IS REPEAT FNAB NECESSARY FOR THYROID NODULES WITH ND / UNS CYTOLOGY?

Context/Objective: The standard approach is to perform repeat FNAB (rFNAB) in thyroid nodules with non-diagnostic (ND) / insufficient (UNS) cytology. However, due to the nature of these nodules, recurrent FNABs may also be insufficient. Therefore, by comparing the clinical-radiological-pathological parameters of nodules with a definite diagnosis of excision, we questioned the possibility of patient management without rFNAB. Methods: Clinical-radiological parameters of 275 nodules belonging to 264 patients in the ND/UNS aspiration group with definite pathological diagnosis after surgery were determined. Under the guidance of these parameters, those with and without rFNAB were compared. Results: The incidence of malignancy was found to be significantly higher in nodules without rFNAB compared to nodules with rFNAB (p = 0.036). In addition, the incidence of malignancy in BC-1 nodules without rFNAB was significantly higher than in nodules with rFNAB result also BC-1 (p = 0.009). In all cases, nodule size smaller than 10 mm and border irregularity were found to be statistically significant for malignancy (p <0.020, p <0.002). When looking at the distribution of rFNAB results, a significant correlation was observed with female gender, solid component, hypoechogenicity, border irregularity and halo loss around the nodule in patients with BC-4,5,6 cytology results (respectively, 0.005 / 0.031 / 0.001 / 0.012 / 0.004). Conclusion: rFNAB did not show the expected effect in ND / UNS nodules. We recommend direct surgical excision without rFNAB for nodules with border irregularity, solid structure, halo loss and hypoechogenicity, which should be considered more important in female patients.

What are the factors affecting glanular dehiscence after hypospadias surgery?

BACKGROUND: Glanular dehiscence (GD) is one of the main complications after hypospadias surgery. There is a limited number of publications regarding GD in the literature. OBJECTIVE: The aim of this work is to reveal the factors that affect GD after a literature review. EVIDENCE ACQUISITION: A literature search for relevant articles was performed in database using the search term glans dehiscence without setting date range limit or any other limits. All articles related to GD after hypospadias surgery were included in this study. After collecting the information from full text articles, 71 articles were included in this systematic review. In these studies, localization of hypospadic meatus, type of surgery, and other clinical data which were thought to behave as risk factors for GD were obtained. Chi-Square test was used to evaluate the differences between the parameters, where p < 0.05 was taken as statistically significant. RESULTS: After evaluating the 71 articles that met the inclusion criteria, 309 cases (3.48%) of GD after 8858 hypospadias repairs were obtained in this review. GD rates were found significantly high for proximal hypospadias (5%), two-stage hypospadia repairs (5%) and re-do hypospadias repair (8.75%) (p = 0.002, 0.022, and 0.004, respectively). Glans width <14 mm, urethral plate (UP) width <7 mm, hypospadias surgeries performed before 6 months of age and after puberty, and caudal block anesthesia increased the rate of GD. CONCLUSIONS: The rate of GD increases after proximal, cripple and staged hypospadias surgeries, a glans width <15 mm and UP width <8 mm, postpubertal surgeries, and caudal anesthesia use during surgery.

Effects of branched-chain amino acids on glucose uptake and lactose synthesis rates in bovine mammary epithelial cells and lactating mammary tissue slices.

Even though supplementations of essential AA (EAA) are often related to increased lactose yields in dairy cows, underlying mechanisms connecting EAA availability to the mammary glands and lactose synthesis are poorly understood. The objective of this study was to examine the effects of branched-chain AA (BCAA) including Leu, Ile, and Val on (1) glucose transporter (GLUT1) abundance and glucose uptake, (2) the abundance of proteins regulating lactose synthesis pathway, and (3) fractional synthesis rates of lactose (FSR) using bovine mammary epithelial cells (BMEC) and mammary tissues slices (MTS). The BMEC (n = 4) were allocated randomly to regular Dulbecco's Modified Eagle Medium with Ham's F12 (DMEM/F12) medium (+EAA) or +EAA deficient (by 90%) in all EAA (-EAA), all BCAA (-BCAA), only Leu (-Leu), only Ile (-Ile) or only Val (-Val). Western immunoblotting analyses, depletion of glucose in media, and a proteomic analysis were performed to determine the abundance of GLUT1 in the cell membrane, net glucose uptake, and the abundance of enzymes involved in lactose synthesis pathway in BMEC, respectively. The MTS (n = 6) were allocated randomly to DMEM/F12 medium having all EAA and 13C-glucose at concentrations similar to plasma concentrations of cows (+EAAp), and +EAAp deprived of all BCAA (-BCAAp) or only Leu (-Leup) for 3 h. The 13C enrichments of free glucose pool in MTS (EGlu-free) and the enrichments of glucose incorporated into lactose in MTS and media [ELactose-bound (T&M)] were determined and used in calculating FSR. In BMEC, -BCAA increased the fraction of total GLUT1 translocated to the cell membrane and the fraction that was potentially glycosylated compared with +EAA. Among individual BCAA, only -Leu was associated with a 63% increase in GLUT1 translocated to the cell membrane and a 40% increase in glucose uptake of BMEC. The -BCAA tended to be related to a 75% increase in the abundance of hexokinase in BMEC. Deprivation of Leu tended to increase glucose uptake of MTS but did not affect EGlu-free, ELactose-bound (T&M), or FSR relative to +EAAp. On the other hand, -BCAAp did not affect glucose uptake of MTS but was related to lower ELactose-bound (T&M), or FSR relative to +EAAp. Considering together, decreasing Leu supply to mammary tissues enhances GLUT1 and thus glucose uptake, which, however, does not affect lactose synthesis rates. Moreover, the deficiency of other BCAA, Ile, and Val alone or together with the deficiency of Leu seemed to decrease lactose synthesis rates without affecting glucose uptake. The data also emphasize the importance of addressing the effect of the supply of other nutrients to the mammary glands than the precursor supply in describing the synthesis of a milk component.

Comparison of decentration, tilt and lenticular astigmatism of intraocular lens between sutured and sutureless scleral fixation techniques.

PURPOSE: To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery. METHODS: We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism. RESULTS: The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P=0.008 horizontally and P=0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P˃0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P=0.003 and P<0.001). CONCLUSION: In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.

WHICH FACTORS ARE ASSOCIATED WITH MALIGNANCY IN THYROID NODULES CLASSIFIED AS BETHESDA CATEGORY 3 (AUS/FLUS) AND HOW DO THEY INFLUENCE THE PATIENT'S MANAGEMENT?

BACKGROUND: Thyroid nodules are a common pathology worldwide. Fine needle aspiration biopsy (FNAB) is an important diagnostic method for the investigation of malignancy in thyroid nodules. However, according to the Bethesda System used to classify the results, patients with atypia of undetermined significance/follicular lesion of undetermined significance (AUS / FLUS) may not be classified as benign or malignant. Therefore, it may be necessary to determine some clinical risk factors to apply the best treatment in these patients. AIM: To determine the factors that increase the risk of malignancy in this patient group. METHODS: A retrospective study including 138 patients with an FNAB categorized as AUS/FLUS and operated between June 2015-September 2018. Demographical, Laboratory (TSH) and Ultrasound variables (number, size and characteristics of nodules) of the patients were compared among postoperative histopathological results. RESULTS: Hypo-echoic structure, microcalcification and irregular margin of the nodules were detected to be associated with malignancy in patients with FNAB results of AUS/FLUS (p <0.001). CONCLUSION: We suggest that surgical treatment should be considered if the patients have nodules with the hypo-echoic structure, microcalcification and irregular margin with an FNAB histopathological result of AUS / FLUS.

Sedative-analgesic activity of remifentanil and effects of preoperative anxiety on perceived pain in outpatient mandibular third molar surgery.

The aim of this study was to assess the sedative-analgesic activity of different doses of remifentanil and effects of preoperative anxiety on intraoperative pain levels in patients attending a dental clinic. The patients (n=60) were divided into two groups according to the remifentanil infusion dose given: group R1: 0.05µg/kg/min; group R2: 0.1µg/kg/min. The following were evaluated: haemodynamic parameters, State-Trait Anxiety Inventory (STAI) TX-I score, pain level due to local anaesthesia injection, time to reach a Ramsay Sedation Scale (RSS) score of 3, amount of bolus dose, total drug consumption, recovery period, patient and surgeon satisfaction, and complications. The patient satisfaction score on a visual analogue scale (VAS) was 90 in group R1 and 100 in group R2 (P=0.008); the surgeon satisfaction score was 80 in group R1 and 90 in group R2 (P=0.004). The time to reach an RSS score of 3 and the amount of bolus dose were significantly lower in group R2 than in group R1. High levels of anxiety did not affect intraoperative pain levels. In conclusion, high doses of remifentanil can safely be used for various same-day dental surgery interventions.

A successful management of a giant mucinous ovarian tumor with intraoperative controlled fluid aspiration.

BACKGROUND: The aim of this article was to present management of a giant ovarian mass. CASE REPORT: A 61-year-old patient was admitted with compliants of abdominal swelling and dyspnea. Ultrasound revealed a giant ovarian mass with dimesnions 47x43x30 cm. The patient underwent laparatomy and the cyst's content was aspirated before total cyst excision. The total weight of the mass was calculated to be 42.5 kg. Postoperatively, the patient was discharged on her postoperative seventh day. CONCLUSION: Giant ovarian cysts can be managed with controlled aspiration before total cyst excision.

Effects of Urethral Stricture on Allografts in Kidney Transplantation.

BACKGROUND: Iatrogenic urethral stricture after renal transplantation is mostly seen after urethral manipulations. Early diagnosis and treatment are crucial for the safe continuity of the graft functions. In this study, the effect of urethral strictures on graft functions during the post-transplantation period was investigated. METHODS: A total of 477 kidney transplantations were carried out from both live and cadaveric donors in our center from 2004 to 2014. Thirty-two patients who had insufficient data were excluded from the study. All the patients' urine cultures were negative before the surgery, and antibiotic prophylaxis were applied to all. Urethral catheters were taken out 4-7 days after transplantation. Double-J catheters were removed 6 weeks later. Internal urethrotomy and open urethroplasty surgeries were done for the patients who had urethral stricture. The results of creatinine, post-micturitional residual urine (PMR), International Prostate Symptom Score (IPSS), and uroflow examinations were evaluated. RESULTS: Average preoperative creatinine and postoperative creatinine values were, respectively, 1.74 ± 0.65 mg/dL (range, 0.83-3.03) and 1.24 ± 0.57 mg/dL (range, 0.9-2.24). A meaningful improvement was observed in terms of preoperative and postoperative IPSS values. A significant difference was seen between preoperative and 6th-month postoperative PMR values: 192.6 ± 57.2 mL and 36.7 ± 17.4 mL, respectively. CONCLUSIONS: Urethral strictures in transplant patients may arise due to many factors, such as repetitive urethral catheterization and inflammation. Early diagnosis helps to have better results for the treatment of the kidney functions.

A prospectively validated nomogram for predicting the risk of chemotherapy-induced febrile neutropenia: a multicenter study.

PURPOSE: There is clinical need to predict risk of febrile neutropenia before a specific cycle of chemotherapy in cancer patients. METHODS: Data on 3882 chemotherapy cycles in 1089 consecutive patients with lung, breast, and colon cancer from four teaching hospitals were used to construct a predictive model for febrile neutropenia. A final nomogram derived from the multivariate predictive model was prospectively confirmed in a second cohort of 960 consecutive cases and 1444 cycles. RESULTS: The following factors were used to construct the nomogram: previous history of febrile neutropenia, pre-cycle lymphocyte count, type of cancer, cycle of current chemotherapy, and patient age. The predictive model had a concordance index of 0.95 (95 % confidence interval (CI) = 0.91-0.99) in the derivation cohort and 0.85 (95 % CI = 0.80-0.91) in the external validation cohort. A threshold of 15 % for the risk of febrile neutropenia in the derivation cohort was associated with a sensitivity of 0.76 and specificity of 0.98. These figures were 1.00 and 0.49 in the validation cohort if a risk threshold of 50 % was chosen. CONCLUSIONS: This nomogram is helpful in the prediction of febrile neutropenia after chemotherapy in patients with lung, breast, and colon cancer. Usage of this nomogram may help decrease the morbidity and mortality associated with febrile neutropenia and deserves further validation.

Incidental parathyroidectomy as a cause of postoperative hypocalcemia after thyroid surgery: reality or illusion?

AIM: We aimed to investigate the incidence and clinical relevance of incidental parathyroidectomy (IPT) following thyroid surgery. METHODS: A retrospective review of thyroid operations was performed between January 2013 and January 2014. Pathology and operative reports were analyzed to identify the specimens which included parathyroid tissue. Information related to diagnosis, operative details and postoperative complications were collected. Calcium levels of ≤8 mg/dL was defined as biochemical hypocalcemia and those presenting with classic findings of acute hypocalcemia, were classified as clinical hypocalcemia. RESULTS: Two hundred and forty-five thyroid procedures were performed during study period. IPT was found in 34 (13.8%) cases: 25 were benign and 9 were malignant. Parathyroid tissue was found intrathyroidal in 6 patients (17.6%); lobar locations were right lobe in 19 (55.8%) and left lobe in 13 (38.2%) and isthmus in 2 cases (5.8%). The frequency of biochemical and clinical hypocalcemia were 50% (N.=17) and 8.8% (N.=3), respectively. Neither surgical type (lobectomy or thyroidectomy) nor malignancy (benign or malign) was not found associated with biochemical hypocalcemia. In those with biochemical hypocalcemia, left location of both dominant nodule and extracted parathyroid gland were significantly higher (P=0.01 and 0.04, respectively). CONCLUSION: Incidental parathyroidectomy which is not uncommon (13.8%) after thyroidectomy is not associated with postoperative biochemical hypocalcemia. Neither the type of surgical procedure (lobectomy or thyroidectomy) nor the pathology but adjacent dominant nodule location may increase the risk of IPT.

Is gynaecological laparoscopic surgery safe for elderly women? A comparison study.

The aim of this study was to evaluate the efficacy and safety of gynaecological laparoscopic surgery in an elderly group, by comparing the operative outcomes of the elderly group with those of the younger group. We analysed retrospective data of 121 women who underwent laparoscopic surgery for benign gynaecological disease. Women aged > 60 years were compared with women aged between 30 and 50 years who had the same operation. We evaluated body mass index, comorbidities, number of previous abdominal surgeries, operating time, haemoglobin change, postoperative complications, hospital stay and return of bowel activity. There were no significant differences between the elderly and a matched younger group in number of previous abdominal surgeries, operating time, ASA score distribution, changes in haemoglobin level, hospital stay and postoperative complications (p > 0.05). Laparoscopic surgery can be safely performed in elderly patients with benign gynaecological disease, and surgeons should not hesitate to perform laparoscopic surgery in elderly patients.

Uterine preservation in placenta percreta complicated by unscarred uterine rupture at second trimester in a patient with repeated molar pregnancies: a case report and brief review of the literature.

Placenta-percreta causing uterine rupture in unscarred uterus is a rare obstetric surgical emergency that can cause maternal and perinatal morbidity and mortality. A 25-year-old woman presented with abdominal pain for four days. Previously, she had undergone two suction curettages for complete hydatiform moles. Ultrasound revealed a non-viable fetus with an estimated gestational age of 21 weeks and free fluid and coagulum in the abdominal cavity. An emergency laparotomy was performed because of the acute abdomen. At exploration, the placenta had invaded the entire thickness of the myometrium and the non-viable fetus was in the abdominal cavity. The uterus was closed with a double-layer of interrupted sutures and uterine-sparing surgery was performed. The patient was discharged on postoperative day seven. The authors present a case of placenta-percreta in an unscarred uterus complicated with uterine rupture during the second-trimester that was managed successfully with uterine repair. They also review the literature briefly and discuss similar cases managed conservatively in the second-trimester.

Is laparoscopic surgery safe in patients with an elevated shock index due to ruptured ectopic pregnancy?

PURPOSE: To evaluate the effectiveness of laparoscopic surgery in patients with elevated shock index (SI), which is a unique determinant of acute hemorrhage. MATERIALS AND METHODS: A retrospective chart review of all patients treated for ectopic pregnancy (EP) in the present gynaecology department between January 2007 and March 2011 was performed. For each measurement of heart rate (HR) and systolic blood pressure (SBP), a SI was calculated by dividing HR by SBP (normal, 0.5 - 0.7). RESULTS: One hundred sixty patients were selected as SI above 0.7. There were 111 (69.4%) patients in the laparotomy group and 49 (30.6%) patients in the laparoscopy group. The postoperative hemoglobin (Hb) level was 8.46 +/- 1.56 (g/dl) in the laparotomy group and 9.37 +/- 1.52 (g/dl) in the laparoscopy group, with lower postoperative levels in the laparotomy group. The mean duration of postoperative hospital stay was 2.37 +/- 0.74 days in the laparotomy group and 2 +/- 0.84 days in the laparoscopy group. CONCLUSION: The availability of suitable operative equipment, nursing teams, and advanced laparoscopic skills, all justify operative laparoscopy for the surgical treatment of EP in women with elevated SI.

Analysis of expression of TNF-alpha and TGF-beta3 in intrinsic ureteropelvic junction obstruction.

OBJECTIVES: Ureteropelvic junction (UPJ) obstruction is of critical importance to understand the histopathology of UPJ obstruction in terms of therapy planning and follow-up. For this purpose, our study was conducted with TNF-α and TGF-ß markers to investigate possible underlying problems in intrinsic UPJ obstruction. METHODS: Of the patients who had undergone surgery in our clinic, 36 UPJ segments of patients who had undergone dismembered pyeloplasty surgery due to UPJ obstruction and 14 UPJ segments of the patients who had undergone nephrectomy were collected to form 2 groups. All histological sections were examined by applying immunohistochemical transforming growth factor beta 3 (TGF-ß3) and tumour necrosis factor alpha (TNF-α) monoclonal antibody dyes. RESULTS: The mean staining values for TNF-α in mucosal tissue and mucosa were 0.53±0.84 and 0.58±0.84, respectively in the obstruction group, whereas the values observed in the control group were 0.86±0.36 and 0.93±0.47, respectively. While the mean staining values in the obstruction group in mucosal tissue and mucosa for TGF-ß3 were 1.75±0.73 and 2.17±0.77, respectively, the values established in the control group were 1.14±0.66 and 1.43±0.93, respectively. The difference between the obstruction and control groups were statistically significant for both values (p<0.05). CONCLUSION: Only a limited number of studies have been carried out on this particular issue. Data from the present study indicate that TGF-ß3 and TNF-α may play a role in the histopathogenesis of UPJ obstruction (Tab. 1, Fig. 1, Ref. 18).

Modified Raz operation backed with periurethral roll mesh in female stress urinary incontinence.

OBJECTIVES: With the modifications that we made, the aim is to increase the effectiveness and the success rate of the Raz operation in the treatment of stress urinary incontinence (SUI) and to present a new approach in the treatment by reducing the complication rates. PATIENTS AND METHODS: Between November 2002 and December 2010, the Raz operation that we modified with the changes such as the placement of cystostomy catheter with the Lowsley clamp, vaginal incision of the bilateral oblique, the placement of periurethral roll mesh, the use of a single 0-degree stamey needle instead of a double needle applicator, binding the sutures mutually and on the support of the polypropylene mesh in suprapubic region was performed to 81 female patients with SUI in lithotomy position under the regional anesthesia. RESULTS: We performed the modified Raz operation to 81 female patients with SUI, who had the complaint of urinary incontinence with the effort lasting for about 4.5 years (between 1-16 years) and whose ages were 28-83 years (mean 55.2 years), childbirth numbers were 0-11 (mean 4.8), weights were 60-85 kg (mean 69.3 kg), and 32 of whom (39.5%) were of grade 1, 49 of whom (60.5%) were of grade 2 with the amnesia of SUI, and whose stress test was (+) in the physical examination. While the duration of the operation was 39.8 minutes (20-85 minutes) and the duration of the hospitalization was 2.9 days (2-4 days), the duration of the stay of the patients with the cystostomy catheter was determined to be 4.8 days (3-11 days). We found the rate of our success as 93.8% according to the objective criteria. CONCLUSIONS: With the modifications that we made, we increased the success rate of the Raz operation and reduced the rates of the complication. We believe that the place of our modification method in incontinence surgery becomes more clearly with the comparison of the other anti-incontinence surgery techniques in patient groups with the same characteristics.

The predictive role of Bcl-2 expression in operable locally advanced or metastatic gastric carcinoma.

PURPOSE: Gastric carcinoma is an aggressive disease with different epidemiologic and clinical profiles. Combination chemotherapy containing docetaxel, cisplatin and 5-fluorouracil/5-FU (DCF) is a frequently used regimen in metastatic gastric cancer. We studied the role of B-cell lymphoma 2 (Bcl-2) expression in predicting the response to DCF combination chemotherapy in metastatic gastric carcinoma. METHODS: This study included patients with pathologically confirmed locally advanced, surgically inoperable gastric carcinoma, or with metastatic disease. For immunohistochemical staining of Bcl-2 oncoprotein, lyophilized mouse monoclonal antibody (clone100/D5, 1:50, Thermo Scientific, Fremont, ABD) was used. Bcl-2 expression was evaluated with respect to the nuclear and cytoplasmic staining of the cells. Staining > 10% was accepted as positive and ≤ 10% as negative. RESULTS: Bcl-2 expression was positive in 5 (23.8%) patients and negative in 16 (76.2%), while partial response was achieved in 12 (57%) patients. No complete response was seen in any patient. The effect of positive Bcl-2 expression on survival was statistically significant by log-rank test (p=0.035). CONCLUSION: The patient group that expressed Bcl-2 survived longer confirming that Bcl-2 expression is a good prognostic factor in advanced-stage patients. We believe that Bcl-2 expression has an additional contribution in predicting response to this chemotherapy combination.

Cardiomyopathy with alopecia and palmoplantar keratoderma (CAPK) is caused by a JUP mutation.

Inherited desmosomal cardiocutaneous syndromes are characterized by the quartet of woolly hair, palmoplantar keratoderma (PPK), skin fragility and cardiac abnormalities, which are caused by mutations in genes coding for desmosomal proteins. We describe a previously unrecognized autosomal recessive syndrome in a family with arrhythmogenic right ventricular cardiomyopathy associated with alopecia and PPK (named CAPK). Genetic investigation of the family led us to find a homozygous disease-causing mutation, p.R265H, in JUP which encodes plakoglobin, a well-described member of the desmosome complex. This study expands the clinical spectrum of disorders associated with germline mutations affecting desmosomal proteins by describing a novel phenotype.

Comparison of the effects of atorvastatin and simvastatin in women with polycystic ovary syndrome: A prospective, randomized study.

UNLABELLED: Polycystic ovary syndrome (PCOS) is associated with hyperandrogenism, insulin resistance (IR), and chronic inflammation. Simvastatin improves endocrine/clinical aspects of PCOS and decreases systemic inflammation in PCOS. There have been no comparative studies carried out regarding the effects of different statin treatment in PCOS. We aimed to assess the effects of two different statin treatments on various metabolic, endocrine, oxidative and inflammatory factors in PCOS. DESIGN: Prospective, randomized clinical trial METHODS: Sixty-four (64) women with PCOS were included in the study. Group 1 had (atorvastatin, 20lmg daily; n=32) or group 2 had (simvastatin, 20l mg daily n=32). The metabolic, endocrine, inflammatory and oxidative profiles were evaluated. RESULTS: Group 1 resulted in a significant reduction in the HOMA index and fasting insulin (-26.9+/-9.6%, -26.2+/-10.8%, P<0.01, respectively).CRP levels decreased by 63.6+/-15.9% in group 1 (P<0.01), whereas in the group 2 it decreased by 34.6+/-10.7% (P<0.05). Serum levels of LH declined by 19.1+/-4.5% (P<0.05) in the group 1 and by 39.3+/-11.9% (P<0.01) in the group 2. FAI decreased by -20+/-9.9% in group 1 (P<0.05) and it decreased by -38.7+/-13.8% in the group 2 (P<0.01). MDA levels decreased by 32.6+/-9.6% in group 1 (P<0.05), whereas in the group 2 it decreased by 30.3+/-10.9% (P<0.01). HOMA index and fasting insulin showed a reduction but not reached statistically significance in the group 2 (8.3+/-1.9%, 3.0+/-0.8%, P>0.05, respectively). CONCLUSION: Both the statins are effective in reducing inflammation, hyperandrogenemia, oxidative stress and metabolic parameters. While atorvastatin has more noticeable effects on fasting insulin and insulin sensitivity, simvastatin has a dominant effect on total T in PCOS women.

[Unresolved problems of undocumented migrants in Germany: an analysis of medical consultations in Berlin, Cologne and Bonn]. / Problemlagen von versteckt lebenden Migranten in Deutschland: Analyse der medizinischen Beratungsanlässe in Berlin, Bonn und Köln.

INTRODUCTION: Little is known about health related problems of undocumented migrants in Germany. Patterns for medical consultations and socio-demographic characteristics are only available in isolated reports. This article identifies and compares empirical data from non-governmental organisations (NGOs) who provide medical care for unregistered migrants. METHODS: Annual reports of 2006 and 2007 of the Malteser Migranten Medizin (Berlin, Cologne) and the MediNetz Bonn were selected for this document analysis. RESULTS: We identified similarities and differences in the socio-demographic background and patterns of medical consultations between the explored regions. The number of documented migrants without medical insurance increased during the observed period. DISCUSSION: The patterns of health-care utilisation for undocumented immigrants changed in the observed period which might be caused by the EU enlargement to the East. The heterogeneous quality of the annual reports and the lack of information about the use of alternative health-care facilities limit the results of this analysis.

Antihypertensive and analgesic/nonsteroidal antiinflammatory drug use by the elderly living in residential homes in Istanbul.

OBJECTIVE: To assess the usage, knowledge and attitudes of elderly individuals living in residential homes in the Anatolian region of Istanbul, with particular reference to analgesic/nonsteroidal antiinflammatory drugs (NSAIDs) and antihypertensives. METHODS: This cross-sectional study was carried out with 247 representative individuals who were >or= 65 years old, and were living in residential homes in Istanbul. They scored >or= 24 in a Mini Mental Status Examination and were not suffering from speech, understanding or expression disorders, nor was any serious disease included in the study. Each medication that participants held, was recorded at sight. After asking about the dose, frequency, duration, purpose and side effects related with antihypertensives and analgesic/NSAIDs, the individual's weight, height and blood pressure were measured and activities of daily living and falling status were evaluated. RESULTS: 47% of the participants were male and the mean age was 76 +/- 7.2 years. 47% of the participants were using antihypertensives and 45% of them were using analgesic/NSAIDs. 30% of subjects who declared that they had hypertension were not on therapy. There was a statistically significant relationship between NSAID usage and having hypertension (p = 0.013, OR 2.064, 95% CI 1.16 - 3.65). 78 of the antihypertensive and 88% of the analgesic/NSAIDs users explained the purpose of the drug usage properly. However, only 9 and 18% were aware of the effects, respectively. CONCLUSIONS: Although these results suggest that regarding the antihypertensive and analgesic/NSAIDs administration, individuals were treated with proper drugs and doses, but a considerable number of old people are not sufficiently aware about their diseases and drugs.