Lacrimal gland marginal zone lymphoma: regression after treatment of chronic hepatitis C virus infection: case report and review of the literature.

A 43-year-old woman was first admitted to the ophthalmology clinic with the complaint of a mass compressing the right eye. Based on clinical and laboratory examinations she was diagnosed as having marginal zone lymphoma (MZL) of the right lacrimal gland in addition to hepatitis C virus (HCV) infection. After the treatment for HCV infection with pegylated interferon plus ribavirin, a radiographic response of the MZL was obtained; she remains in remission through thirty months of clinical follow-up. In this case, the treatment of HCV infection led to regression of MZL suggesting the necessity of testing for HCV infection and treatment of the HCV infection should be highly considered in all HCV-positive patients with MZL's.

Relationship between oxidative stress and chronic daily headache in children.

The aim of this study was to investigate the relationship between oxidative stress and chronic daily headache (CDH) in children. Although there are reports that oxidative injury may play a role in the pathophysiology of some neurologic disorders, such as migraine and epilepsy, by disrupting or destroying cell membranes through the formation of free radical and reactive oxygen species, the pathophysiology of headache is not clearly established. A total of 38 children (16 boys and 22 girls) with CDH, aged between 7 and 15 years, were enrolled in the study. The control group consisted of 39 healthy children (17 boys and 22 girls), aged between 7 and 14 years. The mean age was 10.9 ± 2.2 years for both the groups. Activities of erythrocyte superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) as well as malondialdehyde (MDA) levels in all the children of both the groups were measured. Mean activities of erythrocyte SOD, CAT, and GPx as well as MDA levels were significantly higher in the study group than in the control group (p < 0.001). The findings of this study suggest that oxidative stress may play a causal or consequential role in children with CDH.

May long term oxcarbazepine treatment be lead to secondary hyperparathyroidism?

BACKGROUND AND PURPOSE: The adverse effects of newer antiepileptic drugs are not well-known. This study assessed the impact of oxcarbazepine (OXC) treatment on bone turnover. METHODS: Forty-four children with idiopathic focal (and/or secondarily generalized) epilepsy who had been treated with OXC for more than 1 year were compared with 33 healthy, age- and sex-matched children. Serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, osteocalcin, calcitonin, and 25-hydroxyvitamin D, and bone mineral density were measured to evaluate and compare bone mineralization between the two groups. RESULTS: The serum levels of calcium, osteocalcin, 25-hydroxyvitamin D, and bone mineral density did not differ significantly between the study and control groups. However, serum levels of parathyroid hormone, alkaline phosphatase, phosphorus, and calcitonin differed significantly between the two groups. CONCLUSIONS: These findings suggest that OXC treatment leads to secondary hyperparathyroidism with high-turnover bone disease and/or impaired intestinal calcium absorption.

Penile anthropometry of normal prepubertal boys in Turkey.

AIM: The age-related values of penile length must be known to determine abnormal penis sizes and to follow the treatment of underlying diseases. The aim of this study is to evaluate abnormal penile length in Turkish children by establishing novel reference values for Turkish population and to compare the mean penile length and other parameters with alternates from different ethnic populations and geography. METHODS: This cross-sectional study was conducted on a voluntary basis between November 2008 and November 2009 from four centres in Turkey and comprised of 1278 healthy volunteered prepubertal children. Complete stretched penile length and penis circumference measurements were used for penile length and penis circumference evaluations, respectively. All measurements were taken twice by only one investigator, and mean values were recorded. RESULTS: Penile length and penis circumference for every age group were obtained, percentile curves were established and these findings were compared with the results of previous studies. Significant differences were found between penile length of Turkish children and recently used reference values. CONCLUSION: With this study, novel reference values for penile length in prepubertal children were presented to the literature.

Emergent therapy with therapeutic plasma exchange in acute recurrent pancreatitis due to severe hypertriglyceridemia.

Hypertriglyceridemia causes acute pancreatitis in 1.3-3.8% of patients. We report here on two cases with severe (triglyceride level >1000 mg/dL) hypertriglyceridemia-induced acute recurrent pancreatitis. Both patients had uncontrolled hypertriglyceridemia and suffered from acute pancreatitis. No cause of secondary hypertriglyceridemia was detected. While stage E pancreatitis (Ranson's score: 2) was diagnosed in the first case, stage D pancreatitis with a null Ranson's score was detected in the second case. Both patients were treated with classical treatment with fluid replacement, analgesic, antibiotics and discontinuation of oral intake. Therapeutic plasma exchange (TPE) with fresh frozen plasma was performed consecutively and with two procedures on the 2nd and 3rd day in the first case. After TPE, while the triglyceride levels decreased from 4408 to 302 mg/dL, the amylase levels dropped from 4234 to 171 IU/L. In the second case, TPE was performed once daily. After TPE, the levels of triglyceride and amylase decreased from 2210 mg/dL and 1618 IU/L to 154 mg/dL and 110 IU/L, respectively. Local and systemic complications due to acute pancreatitis were not observed. Clinical signs and laboratory values improved. At the two-year follow-up of both patients, acute pancreatitis had not recurred with regular fenofibrate treatment. Hypertriglyceridemia should be considered in patients with acute recurrent pancreatitis. Although there is no definitive evidence for early application of TPE in severe hypertriglyceridemia-induced acute pancreatitis yet, therapy with TPE may be of benefit, improving the clinical course.

Effect of proanthocyanidin, arginine and glutamine supplementation on methotrexate-induced gastrointestinal toxicity in rats.

Methotrexate is a folate antagonist that is commonly used as an antitumor and antiarthritic drug. The aim of this study was to investigate the possible roles of exogenous glutamine (Glu), arginine (Arg) and proanthocyanidin (PA) on gut protection from methotrexate-induced intestinal damage in rats. Experimental rats were separated into eight groups. The first (sham) group received a 0.9% NaCl solution alone. The second group received intraperitoneal injections of methotrexate (20 mg/kg/day) administered on day 4 of the experiment and continued for 5 days. Rats in the other six groups were administered PA, Glu, Arg, Glu+PA, Arg+PA or Glu+Arg orally by gavage together with methotrexate and animals were sacrificed on day 8 of the experiment. All animals were sacrificed 4 days after methotrexate injection for histopathological analysis, tissue glutathione peroxidase, malondialdehyde and superoxide dismutase assays. Proanthocyanidin and Glu decreased the severity of intestinal injury and oxidant injury as evident by histopathology and changes in malondialdehyde levels. Histological analysis confirmed that PA and to a lesser extent Glu supplementation were more favorable than Arg for the protection of the small intestine from methotrexate-induced injury.

Infliximab in experimental alkali burns of the oesophagus in the rat.

BACKGROUND: We aimed to investigate the efficacy of infliximab, a chimeric TNF-alpha antibody, in the prevention of fibrosis in an experimental alkaline burn of the oesophagus in the rat. METHODS: Thirty-two Wistar albino rats divided into four experimental groups. Caustic oesophageal burn was induced by applying 37.5% NaOH to the distal oesophagus. Infliximab was given at a dose of 5 mg/kg via the intraperitoneal route. Group A (sham) animals were uninjured, group B had untreated oesophageal burns, group C had oesophageal burns treated with a single dose of infliximab on the first day, and Group D had oesophageal burns treated with infliximab on the first and 14th days. Efficacy of the treatment was assessed on the 28th-day by measuring stenosis index of the oesophagus and histopathological damage score, and biochemically by determining tissue hydroxyproline content. RESULTS: There was no significant difference between the Group B and the infliximab treated Groups C and D in means of tissue hydroxyproline content and histopathological damage scores. Stenosis index was not significantly different between the Group B, Group C, and Group D. CONCLUSION: Anti-TNF-alpha treatment with infliximab does not ameliorate the degree of fibrosis in alkali burns of the oesophagus in the rat. Further evaluation of inflammatory and immunological events leading to stricture in alkaline oesophageal burns may provide new perspectives for the treatment of alkaline oesophageal burns.

Urine calcium and deoxypyridinoline in assessment of response to local radiation therapy for metastatic bone disease.

To evaluate the predictability of urine calcium (Ca+2) and deoxypyridinoline (DPD) in the assessment of response to palliative radiation therapy (RT) for metastatic bone disease. Forty-two patients with osteolytic bone metastases from breast or lung primaries were enrolled in this study. Serial urine Ca+2 and DPD measurements were performed before RT, six weeks, and twelve weeks afterwards. All eligible patients received a total of 30 Gy RT in 3 Gy daily fractions. Pre-irradiation mean urine Ca+2 and DPD levels were 16 +/- 3.7 g/micromol/dL, and 89.2 +/- 61 pmol/micromol crea. Both were significantly higher than normal range. A significant correlation between pre-irradiation Ca+2 (r = 0.6, p < 0.001), DPD (r = 0.8, p < 0.001) levels and the extent of bone metastases were detected. Thirty-six patients (Group I) were alive without disease progression outside the radiation portal. Urine Ca+2 and DPD levels demonstrated a significant and progressive decrease following RT in Group I patients (p < 0.001). Clinical and radiological evaluation revealed occurrence of new bone metastases in six patients (Group II), with concurrent significant increase in concentrations of urine DPD and Ca+2 (p = 0.006 for Ca+2 and p = 0.009 for DPD, respectively). Urine Ca+2 and DPD levels can be used for assessment of response of bone to local irradiation, and are able to predict further progression of bone metastases in cancer patients.

Effect of thyroid function on LDL oxidation in hypothyroidism and hyperthyroidism.

Oxidized low-density lipoproteins (LDL) are highly suspected of initiating the atherosclerosis process. Hypothyroidism is frequently associated with hypercholesterolemia and carries increased risk for atherosclerosis. In contrast to hypothyroidism, hyperthyroidism is not associated with increased LDL cholesterol, but is associated with increased oxidized LDL. This study was designed to evaluate the changes in LDL oxidation in subjects with hypothyroidism or hyperthyroidism, and to reveal the effects of treatment in hypothyroidism and hyperthyroidism on LDL oxidation and lipid profiles. Thirty-two patients with hypothyroidism and 16 patients with hyperthyroidism were studied before the therapy and thereafter, when they were euthyroid with appropriate treatment. Plasma lipids and lipoproteins, and the oxidizability of LDL by determining the levels of malonaldehyde bis (dimethyacetyl) (MDA) and diene conjugation, were determined at baseline and after the patients were rendered euthyroid. The actual content of dienes in LDL particles was increased in hypothyroidism, with a decrease after T4 supplementation (p < .001). Dienes in LDL particles were increased in hyperthyroidism, with a decrease after treatment (p < .05). In hypothyroid patients, the lag phase was shorter in the pretreatment period than in the euthyroid period (p > .05). The lag phase of hyperthyroid patients was shorter in the pretreatment period than in the euthyroid period and hypothyroid state (p < .001). The Cu2+-catalyzed dienes of LDL and MDA oxidation in the hypothyroid state and the subsequent euthyroid states were decreased (p < .001). The Cu2+-catalyzed dienes of LDL (p < .01) and MDA oxidation (p < .001) in hyperthyroid patients after treatment were decreased. The enhanced LDL oxidation may play a role in the cardiac disease process in both hypothyroidism and hyperthyroidism.

Obstructing Crohn's disease of the duodenum: is surgery always mandatory?

Crohn's disease may involve any part of the alimentary tract. But, Crohn's disease of the duodenum is a very rare condition. Systemic steroid therapy had been shown to be effective in patients with Crohn's disease, and the most common indication for surgical intervention is duodenal obstruction. We report a case with Crohn's disease of the duodenum presenting with duodenal obstruction. Medical treatment option was successful as a first line of therapy because of young age and new diagnosis. The patient was administered mesalazine as a treatment, and the obstruction was resolved. The patient is still in remission for the last 2 years.

Partial seizure: an unusual cause of recurrent vomiting.

Partial seizure is a rare cause of nausea and vomiting. We report an adult patient with abdominal discomfort lasting 15 years accompanied by nausea and vomiting at least twice a week. On admission, physical examination and detailed laboratory tests were normal. Abdominal ultrasound examination, upper gastrointestinal endoscopy and CT scanning of the brain did not reveal any evidence of disease. Electroencephalography revealed bilateral synchronous sharp wave discharges and spike wave activities. The diagnosis of partial seizure was considered and the patient was administered sodium valproate. The patient's symptoms subsided and he has been asymptomatic for the past 20 months. We conclude that partial seizure should be considered in patients suffering from abdominal complaints who do not have any underlying gastrointestinal disorder.

Plummer-Vinson syndrome: a report of three cases.

Plummer-Vinson syndrome is characterised by dysphagia, anaemia, glossitis and oesophageal web. We report our findings in three patients with membranes in the upper oesophagus. All patients underwent endoscopic dilatation and iron replacement therapy, with good results. We review the literature of this syndrome.

In treatment of active duodenal ulcer and Helicobacter pylori eradication.

AIM: To compare the efficacy of lansoprazole and pantoprazole in treatment of active duodenal ulcer and Helicobacterpylori eradication. METHODOLOGY: A total of 50 patients, with a positive rapid urease test and endoscopically diagnosed active duodenal ulcer, were randomly assigned to one of two treatment groups after endoscopic examinations. Patients in the first group received lansoprazole 30 mg b.d., amoxycillin 1000mg b.d., clarithromycin 500 mg b.d.; patients in the second group received pantoprazole 40 mg b.d., amoxycillin 1000 mg b.d., clarithromycin 500 mg b.d for two weeks. Patients were scheduled for repeat endoscopic examination; repeat rapid urease test, and histological examination 4 weeks after the end of the therapy. RESULTS: Hp was eradicated in 84.2% of the patients received lansoprazole and in 83.3% of the patients received pantoprazole. The difference was not significant (P>0.05). In the lansoprazole group 90.5%, and in the pantoprazole group 83.3% of the patients experienced complete duodenal ulcer healing at the time of follow-up endoscopic examination. We found no statistical significant difference between the two groups. CONCLUSION: Lansoprazole and pantoprazole both have similar effect in eradication of Hp, and in terms of ulcer healing. Comparative studies in larger trials are needed to compare the efficacy of lansoprazole and pantoprazole in treatment of active duodenal ulcers.