Cat scratch disease.

Approximately 24,000 people are infected with cat scratch disease (CSD) every year. CSD is caused by the bacteria Bartonella henselae, a gram-negative bacteria most often transmitted to humans through a bite or scratch from an infected cat or kitten. Although CSD is often a benign and self-limiting condition, it can affect any major organ system in the body, manifesting in different ways and sometimes leading to lifelong sequelae. It is a disease that is often overlooked in primary care because of the wide range of symptom presentation and relative rarity of serious complications. It is important for health care providers to recognize patients at risk for CSD, know what laboratory testing and treatments are available, and be aware of complications that may arise from this disease in the future.

Comparative analysis of prognostic significance of molecular markers of apoptosis with clinical stage and tumor differentiation in patients with colorectal cancer: a single institute experience.

BACKGROUND/AIMS: The most important parameter determining the outcome of colorectal cancer (CRC) is the presence of metastases, which occur in 45-50% of all cases. The balance between proliferation and apoptosis is a key factor for tumor growth, and thus--for metastasis. Evaluation of markers for proliferation and apoptosis could therefore be helpful in predicting tumor behavior in early stage of carcinogenesis. METHODOLOGY: Seventy-two biopsies from cases of colorectal cancer (CRC) were immunostained for the proliferation/apoptosis-related proteins Bcl-2, Bax and p53. The resected specimens were also subjected for routine pathologic assessment as part of Tumor, Node and Metastases (TNM) staging. RESULTS: Comparing the marker protein expression with standard prognostic factors such as clinical stage and grade of differentiation revealed a lack of correlation between markers and standard prognostic factors in cases where clinical stage favors good prognosis (I and II stage). We found lack of correlation in 52% of diagnosed patients by tumor grade and 46% in patients by clinical stage. CONCLUSIONS: Co-expression of Bax with p53 protein is associated with poor clinical outcome, especially in cases without concomitant expression of bcl-2. The blocked apoptosis and inability of the organism to "liquidate" the neoplastic transformation of the cell (loss/mutation of p53), which we establish in our study in the half the patients with high and moderately differentiated carcinoma and separately in 46% of the patients with favorable prognosis by clinical stage is a reason for fast progression, too. The presence of a low correlation between the staging and the results of the molecular profiling suggest that the staging system needs to improve to address more precisely the issues of therapeutic options and patient survival. Using a panel of markers rather than a single marker is a step in this direction.

Influence of DL-alpha-tocopherol acetate on indomethacin-induced gastric mucosal injury in rats.

1 There is an increasing body of evidence supporting the hypothesis that antioxidants are able to reduce gastric mucosal damage induced by stressors of different origin. The aim of the present study was to investigate the influence of dl-alpha-tocopherol acetate (TA) on indomethacin-induced gastric mucosal injury in rats and a possible role for an anti-oxidative mechanism in the response. 2 TA (25, 50 and 100 mg kg(-1)) was applied intraperitoneally as a pretreatment 1 h before the subcutaneous administration of indomethacin (30 mg kg(-1)). 3 TA reduced the area of indomethacin-induced gastric ulcers, the effect being significant (P < 0.05) at the highest dose of 100 mg kg(-1). 4 Histopathological examination of rat stomach samples demonstrated that TA caused an increase in gastric mucus production and a reduction of the severity of mucosal lesions. 5 The three doses of TA prevented indomethacin-induced elevation of plasma and mucosal malondialdehyde (MDA) levels, which in TA-pretreated rats were not significantly different from the control values. Neither indomethacin treatment nor TA pretreatment had a significant influence on the gastric mucosal levels of reduced glutathione or oxidized glutathione. 6 Our results suggest that the gastroprotective effect of TA is likely to be due to increased mucus production and interference with oxidative stress development as evidenced by the decreased plasma and gastric mucosal MDA.

Antihyperlipidemic effect of Aronia melanocarpa fruit juice in rats fed a high-cholesterol diet.

Aronia melanocrpa fruit juice (AMFJ) used in our experiment was very rich in phenolic substances (709.3 mg gallic acid equivalents/100 ml juice). Anthocyanins (106.8 mg cyanidin-3-glucoside equivalents/100 ml juice) were the main flavonoid group. The aim of this study was to assess the influence of AMFJ on plasma lipids and lipoprotein profile, and histopathology of liver and aorta in rats with dietary-induced hyperlipidemia. AMFJ was administered by gavage for 30 days at doses of 5, 10 and 20 ml/kg body weight to rats fed a standard diet (SD) or a 4% cholesterol-containing diet (4% ChD). The 4% ChD caused a significant elevation of plasma total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). AMFJ did not significantly influence plasma lipids in rats fed the SD and significantly hindered the elevation of plasma TC, LDL-C and TG in rats fed the 4% ChD. High-density lipoprotein cholesterol (HDL-C) levels were not significantly influenced either by the 4% ChD or by AMFJ. Neither the cholesterol feeding, nor AMFJ treatment induced any histopathological changes in rat liver and aorta. In conclusion, AMFJ showed an antihyperlipidemic effect in rats with hyperlipidemia and could be valuable in reducing this factor of cardiovascular risk.

[Sentinel lymph node biopsy in patients with papillary thyroid carcinoma].

UNLABELLED: The concept of sentinel lymph node (SLN) has been proven to be successful and accurate in surgical decision making for the treatment of some solid tumors. The AIM of this study is to investigate the feasibility and accuracy of the SLN biopsy in patients with papillary thyroid carcinoma. PATIENTS AND METHODS: Twenty eight patients underwent SLN biopsy for the period from 01 January 2003 to 30 June 2006 in our institution.Twenty three of them were females and 5 males, at the age of 21 to 57 years. All patients have had a solitary thyroid nodule, 0.8 to 3.0 cm in size. Patients with any palpable or ultrasonografically detectable cervical LNs or history for previous neck surgery and/or radiation in the same region have been excluded from the study. Blue dye (Patent blue V) injection around or inside the thyroid nodule was utilized for the SLN detection followed by SLN biopsy. RESULTS: SLN have been detected and obtained in all 22 patients with papillary thyroid carcinoma. One SLN in the central compartment was found in 19 (40,9%) patients and one in lateral compartment in 3 (13,6%) patients. In 2 (9,1%) patients one SLN was found in both, central and lateral compartments. Metastasis in SLN was found in 9 (40,9%) patients. SLN in last 13 (59,1%) patients were negative for metastases. From patients with metastasis-positive SLN, metastasis in a next regional lymph node was found in 3 (13,6%) patients. In the remaining 6 cases next lymph nodes in both compartments were metastasis-negative. Metastatic disease in regional lymph nodes was not found in anyone from the patients with metastasis-negative SLN. CONCLUSIONS: Sentinel lymph node biopsy provides reliable information about the pathomorphological lymph node status in patients with papillary thyroid carcinoma, thus making possible to avoid unnecessary neck dissections and to minimize the risk from local surgical complications and disease recurrencies. The initial results with SLN biopsy give us a reason to accept this technique as a feasible, accurate and safe option in the surgical treatment of papillary thyroid carcinoma.

Effect of Aronia melanocarpa fruit juice on indomethacin-induced gastric mucosal damage and oxidative stress in rats.

Aronia melanocarpa fruits are rich in phenolic substances-mainly flavonoids from the anthocyanin subclass. The anthocyanins are water-soluble plant pigments with antioxidant, anti-inflammatory, antimicrobial, hepatoprotective, gastroprotective and other activities. We studied the effect of A. melanocarpa fruit juice (AMFJ) on indomethacin-induced gastric mucosal damage in rats and its possible relation to the oxidative status. AMFJ (5, 10 and 20 ml kg(-1)) was applied orally as a pretreatment 1 h before the subcutaneous administration of indomethacin (30 mg kg(-1)). Gastric ulcer formation was estimated morphometrically and histopathologically 4h after the indomethacin administration. Malondialdehyde (MDA) in rat plasma and gastric mucosa and also reduced glutathione (GSH) and oxidized glutathione (GSSG) in gastric mucosa were determined and used as biochemical markers of the oxidative status. AMFJ-pretreatment diminished the number and area of indomethacin-induced gastric lesions. Histopathological examination of rat stomachs demonstrated that AMFJ induced an increase in gastric mucus production and a reduction of the depth and severity of indomethacin-induced mucosal lesions. AMFJ dose-dependently reduced the elevated indomethacin plasma and gastric MDA levels and at the doses of 10 and 20 ml kg(-1) they were not significantly different from the control values. Neither indomethacin-treatment, nor AMFJ-pretreatment had a significant influence on GSH and GSSG gastric mucosal levels. These results demonstrated that indomethacin-induced gastric mucosal damage was accompanied by the development of oxidative stress, evidenced by the accumulation of MDA. AMFJ-pretreatment decreased the gastric lesions caused by indomethacin. It could be suggested that this effect of AMFJ was probably due to the increased mucus production and interference with oxidative stress development as evidenced by the decreased plasma and gastric mucosal MDA.

[Argon plasma thyroid resections--main points and advantages].

UNLABELLED: Here in we present our experience with a new surgical technique of Argon Plasma Thyroid Resections which was developed in our institution to avoid the use of lots of haemostatic instruments and various size blood vessels ligations. AIM: To demonstrate the results we achieved and the advantages of APR, compared with the conventional thyroid resection. MATERIAL AND METHODS: For the period from 01. Feb. 2003 to 31. May 2004 85 patients underwent argonplasma resection (APR) of the thyroid gland in our institution. All patients were females, mean age 38, 5 years. Preoperative ultrasound examination of the thyroid has been performed in all patients for more precise determination of both thyroid lobes volume and echoic pattern of the thyroid gland. FNAB has been performed in 37 (43.5%) patients with suspicious malignancy. The distribution of patients according to the nature of the thyroid disease was as follows: 12 patients with Grave's disease, 7 patients with diffuse goiter, 20 patients with nodular goiter, 28 patients with thyroid adenoma, 14 patients with Hashimoto thyroiditis and 4 patients with thyroid cancer. The procedure has been made by means of an Argon Plasma Coagulation System (Berchtold GmbH). A power setting at 20 W has been used, with time of exposition at 15 seconds and gas-flow at 2 l/h. RESULTS: Twenty one isthmusectomies with partial resection of one lobe, thirty one isthmusectomies with subtotal resection of one lobe, nine isthmusectomies with partial resection of both lobes, six isthmusectomies with partial resection of one lobe and subtotal resection of the other lobe fourteen subtotal thyroidectomies and four thyroidectomies were performed. Lack of bleeding, smooth resection line, without need for haemostatic instruments and blood vessels ligation, minimal injury on the remaining thyroid tissue as well as shortening of the operative time have been observed. CONCLUSIONS: The experience we've gained delineates the newly developed technique of APR as a safe and promissing technique in the surgical treatment of selected patients with indications for thyroid sugery.

[Hashimoto's thyroiditis: indications for surgical treatment].

BACKGROUND: Hashimoto's thyroiditis (HT) is the prototypical example of autoimmune thyroiditis and the primary way to treat the disease is conservative. However, there are patients with HT, in which surgical treatment is mandatory. AIM: Summarizing our institutional experience, to formulate the indications for surgical treatment of Hashimoto's thyroiditis. MATERIALS AND METHODS: 132 patients (131 females and 1 man, mean age 45 years) underwent surgery for HT in the period from 1.01.1987-1.01.2004. Serum thyroid hormone levels, autoimmune and ultrasonographic findings and FNA biopsy confirmed the diagnosis of HT in 115 (87.1%) patients. In the remaining 17 (12.9%) cases, the diagnosis was based on the intraoperative findings as well as on the histological results. From 1987 to 2002 year 110 patients with HT underwent surgery and for the period 01.01.2003 to 01.01.2004 - 22 (54.6%) patients 10 (45.4%) underwent conventional thyroid resection and 12 (54.6%)--argon plasma resection (APR/introduced in our practice since 2003). The indications for surgery were: thyromegaly with compression symptoms, non-responding to L-thyroxin treatment; nodular form of HT with dominant thyroid nodul over 2 cm in size; suspicion for neoplasm or an unsightly neck appearance due to a large goiter. RESULTS: 17(12.9%) patients with diffuse form of HT were surgically treated. Isthmectomy with bilateral medial partial thyroid resection was performed (in 14 cases by conventional method and in 3 by APR). In 81 (61.4%) patients with nodular form of HT isthmectomy with bilobar or unilobar partial or near total thyroid resections were performed (74 conventional resections and 7 APRs). Seven (5.5%) patients have had pseudonodules. In 6 from these cases conventional isthmectomy was performed and in 1 isthmectomy by APR. Coexistent HT with thyroid carcinoma was diagnosed in 27 (20.4%) patients. All underwent thyroidectomy (1 by APR). CONCLUSIONS: Surgery has it's place and efficacy in the treatment of selected patients with Hashimoto's thyroiditis and compression symptoms or nodular forms with dominant nodules over 2 cm, suspicion for neoplasm or an unsightly neck appearance due to a large goiter. Argon plasma resection (APR) is a new, safe and promising technique of thyroid resection, particularly appropriate for patients with Hashimoto's thyroiditis.

[Minimally invasive open thiroydectomy--our initial experience].

UNLABELLED: A crescent number of reports concerning the use of minimally invasive approach in thyroid surgery arise in the last years. AIM: This report describes the recently developed technique of minimally invasive open thyroidectomy and represents our initial experience. PATIENTS AND METHODS: Thirty seven patients underwent a minimally invasive open thyroidectomy in the Clinic of Thoracic Surgery, Medical University of Varna between February the 1th and May the 31th, 2003. Nodular thyroid diseases were the dominant cause. All patients were females. In all cases a preoperative ultrasonography was made to evaluate the volume of each thyroid lobe, as well as the number, size and location of the thyroid nodules. RESULTS: The length of the skin incision varied from 2 to 3,5 cm. Operative time was at 45,4 +/- 10,3 min. Postoperative hospital stay was at 24 +/- 8 hours. There were not any postoperative complications. The extent of thyroid resections was as follows: partial lobe resection in 6 patients; lobectomy in 16 patients; lobectomy and partial counter lateral lobe resection in 4 patients; lobectomy with subtotal thyroidectomy of the other lobe in 2 patients and thyroidectomy in 1 patient. The cosmetic results we have observed were undoubtedly better. CONCLUSIONS: Although initial, our experience shows that minimally invasive open thyroidectomy provides surgeons with an adequate operative field, and that it has proven to be simple, safe, quick and practical for selected patients with small to middle sized thyroid nodules.

Hepatoprotective effect of the natural fruit juice from Aronia melanocarpa on carbon tetrachloride-induced acute liver damage in rats.

The fruits of Aronia melanocarpa are rich in anthocyanins--plant pigments with anti-inflammatory and antioxidant activity. We studied the effect of the natural fruit juice from A. melanocarpa (NFJAM) on carbon tetrachloride (CCl4)-induced acute liver damage in rats. Histopathological changes such as necrosis, fatty change, ballooning degeneration and inflammatory infiltration of lymphocytes around the central veins occurred in rats following acute exposure to CCl4 (0.2 ml kg(-1), 2 days). The administration of CCl4 increased plasma aspartate transaminase (AST) and alanine transaminase (ALT) activities, induced lipid peroxidation (as measured by malondialdehyde (MDA) content in rat liver and plasma) and caused a depletion of liver reduced glutathione (GSH). NFJAM (5, 10 and 20 ml kg(-1), 4 days) dose-dependently reduced the necrotic changes in rat liver and inhibited the increase of plasma AST and ALT activities, induced by CCl4 (0.2ml kg(-1), 3rd and 4th days). NFJAM also prevented the CCl4-induced elevation of MDA formation and depletion of GSH content in rat liver.

Gastric teratoma in a 2-month-old boy.

Gastric teratoma is an extremely rare neoplasm accounting for less than 2% of all teratomas in children. Clinical manifestations usually consist in vomiting, palpable abdominal tumor and/or bleeding from the upper gastrointestinal tract. Considering its rareness and the scarce information in the literature we present a case of gastric teratoma in a 2-month-old boy with vomiting after feeding, persisting since birth. The child was referred for examination with clinical suspicion of hypertrophic pyloric stenosis. He also suffered from septic meningitis with fulminant course which caused his death 5 days after the diagnosis of teratoma was done. Imaging studies were indicative of the diagnosis.