The value of liver and spleen ADC measurements in the diagnosis and follow up of hepatic fibrosis in chronic liver disease

AIMS

To evaluate the value of spleen and liver apparent diffusion coefficients (ADC) in chronic liver disease patients, with and without hepatocellular carcinoma (HCC), and to investigate the use of diffusion-weighted imaging (DWI) in the diagnosis and follow-up of hepatic fibrosis.

MATERIALS AND METHODS

This study population comprised 68 chronic liver disease patients (Group 1) and 70 healthy volunteers as controls (Group 2). In Group 1, 40 patients had chronic hepatitis-B, 20 had chronic hepatitis-C, 5 had non-alcoholic steatohepatitis and 3 had alcoholic steatohepatitis. Diagnosis of chronic liver disease was made by percutaneous liver biopsy and the degree of fibrosis (stage) was determined using the METAVIR scoring system. HCC diagnosis was made with a lesion biopsy. The patient group was subdivided based on the degree of fibrosis (F1, F2, F3 and F4) and presence of HCC. After patient and control groups underwent b-value 600 s/mm(2) DWI examination, liver and spleen ADC values were mapped and measured. The ADC values of the patient groups (F1, F2, F3, F4; with HCC, without HCC) were compared with each other and with the control group.

RESULTS

Liver ADC values were lower in Group 1 compared to Group 2 (P<0·001). There was a statistically significant difference between the patient and control groups liver right lobe, left lobe and caudate lobe ADC values (P<0·001). Comparing the F1, F2, F3 and F4 groups, there was no statistically significant difference found in terms of ADC values (P>0·05). However, as degree of fibrosis increased there was a reduction in ADC values, though not statistically significant. Comparing the groups with HCC and without HCC, there was no statistically significant difference in ADC values (P>0·05). There was no statistical difference in average spleen ADC values between patient and control groups (P>0·05).

CONCLUSIONS

In chronic liver disease, ADC values were lower. As the degree of liver fibrosis increased, ADC levels decreased, though the relationship between ADC values and fibrosis degree was not statistically significant. Quantitative DWI may help in the diagnosis of fibrosis in chronic liver disease patients, however as it does not show the degree of fibrosis, its use in treatment planning and follow-up is controversial. Spleen DWI measurement is not a sufficient method to diagnose and determine the degree of fibrosis in chronic liver disease patients.

A decreased serum omentin-1 level may be an independent risk factor for peripheral arterial disease

AIM

Recent evidence suggests that omentin-1, a visceral adipose-derived cytokine, may play a role in atherosclerosis The aim of this study was to evaluate whether serum omentin-1 levels are associated with peripheral artery disease (PAD) and its severity.

METHODS

The present study was cross-sectional and observational. We enrolled 123 patients with PAD and 50 age-matched subjects without PAD. The cardiovascular risk factors, ankle-brachial index (ABI), and serum omentin-1 levels were assessed in all participants

RESULTS

Patients with PAD had significantly lower omentin-1 levels than those without PAD (206. ±48.4 vs. 345. ±80 ng/mL, respectively; 0.001). A correlation analysis revealed positive correlations between the omentin-1 level and the ABI ( 0.52, P=0.008). After adjusting for cardiovascular risk factors, a decreased omentin-1 level was found to be an independent predictor of both PAD and its severity as measured by ABI in multivariate logistic regression analysis.

CONCLUSION

The current study suggests a strong association between decreased serum omentin-1 levels and PAD and its severity. Thus, omentin-1 may be a novel biomarker for PAD.

Acute effects of a resisted dynamic warm-up protocol on jumping performance

This study aimed to investigate the kinematic and kinetic changes when resistance is applied in horizontal and vertical directions, produced by using different percentages of body weight, caused by jumping movements during a dynamic warm-up. The group of subjects consisted of 35 voluntary male athletes (19 basketball and 16 volleyball players; age: 23.4 ± 1.4 years, training experience: 9.6 ± 2.7 years; height: 177.2 ± 5.7 cm, body weight: 69.9 ± 6.9 kg) studying Physical Education, who had a jump training background and who were training for 2 hours, on 4 days in a week. A dynamic warm-up protocol containing seven specific resistance movements with specific resistance corresponding to different percentages of body weight (2%, 4%, 6%, 8%, 10%) was applied randomly on non consecutive days. Effects of different warm-up protocols were assessed by pre-/post- exercise changes in jump height in the countermovement jump (CMJ) and the squat jump (SJ) measured using a force platform and changes in hip and knee joint angles at the end of the eccentric phase measured using a video camera. A significant increase in jump height was observed in the dynamic resistance warm-up conducted with different percentages of body weight (p < 0.05). On the other hand, no significant difference in different percentages of body weight states was observed (p > 0.05). In jump movements before and after the warm-up, while no significant difference between the vertical ground reaction forces applied by athletes was observed (p > 0.05), in some cases of resistance, a significant reduction was observed in hip and knee joint angles (p < 0.05). The dynamic resistance warm-up method was found to cause changes in the kinematics of jumping movements, as well as an increase in jump height values. As a result, dynamic warm-up exercises could be applicable in cases of resistance corresponding to 6-10% of body weight applied in horizontal and vertical directions in order to increase the jump performance acutely.

Giant benign Chondroid Syringoma in the elbow

Chondroid syringoma (CS) is a rarely seen benign tumor rooted in the epithelial and mesenchymal cells of the skin. It is generally localized in the head and neck region and rarely in the extremities. A case is presented here of a giant CS in the rarely seen location of the elbow. A 55-year old male presented at our hospital with the complaint of a slow-growing painless mass in the left elbow. On the left elbow radiograph, mass opacity was observed with a regular border surrounded by a fine radiolucent line within the subcutaneous tissue adjacent to the humerus in the posterior of the elbow. On the contrast elbow MRI mass was observed lobular contours, a regular border and isointensity to muscle in the subcutaneous fat plans. Hypointense linear images were observed in the mass. The lesions demonstrate evident enhancement. An excisional biopsy was performed. A diagnosis of benign CS was made histopathologically. Especially in the differential diagnosis of slow growing cutaneous and subcutaneous nodules in the extremities, CS should feature when fibrous septa are seen on MRI.

Pantoprazole may improve beta cell function and diabetes mellitus

BACKGROUND

Proton pump inhibitors induce hypergastrinemia by suppressing gastric acidity. Gastrin has incretin-like stimulating actions on beta cells. Proton pump inhibitors have been shown to decrease glycosylated hemoglobin.

AIM

We aimed to observe changes in beta cell function in diabetic and non-diabetic subjects given pantoprazole for an acid-related ailment.

METHODS

Seventy-nine male patients (38 non-diabetic and 41 type-2 diabetic receiving only metformin therapy) were followed for 12 weeks after pantoprazole 40 mg/day was given. Fasting plasma glucose, HbA1c, fasting insulin, Pancreatic B cell function (HOMA-B), proinsulin and c-peptide levels were measured before and after the treatment.

RESULTS

In non-diabetic patients (n = 38), FPG decreased, whereas c-peptide, log-HOMA-B, increased significantly (p = 0.002, p = 0.03, p = 0.042, respectively) after 12 weeks of pantoprazole administration. In type 2 diabetic patients, FPG, HbA1c and weight decreased, whereas log-HOMA-B, c-peptide and log-proinsulin levels increased significantly after pantoprazole treatment (p = 0.003, p = 0.007, p < 0.001; p < 0.001; p = 0.017, p = 0.05, respectively). After pantoprazole treatment, pancreatic B-cell function was correlated with c-peptide and insulin and inversely with FBG and HbA1c levels in the whole group (r = 0.37, p = 0.001; r = 0.60, p < 0.001, r = -0.29, p = 0.011 and r = -0.28, p = 0.013, respectively). After pantoprazole treatment, HbA1c was correlated with FBG (r = 0.75, p < 0.001) and inversely with only log-HOMA-B level (r = -0.28, p = 0.013).

CONCLUSIONS

Pantoprazole administration seems to correlate with increased beta cell function. Pantoprazole administration improves HbA1c, HOMA-B, c-peptide and proinsulin levels. Since beta cell loss plays a significant role in the pathogenesis of type 2 diabetes, PPI-based therapies may be useful in the treatment of diabetes.

Maspin expression in endometrial hyperplasia and carcinoma, and its relation with angiogenesis

AIM

The purpose of this study was to evaluate the maspin expression in endometrial hyperplasia and cancer, and also to investigate its relation with angiogenesis.

MATERIALS AND METHODS

A total of 19 women with complex atypical hyperplasia, 44 patients with simple hyperplasia without atypia, and 67 patients with endometrial carcinoma were included. Maspin expression was assessed by immunohistochemistry (IHC), and tested for possible significant relation with age, FIGO stage, histologic type, grade, depth of myometrial invasion (MI), lymphovascular space involvement (LVSI), lymph node metastasis, and overall survival (OS). Angiogenesis was determined by vascular endothelial growth factor (VEGF) staining.

RESULTS

Maspin expression was detected in only three patients with endometrial hyperplasia (5%). In patients with endometrial cancer, cytoplasmic and nuclear maspin expressions were detected in 36 (53.7%) and 18 (26.9%) patients, respectively. No significant relation was noted between staining localizations and prognostic variables. The five-year OS rate for patients with cytoplasmic staining was 91%, compared to 87% for patients without staining (p = 0.31). These values for nuclear expression were 100% and 87%, respectively (p = 0.16). The cytoplasmic and nuclear maspin expressions were found to be significantly correlated with VEGF (r = 0.278, p = 0.02 and r = 0.295, p = 0.01, respectively).

DISCUSSION

This is the first study to demonstrate the relation between maspin expression and angiogenesis in endometrial cancer. Although no survival difference was noted for cytoplasmic or nuclear maspin expressions, a tendency was detected for nuclear staining. Further series will clarify the exact prognostic role of maspin expression in gynecological malignancies including endometrial cancer.

High-resolution birefringence investigation of octylcyanobiphenyl (8CB): an upper bound on the discontinuity at the smectic-A to nematic phase transition

We report optical birefringence data by two different methods with high temperature resolution for octylcyanobiphenyl (8CB) near the smectic-A to nematic (Sm-A-N) phase transition temperature T(AN). Within the resolution of our experiments, we find that the Sm-A-N phase transition is continuous. For a possible discontinuity in the orientational order parameter S(T) at T(AN), we arrive at an upper limit of 0.0002, which is substantially smaller than other estimates in literature, but consistent with the value of 0.00008 derived from the upper limit of the latent heat from high-resolution adiabatic scanning calorimetry (ASC), which is itself consistent with the Halperin-Lubensky-Ma theory. The temperature derivative of the order parameter exhibits a power law divergence with a critical exponent that is consistent with the value α = 0.31 ± 0.03 for the specific heat capacity obtained by ASC.

Examining cerebral metabolic abnormalities in chronic obstructive pulmonary disease (COPD) patients by localized proton magnetic resonance spectroscopy (MRS)

PURPOSE

The study was planned based on the hypothesis that cerebral metabolism is impaired in chronic obstructive pulmonary disease (COPD) by using localized in vivo proton magnetic resonance spectroscopy.

MATERIALS AND METHODS

The study comprised 30 male patients, aged 45-70 years, with moderate level COPD and an aged matched group of 30 healthy males as the control group. Cerebral metabolism was investigated with proton magnetic resonance spectroscopy (MRS) using multivoxel technique. Data normal distribution conformity was evaluated by the One Sample Kolmogorov Smirnov Test and homogeneity by the One-Way ANOVA test. For both the COPD and control group, data were obtained as mean, standard deviations, minimum and maximum values. Independent sample t-test was used for the comparison of means between the two groups.

RESULTS

The frontal and parietal white matter in patients with COPD showed an overall reduction in cerebral metabolites. The NAA (N-acetylaspartate)/Cr (Creatinine), Cho (Choline)/Cr ratios of the cerebral frontal and parietal white matter regions in the COPD group were significantly lower than the control group.

CONCLUSIONS

The findings of this study through the use of MRS confirmed that most patients with symptomatic COPD have cerebral metabolic abnormalities.

Evaluation of estrogenic effects of polychlorinated biphenyls and organochlorinated pesticides using immature rat uterotrophic assay

In this study, we investigated the effects of polychlorinated biphenyls (PCBs) and organochlorinated pesticides on the serum levels of luteinising hormone (LH), follicle stimulating hormone (FSH) and weights and histomorphometry of uterine tissue in immature female rats using uterotrophic assay. A total of 36 rats were randomly divided into six groups ( n = 6 per group) as control, oestradiol (E2, 100 μg/kg), PCB 180, Aroclor 1221, endosulfan and mirex at 10 mg/kg dosage. After 3 days of injections (subcutaneous), animals were decapitated and blood samples were collected. Uteri were dissected, weighed out and then fixed in 10% formaldehyde. They were processed for histomorphometry. The serum levels of LH and FSH were determined by enzyme immunoassay.

Uterine weight was significantly increased by E2 and reduced by mirex ( p < 0.001 and p < 0.05, respectively). Total volume of uterus was significantly raised by E2, Aroclor 1221 and endosulfan compared with that of the control group ( p < 0.01). The ratio of epithelium was significantly increased by E2, PCBs and pesticides ( p < 0.01). The uterine cavity ratio was decreased by aroclor ( p < 0.01), PCB 180 and mirex ( p < 0.05). The serum levels of LH did not significantly differ among the groups but the levels of FSH were decreased by PCB 180 and endosulfan ( p < 0.05 and p < 0.01, respectively). These findings suggest that PCB 180, Aroclor 1221 and endosulfan may be estrogenic in immature uterotrophic assay.

Infective endocarditis and spondylodiscitis due to posterior nasal packing in a patient with a bioprosthetic aortic valve

Infective endocarditis (IE) is a severe form of heart valve disease and is associated with a poor prognosis and high risk of mortality. We report the first known case of bioprosthetic aortic valve endocarditis associated with spondylodiscitis as a result of posterior nasal packing coated with antibiotics but without systemic antibiotic prophylaxis.

One hundred six live kidney donors in a single German transplantation center: renal, physical, and psychological follow-up

OBJECTIVE

The objective of this study was to analyze the psychological and physical status as well as renal outcomes of 106 live kidney donors between 1993 and 2003.

METHODS

We performed general and nephrological examinations, including measurements of creatinine clearance (ClCr), proteinuria, and 24-hour blood pressure monitoring. We evaluated the psychological and general health situation using the standardized SF-36 questionnaire.

RESULTS

We evaluated 69/106 (65%) live kidney donors at 5.3 ± 0.4 years after donation. The reason for the 37 drop-outs were unknown current address (n = 21), refusal of study participation (n = 14), and death due to accident and suicide (n = 2). In the 69 donors renal function was well preserved: serum creatinine 1.3 ± 0.0 mg/dL; ClCr 81 ± 2 mL/min; postdonation to predonation ClCr ratio 0.73 ± 0.02; and proteinuria 104 ± 11 mg/d. None of the donors experienced renal failure, although 36/69 (52%) patients have developed de novo hypertension. Compared with normotensive donors, the hypertensive subgroup was significantly older at the time of donation (50.7 ± 1.4 vs 46.4 ± 1.6 years; P = .010) and had a longer interval since donation (6.4 ± 0.2 vs 3.9 ± 0.1 years; P = .001). SF-36 questionnaire results in live kidney donors showed higher scores regarding physical (54.3 ± 0.8 vs 49.3 ± 0.1; P = .048) and psychological health (53.8 ± 0.6 vs 50.7 ± 0.1; P = .043) compared with the average German population.

CONCLUSION

Our cohort of live kidney donors showed good renal outcomes and superior SF-36 scores in both physical and psychological health compared with the German population. The risk of de novo hypertension increased with age and time after donation. Blood pressure screening should be regularly performed especially in the long term after donation.

Epidemiological Findings and Clinical and Magnetic Resonance Presentations in Subacute Sclerosing Panencephalitis

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, inflammatory neurodegenerative disease. This study investigated the relationships of clinical stage with epidemiological and magnetic resonance imaging (MRI) findings in SSPE by retrospective review of 76 cases (57 male) diagnosed by typical periodic electroencephalographic features, clinical symptoms and elevated measles antibody titre in cerebrospinal fluid. Clinical stage at diagnosis was I or II in 48 patients, III in 25 and IV in three. Prominent findings at presentation were atonic/myoclonic seizures (57.9%) and mental deterioration with behaviour alteration (30.3%). Frequent MRI findings (13 – 32 patients) were subcortical, periventricular and cortical involvement and brain atrophy; the corpus callosum, basal ganglia, cerebellum and brainstem were less frequently involved. Five patients had pseudotumour cerebri. Cranial MRI at initial diagnosis was normal in 21 patients (19 stage I/II, two stage III/IV). Abnormal MRI findings were significantly more frequent in the later stages, thus a normal initial cranial MRI does not exclude SSPE, which should, therefore, be kept in mind in childhood demyelinating diseases even when the presentation is unusual.

Dopamine receptor-mediated regulation of neuronal "clock" gene expression

Using a transgenic mice model (i.e. "clock" knockouts), clock transcription factors have been suggested as critical regulators of dopaminergic behaviors induced by drugs of abuse. Moreover, it has been shown that systemic administration of psychostimulants, such as cocaine and methamphetamine regulates the striatal expression of clock genes. However, it is not known whether dopamine receptors mediate these regulatory effects of psychostimulants at the cellular level. Primary striatal neurons in culture express dopamine receptors as well as clock genes and have been successfully used in studying dopamine receptor functioning. Therefore, we investigated the role of dopamine receptors on neuronal clock gene expression in this model using specific receptor agonists. We found an inhibitory effect on the expression of mClock and mPer1 genes with the D2-class (i.e. D2/D3) receptor agonist quinpirole. We also found a generalized stimulatory effect on the expression of clock genes mPer1, mClock, mNPAS2 (neuronal PAS domain protein 2), and mBmal1 with the D1-class (i.e. D1) receptor agonist SKF38393. Further, we tested whether systemic administration of dopamine receptor agonists causes similar changes in striatal clock gene expression in vivo. We found quinpirole-induced alterations in mPER1 protein levels in the mouse striatum (i.e. rhythm shift). Collectively, our results indicate that the dopamine receptor system may mediate psychostimulant-induced changes in clock gene expression. Using striatal neurons in culture as a model, further research is needed to better understand how dopamine signaling modulates the expression dynamics of clock genes (i.e. intracellular signaling pathways) and thereby influences neuronal gene expression, neuronal transmission, and brain functioning.

Antibiotic and hyperbaric oxygen therapy in the management of post-operative discitis

OBJECTIVE

Despite the use of antibiotics, the management of postoperative discitis (POD) still presents a challenge. This study was designed to evaluate the effect of adjuvant hyperbaric oxygen (HBO2) therapy on the duration of antibiotic treatment.

METHODS

Between 1999 and 2004, 22 patients diagnosed with POD were treated with antibiotic and HBO2 therapy. There were 14 male (63.6%) and 8 female (36.3%) patients, and their mean age at the time of surgery was 45.4 years (range, 20-59 years). Diagnosis of a POD was established on the basis of clinical, laboratory, and radiographic findings. All patients were given a 4-week course of vancomycin (1g i.v. every 12 h). Additionally, patients received HBO2 (100% O2 at 2.4 ATA for 90 min) twice daily for the initial five consecutive days, and an additional treatment (100% O2 at 2.4 ATA for 90 min daily) was given for 25 days. The duration of follow-up was 24 months.

RESULTS

This treatment modality allowed infection control and healing for all 22 patients with 0% recurrence rate. HBO2 treatment was tolerated well.

CONCLUSION

This series represents the first reported group of POD patients treated with antibiotic and HBO2 therapy. Our preliminary results indicate that the length of time on antibiotic therapy can be shortened with the use of HBO2 as an adjunctive treatment. Erythrocyte sedimentation rates and serum C-reactive protein levels returned to the preoperative levels earlier (within 8-30 days after the initiation of treatment) and a reasonable length of immobility was obtained (mean 12.2 days). After completion of the one-month period of antibiotic and HBO2 therapy, patients were accepted disease-free regarding pain and mobility.

MRI screening of dysbaric osteonecrosis in hyperbaric-chamber inside attendants

Inside attendants are medical staff who accompany patients during hyperbaric oxygen treatments. Dysbaric osteonecrosis (DON) is a well-known consequence of hyperbaric exposure. The aim of this study was to evaluate DON in inside attendants using magnetic resonance imaging (MRI). The bilateral shoulder, hip and knee joints of 12 inside attendants (four men, eight women; mean age 29 years; age range 22 - 36 years) were investigated. The mean +/- SD duration of employment as an inside attendant was 3.8 +/- 3.0 years (range 1 - 9 years) and the mean +/- SD number of hyperbaric exposures was 198 +/- 267 (median 96; range 30 - 950). None of the inside attendants had a history of decompression sickness. The MRIs of the attendants did not reveal bone lesions consistent with DON. This study failed to find an increased risk for DON in inside attendants. Additional multicentre epidemiological studies are warranted to investigate the occupational safety of inside attendants.

Use of GnRH antagonists in ovarian remnant syndrome experimentally induced in rats

PURPOSE

The objective of this study was to demonstrate the efficacy of cetrorelix, a GnRH antagonist, in rats with experimentally induced ovarian remnant syndrome.

METHODS

25 Wistar female rats at seven to eight weeks of age and weighing 200-250 g were used. The rats were randomly divided into five groups: the first group was used as a control group; the second and third groups underwent a sham operation; and the fourth and fifth groups underwent bilateral hemiovariectomy. At the first proestrus detected by vaginal cytology from postoperative day 2, the animals in groups 1, 2 and 5 received placebo and the animals in groups 3 and 4 received cetrorelix subcutaneously. In the study, the Kruskal-Wallis analysis of variance was used for comparison of the results of vaginal irrigation, histopathblogical examination, and of blood FSH and LH values, and the Mann Whitney U-test was used for determination of the differences between the groups.

RESULTS

It was determined that according to vaginal cytology results, estrus-like cytological changes disappeared in a shorter time and according to histopathology results, the number of follicles were fewer in the ovarian remnant syndrome-induced and cetrorelix-injected group 4 (p < 0.05), but there was no difference between the groups for FSH and LH concentrations.

CONCLUSIONS

Ovarian remnant syndrome is a complication of bilateral ovariohysterectomy. In cases with this syndrome, certain treatment is possible with re-operation. However, it may not always be possible to perform an operation, or even if operated, it is difficult to determine the place of the residual ovarian tissue. In this study, it was determined that the use of cetrorelix as a GnRH antagonist in rats with ovarian remnant syndrome reduced the duration of estrogenic affect.

Antenatal and delivery risk factors and prevalence of cerebral palsy in Duzce (Turkey)

This cross-sectional study aimed at investigating the prevalence and the etiological factors of cerebral palsy (CP) and comparing them with normal population within the rural and urban areas of Duzce province. Of the 102 children with cerebral palsy, 98 were associated with antenatal and delivery risk factors. The mean crude prevalence of cerebral palsy was 1.1 per 1000 live births. The children with CP were compared with 530 control subjects. The mothers of the children with cerebral palsy were significantly younger than the mothers of children in control group, and they had less parity and abortion. Preeclampsia, premature rupture of membranes, home births, prolonged labor, and twin pregnancies were significantly more common in the mothers of children with cerebral palsy, where no significant differences were found between the groups in terms of breech delivery, rate of cesarean births, gestational diabetes, and hemorrhage in late pregnancy. Birth asphyxia, liqueur with meconium stained, prolonged jaundice and neonatal seizure were also significantly more common in the group with cerebral palsy. Of the children with cerebral palsy, 78% were born at term, 20% were born with gestational ages of 32-36 weeks, 2% were born with gestational ages of 30-31 weeks. Nine percent of those children had a birth weight of >or= 3000 g, 12.2% had a birth weight of 2500-2999 g, 33.7% had a birth weight of 1500-2499 g, and 5.1% had a birth weight of <or= 1500 g. The causes of low prevalence of cerebral palsy were due to insufficient neonatal care, resulting in low survival in preterm and low birth weight children, and poor postnatal care of children with cerebral palsy.

Facial motor cortex plasticity in patients with unilateral peripheral facial paralysis

Hand motor representation area expands towards the area of the perioral facial motor cortex in patients with peripheral facial paralysis (PFP) and in hemifacial spasm cases treated with botulinum toxin. In this current study, we aimed to investigate the changes both in the ipsilateral and contralateral facial motor cortex areas in patients with PFP with transcranial magnetic stimulation (TMS). Thirty healthy individuals and 41 patients with unilateral PFP with partial or total axonal degeneration participated in this study. Motor evoked potentials (MEPs) of perioral muscles elicited by TMS of the intracranial portion of the facial nerve and motor cortex, were recorded. TMS was delivered through a figure-of-eight coil. Mapping of the cortical representation of perioral muscles were also studied in 13 of 41 patients and in 10 of control subjects. Mean amplitude of the intact perioral MEPs elicited by the ipsilateral hemisphere TMS, was significantly higher in patients than the control subjects. There was also a mild enlargement of the mean cortical representation area of intact perioral muscles on both hemispheres though it was not significant. We have concluded that there was a cortical reorganization in the hemisphere contralateral to the paralytic side resulting in an increase at corticofugal output related to intact perioral muscles.

A preliminary investigation on boron and metal concentrations of the main drainage channel in Konya-Turkey

In this work, the wastewaters and sediments of the main drainage channel in Konya (Turkey) were collected from three different sampling points and analyzed for metals, including iron, chromium, copper, lead, zinc and nickel by using inductively coupled plasma-atomic emission spectrometry (ICP-AES). It was found that for all sampling points sediment samples show a decrease in concentrations in the order Fe >> Zn > Cr > Ni > Cu > Pb. For all sampling points, heavy metal concentrations in wastewater did not exceed the maximum admissible discharge levels regulated by the Institute of Turkish Standards. However, it was found that boron concentration of wastewaters exceed the safe level for irrigation of farmland.

Post-transplant sCD30 and neopterin as predictors of chronic allograft nephropathy: impact of different immunosuppressive regimens

Immunological monitoring for chronic allograft nephropathy (CAN) is of great potential interest. We assessed serum soluble CD30 (sCD30) together with in vitro Th2-type responses (IL-4, IL-10, CD4 helper activity) and neopterin in a prospective study of 84 renal transplant recipients with 2-year follow-up. Patients were randomized to CsA/Aza, CsA/MMF and Tacr/Aza, respectively, to analyze the effect of immunosuppression on posttransplant sCD30 and neopterin. ATG induction and acute rejections did not alter sCD30 levels whereas CMV disease was associated with transient upregulation of sCD30 (p = 0.003 at 4 months) and sustained upregulation of neopterin (corrected for graft function (Neo/CR) p = 0.005 at 2 years). Tacr versus CsA treatment proved to be an independent variable associated with downregulation of 1-year sCD30, which was positively related to Neo/CR (p = 0.007 and 0.01, respectively; logistic regression). Importantly, increased 1-year sCD30 and Neo/CR were associated with decreased glomerular filtration rate at 2 years (p = 0.02 and p < 0.0005, respectively) and evidence of CAN (p < 0.0005). High 1-year sCD30 could not be attributed to enhanced Th2-type responses and was not associated with HLA antibody formation. Our data suggest that elevated sCD30 and neopterin predict graft deterioration by CAN. Tacr effectively downregulates these responses and might be of advantage in patients with elevated sCD30 or neopterin.

Effect of combined therapy with hyperbaric oxygen and antioxidant on infarct volume after permanent focal cerebral ischemia

The aim of the present study was to evaluate the efficiency of combination of hyperbaric oxygen (HBO) and an antioxidant on permanent focal cerebral ischemia. Male Wistar rats underwent permanent middle cerebral artery occlusion (MCAO). Then, animals were randomly assigned to one of four groups: the control group (n=9) received no treatment, HBO group (n=9) was treated for 90 min at 2.5 absolute atmosphere for 3 days, the U-74389G group (n=8) received single U-74389G injection (3 mg/kg), the HBO + U-74389G group (n=8) received both HBO and U-74389G treatments. Treatments were initiated within the first 10 min after MCAO. After 3 days, the infarct volumes in rat brains were measured. The infarct ratios were 25.6+/-6.5 % for the control group, 21.9+/-6.4 % for the HBO group, 15.7+/-5.7 % for U-74389G group and 12.5+/-3.8 % for HBO + U74389G group. The infarct volumes were significantly reduced in rats treated with U-74389G (p<0.05) and combination therapy (p<0.05). HBO failed to reduce infarct volume significantly. We concluded that 1) U-74389G is more beneficial than HBO on permanent MCAO in rats, and 2) a combined therapy failed to significantly improve infarct volume more than either single treatment.

Dehydroepiandrosterone and human adipose tissue

OBJECTIVE

The aim of this study was to investigate whether DHEA alters the proliferation and differentiation of human sc and visceral adipose cells in primary cultures.

METHOD

Sc and omental adipose tissue was obtained from 10 female donors aged 36+/-3.6 yr with a body mass index (BMI) of 33+/-3.21 kg/m2. Stromal vascular cells were isolated and cultured using modified procedures described by Entenmann and Hauner. For the proliferation assay, stromal-vascular cells from sc and visceral adipose tissue cultures were fed with proliferation media containing 0, 25 or 100 microM DHEA for 3 days. At the end of this treatment period, two type cultures were prepared for determining their metabolic activity using the sulforhodamine B staining procedure.

RESULTS

The metabolic activity of proliferating human visceral adipose tissue was higher than sc adipose tissue. The activity of proliferating human visceral tissue cultures decreased more than the sc tissue as the level of DHEA in the cultures was increased.

CONCLUSIONS

These data suggest that DHEA predominantly influences the proliferation and differentiation of human omental adipose tissue.

Renal medullary changes in renal allograft recipients with raised serum creatinine

OBJECTIVE

To test the hypothesis that the renal medulla may reflect rejection related changes and thus have a predictive value in the assessment of acute renal allograft rejection or chronic graft damage.

METHODS

75 post-transplant biopsies from 57 patients were scored according to the Banff 1997 scheme. The biopsies with adequate cortical and medullary tissue (n = 23) were selected and medullary tissues were reviewed for rejection related lesions except intimal arteritis. Chronic damage was determined by image analysis depending on periodic acid-methenamine silver (PAMS)-Masson trichrome (MT) staining. Medullary and cortical changes were compared.

RESULTS

Interstitial inflammation and tubulitis were more frequent and severe in the cortex (p<0.001). Medullary tubulitis was associated with intimal arteritis (p = 0.003, r = 0.598). Medullary interstitial inflammation (n = 8) and tubulitis (n = 4) were associated with cortical borderline changes (n = 5) or allograft rejection (n = 3). The sensitivity, specificity, and positive and negative predictive values of medullary inflammatory changes in predicting cortical allograft rejection were 43%, 69%, 37%, and 73%, respectively. A significant association was observed between medullary MT-SAP and cortical PAMS-SAP values (p = 0.02, R(2) = 0.23).

CONCLUSIONS

Acute rejection related lesions are more common and severe in the cortex, and the renal medulla does not sufficiently reflect cortical rejection. The positive and negative predictive values of medullary changes for allograft rejection are low, and medullary inflammation is not a reliable indicator of allograft rejection. Increased medullary fibrosis is correlated with chronic cortical damage.

The effect of hyperbaric oxygen on intraocular pressure

The effects of hyperoxia on intraocular pressure (IOP) have been studied in experiments on human beings and animals. The changes occurring in IOP in patients during routine HBO2 therapy are unknown. In this study we investigated IOP changes arising during the HBO2 therapy at 2.5 ATA. Fifty-six patients receiving HBO2 therapy for various reasons were included in the study. Bilateral IOPs of patients measured with the Tono-pen XL (Medtronic, Solan, USA) tonometer before, during and after HBO2 therapy. Average IOPs were 14.85 +/- 3.17 mmHg (range, 10-24), 13.00 +/- 2.97 mmHg (range, 9-21) and 14.74 +/- 3.12 mmHg (range, 10-22), respectively. IOP was reduced significantly during HBO2 therapy and returned its pre- HBO2 levels after therapy. Our data indicated a statistically significant decrease in IOPs during therapy at 2.5 ATA. This decrease was of minor physiological significance in these patients whose baseline IOP values were within the normal range.

sCD30 and Neopterin as Risk Factors of Chronic Renal Transplant Rejection: Impact of Cyclosporine A, Tacrolimus, and Mycophenolate Mofetil

High pretransplantation sCD30 levels have been shown to be associated with lower 5-year kidney graft survival in mainly Cyclosporine A (CsA)-treated recipients (Collaborative Transplant Study database). To analyze the effect of different immunosupressive regimens (CsA/Azathioprine [Aza], CsA/Mycophenolate Mofetil [MMF], Tacrolimus [Tacr]/Aza) on sCD30, we assessed serum sCD30 and neopterin together with in vitro cytokine responses in a prospective randomized study of 84 renal transplant recipients before, 4 months, and 1 year after transplantation. Panel-reactive antibody (PRA) formation, HLA matching, ATG induction therapy, and acute rejections had no impact on sCD30 levels, whereas cytomegalovirus (CMV) infections induced an up-regulation of sCD30 4 months posttransplantation (P = .003). Whereas MMF showed no effect on sCD30 compared with Aza therapy, we found a significant impact of Tacr versus CsA treatment (1-year sCD30 > or = 60 U/mL: 14/42 (33%), CsA; 1/38 (3%), Tacr; P < .0005). Chronic rejection 2 years posttransplantation was associated with elevated 1-year sCD30 (P = .001) and neopterin levels (P = .006). Our data indicate that the Th2 activation marker sCD30 provides a risk factor for chronic rejection independent of classical immunological risk factors and may be down-regulated using Tacr treatment.

Changes in the perioral muscle responses to cortical TMS induced by decrease of sensory input and electrical stimulation to lower facial region

OBJECTIVE

To determine the changes in the motor cortex due to repetitive electrical stimulation and cutaneous anesthesia in lower facial region.

METHODS

A total of 11 subjects participated in the study of repetitive electrical stimulation, and 10 other subjects in the study of lower facial anesthesia. Facial nerve root and face associated cortical MEPs by transcranial magnetic stimulation (eight-shaped coil) were recorded from perioral muscles pre- and post- electrical stimulation and lower facial anesthesia. Cheek near to the corner of the mouth was transcutaneously stimulated by bipolar surface electrode giving repetitive electrical shocks at 5 Hz. Five percent lidocain/prilocain local anesthetic cream was applied to left or right lip-cheek region.

RESULTS

There was no significant change in perioral MEP responses after 10-30 min of 5 Hz electrical stimulation. We found a significant increase of amplitude in cortical MEP recordings during lower facial anesthesia especially in cases of cortical magnetic stimulations ipsilateral and contralateral to the anaesthetized side and in perioral recordings contralateral to the anaesthetized side.

CONCLUSIONS

The present study demonstrates that topical anesthesia to the lower facial region leads to cortical modulation and fast plastic changes in both hemispheres that are directed to the normal side.

Qt dispersion in soccer players during exercise testing

Screening for cardiac health should involve relevant parameters or indices that are easy and inexpensive to obtain. Various cardiac adaptation mechanisms develop during regular exercise that are affected by many factors, and these are reflected on a surface electrocardiogram. QT dispersion has been considered a surrogate for heterogeneity of repolarization, leading to ventricular arrhythmias. We compared QT parameters between athletes and sedentary subjects. A total of 225 men were assessed, comprising a group of professional soccer players and sedentaries. Each subject underwent supine 12-lead electrocardiographic examinations and exercise testing by ergospirometry. QT parameters were taken at rest and at peak exercise. Peak oxygen consumption was considerably higher in the athletes than in the controls (59.3 +/- 5.6 vs. 44.3 +/- 2.4 ml/kg/min, mean +/- SD, p < 0.001). QT parameters at rest: There were significant differences in heart-rate-corrected rest maximal QT duration (413.9 +/- 50.5 vs. 445.3 +/- 45.7 ms, p < 0.001) and in heart-rate-corrected rest minimum QT duration (380.5 +/- 51.2 vs. 409.5 +/- 46.7 ms, p < 0.001). QT parameters at peak exercise: maximal QT duration at peak exercise (253.9 +/- 20.8 vs. 261.7 +/- 26.2, p = 0.02), QT dispersion at peak exercise (25.2 +/- 9.1 vs. 29.5 +/- 15.8 ms, p = 0.04), heart-rate-corrected QT dispersion at peak exercise (44.6 +/- 16.4 vs. 52.6 +/- 28.3 ms, p = 0.03) differed significantly between professional soccer players and controls. QT dispersion and corrected QT dispersion at peak exercise are lower in athletes than in controls. Athletes and other subjects identified with a long QT interval should be examined at regular intervals.

Can computed tomography scout radiography replace plain film in the evaluation of patients with acute urinary tract colic?

PURPOSE

To determine the sensitivity of computed tomography (CT) scout view in detecting ureteral stones and whether CT scout radiography can replace plain film in the evaluation of patients with acute urinary tract colic.

MATERIAL AND METHODS

Between January 2000 and 2002, 110 patients with ureterolithiasis were prospectively evaluated for the detection of ureteral stones on CT scout radiographs. The findings were compared with those of plain films. All patients were examined with plain film, CT scout radiography, and unenhanced helical CT. CT scans were performed within 24 h of plain films. Each CT scout radiograph was interpreted without knowledge of the findings on plain film.

RESULTS

111 stones were detected by unenhanced helical CT. Mean stone size was 3.9 mm (range 1-10 mm). Of all stones, 57 (52%) were visible on plain film; 44 (40%) were seen on CT radiographs. The sensitivity of 79 small stones (< 5 mm) on CT scout radiography was 29% and of abdominal radiography 37%. For 32 big stones (> 5 mm), the sensitivity of CT scout radiography was 66% and of abdominal radiography 87.5%.

CONCLUSION

In this study, plain film was more sensitive than CT scout radiography in revealing ureteral calculi. However, the detection of stones 5 mm or larger had a sensitivity of 66% on CT scout radiographs; 77% (44/57) of the stones visible on plain films were also seen on CT scout radiographs. We therefore believe that CT scout radiography can be used as a baseline study in most patients with big ureteral stones.

Effectiveness of Hyperbaric Oxygen Therapy in the Treatment of Complex Regional Pain Syndrome

In this double-blind, randomized, placebo-controlled study we aimed to assess the effectiveness of hyperbaric oxygen (HBO) therapy for treating patients with complex regional pain syndrome (CRPS). Of the 71 patients, 37 were allocated to the HBO group and 34 to the control (normal air) group. Both groups received 15 therapy sessions in a hyperbaric chamber. Pain, oedema and range of motion (ROM) of the wrist were evaluated before treatment, after the 15th treatment session and on day 45. In the HBO group there was a significant decrease in pain and oedema and a significant increase in the ROM of the wrist. When we compared the two groups, the HBO group had significantly better results with the exception of wrist extension. In conclusion, HBO is an effective and well-tolerated method for decreasing pain and oedema and increasing the ROM in patients with CRPS.

A New Treatment Modality for Fibromyalgia Syndrome: Hyperbaric Oxygen Therapy

Fibromyalgia syndrome (FMS) is characterized by longstanding multifocal pain with generalized allodynia/hyperalgesia. There are several treatment methods but none has been specifically approved for this application. We conducted a randomized controlled study to evaluate the effect of hyperbaric oxygen (HBO) therapy in FMS (HBO group: n = 26; control group: n = 24). Tender points and pain threshold were assessed before, and after the first and fifteenth sessions of therapy. Pain was also scored on a visual analogue scale (VAS). There was a significant reduction in tender points and VAS scores and a significant increase in pain threshold of the HBO group after the first and fifteenth therapy sessions. There was also a significant difference between the HBO and control groups for all parameters except the VAS scores after the first session. We conclude that HBO therapy has an important role in managing FMS.

Effect of hyperbaric oxygen on experimental acute distal colitis

It has been demonstrated that hyperbaric oxygen (HBO) is useful as an adjunctive therapy for Crohn's disease. However, its effects on ulcerative colitis have not been investigated. In the present study, HBO was tested for acetic acid-induced colitis, and antioxidant systems were evaluated to clarify its possible mode of action. Thirty-six Sprague-Dawley rats were randomly divided into three groups: sham control (Group I), colitis induced by acetic acid without any therapy (Group II), colitis induced by acetic acid and treated with HBO (Group III). HBO was given for 5 days, 2 sessions per day at 2.5-fold absolute atmosphere pressure (ATA) for a period of 90 min in rats in which colitis had been induced (Group III). Rats were sacrificed on the 5th day after the procedure. Superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH Px) activity were measured in the intestinal tissue and erythrocyte lysate. MDA and GSH Px were also determined in the plasma. Whereas MDA levels in erythrocyte, plasma and intestinal tissue were decreased, the levels of GSH Px and SOD were significantly increased in Group III as compared to those of Group II. The results of our study suggest that hyperbaric oxygen therapy has beneficial effects on the course of experimental distal colitis and that antioxidant systems may be involved in its mode of action.

Effect of hyperbaric oxygen on experimental acute distal colitis

It has been demonstrated that hyperbaric oxygen (HBO) is useful as an adjunctive therapy for Crohn's disease. However, its effects on ulcerative colitis have not been investigated. In the present study, HBO was tested for acetic acid-induced colitis, and antioxidant systems were evaluated to clarify its possible mode of action. Thirty-six Sprague-Dawley rats were randomly divided into three groups: sham control (Group I), colitis induced by acetic acid without any therapy (Group II), colitis induced by acetic acid and treated with HBO (Group III). HBO was given for 5 days, 2 sessions per day at 2.5-fold absolute atmosphere pressure (ATA) for a period of 90 min in rats in which colitis had been induced (Group III). Rats were sacrificed on the 5th day after the procedure. Superoxide dismutase (SOD), malondialdehyde (MDA) and glutathione peroxidase (GSH Px) activity were measured in the intestinal tissue and erythrocyte lysate. MDA and GSH Px were also determined in the plasma. Whereas MDA levels in erythrocyte, plasma and intestinal tissue were decreased, the levels of GSH Px and SOD were significantly increased in Group III as compared to those of Group II. The results of our study suggest that hyperbaric oxygen therapy has beneficial effects on the course of experimental distal colitis and that antioxidant systems may be involved in its mode of action.