The risk of recurrent IgA nephropathy in a steroid-free protocol and other modifying immunosuppression.

Recurrent glomerulonephritis is an important cause of kidney allograft failure. The effect of immunosuppression on recurrent IgA nephropathy (IgAN) is unclear. We analyzed the impact of steroids and other immunosuppression on the risk of recurrent IgAN post-kidney transplantation. Between June 1989 and November 2008, 3311 kidney transplants were performed at our center. IgAN was the primary disease in 124 patients; of these, 75 (60.5%) patients received steroid-based immunosuppression (15 undergoing late steroid withdrawal), and 49 (39.5%) were maintained on steroid-free immunosuppression. Recurrent IgAN was diagnosed in 27 of 124 (22%) patients in clinically indicated kidney allograft biopsies over a median follow-up of 6.86 ± 5.4 yr. On cox proportional hazards model multivariate analysis, the hazard risk (HR) of IgAN recurrence was significantly higher in patients managed with steroid-free (HR 8.59: 3.03, 24.38, p < 0.001) and sirolimus-based (HR = 3.00:1.16, 7.75, p = 0.024) immunosuppression without antilymphocyte globulin induction (HR = 4.5: 1.77, 11.73, p = 0.002). Mycophenolate use was associated with a lower risk (HR = 0.42: 0.19, 0.95, p = 0.036), whereas cyclosporine did not have a significant impact on the risk of IgAN recurrence (p = 0.61). These results warrant future prospective studies regarding the role of steroids and other immunosuppression drugs in reducing recurrence of IgAN and other glomerulonephritis post-transplant.

Management of patients with recurrent hepatocellular carcinoma following living donor liver transplantation: a single center experience.

OBJECTIVE: Tumor recurrence is the most important predictive factor for the survival of patients following liver transplantation for hepatocellular carcinoma (HCC). The management of recurrent HCC remains controversial. In this study, we presented the clinical outcomes of patients with recurrent HCC following living donor liver transplantation. MATERIAL AND METHODS: Of the 109 patients who underwent liver transplantation due to hepatocellular carcinoma, sixteen (14.7%) developed tumor recurrence and were included in the study. We analyzed the management of patients with recurrent tumors and their outcomes. RESULTS: The mean age of patients included in the study was 55.2 ± 7.82 (28-65) years, and 13 patients (81%) were male. The mean follow up and time to recurrence were 25.8 ± 19.2 (5-78) months and 11 ± 9.4 (4-26) months, respectively. Four patients developed recurrence in the liver graft and 12 (75%) developed recurrence in extrahepatic organs. Of these patients, seven had surgical treatment, seven received chemotherapy, and two did not receive any treatment. All four surviving patients received surgical treatment. CONCLUSION: Recurrence of HCC following liver transplantation generally occurs in the first two years and in extrahepatic organs. The most effective treatment for patients with single and isolated recurrent tumors is surgery. However, the long term survival differed according to the type of recurrence, depending on which organs recurrence occurred in and whether recurrence was in single or multiple locations. Therefore, the treatment strategy should be individualized for longer survival. KEYWORDS: The management of HCC, Recurrent HCC, Living donor liver transplantation.

A novel mechanism of anti-T-lymphocyte globulin mediated by fractalkine in renal ischemia-reperfusion injury in rats.

BACKGROUND: Ischemia-reperfusion injury (IRI) is among the main challenges in kidney transplantation. It causes delayed graft function and graft loss in long-term follow-up studies. Anti-T lymphocyte globulin (ATG), a common induction immunosuppressive, has been used in kidney transplantation to prevent rejection. Fractalkine (FKN) is among the main chemokines involved in IRI. This study was designed to identify the relationship between ATG and FKN after warm ischemia in rat kidneys. METHODS: Rats were divided into three groups: Control, IRI+normal saline(NS) and IRI+ATG. After IRI was initiated, rats received a dose of ATG or NS during surgery as well as two more doses at 24 and 48 hours after surgery. All rats were humanely killed at 72 hours. RESULTS: The concentration of FKN as well as dendritic cells (DC) and macrophages were lower in both peripheral blood and the injured kidney among ATG-treated versus control rats. Additionally cell necrosis, cytoplasmic vacuolization, cast formation, and tubular dilatation were improved among ATG-treated rats. Serum creatinine levels were lower in rats that received ATG. CONCLUSION: ATG depleted the concentration of FKN, which inhibits migrations of DCs and macrophages into the kidney, and reduces IRI-related pathology.

Facilitation of facial prosthesis placement with tattoo markers: a clinical report.

Proper repeatable alignment of an adhesive-retained auricular prosthesis may be a difficult challenge. Usually anatomical undercuts, tissue remnants, and scars are used as references to secure a facial prosthesis and provide retention and stability. Repeated application may be hindered when none of these references is present. This clinical report describes a method of using tattoo marks as references to repeatably align the facial prosthesis of a patient with a skin flap reconstruction.

Improved edge strength in a facial prosthesis by incorporation of tulle: a clinical report.

This clinical report describes the use of tulle for increasing the tear resistance of a facial prosthesis. By incorporating tulle, a prosthesis' margins may be more stable, more resistant to tearing, and less likely to deform while adhesive, cosmetics, and cleaning agents are applied and removed.

Treatment of aggressive periodontitis by osseointegrated dental implants. A case report.

BACKGROUND: Generalized aggressive periodontitis is described as a clinical entity affecting both deciduous and permanent dentition with extensive alveolar bone loss, mobility, and exfoliation of all or many teeth. Controversy exists on dental implant use to restore missing dentition in younger patients. METHODS: This case report presents a patient diagnosed with aggressive periodontitis who has lost all but 4 of her teeth. Her personal and functional desires led us to include implant therapy in her treatment plan. The hematological data are presented with an analysis of the immunological profile. RESULTS: Dental implants were placed, and following 3 months of osseointegration, an implant-supported prosthesis was completed. The patient was followed up for 36 months. CONCLUSIONS: This case report presents an alternative treatment for rehabilitating dentition in a young patient treated for aggressive periodontitis. Similar case studies may help eliminate some of the controversy that exists regarding the use of dental implants in aggressive periodontitis patients.

Suicides by jumping from Bosphorus Bridge in Istanbul.

Suicide methods may differ widely. One of these methods is jumping from a height. The people who choose a high bridge for jumping may be considered as a special group. In this study, we evaluated the demographic data, mortality rates and postmortem findings of individuals who jumped from the 64m high Bosphorus Bridge of Istanbul. For this purpose, we reviewed registration forms of two police centers on both sides of the bridge, court archives, and postmortem examination reports of the deceased for a period of 10 years between 1986 and 1995. During this period, 65 people had jumped from the Bosphorus Bridge of Istanbul. The mortality rate was 96.9%, as two individuals survived their suicide attempt. The male/female ratio for attempts was 15:1 (61 males, four females) in this study in contrast to the male/female ratio of 1.6:1 for all suicidal cases in Turkey. The average age of subjects was 29.2 (median: 26, range: 16-54). The frequency was highest in the 15-24 age group with a rate of 38.4%. People who jumped from the bridge were younger than other reported cases of suicide. For all methods of suicide in Turkey 53.5% of subjects are under the age of 35. However, in our study, 75.8% of individuals who committed suicide from the Bosphorus Bridge were under the age of 35. Unmarried people accounted for 56% of the individuals whose marital status was known. 20.8% of the individuals whose employment status was known were unemployed. 59% of the cases whose education was known were high school graduates. The highest rate of suicide by jumping was in 1990, and occurred during the fall and winter months, primarily between the hours of 24.00 and 06.00. The Bosphorus Bridge is forbidden to pedestrians. Arrival method to the bridge was by a taxicab in 53.3% of the cases. 91% of the recovered bodies had been discovered during the first 2 days of jumping. Positions on impact with the water were estimated according to external and internal injuries. Among the cases in which the position of impact could be assessed by external and internal injury patterns, combined lateral and horizontal positions were most common.

The value of the size of foramen magnum in sex determination.

Sex determination in unidentified skeletons is not always easily and correctly performed by a non-specialist without formal training in forensic anthropology. In explosions, warfare and other mass disasters like aircraft crashes, identification may be extremely complicated because of skeletal fragmentation. The aim of the present study was to determine whether the area of the foramen magnum was a useful criterion for the sex determination in fragmented skulls. In a total of 219 skeletons (170 males and 39 females) the longest and the shortest diameter of the foramen magnum was measured; the area within was determined using the mean of the diameters as the radius for calculation. The mean of foramen magnum area was significantly different (909.91 +/- 126.02 mm2 in males, 819.01 +/- 117.24 mm2 in females homogeneous variance, Student's t-test: 4.11 P< 0.001). However, the correlation coefficient between the areas of foramen magnum and sex was 0.27. The results confirmed that the mean foramen magnum area in females is lower than in males. However, the area of foramen magnum is not a very useful indicator for sex identification and can be used only under some circumstances as a supportive finding.

Fusion of maxillary and mandibular alveolar process together with a median mandibular cleft: a rare congenital anomaly.

Congenital fusion of the maxillary alveolar process and mandible is a very rare entity. A one day old male newborn was referred to our clinic with a diagnosis of a 'absence of oral cavity'. Physical examination revealed that there was no mouth opening bilaterally in the posterior region due to maxillary and mandibular bone fusion; and in the front there was only 1 mm of mouth opening. Examination of the intraoral space could not be achieved. No other congenital anomaly was detected on general examination. The infant, who was fed via a nasogastric tube for 1 month, was operated on. An intra-oral device which separated maxillary and mandibular alveolar arches from each other was designed and used for 8 weeks to avoid recurrence of the fusion. An adequate mouth opening was obtained and the infant could be fed orally.

Comparison of the effects of vasectomy and experimental cryptorchidism in rats: II. Epididymal histology.

Vasectomy is a male contraception method that its side effects and reversibility rate are still controversial. Effects of vasectomy on epididymal morphology and function, which plays a crucial role in sperm maturation and storage, have not yet fully described. Therefore the present study was planned to find out the effects of vasectomy on epididymal structure, and comparisons of these effects were also made with the effects of a persistent infertility model, experimental cryptorchidism. To do this, 15 male Swiss albino rats were divided into 3 groups. While 5 animals were sham-operated, the rest were undergone either vasectomy (5 rats) or experimental cryptorchidism (5 rats) procedures. Epididymal tissue samples were collected prepared for light microscopy. Tissue sections were stained using appropriate staining techniques and evaluated under the light microscope. While there were distinct alterations in the epididymal morphology following experimental cryptorchidism, vasectomized rat epididymal features seemed similar to those seen in the sham-operated group. In conclusion, it could be suggested that the vasectomy might be a convenient method for male contraception.

Effect on caries experience of a long-term preventive program for mothers and children starting during pregnancy.

The aim of this three-phase prospective study was to determine the effects of a primary-primary prevention program on the oral health of children. Eighty-six pregnant women from various social backgrounds participated in the first phase of this study. In the second phase (at 3 years of age) 54 of the mother-child couples and in the third phase (at 4 years of age) 47 of the mother-child couples remained. Participants were recalled every 6 months and received individual prophylactic care. The following clinical parameters were assessed at each examination period for mother and child: DMF-S or dmf-s, proximal plaque index, and the salivary level of Streptococcus mutans (Dentocult SM). The control group consisted of 65 (at 3 years of age) and 45 (at 4 years of age) children from various kindergartens. All children in the second phase of the study group revealed a naturally healthy dentition with an API of 0-25% and a salivary S. mutans score of 0 (0-10(3) cfu/ml). In the third phase, only four of the 47 children of the study group showed caries, with a mean dmf-s of 1.5. No S. mutans could be detected in 20 (42.6%) children. Ten (21.3%) children of the study group showed a S. mutans score of > or = 2 (> 10(5) cfu/ml). In contrast, only 53 of the 65 children of the control group (second phase) and 26 of the 45 control children (third phase) revealed a naturally healthy dentition. The remaining 19 children of the control group revealed a mean dmf-s of 7.0 at 4 years of age. In the control group, no S. mutans could be detected in 25 (38.5%) children at 3 years of age whereas 21 (32.3%) children showed a S. mutans score of > or = 2. In the third phase, a salivary S. mutans score of > or = 2 was found in 27 (60%) children of the control group. The statistical comparison between the study and the control groups revealed significant differences for all results determined (P < 0.001). Additionally, all mothers revealed a significant improvement in oral health and a reduction of salivary S. mutans colonization. From our data we conclude that a pre- and postnatal prevention program (primary-primary vs primary prevention) may significantly improve the oral health of mother and child.

Does vancomycine increase aminoglycoside nephrotoxicity?

Vancomycine and amikacin combined is an effective antibiotic combination used in the treatment of serious Gram-positive bacteremia in childhood. However, both drugs may have a potential nephrotoxic effect when used individually. The present study investigates whether the nephrotoxicity of these drugs that display a nephrotoxic effect when used separately increases when used in a combined manner. Ten 2-month-old rats were subjected to intraperitoneal injections of vancomycine (100 mg/kg) and amikacin (80 mg/kg) and ten other 2-month-old rats were administered amikacin (80 mg/kg) for a period of 15 days. The control group of animals consisting of five 2-month old rats were untreated. The renal tissues obtained by laparotomy were processed for both light and electron microscopy. Paraffin sections and ultrathin sections were evaluated in order to determine the renal structure of the control and the experimental groups. In addition, serum creatinine and blood, urea and nitrogen (BUN) levels were measured in blood samples obtained from the rats. In the amikacin and combined amikacin-vancomycine treatment groups, renal morphological changes were observed at the glomerular and tubular levels when compared to the control group, and the serum creatinine and BUN levels were also higher in these groups. Although both experimental groups were different from the control group, they had similar morphological and biochemical features. It was concluded that vancomycine did not influence the nephrotoxic effect of amikacin and both drugs could be used in a combined manner.

Tessier type VI-VII cleft combination associated with congenital bimaxillary fusion and anophthalmia.

Congenital intermaxillary fusion is a rare anomaly. Combination of the anomaly with any type of facial cleft is extremely rare. Death in a majority of these patients as a result of feeding and aspiration problems in early life may have caused the reports to be limited. In this article a 5-year-old patient, probably the first in the literature having Tessier type VI-VII facial cleft combination associated with bimaxillary fusion and anophthalmia on the right side, is presented. The patient has survived on fluid meal through a very small opening for 5 years. The features of the case are presented, and the time and method of the management of such a rare anomaly are discussed with a review of the literature.

Antimicrobial activity of some isoquinoline alkaloids.

The isoquinoline alkaloids are of great importance to humanity because of their medicinal value and different structure. During the last ten years, many isoquinoline alkaloids were isolated from Fumaria and Corydalis species growing in Turkey. There have been many researches on the antimicrobial activity of extracts of higher plants, but relatively few pure compounds have been investigated.