Variation Analysis in Premenopausal and Postmenopausal Breast Cancer Cases

Menopausal status affects the prognoses and consequences of breast cancer. Therefore, this retrospective study aimed to reveal the molecular variation profile differences in breast cancer patients according to their menopausal status, with the hypothesis that the molecular variation profiles will be different at premenopausal and postmenopausal ages. Breast cancer patients (n = 254) who underwent molecular subtyping and QIAseq Human Breast Cancer NGS Panel screening between 2018 and 2022 were evaluated retrospectively. Their menopausal status was defined by age, and those aged 50 years and above were considered postmenopausal. Of the subjects, 58.66% (n = 149) were premenopausal and 41.34% (n = 105) were postmenopausal. The mean age at the time of diagnosis for all patients was 49.31 ± 11.19 years, with respective values of 42.11 ± 5.51 and 59.54 ± 9.01 years for the premenopausal and postmenopausal groups, respectively (p = 0.000). Among premenopausal patients, the percentages of patients in BCa subtypes (luminal A, luminal B-HER2(-), luminal B-HER2(+), HER2 positive, and triple-negative) were determined to be 34.90%, 8.05%, 26.17%, 10.74%, and 20.13%, respectively, while in the postmenopausal group, these values were 39.05%, 16.19%, 24.76%, 6.67%, and 13.33%, respectively (p > 0.05). Considering menopausal status, the distribution of hormone receptors in premenopausal patients was ER(+)/PgR(+) 63.76%, ER(-)/PgR(-) 23.49%, ER(+)/PgR(-) 10.74%, and ER(-)/PgR(+) 2.01%, respectively, while in postmenopausal women, this distribution was observed to be 74.29%, 23.81%, 1.90% and 0.00% in the same order (p = 0.008). The most frequently mutated gene was TP53 in 130 patients (51.18%), followed by PIK3CA in 85 patients (33.46%), BRCA2 and NF1 in 56 patients (22.05%), PTEN in 54 patients (21.26%), and ATR and CHEK2 in 53 patients (20.87%). TP53, PIK3CA, NF1, BRCA2, PTEN, and CHEK2 mutations were more frequently observed in premenopausal patients, while TP53, PIK3CA, BRCA2, BRCA1, and ATR mutations in postmenopausal patients. These findings contribute to a deeper understanding of the underlying causes of breast cancer with respect to menopausal status. This study is the first from Turkey that reflects the molecular subtyping and somatic mutation profiles of breast cancer patients according to menopausal status.

The prognostic role of baseline 18F-FDG PET/CT SUVmax and SUVmax change in patients with node-positive breast cancer receiving neoadjuvant chemotherapy

OBJECTIVE

This study aimed to determine the prognostic role of baseline maximum standardized uptake value (SUVmax) obtained by pretreatment PET/CT and the change in SUVmax (ΔSUVmax [%]) in patients with axillary lymph node-positive breast cancer receiving neoadjuvant chemotherapy (NAC).

METHODS

One hundred and eighty patients with baseline SUVmax and 121 patients with SUVmax measurement after treatment were evaluated in the study. The baseline SUVmax value of the breast (SUVmaxBI) and axilla (SUVmaxAI) and the change in the SUVmax of the breast (ΔSUVmaxB) and axilla (ΔSUVmaxA) were measured. The optimal cut-off value of SUVmax and ΔSUVmax were determined by ROC curve analysis. Disease-free survival (DFS) and overall survival (OS) were calculated using Kaplan-Meier curves.

RESULTS

ΔSUVmaxB, pCRB, pCRA, and pCR parameters were found to be associated with relapse (p < 0.001, p = 0.033, p = 0.016, and p = 0.013, respectively). ΔSUVmaxB and SUVmaxAI were associated with mortality (p = 0.001 and p = 0.006, respectively). Multiple Cox regression analyses revealed that ΔSUVmaxB value was an independent prognostic factor for relapse and mortality (p = 0.013 and p = 0.010, respectively).

CONCLUSION

The results showed that ΔSUVmaxB was an independent prognostic factor for relapse and mortality in patients with axillary lymph node-positive breast cancer who received NAC.

Abstract P6-14-04: Is fat mass more effective than body mass index (BMI) to predict toxicity in early breast cancer patients treated with doxorubicin and cyclophosphamide?

Patients and Methods:We performed a retrospective cohort study of 207 operated breast cancer women treated with doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) for adjuvant setting between 2007 and 2016. Patients' demographic features, toxicities, fat mass, body mass index (BMI) and body surface area (BSA) were evaluated in their charts. Patients were evaluated according to fat mass (high ≥35% vs. low &lt;35%), BMI (obese ≥30 kg/m2 vs. nonobese &lt;30 kg/m2), and BSA (≥1.73 vs. &lt;1.73) levels.

Results:Median age was 46 (23-82) and 61.8% of the patients (n=128) were premenopausal. Median fat mass, BSA, and BMI level was 37 (10-55), 1.75 (1.3-2.27) and 29.4 (16-54.7), respectively. Grade ≥3 toxicity was observed in 68 patients (%32.9). Although, in univariate analyses [table 1] there are no differences in terms of grade ≥3 toxicity according to BMI (in obese and nonobese patients, 34.8% vs. 31.4%, respectively, p=0.589), and BSA (in patients with m2 ≥1.73 vs. m2 &lt;1.73, 35.8% vs. 29.6%, respectively, p=0.344), statistically significant difference was observed according to fat mass (fat mass high and low, 39.1% vs. 25.0%, respectively, p=0.031). In multivariate analyses [table 2], fat mass [&lt;35 vs. &gt;35, OR (odds ratio): 2.341 %95CI:0.39-5.27, p=0.040] was affect grade ≥3 toxicity, while BMI [&lt;30 vs. &gt;30; OR:0.876 %95 CI=0.392-1.959, p=0.748], BSA [&lt;1,73 vs. &gt;1.73 m2, OR:0.956, %95CI:0.450-2.034, p=0.908], age [&lt;50 vs. &gt;50, OR:2.171, %95CI:0.338-13.956, P= 0.414], menopausal status [premenopausal vs. postmenopausal, OR:4.374, %95CI:0.661-28.964, p=0,126], stage [1,2 vs 3, OR:0.535, %95CI:0.279-1.024, p=0.059] and histologic subtype [ductal vs. others; OR:2.010 %95 CI=0.368-2.010, p:0.729] was not.

Grade ≥3 toxicity according to BMI, BSA, and fat massMethodGrade ≥3 toxicityP valueBMI (obese vs nonobese)34.8% vs. 31.4%0.589BSA (≥1.73 vs. m2 &lt;1.73)35.8% vs. 29.6%0.344Fat mass (≥35% vs. &lt;35%)39.1% vs. 25.0%0.031BMI: Body mass index, BSA: body surface area

Multivariate analayses for grade ≥ 3 tocicityParametersOdds Ratio%95 Confidence IntervalP valueFat mass (≥35% vs. 35%)2.3410.39-5.270.040BMI (≥30 vs. &lt; 30)0.8760.392-1.9590.748BSA (&lt;1,73 vs. &gt;1.73)0.9560.450-2.0340.908Age (≥50 vs. &lt;50)2.1710.338-13.9560.414Menopausal status4.3740.661-28.9640,126Stage0.5350.279-1.0240.059Histhologic type2.0100.368-2.0100.729BMI: Body mass index, BSA: Body surface area

Discussion:BSA-based dosing has been widely adopted in oncology as a means of safely administering cytotoxic drugs. In our study demonstrated that fat mass is most valuable than BSA and BMI for evaluation to grade ≥3 toxicity for breast cancer patients treated with AC in the adjuvant setting.

Citation Format: Kaplan MA, Kavak H, Urakci Z, Nas N, Oruç Z, Yerlikaya H, Akdeniz N, Isikdogan A. Is fat mass more effective than body mass index (BMI) to predict toxicity in early breast cancer patients treated with doxorubicin and cyclophosphamide? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-14-04.

Nine case series with phototoxic dermatitis related to Chenopodium album

Chenopodium album L. ssp. album is a common plant species worldwide, especially in humid areas. Sun exposure after oral intake of the plant can lead to sunburn-like rashes owing to its furocoumarin content. In this article, we reported nine patients who developed dermatitis with edema, erythema and necrosis on the face and dorsum of the hands. Each was exposed to sunlight after eating selemez (the vernacular name of C. album L. ssp. album). The plant samples analyzed by an expert botanist were described as C. album L. ssp. album belonging to Chenopodiacea family.

Incontinentia pigmenti with ocular involvement: two cases

Incontinentia pigmenti (IP) is a rare, X-linked dominant disorder that presents at or soon after birth and presents with cutaneous signs and symptoms. Besides its typical skin signs presenting in all patients, central nervous system (CNS), ophthalmologic and dental involvement are encountered as well. In this report, we present two patients at the verrucous stage of IP and review the literature concerning the diagnosis and course of IP.

Resistin may not associate with gestational diabetes mellitus although insulin resistance

OBJECTIVE

Resistin is a potent regulator of glucose homeostasis which is thought to oppose the action of insulin in peripheral tissues. The aim of this study was to determine changes in resistin levels in gestational diabetes mellitus (GDM).

MATERIAL AND METHOD

Twenty women with GDM (mean age 32.28 +/- 5.01 years old, and gestational age 32.2 +/- 4.8 weeks) matched with 22 non diabetic pregnant women (NGDM) (mean age 30.30 +/- 4.5 years old, and gestational age 34.8 +/- 3.5 weeks) were included in the study. Body mass index (BMI) was calculated. Serum resistin levels were measured and insulin resistance was calculated with HOMA-IR. The Mann Whitney U test was used for statistical analysis.

RESULTS

BMI was 33.8 +/- 6.2 kg/m2 in the GDM group and 28.4 +/- 6.2 kg/m2 in the NGDM group (p = 0.04). Serum resistin levels were 8.7 +/- 2.1 ng/ml in the GDM group and 8.1 +/- 2.5 ng/ml in the NGDM group. Mean resistin level was not different between the two groups. HOMA-IR in GDM was higher than in the NGDM group (13.2 +/- 12.2 vs 5.8 +/- 5.1, p = 0.02, respectively).

CONCLUSION

Although mean BMI in GDM was higher than in NGDM and insulin resistance in GDM was more marked than in NGDM, serum resistin levels in GDM were not found to be any different from NGDM.

Nonsteroidal anti-inflammatory drugs-induced generalized fixed drug eruption: two cases

Fixed drug eruption (FDE) is a drug-induced cutaneous reaction that occurs at the same site with each exposure to a specific medication and usually manifests as round or oval, sharply demarcated erythematous or edematous plaques. The exact mechanism is unknown. The most common causative agent is co-trimoxazole. Other major categories of causative agents of FDE include antibiotics, antiepileptics, and nonsteroidal anti-inflammatory drugs (NSAIDs). FDE usually causes localized eruptions and very rarely generalized lesions. We report two cases of developing generalized FDEs after exposure to diclofenac and naproxen.

Alström syndrome with acanthosis nigricans: a case report and literature review

Alström syndrome (AS) is a very rare autosomal recessively inherited disorder that can lead to infantile-onset dilated cardiomyopathy, blindness, hearing impairment, obesity, diabetes, hepatic and renal dysfunction. AS is caused by mutations in the ALMS1 gene, which is located at chromosome 2p13. The life span of patients with AS rarely goes beyond an age of 40 years. There is no specific therapy for AS, but early diagnosis and intervention may moderate the progression of the disease and may improve the length and quality of the patient's life. We report a 10 year-old boy presenting with Alström Syndrome and acanthosis nigricans.

Mucocutaneous disorders in children with down syndrome: case-controlled study

OBJECTIVE

Down's syndrome is the most frequent chromosomal anomaly that can affect a multiple organ systems, including skin. In this study, we compared the frequency of mucocutaneous disorders in children with Down's syndrome with normal children.

METHODS

We recruited fifty children with Down's syndrome and 50 healthy children as a control in our study. Mucocutaneous abnormalities were examined in both groups.

FUNDINGS

Of 50 patients, 22 were girls and 28 were boys. The skin findings such as xerosis and Mongolian spots were the most frequently seen in the patients with Down's syndrome. Seborrheic dermatitis, cheilitis and fissured tongue were seen frequently, as well. The rare findings were plantar hyperkeratosis, alopecia areata, geographic tongue, café-au-lait macula, livedo reticularis, cutaneous infections, pityriasis capitis simplex, cutis marmorata, neurotic excoriation, trichotillomania, keratosis pilaris and diaper dermatitis. No mucocutaneous finding was seen in 16 patients. The prevalence of the skin disorders including Mongolian spot, seborrheic dermatitis, cheilitis, fissured tongue was significantly higher in patients with Down syndrome than normal individuals (p<0.05).

CONCLUSION

Therefore, large-scaled epidemiological studies covering the entire population are needed. We believe that these studies could provide better understanding the dermatological diseases in children with Down's syndrome that would help to practitioners to treat these problems.

Umbilical cord prolapse in the southeast region of Turkey: evaluation of 79 cases

OBJECTIVE

The aim of the study was to determine the risk factors and perinatal outcomes of umbilical cord prolapse (UCP).

MATERIAL AND METHODS

This study was performed at Dicle University between January 2000 and December 2008 on 79 cases in which deliveries were complicated by umbilical cord prolapse.

RESULTS

0.36% of all deliveries were complicated by umbilical cord prolapse. The presentation of the fetuses were as follows: vertex, breech and transverse lie and foot presentation. Thirty-four (43%) fetuses with UCP had a fetal weight of < or = 2500 g as compared with nine (9%) for fetuses in the control group (p < 0.05). Mothers in the study group were 1.3 times more likely to be multiparas than the control group (p = 0.16) Cesarean section was performed in 76 cases (96.2%) and there were nine (11.3%) perinatal deaths.

CONCLUSION

Umbilical cord prolapse is a risk factor of perinatal morbidity and mortality. Fetal weight < or = 2500 and abnormal fetal presentation are associated with increased risk of umbilical cord prolapse. Cesarean section resulted in a significantly decreased risk of perinatal mortality.

Factors affecting maternal and perinatal outcomes in HELLP syndrome: evaluation of 126 cases

OBJECTIVES

To ascertain the characteristics, clinical features, and maternal fetal outcome in HELLP (hemolysis elevated liver enzymes, low platelets) syndrome at a tertiary referral center.

MATERIAL AND METHODS

This was a cross-sectional study carried out at Dicle University between January 2004 and December 2008 in which the charts of 126 cases were retrieved retrospectively and data analyzed descriptively.

RESULTS

Of all deliveries 0.9% were complicated by HELLP syndrome. Of the cases with HELLP syndrome 79 (62.6%) had preeclampsia, 28 (22.2%) had eclampsia and 19 (15.2%) had a diagnosis of HELLP syndrome. The values of significant biochemical parameters (mean +/- SD) were documented as ALT (alanin aminotransferase) 224 +/- 42 IU/I and ALT1 (after birth) 140 +/- 22, AST 379 +/- 23 IU/l and AST1 215 +/- 51, LDH (lactate dehydrogenase) 1418 +/- 67 IU/l and LDH1 875 +/- 16, together with the hematological parameters as platelet count (86 +/- 12 K/Ul), urine protein (3 + in urine test stick) and albumin levels (2 + 0.9 g/dl). Eighty-six (68.25%) of the patients required albumin replacement. Thirty-one (24.6%) cases were nullipara and 95 (75.4%) multipara; of which 32 women (25.4%) were in Class I, and 94 (74.6 %) in Class II of complete HELLP syndrome. Regular antenatal examination was accomplished in a very small number of patients (12.25%). Fifty-eight (46.03%) patients required transfusions with blood or blood products and 12 (9.5%) underwent laparotomy due to major intraabdominal bleeding. Magnesium sulphate to prevent convulsions and corticosteroids (12 mg betametazone) to enhance fetal lung maturity were administered. Forty-four (34.9%) cases had vaginal delivery and 82 (65.1%) cesarean section; another 18 (14.2%) were with in utero stillbirth. Fifteen babies (11.9%) died, 26 (20.63%) developed placental abruption, 14 (11.11%) acute renal insufficiency, and 13 (10.31%) postoperative subcutaneous hematomas. Maternal mortality occurred in ten cases (7.93%).

CONCLUSION

HELLP syndrome is a pathology associated with a high incidence of maternal and perinatal complications. Laboratory parameters in cases with HELLP syndrome are not efficient in detecting perinatal results, but can be used as risk denominators in evaluating maternal complications. Therefore, for patients with HELLP syndrome, standard antenatal follow-up protocols should be applied in order to obtain early diagnosis and improve the speed of transfer to obstetric departments with expertise in this field.

Pregnancy-related acute renal failure in the southeast region of Turkey: analysis of 75 cases

OBJECTIVE

To study the clinical profile, management and outcome of the patients with pregnancy-related acute renal failure (PRARF).

METHODS

All patients with PRARF admitted between January 2006 and January 2009 were analyzed.

RESULTS

The total number of women with PRARF was 75. Age range of women with PRARF was 21 to 46 years and 36% of the cases of PRARF were seen in the postpartum period. PRARF was caused by sepsis in 14.6%, toxemias of pregnancy in 75.2%, and hemorrhage of pregnancy in 12%. Postabortal sepsis was the cause in 14.6%. Dialysis was needed in 33.3%. Maternal mortality rate was 10.6%.

CONCLUSIONS

Pregnancy-related acute renal failure is a major health problem and carries very high mortality and morbidity. Poor healthcare facilities and lack of antenatal healthcare clinics are major identified causes.

Treatment of osteoporosis by long-term magnetic field with extremely low frequency in rats

BACKGROUND

Osteoporosis is characterised by low bone mass and structural deterioration of bone tissue. In this study, the role of long-term extremely low frequency magnetic field (ELFMF) on osteoporosis was evaluated.

METHODS

The experiments were performed on 45 female Sprague-Dawley rats. The rats were divided into three groups (n = 15): Group I (ovariectomy (OVX) + ELFMF exposure), Group II (ovariectomised rats did not receive any treatment) and Group III (cage-control). Six months, 50 Hz, 1.5 mT magnetic field (MF) was used on Group I and Group II. Total body images of the animals were obtained with dual-energy X-ray absorptiometry.

RESULTS

Bone mineral content (BMC) and bone mineral density values were increased significantly in ELFMF group, decreased in the group of OVX and not changed in cage-control. At the end of the 6 months after exposure with ELFMF, alteration in studied biochemical markers were detected significant. Bone specific alkaline phosphatase (BAP) levels were increased in ELFMF and decreased in OVX groups when compared with cage-control group. N-telopeptide levels in OVX group were significantly higher than other groups. Testosterone and cortisol levels in OVX group were significantly higher and estradiol was lower than other groups.

CONCLUSIONS

Our study suggests that ELFMF may be useful in the prevention and treatment of osteoporosis.

Risk factors for postmenopausal osteoporosis: anthropometric measurements, age, age at menopause and the time elapsed after menopause onset

OBJECTIVES

The aim of this study was to determine, how much the anthropometric measurements and age affect the femur and vertebra T-scores by using correlation and regression analysis in postmenopausal women.

METHODS

Data of 540 healthy postmenopausal women were included in this analysis. Bone mineral density was determined by dual energy X-ray absorptiometry (DXA). The data of the patients related to height, weight, age, age at menopause were obtained from records, and body mass index (BMI) was calculated (BMI = W (kg)/H(m(2))). Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Chicago, IL).

RESULTS

Mean age and standard deviation of 540 postmenopausal women was 59.3 +/- 8.4 years. The correlation coefficients among femur, vertebra T-scores, weight, the time elapsed after the menopause onset, age, BMI and height were found as follows, from higher to lower values with 0.465, 0.453, 0.411, 0.382, 0.232, respectively, and were statistically significant (p < 0.001).

CONCLUSIONS

We determined the effects of the anthropometric measurements on osteoporosis from higher to lower influence as follows: weight, menopause age, age, BMI and height. Weight and menopause age of the patients were the major determinants for osteoporosis.

Post abortion family planning counseling as a tool to increase contraception use

BACKGROUND

To describe the impact of the post-abortion family planning counseling in bringing about the contraceptive usage in women who had induced abortion in a family planning clinic.

METHOD

The Diyarbakir Office of Turkish Family Planning Association (DTFPA) is a nonprofit and nongovernmental organization which runs a family planning clinic to serve the lower socio-economic populations, in Diyarbakir-Turkey. Post abortion counseling is introduced by using proper communication skills and with using appropriate methods to women. In this study we introduced contraceptive usage of women who had induced abortion one year ago and followed by DTFPA's clinic.

RESULTS

55.3% of our clients were not using contraceptive methods before abortion. At the end of the one year, 75.9% of our followed-up clients revealed that they were using one of the modern contraceptive methods. There was no woman with IUD before induced abortion. At the end of one year 124 (52.3%) women had IUD. "A modern method was introduced immediately after abortion" was the most important factor increasing modern method usage.

CONCLUSION

Our results advocate that post-abortion counseling may be an effective tool to increase the usage of contraceptives. Improved and more qualified post-abortion family planning counseling should be an integral part of abortion services.

Risk of malignancy index for adnexal masses

OBJECTIVES

The aim of this study was to determine the effectiveness of the risk of malignancy index (RMI) and retrospective analysis of patients presenting with adnexal masses to our clinic for treatment.

METHODS

Data of 137 women who had adnexal masses were included in the analysis. A simple algorithm called "risk of malignancy index" (RMI) reported by Jacobs includes menopausal status, ultrasound morphologic features and serum CA125 level. The RMI values were detected for each patient and analyzed to detect the relationship between benign and malign groups of the patients. Statistical analyses were performed with SPSS 15.0 for Windows (SPSS, Inc., Chicago, IL USA). Sensitivity and specificity was calculated for RMI in diagnoses of ovarian cancer by using receiver operating characteristic (ROC) analysis.

RESULTS

A total of 137 patients with adnexal masses were operated on. Mean age and SD of 137 patients were 30.64 +/- 10.05. Fourteen patients (10.2%) had malignant disease and 123 patients (89.8%) benign pathology. ROC analysis of the RMI showed that the values of area under the curve were significantly high with a value of 0.883 (p < 0.001).

CONCLUSION

The RMI is a simple scoring system and has a high sensitivity and specificity for the detection of malignant adnexal masses. Application of the RMI in clinical practice may provide a rational basis for specialists to treat patients with adnexal masses before diagnostic surgery.

Cutaneous anthrax in Eastern Turkey: a review of 85 cases

BACKGROUND

Anthrax is a zoonotic disease diminishing worldwide. Although a very rare disease in developed countries, anthrax is still endemic in developing countries.

AIM

To evaluate the clinical history and features, treatment and outcome of our patients with anthrax and emphasize the importance of the disease in our region.

METHOD

In this study, the records of all patients diagnosed with cutaneous anthrax admitted to Yüzüncü Yil University Medical Faculty between March 2002 and March 2007, were reviewed, and data on age, gender, occupation, clinical symptoms and findings, location and type of lesions, clinical history, laboratory findings, treatment and outcome were recorded.

RESULTS

There were 85 patients [46 (54.1%) male, 39 (45.9%) female; mean age 30.6 years, range 6-72]. All the patients had a history of contact with infected animals or animal products. The infectious agent was found using direct examination of Gram-stained smears from 17 patients (20%), and Bacillus anthracis was isolated from vesicle fluid cultures from 11 patients (12.9%). Diagnosis was based on clinical findings in the remaining 57 patients (67.1%). All patients, except for two with respiratory tract obstruction, made a full recovery.

CONCLUSION

Anthrax continues to be an endemic disease in Turkey, and should be considered in patients with a relevant contact history having a painless ulcer and vesicular skin lesions surrounded by a zone of oedema. Gram staining and simple culture methods are useful aids to diagnosis, but diagnosis may have to be based on clinical grounds in the majority of patients.

Factor V Leiden and G20210A prothrombin mutations in patients with recurrent pregnancy loss: data from the southeast of Turkey

Factor V Leiden (FV-Leiden) and prothrombin gene mutations (FII G20210A) are well-established independent risk factors for thrombosis. In the recent years, many studies have suggested that these mutations are associated with an increased risk of recurrent pregnancy loss (RPL). We aimed to investigate the prevalence of these molecular defects in subjects with a history of early RPL. One hundred and fourteen women with three or more consecutive unexplained first-trimester miscarriages were compared to 185 parous women with uncomplicated pregnancies from the same ethnic origin. The presence of FV-Leiden and FII G20210A mutations was assessed by polymerase chain reaction analysis. Overall, 11 out of the 114 women with early RPL (9.6%) had either FV-Leiden or FII G20210A mutation, as compared with 16 out of the 185 women with normal pregnancies (8.6%; p = 0.756). The prevalence of FV-Leiden mutation was 7.9% (9/114) in patient group, compared with 7% (13/185) in control group (p = 0.780). One hundred and two patients were primary and 12 were secondary aborters. All FV-Leiden positive cases were primary aborters (8.8%; 9/102, p = 0.584). Concerning the FII G20210A, two out of 114 (1.7%) were first-trimester RPL (primary aborters) and three out of 185 (1.6%) controls were carriers of the FII G20210A mutation (1.7 vs 1.6%, p = 0.931). The results obtained from patients with first-trimester RPL and the control group have no statistical significant differences in the prevalence of FV-Leiden and FII G20210A mutations. These results suggest that mutations have no role in etiology of first-trimester recurrent abortions.

Proposal of a Diagnostic Test for the Detection of Preterm Premature Rupture of Membranes Based on the Determination of Thyroid Hormones in Vaginal Washing Fluid

OBJECTIVES

To determine whether measurement of total T3 (triiodothyronine) , total T4 (thyroxine), free T3 (free triiodothyronine) and free T4 (free thyroxine) levels in vaginal fluid is useful for the diagnosis of preterm premature rupture of membranes (PPROM).

STUDY DESIGN

The PPROM group and normal pregnancy group consisted of 30 and 30 pregnant patients between 26 and 36 weeks' gestation, respectively. Vaginal fluid total T4, free T4, total T3 and free T3 levels were measured in both groups.

RESULTS

Vaginal fluid total T3 and free T3 levels were not statistically significant in the PPROM group as compared with the control group (p = 0.087, p = 0.123, respectively). Vaginal fluid total T4 and free T4 levels were significantly higher in the PPROM group as compared with the control group (p = 0.002, p < 0.000, respectively). The optimal cut-off value for total T4 (0.866 mug/dl) gave a sensitivity level of 83.3% (65.3-94.3, 95% CI) at a specificity of 60.0% (40.6-77.3, 95% CI) with positive and negative predictive values of 67.6 and 78.3%, respectively. The optimal cut-off value for free T4 (0.079 ng/dl) gave a sensitivity level of 90% (73.4-97.8, 95% CI) at a specificity of 70.0% (50.6-85.2, 95% CI) with positive and negative predictive values of 75.0 and 87.5%, respectively.

CONCLUSIONS

Total and free T4 measurements from vaginal fluids appears to be a useful marker of PPROM.

Elevated amniotic fluid amino acid levels in fetuses with gastroschisis

Our objective was to measure maternal plasma and amniotic fluid amino acid concentrations in pregnant women diagnosed as having fetuses with gastroschisis in the second trimester of pregnancy. Twenty-one pregnant women who had fetuses with gastroschisis detected by ultrasonography (gastroschisis group) in the second trimester and 32 women who had abnormal triple screenings indicating an increased risk for Down syndrome but had healthy fetuses (control group) were enrolled in the study. Amniotic fluid was obtained by amniocentesis, and maternal plasma samples were taken simultaneously. The chromosomal analysis of the study and control groups was normal. Levels of free amino acids and non-essential amino acids were measured in plasma and amniotic fluid samples using EZ:fast kits (EZ:fast GC/FID free (physiological) amino acid kit) by gas chromatography (Focus GC AI 3000 Thermo Finnigan analyzer). The mean levels of essential amino acids (histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine) and non-essential amino acids (alanine, glycine, proline, and tyrosine) in amniotic fluid were found to be significantly higher in fetuses with gastroschisis than in the control group (P < 0.05). A significant positive correlation between maternal plasma and amniotic fluid concentrations of essential and nonessential amino acids was found only in the gastroschisis group (P < 0.05). The detection of significantly higher amino acid concentrations in the amniotic fluid of fetuses with a gastroschisis defect than in healthy fetuses suggests the occurrence of amino acid malabsorption or of amino acid leakage from the fetus into amniotic fluid.

Two novel mutations in the MEN1 gene in subjects with multiple endocrine neoplasia-1

Multiple endocrine neoplasia type 1 (MEN1) is characterized by parathyroid, enteropancreatic endocrine and pituitary adenomas as well as germline mutation of the MEN1 gene. We describe 2 families with MEN1 with novel mutations in the MEN1 gene. One family was of Turkish origin, and the index patient had primary hyperparathyroidism (PHPT) plus a prolactinoma; three relatives had PHPT only. The index patient in the second family was a 46-yr-old woman of Chinese origin living in Taiwan. This patient presented with a complaint of epigastric pain and watery diarrhea over the past 3 months, and had undergone subtotal parathyroidectomy and enucleation of pancreatic islet cell tumor about 10 yr before. There was also a prolactinoma. Sequence analysis of the MEN1 gene from leukocyte genomic DNA revealed heterozygous mutations in both probands. The Turkish patient and her affected relatives all had a heterozygous A to G transition at codon 557 (AAG-->GAG) of exon 10 of MEN1 that results in a replacement of lysine by glutamic acid. The Chinese index patient and one of her siblings had a heterozygous mutation at codon 418 of exon 9 (GAC-->TAT) that results in a substitution of aspartic acid by tyrosine. In conclusion, we have identified 2 novel missense mutations in the MEN1 gene.

Oesophageal involvement during attacks in pemphigus vulgaris patients

BACKGROUND

Pemphigus vulgaris (PV) is a rare autoimmune bullous skin disorder characterized by frequent involvement of the mucous membranes, usually beginning at the mouth.

AIMS

To investigate the oesophageal involvement in patients with PV and to explore the primary relationship of the disease with symptoms such as dysphagia, odynophagia and retrosternal burning.

METHODS

Oesophageal involvement was investigated by upper gastrointestinal endoscopy and biopsy during the early phase of the attacks in 26 patients with PV (12 men, 14 women, age range 24-63 years).

RESULTS

Histopathological examination and direct immunofluorescence of the oesophageal biopsy specimens revealed pemphigus involvement in 12 of 26 patients (46.15%).

CONCLUSION

The oesophagus is an important predilection zone for PV, thus care must be taken to detect these lesions at an early stage.

The relationship between thrombophilic mutations and preeclampsia: a prospective case-control study

BACKGROUND

Preeclampsia and its association with thrombophilia remain controversial, due to inconsistent results in different studies, which include different ethnic groups, selection criteria, and patient numbers. The aim of this study was to determine the relationship between thrombophilia and preeclamptic patients in our region.

METHODS

In a prospective case-control study, we compared 100 consecutive women with preeclampsia and eclampsia (group 1) with 100 normal pregnant women (group 2). All women were tested two months after delivery for mutations of factor V Leiden, methylenetetrahydrofolate reductase (MTHFR), and prothrombin gene mutation as well as for deficiencies of protein C, protein S, and antithrombin III.

RESULTS

A thrombophilic mutation was found in 42 (42%) and 28 (28%) women in group 1 and group 2, respectively (P=0.27, OR 1.5, 95%CI 1.0-2.2). The incidence of Factor V Leiden mutation (heterozygous), prothrombin mutation (heterozygous), prothrombin mutation (homozygous), MTHFR mutation (homozygous) was not statistically significant in group 1 compared with group 2 (P>0.05). Also, deficiencies of protein S, protein C, and antithrombin III were not statistically significant in group 1 compared with group 2 (P>0.05).

CONCLUSION

There was no difference in thrombophilic mutations between preeclamptic patients and normal pregnant women in our region. Therefore, we suggest that preeclamptic patients should not be tested for thrombophilia.

Pregnancy complicated by superior vena cava thrombosis and pulmonary embolism in a patient with Behcet disease and the use of heparin for treatment

Behcet disease is a multisystemic vasculitis of unknown origin. Vascular involvement has been considered to result from systemic vasculitis, occurs in 5-10% of these patients. We report a 34-year-old pregnant woman complicated by superior vena cava thrombosis, and pulmonary embolism in a patient with Behcet disease.

Anti-inflammatory effects of tretinoin (all-trans-retinoic acid) 0.1% and adapalene 0.1% in rats

In this study, the anti-inflammatory effects of tretinoin (all-trans-retinoic acid) 0.1% cream and adapalene 0.1% gel were compared in rats to determine whether there was a difference between these agents. Thirty-six rats of either sex were divided into six groups (two control groups, and an etodolac, indomethacin, tretinoin and adapalene group) of six animals each. Each group was given different drugs or chemicals. The inhibitory activities of the drugs were determined on carrageenan-induced rat-paw oedema. The inhibition rate (53.48%) in the tretinoin group was found to be higher than adapalene and controls (P < 0.05). Adapalene was found to have an inhibition rate of 10.28%, and when compared with the other groups, was found to have no statistically significant anti-inflammatory activity. We conclude that tretinoin has a higher anti-inflammatory activity than adapalene and thus should be preferred for the treatment of inflammatory lesions.

The comparison of amino-terminal probrain natriuretic peptide levels in preeclampsia and normotensive pregnancy

OBJECTIVE

The purpose of this study was to evaluate the levels of amino-terminal probrain natriuretic peptide (Nt pro-BNP) in preeclampsia in comparison with normotensive pregnancy.

MATERIALS AND METHODS

Women with preeclampsia (proteinuria > or = 300 mg/24 h and at least two readings of systolic blood pressure > or = 140 mm Hg and diastolic blood pressure > or = 90 mm Hg) (n = 32 mild preeclampsia and n = 8 severe preeclampsia) were compared with normotensive women (n = 40). Serum Nt pro-BNP was measured using an electrochemiluminescence immunoassay (ECLIA) method (Nt pro-BNP, Roche) with a Roche modular analytics E170 immunoassay analyzer. Statistical analysis was carried out by the Student t-test, and a P value of <0.05 was accepted as statistically significant.

RESULTS

The median serum Nt pro-BNP was 430+/-28.91 pg/mL in preeclampsia. The levels of serum Nt pro-BNP were 74+/-16.82 pg/mL in normotensive pregnant women (P < 0.001) and significantly higher in women with preeclampsia (P < 0.001).

CONCLUSION

The higher levels of serum Nt pro-BNP in preeclamptic women may be an indicator of high left-ventricular filling pressure, and indicate left-ventricular diastolic dysfunction.

Serum interleukin-2, interleukin-6, tumour necrosis factor-alpha and nitric oxide levels in patients with Behcet's disease

INTRODUCTION

Behcet's disease (BD) is a chronic systemic disorder characterised by oral and genital ulcerative lesions, ocular and cutaneous manifestations. Cytokines are the major mediators of immunologic and inflammatory reactions. Nitric oxide is reactive nitrogen intermediate which plays a key role in pathogenesis of many inflammatory and autoimmune skin diseases. The study was conducted to determine serum interleukin-2 (IL-2), interleukin-6 (IL-6), tumour necrosis factor (TNF)-alpha and nitric oxide levels in relation to the pathogenesis of Behcet's disease.

MATERIALS AND METHODS

Serum IL-2, IL-6, and TNF-alpha levels were measured with test kits by enzyme-linked immunosorbent assay (ELISA) method, while serum nitric oxide levels were determined with a test kit by colorimetric method. Serum IL-2, IL-6, TNF-alpha and nitric oxide concentrations in 27 patients with Behcet's disease and in 16 healthy controls were determined by extrapolation from their standard curves. The significance of the mean differences between the 2 groups was assessed by the Mann-Whitney U test.

RESULTS

The serum levels of IL-2, IL-6, TNF-alpha, and nitric oxide concentrations in patients with BD were significantly higher than those of the controls (P <0.001).

CONCLUSION

Our results suggest that elevated levels of IL-2, IL-6, TNF-alpha, and nitric oxide in Behcet's disease appear to be related to the disease.

Hairy tongue: a case report

Hairy tongue or black hairy tongue is a benign condition characterized by hypertrophy of the filiform papillae that give the dorsum of the tongue a furry appearance. The color of the elongated papillae varies from yellowish white to brown or black. The etiology is unclear, but the disorder has been associated with numerous predisposing conditions such as heavy smoking, poor oral hygiene, use of topical or systemic antibiotics, systemic corticosteroid therapy, yeast infections, and radiotherapy for head and neck malignancies. A case is presented in which a hairy tongue appeared in a 67-year-old man.

Cervical biopsy specimens and human papilloma virus positivity in patients with external genital warts

Cervical biopsy specimens were taken from 16 women with external genital warts in order to diagnose concomitant cervical human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) according to pathology. Positive HPV infection was detected 56% (9/16) of the patients. Among those patients 66% (6/9) had concurrent subclinical low-grade CIN lesions. One of those patients had a high-grade CIN lesion. It is concluded that cervical HPV infection was rather common in women with external genital warts and it is valuable to examine cervical HPV infection by biopsy to detect concomitant CIN.