Single dose regorafenib-induced hypertensive crisis

Gastrointestinal stromal tumors (GISTs) are uncommon tumors of the gastrointestinal (GI) tract. Regorafenib is a new multikinase inhibitor and is approved for the treatment of GISTs in patients who develop resistance to imatinib and sunitinib. The most common drug-related adverse events with regorafenib are hypertension, hand-foot skin reactions, and diarrhea. Grade IV hypertensive side effect has never been reported after a single dose. In this report, we present a case of Grade IV hypertensive side effect (hypertensive crisis and seizure) after a single dose of regorafenib. A 54-year-old male normotensive GIST patient was admitted to the emergency department with seizure and encephalopathy after the first dosage of regorafenib. His blood pressure was 240/140 mmHg upon admission. After intensive treatment with nitrate and nitroprusside, his blood pressure returned to normal levels in five days. Regorafenib was discontinued, and he did not experience hypertension again. This paper reports the first case of Grade IV hypertension after the first dosage of regorafenib. We can suggest that hypertension is an idiosyncratic side effect unrelated to the dosage.

A new prognostic strategy for gastric carcinoma: albumin level and metastatic lymph node ratio

AIM

We evaluated the prognostic significance of preoperative serum albumin value and metastatic lymph node ratio for gastric cancer patients.

METHODS

We studied patients diagnosed with gastric carcinoma in the first Department of Surgery, Bezmialem Vakif Gureba Training and Research Hospital between January 2004 and December 2010; the patients were studied retrospectively.

RESULTS

A total of 67 patients with a mean age of 58.7 ± 11.4 years were included in the study. The majority of patients were male (N.=53 male; N.=14 female). Most patients were in an advanced stage of the disease (stage III-IV) on admission (67.2%). We classified patients according to albumin value as "normal" Group 1 (83%) and "hypoalbuminemic" Group 2 (17%). With albumin, age, resection type, perineural invasion, and ratio of metastatic lymph nodes, T and TNM stages were significant predictors of cancer-specific survival.

CONCLUSION

As a result, irrespective of mechanism, pre-operative evaluations of albumin and metastatic lymph node ratio should be performed to stratify the patients for risk analysis and prognosis. A level less than 3.5 g/dL is a negative prognostic factor for resectable gastric cancers.

Ultrasound guided block of the saphenous neuroma following use of an AFO in a patient with paraplegia. A case report

The saphenous nerve is the terminal branch of the femoral nerve and a pure sensory nerve that provide sensation to medial leg. Injury to saphanous nerve following trauma or surgery of the knee can result in formation of a painful neuroma along its distribution. We present a case of saphenous neuroma following use of an ankle-foot orthosis (AFO) in a patient with paraplegia. A 36-year-old patient with paraplegia who was capable of walking independently with his AFO presented to our department with a 3-month history of pain in his left calf. Examination revealed tenderness, paresthesias and positive Tinel sign over the anteromedial aspect of the calf. Ultrasonographic examination of the painful area showed a mass with heterogenous echogenity which was consistent with a saphenous neuroma at the site where fastener band of AFO compressed to skin. We performed a nerve block with steroid and local anesthetic injection under ultrasound guidance to the neuroma. The patient reported pain relief following injection. The use of the AFO may cause a painful saphenous neuroma which is an unusual cause of extremity pain in patients with paraplegia. Ultrasound may be a beneficial diagnostic tool and a guidance for the therapeutic interventions in this condition.

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.

Determination of 17 β-Estradiol in Rabbit Plasma by Gas Chromatography with Flame Ionization Detection

This article describes gas chromatography-flame ionization detection method for determination of 17 β-estradiol in rabbit plasma. 17 β-estradiol and internal standard progesterone were extracted from plasma using liquid-liquid extraction method. Linearity was found between 0.25 and 20 μg/ml (r(2)=0.994) for plasma samples. Intra-day and inter-day precision, expressed as the relative standard deviation were less than 5.5%, and accuracy (relative error) was less than 3.5%. The mean recovery of 17 β-estradiol samples was 94.4%. The limits of detection and quantification of method for plasma samples were 0.10 μg/ml and 0.15 μg/ml, respectively. Also, clinically used other 10 drugs were investigated to check for potential interferences and the method was successfully applied to the determination of 17 β-estradiol in New Zealand white rabbits.

Effects of melatonin on behavioral changes of neonatal rats in a model of cortical dysplasia

BACKGROUND

Cortical dysplasia (CD) is associated with several behavioral disorders in both the pediatric and the adult population. The effect of melatonin on behavioral disorders in rats generated CD has not been investigated so far.

AIM

To investigate the effects of melatonin administration on activity and anxietic behavior of neonatal rats in a model of CD.

MATERIALS AND METHODS

Newborn Sprague-Dawley rats (n=21) were randomized into three groups. On postnatal day 1, one freeze lesion was carried out in 14 rats between bregma and lambda to create a CD model. Another group of neonatal rats served as control group (n=7). Those 14 rats were either administered melatonin (n=7) or vehicle solution (n=7). Melatonin treatment (4 mg/kg/day, i.p.) was initiated ten days after induction of cold injury and continued for three weeks. Animal activity and anxiety were analyzed by using open field and elevated plus maze tests 24h after the last melatonin administration (day 32) in a blind manner.

RESULTS

It was observed that CD induced animals spent significantly less time in the open field area when compared to the other groups (p < 0.01). Additionally, the time spent in the open field area was significantly elevated in the melatonin-treated animals compared to both the control and the CD groups (p < 0.01). Accordingly, anxiety scores in the CD group was significantly increased (p < 0.01), and this effect could be reversed by administration of melatonin.

CONCLUSIONS

Melatonin exerts protective behavioral effects against cortical dysplasia in newborn rats. Further clinical investigations may prove melatonin as a useful therapeutic adjunct to prevent from possible behavioural damages of cortical dysplasia.

Postoperative visual impairment after spinal fusion surgery

OBJECTIVE

The aim of this prospective study was to detect risk factors for visual impairment or changes in vision following spinal fusion surgery.

METHODS

A total of 68 patients aged 18-65 years, scheduled for posterior spinal fusion surgery, were included. Ophthalmic examinations were performed by an ophthalmologist on the day before surgery and repeated after the second postoperative day, within the first postoperative week. Patient characteristics were compared according to two clinical outcomes following surgery: worsening of vision during the pre- and postoperative interval (group 1) and no change in pre- and postoperative examinations (group 2).

RESULTS

The mean age of patients with postoperative visual changes was significantly higher than that for patients without postoperative visual changes. Total number of female patients and use of intraoperative ephedrine to treat hypotensive episodes were significantly higher in group 1 than in group 2 patients.

CONCLUSION

Older age, female gender and intraoperative hypotensive episodes are potential risk factors for postoperative visual impairment in patients who have undergone spinal fusion surgery.

The efficacy of ProTaper Universal rotary retreatment instrumentation to remove single gutta-percha cones cemented with several endodontic sealers

AIM

To evaluate residual root filling material following removal of three newly developed root canal sealers used with a matched-taper single-cone root filling technique and to compare the efficacy of ProTaper Universal rotary retreatment instruments with that of a conventional manual technique.

METHODOLOGY

The canals of 120 palatal roots in maxillary molar teeth were instrumented with EndoWave nickel-titanium rotary instruments and filled using Hybrid Root SEAL, EndoSequence BC Sealer, Activ GP system or AH Plus with matched-taper single gutta-percha cones. The root fillings were then removed with ProTaper Universal retreatment rotary instruments or a manual technique. Buccolingual and proximal digital radiographs of the roots were exposed to determine the area of remaining filling material in the coronal, middle and apical thirds. The area percentages of remaining filling material in each third and total canal area were calculated. Data were analysed statistically with Kruskal-Wallis and Mann-Whitney U-tests. The level of significance was set at P<0.05.

RESULTS

Irrespective of the sealer type and retreatment technique, filling material could not be removed completely from the root canals. Significantly, more remaining filling material was observed in the apical third (P<0.05). When comparing the sealers, the only significant difference was detected between AH Plus/manual and Activ GP/manual groups with respect to residual material in the total canal area (P<0.05). There were no significant differences between manual and ProTaper groups.

CONCLUSIONS

When using gross radiographic criteria, the Activ GP was more effectively removed from root canals than AH Plus with hand instrumentation. Hybrid Root SEAL, EndoSequence BC Sealer and AH Plus were removed to a similar extent. ProTaper Universal retreatment instruments were as safe and effective as hand instruments in reaching the working length.

The effects of lipopolysaccharide-induced endogenous hyperthermia and different antipyretic treatment modalities on rat brain

BACKGROUND

In the present study, the effects of fever and hyperthermia, and different anti hyperthermia treatment modalities on the brain by was investigated by using experimental animal model

MATERIALS AND METHODS

Endogenous hyperthermia (41 degrees C) was induced by lipopolysaccharide (LPS) injection, and the signs of probable neuronal damage were evaluated by healthy, necrotic and apoptotic cells, and heat-shock proteins (HSP 27 and HSP 70) in cerebral cortex, cerebellum and hypothalamus. The animals were treated with widely used treatment modalities for high fever in pediatric practice, namely hypothermia, dexamethasone, paracetamol and diclofenac, and their effect on the hyperthermia-induced brain changes were evaluated.

RESULTS

Generalized seizure was observed in fifteen rats of which rectal temperature achieved 41 degrees C (15/36, 41%); five of them died on second day (5/15, 33%). LPS-induced endogenous hyperthermia; (i) caused significant increase of necrotic cells in cerebral cortex and cerebellum and apoptotic cells in all three regions (p < 0.05), (ii) caused significant decrease of healthy cells in cerebral cortex (p < 0.05), and (iii) no significant change of HSP 27 and 70 in all three neuronal locations (p > 0.05). For the treatment modalities applied; (i) paracetamol had an effect of increasing the healthy cell count in cerebral cortex and hypothalamus and decreasing the necrotic cell count in cerebellum and hypothalamus (p < 0.05).

CONCLUSION

The neuronal tissue in different regions of brain can show various degrees of damage in response to endogenous hyperthermia and the applied medications have varying degree of protection (Tab. 3, Fig. 6, Ref. 44).

The effects of phenol neurolysis of the obturator nerve on the distribution of buttock-seat interface pressure in spinal cord injury patients with hip adductor spasticity

OBJECTIVES

Hip adductor spasticity may adversely effect shear-force and pressure distribution on the buttocks, where ulcerations most frequently appear in patients with spinal cord injury (SCI). Phenol neurolysis of the obturator nerve (ON) is commonly used to manage hip adductor spasticity. This study aimed to determine the effects on the distribution of buttock-seat interface pressure (BSIP) in a group of SCI patients with adductor spasticity that underwent ON blockade with phenol.

METHODS

We reviewed the records of SCI patients that were admitted to our clinic between January 2009 and December 2009. BSIP values (obtained with an X-sensor 48) and hip adductor spasticity levels of SCI patients with hip adductor spasticity that underwent ON blockade with phenol were collected. BSIP distributions of the patients were divided into two portions: first one is the BSIP distribution at the pressure ≤37 mm Hg, and the second one is at the pressure >37 mm Hg.

RESULTS

The study included 20 SCI patients (19 males and 1 female), with a mean age of 42.85±13.24 years. Although the percentage of BSIP distribution at ≤37 mm Hg range increased significantly (P<0.001), after ON neurolysis, BSIP distribution at >37 mm Hg range decreased significantly (P<0.001). In addition, mean hip adductor spasticity decreased significantly after ON neurolysis (P<0.001).

CONCLUSION

Phenol neurolysis of the ON is a promising treatment for the management of hip adductor spasticity in SCI patients and also has positive effects on BSIP, which has a crucial function in the development of pressure ulcers.

Coccyx fractures in patients with spinal cord injury

AIM

The aim of this study was to report whether coccyx fractures are present in spinal cord injury (SCI) patients, who suffered from painful symptoms in the low back, gluteal, hip and thigh regions; and to determine the pain characteristics of coccydynia in these patients.

METHODS

Twenty males and six females with traumatic SCI (mean age: 31.57+/-12.23 years) who described painful symptoms in the low back, hip, gluteal or thigh regions were included in the study. Pain assessment was done by using visual analogue scale (VAS) and the short form of McGill pain questionnaire. Radiological assessment comprised two-sided lumbar vertebrae, hip and coccyx X-ray graphics.

RESULTS

Mean duration of SCI was 19.54+/-30.08 months. Nine patients (34.62%) had coccyx fractures. Sensory Pain Index and total McGill scores were found to be significantly higher in patients with coccyx fractures. Correlation analyses revealed significant correlations between VAS, SPI, affective pain index, present pain intensity and McGill total scores (all P<0.05). Duration of SCI was correlated with SPI (P=0.03) and total McGill scores (P=0.05).

CONCLUSION

Coccyx fractures have been detected in patients with SCI and the presence of such fractures seems to affect the pain scenario unfavorably. Involved patients will be treated promptly and their rehabilitation process will be enhanced when these fractures are recognized early.

Effects of ascorbic acid and lighting schedule on tibiotarsus strength and bone characteristics in broilers

Abstract. This study was conducted to determine the effects of two lighting programs (continuous program; 24 h lighting or intermittent; 12 h daylight followed by three cycles of 1 h lighting and 3 h dark program during the night period) and three different ascorbic acid (AA) supplementations (0, 200 and 400 mg/l, added to water) on some serum parameters, ash content and mechanical properties of tibiotarsus. For this purpose one-day-old male commercial (Ross PM3) broiler chicks (n=600) were divided into 6 treatment groups (2×3) with random replicates (4 replicates per treatment). At the end of 6 weeks, intermittent lighting program negatively influenced serum alkaline phosphatase (ALP) and calcium (Ca) levels (P<0.001) while continuous lighting program had positive influence on bone ash, Ca and phosphorus (P) content (P<0.001). The AA addition decreased serum inorganic phosphorus (Pi) level and positively affected bone chemical characteristics (P<0.001). On the mid-section of the bone, although intermittent lighting had positive effect on bone mechanical parameters (P<0.001), no remarkable effect was observed by AA supplementation. The results of the present study suggest that interaction of intermittent lighting and AA supplementation (200 mg/ l) may have positive effect on chemical composition and mechanical characteristics of bone in broilers.