Can nonproliferative breast disease and proliferative breast disease without atypia be distinguished by fine-needle aspiration cytology?

BACKGROUND

Cytologic criteria reported to be helpful in the distinction of proliferative breast disease without atypia (PBD) from nonproliferative breast disease (NPBD) have not been rigorously tested.

METHODS

Fifty-one air-dried, Diff-Quik-stained fine-needle aspirates (FNA) of palpable breast lesions with biopsy-proven diagnoses of NPBD (34 cases) or PBD (17 cases) were reviewed. The smears were evaluated for the cellularity, size, and architectural arrangement of the epithelial groups; the presence of single epithelial cells and myoepithelial cells; and nuclear characteristics.

RESULTS

The only cytologic feature found to be significantly different between PBD and NPBD was a swirling pattern of epithelial cells. A swirling pattern was noted in 13 of 17 PBD cases (76%) and 12 of 34 NPBD cases (35%) (P = 0.008).

CONCLUSIONS

Because there is significant overlap in cytologic features between NPBD and PBD, the distinction between the two entities is difficult in cytologic sampling.

Amelioration of energy metabolism by melatonin in skeletal muscle of rats with LPS induced endotoxemia

In the literature, few studies have investigated the effects of melatonin on energy metabolism in skeletal muscle in endotoxemia. We investigated the effects of melatonin on tissue structure, energy metabolism in skeletal muscle, and antioxidant level of rats with endotoxemia. We divided rats into 4 groups, control, lipopolysaccharide (LPS) (20 mg/kg, i.p., single dose), melatonin (10 mg/kg, i.p., three times), and melatonin + LPS. Melatonin was injected i.p. 30 min before and after the 2nd and 4th hours of LPS injection. Antioxidant status was determined by glutathione (GSH) measurement in the blood. Muscle tissue was stained using modified Gomori trichrome (MGT), succinic dehydrogenase (SDH), and cytochrome oxidase (COX) and histological scored. Also the sections were then stained with hematoxylin and eosin. The stained sections were visualized and photographed. Creatine, creatine phosphate, adenosine triphosphate (ATP), adenosine diphosphate (ADP), and adenosine monophosphate (AMP) levels were investigated using high performance liquid chromatography (HPLC) in muscle tissue. In the Melatonin + LPS group, blood GSH levels were increased compared with the LPS group (P<0.01). Melatonin reduced myopathic changes in the LPS group according to the histopathologic findings. In addition, ATP values were increased compared with the LPS group (P<0.05). Our findings showed melatonin treatment prevented muscle damage by increasing ATP and GSH levels in rats with LPS induced endotoxemia.

Acute fulminant SSPE: clinical and EEG features

We report an autopsy-proven case of SSPE in which the course was rapidly progressive, leading to death in 2 months. The patient was admitted for investigation of visual symptoms. His examination revealed complete right homonymous hemianopia and myoclonic jerks in the right half of the body. EEG showed high voltage periodic slow-wave discharges that were often associated with jerks. Measles antibody was positive in serum and CSF. MRI showed hyperintensity in the white matter of the occipital poles. The patient became completely blind and had jerks in all four limbs. His condition continued to deteriorate and within 3 weeks he reached a state of deep coma. The myoclonic jerks became less marked and gradually completely ceased. The EEG showed diffuse slow activity without periodic complexes. The patient died approximately 2 months from onset of disease. Brain autopsy revealed severe neuronal loss with abundant inclusion bodies in the remaining neuronal and oligodendroglial nuclei, which was compatible with SSPE.

The effect of diltiazem on the manifestations of hyperthyroidism and thyroid function tests

The aim of this study is to evaluate the effect of diltiazem on the symptoms and signs of hyperthyroidism and thyroid function tests and to assess whether diltiazem can be used associated with an anti-thyroid drug, propylthiouracil. Twenty-two patients with hyperthyroidism were included in a prospective, randomized and placebo controlled study. Group 1 (n:12) patients received diltiazem, 60 mg twice a day, for 30 days. Group 2 (n:10) patients received placebo for 30 days. The patients in both groups were given propylthiouracil, 100 mg three times a day, for the last 20 days of the study period. The patients remained in the hospital during the first 10 days. A standardized hyperthyroid symptom score (HSS) and thyroid function tests including thyroid-stimulating hormone (TSH), free thyroxine (free T4), free triiodothyronine (free T3), total thyroxine (T4) and total triiodothyronine (T3) were evaluated before and after 10 and 30 days of the study period. HSS decreased from 27.80 +/- 4.54 to 22.51 +/- 4.04 after 10 days of diltiazem therapy in Group 1 (p < 0.01). But there was no change in HSS in Group 2 (p > 0.01). No significant changes in thyroid function tests have occurred in both groups after 10 days of treatment. Diltiazem can be used in patients with hyperthyroidism to alleviate adrenergic manifestations. It can also be safely combined with propylthiouracil.

Metal (Al, Fe, Mn and Cu) distributions and origins of polycyclic aromatic hydrocarbons (PAHs) in the surface sediments of the Marmara Sea and the coast of Istanbul, Turkey

In this study, total metal (Al, Fe, Mn and Cu) and PAHs analyses have been done in the surface sediments. Sediment samples have been collected from seven parts of the Marmara Sea and the coast of Istanbul during 2009. Total Al, Fe, Mn and Cu contents vary between 1.8% and 5.4%; 1.1% and 2.8%; 122 and 259 μg g(-1); 27 and 416 μg g(-1), respectively. EF and CF values of Fe and Mn are lower than 1.5 and 1, respectively, in all the stations. Total PAH contents range between 135 and 6009 ng g(-1) in the surface sediments. The origin of PAHs has been found pyrolitic according to the Phe/Ant ratio in the all stations. Contrastingly, at K0, MKC and MY1 Stations, PAH origins have been observed petrogenic according to the Flu/Pyr ratio.

The Relationship Between the Preoperative Neutrophil-to-Lymphocyte Ratio and Postoperative Nausea and Vomiting in Patients Undergoing Septorhinoplasty Surgery

BACKGROUND

Postoperative nausea and vomiting (PONV) is one of the most common complications during the postoperative period. In the literature, there are many factors associated with PONV risk, but it is claimed that inflammation increases this risk. The neutrophil-to-lymphocyte ratio (NLR) is a cheap parameter to use in the diagnosis and follow-up of systemic inflammatory diseases. In this study, we aimed to investigate whether the preoperative NLR was a marker for PONV and to determine its relation with antiemetic use.

METHODS

Eighty patients who were planned to undergo elective septorhinoplasty and were in ASA I-II were prospectively included in the study. The NLR value was calculated by dividing the number of neutrophils by the number of lymphocytes obtained from the preoperative complete blood count. The patients were divided into two groups of 40 patients: patients with an NLR < 2 (group 1) and patients with an NLR > 2 (group 2). Nausea and vomiting during the first 24 h in the recovery room and in the related clinic and antiemetic requirement were recorded.

RESULTS

The rate of nausea-vomiting in the recovery room and in the postoperative 24-h period in group 1 was significantly lower than in group 2 (p < 0.05). The rate of use of antiemetics in the recovery room and in the postoperative 24-h period in group 1 was significantly lower than in group 2 (p < 0.05).

CONCLUSION

NLR values above 2 calculated in the preoperative period may be an indicator of PONV risk. Antiemetic prophylaxis may be given according to this value.

LEVEL OF EVIDENCE IV

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Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia

PURPOSE

Obese patients have a significantly higher risk of adverse effects associated with general anesthesia. The purpose of this study was to evaluate the effects of Patient State Index (PSI) monitoring on recovery from anesthesia and the incidence of any postoperative complications among patients undergoing bariatric surgery with total intravenous anesthesia (TIVA) and inhalational anesthesia.

DESIGN

This prospective, double-blind, and randomized controlled trial was conducted between February 2017 and August 2017 and included 120 morbidly obese patients (body mass index >40 kg/m²).

METHODS

Patients were randomly divided into four groups; group P-PSI (n = 30): TIVA with PSI monitoring; group P (n = 30): TIVA without PSI monitoring; group D-PSI (n = 30): desflurane with PSI monitoring; and group D (n = 30): desflurane without PSI monitoring. The discharge time from the postanesthesia care unit (PACU), postoperative complications, and hemodynamic parameters were recorded and evaluated.

FINDINGS

No significant differences were found in demographic data, duration of anesthesia, admittance to PACU, discharge from PACU, modified Aldrete scores, and perioperative mean blood pressure and heart rate. Nausea and vomiting scores were significantly lower in group P-PSI, group P, and group D-PSI compared with group D.

CONCLUSIONS

Although TIVA and inhalational anesthesia can be safely used for obese patients, intraoperative PSI monitoring may decrease the discharge time from PACU and reduces incidence of postoperative nausea and vomiting caused by inhalation anesthetics.

Organochlorine residue and toxic metal (Pb, Cd and Cr) levels in the surface sediments of the Marmara Sea and the coast of Istanbul, Turkey

In this study, organochlorine and toxic metal (Pb, Cd and Cr) analyses have been done in the surface sediments. Sediment samples have been collected from 7 parts of the Marmara Sea and the coast of Istanbul during 2009. Total Pb, Cd and Cr contents vary between 32 μg g(-1) and 122 μg g(-1); 0.19 μg g(-1) and 1.16 μg g(-1); 62 μg g(-1) and 372 μg g(-1), respectively. EF values of Pb and Cr are higher than 1.5 in all the stations. EF value of Cd is considerably high at Station MY1 (Tuzla Port). Total organochlorine residue contents range between 4.33 ng g(-1) and 22.2 ng g(-1) in the surface sediments.

Prevalence of erythrocyte pyruvate kinase deficiency and normal values of enzyme in a Turkish population

A pyruvate kinase deficiency prevalence study and determination of the normal levels of the enzyme were performed in Antalya city, Turkey. Heparinized blood samples obtained from a representative population of the Antalya province (617 women and 573 men) were tested for pyruvate kinase deficiency by qualitative and quantitative tests between April 1992 and March 1994. The mean pyruvate kinase activity was found to be 19.8 +/- 4.0 IU/g Hb whereas the enzyme activity of deficient cases varied between 7.5 and 12.2 IU/g Hb. Taking into account that pyruvate kinase deficiency is the second most common cause of nonspherocytic congenital hemolytic anemia, detection of deficient cases by genetic screening tests appears to be an informative clinical indicator of hemolytic anemia.

Gabapentin pretreatment for propofol and rocuronium injection pain: A randomized, double-blind, placebo-controlled study

AIM

This prospectively-planned, randomized, double-blind and placebo-controlled study aims to evaluate the effect of 1200 mg gabapentin premedication on the incidence and severity of propofol and rocuronium injection pain.

METHOD

One hundred patients, between 18-60 years of age and ASA I-II for elective surgery planned under general anaesthetic, were randomized and divided into two groups. Two hours before the operation, the patients were given either a placebo tablet (Group P, n = 50) or 1200 mg gabapentin tablet (Group G, n = 50). On the back of the non-dominant hand, a vein was opened using a 20 G cannula , 0.9% NaCl was begun and preoxygenation was provided. For anaesthesia induction, 1% propofol at 800 ml/hr infusion rate was administered for 20 s. Propofol injection pain was evaluated up to the 20th second and recorded using a scale between 0 and 3 developed by McCrirrick and HunteR The remaining propofol dose (2.5 mg/kg), 5 ml saline and 0.6 mg/kg rocuronium were injected in that order over 10 seconds and rocuronium injection pain response was evaluated with a four point scale.

RESULTS

Pain after propofol infusion average score (degree ≥ 1) (Group G = 0.5; Group P = 1.0) and incidence (Group G = 46%; Group P = 68%); and average withdrawal movements response score linked to rocuronium injection pain (≥ 1 response) (Group G = 0.3; Group P = 1.2) and incidence (Group G = 20%; Group P = 80%) were detected to be significantly lower in the gabapentin group compared to the placebo group (p < 0.001).

CONCLUSION

Premedication with 1200 mg gabapentin 2 hours before propofol and rocuronium injection reduced the incidence and severity of injection pain.

[Estrus synchronization and insemination results in Arabian mares in the Eskisehir stud]

An Arab broodmare herd of 30 mares age ranging from 4 to 12 years was grouped into 3 groups (group A, B, C) with 10 mares each and exposed to three different methods of cycle synchronisation. Group A mares received two PGF2 alpha injections 14 days apart. Group B mares got additionally 2,500 IU of hCG 5 days after second prostaglandin application. Group C consisted of mares which had foaled in a synchrony of one week and got a PGF2 alpha injection 3 weeks after parturition. All the mares responding to synchronisation were inseminated closely to ovulation detected by serial rectal palpations with an insemination doses of 0.5 billion of progressively motile spermatozoa. Conception control was performed on the 18th day after ovulation to be continued up to pregnancy confirmation on day 60. Synchronisation response in the different groups A, B, C was 60, 80, 80% starting first oestrus signs between 24 to 36 hours and ovulation time between 5 to 6.5 days post last PGF2 alpha application. Pregnancy rate (first cycle) was 66.7% (A), 75% (B) and 87% (C) basing on the number of mares who responded to synchronisation exposure.

Beta-tricalcium phosphate patient-specific gap implants in bilateral sagittal split osteotomy: an innovative treatment method to enhance the mandibular border contour. Part 1: concept and workflow

Antegonial notching can occur after bilateral sagittal split osteotomy (BSSO) and may lead to unpleasant aesthetic outcomes in both young and older patients. This clinical study presents a new concept to potentially overcome this problem and describes the workflow. Beta-tricalcium phosphate patient-specific gap implants (β-TCP gap-PSIs) are biocompatible and resorbable bone grafts that are placed in the space of the osteotomy gap during orthognathic procedures; they are virtually planned and printed in 3D. Between July 9, 2017 and July 31, 2018, 14 patients received bilateral β-TCP gap-PSIs during BSSO procedures. Nine were female (64.3%) and five were male (35.7%); mean age at surgery was 32.4 ± 12.7 years and the mean sagittal advancement gap was 9.4 ± 1.74 mm. The immediate postoperative position of the β-TCP implants, as well as early and long-term complications were evaluated; the clinical follow-up was 5 years. Intraoperative placement of the β-TCP implants was achieved without early complications, and the mandibular border contour was rated as very good or good in 82.1% of sides. Two minor long-term complications occurred, resulting in a total grafting success rate of 92.9%. In conclusion, this initial study (part 1) showed the potential of the β-TCP gap-PSI concept in BSSO procedures to prevent antegonial notching, which is currently underestimated and underreported. However, further extensive quantitative assessment is mandatory and will be presented in part 2.

Investigation of zinc and copper levels in methimazole-induced hypothyroidism: relation with the oxidant-antioxidant status

Thyroid hormones are associated with the oxidative and antioxidative status of the organism. Depression of metabolism by hypothyroidism has been reported to decrease oxidant production and thus protect tissues against oxidant damage. The purpose of the present study was to investigate Zn and Cu levels in MMI-induced hypothyroidism and to show whether there is a connection between these trace elements and the oxidant-antioxidant status in experimental hypothyroidism. 3-Nitrotyrosine was measured as a marker of nitro-oxidative stress. In order to examine the antioxidant status of MMI-induced hypothyroidism in rats, GSH and SOD levels were determined as well. Significantly decreased 3-nitrotyrosine, Cu and Zn levels were observed in our experimental model when compared with the controls. On the other hand, GSH and SOD levels remained constant. It may be suggested that Cu and Zn serve as antioxidant molecules and exert their effects in an indirect manner to reduce oxidative stress in experimental hypothyroidism.

The value of PET/CT radiomic texture analysis of primary mass and mediastinal lymph node on survival in patients with non-small cell lung cancer

OBJECTIVE

This study was designed to determine the potential prognostic value of radiomic texture analysis and metabolic-volumetric parameters obtained from positron emission tomography (PET) in primary mass and metastatic hilar/mediastinal lymph nodes in stage 2-3 non-small cell lung cancer (NSCLC).

METHODS

Images of patients diagnosed with stage 2-3 NSCLC who underwent 18F-FDG PET/CT imaging for staging up to 4 weeks before the start of treatment were evaluated using LIFEx software. Volume of interest (VOI) was generated from the primary tumor and metastatic lymph node separately, and volumetric and textural features were obtained from these VOIs. The relationship between the parameters obtained from PET of primary mass and the metastatic hilar/mediastinal lymph nodes with overall survival (OS) and progression-free survival (PFS) was analyzed.

RESULTS

When radiomic features, gender and stage obtained from lymph nodes were evaluated by Cox regression analysis; GLCM_correlation (p: 0.033, HR: 4,559, 1.660-12.521, 95% CI), gender and stage were determined as prognostic factors predicting OS. In predicting PFS; stage, smoking and lymph node MTV (p: 0.033, HR: 1.008, 1.001-1.016, 95% CI) were determined as prognostic factors. However, the radiomic feature of the primary tumor could not show a significant relationship with either OS or PFS.

CONCLUSIONS

In a retrospective cohort of NSCLC patients with Stage 2 and 3 disease, volumetric and radiomic texture characteristics obtained from metastatic lymph nodes were associated with PFS and OS. Tumor heterogeneity, defined by radiomic texture features of 18 F-FDG PET/CT images, may provide complementary prognostic value in NSCLC.

[Survey of the reproductive features and insemination/mating results in full blood Arabian and Haflinger mare herds on stud farms in west and middle Anatolia]

Within a German-Turkish university partnership documentation of reproductive data of brood-mares was performed as a part project of the cooperation contract. In the study Arab, Haflinger and cross-breed mares were included. The mares mainly were housed in big studfarms and a smaller part was kept under small private farms. Almost three quarters of both the Arab and Haflinger mares exhibited an estrous length of 1-4 days, whereas the others showed a heat duration of a period of 5-10 days. In the same group of probands a mean length of sexual cycle of 18-24 days could be observed in 38.2% of the Haflinger. The majority of the other mares in both races documented a cycle duration of more than 25 days. The remarkable short duration of heat is discussed as caused by the sharp change from winter to spring environment conditions in that area. An explanation of the marked long mean cycle interval is difficult and might be caused by inadequate documentation of the data. Conception results and foaling data as 83.4% resp. 78.8% in the Arabs and 76.6% resp. 74.8% in the Haflinger mares are within the international standard. Conception rate and foaling data in the cross-breed (72.3% resp. 55.3%) are low compared with data (96.9% 70.8%) of Arab brood-mares kept under stud condition in that area. These data point out the necessity of improving pre- and postconceptional care of the mares under stud conditions as well as in private keeping.

Acquired unilateral nevoid telangiectasia syndrome

We describe a man with acquired unilateral nevoid telangiectasia syndrome, in whom no underlying disease, alcohol abuse or physiological conditions causing hormonal changes are demonstrable. To our knowledge, this is the first case of acquired unilateral nevoid telangiectasia syndrome seen in a healthy adult male and not associated with a hyperestrogenaemic state and estrogen receptor abnormality. This case report casts doubt on the commonly held view that unilateral nevoid telangiectasia syndrome is an estrogen-sensitive nevoid anomaly.

Fine needle aspiration cytology of malignant lymphoepithelial lesion of the salivary gland. A report of two cases

Fine needle aspiration cytologic findings in two cases of malignant lymphoepithelial lesion (MLEL) of the parotid glands are presented. Aspirates of both cases showed individual or cohesive clusters of tumor cells intermingling with mature lymphocytes. Cervical lymph node aspirates in both cases were similar to those seen in the parotids. Our findings suggest that neither cytology nor histology of the cervical lymph nodes is conclusive in establishing the primary site of a metastatic lymphoepitheliomalike carcinoma. MLEL of the salivary glands must be included in the differential diagnosis.