Can platelet-rich plasma be used safely in intra-abdominal operations?

OBJECTIVES: In this study, it was aimed to investigate whether or not platelet­rich plasma (PRP) causes intra-abdominal adhesions and therefore, whether or not PRP can be used safely in intra-abdominal operations. METHODS: Of the total of 35 animals, 5 were used as donors for the preparation of platelet­rich plasma (PRP). The surgical procedures were performed on the remaining 30 animals. These rats were randomized and divided into 3 groups of 10. In Group 1, no adhesion induction was performed. Adhesion was induced by cecal abrasion and peritoneal resection model in Groups II and IIII. In Group 2, no treatment was given. In Group 3, 1 cc PRP was applied on the cecum. The rats were sacrificed on postoperative day 21. RESULTS: According to adhesion scores, the difference between the sham and PRP groups was not statistically significant. There was also no significant difference between the control and PRP groups, but the adhesion scores in the PRP group was lower than those in the control group. On histopathological evaluation, the difference between the sham and PRP groups was not statistically significant. There was also no significant difference between the control and PRP groups, but the average fibrosis and inflammation scores in the PRP group were lower than those in the control group. CONCLUSION: The results of the present study have demonstrated that PRP neither reduced nor exacerbated postoperative adhesions. Thus, PRP can be used safely in experimental and clinical studies where it will be applied intra-abdominally (Tab. 2, Fig. 3, Ref. 11).

Antimicrobial resistance in gram-negative hospital isolates: results of the Turkish HITIT-2 Surveillance Study of 2007.

Resistance rates to amikacin, ciprofloxacin, ceftazidime, cefepime, imipenem, cefoperazone/sulbactam and piperacillin/tazobactam in Escherichia coli (n= 438), Klebsiella pneumoniae (n= 444), Pseudomonas aeruginosa (n= 210) and Acinetobacter baumanni (n=200) were determined with e-test in a multicenter surveillance study (Hitit-2) in 2007. ESBL production in Escherichia coli and K. pneumoniae was investigated following the CLSI guidelines. Overall 42.0% of E.coli and 41.4% of K. pneumoniae were ESBL producers. In E. coli , resistance to imipenem was not observed, resistance to ciprofloxacin and amikacin was 58.0% and 5.5% respectively. In K. pneumoniae resistance to imipenem, ciprofloxacin and amikacin was 3.1%, 17.8% 12.4% respectively. In P. aeruginosa the lowest rate of resistance was observed with piperacillin/tazobactam (18.1%). A. baumanni isolates were highly resistant to all the antimicrobial agents, the lowest level of resistance was observed against cefoperazone/sulbactam (52.0%) followed by imipenem (55.5%). this study showed that resistance rates to antimicrobials are high in nosocomial isolates and show variations among the centers.

Oropharyngeal candidiasis with dry-powdered fluticasone propionate: 500 microg/day versus 200 microg/day.

We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler. We selected four groups of patients: 62 asthmatic patients who were taking 200 microg/d FP, 122 asthmatics who were taking 500 microg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects. The frequency of positive swabs for Candida colonization was higher in 500 microg/d FP group than asthmatics without ICS use (chi2 = 6.8, p < 0.05) and normal controls (chi2 = 4.9, p < 0.05), whereas it wasn't different in the 200 microg/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05). The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months.

Oropharyngeal candidiasis with dry-powdered fluticasone propionate: 500 mg/day versus 200 mg/day

We aimed to determine the frequency of oropharyngeal candidiasis and its clinical correlates in the asthmatic patients who use fluticasone propionate (FP) as a dry powdered inhaler. We selected four groups of patients: 62 asthmatic patients who were taking 200 ìg/d FP, 122 asthmatics who were taking 500 ìg/d FP, 50 asthmatic patients who had not been on inhaled corticosteroid (ICS) treatment and 40 normal non-asthmatic subjects. The frequency of positive swabs for Candida colonization was higher in 500 ìg/d FP group than asthmatics without ICS use (÷2 = 6.8, p < 0.05) and normal controls (÷2 = 4.9, p < 0.05), whereas it wasn't different in the 200 ìg/day FP group when compared to controls. When we considered patients who used ICS, the most effective variables affecting the occurrence of Candida colonization were washing of the throat by the patients (OR = 9.4, 95 % Confidence Interval [CI] = 3.9-22.7, p < 0.0001) and duration of ICS use more than 12 months (OR = 2.5, 95 % CI = 1.1-2.6, p < 0.05). The present study showed that in the patients who use ICS, the most important determinants on colonization were not washing the throat regularly and duration of ICS use for more than 12 months

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Risk factors affecting morbidity in typhoid enteric perforation.

INTRODUCTION: Typhoid enteric perforation is a cause of high morbidity and mortality. This study aim is to determine the factors affecting morbidity in patients with typhoid enteric perforation. MATERIALS AND METHODS: Ninety-six patients with typhoid enteric perforation were reviewed. The variables are defined as follows: Age, gender, complaints, perforation-operation interval, typhoid fever treatment before the perforation or not, white blood cell (WBC) count, hemoglobin level (Hgb), intraoperative peritonitis intensity, the number of perforations, and type of surgery were examined. To determine the independent risk factors that might affect morbidity in typhoid enteric perforation, we made use of multivariate logistic regression analysis. RESULTS: Nine variables were applied the univariate analysis, which were greater than 30 years (P = 0.218), male gender (P = 0.02), preoperative treatment (P = 0.147), less than or equal to 48 h perforation-operation interval (P = 0.013), greater than 4,000 K/UL WBC (P = 0.388), less than 8 g/dL Hgb (P = 0.026), greater than 29 Mannheim Peritonitis Index (P < 0.0001), multiple perforation number (P = 0.614), and primary repair (P = 0.105). Logistic regression analysis showed that Mannheim Peritonitis Index (P = 0.014) and perforation-operation interval (P = 0.047) were defined as independent risk factors affecting morbidity. CONCLUSIONS: If liquid electrolyte, blood, antibiotics, and parenteral nutrition are applied in typhoid enteric perforation cases adequately, then severe peritonitis becomes an independent risk factor that affects morbidity. Early diagnosis and appropriate surgery type would decrease morbidity and mortality.

Rapid detection of Mycobacterium tuberculosis from sputum specimens using the FASTPlaqueTB test.

OBJECTIVES: To determine the performance of the FASTPlaqueTB test, based on bacteriophage amplification technology, by comparison with the BACTEC 460 TB culture system, the Löwenstein-Jensen (LJ) medium culture method and Ziehl-Neelsen (ZN) staining. METHODS: Of 400 sputum specimens studied in our laboratory, 19 were excluded due to contaminant growth. The FASTPlaqueTB test was performed according to the manufacturer's instructions. RESULTS: Only 42 of the 381 specimens examined were positive on at least one test: 30 were positive with ZN staining, 34 with LJ medium, 36 with the FASTPlaqueTB test and 39 with BACTEC 460 TB. The combination of BACTEC 460 TB and LJ medium culture was considered the gold standard. The sensitivity and specificity were 70.7% and 99.7% for ZN staining, 87.8% and 100% for the FASTPlaqueTB test, 82.9% and 100% for LJ, and 95.1% and 100% for BACTEC 460 TB. CONCLUSIONS: The FASTPlaqueTB test is useful in the rapid diagnosis of TB.

Factors affecting morbidity and mortality in gangrenous cholecystitis.

INTRODUCTION: Gangrenous cholecystitis is a serious complication of acute cholecystitis. Male gender, older age, leukocytosis, cardio-vascular diseases and diabetes were reported as factors that increase the risk of gangrenous cholecystitis. The aim our study was to determine variables affecting morbidity and mortality as well as to define the independent risk factors in Gangrenous Cholecystitis. METHODS: Fifty three patients who had been treated for Gangrenous Cholecystitis were reviewed. The variables are defined as follows: age, gender, systemic diseases, Mannheim Peritonitis index, aspartate aminotransferase, alanine aminotransferase, white blood cell count and type of surgery. In order to determine the independent risk factors that might affect morbidity and mortality in Gangrenous Cholecystitis, we made use of multivariate logistic regression analysis. RESULTS: The independent risk factors affecting on morbidity were age (P = 0.037), existing systemic disease (P = 0.047) and > or = 29 Mannheim Peritonitis index (P = 0.008), and the independent risk factors affecting on mortality were age (P = 0.046), white blood cell count (P = 0.035). Pre-operative and post-operative third day aspartate amino-transferase and alanine aminotransferase average values were compared, there was a significant difference (P < 0.0001, P < 0.0001 respectively). CONCLUSIONS: We found that older age, > or = 29 Mannheim Peritonitis index and existence of systemic diseases were independent risk factors affecting morbidity. Older age and lower of white blood cell count were independent risk factors affecting mortality. We believe that further comprehensive studies, involving prospective, multi-center and a large number of patients, are needed.

The prevalence of allergic rhinitis in urban and rural areas of Eskisehir-Turkey.

Allergic rhinitis is the most common allergic disease in our country. The epidemiology of allergic rhinitis varies according to the geographic regions of the country. The aim of this study was to find out if it also differs in urban and rural areas of the same region. The study groups were randomly selected in order to sample high school students living in small towns or villages in rural areas and in the city center. Initially the screening questionnaires about allergic rhinitis were responded by the students at school. Then the questionnaires were evaluated. Seven hundred eighty-three students who had a positive questionnaire outcome were underwent an ENT examination. Then skin tests and blood analysis were performed to two hundred forty-six students who were diagnosed as allergic rhinitis clinically. Prick test results was found to be positive 61.8% in urban areas and 46.7% in rural areas. The comparison of the ratios of urban and rural areas was significant. Similar results were obtained in serum specific Ig E analysis. The correlation of specific Ig E levels and skin prick test results was significant in all allergens. Allergic rhinitis is a medical and economic problem all over the world and further epidemiologic investigations should be performed.

The prevalence of allergic rhinitis in urban and rural areas of Eskis¸ehir-Turkey

Allergic rhinitis is the most common allergic disease in our country. The epidemiology of allergic rhinitis varies according to the geographic regions of the country. The aim of this study was to find out if it also differs in urban and rural areas of the same region. The study groups were randomly selected in order to sample high school students living in small towns or villages in rural areas and in the city center. Initially the screening questionnaires about allergic rhinitis were responded by the students at school. Then the questionnaires were evaluated. Seven hundred eighty-three students who had a positive questionnaire outcome were underwent an ENT examination. Then skin tests and blood analysis were performed to two hundred forty-six students who were diagnosed as allergic rhinitis clinically. Prick test results was found to be positive 61.8 % in urban areas and 46.7 % in rural areas. The comparison of the ratios of urban and rural areas was significant. Similar results were obtained in serum specific Ig E analysis. The correlation of specific Ig E levels and skin prick test results was significant in all allergens. Allergic rhinitis is a medical and economic problem all over the world and further epidemiologic investigations should be performed

La rinitis alérgica es la enfermedad alérgica más común en Turquía, y su epidemiología varía dependiendo de las regiones del país. El presente estudio tenía por objeto averiguar si la epidemiología variaba también entre las zonas urbanas y rurales de la misma región. Los grupos de estudio se seleccionaron aleatoriamente para realizar un muestreo de los alumnos de educación secundaria tanto de aldeas y pueblos de zonas rurales como del núcleo urbano. Inicialmente los alumnos respondieron en los institutos a cuestionarios de diagnóstico, que posteriormente se evaluaron. 783 alumnos cuyo cuestionario resultó positivo se sometieron a una exploración de oído, nariz y garganta. A continuación se realizaron pruebas cutáneas y análisis de sangre a 246 alumnos a los que se había diagnosticado clínicamente una rinitis alérgica. Las pruebas cutáneas dieron positivo en un 61,8 % en las zonas urbanas y en un 46,7 % en las zonas rurales. La diferencia entre los porcentajes de las zonas rurales y urbanas fue significativa, obteniéndose resultados similares en los análisis de IgE específica sérica. La correlación entre los niveles de IgE específica y los resultados de las pruebas cutáneas fue significativa en todos los alergenos. La rinitis alérgica es un problema médico y económico en todo el mundo, y deben realizarse más investigaciones epidemiológicas

Decay of maternally derived measles antibody in central Turkey.

The aim of this cross-sectional study was to investigate maternal antibodies in sera of infants below vaccination age and their relation to the immunity status of the mothers. The study group consisted of 184 mothers and their babies aged 0-9 months. Mothers were interviewed to obtain demographic information. Samples of sera were taken from mothers and their babies and tested for measles IgG antibodies. In our study, 174 mothers (94.6%) were immune to measles. Only 78.4% of the 0 month-old infants of seropositive mothers and 26.0% of the 4-9 month-old infants were seropositive. When correlation analysis for antibody titres was made between the seropositive mothers and their seropositive infants, positive correlation was found. It was found that the time for which infants were protected was related to maternal IgG antibody titre. It will be proper to determine the vaccination strategies considering the changing epidemiological characteristics.

[The effectiveness of hemopoietic growth factors in sepsis]. / Sepsiste hemopoetik büyüme faktörlerinin etkinligi.

In this experimental study, consist of 54 Sprague-Dawley rats, we tried to observe the effectiveness of haemopoietic growth factors such as G-CSF and GM-CSF in treatment of sepsis and see if they have any effects on phagocytic activity of macrophages when are administered after establishment of sepsis. In first phase of this study, twenty one rats were randomly divided into three groups of 7 animals each. Cecal ligation and perforation were carried out in each rat and sepsis made up. The Control group received 2 x 0.2 cc %5 dextrose injection subcutaneous (s.c.).. The G-CSF group received 2 x 1 g G-CSF with 0.2 cc %5 dextrose s.c. The GM-CSF received 1 x 2 g GM-CSF with 0.2 cc %5 dextrose s.c. Seventh day survival was considered as criterion in the three groups. In second phase of this study, thirty three rats were randomly divided into three groups of 11 animals each. The same procedures were carried out also in these groups. Leukocyte counts and peripheric spread were analyzed in postoperative 24th and 72th hours, alveolar and peritoneal macrophages were Investigated in postoperative 72nd hour. There was significantly neutrophilic leukocytosis in the G-CSF group according to the control group. Nevertheless, there was no change in the phagocytic activity of alveolar and peritoneal macrophages. GM-CSF brought about positive effect of phagocytic activity of macrophages without change of leucocyte count in the sepsis, but it caused neutrophilic, monocytosis and lymphocytopenia. The seventh day survival rates in control, G-CSF, GM-CSF groups were as; 42.8%, 71.4%, 28.5% respectively. As a result, we saw that G-CSF has no effect on the phagocytic activity of macrophages, while increases the survival by enhancing the count and probably the function of neutrophils. GM-CSF fails to increase survival while effects the phagocytic activities of macrophages positively and enhances the peripheral neutrophil and monosit counts without changing the total number of leukocytes.

[Trauma and resuscitation course (TRC): evaluation of the first 2 years]. / Travma ve resüsitasyon kursu (TRK): ilk 2 yilin degerlendirmesi.

Eight Trauma and resuscitation Courses (TRC): two instructor and 6 student courses have been organized in Turkey between December 1998 and November 2000. Questionnaire results of 121 students and 63 instructors were reviewed. We strongly believe that these results will be supportive for the courses in the future. Fifty-five of the instructors were from university, and 8 were from teaching hospitals. 121 doctors attended six student courses, the average age of whom was 34. Average time period following university graduation was 10 years (3 months 43 years) for the participants. Among these, 94% found the course content sufficient. The course book was determined as insufficient in terms of drawings and pictures by 15%. The main target population of the course was selected as emergency service doctors and practitioners. As a result we determined that the main criticisms were insufficient practical and video sessions and the lack of drawings in the course book our main goal is to accomplish the required changes, and make new courses more yielding and profitable, thus introduce standardization in terms of trauma care nationwide.

Serum soluble endothelial-cell specific adhesion molecules in children with insulin-dependent diabetes mellitus.

Endothelial-cell specific adhesion molecules are reported to be elevated in patients with diabetes mellitus and related to diabetic vascular complications. We studied serum concentrations of soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), endothelial-leukocyte adhesion molecule (sE-selectin) in 30 healthy children and 35 children with type 1 diabetes without symptomatic vascular complications. sE-selectin levels were higher in diabetics than in controls (p < 0.001). sVCAM-1 and sICAM-1 levels were not different between the groups (p > 0.05). In seven newly diagnosed diabetics with ketoacidosis, concentrations of these molecules were not different before and after one month of insulin therapy (p > 0.05). In the combined group, only sE-selectin was correlated positively with serum glucose, HbA1c (r = 0.3, p < 0.05 for both) and negatively with C-peptide levels (r = -0.4, p < 0.05). In diabetic children without symptomatic vascular complications, sE-selectin but not sICAM and sVCAM levels was elevated; this finding might reflect ongoing endothelial-cell activation rather than endothelial damage.

Lymphadenitis caused by Scedosporium apiospermum in an immunocompetent patient.

A case of lymphadenitis caused by Scedosporium apiospermum in a 25-year-old immunocompetent woman had been misdiagnosed as tuberculous lymphadenitis. Clinical response to itraconazole therapy was obtained in 6 months; to our knowledge, this is the first report of lymphadenitis caused by S. apiospermum in humans.

Case report. Rhodotorula rubra fungaemia due to use of indwelling venous catheters.

Rhodotorula has been an infrequent cause of infection in humans but there have been some case reports about this systemic yeast infection. In this article, a Rhodotorula rubra fungaemia due to an indwelling catheter in a 23-year-old woman who had been diagnosed with non-Hodgkin's lymphoma grade IV B is described.

Phenotypic variation and antifungal susceptibility patterns of Candida albicans strains isolated from neutropenic patients.

The aim of this study was to investigate the relationship between phenotypes of Candida albicans strains isolated from clinical specimens and the susceptibility of the strains to three antifungal agents, fluconazole, amphotericin B and flucytosine. Oropharyngeal, gastrointestinal and urogenital tract specimens were collected from 122 neutropenic patients who had received no previous prophylactic treatment. Each of 122 C. albicans strains recovered was found to express one of the six phenotypes: smooth, fuzzy, irregular, star, ring and stipple. The mean minimum inhibitory concentrations (MICs) of fluconazole was consistently higher for C. albicans strains expressing the stipple phenotype. The mean MICs for the six phenotypes of C. albicans strains ranged between 1.22 and 7.94 micrograms ml-1 for fluconazole, 0.99 and 2.55 micrograms ml-1 for amphotericin B and 1.23 and 1.83 micrograms ml-1 for flucytosine. The antifungal susceptibility of the stipple phenotype requires attention, especially in patients who are clinically unresponsive to fluconazole chemotherapy or in cases of life-threatening C. albicans infections of immunocompromised hosts. Long-term use of fluconazole may explain the outcome of the resistant stipple phenotype.

[Granulomatous peritonitis due to Ascaris lumbricoides]. / Ascaris lumbricoides'e bagli granülomatöz peritonit.

Ascaris lumbricoides is one of the most common and most widespread helminthic infections of humans. Infection with ascaris appears to be asymptomatic in the vast majority of cases, but may produce serious pulmonary disease or obstruction of biliary or intestinal tract in a small proportion of infected people. We examined under the light of literature this case which caused the granulomatous peritonitis by ascaris, the adult worm, without any evidence of intestinal perforation.

Experience with renal gunshot injuries in a rural setting.

OBJECTIVES: To investigate the high nephrectomy rate in patients with gunshot injury at Dicle University Medical School Research Hospital and to determine the factors that affect our nephrectomy decision. METHODS: During a 4-year period, 71 patients were hospitalized for renal injuries at our hospital. Renal gunshot injuries (RGIs) were noted in 45 kidneys of 42 patients (59.1%). Twenty-five patients underwent nephrectomy (55.5%). Twenty kidneys were reconstructed (44.4%). The hospital records were reviewed retrospectively. In these two groups of patients, the following clinical data were entered into a computer data base and compared: presence and type of hematuria, type and degree of renal injury, hemodynamic status, results of imaging studies, surgical technique, type of weapon, reason for nephrectomy, associated organ injury, injury severity score, complications, and mortality. RESULTS: The patients who underwent renal repair and those who underwent nephrectomy had a mean injury severity score of 33.6 +/- 7.5 and 42.0 +/- 9.9, respectively (P <0.001). The main grade of injury was 4.4 +/-0.8 in nephrectomy patients and 2.8 +/- 0.9 in the patients for whom renal salvage was possible (P <0.05). Patients who required nephrectomy, as a group, appeared to have a higher rate of high-velocity bullet injury (HVBI) (76%) (P <0.05) and higher numbers of associated abdominal injury (P <0.05). CONCLUSIONS: HVBI makes extensive tissue debridement imperative and reconstruction difficult. We believe that in RGIs caused by a high-velocity bullet, nephrectomy is more likely to be required. Hemodynamic instability was the major reason for our intraoperative nephrectomy decision. a subcategory of RGI.

Amebic liver abscess: changing trends over 20 years.

Amebiasis and amebic liver abscess (ALA) continue to be a major fatal disease in developing countries where unhygienic environmental conditions prevail. Between January 1975 and December 1984 there were 60 patients and from January 1985 to December 1994 there were 44 patients with ALA who were diagnosed and treated. In the first group, all patients were operated on, and drainage was performed. The morbidity and mortality rates were 53.3% and 23.3%, respectively. Metronidazole was given to all patients in the second group, and in those who did not respond to the metronidazole percutaneous needle aspiration was applied. Surgical treatment was performed in seven patients because four did not respond to metronidazole therapy and percutaneous needle aspiration, and in three the abscess ruptured into the peritoneal cavity. The lesion disappeared ultrasonographically after 4 months in all patients. The morbidity and mortality rates were 4.5% and 2.2%, respectively. The result of this study suggests that uncomplicated ALA can be managed conservatively with metronidazole and needle aspiration of the abscess. Operative therapy should be performed for complications of the abscess and when conservative therapy fails.