Effects of recurrent sevoflurane anesthesia on cognitive functions with streptozotocin induced Alzheimer disease.

OBJECTIVE: We aimed to investigate the effects of recurrent sevoflurane anesthesia on cognitive functions in Alzheimer Disease. MATERIALS AND METHODS: Rats were divided into 4 groups as followed: control (Group C), sevoflurane (Group S), Alzheimer's (Group A) and Alzheimer's + sevoflurane (Group AS)]. Cognitive functions were evaluated with Radial Arm Maze Test (RAMT). Alzheimer model was created by administering 3 mg/kg (10 µl) STZ. Sevoflurane was administered to S and AS groups. Serum samples and hippocampus tissues were analyzed. RESULTS: In RAM test, the entry-exit data were significantly decreased in A and AS groups. After the 2nd and 3rd administration of anesthesia, the numbers were significantly decreased in Group S. Glial-fibrillary-acidic protein levels were significantly higher in AS compared to the C and S groups. The brain tissue caspase 3 activity was less than 1% in all rats in the Group C, 3 % in 2 rats and 1 % in 1 rat in the Group AS. In A and AS group, serum catalase, myeloperoxidase and ferroxidase activities were found to be higher than in the other groups and myeloperoxidase activity was higher in the AS than in the A Group. Serum native thiol, total thiol and disulfide levels were found to be significantly different in the A and AS groups. CONCLUSION: Sevoflurane anesthesia negatively affected the cognitive functions (Tab. 5, Fig. 10, Ref. 51).

Dental anxiety and oral health-related quality of life in children following dental rehabilitation under general anesthesia or intravenous sedation: A prospective cross-sectional study.

PURPOSE: The study aimed to investigate dental anxiety and oral health-related quality of life among children undergoing dental rehabilitation under general anesthesia (GA) and intravenous sedation (IVS). MATERIALS AND METHODS: Participants were 99 healthy children aged 3-5 or 6-12 years operated under GA or IVS. Dental anxiety before treatment and 1 month postoperatively were measured using the Frankl behavior scale (FBS), the venham picture test (VPT), the early childhood oral health impact scale (ECOHIS), and the children's fear survey schedule-dental subscale (CFSS-DS). Data were analyzed using Student's t-test and Mann-Whitney U-test. RESULTS: ECOHIS scores decreased in all groups. VPT scores increased in the 3-5-year-olds treated under GA (P = 0.003). Postoperative CFSS-DS anxiety scores were lower in IVS groups. FBS scores were significantly higher for both age groups (P < 0.001). There was no effect of numbers of extracted or treated teeth. CONCLUSIONS: Dental rehabilitation under GA and IVS improved the quality of life and dental behavior. In the 6-12-year-olds, there was no statistically significant difference between children undergoing dental operations under GA and those undergoing dental operations under IVS. Dental anxiety decreased in 3-5-year-olds after treatment under GA but not after IVS.

The protective effect of vitamin D against carbon tetrachloride damage to the rat liver.

We investigated the protective effect of vitamin D against liver damage caused by carbon tetrachloride (CCl4). Twenty-four male rats were divided into four equal groups: G1, untreated controls; G2, administered CCl4; G3, administered both CCl4 and vitamin D for 10 weeks; G4, administered CCl4 for 10 weeks and vitamin D for 12 weeks. At the end of experiment, intracardiac blood samples were taken and liver samples were removed. Hepatic damage due to CCl4 was assessed using biochemistry and histopathology. Glutathione (GSH) levels decreased, while malondialdehyde (MDA) levels increased in liver tissues of G2. Alanine transaminase (ALT), alkaline phosphatase (ALP), and gamma-glutamyl-transaminase (GGT) levels increased, while albumin (ALB) levels decreased. Hepatocyte degeneration, lobular disorder, sinusoid dilation, focal necrotic areas, hyperemia, and glycogen loss were observed. Hepatic fibrosis was observed around portal areas and central veins. Bridging fibrous septa were formed between portal veins. By immunohistochemistry, both matrix metalloproteinase-9 (MMP-9) and desmin reactivity were increased. All aspects of liver damage were at least partially prevented in rats treated with vitamin D. Vitamin D appears to act as an antioxidant and anti-fibrotic to protect the rat liver against damage.

The comparison of modified early warning score and Glasgow coma scale-age-systolic blood pressure scores in the assessment of nontraumatic critical patients in Emergency Department.

INTRODUCTION: The purpose of this study is to assess and compare the discriminatory ability of the Glasgow coma scale (GCS)-age-systolic blood pressure (GAP) score and modified early warning scoring system (mEWS) score for 4-week mortality, for the patients being in the triage category 1 and 2 who refer to Emergency Department (ED). METHODS: Five hundred and two nontraumatic cases being in the triage category 1 and 2 who were ≥18-year-old and who referred to ED were assessed prospectively. Reason of referral, fashion of referral, age, gender, vital signs, GCS/alert/verbal/painful/unresponsive scores, consultations, diagnoses, and treatments and final outcome (hospitalization, transfer, discharge, treatment rejection, and exitus) were recorded. The mEWS and GAP scores and the mortality ratios of the cases were calculated by observing both in ED and 4-week survivals of the patients. RESULTS: When the mEWS and GAP scores were compared in the prediction of 4-week mortality, no statistically significant difference was found between them (P > 0.05). The power of mortality estimation was found significant for both scoring systems (for both; P< 0.001). CONCLUSION: GAP score with a simple use being a score developed for the estimation of mortality of trauma patients seems to be usable also for the nontraumatic patients with triage category 1-2 in the ED.

Preoperative chemoradiotherapy improves local recurrence free survival in locally advanced rectal cancer.

PURPOSE: Preoperative chemoradiotherapy (pre-CRT) followed by total mesorectal excision (TME) is the recommended therapy for patients with locally advanced rectal cancer (LARC). The primary aim of this study was to compare the rates of local and distant recurrence and overall survival (OS) in LARC patients who received pre-CRT vs postoperative (post) CRT. METHODS: The medical records of 158 rectal cancer patients with clinical stage T3, T4 or N positive disease who received either pre-CRT or post-CRT between 2000-2009 were retrospectively analysed. Pre-CRT employed protracted 5-fluorouracil (5FU) infusion, whereas post-CRT included bolus 5FU and leucovorin concurrently with radiation therapy (RT). Radiation dose was 50.4 Gy in 82% and 45 Gy in 18% of the patients. RESULTS: 158 patients (65 females, 93 males) were analysed. Median age was 56.5 years (range 19-78). Fifty-three (34%) patients received pre-CRT and 105 (66%) post-CRT. Median follow-up was 43.3 months (range 8-182) and 47.6 months (range 9-194) in pre-CRT and post-CRT patients, respectively. After pre-CRT, significant downstaging was achieved. However, the type of surgical resection was not influenced by the administration of pre-CRT in tumors ≥5 cm distant from the anal verge (p=0.3). Pathologic complete response was achieved in 20% of the patients in the pre-CRT group. Local recurrence free survival (LRFS) at 5-years was 89.2% in the pre-CRT and 74.8% in the post-CRT group (p=0.04). Distant recurrence free survival (DRFS) at 5-years was 81.7% and 68.5 % in pre-CRT and post-CRT groups, respectively (p=0.1). OS was similar in the two groups (71.4 vs 64.4%, p=0.9). CONCLUSION: Treatment of LARC with pre-CRT followed by surgery improved LRFS as compared to surgery followed by post-CRT, but failed to improve DRFS or OS in our patient population.

The costimulatory molecule CD70 is regulated by distinct molecular mechanisms and is associated with overall survival in diffuse large B-cell lymphoma.

In diffuse large B-cell lymphomas (DLBCL), a recurrent deletion of the 19p13 region has recently been described. CD70 and TNFSF9 genes are suspected tumor suppressor genes, but previous studies suggest an oncogenic role for CD70. Therefore, we studied the consequences of variation in CD70 copy number and epigenetic modifications on CD70 expression. Copy-number variation was investigated in 144 de novo DLBCL tissues by comparative genomic hybridization array and quantitative multiplex PCR. Gene expression was assessed by quantitative RT-PCR, and CD70 promoter methylation was determined by pyrosequencing. The 19p13.3.2 region was deleted in 21 (14.6%) cases, which allowed the minimal commonly deleted region of 57 Kb that exclusively includes the CD70 gene to be defined. Homozygous deletions were observed in four (2.7%) cases, and acquired single-nucleotide variations of CD70 were detected in nine (6.3%) cases. CD70 was highly expressed in both germinal centre B-cell-like (GCB) and activated B-cell-like (ABC) DLBCL compared to normal tissue, with distinct molecular mechanisms of mRNA expression regulation. A gene dosage effect was observed in the GCB subtype, whereas promoter methylation was the predominant mechanism of down regulation in the ABC subtype. However, high CD70 expression levels correlated to shorter overall survival in both the GCB (P = 0.0021) and the ABC (P =0.0158) subtypes. In conclusion, CD70 is targeted by recurrent deletions, somatic mutations and promoter hypermethylation, but its high level of expression is related to an unfavorable outcome, indicating that this molecule may constitute a potential therapeutic target in selected DLBCL.

Effect of an oral anxiolytic medication and heart rate variability on image quality of 64-slice MDCT coronary angiography.

PURPOSE: The aim of the study was to investigate the relationship between image quality in 64-slice multidetector computed tomography (MDCT) and patients' preimaging anxiety status and heart rate variability (HRV), and to evaluate the efficacy of an orally administered anxiolytic medication on HRV and image quality. MATERIALS AND METHODS: Sixty patients [14 women, 46 men; mean age 52.53 ± 10.55 (SD), range 33-78 years] were studied. Anxiety levels were assessed with the State-Trait Anxiety Inventory 60 min before the procedure. The participating patients were randomly assigned to one of the two study groups: a control group (no medication administered for anxiety reduction) and an anxiolytic medication group, with 30 patients in each group. The presence of motion artefacts and image quality for each coronary artery segment were evaluated using a four-point grading system. To estimate HRV, the duration of each heartbeat during MDCT data acquisition was measured in each patient. RESULTS: A moderate correlation was found between HRV during MDCT scanning and the mean image quality for all coronary segments (r=0.47, p<0.01). There was an association between HRV and state anxiety scores in all cases (r=0.370, p<0.01). HRV in the patients who received alprazolam was statistically significantly lower than in controls (p<0.05). The average image quality in patients who used alprazolam was also statistically significantly higher than in controls (p<0.05). CONCLUSIONS: The most important finding in our study is that oral premedication to reduce anxiety is also effective in decreasing HRV and improves image quality. Therefore, we suggest that using alprazolam in addition to a ß-blocker may improve image quality in patients undergoing MDCT coronary angiography (MDCT-CA). Anxiolytic usage may improve image quality by lowering the HRV in selected cases where administration of a ß-blocker is contraindicated. We also suggest that further studies in larger series are required to validate this finding.

Sexual dysfunction in type III chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) observed in Turkish patients.

AIM: Chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS) is a common disabling condition that is primarily associated with pain in the urogenital region and disturbances in urinary and sexual function. Chronic pelvic pain symptoms are the most common presentation, especially perineal, lower abdominal, testicular, penile as well as ejaculatory pain. Other genitourinary tract complaints include voiding disorders and sexual dysfunction. We aimed in the study at examining the prevalence rates of premature ejaculation and erectile dysfunction in patients with chronic pelvic pain syndrome and comparing these rates with those of healthy control subjects. MATERIALS AND METHODS: Between November 2006 and January 2008, 85 patients with the diagnosis of CP/CPPS were chosen for the study; 30 patients without regular sexual activity and 12 patients without inclusion criteria were excluded from the study. A total of 43 patients were included in the study. Twenty healthy volunteers without prostatitis-like syndromes were used as a control group. The sexual function of the patients and the healthy volunteers were evaluated using Arizona Sexual Function Questionary Form and International Index of Erectile Function (IIEF). Erectile dysfunction (ED), ejaculatio precox (EP) and pain on ejaculation (PEP) were investigated as sexual dysfunction. RESULTS: The mean age of the patients was 33.7 (22-48) years; the mean symptom period was 37.7 (6-120) months, while the mean age of the control group was 32.4 (24-48) years. The mean NIH-CPSI score of the patient group was 26.1 (16-34). Patient group was classified as CPPS type IIIa and CPPS type IIIb. Mild and moderate erectile dysfunction (ED) was found in [9] 23.2% patients at the patient group and [2] 10% at the control group (P: 0.185). Severe erectile dysfunction was not found in both groups. Ejaculatio Precox (EP) was found at (29) 67.4% of the patient group and [7] 40% of the control group. Pain on ejaculation (PEP) was detected in [15] 37.2% of the patient group, while none of the control group had pain on ejaculation. More than one sexual dysfunction was found in [17] 41.8% of the patient group and none of the control group. Comparing patient group versus control group, ejaculation disorders (EP and PEP) and more than one sexual dysfunction disorder were statistically significant. According to ED, there is no statistical difference between the groups (P > 0.05). CONCLUSION: Sexual function disorders, especially ejaculation disorders (EP and PEP), are frequently seen in CP/CPPS patients versus normal population. Age, symptoms period, symptom score and CP/CPPS subgroups are not risk factors for sexual function disorders. Patients with the diagnosis of CP/CPPS should be evaluated for sexual function disorders.

Ovarian metastasis of a primary renal cell carcinoma: case report and review of literature.

Ovarian metastases from renal cell carcinoma (RCC) are very rare, with only 23 cases reported in the literature. We report a case of 54-year-old women who developed bilateral ovarian metastasis 39 months after diagnosis of clear cell carcinoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was carried out. Subsequently she was treated with sunitinib and her disease stabilized. She is still alive four years after diagnosis of the renal primary, and disease has stabilized on sunitinib. We conclude that, although rare, the possibility of metastatic RCC should be considered in the differential diagnosis of clear cell tumors of the ovary. Due to therapeutic and prognostic implications, it is very important to differentiate if the tumor is a primary ovarian tumor or a metastasis from a renal cell carcinoma. Early diagnosis of this rare metastatic tumor results in prompt treatment and prolonged patient survival.

A giant villous adenoma: case mimicking rectosigmoid malignancy; radiological survey to diagnosis.

Villous adenomas are benign lesions, which are difficult to interpret because of their malignancy potential. They have similar radiological findings to malignant lesions. Usually, villous adenomas are asymptomatic although they may cause rectal bleeding like malignant tumours. We present a case of giant villous adenoma to evaluate the contribution of its radiological features including double contrast barium enema, computed tomography and magnetic resonance imaging examinations for the differential diagnosis.

Correlation between breast density in mammography and background enhancement in MR mammography.

PURPOSE: We aimed to analyse the influence of mammographic breast density on background enhancement (BE) at magnetic resonance (MR) mammography in pre- and postmenopausal women. In addition, we questioned predictability of contrast-enhancement dynamics of normal fibroglandular tissue (NFT) at MR mammography according to mammographic breast density. MATERIALS AND METHODS: Twenty-six patients (mean age 51.54+/-11.5 years; range 37-79 years) who underwent both MR mammography and conventional mammography were included in this retrospective study. Fourteen patients were premenopausal and 12 were postmenopausal. The ethics committee of our institution approved the study. The mammograms were retrospectively reviewed for overall breast density according to the four-point scale (I-IV) of the Breast Imaging Reporting and Data System (BI-RADS) classification. Two radiologists, who were unaware of the clinical data, separately assessed the MR mammography images. Images were assessed for enhancement kinetic features (enhancement kinetic curve and the early-phase enhancement rate) and BE. MR mammography and conventional mammography findings were compared according to BI-RADS breast density category and menopausal status. RESULTS: Percentage of increased signal intensity values during the first minute did not change according to mammographic breast density, and the mean early-phase enhancement rate scores were similar among breast density groups (p=0.942). There was no significant difference between pre- and postmenopausal groups. Enhancement kinetic features of the different groups based on BI-RADS breast density category and menopausal status were similar. There was no correlation between breast density and BE in either premenopausal (p=0.211) or in postmenopausal (p=0.735) groups. CONCLUSIONS: We determined no correlation between mammographic breast density and so-called BE in MR mammography in either premenopausal or postmenopausal women. NFT at MR mammography cannot be predicted on the basis of mammographic breast density.

Is bone mineral density measurements correlated with facet joint orientation? A dual energy X-ray absorptiometry study.

We aimed to study correlation between bone mineral density (BMD) and facet joint orientation in normal, osteopenic and osteoporotic patients. The correlation between more sagittally oriented facet joint and facet joint osteoarthritis and spondylolisthesis was described previously. However, the correlation between facet joint orientation and its possible correlation with BMD measurements has not been evaluated. Our study is a primary effort to describe the correlation of BMD with facet joint orientation, which is important in terms of spinal biomechanics. Thirty-seven patients who had undergone both lumbar spinal Magnetic Resonance Imaging and Dual-energy X-ray absorptiometry were included in the study. Facet joint osteoarthritis and orientation were evaluated in five levels between L1-S1. For facet joint orientation, axial images were used. For grading of facet joint osteoarthritis the classification of Weishaupt and co-workers were used. Lumbar BMD was correlated with BMD of the hip. Facet orientation was similar among the 3 groups namely patients with normal BMD values, osteopenia and osteoporosis. Facet orientation was not correlated with lumbar BMD measurements. Facet joint orientation is not correlated with BMD measurements in our patient group without spondylolisthesis. Since spondylolisthesis has been demonstrated to alter BMD measurements, we suggest that spinal degenerative disease secondary to spondylolisthesis is the main entity leading to measurement errors.

Evaluation of the role of ultrasound machines as a source of nosocomial and cross-infection.

RATIONALE AND OBJECTIVES: To evaluate the potential role of ultrasonography probes and coupling gel for cross-infection in patients undergoing ultrasonography; to describe a cost-effective method of probe handling; and to emphasize the importance of position of the probes in the boxes. METHODS: Cultures were taken from 43 probes used in different scanning regions. Cultures were also taken from probe boxes and coupling gel. RESULTS: After abdominal scanning, cleaning with paper seems to be effective, but even wiping with alcohol is insufficient for inguinal and axillar regions. Before scanning of these areas is started, cleaning the inguinal and axillar regions with alcohol reduces the contamination risk. Placing the probes downward in boxes also increases the risk of contamination. CONCLUSIONS: Wiping the probes with dry paper seems to be effective only for abdominal scanning; for inguinal and axillar scanning, cleaning the region with alcohol before scanning seems more appropriate. Placing the probes downward in boxes may also be a source of contamination.

Surface landmarks of brachial plexus: ultrasound and magnetic resonance imaging for supraclavicular approach with anatomical correlation.

The present study is able to describe a certain line, under which brachial plexus (BP) lies underneath in the supraclavicular region. A line drawn between midpoint of the sternocleidomastoid muscle to the midpoint of the clavicle was considered for BP. Surface landmarks were evaluated by applying ultrasound (US) on 30 volunteers (15 female, 15 male). Axial and sagittal views of BP were taken and distances between skin and BP were measured. Coronal magnetic resonance (MR) sections were taken from 7 volunteers according to the second line after applying two fat capsules on each line. The sonographic views were seen at the same line. Mean distances from skin were found as 16.5+/-0.7 mm for male and 14.5+/-0.5 mm for female volunteers. MR images were obtained bilaterally, which were parallel and posterior from sonographic lines. Surface landmarks, as presented in this study, are simple to accomplish and are not dependent on structural variations as external jugular vein.

The effect of extracorporeal shock wave treatment (ESWT) on bone defects. An experimental study.

The aim of this study was to investigate the effects of extracorporeal shock wave therapy (ESWT) on the formation of callus in bone defects created in rabbit radii. this study searches for an answer to whether ESWT may have a therapeutic effect on bone defects. A bone defect with a radius of 1 cm was created in both forelimbs of 20 rabbits. At the 7th, 14th, and 21st days ESWT treatment was applied to the forming callus in the right radius under fluoroscopic control. At the 6th and 12th weeks, the animals were sacrificed and callus analysis was performed by computerized scan, dual energy x-ray absorptiometer. Histological analyses were also performed. The results revealed that the average callus area in the right (ESWT applied) radial defect was greater in both groups and statistically significant at the 12th week (p < 0.05). There was no difference in bone density between defects. Histologically the callus area was greater on the right side (ESWT applied side) in both groups. However in the first group trabeculae were occupying less space on the right side. Granulation tissue areas and chondroid areas were greater on the right side. We conclude that ESWT has a disorganizing and dispersing rather than a direct osteoinductive effect on forming callus. This effect may play a therapeutic role in bone defects and in situations like callus lengthening where a greater amount of callus is necessary.

Mastoid buffering properties: I. Gas partial pressures.

Differences in the gas partial pressures between the middle ear (ME) cavity and the blood are an important factor in ME gas economy. Differences in gas partial pressures between various regions of the ME-mastoid air cell system (ME-MACS) could play a role as well. To determine whether gas partial pressure differences do occur between various compartments in the ME, we measured the rate of gas diffusion from one compartment to another in both an artificial model and in the ME-MACS of human temporal bones. The rate of gas diffusion between various areas of the ME and the mastoid tip was found to be rapid, with a half-life on the order of 2 minutes (range 0.8 to 5.3 minutes). We suggest that this high diffusion rate prevents the buildup of significant differences in gas composition in the ME-MACS system, which can therefore be regarded as a homogeneous gas pocket.

Age-specific PSA reference ranges in a group of non-urologic patients.

Age-specific serum PSA reference ranges have recently been proposed to be more sensitive in young and more specific in elder patients. However, some conflicting results have been reported from different centers. In order to establish age-specific PSA reference ranges for our country, we measured the serum PSA levels of 400 healthy men over 40, between February 1995 and June 1996. Our study population consisted of men who had either PSA values lower than 4.0 ng/ml and normal digital rectal examination or negative prostatic biopsies taken for any reason. IMX assay was used for PSA determination in all patients. Mean PSA values and standard deviations for each age group were: 1.7+/-1.1 ng/ml for 40-49 years (n = 28), 2.0+/-1.2 ng/ml for 50-59 years (n = 110), 2.9+/-1.7 ng/ml for 60-69 years (n = 158) and 3.5+/-2.0 ng/ml for 70-79 years (n = 104). We conclude that further studies of larger series will lead us to standardize age-specific reference ranges in our country and, accordingly, we will be able to select the candidates for prostate biopsy more adequately.