Aromatase cytochrome P450 enzyme expression in prolactinomas and its relationship to tumor behavior

The aim of the study was to evaluate the presence of aromatase cytochrome P450 enzyme (P450AROM) expression in normal pituitary tissues and tumor tissues of patients with prolactinoma and to examine the impact of the P450AROM expression on clinical outcome. Twenty-six consecutive human pituitary tissue samples were obtained from autopsies performed at the Institute of Forensic Medicine. Sixty-four patients who had an adenomectomy between 2000 and 2009 after prolactinoma diagnosis with histologically confirmed pituitary tumor tissues were retrospectively included in this study. The slices from the pituitary tissues were subjected to immunohistochemical staining for evaluation of P450AROM and estrogen receptor beta (ER beta) subunit. Immunohistochemistry results were compared according to age, gender, remission rate, resistance and invasion status of the patients. Higher than normal P450AROM expression was found in the pituitary tissues of the patients with prolactinoma (p < 0.001). P450AROM intensity had no relation to resistance or remission in patients with prolactinoma (p = 0.44, p = 0.45, respectively). The subgroup analysis showed that compared to males without invasive adenoma, males with invasive adenoma had higher P450AROM expression (p = 0.048). ER beta was found to have an impact on resistance (p = 0.049). This study shows that P450AROM expression is present in the pituitary tissues of patients with prolactinoma and that this presence could be important in development and tumor behavior of prolactinomas.     

Knowledge, practices, and barriers concerning the use of emergency contraception among women of reproductive age at a university hospital of Aydin, Turkey

Purpose  

This study aimed to investigate the extent of knowledge and use of emergency contraception among women of reproductive age and to identify barriers existing in Turkey in this context. There is limited research regarding the knowledge and use and barriers to emergency contraception use, since the prepackaged form of hormonal emergency contraception has been available over the counter in Turkey.     

Erythema multiforme‐like eruption localized to a sun‐exposed area

We report on a 35‐year‐old woman with cutaneous lesions characterized by an erythema multiforme‐like appearance localized in the photo‐distributed pattern. She had no history of systemic drug ingestion, herpes simplex virus or any other infection, possible causes of erythema multiforme, before the sun exposure. She had normal tolerance to a phototest, but photoprovocation tests could not be performed because she did not agree to them. This case was diagnosed to be an erythema multiforme‐like variant of a polymorphous light eruption; the differential diagnosis of target‐like lesions in a photo‐distributed pattern is discussed.     

Prostate-specific antigen doubling time before onset of chemotherapy as a predictor of survival for hormone-refractory prostate cancer patients.

BACKGROUND: We evaluated the possible use of prostate-specific antigen doubling time (PSA-DT) before chemotherapy initiation as a surrogate marker of survival in hormone-refractory prostate cancer (HRPC) patients. PATIENTS AND METHODS: Data from 250 consecutive metastatic HRPC patients treated with chemotherapy between February 2000 and November 2006 were retrospectively analysed. At least three PSA assays were required within 3 months before chemotherapy. PSA-DT was calculated as ln 2 divided by the slope of the log PSA line, and the difference between two log PSA levels was divided by the time interval. The primary endpoint was overall survival (OS). Survival rates according to PSA-DT were stratified on chemotherapy regimen. Multivariate Cox regression analysis was performed to isolate the impact of PSA-DT on OS, controlling for associate prognostic covariates. RESULTS: Patients received docetaxel- (82%) or mitoxantrone-based chemotherapy. The median PSA-DT was 45 days (range 4.7-1108 days). There were 174 deaths (70%). The median survival was 16.5 months (95% confidence interval [CI] = 12.5-20.5) and 26.4 months (95% CI = 20.3-32.4) for patients with a PSA-DT < 45 and > or =45 days, respectively. In the multivariate setting, the adjusted hazard ratio (HR) was 1.39 (95% CI = 1.03-1.89; P = 0.04), stratified by chemotherapy regimen. CONCLUSION: A short PSA-DT before onset of chemotherapy in HRPC patients was associated with an increased risk of death. This could be useful as a stratification parameter in trials with new drugs in a metastatic setting.     

Observations questioning a protective role for breast-feeding in severe rotavirus diarrhea

To investigate whether breast-feeding protects children against rotavirus diarrhea (RVD), we compared rates of breast-feeding by age and enteric pathogens among 2,276 children with diarrhea 0-4 years of age who attended a diarrhea hospital in Bangladesh. Infants 0-5 months were less likely to be breast-fed than children 6-11 months of age suggesting that some protection against diarrhea with all agents was associated with early breast-feeding. In every age group studied, breast-feeding was more common among children with RVD than among children with non-RVD whereas it was less common among children with cholera and shigellosis. Twenty percent of breast milks consumed by infants less than 1 year of age had high levels of neutralizing activity (greater than or equal to 320) to the Wa strain of rotavirus but this activity did not appear to be protective since the 30 infants with RVD consumed milk which had titers that did not differ significantly from those consumed by 44 infants with diarrhea of other cause. Despite the prolonged breast-feeding which is common in Bangladesh, the mean age of hospitalization with RVD is approximately the same as in countries where the duration of breast-feeding is quite short. None of these 3 independent observations support a protective role for breast-feeding against rotavirus diarrhea after the first months of life.     

Extra-axial cavernomas of the cerebellopontine angle involving the seventh-eighth nerve complex

Extra-axial cavernous malformations (cavernomas) of the central nervous system are rare. Although occasional cases located in different parts of the central nervous system have been reported, only five cases of extra-axial cavernous malformation in the cerebellopontine angle are to be found. We describe here two additional cases of cavernomas in the cerebellopontine angle causing hearing loss and tinnitus presenting as vestibular schwannoma. Electronic Publication     

Antioxidant actions and early ultrastructural findings of thiopental and propofol in experimental spinal cord injury

Thiopental and propofol are effective antioxidant agents. The current study was undertaken to examine the neuroprotective effects of a single intraperitoneal dose of thiopental and propofol. Effects of the drugs were evaluated by lipid peroxidation and ultrastructural findings. Fifty male Wistar rats were divided into five groups. Group 1 was the control group. Rats underwent laminectomy only, and nontraumatized spinal cord samples were obtained 1 hour after surgical intervention. All other rats sustained a 50-g/cm contusion injury by the weight drop technique. Group 2 rats underwent spinal cord injury alone, group 3 rats received 1 mL intralipid solution intraperitoneally immediately after trauma as the vehicle group, group 4 rats received a 15-mg/kg single dose of thiopental, and group 5 rats received a 40-mg/kg single dose of propofol intraperitoneally following the trauma. Samples from groups 2, 3, 4, and 5 were obtained 1 hour after injury. Lipid peroxidation was determined by measuring the concentration of malondialdehyde in the spinal cord tissue. The ultrastructure of the spinal cord was determined by electron microscopy. The contusion injury was associated with a rise in lipid peroxidation. Compared with the trauma group there was significant attenuation in lipid peroxidation of groups 4 and 5. Ultrastructural findings showed that the rats of group 4 sustained minor damage after spinal cord injury, but there was more evident damage in group 5 rats. These results indicate that thiopental decreases lipid peroxidation and improves ultrastructure, whereas propofol decreases lipid peroxidation without improving ultrastructure 1 hour after spinal cord injury in rats.     

Laparoscopic repair of congenital diaphragmatic hernias

Bochdalek and Morgagni hernias are the least common congenital diaphragmatic hernias, with the prevalence of Bochdalek hernia being 1/2200 births and the prevalence of Morgagni hernia being 1/1 million births. Although they are usually asymptomatic, congenital diaphragmatic hernias, especially Bochdalek and Morgagni hernias, are diagnosed in early childhood. In adulthood, they are diagnosed incidentally or when they become symptomatic. The repair of congenital diaphragmatic hernia is indicated in all children and symptomatic adults. We present three cases of congenital diaphragmatic hernia, two Morgagni and one Bochdalek hernias, repaired laparoscopically. We describe the operational methods. The results of the operations were satisfactory, with cure defined with radiological images after 1 month. We propose the use of laparoscopy in the repair procedure because it is a safe and effective method. Benefits include that it provides an excellent view of the surgical field, ease of execution, minimal surgical trauma, excellent cosmetic results, rapid recovery, and shorter hospitalization stay.