Knowledge and attitude changes of pregnant women regarding prenatal screening and diagnostic tests after counselling.

OBJECTIVES: This study aimed to reveal the knowledge level of pregnant women about prenatal diagnostic tests, Down syndrome (DS) and amniocentesis, their attitudes toward uptaking these tests, undergoing amniocentesis, and the termination of pregnancy. It also aimed to evaluate the effects of providing information, as well as a written information brochure about all the issues concerning women's knowledge and attitudes. MATERIALS AND METHODS: The gynecologists provided verbal and written information on prenatal screening tests (PSTs) and invasive prenatal diagnostic tests. Data were collected using an anonymous questionnaire, which was designed by the researchers on the basis of the literature. RESULTS: Knowledge of both DS and amniocentesis was found to be significantly higher after the education (p = 0.000 and p = 0.000, respectively). Attitudes toward amniocentesis changed significantly after the education. CONCLUSIONS: This study has shown that women had an inadequate knowledge about PSTs, DS, and amniocentesis. It has also revealed that education provided by gynecologists along with a written brochure of information tended to increase women's knowledge about PSTs.

Co-existence of Echinococcus granulosus infection and cancer metastasis in the liver correlates with reduced Th1 immune responses.

A possible relationship between cancer and Echinococcus granulosus infection has been postulated. As T cells are critical players in immune responses against both infections and malignancies, in an experimental model of secondary echinococcosis and breast cancer, this study aims to observe the progression of cancer and to determine the characters of T-cell responses. 4T1 breast tumour cells were subcutaneously injected into mammary region, whereas protoscoleces were intraperitoneally inoculated into the mice. Hydatid cysts, tumours and metastases were determined with macroscopic and histopathological evaluation. T cells found in spleen, liver and tumour were characterised by flow cytometric analysis of CD3, CD4, CD8, CD25, CCR5, CCR3, IL-4 and IFN-γ. In the mice inoculated both with protoscoleces and with breast tumour cells, increased frequency of cancer metastasis was observed in the liver. The amount of CD4(+) T cells was increased in the liver and in the spleen of mice infected with E. granulosus. However, co-existence of echinococcosis and metastatic lesions in the liver was associated with significant reduction in the IFN-γ(+) and CCR5(+) Th1 cells and increase in the CD25(+) T cells. Our results may indicate an immunological link between cystic echinococcosis and cancer that allows tumour metastasis to flourish in the liver.

Angiotensin-converting enzyme gene polymorphism (insertion/deletion) and liver fibrosis in Turkish patients from the western Black Sea region, Turkey.

Chronic viral hepatitis B, chronic viral hepatitis C, non-alcoholic steatohepatitis, alcoholic liver disease, autoimmune hepatitis, primary biliary cirrhosis, and secondary biliary cirrhosis are important health issues worldwide. While an association between angiotensin-converting enzyme gene insertion/deletion (ACE gene I/D) polymorphism and liver fibrosis has been demonstrated in rat studies, the results of clinical studies area have been contradictory. The aim of this study was to assess the possible association between ACE gene I/D polymorphism and liver fibrosis in a large group of Turkish patients from the western Black Sea region. In 418 patients with different etiologies, ACE gene I/D polymorphism and serum ACE levels were investigated. The distribution of the "DD", "ID", "II" genotypes of the ACE gene were 32.5, 48.8, and 18.7% in the mild to moderate fibrosis group (N = 246, F:1-3 according to Ishak's score) and 39.0, 44.2, and 16.9% in the advanced fibrosis group (N = 172, F:4-6 according to Ishak's score). A significant correlation between serum ACE levels and ACE gene alleles was identified (P < 0.001): serum ACE levels of patients with D alleles were higher than those of patients with I alleles [44 (min 7-max 101) versus 29 (min 7-max 96)]. Patients with advanced fibrosis were also found to be older than those with mild to moderate fibrosis (P < 0.001). No significant association was noted between the patient gender and fibrosis severity. We conclude that ACE I/D polymorphism is not associated with the degree of liver fibrosis.

Transcutaneous electrical nerve stimulation improves low back pain during pregnancy.

BACKGROUND: To compare the efficiency of transcutaneous electrical nerve stimulation (TENS) with those of exercise and acetaminophen for the treatment of pregnancy-related low back pain (LBP) during the third trimester of pregnancy. METHODS: This prospective study included 79 subjects (≥32 gestational weeks) with visual analog scale (VAS) pain scores ≥5. Participants were divided randomly into a control group (n = 21) and three treatment groups [exercise (n = 19); acetaminophen (n = 19); TENS (n = 20)]. The VAS and the Roland-Morris disability questionnaire (RMDQ) were completed before and 3 weeks after treatment to assess the impact of pain on daily activities. RESULTS: During the study period, pain intensity increased in 57% of participants in the control group, whereas pain decreased in 95% of participants in the exercise group and in all participants in the acetaminophen and TENS groups. Post-treatment VAS and RMDQ values were significantly lower in the treatment groups (p < 0.001). VAS and RMDQ scores indicated a significantly greater degree of pain relief in the TENS group than in the exercise and acetaminophen groups (p < 0.001). No adverse effect of TENS application on pregnant women was observed during the study. CONCLUSION: TENS is an effective and safe treatment modality for LBP during pregnancy. TENS improved LBP more effectively than did exercise and acetaminophen.

Hearing levels in menopausal women and the effect of tibolone on audiological functions.

The aim of this study was to examine the hearing levels of menopausal and premenopausal women of the same age and to evaluate the effect of tibolone on hearing. The study involved 83 postmenopausal women. Cases using tibolone were grouped into the tibolone group (T-group) and women without any hormone therapy were grouped into the non-tibolone group (NT-group). A total of 45 premenopausal women of the same age were taken as controls. Hearing levels of both ears were measured by audiometry. Significantly lower levels of hearing threshold at different levels were detected in the control group compared with the other groups. Postmenopausal women with and without tibolone therapy have poorer thresholds compared with still menstruating women of the same age. Thus, intrinsic oestrogen at physiological levels might slow down hearing loss in ageing women. Tibolone had no negative effect on hearing function.

Defining prognostic parameters of well-differentiated gastric neuroendocrine tumors based on metastatic potential: a two-center experience.

Background: Gastric neuroendocrine tumors [gNETs] are heterogeneous tumors and we are still unable to predict the behavior of these tumors. We aim to define the prognostic parameters of well-differentiated gNETs based on metastatic potential and to evaluate the current classification systems. Patients and methods: We retrospectively retrieved 44 well differentiated gNET cases who underwent radical surgery between 2000-2015 at two tertiary-care centers. Results: Among the 44 well-differentiated gNET patients, 17 (38%) patients had metastatic disease to lymph nodes and/or distant sites, while 27 (62%) were confined to the stomach. Higher risk of metastasis was observed with increasing tumor size, grade, depth of invasion and with type-3 and solitary tumors. 30 (68%) patients had type-1 gNET and 14 (32%) had type-3 gNET. Majority of the type-1 cases (76,6%) were Grade 1 [G1] and type-3 cases (78,5%) were Grade 3 [G3]. Type-1 subgroup had no G3 tumor, and type-3 had no G1. Grade 2 [G2] tumors were more controversial, with metastatic and non-metastatic cases. G2 cases with a >10% Ki67 expression or type-3, had a worse prognosis. Although most of the type-1 gNETs had an indolent course, 6 of 30 (20%) patients had metastatic disease. Metastasizing type-1 gNETs were >10 mm in diameter or extended to/beyond the submucosa. Conclusion: Regarding our results, tumor type, grade, size, focality and depth of invasion are the prognostic parameters for gNETs, based on metastatic potential. Besides these parameters, a two-tiered grading system with a 10% Ki-67 proliferation index cut-off value could be considered for right treatment choice.

Effect of tibolone on audiologic functions in menopausal women.

OBJECTIVE: The aim of this study was to examine the effect of tibolone on hearing function in postmenopausal women. METHODS: This prospective study involved 60 postmenopausal women. Participants were randomly divided into two groups. The tibolone group was assigned to receive a tibolone tablet daily (n = 30). The other 30 cases who had not received any kind of hormone therapy were taken as the control group. The hearing levels of both ears in all women were measured by audiometry before initiation of tibolone therapy and 6 months after therapy. RESULTS: The baseline hearing threshold levels of the two groups were similiar. After 6 months, audiometry results did not differ from baseline levels in the control group. In the tibolone group, there was some improvement in almost all hearing threshold levels after therapy. Statistically significant differences were only observed on the right side at pure tone audiometry and at the 500 and 6000 Hz levels. CONCLUSIONS: Although tibolone has both gestagenic and androgenic properties together with estrogenic properties, no negative effect on hearing after 6 months of treatment was observed. On the contrary, there was significant improvement in audiometry results at low frequencies after 6 months' treatment. Although statistically not significant, there was some improvement at high frequencies.

Spontaneous rupture of fetal hydronephrosis: case report.

Hydronephrosis is the most common congenital anomaly observed with prenatal ultrasonography. Ureteropelvic junction obstruction (UPJO) is the most common cause of prenatal hydronephrosis. Spontaneous rupture has been reported in adults with severe hydronephrosis. There is no reported spontaneous rupture case in the fetus in the literature. A spontaneous ureteral rupture due to severe UPJO was reported in this case report. Prenatal ultrasound at 33 week gestation in a 21-year-old pregnant woman, revealed a female fetus with grade IV hydronephrosis of the right kidney, suggestive of a UPJO. During the follow-up at XXXVIII week, 5 cm cystic structure was not observed in right kidney. Mild ectasia was present in pelvicalyciel part which make us think about spontaneous rupture. Ultrasonographic examination after a week post-delivery revealed 15 mm pelvicalyciel ectasia on right side which persisted during the second control after 1 month. Vesicoureteral reflux was not detected during voiding cystourethrogram. Diuretic renography revealed loss of right renal function completely. Because there was not any complain or any clinical sign, surgery was not thought. Spontaneous follow-up was recommended.

Role of enoxaparin resistance in recurrent chest pain in the intensive care unit.

To investigate the relationship between anticoagulation treatment and drug resistance in chest pain, levels of factor Xa residual activity were determined in patients seen in intensive care with recurrent chest pain and compared with levels in patients who had no ischaemic events during hospitalization. A total of 122 patients aged 18 - 75 years who were admitted to hospital with acute coronary syndrome and treated with enoxaparin were included. Of these, 62 patients had recurrent chest pain while hospitalized (group A) and 60 patients had an uneventful follow-up period (group B). Patients requiring primary percutaneous transluminal coronary angioplasty and/or treatment with glycoprotein IIb/IIIa inhibitors, and those with renal failure, a high risk of bleeding or receiving anti-inflammatory drugs were excluded from the study. Median levels (+/- interquartile range) of factor Xa residual activity were significantly higher in group A compared with group B (0.68 +/- 0.29 IU/ml versus 0.34 +/- 0.33 IU/ml). It is concluded that enoxaparin resistance, resulting in high levels of factor Xa residual activity, should be considered in patients with recurrent ischaemia.

Fulminant hepatic failure due to secondary amyloidosis.

Systemic amyloidosis frequently involves liver, however, clinically apparent liver disease is rare and, if observed, is usually mild. Rarely, primary amyloidosis may present with evidence of portal hypertension or hepatic failure. Although secondary amyloidosis may involve the liver and rarely causes liver pathologies such as cholestatic hepatitis and portal hypertension, to our knowledge, hepatic failure due to secondary amyloidosis has been reported once before. Herein, we presented a woman with subacute fulminant hepatic failure who had no known history of a chronic disease other than episodes of urinary tract infection, and secondary amyloidosis was diagnosed with post-mortem liver biopsy.

Bilateral drop-foot after orthotopic liver transplant.

Patients may demonstrate various neuromuscular abnormalities after liver transplantation. We report a patient who developed bilateral drop foot after orthotopic liver transplantation. He was diagnosed with critical illness polyneuropathy. During follow-up, his complaints gradually recovered and his electrodiagnostic findings improved.

Predictive Value of Unenhanced Computerized Tomography for Detecting Hepatosteatosis in Living Liver Donors.

OBJECTIVE: Macrovesicular hepatosteatosis is related to post-transplantation complications, so preoperative hepatosteatosis determination plays a critical role in donor selection. The aim of this study was to evaluate the efficacy of unenhanced computerized tomography (CT) in determining hepatosteatosis in liver donor candidates. METHODS: Information about donor candidates was retrospectively reviewed. In this screening, 27 donor candidates who underwent liver biopsy because of suspected hepatosteatosis in routine abdominal CT examination before transplantation, were reviewed. Liver biopsies and CT images were reevaluated by an experienced pathologist and radiologist. Macrovesicular hepatosteatosis was graded according to percentage and divided into 3 groups. Three radiologic liver attenuation indices were used: 1) hepatic attenuation value (CT(L)); 2) the difference between hepatic attenuation and spleen attenuation (CT(L-S)); and 3) the ratio of hepatic attenuation to splenic attenuation (CT(L/S)). RESULTS: CT(L), CT(L-S), and CT(L/S) values of donors with hepatosteatosis were significantly higher than the donors without hepatosteatosis. In receiver operating characteristic analysis, the optimal cutoff value of these indices for determining hepatosteatosis were; 42.5, -5, and 0.98, respectively. At these cutoff values, the sensitivity and specificity of these indices were calculated to be 80% and 75%, 93.3% and 83.3%, and 93.3% and 83.3%, respectively. There were no statistical differences between their diagnostic performances. When these 3 indices were used for detect significant hepatosteatosis (>20%) it was observed that hepatosteatosis of only one donor could not be determined whereas it was seen that specificity was decreased markedly. CONCLUSIONS: Despite the high diagnostic yield of unenhanced CT, it is not suitable to use alone for assessment of hepatosteatosis in clinical practice.

Prevalence of advanced histologic features in diminutive colon polyps.

BACKGROUND/AIMS: Accurate in vivo differentiation of colon polyp histology may serve to prevent the resection of diminutive hyperplastic polyps in the distal colon or the need for histologic assesment of diminutive polyps after resection. The clinical implementation of these strategies depends on the prevalence of advanced histologic findings among diminutive polyps. We aimed to determine the prevalence of advanced histologic features (villous features, high-grade dysplasia, and adenocarcinoma) in diminutive colon polyps and compare it to small and larger polyps. PATIENTS/METHODS: The data of patients who had undergone elective colonoscopy at a tertiary-care referral center were retrospectively reviewed. The size, morphology, and location of all polyps were recorded. Polyps were divided into 3 groups according to their size: diminutive (≤ 5 mm), small (6-9 mm), and large (≥ 10 mm). RESULTS: A total of 7160 polyps in 3226 eligible patients were evaluated. The mean diameter of the polyps were 6.7 ± 4.9 mm. Histopathologic diagnosis were adenomatous in 4548 (63.5%) and non-adenomatous in 2612 (36.5%). Out of 7160 polyps, 4902 (68.5%) were diminutive (1-5 mm), 1360 (19%) were small (6-9 mm), and 898 (12.5%) large (≥ 10 mm) polyps. Among the diminutive polyps 2739 (55.9%) had adenomatous histology. There were 66 polyps (1.3%) with advanced histology in the diminutive group, 72 (5.2%) in the small group, 263 (29.2%) in the large polyp group. Diminutive polyps had a lower frequency of advanced histology compared to small and large polyps (p = 0.001). When the histology of the polyps were evaluated based on the size of the largest polyp the patient has, 2202 patients had polyp(s) ≤ 5 mm. The frequency of advanced histology was 2.2% in these patients. CONCLUSIONS: The prevalence of advanced histology in diminutive polyps is quite low (1.3%) which supports the clinical implementation of discard, resect and discard strategies in diminutive polyps.

Powerful morphometric indicator of prognosis in lupus nephritis.

BACKGROUND: Changes in renal biopsies in lupus nephritis have been analysed in many ways, but few have had prognostic value. AIM: To see whether a morphometric measure of chronic renal damage that was a prognostic indicator in other conditions had similar value in lupus nephritis. DESIGN: Retrospective analysis of biopsies and study of outcome. METHODS: On sections of 260 biopsies from 182 consecutive patients with systemic lupus erythematosus, an image analysis system measured chronic damage as a proportion of cortical area, to give the index of chronic damage. This was related to survival (until death or onset of dialysis). Patients were followed for up to 20 years. RESULTS: The index of chronic damage ranged from 0 to 93%. Twenty-three patients (13%) died before dialysis, many from infection or myocardial infarction, and 40 (22%) went onto permanent dialysis. There were strong correlations between the index and time until death or dialysis (log rank test: chi(2) = 51.08, three degrees of freedom [df], p < 0.001) and time to dialysis (log rank test: chi(2) = 72.88, 3df, p < 0.001), but there was no correlation with time until death before dialysis (log rank test: chi(2) = 0.36, 3df, p > 0.9). WHO class of nephritis had no major relation to outcome after the index was taken into account and after appropriate treatment of the different classes. DISCUSSION: The index was a strong indicator of risk of progression to renal failure in lupus nephritis, but not of risk of death before dialysis. This will be useful in clinical management and treatment trials.

Secretory breast carcinoma in a boy.

Secretory breast carcinoma is a very rare condition in boys. An 11-year-old boy with secretory breast carcinoma is presented here. Modified radical mastectomy was performed by irradiation and chemotherapy because of axillary metastasis. There was no local recurrence or distant metastases in the follow-up period of 14 months.

Scapula length measurement for assessment of fetal growth and development.

To determine the value of prenatal ultrasonographic scapula measurements for fetal growth and development as an adjunct to assessing in utero development, a prospective study of ultrasonography was conducted in 343 pregnant women with uneventful pregnancies with gestational ages from 16 to 41 weeks, and several biometric measurements were obtained. The relationships of scapula length with gestational age and with biparietal diameter, femur length, abdominal circumference and scapula length were examined. With the ultrasonographic examinations of 343 healthy pregnant women, a nomogram of scapula length measurements estimating gestational age and predicting the biparietal diameter, abdominal circumference, and femur length was generated. Linear relationships were found between the scapula length and the gestational age (R2 = 0.94, p < 0.0001), the biparietal diameter (R2 = 0.94, p < 0.0001), abdominal circumference (R2 = 0.94, p < 0.0001), and the femur length (R2 = 0.95, p < 0.0001). The rate of increase of scapula length was significantly higher before 28 weeks of gestation than in later pregnancy (p < 0.0001). The correlation coefficients between gestational age and scapula length were 0.95 before 28 weeks of gestation and 0.86 in later weeks. These results suggest that scapula length measurement is a valuable parameter for the assessment of fetal growth and development.

Benign cystic teratoma of the douglas.

We report a case of a benign cystic teratoma in a 30-year-old woman who underwent laparoscopy for a persisting pelvic mass in the posterior cul-de-sac. Our review of the literature indicates that, this is the second teratoma case of the douglas and the first one removed laparoscopically.

Acute uterine inversion due to a growing submucous myoma in an elderly woman: case report.

A case of acute non-puerperal uterine inversion due to a growing submucous myoma in elderly woman is presented. This is rare and the diagnosis is often difficult.