Tuberculosis of the knee in a child

The diagnosis for skeletal tuberculosis is often overlooked. We report a 9-year-old patient with a history of 2 years of swollen joint, with a diagnosis of tuberculosis of the knee with involvement of the proximal tibial epiphysis, and treated surgically and with anti-tuberculosis drug therapy.     

Experimental sinusitis in a rhinogenic model

OBJECTIVES/HYPOTHESIS: The objectives were to determine the optimal sinusitis induction period and to examine microbiological and histopathological changes of sinusitis recovery stage in a rhinogenic sinusitis model. METHODS: A synthetic sponge was inserted into the right-side nasal cavities of rabbits. The sponge was impregnated with a Streptococcus pneumoniae strain in group 1 and with sterile saline solution in groups 2 and 3. After the fourth day of sponge insertion, sinuses were examined by coronal computed tomography scans at two-day intervals until any radiological evidence of sinusitis was observed. When sinusitis was detected radiologically, five rabbits each from groups 1 and 2 were killed for histological examination. To determine the recovery period of sinusitis, sponges were removed from the rest of the rabbits in groups 1 and 2. Rabbits were selected randomly and killed on the 15th and the 30th days of the recovery period, immediately after radiological examinations. Group 3 was considered a sham group. RESULTS: Sinusitis induction was performed in all rabbits in groups 1 and 2 until the 8th day. After the sponges were removed, inflammation persisted until the 30th day of the study. CONCLUSION: In a rhinogenic sinusitis model, although histological features of sinusitis were demonstrated, further studies are required to standardize this model and to examine whether or not the studied bacterial strain spreads from nasal cavity into sinus.     

Effects of diazeniumdiolates (NONOates) and methylene blue on the reduction of postoperative adhesion in rats

We investigated the effects of spermine NONOate (SPER/NO), diethylenetriamine NONOate (DETA/NO) and methylene blue for preventing postoperative adhesion in a rat uterine horn model. Before operations, rats were randomly assigned into 6 groups, each composed of 12 rats. These were the sham, control, normal saline, SPER/NO, DETA/NO and methylene blue groups. Each rat was anesthetized with ketamine hydrochloride (40 mg/kg i.v.). The abdominal wall was shaved; the surgical site was scrubbed with povidone iodine and rinsed with sterile saline 3 times before surgery. Under sterile conditions, a 3-cm vertical midline incision was made in all groups. In the sham group, we closed the abdominal wall without any procedure. In the other groups, a 2-cm segment of each uterine horn was injured in 10 spots on the antimesenteric surface using unipolar cautery. Before the final abdominal closure, no adjuvant therapy was administered intraperitoneally to the rats in the control group; 2 ml of normal saline solution, 1% methylene blue solution, SPER/NO (0.5 mg/ml) and DETA/NO (0.1 mg/ml) were instilled into the uterine horns of the rats in the respective groups. The incision was closed with a running 4-0 monofilament delayed absorbable suture in a single layer of muscle and fascia in a running pattern, excluding the peritoneum, and in the covering layer of skin in an interrupted pattern, in all groups. Two weeks after the surgery, all animals were killed, second laparotomies were performed, and the extent and severity of adhesions were determined by a blinded examiner. The adhesion scores of the sham group were significantly lower than those of the other groups (p < 0.05). In the methylene blue, SPER/NO and DETA/NO groups, adhesion scores were significantly lower than in the normal saline and control groups (p < 0.05). However, there were no significant differences related to the extent and severity scores of adhesions between the methylene blue, SPER/NO and DETA/NO groups (p > 0.05). This study showed that SPER/NO, DETA/NO and methylene blue administered at the end of surgery reduced the adhesion formation in a rat uterine horn model.     

Distinct Expression of APO-1/Fas and Caspase-8 in the Human Growth Plate

Chondrocytes in the growth plate undergo a characteristic sequel of differentiation processes, finally leading in their death by apoptosis. The mechanisms that mediate these remarkable biological phenomenon are still widely unknown. For this study, growth plates from five resected polydactylic infantile fingers were taken and immunostained for APO-1 and Caspase-8, two apoptosis-mediating proteins. The expression of both proteins was examined in the resting zone, proliferating zone, and hypertrophic zone, representing the maturation stages of the growth plate. Positive cells for APO-1 and Caspase-8 were found in all zones of the physis with a significant increase from the resting to the hypertrophic zone (from 17.4% to 33.067% for APO-1 and from 13.17% to 28.22% for Caspase-8). Our findings suggest that both APO-1 and Caspase-8 are involved in chondrocyte development in the growth plate, predominantly near to the closure area.     

Terazosin and doxazosin in the treatment of BPH: results of a randomized study with crossover in non-responders

OBJECTIVE: To compare the effects of the doxazosin and terazosin on total International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in treating patients with lower urinary tract symptoms (LUTS) and compare this effectivity by switching the drugs in the patients who did not benefit from either the first or the second drug. METHODS: This is a prospective randomized study of the patients with LUTS suggestive of benign prostatic hyperplasia (BPH). Fifty male patients (mean age 59.4 +/- 7.6 years) received either doxazosin (n = 25) or terazosin (n = 25) once daily every night. The patients were evaluated in the 1st, 2nd and 3rd months of treatment. Minimum 20% improvement in IPSS and Qmax in the 3rd month was considered as improvement. The patients with no improvement in any of the parameters switched the drugs, and they were followed up in the next 3 months. The patients whose only one parameter improved were excluded from the study. RESULTS: Eleven (44%) out of 25 patients using doxazosin and 10 (40%) out of 25 patients using terazosin showed improvement in both IPSS and Qmax at the end of the 3rd month and continued using the drug. After 3 months of treatment, increase in Qmax (p < 0.001) and decrease in IPSS (p < 0.01) was significant for both doxazosin and terazosin. Nineteen patients, who did not show improvement in any of the parameters, switched the drug. Of the patients who switched the drug, 2 (4%) showed improvement both in IPSS and in Qmax, while 2 (4%) showed improvement only in IPSS but not in Qmax. The remaining 15 (30%) patients did not show improvement in any of the parameters. CONCLUSION: The results of the study suggest that alpha-blockade with either doxazosin or terazosin is effective in males with LUTS. The two alpha-blocking drugs showed equal effectiveness in the treatment of LUTS. If one of the drugs is ineffective in the treatment of LUTS, then the other drug will probably be ineffective.     

Plasma D-lactic acid level: a useful marker to distinguish perforated from acute simple appendicitis

Early diagnosis of perforated appendicitis is important for reducing morbidity rates. The aim of this study was to determine the value and utility of plasma D-lactic acid levels in identifying the type of appendicitis. In this clinical study, plasma D-lactic acid levels were assessed in 44 consecutive paediatric patients (23 with acute appendicitis, 21 with perforated appendicitis) before laparotomy. D-lactic acid levels were determined by an enzymatic spectrophotometric technique using a D-lactic acid dehydrogenase kit. Patients with perforated appendicitis had higher D-lactic acid levels (3.970 +/- 0.687 mg/dL) than patients in the control group (0.478 +/- 0.149 mg/dL) and patients with acute appendicitis (1.409 +/- 0.324 mg/dL; p < 0.05). For a plasma D-lactic acid level greater than 2.5 mg/dL, the sensitivity and specificity of the D-lactic acid assay were 96% and 87%, respectively. The positive predictive value was 87%, the negative predictive value was 96%, and the diagnostic value was 91%. These results suggest that the measurement of plasma D-lactic acid levels may be a useful adjunct to clinical and radiological findings in distinguishing perforated from acute non-perforated appendicitis in children.     

Secretory breast carcinoma with extensive intraductal component: case report

Secretory breast carcinoma is a rare entity. It was first reported in pediatric patients in 1966, and was named juvenile breast carcinoma. Incidences of pediatric and adult patients are similar. Prognosis is favorable in both groups, but distant metastases have been reported. The authors describe a case of secretory breast carcinoma with extensive intraductal component.     

Determination of environmental exposure to asbestos (tremolite) and mesothelioma risks in the southeastern region of Turkey

In this study, the authors examined the concentrations and mineralogical analyses of asbestos, and investigated mesothelioma risk in southeastern Anatolia, Turkey. They used a gravimetric dust sampler to collect samples from 2 villages and 2 asbestos mines (1 active). Samples were then evaluated by an X-ray diffractometer and an electron microscope. The authors found high concentrations of asbestos in an active mine (4.9 fibers[f]/cm3) and at a house that was plastered with asbestos (1.24 f/cm3) and had a very active population. They found a low concentration (0.0042 f/cm3) in indoor measurements taken in Armutova village, and an even lower concentration (0.000081 f/cm3) in the inactive mine environment. Outdoor measurements included a low concentration of 0.007 f/cm3 in the village environment, and a high concentration of 1.17 f/cm3 on the mine road during the passing of a sheep herd. The people in the region are continuously exposed to asbestos during normal activities. This cumulative exposure to asbestos carries sufficient risks for mesothelioma development.