Use of activated protein C has no avail in the early phase of acute pancreatitis

AbstractObjectives. Sepsis and acute pancreatitis have similar pathogenetic mechanisms that have been implicated in the progression of multiple organ failure. Drotrecogin alfa, an analogue of endogenous protein C, reduces mortality in clinical sepsis. Our objective was to evaluate the early therapeutic effects of activated protein C (APC) in a rat model of acute necrotizing pancreatitis. Subjects and method. Acute necrotizing pancreatitis was induced by intraductal injection of 5% Na taurocholate. Hourly bolus injections of saline or recombinant human APC (drotrecogin alfa) was commenced via femoral venous catheter four hours after the induction of acute pancreatitis. The experiment was terminated nine hours after pancratitis induction. Animals in group one (n=20) had a sham operation while animals in group two (n=20) received saline and animals in group three (n=20) received drotrecogin alfa boluses after acute pancreatitis induction. Pancreatic tissue for histopathologic scores and myeloperoxidase, glutathione reductase, glutathione peroxidase, and catalase activites were collected, and blood for serum amylase, urea, creatinine, and inleukin-6 measurements was withdrawn. Results. Serum amylase activity was significantly lower in the APC treated group than the untreated group (17,435±432 U/L vs. 27,426±118 U/L, respectively). While the serum interleukin-6 concentration in the APC untreated group was significantly lower than the treated group (970±323 pg/mL vs. 330±368 pg/mL, respectively). Conclusion. In the early phase of acute pancreatitis, drotrecogin alfa treatment did not result in a significant improvement in oxidative and inflammatory parameters or renal functions

Patients with Bulbar Papilla and Choledocholithiasis and their Endoscopic Management

WOS: 000265203100006PubMed ID: 19453023Background/Aims: This study presents the endoscopic management of twenty-one patients with biliary stones, deformity at the duodenal bulb, and a flat shaped papilla ectopically located at duodenal bulb. Methodology: Most of the patients were male with a mean age of 53.9 +/- 9.6 years. In four (19%) of the 21 patients stenotic parts in the bulbus were dilated with TTS balloons, thus allowing ectopic papillae to be reached in all of the cases. Papillary orifice and distal CBD were dilated with balloons from 4 mm diameter and increasing the diameter of the balloons stepwise to 6 to 15 mm. Results: In 20 (95%) the patients, the stones could be extracted in either the first or subsequent endoscopy session as the cholangiography. In one patient, retroperitoneal perforation in the intrapancreatic segment of the CBD occured after dilatation of CBD with a 15 mm balloon, and an operation was necessary. Conclusion: The shared features which may constitute a unique clinical entity of the presented cases are 1) male gender, 2) bulbar papilla, 3) flat appearance of the major papilla endoscopically 4) deformed bulbus, and 5) presence of stones in the CBD. Bile duct stones can be treated with endoscopic balloon dilatation of the distal CBD and papilla

Open-label study of adjunct modafinil for the treatment of patients with fatigue, sleepiness, and major depression treated with selective serotonin reuptake inhibitors

WOS: 000242284300015PubMed: 17050507Despite the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depression, a significant number of patients show partial or no remission of symptoms. Some evidence suggests that psychostimulant augmentation may be helpful in treating patients with residual symptoms of depression. The efficacy of modafinil in augmenting SSRIs in depressed patients with residual fatigue or excessive daytime sleepiness has yet to be systematically investigated. In a series of 25 patients with major depressive disorder, according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, who showed significant residual symptoms after an adequate SSRI trial (12 wk) and who were evaluated according to the Fatigue Severity Scale (FSS), subjects with scores >= 4 were given open-label modafinil augmentation for a minimum of an additional 6 wk. Treatment response was assessed prospectively with the FSS, the Epworth Sleepiness Scale (ESS), and the Hamilton Rating Scale for Depression (HAM-D) during the first visit and at the second and sixth weeks. Twenty-one of 25 patients in this series who were treated with modafinil and SSRIs completed the 6-wk augmentation trial. At end-point assessment, all patients showed significant improvement in fatigue and sleepiness in FSS and ESS scores, as well as in HAM-D scores (P <.01). In the second week, 29.4% of patients had a HAM-D score < 7, which was defined as remission; this rate was 64.7% in the sixth week. The rate of patients whose HAM-D score dropped by more than 50%, defined as responders to treatment, was 41.1% and 76.4% in the second and sixth weeks, respectively. Results of this preliminary, open-label trial suggest that modafinil may be effective in augmenting ongoing SSRI treatment for a portion of patients with major depression who have residual fatigue and sleepiness. Larger, placebo-controlled trials appear warranted to investigate the clinical efficacy and tolerability of modafinil augmentation of SSRI treatment in these patients

Serum iron and vitamin B 12 deficiency could indicate celiac disease by flexible spectral imaging color enhancement

INTRODUCTION: Celiac disease (CeD) is an autoimmune disease that can be delayed in diagnosis due to the presence of atypical and asymptomatic cases in adulthood. Herein we aimed to study the frequency of CeD and evaluate whether magnified endoscopy and magnified/FICE (flexible spectral imaging color enhancement) techniques contribute to the diagnosis in patients with serum iron and vitamin B12 deficiency

Pain perception in patients with bipolar disorder and schizophrenia

Objective: Pain perception is reported to be altered in patients with depression and schizophrenia. However, few studies have investigated the pain perception in patients with bipolar disorders. We therefore aimed to compare pain sensitivity between patients with bipolar disorder, schizophrenia and controls

Role of omentum in acute pancreatitis

WOS: 000246499700019PubMed ID: 1731247

An Anatomical and Radiological Study for C1 Lateral Mass Screw Fixation

WOS: 000323600800012Morphometrical analysis of 30 dry stored atlas (C1) vertebrae was performed in order to determine the appropriate length of the screws to be placed on the atlas via posterior approach. In addition, a 3D CT scanning was performed on all samples and angles and lengths were measured on radiological data derived from CT scans. The previous morphometric studies carried out on C1 screw fixation were meticulously reviewed. The literature review has revealed that two non-assessed measurement parameters akin to the ideal screw length have been generated in this study. The first of these parameters, the length of the screw in the saggital plane, has been found 17.8 mm on right and 18.72 mm on left sides. The length of the screw in the vertical plane was found 19.06 mm on right and 19.26 mm on left sides. It's clear that the differences between the interval values of the two measurement parameters range between 5.65 mm and 9.25 mm at minimum. According to the measurements and the literature review carried out so far, there is not a standard screw length for C1 lateral mass screwing technique. The screw length is different for every individual. The surgeon to apply C1 lateral mass screwing must calculate the appropriate screw length via pre-operative cervical CT examinations and use the appropriate-sized screws in the operations

Computed tomography vs. magnetic resonance imaging in unstable cervical spine injuries

Altunci, Yusuf Ali/0000-0002-4803-5419WOS: 000536020600014PubMed: 32436971BACKGROUND: This study aimed to investigate the role of computed tomography (CT) in identifying missed unstable blunt cervical injuries. METHODS: Patients admitted to the emergency department between June 2014 and June 2018 with a diagnosis of blunt cervical trauma were included in this study. All participants underwent cervical magnetic resonance imaging (MRI) after an initial cervical CT investigation. All imaging results were reviewed, and decisions were taken by the consensus of a team consisting of an emergency medicine specialist, a neuroradiologist, and a neurosurgeon. Other variables included age, sex, the Glasgow Coma Scale, medical comorbidities, multi-trauma, neurological deficits, accompanying intracranial hemorrhage, extremity fractures, and the mechanism of the injury. RESULTS: Data for 195 patients were analyzed. the mean (+/- standard deviation) age of the participants was 47.34 +/- 21.90 years, and 140 (71.8%) were males. Eighteen patients (9.2%) were below age <18. the most frequent mechanism of injury was fall from height (n=100; 51.3%). Using MRI as the gold standard, the sensitivity of CT in diagnosing unstable cervical injury was 77.7% (95% CI [67.1-86.1]), while its specificity was 100.0% (95% CI [59.0-100.0]). CONCLUSION: Although computed tomography is relatively good in diagnosing unstable cervical injuries, its sensitivity in detecting positive cases is not as successful. Thus, the use of MRI in patients with an unstable injury seems to be warranted

A RARE PRESENTATION OF MUSCULOSKELETAL TUBERCULOSIS: TENOSYNOVITIS OF THE FLEXOR TENDONS OF THE WRIST AND DIGITS

One of the extrapulmonary mycobacterium tuberculosis infection is wrist tenosynovitis and treatment of the wrist tenosynovitis includes antibiotics and surgical debridement. We report the diagnosis and treatment of a patient with tuberculosis tenosynovitis of the flexor tendons of the wrist and digits. Our patient was 65 years old. In his physical examination, swelling, redness, and warming along the wrist and draining open wounds on the palmar surfaces of the first and fifth fingers at the same hand were detected. In the laboratory tests, his acute-phase reactants had increased and in the T2A series, MRI findings depicted millimetric nodular images on the sheath of the flexor tendons of the wrist and first and fifth digits, which were consistent with synovitis. Debridement and synovectomy of flexor tendons of the wrist and D1, D5 of the left side was performed. A total of 6 months of a rifampicin-based anti-tuberculosis treatment was administered. In the second year after the operation, there was no problem with previous wound, and range of motion and muscle strength of the fingers and wrist joint were complete