What is the role of andexanet alfa in the reversal of anticoagulant effects?

ABSTRACT

Although using direct oral anticoagulants increases patient risk for hemorrhagic events, FDA-approved options for reversing anticoagulant effects are limited. This article discusses one of the more recent FDA-approved antidotes, andexanet alfa, and provides guidelines for its safe and effective use.

Laboratory results and clinical findings of children with hydatid cyst disease

Objectives

The relationship hydatid cyst (HC) is a parasitic disease that is endemic worldwide.

Aims

To study the clinical findings and laboratory results of patients with hydatid disease.

Materials and Methods

Total number of patients (n = 78) who underwent surgery for HC disease from 2000 to 2017 were retrospectively evaluated. The patients' demographic characteristics, reasons for admission into hospital, lesion location and size, laboratory results, and complications were recorded.

Results

Of the HCs, 59% and 26.9% were located in the liver and lungs, respectively. The rate of multiple organ involvement was 10.3%. A total of 16 (20.5%) cases had ruptured HCs (7 livers, 7 lungs, 1 spleen, and 1 omentum). There was no significant difference in the rate of eosinophilia between patients with and without cyst rupture (P = 0.9). Indirect hemagglutination (IHA) tests yielded negative results in 38.9% of the patients; among them, 32.1% had ruptured HCs. A negative IHA test result was significantly associated with rupture (P = 0.046). No significant difference between rupture and cyst size or location was found.

Conclusions

HC rupture was not correlated with cyst size. The sensitivity of serological tests and the blood eosinophil count was low, even in cases of ruptured HCs. The recurrence rate can be reduced by open surgery and medical treatments.

Is stent type used in snodgrass method a factor in fistula formation?

Context

Snodgrass method (tubularized incised plate urethroplasty [TIPU]) is a widely used technique for hypospadias repair.

Aim

It was aimed to compare the outcome of hypospadias repair with stenting using feeding tube compare with those with Foley catheter.

Subjects and Methods

The demographic characteristics of the 123 patients who underwent hypospadias repair with Snodgrass method, the success of the applied method, and the factors affecting fistula complication were evaluated retrospectively. Patients were divided into two groups: those operated before January 2010 (Group A) and those who were operated after (Group B). In Group A patients, urethroplasty was performed using silicone Foley catheters, in which balloon of these catheters was filled by saline at appropriate size. In Group B, urethroplasty was performed using feeding catheter.

Results

Group A and Group B consisted of 32 and 91 patients, respectively. Fistula developed in 10 (31.3%) and 4 (4.39%) patients in Group A and Group B, respectively. There was a statistically significant difference between the two groups in terms of the development of fistula complication (P = 0.0002).

Conclusion

The use of a feeding catheter in TIPU could be a more advantageous than using a Foley catheter.

Bochdalek hernia and intrathoracic ectopic kidney: Presentation of two case reports and review of the literature

Bochdalek hernia is a congenital abnormality with high morbidity and mortality characterized by passage of the abdominal organs into the thoracic cavity through a diaphragmatic defect. Intrathoracic location of abdominal organs such as kidneys is very rare, with a reported incidence of only 0.25% in the literature. Herein, we present two cases of Bochdalek hernia with a herniation of intra-abdominal organ such as kidney that was treated in our clinic and compare this rare case with those in the literature. In both cases, the functionally normal kidneys were left in situ during diaphragmatic repair. No complications were observed during the postoperative period, and 10- and 1-year follow-ups. In cases with Bochdalek hernia associated with an intrathoracic ectopic kidney, the functionally normal ectopic kidneys were left in situ during repair of the diaphragmatic defect without complications.

Ghrelin and NUCB2/Nesfatin-1 expression in unilateral testicular torsion-induced rats with and without N-acetylcysteine

Testicular torsion (TT) is a common urological problem in the field of pediatric surgery. The degree and duration of torsion determines the degree of testicular damage; however, its effects on the expression of octanoylated ghrelin and nucleobindin 2 (NUCB2) /nesfatin-1 synthetized from testicular tissue remain unclear. We explored the effects of experimentally induced unilateral TT on serum and contralateral testicular tissue ghrelin and NUCB2/nesfatin-1 levels, and determined whether N-acetyl cysteine (NAS) treatment had any effects on their expression. A total of 42 Wistar Albino strain rats were divided into 7 groups: Group (G) I control, GII sham, GIII 12-hour torsion, GIV 12-hour torsion + detorsion + 100 mg/kg NAS, GV 24-hour torsion, GVI 24-hour torsion + detorsion + 100 mg/kg NAS, and GVII 100 mg/kg NAS. Octanoylated ghrelin and NUCB2/nesfatin-1 concentrations were evaluated in serum using the ELISA method and in testicular tissue with immunohistochemical methods. Immunoreactivity of octanoylated ghrelin significantly increased in GI compared to GIII, GV, and GVI (p<0.05). NUCB2/nesfatin-1 immunoreactivity increased in GV and GVIII relative to GI (p<0.05). In the 12-hour torsion group, a significant decrease in octanoylated ghrelin levels with NAS treatment was observed; however, in the 24-hour torsion group, a significant decrease was not observed. In the 12-hour torsion + NAS treatment group, a significant change was not observed in NUCB2/nesfatin-1 expression. Following 24-hour torsion, an increase in NUCB2/nesfatin-1 levels was observed, and NAS treatment did not reverse this increase. It was determined that increases in the expression of octanoylated ghrelin and NUCB2/nesfatin-1, the latter of which was a result of TT, reflect damage in this tissue. Importantly, NAS treatment could prevent this damage. Thus, there may be a clinical application for the combined use of NAS and octanoylated ghrelin in preventing TT-related infertility.

Bladder perforations in children

CONTEXT

Bladder perforations in children occur due to several different reasons.

AIM

In this clinical series study, we focused on bladder perforations due to the pelvic injury, and our aim also was to create awareness for a rare type of bladder injuries.

SETTING AND DESIGN

This was a retrospective study of the patients who were treated in our clinic for bladder perforation between 2006 and 2011.

SUBJECTS AND METHODS

We reviewed the documents of childhood bladder perforations, and demographic and clinical characteristics of the patients were obtained. No statistical analyses were used because of the limited number of cases.

RESULTS

There were ten patients who suffered from bladder perforation in 5-year period; 5 were male, and 5 were female. The mean age of the patients was 4.35 years. Four patients (40%) experienced iatrogenic perforation and six patients (60%) experienced perforation due to the accident. Common symptoms were hematuria, abdominal tenderness, and inability to urinate. Three patients were diagnosed via emergency laparotomy, without any radiological examinations performed before surgery. Four patients suffered from the intraperitoneal perforation, three patients suffered from extraperitoneal injury and three of them both of intraperitoneal and extraperitoneal injuries. Mean recovery time for patients was 15 days. One patient developed a urinary tract infection and one newborn died due to accompanying morbidities. Nine patients were discharged from the hospital.

CONCLUSION

If the patients had a pelvic injury, surgeons must pay attention for the bladder perforation. Isolated bladder perforations are rare, and they are generally associated with iatrogenic injuries. Clinicians should pay attention to findings such as anuria, inability to insert a urinary catheter, and free fluid in the abdomen in order to diagnose the bladder perforation in newborns. Novice surgeons should pay more attention to avoid causing iatrogenic bladder perforation during inguinal hernia repair.

Rare malformation of glans penis: arteriovenous malformation

Pediatric glans penis malformations, especially arteriovenous malformations (AVM), are very rare. Herein, we report two rare cases. A 14-year-old boy attended our outpatient clinic with chief complaints of purple swelling and rapidly growing lesion on the glans penis. The lesion was excised surgically after physical and radiological evaluations. Pathology reported AVM and the patient is being followed up. The second case is a 2-year-old boy who was admitted with a big lesion involving glans penis and genital area that has been present since birth. In physical and radiological evaluations, lesion on the glans penis was pulsatile. Parents of the patient did not want any surgery and patient has been in follow-up. Diagnosis of the vascular lesions on glans penis is very easy by physical and radiological examinations today. Long-term follow-up is very important for AVM. Clinicians must make a careful effort to document new glans lesions in the pediatric population and decrease anxiety in the parents of affected children.

Protective role of vitamin C in diazepam-induced apoptosis in rat thymocytes

Diazepam, a peripheral-type benzodiazepine receptor ligand, is widely used as a therapeutic agent. On the other hand, peripheral-type benzodiazepines have been shown to induce apoptosis in different immune cell types. In this study, we examined the possible protective role of vitamin C in diazepam-induced apoptosis and evaluated the cellular content of glutathione during this process. Rat thymocytes were incubated for 24 hours with diazepam and increasing concentrations of vitamin C or with diazepam alone. The exposure to diazepam resulted in an increase in apoptotic cell death and decrease in glutathione content in rat thymocytes. Vitamin C was effective in ameliorating the effect of diazepam in rat thymocytes by decreasing the proportion of apoptotic cells and increasing the cellular content of glutathione. These results suggest that vitamin C reduced the diazepam-induced apoptosis in rat thymocytes by restoring the cellular content of glutathione, which may be useful in preventing the diazepam-induced immunosupression (Tab. 1, Fig. 1, Ref. 31).

The role of ascorbic acid and monosodium glutamate in thymocyte apoptosis

The studies on experimental animals have confirmed toxic effect of monosodium glutamate in different organs, mainly manifested by increased oxidative stress and cytotoxicity, strongly correlated with numerous diseases. Continuous intake of this flavor enhancer in modern nutrition also resulted with toxic effects on human health, known as Chinese restaurant syndrome. The reference data about influence of monosodium glutamate on the cells of the immune system or primary immune organs and possible protective effects of specific antioxidants are still largely unknown. This review summarizes recently known facts about the role of monosodium glutamate in the cells of the immune system, especially in thymocytes. Also, in this review many new data on positive effects of ascorbic acid on immune system and the mechanisms of its protective influence on thymocytes are discussed (Tab. 1, Ref. 52).

Monosodium glutamate induces apoptosis in naive and memory human B cells

The aim of this study was to establish the existence of mGluR7 in normal B lymphocytes and analyse the effect of monosodium glutamate (MSG) on B cell apoptosis in vitro. B cells were purified by magnetic cell sorting using anti-CD19-coupled magnetic beads. Cells (10(6)/ml) were cultured with increasing MSG concentrations (1-100 mM). Detection of apoptosis by flow cytometry was performed using the Annexin V-FITC/Propidium iodide (PI) apoptosis detection kit. Naïve and memory B cell population were identified by CD27 staining. Expression of GluRs was determined using PCR. Exposure to increasing MSG concentrations displayed dose dependent effect on B cell viability altogether, ranging from 35% with 100 mM up to 80% with 1 mM MSG. Moreover, the number of late apoptotic cells as well as necrotic cells was dose dependant. Both CD27- as well as CD27+ B cells were affected by MSG. Basal expression of GluRs7 was detected in unstimulated B cells. Glutamate induced apoptosis can be seen in memory as well as naive B cell population and is probably mediated through mGluR7, whose expression in B cells we also confirmed. Our study suggests a new possible mechanism of crosstalk between the nervous and the immune system through glutamate as a potential key mediator (Fig. 4, Ref. 27). Full Text (Free, PDF) www.bmj.sk.

Ascorbic acid modulates monosodium glutamate induced cytotoxicity in rat thymus

BACKGROUND

Monosodium glutamate (MSG) is a commonly used flavor enhancer in modern nutrition. It has been shown that administration of MSG induces toxic effects in various regions of brain, thymus, liver and kidney. Also, it is well-documented that Vitamin C (ascorbic acid) has a protective role in MSG-induced cytotoxicity in rat liver, kidney and various brain regions, but has not been studied in thymus.

OBJECTIVES

In the present study, we examined the possible protective role of Vitamin C in MSG-induced cytotoxicity in adult (Kindly indicate the strain of rat) rat thymus.

MATERIAL AND METHODS

MSG was administrated intraperitoneally (4 mg/g of body weight), with or without Vitamin C (500 mg/kg of body weight), for six consecutive days. Animals were sacrificed at 1st, 7th and 14th day of last MSG dose.

RESULTS

This study demonstrates that MSG administration in animals significantly decreases cell viability with significant down-regulation of Bcl-2 protein, while Bax protein expression was not significantly changed in rat thymocytes. Vitamin C was effective in ameliorating the effect of MSG in rat thymocytes by increasing the proportion of viable cells and up-regulating the expression of Bcl-2 protein in rat thymocytes.

CONCLUSION

These results suggest that the treatment with Vitamin C may prevent the MSG-induced cytotoxicity in rat thymocytes by up-regulating Bcl-2 protein expression resulting in a change in Bcl-2/Bax protein ratio (Tab. 1, Fig. 1, Ref. 32). Full Text (Free, PDF) www.bmj.sk.

Lipid peroxides in obese patients and effects of weight loss with orlistat on lipid peroxides levels

OBJECTIVE

Obesity is a well-known risk factor of atherosclerosis. Recent studies showed that obesity is associated with enhanced lipid peroxidation. The aim of this study is to investigate the effect of weight reduction with orlistat treatment on lipid peroxidation levels. We assessed lipid peroxidation by measuring the concentration of plasma malondialdehyde (MDA).

DESIGN

A randomized, controlled, open-label 6-month study.

SUBJECTS

In total, 36 obese (body mass index (BMI) >30 kg/m2) and 11 healthy age-matched control subjects were enrolled in the study.

MEASUREMENTS

Fasting glucose, triglyceride, total cholesterol, HDL cholesterol and LDL cholesterol and MDA levels were measured in both groups. Obese subjects received orlistat, 120 mg three times daily together with hypocaloric diet. After 6 months of treatment laboratory tests were repeated.

RESULTS

MDA levels were significantly higher in obese patients than the control group (P<0.0001). After 6 months of treatment in obese subjects, the mean weight of the patients decreased by 6.8 kg, the BMI by 3.2 kg/m2. Plasma MDA levels were significantly reduced by weight loss from 2+/-0.77 to 0.89+/-0.41 nmol/ml (P<0.001). BMI correlated with MDA levels at baseline (r=0.6, P<0.0001). Changes in BMI was positively associated with plasma MDA level reduction (r=0.36, P<0.05).

CONCLUSION

These results indicate that obesity is associated with increases in endogenous lipid peroxides. Our data show that the indicator of lipid peroxidation-MDA-falls markedly in association with weight loss with orlistat. The demonstration of decreased free radical generation has important implications for oxidative mechanism underlying obesity-associated disorders.

[Complications in laparoscopic cholecystectomy]

INTRODUCTION

For more than a century classical cholecystectomy has been a method of choice in surgical management of gallbladder diseases. At the end of eighties and at the beginning of nineties of this century, laparoscopic cholecystectomy has been introduced gradually taking the place of classical. Numerous studies deal with complications associated with this surgical procedure.

COMPLICATIONS RELATED TO INSERTION OF VERESS NEEDLE

During insertion of Veress needle, injuries of the frontal abdominal wall may occur (9). Insertion of the needle into the peritoneal cavity may cause: injury of the omentum with consequential hemorrhage; intestinal and mesenteric injuries as well as injuries of urinary bladder and great blood vessels of retroperitoneum. Initial insufflation of CO2 through the needle, if it is inadequately placed, may cause subacute emphysema, intraperitoneal adhesion formation, mediastinal emphysema and pneumothorax (8-10). COMPLICATIONS RELATED TO TROCAR INSERTION--TROCAR INJURIES: Apart from injuries associated with insertion of Veress needle, insertion of trocar may cause injuries of the liver, spleen and falciform ligament (4). Trocar injuries are more severe (8,9).

BILE DUCTS INJURIES

Bile ducts injuries are divided into mild (injuries of a smaller bile duct, incomplete ductus cysticus occlusion or partial that is lateral injury of greater ducts) and severe (injuries of duct choledochus or hepatic ducts) (1). Bile ducts injuries are extremely severe complications with high morbidity, long-term hospitalization and may be life threatening (11,12).

INTRAOPERATIVE BLEEDING

Intensive and uncontrolled intraoperative bleeding, especially within the operative field, both arterial (from arterial cyst) and venous (gallbladder, vena porte) requires conversion. POSTOPERATIVE HEMORRHAGE: Postoperative hemorrhage usually occurs in cases of cystic artery damage, prolonged hemorrhage from the gallbladder, parenchymal liver injuries and as well as in open cholecystectomy it is an indication for reoperation (8,9).

OTHER COMPLICATIONS

Other complications, thermic and mechanic diaphragmatic injuries and infections of incisional injuries and herniations at the place of trocar insertion.

OUR EXPERIENCES

In the period June 1995-November 1997, 500 patients underwent laparoscopic cholecystectomy (401 female--80.2% and 99 male--19.8%) aging from 16-78 years of age, average age 46 years. 16 (3.2%) mild complications were recorded (reoperation was necessary in one case): 1) subcutaneous emphysema in 3 patients (0.6%) which gradually disappeared up to 36 hours after surgery; 2) Retzin's space emphysema in 1 patient (0.2%) causing dysuria for 3 days; 3) bilirea--bile excretion through subhepatic drain in 2 patients (0.4%)--from the second to seventh postoperative day (excretion did not exceed 500 ml a day) and it spontaneously stopped; 4) inflammatory hematoma of the falciform ligament (0.02%); 5) in 8 patients (1.6%) postoperative infection of infraxifoid wound was registered; 6) in 1 patient (0.2%) segmental bile duct injury occurred. Out of 500 laparoscopic cholecystectomies conversion was necessary in 19 cases (3.8%).

CONCLUSION

In spite of numerous advantages and better comfort for patients, this method may have complications, whereas incidence of bile ducts injuries seems to be higher than in the classical procedure. The more laparoscopic cholecystectomies are performed, the more bile ducts injuries occur. Out of 500 laparoscopic cholecystectomies performed at the Surgery Department of the hospital in Senta, 3.2% of mild complications were registered with 1 case needing reoperation, while in 1 case (0.2%) it was probably type A bile duct injury.

Orthodontic and orthopedic effects of Activator, Activator-HG combination, and Bass appliances: a comparative study

The orthodontic and orthopedic effects of the Activator, Activator-Headgear Combination (ACHG) and the Bass appliance systems were compared by analyzing the cephalometric records of 64 subjects, who were treated for skeletal Class II malocclusion, with both conventional and Pancherz's methods. Differences between observations on the different occasions (starting and ending values) were tested with Wilcoxon's matched pairs rank test. Kruskal-Wallis nonparametric analysis of variance was carried out in different situations among all three groups. If a level of significance less than 0.05 was observed, Scheffè's method of multiple comparisons was used to determine differences among groups. The results of this study showed that greater improvement in sagittal skeletal relationship (ANB angle) was obtained in both Bass and ACHG groups than in the Activator group. The differences between the groups were most pronounced for dental variables. The Bass appliance was found to be more effective in the control of the unwanted side effects (proclination of lower incisors, retroclination of upper incisors). Unfavorable labial tipping of the lower incisors was also prevented with the ACHG appliance.

Bromocriptine-induced inhibition of hydroxylase/lyase activity of adult rat Leydig cells

The present in vitro studies using a suspension of Leydig cells from adult rat testis demonstrated that bromocriptine (BR, 2 x 10(-5)M) inhibits hCG-stimulated testosterone production (in the presence of submaximal and maximal doses of hCG), while basal production was unaffected. When the cells were exposed to 8-bromo-cAMP either in the presence or absence of hCG, the inhibitory effect of BR was not reversed. In intact cells, BR inhibited conversion of progesterone and 17-hydroxy-progesterone to testosterone while conversion of androstenedione was not affected. Incubation of homogenates of Leydig cells in the presence of limiting NADPH concentrations (< or = 0.1 mM) resulted in significant BR-induced inhibition of conversion of progesterone (10 microM) to testosterone, while in the presence of "high" concentrations of NADPH (> or = 0.5 mM) BR was without effect. Present results suggest that BR inhibits androgen production at the level of the microsomal enzymes 17 alpha-hydroxylase and/or 17,20-lyase. The inhibitory effect of BR using homogenates of Leydig cells was evident only in the presence of limiting NADPH concentrations that suggests a competitive-like pattern of inhibition, but mechanisms by which BR decreases activity of microsomal enzymes remain to be determined.