The morphology of cyamella and its prevalence in Turkish society

OBJECTIVE

The aim of this study is to determine the prevalence and morphometry of cyamella, one of the sesamoid bones around the knee joint.

PATIENTS AND METHODS

In this retrospective study, a total of 9,500 plain/digital radiographs of 6,500 patients over the age of 18 who applied to Elazig Fethi Sekin City Hospital between January 2021 and January 2022 were examined.

RESULTS

Examinations revealed cyamella in a total of 76 (0.8%) knees in the direct X-ray images of 49 (0.75%) patients. Eighteen (36.74%) of the patients with the presence of cyamella were males, and 31 (63.26%) were females. The mean age of the patients with cyamella was 50.9±12.9. Twenty-seven (55.1%) of the 49 cyamella were bilateral; seven (14.3%) were in the right knee, and 15 (30.6%) were in the left knee. The comparison of cyamella sizes between genders revealed a statistically significant difference in the transverse measurements only (p=0.015) in the right knee, while a statistically significant difference was found in all 3 parameters (p=0.032 for thickness; p=0.04 for transverse; p=0.026 for length) in the left knee.

CONCLUSIONS

We believe that sufficient knowledge regarding the prevalence and distribution of cyamella in patients presenting with the complaint of knee pain and its differentiation from fabella, another sesamoid bone in the same region, as well as other anatomical structures, will aid an early and accurate diagnosis.

Carvacrol protects rat liver exposed to formaldehyde by regulating oxidative stress, and asprosin and subfatin hormones

Toxic doses of formaldehyde (FA) can cause oxidative damage and impair energy metabolism. Asprosin (ASP) and subfatin (SUB) are adipokines produced by adipose tissue that help regulate energy metabolism. We investigated the effects of carvacrol (CAR), an antioxidant with hepatoprotective properties, on ASP and SUB in rats exposed to FA using immunohistochemistry and biochemistry. We used 42 male Wistar albino rats divided into six groups of seven: group 1, untreated control; group 2, FA (10 ppm FA by inhalation 8 h/day, 5 days/week); group 3, CAR-20 (20 mg/kg); group 4, CAR-40; group 5, FA (10 ppm FA by inhalation 8 h/day, 5 days/week) + CAR-20 (20 mg/kg); group 6, FA (10 ppm FA by inhalation 8 h/day, 5 days/week) + CAR-40 (40 mg/kg). Levels of ASP and SUB, and total oxidant status (TOS) and total antioxidant status (TAS) in blood and liver tissue were measured using ELISA. ASP and SUB immunoreactivity was assessed using immunohistochemistry. The number of apoptotic cells was determined using the TUNEL method. The number of apoptotic cells in group 2 was increased compared to group 1. TOS in group 2 was increased compared to group 1. The numbers of apoptotic cells and TOS in group 3 were decreased compared to group 1. TOS was decreased in group 6 compared to group 2, but TOS was increased compared to group 1. We found ASP and SUB immunoreactivity in the liver. All alterations were reversed by addition of CAR. It appears that FA disrupts energy metabolism and CAR ameliorates the destructive effects of FA when used at appropriate doses, although CAR might be harmful at high doses.

The morphology of fabella and its prevalence in Turkish society

OBJECTIVE

Fabella is a sesamoid whose prevalence is unstable and can be found as bone or cartilage, which changes over time. This study aims to reveal the prevalence, distribution, gender differences, and morphometric characteristics of cartilage and bony fabella in the Turkish population.

PATIENTS AND METHODS

The study included 2.035 individuals over 18 years of age. MR images of 121 individuals, whose MR images of both knees could be obtained by anteroposterior and lateral radiographs of the participants, were evaluated retrospectively.

RESULTS

The prevalence of fabella was 39.6% in females, 38.4% in males, and 38.8% in total. The prevalence of cartilage fabella was 9.1%, whereas bone fabella incidence was 29.7% regardless of gender. The fabella's mean thickness, width, length, and distance to the epicondylus lateralis femoris were 3.84 mm, 6.04 mm, 6.23, and 31.26 mm, respectively.

CONCLUSIONS

The data of this study showing the occurrence and morphometric characteristics of bony and cartilaginous fabella allow early and accurate diagnosis of various pathological conditions caused by fabella.

Could the Prevalence and Distribution of Os Supratrochleare Dorsale and Patella Cubiti be the Key to Accurate Diagnosis?

BACKGROUND

The aim of this study was the prevalence of patella cubiti and os supratrochleare dorsale, and to detect the differences between genders.

MATERIALS AND METHODS

In the study, direct radiographs of 1646 people (959 females and 687 males), who presented to Fırat University Hospital between 01.01.2016 and 31.01.2019 and had elbow joint radiographs, were evaluated retrospectively. Of the radiographs evaluated, 346 were right and left elbow radiographs of the same people, 689 were just right elbow radiographs, and 611 were only left elbow radiographs.

RESULTS

The prevalence of os supratrochleare dorsale was 2.08% (20 in 959 women) in women, 2.62% (18 in 687 men) in men, and 2.3% (38 in 1646 people) in total. The prevalence of patella cubiti was found to be 0.42% (4 in 959 women) in women, 1.31% (9 in 687 men) in men, and 0.79% (13 in 1646 people) in total. In addition, the prevalence of both sesamoid bones only in the left elbow and in both elbows was determined with and without separation according to male-female genders.

CONCLUSION

We are of the opinion that knowing the prevalence and distribution of these sesamoid bones will help with establishing early and correct diagnoses for patients who present with complaints, such as elbow extension limitation and pain in the elbow area.

Adrenergic receptor behaviors of mesenchymal stem cells obtained from different tissue sources and the effect of the receptor blockade on differentiation

In this study, it was aimed to analyze behavioral changes of adrenergic receptors (ARs) in first three passages and osteogenic/adipogenic differentiation of mesenchymal stem cells (MSCs) derived from placenta fetal membrane (FM) and bone marrow (BM). It was also aimed to evaluate effects of receptor blockade on differentiation. We obtained first three passages of MSCs from placenta and BM samples. For cell identification, the cells were analyzed by flow cytometry using CD34, CD45 and CD3, CD105 antibodies in each passage. The effects of propranolol and phenoxybenzamine at incremental doses were analyzed by MTT. In addition, cell cultures were separately maintained with the blockers or without after second passage. After each passage and differentiation, α1A, α1B, α2A, α2B, β1, β2, β3 AR-mRNA expressions analyzed by RT-qPCR technique. BMP6 and PPARG mRNA expressions only after differentiation and passage 3 were analyzed. A microscopic examination was also performed. Our results showed that AR expression behaviors were different in MSCs obtained from different tissue sources. In particular, α_1A-AR and α_2A-AR were expressed with considerably high coefficients in differentiation under blocker effect in BM-derived MSCs. No such coefficients were observed in any group of placental MSCs. In addition, it was found that the blockers stimulated adipogenesis in BM-derived MSCs during osteogenic differentiation. MSCs exhibit protein expressions that vary according to source of tissue and differentiation. Given that MSCs from different sources are used for repair and modulation, our study makes implications of this variable expression intriguing in the clinical practice.

Synthesis of curcumin complexes with iron(iii) and manganese(ii), and effects of curcumin–iron(iii) on Alzheimer's disease

Plants provide a wealth of bioactive compounds which aid in exerting a substantial strategy for the treatment of neurological disorders such as Alzheimer's disease and dementia.

Dipyrone ameliorates behavioural changes induced by unpredictable chronic mild stress: gender differences

Purpose: Antidepressant effects of analgesics have been investigate in both clinical and experimental studies. The purpose of this study was to investigate if the analgesic-antipyretic drug, dipyrone, also had antidepressant-like effects. Methods: Depression-like effects were investigated in an unpredictable chronic mild stress (UCMS) model in both male and female mice. Cage changes, light-dark cycle reversal, cage tilting, wet floor, empty cage, foreign material on the floor and predator sounds were used to induce light stress at different times for six weeks. Dipyrone was administered intraperitoneally beginning from the third week. Splash, rota-rod (RR) and forced swimming (FST) tests were performed at the seventh week as behavioural tests to evaluate the antidepressant-like effects of dipyrone. Coat state score (CSS) and weights of animals were recorded at seventh weeks. Results were analyzed using one or two-way ANOVA followed by the Bonferonni post hoc test. Results: Weight of UCMS-exposed mice did not change compared with controls; however, significant changes were observed in CSS in both sexes of stressed mice (p

Dipyrone ameliorates behavioural changes induced by unpredictable chronic mild stress: gender differences

PURPOSE

Antidepressant effects of analgesics have been investigate in both clinical and experimental studies. The purpose of this study was to investigate if the analgesic-antipyretic drug, dipyrone, also had antidepressant-like effects.

METHODS

Depression-like effects were investigated in an unpredictable chronic mild stress (UCMS) model in both male and female mice. Cage changes, light-dark cycle reversal, cage tilting, wet floor, empty cage, foreign material on the floor and predator sounds were used to induce light stress at different times for six weeks. Dipyrone was administered intraperitoneally beginning from the third week. Splash, rota-rod (RR) and forced swimming (FST) tests were performed at the seventh week as behavioural tests to evaluate the antidepressant-like effects of dipyrone. Coat state score (CSS) and weights of animals were recorded at seventh weeks. Results were analyzed using one or two-way ANOVA followed by the Bonferonni post hoc test.

RESULTS

Weight of UCMS-exposed mice did not change compared with controls; however, significant changes were observed in CSS in both sexes of stressed mice (p.

Effects of Low Intensity Exercise Against Apoptosis and Oxidative Stress in Streptozotocin-induced Diabetic Rat Heart

Background The aim of this study was to investigate the effects of low intensity exercise on heart of streptozotocin (STZ)-induced diabetic rats. Materials and Methods The rats were randomly divided into 3 experimental groups: A (control), B (diabetic untreated), and C (diabetic treated with low intensity exercise); each group contains 8 animals. B and C groups received STZ. Diabetes was induced in 2 groups by a single intraperitoneal (i.p) injection of STZ (40 mg/kg, freshly dissolved in 0,1 M citrate buffer, pH 4.2). 2 days after STZ treatment, diabetes in 2 experimental groups was confirmed by measuring blood glucose levels. Rats with blood glucose levels of 250 mg/dl or higher were considered to be diabetic. Animals in the exercise group were made to run the treadmill once a day for 4 consecutive weeks. Exercise started 3 days prior to STZ administration. Results After induction of diabetes, histological abnormalities were observed, including myofibrillar loss, vacuolization of cytoplasm and irregularity of myofibrils. These alterations were attenuated by low intensity exercise. Our data indicates a significant reduction of oxidative stress and apoptosis in cardiomyocytes after exercise. Treatment of diabetic animals with low intensity exercise, decreased the elevated tissue malondialdehyde (MDA) levels and increased the reduced activities of the enzymatic antioxidants superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in cardiac tissue. Conclusion These findings suggest that low intensity exercise has a therapeutic protective effect in diabetes by decreasing oxidative stress and apoptosis, and by preservation of myocardial integrity.

Anatomy of the anteromedial thigh flap based on the oblique branch of the descending branch of the lateral circumflex femoral artery

Anteromedial thigh (AMT) flaps based on lateral circumflex femoral artery (LCFA) have characteristics which make them favourable for use in reconstruction of extensive thigh, head, neck and leg defects. AMT flap which is elevated on the artery has the advantages of low donor site morbidity and preservation of main arteries. Due to inconstant anatomy of the pedicle, the flap is mostly not preferable. Hence, we aimed to describe the anatomical features of the unnamed branch of the descending branch of the LCFA harvesting AMT flap. For this purpose, the external iliac artery was displayed bilaterally on 15 adult (13 males and 2 females; age range 55-82 years) preserved cadavers using latex injection. The perforator branch of the descending branch from the LCFA was microdissected under 4× loupe magnification. The perforator branch was located 28.53 (20.20-34.20) cm distal to the anterior superior iliac spine, 22.12 (13.40-28.00) cm distal to the pubic tubercle, and 13.20 (10.80-16.20) cm proximal to the interepicondylar line. At the level of origin point the mean diameter of the perforating branch was 0.17 cm and the mean diameter of its cutaneous branch was 0.14 cm. The mean length of the pedicle was 5.71 (3.70-9.00) cm. We conclude that our findings contribute to the literature in terms of anatomical knowledge for surgical safety.

Suprascapular foramen: a rare variation caused by ossified suprascapular ligaments

BACKGROUND

The aim of this study was to investigate the incidence of the suprascapular foramen in West Anatolian population.

MATERIALS AND METHODS

Eighty-one dried human scapulae of West Anatolian people of unknown ages and gender belonging to the Anatomy Department Laboratory of Dokuz Eylul University Medical School were examined macroscopically. The vertical and transverse diameters of the suprascapular foramen and central thickness of the ossified ligaments were measured with calliper in millimetres and digital calliper, respectively.

RESULTS

We observed the suprascapular foramen due to ossification of the suprascapular ligament only in 2 of 81 (2.47%) scapulae. The vertical and transverse diameters of the suprascapular foramen and central thickness of the ossified ligaments (No. 1 and No. 2) were measured as 8.0 mm vs. 4.0 mm, 3.6 mm vs. 2.0 mm and 4.0 mm vs. 1.4 mm, respectively.

CONCLUSIONS

The suprascapular foramen caused by ossified suprascapular ligament is rarely observed variation in West Anatolian population.

Difficulties in screening for peripheral neuropathies in children with diabetes

AIMS

To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children.

METHODS

A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the 'gold standard' for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods.

RESULTS

A total of 43 (49%) children (aged 6-18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%.

CONCLUSION

The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence.

Evaluation of early cardiac dysfunction in patients with systemic lupus erythematosus with or without anticardiolipin antibodies

The aim of this study was to use transthoracic Doppler echocardiographic (TTE) imaging methods to identify cardiac dysfunction, an indicator of subclinical atherosclerosis in asymptomatic systemic lupus erythematosus (SLE) patients in terms of cardiac effects. This study involved 80 patients: a study group ( n = 50) and control group ( n = 30). They were categorized into four subgroups: anticardiolipin antibodies (aCL) (+) ( n = 14) and aCL (−) ( n = 36); systemic lupus erythematosus disease activity index (SLEDAI) ≥ 6 ( n = 15) and SLEDAI < 6 ( n = 35); disease period ≥ 5 years ( n = 21) and disease period < 5 years ( n = 29); major organ involvement (+) ( n = 19), major organ involvement (−) ( n = 31). The ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E′) for the study group was found to be higher than the control ( p < 0.01). Systolic septal motion velocity (Ssm) was lower in the study group compared with the control ( p < 0.01). Left atrium (LA) dimension was greater in the study group than the control ( p < 0.01). Ssm was found to be lower in the aCL (+) patients compared with the control and aCL (−) groups ( p < 0.01, p < 0.05, respectively). LA dimension was greater in the aCL (+) and (−) groups compared with the control, ( p < 0.01, p < 0.05, respectively) and aCL groups compared with each other ( p < 0.05). The E/E′ ratio for the aCL (+) and (−) groups was found to be greater than the control ( p < 0.05). In the study, both the Ssm and the late diastolic septal velocity (sA′) was found to be lower in the SLEDAI ≥6 group compared with SLEDAI<6 group, ( p < 0.001, p < 0.05, respectively). LA dimension was statistically greater in the SLEDAI ≥6 group compared with the SLEDAI <6 group ( p < 0.001). E′ and early diastolic septal velocity (sE′) were statistically lower in the disease period >5 years group compared with the disease period <5 years group ( p < 0.01, p < 0.05, respectively). Carrying out regular scans with TTE image of SLE patients is important in order to identify early cardiac involvement during monitoring and treatment. Identifying early cardiac involvement in SLE may lead to a reduction in mortality and morbidity rates.

Effects of methylene blue in acute lung injury induced by blunt chest trauma

BACKGROUND

We studied whether methylene blue (MB) treatment blunts chest trauma-induced lung injury in rats.

MATERIAL AND METHODS

Forty male Sprague-Dawley rats, 200-300g, were used. The rats were divided into five groups (n=8): control, early contusion (EC), early contusion + methylene blue (2 mg/kg, EC+MB), late contusion (LC), and late contusion + methylene blue (2 mg/kg, LC+MB).

RESULTS

Histopathological analysis showed increased hemorrhage, alveolar wall thickness, edema, and inflammatory cell infiltrates in the EC and LC rats, which decreased upon MB treatment. Immunohistochemical studies revealed that MB reduced activation of inducible nitric oxide synthase (iNOS) and the number of active terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive cells. A significant increase was observed in the malondialdehyde (MDA) and nitric oxide (NO) levels in the EC group compared to the control group (p<0.05). In addition, a significant decrease was reported in the glutathione (GSH), superoxide dismutase (SOD), and glutathione peroxidase (GPx) levels (p<0.01), but no significant difference was observed in the catalase (CAT) levels among the groups. The MDA level was significantly higher in the LC group compared to the control group, whereas the GSH level was significantly lower compared to the control group. The NO level in the EC+MB group was significantly lower when compared to the NO level in the EC group (p<0.05).

CONCLUSION

The present study provides evidence that MB might serve as a therapeutic treatment for blunt chest trauma.

Childhood diabetic neuropathy: functional impairment and non-invasive screening assessment

AIM

Sensory diabetic neuropathy, determined by nerve conduction studies, is common in children with Type 1 diabetes. Diabetic neuropathy diagnoses are rarely made in paediatric daily care because they are asymptomatic, vibration detection is mostly normal and nerve-conduction testing is impractical. The present study aims to: (1) describe somatosensory dysfunction in children with diabetes, (2) test whether diabetes duration and HbA(1c) are related to somatosensory dysfunction and (3) identify the best screening test for large-fibre dysfunction, as indicated by nerve conduction studies.

METHODS

Forty-five children (age 13.2 ± 2.5 years) with Type 1 diabetes for 6.7 ± 2.5 years and matched control subjects were assessed by neurological examinations, nerve conduction tests and quantitative sensory testing on the feet using the protocol of the German Research Network on Neuropathic Pain. Abnormal nerve conduction was used as gold standard to define neuropathies.

RESULTS

We found a high prevalence of mechanical (38%) and thermal (24%) hypoesthesia often associated with hyperalgesia (47%). Tactile hypoesthesia (33%) was more frequent than pallhypaesthesia (11%). Only cold detection and mechanical pain thresholds were related to HbA(1c). Tactile hypoesthesia had the highest sensitivity (75%), specificity (89%) and positive (75%) and negative (89%) predictive values for neuropathies defined by nerve conduction tests (31% abnormal).

CONCLUSIONS

Almost half of the children with diabetes have subclinical large- and small-fibre neuropathies. Tactile detection was better than vibration for neuropathy assessment. Quantitative sensory testing is a valuable tool for assessment of neuropathy as well as a target of interventional studies in children with diabetes.

The arterial anatomy of the saphenous flap: a cadaveric study

The saphenous flap is a fasciocutaneous flap generally used for knee and upper third of the leg coverage. Due to various descriptions of the saphenous flap, such as venous, sensory, and free flap, the origin and distributing characteristics of the saphenous artery are important for plastic surgeons. The aim of this cadaveric study was to evaluate the anatomical features of the saphenous flap. The pedicles of the saphenous flap were dissected under 4 x loop magnification in thirty-two legs of 16 formalin-fixed adult cadavers. The findings of this anatomic study were as follows: Descending genicular artery originated from the femoral artery in all of the cases. The first musculoarticular branch, which arose from descending genicular, to the vastus medialis muscle existed in all dissections. The second branch was the saphenous artery which separately originated from the descending genicular artery in all of the cases. At the level of origin the mean diameter of the saphenous artery was found to be 1.61 mm. The muscular branches to the anterior or posterior sides of the sartorious muscle existed in all of the dissections. Two vena comitantes and a saphenous nerve were accompanying the saphenous artery in all cadavers. The mean distance between the origin of the artery and interepicondylar line of tibia was 115 mm. The muscular branches of the saphenous artery to the gracilis muscle were encountered 6.66% of the cases. The cutaneous branches numbered between one and four, and arose 3.5 to 9.5 cm from the site of origin of the saphenous artery. The distal end of the saphenous artery reached approximately 122 mm distally to the knee joint in all cases. Due to variations of the arterial anatomy and limited number of anatomic studies of the saphenous flap, we studied the topography and anatomy of the saphenous artery for increasing reliability of the saphenous flap.

What kinds of hand injuries are more likely to result in amputation? An analysis of 6549 hand injuries

We analysed 6549 hand injuries treated between 1992 and 2005 at a specialist hospital in Turkey to identify risk factors for amputations. There were 2899 (44%) hand amputations. Left-side injuries were more prone to amputation. The risk of amputation was higher in men, workers and those in the 15-24 and 45-54 year-old age groups. Compared to home, commercial areas were the places with highest risk, followed by farms and industrial/construction areas. The majority of amputations occurred in industrial/construction areas (87%). Among objects/substances producing injury, watercraft led to the highest risk of amputation and contact with machinery was the mechanism with highest risk. Press machines were the most frequent objects causing amputation both in men and women, followed almost equally by powered wood cutters in men. Doors were the most frequent objects of amputation in children, followed by powered wood cutters. Education, enforcement, and improved engineering are the keys to prevent amputations. Precluding illegal child labour is essential.

Obstructive sleep apnoea, cigarette smoking and plasma orexin-A in a sleep clinic cohort

Orexin-A is a neuropeptide involved in the regulation of food intake and the sleep-wake cycle. This study investigated plasma orexin-A levels in a sleep clinic cohort, adjusting for smoking habits, in 76 participants comprising 41 with obstructive sleep apnoea (OSA) (apnoea-hypopnoea index [AHI] 44.1 +/- 19.1 events/h) and 35 without OSA (AHI 6.3 +/- 4.7 events/h). Plasma orexin-A levels were significantly lower in OSA patients (15.0 +/- 4.6 ng/ml) compared with those without OSA (31.4 +/- 6.5 ng/ml). In non-OSA subjects, there was no significant difference between never smokers and ex/current smokers in plasma orexin-A levels (32.9 +/- 9.5 versus 29.7 +/- 8.9 ng/ml, respectively) whereas, in the OSA sub-group, orexin-A levels were significantly lower in never smokers than in ex/current smokers (4.0 +/- 1.2 versus 21.4 +/- 7.0 ng/ml). A significant inverse relationship was found between plasma orexin-A levels and AHI amongst never smokers, but there was no significant relationship amongst ex/current smokers. These results confirm previous studies demonstrating lower levels of plasma orexin-A in OSA patients and indicate that smoking may affect orexin-A levels and AHI.

Obstructive Sleep Apnoea, Cigarette Smoking and Plasma Orexin-A in a Sleep Clinic Cohort

Orexin-A is a neuropeptide involved in the regulation of food intake and the sleep-wake cycle. This study investigated plasma orexin-A levels in a sleep clinic cohort, adjusting for smoking habits, in 76 participants comprising 41 with obstructive sleep apnoea (OSA) (apnoea-hypopnoea index [AHI] 44.1 ± 19.1 events/h) and 35 without OSA (AHI 6.3 ± 4.7 events/h). Plasma orexin-A levels were significantly lower in OSA patients (15.0 ± 4.6 ng/ml) compared with those without OSA (31.4 ± 6.5 ng/ml). In non-OSA subjects, there was no significant difference between never smokers and ex/current smokers in plasma orexin-A levels (32.9 ± 9.5 versus 29.7 ± 8.9 ng/ml, respectively) whereas, in the OSA sub-group, orexin-A levels were significantly lower in never smokers than in ex/current smokers (4.0 ± 1.2 versus 21.4 ± 7.0 ng/ml). A significant inverse relationship was found between plasma orexin-A levels and AHI amongst never smokers, but there was no significant relationship amongst ex/current smokers. These results confirm previous studies demonstrating lower levels of plasma orexin-A in OSA patients and indicate that smoking may affect orexin-A levels and AHI.

[Headache and diplopia in an extremely obese adolescent]

BACKGROUND

The prevalence of idiopathic intracranial hypertension is increased in overweight children and adolescents.

CASE REPORT

In a fifteen-year old, extremely obese adolescent with a history of headache and diplopia treatment with acetazolamide resulted in relief of the neurological symptoms.

Student evaluation of an integrated, spiral model of epidemiology education at the Ege University

OBJECTIVES

The Ege University Faculty of Medicine (EUMF) introduced a community-oriented undergraduate curriculum in 2001. In developing the epidemiology portion of the new curriculum, learning objectives were written for their relevance to different learner stages within the general curriculum and to Turkey's public health problems. Key learning objectives were that students should be able to comprehend the moral values of scientific research, principles of study design and evidence appraisal, and the role of epidemiology in clinical practice. The curriculum included didactic lectures and group activities. The aim of the present study was to explore third-year students' perceptions of the epidemiology curriculum.

METHODS

The program was evaluated at the end of our students' third year through written evaluations using quantitative and qualitative methods. Two hundred fifty-five students (92.7%) of all third-year medical students participated in the evaluation. Quantitative methods were based on student ratings, whereas qualitative method assessments involved content analysis of the students' open-ended statements.

FINDINGS

Based on responses to fixed response items, more than seven out of every 10 students appreciated the value of epidemiology to the work of physicians. More than six out of 10 students evaluated the curriculum favorably, but only a third indicated that they became more interested in epidemiology with time, and one-quarter found epidemiology challenging. In students' open-ended responses, the most frequent positive statements referred to students' heightened interest in research and appreciation of the curriculum's interactive teaching. Some students criticized the content as difficult and felt that there were too many didactic lectures.

CONCLUSION

Based on their evaluations, students found our new epidemiology curriculum acceptable, and regarded it as relevant and valuable to their future practice.

Antidepressant-like effect of tramadol in the unpredictable chronic mild stress procedure: possible involvement of the noradrenergic system

Tramadol, which inhibits the reuptake of noradrenaline and serotonin, is effective in animal models of depression. Its antidepressant-like effects may be mediated mainly by the noradrenergic system. This study investigated the role of the noradrenergic system in the antidepressant-like effects of tramadol and desipramine in the unpredictable chronic mild stress model. We assessed the involvement of beta-adrenoreceptors, particularly beta2-receptors in the activity of these drugs. In addition, we measured the level of noradrenaline and its metabolite 3-methoxy-4-hydroxy-phenylglycol (MHPG) in the locus coeruleus, hypothalamus, hippocampus and cerebellum in stressed mice. Unpredictable chronic mild stress induced a degradation of coat state and decreased grooming behaviour in the splash test, which was reversed by the chronic administration of tramadol (20 mg/kg) and desipramine (10 mg/kg). The nonselective beta-adrenoreceptor antagonist propranolol (5 mg/kg, intraperitoneally) and the selective beta2-receptor antagonist ICI 118,551 (2 mg/kg, intraperitoneally) reversed the antidepressant-like effects of tramadol and desipramine. Moreover, chronic tramadol and desipramine treatment increased the level of noradrenaline (NA) and MHPG in the locus coeruleus but not in the cerebellum, whereas only MHPG level was increased in the hypothalamus. Tramadol, however, increased the levels of MHPG and NA in the hippocampus, whereas desipramine only increased NA level. These data support the view that the noradrenergic system plays an important role in the antidepressant-like action of tramadol.

Rho-kinase inhibitor, Y-27632, has an antinociceptive effect in mice

The possible antinociceptive effect of a Rho-kinase inhibitor, (+)-(R)-trans-4-(1-aminoethyl)-N-(4-pyridyl) cyclohexanecarboxamide dihydrochloride monohydrate (Y-27632), was investigated in mice by using the hot-plate and abdominal constriction response (writhing) tests. In addition, the expression of Rho-kinase protein (ROCK-2) was studied in the mouse brain and spinal cord by Western blotting. Male balb/c mice (n=8, for each group) were used in the experiment. Hot-plate latency and the number of writhes were recorded in control and in Y-27632-treated (1-5 mg/kg, i.p.) groups. Y-27632 (1 mg/kg) did not affect hot-plate latency; however, it considerably diminished the number of writhes, from 89+/-12 in control to 30+/-6 in the mice treated with 1 mg/kg Y-27632 (P=0.001). At a higher dose (5 mg/kg), Y-27632 prolonged the hot-plate latency from 8.7+/-1.0 s to 14.4+/-1.7 s (P=0.005) and decreased the number of writhes from 80+/-8 to 24+/-7 (P=0.002). Western blot analysis revealed that mouse spinal cord and brain homogenates expressed ROCK-2 protein. These results indicate that Rho-kinase may be involved in nociception and that its inhibitors, such as Y-27632, may represent a new type of antinociceptive drug.

Effects of desipramine and tramadol in a chronic mild stress model in mice are altered by yohimbine but not by pindolol

This study investigated the antidepressant-like effects of a chronic treatment with either tramadol (20 mg/kg, i.p.) or desipramine (10 mg/kg, i.p.) in the unpredictable chronic mild stress model of depression in BALB/c mice. Mice were first submitted to a 2 week drug-free unpredictable chronic mild stress before the onset of the treatments. The unpredictable chronic mild stress regimen induced a degradation of the state of the coat and decreased the grooming behaviour in the splash test. These physical and behavioural abnormalities were counteracted by tramadol and desipramine. Furthermore, we observed neither a significant acceleration nor diminution by pindolol (5-HT1A/1B receptor antagonist, 10 mg/kg, i.p.) on the antidepressant-like actions of desipramine and tramadol whereas yohimbine (alpha2-adrenergic receptor antagonist, 2 mg/kg, i.p.) antagonized the antidepressant-like effects of both drugs during the unpredictable chronic mild stress regimen. The results of the study support the suggestion that antidepressant-like effect of tramadol and desipramine in mice in the unpredictable chronic mild stress model is mediated by the noradrenergic system rather than the serotonergic system.

Cystic leukoencephalopathy without megalencephaly: A distinct disease entity in 15 children

OBJECTIVE

To describe a distinctive syndrome of nonprogressive encephalopathy, normo- or microcephaly, and early onset of severe psychomotor impairment in 15 white patients, including two siblings and two first cousins.

METHODS AND RESULTS

MRI revealed bilateral cysts in the anterior part of the temporal lobe and white matter abnormalities with pericystic abnormal myelination and symmetric lesions in frontal and occipital periventricular regions. None of the usual inborn errors of metabolism/infectious diseases associated with leukoencephalopathy and bilateral anterior temporal lobe cysts were detected.

CONCLUSIONS

These patients' clinical signs and cranial MRI abnormalities are strikingly similar and may represent a distinctive disease with autosomal-recessive inheritance: cystic leukoencephalopathy without megalencephaly.

Involvement of potassium channels and nitric oxide in tramadol antinociception

It has been considered that tramadol, a centrally acting analgesic, shows its effect via opiatergic, noradrenergic, and serotonergic systems. It has a low affinity for opioid receptors, and its effect can be partly blocked by naloxone. Since the noradrenergic and serotonergic mechanisms are still unknown, other systems which are associated with pain and analgesia may have a role on the antinociceptive effect of tramadol. The aim of this study was to evaluate the effects of K+ channels and nitrergic systems on the antinociceptive action of tramadol. The antinociceptive effects of tramadol were determined in mice by the hot plate test. To examine the effects of K+ channels and the nitrergic system nonspecific voltage-dependent K+ channel blockers 4-aminopyridine (4-AP) and tetraethylammonium (TEA), nitric oxide (NO) precursor L-arginine, and the NO synthase (NOS) inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) were used. Our results indicated that 4-AP, TEA, and L-arginine reduced the antinociceptive effect of tramadol. However, L-NAME augmented the antinociceptive effect of tramadol. The reduction of the effects of tramadol by L-arginine was reversed by L-NAME. The results of our study suggest that nonspecific voltage-dependent K+ channels and nitrergic system have a role on the antinociceptive effect of tramadol in mice hot plate test.

Dual effects of nitric oxide in the mouse forced swimming test: possible contribution of nitric oxide-mediated serotonin release and potassium channel modulation

Recent findings have indicated that nitric oxide (NO) may change the duration of immobility biphasically in the forced swimming test, which is a useful experimental model for screening antidepressant-like activity in rodents. In the present study, we have investigated the role of serotonin and of potassium (K(+)) channels in the dual effects of NO in the mouse forced swimming test (MFST). For this purpose, we tested the effects of l-arginine, an NO precursor, the NO synthase inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME), and of K(+)-channel blockers tetraethylammonium (TEA) and 3,4-diaminopyridine (3,4-DAP). In addition, we used sertraline as a serotonin reuptake inhibitor and cyproheptadine as a serotonin antagonist. l-Arginine increased the duration of immobility in the MFST in low doses (25 mg/kg ip) but decreased it in higher doses (500 and 1000 mg/kg ip). Low doses of l-NAME (50 and 75 microg icv) decreased while higher dose of this drug (150 microg icv) increased the immobility time. TEA (5 microg icv) and 3,4-DAP (0.05 microg icv) significantly reduced the time, whereas K(+) channel opener pinacidil increased the duration of immobility. l-Arginine (100 mg/kg ip) significantly antagonised the effects of l-NAME (50 microg), 3,4-DAP and TEA. Higher dose of l-arginine (500 mg/kg ip) significantly potentiated the effects of 3,4-DAP and TEA, but reduced the effect of pinacidil. Low doses of l-arginine antagonized, but higher doses of l-arginine potentiated the antidepressant-like effect of sertraline. Sertraline potentiated the effects of 3,4-DAP and TEA, but reversed the effect of pinacidil. Cyproheptadine reduced the anti-immobility effect of l-arginine and 3,4-DAP. At the highest effective doses, drugs did not impair the motor functions. These data support the hypothesis that NO effects may involve the release of serotonin and/or modulation of K(+) channels.

[Istanbul University Cerrahpaşa School of Medicine Department of Obstetrics and Gynecology: the list of diplomas and the related thesis of graduates in the twentieth century (1892-2000)]

Obstetrics Gynecology Department of Cerrahpaşa Faculty of Medicine is the first and the unique clinic which has ever been founded in Ottoman Empire by Besim Omer Pasha (Akalin) in 1892 under the name of "Veladethane" (meaning labor-in hospital) upon a decree of the Emperor. In 1909, it has been transferred from its first building located in Demirkapi Sirkeci to Kadirga and following a change from Kadiga to Haydaraşa in 1928. In 1933, after the university reform, it has moved again from Haydarpaşa. In 1966, from Haseki to Cerrahpaşa to its last and actual residence. Covering all these years, ten residents from Sirkeci, 17 from Kadirga, 7 from Haydaraşa, 195 from Haseki and 167 from Cerrahpaşa were graduated, all together they are 395 graduates. In this documentary you will find the list of their diplomas and thesis that have been officially accepted from 1946 to the presenting time. Essentially, many clinic, departments and specialty hospitals have been founded in Turkish Republic by these graduates and their successors of this faculty which has anniversarried its 108 years as an Obstetrics and Gynecology Department.

The effects of some K(+) channel blockers on scopolamine- or electroconvulsive shock-induced amnesia in mice

The effects of three K(+) channel blockers, 4-aminopyridine, 3, 4-diaminopyridine and apamin, on scopolamine- or electroconvulsive shock-induced amnesia were investigated in mice by using a one-trial step-down passive avoidance system. Scopolamine and electroconvulsive shock reduced the retention latency of passive avoidance, which indicated the amnestic effect of these treatments. 4-Aminopyridine, 3,4-diaminopyridine and apamin injected immediately after the acquisition trial, reversed the amnestic effect of scopolamine or electroconvulsive shock in a dose-dependent manner. None of the drugs or electroconvulsive shock treatment affected the rotarod or activity cage performance of the mice. These results indicate that K(+) channel blockers may improve cognitive deficits when memory is impaired by a drug or any other manipulation.

Influence of insulin resistance on total renin level in normotensive women with polycystic ovary syndrome

OBJECTIVE

To evaluate the influence of insulin resistance on the plasma total renin level in normotensive women with polycystic ovary syndrome (PCOS).

DESIGN

Prospective, controlled study.

SETTING

University hospital.

PATIENT(S)

Twenty-five normotensive women with PCOS were compared with 11 normotensive control women with regular cycles and no features of PCOS.

INTERVENTION(S)

Clinical, ultrasonographic, and hormonal findings were used to define PCOS. Insulin resistance was estimated by continuous infusion of glucose with model assessment in the early follicular phase.

MAIN OUTCOME MEASURE(S)

Plasma levels of total renin and angiotensin II and serum levels of gonadotropins, DHEAS, total T, free T, 17 alpha-hydroxyprogesterone, and PRL were determined.

RESULT(S)

Plasma concentrations of angiotensin II were similar in the PCOS group and the control group. The concentration of total renin in plasma was higher in women with PCOS than in healthy women independent of insulin resistance. The sensitivity and specificity of the plasma total renin level to diagnose women with PCOS were calculated as 80% and 71.4%, respectively.

CONCLUSION(S)

The plasma total renin level is higher in normotensive women with PCOS than in healthy women independent of insulin resistance.

Lipid peroxidation and antioxidants in preeclampsia

OBJECTIVE

To determine the changes in plasma levels of lipid peroxide, vitamin E and vitamin C in women with preeclampsia and to investigate their relationship with diastolic blood pressure.

STUDY DESIGN

Cross sectional study consisting of 22 preeclamptic and 21 healthy pregnant women. Fasting venous blood samples were collected during the antepartum period and plasma levels of malondialdehyde, alpha-tocopherol and ascorbic acid were measured.

RESULTS

In the preeclamptic group malondialdehyde, a lipid peroxidation product, was significantly increased, while vitamins E and C were significantly decreased compared to healthy pregnant women. A strong correlation was detected between malondialdehyde and antioxidant factors (vitamins E and C) with blood pressure.

CONCLUSION

Our findings are consistent with previous studies suggesting that lipid peroxidation is an important factor in the pathogenesis of preeclampsia. In preeclampsia, antioxidant nutrients are excessively utilised to counteract the cellular changes mediated by free radicals.