Influence of age and sex on lumbar vertebral morphometry determined using sagittal magnetic resonance imaging.

We evaluated age-related changes in the morphometric features of lumbar vertebrae in both sexes using magnetic resonance imaging (MRI). Midsagittal MRI scans of 366 individuals (156 males, 210 females; 25-82 years old) were evaluated retrospectively. The anterior height (H(a)), central height (H(c)), posterior height (H(p)), and anteroposterior diameter (D) of the body of each lumbar vertebra were measured. These measurements were used to calculate three indices, namely, the anterior wedge index (H(a)/H(p)), the biconcavity index (H(c)/H(p)), and the compression index (H(p)/D). The values of each of the three indices for the upper lumbar vertebrae of females were higher than those of the same vertebrae in males. The values of the compression index for all lumbar vertebrae decreased with age in females, whereas in males the compression index of the L1-L4 vertebrae decreased with age. No significant changes were observed in the value of the anterior wedge index in either sex. The biconcavity indices of the L1 and L5 vertebrae decreased with age in males. These results may be useful for evaluating age-related morphological changes that occur in the lumbar vertebrae.     

Reliability of mini nutritional assessment in hemodialysis compared with subjective global assessment.

Protein-energy malnutrition (PEM) is common in hemodialysis patients. Subjective Global Assesment (SGA) and Mini Nutritional Assessment (MNA) are two tools for monitoring PEM. Our aim was to determine reliability of MNA in detecting malnutrition in hemodialysis patients in comparison with SGA. The study population consisted of 137 patients with pure PEM with no signs of chronic inflammation. Nutritional statuses of patients were assessed concomitantly by SGA and MNA. Ninety-two patients were in SGA-A, 40 patients were in SGA-B, and 5 patients were in SGA-C. Forty-seven patients were in MNA-1, 77 patients were in MNA-2, and 13 patients were in MNA-3. Albumin (P = .0001), prealbumin (P = .0001), body mass index (P = .01), creatinine (P = .0001), and nPNA (P = .04) were statistically different between SGA groups. Creatinine (P = .001), blood urea nitrogen (P = .017), albumin (P = .001), prealbumin (P = .005), body mass index (P = .0001), and nPNA (P = .005) were statistically different between MNA groups. Fifty-two patients who had no evidence of malnutrition according to SGA were defined as having moderate malnutrition according to MNA. Seven patients who were in a state of moderate malnutrition determined by SGA were in good nutritional status according to MNA. SGA identified 8 patients as moderately malnourished; the same patients were defined as having severe malnutrition in MNA. Our results suggest that MNA might underestimate the nutritional status of hemodialysis patients who are not in an inflammatory state and may not be a reliable method for detecting moderate malnutrition when compared with SGA.     

Occlusion of the gastric outlet caused by a trichobezoar

Bezoars are concretions formed in the gastrointestinal tract. The trichobezoars are hairballs in the stomach or intestines composed of hair. They are usually found in young girls as in our case which we operated in April 1989 on Surgical Ward in Kartal State Hospital in Istanbul. The postgastrectomy state predisposes to bezoar formation. Persimmon peels or pits, orange or grapefruit pulp are the usual offenders. Bezoars are associated with vague upper gastrointestinal discomfort, nausea, and vomiting. The patients may complain of abdominal pain. Ulceration, bleeding, obstruction, and perforation are the most common complications. Treatment consist of mechanical fragmentation via the endoscope or operative extraction. Dissolution of the undigested bolus by ingestion of proteolytic enzymes such as papain may be tried. As prophylaxis the postgastrectomy patient must be warned of ingesting citrus fruits.     

Abdominal paravaginal defect repair in the treatment of paravaginal defect and urodynamic stress incontinence.

We evaluated the morbidity, complications and outcomes in 42 patients who underwent abdominal paravaginal defect repair (PDR) for vaginal wall prolapse due to a paravaginal defect and the prolapse of other pelvic organs. Out of a total of the 42 patients, 32 underwent PDR and concomitant pelvic reconstructive procedures, and 10 patients underwent PDR plus anti-incontinence surgery and concomitant pelvic reconstructive procedures. The mean patient age was 44.5 years. The mean follow-up period was 40 months. One bladder injury and two hemorrhages occurred intraoperatively. The cure rate of anterior vaginal wall prolapse was 92.9%. Of the 20 patients with urodynamic stress incontinence (USI) who underwent PDR alone, the rate of recurrence of USI was 20%; however, there was no recurrence in the 10 patients who underwent PDR plus the anti-incontinence procedures. Paravaginal repair is a safe and effective procedure for the surgical correction of a paravaginal defect, but has limited applicability in the surgical correction of USI.     

Is leptin associated with hypertensive retinopathy?

Previous studies have demonstrated that elevated plasma leptin concentrations are associated with essential hypertension. It has also recently been shown that leptin plays a promoting role in angiogenesis, and the vascular endothelium expresses the long form of leptin receptor. Those data led us to hypothesize that leptin might contribute to end-organ damage in hypertension. Thus, in the present study we evaluated the relationship between plasma leptin concentrations and hypertensive retinopathy (HR). One hundred and eleven patients newly diagnosed with essential hypertension [EHT; mean age, 43.5 +/-10.7 yr; body mass index (BMI), 28.1 +/- 4.4 kg/m2; male/female ratio, 71/40] and 79 healthy normotensive control subjects (NT; mean age, 43.6 +/- 9.2 yr; BMI, 28.2 +/- 3.3 kg/m2; male/female ratio, 50/29) were enrolled in the study. For the assessment of retinopathy according to the Keith-Wagener classification, direct and indirect ophthalmoscopy were performed in all subjects after dilatation of the pupils. Plasma leptin levels were significantly higher in EHT (11.8 +/- 11.1 ng/mL) than in NT (7.2 +/- 5.1 ng/mL) (P = 0.003). Plasma leptin concentrations were strongly correlated with BMI in both EHT (r = 0.45; P = 0.001) and NT (r = 0.38; P = 0.001) groups. Plasma leptin in patients with grade 2 HR (24.8 +/- 15.8 ng/mL; n = 22) was significantly higher than that in patients with grade 1 HR (16.1 +/- 4.9 ng/mL; n = 29; P = 0.001), grade 0 HR (5.1 +/- 3.1 ng/mL; n = 60; P = 0.001), and NT (P = 0.001). Plasma leptin in patients with grade 1 HR was also significantly higher than that in patients without retinopathy (P = 0.001) or in NT (P = 0.001). The estimated threshold of plasma leptin concentration for HR was 10.2 ng/mL. This critical leptin level served largely to separate patients with retinopathy from those without retinopathy. In summary, our results show that plasma leptin concentrations increase progressively with higher grades of hypertensive retinopathy even after correction for BMI, suggesting that a critical leptin level is needed for the development of retinopathy. Elevated concentrations of plasma leptin might be secondary to release of leptin by the vascular endothelium damaged by high blood pressure, as an epiphenomenon. However, a pathogenic role for leptin in hypertensive retinopathy cannot be excluded.     

In vitro evaluation of the amoebicidal activity of garlic (Allium sativum) extract on Acanthamoeba castellanii and its cytotoxic potential on corneal cells.

Free-living protozoa of the genus Acanthamoeba can cause one of the most severe, potentially sight-threatening infections of the eye, the so-called A. keratitis. A. keratitis is difficult to treat because, under adverse conditions, the amoeba encyst and medical therapy is often less effective against cysts than against trophozoites. The aim of this study was to investigate evaluate the in vitro effect of the nonpolar subfraction of the methanol extract of garlic (Allium sativum) on the growth of A. castellanii trophozoites and cysts and also its cytotoxicity on corneal cells in vitro. Extract was evaluated for its amoebicidal activity, using an inverted light microscope. The effect of the nonpolar extract with the concentrations, ranging from 0.78 to 62.5 mg/mL on the proliferation of A. castellanii trophozoites and cysts, were examined in vitro. For the determination of cytotoxicity of the extract on corneal cells, agar diffusion tests were performed. The present study demonstrates the in vitro effectiveness of the garlic against the A. castellanii growth curve. Evaluations revealed that garlic inhibits trophozoite growth in dose- and time-dependent ways. In the case of the cyctotoxic acitivities, it showed no cytotoxicity for the cornea cells in the concentration of 3.90 mg/mL. These findings indicate that nonpolar subfraction of the methanol extracts of garlic has amoebicidal, as well as its cysticidal, properties on Acanthamoeba trophozoites and cysts. Garlic alone, and in combination with other amoebicidal agents, may be used in clinical practices after further investigations.     

Effect of clomiphene citrate on ovarian, endometrial, and cervical histologies in a rat model

OBJECTIVE: To examine the effect of clomiphene citrate (CC) on the ovarian, endometrial, and cervical histologies in a rat model. METHODS: The rats (n = 40) were randomly assigned to 4 treatment groups: CC 50 (repetitive doses of 0.2 mg CC); CC 100 (repetitive doses of 0.4 mg CC); CC 200 (repetitive doses of 0.8 mg CC), and control (repetitive doses of normal saline). Each study group received its CC dose intraperitoneally in 2 ml saline for 5 days and the controls received 2 ml saline only. Each treatment cycle was repeated six times. Six months later the rats were euthanized. Their ovaries, uterine horns, and cervices were removed and examined for histologic changes. RESULTS: We found no significant difference in the number of follicles and corpora lutea of the study groups (p > 0.05). The numbers of granulosa, theca, and luteal cells of the CC 100 and CC 200 groups were significantly higher than those of the CC 50 group and controls (p < 0.05). There was no important finding related to pre-malign and malign changes in ovarian, endometrial and cervical samples of the control and CC 50 groups. Focal atypia and atypical mitoses were noted in 2 cases of granulosa cells in the CC 100 and CC 200 groups. CONCLUSION: We did not find an association between the use of CC and ovarian, endometrial, and cervical neoplasms; nevertheless, we noticed an increase in granulosa, theca and luteal cells with high doses of CC, which may be a risk factor for granulosa, theca, and luteal cell tumors.