoplasia and angiogenesis are relatively limited. We investigated the role of angiogenesis in non-Hodgkin's lymphomas (NHLs) and its relation with clinical and histopathologic prognostic indicators. In this respect, angiogenesis markers were evaluated in 71 patients with NHL and these were compared with other prognostic indicators including age, gender, histological grade, stage, extranodal involvement and survival. Microvessel density (MVD) using Factor VIII monoclonal antibody and vascular endothelial growth factor (VEGF) using monoclonal antibody for VEGF expression were studied in paraffin-embedded tissue samples. We did not find a significant relationship between MVD and patient characteristics including age, gender, stage, histological grade, nodal status, international prognostic index (IPI), and response to treatment. MVD was found to be greater in cases with B symptoms compared to those without B symptoms (14.6±5.7 and 11.4±5.3, respectively, p=0.002). No significant relationship was found between VEGF and age, gender, stage, histological grade, IPI, and overall survival. The complete and partial response rate to therapy was significantly higher in VEGF-negative patients than in the VEGF-positive patients (p=0.003). In conclusion, there appears to be a role for angiogenesis and angiogenic factors in NHLs. The combination of anti-angiogenic drugs with conventional anti-neoplastic treatment will probably be used in the future. Larger series of patients are needed to determine the prognostic value of angiogenesis in NHL.     

Serum carnitine levels during oxcarbazepine and carbamazepine monotherapies in children with epilepsy

Prolonged antiepilepsy drug treatment can result in secondary carnitine deficiency. The effect of oxcarbazepine on carnitine metabolism has not been reported previously. In this study, serum concentrations of total and free carnitine were measured in 20 children with epilepsy treated with oxcarbazepine monotherapy and were compared with 20 children with epilepsy who were taking carbamazepine as monotherapy. The assays were performed between 3 and 6 months of anticonvulsant treatment. The mean values of serum total and free carnitine levels in patients receiving carbamazepine monotherapy were 63.0 +/- 20.7 micromol/L and 49.1 +/- 16.7 micromol/L, respectively. The mean values of serum total and free carnitine levels in patients receiving oxcarbazepine monotherapy were 64.2 +/- 17.4 micromol/L and 50.3 +/- 13.7 micromol/L, respectively. The values were all between normal ranges. No significant difference was observed in the level of total and free carnitine levels between the two groups. Our results suggest that neither oxcarbazepine nor carbamazepine as monotherapy causes carnitine deficiency in otherwise healthy children with primary idiopathic epilepsy.     

A retrospective comparison between lamicel and gemeprost for cervical ripening before surgical interruption of first-trimester pregnancy

To study the effect and complication rate of lamicel versus gemeprost as pretreatment to vacuum aspiration for the interruption of early pregnancy, the files of 622 medical records of women having a first-trimester abortion at S?der Hospital were studied retrospectively. Group A consisted of 317 women treated with lamicel in 1995 and Group B of 305 women treated with gemeprost in 1996. Complications were more common in Group A than in Group B (55 vs. 22; p < 0.05). Re-admission took place more often in Group A (25) than in Group B (6) (p < 0.05). The complications were more severe in Group A than in Group B. Using multivariate logistic regression analysis, the only impact factor for having a complication was the use of product for cervical priming. Gemeprost for preoperative treatment was found to render a fairly low rate of complications in this study, while complication rate was higher after treatment with lamicel.     

Using Conjoint Analysis to Estimate Healthy-Year Equivalents for Acute Conditions: An Application to Vasomotor Symptoms

Objective:  Conventional standard gamble and time trade-off methods may be inappropriate for eliciting preferences for some health states because both require subjects to make trade-offs between a morbid health state and death. Thus, the objective of this study is to demonstrate the use of conjoint analysis to obtain time trade-off estimates of healthy-year equivalents (HYEs) for clinically relevant durations and severities of acute, self-limiting, or nonfatal conditions such as vasomotor symptoms.
Methods:  A self-administered, web-enabled, graded-pairs conjoint-analysis survey was developed to elicit women's preferences for reducing the frequency and severity of vasomotor symptoms (daytime hot flushes and night sweats). Observed trade-offs between symptom duration and symptom relief were used to calculate HYEs for different severities and durations of vasomotor symptoms.
Results:  A total of 523 women with a mean age of 52 years completed the survey. For these women, an improvement from severe to moderate vasomotor symptoms yields a gain of 4.44 HYEs, and an improvement from moderate to mild vasomotor symptoms over 1 year yields a gain of 4.62 HYEs over a period of 7 years. HYE gains for symptom relief are larger for younger women than for older women.
Conclusions:  Conjoint analysis is a feasible method for estimating HYEs for acute, self-limiting, or nonfatal conditions. This approach may provide an alternative utility-elicitation method when conventional standard gamble and time trade-off methods are inappropriate to the decision context.     

Antioxidant enzyme activities and lipid peroxides in the plasma of patients with benign prostatic hyperplasia or prostate cancer are not predictive

In this study, lipid peroxide and total sulfhydryl contents and activities of superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) were investigated in the plasma of patients with benign prostatic hyperplasia (BPH) and prostate cancer. No significant change was found in lipid peroxidation or antioxidant systems in the plasma of patients with BPH and prostate cancer. The results indicate that evaluation of the prooxidant-antioxidant balance in the plasma of BPH and prostate cancer patients cannot be used as a marker to discriminate between these diseases. Received: 5 November 1998 / Accepted: 19 January 1999     

Vasculitis and Leukemia

Vasculitis may accompany neoplasias and be of paraneoplastic type or associated with drugs used in patient treatment. We evaluated skin biopsies of twenty-eight cases with vasculitis accompanying leukemias reviewed and clinical outcome was evaluated. Eleven of the 28 cases had paraneoplastic vasculitis and 17 had vasculitis associated with various drugs including chemotherapy, cytokines and antibacterial agents. Paraneoplastic vasculitis was seen in 3 cases with chronic myelocytic leukemia in blastic phase, 5 patients with acute myeloblasts leukemia, and 3 with myelodysplastic syndrome. Drugs responsible for the 17 cases of vasculitis included hydroxyurea, vincristine, cytosine-arabinoside, methotrexate, all-trans retinoic acid, granulocyte-colony stimulating factor, interferon and antibiotics.

Paraneoplastic vasculitis is not rare in leukemias and may be a manifestation of the blastic phase of chronic myeloid leukemia. Furthermore paraneoplastic vasculitis can be fatal in myelodysplastic syndromes and may be present clinically before the specific diagnosis is made. Drugs used in routine therapy may be the cause of the vasculitis, thus skin biopsy should be performed in all cutaneous lesions in patients with hemopoietic neoplasias.     

The bipedicled medial plantar flap: Vascular enhancement of a reverse flow Y–V medial plantar flap by the inclusion of a metatarsal artery perforator for the reconstruction of a forefoot defect—A case report

The pedicled medial plantar (MP) flap is an optimal solution for defects involving the weight‐bearing areas of the foot. However, venous congestion is a frequently encountered complication, especially with the reverse‐flow variants of the flap, and several strategies have been reported in literature both to prevent and to manage it. In this article, we present the use of a medial plantar flap based distally on the lateral plantar artery with the adjunct of an extra metatarsal perforator from the dorsalis pedis artery as a vascular enhancement to avoid the venous congestion and to improve the overall circulation. This bipedicled flap was successfully advanced to cover a 5 × 3 cm soft‐tissue defect located at the level of the first and second metatarsal heads of the right foot resulting from the excision of a squamous cell carcinoma in an 80‐year‐old male patient with a history of cardiovascular disease. The postoperative course was uneventful. The patient was discharged 7 days after the operation and was able to walk after 6 weeks wearing normal shoes. We believe that preserving plantar metatarsal perforators during the harvesting of an MP flap based distally on the lateral plantar artery may be a precious adjunct as it increases blood supply, especially the venous drainage of the flap.     

Radiographic changes in the lumbar spine in former professional football players: a comparative and matched controlled study

Heavy physical work and activity lead to degenerative changes, especially in the lumbar spine. We aimed to find out the occurence of radiographic changes (vertebral osteophytes, heights of lumbar dicsc, concavity index) and abnormalities of the lumbar spine in former professional football (association football or soccer) players according to their specialization (goalkeeper, defender, midfielder, forward) in their past professional sport life. We included 70 male former professional football players and 59 men as the control group. The football players group consisted of 15 defenders (21%), 29 midfielders (41%), 18 forwards (26%) and 8 goalkeepers (12%). Their mean professional football life was 11.04 years and the mean time period after their retirement was 13.87 years. Radiographs of both groups were taken to measure the disc height, concavity index and to determine osteophytes and abnormalities of the lumbar spine. FFbH-R score was assessed for daily activities. The mean FFbH-R score of football players was lower than that of the control group (P = 0.005). The total number of osteophytes in the player group was higher than in the control group (P = 0.001). The mean disc height of L1–L2 in football players was higher than in the control group (P = 0.045). The mean disc height of T12–L1 in goalkeepers was higher than in forward players (P = 0.019). The mean concavity index of L1 in forward players was lower than in defenders (P = 0.018). The mean disc heights of T12–L1 and L2–L3 were both higher in players whose professional sport life was >10 years than in players with ≤10 years (P = 0.018, P = 0.016). The mean disc height of L5–S1 was higher in players who had continued sport activity after retirement (P = 0.025). No statistically significant result was obtained with the rest of the variables. Playing football is heavy work. The decreased height of lumbar discs and the lower value of concavity index of forward players are because the lumbar spine of forward players is loaded more than in the rest of the players. Presented in part orally at Eurospine 2006, İstanbul, Turkey, 25–28 October 2006. Presented in part as poster at XXXVI Scientific Congress of Polish Orthopaedic and Traumatology Society, Katowice, Polland, 28–30 September 2006.