Search

Byline: E. Gunel (1), O. Caglayan (1), F. Caglayan (1), T. K. Sahin (1) Keywords: Key words Surgical stress; Visceral protein; Acute-phase protein; Childhood Abstract: The metabolic response to surgical stress is a nonspecific increase in hepatic synthesis of some specialized acute-phase proteins and a decrease in plasma concentrations of visceral proteins following surgical trauma. This study was undertaken determine which specific proteins were the better clinical indices in monitoring the metabolic response to surgical stress in children recovering from minor surgery. Forty-four patients undergoing elective inguinal surgical procedures under general anesthesia were studied. Blood samples were collected preoperatively (-1) and at 1(+1) and 5(+5) days postoperatively to determine albumin (AL), Prealbumin (PA), C-reactive protein (CRP), and a.sub.1-acid glycoprotein (AGP) values, and to calculate the prognostic inflammatory and nutritional index (PINI). Mean AL values were the same on all days. Mean PA +1 was significantly lower than PA -1 and PA +5 (P&lt 0.001). Median CRP +1 and mean AGP +1 values were significantly higher than median CRP -1 and mean AGP -1 (P&lt 0.0001), respectively. Although there was a decrease after postoperative day 1, median CRP +5 and mean AGP +5 values were still significantly higher than preoperative values (P&lt 0.01 and P&lt 0.0001). Moreover, the median PINI +1 was also greater than PINI -1 and PINI +5 (P&lt 0.0001), but the median PINI+5 was significantly higher than PINI -1 (P&lt 0.01). Median percent changes of PINI values were significantly higher than those of the other parameters from both preoperatively to postoperative day 1 and preoperatively to postoperative day 5. Although several specific proteins (AL, PA, CRP, and AGP) have been evaluated as indicators of the acute metabolic response, we suggest that the PINI is more valuable for reflecting the response to surgical stress in patients recovering from minor surgery. Author Affiliation: (1) Departments of Pediatric Surgery, Biochemistry and Public Health, Selcuk University, School of Medicine, Konya, Turkey, TR Article note: Accepted: 17 June 1998

Byline: E. Gunel (1), O. Caglayan (1), F. Caglayan (1) Keywords: Key words Ischemia-reperfusion injury; Serum D-lactate; Mannitol Abstract: Currently, no serum marker has proved helpful in diagnosing intestinal ischemia and reperfusion (I/R) injury. An experimental study was conducted to determine the value of serum D-lactate in detecting intestinal I/R injury. Thirty New Zealand White rabbits were divided into three groups of 10 animals each: sham-operation controls (S) I/R and I/R plus mannitol treatment (M). Serum samples were obtained before operation (T.sub.0), at the end of the ischemic period (T.sub.1), after the first 30min of reperfusion (T.sub.2), and at the end of the reperfusion period (T.sub.3). In Group S, mean D-lactate levels for T.sub.0, T.sub.1, and T.sub.2 were 0ug/dl, while T.sub.3 was 5.8+-4.7ug/dl. Before the operation (T.sub.0), serum mean D-lactate levels were 0ug/dl in all groups (S, I/R, M). Levels increased after 1h of ischemia (T.sub.1) in groups I/R (83.5+-25.6ug/dl) and M (89.8+-19.9ug/dl), but not in group S (0ug/dl). The mean T.sub.2 level in group I/R (231.6+-78.6ug/dl) was statistically higher than in group M (140.1+-53.5ug/dl) (P=0.007). At the end of the reperfusion period, the mean T.sub.3 level in group I/R (698.4+-360.4ug/dl) was significantly higher than in group M (158.7+-61.4ug/dl) (P=0.000). In group I/R, mean D-lactate levels changed significantly at each time point (T.sub.1 vs T.sub.2, P=0.001 T.sub.2 vs T.sub.3, P=0.004). However, in group M the increase from T.sub.1 to T.sub.2 was significant (P=0.012), but that from T.sub.2 to T.sub.3 was not (P=0.293). As a result, the mean T.sub.3 level was significantly higher than the T.sub.2 level in group I/R (P=0.004), but not in group M. This study confirmed a significance rise in D-lactate levels in animals with I/R injury compared to sham-operated and I/R injury plus M treatment. We suggest that serum D-lactate levels could be a useful marker of intestinal I/R injury before laparatomy. Author Affiliation: (1) Departments of Pediatric Surgery, and Biochemistry, Medical School of Selcuk University, Konya, Turkey, TR Article note: Accepted: 26 May 1998

Byline: E. Gunel (1), D. FA+-ndA+-k (1), O. Caglayan (1), F. Caglayan (1), Z. Topgac (1) Keywords: Key wordsHelicobacter pylori; Gastritis; Recurrent abdominal pain; Gastrin; Children Abstract: Recurrent abdominal pain (RAP) is a significant problem in the pediatric population, and there has been much recent interest in the role that Helicobacter pylori (Hp) might play in this disorder. In this case control study, the authors aimed to determine whether Hp is an agent responsible for RAP, and to assess fasting gastrin concentrations in children with and without RAP in the Hp-positive and -negative groups. The study was conducted in 42 patients with RAP and 50 healthy children attending routine day-case surgery as a control group, aged 3 to 15 years, over a 12-month period. Of the 42 children with RAP, 30 were seropositive (71.4%) for Hp IgG, and of 50 children in the control group, 32 were seropositive (64%) for Hp IgG (P&gt 0.05). We found that Hp infection was as high in healthy children as in children with RAP. The mean fasting gastrin levels in 62 Hp-seropositive children (60.4ng/l) were not different from those in 30 Hp-seronegative children (57.3ng/l) and those in 42 children with RAP (58.2ng/l) were also not significantly different from those in 50 healthy children (62.9ng/l). Thus, no association between childhood Hp infection, hypergastrinemia, and RAP was found in our Turkish population. Author Affiliation: (1) Departments of Pediatric Surgery, Microbiology, Biochemistry, and Pediatrics, Medical School of Selcuk University, Konya, Turkey, TR Article note: Accepted: 26 May 1998

Tumour lysis syndrome (TLS) is a rare but serious complication of cancer treatment. It is generally seen in patients with high tumour load or chemosensitive tumour after chemotherapy and is more common with haematological malignancies like leukaemia and lymphoma when compared to solid tumours. TLS occurring after radiotherapy (RT) in patients with solid tumours is very rare. We aimed to present TLS seen after RT for a vertebral tumoral mass in a patient with metastatic adenocarcinoma of unknown origin. A 78-year-old woman, who was diagnosed with adenocarcinoma of unknown origin, was hospitalized to undergo palliative RT for the vertebral mass. On the 1st day, 4 mg q6hour perioral dexamethasone was started. 300 cGy per session RT started on the 2nd day of hospitalization. After the fifth session of RT (after a total dose of 15 Gy), she developed TLS complicated with acute kidney injury requiring renal replacement therapy and she was successfully treated by haemodialysis. Close monitoring, even in patients with low risk for TLS and early administration of preventive modalities should be kept in mind. [ABSTRACT FROM AUTHOR]

Objective: Several studies have shown increased oxidative stress in patients with pre-diabetes and newly diagnosed Type 2 diabetes mellitus (T2DM). It has been proposed that oxidative stress initiates insulin resistance in genetically predisposed individuals. The aim of this study was to evaluate the markers of oxidative stress in the off spring of patients with T2DM. Material and Methods: We examined 60 lean normoglycemic off spring of Type 2 diabetics, and 52 age, sex and body mass index matched subjects without family history of T2DM as controls. Anthropometric, biochemical and carotid intima media thickness (IMT) measurements and oral glucose tolerance test (OGTT) were performed. Erythrocyte superoxide dismutase and glutathione peroxidase activities, serum nitric oxide, plasma total sulfhydryl (tSH) groups, plasma total antioxidant status, plasma malondialdehyde and serum 8-hydroxydeoxy-guanosine (8-OHdG) levels were compared between 2 groups. Results: 2 groups were similar for the measurements of anthropometric, blood pressure, lipids, fasting glucose, HOMA-IR and carotid IMT. Glucose levels during OGTT were signifi cantly higher in the off spring of Type 2 diabetics than controls (p = 0.035). The off spring of Type 2 diabetics showed a signifi cant increase in serum 8-OHdG level (p = 0.005) and plasma tSH groups (p = 0.032) when compared to the controls. Signifi cant diff erences were not obtained in other oxidative stress marker levels between 2 groups. Conclusion: Main finding of our study was the presence of increased oxidative DNA damage in lean normoglycemic off spring of Type 2 diabetic patients. There is a need for further clinical studies in order to explain whether oxidative stress is present in genetically predisposed subjects and induces the insulin resistance. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIMS: This study aimed to determine whether there is an adrenomedullin (AM)-mediated protective effect of postmenopausal estrogen/progestin therapy (HRT) against cardiovascular disorders. METHODS: A total of 22 post-menopausal women without hysterectomy undergoing postmenopausal symptoms (aged 43-52) were treated with conjugated equine estrogen (0.625 mg/die) plus medroxyprogesterone acetate (2.5 mg/die) for six months. The flow velocity of the right middle cerebral artery [measured as resistance index (RI) and pulsatility index (PI)], plasma levels of adrenomedullin and endothelin- 1 (ET-1), mean baseline ratio of AM to ET-1, and lipid profiles were assessed before and after HRT. RESULTS: A statistically significant difference was found for triglycerides, total cholesterol, AM/ET-1 ratio and right middle cerebral artery PI (p<0.05), without any significant differences in HDL, LDL, AM, ET-1, systolic blood pressure, diastolic blood pressure, a right middle cerebral artery RI (p>0.05) between pre- and post- HRT. CONCLUSIONS: Adrenomedullin may be added to other vasoactive peptides as a new potential candidate for HRT-mediated vascular protection. The ratio of AM/ET-1 vs AM or ET-1 alone may be a useful biological marker of this protection. [ABSTRACT FROM AUTHOR]

ABSTRACTPurpose:To compare transobturator midurethral sling (TOS) and single-incision sling procedures in terms of their effects on urinary incontinence and the quality of life in overweight (BMI ≥25-29.9 kg/m2) female patients using the International Consultation on Incontinence Questionnaire scoring form (ICIQ-SF) and Quality of Life of Persons with Urinary Incontinence scoring form (I-QOL).Materials and Methods:In this prospective trial, the patients were divided into two groups consecutively; first 20 overweight female patients underwent the TOS (Unitape T®,Promedon, Cordoba, Argentina) procedure and the subsequent 20 consecutive overweight female patients underwent the single-incision sling [TVT-secur (Ethicon Inc., Sommerville, USA)] procedure. Age, urinary incontinence period, parity and daily pads usage were recorded. No usage of pads was defined as subjective cure rate postoperatively. Before the operation and 6. month after the surgery, the patients completed the ICIQ-SF and I-QOL.Results:There was no significant difference between the two groups in terms of mean age, duration of incontinence, parity, and BMI (p>0.05). ICIQ-SF and I-QOL revealed that the patients in the TOS group showed significantly better improvement (76.20% versus 64.10%, p=0.001, 81.31% versus 69.28%, p=0.001, respectively). In addition, subjective cure rates were found higher in TOS group (75% versus 55%, p=0.190).Conclusions:The existing data is showed that incontinence symptoms and the quality of life have higher improvement in overweight female patients who underwent the TOS procedure. It is likely that the TOS procedure may provide stronger urethral support and better contributes to continence in this group of patients.