The Effect of ACE Gene Polymorphisms on Doppler Blood Flow Parameters of Carotid and Brachial Arteries in Patients With Myocardial Infarction

The authors investigated the relationship between the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and the blood flow characteristics of common carotid (CCA) and brachial arteries (BA) by color Doppler ultrasound (CDUS) in patients with acute anterior myocardial infarction (AAMI). Sixty four patients (11 women and 53 men), aged 25 to 77 years, with AAMI were studied. The ACE genotypes were established. Peak-systolic (PSV) and end-diastolic velocity (EDV) of right and left CCA, PSV of right BA, and intimal-medial thickness (IMT) of both CCAs were measured by CDUS. All results were evaluated statistically. The ACE genotypes were distributed as follows: 43.8% DD, 43.8% ID, and 12.5% II. PSVs of BA and both CCAs were lower in patients with DD and ID than with II (p<0.05). EDVs of both CCAs were also lower in the same groups, but statistically not significant (p>0.05). IMTs of both CCAs did not differ among patients with various ACE genotypes (p>0.05). These results suggest that ACE I/D polymorphism influences Doppler blood flow parameters of both BA and CCA, but does not affect IMT of CCA.

Association Between ACE Gene Polymorphism and QT Dispersion in Patients with Acute Myocardial Infarction

Background:

Angiotensin converting enzyme (ACE) gene polymorphism is associated with high renin-angiotensin system causing myocardial fibrosis and ventricular repolarization abnormality. Based on these findings, this study was designed to determine the association between ACE gene insertion/deletion (I/D) polymorphism and QT dispersion after acute myocardial infarction (MI).

Objective and Methods:

The study included 108 patients with acute MI. Blood samples were obtained from all the patients for genomic DNA analysis. ECGs were recorded at baseline and at the end of a 6-month follow up. The OT dispersion was manually calculated.

Results:

The mean age of the patients was 57.5 ±9.9 years (ranging from 36 to 70). The patients with DD genotype showed longer QT dispersion than patients with II or DI genotype at the baseline, while at the end of the six-month follow up the patients with DI genotype showed longer QT dispersion than patients with DD or II genotypes. However, the magnitude of the QT dispersion prolongation was higher in patients carrying the ACE D allele than patients who were not carrying it, at baseline and at the end of six-month follow up (52.5 ±2.6 msn vs. 47.5±2.1 msn at baseline, 57±3.2 msn vs. 53±2.6 msn in months, P: 0.428 and P: 0.613, respectively).

Conclusion:

Carriers of the D allele of ACE gene I/D polymorphism may be associated with QT dispersion prolongation in patients with MI.An interaction of QT dispersion and ACE gene polymorphism may be associated with an elevation of serum type I-C terminal pro-collagen concentration, possibly leading to myocardial fibrosis, and increased action potential duration.

Thiol/disulfide homeostasis: A prognostic biomarker for patients with advanced non-small cell lung cancer?

BACKGROUND

The aim of this study was to investigate oxidative stress and thiol/disulfide status with a novel automated homeostasis assay in advanced non-small cell lung cancer (NSCLC).

METHODS

Thirty-five patients with advanced NSCLC, who had been newly diagnosed and previously untreated, and 35 healthy subjects were chosen for the study. We measured plasma total thiol (-SH+-S-S-), native thiol (thiol) (-SH), and disulfide (-S-S-) levels in the patients with NSCLC and the healthy subjects. The thiol/disulfide (-SH/-S-S-) ratio was also calculated.

RESULTS

Statistically significant differences between the patient group and the control group were detected for the thiol/disulfide parameters. The mean native thiol, total thiol, and disulfide levels were significantly lower in the group with advanced stage NSCLC. The cut-off value was 313 and 13.8 for native thiol and disulfide, respectively. Median overall survival (OS) was significantly shorter in patients with low native thiol and disulfide levels according to the cut-off value (respectively, P = 0.001; P = 0.006). Native thiol, total thiol, and disulfide levels were correlated with Karnofsky performance status (KPS), OS, and age. Additionally, hierarchical regression analyses showed gender, KPS, lung metastases, and plasma native thiol levels were the determinants of OS in the final model.

CONCLUSION

These results suggest that in advanced stage NSCLC, the native thiol, total thiol, and disulfide levels decrease, while the native thiol/disulfide ratio does not change. Low levels of thiol/disulfide parameters are related to tumor aggressiveness and may predict a poor outcome for patients with NSCLC.

Huge inflammatory myofibroblastic tumor of pleura with concomitant nuchal fibroma

Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm. It is a challenging disease because the symptoms and radiologic findings are diverse and nonspecific. Although pulmonary IMT is the most common form, pleural origin is an extremely rare clinical entity. Nuchal fibroma (NF) is another rare benign neoplasm. We report herein a case of pleural IMT with concomitant NF in a 15-year-old girl. To the best of our knowledge, this is the first report suggesting an association between IMT and NF, and our case had the largest reported intrathoracic IMT. Moreover, we found a possible association between IMT and increased CA-125 levels.

The attitudes of surgeons concerning preoperative smoking cessation: a questionnaire study*

BACKGROUND

The purpose of this study was to evaluate the attitudes and behavior of surgeons regarding preoperative smoking cessation.

METHODS

A total of 109 anonymous questionnaires were distributed to non-vascular surgeons in our hospital, inquiring about their smoking attitudes, their smoking cessation advice practices, whether they appreciated the benefits of preoperative smoking cessation, and their knowledge of smoking cessation methods.

RESULTS

Eighty questionnaires (from 51 resident doctors and 29 academic staff) were returned (response rate: 73.40%). Of the surgeons, 17.50% were current smokers. Although 40% of the surgeons surveyed believed that preoperative smoking cessation reduces postoperative complications, 31.2% of the surgeons (25/63) had given smoking cessation advice at least to 1 patient in the last month. Most of the resident doctors (39.2%) advised smoking cessation within a month; prior to surgery however, the academic staff (27.6%) advised cessation immediately before the operation (p=0.038). There was a significant difference between academic sfaff and resident doctors concerning the method to increase a patient's chance of quitting (p=0.045), even among current smokers (p=0.049).

CONCLUSION

The surgeons who participated in the questionnaire were aware that smoking cessation improves outcome, but most of them did not appreciate that providing brief advice, referring to cessation services, or prescribing nicotine replacement therapy (NRT) may be of benefit in helping patients to quit. It is necessary to educate surgeons about the scale of the benefit and the efficacy of smoking cessation interventions or to set up systematic frameworks to offer smoking cessation advice to preoperative patients who smoke.

Effects of body weight supported treadmill training on cardiac and pulmonary functions in the patients with incomplete spinal cord injury

We aimed to investigate the effects of body weight supported treadmill training (BWSTT) on cardio-pulmonary functions and on depression in subjects with incomplete spinal cord injury (SCI). Eight subjects (2 female, 6 male) with incomplete SCI participated in this study. Heart rate (HR), blood pressure (BP) and resting pulmonary function parameters were obtained from each subject at baseline and after BWSTT. The training programme was scheduled five times per week for six weeks. The psychological status was evaluated by Beck Depression Inventory (BDI). The post-BWSTT HR value was lower than the pre-training HR value (p< 0.05). In comparison of pre- and post-BWSTT pulmonary parameters, there were only significant improvement in FVC and IC (p< 0.05). The mean BDI score was lower after BWSTT compared to before BWSTT value. As a conclusion, 6 weeks BWSTT had positive effect on heart rate and limited effect on pulmonary functions. There was an improvement in depression level of the SCI subjects.

Relation between angiotensin-converting enzyme I/D gene polymorphism and pulse pressure in patients with a first anterior acute myocardial infarction

OBJECTIVE

Evidence shows that an elevated pulse pressure (PP) may lead to an increased risk of cardiovascular morbidity and mortality. The aim of the present study was to determine the effects of polymorphism of the angiotensin-converting enzyme (ACE) gene on the PP after a first anterior acute myocardial infarction (AMI).

METHODS

Overall 116 patients with a first anterior AMI were included in this cross-sectional study. DNA was isolated from peripheral leukocytes. The ID status was determined by polymerase chain reaction by a laboratory staff member who was unaware of the clinical details. Based on the polymorphism of the ACE gene, they were classified into 3 groups: Deletion/Deletion (DD) genotype (Group 1, n=45), Insertion/Deletion (ID) genotype (Group 2, n=58), Insertion/Insertion (II) genotype (Group 3, n=13). Blood pressure measurements were performed in all patients within 10 minutes admitted to coronary care unit. The PP was calculated by subtraction of diastolic blood pressure (DBP) from systolic blood pressure (SBP). Echocardiographic examinations were performed using the parasternal longitudinal axis and apical 4-chamber windows in accordance with the recommendations of the American Echocardiography Committee. One-way analysis of variance (ANOVA) and Chi-square analyses were used to compare differences among subjects with different genotypes.

RESULTS

There were no significant differences among clinical parameters of patients. Pulse pressure was significantly higher in patients who have ACE DD and ID genotypes than in patients who have ACE II genotype (47+/- 16, 47+/- 14 and 39+/- 12, F=3.4, p<0.05). But SBP, DBP and heart rate were not significantly different among ACE DD, ACE ID and ACE II genotypes.

CONCLUSION

Our results suggested that, ACE Gene I/D polymorphism D allele may affect PP in patients with a first anterior AMI.

[The concordance of manuel (visual) scoring and automatic analysis in sleep staging]

Full night polysomnography (PSG) remains the gold standard diagnostic test for the evaluation of sleep and the detection of sleep disorders. The computer-assisted scoring methods have been developed to accelerate the scoring. It is said that there was a concordance up to 80% between these scoring softwares and manual scoring. According to our experiences, it is not matched with this belief. In this study, we intend to examine whether the results of automatic analysis match with manual (visual) evaluation. The PSG records of 30 cases with a diagnosis of obstructive sleep apnea syndrome (OSAS) are chosen randomly. We compare the results of automatic analysis with the results of two scorers who have a concordance of 80-95% and at least 1000 PSG scoring experiences. We evaluated 21.060 epochs of 18 men with 48.83 + or - 13.51 ages, and 12 women with 44.56 + or - 14.28 ages. In automatic analysis; total sleep time (p= 0.003) and sleep efficiency (p= 0.004) were low. AHI (p= 0.802) and ODI (p= 0.193) values were high. The epochs scored differently were 8819 epochs (41.88%). The stage I (88.43%) scored mostly different, was allocated to be awake (572 epochs). Stage II and stage IV were scored as stage III in 2276 and 983 epochs respectively. REM epochs were allocated to stage II (574 epochs). The differences in recording times and sleep architecture of PSG tests which examed by automatic analysis will affect all other parameters. Thus, we believe that it will make mistakes in the diagnosis and treatment of sleep disorders.

[A rare agent of pneumonia: Brucella melitensis]

Brucellosis remains a world-wide public health problem especially in developing brucellosis remains a world-wide public health problem especially in developing countries. Although involvement of the respiratory system in brucellosis is an acknowledged but rare event, its clinical manifestations and focal complications are often troublesome in making a diagnosis. Herein, we report a pneumonia case which proved due to Brucella melitensis in a 57-year-old man who presented with chronic cough, sputum, hemoptysis and fever.

Mediastinal tuberculous lymphadenitis with anthracosis as a cause of vocal cord paralysis

Anthracotic pigmentation in the bronchial mucosa has been regarded as a bronchoscopic finding of pneumoconiosis or evidence of heavy atmospheric soot. Anthracotic pigmentation with bronchial narrowing or obliteration, surrounded by calcified or noncalcified lymph nodes is typical finding of anthracofibrosis. There is a potential relationship between bronchial anthracofibrosis and tuberculosis. Tuberculous lymphadenopathy of superior mediastinum presentation with hoarseness is very rare. The paper reports a case of tuberculous mediastinal lymphadenitis with anthracosis causing vocal cord paralysis. A 66-year-old woman was admitted to our clinic with the symptoms of dry cough, hoarseness, malaise, anorexia, night sweats and with the multiple mediastinal lymphadenopathy. Fiberoptic bronchoscopy revealed left vocal cord paralysis, bronchial mucosal inflammation and multiple anthracotic plaques. Bronchial lavage and mucosal biopsy were negative for malignancy and tuberculosis. The thoracotomy was performed and a mediastinal lymph node showing caseating granulomatous inflammation with anthracosis and parenchymal anthracosis were detected. The diagnosis of anthracosis and mediastinal tuberculous lymphadenitis was made and the patients put on antituberculous treatment. But she unfortunately died in the second month of the treatment because of the abdominal complication of gastric adenocarcinoma operation.

Hodgkin's disease in the nasopharynx

Nasopharyngeal presentation of Hodgkin's disease (HD) is an uncommon event with relatively favorable prognosis. It is predominantly seen in males and most papers are case reports. Here, we report an unusual case in a female patient with stage IA(E)HD treated by radiotherapy (RT), and achieving complete disease remission, lasting 26(+) months.

Evaluation of patients followed up in a cigarette cessation clinic

OBJECTIVES

The aim of this study was to evaluate the demographic characteristics and factors determining success in a smoking cessation clinic in smokers who completed a 1-year follow up.

METHOD

A total of 349 patients were assessed retrospectively.

RESULTS

There were 238 men (mean age: 41+/-13.5 years) and 111 women (mean age: 37+/-11.9 years) (t-test P=0.004). The average age at which they began to smoke, number of years of smoking and the number of cigarettes/day were 17.5+/-5.2 years (median 17), 22.1+/-13.3 years, 23.5+/-12.0, respectively. Cigarette smoking was mostly observed in university graduates (56.8%) and a moderate negative correlation existed between education status and smoking duration (r=-0.27, P=0.000). Patients with a Fagerström Tolerance Questionnaire score of >or=6 and those exposed to cigarette smoke in childhood tended to commence and become committed smokers later in life (chi2=4.915, P=0.027). In all, 151 patients (43.26%) were successful in quitting (chi2=36.4, P=0.000). Of these, 87 (24.93%) used medication such as nicotine patches (13.5%), bupropion (7.2%), nicotine patches+bupropion (4.3%) and 64 (18.33%) refused medication, but came for professional support.

CONCLUSION

Increased education level, behavioural therapy and intensive motivational support, follow-up visits and phone calls all appear to play important roles in smoking cessation. Families also play a major role.

[C-reactive protein, leukocyte count and ESR in the assessment of severity of community-acquired pneumonia]

This study aimed to evaluate the relations between the levels of CRP, leukocyte count and ESR on admission and the severity of pneumonia according to the criteria of Turkish Thoracic Society (TTS) and British Thoracic Society (BTS) CAP guidelines. This study included the adult patients with CAP admitted to our clinic between the years 2003-2005. The history, physical findings, hemogram, ESR, the levels of CRP and the results of other laboratory investigations were obtained from the medical records. The patients were grouped according to BTS and TTS guidelines. The mean age was 47.2 years; 70 patients (75.3%) were male and 23 patients (24.7%) were female. The severity of pneumonia according to BTS criteria was correlated with the levels of CRP and leukocyte count (p= 0.037, p= 0.01, respectively). The severity of pneumonia according to TTS criteria was correlated with the levels of CRP, leukocyte count and ESR (p= 0.000, p= 0.014, p= 0.015, respectively). Among TTS pneumonia groups, there were statistically significant differences between groups 1 and 3; groups 1 and 4; groups 2 and 3 (p= 0.006, p= 0.041, p= 0.05, respectively) for mean CRP levels. The mean levels of CRP (103.2 +/- 76.4 mg/L), leukocyte count (19.8 +/- 9.5 x 10(3)/microL) and ESR (57.2 +/- 26.8 mm/hour) were statistically significantly higher in inpatients than the mean levels of CRP (53.2 +/- 52.8 mg/dL), leukocyte count (14.6 +/- 5.4 x 10(3)/microL) and ESR (43.1 +/- 25.9 mm/hour) in outpatients (p= 0.000, p= 0.001, p= 0.012, respectively) according to TTS. It is considered that CRP, a powerful marker of inflammation, is related with severity of pneumonia and a high level of CRP may be useful to make a decision about hospitalisation.

Marked changes in erythrocyte antioxidants and lipid peroxidation levels of rats exposed to acute, repeated and chronic restraint stress

The aim of this study was to investigate the effects of acute, repeated and chronic restraint stress on the antioxidant status and lipid peroxidation. For this purpose, 48 male Wistar rats, aged three months were used in this study. Rats were separated into six groups as follows; control (C), acute stress (AS), restrained for 7 days (1 h/day) (RS), restrained for 21 days (1 h/day) (CS1), restrained for 28 days (1 h/day) (CS2) and restrained for 21 days (1 h/day) and allowed to recovery for 7 days (CS3). Copper, zinc-superoxide dismutase (Cu, Zn-SOD), catalase (CAT) and selenium-dependent glutathione peroxidase (Se-GSH-Px) activities, corticosterone, reduced glutathione (GSH) and thiobarbituric acid-reactive substances (TBARS) levels were measured in blood samples. Corticosterone levels of all groups were found to be elevated after stress compared to group C. Cu, Zn-SOD activity was lower in all stress groups than in group C. CAT and Se-GSH-Px activities were increased in all stress groups. All stress models decreased GSH levels except for the CS3 group. TBARS levels were higher in stress groups than in C group except for AS group. The highest corticosterone level, CAT and Se-GSH-Px activity and TBARS level were seen in group RS. The lowest Cu, Zn-SOD activity and GSH level were seen in group CS2. These results may have an important implication for impaired erythrocyte antioxidant enzyme activities and glutathione levels resulting from exposure to different stress models (acute, repeated and chronic restraint stress).

Increased plasma levels of interleukin-6 and interleukin-8 in beta-thalassaemia major

Several immunological defects can be found in patients with beta-thalassaemia, among which the impairment of neurophil and macrophage phagocytic and killing functions and the production of some cytokines are the most important. It is known that interleukin-6 (IL-6) and interleukin-8 (IL-8) are important components of the pro-inflammatory response. The plasma levels of these cytokines may be relevant in the pathophysiology of beta-thalassaemia. To assess this hypothesis, the plasma IL-6 and IL-8 concentrations in patients with beta-thalassaemia, were investigated. Fourteen patients with thalassaemia major were studied by evaluating body iron status, iron supply for erythropoiesis, and plasma IL-6 and IL-8 levels, together with 12 age-matched healthy controls. The plasma levels of IL-6 and IL-8 were determined by enzyme-linked immunosorbent assay (ELISA). Patients with beta-thalassaemia were found to have higher IL-8 concentrations than normal controls (p < 0.001) and plasma IL-6 concentrations increased significantly in the beta-thalassaemic patients compared with control subjects (p = 0.01). Serum ferritin levels of beta-thalassaemic patients were significantly higher than those of control groups (p < 0.05). IL-8 levels correlated with ferritin levels (r = 0.694; p < 0.05) and the total number of transfusions (r = 0.64; p < 0.05). Plasma IL-6 levels in beta-thalassaemic patients did not correlate with any clinical, haematological or biochemical parameters. It was also found that plasma IL-8 levels in the patients who had blood transfusions over 100 times were significantly higher than those of under 100 times (p < 0.05), whereas there was no statistical difference for IL-6. Markedly increased plasma IL-6 and IL-8 levels were documented in patients with beta-thalassaemia. Increased production of IL-6 and IL-8 might have contributed to abnormalities in iron metabolism and it is probably due to overstimulation of macrophages. Before a clinical value can be ascribed to these changes in plasma cytokine levels in beta-thalassaemia, the follow-up samples of larger series of patients with 8-thalassaemia should be evaluated.

Primary malignant melanoma of the pharynx

Primary mucosal malignant melanomas are rare. They appear late in life and their prognosis is grave. Although there is no consensus on therapy, wide surgical resection followed by radiotherapy, chemotherapy and immunotherapy are treatment modalities. In this report we present a case of widespread primary mucosal malignant melanoma located in the pharynx. After immunotherapy (four cycles of interleukin-2 and interferon-alpha) and chemotherapy (four cycles of cisplatin and dacarbazine) has been applied as primary therapy for suppression of the mass, transoral total pharyngeal resection was performed. After surgery three cycles of immunotherapy and three cycles of chemotherapy were administered followed by radiotherapy (total dose of 6600 cGy). An additional three cycles of immunotherapy and chemotherapy were administered. Although no local recurrence was observed during the 14 months of follow-up after the completion of radiotherapy, cranial and lung metastasis were detected in the 12th month.

Clinical importance of supratubal recess in cholesteatoma surgery

OBJECTIVE

To determine the importance of supratubal recess in cholesteatoma surgery by presenting the clinical presentation, imaging findings, and surgical treatment methods of 66 patients with cholesteatoma. We propose that the management of supratubal recess allows the opportunity for total removal of the cholesteatoma with the prevention of recurrence.

STUDY DESIGN

Retrospective review of surgical cases.

SETTING

Tertiary referral center.

INTERVENTIONS

Diagnostic and therapeutic procedures were performed.

PATIENTS AND METHODS

We present a series of patients with involvement of supratubal recess by reviewing the operative charts of 347 patients surgically treated for aural cholesteatoma between 1990 and 1999.

RESULTS

We detected the involvement of supratubal recess in 19% (n = 66) of our operations for aural cholesteatoma removal.

CONCLUSION

The intent of this study is to improve the chance for a successful outcome by decreasing the rate of recurrence. The surgical approach to supratubal recess in cholesteatoma operations is emphasized with our series.

The one-month effects of topical betaxolol, dorzolamide and apraclonidine on ocular blood flow velocities in patients with newly diagnosed primary open-angle glaucoma

PURPOSE

This double-masked, prospective and randomized clinical trial was planned to investigate with color Doppler imaging the 1-month vascular effects of betaxolol, dorzolamide and apraclonidine treatment on patients with newly diagnosed primary open-angle glaucoma (POAG).

METHODS

22 consecutive patients with newly diagnosed POAG between the ages of 46 and 72 years were enrolled in this study. All patients were newly diagnosed cases and had not received any antiglaucoma medication before. Patients who had a systemic vascular disease (including systemic hypertension) or were taking beta-blockers, nitrates or calcium channel blockers were excluded from the study. The patients were randomly divided into three groups. Groups A and B contained 7 patients, group C contained 8 patients. Group A patients were treated with topical betaxolol, group B patients received topical dorzolamide eye drops, and group C patients were treated with topical apraclonidine eye drops. Peak systolic velocities (PSV), end-diastolic velocities (EDV) and resistive indices (RI) in the right ophthalmic arteries (OA), central retinal arteries (CRA) and posterior ciliary arteries (PCA) were measured at baseline by using color Doppler imaging on a masked basis. On days 15 and 30 of treatment, the same measurements were repeated. The inter- and intragroup results were compared statistically.

RESULTS

Compared to pretreatment measurements, topical betaxolol therapy significantly decreased PSV only in the PCA and only on day 30 of treatment (p = 0.011). On days 15 and 30, dorzolamide decreased RI measurements in the PCA compared to pretreatment measurement (p = 0.013 and p = 0.011, respectively). Apraclonidine also decreased PSV in the OA on days 15 and 30 of treatment when compared to pretreatment values (p = 0.013 and p = 0.012, respectively). When 15-day measurements were compared between the groups, PSV in the OA were significantly higher in dorzolamide-treated patients compared to other groups (p = 0.01 and p = 0.011). On day 30 of treatment, PSV in the OA was also higher in the dorzolamide-treated group than the other groups (p = 0.012 and p = 0.01). Additionally, apraclonidine-treated patients had a significantly lower EDV in the OA than the other groups (p = 0.013 and p = 0.01). The RI in the OA was also significantly lower in the apraclonidine-treated group compared to the other groups (p = 0.01 and p = 0.011).

CONCLUSION

Our study suggests that dorzolamide has the most advantageous 1-month effects on blood flow velocity in the retrobulbar arterial circulation of POAG patients. Betaxolol seems superior to apraclonidine in this regard. Our data may help the clinician when treating patients with POAG medically. Further studies using a larger population size may clarify our results.

Endolymphatic sac tumor: a case report

Papillary tumors of the temporal bone are aggressive neoplasms which may occur sporadically or as a part of von Hippel-Lindau disease. The term 'endolymphatic sac tumor' identifies the origin of these rare tumors. The clinical manifestations are sensorineural hearing loss, facial paralysis, cerebellar disorders and vertigo. The tumor is locally invasive, destructive and hypervascular exhibiting consistent imaging and histopathologic features. The treatment of choice is the total removal of the lesion although complete excision of the advanced lesion is nearly impossible due to the anatomic complexity of the endolymphatic sac and distinct patterns of extension. We present a 50-year-old male patient with endolymphatic sac tumor with left sided sensorineural hearing loss and review the literature.

The effect of medroxyprogesterone acetate on bone marrow and testis during cytotoxic chemotherapy

The effect of medroxyprogesterone acetate (MPA) on the mitotic activity of bone marrow and testis during chemotherapy was investigated experimentally in an animal study. A total of 120 male Swiss albino mice were included in this study. Six groups were formed, each consisting of 20 mice. Low-dose MPA (LD-MPA) (15 mg/kg), high-dose MPA (HD-MPA) (100 mg/kg), LD-MPA plus cyclophosphamide (CP) (65 mg/kg), HD-MPA plus CP (65 mg/kg), and CP (65 mg/kg) were administered to the test groups and no drug was administered to the control group. Bone marrow samples and testis were examined for mitotic activity rate (MAR) on days 0, 18, 22, 26, and 30. In groups with regimens containing CP, MAR of hematopoietic cells in bone marrow was suppressed significantly (p<0.05). There was no difference in MAR of hematopoietic cells in bone marrow between the groups given MPA or not (p>0.05). Mitotic activity rate of the testis cells was significantly suppressed in groups with regimens containing MPA (p<0.05). In conclusion, MPA inhibited mitotic activity of testis, but there was no effect on the mitotic activity of bone marrow. These data do not seem to confirm the hypothesis of a myeloprotective effect of MPA.

The effects of Brassica oleraceae var capitata on epidermal glutathione and lipid peroxides in DMBA-initiated-TPA-promoted mice

BACKGROUND

The objective of the present study was to determine if modulation of GSH-dependent antioxidant protective system by Brassica oleraceae var capitata might inhibit the molecular mechanism of skin tumor promotion.

MATERIALS AND METHODS

In a two stages skin carcinogenesis model, the protocol used included a single topical application of 200 nmol of the initiator 7,12-dimethyl-benz(a) anthracene (DMBA) to the backs of mice, followed 1 week later by promotion with 10 nmol of 12-O-tetradecanoyl-phorbol-13 acetate (TPA) twice weekly for 30 weeks. In addition to this regimen, 0.1 g/L brassica extract was added water week prior to the initiating dose of DMBA in the treatment group. Tissue glutathione (GSH) contents and levels of lipid peroxidation products (measured as thiobarbituric-acid (TBA)-reactive substances) were quantitated in the skin tumors generated by the initiation-promotion protocol.

RESULTS

It was observed that the tumor incidence and tumor multiplicity in the treatment group was highly significantly low compared to the first group of mice (p < 0.001 and p < 0.001, respectively). In the treatment group, GSH content in the papillomas was higher than in the non-involved skin surrounding the papillomas.

CONCLUSIONS

We suggest that the anticarcinogenicity of Brassica may be linked to its ability to facilitate or enhance the activity of the natural GSH-dependent antioxidant protective system of the epidermal cells during the later stages of skin tumor promotion.

Long-term prevention of atrial fibrillation after coronary artery bypass surgery: comparison of quinidine, verapamil, and amiodarone in maintaining sinus rhythm

AIM OF STUDY

To evaluate the necessity and efficacy of quinidine fumarate, verapimil, or amiodarone prophylaxis for sinus rhythm maintenance in patients who experienced atrial fibrillation after coronary artery bypass surgery.

METHODS

Between 1992 and 1995, this prospective, randomized, placebo-controlled study examined 120 patients in whom atrial fibrillation occurred and was restored to sinus rhythm by pharmacological therapy or direct current cardioversion in the immediately postoperative period after coronary artery by-pass surgery. There were no significant differences in perioperative characteristics among the patients, who were randomly separated into four groups in the course of discharge. In group 1 (n = 30), patients did not receive antiarrhythmic drugs. Quinidine fumarate was given in group 2 (n = 30), verapimil in group 3 (n = 30), and amiodarone in group 4 (n = 30). Patients were monitored six times over a 90-day postoperative period by 24-hour Holter monitoring and routine examination.

RESULTS

The recurrent atrial fibrillation usually developed within 15 days of discharge. Atrial fibrillation occurred in one patient (3.33%) in group 1, and two each (6.66%) in groups 2, 3, and 4. Atrial fibrillation was asymptomatic and occurred with slow ventricular response in groups 3 and 4. Side effects occurred in 5 patients (16.6%) given quinidine, 1 patient given amiodarone, but in no patient given verapimil.

CONCLUSIONS

There were no significant differences in the maintenance of sinus rhythm among the four groups, so we suggest that long-term prevention of atrial fibrillation in patients with coronary artery bypass grafting was not necessary at the postdischarge period.

Topical use of aprotinin in open heart operations

Among various pharmacological agents used to reduce bleeding after open-heart operations, high-dose aprotinin therapy seems most promising. However, its long-term effects are still obscure; there is almost always possibility of bypass graft occlusions produced by the hypercoagulable state induced by aprotinin in coronary bypass operations. Topical application of aprotinin into the pericardial cavity could prevent the adverse effects. Fifty patients were prospectively studied to evaluate the effects of topical aprotinin. One million KIU of aprotinin was poured into the pericardial cavity before closure of the sternotomy in group 1 (n = 25). Patients in group 2 (n = 25) served as controls. Total postoperative bleeding was significantly reduced in group 1 when compared with that of group 2 (722.7 +/- 230.8 versus 1,282.6 +/- 225.7 mL; p < 0.01). The use of banked donor blood products was significantly less in group 1 than in group 2 (0.33 +/- 0.67 versus 1.36 +/- 0.86 units; p < 0.01). These results show that topical use of aprotinin reduces post-operative blood loss and need for transfusion. It seems promising and warrants further studies to be done.

Exact positioning of intra-aortic balloon catheter

The positioning of the intra-aortic balloon catheter in the descending aorta is vital for successful balloon pumping. With transesophageal echocardiography, the catheter could be properly and rapidly positioned in the descending aorta.

Percutaneous drainage of prostatic abscess

The treatment results of 2 patients with prostatic abscess who underwent perineal percutaneous drainage under transrectal ultrasonographic guidance are described. Both patients were treated definitely and without complications. It is concluded that the use of transrectal ultrasound during the procedure increases the effectivity and safety of treatment.

Formulation and in vitro-in vivo evaluation of sustained-release lithium carbonate tablets

The release of lithium carbonate incorporated into polymethylmethacrylate, polyvinyl chloride, hydrogenated vegetable oil, and carbomer matrix tablets was studied in vitro. The formulation containing 10% carbomer showed a sustained-release profile comparable to that of a standard, commercially available, sustained-release preparation containing 400 mg lithium carbonate embedded in a composite material. In vivo the newly formulated and standard sustained-release lithium carbonate tablets were compared to an oral solution and conventional lithium carbonate tablets in 12 healthy subjects. These crossover studies showed that the sustained-release tablets produced a flatter serum concentration curve than the oral solution and conventional tablet, without loss of total bioavailability.