The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

INTRODUCTION: Acute mesenteric ischemia (AMI) is an abdominal-vascular emergency which is rare and has high mortality rates (60-80 %) due to late diagnosis (1-3). Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1). MATERIALS AND METHODS: In this study, we used male Wistar-Albino rats weighing 250-300 grams obtained from Pamukkale University Experimental Research Laboratory. Animals were exposed to light-dark cycles for 12 hours and had free access to food and water. They were kept in cages for 7 days to stabilise their intestinal flora. In animals of group I, nothing was made other than taking 0.5 ml blood intracardially. In other animals, abdomen was reached with midline laparotomy and superior mesenteric artery (SMA) was located. In group II (operative control group), SMA was isolated and manipulated but was not ligated. In Group III (intestinal ischemia group), SMAwas isolated and ligated with 3/0 silk tie distally to the aorta. After this process, intestinal ischemia was achieved which was confirmed by paleness and pulselessness of intestines, caecum and right colon. Later on, abdomen was closed with double 3/0 polyglactin sutures. At postoperative 1st, 4th and 6th hours 0.5 ml blood was taken intracardially from the animals in groups II and III in order to quantify D-dimer and L-lactate levels. LABORATORY TESTS: D-dimer: Blood samples which were put into tubes containing sodium citrate, were seperated from plasma with centrifugation at 4000 rpm for 7 minutes. L-lactate: Blood L-lactate levels were determined from blood taken into capillary tubes with the help of immobilised enzyme electrode technology using YSI 1500 Sport portative lactate analyzer (Yellow Springs Instruments Inc., Ohio-USA). HISTOPATHOLOGIC VERIFICATION: Two cm long intestinal samples were taken from animals in which SMA was ligated in order to achieve mesenteric ischemia and these samples were fixed in 10 % formol. DISCUSSION: As a result, in rats with SMA occlusion serum D-dimer levels were not increased significantly when compared either in the group or with the basal values of the control group and values in operative control group. Therefore, it is concluded that D-dimer is not a useful marker for early diagnosis of AMI. On the other hand, it is revealed that blood L-lactate levels began to increase significantly following 4th hour of mesenteric ischemia and it is shown that this increase continued at the 6th hour. In addition, considering the utmost importance of the early diagnosis in patients with the clinical suspicion of AMI, L-lactate seems to be a suitable marker to use in emergency departments because it is achieved with a portable device that gives fast and accurate results. Nevertheless, our results are need to be supported by clinical studies with larger patient series (Tab. 2, Fig. 11, Ref. 39). Text in PDF www.elis.sk

Morbid obezitede gastrik histopatolojik bulgular ve Ghrelin ekspresyonu

Objective: The role of Ghrelin, also known as the appetite hormone, is not fully explained in the development of morbid obesity. Plasma Ghrelin level is low in obese and high in slim subjects. Ghrelin-expressing cells were investigated histopathologically in the stomach of morbid obese patients in this study. Tissue Ghrelin expression was also compared with various parameters such as the distribution of endocrine cells, age, gender, body mass index, preoperative plasma Ghrelin level and presence of accompanying diseases. Material and Method: The study included 33 morbidly obese patients, and 8 non-obese control patients. Plasma Ghrelin levels were measured preoperatively. Sleeve gastrectomy resection materials of 33 cases were evaluated with histopathological and immunohistochemical (Ghrelin and Chromogranin-A) techniques. The results were statistically evaluated by nonparametric tests. Results: Histopathological findings observed in sleeve gastrectomy resection materials were interstitial lymphocytic infiltration (63.6%), hyperplasia of lymphoid follicles in the lamina propria (60.7%) and microvesiculation / dilatation of parietal cells (57.6%). The number of Ghrelin immunopositive cells in the gastric mucosa in females was significantly higher compared to males (p=0,007). Additionally, the number of Ghrelin immunopositive cells was significantly higher at the fundus-proximal corpus compared to the distal corpus of the stomach (p=0.0001). No significant correlation was found between Ghrelin-chromogranin immunopositive endocrine cell distribution and preoperative plasma Ghrelin levels and endocrine cell hyperplasia. Conclusion: Our study confirms that Ghrelin producing cells are most dense in the proximal stomach. Increased number of Ghrelin expressing cells in the gastric mucosa in females compared to males suggests that gender may also be a factor in determining the method for treatment of morbid obesity

Pseudoxanthoma elasticum: A pediatric case

Pseudoxanthoma elasticum (PXE) is a multisystemic, metabolic and autosomal recessive inherited disorder affecting especially elastic fibers of skin, retina and blood vessels. The prevalence varies from 1:25,000 to 1:100,000. The average age of onset is 13.5 years. Yellowish papules 1-3 mm in diameter and plaques merging as linear or reticular pattern are mostly on antecubital fossae, popliteal fossae, inguinal region, lower clavicle, neck, axilla, flexural regions as umbilicus and trauma sites. Of the patients, 85% have eye involvement. The first symptom of eye involvement is spot retinal pigmentation. Cardiovascular complications occur usually in adults. The most common and early cardiovascular complication is intermittent claudication. There is no specific treatment for skin signs. Lifestyle changes may have important effects on prognosis. A male patient with 3-year history of yellowish papules on his neck and 1-year history of yellowish papules on his groins, was presented in this case report. This 7-year-old patient received a diagnosis of PXE based on medical story, clinical examination and histopathological findings. This case was presented as PXE is a rare disease and should be diagnosed by the clinician at early ages. © 2015 by Turkish Society of Dermatology

Surgical treatment of classic kaposi's sarcoma in the lower extremity

Objective: Classic Kaposi's sarcoma is an indolent, angioproliferative tumor that is usually observed in the lower extremities of elderly men. Depending on their stages, skin lesions are maculonodular or vegetative ulcerated masses. Visceral organ or lymph node involvement may rarely occur. There is no gold standard treatment for local diseases. Surgical excision, radiotherapy, chemotherapy, and cryotherapy can be performed. This retrospective study aimed to evaluate the long-term results of surgical excision and skin graft repair of stage I and II classic Kaposi's sarcoma skin lesions around the foot and ankle. Material and Methods: Eleven patients were included. The patients' age and gender, location of lesion, surgical treatment, follow- up period, and recurrence were evaluated by retrospectively examining patient records. For the surgical treatment, the lesion was excised with a 0.5-cm safe skin margin. The defect area was repaired with full-thickness skin grafts that were obtained from the inguinal region in all patients. Results: Eight of the patients were male and three were female. The average age of the patients was 69 (54-84) years. All patients were completely cured. The average follow-up period was 1.8 (1-3) years. No recurrence was observed in any of the patients at the end of the follow-up period. Conclusion: Classic Kaposi's sarcoma skin lesions in the lower extremity can be completely cured by surgical excision, with no recurrence risk. After surgical excision, using a full-thickness skin graft for repairing primary cutaneous defects, particularly those in the soles, is a simple and reliable method

Pemfigus etiyopatogezinde coxsackle virüsün olası rolünün araştırılması

Başlangıç seviyesi projesiPemfigus desmozomal proteinlere karşı oluşan antikorlara bağlı gelişen otoimmun büllöz hastalık grubudur. Etiyolojisi tam olarak aydınlanmamış olmakla birlikte viral enfeksiyonlar da suçlanmaktadır. Sunulan çalışmada Pamukkale Üniversitesi Tıp Fakültesi Hastanesi Dermatoloji polikliniğine başvuran pemfigus tamlı hastalarda, histopatolojik olarak akantolizin izlendiği başka bir hastalık olan el- ayak-ağız hastalığı etkeni Coxsackie virüslerin, hastalığın seyri sırasında artmış olduğu gösterilmiş çeşitli kemokin ve sitokinler üzerine sahip olduğu arttırıcı etkilerinden yola çıkarak, perilezyonel deri biyopsi materyalinde ve kanda Coxsackie virus varlığı araştırılmıştır. Bu çalışma ile Pemfigus tamlı hastalar ile sağlıklı kontrol olguları Coxsackie virus IgM ve IgG seroprevalansı açısından karşılaştırılmıştır. Bu araştırma Pamukkale Üniversitesi Bilimsel Araştırma Projeleri Birimi tarafından 2009BSP016 No.lu proje olarak desteklenmiştir

Poststreptococcal septal panniculitis with leukocytoclastic vasculitis

The panniculitides are group of heterogeneous inflammatory diseases involving the subcutaneous fat. Erythema nodosum is an inflammatory lesion of the subcutaneous tissue consisting of warm, reddish, painful and indurated nodules, usually located on the anterior aspects of the lower extremities. Histopathologically, erythema nodosum is the stereotypical example of a mostly septal panniculitis with no vasculitis. The process may be associated with infections, sarcoidosis, rheumatologic diseases, inflammatory bowel diseases, medications, autoimmune disorders, and malignancies. In this paper, a case of poststreptococcal erythema nodosum is reported characterized by septal panniculitis with leukocytoclastic vasculitis

Continuous professional development and learning needs of physicians without vocational training: a cross-sectional study

Amaç: Sürekli mesleksel gelişim (SMG), mezuniyet öncesi ve sonrası eğitimi tamamlayan sürekli bir öğrenme sürecidir. Bu çalışmanı n amacı, farklı ortamlarda çalışan uzman olmayan hekimlerin öğrenme gereksinimleriyle tercih ettikleri SMG etkinlikleri ve eğitim yöntemlerini belirlemek ve gelecekte düzenlenecek SMG etkinlikleri için sonuçlar çıkarmaktır. Yöntem: Denizli’de farklı ortamlarda çalışan uzman olmayan 473 hekim çalışmanın evrenini oluşturdu ve tamamı çalışmaya alındı. Beşli Likert tipi puanlaması olan ve öğrenme ihtiyaçları ile ilgili açık uçlu sorular içeren 22 maddelik bir anket formu Ocak-Mayıs 2009 tarihleri arasında katılımcılara gönderildi. Ankette yer alan maddelerin güvenilirlik katsayısı yüksek bulundu (Cronbach Alfa=0.83). Bulgular: Anketin yanıtlanma oranı %54.3 idi (s=257). Hekimlerin %79.8’i (s=205) bir günde ortalama 30’dan fazla hasta gördüklerini ve %77.4’ü (s=199) bir poliklinik gününde 5-15 arası klinik soru ile karşılaştıklarını bildirdiler. En sık tercih edilen bilgi kaynakları tıbbi kitaplar ve dergilerdi; bunları internet takip etti. En sık tercih edilen SMG yöntemleri ise tıbbi beceri kursları ve küçük grup çalışmalarıydı. Sonuç: Uzman olmayan birinci basamak ve acil servis hekimleri, geleneksel eğitim yöntemlerini değil öğrenen merkezli, kendi kendine öğrenmeye ve karşılıklı etkileşime dayalı etkinlikleri tercih etmektedirler. Bu durumun gelecekte düzenlenecek olan SMG programlarında dikkate alınması sağlık hizmetlerinin kalitesinde iyileşme sağlayabilir.Objective: Continuing professional development (CPD) is a continuing learning process that complements formal undergraduate education and postgraduate training. The aim of this study was to define learning needs, and preferred CPD activities and educational methods of non-vocationally trained physicians working in different settings and to draw conclusions for future CPD activities. Methods: All physicians without vocational training working in Denizli were enrolled (s=473). A self-completed 22-item questionnaire with five-point Likert-type scale was sent to the participants from January 2009 to May 2009. The learning needs of the participants were asked in open-ended questions. The reliability coefficient of items in the questionnaire was high (Cronbach's Alpha= 0.83). Results: The response rate was 54.3% (n=257). Of 257 physicians, 79.8% (n=205) reported that they saw 30 and more patients per day and 77.4% (s=199) reported that they encountered with 5-15 clinical questions per day. The most common preferred sources of information were medical textbooks and journals, followed by internet. The most common preferred methods of CPD were medical skills courses and workshops. Conclusions: Primary care and emergency care physicians without vocational training do not seem to prefer traditional educational methods but rather they prefer learner-centered, selfdirected and interactive CPD activities. Taking this situation into consideration while planning the future CPD programs may improve the quality of health care provision

Immunohistochemical expression of β-catenin, E-cadherin, cyclin D1 and c-myc in benign trichogenic tumors

Background: β-catenin gene mutations have been reported in vast majority of pilomatrixomas (PMXs). β-catenin, a component of the adhesion molecules of the cytoskeleton, is degraded at the cytoplasm. Excess cytoplasmic β-catenin enters into the nucleus and activates the transcription of several genes encoding c-myc, cyclin D1 and others. Sublocation of β-catenin has been demonstrated by immunohistochemistry. The aim of this study was to determine the role of β-catenin-related proteins in various benign trichogenic tumors. Methods: We investigated the expression of β-catenin, E-cadherin, c-myc and cyclin D1 immunohistochemically, and the expression of these molecules were compared between two groups consisting of 12 PMXs and 12 other benign trichogenic tumors (OBTTs). Results: In PMX group, nuclear and/or cytoplasmic expression of β-catenin was associated with a loss of membranous expression of E-cadherin (p = 0.002). In OBTT group, a membranous expression of E-cadherin and β-catenin was observed, and there was a stronger nuclear immunoreactivity of cyclin D1 compared with PMX group (p = 0.006). Conclusions: In PMX, nuclear and/or cytoplasmic β-catenin expression of tumoral cells is not related with β-catenin-related gene expressions (c-myc or cyclin D1). The molecular behaviour of OBTTs is clearly different from that of PMXs in terms of to E-cadherin and β-catenin expression. © Blackwell Munksgaard 2006