Estrogen as primary factor in vaginal healing in rats.

OBJECTIVE: Although the effect of estrogens on wound healing is already known, its complex mechanism is not fully understood in literature. The aim of this study is to investigate the effect of estrogen on vaginal healing after surgical intervention performed in the age group with low estrogen level and in an adult group with high estrogen level. MATERIALS AND METHODS: Seven young and seven adult female Wistar Albino rats were procured. For control group, one animal was chosen each from the young (Group I) and adult groups (Group II), and their vaginal tissue was removed. An incision was made to the posterior vaginal wall under anesthesia and sutured with 5-0 polyglactin in all the rats. On the seventh postoperative day, the posterior vaginal wall was excised. A semi-quantitative method was used to evaluate the histological processes and structures during wound healing. RESULTS: Although there were no evident differences in the evaluation of histological scoring system, the presence and distribution of new vascularization and fibroblasts showed that vaginal mucosal healing was more intense in adult rats. CONCLUSIONS: The effect of estrogens on vaginal mucosal healing has been discussed in several experimental studies and literature information has been presented; it has been concluded that it would be beneficial to consider the positive effect of vaginoplasty procedures.

Inappropriate drug use rates of geriatric patients attending to a university hospital cardiology policlinic.

BACKGROUND: The interest in risks related to inappropriate drug use (IDU) and polypharmacy among the elderly has increased in recent years. AIMS: We aimed to determine the frequency of IDU and multiple drug use in elderly patients in the cardiology outpatient clinic. PATIENTS AND METHODS: : In this prospective, cross-sectional study, a total of 513 patients aged 65 years and above who were admitted to the Cardiology Policlinic between December 2017 and January 2018 were included. To determine the prevalence of IDU, we investigated the suitability of the drugs used by the patients (according to the criteria of Beers 2015 and Screening Tool of Older People's Prescriptions [STOPP] version 2), the number of violated criteria in both the guidelines and which criterion was violated by the inappropriate drugs. RESULTS: : The 513 patients (mean age: 73.18 ± 5.99) in this study included females (n = 235; 45.8%) and males (n = 278; 54.2%). A total of 2,910 drugs were used by the 513 patients (mean per patient: 5.67 ± 2.51); 52.8% of the patients were using more than five drugs. The Beers criteria revealed that 304 IDUs were detected among the drugs and showed that 38.6% (n = 198) of the patients had IDU. According to the STOPP criteria, 366 IDUs were identified among the drugs used, and 45.6% (n = 234) of the patients had IDU. CONCLUSION: IDU frequencies of the elderly patients are similar to the world literature in our study. As the number of chronic illnesses the patients had increases, the frequency of IDU increases according to Beers and STOPP criteria in our study.

Influence of influenza vaccination on recurrent hospitalization in patients with heart failure.

BACKGROUND: The current study aimed to evaluate the influence of regular annual influenza vaccinations on cardiovascular (CV) death and heart failure-related hospitalizations (HFrH) in stable outpatients with heart failure with reduced ejection fraction. METHODS: The Turkish research team-HF (TREAT-HF) is a network undertaking multicenter, observational cohort studies in HF. This study is a subgroup analysis of TREAT-HF outpatient cohorts who completed a questionnaire on influenza vaccination status and for whom follow-up data were available. A total of 656 patients with available follow-up data for CV death and HFrH including recurrent hospitalization were included in the study. Patients were classified into two groups: those who received regular influenza vaccination (40 %) and those who did not receive vaccination. RESULTS: During a mean follow-up of 15 ±6 months, 113 (18 %) patients had CV death and 471 (72 %) patients had at least one HFrH. The CV death rate was similar in both groups of patients (16 vs. 19 %, p = 0.37), whereas, HFrH and recurrent HFrH were significantly less frequently encountered in patients who received regular influenza vaccination than in those who did not receive vaccination (43 vs. 92 % and 16 vs. 66 %, p < 0.001, respectively). In a multivariate Cox proportional hazards model - in addition to a few clinical factors - vaccination status (HR = 0.30, 95 % CI = 0.17-0.51, p < 0.001) and graduation from university (HR = 0.35, 95 % CI = 0.17-0.72, p = 0.004) remained independently associated with the risk of recurrent HFrH. CONCLUSION: Regular influenza vaccination does not influence CV deaths; however, it decreases HFrH including recurrent episodes of HFrH in outpatients with heart failure with reduced ejection fraction.

Long-term stability of early implant placement with contour augmentation.

In this prospective case series study, 20 patients with an implant-borne single crown following early implant placement with simultaneous contour augmentation were followed for 6 years. Clinical, radiologic, and esthetic parameters were assessed. In addition, cone beam computed tomography (CBCT) was used at 6 years to examine the facial bone wall. During the study period, all 20 implants were successfully integrated, and the clinical parameters remained stable over time. Pleasing esthetic outcomes were noted, as assessed by the pink esthetic scores. None of the implants developed mucosal recession of 1 mm or more. The periapical radiographs yielded stable peri-implant bone levels, with a mean DIB of 0.44 mm at 6 years. The CBCT scans showed that all 20 implants had a detectable facial bone wall at 6 years, with a mean thickness of around 1.9 mm. In summary, this prospective case series study demonstrated stable peri-implant hard and soft tissues for all 20 implants, and pleasing esthetic outcomes overall. The follow-up of 6 years confirmed that the risk for mucosal recession is low with early implant placement. In addition, contour augmentation with guided bone regeneration (GBR) was able to establish and maintain a facial bone wall in all 20 patients.

A novel WT1 gene mutation in a newborn infant diagnosed with Denys-Drash syndrome.

Denys-Drash syndrome (DDS) is a rare disorder characterized by glomerulopathy, genital abnormalities and predisposition to Wilms' tumor. It is associated with constitutional Wilms'tumor suppressor 1 (WT1) gene mutations, in which the majority being missense mutations in the zinc-finger region. Here, we present a newborn with DDS, associated with a novel heterozygous missense mutation, p.Asp396His, on exon 9 of WT1.

Statins improve myocardial perfusion in metabolic syndrome patients who have perfusion defects on myocardial perfusion imaging and angiographically normal coronary arteries.

OBJECTIVE: Previous studies in hypercholesterolemic patients with coronary artery disease (CAD) have demonstrated that lipid lowering therapy restores coronary endothelium dependent vasodilatation and increases myocardial perfusion. However, there is not enough data showing the effects of statins on myocardial perfusion in metabolic syndrome (MetS) patients who have perfusion abnormalities but not evident CAD, which are attributed to microvascular dysfunction. We aimed to evaluate whether or not statin therapy improves myocardial perfusion, as assessed by Technetium (Tc)-99m single-photon emission computed tomography (SPECT), in patients with MetS and angiographically normal epicardial coronary anatomy. MATERIALS AND METHODS: The study population consisted of 55 selected patients (mean age: 52, 72% female) with MetS who have perfusion defect on exercise stress Tc-99m SPECT and normal coronary arteries. Patients were treated with 20 mg atorvastatin for six months regardless of baseline lipid levels and SPECT study was repeated after the therapy. The summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS), and left ventricular (LV) volumes and ejection fractions (EF) at rest and stress were obtained. RESULTS: We found significant improvements in SSS, SRS and SDS after six months of statin therapy (p = 0.001, 0.001 and 0.002, respectively). In addition, end-diastolic volumes at rest and stress, and stroke volume at rest were significantly decreased (p = 0.001, 0.001 and 0.026, respectively). Also, LV EF at stress was significantly increased (p = 0.035). CONCLUSIONS: Statin therapy in patients with MetS who have perfusion defects on Tc-99m SPECT and normal coronary arteries produces significant improvements in myocardial perfusion abnormalities.

The transscrotal approach for recurrent and iatrogenic undescended testes.

PURPOSE: Aim of the study was to evaluate the efficacy of the transscrotal approach in redo orchiopexy. MATERIAL AND METHODS: Redo orchiopexy using the transscrotal approach was used to treat 16 testes during a 4-year period from 2005 to 2009. Five of these cases occurred following inguinal hernia repair and 11 after previous orchiopexy. Only testes located distal to the external ring that could be moved to the upper part of the scrotum were included in the study. The vas deferens and testicular vessels were dissected free from the surrounding tissue using a scrotal approach and the testis placed into a dartos pouch. RESULTS: All testes except one could be placed into the scrotum with the transscrotal approach. The mean duration of surgery was 33+/-13 min. No patient suffered from atrophy or reascending testes. CONCLUSION: The transscrotal approach is a fast, simple and reliable method for redo procedures for undescended testes.

Does gum chewing reduce postoperative ileus after intestinal resection in children? A prospective randomized controlled trial.

INTRODUCTION: The aim of this study was to determine whether the addition of gum chewing to standardized postoperative care is associated with a significantly earlier return of bowel function compared to simple postoperative management in children with intestinal anastomosis. MATERIALS AND METHODS: We performed a prospective, randomized, controlled trial. All patients who underwent laparotomy with either colon or small bowel resection between June 2006 and March 2008 were randomized to one of two groups. Group one consisted of patients receiving standardized postoperative care plus gum chewing (gum-chewing group) (n=15); Group two consisted of patients receiving only standardized postoperative care (control group) (n=15). The patients in the gum-chewing group chewed one stick of sugarless gum three times per day, for an hour, each day. RESULTS: The groups were statistically similar. The time to first flatus was 35.73+/-14.67 h in the gum-chewing group and 42.00+/-20.77 h in the control group (p=0.347). The time to first bowel movement was 56.27+/-22.14 h in the gum-chewing group and 63.00+/-26.34 in the control group (p=0.444). The length of hospital stay was 5.80+/-0.68 days for the gum-chewing group and 6.67+/-0.98 days for the control group (p=0.005). The hospital charges were 2451+/-806 YTL for the gum-chewing group and 2102+/-678 YTL for the control group (p=0.206). CONCLUSIONS: The addition of gum chewing to the standardized postoperative care of children with intestinal anastomosis was not associated with a significantly earlier return of bowel function compared to simple postoperative management, but it was associated with an earlier discharge from hospital, although this earlier discharge had only minor clinical significance and no difference was found in hospital charges.

Fetus in fetu: A report of two cases.

Fetus in fetu is a rare condition that has been defined as the presence of one of the twins in the body of the other. It is most frequently located in retroperitoneal area; however, it has been reported in other locations as well. This report presents two cases of "fetus in fetu" cases: one located in the retroperitoneal area and the other in the sacrococcygeal area.

Our experience with transanal endorectal pull-through in Hirschsprung's disease.

AIM: The aim of the study was to evaluate the functional results, complications, the problems caused, and the outcomes of the transanal endorectal pull-through (TEPT) operation in Hirschsprung's disease. PATIENTS AND METHODS: The 22 patients who were operated for Hirschsprung's disease with TEPT between November 2003 and September 2006 were reviewed retrospectively. The patients were evaluated for age, gender, operational findings, duration of hospitalization and functional outcomes after the operation. RESULTS: A total of 22 patients, sixteen males (72.7 %) and 6 females (27.3 %) aged 23 days to 11 years (mean 19.3 +/- 6.9 months), were operated using TEPT over a 34-month period. The mean length of the resected aganglionic segment was 23 +/- 2.4 cm; the shortest segment was 7 cm and the longest 40 cm. The postoperative hospital stay was 3 - 10 days, oral feeding was started at 1 - 4 days, the first bowel movement was at 1 - 7 days and the number of daily movements for patients in whom the colostomy was closed was 2 - 5. The mean postoperative follow-up period was 18 +/- 2.4 months (1 - 33 months). Two patients (9 %) were hospitalized once for enterocolitis. One patient had a constipation problem that resolved with medical treatment. One patient needed colostomy for anastomosis leakage on the 5th postoperative day, followed by a redo pull-through using a posterior sagittal approach. None of the patients had a continence problem. No urethral damage was observed and there were no abscesses at the muscular cuff. We observed that mucosal dissection was more difficult in the rectal biopsy area. CONCLUSIONS: Although only recently accepted, TEPT has quickly found a place in clinical practice as it is based on an operational technique whose results are well identified and accepted and with which there is extensive experience. It seems that TEPT has the advantages of having no additional problems compared to the classical techniques with respect to complications and functional outcomes while providing better patient comfort and cosmetic outcomes. We conclude that TEPT may be preferred in appropriate cases and will evolve to become a more practical and effective technique.

Comparison of two methods for the management of appendicular mass in children.

Appendicitis is the most common surgical emergency in pediatric surgery. In the presence of an appendicular mass, surgical management can be difficult. We evaluate the results of appendix mass management both with immediate operation and conservative treatment over a period of 5 years. Forty children who presented with appendicular mass over a period of 5 years were reviewed. Their mean age was 7.6+/-2.7 years, and the mean duration of symptoms was 7.8+/-2.7 days. We evaluated the children in two groups: The first group included 19 children who were operated on immediately, and the second group included 21 children who were managed conservatively, followed by elective appendectomy. In the first group, mean hospitalization time was 8.7+/-3.2 days. The complication rate was found to be high (26.3%). Ileal injury occurred in two patients, intraabdominal abscess developed in one patient, and wound infection developed in another. Appendectomy could not be done in one patient who required another laparotomy 8 weeks later. In the second group, mean hospitalization time was 8.9+/-2.6 days. Two patients (8.6%) failed to respond to conservative management. Elective appendectomy was performed after 2-3 months. Two patients returned with perforated appendicitis 5 months and 12 months later, respectively, because they were not brought back for subsequent appendectomy. It can be concluded that conservative treatment of appendicular mass is safe; we also advocate elective appendectomy because of the probable risk of recurrence.

Magill forceps technique for removal of safety pins in upper esophagus: a preliminary report.

OBJECTIVE: Foreign body ingestion is not an uncommon problem in children. Children can ingest various foreign objects. One of such objects is safety pin, which is not widely reported in the literature. The purpose of this study is to consider the efficacy of Magill forceps for removal of safety pins from upper esophagus. METHODS: A retrospective chart review was conducted for all children admitted to our hospital with safety pin ingestion from 1995 to 2003. In 58 children who had been found to ingest safety pin, the attachment site was gastrointestinal tract. In 12 of the cases, safety pins were located in the upper end of the esophagus. In seven of the children safety pin extraction was achieved by using a Magill forceps with the assistance of a laryngoscope maintaining general anesthesia with mask inhalation. RESULTS: Safety pins were successfully removed with Magill forceps without any complications in seven patients whom they were located in the upper esophagus. Upper esophageal safety pins in the other five patients were extracted with rigid esophagoscopy for they were not seen under direct laryngoscopy. There were no complications. CONCLUSIONS: This is a preliminary report, but we believe that the Magill forceps technique for the removal of safety pin in the upper end of the esophagus is safe and minimally invasive method compared to rigid esophagoscopy.

Electrical cardioversion of atrial fibrillation in a case of dextrocardia.

Although atrial fibrillation is one of the most frequent and widespread cardiac arrhythmias, there is not sufficient data on frequency and electrical cardioversion of this arrhythmia in cases of dextrocardia. The present case report describes a 66-year-old woman with atrial fibrillation and dextrocardia who was admitted to hospital with a complaint of palpitations; no cause of the atrial fibrillation was found. Electrical cardioversion was performed for termination of the arrhythmia. By placing the anterior paddle in the right parasternal area and the lateral paddle in the area where the apex of the left ventricle palpated at the right side of the chest, cardioversion was performed and sinus rhythm was achieved.

TAR syndrome with annular pancreas and anal atresia - a case report.

TAR syndrome is manifested by the presence of hypomegakaryocytic thrombocytopenia and the bilateral absence of radii. An 8-day-old female newborn was referred to our clinic with diagnosis of TAR syndrome and symptoms of intestinal obstruction. On perineal examination she also had anal atresia with rectovestibular fistula. Because of persistent bile-stained drainage from the nasogastric tube, an upper gastrointestinal contrast study was performed and partial duodenal obstruction was detected. At operation, an annular pancreas was encountered and side-to-side duodenoduodenostomy was performed. A small number of gastrointestinal system malformations associated with TAR syndrome has been reported. Our case is unique; the association with annular pancreas and anal atresia with rectovestibular fistula has never been previously reported.

Detection of myocardial injury after internal cardioversion for atrial fibrillation.

BACKGROUND: Cardiac troponin levels do not rise to marked levels after external cardioversion of atrial fibrillation. Subsequent test discharges during implantation of cardioverter defibrillators may cause an elevation of cardiac troponin levels, but are still controversial. OBJECTIVE: To determine whether the biomarkers of cardiac injury increase after internal cardioversion (IC) of atrial fibrillation. METHODS: Forty-four patients with chronic atrial fibrillation were studied (mean age 59 +/-7 years). Electrode catheters were inserted through the femoral vein. One of these was positioned in the lower right atrium. A second defibrillation electrode was placed in the coronary sinus and an additional catheter was positioned in the right ventricular apex in order to obtain satisfactory R wave synchronization and to provide postshock ventricular pacing. The shocks were delivered by external defibrillator. Starting with a test shock of 1 J intensity, the energy was increased in steps (to maximum 15 J) until cardioversion was achieved. At least 1 min was permitted to elapse between unsuccessful defibrillation attempts before the next shock was applied. Blood samples for serum levels of cardiac troponin T, cardiac troponin I, creatine kinase MB and myoglobin were drawn before and 2 h, 4 h, 8 h and 24 h after IC. Each level of biomarker was compared with baseline. RESULTS: In 40 of 44 patients, IC was successful at a mean cardioversion threshold of 7.6+/-3.3 J. Although the serum levels of these biomarkers tended to rise, marked elevation was not detected in any of samples (P>0.05 for each). There was no correlation between the levels of biomarkers and the number and energy of shocks applied. No severe complications were observed. CONCLUSIONS: Following uncomplicated IC of atrial fibrillation, cardiac biomarkers do not rise to marked levels, which indicates that significant myocardial injury does not occur by shocks in the usual dosage.

Clinical importance of the initiation pattern of monomorphic ventricular tachycardia.

We investigated the clinical and electrophysiological features of monomorphic ventricular tachycardia (MVT) with different initiation patterns in patients with implantable cardioverter defibrillator to assess whether there is a relationship between the initiation patterns of sustained MVT and clinical characteristics, and the efficacy of antiarrhythmic and electrical therapy. Fifty-five stored IECGs in twenty-two patients with MVT were evaluated. All MVT episodes were classified as initiating with ventricular premature beats (non-sudden onset MVT) or without ventricular ectopy preceding tachycardia (sudden onset MVT). Non-sudden onset MVT was characterized by shorter tachycardia cycle length (CL) and required higher shock energy for termination. Sudden onset MVT was precipitated by shortening of the sinus CL before tachycardia and was more common with relatively better preserved systolic function.

Long-short sequence may predict immediate recurrence of atrial fibrillation after external cardioversion.

AIM: We thought, that analysis of surface electrocardiograms recorded immediately after electrical external cardioversion (EC) might enlighten the mechanisms responsible for immediate recurrence of atrial fibrillation (AF) and especially to test whether atrial ectopic beats (PAC) with long-short (LS) sequence are related to the recurrence of arrhythmia after cardioversion in patients with chronic AF. METHODS AND RESULTS: One hundred and thirty-seven patients (mean age 57+/-7 years) undergoing EC for chronic AF entered the study. Evaluation of the patients included clinical history, physical examination, ECG, routine laboratory tests, and transthoracic echocardiography. The cardioversion was performed with monophasic waveform shock and immediately after successful EC, 1 min of recording of the ECG lead II was analysed. One hundred and twenty patients (87%) of 137 patients enrolled in the study had had successful EC and 33 (27%) of them experienced immediate recurrence of AF within 1 min (Group I) and 87 patients had no arrhythmia recurrence (Group II). In group I in 24 patients (73%) recurrence of AF was initiated by PAC with LS sequence. In only 12 of 87 (13%) patients who did not experience immediate recurrence of AF (Group II) PACs were recorded. CONCLUSIONS: Atrial ectopic beats (PACs) with LS sequence, being responsible for AF relapse in about 70% of patients, might predict early re-initiation of arrhythmia after EC. Electrocardiograms, recorded immediately after EC, are a potentially feasible approach in establishing the patterns of AF relapse that may be useful in the management of AF recurrence.

Implantable event loop recorder prevents misdiagnosis of underlying arrhythmia in patients with unexplained palpitations--a case report.

The implantable event loop recorder is informative in the establishment of underlying arrhythmia and may aid in treatment of patients with infrequent unexplained palpitations.