Pseudallescheria boydii keratitis

We describe a patient with Pseudallescheria boydii keratitis. The treatment of mycotic keratitis remains difficult. This case demonstrates that identification and susceptibility testing should be rapidly performed. In cases of indolent keratitis, the possibility of fungal infection should be kept in mind.     

Repair of an extensive iatrogenic tracheal rupture with a pleural patch and a vascular graft

Here we describe a 48-year-old woman who suffered a 7-cm rupture in the lower trachea after intubation with a double-lumen tube. We repaired the rupture with a new technique using a pleural patch reinforced by a ringed vascular graft. This technique appears to be appropriate for use in patients who have large tracheal ruptures to avoid tracheal stenosis.     

Reduced CD19 expression and decreased memory B cell numbers in transient hypogammaglobulinemia of infancy

We aimed to evaluate the role of the CD19 complex in the pathogenesis of transient hypogammaglobulinemia of infancy (THI) and to better characterize the subsets of memory B cells. The study population consisted of 22 male and 14 female patients with a mean age at presentation of 20 ± 9.9 months. The CD19 complex and B cell subsets were evaluated by flow cytometry. While the CD19 median fluorescence index (MFI) in patients with THI was significantly lower than controls (122.9 ± 66.7 in patients; 184.2 ± 39 in controls, p < 0.01), expression of CD21 and CD81 was increased (94.4 ± 3, 96.8 ± 2.5 % in patients; 91 ± 3.9; 94.7 ± 3.5 % in controls, p < 0.01 vs. p < 0.05, respectively). The expressions of switched memory B cells and IgM memory B cells were found to be reduced in THI. Considering that the CD19 complex regulates the events following antigen stimulation, the change in CD19 complex detected in THI may be related to insufficiency of antibody production.     

“The Diagnostic Accuracy of Thyroid Nodule Fine-Needle Aspiration Cytology Following Thyroid Surgery: a Case–Control Study”

Thyroid surgery may cause regional scarring and some degree of fibrotic process which may extend into the perithyroidal soft tissues. This may result in problems when collecting thyroid fine-needle aspiration biopsy (FNAB) samples and evaluating the cellular abnormalities. This study aimed to determine if a history of thyroid surgery is a risk factor for nondiagnostic (ND) FNAB results. Patients with ≥1 discrete nodular lesion of the thyroid who underwent FNAB were included. The patients with a history of thyroid surgery constituted group 1, and the others constituted group 2. The factors which may influence FNAB results, including age, gender, presence of Hashimoto’s thyroiditis, and ultrasound characteristics, were also evaluated. Group 1 included 123 patients with 200 nodules, and group 2 included 132 patients with 200 nodules. The two groups were similar with respect to demographic characteristics of the patients and ultrasonographic features of the nodules including diameter, content (cystic or solid), echogenicity, margin, and calcifications (P?>?0.05). In all, 176 (44 %) of the participants had ND FNAB results. The median time interval between thyroid surgery and FNAB was 15 years [range, 1–45 years; interquartile range (IQR) 13 years]. Significantly more nodules in group 1 had ND FNAB results than in group 2 [98 (49 %) vs 78 (39 %), respectively, P?=?0.028]. Multivariate analysis revealed that history of thyroid surgery was independently associated with ND FNAB [odds ratio (OR) 1.55, 95 % confidence interval (CI) 1–2.33, P?=?0.033]. A history of thyroid surgery increases the risk of initial ND FNAB.     

Malignancy Rate of Thyroid Nodules Defined as Follicular Lesion of Undetermined Significance and Atypia of Undetermined Significance in Thyroid Cytopathology and Its Relation with Ultrasonographic Features

Fine-needle aspiration biopsy (FNAB) has been widely accepted as the most accurate, safe, and cost-effective method for evaluation of thyroid nodules. The most challenging category in FNAB is atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS). The Bethesda system (BS) recommends repeat FNAB in that category due to its low risk of malignancy. In our study, we aimed to investigate the malignancy rate of thyroid nodules of AUS and FLUS and whether there were different malignancy rates among the different patterns in this category, and to evaluate the presence of biochemical, clinical, and echographic features possibly predictive of malignancy related to AUS and FLUS. Data of 268 patients operated for AUS and FLUS cytology were screened retrospectively. Ultrasonographic features and thyroid function tests, thyroid antibodies, scintigraphy, and histopathological results were evaluated. Of the 268 patients’ results, 276 nodules are evaluated. Malignancy rates were 24.3 % in the AUS group, 19.8 % in the FLUS group, and 22.8 % in both groups. In the evaluation of all nodules, the predictive features of malignancy are hypoechogenicity and peripheral vascularization of the nodule. We determined that the malignancy rates in these nodules are higher than that in the literature rate. This high ratio may be due to the fact that we studied only patients who underwent surgery. The ultrasonographic features alone may be insufficient to predict the malignancy; therefore, all the clinical and ultrasonographic features must be considered in the evaluation of the thyroid nodules. In addition, we think that the recommended management of repeat FNAB in these groups must be reconsidered with the clinical and ultrasonographic features.     

The diagnostic accuracy of the revised mini nutritional assessment short form for older people living in the community and in nursing homes

Objective

The aim of this study was to determine the diagnostic accuracy of the CC-SF, which was developed to use calf circumference (CC) instead of BMI in the MNA-SF, for elderly people living in the community and in nursing homes. It also aimed separately to determine the correlation of CC-SF and BMI-SF with the full MNA.

Study Design and Methods

The study included 640 elderly people living in their community and 243 elderly people living in nursing homes. Accuracy was assessed by determining the sensitivity and selectivity of the nutritional assessments. The correlations between the MNA-SFs and the full MNA were analyzed.

Results

The correlation between MNA-SFs and full MNAs was strong, significant and almost identical both in the community and in nursing homes (r=0.86–0.88; p<0.001). The observed agreement between the BMI-SF and the full MNA was 82.2% in the community and 77.8% in the nursing homes. There was a substantial agreement by kappa values in the comparison of community and nursing homes (the Kappa value of the BMI-SF was 0.63 in the community and 0.62 in the nursing homes, and the kappa value of the CC-SF was 0.62 in the community and 0.63 in the nursing homes). When compared to the full MNA the MNA-SFs tended to underestimate nutritional status. Both MNA-SFs had similarly high sensitivity and selectivity, both in the community and nursing homes. (when dichotomized as “malnourished-at risk of malnutrition” versus “well nourished” and “malnourished” versus “at risk of malnutrition-well nourished”) (over 80%).

Conclusion

In cases where BMI cannot be determined, the CC-SF is a good substitute for the BMI-SF.     

Association between human leukocyte antigen gene polymorphisms and multiple EPIYA-C repeats in gastrointestinal disorders

BACKGROUND Polymorphisms of human leukocyte antigen(HLA) genes are suggested to increase the risk of gastric cancer(GC).AIM To investigate the HLA allele frequencies of patients with GC relative to a control group in terms of CagA+ multiple(≥ 2) EPIYA-C repeats.METHODS The patient group comprised 94 patients [44 GC and 50 duodenal ulcer(DU) patients], and the control group comprised 86 individuals [(50 non-ulcer dyspepsia patients and 36 people with asymptomatic Helicobacter pylori(H. pylori)]. Polymerase chain reaction was performed for the amplification of the H. pylori cagA gene and typing of EPIYA motifs. HLA sequence-specific oligonucleotide(SSO) typing was performed using Lifecodes SSO typing kits(HLA-A, HLA-B HLA-C, HLA-DRB1, and HLA-DQA1-B1 kits).RESULTS The comparison of GC cases in terms of CagA+ multiple(≥ 2) EPIYA-C repeats showed that only the HLA-DQB1*06 allele [odds ratio(OR): 0.37, P = 0.036] was significantly lower, but significance was lost after correction(Pc = 0.1845). The HLA-DQA1*01 allele had a high ratio in GC cases with multiple EPIYA-C repeats, but this was not significant in the univariate analysis. We compared allele frequencies in the DU cases alone and in GC and DU cases together using the same criterion, and none of the HLA alleles were significantly associated with GC or DU. Also, none of the alleles were detected as independent risk factors after the multivariate analysis. On the other hand, in a multivariate logistic regression with no discriminative criterion, HLA-DQA1*01(OR = 1.848), HLA-DQB1*06(OR = 1.821) and HLA-A*02(OR = 1.579) alleles were detected as independent risk factors for GC and DU.CONCLUSION None of the HLA alleles were detected as independent risk factors in terms of CagA+ multiple EPIYA-C repeats. However, HLA-DQA1*01, HLA-DQB1*0601, and HLA-A*2 were independent risk factors with no criterion in the multivariate analysis. We suggest that the association of these alleles with gastric malignancies is not specifically related to cagA and multiple EPIYA C repeats.     

Evaluation of central corneal and central retinal thicknesses and intraocular pressure in acromegaly patients

Introduction

Acromegaly is a disorder with increased morbidity which can involve many organs and the eye can be one of them which was investigated in few reports. Herein, we aimed to evaluate CCT, IOP and retinal thickness (RT), and their relationships with serum GH and IGF-1 levels and disease duration, in acromegaly patients. We compared the ocular parameters with those of a control group. This study included the largest number of patients of any comparable investigation to date.

Material and Method

We enrolled 30 acromegaly patients (15 male, 15 female and age: 48.4 ± 12.8 years) and 21 age and gender matched controls. All participants underwent complete hormonal and ophtalmological evaluation including central corneal thickness (CCT), retinal thickness (RT) and intraocular pressure (IOP) values.

Results

There were no significant differences in median right and left CCTs and mean CCT (p = 0.646, p = 0.667 and p = 0.384, respectively). Nor were there statistically significant differences in median right and left RT, or mean central RT, between the acromegaly and control groups (p = 0.977, p = 0.738 and p = 0.811, respectively). However median right, left and mean IOPs were found to be significantly higher in the acromegaly group, despite there being no difference in the CCT values (p = 0.011, p = 0.028 and p = 0.047, respectively). When we analyzed two subgroups of acromegaly patients (active/inactive), we found that the median right, left and mean CCTs and RTs, were not significantly different between the groups. Although there was a significant difference in IOP between the acromegaly and control groups, the two subgroups of acromegaly patients had similar IOPs (p = 0.400, p = 0.621 and p = 0.451 for right, left and mean IOPs, respectively). IOP was not found to be correlated with serum IGF-I, GH or disease duration in acromegaly patients.

Conclusion

Our study results suggest that acromegaly is associated with increased ocular pressures irrespective of disease activity. Therefore detailed ocular evaluation should be a routine component of the follow up visits of acromegaly patients.     

18F-FDG uptake in diffuse peritoneal lymphomatosis

A 38-year-old man presented with declining appetite and progressive abdominal distention. Abdominal ultrasonography revealed omental and bowel wall thickening. Histopathologic examination showed a high-grade lymphoblastic Burkitt-like B-cell lymphoma. 18F fluorodeoxyglucose positron emission tomography/computed tomography images showed diffusely increased metabolic activity in the thickened omentum, intestines, mesentery, and peritoneum (omental caking). Diffuse peritoneal and omental seeding are well-known forms of dissemination of metastatic carcinoma. However, omental and peritoneal lymphomatosis are rare manifestations of high-grade lymphomas. This uncommon case demonstrates usefulness of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in omental and peritoneal involvement in lymphoma.