The effect of kangaroo care on maternal attachment in preterm infants.

AIM: The study was conducted to determine the effect of kangaroo care on maternal attachment in preterm infants in Turkish mothers. SUBJECTS AND METHODS: The study was conducted a quasi-experimental research design between October 2015 and February 2016 in the neonatal intensive care units (NICU) of two state hospitals located in the east and west of Turkey. The study population consisted of preterm infants hospitalized in the NICU at the time of the research and met the study-group selection criteria. The study population was divided into two groups as an experimental and control group. Kangaroo care (n = 30) was provided to the infants in the experimental group by their mothers. No intervention was applied to the infants in the control group (n = 30) other than the routine practice. Data were collected by the researcher using the 'Introductory Information Form' and the 'Maternal Attachment Inventory'. Data analysis was performed with SPSS (Statistical Package for Social Sciences) 18 software package. The data were analyzed using percentile distributions, mean, standard deviation, t-test, and Chi-square test. Official permissions and ethical approval were obtained to conduct the study. RESULTS: It was determined that the experimental and control group included in the study were similar in terms of the characteristics of the baby and the mother (P> 0.05). In the study, the mean maternal attachment scale score (MAS) of the group in which the kangaroo care was provided was higher than the control group with a statistically significant difference between the groups (P < 0.05). CONCLUSION: As a result of the study, it was concluded that kangaroo care positively affects maternal attachment and it is suggested that further studies should be conducted to evaluate the effect of kangaroo care on mother-infant attachment in Turkey.

Immunohistochemical expression of nitric oxide synthase enzymes (iNOS, eNOS, nNOS) in the estrual and luteal phases of the sexual cycle in the cow oviduct.

This study was aimed to determine staining intensity, cellular localization and distribution of the nitric oxide synthase (NOS) enzymes during the sexual cycle in the cow oviduct. Oviduct samples belonging to 20 cows, 10 of which were in the estrual phase and 10 in the luteal phase of the sexual cycle, were examined by an immunohistochemical procedure to determine the presence of the NOS enzymes. In the epithelial cells of the isthmus, endothelial NOS (eNOS) expression showed a strong positive reaction during the estrual phase and a weak positive reaction during the luteal phase in the endothelium and smooth muscle of the blood vessels found in the serosa and lamina propria. eNOS expression was not observed in the epithelium of either the ampulla or the fimbria in the two particular phases of the sexual cycle. The eNOS reactions observed in the blood vessel wall in these regions were stronger during the estrual phase. eNOS activity was not observed in the tunica muscularis in any of the regions of the oviduct. During the estrual phase, it was observed that inducible NOS expression showed a stronger positive reaction in the epithelium and muscle layer of the isthmus and ampulla and in the epithelium of the fimbria, compared to the luteal phase. Neuronal NOS immunoreactivity was observed in the epithelial cells of all oviduct regions and in the muscle layer of the isthmus and ampulla and did not display any significant difference between the estrual and luteal phases.

Complex regional pain syndrome in a patient with spinal cord injury: management with pulsed radiofrequency lumbar sympatholysis.

STUDY DESIGN: Short communication. OBJECTIVES: To report a case with bilateral lower extremity complex regional pain syndrome (CRPS) in a patient with paraplegia occurring following spinal disc herniation surgery, who was treated successfully with pulse radiofrequency (PRF) lumbar sympatholysis. SETTING: Departments of Physical Medicine and Rehabilitation, Algology Department of Anaesthesiology and Nuclear Medicine, Medical Faculty of Ege University, Izmir, Turkey. METHODS: A 55-year-old woman had neuropathic pain in her lower extremities after T12-L1 disc herniation surgery. The pain decreased to a tolerable level with conservative treatment and her condition remained stable for the following 6 months; then she developed swelling, redness and severe burning pain in both feet. Physical examination showed edema and redness in the feet. On the basis of clinical findings and Tc-99m methylene diphosphonate (MDP) three-phase bone scintigraphy, she was diagnosed to have CRPS. RESULTS: The patient underwent a diagnostic sympathetic ganglion blockade with bupivacaine, which resulted in a marked decrease in the pain and edema of the feet. Consequently, PRF lumbar sympatholysis was performed with a successful outcome in pain, edema and color changes in the feet. CONCLUSION: When treatment of CRPS fails with conventional modalities, PRF sympatholysis may be used for control of pain and other symptoms in such patients.

Prenatally diagnosed unilateral renal pelvic dilatation: a dynamic condition on ultrasound and diuretic renography.

PURPOSE: Imaging characteristics obtained from serial scintigraphic and ultrasonographic studies in children with the prenatal diagnosis of unilateral pelvic dilatation are presented. MATERIALS AND METHODS: Serial ultrasonographic and scintigraphic findings in 101 children with unilateral pelvic dilatation collected during followup were reviewed. Changes in hydronephrotic kidney in terms of renal pelvis diameter, kidney size, differential renal function and drainage were noted. A total of 42 children underwent surgery at a mean age of 15.6 months (range 3.1 to 69.2, median 8.2), while 59 were treated nonsurgically. RESULTS: Mean age at presentation was 5.6 months (range 0.8 to 36.4, median 3.5). Mean followup was 35.5 months (range 6.4 to 78.4, median 29.6). Differential renal function remained stable (46.4% vs 47.3%) but improved drainage (68.4% vs 81.2%) and decreased renal pelvis size (22.2 vs 18.3 mm) was noted in the 2 groups. With age drainage function improved, especially between the younger than 12-month and 12-month or older groups. The mean affected-to-unaffected kidney length ratio at presentation was significantly greater than the ratio at the final followup (paired t test p <0.05). CONCLUSIONS: In this retrospective review drainage function was prolonged in infants. During followup drainage, dilatation and relative renal size improved in the surgery and nonsurgery groups. There was no change in renal function in either groups during followup. These data support the benign nature of prenatal unilateral hydronephrosis.

Assessment of regional kidney function may provide new clinical understanding and assist in treatment of children with prenatal hydronephrosis.

PURPOSE: As calculated from a (99m)technetium (Tc)-mercaptoacetyltriglycine (MAG3) renogram, differential renal function is an important parameter affecting the clinical treatment of children with prenatal unilateral hydronephrosis. We determined whether value is potentially added by calculating a functional image from MAG3 renograms that represents proximal tubule ability to clear tracer from the blood, that is the MAG3 clearance image. MATERIALS AND METHODS: MAG3 clearance image findings and differential renal function at presentation and followup in 59 nonsurgically and 42 surgically treated children with prenatally diagnosed unilateral hydronephrosis were retrospectively reviewed. All patients underwent at least 3 99mTc-MAG3 renograms. RESULTS: In the surgical and nonsurgical groups there was no significant difference in followup (p = 0.11), age at presentation (p = 0.98) or age at last visit (p = 0.97), whereas differential renal function was significantly different (p = 0.01). A large affected kidney with focal defects was the most frequent finding in each group, including kidneys with a normal differential renal function of 45% to 55%. In the nonsurgical group the most common observation was improvement in the MAG3 clearance image in 26 of 59 cases (44%) and stabilized differential renal function in 41 (70%). Postoperatively the MAG3 clearance image improved in 31 of 42 cases (74%) and differential renal function remained stable in 25 (60%), while no significant increase in differential renal function was noted at the last visit (p = 0.74). CONCLUSIONS: This study shows that it is possible to assess regional parenchymal function using the MAG3 clearance image in children with unilateral hydronephrosis. This information is available in addition to 99mTc-MAG3 information on the whole kidney, that is differential renal function. The majority of affected kidneys with normal differential renal function showed parenchymal defects, suggesting regional renal dysfunction. However, functional improvement on a regional basis occurred in each group of children during followup.

The role of 99mTc-MIBI scintigraphy in the assessment of MDR1 overexpression in patients with musculoskeletal sarcomas: comparison with therapy response.

The occurrence of multidrug resistance (MDR), which is in part due to the overexpression of P-glycoprotein (Pgp), is a major problem in neoadjuvant therapy of malignant musculoskeletal tumours. The aim of this study was to investigate the role of technetium-99m hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) scintigraphy for functional imaging of the MDR1 phenotype in patients with musculoskeletal sarcomas. We aimed to compare 99mTc-MIBI uptake and washout kinetics with the expression of Pgp and with chemotherapy response. Twenty-five patients (16 males and 9 females, aged between 8 and 65 years) with malignant musculoskeletal tumours were studied. After injection of 555-740 MBq 99mTc-MIBI, dynamic flow images of the involved area were obtained for 3 min, and planar images were acquired at 10 min and 1 h. From the dynamic images, a tumour perfusion index (TPI) was obtained using Patlak-Rutland analysis. Tumour to background (T/B) ratios of both early and delayed images and percent wash-out rate (WR%) of 99mTc-MIBI were calculated. Immunohistochemical analysis of Pgp was performed on biopsy specimens and the degree of expression was graded according to a semiquantitative scoring system, from 0 to 6. After neoadjuvant therapy, tumour response was assessed by examining the ratio of viable cells and by detecting percent necrosis. Scintigraphic results were compared with Pgp status and therapy response. Irrespective of the Pgp status, all patients showed significant perfusion and 99mTc-MIBI uptake in early images. There was not a significant correlation between T/B ratios of early and delayed images and Pgp expression. We observed a positive correlation between WR% and Pgp status (r=0.61, P<0.01), and the wash-out rate of 99mTc-MIBI was significantly higher in patients with high Pgp expression than in those with a low Pgp score (33% +/- 9% vs 17% +/- 9%). Therapy response was determined in 21 of 25 patients, and in only 5 of 21 cases was the percent necrosis more than 90%. Neither Pgp expression rate nor WR% was found to show a significant correlation with percent necrosis in the bulk tumour specimens. In conclusion, the initial uptake of 99mTc-MIBI in bone and soft tissue sarcomas did not correlate with Pgp expression. A relationship was found between the wash-out rate of 99mTc-MIBI and the Pgp score, with a significant difference in WR% being observed between patients with high and patients with low Pgp expression.

Scintigraphy in the detection of gastro-oesophageal reflux in children with caustic oesophageal burns: a comparative study with radiography and 24-h pH monitoring.

BACKGROUND: Caustic injury of the oesophagus not only causes luminal narrowing but is also responsible for longitudinal contraction, resulting in gastro-oesophageal reflux (GOR), which leads to failure of conventional therapy. Therefore, the development of GOR should be investigated periodically to direct appropriate management of these patients. PURPOSE: To determine the ability of scintigraphy to detect GOR in children with caustic oesophageal strictures in comparison with barium study and 24-h pH monitoring. MATERIALS AND METHODS: Seventeen children with caustic oesophageal injury underwent scintigraphy, an upper GI barium study and 24-h pH monitoring within the same week. Five patients were also investigated post-operatively for the assessment of surgical outcome after antireflux surgery. RESULTS: On the whole, there was good correlation (r = 0.78, P < 0.00 l) between scintigraphy and 24-h oesophageal pH monitoring. Scintigraphy detected all but one (9/10) refluxing patients and also correctly identified all (7/7) non-refluxing patients. Barium studies demonstrated 6 out of 10 refluxing patients. There were no false-positive barium studies in non-refluxing patients. Post-operative studies demonstrated no evidence of GOR in surgically treated patients. CONCLUSIONS: Our results indicate that, by comparison with barium studies, scintigraphy is useful in the detection of GOR in cases with caustic oesophageal strictures and may be used as a screening modality for those under clinical follow-up.

Correlation of 99mTc-sestamibi uptake with blood-pool and osseous phase 99mTc-MDP uptake in malignant bone and soft-tissue tumours.

Technetium-99m-sestamibi (99mTc-MIBI) imaging is a well-established modality in oncologic investigations. The current study aimed to investigate whether any relationship could be found between 99mTc-MIBI uptake and local perfusion in malignant bone and soft-tissue tumours. It also aimed to compare 99mTc-MIBI images with those of technetium-99m-methylene diphosphonate (99mTc-MDP) bone scintigraphy with regard to the activity distribution pattern, intensity and lesion extension. The study group included 24 patients with various bone and soft-tissue tumours. Three-phase bone scintigraphy and 99mTc-MIBI studies were performed within the same week before any surgical and therapeutic intervention. Images were evaluated visually and quantitatively using regions of interest (ROIs) over the lesion and adjacent normal tissue. The 99mTc-MIBI study was positive with varying degrees of uptake (range, 1.4-5.3). The mean 99mTc-MIBI uptake and 99mTc-MDP blood-pool and osseous phase activity ratios were 2.5 +/- 0.5, 2.8 +/- 1.0 and 5.5 +/- 4.0, respectively. The correlation between the 99mTc-MIBI uptake and blood-pool ratios was 0.70 (P<0.05). While activity distribution patterns were in agreement in 99mTc-MIBI and blood-pool images in the majority of cases, 99mTc-MIBI better delineated tumour viability and extension in five cases. In conclusion, 99mTc-MIBI accumulation shows a reasonable correlation with blood-pool uptake assuming the presence of multifactorial mechanisms in addition to local hyperaemia. Better delineation of tumour outlines and cellular activity seems to be an advantage of 99mTc-MIBI scintigraphy which may be helpful in the evaluation of musculoskeletal tumours.

Distribution and morphometry of fiber types in cremaster muscles of boys with inguinal hernia or undescended testis.

In the present study, we determined and compared the distribution and mean diameters of fiber in the cremaster muscles (CM) of boys with either inguinal hernia (IH) or undescended testis (UT). Samples of CM were obtained from 20 patients (10 boys with IH, and 10 boys with UT) of similar age. The CM muscles of two boys each, without inguinal pathology, were sampled during autopsy. Sections were stained for oxidative and glycolytic enzymes, as well as for ATP-ase reactions after acid (pH: 4.6) and alkaline (pH: 10.6) preincubations. Specimens were also analyzed morphometrically using a KONTRON 400 computerized image analysis system. The Mann- Whitney U test was applied to compare the percentages of fiber types and mean diameters of fibers according to the types of the CM of boys with IH or UT. In boys, the CM is mainly composed of type 1 fibers. The CMs of patients with UT reveal alterations of neurogenic origin. Although both type 1 and type 2 fibers reveal alterations, type 2 fibers appear to be affected more profoundly and characterized by significantly decreased mean diameters. Significantly decreased mean diameters of type 2 fibers in CM may support disuse, lack of sensitivity to the hormonal influences, or an alteration in the corticospinal tracts of boys with UT.

False-negative scintigraphy with Tc-99m sestamibi in stage IV neuroblastoma.

Tc-99m sestamibi, originally developed for myocardial studies, has been used as a tumor-seeking agent. Recently, the agent also was reported to be a functional tracer to predict multidrug resistance-related p-glycoprotein expression in tumor tissue. The current report presents the authors' experience with sestamibi tumor scintigraphy in a neuroblastoma. Although I-131 MIBG tumor imaging and Tc-99m MDP bone scanning accurately demonstrated the extent of the disease, Tc-99m sestamibi showed no accumulation in primary and metastatic foci. Lack of sestamibi uptake was initially thought to be suggestive of failure to respond to chemotherapy because of p-glycoprotein expression. However, the patient responded well to chemotherapy and complete remission was achieved. The failure of Tc-99m sestamibi to detect a neuroblastoma and the lack of sestamibi accumulation in the tumor may not always be related to chemotherapy resistance.

Assessment of chemotherapy-induced changes in bone sarcomas: clinical experience with 99Tcm-MDP three-phase dynamic bone scintigraphy.

The aim of this study was to evaluate the value of three-phase dynamic bone scintigraphy (TPBS) in the assessment of the response of bone sarcomas to pre-operative chemotherapy and to correlate serial scintigraphic changes with histological findings. The study group comprised 27 patients (osteogenic sarcoma, n = 20; Ewing's sarcoma, n = 5; malignant fibrous histiocytoma, n = 2) with a mean age of 19.2 years. All patients received 99Tcm-methylene diphosphonate TPBS before and after pre-operative chemotherapy. Each phase of the imaging procedure was interpreted qualitatively and quantitatively. The percentage of tumour necrosis was analysed on resection materials following surgery. Histologically, 12 patients were non-responsive (tumour necrosis less than 90%) and 15 patients were responsive (tumour necrosis more than 90%). A decrease in the tumour blood flow ratio and extension were the most notable findings in the responders. The mean change in the tumour blood flow ratio following therapy was 58.7 +/- 8.3% and 19.9 +/- 26.6% (P < 0.005) in responders and non-responders respectively. The accuracy of three-phase imaging and static bone scintigraphy was 88% and 74% respectively. Since bone scintigraphy is a valuable technique owing to its ability to detect distant metastases in clinically early disease, TPBS should be helpful in monitoring therapy effects without any additional cost or radiation dose.

Is 201Tl a reliable agent in tumour imaging?

Thallium-201 (201Tl) imaging has been widely used to differentiate post-therapy reactions from residual viable tumour or local recurrence. However, the ability of 201Tl to discriminate between tumour and post-therapy changes with superimposed infection/inflammation is unclear. This experimental study investigated the localization of 201Tl in infected/inflamed tissues. Twenty-four rats infected with Staphylococcus aureus and 10 rats injected with a standard volume of saline solution (SS) into the thigh muscles were studied. Twenty-four ours after microorganism or SS administration, 18 MBq 201Tl was injected intravenously. Images were recorded at 20 min and 3 h post-injection. The increased tracer uptake was evaluated qualitatively and quantitatively by calculating the ratios (L/C) derived from regions of interest drawn over the lesion and the contralateral thigh muscle. After the imaging procedure, histopathological examination was also performed. Whereas the control group showed no abnormal accumulation of activity, the infected rats demonstrated markedly increased activity, especially on the 20 min images. The mean L/C ratios for the 20 min and 3 h images for the infected rats were 2.18 +/- 0.20 and 1.52 +/- 0.04, respectively (P < 0.0005). In conclusion, positive uptake due to an infective process may limit the use of 201Tl in studies monitoring response to tumour therapy. Although delayed imaging may help to overcome this limitation, further investigations among a large series of patients are required in order to improve the reliability of 201Tl imaging in oncology.

Accumulation of 99Tcm-polyclonal immunoglobulin in different stages of infection: an experimental study.

In this experimental study, the utility of 99Tc(m)-polyclonal human immunoglobulin (99Tcm-HIG) for localizing acute and chronic phases of inflammatory lesions was investigated. Three groups of rats were inoculated with Staphylococcus aureus in the right thigh. Then, 24 h (group I, n = 12), 48 h (group II, n = 12) and 72 h (group III, n = 12) post-inoculation, the rats received 40 MBq 99Tcm-HIG into the jugular vein. In addition, two control rats were studied at 24 h after inoculation of sterile saline. Both visual and quantitative evaluations were undertaken. The acute and chronic stages of inflammation were determined by pathological examination. The mean ( +/- S.D.) lesion/contralateral uptake ratios at 4 and 24 h after 99Tcm-HIG injection were: group I, 1.22 +/- 0.1 and 2.12 +/- 0.16; group II, 1.15 +/- 0.08 and 2.25 +/- 0.16; group III, 1.06 +/- 0.09 and 2.08 +/- 0.14. In conclusion, the acute and chronic phases of infection showed non-significant differences in 99Tcm-HIG uptake ratios.

[Microscopic studies of the skin of the Turkish angora goat. II. Functional morphology of the hair follicle]. / Mikroskopische Untersuchungen an der Haut der Türkischen Angoraziege. II. Funktionelle Morphologie der Haarfollikel.

The study supplies a detailed description of the development, morphology and function of anagen hair follicles in the Turkish Angora goat. In this connection, the formation of the hair root and the epithelial root sheaths is of specific interest. Furthermore, the intensive structural alterations and disintegrative processes occurring during the catagen phase are presented. The telogen hair follicle development is also referred to with special regard to typical structural and functional features.