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.     

Renin-angiotensin system polymorphisms and coronary artery surgery patients

The frequencies of angiotensin-converting enzyme gene insertion/deletion, angiotensinogen-M253T, and angiotensin II type 1 receptor-A1166C polymorphisms were analyzed in 105 patients undergoing coronary artery bypass grafting (group 1) and a control group of 105 non-cardiac patients (group 2). Blood samples were obtained for biochemical analyses and DNA extraction. Genotyping was performed by polymerase-chain-reaction-based restriction analysis. According to the angiotensin-converting enzyme gene insertion/deletion polymorphism, 36.3% of patients in group 1 and 30.7% in group 2 were homozygous for the DD allele. This difference was not statistically significant. Angiotensin II type 1 receptor-A1166C genotype polymorphism was also not significantly different between the groups. The results showed the angiotensinogen-M235T polymorphism to be heterogenous. The MM homozygote frequency was significantly higher in controls (72.3%), whereas 80% of the TT homozygote frequency was in the surgical group ( p = 0.001). These results show that although there were no significant differences in angiotensin-converting enzyme gene insertion/deletion and angiotensin II type 1 receptor-A1166C genotype polymorphisms between the groups, angiotensinogen-M235T polymorphism of TT homozygote frequency was significantly associated with patients undergoing coronary artery bypass surgery.     

Anesthesia management in Kabuki make-up syndrome

Kabuki make-up syndrome KMS is a rare condition with a number of characteristic congenital abnormalities. The syndrome is characterized by peculiar facial appearance resembling the make-up of actors in Kabuki, the traditional Japanese theater, skeletal anomalies, dermatoglyphic abnormalities, postnatal growth deficiency, and mental retardation. These are rare reports of central nervous system dysfunctions, other than mental retardation, and no previously described congenital talipes calcaneo-valgus in this syndrome. We report the case of a 22-month-old girl having Kabuki make-up. At presentation, she had an adenoid hypertrophy and a history of recurrent otitis media. She had also delay in motor development, and a postnatal growth deficiency. The variable phenotypic expression is a well-known characteristic of the syndrome. For that reason, we should perform careful morphologic examination in every patient and their parents, and use flexotype laryngoscope Heine, Germany to visualize vocal cord in case of difficult intubation. At preoperative examination, as clinicians, we must be careful regarding patient morphology. Congenital heart defects and epilepsy are important for anesthesia management in KMS.     

Prevalence and risk factors of occupational asthma among hairdressers in Turkey

This study was designed to evaluate the questionnaire-based prevalence and possible risk factors of occupational asthma among hairdressers in Turkey. We investigated occupational history and respiratory, ocular, dermal, and nasal symptoms using a standardized questionnaire, evaluated worksite pulmonary function tests, and performed allergen skin testing. We then determined asthma risk factors using age- and gender-adjusted logistic regression models. The prevalence of occupational asthma in hairdressers was 14.6%. The odds ratio for hairdressers in a high work intensity group was 3.6 (95% confidence interval, 1.2 to 10.9) with a significant dose-response trend (chi 2 trend = 4.875; P = 0.027). The odds ratio for occupational asthma among workers with atopy was 4.5 (95% confidence interval, 1.2 to 17.2). We also observed an excess risk of occupational asthma with allergic rhinitis and conjunctivitis. Occupational asthma did not differ among subgroups of hairdressers. We observed an important risk of occupational asthma among hairdressers. The most prominent risk factors were work intensity and atopy.     

宫腔镜及B超在异常子宫出血中的诊断价值

目的:分析宫腔镜检查与B超检查对异常子宫出血病因的诊断价值。方法:对220例异常子宫出血患者病历资料进行回顾性分析,对病历中B超、宫腔镜和病理检查结果进行对照研究。结果:①在异常子宫出血病因诊断中,宫腔镜对宫内残留、子宫内膜炎及子宫内膜息肉的敏感度高,对子宫内膜癌、子宫粘膜下肌瘤和宫内残留的特异度高;②B超对子宫粘膜下肌瘤的敏感度高,对宫内残留的特异度高;③对子宫内膜息肉和子宫内膜增生的诊断,B超与病理检查的符合率和宫腔镜与病理检查的符合率之间存在极显著性差异(P<0.01),对子宫粘膜下肌瘤和宫内残留的诊断,上述两组符合率之间差异无显著性意义(P>0.05)。结论:①宫腔镜对异常子宫出血的病因有很高的诊断价值,与B超之间存在互补关系;②提倡将B超、宫腔镜及定位活检合理地综合应用,使异常子宫出血的病因从影像学、形态学和组织学三方面得以准确诊断。     

Occupational dust exposure and the risk of laryngeal cancer in Turkey

OBJECTIVES: A hospital-based case-referent study was conducted to identify occupational risk factors for laryngeal cancer. In a previous report an association was found between laryngeal cancer and occupations with potential dust exposure; a job-exposure matrix was developed to aid further evaluation of laryngeal cancer risks from five occupational dust exposures. METHODS: Among 7631 cancer cases from the Okmeydani Hospital, Istanbul, between 1979 and 1984, 958 larynx cancer cases were identified among men. After exclusions, 940 laryngeal cancer cases and 1519 referents were available. A standardized questionnaire was used to obtain basic information on the patients. Seven-digit standard occupational and industrial codes were created to classify the job and industrial titles. A job-exposure matrix was developed for occupational dusts, including silica, asbestos, wood, cotton, and grain, and age-, smoking-, and alcohol-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to evaluate risks of laryngeal cancer. RESULTS: An excess of laryngeal cancer occurred for workers potentially exposed to silica and cotton dust, particularly for supraglottic cancer (OR 1.8, 95% CI 1.3-2.3, for silica and OR 1.6, 95% CI 1.1-2.5, for cotton dust), and there was a significant dose-response relationship with silica exposure. No relationship was found between laryngeal cancer and asbestos, grain, or wood dust exposures. CONCLUSION: Laryngeal cancer, especially supraglottic tumors, is associated with silica and cotton dust exposures in Turkey.     

The clinical significance of A2ML1 variants in Noonan syndrome has to be reconsidered

The RASopathies are a group of clinically and genetically heterogeneous developmental disorders caused by dysregulation of the RAS/MAPK signalling pathway. Variants in several components and regulators of this pathway have been identified as the pathogenetic cause. In 2015, missense variants in A2ML1 were reported in three unrelated families with clinical diagnosis of Noonan syndrome (NS) and a zebrafish model was presented showing heart and craniofacial defects similar to those caused by a NS-associated Shp2 variant. However, a causal role of A2ML1 variants in NS has not been confirmed since. Herein, we report on 15 individuals who underwent screening of RASopathy-associated genes and were found to carry rare variants in A2ML1, including variants previously proposed to be causative for NS. In cases where parental DNA was available, the respective A2ML1 variant was found to be inherited from an unaffected parent. Seven index patients carrying an A2ML1 variant presented with an alternate disease-causing genetic aberration. These findings underscore that current evidence is insufficient to support a causal relation between variants in A2ML1 and NS, questioning the inclusion of A2ML1 screening in diagnostic RASopathy testing.Subject terms: Genetics research, Genetic testing     

Evaluation of Blood Clot,Platelet-rich Plasma,Platelet-rich Fibrin,and Platelet Pellet as Scaffolds in Regenerative Endodontic Treatment: A Prospective Randomized Trial

Introduction

Regenerative endodontic procedures (REPs) using autologous platelet concentrates as scaffolds can improve the biologic outcome of treatment. This prospective, randomized trial compared the clinical and radiographic performance of REPs using platelet-rich plasma (PRP), platelet-rich fibrin (PRF), a platelet pellet (PP), and an induced blot clot (BC).