Lymphocyte count and NLR as predictive value for the severity of acute cholangitis.

OBJECTIVE: Acute cholangitis is a serious infectious condition in which systemic complications occur and can lead to mortality. In this study, we tried to elucidate the relationship between lymphocyte count and neutrophil-lymphocyte ratio (NLR) with disease severity in patients with acute cholangitis. PATIENTS AND METHODS: In this retrospective analysis, 633 patients who met the definitive diagnosis criteria for acute cholangitis were enrolled as the study group. In the same period, 155 patients without acute cholangitis who had normal inflammatory markers and underwent endoscopic retrograde cholangiopancreatography (ERCP) were included in the study as the control group. The lymphocyte count, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) of the acute cholangitis group, the control group, and the acute cholangitis group were compared according to the severity of cholangitis. RESULTS: There was a statistically significant correlation between the severity of cholangitis and the degree of lymphocytopenia (p<0.05). It was observed that as the disease severity increased, the proportion of patients with normal lymphocytopenia degree decreased, and abnormal findings increased. It was seen that the NLR and PLR results of the patients increased as the severity of cholangitis increased. CONCLUSIONS: As a result, one can conclude that the increase in the severity of cholangitis caused an increase in NLR and PLR and a decrease in lymphocytes. Although the increase in NLR and lymphocytopenia results were considered statistically significant, the increase in PLR was not at an acceptable level.

The Effect of Different Surface Roughening Systems on the Micro-Shear Bond Strength of Aged Resin Composites.

BACKGROUND: There are controversies regarding the most effective surface treatment method to be applied for the effective repair of resin composites. AIMS: This study aimed to compare the effects of surface roughening processes on repair bond strength of different types of aged composites. Water aging was applied to 60 nanohybrid and 60 micro-hybrid resin composite samples for 1 year. Samples were randomly divided into five groups and four types of roughening processes. Bur, OPTIDISC, SUPERSNAP, and BISCO were applied to the water-aged resin composite samples. Micro-shear test method was used to measure the repair bond strength. MATERIALS AND METHODS: Data were analyzed with IBM SPSS V23. Compliance with normal distribution was examined by Kolmogorov-Smirnov test. Two-way analysis of variance (ANOVA) and Tukey HSD test for multiple comparisons were used. RESULTS: The main effect of the type of resin composites and surface roughening methods were found to be significantly different. The MPa values of surface roughening groups were similar while the lowest mean value was obtained for the untreated group of the nanohybrid resin composite (P < 0.001). The bond strength for both resin composites was generally considered within acceptable limits except for no treatment group of nanohybrid resin composite. CONCLUSIONS: This study showed that surface roughening method is mandatory for effective bond strength and the type of fillers in resin composite affects the micro-shear bond strength.

Endoscopic treatment of biliary complications after duct-to-duct biliary anastomosis in pediatric liver transplantation.

BACKGROUND: Studies reporting outcomes of endoscopic treatment methods in children who underwent liver transplantation (LT) is very limited. We present our outcomes, as a high-volume transplant center where endoscopic methods are preferred as the first choice in the treatment of biliary complications in children. METHODS: Patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) as the first treatment approach for biliary complications after LT between 2005 and 2017 were included. Clinical data included patient demographics, ERCP indications (stricture or leak), and treatment outcomes, including the need for percutaneous and surgical intervention. RESULTS: ERCP was performed in 49 patients who had a duct-to-duct anastomosis (38 living donor liver transplantation (LDLT), 11 deceased donor liver transplantation (DDLT)). The most common biliary complication was stricture. Our endoscopic success rate was 66.7% (18/27) and 75% (6/8) in LDLT and DDLT patients with stricture (p > 0.05), respectively. While our endoscopic success rate was 75% (3/4) in patients with leak alone after LDLT, it was 25% (1/4) in patients with leak and stricture in this group. The endoscopic success rate was 50% in two patients who had leak alone after DDLT. CONCLUSIONS: ERCP should be considered as a preferential treatment option for the management of biliary complications in pediatric liver transplant patients with duct-to-duct anastomosis, as in adults.

Relationship between nucleotide-binding oligomerization domain-containing protein 2 variants and severity of acute pancreatitis.

BACKGROUND AND AIM: Intestinal barrier dysfunction has been implicated in the development of infectious complications of acute pancreatitis. Nucleotide-Binding Oligomerization DomainContaining Protein 2 (NOD2) plays an important role in the proper functioning of intestinal defense mechanisms. Here, we investigated the frequency of NOD2 variants in patients with mild and severe acute pancreatitis. MATERIALS AND METHODS: Groups 1, 2 and 3 comprised healthy participants and patients with mild and severe pancreatitis, respectively. Four NOD2 variants and serum interleukin-6 (IL-6), Tumor Necrosis Factor-a (TNF-a) and lipopolysaccharide-binding protein (LBP) levels were analyzed. RESULTS: Three patients (3/32, 9.4%) in the severe pancreatitis group were positive for the p.R702W variant. This variant was negative in other groups. One, three and three patients in the healthy (1/27, 3.7%), mild (3/36, 8.3%) and severe pancreatitis (3/32, 9.4%) groups tested positive for the 1007fs variant, respectively. No significant differences in the frequencies of NOD2 variants were evident among the groups. Serum IL-6, TNF-a and LBP levels were markedly higher in the severe pancreatitis than the healthy and mild pancreatitis groups (all p<0.001). We observed no significant correlation between cytokine levels and NOD2 variants. CONCLUSION: Our results support an association between the presence of the p.R702W variant and severe pancreatitis.

MDCT evaluation of nasopalatine canal morphometry and variations: An analysis of 100 patients.

OBJECTIVE: The goal of this study was to investigate the possible variations in morphology of nasopalatine canal (NPC) morphometry depending on age, gender and absence of anterior incisors using multidetector row computed tomography (MDCT). MATERIALS AND METHODS: A total of 100 patients (50 men, 50 women) with a mean age of 43.29±18.81 (SD) years (range: 18-90 years) who have undergone head MDTC were included into the study. Foramen nasalis diameter (P1), foramen incisivum diameter (P2), NPC length (P3), distance between buccal wall of incisive foramen and facial side of the buccal bone (P4), distances between buccal bone wall of NPC and facial side of buccal bone (P5), distance between mid-NPC buccal wall and facial side of buccal bone (P6), distance between buccal wall of NPC and the apex of anterior central incisors (P7) and NPC angle (P8) were measured. Formal variations in NPC were searched for. Differences in morphometric data were searched using Student t-test or Mann-Whitney test. Gender-based analysis of the variations was done with the χ2 test. Pearson's test was used to search for correlation between morphometric data and age. RESULTS: P1 was larger in men (3.72±1.41mm) than in women (3.07±1.34mm) (P<0.001). Similarly, P3 was larger in men (13.68±2.73mm) than in women (11.43±2.78mm) (P<0.001). No differences in the other NPC measurements (P2, P4, P5, P6, P7, P8) were found between men and women. Morphological variations in NPC (cylindrical, hourglass, banana shape, funnel shape, single canal, Y-type canal, parallel canal and others) were detected with frequencies ranging from 8 to 65.3%. A significant negative correlation was found between NCP measurements and patient age for P3 (r=-0.311; P=0.002), P4 (r=-0.267; P=0.007) and P8 (r=-0.318; P<0.001). New NPC variations, which were not reported before were found in 19% of our patients. CONCLUSION: NPC shows myriad potential variations that have various prevalences. It is assumed that familiarity with these variations may help decrease the incidence of complications during facial or dental surgery.

The evaluation of palatal bone thickness for implant insertion with cone beam computed tomography.

The palate is an alternative anchoring site for orthodontic implants and screws. The use of osseointegrated implants in the intermaxillary suture has recently been described as a fast, effective, and low-cost technique for patients with atrophy of the maxillae. The aim of this study was to use cone beam computed tomography (CBCT) to evaluate the thickness of the bone surrounding the intermaxillary suture in relation to the insertion of osseointegrated implants. CBCT images of 144 patients (72 males, 72 females) aged 35-86 years were evaluated. The vertical bone height of the intermaxillary suture was measured using coronal and sagittal Images 5, 10, 15, 20, and 25 mm posterior to the incisive foramen. The mean bone thicknesses from the anterior to the posterior region were 5.59, 4.38, 3.91, 3.95, and 3.94 mm, respectively. Bone thickness was significantly different among the five anteroposterior areas of the suture, but there were no significant differences between males and females, or among age groups. The highest part of the intermaxillary suture was in the anterior region. Three-dimensional imaging is recommended to accurately identify palate bone thickness for implant placement.

Serum estradiol/free testosterone ratio can be important predictor for varicose vein recurrence in men.

AIM: Recurrent varicose veins are a frustration for both the patient and the surgeon. More investigation of the exact diagnosis, proper practice, and causes for the recurrence of varicose veins is needed. METHODS: We investigated a total number of 187 patients in a five year period with an estradiol-2/free testosterone (E2/fT) ratio relationship on recurrent varicose veins in men between the ages of 20-50. Fifity years was the maximum age due to the age dependent sex steroid hormone regression that occurs after this age, which may interefere with the assessment. Fifty three men with an elevated E2/fT ratio (group A), and 143 men with no endocrinologic problems (group B) were enrolled in the study and had surgery for varicose veins. After 5 years follow up (mean 3 years), Group A (N.=29) and group B (N.=43) had recurrent varicose veins by clinical and radiologic findings. Venous blood samples were driven from all patients of both groups in the morning to detect the levels of serum E2 and fT levels. Patient history of surgery for varicose veins, physical examination, color duplex ultrasound of both limbs, and classification of CEAP were performed in both groups. RESULTS: The serum E2/fT ratio was significantly higher in Group A (5.21 ± 0.56) compared to group B (2.54±0.27) in the recurrent varicose vein groups (p ≤ 0.05). Moreover, there was a high correlation between serum E2/fT ratio and the CEAP clinical classification in group A (5) compared to group B (2) (P≤0.05). Also, recurrence rate was higher in group A (54%) compared to group B (32%)(P≤0.05). CONCLUSION: Elevated serum E2/fT ratio is a precipitating factor for recurrent varicose veins in male patients.

Using oxidant and antioxidant levels to predict the duration of both acute peripheral and mesenteric ischemia.

OBJECTIVE: The aim of this study was to determine the relationship between oxidative stress markers and the duration of ischemia in rat mesenteric and peripheral ischemia models. METHODS: Forty rats were divided into five equal groups, as follows: rats in Group I (control group) were sacrificed to determine the baseline characteristics of the serum markers; the superior mesenteric artery was clamped via a simple laparotomy to induce mesenteric ischemia in Groups II and III; the right common femoral artery was clamped to induce peripheral ischemia in Groups IV and V. Blood samples were taken at 2 (Groups II and IV) and 6 (Groups III and V) hours after these procedures. The serum total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and paraoxonase-1 (PON-1) enzyme activities were evaluated in the samples obtained from each group. RESULTS: The OSI level of the control group was 91.00±5.46 (mean ± SD). The OSI levels taken 2 hours after the induction of mesenteric ischemia and peripheral ischemia were significantly higher (194.50±11.16 and 301.75±19.98, respectively (p<0.05)). However, these levels decreased to 151.88±17.02 (mesenteric ischemia) and 108.88±9.46 (peripheral ischemia) after 6 hours. The PON-1 levels of Group III (mesenteric ischemia at 6 hours) (99.75±7.26), Group IV (peripheral ischemia at 2 hours) (96.88±4.09), and Group V (peripheral ischemia at 6 hours) (111.25±10.33) were slightly elevated over that of the control group (87.38±5.31). However, the PON-1 level of Group II (mesenteric ischemia at 2 hours) (42.88±3.14) was lower than that of the other groups (p<0.05). CONCLUSION: Despite the increment of oxidative markers in early periods of ischemia (2(nd) hour), which was a hypoxic response of ischemic cells, they have decreased markedly in prolonged ischemia. This might have been caused by the opening of some collateral circulation or the destruction of the ischemic cells.

Serum ischaemia-modified albumin level is an irrelevant predictive factor for ischaemic duration in mesenteric ischaemia.

BACKGROUND: Acute mesenteric ischaemia is an emergency condition that requires urgent and expeditious diagnosis and immediate surgical or medical intervention. The initial hours are critical for the recovery of the affected bowel segment. Thus, its clinic diagnostic biomarkers are important when it comes to reducing mortality and morbidity rates. METHODS: Twenty-four male Sprague-Dawley rats were included in the study. The rats were divided into three equal groups. Those in Group I were sacrificed to determine the basal serum values of ischaemia-modified albumin (IMA) after a simple laparotomy. The superior mesenteric artery (SMA) was clamped in a simple laparotomy in Groups II and III; blood samples were taken at 120 minutes in Group II and 360 minutes in Group III. The serum IMA levels were identified from the blood samples and the results obtained were compared statistically. RESULTS: The serum IMA levels were determined to be 22±6 (22) µ/L, 34±7 (34) µ/L and 36±4 (37) µ/L in Groups I, II and III, respectively. The differences between the groups were not statistically significant. CONCLUSION: Our results showed that the serum IMA level is not an appropriate biomarker for acute mesenteric ischaemia. Additionally, the IMA level is not an appropriate biomarker for the detection of ischaemia duration. However, future studies should be conducted to clarify the efficacy of serum IMA levels under different ischaemic conditions.

Iloprost reduces myocardial edema in a rat model of myocardial ischemia reperfusion.

OBJECTIVE: Myocardial ischemia severely reduces myocyte longevity and function. Extensive interstitial edema and cell damage occur as a result of myocardial reperfusion injury. Current therapies are directed at prevention of ischemia-induced damage to cardiac tissue. Iloprost is a novel pharmaceutical agent for the treatment of ischemia. METHODS: Twenty rats were segregated into four experimental groups. The procedure control group consisted of four rats undergoing a sham operation. The remaining 16 rats were divided into two equal groups. The first group (control group) received a continuous intravenous infusion of physiological serum immediately prior to the procedure. Iloprost was administered by a continuous intravenous infusion into the right jugular vein at an infusion rate of 100 ng/kg/min for 30 minutes prior to reperfusion in the experimental group (study group). Following the infusion treatments, ligation of the left coronary artery was conducted for 30 minutes to induce myocardial ischemia. The rats were euthanized 24 hours after reperfusion and cardiac tissue was harvested from all specimens for analysis. RESULTS: Histological examination revealed three myocardial tissue specimens with grade II damage and five myocardial tissue specimens with grade III reperfusion injury in the control group. However, the study group consisted of two grade III myocardial tissue specimens, five grade II myocardial tissue specimens and one grade I myocardial tissue specimen. Moreover, a statistically significant reduction in myocardial edema was observed in the study group (p=0.022). CONCLUSION: Our results support the hypothesis that iloprost enhances protection against cardiac ischemia reperfusion injury. This protective effect may be associated with vasodilation, antioxidant or anti-edema mechanisms.

The predictors of poor outcomes in patients with femoral artery injuries.

PURPOSE: This study investigated the predictors of poor outcomes, including limb loss and death, in patients with femoral artery injuries. PATIENTS AND METHODS: The study included 158 patients aged 2-82 (mean age 28.4 ± 16.5) with femoral arterial injury (common, deep, and superficial femoral artery) that were treated surgically between 2000 and 2010. Isolated venous injuries were excluded. Demographic and clinical data of the patients, including age, gender, admission time, pulse rate and blood pressure, hematocrit value, reason of injury, associated injury, and Mangled Extremity Severity Score (MESS) were recorded. RESULTS: Of the 158 patients, the death and amputation rates were 5.7% (9) and 5.1% (8), respectively. In logistic regression analysis, four variables (pulse rate, MESS, hematocrit, and bone trauma) were found to be independent predictors for poor outcomes. The Odd's ratios and confidence interval values of these variables were as follows: 7.24 (1.94-26.92), 21.75 (5.41-87.48), 5.93 (3.04-11.54) and 7.46 (2.09-9.56), respectively. CONCLUSIONS: The MESS value, presence of bone fracture, hematocrit, and pulse rate on admission are predictive risk factors for poor outcomes in patients with femoral artery injury. Therefore, in these patients, prompt intervention by experienced surgeons is crucial for limb salvage and decreased mortality.

Determination of oestrous cycle of the rats by direct examination: how reliable?

For determination of the oestrous cycle in rats classical Papanicolaou technique has long been used successfully. Instead of using many stains in Papanicolaou, staining the vaginal secretions with only methylene blue has also been defined. Recently a new technique in which vaginal samples are directly examined under light microscope has been introduced. The aim of this study was to assess the reliability of this new technique by comparing it with the classical staining techniques. From 20 Wistar rats 60 vaginal samples were collected with a micropipette, three from each. Briefly, the vagina was flushed two to three times then the fluid was placed onto a glass slide. The fluid was equally distributed onto three glass slides. The glass slides were coded. Two samples were stained with Papanicolaou and methylene blue while the other one was examined directly. Determination of the phases of the oestrous cycle was made by the same histologist who was blinded to the groups and coding system. After determination of the oestrous phase in all samples, the results were compared and it was found that the results were matching. In conclusion, the same results can be obtained with the direct examination technique and this technique is reliable, so there is no need to use relatively time-consuming, less practical and more expensive techniques such as Papanicolaou or methylene blue.

[Antimicrobial susceptibilities and serotype distribution of Streptococcus agalactiae strains isolated from pregnant women]. / Gebe kadinlardan izole edilen Streptococcus agalactiae suslarinin antimikrobiyal duyarliliklari ve serotip dagilimi.

Streptococcus agalactiae (Group B streptococcus, GBS) is an important cause of neonatal morbidity and mortality. The aim of this study was to determine the serotype distribution and antibiotic susceptibility patterns of GBS isolated from pregnant women. A total of 671 pregnant women were screened for vaginal carriage of GBS, and vaginal colonization rate was found to be 14.6%. All GBS isolates were susceptible to penicillin, vancomycin, chloramphenicol and ofloxacin. The rates of GBS resistance to tetracycline, erythromycin and clindamycin were 81.6%, 24.5% and 19.4%, respectively. The serotype distribution of GBS isolates was as follows in order of frequency; serotype III (33.7%), serotype Ib (24.5%), serotype V (18.4%), serotype Ia (7.1%), serotype IV (3.1%) and serotype II (2%). Eleven GBS isolates could not be serotyped by the antisera set used in the study.

The effect of rosiglitazone in the prevention of intra-abdominal adhesion formation in a rat uterine horn model.

BACKGROUND: Effects of rosiglitazone in the prevention of adhesion formation were evaluated. METHODS: Eighty Wistar albino rats were randomly grouped into eight equally sized groups. A 2-cm segment of the antimesenteric surface of the right uterine horn was traumatized to form a standardized lesion, using bipolar cautery. A dose-response study was performed with 0.1, 0.3, 1 and 3 mg/kg/day rosiglitazone. Fifteen days later, adhesions were evaluated clinically and histopathologically. A time-response study was performed with 1 mg/kg/day rosiglitazone (the minimum dose found to significantly affect adhesion formation). Rosiglitazone was given for 7 days post-operatively and results were compared with those of control and the 15-day group (time-response). In all these studies, rosiglitazone was orally administered 3 days before the operation and continued post-operatively. In two further experimental groups, rosiglitazone was only administered pre-operatively or post-operatively. RESULTS: Approximately 1 mg/kg/day rosiglitazone was found to reduce adhesion scores both clinically and histopathologically. Duration of treatment was also found to affect the extent of adhesion formation. However, giving rosiglitazone either just pre-operatively or post-operatively did not significantly reduce adhesion formation. CONCLUSION: Rosiglitazone with peroxisome proliferator-activated receptor (PPAR)-gamma agonist activity reduced the formation of i.p. adhesion possibly by reducing the initial inflammatory response and the subsequent exudation in this study.

Correlation between clinical stages and EEG findings of subacute sclerosing panencephalitis.

In this retrospective study 67 patients with SSPE seen between the years 1980 and 1998 were reviewed. Using the criteria of SSPE diagnosis (clinical signs, characteristic EEG patterns, high titres of measles antibodies in the serum and CSF), the patients were divided into two groups. Group A fulfilled all criteria, however, due to the inability of measuring measles antibody before 1987, it was not possible to observe the third criterion in Group B. Among 67 patients, groups A and B consisted of 51 boys and 16 girls ranging in age between 1 to 23 years, mean age 13.1. The male/female ratio was 3.1. The periodic EEG complexes (PCs) were usually bilateral, synchronous and symmetrical. PC amplitude asymmetry was seen in 12 patients and 2 patients had no PC synchronization between the hemispheres. Six patients had more than one form of PC. Delta activity in anterior hemispheres after PC was seen in 40 patients, mostly in stage 2A. Thirty-two patients had focal epileptiform abnormalities in multiple locations at every stage but most frequently in frontal, central and temporal regions. One patient had PC over both hemispheres and periodic lateralized epileptiform discharges (PLEDs) over the right hemisphere. The EEG findings described and observed in our study do not seem to be specific to SSPE but these findings were not atypical or unusual.

A clinically recognizable neuronal migration disorder: congenital bilateral perisylvian syndrome. Case report with long-term clinical and EEG follow-up.

Congenital bilateral perisylvian syndrome (CBPS) is a recently described, neuronal migration disorder, characterized by pseudobulbar palsy, epilepsy and mental retardation and bilateral perisylvian dysplasia. A 15-year-old boy was diagnosed with CBPS according to the typical clinical, and magnetic resonance imaging (MRI) features. The patient was suffering from atypical absence seizures, repeating daily in spite of antiepileptic drug therapy, since age 7 years. He had also experienced rare generalized tonic-clonic seizures and complex partial seizures. Neurological examination showed severe restriction of tongue movements, severe dysarthria, dysphagia, facial diplegia, mild pyramidal signs and moderate mental retardation. A computed tomographic (CT) scan demonstrated bilateral perisylvian enlargement. The diagnosis was corrected with MRI after six years. Frequent irregular generalized spike and wave abnormalities and focal sharp and slow waves over the posterior regions of both hemispheres were shown by electroencephalograms (EEG). The patient was treated with Na-Valproate, carbamazepine and lamotrigine but did now show any significant change in seizure frequency in the eight-year follow-up period. Intractable seizures, mental retardation and particularly congenital pseudobulbar palsy suggest this congenital entity. Those patients who exhibit these typically clinical features, must have MRI.

Diffuse spike-wave status of 9-year duration without behavioral change or intellectual decline.

Continuous, generalized 2.5 to 3.5-Hz spike-wave (SW) discharges were evident in an EEG performed 13 h after a first seizure associated with a viral illness, in an 8-year-old girl. On eye opening, the EEG abnormality was suppressed and replaced by delta activity and brief spike-wave paroxysms. No alteration in consciousness and seizures or behavioral abnormalities accompanied the EEG findings. Based on the EEG, she was diagnosed as having "diffuse electrical status," the rare EEG phenomenon that occurs during wakefulness without associated behavioral changes. Although the child was completely normal clinically, the EEG findings persisted during a 9-year-follow-up period. Ethosuximide (ESM) 1 gr daily resulted in temporary disappearance of the bioelectrical status. During the last 2 years without medication the EEG finding tended to be restricted to the posterior regions.

Electrical status epilepticus lasting for 17 months without behavioural changes.

In an 8-year-old girl a seizure occurred, lasting 45 min with loss of consciousness and deviation of the eyes, 2 days after the onset of mumps. Next day the EEG showed bilateral, synchronized, continuous 2.5-3.5 c/sec spike-wave discharges, more prominent over the posterior regions. The abnormality was suppressed on eye opening and replaced by delta activity and short duration spike-wave paroxysms. Mental activity, hyperventilation, and photic stimulation did not change the pattern. The same EEG pattern persisted during daytime sleep. This picture has lasted for 17 months without any associated epileptic manifestations or behavioural disturbances. Psychometric tests and CAT scan were normal.