Helicobacter pylori's historical journey through Siberia and the Americas.

The gastric bacterium Helicobacter pylori shares a coevolutionary history with humans that predates the out-of-Africa diaspora, and the geographical specificities of H. pylori populations reflect multiple well-known human migrations. We extensively sampled H. pylori from 16 ethnically diverse human populations across Siberia to help resolve whether ancient northern Eurasian populations persisted at high latitudes through the last glacial maximum and the relationships between present-day Siberians and Native Americans. A total of 556 strains were cultivated and genotyped by multilocus sequence typing, and 54 representative draft genomes were sequenced. The genetic diversity across Eurasia and the Americas was structured into three populations: hpAsia2, hpEastAsia, and hpNorthAsia. hpNorthAsia is closely related to the subpopulation hspIndigenousAmericas from Native Americans. Siberian bacteria were structured into five other subpopulations, two of which evolved through a divergence from hpAsia2 and hpNorthAsia, while three originated though Holocene admixture. The presence of both anciently diverged and recently admixed strains across Siberia support both Pleistocene persistence and Holocene recolonization. We also show that hspIndigenousAmericas is endemic in human populations across northern Eurasia. The evolutionary history of hspIndigenousAmericas was reconstructed using approximate Bayesian computation, which showed that it colonized the New World in a single migration event associated with a severe demographic bottleneck followed by low levels of recent admixture across the Bering Strait.

Acute abdominal emergencies and spinal cord injury; our experiences: a retrospective clinical study.

STUDY DESIGN: Retrospective review of medical notes. OBJECTIVE: To describe clinical, laboratory and examination findings of acute abdominal emergencies (AAE) in Turkish patients with spinal cord injury (SCI) and to examine diagnosis and management of AAE in early stages. SETTING: Inpatient rehabilitation unit of tertiary research hospital. METHODS: The medical records of 237 SCI patients were reviewed. The SCI patients who were recruited in the study had been diagnosed with AAE and treated medically or surgically while they were inpatients at the rehabilitation clinic. RESULTS: Nine out of 237 SCI patients had been diagnosed with one of the AAE. Three patients were AIS A, three patients were AIS B and three patients were AIS C. The most common AAE was acute cholecystitis; three patients were diagnosed with this. The others were single cases of intra-abdominal hemorrhage, intra-abdominal abscess, tuba-ovarian abscess, subileus, Crohn's disease and cholangitis. Three of the patients were treated with surgery and six were treated medically. The most common symptoms in patients were fever, abdominal pain and abdominal discomfort (four of AAE). Three patients had abdominal tenderness and abdominal distension. The expected findings of AAE, rebound and defense, were positive only in two patients. CONCLUSION: Gall bladder disease is a common cause of AAE. The classic symptoms and examination findings will usually not facilitate acute abdomen diagnosis in the SCI group, so we should be aware of patients' subjective complaints and when necessary use advanced imaging techniques immediately.

Successful medical treatment of cesarean scar pregnancy: a case report.

OBJECTIVE: Cesarean scar pregnancy is implantation of the pregnancy within the fibrous tissue of the cesarean scar which is completely surrounded by myometrium. METHOD AND RESULT: A 32-year-old woman, gravida 2, para 1 presented at our emergency department with mild lower abdominal pain and minimal vaginal bleeding. She was diagnosed with cesarean scar pregnancy. Conservative treatment with methotrexate 50 mg/m2 was administered IM on days 0 and 8. Her betaHCG value was zero at the 14th week after beginning of the treatment. CONCLUSION: Repeated methotrexate administration in the management of cesarean scar pregnancy should be attempted in informed patients who especially desire fertility and can be closely followed up.

Difficulties in achieving optimal cytoreduction in primary peritoneal carcinoma management.

Primary peritoneal carcinoma (PPC) occurs mostly in older women and rarely in women under 50 years of age. The mean age of patients with PPC in our study was 65.5 years. We present the clinical and demographic data, management of cases and the results of six women who underwent exploratory laparotomy between January 2003 and August 2006.

Investigation of Keyes skin biopsy instrument for cervical biopsy procedures versus Kevorkian biopsy forceps.

OBJECTIVE: We aimed to investigate the utility and efficacy of the Keyes skin biopsy instrument for cervical biopsy procedures. MATERIAL AND METHODS: A prospective clinical trial was conducted on 50 women with cervical lesions. Colposcopy-guided cervical biopsies were collected using a Keyes biopsy punch and a Kevorkian biopsy forceps and the two methods were compared with definitive histopathological examination of the specimens obtained by the loop electrosurgical excision procedure (LEEP), conization or hysterectomy. RESULTS: There were no differences in speed of collection, diagnostic value of specimens, complication rates, or sample quality. The sensitivity, specificity, positive and negative predictivity of specimens were all 100% for both methods. CONCLUSIONS: The Keyes biopsy punch was found to be a safe, rapid and accurate diagnostic tool in cervical biopsy procedures. Based on the results of this study, the use of a Keyes punch instrument can be recommended as an alternative to other cervical biopsy methods.

A case of endodermal sinus tumor associated with the first pregnancy and successful management of the second pregnancy: a case report and review of the literature.

BACKGROUND: Pregnancy complicated by endodermal sinus tumor (EST) of the ovary has rarely been reported. CASE: A huge ovarian EST causing bowel obstruction was found in a 22-year-old patient at 34 weeks of gestation. Abnormally high alpha-fetoprotein (AFP) levels suggested a malignant germ cell tumor of the ovary. The patient was submitted to cesarean section and fertility sparing surgery, and then received four courses of combination chemotherapy. There was no evidence of recurrence 19 months after initial treatment but transvaginal ultrasound (US) evaluation showed an intrauterine pregnancy of six weeks. We delivered a 3,200 g healthy male baby with Apgar scores of 8 and 9 by elective cesarean section at 39 weeks of gestation. CONCLUSIONS: Successful outcome of a second pregnancy is possible after treatment with fertility sparing surgery and combination chemotherapy for an endodermal sinus tumor associated with a first pregnancy. Moreover checking of weekly AFP levels and performing monthly abdominal US could be effective for surveillance of these pregnancies. However management of EST during pregnancy should be based on consideration of the patient's presenting condition, preferences, and gestational age.

Primary serous carcinoma of the fallopian tube with synchronous cervical epidermoid carcinoma in situ: a case report.

Primary carcinoma of the fallopian tube is rare and its preoperative diagnosis difficult due to the lack of specific symptoms. In this report we present a rare case of primary carcinoma of the fallopian tube with synchronous cervical high-grade squamous intraepithelial lesion (HSIL). A 39-year-old women was admitted to our hospital for routine gynecological examination and underwent surgery because of the finding of HSIL on a routine papanicolaou smear. The histological diagnosis on cervical biopsy and conization material were of cervical intraepithelial neoplasia III (CIN III). Serous carcinoma of the fallopian tube was incidentally found during a planned hysterectomy operation. Postoperatively the patient received six cycles of adjuvant chemotherapy (carboplatin and paclitaxel) and is still under routine control. In conclusion, the genital tract should be examined in detail in case of any existence of a primary genital tumor and CA125 should be added to the examination.

Synchronous cervical and vulvar malign melanomas: metastasis or multifocality of the disease? A case report and review of the literature.

Vulvar melanoma is rare and has a worse prognosis and higher recurrence rate than cutaneous melanoma. Multifocality is also more common in vulvar melanomas. A case having synchronous cervix and vulvar malign melanoma is presented and discussed in the light of the literature whether it is a metastasis of vulvar malign melanoma to cervix or multifocal originated disease. In conclusion, it is important to evaluate the whole genital system in vulvar melanomas as it is in squamous cancers.

The effects of vaginal delivery and cesarean section on bladder neck mobility and stress urinary incontinence.

We investigated the effects of vaginal delivery (VD) and cesarean section (CS) on bladder neck (BN) mobility and genuine stress incontinence (GSI). Of the 230 patients included in the study, 95 had CS, 95 had VD and the remaining 40 continent nulliparous women served as controls. In both the CS and the VD groups 40 women had delivered once, 35 women twice and 20 women three times. Perineal ultrasonography was performed in all patients. Vaginal delivery affects BN mobility and its position more negatively than does CS, and increases its mobility in two directions. The CS group also has similar findings after the third delivery. The GSI rate was not significantly different between the CS and the VD groups, but the VD group had a higher percentage. Our study also shows that BN mobility is associated with GSI compared to the continent controls.