Gulsen Yilmaz

FACTORS AFFECTING MORTALITY OF FOURNIER’S GANGRENE: REVIEW OF 70 PATIENTS

Background:  Fournier’s disease is a potentially fatal, acute, gangrenous infection of the scrotum, penis or perineum associated with a synergistic bacterial infection of the subcutaneous fat and superficial fascia.

Elevated serum S100B protein and neuron-specific enolase levels in carbon monoxide poisoning

OBJECTIVE Carbon monoxide (CO) poisoning causes cerebral and generalized hypoxia. This study aimed to assess the possible use of serum glial marker S100B protein and neuron-specific enolase (NSE) as biochemical markers of hypoxic brain damage in acute CO poisoning. METHODS Patients with acute CO poisoning admitted to the ED of 2 training hospitals (Ankara, Turkey) were included in this cross-sectional study. Serum levels of S100B and NSE were measured on admission. The patients were divided into 2 groups (unconscious and conscious). Twenty healthy adults were included in the study to serve as controls. RESULTS A total of 70 patients poisoned by CO (mean age +/- SD, 36.6 +/- 16.3 years; 64.3% women) were enrolled. Although S100B concentrations were higher in patients than in the control group (P = .018), no significant difference was determined between patient and control groups with respect to NSE concentrations (P = .801). A positive correlation was noted between levels of S100B and NSE (r = 0.388; P = .001). The S100B and NSE values were higher in unconscious patients than in the control group (P = .002 and P = .013, respectively). Furthermore, S100B and NSE values were higher in unconscious vs unconscious patients (P = .047 and P = .005, respectively). CONCLUSION Elevated serum S100B and NSE levels were associated with loss of consciousness in CO poisoning in this series of patients. Serum S100B and NSE may be useful markers in the assessment of clinical status in CO poisoning.

Are preservatives necessary in 24-hour urine measurements?

BACKGROUND 24-h urine measurements are used in the routine diagnosis and follow-up of many diseases in the clinical laboratory. Calcium (Ca(2+)), magnesium (Mg(2+)), phosphate (PO(4)(3-)) and uric acid are frequently requested markers in 24-h urine samples. Because of the different solubilities of these parameters, different urine collection conditions - urine in base for uric acid and urine in acid for Ca(2+), PO(4)(3-) and Mg(2+) measurements - are recommended. METHODS We aimed to test the effect of addition of preservatives and heating of the urine specimen on the results obtained for Ca(2+), Mg(2+), PO(4)(3-) and uric acid by comparison with untreated samples results. Spot (n=20) and 24-h urine (n=50) samples were obtained from patients for routine urine analysis. A single spot urine sample was divided into five aliquots of 10 mL each: one containing 200 microL of HCl (6 N), another containing 200 microL of sodium bicarbonate, NaHCO(3) (5 g/L), two others in which the same preservative agents were added 24 h after the collection, and one without any preservative (untreated). Ca(2+), PO(4)(3-), uric acid and Mg(2+) were measured in triplicate and at three different time points during the study: at the time of sampling (0 h), 24 h after sampling, and after heating the samples. The 24-h urine samples were collected without preservatives and analytes were measured promptly before and after acidification/alkalinization. RESULTS There was no statistically significant difference between untreated and treated samples (p>0.05). Heating also failed to show any difference in the results (p>0.05). CONCLUSION According to our results, addition of preservatives is not necessary for measurement of Ca(2+), Mg(2+), PO(4)(3-) and uric acid in promptly assayed 24-h urine samples.

Efficiency of obliteration procedures in the surgical treatment of hydatid cyst of the liver

Background:  Hydatid cyst of the liver (HCL) is a parasitic infestation caused by several species of Echinococcus and is endemic in many sheep‐raising areas. The aim of the present study is to evaluate the value of clinical, physical and laboratory findings and to discuss the diagnostic and therapeutic options in 250 patients with HCL.

Nitric oxide, lipid peroxidation and total thiol levels in acute appendicitis

Background: The mechanisms involved in the pathology of acute appendicitis (AA) and the factors affecting the progression have still been investigated. Oxidative stress is one of the factors of interest. Nitric oxide (NO) and its role in AA has not been studied previously. Methods: Thirty‐four patients who underwent operation with a perioperative diagnosis of AA and 16 age and sex‐matched controls were included in the study. Serum thiobarbituric acid reactive substances (TBARS), thiol groups (SH), NO metabolites (NOx), and conventional inflammation markers were determined. Results: NOx, TBARS, C‐reactive protein (CRP) levels, white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were significantly higher, and total SH was significantly lower in AA than in control group. NOx, TBARS, and SH levels were comparable in acute phlegmonous appendicitis and advanced appendicitis. There was a significant positive correlation between NOx and TBARS, CRP, ESR, WBC and a significant negative correlation between NOx and SH. Conclusions: Serum NOx levels and oxidative stress elevate in AA independent from the extent of the lesion. Increased NO may play a role in the increased oxidative stress in AA. J. Clin. Lab. Anal. 24:63–66, 2010.

Retrospective analysis of 135 renal trauma cases

Background: We review our trauma cases over the last 11 years and discuss our diagnosis and treatment modalities.

Evaluation of a card test for procalcitonin in continuous ambulatory peritoneal dialysis peritonitis.

Background: Peritonitis is an important complication in continuous ambulatory peritoneal dialysis (CAPD) patients. Procalcitonin (PCT) has recently been identified as an inflammation marker and recommended as a new potential marker in CAPD peritonitis. We aimed to study a card test for PCT and compare the results with the conventional markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count. Patients and methods: A total of 40 CAPD patients; 20 patients with an episode of peritonitis and 20 patients without any clinical or laboratory sign of infection were included in the study. PCT, CRP, ESR, WBC and dialysate cell count were performed at the beginning of the clinical signs of peritonitis. Results: CRP and ESR had the highest sensitivities (100% for both) but lower specificities (55 and 10%; respectively) and PCT had the highest specificity with a relatively low sensitivity (100 and 70%) according to the calculated results. Conclusions: The card test for PCT seems to be suitable for the adjunctional use in CAPD peritonitis, with its shorter turn-around time, appropriateness for near-patient testing and high specificity.

Elevated adenosine deaminase levels in celiac disease

Celiac disease (CD) is a genetically based chronic inflammatory disorder of the small bowel induced by the dietary gluten and possibly other environmental cofactors. The objective of this study was to investigate the relation of adenosine deaminase (ADA), a cytoplasmic enzyme involved in the catabolism of purine bases, as an index of altered immune response, with adult CD patients. ADA has been shown to increase in several inflammatory conditions, but there is no literature data indicating an alteration in CD. Serum levels of ADA were investigated in newly diagnosed 20 CD patients. ADA levels were compared in patients with CD and in healthy controls. Correlation analysis was also performed between ADA and other serum markers of CD (anti‐gliadin and anti‐endomysial antibodies) Mean serum ADA levels were significantly elevated in CD patients compared with control group. ROC curve analysis suggested that the optimum ADA level cut‐off point for CD was 12.27 U/l. At a cut‐off value of 12.27 U/l, the sensitivity was 80% and specificity was 100%. There was no statistically significant correlation between ADA and anti‐gliadin and anti‐endomisium antibodies. Serum ADA levels elevated significantly in CD patients, suggesting a partial role in activated T‐cell response in the disease pathophysiology. ADA can be used as a supportive diagnostic marker in patients with CD. J. Clin. Lab. Anal. 24:323–326, 2010.

Serum adenosine deaminase activities during acute attacks and attack-free periods of familial Mediterranean fever.

BACKGROUND Familial Mediterranean Fever (FMF) is a systemic relapsing autoinflammatory disorder. Adenosine deaminase (ADA) is an enzyme widely distribute in tissues and body fluids. Circulating levels of ADA have been shown to increase in several inflammatory conditions. This study was designed to evaluate the serum ADA in patients with FMF during acute attacks and attack-free periods. METHODS The study groups comprised 23 FMF patients in attack-free period (male/female: 11/12), 30 FMF patients in attack period (male/female: 11/19) and 20 healthy control (male/female:10/10). The groups were similar for age, gender and disease duration. RESULTS The mean age of FMF patients in attack-free period, patient with acute attack were 34.3+/-11.7 and 29.4+/-11.1 respectively. The disease durations were 13.1+/-10.2 and 8.2+/-7.6 years for patients in attack-free periods and patients with acute FMF attack, respectively. Patients with acute attack had significantly higher ADA levels than both patients with attack-free periods and healthy controls (for each, p<0.001). CONCLUSION In this study we demonstrated that FMF patients with acute attacks had higher serum ADA levels than attack-free periods and healthy controls. It is likely that ADA may have a role in the cytokine network of the inflammatory cascade of FMF. Also, elevated ADA levels may be a part of the activated Th1 response in the disease. ADA may be used as a supportive marker to differentiate FMF attacks from attack-free periods. Further larger-scale studies are needed to support this result.

Effect of povidone iodine on thyroid functions and urine iodine levels in caesarean operations

Abstract Objective: In the present study, the effects of povidone iodine (PI) used during Caesarean operations on maternal thyroid hormones and urine iodine levels in the infant and the mother were investigated. Design: Twenty-seven patients were allocated to the PI group I (Gr I), and 28 to the non-PI group (Group II). Maternal preoperative and 24th-h postoperative free T3 (fT3), freeT4 (fT4), TSH, and urine iodine levels were determined, as well as infant urine iodine values. Results: In both groups, fT3 levels before and after the operation were found to be reduced (p < 0.01, p = 0.01, respectively). However, the decrease in fT3 was approximately 1.5-fold higher in Gr I than in Gr II. TSH levels increased significantly in Gr I (p = 0.005). The urine iodine levels of the mothers increased 25% in Gr I, but only 2% in Gr II. Conclusions: The absorption of PI by the skin was found to lead to changes in fT3, TSH, and urine iodine excretion values in the mothers. The findings of this study of Caesarean operations, which have a short duration, might be a signal to be careful of thyroid hormone effects in operations lasting longer.