Evaluation of visual field and ocular surface parameters by clinical comparison after blepharoplasty for dermatochalasis

PURPOSE

To evaluate the effect of upper eyelid blepharoplasty surgery on corneal topography, visual field, ocular surface, meibography, corneal biomechanics and dry eye parameters.

METHODS

This prospective study included a total 80 eyes of 40 patients. Following a detailed ophthalmological examination, standardized patient satisfaction questions were posed to patients before and after upper eyelid blepharoplasty surgery. Visual field test, non-invasive break up time (NIBUT), meibography, and corneal topography parameters were analyzed and evaluated.

RESULTS

The mean (+) visible areas in the visual field were found to be 46.20±24.96 preoperatively, 56.73±21.98 at the 1st postoperative month and 65.96±18.5 at the 3rd month, which were statistically significant. NIBUT values preoperatively, at 1 month and at 3 months were 11.26±4.48, 11.16±4.5 and 10.14±4.0, respectively, which were statistically significant. Meibomian gland loss rates on meibography preoperatively and postoperatively at 1 and 3 months were found to be 30.24±8.3, 29.36±8.2 and 28.22±7.7 respectively and were statistically significant. With the scoring system after blepharoplasty, patients reported improvement in their symptoms.

CONCLUSION

Upper eyelid blepharoplasty surgery is predicted to increase the quality of vision. It was observed that there was a functional and cosmetic improvement in the complaints of the patients after blepharoplasty. However, blepharoplasty may cause changes in eyelid dynamics and cause dry eye syndrome.

Novel banana lectin CAR-T cells to target pancreatic tumors and tumor-associated stroma

BACKGROUND

Cell therapies for solid tumors are thwarted by the hostile tumor microenvironment (TME) and by heterogeneous expression of tumor target antigens. We address both limitations with a novel class of chimeric antigen receptors based on plant lectins, which recognize the aberrant sugar residues that are a 'hallmark' of both malignant and associated stromal cells. We have expressed in T cells a modified lectin from banana, H84T BanLec, attached to a chimeric antigen receptor (H84T-CAR) that recognizes high-mannose (asparagine residue with five to nine mannoses). Here, we tested the efficacy of our novel H84T CAR in models of pancreatic ductal adenocarcinoma (PDAC), intractable tumors with aberrant glycosylation and characterized by desmoplastic stroma largely contributed by pancreatic stellate cells (PSCs).

METHODS

We transduced human T cells with a second-generation retroviral construct expressing the H84T BanLec chimeric receptor, measured T-cell expansion, characterized T-cell phenotype, and tested their efficacy against PDAC tumor cells lines by flow cytometry quantification. In three-dimensional (3D) spheroid models, we measured H84T CAR T-cell disruption of PSC architecture, and T-cell infiltration by live imaging. We tested the activity of H84T CAR T cells against tumor xenografts derived from three PDAC cell lines. Antitumor activity was quantified by caliper measurement and bioluminescence signal and used anti-human vimentin to measure residual PSCs.

RESULTS

H84T BanLec CAR was successfully transduced and expressed by T cells which had robust expansion and retained central memory phenotype in both CD4 and CD8 compartments. H84T CAR T cells targeted and eliminated PDAC tumor cell lines. They also disrupted PSC architecture in 3D models in vitro and reduced total tumor and stroma cells in mixed co-cultures. H84T CAR T cells exhibited improved T-cell infiltration in multicellular spheroids and had potent antitumor effects in the xenograft models. We observed no adverse effects against normal tissues.

CONCLUSIONS

T cells expressing H84T CAR target malignant cells and their stroma in PDAC tumor models. The incorporation of glycan-targeting lectins within CARs thus extends their activity to include both malignant cells and their supporting stromal cells, disrupting the TME that otherwise diminishes the activity of cellular therapies against solid tumors.

Future Physicians and Cosmetic Medical Interventions

Background

International Union of Aesthetic Plastic Surgeons’ survey-2017 showed Turkey is the second country among others in terms of numbers of cosmetic medical interventions (CMI) in Europe and ranks ninth worldwide. Therefore future physicians’ (FT) perceptions are important on this topic as potential implementer and service user.

Objective

Objectives are: To examine FPs (interns) personal CMI experience; practiced/observed CMI; their attitude towards CMI and related factors.

Methods

Study is descriptive with 274 interns. Data collected by online survey contains 22 questions and acceptance of cosmetic surgery scale (ACSS) (Henderson and King, 2005).

Findings

Of the interns, 51.5% were female; 47.8% perceived good economic status; 40.5% had cosmetic-surgery training; 23.0% had CMI (laser on skin and teeth interventions mostly); 39.7% of these interventions were performed in private clinics while some of them are realized in beauty centers; body-perception was found (75.5%) the main motive of CMI. There was a strong relation between CMI and gender. Female interns constituted majority (p = 0.01). Respondents who had CMI had the highest scores of ACSS (p < 0,001). It was found that ACSS is positively related to positive familial and social environment (p = 0,007); negatively related with strong traditional (p = 0,005) and religious beliefs (p < 0,001); positively related with the given importance of body-perception (p = 0,015). Media effect was found important factor on ACSS scores (p < 0,001).

Conclusions

If the awareness of the quality, results, benefits and harms of CMIs is well established, it may be thought that there will be differences in attitude scale and less CMI performance. Therefore, it is necessary to constitute training programs on the different aspects of CMIs in medical curriculum.

Key messages

CMIs are not medically necessary and not a public-health issue and has economic burden. Awareness on the quality, results, benefits and harms of CMIs is should be well-clarified in the society.

Abstract P5-02-03: Testing machine learning algorithms' performance for non-invasively identifying breast cancer molecular subtypes using BI-RADS evaluations

Purpose: Inter- and intra-observer variability adversely affects interpretation of highly advantageous MRI data in breast cancer diagnosis, prognosis and therapeutic decisions. Machine learning (ML) might potentially provide support to the physicians for objective decision strategies. In this work, ML methods using BI-RADS features were tested for non-invasively determining molecular subtypes of breast cancer.

Methods: In this IRB approved study, Out of 126 consecutive patients' retrospective data with written consent, 69 patients (mean±std age 48.24±11.62 and range [27-82]) with full histopathological and MRI data were selected. In surgical histopathological data ER+PR+HER2- was classified as luminal HER2(-), ER+PR+HER+ was classified as luminal HER2(+), ER-PR-HER2+ was classified as HER2(enriched) and ER-PR-HER2- was classified as triple negative. The cohort revealed 51 luminal HER2(-), 11 luminal HER2(+), 7 triple negative cases without any HER2(enriched) occurrence. DCE, DW, T2W MRI data were obtained on a 1.5T Magnetom Espree (Siemens, Erlangen, Germany) scanner which were subsequently interpreted in consensus by 2 radiologists of 15 and 10 years of experience.

Age, mass and non-mass properties, non-enhancing BI-RADS findings, ADC values obtained from radiologist drawn ROIS and kinetic curve properties were fed to 22 standard ML algorithms provided in Matlab® (Mathworks, Natick, MA, USA) as predictors for 3 categories. The algorithms were run by cross validating on 50 folds whereby reported classifier accuracy was obtained from each of the observations when in held-out fold.

Results: Out of 22 ML algorithms tested Support Vector Machine's Fine Gaussian variant, Ensemble Boosted Trees and Fine K-Nearest Neighbor resulted in 76.8%,71.0% and 53.6% accuracy with (100%, 18%, 0%), (92%, 9%, 14%) and (67%, 18%, 14%) true positive rates for predicting each histopathological category respectively. Furthermore, PCA based dimension reduction worsened the outcomes indicating high sensitivity to the feature set.

Conclusion: ML algorithms demonstrated potential as a decision support system increasing assessment objectivity with an added non-invasiveness advantage. However, overall algorithm performance indicates further studies with larger cohorts and broader feature are necessary for refinements and improving ML methodology in breast cancer imaging.

Citation Format: Ozcan A, Aksoy Ozcan U, Ekemen S, Ulus S, Oyan B. Testing machine learning algorithms' performance for non-invasively identifying breast cancer molecular subtypes using BI-RADS evaluations [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-02-03.

Abstract P5-02-05: Correlation of proliferation index markers (Ki-76 and PHH3) with breast MRI apparent diffusion coefficient values

Objective: In recent literature, increasing number of studies have analyzed associations between the MRI findings and histopathological features of breast cancer. Ki-67 index is an important prognostic factor in breast cancer which provides information about the mitotic activity and the growth rate of the tumor. The proliferation index markers like Ki-67 and PHH3 (Phosphohistone H3) play an important role in decision making in the treatment regimes. PHH3 is a relatively new entity which is specific only to the proliferation giving it a unique characteristic because it is not observed at the interphase. PHH3 provides a more sensitive and accurate mitotic index with less interobserver variability when compared with conventional H&E staining, thus emphasizing its potentially increased value in practice. In this study, our aim is to correlate both proliferation index markers (Ki-67 and PHH3) with breast MRI features in cases of invasive breast carcinoma.

Material and Methods: In this IRB approved study, out of 126 consecutive patients' retrospective data with written consent, 29 patients (mean±std age 48.86±13.10 and range [28-82]) with full apparent diffusion coefficient (ADC), Ki67 and PHH3 data were selected. In all of these surgical specimens, immunohistochemically administered Ki-67 and PHH3 and immunopositive cells in the digital pathology were counted. MRIs were performed in a 1.5T MR unit (MagnetomEspree with Syngo MR B15 software; Siemens, Erlangen, Germany). Images were evaluated by two radiologists in consensus. Mean ADC values were obtained from radiologist drawn ROIs. The results were analyzed with principle component analysis (PCA) and pairwise covariance analysis.

Results: Mean ADC value was (mean±std) 0.92±0.18 with range [0.67-1.3] (10-3mm2/s), mean Ki67 was 18.62±13.32 with range [5-62] ('%' for Ki-67) and PHH3 27.17±30.81 with a range [1-111] ('10HPF' for PHH3). When PCA was conducted in (ADC, Ki67, PHH3) space, after normalizing each of the variables 45.223% of total variance was explained mainly by the new variable obtained as a linear combination of the normalized values -0.0866*ADC - 0.9879* Ki67 - 0.7910*PHH3, 37.282% by -0.9879*ADC + 0.1545Ki67 -0.0101*PHH3 and 17.494% by 0.1283*ADC + 0.7806*Ki67 - 0.6117*PHH3 respectively. The analysis demonstrates that while Ki67 and PHH3 values explain much of the variance (45.223% + 17.494%) and thereby are highly correlated as expected, ADC on its own determines a significant portion(37.282%) of the data as well. Moreover, pairwise covariance analysis resulted in ADC, Ki67 and PHH variance values of 2.170, 1.528 and 2.197 respectively and, covariances of ADC|Ki67 (-0.1169), ADC|PHH3 (0.2048) and Ki67|PHH (1.31).

Conclusion: Ki-67 and PHH3 both show good correlation in the assessment of proliferative status of breast cancer. However, breast MRI ADC values cannot be reliably used for the prediction of Ki-67 and PHH3 status of the invasive breast tumors. More studies with larger series are needed to assess the potential of breast MRI to serve as a clinical and/or prognostic factor.

Citation Format: Ekemen S, Ozcan A, Aksoy Ozcan U, Ulus S, Oyan Uluc B. Correlation of proliferation index markers (Ki-76 and PHH3) with breast MRI apparent diffusion coefficient values [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-02-05.

Smartphone-based clinical diagnostics: towards democratization of evidence-based health care

Recent advancements in bioanalytical techniques have led to the development of novel and robust diagnostic approaches that hold promise for providing optimal patient treatment, guiding prevention programs and widening the scope of personalized medicine. However, these advanced diagnostic techniques are still complex, expensive and limited to centralized healthcare facilities or research laboratories. This significantly hinders the use of evidence-based diagnostics for resource-limited settings and the primary care, thus creating a gap between healthcare providers and patients, leaving these populations without access to precision and quality medicine. Smartphone-based imaging and sensing platforms are emerging as promising alternatives for bridging this gap and decentralizing diagnostic tests offering practical features such as portability, cost-effectiveness and connectivity. Moreover, towards simplifying and automating bioanalytical techniques, biosensors and lab-on-a-chip technologies have become essential to interface and integrate these assays, bringing together the high precision and sensitivity of diagnostic techniques with the connectivity and computational power of smartphones. Here, we provide an overview of the emerging field of clinical smartphone diagnostics and its contributing technologies, as well as their wide range of areas of application, which span from haematology to digital pathology and rapid infectious disease diagnostics.

Investigation of haptoglobin, serum amyloid A, and some biochemical parameters in calves with omphalitis

Aim:

In this study, it was aimed to determine the concentration of some important acute phase proteins (APPs) and some biochemical parameters pre-operative and post-operative in calves with omphalitis.

Materials and Methods:

A total of 20 calves were used in the study and they consist of 10 clinically healthy calves that were used as a control and 10 calves with omphalitis were used as the treatment group. Blood samples were collected from Vena jugularis of animals to tubes with anticoagulant (sodium citrate) and without anticoagulants, pre-operative (day 0), and post-operative (day 7). Samples were used to determine the concentration of haptoglobin (Hp), serum amyloid A (SAA), ceruloplasmin (Cp), fibrinogen, glucose, total protein, albumin, urea, total bilirubin, creatinine, calcium, phosphorus, aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) concentrations.

Results:

While the Hp, SAA, Cp, fibrinogen, urea, creatinine, total bilirubin, ALP, and GGT concentrations were statistically and significantly increasing rather than the control group during the pre-operative period for calves with omphalitis, they decreased to the post-operative period. Moreover, an insignificant increase in the glucose, total protein, and AST concentrations and an insignificant decrease in the albumin, calcium, and phosphorus concentrations were statistically determined.

Conclusion:

We have the opinion that the assessment of biochemical parameters and especially APP levels in calves with the omphalitis together with the clinical findings may be important in terms of the treatment and prognosis.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Protective effect of omega-3 fatty acids on diethylnitrosamine toxicity in rats

OBJECTIVES

In this study, it was aimed to investigate the effect of n-3 fatty acids (n-3 FA) on diethylnitrosamine (DEN) toxicity with respect to alterations including nitric oxide (NO) formation, uric acid level as well as some liver related enzymes such as aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activities in rats.

MATERIALS AND METHODS

Forty male Wistar albino rats were used as animal materials. Animals were divided into 4 groups and treated as follows: Rats in group 1 (control) were intraperitoneally (i.p) injected with single dose of saline; rats in group 2 were i.p. injected with DEN at a dose of 150 mg/kg/body weight; rats in group 3 were treated with DEN (via single i.p. injection at 150 mg/kg/body weight) plus n-3 FA (at a dose of 0.4 g /kg/day via subcutaneous route in fish oil) for 7 days, and group 4 received n-3 FA via s.c. route at a dose of 0.4 g/kg/day in fish oil for 7 days. The plasma samples were analyzed for NO, uric acid levels as well as for activities of AST, ALT and ALP.

RESULTS

Uric acid level was lower in DEN group than in control. In addition, NO level and AST, ALT, ALP activities in DEN group were significantly higher than in control. Nitric oxide concentration, ALT and ALP activities in DEN + n-3 FA treated rats were lower than in DEN alone. Uric acid level in DEN + n-3 FA group was higher than in DEN group.

CONCLUSIONS

These results suggest that n-3 fatty acids could ameliorate the toxic effects of DEN in part by means of its free radical scavenging activity and may be of therapeutic value in the protection of liver against toxic effects of DEN.  

Assesment of correlation between bispectral index and four common sedation scales used in mechanically ventilated patients in ICU

PURPOSE

The aim of this study was to compare the correlation between bispectral index (BIS) monitor and four commonly used subjective clinical scales (Ramsay Sedation Scale (RSS), Richmond Agitation Sedation Scale (RASS), Sedation Agitation Scale, Adaptation to Intensive Care Environment scale) in mechanically ventilated patients in intensive care unit (ICU). In addition, comparison of responsiveness of the clinical scales in respect to BIS changes is another goal of this study.

MATERIALS AND METHODS

Mechanically ventilated thirty patients who required sedation for any reason were enrolled to study. Patients who needed neuromuscular blockade, patients with known hearing and visual problems, neurological diseases, anoxic encephalopathy, mental retardation and who developed hemodynamic instability (mean arterial pressure below 60 mmHg) and hypoxemia (sPO2 below 90%) during follow-up were excluded. Starting before the initiation of sedation, first BIS scores then clinical sedation scales were evaluated. This procedure is repeated every 2 hours for 24 hours.

RESULTS

All of the four clinical scales were significantly correlated with BIS. BIS and clinical scale values, except Adaptation to Intensive Care Environment scale, showed significant changes compared to baseline after the initiation of sedation. Ramsay and Richmond scales showed the highest correlation with BIS (respectively, r = 0.758, r = 0.750). Adaptation to Intensive Care Environment revealed the lowest correlation (r = 0.565).

CONCLUSIONS

All of the scales were significantly correlated with BIS. RSS and RASS showed higher correlation than other scales. As a conclusion: RSS and RASS can be used for monitoring the depth of sedation in mechanically ventilated patients in ICU.

5/6 nephrectomy as a validated rat model mimicking human warfarin-related nephropathy

BACKGROUND/AIMS

We previously reported that patients with chronic kidney disease (CKD) receiving warfarin therapy and whose international normalized ratio increases to >3.0 may develop acute kidney injury (AKI) as a result of glomerular hemorrhage and formation of obstructive red blood cell (RBC) casts. We named this condition warfarin-related nephropathy (WRN). We also previously reported that acute excessive anticoagulation with brodifacoum (superwarfarin) induces AKI in 5/6 nephrectomy (5/6NE) rats. Limitations of the brodifacoum model precluded a careful assessment of dose-response relationships.

METHODS

Warfarin treatment was used in 5/6NE.

RESULTS

Herein we report that warfarin treatment of 5/6NE rats resulted in a dose-dependent increase in serum creatinine (SC). The increase in SC following warfarin treatment was greater at 3 and 19 weeks after the ablative surgery, than that observed 8 weeks after the ablative surgery. The SC increase was correlated with the prothrombin time increase. Morphologically, 5/6NE, but not control rats, had acute tubular injury with RBC and RBC casts in the tubules. Treatment with vitamin K prevented SC increase and morphologic changes in the kidney associated with warfarin treatment. A single episode of WRN did not affect the progression of CKD in 5/6NE.

CONCLUSION

(1) The 5/6NE model of CKD is an appropriate animal model to study the pathogenesis of WRN. (2) The pharmacokinetics of warfarin is better suited to the study of WRN than that of brodifacoum. (3) The more advanced stages of 5/6NE are more susceptible to WRN than the earlier stages. (4) Vitamin K treatment prevents WRN.

Thyroglossal duct cysts: evaluation and treatment of 49 cases

OBJECTIVE

The aim of the study was to evaluate the clinical features and treatment outcomes of patients with a thyroglossal duct cyst (TGDC) or fistula.

METHODS

The records of 49 patients (9 female, 40 male; mean age: 23.16 +/- 1.13 years; range 6 to 56 years) operated on between January 1995 and July 2009 were reviewed retrospectively. Patient's age, sex, duration of symptoms, clinical features, pre-operative diagnostic tests, treatment, histopathologic diagnosis, and post-operative complications were noted. All patients underwent the Sistrunk procedure.

RESULTS

Fifteen patients (30.6%) were < or = 20 years old, while 3 (6.1%) patients were 40 years old at the time of operation. There was cyst formation in 26 patients (53.1%) and fistula formation in 23 patients (46.9%). The lesions of 41 patients (83.7%) were located in the midline, while the lesions of 8 patients (16.3%) were located in the paramedian neck (5 left side, 3 right side). The most common presenting symptoms were painless mass in the midline of the neck and recurrent suppuration of fistula formation. Neck ultrasonography (USG) was the most common pre-operative diagnostic procedure and was performed on all patients with cyst formations. There were no major complications postoperatively. There was recurrence in only one patient after the Sistrunk procedure. One patient was incidentally diagnosed with thyroid papillary carcinoma after histopathological examination.

CONCLUSIONS

A TGDC is the most common congenital mass in the neck and is usually located midline. USG is suggested for a clinically suspected TGDC. The Sistrunk procedure is a safe and successful technique with low complication and recurrence rates. Even though carcinomas arising in TGDCs are uncommon, histopathological examination must be routinely performed to confirm the diagnosis and rule out malignancy.

Anti-apoptotic and growth-promoting markers in adult medulloblastomas

AIM

the aim of this study was to investigate the pathologic features, proliferation potential and expression of some anti-apoptotic and growth-promoting markers in adult medulloblastomas.

METHOD

we analyzed the immunohistochemical expression of survivin, c-KIT, Bcl-2, fascin, p-53 and Ki-67 in 18 adult medulloblastomas (> 16 years of age).

RESULTS

study included 14 males and 4 females (mean age: 22.9 ± 8.2). 14 cases were classical, 2 desmoplastic/nodular and 2 large cell medulloblastomas. Moderate-to-high nuclear survivin expression was observed with high percentages (55 - 100%) in all medulloblastomas while Bcl-2 was mildly positive in only 1 case. Interestingly, mild-to-moderate cytoplasmic c-KIT expression was demonstrated in 16 cases (89%) without membranous accentuation. Fascin expression was observed in 13 medulloblastomas (72%), 9 of which showing moderate to high immunoreactivity. Mild p53 expression was present in only 4 cases (22%). Mean Ki-67 index was 20.6% (range 8 - 55%).

CONCLUSION

frequent nuclear survivin expression implies the predominance of anti-apoptotic factors in pathogenesis of adult medulloblastomas. It may also be a potential therapeutic target for adult medulloblastomas. Although Blc-2 immunoreactivity was previously reported in approximately 30% in medulloblastomas, we have observed that it is rarely expressed in the present series of adult medulloblastomas. To our knowledge, this is the first study evaluating fascin expression in medulloblastomas. Its presence may be related to the neuronal differentiation. Mild-to-moderate cytoplasmic c-KIT immunoreactivity without membranous staining in adult medulloblastomas may support the previous studies reporting low level of c-KIT protein expression with lack of activating mutations in medulloblastomas. It seems p53 is rarely involved in the course of develepment of adult medulloblastomas.

A case of crescentic IgA nephropathy treated with prednisolone and cyclophosphamide

IgA nephropathy (IgAN) is the most common glomerulonephritis in the world, and currently is known to be an important cause of end stage renal disease (ESRD). Hypertension, proteinuria more than 1 g/d, and the presence of severe lesions on initial renal biopsy such as crescents and interstitial fibrosis are the most significant predictive factors for progression to ESRD. Despite its prevalence and clinical importance, there is no consensus for the treatment of patients with risk factors for a worse prognosis. Our aim is to describe here a case of crescentic IgAN, and to emphasize the effect of immunosuppressive treatment.

Image formation in fluorescence coherence-gated imaging through scattering media

Recently, we have experimentally demonstrated a new form of cross-sectional, coherence-gated fluorescence imaging referred to as SD-FCT ('spectral-domain fluorescence coherence tomography'). Imaging in SD-FCT is accomplished by spectrally detecting self-interference of the spontaneous emission of fluorophores, thereby providing depth-resolved information on the axial positions of fluorescent probes. Here, we present a theoretical investigation of the factors affecting the detected SD-FCT signal through scattering media. An imaging equation for SD-FCT is derived that includes the effects of defocusing, numerical-aperture, and the optical properties of the medium. A comparison between the optical sectioning capabilities of SD-FCT and confocal microscopy is also presented. Our results suggest that coherence gating in fluorescence imaging may provide an improved approach for depth-resolved imaging of fluorescently labeled samples; high axial resolution (a few microns) can be achieved with low numerical apertures (NA<0.09) while maintaining a large depth of field (a few hundreds of microns) in a relatively low scattering medium (6 mean free paths), whereas moderate NA's can be used to enhance depth selectivity in more highly scattering biological samples.

Clarithromycin in the treatment of RSV bronchiolitis: a double-blind, randomised, placebo-controlled trial

Respiratory syncytial virus (RSV) bronchiolitis is the most common lower respiratory tract infection in infancy. To date, there is no effective therapy for RSV bronchiolitis. In order to investigate the efficacy of clarithromycin in the treatment of RSV bronchiolitis, the present authors conducted a randomised, double-blind, placebo-controlled trial comparing clarithromycin with placebo in 21 infants with a diagnosis of RSV bronchiolitis. The infants were randomised to receive clarithromycin or placebo daily for 3 weeks. Levels of interleukin (IL)-4, IL-8, eotaxin, and interferon-gamma were determined in plasma, before and after treatment, using ELISA. Six months after treatment, parents were surveyed as to whether their child had experienced wheezing within the previous 6 months. Treatment with clarithromycin was associated with a statistically significant reduction in the length of hospital stay, the duration of need for supplemental oxygen and the need for beta(2)-agonist treatment. There were significant decreases in plasma IL-4, IL-8 and eotaxin levels after 3 weeks of treatment with clarithromycin. Readmission to the hospital within 6 months after discharge was significantly lower in the clarithromycin group. In conclusion, clarithromycin has statistically significant effects on the clinical and laboratory findings in respiratory syncytial virus bronchiolitis. Therefore, clarithromycin treatment may be helpful in reducing the short-term effects of respiratory syncytial virus bronchiolitis.

Fluorescence coherence tomography

In this paper, we introduce a new form of cross-sectional, coherence-gated fluorescence imaging, which we term 'spectral-domain fluorescence coherence tomography' (SD-FCT). SD-FCT is accomplished by spectrally detecting self-interference of the spontaneous emission of fluorophores located along the axial (depth) dimension of the sample. We have built a first generation SD-FCT system that utilizes two opposing low numerical-aperture objective lenses in an interferometer and an imaging spectrometer for detecting self-interference of fluorescence emitted from a sample. Here, in proof-of-principle experiments we demonstrate cross-sectional profiling of layered fluorescence phantoms. Narrow (a few micrometers FWHM) axial point-spread functions, large ranging depths (a few hundreds of micrometers) and wide fields of view (>1 mm) were measured. Initial results suggest that SD-FCT may be a viable tool for the investigation of semi-transparent and selectively labeled fluorescent samples.

Hemangiopericytoma arising from the wall of the urinary bladder

Hemangiopericytoma (HPC) arising from within the urinary bladder is exceptionally rare. A 45-year-old man having the symptoms of left groin pain, vague suprapubic discomfort and frequency was admitted to our clinic. Pelvic tomography revealed a tumor in the bladder wall measuring 4 x 3 cm and was not clearly distinct from the lower abdominal wall. Partial cystectomy was performed and the histopathological examination confirmed the hemangiopericytoma. Three thousand rad exterior beam irradiation was performed after operation. Partial cystectomy and adjuvant radiotherapy may be a simple and effective alternative operation for the patient with HPC.

Sedation as an alternative method to lessen patient discomfort due to transrectal ultrasonography-guided prostate biopsy

BACKGROUND

Despite being highly efficient for the relief of patient discomfort due to transrectal ultrasound (TRUS) guided prostate biopsy, periprostatic anesthesia is occasionally reported to be of limited use. We aimed to evaluate the efficacy of conscious sedation, an accepted method for lessening patient discomfort due to interventional radiological procedures and compare it with periprostatic anesthesia.

METHODS

93 candidates for biopsy were randomised to three groups: group 1 (n = 31) received intravenous midazolam, group 2 (n = 31) received periprostatic lidocaine injection, whereas group 3 (n = 31) received no anesthetic before the procedure. After the biopsy patients were asked to express discomfort by visual anologue scale (VAS).

RESULTS

The mean scores for groups 1 and 2 were significantly lower than that of group 3 (1.4 +/- 1.1 and 2.0 +/- 1.5 versus 4.7 +/- 1.6, respectively; p < 0.05 for both). For patients with VAS scores exceeding 4 (moderate to severe discomfort), a significant difference was calculated between groups 1 and 2 (3% versus 29%, p < 0.05) and between each and group 3 (3% and 29% versus 80%, respectively; p < 0.05 for each).

CONCLUSIONS

Sedation is an alternative for increasing patient comfort during TRUS-guided prostate biopsy, especially in clinical situations like patient anxiety, young age, repeat biopsies or inflammatory anal diseases.

Evaluation of neuronal damage following hypoxic–ischaemic brain injury in acute and early chronic periods in neonatal rats

This study was undertaken to investigate the effects of neonatal cerebral hypoxic-ischaemic brain injury (HIBI) in acute and early chronic phases in the rat. HIBI was induced in 7-day-old rat pups by ligation of the right common carotid and then the pups were exposed to 1 h of hypoxia in 8% oxygen. They were divided into two groups: 1-day (acute phase, in the first 24 h) and 5-day (early chronic phase, 120 h). Neuropathological evaluation was performed using the hippocampus, cerebral cortex and basal ganglia on the coronal plane. The following values were obtained: (i) the ratio of the infarcted area; (ii) hemispheric atrophy/asymmetry; (iii) patchy lesions confined to the thalamus, caudate and putamen; (iv) the ratio of damaged neurons to all neurons; and (v) the percentage of apoptotic neurons relative to the total neurons in all brain areas. HIBI-induced global cerebral damage and cellular damage findings did not significantly differ between the two groups. However, they showed a tendency to recover/deteriorate in both acute and early chronic phases. The ratio of ipsi- and contra-lateral hemisphere infarct areas (20.7 and 15.7% vs. 40.1 and 26.7%, respectively), basal ganglia patchy lesion ratio (27.5 vs. 36.7%) and hemispheric atrophy/asymmetry (92.4 vs. 84.7%) were found to be lower in the rat pups in the chronic phase than those in the acute phase. In contrast, increases in the ratio of damaged neurons (16.7 vs. 13.3% in the cerebral and dorsal hippocampus, respectively) and in the ratio of apoptotic neurons (ipsi-lateral: 18 vs. 6%; contra lateral hemispheres: 3.5 vs. 1.7%, respectively) were recorded. It is concluded that cellular damage tends to deteriorate (damaged and apoptotic neurons) while global damage (cerebral infarct and patchy damage) improves with the progression of HIBI. However, further studies are needed in order to elucidate this process.

Increased frequency of ultrasonographic findings suggestive of renal stones in patients with ankylosing spondylitis

OBJECTIVE

To determine the frequency of hypercalciuria and renal stones in ankylosing spondylitis (AS) sufferers.

METHODS

This study involved 83 consecutive AS patients (21 female, 62 male; mean age 36.7 yr), 72 consecutive Behcet's disease (BD) patients (29 female, 43 male; mean age 37.7 yr) as disease control and 92 healthy control (HC) (26 female, 66 male; mean age 32.9 yr.) Twenty-four hour urine analyses for urinary calcium and uric acid levels were performed in each patient. Likewise, blood samples for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), parathyroid hormone (PTH), calcium and uric acid evaluation were taken. Renal ultrasonography to evaluate the presence of renal stone was performed in patients with AS, as well as in the BD patients and HC individuals after a fasting period of 12 hours.

RESULTS

20 of the 80 (25%) patients with AS were diagnosed with renal stones. Only 4/72 (5.5%) BD patients, and 3/98 (3.3%) HC individuals had renal stones by ultrasonography. AS patients had a significantly higher frequency of renal stones compared with BD (p < 0.001) and HC (p < 0.0001). AS patients with renal stones were much older and their disease duration was much longer in comparison with AS patients without renal stones. Ultrasonographic and laboratory findings did not correlate. The number of AS patients with hypercalciuria who had renal stones was higher than that of AS patients who did not have renal stones (p < 0.01). There was a negative correlation between acute phase response and spinal mobility.

CONCLUSION

Renal stone prevalence was found to increase in AS patients. The likelihood of renal stone formation was also found to increase with the extension of the disease duration of AS sufferers.

Characterization of thermally poled germanosilicate thin films

We report measurements of the nonlinearity profile of thermally poled low-loss germanosilicate films deposited on fused-silica substrates by PECVD, of interest as potential electro-optic devices. The profiles of films grown and poled under various conditions all exhibit a sharp peak ~0.5 microm beneath the anode surface, followed by a weaker pedestal of approximately constant amplitude down to a depth of 13-16 microm, without the sign reversal typical of poled undoped fused silica. These features suggest that during poling, the films significantly slow down the injection of positive ions into the structure. After local optimization, we demonstrate a record peak nonlinear coefficient of ~1.6 pm/V, approximately twice as strong as the highest reliable value reported in thermally poled fused silica glass, a significant improvement that was qualitatively expected from the presence of Ge.

Polymerase chain reaction based detection of Mycobacterium tuberculosis complex in lupus vulgaris: a case report

Lupus vulgaris (LV), the commonest of all forms of cutaneous tuberculosis, can affect the earlobes. Authors present a 20-year-old male patient with LV of the left earlobe initially misdiagnosed as pyoderma and treated superfluously with antibiotics at different intervals over the last 4 years in another hospital. Mycobacteria could not be seen or isolated by stained smears or conventional or radiometric culture methods from the skin biopsy specimens. Suspected clinical diagnosis of our patient was LV. This was supported by positive polymerase chain reaction assay and histological findings. The lesion was treated successfully with anti-tuberculosis chemotherapy, further confirming the diagnosis of LV.

Iterative processing of second-order optical nonlinearity depth profiles

We show through numerical simulations and experimental data that a fast and simple iterative loop known as the Fienup algorithm can be used to process the measured Maker-fringe curve of a nonlinear sample to retrieve the sample's nonlinearity profile. This algorithm is extremely accurate for any profile that exhibits one or two dominant peaks, which covers a wide range of practical profiles, including any nonlinear film of crystalline or organic material (rectangular profiles) and poled silica, for which an excellent experimental demonstration is provided. This algorithm can also be applied to improve the accuracy of the nonlinearity profile obtained by an inverse Fourier transform technique.

[Referred shoulder pain]

Referred pain; feeling pain at a site different than the source of pain; is also included in cancer pain. Mechanisms and treatment of referred pain has been evaluated because of a case with shoulder pain rising from diaphragmatic irritation.

Effects of neurotensin on the healing of experimental anastomosis of the colon

The leakage of colonic anastomoses increases perioperative morbidity significantly. The purpose of the study was to investigate the influence of neurotensin, an intestinal trophic peptide, on the healing of colonic anastomosis. Forty-two Wistar-albino rats were separated into three equal groups: Group 1 (control group)--segmental resection of the left colon and end-to-end anastomosis; Group 2 (dexamethasone group)--resection and anastomosis, plus 0.1 mg/kg/day of dexamethasone; Group 3 (neurotensin group)--same surgical procedure plus 300 micrograms/kg/day of neurotensin. Bursting pressure and tissue hydroxyproline content were determined as parameters of the anastomosis strength and healing on the 3rd and 7th days postoperatively. On the 3rd day, mean bursting pressures were 141.4, 146.7 and 73.1 (p = 0.0001) cm of water in the control group, dexamethasone and neurotensin groups respectively. On the 7th day, bursting pressures were measured as 237.4, 100.6 (p = 0.0001) and 72.7 (p = 10(-6)) cm of water, in the control group, dexamethasone and neurotensin groups respectively. Between the 3rd and 7th days, bursting pressures were increased significantly in the control group (p = 0.0001), decreased in the dexamethasone (p = 0.048), and maintained their lowest values in the neurotensin (p = 0.96) groups. On the 7th day, mean hydroxyproline levels were measured as 9.20, 3.30 (p = 0.007), 2.86 (p = 0.007) micrograms, in the control group, dexamethasone, and neurotensin groups respectively. Between the 3rd and 7th days, tissue hydroxyproline levels were increased significantly in the control group (p = 0.004), decreased in the dexamethasone (p = 0.03), and maintained their lowest values in the neurotensin (p = 0.87) groups. The anastomosis resistance to intraluminal pressure was weak, tissue collagen content was insufficient, and healing was inadequate in the dexamethasone and neurotensin groups in respect to the control group. We concluded that neurotensin impaired the healing, and affected the strength of the colonic anastomosis.

Erythema annulare centrifugum as the presenting sign of CD 30 positive anaplastic large cell lymphoma--association with disease activity

Erythema annulare centrifugum is a figurate erythema that has been associated with many different entities. A case of erythema annulare centrifugum related to non-Hodgkin's lymphoma in a 38-year-old woman is described in this case report. Response of the lymphoma to a combination chemotherapy was accompanied by disappearance of skin lesions. When therapy was discontinued, both disorders recurred, and both responded to reinstitution of a different chemotherapy regimen. To our knowledge, this case is the first reported association of erythema annulare centrifugum and non-Hodgkin's lymphoma in the medical literature.

Evaluation of the effects of different biomaterials on bone defects

Studies concerning natural and synthetic graft materials that have been used in different medical procedures have focused on freeze-dried bone, coral, hydroxylapatite, and tricalcium phosphate. This study histologically investigates the effects of these materials on the healing of bone defects. The experiments were performed on 30 albino rabbits. Cavities were drilled in the posterior right tibias of rabbits and were filled with coral, freeze-dried bone, hydroxylapatite, or calcium hydroxide. One cavity was left unfilled as a control. The bone in which the materials were implanted was excised at 7, 15, 30, 45, and 60 days. After the histological staining procedures, the prepared materials were observed using a light microscope. Although all materials showed good bone remodeling at the end of 60 days, coral and hydroxylapatite materials could be seen in the bone structure. The most effective materials within bone defect improvement were freeze-dried bone and calcium hydroxide.

Disseminated lupus vulgaris and papulonecrotic tuberculid: case report

The incidence of tuberculosis and extrapulmonary forms of this disease is increasing all over the world. Lupus vulgaris is the most prevalent form of cutaneous tuberculosis in Europe and the Middle East. Papulonecrotic tuberculid, the most common form of hyperergic response to mycobacteria or their fragments, is uncommon in children. We report lupus vulgaris with papulonecrotic tuberculid in a 12-year-old girl who had a 3-year history of slowly growing plaques on her trunk, extremities, and the tip of her nose and papuloulcerative lesions over her entire body. A skin biopsy specimen showed minimally caseating granulomatous inflammation. Staining for acid-fast bacilli was negative in both plaques and papules. Polymerase chain reaction identified Mycobacterium tuberculosis DNA in the patient's sputum, gastric fluid, and plaques and was negative in the papules. She was started on antituberculous therapy with four drugs and her lesions responded rapidly.

The risk of coronary heart disease in men with androgenetic alopecia

BACKGROUND

The meaningful association of androgenetic alopecia and coronary heart disease has been well documented, but few studies have focused on the importance of lipid parameters, such as total cholesterol, triglycerides, high density lipoprotein-cholesterol, low density lipoprotein-cholesterol, lipoprotein (a), apolipoprotein A1 and apolipoprotein B in patients with androgenetic alopecia.

OBJECTIVE

The aim of this study is to investigate the relation between androgenetic alopecia and coronary heart disease and to determine the significance of certain lipid parameters on this relationship.

SUBJECTS

Forty-one men with vertex type androgenetic alopecia (study group) and 36 men, age-matched, with normal hair status (control group) were the subjects of this study.

RESULTS

We found significant differences in serum lipoprotein (a) and triglyceride levels between the study and control groups (P < 0.05). Forty-seven percent of patients and 30% of controls had a lipoprotein (a) level more than 30 mg/dl higher than the level critical for atherosclerotic heart disease.

CONCLUSION

Dermatologists should investigate lipid profile, especially lipoprotein (a), of patients with androgenetic alopecia and refer to a cardiologist if necessary.

Tularemia: a case transmitted from a sheep

Tularemia is an arthropod-borne infectious disease caused by Francisella tularensis, a gram-negative microorganism that normally resides in a wide range of wild and domestic animals. The disease is characterized by a sudden onset with high fever, headache, malaise, chills, myalgia, and arthralgia. A short time after exposure, an inflamed and ulcerated lesion rapidly appears at the site of entry. A regional lymphadenopathy follows the cutaneous presentation. Cultures from the lesions or blood generally give negative results. Histopathologic examination reveals either a nonspecific inflammatory infiltrate or an infectious granuloma. The most useful laboratory procedure in the diagnosis of tularemia is serologic tests. Streptomycin, gentamicin, and tetracycline are the drugs of choice in the treatment. Quinolones are also effective. Tularemia is fairly rare in Turkey. We present a typical case of ulceroglandular tularemia transmitted from a sheep to a young man.