Osteopontin Concentration in Prostates Fractions: A Novel Marker of Sperm Quality in Dogs.

This study aimed to investigate the relationship between the sperm quality and the osteopontin (OPN) concentration in the prostates of Malakli shepherd dogs. Ejaculates were collected once by digital manipulation from 39 male dogs aged between 2 and 4 years and older. The first and third fractions of the ejaculate were centrifuged at 5000× g for 30 min, and supernatants were stored at -80 °C for further analysis of OPN using a double-antibody sandwich method (SEA899CA, Cloude-Clone Corp, Houston, TX, USA). Meanwhile, the second fractions were evaluated for sperm motility, concentration, viability, and rate of abnormal spermatozoa (head, acrosome, midpiece and tail abnormalities). The average concentration of OPN was 8.7 ± 5.2 ng/mL, and it differed significantly between the 1st 10.4 ± 5.3 ng/mL and 3rd 7.4 ± 5 ng/mL fractions. According to ROC (receiver operating characteristic curve) analysis, the OPN concentration had a better diagnostic ability for sperm motility (p < 0.001) than for the rate of abnormal spermatozoa (p < 0.05). Additionally, the OPN concentration was negatively correlated with poor sperm morphology and motility. In conclusion, the OPN concentration in prostate-derived secretions may be a possible marker of sperm quality in dogs. Further research could explore the involvement of OPN in sperm motility during cryopreservation and in vivo fertility.

Use of Infrared Thermography during Ejaculation Process and Its Link with Semen Quality and Freezability in Dogs.

This study aimed to describe the thermal variation of external reproductive tracts during ejaculation in relation to sperm quality in dogs. Forty-six adult fertile dogs were monitored using a thermal camera before, during and after the semen collection, taking into account penile and scrotal temperatures as reproductive thermal patterns while eye and perianal temperatures were recorded as complementary thermal patterns of behavioral response. The parameters were classified depending on age (≤4 years and >4 years), body weight (BW) (≤75 kg and >75 kg), sperm concentration (CON) (≤300 million and >300 million), total testicular volume (TTV) (≤600 cm3 and >600 cm3) and total ejaculation time (TET) (≤800 s and >800 s) of the animals from which semen was collected successfully. Heavier males (p < 0.05) that have more consistent testicles (p < 0.01) as well as quicker ejaculate responders (p < 0.001) and lower scrotal temperature had better semen (Δ motility) freezability. The lower eye temperature prior to the ejaculation (p < 0.01), lower scrotal temperature following ejaculation (p < 0.01), and conversely, higher penile temperature during the ejaculation (p < 0.001) had a higher sperm concentration. Furthermore, the sperm freezability was negatively correlated with total ejaculation time (r = -0.39, p < 0.05) and sperm abnormalities were lower in the ejaculate of dogs having a higher temperature of the scrotum, bulbus and penis. In conclusion, infrared monitoring throughout semen collection in dogs can provide information on behavioral reactions during human manipulation, as well as semen quality and testicular functionality.

Companion animals get close to the toxic aspects of antropogenic world: cytotoxicity of phthalates and bisphenol A on dog testicular primary cells.

Phthalates, which are among the most abundant plasticizers, have detrimental effects on the reproductive system. Similar to human, dogs are prominently exposed to phthalates in daily routines at low concentrations; while toys, training devices and commercial dog foods are considered as the primary sources of exposure. This study aimed to reveal and compare the cytotoxic effects of selected phthalates (Benzyl butyl phthalate (BBP), Diethyl phthalate (DEP), Bis (2-ethylhexyl) phthalate (DEHP), Di-'isobutyl' phthalate (DIBP), Di-'isodecyl' phthalate (-DIDP) Di-'isononyl' phthalate (DINP), Dimethyl phthalate (DMP), Di-n-octyl phthalate (DNOP)), and Bisphenol A (BPA) following 24 h exposure on primary testicular parenchymal cells of dog in vitro at concentrations between 0.001 and 2.5 nM. According to cytotoxicity results, DEHP was found to be the most toxic phthalate with IC50 at 22.53 µM; while DMP was the least (169.17 nM). IC50 of BPA was 161.81 nM, less than the average (61.95 nM) of phthalates. In addition, dog primary testicular cells were found more susceptible to the high molecular weight phthalates (DNOP, DEHP, DINP, DIDP) than low molecular weight phthalates (DMP, DEP, DIBP, BBP). Further studies should focus on morphological, physiological and molecular differences to comprehend the mechanisms involved as well as decreasing the risk for impaired spermatogenesis caused by environmental toxicants in companion animal medicine.

Semen collection by trans-rectal digital stimulation and insemination campaign in goat.

The overall purpose of this study was to describe a method of semen collection via trans-rectal digital massage (TDM) and to carry out a related fertility trial in Angora goat. Sixteen Angora bucks (ranging 1-4 years) and 28 nulliparous does (1-2 years) were used in this study. Semen samples were collected via trans-rectal massage from 85.71% of the bucks in multiple attempts (18/21). The mean values of volume, pH, mass motility, total motility, concentration, viability, abnormal spermatozoa rate and ejaculation time were 0.64 ± 0.09 ml, 6.3 ± 0.21, 2.7 ± 0.34, 58.18 ± 5.1%, 3.68 ± 0.31 × 109 /ml, 71.38 ± 7.12%, 18.22 ± 2.48% and 3.4 ± 0.33 min respectively. Oestrus was detected with teaser buck and confirmed by using infrared thermography and ultrasonography (US). The success rate of synchronisation was found as 71.4% (20/28). On Day 21, pregnancy diagnosis was performed trans-rectally with US and the pregnancy rate was determined as 78.57% (11/14). TDM method of semen collection seems to be easily applicable to the buck and it could be a good alternative to collect semen as well as its use in artificial insemination campaign. Thermal monitoring is found to be a valuable tool to monitor the response to hormonal driven ovulatory synchronisation in Angora does during timed artificial insemination.

Effects of phthalates on bovine primary testicular culture and spermatozoa.

Among environmental endocrine-active chemicals, phthalates, commonly known as plasticizers, disrupt the development of the male reproductive tract. In this study, the effects of phthalates (DIBP, BBP, DINP, DBP, DEP, DEHP and DMP) were evaluated on cultures of bovine primary male reproductive cells (n = 3) and spermatozoa (n = 4). Epididymal (caput and corpus epididymis), testicular (parenchymal and mediastinal/tubular) and vas deferens cells (VDC) were prepared from samples collected from slaughterhouse. Second part of caput epididymis which have fewer amount of principal cells, were found to be less affected compared to the first part except DEHP; while corpus epididymis was found to be more affected with IC50 values below 0.976 ng/mL (except for DEP at 4.97 ng/mL). In testicular parenchymal cells, IC50 ranged from 0.15 to 4.11 ng/mL and for mediastinum from 0.01 to 7.31 ng/mL; where cytotoxic effects were more evident in mediastinal section. Least cytotoxic and even proliferational effects (DEHP, DMP and DEP) were observed in VDC, the muscular tube carrying sperm from epididymis to the ejaculatory duct. Least spermiotoxic phthalate was DBP (3.928 ng/mL); while DINP (0.550 ng/mL) induced highest cytotoxic effect on bovine spermatozoa. Differences in the cellular structure and/or the androgen receptor distribution effect the toxicity of phthalates. Our preliminary findings on bovine spermatozoa indicate possible morphological and motility alterations; which challenges further investigation of the transition of phthalates on semen straws used in cryopreservation. Increase of exposure to environmental contaminants raise the issue of the requirement of a new perspective on reproductive health, species and tissue specific differences should further be emphasized.

Effect of polyvinyl alcohol on survival and function of angora buck spermatozoa following cryopreservation.

The aim of this study was to examine effects of polyvinyl alcohol (PVA) on buck semen quality. Seventy-five ejaculates were collected and diluted in Tris-egg yolk extender containing one of three PVA co-polymers of 9, 18 and 100 kDa. Five different concentrations 0.001, 0.01, 0.1, 1 and 2% of the PVA co-polymers were added to the extender with respected to the decreasing glycerol concentrations of 5, 4, 3, 3, 2% respectively. Following freeze-thaw, sperm motility, viability, acrosome-intact spermatozoa and mitochondrial membrane potentials were analysed. During freezing, sperm seeding temperature were recorded with a cryo-thermometer. PVA 2% glycerol group gained 8.2 ±â€¯1 °C latent heat plateau difference comparing to control. Highest motility was found in PVA 18 kDa with regardless of the dosage (P < 0.001). All PVA copolymers gained higher motility independently in all other dosage groups (except PVA 2%) comparing to control (P < 0.001). Live spermatozoa rate between treatment groups were statistically insignificant (P = 0.953), however, when moribund sperm were gated out PVA 9 induced better protection with respect to other groups (P < 0.05). Intact acrosome rate was statically higher in PVA groups (P < 0.002) and subgroups (P < 0.001). Mitochondrial membrane potential was higher in all experimental groups comparing to control group (P < 0.001). PVA co-polymer concentrations of 0.01, 0.1, 1 and 2% v/v (PBS: PVA) decreased the concentration of glycerol required for freezing in a 100 ml volume by 0, 1, 2, 2, and 3% v/v from the control dose (5%), respectively. In conclusion, synthetic PVA-derived ice blocking agents offer new opportunities for improving the post-thaw buck sperm quality.

Genomewide association of male reproductive traits in Aksaray Malakli dogs.

Male reproductive parameters are often used for the functional examination and evaluation of predicted genetic values for future aspects. However, these traits are relatively reliable until the measurable effects are expressed on desired traits. Therefore, we aimed to associate the single nucleotide polymorphism (SNP) genotype of the investigated characteristics and reproductive loci. A total of 46 male dogs are divided into three age groups (I ≤ 3 years, n = 19; II 4-6 years; n = 19, and III ≥7 years, n = 8). The testis, scrotum and body weight, libido sexualis and ejaculation time for each fraction were monitored as functional traits, while the pH, fractional semen volume, motility, concentration, and abnormal and dead spermatozoa rate were recorded as spermatological traits. The Affymetrix Canine 127 K SNP genotyping array v2 (Affymetrix Inc., California, USA) was used for SNP genotyping. In the primary results, the scrotal circumference was found to be higher in group II compared to other groups (p < 0.05) and the lowest total abnormal spermatozoa rate was found in group I (p < 0.05). The normal spermatozoa rate was found to be significantly above the threshold in relation to the SNP in chromosome 17. In conclusion, this study represents an exciting first step towards SNP association with dog semen spermatological parameters. Future studies might be undertaken to evaluate this SNP region for gene-knockout and expression analysis and for fine mapping to validate and/or discover the exact position of the effect region.

Effect of cholesterol loaded cyclodextrin on semen cryopreservation of Aksaray Malakli shepherd dogs of different ages.

The objective of the study was to determine the effect of cholesterol-loaded cyclodextrin (CLC) on the quality parameters of semen from Aksaray Malakli Shepherd dogs of different age groups. Forty-eight male dogs were divided into 3 groupings according to their ages (young age (Y): ≤3 years, n: 20; middle age (M): 4-6 years, n: 20; old age (O): ≥7 years; n: 8). The sperm-rich portion of the ejaculate from each dog was divided into four aliquots and extended with either tris as a control (C) or tris loaded with 0.5, 1.0, and 1.5 mg/120 × 106 CLC as low (L), intermediate (I), and high (H) doses, respectively. Following equilibration for at least half an hour, the straws were frozen in nitrogen vapor and then stored in liquid nitrogen at least for 48 h. Later, the frozen straws were thawed in a water bath for spermatological evaluation. Significant differences were observed between different age groups in terms of the spermatological parameters (p < 0.05). The evidence suggests that increasing age is associated with poor in-vitro spermatological parameters and CLC was able to protect the acrosome integrity from cryo-damage during the freeze-thawing process. Better semen freezability characteristics were obtained at young ages, considering the overall parameters.

Vulvar thermal pattern following synchronization of estrus is linked to fertility after timed artificial insemination in goat.

Aim of this study was to study the vulvar thermal pattern variation during the timed artificial insemination protocol in Angora goat and identify the relationship with the successful rate. Does (36 adult healthy females) were synchronized using PGF2α at the day 0, 11 days of progesterone impregnated sponges intra-vaginally, PMSG 48 h before sponges withdraw (day 11) and the intra-cervical inseminations were carried out 48 h later (Timed Artificial Insemination: TAI) with chilled semen. Vulvar (VST) and perivulvar (PST) areas were considered to evaluate the thermal pattern during the protocol at the day 0 and at the TAI using a thermo camera (E60, FLIR System). Differences of temperature (ΔT) between the surfaces were calculated for each time. The does were monitored for pregnancy, delivery time and prolificacy. Pregnant (P) and non-pregnant (NP) does were compared in terms of VST, PST and ΔT using two ways ANOVA considering time and pregnancy as sources of variability. VST was lower than PST in all the monitored does (P < 0.05) (34.79 ± 0.14 vs 36.58 ± 0.14 °C) and without differences between P and NP at day 0 (35 ± 0.18 vs 36.39 ± 0.22 °C). Significant difference (P < 0.05) between P and NP does was recorded at TAI in terms of VST (33.89 ± 0.31 vs 35.40 ± 0.24 °C) and ΔT (-3.16 ± 0.34 vs -1.62 ± 0.26 °C). In conclusion thermal emission by glabrous surfaces in goat may be used to identify the right response induced by hormonal treatments and to optimize the application of assisted reproductive techniques at the field level.

Acute renal artery thrombosis after kidney transplantation / Trombose aguda de artéria renal após transplante de rim

Early kidney transplant loss as a result of acute thrombosis of the renal artery remains a constant and devastating complication, with an incidence of 0.2-7.5%. While uncommon, arterial obstruction in the early postoperative period is a surgical emergency and must be ruled out if previously established diuresis ceases suddenly. Arterial thrombosis may occur as a result of injury to a diseased artery, problems with anastomoses, hypercoagulability or malpositioning of the allograft. In this study, we analyzed data on a group of 105 renal transplant recipients who presented with acute postoperative graft dysfunction between January 2006 and May 2012, to identify cases of acute renal artery thrombosis. We report on our experience of immediate re-transplantation following early kidney transplant thrombosis. Overall, two (1.9%) patients suffered early (within 48 hours of surgery) allograft renal artery thrombosis. In both patients, transplantation had not been complicated by atherosclerotic lesions or other thrombophilic states and postoperative diuresis had been successfully achieved, but diuresis ceased abruptly during the early postoperative period. Emergent duplex ultrasound scans were performed and acute renal artery thrombosis was detected in both patients. The patients were operated immediately and retransplantation procedures were conducted. We have reported our experience of immediate retransplantation following early primary graft dysfunction due to renal artery thrombosis. In conclusion, close monitoring of postoperative diuresis and, if necessary, immediate retransplantation in this situation can prove to be a successful treatment for preventing graft loss.

A perda precoce de transplante renal resultante de trombose aguda da artéria renal permanece sendo uma complicação constante e devastadora, com uma incidência de 0,2-7,5%. Apesar de incomum, a obstrução da artéria no período pós-operatório imediato é uma emergência cirúrgica e deve ser descartada caso a diurese previamente estabelecida se interrompa de forma súbita. A trombose arterial pode ocorrer como resultado de dano à artéria previamente doente, problemas com anastomoses, hipercoagulabilidade ou mal posicionamento do enxerto. Neste estudo, analisamos os dados de 105 receptores de transplante renal que apresentaram disfunção aguda do enxerto no pós-operatório entre janeiro de 2006 e maio de 2012, para identificar casos de trombose aguda da artéria renal. Relatamos nossa experiência com retransplante imediato após trombose precoce de transplante renal. Ao todo, dois (1,9%) pacientes apresentaram trombose precoce (dentro de 48 horas após a cirurgia) da artéria renal do enxerto. Em ambos os casos, não haviam ocorrido complicações relacionadas a lesões ateroscleróticas ou outros estados trombofílicos durante o transplante, e a diurese pós-operatória havia sido estabelecida com sucesso, porém cessou bruscamente no pósoperatório imediato. Ecografia dúplex de emergência foi realizada e revelou trombose aguda de artéria renal nos dois pacientes. Os pacientes foram operados imediatamente, e foi realizado o retransplante. Relatamos nossa experiência com retransplante imediato após disfunção precoce do enxerto primário devido a trombose da artéria renal. Concluise que o monitoramento da diurese no pós-operatório e, se necessário, a realização do retransplante imediato nessa situação podem ser um tratamento bem-sucedido para evitar a perda do enxerto.

Post-kidney transplantation external iliac artery stenosis due to vascular clamp: report of a case / Estenose de artéria ilíaca externa após transplante renal devido a clampe vascular: relato de um caso

We report a case of right external iliac artery stenosis after kidney transplantation surgery caused by vascular clamp application injury. The patient presented with claudication of the ipsilateral lower limb and the lesion was diagnosed angiographically. The patient was treated with endovascular stent placement...

Relatamos um caso de estenose da artéria ilíaca externa direita após cirurgia de transplante renal causada por lesão durante a colocação de um clampe vascular. O paciente apresentou claudicação do membro inferior ipsilateral e a lesão foi diagnosticada angiograficamente. O paciente foi tratado com colocação de stent endovascular...

Gastric histopathological findings and ghrelin expression in morbid obesity.

OBJECTIVE: The role of Ghrelin, also known as the appetite hormone, is not fully explained in the development of morbid obesity. Plasma Ghrelin level is low in obese and high in slim subjects. Ghrelin-expressing cells were investigated histopathologically in the stomach of morbid obese patients in this study. Tissue Ghrelin expression was also compared with various parameters such as the distribution of endocrine cells, age, gender, body mass index, preoperative plasma Ghrelin level and presence of accompanying diseases. MATERIAL AND METHOD: The study included 33 morbidly obese patients, and 8 non-obese control patients. Plasma Ghrelin levels were measured preoperatively. Sleeve gastrectomy resection materials of 33 cases were evaluated with histopathological and immunohistochemical (Ghrelin and Chromogranin-A) techniques. The results were statistically evaluated by nonparametric tests. RESULTS: Histopathological findings observed in sleeve gastrectomy resection materials were interstitial lymphocytic infiltration (63.6%), hyperplasia of lymphoid follicles in the lamina propria (60.7%) and microvesiculation / dilatation of parietal cells (57.6%). The number of Ghrelin immunopositive cells in the gastric mucosa in females was significantly higher compared to males (p=0,007). Additionally, the number of Ghrelin immunopositive cells was significantly higher at the fundus-proximal corpus compared to the distal corpus of the stomach (p=0.0001). No significant correlation was found between Ghrelin-chromogranin immunopositive endocrine cell distribution and preoperative plasma Ghrelin levels and endocrine cell hyperplasia. CONCLUSION: Our study confirms that Ghrelin producing cells are most dense in the proximal stomach. Increased number of Ghrelin expressing cells in the gastric mucosa in females compared to males suggests that gender may also be a factor in determining the method for treatment of morbid obesity.

Is short course of antimicrobial therapy for asymptomatic bacteriuria before urologic surgical procedures sufficient?

INTRODUCTION: Duration of treatment of asymptomatic bacteriuria for patients undergoing urologic surgical procedures is undetermined. We compared the efficacy of long- versus short-course antimicrobial treatment in patients with asymptomatic bacteriuria undergoing urologic surgical procedures. METHODOLOGY: Patients were divided into two groups according to duration of antimicrobial treatment. Group A patients received a single dose of an appropriate antibiotic, determined by antimicrobial sensitivity testing, 30 to 60 minutes before the surgical procedure. If a urinary catheter was placed postoperatively, a second dose was given following the recommended dose interval. Group B patients received antimicrobial treatment prior to surgery at least until patient urine became sterile. All patients were monitored for signs and symptoms of septicemia following surgical procedures. RESULTS: None of the patients enrolled in the study developed infectious complications such as sepsis or upper urinary tract infection. In group A, 31 patients were treated with antimicrobials before 39 urological procedures. In group B, the mean treatment time for 28 patients before 30 urological procedures was 8.03 ± 3.86 days. There were also significant differences in length of stay and the cost of antimicrobial therapy between the groups (P < 0.0001). Isolation of an increased number of resistant microorganisms was associated with long course therapy in group B. CONCLUSIONS: Short course therapy protocol may be a practical, simple approach for antibiotic use; it decreases hospital stays, eliminates delayed procedure times, lowers the economic cost of antimicrobials and lessens the chance of superinfection with and spread of antimicrobial resistant microorganisms.

Is laparoscopic antireflux surgery safe and effective in obese patients?

BACKGROUND: It is not clear whether obesity has any negative impact on the results of laparoscopic antireflux surgery (LARS). In this prospective study we investigated the effect of body mass index (BMI) on the surgical outcome of LARS. METHODS: Patients undergoing primary LARS were divided into three groups: BMI < 25 (normal), BMI = 25-29.9 (overweight), BMI > 30 (obese). All perioperative data, operative and postoperative complications, and follow-up data were recorded prospectively. All patients were seen 2 months postoperatively and yearly thereafter. RESULTS: One thousand patients underwent LARS from May 2004 to August 2009. There were 484, 384, and 132 patients in normal, overweight, and obese groups, respectively. The incidence of Barrett's metaplasia (8.5% for the entire series) increased with BMI, although this difference was not statistically significant. 684 patients had Nissen and 316 had Toupet fundoplication. Mean follow-up was 53.33 ± 17.21 months. There was no mortality or conversion to open surgery. Mean operating times were 48.04 ± 21.20, 53.54 ± 23.42, and 61.33 ± 28.47 min for normal, overweight, and obese groups, respectively (P = 0.0001). Esophageal perforation, jejunal perforation, and pulmonary emboli were the three major complications in separate patients. Dysphagia occurred in 18.4, 13.1, and 9.9% of normal, overweight, and obese patients, respectively (P = 0.122). Bloating occurred in 18, 14.1, and 20.5 % of normal, overweight, and obese patients, respectively (P = 0.150). Rehospitalization for any reason, excluding redo surgery or dilatation, occurred less in overweight subjects (4.8, 1, and 3.8% respectively, P = 0.008). All other minor complications were distributed evenly among the groups with the exception of hiccups, which occurred more frequently in normal weight patients. Recurrence of reflux was observed in 0.6, 3.6, and 2.3% of the normal, overweight, and obese patients, respectively (P = 0.007). CONCLUSION: LARS is a safe but more demanding procedure in obese patients and a significant increase in complications should not be anticipated. Long-term control of reflux by LARS in higher-BMI patients is slightly worse than that in normal-weight subjects.

Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: a prospective cohort study.

BACKGROUND: Diabetes mellitus is a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection. We attempted to determine the prevalence and risk factors for MRSA colonization in a population of outpatients with diabetes. METHODS: This prospective cohort study enrolled patients with diabetes. Anterior nares cultures were obtained from patients with diabetes admitted to outpatient endocrinology and metabolism clinics, and risk factors for MRSA colonization were analyzed. RESULTS: Out of the 304 patients evaluated, 127 (41.9%) were colonized with S aureus and 30 (9.9%) were colonized with MRSA. Overall, 23.6% of all S aureus isolates were MRSA. In multivariate analysis, factors independently associated with an increased risk of MRSA colonization included the presence of connective tissue disease (odds ratio, 7.075; 95% confidence interval, 2.157-23.209; P = .001) and insulin therapy (odds ratio, 3.910; 95% confidence interval, 1.652-9.251; P = .002). CONCLUSIONS: The prevalence of MRSA colonization in our sample of diabetic outpatients was 9.9%. Independent risk factors for MRSA colonization were the presence of connective tissue disease and insulin use. A better understanding of the epidemiology and risk factors for nasal MRSA colonization in the persons with diabetes may have significant implications for the treatment and prevention of MRSA infections.

Laparoscopic Nissen versus Toupet fundoplication: assessment of operative outcomes.

BACKGROUND: This study was designed to analyze the outcomes of Nissen fundoplication (NF) versus Toupet fundoplication (TF) in patients undergoing laparoscopic antireflux surgery (LARS). METHODS: All perioperative data, operative/postoperative complications, and follow-up data were prospectively recorded. All patients were seen on the 2nd month postoperatively and by yearly intervals thereafter. All patients have at least 12-month follow-up. Using SPSS software, groups were compared by t-test and chi-square tests as appropriate. RESULTS: One thousand consecutive patients underwent primary LARS from May 2004 to August 2009. Six hundred eighty-four patients had NF and 316 had TF fundoplication. The mean follow-up of the NF (51.26 months) group was slightly longer than the TF group (43.53 months) (P=.018). There was no mortality and conversion. Esophageal perforation, jejunal perforation, and pulmonary emboli were the sole three major complications in separate patients. Dysphagia occurred in 15.4% and 9.9% in NF and TF, respectively (P=.001). Corresponding numbers for bloating were 19.6% and 10.8% in NF and TF, respectively (P=.001). Seventeen patients underwent reinterventions such as dilatation and re-do surgery and all 17 were in the NF group (P<.05). All other minor complications were similar except hiccups, which were seen in 30 patients and all were in the NF group (P<.05). Recurrence of reflux was observed in 1.8% and 2.2% of the NF and TF, respectively (P=.620). CONCLUSION: Both NF and TF are effective procedures in controlling the acid-reflux symptoms. The functional side effects appear more often in the NF group. These side effects can be minimized and reinterventions for severe/prolonged dysphagia can be avoided with TF.

What would be left behind if subtotal thyroidectomy were preferred instead of total thyroidectomy?

BACKGROUND: The choice between subtotal thyroidectomy (STT) and total thyroidectomy (TT) for multinodular goiter (MNG) remains controversial. METHODS: Thyroid tissue samples of 34 patients who underwent TT for multinodular disease between October 2005 and June 2007 in Pamukkale University Hospital, Department of General Surgery were evaluated. Thyroid tissues weighing 2 g each from either side were separated from the main specimen to simulate the tissues that would be left behind if a subtotal resection were performed instead of a total resection. Ki-67 staining was performed. RESULTS: The mean age of subjects was 49.3 +/- 12 years and 25 (73.5%) were females. Papillary microcarcinomas were found in 4 patients, 1 of which was in a residual thyroid specimen (RTS). Micronodule formations were found in 73.5% of specimens simulating residual thyroid. While Ki-67 indexes of residual thyroid tissues were 4.65% in nodules and 1.91% in normal areas (P < .05), they were 5.42% and 2.84%, respectively, for nodular and normal areas in the main specimens (P < .05). CONCLUSION: Remnant thyroid tissues, following STT, have a high percentage of micronodule formation with a remarkable cellular proliferative activity.

Tempol reduces bacterial translocation after ischemia/reperfusion injury in a rat model of superior mesenteric artery occlusion.

PURPOSE: We investigated whether Tempol, a water-soluble antioxidant, prevents the harmful effects of superior mesenteric ischemia/reperfusion on intestinal tissues in rats. METHODS: The rats were divided into three groups of 10. In group 1, the superior mesenteric artery (SMA) was isolated but not occluded, and in groups 2 and 3 the superior mesenteric artery was occluded for 60 min. After that, the clamp was removed and reperfusion began. In group 3, 5 min before the start of reperfusion, a bolus dose of 30 mg/kg Tempol was administered intravenously and continued at a dose of 30 mg/kg for 60 min. All animals were euthanized after 24 h and tissue samples were collected for analysis. RESULTS: There was a significant increase in myeloperoxidase activity, malondialdehyde levels, and the incidence of bacterial translocation in group 2, with a decrease in glutathione levels. These parameters were found to be normalized in group 3. The intestinal mucosal injury score in group 2 was significantly higher than those in groups 1 and 3. CONCLUSION: Tempol prevents bacterial translocation while precluding the harmful effects of ischemia/reperfusion injury on intestinal tissues in a rat model of superior mesenteric artery occlusion.

Penetrating abdominal wound caused by a close-distance blank cartridge pistol shot: a case report.

Blank cartridge pistols, which are produced for self-defense needs and considered harmless, can be easily purchased by adults due to lack of legal regulations. We present this case because injuries caused by blank cartridge pistol shots may be fatal and are rarely encountered in emergency departments. A 15-year-old boy was brought to the emergency department with a wound on his abdomen caused by a blank cartridge pistol shot. Physical examination revealed an entrance wound, 1 cm in diameter, with a ring-shaped abrasion, 4 cm in diameter, and a surrounding area of contusion, just 2 cm caudal to the left arcus costarum on the anterior axillary line. Muscular defense and rebound tenderness were present in all quadrants of the abdomen. The patient underwent an exploratory laparotomy. At the time of surgery, a proximal jejunal perforation on the antimesenteric side, approximately 1 cm in diameter, and left-sided hematoma of the greater omentum were identified. A wedge resection of the perforated jejunal loop with end-to-end anastomosis and partial left-sided omentectomy were performed. A mass education on the dangers of these guns and the harm they can cause as well as legal regulations for their restricted use seem to be necessary. Physicians should keep in mind that blank cartridge guns can cause fatal injuries.

The incidence of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography.

BACKGROUND: Mirizzi syndrome is a rare complication of cholelithiasis, characterized by the narrowing of the common hepatic duct as a result of mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct. In this study, we aimed to describe the clinical presentations, investigations, operative details, and complications of seven patients who underwent endoscopic retrograde cholangiopancreatography and were finally diagnosed with Mirizzi syndrome in our center. METHOD: We performed a retrospective analysis of the records of 7 patients with Mirizzi syndrome who underwent endoscopic retrograde cholangiopancreatography. RESULTS: The incidence of Mirizzi syndrome was 1.07% of 656 patients given endoscopic retrograde cholangiopancreatography. Ultrasonography was able to diagnose one case. Endoscopic retrograde cholangiopancreatography suggested the diagnosis in five cases and helped further in the management of these patients. Four patients had cholecystectomy and T-tube placement, and two had cholecystectomy and choledochoduodenostomy. One patient with type I Mirizzi syndrome according to the Csendes classification successfully underwent laparoscopic cholecystectomy. CONCLUSIONS: In the study, the incidence of Mirizzi syndrome was 1.07% of patients who underwent endoscopic retrograde cholangiopancreatography. Preoperative diagnosis of Mirizzi syndrome by endoscopic retrograde cholangiopancreatography is important to prevent complications.