A Decrease in Lactobacilli in the Vaginal Microbiota Is Independently Associated With HPV Persistence in Women With High-Risk HPV Infection

Background Vaginal dysbiosis, an imbalance between species, can initiate some local changes in immune and metabolic signaling causing chronic inflammation. The mechanism of the clearance or progression of the HPV infection has not been uncovered yet. We hypothesized that vaginal dysbiosis may contribute to the persistence of the cervical HPV infection. Therefore we aimed to determine the association of lactobacillus dominancy index with cervical HR-HPV persistence. Methods A total of 100 women who were followed up because of high-risk HPV infection were defined as the target study group. The patients were evaluated in two groups; HPV positive (group with HPV persistence, n=43) and HPV negative (group with HPV clearance, n=57). Cervicovaginal swab samples and blood samples were evaluated for Nugent score, lactobacillus dominance, and white blood cell count. Statistical tests were performed by the IBM Statistical Product and Service Solutions (version 22, IBM SPSS Statistics for Windows, Armonk, NY) program. The continuous variables were presented using the mean±standard deviation (SD), and the categorical variables were presented as the number of cases and their percentage. A p value less than 0.05 (<0.05) was set as statistically significant. Results HPV persistence was observed in 43 (43%) patients. Univariate analysis revealed that age, menopausal status, and lactobacillus reduction were associated with HPV persistence (p<0.05). The median value of the Nugent score was similar among groups. After logistic regression analysis, lactobacillus reduction continued to be associated with HPV persistence, independent of age and menopause (OR: 2.668, 96% CI: 1.069-6.662, p<0.05) Conclusions A decrease in lactobacilli in the cervicovaginal microbiota is associated with the persistence of HPV, regardless of age and menopausal status in this study.

Is the Anal Component of the Anogenital HPV-Related Disease Overlooked During the Surveillance of Patients Treated for Cervical Intraepithelial Neoplasia?

AIM

To investigate the anal component of the anogenital Human Papillomavirus (HPV) related disease during surveillance of patients treated for cervical intraepithelial neoplasia (CIN).

METHODS

Patients were analyzed within two groups according to the histopathological examination of the cervical biopsies: Low-Grade Squamous Intraepithelial Lesion (LSIL) and High-Grade Squamous Intraepithelial Lesion (HSIL) groups. Anal specimens were also collected in the first-year follow-up visit.

RESULTS

All patients had cervical high-risk HPV (HR HPV) infection at admission. At the first-year follow-up, positive HR HPVs were found in 47% of cervical samples. Despite this clearance, the anal HPV infection rate after the first year was 42.5% and 39.6% in LSIL and HSIL groups. Amongst the HSIL group, anal HR HPV positivity was observed in 29.6% of cases without any cervical HPV infection.

CONCLUSION

A group of women cured of high-grade lesions have ongoing anal HPV infection. It is reasonable to propose that detecting anal HPV could impact the patient's treatment process. Therefore, prospective studies are needed to investigate this group of women's clinical outcomes and define the clearance rate of cervical HPV infection when anal HPV persists.

The association of polypoid growth pattern with lymph node involvement in endometrioid type endometrial adenocarcinoma

Background

Tumor size is an independent predictor of lymph node metastasis and survival in the endometrioid type endometrial adenocarcinoma (EC). However, some of the ECs tend to grow towards the cavity in the polypoid pattern, which can reach very large sizes. In this study, we aimed to analyze the association of growing in the polypoid pattern of the tumor with the proportion of lymph node metastasis and extrauterine tumor spread.

Methods

Four hundred seven patients were analyzed retrospectively. The effect of tumor size, tumor growing pattern, myometrial invasion, grade, and lymphovascular space invasion on the lymph node metastasis and extrauterine tumor spread were investigated. Statistical analysis consisted of unpaired t-tests for parametric data and Mann Whitney-U test for non-parametric data, whereas the Chi-square test for categorical variables. Logistic Regression, Cox Regression and multivariate analysis were used to estimate the risk predictors.

Results

No association was found between the growing in polypoid pattern and lymph node metastasis (P > 0.05). In the analysis of endometrioid type EC patients who had myometrial invasion less than ½ as a subgroup, no association was found between the growing pattern and lymph node metastasis and extrauterine disease. Tumor size was found to be a statistically significant predictor of lymph node metastasis and extrauterine disease (P < 0.05).

Conclusions

Lymphovascular space invasion, grade, and myometrial invasion are associated with a higher proportion of lymph node metastasis. The polypoid growth pattern of the tumor does not correlate with any histopathological parameters.

Relationship Between Immunohistochemical CD3, CD4, CD5, CD8, and PD1 Staining and Histopathological Diagnosis of Cervical Lesions in Patients With Abnormal Colposcopic Findings

INTRODUCTION

This study aimed to analyse the relationship between clinicopathological factors in cervical intraepithelial lesions and abnormal colposcopic findings.

MATERIAL AND METHODS

Thirty high-grade squamous intraepithelial lesion (HSIL) and thirty low-grade squamous intraepithelial lesion (LSIL) patients who underwent biopsy due to abnormal colposcopic findings were included in the study. The immunoreactivity of CD3, CD4, CD5, CD8, and PD-1 was analysed immunohistochemically in tumor-infiltrating lymphocytes (TILs) and stromal lymphocytes.

RESULTS

In TILs, CD3, CD4, CD5, CD8, and PD-1 were highly stained in 20/30 (66.6%), 16/30 (53.3%), 15/30 (50.0%), 24/30 (80.0%), and 13/30 (43.3%) of the cases for the HSIL group, while 7/30 (23.3%), 4/30 (13.3%), 5/30 (16.6%), 9/30 (30.0%), and 5/30 (16.6%) were in the LSIL group, respectively. CD3, CD4, CD5, CD8, and PD-1 immunostainings for TILs were higher in the HSIL group (p=0.001, p=0.001, p=0.006, p˂0.001, p=0.024, respectively). Only PD-1 was significantly higher in lymphocytes in the stroma (p=0.001).

CONCLUSIONS

CD3, CD4, and CD8 also show a positive correlation with the Ki-67 proliferation index. CD3, CD4, CD5, and CD8 may contribute to PD-1-mediated tumour control. Immunohistochemical staining plays a key role in evaluating the tumour microenvironment.

An investigation of the relationship between the functional status of the individuals with knee osteoarthritis and their quality of life

Background

Knee osteoarthritis, a chronic and degenerative joint disease, is more common among the growing elderly population. With the increasing life expectancy and obesity, the significance of knee osteoarthritis for public health has become more evident.

Aim

This study was carried out to investigate the relationship between the functional status of individuals with knee osteoarthritis and their quality of life.

Patients and Methods

The population of the study consisted of individuals with 1-4 s level of knee osteoarthritis diagnosed over the age of 50 who attended the physical therapy and rehabilitation polyclinic at Atatürk University hospital. The study was carried out with 129 individuals with knee osteoarthritis without sample selection. The data were collected using a demographic questionnaire and The Knee Injury and Osteoarthritis Outcome Score (KOOS) and analyzed with SPSS 22.00 statistical package program using frequency, percentage, t-test, Mann-Whitney U test, Kruskal-Wallis H test, and Dunnett T3 post hoc test.

Results

According to the results, the KOOS Function and Daily Life scores showing the functional status of the participants were 46.61 ± 16.17. The Function and Sports/Leisure Activities subscale scores were 29.49 ± 23.73, and the mean scores of the Quality of Life subscale were 34.15 ± 18.11. A positive significant relationship was determined between the functional status and the quality of life in the individuals.

Conclusions

As the functional status of individuals improves, the quality of life increases too.

The impact of uterine adenomyosis on the histopathological risk factors and survival in patients with endometrial adenocarcinoma

A retrospective cohort study was performed on patients diagnosed with endometrial adenocarcinoma (EC) during a 9-year period to investigate the impact of co-existing adenomyosis on patients with EC. Group A included women with EC and adenomyosis and Group B EC cases without the presence of adenomyosis. Group A was more likely to have early-stage disease, tumours without deep myometrial invasion, low-grade tumours and tumours with negative lymphovascular space invasion when compared to Group B (p = 0.012, p = 0.004, p < 0.001, p = 0.02). There were no statistically significant difference between Group A and Group B for lymph node metastasis (p = 0.064). There was no significant relation between the adenomyosis and survival outcomes in the multivariant analysis (p = 0.437). As a conclusion, patients with adenomyosis were more likely to accompany good histopathologic prognostic factors. Multivariate analysis showed no significant effect of adenomyosis on recurrence and survival parameters.IMPACT STATEMENTWhat is already known on this subject? Adenomyosis is one of the most common accompanying benign histopathological findings of type 1 endometrial carcinomas (EC). Adenomyosis comprises some characteristics similar to malignant tumours, such as invasion, abnormal tissue growth and angiogenesis. Despite concerns have arisen due to both their high incidence and similar molecular links, the possible relation between EC and adenomyosis is still not well grounded.What the results of this study add? We presented a 9-year period retrospective cohort of a tertiary referring single centre and evaluated the prognostic effect of adenomyosis in patients with EC as well as the survival outcomes of these patients. The co-occurrence of adenomyosis was more likely to accompany early-stage (stages 1-2) disease, low-grade tumours (grades 1-2) and tumours with negative LVSI in patients with EC. However, multivariate and survival analysis showed no significant effect of adenomyosis on recurrence and survival parameters.What the implications are of these findings for clinical practice and/or further research? Based on these findings, we suggest that the presence of adenomyosis should not be considered as a prognostic factor in EC. Our results support the overriding opinion about the prognostic value of co-occurrence of adenomyosis and EC. However, further studies exploring the molecular and genomic markers in these two groups are needed to uncover the exact relation of adenomyosis on the prognosis of EC.

Severe Preeclampsia is Associated with Functional and Structural Cardiac Alterations: A Case-control Study

BACKGROUND

The aim of the current study is to compare electrocardiographic and echocardiographic changes in patients with severe preeclampsia (PE) and those with uncomplicated pregnancies.

METHODS

This is a case-controlled prospective study consisting of 21 pregnant women with severe preeclampsia and a control group consisting of age- and gestational age-matched 24 healthy pregnant women. All patients underwent electrocardiographic and echocardiographic investigation.

RESULTS

QRS intervals were shorter and PR intervals were longer in the PE group (QRS duration: 80 (60-120) ms and 80 (40-110) ms, p=0.035; PR duration: 160 (100-240) ms and 120 (80-200) ms, respectively; p=0.046). The left ventricular end-systolic diameters of the patients with severe PE group were significantly larger than the control group (31 (24-36) mm and 30 (24-33) mm, respectively; p=0.05). Similarly, posterior wall thickness values of the PE group were significantly higher compared to the control group (9 (7-11) mm vs. 8 (6-10) mm, respectively; p=0.020). Left ventricular mass (146.63±27.73 g and 128.69±23.25 g, respectively; p=0.033) and relative wall thickness values (0.385±0.054 and 0.349±0.046, respectively; p=0.030) were also higher in the PE group. In addition, patients with early-onset severe PE had significantly a higher left ventricular end-diastolic diameter and volume compared with late-onset PE patients.

CONCLUSIONS

The structural changes detected in the severe PE group suggest a chronic process rather than an acute effect. In addition, diastolic dysfunction and left ventricular remodeling are most marked in patients with severe early-onset PE.

EFFECTS OF ISOLATED POSTERIOR VAGINAL WALL PROLAPSE ON LOWER URINARY TRACT SYMPTOMS

AIM

To investigate the effects of isolated posterior vaginal compartment prolapse to lower urinary tract symptoms (LUTS).

MATERIALS-METHODS

Patients who were admitted with any kind of LUTS and diagnosed with posterior compartment defects were retrospectively analyzed at urogynecology units of 2 different tertiary referral centers. Patients were included in the analysis if they had isolated posterior vaginal compartment defects with no clinically significant anterior and apical compartment defects. The control group consisted of patients with no pelvic organ prolapse (POP). All pelvic examinations were performed by the same 2 specialists. The responses to a detailed LUTS questionnaire in the unit were assessed.

RESULTS

Of the 340 women with posterior POP, 280 were excluded from the analysis due to combined anterior and/or apical POP with posterior POP and stage 4 POP. When we compared the symptoms between the control group and the remaining 60 patients with isolated posterior POP, there was a statistically significant difference in urge, frequency, nocturia, abnormal emptying, vaginal winding, difficult stool passage (p = 0.031, p < 0.001, p < 0.001, p = 0.022, p = 0.041, and p = 0.039, respectively).

CONCLUSION

Women with posterior POP should be carefully examined not only for anorectal or bulging symptoms but also for LUTS.

Systemic inflammation in both open-angle and angle-closure glaucoma: role of platelet-to-lymphocyte ratio

AIM

To analyse the effect of systemic inflammatory status in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) by calculating platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR).

METHODS

This retrospective case-control study included 200 patients with POAG, 22 patients with PACG and 100 healthy subjects. The participants' white-blood-cell, lymphocyte, neutrophil, and platelet counts were recorded from previous blood assays. NLR and PLR were calculated manually. Results were compared among the groups.

RESULTS

Both the POAG and PACG groups had higher platelet counts and PLR values than the control group (p=0.001 and p=0.001; respectively). The difference in NLR between POAG, PACG and control groups was not statistically significant (p=0.076). The POAG group had higher NLR values than the control (p=0.035).

CONCLUSION

Both the POAG and the PACG groups exhibited higher platelet and PLR levels than the control. These results indicate a potential role of systemic inflammation in the pathogenesis of POAG and PACG (Tab. 4, Fig. 1, Ref. 35).

Association between endometriosis and increased arterial stiffness

BACKGROUND

Endometriosis is a common gynecologic disease associated with systemic inflammation and atherogenic risk factors. Therefore, women with endometriosis may have increased cardiovascular risk.

AIMS

We aimed to evaluate arterial stiffness using cardio-ankle vascular index (CAVI) in women with and without endometriosis.

METHODS

We enrolled 44 patients with endometriosis and 76 age‑matched controls without endometriosis.Endometriosis was diagnosed based on histopathologic examination or magnetic resonance imaging. Arterial stiffness was evaluated using CAVI in all study participants.

RESULTS

No differences were observed between patients and controls in terms of age (median [interquartile range, IQR], 30 [24.25-5] years and 26 years [24-35] years, respectively), body mass index (median [IQR], 23.31 [20.82-24.98] kg/m2 and 23.74 [21.13-26.78] kg/m2, respectively), or waist circumference (median [IQR], 69 [64-75] cm and 72 [65-81.25] cm, respectively). C‑reactive protein levels were higher in women with endometriosis than in controls (median [IQR], 0.27 [0.14-0.68] mg/dl vs 0.12 [0.06-0.24] mg/dl; P <0.001). Left ventricular ejection fraction, left ventricular mass index (LVMI), relative wall thickness, as well as systolic and diastolic blood pressures were similar in both groups. Women with endometriosis had higher CAVI than controls (mean [SD], 5.961 [0.644] vs 5.554 [0.654]; P = 0.001). Elevated arterial stiffness was observed in the endometriosis group also after adjustment for age and LVMI.

CONCLUSIONS

Our results indicate increased arterial stiffness measured by CAVI in women with endometriosis. Therefore,clinicians should be aware that these patients may be at increased cardiovascular risk.

An alternative technique in surgical correction of anterior compartment prolapse; Iliococcygeal fixation of the pubocervical fascia by native tissue repair

AIM

To present 'bilateral iliococcygeal fixation of the pubocervical fascia' as an alternative vaginal surgical technique for anterior compartment repair with native tissue and the surgical outcomes of 30 cases.

MATERIALS-METHODS

The consecutive 30 cases who admitted to urogynecology clinic with anterior vaginal prolapse/cystocele and underwent anterior compartment repair by bilateral iliococcgeal fixation of the pubocervical fascia by native tissue were included to the study. All cases attended to the postoperative follow-up visits at the sixth and the twelfth months.

RESULTS

There were no major or minor intraoperative complications. Overall, in 28 (93.3 %) patients surgical success was achieved at the postoperative 12th month when it was defined as the maximum descent of the anterior segment was proximal to the hymen. During the study period, none of the patients requested or admitted for re-treatment for anterior compartment prolapse. Subjective cure that was assessed by the absence of bulge symptoms was achieved in 29 cases (96.7 %) at first year follow-up. Lower urinary tract symptoms (LUTS) were found to be significantly lower at the first-year postoperative visit compared to pre-operative evaluation. A clinically significant improvement in the quality of life parameters were also noted (mean PFIQ-7 scores = 8.5, 5.6 and 50.8, respectively).

CONCLUSION

Bilateral iliococcygeal fixation of the pubocervical fascia seems to be effective in surgical correction of anterior vaginal prolapse according to our post-operative follow-up results. It is an easy to learn procedure with low complication rates and associated with high patient satisfaction.

Arterial stiffness measured by cardio-ankle vascular index is greater in non-obese young women with polycystic ovarian syndrome

AIM

The association of metabolic abnormalities and polycystic ovarian syndrome (PCOS) has been documented, but few studies have focused on cardiovascular risk in these women. The aim of this study was to compare arterial stiffness by using the cardio-ankle vascular index (CAVI) in PCOS women with controls, and to evaluate whether any clinical or laboratory variables had independent associations with it.

METHODS

A group of 160 women, matched for age and body mass index were recruited. Diagnosis of PCOS was made according to the Rotterdam criteria. Arterial stiffness using CAVI was evaluated in non-obese young woman, with and without PCOS.

RESULTS

In the PCOS group (n = 80), 60 cases (75%) had findings of hyperandrogenism, 59 (73.8%) had ovulatory dysfunction, and 70 (87.5%) had an ultrasonographic appearance of polycystic ovaries. Women with PCOS had significantly higher mean CAVI values when compared to subjects without PCOS (5.78 ± 0.64 vs 5.28 ± 0.77, P < 0.001). Multiple regression analysis revealed that androgen excess was associated with increased arterial stiffness, independent of ovulatory dysfunction, polycystic ovaries, body mass index and age.

CONCLUSION

This data suggests that vascular compliance is decreased in young women with PCOS. Androgen excess is independently associated with increased arterial stiffness.

Comparison of serum adiponectin and osteopontin levels along with metabolic risk factors between obese and lean women with and without PCOS

INTRODUCTION

The objective of this study was to investigate the possible relation between serum adiponectin and osteopontin levels as metabolic risk markers among women with different polycystic ovary syndrome (PCOS) phenotypes.

MATERIAL AND METHODS

In a University Hospital setting PCOS patients diagnosed according to Rotterdam Consensus Conference criteria with body mass index (BMI) between 18 and 35 were recruited.

RESULTS

Overall, 57 PCOS patients and 57 age- and BMI-matched healthy controls were included in the study. Luteinising hormone (LH) to follicle-stimulating hormone FSH ratio (LH/FSH), free androgen index (FAI), and dehydroepiandrosterone sulphate (DHEAS-S) was found to be significantly higher in women with PCOS. There was significant interaction between PCOS status and obesity for serum adiponectin levels. Although mean adiponectin and osteopontin levels were similar among cases and controls, a further two-way ANOVA comparison within lean and obese subgroups revealed adiponectin to be significantly lower in lean PCOS women than in lean controls. LH/FSH ratio and adiponectin levels were all found to differ between lean counterparts; however, they did not show any correlation with metabolic markers [cholesterol, homeostatic model assessment (HOMA) or C-reactive protein (CRP) levels] in overall lean women or in the lean PCOS subgroup.

CONCLUSION

Serum adiponectin levels in lean PCOS women were significantly lower than those in lean controls. On the other hand, mean adiponectin and osteopontin levels were similar in PCOS cases and controls overall.

Does apical prolapse in addition to early stage anterior prolapse have any effect on lower urinary tract symptoms?

OBJECTIVE

To investigate whether apical prolapse in addition to early-stage anterior prolapse has any effect on lower urinary tract symptoms (LUTS).

METHODS

Patients with early-stage pelvic organ prolapse (POP) were retrospectively analyzed at the urogynecology unit of a tertiary referral center. Cases with posterior POP were excluded, and the remaining women were distributed across four main groups: (1) no determinable anterior and/or apical POP (control); (2) isolated anterior POP; (3) anterior + apical POP; and (4) isolated apical POP. Each LUTS symptom in these groups was recorded. Women with isolated anterior POP and women with anterior + apical POP were then compared to define the additional effects of apical prolapse on LUTS. In order to asses; symptoms of urgency, urinary incontinence, stress urinary incontinence, frequency, abnormal emptying, hesitancy, interrupted stream, nocturia, post-micturition dribble, and dysuria were noted and Incontinence Impact Questionnaire (IIQ-7), and domains of Urinary Distress Inventory (UDI-6) were compared between the groups.

RESULTS

Of the 225 patients, 66 were excluded from the analysis due to accompanying posterior compartment defect. There was no statistically significant difference for age, systemic disease history, or smoking status between the groups (p > 0.05). However, history of traumatic vaginal delivery was significantly lower in the control group than in the other groups (p = 0.039). The prevalence of hesitancy and interrupted stream were found to be significantly higher in the anterior + apical POP group than in the isolated POP group (p<0.05). Obstructive subscale of the Urinary Distress Inventory was higher both in the isolated anterior POP and anterior + apical POP groups than the control group (p<0.05).

CONCLUSION

The current study demonstrates that even minimal loss of apical support accompanying anterior prolapse exacerbates LUTS.

Predictors of Human papillomavirus (HPV) persistence after treatment of high grade cervical lesions; does cervical cytology have any prognostic value in primary HPV screening?

OBJECTIVE

This study aimed to determine the factors associated with Human Papillomavirus (HPV) persistence in women undergoing cervical excision for pre-invasive lesions, after they have been referred from a primary HPV screening program.

METHODS

A retrospective study design involving patients who were treated at a Cervical Disease Screening and Treatment Unit, in a university hospital setting. After initial treatment, cervical HPV infection status was analyzed at the sixth month, first year and then subsequently after the second year.

RESULTS

Totally, 395 patients who were diagnosed with pre-invasive cervical lesions and who subsequently undergone cervical excision were identified. In the first-year visit after cervical excision, HPV 18 was cleared in almost all (95.8%) cases, followed by HPV 16 (69.9%) and other hrHPV types (65.6%). Available data documented that 88.6% of women reached clearance after the two-year follow-up. Univariate analysis revealed a significantly higher proportion of HPV clearance among women who were younger (p = 0.019), premenopausal (p = 0.002), and who had been found to have a negative cytology result on their initial Pap test (p = 0.018). However, only cervical cytology result remained as the independent predictor of HPV persistence on a multivariate logistic regression (OR 0.43; 95% CI 0.21-0.87; p = 0.019).

CONCLUSIONS

A low risk of HPV persistence was found among every HPV genotype in women undergoing cervical excision for pre-invasive cervical lesions. Initial cervical cytology result was the only independent predictor of HPV clearance during surveillance, which indicates the prognostic value of Pap test in primary HPV screening.

Does cervicovaginal cytology have a role in the diagnosis and surveillance of endometrial adenocarcinoma?

OBJECTIVE

To examine the role of cervicovaginal cytology in diagnoses and surveillance of the patients with endometrial carcinoma (EC).

METHODS

Patients who underwent EC surgery that included a follow-up were reviewed retrospectively. The cohort was limited to the patients who had an available cervical cytology result within 12 months before the primary surgery took place. The glandular abnormalities were classified in the following subclassifications: "atypical glandular cells" (AGC)-not otherwise specified (NOS), AGC-favor neoplasia, endocervical AIS, and adenocarcinoma.

RESULTS

A total of 411 patients were eligible for the study. The cervical cytology was found to be normal and recorded as negative for intraepithelial lesion or malignancy in 368 (89.5%) patients. In 43 (10.5%) patients, cervical cytology was interpreted as: AGC-NOS (n = 11), AGC-FN (n = 7), adenocarcinoma (n = 20), malignant epithelial tumor (n = 3), and squamous carcinoma (n = 2). During the follow-up, recurrence was observed in 53 (12.9%) patients. Among six isolated vaginal cuff recurrences, two of the cases presented with malignant cytology, and the additional four cases were suspected during clinical examination. Among women with recurrence (n = 53), there were malignant cytological findings in four of the patients. In the whole population (n = 411), there were four other abnormal cytological findings detected within the surveillance. These four cytology results were nonmalignant and no recurrence was identified.

CONCLUSION

There is no significant clinical advantage of cervicovaginal cytology testing before diagnosis or during the surveillance of EC.

Variations of the 6th cranial nerve (nervus abducens) in the petroclival region: A microsurgical study

The aim of this study is to present the variations of nervus abducens in localization and number as it pierces the clival dura mater. The calvaria of 16 cadaveric heads were removed by making horizontal incisions from Glabella to Inion in both sides of the head. The dura mater was dissected. Cerebrum and cerebellum were taken out by obtuse dissection. Dissections of cavernous sinus were made under the stereomicroscope and the findings were photographed. Out of 16 specimens, one of them was excluded. Fifteen heads were bilaterally analyzed. Analysis of these nerves presented four different variations. Variation types a classified CN VI as a single trunk and entering a single dural pore with 77% occurrence. Variation type b classified CN VI with two branches running in the petroclival region and entering a single dural pore with 10% occurrence. Variation type c classified CN VI as 2 trunks and entering 2 separate but close dural pores with 10% occurrence. Variation type d classified CN VI with 2 distinct trunks and 2 branches entering 2 separate but close dural pores with 3% occurrence. CN VI plays a major role in the clinic of the eye. Due to its intracranial and extracranial course, injuries to the head and to the nerve may result in malfunctioning of the lateral muscles of the eye. Therefore, the variations of branching, relations and its course were analyzed.

Distinctive role of opinion leaders in the social networks of school adolescents: an investigation of e-cigarette use

OBJECTIVES

This study examines a diverse set of social motives (e.g. peer support, peer pressure, social loneliness) for e-cigarette use, through the mediating effects of opinion leadership, among both male and female adolescents.

STUDY DESIGN

Prospective cohort study.

METHODS

The data were obtained from a survey conducted among 666 adolescents across 14 school classes, namely, students at three urban schools, public and private, in Lille, France. The proposed integrative model includes social motives, opinion leadership and e-cigarette use in a trilateral relationship; gender is proposed and tested as a potential moderator in a structural equation model.

RESULTS

More positive peer support is negatively associated with opinion leadership and e-cigarette use. Both loneliness and susceptibility to peer influence are positively related to opinion leadership and e-cigarette use. Moreover, social support from peers and opinion leadership shape e-cigarette use differently across genders.

CONCLUSIONS

Policy makers should account for the various (positive and negative) roles of peers and consider the gender of their audience when designing anti-e-cigarette policies.

Depression and socio-economical burden are more common in primary caregivers of patients who are not aware of their cancer: TURQUOISE Study by the Palliative Care Working Committee of the Turkish Oncology Group (TOG)

In this study, we aimed to determine the personal, social and economic burden and the frequency of depression, as well as in caregivers of cancer patients who are being treated with chemotherapy in Turkey. The study is designed as a cross-sectional survey study using a 5-point Likert-type response scale, and the last part of the questionnaire includes the Beck Depression Inventory. The depression rate was found to be 64% (n = 476) among all subjects (n = 968), with 91% of those with depression demonstrating signs of mild depression. In this study, a significant difference was found between the presence of depression and age (young), sex (female), educational level (high), economic status (low), financial loss during treatment, patient's lack of knowledge about his/her diagnosis, metastatic disease and short survival time. In addition, 64% of all subjects had concerns of getting cancer, and 44% of all subjects had feelings of anger/rage against other people. In a multivariate regression analysis, the patient's lack of knowledge of the diagnosis was the independent risk factor. In conclusion, depression incidence and burden rate increased among cancer caregivers, and care burden was highly associated with depression. Accordingly, approaches to reducing the psycho-social effects of cancer should focus intensively on both the patients and their caregivers in Turkey.

Optical coherence tomography in bioabsorbable stents: mechanism of vascular response and guidance of stent implantation

Fully biodegradable L-polylactic acid stents (biodegradable vascular scaffold, BVS), the latest breakthrough in the area of coronary implants, entered clinical trials in 2005 and became commercially available in 2011. Optical coherence tomography (OCT) was used from the first implants to study the vessel wall response and the timing of the resorption process in man. Analysis of BVS with OCT has several advantages over that of metallic stents. BVS polymeric struts are transparent to the light so that scaffold integrity, apposition to the underlying wall, presence of thrombus and hyperplasia, and changes in the strut characteristics over time can be easily studied. We present a comprehensive review of the findings OCT provided when used as a research tool in serial examination up to five years for investigation of the mechanism of resorption, neointimal coverage, shrinkage and late lumen enlargement. We also report our experience with OCT in 47 lesions of various complexity as a practical means of percutaneous coronary intervention guidance during BVS implantation.

Comparison of hematologic toxicity between 3DCRT and IMRT planning in cervical cancer patients after concurrent chemoradiotherapy: a national multi-center study

PURPOSE

To compare the incidence and severity of acute and chronic hematologic toxicity (HT) in patients treated with three-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) for curative treatment of cervical cancer and to ascertain the dosimetric parameters of two techniques associated with acute and chronic HT.

MATERIALS AND METHODS

A total of 127 patients with cervical cancer receiving concomitant pelvic radiotherapy (RT) and cisplatin were evaluated. Pelvic bone marrow (BM) was contoured for each patient and divided into five sub-regions: lumbosacrum (LS), ilium (IL), lower pelvis (LP), pelvis (P), and whole pelvis (WP). The volume of each BM region receiving 10, 20, 30, and 40 Gy was calculated (V10, -V20, -V30, and -V40). The lowest level of hemoglobin, leukocyte, neutrophil, and platelet counts were obtained during chemoradiotherapy and six months after RT. The nadir values were graded according to Common Terminology Criteria for Adverse Events (version 3.0).

RESULTS

Grade 2 or greater acute anemia, leukopenia, neutropenia, thrombocytopenia was observed in 2%, 41.5%, 12% ,and 0% in 3DCRT group and in 27%, 53%, 24.5%, and 4.5% in IMRT group, respectively. Grade 2 or greater chronic anemia, leukopenia, neutropenia, and thrombocytopenia was observed in 11%, 10%, 6%, and 0% in 3DCRT group and in 11%, 9%, 4.5%, and 0% in IMRT group, respectively. LS-V30, 40; IL-V10, 20, 30, 40; LP-V10, 20 ,40; P-V10, 20, 30, 40, and TP-V10, 20, 30, 40 were significantly reduced with IMRT planning compared to 3DCRT planning. Logistic regression analysis of potential predictors showed that none of the dosimetric parameters were significant for predicting acute and chronic HT.

CONCLUSION

The present findings showed that IMRT planning reduced irradiated BM volumes compared to 3DCRT planning. However, no difference between the two techniques was observed in terms of acute and chronic HT. Further studies are needed to confirm these results.

The protective effects of Ginkgo biloba extract (EGb-761) on radiation-induced dermatitis: an experimental study

BACKGROUND

Irradiation of the skin induces production of free radicals, resulting in oxidative stress. EGb-761, an extract from the leaves of the Ginkgo biloba tree, has been reported to be an effective exogenous antioxidant based on its free-radical scavenger properties.

AIM

To investigate the protective effect of G. biloba extract (EGb-761) on radiation-induced dermatitis in rats.

METHODS

Forty male Wistar rats were divided equally into four groups: group 1 received sham radiotherapy (RT) without EGb-761, group 2 received sham RT with EGb-761, group 3 received RT without EGb-761, and group 4 received RT with EGb-761. Levels of malondialdehyde (MDA), nitric oxide (NOx) and glutathione (GSH) were measured. Dermatitis was assessed with a semiquantitative dermatitis item score. The intensity of staining and diffusion of expression for proliferating cellular nuclear antigen (PCNA) and transforming growth factor (TGF)-β3 were also evaluated.

RESULTS

The enhanced oxidative stress seen after RT was markedly diminished when EGb-761 was administered with RT; significantly lower mean MDA (P < 0.005) and higher mean GSH (P < 0.001) levels were seen in group 4 compared with group 3. Although there was a decrease in NOx levels, this was not significant. All (100%) of the animals in group 3 developed dermatitis, whereas only 13% of the animals in group 4 did so (P < 0.0001). There was a significant difference between group 1 and group 3 in PCNA and TGF-β3 staining (P < 0.05), whereas no difference was seen between groups 3 and 4; however, the intensity of staining and diffusion of expression were lower in group 4 than in group 3.

CONCLUSIONS

Prophylactic administration of EGb-761 seems to have a protective effect against radiation-induced dermatitis.

Factors affecting morbidity and mortality in flail chest: comparison of anterior and lateral location

OBJECTIVE

Flail chest is most often accompanied by significant underlying pulmonary parenchymal injuries and may constitute a life-threatening thoracic injury. In this study we evaluated the treatment modalities for flail chest depending on the effect of trauma localization on mortality and morbidity.

METHODS

Between 2003 and 2008, 23 patients (20 males/3 females) were treated for flail chest. Location of the trauma in the chest wall, mechanical ventilation support, prognosis and injury severity score (ISS) were recorded for all patients. Mechanical ventilation support was given in 14 patients (60.8 %), and 12 of these 14 patients required subsequent tracheostomy. Internal fixation was used in 3 patients.

RESULTS

The major cause of flail chest was a car crash in 18 of 23 patients (76 %). Median ISS was 62.8 for all patients. The patients with flail chest who had bilateral costochondral separation (anterior chest location) (group I, n = 10) had a significantly higher ISS than those with single-side posterolateral flail chest (group II, n = 13; ISS: 70/55; P = 0.02). The need for mechanical ventilation support was also higher in the group with bilateral costochondral separation. Morbidity was higher in group I than in group II ( P = 0.198), and mortality was also significantly higher in group I ( P = 0.08). Patients with a cranial trauma and flail chest had a higher mortality (19 %) than patients with only flail chest (no mortality). The mean ISS was 75 for patients with cranial trauma and flail chest and 55.7 ( P = 0.001) for patients with only flail chest. Sepsis and subarachnoid bleeding were the major causes of mortality. The mean ISS was 54.5 for patients under the age of 55 (n = 14) whereas it was 69.4 in those aged 55 and over (n = 9; P = 0.034). Mortality in the older group was also higher (33 % versus 7 %; P = 0.02).

CONCLUSION

Early intubation and mechanical ventilation is of paramount importance in patients with flail chest. However, prolonged mechanical ventilation is associated with a poor outcome. Tracheotomy and frequent flexible bronchoscopy are an effective pulmonary toilet. Advanced age was a major risk factor for flail chest trauma mortality, together with the severity of the injury. When cranial trauma was accompanied by flail chest, mortality and morbidity rates increased. Bilateral costochondral separation also increased the risk of morbidity and the need for mechanical ventilation in patients with flail chest.

[The value of intermittent ultrasound treatment in subacromial impingement syndrome]

OBJECTIVES

The role of intermittent ultrasound in the conservative treatment of subacromial impingement syndrome (SIS) has not been clarified. We aimed to evaluate the efficacy of ultrasound treatment in SIS.

METHODS

Thirty-six patients (29 females, 7 males; mean age 51 years; range 40 to 69 years) with type II SIS were randomized to two groups to receive intermittent ultrasound (group 1, n=20) and placebo ultrasound (group 2, n=16) for three weeks (15 sessions). All the patients received the same standard physical therapy and rehabilitation modalities besides ultrasound treatment. Evaluations were made before and three and six weeks after treatment. Functional results were assessed by the Constant score, pain was assessed by a visual analog scale, and range of motion was measured.

RESULTS

Within-group comparisons showed significant improvements in both groups three and six weeks after treatment (p<0.05). Comparison between pretreatment and 6-week values were as follows: the mean flexion increased from 148.8+/-20.4 degrees to 175.6+/-6.0 degrees in group 1, and from 165.9+/-14.1 degrees to 177.4+/-4.4 degrees in group 2; internal and external rotation increased from 66.8+/-20.7 degrees and 61.9+/-22.9 degrees to 83.2+/-10.9 degrees and 84.4+/-9.6 degrees in group 1, and from 75.0+/-17.3 degrees and 70.0+/-19.8 degrees to 87.1+/-6.8 degrees and 84.6+/-8.4 degrees in group 2, respectively. There were no significant differences between the two groups with respect to the range of motion at the end of six weeks (p>0.05). The Constant score improved from 43.7+/-12.9 to 65.7+/-7.7 in group 1, and from 43.9+/-16.4 to 65.3+/-7.6 in group 2. Pain scores decreased from 5.5 to 2 and from 5 to 1 in group 1 and 2, respectively. Improvements in Constant scores and pain scores were similar in both groups (p>0.05).

CONCLUSION

Our findings suggest that intermittent ultrasound added to conservative treatment of SIS do not provide an additional benefit to the patients.

Bilateral trapped lung with concomitant Wermer's syndrome and cutis laxa

We report a rare occurrence of trapped lung associated with Wermer's syndrome and cutis laxa. A 25-year-old man with bilateral trapped lung presented with respiratory distress. Additional investigation revealed adenoma of the parathyroid and hypophysis, a neuroendocrine abdominal tumor, and cutis laxa. Successful treatment of the respiratory symptoms was achieved through a median sternotomy with bilateral decortication, and excision of the bilateral fibrous pleural bands and bullae on the right upper lobe. Octreotide therapy was initiated and a percutaneous ultrasound-guided alcohol injection to the parathyroid adenoma was done. The patient has gynecomastia, acromegaly, and kyphoscoliosis. The patient remains well at 19 months after treatment.

Unusual manifestation of bronchiolitis obliterans organizing pneumonia

Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon fibrotic lung disease characterized by involvement of the small conducting airways. BOOP has a wide spectrum of radiologic and clinical features. Usually, it appears radiologically as multiple alveolar patchy areas of consolidation. However, different presentations have also been described. We report two cases of solitary masses of the lung that preoperatively presented as malignant lesions but were subsequently diagnosed as bronchiolitis obliterans organizing pneumonia. One of the cases of BOOP was probably secondary to suppuration of a hydatid cyst. Complicated hydatid cyst may give rise to various clinical manifestations and may present radiologically as a solid lung mass. The radiologic findings of pulmonary ruptured or complicated hydatid cyst may resemble primary lung tumor. Open surgery can be required for not only for diagnosis but also for treatment of solitary BOOP. A review of the literature is also presented.

Descending necrotizing mediastinitis: treatment of a delayed case

Descending necrotizing mediastinitis (DNM) is a severe and rare infection that can spread to the mediastinum through the anatomic cervical spaces, secondary to cervical or odontogenical infections. Delay of diagnosis and insufficient drainage always result in high mortality. We present a case of DNM with bilaterally pulmonary infiltration in a 45-year old woman. The cause of DNM was postextraction odontogenic abscess and delay of diagnosis which resulted in sepsis. Surgical treatment was performed as soon as possible in following sequence: cervical mediastinotomy, right thoracotomy, and pleural and mediastinal irrigation with saline. Although the diagnosis was delayed, invasive surgical interventions allowed successful eradication of the injection.

Pedunculated solitary fibrous tumours arising from the pleura

Solitary fibrous tumour (SFT) is one of the rare tumours which arise from visceral pleura. Klemperer and Rabin first described SFT as a distinct clinical entity among primary pleural tumoUrs in 1931. Approximately 820 cases have been reported in literature to date. The management of patients with SFT is complete resection of the tumour and follow up of the patient to detect any possible late recurrence. In the present paper, we report two cases of pedunculated solitary fibrous tumours of the pleura that appeared as a wandering chest nodule to which surgical resection undertaken at our hospital. The aim is to summarise our experience in the management of solitary fibrous tumour.

Sunflower seed mimicking complicated hydatid cyst

We present a case of a foreign body in lung parenchyma, found incidentally during surgery in an adult woman. The clinical and radiological findings were consistent with a pulmonary hydatid cyst. Owing to the similar clinical and radiological appearances, a thoracotomy was required for the correct diagnosis of a sunflower seed mimicking hydatid disease.

Extrapleural hematoma: when is surgery indicated?

Extrapleural haematoma (EH) is a rare clinical condition of which four cases are presented. Different etiologies were encountered. Identical findings were found on the chest X-ray. Two cases were secondary to spontaneous rib fracture and the other two were iatrogenic. Surgical exploration was necessary in one patient following pleural biopsy. Medical treatment and clinical observation were the treatment of choice in the remaining three stable patients.

The effects of ageing and sulfur dioxide inhalation exposure on visual-evoked potentials, antioxidant enzyme systems, and lipid-peroxidation levels of the brain and eye

The effects of ageing and 10 ppm sulfur dioxide (SO(2)) inhalation exposure on visual-evoked potentials (VEPs), thiobarbituric acid reactive substances (TBARS), a product of lipid peroxidation, and the activities of Cu, Zn superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) of brain and eye were investigated in young (3-month), adult (12-month), and mature (24-month) Swiss male albino rats. The experimental groups were placed in an exposure chamber containing a constant level of 10 ppm SO(2), while control groups were placed in an exposure chamber, which was continually pumped with filtered air, for 1 h/day x 7 days/week for 6 weeks. SO(2) inhalation exposure caused increased levels of brain, retina, and lens Cu, Zn SOD activity, and decreased levels of brain and lens GSH-Px activity in all experimental groups with respect to their corresponding control groups, whereas no change was observed in the level of retina GSH-Px activity. No alterations were observed in brain CAT activity. On the other hand, retina CAT activity was slightly decreased in SO(2)-exposed rats, but no change was observed in their lens CAT activity. The brain and lens TBARS levels of all SO(2)-exposed groups were significantly increased in comparison with their respective control groups. The amount of TBARS was only increased in the retina of the SO(2)-exposed 3-month group compared with its control. Of the SO(2)-exposed rats, the mean latencies of the P(1), N(1), P(2), and P(3) components of the 3-month group, P(1), N(1), and N(2) components of the 12-month group, and only P(3) of the 24-month group were significantly prolonged in comparison with those of their control groups. The amplitudes of N(1)P(2) and P(2)N(2) in the 12- and 24-month control groups were significantly decreased compared with those of the 3-month group. On the other hand, no differences were observed among those of SO(2)-exposed groups. These findings suggest that ageing and SO(2) inhalation exposure have the potential to induce antioxidant enzymes in the brain and eye, and VEP alterations, which are the primary target for air pollutants. It could be concluded that lipid peroxidation could play a critical role in the mechanism responsible for VEP alterations with ageing.

Neoadjuvant radiotherapy in anorectal malignant melanoma

Primary anorectal malignant melanoma is a rare neoplasm that carries a poor prognosis with a high metastatic potential. A case of a 60-year-old male who was admitted to the emergency service with signs of colonic obstruction forced us to reconsider diagnostic and therapeutic implications in anorectal melanoma. Following urgent decompression with laparoscopic sigmoid loop colostomy, the patient was treated with preoperative radiotherapy and local excision. He has since been free of disease for 30 months. The previously published reports are reviewed and the current therapeutic options are discussed.

Candida colonisation within a silicone tissue expander

The fungal contamination of tissue expanders is rarely reported. There are, however, occasional reports of fungi in association with inflatable mammary implants. We describe the colonisation of a tissue expander with Candida albicans, resulting in the fluid becoming a turbid brown colour. The possible modes of inoculation and survival of the microorganism within the expander shell were investigated by means of biochemical and microbiological analyses of the fluid. The colonisation of silicone implants by opportunistic fungi is probably more common than has been reported, and precautions that can be taken to avoid this complication are emphasised.

Sulfasalazine decreases acute gastrointestinal complications due to pelvic radiotherapy

BACKGROUND

Radiation-induced gastrointestinal toxicity is a significant concern for patients who are treated with this modality for pelvic malignancies. Eicosanoids and free radicals are thought to be among the reasons for this effect. Sulfasalazine is an inhibitor of their synthesis in the mucosa. OBJECTlVE: To determine whether sulfasalazine can reduce the radiation-induced acute gastrointestinal complications.

METHODS

In this prospective, double-blind study, 31 patients receiving pelvic radiotherapy were randomized to receive two sulfasalazine 500-mg tablets twice daily or placebo, administered orally from the first day of irradiation. Patients were evaluated weekly, and gastrointestinal toxicities were graded according to the Late Effect of Normal Tissue-Subjective Objective Management Analytic (LENT-SOMA) toxicity table during pelvic radiotherapy. On the last day of week 5, the subjects were graded endoscopically, and biopsies taken from the rectum were classified histopathologically.

RESULTS

Groups did not differ in age, gender, tumor site, or irradiation procedure. During radiotherapy, grade 2 or higher gastrointestinal toxicity occurred in 20% (3/15) and 63% (10/16) of the sulfasalazine and placebo groups, respectively. This difference was significant (p = 0.017). No statistically significant differences were found in endoscopic and histopathologic evaluations.

CONCLUSIONS

Sulfasalazine is effective in decreasing clinically acute gastrointestinal toxicities. Long-term follow-up with the subjects will help to determine the net effect of sulfasalazine on the radiation-induced gastrointestinal injuries.

The effect of granulocyte macrophage-colony stimulating factor on glutathione and lipid peroxidation in a rat model

AIMS

Irradiation decreases incisional healing and produces oxygen radicals that damage cells. Because of the lipid component in the membrane, lipid peroxidation is reported to be particularly susceptible to radiation damage. Glutathione acts as a cosubstrate in the enzymatic repair of radiation damage. The aim of this study is to examine the role of granulocyte macrophage-colony stimulating factor (GM-CSF) in incisional skin wounds by investigating lipid peroxidation and reduced glutathione levels in the irradiated rats.

METHODS

Rats were irradiated with cobalt 60 and a dorsal skin incision was made 2 days after irradiation. Rats were divided into four groups: group 1: control; group 2: GM-CSF administered; group 3: irradiated control group; group 4: irradiated and GM-CSF administered group.

RESULTS

By irradiation, a marked lipid peroxidation increase was demonstrated. Two days after irradiation, in animals given total body irradiation (TBI), application of a single topical dose of GM-CSF decreased lipid peroxidation of the tissue decreased significantly. By drug administration, the GSH content of the skin increased both in the irradiated and non-irradiated groups.

CONCLUSIONS

Our results suggest that GM-CSF modulate lipid peroxidation and GSH of the skin wound.