Ultrastructural changes in pneumocyte type II cells following traumatic brain injury in rats.

OBJECTIVE: We aimed to demonstrate the time-dependent ultrastructural changes in pneumocyte type II cells following brain injury, and to propose an electron microscopic scoring model for the damage. METHODS: Forty Wistar-Albino female rats weighing 170-200 g were used. The rats were allocated into five groups. The first group was the control and the second was the craniotomy without trauma. The others were trauma groups. Weight-drop method was used for achieving head trauma. Samples were obtained from the right and left pulmonary lobes at 2-, 8-, and 24-h intervals after transcardiac perfusion. An electron microscopic scoring model was used to reveal the changes. RESULTS: There were no ultrastructural pathological findings pointing to lung injury in any rat of the control groups. There was intense intracellular oedema in type II pneumocyte and interstitial oedema in the adjacent tissue in trauma groups. Oedema in mitochondria and dilatation in both smooth endoplasmic reticulum and Golgi apparatus was more evident in the 8- and 24-h trauma groups. The chromatin dispersion was disintegrated in the nucleus in all trauma groups. Scores of all trauma groups were significantly different from the controls (P<0.05). All trauma groups were different from each other at significant levels (P<0.05 for each trauma groups). CONCLUSIONS: The data suggested that ultrastructural damage is obvious at 2 h and deteriorates with time. The electron microscopic scoring model worked well in depicting the traumatic changes, which were supported by lipid peroxidation. Further experiments are needed to determine the exact outcome after brain death model.     

Serum lipid levels in psoriasis

A predisposition to occlusive vascular diseases has been reported in patients with psoriasis and it has been suggested that some of these patients have some disorders of lipid metabolism. In this study, serum lipid levels were investigated in psoriatic patients to explore to the knowledge of this relationship. One hundred psoriatic patients and 100 non- psoriatic controls were included in the study. Total cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-cholesterol), low-density lipoprotein-cholesterol (LDL-cholesterol), and very low-density lipoprotein-cholesterol (VLDL-cholesterol) levels were measured. In patients with psoriasis, total cholesterol and LDL-cholesterol levels were found to be significantly higher than those of controls. No significant differences were found in the other parameters. We concluded that psoriatic patients should be evaluated and followed up for the risk of hyperlipidemia and obstructive vascular diseases.     

Phenotypic variability of triphalangeal thumb-polysyndactyly syndrome linked to chromosome 7q36

Triphalangeal thumb-polysyndactyly (TPT-PS) is an isolated limb malformation consisting of pre- and postaxial polysyndactyly of hands and feet. The only family reported so far is of Dutch origin, and the genetic mapping study localized the TPT-PS locus at chromosome region 7q36 where the isolated triphalangeal thumb (TPT) anomaly has also been mapped. It was suggested that TPT-PS is a phenotypic variation of isolated TPT, and the same ancestral mutation may produce both phenotypes. Here we report on the second family with this malformation from the Turkish population. The characteristic findings in this family are triphalangeal thumb, webbing between 3rd, 4th, and 5th fingers associated with bony synostosis in the distal phalanges of the same fingers, and pre- and postaxial polysyndactyly of feet. Some individuals show a more severe phenotype with a complete syndactyly of all fingers giving a "cup-like" appearance to the hands. Genetic linkage study with DNA markers D7S1823, D7S550, D7S559, and D7S2423 demonstrated that this family is also linked to chromosome band 7q36. Identification of a second family from a distinct ethnic background suggests that TPT-PS and isolated TPT are not caused by the same ancestral mutation as it was originally anticipated.     

Perianal infections: Reader agreement and diagnostic performance of fat‐suppressed contrast‐enhanced MRI

We aimed to determine the diagnostic performance of the contrast‐enhanced fat‐suppression technique in the detectability of perianal infections and to compare this technique with different MR sequences used for this purpose. Thirty consecutive patients with clinically suspected anorectal infections were examined with fast spin‐echo (FSE) T2‐weighted, short‐inversion‐time inversion recovery (STIR), and fat‐suppressed and non‐fat‐suppressed T1‐weighted spoiled gradient‐echo (SGE) (in‐phase) dynamic contrast‐enhanced sequences. The results of MRI were correlated with the findings of surgery, which was considered as the standard of reference. Receiver‐operating‐characteristic curves were reconstructed to describe and compare the diagnostic value of each MR technique. The values of kappa were used as a measure of observer reliability. Diagnostic performances of STIR, FSE T2‐weighted and fat‐suppressed and non‐fat‐suppressed, contrast‐enhanced SGE T1‐weighted techniques showed statistically insignificant differences in detection of perianal infections. There was almost perfect interobserver agreement regarding the presence of lesions on each MR technique. Fat‐suppressed, contrast‐enhanced SGE T1‐weighted MRI showed adequate diagnostic performance in the detection of perianal infections. However, its significance is not different from the other MR sequences used for the present study.     

Clinical spectrum of acute abdominal pain in Turkish pediatric patients: A prospective study

Abstract Background : The aim of the present study was to determine the prevalence, associated symptoms, and clinical outcomes of children with acute abdominal pain who had been admitted to an emergency department. Methods : Children aged between 2 and 16 years who presented to the emergency department of Cerrahpa?a Medical School, Istanbul University between July 2001 and August 2002 with acute abdominal pain were enrolled in this study. A questionnaire was completed each patient admitted to our pediatric emergency unit for acute abdominal pain. Data collected included presenting signs and symptoms, the hospital follow up for all children who returned within 10 days, test results, and telephone follow up. Results : The number of children referred to the emergency department was 7442, with 399 (5.4%) of these having acute abdominal pain. The mean age of the study population was 6.9 ± 3.5 years, and 201 of the patients were male. The five most prevalent diagnoses were: (i) upper respiratory tract infection and/or complicated with otitis media or sinusitis (23.7%); (ii) abdominal pain with uncertain etiology (15.4%); (iii) gastroenteritis (15.4%); (iv) constipation (9.4%); and (v) urinary tract infection (8%). The most common associated symptoms were decreased appetite, fever and emesis. Because of follow‐up deficiency the progress of 28 patients was not obtained. Eighty‐two children were referred to the department of pediatric surgery, but only 17 of 82 (20.7%) required surgical intervention (15 of these 17 for appendicitis). Eleven patients returned within 10 days for re‐evaluation, but the initial diagnosis was not changed. The complaints of 57 patients with uncertain etiology were resolved within 2 days. Conclusions : An acute complaint of abdominal pain was usually attributed to a self‐limited disease. However, the percentage of surgical etiology is not negligible.     

The First Identification of Encephalitozoon cuniculi Infection in an Animal Care Worker in Turkey

Background:

As a zoonotic pathogen, Encephalitozoon cuniculi is a cause of serious disease in animals and people. The present study was to evaluate the health status examination of this seropositive animal care worker in our previous study.

Methods:

Blood samples were taken from five workers. CIA test was applied to detect antibodies against E. cuniculi in blood serum. The indirect immunofluorescence antibody test was used as confirmation test. Seropositive worker had a complete medical examination.

Results:

Only one worker was found to be seropositive according to the results of the serological test. Sera positive to E. cuniculi was confirmed with IFAT and spores were detected in the urine sample of the worker. The worker was treated with albendazole.

Conclusion:

Rabbits should be examined routinely for the presence of anti-E. cuniculi antibody. People working with laboratory animal should avoid contact with urine and faeces of infected or pay attention to personal hygiene.     

Chronic noncancer pain management in primary care: family medicine physicians’ risk assessment of opioid misuse

Objective: The majority of patients with chronic noncancer pain (CNCP) are managed in the primary care settings. The primary care family physician (PCFP) generally has limited time, training, or access to resources to effectively evaluate and treat these patients, particularly when there is the added potential liability of prescribing opioids. The aim of this study is to make a favorable change in PCFPs’ knowledge, attitudes, and practices about opioid use in CNCP via education on assessment of the risk of opioid misuse. Materials and methods: The universe of this cross-sectional study comprised 36 family physicians working at Family Health Centers affiliated to Antalya Provincial Directorate of Health who volunteered to participate in the study. Initially, a survey on patients risk assessment was performed in both intervention and control groups; whereas the intervention group received education on assessment of the risk of opioid misuse, the control group did not. The survey was repeated after 6 months and the intervention group underwent a core examination. Data obtained were analyzed with Statistical Package for the Social Sciences 18.0 statistics program. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared. Results: About 61.1% of family physicians reported concern and hesitation in prescribing opioids due to known risks, such as overdose, addiction, dependence, or diversion, and agreed that family physicians should apply risk assessment before opioid use in CNCP. Only 16.6% of PCFP reported that risk assessment is not so necessary, whereas 22.2% of PCFP were undecided. Although 47.2% of the family physicians expressed a willingness to apply risk assessment before starting opioids, the rate of eagerness increased markedly to 77.7% after the education, but the rate of increase in practicing was not statistically significant. Conclusion: Knowledge and competency of the family physicians in managing CNCP were improved as was expected. Although the rate of eagerness about risk assessment of opioid misuse was increased, expected increase in the rate of using risk assessment was not achieved. Further studies are needed to identify the reasons of the difficulties on changing the attitudes and practices of primary care physicians about this subject.     

Recipient splenic artery utilization for arterial re-anastomosis in living donor liver transplantation: single-center experience

Thrombosis of recipient hepatic artery is a life threatening complication for liver transplantation. The etiology of hepatic arterial thrombosis is multi-factorial and can be caused by intimal dissection, poor surgical technique and coagulopathies. The patency of hepatic arterial flow is very important for both graft survival and patient survival. Intraoperative diagnosis of inadequate hepatic arterial flow found with Doppler ultrasonography is essential in order to achieve good results after liver transplantation. Urgent re-anastomosis is necessary when the arterial blood flow is insufficient. We performed 317 living donor liver transplantations from July 2004 to July 2011. We used recipient splenic artery for hepatic artery reconstruction in six patients. These six patients were included in this study. Using the recipient splenic artery is a simple, safe and practical alternative for hepatic artery re-anastomosis in living donor liver transplantations.