Band 5, Heft 1

The etiology of Dupuytren’s disease is controversial and thus the disease can only be treated when it presents with symptoms to warrant intervention. Surgical treatment is the method of choice to preserve hand dexterity and function. It is advisable to perform surgery at an early stage of disease progression, but various surgical techniques have been advocated. A partial fasciectomy is recommend by many authors, whereas a total aponeurectomy, where all palmar tissue is removed, might reduce the risk of recurrent disease due to the widespread removal of aponeurosis. The total aponeurectomy is performed less frequently due to the potential complications of this technique. In order to achieve an objective comparison of both surgical options we performed a literature meta-analysis, involving a comparison of surgical indications, results and complications following partial and total aponeurectomy, which are described in detail within this review article.

Anti-annexin A5 antibodies are directed against annexin A5 — a phospholipid-binding protein that belongs to the ubiquitous annexin family. These antibodies were first discovered in 1994 by Matsuda et al. in women with recurrent fetal loss or preeclampsia and in patients with systemic lupus erythematosus and positive lupus anticoagulant and/or anticardiolipin antibodies. Since then anti-annexin A5 antibodies have been the focus of research. In addition to their well known prothrombotic and procoagulant activities the authors discuss the involvement of these antibodies in the pathogenesis of antiphospholipid syndrome, recurrent pregnancy loss, systemic lupus erythematosus and other immune and non-immune disorders. Controversial reports are presented and a possible interpretation of the results is given. The authors suggest the significance of anti-annexin A5 antibodies as an additional diagnostic marker and discuss the necessity of more extensive research on their clinical significance.

Staphylococcus aureus is the third most dreaded pathogen posing a severe threat due to its refractory behavior against the current armamentarium of antimicrobial drugs. This is attributed to the evolution of an array of resistance mechanisms responsible for morbidity and mortality globally. Local and international travel has resulted in the movement of drug resistant S. aureus clones from hospitals into communities and further into different geographical areas where they have been responsible for epidemic outbreaks. Thus, there is a dire necessity to refrain further cross movement of these multidrug resistant clones across the globe. The plausible alternative to prevent this situation is by thorough implementation of regulatory aspects of sanitation, formulary usage and development of new therapeutic interventions. Various strategies like exploring novel antibacterial targets, high throughput screening of microbes, combinatorial and synthetic chemistry, combinatorial biosynthesis and vaccine development are being extensively sought to overcome multidrug resistant chronic Staphylococcal infections. The majority of the antibacterial drugs are of microbial origin and are prone to being resisted. Anti-staphylococcal plant natural products that may provide a new alternative to overcome the refractory S.aureus under clinical settings have grossly been unnoticed. The present communication highlights the new chemical entities and therapeutic modalities that are entering the pharmaceutical market or are in the late stages of clinical evaluation to overcome multidrug resistant Staphylococcal infections. The review also explores the possibility of immunity and enzyme-based interventions as new therapeutic modalities and highlights the regulatory concerns on the prescription, usage and formulary development in the developed and developing world to keep the new chemical entities and therapeutic modalities viable to overcome antimicrobial resistance in S. aureus.

The goal of this research was detection of the drug-resistance level of Mycobacterium tuberculosis infection in the Odesa region of Southwest Ukraine, investigation of the level of mutation in katG and rpoB genes for M. tuberculosis with polymerase chain reaction (PCR), and spread of these mutations in different groups of patients with tuberculosis. An extremely high level of primary and acquired resistance of M. tuberculosis to first-line antituberculosis drugs has been found in the Southwest region of Ukraine. The PCR method has proved to have high sensitivity in the detection of mutations in katG and rpoB genes. The data showed significant spreading of M. tuberculosis strains with mutations in katG and rpoB genes in penitentiaries and an increased level of these mutations during tuberculosis treatment. The presence of mutations in rpoB and katG genes was associated with a more severe course of tuberculosis, increased risk of treatment default, persistence of positive smears on microscopy at discharge, and poor closing of tuberculous cavities. Extremely high level of mutations in the rpoB and katG genes of M. tuberculosis was observed in Beijing family strains. Our findings support the capability of the PCR method to detect M. tuberculosis that is resistant to drugs such as isoniazid and rifampicin.

To examine the plasma levels of MPO in oligoarthritis and polyarthritis subtypes of JIA in comparison with healthy age-matched controls. Thirty-eight JIA patients (25 girls and 13 boys) aged 9.1–11.8 years and 23 healthy controls (8 girls and 15 boys) participated in the study. Twenty-one patients had oligoarthritis (8 with extended oligoarthritis) and 17 had polyarthritis (among them three were seropositive). The plasma concentration of MPO was measured by the ELISA technique (OxisResearchTM, BIOXYTECH® MPO-EIATM, Portland, OR USA). The mean plasma concentration of MPO in the JIA group was significantly higher than in the control group (76.6±24.8 µg/L versus 62.7±15.6 µg/L; p=0.01). Patients with polyarthritis presented a significantly higher mean plasma MPO level than patients with oligoarthritis (81.3±25.6 µg/L and 62.1±27.1 µg/L, respectively; p=0.02). Different subtypes of JIA may have different MPO-related backgrounds. MPO is a new potent inflammatory marker. Patients with polyarthritis have higher mean plasma MPO levels than patients with oligoarthritis and may therefore have an enhanced risk for subclinical oxidative stress-related atherogenic promotion.

Influenza contributes significantly to morbidity and mortality in the winter season. The aim of the study was to identify clinical signs and symptoms most predictive of influenza infection in children and adults with influenza-like illness. A prospective systematic sampling analysis of clinical data collected through sentinel surveillance system for influenza in 32 primary care centers and one tertiary care hospital in Slovenia during two consecutive influenza seasons (2004/2005 and 2005/2006) was carried out. Children and adults who had influenza-like illness, defined as febrille illness with sudden onset, prostration and weakness, muscle and joint pain and at least (cough, sore throat, coryza) were included and tested for influenza A and B virus, adenovirus, respiratory syncytial virus and enterovirus by RT-PCR. Clinical data were evaluated in statistical models to identify the best predictors for the confirmation of influenza for children (under age of 15) and adults. Of 1,286 patients with influenza-like symptoms in both seasons 211 were confirmed to have influenza A or B alone and compared to 780 influenza-negative patients. A fever over 38°C, chills, headache, malaise and sore eyes revealed a significant association with positive RT-PCR test for influenza virus in children. In adults, only three symptoms were significantly related to PCR-confirmed influenza infection: fever, cough and abnormal breath sounds. The stepwise logistic regression analysis showed that four symptoms predicted influenza in children: fever (38°C or more) (p=0.010), headache (p=0.030), cough (p=0.044) and absence of abnormal breathing sounds (p=0.015) with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 5.1%, 98.1%, 57.1% and 80.1%, respectively. For adults, the strongest impact on influenza positivity was found for fever (p=0.008) and cough (p=0.085). The model for adults had less favorable characteristics, with sensitivity, specificity, PPV and NPV of 0%, 100%, 0% and 76.4%, respectively. Differences in clinical predictors of influenza in children compared to adults were found. The model for adults was acceptable but not a good one. The model for children was found to be more reliable than the prediction model for adults.

Fungal peritonitis is a rare but serious complication in patients with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD). The purpose of this study was to report the prevalence of fungal peritonitis in patients on CAPD in the Clinical Center-Nis (South Serbia) in the period from 1997 until the end of 2007. Fungal species were isolated in 66 cases (4.5%) of 1471 peritoneal fluid (PF) samples that we examined. During the study period, 22 (1.5%) cases of fungal peritonitis were registered. In 19 cases, Candida isolates were identified, Candida albicans (C. albicans) being the most common species (n=15). Two cases of fungal peritonitis caused by Aspergillus fumigatus and 1 possible case caused by Cladosporium cladosporioides (Cl. cladosporioides) were also detected.

We describe below a patient with Multiple Endocrine Neoplasia type 1 (MEN type 1) who presented with features of Primary Hyperparathyroidism. However, the actual diagnosis of Parathyroid Carcinoma was delayed until metastases to the lung were discovered. She was also found to have Pituitary Macro adenoma with Silent Acromegaly, with no clinical features whatsoever. She underwent transphenoidal hypophysectomy with postoperative radiotherapy. However, the disease process remained biochemically active necessitating commencement of somatostatin analogues. There is also a tumour at the head of the pancreas which at present is non functional with normal gut hormone profile and normal 24 hour urinary 5-hydroxyl indole acetic acid (5-HIAA) excretion assay. Our case highlights the pitfalls in diagnosing the parathyroid carcinoma due to lack of initial proper histological features. The diagnosis of parathyroid carcinoma was based on histologically confirmed metastases to the lungs. We also discuss below the entity called Silent Acromegaly where patients have biochemically and/or histologically confirmed growth Hormone (GH) excess with no clinical features suggesting Acromegaly. We discuss the benefits of somatostatin analogues in indirectly controlling the rest of the tumours in MEN1 and hypothesise the same for metastatic parathyroid carcinoma. Metastatic parathyroid carcinoma with multiple endocrine neoplasia type 1 is extremely rare. Our case highlights the complexities of managing MEN1 with metastatic parathyroid carcinoma and the dilemmas in dealing with the various aspects of the care.

The H5N1 infection was diagnosed in 12 patients in Turkey and confirmed by the WHO. Of these 12 patients so far, 8 have been published. In this case, we are presenting a case of pneumonia that developed following avian influenza infection in Eskisehir. Our case is one of the 4 patients who were not reported previously.

In this report, we describe a case of tuberculous bursitis-osteomyelitis of the wrist, in an elderly patient with rheumatoid arthritis and anti-TNFalpha (anti-Tumor Necrosis Factor alpha) treatment.

Oral sodium phosphate (NaP) is increasingly being used for bowel preparation. There are several reports of significant serum electrolyte changes after the administration of oral NaP solution in renal failure. We report a case of postoperative hypoparathyroidism who developed severe hyperphosphatemia and associated hypocalcemia after bowel preparation with oral NaP. A 39-year old woman was admitted to the hospital because of multiple bone fractures. The diagnosis of primary hyperparathyroidism was confirmed. Further assays suggested Cushing’s disease and MRI disclosed a pituitary microadenoma. Considering the diagnostic suspect of multiple endocrine neoplasia type 1, computed tomography of abdomen was performed, showing a mass in the right adrenal. The patient underwent transsphenoidal surgery and then total parathyroidectomy. Despite total removal of the microadenoma by transsphenoidal surgery, there was no suppression in serum cortisol levels. So, an operation was scheduled for the adrenal tumor. The patient was administered 45 mL oral NaP solution for bowel cleansing before the surgery. Although her calcium and phosphorus levels were normal before NaP administration, four hours later she developed respiratory distress and tetany. Laboratory studies revealed severe hyperphosphatemia and hypocalcemia. We conclude that the use of NaP for bowel preparation should be avoided in patients with hypoparathyroidism.

House dust mites live in house dusts and affect the health of humans. Among the many species, Dermatophagoides farinae, D. pteronyssinus, and Euroglyphus maynei have been found to be commonly associated with Ig-E-mediated allergic diseases. As a result, there is increasing effort to develop methods for the diagnosis and treatment of diseases caused by these species. The purpose of the current study was to explore the evolutionary relationships among house dust mites. After adult D. farinae were separated and isolated for total RNA extract, the cDNA coding for Der f 1 and Der f 2 were cloned and sequenced. Then amino acid sequences for group 1 and 2 allergens of two of the most common house dust mites, D. pteronyssinus, E. maynei, were obtained from databases. Interestingly, homological analysis of amino acid sequences showed that both Der p 1 and Der p 2 from D. pteronyssinus had more similarities to Eur m 1 and Eur m 2, respectively, than they had to Der f 1 and Der f 2 from D. farinae. In the phylogenetic trees, D. pteronyssinus clustered with E. maynei, but not with D. farinae, although D. pteronyssinus and D. farinae belong to the same genus according to morphological taxonomy. It was previously assumed that D. pteronyssinus was more similar to E. maynei than to D. farinae at evolutionary levels.

Chronic eosinophilic pneumonia is a rare interstitial lung disorder, which causes diagnostic difficulties. Often the disease is diagnosed correctly after several weeks or months following initial presentation. The aim of the study was to prospectively evaluate peculiarities of manifestation of idiopathic chronic eosinophilic pneumonia (ICEP), which may allow to improving early diagnosis. Twenty patients with ICEP were involved in this investigation. The cases of acute eosinophilic pneumonia and cases of chronic eosinophilic pneumonia of known origin were excluded. To define archetypal signs of the idiopathic chronic eosinophilic pneumonia, 3 comparable groups were selected. They were the group of 50 patients with community-acquired pneumonia (COP); the group of 21 asthmatic patients with COP, and the cluster of 10 patients with morphologically confirmed cryptogenic organizing pneumonia (OP). Clinical and radiological manifestation of ICEP was similar to COP and cryptogenic OP manifestation. We have found that chest pain; fine rales and pleurisy were unrepresentative for ICEP. However, blood eosinophilia was typical sign of ICEP and wheezing was a frequent observation. Usually ICEP patients had relative mild clinical symptoms and moderate increased C reactive protein (CRP) level even in cases of multiple pulmonary infiltrates. In conclusion, in cases of not typical pneumonia course, i.e. non-resolving or recurrent pulmonary infiltrates; relative mild clinical symptoms and moderate increased CRP level with multiple pulmonary infiltrates; blood eosinophilia and/or signs of airway obstruction eosinophilic pneumonia should be suspected and bronchoalveolar lavage and/or bronchoscopic lung biopsy performed.

The behavior of dispersible tablets containing enteric-coated pellets and oral suspension, both containing roxithromycin, was investigated using dissolution tests in different media. The dissolution test was performed under different pH conditions. For both dosage forms investigated, the test was conducted at pH 1.2, 4.5, and 6.8. Additionally, for dispersible tablets, the test involving increasing pH was performed at pH 1.2 (acid stage) and afterwards at pH 6.8 (buffer stage). The extent of dissolution was measured using high-performance liquid chromatography (HPLC). In all cases tested, roxithromycin underwent rapid degradation at pH 1.2. Dispersible tablets displayed the features of modified release preparations with a non-complete dissolution during the test times in all media. Conversely, the oral suspension behaved as an immediate release preparation, with degradation at pH 1.2. However, the dissolution of the oral suspension at pH 4.5 and 6.8 was rapid and complete. The role of enteric-coated pellets is to mask the bitter taste of the active substance upon administration. However, the coating showed lack of resistance to media at pH 1.2. Therefore, dispersible tablets containing enteric-coated pellets are not pharmaceutically equivalent to the immediate-release oral suspension.

The prevalence of genetic diseases and congenital malformation in the Israeli Arab community is relatively high, but its distribution is not uniform. The aim of this study was to estimate the frequency of mental retardation disorders in children living in 5 Israeli Arab villages and determine its association with consanguinity. Mental retardation was found to affect 300 children in the screened population, yielding an overall prevalence of 14.5 per 1000. Most of those affected (68%) were the offspring of consanguineous marriages. One village with a high prevalence (4.3%) of neurological hereditary diseases was studied in detail. The prevalence of neurological hereditary diseases and mental retardation associated with consanguinity in these children highlights the need to implement appropriate preventive program.

The aim of this study was to compare and get a deeper insight into issues of the health and health behavior inequalities among Lithuanian, Polish and Russian school-aged children in national and international contexts. Investigations were carried out in the framework of Health Behavior in School-aged Children (HBSC) study — a WHO collaborative cross-national survey. Five thousand seven hundred and seventy six randomly selected students aged 11, 13, and 15 years of age answered questionnaires in the classroom in 108 schools located in different regions in Lithuania in March–April of 2006. Questions on perceived health and health related behaviors were addressed to the respondent (response rate was 95 %). 5632 questionnaires were selected for further analysis by the international data center in Bergen. SPSS version 11.5 and multilevel analysis program MLwiN 2.0 was applied for statistical analysis of data. Relatively minor inequalities in health and health behavior were established when comparing different health and health behavior indicators in Lithuanian, Polish and Russian school-aged children in Lithuania. These disparities are lower in comparison with differences, which were established among respondents of HBSC international studies. Odds ratios to have negative self-rated health evaluation were higher in girls of Russian (OR-1.71, p<0.05) and Polish (OR-1.62, p<0.05) nationality. Therefore, Russian and Polish students were tending to have higher odds ratios for perception of happiness (p<0.05). Respondents of Russian nationality have expressed less somatic and psychological complaints. Polish boys (OR=1.38, p<0.05) were tending for higher prevalence of headache, but have expressed fewer complaints for depression (OR=0.65, p<0.05), anxiety (OR=0.71, p<0.05). Chances to be involved in risk taking behaviors (alcohol consumption, smoking, drug use) were lower among Polish and Russian respondents. In schools with Lithuanian language based-schoold, health and health behavior indicators were more negative in Polish and Russian respondents in comparisons with their Lithuanian peers However, Lithuanian students, who were enrolled in Russian and Polish schools, tending to have better perceived health evaluation and better health behavior in comparison with their peers of Polish and Russian nationality. Analysis shows, that Polish and Russian students are integrated well into Lithuanian society and being a member of the minority class is not related to poor health or negative lifestyle. Therefore, with few exceptions universal health promotion programs should be provided to school-aged children of all ethnicities and cultural backgrounds.

We compared the intensity of staining of interstitial cells (ICs) and neural tissue in the lower urinary tract of rabbits with diabetes with the intensity in normal subjects. Diabetes was induced by injecting alloxane (65mg/kg) in adult male rabbits. After 3 days, rabbits with a blood glucose level >300 mg/dL were considered to have diabetes. After 8 weeks, the rabbits were killed, and tissue specimens from the bladder, prostate and urethra were obtained. ICs were stained with anti-human CD117 (c-kit) rabbit polyclonal antibody, and neural tissue was stained with synaptophysin. The streptavidin-biotin method was used for immunohistochemical staining. The intensity of c-kit and synaptophysin staining were scored as negative (0), weak (+), moderate (++), and strong (+++). Staining intensity of ICs and neural tissue was assessed and compared in tissues obtained from rabbits with diabetes (n=8) and from control subjects (n=7). Although staining intensity of both ICs and neural tissue was found to be significantly decreased in the bladder tissue of rabbits with diabetes compared to that in the control group (p=0.0001 [ICs] and p=0.021 [neural tissue]), no significant differences in staining intensity of ICs and neural tissue in the urethra and in the prostate was found when rabbits with diabetes were compared to the control group. Diabetes may cause dysfunction of the lower urinary tract, particularly in the urinary bladder, as shown by the staining intensity of ICs and neural tissue.

Short bowel syndrome (SBS) is characterized by the malabsorption of nutrients and fluids that occurs after major intestinal resection, resulting from an adaptation process that begins immediately to increase the mucosal surface area and absorption. Certain nutrients and trophic factors are widely used to increase intestinal adaptation following massive intestinal resection. The efficacy and benefits of glutamine on the intestinal adaptation process is still controversial. This study was conducted to determine the effects of parenteral glutamine administration on intestinal adaptation in a rat model of SBS. Fourteen male Wistar rats were divided into two groups; all 14 underwent 75% small bowel resection. Within each group, rats were assigned to 14 days of treatment with subcutaneous glutamine (0.3 g/kg/day) or isotonic saline daily. Weight changes and histological intestinal adaptation parameters (mucosal thickness, villus height, and crypt depth) were measured. Non-mucosal intestinal changes were evaluated by intestinal fractioned collagen analysis. All rats initially lost weight and began to gain weight postoperatively; however, they did not reach their preoperative weights during the experiment and there was no significant difference between the groups. Histological adaptation parameters were significantly increased after 75% intestinal resection in both groups compared to paired native samples (P<0.01); although the percent of increase was slightly higher in Gln group, no significant difference was detected between the two groups. Fractioned-collagen amounts were found to be similar between groups. The results indicated that parenteral glutamine administration alone does not improve the intestinal adaptation process after massive intestinal resection in rats.

The production of reactive oxygen species (ROS) in cells is well balanced with their elimination by the antioxidant defence system. This balance is essential for maintenance of physiological conditions, and its disturbance (oxidative stress) has been suggested as a potential pathogenic mechanism in a variety of diseases, accompanied by inflammation. In this study, the in-vivo effects of nociceptin (N/OFQ(1–13)NH2) and its structure analogue [Orn9]N/OFQ(1–13)NH2 were studied on markers of oxidative stress in erythrocytes and liver of rats 4 hours after subplantar administration of carrageenan (CG) (1%, 100 µl) in the right hind paw. A considerable inflammatory oedema of the paw was observed. CG did not change blood haemoglobin content, hematocrit value, glutathione level and antioxidant enzyme activities in the erythrocytes, but there was an increase in lipid peroxidation. In liver, CG-induced imbalance was manifested by an increase in lipid peroxidation and a decrease in glutathione level. Both peptides (20 µg, i.p.), when administered alone, had no effect on all parameters tested. When either [Orn9]N/OFQ(1–13)NH2 or N/OFQ(1–13)NH2 was injected simultaneously with CG or 15 minutes before it, they did not affect the CG-induced changes in the antioxidant status of the erythrocytes and liver. Our results suggest that the peptides tested did not play a role in the free radical processes that accompany CG-induced paw inflammation.

Gastric volvulus (GV) is a rare pathological entity, which is difficult to diagnose, may rapidly progress to infarction and necrosis of the stomach, and can be fatal. A 68-year-old woman presented to the surgical outpatient clinic of Istanbul University, Istanbul Faculty of Medicine, in August, 2006, with a 3-month history of nausea, vomiting, and recurrent abdominal pain. Physical examination revealed epigastric tenderness, but otherwise within normal limits. An urgent abdominal computed tomographic examination revealed only a paraesophageal hernia. A mesenteroaxial gastric volvulus with a large paraesophageal hernia was found on laparoscopy. The surgical procedure involved derotation of the stomach and closure of the paraesophageal hernia with a dual V-shaped graft gastropexy to the triangular ligament of liver; in addition, a laparoscopic cholecystectomy was performed. We found that derotation of stomach and gastropexy to the triangular ligament is technically easy to perform and is a safe procedure in the treatment of gastric volvulus.

Gossypiboma (retained surgical sponge) is a pseudotumor within the body that is composed of non-absorbable surgical material with a cotton matrix. Because the symptoms of gossypiboma usually are nonspecific and may appear years after surgery, the diagnosis of gossypiboma may be difficult because the condition may mimic a benign or malignant soft-tissue tumour in the abdomen and pelvis. A 61-year-old woman with a one-year history of left upper-quadrant pain and weight loss was referred to our center. She had undergone peptic ulcer perforation 23 year ago. Physical examination revealed dullness and palpable mass in the left upper abdomen. On examination by computed tomography (CT), a hypodense mass of 12 cm in diameter between the greater curvature of the stomach, pancreas, and splenic hilus was detected. Upon exploration, a mass lesion of 10 cm in diameter was detected between the greater curvature of the stomach and splenic hilus, which caused dense adhesions not in communication with the pancreas. It was excised and a splenectomy was performed. After a macroscopic examination, the mass lesion was diagnosed as gossypiboma. Although ultrasonography (US), CT, angiography, and magnetic resonance imaging (MRI) may be used to diagnose gossypiboma, definitive diagnosis is possibile only upon surgery or histopathological examination. As a result, when an abdominal mass is observed, surgeons should carefully investigate the patient’s past surgical history while taking the possibility of gossypiboma into consideration.

It is known that coexistence of extreme thrombocytosis and thrombosis is observed frequently in chronic myeloproliferative disorders. In this paper, we report a patient who was prediagnosed with chronic myeloproliferative disorder; however, later on the diagnosis was confirmed as metastatic gastric cancer. The patient was a 75-year old female who was admitted with pain, swelling and erythema on her right arm. White blood cell count was 20 ×109/l, hemoglobin 5.2 g/dl and platelet count 1 088 ×109/l. Doppler ultrasonography revealed acute thrombotic process in right brachial vein. Since brachial vein thrombosis, thrombocytosis and anemia were seen together, the presumed diagnosis for this patient was chronic myeloproliferative disorder, and therapy with hydroxyurea, allopurinol and enoxaparin was started. One day after the heparin treatment, hematemesis and melena occurred. Eusophagogastroduodenal endoscopy showed an ulcerated and hemorrhagic polipoid lesion extending towards the cavity in the cardia region. Hydroxyurea treatment was stopped since the myeloproliferative disorder was excluded. Abdominal ultrasonography and tomography proved multiple metastatic lesions in the liver. Gastric and liver biopsies revealed “well differentiated adenocarcinoma” and 5-fluorouracil chemotherapy plus folinic acid was planned. As a result, in cases with thrombocytosis and thrombosis, metastatic cancers should be kept in mind besides chronic myeloproliferative disorders.