The investigation of the antitumoral effect of Cornus mas L in mice with ehrlich solid tumor.

AIM: Cornus mas L is commonly used due to its anti-inflammatory, anti-carcinogenic and anti-oxidant properties. In the study, the effects of C. mas L extract on a solid tumor were examined in the Ehrlich solid tumor model developed in Balb/C type mice. METHODS: Ehrlich acid tumor (EAT) cells (1x106 EAT cell) from the stock animal were injected subcutaneously (s.c.) through the nape of the mice. Treatment groups of solid tumor-induced animals received 100 mg/kg and 200 mg/kg of C. mas L extract intraperitoneally (i.p.) for 14 days. RESULTS: Tumor volumes and animal weights were found to be statistically significant compared to the control group (p < 0.05). AgNOR staining was performed in tumor tissues. Statistically significant differences were observed between the groups in terms of TAA/NA ratio (p < 0.05). Immunohistochemical and biochemical parameters were also evaluated. An estimation of tumor proliferation of the lung, liver, brain, kidney, testis and tumor antioxidant parameters viz. lipid peroxidation, reduced glutathione (GSH), glutathione S-transferase (GST), superoxide dismutase (SOD) and catalase (CAT) was made. CONCLUSIONS: Our study showed that the anti-tumor effect of C. mas L in assisted tumor development with EAT cells, was mediated by the enhancement of oxidative stress with multiple mechanisms (Tab. 6, Fig. 12, Ref. 38).

Role of mean platelet volume and neutrophil/lymphocyte ratio to predict single-dose methotrexate treatment success in tubal ectopic pregnancy.

OBJECTIVE: The aim of the study was to evaluate the value of mean platelet volume (MPV) and neutrophil/lymphocyte ratio (NLR) to predict single-dose methotrexate (MTX) treatment success in ectopic pregnancy (EP). MATERIALS AND METHODS: A total of 115 EP diagnosed and hemodynamically stable women were enrolled in the study and divided into two groups as group 1, the treatment success group (n= 78) and group 2, the treatment failure group (n = 37). The authors compared the groups in terms of MPV and NLR. RESULTS: MPV and NLR levels were higher in MTX treatment successful group than in failure group.The cut-off values of MPV and NLR were determined as 10.1 fL and 1.82, respectively. These cut off values showed similar sensitivity and specificity in prediction of MTX treat- ment success. CONCLUSION: MPV and NLR can be used as reliable markers to predict single-dose MTX treatment success however further studies are needed.

Steroid cell tumor of the ovary associated with endometrial adenocarcinoma--a rare case report.

Endometrial carcinoma is the most common invasive neoplasm of the female genital tract and is associated to the elevated levels of unopposed estrogen, especially in postmenopause. Ovarian Steroid cell tumors are rare tumors and they are named according to the origin of cell. The most common cancer of the female genital tract is the endometrial adenocarcinoma and it accounts for 7% of all invasive cancers in women. In the present case report, the authors present a 59-year-old multiparous woman with a postmenopausal bleeding complaint and they discuss the case of ovarian steroid cell tumor associated with endometrioid adenocarcinoma of endometrium. Endometrial adenocarcinoma is the most common cancer of female genital tract and its contemporarity with an ovarian steroid cell tumor is extremely rare.

The association of the microcystic, elongated and fragmented (MELF) invasion pattern in endometrial carcinomas with deep myometrial invasion, lymphovascular space invasion and lymph node metastasis.

The purpose of this study was to investigate the frequency of microcystic, elongated and fragmented (MELF) pattern of invasion in endometrioid endometrial adenocarcinomas (EA) and its association with prognostic factors. Stained tissue sections from 121 cases of EA (total hysterectomy and pelvic, with or without para-aortic, lymphadenectomy specimens) were reviewed to identify cases showing MELF-type invasion. The prognostic factors of low tumour grade, deep myometrial invasion (MI), cervical stromal involvement, lymphovascular space invasion (LVSI), lymph node (LN) metastasis and advanced clinical stage were more frequently observed in MELF-positive cases (p < 0.05). Thus, MELF-positive cases had an increased frequency (28/121) of these prognostic factors, which has implications in routine clinical practice, as it signals the importance of recognising MELF pattern invasion. In univariate analysis, MELF positivity, deep MI, cervical stroma involvement and LVSI were significantly related to LN metastasis (p < 0.05). However, in multivariate analysis, only MELF pattern invasion and cervical stroma involvement were independent factors for LN metastasis. Nevertheless, further studies are needed to evaluate the clinical significance of MELF pattern of invasion in endometrial adenocarcinoma.

Study on relationships among deep vein thrombosis, homocysteine & related B group vitamins.

OBJECTIVES: Hyperhomocysteinemia has been considered as a potential risk factor for deep venous thrombosis (DVT) but it is still controversy. We aimed to evaluate the prevalence of hyperhomocysteinemia in patients with DVT. Our second objective was to document the prevalence of folate, Vitamin B6, and Vitamin B12 level in this patient population. METHODS: Sixty patients with DVT aged from 23 to 84 years, were assessed regarding demographic characteristics, serum levels of homocysteine, folate, vitamin B12, and vitamin B6. The diagnosis of DVT was based upon Wells scoring system and serum D-dimer level and confirmed by deep venous Doppler ultrasonography of the lower limbs. RESULTS: Mean serum homocysteine levels were found significantly higher in patients over the age of 40 years (10.81±4.26 µmol/L vs 9.13±3.23 µmol/L). Of all the patients, 9 patients had homocysteine level above the 15µmol/L, 26 had folic acid level below 3 ng/ml, one had vitamin B12 level below 150 pmol/L, and two had vitamin B6 level below 30 nmol/L. In the hyperhomocysteinemic group, five patients had low folic acid level, one had low vitamin B12 level, and two had low vitamin B6 level. CONCLUSIONS: Hyperhomocysteinemia, in women older than 40 years, may be a risk factor for DVT. Folic acid deficiency may also influence serum homocysteine concentrations. Folate therapy may be offered to the patients with DVT. However further studies are required to clarify the underlying molecular mechanisms.

Serum levels of vitamin D, vitamin D-binding protein and vitamin D receptor in migraine patients from central Anatolia region.

OBJECTIVES: Inflammation is proposed to be involved in the pathogenesis of both vitamin D deficiency and migraine. However, the data examining the relation of vitamin D with migraine are limited. We aimed to investigate the serum levels of vitamin D, vitamin D-binding protein (VDBP) and vitamin D receptor (VDR) in combination, in migraine patients from central Anatolia region. METHODS: Fifty-two newly diagnosed migraine patients and age- and sex-matched 49 control subjects were enrolled in this cross-sectional prospective study. Migraine diagnosis was settled according to the International Classification of Headache Disorders-II diagnostic criteria. Serum samples were analysed for the measurement of vitamin D, VDBP and VDR levels by using commercial enzyme-linked immuno sorbent assay kits. RESULTS: Serum vitamin D and VDR levels were found to be significantly lower in migraine patients than in controls (p = 0.012 and p = 0.038, respectively); whereas serum VDBP levels were similar between the groups (p > 0.05). There was no correlation between serum vitamin D, VDBP and VDR levels and headache characteristics including aura, attack severity, frequency and duration, and disease duration (p > 0.05). In terms of headache characteristics, no significant difference between migraineurs with vitamin D values < 25 and ≥ 25 ng/ml was observed (p > 0.05). CONCLUSIONS: The present findings may suggest that decreased serum vitamin D levels were associated with migraine.

Effects of long-term fasting on female hormone levels: Ramadan model.

BACKGROUND: Ramadan fasting is a special model of hunger and particularly affects metabolic processes, including carbohydrate and lipid levels. Endocrine changes induced by Ramadan fasting are not well known. OBJECTIVE: The aim of this article was to evaluate the changes in hormone levels in women before and after the special Muslim fasting period of Ramadan. MATERIALS AND METHODS: This study was performed in 30 healthy women in Obstetrics and Gynecology department during the Ramadan month of2011. Patients during and after the first menstrual period had menstrual cycles fasting blood samples taken on the same days. Luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol (E2), testosterone, and prolactin (PRL) levels were determined. RESULTS: Before and during fasting LH, FSH, E2, testosterone and PRL levels were not statistically different. CONCLUSION: Despite the limited available studies on these subjects in women, effect of Ramadan fasting on hormone levels were found to be within the normal limits.

Diagnostic laparoscopy findings in unexplained infertility cases.

OBJECTIVE: Evaluation of diagnostic laparoscopy findings in 600 unexplained infertility cases. MATERIALS AND METHODS: A total of 600 diagnostic laparoscopies performed between 1995 and 2008 were investigated. Laparoscopies were performed in the proliferative phase of the cycle, General anesthesia was performed in all cases. RESULTS: Normal genital findings were determined in 47.50% of primary infertile cases and in 47% of secondary infertile cases. Pelvic adhesion was the most frequent finding encountered and it was seen at a rate of 20% in the primary infertility group and 18% in the secondary infertility group. Endometriosis was determined to have a rate of 15% in the primary infertility group and 11.5% in the secondary infertility group. CONCLUSION: Laparoscopy has an important place in the diagnosis and planning in the treatment of infertility. Planning the convenient treatment for patients will prevent both economic loss and time loss.

Oxidative stress and asymmetric dimethylarginine is independently associated with carotid intima media thickness in peritoneal dialysis patients.

BACKGROUND: Oxidative stress (OS) and asymmetric dimethylarginine (ADMA) are accepted as nonclassical cardiovascular risk factors in end-stage renal disease patients. To clarify the role of these factors in the atherosclerotic process, we investigated if OS and ADMA are associated with common carotid artery intima media thickness (CIMT) in peritoneal dialysis (PD) patients. METHODS: Thirty PD patients without known atherosclerotic disease and classical cardiovascular risk factors as well as age- and gender-matched 30 healthy individuals were included. We measured serum thiobarbituric acid-reactive substances (TBARS), malondialdehyde (MDA), advanced glycation end product (AGE), pentosidine, advanced oxidation protein products (AOPP), ADMA and CIMT in each subjects. RESULTS: TBARS, MDA, AOPP, AGE, pentosidine and ADMA levels were significantly higher in PD patients than in controls (p < 0.001). CIMT in patients was higher than in the control group (0.83 +/- 0.09 vs. 0.77 +/- 0.06 mm; p < 0.01). CIMT was independently correlated with TBARS (beta = 0.33, p < 0.01), MDA (beta = 0.27, p < 0.01), AOPP (beta = 0.22, p < 0.02), AGE (beta = 0.45, p < 0.01), pentosidine (beta = 0.56, p < 0.01) and ADMA (beta = 0.54, p < 0.01). CONCLUSIONS: OS markers and serum ADMA levels independently predict the CIMT level in PD patients.

Acromegalic pneumonomegaly: lung growth in the adult.

Lung size was evaluated with pulmonary function tests in 10 patients with acromegaly, 1 pituitary giant, and 1 patient who had acromegaly but now has hypopituitarism. In the six acromegalic men all lung volumes were increased. The average values and per cent of predicted were total lung capacity 9.1 liters. 139%; functional residual capacity 5.2 liters, 145%; vital capacity 6.0 liters, 134%; and tissue volume 1.1 liters. There was no evidence of airflow obstruction or air trapping. Anatomic dead space was increased in proportion to the large lung volumes. Lung compliance was increased, averaging 0.43 liters/cm H(2)O, but lung elastic recoil was normal. These studies show that the lung is involved in the general visceromegaly of acromegaly and that lung size increases in acromegalic men as a result of actual lung growth. Despite the large lung volumes, diffusing capacity was normal suggesting that lung growth resulted from an increase in the size rather than from an increase in the number of alveoli. In contrast to the acromegalic men, lung volumes, anatomic dead space and tissue volume were normal in four acromegalic women, suggesting that sex hormones may modify the effect of growth hormone on the lung. Lung size was large in the pituitary giant but lung volumes were normal according to predicted values based on the patient's great height. Lung volumes were normal in the one male who had been acromegalic but who has been hypopituitary for 21 yr. The role of growth hormone in normal postnatal lung growth and in the maintainance of normal lung size remains to be defined.

Comparison of lornoxicam with tramadol in patient-controlled analgesia after gynecological surgery.

BACKGROUND: The aim of this study was to compare the effects of lornoxicam and tramadol in patient-controlled analgesia (PCA) after gynecological surgery. METHODS: Forty-four patients were randomly allocated to one of two groups after elective gynecological surgery. Patients in group I (n = 22) received IV tramadol, and group II patients (n = 2) received IV lornoxicam with a PCA pump. A visual analogue scale (VAS) (0 = no pain, 10 = worst pain), hemodynamic parameters and side-effects were assessed before starting the infusion (baseline), at the 15th and 30th min, 1st, 2nd, 3rd, 4th, 6th, 8th, 12th, 18th, 24th, 36th and 48th hour thereafter, and results were compared. RESULTS: Adequate analgesia was achieved in both groups. VAS values in the tramadol group were lower than those of lornoxiacam at the 15th and 30th minute, 1st, 2nd, 4th, 6th, 8th and 12th hour measurements (p < 0.05). Eight patients (36.3%) in group I and six patients (27.2%) in group II suffered from nausea (p > 0.05). CONCLUSIONS: Tramadol and lornoxicam may be used for pain control after gynecological surgery via PCA. However, we conclude that tramadol has better analgesic efficacy than lornoxicam during the first 12 hours postoperatively.

Xanthoma disseminatum: a child with respiratory system involvement and bronchiectasis.

Xanthoma disseminatum (XD) is a rare normolipemic mucocutaneous xanthomatosis due to the proliferation of non-x histiocytes. Occasional involvement of the upper respiratory system has been reported, but lower respiratory tract involvement is very rare. Here, we present a child with severe involvement of the upper and lower respiratory tract by XD and bronchiectasis in the lower lobes of both lungs. The patient was an 8-year-old boy who was admitted to our hospital because of red-brown papules which developed on the skin and progressive dyspnea. He was diagnosed as having XD by skin biopsy. Physical examination revealed disseminated, numerous yellow-reddish brown papular xanthomas on the forehead and eyelids, around the neck and axillary area, and in the oral cavity and pharynx. He had respiratory distress and clubbing of the fingers. Chest x-rays showed hyperaeration and segmental atelectasis. High-resolution CT of the thorax revealed diffuse thickening of the whole tracheal and bronchial wall, and bronchiectasis in the lower lobes. Flexible fiberoptic bronchoscopy revealed numerous xanthomatous lesions in the nasal cavity, nasopharynx, oropharynx, subglottic area, trachea, bifurcation, both main bronchi, and smaller bronchi. To the best of our knowledge, this is the first report of a child with typical lesions of XD with severe involvement of the lower respiratory tract and bronchiectasis.

Two cases of uterine septum with intrauterine device.

Intrauterine devices (IUDs) have been used worldwide for contraception for decades. They are easily deployed, inexpensive and one of the most reliable contraceptive methods. Though ease of placement is such that they are frequently placed by midwives in the outpatient setting in developing countries, some complications due to its misplacement occasionally can occur. We present two cases with unknown uterine septum in which IUDs were placed without prior ultrasound examination of the pelvis. We conclude evaluation of the pelvis by ultrasound prior to placement of IUDs in women with a history of breech presentation, preterm labour, or recurrent miscarriage may be helpful in identifying uterine anomalies that make IUD placement unsuitable.

Effect of hysterosalpingography on serum cancer antigen (CA-125) levels.

OBJECTIVE: The aim of our study was to detect any rise in serum levels of CA-125 after hysterosalpingography (HSG) as a result of irritation of the peritoneum. STUDY DESIGN: Serum levels of CA-125 were assessed before HSG and at the 2nd and 6th hours after HSG in 32 infertile patients who were admitted to our clinic from April 2002 to September 2002. Patients who showed tubal occlusion or Asherman Syndrome were excluded from the study. The levels of serum CA-125 were compared statistically. Statistical analysis was performed with SPSS 10.0 statistical software and the paired-sample t-test was applied. RESULTS: The mean levels of serum CA-125 before HSG, and at the 2nd and 6th hours after HSG were; 14.11 +/- 5.97 mIU/ml, 13.96 +/- 5.80 mIU/ml, and 14.06 +/- 5.80 mIU/ml, respectively. There was no statistically significant difference between serum levels of CA-125 before HSG and at the 2nd or 6th hours after HSG, and also between the 2nd and 6th hours after HSG (p > 0.05). CONCLUSION: We have not found any reports up to date about the levels of serum CA-125 after HSG. In our study we did not detect any increase in levels of serum CA-125 at the 2nd and 6th hours after HSG in spite of peritoneal irritation. We propose that this finding is because leakage of radioopaque material to the abdominal cavity is minimal during the HSG procedure.

Comparison of clinical diagnosis and microbiological test results in vaginal infections.

Lower genital tract infections continue to be a problem due to the fact that the clinical diagnosis is usually inadequate, and subsequent care is suboptimal. This study aimed at evaluating the accuracy of clinical diagnosis by comparing it with microbiologic test results, and to determine the causative agents of vaginal infections. Sixty-seven nonpregnant women (18-45 years of age) with the clinical diagnosis of lower genital tract infection were enrolled in the study. Patients were not included if they had a history of vaginal infection during the previous three-month period or intrauterine device. The clinical diagnosis was based on the combinations of symptoms, direct observation of wet mount, homogeneous discharge, vaginal pH > 4.5, and detection of the amine odor after exposure of vaginal secretions to 10% KOH. Vaginal samples were taken with two cotton swabs, one was used for pH determination, and the second was utilized for microbiological tests. Gram staining and cultures with Sabouraud agar and chocolate agar were performed for microbiological diagnosis, and the results were compared. The clinical diagnoses included 26 (38.8%) candidiasis, 18 (26.8%) bacterial vaginosis, three (4.5%) trichomoniasis, and 20 (29.9%) mixed vaginal infections. Of the 26 patients with clinical diagnoses of candidiasis, 12 (46.1%) revealed Candiada albicans, nine (34.6) patients revealed microorganisms other than candida species, and five (19.2%) patients had no growth. Five (27.8%) bacterial vaginosis patients revealed Gardnarella vaginalis and 12 patients (66.6%) did not grow any microorganism. The overall rate of accurate clinical diagnoses confirmed by microbiological test results was 43.2%. Seventeen (43.6) of the 39 microbiological test results correlated with clinical diagnosis, and no growth was observed in 28 (41.8%) cultures. We conclude that the clinical diagnosis of vaginal infection is inadequate and should be confirmed with microbiological testing if the resources are avaliable.

Epidemiology of hexachlorobenzene-induced porphyria in Turkey: clinical and laboratory follow-up after 25 years.

Cutanea tarda and mixed porphyric symptoms resulted from accidental ingestion of hexachlorobenzene (HCB)-treated seed grain in Turkey 25 years ago and involved about 4,000 persons with a 10% mortality. Twenty-five years later, 161 patients, 63 women and 98 men, with histories of HCB exposure as children or young adults were studied. Many patients had persistent abnormal porphyrin metabolism and prominent neurological, dermatologic, and orthopedic symptoms and signs. Thyromegaly was seen in 60% of the women and 27% of the men. The children born to porphyric mothers 25 years ago all died of pembe yara secondary to maternal milk and transplacental transfer of HCB. Current lactation specimens of porphyric patients show high HCB levels, up to 3.12 ppm, but the infant offspring appear normal.

Comparison of three different primer pairs for the detection of Mycobacterium tuberculosis by polymerase chain reaction in paraffin-embedded tissues.

SETTING: More than five different primer pairs have been used for the detection of Mycobacterium tuberculosis deoxyribonucleic acid (DNA) with the polymerase chain reaction (PCR). OBJECTIVE: The sensitivity and specificity of PCR were evaluated using three different primer pairs in the detection of M. tuberculosis in paraffin-embedded tissues. DESIGN: Thirty-eight tissue specimens from 23 patients were studied. Eighteen samples were obtained from 10 tuberculosis patients, and 20 samples obtained from 13 patients with other diseases were used as negative controls. DNA extracted from paraffin-embedded tissues was used directly for PCR amplification using primers IS1 and IS2 to amplify a 123 base pair (bp) region of IS6110, sjMT3 and sjMTr2 to amplify a 281 bp region of protein antigen b, and INS1 and INS2 to amplify a 245 bp region of IS986. Each amplification was performed double-blinded and repeated three times including positive and negative control samples. RESULTS: IS1 and IS2 gave a positive result in each of the double samples obtained from eight tuberculosis patients and in the single samples obtained in the two others, sjMT3 and sjMTr2 detected 13 of the 18 tuberculosis samples, and INS1 and INS2 detected only three of the 18. CONCLUSION: These results highlight the importance of selecting appropriate primers to obtain high sensitivity in detecting M. tuberculosis in paraffin-embedded tissues by PCR.

Porphyria turcica. Twenty years after hexachlorobenzene intoxication.

Porphyria involving more than 4,000 persons occurred in Eastern Turkey from 1956 to 1961 due to ingestion of hexachlorobenzene (HCB), a fungicide added to wheat seedlings. During a site visit in 1977, 32 porphyric Turks (mean age, 29 years) were examined. Porphyrin concentrations were determined with samples of urine and stool from 29 porphyric and 10 control Turks and compared with results from 40 subjects in the United States. Distinctive clinical features were found in porphyric subjects, including hyperpigmentation, hirsutism, severe scarring, short stature, pinched facies, small hands, painless arthritis, weakness, and enlarged thyroids. Porphyrin levels were still substantially elevated in five subjects. Hexachlorobenzene, which is fat soluble, was detected in maternal milk of one porphyric patient and in one other patient's fat. The level of HCB was not considered sufficient to account for persistence of porphyria but may be a clue to the cause of pembe yara (pink sore), in which many children who were breast-fed by affected mothers died with associated weakness, convulsions, and annular erythema.

Hydatid disease in childhood: a retrospective analysis of 376 cases.

During a 20-year period, 376 children with hydatid disease were treated at Hacettepe University Ihsan Dogramaci Children's Hospital. There were 223 males and 153 females with a mean age of 8.9+/-0.1 years. Hydatid cysts were localized in the lungs in 222 patients, in the liver in 56 patients, and in other organs in the remaining patients. Cough, fever, and abdominal pain were the most common symptoms. One hundred eight patients had medical, 182 patients had surgical, 73 patients had medical and surgical, and 4 patients had medical and percutaneous drainage treatment as the initial therapy. When evaluating the results of therapy, the relapse rate was higher in surgically treated patients than medically treated patients. We conclude that medical treatment of childhood hydatidosis is best, except in cases with complications such as infection, parenchymal compression or obstruction of airways, bile duct or viscera; all of these are indications for surgical therapy.

Long-term clinical course of patients with idiopathic pulmonary hemosiderosis (1979-1994): prolonged survival with low-dose corticosteroid therapy.

Idiopathic pulmonary hemosiderosis (IPH) is a rare disease of unknown etiology characterized by recurrent episodes of pulmonary symptoms such as cough, hemoptysis, and dyspnea. Our study consisted of 23 patients: 12 males and 11 females with IPH. The diagnosis was based on history, presence of anemia, and characteristic chest X-ray, and was confirmed by showing macrophages laden with hemosiderin in gastric washings or bronchoalveolar lavage and/or open lung biopsy. All but one patient were diagnosed in our department between 1979-1994. There was a history of multiple blood transfusions for anemia in 10 patients. Consanguinity between parents was noted in 11 patients. Severe pallor, cough, hemoptysis, and hepatomegaly were the most common findings on physical examination. All but 2 patients had hypochromic microcytic anemia of varying severity. In 12 children, moderate reticulocytosis was noted. Corticosteroids were administered with doses ranging from 5 mg every other day to 2 mg/kg/day depending on the severity of the episodes (duration of disease from 2-14 years). It is our impression that patients with IPH, benefit from long-term steroid treatment which in turn results in a milder course. Long-term low-dose steroid treatment appeared to prevent crises and assured a prolonged survival.