Histopathological Response and Adhesion Formation After Omentectomy with Ultrasonic Energy,Bipolar Sealing,and Suture Ligation

This study was designed to evaluate the histopathological response and intra-abdominal adhesion formation after an omentectomy in rats using the bipolar vessel-sealing device, ultrasonic coagulator, and suture ligation techniques. Forty Wistar albino rats were used, divided into four random groups. The rats underwent a midline laparotomy, and a partial omentectomy was performed using a 3–0 silk suture with suture ligation in group 1, bipolar device in group 2, and ultrasonic coagulator in group 3; only a laparotomy was performed on the control group. Lateral thermal damage was examined the same day, and a piece of the omentum was left in the animals to be examined on postoperative day 15. A relaparotomy was performed to assess adhesion formation and histopathological response. In pairwise comparisons, there was no statistically significant difference among the ultrasonic device, bipolar device, and suture ligation groups in terms of microscopic adhesion scoring; however, the scores of the bipolar device and suture ligation groups were significantly higher compared with those of the control group (p?<?0.01). Furthermore, the macroscopic adhesion scores were significantly lower for the ultrasonic device group when compared with those of the bipolar device and suture ligation groups (p?<?0.05 and p?<?0.01). The ultrasonic device seems to be superior to the bipolar device and suture ligation in terms of macroscopic adhesion formation, but no significant difference was found in terms of the histopathological response in rats following an omentectomy. Further research may be required.     

Brief Report: Homozygous IL37 mutation associated with infantile inflammatory bowel disease

Interleukin (IL)-37, an antiinflammatory IL-1 family cytokine, is a key suppressor of innate immunity. IL-37 signaling requires the heterodimeric IL-18R1 and IL-1R8 receptor, which is abundantly expressed in the gastrointestinal tract. Here we report a 4-mo-old male from a consanguineous family with a homozygous loss-of-function IL37 mutation. The patient presented with persistent diarrhea and was found to have infantile inflammatory bowel disease (I-IBD). Patient cells showed increased intracellular IL-37 expression and increased proinflammatory cytokine production. In cell lines, mutant IL-37 was not stably expressed or properly secreted and was thus unable to functionally suppress proinflammatory cytokine expression. Furthermore, induced pluripotent stem cell–derived macrophages from the patient revealed an activated macrophage phenotype, which is more prone to lipopolysaccharide and IL-1β stimulation, resulting in hyperinflammatory tumor necrosis factor production. Insights from this patient will not only shed light on monogenic contributions of I-IBD but may also reveal the significance of the IL-18 and IL-37 axis in colonic homeostasis.     

The comparison of angular and curvilinear marginal mandibulectomy on force distribution with three dimensional finite element analysis

AimThe purpose of this study was to analyse and compare right angled and curved osteotomy design on stress distribution and to determine an osteotomy design which decreases the risk of pathologic fracture.Patients and methodsSolid mathematical model of the mandible was created by three dimensional finite element analysis and two different osteotomy, right angled and curvilinear osteotomy was performed on model. 150 N incisal force vertically and 250 N molar force to the angulus area oblically were applied. The effects of osteotomy types to the stress formation and risk of fracture between models were evaluated.ResultsRight angled osteotomy causes much more stress in the posteroinferior quadrant and mainly localized on the horizontal and vertical osteotomy intersection area. On the other hand, the distribution of the stress on curvilinear formed osteotomy shows posteroinferior localization and stress spreads wider area. Furthermore the amount of stress was less than right-angled one.ConclusionIn this study, curved osteotomy denominated less stress distribution. The shape of osteotomy might be a factor to decrease the risk of postoperative atrophic mandible fracture.     

High-dose interferon results in high HBsAg seroclearance in children with chronic hepatitis B infection

Clinical trials for chronic hepatitis B (HBV) infection in children have shown usefulness of interferon alpha 2b (IFN-alpha) in eliminating HBV replication and in improving liver histology. Although it is not the ultimate goal of the interferon treatment for chronic HBV infection, it has been suggested in adults that HBsAg clearance decreases the likelihood of development of hepatocellular carcinoma, and prolongs the survival. HBV DNA clearance has been shown to be higher with higher doses of interferon in children, but it was rarely associated with HbsAg clearance. Ten MU/m2 was tried in 46 children who had biopsy-proven chronic HBV infection. They received IFN-alpha subcutaneously three times/week for six months. The treatment regimen was completed in 41 children and the second liver hiopsy was carried out one year after the end of the treatment in 30 of 41 patients. With this schedule, 15 (36.6%) children showed persistent loss of HBV DNA 12 months after the cessation of the treatment, 20 (48.7%) lost HBeAg, and eight (19.5%) developed anti-HBs antibody with loss of HBsAg. A significant improvement in liver histology was obtained in children with HBV DNA clearance. Serum ALT levels normalized in all HBeAg seroconverters. These findings suggested that the 10 MU/m2 IFN-alpha treatment was well tolerated and resulted in a high rate of HbsAg clearance in addition to HBV DNA clearance in a group of chidren with chronic HBV infection.     

Myocardial performance index combining systolic and diastolic myocardial performance in doxorubicin-treated patients and its correlation to conventional echo/Doppler indices

This study was designed to evaluate the utility of myocardial performance index (MPI) in anthracycline cardiotoxicity. The MPI measures the ratio of total time spent in isovolumic activity (isovolumetric contraction time and isovolumetric relaxation time) to the ejection time, thus giving a global index combining systolic and diastolic myocardial performance. In this study, MPI was measured in 35 doxorubicin-treated children (aged 108.5+/-55.31 months, 23 males and 12 females) in sinus rhythm and 32 age-matched controls, and it was compared with conventional Doppler echocardiographic parameters. The isovolumetric contraction time was prolonged (38.37+/-24.43 vs 26.37+/-15.53, p <0.02) and ejection time was shortened (231.91 +/- 28.87 vs 256.21+/-19.55, p<0.001) in doxorubicin-treated patients compared to that in normal children. The isovolumetric relaxation time did not show significant difference between patients and control group (60.11+/-10.92 vs 61.06+/-12.12, p>0.05). MPI was significantly increased in doxorubicin-treated patients compared with that in control groups (0.42+/-0.07 vs 0.34+/-0.06, p<0.001), and significant correlation was observed between MPI and fractional shortening, ejection fraction, and left ventricular end diastolic and end systolic diameters (respectively, r = -0.508, p <0.002; r = -0.532, p<0.001; r = 0.467 p<0.005; r=0.606, p<0.001). Also, a weak correlation was found between MPI and duration of the disease and patient ages (r = 0.393, p < 0.02; r = 0.379; p < 0.02). However, there was no correlation between MPI and cumulative doxorubicin dose (r = 0.311, p > 0.05) and diastolic Doppler parameters in doxorubicin-treated patients. We think that MPI may be a useful parameter in monitoring left ventricular dysfunction in anthracyline-treated patients.     

Poliomyelitis eradication programme: acute flaccid paralysis surveillance in mardin and five other provinces around Mardin, Turkey 1998

After the successful eradication of small pox, the eradication of poliomyelitis was planned. In the poliomyelitis eradication programme, conducted since 1989, routine vaccination, supplemental immunisation activities and acute flaccid paralysis (AFP) surveillance were the main strategies. In 1997, in Mardin provinces six poliomyelitis cases were reported. Therefore it was planned to strengthen the eradication programme in this province and those around it. In 1998 in Mardin and five neighboring provinces, a study was conducted that included monthly visits, educational activities, etc. At the result of this study, 64 AFP cases (22 of them poliomyelitis) were reported. Non-poliomyelitis AFP rate had increased from 0.9 in 1997 to 2.8 in 1998. An adequate two specimen ratio was 72%. We recognised that more poliomyelitis cases were reported in hot seasons when compared with non-poliomyelitis cases reported throughout the year. This difference was statistically significant (P<0.001). Most AFP cases were aged under 35 months. At the 60th day follow-up visits of the patients, we found 90.9% of the poliomyelitis cases but only 19.0% of the non-poliomyelitis case had residual paralysis. Presence of prodromal fever was another finding that distinguished poliomyelitis cases from non-poliomyelitis AFP cases. 90.9% of the poliomyelitis cases but only 64.3% of the non-poliomyelitis cases had fever at onset. This finding was also statistically significant (P<0.05).