The development of papillary serous carcinoma of the peritoneum subsequent to endometrial carcinoma: a case report and review of the literature.

Metachronous papillary serous carcinoma of the peritoneum (PSCP) after endometrial carcinoma (EC) is an extremely rare condition. Only three patients have been reported in the English literature. We present the fourth patient who had a more aggressive and fatal clinical course. A 79-year-old multiparous woman complained of progressive abdominal pain and distension after 5 years, subsequent to total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrioid type EC. Serum CA-125 level being followed routinely rose above 500 IU/mL. Abdominal and pelvic computed tomography demonstrated ascites, omental thickening, and nodularity. Paracentesis showed malignant cells resembling papillary adenocarcinoma. Omentectomy and bilateral pelvic lymphadenectomy were performed as cytoreductive surgery. The histologic slides of the totally sampled ovaries obtained from the first operation were reexamined and the corresponding paraffin blocks were re-sectioned but no tumor was detected. The microscopic appearance of the tumor in the omentum differed from that of the previous EC. Immunohistochemically, while the tumor showed reactivity for low and high molecular weight cytokeratin (CK) cocktail, epithelial membrane antigen, CK7, CA-125, and Ber-EP4, the immunostains for calretinin, monoclonal carcinoembryonic antigen, and CK20 were negative. On the basis of these results and the criteria proposed by the Gynecologic Oncology Group, the tumor was diagnosed as metachronous PSCP developed after EC, which corresponded to stage IIIC according to FIGO criteria for ovarian carcinoma. The patient received two cycles of carboplatin and paclitaxel and died 2 months after the cytoreductive surgery.

The role of p53, Bcl-2 and Ki-67 in premalignant cervical lesions and cervical cancer.

PURPOSE: The aim of this study was to determine the role of p53, Bcl-2 and Ki-67 expression in the carcinogenesis of cervical carcinoma and aggressiveness of cervical intraepithelial neoplasia (CIN). METHODS: The pathology specimens of 63 patients with a diagnosis of normal squamous epithelium (22 cases), CIN I (14), CIN II (5), CIN III (8) and squamous cell carcinoma (14) were evaluated immunohistochemically for the expression of p53, Bcl-2 and Ki-67 in paraffin sections. RESULTS: The expression of p53 and Ki-67 increased proportionally to the grade of CIN and cervical cancer, but only the increase of p53 expression was statistically significant (p = 0.002). There was no significant correlation between Bcl-2 expression and premalignant and malignant cervical lesions. CONCLUSION: p53 expression may have a role in the carcinogenesis of squamous cell cervical carcinoma whereas Bcl-2 expression has no role. Ki-67 expression can not be used in determining the aggressiveness of CIN lesions.

MDCT evaluation of early pulmonary infection types after liver transplantation.

INTRODUCTION: Opportunistic pulmonary infections frequently occur after liver transplantation, and affect mortality and morbidity significantly. The purpose of this study was to define the incidence, types, and imaging characteristics of pulmonary infections in liver transplant recipients with multidetector CT (MDCT) evaluation. METHODS: Thirty-five adult transplant recipients diagnosed with a pulmonary infection within the first 45 days posttransplantation were reviewed retrospectively from March 2002 to December 2013. MDCT features were evaluated retrospectively by 2 radiologists in consensus. All diagnoses were made by sputum analysis, cultures, biopsies, and postmortem histopathologic evaluation. RESULTS: Pneumococcus pneumonia was found in 7 patients. Five patients had nonspecific pneumonia, Candidiasis, Klebsiella, and Aspergillosis separately. S aureus pneumonia was detected in 2 patients and the other 2 patients had Escherichia coli pneumonia. Two patients had active tuberculosis and 1 patient had Acinetobacter pneumonia also. Four main MDCT patterns were identified: patchy infiltrations (10%), tree-in-bud pattern (9.5%), ground-glass opacity (8.5%), and nodules with halo sign (6%). One patient had a cavitary lesion owing to tuberculosis. CONCLUSION: Although the incidence of pulmonary complications in liver recipients was relatively low, mortality from serious infections was high. Care must be taken with pulmonary infectious complications in the posttransplant period. For any suspicious case, MDCT evaluation for specific patterns of early accurate diagnosis is very important.

Prevalence of asthma symptoms in school children in Ankara, Turkey.

The aim of this study was to determine the prevalence of symptoms suggestive of asthma in children aged 7-14 years in Ankara, Turkey. For this purpose, the recently developed ISAAC (International Study for Asthma and Allergies in Childhood) questionnaire supplemented with six additional questions was issued to parents of 3154 primary school children from 12 schools. A separate page with questions regarding risk factors was also added to the questionnaire. The response rate was 88.3%. The cumulative and 12-month prevalence of wheezing were 14.4 and 4.7% respectively. The prevalence of physician-diagnosed asthma was 8.1%. A family history of atopy was found to be the strongest risk factor for having ever had wheezing (odds ratio (OR) = 2.89, 95% confidence interval (CI) = 2.32-3.60), wheezing in the past 12 months (OR = 3.21, CI = 2.21-4.67), and severe attack (OR = 2.41, CI = 1.36-4.25). Passive smoking was a risk only for having ever had wheezing (OR = 1.33, CI = 1.03-1.76). Increasing age was associated with a lower risk of current wheezing (OR = 0.85, CI = 0.81-0.90) and severe attack (OR = 0.77, CI = 0.67-0.88). Gender, socio-economic level and pet ownership did not appear to be risk factors for asthma-related symptoms. This study, the first epidemiological survey in Ankara, Turkey, using the ISAAC protocol, clearly shows that symptoms suggestive of asthma, albeit lower than in most European countries, are quite common and constitute a major health problem in Turkey.

Cardiovascular mortality patterns in Turkey: what is the evidence?

In Turkey, reliable cause-specific mortality data are not available. It is thus unknown whether ischaemic heart disease (as in western Europe and the US) or stroke (as in the Far East) is the prevailing cause of cardiovascular death. This information, however, is required for planning cardiovascular prevention programmes. We analyse available Turkish national cause-of-death data as well as patterns of cardiovascular mortality in a hospital in Ankara and among Turkish migrants in Germany. According to national statistics, the ischaemic heart disease-to-stroke ratio would be 0.3 among men aged 45-64 years, lower than that in Japan. Hospital and migrant data show this ratio to be 2-4. We demonstrate the implausibility of the national data by assessing the precision of cause-of-death assignment. We then discuss to what degree mortality experience among migrants is representative for their country of origin. Our findings suggest that the pattern of cardiovascular mortality in Turkey is closer to that in western Europe and the US than to that in the Far East. Finally, we discuss options for improving cardiovascular surveillance in Turkey.

Comparison of load transfer by implant abutments of various diameters.

The effects of diameter and position of implants on displacement and stress distribution, were investigated. ITI Hollow Cylinder two-stage implants with various diameters (3.5 mm, 4.5 mm and 6 mm) and positions are compared on the basis of a two dimensional finite element analysis. The mathematical results of this study demonstrate that, using conventional assumptions for stress levels in the crestal bone, relatively large diameter implants are preferable in the posterior mandibular area.

Comparison of load transfer by angulated, standard and inclined implant abutments.

In order to avoid improper loading of implants, the type of prosthesis, as well as the number, localisation and position of the abutments, should be analysed. In this study three-unit fixed partial prostheses in the posterior mandibular region, supported by an angulated, standard or inclined Bonefit ITI Hollow-Cylinder two-stage implant connected to a natural tooth, are modelled and the stress distributions investigated using the finite element method. It is suggested that the angulated or inclined implant abutments may be recommended because of lower stress around the crestal region of the implant bone interface.

Promoter methylation of P15(INK4B) gene is possibly associated with parvovirus B19 infection in adult acute leukemias.

In this study, we examined the P15(INK4B) gene promoter methylation in patients with myelodysplastic syndrome and acute leukemia and its possible relationship with parvovirus B19 and Epstein-Barr virus infections. P15(INK4B) methylation frequency was significantly higher in acute leukemia patients than in that of non-malignant patients (P < 0.05). When the patients with myelodysplastic syndrome were included, no significant difference was found between these groups regarding the methylation status. The possible correlation between P15(INK4B) promoter methylation and parvovirus B19 infection was observed in adult acute leukemia patients (P < 0.05). However, no similar relationship in EBV-infected patients was observed. To the best of our knowledge, this is the first report showing the possible association between P15(INK4B) promoter methylation and parvovirus B19 infection in acute leukemia.

[An approach to determine the scope of induced abortion in the community]. / Cocuk dusurmenin boyutunu dogru saptamada bir yaklasim

Information on the extent of abortion is generally obtained through direct enquiries of women. However, there is always the possibility of underreporting abortion due to several factors. In this article, the results of a study on underreporting of abortion in Cubuk Health Center are presented. Unlike the findings of similar studies, the overall underreporting of all abortion was only 4% and no relationship was found between the underreporting rate and sociodemographic characteristics of the women. The results have been discussed in the context of the special features of the health services provided in the study area.

[The demographic structure and fertility levels of the population in the new and old slum areas of a "gecekondu" settlement in Antalya Province center]. / Antalya il merkezindeki bir gecekondu yerlesiminde yeni ve eski gecekondu mahallelerinde toplumun demografik yapisi ve dogurganlik duzeyi.

"The demographic structure and fertility level of the population in two slum areas [in Turkey's Antalya Province]...were investigated with a cross-sectional study in 1989. It was found that the distribution of population by age groups differed and especially the fertility measurements were high in the new area in relation to various social and demographic characteristics. In order to facilitate and accelerate the transition period of slum communities, it is necessary to provide health education, mother and child health and family planning services." (SUMMARY IN ENG)

Prevalence and reporting of induced abortion in Turkey: two survey techniques.

This study was designed and conducted to test the relative reliability of reported induced abortion obtained through a conventional survey technique (direct questioning) as compared with an estimated proportion of women with induced abortion obtained through the randomized response technique. Two independent, nationally representative samples were used, one for each approach. A total of 1,521 women were interviewed in the direct question sample, providing a 70.1 percent response rate. In the randomized response sample, 1,674 women participated in the study, representing a 72.9 percent response rate; 1,044 or 62.4 percent of these women provided usable answers. There were substantial differentials in the successful use among the subcategories of independent variables. Of the 1,044 women in the RRT sample, 33.1 percent were estimated to have had at least one induced abortion during their reproductive lives--a much higher rate than the 13.9 percent obtained from the DQ sample. The factors found to be of relevance in relation to induced abortion including age, education, place of residence, development status of the province where the woman resided, number of pregnancies and living children, occupation, and family type.

The extent and causes of mortality among reproductive age women on three districts of Turkey.

PIP: This study attempted to determine the extent and etiology of all deaths among those of reproductive age, to examine the relationship between sociodemographic and reproductive characteristics and mortality, and to determine the level of utilization of health services among women prior to their death. Mortality rates were 5.1/10,000 in Etimesgut, 10.1/10,000 in Cubuk, and 5.1/10,000 in Nevsehir. The 5 main causes of death were: all cancers, heart disease, kidney disease, accidents, and suicide. Suicide was highest among unmarried women and it was most common under age 25. In order to achieve complete, correct, and continuous registration of health events, sufficient numbers of health personnel who have been well trained and supervised, as well as adequate transportation for clients will be essential.^ieng

Varicella seroprevalence in a random sample of the Turkish population.

Chicken pox highly contagious and common throughout the world, is an infectious disease caused by varicella zoster virus (VZV). This study was conducted to determine the seroprevalence of VZV in a population under age 30 and to identify the relationship of VZV seroprevalence and several characteristics of the study subjects in nine provinces of Turkey. The sampling method of 30 clusters recommended for field studies was used for selecting subjects of a pre-determined number in the rural and urban areas in each province. For this, a total of 60 groups, 30 clusters in the rural and 30 in the urban areas were determined. It was planned that a total of 4800 subjects, including 600 subjects from five big provinces (Istanbul, Ankara, Izmir, Adana, Diyarbakir) and 450 subjects from the remaining smaller provinces (Samsun, Erzurum, Trabzon, Edirne), be included in the study. ELISA method was used to examine the blood samples for VZV seropositivity. Positive VZV seroprevalence was detected in 77.8% of 4387 subjects under age 30 in nine provinces of Turkey. There was no difference in seroprevalence rate between rural and urban areas. Seroprevalence was found to be 79.0% in urban areas and 76.3% in rural areas. Seroprevalence increased with age. Seroprevalence was 20% at the age of 1 year, subsequently increased to 40% at the age of 4 years, 60% at the age 6 years, 80% at the age of 8 years, 85% at the age of 10 years, and then remained at 85-90% in subjects over the age of 10 years. In order to develop vaccination protocols and take appropriate preventive health care measures against diseases in different countries, it is very important to know the seroprevalence of any disease for an individual country.

[Comparing of the results obtained from distalization of the upper molar teeth by applying extraoral forces to permanent and removable appliances]. / Sabit ve müteharrik aygitlara agiz disi kuvvetler uygulayarak, üst alti yas disinin distalizasyonundan elde edilen sonuçlarin karsilastirilmasi.

The purpose of the present study is to compare the experimental and clinical results of permanent and removable appliances on headgears. 3 dimensional photoelastic models were used in the experimental work. On these models, forces applied to face bows which were attached to permanent and removable ancher units. After the experiment sagittal sections prepared and analyzed under polaroscope. The results of the 8 case with removable ancher units and 7 case with permanent ancher units were compared by cephalometric processes. As a result, there was no significant difference between permanent and removable headgears.

Continuation and termination rates of some contraceptive methods in two districts of Ankara, Turkey.

PIP: Information was provided on the method-specific continuation rate and the cause-specific termination rate of the most widely used contraceptives in 2 districts of Ankara Province, Etimesgut and Golbasi. The 1st phase of the study, the baseline survey, was carried out in September 1987, when 2179 women in Etimesgut and 2827 women in Golbasi were interviewed concerning sociodemographic characteristics, reproductive and contraceptive history, and utilization of local health services. The 2nd phase was a follow-up survey conducted in September 1988. Examination of contraceptive continuation and termination was based on contraceptive use 12 months preceding and 12 months following the baseline survey. Calculation of continuation and termination rates was by Laing's life table method for calendar data. The most commonly used methods were, in order of greatest use, IUD, withdrawal, and condom. The first-method rates of IUD were quite high: of all IUD users, 75.4% in Etimesgut and 79.7% in Golbasi were continuing for 24 months, whereas the first-method continuation rates of condom, withdrawal, and modern methods were higher up to the 3rd month of acceptance but thereafter rapidly dropped. For IUD all-method rates were slightly higher than first-method rates. On the other hand, all-method rates for condom, withdrawal, and modern methods were much higher than the first-method rates, particularly after 3 months of acceptance. In 1988, 1-year failure rates of various contraceptive methods in Turkey were 4.9% for IUDs, 14.5% for condoms, 27.0% for other modern methods (excluding pill), 13.9% for withdrawal, and 11.5% for other traditional methods. In general the accidental pregnancy rates obtained were lower (particularly in Etimesgut) than the national figures. The accidental pregnancy or failure rate was lowest for IUDs, less than 1.0% at 12 months and 2.0-3.0% at 24 months in both areas, whereas the rate was 4.9% for the country. The failure rates of condom, withdrawal, and other modern and traditional methods were markedly higher.^ieng

Seroprevalence and some correlates of Helicobacter pylori at adult ages in Gülveren Health District, Ankara, Turkey.

The purpose of the study was to detect the frequency and distribution of Helicobacter pylori in the Gülveren Health Centre service area among residents aged between 25 and 64 years and to evaluate the relation of H. pylori infections with general health status, socioeconomic status, and some lifestyle habits. The study included a representative sample of Gülveren Health Centre residents, aged between 25 and 64 years. A stratified random sample of 1672 individuals was selected for study purposes out of 10,569 residents, stratified by age and gender. A standardized questionnaire was completed for all study participants using a face-to-face interview and all participants were invited to the local health centre for a thorough physical examination and blood tests. The overall prevalence of H. pylori was found to be 77.5 % among individuals aged between 25 and 64 years. The frequency of H. pylori was higher among individuals with low socioeconomic status; those who migrated to Ankara after the age of 20 years; members of large families (household size of 4 or above); non-alcohol drinkers; and those who regularly drink tea.

Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study.

OBJECTIVE: To investigate the prevalence of juvenile chronic arthritis (JCA), familial Mediterranean fever (FMF), and Behçet's disease in Turkish children through a field survey. METHODS: The field survey was based on cluster centering with 2 level strata. A total of 46,813 children were screened. For the diagnosis of chronic arthritis and Behçet's previously suggested criteria were used. We have developed criteria for the diagnosis of probable FMF. Children previously diagnosed to have these diseases were also defined and included. RESULTS: JCA was found in 6.4/10,000. 2.8/10,000 children were previously diagnosed as FMF (minimum phenotype frequency). Together with the probable diagnosis of FMF, the prevalence increased to 9.3/10,000. The findings were also compared with those of our center. None of the 46,813 children had Behçet's disease. CONCLUSION: The prevalence of chronic arthritis is similar to the other childhood populations reported. However, FMF has a very high prevalence.

Cardiovascular risk factor levels in a lower middle-class community in Ankara, Turkey.

STUDY OBJECTIVE: To assess the prevalence of risk factors for coronary heart disease (CHD) in a lower middle-class urban community of Turkey. DESIGN: Cross-sectional study in an age- and sex-stratified random community sample with equal sample size per stratum. Direct age-standardization using the standard world population to allow international comparison of findings. Logistic regression modelling to identify risk factors for obesity. SETTING: Gülveren, a residential area in Ankara, total population 23,000 persons. PARTICIPANTS: A total of 1672 adults aged 25-64 years and resident in the study community were interviewed, 1272 (76.1%) of those came for physical examination. MAIN RESULTS: The age-standardized prevalence of hypertension according to WHO MONICA criteria was 18.6% (95% confidence interval: 16.1-21.1%) among women and 12.3% (9.7-14.9%) among men; of obesity (body mass index, BMI > or =30 kg/m2) 51.0% (47.6-54.3%) among women and 15.1% (12.0-18.2%) among men; of current smoking 20.1% (17.5-22.6%) among women and 64.8% (61.4-68.2%) among men; of hypercholesterolaemia 20.1% (17.4-22.9%) among women and 13.8% (10.8-16.8%) among men; and of low high density lipoprotein (HDL) 48.4% (44.8-52.1%) among women and 40.6% (36.0-45.2%) among men. In the regression model, age, female sex, non- and ex-smoking were associated with obesity. CONCLUSIONS: The prevalence of smoking, obesity and low HDL is high in this urban, lower middle-class population, even in comparison with industrialized countries. Unexpectedly, women have less favourable CHD risk profiles than men, except for smoking. Preventive action should be community-wide and address the common risk factors simultaneously to avoid replacement effects such as becoming obese after quitting smoking.