A case of endobronchial inflammatory pseudotumor invading the mediastinum

A 50-year-old-male was admitted to our hospital in March 2007, complaining of cough and hemoptysis for 3 months. Postero-anterior chest X-ray showed an opacity on right upper zone. Computed tomography of the thorax showed a mass lesion occupying the right upper lobe and superior segment of the lower lobe and invading the mediastinum. Fiberoptic bronchoscopy showed total occlusion of the right upper lobe bronchus by the mass and infiltration of the bronchus intermedius. Bronchoscopic biopsies were nondiagnostic. PET-CT revealed SUVmax of 18.8. Right thoracotomy was performed. Vena cava superior and right pulmonary artery was invaded by the mass. Biopsies were performed. Histopathologic examination demonstrated an inflammatory pseudotumor. Corticosteroid treatment was started. The tumor was clinically and radiologically unresponsive to corticosteroids. He was referred to oncology department for radiotherapy. The patient died on November 2007.     

Rosuvastatin induces apoptosis in cultured human papillary thyroid cancer cells

Statins show antiproliferative activity in various cancer cells. The aim of this study was to evaluate the effects of rosuvastatin treatment on papillary thyroid carcinoma. The papillary thyroid carcinoma (B-CPAP) and normal (Nthy-ori 3-1) thyroid cell lines were treated with rosuvastatin at 12.5, 18.5, 25, 50, 100, and 200 μM concentrations. After 48 and 72 h of rosuvastatin treatment, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide, Ki-67 immunolabeling, FACS analysis, electron microscopy, caspase-3, and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) analysis were performed. Decreased cell viability and G1 phase arrest were detected in papillary thyroid cell line treated with rosuvastatin. Positive immunoreactivity of Ki-67 and dose-dependent increase in S phase on Nthy-ori 3-1 cells were also detected. B-CPAP cells showed intense vacuolisation and autophagosomes with low concentrations and 48 h incubations, while Nthy-ori 3-1 cells showed these changes at higher concentrations. A decrease in the percentage of cells showing autophagy was determined with increasing concentrations of rosuvastatin in B-CPAP cells. Rosuvastatin treatment also caused a dose- and time-dependent increase in caspase-3 activity and apoptotic index by TUNEL assay in B-CPAP cells compared with the Nthy-ori 3-1 cells. Apoptotic cells with nuclear condensation and fragmentation were observed in B-CPAP cell line. Rosuvastatin induced autophagic changes in B-CPAP papillary thyroid cancer cells in lower doses and caused a shift from autophagy to apoptosis. Rosuvastatin may be an alternative treatment for refractory papillary thyroid cancer. Further in vivo studies are necessary to clarify the effects of rosuvastatin in papillary thyroid carcinoma and the clinical implications of rosuvastatin treatment.     

Mean platelet volume in predicting short- and long-term morbidity and mortality in patients with or without ST-segment elevation myocardial infarction

Mean platelet volume (MPV) is a marker of platelet activation. An increased MPV is associated with acute myocardial infarction (AMI) and long-term mortality. The aim of this study was to compare MPV in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Also, we investigated the value of MPV on in-hospital mortality and long-term prognosis of patients with STEMI and NSTEMI. We studied 429 patients with AMI (70.4% male, 61.9 ± 12.4 years; 279 patients with STEMI, 150 patients with NSTEMI). MPV and platelet count were similar in both groups. Elevated MPV increased the risk of death by 3.1-fold (p < 0.001) in STEMI group during the hospitalization. However, increased MPV was not associated with in-hospital mortality in NSTEMI group. The area under the receiver operating characteristic curve of MPV was 0.868 (95% CI, 0.830-0.907) for predicting two-year mortality. A cut-off point of 11.1 fL showed a sensitivity of 81% and a specifity of 77% for prediction of two-year mortality. Kaplan-Meier survival curve showed two-year mortality rate of 12.5% in patients with MPV >11.1 fL versus 9.9% in patients with MPV <11.1 fL (p < 0.001). Cox regression analysis showed MPV to be an independent predictor of two-year mortality (Hazard ratio 1.7; 95% CI 1.5-1.9; p < 0.001). An increased MPV is an independent predictor of in-hospital mortality in patients with STEMI. However, elevated levels of MPV did not predict in hospital mortality in NSTEMI group. The increase in MPV values was independently correlated with two-year mortality in all study patients.     

Rehabilitation Outcomes of Children with Cerebral Palsy

[Purpose] To evaluate the results of Bobath-based rehabilitation performed at a pediatric cerebral palsy (CP) inpatient clinic. [Subjects and Methods] The study subjects were 28 children with CP who were inpatients at a pediatric service. Inclusion criteria were: being an inpatient of our hospital aged 2–12 with a diagnosis of CP; having one permanent primary caregiver; and the caregiver having no medical or psychotic problems. All of the patients received Bobath treatment for 1 hour per day, 5 days a week. The locomotor system, neurologic and orthopedic examination, Gross Motor Function Measure (GMFM) of the patients, and Short Form-36 (SF-36) of permanent caregivers were evaluated at the time of admission to hospital, discharge from hospital, and at 1 and 3 months after discharge. [Results] Post-admission scores of GMFM at discharge, and 1 and 3 months later showed significant increase. Social function and emotional role subscores of SF-36 had increased significantly at discharge. [Conclusion] Bobath treatment is promising and randomized controlled further studies are needed for rehabilitation technics.Key words: Cerebral palsy, Rehabilitation, Bobath     

A controlled study of sexual function in men with cannabis use disorder: A brief report

Background: Studies about the effects of cannabis on male sexual function have contradictory results. This contradiction is thought to depend on the subjective assessment of the patient or on the use of non-validated questionnaires. Aims: The objective of this study was to evaluate the sexual function of male patients with cannabis use disorder by a validated questionnaire and to compare them with a healthy control group. Methods: 47 male patients with cannabis use disorder and without any comorbid psychiatric disorders were included in this study. The education level and age of the patients were matched with 33 healthy male participants. In addition to the sociodemographic characteristics, the pattern of cannabis use and sexual life were also questioned. Sexual function was evaluated by International Index of Erectile Function. Results: The scores of erectile function and orgasmic function in the patient group were found significantly lower than the control group. Erectile dysfunction was significantly more frequently reported in the patient group than the control group. Sexual desire, intercourse satisfaction, and overall satisfaction scores did not differ significantly between groups. Conclusions: Our findings indicated that sexual function should be inquired in men with cannabis use disorder. These findings could be used in prevention studies focused on cannabis use disorder.     

A comparison of two manual physical therapy approaches and electrotherapy modalities for patients with knee osteoarthritis: A randomized three arm clinical trial

A broad spectrum of physical therapy exercise programs provides symptom relief and functional benefit for patients with knee OA. Manual physical therapy, including tailored exercise programs provide relatively higher level benefit that persists to one year. It is currently unknown if there are important differences in the effects of different manual physical therapy techniques for patients with knee OA and there are virtually no studies comparing manual physical therapy and electrotherapy modalities. The aim of the study was to compare long-term results between three treatment groups (mobilization with movements [MWMs], passive joint mobilization [PJM], and electrotherapy) to determine which treatment is most effective in patients with knee OA. A single-blind randomized clinical trial with parallel design was conducted in patients with knee OA. Seventy-two consecutive patients (mean age 56.11 ± 6.80 years) with bilateral knee OA were randomly assigned to one of three treatment groups: MWMs, PJM, and electrotherapy. All groups performed an exercise program and received 12 sessions. The primary outcome measures of the functional assessment were the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) and Aggregated Locomotor Function (ALF) test scores. The secondary outcome measures were pain level, measured using a pressure algometer and a visual analogue scale (VAS), range of motion (ROM), measured using a digital goniometer, and muscle strength, evaluated with a handheld dynamometer. Patients were assessed before treatment, after treatment and after 1 year of follow-up. Patients receiving the manual physical therapy interventions consisting of either MWM or PJM demonstrated a greater decrease in VAS scores at rest, during functional activities, and during the night compared to those in the electrotherapy group from baseline to after the treatment (p < 0.05). This improvement continued at the 1-year follow-up (p < 0.05). The MWMs and PJM groups also showed significantly improved WOMAC and ALF scores, knee ROM and quadriceps muscle strength compared to those in the electrotherapy group from baseline to 1-year follow-up (p < 0.05). In the treatment of patients with knee OA, manual physical therapy consisting of either MWM or PJM provided superior benefit over electrotherapy in terms of pain level, knee ROM, quadriceps muscle strength, and functional level.     

Color Doppler twinkling artifact in intrauterine fetal demise

PURPOSE: To determine whether twinkling artifacts on color and power Doppler sonography could be used as a new sonographic sign of intrauterine fetal demise (IUFD). METHODS: In this prospective study, 24 consecutive pregnant women with IUFD were included after fetal sonographic examinations. Sonographic examination included gray-scale, color, power, and spectral Doppler imaging. The sonograms were then analyzed for the presence, appearance, and intensity of the twinkling artifacts. RESULTS: Twinkling artifacts on color Doppler were observed in all of the 24 IUFD as a rapidly changing color Doppler signal complex associated persistently with different parts of the fetal body. The artifacts were localized especially in the neck, back, and iliac regions. Artifact intensity correlated with the time elapsed since death. CONCLUSION: Twinkling artifact was noted in all dead fetuses on color, power, and spectral Doppler examinations. Thus, the observation of these artifacts may be considered as a new sonographic sign of fetal demise, which may reflect the time elapsed since death.     

The comparison of amino-terminal probrain natriuretic peptide levels in preeclampsia and normotensive pregnancy

OBJECTIVE: The purpose of this study was to evaluate the levels of amino-terminal probrain natriuretic peptide (Nt pro-BNP) in preeclampsia in comparison with normotensive pregnancy. MATERIALS AND METHODS: Women with preeclampsia (proteinuria > or = 300 mg/24 h and at least two readings of systolic blood pressure > or = 140 mm Hg and diastolic blood pressure > or = 90 mm Hg) (n = 32 mild preeclampsia and n = 8 severe preeclampsia) were compared with normotensive women (n = 40). Serum Nt pro-BNP was measured using an electrochemiluminescence immunoassay (ECLIA) method (Nt pro-BNP, Roche) with a Roche modular analytics E170 immunoassay analyzer. Statistical analysis was carried out by the Student t-test, and a P value of <0.05 was accepted as statistically significant. RESULTS: The median serum Nt pro-BNP was 430+/-28.91 pg/mL in preeclampsia. The levels of serum Nt pro-BNP were 74+/-16.82 pg/mL in normotensive pregnant women (P < 0.001) and significantly higher in women with preeclampsia (P < 0.001). CONCLUSION: The higher levels of serum Nt pro-BNP in preeclamptic women may be an indicator of high left-ventricular filling pressure, and indicate left-ventricular diastolic dysfunction.     

Metformin therapy improves coronary microvascular function in patients with polycystic ovary syndrome and insulin resistance

BACKGROUND: Women with polycystic ovary syndrome (PCOS) are thought to have increased cardiovascular risk. Metformin therapy reduces whole-body insulin resistance (IR) in patients with type-2 diabetes mellitus (DM). OBJECTIVE: As insulin resistance accompanying PCOS may be reversed by metformin therapy, we hypothesized that metformin therapy might improve coronary microvascular functions in women with PCOS and IR. PATIENTS AND METHODS: We treated 16 women with PCOS and IR with metformin, and measured coronary flow reserve (CFR) at the beginning and after 6 months of metformin therapy using transthoracic second-harmonic Doppler echocardiography. RESULTS: At the end of the 6 months of metformin therapy, baseline coronary diastolic peak flow velocity (DPFV) did not change significantly (from 24.6 +/- 4.3 to 23.0 +/- 3.1, P = 0.106); however, hyperaemic coronary DPFV (from 68.2 +/- 12.7 to 74.5 +/- 9.7, P = 0.08), and CFR (from 2.75 +/- 0.48 to 3.3 +/- 0.5, P = 0.016) was significantly improved by metformin therapy. CONCLUSION: In women with PCOS, coronary microvascular function and CFR are significantly improved by 6 months of therapy with metformin.     

Adenosquamous carcinoma of the lung (an analysis of 13 cases)

Adenosquamous carcinoma of the lung is a rare disease. The biological behavior and clinicopathologic characteristics of this tumor have not been well described. In this study, we retrospectively evaluated 13 patients with adenosquamous carcinoma of the lung diagnosed at our center between January 2001 and May 2004. There were 12 males and 1 female whose ages ranged from 45 to 69 years, with a mean age of 55.9 years. Ten patients were smoker. The most frequent symptoms were chest pain and cough. Bronchoscopic examination detected that tumor was centrally located in four cases and was peripherally located in nine cases. Preoperative pathological diagnosis was squamous cell carcinoma in eight patients, non-small cell lung carcinoma in four patients and adenocarcinoma in one patient. One patient was in pathological stage IA, three patients in stage IB, one patient in stage IIA, two patients in stage IIB, five patients in stage IIIA, and one patient in stage IIIB. Twelve patients underwent resection (six, lobectomy; five, pneumonectomy; one, bilobectomy). Five of 12 patients received adjuvant therapy. Five patients died of disease within 3 and 21 months. Seven patients have had survival time between 9 and 31 months.