Sacroiliitis in systemic lupus erythematosus : The rates of involvement of the forgotten joint.

OBJECTIVE: Although musculoskeletal system involvement is a well-known manifestation in systemic lupus erythematosus (SLE), the probability of sacroiliac joint involvement and its effect on patients might be ignored. The aim of the study was to investigate the association between SLE and sacroiliitis and to evaluate the relationship between clinical parameters and sacroiliitis in SLE. METHODS: The study was designed as a case-control study. A total of 63 patients with SLE and 31 age- and sex-matched healthy controls were included in the study. The clinical and demographic variables of the study population were documented. The sacroiliac joints of patients and controls were evaluated with sacroiliac magnetic resonance imaging. Human leukocyte antigen (HLA) B27 was assessed using flow cytometry (Beckman Coulter Navios-model 3, Beckman Coulter Inc., Brea, CA, USA). Multinomial logistic regression analysis was used to determine the clinical risk factors related to sacroiliitis. RESULTS: Among the 63 patients, acute sacroiliitis was found in 25 patients (39.7%) and chronic sacroiliitis was found in 21 patients (33.3%). Sacroiliitis was higher in patients than in controls (p = 0.001). Acute sacroiliitis was more frequently observed in patients when compared with the control group (p = 0.001). Higher C­reactive protein (CRP) concentrations (odds ratio = 1.75, 95% confidence interval: 1.30-2.35; p < 0.001) were found to be a risk factor for acute sacroiliitis. CONCLUSION: The ratio of sacroiliitis was higher in patients with SLE than in controls. Increased CRP concentrations were determined as a risk factor for acute sacroiliitis. Thus, one should keep in mind that patients with SLE and higher CRP concentrations may have sacroiliitis.

Disorder-Induced Phase Transitions in the Transmission of Dielectric Metasurfaces.

Light interaction with disordered materials is both complex and fascinating at the same time. Here, we reveal disorder-induced phase transitions in a dielectric Huygens' metasurface made from silicon nanocylinders that simultaneously support an electric and magnetic dipole resonance. Depending on the degree of positional disorder and the spectral detuning of the two resonances, the phase angle of the transmission coefficient exhibits a clear phase transition from normal to anomalous dispersion. Combined with the considerations of whether the resonances of spectrally detuned particles appear as separated or overlapping, we distinguish four different phase states. We study this phenomenon analytically by employing dipole particles and disclose the entire phase diagram, support our insights with full-wave simulations of actual structures, and corroborate the findings with experimental results. Unveiling this phenomenon is a milestone simultaneously in the growing fields of metamaterial-inspired silicon nanophotonics, photonics in disordered media, and the fundamental physics of phase transitions.

Efficacy of photon-initiated photoacoustic streaming on apically extruded debris with different preparation systems in curved canals.

AIM: To determine the effect of photon-initiated photoacoustic streaming (PIPS) on the extrusion of debris using multiple-file (ProTaper Next-PTN) and single-file (One Shape-OS) continuous rotary systems in curved canals in human molar teeth. METHODOLOGY: Sixty extracted maxillary first molar teeth with curved mesial roots, mature apices and of similar lengths were selected. Teeth having canals with apical diameters larger than size 15 were discarded. The teeth were randomly divided into four experimental groups (n = 15 teeth per group) according to the file used and irrigation systems: (i) OS with PIPS with a 2940 nm Er:YAG laser (0.3 W, 15 Hz, and 20 mJ), (ii) OS with conventional needle irrigation (CNI) with a 27-G needle, (iii) PTN with PIPS and (iv) PTN with CNI. The PIPS and CNI was applied during each file change for 20 s. Total irrigation and activation time was 1 min, and a total volume of 7.5 mL of bidistilled water was used as the irrigant. The apically extruded debris was collected into pre-weighed Eppendorf tubes. The tubes were then stored in an incubator at 70 °C for 5 days. The weight of dry extruded debris was assessed by subtracting the initial weight of the tube from the final weight. The results were analysed statistically using one-way analysis of variance and Tukey's post hoc tests. Bonferroni correction was used to compare the groups. RESULTS: The PIPS irrigation technique was associated with significantly more debris extrusion than the CNI system (P < 0.05). The single-file (One Shape-OS) rotary system was associated with more debris than the multiple-file (ProTaper Next-PTN) rotary systems when the same irrigation system was used (P > 0.05). The total amount of debris extruded apically by PIPS activation was significantly greater than that by CNI (P < 0.05). CONCLUSIONS: All file and irrigation systems extruded debris apically. PIPS activation was associated with significantly more extrusion debris in curved canals compared with no activation.

A rare complication of colporraphy anterior procedure: vesicovaginal fistula due to foreign body.

Iatrogenic vesicovaginal fistula (VVF) is one of the possible complications after gynecologic operations. However, fistula formation owing to a forgotten foreign body is a rare condition. Infectious complications and subsequent vesicovaginal perforation due to foreign body is difficult to diagnose since it is an unlikely condition. Delays in diagnosis and treatment can lead to serious morbidities and even mortality. This paper aims to discuss a VVF case developed after anterior colporraphy owing to forgotten gauze.

Medical management of cesarean scar pregnancy at advanced age: case report and literature review.

AIM: Cesarean scar pregnancy is a rare condition that is increasing in frequency parallel to the increase in cesarean section rates. The authors hereby discuss a case with cesarean scar pregnancy at advanced age that was treated with methotrexate (MTX) in Nyala Sudan Turkey Training and Research Hospital. CONCLUSION: Cesarean scar pregnancy is a rare type of ectopic pregnancy that is increasing in number due to the increase in cesarean deliveries. Clinical vigilance is imperative for diagnosis and treatment of this highly mortal and morbid entity.

Large pedunculated angiomyofibroblastoma of the vulva with concomitant anemia: a case report and mini review of the literature.

Angiomyofibroblastoma is a rare myxoid tumor and is often seen in vulvar and vaginal area. Patients usually present with a mass on the vulva or labium majus at the premenopausal ages. The lesions are usually between 0.5 cm and ten cm. Lesions have quite cellularity with regular borders under the microscope. Lesions contain numerous veins and bulging stromal cells. Treatment of angiomyofibroblastoma is simple surgical resection. Angiomyofibroblastoma should be differentiated from the other vulvar neoplasms, which need radical surgical treatment, especially from the aggressive angiomyxoma. Hereby, the authors aimed to report a premenopausal women presented with vulvar mass and accompanying anemia. She was diagnosed with angiomyofibroblastoma.

Complete response of primary bladder adenocarcinoma with the FOLFOX4 regimen.

INTRODUCTION: Primary adenocarcinoma of the bladder is a very rare disease that is difficult to treat. In this paper, we report the second case in the literature with primary mucinous adenocarcinoma of the bladder which showed complete response to FOLFOX4 (fluorouracil, leucovorin, oxaliplatin) chemotherapy regimen. CASE REPORT: A 41-year-old man was admitted to our hospital with a diagnosis of primary adenocarcinoma of the bladder. Due to the similarity in histology with colon carcinoma, a FOLFOX4 regimen was started. Complete response was achieved at the end of this treatment. Today the patient is free of local or systemic disease. CONCLUSION: FOLFOX4 regimen may be a treatment option for primary adenocarcinoma of the bladder.

Comparison of various current electronic apex locators to determine the working length using the clearing technique.

BACKGROUND: Correct working length determination is an important step for successful endodontic therapy. OBJECTIVE: The objective was to compare in vitro the accuracy of three electronic apex locators (EALs) (DentaPort ZX [Morita Co., Tokyo, Japan], SIROEndo Pocket [Sirona Dental Systems, NY, USA], and Rootor [Meta Biomed, Cheongwon-gun, Korea]) in detecting the major foramen using the clearing technique. MATERIALS AND METHODS: Forty-five human extracted single-rooted teeth with mature apices were used for the study and divided into three groups of 15 teeth each. All teeth were embedded in an alginate model, and the electronic measurements were taken following the manufacturers' orientations. Then, the teeth were cleared and photographed under a stereomicroscope with a digital camera. The distance from the file tip to the major foramen was measured using image analysis software program. Statistical analysis was performed using the Kruskal-Wallis, Mann-Whitney U, and Chi-square tests at a significance level of 0.05. RESULTS: The mean distances from the file tip to the major foramen were 0.164 ± 0.292, -0.162 ± 0.234, 0.341 ± 0.166 mm in the DentaPort ZX, SIROEndo Pocket, and Rootor groups, respectively. Statistical analysis showed that there was a significant difference between SIROEndo Pocket and Rootor (P < 0.05). However, no significant difference was found between DentaPort ZX and other EALs (P > 0.05). CONCLUSION: DentaPort ZX located the major foramen with 100% accuracy within the range of ± 0.5 mm. However, the accuracy of the SIROEndo Pocket and Rootor in locating the major foramen within ± 0.5 mm was 73.3% and 86.7%, respectively. All EALs showed an acceptable determination of the major foramen within the range of ± 0.5 mm.

A case of Seckel syndrome with tricuspid atresia.

Seckel syndrome is an autosomal recessive disease presenting with marked growth retardation, microcephalic dwarfism, some facial and skeletal abnormalities. Tricuspid atresia is a rare and life threatening cyanotic congenital heart diseases, with an incidence of 1% to 3%. It is feature of the anatomically normally related great arteries with a large ventricular septum defect and stenosis of right ventricular outflow tract. Tricuspid atresia has never been reported in patients with Seckel syndrome. Here we report a 15-day-old girl baby diagnosed as having Seckel syndrome with tricuspid atresia.

In vitro comparison of four different electronic apex locators to determine the major foramen using the clearing technique.

OBJECTIVES: The aim of this study was to evaluate the accuracy of four electronic apex locators (EALs) (DentaPort ZX, Raypex 5, Endo Master and VDW Gold) in detecting the major foramen using the clearing technique. MATERIALS AND METHODS: Forty-eight extracted single-rooted extracted teeth with mature apices were used for the study and divided into four groups of 12 teeth each. All teeth were embedded in an alginate model. Electronic measurements were taken using a size 15 K-file attached to the holder. Then, the teeth were cleared and photographed under a stereomicroscope with a digital camera. The distance between the tip of the file and the major foramen was measured by using an image analysis software program. Positive and negative values were recorded when the file tip was beyond or short of the major foramen and zero value when the file tip and the major foramen coincided. Statistical analysis was performed using the Kruskal-Wallis and Chi-square tests at a significance level of 0.05. RESULTS: Mean distance from the file tip to the major foramen were 0.302 ± 0.202, 0.065 ± 0.293, 0.117 ± 0.475, and 0.258 ± 0.160 mm in the DentaPort ZX, Raype 5, Endo Master, and VDW Gold groups, respectively. There were no statistically significant differences among the devices (P > 0.05) . CONCLUSION: Under the experimental conditions, all EALs showed an acceptable determination of the major foramen.

Chronic Behavioral and Neurochemical Effects of Four Novel N-Benzyl-2-phenylethylamine Derivatives Recently Identified as "Psychoactive" in Adult Zebrafish Screens.

Potently affecting human and animal brain and behavior, hallucinogenic drugs have recently emerged as potentially promising agents in psychopharmacotherapy. Complementing laboratory rodents, the zebrafish (Danio rerio) is a powerful model organism for screening neuroactive drugs, including hallucinogens. Here, we tested four novel N-benzyl-2-phenylethylamine (NBPEA) derivatives with 2,4- and 3,4-dimethoxy substitutions in the phenethylamine moiety and the -F, -Cl, and -OCF3 substitutions in the ortho position of the phenyl ring of the N-benzyl moiety (34H-NBF, 34H-NBCl, 24H-NBOMe(F), and 34H-NBOMe(F)), assessing their behavioral and neurochemical effects following chronic 14 day treatment in adult zebrafish. While the novel tank test behavioral data indicate anxiolytic-like effects of 24H-NBOMe(F) and 34H-NBOMe(F), neurochemical analyses reveal reduced brain norepinephrine by all four drugs, and (except 34H-NBCl) - reduced dopamine and serotonin levels. We also found reduced turnover rates for all three brain monoamines but unaltered levels of their respective metabolites. Collectively, these findings further our understanding of complex central behavioral and neurochemical effects of chronically administered novel NBPEAs and highlight the potential of zebrafish as a model for preclinical screening of small psychoactive molecules.

Line of abiraterone acetate in castration-resistant metastatic prostate cancer--Does it matter? report of a multi-institutional experience.

OBJECTIVE: We present our data comparing retrospectively the efficacy of abiraterone and cabazitaxel in patients who progress after docetaxel treatment. PATIENTS AND METHODS: The study included 56 patients diagnosed with hormone-refractory metastatic prostate cancer who were previously treated with abiraterone therapy at four oncology centers in Turkey. RESULTS: With abiraterone, the patients had a median progression-free survival (PFS) of 5.9 months (95% confidence interval (CI) for hazard ratio (HR) (4.4-7.4)) and an overall survival of 13.4 months (95% CI for HR (5.5-21.3)). When we compared the disease-free survival (DFS) of reference patients treated with cabazitaxel as a second-line treatment with those receiving second-line abiraterone therapy, there was no significant difference. (PFS = 5.9 months with cabazitaxel vs. 6.7 months with abiraterone, P = 0.213). CONCLUSION: This study has shown that in our experience abiraterone acetate is an effective agent in metastatic castration-resistant prostate cancer (mCRPC) regardless of the line of treatment.

Factors predicting lapatinib efficacy in HER-2+ metastatic breast carcinoma: Does it work better in different histologic subtypes?

CONTEXT: Introduction of trastuzumab, a recombinant monoclonal antibody against the extracellular domain of HER-2, is a cornerstone in the treatment of HER-2+ breast carcinoma. However, many cancers that have an initial response to trastuzumab will progress some time later. After progression on trastuzumab-based first-line treatment, there are several options. Although TDM-1 (Trastuzumab emtansine) has prolonged progression-free survival (PFS) and overall survival in patients previously treated with trastuzumab and taxane, it is still not available in Turkey. Patients may be switched to lapatinib (an oral tyrosine kinase inhibitor targeting both HER-1 and HER-2), or they may re-challenge with trastuzumab. There is no clear definition of the patients who should be switched to lapatinib. AIM: In this study, we investigated the factors predicting the efficacy of lapatinib. SUBJECTS AND METHODS: Totally, 94 patients treated with lapatinib for metastatic breast carcinoma was included in our study. Retrospective data including pathology, treatments and treatment results, metastatic sites, and laboratory tests were collected. RESULTS: Progression-free survival was 9.1 months. Histologic subtypes other than invasive ductal carcinoma and liver metastasis were inversely related with PFS. Overall survival was 22.1 months, and patients with histologic subtypes other than invasive ductal carcinoma and who progress with brain metastasis had a worse prognosis. CONCLUSION: Clinicians should give attention to histologic subtype and metastatic sites when choosing patients for lapatinib treatment.

Sexual dysfunction in male patients on hemodialysis: assessment with the International Index of Erectile Function (IIEF).

In this study we determine the sexual problems and the prevalence of erectile dysfunction (ED) in male hemodialysis patients by means of the International Index of Erectile Function (IIEF). A total of 187 male patients were included in the study. All of the patients who underwent hemodialysis were asked to complete the IIEF questionnaire. The IIEF domain scores were calculated and erectile dysfunction grading was determined on erectile function domain. Patients were also asked to report whether they had disclosed their sexual problems to physicians or not.The mean age was 49.3+/-13.2 y and the duration of hemodialysis was 38.1+/-8.4 months. By means of the IIEF, the prevalence of erectile dysfunction of any degree was 80.7%. The prevalence of any ED for the patients <50 y and >or=50 y was 74.5% and 86.6%, respectively. The prevalence and the severity of ED was significantly higher in patients >or=50 y. The frequency of intercourse attempts during the last four weeks was 1-2 in 130 (69.5%) of patients. Only 1% of patients disclosed their erectile problems and sought medical assistance prior to our study.Erectile dysfunction is highly prevalent in hemodialysis patients. The prevalence and the severity of ED increased with age. Evaluations for ED should be included in routine assessment of hemodialysis patients.

Effects of DMSO on platelet functions and P-selectin expression during storage.

Recent studies suggested that the expression of P-Selectin on stored platelets is related to in vitro activation and loss of viability. We examined the effects of dimethylsulfoxide (DMSO) on in vitro function and P-Selectin expression of platelet concentrates. Fresh random-donor platelet units (n = 60) were divided into four equal groups. A DMSO-free group was chosen as a control. DMSO (0.5%, 1.0%, and 3.0%) was added to the other three groups. The samples were stored on a horizontal shaker at room temperature. Biochemical, morphological and platelet function tests and P-Selectin expression were monitored during storage. In all groups, P-Selectin expression, lactate and LDH levels, mean platelet volumes and PO2 increased but the aggregation response to agonist, the recovery response to hypotonic shock, platelet count, glucose level, pCO2, and HCO3 decreased during storage. In DMSO-containing groups, the P-Selectin expression which is a predictor of in vitro activation, was found significantly less often than in the DMSO-free group.

Celiac disease and Turner's syndrome: patient report.

Turner's syndrome is a chromosomal disease frequently associated with autoimmune disorders including thyroid disease, inflammatory bowel disease, diabetes mellitus and juvenile rheumatoid arthritis. Recent reports have described an association of celiac disease with Turner's syndrome. We present an additional patient with Turner's syndrome associated with celiac disease. A girl aged 15- 7/12 yr was seen for the complaints of delayed growth and puberty, abdominal pain and chronic diarrhea. She was diagnosed as having celiac disease and a gluten-free diet was initiated. Despite one year of strict diet no signs of puberty were observed. She was then evaluated again for absence of puberty, and 45,XO karyotype Turner's syndrome was diagnosed.

Helicobacter pylori infection in children with insulin dependent diabetes mellitus.

To assess the seroprevalence of Helicobacter pylori (HP) in children with insulin dependent diabetes mellitus, a serological test for Helicobacter pylori (anti-HP IgG with ELISA) was performed in 88 diabetic and 42 healthy control children. Anti-HP IgG was positive in 49/88 (55.6%) of diabetics and 13/42 (30.9%) of controls (p<0.01). Diabetic children were divided into two groups according to HP status: HP(+) and HP(-). The two groups were compared for age, gender, duration of diabetes, diabetic control (HbA1c), SDS for height and gastric emptying time. Seroprevalence of HP was higher in IDDM patients than in healthy controls. Duration of diabetes was the only factor which correlated significantly with HP status. HP status was not related to gastric emptying time.

Anticholinesterase poisoning in Turkey--clinical, laboratory and radiologic evaluation of 269 cases.

A retrospective study was conducted on 269 patients with anticholinesterase poisoning who had been admitted to the Internal Medicine and Pediatric Clinics over the past 10 years. Their ages ranged from 17 d to 62 years. In adults, suicide was the most common means of intoxication. Miosis was the most frequent symptom and was seen in 80.66% of the patients. Hyperglycaemia, hypoglycaemia, hypokalaemia, hyperkalaemia, hyperchloraemia, hypochloraemia and hyponatraemia were among the electrolytic and haematologic disorders (hyperglycaemia 48.00%, hypoglycaemia 6.40%). There were also electrocardiographic abnormalities. Asthma, although usually a late complication, was also noted at the beginning of treatment. Mortality rates were 8.98% for children and 9.6% for adults. Since hypoglycaemia was found in all the patients who died, it was accepted as an ominous prognostic sign. We think that anticholinesterase poisoning is an important health problem in our country. It is much less common in developed than semi-developed countries, and a complete understanding of it is essential for the emergency physician.

X-linked agammaglobulinemia and isolated growth hormone deficiency.

X-linked agammaglobulinemia and isolated growth hormone deficiency was first described in 1980 and then classified as a different primary immune deficiency. Delayed puberty in patients with X-linked agammaglobulinemia may result in delayed secretion of growth hormone (GH). To determine true isolated growth hormone deficiency. GH stimulation tests and other hypophyseal hormone evaluations must be performed. In this paper, we report a 15-year-old boy with X-linked agammaglobulinemia and isolated growth hormone deficiency, and review related literature.

Castleman's disease. A case report.

Angiofollicular lymph node hyperplasia or Castleman's Disease (CD) is a rare lymphoproliferative disorder that manifests itself as a local or generalized tumor-like condition affecting both lymph nodes and non-nodal tissues, usually in the chest and abdomen. Hyaline vascular and plasma cell types have been identified histologically. A new clinical form of CD with multisystemic involvement has been defined as multicentric Castleman's disease. It is very rare in childhood. In this paper we present an eight-year-old boy with multicentric Castleman's disease.