Spigelian hernias: a prospective analysis of baseline parameters and surgical outcome of 34 consecutive patients

Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective multicenter study, we aimed to outline the specific features of spigelian hernias and patients’ characteristics more clearly. Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34 patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications and is very well tolerated by the patient.     

P wave dispersion is prolonged in patients with Wilson＇s disease

AIM： To investigate the P wave dispersion as a noninvasive marker of intra-atrial conduction disturbances in patients with Wilson＇s disease.
METHODS： We compared Wilson＇s disease patients （n = 18） with age matched healthy subjects （n = 15） as controls. The diagnosis was based on clinical symptoms, laboratory tests （ceruloplasmin, urinary and hepatic copper concentrations）. P wave dispersion, a measurement of the heterogeneity of atrial depolarization, was measured as the difference between the duration of the longest and the shortest P-waves in 12 lead electrocardiography.
RESULTS： All the patients were asymptomatic on cardiological examination and have sinusal rhythm in electrocardiography. Left ventricular and left atrial diameters, left ventricular ejection fraction and left ventricular mass index were similar in both groups. The Wilson＇s disease patients had a significantly higher P wave dispersion compared with the controls （44.7 ± 5.8 vs 25.7 ± 2.5, P 〈 0.01）.
CONCLUSION： There was an increase in P wave dispersion in cardiologically asymptomatic Wilson＇s disease patients which probably represents an early stage of cardiac involvement.     

Effects of Rosiglitazone on Cardiac Function in CAPD Patients: A Tissue Doppler Study

Background. Insulin resistance was an independent predictor of cardiovascular mortality in uremic patients without diabetes. Rosiglitazone (ROS) improves insulin sensitivity in the liver, muscle, and adipose tissue. We prospectively investigated the effects of ROS on cardiac functions by standard (SDE) and tissue Doppler echocardiography (TDI) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods. A total of 24 CAPD patients (13 males, 11 females; mean age 42.2 ± 14.8 years) were included. Routine blood samples were examined. Left and right ventricular functions were assessed, and myocardial performance index (MPI) was calculated by SDE and TDI at baseline and after 12-month ROS therapy. Left and right atrial volumes were measured and indexed to body surface area. Results. When compared with baseline, after 12 months of ROS treatment, it was shown that early (E) and late (A) diastolic velocities of atrioventricular valves, E/A ratio, mitral E-wave deceleration time (DT), isovolumetric relaxation time (IVRT), and MPI were similar (p > 0.05). Also, no significant changes were detected in LV dimensions, LV mass index, LVEF, LA volume index, or RA volume index measured by SDE before and after ROS therapy (p > 0.05). Left and right ventricular function parameters measured by TDI including Sm, Em, Am, Em/Am ratio, E/Em ratio, and MPI were similar. Conclusion. It was found that there was no negative effect of long-term ROS therapy on cardiac functions measured by SDE and TDI in CAPD patients.     

Clinical and angiographic features of large left main coronary artery aneurysms

Coronary artery aneurysms are defined as coronary dilatations which exceed the diameter of normal adjacent segments by 1.5 times. Left main coronary artery (LMCA) is the least frequently involved artery with a prevalence of 0.1%. Majority of coronary artery aneurysms are atherosclerotic in origin. Their size and clinical presentation is variable. A number of complications have been reported to occur during the course of the disease including thrombosis and distal embolization, myocardial ischemia and/or infarction, dissection, vasospasm, calcification, fistulization and very rarely rupture. Large aneurysms of LMCA represent a potentially fatal condition even without concomitant atherosclerotic coronary disease. Because of rarity of coronary artery aneurysms, it is difficult to standardize treatment. In this article, we presented 4 cases of large LMCA aneurysms with various clinical and angiographic features.     

Combined effects of niacin and chromium treatment on heart of hyperlipidemic rats

The present study was undertaken to investigate the effects of the combination of niacin and chromium(III)-chloride on heart glutathione (GSH), lipid peroxidation (LPO) levels, serum paraoxonase (PON), gamma-glutamyl transferase (GGT) activities and protein carbonyl contents (PCC) of hyperlipidemic rats. In this study, female Swiss albino rats were used. They were divided into four groups. The animals of the first group (group I) were fed with pellet chow. The rats (group II) were fed with a lipogenic diet consisting of 2% cholesterol, 0.5% cholic acid and 20% sunflower oil added to the pellet chow, and given 3% alcoholic water for 60 days. The rats (group III) were fed with the same lipogenic diet and treated by gavage technique with CrCl(3) 6H(2)O to a dose of 250 μg/kg and 100 mg/kg niacin for 45 days, 15 days after experimental animals were done hyperlipidemic. Group IV was fed with pellet chow and treated with 250 μg/kg CrCl(3) 6H(2)O and 100 mg/kg niacin for 45 days. On the 60th day, the heart tissue and blood samples were taken from animals. As a result, heart LPO, serum GGT activity and serum PCC were increased; serum PON activity and heart GSH levels were decreased in hyperlipidemic rats. Treatment with combined niacin and chromium reversed these effects. In conclusion, the combined treatment with niacin and chromium might induce a protective effect on heart tissue.     

A case of asymptomatic cardiopericardial hydatid cyst

Cases with cardiac hydatid cyst disease are uncommon, being approximately 0.2-2% of all cases. Most cardiac hydatid cysts are located in the interventricular septum or left ventricular wall. Pericardial location is very rare. We report a 42-year old Turkish man with pericardial hydatid cyst disease who was otherwise asymptomatic, having no cardiac symptomatology. The most appropriate therapeutical option for a hydatid cyst is surgical removal of the cyst mass. However, our patient refused surgical treatment and thus medical treatment with albendazole was initiated. Following the first month of the drug therapy, pericardial effusion disappeared. The cystic nature of the mass disappeared and was solidified at the 6th month of treatment. The patient has been followed-up by us asymptomatically.     

Is mannitol effective against platelet-activating factor (PAF)-induced liver damage in obstructive jaundice?

BACKGROUND/AIMS: Platelet-activating factor, is a unique phospholipid with a broad range of biological activities that may be relevant in the development of inflammatory reactions. Platelet-activating factor has been suspected to play an important role in liver pathophysiology. The cultured Kupffer and endothelial cells produce and release platelet-activating factor in order to facilitate communication between hepatic sinusoidal and parenchymal cells. In this study, in the experimental jaundice model, platelet-activating factor levels were measured in liver tissue and plasma and the possible effects of mannitol on this mediator were assessed. METHODOLOGY: The experimental model consisted of 7 rats in the control group (CG), 7 rats in the sham operation group (ShG), and 7 rats in the obstructive jaundice group (JG) created by ligating the common bile duct. The last group was the mannitol-treated jaundiced group (MJG) and all animals in this group received 20% mannitol in doses of 2 mL/day, intraperitoneally, following common bile duct ligation. A week later all animals were sacrificed and plasma and liver tissue samples were collected. Platelet-activating factor levels were measured by radioimmunoassay technique. RESULTS: Liver tissue platelet activating factor levels (pg/mg tissue protein) were 72 +/- 18 in the CG, 183 +/- 51 in the JG, 84 +/- 17 in ShG, and 124 +/- 36 in MJG. Plasma levels were 460 +/- 13, 1600 +/- 40, 560 +/- 19, and 1200 +/- 23, respectively. In both sample types, MJG and JG values were significantly different from CG and ShG as well. MJG levels were also different from JG. CONCLUSIONS: These results showed that plasma and liver tissue platelet-activating factor levels are increased in experimental obstructive jaundice; and activation of this mediator contributes to the ongoing liver injury. Mannitol may improve or lessen this damage.     

QT dispersion and transmural dispersion of repolarization in patients with familial Mediterranean fever

Familial Mediterranean fever (FMF) is a disease characterized by sporadic, paroxysmal attacks of fever and serosal inflammation. QT dispersion (QTd) and transmural dispersion of repolarization (TDR), simple noninvasive arrhythmogenic markers, that can be used to assess homogeneity of cardiac repolarization, have not been studied in FMF patients before. The aim of our study was to evaluate the QTd and TDR in FMF patients without overt cardiac involvement. A total of 50 patients with FMF (30 men, 20 women, 29.4 ± 11.8 years) and 50 controls (30 men, 20 women; mean age 31.3 ± 11.9 years) were included. QTd, corrected QTd (cQTd), maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT (QTmin), and minimum corrected QT intervals (cQTmin) and TDR were measured from standard 12-lead electrocardiography (ECG). We found that QTd, QTmax, and TDR were greater in FMF patients than in the control group (36.0 ± 11.4 vs. 20 ± 11.2, P < 0.001 and 354.8 ± 30.9 vs. 342.8 ± 18.0, P = 0.02; 62.0 ± 16.0 vs. 49.0 ± 9.5 P < 0.001, respectively), as were cQTd and cQTmax (40.4 ± 13.5 vs. 21.9 ± 12.4, P < 0.001 and 397.7 ± 40.2 vs. 375.5 ± 25.4 P = 0.001). A modest positive correlation was found between cQTd and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (r = 0.30, P < 0.001; r = 0.40, P < 0.001; respectively). QTd, which is an index of inhomogeneity of ventricular repolarization and an important predictor of cardiovascular mortality, and TDR, which is a better marker of cardiac repolarization, increased in FMF patients similarly as in other rheumatologic diseases.     

Prognostic significance of matrix metalloproteinase-2, cathepsin D, and tenascin-C expression in colorectal carcinoma

Matrix metalloproteinase-2 (MMP-2) and cathepsin D (CD) play a significant role in degrading the components of basement membrane and extracellular matrix (ECM), whereas tenascin-C (TN-C) is a glycoprotein of the ECM related to cell adhesion and detachment. These proteins have been implicated in tumor invasion and metastasis. Therefore, we aimed at investigating the prognostic significance of MMP-2, CD, and TN-C expressions in primary colorectal cancer. Overall, 112 colorectal adenocarcinomas were included in the present study. MMP-2, CD, and TN-C expressions were evaluated by immunohistochemistry and correlated with clinicopathologic prognostic parameters and survival. Diffuse stromal TN-C immunostaining was found to be significantly correlated with advanced stage and shorter survival time (p = 0.002 and 0.02, respectively). MMP-2 expression was found to correlate with lymph vessel invasion (p = 0.006) and stage (p = 0.03). CD expression was related to depth of invasion (p = 0.005). No significant relationship was found between survival and MMP-2 and CD expression (p > 0.05). In multivariate analysis, stage and vascular invasion were independent prognostic factors, whereas TN-C did not retain a clear independent relationship to survival (p > 0.05). Our findings suggest that TN-C expression may be a potential prognostic marker in colorectal carcinoma. However, MMP-2 and CD do not appear to be significant indicators of survival.