Are sonographic characteristics of Hashimoto's thyroiditis related with immunologic parameters? A cross-sectional study.

BACKGROUND: The clinical, laboratory, and imaging characteristics of Hashimoto's thyroiditis are widely recognized. However, there is a dearth of information concerning the relationship between these aspects. The primary objective of this study was to investigate the correlation between sonographic features and immunologic parameters in individuals with Hashimoto's thyroiditis. METHODS: This cross-sectional study enrolled a cohort of 100 consecutive patients diagnosed with Hashimoto's thyroiditis. Ultrasonography was performed to classify thyroid gland characteristics, including parenchymal heterogeneity (mild/moderate-to-high), extent of fibrosis (none-to-mild/moderate-to-high), and volume (atrophic/non-atrophic). As for immunologic parameters, thyroid autoantibodies (TOA; anti-TPO and anti-Tg), along with IG (immunoglobulin) G4 levels and lymphocyte subsets, were assessed. RESULTS: Of the 100 patients evaluated, 88 were female (88%) and 12 were male (12%). IgG4/IgG ratio and weekly levothyroxine (LT4) dose were significantly higher in the group with moderate-to-high heterogeneity than the group with mild parenchymal heterogeneity (p = 0.043 and p < 0.001, respectively). Compared to the group with none-to-mild fibrosis, the anti-TPO, IgG4, IgG4/IgG ratio and LT4 dose were significantly higher in the moderate-to-high fibrosis group. Anti-TPO and IgG levels were significantly lower in the atrophic thyroid group compared to the non-atrophic thyroid group. Although not reaching statistical significance, the proportion of plasma cells in the moderate/high fibrosis group was higher than in the non-fibrosis/mild fibrosis group. There was a moderate positive correlation between fibrosis with Anti-TPO, and a low positive correlation between anti-Tg, IgG4 levels with IgG4/IgG ratio. CONCLUSION: TOA, Ig G4 levels and severity of hypothyroidism were associated with ultrasonographic features such as parenchymal heterogeneity and fibrosis in Hashimoto's thyroiditis.

Effect of L-Tryptophan on Sperm Quality of Tigris Scraper (Capoeta umbla) (Pisces: Cyprinidae) after Cryopreservation.

BACKGROUND: The aromatic amino acid L-tryptophan is a versatile molecule and needed for the biosynthesis of proteins. Due to metabolic functions, it has been widely used in research and clinical trials. OBJECTIVE: The present study aimed to test the usefulness of L-tryptophan as an extender of Tigris scraper (Capoeta umbla) sperm during cryopreservation. MATERIALS AND METHODS: Semen samples were diluted with a ratio of 1:3 (sperm: extender) and base extenders were supplemented with L-tryptophan (0 mM, 0.5 mM, 1 mM, 2 mM and 4 mM). Sperm motility and duration of post-thawed samples were assessed after the cryopreservation process. RESULTS: Our results revealed that motility rate and duration of sperm increased when the cryomedia was supplemented with L-tryptophan. On the other hand, an increase in the concentration of L-tryptophan in the extender caused a significant decrease (p<0.05) in the motility rate of Tigris scraper (C. umbla) sperm. The ideal results were obtained at 1 mM L-tryptophan; however, no motile sperm were shown in any samples when a concentration of 2 mM was used. CONCLUSION: The current study shows the importance of conducting further studies related to long-term storage and reproduction management.

A RARE CAUSE OF PITUITARY APOPLEXY: CABERGOLINE THERAPY.

Pituitary apoplexy (PA) is a life-threatening clinical syndrome. Dopamine receptor agonists are the drugs of choice in the treatment of prolactinomas. The use of cabergoline is reported to cause an increased risk of PA, particularly in macroprolactinomas of cystic nature. In this report, we present a patient with a cystic macroprolactinoma who developed PA on the 16th week of cabergoline treatment.

The evaluation of Nesfatin-1 levels in patients with OSAS associated with metabolic syndrome.

PURPOSE: The association of obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS) has been demonstrated in studies and in recent years; the effect of OSAS on insulin resistance independent of the level of obesity is being investigated. Nesfatin-1 is a newly defined 82 amino acid protein with a precursor molecule of NUCB2 (nucleobindin 2). Nesfatin-1 is not only essential in regulation of food ingestion but also important in regulation of some brain functions, autonomic regulation, stress, mental state, and paradoxical sleep. We aimed to evaluate the relationship between OSAS and MS and the MS dependent or independent effect of Nesfatin-1 on this relationship. METHODS: Patients admitted with clinical signs of OSAS are included. Patients are divided into three groups based on Apnea-Hypopnea Index (AHI) on Polysomnography (PSG) as mild, moderate, and severe OSAS. A total of 59 patients were included the control patients. Several OSAS parameters and laboratory findings which are and are not MS dependent are compared. Nesfatin-1 levels are evaluated in all OSAS patients with and without MS. RESULTS: There were significantly more males in all groups (p = 0.007). There was no significant difference between groups in terms of Nesfatin-1 levels. Nesfatin-1 levels were significantly lower in MS group compared to non-MS group (p = 0.021). CONCLUSION: Nesfatin-1 which is known to play a role in the pathophysiology of insulin resistance can be a beneficial target in developing new therapeutic targets for treatment of patients with obesity without any toxic effects in the future.

The effect of montelukast on eosinophil apoptosis: induced sputum findings of patients with mild persistent asthma.

BACKGROUND: Apoptosis may be important in limiting airway eosinophilia. Treatment with leukotriene antagonists decreases the number of eosinophils in both peripheral blood and sputum. AIM: To assess the effect of montelukast on eosinophil apoptosis in a group of patients with mild persistent asthma (MPA) and to compare this effect with the apoptotic effect of fluticasone propionate (FP). METHODS: Randomly selected patients with MPA (n = 22) who had not taken anti-inflammatory therapy within the preceding 12 months were included in the study. The sputum induction procedure was performed and the patients were divided into two groups: group 1 (n = 10) received FP 250 microg/day and group 2 (n = 22) received montelukast 10 mg/day orally for 4 weeks. Sputum induction was repeated after the treatment period. The resulting cytospin slides were stained by Wright's stain and morphologic changes in apoptotic eosinophils were assessed by the use of light microscopy by two blinded expert pathologists. Serum soluble Fas ligand (sFasL) concentrations were measured by an ELISA method at baseline and after treatment in both groups, as well as in a group of healthy subjects. RESULTS: In within-group comparisons, the apoptotic ratio (AR) increased at the end of the study period in group 1 (p = 0.05). In the group treated with FP the ratio of sputum eosinophils significantly decreased (p = 0.02), and the AR significantly increased (p < 0.005). No differences were found in the two study groups in serum sFasL levels at the end of the treatment period compared with baseline values (p > 0.05). CONCLUSION: Our findings demonstrate that 4 weeks' treatment with a CysLT receptor antagonist (montelukast) resulted in an increase in eosinophil apoptosis comparable to that produced by FP, suggesting that induction of apoptosis may be a potential mechanism for the mode of action of CysLT receptor antagonists in asthma.

Giant ancient schwannoma of the posterior mediastinum cytologically misdiagnosed as a malignant tumour. A case report.

We report a case of a 45-year old woman who was found to have a giant mediastinal tumour with radiological degenerative changes. She underwent thoracotomy to remove the mass, which was eventually diagnosed histologically as an ancient schwannoma, whereas cytological interpretation of the accompanying pleural fluid was malignant. Ancient schwannoma is a rare variant of schwannoma, histologically showing atypical features that may result in erroneous diagnosis of a malignant tumour. Clinical and radiological findings are important aids for further consideration of surgical removal of these potentially resectable tumours.

Cytologic diagnosis and subtyping of rhabdomyosarcoma.

We reviewed the cytological findings of 38 cases of rhabdomyosarcoma (RMS) with histological confirmation performed during a period of 15 years and proposed a morphological subtyping based on the most prominent cytologic features. Seventeen of these cases were alveolar, 14 cases embryonal, and seven botryoid subtypes. From these cases, a total of 43 samples, of which 37 were fine needle aspiration (FNA) biopsies and six were touch imprints, were evaluated. Detailed cellular features were identified which enabled differentiation into histological subtypes. In the alveolar RMSs, most tumour cells were small and lymphocyte-like, having finely granular chromatin. The finding of cells with more abundant cytoplasm, eccentrically located nuclei and bi/multinucleated tumour cells in a background of mucosubstance helped in the differential diagnosis. Two cell types, including large, tadpole or ribbon-shaped tumour cells and small, round cells with scant cytoplasm, were seen in embryonal RMSs. In botryoid RMSs, a cell type with tightly grouped nuclei within elongated cytoplasm similar to a myotubular structure was observed in addition to the two cell types of embryonal RMSs. We conclude that with experience it will be possible to subtype these tumours by cytologic examination alone.

A case of Lenz microphthalmia syndrome.

Lenz microphthalmia syndrome was first described by Lenz et al in 1955. The cardinal features of the syndrome are microphthalmia or anophthalmos, narrow shoulders, other skeletal anomalies, and dental and urogenital malformations. Here we present a case of Lenz microphthalmia syndrome who shows the typical characteristics and, additionally, dysgenesis of the corpus callosum associated with dilatation of the lateral ventricles. The patient, a 13 year old male, was referred to our hospital by a dental hospital for genetic counselling. On physical examination, height, weight, and head circumference were below the 3rd centile and he had brachymicrocephaly, a preauricular tag, microphthalmia, missing teeth, narrow shoulders, long, proximally placed thumbs, hypospadias, cryptorchidism, and a normal IQ. Ophthalmological examination showed microcornea, sclerocornea, absence of the pupil, no vision in the left eye and decreased vision and a small pupil in the right eye in addition to his bilateral microphthalmia. Cranial MRI showed dilatation of the lateral ventricles and dysgenesis of the corpus callosum.

Primary mediastinal liposarcoma. A report of a case and review of the literature.

A case of primary liposarcoma of the mediastinum with a review of the literature is presented. Liposarcomas may attain a large mass and exhibit various kinds of clinical symptoms according to their localisation. Histological typing is very important in determining the type and extent of therapy. Surgical excision of the tumour is the therapy of choice in all cases. Radiotherapy may be of value for the palliation of unresectable cases.