Intestinal effects of iron deficiency anemia in children.

A group of 11 children with iron deficiency anemia were studied with respect to intestinal structure and function. In six cases there were histological abnormalities of intestinal mucosa in varying degrees consisting of villous damage, increased activity in the crypts, increased lymphoplasmocytic infiltration and changes in the surface epithelium. Ultrastructurally, microvilli lesions, mitochondrial changes and an increase in lysosomes were observed. Relative malabsorption of iron and d-xylose malabsorption were present in a minority of patients. Functional and structural changes were correlated. Our results suggest that these changes are due to impairment of cell metabolism.     

Chromosome 22q11.2 deletion and phenotypic features in 30 patients with conotruncal heart defects

This report describes the dysmorphic features and frequency of 22q11.2 deletion (del22q11) in 30 Turkish patients with conotruncal heart defects (CTHDs). Fluorescence in situ hybridization (FISH) analysis revealed deletions in the 22q11.2 region in nine (30%) individuals. The CTHDs in this group were tetralogy of Fallot (four cases), double-outlet right ventricle (DORV) (two cases), transposition of great arteries (two cases), and ventricular septal defect (VSD) associated with other CTHDs (one case). The frequency of del22q11 in the study group was relatively high because many of the patients with dysmorphic findings also had cardiac anomalies involving the pulmonary artery, ductus arteriosus, or the aortic arch and its main branches. Twenty of the 30 patients exhibited several dysmorphic findings. Two of the nine patients with del22q11 exhibited no apparent dysmorphic features other than sacral dimple. Interestingly, one of the patients with del22q11 had a phenotypic appearance similar to that seen in oculo-auriculo-vertebral spectrum (OAVS). This individual had left microtia, atresia of the external meatus, mandibular asymmetry, and peripheral facial nerve paralysis. His mental development was normal and there were no abnormalities on ophthalmological examination. The CTHDs in this patient were situs inversus dextrocardia, DORV, pulmonary stenosis, and VSD. Radiographs of this patient showed platybasia, complete fusion of C2-C3, and posterior fusion of the T1-T2 vertebrae. This particular case indicates that the phenotypic features of del22q11 and OAVS may overlap.     

Kinetics of antagonism at histamine-H1 receptors in isolated rabbit arteries

Summary Kinetics of antagonist-induced decrease of histamine-H₁ receptor-mediated steady-state responses in isolated rabbit arteries were studied in the presence of histamine-H₂ receptor antagonist famotidine. Data were fitted using a model which describes competition kinetics at the receptor level. Estimated rate and equilibrium constants were evaluated for their dependence on tissue, agonist and antagonist concentrations, using (+)-brompheniramine as antagonist. In large arteries (thoracic and arcus aorta), rate constants were observed to be modified by agonist and/or antagonist concentrations, suggesting a diffusion-controlled process. In relatively small (common carotid and iliac) arteries, estimated equilibrium constants (and consequently the rate constants) were found to diverge despite the invariance of equilibration times between arteries, leading us to include the effects of spare receptors in our evaluation. A model describing the effects of receptor reserve on the estimated equilibrium dissociation constant was developed and stimulated and the results then compared with those that had been experimentally estimated. The reserve hypothesis was experimentally verified in common iliac artery (where EC₅₀ K _A) using the irreversible antagonist phenoxybenzamine. A rationalized rule for the optimization of experimental design for in-vitro disequilibrium-competition experiments was proposed. Common carotic artery was found to be favorable for the present design in view of its reserve properties. In addition, competition reaction seems to be the rate-determining step in this artery. Rate and equilibrium constants of mepyramine, (+)-brompheniramine, diphenhydramine and antazoline were therefore determined in the common carotid artery and were compared with those obtained from independent experiments. Results suggest that the estimated parameters reflect drug-receptor interaction.This work constitutes a part of the PhD thesis of H. O. Onaran Send offprint requests to T. A. Bökesoy at the above address     

Evaluation of research ethics committees in Turkey

In Turkey, there was no legal regulation of research on human beings until 1993. In that year "the amendment relating to drug researches" was issued. The main objectives of the regulation are to establish a central ethics committee and local ethics committees, and to provide administrative control. There are no compulsory clinical ethics lectures in the medical curriculum, so it is also proposed that research ethics committees (RECs) play a central educational role by helping physicians to be aware of moral problems and by contributing to the training of research teams.     

The experience of the research ethics committees in Turkey

In this article the experience of the research ethics committees in Turkey, which are nearly ten years old, is introduced. Although the legislation related to Research on Human Beings by using Drugs and Chemical Substances, issued on 29th January 1993 by the Ministry of Health, there are a lot of problems about RECs, for example the central ethics committee has no medical ethicist as a member, and there is no ethical concept other than "consent" in their operational procedures. Membership characteristics of the ECs, and their specialty areas described functions of the ECs, the forms used, and the major items used for the evaluation of the proposals are explained. Finally the ethics committee of the Turkish Medical Association is also introduced as another model of ECs in Turkey.     

Lingual angioedema after alteplase treatment in a patient with acute ischemic stroke

BACKGROUND: In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare but potentially life-threatening complication of alteplase treatment. Only a few studies have examined the incidence of angioedema after treatment with alteplase for stroke.METHODS: A 75-year-old man complaining of right hemiparesis was admitted to our emergency department. He was diagnosed as having acute ischemic stroke, and alteplase infusion was given two hours after the onset of stroke symptoms. Immediately after the completion of infusion he was noted to have a large swollen tongue.RESULTS: His neurological symptoms resolved gradually within 4 hours, whereas his upper extremity strength improved to 4/5 and lower extremity 5/5. Lingual edema resolved within 16 hours without any complication. He died from presumed nosocomial infection 5 days later.CONCLUSIONS: Lingual angioedema may appear as a possible complication in patients who were treated with alteplase. The management of these patients should be very careful.     

Robot-Assisted Radical Prostatectomy After Previous Prostate Surgery

Background and Objectives:

Our objective is to clarify the effect of previous transurethral resection of the prostate (TURP) or open prostatectomy (OP) on surgical, oncological, and functional outcomes after robot-assisted radical prostatectomy (RARP).

Methods:

Between August 1, 2009, and March 31, 2013, 380 patients underwent RARP. Of these, 25 patients had undergone surgery for primary bladder outlet obstruction (TURP, 20 patients; OP, 5 patents) (group 1). A match-paired analysis was performed to identify 36 patients without a history of prostate surgery with equivalent clinicopathologic characteristics to serve as a control group (group 2). Patients followed up for 12 months were assessed.

Results:

Both groups were similar with respect to preoperative characteristics, as mean age, body mass index, median prostate-specific antigen, prostate volume, clinical stage, the biopsy Gleason score, D''Amico risk, the American Society of Anesthesiologists (ASA) classification score, the International Prostate Symptom Score, continence, and potency status. RARP resulted in longer console and anastomotic time, as well as higher blood loss compared with surgery-naive patients. We noted a greater rate of urinary leakage (pelvic drainage, >4 d) in group 1 (12% vs 2,8%). The anastomotic stricture rate was significantly higher in group 1 (16% vs 2.8%). No difference was found in the pathologic stage, positive surgical margin, and nerve-sparing procedure between the groups. Biochemical recurrence was observed in 12% (group 1) and 11.1% (group 2) of patients, respectively. No significant difference was found in the continence and potency rates.

Conclusions:

RARP after TURP or OP is a challenging but oncologically promising procedure with a longer console and anastomosis time, as well as higher blood loss and higher anastomotic stricture rate.     

Autoimmune Polyglandular Syndrome Type 3c with Ectodermal Dysplasia,Immune Deficiency and Hemolytic-Uremic Syndrome

Autoimmune polyglandular syndrome (APS) is a disorder which is associated with multiple endocrine gland insufficiency and also with non-endocrine manifestations. The pathophysiology of APS is poorly understood, but the hallmark evidence of APS is development of autoantibodies against multiple endocrine and non-endocrine organs. These autoantibodies are responsible for the dysfunction of the affected organs and sometimes may also cause non-endocrine organ dysfunction. The hemolytic-uremic syndrome (HUS) is a serious and life-threatening disease which develops due to many etiological factors including autoimmune disorders. Here, we present an unusual case of APS. Ectodermal dysplasia with immune deficiency and HUS occurred concomitantly in the same patient with APS type 3c. Once the autoantibody generation was initiated in the human body, development of multiple disorders due to organ dysfunction and also autoantibody-related diseases may have occurred.