High Anxiety Levels before Elective Cesarean Section Can Negatively Affect the Mother and Fetus.

BACKGROUND: Both pregnancy and surgery cause anxiety. This situation may negatively affect the health of the mother and baby. AIM: The effect of anxiety level before cesarean section (CS) on feto-maternal outcomes was investigated. METHODS: The preoperative anxiety score was determined with the State-Trait Anxiety Inventory (STAI) in 224 pregnant women who were planned for elective CS. RESULTS: Among patients, 33.5% were in the low anxiety group, 27.2% in the moderate, and 39.3% in the high anxiety group. The average birth weight in the low anxiety group was noticeably higher than that of the high anxiety group (P = 0.018). The mean heart rate at postop 1st and 24th hour in the high anxiety group was higher than the moderate anxiety group (P < 0.028). In addition, diastolic blood pressure (DBP) at the sixth hour in the low anxiety group was found to be lower than in the moderate anxiety group (P < 0.05). CONCLUSION: According to these results, it was found that an increased anxiety score before CS is associated with low birth weight in the baby, higher heart rate, and DBP in the mother.

Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) as a Marker of Diabetic Nephropathy in Type 1 Diabetic Patients.

BACKGROUND: Glomerular and tubulointerstitial damage plays a role in renal function failure in diabetic patients. While both serum and urine levels of neutrophil gelatinase-associated lipocalin (NGAL) show significantly increased levels in acute renal pathologies, the NGAL increase in active phase indicates a reversible condition in chronic cases. MATERIALS AND METHODS: 52 type 1 diabetic patients and 30 healthy volunteers participated in the study. The diabetic participants were separated into two groups as follows: a normoalbuminuria group consisting of those with an albumin/creatinine ratio less than 30 mg/g and an albuminuria group consisting of those with an albumin/ creatinine ratio equal or greater than 30 mg/g. Albumin, creatinine and NGAL were measured in all participants. RESULTS: Urinary NGAL median level was 21.1 ng/mL for diabetic patients and 11.9 ng/mL for healthy controls, and the difference between the two groups was statistically significant. When diabetic patients were compared as those with and without albuminuria, the median urinary NGAL levels of normoalbuminuria and albuminuria were 24.7 and 16.1 ng/mL, respectively, but the difference was not statistically significant. Statistically similar results were obtained through evaluation of the ratio of urinary NGAL excretion to creatinine excretion. The NGAL/Cr ratio was significantly higher in diabetic patients than in healthy controls, but no statistically significant difference was found between the diabetic patients with and without albuminuria. CONCLUSIONS: Urinary NGAL excretion in type 1 diabetic patients is found to be increased over a wide range, but it does not correlate with urinary albumin excretion. In this regard, urinary NGAL excretion should not be used as an alternative to microalbuminuria in detecting diabetic nephropathy. The greater amount of NGAL excretion among diabetic patients may be due to diabetic nephropathy with possible tubulointerstitial damage pathologies.

Cardioprotective effects of fish omega-3 fatty acids on doxorubicin-induced cardiotoxicity in rats.

The aim of this study was to investigate the protective effects of fish omega-3 (n-3) fatty acids on doxorubicin (DOX)-induced acute cardiotoxicity. A total of 24 rats were divided into three groups: control, DOX-treated, and DOX treated with fish n-3 fatty acids. Control group received 0.4 ml/kg/day of saline intragastrically. The rats in the fish n-3 fatty acid-pretreated group were given 400 mg/kg/day fish n-3 fatty acids for 30 days by intragastric intubation. To induce acute cardiotoxicity, DOX (30 mg/kg) was injected intraperitoneally by a single dose and the rats were killed after 48 h. DOX treatment caused severe damage in heart tissues. Disorganization of myocardial muscle fibers, myofibrillar loss, and cardiotoxic myocardial fibers with cytoplasmic vacuoles were seen. Fish n-3 fatty acid-treated rats showed an improved histological appearance in the DOX-treated group. Our data indicate a significant reduction in the activity of terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling in cardiomyocytes of the DOX-treated group with fish n-3 fatty acids therapy. The DOX-treated with fish n-3 fatty acids group showed a significant decrease in malondialdehyde levels, and an increase in superoxide dismutase and glutathione peroxidase activities in comparison with the DOX-treated group. This study showed that fish n-3 fatty acids may be a suitable cardioprotector against acute toxic effects of DOX.

CDC25B, Ki-67, and p53 expressions in reactive gliosis and astrocytomas.

PURPOSE: To investigate the expression of CDC25B, which is a member of the cyclin-dependent kinase activating phosphatase family, in diffuse astrocytoma (DA), anaplastic astrocytoma (AA), glioblastoma multiforme (GBM), pilocytic astrocytoma (PA) and reactive gliosis (RG). Also, to study the relationship of the expression level of CDC25B with clinical parameters and with p53 and Ki-67 proliferation index (PI). METHODS: Tissues were collected from 36 cases diagnosed with astrocytoma (10 DA, 6 AA, 20 GBM), 10 PA, 10 RG and 10 normal brain tissues for controlling purposes. The sections were immunohistochemically stained with CDC25B, Ki-67 and p53. For each marker, 1000 tumor cells were counted and the ratio of positive tumor cells was calculated. RESULTS: The average CDC2B staining index (CSI) was 0.6% in PA, 0.4% in DA , 7.7% in AA and 25.5% in GBM. The increase of CSI in parallel with the increase of WHO grade was significant (p=0.001). No expressions were identified in RG and normal brain. There was also significant relationship between the tumor size and CSI (p=0.027) and also between Ki-67 PI and CSI (p=0.001). Among the groups with low and high CSI in astrocytoma cases, the disease free survival (DFS) was significantly higher in the low CSI group (p=0.0001). CONCLUSIONS: Positive expression of CDC25B in astrocytoma affects the prognosis in an adverse manner. CSI can be used as a diagnostic method and CDC25B may be a possible target molecule for treatment.

Vertical vs. transverse sections of scalp biopsy specimens: a pilot study on the comparison of the diagnostic value of two techniques in alopecia.

BACKGROUND: Using both vertical and transverse sections is preferred for histopathological diagnosis of alopecia. However, in cases in which only a single biopsy is taken, it is not clear which type of sectioning is better. AIM: To compare the diagnostic value of transverse and vertical sections. METHODS: In total, 53 patients with alopecia were enrolled in the study. Two biopsies were taken from each patient, and cut into either transverse or vertical sections. The clinical and histopathological findings were evaluated together for the definitive diagnosis. After the study period, a pathologist randomly re-evaluated the sections. We compared the histopathological diagnoses with the definitive diagnoses, and determined the sensitivity and specificity of each method. RESULTS: A definitive diagnosis was made for 47 patients (88.7%). Of these, 30 (63.8%) had noncicatricial and 17 (36.2%) had cicatricial alopecia, and the diagnosis was made by transverse and vertical sections for 43 (91.5%) and 39 (88%), respectively (P > 0.05; sensitivity; 91.5% vs. 82%). All 30 patients with noncicatricial alopecia were diagnosed by transverse sections, and 25 (83.3%) of the 30 were diagnosed with vertical sections (P = 0.05; sensitivity 100% vs. 83.3%). Of the 17 patients with cicatricial alopecia, 13 (76.5%) and 14 (82.4%) patients were diagnosed by transverse and vertical sections, respectively (P > 0.05; sensitivity 76.5% vs. 82.4%). Five patients with lichen planopilaris were diagnosed by vertical sections, and one by transverse sections. There were several limitations to the study: (i) statistical subtype analysis could be performed only for alopecia areata; (ii) no conclusion could be drawn about the interobserver reliability of two sections; and (iii) having the pathologist-blinded study performed retrospectively might have caused a recall bias. CONCLUSION: If only a single biopsy specimen is available, it may be preferable to have transverse sections in cases of suspected noncicatricial alopecia, and vertical sections in cases of suspected lichen planopilaris. Either type of sectioning is suitable for cicatricial alopecia when lichen planopilaris is clinically unlikely.

The association of tethered cord, syringomyelia, diastometamyelia, spinal epidermoid, spinal lipoma and dermal sinus tract in a child.

We report on a 5-year-old boy presenting with tethered cord, diastometamyelia, spinal dysraphism, terminal lipoma, spinal epidermoid, and dermal sinus tract with CT, conventional MRI, and diffusion-weighted MRI findings. To the best of our knowledge, our case has the property to be the first case in the literature showing the association of these pathologies all together.

Body image and self-esteem in somatizing patients.

AIM: The aim of the present study was to determine dissatisfaction with body appearance and bodily functions and to assess self-esteem in somatizing patients. METHODS: Body image and self-esteem were investigated in 128 women; 34 of those had diagnosed somatoform disorders, 50 were breast cancer patients with total mastectomy surgery alone, and 44 were healthy subjects. Body image and self-esteem were assessed using the Body Cathexis Scale and Rosenberg Self-Esteem Scale. RESULTS: The two clinical groups did not differ from one another (z = -1.832, P = 0.067), but differed from healthy controls in terms of body image (somatizing patients vs healthy controls, z = -3.628, P < 0.001; total mastectomy patients vs healthy controls, z = -3.172, P = 0.002). They also did not differ significantly in terms of self-esteem (z = -0.936, P = 0.349) when depressive symptoms were controlled. No statistically significant difference was observed between total mastectomy patients and healthy controls in terms of self-esteem (z = -1.727, P = 0.084). The lower levels of self-esteem in somatizing patients were largely mediated by depressive symptoms. Depressed and non-depressed somatizing patients differed significantly from healthy controls with respect to their self-esteem and body image. CONCLUSIONS: Somatizing patients who were dissatisfied with their bodily functions and appearance had lower levels of self-esteem and high comorbidity of depression. In clinical practice it is suggested that clinicians should take into account psychiatric comorbidity, self-esteem, and body image in somatizing patients when planning treatment approaches.

Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases.

OBJECTIVES: Fine needle aspiration cytology (FNAC) of the thyroid is a non-invasive, cost-effective screening procedure that is valuable for distinguishing neoplastic lesions from non-neoplastic nodules. The aim of this study was to determine the diagnostic accuracy of FNACs performed at our institution by correlating FNAC results with histopathological diagnoses. METHODS: Two hundred and seventy-one aspiration cytology specimens followed by thyroidectomy were included in the study, and the results of 260 adequate FNACs were compared with their histological diagnoses. RESULTS: The sensitivity and specificity of thyroid FNAC for detecting neoplasia were 92.6% and 91.6%, respectively. There were 15 (5.7%) false positives and six (2.3%) false negatives. CONCLUSIONS: The results showed that follicular cells that exhibit some of the features of papillary carcinoma could be observed in a cytology slide of Hashimoto's thyroiditis, leading to a diagnostic pitfall. In addition, cellularity and overlapping cytological criteria in hyperplasia might lead to a false diagnosis.

Effects of testosterone on leptin production in anterior pituitary cells of rats: an immunohistochemical study.

The aim of this study was to immunohistochemically examine the effects of orchidectomy and administration of testosterone hormone on leptin production in the rat anterior pituitary. Twenty-one male Wistar rats were divided into three groups. Group I and group II were designated as control (sham-orchidectomized) and orchidectomized rats, respectively. Rats in group III were orchidectomized and injected daily with testosterone propionate for 1 month. At the end of the experimental period, all animals were sacrificed by decapitation. The pituitary glands of all rats were removed and processed for semi-quantitative evaluation of immunohistochemical leptin staining. Intensity of immunostaining was determined on a scale between 0 (no staining) and 5 (heavy staining). Immunostaining of leptin was moderate (3+) in control rats, heavy (5+) in orchidectomized rats, and low (1+) in testosterone-treated orchidectomized rats, respectively. These findings indicate that orchidectomy increases leptin secretion in anterior pituitary cells, and this increase of leptin synthesis can be prevented by administration of testosterone propionate. Thus, testosterone seems to affect leptin production in the anterior pituitary of male rats.

Treatment of Morgagni hernias by transabdominal approach / Tratamiento de las hernias de Morgagni mediante el abordaje transabdominal

BACKGROUND: Recently, the thoracic approach has been suggested in the surgical treatment of Morgagni hernias with some reported advantages over abdominal surgery. This manuscript reports the authors' experience with childhood Morgagni hernias repaired via laparotomy. SUBJECTS AND METHODS: Records of five cases of Morgagni hernias were evaluated with respect to age, presentation, operative data, complications, and outcome. RESULTS: The average age of four male and one female patients was 34 months (range 6 months to 8 years). Predominant presenting symptoms were related to the respiratory system. The diagnoses were made by posterior-anterior and lateral chest X-rays and confirmed by barium enema contrast radiographs. Associated anomalies were detected in three cases. All cases were managed by abdominal approach through upper midline incisions reducing the herniated viscera (transverse colon in all and including omentum in one patient) and excising the hernia sac which was present in all patients. The postoperative period was uneventful in this series and no recurrence was detected in an average of four years of follow-up. CONCLUSION: The transabdominal approach is appropriate in the surgical correction of paediatric Morgagni hernias.

Antecedentes: Recientemente, se ha sugerido el empleo del abordaje torácico en el tratamiento de las hernias de Morgagni, reportándose algunas ventajas del mismo sobre la cirugía abdominal. Este trabajo reporta la experiencia de los autores en relación con hernias de Morgagni en la infancia, reparadas mediante laparotomía. Sujetos y métodos: Las historias clínicas de cinco casos de hernias de Morgagni operadas en nuestro departamento, fueron evaluadas con respecto a edad, presentación, datos operatorios, complicaciones, y resultado. Resultados: La edad promedio de cuatro pacientes varones y una hembra fue de 34 meses (rango de 6 meses a 8 años). Los síntomas presentados estuvieron relacionados de forma predominante con el sistema respiratorio. Los diagnósticos se hicieron mediante rayos X posterior-anterior y lateral de tórax, y confirmados luego mediante estudio radiográfico de contraste con enema de bario. Se detectaron anomalías asociadas en tres casos. Todos los casos fueron manejados mediante abordaje abdominal a través de incisiones de la línea media superior, reduciendo así la víscera herniada (colon transversal en todos, incluyendo el omento en un paciente) y practicando la excisión del saco de la hernia, presente en todos los pacientes. El período post-operatorio no presento incidentes en esta serie, y no se detectó recurrencia durante el seguimiento, que duró un promedio de cuatro años. Conclusión: El abordaje transabdominal es apropiado en la corrección quirúrgica de las hernias pediátricas de Morgagni.

Treatment of Morgagni hernias by transabdominal approach.

BACKGROUND: Recently, the thoracic approach has been suggested in the surgical treatment of Morgagni hernias with some reported advantages over abdominal surgery. This manuscript reports the authors' experience with childhood Morgagni hernias repaired via laparotomy. SUBJECTS AND METHODS: Records of five cases of Morgagni hernias were evaluated with respect to age, presentation, operative data, complications, and outcome. RESULTS: The average age of four male and one female patients was 34 months (range 6 months to 8 years). Predominant presenting symptoms were related to the respiratory system. The diagnoses were made by posterior-anterior and lateral chest X-rays and confirmed by barium enema contrast radiographs. Associated anomalies were detected in three cases. All cases were managed by abdominal approach through upper midline incisions reducing the herniated viscera (transverse colon in all and including omentum in one patient) and excising the hernia sac which was present in all patients. The postoperative period was uneventful in this series and no recurrence was detected in an average of four years of follow-up. CONCLUSION: The transabdominal approach is appropriate in the surgical correction of paediatric Morgagni hernias.

Correlation between histological grade and MIB-1 and p53 immunoreactivity in meningiomas.

OBJECTIVE: Meningiomas for the most part are slow-growing benign tumors, but complete removal can be difficult and recurrence is an issue. The aim of this study was to re-evaluate tumors diagnosed as meningioma previously in our hospital, according to the latest World Health Organization classification. We also examined the relationships among parameters such as brain invasion, histological grade and Ki-67 and p53 expression in these tumors. MATERIALS AND METHODS: Meningioma biopsy specimens numbering 60 (48 grade I, 11 grade II, and 1 grade III tumors) were examined immunohistochemically using monoclonal antibodies for Ki-67 (MIB-1) and p53 protein. The MIB-1 labeling index (LI) for each tumor was calculated as a percentage based on the number of stained cells per total cells counted. The level of p53 expression in each sample was semiquantatively evaluated as < 1%, 1 - 10%, 10 - 70%, or > 70%. Any value > 1% was accepted as presence of p53 expression. RESULTS: Of the 60 meningiomas, 7 (11.7%) exhibited brain invasion. The mean MIB-1 LI values for the grade I and grade II tumors were 1.1% and 2.3%, respectively. The corresponding levels of p53 protein expression in these groups were 54.1% and 72.7%. The MIB-1 LI and the level of p53 expression in the one grade III meningioma were 6.7% and 10 - 70%, respectively. Histological grade was significantly correlated with MIB-1 LI and with p53 expression (p < 0.01 for both). Brain invasion was not correlated with histological grade, MIB-1 LI, or p53 expression. CONCLUSION: The results indicate that MIB-1 LI and p53 protein expression are good indicators of histological grade in meningioma and may be particularly valuable for distinguishing borderline atypical meningiomas. The number of cases was limited, but the findings also suggest that brain invasion is a prognostic parameter independent of grade, MIB-1 LI and p53 expression.

Experiments on the role of gas height in the Rayleigh-Marangoni instability problem.

Experimental evidence is provided to show the effect of gas phase dynamics on the onset of thermal convection and on the accompanying patterns in a silicone oil-air convecting bilayer. Very good agreement with three-dimensional calculations for linearized stability is obtained mostly for small and large gas heights. Reasons for this agreement as well as the results at intermediate gas heights are qualitatively explained from the perspective of well-established nonlinear analysis.

Ki-67 proliferation index in Kaposi's sarcoma after renal transplantation: findings in skin-only cases versus cases with internal-organ involvement.

Kaposi's sarcoma (KS) is an angioproliferative condition that accounts for 6% of all malignancies in organ transplant patients. When we review the literature, the results of the studies comparing the different stages and the proliferative activity of the tumor are challenging. However, we found no previous study on Ki-67 protein expression in KS that correlates skin and organ lesions. In the current study, we investigated whether there is a correlation on the proliferative activity between skin and internal organ lesions in KS. Proliferative activity of 13 biopsy specimens of KS was assessed immunohistochemically using the monoclonal antibody MIB-1 (Ki-67). Mann-Whitney U test is used for statistical analysis and a P value < .05 was considered significant. Seven of 13 cases were skin and six were internal organ KS. For skin lesions, the mean MIB-1 proliferation index was 14.5%, and it was 13% for organ lesions. There was no significant association between skin and internal organ KS in regard to MIB-1 PI (P > .05). The findings suggested that the proliferative activity in KS does not differ in skin and organ lesions. On the other hand, it should be considered that the number of cases in our study was limited and further studies with a larger series are needed.

Pinealectomy increases and exogenous melatonin decreases leptin production in rat anterior pituitary cells: an immunohistochemical study.

Melatonin, the main hormone of the pineal gland, informs the body about the environmental light and darkness regimen, which in turn contributes to the photoperiodic adaptation of several physiological functions. Leptin, the hormone secreted mainly by adipocytes and some other tissues including the pituitary, informs the brain about the mass of adipose tissue, which plays an important role in energy homeostasis. Melatonin has been shown to decrease circulating leptin levels. It is currently not known whether melatonin has an effect on leptin synthesis in the pituitary. The aim of this study was to immunohistochemically examine the effects of pinealectomy and administration of melatonin on leptin production in the rat anterior pituitary. The pituitary samples obtained from 18 male Wistar rats including sham-pinealectomized, pinealectomized and melatonin-injected pinealectomized groups were immunohistochemically evaluated. Immunostaining of leptin was moderate (3+) in sham-pinealectomized rats, heavy (5+) in pinealectomized rats and low (1+) in melatonin-treated pinealectomized rats, respectively. The present results indicate that pinealectomy induces leptin secretion in anterior pituitary cells, and this increase of leptin synthesis can be prevented by administration of melatonin. Thus, melatonin seems to have both physiological and pharmacological effects on leptin production in the anterior pituitary of male rats.

Localized benign pleural mesothelioma: a case report.

Primary neoplasms of the pleura are rare tumors and the majority are generally mesotheliomas. Mesotheliomas are either localized and mostly benign, or diffuse and uniformly malignant neoplasms. Localised benign pulmonary mesothelioma (solitary fibrous tumor of the pleura) are originally thought to be a variant of diffuse pleural mesothelioma because they consists of a spindle cell stroma associated with branching tubular structures lined by cuboidal cells. Our case which is reported below shows the clinical spectrum of the more common benign variant. Clinical differential diagnosis of benign and malign mesotheliomas is not clear. Complete surgical resection is the preferred treatment for both types and usually curative with the benign mesothelioma. The localised pleural variant is benign in most cases, and it is even less common, constituting only 10% of all mesotheliomas [1]. The importance of localised benign mesothelioma is that it is almost impossible to differentiate from a malignant neoplasm preoperatively and it may occasionally recur, sometimes with a malignant change.

Diffuse fibrous proliferation of tunica vaginalis associated with testicular infarction: a case report.

Fibrous pseudotumor of the tunica vaginalis testis is an uncommon lesion of unknown pathogenesis. Although this reactive process of testicular tunics is benign, this usually is diagnosed after radical orchiectomy. The authors describe a case of fibrous pseudotumor of the tunica vaginalis testis associated with testicular infarction. To our knowledge, this is the first case presented with similar association, second case consisting predominantly of myofibroblasts and the fourth reported case encountered in childhood.

Hydatid cysts of the lung in childhood: is capitonnage advantageous?

In the treatment of thoracal hydatid cysts, there is not an agreement whether the cyst cavity to be capitonnaged or not. In this retrospective study, it was aimed to compare the cases of capitonnaged and not capitonnaged thoracal hydatid cysts with regard to hospital stay and post-operative chest tube removal day. Documents of 15 patients operated for pulmonary hydatid cysts in our clinic were reviewed. In 7 cases pericystectomy and removal of germinative membrane was performed whereas in 8 patients capitonnage was added to the procedure. In all cases open airways were suture controlled and pleural cavity was drained with chest tube connected to waterseal system. Average hospital stay of capitonnaged cases was 8 days and of uncapitonnaged ones was 12 days. Thoracal drainage tubes were removed in an average of 4 post-operative days in capitonnaged cases and of 7 days in the others. Statistical analysis were made by Mann-Whitney U test. Difference between the hospital stays of the 2 groups were not significant, whereas it was significant statistically between chest tube removal days (p<0.05). Capitonnage shortens postoperative chest tube drainage period in pulmonary hydatid cysts, resulting in lower morbidity compared with the uncapitonnaged cases.