Elevated carbohydrate antigen 19-9 levels in a patient with choledocholithiasis.

Carbohydrate antigen 19-9 (CA19-9) has been used as a tumor marker in the diagnosis and differentiation of pancreatic cancers. However, significantly high levels of CA 19-9 in the absence of pancreatic malignancy have also been reported. We present a 50-year-old woman with a common bile duct stone and cholangitis, whose CA 19-9 level of 1.500 U/ml returned to normal after definitive treatment of choledocholithiasis.     

Total oxidative/anti-oxidative status and relation to bone mineral density in osteoporosis

The aim of this study was to evaluate the total antioxidant status (TAS), total oxidative status (TOS) and oxidative stress index (OSI) in patients with postmenopausal osteoporosis. We also investigate the relation between bone mineral density and oxidative/antioxidative parameters. Thirty-nine patients with osteoporosis and 26 healthy controls were included in the study. Plasma TAS, TOS levels were determined by using a novel automated methods. Plasma TOS and OSI value were significantly higher, and plasma TAS level was lower in patients than in healthy controls (P < 0.001 for all). There was a significant negative correlation between OSI and BMD in lumbar and femoral neck region (r = −0.63, P < 0.001; r = 0.40, P = 0.018). The results of this study indicated that increased osteoclastic activity and decreased osteoblastic activity may be associated with an imbalance between oxidant and antioxidant status in postmenopausal osteoporosis. Therefore, supplementation of antioxidant-enriched diet to the therapy might shed light on the development of novel therapeutic strategies for osteoporosis.     

The spectrum of diseases causing fever of unknown origin in Turkey: a multicenter study.

OBJECTIVE: The purpose of this trial was to determine the spectrum of diseases with fever of unknown origin (FUO) in Turkey. METHODS: A prospective multicenter study of 154 patients with FUO in twelve Turkish tertiary-care hospitals was conducted. RESULTS: The mean age of the patients was 42+/-17 years (range 17-75). Fifty-three (34.4%) had infectious diseases (ID), 47 (30.5%) had non-infectious inflammatory diseases (NIID), 22 (14.3%) had malignant diseases (MD), and eight (5.2%) had miscellaneous diseases (Mi). In 24 (15.6%) of the cases, the reason for high fever could not be determined despite intensive efforts. The most common ID etiologies were tuberculosis (13.6%) and cytomegalovirus (CMV) infection (3.2%). Adult Still's disease was the most common NIID (13.6%) and hematological malignancy was the most common MD (7.8%). In patients with NIID, the mean duration of reaching a definite diagnosis (37+/-23 days) was significantly longer compared to the patients with ID (25+/-12 days) (p=0.007). In patients with MD, the mean duration of fever (51+/-35 days) was longer compared to patients with ID (37+/-38 days) (p=0.052). CONCLUSIONS: Although infection remains the most common cause of FUO, with the highest percentage for tuberculosis, non-infectious etiologies seem to have increased when compared with previous studies.     

Feasibility of using post-contrast dual-energy CT for pediatric radiation treatment planning and dose calculation

Objectives:When iodinated contrast is administered during CT simulation, standard practice requires a separate non-contrast CT for dose calculation. The objective of this study is to validate our hypothesis that since iodine affects Hounsfield units (HUs) more than electron density (ED), the information from post-contrast dual-layer CT (DLCT) would be sufficient for accurate dose calculation for both photon and proton therapy.Methods and materials:10 pediatric patients with abdominal tumors underwent DLCT scans before and after iodinated contrast administration for radiotherapy planning. Dose distributions with these DLCT-based methods were compared to those with conventional calibration-curve methods that map HU images to ED and stopping-power ratio (SPR) images.Results:For photon plans, conventional and DLCT approaches based on post-contrast scans underestimated the PTV D99 by 0.87 ± 0.70% (p = 0.18) and 0.36 ± 0.31% (p = 0.34), respectively, comparing to their non-contrast optimization plans. Renal iodine concentration was weakly associated with D99 deviation for both conventional (R² = 0.10) and DLCT (R² = 0.02) approaches. For proton plans, the clinical target volume D99 errors were 3.67 ± 2.43% (p = 0.0001) and 0.30 ± 0.25% (p = 0.40) for conventional and DLCT approaches, respectively. The proton beam range changed noticeably with the conventional approach. Renal iodine concentration was highly associated with D99 deviation for the conventional approach (R² = 0.83) but not for DLCT (R² = 0.007).Conclusion:Conventional CT with iodine contrast resulted in a large dosimetric error for proton therapy, compared to true non-contrast plans, but the error was less for photon therapy. These errors can be greatly reduced in the case of the proton plans if DLCT is used, raising the possibility of using only a single post-contrast CT for radiotherapy dose calculation, thus reducing the time and imaging dose required.Advances in knowledge:This study is the first to compare directly the differences in the calculated dose distributions between pre- and post-contrast CT images generated by single-energy CT and dual-energy CT methods for photon and proton therapy.     

Comparison of speech outcomes using type 2b intravelar veloplasty or furlow double-opposing Z plasty for soft palate repair of patients with unilateral cleft lip and palate

BackgroundThe aim of this study is to compare speech outcomes, fistula rates, and rates of secondary speech surgeries after palatoplasty using Furlow palatoplasty or type 2b intravelar veloplasty for soft palate repair.Patients and methodsPatients with unilateral cleft lip and palate who had either Furlow palatoplasty or intravelar veloplasty for soft palate repair were retrospectively evaluated for demographic and perioperative variables and speech outcomes. Fistula rate, secondary surgical intervention for improved speech results, and findings of speech assessment were further reviewed for the patients who met the inclusion criteria.ResultsA total of 76 patients, 36 in the Furlow palatoplasty group and 40 in the intravelar veloplasty group, were included in the study. In the speech assessment, nasalance values were statistically similar between the two groups. Also, there was no statistically significant difference between the groups in velopharyngeal motility (p = 0.103). The total rates of secondary surgeries and fistula were statistically similar between the groups (p = 0.347 and 0.105, respectively).ConclusionThe similar outcomes of speech and surgical evaluation between the two groups make the surgeon's preference determinant in the selection of the surgical technique for soft palate repair.     

Effects of laser modalities on shear bond strengths of composite superstructure to zirconia and PEEK infrastructures: an in vitro study

Odontology - In the last decade, demand for metal-free esthetic restorations has grown considerably due to the development of materials to fulfill the need for an esthetic prosthesis. We examined...     

The pleuro-esophageal muscle: a disregarded anatomical structure

A transverse muscular band extending from the left pleura to the esophagus was detected during routine dissection of posterior mediastinum in Anatomy Department of Ege University Medical Faculty. As a result of a detailed review of the literature, we found that this structure is named as the pleuro-esophageal muscle. This muscle was made of smooth fibers, acting as an anchoring structure to the lower part of the esophagus. While the entire esophageal muscle is smooth in the early stage of fetal development, this muscle probably derives as an early separation from the esophagus.     

Magnetic resonance image-guided stereotactic body radiation therapy for liver rhabdoid tumor in infancy: A case report

Extracranial malignant rhabdoid tumors are rare and aggressive tumors that typically occur in the pediatric age group and have a poor prognosis. Herein, we report a case of a one year and five months old male infant who was referred with the diagnosis of malignant rhabdoid tumor of the liver. Magnetic resonance guided stereotactic body radiotherapy was administered with concomitant chemotherapy. Treatment was well tolerated with no severe acute side effects. A 40.8% volumetric reduction of the tumor was observed at the last fraction of MR guided radiotherapy.     

Convalescent plasma therapy in patients with COVID-19

IntroductionPassive antibody therapy has been used to immunize vulnerable people against infectious agents. In this study, we aim to investigate the efficacy of convalescent plasma (CP) in the treatment of severe and critically ill patients diagnosed with COVID-19.MethodThe data of severe or critically ill COVID-19 patients who received anti-SARS-CoV-2 antibody-containing CP along with the antiviral treatment (n = 888) and an age-gender, comorbidity, and other COVID-19 treatments matched severe or critically ill COVID-19 patients at 1:1 ratio (n = 888) were analyzed retrospectively.ResultsDuration in the intensive care unit (ICU), the rate of mechanical ventilation (MV) support and vasopressor support were lower in CP group compared with the control group (p = 0.001, p = 0.02, p = 0.001, respectively). The case fatality rate (CFR) was 24.7 % in the CP group, and it was 27.7 % in the control group. Administration of CP 20 days after the COVID-19 diagnosis or COVID-19 related symptoms were associated with a higher rate of MV support compared with the first 3 interval groups (≤5 days, 6?10 days, 11?15 days) (p=0.001).ConclusionCP therapy seems to be effective for a better course of COVID-19 in severe and critically ill patients.