Endolaryngeal resection of laryngeal chondrosarcoma

Chondrosarcoma is a rare tumor. In this study, we present a case with laryngeal chondrosarcoma that was treated by an endolaryngeal approach using an operation microscope. The patient remains disease-free to date, with no evidence of new or recurrent disease more than 3 years after the endolaryngeal surgery. The computerized tomography and endoscopic examinations did not reveal any recurrent disease, indicating the success of the endolaryngeal approach.     

Is pneumoperitoneum harmful during intra-abdominal hemorrhage in rats?

BACKGROUND: Laparoscopic surgical interventions are being used in trauma patients for diagnostic and therapeutic purposes, but there are limited studies on this subject. The effect of pneumoperitoneum during intra-abdominal hemorrhage has not been elucidated. The aim of this study was to investigate the hemodynamic, respiratory, and renal effects of pneumoperitoneum in the splenic injury/ hemorrhagic shock model in rats. MATERIAL AND METHODS: In this study, 80 anesthetized Wistar male rats (294.5 +/- 31.2 g) were randomized into 2 main groups: nontraumatized (group A) and traumatized (group B). After initial preparation and monitoring, each group was divided according to the degree of pneumoperitoneum. The nontraumatized subgroups were A1, sham-operated; A2, 4-8 mm Hg; A3, 9-13 mm Hg; and A4, 14-18 mm Hg. The traumatized subgroups were B1, splenic injury without pneumoperitoneum; B2, B3, and B4, splenic injury with pneumoperitoneum at 4-8 mm Hg, 9-13 mm Hg, and 14-18 mm Hg, respectively. Mean arterial pressure, heart rate, and respiratory rate were monitored continuously. Blood samples were obtained for hemoglobin, hematocrit, arterial blood gases, and biochemical analyses. Twenty-four hour urine output was collected. RESULTS: In group B4, pH, pCO2, and HCO3 levels were lower than in all other groups, while pCO2 and base deficit levels were significantly higher (P < 0.05). Both blood and urine analysis results showed that 24-hour urine output and the glomerular filtration rate of groups A4 and B4 were significantly lower (P < 0.05), while urinary osmolarity and fractional sodium excretion levels were significantly higher (P < 0.05). CONCLUSION: High-pressure pneumoperitoneum in splenically traumatized rats amplifies acidosis, decreases urine output, decreases glomerular filtration rate, and increases urinary osmolarity and fractional sodium excretion significantly.     

Nitric oxide synthase inhibitors protect cerebellar Purkinje cells from zinc-induced cell loss in adult rat

Zinc is an important trace element in biological systems; however, excessive extracellular zinc could lead to neuronal cell death following ischemia, seizures, and brain trauma. In this study, we investigated whether the intracortical injection of zinc sulphate (200 μg/kg, i.c.) changes total number of Purkinje cells in the cerebellum and whether different types nitric oxide synthase inhibitors, N-(G)-nitro-L-arginine methyl ester (L-NAME), N(omega)-nitro-L-arginine (L-NNA), aminoguanidine and 7-nitroindazole (7-NI), have protective effects against zinc neurotoxicity in Wistar albino rats. Animals were divided into 6 groups: control, zinc, zinc+L-NAME (100 mg/kg, i.p.), zinc+L-NNA (100 mg/kg, i.p.), zinc+7-NI (100 mg/kg, i.p.) and zinc+aminoguanidine (100 mg/kg, i.p.) groups. Total number of Purkinje cells in the cerebellum was estimated using unbiased stereological technique as 318,947 ± 20,549, 123,483 ± 23,762, 206,537 ± 43,128, 178,135 ± 26,635, 193,148 ± 46,104 and 212,910 ± 26,399 in the control, zinc, zinc+L-NAME, zinc+L-NNA, zinc+7-NI and zinc+aminoguanidine groups, respectively (mean ± SD). The number of Purkinje cells in zinc group was significantly lower than that of the other groups (P<0.001). It was found that the nitric oxide synthase inhibitors have neuroprotective effect against zinc neurotoxicity on Purkinje cells. These data show that the inhibition of the nitric oxide synthase could prevent some of the deleterious effects of zinc on Purkinje cells.     

Relation between aortic knob width and subclinical left ventricular dysfunction in hypertensive patients

Background: The assessment of left ventricular (LV) structure and function is important in the evaluation of hypertensive heart disease, as it provides information on the cardiovascular morbidity and mortality. Aortic knob width (AKW) is a measurement of radiographic structure formed by the foreshortened aortic arch and a portion of the descending aorta. The main aim of this study was to investigate the relation between AKW on the routine chest radiography and subclinical LV dysfunction in hypertensive patients.

Patients and Methods: A total of 144 patients with hypertension admitted to the cardiology outpatients clinic were enrolled consecutively. The patients were divided into two groups according to tissue Doppler-derived myocardial performance index (MPI): subclinical LV dysfunction group (abnormal MPI ≥ 0.5, n = 85) and absence of subclinical LV dysfunction group (normal MPI< 0.5, n = 59).

Results: Patients with subclinical LV dysfunction were older (60 ± 8 vs. 54 ± 8, p = 0.001). Left ventricular mass index (LVMI) (96 ± 27 vs. 74 ± 24, p < 0.001) and prevalence of LV hypertrophy (28 vs. 8%, p = 0.011) were significantly different between two groups. Patients with subclinical LV dysfunction had higher AKW (42 ± 6 vs. 34 ± 5, p < 0.001) compared with patients without subclinical LV dysfunction. There was a significant correlation between MPI and AKW (r = 0.7, p < 0.001). Multiple logistic regression analysis showed that AKW (β = 0.617, p = 0.001) and posterior wall thickness (PWth) (β = 1.189, p = 0.021) were independently associated with subclinical LV dysfunction. Analysis using the Receiver Operating Characteristic (ROC) curve has demonstrated that aortic knob of 37 mm constitutes the cutoff value for the presence of subclinical LV dysfunction with 85.9% sensitivity and 86.4% specificity (The Area under the Curve ± Standard Error (AUC±SE) = 0.916 ± 0.024, p < 0.001).

Conclusion: AKW may provide important predictive information on subclinical LV dysfunction in patients with hypertension.     

Videolaparoscopic treatment of hepatic hydatid cyst

BACKGROUND/AIMS: Unroofing, cystopericystectomy, or cystic evaluation and omentoplasty have been used in videolaparoscopic treatment in hepatic hydatidosis since 1992. Currently it is shown that videolaparoscopic treatment has been carried out successfully in selected cases. METHODOLOGY: Fifteen hepatic hydatid cysts in 12 cases were treated by videolaparoscopic methods. Formerly in the 5 cases, the cysts were aspirated with a needle designed for a 5-mm trocar, leaving a cystic cavity that was tension-free, then scolicidal solution was injected and aspirated. In the last 7 patients an aspirator-grinder apparatus was used. Intraoperative ultrasonography was applied in all patients. RESULTS: All the cysts were treated by drainage and omentoplasty. In one case cystic cavity infection was diagnosed in the 2nd postoperative month (morbidity rate 8.33%). Another patient died due to cerebral hydatid cyst and multiple organ failure after the postoperative first month (mortality rate 8.33%). Operative mortality was not seen. CONCLUSIONS: Videolaparoscopic treatments of hepatic hydatid cysts may be carried out successfully in selected cases.     

Primary coronary angioplasty in patients with ST segment elevation acute myocardial infarction and diabetes

BACKGROUND: Subjects with diabetes constitute 13-25% of patients with ST segment elevation acute myocardial infarction (STEMI). In spite of the introduction of thrombolytic therapy, patients with STEMI and diabetes continue to have worse prognosis than those without diabetes. Primary percutaneous coronary intervention (PCI) has been shown in recent years to be the most effective therapy in patients with STEMI. AIM: To compare the outcome of STEMI patients with or without diabetes who underwent primary PCI. METHODS: The study group consisted of 500 consecutive patients with STEMI. The occurrence of major adverse cardiac events (MACE) which included death, reinfarction or repeated PCI of the target vessel, was analysed peri-operatively and during a six-month follow-up period.Results. Diabetes was diagnosed in 68 (13.6%) patients. The mean time duration from the onset of STEMI symptoms to treatment was similar in patients with or without diabetes (230+/-97 min vs 231+/-139 min, NS). Patients with diabetes were older (61.9+/-8.9 vs 57.9+/-10.8 years, p=0.004), had higher body mass index (29+/-4 vs 27+/-5, p=0.002), more frequent history of coronary artery disease (57.4% vs 37.9%, p=0.002), higher prevalence of arterial hypertension (71.6% vs 56.8%, p=0.02) and more frequently the left anterior descending artery as the infarct-related artery (58.8% vs 42.1%, p=0.01). Immediately after PCI, epicardial and myocardial reperfusion rates were lower in patients with rather than without diabetes (TIMI 3: 84.9% vs 91.3%, p=NS, cTFC: 32+/-26 vs 22+/-16, p<0.0001, and MPG3: 25% vs 41.9% p=0.008). Diabetes increased the risk of MACE during in-hospital period by 2.7 times. The rate of MACE during a six-month follow-up period was almost two times higher in patients with rather than without diabetes (death: 8.8% vs 5.1%, reinfarction: 1.5% vs 1.2%, repeated PCI: 11.8% vs 6.9%). CONCLUSIONS: Primary PCI-achieved epicardial and myocardial reperfusion rate is lower in STEMI patients with rather than without diabetes. The presence of diabetes almost doubles the risk of MACE during a six-month follow-up.     

Transmission of human immunodeficiency virus and hepatitis B virus by blood brotherhood rituals

Blood brother/sisterhood is a ritual that involves the exchange of a small amount of venous blood via the binding of excisions. Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) could be transmitted by this ritual. Two cases infected with HIV and HBV by a blood brotherhood ritual are reported.