May the best friend be an enemy if not recognized early: hypernatremic dehydration due to breastfeeding

Hypernatremic dehydration is a serious condition in the newborn period. We present 5 infants with hypernatremic dehydration due to breastfeeding; one of them died because of brain edema during treatment.Hypernatremic dehydration in breast-fed newborns is secondary to insufficient lactation and all mothers should be encouraged about breastfeeding, taught the signs of successful breastfeeding, and the warning signs of dehydration. Here, we discuss hypernatremic dehydration in breastfeeding neonates, its causes and treatment.     

Acute myeloblastic leukemia in pregnancy: a case report and review of the literature

Leukemia is a rare event during pregnancy. The presence of leukemia during pregnancy raises several concerns about the effect of pregnancy on the prognosis of leukemia, the effect of the disease on pregnancy outcome and the teratogenic and mutagenic effect of chemotherapeutic agents on the fetus. We report a case of acute myeloblastic leukemia diagnosed during the third trimester of gestation and treated with chemotherapeutic agents before delivery. The duration of pregnancy was able to be prolonged for four weeks after clinical diagnosis of the disease and then terminated by cesarean section due to the presence of signs of fetal distress.     

Auditory neuropathy in hyperbilirubinemia: is there a correlation between serum bilirubin, neuron-specific enolase levels and auditory neuropathy?

This study evaluated whether a correlation exists between increased serum bilirubin and neuron-specific enolase (NSE) assays (a biochemical index of neuronal damage) and auditory neuropathy. Nineteen term neonates without hemolysis whose serum bilirubin levels were above 20 mg/dl and 27 healthy term newborns with bilirubin levels <13 mg/dl were included in the study. Auditory brainstem responses (ABRs) and transient evoked otoacoustic emissions (TEOAEs) of patients with hyperbilirubinemia were obtained before discharge. This preliminary study did not show any correlation between the serum NSE and bilirubin values. However, infants who had auditory neuropathy had significantly higher NSE levels, and thus these patients, being in the high-risk group, need close follow-up.     

Isolated bone metastasis in testicular germ cell tumors: a case report and review of the literature

BACKGROUND: In testicular germ cell tumors (GCT), bone metastases are usually seen late in the disease progress and are almost always associated with involvement of other sites. However, isolated bone metastasis is an extremely rare finding in these patients. CASE REPORT: A 43- year-old man was admitted to the neurosurgery department of our hospital suffering from dysarthria, ataxia, headaches and a progressive swelling above the parietooccipital region of the skull. Radiological, biochemical and pathologic tests showed that the lesion of the skull was an isolated skull metastasis as an initial manifestation of nonseminomatous GCT of the testis. DISCUSSION: When a young patient presents with bone pain or painless swelling, even if it is an unusual site and isolated, testicular GCT should be considered as a differential diagnosis, as these lesions could be the first evidence of metastatic GCT.     

Immunoglobulins and complement components in patients with lung cancer

Based on data providing a correlation between immunoglobulin or complement components levels and malignancies and specific disease parameters, we examined the possible correlation between the immunoglobulins, complement component levels and the stage of disease and the survival of patients. Sera from 55 patients with lung cancer and 22 healthy donor were assayed in order to evaluate the concentration of IgG, IgA, IgM, IgE, C3, C4. No considerable differences were found between the levels of immunoglobulins in patients with carcinoma of the lung versus subjects in the control group. Complement components (C3 and C4) levels were elevated in cancer patients with different cell types compared with levels in the control group. No statistically significant differences were found between the levels of the studied parameters and the stage of the disease and the survival time of patients. Our study confirm the hypothesis that malignant tumours contribute to elevation of complement components levels but additional studies are needed for demonstrating the prognostic value of immunoglobulin and complement components levels in lung cancer patients.     

Bilateral spontaneous rupture of the long head of the biceps brachii tendon in rheumatoid arthritis

Rheumatology International -     

The effects of estradiol and progesterone on the synthesis of collagen in tracheal surgery

OBJECTIVE: Estrogen and progesterone have the decreasing effect on massive collagen synthesis in wound healing. Here, it is aimed to determine their decreasing effect on collagen accumulation and fibroblast proliferation in trachea histologically and to understand if they would be protective for tracheal stenosis. METHODS: Thirteen male Winstar rats were divided randomly into two groups: estrogen-progesterone group (group 1, eight rats) and control group (group 2, five rats). Under general anesthesia, tracheas were incised vertically extending from second to fifth tracheal ring. Incision was closed with absorbable sutures. Estrodiol benzoat and progesterone was given intramuscularly to estrogen progesterone group, saline solution to control group. After 4 weeks they were sacrificed and tracheas were excised. Horizontal cross section of the narrowest part of the incised trachea was examined histologically. Epithelial regeneration, inflammatory cell infiltration, angiogenesis, fibroblast proliferation and collagen deposition were evaluated by histological grading. RESULTS: Statistically significant difference was found between the groups in collagen deposition and fibroblast proliferation (p=0.011, <0.05). For epithelial regeneration, inflammatory cell infiltration, and angiogenesis there was no difference. CONCLUSION: As a result, it was proved that sex hormones inhibit massive collagen deposition and fibroblast proliferation in wound healing of tracheal surgery. Hence, they may prevent tracheal stenosis.     

The value of the insulin-like growth factor binding protein-1 in the cervical-vaginal secretion detected by immunochromatographic dipstick test in the prediction of delivery in women with clinically unconfirmed preterm premature rupture of membranes

OBJECTIVE: The aim of this study was to determine the value of detecting insulin-like growth factor binding protein-1 (IGFBP-1) in the cervical-vaginal secretion in the prediction of delivery in women with clinically uncorfirmed preterm premature rupture of membranes (PPROM). MATERIAL AND METHODS: A total of 87 women, gestational age between 20 and 36 weeks were enrolled into this prospective study. Based on the clinical diagnosis, patients were grouped as clinically evident PPROM (n = 25), clinically suspected PPROM (n = 42) and women with intact fetal membranes (n = 20). Detection of IGFBP-1 in the cervical-vaginal secretions was done using a one-step immunochromatographic dipstick test in all women. The outcome measures were gestational age at delivery, neonatal birth weight and duration of the interval between the test and delivery between women with positive and negative test results. RESULTS: The test was positive in all 25 women (100% sensitivity) with clinically evident PPROM and all delivered prematurely, and negative in 19 out of the 20 (95% specificity) women with intact fetal membranes. Among 36 women with clinically suspected PPROM, 13 (36%) tested positive and 23 (63%) tested negative for IGFBP-1. In this group, the mean gestational age and birth weight at the time of delivery were significantly lower in patients with positive test (31.38+/-2.6 weeks versus 38.61+/-0.99 weeks and 1761+/-527g versus 3500+/-355g, P < 0.05 for both). Eleven (85%) of the 13 women with positive test, delivered within 2 weeks after the performance of the test whereas all the women with negative test results delivered after 2 weeks (P = 0.001). The test had 100, 92, 84 and 100% sensitivity, specificity, positive predictive value and negative predictive value, respectively, for the outcome measure of test-delivery interval. CONCLUSION: The screening test for IGFBP-1 in the cervical-vaginal secretions is a useful adjunct in the prediction of delivery in women with clinically unconfirmed PPROM.     

Spondyloepiphyseal dysplasia tarda with progressive arthropathy

Spondyloepiphyseal dysplasia tarda with progressive arthropathy (SEDT-PA) is a rare autosomal recessive skeletal dysplasia affecting primarily the articular cartilage. Here we present a nine-year-old girl from Middle Anatolia (Sivas) with SEDT-PA. Her complaints were pain and progressive deformity of the joints. She had a short stature with increased thoracic kyphosis and lumbar lordosis. The range of motion was limited in the spine and the peripheral joints and she had deformities. Radiologic examination revealed generalized platyspondyly and irregularity of the vertebral endplates. There was minimal joint space narrowing at proximal interphalangeal joints, but there were no bone erosions. Metaphyses were widened and epiphyses were squared in other joints with generalized osteopenia and severe osteoarthritic changes prominent in hips. Laboratory examination revealed a mild increase in acute phase reactants. Genetic disorders like SEDT-PA may also have rheumatological involvement, so they should be kept in mind in differential diagnosis of inflammatory joint diseases.     

Effect of cerebrospinal fluid leakage on wound healing in flap surgery: histological evaluation

The aim of this study was to find out the effect of CSF leakage on wound healing after flap surgery. Sixteen male Wistar rats were used. The superiorly based rectangular dorsal skin flap 3 x 3 cm was elevated at the interscapular region. Through this opening, paraspinal muscle dissection and three-level bilateral laminectomy were done. Finally, a dura defect with a diameter of 3-4 mm was created. In the control group, laminectomy was performed as in the study group but the dura was left intact. Persistent CSF leakage was confirmed using isotope cisternography. At the end of 2-week study period, there was no necrosis, infection, or dehiscence of the flap in either group. On necroscopy, cyst formation over the dura defect was detected in 4 animals of the study group. Another gross finding in this group was intensive vascularization of the undersurface of the flap and wound bed. With HE staining, the tissue sections from the study group revealed new vessel formation with small diameter, increase in the reactional mesenchymal tissue, granulation tissue, degeneration of the striated muscle fibers, dystrophic calcifications, fat necrosis, and coagulation necrosis (ischemic necrosis). In the control group, there was only minimal lymphocytic invasion of the subdermal plane. In this study, we have shown that CSF leakage itself has effects on wound healing in the absence of known causative factors.