Adrenal ganglioneuroma: report of a new case

Although adrenal ganglioneuroma (GN) is a rare tumor originating from the neural crest tissue of the sympathetic nervous system, detection of this tumor has increased, as imaging procedures such as ultrasonography (US) and computed tomography (CT) have become prevalent. The clinical presentation for most patients is asymptomatic, and most of those tumors are hormone silent. We describe a case of adrenal GN incidentally diagnosed in a 68-year-old female patient. Physical examination, routine laboratory studies, and hormonal tests were within normal ranges. Abdominal CT and magnetic resonance imaging showed a solid oval tumor approximately 6 × 4 cm in the left adrenal gland without remarkable signs of malignancy. Left adrenalectomy was performed for treatment purposes. Histological diagnosis of the tumor was a ganglioneuroma originating from the adrenal medulla. Adrenal GN occurs rarely in adults and preoperative diagnosis is difficult, especially in asymptomatic cases. It needs careful evaluation and surgical treatment. According to our knowledge, this is the fifth case of adrenal GN in an adult patient from Turkey in English literature.     

Progressive pseudorheumatoid arthropathy of childhood

Progressive pseudorheumatoid arthropathy of childhood (PPAC) described by Sprangeret al is a rare autosomal recessive disorder. An 11 year-old girl was diagnosed as having PPAC at Ege University, Faculty of Medicine, Department of Paediatrics. Her complaints of painful joints, difficulty in walking and joint contractures began at the age of 3 years and she was treated for juvenile rheumatoid arthritis for 8 years. Her symptoms did not respond to nonsteroid anti-inflammatory treatment. During her last hospitalisation period, she was reinvestigated. Radiological examination showed spondyloepiphyseal dysplasia, severe acetabular irregularity and osteoporosis. All the laboratory test results for rheumatoid arthritis were negative. The clinical and radiological findings of the patient are illustrated.     

Lymphedema after treatment of breast cancer

BACKGROUND: Lymphedema is one of the major long-term complications of axillary dissection. This study was designed to investigate the risk factors that are predicted to effect the development of lymphedema after complete axillary dissection. METHODS: Two hundred forty patients who had undergone modified radical mastectomy with complete axillary dissection were examined at least 18 months after the surgery. The effects of age, diabetes, smoking, hypertension, chemotherapy, radiotherapy, tamoxifen use, stage, body mass index, number of the removed and metastatic lymph nodes, and total volume of the wound drainage on the development of lymphedema were analyzed. RESULTS: Lymphedema developed in 68 (28%) of the 240 cases. Axillary radiotherapy and body mass index were found to increase the incidence of the lymphedema. CONCLUSIONS: Women who had the combination of full axillary dissection and axillary radiotherapy carry a significant risk of lymphedema.     

Effect of PUVA therapy on electrodermal activity parameters in vitiligo patients

Recent electrophysiological studies on autonomic dysfunction in vitiligo patients show an autonomic dysfunction as measured by absent sympathetic skin response (SSR). Nothing is known about the reversibility of these autonomic parameters with treatment. The present study examined how Electrodermal Activity (EDA) parameters were affected from vitiligo illness before PUVA therapy and whether any electrophysiological gains acquired from PUVA therapy would influence the progression of the condition itself. We studied in 14 healthy subjectS and 14 patients with generalized vitiligo before and after treatment. EDA was recorded with a skin conductance unit connected to a personal computer. Before treatment, skin conductance level (SCL) and habituation number (HN) was higher in vitiligo group than control groups. After treatment, SCL and HN were decreased nearly to normal value. Before and after treatment, prevalence of non-responsivity was higher in vitiligo group than controls. CONCLUSION: The sympathetic nervous system might have a particular role in the pathogenesis of vitiligo. Thus, patients with vitiligo may have changes to EDA parameters that are reversible to great extent with PUVA therapy. EDA is a useful method of studying the autonomic dysfunction in humans.     

Cardiac hydatid cysts: surgical treatment and results

From 1991 to 2000 six patients with intracardiac echinococcosis underwent surgical treatment. Four patients were females and two were males, age of the patients ranged from 20 to 68 years. Two patients had symptoms, all patients were diagnosed as a component of multi-organ echinococcosis and three of them underwent operation before. They were examined serologically and echocardiographically. Cardiac hydatidosis were diagnosed in right ventricle (in three cases), left ventricle (in one case), and interventricular septum (in two cases). Sternotomy was the approach used and all patients were operated on using cardiopulmonary bypass. Intraoperative rupture did not occur. There was no operative mortality, the only morbidity was complete atrioventricular block necessitating VVD pacemaker implantation in the patient with hydatid cyst involving the basal interventricular septum. All patients were followed by medical treatment with albendazole (400 mg/day) and no recurrences were reported in the late follow-up.     

Rotavirus gastroenteritis among children under five years of age in Izmir, Turkey

Little is known about the epidemiology of rotavirus infection in Turkey. The aim of the study was to determine the incidence and clinical significance of rotavirus gastroenteritis, in view of the potentially available prevention by rotavirus vaccination. The study also sought to determine possible risk factors for rotavirus gastroenteritis. Therefore, 920 children under five years of age with acute gastroenteritis admitted to three pediatric hospitals in Izmir were studied. Rotavirus was identified in 39.8% of the children. Most children with rotavirus gastroenteritis (80.7%) were younger than two years of age. Marked seasonality of rotavirus gastroenteritis was observed, with a peak incidence from January to March. A total of 91% of rotavirus strains that were typed were of serotypes G 1-4. There was no significant difference among rotavirus-positive and rotavirus-negative patients with regard to family income. Compared with children who were exclusively breast-fed, those who were not exclusively breast-fed were at a two-fold greater risk of rotavirus diarrhea. Rotavirus gastroenteritis was significantly more severe than non-rotavirus gastroenteritis; 69% of children with rotavirus infection had severe gastroenteritis (score > or = 11). In conclusion, rotavirus is the most common cause of severe gastroenteritis among children under five years of age in Izmir. A new potent rotavirus vaccine, when available, will provide effective protection against severe rotavirus infection. Promotion of breast-feeding would augment the impact of rotavirus vaccines in preventing severe childhood diarrhea.     

Thrombolytic treatment of right atrial thrombus in Behçet's disease under guidance of serial transesophageal echocardiography

The case is presented of a 26-year-old man with Beh?et's disease in whom a large and highly mobile right atrial thrombus was detected. Gradual lysis was achieved after two successive infusions of 1,500,000 units of streptokinase guided by serial transthoracic and transesophageal echocardiography.     

Trace elements and superoxide dismutase in benign and malignant breast diseases

This study was planned to determine the probable changes in trace elementlevels and superoxide dismutase (SOD) activity in women with neoplasticbreast diseases. Measurements were performed in three different groups. Thefirst group consisted of 20 healthy women, control group, the second groupcontained 16 patients with benign breast disease and the third groupcontained 39 patients with malignant breast disease. The trace elementconcentrations were determined by using atomic absorption spectrophotometryand SOD activity by using spectrophotometry. When compared with the controlvalues, the plasma copper levels were slightly increased in the second groupand significantly in the third group (p < 0.001). The difference betweenthe benign and malignant groups was also significant (p < 0.001). The redcell copper values showed a marked decrease in both groups (p < 0.001).Although there were increases in the plasma zinc levels of both patientgroups, the differences were not significant statistically. But, the redcell zinc values showed an significant increase in benign and malignantpatients compared to the control group (p < 0.001) (p < 0.001). Theplasma magnesium and red cell magnesium values did not show significantdifferences. The red cell SOD activity showed an significant increase in thebenign and malignant patient groups (p < 0.001). The results of thisstudy suggested that reactive oxygen metabolites may play a pathogeneticrole in both benign and malignant tumor development, which is reflected bythe change in SOD activity, and in trace element concentrations.     

Assessment of right ventricular diastolic filling parameters by Doppler echocardiography

BACKGROUND: Right ventricular diastolic function has been evaluated in various diseases by the pulsed Doppler technique. Right ventricular diastolic filling parameters show changes with age, heart rate and respiration. Evidences of diastolic left and right ventricular dysfunctions have been reported by echocardiographic studies in asthmatic patients. In the present study, before and after treatment of asthma the right ventricular diastolic filling parameters were compared in children with moderate asthma by Doppler echocardiography (a non-invasive technique). METHODS: The study group consisted of 20 children (eight girls, 12 boys) with asthma. During the present study these patients were treated with inhaled steroid and beta-2 agonist daily. Before treatment all patients were evaluated by Doppler echocardiography. At 4-6 weeks after treatment 15 patients that had shown improvement in their symptoms according to the symptom score were also evaluated by Doppler echocardiography. RESULTS: The mean age was 8.6 +/- 2.69 years and mean period of symptoms were 56.4 +/- 35.8 months. When compared with results of echocardiography before and after treatment, the right ventricular diastolic filling parameters (acceleration time: P < 0.01, deceleration time: P < 0.01 and isovolumetric relaxation time: P < 0.05) were found to be significantly different. CONCLUSIONS: We observed significant improvement of right ventricular diastolic filling parameters by Doppler echocardiography after treatment in children with asthma.