Effect of Neurostimulator Usage on Block Success in Costoclavicular Block: A Randomized Controlled Trial.

BACKGROUND: The need of a neurostimulator for a successful nerve block was questioned in different block types after ultrasound had become standard. AIM: To determine the effect of neurostimulator use on block success in the costoclavicular block (CCB). METHODS: Sixty patients undergoing upper limb surgery were enrolled in the study. Patients using ultrasound and injection pressure manometer were divided as Group USP, and those using ultrasound, injection pressure manometer, and neurostimulator were divided as Group USPN. After block was applied, sensory and motor block levels were measured on a numeric scale. The block was considered successful when the desired score was reached or general anesthesia was not required intraoperatively. The number of successful and unsuccessful blocks for each group was summed up. The successful block rate was compared as the primary objective. Block application time, time to readiness for surgery, the number of needle passes, diaphragm paralysis rate, and complication rate were compared as secondary goals. RESULTS: Block success rate was 90% (27/30) in Group USP and 96.7% (29/30) in Group USPN. There was no statistical difference in terms of block success rate. Block application time was significantly shorter in Group USP (207.2 ± 32.7 s) when compared to Group USPN (280.9 ± 70.1 s). Other secondary outcomes were similar. CONCLUSION: Neurostimulator use did not affect block success in the CCB. Neurostimulator utilization prolonged block application time explicitly and did not change the complication rate. Ultrasound and injection pressure manometer are sufficient for a safe and successful CCB.

EFFECT OF PARATHYROIDECTOMY ON OXIDATIVE STRESS IN PATIENTS WITH PRIMARY HYPERPARATHYROIDISM.

Introduction: Primary hyperparathyroidism is diagnosed earlier and more frequently with the introduction of routine serum calcium measurements. In literature, it is shown that mortality and morbidity decrease after parathyroidectomy. In our study, we aimed to determine the effect of parathyroidectomy on oxidative stress. Materials and Methods: The results of 41 patients who underwent parathyroidectomy for primary hyperparathyroidism between March 2018 and end of December 2018 were evaluated prospectively. Total antioxidant capacity (TAC), superoxide dismutase (SOD), thiobarbituric acid reactive substances (TBARS), 8-hydroxy-2'-deoxyguanosine (8-OHdG), malondialdehyde (MDA), parathyroid hormone, calcium and albumin were measured before and after parathyroidectomy. Results: The mean age of the patients in the study was 45 ± 13.1 years (age range: 18-76 years). The female/male ratio was 32/9. Postoperative values of 8OHdG, MDA and SOD 1 were significantly lower than preoperative values (p <0.05). There was no significant difference between preoperative and postoperative TAC and TBARS values. Conclusion: Oxidative stress decreased in patients with primary hyperparathyroidism after parathyroidectomy. Randomized prospective studies are needed to show the relationship between biochemical and clinical parameters in order to see the clinical reflection of the study.

EARLIER PREDICTION OF HYPOCALCEMIA BY POSTOPERATIVE SECOND HOUR PARATHYROID HORMONE LEVEL AFTER TOTAL THYROIDECTOMY.

CONTEXT: Thyroidectomy is becoming an ambulatory surgical procedure. By predicting hypocalcemia,duration of hospital stay might decline. We tried to determine whether measuring parathormone two hours after total thyroidectomy predicts hypocalcemia. OBJECTIVE: We aimed to design a protocol for early prediction of hypocalcemia by defining PTH measurement time and cut-off value of our center. DESIGN: One hundred and six patients undergoing total thyroidectomy between November 2017 and October 2018 were prospectively studied. METHODS: Pregnant women, patients with renal failure, parathyroid disease, previous neck operation and thyroid malignancy requiring neck dissection were excluded from the study. Parathormone (PTH) and calcium measurement was done preoperatively and in the postoperative second hour. RESULTS: Group 1 consisted of 75 normocalcemic patients while group 2 had 31 hypocalcemic patients. Mean age was 45±13.1 (age range: 18-76). Female/male ratio was 82/24. While with a 8.36 pg/mL postoperative second hour PTH, hypocalcemia can be predicted with a 51.5% sensitivity and 90.7% specificity while with a PTH decline of 40.8% hypocalcemia can be diagnosed with a 83.9% sensitivity and 52% specificity. CONCLUSION: Postoperative second hour PTH and PTH percentage decline can predict postoperative hypocalcemia in total thyroidectomies. Preoperative Dual-energy X-ray absorptiometry (DXA) was not found useful in hypocalcemia prediction.

Investigation the relaxant effects of proton pump inhibitors and their relaxation mechanism on sheep sphincter of Oddi.

BACKGROUND: Using a relaxant agent before an endoscopic retrograde cholangiopancreatography (ERCP) might reduce complications. STUDY AIMS: We aimed to investigate the relaxant effects of proton pump inhibitors (PPIs) on sheep sphincter of Oddi (SO) and the mechanisms that might take part in this relaxant effect. PATIENTS AND METHODS: The sheep SO was mounted in an organ bath filled with Krebs-Ringer bicarbonate solution under 1.5 g tension and the relaxant effects of PPIs were evaluated in the tissues precontracted by carbachol (10-6 mol/l). The relaxant responses to the PPIs were tested in the presence of various blockers to enlighten the underlying mechanism by the PPIs. RESULTS: The PPIs exerted relaxant responses in a concentration-dependent manner in the sheep SO (P < 0.05). Esomeprazole produced the strongest relaxation. The administration of atropine, indomethacin, L-NAME, methylene blue, clotrimazole, glibenclamide, and 4-aminopyridine into the organ baths did not change the relaxations induced by PPIs in vitro (P> 0.05). On the other hand, Ca+2-activated potassium channel blocker tetraethylammonium (TEA) reduced the relaxation responses created by PPIs (P < 0.05). CONCLUSIONS: The present study suggests that PPIs create relaxation on SO partially via Ca+2-activated potassium channels. PPIs, especially esomeprazole, may be beneficial during the ERCP procedure. Further clinical studies are needed to confirm our results.

Characterization of bacterial knot disease caused by Pseudomonas savastanoi pv. savastanoi on pomegranate (Punica granatum L.) trees: a new host of the pathogen.

UNLABELLED: This study aimed to isolate and identify the causal organism causing hyperplastic outgrowths (knots) on stems and branches of pomegranate trees in the Eastern Mediterranean region of Turkey. Bacterial colonies were isolated from young knots on plates containing selective nutrient media. Biochemical tests, fatty acid analysis and PCR were performed to identify possible causal disease agent. Representative isolates were identified as Pseudomonas.pv.savastanoi (Psv) using biochemical tests, fatty acid profiling and PCR. Following inoculation of pomegranate plants (cv. hicaz) with bacterial suspensions, 25 of 54 bacterial isolates caused typical knots at the site of inoculation. PCR analysis, using specific primer for Psv, generated a single amplicon from all isolates. The similarity of the sequence of Turkish pomegranate isolate was 99% similar to the corresponding gene sequences of Psv in the databases. Based on symptoms, biochemical, molecular, pathogenicity tests and sequence analyses, the disease agent of knots observed on the pomegranate trees is Psv. To the best of our knowledge, this research has revealed pomegranate as a natural host of Psv, which extends the list of host plant species affected by the pathogen in the world and Turkey. SIGNIFICANCE AND IMPACT OF THE STUDY: Pomegranate trees were affected by the disease with outgrowths (galls or knot) disease. Currently, there is no published study on disease agent(s) causing the galls or knots on pomegranate trees in worldwide. Bacterial colonies were isolated from young knots. The causal agent of the knot Pseudomonas savastanoi pv.savastanoi (Psv) was identified based on symptoms, biochemical, molecular methods, pathogenicity tests and sequence analysis. To the best of our knowledge, this is the first report of Psv on pomegranate as a natural host, which extends the growing list of plant species affected by this bacterium in the world and Turkey.

First Report of Bacterial Blight of Pomegranate Caused by Xanthomonas axonopodis pv. punicae in Turkey.

Pomegranate (Punica granatum L.) is an increasingly important fruit crop that is widely cultivated in Turkey. Typical bacterial blight symptoms were observed since spring of 2011 in pomegranate orchards located in Antalya Province. Symptoms were characterized by dark brown, angular to irregularly shaped spots on leaves and fruit; cankers on stems, branches, and trunks; and split trunks. The pathogen was isolated from leaf spots on naturally infected plants showing typical symptoms onto yeast dextrose chalk agar. Bright yellow bacterial colonies were consistently isolated. Bacterial strains were characterized as gram negative, oxidase negative, catalase positive, tobacco hypersensitivity positive, and able to produce acid from L-arabinose, D-galactose, D-glucose, and D-mannitol but not from D-xylose. Pathogenicity of the representative bacterial strain Serik-4 was performed on 2-year-old pomegranate plants cv. Hicaz. Leaves were sprayed until runoff with bacterial cell suspensions containing 107 CFU/ml. Inoculated plants were covered with transparent plastic bags to maintain moisture for 48 h. Negative control plants were inoculated with sterile distilled water. Plants were then incubated in a greenhouse at 30°C for 14 days. Symptoms on leaves included dark brown, angular to irregularly shaped water soaked lesions along the veins of the inoculated plants 10 days after inoculation. No lesions developed on the control plants. The symptoms on inoculated plants were similar to those on naturally infected plants. Yellow bacterial colonies were re-isolated from the inoculated plants and identified as the same as the original strain by conventional tests and FAME analysis, thus fulfilling Koch's postulates. Fatty acid methyl ester profiling of the representative strain Serik-4 using GC-MIDI (Microbial Identification Inc, Newark, DE) identified the genus of the bacterium as Xanthomonas. The identity of Serik-4 was further confirmed by amplifying the 16S rRNA gene with the universal primers 27F and 1492R (3) and sequence analysis (GenBank Accession No. KM007073). The 16S rRNA gene sequences of Serik-4 was 99% identical to the corresponding gene sequences of the Xanthomonas axonopodis pv. punicae strain present in the NCBI database (JQ067629.1). High incidence of bacterial blight caused by X. axonopodis pv. punicae on pomegranate has been previously reported in India (2), Pakistan (1), and South Africa (4). To our knowledge, this is the first report of bacterial blight on pomegranate caused by X. axonopodis pv. punicae in Turkey. References: (1) M. A. Akhtar and M. H. R. Bhatti. Pakistan J. Agric. Res. 13:95, 1992. (2) R. Chand and R. Kishun. Indian Phytopathol. 44:370, 1991. (3) D. J. Lane. Page 115 in: Nucleic Acid Techniques in Bacterial Systematics, 1991. (4) Y. Petersen et al. Australas. Plant Pathol. 39:544, 2010.

Polypropylene mesh repair of incarcerated and strangulated hernias: a prospective clinical study.

PURPOSE: There is a common doubt regarding the application of polypropylene mesh to treat incarcerated and strangulated hernias due to the possibility of surgical site infection. We aimed to investigate the results of mesh repair of incarcerated and strangulated hernias, and to evaluate the incidence of wound infection and recurrence. METHODS: One hundred and fifty-three consecutive patients with incarcerated and strangulated hernias underwent surgery with mesh repair. The patients were divided into two groups: a resection group and a nonresection group. Fisher's exact test, the Chi-square test and independent samples t test were used to determine the statistical significance level (p < 0.05). RESULTS: While 53 patients required organ resection, the remaining 100 patients did not. The most frequently incarcerated organs were the omentum (86), small bowel (74) and colon (15). Most of the resections were performed in the omentum (36), small bowel (23) and colon (2). While five of the 53 patients (9.4%) in the resection group developed wound infections, no infections were observed in the nonresection group (p = 0.004). The infection rate in all patients was 3.3% (five of 153 patients). None of the infected patients required mesh removal. There were no mortalities or recurrence in either group. CONCLUSIONS: The findings revealed effective and safe usage of mesh along with antibiotic therapy in patients undergoing incarcerated and strangulated hernia repair.

First Report of a Root Rot Caused by Phytophthora palmivora on Lavandula angustifolia in Turkey.

English Lavender (Lavandula angustifolia Mill.) has been considered an alternative crop to tobacco in Hatay Province of Turkey because of its great production potential. As a new, nonnative crop, diseases and pests of lavender are not well known in the region. In summer 2010, root rot symptoms were observed with an average incidence of 45% in a 2-year-old lavender nursery in Hatay. Initial symptoms of chlorosis and wilting were followed by progressive death of the plants starting at the shoot tips. An oomycetous species was isolated consistently from the stems and roots of diseased plants on potato dextrose agar (PDA) amended with several fungicides and antibiotics. The culture of the single-zoospore isolate produced arachnoid growth on PDA. Chlamydospores of the isolate were approximately 35.0 µm in diameter. The isolate produced papillate, caduceus, hyaline sporangia in different shapes ranging from spherical to ellipsoidal. Sporangia with short pedicels (5 µm) were 35.0 to 57.5 × 27.5 to 42.5 µm with a length/width ratio of 1.2 to 1.8. On the basis of symptoms and morphology of the organism, the pathogen was identified as Phytophthora palmivora (E.J. Butler) E.J. Butler (3). Identification of the isolate was also confirmed by comparison of the sequence of the nuclear ribosomal internal transcribed spacer (ITS) region with reference isolates. The ITS region of rDNA was amplified by PCR with primers ITS1/ITS4 and sequenced (GenBank Accession No. JF777117). BLAST analysis of the sequence obtained showed a 99 to 100% homology with P. palmivora. Pathogenicity tests were performed on 12 greenhouse-grown 2-year-old lavender plants in 2-liter pots containing a steamed sand/peat/soil mixture. After rooting, the plants were inoculated by placing mycelial plugs from a 1-week-old culture of the isolate into an incision made at the base of each plant. Control plants were treated with plugs of sterile PDA. Inoculated plants were kept at 27°C for 5 weeks. Similar symptoms developed on the inoculated plants within 4 weeks after inoculation. P. palmivora was consistently reisolated from symptomatic plants. No symptoms developed on control plants. P. palmivora attacks a wide range of crop species including lavenders (1,2,4). To our knowledge, this is the first report of a root rot caused by P. palmivora, a new pathogen of lavender in Turkey. References: (1) S. Davino et al. Plant Dis. 86:561, 2002. (2) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society, St Paul, MN, 1996. (3) D. J. Stamps. C.M.I. Descr. Fungi Bact. 831:1, 1985. (4) G. A. Torres et al. Plant Dis. 94:1163, 2010.

First Report of Nigrospora sphaerica Causing Leaf Spots on Chinese Wisteria: A New Host of the Pathogen.

Chinese wisteria, Wisteria sinensis (Sims) DC., is a woody, twining vine and is commonly cultivated as an ornamental for its foliage and striking, drooping racemes of white, pink, or lavender sweet pea-like flower. Distinct leaf spots were observed in several gardens, retail nurseries, and parks located in Hatay Province since May 2009. The primary infection zones are frequently observed on the leaf margins and apices, brown, up to 2 mm in diameter, and often surrounded by a yellow zone. Foliar symptoms are characterized by grayish, round, semicircular or irregular-shaped, numerous spots (up to 9 mm in diameter) with dark brown borders and the appearance of black, granular structure within the dead leaf tissues. A fungus was consistently isolated from symptomatic tissues on potato dextrose agar (PDA). Fungal colonies were initially white, becoming light to dark gray with the onset of sporulation with black, spherical to subspherical single-celled conidia (15 to 18 × 12 to 15 µm), which were borne on a hyaline vesicle at the tip of the conidiophore. These characteristics agree with published descriptions of Nigrospora sphaerica (Sacc.) E.W. Mason 1927 (1,3). To fulfill Koch's postulates, a conidial suspension (106 conidia per ml) collected from PDA cultures was used to spray inoculate leaves of potted 3-year-old Chinese wisteria plants. Inoculated plants were kept for 48 h in polyethylene bags and maintained in a controlled environment chamber at 20°C with a 12-h photoperiod. The bags were removed after 3 days. In addition, five 3-year-old plants were sprayed with sterile water to serve as controls. After 14 to 20 days, inoculated leaves showed infection symptoms similar to those observed on naturally infected leaves with N. sphaerica. The pathogen was reisolated from the margins of necrotic tissues, but not from the controls. Although N. sphaerica is frequently encountered as a secondary invader or as a saprophyte on many plant species, this fungal agent is also known as a leaf pathogen on several hosts worldwide (2,4). To our knowledge, this is the first report of N. sphaerica as a leaf pathogen of Chinese wisteria in Turkey or worldwide. References: (1) M. B. Ellis. Dematiaceous Hyphomycetes. CMI, Kew, Surrey, UK, 1971. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Mycology and Microbiology Laboratory. Online publication. ARS, USDA. Retrieved 28 October from http://nt.ars-grin.gov/fungaldatabases/ , 2010. (3) P. M. Kirk. IMI Descr. Fungi Bact. 106:1056, 1991. (4) E. R. Wright et al. Plant Dis. 92:171, 2008.

First Report of Powdery Mildew Caused by Golovinomyces cichoracearum on Zinnia elegans in Turkey.

Powdery mildews are one of the most common diseases of plants growing in many nurseries, city parks, and home gardens in Turkey. Common zinnia (Zinnia elegans Jacq.) is widely cultivated in Turkey for ornamental purposes. In September 2010, zinnia plants grown in Hatay, Turkey were found to be heavily infected with a powdery mildew. Pathogen mycelia and sporulation were observed as circular to irregular, white patches on both sides of the leaves and on stems and flower petals. As the disease progressed, infected leaves turned yellow and died. Hyphae were straight to wavy and 4 to 7 µm wide. Conidiophores arose from the upper part of the hyphae, measured 120 to 190 × 10 to 13 µm, were simple, and produced two to six immature conidia in chains with a sinuate edge, followed by two to three straight cells. Conidia were hyaline, ellipsoid to barrel-shaped, measured 25 to 42 × 14 to 22 µm (length/width ratio = 1.3 to 2.5), lacked distinct fibrosin bodies, and produced germ tubes on the perihilar position, with reticulate wrinkling of the outer walls. No chasmothecia were observed. The structures described above were typical of the Oidium subgenus Reticuloidium, anamorph of the genus Golovinomyces, and the fungus measurements were compatible with those of G. cichoracearum (DC.) V.P. Heluta described previously (1,3). To confirm the tentative identification based on morphological characteristics, molecular analysis of internal transcribed spacer (ITS) rDNA sequences from a representative material (MKU-ZK311077, duplicate KUS-F25655) was conducted. The complete ITS regions of rDNA were amplified using primers ITS5 and P3 as described by S. Takamatsu (4) and sequenced. The resulting sequence of 508 bp from MKU-ZK311077 was deposited in GenBank (Accession No. JN051414). A GenBank BLAST search using the current data revealed an exact match for several sequences of G. cichoracearum, including Australian and Korean powdery mildews on zinnia plants, with a 100% sequence similarity. Pathogenicity was confirmed through inoculation by gently pressing diseased leaves onto leaves of three healthy, potted zinnia plants. Three noninoculated plants served as controls. Plants were maintained in a greenhouse at 25°C. Inoculated plants developed signs and symptoms after 10 days, whereas the control plants remained healthy. The fungus present on the inoculated plants was morphologically identical to that originally observed on diseased plants. The powdery mildew infections of Z. elegans associated with G. cichoracearum are nearly circumglobal, including Europe, North America, South America, Africa, Oceania, and Western Asian localities like India, Nepal, Jordan, and Israel (1,2). The current work confirmed the occurrence of G. cichoracearum infecting Z. elegans in Turkey using detailed morphological and molecular analysis. References: (1) U. Braun. Beih. Nova Hedw. 89:1, 1987. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ , May 24, 2011. (3) M. J. Park et al. Plant Pathol. J. 27:85, 2011. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

Intermittent pneumatic leg compressions acutely upregulate VEGF and MCP-1 expression in skeletal muscle.

Application of intermittent pneumatic compressions (IPC) is an extensively used therapeutic strategy in vascular medicine, but the mechanisms by which this method works are unclear. We tested the hypothesis that acute application (150 min) of cyclic leg compressions in a rat model signals upregulation of angiogenic factors in skeletal muscle. To explore the impact of different pressures and frequency of compressions, we divided rats into four groups as follows: 120 mmHg (2 s inflation/2 s deflation), 200 mmHg (2 s/2 s), 120 mmHg (4 s/16 s), and control (no intervention). Blood flow and leg oxygenation (study 1) and the mRNA expression of angiogenic mediators in the rat tibialis anterior muscle (study 2) were assessed after a single session of IPC. In all three groups exposed to the intervention, a modest hyperemia (approximately 37% above baseline) between compressions and a slight, nonsignificant increase in leg oxygen consumption (approximately 30%) were observed during IPC. Compared with values in the control group, vascular endothelial growth factor (VEGF) and monocyte chemotactic protein-1 (MCP-1) mRNA increased significantly (P < 0.05) only in rats exposed to the higher frequency of compressions (2 s on/2 s off). Endothelial nitric oxide synthase, matrix metalloproteinase-2, and hypoxia-inducible factor-1alpha mRNA did not change significantly following the intervention. These findings show that IPC application augments the mRNA content of key angiogenic factors in skeletal muscle. Importantly, the magnitude of changes in mRNA expression appeared to be modulated by the frequency of compressions such that a higher frequency (15 cycles/min) evoked more robust changes in VEGF and MCP-1 compared with a lower frequency (3 cycles/min).

First Report of Black Spot Disease Caused by Alternaria alternata in Persimmon Fruits in Turkey.

In recent years, postharvest rot symptoms have been observed in persimmon fruit (Diospyros kaki L.) during long storage in Hatay Province, one of the main production areas of Turkey. Infection appeared to begin through small cracks around and beneath the calyx. Symptoms developed as small, slightly depressed, dark brown spots. Slices of infected peel were surface sterilized in 1% sodium hypochlorite for 2 min, plated on potato dextrose agar (PDA), and then incubated at 24°C in darkness for 7 days. Hyphal tips from the margin of each developing colony were subcultured on PDA. Fungal colonies were initially white, becoming olivaceous, and turning brown with age. Conidiophores were brown, short, simple, or sometimes branched. Conidia were obclavate, obpyriform or ellipsoidal with a short conical beak, and 18 to 32 µm long and 5 to 14 µm wide at the broadest point. The pathogen was identified as Alternaria alternata (Fr.:Fr.) Keissler based on morphological characteristics (2). Pathogenicity tests were conducted on previously wounded persimmon fruit (cv. Fuyu) by spraying 12 fruits with a conidial suspension (106 conidia per ml). Six control fruits were treated with sterilized water only. All fruit were kept in a moist chamber (100% relative humidity) at 25°C for 3 days, and then moved to a growth chamber at 26°C with a 16-h photoperiod. Many, small, and black sporulating spots were observed on inoculated fruit 5 days after treatment. After 21 days, these spots developed into lesions similar to those produced on naturally infected fruit. No lesions developed on the control fruit. A. alternata was reisolated from inoculated fruit. The disease was previously reported in Israel (1). To our knowledge, this is the first report of A. alternata infecting persimmons in Turkey. References: (1) D. Prusky et al. Phytopathology 71:1124, 1981. (2) E. G. Simmons. Alternaria: An Identification Manual. The American Phytopathological Society, St. Paul, MN, 2007.

Giant congenital melanocytic naevus associated with Dandy-Walker malformation, lipomatosis and hemihypertrophy of the leg.

A 30-year-old woman presented with congenital hyperpigmented plaques and multiple tumoral lesions. Her left leg was hypertrophic, although the bones were normal. Dermatological examination revealed hyperpigmented macules and plaques with hair on the legs, abdominal and lumbar areas (covering > 60% of the total body surface) and multiple naevi on the face, arms, back and chest. Multiple soft masses of various sizes, some of which colocalized with hyperpigmented plaques, were seen on the trunk and legs. Malignant melanoma was excluded by histopathological examinations of multiple biopsy specimens obtained from the pigmented lesions. Histopathological examination of one of the soft masses showed that it was a lipoma. Cranial magnetic resonance imaging and computed tomography scans showed an enlarged fourth ventricule and vermis hypoplasia (Dandy-Walker malformation; DWM). Neurocutaneous melanosis is a rare combined abnormality of the skin and central nervous system. A few case reports relating to the coexistence of giant congenital melanocytic naevus, lipomatosis and hemihypertrophy have been published in the literature. We report this very rare case of giant melanocytic naevus with lipomatosis, hemihypertrophy of the leg, and DWM.

Homocysteine, vitamin B12 and folic acid levels in psoriasis patients.

BACKGROUND: Hyperhomocysteinaemia is a risk factor for atherosclerotic cardiovascular disease, stroke, peripheral arterial occlusive disease and venous thrombosis. An association between psoriasis and cardiovascular diseases has been reported. AIM: The aim of our study was to examine serum homocysteine, folic acid and vitamin B12 levels in psoriasis patients. MATERIAL AND METHODS: We performed a cross-sectional study in 70 consecutive outpatients with chronic plaque psoriasis and 70 age- and gender-matched controls. Serum levels of homocysteine, vitamin B12 and folic acid levels were measured in both groups. RESULTS: Serum homocysteine, folic acid and vitamin B12 levels did not differ between patient and control groups. In psoriasis patients, homocysteine levels correlated directly with psoriasis severity as measured by psoriasis area and severity index. Serum homocysteine level inversely correlated with serum folic acid levels in the patient group. DISCUSSION: Homocysteine levels correlated with psoriasis area and severity index in the patient group, which shows the disease severity. The increase in cardiovascular mortality with the severity of psoriasis might be also due to the effects of homocysteine.

Effect of nitric oxide/cyclic guanosine mono-phosphate pathway on gallbladder relaxant response in bile duct-ligated guinea pigs.

BACKGROUND/AIMS: Common bile duct ligation (CBDL) in the guinea pig is a well-defined model of acalculous cholecystitis. Nitric oxide (NO) mediates smooth muscle relaxation by stimulating the activity of soluble guanylate cyclase. The aim of this study was to determine whether the NO/cyclic guanosine monophosphate pathway plays a role in gallbladder relaxant response after CBDL. METHODS: Relaxant response of gallbladder muscle strips from CBDL and sham-operated guinea pigs was studied in vitro. Animals were treated with saline, aminoguanidine or an aminoguanidine + L-arginine combination in vivo. Concentration-response curves of papaverine, diethylamine/NO, YC-1, sildenafil and amrinone were obtained and relaxations in each group were calculated as the percent of the contractions induced by carbachol (10(-6) M). RESULTS: There was a significant decrease in the gallbladder muscle relaxant responses to these substances in CBDL and aminoguanidine groups compared with sham surgical controls. The decreased relaxant response was reversed by aminoguanidine + L-arginine but not by aminoguanidine alone. CONCLUSION: Decreased relaxant responses might be due to the reduced guanylate cyclase enzyme activity, but further studies are required.

Antifungal effects of essential oils from oregano and fennel on Sclerotinia sclerotiorum.

AIMS: The antifungal effects of essential oils of oregano (Origanum syriacum var. bevanii) and fennel (Foeniculum vulgare) were evaluated against Sclerotinia sclerotiorum. Effects of the essential oils on morphological structures of hyphae and sclerotia were studied under light and scanning electron microscopes (SEM). METHODS AND RESULTS: Inhibitory effects of volatile and contact phases of the essential oils used were determined on hyphae and sclerotia. Both essential oils have a marked antifungal effect against S. sclerotiorum. Soil amendment with essential oils has significant effect on reducing sclerotial viability. Both essential oils significantly inhibited the fungal growth in soil, thereby increasing the number of surviving tomato seedling by 69.8% and 53.3%, respectively. Light and SEM observations on pathogen hyphae and sclerotia revealed considerable morphological alterations in hyphae and sclerotia. CONCLUSIONS: The significant reduction in the mycelial growth and germination of sclerotia would greatly reduce the pathogen inoculum source. This may influence the rate of disease development in soil. SIGNIFICANCE AND IMPACT OF THE STUDY: Considering the reduction in the number of diseased plants in infested soil amended with essential oils, we concluded that oregano and fennel essential oils could be used as possible bio fungicides alternative to synthetic fungicides against phytopathogenic fungi.

Palliation of malignant obstructive jaundice. Use of self-expandable metal stents.

PURPOSE: The aim of this study was to analyze the clinical efficacy of metal stents in the palliation of malignant obstructive jaundice. MATERIAL AND METHODS: Fifty patients with malignant biliary obstruction were palliated by means of drainage with a metallic self-expandable stent (Wallstent). Nineteen patients had pancreatic carcinoma, 22 cholangiocarcinoma, 4 hepatocellular carcinoma, and the remaining 5 metastatic carcinoma from a variety of primary sites. The obstruction was at the level of the liver hilum in 19 cases, in the middle common bile duct in 11, and in the lower common bile duct in 20. RESULTS: The patients were followed over a period of 1-17 months. A total of 36 patients (72%) died; 14 (28%) survived. The mean observation time for the whole group of 50 patients was 3.3 months. The 30-day mortality rate was 14% (7 patients). Short-term complications occurred in 6 patients (12%). Long-term complications included stent occlusion requiring a 2nd intervention in 2 patients (4%), and cholangitis in 2 patients (4%). Excellent palliation was achieved in most of the patients. No stent migration was observed. CONCLUSION: The metallic stent provides good palliative drainage, and the percutaneous insertion of metallic stents is well tolerated by the patients. The procedure is simple and safe to use and can be executed in one stage. The one-stage procedure, compared to the 2-stage procedure, may reduce hospital stays.