A Rare Bacteremia in a Burn Patient: A Case Report of Achromobacter Xylosoxidans and Denitrificans.

Achromobacter is a rare bacteria that causes bacteremia in immune-compromised patients. In this case, a 26-year-old male patient with major burns with a positive blood culture for Achromobacter is presented. A rare bacterium, Achromobacter xylosoxidans, and denitrificans, was detected in the blood culture of a patient who was hospitalized due to major burn trauma and had delayed wound healing and had no graft take. After treatment with culture-specific antibiotics, the patients' acute phase reactants decreased, and he was discharged with 100% graft-take. Sepsis is the most common cause of death in major burns. Endogenous and exogenous bacteria cause sepsis. Bacteremia and sepsis are the most important factors affecting wound healing in burn patients. This case shows that rare opportunistic bacteria such as Achromobacter spp. should be considered in major burn patients with delayed wound healing and recurrent graft lysis.

The estrogenic effects of apigenin, phloretin and myricetin based on uterotrophic assay in immature Wistar albino rats.

Chemicals that occur in vegetal food and known as phytoestrogens, because of their structures similarity to estrogen, have benefits on chronic diseases. Despite this, when they are taken at high amounts, they can cause harmful effects on endocrine system of human and animals. In this study, it has been intended to determine the estrogenic potencies of phytoestrogens apigenin, phloretin and myricetin whose affinities for estrogen receptors in vitro. The female rats divided into 17 groups, each containing six rats. There was a negative control group and there were positive control dose groups which contains ethinyl estradiol, ethinyl estradiol+tamoxifen and genistein. The other dose groups which were tested for estrogenic activity contains apigenin, myricetin and phloretin All chemicals have been given to Wistar immature female rats with oral gavage for 3 consecutive days. By using uterotrophic analysis, uterus wet and blotted weights, vaginal opening, uterus length of female rats has been recorded at the end of the experiment. For detect of cell response, luminal epithelium height, gland number and lactoferrin intensity in luminal epithelium of uterus were evaluated. Biochemical analysises in blood were performed. Relative uterus weights of rats in 100 mg/kg/day dose group of myricetin were statistically increased according to vehicle control and positive control groups. In dose groups of apigenin and phloretin it was found that there were cell responses in uterus. All treatment groups had a significant difference in the high intensity of lactoferrin and uterine gland count compared to oil control group. There was no difference between phloretin and apigenin treatment groups in uterine weight statictically. Uterine heights were increased in positive control groups and 100 mg/kg/day dose group of myricetin. Epithelial cell heights were increased in treatment groups except apigenin and phloretin dose groups. There was no difference between all treatment groups in vaginal opening values according to positive control.

Is familial Mediterranean fever (FMF) common in patients with negative appendectomy?

OBJECTIVES: Familial Mediterranean fever (FMF) is an autosomal-recessive disease characterized by recurrent attacks of fever with serositis. Differential diagnosis of a FMF abdominal attack with acute abdomen is difficult. Acute appendicitis is the most common cause of acute abdominal pain that requires surgical treatment. The aim of this study was to investigate frequency of FMF in patients with negative appendectomy. METHODS: We assessed 278 patients (female/male 127/151) who were operated with preoperative diagnosis of acute appendicitis. In 250 of the patients, definitive diagnosis of acute appendicitis was established by histo-pathological examination. Patients with negative appendectomy were assessed for FMF by rheumatologist. RESULTS: Negative appendectomy was detected in 28 patients (M/F 5/23, mean age 25.3 ± 8.4 years). Negative appendectomy ratio was 10.1 %. Among 28 patients two had FMF (7.7 %). CONCLUSIONS: FMF were established in 7.7 % of patients with negative appendectomy. Our study suggests patients having negative appendectomy should be evaluated for FMF. Further large sample studies are needed to define the real prevalence of FMF among negative appendectomy patients.

Comparison of short-term results of modified Karydakis flap and modified Limberg flap for pilonidal sinus surgery.

The aim of this study was to compare and analyze the short term results of modified Karydakis flap reconstruction (MKF) and modified Limberg flap reconstruction (MLF). This is a retrospective analysis of 81 patients operated for pilonidal sinus disease. There were 46 patients in MLF group and 35 patients in MKF group. We compared patients age, BMI, operation time, removal time of suction drain, time of feeling completely healed, type of presentation, complications, postoperative 1., 3., 5. Days VAS scores, time to stop analgesic drugs and time to sit on chair or throne without pain. Complication rate, analgesic drug stopping time, postoperative 5. days VAS score were lower in MLF group and there were significant difference between groups. MLF group patients feel better (P: 0.010), they recommended this operation to other pilonidal sinus patients (P: 0.010) and 36 of them rated their satisfaction excellent and 10 of them good (P: 0.010). MLF procedure was more comfortable for patients. Lesser pain, lower complication and recurrence rates and higher patient satisfaction were detected in MLF group.

Impact of high dose chemoimmunotherapy after surgery on the overall and disease-free survivals in advanced stage malignant melanoma.

BACKGROUND: To investigate the impact of high dose chemoimmunotherapy in addition to surgery on the cumulative survival and disease-free survey of malignant melanoma patients. METHODS: A total of 86 malignant melanoma patients [35 females (40.7%), 51 males (59.3%), mean age: 55.5] were treated according to their stages between Februrary 1997 and June 2007. After surgery, adjuvant immunotherapy was applied to patients in Stage 2, while adjuvant chemotherapy and adjuvan immunotherapy were administered to those at Stages 3 and 4. RESULTS: Overall rate of mortality was 31.4% (27/86). The most frequent postoperative complications were wound infection (n=8, 9.3%) in the early period and lymphedema in lower extremities (n=4, 4.6%) in the late period. Temporary and tolerable complications ensourcing from chemoimmunotherapy were encountered in 9 (10.4%) patients. The survival rates and disease-free periods of combined treatment protocol were found to be similar to those in ECOG 1684 and ECOG 1690 studies. CONCLUSION: Adjuvant immunotherapy and chemoimmunotherapy seem to improve overall survival and disease-free survey in malignant melanoma. Further clinical studies are necessary to demonstrate the actual effectivity of this promising protocol in the management of malignant melanoma.

The effect of oral honey and pollen on postoperative intraabdominal adhesions.

BACKGROUND/AIMS: We evaluated the effect of oral usage of honey and pollen, either separately or together, on postoperative intraabdominal adhesions. METHODS: Forty rats were randomly separated into 4 groups of 10 rats each. Abrasion was performed on the cecum, and a patch of peritoneum located opposite to the cecal abrasion was completely dissected. Group 1 rats received no treatment; Group 2 rats received 4 g/kg/day honey; Group 3 rats received 4 g/kg/day pollen; and Group 4 rats received 4 g/kg/day honey and pollen mixed in equal amounts, in addition to the standard feeding for postoperative 21 days. All the rats were sacrificed on the 21st day. Following the adhesion scoring, tissue specimens of the peritoneum and bowel were subjected to histopathological investigation. The tissue and blood specimens were also taken for biochemical analysis to investigate the antioxidant capacity. RESULTS: Adhesion scores were significantly different between the control and other groups. No dense adhesion was observed in the treatment groups. Tissue malondialdehyde levels were significantly different between the control and honey and honey+pollen groups. Superoxide dismutase and glutathione-peroxidase levels were significantly different between the control and other groups. Catalase levels were different between the control and honey groups. Plasma antioxidant levels were different between the control and other groups. The pathological scores for fibrosis and inflammation were significantly different between the control and other groups. CONCLUSIONS: Honey and pollen were found to be effective in preventing postoperative intraabdominal adhesions, and these effects were thought to be a result of their antiinflammatory and antioxidant properties.

Mucosa-associated lymphoid tissue lymphoma of the ileum as the cause of an intestinal invagination.

We herein report a case of a 14-year-old male with mucosa-associated lymphoid tissue (MALT) lymphoma of the ileum as the cause of an intestinal intussusception. The patient was referred to the hospital with abdominal pain and dyspeptic complaints and was operated on with a prediagnosis of acute abdomen. Abdominal exploration revealed an ileoileal intussusception induced by a 2-cm tumor. A segmental ileal resection was done at the operation. The histopathologic examination of the specimen revealed atypical lymphocytes starting from the mucosae infiltrating the muscular layer and the serosae. Based on these findings, the tumor was diagnosed as a high-grade MALT lymphoma. The patient recovered uneventfully after the surgery, and chemotherapy was started.

Acute appendicitis presenting with abdominal wall and right groin abscess: a case report.

We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.