Autotransplantation of an inverse impacted dilacerated incisor: a case report with 11-year follow-up.

BACKGROUND: Dilaceration can lead to impaction of maxillary incisors, resulting in both aesthetic and functional problems. This case report presents the multidisciplinary approach to managing an inverse impacted dilacerated left lateral incisor in a 9-year-old male patient. CASE REPORT: The orthodontic alignment of the remaining three incisors was achieved within six months. After using the diode laser to remove the gingiva covering the right lateral incisor during alignment process, a lingual button was bonded. The primary left canine and the impacted permanent left lateral incisor were extracted by raising the full-thickness mucoperiosteal flap, followed by the transplantation of the dilacerated lateral incisor into its correct position, splinted to the adjacent central incisors using composite resin. Root canal treatment was performed after the apical plug was created with mineral trioxide aggregate. The composite splint was removed after three weeks, and a new bracket was bonded to the left lateral incisor. It was left passively for 18 months until the permanent canines started to erupt. Light orthodontic forces were then applied for six months, and a passive eruption was expected over three months to properly position the canines within the dental arch. After an 11-year follow-up, the incisor displayed no clinical symptoms, although radiographic examination revealed external resorption in the long-term. CONCLUSION: This case demonstrates the successful and fast autotransplantation of an immature inverse impacted dilacerated incisor, highlighting the long-term clinical success and favorable aesthetic outcomes.

A comparison of the social cognition and neurocognitive characteristics of adolescents with suicide behavior, adolescent with depression and healthy controls.

INTRODUCTION: Deficits in neurocognition and social-cognition have been suggested to be an endophenotype for suicidal behavior. We aimed to compare the social-cognition and neurocognitive characteristics of adolescents diagnosed with depression with and without suicidal behavior and to investigate whether these functions predict suicide. METHOD: Adolescents diagnosed with Major Depressive Disorder (MDD) with suicidal behavior (n = 42); MDD without suicidal behavior (n = 44) and age- and sex-matched controls (n = 43) were included. The University of Pennsylvania Computerized Neurobehavioral Test Battery and Autism Spectrum Screening Questionnaire (ASSQ) were used to evaluate social-cognition and neurocognitive characteristics. RESULTS: Several neurocognitive domain values of MDD groups, were significantly different from the control group. Neutral emotion recognition task (p = 0.025) and ASSQ scores were found to be significantly impaired in the patient groups (p < 0.001). Logistic regression analysis showed that, only the increase in the Suicide Probability Scale score was found to be significant as a risk factor predicting suicide (p = 0.007, OR: 1.246). CONCLUSION: While the neurocognitive and social-cognitive performances of adolescents with MDD were significantly lower than the control group, these performances in the two depression groups were similar. When the predictors of suicidal behavior were examined, it was found that only the increase in suicidal ideation scores predicted suicide.

Assessment of Tp-Te interval in patients with cardiac AL amyloidosis.

BACKGROUND: Prolonged Tp-Te interval is strongly associated with fatal ventricular arrhythmias and mortality. This association has been demonstrated in various diseases. However, the current literature does not give any information on Tp-Te interval in cardiac amyloid light-chain (AL) amyloidosis. METHODS: We retrospectively screened 116 cardiac AL amyloidosis patients and 35 patients were included in the study. Demographic, laboratory, 12-lead electrocardiographic (QTc, Tp-Te V1-V6) and transthoracic echocardiographic data of the patients were analysed and compared with 35 healthy controls. RESULTS: QTc and Tp-Te V2-V5 were significantly prolonged in the cardiac AL amyloidosis group (p < 0.05). Also, there was a positive and statistically significant correlation between the parameters of QTc and Tp-Te V3-V6, and also between the parameters of interventricular septum thickness at enddiastole and Tp-Te V2-V5. CONCLUSION: We present the first strong evidence of prolonged Tp-Te intervals in patients with cardiac AL amyloidosis. There may also be a relationship between prolonged Tp-Te interval and the development of arrhythmia in this patient group, as in some other groups. There is a need for prospective studies examining the relationship of prolonged Tp-Te interval with arrhythmias and its prognostic significance in cardiac AL amyloidosis.

Effect of main pancreatic duct suture ligation on the prevention of clinically relevant pancreatic fistula after distal pancreatectomy: analysis of 82 consecutive patients.

OBJECTIVE: This study aimed to examine the factors linked to the development of clinically significant pancreatic fistulas following distal pancreatectomy (DP) and to assess the efficacy of suture ligation of the main pancreatic duct. PATIENTS AND METHODS: A single-center retrospective study was performed on the medical records of 82 patients who underwent DP in our institution between January 2011 and December 2019. RESULTS: There were 28 males (34.1%) and 54 females (65.9%). The patients' age ranged from 18 to 86 years (median: 55.5 years). Indications for DP included primary pancreatic disease (n=63, 76.8%) and non-pancreatic disease (n=19, 23.2%). Postoperative mortality and morbidity rates were 3.7% and 48%, respectively. Pancreatic parenchymal closure was accomplished by a hand-sewn technique or mechanical stapling in 89 and 13 patients, respectively. Identification of the pancreatic duct and suture ligation was performed in 46 patients (56.1%). Pancreatic fistula was developed in 20 patients (24.4%); 12 fistulas were classified as Grade B, and 8 as Grade C. Biochemical leaks (Grade A) were identified in 8 patients (9.8%). Multivariate analysis indicated that failure to ligate the main pancreatic duct was the only variable associated with an increased risk for pancreatic leak (p=0.031; odds ratio=0.233; 95% confidence interval, 0.062-0.879). CONCLUSIONS: Pancreatic leak remains a common complication after DP. The incidence of leaks is reduced significantly when the main pancreatic duct is identified and directly ligated during DP.

Criteria for Hyperinflammation Developing in COVID-19: Analysis of 2 Cohorts From Different Periods of the Pandemic.

OBJECTIVE: Hyperinflammation (HI) that develops in week 2 of COVID-19 contributes to a worse outcome. Because week 2 laboratory findings can be relatively mild, the available criteria for classification of hemophagocytic lymphohistiocytosis or macrophage activation syndrome are not helpful. METHODS: Our study included a discovery cohort of patients from Turkey with symptomatic COVID-19 who were followed up while hospitalized during the initial wave and a replication cohort of hospitalized patients from a later period, all of whom required oxygen support and received glucocorticoids. Diagnosis of HI was made by an expert panel; most patients with COVID-19-associated HI (HIC) received tocilizumab or anakinra. Clinical and laboratory data from start day of treatment with tocilizumab or anakinra in HIC patients were compared with the data from day 5-6 in patients without HIC. Values maximizing the sensitivity and specificity of each parameter were calculated to determine criteria items. RESULTS: The discovery cohort included 685 patients, and the replication cohort included 156 patients, with 150 and 61 patients receiving treatment for HI, respectively. Mortality rate in HI patients in the discovery cohort (23.3%) was higher than the rate in patients without HI (3.7%) and the rate in patients in the overall replication cohort (10.3%). The 12-item criteria that we developed for HIC showed that a score of 35 provided 85.3% sensitivity and 81.7% specificity for identification of HIC. In the replication cohort, the same criteria resulted in 90.0% sensitivity for HIC; however, lower specificity values were observed because of the inclusion of milder cases of HIC responding only to glucocorticoids. CONCLUSION: The use of the 12-item criteria for HIC can better define patients with HIC with reasonable sensitivity and specificity and enables an earlier treatment start.

Ileal rhabdomyosarcoma in a patient with a history of squamous cell lung cancer.

Rhabdomyosarcoma is an infrequent muscular cancer seen in adults. We present a case of ileal intussusception due to pleomorphic rhabdomyosarcoma in a patient diagnosed previously with squamous cell carcinoma of the lung (SCCL). The patient was a 68-year-old man with a history of SCCL. He was admitted to the emergency department for nausea, emesis and obstipation. Surgical investigation of the abdomen revealed an intussusception caused by a tumour located 160cm distal of the ligament of Treitz. Pathological examination showed that tumour was a primary rhabdomyosarcoma of the ileum. This case contributes to the literature by defining an infrequent presentation of rhabdomyosarcoma causing ileal intussusception in an adult patient.

NF-κB-mediated effects on behavior and cartilage pathology in a non-invasive loading model of post-traumatic osteoarthritis.

OBJECTIVE: This study aimed to examine the temporal activation of NF-κB and its relationship to the development of pain-related sensitivity and behavioral changes in a non-invasive murine knee loading model of PTOA. METHOD: Following knee injury NF-κB activity was assessed longitudinally via in vivo imaging in FVB. Cg-Tg (HIV-EGFP,luc)8Tsb/J mice. Measures of pain-related sensitivity and behavior were also assessed longitudinally for 16 weeks. Additionally, we antagonized NF-κB signaling via intra-articular delivery of an IκB kinase two antagonist to understand how local NF-κB inhibition might alter disease progression. RESULTS: Following joint injury NF-κB signaling within the knee joint was transiently increased and peaked on day 3 with an estimated 1.35 p/s/cm2/sr (95% CI 0.913.1.792 p/s/cm2/sr) fold increase in signaling when compared to control joints. Furthermore, injury resulted in the long-term development of hindpaw allodynia. Hyperalgesia withdrawal thresholds were reduced at injured knee joints, with the largest reduction occurring 2 days following injury (estimate of between group difference 129.1 g with 95% CI 60.9,197.4 g), static weight bearing on injured limbs was also reduced. Local delivery of an NF-κB inhibitor following joint injury reduced chondrocyte death and influenced the development of pain-related sensitivity but did not reduce long-term cartilage degeneration. CONCLUSION: These findings underscore the development of behavioral changes in this non-invasive loading model of PTOA and their relationships to NF-κB activation and pathology. They also highlight the potential chondroprotective effects of NF-κB inhibition shortly following joint injury despite limitations in preventing the long-term development of joint degeneration in this model of PTOA.

The harm of anticoagulation in patients with low-risk by CHADS2 and reclassified as high-risk by CHA2DS2VASc: inferences from TRAF cohort.

OBJECTIVE: There is a gap in the knowledge concerning oral anticoagulation (OAC) in atrial fibrillation (AF) patients with a non-high risk of stroke. CHA2DS2VASc and CHADS2 scores generated imprecise risk estimates for low risk patients. We aimed to assess OAC in patients with low risk by CHADS2 and reclassified as high-risk by CHA2DS2VASc. PATIENTS AND METHODS: In this study, retrospective nationwide population-based study, data were obtained from the Turkish claims and utilization management system. Patients with non-valvular AF (n=451,113) between 2007 and 2012 sub-divided into those with a CHA2DS2VASc≥1 and CHADS2=0 (n=41,273) who were off-warfarin (n=29,448) and on-warfarin (n=11,825). Stroke and systemic embolism, major bleeding, all-cause mortality, net clinical benefit (NCB) and ultimate NCB (UNCB) were assessed. RESULTS: Of the total cohort (mean age 66.1 ± 14.1 years, 56.1% female), CHA2DS2VASc improved the net reclassification index of observed 5-year composite thromboembolic endpoint by 6.9% (p<0.05). CHA2DS2VASc reclassified 9.7% low risk patients as high risk. Among reclassified-high-risk category (patients with a CHA2DS2VASc score of ≥1 and CHADS2 score of 0), major bleeding for that prescribed warfarin was 3% and higher than the rate of thromboembolism among those off-warfarin. NCB (-0.035) and UNCB (-0.021) were negative. Death and hospitalization at 1 year were significantly higher for on-warfarin group. CONCLUSIONS: Clinical outcomes, net clinical benefit indices are negative; rates of death and hospitalization were significantly higher for OAC in reclassified category. This emphasizes the importance of greater attention to balancing the risks and benefits of OAC in patients with low risk by CHADS2 and reclassified as high-risk by CHA2DS2VASc.

Importancia pronóstica de la captación de 18F-Fluorodeoxiglucosa mediante tomografía de emisión de positrones para el cáncer de pulmón de células no pequeñas en estadio III tratado con quimio-radioterapia definitiva / Prognostic importance of 18F-fluorodeoxyglucose uptake by positron emission tomography for stage III non-small cell lung cancer treated with definitive chemoradiotherapy

OBJETIVOS: Existe heterogeneidad en la supervivencia entre los pacientes con cáncer de pulmón de células no pequeñas (NSCLC), aun dentro del mismo estadio. Nuestro objetivo fue evaluar el papel pronóstico del máximo valor de captación estandarizado pretratamiento (SUVmáx) en pacientes tratados con quimiorradioterapia concurrente definitiva para NSCLC estadio III. MATERIALES Y MÉTODOS: Entre 2010 y 2017, se incluyó en el estudio a 103 pacientes con NSCLC estadio III sometidos a PET/TC con 18F-FDG en el momento del diagnóstico. RESULTADOS: Los estadios tumorales superiores se correlacionaron con el SUVmáx pretratamiento de los ganglios linfáticos (p = 0,005), pero no guardaron relación con el SUVmáx del tumor primario (p = 0,2). El SUVmáx medio de los ganglios linfáticos fue de 2,84, 8,06, y 11,11 en los estadios IIIa, IIIb y IIIc, respectivamente. Los estadios nodales superiores se correlacionaron también con un SUVmáx superior de los ganglios linfáticos (p = 0,01). Con arreglo al análisis ROC, no se observó ningún valor de corte significativo de SUVmáx para el tumor primario, por lo que las variables continuas se utilizaron para los análisis de supervivencia. El mejor punto de corte para SUVmáx fue de 3,5 para los ganglios linfáticos, por lo que el SUVmáx de los mismos se evaluó como variable dicotómica y continua. El SUVmáx pretratamiento del tumor primario no predijo los resultados de supervivencia, pero tanto las variables dicotómica y continua de SUVmáx de los ganglios linfáticos predijeron la supervivencia libre de recurrencia y la supervivencia global. El estadio nodal (N0-2 vs. N3) y la estadificación de la AJCC (IIIa vs. IIIb vs. IIIc) constituyeron el resto de factores pronósticos. CONCLUSIONES: El SUVmáx pretratamiento de los ganglios linfáticos tuvo un valor pronóstico en los pacientes tratados con quimiorradioterapia concurrente definitiva para el NSCLC en estadio III. En ensayos futuros, el SUVmáx pretratamiento de los ganglios linfáticos podría servir de guía a los pacientes que pudieran utilizar tratamientos más agresivos

OBJECTIVES: Survival heterogeneity exists among patients with non-small cell lung cancer (NSCLC), even within the same stage. We aimed to evaluate the prognostic role of pre-treatment maximum standardized uptake value (SUVmax) in patients treated with definitive concurrent chemoradiotherapy for stage III NSCLC. MATERIALS AND METHODS: Between 2010 and 2017, 103 patients with stage III NSCLC who underwent 18F-FDG PET/CT at the time of diagnosis were included in the study. RESULTS: Higher tumor stages were correlated with higher pre-treatment SUVmax of lymph nodes (LNs) (p = 0.005) but were not correlated with higher SUVmax of primary tumor (p = 0.2). The median SUVmax of LNs was 2.84, 8.06, and 11.11 in stage IIIa, IIIb and IIIc, respectively. Higher nodal stage was also correlated with higher SUVmax of LNs (p = 0.01). According to ROC analysis, there was no significant cut-off value of SUVmax observed for primary tumor, therefore continuous variables were used for survival analyses. The best SUVmax cut-off was 3.5 for the LNs, therefore the SUVmax of LNs was evaluated as both a dichotomous and a continuous variable. Pre-treatment SUVmax of primary tumor did not predict survival outcomes but both the continuous and dichotomous variables of SUVmax of LNs predicted recurrence free survival and overall survival. Nodal stage (N0-2 vs. N3) and AJCC stage (IIIa vs IIIb vs. IIIc) were the other prognostic factors. CONCLUSIONS: Pre-treatment SUVmax of LNs had prognostic value in patients treated with definitive concurrent chemoradiotherapy for stage III NSCLC. In future trials, pre-treatment SUVmax of the LNs would serve as a guide for patients who might benefit from more aggressive treatments

Prognostic importance of 18F-fluorodeoxyglucose uptake by positron emission tomography for stage III non-small cell lung cancer treated with definitive chemoradiotherapy. / Importancia pronóstica de la captación de 18F-Fluorodeoxiglucosa mediante tomografía de emisión de positrones para el cáncer de pulmón de células no pequeñas en estadio III tratado con quimio-radioterapia definitiva.

OBJECTIVES: Survival heterogeneity exists among patients with non-small cell lung cancer (NSCLC), even within the same stage. We aimed to evaluate the prognostic role of pre-treatment maximum standardized uptake value (SUVmax) in patients treated with definitive concurrent chemoradiotherapy for stage III NSCLC. MATERIALS AND METHODS: Between 2010 and 2017, 103 patients with stage III NSCLC who underwent 18F-FDG PET/CT at the time of diagnosis were included in the study. RESULTS: Higher tumor stages were correlated with higher pre-treatment SUVmax of lymph nodes (LNs) (p=0.005) but were not correlated with higher SUVmax of primary tumor (p=0.2). The median SUVmax of LNs was 2.84, 8.06, and 11.11 in stage IIIa, IIIb and IIIc, respectively. Higher nodal stage was also correlated with higher SUVmax of LNs (p=0.01). According to ROC analysis, there was no significant cut-off value of SUVmax observed for primary tumor, therefore continuous variables were used for survival analyses. The best SUVmax cut-off was 3.5 for the LNs, therefore the SUVmax of LNs was evaluated as both a dichotomous and a continuous variable. Pre-treatment SUVmax of primary tumor did not predict survival outcomes but both the continuous and dichotomous variables of SUVmax of LNs predicted recurrence free survival and overall survival. Nodal stage (N0-2 vs. N3) and AJCC stage (IIIa vs IIIb vs. IIIc) were the other prognostic factors. CONCLUSIONS: Pre-treatment SUVmax of LNs had prognostic value in patients treated with definitive concurrent chemoradiotherapy for stage III NSCLC. In future trials, pre-treatment SUVmax of the LNs would serve as a guide for patients who might benefit from more aggressive treatments.

Helicobacter pylori and cardiovascular disease.

Helicobacter pylori (H. pylori) is one of the most common infections in human. The association between H. pylori and gastrointestinal diseases including peptic ulcer, chronic gastritis, mucosa associated tissue lymphoma (MALT) and gastric cancer is well known. However it was also suggested that H. pylori was linked to various extra-gastrointestinal disorders such as diabetes mellitus and coronary artery disease. In this review we summarized the association between H. pylori and cardiovascular disease.

Sarcopenia assessment project in the nursing homes in Turkey.

BACKGROUND/OBJECTIVES: Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO. SUBJECTS/METHODS: This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria. RESULTS: According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population. CONCLUSIONS: Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered.

An alternative way for the evaluation of zinc status in the elderly; nail zinc levels and relationship with Alzheimer's disease.

BACKGROUND: Zinc is one of the most important elements for human body. Zinc deficiency can occur in any age, if it is seen in elderly its clinical results can be more harmful due to already diminished functions. Some studies showed zinc deficiency has an important role in the pathogenesis of Alzheimer disease. In this study we measured the nail zinc levels and aimed to show its clinical implications in geriatric patients, especially Alzheimer disease. PATIENTS AND METHODS: 43 patients with Alzheimer disease and 89 patients with normal cognitive function were evaluated. The diagnosis of Alzheimer disease was made according to DSM-IV and NINCDS-ADRDA criteria after cognitive assessment and neuroimaging performed using magnetic resonance. Hand fingernail samples are obtained from the patients. RESULTS: Mean zinc level from fingernail samples was 117.99 ± 73.44 ppm in Alzheimer Disease patients, 123.86 ± 77.98 ppm in control group (p: 0.680). CONCLUSIONS: This is the first study measuring nail zinc levels in elderly patients with and without Alzheimer disease. Our data reveal no significant difference in nail zinc levels between two groups. However, fingernail zinc may be a useful biomarker in elderly population.  

Malnutrition in Turkish nursing homes: a correlate of short term mortality.

OBJECTIVE: Elderly nursing home residents are under high risk of malnutrition. Early interventions to prevent malnutrition may play a critical role in malnutrition-mortality correlation. This study aimed to obtain insight into the prevalence of malnutrition in nursing homes in the capital city of Turkey and the role of malnutrition in predicting the risk for short-term mortality. DESIGN: This study was conducted in seven different residential care facilities in Ankara. MEASUREMENTS: Nutritional status was evaluated by Mini Nutritional Assessment-Short Form. RESULTS: The mean age of the 534 participants was 79.46±7.22 years. Nutritional assessment revealed that 15.9% of all older adults suffered from malnutrition and another 53.6% were at risk of malnutrition. The mortality rate for all subjects was 118 (22.1%) over 18 months, which was significantly higher in participants with malnutrition. CONCLUSIONS: We noted a high prevalence of malnutrition and a strong correlation of increased mortality with malnutrition in nursing home residents. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy in nursing homes.

Antimicrobial and antioxidant activities of Stachys lavandulifolia subsp. lavandulifolia essential oil and its infusion.

Stachys lavandulifolia Vahl. subsp. lavandulifolia (Lamiaceae) is widely used in south Anatolia as a herbal tea. It is used for the treatment of gastrointestinal and respiratory disorders. Constituents of the essential oil obtained by hydrodistillation were analyzed both by GC-FID and GC/MS, simultaneously. Thirty-seven compounds representing 98.3% of the oil were characterized. Beta-Phellandrene (27%), alpha-pinene (18.5%) and germacrene-D (13%) were found as major components of the oil. Anticandidal, antibacterial and antioxidant properties of the oil and the prepared infusion were evaluated using several methods. The oil exhibited good inhibitory activity on Candida tropicalis (MIC 0.094 mg/mL). Staphylococcus aureus and Salmonella typhimurium growths were also inhibited by the oil at a concentration of 0.375 mg/mL. The prepared infusion of the flowering aerial parts showed weak antimicrobial effects against all the tested microorganisms, but demonstrated a remarkably radical scavenging activity (IC50: 3.9 microg/mL).

Iron deficiency can cause cognitive impairment in geriatric patients.

OBJECTIVES: Deficiency of iron, which plays an important role in oxygen transport and storage, may lead to cerebral hypoxia and cognitive decline. This relationship which was studied in children and adults was not evaluated in the elderly. The objective of this study is to examine the effect of iron deficiency on cognitive function in the elderly. DESIGN, SETTING, PARTICIPANTS: This is a cross-sectional study conducted in a geriatric medicine outpatient clinic of a university hospital. Consecutive 2009 patients admitted to Geriatric Medicine outpatient clinic were examined and 622 patients who fulfilled the inclusion criteria were enrolled in the study. MEASUREMENTS: Comprehensive geriatric assessment, cognitive assessment and laboratory analysis including blood count, iron, total iron binding capacity, ferritin, and transferrin saturation were performed. RESULTS: Mean age of the study group was 72.5±6.5 and 439 (70.6%) were women. MMSE scores were moderately and significantly correlated with iron levels (r=0.33, p<0.001) and transferrin saturation (r=0.32, p<0.001). Transferrin saturation was significantly lower in the patients with dementia (p=0.040). It was found that patients with iron deficiency had lower MMSE scores (p<0.001) and this relationship was also present in patients without anemia (p=0.004). CONCLUSION: The results of this study revealed a negative influence of iron deficiency on cognitive function and this influence was independent from the presence of anemia. As iron deficiency can be easily diagnosed and treated, detecting its effect on cognitive function is of importance. Screening for iron deficiency and initiating appropriate treatment should be a routine part of comprehensive geriatric assessment.

Liver alveolar echinococcosis metastasized to the breast.

BACKGROUND: Alveolar echinococcosis (AE) is a potentially fatal and chronically progressive infestation produced by the multivesicular metacestode of Echinococcus multilocularis, which most commonly affects the liver, lungs, and brain. CASE REPORT: We present a case of AE in which an alveolar cyst, as a result of exophytic growth, adhered to intra-abdominal and pelvic organs and metastasized to the breast. Exploration showed that the exophytic cyst in the liver filled the entire abdominal cavity, reaching to the uterus and bladder, and was adherent to the neighboring tissues and organs. This cystic lesion was totally excised, as was the 7×6 cm cystic lesion in the right breast. CONCLUSIONS: The liver is the most common site for echinococcal cysts of the pastoral strains (>65%), followed by the lungs (25%); the cyst is seen less frequently in the spleen, kidneys, heart, bone, and central nervous system. AE must be considered in areas where liver cysts are endemic and in the presence of a liver cyst, and the organs where a metastasis is possible must be thoroughly investigated. Furthermore, in these areas, when cystic disorders of the breast are present, AE should not be discounted among possible definitive diagnoses.

Intra-erythrocyte magnesium levels and their clinical implications in geriatric outpatients.

OBJECTIVES: Magnesium deficiency has been implicated as a factor in numerous chronic diseases and previous studies suggest a greater prevalence of occult magnesium deficiency among older adults. Serum is the choice for the assessment of most analyses used in clinical medicine, although serum magnesium concentrations have been shown to be poor predictors of intracellular magnesium concentration. The aim of this study was to compare intracellular and extracellular magnesium concentrations in geriatric outpatients. Moreover, we examined whether a significant correlation between magnesium parameters and clinical outcome existed. DESIGN: Cross-sectional study. SETTING: Geriatric medicine outpatient clinic of a university hospital. PARTICIPANTS: A total of 246 patients with a mean age of 71.9 ± 5.7 years were involved. MEASUREMENTS: Intra-erythrocyte magnesium levels were analyzed with atomic absorption spectrophotometry. RESULTS: Serum magnesium levels were within normal range in all patients, whereas intra-erythrocyte magnesium measurements were low in 57% of the patients. Increase in serum levels were together with just only a slightly increase in intra-erythrocyte measurements and the relationship was very weak. Intra-erythrocyte Mg levels were not significantly correlated with many laboratory or clinical parameters. CONCLUSION: Our results confirm that intra-erythrocyte Mg does not correlate with serum levels and clinical parameters in geriatric outpatients, but further studies are needed to define the correlation.