Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective?

BACKGROUND

Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management.

MATERIALS AND METHODS

Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed.

RESULTS

In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding.

CONCLUSIONS

This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.

Gastric medullary carcinoma: clinicopathological features and prognosis-a single-center study

BACKGROUND

Gastric medullary carcinoma (GMC) is a distinct histologic subtype of gastric adenocarcinoma, which prominently associated with Epstein-Barr virus infection. This study aimed to evaluate the clinicopathological features and prognosis of patients with medullary carcinoma in one center.

METHODS

Data regarding patients with gastric cancer were retrospectively analyzed at Marmara University between 2014 and 2019. Demographics, pathological features, and overall survival of patients with GMC were evaluated. The primary outcome of this study was to compare the pathological features of GMC to non-GMC (NGMC). The secondary outcome was comparing overall survival between the two groups.

RESULTS

A total of 412 patients were enrolled in the study. Of 412 patients, 19 (5%) were diagnosed with medullary cancer. Compared to NGMC, no significant differences were observed in patient age, gender, tumor macroscopic pattern, size, lymphovascular invasion, pathological stage, location and size of the tumors, and the number of metastatic lymph nodes in GMC. However, perineural invasion and Borrmann ulcerated type rates were significantly higher among NGMC. Whereas the microsatellite instability (MSI) rate was significantly higher in the GMC (64% and 11%, respectively, p < 0.001). Multivariate analysis showed that the MSI status was the solely significantly different feature between the two groups.

CONCLUSION

This study showed that GMC was associated with MSI, which could explain the better prognosis of medullary carcinomas.

Subcostal Transversus Abdominis Plane Block for Laparoscopic Sleeve Gastrectomy, Is It Worth the Time?

BACKGROUND

Obesity is a complex and multifactorial disease whose incidence has increased, making it a serious public health issue. Laparoscopic sleeve gastrectomy (LSG) is one of the most common surgical procedures that is chosen for bariatric surgery. Decreasing postoperative pain in these patients which will increase patients' compliance and quality of life will lead to better surgical results. This study aims to compare the effectiveness of trocar site infiltration versus bilateral subcostal transversus abdominis plane block (TAP) in controlling postoperative pain in patients.

METHODS

Forty-five consecutive patients who have undergone LSG in xxx General Surgery Department have been enrolled in the study. Patients were divided into two groups according to the surgeon's choice. The first group underwent TAP block, while the second group underwent trocar site infiltration. Patients' pain was recorded via visual analogue scale (VAS) in postoperative periods.

RESULTS

Twenty-nine female (69%) and 13 (31%) male patients were included in the study. Median age was 41 (18-58) and median BMI was 48 (41.1-68). When the VAS values were compared, in the TAPB group, 6th hour resting and coughing pain was statistically significantly less. Other VAS values measured while resting, coughing, and post-mobilization did not show significant differences. There were no significant differences between the groups' tramadol use.

CONCLUSIONS

After LSG, TAP block and trocar site infiltration yield similar pain control. Due to the faster application and fewer side effects, we concluded that trocar site infiltration should be the intervention of choice in controlling postoperative pain in LSG.

The electrical modulus and other dielectric properties by the impedance spectroscopy of LaCrO3 and LaCr0.90Ir0.10O3 perovskites

We have prepared LaCrO₃ (LCO) and 10% Ir doped LCO samples by the solid state reaction method and studied the electrical modulus and the other dielectric properties of the samples by means of the impedance spectroscopy in the −100 °C to 100 °C range, with steps of 20 °C. It has been clearly observed that the dielectric properties change due to Ir doping. The absolute dielectric constant value of Ir doped LCO has decreased and this reduction was attributed to decreasing Cr⁶⁺ ions which may play a vital role in space charge polarization and charge hopping. A plateau region appeared in the temperature-dependent real electrical modulus M′ versus f curves of the pure LCO sample while almost no plateau region is visible in the Ir doped LCO sample. The temperature-dependent imaginary modulus M′′ versus f curves has two peaks at each temperature; one of the peaks is at low frequency and the other at the high frequency region, which shifts through higher frequency region with increasing temperature. This originates from free charge accumulation at the interface with the increase of the temperature. Furthermore, it has been seen that the Ir doped LCO sample has higher impedance and resistance values than the undoped LCO sample at the same frequency and temperature. This phenomenon was attributed to doped Ir ions behaving like a donor in LCO because LCO is a p-type compound. Moreover, the activation energy values of 0.224 eV and 0.208 eV for LCO and of 0.161 eV and 0.265 eV for the Ir doped LCO have been obtained from the slopes of the ρ_dcvs. (kT)⁻¹ curves, respectively. Also the activation energies were calculated from the slopes of the f_maxvs. (kT)⁻¹ curves and the obtained results from low frequency region were in good agreement with ρ_dcvs. (kT)⁻¹ ones.

In this work, LaCrO₃ and Ir doped LaCrO₃ compounds were synthesized and their frequency dependent electrical properties were studied.

Neutrophil-lymphocyte ratio and mean platelet volume can be a predictor for severity of acute appendicitis

BACKGROUND

Early diagnosis of perforation in acute appendicitis (AA) allows surgeons to select the most appropriate treatment. The aim of the present study was to determine whether preoperative neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) could predict perforation in AA.

METHODS

Data collected from 413 consecutive patients with AA and 100 healthy controls were analyzed retrospectively. Patients were categorized as having had phlegmonous appendicitis, appendicitis with localized peritonitis, or appendicitis with perforation and/or gangrene. MPV and NLR values were compared among the control group and the 3 groups of patients with AA.

RESULTS

Means values of MPV were 9.3±8 fL for the patient group and 8.5±0.9 fL for the healthy control group (p=0.0005). Mean values of MPV by patient subgroup were 8.8±5.8 for phlegmonous appendicitis, 8.9±5.8 for localized peritonitis, and 12.8±9.7 for appendicitis with perforation and/or gangrene (p=0.005). Cut-off value of MPV was set at 8.92 to differentiate AA with perforation and/or gangrene from other types of AA. Mean NLRs of patients with phlegmonous appendicitis, appendicitis with localized peritonitis, and appendicitis with perforation and/or gangrene were 8.3±5.6, 9.1±6.2, and 10.6±6.4, respectively; p=0.023. The cut-off value for NLR was set at 7.95 to differentiate AA with perforation and/or gangrene from other types of AA.

CONCLUSION

Both NLR and MPV can be useful in predicting severity of AA.

Genomic damage in patients with type-2 diabetes mellitus

DNA damage seems to play a role in the pathogenesis of type-2 diabetes mellitus (DM2) and its complications. Several in vitro assays have been used to measure the DNA damage. In the present study, we aimed to investigate the frequency of sister chromatid exchange (SCE) and micronuclei (MN) in DM2 patients compared with healthy controls. SCE and MN tests were carried out with the blood-cell cultures from 50 DM2 patients and 30 healthy, age- and sex-matched control subjects. The mean age of the DM2 patients was 58.12 +/- 13.39 years, with a mean duration of the diabetes of 5.40 +/- 4.32 years. The mean level of HbAlc of the DM2 patients was 8.93 +/- 2.56. Patients with DM2 showed a higher frequency of SCE compared with controls (7.11 +/- 1.14 and 4.96 +/- 0.92, p < 0.001). Furthermore, the SCE frequency was positively correlated with the plasma HbA1c level (p < 0.05), but there was no significant correlation between the duration of diabetes and SCE. On the other hand, our result showed a MN frequency significant increase in DM2 patients (3.45 +/- 1.01 per 1000 cells) relative to that of the control group (1.79 +/- 0.67 per 1000 cells) (p < 0.001), but there was no significant correlation between the duration of diabetes, HbA1c and MN. In conclusion, these results suggest that DM2 is a condition with genomic instability characterized by an increased level of SCE and MN. Hyperglycemia-induced oxidative stress may be the underlying factor of the increased SCE and MN frequency.

Country-specific correlations across Europe between modelled atmospheric cadmium and lead deposition and concentrations in mosses

Previous analyses at the European scale have shown that cadmium and lead concentrations in mosses are primarily determined by the total deposition of these metals. Further analyses in the current study show that Spearman rank correlations between the concentration in mosses and the deposition modelled by the European Monitoring and Evaluation Programme (EMEP) are country and metal-specific. Significant positive correlations were found for about two thirds or more of the participating countries in 1990, 1995, 2000 and 2005 (except for Cd in 1990). Correlations were often not significant and sometimes negative in countries where mosses were only sampled in a relatively small number of EMEP grids. Correlations frequently improved when only data for EMEP grids with at least three moss sampling sites per grid were included. It was concluded that spatial patterns and temporal trends agree reasonably well between lead and cadmium concentrations in mosses and modelled atmospheric deposition.

Nitrogen concentrations in mosses indicate the spatial distribution of atmospheric nitrogen deposition in Europe

In 2005/6, nearly 3000 moss samples from (semi-)natural location across 16 European countries were collected for nitrogen analysis. The lowest total nitrogen concentrations in mosses (<0.8%) were observed in northern Finland and northern UK. The highest concentrations (≥ 1.6%) were found in parts of Belgium, France, Germany, Slovakia, Slovenia and Bulgaria. The asymptotic relationship between the nitrogen concentrations in mosses and EMEP modelled nitrogen deposition (averaged per 50 km × 50 km grid) across Europe showed less scatter when there were at least five moss sampling sites per grid. Factors potentially contributing to the scatter are discussed. In Switzerland, a strong (r(2) = 0.91) linear relationship was found between the total nitrogen concentration in mosses and measured site-specific bulk nitrogen deposition rates. The total nitrogen concentrations in mosses complement deposition measurements, helping to identify areas in Europe at risk from high nitrogen deposition at a high spatial resolution.

Mosses as biomonitors of atmospheric heavy metal deposition: spatial patterns and temporal trends in Europe

In recent decades, mosses have been used successfully as biomonitors of atmospheric deposition of heavy metals. Since 1990, the European moss survey has been repeated at five-yearly intervals. Although spatial patterns were metal-specific, in 2005 the lowest concentrations of metals in mosses were generally found in Scandinavia, the Baltic States and northern parts of the UK; the highest concentrations were generally found in Belgium and south-eastern Europe. The recent decline in emission and subsequent deposition of heavy metals across Europe has resulted in a decrease in the heavy metal concentration in mosses for the majority of metals. Since 1990, the concentration in mosses has declined the most for arsenic, cadmium, iron, lead and vanadium (52-72%), followed by copper, nickel and zinc (20-30%), with no significant reduction being observed for mercury (12% since 1995) and chromium (2%). However, temporal trends were country-specific with sometimes increases being found.

Computed tomography volumetric follow-up of graft volume in living related liver recipients

AIM

Liver regeneration is a fascinating process that makes living related donor transplantation feasible for patients. In this study we evaluated the changes in graft volumes among living related liver transplantation (LRLT) patients using computerized tomography (CT)-assisted volumetry technique.

MATERIALS AND METHODS

Thirty three patients (17 adults, 16 children) who underwent liver transplantation were included in this study. Pediatric patients were referred to as group A, and adult patients were referred to as group B. The initial graft weight measured during operation was used as the initial graft volume. All patients' graft volumes were retrospectively calculated by CT volumetry technique. The data was compared with the initial graft volume in each patient. Paired samples Student t test was used for statistical analyses.

RESULTS

The graft volume increased from 2.7% to 285.6% with the mean increase 78% in group A, and 10.5% to 150.8% with a mean increase of 89% in group B. These changes were significant (P<.0001) in both groups.

DISCUSSION

The liver regeneration of recipient grafts is more complicated than that of the donors. There are a limited number of reports of complete volume recovery. We observed significant volume regeneration in liver grafts after transplantation, which was easily followed by CT-assisted volumetry.

Nonvascular complications in pediatric liver recipients: multidetector computed tomography evaluation

In pediatric liver transplantation postoperative diagnosis of complications is crucial for graft salvage. Multidetector computed tomography (MDCT) is a technique to evaluate complications. In this study we present nonvascular abdominal complications encountered in pediatric recipients after liver transplantation. We retrospectively examined 113 MDCT examinations in 43 pediatric patients who underwent liver transplantation between 1997 and 2005. Computed tomography (CT) examinations were made by a 16-detector multislice CT scanner. The pathological findings on CT images were: intraperitoneal free fluid, intrahepatic bile duct dilatation, graft liver infarction, perihepatic and intraperitoneal fluid collections (six biloma), colonic and/or intestinal dilatation, splenic infarction, perihepatic hematoma, right adrenal hemorrhage, perihepatic abscess, incisional hernia, intrahepatic biloma and periportal collar. In one patient intestinal hemorrhage was suspected. Intestinal perforation was suspected in three patients. Among these three patients, one patient died before any surgical intervention. In two patients the diagnosis was confirmed at surgery. In pediatric patients, the short examination time, brief sedation duration, and high-resolution images make MDCT an effective radiological method to evaluate nonvascular transplant complications.

A very unusual presentation of Niemann-Pick disease type B in an infant: similar findings to congenital lobar emphysema

The main features of Niemann-Pick disease type B (NPD-B) are enlargement of the liver and spleen, and mild pulmonary involvement. Recurrent respiratory tract infection and progressive decline in pulmonary function are major contributors to morbidity and mortality in this patient group. Massive pulmonary involvement in early life is extremely rare. The most common finding on chest X-rays of NPD-B patients is reticular or nodular infiltration of the lungs. This article describes a very rare presentation of NPD-B in an infant who had suffered recurrent respiratory tract infections. Massive emphysema and marked infiltrative parenchymal changes (infiltration of the parenchyma) were initially attributed to congenital lobar emphysema and its compressive effects. However, NPD was suspected when a lung biopsy showed foamy cells and sea-blue histiocytes were detected in a bone marrow biopsy. The definitive diagnosis was established with an enzyme study for sphingomyelinase.

Imaging of Hepatic Arterial Anatomy for Depicting Vascular Variations in Living Related Liver Transplant Donor Candidates With Multidetector Computed Tomography: Comparison With Conventional Angiography

AIMS

The aim of this study was to evaluate liver arteries to depict variations by using multidetector computed tomography (CT) in donor candidates for living related liver transplantation.

METHODS

Computed tomographic hepatic angiography was carried out using a multidetector 16-row CT scanner (Sensation 16; Siemens) in 48 candidates between April 2003 and August 2004. Multidetector CT was performed after intravenous injection of 150 mL of contrast material at a rate of 4 mL/s. Arterial phase images were acquired after contrast injection. Afterward, maximum intensity projections and volume-rendered images were produced from the axial image data. Twenty-eight of these patients underwent conventional catheter angiography.

RESULTS

Excellent arterial opacification was shown on multidetector CT scans in all patients; arteries up to tertiary branches were identified with CT. Of 28 patients who had both multidetector CT angiography and conventional angiography, only a branch of hepatic artery originating from superior mesenteric artery that supplied the posterior segment of the right lobe was not identified on multidetector CT angiography. In 27 donors, hepatic arterial anatomy depicted at multidetector CT angiography was identical to that at conventional angiography. We identified hepatic vascular variants in 22 of 48 patients with multidetector CT. The most common arterial variant was an accessory hepatic artery arising from the left gastric artery.

CONCLUSIONS

Preoperative imaging evaluation of hepatic vascular anatomy is crucial for surgical planning in living related transplant donors. Multidetector CT is useful to depict hepatic arterial anatomy with high accuracy.

Antioxidant and antimicrobial activities of Onosma argentatum and Rubia peregrina

The n-hexane-dichloromethane (1:1) extract of the roots of Onosma argentatum and the methanol extract (partitioned between water and chloroform, ethyl acetate and n-butanol, respectively), of the underground parts (roots and rhizomes) of Rubia peregrina were tested in vitro for their antioxidant and antimicrobial activities. The highest antioxidant activity (98%) was observed at 0.1% concentration for the roots of O. argentatum. It was 96% at 0.25% concentration on the ethyl acetate fraction of R. peregrina. O. argentatum extract was effective on Staphylococcus aureus, Bacillus subtilis and Escherichia coli. The ethyl acetate and chloroform fractions of R. peregrina were effective on S. aureus and E. coli, respectively. These two species did not have any antifungal activity.

Portacaval shunt creation using the percutaneous transhepatic-transjugular technique

BACKGROUND

The feasibility and efficacy of portacaval shunt creation through the transhepatic and transjugular approach were evaluated in patients with portal hypertension whose hepatic venous anatomies were unsuitable for the standard shunt procedure.

METHODS

Portacaval shunts were created via percutaneous transhepatic access in six patients. We used snares to target the portal vein and the inferior vena cava. Then a needle was introduced percutaneously and advanced through the snares. A guidewire was advanced through the needle and snared in the inferior vena cava. The wire was then withdrawn through the transjugular sheath. The rest of the procedure was completed in standard fashion. The transhepatic tracts were embolized.

RESULTS

The portacaval shunt procedures were successful in all patients. There were no major complications during the procedures, but one patient died of sepsis 1 week later. Two patients developed shunt occlusion, and in one case the shunt was revised successfully. The other patient with occlusion underwent orthotopic liver transplantation. The shunts in the remaining three patients and the revised shunt were patent at 5 to 20 months of follow-up.

CONCLUSION

Direct portacaval shunt creation using the percutaneous transhepatic and transjugular technique is a good alternative when standard portosystemic shunt creation is difficult or impossible.

Thrombopoietin levels of thrombocytopenic term and preterm newborns with infection

We measured Thrombopoietin (Tpo) levels in thrombocytopenic term and preterm babies with infection to investigate the relationship between thrombopietin levels and platelet counts. Sixteen preterm (27-34 weeks' gestational age) and 5 term neonates (38-41 weeks' gestational age) with the diagnosis of neonatal infection and thrombocytopenia (platelets <150 x 10(9)/L) but, without the evidence of disseminated intravascular coagulation, were prospectively enrolled in the study. Fifteen preterm (27-34 weeks' gestational age) and 9 term (38-40 weeks' gestational age) age-matched healthy neonates were enrolled in the study as control. Blood samples were obtained from each subject at the time when infection and thrombocytopenia were detected and stored until assay. Bacterial infection was confirmed by blood cultures in five patients and by tracheal cultures in five. Median Tpo levels of term controls were lower than those of preterm controls (62 pg/mL vs. 87 pg/mL) (p <0.05). Median Tpo levels of thrombocyopenic preterm patients were higher than the levels of healthy preterms (258 pg/mL vs. 87 pg/mL) (p <0.05). Similarly, median Tpo levels of sick terms were significantly higher than those of healthy term controls (209 pg/mL vs. 62 pg/mL) (p <0.001). There was not significant difference between the median Tpo levels of term and preterm babies with infection (258 pg/mL vs. 209 pg/mL) (p >0.05). There was no correlation between platelet counts and Tpo levels in both term and preterm groups. The results of our study show that healthy term and preterm babies have detectable levels of Tpo and preterm babies have higher Tpo levels than term infants. Although thrombocytopenic babies with infection have increased levels of Tpo, these levels are still lower than the levels of thrombocytopenic children/adult patients and there seems to be no correlation between platelet counts and thrombopoietin levels. So our observation of increased Tpo levels may still be inadequate for normal platelet production in this period. and this group of babies may also be candidates for the administration of recombinant human Tpo.

Biological Dosimetry of Co-60 Gamma Irradiation

Development of radiation technology has resulted in increasing numbers of people working with it. Therefore it has increasingly been important to monitor the radiation in order to ensure public safety. Physical dosimetry plays an important role in monitoring. But a need arise for biological dosimetry where physical dosimetry is absent or its presence is insufficient. In this study Co-60 gamma radiation dose-response curves for chromosome aberrations were determined for use as controls in biological dosimetry. Peripheral blood that were taken from healthy individuals not working with radiation were irradiated at different radiation doses. The relationship between unstable chromosome aberrations in metaphaseblocked cells and radiation dose were drawn by using the linear-quadratic (LQ) formula. The absorbed radiation doses of the test group consisting of five people that had been working with Co-60 teletherapy machines were estimated using the LQ parameters of control dose-response curves in the Qdr method. Estimated radiation doses were below the permissible radiation dose-limits for four workers, but one worker's estimated dose was higher than these limits.

Polysplenia syndrome with hepatic artery of superior mesenteric artery origin and a circumaortic renal vein

An 8 1/2-month-old girl with biliary atresia and polysplenia syndrome having multiple vascular anomalies without cardiac anomalies is reported. Interruption of the inferior vena cava with azygous continuation, which is a common anomaly, was seen in conjunction with origin of the common hepatic artery from the superior mesenteric artery and with a circumaortic renal vein. The case has particular importance in that no hepatic artery or renal vein variations have been described with biliary atresia and polysplenia syndrome in the literature thus far to our knowledge. The anomalies were shown using different radiological examinations including computed tomography, echocardiography, angiography, venography and magnetic resonance imaging.

CT features of a pericardial gossypiboma

We report a case of surgically retained pericardial sponge as a cause of paracardiac mass in a woman who had thoracotomy 3 weeks prior for replacement of mitral valve prosthesis. Computed tomography examination showed a thin-walled mass containing relatively high-density material in the central part with low-density rim at the periphery suggesting a haematoma with clot formation at first. Surgically removed mass was a retained sponge between right atrium and pericardium. Gossypiboma should be included in the differential diagnosis of an intrathoracic mass besides haematoma and abscess formation in any patient who has had previous thoracotomy.

Pachymeningitis and optic neuritis in rheumatoid arthritis: MRI findings

Rheumatoid arthritis is a systemic disease in which cerebral and eye involvement is neither common nor fully understood. Although it is rarely the cause of pachymeningitis and optic neuritis, rheumatoid arthritis should always be kept in mind in these two conditions. We present a 52-year-old male with an 8 month history of rheumatoid arthritis who was referred to the neurology department with headache and decreasing vision and was diagnosed as having rheumatoid pachymeningitis and optic neuritis on the basis of MRI findings.

Thoracic CT findings in long-term hemodialysis patients

PURPOSE

To evaluate thoracic CT findings of long-term hemodialysis patients.

MATERIAL AND METHODS

Thoracic CT findings of 117 uremic patients (61 men, 56 women) with complaints of cough, dyspnea, low-grade pyrexia, malaise, weight loss, and profuse perspiration were retrospectively documented.

RESULTS

Atelectasis (60%), cardiomegaly (60%), pleural effusion (51%), vascular congestion (44%), parenchymal consolidation (38%), parenchymal scarring-fibrosis (31%), and lymphadenopathy (29%) were the most common CT findings in the thoraces of the long-term hemodialysis patients. Staphylococcus aureus was detected in 13 patients (11%) who had parenchymal infiltration. Thoracic tuberculosis was identified in 15 patients (13%), 11 of these cases being confined to the lung parenchyma, 3 to the pleura, and 1 involving the pleura and pericardium.

CONCLUSION

In patients under long-term hemodialysis treatment, parenchymal consolidation, secondary to infectious agents such as S. aureus and Mycobacterium tuberculosis, is the most important CT finding since these lesions can be detected and treated successfully if they are considered as etiologic factors early on.

Primary choriocarcinoma of the stomach and pancreas: CT findings

In this report we present the CT findings of two non-gestational, extragonadal choriocarcinomas, one arising within the stomach and one in the pancreas. These are rare tumours and a pancreatic primary site has not been previously described.

MRI of hydatid disease of the liver: a variety of sequences

Hydatid disease is a parasitic manifestation that is most commonly seen in the liver. Diagnosis of this condition in the liver is usually straightforward and achieved through US and CT. Complicated cases and the often bizarre appearance of the disease can frequently create problems for the diagnostician, however. MRI has become an important diagnostic tool in the evaluation of complicated liver masses, with routine application of fat-suppressed, fast, and breath-hold techniques. In this pictorial essay, we demonstrate various features of hydatid disease using these new methods.

Osmotic demyelination syndrome with a dysequilibrium syndrome: reversible MRI findings

Neurological disorders may be seen in end-stage renal disease patients due to uraemia or to complications of dialysis. A dysequilibrium syndrome may be seen, usually soon after or towards the end of haemodialysis. This group of patients has no particular findings on MRI. On the other hand, the osmotic demyelination syndrome has definitive MRI findings, not to date reported with the dysequilibrium syndrome. We report a patient with end-stage renal disease and the dysequilibrium syndrome who showed findings of osmotic demyelination on MRI. The patient had a convulsion after a first haemodialysis, with quadriparesis and hyperactive deep tendon reflexes and bilateral Babinski signs. The upper motor neurone signs lasted for a week. Meanwhile, he was also dysarthric and had dysphagia. He recovered neurologically without any residuum following appropriate treatment and there was improvement on MRI.

HLA antigens and linkage disequilibrium patterns in Turkish Behçet's patients

Behçet's disease (BD) is a multisystem disorder featuring mucocutaneous, ocular, articular, vascular, intestinal, pulmonary, and neurologic involvement. Although the pathogenesis of the disease is still unknown, most studies have proposed that immunologic factors may play a major role in its development in genetically predisposed individuals. Seventy-one Turkish patients with BD, diagnosed according to the International Study Group for Behçet's Disease criteria, were studied and compared with 600 healthy controls to determine not only frequencies of HLA-A, B, and DR antigens but also whether BD shows any distinct linkage disequilibrium (LD) patterns. In addition, three-point linkage disequilibrium and relative risk (RR) values were determined. Of the HLA-A, B, and DR antigens examined, only B5 (51) was significantly increased in the patient group (X2 = 55.4; p < 0.05; RR = 6.44). DR7 was significantly decreased in the patient group (X2 = 6.9; p > 0.05; RR = 0.31). HLA haplotype B5-DR5 was found to be in negative LD in the control group, but Behçet's patients showed a strong positive LD between these two antigens. HLA haplotypes A2-B12, B5-DR2, and B12-DR4 showed negative LD in the patients; A1-B5 and B5-DR5 had positive LD in the patients. HLA haplotype A2-B5-DR5 was found to be more frequent than expected in both patients and control groups. A2-B12-DR4 showed a negative LD in the patients. The strong LD patterns between HLA-B and DR antigens in BD suggest that the susceptibility gene to BD could reside between the these two antigens.

Granulocyte and granulocyte-macrophage colony-stimulating factors, their receptors and interleukin-3 levels in newborns

Serum levels of granulocyte-macrophage colony-stimulating factor (GM-CSF), granulocyte colony-stimulating factor (G-CSF) and interleukin-3 (IL-3) as well as neutrophil counts were studied on the first, second and fifth days after birth, in order to elucidate the relations between neutrophil kinetics and these hematopoietic factors. The G-CSF and GM-CSF receptors on neutrophils were also investigated in 16 healthy newborns. G-CSF and GM-CSF receptor-positive neutrophil percentages were not different from those in the peripheral blood of adult controls. The receptor densities, assessed by mean fluorescence channel number, were also similar in newborn and adult neutrophils. The mean serum concentrations of G-CSF were high (191 pg/ml) on the first day of life and gradually decreased on the second (128 pg/ml) and fifth (112 pg/ml) days. A statistically significant correlation (p < 0.05) was found between G-CSF levels and absolute neutrophil counts (ANC). Furthermore, the percentage of decrease in G-CSF levels correlated significantly with the percentage of decrease in ANC (p < 0.001). GM-CSF levels were also high, though less striking, on the first day of life (9.5 pg/ml), remained at high levels on the second (10 pg/ml), and gradually decreased on the fifth (8.8 pg/ml) day. IL-3 levels were high (110 pg/ml) on the first day of life and remained at high levels on the second (138 pg/ml) and fifth (138 pg/ml) days. We found that the IL-3, GM-CSF and G-CSF levels were elevated during the first week of postnatal life. Our findings suggest that significant changes in the levels of the growth factors are likely to be the cause of significant leukocyte blood picture changes during the first week of life. We found normal GM-CSF and G-CSF receptors in uninfected newborns.

Cytokines in acute rheumatic fever

Plasma concentrations of inflammatory cytokines (IL-1 alpha, IL-1 beta, IL-6, IL-8 and TNF alpha) were determined by ELISA in 27 patients with acute rheumatic fever (RF), 12 with only arthritis (RFA) and 15 with rheumatic heart disease (RHD), before, during and after treatment. Altogether, significant increases in TNF alpha, IL-8 and IL-6 levels were observed in the acute phase as compared to the data found during and after treatment. No significant differences were observed for the other cytokines. Elevations of one or more of the inflammatory cytokines were observed in 9 of 12 patients with RFA, and 12 of 15 with RHD. Increase of TNF alpha (6/9) and IL-8 (5/9) levels were higher in RHD patients with cardiac failure. These cytokines were below the detection limits on day 7 of treatment in all 22 patients, except in two, and in all 10 days after treatment.

CONCLUSIONS

These findings suggest that inflammatory cytokines, as TNF alpha, IL-8 and IL-6, may play a pathogenic role in rheumatic fever.

Cutaneous histoplasmosis in a child with hyper-IgM

Immunodeficiency with hyperimmunoglobulinemia M is a rare disease characterized by very low levels of IgG and IgA and normal or high levels of serum IgM and IgD. Recurrent and severe systemic infections with pathogenic bacteria are frequent if immunoglobulin replacement therapy is not given. Histoplasmosis is a systemic granulomatous mycosis due to Histoplasma capsulatum and characterized by a particular affinity for the reticuloendothelial system. Glabrous skin involvement in histoplasmosis is highly unusual except in patients with advanced human immunodeficiency viral disease. Cutaneous histoplasmosis and granulomatous reaction were diagnosed in a 5-year-old boy with hyper-IgM disease. The lesion improved after oral ketoconazole therapy. To our knowledge, this is the first case of cutaneous histoplasmosis associated with hyper-IgM to be reported.

Systemic oxalosis: pathognomonic renal and specific extrarenal findings on US and CT

Hyperoxaluria is characterized by nephrocalcinosis and nephrolithiasis on radiological examination and may also result in diffuse deposition of calcium oxalate crystals in multiple extrarenal organs (oxalosis). In two cases, the renal findings of primary hyperoxaluria were diagnosed by ultrasound and computed tomography scans. In addition to renal involvement, both patients had liver involvement, and one patient had cardiac involvement.

CT and MR imaging of splenic leiomyoma in a child with ataxia telangiectasia

Computed tomographic and magnetic resonance imaging findings of a splenic leiomyoma in an 8-year-old boy with ataxia telangiectasia are presented. This is the first reported case of a splenic leiomyoma in the literature.

Neonatal tumor necrosis factor, interleukin-1 alpha, interleukin-1 beta, and interleukin-6 response to infection

Various studies have shown that in vitro production of cytokines by leukocytes from the newborn are normal, decreased, or increased. We investigated the blood levels of tumor necrosis factor-alpha (TNF-alpha) interleukin-1 alpha, interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) simultaneously to assess the cytokine response to systemic infection during the neonatal period. One or more cytokine levels were elevated in all of the newborns with sepsis. Serum TNF levels in the newborns with sepsis were significantly higher than the two control groups (P < 0.002). Serum IL-6 levels in the study group were also found to be significantly higher than the control groups (P < 0.0004 for sepsis vs adult controls and P < 0.03 for sepsis vs newborn controls). We could not find statistically significant correlation between any of the cytokine levels, C-reactive protein, white blood cells, and platelet counts and the outcome. Gram-negative bacteria were the main causative agents in these patients, although one of them was infected with gram-positive bacteria, besides one premature infant (29 weeks) with Candida sepsis also had significantly elevated TNF, IL-1 beta, and IL-6 levels. Our data show that both mature and premature neonates were able to produce and significantly increase the blood levels of the cytokines in response to sepsis. Because the biologic relevance of cytokine levels is not known, further prospective and sequential studies on cytokine levels simultaneously and correlation with clinical parameters are needed to clarify the biological role of this important component of the host defense system.