FOUR EXTREMITY FRACTURES IN A PATIENT WITH RENAL OSTEODYSTROPHY

Renal osteodystrophy (ROD) is the skeletal complication of chronic kidney disease. Secondary hyperparathyroidism and 125 dihydroxy vitamin D3 deficiency are the major causative factors in ROD. Musculoskeletal problems remain among the main limitations of the quality of life of renal failure patients. In this report, a 60‐year‐old male with four extremity fractures due to a minor trauma was presented. The patient had been receiving haemodialysis for seven years due to hypertensive nephropathy. Our case emphasises the importance of multispecialty approach to the investigation and treatment of patients with ROD.     

The impact of cesarean birth on subsequent fertility

PURPOSE OF REVIEW: Recently, the rate of cesarean delivery has increased to 25-30% of all births, the highest rate ever reported in the USA. Primary cesarean deliveries, especially elective procedures, mainly contribute to this increase. Currently, controversy concerning elective cesarean delivery is an area of growing debate. Women should be well informed about the benefits and risks of on-demand cesarean delivery. This may be problematic, however, due to the limited current scientific data on the benefits and risks. One of the issues causing debate is the association between cesarean section and subsequent infertility. In the present review, we aim to analyze the evidence for the impact of cesarean delivery on subsequent fertility. RECENT FINDINGS: Cesarean section has been reported to be associated with decreased subsequent fertility. Recent studies, which have tried to explain this association, suggest that this is most probably voluntary or due to some other biases, or possible confounding factors, which are due to organic or psychosocial effects of an emergency cesarean section or labor preceding the cesarean delivery. SUMMARY: Elective cesarean section does not appear to cause infertility. What we need now, however, are more qualitative studies to determine the contribution of cesarean section per se on fecundity.     

Abdominal obesity is an independent risk factor for increased carotid intima- media thickness in obese children

We aimed in this study to investigate carotid intima-media thickness (IMT) in obese children and evaluate the relationship of IMT to various cardiovascular risk factors. One-hundred four obese children (9.3 +/- 2.5 years) and 30 healthy age-matched control subjects were enrolled in the study. All children were assessed for fasting levels of glucose, insulin, lipid profile, skinfold thickness (SFT), waist circumference (WC), and blood pressure (BP). Insulin resistance was estimated by the homeostasis model assessment (HOMA) index. Carotid IMT measurements and non-alcoholic fatty liver disease (NAFLD) were diagnosed with ultrasonographic findings. IMT was significantly higher in obese children compared to controls (0.49 +/- 0.05 vs. 0.40 +/- 0.02 mm, p < 0.001). Significant positive correlations were found between increased carotid IMT and body fat percentage (BFP), body mass index (BMI), age, height, systolic BP, WC, SFT, triglyceride and insulin levels, and insulin resistance index. In a linear logistic regression analysis, the only parameter affecting the increase in carotid IMT was WC (beta: 0.589, p < 0.001). Furthermore, IMT was increased significantly in obese children with NAFLD when compared to obese children without NAFLD (0.54 +/- 0.04 vs. 0.48 +/- 0.05 mm, p < 0.001). Children with abdominal obesity are at increased risk for atherosclerosis, and WC can be used to determine the atherosclerosis risk in obese children.     

Bone metastasis: evaluation of 1100 patients with breast cancer

The aim of this study is to determine the relationship between the demographics and the clinical characteristics of breast cancer (BC) patients with bone metastasis (BM). The study included 1100 BC patients, of whom 174 had BMs and 926 had no BMs. Immunohistochemical methods were employed to understand estrogen receptor (ER)/progesterone receptor (PgR) receptor levels, Ki-67 protein levels and human epidermal growth factor receptor 2 (HER2) expression levels. Data were collected based on the hospital records of these patients, and ultrasonography or magnetic resonance imaging (MRI) results were employed for tumor localization. Positron emission tomography (PET)-computed tomography (CT) data were employed for the BM evaluation. The mean age (P = 0.067) and tumor diameter (P = 0.022) of BC cases who showed BM were significantly different from those who did not show BM. In addition, a significant relationship between the tumor diameter (P = 0.001) and axillary lymph node (ALN) number (P = 0.000) and BM was observed. The percentages of ER and PgR (r = 0.639; P = 0.000) were positively correlated, while the percentage of ER and Ki-67 protein levels (r = -0.505; P = 0.000) were negatively correlated. However, these correlations were not significant between the groups. The tumor diameter and positive ALNs may have an important role in BM of BC. There was no significant effect of ER/PgR receptor levels, Ki-67 protein levels, or HER2 expression levels in BMs of BC.     

Radioguided occult lesion localization versus wire-guided localization for non-palpable breast lesions: randomized controlled trial

AIM:

This prospective randomized clinical study was conducted to compare radioguided occult lesion localization (ROLL) with wire-guided localization to evaluate optimum localization techniques for non-palpable breast lesions.

METHODS:

A total of 108 patients who were undergoing an excisional biopsy for non-palpable breast lesions requiring pathologic diagnosis were randomly assigned to the ROLL group (n = 56) and wire-guided localization group (n = 52). In the study, patients'' characteristics, radiological abnormalities, radiological technique of localization, localization time, operation time, weight of the excised specimen, clearance margins, pathological diagnosis and perioperative complications were assessed.

RESULTS:

There were no differences between the two groups in terms of age, radiological abnormalities and localization technique (p = non-significant for all). ROLL techniques resulted in 100% retrieval of the lesions; for the wire-guided localization technique, 98%. Both localization time and operation time were significantly reduced with the ROLL technique (p = significant for all). The weight of the specimen was significantly lower in the ROLL group than in the wire-guided localization group (p = significant). The overall complication rate and pathological diagnosis were similar for both groups (p = non-significant for all). Clear margins were achieved in 91% of ROLL patients and in 53% of wire-guided localization patients, and the difference was significant.

CONCLUSIONS:

The present study indicated that the ROLL technique is as effective as wire-guided localization for the excision of non-palpable breast lesions. In addition, ROLL improved the outcomes by reducing localization and operation time, preventing healthy tissue excision and achieving clearer margins.     

The relationship between soluble L-selectin and the development of diabetic retinopathy

Diabetic retinopathy is a leading cause of adult vision loss and blindness. Earlier studies have shown that polymorphonuclear neutrophils play an important role in the pathogenesis of diabetic vascular complications. Stimulation of these cells is associated with the desquamation of L-selectin. The aim of the study was to evaluate the relationship between the serum concentration of L-selectin and the development of retinopathy in Type 2 diabetic patients. The study comprised 51 Type 2 diabetic patients, aged 65.2 +/- 7.5 years, with a diabetes duration of 10.1 +/- 8.9 years and HbA1c of 8.2 +/- 1.4. The study subjects were divided into two groups: Group A diabetic patients with retinopathy (n = 28) and Group B diabetic patients without retinopathy (n = 23). Twenty age- and sex-matched nondiabetic healthy subjects were enrolled as the control group. Patients with any inflammatory disease were excluded. Retinopathy was assessed by centrally graded retinal photographs. The serum concentration of sL-selectin was estimated using an ELISA test. We observed significantly higher serum concentrations of sL-selectin in Type 2 diabetic patients with retinopathy than in healthy subjects (36.5 +/- 18.1 vs. 11.4 +/- 7.5 ng/ml, p < 0.001). There was also a significant difference between Group A and Group B (36.5 +/- 18.1 vs. 24.2 +/- 13.5 ng/ml, p < 0.05) as well as between Group B and the controls (24.2 +/- 13.5 vs. 11.4 +/- 7.5 ng/ml, p < 0.01) with regard to sL-selectin levels. sL-selectin was significantly correlated with HbA1c (r = 0.93, p < 0.001) and with diabetes duration (r = 0.44, p < 0.001). These results suggest that there was a strong relationship between sL-selectin and diabetic retinopathy. The strong correlation between sL-selectin and HbA1c levels supports the concept that the sL-selectin level is increased with poor glycemic control, which may affect endothelial cell activity and cause subsequent microvascular complications.     

Effect of resin-based material combination on the compressive and the flexural strength

The mechanical properties, elasticity and compressive strength, of restorative materials play a crucial role during mastication for clinical performance of materials in particular stress bearing areas at posterior regions. This in vitro study was objected to evaluate the changes in the compressive and flexural strength of tooth-coloured resin-based dental restorations placed on flowable composites. Specimens in the control group were produced in cylindrical form for testing compressive strength and in quadrangular prism form for flexural strength test. Tetric Ceram, Charisma, Surefil, Admira and two compomers; Dyract AP and Compoglass F in test group specimens were fabricated by placing the control materials on different flowables. The material combinations were as follows: Tetric Ceram/Tetric Flow Charisma/Flowline, Surefil/Dyract Flow, Admira/Admira Flow, Dyract AP/Dyract Flow, Compoglass F/Compoglass Flow. Compressive strength values were measured at the Instron Testing Machine with a cross-head speed of 10 mm min(-1) while flexural strength were determined in three-point bending with a cross-head speed of 1 mm min(-1). One-way anova and Tukey's multiple comparison tests were performed for the statistical analysis. The flexural strength values of Tetric Ceram/Tetric Flow (135.9 +/- 3.2), Charisma/Flowline (120.4 +/- 5.6) and Compoglass F/Compoglass Flow (108.2 +/- 5.2) combinations were statistically greater than Tetric Ceram (110.8 +/- 10.5), Charisma (95.3 +/- 5.3) and Compoglass F (86.9 +/- 4.9). The results of the present study support the idea that the placement of flowable composite as a liner under the resin-based composite restoratives increase the flexural strength.