Pulmonary artery intimal sarcoma: Case report of a patient managed with multimodality treatment and a comprehensive literature review.

Pulmonary artery intimal sarcoma (PAIS) is a rare and aggressive malignancy originating from the intimal layer of the pulmonary artery with poor prognosis due to its aggressive nature. The management of PAIS poses both diagnostic and therapeutic challenges. It presents with nonspecific symptoms and is often misdiagnosed as pulmonary embolism. While surgical resection is the primary treatment modality, the role of adjuvant chemotherapy and radiotherapy remains uncertain. However, given the high recurrence rate, adjuvant chemotherapy and/or radiotherapy have been utilized in a limited number of case reports. We present the case of a 46-year-old woman who was diagnosed with PAIS and underwent surgical resection followed by adjuvant chemotherapy (ChT) and radiotherapy (RT), demonstrating good tolerance to this multimodal treatment approach.

Starch/PCL composite nanofibers by co-axial electrospinning technique for biomedical applications.

BACKGROUND: In this study, starch and polycaprolactone (PCL), composite nanofibers were fabricated by co-axial needle electrospinning technique. Processing parameters such as polymer concentration, flow rate and voltage had a marked influence on the composite fiber diameter. Fourier transform infrared spectroscopy, scanning electron microscopy (SEM), mechanical and physical properties (such as density, viscosity and electrical conductivity) of the composite fibres were evaluated. Moreover, a cell culture test was performed in order to determine their cytotoxicity for wound dressing application. RESULTS: The effect of starch ratio in the solution on the properties and morphological structure of the fibers produced was presented. With lower starch concentration values, the fibers have greater ultimate tensile strength characteristic (mostly 4 and 5 wt%). According to SEM results, it can be figured out that the nanofibers fabricated have good spinnability and morphology. The mean diameter of the fibers is about 150 nm. According to results of cell culture study, the finding can be determined that the increase of starch in the fiber also increases the cell viability. CONCLUSIONS: Composite nanofibers of starch/PCL have been prepared using a co-axial needle electrospinning technique. PCL was successfully encapsulated within starch. Fiber formation was observed for different ratio of starch. With several test, analysis and measurement performed, some important parameters such as quality and effectuality of each fiber obtained for wound dressing applications were discussed in detail.

[Low-flow low-gradient aortic valve stenosis : Current evidence]. / "Low-flow-low-gradient"-Aortenklappenstenose : Aktuelle Evidenz.

Many patients with severe aortic stenosis have a "low-flow, low-gradient" aortic stenosis. The management of these patients can be quite difficult, as these patients often show impairment of the left ventricle, which can lead to false measurements of the severity of stenosis and also leads to a higher risk during aortic valve replacement. More diagnostic tools than only standard echocardiography are needed to correctly differentiate true severe aortic stenosis from pseudo severe aortic stenosis.

[We carry out too many TAVI - contra]. / Wir machen zu viele TAVI - Kontra.

Transcatheter aortic valve implantation (TAVI) is an established and approved procedure with an increasing implantation rate, whilst the number of surgical aortic valve replacements (SAVR) remained unchanged (AQUA data). This demonstrates that more patients who were unsuitable for SAVR were treated with TAVI. First randomized trials have shown a significant survival benefit for TAVI compared to conservative therapy (PARTNER B) and non-inferiority to SAVR in high-risk patients (PARTNER A). The US pivotal trials demonstrated even a significant survival benefit in TAVI patients compared to SAVR. The current 5-year data of the PARTNER trials demonstrate a long-term durability of the TAVI valves, which even have superior hemodynamic parameters. Increasing experience, optimization and evolution of the TAVI systems lead to better results and lower rates of complications and mortality, as was shown by the "real world data" from the German aortic valve registry (GARY). The analysis of the subgroups and also the Nordic aortic valve intervention (NOTION) study showed equivalent results for TAVI and SAVR in patients with intermediate and low risk. There is a trend to expand the indications to patients with intermediate risk and the currently ongoing large prospective and randomized trials SURTAVI and PARTNER II could provide greater clarity.

[Interdisciplinary differential treatment of structural heart disease : When operation and when catheter-based intervention?]. / Interdisziplinäre Differenzialtherapie struktureller Herzerkrankungen : Wann Operation und wann kathetergestützte Intervention?

The demographic changes in society lead to an increasing number of patients with aortic valve stenosis and mitral regurgitation. Simultaneously the higher age of patients is associated with an increase in multimorbidity with a high surgical risk so that they cannot be referred to surgery. Besides the current gold standard of surgery, minimally invasive therapeutic options are increasingly becoming established for these patients. For the differentiated indications and therapeutic success, a multidisciplinary heart team assumes an important role. The next generation of transcatheter aortic valve implantation (TAVI) systems will lead to improvement in the results, lower complication rates and mortality and as a result there is a general trend towards expanding the indications. New innovative minimally invasive mitral valve devices are still undergoing clinical trials and will define future therapy options.

Creatine supplementation alters homocysteine level in resistance trained men.

AIM: This study was conducted to investigate the effects of creatine loading and resistance training on the homocysteine and lipid profiles of young males. METHOD: Sixty male University students (22.34 ± 2.19 years, 1.79 ± 0.08 m, 77.18 ± 12.57 kg, 15.48 ± 4.57% body fat) were randomly divided in to three groups; control (CG=20), creatine supplement (CEG=20) and placebo (PEG=20). Both CEG and PEG participated in a same resistance-training regimen and either taking a creatine supplement (25 g/d for the first 5 days followed 5 g/d thereafter) or the same amount of placebo for 8 weeks. Participants in CG did not take any creatine supplementation and not engage any exercise program. After the body composition were assessed, the homocysteine (Hcy) concentrations, blood lipids, folic acid and vitamin B12 levels of all the participants were measured at the beginning and end of the eight weeks of resistance training. RESULTS: The analysis of the data indicated that the Hcy levels of the CEG after resistance training and receiving the creatine supplement (9.33 ± 4.60) was significantly lower than that of baseline (12.66 ± 5.89) measurements, F(1,18)=12.28, P=0.00. No significant differences were seen in the Hcy levels of the PEG (15.01 ± 10.87) after 8 weeks of training and receiving a placebo (12.46 ± 12.50), F(1,16)=4.65, P=0.05. Furthermore, there were no significant differences among groups in terms of Hcy levels, F(2,52)=1.72, P=0.19. CONCLUSION: The present study suggests that as well as strength gain; creatine supplementation with resistance training may afford some protection against emerging cardiovascular risk factors.

The consistency of Gleason scores may effect the operation outcomes for laparoscopic radical prostatectomy: a single surgeon and a single pathologist data.

INTRODUCTION: To evaluate the effects of consistency in preoperative and postoperative Gleason scores to the operation outcomes in patients who underwent laparoscopic radical prostatectomy. MATERIALS AND METHODS: 204 of 347 patients were included the study. 143 patients whose preoperative prostate biopsies were evaluated in the other Institute were not included into the study. The preoperative data of patients and operation outcomes were investigated from institute's files of patients. Patients were divided to three groups by using consistence of pre and postoperative Gleason scores. The tumor, node and metastasis classification were used for staging prostate cancer. RESULTS: Mean age was 63 and the mean PSA level was 11 ng/dl overall. In statistical analysis PSA levels, Gleason score and rate of positive score were significantly low in Group I (p < 0.05). As in operative data, nerve sparing surgical technique was performed statistical significance higher in Group 1 than other Groups. External bleeding rate of Group II was significantly lower than the other Groups. In univariate and multivariate analysis, postoperative pathologic stage was statistical significant for consistency of pre and postoperative Gleason scores. CONCLUSIONS: The modified Gleason scoring system is safe and usable for evaluating prostate biopsies and operative specimens. The consistency in pre and postoperative Gleason score effect the operation technique and also operation outcomes. Working with an experienced uro-pathologist provides to inform patients more accurate and better.

Rare malformation of glans penis: arteriovenous malformation.

Pediatric glans penis malformations, especially arteriovenous malformations (AVM), are very rare. Herein, we report two rare cases. A 14-year-old boy attended our outpatient clinic with chief complaints of purple swelling and rapidly growing lesion on the glans penis. The lesion was excised surgically after physical and radiological evaluations. Pathology reported AVM and the patient is being followed up. The second case is a 2-year-old boy who was admitted with a big lesion involving glans penis and genital area that has been present since birth. In physical and radiological evaluations, lesion on the glans penis was pulsatile. Parents of the patient did not want any surgery and patient has been in follow-up. Diagnosis of the vascular lesions on glans penis is very easy by physical and radiological examinations today. Long-term follow-up is very important for AVM. Clinicians must make a careful effort to document new glans lesions in the pediatric population and decrease anxiety in the parents of affected children.

Risk of hepatitis B infections in Olympic wrestling.

OBJECTIVE: First, to investigate the prevalence of the hepatitis B virus (HBV) and occult HBV infection (OC-HBV) in Turkish Olympic wrestlers. Second, to examine the relationship between HBV DNA values in sweat and blood. METHODS: A total of 70 male Olympic wrestlers were recruited as the study sample. RESULTS: As a result of the standard monoclonal antibody based hepatitis B surface antigen (HBsAg) detection, none of the Olympic wrestlers carried HBsAg in this study. On the other hand, according to real time PCR for serum HBV DNA detection in this study, 9 (13%) of the wrestlers had OC-HBV infection. Eight (11%) of the participants had HBV DNA in their sweat. In addition, there was a significant relationship between HBV DNA values in the blood and sweat of the wrestlers (r = 0.52, p<0.01). CONCLUSIONS: In addition to bleeding wounds and mucous membranes, sweating may be another way of transmitting HBV infections in contact sports. An HBV test should be done and each wrestler should be vaccinated at the start of his career.

The efficacy of intrathecal morphine in post-thoracotomy pain management.

This study compared the analgesic efficacy of intrathecal (IT) morphine plus IV patient-controlled analgesia (PCA) morphine with IV PCA morphine alone in 33 patients undergoing thoracotomy randomized to two groups: the IT morphine group (n=17) received 10 microg/kg morphine 1 h before the end of surgery, while the control group (n=16) did not. All patients had access to an IV PCA pump post-operatively that delivered 2 mg morphine boluses. Post-operative pain and sedation scores, respiratory and haemodynamic parameters, and morphine demand and delivery were assessed up to 48 h. Post-operative pain scores and morphine consumption were significantly reduced, while peak expiratory flow rates were significantly increased in the IT morphine group compared with controls. We concluded that IT morphine in addition to IV PCA established superior analgesia and maintained better respiratory function compared with IV PCA alone in post-thoracotomy patients.

Bilateral shoulder fracture dislocations and radiculopathies secondary to electrical injury (a case report).

INTRODUCTION: In this report a case of bilateral shoulder fracture dislocations and C5 radiculopathy developed after an electrical injury is presented. CASE: A 29 year-old male patient referred to our hospital with complaints of inability to raise his hands overhead starting 3 months ago after an electrical injury. The first physical examination revealed loss of strength (3/5) in deltoid muscles bilaterally, bilateral shoulder fracture dislocations and C5 radiculopathies. An open reduction and internal fixation (using K wire, cortical screw) procedure was applied for the right side in the Department of Orthopedics. Postoperatively active (A) and passive (P) ranges of motion (ROMs) were restricted extremely in the right and left shoulder respectively. Since applications of 15 sessions of electrical stimulation for deltoid muscle and physical treatment for both shoulders failed to achieve satisfactory ROMs, K wire extraction was instituted with resultant increase in the right shoulder A/P ROMs after 10 sessions of physical therapy postoperatively. At the last examination which was 18 months after the injury, ROMs of the right shoulder were increased, but not normal. CONCLUSION: It must be remembered that in electrical injury, fractures and dislocations might occur in affected sites without any evidence of trauma with associated neurologic complications, and that these cases must be promptly detected and managed without any delay.

Malignant mesothelioma of tunica vaginalis: an extremely rare case presenting without risk factors.

Testicular tumours have many different manifestations, including hydrocele formation. Herein, we present an extremely rare case of testicular mesothelioma presenting with left hydrocele, but without risk factors. Left radical inguinal orchidectomy was performed, and pathological examination revealed a malignant mesothelioma of the tunica vaginalis of the testis. No infiltration of the spermatic cord was evident, and upon advanced radiological evaluation, no sign of metastasis was detected. Follow-up was still ongoing in our urology outpatient clinic at the time of this report. Although hydrocele is a simple and common condition that is easy to diagnose, a detailed investigation should be performed. Thus, when encountering a patient with hydrocele, the clinician should evaluate the possibility of the presence of an underlying testicular/paratesticular tumour, including a rare one such as mesothelioma of the tunica vaginalis.