Diprosopus associated with neural tube defect and facial cleft in the first trimester

We report a case of diprosopus presenting with increased nuchal translucency of 5.3 mm at 14 weeks of gestation. Ultrasonographically, the fetus presented with micrognathia, anterior indentation of the cephalic pole, abnormal cerebral hemispheres with a cystic 4th ventricle and angulation of the spine. The fetal karyotype was normal (46,XX). Following termination of pregnancy, postmortem examination established the diagnosis of diprosopus tetraophthalmus with facial cleft of the 2 faces.     

Characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul

BACKGROUND: The aim of this retrospective study was to analyse the characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul, Turkey. PATIENTS AND METHODS: All cases admitted to the Emergency Unit of the Istanbul University Cerrahpa?a Medical Faculty Hospital, between January 2001 and December 2001, were included in this study. We analysed the clinical charts for aetiological and demographical characteristics of the acutely poisoned patients. RESULTS: There were 284 poisoning cases (207 females and 77 males) among 11834 patients admitted to the Emergency Unit. This was 2.4% of all emergency admissions. The female-to-male ratio was 3:1. The mean age was 27+/-12 years (age range 15-87) and the majority of the patients (73.94%) were below the age of 30 years. The median age was 24 years. Medicinal drugs were the major cause (69.37%) of the cases, followed by inhalation of gases (14.44%), alcohol (5.99%), alcohol together with illicit drugs (4.23%), food (3.17%), corrosives (1.76%) and pesticides (1.06%). The route of administration was as follows: 84.51% orally, 14.44% by inhalation and 1.06% by intravenous injection. Seventy-one per cent of acute poisonings were self-inflicted and 88% occurred at home. The most frequently involved medicinal drugs were antidepressants and analgesics. In 32.04% of cases, there was more than one medicinal drug responsible for the poisoning. The seasonal distribution in poisoning patients suggested a peak in summer (31.7% of presentations) and winter (30.9%) and lower numbers in spring (22.9%) and autumn (14.5%). The follow-up period of the patients were 1-12 hours for 42 cases (15%), 13-24 hours for 134 cases (47%) and more than 24 hours for 108 cases (38%). Two of the 284 cases with acute poisonings were fatal. This was a university hospital-based study, so these results may not be representative of the general population. Despite this drawback, these data still provide important information about the characteristics of poisoning in the largest city of the country. cn     

Plasma and placental levels of interleukin-10, transforming growth factor-beta1, and epithelial-cadherin in preeclampsia

OBJECTIVE: To investigate the plasma and placental levels of interleukin-10 (IL-10), transforming growth factor-beta1 (TGF-beta1), and epithelial-cadherin (E-cadherin) in normotensive and preeclamptic pregnancies. METHODS: The study population consisted of 33 women with normotensive pregnancy and 35 women with preeclampsia. Peripheral venous blood samples were collected before labor (35.3 +/- 1.1 and 34.2 +/- 3.4 weeks' gestation for normotensive and preeclamptic pregnancies, respectively), and placental tissues were obtained after delivery. Maternal plasma and placental homogenate IL-10, TGF-beta1, and E-cadherin levels were determined by enzyme-linked immunosorbent assay. RESULTS: The mean plasma and placental levels of IL-10, TGF-beta1, and E-cadherin were significantly higher in preeclamptic than normotensive patients (P <.001). The plasma and placental levels of IL-10, TGF-beta1, and E-cadherin significantly increased with the increments in diastolic blood pressure (P <.001). CONCLUSION: IL-10, TGF-beta1, and E-cadherin may be involved in the pathologic process of preeclampsia. The pathophysiologic changes associated with preeclampsia may stem in part from the overproduction of these placental mediators.     

Changes in nitric oxide level and superoxide dismutase activity during antimanic treatment

Oxidant nitric oxide (NO) and antioxidant superoxide dismutase (SOD) have been implicated to play a role in the pathogenesis of bipolar disorders. This is the first prospective study aimed to evaluate NO levels and SOD activity in bipolar disorder (type I manic episode) (BD-ME). 29 inpatient subjects with BD-ME and 30 healthy controls were included. Serum NO levels and SOD activity have been studied at 1st (NO [1st] and SOD [1st] respectively) and 30th days (NO [30th] and SOD [30th] respectively) after treatment. The clinical outcome was measured by Bech-Rafaelson Mania Scale (BRMS). The mean NO [1st] (p<.001) and NO [30th] levels (p<.001) were higher than controls, but SOD [1st] (p<.001) and SOD [30th] (p<.001) activities in BD-ME were lower than controls. SOD(1) activity was higher than SOD [30th] (p<.001), while there was no significance in comparison between NO [1st] and NO [30th] (p>.05). SOD [30th] activity is negatively correlated with the number of previous manic attacks and NO [1st] was negatively correlated with sleep item score of BRMS at first day. Also there was a significant correlation between NO [1st] levels and with the existence of a delusion. NO and SOD appear to play a role in the pathophysiological events occurring in BD, especially in BD-ME. This study for the first time showed the possible role of NO on sleep and the generation of delusions in the pathophysiology of BD. In the light of literature, induced glutamate pathway might be responsible for delusions in BD. The results of this research need further investigation to understand the oxidative vs antioxidative process in BD.     

Pain relief after cervical ganglionectomy (C2 and C3) for the treatment of medically intractable occipital neuralgia

Occipital neuralgia (ON) presents a diagnostic challenge because of the wide variety of symptoms, surgical findings, and postsurgical outcomes. Surgical removal of the second (C2) or third (C3) cervical sensory dorsal root ganglion is an option to treat ON. The goal of this study was to evaluate the short-term and the long-term efficacy of these procedures for management of cervical and occipital neuropathic pain. Twenty patients (mean age 48.7 years) were identified who had undergone C2 and/or C3 ganglionectomies for intractable occipital pain and a retrospective chart review undertaken. Patients were interviewed regarding pain relief, pain relief duration, functional status, medication usage and procedure satisfaction, preoperatively, immediately postoperative, and at follow-up (mean 42.5 months). C2, C3 and consecutive ganglionectomies at both levels were performed on 4, 5, and 11 patients, respectively. All patients reported preoperative pain relief following cervical nerve blocks. Average visual analog scale scores were 9.4 preoperatively and 2.6 immediately after procedure. Ninety-five percent of patients reported short-term pain relief (<3 months). In 13 patients (65%), pain returned after an average of 12 months (C2 ganglionectomy) and 8.4 months (C3 ganglionectomy). Long-term results were excellent, moderate and poor in 20, 40 and 40% of patients, respectively. Cervical ganglionectomy offers relief to a majority of patients, immediately after procedure, but the effect is short lived. Nerve blocks are helpful in predicting short-term success, but a positive block result does not necessarily predict long-term benefit and therefore cannot justify surgery by itself. However, since 60% of patients report excellent-moderate results, cervical ganglionectomy continues to have a role in the treatment of intractable ON.