Assessment of Left Ventricular Systolic Synchronization in Patients with Chronic Kidney Disease and Narrow QRS Complexes

Objective: The evidence of structural and functional cardiac abnormalities has been demonstrated by echocardiography in patients with chronic kidney disease (CKD). This study investigated whether left ventricular (LV) asynchrony is present in patients with CKD and normal QRS duration. Methods: Tissue synchronization imaging (TSI) was performed in 25 (56 ± 14 years) patients with CKD and narrow QRS complexes and 25 (51 ± 12 years) control subjects. LV asynchrony was identified on TSI images and the time to regional peak systolic velocity (Ts) in LV was measured by the six-basal–six-midsegmental model. Four TSI parameters of systolic asynchrony were computed when Ts was measured in ejection phase. Results: The standard deviation of Ts of 12 LV segments (33.6 ± 17.8 vs 16.7 ± 10 ms, P = 0.0001), standard deviation of Ts of the six basal LV segments (30 ± 20 vs 17.6 ± 9.6 ms, P = 0.008), maximal difference in Ts between any two of the 12 LV segments (102 ± 45 vs 54 ± 32 ms, P = 0.0001), and maximal difference in Ts between any two of the six basal LV segments (78 ± 50 vs 46 ± 22 ms, P = 0.007) were prolonged in patients with CKD compared with controls. The prevalence of LV systolic asynchrony was significantly higher in patients with CKD compared with controls (44% vs 12%, P = 0.01). The standard deviation of Ts of 12 LV segments were significantly associated with LV diameters, LV volumes, LV mass, blood pressure levels, and renal functions in univariate analysis. Conclusion: The results of this study indicate that LV systolic asynchrony may develop in patients with CKD.     

Anxiety scores before and after genetic sonogram

Objective  The value of genetic sonogram is controversial in low-risk population. The aim of our study was to compare the anxiety levels among women with high risk and low risk for fetal chromosomal/structural defects. Materials and methods  A total of 115 consecutive pregnant women were included. The anxiety levels were assessed by the use of Turkish version of the standardized state-trait-anxiety-inventory. Before and after genetic sonogram, state and trait-anxiety was measured. Results  The mean state anxiety score before genetic sonogram was statistically, significantly higher than the mean score after the examination. Before genetic sonogram, the mean state-anxiety score of the women with high risk for fetal chromosomal/structural defects was significantly higher than the mean score of women with low risk. Following genetic sonogram, although the anxiety scores decreased, the scores of women with high risk still remained significantly higher than the scores of women with low risk and the anxiety scores significantly further increased among women with a positive minor or major ultrasound finding. Conclusion  Genetic sonogram presents an anxiety-inducing situation for the parents-to-be. The level of experienced anxiety was found to be proportional to the level of the perceived risk. Women with low risk for chromosomal/structural defects experienced lower anxiety than women with high risk. Following the examination, women with a negative result were found to have a significant reduction of anxiety and emotional relief whereas a positive test result led to a further increase in anxiety scores.     

Multicenter retrospective analysis regarding the clinical manifestations and treatment results in patients with hairy cell leukemia: twenty‐four year Turkish experience in cladribine therapy

In this multicenter retrospective analysis, we aimed to present clinical, laboratory and treatment results of 94 patients with Hairy cell leukemia diagnosed in 13 centers between 1990 and 2014. Sixty‐six of the patients were males and 28 were females, with a median age of 55. Splenomegaly was present in 93.5% of cases at diagnosis. The laboratory findings that came into prominence were pancytopenia with grade 3 bone marrow fibrosis. Most of the patients with an indication for treatment were treated with cladribine as first‐line treatment. Total and complete response of cladribine was 97.3% and 80.7%. The relapse rate after cladribine was 16.6%, and treatment related mortality was 2.5%. Most preferred therapy (95%) was again cladribine at second‐line, and third line with CR rate of 68.4% and 66.6%, respectively. The 28‐month median OS was 91.7% in all patients and 25‐month median OS 96% for patients who were given cladribine as first‐line therapy. In conclusion, the first multicenter retrospective Turkish study where patients with HCL were followed up for a long period has revealed demographic characteristics of patients with HCL, and confirmed that cladribine treatment might be safe and effective in a relatively large series of the Turkish study population. Copyright © 2014 John Wiley & Sons, Ltd.     

Neoadjuvant chemotherapy with taxotere-epirubicin-5-fluorouracil (TEF) in local-regionally advanced breast cancer: a preliminary report

AIMS AND BACKGROUND: Sixty-three patients with local-regionally advanced breast cancer were treated with neoadjuvant chemotherapy consisting of docetaxel (Taxotere), epirubicin, and 5-fluorouracil (TEF). METHODS AND STUDY DESIGN: Preoperatively, patients received four cycles of Taxotere (80 mg/m2), epirubicin (60 mg/m2), and 5-fluorouracil (500 mg/m2), repeated every 21 days. Following completion of four cycles of chemotherapy, appropriate surgery was performed. After the surgery, patients received one cycle of the TEF chemotherapy regimen; following chemotherapy, radiotherapy was applied, and at the end two more cycles of TEF chemotherapy regimen were given. RESULTS: Sixty-three patients with locally advanced breast cancer were treated. Three patients were excluded from the study before the evaluation of response. Median age of the patients was 50 years (range, 25-77). Twenty-seven and 33 patients were premenopausal and postmenopausal, respectively. Thirty-nine patients were in stage IIIA and 21 in stage IIIB. Complete and partial responses were observed in 15 (25%) and 42 (70%) of the patients following four cycles of preoperative TEF chemotherapy regimen, respectively. Overall response was 95%, and primary lesion progressed only in 3 (5%) patients. The mean disease-free survival was 15.9 +/- 6.8 (range, 3.5-28) months and the mean overall survival was 18.6 +/- 7.2 (range, 5-30) months. The most frequent side effects were nausea-vomiting, mucositis, alopecia and leukopenia. CONCLUSIONS: TEF therapy is a treatment with a high overall response rate and toxicities similar to other taxotere combinations. A longer follow-up of patients is necessary for the determination of disease-free survival and overall survival.     

T-cell-rich B-cell lymphoma: a clinicopathologic study of 21 cases and comparison with 43 cases of diffuse large B-cell lymphoma

Clinicopathologic features of 21 patients with T-cell-rich B-cell lymphoma (TCRBCL) were reviewed and compared to 43 patients with diffuse large B-cell lymphoma (DLBCL) to determine if there were distinguishing clinical characteristics and differences in response or survival to CHOP therapy. For the diagnosis of TCRBCL, the current WHO criteria was used. In all of our cases, the majority of cells are non-neoplastic T cells and <10% large neoplastic B cells are present. The initial pathologic diagnosis was nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) in two cases. Patients with TCRBCL were significantly younger (median: 46 years) and had a significantly higher incidence of B symptoms (62%), hepatomegaly (33%) and marrow infiltration (33%) at presentation when compared to DLBCL (P<0.03). The CR rate after treatment was 48% for TCRBCL patients versus 79% for the DLBCL (P<0.003). Although the CR rates in between the two groups are significant, the difference in 3 years survival rates in each CR groups was insignificant (80% versus 77%). The overall survival time in the two groups was 17 months. Event-free survival time in TCRBCL was 12 months, compared with 17 months in the DLBCL (P>0.05). The frequency of patients with TCRBCL achieving CR was 52.6% whereas that of patients with DLBCL was 79% (P<0.003). The TCRBCL 3 years event-free survival 48% and overall survival 64% were 63 and 72% for DLBCL, respectively.     

Interaction with intraocular lens materials: Does heavy silicone oil act like silicone oil?

PURPOSE: To determine the interaction of heavy silicone oil with various intraocular lens (IOL) materials and whether heavy silicone oil covers the silicone IOL optic as silicone oil does. SETTING: Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey. METHODS: The study group comprised 5 poly(methyl methacrylate) (PMMA) IOLs, 4 foldable silicone IOLs, 5 foldable hydrophilic acrylic IOLs, and 5 foldable hydrophobic acrylic IOLs. Each IOL was bathed in balanced salt solution (BSS) for 10 minutes and then placed in heavy silicone oil dyed with Sudan Black for another 10 minutes. Afterward, each IOL was reimmersed in BSS for 5 minutes and examined under the light microscope. Digital images were analyzed to determine the optic area covered with heavy silicone oil. RESULTS: The mean heavy silicone oil coverage was 7.05% +/- 7.88% (SD) (range 1.13% to 20.54%) on PMMA IOLs, 100% on silicone IOLs, 12.17% +/- 11.43% (range 1.25% to 31.52%) on hydrophobic acrylic IOLs, and 34.64% +/- 13.28% (range 12.57% to 44.42%) on hydrophilic acrylic IOLs. Heavy silicone oil coverage of silicone IOLs was statistically significantly greater than the coverage of other IOL materials. CONCLUSION: Heavy silicone oil acted the same as silicone oil and covered the entire surface of silicone IOLs.     

The effect of scleral buckling surgery on corneal astigmatism, corneal thickness, and anterior chamber depth

PURPOSE: To evaluate the effect of scleral buckling surgery on corneal topography, corneal thickness, and anterior chamber depth. METHODS: Thirty-two eyes of 32 patients who underwent encircling buckling surgery for rhegmatogenous retinal detachment were included in the study. Fellow eyes comprised the control group. Orbscan II topography system was used to determine the changes in corneal topography, corneal thickness, and anterior chamber depth before surgery and 1 week, 1 month, and 3 months after surgery. Statistical analyses used in the study were independent t test, paired t test, one way analysis of variance, and correlation analyses. RESULTS: Postoperatively, mean central corneal astigmatism at 1 week, 1 month, and 3 months was 4.3 +/- 2.0 diopters (D), 3.3 +/- 1.6 D, and 3.1 +/- 1.0 D, respectively. The change between 1 week and 3 months was statistically significant. Central cornea was thickened at the first postoperative week. The thickness gradually decreased to the preoperative levels at 3 months. Anterior chamber depth decreased, and the anterior chamber remained shallow after the surgery. The comparison between preoperative (2.94 +/- 0.6 mm) and postoperative anterior chamber depth was statistically significant at 1 week (2.57 +/- 0.7 mm), 1 month (2.83 +/- 0.7 mm), and 3 months (2.73 +/- 0.6 mm). CONCLUSIONS: Corneal changes after scleral buckling surgery were mild to moderate and the cornea almost resumed its preoperative parameters in 3 months' time. However, the anterior chamber remained shallow during 3 months of follow-up.     

Microscopic evaluation of mandibular symphyseal distraction osteogenesis

The purpose of this study was to evaluate microscopically the newly formed hard tissue after a consolidation period of mandibular symphyseal distraction osteogenesis (MSDO). Sixteen patients underwent MSDO treatment. After a latency period of seven days, the distraction device was activated by the patient once in the morning and once in the evening, for a total of one mm per day for a mean 10.1 +/- 2.8 days, and the mean opening of the device was 8.1 +/- 1.7 mm. The device was usually maintained in position approximately 90 days after surgery. After the completion of the distraction period, the lower anterior teeth were bonded and tooth movement into the distraction site was initiated. After a consolidation period, second surgery was performed to remove the distraction devices. During the second surgery, hard tissue biopsies were taken on the apical region of the two central incisors and the left canine. The samples were fixed in 10% buffered formalin and decalcified in 3% HNO(3) solutions. New bone formation was present within the distraction gap immediately after the consolidation period. The cellular construction was more irregular in the distraction sections than in the normal bone sections. The newly distracted area was not complete immediately after the consolidation period. Furthermore, the newly formed bone had a membranous structure, which indicates continual maturation. Bone exposed to stretching forces undergoes new bone formation, and the newly formed bone is of a membranous type also named as a woven type.