Comparison of total thyroidectomy, bilateral subtotal thyroidectomy and Dunhill operations in the treatment of benign thyroid disorders

AIM

The surgical treatment of benign thyroid disease is still controversial. Many treatment modalities have been described for the surgical management of various thyroid diseases, including excision, bilateral subtotal thyroidectomy (BST), near-total thyroidectomy, and total thyroidectomy (TT).

METHODS

Hospital records were reviewed for 2863 patients who underwent thyroid surgery for presumed multinodular goiter (MNG) between 1990 and 2009. However, due to the inefficiency of the hospital archive system, we were able to access detailed personal and surgical information for only 803 patients.

RESULTS

Of the 803 patients, 227 (28.3%) underwent DP, 228 (28.4%) BST and 348 (43.3%) TT operations. While there were no complications in 683 (85.1%) of the 803 operations, complications developed with 120 (14.9%). A definite difference between TT and the other (BST and DP) types of operation in relation to complications. The duration of hospital stay was 2.2±0.4 days for the BST group, 2.2 ± 0.4 days for the DP group and 2.3 ± 0.7 days for the TT group. There was a significant difference among all three groups. Recurrence rates of the operations performed were 35 (15.3%), 20 (8.8%) and 4 (1.15%), respectively, for BST, DP and TT. There was significant difference between the recurrence rates of TT and BST, and between TT and DP.

CONCLUSION

When the frequency of complications in recurrent operations and the malignity possibility of the thyroid tissue left behind are taken into consideration, we believe that TT will be more beneficial in the surgical treatment of benign thyroid disorders.

Dark side of the town: depressive symptoms in disadvantaged senior citizens

OBJECTIVES

Depression is frequently overlooked in older adults. Detection of depressive symptoms (DS) is important in primary care. This study aimed to detect the rate, risk factors and effects of DS in a disadvantaged older population.

DESIGN

Descriptive study.

SETTING

Community based rehabilitation centers and Sehzadebasi medical center of Istanbul Metropolitan Municipality (IMM).

PARTICIPANTS

1163 Consecutive patients at least 60 years old, and applied to IMM; mostly poor and/or without health insurance.

MEASUREMENTS

Detailed history and geriatric scales were obtained. Depressive symptoms (DS) were defined as 14 or more points in 30 item Geriatric Depression Scale. Relations of DS and ordinal variables were tested by Chi-square; DS and numeric variables by T-test. Multiple regressions followed.

RESULTS

Younger old and women subjects were in majority. The rate of DS was 52%, while 9.1% have depression diagnosis in their history. After multiple regressions, lack of health insurance was found to be the strongest independent risk factor for DS (p < 0.0001). Other variables that remained significant were: Limited mobility, lower Instrumental Activities of Daily Living and Tinetti Balance scores, onset insomnia, nightly awakenings and reported dizziness (p values = 0.008; 0.021; 0.005; 0.022; 0.04 and 0.03 respectively).

CONCLUSION

These results indicate the need for comprehensive geriatric assessment in primary care to detect DS, in addition to negative effect of DS on sleep and independency. Health insurance coverage of the senior citizens also is an important challenge.

Comparative efficacy of reduced or standard doses of lenograstim for peripheral blood stem cell mobilization and transplantation: A randomized study in patients undergoing autologous peripheral stem cell transplantation

7099

Background: 10 microg/kg/day of filgrastim and lenograstim have been recommended for mobilization of CD34+ cells without associated chemotherapy. However,in our previous randomized study we demonstrated that a 7.5 microg/kg/day dose of lenograstim has been as efficacious as 10 microg/kg/day of filgrastim. In this study, we investigated whether a reduced dose of lenograstim is equavalent to standard dose for autologous peripheral blood stem cell (PBSC) mobilization and transplantation. Methods: A total of 49 consecutive patients were randomized to either low dose (7.5 microg/kg/day, n = 24) or standard dose (10 microg/kg/day, n = 25) of lenograstim. These two groups were similar in regard to disease, sex, body weight, body surface area, conditioning regimens, previous chemotherapy cycles and radiotherapy. Each dose of lenograstim was administered for 4 consecutive days. The first PBSC apheresis was done on the 5th day. In the posttransplant period, lenograstim was given at 5 microg/kg/day until leukocyte engraftment. Results: Successful mobilization with the first apheresis, was achieved in 10/24 (42%) patients in low dose group versus 14/25 (56%) patients in standard dose group. No significant difference was seen in the median number of CD34+cells mobilized, as well as the median number of apheresis, median volume of apheresis, percentage of CD34+ cells, and CD34+ cell number. Leukocyte and platelet engraftments, the number of days requiring G-CSF and parenteral antibiotics, the number of transfusions were similar in both groups in the posttransplant period. Conclusions: Lenograstim 7.5 microg/kg/day is as efficious as Lenograstim 10 microg/kg/day for autologous PBSC mobilization and transplantation.

No significant financial relationships to disclose.

Small cell carcinoma of the lung presenting with ocular metastasis. A case report

Metastasis to the eye is rare but it may be the presenting symptom. Therefore awareness of the radiological findings of metastasis may aid in establishing its diagnosis. Here we report an ocular metastasis of small cell carcinoma of the lung presenting with pulmonary and ocular manifestations.

Nail changes in connective tissue diseases: do nail changes provide clues for the diagnosis?

OBJECTIVE

To evaluate the frequency and the specificity of nail changes associated with connective tissue diseases (CTD).

METHODS

In a case-control study, 190 patients including those with systemic lupus erythematosus (SLE; 56), rheumatoid arthritis (RA, 47), primary Sjögren's syndrome (pSS; 35), systemic sclerosis (SSc; 39), and dermatomyositis/polymyositis (DM/PM; 13) were enrolled in the study. Patients with SLE and other CTDs were compared with two different control groups. Twenty nails were examined. Nail features were noted and classified. Nail samples were collected for mycological cultures.

RESULTS

In patients with SLE, erythema of proximal nailfold (P<0.01), splinter haemorrhages in fingernails (P<0.01), capillary loops in proximal nailfold (P<0.05), periungual erythema (P<0.05), and thin nail plates (P<0.05) were more common than those in controls. Only splinter haemorrhages were associated with the disease activity. In patients with SSc and DM/PM, splinter haemorrhages (P<0.05) and capillary loops in proximal nailfold (P<0.01) in fingernails were common as well. Increase in longitudinal curvature (P<0.001), transverse curvature (P<0.01), and white dull colour in fingernails were other frequent findings in patients with SSc. Increase in transverse curvature was associated with the disease activity in SSc. In patients with RA, splinter haemorrhages (P<0.05), red lunula (P<0.05), and white dull colour (P<0.05) in fingernails were frequent. The sensitivity values of all these changes were very low. However, their specificity values were found to be relatively high.

CONCLUSION

Proximal nailfold is the most important site of affection in CTDs. These nail changes can be used in combination with highly sensitive diagnostic modalities to establish an accurate diagnosis.

Granulomatous mastitis: radiological findings

PURPOSE

To evaluate the radiological, ultrasonographic, and magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis.

MATERIAL AND METHODS

Between April 2002 and June 2005, the mammography, ultrasound, color Doppler ultrasound, nonenhanced MR, and dynamic MR findings of nine patients with the preliminary clinical diagnosis of malignancy and the final diagnosis of granulomatous mastitis were evaluated.

RESULTS

On mammography, asymmetrical focal densities with no distinct margins, ill-defined masses with spiculated contours, and bilateral multiple ill-defined nodules were seen. On ultrasound, in four patients a discrete, heterogenous hypoechoic mass, in two patients multiple abscesses, in one patient bilateral multiple central hypo peripheral hyperechoic lesions, in two patients heterogeneous hypo- and hyperechoic areas together with parenchymal distortion, and in one patient irregular hypoechoic masses with tubular extensions and abscess cavities were seen. Five of the lesions were vascular on color Doppler ultrasound. On MR mammography, the most frequent finding was focal or diffuse asymmetrical signal intensity changes that were hypointense on T1W images and hyperintense on T2W images, without significant mass effect. Nodular lesions were also seen. On dynamic contrast-enhanced mammography, mass-like enhancement, ring-like enhancement, and nodular enhancement were seen. The time-intensity curves differed from patient to patient and from lesion to lesion.

CONCLUSION

The imaging findings of idiopathic granulomatous mastitis have a wide spectrum, and they are inconclusive for differentiating malignant and benign lesions.

The effects of 5-aminoimidazole-4-carboxamide riboside on the pancreas in neonatal streptozotocin-diabetic rats

In this study, we aimed to determine the alterations of beta-cell ultrastructure, insulin mRNA and protein products of the same gene on the pancreas of rats following long-term treatment of 5-aminoimidazole-4-carboxamide riboside (AICAR). A single dose of streptozotocin (STZ) 100 mg/kg was injected intraperitoneally (i.p.) to 2-day-old newborn (n2) rats. The rats were divided into three groups. The first group was the n2 STZ-diabetic rats. The second group consisted of n2 STZ-diabetic rats treated with AICAR 10 mg/kg/day for one month. The third group was non-diabetic control rats. Our findings demonstrate that AICAR treatment decreases the blood glucose level but increases the body weight in n2 STZ-diabetic rats. In the AICAR-treated group, numerous beta cells showed increased insulin gene expression. We also observed increased exocytosis in this group, in an ultrastructural manner. As a result, it is suggested that AICAR may induce insulin synthesis and betacell regeneration in n2 STZ-diabetic rats.

Autologous peripheral blood stem cell transplantation in first remission in adult patients with Burkitt and lymphoblastic lymphoma: A single center phase-II study

16517

Background: Optimal therapeutic modality and duration of adult Burkitt and lymphoblastic lymphoma (LL) are still unknown. Despite long-lasting and intensive chemotherapy administration, post-therapy relapses are common. Methods: In this single center phase-II prospective study, high-dose therapy (HDC) and autologous peripheral blood stem cell transplantation (APSCT) was done during the first remission following induction and consolidation therapy for 18 patients with Burkitt (n: 5) and LL (n: 13) without bone marrow and central nervous system involvement at presentation. Cyclophosphamide, vincristine, prednisolone, adriamycin with or without L-asparaginase induction regimen was followed by dexamethasone, cytarabine, and cisplatin consolidation therapy with total body irradiation and cyclophoshamide conditioning. Results: Mean patient age was 24.6 (range: 21–55) years and male to female ratio was 5 to1. 44% (8/18) of the patients were in the intermediate and high-risk groups of International Prognostic Index. Median treatment duration until APSCT was 104 days (range: 87–128). 83% and 17% of the patients were in complete and partial remission before transplantation. One patient with Burkitt lymphoma out of 5 (20%) and 6 patients with LL out of 13 (46%) have died of progression. Overall survival (OS) at 113-month follow-up for all patients was 59.03% with 59.26% of disease-free survival (DFS). However, LL cases revealed OS and DFS rates of 50.35% and 50.77%, respectively. Only one early death (5.5%) was noted due to liver toxicity following HDC and APSCT. Conclusions: In conclusion, this single center phase-II study reveals an acceptable toxicity, short treatment period and high survival rate in adult Burkitt and LL cases, suggesting APSCT to be a good treatment option in the first remission.

No significant financial relationships to disclose.

Bisphosphonate-associated osteonecrosis of the jaws: Case reports and analysis of 184 cases

18595

Background: In this study, we described four new cases of bisphosphonates-related jaw osteonecrosis and reviewed the English Medical Literature for similar case reports. Methods: A MEDLINE literature search was performed from September 2003 to November 2005 for all case reports of bisphosphonates-associated jaw osteonecrosis. Results: Our patients were three female and one male with a median age of 50.5 years (range, 35–57 years). Two patients had breast cancer and two another had multiple myeloma. Two patients received pamidronate initially and were switched later to zoledronate. The two other patients were treated with zoledronate. The median duration from the first administration of bisphosphonates to the diagnosis of osteonecrosis was 48 (range, 18–75) months. Review of the literature of all published cases revealed 184 patients. Age of these patients ranged from 37 to 89 years (median, 64 years). Seventy-eight patients (43.4%) were treated with bisphosphonates for metastatic breast carcinoma, 65 (36.3%) for multiple myeloma, and 14 (7.8%) for metastatic prostate cancer. Thirteen patients (7.2%) without cancer diagnosis were treated for osteoporosis (10 patients) or Paget’s disease (3 patients). Primary disease was not specified in five patients. Eighty-two patients (46.8%) were treated with pamidronate, 47 (26.8%) treated with zoledronate, 35 (20%) treated with pamidronate initially and later were changed to zoledronate, 9 (5.1%) treated with oral bisphosphonates and 2 (1.1%) treated with oral bisphosphonates initially and subsequently switched to zoledronate. Type of bisphosphonate was not specified in ten patients. The duration of bisphosphonates treatment was available for 45 patients (24.4%) and ranged from 1 to 93 (median, 28) months. Conclusion: Oncologists and dental professionals should be aware of this potential serious complication of long-term bisphosphonates treatment and special caution should be taken before dental intervention in such patients.

No significant financial relationships to disclose.

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.

Tongue abscesses: MR imaging findings

BACKGROUND AND PURPOSE

A lingual abscess is difficult to diagnose in the absence of physical signs. MR imaging may provide an excellent and invaluable adjunct to clinical examination, but the literature is incomplete in defining the various MR imaging findings of abscess. The objective of this study was to determine the MR imaging features of tongue abscesses.

METHODS

Seven surgically proved tongue abscesses were evaluated with MR imaging. Four patients underwent MR imaging because of suspected tumor, and 3 patients, to show the extent and precise anatomic location of the lesion. Lesions were assessed with regard to the location, size, signal-intensity characteristics, and pattern of contrast enhancement.

RESULTS

Five lesions were located in the anterior tongue and 2, in the posterior tongue. The central parts of 4 anterior tongue abscesses were hypointense, surrounded by a hyperintense wall on T1-weighted precontrast images. On postcontrast images, marked wall enhancement was detected. On T2-weighted images, a markedly hyperintense central part surrounded by a hypointense rim was seen. In 2 of these patients, there was a hypointense halo surrounding the wall (target sign). In 3 patients, a perilesional hyperintense area that enhanced diffusely after contrast administration was detected on T2-weighted images. The smallest lesion located in the anterior tongue was hypointense on T1-weighted images and enhanced diffusely on postcontrast images. On T2-weighted images, a markedly hyperintense central part surrounded by a mildly hyperintense peripheral part was depicted. Posterior tongue lesions appeared as polypoid ill-defined masses and were hypointense on T1-weighted images and heterogeneously hyperintense on T2-weighted images. On postcontrast images, the lesion in 1 patient showed diffuse and heterogeneous contrast enhancement, whereas the lesion in another patient enhanced peripherally. The lesions were totally excised in 4 patients and drained with surgical incisions in 3 patients. No recurrence was detected on follow-up.

CONCLUSION

An abscess typically presents as a cystic lesion surrounded by an enhancing capsule formation, but lesions may also present as solid masses that enhance diffusely or peripherally.

The effect of long-term use of progesterone therapy on proliferation and apoptosis in simple endometrial hyperplasia without atypia

The aim of this study was to evaluate the effect of long-term use of progesterone treatment on proliferation and apoptosis in simple endometrial hyperplasia without atypia. In this prospective control study, endometrial tissue samples of 19 patients with simple endometrial hyperplasia without atypia (group 1), posttreatment biopsy materials of the patients after 3 months of cyclic progesterone treatment with noretisterone for 10 days (group 2), and 18 endometrial biopsy materials of the control group (group 3) were examined for proliferative and apoptotic activities. There was a statistically significant difference between the median values of the proliferative index of the three groups (P = 0.000). The proliferative index was significantly higher in the endometrial hyperplasia group than in posttreatment group (P = 0.000). But there was no significant difference between posttreatment group and control group. The median value of apoptotic activity was significantly different between three groups (P = 0.000). Apoptotic index was highest in hyperplasia group. A significant decrease in apoptosis was observed after the progesterone treatment (P = 0.002). The lowest apoptotic activity was detected in the control group. In conclusion, 3 months of cyclic progesterone treatment reduces both proliferative and apoptotic activities in endometrial tissue with simple hyperplasia.

An Unusual Cause of Ureteral Obstruction in a Renal Transplant Recipient: Ureteric Aspergilloma

Mycotic infections in various organ transplant recipients represent severe and often fatal complications. Aspergillosis isolated from the urinary tract occurs quite infrequently in renal transplant recipients. Besides, fungus balls are rare causes of ureteral obstruction. We report a 51-year-old patient with the diagnosis of ureteral obstruction caused by aspergillosis in the early post-renal transplant period, who unfortunately died with the clinical picture of disseminated infection and its complications.

CA 125 levels in patients with non-Hodgkin lymphoma and other hematologic malignancies

Cancer antigen (CA 125) is a glycoprotein commonly used as a tumor marker. In this study, CA 125 levels were measured in 149 patients and 26 healthy control subjects. The study group included 69 non-Hodgkin lymphomas (NHL), 25 Hodgkin disease (HD), 20 acute myelocytic leukemia (AML), 14 chronic lymphocytic leukemia (CLL), 12 chronic myelocytic leukemia (CML), and nine multiple myeloma (MM) patients. CA 125 was elevated in 37 of the patients and in none of the control subjects. Average CA 125 level in NHL patients was significantly higher than the controls (56.2 +/- 9.2 U/ml, 7.99 +/- 1.05 U/ml respectively) (P < 0.05). CA 125 levels were significantly higher in NHL patients with abdominal involvement (113.6 +/- 23.4 U/ml), with B-symptoms (72.3 +/- 13.2 U/ml), higher stage of the disease (stages III and IV -75.3 +/- 14.9 U/ml), bulky disease (99.9 +/- 30.4 U/ml) and in those with serosal involvement (103.1 +/- 18.5 U/ml) (P < 0.05 for all). CA 125 levels were also elevated in seven patients with HD and in a patient with CLL with pleural effusion. In conclusion, for patients with NHL, high levels of CA 125 were associated with B-symptoms, advanced stage, bulky disease, abdominal, and serosal involvement. Therefore, CA 125 might be used as a marker to predict prognosis and to detect advanced disease in NHL.

A New Set of Monoclonal Antibodies Directed to Proline-Rich and Central Regions of p53

The p53 protein can adopt several conformations in cells--"latent," "active," or mutant--depending on cellular stress or mutations of the TP53 gene. Today, only a few antibodies discriminating these conformations are available. We produced three new anti-p53 monoclonal antibodies (MAbs) directed against epitopes of human p53. The H53C1 MAb recognizes an epitope located at the N-terminal part of the central region of p53 and can discriminate mutant from wild-type conformation. The H53C2 and H53C3 MAbs are against different epitopes within the proline-rich region of p53. Moreover, the H53C2 epitope is located in the second negative regulatory domain of p53 between residues 80 and 93. These MAbs can be used as new tools to study and modulate the cellular functions of p53.

Electrocardiographic changes in patients with ischaemic stroke and their prognostic importance

We investigated prognostic importance of electrocardiographic (ECG) changes in ischaemic stroke patients without primary heart disease because of the limited evidence. This study consisted of 162 patients (92 male, age 64 +/- 14 years) with first ischaemic stroke presenting to hospital during 18 months. One-month mortality was analysed by means of ischaemia-like ECG changes, long QT and arrhythmia. Ischaemia-like ECG changes were observed in 79% of stroke patients and long QTc in 26% and arrhythmias in 44%. Early mortality rate was 27% (n = 44). Age, ST-segment change and abnormal U wave were univariate predictors of early mortality (each p < 0.05). In multivariate analysis, age > 65 years (OR = 1.4, p = 0.02) and presence of ST-segment change (OR = 2.6, p = 0.01) were only independent predictors. Although sensitivity and specificity of ST-segment change were relatively low to identify patients at risk of death, its negative predictive value was 82%. The ECG changes are frequently seen in selected patients with ischaemic stroke. Regardless of origin, ST-segment change can be a predictor of early mortality.

Assessment of information and education about topical corticosteroids in dermatology outpatient departments: experience from Turkey

BACKGROUND

Topical corticosteroids are commonly used in dermatological practice. The aim of this study was to assess the baseline level of knowledge about topical steroids in a group of dermatology patients and to evaluate the impact of educational materials on patients' level of information.

METHODS

A 10-item questionnaire was developed, and 126 patients who were prescribed topical steroids for several dermatologic diseases were asked mostly about side-effects of the drugs. Three different educational methods were used in parallel to the questionnaire: verbal (n = 42), written (n = 42) or verbal and written (n = 42). The same questions were asked again 1 or 2 weeks later.

RESULTS

Only 7.1% of the study group mentioned that they were informed by doctors about the side-effects of topical steroids before they were administered. The baseline information scores about topical corticosteroids were higher in high school and college graduates and in those who noted side-effects or who were informed about side-effects before administration. A statistically significant difference was detected between pre- and posteducation scores of patients in the whole group and within the three groups of different educational methods (P < 0.001). Posteducation scores of the combined verbal- and written-educated group were higher than the written-educated group or the verbal-educated group.

CONCLUSION

The present study indicated that patient knowledge is enhanced by any kind of educational method, and particularly written information supported by verbal instructions given in dermatology outpatient departments. Moreover, we conclude that the 10-item questionnaire can be used in Turkey to assess patients' knowledge about topical corticosteroids.

Developmental changes in localization of steroid synthesis enzymes in camelid placenta

The uninucleate trophoblast of epitheliochorial camelid placenta produces multinucleate giant cells starting between day 30 and day 35 of pregnancy. The giant cells are found scattered along the trophoblast at similar frequency throughout gestation. Light microscope immunocytochemistry indicates that the four steroid synthesis enzymes (cholesterol side chain cleavage, 3beta-hydroxysteroid de-hydrogenase, 17alpha-hydroxylase and aromatase) are present in all uninucleate trophoblast cells between day 14 and day 30 of pregnancy, but are found only in the giant cells once they are established, and that this localization persists until term. The giant cells show massive amounts of smooth endoplasmic reticulum and numerous small mitochondria, again as has been shown in other steroid-producing cells. As progesterone from the corpus luteum is necessary throughout gestation in camels, the capacity for oestrogen production by the trophoblast presumably has an important role, but one limited mostly to the immediate vicinity of the fetomaternal interface.

PATIKA: an integrated visual environment for collaborative construction and analysis of cellular pathways

MOTIVATION

Availability of the sequences of entire genomes shifts the scientific curiosity towards the identification of function of the genomes in large scale as in genome studies. In the near future, data produced about cellular processes at molecular level will accumulate with an accelerating rate as a result of proteomics studies. In this regard, it is essential to develop tools for storing, integrating, accessing, and analyzing this data effectively.

RESULTS

We define an ontology for a comprehensive representation of cellular events. The ontology presented here enables integration of fragmented or incomplete pathway information and supports manipulation and incorporation of the stored data, as well as multiple levels of abstraction. Based on this ontology, we present the architecture of an integrated environment named Patika (Pathway Analysis Tool for Integration and Knowledge Acquisition). Patika is composed of a server-side, scalable, object-oriented database and client-side editors to provide an integrated, multi-user environment for visualizing and manipulating network of cellular events. This tool features automated pathway layout, functional computation support, advanced querying and a user-friendly graphical interface. We expect that Patika will be a valuable tool for rapid knowledge acquisition, microarray generated large-scale data interpretation, disease gene identification, and drug development.

AVAILABILITY

A prototype of Patika is available upon request from the authors.

Effect of 5-aminoimidazole-4-carboxamide riboside (AICA-r) on isolated thoracic aorta responses in streptozotocin-diabetic rats

Diabetes mellitus alters the vascular responsiveness to several vasoconstrictors and vasodilators. 5-amino-4-imidazole-carboxamide riboside (AICA-r), a nucleoside corresponding to AICA-ribotide and an intermediate of the de novo pathway of purine biosynthesis, was recently proposed as a new insulinotropic tool in non-insulin-dependent diabetes mellitus. The aim of the present study was to define whether AICA-r affects altered vascular responsiveness to vasoconstrictors and vasodilators in the thoracic aorta of neonatal streptozotocin (STZ)-diabetic rats. The results of this study indicate that a 1-month treatment with AICA-r significantly increases the body weight in diabetic rats; significantly decreases the blood glucose level of diabetic rats (from 302+/-47 to 135+/-11 mg/dL, p<0.001); does not significantly affect the fast, slow, and total components of responses to noradrenaline in all the experimental groups; reverses the increased Emax values of noradrenaline in diabetic rats to near-control values; reverses the completely abolished responses of acetylcholine (pD2 and percent relaxation) in diabetic rats to control values; and reverses the decreased pD2 values of sodium nitroprussiate in diabetic rats to control values. In conclusion, AICA-r treatment in neonatal STZ-diabetic rats improved increased blood glucose levels, accelerated weight gain, reversed endothelial dysfunction, and normalized vascular responses.

NAPO as a novel marker for apoptosis

Apoptosis or programmed cell death plays a pivotal role in embryonic development and maintenance of homeostasis. It is also involved in the etiology of pathophysiological conditions such as cancer, neurodegenerative, autoimmune, infectious, and heart diseases. Consequently, the study of apoptosis is now at center of both basic and clinical research applications. Therefore, sensitive and simple apoptosis detection techniques are required. Here we describe a monoclonal antibody-defined novel antigen, namely NAPO (negative in apoptosis), which is specifically lost during apoptosis. The anti-NAPO antibody recognizes two nuclear polypeptides of 60 and 70 kD. The antigen is maintained in quiescent and senescent cells, as well as in different phases of the cell cycle, including mitosis. Thus, immunodetection of NAPO antigen provides a specific, sensitive, and easy method for differential identification of apoptotic and nonapoptotic cells.

Acquired expression of transcriptionally active p73 in hepatocellular carcinoma cells

p53 and p73 proteins activate similar target genes and induce apoptosis and cell cycle arrest. However, p53, but not p73 is considered a tumour-suppressor gene. Unlike p53, p73 deficiency in mice does not lead to a cancer-prone phenotype, and p73 gene is not mutated in human cancers, including hepatocellular carcinoma. Here we report that normal liver cells express only DeltaN-p73 transcript forms giving rise to the synthesis of N-terminally truncated, transcriptionally inactive and dominant negative p73 proteins. In contrast, most hepatocellular carcinoma cells express TA-p73 transcript forms encoding full-length and transcriptionally active p73 proteins, in addition to DeltaN-p73. We also show that together with the acquired expression of TA-p73, the 'retinoblastoma pathway' is inactivated, and E2F1-target genes including cyclin E and p14(ARF) are activated in hepatocellular carcinoma. However, there was no full correlation between 'retinoblastoma pathway' inactivation and TA-p73 expression. Most TA-p73-expressing hepatocellular carcinoma cells have also lost p53 function either by lack of expression or missense mutations. The p73 gene, encoding only DeltaN-p73 protein, may function as a tumour promoter rather than a tumour suppressor in liver tissue. This may be one reason why p73 is not a mutation target in hepatocellular carcinoma.

Carpal tunnel syndrome in carpet workers

OBJECTIVE

Repetitive and forceful use of wrist and finger flexors is purported to be an occupational risk factor for carpal tunnel syndrome (CTS). While weaving carpet, wrist and finger flexors and extensors are used repetitively, with pinching movements and forced grasping. We aimed to investigate CTS frequency in hand-made carpet workers.

METHODS

Seventy women from carpet workshops in the city center and 30 healthy unemployed women were evaluated by clinical examination and electrophysiology. The relationship between CTS development and employment duration, and work produced per year were also investigated. Our study is cross-sectional.

RESULTS

CTS was present in 31 hands (22.1%) of workers and in four hands (6.7%) of the control group. The estimated relative risk of developing CTS was 3.3 times greater in carpet-workers than it was in controls. Considering all hands, we could not find any correlation between CTS development and employment duration (P = 0.977), or with work produced per year (P = 0.505); but these two were the prominent factors contributing to delayed median sensory latency (P = 0.013, P = 0.009, respectively).

CONCLUSIONS

We could not find any correlation between CTS development and employment duration, or with work produced per year; but these two were the prominent factors contributing to delayed median sensory latency The results indicates that women working in the hand-made carpet industry have a higher risk of CTS development.

Effect of oral glucose loading on serum gastrin level in pregnant and non-pregnant women

AIM

To evaluate the relationship between the changes in gastrin and insulin serum concentrations after oral glucose loading in pregnant and non-pregnant women.

METHODS

Thirty women, 12 pregnant and 18 non-pregnant, with normal fasting glucose values were included in the study. Serum concentrations of gastrin, glucose, insulin, and glucagon were analyzed at 0 (t1), 30 (t2) and 60 (t3) minutes after 75 g oral glucose loading. Gastrin, insulin, and glucagon levels were determined by means of radioimmunoassay kits.

RESULTS

Serum gastrin concentration in pregnant women increased insignificantly (gastrin median values 57.91, 70.62, and 68.70 for t1, t2, and t3, respectively; Friedman's test, p = 0.264). In non-pregnant women gastrin levels insignificantly increased from t1 to t2, but reduced significantly from t2 to t3 (gastrin median values 62.91, 86.92, and 62.25 for t1, t2 and t3, respectively; Bonferroni adjusted Wilcoxon test, p = 0.002). Unlike in pregnant women, the changes in gastrin release in non-pregnant women were associated with changes in blood glucose concentrations at t2 and t3, which were induced by oral glucose loading. Glucose median values were 7.48 and 6.43 for t2 and t3, respectively. The insulin release due to the oral glucose loading markedly increased at t2 and t3 (Friedman's test, p < 0.001), whereas glucagon release decreased irrespective of pregnancy.

CONCLUSION

Changes in blood glucose concentrations induced by oral glucose loading could influence gastrin release, especially in non-pregnant women. Changes in insulin and glucagon levels induced by oral glucose loading, particularly after 60 minutes, could not be associated with changes in gastrin release.

A monoclonal antibody against DNA binding helix of p53 protein

Three monoclonal antibodies (Mabs) were generated against p53 DNA-binding core domain. When tested by immunoprecipitation, Western blot and immunofluorescence techniques, Mab 9E4, as well as 7D3 and 6B10 reacted with both wild-type and various mutant p53 proteins. The epitopes recognized by Mabs 7D3, 9E4 and 6B10 were located respectively within the amino acid residues 211-220, 281-290 and 291-300 of human p53 protein. The epitope recognized by 9E4 Mab coincides with helix 2, also called p53 DNA binding helix, which allows the direct contact of the protein with its target DNA sequences. This antibody may be useful to study transcription-dependent and transcription-independent activities of wild-type and mutant p53 proteins.

P53 codon 249 mutation in hepatocellular carcinomas from Nigeria

Mutations of p53 tumour suppressor gene often occur in hepatocellular carcinoma and, in particular, codon 249 hot-spot mutation is displayed by hepatocellular carcinomas occurring in hepatitis B virus-endemic areas with high dietary aflatoxin intake. This study was done to determine the frequency of p53 codon 249 mutation in hepato-cellular carcinoma in Nigerian patients with this tumour. Tumour samples were obtained from 18 Nigerian patients (all from the Southwest of the country) with histologically confirmed hepatocellular carcinoma by autopsy (n = 14), surgical resection (n = 3) and ante-mortem liver biopsy (n = 1). Fourteen of them had co-existing cirrhosis. Amplification of exon 7 of p53 gene from DNA samples of hepatocellular carcinoma tissue was undertaken by nested polymerase chain reaction followed by restriction enzyme analysis. One out of the 18 tumour samples tested (5.5%) demonstrated codon 249 mutation. This study suggests that, in Nigeria, especially the south-western region, aflatoxins appear to play a limited role in hepatocarcinogenesis.

Congenital dyserythropoietic anemia type I with ringed sideroblasts

A 25-year-old male with anemia, jaundice and liver dysfunction was admitted to our institution. Anisopoikilocytosis with tear-drop forms, polychromasia, basophilic stippling in peripheral blood smear, erythroid hyperplasia with megaloblastoid changes, binucleated cells and intranuclear bridging in bone marrow aspirate and spongy, unevenly condensed nuclear chromatin in electron microscopy studies indicated that he had congenital dyserythropoietic anemia (CDA) type I. As a rare finding in CDA, ringed sideroblasts were noted. It is proposed that this patient is an example for the designation 'variant congenital dyserythropoietic anemia with ringed sideroblasts'.

Masses of the tongue and floor of the mouth: findings on magnetic resonance imaging

The purpose of this study was to determine the value of MR imaging for the demonstration of masses in the tongue and floor of the mouth. Nine patients were prospectively examined with MR imaging after physical examination. Imaging protocol included T2 and contrast-enhanced and non-contrast-enhanced T1-weighted turbo spin-echo sequences, and the findings were compared with surgical and histopathological results. Histopathological examination revealed four squamous cell carcinomas, one adenoid cystic carcinoma, two tongue abscesses, and one chronic inflammatory change. The other case was diagnosed as hemangioma depending on clinical and imaging findings alone. In cases with squamous cell carcinoma, staging was done on the basis of MR imaging findings, and was found to be T4 in two cases, T3 in one case, and T2 in another. The primary role of MR imaging of the tongue and oropharynx is not to make a tissue diagnosis. Multiple deep biopsies are mandatory for the differentiation of other inflammatory and neoplastic lesions. Magnetic resonance imaging produces coronal and sagittal image planes to assess the volume and spread of the lesion and helps the surgeon determine the direction in which the biopsy should be performed.

Anger attacks in depressed Turkish outpatients

Anger attacks have been described as sudden spells of anger accompanied by symptoms of autonomic activation and have been experienced by patients as uncharacteristic of them and inappropriate to the situations in which they had occurred. The aim of this study was to assess the prevalence of anger attacks in a non-Western depressed population. We also wanted to see whether depression in patients with anger attacks was qualitatively different from depression without anger attacks. The Anger Attacks Questionnaire, designed by Fava et al. to assess these attacks, was administered to 88 medication-free consecutive outpatients diagnosed as major depression according to DSM-IV criteria by two psychiatrists. The patients also were assessed by the Beck Depression Inventory, the Beck Anxiety Inventory, the Beck Hopelessness Scale, and the Spielberger's State-Trait Anger Expression Inventory. Forty-three (49%) of these patients had reported having anger attacks. The patients with anger attacks were significantly more depressed and anxious than patients without anger attacks. Anger-out and trait anger measures were significantly higher in depressed patients with anger attacks than patients without anger attacks. Patients with anger attacks also scored higher in hopelessness measure and there was a trend toward statistical significance. Our results are in line with previous literature which show, that anger attacks are prevalent in depressed patients. We also conclude that patients with anger attacks constitute a more depressed population than those without anger attacks. Severity of depression emerges as the strongest predictor of the presence of anger attacks in our study.

The effect of organophosphate insecticide chlorpyrifos-ethyl on lipid peroxidation and antioxidant enzymes (in vitro)

Organophosphates are known primarily as neurotoxins. However, reactive oxygen species (ROS) caused by organophosphates may be involved in the toxicity of various pesticides. Therefore, in this study we aimed to examine how an organophosphate insecticide, chlorpyrifos-ethyl (CE) [0,0-diethyl 0 (3,5,6-trichloro-2-pyridyl) phosphorothioate], affects lipid peroxidation and the antioxidant defense system in vitro. For this purpose, four experiments were carried out. In experiment 1, erythrocyte packets obtained from six (three male, three female) volunteers were divided into six portions, and to each was added CE in both a high concentration range (0, 0.4, 2, 10, 50, 100 g/l) and a low concentration range (0, 0.01, 0.1 g/l). Additionally, each concentration group was divided into five tubes, and incubated at +4 degrees C for 0, 30, 60, 120, and 240 min. After incubation, the levels of malondialdehyde (MDA) and the activity of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) were determined in the erythrocytes in all tubes. In experiment 2, to examine the effect of CE (or its main metabolites) on the activity of purified, commercially available enzymes, CE at concentrations of 0. 0.01, 0.1, 0.4, and 10 g/l was incubated with purified SOD, GSH-Px and CAT at the concentrations observed in control group at the 0 CE concentration level in experiment 1 for 1 h at room temperature (25 degrees C). In experiment 3, the xanthine-xanthine oxidase system was used to determine whether the activities of SOD, GSH-Px and CAT were inactivated other than by CE, for example by superoxide radicals inducing lipid peroxidation in erythrocytes. Samples with xanthine and xanthine oxidase were mixed and incubated for 1 h at room temperature (25 degrees C). In experiment 4, to determine whether enzyme activities were still inhibited if lipid peroxidation was prevented by exogenous antioxidants, experiment 1 was repeated with the CE concentrations of 0.01, 0.1, 0.4, and 10 g/l by adding butylated hydroxytoluene and vitamin E to the medium. The MDA levels were determined spectrophotometrically. Enzymatic methods were used for the determination of SOD, GSH-Px, and CAT activities. The Friedman test and Wilcoxon's Signed Ranks test were used to compare paired groups. MDA values and GSH-Px activities increased with increasing CE concentration and incubation period (P<0.05), but SOD and CAT activities decreased with increasing CE concentration and incubation period (P<0.01). From these results, it can be concluded that in vitro administration of CE resulted in the induction of erythrocyte lipid peroxidation and significant changes in antioxidant enzyme activities, suggesting that ROS and/or free radicals may be involved in the toxic effects of CE.

Genome organization and phylogenetic distribution of a novel family of ancient murine endogenous proviruses with evidence for transposition-mediated proliferation

A new family of murine endogenous proviruses (VL6.0) is described here. The intact provirus is near 6 kb in length and shows a genomic organization of 5' LTR, gag, pol, env, and 3' LTR. The primer binding site (PBS) is that of a tRNA(gly). The lack of functional open reading frames and occurrence of significant gaps in most, if not all, members of this group show it to be ancient. Our estimate of copy number per haploid genome is 30+. Members of this group have been isolated from Mus musculus domesticus, M. m. casteneus, M. m. hortulanus, M. caroli, and M. spretus. The occurrence of these sequences throughout such diverse members of the genus Mus may indicate that the date of the original infection predated the divergence of the extant Mus lineages at around 2.5 million years ago. Analysis of gap (deletion/insertion) patterns indicates that these sequences may have proliferated within the Mus genome by a mechanism of reverse transcriptase-mediated transposition. As yet, there are no closely related murine retroviruses described. The closest mammalian retrovirus based on sequence similarity is from the miniature swine (Sus scrofa).

P53 but not p16INK4a induces growth arrest in retinoblastoma-deficient hepatocellular carcinoma cells

BACKGROUND/AIM

Both p16INK4a and p53 proteins are negative regulators of the cell cycle. In human hepatocellular carcinomas (HCC), the loss of function of p53, retinoblastoma (pRb) and pl6INK4a genes by different mechanisms has been largely documented, but their hepatocellular effects are poorly known. We compared the growth-inhibitory effects of p16INK4a and p53 proteins in Hep3B cell line-derived clones.

METHODS

Cells were transfected with inducible p16INK4a and p53 expression vectors, and stable clones were analyzed for transgene expression by Western blotting and immunoperoxidase staining. Effects on cell growth were analyzed by in vitro growth assay, thymidine incorporation and flow cytometry. Biochemical effects of p53 were tested by Northern blotting of p21Cip1 transcripts and by Western blotting of p21Cip1, mdm-2, bax, cyclin-dependent kinase 2 and cyclin E proteins. The pRb protein was studied by Western blotting and immunoprecipitation assays.

RESULTS

The induction of p16INK4a protein expression did not affect in vitro growth of cells. In contrast, p53 protein in its wild-type conformation provoked a growth arrest accompanied by transactivation of p21Cip1 gene and accumulation of p21Cip1, bax and mdm-2 proteins. p53-induced growth arrest was due to a cell cycle arrest at the G1/S transition, probably mediated by p21Cip1 protein, which inhibits cyclin-dependent kinase 2/cyclin E complexes.

CONCLUSIONS

The lack of detectable pRb protein and resistance of cells to p16TNK4a strongly suggest that p53 is able to arrest the growth of HCC cells by a mechanism independent of "p53-retinoblastoma pathway". These findings are applicable to HCC with abberrations of both p53 and pRb genes, and may not represent the universal effects of p53 in hepatic cells.