Comparativa de los métodos de evComparativa de los métodos de evaluación de la reserva de yodo corporal previamente a la realización de tratamiento con radioyodoaluación de la reserva de yodo corporal previamente a la realización de tratamiento con radioyodo / Comparison of Body Iodine Pool Assessment Methods Before Radioiodine Therapy

Introducción y objetivos: El tratamiento con yodo radiactivo (RAIT) se recomienda para reducir el riesgo de recurrencia y de metástasis en personas con cáncer diferenciado de tiroides (CDT) de riesgo intermedio-alto. En la preparación para la RAIT, la estimulación de la tirotropina y la reducción en la reserva corporal de yodo son elementos importantes para contribuir al éxito de la terapia. Para ello, se pide a los pacientes que reduzcan la ingesta de este mineral antes de la RAIT, y puede evaluarse su reserva corporal midiendo su excreción por la orina (yoduria) antes del tratamiento. El objetivo de nuestro estudio ha sido comparar los métodos utilizados para medir la reserva de yodo corporal en la evaluación de la eficacia de la dieta con bajo contenido en yodo (RID) aplicada a la preparación del paciente para la RAIT. Pacientes y métodos: Suspendieron la levotiroxina tres semanas antes de la RAIT y fueron controlados con una RID durante las dos semanas previas a la realización del tratamiento 80 pacientes con CDT. Tras dos semanas de RID, en todos se llevó a cabo una recolección de orina de 24h el día previo a la fecha de administración de la RAIT. Los sujetos finalizaron dicha recolección en la mañana de la fecha de RAIT y suministraron una muestra puntual de orina. Se calculó la excreción estimada de creatinina en orina de 24 horas de los pacientes. La estimación de la excreción urinaria de yodo o yoduria (UIE) de 24 horas oras se determinó a partir del índice yodo/creatinina (I/C) obtenido en la muestra de orina puntual de los individuos. Se compararon los resultados de la yoduria de 24 horas, la concentración de yodo en la muestra puntual de orina, el cociente I/C en la muestra puntual de orina y la estimación de la yoduria de 24 horas en los pacientes. Resultados: En 99%, la eficacia de la RID fue suficiente según la yoduria de 24 horas obtenida previamente a la RAIT...(AU)

Introduction and Objectives: Radioactive iodine therapy (RAIT) is recommended to reduce the risk of recurrence and metastasis in patients with intermediate-high risk differentiated thyroid cancer (DTC). In preparation for RAIT, stimulation of thyroid-stimulating hormone and reduction of body iodine pool are important for treatment success. For this purpose, patients are asked to reduce their iodine intake before RAIT, and the body iodine pool can be evaluated by measuring iodine excretion in urine before treatment. The aim of our study is to compare the methods used to measure the body iodine pool in the evaluation of the restricted iodine diet (RID) effectiveness applied in the RAIT preparation. Patients and methods: Eighty DTC patients discontinued levothyroxine three weeks before RAIT and followed up with a RID two weeks before treatment. After two weeks of RID, all patients collected their 24-hour urine the day before the RAIT date. Patients completed 24-hour urine samples on the morning of the RAIT date and also provided a spot urine sample. The estimated 24-hour creatinine excretion of the patients was calculated. Estimated 24-hour urinary iodine excretion (UIE) was calculated using the spot urine iodine/creatinine (I/C) ratio of the patients. 24-hour UIE, iodine concentration in spot urine, I/C ratios in spot urine and estimated 24-hour UIE of the patients were analyzed by comparing with each other. Results: In 99% of the patients, RID efficiency was sufficient according to 24-hour UIE before RAIT. The mean 24-hour UIE was 48.81 micrograms/day (mcg/day) in 24-hour urine samples taken from the patients to evaluate the body iodine pool. The patients’ iodine concentrations in spot urine, I/C ratios in spot urine, and estimated 24-hour UIE were all statistically significantly lower than actual 24-hour UIE, which was the reference method (p: 0.026 vs <0.001 vs 0.041)..... (AU)

Comparison of Laser Hemorrhoidoplasty and Milligan-Morgan Hemorrhoidectomy Techniques in the Treatment of Grade 2 and 3 Hemorrhoidal Disease.

INTRODUCTION: The estimated prevalence of hemorrhoidal disease (HD) worldwide ranges from 2.9% to 27.9%. Conservative, medical, non-operative, and surgical therapy approaches are applied in HD treatment. Milligan-Morgan (MM) hemorrhoidectomy which is the most well-known and frequently applied surgical treatment method, and Laser hemorrhoidoplasty (LH) are among the accepted treatment methods in Grade 2-3 HD treatment where medical treatment is insufficient. PURPOSE: In this study, the early results of laser hemorrhoidoplasty and Milligan-Morgan hemorrhoidectomy techniques were compared. MATERIAL AND METHODS: A randomized clinical trial. The study included ASA 1-3, total 85 patients aged 18-70 years old with symptomatic Grade 2 and Grade 3 hemorrhoidal disease whose symptoms persisted despite at least one month of medical treatment. Fifty-four patients were allocated to Group L, whereas 31 were allocated to Group M. Age, gender, weight, body mass index, preoperative symptoms, presence of additional disease, use of anticoagulant medication, and length of hospital stay of the patients included in the study were recorded. Rescue analgesic used was recorded. Postoperative VAS score and complications were recorded within 10 days. The total energy numbers applied to all packages were recorded. RESULTS: The incidence of minor perioperative hemorrhage was significantly lower in Group L compared to Group M (P = .035). The postoperative 3rd-hour VAS scores were statistically significantly lower in Group L compared to Group (P < .001). At the 3rd hour postoperatively, the need for rescue analgesia was statistically significantly higher in Group M compared to Group L. On the seventh postoperative day, Group M needed considerably more rescue analgesia compared to Group L (P < .001, P = 1.00, P = .035, respectively). The cut-off value of 571 J was calculated in Group L. CONCLUSION: We believe that it is not an advantageous method compared to MM hemorrhoidectomy, both in terms of patient comfort and cost-effectiveness, since postoperative pain, which is shown as the most important advantage of LH over conventional hemorrhoidectomy methods in the literature, can be relieved with simple NSA-I rescue analgesia in patients undergoing MM. Trial Registration: 03.06.2021/21-63.

Variaciones en los parámetros cuantitativos y en la puntuación de la escala de Deauville aplicando diferentes algoritmos de reconstrucción en las imágenes PET/TC con [18F]FDG de pacientes con linfoma / The variation of quantitative parameters and Deauville scores with different reconstruction algorithms in FDG PET/CT imaging of lymphoma patients

Objetivos La escala de Deauville (DS) en la tomografía de emisión de positrones (PET) con [18F]fludeoxiglucosa ([18F]FDG) es un método semicuantitativo único para la evaluación del linfoma. Sin embargo, el tipo de algoritmo de reconstrucción empleado para el cálculo de los valores de captación estándar (max, medio y pico) podría afectar a la DS. Comparamos el algoritmo de reconstrucción de probabilidad penalizada bayesiano (BPL) con el de maximización de expectativas de subconjuntos ordenados (OSEM) respecto a los parámetros cuantitativos y en la DS en el linfoma. Investigamos el efecto del tamaño del ganglio linfático sobre la variación cuantitativa. Métodos Se reconstruyeron por separado los resultados de la PET sin procesar de 255 pacientes con linfoma utilizando la aplicación Q.Clear (General Electric Healthcare, Milwaukee, WI, EE. UU.), un algoritmo BPL, y la aplicación SharpIR (General Electric Healthcare, Milwaukee, WI, EE. UU.), un algoritmo OSEM. En ambas imágenes, para cada paciente, se valoró hígado, el pool sanguíneo mediastínico y los valores de captación estándar (SUV) (SUVmáx, SUVmedio y SUVpico) de un total de 487 lesiones seleccionadas. Se compararon DSmáx, DSmedio y DSpico. Resultados En nuestro estudio hubo un aumento significativo de la DS con el BPL (p<0,001) que pasó a una puntuación de 4 a 5 en 30 pacientes inicialmente catalogados como 1-2-3 mediante el algoritmo OSEM. Se observó que los valores cuantitativos de los ganglios linfáticos aumentaban de forma estadísticamente significativa con el BPL (p<0,001), mientras que la disminución de los valores de hígado fue notable respecto a las regiones de referencia (p<0,001). Además, la diferencia en los ganglios linfáticos se asoció de forma independiente con el tamaño de la lesión y fue considerablemente más pronunciada en las lesiones de pequeño tamaño (p<0,001) (AU)

Introduction and Objectives 18F-FDG PET with the Deauville score (DS) is a unique semiquantitative method for lymphoma. However, type of standard uptake values (max, mean, and peak) reconstruction algorithms could affect DS. We compared the Bayesian Penalized Likelihood reconstruction algorithm (BPL) with Ordered Subsets Expectation Maximization (OSEM) on quantitative parameters and DS in lymphoma. We investigated the effect of the size of the lymph node on quantitative variation. Patients and Methods Raw PET data of 255 lymphoma patients were reconstructed separately with Q.Clear (GE Healthcare), a BPL, and SharpIR (GE Healthcare), an OSEM algorithm. In both images, each patient's liver, mediastinal blood pool, and SUVs (SUVmax, SUVmean, and SUVpeak) of a total of 487 lesions selected from the patients were performed. DSmax, DSmean, and DSpeak were compared. Results In our study, DS increased significantly with BPL (p<0.001), and the DS increased to 4-5 in 30 patients evaluated as 1-2-3 with OSEM. It was found that the quantitative values of the lymph nodes increased statistically with BPL (p<0.001), and the liver from the reference regions were significantly decreased (p<0.001). In addition, difference in lymph node was independently associated with size of lesion and was significantly more pronounced in small lesions (p<0.001). The effects of BPL algorithm were more pronounced in SUVmax than in SUVmean and SUVpeak. DS-mean and DS-peak scores were less changed by BPL than DS-max. Conclusion Different reconstruction algorithms in FDG PET/CT affect the quantitative evaluation. That variation may affect the change in DS in lymphoma patients, thus affecting patient management (AU)

Investigation of temporal illicit drugs, alcohol and tobacco trends in Istanbul city: Wastewater analysis of 14 treatment plants.

Wastewater-based drug monitoring is a complementary tool that has been used worldwide in recent years, and many cities have periodically reported monitoring results. However, this study is the first to analyze drugs in wastewater in a single city with a high population during four periods simultaneously from 14 treatment plants. The aim was to estimate the consumption of conventional illicit drugs [amphetamine (AMP), methamphetamine (METH), 3,4-methylenedioxymethamphetamine (MDMA), cannabis, cocaine, and heroin], tobacco, and alcohol in 2019 for quarterly periods in Istanbul city, which has a population of almost 20 million, to aid in implementing evidence-based measures. Additionally, the seasonal variations among the 14 wastewater treatment plants and their weekday/weekend comparison of drug use patterns and consumption per substance were examined. Solid phase extraction was followed by liquid chromatography-tandem mass spectrometry and a previously validated method was enhanced by adding new parameters (morphine, cotinine, and ethyl sulfate), and satisfactory results were obtained. In this study, alcohol, nicotine, and cannabis had the highest estimated per capita consumption with mean values of 29655.3 mL/1000 inh/day, 5507.6 mg/1000 inh/day and 3607.0 mg/1000 inh/day, respectively. These results were followed by heroin and cocaine consumption with mean values of 557.0 and 200.9 mg/1000 inh/day, respectively, whereas AMP-type stimulants had the lowest values among the targeted substances. METH and cannabis were also highly consumed drugs when compared with the results of other metropolitan cities, whereas heroin consumption was remarkably high owing to Turkey's location on a possible heroin trafficking route. Because Istanbul is the business center of the country and has the potential to attract tourists in all four seasons, meaningful seasonal consumption differences were not observed for all substances.

The association of impaired gestational glucose tolerance with maternal and fetal outcomes.

The aim of the present study was to examine the associations of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) with maternal and fetal outcomes.A total of 200 pregnant women were included in this cross-sectional study. A 50-gram oral glucose challenge test (GCT) was performed between 24 and 28 weeks of gestation, followed by glucose tolerance test (OGTT) with 100 grams of oral glucose in those with an abnormal one-hour test result. The following were not significantly different between groups. Preterm labour (PL), pregnancy induced hypertension(PIH), pre-eclampsia, polyhydramnios, and macrosomia. However, a significant increase was noted in the fetal birth weight as well as in number of cesarean deliveries among GDM subjects. Neonatal outcomes were also similar between the two groups. In conclusion, the present results suggest that single high glucose readings in OGTT may be as important as a diagnosis of GDM in terms of fetomaternal complication risk.

The relationship between uterine prolapse and premalignant endometrial pathology.

OBJECTIVE: The aim of this study was to stress the importance of performing a thorough uterine assessment before selecting an organ- sparing surgery in patients presenting with uterine prolapse and no other complaints. MATERIALS AND METHODS: This study included a total of 111 participants who presented with pelvic organ prolapse and underwent hysterectomy for grades 3-4 uterine prolapse. The posthysterectomy histopathology results were classified as benign (atrophic endometrium, proliferative or secretory endometrium) or pathologic (endometrial hyperplasia, endometrial polyp, adenomyosis, myoma uteri, and endometrium carcinoma). RESULTS: Of the 111 patients enrolled in this study, 23 (20.2%) had endometrial hyperplasia, eight (7.2%) had endometrial polyps, 30 (27%) had uterine fibroids, and 20 (18%) had adenomyosis. CONCLUSION: There may be premalignant lesions of the endometrium in both premenopausal and postmenopausal women presenting with uterine prolapse and no other symptoms. A chronic inflammatory process resulting from the extra-vaginal location of the uterus may play a role in the development of these lesions. Further studies are needed on this subject.

Alterations in lipid peroxidation and T-cell function in women with hyperemesis gravidarum.

The objective of this study was to investigate serum adenosine deaminase (ADA) activity as a marker of T lymphocyte activation and parameters of oxidative stress and antioxidant defence in hyperemesis gravidarum (HG). Serum ADA activity, malondialdehyde (MDA), catalase (CAT) and glutathione peroxidase (GPx) levels were investigated in 40 pregnant women with the HG and 40 with healthy pregnancies, in a descriptive study. Although serum ADA and CAT were measured to be higher in HG group, the difference was not significant. Serum MDA and GPx levels were significantly elevated in women with HG when compared with those without HG. The significance of changes in lipid peroxidation and T-cell activation in the pathogenesis of HG and whether this is a cause or a compensatory reaction to HG requires further investigations with larger multicentre trials.

A diagnostic dilemma for solid ovarian masses: the clinical and radiological aspects with differential diagnosis of 23 cases.

OBJECTIVE: This study aimed to analyze the clinical characteristics and diagnostic features of ovarian fibromatous masses. MATERIALS AND METHODS: The authors reviewed the records of 23 women who underwent laparotomic surgeries and whose final histopathological diagnoses were ovarian fibroma, cellular fibroma, or fibrothecoma from January 2005 to January 2013. The clinical, ultrasonographic, magnetic resonance imaging, tumor marker, therapeutic, and histologic data were analyzed. RESULTS: The mean age of the patients was 50.9 years. Sixteen patients were menopausal. The preoperative ultrasonography examination incorrectly diagnosed seven lesions as uterine fibromas, and the magnetic resonance imaging examination incorrectly labeled three lesions as pedunculated subserous uterine fibromas. The cancer antigen-125 levels of 17 cases were measured, with four being abnormal. Twenty-three patients underwent a laparotomy. Twenty patients underwent a total hysterectomy with bilateral salpingo-oophorectomy, and three underwent a tumorectomy. The histological diagnosis was fibrothecoma in 21 cases, fibroma in one case, and cellular fibroma in one case. Histopathologic examination of the endometrium of seven of the 20 patients who underwent hysterectomy revealed simple endometrial hyperplasia without atypia. CONCLUSION: Ovarian fibromas and fibrothecomas are often misdiagnosed as uterine fibromas and occasionally mistaken for malignant tumors of the ovary preoperatively. As these tumors originate from ovarian stroma, they may be hormone-active tumors. Therefore, they may lead to premalignant changes in the endometrium. The preoperative evaluation of the endometrium is recommended.

Does bupivacaine and fentanyl combination for epidural analgesia shorten the duration of labour?

In this study we aimed to explore the effects of epidural analgesia achieved by a combination of low-dose bupivacaine and fentanyl infused through an epidural catheter on mother, foetus and labour process in nulliparous at-term pregnant women during vaginal delivery. This study was designed in a prospective, randomised controlled manner. Epidural analgesia was achieved in 50 nulliparous women. Fifty nulliparous women did not undergo epidural analgesia procedure. The duration of the first stage of labour was significantly shortened, while the second stage was significantly lengthened in pregnant women who underwent epidural analgesia (p < 0.05). In conclusion, starting epidural analgesia application during the active phase of the first stage of labour may shorten the duration of the first stage compared with the group of nulliparous women not undergoing epidural analgesia. The factor that has an impact on this may be the addition of fentanyl to bupivacaine used for epidural analgesia.

Endometrial pathology in postmenopausal women with no bleeding.

OBJECTIVE: The aim of this study was to determine the rate of unexpected uterine pathology in postmenopausal women admitted to a gynecology clinic with symptoms other than vaginal bleeding and who were scheduled to undergo hysterectomy. MATERIALS AND METHODS: We reviewed retrospectively the medical records of 283 postmenopausal patients who had gynecological surgery between September 2007 and January 2014. We reviewed their presenting symptoms on admission, the indications for surgery, and their transvaginal ultrasonographic findings. Postoperative histopathological results based on uterine specimens were also recorded. The results were analyzed statistically. RESULTS: Of 283 patients who had surgery, 209 had no vaginal bleeding at the time of admission. From this group, 75.6% were found to have unsuspected pathology, including endometrial hyperplasia, endometrial polyps, uterine fibroids, adenomyosis, and one case of endometrial carcinoma (0.5%). The remaining 74 patients had experienced postmenopausal bleeding and in 87.8% there were pathological findings including 13 cases (17.6%) of endometrial cancer (p = 0.0001). CONCLUSION: Vaginal bleeding in postmenopausal women is indicative of a wide array of gynecological pathologies, including endometrial carcinoma. However, uterine fibroids, pelvic masses, or even endometrial cancer may develop without co-morbid vaginal bleeding. Therefore we advocate that postmenopausal women should undergo yearly screening and consultation, without waiting for an episode of vaginal bleeding.

Bilateral Krukenberg tumor in a 16-week pregnant woman.

The authors present the case of a G2P1001 who presented in 16-week gestation with bilateral Krukenberg tumor, abdominal pain, and iterative vomiting episodes. Although a few cases of Krukenberg tumor in pregnant women have been reported, no case reports asymptomatic and free of disease at 18 months were found in the English literature. Early detection followed by surgery and chemotherapy during pregnancy could possibly result in a favorable outcome in such patients.

Location of the middle cranial fossa dural plate in patients with chronic otitis media.

AIM: This study aimed to determine whether or not the middle cranial fossa dural plate is located lower (i.e. more caudally) in patients with chronic otitis media, relative to adjacent structures. METHODS: The authors retrospectively investigated computed tomography temporal bone scans of 267 ears of 206 patients who had undergone surgery with a diagnosis of chronic otitis media, together with scans of 222 ears of 111 patients without chronic otitis media. The depth of the middle cranial fossa dural plates was recorded. RESULTS: The mean depth of the middle cranial fossa dural plate was 4.59 mm in the study group and 2.71 mm in the control group (p < 0.001). The middle cranial fossa dural plate was located lower in the right ear in both the study and control groups. CONCLUSION: The middle cranial fossa dural plate was located lower in patients with chronic otitis media, and in the right ears of both patients and controls. Surgeons should take this low location into consideration, and take extra care, during relevant surgery on patients with chronic otitis media.

Diffusion-weighted imaging in the evaluation of hormonal cyclic changes in abdominal wall endometriomas.

AIM: To investigate the utility of diffusion-weighted (DW) magnetic resonance imaging (MRI) in the diagnosis of abdominal wall endometrioma (AWE) and to compare the ADC (apparent diffusion coefficient) values of AWE with those of the uterine endometrium during two different phases of the menstrual cycle. MATERIALS AND METHODS: A total of 22 women aged between 27 and 42 years (mean 32.8 years) and who had regular menstrual cycles were included in the study. These patients had a total of 25 AWE lesions. The mean and standard deviation of the ADC values of the normal endometrium/AWE were calculated for the menstrual and luteal phases. All examinations were performed using a 1.5 T magnet (b-values of 50, 400, and 800 mm/s(2)). The results were analysed using the Shapiro-Wilk test, the Pearson correlation test, the analysis of variance (ANOVA) test, and the paired sample t-test. RESULTS: The ADC values of the endometrium were different in the two phases of the menstrual cycle (menstrual phase: 0.924 ± 0.171; luteal phase: 1.171 ± 0.135). Similarly, the ADC values of the AWE were different in these phases (menstrual phase: 0.937 ± 0.256, luteal phase: 1.256 ± 0.215). In both AWE and the uterine endometrium, the ADC measurements were significantly lower in the menstrual phase than during the luteal phase. This difference was statistically significant (p < 0.05). There was no significant difference in the ADC values between the endometrial layer and AWE during the same phase (p = 0.216 for menstrual phase, p = 0.104 for luteal phase, paired sample t-test). CONCLUSION: The present study demonstrated that in all patients, the DWI features of AWEs were significantly similar to those of the uterine endometrial tissue. Additionally, the ADC measurements of the patients showed similar cyclical changes. These results suggest that the ADC values of a lesion close to the uterine endometrium may be used to differentiate AWE from the other disease entities of the abdominal wall.

Prevalence of the palmaris longus muscle and its relationship with grip and pinch strength: a study in a Turkish pediatric population.

Clinical studies generally reveal a trend of variation in the reported prevalence of the palmaris longus (PL) muscle absence. The aim of this study was to find an answer to the question of whether the congenital absence of tendon would affect hand functions or not. A total of 585 subjects, comprised of 305 males and 280 females, were included in our study. Mean age was 8.9 ± 1.4 standard deviation within a range of 6-11. For both sexes, the groups were divided further into three subgroups including 6-7, 8-9, and 10-11 years of age ranges. The grip strength of each hand and pinch strength of all fingers of each subject were measured separately. The absence of PL tendon in the right hand was 35.4 % in females, 25.9 % in males, and 30.4 % in overall average. The distribution of absence of the palmaris longus muscle between both genders was statistically significant. The p value for the right hand was 0.013. The absence of PL tendon in the left hand was 37.5 % in females, 27.9 % in males, and an overall average of 32.5 %. The p value for the left hand was 0.017. In terms of grip strength, a comparison between females and males did not reveal a significant difference. The pinch strength of the second fingers of both hands did not show any difference in both sexes. Pinch strength of the third finger of the right hand was different only in girls of subgroup 6-7 ages (p = 0.024). In girls, the pinch strength of the fourth finger of the right hand of subgroups 6-7 and 10-11 ages showed difference (p = 0.009 and p = 0.026, respectively). In boys, the fourth finger in subgroup of 8-9 ages showed significant difference in both hands (p = 0.011). The fifth fingers of both hands were found different in males for only subgroup of 8-9 ages (p = 0.001). Pinch strength of the fifth finger of the right hand was different in females for only subgroups of 6-7 and 10-11 ages (p = 0.023 and p = 0.047, respectively). While grip strength of the hand was not affected in the case of absence of the palmaris longus, in both sexes, pinch strength of the fourth and fifth fingers of both hands decreased.

Endogenous bacterial flora in pregnant women and the influence of maternal genetic variation.

Preterm labour, premature prelabour rupture of membranes and low birth weight have all been associated with either specific maternal genital tract infections or an altered vaginal microflora during pregnancy. Factors that influence the variation in microbial-host interaction play an important role in individual susceptibility to adverse pregnancy outcomes. The innate immune responses at mucosal surfaces play a crucial role against microbial invasion. Multiple genes are responsible for the regulation of the innate immune system. Genetic polymorphisms that disrupt innate immune recognition or the responses to infectious microorganisms could explain the alterations in microflora and individual susceptibility to pregnancy complications.

Correlation between osteopontin protein expression and histological grade of astrocytomas.

Osteopontin is a ligand for the integrin proteins, which are cell surface receptors that mediate the physical and functional interactions between a cell and the extracellular matrix. The expression of osteopontin is reportedly increased in a number of transformed cell lines and tumor tissues. Furthermore, increased expression of osteopontin results in some infiltrative features of tumors. The aim of the study is to demonstrate that expression of osteopontin in human astrocytomas correlates with histological tumor grade. The expression of osteopontin in human astrocytomas was determined with immunohistochemistry. Median osteopontin expression levels were 1%, 7.5%, 60%, and 50% in grade I, II, III, and IV tumors, respectively. Osteopontin staining was significantly higher in high grade (grade III-IV) than low grade (grade I-II) tumors. These findings indicate that osteopontin immunoreactivity in human astrocytomas may correlate with the grade of a tumor.

Vaginal high dose rate brachytherapy alone in patients with intermediate- to high-risk stage I endometrial carcinoma after radical surgery.

The objective of this study was to analyze the efficacy and morbidity of vaginal cuff brachytherapy alone in intermediate- to high-risk stage I endometrial cancer patients after complete surgical staging. Between October 1994 and November 2005, 128 patients with intermediate- to high-risk stage I endometrial adenocarcinoma were treated with high dose rate (HDR) brachytherapy alone after complete surgical staging. The intermediate- to high-risk group was defined as any stage I with grade 3 histology or stage IB grade 2 or any stage IC disease. The comprehensive surgery was in the form of total abdominal hysterectomy, bilateral salpingo-oophorectomy in addition to infracolic omentectomy, and routine pelvic and para-aortic lymphadenectomy. The median number of the lymph nodes dissected was 33. The median age at the time of diagnosis was 60 years. Forty patients were staged as IB (grade 2: 25 and grade 3: 15), and 88 patients were staged as IC (grade 1: 31, grade 2: 41, and grade 3: 16). A total dose of 27.5 Gy with HDR brachytherapy, prescribed at 0.5 cm, was delivered in five fractions in 5 consecutive days. Median follow-up was 48 months. Six (4.7%) patients developed either local recurrence (n = 2) or distant metastases (n = 4). Five-year overall survival and disease-free survival (DFS) rates are 96% and 93%, respectively. Only age was found to be significant prognostic factor for DFS. Patients younger than 60 years have significantly higher DFS (P = 0.006). None of the patients experienced grade 3/4 complications due to the vaginal HDR brachytherapy. Vaginal cuff brachytherapy alone is an adequate treatment modality in stage I endometrial adenocarcinoma patients with intermediate- to high-risk features after complete surgical staging with low complication rates.

Radiotherapy in the adjuvant setting of cervical carcinoma: treatment, results, and prognostic factors.

To evaluate the efficacy of postoperative radiotherapy and to investigate prognostic factors for early-stage cervical cancer patients. From December 1993 to December 2001, 141 patients with stage I-II cervical cancer without para-aortic lymph node (LN) metastases and treated by surgery and postoperative radiotherapy (RT) were included in this study. Indications for postoperative external RT were based on pathologic findings, including LN metastasis, positive surgical margins, parametrial involvement, pT2 tumor, and presence of any two minor risk factors like lymphvascular space involvement, deep stromal invasion, and tumor diameter between 2-4 cm. Sixty-six (47%) patients received RT alone, whereas 59 (42%) were treated with RT and concomitant chemotherapy (CT), and 16 received neoadjuvant CT. Patients with positive vaginal margins also received 27.5 Gy high-dose rate vaginal cuff brachytherapy in five fractions. Median follow-up time was 55 months. The actuarial 5-year overall (OS), disease-free (DFS), locoregional recurrence-free (LRFS), and distant metastases-free (DMFS) survival rates are 70%, 68%, 77%, and 88%, respectively. Univariate and multivariate analyses revealed that level and number of metastatic LNs and concomitant CT were unique significant prognostic factors for OS, DFS, and LRFS. Endometrial involvement, on the other hand, was proven to be significant for DFS and DMFS. Patients with less than three LN metastases or having only obturator LN involvement showed similar prognosis with their counterparts having no LN metastases. On the other hand, patients with either common iliac LN or more than three LN metastases had significantly worse outcome. Our results indicate that level and number of metastatic LNs are the most important prognostic factors determining the survival rates, and patients with upper lymphatic involvement or more than three metastatic LNs seem to need more effective treatment approaches.

Rubella seroprevalence in an unvaccinated pregnant population in Malatya, Turkey.

BACKGROUND: Controlling congenital rubella by 2010 is one of the targets of the World Health Organization. Most European countries currently include rubella vaccine in their national immunization programmes, but not yet in Turkey. OBJECTIVES: To define rubella seroprevalence in pregnancy in Malatya, Turkey. STUDY DESIGN: A cross-sectional interview survey was conducted among pregnant women living in Malatya province from November 2003 to May 2004, together with a follow-up component. METHODS: Stratified probability proportional to size sampling methodology. A total of 824 pregnant women from 60 clusters were enrolled. After obtaining informed consent, participants' socio-demographic and fertility characteristics were collected by interview questionnaire. Various blood samples were drawn. After storing serum samples at -20 degrees C for 6 months, anti-rubella IgM and IgG titres were studied by micro ELISA. Only 803 sera were eligible for serological study. RESULTS: Of the 803 samples tested for rubella antibodies, 753 cases (93.8%) had anti-rubella IgG positivity, indicating past infection. Five of the pregnant women (0.6%) had both anti-rubella IgM and IgG positive results, suggesting a recent infection. The remaining 45 women (5.6%) were seronegative for both antibodies. Seroprevalence was not associated with age or urban/rural residency. All the five anti-rubella IgM positive women were in the second trimester of pregnancy. CONCLUSIONS: As 5.6% of pregnant women were susceptible to rubella during pregnancy, and five of them had already had a recent infection, immunization efforts should be directed at babies and adolescents.