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.     

The Effects of Pelvic Floor Muscle Training and Behavioral Training on Sexual Dysfunction,Incontinence, Physical Activity Level and Quality of Life in the Elderly

Sexuality and Disability - Alterations in hormonal balance, especially with ageing, cause many pelvic floor problems such as urinary incontinence, lack of interest in or desire for sex and...     

Medical treatment of vulvar squamous cell hyperplasia.

OBJECTIVE: To evaluate symptomatic response and recurrence rates of graduated topical fluorinated corticosteroid in patients with vulvar squamous cell hyperplasia. METHODS: Nine hundred seventy-six patients with biopsy-proven vulvar squamous cell hyperplasia from 1990 to 2003 were reviewed in this retrospective study. All patients were treated with graduated topical fluorinated corticosteroid. Data were obtained from hospital records. Symptomatic remission and recurrence rates were noted following six months local therapy. RESULTS: The mean age was 42.55+/-10.93 (15-85). The remission rate was 93.8% in six months. The remission rate was non-significantly higher in postmenopausal patients than that in their premenopausal counterpart (94.9% vs 93.0%, p=0.15). The disease recurred in 6.9% of patients. Of the patients that suffered recurrence 47.5% had persistent disease initially. The patients with following factors older ages (>40 years), postmenopausal period had significantly higher recurrence rates. Four patients with recurrent disease and six patients with persistent disease in the form of vulvar intraepithelial neoplasia I-II or atypical squamous hyperplasia, were treated with skinning vulvectomy. CONCLUSION: Corticosteroid in the treatment of vulvar squamous cell hyperplasia yielded excellent response rates. In the evaluation of patients without symptomatic relief, the first step should be a vulvar biopsy to exclude the presence of atypical components.     

Treatment in patients with low traumatic pneumothorax ratio

Thoracostomy tube placement (TT) is currently one of the most important treatment modalities used in traumatic pneumothorax patients. In patients with low pneumothorax ratio (percentage), both follow-up without surgery and employing intervention when indicated may be appropriate choice. We presented the outcome of patients with low traumatic pneumothorax ratio treated by follow up without surgical intervention in our clinic. During the period from January 2000 until January 2002, 108 patients who were treated and followed with low percentage traumatic pneumothorax in Ankara Numune Hospital Thoracic Surgery Clinic were allocated into three groups due to blunt trauma of the thorax, penetrating-cutting instrument injury and gunshot injury. All patients were admitted to the clinic with the purpose of observation without surgical intervention and chest roentgenograms were taken at the sixth and twelfth hours and daily thereafter. TT was performed for 46 (43%) patients whose pneumothorax ratio increased during the observation period. TT was more frequent in patients with 20% percentage pneumothorax (69%) as well as with two or more fractured ribs (69%). Follow-up without surgical intervention may one of the appropriate modes of treatment in patients who have minimal traumatic pneumothorax.     

Pseudoaneurysms of the popliteal and tibioperoneal arteries after gunshot injuries

BACKGROUND: Pseudoaneurysms (PsAns) of the popliteal and tibioperoneal arteries are very rare and occur as a late complication after arterial injury. This study was undertaken to describe the management of PsAns of the popliteal and tibioperoneal arteries after gunshot injuries in a civilian vascular surgical unit with a large trauma workload. METHODS: A retrospective review of the records of nine patients treated between January 1998 and November 2001 at the Thoracic and Cardiovascular Surgery Department of Numune Education and Research Hospital was undertaken. RESULTS: Nine PsAns of the popliteal and tibioperoneal arteries after gunshot injuries were treated. The delay in diagnosis from the time of injury ranged from 15 days to 14 months, with a median delay of 75 days. One case with graft occlusion was noticed in a patient with a popliteal artery PsAn. In these cases, the early and late patency rate and limb salvage were 100%. CONCLUSION: Early diagnosis of popliteal and tibioperoneal PsAns is an important factor in successful surgical reconstruction. The operative procedures will be simple if the interval between injury and operation is short, and surgical treatment for PsAns includes reconstruction of both arterial and venous arteries.     

The time course of recovery following mild thoracic trauma

PURPOSE: The purpose of this study was to determine when patients are able to return to their normal work or home activities. PATIENTS AND METHODS: Eighty cases, 35 females (44%) and 45 males (56%), presenting to our hospital between the years of 2003 and 2004 were prospectively evaluated. There were no hemopneumothorax or associated injury. The patients were randomized into two groups with respect to treatment modalities as the following: non-steroid anti-inflammatory (NSAIDs) and Tramadol treatment groups. In the follow-up, visual analog scale (VAS), and vital capacity were conducted on the days 0, 2, 7 and 30 and 6 months. The results were statistically analyzed. RESULTS: The mean age of the group receiving NSAIDs was 55.42 +/- 15.72, and for the group receiving tramadol treatment, it was 55.67 +/- 17.23. VAS result was 7.8 +/- 1.8 in those receiving NSAIDs treatment, while it was 8.2 +/- 1.6 in the other group. The vital capacity was 235.54 +/- 82 ml for the former group, and 232.43 +/- 89.44 for the latter. In their follow-up, particularly by the 7th day, significant improvement of VAS and vital capacity were observed (p < 0.01). Maximum improvement was achieved on the 30th day (p < 0.001). There was no change in the 6th month. CONCLUSION: Patients are able to return to their normal work or home activities after 7 days. Patients experienced steadily decreasing pain and improved vital capacity at each time point after injury. No difference in response was seen between the two medications. A significant improvement is observed by the 7th day after the trauma (p < 0.01). Optimal improvement was achieved on the 30th day (p < 0.001).     

A new and safe technique for removing cervical esophageal foreign body.

Despite the recent advances in instrumentation and anesthesia, removal of esophageal foreign bodies remains a challenge. Endoscopic removal of foreign bodies has yielded a success rate of 80%. Surgical removal of these foreign bodies is necessary when the endoscopic manipulations fail. Localization and size of the bodies play a critical role in the method of treatment. Here we present a patient with a large stone with sharp edges located in the cervico-thoracic region which was removed after being pushed into the hypopharynx through the esophagus rather than being pushed into the stomach. The technique used proved to be effective and safe; this may be the first use of the procedure in the literature.     

Transaxillary approach in thoracic outlet syndrome: the importance of resection of the first-rib.

OBJECTIVE: The aim of this study was to analyze the transaxillary surgical approach and results of thoracic outlet cases in our clinic in the light of the recent literature data. METHODS: Between 1996 and 2002 a series of 35 cases diagnosed as thoracic outlet syndrome (TOS) hospitalized and surgically treated in our clinic have been studied retrospectively. RESULTS: Twenty-six of our cases were females (75%) and the mean age was 25+/-1 (17-40 years). The most important symptom was localized pain in the arm. In 90% of the cases the Adson, hyperabduction and abduction external rotation (AER) tests were positive. There was paresthesia in 30 cases (85%), atrophy in 3 cases (10%), and cyanosis in 6 cases (20%). Preoperative electromyogram (EMG) was demonstrated as 56.7 m/s (50-65) and postoperative EMG was demonstrated as 65.1 m/s (60-71). Postoperative EMG values were significantly higher than the preoperative EMG values (p<0.001). All patients were operated using the transaxillary approach. A total number of 40 operations were performed. Upon radiological investigation (n=17) 50% of the patients were found to have cervical ribs. In 30 cases (85%) the results were very good and in four cases (12%) good, and in one case (3%) the results were bad. There was no recurrence and reoperation in the long term follow-up. CONCLUSION: Careful patient history and physical examination should be done by a team, which consists of thoracic surgeon, physical therapy specialist, and a neurologist. Total resection of the first-rib with periosteally should be preferred in all of these cases with accompanying pathologies such as cervical rib, fibrous ligaments, and scalenius muscles. The transaxillary approach has provided a good exposure for the resection of cervical ribs, the first-rib and excision of fibrous ligaments and scalenius muscle by a perfect cosmetic result. All the patients should be encouraged for 2 months of physical exercises starting from early postoperative period.     

Ultrastructural changes in tracheobronchial epithelia following experimental traumatic brain injury in rats: Protective effect of erythropoietin

BACKGROUND: We aimed to demonstrate the time dependent ultrastructural changes in tracheobronchial epithelia after traumatic brain injury. And also, protective effect of erythropoietin was demonstrated. METHODS: We used 56 Wistar-Albino female rats weighing 170 to 200 g. The rats were allocated into 7 groups. First group was the control. The second underwent craniotomy without trauma. The third, fourth, and fifth groups were respectively 2-, 8-, and 24-hour trauma groups. The sixth and seventh groups were respectively treatment (erythropoietin, 1,000 IU/kg) and vehicle (0, 4 ml/rat) groups. Weight-drop method was used for achieving head trauma. Samples were obtained from both trachea and main bronchi. Modified electron microscopic scoring model was used to reveal the ultrastructural changes in both trauma and treatment groups. RESULTS: There was no statistical difference between control and sham groups (p >0.05). Scores of all trauma groups were significantly different from the controls (p <0.05). Trauma produced obvious gradual damage on ultrastructure of the tracheobronchial epithelia. Erythropoietin decreased tracheobronchial scores after traumatic brain injury in significant levels. Erythropoietin attenuated ultrastructural scores for each organelle in significant levels (p <0.05 for each organelle). CONCLUSIONS: The data suggested that ultrastructural damage is obvious at 2 hours deteriorating with time. Erythropoietin protects epithelia against damage after traumatic brain injury. Pharmaceutical lung preservation may help gaining efficacious donor lungs in brain death. But, further time dependent experiments are needed to determine the liability of the donor lung after traumatic brain injury. This fact is to be known for achieving higher graft survival rates.     

Immunolocalization of cell cycle proteins (p57, p27, cyclin D3, PCNA and Ki67) in intrauterine growth retardation (IUGR) and normal human term placentas

Placental development involves a series of events that depend on the coordinated action of proliferation, differentiation and invasion of trophoblasts. Studies on cell cycle related proteins controlling these events are fairly limited. It is still not fully determined how placental tissue proliferation is affected by intrauterine growth retardation (IUGR). Information on cell cycle related proteins that control these events is limited and how they are affected in IUGR is not fully understood. The aim of this study was to understand the role of cell cycle regulators in IUGR placentas and to determine the spatio-temporal immunolocalization of these cell cycle regulators in human IUGR and normal term placentas. Placental samples were stained immunohistochemically with PCNA, Ki67, cyclin D3, p27 and p57 antibodies and were examined by light microscopy. In all regions of IUGR placentas, PCNA, Ki67 and cyclin D3 staining intensities were statistically significantly decreased compared to normal controls. p27 staining intensity of the IUGR group was statistically significantly increased in villous parts and chorionic plates in comparison with the normal term placentas. Moreover, p57 staining intensity was statistically significantly increased in all parts of the IUGR group compared to controls. The observed placental abnormalities in IUGR placentas may be associated with arrest mechanisms affecting cell proliferation and cell cycle alterations in IUGR.