Humphrey visual field analysis, visual field defects, and ophthalmic findings in patients with macro pituitary adenoma

OBJECTIVE: To evaluate the Humphrey visual field parameters in patients with pituitary adenoma and classify the visual field defects in this patient group. METHODS: Forty primary pituitary adenoma patients underwent neuro-ophthalmological examination and Humphrey Perimetry 30-2 visual field test at Baskent University, Departments of Ophthalmology, and Neurosurgery, between 2003 and 2005. Global indices, mean+/-SD and pattern standard deviation (PSD) of pituitary adenoma patients (group 1) were taken as the test parameters and compared with age- and sex- matched controls (group 2). RESULTS: There were no significant differences between groups 1 and 2 with respect to mean age or gender distribution (p>0.05). The MD and PSD results of group 1 according to the age groups and gender were not statistically significant (p>0.05). The MD and PSD results of subjects in group 2 were within normal limits, and no special visual field defects were observed. When compared with healthy controls, the MD and PSD values of patients with hypophyseal adenomas were statistically significantly (p<0.05). In group 1, the mean adenoma size was 13.34 mm and no statistically significant correlation was found between the adenoma size and either the MD or PSD values (p>0.05). Sixteen (40%) patients had visual field defects, the specific complete bitemporal hemianopsia was found in 5 (12.5%) patients. Only in 3 patients (7.5%) the primary diagnosis was made by ophthalmologic examination. CONCLUSION: Although ophthalmologists rarely have a role in the primary diagnosis of hypophyseal adenoma, routine ophthalmologic examination is still important. To detect early visual field abnormalities, automated perimetry should be performed as a part of routine examination in patients with suspected hypophyseal adenomas.     

Identification of the culprit artery involved in inferior wall acute myocardial infarction using electrocardiographic criteria

We tested whether particular electrocardiogram (ECG) changes can identify the right coronary (RCA) or left circumflex (LCX) artery as the responsible vessel in inferior wall acute myocardial infarction (AMI) in 73 patients. A standard 12-lead ECG was performed within 6 h of onset of chest pain. Coronary angiography was performed between 1 week and 6 weeks after the infarction. RCA and LCX lesions were detected in 53 and 20 patients, respectively. The most useful ECG parameters for implicating the RCA were a higher ST elevation in lead III than lead II (specificity 94%, sensitivity 86%) and an S/R wave ratio > 0.33 plus ST segment depression > 1 mm in lead aVL (specificity 94%, sensitivity 92%). Absence of these criteria was associated with LCX occlusion (specificity 100%, sensitivity 87%). These results indicate that composite ECG criteria are useful in predicting the artery involved in inferior wall AMI.     

Blastic Plasmacytoid Dendritic Cell Neoplasm: Skin and Bone Marrow Infiltration of Three Cases and the Review of the Literature

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a distinct and rare neoplastic entity and was classified as a subgroup of acute myeloblastic leukemia by the WHO in 2008. The median survival of patients was 15.2 months in a large case series. Allogeneic or autologous bone marrow transplantation has been recommended by some reports because of the disease’s poor prognosis. We present three patients who presented with both skin and bone marrow infiltration. A 57-year-old man, a 62-year-old woman, a 64-year-old man were admitted to our outpatient clinic because of skin lesions. All of the patient’s had bone marrow infiltration with positivity of the CD4, CD56, and CD123 staining. Survival of the patient’s were 42, 6 and 12 months, respectively. Two of the patients who presented as blastic form didn’t respond to any chemotherapy. BPDCN is a difficult disease to diagnosis and manage. CD4, CD56, CD123, CD303, and T cell leukemia/lymphoma 1. Cutaneous lesions can present as isolated nodules, macules, and disseminated macules and nodules. Positivities are crucial to the diagnosis of the disease in histological examination. Bone marrow infiltration or disease relapse at presentation were related to poor prognosis. Complete immunocytochemical staining must be performed for all patients who have cutaneous lesions with or without blood count abnormalities. Bone marrow (allogeneic or autologous) transplantation should be considered at the first remission.     

Cone-beam computed tomography evaluation of palatogingival grooves: a retrospective study with literature review

Objectives

The purpose of the present study was to radiographically evaluate the prevalence and characteristics of palatogingival grooves (PGs) in maxillary anterior teeth on cone-beam computed tomography (CBCT) to better understand the nature of these defects.

Methods

The CBCT examinations of 993 teeth (330 canines, 315 lateral incisors, 348 central incisors) in 191 patients (87 males, 104 females; age range 16–80 years) were evaluated retrospectively. The diagnosis and radiographic condition of PGs were obtained by consensus among all observers. Verification of PGs was achieved from the patients’ clinical records, which were stored in a database after their clinical evaluation. Differences in age, sex, occurrence, and location were evaluated by the Chi-square test. The level of significance was set at p < 0.05.

Results

Among the 993 teeth examined, nine PGs were observed in seven lateral incisors and two central incisors in eight patients (four males and four females). There was one bilateral case in the lateral incisors. The frequencies of PG occurrence and affected patients were 0.90 and 4.18%, respectively, without significance for sex and location (p > 0.05).

Conclusions

PGs were a relatively infrequent anomaly of teeth in this population, but when present, clinicians should understand the clinical features of these root variations.

     

Serum,salivary, and tissue levels of plasminogen in familial Mediterranean fever,amyloidosis, and chronic periodontitis

1 Background

There are no published studies regarding the role of the plasminogen (PLG) system in familial Mediterranean fever (FMF), FMF‐associated secondary amyloidosis, or chronic periodontitis (CP), although recent limited data have focused on the association between FMF and chronic periodontitis. Therefore, the aim of this study was to evaluate the serum, salivary, and gingival tissue levels of PLG in patients with CP, FMF, and amyloidosis.

2 Methods

The study population included 122 patients with FMF (only FMF, and FMF and amyloidosis and 128 individuals who were systemically healthy controls. Blood and salivary samples were obtained from the cases and controls, and clinical periodontal parameters were recorded. Serum and salivary PLG levels were assessed. The gingival tissue samples of the case and control groups were analyzed histopathologically and immunohistochemically for amyloid deposition and PLG.

3 Results

The amyloidosis group had significantly more severe clinical periodontal parameters than those of the FMF and systemically healthy groups (P < 0.05). Salivary levels of PLG were significantly higher in the FMF and amyloidosis groups compared with those in the control group (P < 0.001). The FMF with periodontitis and amyloidosis with periodontitis groups had higher salivary PLG levels compared with those in the CP group. Serum and salivary PLG levels were significantly associated with the clinical periodontal parameters in the FMF group. The amyloidosis cases had hyperplasia, severe inflammation, and activation of the gingiva.

4 Conclusion

The PLG system could play an important role in inflammatory diseases, such as chronic periodontitis, FMF, and FMF‐associated secondary amyloidosis.     

Efficacy of the Combination of Tetracycline, Amoxicillin, and Lansoprazole in the Eradication of Helicobacter pylori in Treatment-Naïve Patients and in Patients Who Are Not Responsive to Clarithromycin-Based Regimens: A Pilot Study

Background/Aims

The aim of this study was to evaluate the eradication rate of a triple therapy regimen that included a proton pump inhibitor, amoxicillin, and tetracycline instead of clarithromycin in treatment-Naïve patients and in patients who did not respond to standard triple therapy.

Methods

This study included 110 patients infected with Helicobacter pylori. Patients in groups A and B were treatment-Naïve, and those in group C were not responsive to previous standard triple therapy. Patients in group A (n=40) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and clarithromycin 500 mg b.i.d. for 14 days. Patients in groups B (n=40) and C (n=30) received lansoprazole 30 mg b.i.d., amoxicillin 1,000 mg b.i.d., and tetracycline 500 mg q.i.d. for 14 days.

Results

In group A, eradication was achieved in 18 (45%) of the 40 patients included in the intention-to-treat (ITT) analysis and in 18 (47.4%) of the 38 patients included in the per-protocol (PP) analysis. In group B, eradication was achieved in 15 (37.5%) of the 40 patients included in the ITT analysis and in 15 (39.3%) of the 38 patients included in the PP analysis. In group C, eradication was achieved in 14 (46.6%) of the 30 patients included in the ITT analysis and in 14 (43.8%) of the 29 patients included in the PP analysis. There was no statistically significant difference among the 3 groups with regard to eradication rates (p>0.05).

Conclusions

Despite the low rate of resistance to tetracycline, the combination of lansoprazole, amoxicillin, and tetracycline instead of clarithromycin is not a good option for the eradication of H. pylori.     

An unusual renal presentation of Wegener's granulomatosis

A 63-year-old woman was admitted to our clinic with arthralgia, microhematuria and a pleural based solid mass in lower lobe basal segment of right lung seen in computerised tomogram of thorax. She was diagnosed as Wegener's granulomatosis by histopathological findings of right thoracotomy, wedge resection and decortication. The patient had positive antineutrophil cytoplasmic antibodies (c-ANCA) in serum and tissue specimens. Histopathologic examination of the renal biopsy specimen revealed the diagnosis of tubulointerstitial nephritis. We report this case because of the unusual histologic type of renal involvement by reviewing the literature.