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The influence of relative humidity (RH) on quasistatic current-voltage ${(I-V)}$ characteristics of Bifidobacterium animalis subsp. lactis BB-12 thin layers have been studied for the first time. The value of electrical conductivity in 75$ \%$ RH was found to be in the order of 10$^{-7}$ (ohm cm)$^{-1}$ which was 10$^{6}$ orders of magnitude higher than that observed in dry atmosphere. Here we also demonstrated that RH played a key role in hysteresis behaviour of the measured ${(I-V)}$ characteristics. FTIR measurements showed that under water moisture environment the associated bonds for amine and carboxyl group were greatly strengthened that was the source of number of free charge carries after ionization. The type of surface charge of Bifidobacterium animalis subsp. lactis BB-12 was found to be negative by zeta potential measurements, claiming that electrons were the charge carriers.

Closed shell charmed hypernuclei $^5_{\Lambda_c}$Li, $^{17}_{\Lambda_c}$F, $^{41}_{\Lambda_c}$Sc, $^{57}_{\Lambda_c}$Cu, $^{133}_{\Lambda_c}$Sb and $^{209}_{\Lambda_c}$Bi are calculated within Hartree-Fock approach by using three different force sets derived from microscopic Brueckner-Hartree-Fock calculations of $\Lambda$ hypernuclei. Ground state properties (binding energies, $\Lambda_c$ separation energies, $\Lambda_c$ single particle energies and $\Lambda_c$ densities) of charmed nuclei are examined. Due to the Coulomb repulsion between protons and the $\Lambda_c$ baryon, charmed hypernuclei are most bound for $16\leq$A$\leq 41$, where $^{17}_{\Lambda_c}$F can be considered as an excellent candidate to measure charmed hypernuclei. The competition between the attractive nucleon-$\Lambda_c$ interaction and the Coulomb repulsion is discussed, and we compare $\Lambda$ and $\Lambda_c$ hypernuclei properties., Comment: 9 pages, 6 figures

Appendix vermiformis agenesis is quite rare. It is seen in 1/100,000 of patients who underwent laparotomy with an initial diagnosis of appendicitis. A 72-year-old woman who had not undergone any previous surgery was operated on for mechanical intestinal obstruction. Right hemicolectomy was performed due to obstructive tumoral mass in the hepatic flexure. There was no appendix vermiformis in exploration. Before deciding on the diagnosis of appendix agenesis, a thorough and rigorous exploration should be performed in ileocecal region and ascending colon. In our case, the diagnosis of appendix agenesis was incidental. However, it should be kept in mind that appendix agenesis may be present in patients undergoing surgery with the diagnosis of acute appendicitis. KEY WORDS: Appendicular agenesis, Colorectal carsinoma, Congenital Abnormalities.La agenesia dell’appendice vermiforme è abbastanza rara, e si riscontra in 1 su 100.000 pazienti sottoposti a laparotomia con una diagnosi iniziale di appendicite. Una donna di 72 anni che non aveva subito alcun intervento chirurgico precedente è stata operata per ostruzione intestinale meccanica. L’emicolectomia destra è stata eseguita a causa della presenza di una massa tumorale ostruttiva a livello della flessura epatica. All’esplorazione del pezzo operatorio non si è trovata l’appendice vermiforme. Prima di concludere per una diagnosi di agenesia dell’appendice, deve essere eseguita un’esplorazione approfondita e rigorosa nella regione ileocecale e nel colon ascendente. Nel nostro caso, la diagnosi di agenesia dell’appendice è stata casuale.Tuttavia, va tenuto presente che l’agenesia dell’appendice può essere presente in pazienti sottoposti a chirurgia con diagnosi di appendicite acuta.

Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient.

Surgical staging in early endometrial cancer is not universally done and lymphadenectomy in early-stage disease is controversial. Aim of the present study was to evaluate surgical staging in patients with endometrioid histology, FIGO Stage IA endometrial cancer.Eighty-seven patients with FIGO Stage IA, low-risk patients were included in the study. Staging surgery group included patients who had comprehensive surgical staging (hysterectomy, oophorectomy, and pelvic lymph node dissection with or without para-aortic lymph node dissection). Non-staging surgery group included patients who had hysterectomy, and bilateral oophorectomy with or without lymph node sampling. Two groups were compared for lymph node status, occult cervical involvement, other prognostic factors, and outcome were analyzed.In total 17.2% of patients were upstaged in final pathological examination; 12.9% in non-staging surgery group and 24.2% in staging surgery group. Upstaging was due to lymph node involvement (6%), cervical stromal invasion (13.7%), and myometrial invasion greater than 50% (1.1%). Median pelvic lymph node number was 23 and pelvic lymph node metastases was found in 3% of the patients. Median para-aortic lymph node number was 11.5 and there was one isolated para-aortic lymph node metastases (5.8%).Of the patients, 17.2% had stage migration. Until the issue is solved by future studies, surgical staging might be considered standard surgery for endometrial cancer.

In this case report we overview the diagnostic and therapeutic approaches for pleural effusions encountered during the tre- atment and follow-up of patients with myeloma in the light of the current medical literature. A 73-year-old female patient with a stage IIIA multiple myeloma was being treated with melphalan and methyl prednisolone. In the third month of the treat- ment, she had complaints of coughing, dyspnea and right side pain. Computed tomographic examination of the thorax re- vealed pleural effusion. Pathological examinations of the pleural fluid and pleural biopsy specimen were compatible with ade- nocarcinoma. Repeated examinations did not reveal a progression in myeloma or a pleural involvement of myeloma. The pa- tient died of respiratory insufficiency due to the progression of the pleural adenocarcinoma.

Cornu cutaneum (CC) is a clinical term that describes the horn-like keratotic lesions extending vertically from the skin. Benign, premalignant or malignant lesions may be present at the base of CC. Seborrhoeic keratosis and squamous cell carcinoma (SCC) are the most commonly reported benign and malignant forms, respectively. Basal cell carcinoma (BCC) at the base is rare. Here, we report on an 85-year old female patient having multiple CC lesions, one being giant on her face and two of the lesions diagnosed with BCC at the base. This case is of significance due to the presence of giant and multiple CC and detection of BCC at the base of more than one lesion. This present case indicates the need for the treatment of possible malignant lesions underlying CC in the elderly by total surgical excision.

The findings and the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) for the diagnosis of ovarian granulosa cell tumor (OG) are described. We present the pre-operative findings of (18)F-FDG PET/CT scan of a case of OG concurrent with endometrium cancer and endometrial hyperplasia, which revealed a 48mm mass demonstrating mild increased metabolic activity on the right ovary. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Frozen and paraffin-enbeded sections showed an encapsulated OG. There were few mitoses. There was concurrent atypical endometrial hyperplasia. In conclusion, we reported a case of an encapsulated OG, which showed mild uptake of the (18)F-FDG with concurrent endometrial cancer. There has been only one report of (18)F-FDG findings in primary ovarian granulosa cell tumor, similar to ours.

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A case of Behçet's disease, in which superior vena cava syndrome was the presenting feature is reported. Magnetic resonance imaging and echocardio graphy revealed a mass lesion in the right atrium. This patient developed bilat eral pulmonary artery aneurysms postoperatively and represents one of the bizarre manifestations of Behçet's disease.

The aim of the present study was to define the roles of trace elements and toxic heavy metals in Buerger disease and atherosclerotic peripheral arterial occlusive disease (PAOD).Seventy-five subjects who were identical in demographic charecteristics were selected for the study; 25 with Buerger disease, 25 with PAOD, 25 healthy volunteers. Serum selenium (Se), zinc (Zn), copper (Cu), iron (Fe),whole blood cadmium (Cd) and lead (Pb), erythrocyte glutathione (GSH), erythrocyte glutathione peroxidase (GSH-Px), erythrocyte and plasma malondialdehyde (MDA) levels were measured.Serum Se and Zn levels were significantly low in patients with Buerger disease compared to patients with PAOD and controls (P0.001 and P0.001 respectively). Serum levels of Fe and Zn were also significantly low in patients with PAOD compared to controls (p0.001 and p0.05 respectively). In contrast, Cu and Pb levels in Buerger disease group were significantly high compared to PAOD and control groups (P0.001 and P0.001 respectively). Erythrocyte GSH and GSH-Px levels were significantly lower in patients with Buerger disease compared to patients with PAOD and controls (P0.001 and P0.001 respectively), while erythrocyte and plasma MDA levels were significantly higher (P0.001 and P0.001 respectively).It can be concluded that the levels of trace elments and toxic heavy metals and oxidative stress influence the disease process in Buerger disease more than PAOD.

Reoperations for bypass surgery increase the need for new grafts. We investigated early changes in both the normal human saphenous vein and in ectatic varicose veins externally supported by PTFE (polytetrafluoroethylene) graft and exposed to arterial pressure in an IN VITRO non-pulsatile flow model.A total of 24 saphenous vein pieces (11 of them normal, the other 13 with varicosities) with a length of 6 centimeters were divided into equal parts; half of these parts were wrapped in PTFE grafts. All vein parts were placed in a perfusion circuit. Tissue biopsies were obtained from the vein segments. Light and electron microscopy examinations were performed, and endothelial continuity, elastic laminate continuity, medial connective tissue uniformity, medial smooth muscle uniformity, and adventitial connective tissue uniformity parameters were identified.All parameters in the PTFE protected vein groups were better. The fewest morphological changes among all four groups were detected in the vein walls from normal veins with PTFE protection. There was no significant difference in endothelial continuity and adventitial connective tissue uniformity between the normal vein group and the varicose vein group with PTFE protection.It is suggested that supporting vein grafts externally with PTFE sufficiently protects the vein walls against damage from exposure to arterial pressure. If varicose veins are used as arterial grafts, supporting them with PTFE may be useful because of the good protection of endothelial and medial connective tissues, resulting in similar parameters to those of normal vein walls.

The purpose of this study was to examine the effects of N-acetylcysteine (NAC), calcium dobesilate (DOBE) and aprotinin on the amelioration of lung damage following ischemia/reperfusion injury in a rat hind limb model. A well known antioxidant dimethyl-sulfoxide (DMSO) was also tested for comparison.Ischemia was induced in the lower limb for 4 h by vascular clamping and followed by 1 h of reperfusion. Lung injury was evaluated in 5 groups as a saline (control), DMSO, NAC, DOBE and aprotinin group. Plasma creatine kinase, lactate dehydrogenase, thiobarbituric acid reactive substances (TBARS) as well as lung tissue TBARS levels were measured. Lung tissue samples were taken for histological examination. P0.005 was considered statistically significant.Plasma TBARS values were found to be significantly lower in the DMSO (P0.005), NAC (P0.005) and aprotinin (P0.005) groups compared to the control group. Lung TBARS values were significantly lower in the DMSO, NAC, DOBE and aprotinin groups compared to the control group (P0.001, P0.001, P0.001). Also in the aprotinin group lung TBARS values were found to be significantly lower compared to DMSO (P0.001), NAC (P0.001) and DOBE (P0.001) groups. Histological examination showed less prominent peribronchial leukostasis (P0.005) and interstitial leukostasis (P0.005) in all drug groups compared to the control group.These observations indicate that DOBE and NAC, which are known to have antioxidant properties and aprotinin, a serine proteinase inhibitor, acted effectively on the prevention of lung injury in a rat hind limb ischemia/reperfusion model. The reason why aprotinin exerts a more protective effect than the other drugs is not clear, however, its clinical use may have the dual advantage of hemostasis and lung protection in surgical practice.

The aim of this study was to compare the effects of iloprost and lumbar sympathectomy (LS) in the treatment of Buerger's disease.Two hundred patients with rest pain and/or ischemic ulcers were randomized to undergo LS or 28-day intravenous treatment of iloprost. The primary endpoint was complete healing without pain or major amputation at 4 and 24 weeks. The secondary endpoints were analgesic requirement, reduction in the ulcer size, 50% reduction of the ulcer, and shift in the modified SVS/ISCVS clinical status grading scale.The comparison was carried out in 162 patients (iloprost: n=84; LS: n=78). Complete healing rate was 61.9% in the iloprost group, but 41% in the LS group at the 4th week (P=0.012); respective values for the 24th week were 85.3%, 52.3%, P0.001. Analgesic requirement was lower in the iloprost group at the 4th and 24th weeks (P=0.01, and P=0.098, respectively). The size of the ulcers decreased more in the iloprost group than the LS group (P=0.044 and P=0.035 at 4th and 24th weeks); 50% reduction in the ulcer size in the iloprost group was greater than in the LS group (P=0.001 and P=0.009 at 4th and 24th weeks). SVS/ISCVS grading scale demonstrated a better clinical benefit in patients treated with iloprost (P0.001 at 4th week, and P0.001 and at 24th week).The results of this independent study indicate that using iloprost relieves ischemic symptoms better than LS. In the era of stable prostacyclin analogues, there is no reliable evidence to support the use of LS in Buerger's disease.

Purpose: The aim of this study is to specify the precise role of bone scintigraphy and serum CEA and CA 15-3 assays in the monitoring of breast cancers in order to optimize their use and to determine whether it is possible to guide the prescription of bone scan by the use of CEA and CA 15-3 assays in the monitoring of breast cancer. Methods: For this purpose, from November 1997 to May 2002, 98 consecutive female breast cancer patients (median age, 52 years; range 35-77 years) underwent bone scintigraphy during follow-up. In these patients values of tumor markers were compared with the results of bone scintigraphy. Some of the patients with bone metastasis were checked repeatedly at intervals of 6 to 12 months, resulting in 49 patients with bone metastasis and 74 patients without bone metastasis being included in the study. Results: In patients with bone metastasis, serum CEA levels were abnormal in 23/49 cases and CA 15-3 serum concentrations were elevated above the cut-off in 33/49 cases. Among patients without bone metastasis, CEA and CA 15-3 serum concentrations were normal in 50/74 and 55/74 cases respectively. The combination of the two markers improved the diagnostic sensitivity. Conclusion: Although serial tumor marker measurements are an efficient and cost effective method of monitoring disease progression, it does not allow prediction of the bone scan results; so it is not justifiable to reject a bone scintigraphy on the basis of these markers.

A 3-year-old girl was admitted with the diagnosis of left ventricular hydatid cyst. She also had pulmonary, hepatic and splenic cysts. The diagnosis of the left ventricular cyst was made by means of computerized tomography and confirmed using cardiac magnetic resonance imaging and transthoracic echocardiography. The patient was submitted to cystectomy on beating heart with a straightforward postoperative period.

In the present study we evaluated the value of hydrosonography in the screening for intracavitary structural pathologies in patients with a history of infertility before the implementation of assisted-reproductive technology. Hysterescopy was regarded as the gold standard procedure.A retrospective study.A total number of 115 infertile women aged between 19 and 47 (33.4 +/- 5.3), who were candidates for assisted reproductive techniques, were enrolled in this retrospective analysis. The study comprised data obtained from patients undergoing infertility investigation between 2001 and 2003 at Ozel Ege IVF Center and the Department of Obstetrics and Gynecology of Ege University Faculty of Medicine. The results obtained by hydrosonography were later compared with those of hysteroscopy. Sensitivity, specificity, positive predictive value and negative predictive value for hydrosonography were calculated.In a total of 115 women, 53 (46%), 24 (20%), 30 (26%) and 8 (7%) were found to have normal endometrial cavities, submucous myoma, endometrial polyps and uterine septum, respectively, on hydrosonography. Forty-five (85%) of 53 women, who were supposed to have normal findings on hydrosonography, were confirmed by hysteroscopy. In the remaining eight women (15%), two had endometrial polyps, three had uterine septum, one had submucous myoma and two had intrauterine synechia on hysteroscopic examinations. The sensitivity, specificity, positive and negative predictive values of hydrosonography in the detection of structural endometrial cavity lesions were 85%, 75%, 75% and 84%, respectively. Two intrauterine adhesions were not recognized by hydrosonography.Hydrosonography may be a useful tool in the evaluation of intrauterine cavity structural pathologies in infertile patients with the exception of intrauterine adhesions. In addition, hydrosonography was found to be sensitive in the detection of intrauterine septum.

The aim of this study was to investigate the relationship between plasma viscosity and lipoprotein and apolipoprotein pattern in normo- and hypercholesterolemic patients with peripheral occlusive arterial disease (POAD). 40 patients with POAD have been selected (8 females and 32 males, mean age: 54+/-3.2 years) with clinically evident superficial femoral occlusive artery disease. They were separated into two groups as normocholesterolemic (plasma total cholesterol200 mg/dl) and hypercholesterolemic (plasma total cholesterol200 mg/dl). Plasma total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides, total protein, and albumin levels were determined by enzymatic methods using commercial kits. Levels of apolipoprotein AI (apo AI), and apolipoprotein B (apo B) were measured using a immunoturbidometric method. Plasma viscosity (PV) was measured by capillary viscometer. Classifying the patients with PAOD according to the cholesterol levels; hypercholesterolemic (mean total-cholesterol: 227.90+/-26.97 mg/dl) patients had significantly higher LDL-C, PV and triglyceride levels compared with nornocholesterolemic patients (p0.001, p0.001, p0.001, respectively). HDL-C and apo B were significantly lower in hypercholesterolemic patients than in normocholesterolemic patients (p0.001, p0.001, respectively). PV was positively correlated with total cholesterol (r=0.485, p0.05), atherogenic index (r=0.624, p0.01), total-C/HDL-C ratio (r=0.624, p0.05), and LDL-C/HDL-C ratio (r=0.707, p0.001) in hypercholesterolemic patients with POAD. PV was higher in hypercholesterolemic patients with POAD than in normocholesterolemic patients with POAD. We suggest that POAD patients should be regarded as a heterogenous group with lipid and lipoprotein parameters in order to assess the microcirculation in the affected limb. In case of dyslipidemia in POAD patients an elevated plasma viscosity should be considered as coexisting risk factor.

Impaired hemorrheological properties may worsen the tissue hypoxia distal to an arterial narrowing in patients with peripheral arterial occlusive disease (PAOD). The objective of this study was to investigate the changes in red blood cell rigidity, blood viscosity and plasma viscosity as contributing factors in the development of hypoxia in patients with critical limb ischemia (CLI).Forty patients with critical limb ischemia and 40 healthy subjects were included in the study. The subjects included in the study were non-diabetic with blood pressure measurements within the normal range. Compound known to interfere with hemorrheological parameters were not taken by the patients for at least 7 days prior to investigation. Routine blood counts (WBC, RBC, Hb, Hct), plasma fibrinogen levels, plasma total cholesterol levels, red blood cell rigidity, blood and plasma viscosity were determined in both groups. Statistical evaluation of the results of both groups was compared by student's "t"-test. The level of significance was set at p0.05.Blood viscosity at a shear rate of 6.00 sec(-1) was found to be significantly lower in the CLI group (p0.001), whereas no significant difference was encountered when blood viscosity was measured at a shear rate of 225 sec(-1). Plasma viscosity and plasma fibrinogen levels were comparable. Plasma total cholesterol levels were found to be significantly higher in the CLI group (p0.05) and red blood cell rigidity significantly lower (p0.001).These findings may provide new insights into the role of blood viscosity in patients with CLI contrary to the previous reports in the literature. Therapies that address red blood cell rigidity more directly may decrease tissue hypoxia distal to arterial narrowing by preventing hemolysis, improving microcirculation, and increasing oxygen carrying capacity and may be more beneficial for these patients.

We examined the effects of calcium dobesilate on ameliorating the lung damage following ischemia-reperfusion injury in skeletal muscle of rats. A well known antioxidant, dimethyl sulfoxide, was also tested for comparison. The study included three groups: normal saline, dimethyl sulfoxide and calcium dobesilate. Plasma bicarbonate, creatine kinase, lactate dehydrogenase, thiobarbituric acid reactive substances (TBARS), as well as muscle and lung tissue TBARS levels were measured. Lung tissue samples were taken for histological examination. The dimethyl sulfoxide group showed significant amelioration of plasma (p = 0.004), skeletal muscle (p = 0.006) and lung TBARS (p = 0.004) levels, compared with controls. Calcium dobesilate-treated rats showed significantly low level muscle (p = 0.025) and lung TBARS (p = 0.004), compared with the control group. The extent of lung injury according to the histological findings was less in the dimethyl sulfoxide (p = 0.004) and calcium dobesilate (p = 0.003) groups. These observations indicated that calcium dobesilate acted effectively in the prevention of lung damage following ischemia-reperfusion injury in the rat skeletal muscle.

The aim of this study was to clarify the role of a-tocopherol (vitamin E) and iloprost on skeletal muscle ischemia/reperfusion injury.animal research laboratory of a university hospital.the iliac arteries of the 24 adult Sprague-Dawley rats were clamped and 4 hours of ischemia followed by 1 hour of reperfusion was applied. In an attempt to decrease reperfusion injury, the rats were given either a-tocopherol (n=8), iloprost (n=6) and 8 rats were given normal saline and served as control group (n=8).blood pH, pO2, pCO2, HCO3, Na, K, creatine kinase (CPK), lactate dehydrogenase (LDH) values were determined at the end of the reperfusion period. Malondialdehyde (MDA), a product of lipid peroxidation, was measured in blood, muscle and lung as an indicator of free radicals.Blood pO2 and HCO3 levels were significantly high (p0.05); CPK, LDH and MDA levels were significantly low (p0.05) in both a-tocopherol and iloprost groups when compared to the control group. Similarly, the MDA levels in the gastrocnemius muscle were significantly low in both treatment groups when compared to the controls (p0.05). There was no significant difference between groups in other parameters.The results suggest that, both a-tocopherol and iloprost are useful for attenuating oxidative muscle damage occurring after a period of ischemia/ reperfusion.

Subcutaneous involvement is a rare manifestation of echinococcosis. We report a rare case of a 28-year-old woman with widespread hydatidosis of the lung, liver, and subcutaneous adipose tissue. The patient underwent surgical excision of multiple hepatic and pulmonary cysts with a thoraco-abdominal incision two years earlier. The subcutaneous cyst was located over the incision, and it is likely that resulted from accidental rupture of the primary cyst and spreading of scolices during surgery.

A case of an 11-year-old boy with Ehlers-Danlos syndrome (EDS) type IV is presented. He was referred with a pulsatile mass above the right antecubital fossa and Doppler revealed a saccular aneurysm. Excision and ligation of the brachial artery aneurysm was performed. The diagnosis was confirmed by skin fibroblast cultures and histopathologic evaluation. We conclude that arteriography should be avoided in EDS and color-Doppler should be the sole means of diagnosis. Ligation rather than arterial reconstruction should be preferred.

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Steroid hormones would have an effect on the duration of pregnancy. Venous blood was drawn in 90 patients who were scheduled for provoked delivery for assay of serum dehydroepiandrosterone sulphate (S-DHEA), oestrogen, progesterone and cortisol. Serum concentration of S-DHEA was significantly higher (p0.005) in women with a favourable Bishop score (6) compared with those with an unfavourable score. These findings suggest that a rise in S-DHEA level occurs before modifications in the cervix.

Buerger's disease (thromboangiitis obliterans) is a rare peripheral vascular disease that usually affects young male smokers. It is characterized by multiple occlusions distal to the knee and elbow. Although rarely encountered in this condition, major arterial occlusions can be corrected by arterial revascularization. The hospital records of 216 patients (214 men and 2 women) with Buerger's disease were reviewed retrospectively, 142 (66%) between 1 and 120 (mean(s.d.) 72.8(24)) months after diagnosis. Of these patients 21 had had an arterial revascularization; 183 lumbar and 20 thoracic sympathectomies had been performed. In 30 of the patients a total of 29 minor and four major amputations had been performed. In appropriate cases arterial reconstruction provides better healing of ischaemic lesions. Although vasomotor tone is usually normalized in 2 weeks to 6 months after sympathectomy, the temporary increase in blood flow is often sufficient to heal ischaemic lesions during this period.

I read with interest the excellent review of Behcet's disease by Erkan et al 1 and wish to comment on the treatment of pulmonary artery aneurysms (PAA) with embolisation. Durieux et al reported the first case in 1981, and a further four successfully treated cases have been reported since 1985.2–5 As reported by others,6–8 we have found …

WOS: 000336986700024, PubMed ID: 24557334, Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with a parts per thousand yen5 times of the upper limit of normal for aminotransferases, total bilirubin level a parts per thousand yen2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.