Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review

After an unsuccessful midwife-assisted delivery in which a head was born but delivery could not be advanced, episiotomy performed at Sanliurfa Maternity Hospital allowed vaginal delivery of female conjoined twins. Visual and x-ray examination showed two heads, two vertebral columns, two feet, two arms, and fusion at the level of the pelvis. The baby was born dead, but the mother made an uneventful recovery. Parapagus (anterolaterally joined) dicephalus (two-headed) twins account for only 11-13% of all conjoined twins, and they rarely survive. Complex malformations of hearts, lungs and abdominal organs, duplication of the tracheae, upper gastrointestinal tract and spinal column, and either double or single versions of other organs have been reported in parapagus dicephalus cases. The incidence, anatomical, embryological, diagnostic, prognostic, obstetrical, perinatal, and ethical aspects of conjoined twins are reviewed, with a focus on parapagus dicephalus conjoined twins.     

Diagnosis of abdominal tuberculosis： Experience from 11 cases and review of the literature

AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis.METHODS: The records of 11 patients (4 males, 7 females,mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed.RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125 were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3,bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasoundguided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white‘miliary nodules‘ or plaques, enlarged lymph nodes, ascites,‘violin string‘ fibrinous strands, and omental thickening.Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis ( M. tuberculosis) in all cases.CONCLUSION: Abdominal TB should be considered in all cases with ascites. Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.     

Work-related asthma-like symptoms among florists

OBJECTIVES: In this study, we evaluated the prevalence of work-related asthma-like symptoms and possible risk factors among florists in Turkey. METHODS: We collected questionnaire data from 128 florists, and investigated occupational history and respiratory, ocular, dermal, and nasal symptoms. We evaluated pulmonary function tests with spirometry and atopy by using the skin-prick test. Possible risk factors were analyzed by age-adjusted, smoking-adjusted, and gender-adjusted logistic regression models comparing symptomatic and asymptomatic individuals. RESULTS: The prevalence of work-related asthma-like symptoms was 14.1% (18 patients). We observed excess risk with a high work intensity (odds ratio [OR], 7.3; 95% confidence interval [CI], 1.1 to 51.8) and long work duration (OR, 5.1; 95% CI, 1.2 to 21.6). Florists with work-related asthma-like symptoms were 5.9 times more likely (95% CI, 1.4 to 24.3) to have a positive skin test response to a flower mix allergen. We also observed an excess risk for work-related asthma-like symptoms among those with allergic rhinitis (OR, 13.2; 95% CI, 3.1 to 56.4) and conjunctivitis (OR, 8.4; 95% CI, 2.4 to 29.2). CONCLUSION: The most prominent risk factors in florists were work intensity, work duration, and specific atopy.     

Ketotifen ameliorates development of fibrosis in alkali burns of the esophagus

An experimental study was performed to investigate the efficacy of ketotifen, which is a mast cell stabilizer and histamine H₁-receptor antagonist, on the prevention of stricture development after esophageal caustic injuries in the rat. Caustic esophageal burn was created by applying 37.5% NaOH to the distal esophagus. Forty rats were divided into four equal groups. Group A (sham) animals were uninjured. Group B rats were injured but untreated. Group C rats were injured and received ketotifen (1 mg/kg/day) via the oral route. Group D rats were injured and received ketotifen (1 mg/kg/day) via the intraperitoneal route. Efficacy of the treatment was assessed on day 28 by measuring the stenosis index and histopathologic damage score and biochemically by determining tissue hydroxyproline content. The stenosis index in group B (0.93±0.22) was significantly increased compared with group A (0.39±0.06, p <0.05), group C (0.42±0.09, p <0.05), and group D (0.35±0.07, p <0.05). The hydroxyproline level (µg/mg wet tissue) was significantly increased in group B (1.31±0.08, p <0.05) compared with group A (0.69±0.16, p <0.05), group C (1.06±0.16, p <0.05), and group D (0.95±0.12, p <0.05). In group B the histopathologic damage score was significantly higher than in groups C (p <0.05) and D (p <0.05). There was no significant difference between group C and group D in terms of all parameters evaluated. Treatment with ketotifen decreased tissue hydroxyproline levels, histological damage, and the stenosis index. We conclude that ketotifen has a preventive effect in the development of fibrosis in an experimental model of corrosive esophagitis in rats.     

Erythropoietin improves long-term spatial memory deficits and brain injury following neonatal hypoxia-ischemia in rats

It is well known that neonatal hypoxic-ischemic brain injury leads to mental retardation and deficits in cognitive abilities such as learning and memory in human beings. The ameliorative effect of erythropoietin (Epo) on experimental hypoxic-ischemic brain injury in neonatal rats has been recently reported. However, the effect of Epo on cognitive abilities in the hypoxic-ischemic brain injury model is unknown. The aim of this study is to investigate the effects of Epo on learning-memory, behavior and neurodegeneration induced by hypoxia-ischemia. Seven days old Wistar Albino rat pups have been used in the study (n = 28). Experimental groups in the study were: (1) saline-treated hypoxia-ischemia group, (2) Epo-treated (i.p., 1000 U/kg) hypoxia-ischemia group, (3) sham-operated group, (4) control group. In hypoxia-ischemia groups, left common carotid artery was ligated permanently on the seventh postnatal day. Two hours after the procedure, hypoxia (92% nitrogen and 8% oxygen) was induced for 2.5 h. Epo was administered as a single dose immediately after the hypoxia period. When pups were 22 days old, learning experiments were performed using Morris water maze. On the 20th week, when brain development is accepted to be complete, learning experiments were repeated. Rats were then perfused and brains removed for macroscopic and microscopic evaluation. Epo treatment immediately after hypoxic-ischemic insult significantly improved long-term neurobehavioral achievements when tested during the subsequent phase of brain maturation and even into adulthood. Histopathological evaluation demonstrated that Epo also significantly diminished brain injury and spared hippocampal CA1 neurons. In conclusion, Epo administrated as a single dose immediately after neonatal hypoxic-ischemic insult provides benefit over a prolonged period in the still developing rat brain. Since the wide use of Epo in premature newborns, this agent may be potentially beneficial in treating asphyxial brain damage in the perinatal period.     

Otomycosis in Turkey: predisposing factors,aetiology and therapy

Otomycosis usually requires long-term treatment and tends to recur. This study was performed on 87 patients with the clinical diagnosis of otomycosis and 20 controls in order to determine the pathogenic agents, predisposing factors and a cost-effective treatment. The predisposing factors included wearing head clothes (74.7 per cent), presence of dermatomycoses (34.5 per cent) and swimming (27.6 per cent). The most common pathogenic fungus was Aspergillus niger (44.8 per cent) in the otomycosis group. The only isolate was Candida albicans in the control group (2.5 per cent). We concluded that administration of four per cent boric acid solution in alcohol and frequent suction cleaning of the ear canal might be a cost-effective treatment for otomycosis since 77 per cent of the patients were treated effectively this way. Eighty per cent of the resistant cases had mixed fungal-bacterial infections, and 50 per cent of them had dermatomycoses. These resistant cases were treated by administration of tioconazole ointment.     

Sibutramine has a positive effect on clinical and metabolic parameters in obese patients with polycystic ovary syndrome

OBJECTIVE: To evaluate the effectiveness of sibutramine therapy alone and in combination with ethinyl estradiol-cyproterone acetate (EE-CPA) on the clinical and metabolic parameters of obese women with polycystic ovary syndrome (PCOS). DESIGN: Prospective randomized, controlled study. SETTING: Endocrinology and gynecology clinics. PATIENT(S): Forty obese women with PCOS. INTERVENTION(S): Group 1 was treated with oral EE-CPA (35 microg-2 mg/day), group 2 with oral sibutramine (10 mg/day), and group 3 with a combination of EE-CPA plus sibutramine for 6 months. All groups were advised to consume a diet of 1200 kcal/day. MAIN OUTCOME MEASUREMENT(S): Measurements were performed before and 6 months after treatment of body mass index, waist-to-hip ratio, systolic and diastolic blood pressure, Ferriman-Gallwey hirsutism score, total testosterone, free testosterone, sex hormone-binding globulin, dihydroepiandrosterone sulfate (DHEAS), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, glucose and insulin during oral glucose tolerance test, and insulin sensitivity index; area under the curve for glucose and insulin were obtained from OGTT. RESULT(S): Body mass index, Ferriman-Gallwey hirsutism score, serum total testosterone, free testosterone, and DHEAS levels were significantly decreased and SHBG was significantly increased in all groups at the end of the study. WHR, diastolic blood pressure, and serum triglyceride level were significantly reduced only in the sibutramine group. CONCLUSION(S): Sibutramine might have a positive effect on hyperandrogenemia, and clinical and metabolic risk factors for cardiovascular disease in obese women with PCOS.     

Risk of laryngeal cancer by occupational chemical exposure in Turkey

Laryngeal cancer is the second most common cancer among men in Turkey. In this hospital based case-control study, we evaluated laryngeal cancer risks from occupational chemical exposures. We analyzed 940 laryngeal cancer cases and 1519 controls. Occupational history, tobacco, and alcohol use and demographic information were obtained by a questionnaire. The job and industries were classified by special seven-digit codes. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) based on a developed exposure matrix for chemicals, including diesel exhaust, gasoline exhaust, polycyclic aromatic hydrocarbons (PAHs), formaldehyde, and solvents. An excess of laryngeal cancer occurred with diesel exhaust (OR=1.5, 95% CI=1.3-1.9), gasoline exhaust (OR=1.6, 95% CI=1.3-2.0), and PAHs (OR=1.3, 95% CI=1.1-1.6). There was a dose-response relationship for these substances with supraglottic cancers (P<0.000). The PAH association only occurred among those who also had exposure to diesel exhaust.     

Evaluation of standard tangential irradiation versus breast ring technique using three-dimensional tools in cancerous large breasts

AIMS AND BACKGROUND: In patients with large breasts, tangential irradiation after lumpectomy is technically difficult. Tangential plans of large breasts comprise a large volume of the lung, axilla and heart, as well as an important volume of the opposite breast and lung. METHODS: Instead of classical positioning of the breast, we encircled the breast with a plastic polyvinyl ring-shaped tube. All five left-sided breast cancer patients underwent CT scan planning with and without the plastic ring in conventional treatment positioning. Skin treatment portals at the midline and mid axilla were marked with radio-opaque markers. The scan volume encompassed the region from just below the diaphragm to the lung apex. Patients' plans were evaluated with regard to dose-volume coverage of the breast planning target volume, ipsilateral lung, contralateral lung, heart and contralateral breast. End points were maximum dose, minimum dose, and mean dose delivered to the target or critical structure. RESULTS: As expected, the average volume of the left lung treated above a tolerance dose of 2000 cGy was less than 10% in the ringed breast, whereas in the other method without the ring the corresponding lung volume was 30%. The cardiac volume receiving a dose over 4000 cGy was 2% in the ringed breast and 18% in the breast without a ring. CONCLUSIONS: With the use of a simple technique with a fairly low expenditure, acute skin reactions and late cardiac and lung morbidity can be minimized in patients with large breasts.