Migration of an intrauterine contraceptive device to the ovary

We present the case of a 37-year-old woman with a history of 2 consecutive insertions of intrauterine contraceptive devices (IUDs) 3 years before she was referred to us for sonographic evaluation of lower abdominal pain. The first of the IUDs was presumed to have been expelled spontaneously, and 3 months after insertion of the second device, the patient had begun experiencing lower abdominal pain. Medical treatment with antibiotics and spasmolytics had been unsuccessful. We performed transvaginal sonography, which revealed the presence of an IUD in the uterus and a 2-cm linear metallic echogenic area in the left ovary, believed to represent another IUD. Anteroposterior radiography confirmed that there were 2 IUDs in the pelvis, and CT demonstrated 1 IUD in the uterus and another in the left ovary. The patient underwent laparoscopic removal of the ovarian IUD and was discharged in good condition. To our knowledge, this is the first report of migration of an IUD to the ovary detected on transvaginal sonography. We recommend consideration of this possibility during evaluation of women with unexplained chronic pelvic pain.     

Effects of alpha tocopherol and verapamil on liver and small bowel following mesenteric ischemia-reperfusion.

BACKGROUND/AIMS: We have previously shown that alpha tocopherol is a potent antioxidant which prevents reperfusion injury in a kidney and small bowel autotransplant model. In this study, the effect of systemic alpha tocopherol and verapamil on small bowel and hepatic functions following mesenteric ischemi-reperfusion was evaluated. METHODS: Fourty male Wistar Albino rats (weight, 250-300 g) all subjected to an ischemia-reperfusion experiment were divided into four groups of 10 as follows: Group 1: (SHAM), Group 2, given prophylactic and systemic alpha tocopherol, Group 3: given verapamil and Group 4: given (both verapamil and alpha tocopherol). RESULTS: Glutaminase activities 120 minutes after reperfusion were found to be significant in liver tissues (p=0.004). The highest to the lowest glutaminase activities in liver tissue at 120 minutes after reperfusion were in Group 1, Group 3, Group 2 and Group 4 respectively. Significant differences in MDA levels were found in the small bowel at 30 minutes and 120 minutes time points (p<0.05). There were statistically significant higher glutaminase levels at 30 minutes and 120 minutes of reperfusion in the small bowel, especially in Group 4 (p=0.005). CONCLUSION: Both small bowel and liver injuries reperfusion, can be decreased by prophylactic use of alpha tocopherol and verapamil. Glutaminase activity in liver tissue can also be affected by small bowel ischemia-reperfusion.     

Unusual hemodynamic findings in a patient with obstruction of the pulmonary vein by tumor

A 63-year-old woman with chronic obstructive airway disease presented with progressive dyspnea, episodic chest pain, a left lower lobe infiltrate and a pleural transudate. Right-heart catheterization showed pulmonary arterial diastolic and capillary wedge pressures elevated on the left side. At autopsy, she had an anaplastic carcinoma encasing and invaginating the left pulmonary vein. The pleural transudate probably resulted from a combination of unilateral pulmonary venous hypertension, and local changes in the systemic pleural capillaries and subpleural lymphatics. Invasion of pulmonary veins by tumor is observed frequently at autopsy, but is infrequently diagnosed during life.     

Overexpression of cyclooxygenase-2 in multiple myeloma: association with reduced survival

Cyclooxygenases (COX) are key enzymes in the conversion of arachidonic acid to prostaglandins. Several studies have shown a relation between angiogenesis and COX-2 expression. Elevated expression of cyclooxygenase-2 (COX-2), however, has not been reported in multiple myeloma (MM) in the literature. The aim of this study is to investigate COX-2 expression in MM as well as its correlation with prognostic factors and estimated survival rates. Immunohistochemical staining of the paraffin-embedded bone marrow biopsy tissues (n = 51) was performed using isoform-specific COX-2 polyclonal antisera (Santa Cruz Biotechnology, Santa Cruz, CA). Results were correlated with recognized clinical parameters, which were retrospectively obtained from patients' files. There were 15, 19, and 17 bone marrow biopsy specimens with negative, weak-moderate, and strong COX-2 immunostaining, respectively. According to univariate analysis, beta2-microglobulin, age, stage, COX-2 expression, and serum lactate dehydrogenase levels were significant prognostic factors for survival in patients with multiple myeloma. COX-2 expression, age, and serum lactate dehydrogenase levels (greater than 1x normal level) were significant prognostic factors by multivariate analysis. Kaplan-Meier overall survival estimate of those patients with negative or weak-moderate COX-2 immunoreactivity in myeloma cells was significantly better than that of patients with strong COX-2 immunoreactivity (log-rank chi(2) = 21,43, P < 0.001). COX-2 overexpression was associated with reduced estimated survival. Poor prognostic factors such as LDH, age, and beta2-microglobulin were also correlated with COX-2 expression. Potent, specific COX-2 inhibitors showing evident antiangiogenic and antitumor effects on cancers could provide new therapeutic strategies in the treatment of MM.     

A case of chronic eosinophilic pneumonia with atypical clinical and radiological progress

Eosinophilic lung disease is characterised by eosinophilic infiltration of lung tissue besides peripherical blood and bronchoalveolar lavage (BAL) fluid eosinophilia. A 48 year-old male who attended our clinics with cough and sputum lasting for 2-3 months, has been evaluated for micronodular interstitial infiltration bilaterally in all lung areas. Eosinophilia was detected in hemogram but BAL fluid was not diagnostic. Transbronchial lung parenchymal biopsy was compliant with chronic eosinophilic pneumonia. No special cause has been found after evaluation and the case was accepted to be idiopathic. Because of unfamiliar clinical, radiological and pathological findings, we decided to present this case.     

Evaluation of the clinical presentations in neurobrucellosis.

BACKGROUND: Brucellosis is a multisystem disease that may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is one of the complications. METHODS: In this study, we describe our experience in the diagnosis, treatment, and the final outcomes of 20 patients with neurobrucellosis out of 305 patients with brucellosis, within a five-year period between January 1999 and June 2004. RESULTS: The rate of neurobrucellosis was 6.6%. Twelve males and eight females with a mean age of 37.4 years were investigated. Fever, headache, confusion, and gait disorders were the main complaints. The duration of their complaints varied between one week and six months. On physical examination, 13 patients had fever, six had neck stiffness and confusion, three had motor deficit on either their upper or lower extremities, and four of them had diplopia. The Rose-Bengal test and standard tube agglutination tests were positive in all of the patients. Brucella melitensis was isolated from the blood of six of the 20 (30%) patients. Cerebrospinal fluid (CSF) was analyzed in 18 patients. Pleocytosis with a mean value of 244x10(6)cells/L, and high protein levels were detected in all. A low glucose level in the CSF was detected in ten patients. Patients were treated medically and a complete resolution was achieved in all. CONCLUSION: Patients with a Brucella infection occasionally manifest central nervous system involvement. Clinicians, especially serving in endemic areas or serving patients coming from endemic areas should consider the likelihood of neurobrucellosis in the patients with unexplained neurological and psychiatric symptoms, and should perform the necessary tests on blood and CSF.