Dysembryoplastic neuroepithelial tumor in the left lateral ventricle.

Extracortical location of dysembryoplastic neuroepithelial tumor (DNT) is rare. We present a case of DNT localized in the left lateral ventricle of a 21-year-old female patient. Magnetic resonance imaging of the brain showed a round mass lesion in the floor of the anterior horn of the left lateral ventricle. The lesion was hypointense on T (1)-weighted images and slightly hyperintense on T (2)-weighted images without contrast enhancement. Total removal of the yellowish-white colored soft tumor was performed through a transcallosal approach. Histologically, the tumor was of simple type of DNT that was composed of small oligodendrogliocytes clustered tightly about perivascular spaces with neurons floating in mucoid pools showing an eosinophilic fibrillary matrix in the background. The recognition of DNT with an unusual location in lateral ventricle has therapeutic and prognostic significance since DNT is curable by surgical excision and radiation therapy is of no obvious benefit.     

Effects of cerium nitrate bathing and prompt burn wound excision on IL-6 and TNF-alpha levels in burned rats

The physiopathological events following thermal injury are not limited to the surface effects of heat but are also related to acute inflammatory reactions. Both tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are important mediators of the acute and severe inflammatory reaction in thermal injury. Surgical manipulation of the burn wound is known to prevent excessive release of cytokines. Cerium nitrate--a rare earth element--has been reported to have a protective effect against postburn immunosuppression. The aim of this study was to compare the effects of burn wound debridement and treatment with cerium nitrate bathing on the serum levels of TNF-alpha and IL-6 in rats. Treatment by cerium nitrate bathing prevented the elevation of TNF-alpha levels in the early period after thermal injury. The experimental study showed, as in other studies, that high levels of IL-6 appear to inhibit TNF-alpha elevation. High levels of IL-6 and, as a result, relatively low levels of TNF-alpha in the early period of thermal injury may limit the severity of the inflammatory reaction, which is caused by TNF, the most potent inflammatory cytokine. Since similar levels of IL-6 and TNF-alpha were achieved by both cerium nitrate bathing and burn wound debridement, cerium nitrate may be considered as equivalent to prompt excision of burn eschar.     

Biliary atresia splenic malformation syndrome--is it a result of embryonically midline rotational defects? A case report

The authors present a case of biliary atresia splenic malformation (BASM) syndrome in a 34-week gestational age boy who died shortly after birth. Autopsy results showed polysplenia, short pancreas, extrahepatic biliary atresia, heterotaxy of liver, tracheoesophageal and duodenal atresia, right lung hypoplasia, cardiac defects with tetralogy of Fallot, axial skeletal defects, and minor genitourinary disorders. Additional histopathologic findings were congenital hepatic fibrosis and bronchopulmonary dysplasia. The authors consider that the abnormalities of this case are possibly a unique combination. Midline defects, which are the most notable features of the presented case, may be closely related to pathogenesis of BASM syndrome.     

Inhibition of inducible nitric oxide synthase reduces bacterial translocation in a rat model of acute pancreatitis

INTRODUCTION: Translocation of bacteria from the gut into pancreatic necrosis is an important factor in the development of septic complications and mortality in acute pancreatitis. S-methylisothiourea (SMT) is an inducible nitric oxide synthase inhibitor that has been shown to decrease bacteria] translocation in sepsis and thermal injury. AIM: To investigate whether SMT could affect bacterial translocation in acute necrotizing pancreatitis. METHODOLOGY: Forty-five Sprague-Dawley rats were studied. Acute pancreatitis was induced in Group I and Group II by injection of taurocholate and trypsin into the common biliopancreatic duct. Group III underwent laparotomy with the manipulation (but not cannulation) of the pancreas and received saline injection. Group I rats received normal saline as a placebo, and Group II rats received SMT after surgery for 2 days. At 48 hours, blood was drawn for serum amylase determinations. Bacterial translocation to mesenteric lymph nodes and distant sites (pancreas, liver, and peritoneum) were examined. A point scoring system of histologic features was used to evaluate the severity of pancreatitis. RESULTS: Plasma amylase levels and pancreatic histologic score were significantly reduced in Group II rats given SMT compared with those in Group I rats given saline (p < 0.01, p < 0.05, respectively). All Group I rats had bacterial translocation to mesenteric lymph nodes compared with 7 of 12 rats in Group II (p < 0.05). There was no difference in bacterial translocation to distant organs between the two groups, although rates tended to be lower in Group II compared with Group I (p > 0.05). Bacterial counts in the pancreas were significantly reduced in Group II rats compared with those in Group I rats (p < 0.05). CONCLUSION: Treatment with SMT appears to have ameliorated the course of acute pancreatitis; however, mortality was not affected.     

‘Use of Electrothermal Vessel Sealing with LigaSure™ Device During Laparoscopic Splenectomy’

Purpose: Main causes of conversion to open surgery are uncontrolled bleeding from splenic hilum and capsular injury of spleen during laparoscopic splenectomy (LS). We present the use of LigaSure? in laparoscopic splenectomy for hemostasis.

Material &; Method: Between January 2005 and May 2006, LS was performed in a total of 29 patients (6 male and 23 female) with a mean age of 35.44 ± 13.63. Indications for splenectomy were idiopathic thrombocytopenic purpura (ITP) in 20 patients, thrombotic thrombocytopenic purpura (tTp) in 2, hereditary spherocytosis (HS) in 3, lymphan-gioma in 2, hodgkin lymphoma in 1 and splenic cyst in one patient. LS was performed in the right semilateral position with three 10 mm trocars. LigaSure? was used in dissection and division of splenic ligaments and hilar vascular structures.

Results: Conversion to open surgery was necessary in one patient due to peroperative bleeding. The mean duration of the operation was 71.3 ± 19.8 minutes and the estimated blood loss was 85 ± 23 ml. The diameter and the weight of the spleen were 10.7 ± 2.68 cm and 250 ± 90 g, respectively. There was no mortality. Postoperative complications included pancreatic fistula, trocar site infection and deep venous thrombosis that were encountered in three patients. These were managed without morbidity. The overall complication rate was 10.3% (n = 3). The mean duration of postoperative hospital stay was 2.86 ± 1.59 days.

Conclusion: LigaSure? use in LS had easy application, provided sufficient hemostasis, and shortened the operative time.     

Increased Circulating Copeptin Levels Are Associated with Vaso-Occlusive Crisis and Right Ventricular Dysfunction in Sickle Cell Anemia

ObjectiveVaso-occlusive crisis (VOC) is a common clinical manifestation of sickle cell anemia (SCA) and is associated with increased proinflammatory mediators. Copeptin is the C-terminal part of the prohormone for provasopressin and seems clinically relevant in various clinical conditions. Right ventricular (RV) dysfunction significantly appears in SCA patients due to pulmonary hypertension. This study aimed to investigate the association of copeptin levels in VOC patients and evaluate RV dysfunction.Materials and MethodsA total of 108 patients were enrolled in the study. Twenty-eight SCA patients in steady state (30.2 ± 0.9 years), 25 SCA patients in VOC (36.8 ± 11.8 years), and 55 healthy individuals (31.9 ± 9.4 years) with HbAA genotype were included. Clinical, echocardiographic, and laboratory data were recorded. ELISA was used for the determination of serum levels of copeptin.ResultsVOC patients had significantly higher copeptin level compared both with controls and SCA subjects in steady state (22.6 ± 13.0 vs. 11.3 ± 5.7 pmol/L, 22.6 ± 13.0 vs. 12.4 ± 5.8 pmol/L, p = 0.009 for both). Additionally, the copeptin level was significantly higher in SCA patients with RV dysfunction than those without RV dysfunction (23.2 ± 12.2 vs. 15.3 ± 9.5 pmol/L, p = 0.024). Multiple logistic regression analysis revealed that high-sensitivity C-reactive protein and copeptin levels were found to be associated with VOC.ConclusionThis study showed that copeptin and hs-CRP levels were increased in patients with VOC, and it was found that RV dysfunction was more common in SCA patients with VOC than in the control group. Copeptin can be considered for use as a potential biomarker in predicting VOC crisis in SCA patients and in the early detection of patients with SCA who have the potential to develop RV dysfunction.