A rare case of primary rectal choriocarcinoma and review of the literature.

INTRODUCTION: Primary choriocarcinoma of the colon is an extremely rare neoplasm which has a poor prognosis. Only 18 cases have been previously reported in English medical literature. Here we present a case of primary rectal choriocarcinoma with a good response to chemotherapy and review the literature on this uncommon tumor. CASE REPORT: A 36-year-old woman presented with abdominal pain and vaginal bleeding. Abdominal magnetic resonance imaging revealed 6.9 × 5.3 × 6.4 cm hypervascular mass posterior to uterus very close to rectum. Beta-human chorionic gonadotropin (ß-hCG) level was markedly elevated. Low anterior resection of the rectum with lymph node dissection and total abdominal hysterectomy with bilateral salpingo-oophorectomy were performed. Pathologic diagnosis was reported as colonic choriocarcinoma with a focal component of adenocarcinoma. Post-operative magnetic resonance imaging detected multiple metastatic lesions throughout the liver. The patient was treated with systemic chemotherapy using bleomycin, etoposide and cisplatin (BEP protocol). After three cycles, ß-hCG level decreased to normal and magnetic resonance imaging showed regression of liver metastasis. However, the patient died of respiratory failure due to bleomycin toxicity and pneumonia accompanied by rapid disease progression. DISCUSSION: This is an extremely rare case of primary rectal choriocarcinoma. Due to poor prognosis of the disease, it seems very important to start prompt treatment to improve patient's survival.

Intraductal Oncocytic Papillary Neoplasms: Clinical-Pathologic Characterization of 24 Cases, With An Emphasis on Associated Invasive Carcinomas.

BACKGROUND: Intraductal oncocytic papillary neoplasm (IOPN) of the pancreas is a rare tumor. Recent molecular data indicate that it is distinct from other intraductal neoplasms; however, its clinicopathologic characteristics, especially the frequency/significance of an invasive carcinoma component, and biologic behavior remain to be fully defined. DESIGN: Clinicopathologic characteristics and survival of 24 IOPNs were analyzed. By definition, all tumors exhibited intraductal growth and oncocytic morphology. RESULTS: The female:male ratio was 1.7, and mean age was 59. In 44% of the patients, the IOPN was discovered incidentally; however, the working diagnosis was "ductal adenocarcinoma" in 42%. Fourteen IOPNs occurred in the head of the pancreas. The median tumor size was 4.5 cm. The tumors often grew along adjacent benign ducts, mimicking invasion, but only 29% exhibited unequivocal invasive carcinoma, mostly in the form of microscopic foci (pT1a=4, pT1b=1, pT2=2), and only 6% had lymph node metastasis. Invasive carcinoma was predominantly composed of small tubular units lined by oncocytic cells, or individual oncocytic cells infiltrating the periductal stroma. Follow-up information was available for 18 patients (median=6.8 y). No patients died from the disease, and the overall 10-year survival was 94%. Patients with invasive carcinoma trended toward a lower 5-year recurrence-free survival than those with noninvasive IOPNs (66% vs. 93%, P=0.066), but overall survival was not impacted by the presence of invasion (P=0.38). CONCLUSIONS: IOPN is a distinct tumor type in the pancreas. Despite its morphologic complexity and often extensive pagetoid spread to adjacent ducts, conventional invasive carcinoma is seen in only 29% and usually as microscopic foci. Thus, it is not surprising that IOPN exhibits indolent behavior even when invasion is present.

Tumor cell seeding in the biopsy tract and its clinical significance in osteosarcomas.

BACKGROUND AND OBJECTIVES: The reasons behind the removal of the biopsy tract in osteosarcomas are not well known, and studies about tumor seeding in the biopsy tract have generated conflicting results. This study is designed to evaluate the presence and possible clinical significance of tumor cell seeding in the biopsy tract of osteosarcomas. METHODS: We prospectively evaluated 55 cases of osteosarcomas for tumor cell seeding and other clinical and pathologic prognostic parameters. RESULTS: Eleven cases (20%) involved microscopic tumor foci in the biopsy tract. The higher local recurrence rates (P = 0.005) and worse recurrence-free survivals ( P = 0.009) were observed in patients with tumor cell foci in the biopsy tract. Mitotic rate, tumor cell pleomorphism, and matrix production in main tumor foci were higher in cases with tumor seeding ( P = 0.047, P = 0.012, and P = 0.005, respectively) CONCLUSIONS: Tumor seeding in the biopsy tract is a fact in osteosarcomas. The higher local recurrence rates are more likely to occur in cases with tumor seeding.

Evaluación de la adherencia a la dieta mediterránea en pacientes con antecedentes de revascularización coronaria / Evaluation of Mediterranean diet adherence in patients with a history of coronary revascularization

Introducción: Los cambios en el estilo de vida son un elemento importante de las estrategias de prevención secundaria, y una dieta sana es una de las piedras angulares del manejo de la enfermedad coronaria (EAC). Nos propusimos investigar los hábitos alimentarios de pacientes con antecedentes de revascularización coronaria y las características de aquellos con buena adherencia, utilizando para ello el cuestionario DMed adaptado. Métodos: Incluimos a pacientes ambulatorios con antecedentes de revascularización coronaria, al menos 6 meses antes de ser inscritos en el estudio. Cada participante rellenó un cuestionario con el fin de recopilar los datos demográficos y las características clínicas. Las puntuaciones obtenidas de la Escala DMed adaptada se calcularon para evaluar la adherencia a la dieta mediterránea. Esta escala adaptada se basa, originalmente, en un cuestionario de 14 ítems; lo ajustamos para la población relevante (sobre una puntuación máxima de 13 puntos). Resultados: Incluimos a 226 pacientes consecutivos (edad 61,7±10,9 años, 72% varones). La mediana de tiempo transcurrido desde la revascularización fue de 60 meses. Un total de 112 (49,6%) pacientes habían sido sometidos a una intervención coronaria percutánea, 77 (34,1%) a cirugía de revascularización coronaria y 36 (15,9%) a ambas. La puntuación mediana obtenida en la Escala DMed fue de 6. Los pacientes fueron estratificados en 2 subgrupos (puntuación en la Escala DMed≥7 vs. <7). Un total de 61 (26,9%) pacientes obtuvieron una puntuación ≥7 en la Escala DMed. En el análisis multivariado las buenas puntuaciones en la Escala DMed se asociaron a una mayor edad, menores circunferencia de cintura, e índice de masa corporal, a un mayor nivel educativo, a un seguimiento regular de la dieta, al tiempo transcurrido desde la primera revascularización y a revascularización con cirugía de revascularización coronaria quirúrgica y percutánea. En el análisis multivariado un nivel educativo alto (p=0,002, OR=8.212; IC 95%: 2,155-31,291) y el tiempo transcurrido desde la revascularización (p=0,034, OR=1,007, IC 95%: 1,001-1,013) resultaron ser predictores independientes de buenas puntuaciones en la Escala DMed. Conclusión: El índice de adherencia a una dieta sana fue bajo en pacientes previamente sometidos a revascularización coronaria. La Escala DMed parece ser una herramienta práctica y útil para evaluar los hábitos alimentarios en el entorno ambulatorio. Los índices de adherencia a la dieta mediterránea se asociaron a un nivel educativo alto y al tiempo transcurrido desde la revascularización

Introduction: Lifestyle modification is an important component of the secondary prevention strategies; and a healthy diet is one of the cornerstones in management of the coronary heart disease. We aimed to investigate the dietary habits of the patients with history of coronary revascularization, characteristics of the ones with good adherence by using alternate MedDiet questionnaire. Methods: We included outpatients who had a history of coronary revascularization at least 6 months prior to enrollment. Each participant filled out a questionnaire to collect the data of demographics and clinical characteristics. Alternate MedDiet score was calculated to evaluate the Mediterranean style dietary adherence. Alternate MedDiet was originally based on 14-item questionnaire; we adjusted it to our population (max 13 points). Results: We enrolled 226 consecutive outpatients (age 61.7±10.9 years, 72% males). The median duration after revascularization was 60 months. A total of 112 (49.6%) patients had previous percutaneous coronary intervention (PCI), 77 (34.1%) had coronary by-pass graft surgery (CABG), and 36 (15.9%) had both revascularization procedures. The median MedDiet score was 6. Patients were stratified into two subgroups (MedDiet score ≥7 vs. <7). A total of 61 (26.9%) patients had MedDiet score ≥7. By univariate analysis, good MedDiet scores were associated with older age, waist circumference, body mass index, high education level, regular follow-up, duration after first revascularization and revascularization with CABG+PCI. In the multivariate analysis, high education level (P=.002, OR=8.212, 95%CI: 2.155-31.291) and duration after revascularization (P=.034, OR=1.007, 95%CI: 1.001-1.013) were independent predictors of good MedDiet scores. Conclusion: The adherence rate to a healthy diet was low in patients with previous coronary revascularization. MedDiet score seems to be practical and useful item to evaluate the dietary habits in outpatient setting. Mediterranean diet adherence rates were associated with high education level, and duration after revascularization

Evaluation of Mediterranean diet adherence in patients with a history of coronary revascularization. / Evaluación de la adherencia a la dieta mediterránea en pacientes con antecedentes de revascularización coronaria.

INTRODUCTION: Lifestyle modification is an important component of the secondary prevention strategies; and a healthy diet is one of the cornerstones in management of the coronary heart disease. We aimed to investigate the dietary habits of the patients with history of coronary revascularization, characteristics of the ones with good adherence by using alternate MedDiet questionnaire. METHODS: We included outpatients who had a history of coronary revascularization at least 6 months prior to enrollment. Each participant filled out a questionnaire to collect the data of demographics and clinical characteristics. Alternate MedDiet score was calculated to evaluate the Mediterranean style dietary adherence. Alternate MedDiet was originally based on 14-item questionnaire; we adjusted it to our population (max 13 points). RESULTS: We enrolled 226 consecutive outpatients (age 61.7±10.9 years, 72% males). The median duration after revascularization was 60 months. A total of 112 (49.6%) patients had previous percutaneous coronary intervention (PCI), 77 (34.1%) had coronary by-pass graft surgery (CABG), and 36 (15.9%) had both revascularization procedures. The median MedDiet score was 6. Patients were stratified into two subgroups (MedDiet score ≥7 vs. <7). A total of 61 (26.9%) patients had MedDiet score ≥7. By univariate analysis, good MedDiet scores were associated with older age, waist circumference, body mass index, high education level, regular follow-up, duration after first revascularization and revascularization with CABG+PCI. In the multivariate analysis, high education level (P=.002, OR=8.212, 95%CI: 2.155-31.291) and duration after revascularization (P=.034, OR=1.007, 95%CI: 1.001-1.013) were independent predictors of good MedDiet scores. CONCLUSION: The adherence rate to a healthy diet was low in patients with previous coronary revascularization. MedDiet score seems to be practical and useful item to evaluate the dietary habits in outpatient setting. Mediterranean diet adherence rates were associated with high education level, and duration after revascularization.

Protective effects of silymarin and curcumin on cyclophosphamide-induced cardiotoxicity.

INTRODUCTION: Cyclophosphamide (CP) is a potent anticancer agent; its clinical use is limited due to its marked cardiotoxicity. AIM: The present study was aimed at evaluating the cardioprotective effects of silymarin (SLY) and curcumin (CUR), which have strong antioxidant properties, against the toxic effects of high-dose CP on the heart of rats. MATERIALS AND METHODS: A total of 36 adult Wistar albino female rats were randomly divided into six groups. Group I (control group; nothing was administered), Group II (CP group; 30mg/kg/day CP was administered intraperitoneally to each animal for seven days), Group III (SLY group; 100mg/kg/day SLY by gavage for 14 days), Group IV (CUR group; 100mg/kg/day CUR by gavage for 14 days), Group V (SLY+CP group; 100mg/kg/day SLY by gavage for 14days plus 30mg/kg/day CP intraperitoneally starting from the seventh day) and Group VI (CUR+CP group; 100mg/kg/day CUR by gavage for 14days plus 30mg/kg/day CP intraperitoneally starting from the seventh day). Biochemical, histopathological and immunohistochemical methods were utilised for evaluation of the cardiotoxicity. RESULTS: The result showed that an increase in heart MDA and DNA fragmentation levels were detected while significant decreases were seen in SOD levels in CP alone group when compared to the other groups. CP caused severe damage in the histopathological status of heart tissue including intersititial oedema, haemorrhage, degeneration and necrosis in muscle fibrils and perinuclear vacuolization. A significant increase in the percentage of TUNEL-positive cells and γH2AX protein expression was detected in the CP-treated group compared to the control and other treated groups. There was significant increase in the percentage of caspase 3-positive cells and decrease in the percentage of Bcl-2 positive cells in the CP group compared to the control group and other treated groups. However, a significant decrease in the percentage of cTnI and cTnT immunoreactivity was also observed in the CP-treated group compared to the control and other treated groups. In the groups in which SLY and CUR were administered concurrently with CP, biochemical parameters, histopathological and immunohistochemical results were found to be significantly lower than in the CP-only group. CONCLUSIONS: These results lead to conclusion that the natural antioxidant SLY and CUR might have protective effects against CP-induced cardiotoxicity and oxidative stress in rats.

Evaluation of heart rate variability and night-time blood pressure measurements in patients with idiopathic sudden sensorineural hearing loss.

OBJECTIVE: The aim of this study is to investigate the role of the autonomic nervous system in the etiology of idiopathic sudden sensorineural hearing loss (ISSHL) by measuring heart rate variability (HRV) and night-time blood pressure levels. PATIENTS AND METHODS: A total of 58 patients, 31 ISSHL patients (group 1) and 27 healthy volunteers (control group; group 2), were included in this study. Clinical and ambulatory blood pressure measurements and Holter electrocardiography were performed in both groups. After these evaluations, HRV parameters and night-time blood pressure values were determined. RESULTS: Mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) measured at night-time were higher in group 1 compared to group 2 (p < 0.05). Heart rate variability parameters were lower in group 1 than in group 2. CONCLUSIONS: In patients with ISSHL, elevated blood pressure at night-time and reduced heart rate variability suggest that autonomic nervous system dysfunction might play a role in the etiopathogenesis of the disease. The measurements of ambulatory blood pressure and heart rate variability can reveal more enlightening data in the determination of the etiology of ISSHL and guiding the treatment.

Evaluation of galectin-3 levels in acute coronary syndrome.

Galectin-3 is a new biomarker that is assumed to reflect fibrogenesis and inflammation. In this study, we aimed to evaluate the levels of galectin-3 in patients with acute coronary syndrome (ACS) and the relation of galectin-3 to the burden of atherosclerosis. Nineteen patients with ACS who underwent coronary angiography and 17 age-matched healthy controls were enrolled. The burden of atherosclerosis was assessed with Gensini score and with the number of involved vessels. Galectin-3 levels were measured on admission by using ELISA. The mean age of the cohort was 62.8±10.6 and 56% of the patients were male. Compared to control group, median galectin-3 levels were significantly higher in ACS patients (0.77ng/mL [0.50-1.19] vs. 0.51ng/mL [0.41-0.78], P=0.01). Patients were classified into three groups according to the number of involved vessels. Median galectin-3 levels did not differ significantly among groups (one vessel: 0.68ng/mL [0.55-0.74], two vessels: 0.67ng/mL [0.46-1.84], three vessels 0.90ng/mL [0.53-1.38], P=0.62). There was a strong correlation between galectin-3 levels and Gensini score (r=0.625, P=0.004). In conclusion, galectin-3 levels were elevated in patients with ACS and there was a strong correlation between galectin-3 levels and Gensini score.

First molecular detection and characterization of Akabane virus in small ruminants in Turkey.

Abortion outbreaks associated with congenital malformations in two distinct small-ruminant flocks were reported in Turkey in 2013-2014. This paper describes the first molecular characterization of Turkish Akabane virus strains in small-ruminant flocks using partial sequence analysis of the S segment and pathological findings.

Relationship between left atrial functions, P-terminal force and interatrial block in chronic haemodialysis patients.

OBJECTIVE: Interatrial block (IAB) connotes a P wave duration ≥ 110 msec on electrocardiography (ECG). P-terminal force corresponds to a biphasic P wave with its terminal negative phase ≥ 40 msec x mm in V1 derivation on ECG. IAB and P-terminal force are closely related parameters and they are accepted as predictors for left atrial dysfunction, left atrial dilatation, atrial fibrillation and strokes. Left atrial functions in chronic haemodialysis patients becomes worse in the course of time because of long standing pressure and volume overload. The aim of this study is to evaluate the relationship between IAB, P-terminal force and left atrial functions. PATIENTS AND METHODS: 68 chronic haemodialysis patients and 60 control subjects were included in the study. Conventional echocardiography and left atrial dynamic functions were measured in all cases. The subjects with IAB and P-terminal force on ECG were identified. RESULTS: Left ventricular size, wall thickness and left atrial diameters were significantly greater in haemodialysis patients than the control group (p < 0.001). 42 (62%) patients had IAB (≥ 110 msec) and 45 (66%) patients had P-terminal force ( ≥ 40 msec x mm) in the haemodialysis group. Left atrial reservoir, conduit and pump functions were significantly lower in the haemodialysis group than the control group (p < 0.001). There was a statistically significant correlation between left atrial functions, IAB (≥ 110 msec) and P-terminal force (≥ 40msec x mm) in all parameters (p < 0.001). CONCLUSIONS: This study showed that decreased left atrial functions in chronic haemodialysis patients are closely correlated with IAB and P-terminal force.

Single coronary artery incidence in 215,140 patients undergoing coronary angiography.

BACKGROUND: The aim of our study is to determine the incidence of single coronary artery (SCA). SCA is a rarely seen coronary anomaly in which the right coronary artery and the left main coronary artery arise from single aortic sinus. Although SCA has a benign course in most cases and its clinical significance is unknown, in some autopsy studies it was shown to be related to sudden cardiac death. MATERIALS AND METHODS: SCA patients detected among 215,140 coronary angiographies (CAG) performed between 1998 and 2013 in SANKO Hospital were included in our study. The classification of CAG was made according to the two different classifications defined by Smith and Lipton and colleagues. RESULTS: A total number of 215,140 patients who underwent routine CAG were included in the study, and SCA was detected in 67 (0.031%) patients. There were 6 (9%) type R-I, 23 (34%) type R-II, 10 (15%) type R-III, 16 (24%) type L-I and 12 (18%) type L-II patients according to the angiographic classification. CONCLUSIONS: SCA is rarely seen during routine cardiac catheterisation and its incidence is 0.014-0.066% in angiographic series. In our study, the incidence was shown to be similar to the previous studies.

The relationship between microalbuminuria and isolated coronary artery ectasia.

AIM: Coronary artery ectasia (CAE), is at least 1.5 fold dilatation of at least one coronary segment due to congenital or acquired causes. In this study, we aim to investigate the relation of CAE with microalbuminuria, which is a marker of endothelial dysfunction shown to be associated with increased cardiovascular mortality and morbidity. PATIENTS AND METHODS: Patients with CAE detected during routine coronary angiogram (CAG) and individuals with normal CAG findings have been included in our study. Urine albumin levels were measured by immunoturbidimetric method from samples collected in the morning. Patients with an albumin/creatinine (A/C) ratio less than 0.03 were normal and the ones between values 0.03-0.3 were considered to be microalbuminuric. Patients whose A/C ratios > 0.3 had macroalbuminuria and were excluded. RESULTS: A total of 105 patients (60 with CAE and 45 with normal CAG) were included in the study. Serum creatinine, low-density lipoprotein cholesterol and homocysteine levels were increased in the CAE group. Urine A/C ratio was 0.036 ± 0.040 in the CAE group and 0.018 ± 0.013 in the controls; the difference was statistically significant (p = 0.002). CONCLUSIONS: Blood homocysteine levels and urinary albumin levels are significantly increased in patients with CAE when compared to individuals with normal CAG. Microalbuminuria and hyperhomocysteinemia, two markers of endothelial dysfunction might be associated with pathophysiologic processes leading to CAE.

Two cases of very late bare-metal stent thrombosis and literature review.

BACKGROUND: Bare metal stents (BMS) are commonly used in the treatment of coronary artery disease. Very late stent thrombosis (VLST) is a quite rare clinical entity. However, it is a serious complication that often results myocardial infarction or death. Since the stent endothelialization is considered to be completed within 4 weeks after the intervention, VLST is not common with BMS. PATIENTS AND METHODS: The pathogenesis of the VLST is poorly defined. Herein, we report two cases of VLST in which one a 62 year old male patient devoloped VLST of a BMS implanted in the right coronary artery (RCA) and presented inferior myocardial infarction and other a 48 year old male patient devoloped very late thrombosis of a BMS implanted in the RCA and presented inferior myocardial infarction, respectively. CONCLUSIONS: On the basis of these two cases and our review of the current literature we suggest that what can be done to prevent this rare but offending complication. Moreover, in the light of new imaging modalities such as optical coherence tomography (OCT), the pathophysiology of stent thrombosis will be clearly defined and preventive measures will be taken before it occurs.