Knowledge and attitude changes of pregnant women regarding prenatal screening and diagnostic tests after counselling

OBJECTIVES

This study aimed to reveal the knowledge level of pregnant women about prenatal diagnostic tests, Down syndrome (DS) and amniocentesis, their attitudes toward uptaking these tests, undergoing amniocentesis, and the termination of pregnancy. It also aimed to evaluate the effects of providing information, as well as a written information brochure about all the issues concerning women's knowledge and attitudes.

MATERIALS AND METHODS

The gynecologists provided verbal and written information on prenatal screening tests (PSTs) and invasive prenatal diagnostic tests. Data were collected using an anonymous questionnaire, which was designed by the researchers on the basis of the literature.

RESULTS

Knowledge of both DS and amniocentesis was found to be significantly higher after the education (p = 0.000 and p = 0.000, respectively). Attitudes toward amniocentesis changed significantly after the education.

CONCLUSIONS

This study has shown that women had an inadequate knowledge about PSTs, DS, and amniocentesis. It has also revealed that education provided by gynecologists along with a written brochure of information tended to increase women's knowledge about PSTs.

A case of fever of unknown origin: necrotizing sarcoid granulomatosis

Necrotizing sarcoid granulomatosis is a rare type of vasculitis; its etiology and pathogenesis are still unknown. The disease primarily affects the lungs, although extra-pulmonary involvement has been reported. The typical symptoms are cough, chest pain, dyspnea, and weight loss; high temperatures have been reported in rare cases. We present the case of a 65-year-old woman who was diagnosed with lymph node tuberculosis, for which she received treatment for six months. The patient experienced no improvement in her symptoms, which included fever, weakness and dyspnea. A re-evaluation of previously collected thoracoscopic biopsy material revealed compatibility with necrotizing sarcoid granulomatosis.

Prevalence of advanced histologic features in diminutive colon polyps

BACKGROUND/AIMS

Accurate in vivo differentiation of colon polyp histology may serve to prevent the resection of diminutive hyperplastic polyps in the distal colon or the need for histologic assesment of diminutive polyps after resection. The clinical implementation of these strategies depends on the prevalence of advanced histologic findings among diminutive polyps. We aimed to determine the prevalence of advanced histologic features (villous features, high-grade dysplasia, and adenocarcinoma) in diminutive colon polyps and compare it to small and larger polyps.

PATIENTS/METHODS

The data of patients who had undergone elective colonoscopy at a tertiary-care referral center were retrospectively reviewed. The size, morphology, and location of all polyps were recorded. Polyps were divided into 3 groups according to their size: diminutive (≤ 5 mm), small (6-9 mm), and large (≥ 10 mm).

RESULTS

A total of 7160 polyps in 3226 eligible patients were evaluated. The mean diameter of the polyps were 6.7 ± 4.9 mm. Histopathologic diagnosis were adenomatous in 4548 (63.5%) and non-adenomatous in 2612 (36.5%). Out of 7160 polyps, 4902 (68.5%) were diminutive (1-5 mm), 1360 (19%) were small (6-9 mm), and 898 (12.5%) large (≥ 10 mm) polyps. Among the diminutive polyps 2739 (55.9%) had adenomatous histology. There were 66 polyps (1.3%) with advanced histology in the diminutive group, 72 (5.2%) in the small group, 263 (29.2%) in the large polyp group. Diminutive polyps had a lower frequency of advanced histology compared to small and large polyps (p = 0.001). When the histology of the polyps were evaluated based on the size of the largest polyp the patient has, 2202 patients had polyp(s) ≤ 5 mm. The frequency of advanced histology was 2.2% in these patients.

CONCLUSIONS

The prevalence of advanced histology in diminutive polyps is quite low (1.3%) which supports the clinical implementation of discard, resect and discard strategies in diminutive polyps.

Is endorectal ultrasound still useful for staging rectal cancer?

OBJECTIVE

Staging in rectal carcinoma is important for planning treatment. Preoperative staging and treatment strategies have changed along with improvements in imaging techniques. The aim of this work is to evaluate the accuracy of endorectal ultrasound (ERUS) in rectal cancers, especially in low rectal cancers and stenotic cases.

PATIENTS AND METHODS

From January 2011 to December 2011, patients diagnosed with rectal cancer who were admitted to our endosonography unit for staging and who were operated on in our hospital were evaluated retrospectively. Patients who received neoadjuvant chemotherapy were excluded. Endosonographic staging was compared to postoperative pathological staging.

RESULTS

In total, 38 patients (28 males, 10 females) were included. Their mean age was 57.6±11.3 years (27-75 years). Thirteen (34.2%) had stenotic lesions. The accuracy of ERUS for staging of lesions was evaluated according to pathology and was 73.7% overall (kappa coefficient = 0.317; p = 0.002). When patients were split into stenotic and non stenotic groups, the accuracy was 68% (kappa coefficient = 0.170; p = 0.125) for stenotic lesions and 84.6% (kappa coefficient = 0.606; p = 0.001) for non-stenotic lesions. Internal and external sphincter involvement were significantly correlated with the postoperative pathological evaluation in both groups.

CONCLUSIONS

Technological improvements in imaging methods have made the diagnosis and management of malignancies more precise. Low rectal tumours, have difficult characteristics for evaluation because of their unique location. Although ERUS has some disadvantages, it is still useful for T staging, evaluating sphincter involvement, and defining tumour size and distance from the anal verge. ERUS was less accurate for T staging of stenotic tumours, but the accuracy may still be within acceptable limits.

Do cigarette smoke and vitamin E affect the development of endometrial pinopods? An animal study

OBJECTIVES

To study the effects of cigarette smoke and vitamin E on the development of endometrial pinopods.

STUDY DESIGN

Eighteen female and 12 male Swiss albino mice, 12-14 weeks old, with a mean weight of 25g (standard deviation 5g) were used in this study. Female mice were divided into three equal groups. Every day for 10 weeks, mice in Group 1 (control group) received normal saline intraperitoneally; mice in Group 2 were exposed to smoke from 20 cigarettes/day using a smoke machine; and mice in Group 3 were exposed to smoke from 20 cigarettes/day using a smoke machine and also received 50mg/kg vitamin E intraperitoneally. After 10 weeks, vaginal smears were taken from the female mice and they were copulated with the 12 male Swiss albino mice on the day of oestrus. Day 0 was defined as the day on which sperm were detected in the vagina by smear test. Mice were killed at the end of Day 5, which was considered to represent the optimal day for implantation. The uteri were removed and the effects of cigarette smoke and vitamin E on the development of endometrial pinopods were studied using an electron microscope.

RESULTS

The endometrial tissue of the control group appeared morphologically normal, with short microvilli, cytoplasm and pinopods in the form of cytoplasm and cell membrane enlargements in patches. In total, 149 pinopods were counted in the control group using a scanning electron microscope (two histologists performed the analysis and were blinded to each other's findings). In the smoke-exposed group, the cytoplasmic structure was degenerated considerably, and fewer pinopods were counted (n=11). The number of pinopods in mice who were exposed to cigarette smoke and vitamin E (n=67) was significantly higher compared with the cigarette-exposed group (p=0.002), but considerably lower compared with the control group (p=0.002).

CONCLUSION

Smoke exposure led to a significant decrease in the development of endometrial pinopods. Vitamin E, an antioxidant, partially reversed the adverse effects of cigarette smoke. This suggests that cigarettes may have a negative effect on fertility by decreasing the number of pinopods. However, this negative effect can be reduced using vitamin E. More studies should be conducted to support this finding.

Spontaneous rupture of fetal hydronephrosis: case report

Hydronephrosis is the most common congenital anomaly observed with prenatal ultrasonography. Ureteropelvic junction obstruction (UPJO) is the most common cause of prenatal hydronephrosis. Spontaneous rupture has been reported in adults with severe hydronephrosis. There is no reported spontaneous rupture case in the fetus in the literature. A spontaneous ureteral rupture due to severe UPJO was reported in this case report. Prenatal ultrasound at 33 week gestation in a 21-year-old pregnant woman, revealed a female fetus with grade IV hydronephrosis of the right kidney, suggestive of a UPJO. During the follow-up at XXXVIII week, 5 cm cystic structure was not observed in right kidney. Mild ectasia was present in pelvicalyciel part which make us think about spontaneous rupture. Ultrasonographic examination after a week post-delivery revealed 15 mm pelvicalyciel ectasia on right side which persisted during the second control after 1 month. Vesicoureteral reflux was not detected during voiding cystourethrogram. Diuretic renography revealed loss of right renal function completely. Because there was not any complain or any clinical sign, surgery was not thought. Spontaneous follow-up was recommended.

Role of enoxaparin resistance in recurrent chest pain in the intensive care unit

To investigate the relationship between anticoagulation treatment and drug resistance in chest pain, levels of factor Xa residual activity were determined in patients seen in intensive care with recurrent chest pain and compared with levels in patients who had no ischaemic events during hospitalization. A total of 122 patients aged 18 - 75 years who were admitted to hospital with acute coronary syndrome and treated with enoxaparin were included. Of these, 62 patients had recurrent chest pain while hospitalized (group A) and 60 patients had an uneventful follow-up period (group B). Patients requiring primary percutaneous transluminal coronary angioplasty and/or treatment with glycoprotein IIb/IIIa inhibitors, and those with renal failure, a high risk of bleeding or receiving anti-inflammatory drugs were excluded from the study. Median levels (+/- interquartile range) of factor Xa residual activity were significantly higher in group A compared with group B (0.68 +/- 0.29 IU/ml versus 0.34 +/- 0.33 IU/ml). It is concluded that enoxaparin resistance, resulting in high levels of factor Xa residual activity, should be considered in patients with recurrent ischaemia.

Bilateral Drop-Foot After Orthotopic Liver Transplant

Patients may demonstrate various neuromuscular abnormalities after liver transplantation. We report a patient who developed bilateral drop foot after orthotopic liver transplantation. He was diagnosed with critical illness polyneuropathy. During follow-up, his complaints gradually recovered and his electrodiagnostic findings improved.

Fulminant hepatic failure due to secondary amyloidosis

Systemic amyloidosis frequently involves liver, however, clinically apparent liver disease is rare and, if observed, is usually mild. Rarely, primary amyloidosis may present with evidence of portal hypertension or hepatic failure. Although secondary amyloidosis may involve the liver and rarely causes liver pathologies such as cholestatic hepatitis and portal hypertension, to our knowledge, hepatic failure due to secondary amyloidosis has been reported once before. Herein, we presented a woman with subacute fulminant hepatic failure who had no known history of a chronic disease other than episodes of urinary tract infection, and secondary amyloidosis was diagnosed with post-mortem liver biopsy.

Powerful morphometric indicator of prognosis in lupus nephritis

BACKGROUND

Changes in renal biopsies in lupus nephritis have been analysed in many ways, but few have had prognostic value.

AIM

To see whether a morphometric measure of chronic renal damage that was a prognostic indicator in other conditions had similar value in lupus nephritis.

DESIGN

Retrospective analysis of biopsies and study of outcome.

METHODS

On sections of 260 biopsies from 182 consecutive patients with systemic lupus erythematosus, an image analysis system measured chronic damage as a proportion of cortical area, to give the index of chronic damage. This was related to survival (until death or onset of dialysis). Patients were followed for up to 20 years.

RESULTS

The index of chronic damage ranged from 0 to 93%. Twenty-three patients (13%) died before dialysis, many from infection or myocardial infarction, and 40 (22%) went onto permanent dialysis. There were strong correlations between the index and time until death or dialysis (log rank test: chi(2) = 51.08, three degrees of freedom [df], p < 0.001) and time to dialysis (log rank test: chi(2) = 72.88, 3df, p < 0.001), but there was no correlation with time until death before dialysis (log rank test: chi(2) = 0.36, 3df, p > 0.9). WHO class of nephritis had no major relation to outcome after the index was taken into account and after appropriate treatment of the different classes.

DISCUSSION

The index was a strong indicator of risk of progression to renal failure in lupus nephritis, but not of risk of death before dialysis. This will be useful in clinical management and treatment trials.

Sonographic findings in intussusception caused by a lipoma in the muscular layer of the colon

Lipomas of the gastrointestinal tract are uncommon tumors. Almost all gastrointestinal lipomas are submucosal or subserosal, and most are asymptomatic, although they may cause abdominal pain, bowel obstruction, and gastrointestinal bleeding. The diagnosis of gastrointestinal lipoma is usually not made before surgery. We present a case of colonic intussusception caused by a lipoma that was located in the muscular layer of the colon and was diagnosed preoperatively by sonography. The descending colon appeared edematous and thick. There was layering within the lumen of the descending colon, mimicking the target sign. At the distal end of the intussusception, there was a 4.7-cm, hyperechoic, rounded lesion with a smooth margin. Surgery revealed a polypoid mass originating from the splenic flexure and causing intussusception of the colon, and pathologic analysis confirmed the diagnosis of lipoma of the muscular layer of the colon.

Secretory breast carcinoma in a boy

Secretory breast carcinoma is a very rare condition in boys. An 11-year-old boy with secretory breast carcinoma is presented here. Modified radical mastectomy was performed by irradiation and chemotherapy because of axillary metastasis. There was no local recurrence or distant metastases in the follow-up period of 14 months.

Thyroid function: fetal-maternal relationship at term

The present study was undertaken to examine serum parameters of thyroid function at term in normal pregnant women and their normal fetuses. Paired sera from 56 mothers and their respective newborn infants' umbilical cord were obtained at parturition. Maternal and fetal TSH, FT4, T4, FT3 and T3 levels were measured and the differences between these two groups were analysed. The levels of fetal serum TSH (8.86 +/- 5.82 IU/ml) were significantly higher than maternal TSH levels (3.32 +/- 3.3 IU/ml) (P < 0.001), but there was no significant difference between the fetal and maternal T4, FT4 and T3. On the other hand, cord FT3 levels (1.7 +/- 1.2 pg/dl) were significantly lower than maternal levels (2.7 +/- 1.4 pg/dl) (P < 0.001).