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Biomedical subjects

A Celik

Publications and source records attributed to A Celik.

At least 19 recordsLinked to original sources

Practical design of a 4 Tesla double-tuned RF surface coil for interleaved 1H and 23Na MRI of rat brain.

MRI is proving to be a very useful tool for sodium quantification in animal models of stroke, ischemia, and cancer. In this work, we present the practical design of a dual-frequency RF surface coil that provides (1)H and (23)Na images of the rat head at 4 T. The dual-frequency RF surface coil comprised of a large loop tuned to the (1)H frequency and a smaller co-planar loop tuned to the (23)Na frequency. The mutual coupling between the two loops was eliminated by the use of a trap circuit inserted in the smaller coil. This independent-loop design was versatile since it enabled a separate optimisation of the sensitivity and RF field distributions of the two coils. To allow for an easy extension of this simple double-tuned coil design to other frequencies (nuclei) and dimensions, we describe in detail the practical aspects of the workbench design and MRI testing using a phantom that mimics in vivo conditions. A comparison between our independent-loop, double-tuned coil and a single-tuned (23)Na coil of equal size obtained with a phantom matching in vivo conditions, showed a reduction of the (23)Na sensitivity (about 28 %) because of signal losses in the trap inductance. Typical congruent (1)H and (23)Na rat brain images showing good SNR ((23)Na: brain 7, ventricular cerebrospinal fluid 11) and spatial resolution ((23)Na: 1.25 x 1.25 x 5mm(3)) are also reported. The in vivo SNR values obtained with this coil were comparable to, if not better than, other contemporary designs in the literature.

Animals↗

Renal medullary changes in renal allograft recipients with raised serum creatinine.

OBJECTIVE: To test the hypothesis that the renal medulla may reflect rejection related changes and thus have a predictive value in the assessment of acute renal allograft rejection or chronic graft damage. METHODS: 75 post-transplant biopsies from 57 patients were scored according to the Banff 1997 scheme. The biopsies with adequate cortical and medullary tissue (n = 23) were selected and medullary tissues were reviewed for rejection related lesions except intimal arteritis. Chronic damage was determined by image analysis depending on periodic acid-methenamine silver (PAMS)-Masson trichrome (MT) staining. Medullary and cortical changes were compared. RESULTS: Interstitial inflammation and tubulitis were more frequent and severe in the cortex (p<0.001). Medullary tubulitis was associated with intimal arteritis (p = 0.003, r = 0.598). Medullary interstitial inflammation (n = 8) and tubulitis (n = 4) were associated with cortical borderline changes (n = 5) or allograft rejection (n = 3). The sensitivity, specificity, and positive and negative predictive values of medullary inflammatory changes in predicting cortical allograft rejection were 43%, 69%, 37%, and 73%, respectively. A significant association was observed between medullary MT-SAP and cortical PAMS-SAP values (p = 0.02, R(2) = 0.23). CONCLUSIONS: Acute rejection related lesions are more common and severe in the cortex, and the renal medulla does not sufficiently reflect cortical rejection. The positive and negative predictive values of medullary changes for allograft rejection are low, and medullary inflammation is not a reliable indicator of allograft rejection. Increased medullary fibrosis is correlated with chronic cortical damage.

Adolescent↗

Quantitative digital histochemistry with methenamine silver staining in renal allograft biopsies excluding pure chronic allograft nephropathy cases.

Deterioration of renal function is correlated with irreversible damage in chronic diseases. Recently we described a digital quantitative histochemistry method, relying on periodic acid methenamine silver (PAMS) staining to determine the chronic renal lesions. This index was strongly correlated with progressive deterioration of renal function in grafts with chronic allograft nephropathy (CAN). Herein the method has been applied to a cohort of renal allografts which were biopsied for various reasons, we sought to highlight its value to quantify chronic graft damage. Forty-four renal allograft biopsies from 37 patients with elevated serum creatinine values (SCr) underwent light microscopic image analysis (Mediscope, Dokuz Eylül University, Clinical Engineering Department, Izmir, Turkey) of the PAMS-stained area percentage (SAP). SCr was recorded at four intervals to overcome acute effects: the under SCr value before (SCr1) and after a biopsy within 3 months (SCr3), SCr at the time of the biopsy (SCr2), and the latest value (SCr4). The PAMS-SAP scores were strongly associated with increased interstitial fibrosis and tubular atrophy Banff scores (Kruskal-Wallis test, P = .006 and P = .003, respectively). There was a moderate positive correlation between PAMS and SCr3 (Pearson correlation test, P = .04, r = .312), and a strong positive correlation between time from transplantation to biopsy (Pearson correlation test, P << .000, r = .532). The present results show that PAMS-SAP seems to be of value to quantify renal scarring in allograft biopsies, reflecting four compartments. The strong correlation with time is noteworthy especially as a probable reflection of aging of the renal allograft.

Anti-Infective Agents, Urinary↗

Association of corticosteroids and factor V, prothrombin, and MTHFR gene mutations with avascular osteonecrosis in renal allograft recipients.

The mechanism of posttransplantation avascular osteonecrosis (AVN) is controversial. Besides an increased bone marrow pressure due to reduced blood supply, enhanced coagulation has been considered. We investigated the associations of factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations as well as cumulative corticosteroid doses with AVN in renal allograft recipients. The records of 39 volunteer patients and 11 patients in whom osteonecrosis was previously identified were reviewed for cumulative corticosteroid dosages during the first year. All patients were screened for factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations by direct sequencing of genomic DNA. The cumulative corticosteroid dosages at 3, 6, and 12 months in the osteonecrotic group (5033.5 +/- 1565.3, 7164.9 +/- 2063.1, 8835.1 +/- 2216.8 mg) were significantly higher than in the control group (3629 +/- 1504.1, 4784.5 +/- 1568.7, 6322.4 +/- 1686.6 mg; P = .013, P = .001, P = .001, respectively). No significant difference in factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations was observed between the osteonecrotic and control groups (P > .05). In conclusion, an association between the first year (3, 6, and 12 month) cumulative corticosteroid dosages and AVN was demonstrated in renal transplant recipients. However, no correlation was determined between factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations and osteonecrosis.

Adrenal Cortex Hormones↗

Outcome of kidney transplantation for renal amyloidosis:a single-center experience.

The aim of this retrospective study was to investigate the results of kidney transplantation in patients with renal amyloidosis. We analyzed the results of renal transplantation in 13 amyloidotic transplant recipients compared with those in a control group of 13 nonamyloidotic patients. While the etiology of amyloidosis was rheumatoid arthritis in one patient, in all of the others it was secondary to familial Mediterranean fever. Acute rejection episodes developed once in six and twice in one patient. The renal function in these patients was improved by antirejection treatment. Chronic rejection did not develop in any patient. However six patients (46%) died due to various complications despite functional grafts. The others are still being followed with well-functioning grafts. Among the control group, acute and chronic rejection were diagnosed in three and two patients, respectively: one patient returned to hemodialysis after 26 months of transplantation, while the others are still alive with functional grafts. There was no death in the control group. The 5- and 10-year actuarial patient survival rates of the amyloidosis and control groups were 52.2%, 26.6%, and 100%, 100%, respectively (P = .002). However, the graft survivals of the amyloidosis versus control groups were 100%, 100%, versus 87.5%, 87.5, respectively (P = .47). In conclusion, we observed a high rate of early mortality among recipients with amyloidosis associated with infectious complications. Moreover, patient survivals were lower among amyloidotic renal recipients.

Actuarial Analysis↗

Effects of glucose-insulin-potassium solution on cardiac cytokines and enzymes.

OBJECTIVE: The aim of this study was to assess the effects of glucose-insulin-potassium (GIK) solution on intraoperative cardiac cytokines and cardiac enzymes in coronary artery bypass surgery patients. METHODS: The study group consisted of 49 patients with unstable angina who required urgent CABG. Patients were randomized to a GIK (n = 25) or a non-GIK (n = 24) group. The GIK group received 500 ml of 30 % dextrose solution, containing 100 IU insulin and 80 mEq of potassium, at a rate of 1 ml x kg (-1) x h (-1). The control group received an equivalent rate of 5 % dextrose. Serum cytokine levels were measured in blood samples obtained from coronary sinus blood samples. Cardiac enzymes such as creatinin kinase (CK), myocardial band of creatinin kinase (CK-MB) and Troponin-T were measured immediately after operation and at 6, 24 and 48 hours after operation. RESULTS: No patient in the two groups developed ECG or enzyme changes after surgery suggestive of acute myocardial infarction and myocyte damage. Interleukin-10 concentrations were greater in the GIK group (31.10 +/- 3.36) than in the non-GIK group (19.10 +/- 4.32) ( P < 0.05). CONCLUSION: We conclude that a GIK solution increases the serum cardioprotective interleukin-10 concentrations in CABG patients with unstable angina pectoris. We found no significant difference in any of the other parameters respecting myocyte damage.

Angina, Unstable↗

The influence of urine osmolality and other easily detected parameters on the response to desmopressin in the management of monosymptomatic nocturnal enuresis in children.

AIM: The aim of this paper was to examine the early morning spot urine osmolality and some other parameters easily detected from home chart recordings and history as predictive of the therapeutic response to desmopressin in children with monosymptomatic nocturnal enuresis. METHODS: Sixty seven monosymptomatic nocturnal enuretic children were included in the study. Age, sex, family history, the number of family members and siblings, existence of urgency symptoms, the history of urinary tract infection, sleep patterns, the number of wet nights per month and bedwetting in the same night were recorded. Additionally, spot morning urine osmolality was examined. All children were given desmopressin for at least 2 months. At the end of the treatment period, patients considered as responders and non-responders were compared in all these parameters. RESULTS: Although there was considerable overlap between groups, lower spot urine osmolality was the only data we found statistically significant as predictive of response to desmopressin. Moreover, male predominance, fewer wet nights per month and bedwetting per night were also associated with a better response. CONCLUSIONS: We believe that it is important to characterize such different subgroups that could be used as predictors of a good response to desmopressin.

Antidiuretic Agents↗

Methenamine silver staining quantitative digital histochemistry in chronic allograft nephropathy.

Renal function and final outcome of renal allografts have been correlated with irreversible damage. This study describes a quantitative histochemical method relying on periodic acid methenamine silver (PAMS) staining of all renal compartments. Among 60 renal allograft biopsies from 43 patients, 15 biopsies showing pure chronic allograft nephropathy were selected to determine PAMS-stained area percentage (SAP), using image analysis with quantitative histochemistry. Of the 15 cases, 9 (60%) were grade I and 6 (40%) were grade II chronic allograft nephropathy (CAN). The mean serum creatinine (sCr) value was 1.86 +/- 0.47 for allograft biopsies. The mean (+/-SD) SAP for the implantation biopsies was 10.58 +/- 1.87%, and for allograft biopsies 25.26 +/- 9.67 (P <<.000). The serum creatinine (sCr) values for grade I versus II CAN were 1.63 +/- 0.24 versus 2.20 +/- 0.54 mg/dL, respectively (P=.019), and SAP values were 18.97 +/- 0.24 versus 34.7 +/- 5.89 (P=.003). There was a strong positive correlation between sCr values and SAP (P=.005; r=0.64). These findings show the PAMS approach to be a useful alternative method for reflecting damage in more than one compartment of the renal tissue. Also, the method can discriminated implantation and allograft biopsies as well as grade I and II CAN cases. The series is small for a multivariate analysis of the value of SAP measurements in PAMS-stained sections as a prognosticator, but the data support its use.

Biopsy↗

Prophylactic antibiotic use in pediatric burn units.

Prophylactic antibiotic use in childhood burns is controversial. The efficiency of antibiotic prophylaxis in 77 pediatric burn patients was evaluated. Forty-seven patients received prophylactic antibiotics (Group AP), while 30 patients received no prophylaxis (Group NP). Age, wound depth, day of admission, mechanism of burn injury, type of dressings were similar for both groups (p > 0.05). Wound infection rates were 21.3 % in Group AP and 16.7 % in Group NP (p > 0.05). S. aureus, Enterobacter spp., P. aeruginosa, and E. coli were the most common microorganisms. Patients with wound colonization and infection had a larger burned total body surface area (BTBSA) in both groups (p < 0.01). Eight patients had clinical sepsis. All but one of the septic patients were from Group AP. Associated infections of the upper and lower respiratory tract (16), urinary tract (7), and otitis media (2) were more common in Group AP. One patient died from sepsis in Group AP. Hospital stays were longer in Group AP (21.7 +/- 16.4 vs. 13.5 +/- 10 days; p < 0.05). Antibiotic prophylaxis in childhood burns does not reduce the rate of wound infection. Age, wound depth and BTBSA are not critical variables for prophylaxis. Reinforcing the use of culture-specific antibiotics for more beneficial and cost-effective results in the treatment of childhood burns is recommended.

Adolescent↗

Is it justified to obtain routine peritoneal fluid cultures during appendectomy in children?

Controversy exists regarding obtaining routine peritoneal cultures during appendectomy. The aim of the study was to determine the impact of obtaining routine peritoneal fluid cultures during appendectomy on the treatment and clinical outcome in children. The charts of 269 children who were operated with the diagnosis of appendicitis between January 1996 and January 2001 were reviewed. The microorganisms in peritoneal cultures, selection of antibiotics and clinical outcome were evaluated. Average age was 10.1+/-3.3 (range, 1 to 17 years) years with a male to female ratio of 1.7 (170/99). There were two groups of patients; Group 1: uncomplicated appendicitis (201/269=75%), and Group 2: complicated (perforated) appendicitis (49/269=18%). In the series, 19 patients were found to have a normal appendix in histopathological examination (7%). Cultures were obtained from 95 (35.3%) patients (group 1: 59/95, group 2: 36/95). In patients with uncomplicated appendicitis, 6.7% of the cultures (4/59) were positive while in group 2, the rate was 47.2% (17/36) ( p<0.05). Only in four patients who were in group 2, antibiotics were re-adjusted according to the cultures. Escherichia coli and Klebsiella pneumoniae were the most common microorganisms. There were no complications in group 1, while wound infection (18.3%) and intra-abdominal abscess (2%) were the two most common complications in group 2. Intra-operative peritoneal cultures during appendectomy do not add much to the treatment of children. Therefore, it is not necessary to get peritoneal swab cultures during the procedures, and empiric use of wide spectrum antibiotics when necessary is generally sufficient in the management of this group of children.

Adolescent↗

The role of surgery in intraabdominal Burkitt's lymphoma in children.

The role of surgery in intraabdominal Burkitt's lymphoma remains controversial and different opinions are present in the literature. In our institution, forty patients (30 boys and 10 girls) with intraabdominal Burkitt's lymphoma with ages ranging from 3 to 12 years have been treated and followed from 1989 through 2000. In ten cases, the patients underwent surgery because of their acute abdominal diseases (intestinal obstruction in 5, intussusception in 3, intestinal perforation in one, and acute appendicitis in one). The remaining thirty patients were referred to our clinic because of their abdominal masses, pain, anorexia and fatigue. Twelve children had localized tumors and total resection could be performed. There was one death in this group due to central nervous system involvement during chemotherapy. In the remaining 28 children, extensive intraabdominal diseases were detected. In four of them, debulking procedures were performed, while in 24 children only biopsies could be made; 8 of them underwent a second-look operation. In the debulking procedures group, two children were lost (50 %) due to tumorlysis and acute renal failure. In the biopsy group, there were six deaths (25 %). All patients received chemotherapy after operative recovery. In conclusion, our results suggest that when the tumor is localized, total resection results in a good outcome. However, in the presence of extensive intraabdominal diseases instead of resection, the operation should be limited to biopsy only.

Abdominal Neoplasms↗

Solid and cystic tumor of the pancreas: a case report.

A case of a solid and cystic tumor of the pancreas occurring in a 15 year-old girl is reported. This patient was admitted with epigastric and left upper quadrant pain and vomiting. A mass was detected in the pancreas on CT scan and the patient was referred for surgery. A distal pancreatectomy was performed. A pathological diagnosis of solid and cystic tumor of the pancreas was made and the patient was discharged uneventfully.

Adolescent↗

Quantitative measurements of cerebral blood flow in patients with unilateral carotid artery occlusion: a PET and MR study.

Although it has been demonstrated that quantitative measures of cerebral blood flow (CBF) can be obtained with the singular value decomposition (SVD) algorithm, the extent to which quantitative CBF measurements can be utilized under pathophysiological conditions has not been systematically studied. A total of five healthy volunteers and five patients with unilateral carotid artery occlusion were studied. Only magnetic resonance (MR) images were acquired for the volunteer group while both MR and positron emission tomography (PET) images were acquired for the patient group. Assessments of CBF from normal volunteers compared favorably with values reported in the literature. However, while a linear relationship was observed for each patient when MR measured CBF was compared to that obtained from PET, this linear relationship diminished when all patients were analyzed as a group (r = 0.41). A correction factor (CF) was proposed that was equal to the ratio of the area of the venous output function (VOF) in each patient to the mean VOF obtained from the volunteer group. After globally scaling the CBF of each patient based on the experimentally derived CF, a substantial improvement was observed (a slope of 1.02 and r = 0.8 for the linear regression line) in the relationship between MR estimated CBF and those obtained from PET.

Analysis of Variance↗

Engineering the active site of ascorbate peroxidase.

Understanding the catalytic versatility of haem enzymes, and in particular the relationships that exist between different classes of haem-containing proteins and the mechanisms by which the apo-protein structure controls chemical reactivity, presents a major experimental and theoretical challenge. These issues are discussed in the general context of peroxidase and cytochrome P450 chemistry, and specific issues relating to the catalytic chemistry of ascorbate peroxidase are highlighted.

Ascorbate Peroxidases↗

Engineering the active site of ascorbate peroxidase.

The oxidation of a number of thioethers, namely methyl phenyl sulphide (1), ethyl phenyl sulphide (2), isopropyl phenyl sulphide (3), n-propyl phenyl sulphide (4), p-chlorophenyl methyl sulphide (5), p-nitrophenyl methyl sulphide (6) and methyl naphthalene sulphide (7), by recombinant pea cytosolic ascorbate peroxidase (rAPX) and a site-directed variant of rAPX in which the distal tryptophan 41 residue has been replaced with an alanine (W41A) has been examined. The electronic spectrum (pH 7.0, mu = 0.10 M, 25.0 degrees C) for the ferric derivative of W41A (lambda(max)/nm = 411, 534, 560, 632) is indicative of an increased quantity of 6-coordinate, high-spin and/or 6-coordinate, low-spin haem compared to rAPX. Steady state oxidation of sulphides 1-4 and 7, gave values for kcat that are approximately 10-fold and 100-fold, respectively, higher for W41A than for rAPX. For rAPX, essentially racemic mixtures of R- and S-sulphoxides were obtained for all sulphides. With the exception of sulphide 7, the W41A variant shows substantial enhancements in enantioselectivity, with R : S ratios varying between R : S = 63 : 37 (sulphides 1 and 4) and R : S = 85 : 15 (sulphide 6). Incubation of sulphide 2 with rAPX or W41A and [(18)O] H(2)O(2) shows 95% (rAPX) and 96% (W41A) transfer of labelled oxygen to the substrate. Structure-based modelling techniques have provided a fully quantitative rationalization of all the experimentally determined R : S ratios and have indicated that reorientation of the sidechain of Arg38, such that access to the haem is much less restricted, is influential in controlling the stereoselectivity for both rAPX and W41A.

Amino Acid Substitution↗

Primary pulmonary rhabdomyosarcoma arising within cystic adenomatoid malformation: a case report and review of the literature.

The current report describes a 13-month-old boy with primary pulmonary rhabdomyosarcoma (RMS) that originated within a congenital cystic adenomatoid malformation (CCAM). To the best of our knowledge, he is the youngest patient of all primary pulmonary RMS cases reported in the English-language literature. The tumor, localized in left upper lobe, was removed completely, and histologic examination showed embryonal subtype. Postoperative systemic chemotherapy was carried out. Recent evaluation 15 months after resection has not identified any residual or recurrent disease. Primary pulmonary RMS, although very rare in the pediatric age group, should be considered in young patients with solitary pulmonary masses and associated cystic lesions.

Cystic Adenomatoid Malformation of Lung, Congenita↗