Microsatellite instability is not a common feature in medullary breast cancer

Microsatellite instability (MSI) is a form of genomic instability associated with defective DNA mismatch repair in tumors. MSI is found in 85-90% of hereditary nonpolyposis colorectal cancer cases; however, its occurrence in breast carcinogenesis still remains to be clarified. In addition, data are limited on the incidence of MSI in the medullary subtype. The purpose of this study was to investigate the occurrence of MSI in medullary breast cancer (MBC). The study included a total of 16 patients with MBC, nine with typical and seven with atypical histology. The incidence of MSI in five microsatellite loci (D2S123, D3S1611, D17S807, D17S796 and Xq11-12) was determined by comparing paired normal and tumor tissue DNA after PCR amplification from paraffin-embedded tissues. All 16 tumors showed stability at five loci. Although the number of microsatellite markers and DNA samples may limit the value of our results, we conclude that the MSI phenotype is uncommon in human MBC.     

Is Endocan a Novel Diagnostic Marker for the Severity of Bronchopulmonary Dysplasia in Very Low Birth Weight Infants?

IntroductionEndocan levels were found to be associated with severity and mortality of the respiratory system diseases.ObjectiveWe aimed to figure out whether endocan was an important marker for the diagnosis, severity and follow-up of bronchopulmonary dysplasia (BPD).Materials and methodsInfants with moderate/severe BPD, and who required hydrocortisone treatment were included in the study group. Infants without BPD were allocated in the control group. Endocan levels were compared between the control group and the study group, and before and after the treatment in the study group.ResultsA total of 148 infants, 74 infants in the control group and 74 infants in the BPD group, were included. The endocan level was higher in the BPD group than in the control group (P = .001). Endocan levels before treatment in the BPD group was found to be higher than endocan level after treatment (P = .021).ConclusionOur study found that endocan levels increased in moderate/severe BPD. Serum endocan levels may be a safe and novel indicator for the follow-up of response to treatment and the prognosis of the severity of the disease.     

Pleural involvement by hydatid cysts of the lung

Hydatid cyst disease is encountered in Turkey frequently. Rupture of a pulmonary cyst into the pleural cavity is rare, but represents the most serious complication of the hydatid disease. Surgical intervention was carried out in all cases in our clinic when expansion of the lungs could not be achieved. Open ends of the bronchus were closed and the pericyst layer was sutured after the removal of the germinative layer. We here present 5 cases of hydatid cysts with the above mentioned complication.     

The results of electrophysiological study and radio-frequency catheter ablation in pediatric patients with tachyarrhythmia

A total of 135 consecutive pediatric patients (pts) with tachyarrhythmia ranging from two to 21 years of age (median age 11 years) underwent electrophysiological study (EPS) between January 1994 and July 2001. Tachycardia could not be induced in 38 of 135 pts (28%) and studies in these patients were accepted as the normal EPS. Supraventricular tachyarrhythmia mechanisms were atrioventricular (AV) accessory pathways in 47 patients (manifest accessory pathways in 23 patients, concealed accessory pathways in 17 patients, permanent junctional reciprocating tachycardia in 7 patients), re-entry without accessory pathway in 26 patients (AV nodal reentry tachycardia in 20 patients, atrial flutter in 5 patients, sinus node re-entry tachycardia in 1 patient) and atrial ectopic tachycardia in eight patients. The diagnosis of ventricular tachycardia (VT) was made in 16 patients. Seventy-three of the 97 patients with the diagnosis of tachyarrhythmia as a result of EPS underwent radiofrequency (RF) catheter ablation. The indications, early results, complications, safety and efficacy of RF catheter ablation were reviewed in these patients. Among the 73 patients who underwent RF ablation (85 procedures), the overall final success rate for all the diagnoses was 82% (60 of 73 patients). The median follow-up period for all patients was 16 months (range 2 to 60 months). Total recurrence rate in 73 patients was 4% (3 patients). Re-ablation was performed in only one of them and was successful. Procedure-related complications occurred in eight patients (11%): transient third-degree AV block in one patient, transient second-degree AV block in one patient, atrial flutter in two patients (1 needed direct current cardioversion), and atrial fibrillation in three patients (2 needed defibrillation and transient pacemaker implantation). In one patient with permanent third-degree AV block a transvenous pacemaker implantation was required. These midterm results suggest that RF catheter ablation has a good success rate and a low complication rate in pediatric patients, especially when it is carried out in experienced pediatric cardiology centers.     

Preventive services in a health maintenance organization: how well do pediatricians screen and educate adolescent patients?

OBJECTIVE: To determine whether pediatricians in managed care settings adhere to national guidelines concerning the provision of clinical preventive services. DESIGN: Surveys were mailed between September 1996 and April 1997 to all pediatricians practicing in a California group-model health maintenance organization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior. RESULTS: The response rate was 66.2% (N = 366). Pediatricians, on average, screened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual intercourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, and driving after drinking alcohol; fewer than 20% for use of smokeless tobacco, sexual orientation, sexual and physical abuse, and riding a bike or swimming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior. Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Female physicians, physicians who saw a greater proportion of older adolescents, and recent medical school graduates were more likely to provide preventive services. CONCLUSIONS: Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations but at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent mortality and for patients who screen positive for a risk behavior.     

Anatomical study of the communicating branches between the medial and lateral plantar nerves

The plantar areas of the foot have specific biomechanical characteristics and play a distinct role in balance and standing. For the forefoot surgeon, knowledge of the variations in the anatomy of communicating branches is important for plantar reconstruction, local injection therapy and an excision of interdigital neuroma. The anatomy of the communicating branches of the plantar nerves between the fourth and third common plantar digital nerves in the foot were studied in 50 adult men cadaveric feet. A communicating branch was present between the third and fourth intermetatarsal spaces nerves in all eight left feet and in six right feet (overall, 28%), and absent in 36 (72%). A communicating branch was found in 14 ft. Ten of the 14 communications were from the lateral to the medial plantar nerve. The length of the communicating branch ranged from 8 to 56 mm (average 16.4 mm) and its diameter was 0.2–0.6 times of the fourth common plantar digital nerve. The angle of the communicating branch with the common plantar digital nerve from which it originated was less than 30° in 11 ft, 30–59° in 27 ft, 60–80° in 8 ft, and more than 80° in 4 ft. Classification of the branch is based on the branching pattern of the communicating branch and explains variations in plantar sensory innervations. We think that the perpendicular coursing communicating branch is at higher risk to be severed during surgery.     

Sensitization to common allergens, especially pollens, among children with respiratory allergy in the Trakya region of Turkey

Asthma and allergic rhinitis are common problems in children and the causative pollen allergens vary according to the geographical area. The aim of this study was to investigate patterns of sensitization to common inhalant allergens, especially pollens, in Turkish children living in the Trakya region and to determine differences between rural and urban areas. Allergen skin testing was prospectively performed on 539 children aged between 4 and 17 years with respiratory allergy. The reaction was considered to be positive if the mean wheal diameter was at least 3 mm greater than that of the negative controls. We detected positive skin reactions in 420 (77.9%) children. Two hundred and eighty-one (52.1%) mite, 277 (51.4%) pollen, 174 (32.3%) mold, 65 (12.1%) animal dander, 12 (2.2%) cockroach and 6 (1.1%) latex skin sensitivities were detected. Among the pollen allergies 173 were cereal pollen (32.1%), 170 grass pollen (31.5%) and 144 tree pollen allergies (26.7%). The most common positive skin test among the pollens was to cultivated wheat (Titicum vulgare) (n = 116, 21,5%), followed by rye grass (Lolium perenne) and orchard grass (Dactylis glomerata). Positive skin reactions to Alternaria, to Candida albicans, and to all pollens except Ulmus competris, Pinus sylvetris, Platanus vulgaris and Tilia platyphyllos, were higher in children with allergic rhinitis than in those with asthma. In children from rural areas, allergic skin reactivity was found to be more common against Candida albicans, sheep dander and all pollens except Corylus avellana, Fraxinus excelsior, Populus alba, Pinus sylvetris, Platanus vulgaris and Chenopodium album, than in urban children. Although Trakya is close to Greece and other Mediterranean countries, this study suggests that the pollens, which sensitize children, are not similar.     

Femoral seating position of the EndoButton in single incision anterior cruciate ligament reconstruction: an anatomical study

Arthroscopic EndoButton fixation of anterior cruciate ligament (ACL) grafts over the femoral cortex has become popular in recent years. However, elongation of fixation materials has lead to tunnel enlargement, graft tunnel motion and instability. Synovial fluid passages along femoral tunnels following ACL reconstruction may result in destruction of tissues. The purpose of the present study was to identify the seating position of the EndoButton in regard to the boundaries of the knee capsule in single-incision arthroscopic ACL reconstruction. A total of 20 cadaveric knees were dissected and arthroscopic drill guides were used to create tibial and femoral tunnels. The distances between the exit points and boundaries of the suprapatellar bursa at three different degrees of knee flexion were measured. The average distances from the exit points to the superior boundaries of the suprapatellar bursa were 6.89 ± 5.40 mm (range, 16.87–1.21). However, in knee flexion of greater than 90°, tunnel exits were placed below the superior boundaries of the suprapatellar bursa (−7.08 ± 3.69 mm, range, −3.24 to −12.87). In order to place the EndoButton extraarticularly, a safe degree of knee flexion during femoral tunnel drilling was defined as 80°.