Prenatal diagnosis of a fetus with androgen insensitivity syndrome (AIS)

OBJECTIVE: The aim of this study is to describe a fetus with androgen insensitivity syndrome diagnosed at mid-second trimester. CASE AND METHODS: Nuchal translucency was measured thick and double test was found higher. The patient referred to our center at 16(th) weeks of gestation. Fetal ultrasound examination and amniocentesis was performed. RESULTS: The nuchal translucency (NT) of fetus in present pregnancy was measured approximately 10 mm at 13 weeks and Down syndrome risk was calculated 1 in 10 by double test. On ultrasound examination; thick nuchal fold (NF) and short fetal limbs were found, and the fetus was seen a female and amniocentesis was performed. Three weeks later the fetal karyotype was reported normal as 46,XY. Thereupon the fetus reexamined for 2D and 4D ultrasound, and confirmed previous findings. The fetus was terminated at 19(th) weeks and seen a female phenotype. The fetal gonads removed in abdomen and testicles confirmed histopatologically. CONCLUSION: In generally, diagnosis of AIS is most made postnatally. This is the second case in English literature, which diagnosed mid-second trimester. In this situation, the fetus with thick NT/NF and short limbs may be AIS, therefore appearance of fetal sex on ultrasound should be compared with genetic sex.     

Bullous pemphigoid and cholestatic hepatitis associated with Castleman's disease.

The case of a 21-yr-old woman admitted with a two-week history of icterus, fever, multiple peripheral lymphadenopathy and pruritic eruption is presented. A full evaluation including computed tomography, endoscopic retrograde cholangiography, liver, skin and lymph node biopsies and biochemical tests confirmed the diagnosis of multicentric Castleman's disease (angiofollicular lymph node hyperplasia). All symptoms improved within four weeks of commencing prednisone therapy. Castleman's disease should be considered in the differental daignosis of cholestatic hepatitis and bullous pemphigoid.     

Effects of volatile anesthetics on mechanical properties of rat cardiac skinned fibers

Volatile anesthetics were demonstrated to decrease calcium sensitivity and maximal developed force of detergent-treated rat cardiac skinned fibers. To further investigate the possible mechanisms involved in the decrease of force production, stiffness measurements were performed at defined levels of activation with the use of quick length changes of 0.3 to 4% of initial muscle length in the absence and in the presence of 2 MAC of halothane, enflurane, or isoflurane. The results of various series of experiments suggest that these anesthetics have multiple sites of action on cardiac myofibrillar proteins: 1) they decreased active stiffness indicating a decreased number of attached force-generating cross-bridges; 2) they increased the stiffness/force ratio suggesting that the individual force developed by each cross-bridge was decreased during anesthetic exposure; and 3) they increased the time constant of force recovery, which is consistent with the decreased rate of ATP hydrolysis described by others. These changes in cross-bridges kinetics and efficiency may result from conformational changes in all the protein systems involved in force production, and especially actin-myosin attachment and detachment. However, the changes observed were small despite a relatively high concentration of anesthetics; therefore, they will probably participate only to a moderate extent in the overall negative inotropic effect of these agents.     

Retrieval of zona-free immature oocytes in a woman with recurrent empty follicle syndrome: a case report

BACKGROUND: Different ovulation trigger methods such as gonadotropin releasing hormone-agonist (GnRH-a) and recombinant human chorionic gonadotropin (r-hCG) plus rescue oocyte retrieval might reveal oocytes in patients with recurrent empty follicle syndrome. CASE: Endogenous luteinizing hormone was triggered with a GnRH-a (Buserelin [Suprefact pro-injection, Aventis-Pharma, Turkey], 250 microg subcutaneously) in a GnRH antagonist (Cetrorelix [Cetrotide 0.25, SeronoTurkey], 0.25 mg/d, starting on day 6), down-regulated cycle. At the first scheduled retrieval, 3 cumulus-oocytecorona complexes were recovered from the left ovary. During chemical denudation with hyaluronidase, 2 of them underwent lysis. The third was a zona-free, germinalvesicle-stage oocyte after mechanical denudation. Oocyte pickup was stopped, and recombinant human chorionic gonadotropin (hCG) (250 microg subcutaneously) was injected. Five cumulus-oocyte-corona complexes were retrieved from the right ovary 24 hours after rescue with recombinant hCG. Only mechanical denudation was done, and 4 zona-free oocytes with germinal vesicle breakdown were seen. All oocytes underwent intracytoplasmic sperm injection, and none of them were fertilized. CONCLUSION: Oocyte maturation defects should be included in etiologic mechanisms for counseling patients with empty follicle syndrome.     

Effect of administration mode (patient vs physician) and patient''s educational level on the Turkish version of the International Prostate Symptom Score

OBJECTIVES: To compare the effectiveness of the International Prostate Symptom Score (IPSS) when administered by the physician to when self-administered by the patient. The effect of the patient's educational level on the IPSS was also evaluated. METHODS: One hundred and seven previously untreated patients with symptomatic benign prostatic hyperplasia (BPH) completed the Turkish version of the International Prostate Symptom Score (Turkish I-PSS) and quality of life (QOL) questionnaires during a single office visit, first on their own and then with an interviewing physician. The patients were categorized into three groups according to their educational levels. Paired t-tests were performed to compare the total IPSS (tIPSS) and QOL results between the two testing modes. IPSS and QOL scores resulting from both modes were compared using a kappa test. Differences between the physician-assisted and self-administered scores among the different educational groups were further compared using a one-way anova test and Post Hoc Multiple Comparisons. To compare the objective effectiveness of tIPSS and QOL between the two testing modes, we selected the positive actual state, which was maximum urine flow (Qmax) of 15 mL/s or less and constructed receiver operating characteristics (ROC) curves for all patients. This estimation was constructed for each educational level. RESULTS: There were no statistical differences in IPSS and QOL values obtained by the patients or physicians (P > 0.05). The ROC areas for tIPSS were 0.94 and 0.93, and the ROC areas for QOL scores were 0.97 and 0.91 for information obtained by physicians and patients, respectively. When IPSS answers and QOL scores were evaluated separately, consistency was found across both modes of administration. However, there were lower levels of consistency in answers to IPSS questions 2, 5 and 6 (P = 0.59;0.42; 0.52, respectively). There was no significant difference among the aforementioned data in the educational groups. CONCLUSION: Although the total IPSS and QOL scores were not affected by the different modes of administration, we recommend that the physicians should evaluate answers to questions 2, 5 and 6 carefully. The present study demonstrates that the educational level did not affect the IPSS and QOL when administered either by the physician or the patient.     

Expression of proliferative and preapoptotic molecules in human myometrium and leiomyoma throughout the menstrual cycle

The pathogenesis of leiomyoma may be related to an imbalance in the interaction of sex steroids with paracrine growth factors that may control the modulation of mitogenesis and local immunity. The authors investigate the temporal and spatial expression of proliferative and preapoptotic molecules that may participate in the modulation of myometrial function and leiomyoma pathogenesis. Immunohistochemistry and Western blot analysis are used to investigate Fas ligand (FasL), phosphatase and tensin homolog deletion on chromosome 10 (PTEN), and proliferating cell nuclear antigen (PCNA) expression in myometrium and leiomyoma. Western blot results show that in the secretory phase, FasL expression is 1.8-fold and 2.3-fold higher compared with the proliferative phase in the myometrium and leiomyoma, respectively (P = .022 and .047, respectively). A paired comparison between myometrium and leiomyoma reveals higher FasL expression in the leiomyoma (P = .003). On the contrary, when compared with the secretory phase, PCNA expression during the proliferative phase is 4.6-fold and 3.7-fold higher in the myometrium and leiomyoma, respectively (P = .041 and .034, respectively). A paired comparison between myometrium and leiomyoma reveals higher PCNA expression in the leiomyoma. Furthermore, lower PTEN expression is detected in the leiomyoma compared with the myometrium (P < .032). Immunohistochemistry results reveal that FasL, PTEN, and PCNA are expressed in the myometrium and leiomyoma, consistent with the results from the Western blot analysis. The results suggest that FasL, PTEN, and PCNA may be involved in the pathophysiology of leiomyoma. A higher FasL level in the leiomyoma is likely to correspond to suppression of local immunity by inducing apoptosis of immune cells, while a higher level of PCNA and a lower level of PTEN may be related to increased mitogenesis and decreased apoptosis in leiomyoma.     

Comparison of the effects of octreotide and melatonin in preventing nerve injury in rats with experimental spinal cord injury.

In this study, we aimed to investigate the biochemical and histopathological protective effects of octreotide and melatonin in an experimental model of spinal cord injury. Fifty- six male albino Wistar rats were divided into four groups. Rats in the G1 group (n=7; control group) did not undergo any treatment except for anesthesia prior to being killed. Rats in the G2 group (n=7) underwent laminectomy and aneurysmal clip application at the T4-5 level. G3 group rats (n=14) were either treated with a 7.5 mg/kg intraperitoneal dose of melatonin (Sigma, St. Louis, MO, USA) immediately after laminectomy, then the same dose again on the day following injury (G3a), or given three equal doses over 10 days to achieve a total dose of 7.5 mg/kg/day (G3b). G4 group rats (n=14) were either treated with a 30microg/kg intraperitoneal dose of octreotide (Sandostatin; Novartis, Istanbul, Turkey) immediately after laminectomy, then the same dose again on the day following injury (G4a), or given three equal doses over 10 days to achieve a total dose of 30miocrog/kg/day (G4b). Rats in the G3 and G4 groups were sacrificed on days 1 and 10 after spinal cord injury (n=7 at each time point) and spinal cord samples were obtained. Tissue malonyldialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were assayed. G3a, G3b and G4b had significantly lower levels of MDA than G2 (p<0.01). G3b had significantly higher SOD and GSH-Px levels than G2 (p<0.01). Histopathologically, melatonin significantly reduced necrosis and degeneration in both the initial and late stages (p<0.01). Octreotide had significant effects on necrosis and degeneration during the late stages, and on edema and congestion in both the initial and the late stages of injury (p<0.01). Melatonin was found to be superior to octreotide with respect to the prevention of congestion, edema, axonal degeneration and necrosis.     

Skin and soft tissue necrosis from calcium chloride in a deicer

Calcium chloride salt is the principle ingredient of many commercially available deicers. Calcium chloride melts snow and ice by its osmotic action. We present a case of skin and soft tissue necrosis associated with the use of a calcium chloride-containing deicer. Although calcium chloride is known to produce soft tissue necrosis if it extravasates during intravenous administration, necrosis and skin sloughing has rarely been described after topical exposure to this salt. Calcium chloride likely produces tissue injury from the heat liberated by mixing calcium chloride with water (exothermic reaction) and from direct calcium deposits in the skin (calcinosis cutis) and soft tissue.