Mustafa Turan

Gastric Necrosis and Perforation Caused by Acute Gastric Dilatation : Report of a Case

Abstract.We report the case of an 18-year-old, mentally retarded boy who suffered acute abdominal symptoms and signs after eating a heavy meal. Laparotomy showed massive gastric dilatation with near-total infarction and perforation. Total gastrectomy and esophagojejunostomy were performed, but the patient died a few hours after the operation.

Does Mud Pack Treatment Have Any Chemical Effect? A Randomized Controlled Clinical Study

OBJECTIVE The aim of this study was to reveal the efficacy of mud pack treatment in patients with knee osteoarthritis and to find the contribution of chemical factors to the build up of these effects. METHODS Sixty patients were randomly assigned to directly applied mud pack (study) group or to nylon-covered mud pack (control) group. Thirty patients in the study group had mud application 15 times to both knees: heated mud, up to 43 degrees C, was applied to skin directly for 30 minutes. Thirty patients in the control group had the same treatment as the study group except heated mud was applied over an impermeable nylon pack. Primary outcome measures of the study were the Western Ontario and McMaster Universities (WOMAC) index, pain intensity on a visual analog scale (VAS), patients assessment of disease severity index, physicians assessment of disease severity index, and analgesic consumption. The patients were evaluated before and after (end of 15th application) the intervention and followed up for 24 weeks at 4-week intervals. The results were assessed on an intent-to-treat basis. RESULTS As compared to the baseline, significant decreases were observed in WOMAC, pain intensity, disease severity index scores, and analgesic consumption in both groups after the intervention. Observed improvements in the study group were found to be superior to the control during the whole postintervention follow-up, except for analgesic consumption in the third week. A significant number of patients in the study group showed minimal clinically important improvement as compared to the control group. CONCLUSION Mud pack treatment significantly improved the pain and functional status of patients with knee osteoarthritis, whether applied directly or coated with nylon. Direct application was found to be superior, which implies chemical properties of the mud contribute to the build up of therapeutic effect.

Chlorhexidine Gluconate: An Ideal Scolicidal Agent in the Treatment of Intraperitoneal Hydatidosis?

Hydatid disease is a parasitic disease that is treated primarily by surgery. The most important complication of surgical treatment is spillage of the contents of the cyst, leading to secondary dissemination. In this study, the effect of chlorhexidine gluconate (Chx-Glu) was investigated in the treatment of experimental intraperitoneal hydatidosis (IPH). IPH was reproduced in 100 Wistar albino rats by inoculation with 1 ml of a suspension contained approximately 1500 viable protoscolices of Echinococcus granulosus following determination of scolicidal activity of chlorhexidine gluconate in vitro. Five minutes after protoscolex inoculation, 5 ml of the scolicidal solution was instilled into the peritoneal cavity: 0.9% NaCl (control group), 4.0% Chx-Glu, 0.4% Chx-Glu, and 0.04% Chx-Glu. After 6 months of follow-up, the rats were sacrificed, and the number of isolated cysts, peroperative and postoperative deaths, and toxicity were evaluated. Cyst formation did not occur in any of the Chx-Glu groups compared to the control group (p < 0.05), whereas it was detected in all of the control rats. In addition, to 4.0% Chx-Glu was found to be more toxic and to cause a high mortality rate compared to the 0.4% and 0.04% Chx-Glu groups and the control group (p < 0.05). Chx-Glu 0.04% was found to be the most potent, nontoxic agent; it is easily available, inexpensive, and highly potent in a short period of time at the low concentration. Chx-Glu 0.04% can be used safely in the treatment of intraperitoneal hydatidosis and hydatid cyst.

Pancreatic Pseudotumor due to Peripancreatic Tuberculous Lymphadenitis

Peripancreatic tuberculous lymphadenitis is a very rare and difficult diagnosis. We report herein a patient with a clinically solitary abdominal tuberculoma. A 68-year-old woman was admitted to our hospital with moderate-level obstructive jaundice due to a mass located between pylorus and head of the pancreas. There were no clinical signs or symptoms of tuberculosis in lungs or abdomen. After the diagnosis of a neoplasm of the pancreas was made, exploratory laparotomy was performed which revealed a conglomerated mass penetrating into the pancreas. Since an exact diagnosis could not be reached on the basis of frozen sections prepared during the operation, a standard Whipple procedure was performed. After the histopathological examination of the resected specimen revealed tuberculous lympadenitis, the patient was given antituberculous medication. The patient recovered well. An abdominal tuberculoma is often mistaken for a malignant neoplasm, and nonsurgical diagnosis and treatment of this entity continues to be a challenge.

Sigmoid colon perforation as an unusual complication of Behçet's syndrome: report of a case.

Abstract.A 47-year-old man with long-standing Behçets syndrome presented with an acute abdomen, and was found to have perforation of the sigmoid colon. Laparotomy revealed gangrenous changes in the sigmoid colon and perforation in the center of the affected segment. This is a very rare complication of Behçets disease, and we report this case to stress the importance of performing careful abdominal examination while evaluating patients with Behçets disease.

Thyroid Hormone Supplementation in Sepsis : An Experimental Study

Abstract.Purpose: The levels of thyroid hormones decrease in septic, critically ill, and major trauma patients who show a bad prognosis. The aim of this study was to investigate the effects of thyroid hormone supplementation on the sepsis criteria and mortality in an experimental sepsis model. Methods: Forty-eight Wistar-Albino rats were divided into four experimental groups. A cecum ligation and puncture was used as a sepsis model. Group I: sham; group II: a cecum ligation and puncture (control); group III: a cecum ligation and puncture +T3 (0.4 μg/100 g body weight/day) intraperitoneally; group IV: a cecum ligation and puncture +T4 (1 500 ng/100 g body weight/day) intramuscularly. The PCO2, leukocyte count, peritoneal bacterial content, neutropenia, and mortality rates were assessed in all groups. Results: The PCO2 levels decreased only in the control group (P < 0.05). The leukocyte counts were lower in the therapy groups (P < 0.05). The rate of neutropenia was seen much more in the control group (P < 0.05). The peritoneal bacteria content decreased in the therapy groups (P < 0.05). The mortality rate significantly decreased in the thyroid hormone-treated animals (P < 0.05). Conclusions: Thyroid hormone supplementation in septic rats had a beneficial effect on the sepsis criteria and also resulted in a lower rate of mortality.

Antitumoral effects of Melissa officinalis on breast cancer in vitro and in vivo.

BACKGROUND There is a long standing interest in the identification of medicinal plants and derived natural products for developing cancer therapeutics. Here we investigated the antiproliferative properties of Melissa officinalis (MO) from Turkey on breast cancer. METHODS MO extracts were studied for cytotoxicity against breast cancer cell lines (MCF-7, MDA-MB-468 and MDA-MB-231). In vitro apoptosis studies were performed by annexin V staining and flow cytometry analyses. Immunohistochemistry for Ki-67 and caspase 7 in the tumoral tissue sections of DMBA-induced mammary tumors in rats was also performed, along with TUNEL assays to detect apoptotic cells. In vivo anticancer activity testing was carried out with reference to inhibition of growth of DMBA induced mammary tumors in rats. RESULTS MO showed cytotoxicity against three cancer cell lines, inducing increase in Annexin-positive cells. Expression of caspase-7 protein and TUNEL positive cells were much higher in rats treated by MO, compared with the untreated control group, while expression of Ki-67 was decreased. Furthermore, in vivo studies showed that mean tumor volume inhibition ratio in MO treated group was 40% compared with the untreated rats. CONCLUSION These results indicated that MO extrcts have antitumoral potential against breast cancer.

Different ELR (+) angiogenic CXC chemokine profiles in synovial fluid of patients with Behçet’s disease, familial Mediterranean fever, rheumatoid arthritis, and osteoarthritis

The aim of the present study was to determine synovial levels of ELR (+) CXC chemokines, known to attract mainly neutrophils to inflamed tissues by binding the neutrophil chemokine receptors CXCR1 and CXCR2 and promoting neovascularization in patients with various inflammatory disorders. The study group consisted of 14 patients with Behçet’s disease and nine with familial Mediterranean fever. Fourteen patients with rheumatoid arthritis and 16 with osteoarthritis served as controls. Synovial chemokine levels were measured by two-step sandwich enzyme-linked immunosorbent assay, and significant differences were found in the various chemokines studied. In addition to its angiogenic properties, increased synovial levels of interleukin-8 by attraction of more neutrophils to synovial fluids might also be responsible for the acute synovitis in patients with Behçet’s disease. However, the absence of chronic changes with the eventual development of pannus and erosions might result from relatively lower expression of interleukin-8 and the transient, short-lived nature of the arthritis observed in these patients.

Antimicrobial Susceptibility of Bacillus anthracis in an Endemic Area

We aimed to test the antimicrobial susceptibility of 28 Bacillus anthracis strains isolated from cutaneous anthrax cases to various antimicrobial agents using the Sceptor automatic system in an anthrax endemic area. All strains tested were susceptible to penicillin (MIC ≤⃒ 0.03 μg/ml). Piperacillin-tazobactam and carbapenems showed good activity towards all strains. Trimethoprim-sulfamethoxazole and cefepime had no activity. Strains were also tested with other antimicrobials.

Secondary osteoporosis in women. A retrospective analysis.

Abstract Secondary osteoporosis comprises a minority of all osteoporosis cases. In this study we summarize the causes of secondary osteoporosis we encountered in patients currently on follow-up in our osteoporosis outpatient clinic. A total of 1015 female patients are involved in the study. Recorded data of the patients are evaluated retrospectively. Patients with spine bone mineral density (BMD) 2.5 standard deviation below a reference range established using our own data obtained from a Turkish population of normal healthy women using dual energy X-ray absorptiometry (T score less than –2.5) were accepted as having osteoporosis. We detected osteoporosis in 384 (38%) of the female patients. A secondary cause for osteoporosis has been found in 33 (8.6%) of the 384 osteoporotic patients. Thyrotoxicosis (n=10), parathyroid adenoma (n=10), and glucocorticoid administration (n=7) constituted 82% of the causes of osteoporosis. The data obtained in our study indicate that appropriate search for secondary causes of osteoporosis is essential because different modalities are needed for treatment.