High Anxiety Levels before Elective Cesarean Section Can Negatively Affect the Mother and Fetus

BACKGROUND

Both pregnancy and surgery cause anxiety. This situation may negatively affect the health of the mother and baby.

AIM

The effect of anxiety level before cesarean section (CS) on feto-maternal outcomes was investigated.

METHODS

The preoperative anxiety score was determined with the State-Trait Anxiety Inventory (STAI) in 224 pregnant women who were planned for elective CS.

RESULTS

Among patients, 33.5% were in the low anxiety group, 27.2% in the moderate, and 39.3% in the high anxiety group. The average birth weight in the low anxiety group was noticeably higher than that of the high anxiety group (P = 0.018). The mean heart rate at postop 1st and 24th hour in the high anxiety group was higher than the moderate anxiety group (P < 0.028). In addition, diastolic blood pressure (DBP) at the sixth hour in the low anxiety group was found to be lower than in the moderate anxiety group (P < 0.05).

CONCLUSION

According to these results, it was found that an increased anxiety score before CS is associated with low birth weight in the baby, higher heart rate, and DBP in the mother.

P–641 Pubertal high-fat diet interferes with the ovarian kisspeptin ligand and receptor expressions regulating female fertility

Study question

Does chronic high-fat diet affect ovarian dysfunctions via changing of kisspeptin and kisspeptin receptor expressions?

Summary answer

Ovarian kisspeptin and kisspeptin receptor expressions are significantly affected by the chronic high-fat diet.

What is known already

Regarding the hypothalamic-pituitary-gonadal (HPG) roles of kisspeptin, it appears that it directly stimulates LH secretion from the pituitary, consecutively stimulates ovulation in the female. There are also studies showing that kisspeptins can increase GnRH release, serum FSH, LH, and testosterone (in vivo), and regulate ovulation in women who have reached sexual maturity through the central control of the HPG axis.

Fatty acids can act as nutritional signals that regulate the HPG axis, and elevated levels of circulating saturated fatty acids associated with high-fat diet (HFD)-feeding has been shown to induce ovarian dysfunction. HFD consumption induces ovarian dysfunction in rodents.

Study design, size, duration

4-week-old female rats obtained from Akdeniz University Experimental Animals Unit. Animals were kept in standard conditions; fed with control diet consisting of standard laboratory food (13.5% of total energy from oil) or HFD (60% of total energy from oil) for 8 weeks. Experimental procedures were performed at the age of 12 weeks (250–275 g live weight). Live weights and food consumption of the animals in both groups were calculated weekly and recorded during the experiment.

Participants/materials, setting, methods

At the end of the experimental period, the animals were sacrificed and tissues were obtained. Sections were taken from paraffin-embedded tissues. Immunohistochemical staining for KISS1 and GPR54 were performed in both groups’ ovaries. Tissue collecting, processing, and immunohistochemical staining were performed at the histology and embryology department of Akdeniz University Faculty of Medicine.

Main results and the role of chance

There was a significant increase in body weights of the HFD group during the experiment period compared to the control group.

As a result of immunohistochemical staining, kisspeptin expression is specifically localized to the corpora lutea of the control ovaries. However, kisspeptin expression in the corpora lutea of the HFD ovaries was increased regardless of the ovarian follicles.

KISS1R expression was located in the cytoplasm of oocytes. HFD group also expressed the KISS1R in the oocytes with increasing intensity.

Limitations, reasons for caution

The study design included pubertal age limit of the samples. The functional reproductive period in different mammal species should be considered.

Wider implications of the findings: We suggest that chronic exposure of female rats to a high-fat diet may induce ovarian Kisspeptin expression while kisspeptin receptor expression is not affected in oocytes. Clinical implications should be considered.

Trial registration number

B.30.2.AKD.0.05.07.00/99

Clinical assessment of primary and secondary hypertension in children and adolescents

The aim of this study was to compare the clinical features of patients with elevated blood pressure and to detect variables associated with the diagnosis of primary hypertension. We identified 383 (69%) hypertensive children (197 [51.5%] with primary hypertension, and 186 [48.5%] with secondary hypertension) out of 553 children referred to our clinic with a history of elevated blood pressure. The primary hypertension group was significantly older and had higher BMI, positive family history of hypertension, and lower prevalence of preterm birth compared with those with secondary hypertension. No difference was found between the two groups in terms of the frequency of target organ damage. Multiple regression analysis showed that a family history of hypertension, obesity, age over 10 years, elevated uric acid, and presence of higher systolic blood pressure values at admission were independent predictors of primary hypertension; therefore, these parameters can be considered important clues for diagnosing primary hypertension.

Can Intra-articular 1α, 25-Dihydroxyvitamin D3 Administration Be Therapeutical in Joint Cartilage Damage?

INTRODUCTION Vitamin D-deficiency is known to cause nerve conduction impairments, cancer and chronic diseases, as well as the pathogenesis of osteoarthritis. Our goal with this study is to evaluate the cartilage healing by applying intraarticular 1α, 25 (OH) 2D3 at different doses in rats with normal vitamin D levels and metabolism, which we made focal chondral damage model in the knee joint. MATERIAL AND METHODS 35 male Sprague-Dawley rats aged 20-24 weeks were used in our study. Both knees of rats were cartilage defected surgically on day 0. Joint injections performed at 06:00 am on 0th and 2nd days and after second injection others performed on days 9-16 and 23 following a weekly period. RESULTS In the fourth week, hematoxylin eosin staining measurements showed statistically significant difference according to the groups (p < 0.01) Metalloproteinase-13 (MMP-13) in histological staining for evaluating cartilage healing and healing levels showed statistically significant differences between the groups at first week and fourth week (p < 0.05). DISCUSSION Vitamin D, which affects many tissues through its receptors, is believed to be chondroprotective and neuroprotective by decreasing the expression of MMP in cartilage fibroblast, macrophage, lymphocyte through its intracellular receptors. To the best of our knowledge, this is the first study known to be intraarticular use of 1α, 25-dihydroxyvitamin D3. Our study has been found to be safe and successful in terms of weight, systemic PTH and 1α, 25-dihydroxyvitamin D3 levels in rats during treatment as well as better healing of cartilage damage. Key words: vitamin D3 receptor, articular cartilage, orthopedics, nerve conduction.

Pulmonary diffusion capacity predicts major complications after esophagectomy for patients with esophageal cancer

A reduced forced expiratory volume in one second (FEV1) is a well-recognized risk factor for complications after esophagectomy. Lung diffusing capacity for carbon monoxide (DLCO) is not routinely integrated in the risk assessment of esophagectomy. The aim of this study is to evaluate the association of preoperative pulmonary function tests with major postoperative complications after esophagectomy for cancer. In order to achieve this aim, 459 patients with newly diagnosed esophageal cancer who underwent elective transthoracic (n = 352) or transhiatal (n = 107) surgical resection of the esophagus with cervical anastomosis between 2003 and 2015 were analyzed. Multivariable logistic regression analysis was performed to assess the association of preoperative pulmonary function tests (expressed as % of predicted) with major complications after esophagectomy, adjusted for previously identified predictors. Major complications were defined as Clavien-Dindo grade IIIb or higher. Of the 459 included patients, 114 (24.8%) developed major complications. In univariable analysis FEV1, forced vital capacity (FVC), vital capacity (VC), and DLCO were associated with major complications. After adjusting each pulmonary function test for age, American Society of Anesthesiologists (ASA) score, cardiac comorbidity, diabetes mellitus, peripheral vascular disease, and surgical approach, FVC (OR: 1.24 per 10% decrease; 95% CI: 1.06-1.45; P = 0.004), VC (OR: 1.19 per 10% decrease; 95% CI: 1.02-1.39; P = 0.025) and DLCO (OR: 1.16 per 10% decrease; 95%CI: 1.02-1.33; P = 0.025) remained predictive factors for major surgical complications. In multivariable analysis in which all pulmonary functions tests were combined, DLCO was the strongest predictor of major complications (OR: 1.14 per 10% increase; 95% CI: 1.01-1.30; P = 0.046). The ideal cut-off for DLCO% of predicted was determined at <84% (OR: 1.97; 95% CI: 1.28-3.03; P = 0.002). These data indicate that DLCO is an independent predictor of major complications after esophagectomy for cancer. This pulmonary function test deserves greater consideration in prediction research of major complications after esophagectomy.

Orthopedics and Traumatology Residency - Working Conditions, Training, and Psychological Stress

PURPOSE OF THE STUDY The specialty of orthopedics and traumatology that is completed in the 5 years period in our country is a challenging educational process and our purpose in this study is to demonstrate through a survey training conditions of the orthopedic assistants in our country and the effects of this process on assistants. MATERIAL AND METHODS 524 (70.05%) of 748 assistants who receive specialization training in Turkey were reached. There were 20 multiple choice questions ( 1 mark each) and 3 questions (more than 1 mark each) in the survey consisting of twenty-three questions. Our study group was formed by doctors who have still worked as assistant in our country and have accepted to participate in the study. The doctors who finished assistantship with any reason and did assistantship for time less than 6 months and did not exactly fill the questionnaire form were excluded from the study. RESULTS 524 (71.97%) of 728 assistant who are in 40 (100%) of 40 provinces where assistant training given in Turkey were reached. 474 (90.45%) participants were satisfied to do orthopedic specialization. When considering working hours, it was observed that 337 (64.31%) participants had over 90 hours weekly including night shift and 521 (99.42%) participants had to work after night shift. The majority of participants (361 persons 68.89%) were receiving salaries between TL 4000-6000. When looking at the entire working group, the rate of participants who said that scientific training is weak or there is no scientific training was 427 (81.48%). CONCLUSIONS Our survey study is one of the first statistical study which investigating professional and social problems of orthopedic assistants. Some of important problems as training satisfaction, abuse by patients and/or manager, the average monthly income and psychological status assessment is emphasized. Orthopedics and Traumatology assistantship is a challenging process to cause physical and psychological problems with the hard working conditions in our Turkey. Key words:residency training, orthopedic surgery, life quality, salary.

Is Intraarticular Antibiotic Administration Effective in the Treatment of Methicillin-Resistant Staphylococcus aureus?

PURPOSE OF THE STUDY Septic arthritis is an infection of joints caused by a pathogenic microorganism. Septic arthritis has a mortality rate of 11-40% when it's not treated properly. The mortality rate with methicillin-sensitive Staphylococcus aureus (MSSA)is 5-7%, while the rate with methicillin-resistant Staphylococcus aureus (MRSA)is 13-20%. The aim of this study is to evaluate the effects of intraarticular vancomycin and teicoplanin on joint cartilage in in vivo settings and its utility in routine MRSA treatment. MATERIALS AND METHODS In our study, 35 male Sprague-Dawley rats aged 28 days were used. Rats were obtained from the Regenerative and Restorative Medicine Research Center (REMER) of Istanbul Medipol University. Rats were randomly divided into 5 groups each containing 7 rats. Joint injections were administered with isoflurane analgesia every day at 6 am. Three rats (15 rats) from each group were sacrified in seventh day and evaluated immunohistologically to evaluate acute healing in articular cartilage. All remaining rats were sacrificed on day 28 and their knees were evaluated by immunohistochemical examination. RESULTS In our study, there were no complications in any rat during injection and the study period. Hematoxylin eosin (H & E) histological staining for evaluating cartilage healing and healing levels did not show statistically significant differences between the groups at first week (p > 0.05). Matrix metalloproteinase-13 (MMP-13) staining did not show any statistically significant difference between the groups. (p > 0.05). DISCUSSION MRSAseptic arthritis, diagnosed for the first time in 1960, has recently been responsible for 6-22% of all septic arthritis and is increasing day by day. The use of systemic vancomycin or teicoplanin is the first-line treatment method in MRSA septic arthritis. Serum levels reach the desired level, especially with intravenous infusion dose. On the other hand, it has been shown that intraarticular concentration does not reach a sufficient level in studies conducted. The use of intraarticular antibiotics during treatment can lead to more effective and early disease control by turning this negative situation into favor of the patient. As a result, intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSAseptic arthritis. CONCLUSIONS Intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSA septic arthritis. Key words:arthritis, infectious; methicillin-resistant Staphylococcus aureus; mortality.

Is platelet-rich plasma injection an effective choice in cases of non-union?

PURPOSE OF THE STUDY

By the expression of several growth factors from activated thrombocytes, the application of Platelet Rich Plasma (PRP) stimulates angiogenesis and regeneration thus stimulating recovery through cell differentiation. This study aimed to evaluate the effects of PRP injection on patients who had undergone surgery for fracture and in whom delayed union or nonunion had been determined.

MATERIAL AND METHODS

The study comprised 20 patients (male 17, female 3; median age 33.5 range 15-77) who had undergone lower extremity fracture surgery and were diagnosed with aseptic delayed union (8 patients) or non-union (12 patients). Blood taken from the patients was centrifuged to separate PRP, which was then activated by calcium chloride. The prepared PRP was injected into the fracture line under fluoroscopy guidance for totally three times once a week. The application of PRP was made at median 6 (range 6-8) months after fracture surgery. All patients were followed-up with clinical examinations and radiographs over a median period of 11 (range 8-12) months.

RESULTS

Fracture union was achieved in six patients at median 15 (range 8-24) weeks. There was non-union of the fracture in eleven patients during the follow-up period and these patients underwent revision surgery. Sufficient union was not determined radiologically and clinically in three patients. Fracture union was achieved in six of eight patients in the delayed union group. There was no patient in the non-union group with fracture union.

CONCLUSIONS

Fracture healing is a process affected by many factors. Although PRP has been reported in literature to be a biological treatment which increases healing, adequate healing was not determined in the treatment of non-union with PRP injection. However, in selected patients determined with delayed union, PRP injection can be recommended in non-surgical treatment.

Platelet-rich plasma injection is more effective than hyaluronic acid in the treatment of knee osteoarthritis

PURPOSE OF THE STUDY

There is increasing use of platelet-rich plasma (PRP) in orthopaedics as it is a simple, cheap and minimally invasive technique. This study aimed to compare the effects of the use of PRP and hyaluronic acid (HA) injections in the knee of patients diagnosed with and being followed-up for degenerative arthritis.

MATERIALS AND METHODS

This prospective study included 90 patients with complaints of knee pain with findings of mild or moderate degenerative arthritis. In the PRP group (n=45), one intra-articular injection was applied and in the HA group (n=45), three doses of intra-articular injection were applied. Clinical evaluation was made by Knee Injury and Osteoarthritis Outcome Score (KOOS) and a visual pain scale.

RESULTS

No severe adverse events was observed. Statistically significant better results in the KOOS score and visual pain scale was determined in PRP group than HA group at 3 months and 6 months follow up. The cost of the application for the PRP group was lower than that of the HA group.

CONCLUSION

The results of this study have shown the application of single dose PRP to be a safe, effective and low-cost method for treating OA. However, further studies are required for a more clear result.

Sustained delayed gastric emptying during repeated restraint stress in oxytocin knockout mice

We have recently shown that impaired gastric motility observed in acute restraint stress was restored following repeated restraint stress in mice. Repeated restraint stress up-regulates oxytocin mRNA expression and down-regulates corticotrophin-releasing factor (CRF) mRNA expression at the hypothalamus. Oxytocin knockout mice (OXT-KO) have been widely used to study the central oxytocin signalling pathways in response to various stressors. We studied the effects of acute and repeated restraint stress on solid gastric emptying and hypothalamic CRF mRNA expression in wild-type (WT) and OXT-KO mice. Heterozygous (HZ) parents (B6; 129S-Oxt(tm1Wsy)/J mice) were bred in our animal facility. Male OXT-KO, WT and HZ littermates were used for the study. Solid gastric emptying was measured following acute restraint stress (for 90 min) or repeated restraint stress (for five consecutive days). Expression of CRF mRNA in the paraventricular nucleus (PVN) was measured by real-time reverse transcriptase-polymerase chain reaction. There were no significant differences of gastric emptying in WT (68.4 ± 4.1%, n = 6), HZ (71.8 ± 3.1%, n = 6) and OXT-KO (70.6 ± 3.1%, n = 6) mice in nonstressed conditions. Acute stress significantly delayed gastric emptying in OXT-KO mice (33.10 ± 2.5%, n = 6) WT (39.1 ± 1.1%, n = 6) and HZ mice (35.8 ± 1.2%, n = 6). Following repeated restraint stress loading, gastric emptying was significantly restored in WT (68.3 ± 4.5%, n = 6) and HZ mice (63.1 ± 2.6%, n = 6). By contrast, gastric emptying was still delayed in OXT-KO mice (34.7 ± 1.3%, n = 6) following repeated restraint stress. The increase in CRF mRNA expression at the PVN was much pronounced in OXT-KO mice compared to WT or HZ mice following repeated restraint stress. These findings suggest that central oxytocin plays a pivotal role in mediating the adaptation mechanism following repeated restraint stress in mice.

Changes in some components of the muscle lipids of three freshwater fish species under natural extreme cold and temperate conditions

Fatty acid composition, conjugated linoleic acid and cholesterol contents in the muscles of three freshwater fish species (Barbus plebejus escherichi, Capoeta capoeta capoeta and Rutilus rutilus) were determined under natural extreme temperate (July) and cold (January) conditions. The aim of the study was to determine whether there were differences in these components of the muscle lipids among these three fish species under extreme natural conditions. Samples were analyzed using gas chromatography. Palmitic, oleic, docosahexaenoic and eicosapentaenoic acids were the predominant fatty acids in all fish in both months. The percentages of polyunsaturated fatty acids, n - 3 polyunsaturated fatty acids, n - 6 polyunsaturated fatty acids and eicosapentaenoic + docosahexaenoic acids in the muscle of B. plebejus escherichi and C. capoeta capoeta were significantly higher in January (P < 0.05) than in July. The ratio of n - 6 to n - 3 polyunsaturated fatty acids was lower than 0.60 in all fish species, with C. capoeta capoeta showing the lowest ratio in January (0.36). The levels of cholesterol and conjugated linoleic acid ranged from 103.46 to 150.10 mg/100 g oil and from 16.27 to 35.45 mg/100 g oil, respectively, for all samples in both months. There were no statistical differences in cholesterol levels among the three fish species in July and January. Conjugated linoleic acid contents were significantly higher in January in B. plebejus escherichi and C. capoeta capoeta. Of the three species tested, the extreme temperate and cold conditions affected B. plebejus escherichi the most.

A case with three primary tumors of the ovary, endometrium and gallbladder

A case with three synchronous tumors is presented. A 52-year-old patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic and paraaortic lymph node dissection, and partial omentectomy for endometrial carcinoma accompanied by an adnexal mass. She further underwent cholecystectomy for a perioperative incidental suspicious nodule on the serosal surface of the gallbladder. Histopathology revealed a uterine endometrioid adenocarcinoma, a mucinous adenocarcinoma of the gallbladder, and an ovarian endometrioid carcinoma with a clear cell component. The progress of the patient until the time of death is discussed.

The influence of partial hepatectomy (PH) on pharmacokinetics of docetaxel (D) in sprague-dawley rats (SDR) with experimental mammary neoplasm models (EMNM)

12021

Background: Docetaxel (Taxotere-Aventis) is used in the treatment of breast, lung, head and neck, prostate and ovarian cancers. Recently, PH for isolated hepatic metastases of breast cancer has been reported in Japan and France. PH is an experimental model of hepatic insufficiency. Therefore we aimed to study the influence of PH on pharmacokinetics of D in SDR with EMNM. Methods: After the approval of Local Ethical Commitee on Laboratory Animal Researches, 40 female 50-day-old SDR were injected with 50 mg/kg body weight N-nitroso-N-methylurea (NMU) in 09% NaCL solution intraperitoneally. 5 female 50-day-old SDR were only injected with 09% NaCL solution intraperitoneally. After 6-months follow-up period for the formation of EMNM, 8 rats in the Group D+H were hepatectomized partially. Baseline venous blood samples were taken. 24 hours after PH, 6 rats were alive. There were 8 rats in the Group D (without hepatectomy). Before chemotherapy and 1 hour after intravenous infusion of 5 mg/kg body weight D, blood samples were taken for biochemical analyses from both groups. 5., 15., 30. minutes and 1., 2., 4., 5. hours after D infusion, arterial blood samples were taken for pharmacokinetic analyses. Biochemical and Pharmacokinetic tests (BPT) were done by auto-analyzer Hitachi Modular Analytic and HPLC (High Performance Liquid Chromatography) respectively. Area under the concentration-time curve [AUC (0–60)] was determined for each group. Statistical analyses were done by SPSS 11.0 for Windows at the 5% significance level. Results: PH affected liver functions and serum albumin levels negatively (p = 0.028). Although D infusion didn’t affect serum ALT and bilirubine levels, low serum albumin was detected 1 hour after chemotherapy in both groups (p= 0.028 and p= 0.030). AUC(0–60) of plasma D in hepatectomized rats were greater than the other group (p = 0.015). Conclusion: During the treatment of cancer patients in posthepatectomy period with taxanes (D), dose adjustment must be done. In both groups, statistically significant low serum albumin after D infusion may be as a result of decreased intertitial fluid pressure, albumin extravasation and edema formation caused by taxanes. Physiological and preventive studies are needed.

No significant financial relationships to disclose.

Effect of vitamin E treatment on the oxidative damage occurring in Henoch-Schönlein purpura

AIM

To evaluate the role of reactive oxygen molecules (ROMs) in the pathogenesis of Henoch-Schönlein purpura and the effect of vitamin E on oxidative damage. ROMs have been suggested to contribute in many pathological conditions including renal diseases and vasculitis.

METHODS

The activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) as antioxidant enzymes were measured, and the level of malondialdehyde (MDA) as an indicator of lipid peroxidation in 27 children with Henoch-Schönlein purpura at the onset of the disease and during the remission period. The results of this study were compared with those of 11 healthy children studied as a control group.

RESULTS

With regard to all the oxidative damage parameters such as SOD, GSH-Px and MDA, significant differences were detected between the patients and the control group in both the acute and remission periods. But no such differences were detected between patients with and those without renal involvement. In 15 patients receiving vitamin E treatment, oxidative damage parameters and clinical course showed no improvement despite significant increases in plasma vitamin E levels.

CONCLUSION

Oxidative damage and lipid peroxidation may play an important part in the pathogenesis of Henoch-Schönlein purpura but vitamin E given after initiation of lipid peroxidation, which is the last phase of cellular damage, is of no use in breaking down the oxidative chain reactions that have already been triggered.

Serum leptin concentration is increased in patients with Behçet's syndrome and is correlated with disease activity

Background Behçet's syndrome is a systemic, relapsing immuno-inflammatory disease with a generalized vasculitis of the microvasculature endothelial dysfunction. Leptin, a recently discovered neuroendocrine hormone, is a metabolic peptide that appears to be involved. Serum proinflammatory cytokines upregulate leptin levels and leptin itself directly induces nitric oxide production from endothelial cells with its specific receptors.

OBJECTIVES

To detect changes of serum leptin concentrations in patients with Behçet's syndrome compared with age- and sex-matched healthy volunteers by using enzyme-linked immunosorbent assay. We also investigated whether disease activity or the duration of Behçet's syndrome correlates with leptin concentration.

METHODS

Thirty-five consecutive patients with Behçet's syndrome (41.2 +/- 8.4 years, 16 male, 19 female) and 20 age- and sex-matched healthy control subjects (40.4 +/- 10.91 years, nine male, 11 female) were included in this study. The body mass index (BMI) [weight (kg) height(-1) (m(2))] was calculated for subjects at study enrollment. We measured serum leptin with a leptin enzyme immunoassay kit, and acute-phase reactants, including erythrocyte sedimentation rate, alpha1-antitrypsin, alpha 2-macroglobulin and neutrophil count. The Mann-Whitney U-test was used for statistical analysis and P < 0.05 was considered significant. Values were expressed as mean +/- SD.

RESULTS

The gender ratio, age and BMI were not substantially different among Behçet's patients and controls. The mean serum leptin concentrations in patients with Behçet's syndrome (16.8 +/- 7.49 ng mL(-1)) were significantly (P < 0.001) higher than in healthy control volunteers (7.5 +/- 2.77 ng mL(-1)). Active Behçet's patients had significantly (P = 0.001) higher leptin concentrations (20.5 +/- 7.99 ng mL(-1)) when compared with patients in inactive periods (12.8 +/- 4.43 ng mL(-1)). In addition, patients with longer disease duration (mean, 20.1 +/- 5.15 years) had also significantly (P = 0.013) higher leptin concentrations (20.2 +/- 8.52 ng mL(-1)) than those with shorter disease duration (13.4 +/- 4.52 ng mL(-1)) (mean, 7.4 +/- 3.29 years). All acute-phase reaction parameters were found to be significantly (for each, P < 0.01) increased in active disease.

CONCLUSIONS

Leptin may have a role in modulating endothelial function and may be involved in mechanisms for vessel endothelium repair, during an exacerbation as well as in chronic disease.

Acute necrotizing tubulointerstitial nephritis due to systemic adenoviral infection

To date, all the reported cases of acute necrotizing tubulointerstitial nephritis (TIN) secondary to systemic adenovirus infection have occurred in individuals with primary or secondary immunodeficiency, and have resulted in renal failure and death. We present the case of a 12-year-old, immunologically competent girl who developed acute necrotizing TIN with acute renal failure (ARF), hepatitis and meningoencephalitis secondary to a systemic adenoviral infection who completely recovered with supportive care.

Isolated tuberculous tenosynovitis of the flexor tendon of the fourth finger of the hand. Case report

A 21-year-old woman presented with a painful swelling of her palm which prevented her from fully extending her fourth finger. Magnetic resonance imaging showed synovial thickening around the flexor tendon and fluid in the tendon sheath. The mass was excised and histopathological examination showed tuberculosis. She had a six-month course of antituberculous treatment and was perfectly well three years later.

Henoch Schönlein purpura and amebiasis

The pathogenesis of Henoch Schönlein purpura (HSP) is unknown but is believed to result from an immune complex reaction to various antigenic stimuli, such as infectious agents. However, its association with Entamoeba histolytica has not been reported before. We present an 11-year-old boy with HSP, confirmed by the demonstration of leukocytoclastic vasculitis from skin and diffuse endocapillary proliferative glomerulonephritis, together with immunoglobulin A and complement component C3 deposition from renal biopsies. Cysts and trophozoites of Entamoeba histolytica were detected from the stool of the patient at the same time and disappeared after the treatment with metranidasole. The temporal association of these two disorders is either coincidental or due to a causal relationship between them.

Microfocal radiography in the diagnosis of childhood renal osteodystrophy

BACKGROUND

Renal osteodystrophy is common in children with chronic renal failure (CRF) and X-ray is an intensive method in the diagnosis of the disease. In this study we compared microfocal radiography with conventional method for the diagnosis of renal osteodystrophy.

METHODS

The X-rays of left wrists of 21 children with CRF and chronic renal insufficiency were taken by conventional and microfocal methods.

RESULTS

Both methods revealed osteopenia in all patients (100%), widening, fraying and cupping of ulnar and radial metaphysis in 10 (47.6%), osteosclerosis in three (14.2%) and pseudofracture in one (4.7%) patient. Microfocal radiography demonstrated osteosclerosis in one patient, pseudofracture in four and subperiosteal resorption in five patients that were not detected by conventional method.

CONCLUSION

Two methods were found to be significantly different in demonstrating the changes due to rickets and hyperparathyroidism and it is concluded that microfocal radiography may be preferred in the diagnosis of childhood renal osteodystrophy.

Erythrocyte superoxide dismutase activity and plasma malondialdehyde levels in children with Henoch Schönlein purpura

Reactive oxygen molecules (ROM) have been suggested to contribute to many pathological conditions including vasculitides and renal diseases. In the present study we measured the activity of superoxide dismutase (SOD) as an antioxidant enzyme in red blood cells and the level of malondialdehyde (MDA), which is a product and an indicator of lipid peroxidation, in the plasma of 16 children (7M, 9F) with Henoch Schönlein purpura (HSP) at the onset of the disease (SOD 1 and MDA 1) and at the remission period (SOD 2 and MDA 2). The results were compared with the results of 17 healthy children studied as a control group. There was no significant difference for SOD activities between the patients in each period and the control group (p > 0.05). There was a statistically significant difference between MDA 1 and MDA 2 levels (p < 0.01), each of which were also significantly different from the MDA levels of control group (p < 0.001 and p < 0.01, respectively). The effect of ROMs on different clinical conditions of HSP was also examined and lipid peroxidation was found to be increased more in patients with renal involvement. It is concluded that oxidant stress especially lipid peroxidation plays an important role in the pathogenesis of HSP and in development of renal injury.

Fatal outcome of infantile oxalosis: case reports from three families and a review of literature

Infantile oxalosis is a rare, autosomal recessive disorder. We present three unrelated cases of infantile oxalosis and their families, emphasizing its place as a cause of acute renal failure in infancy, and showing the clinical heterogeneity of the disease within the same family. The affected infants (two males, one female) were 2.5, 3.5, and five months old. Two families had first degree parental consanguinity; two revealed a history of nephrolithiasis; and one of these two had a member who received liver and kidney transplants because of primary hyperoxaluria type I. All the patients presented with the symptoms and findings of acute renal failure. Their hemoglobin levels were between 6.8-9.6 g/dl, urinalysis revealed (+) to ( +) proteinuria and microscopic hematuria. All had metabolic acidosis with BUN levels 67-113 mg/dl and creatinine 3.5-7.7 mg/dl. The abdominal ultrasonographies revealed normal sized hyperechogenic kidneys with the loss of corticomedullary junctions. Calcium oxalate crystals were demonstrated in retina and bone marrow of two patients, and in renal parenchyma of all the patients. The patients were treated with peritoneal dialysis. Renal functions continued to be abnormal (BUN: 47-168 mg/dl, creatinine: 2.8-11 mg/dl) after dialysis, and the outcome was fatal in all. In the presented families, because of the variation of the clinical presentation and the fatal outcome, presence of the multiple genetic loci appeared to be most likely. Further molecular studies will clarify the heterogeneity of this disorder.

Immunogenicity of two versus three injections of inactivated hepatitis A vaccine in adults

AIM

To investigate the immunogenicity of two versus three injections of inactivated strain CR326F-derived hepatitis A vaccine in healthy adults.

METHODS

Healthy adult volunteers (n = 105) at Utrecht University Hospital, The Netherlands, were randomly assigned to receive intramuscular injections (deltoid muscle) of 25 Units (U) at 0 and 6 months (group A, n = 53), or at 0, 2 and 6 months (group B, n = 52). Blood was drawn before and at various time points after vaccination for determination of serum antibody to hepatitis A (anti-HAV).

RESULTS

One month after the first injection, the seroconversion rates (> or = 10 mIU/ml, international units) were 88% for group A and 90% for group B. Only 2/ 103 (one in each group) showed IgM anti-HAV. One month after the second injection, seroconversion rates were 100% in both groups. At months 3, 6 and 7, anti-HAV geometric mean titers were significantly different because of the different vaccination schedules, but they were similar at months 1, 2 and 12. The anti-HAV geometric mean titer increase after the second injection was higher when the interval between the two doses was of longer duration. Anti-HAV titers of females were significantly higher than those of males and vaccinees < or = 30 years had higher titers than those > 30 years.

CONCLUSIONS

Two 25 U doses of the vaccine investigated given at 0 and 6 months, induce adequate anti-HAV titers in all adult healthy vaccinees and are as immunogenic as three doses given at 0, 2 and 6 months.

Etiological and clinical patterns of urolithiasis in Turkish children

OBJECTIVE

To evaluate the clinical and etiological characteristics of childhood urolithiasis in Turkey.

METHODS

Ninety-two children with urolithiasis were studied retrospectively according to clinical patterns and etiological factors between January 1990 and January 1995.

RESULTS

The age range of the patients was from 2 months to 14 years (mean age 6.9 years), and there was a male/female ratio of 1.6. The onset of the disease was earlier in boys than in girls. The most striking features were the initial admission of 14 (15.2%) children after the development of chronic renal failure and that most of them (64.3%) had infection stones. The stones were localized in the upper urinary system in 68.5% of the patients; bladder stones were rare (10.9%). The recurrence rate at presentation was 15.2% in all patients. As etiological factors, an anatomical defect was found in 30.4% of the patients, infections in 31.5%, and metabolic disorders in 26.1%; 11 (12.0%) of them were classified as idiopathic. The earliest presentation was seen with metabolic and infection stones and the highest recurrence rate (37.5%) in patients with metabolic stones.

CONCLUSION

Childhood urolithiasis is a serious problem in Turkey. In order to prevent the development of end-stage renal failure and to improve the patients' quality of life, more efforts should be made with respect to early diagnosis and management of renal stones and urinary tract infections.

Adenosine deaminase, 5'-nucleotidase, xanthine oxidase, superoxide dismutase, and catalase activities in gastric juices from patients with gastric cancer, ulcer, and atrophic gastritis

Adenosine deaminase (ADA), 5'-Nucleotidase (5NT), Xanthine oxidase (XO), Cu-Zn Superoxide dismutase (SOD) and Catalase (CAT) activities were determined in gastric juices from patients with gastric cancer, ulcer, gastritis and from healthy subjects. Enzyme activities were given as units per ml gastric juice and units per mg protein in gastric juice. ADA, 5NT and XO activities were found lower and protein concentrations were found higher in the cancer group than controls. There was however no significant difference between Cu-Zn SOD activities of the cancer and control groups. In all groups including control one, we could not find catalase activities in most of the samples. On the other hand, ADA, 5NT activities and protein concentrations in the gastric juice were lower in the gastritis group than control group. In the ulcer group, we found higher Cu-Zn SOD and XO activities and lower 5NT activity and protein concentrations compared with control values. In an attempt to establish statistical correlations between mean enzyme activities, pH and protein concentrations in the gastric juices of the groups, we found noticeable intra and inter-correlations, which indicated possible relations between DNA and free radical metabolizing enzymes.