Validity and reliability of the Modified Four Square Step Test in individuals with ankle sprain

BACKGROUND

Postural instability and gait abnormalities are frequently observed after an ankle sprain. A modified Four Square Step Test (mFSST) was developed to assess dynamic balance during gait. The aim of this study was to evaluate the reliability and validity of the mFSST in individuals with ankle sprains.

METHODS

The study included 39 individuals with grade 1 and 2 ankle sprains with a mean age of 30.36 ± 6.21 years. The dynamic balance of the participants was assessed with the mFSST and Timed Up & Go test (TUG). To determine the test-retest reliability of the mFSST, the test was repeated approximately 1 h apart.

RESULTS

The test-retest reliability of the mFSST was excellent (ICC = 0.85). Furthermore, when the concurrent validity of the mFSST was examined, a high correlation was found between with the TUG (r = 0.78, p < 0.001).

CONCLUSION

The mFSST is a valid and reliable clinical assessment method for evaluating dynamic balance during walking in individuals with ankle sprains. We think that the mFSST is preferable in clinical evaluations because its platform is easy to prepare and requires very little equipment.

Bilateral external oblique intercostal plane block (EOIPB) in patients undergoing laparoscopic cholecystectomy: A randomized controlled trial

OBJECTIVES

To measure tramadol intake in the first 24 hours post-surgery. In addition, pain scores and quality of recovery were evaluated as secondary outcomes.

METHODS

A total of 80 adult patients scheduled for laparoscopic cholecystectomy were randomized into 2 groups (with and without external oblique intercostal plane block [EOIPB]). Control group of patients received standard multimodal analgesia, EOIPB was applied on each side to patients in EOIPB group in addition to multimodal analgesia. The primary outcome was to evaluate tramadol consumption at postoperative 24 hours. Secondary outcomes were evaluating the Numeric Rating Scale (NRS) scores, postoperative Quality of Recovery score (QoR-15), sedation score, the incidence of nausea and vomiting, and antiemetic consumption.

RESULTS

In EOIPB group, median (Q1, Q3) tramadol consumption values for 24 hours (0 [0,50] mg) were found to be significantly lower than the control group (50 [50,100] mg) (median difference -50) (p<0.001). NRS values during rest and motion were lower in EOIPB group compared to the control group at all measurement points within 24 hours (p<0.05). The total QoR-15 scores were significantly higher in EOIPB group compared to the control group (p<0.001). No differences were detected in other secondary outcome parameters.

CONCLUSION

External oblique intercostal plane block resulted in less postoperative tramadol consumption. However, there were no minimal clinically important differences about postoperative opioid consumption. On the other hand, compared to multimodal analgesia addition of EOIPB improved overall QoR-15 scores at postoperative 24 hours.Clinical Trial Reg. No.: NCT05536557.

Cryopreservation of Lilium candidum germplasm: analysis of pre- and post-freeze treatments

BACKGROUND

Lilium candidum L. is a perennial ornamental plant that has various medicinal properties and is used in the cosmetic industry. The species is facing threats from urbanization and climate change and requires urgent protection. The most secure and efficient technology for the long-term storage of plant genetic resources is cryopreservation, which involves preserving genetic material at extremely low temperatures.

OBJECTIVE

Today, plant biodiversity is endangered because of the narrowing of its natural distribution areas and/or destruction for different purposes. This study concentrated on creating a cryopreservation process using shoot tips and calluses as explant sources for the long-term conservation of L. candidum species.

MATERIALS AND METHODS

Populations of L. candidum naturally distributed from three different regions of Turkey (Kepsut, Balikesir; the area surrounding Bafa Lake, Aydin; and Fethiye-Mugla) were grown in vitro to supply shoot tip and callus explants. Prior to freezing by droplet-vitrification and vitrification techniques, shoot tips and calluses were treated with MS nutritional medium supplemented with 0.4 M sucrose 7 g per L agar and plant vitrification solution 2 (PVS2).

RESULTS

Cryopreserved shoot tips showed the highest levels of regeneration (71.8%) after a PVS2 treatment of 90 min, while calluses showed the highest levels of regrowth (63.9%) after a PVS2 exposure of 60 min.

CONCLUSION

High levels of regrowth are produced when the various cryopreservation procedures described here are used to preserve both shoot tip and callus explants. This potentially makes the method promising for the long-term preservation of endangered L. candidum varieties. Doi.org/10.54680/fr23510110512.

Differential responses of the scavenging systems for reactive oxygen species (ROS) and reactive carbonyl species (RCS) to UV-B irradiation in Arabidopsis thaliana and its high altitude perennial relative Arabis alpina

The present work aimed to compare antioxidant response and lipid peroxide detoxification capacity of an arctic-alpine species Arabis alpina to its close relative model species Arabidopsis thaliana under acute short duration (3 h and 6 h) UV-B stress (4.6 and 8.2 W/m²). After 3 and 6 h exposure to UV-B, A. alpina showed lower lipid peroxidation and H₂O₂ accumulation when compared to A. thaliana. Moreover, F_v/F_m value of A. thaliana dropped to 0.70, while A. alpina dropped to 0.75 indicating better protection of PSII in this species. For elucidation of the antioxidant response, activities of superoxide dismutase (SOD), catalase (CAT), peroxidase (POX), ascorbate peroxidase (APX), glutathione reductase (GR) and dehydroascorbate reductase (DHAR) were measured. SOD induction with 6 h of UV-B was more prominent in A. alpina. Also, A. alpina had higher chloroplastic FeSOD activity when compared to A. thaliana. APX activity was also significantly induced in A. alpina, while its activity decreased at 3 h or did not change at 6 h in A. thaliana. A. alpina was able to maintain constant CAT activity, but drastic decreases were observed in A. thaliana at both time points. Moreover, A. alpina was able to maintain or induce aldehyde dehydrogenase (ALDH), alkenal reductases (AERs) and glutathione-S-transferases (GST) activity, while an opposite trend was observed in A. thaliana. These findings indicate that A. alpina was able to maintain/induce its antioxidant defence and lipid peroxide detoxification conferring better protection against UV-B.

Relationship between healthy lifestyle behaviors and health related quality of life in turkish school-going adolescents

Background

The aim of this study is to determine the relationship between healthy lifestyles behaviours and health-related quality of life (HRQOL) among Turkish school-going adolescents.

Subjects and Methods

This cross-sectional study was conducted among 413 students studying in a secondary school of Istanbul, Turkey. Data were collected using a questionnaire containing socio-demographic characteristics, health promoting lifestyle behaviors and the Turkish generic health-related quality of life questionnaire for children (Kid-KINDL). Data were analyzed using descriptive statistics, t-test, Pearson's product-moment correlation, and a hierarchical multiple regression analysis.

Results

Univariate statistics showed that gender, school grade, parental education level, monthly income, and all healthy lifestyles behaviours except for fruit and vegetable intake were associated with adolescents' HRQOL. Multivariate statistics indicated that participation in social activities and talking about their problems were the most important predictors of better HRQOL. Healthy lifestyles behaviours, especially talking about their problems to close friends and/or family members and participation in leisure-time social activity were related to better HRQOL of Turkish adolescents, independently of socio-demographic factors.

Conclusion

Collaborative efforts among providers of school health and counseling services are urgently needed to improve all aspects of adolescent health.

An ethnobotanical study in Midyat (Turkey), a city on the silk road where cultures meet

BACKGROUND

Studies of ethnobotanical usages in south-eastern Turkey are rare. To widen this field of knowledge, we conducted an ethnobotanical study in Midyat (Mardin Province), Turkey.

METHODS

The field study was completed during three years (2007-2010). Our aim was to document the ethnobotanical uses of local plants and to make an ethnobotanical inventory of uncommon plants using qualitative interviews.

RESULTS

During field studies, 368 voucher specimens were collected in the investigated area. Ninety-two traditionally used plant species were reported from Midyat and surrounding vicinities in Turkey. Among the 92 taxa (129 usages), 35% were used for medical purposes, 22% for food, 13% for animal fodder, 7% as ornamental plants and dyes, 6% as brooms, 4% for latex and as fragrance, 4% for herbal tea, molasses and wine preparation, 3% for agricultural purposes, and 6% for other purposes. Comparative assessment showed that Teucrium polium (0.51), Matricaria aurea (0.26), Alcea setosa (0.21), and Malva neglecta (0.21) have the highest recorded UVs, and the following taxa had UVs between 0.10-0.20: Anthemis cotula (0.12), Allium cepa (0.13), Alcea striata subsp. striata (0.14), Crupina crupinastrum (0.12), Papaver rhoeas (0.13), Salvia multicaulis (0.14), Thymbra spicata (0.11), and Vicia pannonica subsp. striata (0.15). We reported the ethnobotanical usages of 21 taxa for the first time, in addition to indicating usages previously recorded in the literature. We also recorded four endemic plant usages in the area: Alkanna trichophila var. mardinensis, Centaurea kurdica, Centaurea stapfiana, and Sideritis libanotica subsp. linearis. They have variable leaf and flower morphology that are used traditionally. They are present as well-developed populations and thus their conservation status is not compromised. Additionally, Thymbra sintenisii is a recorded species that is classified as a rare and extensively used species in the region.

CONCLUSIONS

These results contribute to the fundamental knowledge of ethnobotanical usages in Midyat. To date, ethnobotanical studies have not been carried out in this region. This investigation uncovered usages of endemic medicinal plant species and traditional knowledge of Midyat communities living in a mixed culture. The people of Midyat, Batman, and Şırnak are Turkish citizens from various ethnic backgrounds, such as Kurdish, Arabic, and Syriac. We compared our data with results from other studies conducted in Turkey, particularly in south-eastern and eastern regions, as well as with studies from bordering countries, Iraq, Jordan, Syria, and Iran. Nonetheless, more work needs to be conducted to extend the present knowledge for locals to contribute to and evaluate economic potential in the region.

Ultrasonic Spray Pyrolysis Deposited Copper Sulphide Thin Films for Solar Cell Applications

Polycrystalline copper sulphide (Cu _x S) thin films were grown by ultrasonic spray pyrolysis method using aqueous solutions of copper chloride and thiourea without any complexing agent at various substrate temperatures of 240, 280, and 320°C. The films were characterized for their structural, optical, and electrical properties by X-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive analysis of X-rays (EDAX), atomic force microscopy (AFM), contact angle (CA), optical absorption, and current-voltage (I-V) measurements. The XRD analysis showed that the films had single or mixed phase polycrystalline nature with a hexagonal covellite and cubic digenite structure. The crystalline phase of the films changed depending on the substrate temperature. The optical band gaps (E_g ) of thin films were 2.07 eV (CuS), 2.50 eV (Cu_1.765S), and 2.28 eV (Cu_1.765S-Cu₂S). AFM results indicated that the films had spherical nanosized particles well adhered to the substrate. Contact angle measurements showed that the thin films had hydrophobic nature. Hall effect measurements of all the deposited Cu _x S thin films demonstrated them to be of p-type conductivity, and the current-voltage (I-V) dark curves exhibited linear variation.

Effects of isolation rooms on the prevalence of hospital acquired pneumonia in a respiratory ICU

BACKGROUND

The incidence of hospital acquired pneumonia (HAP) varies according to the type of intensive care units (ICUs).

AIM

The aims of this study were to determine the frequency of hospital acquired pneumonia (HAP) and the effect of isolation rooms on the frequency of pneumonia in the ICU.

MATERIALS AND METHODS

The present investigation was carried out between January 2004 and July 2008. The ICU, which was 4-bed ward-type between January 2004 and February 2006 (1st period), was reconfigured as isolated rooms with only 2 beds each after March 2006 (2nd period). 153 and 379 patients were followed up in the ICU in the 1st and 2nd periods, respectively. Blood, sputum, and deep tracheal aspiration cultures were used for the isolation of the causative agents.

RESULTS

No significant difference was detected between the general characteristics of patients. HAP developed in 101 patients (19%). The prevalence of HAP was 22.9% in the 1st period and 17.4% in the 2nd period. During the 1st and 2nd periods, the HAP infection densities were 22.2 and 16.1/1000 patient-days and the ventilator-associated pneumonia densities were 48.1 and 37.6/1000 ventilator-days, respectively. Eighty-six percent of HAP was ventilator-associated pneumonia (VAP).

CONCLUSIONS

Isolation rooms in the ICU may be an effective strategy to control and decrease the rate of pneumonia in the ICU in addition to other preventive strategies.

What happens at the adjacent knee joint after total hip arthroplasty of Crowe type III and IV dysplastic hips?

We prospectively evaluated 30 hips of 22 patients who had normal knees with a mean age of 53.4 years (range, 38-72 years). In the early postoperative period, genu valgum deformity was observed in all knees. Of 22 patients, 17 complained of severe pain owing to strain in the medial collateral ligament and iliotibial tract. Postoperatively, the ipsilateral extremities of the patients were extended by a mean of 16.5 mm (8-25 mm). Q angles of the patients increased by a mean of 4.4° ± 2.5° (P < .001). Although the Harris hip scores were improved (40.7-87.8 points), postoperative Lysholm-Gillquist knee scores were significantly reduced (92-76 points, P < .001). Reduction of displaced hips into the anatomical hip center and lengthening the extremity despite shortening procedure may lead to strain at the knee joint iatrogenically, particularly with the mechanical effect of tensor fascia lata, which results with changes in the knee biomechanics.

Effect of smoking intensity on thyroid volume, thyroid nodularity and thyroid function: the Melen study

AIM

The purpose of our study was to determine the association between smoking habit, goiter, thyroid functions and ultrasonographic nodularity in moderately iodine deficient area.

METHODS

The MELEN study is a prospectively designed survey on the prevalence of thyroid diseases in Turkish adults. A total of 2298 subjects with a mean age of 50 (age range 18 to 92) were interviewed. Smoking habits were registered from questionnaires and subsequent interviews with a physician. Thyroid ultrasonography was performed and interpreted by the same experienced physician, using the same equipment. After an overnight fast, blood samples were collected from all the study subjects for the determination of serum free thyroxine, thyroid stimulating hormone (TSH) were measured.

RESULTS

Mean thyroid volumes of current smokers were significantly lower than either former or never smokers (P=0.014). There were no difference according to smoking habits on goiter and established multinodularity in current smokers (P<0.05). Heavy smokers (>20 pack/year) had higher thyroid volumes, higher goiter and multinodular goiter (MNG) prevalence than moderate smokers (P<0.001). Thyrotoxicosis (TSH<0.35) cases were more frequent among heavy smokers than moderate smokers (14.1% versus 8.2%, P<0.001; respectively). Heavy smoking independently predicted goiter (odds ratio: 1.459 [95% confidence interval: 1.029 and 2.068]; P=0.034).

CONCLUSION

Heavy smoking was associated with increased prevalence of thyroid multinodularity and goiter in respect to moderate smoking. No association was found between smoking habit and thyroid dysfunction.

The effect of total synovectomy in total knee arthroplasty: a prospective randomized controlled study

PURPOSE

The apparent synovial hypertrophy in some cases of noninflammatory knee osteoarthritis suggests that total synovectomy may provide beneficial inflammatory and pain relief after total knee arthroplasty. The aim of the study was to compare the effect of synovectomy on the postoperative pain, bleeding and functional outcome after surgical treatment of knee osteoarthritis.

METHODS

A total of 50 patients with bilateral, non inflammatory, primary knee osteoarthritis were included in the study. Bilateral total knee replacement was performed at the same session. Total synovectomy and total knee arthroplasty (study group) were applied to a randomly selected side, and the total knee arthroplasty alone (as control group) was applied to the contralateral side of the same patient. The overall efficacy of both procedures was assessed postoperatively by determination of blood loss from the drain, pain and functional scores. The Visual Analogue Scale of pain and the Knee Society Knee Score were used to compare the two groups at 3rd, 6th and 12th months, postoperatively.

RESULTS

During the postoperative 48 h, the mean blood loss in the study group (with synovectomy) was significantly higher than the control group (P=0.005). However, in the postoperative follow-up time, there was no significant difference in pain relief and in the Knee Society Score between the two groups.

CONCLUSION

Performing synovectomy in patients with primary knee osteoarthritis does not seem to have any clinical advantage besides it might increase blood loss and recurrent hemarthrosis postoperatively. Thus, during arthroplasty surgery, it should not be performed routinely.

Results of early surgical treatment of intra-articular complex fractures of the humerus in adults

AIM

We present our results for intra-articular fractures of the elbow which we have treated with early restoration of joint combined with the earliest possible motion.

MATERIALS AND METHODS

Our study group consists of 27 patients and all operations were done in Ankara Atatürk Research and Training Hospital 3rd Orthopaedic Clinic between February 2004 and December 2008. According to AO classification, all of the cases were of type C. Mean age of patients was 24.8 years (17-32), mean follow-up period was 30 (22-38) months. All patients underwent early open reducation, stable osteosynthesis and early rehabilitation.

RESULTS

Clinical results were evaluated according to the Mayo Elbow Performance Scores which were excellent in 20 patients (74%), good in 4 (14.8%), fair in 2 (7.4%), and bad in 1 patient (3.7%). Postoperative complications including infection found in 2 patients (7.4%), minor joint deformity (varus, valgus) in 8 (29.6%), loss of power (about 1.5 kg) in 14 (51.8%), and medium level heterotypic ossification in 2 patients (7.4%).

CONCLUSION

We believe that early (first 48 hours) surgical osteosynthesis with rigid fixation of intra-articular humerus fractures combined with postoperative early rehabilitation gives excellent results (Fig. 6, Tab. 3, Ref. 18).

Primary metal-on-metal total hip arthroplasty with large-diameter femoral heads: a clinical trial of 59 hips

Large-diameter femoral heads with nearly anatomical sizes became available for metal-on-metal total hip arthroplasty after recent advances in metal-on-metal technology. We retrospectively studied the clinical and radiological results in 59 hips of 54 patients (32 women and 22 men, mean age 54.4 years) who underwent cementless metal-on-metal total hip arthroplasty with large-diameter heads. Patients were followed for a mean of 48.6 months. Range of motion improved significantly after surgery (p = 0.001). Harris hip scores improved from 38.5 points to 903 points at latest follow-up. We found no gender-related differences in Harris hip scores, whereas there was a correlation between age and Harris hip scores (p < 0.001), with excellent results being observed predominantly in younger patients. Mean acetabular inclination of the acetabular cup was 42.2 degrees (range: 37-51 degrees). Radiologically, a 1 mm thick radiolucency was detected in three acetabula, which were asymptomatic. One acetabulum was revised because of displacement. Three patients reported squeaking within their hips, which however disappeared in a short time. We did not observe any dislocation, deep infection or loosening. Grade 1 heterotopic ossification was detected in one hip. Although the inherent stability and the functional results of large anatomical heads are encouraging, longer follow-up data and larger series are essential to evaluate the real advantages of this type of prosthesis over conventional femoral heads.

Acute formation of lumbar discal cyst: what is the mechanism?

Lumbar discal cysts are extremely rare pathologies, with only few reports describing these lesions in the literature. Moreover, their definite pathogenesis is still unknown, with proposed theories based on radialogic and histologic findings. In this report, the authors present an acute formation of a discal cyst, which is reported for the first time. Also, we center our case on the discussion of the possible pathogenesis. Also, this is the first case of discal cyst reported in Turkey. A 67-year-old woman, whose complaints, and clinical and radiological findings demonstrated lumbar disc herniation with acute Modic 1 degererative changes of the adjacent end plates of L3-4 level. After medical and physical therapies, follow-up lumbar MRI has been taken to demonstrate a discal cyst formation on the adjacent intervertebral disc, showed cranially migrated cyst superior posterior on herniated disc, in 2 weeks period. The patient was treated by microsurgical resection of the cyst, and her complaints resolved completely.

Cementless total hip arthroplasty with subtrochanteric transverse shortening osteotomy for severely dysplastic or dislocated hips

Total hip arthroplasty in dislocated developmental hip dysplasia is a complex, technically demanding procedure with high complication rates. Anatomic abnormalities and the young age of the patients influence the results. Restoration of the anatomic hip center often requires shortening of the femur in order to avoid over-stretching of neurovascular structures. We performed cementless total hip arthroplasty with subtrochanteric transverse osteotomy on 44 hips in 31 patients. There were 29 female and 2 male patients. The average age at the time of the operation was 43.2 (range, 22-63 years) and the mean follow up period was 62 months (range, 24-96 months). Harris hip scores improved from 36.2 to 81.2 with good and excellent results in 79.5% of the patients. We stabilized the osteotomy line with low contact plates and screws primarily on 10 hips when rotational stability was in doubt. In the other hips, good initial rotational stability was obtained by the femoral component. However, we observed 5 nonunions in patients whose osteotomies were not stabilized with plates. These patients were later treated successfully with internal fixation and autogenous bone grafting. The osteotomies healed at a mean time of 4 months (range, 2.5-14 months). Postoperatively two dislocations, one acetabular component displacement under the structural bone autograft and two superficial infections were seen. There were no cases of symptomatic loosening, deep infection, or neurovascular injury. Subtrochanteric transverse osteotomy is a versatile, relatively easy and reliable method for shortening the femur when performing cementless total hip arthroplasty in hip dysplasia cases. This technique makes it possible to implant standard sized cementless femoral stems. When necessary, tortional stability may further be augmented with a plate and screws.

Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation

OBJECTIVE

This study measures and compares the outcome of conservative physical therapy with traction, by using magnetic resonance imaging and clinical parameters in patients presenting with low back pain caused by lumbar disc herniation.

METHODS

A total of 26 patients with LDH (14F, 12M with mean aged 37 +/- 11) were enrolled in this study and 15 sessions (per day on 3 weeks) of physical therapy were applied. That included hot pack, ultrasound, electrotherapy and lumbar traction. Physical examination of the lumbar spine, severity of pain, sleeping order, patient and physician global assessment with visual analogue scale, functional disability by HAQ, Roland Disability Questionnaire, and Modified Oswestry Disability Questionnaire were assessed at baseline and at 4-6 weeks after treatment. Magnetic resonance imaging examinations were carried out before and 4-6 weeks after the treatment

RESULTS

All patients completed the therapy session. There were significant reductions in pain, sleeping disturbances, patient and physician global assessment and disability scores, and significant increases in lumbar movements between baseline and follow-up periods. There were significant reductions of size of the herniated mass in five patients, and significant increase in 3 patients on magnetic resonance imaging after treatment, but no differences in other patients.

CONCLUSIONS

This study showed that conventional physical therapies with lumbar traction were effective in the treatment of patient with subacute LDH. These results suggest that clinical improvement is not correlated with the finding of MRI. Patients with LDH should be monitored clinically (Fig. 3, Ref. 18).

Microfluidic structures for flow cytometric analysis of hydrodynamically focussed blood cells fabricated by ultraprecision micromachining

We present three-dimensional microfluidic structures with integrated optical fibers, mirrors and electrodes for flow cytometric analysis of blood cells. Ultraprecision milling technique was used to fabricate different flow cells featuring single-stage and two-stage cascaded hydrodynamic focusing of particles by a sheath flow. Two dimensional focussing of the sample fluid was proven by fluorescence imaging in horizontal and vertical directions and found to agree satisfactorily with finite element calculations. Focussing of the sample stream down to 5 microm at a particle velocity of 3 m s(-1) is accessible while maintaining stable operation for sample flow rates of up to 20 microL min(-1). In addition to fluorescence imaging, the micro-flow cells were characterised by measurements of pulse shapes and pulse height distributions of monodisperse microspheres. We demonstrated practical use of the microstructures for cell differentiation employing light scatter to distinguish platelets and red blood cells. Furthermore, T-helper lymphocytes labelled by monoclonal antibodies were identified by measuring side scatter and fluorescence.

Oropharyngeal candidiasis with dry-powdered fluticasone propionate: 500 microg/day versus 200 microg/day

We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler. We selected four groups of patients: 62 asthmatic patients who were taking 200 microg/d FP, 122 asthmatics who were taking 500 microg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects. The frequency of positive swabs for Candida colonization was higher in 500 microg/d FP group than asthmatics without ICS use (chi2 = 6.8, p < 0.05) and normal controls (chi2 = 4.9, p < 0.05), whereas it wasn't different in the 200 microg/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05). The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months.

Hamartoma of the breast

Breast hamartoma is a rare benign tumour that leads to unilateral breast enlargement without a palpable localized mass lesion. Histologically, a hamartoma consists of varying amounts of adipose, gland, fibre and smooth muscle tissue. The characteristic mammographic appearance of hamartoma of breast has distinct mammographic features with circumscription and fat and soft-tissue density surrounded by a thin radiopaque capsule or pseudocapsule. Ultrasonographic findings include a well-defined mass lesion consisting of echogenic and sonolucent areas. We present histopathological and radiological findings of a 42-year-old female patient with breast hamartoma who has no complaint.

Atom-by-atom extraction using the scanning tunneling microscope tip-cluster interaction

We investigate the atomistic details of a single atom-extraction process realized by using the scanning tunneling microscope tip-cluster interaction on a Ag(111) surface at 6 K. Single atoms are extracted from a silver cluster one atom at a time using small tunneling biases less than 35 mV. Combined total energy calculations and molecular dynamics simulations show a lowering of the atom-extraction barrier upon approaching the tip to the cluster. Thus, a mere tuning of the proximity between the tip and the cluster governs the extraction process. The atomic precision and reproducibility of this procedure are demonstrated by repeatedly extracting single atoms from a silver cluster on an atom-by-atom basis.

Amphenicol and macrolide derived antibiotics inhibit paraoxonase enzyme activity in human serum and human hepatoma cells (HepG2) in vitro

Human serum paraoxonase (hPON1) was separately purified by ammonium sulfate precipitation and hydrophobic interaction chromatography. The in vitro effects of commonly used antibiotics, namely clarithromycin and chloramphenicol, on purified human serum paraoxonase enzyme activity (serum hPON1) and human hepatoma (HepG2) cell paraoxonase enzyme activity (liver hPON1) were determined. Serum hPON1 and liver hPON1 were determined using paraoxon as a substrate and IC(50) values of these drugs exhibiting inhibition effects were found from graphs of hydratase activity (%) by plotting concentration of the drugs. We determined that chloramphenicol and clarithromycin were effective inhibitors of serum hPON1.

Relationship between hypoxic hepatitis and cor pulmonale in patients treated in the respiratory ICU

To determine independent risk factors associated with the pathogenesis hypoxic hepatitis (HH) in hypoxemic patients. The prospective study, multivariate analysis, between January 1999 and March 2003 was conducted at University hospital, intensive care unit, Department of Chest Diseases. A total of 445 consecutive patients were included in the study. Patients who were not hypoxemic (PaO(2) > 80 mmHg) were excluded from analysis. The total number of those found eligible for the study was 297. Patients with a >20-fold increase in liver enzyme levels were diagnosed as HH (study group). The other patients were defined as control group. There were no interventions. Mean age was 62, and 191 were males. Twenty-two patients were diagnosed as HH (study group; 7.41%). Cor pulmonale (CP) was 77.3% in the study group and 36.7% in the control group. The need for mechanical ventilation and hospital mortality were 63.6 and 54.5% in the study group and 32 and 28.7% in the control group, respectively. On multivariate analysis, the presence of CP (p = 0.007; OR: 4.418; CI: 1.492-13.083), high-serum BUN level (>37 mg/dl; p = 0.0001; OR: 1.029; CI: 1.015-1.044) and low PaO(2) level (<46 mmHg; p = 0.008; OR: 0.945; CI: 0.906-0.985) were found to be significantly different between the two groups. Patients with severe hypoxemia, CP and higher BUN level have higher risk levels for HH, the most important risk factor being CP.

Nonmalignant pleural lesions due to environmental exposure to asbestos: a field-based, cross-sectional study

The aim of the present study was to investigate the frequencies of asbestos-related benign pleural diseases in villagers environmentally exposed to asbestos and the factors affecting these frequencies. A field-based, cross-sectional study was designed. In total, 991 villagers from 10 villages, randomly chosen from 67 villages with known use of asbestos-containing white soil in central Anatolia (Turkey), were investigated. The type of asbestos in the white soil was determined for each village, as well as air-borne fibre concentrations. The villagers were investigated with small-size chest roentgenograms and epidemiological features were recorded. The air-borne fibre levels were generally low. Despite this, pleural plaques were found in 14.4% of the villagers, 10.4% had diffuse pleural fibrosis and 0.4% asbestosis. The significant variables for plaques were age, sex, type of asbestos fibre, e.g. actinolite and tremolite, and exposure duration, while there was a negative relationship with cumulative exposure. The variables affecting diffuse pleural fibrosis were age, exposure duration and cumulative exposure. In conclusion, villagers exposed to environmental asbestos have high frequencies of pleural plaques and diffuse pleural fibrosis, similar to occupationally exposed asbestos cohorts. Different types of asbestos appear to result in different frequencies of pleural lesions.

Multivoxel magnetic resonance spectroscopy in gliomatosis cerebri

Gliomatosis cerebri is a rare entity with non-specific clinical and conventional magnetic resonance imaging (MRI) findings; accurate diagnosis is a differential diagnostic challenge. MR spectroscopy has recently been introduced as a useful diagnostic tool for detection of this entity. We present a gliomatosis cerebri case in which we made the radiological diagnosis using the MR spectroscopy findings; the diagnosis was confirmed by subsequent biopsy and histopathologic evaluation. Multivoxel spectroscopy (CSI, PRESS, 1500/135) shows a marked increase in Cho/NAA (6.6), normal to mild increase in Cho/Cr (1.2), and marked decrease in NAA/Cr (0.2) compared with the normally appearing contralateral side (Cho/NAA: 0.8, Cho/Cr: 0.9, NAA/Cr: 1.2).

Bronchial atresia of the right lower lobe

Bronchial atresia (BA) is a rare congenital anomaly that is found incidentally in approximately 50% of cases. It predominantly affects young men and generally produces no symptoms. The other 50% of cases have pulmonary symptoms such as fever, cough, or shortness of breath due to recurrent pulmonary infection or overinflation of the involved lung parenchyma. The most common site is the left upper lobe, particularly of the apical-posterior segment. The right lower and middle lobes are affected in only 8% of cases. The radiographic features may be highly suggestive of the diagnosis. The mucus-filled bronchus is seen as a rounded, branching opacity emanating from the hilum and is surrounded by an area of increased hyper-translucency. We report an unusual presentation of BA in a 43-year-old woman with a history of recurrent pulmonary infection and dyspnea. The patient was found to have BA in all the basal segments of the lower lobe of the right lung.

Castleman's disease with isolated extensive cervical involvement

Castleman's disease is a lymphoproliferative disorder of uncertain cause characterized by a distinctive pattern of hypervascular lymphoid hyperplasia. Computed tomography and MRI can be used to define the extent of disease. The latter may be used to detect curvilinear hypointensities within the abnormal node. Symmetrical involvement of nasopharyngeal and parapharyngeal regions in our case without disease elsewhere is considered to be an unusual presentation.

One-stage treatment of congenital severely dislocated hips in older children through various acetabuloplasty techniques: 22 children followed for 1-5 years

BACKGROUND

There is no consensus regarding the best treatment for children with late diagnosis of congenital hip dislocation.

PATIENTS AND METHODS

This retrospective study involved 29 hips in 22 children (19 girls) with an age range of 3-14 years, who had been operated with various techniques for congenital hip dislocation between 1998 and 2002. 6 patients had right, 9 patients had left, and 7 patients had bilateral congenital hip dislocation. The mean length of follow-up was 3 (1-5) years.

RESULTS

While the mean acetabular index was 53 degrees (35-65) preoperatively, at the last follow-up it was 30 degrees (15-50). 27 hips were type 4 and 2 hips were type 3 by Tönnis criteria. Satisfactory reduction (Severin Class I) had been achieved in 19 hips at the follow-up radiography, and they developed no osteonecrosis. The outcome was successful in children under 7 years of age, but problems encountered in those over 7 increased unless sufficient reduction had been achieved.

INTERPRETATION

Age at treatment of late-diagnosed congenital hip dislocation appears to be important for outcome.

N-acetyltransferase 2 polymorphisms in patients with Behcet's disease

It is possible that dietary, environmental factors and/or genetic polymorphisms in xenobiotic-metabolizing enzymes may contribute to the development of Behcet's disease. As N-acetyltransferase (NAT) 2 is an important xenobiotic-metabolizing enzyme and theoretically the nonacetylated xenobiotics may induce an autoimmune mechanism, the aim of the present study was to investigate whether the genetic polymorphism of NAT2 plays a role in susceptibility to Behcet's disease. Forty Behcet's disease patients and 82 control subjects were enrolled in the study. NAT2*5A, NAT2*6A, NAT27*A/B and NAT2*14A polymorphisms were detected by using real time PCR with LightCycler (Roche Diagnostics GmbH, Mannheim, Germany). The NAT2*5A and NAT2*6A mutant genotypes carried an increased risk of developing Behcet's disease [odds ratio (OR) = 66.29, 95% confidence interval (CI) = 8.21-535.33; and OR = 24; 95% CI = 2.04-304.98, respectively]. The NAT2*7A/B and NAT2*14A gene polymorphisms were not an increased risk for developing Behcet's disease. As a result of this study we conclude the NAT2 slow acetylator status may be a determinant in susceptibility to Behcet's disease. This finding may have implications for the theories of the pathogenesis of the disease as well as for therapeutic aspects.

The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG

BACKGROUND AND OBJECTIVE

To determine if there is any significant difference between the effects of desflurane, isoflurane and sevoflurane on the QT interval, QT dispersion, heart rate corrected QT interval and QTc dispersion of the electrocardiogram.

METHODS

The study was conducted in a prospective, double blind and randomized manner in a teaching hospital. Ninety ASA I patients, aged 16-50 yr, undergoing general anaesthesia for noncardiac surgery were studied.

RESULTS

There was no significant change in QT intervals during the study in any group (P > 0.05). QT dispersion in the sevoflurane group 49+/-14 ms vs. 37+/-10 ms; in the desflurane group 55+/-16 and 62+/-21 ms vs. 35+/-14 ms and in the isoflurane group 54+/-26 and 59+/-24 ms vs. 42+/-19 ms were significantly increased at 3 and 10 min after 1 MAC of steady end-tidal anaesthetic concentration compared with baseline values (P < 0.05). QTc values in the sevoflurane group were 444+/-24 and 435+/-2 1ms vs. 413+/-19 ms (P < 0.05), in the isoflurane group were 450+/-26 and 455+/-34 ms vs. 416+/-34 ms (P < 0.05), in the desflurane group were 450+/-26 and 455+/-34 ms vs. 416+/-34 ms (P < 0.05) at 3 and 10 min after reaching 1 MAC of anaesthetic concentration and significantly increased compared with baseline values. QTc dispersion increased significantly with sevoflurane 62+/-14 ms vs. 45+/-16 ms (P < 0.05); isoflurane 70+/-36 ms at 3 min and 75+/-36 ms at 10 min after reaching 1 MAC of anaesthetic concentration vs. 50+/-24 ms (P < 0.05); desflurane 67+/-25 ms at 3 min and 74+/-27 ms at 10 min after 1 MAC concentration vs. 41+/-22 ms (P < 0.05).

CONCLUSION

Sevoflurane, isoflurane and desflurane all prolonged QTd, QTc and QTcd but there were no significant intergroup differences.

Does vitamin A prevent high-dose-methotrexate-induced D-xylose malabsorption in children with cancer?

PURPOSE

Our aim was to explore whether vitamin A has protective effect on high-dose-methotrexate (HDMTX)-induced intestinal D-xylose malabsorption in children with leukemia and lymphoma.

PATIENTS AND METHODS

We performed a prospective randomized un-blinded study of vitamin A in 35 children with leukemia and lymphoma who were planned to receive HDMTX 3 g/m(2) and 5 g/m(2), respectively. Twenty-two patients (group 1) received a single dose of 180,000 IU a day before HDMTX was given, and 13 (group 2) received only HDMTX. The vitamin A group received the vitamin only once. Oral D-xylose absorption tests before and 7 days after HDMTX were carried out to evaluate intestinal absorption. Retinol-binding protein (RBP) levels prior to therapy were also measured for vitamin A status.

RESULTS

Although we observed no difference of HDMTX-induced toxicity, including hematological, dermatological, systemic, and other toxicities, between groups, the D-xylose absorption test was significantly better in-group 1 ( p=0.030). Absorption was decreased in five of 22 patients (23%) who received vitamin A comparing to eight of 13 (62%) who received only HDMTX ( p=0.033). RBP levels were lower than normal in 13 of 22 patients in-group 1 and nine of 13 in group 2. In patients whose RBP levels were lower than normal, HDMTX-induced toxicity was lower in the group 1 than group 2 but not statistically significant. No sign of vitamin A toxicity was observed throughout the study.

CONCLUSION

The administration of vitamin A before HDMTX may protect against drug-induced D-xylose malabsorption in children with cancer. Further studies are apparently needed to clarify the full benefits of vitamin A in preventing HDMTX-induced mucosal damage.

Cardiac tamponade caused by an ingested sewing needle. A case report

Ingested sharp-pointed foreign bodies can cause serious complications. A case of a 16-year-old girl with cardiac tamponade due to ingestion of a sewing needle is presented. Ingested needles have often been reported as a cause of gastrointestinal injuries but in this rare case the sewing needle actually migrated into the myocardium.

CT and MRI findings of ameloblastoma in two cases

We report CT and MRI findings in two patients with ameloblastoma. One case had a multilocular mixed lesion and the other had a unilocular solid pattern. The second case is probably one of the youngest reported. CT and MRI can be used to delineate and show the extent of the tumour.

An MRI study of the meniscofemoral and transverse ligaments of the knee

Our aim was to assess the anatomic localization, dimensions and incidence of the transverse and meniscofemoral ligaments, which can show anatomic variations or be mistaken for some pathologic conditions. In 100 healthy subjects (52 female, 48 male) whose ages ranged from 12 to 84 years, sagittal and coronal magnetic resonance images of the knee were obtained. There was at least one anterior or posterior meniscofemoral ligament in 82 cases. The anterior meniscofemoral ligament was present in 8 of the female and 4 of the male subjects. The posterior meniscofemoral ligament was found in 20 female and 22 male subjects. Both the anterior and posterior meniscofemoral ligaments were present in 15 female and 13 male subjects. The transverse ligament of knee was encountered in 19 female and 12 male subjects. In the females, average lengths of the anterior and posterior meniscofemoral ligaments were 9.87 +/- 4.79 mm and 25.60 +/- 5.50 mm, respectively. The corresponding values in the males were 11.11 +/- 2.57 mm and 28.80 +/- 5.49 mm, respectively. In the females, average width of the anterior and posterior meniscofemoral ligaments were 2.45 +/- 1.02 mm and 2.30 +/- 1.15 mm, respectively. The corresponding values in the males were 2.52 +/- 0.87 mm and 2.30 +/- 1.15 mm, respectively. On MRI assessment, in order to differentiate intra-articular lesions such as osteochondral and meniscal fragments or pseudotear of the lateral meniscus from the normal ligamentous anatomy of knee, the orientation and characteristic localization of the meniscofemoral ligaments should be taken into account. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer LINK server located at http://dx.doi.org/10.1007/s00276-002-0023-8.

Structural studies of the O-polysaccharide from the Escherichia coli O77 lipopolysaccharide

The structure of the O-antigen polysaccharide (PS) from Escherichia coli O77 has been determined. Sugar and methylation analysis together with 1H and 13C NMR spectroscopy were the main methods used. The PS is composed of tetrasaccharide repeating units with the following structure:-->2)-alpha-D-Manp-(1-->2)-beta-D-Manp-(1-->3)-alpha-D-GlcpNAc-(1-->6)-alpha-D-Manp-(1-->

Cyclooxygenase-independent inhibition of smooth muscle cell mitogenesis by ibuprofen

The aryl-propionic acid derivative, ketoprofen, has been shown to inhibit fibroblast growth by a cylooxygenase-dependent mechanism [Sánchez, T., Moreno, J.J., 1999. S(+) enantiomer inhibits prostaglandin production and cell growth in 3T6 fibroblast cultures. Eur. J. Pharmacol. 370, 63-67]. The present study demonstrates that ibuprofen, another aryl-propionic acid derivative, inhibited platelet-derived growth factor-BB (20 ng/ml)-induced mitogenesis of cultured bovine coronary artery smooth muscle cells in a stereo-independent manner. In addition, pretreatment of the cells with indomethacin (3 microM) did not affect the inhibitory effects of ibuprofen enantiomers on smooth muscle cell mitogenesis. Thus, aryl-propionic acid-type cyclooxygenase inhibitors can inhibit cell proliferation by both, cyclooxygenase-dependent and -independent ways.

Destructive membranous periodontal disease (Ligneous periodontitis)

Generalized membranous gingival enlargement due to accumulation of amyloid or fibrin-like material is a rare, destructive and poorly defined disease entity. Some patients also show extraoral manifestations. The lesion is an involvement of periodontal tissues caused by the same process as ligneous conjunctivitis. In this report, 3 new cases, two of whom are siblings, are presented. Defective fibrinolysis and abnormal wound healing seem to be the main pathogenetic mechanism of this unusual disease, which should be evaluated systemically considering other mucosal involvement.

Pelvic ultrasound measurements in normal girls: relation to puberty and sex hormone concentration

Pelvic ultrasonography was performed on 75 normal girls. Values were obtained for uterine length, fundal/cervical ratio (FCR), ovarian volume and sex hormones. The resultant data were grouped according to age and pubertal stage (Tanner). For uterine length, FCR and ovarian volume, the data were positively skewed, and the variance increased with age and pubertal stage (p < 0.001). The uterus underwent a regular increase in size and the corpus gradually became larger than the cervix. Uterine length, right ovary volume, FCR and hormones (serum estradiol, follicle-stimulating hormone and luteinizing hormone) showed a correlation with the Tanner score (p < 0.001). Although the correlations were significant, the best correlation was between pubertal stage and serum estradiol level.

Puberty and mineralization of the skeleton in girls

We studied the acquisition of bone mineral and related changes in body mass, pubertal status, and sex hormones in 75 healthy prepubertal and pubertal girls aged 7.5-16 years. Bone mineral density of the lumbar spine (L-1, L-2, L-3, L-4) was measured in children by quantitative computerized tomography. Skeletal mineralization accelerated markedly at puberty. Age, weight, height, and body mass index (BMI) were highly correlated with bone mineral density.