Thrombin activatable fibrinolysis inhibitor activity (TAFIa) levels in neonates with meconium-stained amniotic fluid

OBJECTIVE: Meconium-stained amniotic fluid (MSAF) is thought to be a sign of fetal hypoxia, which causes activation of coagulation and inhibition of fibrinolysis. Inflammation is also seen in MSAF. On the other hand, thrombin activatable fibrinolysis inhibitor (TAFI) is an inhibitor of fibrinolysis and a regulator of vascular inflammation. For this reason, in this study we aimed to evaluate the relation between hypoxia, fibrinolysis, and inflammation by determining the levels of TAFI activity (TAFIa) in MSAF where inflammation was also thought to have a role in the pathogenesis. METHODS: The MSAF group consisted of 22 neonates; 20 neonates served as the control group. Plasma TAFIa levels were evaluated in all neonates in the first six hours of life. RESULTS: TAFIa levels were significantly higher in the MSAF group when compared with the control group and the levels correlated negatively with cord blood pH levels. CONCLUSIONS: Increased TAFIa levels in neonates with MSAF might be due to hypoxia. Inflammation observed in MSAF may also play an additional role in increased TAFIa expression. Although no clinical complication that can be attributed to this increase was seen, one should be alert to the complications of depressed fibrinolysis that might be observed in these neonates.     

Polymorphous low-grade adenocarcinoma of the tongue

Polymorphous low-grade adenocarcinoma has been recently recognized as a distinct entity with a predilection for minor salivary glands. We present an unusual case of polymorphous low-grade adenocarcinoma of the tongue. Only a few cases located at the tongue have been reported in the English literature. Current literature concerning the histopathological and clinical features of this tumor was discussed.     

Hypermobility syndrome in 105 women with pure urinary stress incontinence and in 105 controls

We compared the frequency of Hypermobility Syndrome (HS) in 105 patients with urinary stress incontinence (USI) with the frequency of HS in 105 healthy controls that matched for age and parity. A Beighton score (BS) of more than 3 was used to make the clinical diagnosis of HS. Thirty-six patients (34.28%) from the USI group and 28 patients (26.66%) from the control group were diagnosed as HS. The mean BS values were 6.44±0.35 and 5.21±0.29 respectively. The difference between the two groups was statistically significant (P<0.05).     

The protective effect of caffeic acid phenethyl ester on ischemia-reperfusion injury in rat ovary

OBJECTIVE: This experimental study was designed to determine the changes in tissue levels of malondialdehyde, end-product of lipid peroxidation (MDA), reduced glutathione (GSH) and xanthine oxidase (XO) and the effect of caffeic acid (3,4-dihydroxycinnamic acid) phenethyl ester (CAPE) on these metabolite levels after adnexal torsion-detorsion model in rats. METHOD: Forty adult female albino rats were divided into five groups: basal control (n = 8), sham operation (n = 8), torsion-detorsion plus saline (n = 8), torsion-detorsion plus CAPE (n = 8). and only torsion (n = 8). Rats in the sham operation group underwent a surgical procedure similar to the other groups but the adnexa was not torsioned. Rats in the torsion group were killed after 360 degrees clockwise adnexal torsion for 3 h and ovaries were harvested. CAPE was injected intraperitoneally 30 min before detorsion in the CAPE/detorsion group and saline was administered in the saline/detorsion group. After 3 h of adnexal detorsion, the rats in both groups were killed and adnexa were surgically removed. RESULTS: MDA levels and XO activities in torsion-detorsion plus saline group increased significantly when compared to basal control, torsion and sham operation groups (P < 0.001). In the CAPE group, MDA levels and XO activities were lower than those of torsion-detorsion plus saline group, and differences between the two groups were statistically significant (P < 0.001). GSH levels in torsion-detorsion plus saline group were decreased significantly when compared to basal control and sham operation groups (P < 0.001). GSH levels in the CAPE group were higher than those of torsion-detorsion plus saline group, and differences between the two groups were statistically significant (P < 0.004). Morphologically, polymorphonuclear leukocytic infiltration and vascular dilatation were obvious in the ischemia-reperfusion damaged ovary, a change partially reversed by CAPE. CONCLUSIONS: These results suggest that administration of CAPE has beneficial effects in the prevention of ischemia-reperfusion injury of the ovaries.     

Cervico-mediastinal tuberculous lymphadenitis presenting as prolonged fever of unknown origin

Prolonged fever of unknown origin (FUO) is a challenging and important medical problem. Tuberculosis is the most frequent cause of FUO, especially in endemic regions, such as developing countries. We present a case of cervico-mediastinal tuberculous lymphadenitis that had been searched and followed up as a prolonged FUO. Especially in endemic areas, tuberculosis should be borne in mind in the differential diagnosis of FUO cases with granulomatous lymphadenitis presenting as prolonged or recurrent fever, even if the cultures and polymerase chain reaction for Mycobacterium tuberculosis are negative.     

The effect of vernal keratoconjunctivitis on clinical outcomes of penetrating keratoplasty for keratoconus

BACKGROUND: Although good visual results and low complication rates are commonly reported following penetrating keratoplasty (PKP) in eyes with keratoconus, the outcome of PKP in eyes with keratoconus and concomitant vernal keratoconjunctivitis (VKC) has not been well documented.We performed a study to compare the outcome and relative risk factors of PKP for keratoconus with and withoutVKC. METHODS: Review of the medical records of all patients who underwent PKP for keratoconus at a university-affiliated hospital in Izmir,Turkey, from Nov. 1, 1991, to Jan. 31, 2002. Only eyes that had been followed for at least 18 months postoperatively were included in the study. Twenty-three eyes of 19 patients (14 males and 5 females) had keratoconus with VKC, and 65 eyes of 57 patients (33 males and 24 females) had keratoconus alone.We compared clinical outcomes and complications between the two groups. RESULTS: The mean length of follow-up was 34.0 months (standard deviation [SD] 16.3 months) (range 18-67 months) in the eyes with comitant VKC and 41.0 (SD 19.8) months (range 18-98 months) in the eyes with keratoconus alone. During the follow-up period, 2.35 (SD 1.90) suture-removal sessions for loosened sutures were performed in the eyes with VKC, compared with 1.34 (SD 1.69) sessions in the eyes with keratoconus alone (p = 0.016). Steroid-induced glaucoma developed in two eyes (8.7%) in theVKC group and in three eyes (4.6%) in the keratoconus-alone group (p = 0.603); the rates of steroid-induced cataract were four (17.4%) and two (3.1%) respectively (p = 0.038).The average final best-corrected visual acuity was 20/22 (range 20/50 to 20/20) in the eyes with VKC and 20/23 (range 20/60 to 20/20) in the eyes with keratoconus alone. INTERPRETATION: The clinical outcome of PKP in eyes with keratoconus and VKC is comparable to that in eyes with keratoconus alone. However, because complications such as prematurely loosened sutures and steroid-induced cataract are more common in the coexistence of VKC, closer monitoring is necessary in these cases.     

Nail disorders in hemodialysis patients and renal transplant recipients: a case-control study

BACKGROUND: There is one published case-control study of nail disorders in hemodialysis patients. The nail changes that occur in renal transplant recipients have not been investigated specifically. OBJECTIVE: The aim of this study was to determine prevalence rates of nail disorders in hemodialysis patients and renal transplant recipients, and to investigate whether these nail pathologies are related to hemodialysis and renal transplantation. METHODS: One hundred and eighty-two hemodialysis patients and 205 renal transplant recipients were screened for the presence of nail disorders. The findings in these groups were compared with findings in 143 healthy individuals. RESULTS: One hundred and twenty-seven patients (69.8%) in the hemodialysis group and 116 patients (56.6%) in the renal transplant recipients had at least one type of nail pathology. Absence of lunula, splinter hemorrhage, and half-and-half nails were significantly more common in the hemodialysis patients than in the renal transplant recipients. Leukonychia was significantly more frequent in the renal transplant recipients than in the hemodialysis patients and controls. CONCLUSION: Hemodialysis patients and renal transplant recipients have higher rates of nail disease than the healthy population. Renal transplantation may reduce the frequencies of splinter hemorrhage and half-and-half nails. Interestingly, leukonychia increases significantly after renal transplantation.     

Predicting clinical outcome in patients diagnosed with synchronous ovarian and endometrial cancer

PURPOSE: Patients with synchronous ovarian and endometrial cancers may represent cases of a single primary tumor with metastasis (SPM) or dual primary tumors (DP). The diagnosis given will influence the patient's treatment and prognosis. Currently, a diagnosis of SPM or DP is made using histologic criteria, which are frequently unable to make a definitive diagnosis. EXPERIMENTAL DESIGN: In this study, we used genetic profiling to make a genetic diagnosis of SPM or DP in 90 patients with synchronous ovarian/endometrial cancers. We compared genetic diagnoses in these patients with the original histologic diagnoses and evaluated the clinical outcome in this series of patients based on their diagnoses. RESULTS: Combining genetic and histologic approaches, we were able make a diagnosis in 88 of 90 cases, whereas histology alone was able to make a diagnosis in only 64 cases. Patients diagnosed with SPM had a significantly worse survival than patients with DP (P = 0.002). Patients in which both tumors were of endometrioid histology survived longer than patients of other histologic subtypes (P = 0.025), and patients diagnosed with SPM had a worse survival if the mode of spread was from ovary to endometrium rather than from endometrium to ovary (P = 0.019). CONCLUSIONS: Genetic analysis may represent a powerful tool for use in clinical practice for distinguishing between SPM and DP in patients with synchronous ovarian/endometrial cancer and predicting disease outcome. The data also suggest a hitherto uncharacterized level of heterogeneity in these cases, which, if accurately defined, could lead to improved treatment and survival.