Achievement of pregnancy in globozoospermia with Y chromosome microdeletion after ICSI

Pregnancy achieved with sperm from a patient with globozoospermia is rare, even after ICSI, since the activation of the oocyte may not occur in this disorder. Therefore, activation of the oocytes by piezoelectricity or calcium ionophores has been suggested, although spontaneous activation of the oocyte after ICSI has been reported in some cases. We report a successful pregnancy in a couple in which the male partner had globozoospermia with microdeletions in the Y chromosome with no further assisted activation after ICSI. During the diagnostic study of the husband, increased numerical chromosome abnormalities after fluorescent in-situ hybridization (FISH) and microdeletions in AZFa; sY86 and AZFb; sY 131 were detected. Out of the 13 oocytes injected, four fertilized and a twin pregnancy was obtained after replacement of four embryos. Healthy twin girls were delivered after a term pregnancy. Some patients with globozoospermia may also have Y chromosome microdeletions, which subsequently may be inherited by the male offspring in cases of achievement of pregnancy.     

Effect of timing of chest tube removal on development of pericardial effusion following cardiac surgery

BACKGROUND: There are no standard criteria for the timing of drain removal. The objective of this study was to determine whether the macroscopic appearance of chest tube drainage fluid to serosanguineous may be used as a criteria for drain removal. METHODS: 2,359 patients were assessed retrospectively and 80 randomized patients were followed prospectively who underwent cardiac surgery. In both parts of the study, patients were divided into two groups according to the timing of drain removal. Group I consisted of patients whose chest tubes were removed as soon as the macroscopic appearance of the drainage fluid turned to serosanguineous. Group II consisted of patients whose chest tubes were removed at the second postoperative day when the drainage output declined to less than 50 mL in a five-hour period. In the retrospective part, cases of hemodynamically significant pericardial effusion observed within seven days postoperatively were reviewed. In the prospective part, just before the drain removal, the fluid sample hematocrit obtained from the drain lines and patients' blood hematocrit were measured and recorded. Patients were evaluated with echocardiography for pericardial effusion. RESULTS: No statistically significant difference was detected in the frequency of hemodynamically significant pericardial effusion and incidence or amount of pericardial effusion between the two study groups. The drain hematocrit to blood hematocrit ratios before drain removal showed a significant correlation with pericardial effusion.The strength of correlation between the drain hematocrit to blood hematocrit ratios before drain removal and pericardial effusion was also studied using receiver operating characteristic curve, which suggests that a drain hematocrit to blood hematocrit ratio of < or = 0.3 is strongly predictive that pericardial effusion would be absent or mild between the fifth and seventh postoperative days. CONCLUSIONS: It is safe to remove the chest tubes as soon as the macroscopic appearance of the drainage fluid turns to serosanguineous since this practically indicates cessation of active bleeding.     

Pantothenate kinase-associated neurodegeneration: MR imaging,proton MR spectroscopy,and diffusion MR imaging findings

We herein report the case of a 15-year-old male patient with pantothenate kinase-associated neurodegeneration. The classic "eye-of-the-tiger" appearance was initially present on the globus pallidi on T2-weighted MR images and had disappeared by the time of the 10-month follow-up examination. Fluid-attenuated inversion recovery images revealed marked hypointensity in the globus pallidi and dentate nuclei and high signal intensity changes in the deep cerebral white matter. Proton MR spectroscopy revealed markedly decreased N-acetylaspartate in the globus pallidi, associated with decreased N-acetylaspartate and increased myoinositol in the deep cerebral white matter. Diffusion MR images (b=1000 s/mm(2)) were negative (normal appearing) for deep cerebral white matter lesions, whereas apparent diffusion coefficient values were slightly increased (1.08-1.12 x 10(-3) mm(2)/s), compared with the apparent diffusion coefficient values from the normal white matter regions. Apparent diffusion coefficient values in the globus pallidi were lower than those in the unaffected thalamus.     

A fatal complication due to radiofrequency ablation for atrial fibrillation: atrio-esophageal fistula

Treatment of chronic atrial fibrillation with intraoperative radiofrequency ablation is gaining more acceptance in patients with rheumatic valve disease. This article reports a case of fatal atrio-esophageal fistula after radiofrequency ablation in a patient with rheumatic mitral and aortic valve disease with chronic atrial fibrillation.     

Kotz and Ganz osteotomies in the treatment of adult acetabular dysplasia

In hips with acetabular dysplasia, we performed Kotz osteotomy (group 1) in 22 hips (20 patients; mean age 24.3 years) and Ganz osteotomy (group 2) in 23 hips (22 patients; mean age 23.1 years). Group 1 was followed 83.3 (56-112) months and group 2 40.9 (24-66) months. In group 1, Harris hip score improved from average 74.9 to 86.9, mean center edge (CE) angle from -4.5 degrees to 30.3 degrees, and mean vertical center edge (VCE) angle from 5.3 degrees to 36.2 degrees. In group 2, Harris hip score improved from average 76.6 to 91.1, mean CE angle from -5.9 degrees to 32.0 degrees, and mean VCE angle from 5.0 degrees to 41.3 degrees. Using Pauwels criteria, regression was observed in 12 hips in group 1 and one progressed. In group 2, 15 hips showed regression and three progressed. In patients treated with Ganz osteotomy, the complication rate was higher and the complications more serious than in patients treated with Kotz osteotomy. Most complications were, however, seen among the first ten patients treated with Ganz osteotomy. Although we detected no significant difference between the two groups in terms of clinical and radiological findings, we believe the outcome to be slightly better after a properly performed Ganz osteotomy.     

The ameliorating effect of melatonin on protamine sulfate induced bladder injury and its relationship to interstitial cystitis

PURPOSE: The pineal hormone melatonin was recently shown to have free radical scavenging ability and it reduces lipid peroxidation. In this morphological study we investigated the effects of melatonin on protamine sulfate (Sigma Chemical Co., St. Louis, Missouri) induced bladder injury. MATERIALS AND METHODS: Albino Wistar female rats were catheterized and intravesically infused with phosphate buffered solution (control group) or protamine sulfate (bladder injury group) dissolved in phosphate buffered solution. In the protamine sulfate plus melatonin group after protamine sulfate instillation melatonin was injected intraperitoneally. Bladder morphology was investigated by light and electron microscopy. Tissue samples were also obtained to determine bladder malondialdehyde levels. RESULTS: In the bladder injury group ulcerated areas, an irregular glycosaminoglycan layer, increased number of mast cells, vacuole formation, dilated perinuclear cistern, formation of pleomorphic and uniform microvilli, and dilated urothelial intercellular spaces were observed. In the bladder injury plus melatonin group a relatively normal urothelial topography, glycosaminoglycan layer and decreased number of mucosal mast cells, some dilatation between intercellular areas, less uniform microvilli and in most areas regular tight junctions were observed. CONCLUSIONS: Increased malondialdehyde levels as a result of protamine sulfate induction lead us to propose that free radicals may have a critical role in this injury. The significant decrease in malondialdehyde levels in the protamine sulfate plus melatonin group was in accordance with morphological findings. Thus, melatonin appears to exert a urothelial protective activity in a bladder injury model.     

Diffusion magnetic resonance imaging of solid vestibular schwannomas

Six patients with solid vestibular schwannomas were studied by diffusion magnetic resonance imaging to assess if this modality adds new information for these tumors, because there is no previous report in the relevant literature. The sizes of the tumors ranged from 2.2 to 4.7 cm with respect to their largest diameters. They were isointense to the normal brain parenchyma on b = 1,000 s/mm2 images. The apparent diffusion coefficient (ADC) values in the tumors were high (range: 1.14-1.72 x 10(-3) mm2/s, mean = 1.42 +/- 0.17 x 10(-3) mm2/s) compared with normal brain parenchyma ADC values (mean = 0.80 +/- 0.11 x 10(-3) mm2/s). High ADC values of solid vestibular schwannomas were in conformity with increased diffusion rates, indicating the presence of increased amounts of extracellular water (a relatively loose tissue) in the tumor matrix.     

Congenital cleft in the pontomedullary junction

A 4-month-old boy is reported with complete absence of horizontal gaze. Magnetic resonance imaging revealed a congenital cleft at the pontomedullary junction directed from the right anterior paramedian region toward the posterior midline, sparing the posterior region of the pontine tegmentum and the medulla oblongata. Such clefts are extremely rare, and there is only 1 previous report in the literature.     

Genotyping of clinical Rhodotorula mucilaginosa isolates by pulsed field gel electrophoresis

Identification and typing of fungal isolates is a prerequisite for control and prevention of nosocomial infections. As the discriminatory power of phenotypic methods is not sufficient for epidemiological purposes, genotyping methods such as DNA fingerprinting, random amplification of polymorphic DNA (RAPD) analysis, or pulsed field gel electrophoresis (PFGE) are preferred. To our knowledge, this study is the first application of PFGE for typing Rhodotorula mucilaginosa strains. The PFGE patterns of six clinical isolates produced two different karyotypes, which were confirmed by RAPD analysis. Five strains isolated from bloodstream infections from three different institutions showed the same karyotype and RAPD patterns, while the urological specimen differed slightly.     

Antimalarial activity screening of some alkaloids and the plant extracts from Amaryllidaceae

Four groups of Amaryllidaceae alkaloids, namely lycorine-, crinine-, tazettine-, and galanthamine-type, as well as plant extracts of the Amaryllidaceae plants (Pancratium maritimum, Leucojum aestivum, and Narcissus tazetta ssp. tazetta) growing in Turkey were evaluated in vitro for their ability to inhibit Plasmodium falciparum growth by a high-throughput screening method with a 96-well microtiter plate. All four groups of alkaloids exhibited antimalarial activity at different potencies. 6-Hydroxyhaemanthamine, haemanthamine and lycorine were found to be the most potent alkaloids against P. falciparum (T9.96) and galanthamine and tazettine had the least potent activity against P. falciparum (K1).