In this experimental study, fibrin sealant increased bursting pressure and rupture strength of colonic anastomoses while hyaluronic acid-carboxymethylcellulose had no effects in rats, but both of them showed no effect on adhesion scores. In order to use fibrin sealant to decrease the rate of early leakages from colonic anastomoses, further studies have to be performed.

Our findings suggest several strategies to increase the duration of breastfeeding, including educating fathers along with mothers, supporting a shared bedroom until the child is 2 years of age, and promoting measures that allow mothers to be with their children during working hours.

Background: The relationship between hypertension and cognitive impairment has been investigated in the literature; several clinical studies suggested a relationship between hypertension and retinopathy. Methods: We examined the relationship between the retinopathy status and cognitive functions by using the Mini-Mental State Examination (MMSE) among hypertensive subjects older than 40 years who were admitted to our Family Medicine, Internal Medicine and Ophthalmology clinics. The subjects were categorized into three groups: group 1 = control subjects (n = 39), group 2 = hypertensive patients without retinopathy (n = 32), and group 3 = hypertensive patients with retinopathy (n = 25). Results: The number of patients with total MMSE scores less than 24 was distributed as follows: group 1: 3 patients (7.7%), group 2: 4 patients (12.5%), and group 3: 14 patients (56%). Hypertension was found to be related with a significant decrease in total MMSE scores in comparison with group 1 subjects (p < 0.001). Furthermore, retinopathy significantly correlated with lower MMSE scores among hypertensive patients (p = 0.001). Compared with group 1, group 3 showed a significant decrease in orientation (p = 0.001), registration (p = 0.001), attention and calculation (p = 0.004), recall (p = 0.009), and total (p < 0.001) MMSE scores. We also found a significant decrease in recall (p = 0.032) and total (p = 0.034) scores in group 3 when compared with group 2. There was a significant decrease in registration (p = 0.002) and total (p = 0.029) MMSE scores in group 2 when compared with group 1. We also observed negative correlations between duration of the disease and orientation (R = –0.597, n = 32, p = 0.001), and between duration of the disease and total (R = –0.495, n = 32, p = 0.006) scores in group 2. Conclusions: Hypertension was found to be related with a decline in MMSE scores. This relation was even more significant in the group of hypertensive patients with retinopathy. Thus, we suggest that cognitive tests be routinely used in the follow-up of hypertensive patients.

N-terminal probrain natriuretic peptide (NT-proBNP) is elevated in patients with heart failure. Numerous clinical trials have evaluated the efficacy of spironolactone in heart failure; however, no studies have directly examined the effects of spironolactone treatment on NT-proBNP level. This study investigated whether NT-proBNP levels decrease with daily spironolactone treatment. The study consisted of 117 adult patients with heart failure. All participants were divided into 3 groups, class I, class II, and class III, according to the New York Heart Association classification system. Patients were randomly assigned to receive spironolactone or were treated with another drug, other than spironolactone, as placebo. NT-proBNP plasma samples were taken at baseline and after 6 mo of treatment. A total of 62 patients were treated with daily spironolactone; 55 patients were followed with available treatment without spironolactone. The baseline demographic and laboratory parameters were similar for patients in all groups. At the end of 6 mo, spironolactone-treated patients had significantly lower NT-proBNP levels and significantly better ejection fractions than did patients in all New York Heart Association classes who were not treated with spironolactone. Results suggest that spironolactone decreases plasma NT-proBNP concentrations, and that the measurement of plasma NT-proBNP levels may be helpful in assessing therapeutic efficacy in patients who are treated for heart failure.

Hypothyroidism-Related CA 19-9 Elevation To the Editor: CA 19-9 is a carbohydrate antigen and tumor marker. 1 CA 19-9 assay measures tumor-related mucins that stomach, gallbladder, colon, ovary, lung, and pancreas malignancies secrete to the circulation. Tumor markers are used for tumor staging and to monitor tumor recurrence after resection. 2 Report of a Case.-A 38-year-old woman presented with complaints of fatigue, constipation, weight gain, dry skin, and forgetfulness that occurred over a 5-year period. On physical examination, bradycardia (54 beats/min), apathic appearance, skin dryness, sparse hair, and hypoactive gut sounds were observed. On biochemical examination, we detected hypercholesterolemia (low-density lipoprotein cholesterol, 232 mg/dL) and a sedimentation rate of 35 mm/1 h (reference ranges shown parenthetically) (0-22 mm/1 h), but other biochemical findings were within the reference range. By radioimmunoassay, the thyroid-stimulating hormone (TSH) level was elevated at 55 mU/L (upper limit, 4 mU/L); the free triiodothyronine level was 1.67 pg/mL (1.5-4.1 pg/mL); the free thyroxine level was 0.31 ng/dL (0.79-1.89 ng/dL); the total triiodothyronine level was 45.4 ng/dL (84.4-175.3 ng/dL); and the total thyroxine level was 2.8 µg/dL (4.5-12.5 µg/dL). The diagnosis was primary hypothyroidism, and treatment began with 0.1 µg/d of levothyroxin preparation. For further diagnosis, we measured the thyroglobulin antibody level (1190 U/mL [0-50 U/mL]) and microsomal antibody level (3722 U/mL [0-50 U/mL]) and performed thin-needle aspiration biopsy of the thyroid tissue. Pathologic examination of the biopsy material showed lymphocytic thyroiditis. Tumor markers assayed to evaluate the patient's complaint of constipation showed carcinoembryonic antigen (CEA) level of 3.09 ng/ mL (<3.5 ng/mL), CA 125 level of 13.48 U/mL (0-35 U/mL), and CA 19-9 level of 36.5 U/mL (0-22 U/mL). On examination after the start of thyroid hormone treatment, the TSH level was 14.5 mU/L, and the free thyroxine level was 0.83 ng/dL. The repeat measurement of CA 19-9 was 30.03 U/mL. On the latest examination, the TSH level was 4.83 mU/L, the free triiodothyronine level was 4.16 pg/ mL, and the free thyroxine level was 1.16 ng/dL. The CA 19-9 measurement of 16 U/mL was within the reference range. Comment.-Hypothyroidism affects multiple organs, tissues, and systems in the body. In this case, slight elevation of CA 19-9 was likely related to the patient's hypothyroidism, as the gradual improvement of thyroid function resulted in resolution of elevated CA 19-9 levels. The return of CA 19-9 levels to normal after treatment of hypothyroidism suggests that the high level was a false elevation. False-positive results, especially for CA 50 and CA 19-9, have been reported in other conditions. Chronic renal failure, extrahepatic jaundice due to choledocholithiasis, 3 chronic pancreatitis, 4 retroperitoneal cystadenoma, 5 cirrhosis, hepatitis, and cholecystitis may be responsible for false elevations.