Histopathological predictors of occult lymph node metastases in supraglottic squamous cell carcinomas

Lymph node metastasis appears to be the most important factor determining survival in patients with squamous cell carcinoma of the larynx. Supraglottic laryngeal carcinomas have a known tendency to metastasize to cervical lymph nodes because of the extensive lymphatic network present. This retrospective cohort study was conducted to define possible histopathological parameters affecting cervical lymph node metastasis and then using these parameters to create a scale to predict occult lymph node metastasis in supraglottic squamous cell carcinoma. The pathological slides of 61 operated patients were reevaluated for tumor grade, lymphatic-vascular invasion, invasion pattern of tumor margins, perineural invasion and lymphocytic infiltration. Grade (P < 0.001), lymphatic-vascular invasion (P < 0.001) and tumor margins (P = 0.007) were found to be closely associated with neck metastasis. To define the risk factors for occult metastasis, a grading scale was created by using grade (G), lymphatic-vascular invasion (L) and tumor margin (M) findings of patients. None of the patients with a GLM value of zero developed occult metastasis. On the other hand occult metastasis was found in 58.8% of N0 patients with a GLM value that was more than zero. These findings indicate that patients with high-grade tumors having infiltrating borders and lymphatic-vascular invasion have a high risk for occult metastasis so that elective treatment of the neck either by neck dissection or radiotherapy should be added to therapy. Serial sections of specimens are needed to avoid missing metastatic loci of disease. Received: 19 February 1999 / Accepted: 30 December 1999     

Atrial septal defect and retrosternal toxic goitre operated in the same session: a case report.

In this study, we present a 55-year-old female patient who suffered from atrial septal defect (ASD) and retrosternal toxic goitre simultaneously. The patient had been treated with a 300 mg/day dose of propylthiouracil for 20 days prior to operation. This patient has been operated on for both disorders and has recovered.     

Possible pathogenetic role of new cytokines in postmenopausal osteoporosis and changes during calcitonin plus calcium therapy

The present study was designed to test if the serum cytokines (interleukin, or IL-1beta, -2, -2r, -6, -6r, -8, and -10, and tumor necrosis factor alpha, or TNF-alpha) and osteocalcin levels were different between 50 osteoporotic and 30 postmenopausal nonosteoporotic women and to evaluate the efficacy of calcitonin therapy during 6 months on serum cytokines and osteocalcin levels in postmenopausal osteoporotic women. In our study, serum levels of osteocalcin, TNF-alpha, IL-2, and IL-8 were significantly higher in the patient group (P < 0.05), whereas serum levels of IL-10 and IL-6r were significantly lower in the patient group (P < 0.05). When analysed separately according to bone turnover, serum levels of IL-10 and IL-6r were significantly lower in the normal-turnover group (P < 0.05), and IL-2, IL-8, and TNF-alpha were significantly higher in the high-turnover group than in the control group (P < 0.05). Statistically significant improvement seemed to happen in the patients receiving calcitonin plus calcium therapy (P < 0.05) concerning levels of serum IL-6r at the 1st month (P < 0.05), IL-10, IL-2r, IL-6r, and osteocalcin at the 3rd month, and IL-6r and osteocalcin at the end of the 6th month. Our findings demonstrate that calcitonin plus calcium therapy appears to be particularly more effective for patients with high turnover. In addition, our study suggests that IL-10 and IL-6r may have an important role in normal-turnover osteoporosis, while IL-2, IL-8, and TNF-alpha may play an important role in high-turnover postmenopausal osteoporosis.     

Association of Celiac Disease With Idiopathic Pulmonary Hemosiderosis; Lane Hamilton Syndrome

Introduction:

Idiopathic Pulmonary Hemosiderosis (IPH) is a rare cause of alveolar hemorrhage, which is seen primarily in childhood. Celiac disease is defined as a chronic, immune-mediated enteropathy of the small intestine, caused by exposure to dietary gluten in genetically pre-disposed individuals. Association of IPH and celiac disease is known as Lane Hamilton syndrome. There are limited number of case reports of this syndrome in literature.

Case Presentation:

Although there were no growth and developmental delay and gastrointestinal symptoms like chronic diarrhea, chronic constipation, vomiting, abdominal bloating and pain in the two patients with IPH, they were diagnosed with Lane Hamilton Syndrome. After initiation of gluten-free diet, their IPH symptoms disappeared and hemoglobin levels were observed to return to normal.

Conclusions:

Even if there were no gastrointestinal symptoms in a patient with IPH, celiac disease should be investigated. These patients may benefit from gluten free diet and IPH symptoms may disappear.     

Enhancement of EFS-induced contractions, by agmatine, in guinea pig gallbladder smooth muscle strips

Background Electrical field stimulation of gallbladder muscle strips produces frequency-dependent contractions by activating cholinergic nerves. The cholinergic motor function of the gallbladder and enteric system is also modulated by other mediators. The aim of this study was to investigate the role of agmatine, a ligand for alpha 2-adrenoceptors and imidazoline binding sites, in the cholinergic motor activity of guinea pig gallbladder smooth muscle.Methods Gallbladder muscle strips obtained from guinea pigs were subjected to electrical field stimulation (1–64Hz, 100V, 1-ms pulse width, and 10-s train duration). Frequency-response contractions of gallbladder muscle strips were traced before and after the addition of cumulative concentrations of agmatine (10^–5–10^–3M) to the tissue bath. The same set of experiments was repeated in the presence of different antagonists.Results Agmatine by itself did not produce any contractions in guinea pig gallbladder muscle strips, but significantly enhanced the contractile response produced by electrical field stimulation. Yohimbine (10^–6M), a selective alpha 2-adrenergic blocker, neither decreased nor increased the enhancement induced by agmatine. However, idazoxan (10^–4M), an alpha-receptor blocker and imidazoline receptor antagonist, abolished this enhanced contractile response. Pretreatment with N^W-nitro l-arginine methyl ester (l-NAME; 30µM), and indomethacin (10µM) did not inhibit the effect of agmatine.Conclusions Our findings indicate that agmatine has a modulator role in the electrical field stimulation-induced cholinergic contractions of guinea pig gallbladder smooth muscle strips, and this role could be mediated by imidazoline receptors. Receptor binding studies should be done to determine the presence of endogenous agmatine and imidazoline receptors in gallbladder smooth muscle.     

Efficacy of Iodopovidone Pleurodesis and Comparison of Small-Bore Catheter Versus Large-Bore Chest Tube

Background  To evaluate the efficacy of iodopovidone as an agent for pleurodesis in malignant pleural effusion (MPE) and to compare the efficacy of small-bore catheter (Pleuracan, Braun, Melsungen, Germany) and conventional large-bore chest tube in pleural fluid drainage and sclerotherapy. Methods  Patients with MPE were prospectively consecutively randomized into two groups between August 2004 and February 2007: pleurodesis via conventional (32F) chest tube (group 1) and small-bore catheter (group 2), both using iodopovidone. After 3 months’ follow-up, response rates (complete or partial), complication rates, and duration of procedures within whole group, group 1, and group 2 were compared. Statistical analyses were performed by Mann-Whitney U, χ², and Fisher’s exact test. Results  Forty-three pleurodeses were performed in 41 patients. The response was complete in 26 (60.5%) and partial in 12 (27.9%), and the overall success rate was 88.4%. The response rate was not associated with the type of inserted tube (P = .750), pleural fluid pH (P = .290), or pleural fluid lactate dehydrogenase (P = .727). In group 1 (n = 20), 12 demonstrated complete and 6 demonstrated partial response, with a 90% success rate; success was 86.9% in group 2, with complete response in 14 and partial response in 6 patients. Success rates were similar in the two groups (P = 1.000). Of 43 procedures, complications were observed in 14 (32.5%), and complication rates were 35% and 30.4% in groups 1 and 2, respectively (P = .750). The most frequent complication was pain (16.2%), followed by fever, subcutaneous emphysema, dyspnea, and hypotension. Conclusion  Iodopovidone is an effective, inexpensive, safe, and easily available alternative in chemical pleurodesis in MPE. The success rates of pleurodesis were found to be similar regardless of the type of the tube inserted.     

The effect of polishing techniques on the surface roughness and color change of composite resins

STATEMENT OF PROBLEM: Surface characteristics may affect the color change and surface roughness of composite resins. PURPOSE: This study evaluated the surface roughness and color change of a hybrid, a microhybrid, and a nanohybrid composite resin polished with the use of polishing discs, wheels, and a glaze material. MATERIAL AND METHODS: Fifty discs (10 x 2 mm) were fabricated for each composite resin (nanohybrid, Grandio; microhybrid, Filtek Z250; hybrid, Quadrant Universal LC) for a total of 150 discs, prepared using polyester strips and divided into 5 groups of 10. One of the groups served as control (C) and had no surface treatment (n=10). The specimens of the experimental groups were ground with 1000-grit silicon carbide paper. In 4 experimental groups (n=10), specimen surfaces were polished with polishing discs (D) (Sof-Lex), with polishing wheels (W) (Astropol), with polishing discs preceding the glaze application (DG) (Biscover), or with polishing wheels preceding the glaze application (WG), respectively. Color was assessed using a small area colorimeter. The color differences (DeltaE) values between the specimens of Group C and the experimental groups were calculated, and the data were compared using 2-way analysis of variance (ANOVA) (alpha=.05). Subsequently, the surface roughness (Ra) of the specimens was evaluated using a profilometer, and the data were analyzed by 2-way ANOVA followed by a Tukey multiple comparisons test (alpha=.05). RESULTS: The polishing technique and type of composite resin significantly affected the Ra and DeltaE values of the composite resins (P<.001). While the use of polishing wheels produced the highest Ra values when compared to the other polishing techniques (P<.001), the nanohybrid composite resin showed the lowest Ra values compared to the other composite resins in the control groups (P<.001). All of the nanohybrid and microhybrid composite resin groups were found to be significantly different from each other in terms of color difference (P<.001). CONCLUSION: The highest Ra values were obtained with hybrid composite resins due to the size of the filler particles that were exposed after polishing. Although the smoothest surfaces were obtained with polyester strips, the use of glaze material after polishing discs or polishing wheels resulted in significantly lower Ra and DeltaE values than the use of the latter alone. The glaze appears to fill the structural microdefects and provide a more uniform, regular surface.     

Being alive after a severe inorganic mercury intoxication

Inorganic mercury intoxication should be considered a potentially life-threatening condition that leads to widespread progressive gastrointestinal, renal, hepatic, hematologic, neuropsychiatric, and dermatologic system hazards. We report here a 10-year-old girl with severe inorganic mercury intoxication whose blood and urine mercury levels were 5,380 μg/L (normal, 0.6 to 59 μg/L) and 91 μg/L (normal, 0.1 to 20 μg/L), respectively, to reveal that life can be saved and complete recovery can be achieved even if the clinical situation is very severe. To our knowledge, this is the first report of a mercury intoxication being alive with such a high blood mercury level in children in English pediatric literature.     

Fetal skeletal dysplasia cohort of a single tertiary referral center in Istanbul,Turkey

We report on 314 fetal cases from 297 unrelated families with skeletal dysplasia evaluated in the postmortem period from 2000 to 2017 at a single clinical genetics center in İstanbul, Turkey. The definite diagnostic yield was 40% during the prenatal period, while it reached 74.5% when combined with postmortem clinical and radiological evaluation. Molecular analyses were performed in 25.5% (n: 76) of families, and 21 novel variants were identified. Classification according to International Skeletal Dysplasia Society-2019 revision revealed limb hypoplasia-reduction defects group (39) as the leading one, 24.5%, then followed by FGFR3 chondrodysplasias, osteogenesis imperfecta, and decreased mineralization and polydactyly-syndactyly-triphalangism groups 13.6, 11.1, and 8.9%, respectively. The inheritance pattern was autosomal recessive in 54% and autosomal dominant in 42.6% of index cases. The overall consanguinity rate of the cohort was 33%. The high prevalence of ultrarare diseases along with two or more unrelated autosomal recessive entities running in the same family was noteworthy. This study highlights the pivotal role of postmortem evaluation by an experienced clinical geneticist to achieve a high diagnostic yield in fetal skeletal dysplasia cohorts. The cohort is not only a representation of the spectrum of skeletal dysplasias in a population with a high consanguinity rate but also provides an ideal research group to work on to identify the unknowns of early fetal life.