Safety and efficacy of nivolumab therapy in patients with metastatic renal cell carcinoma and impaired kidney function.

INTRODUCTION: Patients with renal insufficiency, usually defined as those with creatinine clearance < 40 mL/min, were excluded from pivotal clinical trials, especially in studies involving nivolumab therapy in patients with renal cell carcinoma (RCC). The aim of the study is to evaluate the efficacy and safety of nivolumab in patients with metastatic RCC (mRCC) stratified according to creatinine clearance. MATERIAL AND METHODS: Data from mRCC patients treated with nivolumab were retrospectively analyzed. Patients were classified into two categories according to their estimated glomerular filtration rate (eGFR); the first category (C1) included patients with eGFR < 40 mL/min/1.73 m2 and the second category (C2) included those with eGFR ≥ 40 mL/min/1.73 m2. RESULTS: Of the 95 patients enrolled, 1. group included 26 patients (27.4%) and 2. group included 69 patients (72.6%). None of the pts in category 1 were on hemodialysis. Overall incidence of adverse events was not statistically different between the two groups (P = .469). The overall response rate ORR was 50% in the first group and 42.0% in the second group (P = .486). Median overall survival (OS) was longer with 23.3 months in the 2. group versus 11 months in the 1. group (P = .415). CONCLUSION: Renal insufficiency is a common problem in patients with advanced renal cancer since they often undergo nephrectomy and their renal function may also worsen while receiving tyrosine kinase inhibitor therapy. We found that there is no significant difference in the safety and efficacy of nivolumab treatment between two groups. Nivolumab appears to be a safe and effective agent in patients with renal impairment.

Effects of COVID-19 Disease on DNA Damage, Oxidative Stress and Immune Responses.

Coronavirus disease 2019 (COVID-19) has posed a great threat to public health and has caused concern due to its fatal consequences over the last few years. Most people with COVID-19 show mild-to-moderate symptoms and recover without the need for special treatment, while others become seriously ill and need medical attention. Additionally, some serious outcomes, such as heart attacks and even stroke, have been later reported in patients who had recovered. There are limited studies on how SARS-CoV-2 infection affects some molecular pathways, including oxidative stress and DNA damage. In this study, we aimed to evaluate DNA damage, using the alkaline comet assay, and its relationship with oxidative stress and immune response parameters in COVID-19-positive patients. Our results show that DNA damage, oxidative stress parameters and cytokine levels significantly increased in SARS-CoV-2-positive patients when compared with healthy controls. The effects of SARS-CoV-2 infection on DNA damage, oxidative stress and immune responses may be crucial in the pathophysiology of the disease. It is suggested that the illumination of these pathways will contribute to the development of clinical treatments and to reduce adverse effects in the future.

Risk factors for post-ERCP pancreatitis: it depends on the ERCP indication.

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive modality, and has a high risk of causing post-ERCP pancreatitis (PEP). Risk factors of PEP have been investigated and conflicting results are present for most risk factors. The aim of this study was to evaluate the risk factors for PEP and to determine whether the risk factors differ due to the ERCP indication. PATIENTS AND METHODS: A retrospective study was conducted which included 666 patients with 968 ERCP procedures. Some risk factors were evaluated for PEP, and they were also evaluated separately for patients with bile duct stones and patients who underwent ERCP for other reasons than bile duct stones. RESULTS: In patients with bile duct stones detected on ERCP ; female gender, lower diameter of the common bile duct, placing a biliary plastic stent and not having a cholecystectomy history were risk factors for PEP, whereas in patients without bile duct stones the only risk factor for PEP was not having a prior endoscopic sphincterotomy. CONCLUSIONS: Our study revealed that PEP risk factors depend on the indication of ERCP. To the best of our knowledge our study is the first study defining cholecystectomy as a protective factor for PEP in patients with bile duct stones and endoscopic sphincterotomy history as a protective factor for PEP in patients without bile duct stones. Our study also showed that female gender, lower diameter of the common bile duct and placing a plastic biliary stent were risk factors for PEP in patients with bile duct stones.

Clinical significance of interleukin-4 and interleukin-18 levels in aggressive non-Hodgkin's lymphoma patients.

Strong evidence indicates that tumor growth can be actively controlled by the immune system, and interleukins (ILs) are known to play an influential role in immune response regulation. Moreover, inflammatory cytokines are significantly involved in lymphoma pathogenesis. We aimed to investigate serum levels of IL-4 and IL-18 in aggressive non-Hodgkin's lymphoma (A-NHL) patients and their relationship with prognostic parameters and therapy outcome. These serum factors were measured by enzyme-linked immunosorbent assay in 46 patients with pathologically verified A-NHL before and after chemotherapy, and in 20 healthy controls. No significant difference in serum IL-4 (P = 0.11) and IL-18 (P = 0.261) levels was observed between the A-NHL and controls groups. None of the prognostic parameters analyzed significantly correlated with serum IL-4 concentration, while only lactate dehydrogenase (LDH) measurements were associated with IL-18 values. Serum IL-18 was elevated in the patients with high LDH levels compared to those exhibiting normal values (P = 0.045). In addition, no correlation was found between the concentrations of serum IL-4 and IL-18 in A-NHL patients (r = 0.188, P = 0.187). While IL-18 values did not change, serum IL-4 levels decreased following chemotherapy, independently from treatment response (P = 0.002). Our study is the first to report the response of serum IL-4 levels to chemotherapy. In conclusion, although IL-4 serum concentration has no diagnostic role, it is sensitivite to standard chemotherapy in A-NHL. However, serum IL-18 measurements have no diagnostic or prognostic role in this disease.

The mean platelet volume and neutrophil to lymphocyte ratio in obese and lean patients with polycystic ovary syndrome.

PURPOSE: Mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) are the new markers of the detection of inflammation. Our aim is to investigate MPV and NLR in lean and obese patients with polycystic ovary syndrome (PCOS). METHODS: This study was designed to investigate MPV, NLR, and high-sensitive C-reactive protein (hsCRP) levels in 25 obese patients with PCOS and 16 lean patients with PCOS, and our study group was matched with 16 obese and 14 non-obese controls, respectively. RESULTS: PCOS group had higher MPV, NLR, neutrophil count, neutrophil to total leucocyte ratio, basophil count, waist circumference (WC), insulin, glucose, and HOMA-IR rates than those of controls. hsCRP levels were similar in both groups. Subgroup analyses revealed that obese PCOS group had higher insulin and HOMA-IR levels, compared to those of controls. In this subgroup, total leucocyte counts, MPV, and hsCRP levels were similar. On the other hand, lean PCOS group had higher WC, NLR, MPV, and basophil count than controls. In correlation analysis, hsCRP was positively correlated with body mass index (BMI), WC, total leucocyte count, neutrophil count, while negatively correlated with lymphocyte ratio. Although leucocyte count was positively correlated with BMI, MPV was negatively correlated with BMI, total leucocyte, platelet, and neutrophil counts. NLR was positively correlated with HOMA-IR, hsCRP, BMI, WC, and insulin. CONCLUSION: Our study demonstrated that MPV and NLR levels are increased despite similar hsCRP levels in patients with PCOS. However, we failed to demonstrate these differences in obese PCOS patients. Further studies with larger sample size are required to determine the significance of BMI in the inflammation of PCOS patients.

Corticosteroid hypersensitivity in allergic rhinitis.

Corticosteroid hypersensitivity in allergic rhinitis. BACKGROUND: intranasal corticosteroid (IC) is the most effective treatment method in allergic rhinitis patients who are unresponsive to antihistamines. The literature reports an approximate 20% treatment failure for instances where IC is used for the treatment allergic rhinitis. Hypersensitivity reaction to corticosteroids may be one of the causes of this treatment failure. OBJECTIVE: to discover the incidence and confounding factors of corticosteroid hypersensitivity in patients with allergic rhinitis. METHODS: after 31 patients were excluded, 150 consecutive patients who were prospectively evaluated in our outpatient clinics with the diagnosis of allergic rhinitis and 50 age- and sex- matched healthy volunteers were included in this study. To diagnose allergic rhinitis, the symptoms of patients and a skin prick test were used. A skin patch test was used to determine corticosteroid hypersensitivity. Total IgE values and total eosinophil count were obtained for all patients. Total symptom scores were calculated for the severity of symptoms and to determine the response to therapy using intranasal corticosteroids. RESULTS: the incidence of corticosteroid hypersensitivity determined via the skin patch test was 14.0% (21 out of 150 patients). A difference was observed for patch test positivity results between the study and control groups (14% vs. 0%, respectively). Serum IgE levels and total eosinophil count were higher among patients who had corticosteroid hypersensitivity (p:0.005 and p:0.004, respectively). Patients unresponsive to intranasal corticosteroids had a higher incidence of corticosteroid hypersensitivity (71.4% vs. 4.4%, p<0.00 1). CONCLUSION: our study is the largest to date investigating CH in patients with allergic rhinitis and patients with allergic rhinitis have been found to have a high incidence (14%) of corticosteroid hypersensitivity, which may affect the response of patients to intranasal corticosteroid treatment.

Increased Risk of Unfavorable Metabolic Outcome in Patients with Clinically Nonfunctioning Pituitary Adenomas.

The aim of this study was to investigate atherosclerotic risk markers in women with clinically nonfunctioning pituitary adenomas (CNFAs). Records of 47 women with CNFAs and 73 healthy women who were treated as outpatients between January 2010 and March 2014 were evaluated retrospectively. All study data were obtained from file records. Lipid parameters, mean platelet volume (MPV), total testosterone (TT), androstenedione (AS), and dehydroepiandrostenedione sulfate (DHEAS) were recorded. Insulin resistance (IR) was calculated with homeostatic model assessment-insulin resistance (HOMA-IR). Among the atherosclerotic risk markers, the HOMA-IR and AS levels were higher in patients with CNFAs than in healthy subjects (p=0.003, p=0.021, respectively). A positive correlation between AS and insulin/HOMA-IR levels was found among the metabolic parameters in the patients with CNFAs (p=0.001, r=0.550, p=0.004, r=0.498, respectively). The data showed that patients with CNFAs had high atherosclerotic risk markers such as insulin resistance and hyperandrogenemia. Insulin resistance may also cause hyperandrogenemia in patients with CNFAs.

The effect of preeclampsia on the skin to subarachnoid distance in spinal anesthesia.

BACKGROUND: Preeclampsia is characterized by increased extracellular fluid which manifests as generalized edema due to endothelial injury and subsequent capillary leak. Therefore, preeclampsia may lead to increased skin to subarachnoid distance (SSD) which may influence daily clinical practice in this particular gravid population. METHODS: Age- and height-matched gravidas with and without preeclampsia were enrolled prospectively at an allocation ratio of 1:4. Spinal anesthesia (SA) was performed in a sitting position by a mid-line approach at the L3-L4 interspace using a 25-gauge Quincke spinal needle. An internal pilot study was performed to determine the sample size. When the protocol violations were excluded, 146 gravidas were included in the study (25 preeclamptics and 121 normotensive controls) for final analysis. RESULTS: On average, SSD was 0.89 cm greater in preeclamptics compared to normotensive controls. Mean values of the SSD in preeclamptic and normotensive control group patients at the L3-L4 interspace were 6.187 ± 0.967 and 5.301 ± 0.834 cm, respectively. SSD was significantly correlated with body weight and body mass index (BMI). The regression formula for the estimation of SSD in preeclamptic gravidas with BMI during SA was SSD = 3.696 + 0.075×BMI. The regression formula for the estimation of SSD in the normotensive control group with BMI during SA was SSD = 3.144 + 0.067×BMI - 0.0001×BMI×BMI. CONCLUSION: Knowing that the SSD is increased in preeclamptics compared to normotensive gravidas may be of value in terms of selecting needle, and providing safe and comfortable anesthesia.

Characterization of V804M-mutated RET proto-oncogene associated with familial medullary thyroid cancer, report of the largest Turkish family.

PURPOSE: Analysis of the RET proto-oncogen is very important for diagnosis and prognosis of medullary thyroid cancer (MTC). Genotype-phenotype correlation is also well known. Here we report features of the largest known family in Turkey with the V804M-mutated RET proto-oncogene. METHODS: Thirty members from three generations were evaluated. A RET proto-oncogen mutation, calcitonin (Ct) measurement and thyroid ultrasound were performed on all individuals. Seventeen members had V804M mutation. Fourteen of these patients underwent total thyroidectomy and additional central lymph node dissection for five subjects. RESULTS: The mean age of patients with MTC was 46.5 (30-61) years. The mean calcitonin level of RET positive members was 13.27 pg/mL (1-49.8 pg/mL). Three had a basal Ct level above normal limits. Seven of the 14 patients were diagnosed with MTC, and two were diagnosed with papillary thyroid cancer without MTC. One patient had central neck metastasis. Hyperparathyroidism or pheochromocytoma was not detected in any case. Patients who were RET negative, had normal Ct levels and no suspected nodule on ultrasound examination. CONCLUSIONS: Our study revealed a relatively good prognosis in patients with V804M mutation. Despite the surgery was performed in older age no advance disease was observed.

Prognostic factors associated with the response to sunitinib in patients with metastatic renal cell carcinoma.

OBJECTIVE: We investigated the prognostic clinicopathologic factors associated with overall survival (os) and progression-free survival (pfs) in the once-daily continuous administration of first-line sunitinib in a consecutive cohort of Turkish patients with metastatic renal cell carcinoma (rcc). METHODS: The study enrolled 77 Turkish patients with metastatic rcc who received sunitinib in a continuous once-daily dosing regimen between April 2006 and April 2011. Univariate analyses were performed using the log-rank test. RESULTS: Median follow-up was 18.5 months. In univariate analyses, poor pfs and os were associated with 4 of the 5 factors in the Memorial Sloan-Kettering Cancer Center (mskcc) score: Eastern Cooperative Oncology Group performance status of 2 or higher, low hemoglobin, high corrected serum calcium, and high lactate dehydrogenase. In addition to those factors, hypoalbuminemia, more than 2 metastatic sites, liver metastasis, non-clear cell histology, and the presence of sarcomatoid features on pathology were also associated with poor pfs; and male sex, hypoalbuminemia, prior radiotherapy, more than 2 metastatic sites, lung metastasis, nuclear grade of 3 or 4 for the primary tumour, and the presence of sarcomatoid features were also associated with poorer os. The application of the mskcc model distinctly separated the pfs and os curves (p < 0.001). CONCLUSIONS: Our study identified prognostic factors for pfs and os with the use sunitinib as first-line metastatic rcc therapy and confirmed that the mskcc model still appears to be valid for predicting survival in metastatic rcc in the era of molecular targeted therapy.

Impaired coronary flow reserve in metastatic cancer patients treated with sunitinib.

PURPOSE: Hypertension is one of the major side effects of sunitinib, an angiogenesis inhibitor used in the treatment of metastatic renal cell carcinomas (mRCC) and gastrointestinal stromal tumors (GIST). Endothelial dysfunction, an early and reversible event in the pathogenesis of atherosclerosis, is suggested to be one of the possible underlying mechanisms of hypertension caused by angiogenesis inhibitors. Coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial functions, as a cheaper and an easy screening test. We have used TTDE to evaluate endothelial function and coronary microvascular function in mRCC and GIST patients under sunitinib treatment. METHODS: Eighteen metastatic cancer patients (16 mRCC and 2 GIST) on sunitinib treatment and 27 healthy subjects were enrolled in this cross-sectional study. Thyroid stimulating hormone (TSH), lipid profile, creatinine, hemoglobin, glucose, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anthropometric and physical parameters of patients were recorded. CFR recordings were performed by the Vivid 7 echocardiography device. RESULTS: CFR was significantly lower in patients when compared with controls (1.82±0.4 vs 2.71±0.8, respectively; p < 0.001). Impaired CFR was found in 13 (72%) patients whereas all controls had normal CFR values. CFR was inversely correlated with the duration of sunitinib treatment (r=-0.36, p =0.01), high sensitivite (hs) CRP (r = -0.574, p =0.01) and ESR (r = - 0.5, p = 0.02). CONCLUSION: Our findings indicate that CFR is significantly impaired in cancer patients on sunitinib treatment. There is an inverse correlation between CFR and duration of sunitinib treatment and inflammation markers.

Scleral fixation of a single-piece multifocal intraocular lens.

PURPOSE: We describe an ab interno technique for injector implantation of a one-piece multifocal intraocular lens (IOL). METHODS: Transscleral fixation of multifocal posterior chamber IOL implantation using an injector with ab interno technique was performed in an eye of a 9-year-old girl who had undergone pars plana lensectomy 2 years before for bilateral lens subluxation with unknown etiology. RESULTS: No major complications were encountered during a 3-month follow-up of the patient and excellent centration was observed during the follow-up period. Her preoperative best spectacle-corrected distance visual acuity of 20/32 improved to uncorrected distance visual acuity of 20/25. CONCLUSIONS: Closed-loop design of IOL served the function of eyelets and position of the IOL was provided using only a 2-point fixation. Intraoperative position adjustment of the IOL provided an excellent centralization of multifocal IOL.

Iatrogenic bronchopleural fistula occuring during redo cardiac surgery.

Cardiac re-operations are associated with increased morbidity and mortality rates due to adhesion of tissues in the anterior mediastinum. Especially, previous usage of left internal thoracic artery constitutes a major challenge for cardiovascular surgeons. In such cases, the left lung frequently adheres to the thoracic wall and may be injured during dissection. This leads to air leak and the complication may in turn increase the risk of mediastinal infections and the hospital stay. A bronchopleural fistula case treated by a novel technique is reported. In patient iatrogenic bronchopleural fistula occured during dissection of the adhesions which resulted due to the first coronary artery bypass grafting and left internal thoracic artery usage. The air leakage was successfully controlled and treated by a novel method: self adhesive BioGlue immersed and coated Surgicel patch. Although it is a single case experience it may be a promising method as it is less traumatic when compared to the classical treatment methods of bronchopleural fistula.

Comparison of transperitoneal and retroperitoneal approaches in abdominal aortic surgery.

BACKGROUND: The transperitoneal approach (TP) to the aorta is the most widely accepted surgical approach in aortic surgery as it is simple, fast and provides excellent exposure of the intra-abdominal cavity and vascular structures. In recent years, there has been an increasing interest in the retroperitoneal (RP) approach to the aorta since it has been described as having a better outcome, i.e., preserving pulmonary function and gastro-intestinal physiology, reducing the intra-operative blood loss, minimising patient discomfort or pain, decreasing the incidence of wound complications and shortening ICU and hospital stay. The aim of this study is to compare the transperitoneal and retroperitoneal approaches in aortic surgery for aorto-iliac occlusive disease (AIOD). METHODS: From December 2003 to June 2006, a total of 153 consecutive patients who had undergone aortic surgery for AIOD, were studied retrospectively. The TP approach was used in 85 patients and the RP approach in 68 patients. Demographic features, intra-operative and postoperative data were analysed and compared according to the approach used. RESULTS: The mean operating time (83.6 +/- 23 vs. 104.4 +/- 30 min, p < 0.001) and mean aortic cross-clamp time (18.4 +/- 3 vs. 15.2 +/- 3 min, p < 0.0412) were significantly longer in the RP group. Peri-operative blood loss (700 +/- 350 vs. 650 +/- 330 ml, p < 0.683) and mortality rate < or = 30 day (1/1.2% vs. 0/0.0%, p < 0.896) were similar between the groups. The operative 30 day mortality rate was 0.7% (1 of 153) overall. The RP group had an earlier return of bowel functions (17.1 < or = 3 vs. 24.2 < or = 5 hrs, p < 0.001), earlier resumption of diet (26.4 < or = 4 vs. 31.4 < or = 5 hrs, p < 0.001), shorter period of intubation (3.5 < or = 2 vs. 6.5 < or = 3 hrs, p < 0.001), ICU stay (1.5 < or = 1 vs. 4.2 < or = 1 hrs, p < 0.001) and hospital stay (4.0 < or = 1 vs. 5.9 < or = 1 days, p < 0.001). Mean effort-pain scores were significantly lower in the RP group (3.8 < or = 1 vs. 5.3 < or = 1, p < 0.001). Incidence of pulmonary complications (4.4%, 3 of 68 vs. 7.3%, 8 of 85, p < 0.001), paralytic ileus (1.5%, 1 of 68 vs. 3.5%. 3 of 85, p < 0.001) were also lower in the RP group. Wound complications were more common in the TP group (4.7%, 4 of 85 vs. 10.3%, 7 of 86, p < 0.001). Most cases in both groups were related to incisional hernia or evisceration. CONCLUSION: This report presents our experience with the use of TP and RP approaches in a patient population merely consisting of AIOD. The RP approach was associated with a significantly lower incidence of postoperative pulmonary complications, rapid recovery of gastro-intestinal functions, shorter ICU and hospital stay, less peri-operative blood loss and lower mean effort-pain scores. We conclude that the RP approach is a safe and feasible technique that exposes patients to less postoperative complications.

Characteristics of external genitalia in pre- and postmenopausal women.

OBJECTIVE: To determine those objective measurements that characterize the differences between the external genital organs of pre- and postmenopausal women. METHODS: During the study period, 50 premenopausal and 50 postmenopausal patients were recruited. Only women who were admitted for routine control examinations were consecutively included in the study. Exclusion criteria were previous history of pelvic surgery including external and internal genital organs, presence of diseases that may change the anatomy of external genital organs, Mullerian anomalies, previous vaginal birth with mediolateral episiotomy, and use of hormone replacement therapy. The following measurements were performed: length and width of clitoris, labium majus, and labium minus, the distance between the clitoris and urethra, perineal length, and length of vagina. RESULTS: The length of the vagina and the width of the labium minus were significantly different between the two groups. Mean vaginal length was significantly longer in premenopausal women compared to postmenopausal women (90.3 +/- 14.8 mm vs. 82.3 +/- 11.2 mm, respectively). The labia minora were wider in premenopausal women than in postmenopausal women (17.9 +/- 4.1 mm vs. 15.4 +/- 4.7 mm). CONCLUSIONS: Characterization of the anatomical changes and relationships of external genitalia in postmenopausal women is important for functional and perioperative evaluation. In addition to reconstructive surgical procedures, determination of the objective measurements of anatomical landmarks in postmenopausal external genitalia might also be useful for assessing the results of treatment of 'atrophic' changes in women.

Standard open repair versus minilaparotomy approach for abdominal aortic aneurysms: what is the best approach in patients with ischemic heart disease?

AIM: The beneficial effects of minilaparotomy approach in patients undergoing abdominal aortic aneurysm (AAA) repair have been defined. In this respect, the authors compared treatment outcome and procedure-related mortality rates of minilaparotomy technique with those of open standard repair in patients with ischemic heart disease. METHODS: The authors retrospectively reviewed data on 212 patients who underwent elective AAA repair via a minilaparotomy approach at the Hospital of Istanbul over an 8-year period from February 1995 to January 2003. The clinical study included 46 patients who have only ischemic heart disease as a sole risk factor. This group was matched in a case-control fashion to a group of 57 patients with similar characteristics who were operated via standard median laparotomy. All available clinical, pathologic and postoperative data were reviewed and analyzed for postoperative outcome. RESULTS: Mean operative times in mini- and standard laparotomy groups were 190+/-26 min and 165+/-15 min, respectively (P=0.32). Aortic clamping times did not differ significantly between two groups (61+/-12 min vs 53+/-10 min, P=0.43). Blood requirement was lower in minilaparotomy group. Five patients (8.7%) in the standard median laparatomy group died, while one death (2%) occurred in the other group (P<0.01). In patients who have undergone traditional repair, 5 patients suffered from myocardial infarction and 4 patients required prolonged mechanical ventilation. No coronary ischemic event was noticed in minilaparotomy patients. The minilaparotomy group had significantly shorter lengths of hospital (6.2+/-1.1 vs 9.3+/-2.8 days, P=0.03) and intensive care unit (ICU) stays (7.8+/-2.3 vs 14.5+/-3.2 hours, P=0.01). Duration of adynamic ileus (1.9+/-0.6 vs 2.8+/-1.1 days, P=0.02), return to normal diet (3.2+/-1.0 vs 4.6+/-1.3 days, P=0.01) and day of ambulation (1.5+/-0.3 vs 3.2+/-0.7 days, P=0.001) were significantly lower in the minilaparotomy group. The standard median laparotomy group was twice as costly as the minilaparotomy group (3 200+/-600 vs 5 900+/-900 US dollars, P=0.001). CONCLUSION: The minilaparotomy technique has advantages that include less postoperative morbidity and mortality rates, early resumption of intestinal functions, reduced cost, decreased length of stay in the ICU and hospital. There-fore, the authors believe that this approach is still a valid alternative approach in the treatment of patients with AAA having ischemic heart disease as a risk factor.

Cyanoacrylate gluing increases the effectiveness of systemic antimicrobial treatment in sternal infection: experimental study in a rodent model.

BACKGROUND: Sternal infection is a serious complication of cardiac surgery requiring resternotomy and radical debridement. In this experimental study, we aimed to test our hypothesis that the use of cyanoacrylate gluing (application of an acrylic resin, a monomer of cyanoacrylate molecules, which rapidly polymerizes in the presence of water, forming long, strong chains and joining the bonded surfaces together) together with systemic antimicrobial therapy will provide synergy for the treatment of sternal infection caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Forty Wistar albino rats were randomly divided into four groups: Group I, uncontaminated sham group; Group II, untreated contaminated control group; Group III, contaminated group receiving only systemic vancomycin therapy; Group IV, contaminated group treated with a combination of cyanoacrylate gluing and systemic vancomycin. Cyanoacrylate gluing was applied on the 3rd postoperative day and all rats alive at the end of 8th week were sacrificed. The degree of sternal infection was assessed histologically and also by quantitative culture analysis. RESULTS: Histological evaluation revealed that cyanoacrylate was degraded and replaced by connective tissue at the end of the 8th week. Culture analysis revealed that the average growth of microorganisms was significantly reduced in Groups III and IV. In Group IV, the reduction in the amount of growing microorganisms was found to be more pronounced and significantly lower than in Groups II and III. CONCLUSION: Our experimental model suggests that cyanoacrylate gluing provides significant synergy for systemic antimicrobial therapy. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of mediastinitis and sternal osteomyelitis in rats.

The effects of land use changes on some soil properties in Indagi Mountain Pass--Cankiri, Turkey.

Understanding spatial variability of dynamic soil attributes provides information for suitably using land and avoiding environmental degradation. In this paper, we examined five neighboring land use types in Indagi Mountain Pass--Cankiri, Turkey to spatially predict variability of the soil organic carbon (SOC), bulk density (BD), textural composition, and soil reaction (pH) as affected by land use changes. Plantation, recreational land, and cropland were the lands converted from the woodland and grassland which were original lands in the study area. Total of 578 disturbed and undisturbed soil samples were taken with irregular intervals from five sites and represented the depths of 0-10 and 10-20 cm. Soil pH and BD had the lower coefficient of variations (CV) while SOC had the highest value for topsoil. Clay content showed greater CV than silt and sand contents. The geostatistics indicated that the soil properties examined were spatially dependent to the different degrees and interpolations using kriging showed the dynamic relationships between soil properties and land use types. The topsoil spatial distribution of SOC highly reflected the changes in the land use types, and kriging anticipated significant decreases of SOC in the recreational land and cropland. Accordingly, BD varied depending on the land use types, and also, the topsoil spatial distribution of BD differed significantly from that of the subsoil. Generally, BD greatly decreased in places where the SOC was relatively higher except in the grassland where overgrazing was the more important factor than SOC to determine BD. The topsoil spatial distributions of clay, silt, and sand contents were rather similar to those of the subsoil. The cropland and grassland were located on the very fine textured soils whereas the woodland and plantation were on the coarse textured soils. Although it was observed a clear pattern for the spatial distributions of the clay and sand changing with land uses, this was not the case for the silt content, which was attributed to the differences of dynamic erosional processes in the area. The spatial distribution of the soil pH agreed with that of the clay content. Soils of the cropland and grassland with higher amounts of clay characteristically binding more cations and having higher buffering capacities had the greater pH values when compared to the soils of other land uses with higher amounts of sand naturally inclined to be washed from the base cations by the rainwater.

Epidural anaesthesia and mini-laparotomy for the treatment of abdominal aortic aneurysms in patients with severe chronic obstructive pulmonary disease.

PURPOSE: The purpose of this study is to compare the use of epidural and general anaesthesia techniques in the treatment of abdominal aortic aneurysms (AAA) through mini-laparotomy in patients with severe chronic obstructive pulmonary disease (COPD). METHODS: Between March 2002 and October 2005, 23 patients with severe COPD underwent elective infrarenal abdominal aortic aneurysm repair. Endovascular therapy could not be established due to financial reasons and health insurance policies. All the operations were performed through mini-laparotomy, using epidural anaesthesia on 10 patients (Group I) and general anaesthesia on the remaining patients (Group II). Pulmonary disease was diagnosed by clinical history and pulmonary function tests. The diagnosis of severe COPD was made with the presence of one or more of the following criteria : Room air PaO2 < or = 60 mmHg, PaCO2 > or = mmHg in arterial blood gas samples, FEV1 < or = 50% of predicted value and FVC < or = 75% of predicted value in respiratory function tests. RESULTS: There was no significant difference between the ages, sex, pre-operative morbidity status, operation time and total blood loss of the patients in the two groups. Postoperative intensive care unit requirement, postoperative pulmonary complications and hospital stay were significantly higher in group II. All patients tolerated surgery safely. There was one in-hospital mortality from group II on the 35th postoperative day due to prolonged entubation and sepsis related to pulmonary infections. There was no late morbidity or mortality related to the technique in the postoperative follow-up period of the discharged patients. CONCLUSION: Epidural anaesthesia for abdominal aortic aneurysm repair through mini-laparotomy is feasible and should be especially considered in patients with severe COPD where endovascular treatment could not be performed.