A case of mitral papillary muscle rupture due to blunt chest trauma

Mitral regurgitation due to papillary muscle rupture after blunt chest trauma is uncommon. Sudden onset severe mitral regurgitation may lead to death due to heart failure if surgical repair is delayed. A previously healthy 12-year-old girl underwent splenectomy and chest tube insertion for pneumothorax after a traffic accident in a vehicle 15 days before. She was discharged from the hospital after a nine-day follow-up. She was presented to our hospital due to respiratory distress. On physical examination, an apical holosystolic murmur radiating to the axillary region was recognized. Transthoracic echocardiogram showed severe mitral regurgitation with freely moving posterior mitral chordae and prolapse of the posterior mitral valve leaflet. She received reimplantation of the complete ruptured posteromedial papillary muscle of the mitral valve. Her medical condition improved after the operation. On the postoperative echocardiogram, the left ventricular systolic function was normal with no mitral regurgitation.     

Nasal mucosal expression of nitric oxide synthases in patients with allergic rhinitis and its relation to asthma.

BACKGROUND: Nitric oxide (NO) has contradictory roles in the pathophysiology of allergic inflammation in both allergic rhinitis (AR) and asthma. Small amounts of NO produced by constitutive NO synthase (NOS) is anti-inflammatory, whereas large amounts produced by inducible NOS (iNOS) are proinflammatory. OBJECTIVE: To investigate the difference in constitutive endothelial NOS (eNOS) and iNOS expression in nonallergic and allergic mucosa and the possible relation of this to the coexistence of asthma in seasonal AR. METHODS: Seventeen patients (10 women and 7 men) with seasonal AR and 9 nonallergic patients (5 women and 4 men) with nasal septum deviation were enrolled. Inferior turbinate nasal biopsy specimens were obtained in all. Levels of eNOS and iNOS expressed as immunohistochemical scores (HSCOREs) were determined immunohistochemically from the specimens. RESULTS: The mean +/- SD HSCOREs for eNOS in patients with seasonal AR were not significantly different from those of the nonallergic controls (1.85 +/- 0.78 vs 1.63 +/- 0.54; P = .12). On the other hand, the mean +/- SD HSCOREs for iNOS were significantly higher in patients with seasonal AR (1.75 +/- 0.75 vs 0.71 +/- 0.6; P = .004). Furthermore, although eNOS expression was not different between seasonal AR patients with and without asthma, the mean +/- SD HSCOREs for iNOS were significantly higher in the patients with asthma (1.93 +/- 0.78 vs 1.65 +/- 0.55; P = .01). CONCLUSION: Increased expression of iNOS might have a role in the development of allergic inflammation in upper and lower airways and in comorbidity of AR and asthma.     

Trace elements, heavy metals and vitamin levels in patients with coronary artery disease

Aim: In the present study, we aimed to assess serum concentrations of zinc (Zn), copper (Cu), iron (Fe), cadmium (Cd), lead (Pb), manganese (Mn), vitamins A (retinol), D (cholecalciferol) and E (α-tocopherol) in patients with coronary artery disease (CAD) and to compare with healthy controls.Methods: A total of 30 CAD patients and 20 healthy subjects were included in this study. Atomic absorption spectrophotometry (UNICAM-929) was used to measure heavy metal and trace element concentrations. Serum α-tocopherol, retinol and cholecalciferol were measured simultaneously by high performance liquid chromatography (HPLC).Results: Demographic and baseline clinical characteristics were not statistically different between the groups. Serum concentrations of retinol (0.3521±0.1319 vs. 0.4313±0.0465 mmol/I, p=0.013), tocopherol (3.8630±1.3117 vs. 6.9124±1.0577 mmol/I, p<0.001), cholecalciferol (0.0209±0.0089 vs. 0.0304±0.0059 mmol/I, p<0.001) and Fe (0.5664±0.2360 vs. 1.0689±0,4452 µg/dI, p<0.001) were significantly lower in CAD patients. In addition, while not statistically significant serum Cu (1.0164±0.2672 vs. 1.1934±0.4164 µg/dI, p=0.073) concentrations were tended to be lower in patients with CAD, whereas serum lead (0.1449±0.0886 vs. 0.1019±0.0644 µg/dI, p=0.069) concentrations tended to be higher.Conclusions: Serum level of trace elements and vitamins may be changed in patients with CAD. In this relatively small study we found that serum levels of retinol, tocopherol, cholecalciferol, iron and copper may be lower whereas serum lead concentrations may be increased in patients with CAD.     

Chronic unpredictable stress disturbs the blood–testis barrier affecting sperm parameters in mice

Research questionDoes chronic stress affect the key proteins and sperm parameters of the blood–testis barrier (BTB)?DesignC57Bl/6 mice were divided into two groups: a non-treated control group and a chronic unpredictable stress (CUS) applied group. The stress status of the animals was confirmed with behavioural tests. Histopathologic evaluation was conducted by haematoxylin and eosin staining and electron microscope. Malondialdehyde, corticosterone and testosterone levels were evaluated in peripheral blood. Expression levels of BTB proteins, namely zonula occludens-1 (ZO-1), claudin-11 (CLDN11) and clathrin in Sertoli cells, were assessed by Western blotting and immunofluorescence techniques. Sperm samples were collected from cauda epididymis, and sperm parameters analysed.ResultsThe stress model was confirmed by behavioural tests. Histopathological evaluation of the testes demonstrated a mild degeneration in seminiferous tubules. Malondialdehyde (P = 0.008) and corticosterone levels increased (P = 0.004) and testosterone levels decreased (P = 0.005) in the CUS group. Electron microscopic evaluation confirmed the damage in BTB integrity in the CUS group. Western blot analysis showed that ZO-1 and CLDN11 levels were significantly decreased, although clathrin levels were unchanged. Although sperm concentration and total motility rate were not significantly different between the groups, progressive motility (P = 0.03), normal sperm morphology (P = 0.04), chromatin integrity (toluidine blue) (P = 0.002) and the acrosomal reaction rate (P = 0.002) were significantly decreased, and acrosomal abnormality rate was dramatically increased (P = 0.04) in the CUS group.ConclusionsIn mice, CUS disrupted BTB integrity and impaired sperm parameters. A decrease in ZO-1 and CLDN11 expression levels may be proposed as the causative factor.     

Tissue glue in sutureless vitreoretinal surgery for the treatment of wound leakage.

BACKGROUND AND OBJECTIVE: To assess the surgical outcomes of the use of tissue glue to close sclerotomy sites when required and the views of ultrasound biomicroscopy of the sclerotomy sites in 23- and 25-gauge vitrectomy systems. PATIENTS AND METHODS: A 25-gauge transconjunctival sutureless vitrectomy was performed in 38 eyes and a 23-gauge transconjunctival sutureless vitrectomy was performed in 46 eyes for various vitreoretinal diseases. Wound leakage occurred at the sclerotomy sites at the end of the surgery in 6 eyes with 23-gauge transconjunctival sutureless vitrectomy and 7 eyes with 25-gauge transconjunctival sutureless vitrectomy. The sclerotomy sites were closed by using tissue glue to prevent wound leakage and evaluated with ultrasound biomicroscopy postoperatively. RESULTS: No wound leakage was observed at the end of the surgical procedure or during the follow-up period. Abnormal fibrous ingrowth was not detected at the sclerotomy sites by means of ultrasound biomicroscopy. CONCLUSION: The results demonstrated the efficacy of tissue glue for closing site ports when wound leakage is observed in transconjunctival sutureless vitreoretinal surgery.     

Comparison of nickel patch test reactivity in phases of the menstrual cycle

BACKGROUND: In earlier studies, it has been shown that severity of some diseases varies with menstrual cycle. Severity of skin diseases such as atopic dermatitis, lupus erythematosus, infections due to herpes virus, urticaria and acne were also reported to increase in the premenstrual phase. Effect of estradiol on the cellular immune system was investigated and it was found to depress the cellular immune response. In our study, we investigated whether nickel patch test reactivity was different during phases of the menstrual cycle and whether there was an increase in sensitivity to nickel during the premenstrual cycle in nickel-sensitive women. METHODS: The study consisted of 30 women who had a history of nickel sensitivity. Finn Chamber nickel patch test was applied to all 30 women by dividing them into two groups of 15 and applying the test first on days 7-10 and then on days 20-24 of the menstrual cycle or vice versa. RESULTS: The reactions of both the groups on days 20-24 were more severe than those on days 7-10 even though the results were not statistically significant. CONCLUSIONS: Estrogens not only impair the skin barrier but also have a negative impact on the immune system. Estradiol has been proved to suppress cellular immunity. In a few studies conducted to date, the relationship between phases of the menstrual cycle and the severity of patch test reactivity has been examined with equivocal results. In our study, we observed that the presence of reactions due to nickel sensitivity was independent of the phases of the menstrual cycle. Nevertheless, we would like to point out the fact that the reactions seen in the second phase of the menstrual cycle were more severe than those seen in the first phase.     

Intracranial dural arteriovenous fistula draining into spinal cord veins: case report

We present an usual case of intracranial dural arteriovenous fistula with perimedullary and spinal cord venous plexus drainage and discuss its etiological, physiopathological, diagnostic and therapeutic aspects.     

替罗非班输注失败后长期华法林治疗成功溶解冠状动脉血栓

本文报道1例右冠状动脉充满血栓经给予华法林治疗获得成功的病例。替罗非班输注失败后长期华法林治疗成功溶解冠状动脉血栓@Boztosun B. @Gunes Y. @Kirma C. @Barutcu I. $19 m. mah. s.sok. M. Apt. No. 25/17, Kozya-tagi, Istanbul, Turkey @田雨灵