The protective effects of hesperidin pretreatment on kidney and remote organs against renal ischemia-reperfusion injury.

OBJECTIVE: As an antioxidant and anti-inflammatory agent, Hesperidin was investigated to prove whether it prevents damage to the kidney and lung tissues of rats undergoing renal ischemia-reperfusion injury. MATERIALS AND METHODS: Four groups of rats were set, including eight subjects each as Group 1 (control), Group 2-RIR (renal ischemia reperfusion), Groups 3 and 4 as pretreatment groups (50 HES, 100 HES). RESULTS: According to our results, Hesperidin pretreatment improved the biochemical and histopathological parameters in kidney and lung tissues of rats with ischemia-reperfusion injury. Besides, a 100 mg/kg dose of Hesperidin was found to be more beneficial to the rats than 50 mg/kg. CONCLUSIONS: The study suggests that Hesperidin is protective against renal and lung tissues of rats that underwent ischemia-reperfusion injury.

Effects of co-administered melatonin, fructose and bisphenol A (BPA) on rat epididymis and sperm characteristics.

Consumption of fructose-rich food and exposure to endocrine disrupting chemicals continue to increase. High fructose consumption is associated with increased incidence of dyslipidemia, hypertension, hyperuricemia and insulin resistance. Bisphenol A (BPA) is an environmental contaminant that exhibits estrogen-like activity; it impairs reproductive organs, sperm production, spermatogenesis and fertility. We investigated the possible ameliorative effects of melatonin on rat epididymis and sperm characteristics following exposure to fructose and BPA. We used 42 adult male Sprague-Dawley rats divided into seven groups. Group 1, control group, was treated with 25 mg/kg sesame oil + 25 mg/kg 0.1% ethanol. Group 2 was treated with 10% aqueous fructose. Group 3 was treated with 25 mg/kg BPA. Group 4 was treated with 10% fructose and 25 mg/kg BPA. Group 5 was treated with 10% fructose and 20 mg/kg melatonin. Group 6 was treated with 25 mg/kg BPA and 20 mg/kg melatonin. Group 7 was treated with 10% fructose, 25 mg/kg BPA and 20 mg/kg melatonin. After 60 days, epididymal tissue was removed and analyzed using histochemistry and immunohistochemistry. Sperm were counted, and sperm motility and viability were investigated. Administration of BPA caused significant damage to both epididymal tissue and sperm quality; melatonin reduced the damage, but did not prevent it completely.

Association between serum total antioxidant status and coronary microvascular function in idiopathic dilated cardiomyopathy.

BACKGROUND: Coronary microvascular impairment may cause myocardial ischemia and systolic dysfunction in patients with idiopathic dilated cardiomyopathy (IDC). PATIENTS AND METHODS: The study included 41 patients with IDC and 33 healthy control subjects. Serum total antioxidant status (TAS), serum interleukin (IL)-6 levels, and tumor necrosis factor (TNF)-α levels were assayed and coronary flow reserve (CFR) was measured in all subjects via echocardiography. RESULTS: High-sensitivity C-reactive protein (hsCRP) levels were significantly higher in patients with IDC than in the control group (3.42 ± 2.14 vs. 1.91± 1.40, p = 0.001). Serum TAS was statistically lower in patients with IDC than in controls (1.23 ± 0.16 vs. 1.77 ± 0.12, p < 0.001). CFR was statistically and significantly lower in the IDC group (2.10 ± 0.39 vs. 3.09 ± 0.49, p < 0.001). The IDC group was subsequently subdivided into two groups according to CFR values, as CFR ≥ 2 and CFR < 2. HsCRP (4.30 ± 2.42 vs. 2.58 ± 1.42, p = 0.01), TNF-α (16.67 ± 8.08 vs. 10.97 ± 1.63, p = 0.01), and IL-6 (7.54 ± 6.16 vs. 3.14 ± 1.10, p = 0.05) values were significantly higher in the CFR < 2 group compared with the higher CFR group. TAS (1.3 ± 0.16 vs. 1.14 ± 0.10, p < 0.001) was significantly lower in the CFR < 2 group. CFR correlated significantly with hsCRP, TAS, red cell distribution width (RDW), IL-6, and TNF-α. CONCLUSION: Plasma proinflammatory cytokine levels are increased in patients with IDC. CFR was impaired as a reflection of impaired coronary microvascular dysfunction in association with increasing plasma proinflammatory cytokine levels and hsCRP levels.

Do cigarette smoke and vitamin E affect the development of endometrial pinopods? An animal study.

OBJECTIVES: To study the effects of cigarette smoke and vitamin E on the development of endometrial pinopods. STUDY DESIGN: Eighteen female and 12 male Swiss albino mice, 12-14 weeks old, with a mean weight of 25g (standard deviation 5g) were used in this study. Female mice were divided into three equal groups. Every day for 10 weeks, mice in Group 1 (control group) received normal saline intraperitoneally; mice in Group 2 were exposed to smoke from 20 cigarettes/day using a smoke machine; and mice in Group 3 were exposed to smoke from 20 cigarettes/day using a smoke machine and also received 50mg/kg vitamin E intraperitoneally. After 10 weeks, vaginal smears were taken from the female mice and they were copulated with the 12 male Swiss albino mice on the day of oestrus. Day 0 was defined as the day on which sperm were detected in the vagina by smear test. Mice were killed at the end of Day 5, which was considered to represent the optimal day for implantation. The uteri were removed and the effects of cigarette smoke and vitamin E on the development of endometrial pinopods were studied using an electron microscope. RESULTS: The endometrial tissue of the control group appeared morphologically normal, with short microvilli, cytoplasm and pinopods in the form of cytoplasm and cell membrane enlargements in patches. In total, 149 pinopods were counted in the control group using a scanning electron microscope (two histologists performed the analysis and were blinded to each other's findings). In the smoke-exposed group, the cytoplasmic structure was degenerated considerably, and fewer pinopods were counted (n=11). The number of pinopods in mice who were exposed to cigarette smoke and vitamin E (n=67) was significantly higher compared with the cigarette-exposed group (p=0.002), but considerably lower compared with the control group (p=0.002). CONCLUSION: Smoke exposure led to a significant decrease in the development of endometrial pinopods. Vitamin E, an antioxidant, partially reversed the adverse effects of cigarette smoke. This suggests that cigarettes may have a negative effect on fertility by decreasing the number of pinopods. However, this negative effect can be reduced using vitamin E. More studies should be conducted to support this finding.

Immunohistochemical and ultrastructural changes in rat fat tissue related to the local hCG injection.

OBJECTIVES: Recently, it has been observed that weight loss is accelerated by human chorionic gonadotropin (hCG) hormone preparation used for hypothalamic dysfunction in obesity treatment in both sexes. hCG is also used for in vitro fertilization and in treatment of hypogonadotropic hypogonadism. Our aim was to observe the ultrastructural changes caused by local injections of hCG made for purpose of weight loss and to present them to inform those receiving such therapy. MATERIALS AND METHODS: In our study, 10 obese female, 10 male obese, 10 non-obese female and 10 non-obese male rats were used. In each group, single dose of subcutaneous hCG injection has been applied to 7 rats for 5 weeks in 5 days of the week, and placebo has been applied to the remaining 3 rats. Following the injection, the tissues were evaluated morphologically, immunohistochemically and ultrastructurally. RESULTS: Leptin immunoreactivity was similar in all groups. When the adipose tissue samples were examined under electron microscope, they were observed to exhibit normal structure with organelles located around the nuclei and nucleoli, and no distinctive features were found among the groups. CONCLUSIONS: Administering hCG in addition to diet had no advantage on weight reduction in rats.

The effect of histamine on kidney by fasting in rats.

BACKGROUND: The aim of this study was to investigate ultrastructural and apoptotic changes occurring in the kidneys in fasting individuals and to examine the effects of histamine treatment at the electron-microscopic and immunohistochemical levels. METHODS: Eighteen adult Wistar male rats were randomly divided into three groups (n=6 for each). Control group (1), fasting group (12 h) (2), and fasting+histamine injection (0.5 mg/kg) (3) group. Expression of caspase-3 and caspase-9 was determined in the tissue sections using immunohistochemical techniques. Quantitative data were obtained using H-SCORE, and statistical evaluations were then performed. The ultrastructure of the kidney tissues was examined using transmission electron microscopy. RESULTS: Weak caspase-3 and caspase-9 expression was observed in the renal tubules and glomeruli in the control group, while immunoreactivity was more intense in the fasting group (p<0.05). In the fasting+histamine group, caspase-3 and caspase-9 immunostaining was significantly positive in both renal tubules and glomeruli (p<0.05). At electron microscopic evaluation, degenerative changes were seen in the glomeruli of the fasting group, as well as partial vacuolization and disruption at the basal foldings in the tubular epithelial cells. In the fasting+histamine group, in addition to significant dilatation of all glomerular capillaries, there were degenerative changes in all tubular and canalicular epithelial cells in the proximal tubules. CONCLUSIONS: Fasting, an important metabolic stress factor, accompanied by histamine treatment may cause significant disruptions in the kidneys, particularly in the glomerular capillaries and proximal and distal tubules (Tab. 1, Fig. 2, Ref. 34).

Effect of melatonin and n-acetylcysteine on hepatic injury in rat induced by methanol intoxication: a comparative study.

BACKGROUND: Methanol intoxication leads liver injury; in contrast melatonin and n-acetyl cysteine (NAC) are known to have protective effects on liver. AIM: We aimed to investigate the ultrastructural effects of melatonin and NAC on livers of methanol intoxicated rats and compare potential protective effects of melatonin and NAC on their liver ultrastructure. MATERIALS AND METHODS: Fifty-six adult male Wistar rats were carried out and were randomized to eight groups that have seven rats each: Control groups (C 6h, C 24h), treated with intragastric (i.g.) 1.0 ml saline; Methanol groups (M 6h, M 24h), treated with a dose of 3 g/kg i.g. methanol; Melatonin plus methanol groups (MEL+M 6h, MEL+M 24h), treated with dose of 10 mg/kg i.p melatonin immediately, following with a dose of 3 g/kg i.g. methanol; NAC plus methanol groups (NAC+M 6h, NAC+M 24h), treated with dose of 150 mg/kg, following with a dose of 3 g/kg i.g. methanol. 24 h group rats were given the same dose of melatonin and NAC 12 h after intoxication. Electron microscopy was used to evaluate histological changes in liver tissue at both 6th and 24th hour. RESULTS: Histopathological damage was found to be higher in methanol-induced intoxicated rats compared with the controls. Extensive tubules of smooth endoplasmic reticulum, increased mitochondria, increased primary lysosomes and some marked openings of bile canaliculus were distinguished. Melatonin administration prevents liver injury especially in early hours and although not as effective as melatonin, NAC also prevents liver injury. CONCLUSIONS: Melatonin is much more efficient than NAC, as well as significantly greater hepatoprotective effect against the liver injury secondary to the methanol intoxication.

Multiple gene polymorphisms predisposing to the prothrombotic state in an adolescent with acute myocardial infarction.

Acute myocardial infarction with ST-segment elevation (STEMI) is rare in adolescents and its pathogenesis is unclear. Growing evidence shows an association between the prothrombotic state and acute STEMI. Prothrombotic genetic factors may be involved in the pathogenesis of STEMI. We present a case of an adolescent with acute STEMI who had multiple prothrombotic gene polymorphisms: in the beta fibrinogen, methylenetetrahydrofolate reductase and cholesteryl ester transfer protein genes, as well as genotypes in plasminogen activator inhibitor-1 and human platelet antigen type-1. He had normal coronary arteries with catheterinduced spasm and was treated with a calcium antagonist and aspirin.

Mucinous cystadenomas in liver: management and origin.

BACKGROUND: Mucinous cystadenomas of the liver are rare cystic neoplasms. The aim of this study was to assess management of a consecutive series of patients who underwent laparotomy for a suspected cystadenoma or cystadenocarcinoma. Secondly, the origin of ovarian stroma (OS) in mucinous liver cystadenomas was examined during early embryonic development. PATIENTS AND METHODS: Patients diagnosed with mucinous liver cystadenomas or cystadenocarcinoma between 1994 and 2009 were included. Pathology specimens of patients who had undergone resection were reviewed for OS. Furthermore, in human embryos, morphology of the peritoneal epithelium and the position of the gonads in relation to the embryonic liver, pancreas and spleen were examined. RESULTS: 15 surgically treated patients (13 female, 2 male) with hepatic tumors were eventually diagnosed with mucinous liver cystadenomas (12) or cystadenocarcinomas (3). OS was present in all female patients with mucinous cystadenoma or cystadenocarcinoma. The 2 male patients were rediagnosed as intraductal papillary mucinous neoplasm (IPMN) or cystadenocarcinoma with features of IPMN. In human embryos, preceding their 'descent', the gonads are situated directly under the diaphragm, dorsal to the liver, the tail of the pancreas and the spleen, but separated from these organs by the peritoneal cavity. In contrast to the peritoneal epithelium elsewhere, the cells covering the gonads show an activated morphology. CONCLUSION: For the diagnosis of mucinous liver cystadenoma, the presence of OS is prerequisite. This may be explained by the common origin of cystadenoma and OS in epithelial cells that cover the embryonic gonads in early fetal life.

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.

Pregnancy and Crimean-Congo haemorrhagic fever.

Crimean-Congo Hemorrhagic fever (CCHF) is a potentially fatal viral infection with reported case fatality rates of 5-30%. Humans become infected through tick bites, by contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. In this first report in the literature, we present the characteristics of three pregnant women with CCHF infection and the outcome of their babies. Transmission of the CCHF infection could be either intrauterine or perinatal. In endemic regions, CCHF infection should be considered in the differential diagnosis of HELLP syndrome (haemolytic anaemia, elevated liver enzymes, low platelet count), and obstetricians should be familiar with the characteristics of CCHF infection. In the aetiology of necrotising enterocolitis, CCHF should be considered.

Neuroprotective effect of melatonin on experimental peripheral nerve injury: an electron microscopic and biochemical study.

BACKGROUND AND STUDY AIMS: Melatonin is an important antioxidant agent with a protective role in the prevention of oxidative stress. We designed an experimental study which focused on the potential neuroprotective effect of melatonin on peripheral nerve injury. MATERIALS AND METHODS: Sciatic nerve injury was induced in the mid thigh region of 30 male Wistar rats by clip compression. Melantonin was injected intraperitoneally in 15 of the 30 rats. Electron microscope and biochemical studies were performed to assess the potential beneficial effect of melatonin on peripheral nerve regeneration. Changes to cellular organelles, myelin lamellae and axons were studied. RESULTS: There was a significant difference between the melatonin and nerve injury groups. Rats treated with melatonin demonstrated significant structural protection of the myelin lamellae compared to the nerve injury group. Axonal shrinkage and myelin changes were not prominent histopathologically in melatonin-treated group. Biochemical analysis confirmed the neuroprotective effects of melatonin with significantly lower lipid peroxidation and myeloperoxidase activity measurements in the melatonin-treated group compared to the neural injury group. The results indicate that melatonin can improve neural healing. CONCLUSION: With its neuroprotective effect, as demonstrated in this experimental peripheral nerve injury, melatonin might be used successfully in clinical practice. Further studies on the correct dosage and possible side effects are necessary.

The effect of pretreatment with renin-angiotensin-aldosterone system blockers on cardioversion success and acute recurrence of atrial fibrillation.

BACKGROUND: Renin-angiotensin-aldosterone system (RAS) may be activated during atrial fibrillation (AF). It is unclear whether RAS inhibition may facilitate cardioversion from AF and may prevent acute recurrence of AF (ARAF). We thus investigated the effect of pretreatment with RAS blockers on cardioversion success and ARAF in patients with AF scheduled for elective cardioversion. METHODS: This observational study included 356 patients with AF undergoing elective pharmacological or electrical cardioversion. Of these patients, 135 were not included based on exclusion criteria and the remaining 221 patients were divided into RAS group (n = 116, 69 male) or non-RAS group (n = 105, 58 male) based on precardioversion use of any RAS blocker. RESULTS: Hypertension, coronary heart disease and heart failure were more frequent in the RAS group. Cardioversion from AF was more successful in the RAS group than in the non-RAS group (%92 vs. %82, p = 0.026). The rate of ARAF was lower in RAS group compared with that in non-RAS group (17% vs. 31%, p = 0.026). In multivariate analysis, pretreatment with RAS blockers in addition to shock number and enlarged left atrium, independently predicted ARAF (OR: 0.33, 95% CI: 0.15-0.75, p = 0.008). Independent predictors of cardioversion success were shock number and left atrial dilatation, but not use of RAS blocker. CONCLUSION: Precardioversion use of RAS blockers may reduce ARAF following successful cardioversion of AF, but did not improve electrical cardioversion.

Effect of melatonin and time of administration on irradiation-induced damage to rat testes.

The effect of ionizing irradiation on testes and the protective effects of melatonin were investigated by immunohistochemical and electron microscopic methods. Eighty-two adult male Wistar rats were divided into 10 groups. The rats in the irradiated groups were exposed to a sublethal irradiation dose of 8 Gy, either to the total body or abdominopelvic region using a 60Co source at a focus of 80 cm away from the skin in the morning or evening together with vehicle (20% ethanol) or melatonin administered 24 h before (10 mg/kg), immediately before (20 mg/kg) and 24 h after irradiation (10 mg/kg), all ip. Caspace-3 immunoreactivity was increased in the irradiated group compared to control (P < 0.05). Melatonin-treated groups showed less apoptosis as indicated by a considerable decrease in caspace-3 immunoreactivity (P < 0.05). Electron microscopic examination showed that all spermatogenic cells, especially primary spermatocytes, displayed prominent degeneration in the groups submitted to total body and abdominopelvic irradiation. However, melatonin administration considerably inhibited these degenerative changes, especially in rats who received abdominopelvic irradiation. Total body and abdominopelvic irradiation induced identical apoptosis and testicular damage. Chronobiological assessment revealed that biologic rhythm does not alter the inductive effect of irradiation. These data indicate that melatonin protects against total body and abdominopelvic irradiation. Melatonin was more effective in the evening abdominopelvic irradiation and melatonin-treated group than in the total body irradiation and melatonin-treated group.

Effect of melatonin and time of administration on irradiation-induced damage to rat testes

The effect of ionizing irradiation on testes and the protective effects of melatonin were investigated by immunohistochemical and electron microscopic methods. Eighty-two adult male Wistar rats were divided into 10 groups. The rats in the irradiated groups were exposed to a sublethal irradiation dose of 8 Gy, either to the total body or abdominopelvic region using a 60Co source at a focus of 80 cm away from the skin in the morning or evening together with vehicle (20% ethanol) or melatonin administered 24 h before (10 mg/kg), immediately before (20 mg/kg) and 24 h after irradiation (10 mg/kg), all ip. Caspace-3 immunoreactivity was increased in the irradiated group compared to control (P < 0.05). Melatonin-treated groups showed less apoptosis as indicated by a considerable decrease in caspace-3 immunoreactivity (P < 0.05). Electron microscopic examination showed that all spermatogenic cells, especially primary spermatocytes, displayed prominent degeneration in the groups submitted to total body and abdominopelvic irradiation. However, melatonin administration considerably inhibited these degenerative changes, especially in rats who received abdominopelvic irradiation. Total body and abdominopelvic irradiation induced identical apoptosis and testicular damage. Chronobiological assessment revealed that biologic rhythm does not alter the inductive effect of irradiation. These data indicate that melatonin protects against total body and abdominopelvic irradiation. Melatonin was more effective in the evening abdominopelvic irradiation and melatonin-treated group than in the total body irradiation and melatonin-treated group.

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.

Dose-dependent immunohistochemical changes in rat cornea and retina after oral methylphenidate administration.

Methylphenidate hydrochloride (MPH), more commonly known as Ritalin, is a piperidine derivative and is the drug most often used to treat attention deficit/hyperactivity disorder, one of the most common behavioural disorders of children and young adults. The aim of this study was to investigate dose-dependent immunohistochemical Dopamine 2 receptor (D2) expression and apoptosis in the rat cornea and cornea. In this study, 27 female pre-pubertal Wistar albino rats, divided into three different dose groups (5, 10 and 20 mg/kg) and their control groups, were used. They were treated orally with methylphenidate dissolved in saline solution for 5 days per week during 3 months. At the end of the third month, after perfusion fixation, eye tissue was removed. Paraffin sections were collected for immunohistochemical and terminal deoxynucleotidyl-transferase-mediated dUTP-biotin nick end labelling assay studies. In our study, we observed that the cornea D2 receptor reactivity showed a dose-related increase after MPH treatment, especially in basal cells of the epithelium and a dose-dependent decrease in the retinal ganglion cell which was statistically meaningful. Analysis of the cornea thickness results showed no meaningful difference between groups. Apoptotic cell number showed a meaningful increase in the high dose treated group compared to the other groups of the study. The data suggest that Ritalin has degenerative effect on the important functional part of the eye, such as cornea and retina and its activating dopaminergic mechanism via similar neuronal paths, functionally and structurally, to induce morphological changes. As a result, we believe that this morphological changes negatively effecting functional organization of the affected cornea and retina.

Adhesive strength of fibrinogen-coated collagen patch or liquid fibrin sealant in an experimental liver resection model in pigs.

AIM: The aim of this study was to assess the efficacy of sealing bile ducts by determining the adhesive strength of 2 different sealing agents, i.e. a fibrinogen-coated collagen patch (TachoSil) and a liquid fibrin sealant (Tissucol), in an experimental partial liver resection model in pigs. METHODS: Pigs underwent laparotomy and partial resection of the left medial liver lobe. A 16-Ch silicon catheter was introduced into the common bile duct. Pigs were randomly assigned to 2 groups (n = 4 each). In group 1, TachoSil was applied on the resection surface, and in group 2 Tissucol was applied. After 2 h, pressure in the intrabiliary system was gradually increased. RESULTS: No significant differences in the hemostasis times between TachoSil and Tissucol were observed (210.0 +/- 12.9 vs. 208.8 +/- 14.2 s; p = 0.9506). The pressure that could be resisted with Tissucol was significantly lower compared to TachoSil (77.0 +/- 8.6 vs. 131.8 +/- 16.3 mm Hg; p = 0.0405). CONCLUSIONS: The application of TachoSil on the resection surface is equally effective in obtaining hemostasis and in sealing of biliary ducts as Tissucol. The adhesive strength of TachoSil on the resection surface, however, is superior to Tissucol.

Effects of intravenous N-acetylcysteine on periprocedural myocardial injury after on-pump coronary artery by-pass grafting.

AIM: Myocardial ischemia/reperfusion injury in patients undergoing coronary artery by-pass grafting (CABG) involves the reperfusion-induced conversion of reversible injured myocardial and endothelial cells. N-acetylcysteine (NAC) has a potential being the minimization of the impact of reperfusion injury. The aim of this study was to evaluate the effects of intravenous NAC on periprocedural myocardial injury after CABG. METHODS: The population of this prospective-randomized, double blind, placebo controlled study consisted of 40 patients undergoing on-pump CABG. All the patients were treated with standard medical therapy and eligible patients were randomized to NAC group (N.=19; intravenous infusion for 1 hour before the procedure at a dose of 50 mg/kg, followed by intravenous infusion for 48 hours after the operation at a dose of 50 mg/kg/day) and placebo (saline) group (N.=21). The study drug and placebo infusions were set to infuse at the same rate. RESULTS: Demographic and procedural variables were similar in the both groups (All P>0.05). Creatine kinase MB isoform (CK-MB) mass levels did not significantly differ between the groups at both preoperative and postoperative periods. Similarly, cTnT levels were similar in the groups at all periods. Eight patients in the NAC group and 7 in the placebo group had increased CK-MB >3 times normal value. However, only 3 patients in the NAC group experienced CK-MB>5 times normal value. CONCLUSION: Results of this study indicated that periprocedural use of NAC as intravenously did not attenuate myocardial damage after on-pump CABG surgery.

Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures.

BACKGROUND: Immunoglobulin (Ig) G(4)-related lymphoplasmacytic sclerosing pancreatitis has been described in the context of autoimmune pancreatitis mimicking distal cholangiocarcinoma. The aim of this study was to assess the occurrence of this entity in benign bile duct strictures in patients resected for presumed hilar cholangiocarcinoma. METHODS: Of 185 patients who had undergone resection of proximal bile ducts on suspicion of hilar cholangiocarcinoma between January 1984 and June 2005, 32 (17.3 per cent) had a benign bile duct stricture on histopathological examination. After re-evaluation, further immunohistochemical analysis was performed on specimens from patients with features of autoimmune-like disease. RESULTS: The periductal stroma in 15 patients showed features of autoimmune-like disease (diffuse, moderate to severe lymphoplasmacytic infiltration with marked fibrosis). Abundant IgG(4)-positive plasma cell infiltration around the bile duct lesions was seen in two of these. Although not significant, patients with features of autoimmune-like disease on histological changes showed a higher incidence of recurrent biliary complications than those without (P = 0.250). CONCLUSION: Features of autoimmune-like bile duct disease were seen in almost half (15 of 32) of patients with benign hilar strictures resected for presumed hilar cholangiocarcinoma. Frank IgG(4)-related sclerosing disease was found in only two of the 15 patients with autoimmune-like bile duct disease.