Serum tumor marker CA19-9 in the follow-up of patients with cystic echinococcosis

BACKGROUND: The aim of this study was to compare results of the determination of carcinoembryonic antigen, carbohydrate antigens, alpha-fetoprotein, and human chorionic gonadotropin before and after surgical and pharmacologic treatment in patients with cystic echinococcosis (CE). METHODS: Serum samples were obtained from 40 CE patients (all with cysts in the liver) and from 10 sex- and age-matched healthy donors (control group). Serum samples were drawn (1) before (presurgical group) and after (postsurgical group, including a 3-month cycle of albendazole) surgical and pharmacologic treatment. Serum tumor markers were measured, and indirect hemagglutination assay was performed. RESULTS: In 90% of confirmed cases of CE, indirect hemagglutination assay was positive. Mean (SD) serum CA19-9 concentrations for all patients in the presurgical and postsurgical groups were 45.1 +/- 30 kU/L and 17.02 +/- 11 kU/L, respectively. CA19-9 concentrations were significantly greater in CE patients in the presurgical compared with the control group. Also, increased CA19-9 concentrations decreased significantly in the postsurgical compared with the presurgical group. CONCLUSIONS: A significant decrease in serum CA19-9 concentrations after surgical and pharmacologic therapy was demonstrated in the clinical follow-up of patients with CE (patients were tested 3 months after surgery). If our findings are confirmed and more-sensitive methods are developed for measuring serum CA19-9 concentrations, new and interesting perspectives will be gained for the monitoring and treatment of patients with CE.     

Metachronous non-Hodgkin's lymphoma in a patient with localized prostate cancer

Introduction A higher frequency of second malignancies is observed in patients with prostate cancer. We report a case of indolent non-Hodgkin's lymphoma diagnosed 2 years after prostate carcinoma. Case report A 65-year-old man with diagnosis of localized prostate adenocarcinoma was presented with fatigue 2 years after prostatectomy operation. Abdominal ultrasonography showed hepatomegaly and paraaortocaval, parailiac, and perivascular multiple lymph nodes. The complete blood count revealed anemia and thrombocytopenia. Bone marrow biopsy demonstrated small lymphocytic lymphoma. Conclusion Lymphoma should be suspected in cases with newly appeared adenopathy and/or cytopenias during follow-up. In patients with clinically organ-confined prostate cancer, indolent lymphoma should be in the differential diagnosis of newly appeared lymphadenopathy.     

Indirect role of α<Subscript>2</Subscript>-adrenoreceptors in anti-ulcer effect mechanism of nimesulide in rats

Nimesulide, a non-steroidal, anti-inflammatory drug, produces ulcerogenic effects in adrenalectomized rats but is gastro-protective in intact rats. The objective of this study was to determine whether adrenal gland hormones are involved in the anti-ulcer effects of nimesulide. The results revealed that 100 mg/kg nimesulide produces gastric ulceration in adrenalectomized rats, which is prevented by prednisolone and adrenaline. The anti-ulcer effects of adrenaline and prednisolone in adrenalectomized rats were in turn antagonized by yohimbine, a selective α₂-receptor blocker, but not by doxazosine (α₁-receptor blocker) or propranolol (β-blocker). Adrenaline prevented the formation of indomethacin-induced ulcers in both adrenalectomized and intact rats, but prednisolone increased the indomethacin-induced ulcerous area in intact rats, whereas it decreased the size of the ulcers in adrenalectomized rats. In addition, prednisolone prevented ulcer formation in intact rats in which the adrenaline concentration had been decreased by metyrosine. These results suggest that glucocorticoids are anti-ulcerogenic in not only adrenalectomized rats but also in intact rats with diminished circulating levels of adrenaline. In the light of these data, the effect of nimesulide on plasma adrenaline concentrations was studied. In comparison to the adrenaline levels found in intact control rats, the administration of nimesulide at doses of 10, 20, 40 and 100 mg/kg decreased adrenaline concentrations by 12.8, 22.6, 30.4, and 58.2%, respectively, without affecting blood corticosterone concentrations. The anti-ulcer effect of nimesulide was observed to be dose-dependent, and the strength of this effect was directly correlated the decreasing concentration of adrenaline. The concentration of adrenaline was decreased by 60.9% in rats treated with 300 mg/kg metyrosine in which prednisolone produced anti-ulcer effects. In summary, we have shown that nimesulide produces its anti-ulcer effect by decreasing endogenous adrenaline concentrations and that glucocorticoids may induce anti-ulcer effects via α₂-adrenoreceptors, but not via their own receptors. This research was conducted in the Laboratory of Pharmacology at Ataturk University, Faculty of Medicine, Department of Pharmacology, 25240 Erzurum/Turkey.     

Clinical review of grayanotoxin/mad honey poisoning past and present

Grayanotoxin is a naturally occurring sodium channel toxin which enters the human food supply by honey made from the pollen and nectar of the plant family Ericaceae in which rhododendron is a genus. Grayanotoxin/mad honey poisoning is a little known, but well studied, cholinergic toxidrome resulting in incapacitating and, sometimes, life-threatening bradycardia, hypotension, and altered mental status. Complete heart blocks occur in a significant fraction of patients. Asystole has been reported. Treatment with saline infusion and atropine alone is almost always successful. A pooled analysis of the dysrhythmias occurring in 69 patients from 11 different studies and reports is presented. The pathophysiology, signs, symptoms, clinical course, and treatment of grayanotoxin/mad honey poisoning are discussed. In the nineteenth century grayanotoxin/mad honey poisoning was reported in Europe and North America. Currently, documented poisoning from locally produced honey in Europe or North America would be reportable. Possible reasons for this epidemiologic change are discussed.     

Ischemia-modified albumin in the diagnosis of acute mesenteric ischemia: a preliminary study

Ischemia-modified albumin (IMA) is a sensitive marker of myocardial ischemia, skeletal muscle ischemia, pulmonary embolism, and stroke. However, there are no studies showing whether IMA increases in mesenteric ischemia. The aim of this study was to determine whether IMA was elevated in acute mesenteric ischemia. This case-controlled study was performed in an emergency department of a university hospital. The measurement of IMA levels in patient plasma yielded means of 0.264 +/- 0.057 absorbance units (ABSU) in the thromboembolic occlusion of the superior mesenteric artery (SMA) group and 0.163 +/- 0.025 ABSU in the control group. When plasma IMA levels in the thromboembolic occlusion SMA group were compared with those in the control group, statistically significant increases in IMA were observed in the occlusion group (P = .003). Findings indicating that IMA may have a place in the diagnosis of acute mesenteric embolism were obtained in this preliminary study. Further prospective studies are needed to see if IMA is clinically useful in the early detection of thromboembolic occlusion of the SMA.     

Correlation of risk and postoperative assessment methods in wound surveillance

BACKGROUND: Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine practicality of SSI risk assessment methods (Study on the Efficacy of Nosocomial Infection Control [SENIC] and National Nosocomial Infections Surveillance [NNIS]) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure. MATERIALS AND METHODS: Patients were followed with a prospective data chart from January 1, 2003, to December 31, 2005. Correlation of SENIC and NNIS together with ASEPSIS were performed. RESULTS: During the study period, 222 SSI occurred. SSIs were determined within the 21-d period after operations. Correlation between SENIC with ASEPSIS (r(s) = 0.47, P < 0.001) was found better than that for NNIS with ASEPSIS (r(s) = 0.41, P < 0.001). Type of operation (emergency versus elective), body mass index, operation class, and American Society of Anesthesiologists scores were found independently predictive factors for SSI. CONCLUSIONS: This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS.     

Ureteroscopic pneumatic lithotripsy: is the location of the stone important in decision making? Analysis of 1296 patients

PURPOSE: To evaluate the efficacy and complications of pneumatic lithotripsy (PL) in the treatment of ureteral stones in different locations. PATIENTS AND METHODS: From February 2001 to October 2006, a total of 1296 patients underwent PL for treatment of ureteral stones. Of these patients, 471 (36.4%) were women and 825 (63.6%) were men, with a mean age of 37.3 years (range 19-71 years). In 203 (15.6%) of these patients, treatment was performed secondarily after stone disease was refractory to extracorporeal shockwave lithotripty. All patients were evaluated by plain radiographs for the presence of stones on the first day and the sixth week postoperatively. Follow-up studies included ultrasonography and/or excretory urography. RESULTS: The overall stone-free rate was 96.2%. According to the location of the stones, the success rate of pneumatic lithotripsy for upper, middle, and lower ureteral stones was 90.5%, 93.1%, and 98.1%, respectively (P < 0.05). For patients with calculi < or =10 mm and >10 mm in size, the stone-free rate after ureteroscopic lithotripsy was 97.6% (896 of 918) and 91.2% (351 of 378), respectively (P < 0.05). The most common complications were postoperative fever (5.3%), small mucosal lesions without leakage (3.6%), and stone migration (3.4%). CONCLUSIONS: Ureteroscopic pneumatic lithotripsy is a safe and effective treatment with minimal morbidity in the treatment of ureteral stones in all locations.