Serum levels of polyamine synthesis enzymes increase in diabetic patients with breast cancer.

BACKGROUND: In this study, it was aimed to investigate the relationship between diabetes and breast cancer and the detection of enzymes and ornithine levels in polyamine synthesis pathway in diabetes, breast cancer and diabetic breast cancer patients. METHODS: Ornithine, arginine decarboxylase, ornithine decarboxylase and agmatinase levels have been measured in serum of all groups. Ornithine levels were measured spectrophotometrically. Arginine decarboxylase, ornithine decarboxylase and agmatinase levels were determined by ELISA kits. RESULTS: Except for the diabetic group, the levels of enzymes in the polyamine synthesis pathway were increased in all and statistically significant (P < 0.05). The increase in the levels of agmatinase was very important among the enzymes (P < 0.001). CONCLUSIONS: Decreased levels of polyamine synthase enzymes in diabetes mellitus were found to be increased patients with breast cancer. Whether and how diabetes-based breast cancer development relates to increase activity of enzymes responsible for polyamine synthesis requires further mechanistic and prospective monitoring studies in larger patient cohorts.

Mean platelet volume in hepatitis A.

OBJECTIVE: Hepatitis A virus (HAV) still continues to be a serious public health problem worldwide. Mean platelet volume (MPV) is a marker of platelet function and activation. This study aimed to evaluate the relationship between MPV in acute hepatitis A patients as compared to the control group and to assess MPV as an acute phase reactant in acute hepatitis A. PATIENTS AND METHODS: Seventy-six patients were enrolled in this study. The control group consisted of 41 healthy age- and sex-matched individuals. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, prothrombin time (PT), platelet count (PC), serum albumin (ALB), and mean platelet volume (MPV) levels were recorded. The diagnosis of HAV infection was based on anti-HAV Ig M positivity. RESULTS: The mean levels of MPV in the study group were significantly statistically lower than in the control group (p < 0.001). The MPV levels revealed no correlation with the ALT, AST, ALP, and GGT levels (p > 0.05), but the MPV levels correlated with the platelet counts (p < 0.05). A 9.75 fL [area under the curve (AUC: 0.756)] optimal cutoff level of MPV with a sensitivity of 69.7% and specificity of 68.3% was determined in the children with acute hepatitis A. CONCLUSIONS: MPV levels were significantly lower in the patients with acute hepatitis A as compared to the healthy control group. This study demonstrated that MPV may be a negative acute phase reactant for acute hepatitis A. Further studies will explain the role that MPV plays in inflammation and other viral infections.

Should transplant ureter be stented routinely or not?

OBJECTIVE: To compare early complications in patients with/without stents following renal transplantation and to determine whether routine stenting should be used in all renal transplant patients or not. PATIENTS AND METHODS: 194 patients (108 males, 86 females, mean age: 45.2 ± 13.2 years) who were followed-up at the Division of Nephrology of Istanbul Bilim University between 2006 and 2013 were included in the study. Demographic characteristics, etiologies of renal disease, comorbidities, type of renal transplantation, early complications, delayed graft function were retrospectively recorded. All patients were divided into two groups according to stent replacement. Early complications were compared. RESULTS: 101 patients were inserted double-J(DJ) stent (48 females, mean age 46.5 ± 13.7 years, mean body mass index [BMI] 26.1 ± 4.7 kg/m²) and 93 patients were not inserted stent (38 females, mean age 43.7 ± 12.6 years, mean BMI 24.3 ± 4.2 kg/m²). The rate of early complications of urinary tract infections, lymphocele, urinary leaks, wound infection and perirenal hemorrhage of patients with stent were 28.9%,3.0%,4.0%, 5.1% and 1.3%, respectively, while these rates among patients without stent were 35.5%, 2.2%,3.2%,6.5% and 1.2%,respectively. There was no significant difference between with stent and without stent groups with regard to early complications. CONCLUSIONS: Routine DJ stenting in all renal transplant patients is not necessary. Prophylactic use of DJ stent has no effect on early complications. Prophylactic DJ stent replacement can be used in obese patients, in patients receiving cadaveric transplants or in patients receiving transplants from unrelated donors.

The role of heparan sulphate in pathogenesis of Crimean-Congo hemorrhagic fever disease.

BACKGROUND & OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF) is a viral infection typically transmitted by tick bite. This study is to define the level of heparan sulphate (HS) in serum/urine since HS may play a role in the pathogenesis of hemorrhagic events in the patients with CCHF. METHODS: In this study, the patient group consisted of 79 cases with a positive diagnosis of CCHF according to PCR/ELISA outcome among the patients referred to Cumhuriyet University, School of Medicine in 2010. A total of 81 volunteers who had not any viral or metabolic disease were enrolled as the control group. The blood samples were centrifuged, and the serum and urine samples obtained were stored at - 80°C until they were studied. Then, these samples were simultaneously dissolved, and HS level was spectrophotometrically measured using glycosaminoglycans specific 1- 9, dimethyl-methylene blue (DMMB) stain. RESULTS: A statistically significant increase in the HSserum values was found both in the individuals under and above 16 yr old in the patient groups compared to the controls (p <0.05). Also there was a statistically significant increase in the urine levels of HS in the cases >16 yr old compared to the controls (p <0.05). INTERPRETATIONS & CONCLUSION: Increase of the serum/urine levels of HS was though to be due to vascular endothelium damage and to liver injury as well as vascular endothelium damage in the patients who died. Further, comprehensive studies are needed to demonstrate whether the serum/urine levels of HS are correlated to liver and vascular endothelium damage and prognosis of the disease.

The importance of myeloperoxidase enzyme activity in the pathogenesis of Crimean-Congo haemorrhagic fever.

Crimean-Congo haemorrhagic fever (CCHF) is a disease with a severe course including acute viral haemorrhagic fever, ecchymosis, thrombocytopenia, hepatic function disorder and high mortality. Myeloperoxidase (MPO) is an enzyme located in neutrophil granulocytes and plays an important role in the destruction of phagocytosed micro-organisms. The aim of this study was to analyse MPO enzyme activity in CCHF cases compared with a control group. A total of 47 randomly selected CCHF patients admitted to the Department of Infectious Diseases of Cumhuriyet University Hospital in Sivas, Turkey, were studied, and as a control group, 41 age- and sex-matched individuals without any systemic disease were included in this study. MPO enzyme activity was measured in plasma and leukocytes for both groups by the ELISA method. MPO plasma and MPO leukocyte values were calculated as 57.62 ± 8.85 and 44.84 ± 9.71 in CCHF patients, and 0.79 ± 0.29 and 0.49 ± 0.11 in the controls, respectively. MPO enzyme activity was statistically significantly higher in patients with CCHF when compared to the control group. In conclusion, MPO enzyme activity is directly related to the activation of phagocytic leukocytes, and increases in both the plasma and leukocytes in CCHF patients. The increase of the MPO enzyme activity in leukocytes due to viral load leads to the destruction of the leukocyte. It is thought that MPO enzyme activity in plasma was higher in CCHF patients due to the destruction of leukocytes. MPO enzyme activity may be important in terms of the prognosis in patients with CCHF; however, more extensive studies are required on this subject.

Radio-guided occult lesion localisation for breast lesions under computer-aided MRI guidance: the first experience and initial results.

OBJECTIVE: The purpose of this study was to present an alternative technique for the pre-operative localisation of solely MRI-detected suspicious breast lesions using a computer-assisted MRI-guided radio-guided occult lesion localisation (ROLL) technique. METHODS: Between January 2009 and June 2010, 25 females with a total of 25 suspicious breast lesions that could be detected only by MRI, and for whom breast surgery was planned, underwent the computer-assisted MRI-guided ROLL technique. A seven-channel biopsy breast array coil and computerised diagnostic workstation were used for the localisation procedure. Three-phase dynamic contrast-enhanced axial images were taken. After investigating the localisation co-ordinates with the help of intervention software on a workstation, an 18 G coaxial cannula was placed in the exact position determined. Following verification of the cannula position by additional axial scans, (99m)Tc-labelled macroalbumin aggregate and MRI contrast material were injected. Post-procedure MRI scans were used to confirm the correct localisation. RESULTS: All the procedures were technically successful. The mean lesion size was 10.8 mm (range: 4-25 mm). The mean total magnet and the mean localisation times were 28.6 min (range: 18-46 min) and 13.1 min (range: 8-20 min), respectively. Grid and pillar methods were used for localisation in 24 procedures and 1 procedure, respectively. On histopathological examination, 6 malignant, 10 high-risk and 9 benign lesions were identified. All patients tolerated the procedure well. There were no major complications. CONCLUSION: This is the first report documenting the application of MRI-guided ROLL. Based on our preliminary results, this technique is very efficient and seems to be a good alternative to wire localisation.

Determination of serum adenosine deaminase and xanthine oxidase levels in patients with crimean-congo hemorrhagic fever.

OBJECTIVE: Crimean-Congo hemorrhagic fever is an acute viral hemorrhagic fever with a high mortality rate. Despite increasing knowledge about hemorrhagic fever viruses, little is known about the pathogenesis of Crimean-Congo hemorrhagic fever. In this study, we measured serum adenosine deaminase and xanthine oxidase levels in Crimean-Congo hemorrhagic fever patients. METHODS: Serum adenosine deaminase levels were measured with a sensitive colorimetric method described by Giusti and xanthine oxidase levels by the method of Worthington in 30 consecutive hospitalized patients (mean age 42.6 +/- 21.0). Laboratory tests confirmed their diagnoses of Crimean-Congo hemorrhagic fever. Thirty-five subjects (mean age 42.9 +/- 19.1) served as the control group. RESULTS: There was a significant difference in adenosine deaminase and xanthine oxidase levels between cases and controls (p<0.05). However, neither adenosine deaminase nor xanthine oxidase levels varied with the severity of disease in the cases assessed (p>0.05). CONCLUSION: Adenosine deaminase and xanthine oxidase levels were increased in patients with Crimean-Congo hemorrhagic fever. Elevated serum xanthine oxidase activity in patients with Crimean-Congo hemorrhagic fever may be associated with reactive oxygen species generated by the xanthine/xanthine oxidase system during inflammatory responses. In addition, elevated lipid peroxidation may contribute to cell damage and hemorrhage. The association of cell damage and hemorrhage with xanthine oxidase activity should be further investigated in large-scale studies.

Determination of serum adenosine deaminase and xanthine oxidase levels in patients with crimean-congo hemorrhagic fever

OBJECTIVE: Crimean-Congo hemorrhagic fever is an acute viral hemorrhagic fever with a high mortality rate. Despite increasing knowledge about hemorrhagic fever viruses, little is known about the pathogenesis of Crimean-Congo hemorrhagic fever. In this study, we measured serum adenosine deaminase and xanthine oxidase levels in Crimean-Congo hemorrhagic fever patients. METHODS: Serum adenosine deaminase levels were measured with a sensitive colorimetric method described by Giusti and xanthine oxidase levels by the method of Worthington in 30 consecutive hospitalized patients (mean age 42.6 ± 21.0). Laboratory tests confirmed their diagnoses of Crimean-Congo hemorrhagic fever. Thirty-five subjects (mean age 42.9 ± 19.1) served as the control group. RESULTS: There was a significant difference in adenosine deaminase and xanthine oxidase levels between cases and controls (p<0.05). However, neither adenosine deaminase nor xanthine oxidase levels varied with the severity of disease in the cases assessed (p>0.05). CONCLUSION: Adenosine deaminase and xanthine oxidase levels were increased in patients with Crimean-Congo hemorrhagic fever. Elevated serum xanthine oxidase activity in patients with Crimean-Congo hemorrhagic fever may be associated with reactive oxygen species generated by the xanthine/xanthine oxidase system during inflammatory responses. In addition, elevated lipid peroxidation may contribute to cell damage and hemorrhage. The association of cell damage and hemorrhage with xanthine oxidase activity should be further investigated in large-scale studies.

Acute effect of low-flux hemodialysis process on the results of the interferon-gamma-based QuantiFERON-TB Gold In-Tube test in end-stage renal disease patients.

BACKGROUND: Screening for latent tuberculosis infection before solid organ transplantation is mandatory, but this is not so easy in uremic patients on hemodialysis (HD) treatment. The newly developed interferon-gamma (IFN-gamma)-based QuantiFERON((R))-TB Gold In-Tube test (QFT-G) seems to be superior to the other available tests. Objective. To investigate the acute effect of the low-flux HD process on the results of the QFT-G assay. METHODS: A total of 56 HD patients participated in this prospective study. They were dialyzed under low-flux HD for at least 1 month before blood sampling for QFT-G assay. This assay was performed before and after the 4-h low-flux HD session. RESULTS: Compared with the pre-dialysis level, there was an obvious reduction in the IFN-gamma production level (in response to the TB-antigen cocktails) after the HD process (P=0.00). The pre-dialysis test result was negative in 21 (37.5%), positive in 33 (58.9%), and indeterminate in 2 (3.6%) patients. One pre-dialysis negative result changed to positive after the HD process. On the other hand, 7 pre-dialysis positive and 2 indeterminate results become negative after HD (P=0.012). CONCLUSION: In order to maintain the sensitivity of QFT-G assay in chronic renal failure patients on low-flux HD treatment, it is better to perform the test immediately before (not after) the HD process.

Overcoming cloning problems by staining agarose gels with crystal violet instead of ethidium bromide in lactate dehydrogenase gene from Plasmodium vivax and Plasmodium falciparum.

In this study, lactate dehydrogenase gene from Plasmodium vivax has been tried to subclone into an expression vector. Some of the Plasmodium falciparum lactate dehydrogenase mutant genes have also been tried to clone and subclone into a vector, but we failed to clone or subclone either of the genes. DNA visualisation in electrophoretic gels typically requires UV radiation and the fluorecent dye ethidium bromide. A crystal violet-stained gel was run instead of an ethidium bromide gel and so avoided the use of UV radiation. This enabled us to clone or subclone both Plasmodium vivax lactate dehydrogenase gene and Plasmodium falciparum lactate dehydrogenase mutant genes into any desired vector.

Should mammographic screening be done in primary ovarian cancer?: A case control study in Turkish women.

Breast cancer is a significant global health problem. It is the most common malignancy in women. Mammographic screening is recommended for women older than 40 yr for early detection of breast cancer. The aim of this study is to evaluate the role of screening mammography in ovarian cancer independent of age. Eighty-four patients with ovarian cancer were evaluated with bilateral mammography. Two hundred asymptomatic healthy controls with a similar age distribution were also imaged with screening mammography. Mammography results were classified according to the American College of Radiology criteria in five groups. The median age of the study group was 51.4 (range, 27-77) and 49.3 (range, 30-75) in the control group. Screening mammography detected four cases of malignancy (4.8%) in patients with ovarian cancer; two were the primary breast carcinomas(2.5%) and two were metastatic cancers from the ovary. Five subjects (2.5%) among healthy controls were also found to have breast cancer. Although the incidence of primary breast carcinoma was found to be similar in the two groups (2.5%), mammographic imaging detected metastatic disease to the breast from the ovaries. Mammography should therefore be considered in patients with ovarian cancer independent of age.

Immunohistochemical analysis of prostate-specific antigen in female breast cancer.

PURPOSE: Prostate-specific antigen (PSA), a glycoprotein initially thought to be produced only by the epithelial cells of the prostate, has recently been found in various tissues and tumors. It has been suggested that the expression of PSA in breast cancer is a good prognostic indicator and correlated with favorable prognosis. However, in recent years opposite results have been reported. In this study, we investigated the immunoreactivity of PSA in female breast cancer to find out any relationship between PSA and prognostic parameters. PATIENTS AND METHODS: Sections of formalin-fixed, paraffin- embedded samples from 109 invasive ductal carcinomas were immunostained for PSA. The staining results were analyzed in relation to age, tumor size, histologic grade, axillary lymph node status and steroid receptors. RESULTS: PSA immunoreactivity was seen in only 11 (10.1%) out of 109 cases. All PSA positive cases were also estrogen (ER) and progesterone receptor (PR) positive. We found a statistically significant correlation between PSA and the expression of steroid receptors, while no correlation was detected with the other factors. CONCLUSION: The detection of PSA, using immunohistochemistry, does not seem to be a reliable prognostic criterion for female breast cancer patients or a marker of tumor origin.

The effects of vitamin E on the skin lipid peroxidation and the clinical improvement in vitiligo patients treated with PUVA.

Solar-simulated UV-irradiation causes changes in the enzymic antioxidant defence system in the human epidermis. The aim of this study was to investigate the effects on the skin lipid peroxidation and clinical improvement in vitiligo patients treated with PUVA. The first group of patients was treated for six months with psoralen plus UV-A (n = 15). The second group of patients was treated for six months with psoralen plus UV-A vs vitamin E (900 IU daily perorally) (n = 15). There was no significant difference in the clinical improvement between the group of patients who were treated with PUVA and vitamin E and the group of patients treated with PUVA alone (p > 0.05). Statistical analysis revealed a significant difference between the levels of lipoperoxides before and after treatment in the first group (p < 0.05), but there was no significant difference between the levels of lipoperoxides before and after treatment in the second group (p > 0.05). According to our results, vitamin E may prevent oxidative distress resulting from PUVA therapy, but does not affect the clinical improvement of the vitiligo lesions.

Outcome of living unrelated (commercial) renal transplantation.

BACKGROUND: Due to inadequate cadaveric and living related organ supply, many end-stage renal disease patients go to Third World countries for commercial transplantation, although the high risk of complications is well established and ethical arguments debate this practice. METHODS: The midterm outcome of 115 patients who had been commercially transplanted in various countries and admitted to our center for post-transplant care and follow-up between 1992 and 1999 was retrospectively analyzed. Data considering the transplantation practice and post-transplant course were collected from the patient files. Outcome of these patients was compared with those with a living related transplant performed at our center. RESULTS: The patients (91 male and 24 female; mean age of 42 +/- 12 years) were transplanted in India (N = 106), Iraq (N = 7), and Iran (N = 2). The mean follow-up period was 64.5 +/- 23.9 months. Post-transplant course was complicated by numerous surgical and/or medical complications, and many of the latter were unconventional infections caused by malaria, invasive fungal infections, and pneumonia due to various opportunistic pathogens. Overall, 52 patients still have functioning allografts, while 22 lost their grafts, 20 died, and 21 were lost to follow-up. Graft survival rates at two, five, and seven years were 84, 66, and 53%, respectively, for the study group, while it was 86, 78, and 73% for living related transplantations performed at our center (P = 0.036). Patient survival rates for the same periods were 90, 80, and 74% for the study group and 90, 85, and 80% for the living related transplantations (P = 0.53). CONCLUSIONS: Besides the ongoing ethical debate, commercial transplantation carries a high risk of unconventional complications, and despite that the patient survival rate is comparable, graft survival is worse than conventional living related transplantations at the midterm.

[Therapy of pilonidal sinus with the Limberg transposition flap]. / Die Therapie des Sinus pilonidalis mit dem Transpositionslappen nach Limberg.

Pilonidal sinus can not be mentioned as a minor surgery procedure because of high recurrence rate, high morbidity and long disability period. In our clinic between the years of 1988-1991, 92 pilonidal sinus cases were treated primarily with Limberg's flap technique. Only in two cases, late wound healing was detected, no other complications and no recurrences were seen. Compared with other primary treatment methods, Limberg's flap technique was observed to be much more convenient for pilonidal sinus cases.

[Fournier gangrene]. / Fournier-Gangrän.

Fournier's gangrene is a relatively rare, mixed aerobic and anaerobic soft tissue infection in the perineoscrotal area. Although it is convenient to give it a separate name, it is really either necrotizing fasciitis or nonclostridial myonecrosis of the scrotal and perineal areas. The condition frequently develops from perineal diseases, including perianal abscess, and fistulas, inflamed haemorrhoids and indwelling urethral catheter. In patients with Fournier's gangrene morbidity is extreme and mortality high. This article is based on a retrospective study of 15 cases of Fournier's gangrene, 13 in male and 2 in female patients. A combination of surgery and antibiotics was used to treat 9 patients. The last 6 cases were treated with a combination of surgery, antibiotics and hyperbaric oxygen. In 13 cases, the diagnosis was made on the basis of the fulminating progression of the infection to a scrotal gangrene, identification of multiple underlying pathogenic organisms and toxaemia. In the 2 female patients, a similar infection developed in the labia majora and perineum and extended to the buttocks and the anterior abdominal wall.