Comparison of the Efficiency of Epidermal Growth Factor and Negative Pressure Wound Therapy in Diabetic Foot Patients.

Advanced modalities are used for wounds where conventional treatment is insufficient in diabetic foot patients. In this study, we investigated the effects of using Epidermal growth factor (EGF) and NPWTmodalities alone or in combination on the frequency and level of amputation. In the retrospective study, which included 286 patients in total, 76 patients were referred with the decision of amputation or amputation was planned during hospitalization. After the treatments, amputation and distalization of amputation were found 73.3% and 33.3% in the conventional treatment patients. While 86.4% amp and 18.2% amp distalization were found in negative pressure wound therapy (NPWT) only patients, this rate was 52.4% and 90.5% in EGF + NPWT patients, 50% and 83.3% in EGF only patients. While amp and distalization rates were found to be significantly better in those receiving only EGF or EGF + NPWT (P = .015, P = .017 respectively for amputation and P = .000 for distalization), no difference was found in those receiving EGF and EGF + NPWT. As a result of our study, although npwt contributed positively to the number and level of amputations compared to conventional treatment, a significant improvement was found in the number and level of amps when EGF was used alone or combined with NPWT. With this result, EGF was thought to be an important treatment modality that should be evaluated in diabetic foot ulcers (DFUs) without amputation decision.

Tamoxifen citrate: a glimmer of hope for silicosis.

BACKGROUND: Inhalation of crystalline silica nanoparticles causes pulmonary damage resulting in progressive lung fibrosis. Currently, there is no effective treatment for silicosis. Tamoxifen citrate is a selective estrogen receptor modulator, which is one of the adjuvant treatment choices for breast cancer. It is also known with its inhibitory effect on the production of transforming growth factor-beta (TGF-ß) and studied for the anti-fibrotic effect in some fibrotic diseases. The aim of the study was to determine the effect of tamoxifen citrate on the prevention of pulmonary fibrosis and the treatment of silicosis. METHODS: A total of 100 adult female Wistar Albino rats (200-250 g) were used in this study. The rats were divided into five groups including 20 rats in each. Rats were exposed to silica for 84 d in all groups. In group 1, rats were sacrificed on the day 84 without receiving treatment. In group 2, rats received 1 mg/kg tamoxifen (tmx1 + 1), from the first day of the study for the whole 114 d of the study. In group 3, (tmx10 + 10) rats were given 10 mg/kg tamoxifen from the first day of the study for the whole 114 d of the study. In group 4 (tmx1), rats were started 1 mg/kg of tamoxifen on day 84 and were given until day 114. In group 5 (tmx10), rats were fed with 10 mg/kg tamoxifen starting from day 84 to day 114. All rats except group 1 were sacrificed on 114 day of the study. Lung inflammation and fibrosis scores, serum TGF ß levels, lung smooth muscle antigen and tissue transforming growth factor ß (t-TGF-ß) antibody staining levels, and number of silicotic rats were compared between groups. RESULTS: Silicosis was caused successfully in all rats in group 1. There were six silicotic rats in group 3 and it was the lowest number of all groups. Plasma TGF-ß levels and fibrosis score were significantly lower in all groups when compared with the control group. Tamoxifen could have preventive or treating effects in silicosis and found that lung fibrosis score was significantly lower in rats treated with tamoxifen. CONCLUSIONS: Tamoxifen treatment after and/or before induction of silicosis decreased lung fibrosis score with blood TGF-ß levels. We hope that this study may introduce a new indication as prophylactic use of tamoxifen in high-risk groups for silicosis and for treatment of silicosis.

Effects of tamoxifen citrate on postoperative intra-abdominal adhesion in a rat model.

BACKGROUND/AIMS: The aim of this study was to evaluate the effects of oral tamoxifen citrate on postoperative intra-abdominal adhesions. MATERIALS AND METHODS: Forty five rats were randomly separated in to 3 groups. Group 1: Control group (15 rats), Group 2: tmx 1 group (15 rats) and Group 3: tmx 10 group (15 rats). The cecum was abraded with a sterile gauze until subserosal hemorrhage had developed. Full- thickness 4-0 silk sutures were also placed in the traumatized anterior cecal wall to increase the adhesive reaction. In Group 1 (control group), adhesion induction was performed and no treatment was given. In Group 2 (tmx 1 group), after adhesion induction, 1 mg/kg/day tamoxifen citrate was given by orogastric gavage. In Group 3 (tmx 10 group), adhesion induction was performed and 10 mg/kg/day tamoxifen citrate was given by orogastric gavage. Rats were sacrificed on postoperative day 30. At the time of second surgery, after the abdominal fascia had been opened blood samples were collected to evaluate serum TGFß-1 levels and following the macroscopic adhesion scoring, tissue specimens of the bowel and adhesions were subjected to histopathological investigation. RESULTS: In group 1 and group 2 we detected higher scores for the macroscopic classification (2.25 ± 1.13 vs. 1.53 ± 0.77) and histopathological scores (2.72 ± 0.64 vs. 2.53 ± 0.87) for fibrosis and serum TGFß-1 levels (42000 ± 2935 vs. 32988 ± 10804). In group 3 we have detected decreased scores for macroscopic classification (0.91 ± 0.51) and histopathological scores (1.58 ± 0.90) for fibrosis and serum TGFß-1 levels (22847 ± 4976). There were no significant differences between group 1 and group 2 according to the macroscopic classification and pathological scores for fibrosis. There were statistically significant difference between tamoxifen 10 mg/kg group and the other groups according to macroscopic classification ( P: G1-3: 0.004; G2-3: 0.046), pathological scores for fibrosis (P: G1-3: 0.004; G2-3: 0.011) and serum TGFß-1 levels (P: G1-3:<0.001). CONCLUSIONS: In conclusion tamoxifen citrate seems to be useful for preventing postoperative intra-abdominal adhesions. Its effects are in a dose and time dependent manner. Further studies must be carried out to use tamoxifen for preventing intra-abdominal postoperative adhesions in clinical practice.

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

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

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

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

Artificial neural networks in the diagnosis of acute appendicitis.

The aim of the study was to assess the role of artificial neural networks in the diagnosis of acute appendicitis in patients presenting with right lower abdominal pain. Data from 156 patients presenting with suspected appendicitis over a 12-month period to a rural hospital were collected prospectively. The sensitivity, specificity, and positive and negative predictive values of the artificial neural network were 100%, 97.2%, 96.0%, and 100% respectively. Artificial neural networks can be an effective tool for accurately diagnosing acute appendicitis and may reduce unnecessary appendectomies.

External validation of Lintula score in Turkish acute appendicitis patients.

PURPOSE: The aim of this study was to evaluate the predictive accuracy of Lintula score in Turkish appendicitis patients. MATERIALS AND METHODS: Data from a total of 156 patients operated with the diagnosis of acute appendicitis were collected retrospectively. The Lintula score was constructed from nine variables (gender, intensity of pain, relocation of pain, pain in the right lower abdominal quadrant, vomiting, body temperature, guarding, bowel sounds and rebound tenderness) with independent diagnostic value in 156 patients. Lintula score was calculated for all patients. Pathological results of the resected specimen were determined and the diagnostic performance of the Lintula score was compared. RESULTS: Hoshmer-Lemeshow and ROC curve analysis was performed and area under the curve was 0.922. Predictive accuracy of Lintula score among Turkish appendicitis patients was statistically significant. CONCLUSION: Lintula score seems to be useful method to diagnose acute appendicitis among Turkish patients and may reduce the rate of negative appendectomy.

Diagnosis and treatment of multiseptate gallbladder with recurrent abdominal pain.

Laparoscopic cholecystectomy is usually performed for gallstones or polyp of the gallbladder. Multiseptate gallbladder is a rare congenital malformation. Although several asymptomatic cases have been described, patient usually present with right upper abdominal pain. We present a 29-year-old female patient with multiseptate gallbladder, cholecystectomy was performed, and her abdominal pain and gastrointestinal complaints have resolved.

Effect of montelukast and MK-886 on hepatic ischemia-reperfusion injury in rats.

BACKGROUND: Hepatic ischemia-reperfusion injury (I/R) may occur in transplantation, trauma, and elective hepatic resections. Leukotrienes have been shown to play a major role in hepatic I/R injury. Five-lipoxygenase enzyme is an important enzyme in the production of leukotrienes from arachidonic acid. MK-886 is an inhibitor of 5-lipoxygenase, and montelukast is a cysteinyl leukotriene receptor antagonist. The aim of this study was to investigate whether MK-886 and montelukast are effective in preventing hepatic I/R injury. MATERIALS AND METHODS: Rats were divided into five groups consisting of seven rats in each: (1) Control I/R, (2) Control-montelukast, (3) Control-MK-886, (4) I/R+montelukast, and (5) I/R+MK-886. Thirty min of total hepatic vascular occlusion and then 60 min reperfusion were performed to animals in groups 1, 4, and 5. In groups 2 and 4, montelukast, and in groups 3 and 5, MK-886 was applied intraperitoneally before and during the surgical procedures. RESULTS: Apoptosis in the liver and intestine decreased significantly in the I/R+montelukast and I/R+MK-886 groups compared with the I/R group. Tissue malondialdehyde levels and glutathione consumptions also decreased significantly in the I/R+montelukast and I/R+MK-886 groups compared with the I/R group. The difference in serum alanine aminotransferase and aspartate aminotransferase levels between the groups did not reach significance. CONCLUSIONS: Montelukast and MK-886 were found to be effective in prevention of liver and intestine injury by reducing apoptosis and oxidative stress in a hepatic I/R model. Anti-inflammatory properties and inhibition of lipid peroxidation by montelukast and MK-886 could be protective for these organs in I/R injury.