Mitral valve repair in a developing country

Out of 454 patients who underwent mitral valve surgery, 210 (46.2%) had isolated mitral valve disease and the rest had mixed valvular disease. Repair was considered for 393 (86.6%) patients but was feasible in only 269 (59.3%) valves. Commissurotomy was performed in 177 (65.8%), leaflet plasty in 25(9.3%), chordal repair in 93(34.6%), papillotony 116(43.1%) and annuloplasty in 210 (78.0%) patients. The hospital mortality for the repair group was 1.49 per cent. There were 2(0.75%) late dealts. Twenty-seven (10.05%) patients underwent reoperation over 20 months, out of which four could be repaired again. Amongst the survivors, 95.5 per cent are in functional class I and II. The techniques of repairs undertaken have been described and its importance in the setting of a developing country has been highlighted.     

A case of formiminoglutamic aciduria

We describe a boy who excreted massive amounts of formiminoglutamic acid and hydantoin-5-propionic acid in his urine. He was mildly mentally retarded and epileptic, whereas his twin-brother was completely normal. Loading with l-histidine enhanced the excretion of both metabolites. Treatment was attempted with high doses of folic acid and methionine, but both were without effect on the excretion levels.     

Fuzzy organ allocation system for cadaveric kidney transplantation

BACKGROUND: The recipient selection decision for a cadaveric donor kidney is complex and based on multiple criteria, not only medical but also ethical and political criteria. METHODS: In this study, we develop the Fuzzy Organ Allocation System (FORAS) to determine who among potential recipients receives a cadaveric kidney when it becomes available. FORAS balances various kidney allocation objectives and deals with the ambiguity and fuzziness in the allocation process. RESULTS: We used simulation to investigate how well FORAS represents the thinking of a transplant physician with regard to kidney allocation. We also compared FORAS with the United Network for Organ Sharing (UNOS) scoring system and the Turkish National Coordination for Organ Transplant (TONKS) algorithm used in Turkey. We found that FORAS well represents expert thinking in kidney allocation. CONCLUSIONS: A simulated kidney allocation experiment based on real patient and donor data showed that FORAS is more useful than other kidney allocation systems because its results more closely reflect the thinking of experienced transplant physicians.     

Effect on Gastric Emptying and Weight Reduction of Botulinum Toxin-A Injection into the Gastric Antral Layer: An Experimental Study in the Obese Rat Model

Background: We investigated the effects of Botox-A on weight loss and gastric emptying in an experimental obese rat model. Although there is evidence of weight loss in normal-weight rats after Botox-A injection, there are no studies indicating the effect of Botox-A injection on weight loss and gastric emptying time in obese rats. Methods: 37 female Wistar Albino rats were given high calorie diet for 90 days. They were separated into 3 groups. The first group (Botox group) consisted of 15 obese rats whose gastric antrum was injected with 20 U of Botulinum Toxin Type A. The second group (Saline group) consisted of 15 obese rats whose gastric antrum was injected with 20 U of saline. The third group (Control group) had no surgical intervention. Gastric scintigraphy was performed in the 3 groups pre- and postoperatively. Results: The saline group had a weight reduction in the early postoperative days but began to gain weight thereafter. The mean weight of the Botox group between the 16th and 28th days postoperatively was significantly lower than the mean weights of the control and the saline groups (P<0.05, P<0.001). The results of gastric emptying scintigraphy in all 3 groups at day 20 revealed significantly higher T1/2 values in the Botox-A group when compared to the results of the control and saline groups (P<0.001). Conclusion: Botox-A application to the gastric antrum in obese rats leads to weight loss by increasing the gastric emptying time.     

Cardiac surgery after liver transplantation

An aortic valve replacement and an aorto-coronary bypass were done in a woman of 57 years old after an orthotopic liver transplantation. The surgical risk was increased by the antecedent liver transplantation, the immunosuppression, chronic renal insufficiency and antiphospholipid syndrome. Surgery and the post-operative period were not complicated. Cardiac surgery is not a contraindication for patients with a prior organ transplant. These individuals have a higher cardiovascular risk and require a cardiovascular follow-up the modalities of which are yet to be defined.     

Studies on the mechanism whereby acidemia stimulates collecting duct hydrogen ion secretion in vivo

The purpose of these studies was to elucidate the mechanism whereby collecting duct hydrogen ion secretion was augmented by acidemia. The urine minus blood PCO2 difference in alkaline urine (U-B PCO2) was used to evaluate this parameter. In dogs with a normal ECF volume, the U-B PCO2 factored was high, and there was no significant relationship between the U-B PCO2 factored for the urine bicarbonate concentration and the blood hydrogen ion concentrations unless amiloride, an agent that abolishes the transtubular potential difference, was present. In this latter case, the U-B PCO2 was a linear function of the urine bicarbonate concentration, and the U-B PCO2 factored for the urine bicarbonate concentration was directly proportional to the blood hydrogen ion concentration. To extend the pH range considerably, we used lysine to induce bicarbonaturia in dogs with an expanded ECF volume. Amiloride now caused only a small decrease in the U-B PCO2 at any urine bicarbonate concentration, and furthermore, it did not influence the linear relationship between the U-B PCO2 factored for the urine bicarbonate concentration and the blood hydrogen ion concentration. These results suggests that acidemia stimulates collecting duct hydrogen ion secretion by a mechanism that appears to be independent of the amiloride-sensitive component of the U-B PCO2. We speculate that the mechanism might involve an increased intracellular hydrogen ion concentration during acidemia.     

Neonatal lupus erythematosus presenting with cholestatic hepatitis: a case report and review of the literature

Neonatal lupus erythematosus (NLE) is a disease primarily characterized by cardiac and/or cutaneous involvement. Hepatic, hematological, neurological and pulmonary involvement are rare manifestations and normally considered as mild and transient complications. But recent studies have shown more frequent hepatic involvement in NLE. We report a two month-old male infant, born to a clinically asymptomatic mother, presenting with significant hepatic involvement and annular, erythematous plaques with hyperkeratotic borders at the eyebrow region and anterior surface of trunk. Both the infant and his mother were positive for anti-Ro (SS-A) and anti-La (SS-B).     

Periodontal treatment needs of patients with renal disease receiving haemodialysis

AIM/OBJECTIVE: The aim of this study was to perform periodontal assessment, using the CPITN index, on patients undergoing renal dialysis. METHODS: The periodontal conditions of 342 subjects undergoing renal dialysis from eight renal dialysis centres were examined using CPITN. Subjects were distributed into four age groups, 16-19, 20-34, 35-44 and > or =45 years. The study was conducted during a 6-month period. All clinical examinations were performed by one examiner. RESULTS: There was a significant positive relationship between the CPITN scores and age (r=0.164, p=0.002) and dialysis duration (r = 0.240, p=0.000). There was no statistically significant difference between male and female patients (p>0.05). None of the age groups had healthy sextants. The 35-44 year-age group had a higher number of sextants with deep pockets (0.19) than the other age groups and edentulous sextants were the highest among the oldest age group (1.89). CONCLUSION: A very small portion of the renal dialysis population is affected by severe forms of periodontitis requiring complex periodontal treatment. However, all such patients should be given oral hygiene education as a priority.