Comparison of the effectiveness of liposomal doxorubicin and gemcitabine in patients with platinum-sensitive recurrent ovarian cancer receiving third-line chemotherapy

OBJECTIVE

In this retrospective study, we compared the effectiveness and reliability of the third-line chemotherapies gemcitabine and liposomal doxorubicin, in patients with platinum-sensitive ovarian cancer (OC).

PATIENTS AND METHODS

The retrospective study included platinum-sensitive epithelial ovarian cancer patients who had previously received paclitaxel and carboplatin therapy. Between 2013-2021, cross-matched 45 patients who received gemcitabine and 48 who received liposomal doxorubicin as third-line therapy were compared based on clinicopathological characteristics, biomarkers, and blood cancer antigen (CA) 125 levels. Time to treatment failure, survival, and quality of life were additional objectives.

RESULTS

The study included a total of 93 patients. The reported mean survival durations for treatments, 19.45 months for gemcitabine and 17 months for liposomal doxorubicin, did not statistically significantly differ (p=0.398). The mean CA 125 levels for the liposomal doxorubicin and gemcitabine groups after treatment were 54.4±11.4 U/ml and 54.7±11.1 U/ml, respectively. There was no noticeable difference between the treatments when comparing the postop CA 125 value (p=0.37).

CONCLUSIONS

For both pegylated liposomal doxorubicin (PLD) and gemcitabine as single agents in the third line, our data revealed comparable effectiveness results, and there was no substantial difference in progression-free survival (PFS) for recurrent ovarian cancer. These therapies were tolerated with an expected incidence of hematological toxicities.

A Fatal Case of Acute Thrombotic Occlusion in More Than 3 Epicardial Coronary Arteries Associated with the Yasmin Oral Contraceptive

We report a case of a myocardial infarction (MI) due to multiple culprit vessels in a young woman. MI caused by more than 1 culprit vessel is very rare. Oral contraceptives (OCSs) are used for birth control. Despite a few case reports, the association between the new-generation OCS use and the MI risk remains controversial. A 53-year-old woman who had been consuming combined OCS-Yasmin (30 μg of ethinyl estradiol and 3 mg of drospirenone) for 2 years was admitted to our hospital with chest pain. Her past medical history revealed no coronary risk factors except for smoking. No hemodynamic instability was noted at admission. The admission electrocardiogram revealed slight ST elevations in D1 and aVL leads. An urgent coronary angiography showed distal occlusions in the right coronary, left anterior descending, first diagonal, and left circumflex coronary arteries. Unfractionated heparin and abciximab were administered during the procedure, with the latter continued for 12 hours after the procedure. During the hospital course, the patient complained of recurrent anginal attacks. A repeat coronary angiography demonstrated the persistence of thrombotic occlusions. After 24 hours, she experienced chest pain, and her electrocardiogram revealed diffuse ST elevations with a blood pressure of 60/40 mm Hg. She was urgently transferred to the catheterization laboratory. Multiple balloon inflations with intracoronary alteplase (10 mg over 5-10 min) injections failed to restore coronary flow, and she developed cardiovascular collapse. Despite maximal mechanic and mechanical support, she passed away.

Comparison of different cyclin-dependent kinase inhibitors and KI-67 levels on survival and toxicity in breast cancer treatment

OBJECTIVE

As cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors, which play a crucial role in the cell cycle, palbociclib and ribociclib are two novel drugs that are recently being used in the treatment of breast cancer. Despite targeting the same pathway, these agents have different molecular activities and processes. KI-67 is known to play a significant role in cell proliferation that has been related to prognosis. This study investigated the impact of palbociclib, ribociclib, and KI-67 on toxicity and survival in breast cancer treatment.

PATIENTS AND METHODS

The study included 140 breast cancer patients in total. Patients were divided into groups based on the use of different CDK inhibitors and KI-67 values. Mortality, progression, treatment response rates, frequency, and severity of adverse events were assessed retrospectively.

RESULTS

The patients in our study had an average age of 53.62±12.71 years, and 62.9% of them were diagnosed at an early stage. 34.3% (n=48) of the patients progressed after receiving treatment, while 19.3% (n=27) of the patients died. The median follow-up time was 576 days, the maximum follow-up time was 1,471 days, and the median time to progression was 301 days (min=28-max=713). Mortality, progression, and treatment response rate between two different CDK inhibitors or KI-67 groups revealed no statistically significant differences.

CONCLUSIONS

Our data show a comparison between the effectiveness of palbociclib and ribociclib, and no noticeable difference is found in breast cancer patients' survival, progression, or severity of adverse effects. Likewise, there is no meaningful difference in KI-67 expression subgroups between progression and survival following treatment.

Awareness and obscurity: demystifying genomic profiling in real-world practice for the members of the Turkish Society of Medical Oncology (TSMO)

OBJECTIVE

Molecular testing in oncology practice is increasingly being used to offer more relevant therapies to cancer patients. Our study aims to determine the real-world impact of routine incorporation of molecular testing among the Turkish Oncology community across all types of cancer and identify gaps for the first time.

SUBJECTS AND METHODS

This research was conducted in Turkey among medical oncologists from different backgrounds. The survey attendance was entirely voluntary. A questionnaire with twelve items (multiple choice +/- closed-ended) was utilized in this study to assess the effect of molecular tests in real clinical situations.

RESULTS

102 oncologists with various levels of experience participated in this study. Most of the respondents (97%) reported successful implementation of molecular testing. About 10% of the participating oncologists said they preferred genetic tests at the early stages of cancer, compared to the majority who preferred genetic tests at the terminal stage. Molecular tests are often performed in separate locations and 47% of the oncologists were using a targeted panel specific to the type of malignancy.

CONCLUSIONS

Several informational difficulties must be resolved in order to have early personalized therapy as the standard treatment. We need accessible, comprehensive, and regularly updated databases to compare genetic profiling and its therapeutic implications. We also need to continue educating patients and physicians.

The Role of Cardiac Ganglia in the Prevention of Coronary Atherosclerosis: An Analytical Examination of Cholesterol-fed Rabbits

Background

The heart is innervated by the autonomic nervous system, which contributes to the control of the heart’s rhythm and coronary circulation. It has been suggested that the cardiac fibers of the vagus nerve play important roles in controlling circulatory functions and in protecting against atherosclerotic pathologies in coronary arteries.

Aims

To investigate the presence of atherosclerotic differences in the coronary arteries of cholesterol-fed rabbits by measuring the density of cardiac ganglia neurons.

Study Design

Animal experiment.

Methods

This study was conducted using 45 male rabbits. Over a period of 16 weeks, they were kept on an atherogenic diet of water ad libitum and high fat (8.6%) containing saturated fatty acids with 205 mg/kg of cholesterol (1%) per day. Then, their hearts were removed and examined by histopathological methods. Atherosclerotic plaques of the main coronary arteries were examined using the Cavalieri method. Atherosclerosis index values (AIVs) were estimated as the wall surface area/plaque surface area, and the results were analyzed with the Kruskal-Wallis and Mann-Whitney U tests.

Results

While the average atherosclerosis index value was estimated to be ≤8% in 21 animals, the atherosclerosis index value was 9-20% in animals with minor plaque detection (n=11) and ≥20% in animals with major plaque detection (n=10). Increased atherosclerosis index values were more common in animals with low neuron densities than in animals with high neuron densities (p<0.017).

Conclusion

The low neuron density of the cardiac ganglia in cholesterol-fed rabbits is associated with an increased atherosclerotic plaque incidence and volume.

Wandering Thrombi in the Right Atrium: A Fatal Journey From the Heart to Lungs

•

RHT in transit is a rare medical emergency with a high mortality rate.

•

Optimal therapy is not defined, and treatment selection remains a subject of debate.

•

Thrombolysis has been suggested as a better treatment modality.

Evaluating the Association Between the Three Different Ejection Fraction Measurement Techniques and Left Ventricle Global Strain

Objective

The prognosis of cardiovascular diseases (CVDs) is directly associated with systolic function based on the measurement of ejection fraction (EF), and many studies have indicated that the left ventricular global strain (LVGS) provides better predictivity than the EF measurement in the diagnosis, prognosis, survival, and CVD staging. However, these studies did not investigate the correlation between the EF measurement and the LVGS parameters, or which parameters are better correlated with LVGS, but we analyzed the association between three EF measurement methods and LVGS.

Materials and Methods

This study included 62 patients that applied to the clinic between October 2015 and March 2016. An echocardiography examination of these patients was performed. The exclusion criteria were atrial fibrillation and suboptimal image quality.

Results

Sixty-two patients (the average age 61.0±12.6 years; 56% male and 44% female) were enrolled in the study. A statistically significant association was found between the visual EF and Simpson EF measurements and the LVGS parameters (p<0.001). While the visual EF was moderately correlated with the LVGS parameters (r=0.44), there was a good correlation between the Simpson EF and the LVGS parameters (r=0.710).

Conclusion

In this study, we demonstrate that the Simpson's rule LVEF correlates better with LVGS than the Teicholtz method or visual EF and that it has a better area under the curve value for determining an abnormal LVGS. Therefore, we recommend the use of the Simpson EF for the EF measurement that has a better correlation with the LVGS values in the patients whose ventricle functions should be evaluated.

Evaluation of calcium silicate cement bond strength after using gutta-percha solvents

OBJECTIVES

To determine the effect of different gutta-percha solvents (chloroform, Endosolv E, orange oil, and eucalyptol) on the push-out bond strength of calcium silicate cements (CSCs; white mineral trioxide aggregate [WMTA]; capsule-form mineral trioxide aggregate [CMTA], and Biodentine).

MATERIALS AND METHODS

One hundred and fifty extracted single-rooted human mandibular premolars were sectioned into 3-mm-thick slices. The canal lumens were enlarged for 1.35-mm-diameter standardized cavities. The samples were randomly divided into five groups (n = 30) according to the solvent type: G1, chloroform; G2, Endosolv E; G3, eucalyptol; G4, orange oil; G5, no solvent (control). After application of the solvents for 5 min, the specimens were divided into three subgroups (n = 10): (i) WMTA, (ii) CMTA, and (iii) Biodentine. The push-out bond strength was measured. Two-way ANOVA analysis of variance and post hoc Tukey tests were used for analyses (P = 0.05).

RESULTS

The highest push-out bond strength was observed in the Biodentine (P < 0.05), and the values of WMTA and CMTA were not significantly different in all solvent groups (P > 0.05). There were no statistically significant differences among the gutta-percha solvents and control group in WMTA (P > 0.05).

CONCLUSIONS

Gutta-percha solvents used during retreatment decreased the bond strength of Biodentine and CMTA to root dentin. The bond strength of WMTA was not affected by the use of gutta-percha solvents.

The association of the Syntax score II with carotid intima media thickness and epicardial fat tissue

AIM

Syntax score II (SSII) is a highly predictive scoring system, which is used to improve individualized assessment of patients with complex coronary artery disease and facilitates clinical decision making. Surrogate markers [carotid intima-media thickness (CIMT), epicardial fat tissue (EFT)] are also used for risk assessment, but their relation with SSII is not well established.

METHOD

We enrolled 543 consecutive patients, who underwent coronary angiography for stable angina pectoris and acute coronary syndrome, in the study. SSII was calculated for each patient and the patients were divided into two groups as low SSII group and high SSII group according to their median SSII.

RESULTS

The average age of the patients was 61.4 years and 75% of the patients were male. The multivariate analysis indicated that only EFT (p: 0,035), CIMT (p:0,04) and Hypertension (HT) (p: 0,014) were independently associated with high SSII.

DISCUSSION

EFT and CIMT, the surrogate markers which can be simply and non-invasively determined, are of the independent predictors of high SSII. The inclusion of these parameters in the risk classification may provide additional clinical benefit.

Coronary fat embolism following subarachnoid hemorrhage: an experimental study

BACKGROUND

Subarachnoid hemorrhage (SAH) can lead to neurogenic pulmonary edema (NPE), and chylomicron metabolism may be altered unfavorably in acute lung injury. This study aimed to investigate the possible effect of NPE on the development of coronary fat embolism.

METHODS

This study was conducted on 27 rabbits, 5 of which were used as the control (n=5). Experimental SAH was induced in 15 of the animals by injecting homologous blood into the cisterna magna, and the remaining 7 animals were administered only isotonic saline solution (Sham, n=7) in the same manner under general anesthesia. After 21 days, all the animals were euthanized, and their hearts, lungs, and brains underwent histopathological examination.

RESULTS

Six animals died of SAH during the experiment, and foamy hemorrhagic parenchymal lesions and intra-alveolar hemorrhage were observed in their lungs. The histopathologic findings revealed minimal changes in the lungs, heart, and brains of the surviving animals; however, an abundant amount of fat globules was found in the coronary arteries of the six nonsurviving animals. There was a meaningful difference between the number of occluded coronary arteries with fatty globules in the surviving and nonsurviving animals (P<.001). However, the difference between the survivors and the isotonic-saline-injected group was not meaningful (P>.05). Coronary fat embolism was an important mortality factor following SAH (P<.005).

CONCLUSIONS

In SAH-induced NPE, the leakage of chylomicrons into the systemic circulation may lead to coronary fat embolism, which has not yet been reported in the literature.

Effects of Trimetazidine on Lipid Peroxidation, Antioxidant Enzyme Activities and Plasma Brain Natriuretic Peptide Levels in Patients with Chronic Cor Pulmonale

An oxidant/antioxidant imbalance in favour of oxidants appears to occur in chronic cor pulmonale (CCP). Oxidative stress could also be a critical event in the pathogenesis of this condition. Trimetazidine (TMZ) has antioxidant properties and may affect the utilization of oxygen radicals. We investigated the effect of TMZ (20 mg three times daily, orally) on activities of erythrocyte malondialdehyde (MDA) and catalase (eCAT), erythrocyte and plasma glutathione peroxidase (GSH-Px) and plasma superoxide dismutase (pSOD) in CCP patients. We also assessed changes in plasma levels of brain natriuretic peptide (BNP) with TMZ therapy.

Sixty CCP patients with significantly higher MDA and markedly lower pSOD, eCAT and GSH-Px (erythrocyte) activities than 24 healthy controls were randomly allocated to receive routine treatment or routine treatment plus TMZ. After 3 months' therapy, greater pSOD, eCAT and GSH-Px (erythrocyte and plasma) activities and lower MDA activity were found with TMZ treatment compared with routine treatment. Plasma BNP levels were significantly lower in TMZ-treated patients and higher in the routine treatment group than in the control group. TMZ improved antioxidant levels, decreased oxidative stress and decreased plasma BNP levels in CCP patients.

Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization

BACKGROUND

Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models.

METHODS

A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn't specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy.

RESULTS

After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery.

CONCLUSION

The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.

The correlation of ECHO findings of right cardiac pathologies with BNP, uric acid, and CRP in OSAS

BACKGROUND/AIM

Right cardiac pathologies develop in patients with obstructive sleep apnea syndrome (OSAS) and in most patients there are no symptoms in the early stages of right cardiac disorders. We aimed to evaluate a possible relationship between B-type natriuretic peptide (BNP), blood uric acid, C-reactive protein (CRP), and the right cardiac pathologies in patients with OSAS, and the role of these parameters in the management of patients with OSAS.

MATERIALS AND METHODS

A total of 98 subjects, 31 (31.6%) controls and 67 (68.4%) with OSAS, were included in the study. All the subjects underwent polysomnography, and standard and tissue Doppler echocardiography (ECHO) examinations. BNP, CRP, and blood uric acid levels were measured in all patients.

RESULTS

Upon evaluating the relationship between BNP and ECHO parameters, BNP levels were found to positively correlate with such ECHO parameters as pulmonary artery pressure. As for the association between CRP and ECHO findings, RV diameter exhibited a statistically significant positive correlation with them. Moreover, uric acid was found to statistically correlate positively with right atrium dimensions.

CONCLUSION

BNP, CRP, and blood uric acid levels can be used as adjunctive parameters in the early diagnosis and follow-up of right heart pathologies in patients with OSAS.

Severity of mitral stenosis and left ventricular mechanics: a speckle tracking study

BACKGROUND

It has been shown that mitral stenosis (MS) impairs left ventricular (LV) systolic function; however, this issue has not been studied comprehensively. We aimed to evaluate the role of 2D strain in the assessment of subclinical LV systolic dysfunction in patients with MS.

METHODS

Seventy-two patients with isolated MS (mild, moderate and severe) and 31 healthy control subjects constituted the study population. 2D echocardiography images were obtained from LV apical 4-chamber (4C), long axis (LAX), and 2-chamber (2C) views. Peak longitudinal strain and strain rate (Sr) were obtained from 4C, LAX, and 2C views. Global strain and Sr were calculated by averaging the three apical views.

RESULTS

There were no significant differences in LV ejection fraction and LV systolic or diastolic dimensions between the groups. Patients with MS had significantly lower LV longitudinal strain and Sr measurements than the control group. In addition, there were no significant differences in MS subgroups with respect to LV strain and Sr measurements.

CONCLUSION

We demonstrated that patients with MS had lower LV functions using 2D strain imaging, and this is independent of the hemodynamic severity of MS. In the detection of subclinical LV dysfunction in patients with MS, 2D strain imaging appears to be useful.

Effects of hypertension and ovariectomy on rat hepatocytes. Are amlodipine and lacidipine protective? (A stereological and histological study)

BACKGROUND/AIMS

Calcium channel blockers are increasingly used for the treatment of hypertension. Menopause and hypertension are both important risk factors for liver damage and several other circulatory abnormalities. The aim of this study was to determine the effects of amlodipine and lacidipine in an ovariectomy-induced postmenopausal period model and a deoxycorticosterone acetate-salt-induced hypertensive model in rats.

METHODS

In this study, animals were divided into six groups as follows: control (Group 1), hypertension (Group 2), ovariectomy (Group 3), ovariectomy and hypertension (Group 4), ovariectomy, hypertension and amlodipine-treated (Group 5), and ovariectomy, hypertension and lacidipine-treated (Group 6). At the end of the experiment, the livers were removed and tissue samples were histologically and stereologically examined.

RESULTS

The numerical densities of the hepatocytes according to group were 0.000422, 0.00329, 0.000272, 0.00259, 0.00374 and 0.000346 μm3, respectively. Significant differences were found between values of all groups (p<0.01, Mann-Whitney U test). According to histopathological investigation, Group 3 and particularly Group 4 showed some microscopic abnormalities such as dilatation in sinusoids central veins and branches of portal vein, irregularities of the hepatocyte columns, significant mononuclear cell infiltrations, and unstained vacuoles in the cytoplasm of the hepatocytes. Histological structure was protected from the destructive effects of ovariectomy and hypertension in Groups 5 and 6.

CONCLUSIONS

Our experimental results show that both hypertension and the postmenopausal period have negative effects on the number of hepatocytes and histological structure of the liver. Both amlodipine and lacidipine appear to ameliorate the hypertension and/or postmenopausal period-related decrease in hepatocyte number. We thus suggest that lacidipine and particularly amlodipine have important protective and recovering effects on the liver.

Antihypertensive role of glossopharyngeal nerve stimulation by nifedipine using as calcium channel blocking agent in hypertension: an experimental study

Nifedipine is a therapeutic drug in acute attacks of hypertension because of its rapid absorption from oral mucosa. Taste receptors are innervated by glossopharyngeal nerves (GPN) as well as by facial and vagal nerves. Sensory neurons of the GPNs are localised in the petrous ganglion (PG). Transection of the taste sensitive GPN fibres causes taste bud and PG degeneration and spontaneous hypertension. In this study, the role of chemical stimulation of the taste buds of the GPN by nifedipine and its role in treatment of hypertension were investigated in rabbits. Nifedipine was dropped sublingually (20 mg) for 4 days in the study group, followed by measuring blood pressures again. Then, the lingual branches of GPNs were cut. One month later, blood pressures were measured for 4 days. All animals were sacrificed humanely at the end of the experiment, and normal and degenerated neuron densities in the petrosal ganglions were enumerated stereologically. The antihypertensive effect of nifedipine decreased after GPNs denervation, in accordance with the increase of degenerated neurons in the PG. The chemical stimulation of taste buds of the GPNs by nifedipine may be an important effect of nifedipine application in addition to its calcium channel blocking effect. The rapid decrease in blood pressure following sublingual use of nifedipine may also result from the direct stimulation of taste buds innervated by the GPNs.

Left atrial myxoma and concomitant atherosclerotic coronary artery disease

Here we describe the case of a 71-year-old female patient who was admitted to our department with acute coronary syndrome. Trans-thoracic echocardiography evaluation to assess left ventricular functions incidentally detected a left atrial mass attached to the inter-atrial septum together with a left ventricular segmental wall motion abnormality due to acute anterior myocardial infarction. Coronary angiography revealed diffuse coronary artery disease. Because early surgery was not advised due to the high mortality risk, successful coronary angioplasty and stenting was performed in this emergecy situation. It may be informative to study the images from the echocardiography prior to angiography in this study as well as to determine the anticipated signs that may affect the treatment options for similar patients.

Inferior pancreaticoduodenal artery false aneurysm: a rare cause of gastrointestinal bleeding diagnosed by three-dimensional computed tomography

We report a 57-year-old man who presented with a two-month history of persistent epigastric pain associated with indigestion, weight loss and jaundice. Contrast-enhanced computed tomography revealed a large pseudoaneurysm 87 mm x 68 mm in diameter, with its origin from the inferior pancreaticoduodenal artery of the superior mesenteric artery and in continuity with an ectatic gastroduodenal artery. The aneurysmal mass exerted direct pressure over the head of the pancreas, common bile duct and duodenum, causing obstruction. Non-selective abdominal angiography confirmed the aneurysm stemming from the inferior pancreaticoduodenal artery. Because of the obstructive symptoms and the size of the aneurysm, surgery was planned, but the patient refused and died from massive gastrointestinal bleeding one month later.

Destructive effect of monopolar electrocautery knife usage on femoral artery endothelium during spine surgery: experimental study

OBJECTIVE

Circulatory disorders are observed in the lower extremities of some patients after spinal surgery when a monopolar electrocautery knife (MEK) is used. Despite known the knowledge that electric currents can be hazardous to living tissues, MEK has been widely used in spine surgery. In this study, we investigated if MEK can cause endothelial injury in femoral arteries (FA).

MATERIALS AND METHODS

Eighteen rabbits were included in this study, two of which were used as the reference group. The remaining animals were subjected to paravertebral soft tissue dissection along levels L1-L4. Half of the animals were dissected with MEK, and the other half were dissected with scissors and bipolar cautery. One month after the surgery, endothelial changes of the FAs were examined stereologically.

RESULTS

Endothelial desquamation, cytoplasmic and nuclear condensations, cellular shrinkage and cellular loss were developed in the FAs of the MEK group. The endothelial cell density was 270 cells/mm2 in normal animals, 240 cells/mm2 in the non- MEK group and 190 cells/mm2 in the MEK group. The difference between the non-MEK and normal groups was not meaningful (P>0.05). The difference between the MEK and non-MEK groups was statistically significant (P<0.05); differences between the MEK and normal animals were even more significant (P<0.001).

CONCLUSION

Sharp dissection with MEK can have a detrimental effect on the endothelial cells of the FAs and cause postoperative circulatory disorders in the lower extremities. Therefore, long-term high-voltage electrocauterization should be avoided during spinal surgery unless absolutely necessary.

Mitral valvular cyst mimicking a solid mass: misdiagnosis with imaging modalities

This report describes a mitral valvular cyst mimicking a solid mass in an 80-year-old patient. The diagnosis was based on histopathological evaluation of the resected material. This report emphasizes the possibility of misdiagnosis by echocardiographic and other imaging modalities of a mitral valvular mass in a patient without any clinical signs and symptoms.

The serum high-sensitive C reactive protein and homocysteine levels to evaluate the prognosis of acute ischemic stroke

Ischemic stroke is one of the most common causes of death worldwide and is most often caused by thrombotic processes. We investigated the changes in hsCRP and homocysteine levels, two of these risk factors, during the acute period of ischemic stroke and evaluated the relationship between these levels and the short-term prognosis. HsCRP and homocysteine levels were measured at the 2nd, 5th, and 10th days in forty patients admitted within second of an ischemic stroke. The clinical status of the patients was simultaneously evaluated with the Scandinavian stroke scale. The results were compared with 40 healthy control subjects whose age and sex were matched with the patients. The mean hsCRP levels of the patients were 9.4 ± 7.0 mg/L on the 2nd day, 11.0 ± 7.4 mg/L on the 5th day, and 9.2 ± 7.0 mg/L on the 10th day. The mean hsCRP level of the control subjects was 1.7 ± 2.9 mg/L. The mean hsCRP levels of the patients on the 2nd, 5th, and 10th days were significantly higher than the control subjects (P < .001). The patients' mean homocysteine levels were 40.6 ± 9.6 μmol/L on the 2nd day, 21.7 ± 11.1 μmol/L on the 5th day, and 20.7 ± 9.2 μmol/L on the 10th day. The mean homocysteine level of the control subjects was 11.2 ± 1.1 μmol/L. The homocysteine levels of the patients were higher than the control subjects at all times (P < .01). In conclusion, patients with stroke have a higher circulating serum hsCRP and homocysteine levels. Short-term unfavorable prognosis seems to be associated with elevated serum hsCRP levels in patients with stroke. Although serum homocysteine was found to be higher, homocysteine seems not related to prognosis.

The role of adrenomedullin and brain natriuretic peptide levels in acute rheumatic fever in adults

OBJECTIVE

Rheumatic fever, a multisystem disease following infection with group A beta-hemolytic streptococcus, is common among young (5-15 years) but can occur in adults as well. Recently, brain natriuretic peptide (BNP) has been validated as a marker of cardiac function and prognosis. Plasma adrenomedullin (ADM) levels are elevated in various pathological states including cardiovascular and inflammatory diseases. We aim to assess the relationship between ADM and BNP levels in adult patients with acute and convalescent rheumatic fever (ARF).

METHODS

This case -controlled prospective study included 45 patients with ARF (mean age 21.04+/-1.91 years) and 30 age/gender-matched control subjects. Brain natriuretic peptide and adrenomedullin levels were studied in the acute and convalescent phase of ARF. Adrenomedullin was detected by enzyme immunoassay kit of peptides, while brain natriuretic peptide was measured by a commercially available instrument. The study was carried out between May 2006 and October 2006 in Atatürk University Medical Faculty Hospital. Statistical analysis was performed using Shapiro-Wilk, Mann Whitney U, Wilcoxon signed rank, Chi-square tests and Pearson correlation analysis.

RESULTS

Plasma ADM and plasma BNP levels were significantly higher (p<0.05) in adults with ARF, regardless of whether they were in acute or convalescent phase of disease. Plasma ADM levels were 74.43+/-3.4 pmol/mL in acute phases, 59.35+/-1.45 pmol/mL in the convalescent phase, and 44.79+/-13.12 pmol/mL in control group. Plasma BNP levels were 197.51+/-47.41 pg/mL in the acute phase, 145.25+/-51.25 pg/mL in the convalescent phase, and 33.45+/-10.42 pg/mL in control group. The differences were statistically significant for all (p<0.05). Plasma ADM and BNP levels in the acute phase of disease showed significant negative correlation with the left ventricular ejection fraction (r=-0.56, p<0.05 and r=-0.61, p<0.05, respectively).

CONCLUSION

In patients with acute and convalescent rheumatic fever, BNP and ADM levels were high compared to those of healthy subjects and this could be used as a complementary tool in the treatment and prognosis of ARF.

Vascular mechanism of axonal degeneration in peripheral nerves in hemiplegic sides after cerebral hemorrhage: An experimental study

Background

Though retrograde neuronal death and vascular insufficiency have been well established in plegics following intracerebral hemorrhage, the effects of plegia on arterial nervorums of peripheral nerves have not been reported. In this study, the histopathological effects of the intracerebral hemorrhage on the dorsal root ganglions and sciatic nerves via affecting the arterial nervorums were investigated.

Methods

This study was conducted on 13 male hybrid rabbits. Three animals were taken as control group and did not undergo surgery. The remaining 10 subjects were anesthetized and were injected with 0.50 ml of autologous blood into their right sensory-motor region. All rabbits were followed-up for two months and then sacrificed. Endothelial cell numbers and volume values were estimated a three dimensionally created standardized arterial nervorums model of lumbar 3. Neuron numbers of dorsal root ganglions, and axon numbers in the lumbar 3 nerve root and volume values of arterial nervorums were examined histopathologically. The results were analyzed by using a Mann-Whitney-U test.

Results

Left hemiplegia developed in 8 animals. On the hemiplegic side, degenerative vascular changes and volume reduction in the arterial nervorums of the sciatic nerves, neuronal injury in the dorsal root ganglions, and axonal injury in the lumbar 3 were detected. Statistical analyses showed a significant correlation between the normal or nonplegic sides and plegic sides in terms of the neurodegeneration in the dorsal root ganglions (p < 0.005), axonal degeneration in the lumbar 3 nerve roots (p < 0.005), endothelial cell degeneration in the arterial nervorums (p < 0.001), and volume reduction in the arterial nervorums (p < 0.001).

Conclusion

Intracerebral hemorrhage resulted in neurodegeneration in the dorsal root ganglion and axonolysis in the sciatic nerves, endothelial injury, and volume reduction of the arterial nervorums in the sciatic nerves. The interruption of the neural network connection in the walls of the arterial nervorums in the sciatic nerves may be responsible for circulation disorders of the arterial nervorums, and arterial nervorums degeneration could result in sciatic nerves injury.