Laparoscopic treatment of spontaneous bilateral tubal ectopic pregnancies.
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Adult↗
Biomedical subjects
A Coker
Publications and source records attributed to A Coker.
Ovarian malignant melanoma: unusual presentation of a solitary metastasis.
BACKGROUND: Malignant melanomas of the ovary are rare with unpredictable clinical and biological behavior. We present this case report of a metastatic ovarian malignant melanoma, where the ovary was the first site of relapse after 10 years of remission. CASE: A 58-year-old postmenopausal woman was incidentally found to have an abdominal mass, 10 years after removal of a cutaneous malignant melanoma lesion. Ultrasound and CT scan revealed an adnexal mass, which was found to be a solitary ovarian tumor at laparotomy. Histology confirmed malignant melanoma metastasis. CONCLUSION: Relapse after a prolonged period of remission, presenting, as an isolated ovarian metastasis is an unusual presentation of malignant melanoma. As illustrated by this case report, a differential diagnosis of a metastatic malignant melanoma must be considered.
Female↗
Structure of yeast 5-aminolaevulinic acid dehydratase complexed with the inhibitor 5-hydroxylaevulinic acid.
The X-ray structure of the enzyme 5-aminolaevulinic acid dehydratase (ALAD) from yeast complexed with the competitive inhibitor 5-hydroxylaevulinic acid has been determined at a resolution of 1.9 A. The structure shows that the inhibitor is bound by a Schiff-base link to one of the invariant active-site lysine residues (Lys263). The inhibitor appears to bind in two well defined conformations and the interactions made by it suggest that it is a very close analogue of the substrate 5-aminolaevulinic acid (ALA).
Aminolevulinic Acid↗
Port site ischemic necrosis: an unforeseen complication of laparoscopic surgery.
A case of necrosis of the 10-mm umbilical port site after laparoscopic closure of enterocele in a 66-year-old woman is reported. Ischemic necrosis of the superficial tissue with cellulitis of the umbilical wound was seen during debridement. This highlights a hitherto unforeseen complication of laparoscopic surgery.
Aged↗
The atomic resolution structure of methanol dehydrogenase from Methylobacterium extorquens.
The crystal structure of methanol dehydrogenase (MDH) from Methylobacterium extorquens has been refined without stereochemical restraints at a resolution of 1.2 A. The high-resolution data have defined the conformation of the tricyclic pyrroloquinoline quinone (PQQ) cofactor ring as entirely planar. The detailed definition of the active-site geometry has shown many features that are similar to the quinohaemo-protein alcohol dehydrogenases from Comamonas testosteroni and Pseudomonas putida, both of which possess MDH-like and cytochrome c-like domains. Conserved features between the two types of PQQ-containing enzyme suggest a common pathway for electron transfer between MDH and its physiological electron acceptor cytochrome cL. A pathway for proton transfer from the active site to the bulk solvent is also suggested.
Alcohol Dehydrogenase↗
The structure of the C-C bond hydrolase MhpC provides insights into its catalytic mechanism.
2-Hydroxy-6-ketonona-2,4-diene-1,9-dioic acid 5,6-hydrolase (MhpC) is a 62 kDa homodimeric enzyme of the phenylpropionate degradation pathway of Escherichia coli. The 2.1 A resolution X-ray structure of the native enzyme determined from orthorhombic crystals confirms that it is a member of the alpha/beta hydrolase fold family, comprising eight beta-strands interconnected by loops and helices. The 2.8 A resolution structure of the enzyme co-crystallised with the non-hydrolysable substrate analogue 2,6-diketo-nona-1,9-dioic acid (DKNDA) confirms the location of the active site in a buried channel including Ser110, His263 and Asp235, postulated contributors to a serine protease-like catalytic triad in homologous enzymes. It appears that the ligand binds in two separate orientations. In the first, the C6 keto group of the inhibitor forms a hemi-ketal adduct with the Ser110 side-chain, the C9 carboxylate group interacts, via the intermediacy of a water molecule, with Arg188 at one end of the active site, while the C1 carboxylate group of the inhibitor comes close to His114 at the other end. In the second orientation, the C1 carboxylate group binds at the Arg188 end of the active site and the C9 carboxylate group at the His114 end. These arrangements implicated His114 or His263 as plausible contributors to catalysis of the initial enol/keto tautomerisation of the substrate but lack of conservation of His114 amongst related enzymes and mutagenesis results suggest that His263 is the residue involved. Variability in the quality of the electron density for the inhibitor amongst the eight molecules of the crystal asymmetric unit appears to correlate with alternative positions for the side-chain of His114. This might arise from half-site occupation of the dimeric enzyme and reflect the apparent dissociation of approximately 50% of the keto intermediate from the enzyme during the catalytic cycle.
Amino Acid Sequence↗
Laparoscopic and ultrasound-guided transcervical evacuation of cornual ectopic pregnancy: an alternative approach.
Conventional treatment of cornual ectopic pregnancy carries significant morbidity and may compromise future fertility. We present a minimal access technique for the treatment of cornual ectopic pregnancies which we believe carries a reduced morbidity and may be less likely to compromise future reproductive function.
Abdominal Pain↗
Bioembolisation for unresectable hepatocellular carcinoma: preliminary results of a translational research study.
Lack of effective treatment for surgically unresectable hepatocellular carcinoma has made this disease dismal. Although, systemic and/or locoregional chemotherapy and chemo-embolization are among the established treatment options, the results of these modalities are still far from being satisfactory. Systemic interferon administration is also used for the treatment of this disease however it has high toxicity rates. We conducted a pharmacology guided phase I/II study with the aim to explore the effect of hypoxy and interferon alpha-2a in vitro using the HepG2 Hepatoma cell line. We then translated the in-vitro results to the clinical setting and designed a treatment protocol. This schema consisted of lipiodol embolisation via a hepatic artery port in between two sets of seven loco-regional injections of IFNalpha-2a, 3 MU every other day. The in-vitro study revealed the best sequence of hypoxy and IFN as IFN-Hypoxy-IFN. Based on this finding, ten patients with HCC were treated with loco-regional IFN and lipiodolisation. Seven of them achieved partial response and the mean duration of response was 10 months. There was no Grade 4 toxicity. In conclusion, our preliminary clinical results suggest that the combined use of IFN and lipiodolisation in the optimal sequence may provide a new therapeutic option for patients with HCC.
Adult↗
Cyclosporine A toxicity in association with reduced renal mass.
The long-term effect of cyclosporine A (CsA) in male Wistar rats with reduced renal mass was studied. The aim of the study was to highlight the relationship of CsA effect on rats, simulating patients with two functioning kidneys (eg, heart, liver transplant recipients) and one kidney (renal transplant recipients). The Wistar rats were subjected to unilateral nephrectomy (Unx, n = 14) and to 5/6 nephrectomy (STnx, n = 14). Half of these rats and half of the sham operated ones (control, n = 13) were administered CsA (10 mg/kg/d) for 28 days IP. The serum creatinine (S(CR)), total protein (S(P)), and urine protein (U(P)) values as well as the whole blood CsA levels were determined on the 28th day of the study. The remnant kidneys were evaluated by image analyses and semiquantitative methods after sacrifice on the 28th day. In the three non-CsA-treated groups (Unx, STnx, and control) S(CR) was significantly higher in STnx rats than in Unx rats (P =.011). Percent of renal scarring (PRS) was significantly higher in Unx (P =.02) and in STnx rats (P =.017), compared with the control group. Among CsA-treated three groups S(CR) was significantly higher in STnx rats compared with Unx (P =.017). In addition, segmental sclerosis rate (SSR) was higher in STnx rats, compared with the control group (P =.008), whereas S(P) was higher in the control group (P =.005). When CsA-treated groups were compared with non-CsA-treated ones, U(P) of the Unx rats not receiving CsA were significantly higher than the Unx rats receiving CsA (P =.026). Also, U(P) was higher in non-CsA-treated groups (P =.014), whereas S(CR) (P =.001), S(P) (P =.001), and PRS (P =.001) were higher in CsA-treated rats. In conclusion, we suggest that preserved renal mass is not enough to prevent CsA toxicity and that CsA should be administered to patients with both kidneys (eg, heart, pancreas recipients) as carefully as to patients with one functioning kidney (renal transplant recipients).
Animals↗
Hypersensitivity to Mirena--a rare complication.
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Adult↗
Evaluation of prosthetic mesh closure in semiopen-abdomen patients.
BACKGROUND: To avoid the adverse consequences of abdominal compartment syndrome and to reduce the high mortality the celiotomy wound in patients with abdominal sepsis was closed without tension using prosthetic mesh. This produces a semiopen situation that permits staged reinterventions together with the functional reconstitution of the continuity of the abdominal wall. MATERIAL AND METHODS: Twenty-five patients with intra-abdominal sepsis of various causes were evaluated retrospectively to assess the results of semiopen management of the septic abdomen and reoperations on demand in severe peritonitis. All of the patients were in a state of neglected peritonitis, and had at least one failing organ system. The Mannheim Peritonitis Index (MPI) scoring system was used for stratification of abdominal sepsis. RESULTS: The mean MPI score of 25 patients was 24, ranging 10 to 33. Eight (32%) patients were reexplored (MPI=21). There were overall 9 (36%) complications in patients with mean MPI score of 23. Six (24%) mesh-related complications (infection and enterocutaneous fistulas) developed (MPI=19). The mean MPI score of patients without complications was 24. Four (16%) patients died with index MPI score of 26 due to fulminant hepatitis, myocardial infarction, and multiple organ failure. The admission period averaged 63 days. CONCLUSIONS: In 25 critically ill patients with abdominal sepsis the mortality was lower than expected, relative to heterogeneous data from the literature; also, major complications occurred less frequently although the mean MPI score was high. The authors conclude that this approach is a reliable contribution to the complex treatment of these patients.
Adult↗
Protective effects of carnitine in an experimental ischemia-reperfusion injury.
BACKGROUND/AIMS: We aimed to determine the role of exogenous carnitine to prevent ischemia-reperfusion damage in liver tissue in experimental model. METHODS: Rats were divided into four groups as Sham (SG), 30% Hepatectomy (HG), ischemia-reperfusion +30% hepatectomy (IRHG) and ischemia-reperfusion+30% hepatectomy+carnitine (IRHCG). Serum AST, ALT and GGT levels have been determined in systemic blood samples (post-hepatic vena cava) and liver tissue and serum carnitine levels in blood samples from portal vein (pre-hepatic blood samples). RESULTS: Serum carnitine levels were significantly higher in IRHCG compared to SG (P < 0.01). Each of the serum AST, ALT and GGT levels were statistically higher in HG, IRHG and IRHCG than SG (P < 0.001). While these values in IRHG were also higher than those in HG (P < 0.001), in IRHCG enzyme levels were significantly lower than IRHG (P < 0.001). Liver tissue damage was less in IRHCG than IRHG statistically (P < 0.001). CONCLUSIONS: This animal model implies that exogenous carnitine supplementation may be helpful in preventing free oxygen radical damage and inflammatory reactions in liver tissue.
Alanine Transaminase↗
Pancreatic adenocarcinoma: detection and staging with dynamic MR imaging.
OBJECTIVE: To compare the efficacy of dynamic contrast-enhanced MR imaging and spin-echo T1-weighted with and without fat-saturated MR imaging in the detection and staging of pancreatic adenocarcinoma. METHODS AND MATERIAL: Spin-echo T1-weighted, fat-saturated T1-weighted and dynamic breath-hold 2D-FLASH MR imaging were performed in 25 patients with pancreatic adenocarcinoma. MR images were analysed by calculating the CNR between tumor and normal portion of the pancreas. The CNRs calculated at each sequences were compared. A total of 16 out of 25 patients underwent surgery. Preoperative staging according to TNM classification was also done in patients undergoing surgery. RESULTS: The CNR was significantly different (P<0.05) in the arterial phase of dynamic MR images. The accuracy of 'T' staging was 75% for SE T1-W, fat-saturated T1-W and arterial phase of dynamic MR images. CONCLUSION: The CNRs between pancreatic carcinoma and normal pancreas is significantly higher in dynamic MR sequences than the SE T1-W, fat-saturated T1-W sequences. However, the accuracy of tumor staging according to TNM is equivocal to SE T1-W and fat-saturated T1-W images.
Adenocarcinoma↗
[Effectiveness of the Mannheim Peritonitis Index in patients with peritonitis].
Classification of patients regarding to outcome in early periods of peritonitis or intra-abdominal sepsis, has always been a primary goal of intensive care physicians. In order to predict outcome, a wide variety of scoring systems have been proposed. Mannheim Peritonitis Index (MPI) is one of the most effective scoring systems and its predictive value has been shown previously. Three hundred and twenty five patients that were admitted to Emergency Services in both Ege and Dokuz Eylül University Hospitals between 1995 and 1999, have been evaluated retrospectively by using patient records. Among them, 258 patients (79.4%) have been discharged in well condition and 67 patients died (20.6%). In the latter, MPI scores were always equal or more than 26. Mean MPI scores were 30.23 7.05 and 18.55 6.67 in exitus group and discharged group respectively. When all descriptive factors in MPI have been evaluated separately, every predictor was revealed statistically significant differences between exitus and discharged groups. It has been concluded that MPI is effective scoring system in terms of predicting final outcome in patients with peritonitis and intraabdominal sepsis.
Emergency Service, Hospital↗
Beneficial effects of pentoxifylline pretreatment in non-heart-beating donors in rats.
BACKGROUND: Pentoxifylline (PTX) pretreatment of recipients was shown to protect against liver graft failure from ischemia-reperfusion injury after orthotopic rat liver transplantation. It has also been shown that PTX protects against normothermic ischemia-reperfusion injury to the liver in lobar ischemia model in the rat. Whether PTX can benefit the liver procured from non-heart-beating donors (NHBDs) with up to 9 hr of cold ischemia is unknown. METHODS: Donor and recipient rats were pretreated with intraperitoneal PTX (50 mg/kg) 1 hr before cardiac arrest and transplantation, respectively. Grafts were transplanted 0, 30, and 60 min after cardiac arrest with additional 1 and 9 hr of cold ischemia in both PTX-pretreated or untreated (control) groups (10 rats per group). PTX (25 mg/kg/day) was continuously given to the surviving rats for 5 days postoperatively. Recipient survival rates, serum enzyme levels, and histopathological examination of postreperfusion liver biopsies were all analyzed. RESULTS: The survival rates, serum enzyme levels, and postreperfusion histology were significantly improved in groups pretreated with PTX compared to the controls. CONCLUSION: Donor and recipient PTX pretreatment significantly improves the viability of the liver grafts procured from NHBDs.
Alanine Transaminase↗
Mirizzi's syndrome: diagnostic and surgical considerations in 25 patients.
Mirizzi's syndrome is a rare complication of long-standing cholelithiasis. Many surgical approaches of varying complexity have been advocated for treatment. However, the distorted extrahepatic biliary anatomy continues to be threatening, with a high risk of biliary complications. Presented here is a series of 25 patients with Mirizzi's syndrome who were treated at the Dokuz Eylul University Hospital since 1985. Type I lesion (without cholecystocholedochal fistula) was encountered in 11 patients, while the remaining 14 had type II lesions (with cholecystocholedochal fistula). Preoperative diagnoses were made in 14 of the 25 patients (56%). Follow-up in 17 patients ranged from 1 to 96 months (mean, 40 months). Unfortunately, the remaining 8 patients were lost to follow-up after discharge. The morbidity rate in our series was 32%, while no mortality was encountered. During long-term follow-up, no biliary stricture was diagnosed. Following an uneventful postoperative course, all of our patients are symptom-free and doing well, with normal liver function. We conclude that partial cholecystectomy alone is a safe and sound surgical approach for the treatment of type I lesions. For type II lesions, depending on the size of the fistula, either primary closure over a T-tube, or bilio-digestive anastomosis, preferably Roux-en-Y, can be an appropriate treatment modality, with a low morbidity rate.
Adult↗
Tumor angiogenesis as a prognostic predictor in pancreatic cancer.
The purpose of this study was to evaluate the role of angiogenesis, proliferative activity (assessed by Ki-67 expression), p53 and ras-oncogene (H-ras) expression, and conventional clinicopathologic factors in predicting overall survival rates in patients with pancreatic ductal adenocarcinoma. We followed-up 22 patients with ductal adenocarcinoma of the pancreas for a median of 19 months (range, 2 to 44 months). Angiogenesis was quantitated as vascular surface density (VSD) and the number of vessels per mm2 stroma (NVES) after microvessels were immunostained, using factor VIII-related antigen. p53, H-ras, and Ki-67 proteins were also determined immunohistochemically. VSD and NVES showed significant correlations with increased proliferative activity, poor tumor differentiation, and tumor size of 3 cm or more (P = 0.001, P = 0.013, and P = 0.047, respectively). The overall 2-year survival rate of 33.3% in patients with high VSD and NVES values was significantly worse than that of 66.6% estimated in patients with low microvessel count (log rank, 3.97; P = 0.046). In multivariate analysis using the Cox model, VSD was found to be an independent prognostic factor of survival (P = 0.039). H-ras and p53 expressions were not correlated with angiogenesis parameters. We conclude that, in pancreatic ductal adenocarcinoma, angiogenesis is closely related to tumor growth and patient survival.
Adenocarcinoma↗
Assessment of menstrual blood loss using a pictorial chart: a validation study.
OBJECTIVE: To assess the accuracy of a pictorial blood loss assessment chart (PBAC) as a method for estimating menstrual blood loss in women complaining of heavy periods. DESIGN: A prospective analysis of 103 consecutive women complaining of excessive menstrual blood loss. POPULATION: Women recruited into an on-going study of menstrual blood loss in a large district general hospital. MAIN OUTCOME MEASURES: Correlation between pictorial assessment of blood loss and actual measured menstrual blood loss. RESULTS: There was poor correlation between observed PBAC score and menstrual blood loss. CONCLUSION: We have not been able to validate previously published work. The pictorial assessment chart offers no significant improvement in the quality of objective diagnosis in women complaining of menorrhagia.
Adolescent↗