Clinicopathological features and survival rates of patients with renal cell carcinoma under 50 years of age

We analyzed the clinicopathological features and survival rates of the patients with renal cell carcinoma younger than 50 years old. Between 2004 and 2007, 28 patients between 19–49 years underwent surgery for renal cell carcinoma. Presenting symptoms, type of the surgery performed, postoperative outcomes and duration of follow-up were recorded. Mean age was 41.5±7.6 years and 75% of patients were male. The tumor was symptomatic in 19(67.9%) and incidental in 9(32.1%) patients. Radical nephrectomy and nephron-sparing surgery were performed in 18(64.3%) and 10(35.7%) patients, respectively. The most common histologic type was clear cell(67.9%). The mean tumor diameters were 3.5±0.95 and 7.4±5.2 cm in the incidental and symptomatic groups, respectively(p=0.035). Incidentally discovered tumors and tumors treated by NSS did not include Fuhrman grade 4. There were no differences regarding pathological stage and Fuhrman grades when patients were grouped according to their symptomatology(p=0.242 and p=0.265, respectively). Overall mortality was 17.9%(n=5) whereas 4 patients(14.3%) died because of cancer. The mean survival was 30.6 months and cancer specific survival rate was 85.2%. Most of the tumors in this age group were symptomatic and most common histologic subtype was clear cell carcinoma. Incidentally discovered tumors had statistically significant lower tumor size.     

Unmetabolized folic acid in plasma is associated with reduced natural killer cell cytotoxicity among postmenopausal women

Folic acid (FA) supplements and food fortification are used to prevent neural tube defects and to lower plasma homocysteine. Through exposure to food fortification and vitamin supplement use, large populations in the United States and elsewhere have an unprecedented high FA intake. We evaluated dietary and supplemental intakes of folate and FA in relation to an index of immune function, natural killer cell (NK) cytotoxicity, among 105 healthy, postmenopausal women. Among women with a diet low in folate (<233 microg/d), those who used FA-containing supplements had significantly greater NK cytotoxicity (P = 0.01). However, those who consumed a folate-rich diet and in addition used FA supplements > 400 microg/d had reduced NK cytotoxicity compared with those consuming a low-folate diet and no supplements (P = 0.02). Prompted by this observation, we assessed the presence of unmetabolized FA in plasma as a biochemical marker of excess FA. Unmetabolized folic acid was detected in 78% of plasma samples from fasting participants. We found an inverse relation between the presence of unmetabolized FA in plasma and NK cytotoxicity. NK cytotoxicity was approximately 23% lower among women with detectable folic acid (P = 0.04). This inverse relation was stronger among women >or= 60 y old and more pronounced with increasing unmetabolized FA concentrations (P-trend = 0.002). Because of the increased intake of FA in many countries, our findings highlight the need for further studies on the effect of long-term high FA intake on immune function and health.     

The protective effects of trimetazidine on testicular ischemia and reperfusion injury in rats

This study was designed to investigate the protective effect of trimetazidine [TMZ; 1-(2, 3, 4-trimethhoxibenzyl)-piperazine dihydrochloride], as an antioxidant agent, on torsion–detorsion-induced biochemical and histopathological changes in experimental testicular ischemia/reperfusion injury in rats. Twenty-seven male Wistar rats weighing 180–220 g were divided into five groups: control (C, n = 4), sham-operated (S, n = 4), ischemia (I, n = 6), ischemia–reperfusion (I/R, n = 6) and ischemia–reperfusion + trimetazidine (I/R + TMZ; n = 7). Control rats were used for basal normal values. In group I, 2 h torsion of the left testis was performed. In I/R and I/R + TMZ groups, following 2 h of torsion, 4 h detorsion of the testis was performed. In ischemia and I/R groups, physiologic saline was administered orally for 7 days, and the rats in I/R + TMZ group were pretreated orally with 5 mg/kg day TMZ for 7 days before inducing ischemia. At the end of each experiment, ipsilateral orchiectomies were performed for the tissue levels of malondialdehyde (MDA), glutathione peroxidase (GPx) enzyme activities and histopathological examinations in all groups. MDA levels were significantly reduced and GPx enzyme activities were significantly increased in testes in I/R+TMZ pretreated group compared to group I and I/R. The mean seminiferous tubular diameter (MSTD) and Johnsen’s score were significantly better in I/R+TMZ group than groups I and I/R. Pretreatment with TMZ decreased germ cell apoptosis and caspase-3 expression in the ischemic testis. The present results show that TMZ has a protective activity in the testicular injury caused by I/R, and provide the first evidence of the role of TMZ for the prevention of I/R-induced testicular injury.     

Radiologic Manifestations of Colloid Cysts: A Pictorial Essay

Colloid cysts are among rare benign tumours of the third ventricle. Although the most frequent symptoms are headache and syncope, arrest hydrocephalus or sudden death could appear with colloid cysts. The aim of this pictorial essay was to increase awareness of the clinical presentation, computed tomography (CT) and magnetic resonance (MR) imaging spectrum, and treatment options of the colloid cysts. The data of 11 patients with histopathologically and/or clinically proven colloid cyst were analysed, retrospectively; and the neuroradiologic appearances of the cysts were evaluated. The CT and MR appearance of colloid cysts may change, depending on the viscosity or the cholesterol content of the cysts. However, the cystic content is the most important factor that could affect the success of treatment. Cysts that are especially rich in protein and cholesterol tend to be hyperdense on CT, hypointense on T2-weighted sequences and hyperintense on T1-weighted sequences. These cysts are viscous, and the success of aspiration is significantly low. In the diagnosis and evaluation of small-sized cysts that have an ingredient similar to cerebrospinal fluid, 3-dimensional sequences might be useful. The radiologic appearances of colloid cysts could play an important role in directing these patients to alternative surgical modalities, including resection.     

Goal-directed fluid therapy in gastrointestinal cancer surgery:A prospective randomized study

Objective:To investigate the effects of perioperative goal-directed fluid therapy(GDFT)on intraoperative fluid balance,postoperative morbidity,and mortality.Methods:This is a prospective randomized study,and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included.Patients were randomized into 2 groups that received liberal fluid therapy(the LFT group,n=45)and goal-directed fluid therapy(the GDFT group,n=45).Patients’Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity(CR-POSSUM)physiological score,Charlson Comorbidity Index(CCI),perioperative vasopressor and inotrope use,postoperative AKIN classification,postoperative intensive care unit(ICU)hospitalization,hospital stay,and 30-day mortality were recorded.Results:The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group(P<0.05).CR-POSSUM physiological score and CCI were significantly higher in the GDFT group(P<0.05).Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group(P<0.05),postoperative acute kidney injury development was not affected.Postoperative mortality was determined to be similar in both groups(P>0.05).Conclusion:Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery,and it can prevent perioperative fluid overload,and the postoperative results are comparable in the two groups.     

Assessment of opioid receptor μ1 gene A118G polymorphism and its association with pain intensity in patients with fibromyalgia

Fibromyalgia may present with widespread pain and tenderness, fatigue, anxiety, and depression and is associated with a low pain threshold. The etiology of fibromyalgia is yet to be ascertained, although both genetic and environmental factors may play a role in the susceptibility of patients to fibromyalgia. Various genetic variations have been investigated to explain fibromyalgia susceptibility and differences in pain sensitivity, pain threshold, and tolerance. The A118G rs1799971 polymorphism in the opioid receptor μ1 gene (OPRM1) is one of the candidate genes. We hypothesized that the OPRM1 polymorphism may play a role in fibromyalgia susceptibility and impact the pain intensity and pain-related symptoms in fibromyalgia patients. This study comprised of 108 patients with fibromyalgia and 100 healthy controls. Overall, the 118G allele frequency was 16.3 % and was significantly lower in patients with fibromyalgia than in the control group (13.9 and 19 %, respectively). No difference was observed between fibromyalgia patients with and without the A118G allele with regard to the Beck Depression Inventory, widespread pain index, symptom severity, and Fibromyalgia Impact Questionnaire scores. All body parts of patients with fibromyalgia demonstrated lower pressure pain thresholds (PPT) compared to controls. The PPTs were higher in the 118 A/A genotype carrier fibromyalgia patients than in 118*/G carriers; however, the differences were not significant. As the A118G polymorphism frequency was lower in fibromyalgia patients, this polymorphism may exert a protective effect against fibromyalgia in Turkish women. However, the OPRM1 polymorphism does not have a significant effect on pressure pain and fibromyalgia severity.     

Effect of different disinfectant methods on the initial microtensile bond strength of a self-etch adhesive to dentin

The aim of this in vitro study was to evaluate the effect of different disinfection methods on the initial microtensile bond strength of a two-step, self-etch adhesive to dentin. Twenty mandibular molars were sectioned parallel to the occlusal plane to expose the mid-coronal dentin. All of the teeth were divided into four groups (n = 5 per group): (1) in group OZ, the dentin surfaces were exposed to ozone gas from the Ozonytron X delivery system (OzonyTron X-Bioozonix, Munich, Germany), (2) in group ND, the dentin surfaces were irradiated with an Nd:YAG laser (Pulsmaster 600 IQ, American Dental Technologies, U.S.), (3) in group CHX, the dentin surfaces were treated with a 2% chlorhexidine solution, and (4) in the control group, no treatment was applied. In all of the groups, the teeth were restored with Clearfil SE Bond (Kuraray, Tokyo, Japan) and Clearfil Majesty Posterior (Kuraray, Tokyo, Japan), according to the manufacturer's instructions. The teeth were sectioned perpendicular to the bonded surface (surface area of approximately 1 mm(2)). Thus, six to seven specimens were obtained from each tooth, and a total of 34 specimens were analyzed in each group. The specimens were attached to the microtensile test machine (Micro Tensile Tester, T-61010 K, Bisco, U.S.). The data was analyzed using the one-way analysis of variance (ANOVA) and Tukey test (p < 0.05). Fracture modes of each specimen were determined using a stereomicroscope (SZ-PT Olympus, Tokyo, Japan) and a scanning electron microscope (SEM). The lowest bond strength occurred in the OZ group. Significant differences were determined only between group OZ and the other groups (group ND, group CHX, and control group) (p < 0.05). In conclusion, although ozone decreased the microtensile bond strength of the self-etch adhesive system to dentin, the Nd:YAG laser and 2% chlorhexidine did not change the microtensile bond strength so in context of the present study it would appear that the Nd:YAG laser and 2% chlorhexidine may be used as pre-restorative sterilization procedures on the dentin prior to the application of a two-step, self-etch adhesive.     

Prevalence of sacrococcygeal pilonidal sinus as a silent disease

Purpose

The aim of this research was to determine the prevalence of sacrococcygeal pilonidal sinus disease (SPSD) based on clinical examination and histopathological evaluation.

Methods

Between January 1, 2010 and December 30, 2010, 432 corpses were evaluated in the Istanbul Central Office of Forensic Medicine Institute of the Turkish Ministry of Health.

Results

41 of the 432 cases (9.4 %) had SPSD-related findings. 20 (4.6 %) had at least one sinus tract (clinical SPSD) and all of them had at least three positive histopathologic parameters. 16 of 41 cases (3.7 %) were clinically normal but had at least three positive histopathologic parameters (silent SPSD).

Conclusion

Prevalence of SPSD with clinical examination is 4.6 %. These data are according to the literature. But with inclusion of the silent cases, the prevalence rate increases to 8.3 %. We conclude that inflammatory process does not result in SPSD in nearly half of the cases.