Establishing a new screening 17 hydroxyprogesterone cut-off value and evaluation of the reliability of the long intramuscular ACTH stimulation test in the diagnosis of nonclassical congenital adrenal hyperplasia.

OBJECTIVE: Nonclassical congenital adrenal hyperplasia (NCAH) is a common genetic transmitted endocrinological disease. The validity of screening by using a 17 hydroxyprogesterone (17 OH-P) cut-off level of 2 ng/ml is controversial due to the frequent overlap with the polycystic ovary syndrome (PCOS). The availability of the standard intravenous cosyntropin (ACTH) formula is a problem in many countries including our country and the diagnostic test is performed by using the intramuscular depot form. In this study, we aimed to determine our own cut-off value for screening and to test the reliability of long intramuscular ACTH stimulation test in our patients. PATIENTS AND METHODS: One hundred and seventy-five fertile age women whose basal follicular phase 17 OH-P level above 2 ng/ml were included in the study. All of the patients underwent an intramuscular long cosyntropin (ACTH) stimulation test. RESULTS: 17 OH-P levels were above 10 ng/ml in 16 of 175 (9.14%) patients who were compatible with the diagnosis of NCAH. There was no significant difference between NCAH, PCOS and idiopathic hyperandrogenism (IH) groups in terms of hirsutism and hyperandrogenemia. In ROC analysis, 3.19 ng/ml was found to be a reliable cut-off value (AUC: 0.698, 95% GA: 0.540-0.855, p <0.05). In the extended intramuscular ACTH stimulation test, sensitivity increased from 56.2% to 91.6% at 180th minute CONCLUSIONS: Our study gives a perspective about the detection of screening threshold value for the diagnosis of NCAH and the availability of the intramuscular long ACTH stimulation test.

Factors to predict shock-wave lithotripsy results in pediatric patients and external validation of a nomogram. / Factores para predecir los resultados de la litotricia por ondas de choque en pacientes pediátricos y validación externa de un nomograma.

OBJECTIVE: To evaluate the accuracy of the Dogan nomogram in predicting stone-free (SF) rate after a single shock wave lithotripsy (SWL) session and evaluate factors that predict SWL results in children. PATIENTS AND METHODS: The study included 68 patients under 18 years of age who had been treated with SWL for radiopaque upper urinary tract stones in our tertiary centre from January 2010 to December 2016. The median age is 50 (6-207) months and median follow-up period is 9 (4-50) months. Patients with known cystine stone disease, abnormal renal anatomy, urinary diversion and multiple stones located in different calyces were excluded like in the original nomogram study. SF status was evaluated by performing plain abdominal radiography and urinary ultrasonography 2 weeks after each SWL session. Patients who were completely free of stones were considered to be SF. Multiple logistic regression analyses were performed to determine the variables affecting SF status. The bootstrap method with 1,000 replicates was used for the external validity of a nomogram developed by Dogan. RESULTS: SF rates for each SWL session were determined as 54.4% (37/68) for the first session, 33.3% (7/21) for the second session and 55.6% (5/9) for the third session. Overall, the SF rate was 72.1% (49/68). Multiple logistic regression analysis showed positive and significant correlations of age and stone size with risk of SWL failure. The external calibration plot showed a nearly good validation with Dogan nomogram to predict SWL failure in first session. CONCLUSION: Our study demonstrates that the Dogan nomogram can be used to predict the SF status after one session of SWL in pediatric patients.

The -31 G/C promoter gene polymorphism of surviving in Turkish colorectal cancers patients

Introduction: Survivin (also known as birc5) is the first protein discovered among the apoptosis-regulating gene family referred to as inhibitor of apoptosis proteins (IAPs). It is expressed and controlled during cellular differentiation and development in human beings. Survivin expression has been shown in a number of cancers and has been associated with cancer development. Objective: In our study, we compared with blood samples as our control and normal- tumoural tissue samples, which obtained from the same tissue of 100 cases diagnosed with colorectal cancer, at Department of Pathology, Istanbul University. Methods: The present study employed PCR-RFLP to identify the -31 G/C polymorphism in the promoter region of the survivin gene. Distribution of the survivin polymorphism was compared between control and tumoural tissue samples using the chi-square test. Results: Comparison of all samples revealed that there was significant difference in distribution of survivin promoter -31G/C between control group and tumour and normal tissue of the patient group (p<0.05). When genotypes of the control and tumour tissues were compared according to gender, there was no statistically significant difference in the distribution of survivin promoter -31G/C in females p=0.420 or males p=0.309. Conclusion: A significant difference was seen in distribution of C allele in tumour tissue compared to normal tissue.

Giant pericardial cyst with a growing feature.

Pericardial cysts are rare and benign lesions of the heart. They are usually asymptomatic and diagnosed incidentally on echocardiography or chest X-ray. In this report, we present an extremely rare case of a symptomatic giant pericardial cyst (11.6 cm × 10.6 cm × 8 cm) of a 55-year-old male patient who was admitted to our cardiology clinic. A thoracic computed tomography (CT) in 2013 revealed a giant pericardial cyst. However, at that time, the patient was asymptomatic and follow-up was recommended. Recent thoracic CT and magnetic resonance imaging demonstrated a significantly growing feature of this cyst with impending possible complications.

Search for solar axions by the CERN axion solar telescope with 3He buffer gas: closing the hot dark matter gap.

The CERN Axion Solar Telescope has finished its search for solar axions with (3)He buffer gas, covering the search range 0.64 eV ≲ ma ≲ 1.17 eV. This closes the gap to the cosmological hot dark matter limit and actually overlaps with it. From the absence of excess x rays when the magnet was pointing to the Sun we set a typical upper limit on the axion-photon coupling of gaγ ≲ 3.3 × 10(-10) GeV(-1) at 95% C.L., with the exact value depending on the pressure setting. Future direct solar axion searches will focus on increasing the sensitivity to smaller values of gaγ, for example by the currently discussed next generation helioscope International AXion Observatory.

Giant aneurysm of the right coronary artery with fistula to right atrium.

Coronary artery aneurysms are rare entities with a prevalence of 0.15%-4.9%. Giant coronary artery aneurysms are known as more than 2 to 5 cm in size. We present a case of 74 year-old female who was admitted to our clinic with chest pain and dyspnea. Coronary angiography demonstrated a giant right coronary artery (RCA) aneurysm with a significant left-to-right shunt. The patient underwent an open heart surgery. During the exploration, an aneurysm of 40 mm in diameter of the RCA was seen. The aneurysmatic RCA was excluded and continuously closed with the support of intra-aortic balloon pump (IABP). The patient was discharged on the 13th postoperative day without any complication.

Effects of probiotics on experimental short-bowel syndrome.

BACKGROUND: This study was performed to analyze the potential benefits of probiotics on experimental short-bowel syndrome (SBS). METHODS: Forty-eight male Wistar-Albino rats were used in the study. The animals were divided into 6 groups as follows: control, rats that received probiotics, rats that underwent intestinal transection and anastomosis, rats that underwent anastomosis and received probiotics, rats that underwent 75% intestinal resection, and rats that underwent 75% intestinal resection plus received probiotics. Body weight monitoring, intestinal bowel diameter, villus length and crypt depth measurements, goblet cell count, mitosis, and immunohistochemical evaluation were used for the assessment of intestinal proliferation ability. RESULTS: Statistical analysis showed a significant difference in villus length, crypt depth, goblet cell count in villus and crypt, mitosis, and immunohistochemical evaluation in the jejunum when the SBS group was compared with the SBS group that received probiotics. There was no significant difference in these parameters in ileum. CONCLUSIONS: This trial clearly has shown that probiotics had a positive impact on jejunum in the experimental SBS.

Search for sub-eV mass solar axions by the CERN Axion Solar Telescope with 3He buffer gas.

The CERN Axion Solar Telescope (CAST) has extended its search for solar axions by using (3)He as a buffer gas. At T=1.8 K this allows for larger pressure settings and hence sensitivity to higher axion masses than our previous measurements with (4)He. With about 1 h of data taking at each of 252 different pressure settings we have scanned the axion mass range 0.39 eV≲m(a)≲0.64 eV. From the absence of excess x rays when the magnet was pointing to the Sun we set a typical upper limit on the axion-photon coupling of g(aγ)≲2.3×10(-10) GeV(-1) at 95% C.L., the exact value depending on the pressure setting. Kim-Shifman-Vainshtein-Zakharov axions are excluded at the upper end of our mass range, the first time ever for any solar axion search. In the future we will extend our search to m(a)≲1.15 eV, comfortably overlapping with cosmological hot dark matter bounds.

Intraoperative coronary graft flow determination--does it have a prognostic value for midterm graft patency?

OBJECTIVE: To characterise the prognostic value of intraoperative ultrasonic graft flow determination during CABG for mid-term patency. METHODS: From 01/2000 to 08/2003 3146 CABG procedures were performed at our institution. Graft flow was determined in all patients. Lumen diameter was given in mm and a sclerosis score was applied for the target vessel. 100 of these patients (3.2%) underwent postoperative coronary angiography at a mean time interval of 8.0 +/- 0.5 months. RESULTS: In 100 patients, 114 LITA and 204 venous anastomoses were performed. At re-angiography 112 LITA (98%) and 174 venous (85%) anastomoses were patent. The amount of occluded LITA grafts was to low to perform statistical analyses. Mean graft flow of patent vein grafts was 48 +/- 2 ml/min vs. 32 +/- 4 ml/min in occluded vein grafts (p = 0.001). After multiple logistic regression analysis, only intraoperative vein graft flow was found to be a predictor for patency at mid-term (p = 0.005, odds ratio 0.97, 95% confidence interval (CI) from 0.95-0.99). No differences were found concerning sclerosis scores or vessel lumen between patent and occluded grafts. CONCLUSIONS: Significant differences concerning intraoperative graft flow were found between vein grafts patent or occluded at re-angiography. The predictive power of intraoperative vein graft flow for mid-term patency was confirmed by multiple logistic regression analysis.

Effect of sulfur hexafluoride gas on antibacterial activity of antibiotics in vitro against agents causing endophthalmitis.

BACKGROUND: We conducted a study to evaluate the effect of sulfur hexafluoride gas (SF(6)) on the antibacterial activity of antibiotics in vitro against Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa, which are common endophthalmitis-causing agents. METHODS: In this experimental study, antibiotic susceptibility tests were prepared according to the National Committee for Clinical Laboratory Standards macrobroth dilution method. Müller-Hinton broth was the test medium. Standard P. aeruginosa (ATCC 27853), S. epidermidis (ATCC 12228) and S. aureus (ATCC 29213) strains were studied. For P. aeruginosa ceftazidime, ofloxacin and tobramycin dilutions, and for S. epidermidis and S. aureus, cefazolin, ofloxacin and tobramycin dilutions were prepared identically in two sets of tubes. One set of tubes, into which pure SF(6) was injected, was defined as the SF(6) group. The other set of tubes, into which no SF(6) was injected, was taken as the control group. To determine the minimal bactericidal concentrations of the antibiotics, subcultures were made onto Müller-Hinton agar, and the colonies were counted after 18 h of incubation at 37 degrees C. RESULTS: The minimal inhibitory concentrations of the antibiotics in the SF(6) group were found to be identical with those of the control group. However, the minimal bactericidal concentrations of the antibiotics were found to be at least two dilutions lower in the SF(6) group than in the control group, except for the minimal bactericidal concentration of cefazolin for S. aureus, which was found to be one dilution lower in the SF(6) group. CONCLUSION: SF(6) was found to potentiate the in vitro antibacterial activity of ofloxacin and tobramycin against S. aureus, S. epidermidis and P. aeruginosa, ceftazidime against P. aeruginosa, and cefazolin against S. epidermidis. Experimental animal studies are required to determine the role of SF(6) in the management of endophthalmitis.

Effects of caffeic acid phenethyl ester and epidermal growth factor on the development of caustic esophageal stricture in rats.

BACKGROUND/PURPOSE: An experimental study was performed to modify the healing response in caustic esophageal burns to prevent stricture development. Two different agents with different modes of actions, caffeic acid phenethyl ester (CAPE) and epidermal growth factor (EGF), were studied. CAPE has antiinflammatory, immunomodulatory, antioxidant, and antimitotic properties. EGF has known properties in supporting wound healing and in protecting esophagus from injuries. METHODS: The model described by Gehanno and its modification by Liu was used to create standard esophageal burns with 50% NaOH. The study was performed with 76 rats in 4 main groups (sham, CAPE, EGF, and control) and 2 subgroups in each for 5 and 28 days of observation. Efficacy of treatment was assessed in 28-day subgroups by measuring weight gain, contrast esophagograms on day 27, histologic evaluation by measuring stenosis index (wall thickness/lumen diameter), and collagen deposition, and biochemically by determining tissue hydroxy proline (OHP) content. RESULTS: In the end of the study, increase rates of mean body weights of the animals in the 28-day subgroups were as follows: sham, 30%; CAPE, 23%; EGF, 22%; and control, 14%. Although all the animals in subgroups significantly gained weight, the mean weight gain was significantly low in controls when compared with sham, CAPE, and EGF groups (P <.05). Contrast esophagograms on day 27 showed no stenosis in the sham, mild stenosis in CAPE and EGF, and severe stenosis with proximal dilatation in controls. Stenosis indices of the subgroups were as follows: sham, 0.29; CAPE, 0.41; EGF, 0.41; control, 0.84. Index was significantly higher in controls (P <.05). Collagen accumulation scores in the esophageal wall were as follows: Sham, 0.0; CAPE, 0.87; EGF, 0.30; control, 2.70. Scores also were significantly higher in controls (P <.05). Tissue (OHP) levels were as follows (mg/g dry tissue): Sham, 1.48; CAPE, 1.53; EGF, 1.90; control, 4.01. Production of OHP was significantly higher in controls. CONCLUSIONS: The results of the parameters in the study indicate that administration of CAPE and EGF has beneficial effects in the prevention of caustic esophageal strictures. Those effects of CAPE may occur through its antiinflammatory, immunomodulatory, and antioxidant properties, and EGF may occur through its induced proliferative properties on the esophagus.

Local delivery of paclitaxel using the double-balloon perfusion catheter before stenting in the porcine coronary artery.

Paclitaxel is a new cancer chemotherapeutic agent that has been approved for clinical use in patients with a variety of different cancers. Paclitaxel inhibits cell proliferation by an action on microtubules. The aim of this study was to evaluate the safety and efficacy of locally delivered paclitaxel after coronary stent implantation. A novel double-balloon perfusion catheter was used to deliver the drug locally in the pig coronary artery. Twenty-seven domestic pigs underwent stent implantation of the left anterior descending artery. In the treatment group (n = 11), paclitaxel (10 ml; 10 micromol/l) was delivered using the double-balloon perfusion catheter prior to stent implantation. The control group received stent implantation only (n = 16). The animals were sacrificed 4 weeks later. Vessels were perfusion-fixed and morphometric analysis was performed using conventional techniques. In addition, the extent of injury was determined at each stent-strut area. Correlation of local injury and neointimal thickness was evaluated by linear regression. Neointimal thickness (paclitaxel 1.0 +/- 0.4 vs. control 0.7 +/- 0.3 mm), neointimal area (paclitaxel 4.1 +/- 2.2 vs. control 2.4 +/- 1.1 mm(2)), and the lumen area (paclitaxel 2.1 +/- 1.9 vs. control 2.5 +/- 0.9 mm(2)) did not show significant differences between both groups. Medial area (3.3 +/- 2.3 vs. 1.6 +/- 0.4 mm(2)) was larger in the vessels treated with paclitaxel (P < 0.05). Linear regression failed to show any difference in the response to injury between the two groups. Local delivery of paclitaxel with the double-balloon-perfusion catheter did not reduce neointima formation following stent implantation in native pig coronary arteries.

An alternative way to cover ventral penile skin defect in Mathieu technique.

Mathieu technique is used satisfactorily in distal penile hypospadias without chordee or with minimal chordee. After using this technique, a large defect may sometimes appear on the ventral surface of the penis. To cover the defect, a few techniques, including preputial island flap, Byar's flap and Ombrédanne-Nesbit's flap, are used. We describe a new flap to cover the defect more cosmetically. Twenty-four patients ranging in age from one year to 14 years (median age 6.5 years) were operated on. In the patients for whom the defect could not be covered primarily, a longitudinal incision was made along the midline through the penile shaft skin from penile radix up to the border of preputial skin. The relaxed penile skin, which was incised on the dorsal surface, could be approached and sutured easily on the ventral surface without stretching. The new defect that developed on the dorsal surface was closed with the prepuce matching the defect. Nine patients, two with chordee and seven without chordee, underwent this technique. The cosmetic and functional results were excellent in all patients and none of the patient's parents complained about the cosmetic aspect. Only one fistula complication, which healed spontaneously, developed on the 20th postoperative day. Considering these results, we may conclude that excellent cosmetic results can be accomplished by the use of this flap technique.

Multifocal omental mesenteric inflammatory pseudotumor (plasma cell granuloma).

Inflammatory pseudotumor (IP) is an uncommon benign tumor during childhood. The most common location is lung, and sporadic cases of IP with extrapulmonary involvement such as liver and abdomen are reported. However, the IP among the reported cases have appeared as solitary masses. A multifocal IP in a 14-year-old girl presumed to result following an Entamoeba histolytica infestation is reported.

Technetium-99m-MIBI scintigraphy in pulmonary tuberculosis.

UNLABELLED: We investigated the usefulness of 99mTc-methoxyisobutylisonitrile scintigraphy in patients with known or suspected pulmonary tuberculosis (PTB) in comparison with radiological and bacteriological findings. METHODS: Thirty-six patients aged 13-59 yr were scanned 15 and 60 min after intravenous injection of 370 MBq (10 mCi) 99mTc-methoxyisobutylisonitrile. Twenty-four patients had active PTB proven by chest radiograph and sputum examinations, two had miliary tuberculosis and ten were suspected of having relapsed PTB with negative sputum examinations and indeterminate chest radiographs. In 12 patients 99mTc-MIBI imaging was repeated 1-3 mo after chemotherapy. RESULTS: Of 24 patients with active localized PTB, 22 (92%) showed increased focal uptake of 99mTc-MIBI, but two patients with minimal infiltration on chest radiographs had no accumulation of 99mTc-MIBI. Both patients with miliary PTB showed diffuse 99mTc-MIBI uptake in the lungs. Among 10 patients with suspicion of relapse, 99mTc-MIBI scans were true-positive in 4 of 5 patients (80%) with culture-proven tuberculosis and false-positive in 2 of 5 (40%) patients with negative sputum cultures. For repeat imaging, 6 of 10 patients with active localized PTB showed reduced MIBI uptake, which correlated with chest radiograph findings, and one patient had increased MIBI uptake again concordant with clinical and radiological findings which were suggestive of resistance to first line chemotherapy of tuberculosis. The other three patients showed no significant scintigraphic changes despite clinical and partial radiological regression. CONCLUSION: Active PTB granulomas generally present considerable 99mTc-MIBI uptake that is most probably related to disease activity. Therefore, 99mTc-MIBI scanning could be used in the detection and follow-up of active PTB as a complement to routine techniques.

Predictive value of a new scoring system for the outcome of primary in situ experimental extracorporeal shock wave lithotripsy of upper ureteral calculi.

The results of primary in situ extracorporeal shock wave lithotripsy of upper ureteral calculi were analyzed retrospectively in 491 eligible patients. The treatment was successful in 371 patients (76%). Degree of obstruction, stone size, localization of stone, history of previous ipsilateral surgery, and body mass index were found to be factors that can influence the outcome of treatment. A scoring system based on these factors has been developed to select the appropriate group of patients for primary in situ extracorporeal shock wave lithotripsy of upper ureteral calculi.

Partial bladder reconstruction with pedicled rectus and gracilis muscle flaps: an experimental study in dogs.

OBJECTIVE: To investigate the functional, anatomical and histopathological results of partial bladder reconstruction with skeletal muscle flaps. MATERIALS AND METHODS: Partial bladder reconstruction with gracilis or rectus muscle flaps was performed in 10 mongrel dogs. Bladder compliance and uninhibited contractions were investigated in five female dogs. Pre-operative and post-operative cystograms were performed in four female dogs. The dogs were killed 8-12 weeks after the operation. Bladders and muscle flaps were grossly examined and removed for histopathological examination. RESULTS: There was no extravasation on post-operative cystography. Bladder compliance was normal and uninhibited contractions were not present. Severe contracture and atrophy of the muscle flaps were observed in all dogs at necropsy. Bladder volumes were not changed significantly (P > 0.05). Histopathological examination revealed severe mesenchymal metaplasia in all of the flaps. CONCLUSION: Partial reconstruction of the bladder with skeletal muscle flaps did not result in extravasation and bladder function was not altered. However, bladder volume could not be increased because of contracture and atrophy of the flaps.