Co-existence of Gastrointestinal Stromal Tumors with Malign Epithelial Tumors: a Report of Two Cases

Aim: To emphasize the importance of a detailed observation for incidental simultaneous tumoral masses during surgery for gastrointestinal stromal tumors (GISTs) at any location in the gastrointestinal system. Case presentations: Case 1: a 39 years old female patient with an esophageal squamous cell carcinoma and a synchronous small intestinal GIST discovered incidentally during esophagectomy.

Case 2: a 73 years old female patient with a gastric GIST and a synchronous colorectal cancer detected incidentally during gastrectomy. In both cases, immunohistochemical examinations of the resected specimens confirmed the coexistences of GISTs and epithelial malignancies.

Conclusion: The coexistences of GISTs with epithelial tumors have been increasing in recent years. In any case of a GIST or gastrointestinal adenocarcinoma, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin.     

Impairments of Social Interaction in Depressive Disorder

ObjectiveDespite the numerous findings on the altered emotion recognition and dysfunctional social interaction behavior of depressive patients, a lot of the relationships are not clearly clarified.MethodsIn this pilot study, 20 depressive patients (mean±SD, 38.4±14.2) and 20 healthy subjects (mean±SD, 38.9±15.3) (each in dyads) were videographed. We then analyzed their social interaction behavior and emotion processing in terms of emotion recognition, their own emotional experience, and the expression of emotions under the conditions of a semi-structured experimental paradigm. ResultsPatients showed more significant impairment regarding the dimensions of social interaction behavior (i.e., attention, interest, and activity) and their interaction behavior was characterized by neutral affectivity, silence, and avoidance of direct eye contact. This interactive behavioral style was statistically related to depressive psychopathology. There were no differences concerning emotion recognition. ConclusionImpairments of non-verbal and verbal social interaction behavior of depressive patients seem to be less associated with disturbances of basic skills of emotion recognition.     

The effect of saliva contamination on microleakage of an etch-and-rinse and a self-etching adhesive

PURPOSE: To evaluate the effect of saliva contamination on the microleakage of an etch-and-rinse adhesive and a self-etching adhesive. MATERIALS AND METHODS: Class V cavity preparations at the cementoenamel junction were made on the buccal and lingual surfaces of 40 freshly extracted human molars. The teeth were randomly assigned into two groups for different adhesives: Group I, Single Bond (two-step etch-and-rinse adhesive) and Group II, Futura Bond NR (one-step self-etching adhesive). The adhesive materials were applied according to their manufacturers' recommendations. The specimens were then further subdivided into five subgroups (A-E; n = 8): group A, contamination before adhesive curing; group B, contamination before adhesive curing and re-application of adhesive; group C, contamination after adhesive curing; group D, contamination after adhesive curing and re-application of adhesive; and group E, no contamination (control). Contamination of adhesive surfaces was performed with fresh natural saliva and the saliva was removed by a gentle air blast. The specimens were restored with Z250 hybrid composite. After thermocycling (500x, 5 degrees C to 55 degrees C) and immersion in 0.5% basic fuchsin, the dye penetration was evaluated under a stereomicroscope. Statistical analysis was performed with the Kruskal-Wallis test at p < 0.05. RESULTS: No statistically significant differences were found among the contamination subgroups on the enamel or on the dentin for either group (p > 0.05). There was no significant difference in leakage between Group I and Group II for any subgroup (p > 0.05). CONCLUSION: Contamination of adhesives with saliva before and after adhesive curing did not worsen the microleakage of the two-step etch-and-rinse adhesive Single Bond or the one-step self-etching adhesive Futura Bond NR.     

Phenyramidol-associated liver toxicity

OBJECTIVE: To describe a case of hepatotoxicity associated with phenyramidol use that resolved after discontinuation of the drug. BACKGROUND: Phenyramidol is a moderately potent and relatively nontoxic analgesic with concomitant muscle-relaxant activity. A MEDLINE search in June 2003 revealed no reports associating hepatotoxicity with this agent. CASE SUMMARY: A 70-year-old man was investigated because of elevated liver function test values on routine biochemical screening. He had no clinical symptoms. Other etiologies of hepatitis were appropriately ruled out, and elevated enzymes were ascribed to phenyramidol treatment. DISCUSSION: This is the first case published in the English language literature describing probable hepatotoxicity, according to the Naranjo probability scale, resulting from use of phenyramidol. The mechanism of phenyramidol-induced liver damage is unknown. Several features, such as the absence of predictable dose-dependent toxicity of phenyramidol in previous studies and the absence of hypersensitivity manifestations in our patient, are suggestive of a metabolic type of idiosyncratic toxicity. CONCLUSIONS: Phenyramidol should be considered as a drug that possibly causes hepatotoxicity.     

The evaluation of safety and efficacy of colistin use in pediatric intensive care unit: Results from two reference hospitals and review of literature

Colistin, an old cationic polypeptide antibiotic, have been reused due to rising incidence of infections caused by multi-drug resistant (MDR) Gram-negative microorganisms and the lack of new antibiotics. Therefore, we evaluated safety and efficacy of colistin in treatment of these infections. This study included 104 critically ill children with a median age of 55,9 months between January 2011 and January 2016. Nephrotoxicity occurred in 11 (10.5%) patients. Nephrotoxicity occurred between the third and seventh day of treatment in 63% of colistin induced nephrotoxicity episodes. The subgroup analysis between the patients who developed nephrotoxicity during colistin treatment and those that did not, showed no significant difference in terms of age, underlying disease, cause for PICU admission and type of infection required colistin treatment, P values were 0.615, 0.762, 0.621, 0.803, respectively. All patients were receiving a concomitant nephrotoxic agent (P = 0,355). The majority of the patients (52%) were having primary or secondary immune deficiency in treatment failure group and the most common cause of PICU admission was sepsis in treatment failure group, P values were 0.007 and 0.045, respectively. Mortality attributed to colistin failure and crude mortality were 14.4% and 29.8%, respectively. In conclusion, colistin may have a role in the treatment of infections caused by multidrug-resistant Gram-negative bacteria in critically ill children. However, the patients have to be followed for side effects throughout colistin treatment, not for only early stage. And the clinicians should be aware of increase in the rate of nephrotoxicity in patients those have been receiving a concomitant nephrotoxic agent.     

Preventive effects of curcumin on different aspiration material-induced lung injury in rats

Purpose  We have studied whether curcumin protects different pulmonary aspiration material-induced lung injury in rats. Materials and methods  The experiments were designed in 60 Sprague–Dawley rats, randomly allotted into one of six groups (n = 10): normal saline (NS, control), enteral formula (Biosorb Energy Plus, BIO), hydrochloric acid (HCl), NS + curcumin-treated, BIO + curcumin-treated, and HCl + curcumin-treated. NS, BIO, HCl were injected in to the lungs. The rats received curcumin twice daily only for 7 days. Seven days later, both lungs in all groups were examined histopathologically, immunohistochemically, and biochemically. Histopathologic examination was performed according to the presence of peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation. Immunohistochemical assessments were examined for the activity of inducible nitric oxide synthase (iNOS) and the expression of surfactant protein D (SP-D). Malondialdehyde (MDA), hydroxyproline (HP), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activity were measured in the lung tissue. Results  Our findings show that curcumin inhibits the inflammatory response reducing significantly (P < 0.05) all histopathological parameters in different pulmonary aspiration models. Pulmonary aspiration significantly increased the tissue HP content, MDA levels and decreased the antioxidant enzyme (SOD, GSH-Px) activities. Curcumin treatment significantly decreased the elevated tissue HP content, and MDA levels and prevented inhibition of SOD, and GSH-Px enzymes in the tissues. Furthermore, our data suggest that there is a significant reduction in the activity of iNOS and a rise in the expression of SP-D in lung tissue of different pulmonary aspiration models with curcumin therapy. Conclusion  Our findings support the use of curcumin as a potential therapeutic agent in acute lung injury.     

Diffuse optical tomography with a priori anatomical information

Diffuse optical tomography (DOT) poses a typical ill-posed inverse problem with a limited number of measurements and inherently low spatial resolution. In this paper, we propose a hierarchical Bayesian approach to improve spatial resolution and quantitative accuracy by using a priori information provided by a secondary high resolution anatomical imaging modality, such as magnetic resonance (MR) or x-ray. In such a dual imaging approach, while the correlation between optical and anatomical images may be high, it is not perfect. For example, a tumour may be present in the optical image, but may not be discernable in the anatomical image. The proposed hierarchical Bayesian approach allows incorporation of partial a priori knowledge about the noise and unknown optical image models, thereby capturing the function-anatomy correlation effectively. We present a computationally efficient iterative algorithm to simultaneously estimate the optical image and the unknown a priori model parameters. Extensive numerical simulations demonstrate that the proposed method avoids undesirable bias towards anatomical prior information and leads to significantly improved spatial resolution and quantitative accuracy.     

Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices

Ozbaran B, Kose S, Yagdi T, Engin C, Erermis S, Yazici KU, Noyan A, Ozbaran M. Depression and anxiety levels of the mothers of children and adolescents with left ventricular assist devices. Abstract: VADs have been used to provide treatment for end‐stage heart failure. Parents may feel overwhelmed with the VAD regimes responsibility and be affected from this process beside children. In this study, we aimed to evaluate the depressive and anxiety symptoms of mothers of the first eight children equipped with a VAD in Turkey. The mothers of eight pediatric patients living with VADs were filled BDI and STAI at first month of VAD implantation (E.I) and secondly six months after their first evaluation (E.II). In E.I, the BDI mean score of mothers was 20.87, in E.II 14.37. STAI‐S mean score was 53.37 in E.I and 43.62 in E.II. The Wilcoxon nonparametric‐paired t‐test revealed significant difference between baseline and end‐point STAI‐S scores (Z: ?2.035; p: 0.042), and for BDI scores (Z, ?1.965; p, 0.049). Prolonged usage of VAD may increase distress in parents. Psychiatric evaluation and support of the primary caregiver is important for the well‐being of the pediatric patients.