An epidemiological study to evaluate the use of vitamin K antagonists and new oral anticoagulants among non-valvular atrial fibrillation patients in Turkey- AFTER-2 study design.

OBJECTIVES: Atrial fibrillation (AF) is one of the most common causes of preventable ischemic stroke and is related to increased cardiovascular morbidity and mortality. There is a lack of data in Turkey on the use of new oral anticoagulants (NOACs), and time in therapeutic INR range (TTR) in vitamin K antagonist users and AF management modality. In this multi-center trial, we aimed to analyze, follow and evaluate the epidemiological data in non-valvular AF patients. STUDY DESIGN: Four thousand one hundred consecutive adult patients from 42 centers with at least one AF attack identified on electrocardiography will be included in the study. Patients with rheumatic mitral valve stenosis and prosthetic valve disease will be excluded from the study. At the end of one year, the patients will be evaluated in terms of major cardiac end points (death, transient ischemic attack, stroke, systemic thromboembolism, major bleeding and hospitalization). RESULTS: First results are expected in June 2015. Data about major cardiovascular end-points will be available in January 2016. CONCLUSION: The rates and kind of oral anticoagulant use, TTR in vitamin K antagonist users and main management modality applied in non-valvular AF patients will be determined by AFTER-2 study. In addition, the rate of major adverse events (MACEs) and the independent predictors of these MACEs will be detected (AFTER-2 Study ClinicalTrials.gov number, NCT02354456.).

Isolated persistent left superior vena cava with absent right superior vena cava in two cases.

Persistent left superior vena cava (LSVC) with absent right superior vena cava (RSVC) is a very rare congenital anomaly. Its isolated existence is even rarer. Persistent LSVC is usually asymptomatic and discovered incidentally. We present persistent LSVC with absent RSVC in two asymptomatic patients, namely, a 52-year-old woman and 65-year-old man. The diagnosis was confirmed by cardiac computed tomography in both cases.

Giant schwannoma of the cauda equina: case report and review of the literature.

Schwannomas arise from the neoplastic transformation of nerve sheath cells and are considered benign tumors. We report here on a 43-year-old patient seen for radiculopathic pain and loss of sphincter control. Magnetic resonance imaging of the spine revealed a giant intraspinal mass extending from L1 to L5. The patient underwent laminectomy for excision of the solitary mass and histological findings were consistent with schwannoma. Giant schwannoma of the cauda equina is a rare tumor, with variable manifestations.

The effect of blunt abdominal trauma on appendix vermiformis.

OBJECTIVES: Trauma and appendicitis are the most common conditions of childhood for which surgical consultation is sought in emergency departments. Occasionally, appendicitis and trauma exist together, which causes an interesting debate whether trauma has led to appendicitis. We aimed to evaluate our patients with traumatic appendicitis and to discuss their properties in the light of the literature. METHODS: We retrospectively reviewed the charts of children of blunt abdominal trauma accompanied by appendicitis. RESULTS: Of 29 cases of blunt abdominal trauma that had required surgical exploration, five were found to have gross findings of acute appendicitis and underwent appendicectomy. Appendicitis was confirmed histopathologically. CONCLUSION: It should be kept in mind that children managed for severe blunt abdominal trauma may develop appendicitis. If clinical outlook suggests appendicitis in cases conservatively managed for blunt abdominal trauma, physical examinations, abdominal ultrasonography and/or abdominal computed tomography should be repeated for diagnosis of traumatic appendicitis. This approach will help to protect the patients against the complications of appendicitis that are likely to develop.

Mucinous cystadenoma: a rare abdominal mass in childhood.

Ovarian masses are uncommon in children. Only 10 - 17 % of them are epithelial tumours. Mucinous cystadenoma in children is a benign cystic ovarian neoplasm, and it is met very rarely in the medical literature. We present a 13-year-old girl with a giant ovarian mucinous cystadenoma.

Changes in urethral connective tissue after estrogen replacement therapy in ovariectomized rats.

OBJECTIVE: Genuine stress urinary incontinence is a common problem after the middle age. Various treatment modalities have been tried as a treatment for this entity and estrogens are one of the most common alternatives. Their effects on the urethral mucosa have been described in many studies, while the impact on the urethral connective tissue has been evaluated only in a few reports. In this study, we aimed to investigate the effect of estrogen on urethral connective tissue in ovariectomized rats. MATERIAL AND METHODS: Thirty-six Wistar rats (4 months old, 250-300 g weight) were included in the study. They were organized as group 1 (ovariectomized, n = 10), group 2 (ovariectomized + late estrogen treatment, n = 10), group 3 (ovariectomized + early estrogen treatment, n = 10) and group 4 (sham operated, n = 6). Rats in group 1 were killed 6 weeks after the ovariectomy. Group 2 was ovariectomized 6 weeks before treatment and then received estradiol for 6 weeks. Group 3 was treated with estradiol for 6 weeks immediately after the ovariectomy. After killing the rats, urethral tissues were removed. Quantitative analysis of collagen fiber content was done by computerized image analyzer system in specimens stained with Masson's trichrome technique. RESULTS: Percentages of collagen fiber content (mean +/- standard error of mean) were 58.4 +/- 5.9% in group 1; 53.3 +/- 4.8% in group 2; 46.3 +/- 3.4% in group 3 and 40.2 +/- 3.2% in group 4. There was not any significant difference among the groups (p > 0.05). CONCLUSIONS: Our results suggest that early and late estrogen replacements do not seem to have a discriminating effect on the urethral connective tissue. Further studies are needed to assess the preventive effect of estrogen on urethra.

The effect of estrogen-replacement therapy on clitoral-cavernosal tissue in oophorectomized rats: a histo-quantitative study by image analyzer.

Sexual dysfunction is an important problem for aging females. However, little attention has been paid to female sexual dysfunction. The clitoris is an important organ for physiological sexual function in females. There is a close relationship between the presence of sexual complaints and levels of estrogen. Using the rat as an experimental model, we evaluated the effect of estrogen-replacement therapy and its timing on clitoral-cavernosal collogen fiber content after oophorectomy. Four-month-old female Wistar rats (n = 36) weighing 230-250 g were used. They were categorized into four groups: oophorectomized (Group 1: n = 10); oophorectomized delayed estrogen replacement (group 2: n = 10); oophorectomized + immediate estrogen replacement (group 3: n = 10); and sham operated (group 4: n = 6). The estrogen replacement used was 17-beta-estradiol. All rats were euthanized at the same age. The specimens were stained with Masson's trichome technique, and computerized image analysis was used to quantify the collagen-fiber content of clitoral-cavernous tissue. The clitoral collagen-fiber percentages in the different groups were as follows: group 1: 64.17 +/- 5.01%; group 2: 62.57 +/- 5.37%; group 3: 56.33 +/- 3.85%; group 4: 51.48 +/- 6.37%, respectively. Although there was a tendency in the untreated group for a higher collagen-fiber content, no statistically significant difference was found among groups (P > 0.05). Although the results of this study were not statistically significant, estrogen did appear to decrease clitoral-cavernosal collagen-fiber content. These findings may be important in the pathophysiology of postmenopausal female sexual dysfunction.

Effects of trimetazidine on oxidant/antioxidant status in trinitrobenzenesulfonic acid-induced chronic colitis.

Trimetazidine (TMZ), an anti-ischemic agent with proposed antioxidant properties, was used in a chronic colitis model in order to evaluate its effectiveness as a therapeutic agent in chronic colitis. Treatment of male Swiss Albino rats with ethanol (50%) and trinitrobenzenesulfonic acid (TNBS) (30 mg/kg) produced colitis as evidenced by histopathologic damage and inflammatory alterations, lipid peroxidation [increased malondialdehyde (MDA) levels], and enhanced neutrophil infiltration [increased myeloperoxidase (MPO) activity] without marked change in glutathione status. Administration of TMZ (5 mg/kg) to TNBS-treated rats failed to affect the TNBS-induced changes in histopathology and MPO activities. Unexpectedly, intrarectal (i.r.) administration of TMZ significantly elevated colonic MDA levels to a greater extent than TNBS alone. Intraperitoneal (i.p.) TMZ treatment seemed to increase total glutathione (tGSH), GSH, and GSH/GSSG values. In conclusion, our results demonstrated that (a) i.r. administration of ethanol and TNBS is an effective way of inducing a chronic colitis model, (b) inflammation and lipid peroxidation augment tissue damage in the chronic colitis model, (c) i.p. TMZ treatment significantly inhibits MDA production in the chronic colitis model, (d) TMZ treatment is more effective via the i.p. compared to i.r. route, and (e) TMZ seems to show its antioxidant effect via preserving the tissue's GSH/GSSG ratios.

The effect of fibrin adhesive (Tisseel) on interbody allograft fusion: an experimental study with cats.

Fibrin glue has been promoted for use in many neuro- and orthopaedic surgical procedures. At present, some surgeons make routine use of the adhesive in augmentation of bone grafting operations. However, there is controversy about its effectiveness in augmenting bone graft healing. This study investigated the use of two-component fibrin sealant (Tisseel, Immuno AG, Vienna, Austria) as an adjunct to graft material in fusion surgery. Twenty-four cats were fused with corticocancellous bone graft, which was taken from a separate cat, across the disc space in the anterior cervical region. In the present experiment, the authors carried out cervical interbody fusions in 24 cats, divided into two groups, to test the usefulness of fibrin glue in fixation of allograft fusions. At surgery, a piece of corticocancellous allograft was placed into the intervertebral disc space at the C5-C6 region, either untreated or locally treated with fibrin adhesive (Tisseel). Fusion mass formation was examined 6 months after the experimental fusion procedure by radiography and computed tomography (CT) scanning and the new bone formed was evaluated histologically. The authors observed that the allograft fusion mass area is more voluminous in the untreated animals in Group I than in the ones augmented with Tisseel, as illustrated by CT measurement (section area and bone density) (p = 0.038). Accordingly, histopathological studies demonstrated a reduced vascularization of the graft as well as diminished new bone formation in the animals treated with Tisseel in Group II. The present investigation demonstrates that local fibrin sealing significantly retards the osteogenic fusion in a model of corticocancellous bone grafting in cats. In view of our results it seems that fibrin sealant is not suitable for fixation of bone fragments in anterior cervical fusion.

Benign fibrous histiocytoma of the nasal septum.

Among the non-epithelial tumours of the nasal cavity, paranasal sinuses and nasopharynx, fibrous histiocytoma is rarely encountered. A 45 year-old male patient complaining about nasal obstruction and nasal swelling was seen in the hospital ENT department. On examination, there was a mass located on the right anterior part of the nasal septum, about 2 x 1 x 1 cm in size. The pathologic diagnosis was benign fibrous histiocytoma. In this article we discuss the clinical, radiological, histopathological characteristics of fibrous histiocytoma and its differential diagnosis.