A long-term study of liver-related events in Caucasian hepatitis B patients with normal ALT values and high viremia.

Background and study aims: There is ongoing debate whether antiviral therapy should be initiated in hepatitis B e antigen (HBeAg)-negative patients with normal alanine aminotransferase (ALT) levels but high HBV DNA levels >2,000 IU/mL. Since the need for antiviral therapy might be different between Asian and Caucasian patients, we studied the long-term disease outcome in Caucasian patients living in Western Europe. Patients and methods: One hundred sixteen patients with high HBV DNA levels (>2,000 IU/mL) at diagnosis were included in the high viremia group, while those with HBV DNA <2,000 IU/mL were used as controls (n = 327). All patients were Caucasian, HBeAg negative, had normal ALT levels and had no significant liver disease at diagnosis. Results: Median follow-up was 7 + 9.8 years in the high viremia group and this was 10 + 12.5 years in controls. The cumulative probability of a liver-related event over 10 years was 4.8% vs 0.0% in the control group (p=.008). In multivariable analysis, high viremia group was associated with the occurrence of a liver-related event (hazards ratio (HR) 95% confidence interval (CI): 1.20-11.98, p=.023). In this subgroup, older age at diagnosis (HR 95% CI: 1.01-1.16, p=.023) predicted a higher risk of liver-related event. In the high viremia group, liver-related mortality was 0.9% and none of the patients developed hepatocellular carcinoma. Conclusions: HBV DNA >2,000 IU/mL influences the long-term disease outcome in Caucasian HBeAg-negative patients living in Western Europe. Nevertheless, the risk of liver-related events is low.

Effect of maxillary surgical movement on nasal cavity and maxillary sinus dimensions and function after Le Fort I osteotomy.

This study was designed to evaluate the effects of different maxillary movements performed in Le Fort I surgery on the anatomy of the nasal cavity and maxillary sinus, occurrence of rhinosinusitis, and nasal airflow. Patients were divided into three groups: group I underwent pure advancement, group II underwent advancement with yaw rotation, and group III underwent advancement with impaction movements. All evaluations were performed using pre- and postoperative computed tomography images and surveys. Twenty-eight patients were enrolled. The mean pre- and postoperative nasal air volumes in group I were 22.74 ± 6.32 cm3 and 25.17 ± 6.19 cm3, respectively, showing a significant increase (P = 0.041). The mean pre- and postoperative maxillary sinus air volumes were 33.94 ± 13.72 cm3 and 26.28 ± 14.12 cm3 in group II and 35.29 ± 9.58 cm3 and 28.65 ± 8.42 cm3 in group III, respectively, showing significant reductions (P = 0.028 and P = 0.007, respectively). For all movements, the occurrence of septum deviation and nasal airflow impairment was not statistically significant. Pure maxillary advancement movement enhanced nasal cavity air volume. The yaw rotation movement significantly increased quantitative clinical rhinosinusitis symptoms. The risk of airflow impairment following Le Fort I surgery is low.

Uptake of hepatitis C virus screening and treatment in persons under opioid substitution therapy between 2008 and 2013 in Belgium.

BACKGROUND: Hepatitis C is a viral infection caused by the hepatitis C virus (HCV) with people who inject drugs as the main group at risk worldwide. AIM: This study investigated the differences in uptake for HCV screening and treatment between persons in opioid substitution therapy (OST) and the other members of the Christian Health Insurance Fund in Belgium. METHODS: Invoice data were retrospectively collected from the Christian Health Insurance Fund, representing 42% of the healthcare users. Information on demographics, screening, diagnostic tests, treatment and disease progression was obtained from 2008 till 2013. All people in this study were aged 20-65 year. Persons in the OST group were identified as having at least one prescription reimbursed for methadone. This group was compared to the other members of the Insurance Fund not on OST (NOST). RESULTS: The Insurance Fund registered 8,409 unique OST and 3,525,190 members in the general group. HCV RNA screening rate was higher in the OST group after correction for age and gender (4.3% vs. 0.2%). Ribavirin reimbursement, did not differ between the OST and NOST group screened for HCV RNA (16.9% vs. 14.4%), though the probability of having ribavirin reimbursed was smaller for females than for males. Procedures concerning disease progression were reimbursed less frequently in the HCV RNA screened OST group compared to the NOST group (0.3% vs. 1.2%). CONCLUSION: People on OST were screened more often for HCV RNA. However, the general uptake for HCV screening and treatment in both populations remained suboptimal.

The effect of residual bone height and membrane thickness on sinus membrane perforation in crestal sinus grafting: A prospective clinical study.

This study sought to determine the rate of sinus membrane perforation in patients undergoing crestal sinus grafting, as well as the effect of Schneiderian membrane thickness and residual bone height (RBH) on membrane perforation, using cone beam computed tomography. The study included 25 patients undergoing 44 crestal sinus grafting procedures. The sites for crestal sinus grafting were divided into a control group (RBH≥5mm) and a test group (RBH<5mm). All sinus grafting procedures were also categorised based on membrane thickness: group A (<1mm), group B (1-2mm), and group C (≥2mm). The rate of membrane perforation was 18.2%. The median RBH measurement was 5.59mm. No statistically significant difference in membrane perforation rate was found between the test and control groups (P=0.262). The median thickness of the Schneiderian membrane was 1.35mm. There was no statistically significant difference in membrane perforation among the three membrane thickness groups (P=0.431). No significant correlation between RBH and membrane perforation was observed, although clinical observation indicated that there was a tendency for an increased membrane perforation rate in the presence of a RBH<5mm. The perforation rate was found to be at its highest when the membrane was thinner than 1mm.

Safety and immunogenicity of HBAI20 Hepatitis B vaccine in healthy naïve and nonresponding adults.

Approximately 5% of the healthy adult population respond inadequately to the commercial recombinant hepatitis B vaccines. As the recombinant vaccines all have an aluminium-based adjuvant, we tried to enhance the immune response by adding a cytokine-based adjuvant. This new adjuvant AI20, containing 20 µg recombinant human IL-2 attached to 20 µg aluminium hydroxide, was added to HBVaxPro©-10 µg (HBAI20). In a double-blind randomized controlled trial (RCT), 24 naïve subjects were randomized to receive either HBAI20 or commercial HBVaxPro©-10 µg vaccine. In an open-label study, 10 nonresponders received HBAI20 vaccine. All participants received 3 vaccinations (0, 1 and 6 months). In the RCT, the occurrence of any adverse events or severe events was similar between the trial arms. At month 7, all naïve participants were seroprotected; moreover, 92% in the HBAI20 group had protective antibodies 10 days after the second vaccination vs 58% in the HBVaxPro©-10 µg group, P = .16. In the open-label study, no serious adverse events were noted. The HBAI20 vaccine was able to elicit protective anti-HBs titres in 90% of nonresponders, 1 month after the third vaccination. According to these results, the new HBAI20 vaccine seems safe, well-tolerated and may promote more rapid protection against hepatitis B infection.

Horizontal hepatitis B virus transmission through non-sexual close contact in Turkish chronic hepatitis B patients living outside of Turkey.

BACKGROUND AND AIMS: Hepatitis B virus (HBV) infection is a global threat and with the growing cultural diversity in Western Europe, knowledge on routes of infection in order to decrease HBV spreading is essential. This study assessed the risk of horizontal transmission through non-sexual close contact in the chronic hepatitis B (CHB) population in Maastricht (the Netherlands) and Genk (Belgium), with a main focus on the differences between ethnic groups. METHODS: In this multicenter retrospective study, 166 CHB patients, who were still under follow-up between December 2009 to December 2014, were recruited from the Hepatology Outpatient Departments of two hospitals, one in Maastricht and one in Genk. Ethnicity (defined as country of origin (COO)) and routes of transmission were collected from all patients. RESULTS: The CHB population in Maastricht and Genk consisted of 98 and 68 patients, respectively. In Maastricht, 31% were of Dutch and 16% of Chinese origin. In Genk, mainly Belgian (15%) and Turkish (50%) patients were included. The percentage of horizontal transmission in the total study cohort was 9%. Moreover, the COO groups Dutch/Belgian (n=40), Turkish (n=38) and Chinese (n=18) differed in the number of cases infected by horizontal transmission (4%, 30% and 6%, p=0.030). CONCLUSION: Although the prevalence of horizontal transmission in the total study cohort is low, non-sexual close contact may play a role in the migrant population, particularly the Turkish. This should be an important public health target with respect to the prevention of HBV spreading.

Rapid percutaneous nephrostomy catheter placement in neonates with the trocar technique.

PURPOSE: The purpose of this study was to assess the efficacy of a modified percutaneous nephrostomy procedure for grade III-IV hydronephrosis in neonates. MATERIAL AND METHODS: Eleven neonates (five girls, six boys) with a mean age of 13.7days±9.9 (SD) (range, 4-28days) with pronounced hydronephrosis had percutaneous nephrostomy using a modified procedure. In all patients, percutaneous nephrostomy was performed with a trocar catheter under ultrasound guidance and then the catheter was placed into the collecting system without prior dilatation. RESULTS: Technical success was achieved in all patients. There were no major procedure-related complications. There was no perirenal hematoma on control ultrasound examinations and no hematuria was observed after the procedure. The median drainage time was 75days (range: 42-120days). Two children had urinary tract infection, which was controlled by using antibiotics. CONCLUSION: The trocar nephrostomy is a practical and feasible method, which can be used for neonates with grade III-IV hydronephrosis.

Molecular investigation of Coxiella burnetii infections in aborted sheep in eastern Turkey.

Q fever is a zoonotic disease that occurs worldwide and is caused by the obligate intracellular bacterium Coxiella burnetii. The aim of this study was to investigate the presence of C. burnetii infection in aborted sheep in eastern Turkey using PCR. A total of 200 fetuses were collected from aborted sheep belonging to 200 herds in different locations in the eastern part of Turkey. Foetal organ samples such as liver, spleen, lung and stomach were taken and the DNA was purified from two hundred pooled samples. PCR analysis of C. burnetii presence in infected organs was performed, and 4 samples (2%) were found positive. In addition, the pooled organ suspensions were inoculated to embryonated chicken eggs, and PCR analysis of yolk sacs showed C. burnetii DNA in 5 samples (2.5%). This study shows that C. burnetii infection has an important role in sheep abortions in eastern Anatolia region.

The effect of surgical menopause on the intima-media thickness of the carotid and coronary arteries.

OBJECTIVE: To evaluate the effect of prior bilateral oophorectomy on the intima-media thickness (IMT) of coronary and carotid arteries. METHODS: A total of 25 Wistar albino rats, aged 8-10 weeks, were assigned to three groups: ovariectomized (n = 10), control (n = 10) and sham (n = 5). The rats in the sham group only underwent midline laparotomy, while the other rats' ovaries were removed by the same type of laparotomy. All rats were sacrificed to evaluate microscopically the impact of a prolonged 26-week surgical menopause (menopausal period) on the IMT of the carotid and coronary arterial structure. RESULTS: The mean IMTs of both the carotid and coronary arteries in the ovariectomized group were significantly thicker than those of the control and sham groups (carotid arteries: 268.69 ± 53.67, 195.61 ± 47.60 and 193.86 ± 75.01 µm, p = 0.014; coronary arteries: 182.40 ± 30.22, 136.00 ± 35.82 and 165.24 ± 40.68 µm, p = 0.022, respectively). CONCLUSION: According to the results of this study, surgical menopause results in a noteworthy increase in the IMT of the carotid and coronary arteries when compared with the controls. This interventional effect may have a significant role in accelerating the process of atherosclerosis.

Acardiac twin pregnancy: successful intrauterine ablative treatment with alcohol at 14 weeks of gestation.

Twin reversed arterial perfusion (TRAP) sequence is a serious condition of monochorionic twin pregnancy, occurring in approximately one in 35,000 cases. First trimester treatment of TRAP sequence is controversial with higher incidence of procedure related complications. Present case demonstrates a TRAP sequence that was managed by intrauterine treatment with one-ml 100% pure alcohol injection into the abdominal part of the umbilical artery and obliteration of the acardiac twin at 14 weeks of gestation. Antenatal follow-up was uneventful and elective cesarean section was performed at 39 weeks' gestation. Postnatal outcome of the pump twin was excellent at 30 months after birth. Early second trimester elective ablation by alcohol injection can be an inexpensive, alternative, and reasonable minimal invasive treatment option to prevent fetal loss of pump twin before mid and late second trimester in perinatology centers where intrafetal cord occlusive methods are not available.

Clinical Outcomes of Donor Hepatic Artery to Recipient Replaced Right Hepatic Artery Anastomosis in Living-Donor Liver Transplantation.

OBJECTIVE: The aim of this work was to evaluate the clinical outcomes of donor hepatic artery to recipient replaced right hepatic artery anastomosis in living-donor liver transplantation. METHODS: A retrospective analysis of 12 patients with donor hepatic artery to recipient replaced right hepatic artery anastomosis in living-donor liver transplantation from January 2012 to July 2014 was performed. Age, sex, clinical diagnosis of the liver disease, ABO mismatch, hepatic artery thrombosis, biliary strictures and leakage, graft loss, and mortality rates were evaluated. RESULTS: Female-to-male ratio was 4:8. Right lobe was transplanted in 11 (91.7%) of the patients. In 1 patient, left lobe was transplanted. In 9 patients, single duct-to-duct biliary anastomosis was performed with cystic duct catheterization. In 2 patients, double duct-to-duct biliary anastomosis was performed. In 1 patient, double biliary duct-to-duct anastomosis was performed after ductoplasty to achieve a single ductal orifice. No hepatic artery thrombosis was observed. Biliary complications were observed in 6 patients (50%: biliary leaks in 2 patients, biliary stricture in 3 patients, and both in 1 patient). ABO mismatch was not observed. No graft loss due to hepatic artery thrombosis was observed. Mortality was observed in 2 patients (16.6%). CONCLUSIONS: Donor hepatic artery to recipient replaced right hepatic artery anastomosis in living-donor liver transplantation is somewhat related to biliary complications, but not associated with increased rates of hepatic artery thrombosis.

Radiotherapy-induced hypopituitarism in nasopharyngeal carcinoma: the tip of an iceberg.

BACKGROUND: Radiation-induced hypopituitarism is an important late complication of cranial radiotherapy in children and adults. The purpose of this cross-sectional study was to evaluate the effects of radiotherapy on pituitary function in adult nasopharyngeal carcinoma patients. METHODS: Pituitary function was evaluated in 30 patients after cranial radiotherapy for nasopharyngeal carcinoma. Somatotroph and corticotroph axes were assessed by insulin tolerance test while gonadotroph and thyroid axes were evaluated by basal pituitary and end organ hormone levels at 10-133 months after radiotherapy. RESULTS: At least one hormonal disorder was observed in 28 (93%) patients after radiotherapy. 26 (87%) patients had one or more anterior pituitary hormone deficiencies. The rates of pituitary hormone deficiencies were 77% for growth hormone, followed by adrenocorticotropic hormone (73%), thyroid-stimulating hormone (27%) and gonadotropins (7%). Hyperprolactinemia was present in 13 (43%) patients. CONCLUSIONS: Radiation-induced hypopituitarism is more common than expected in patients with nasopharyngeal carcinoma.

Prospective randomized clinical trial of Jean Rives technique versus laparoscopic TEP repair for primary inguinal hernia: 10-year follow-up.

BACKGROUND: The purpose of the present randomized trial was to compare the Jean Rives (JR) technique and the laparoscopic totally extraperitoneal (TEP) repair for the treatment of primary inguinal hernias with respect to operating time, hospital stay, sick leave, chronic pain and recurrences after a follow-up of 10 years. METHODS: 110 patients with primary inguinal hernia were randomized to either a JR repair (53 patients) or to a laparoscopic (TEP) repair (57 patients). All the interventions were exclusively realized by two experienced surgeons. Follow-up examinations were performed after 1, 6 months, 1, 5 and 10 years. RESULTS: Both groups were identical concerning age and hernia type, which were type II and type IIIa according to Nyhus classification. No significant difference was found concerning hospital stay, chronic pain and recurrences. The operating time was significantly lower in JR group, whereas the sick leave was significantly in favor of TEP group. CONCLUSION: Jean Rives technique is a relatively easy technique to perform, requires shorter operating time when compared to laparoscopic TEP technique. JR technique should be taken into consideration while planning surgical treatment of inguinal hernia.

Relationship of thyroid hormone levels and thyroid autoantibodies with early pregnancy loss and infertility.

Prevalence of abnormalities in thyroid hormones and thyroid autoantibodies in patients with a history of early pregnancy loss (EPL) (n = 17) and unexplained infertility (UI) (n = 25), were compared with that of 45 control patients. TSH, antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-TG) antibody levels in UI and EPL groups were similar to that of the control group. TSH was normal in 39, 22 and 13 of control, UI and EPL patients, respectively. Among patients with a normal TSH, fT4 was higher (p < 0.001) and fT3 was lower (p < 0.001) in infertile patients when compared with the control group. Thyroid function tests seem to be associated with infertility but their association with EPL is weaker. Infertility seems to be associated with a high fT4 and low fT3 status. Thyroid autoantibodies do not seem to be associated with either infertility or EPL.

Complete ossification of the superior transverse scapular ligament in an Turkish male adult / Osificación completa del ligamento escapular superior transverso en un hombre adulto de Turquía

Scapula has three margins and angles and located posterolateral of thorax. One of the anatomical structures of scapula is suprascapular notch located medial to coracoid process base. Suprascapular notch can be seen in different shapes and depths. Suprascapular notch is surrounded by transverse scapular ligament which is a short and strong ligament. Suprascapular notch creates an osteofibrosis passage with this structure within suprascapular nerve passes. It has been reported that this osteofibrosis structure can intirely or partially ossify. All lesions of nerves occured in course as result of exposure to compression, tension and bending are called entrapment neuropathy. Like other peripheral nerves, suprascapular nerve can be exposed to compression while passing suprascapular notch. As a result of this compression suprascapular entrapment neuropathy may occur. There are direct trauma, repetitive microtrauma, neurit, progressive compressive lesions in suprascapular entrapment neuropathies etiology. A suprascapular notch taken foramen shape can be a predisposing factor to entrapment neuropathy. In the retrospective screening from Necmettin Erbakan University, Meram Medical Faculty, Department of Radiology archive, a male patient at age 68 with suprascapular notch variation has been detected. This patient's right suprascapular notch had became foramen by an osseous bridge. Diameters of foramen has been measured as 5.27 mm transverse 6.48 mm vertical. We believe having detailed knowledge of suprascapular notch is significant as a possible course of back and shoulder pain is entrapment of suprascapular nerve in suprascapular notch causing nerve paralyses, and it will give a right direction to clinicians in surgical practices.

La escápula tiene tres márgenes y tres ángulos, y se encuentra en la región posterolateral del tórax. Una de las estructuras anatómicas de la escápula es la incisura supraescapular situada medial a la base del proceso coracoides. La incisura supraescapular puede tener diferentes formas y profundidad. Está rodeada por el ligamento escapular transverso, un ligamento corto y fuerte. Con esta estructura, crea un pasaje osteofibroso por el cual pasa el nervio supraescapular. Se ha reportado que esta estructura osteofibrosa se puede osificar completa o parcialmente. Todas las lesiones de los nervios ocurren en su trayecto como resultado de la exposición a compresión, tensión y flexión, lo que se denomina neuropatía por atrapamiento. El nervio supraescapular puede estar expuesto a compresión al pasar por la incisura supraescapular, generando neuropatía por atrapamiento. Su etiología puede ser por traumatismo directo, microtraumatismo repetitivo y lesiones compresivas progresivas. Una incisura supraescapular de forma oval puede ser un factor predisponente para la neuropatía por atrapamiento. En un estudio retrospectivo realizado en la Universidad Necmettin Erbakan, Facultad de Medicina de Meram, Departamento de archivo de Radiología, se observó la imagen de un varón de 68 años con variación en la incisura supraescapular derecha, la cual se transformó en un foramen por un puente óseo. Los diámetros del foramen fueron 5,27 mm transversales y 6,48 mm verticales. Creemos que el conocimiento detallado de la incisura supraescapular es necesario en el diagnóstico y posible curso de dolor del hombro, debido al atrapamiento del nervio supraescapular en la incisura y la posible parálisis nerviosa, dando una guía a los clínicos en las prácticas quirúrgicas.

Turkish community-based palliative care model: a unique design.

An organized palliative care system was lacking in Turkey before 2010. One of the pillars of Turkish Cancer Control Programme is palliative care. The Pallia-Turk project in this respect has been implemented by the Ministry since 2010. The project is unique since it is population based and organized at the primary level. This means, the whole population (>70 million) will have the quickest and easiest way for access to palliative care. This manuscript briefly summarizes the situation before the project and updates what has been done in last 2 years with the project.

Time-dependent effect of non-Hodgkin's lymphoma grade on disease-free survival of relapsed/refractory patients treated with high-dose chemotherapy plus autotransplantation.

Evaluation of time to event outcomes usually is examined by the Kaplan-Meier method and Cox proportional hazards models. We developed a modified statistical model based on histologic grade and other variables to describe the time-dependent outcome for autologous stem cell transplant (autotransplant) performed for non-Hodgkin's lymphoma (NHL) based on histologic grade and other variables. One hundred and fourteen relapsed or refractory NHL patients were treated using BCNU 600 mg/m2, etoposide 2400 mg/m2, and cisplatin 200 mg/m2 IV followed by autotransplant. Median age was 53.5 (range: 25-70) years, 78 patients had aggressive NHL and 36 indolent NHL. Seventy-five patients received involved-field radiotherapy just prior to transplant. At a median follow-up of 33 (range: 3 to 118) months, the estimated 5-year Kaplan-Meier probabilities of overall survival and disease-free survival were 61% and 51%, respectively. Cox proportional hazards model analysis showed that proportionality did not hold for lymphoma grade, indicating that the relationship between the grade and disease-free survival differed over time. By piece-wise Cox model, the relative risk for experiencing relapse or death after 1 year in patients with indolent compared with patients with aggressive NHL was 2.81 (p=0.019) with 95% confidence interval (1.19, 6.65). The time-dependent effect of lymphoma grade on disease-free survival suggests the need for early (within first year) incorporation of novel therapeutic approaches in management of patients with indolent NHL undergoing autotransplant.

Subungual glomus tumour: magnetic resonance imaging findings.

The present study aims to present a case of a subungual glomus tumour with literature to the findings on magnetic resonance (MR) imaging. A 51-year-old man consulted his physician because of a pain in the nail bed of his thumb, which he had had for 2 years. A plain radiography and MR examination was performed. Physical examination showed a blue-brown focus beneath the nail and there was deformation. A plain radiography demonstrated no abnormality. T1-weighted spin-echo images showed a well-marginated, oval, slightly hyperintense lesion (4 mm diameter) located in the subungual region. On turbo spin-echo T2-weighted images the lesion was hyperintense with a hypointense rim. T1-weighted spin-echo images after intravenous administration of contrast medium showed strong enhancement. The lesion was completely excised at surgery and the diagnosis of a glomus tumour was established histologically. In conclusion, MR imaging offers excellent diagnostic information about a clinically suspected glomus tumour.

Pre-mobilization therapy blood CD34+ cell count predicts the likelihood of successful hematopoietic stem cell mobilization.

We examined pre-mobilization blood CD34+ cell count to predict ability to mobilize adequate peripheral blood progenitor cells (PBPC) in 106 cancer patients and 36 allogeneic donors. Mean pre-mobilization therapy blood CD34+ cell count was 3.1 cells x 10(6)/l (s.d. = 3.9, r = 0.3-37) and mean CD34+ cells collected were 5.3 x 10(6) cells/kg/leukapheresis procedure (s.d. = 7.0, r = 0.03-53). Yields correlated with pre-mobilization CD34+ cells x 10(6)/l (r = 0.37, P-value < 0.0001); correlation was stronger in allogeneic donors (r = 0.56, P-value = 0.0004) and males (r = 0.46, P-value < 0.0001). Based on classification and regression tree multivariate analysis, the predictive value of pre-mobilization blood CD34+ cell count was confounded by other variables, including age, gender, mobilization regimen and malignancy type. We generated an algorithm to predict a minimum PBPC yield of 1 x 10(6) CD34+ cells/kg/leukapheresis procedure after mobilization. A threshold pre-mobilization blood CD34+ cell count of 2.65 cells x 10(6)/l was the most important decision point in predicting successful mobilization. Only 2% of subjects with pre-mobilization blood CD34+ cell counts > 2.65 cells x 10(6)/l did not achieve the minimum per apheresis, whereas 24% with pre-mobilization values below threshold had inadequate mobilization. Prospectively identifying individuals at risk for mobilization failure would allow for improved treatment planning, resource utilization and time saving.