Bronchectasis in Horton's disease: fortuitous association?

Respiratory manifestations in Horton's disease are uncommon. We report the case of 63 year-old man with Horton disease diagnosed 2 months before, who was hospitalised for fever, deterioration in general health, cough and hemoptysis. Chest X-ray showed an infiltrate in the right upper lobe and bilateral cystic opacities predominant on basal suggesting bronchectasis who was confirmed secondary in CT-scan. Even though cortico sensible clinical manifestations and radiologic infiltrate were previously described in Horton's disease, association with bronchectasis was never been reported in literature and her etio pathogenic mechanism must be clarified.     

Correlation of serum IgE levels with severity of acute pulmonary thromboembolism

We aimed to investigate whether there is a direct correlation of serum IgE concentration with severity of acute pulmonary thromboembolism (PTE). DESIGN: Prospective study. SETTINGS: University medical center. Forty-six patients (27 female, 19 male) who were diagnosed as acute PTE in our clinic between 01 October 2000 and 30 November 2001 comprised the study group. Mean age was 55 (range was 20-82). The study group was divided into three groups according to severity of PTE: Group A, submassive PTE without pulmonary infarction (20 patients); group B, submassive PTE with pulmonary infarction (15 patients); and group C, massive PTE (11 patients). Serum IgE concentrations were measured by ELISA method at 1st, 5th, 15th, 30th, 60th, 90th days, and 120th days, if needed, after the diagnosis. Statistical analysis was made by Post hoc Tukey test. First day serum IgE levels were highest in group B (mean 507.7) followed by group C (mean 324.2), and were lowest in group A (mean 117.2). The differences between group B and group C, between group B and group A, and also between group C and A were all statistically significant (p< 0.5, p< 0.0001, p< 0.015, respectively). 5th day and 15th day results showed statistically significant differences between group B and A, and between group C and A (at 5th day: p<0.0001, p< 0.015 respectively, and at 15th day: p< 0.0001, p< 0.012 respectively). At 30th, 60th, and 90th days of diagnosis serum IgE concentrations were higher in group B than in group A which were statistically significant (p< 0.0001, p< 0.0001, p< 0.019 respectively). Patients with submassive PTE and pulmonary infarction had the highest serum IgE concentrations and the longest duration of high levels of IgE.     

Cutaneous lobular capillary hemangioma induced by pregnancy

Lobular capillary hemangioma, which is also named as pyogenic granuloma, is a common vascular proliferation of skin and mucous membranes. Hormonal influence in the development of lobular capillary hemangioma on the mucosal surfaces has been demonstrated but for cutaneous lesions located on the skin, this association has not been shown yet. In this report, a 25-year-old female patient with cutaneous lobular capillary hemangioma of the cheek induced by pregnancy is presented. The lesion was excised and lobular capillary hemangioma was given as diagnosis by histopathological evaluation. Estrogen receptor was weakly positive by immunohistochemical analysis. We suggest that elevated levels of estrogens during pregnancy may have an important role also on the development of cutaneous lobular capillary hemangiomas by direct hormonal action.     

Endosulfan-induced cardiotoxicity and free radical metabolism in rats: the protective effect of vitamin E

Endosulfan is widely used in insect control and it is absorbed by both humans and animals through ingestion, inhalation and percutaneously. The aim of this work was to study antioxidant enzyme system which include superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) and malondialdehyde (MDA), the end product of lipid peroxidation and ultrastructural changes that might occur in the heart tissue of adult male Wistar rats as a result of endosulfan intoxication. Vitamin E (200 mg/kg, twice a week), endosulfan (2 mg/kg, per day, once a day in corn oil) and vitamin E (200 mg/kg, twice a week)+endosulfan (2 mg/kg, per day, once a day in corn oil) combination were given to rats (n = 10/group) orally via gavage for 6 weeks. SOD, GPx, CAT activities and MDA level increased in the endosulfan-treated group heart tissue compared to control group (P < 0.01, P < 0.01, P < 0.05 and P < 0.01, respectively). SOD, GPx activities and MDA level decreased in the vitamin E + endosulfan-treated group compared to endosulfan-treated group (P < 0.05, P < 0.05 and P < 0.05, respectively). Decrease of CAT activity was not significant statistically in the vitamin E + endosulfan-treated group compared to endosulfan-treated group. CAT activity increased in the vitamin E + endosulfan treated group compared to control group (P < 0.05). Increase of SOD, GPx activities and MDA levels were not significant statistically in the vitamin E + endosulfan-treated group compared to control group. In electron microscopic investigations while cytoplasmic edema and swelling and vacuolization of mitochondria of myocardial cells in endosulfan-treated group was observing, only a weak swelling of mitochondria of myocardial cells in vitamin E + endosulfan-treated group was observed. We conclude that vitamin E significantly reduce endosulfan-induced cardiotoxicity in rats.     

Synthesis and evaluation of some novel quinazolinone derivatives as diuretic agents

A new series of quinazolin-4(3H)-one derivatives containing either a thiazole or a 1, 3, 4-thiadiazole moiety were prepared in order to study the effect of such a heterocyclic combination on the expected diuretic activity. Synthesis of the target compounds (2, 4, and 6) has been achieved through an interaction of the starting 7-chloro-2-methyl-4H-3, 1-benzoxazin-4-one 1 with different heterocyclic amines. Alkylation of 3-(2-mercapto-1, 3, 4-thiadiazol-5-yl)quinazolin-4(3H)-one derivative 4 with different alkyl halides or chloroacetic acid afforded the corresponding thioethers 5 while interaction of 2-methyl-3-(1, 3, 4-thiadiazol-5-yl or thiazol-5-yl)quinazolin-4(3H)-ones (2 and 6) with various aromatic aldehydes resulted in the formation of the arylvinyl analogs 3 and 7, respectively. On the other hand, 2-morpholinomethyl-3-(2-sulfamoyl or mercapto-1, 3, 4-thiadiazol-5-yl)quinazolin-4(3H)-one derivatives 10 have also been synthesized through an interaction of the sulfonamide or thiol analog 9 with the appropriate amine. Biological evaluation of some of the target compounds as diuretic agents was carried out. The results showed that 2-[2-(4-chlorophenyl)vinyl]-7-chloro-3-(2-sulfamoyl-1, 3, 4-thiadiazol-5-yl)quinazolin-4(3H)-one 7b exhibited significant diuretic activity. The detailed synthesis, spectroscopic and biological data are reported.     

High conformality radiotherapy in Europe: thirty-one centres participating in the quality assurance programme of the EORTC prostate trial 22991

Today, conformality in radiotherapy is at the centre of many investments in equipment and staffing. To estimate the current situation within the European Organisation for Research and Treatment of Cancer (EORTC) conformal radiotherapy trial for prostate cancer, a technology questionnaire was designed to assess whether participating centres can comply with the required radiotherapy procedures of EORTC trial 22991, where a high dose is prescribed to the prostate. Questions covered various items of computed tomography, data acquisition, treatment planning, delivery and verification. All centres (n=31) replied to the questionnaire. All generate beam's eye views and dose volume histograms. All, but two, centres use digitally reconstructed radiographs to display images. The vast majority of the centres perform at least weekly treatment verification and half have access to individual in vivo dosimetry. The results of the questionnaire indicate that participating centres have access to the equipment and apply the procedures that are essential for conformal prostate radiotherapy. The technology questionnaire is the first step in the extensive quality assurance programme dedicated to this high-tech radiotherapy trial.     

Clinical, electrophysiological and neuropsychological findings of twenty-two children with mesial temporal sclerosis

Twenty-two patients, followed with the diagnosis of epilepsy between the ages of 8.5 and 19 years who were found to have mesial temporal sclerosis (MTS) on brain magnetic resonance imaging (MRI) were evaluated according to their clinical, electrophysiological and neuropsychological characteristics, and assessed for the significance of neuropsychological tests on lateralization. In both MTS groups, a remarkable number of patients had their intial seizure before one year of age (45.5% in the right MTS group, and 36.4% in the left MTS group). Half of the patients were seizure-free for a period of two months-9.5 years (average 3.9 years). The duration between the febrile seizure and first non-febrile seizure was 6.2 years. Eleven patients had MTS on the left temporal lobe. Interictal EEG was normal in five (22.5%) patients; 10 (45.5%) had temporal spike on the corresponding side with MTS. Six (27.3%) patients had paroxysmal activity and voltage asymmetry on cortical areas other than temporal region. The Wechsler Memory Scale (WMS), Visual Reproduction Subtest and Auditory Verbal Learning Test (AVLT) Delayed Recall and Retrieval Subtest performances were poor in the right MTS group.     

Protective effect of melatonin on beta-cell damage in streptozotocin-induced diabetes in rats

The aim of the present study was the evaluation of possible protective effects of melatonin against beta-cell damage in streptozotocin-induced diabetes in rats. Malondialdehyde levels and glutathione peroxidase activity were measured in pancreatic homogenates. Pancreatic beta-cells were examined by immunohistochemical methods. Streptozotocin was injected intraperitoneally at a single dose of 60 mg/kg for induction of diabetes. Melatonin (200 microg/kg/day, ip) was injected for 3 days prior to administration of streptozotocin; these injections were continued until the end of the study (4 weeks). Streptozotocin induced a significant increase in malondialdehyde levels (p < 0.01) and a significant decrease in glutathione peroxidase activity (p < 0.05) in pancreatic tissue. Degeneration of islet cells and weak immunohistochemical staining of insulin was observed in diabetic rats. Treatment of diabetic rats with melatonin markedly reduced malondialdehyde production (p < 0.05) and increased glutathione peroxidase activity (p < 0.01) without affecting hyperglycemia. Increased staining of insulin and preservation of islet cells were apparent in the melatonin-treated diabetic rats. These data suggest that melatonin treatment has a therapeutic effect in diabetes by reduction of oxidative stress and preservation of pancreatic beta-cell integrity.     

Frequency of Mycoplasma pneumoniae among atypical pneumonia of childhood

We aimed to investigate the frequency of Mycoplasma pneumoniae among atypical pneumonia of childhood that is acquired from the community and to determine a practical approach to the diagnosis of these patients. In this prospective study, 55 patients (31 male and 24 female) with atypical pneumonia were investigated with conventional laboratory and radiological methods as well as culture and polymerase chain reaction (PCR) on throat swab. In addition, serum of the patients was tested for M. pneumoniae specific IgM. The patients were reevaluated clinically at 3-5 days and 3-4 weeks and serologically at 3-4 weeks. The data on patients with M. pneumoniae pneumonia were compared with the other patients with atypical pneumonia and controls. All patients were treated with macrolide antibiotics. The mean age of the patients was 7.8+/-2.9 years. The frequency of M. pneumoniae by this method was 34.5%. Neither clinical, laboratory, or epidemiological data nor response to macrolide antibiotics was useful in detecting the etiology of atypical pneumonia. Diagnostic sensitivity and specificity of IgM+IgG antibodies plus PCR on throat swab were estimated as 100%. M. pneumoniae was an important microorganism in the etiology of atypical pneumonia of childhood in our community. In order to prevent loss of time with beta-lactamase antibiotics, which are usually started in severe pneumonia, serologic tests and PCR must be done during the initial evaluation of the patient for the reliable diagnosis of M. pneumoniae, which will increase the chance of early and appropriate therapy.     

Relationship between premortem and postmortem diagnosis in critically ill bone marrow transplantation patients

OBJECTIVES: To determine the relationship between the premortem and postmortem diagnosis in critically ill bone marrow transplantation patients Also, to evaluate the appropriateness of the reliance on clinical diagnosis for withdrawal of active treatment decision-making. DESIGN: Retrospective cohort study. SETTING: Two university-affiliated tertiary care medical surgical intensive care units. PATIENTS: Critically ill bone marrow transplantation patients who died in the intensive care unit between November 1,1994, and June 30,1999, and underwent postmortem examination. INTERVENTION: Review of medical records by two independent data extractors. Clinical diagnosis and cause of death in the intensive care unit were compared with the final autopsy report. MEASUREMENTS AND MAIN RESULTS: Premortem clinical diagnoses were classified according to the Goldman criteria and compared with postmortem findings. Twenty-eight autopsies were done. Ten of 28 (36%) patients had discrepancies uncovered on autopsy; only two discrepancies would have influenced patient management and none would have altered patient outcome. Twenty patients had their active treatment withdrawn and underwent postmortem examination. None of the discrepancies noted would have altered outcome in these patients. CONCLUSION: In the bone marrow transplantation population, there is significant concordance between clinical diagnosis and postmortem findings. Reliance on clinical diagnosis may be valid for withdrawal of active treatment decision-making in these patients.