Axillary neuropathy mimicking quadrilateral space syndrome and its follow up for one year

Axillary neuropathy due to entrapment of the nerve in the quadrilateral space is seen rarely. Here, we describe a 24-year-old patient diagnosed with isolated axillary neuropathy that mimicked quadrilateral space syndrome. Quadrilateral or quadrangular space syndrome (QSS), first described by Cahill and Palmer in 1983, was defined as the entrapment of the distal branch of the axillary nerve and the posterior humeral circumflex artery (PHCA) in the quadrangular shaped anatomic space. We tracked the follow up of the patient for one year both clinically and electrophysiologically. Our aim in reporting this case is to stress the point that cases of such a nature usually represent situations of diagnostic and treatment challenges, where multidisciplinary approaches are required.     

The significance of beta-catenin, E-cadherin, and P-cadherin expressions in neoplastic progression of colorectal mucosa: an immunohistochemical study

BACKGROUND AND STUDY AIMS: The purpose of the current study was to investigate the role of beta-catenin, E-cadherin and P-cadherin in colorectal carcinogenesis using tissue array method. PATIENTS AND METHODS: Core tissue biopsies were taken from paraffin-embedded tissue blocks of 167 cases including 26 normal mucosae (NM), 99 colorectal polyps (10 hyperplastic polyps (HP), 8 traditional serrated (TSA), 17 tubular (TA), 37 tubulovillous (TVA), and 27 villous adenomas (VA)), 14 adenomas with intramucosal carcinoma (ACA), and 28 colorectal cancers (CCA). Immunohistochemistry was performed using antibodies to beta-catenin, E-cadherin, and P-cadherin. Distribution of positivity was assessed using percentage expression while an arbitrary grading scale was used for staining intensity. RESULTS: beta-catenin expression was cytoplasmic, membranous, and nuclear. Both E-cadherin and P-cadherin expressions were confined to cytoplasmic-membranous compartments. Membranous expression of beta-catenin significantly decreased in CCA (p < 0.01). Nuclear beta-catenin expression significantly increased in close correlation with neoplastic sequence reaching its highest expression in ACA and CCA (p < 0.001). Polyps with intraepithelial neoplasia (IEN) showed significantly higher nuclear beta-catenin expression in parallel with increasing grades of IEN (p < 0.001). E-cadherin and P-cadherin expression increased in polyps, whereas a significant decrease in their expression was observed in CCA (p < 0.001) while E-cadherin expression significantly increased in CCA compared to NM (p < 0.001), no such difference was observed in P-cadherin expression. CONCLUSIONS: Nuclear beta-catenin expression correlating with the grade of IEN in polyps and carcinomas supports its role in colorectal carcinogenesis. E-cadherin and P-cadherin expressions in adenomas suggest that these molecules might have role in adenoma formation though not necessarily be involved in neoplastic progression.     

Gynaecomastia in a man and hyperoestrogenism in a woman due to ingestion of nettle (Urtica dioica)

Nettle (Urtica dioica) is commonly sold as a herbal tea in Turkey. We report a case of gynaecomastia in a man (in which the only aetiologic factor identified was nettle tea consumption) and a case of galactorrhoea in a woman (in which the only aetiologic factor identified was also nettle tea ingestion).     

Risky sexual behavior among patients in Turkey with bipolar disorder, schizophrenia, and heroin addiction

AimRisky sexual behavior associated with such sexually transmitted infections (STIs) as hepatitis B and C, herpes, Treponema pallidum, and Neisseria gonorrhoeae, is more frequent among psychiatric patients and parenteral drug abusers than the general population. The aim of this study was to investigate risky sexual behavior in psychiatric outpatients diagnosed with schizophrenia (SCH), bipolar disorder, and heroin addiction (HA), and to compare them with those observed in healthy controls.MethodsThe study group (N = 485; 234 females and 251 males) consisted of patients that consecutively presented to Bak?rkoy State and Training Hospital for Psychiatric and Neurological Diseases in Istanbul and normal healthy controls.Main Outcome MeasuresThe chi‐squared test was used for comparisons between groups and categorical variables. One‐way analysis of variance (post‐hoc Bonferroni test) was used for demographic data. A 22‐item questionnaire for collecting demographic, illness history, and sexual activity data, and a structured 23‐item form for collecting data on risky sexually behavior were administered to the participants.ResultsIn all, 10% of the participants had a positive history for STIs. The majority of risky sexual behaviors was observed among the HA patients. The frequency of being sexually assaulted and having homosexual acts among the SCH group were higher. None of the patients had a positive human immunodeficiency virus (HIV) test result. The frequency of positivity for hepatitis B and C markers was highest among the HA patients.ConclusionsThe provision of information and training about all STIs and risky sexual behavior should become routine in the treatment of mentally ill patients, especially those that abuse drugs. Hariri AG, Karadag F, Gokalp P, and Essizoglu A. Risky sexual behavior among patients in Turkey with bipolar disorder, schizophrenia, and heroin addiction. J Sex Med 2011;8:2284–2291.     

Is routine radiological surveillance mandatory after uncomplicated ureteroscopic stone removal?

PURPOSE: Stricture formation and obstruction are rare but significant complications after ureteroscopy (URS), and there are controversial studies regarding follow-up. Our study sought to determine the appropriate follow-up for patients without complications. PATIENTS AND METHODS: A total of 323 patients were treated with URS for removal of ureteric stones, and their charts were retrospectively reviewed. A semirigid ureteroscope was used in all patients, and stone disintegration was accomplished with a pneumatic lithotriptor. Postoperative evaluation included plain abdominal radiograph of the kidneys, ureters, and bladder (KUB) on day 1, intravenous urography (IVU) and/or ultrasonography at postoperative month 3 and annually thereafter in all patients. A KUB radiograph was also obtained on postoperative day (POD) 10 in patients with residual fragments. RESULTS: Complete records of 268 patients were available. The overall success rate was 95.5%. The KUB radiograph on POD 1 revealed complete stone removal in 217 (80.9%) patients, while residual fragments were seen in 40 (14.9%) patients, who were reevaluated on POD 10. Evaluation on POD 10 showed residual fragments in 15 patients, and URS was again performed in eight patients. Perioperative minor complications were observed in 18 (6.7%) patients. IVU performed in the third postoperative month showed stricture formation in two (0.7%) patients and silent obstruction in one (0.3%). No stricture formation was observed in asymptomatic patients after uncomplicated complete stone removal. After a mean follow-up of 27.4 +/- 13.7 (range 12-58) months, annual radiologic studies did not show any additional complications. CONCLUSIONS: Our results indicate that radiologic surveillance for stricture formation and obstruction is not mandatory after complete stone removal with uncomplicated URS.     

Psychiatric morbidity among cancer patients and awareness of illness

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patients environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.This paper was accepted as a poster presentation at the European Conference of Clinical Oncology (ECCO) Congress held in Copenhagen, 21–25 September 2003.