Thyroid disorders in hemodialysis patients in an iodine-deficient community

There are various changes in the thyroid gland and its function in chronic renal failure (CRF). These changes include lower levels of circulating thyroid hormone, altered peripheral hormone metabolism, decreased binding to carrier proteins, possible reduction in tissue hormone content, and increased iodine storage in the thyroid gland. The decrease of excretion of urinary iodine in CRF increases serum inorganic iodine level and iodine content of the thyroid, which consequently enlarges the gland. This study is designed to investigate the prevalence of goiter and thyroid dysfunction in patients with end-stage renal disease (ESRD) on hemodialysis (HD) in an iodine-deficient community. Eighty-seven (40 females and 47 males) HD patients and 169 (79 females and 90 males) healthy individuals as controls are included. Sex ratios for the patient and control groups are 0.85 and 0.88, respectively. Mean ages for the patient and control groups are 42.94 +/- 11.88 and 40.20 +/- 10.72 years, respectively. Examination of the thyroid gland using ultrasonography along with simultaneous measurement of blood levels of free-T4 (FT4), free-T3 (FT3), and thyrotropin (TSH) are made for every individual. The presence of goiter demonstrable by ultrasonography is found in 32.2% of the uremic patients and in 23.5% of the controls and its prevalence increases with age (P = 0.01). In 32 (36.8%) of the patients and 29 (17.1%) of the controls at least one thyroid nodule is found in ultrasonography. Between patients with or without a nodular goiter the authors could not observe any difference for duration of dialysis and serum levels of TSH, FT4, FT3, calcium, and albumin. In ESRD patients the prevalence of nodular goiter is higher for females (47.5% vs. 27.7%, P = 0.045) and increases with age (P = 0.04). Though incidence of hyperthyroidism is found to be similar for the two groups (1.14% in ESRD patients vs. 1.10% in controls), hypothyroidism is observed in 3.4% of ESRD patients but only 0.6% of controls. This high incidence of hypothyroidism and nodular goiter in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests and ultrasonography, should be considered in evaluation of every ESRD patient.     

Sialoblastoma of the parotid gland

A 3 year-old girl presented with a 6- months history of facial swelling in the region of cheek. Physical examination revealed a firm, non-tender, non- erythematous, mobile, 3 × 3 cm mass in the right cheek. Fine needle aspiration biopsy of the mass demonstrated significiant mitotic activity, slight pleomorfism and atypical cells. A transoral incisional biopsy was also done for accurate diagnosis and the tumor was diagnosed as sialoblastoma. After performing superficial parotidectomy, the tumor was excised with large margins. No adjuvant treatment was given and no recurrence has been noted after 6 months. Despite the rareness of the disease, pathologists and otolaryngologists should always consider the possibility of sialoblastoma of salivary glands in childhood and it can be best described as locally agressive with malignant potential.     

Curcumin ameliorates impaired insulin/IGF signalling and memory deficit in a streptozotocin-treated rat model

Increased serum insulin levels and reduced peripheral insulin activities seen in insulin resistance syndrome are associated with age-dependent cognitive impairment and Sporadic Alzheimer’s Disease (SAD), suggesting a disturbance in the insulin signalling system in the brain and possibly being one of the causes of dementia. Therefore, the streptozotocin (STZ)-induced animal may be an appropriate model for the investigation of SAD and related dementia. This study was designed to investigate the beneficial effect of Curcumin (CUR), a neuroprotective agent, on intracerebroventricular (ICV) STZ-induced cognitive impairment in rats. For this purpose, adult male Wistar rats were bilaterally ICV injected with STZ (3 mg/kg). An artificial cerebrospinal fluid (aCSF) was given to the control group (SHAM) instead of STZ on days 1 and 3. Learning and memory performance were assessed using the “passive avoidance task” and the “Morris water maze test”. After confirmation of acquisition impairment with these tests, the STZ group was divided into two subgroups: STZ + vehicle (Vh) and STZ + CUR. The rats in the SHAM and STZ + Vh groups were administered intraperitoneally with 0.5 ml Vh and the rats in the STZ + CUR group were treated intraperitoneally with CUR (300 mg kg⁻¹ day⁻¹ in Vh) for 10 days starting from the 25th day after STZ injection. The Morris water maze test was reapplied on the 35th day after STZ injection and all of the rats were sacrificed on day 36 for quantitation of IGF-1 and for histopathological evaluation. Rats in the STZ + CUR group were found to have a higher performance in cognitive tests than rats in the STZ + Vh group (P < 0.01). In parallel with the cognitive tests, IGF-1 levels were decreased in all of the STZ-injected groups (1.78 ± 0.34) compared to the SHAM group (3.46 ± 0.41). In contrast, CUR treatment significantly increased IGF-1 levels (P < 0.001). The degree of neuronal loss decreased after CUR treatment compared to the SHAM group (P < 0.02). These results clearly indicate that CUR treatment is effective in reducing the cognitive impairment caused by STZ in rats, and may be a potential therapeutic agent for altering neurodegeneration in SAD.     

A coincidence of renal cell carcinoma and hematological malignancies

Hematological malignancies with renal cell carcinoma (RCC) are rarely seen. We reported here two cases of coincidence of RCC with multiple myeloma (MM) and Hodgkin??s disease (HD). A 69-year-old male patient with tumor that was located at the upper pole of left kidney was admitted to our clinic. Partial tumoral resection was perfomed and stage-I RCC was diagnosed after the histopathological examination of tumor. Moreover, he was diagnosed with IgG kappa stage-IIA MM as a result of bone marrow examination and serum immunofixation electrophoresis. Radiotherapy, combination chemotherapy, and autologous stem cell transplantation (ASCT) were performed. The patient is still alive who achieve a complete remission. A 53-year-old male patient suffered from cervival lymphadenopathy. He has a story of right radical nefrectomy that has been performed 4?years ago. Stage II-B lymphocyte-predominant HD was diagnosed. Combination chemotherapy was started, but relapse occurred 25?months later. ASCT was not planned due to cardiovascular problems and the patient died. Clinicans should keep in mind the coincidence of RCC with MM and HD.     

Scleral buckling technique for longstanding inferior rhegmatogenous retinal detachments with subretinal bands.

We investigated the effectiveness and safety of conventional surgery on longstanding retinal detachments (RD) with subretinal bands (SRB). We found that conventional surgery were safe and effective method in the treatment of inferior chronic rhegmatogenous RD cases with SRB without other signs of advanced proliferative vitreopathy. Further studies with larger numbers and longer follow up are needed.     

Unusual Ocular Complications of the HELLP Syndrome: Persistent Macular Elevation and Localized Tractional Retinal Detachment

We report a case of HELLP syndrome with bilateral decreased vision at 25 weeks’ gestation. Fundus examination revealed serous retinal detachment involving the macula. Systemic steroid and oral dorzolamide therapy was initiated and visual acuity improved. At 2 months, peripheral localized tractional retinal detachment was present in the left eye and argon laser photocoagulation was performed. Macular elevation did not resolve; therefore, in the right eye intravitreal triamcinolone acetonide injection was performed. Drs. Taskapili, Kocabora, and Gulkilik are from the Eye Clinic, Vakıf Gureba Training and Research Hospital, Istanbul, Turkey. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

A New,T-Shaped Adaptor for Easy,Quick and Efficient Fat Harvesting During Liposuction

Although there is a controversy about success and failure of autologous fat tissue transfers, it is a widely accepted method for soft tissue augmentation and is performed by many plastic surgeons as well as dermatologists all around the world. Its advantages are that it does not cause reactions, its absorption rates have been reduced by increased knowledge, experience, and techniques, it can yield good, long-term results, and there are now preservation techniques that allow reinjections when necessary. However, no single ideal technique has been determined. In this paper a new, simple, T-shaped adaptor for easy, quick, and efficient fat harvesting during liposuction is described. This study not only describes the clinical use of the adaptor, but also histologically examines its effects on fat cells under various vacuum pressures (-250 mmHg, -500 mmHg, -700 mmHg). The study shows that the cell structure of fat tissue harvested under medium power (with vacuum pressures of -250 mmHg and -500 mmHg) is not disrupted, while that of tissue harvested with a vacuum pressure of -700 mmHg was traumatized and occasional cell wall fragmentation occurred. In conclusion, it is shown that the T-shaped adaptor allows harvesting of the desired amount of fat tissue without causing trauma to fat cells when it is used with medium-power suction.     

Contribution of vitamin C administration for increasing lipolysis

This experiment was designed to investigate whether addition of vitamin C to the solution used in tumescent technique of liposuction might increase lipolysis and whether increased fibrosis might improve skin retraction where liposuction did not work properly and the skin had poor retraction ability. Eighteen Sprague-Dawley rats were used in two groups. Both inguinal fat pads of rats with their vascular structures were elevated and the right inguinal fat pad was injected with 1 cc tumescent solution as a control and the left fat pad with a 1 cc vitamin C-tumescent solution. Histopathological examination showed that all fat pads injected with tumescent solution had normal adipocytes. Those injected with vitamin C-tumescent were shown to have extreme fibrosis and occasional adipocytes.     

Cryopreservation of Hair Follicles at -20C°: Can It Work in Staged Hair Transplantation

Androgenic alopecia is a serious problem for a large proportion of the population, especially males, and causes them to seek medical help. Many methods have been described for treatment of androgenic alopesia. Among them are punch grafts, strip grafts, scalp grafts, scalp reductions, tissue expanders, and flap combinations, and hair transplantations with minigrafts and micrografts. The latter has become popular in the last two to three decades and has been investigated extensively. Improvements in hair replacement with minigrafts and micrografts may allow an ideal result with a nearly normal appearance. However, hair replacement with these grafts has important disadvantages. It requires a long operational time and only a limited number of grafts can be placed in one session. In this study, we investigated morphological structures of micrografts stored at 4 degrees C and those stored at -20 degrees C. We found that morphological structures of the grafts stored at 4 degrees C started to be impaired in the fifth day, but that the morphological structures of the grafts stored at -20 degrees C remained unaltered for 15 days. If this method is put into practice, the use of minigrafts and micrografts available will not only obviate the second graft harvesting, but also allow reconstruction of a large area in a short period of time.