Dietary exposures to selected metals and pesticides.

Average daily dietary exposures to 11 contaminants were estimated for approximately 120,000 U.S. adults by combining data on annual diet, as measured by a food frequency questionnaire, with contaminant residue data for table-ready foods that were collected as part of the annual U.S. Food and Drug Administration Total Diet Study. The contaminants included in the analysis were four heavy metals (arsenic, cadmium, lead, mercury), three organophosphate pesticides (chlorpyrifos, diazinon, malathion), and four organochlorine pesticides (dieldrin, p,p'-DDE, lindane, heptachlor epoxide). Dietary exposures to these contaminants were highly variable among individuals, spanning two to three orders of magnitude. Intraindividual exposures to the metals, organophosphates, and organochlorines were estimated to be strongly correlated; Pearson's correlation coefficients ranged from 0.28 for lindane:dieldrin to 0.84 for lead:mercury. For some of the compounds (e.g., arsenic and dieldrin), a substantial fraction of the population was estimated to have dietary intakes in excess of health-based standards established by the EPA. Before use for risk assessment or epidemiologic purposes, however, the validity of the exposure estimates must be evaluated by comparison with biological indicators of chronic exposure. Because of their low detection rate in table-ready foods, the estimated distributions of exposures for dieldrin, p,p'-DDE, heptachlor epoxide, lindane, diazinon, and chlorpyrifos were found to be sensitive to assumed values for nondetect samples. Reliable estimates of the population distribution of dietary exposures to most other contaminants cannot be made currently, due to their low rate of detection in table-ready foods. Monitoring programs that use more sensitive study designs and population-based assessments for other subpopulations should be a priority for future research.     

Are Cemented Endoprosthetic Reconstructions Superior to Uncemented Endoprostheses in Terms of Postoperative Outcomes and Complications in Patients with Extremity-Located Bone Metastasis Scheduled for Adjuvant Radiotherapy?

BackgroundAdjuvant radiotherapy frequently is used for prevention of recurrence following resection and endoprosthetic reconstruction of bone metastases. Besides this positive effect, radiotherapy can negatively affect both cemented and uncemented endoprostheses.MethodsWe retrospectively analyzed 130 extremities of 115 patients who underwent resection and cemented or uncemented endoprosthetic reconstruction for bone metastasis, followed by postoperative radiation therapy. The functional improvement was assessed by Karnofsky Performance Scale and Musculoskeletal Tumor Society (MSTS) scoring. The radiological evaluation mainly included analysis of “loosening areas” which were defined as the regions of osteolysis between the stem of the endoprostheses and the cement or cortex. The complications resulting in reconstruction failure and patient survival were recorded.ResultsA survival analysis revealed that 21 (18.3%) patients were alive with disease and 94 (81.7%) died of disease at the time of study. The mean last follow-up Karnofsky Performance Scale and MSTS scores of the whole study cohort were 78.69 ± 8.66 and 82.15 ± 9.06, respectively. There were 8 (6.15%) complications resulting in reconstruction failure, including aseptic loosening (2), femoral stem breakage (2), periprosthetic fracture (2), and infection (2). The number and time of complications did not show a significant difference between the cemented and uncemented groups (P > .05).ConclusionThis study demonstrated that there was no significant difference in complication rates of cemented or uncemented endoprosthetic reconstructions in patients with extremity-located bone metastases scheduled for adjuvant radiotherapy. The only result in favor of cemented prostheses was significantly higher MSTS functional scores at last follow-up.     

Nodular lymphocyte predominant Hodgkin's lymphoma in daily practice: A multicenter experience

Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin's lymphoma. In this study, we aimed to investigate the clinical features and therapeutic outcomes of patients with NLPHL who were diagnosed at different institutes in Turkey. We retrospectively reviewed the records of the patients diagnosed with NLPHL. Adult patients who were diagnosed after 2005 with histological confirmation were selected for the study. Forty‐three patients were included in the study. Median age of patients was 37.5 years (18‐70) at the time of diagnosis. About 60.5% patients were diagnosed as stage I and II NLPHL, and remaining 39.5% had stage III and IV disease. Median follow‐up was 46 months. During follow‐up, none of the patients died. Seven patients relapsed or progressed after initial therapy at a median of 12 months. Five of 7 relapsed/refractory patients (71.4%) were salvaged with chemotherapy only (DHAP, ICE), and the remaining 2 (28.6%) were salvaged with chemoimmunotherapy. All of relapsed/refractory patients were able to achieve complete remission after salvage therapy. Lactate dehydrogenase levels were significantly higher in patients with progressive disease compared with nonprogressive disease. Our study showed an excellent outcome with all patients alive at last contact with a median follow up of 46 months despite a wide range of different therapeutic approaches. All relapsed and refractory patients were successfully salvaged despite a low frequency of patients received immunotherapy in conjunction with chemotherapy. Our results suggest that immunotherapy may be reserved for further relapses.     

Light and electron microscopic evaluation of cardinal ligaments in women with or without uterine prolapse

Introduction and hypothesis  

This study investigated light and electron microscopic findings in cardinal ligaments of women with or without uterine prolapse.     

Suture and stapler granulomas: a word of caution.

Newly detected lung nodules during the postoperative follow-up course of a patient who has underwent pulmonary resection, is frequently a diagnostic dilemma. It is crucial to determine if the tumor is a recurrent tumor, a second primary tumor or a benign lesion. Currently, positron emission tomography seems to have replaced most of the invasive diagnostic interventions. In this study, three cases with false-positive nodules interpreted as recurrent malignancy on PET scans are presented. They were eventually found out to be foreign body hyper-reaction granulomas.     

The Size of the Esophageal Hiatus in Gastroesophageal Reflux Pathophysiology: Outcome of Intraoperative Measurements

Objective  

The aim of the study was to investigate the impact of the size of the esophageal hiatus on lower esophageal sphincter pressure (LESP) and acid reflux.     

Urinary Neopterin Levels in Patients with Thyroid Cancer

Increased urinary neopterin concentrations have been described in many cancers. We aimed to evaluate the urinary neopterin levels in thyroid cancer. Sixty-nine patients with thyroid cancer, 76 patients with benign thyroid pathology and 33 healthy subjects were evaluated. First morning urine samples were collected from the patients and normal subjects for neopterin and creatinine measurement and stored at −80 °C until analysed. Neopterin levels were 149.3 (15.2–1,602.2) μmol/mol creatinine in the malignant group, 32 (5.2–275.6) μmol/mol creatinine in the benign group and 9.2 (2.7–78.7) μmol/mol creatinine in normal subjects (p ≤ 0.001). Urinary neopterin levels were significantly higher in patients with thyroid cancer than patients with benign thyroid pathologies and normal subjects. Also the patients with benign thyroid pathologies had a higher urinary neopterin level than the normal subjects. Malignant group was divided to two groups; patients with/without chronic thyroiditis (confirmed histologically). There were 22 (31.9 %) patients with and 47 (68.1 %) patients without chronic thyroiditis. Urinary levels of neopterin didn’t differ in both groups (168.6 (21.3–716.8) μmol/mol creatinine and 135.3 (15.2–1,602.2) μmol/mol creatinine respectively; p = 0.381). Urinary neopterin levels are high in thyroid cancer patients independently from the presence of chronic thyroiditis.     

The influence of CTLA‐4 single nucleotide polymorphisms on acute kidney allograft rejection in Turkish patients

Cytotoxic T‐lymphocyte antigen‐4 (CTLA‐4) is a cell surface protein, which down‐regulates the immune response at CTLA‐4/CD28/B7 pathway. We aimed to investigate the influence of the ?318C/T, +49A/G, ?1661A/G and CT60A/G, and CTLA‐4 gene polymorphisms on acute rejection of kidney allograft in Turkish patients. The study design was a case–control study that consists of three groups: Group 1 (n = 34) represented the kidney transplant (Ktx) recipients who experienced acute rejection, Group 2 (n = 47) was randomly assigned Ktx recipients without acute rejection, and Group 3 (n = 50) consisting of healthy volunteers to evaluate the normal genomic distribution. The polymerase chain reaction–restriction fragment length polymorphism technique was used to determine the polymorphisms. Genotype and allele frequencies among three groups denoted similar distributions for +49A/G, ?1661A/G, and CT60A/G. Conversely, ?318C/T genotype was three times more frequent in the acute rejection group than in the non‐rejection group (OR = 3.45; 95%CI = 1.18–10.1, p = 0.015) and two times more frequent than the healthy control group (OR = 2.45; 95% CI = 0.98 – 6.11, p = 0.047). Additionally, having a T allele at ?318 position was significantly associated with acute rejection (0.147 vs. 0.043, OR = 3.45; 95% CI = 1.13–10.56, p = 0.02). 318C/T gene polymorphism and T allelic variant were found to be associated with increased acute rejection risk in Turkish kidney allograft recipients.