Critical care for lung cancer patients: surgical treatment during COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, some factors have led to changes in the management of patients with lung cancer. In our study, we aimed to present our surgical treatment approach to patients with NSCLC during the COVID-19 pandemic. METHODS: Patients who underwent surgery for NSCLC in our thoracic surgery clinic between March 2020 and March 2021 were evaluated retrospectively. The patients operated on were retrospectively evaluated in terms of sex, age, tumor staging, lung resection type, histopathological type, COVID-19 status, length of stay, complications, and mortality. RESULTS: Thirty-five patients, 27 men and 8 women, underwent surgery for lung cancer. The 2 most common types of surgery were lobectomy (in 32 patients) and pneumonectomy (in 3 patients). According to cancer staging based on 8th TNM, 14 patients were stage 2B, 12 patients were stage 2A, and 9 patients were stage 3A. The morbidity rate was 14 %. No postoperative mortality was observed. Nine patients had a history of COVID- 19 before surgery. No significant difference was found in terms of complications in patients with a preoperative history of COVID-19. In the postoperative period, COVID-19 was observed in no patient in our clinic. CONCLUSION: We think that surgical treatments should not be postponed for diseases such as lung cancer, where the mortality rate is high and early diagnosis and treatment are very important. There will be no delay or inadequacy in the treatment of patients if the rules determined during the COVID-19 pandemic and other types of pandemic possibly occurring in the future are followed (Tab. 1, Ref. 23).

Is Dysphagia in Older Patients with Parkinson's Disease Associated With Sarcopenia ?

BACKGROUND: Parkinson's Disease (PD) and sarcopenia share a number of common pathways, and they can potentially affect each other. OBJECTIVE: We aimed to investigate the relationship between dysphagia and sarcopenia in elderly patients with PD compared to healthy controls. METHODS: This case-control study was conducted on 54 elderly PD patients and age-, sex- and body mass index-matched 54 healthy elder persons. Demographic and disease characteristics such as disease duration, stage of disease and Unified Parkinson's disease rating scale were recorded. All subjects were assessed by 10- item Eating Assessment Tool, Gugging Swallowing Screen tests and flexible fiberoptic endoscopic evaluation of swallowing (FEES) as well as Mini nutritional test short form. Also, A simplified screening tool for assessing sarcopenia (SARC-F), five times sit-to-stand and gait speed tests as well as lumbar magnetic resonance imaging (MRI) cross-sectional area of psoas and paraspinal muscles were used for evaluation of sarcopenia. Patients were divided as «with normal swallowing¼ or «with dysphagia¼ according to the FEES results. Three groups were compared among themselves in terms of evaluation methods. RESULTS: Sarcopenia evaluation parameters were significantly higher in patient groups compared to the control group. Moreover, muscle measurements evaluated by MRI in patients with dysphagia are lower than both patients with normal swallowing and control group (p value between 0.001 and 0.011). CONCLUSIONS: Patients with PD have lower muscle mass compared to healthy controls, and the situation is more pronounced in dysphagic PD patients.

Effects of sunflower meal supplementation in the diet on productive performance, egg quality and gastrointestinal tract traits of laying hens.

1. A trial was conducted to study the effects of additional dietary fibre (DF), resulting from partial replacement of soybean meal (SBM) with high-fibre sunflower meal (SFM), on egg production and gastrointestinal tract (GIT) traits in laying hens. 2. A total of 480 Nick Chick white laying hens (21 weeks of age) were randomly assigned to three dietary treatments and fed for 24 weeks. The hens were fed either the control diet based on corn and SBM, which contained 30 g/kg crude fibre (CF) without SFM, or test diets containing 40 g more CF/kg from adding 47 g/kg SFM or 50 g more CF/kg from adding 97 g SFM/kg. Each dietary treatment was replicated eight times (20 hens per replicate). 3. Body weight (P < 0.05), egg production rate (P < 0.05), egg weight (P < 0.01) and egg mass (P < 0.01) linearly increased but feed conversion ratio linearly decreased (P < 0.01) with increasing SFM supplementation. Feed intake, cracked/broken egg ratios and shell less egg ratios were comparable amongst the groups. 4. The egg quality indices were not influenced by dietary treatments, except for the Haugh units, which decreased (linear, P < 0.01; quadratic P < 0.05) when SFM was added. 5. Digestive organ size was not affected by the dietary treatments, but caecum length increased in hens fed SFM (P < 0.05). Digesta pH in the ileum and caecum was reduced linearly (P < 0.01) with SFM supplementation. 6. Small intestine morphology traits improved with 47 g SFM/kg supplementation, whereas negative effects were observed with 97 g SFM/kg. 7. Productive performance of laying hens improved with 40 or 50 g/kg more CF in feed, mostly from SFM supplementation. It was concluded that this performance increase was attributed mostly to the increase in fat content, rather than DF level, when high-fibre SFM was included in layer diets.

Influence of sunflower meal utilisation on growth performance and digestive tract traits of white strain pullets fed from 29 to 112 d of age.

1. A trial was conducted to study the effects of partial replacement of sunflower meal (SFM) for soybean meal (SBM) on growth performance and gastrointestinal tract traits (GIT) in pullets.2. A total of 600 pullets (29 d of age) was randomly assigned to three dietary treatments and fed for 84 d. The birds were fed a practical diet with a low level of crude fibre (CF; LF) or test diets containing a medium or high level of CF (MF and HF) by partial (50% to 75%) replacement of SBM with SFM. Accordingly, the grower diets contained 29, 40 and 51 g CF/kg, which corresponded to 31, 45 and 59 g CF/kg in developer diets. Each dietary treatment was replicated 8 times (25 pullets per replicate).3. Body weight did not differ significantly among treatments at d 29, 84 and 112 d but increased (P < 0.05) with SFM supplementation at d 54. From 29 to 112 d of age, daily feed and energy intake linearly increased (P < 0.01) with SFM supplementation, but body weight gain and feed conversion ratios were comparable amongst the groups.4. Digestive organ size was not affected by the dietary treatments, but gizzard weight increased in pullets fed MF and HF diets (P < 0.01). Digesta pH in the gizzard, duodenum, jejunum and ileum were reduced linearly (P < 0.01) with SFM supplementation, while a quadratic response was observed for proventriculus pH (P < 0.05).5. Small intestine morphology traits improved with a moderate level of CF intake, whereas no benefit was observed with a high level of CF consumption.6. The results showed that use of SFM up to 140 g/kg can be recommended for pullets fed diets based on corn and soybean meal. However, smaller intestinal absorptive capacity with higher SFM supplementation may occur.

Influence of the particle size and form of feed on growth performance, digestive tract traits and nutrient digestibility of white egg-laying pullets from 1 to 112 D of age.

The influence of the grinding and physical form of diets on growth performance, gastrointestinal tract (GIT) development and nutrient digestibility was studied in layer pullets from hatch to 112 d of age. Diet formed a 2 × 2 factorial with 2 hammer mill screen sizes to grind cereals (4 and 8 mm) and 2 forms (mash and crumble). A total of 864 1-day-old layer chickens were randomly assigned to 1 of the 4 treatment groups with 8 replicates (27 birds per replicate). Cumulatively, pullets fed crumbles consumed less feed (P < 0.05) and had better feed conversion ratio (FCR; P < 0.01) than those fed mash. Coarse grinding cereals (CG) improved FCR (P < 0.05) without significant change in cumulative feed consumption compared to that of fine grinding (FG). With regard to body weight gain (BWG), pullets benefited from crumbles from 1 to 56 d of age (P < 0.01). There were interactions (P < 0.05) between screen size and feed form in relation to FCR (1 to 28 d) and overall BWG. At 112 d of age, the relative weight (RW, g/100 g body weight) of the crop, gizzard, pancreas, and liver of crumble-fed birds were lower (P < 0.05) than those for birds fed mash. Pullets fed coarsely ground feed had higher RW of the crop, proventriculus, gizzard, liver, and caecum compared to those fed finely ground feed. Compared to mash feeding, pullets fed crumbles increased (P < 0.05) total tract digestibility of ether extract and crude protein and the activities of pancreatic amylase and lipase. Digestibility of ether extract (P < 0.05) and pancreatic amylase activity (P < 0.01) were higher in birds fed a CG diet than in birds fed the FG regimen. Regarding the nutrition of egg-laying pullets, crumbles might be preferred to mash feed when the main objective is to improve FCR. Data also suggested that cereals used for pullet feed can be ground more coarsely than is in current practice.

Influence of feed particle size and feed form on productive performance, egg quality, gastrointestinal tract traits, digestive enzymes, intestinal morphology, and nutrient digestibility of laying hens reared in enriched cages.

A total of 640 Lohmann LSL hens were randomly allotted to 4 dietary treatments arranged in 2 × 2 factorial with 2 feed particle sizes (fine and coarse) and 2 feed forms (mash and crumble). The 2 particle sizes were achieved by grinding whole corn and wheat in the hammer mill to pass through 4- and 8-mm sieves. The laying hen diet was isonutritive, and each diet was fed to 8 enriched cages of 20 hens from 21 to 52 wk of age. Screen size and feed form did not affect feed intake, egg production, egg weight, egg mass, and quality traits of the eggs, except for yolk color score, which decreased with crumbling of the feed. Feed conversion ratio was greater (P < 0.01) in hens fed the coarsely ground diet than in hens fed the finely ground diet. Crumbling the feed increased (P < 0.01) feed intake and feed conversion ratio compared to those after mashing. The relative weight of the liver and length of the small intestines were greater (P < 0.05) in hens fed crumble than in hens fed mash. Finely grinding cereals decreased (P < 0.01) the pancreas and gizzard weight compared to those after coarse grinding. The pH of digestive organs showed significant responses to feed form. Crumbling resulted in increased (P < 0.01) pancreatic activities of amylase, while lipase secretion was not affected by the manipulations in screen size and feed form. Ileal villus measurements (villus height, villus height/crypt depth ratio, villus surface area) were greater (P < 0.01) in hens fed crumble than in hens fed mash, whereas particle size had no effect. Total tract digestibility coefficients of crude ash and ether extracts were improved narrowing screen size from 8 to 4 mm. Data illustrated that grinding cereals to pass through a 4-mm screen could improve the efficiency of feed conversion. However, feeding crumbles provided no benefit to productive performance and egg quality, although the absorptive capacity of laying hens increased.

Effects of a meal feeding regimen and the availability of fresh alfalfa on growth performance and meat and bone quality of broiler genotypes.

1. The aim of this study was to identify a feeding regimen that encourages good pasture use in slow (SG) and fast (FG) growing broiler genotypes under free-range management. 2. SG and FG birds fed on either an ad libitum (ADB) or a meal feeding (MEF) programme were given free outdoor access with or without fresh alfalfa from day 22 to 72 and from day 22 to 45, respectively. In two consecutive trials, 800 birds of each genotype were included in a factorial design using groups of 40 birds replicated 5 times. 3. Fresh alfalfa consumption did not improve growth performance and meat quality attributes, whereas the feeding regimen had significant implications. When compared with their ad libitum-fed counterparts, meal-fed birds showed a significantly lower body weight at a considerably lower feed consumption rate, leading to a more favourable feed conversion ratio (FCR) during the course of the experiment. 4. The MEF regimen with a strong feed limitation significantly increased crop and gizzard weight in both genotypes. In FG birds, water holding capacity, drip loss, cooking loss and pH 45 in the breast and thigh meat were adversely affected by MEF; however, feed restriction demonstrated benefits with significant decreases in muscle fat accumulation. In SG birds, decreases in protein and dry matter content of the breast and thigh muscle with meal feeding were conclusive. 5. In both genotypes, there was no treatment-related effect on meat yield, mineral composition of the meat or bone mechanical properties. 6. In conclusion, MEF, irrespective of alfalfa intake, may provide a viable method to decrease FCR; it may be able to contribute to the production of chickens with lean carcasses but it was not capable of improving overall meat quality.

Effects of enhancing vitamin D status by 25-hydroxycholecalciferol supplementation, alone or in combination with calcium and phosphorus, on sternum mineralisation and breast meat quality in broilers.

1. The aim of the present study was to examine the effects of improving vitamin D status in broiler diets by supplementary 25-hydroxycholecalciferol (25OHD3), alone or in combination with calcium (Ca) and available phosphorus (aP), on live performance, sternum mineralisation and breast meat quality in broilers. 2. A total of 936 1-d-old Ross 308 broilers were used in the study. After gender determination at the hatchery, chicks from each sex were randomly distributed into three dietary treatments. The following dietary treatments were used in the experiment from hatch to 38 d: (1) A control diet formulated to meet all of the nutrient requirements of broiler chicks according to the management guide; (2) The control diet supplemented with 18.7-15.0 µg/kg of 25OHD3; and (3) The control diet supplemented with 18.7-15.0 µg/kg of 25OHD3 plus Ca + aP. 3. Improvement in vitamin D status by 25OHD3 supplementation, alone or in combination with Ca and aP, had no effect on body weight and feed conversion ratio of broilers. 4. The serum 25OHD3 concentration significantly increased with 25OHD3 and 25OHD3 plus Ca + aP supplementation (P < 0.05), whereas the ionised Ca and Mg concentrations remained unchanged. 5. Sternum absolute weight, ash content and the concentrations of Ca and P significantly increased (P < 0.01) with supplementation of 25OHD3, alone or in combination with Ca + aP. 6. Supplemental 25OHD3, alone or in combination with Ca + aP, slightly increased pH24 (P = 0.05) and decreased (P < 0.01) squeezable water loss in breast meat, whereas it had no significant effect on lightness, yellowness and sarcoplasmic protein solubility. 7. In conclusion, the results suggested that enhancing vitamin D status by 25OHD3 supplementation alone or in combination with Ca + aP may improve sternum structure and mineral accretion. Furthermore, supplemental 25OHD3, even in a nutritionally complete diet, may offer an effective way to improve protein solubility in female broilers.

Comparative evaluation of dietary supplementation with mannan oligosaccharide and oregano essential oil in forced molted and fully fed laying hens between 82 and 106 weeks of age.

The aim of this study was to investigate the efficacy of feed-grade preparations of mannan oligosaccharides ( MOS: ) and oregano essential oil ( OEO: ) in forced molted or fully fed 82-week-old, laying hens. A 2 × 3 factorial experiment investigated the influence of molting vs. full feeding and dietary supplements [i.e., unsupplemented control, MOS (1 g/kg) diet, and OEO (24 mg/kg) diet] on production parameters, egg quality, serum stress indicators, blood constituents, tibial characteristics, liver antioxidant status, and cecal microflora composition. A total of 864 Single Comb White Leghorn hens were randomly assigned to 6 treatments, each with 6 replicates of 24 hens each, and studied for 25 wk. Hens were fed a molt diet containing of 50% alfalfa and 50% wheat bran ( AA+WB: ) for 12 d, then returned to the laying ration. Results indicate that molt vs. full feed impacted more on most variables measured than supplementation or supplement type. Significant (P < 0.01) interactions between molting and diet were observed for the egg production, egg weight, egg mass, and feed conversion ratio ( FCR: ). In fully fed hens, MOS supplementation improved (P < 0.01) the egg production, egg weight, and FCR, and an OEO addition significantly improved the egg production and FCR in forced molted hens. Molting improved egg quality despite the significant regression in ovary and oviduct weight (P < 0.01), though supplements showed no influence. The bone ash (P < 0.01) and mineral content (P < 0.05) of molted hens were significantly lower than those of fully fed counterparts; however, poor mineralization was not reflected in the bones' mechanical properties. No significant differences were observed among treatments for hematological characteristics. Both the MOS and particularly the OEO supplementation improved (P < 0.01) liver antioxidant status and mitigated the significant increase in cecal pathogenic bacteria after molt. Our results indicate that full feeding with an aa+wb diet is an effective non-feed-removal method for molted hens, the benefit of which can be improved with MOS and OEO supplementation.

Effect of anticoccidial monensin with oregano essential oil on broilers experimentally challenged with mixed Eimeria spp.

Essential oil of oregano ( OEO: ) has proven to be a potential candidate for controlling chicken coccidiosis. The aim of the current study is to determine whether OEO and an approved anticoccidial, monensin sodium ( MON: ), as in-feed supplements could create a synergism when combined at low dosages. Day-old broiler chickens were separated into six equal groups with six replicate pens of 36 birds. One of the groups was given a basal diet and served as the control ( CNT: ). The remaining groups received the basal diet supplemented with 100 mg/kg MON, 50 mg/kg MON, 24 mg/kg OEO, 12 mg/kg OEO, or 50 mg/kg MON + 12 mg/kg OEO. All of the chickens were challenged with field-type mixed Eimeria species at 12 d of age. Following the infection (i.e., d 13 to 42), the greatest growth gains and lowest feed conversion ratio values were recorded for the group of birds fed 100 mg/kg MON (P < 0.05), whereas results for the CNT treatment were inferior. Dietary OEO supplementations could not support growth to a level comparable with the MON (100 mg/kg). The MON programs were more efficacious in reducing fecal oocyst numbers compared to CNT and OEO treatments (P < 0.05). Serum malondialdehyde and nitric oxide concentrations were decreased (P < 0.01), whereas superoxide dismutase (P < 0.05) and total antioxidant status (P < 0.01) were increased in response to dietary medication with MON and OEO. All MON and OEO treatments conferred intestinal health benefits to chickens by improving their morphological development and enzymatic activities. The results suggest that OEO supported the intestinal absorptive capacity and antioxidant defense system during Eimeria infection; however, it displayed little direct activity on the reproductive capacity of Eimeria This might be the reason for inferior compensatory growth potential of OEO compared to that MON following the challenge. Combination MON with OEO was not considered to show promise for controlling chicken coccidiosis because of the lack of a synergistic or additive effect.

Serum neopterin as a prognostic indicator in patients with gastric carcinoma.

PURPOSE: To evaluate the possible association between serum neopterin level and clinical and laboratory findings and their prognostic value of patients with gastric carcinoma. METHODS: Serum samples were collected from patients (n = 38) and normal volunteers (n = 39) and stored at -80 degrees C until analyzed. Neopterin, C-reactive protein (CRP), and IL-6 concentration were measured by ELISA. The clinicopathological parameters were determined by reviewing both medical charts and pathological records. RESULTS: Mean neopterin levels were 15.26 +/- 11.46 nmol/L in patients with gastric carcinoma and 9.87 +/- 2.90 nmol/L in the control group. Serum neopterin concentrations were significantly higher in patients with gastric carcinoma than in the control group. The number of patients with elevated neopterin level was significantly correlated with stage, gastric wall involvement, the number of metastatic lymph nodes, and the level of serum CRP. The mean neopterin concentrations were significantly elevated in patients older than 60 years, in the presence of venous invasion and increased metastatic lymph node number, and in patients with elevated CRP levels. Neopterin level was also correlated with overall survival as an independent prognostic indoicator. CONCLUSIONS: Serum neopterin levels were elevated in patients with advanced gastric cancer and correlated with prognostic parameters and overall survival. Moreover, neopterin measured at the time of diagnosis can be used to predict the survival of gastric carcinoma.

Clinical and electrophysiological evaluation of patients with thalidomide-induced neuropathy.

BACKGROUND: Whether thalidomide induces a sensory ganglionopathy or a length-dependent axonal neuropathy is disputed. Moreover no agreement exists concerning the effects of thalidomide dosage on the clinical and electrophysiological findings. OBJECTIVE: We examined the effect of age, gender disease duration, total cumulative dose on the clinical and electrophysiologic parameters. METHODS: Fifteen patients who had previously received 100 mg/day of thalidomide for the treatment of multiple myeloma were evaluated retrospectively. Clinical findings and nerve conductions studies were evaluated using a modified total neuropathy scoring system. RESULTS: Sensory symptoms (p = 0.033, r = 0.552) and objective sensory findings (p = 0.002, r = 0.730) worsened with higher thalidomide doses. There was no effect of age, gender and disease duration, neither on clinical symptoms and objective findings, nor on electrophysiologic data. Twelve patients (80%) developed the electrophysiological findings of neuropathy. Six (40%) had pure sensory and 4 (26.6%) had sensori-motor peripheral neuropathy, while 4 (26.6%) had carpal tunnel syndrome. Sural sensory nerve action potential (SNAP) amplitudes were more prominently reduced compared to SNAPs obtained from the upper extremities. Sural SNAP amplitude showed a tendency toward reduction as the total cumulative dose, although it is not statistically significant (respectively; p = 0.187). Significantly reduced ulnar peroneal and tibial compound muscle action potential amplitudes, slow motor nerve conduction velocities of the ulnar and peroneal nerves were found in the study group compared to reference norms (p < 0.05). CONCLUSION: Our results suggest that thalidomide produces a dose dependent peripheral neuropathy, mainly localized to the peripheral nerves in a length dependent manner. The patient must be monitored closely to prevent irreversible consequences.

Serum vitamin B12, folate, and homocysteine levels and their association with clinical and electrophysiological parameters in multiple sclerosis.

Patients with multiple sclerosis (MS) may have low serum vitamin B12 and folate levels and high levels of homocysteine. We aimed to evaluate serum vitamin B12, folate, homocysteine, mean corpuscular volume (MCV), hemoglobin (Hb), and hematocrit (Hct) levels in patients with MS. We examined the relationship between these parameters and age, sex, disease type, age at onset, disease duration, Expanded Disability Status Score, immunoglobulin G (IgG) index, oligoclonal band presence, visual evoked potentials (VEP) and posterior tibial somatosensory evoked potentials (SEP). These parameters were evaluated in 35 patients during an acute attack and compared to data collected from 30 healthy individuals (control subjects). Serum vitamin B12, folate, homocysteine, Hb, and Hct levels and MCV were low in a proportion of patients with MS (20%, 14.3%, 20%, 6.7%, 3.3% and 10% respectively), whereas only vitamin B12 and folate levels were low in only 3.3% of the control subjects. Homocysteine levels were high in 20% of patients with MS but were within normal limits in the control group. Elevated Hct levels were significantly correlated (p<0.05) with prolonged posterior tibial SEP P1 and P2 latencies compared to the control subjects. Patients with MS who had prolonged VEP and posterior tibial SEP P1 and P2 latencies also had lower vitamin B12 levels compared to patients with normal latencies. Thus, we found a significant relationship between MS and vitamin B12 deficiency, and also demonstrated a relationship between vitamin B12 deficiency, VEP and posterior tibial SEP in MS.

Event related potentials in hypothyroidism.

Central nervous system (CNS) dysfunction is an important consequence of thyroid hormone deficiency Several studies using objective behavioral measures reported that cognition is impaired in patients with hypothyroidism. The aim of the present study is to evaluate objectively the functional changes in the nervous system and possible cognitive effects of hypothyroidism by using event related potentials (ERP) in order to determine the frequencies of these changes in patients with hypothyroidism. Forty-two patients (3 males, 39 females) (mean age: 40 +/- 11) with newly diagnosed primary hypothyroidism were included in the study. In all patients the cause of hypothyroidism were chronic autoimmune thyroiditis. None of them had received thyroid hormone as a replacement therapy. In hypothyroid group both N2 and P300 latencies from FZ, CZ, PZ electrode positions were prolonged relative to controls and the differences were statistically significant; respectively (N200: P < 0.003, 0.003, 0.002--P300: P < 0.008, 0.02, 0.001) N100 and P200latencies from FZ, CZ, PZ electrode positions did not differed significantly from those of normal controls; respectively. (p < 0.140, 0.195, 0.153--p < 0.400, 0.185, 0.766) Latency and amplitudes of P300 did not correlated with FT3, FT4 or neither with TSH values in the patient group. We believe like other's that with the aid of this technique we are able to detect early effect on central information processing compatible with a reduction of processing resources and increased effort necessary for a given task in hypothyroid individuals.

Primary rectal lymphoma: an unusual treatment for a rare case.

Lymphomas may be localised throughout the whole gastrointestinal tract, from oral cavity to rectum. The rectum is a fairly uncommon site for lymphoma compared to other gastrointestinal sites. Primary rectal lymphoma is the rarest disorder accounting for 0.1-0.6% of all colonic malignancies, and 0.05% of all primary rectal tumours. It is unclear whether surgery, chemotherapy, radiotherapy or combinations of these treatments improve the prognosis and survival rate in such patients. The role of surgery in primary rectal lymphoma of the rectum is still controversial. A case of primary rectal lymphoma treated by a combination of chemotherapy and radiotherapy is described.

Operative approach in traumatic injuries of the duodenum.

BACKGROUND: The management of duodenal traumas remains controversial. The experience of Ankara Numune Training and Research Hospital Emergency Surgery Department with duodenal injuries during a 10-year period was analyzed to identify trends in operative management and sources of duodenum-related morbidity and mortality. METHODS AND RESULTS: Between 1994 and 2003, 1799 patients with blunt abdominal trauma were operated on and the incidence of duodenal trauma was 2.8% (50 patients). The injuries were penetrating in 31 (62%) patients and blunt in 19 (38%). Primary repair (PR) of injury was performed in 24 (48%) patients, primary repair and tube duodenostomy (PRTd) in 8 (16%) patients, complex repair (CR) in 11 (22%) patients, and exploration only without a duodenal procedure in 5 (10%) patients. Two of the patients died during laparotomy. The mortality rate was 12% and the incidence of duodenum-related morbidity was 12%. The overall morbidity rate was 40% (20 patients). The most commonly injured portion of the duodenum was DII (58%), and the most frequent cause of duodenum-related and overall morbidity in our series was Grade III duodenal injury. CONCLUSION: Our experience suggests that the use of primary repair in grade III injury may be associated with higher duodenum-related morbidity. Our recommendation is to use complex repair for grade III duodenal injuries.

Matrix metalloproteinase-9 in broncho-alveolar lavage fluid of patients with non-small cell lung cancer.

AIM: To evaluate concentration of MMP-9 in blood plasma and broncho-alveolar lavage fluid (BALF) from patients with non-small cell lung cancer (NSCLC). METHODS: Blood plasma from 40 NSCLC patients and 40 healthy donors was collected and concentrations of blood plasma and BALF MMP-9 were measured using ELISA. Correlation between MMP-9 level and gender, histological type of tumor and stage of disease was analyzed. RESULTS: Levels of blood plasma MMP-9 were significantly higher in NSCLC patients (p < 0.0001) then in control group, and were especially high in patients with stage IV of disease (stage I vs stage IV - p < 0.005, stage II vs stage IV - p < 0.01, stage III vs stage IV - p < 0.01). Also, stage IV of NSCLC was characterized by the highest level of BALF MMP-9 (stage I vs stage IV - p < 0.002, stage II vs stage IV p < 0.002, and stage III vs stage IV p < 0.007). Correlation between blood plasma and BALF MMP-9 levels and gender or histological type of tumor was insignificant. CONCLUSION: Our data revealed significant correlation between tumor stage and BALF and plasma MMP-9 levels in NSCLC patients.

The role of qualitative and quantitative MRI assessment of multiple sclerosis lesions according to their in evaluating the efficacy of intravenous immunoglobulin G.

We evaluation of the role of determining the distribution of brain-stem, cerebellar and cerebral lesions in number and volume by MRI in determining the efficiency of treatment of multiple sclerosis (MS). We studied 24 patients diagnosed as having relapsing and remitting MS, of whom 12 received intravenous immunoglobulin G; a control group of 12 were given placebo. In a double-blind study, MRI was obtained initially and at 3, 6 and 9 months, and interpreted without knowledge of clinical findings, laboratory tests or treatment. The lesions were classified according to their distribution and evaluated qualitatively and quantitatively. Each patient was also examined clinically and scored according to the expanded disability status scale (EDSS) following every MRI examination. All patients in the treatment group showed significant improvement. The lesions decreased in both in size and number in all sites. In the control group lesions increased both in number and size in all sites, but only the increase between 3()and 6 months was statistically significant. In both groups, significant apparent changes were detected in the cerebellum and brain stem. Volumetric evaluation was found to be more helpful than qualitative assessment.