Use of hyperbaric oxygen therapy of purpura fulminans in an extremely low birth weight preterm: A case report.

Purpura fulminans (PF) is a rare and fatal complication of septic shock or diffuse intravascular coagulation (DIC) resulting in skin and soft tissue necrosis. PF can be caused by congenital or acquired protein C (PC) or protein S (PS) deficiency. The most common cause of PF in a neonate is sepsis. In our extremely low birth weight preterm case, due to PF that started in the right-hand fingers, examination was made and protein S deficiency was detected as well as MTHFR (A1298C) and Factor V Leiden (R506Q) homozygous mutations. While being unresponsive to fresh frozen plasma (FFP) and unfractionated heparin (UFH) therapy, we want to highlight the curative treatment with hyperbaric oxygen (HBOT), which has not previously been used in extremely low birth weight preterm infants for this purpose.

Does increased immune response at early postpartum period have a relationship with metabolic markers and subsequent fertility?

The aim of the present study was to investigate blood parameters and subsequent fertility in cows with or without increased postpartum polymorphonuclear neutrophil activity. The study was conducted with 15 Brown Swiss cows between 1-3 lactations. Polymorphonuclear neutrophil activities were assessed at 10±4 days before and after parturition. The cows which maintained their phagocytic and oxidative burst activites compared to the prepartum period were classified as control (CON), and cows which increased phagocytic and oxidative burst activites were defined as increased cellular immune response (ICIR) cows. Energy, protein metabolism markers, hepatic enzymes, blood mineral levels and body condition scores were measured at -10±4, 3±2, 10±4 days relative to parturition. Pregnancy rates, the number of inseminations, and calving to pregnancy intervals were evaluated. The mean non-esterified fatty acid (NEFA) and beta- -hydroxybutyric acid (BHB) concentrations were lower in ICIR cows. Mean serum calcium (Ca) concentrations were in subclinical hypocalcemia level at day 3±2, 10±4 days postpartum in CON cows. Postpartum immune cell functions and NEFA, BHB concentrations were negatively cor- related. The calving to pregnancy interval were longer in the control cows. However, total preg- nancy rates and the number of insemination in both groups were similar. In conclusion, postpar- tum polymorphonuclear neutrophil activity is affected by periparturient metabolic status. Postpartum energy metabolites negatively affected the postpartum cellular immune response. The increased postpartum polymorphonuclear neutrophil activity at early postpartum period is positively related with subsequent fertility in dairy cows.

Association among lipopolysaccharide, the transforming growth factor-beta superfamily, follicular growth, and transcription factors in spontaneous bovine ovarian cysts.

The aim of this study was to investigate some of the growth and transcriptional factors originating from oocytes and granulosa cells in follicular fluid and to identify the relationships between the basic blood metabolite-metabolic hormones and intrafollicular lipopolysaccharide (LPS) concentrations. Thirty cows included in the study were allocated into 2 groups comprising 15 cows with healthy preovulatory follicles (cyclic cows) and 15 cows with confirmed cystic follicles. The ovaries and uteri of all cows were assessed by transrectal ultrasonographic examination. Blood serum samples were collected at 15, 25, 35, 45, and 55 d after calving for analysis of nonesterified fatty acids, ß-hydroxybutyrate, insulin, glucose, IGF-I, ACTH, and cortisol. Ovaries and uteri were examined using transrectal ultrasound. Vaginal discharge was evaluated on the same days. Follicular fluid was also aspirated on days 35-55 from the healthy preovulatory follicles and cystic follicles using a transvaginal ovum pickup method. The densitometric levels of inhibin-α, growth and differentiation factor (GDF-9), bone morphogenetic protein (BMP-6), and GATA-4 and GATA-6 proteins were analyzed by the Western blotting technique; the concentrations of antimullerian hormone (AMH), IGF-I, estradiol-17 beta (E2), and progesterone (P4) were determined by ELISA; and the concentrations of LPS in the follicular fluid were measured by the Limulus amebocyte lysate test. The serum insulin, ACTH, and cortisol concentrations were higher in cystic cows than cyclic cows, but serum IGF-I concentrations were lower in cystic cows. The IGF-I concentrations of cystic follicular fluids were lower, whereas AMH levels were significantly greater than those of healthy preovulatory follicular fluids. The cystic follicles had significantly lower expression levels of GDF-9, BMP-6, GATA-4, and GATA-6; in contrast, inhibin-α expression and LPS concentrations were significantly higher than in healthy preovulatory follicles. The proportion of pathologic vaginal discharge within 25 d postpartum in cystic cows were higher than in the cyclic group. In conclusion, it is suggested that intrafollicular dysregulation of the transforming growth factor-ß superfamily, growth, and transcriptional factors is affected by high intrafollicular LPS concentrations and systemic metabolic changes and these disturbances may be responsible for the generation of ovarian cysts.

Giant pericardial cyst with a growing feature.

Pericardial cysts are rare and benign lesions of the heart. They are usually asymptomatic and diagnosed incidentally on echocardiography or chest X-ray. In this report, we present an extremely rare case of a symptomatic giant pericardial cyst (11.6 cm × 10.6 cm × 8 cm) of a 55-year-old male patient who was admitted to our cardiology clinic. A thoracic computed tomography (CT) in 2013 revealed a giant pericardial cyst. However, at that time, the patient was asymptomatic and follow-up was recommended. Recent thoracic CT and magnetic resonance imaging demonstrated a significantly growing feature of this cyst with impending possible complications.

Intraductal papillary mucinous neoplasm of the pancreas associated with neuroendocrine tumor: A case report.

INTRODUCTION: Intraductal papillary mucinous neoplasm is an uncommon cystic tumor of pancreas that can be associated with ductal adenocarcinoma. Coexistence of pancreatic IPMN and neuroendocrine tumor is very rare. Here, we report the imaging features of mixed type intraductal papillary mucinous neoplasia of the pancreas with high grade dysplasia together with neuroendocrine carcinoma and perform review of the literature. PRESENTATION: A 68-year old patient has been evaluated for possible IPMN that was suspected during ultrasound. MRI revealed main and side branch duct dilatations. At the head, a contrast enhancing nodular lesion was identified. Due to the presence of high risk stigmata according to guidelines, surgery was performed. Histopathological examination revealed an unusual association, including mixed type IPMN and neuroendocrine carcinoma. DISCUSSION: The concomitant occurrence of pancreatic IPMN and neuroendocrine tumor has been reported in case studies and brief reviews. Yet, the imaging findings and underlying molecular mechanisms of this entity has not been fully understood. In addition to this unusual association, pancreatic intraepithelial neoplasia was also detected in the present case. Although majority of neuroendocrine tumor associated IPMNs were reported to be having low grade dysplasia, our patient had high grade dysplasia. Further studies and reviews with larger groups are needed to establish imaging features and underlying molecular mechanisms of this rare association. CONCLUSION: Although the major concern during work-up of IPMN is presence of associated pancreatic ductal adenocarcinoma, the possibility of neuroendocrine tumor, in the presence of a hypervascular solid foci on imaging studies should be kept in mind.

Characterization of transforming growth factor beta superfamily, growth factors, transcriptional factors, and lipopolysaccharide in bovine cystic ovarian follicles.

The process of transformation of growing bovine follicles into cysts is still a mystery. Local expression of proteins or factors, including transforming growth factor ß, growth factors, and transcription factors, plays a central role in mammals. Therefore, in abattoir-derived cystic ovarian follicles and follicular fluid, the role of some transforming growth factor ß superfamily proteins, insulinlike growth factor-1 (IGF-1) and GATA-4 and GATA-6, were investigated. The relationship between intrafollicular lipopolysaccharide (LPS) and etiopathogenesis of ovarian cysts was also assessed. Data on the preovulatory follicle and the largest follicle (F1) were compared. The number of intrafollicular LPS-positive samples and LPS concentrations were higher in cysts. Immunohistochemical staining was mildly positive for IGF-1, inhibin alpha, and GATA-4 in thecal cells. Staining for anti-Müllerian hormone (AMH), growth differentiation factor-9, bone morphogenetic protein-6 (BMP-6), and GATA-6 was insufficient for their quantitation, and oocytes could not be stained for any of the proteins tested in the cystic follicles. Expression of BMP-6, inhibin alpha, and IGF-1 was moderately higher in granulosa cells of F1 follicles, and all the proteins were moderately expressed in granulosa cells in preovulatory follicles. However, loss of GATA-6 staining was significant in F1 follicles. Intrafollicular progesterone, IGF-1, and AMH concentrations in cysts and F1 follicles were significantly higher than those in preovulatory follicles. Western blot analyses revealed that follicular fluid inhibin-α was strongly expressed, whereas expression of growth differentiation factor-9, BMP-6, GATA-4 and GATA-6 was lower in cysts than in preovulatory follicles. Also, high intrafollicular AMH concentration and low BMP-6 expression were closely associated with cystic degeneration and atresia. In conclusion, immunohistochemical loss of BMP-6 and GATA-6 in the granulosa cells together with high intrafollicular LPS levels may play important roles in disruption of the ovulatory mechanism and steroidogenic reactions in type 2 cyst. Also, high intrafollicular AMH concentration along with low BMP-6 expression may be used as indicators of the bovine degenarative ovarian follicles.

Serum oxidative stress, visfatin and apelin in healthy women and those with premenstrual syndrome.

The aim of this study was to investigate whether there is a relationship between premenstrual syndrome and oxidative stress, visfatin and apelin. The study included 40 women with premenstrual syndrome and 40 healthy women. In all subjects, serum visfatin, apelin and oxidative stress parameters were studied in venous blood samples. The oxidative stress parameters were higher in the premenstrual syndrome group than among the controls, but this difference did not reach statistical significance (p > 0.05). It was found that total antioxidant capacity was similar in both groups. For the insulin-serotonin cycle markers, no significant difference was found between groups in terms of visfatin level (p = 0.893), although apelin was found to be significantly higher in the premenstrual syndrome group when compared with the controls (p < 0.001). According to our results, apelin can be used as an ancillary laboratory test in the diagnosis of premenstrual syndrome.

The effects of EGF and IGF-1 on FSH-mediated in vitro maturation of domestic cat oocytes derived from follicular and luteal stages.

The objective of this study was to evaluate the influence of epidermal growth factor (EGF) and insulin like growth factor-I (IGF-1) on the in vitro maturation of cat oocytes recovered from follicular and luteal stage ovaries. Oocytes from follicular (n=580) and luteal (n=209) stages were harvested and divided into four groups, which were cultured in FSH-mediated maturation medium supplemented with: (1) EGF alone (25ng/mL); (2) IGF-1 alone (100ng/mL); (3) EGF+IGF-1 (25ng/mL EGF+100ng/mL IGF-I); or (4) no growth factor (control). The proportion of follicular stage oocytes reaching the metaphase II stage was significantly higher than that of oocytes obtained at the luteal stage in both control and study groups (p<0.001). The percentages of oocytes reaching the metaphase II stage during the follicular period were 62.6% in control; 70.9% in EGF; 72.8% in IGF-1, and 78.1% in EGF+IGF-1 groups, whereas the respective values for gametes collected from luteal stage ovaries were 12.5%, 17.5%, 12.5%, and 16.9%. Additionally, the differences between the study and control groups were significant in the case of follicular stage oocytes. Finally, supplementing the maturation medium with EGF and/or IGF-1 significantly enhanced the meiotic maturation of oocytes recovered from follicular stage ovaries. The present study also demonstrated that the combination of EGF and IGF-I provides an additional or synergic effect on meiotic maturation of oocytes recovered from the follicular stage.

Anal atresia, abnormal genitalia, and absent thumb: congenital malformations associated with mosaic ring chromosome 13.

Because of the deletion of a segment of the chromosome during the formation of a ring, several clinical findings may be associated with ring chromosomes. Ring chromosome 13 is one of such disorders in which the genotype-phenotype correlation is stronger by virtue of the accumulating literature. It can be associated with multiple congenital abnormalities and severe mental retardation. We report a case with mosaic ring chromosome 13 whose prenatal ultrasound revealed bilateral ventriculomegaly. Anal atresia, unidentifiable external genitalia, and an absent thumb were observed in the postmortem examination.

Post-contrast FLAIR imaging in a patient with posterior reversible encephalopathy syndrome (PRES).

We herein present a case of delayed enhancement of CSF on fluidattenuated inversion recovery (FLAIR) imaging in a patient with posterior reversible encephalopathy syndrome (PRES). In our case despite the settled clinical setting of PRES initial MR scan was negative and on repeated FLAIR imaging increased CSF signal intensity was more conspicuous than subtle cortical involvement.

Oxidative stress and prolidase activity in women with uterine fibroids.

The aim of this study was to investigate oxidative stress markers and prolidase activity in serum and tissue samples of women with uterine fibroids, with further analysis on position and size. Lipid hydroperoxide, ceruloplasmin, catalase, arylesterase, free sulfhydryl group activity and prolidase activity levels were measured in fibroid tissue, myometrial tissue and serum of the same patients (n = 51), at the same time. Results show that ceruloplasmin, catalase, arylesterase, free sulfhydryl group and prolidase activities were higher in fibroid tissue than those in myometrial tissue (p = 0.003, 0.009, 0.004, 0.02, 0.008, respectively). Serum levels of catalase and prolidase were lower, and arylesterase and free sulfhydryl groups were higher in the fibroid group than those in the control group (p < 0.001 for all). Fibroid volume in submucosal subgroup of the fibroid group yield significant correlation with ceruloplasmin, catalase, arylesterase and prolidase activities (r = 0.84, p = 0.02; r = 0.93, p < 0.001; r = 0.63, p = 0.049 and r = 0.87, p = 0.01, respectively). Despite the lack of statistical significance, the highest levels of prolidase activity were found in fibroid samples, especially in submucosal ones. It is concluded that this study demonstrated increased antioxidative repair system in the fibroid tissue compared to the myometrium and serum of the same patients. Additionally, higher pathophysiological potential of the submucosal fibroids over intramural and subserosal fibroids were shown with the levels of oxidative stress markers and prolidase activity levels.

²²6Ra, ²³²Th and 4°K radionuclides enhancement rate and dose assessment for residues of lignite-fired thermal power plants in Turkey.

A total of 77 coal, slag and fly ash samples collected from six thermal power plants were measured by gamma-ray spectrometry. The average (226)Ra activity concentrations in coal, slag and fly ash were measured as 199.8±16.7, 380.3±21.8 and 431.5±29.0 Bq kg(-1), respectively. The average (232)Th activity concentrations in coal, slag and fly ash were measured as 32.0±2.4, 74.0±9.0 and 87.3±9.8 Bq kg(-1), respectively. The average (40)K activity concentrations in coal, slag and fly ash were found to be 152.8±12.1, 401.3±25.0 and 439.0±30.2 Bq kg(-1), respectively. The radium equivalent activities of samples varied from 147.6±8.5 to 1077.4±53.3 Bq kg(-1). The gamma and alpha index of one thermal power plant's fly ash were calculated to be 3.5 and 5 times higher than that of the reference values. The gamma absorbed dose rates were found to be higher than that of the average Earth's crust. The annual effective dose of residues measured in four thermal power plants were calculated higher than that of the permitted dose rate for public, i.e. 1 mSv y(-1).

Persistent left superior vena cava with absent right superior vena cava: a case report and review of the literature.

We report on a rare case of persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC), an anomaly that is also known as isolated PLSVC. This venous malformation was identified incidentally in a 30-year-old woman during thoracic multi-detector computed tomography (MDCT), which was performed with the suspicion of intra-thoracic malignancy. On thoracic MDCT, the RSVC was absent. A bridging vein drained the right jugular and right subclavian veins and joined the left brachiocephalic vein in order to form the PLSVC, which descended on the left side of the mediastinum and drained into the right atrium (RA) via a dilated coronary sinus (CS). The patient was referred to the cardiology department for further evaluation. Transthoracic echocardiography revealed a dilated CS, and agitated saline injected from the left or right arms revealed opacification of the CS before the RA. The patient had no additional cardiac abnormality. Isolated PLSVC is usually asymptomatic but it can pose difficulties with central venous access, pacemaker implantation and cardiothoracic surgery. This condition is also associated with an increased incidence of congenital heart disease, arrhythmias and conduction disturbances. A wide spectrum of clinicians should be aware of this anomaly, its variations and possible complications.

NMDA receptor blockage with 2-amino-5-phosphonovaleric acid improves oxidative stress after spinal cord trauma in rats.

STUDY DESIGN: 2-amino-5-phosphonovaleric acid (APV) is an N-methyl-D-aspartate (NMDA) receptor blocker and has neuroprotective properties. This study is aimed at evaluating the effect of APV treatment on oxidative status after spinal cord injury (SCI). METHODS: The experiment was carried out on the following five groups: Group 1: sham operated, non-traumatized; Group 2: with injured spinal cord, no treatment; Group 3: with SCI, injected with 100 microg kg(-1) APV; Group 4: with SCI, injected with 200 microg kg(-1) APV; and Group 5: with SCI, injected with 400 microg kg(-1) APV. SCI was inflicted by epidural compression with a cerebral vascular clip after T9-11 laminectomy. The experiments were completed after 12 h of trauma. Spinal cords were excised for evaluation of superoxide dismutase (SOD), catalase, reduced glutathione (GSH) and malonyldialdehyde (MDA) levels. RESULTS: After SCI, SOD and GSH levels decreased and the MDA level increased significantly. APV treatment decreased the MDA level and increased SOD, catalase and GSH levels. The maximum decrease in MDA was detected in the group treated with 100 microg kg(-1) APV compared with the other groups. The GSH level was significantly increased in the group treated with 200 microg kg(-1) APV. The SOD level was significantly increased in the group treated with 200 microg kg(-1) APV. CONCLUSION: The results of this study have shown that APV treatment creates a dose-dependent antioxidant effect in rats with SCI and may be used for the treatment of SCIs.

Acute formation of lumbar discal cyst: what is the mechanism?

Lumbar discal cysts are extremely rare pathologies, with only few reports describing these lesions in the literature. Moreover, their definite pathogenesis is still unknown, with proposed theories based on radialogic and histologic findings. In this report, the authors present an acute formation of a discal cyst, which is reported for the first time. Also, we center our case on the discussion of the possible pathogenesis. Also, this is the first case of discal cyst reported in Turkey. A 67-year-old woman, whose complaints, and clinical and radiological findings demonstrated lumbar disc herniation with acute Modic 1 degererative changes of the adjacent end plates of L3-4 level. After medical and physical therapies, follow-up lumbar MRI has been taken to demonstrate a discal cyst formation on the adjacent intervertebral disc, showed cranially migrated cyst superior posterior on herniated disc, in 2 weeks period. The patient was treated by microsurgical resection of the cyst, and her complaints resolved completely.

Persistent primitive hypoglossal artery and fenestration of posterior cerebral artery: CT and MR angiography.

Persistent primitive hypoglossal artery (PPHA) which is a persistent carotid-basilar anastomosis is a rare vascular anomaly. It is usually found incidentally. Fenestrations of cerebral arteries are uncommon. Herein we present a case of PPHA with fenestration of posterior cerebral artery. A 28 year old man was admitted to our hospital with complaints of dizziness and temporary loss of vision. Neurological examination revealed no abnormal findings. The patient was further evaluated with CT and MR angiography. To our knowledge, the case we reported is the first case in the literature with PPHA and fenestration of posterior cerebral artery. The detection of PPHA and associated vascular anomalies and diseases are important before surgical and interventional procedures. CT and MR angiography are much safer diagnostic alternatives in the detection of PPHA and fenestrations. When PPHA is detected, attention should be given to the coexistent posterior circulation anomalies.

Persistent primitive hypoglossal artery and fenestration of posterior cerebralartery: CT and MR angiography

Persistent primitive hypoglossal artery (PPHA) which is a persistent carotid-basilar anastomosis is ar are vascular anomaly. It is usually found incidentally. Fenestrations of cerebral arteries are uncommon. Herein we present a case of PPHA with fenestration of posterior cerebral artery. A 28 year old man was admitted to our hospital with complaints of dizzinessand temporary loss of vision. Neurological examination revealed no abnormal findings. The patient was further evaluated with CT and MR angiography.To our knowledge, the case we reported is the firstcase in the literature with PPHA and fenestration ofposterior cerebral artery. The detection of PPHA and associated vascular anomalies and diseases are important before surgical and interventional procedures.CT and MR angiography are much safer diagnosticalternatives in the detection of PPHA and fenestrations.When PPHA is detected, attention should be given tothe coexistent posterior circulation anomalies (AU)

La arteria hipoglosa primitiva persistente (AHPP) que es una anastomosis carótido-basilar persistente es una anomalía vascular rara. Se encuentra de forma incidental más frecuentemente. Las fenestraciones de arterias cerebrales son raras. Presentamos aquí un caso de AHPP con fenestración de la arteria cerebral posterior. Un varón de 28 años fue admitido en nuestrohospital por presentar mareo y pérdida transitoria devisión. El paciente fue evaluado con TC y angiografía de RM. Para nuestro conocimiento este es el primer casodescrito de una AHPP asociada a fenestración de laarteria cerebral posterior. La detección de AHPP y una anomalía vascular asociada son importantes antes de planificar tratamientos quirúrgicos o endovasculares. El CT y la angiografía en RM son formas de diagnóstico seguras ante anomalías vasculares. Cuando se detecta una AHPP se debe prestar atención a la coexistencia de nanomalías de la circulación posterior (AU)

Case report: Multidetector CT presentation of a parachute-like asymmetric mitral valve.

A 24-year-old man with a complaint of exertional dyspnoea had a Grade III/VI apical pansystolic murmur on physical examination. He underwent a transthoracic echocardiogram, which revealed a funnel-shaped mitral valve with moderately thick leaflet tissue and an eccentric orifice, as well as a bicuspid aortic valve. The mitral valve was mildly stenotic and severely regurgitant. Although demonstration of a single papillary muscle in the parasternal short axis view suggested a parachute mitral valve, the diagnosis was uncertain owing to poor echocardiographic acoustic quality. 16-row multidetector CT (MDCT) clearly demonstrated two papillary muscles and the patient was diagnosed as having a parachute-like asymmetric mitral valve. In conclusion, MDCT can be used as a complementary imaging technique for the evaluation of subvalvular mitral apparatus and papillary muscles, especially in patients with poor echocardiographic acoustic quality.