Effects of losartan on experimental varicocele-induced testicular germ cell apoptosis.

To investigate the potential protective effects of losartan on varicocele-induced germ cell apoptosis, 24 adult male Sprague Dawley rats were divided into three groups: a sham operation was performed in SHAM group, and experimental left varicocele was created in VAR and VAR + LOS groups. Additionally, in VAR + LOS group, losartan was administered for 30 days starting on the day of surgery. At the end of 30 days, all animals were sacrificed and left orchiectomy was performed. Testicular injury and spermatogenesis were evaluated according to Johnsen scoring system. To assess the nitrosative stress, immunohistochemical staining for endothelial nitric oxide synthase was used and evaluated by H-score and apoptotic index (AI) of germ cells was analysed by TUNEL method. A significant decrease in the mean Johnsen score (JS) was observed in VAR group compared with SHAM (p < .001). The mean H-score and AI were significantly higher in VAR group compared with SHAM (p < .001). After losartan administration, mean JS was significantly increased (p < .001) and mean H-score and AI were significantly decreased compared with VAR group (p < .001 and .01, respectively). Findings of this suggest that losartan acts as a potent protective agent against varicocele-induced germ cell apoptosis.

Stage IVB endometrial cancer confined to the abdomen: is chemotherapy superior to radiotherapy?

PURPOSE: To determine the impact of clinical variables and adjuvant therapy on survival in patients with Stage IVB endometrial cancer (EC) confined to abdomen. METHODS AND METHODS: A total of 65 patients were included. Curative chemotherapy was defined as using only chemotherapy (platin based) or sandwich therapy. Patients receiving only radiotherapy had standard pelvic radiotherapy and extended-field radiotherapy when necessary. RESULTS: The optimal cytoreduction was achieved in 89.3% of patients. With a median follow-up of 18 months, two-year progression free survival (PFS) and overall survival (OS) were calculated as 33.4% and 42.2%, respectively. Optimal cytoreduction provided more longer PFS and OS compared to suboptimal cytoreduction. In univariate analysis, curative chemotherapy instead of radiotherapy improved the two-year PFS and two-year OS. Type of adjuvant therapy, tumor grade, and peritoneal cytology were found as the independent prognostic factors for PFS. Peritoneal cytology, adnexal involvement, and adjuvant therapy were independent prognostic factor for OS. CONCLUSION: Curative chemotherapy significantly improved both two-year PFS and OS in patients with Stage IVB endometrial disease confined to abdomen over only radiotherapy.

The importance of age and menopausal status in endometrial complex hyperplasia with atypia.

The effects of menopausal status and age on the intra-operative and post-operative pathology results of patients operated on with a pre-operative diagnosis of complex hyperplasia with atypia (CHA) were assessed. A hundred and eleven patients diagnosed in our centre between January 1993 and March 2013 were included. Cancer was detected in the paraffin blocks (PBs) of 52 (46.8%) patients. Among these, 50 patients had stage-IA disease. In 31.1% of the pre-menopausal patients and 66% of the post-menopausal patients, PB revealed cancer (p < 0.0001). The results of frozen section (FS) and PB were concordant in 51% and 70% in the pre-menopausal and post-menopausal patients, respectively (p = 0.041). In the patients operated on with a pre-operative diagnosis of CHA, the probability of detecting cancer in PB increases with increasing age and menopause. The reliability of FS is limited in younger and pre-menopausal patients.

Undifferentiated uterine carcinoma: analysis of eighteen cases.

Analysis of the surgicopathological characteristics and clinical follow-up of patients with undifferentiated uterine carcinoma (UUC) was conducted. A total of 18 cases operated between January 1993 and December 2013 were included. Among 1,690 patients with endometrial cancer, 18 patients (1.1%) had UUC. Lymph node involvement was detected in 70.6%; depth of myometrial invasion was ≥ 0.5 in 55.6%; lymphovascular space invasion was detected in 99.3%; cervical stromal invasion was positive in 27.8%; omental and adnexal involvement were detected in 11.8% and 38.9%, respectively. The median follow-up time of the 12 patients evaluated in the survival analysis was 66 months. In the follow-up period, recurrence or progression during adjuvant therapy were observed in four patients (33.3%) and two patients (16.6%) died of the disease. UUC manifests as an aggressive tumour. In conclusion, a high rate of survival could be achieved with complete staging surgery, including an extensive lymphadenectomy with the contribution of adjuvant therapy.

Hypothalamic-pituitary-adrenal axis response to oral naltrexone in alcoholics during early withdrawal.

INTRODUCTION: It is thought that naltrexone may play a significant role in the regulation of the hypothalamic-pituitary-adrenal (HPA) axis response to stress. We investigated the HPA axis response following single-dose oral naltrexone administration in the early phase of alcohol withdrawal. METHODS: Cortisol and adrenocorticotrophic hormone (ACTH) responses to naltrexone were measured in alcohol-dependent males (n=23) and in healthy males (n=20). Blood samples were collected for cortisol and ACTH measurements before administering (0 min) 50 mg naltrexone at 08.00 in the morning, and at 60, 90, 120 and 180 min after administering naltrexone. RESULTS: Naltrexone administration resulted in a significant ACTH response in the patients while cortisol and ACTH responses were found to be significant in the controls. Cortisol response was not large enough to reach significance in the patients. ACTH level changes as a response to naltrexone in the patients were lower than that in the controls. DISCUSSION: The study revealed blunted cortisol and attenuated ACTH responses to naltrexone in early alcohol withdrawal. This study may have shown impairment in adrenal and pituitary levels during alcohol withdrawal.

Assessment of arterial stiffness in chronic obstructive pulmonary disease by a novel method: cardio-ankle vascular index.

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of cardiovascular morbidity and mortality. Increased arterial stiffness is associated with the presence and severity of cardiovascular disease. The cardio-ankle vascular index (CAVI) is a new method for assessment of arterial stiffness that is not influenced by blood pressure at the time of measurement and is significantly correlated with the presence and severity of cardiovascular disease. The aim of the present study was to evaluate whether there is an association between the spirometric severity of COPD, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, with arterial stiffness as assessed by CAVI. METHODS: We enrolled 123 patients with COPD (102 men) followed up by the chest medicine outpatient clinics and 35 healthy subjects (26 men). All patients were assessed with spirometry, CAVI, and clinical history. RESULTS: Patients with COPD had significantly increased CAVI values compared with control subjects (10.37 ± 2.26 vs. 6.74 ± 1.42, p < 0.001). CAVI was correlated with FEV1 % predicted, FEV1/FVC, and COPD stage (r: - 0.54, p < 0.001; r: - 0.58, p < 0.001 and r: 0.78, p < 0.001, respectively). Multivariate regression analysis showed that CAVI was independently associated with GOLD stages (p < 0.001). CONCLUSION: In this study, we have shown that increased arterial stiffness assessed by CAVI is associated with the spirometric severity of COPD.

Blood urea nitrogen to left ventricular ejection fraction ratio is associated with long-term mortality in the stable angina pectoris patients.

OBJECTIVE: Left ventricle (LV) dysfunction remains a significant cause of morbidity and mortality in patients with stable angina pectoris (SAP) and has prognostic significance. However, new prognostic indicators may be more useful in clinical practice. There is a growing interest in the role of blood urea nitrogen (BUN) in cardiovascular diseases. Blood urea nitrogen is an indicator of cardiac dysfunction and neurohormonal activation. We aimed to determine the relationship of BUN/LV ejection fraction ratio (BUNLVEFr) with long-term mortality and de novo decompensated heart failure (HF) in SAP patients. PATIENTS AND METHODS: The study comprised 603 consecutive SAP patients who underwent coronary angiography. The median duration of the follow-up period was 112.6±17.8 months. All-cause mortality and de novo decompensated HF were determined as the endpoints. RESULTS: Adverse cardiac events were observed in 141 patients (23.3%), including mortality in 103 (17.1%) and decompensated HF in 38 (6.3%) of them during the follow-up period. Age (p=0.027), BUNLVEFr (p=0.001), glucose (p=0.043), hemoglobin (p=0.035), and Gensini score (p=0.012) were found as independent predictors of mortality and decompensated HF. BUNLVEFr was superior to BUN alone (BUNLVEFr vs. BUN: Z=5.715, p<0.001) and LVEF alone (BUNLVEFr vs. LVEF: Z=4.075, p<0.001) in predicting endpoints. In addition, BUNLVEFr >29 predicted all-cause mortality/decompensated HF with high sensitivity (78%) and low specificity (68%). CONCLUSIONS: BUNLVEFr may provide better prognostic information than either BUN or EF can give alone in determining therapeutic strategies for SAP patients.

Serum INHB levels and ACE gene I/D polymorphism with increased risk for unexplained infertility.

Angiotensin converting enzyme (ACE) has a significant role in the angiogenesis of ovarian endothelium and the resumption of meiosis and folicular growth. However, there is no any study concerning ACE polymorphism and unexplained infertility (UI). The main aim of this study is that both identify ACE polymorphism and measure the serum ACE, anti-Mullerian hormone (AMH) and inhibin-B (INHB) levels in UI patients and controls in Turkish population. Forty-seven UI patients and 41 controls were involved in this study. To determine the ACE polymorphisms, DNA isolation and PCR were performed. Then, serum ACE, AMH and INHB levels were measured spectrophotometrically. Patients with UI had significantly higher serum INHB levels compared with controls (P < 0.05). Serum ACE levels were decreased, compared to controls; however, the decrease was not significant. Serum AMH levels did not significantly differ from controls. When the relationship was analysed between ACE insertion/deletion (I/D) polymorphism and infertility risk, and ID genotype was chosen as reference, it was found to be 2.33 times more risk of UI than the women have DD genotype [DD versus ID: odds ratio = 2.33, 95% confidence interval (0.88-6.19); P = 0.086]. This finding indicates that DD genotype may be high risk for UI. Further studies are warranted to confirm this finding, especially with a larger population.

Molecular characterization of canine astrovirus, vesivirus and circovirus, isolated from diarrheic dogs in Turkey.

BACKGROUND: Canine astrovirus (CAstV) has been considered the primary cause of gastroenteritis in young animals worldwide, while canine vesivirus (CVeV) and canine circovirus (CCiV) are occasionally reported. AIMS: This study aimed to investigate the existence and molecular characteristics for these three viruses in Turkey. Methods: Faecal samples from 150 shelter dogs with gastrointestinal problems (127 adults and 23 puppies) were collected and examined by reverse transcription-polymerase chain reaction (RT-PCR) analysis based on the partial sequence of RdRp gene (ORF1b) for CAstV, ORF2 gene of CVeV and capsid protein (Cap) and replication associated protein (Rep) gene of CCiV. Randomly selected positive samples were submitted to sequencing and molecular analyses were conducted based on partial sequences. RESULTS: It was found that 66% (99/150) of diarrhoeic dogs were positive for CAstV, 3.33% (5/150) for CVeV, and 6% (9/150) for CCiV. Four sub-genotypes for CAstV and two sub-genotypes for CVeV were suggested according to molecular analyses. The phylogenetic relationship of CCiV with other strains obtained from various areas was further demonstrated. CONCLUSION: This study emphasizes the importance of emerging viruses for canids, classification of them and their proportional contribution in gastroenteritis cases. We concluded that astrovirus infection must be considered as the major cause of diarrhea in dogs; However, the prevalences of vesivirus and circovirus were relatively low in cases makes them less important in Turkey.

Association between the plasma levels of IMA and coronary atherosclerotic plaque burden and ischemic burden in early phase of non-ST-segment-elevation acute coronary syndromes.

OBJECTIVE: Ischemia-modified albumin (IMA), a novel biochemical marker, is known to reflect ischemia in early phases of acute coronary syndrome (ACS). In the present study, we evaluated the role of IMA on the prediction of coronary atherosclerotic plaque burden and ischemic burden in patients with non-ST-segment-elevation acute coronary syndromes (NSTEACS). PATIENTS AND METHODS: Ninety-six consecutive NSTEACS patients presented within the first three hours of symptom onset were prospectively enrolled in this study. Blood samples were collected in the first 30 min of admission for IMA measurement. Serum levels of IMA were analyzed using the rapid and colorimetric method and reported in absorbance units (ABSU). Coronary plaque burden was assessed by using angiographic Gensini score (GS). In addition, patients were divided into large (LIBG) and small ischemic burden (SIBG) groups based on angiography findings. RESULTS: Patients were dichotomized into two groups according to median GS as follows; with GS ≤ 44 and GS > 44, respectively. Mean IMA was significantly higher in GS > 44 group as compared to GS ≤ 44 group (0.746 ± 0.15 vs. 0.550 ± 0.12 ABSU, p < 0.001). The GS was positively correlated with the levels of IMA (r = 0.673, p < 0.001). IMA was significantly higher in LIBG as compared to SIBG (0.745 ± 0.16 vs. 0.570 ± 0.13 ABSU, p < 0.001). CONCLUSIONS: IMA measurement in early phases of NSTEACS may give predictive information about ischemic burden and coronary atherosclerotic plaque burden; thus, may be useful in decision-making about treatment options in these patients.

Does synchronous endometrioid endometrial cancer have any prognostic effect on Stage I endometrioid ovarian cancer?

OBJECTIVE: To determine the effect of synchronous endometrial endometrioid cancer (SEEC) on the prognosis of patients with Stage 1 endometrioid ovarian cancer (EOC). STUDY DESIGN: Clinicopathological data of cases with Stage 1 EOC from January 2000 to November 2013 were retrieved from the computerized database of Etlik Zubeyde Hanim Women's Health and Research Hospital. Of the 31 patients included in the study, 15 patients had primary synchronous endometrial and ovarian cancer (SEOC) (Group 1) and 16 patients had EOC alone (Group 2). RESULTS: Ovarian cancer substage and grade were compared between the two groups, and no significant differences were found. Most of the patients with SEEC had Grade 1 tumours (n=13, 86.7%). In Group 1, nine (60.0%) patients had endometrial tumours with superficial myometrial invasion, and six (40.0%) patients had deep myometrial invasion. Median follow-up was 94 months. Ten-year disease-free survival rates were 92.9% for Group 1 and 84.6% for Group 2 (p=0.565). CONCLUSION: Patients with Stage 1 EOC have excellent long-term survival. The presence of SEEC does not influence the prognosis of patients with Stage 1 EOC, even in the presence of deep myometrial invasion.

Treatment of a neck burn contracture with a super-thin occipito-cervico-dorsal flap: a case report.

Postburn neck contractures still represent a surgical challenge due to their exposed location; and early operative treatment is necessary for both functional as well as aesthetic reasons. An excellent functional result was obtained by using a supercharged super-thin occipito-cervico-dorsal flap described by Hyakusoku to repair a large defect of the anterior neck following a very wide neck burn contracture release. In this case report, the technique and its advantages among the other reconstructive modalities are discussed briefly.

Geometric limit of multiple local Limberg flaps: a flap design.

The Limberg rhombic flap is a reliable and widely used technique in head and neck surgery. Since Limberg introduced his original design in 1946, several modifications of the technique have been described. Although a single Limberg flap is frequently used at the face to close small to medium defects, multi-Limberg flap techniques can help the surgeon to cover moderate to large defects of the extremities, trunk, and back. In this study, a design of four neighboring local Limberg flaps to cover a moderate to large defect without using a skin graft is introduced. It is believed that this design is the geometric limit of multiple Limberg flaps that can entirely cover a single large rhombic defect, because one Limberg flap unit can only be adjoined by three others, one from the tip and two from the sides. This flap design of four local Limberg flaps is also the only geometrically possible design that can keep all the bases of these four flaps free of incisions if one attempts to prepare four small Limberg flaps around a large rhombic defect.

Eversion with four sutures: an easy, fast, and reliable technique for microvascular anastomosis.

In this study, a microvascular anastomosing technique called "eversion with four sutures" is introduced. For microvascular anastomosis, this technique requires fishmouth incisions at both vessel ends and the completion of four sutures. In 120 Wistar-Albino rats, 120 eversion and 120 conventional anastomoses were done in 240 femoral arteries. Each rat received both treatments. Operating time, bleeding time, number of sutures used, patency rates, and pseudoaneurysm formation were analyzed statistically; healing was evaluated with both light and electron microscopy. When compared with the conventional technique using nine sutures, the eversion with four sutures technique was found to be a faster and easier method of anastomosis and as reliable as the conventional technique. Without compromising patency rates, bleeding time, or rates of pseudoaneurysm formation, anastomosis time and amount of suture material exposed to the lumen were significantly reduced when using this technique. In conclusion, the authors think that eversion with four sutures is a reliable alternative to the conventional suturing technique, especially for emergency cases that require multiple microvascular anastomoses.

Fusion of maxillary and mandibular alveolar process together with a median mandibular cleft: a rare congenital anomaly.

Congenital fusion of the maxillary alveolar process and mandible is a very rare entity. A one day old male newborn was referred to our clinic with a diagnosis of a 'absence of oral cavity'. Physical examination revealed that there was no mouth opening bilaterally in the posterior region due to maxillary and mandibular bone fusion; and in the front there was only 1 mm of mouth opening. Examination of the intraoral space could not be achieved. No other congenital anomaly was detected on general examination. The infant, who was fed via a nasogastric tube for 1 month, was operated on. An intra-oral device which separated maxillary and mandibular alveolar arches from each other was designed and used for 8 weeks to avoid recurrence of the fusion. An adequate mouth opening was obtained and the infant could be fed orally.

Selective probing of mRNA expression levels within a living cell.

We report on a selective and nondestructive measurement of mRNA (messenger ribonucleic acid) expression levels within a living cell. We first modify an atomic force microscope tip to create a tapered nanoscale coaxial cable. Application of an ac (alternating potential) between the inner and outer electrodes of this cable creates a dielectrophoretic force attracting mRNA molecules toward the tip-end which is pretreated with gene specific primers. We selectively extracted and analyzed both high ( approximately 2500) and extremely low (11 0) copy number mRNA from a living cell mRNA in less than 10 s.

Current status of the management of symptomatic intracranial atherosclerotic disease: the rationale for a randomized trial of medical therapy and intracranial stenting.

Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) is a randomized trial comparing aggressive medical management alone with aggressive medical management in combination with angioplasty and stenting using the Gateway-Wingspan system in patients with symptomatic, high-grade, intracranial stenosis. This trial represents a landmark in the maturation of the field of neurointervention, establishing a foundation for evidenced-based practice. We review the natural history of symptomatic intracranial stenosis when treated medically, the available interventional therapies and the rationale for the design of the SAMMPRIS trial.

Risk factor status and vascular events in patients with symptomatic intracranial stenosis.

BACKGROUND: There are limited data on the relationship between control of vascular risk factors and vascular events in patients with symptomatic intracranial arterial stenosis. METHODS: We utilized the Warfarin Aspirin Symptomatic Intracranial Disease study database to analyze vascular and lifestyle risk factors at baseline and averaged over the course of the trial. Cutoff levels defining good control for each factor were prespecified based on national guidelines. Endpoints evaluated included 1) ischemic stroke, myocardial infarction, or vascular death or 2) ischemic stroke alone. Univariate associations were assessed using the log-rank test and multivariable analysis was done using Cox proportional hazards regression. RESULTS: From baseline until year 2 follow-up, there was not a significant improvement in blood pressure control. During the same period, there were improvements in patients with total cholesterol <200 mg/dL (54.6% to 79.2%, p < 0.001) or low-density lipoprotein <100 mg/dL (28.7% to 55.9%, p < 0.001). Multivariable analysis showed that systolic blood pressure >or=140 mm Hg (HR = 1.79, p = 0.0009, 95% confidence limits 1.27 to 2.52), no alcohol consumption (HR 1.69, 1.21 to 2.39, p = 0.002), and cholesterol >or=200 mg/dL (HR 1.44, 1.004 to 2.07, p = 0.048) were associated with an increased risk of stroke, myocardial infarction, or vascular death. The same risk factors were predictors of ischemic stroke alone in multivariable analysis. CONCLUSIONS: Elevated blood pressure and cholesterol levels in symptomatic patients with intracranial stenosis are associated with an increased risk of stroke and other major vascular events.

Results with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy in gestational trophoblastic neoplasia.

The aim of this study was to evaluate the efficacy and toxicity of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) regimen for the treatment of high-risk gestational trophoblastic neoplasia (GTN). Thirty-three patients with high-risk GTN, scored according to World Health Organization, received 159 EMA/CO treatment cycles between 1994 and 2004. Twenty-three patients were treated primarily with EMA/CO, and 10 patients were treated secondarily after failure of single agent or MAC (methotrexate, actinomycin D, cyclophosphamide, or clorambucile) III chemotherapy. Adjuvant surgery and radiotherapy were used in selected patients. Survival, response, and toxicity were analyzed retrospectively. The overall survival rate was 90.9% (30/33). Survival rates were 91.3% (21/23) for primary treatment and 90% (9/10) for secondary treatment. Six (18.2%) of 33 patients had drug resistance. Four of them underwent surgery for adjuvant therapy. Three of these patients with drug resistance died. Survival and complete response to EMA/CO were influenced by liver metastasis, antecedent pregnancy, and histopathologic diagnosis of choriocarcinoma. Survival rate was also affected by blood group. The treatment was well tolerated. The most severe toxicity was grade 3-4 leukopenia that occurred in 24.3% (8/33) of patients and 6.9% (11/159) of treatment cycles. Febrile neutropenia occurred in one patient (3%). EMA/CO regimen is highly effective for treatment of high-risk GTN. Its toxicity is well tolerated.