The relationship between disease features and quality of life in patients with cancer--I

The high incidence and the severe symptoms of cancer have a considerable effect on quality of life in patients. The relationship between quality of life in patients with cancer and treatment, early diagnosis, disease acceptance, pain, psychological distress, loss of organ, duration of disease, and caregivers was investigated. This study included 508 patients with cancer treated in either inpatient or outpatient clinics of 5 oncology centers in Ankara, Turkey, between August 1 998 and January 2000. Patients were selected by interviews. Data were collected by a questionnaire to determine disease features and to evaluate patients' quality of life. We found that several disease features, including treatment, early diagnosis, disease acceptance, pain, psychological distress, and caregivers, had an effect on patients' quality of life (P < 0.05), whereas loss of organ and duration of disease did not. The results of this study underline the significant effect of psychosocial care programs on quality of life. In the future, assessments of quality of life can help healthcare personnel to prepare psychosocial care programs.

Altered relaxant responses to adenosine and adenosine 5'-triphosphate in the corpus cavernosum from men and rats with diabetes

The present study was aimed at investigating the effects of diabetes on the cavernosal smooth muscle relaxations mediated by adenosine and adenosine triphosphate (ATP) in tissues obtained from men and rats. Adenosine- and ATP-induced relaxant responses showed an enhanced sensitivity with an unaltered effectiveness in diabetic men. Adenosine-elicited relaxation in diabetic rat corporeal tissues exhibited enhanced effectiveness with unaltered sensitivity, whereas ATP-induced relaxations were decreased in diabetic animals when compared to control animals. Tetraethylammonium pretreatment, but not glibenclamide, L-NAME and 8-phenyltheophylline, normalized enhanced apparent affinity to adenosine in tissue from diabetic men and effectiveness (E(max)) to adenosine in diabetic rats. These results suggest that adenosine-elicited relaxation in diabetes is controlled at the receptor level events including K(+) channels in men whereas in rats postreceptor-related events including K(+) channels control the adenosine-induced relaxation. These relaxations to adenosine and ATP in men and rats with and without diabetes may be nitric oxide-independent mechanisms. Our results also suggest that ATP-induced relaxation did not involve K(ATP) channels and Ca-activated K(+) channels.

Jeune syndrome with tongue lobulation and preaxial polydactyly, and Jeune syndrome with situs inversus and asplenia: compound heterozygosity Jeune-Mohr and Jeune-Ivemark?

We report on a male infant with internal hydrocephalus, absence of corpus callosum, papillomas and lobulation of the tongue, notches of the alveolar ridges, short ribs, dysplastic pelvis, hypospadias, short limbs with bowed long tubular bones and postaxial polydactyly of hands, and preaxial polydactyly in one foot. Radiologically this case shares manifestations with Jeune syndrome; the tongue lobulation and the preaxial polydactyly are similar to findings in Mohr syndrome, or short-rib polydactyly syndrome (SRPS), type Majewski. In addition, a female newborn presented with manifestations of Jeune and Ivemark syndromes. One explanation for this overlap may be compound heterozygosity for these syndromes.

Effects of antibacterial therapy on PSA change in the presence and absence of prostatic inflammation in patients with PSA levels between 4 and 10 ng/ml

We investigated the effect of prostatic inflammation on prostate-specific antigen (PSA) and per cent-free PSA levels changing after antibacterial therapy. We evaluated 48 patients whose PSA levels were between 4 and 10 ng/ml, without any suspicious findings on digital rectal examination, with no infection findings in urine analysis. Prostatic inflammation was assessed with prostatic massage. All the patients were given antibiotic therapy for 3 weeks. Patients were re-evaluated 3 weeks after antibacterial therapy with PSA (free/total) and urinalysis. Ten core biopsies were taken with transrectal ultrasound. No differences were found in terms of age, pre- and post-treatment PSA, and PSA varying between patients with and without inflammation in the prostatic massage. In 18 patients, PSA decreased below 4 ng/ml. Prostate cancer was found in 10.8% of the patients with PSA between 4 and 10 ng/ml and none of the patients with PSA values below 4 ng/ml. We suggest an antibiotic therapy for 3 weeks without regarding inflammation findings when PSA is in the gray zone, for biopsy decision.

Impaired endothelium-dependent and neurogenic relaxation of corpus cavernosum from diabetic rats: improvement with L-arginine

This study describes the relaxant response to acetylcholine, electrical field stimulation and sodium nitroprusside after contraction by phenylephrine (10(-5) M) in corpus cavernosum from control and diabetic rats. The response to acetylcholine (10(-9)-10(-3) M) and electrical field stimulation (0.5-64 Hz) is decreased and can be restored by the addition of nitric oxide synthetase substrate, L-arginine(10(-5) M). The response to sodium nitroprusside is not changed in diabetic rats compared to control rats. NADPH-diaphorase staining was enhanced in a diabetic preparation compared to control preparations. The findings suggest a role for the depletion of L-arginine in diabetes mellitus. The enhanced NADPH-diaphorase staining may be due to a deficiency of NOS substrate L-arginine in the endothelium and nerves of diabetic tissues.

Lipid peroxidation and antioxidant system in the blood of patients with Hodgkin's disease

OBJECTIVES

The purpose of this study was to measure the extent of lipid peroxidation and the status of antioxidants in patients with Hodgkin's disease.

DESIGN AND METHODS

Glutathione peroxidase (GPX) and superoxide dismutase (SOD) activities, and malondialdehyde (MDA), selenium, zinc and copper content have been measured in 20 patients with Hodgkin's disease and 30 age-matched controls.

RESULTS

Significantly higher concentrations of MDA in plasma as well as in erythrocytes were found compared to the control group. In both plasma and erythrocytes, GPX activity, selenium and zinc levels were significantly lower in patients than in controls. However, SOD activity in erythrocytes and copper levels in both plasma and erythrocytes were significantly higher in patients.

CONCLUSION

We conclude that the antioxidant system is impaired in Hodgkin's disease due to the abnormal metabolism of trace elements and antioxidant enzymes.

Comparative early results of transurethral electroresection and transurethral electrovaporization in benign prostatic hyperplasia

OBJECTIVE

To compare the results of conventional transurethral electroresection of the prostate (TURP) and transurethral electrovaporization (TUEP) in patients with symptomatic benign prostatic hyperplasia.

PATIENTS AND METHODS

The study comprised 46 patients with moderate or severe symptoms of prostatism and a maximal flow rate of < 15 mL/s. Pre-operatively, all patients underwent a digital rectal examination and the determination of prostatic volume by ultrasonography, and a symptom score, the maximal flow rate, post-void residual urine, routine biochemical variables and serum prostate specific antigen were measured. The haematocrit and blood Na+ levels were also determined pre-operatively and again 24 h after the operation. Patients were divided randomly into two groups: the first underwent a conventional TURP and the second TUEP using 240-300 W of cutting current. Three months after operation, all the variables were remeasured and the values compared with those before treatment and between the groups.

RESULTS

The improvements in symptom score, maximum flow rate and residual urine were slightly better after TURP than after TUEP but the differences between treatments were not statistically significantly different. However, TUEP used slightly less irrigant solution, allowed earlier removal of the urethral catheter, required no blood transfusions and was easier to perform.

CONCLUSION

Although the improvements in the objective variables 3 months after TUEP were almost the same as after TURP, there were advantages in using less resources: further studies with more patients and a longer follow-up are required to determine the efficacy and safety of this procedure.

Posterior bridges retained by resin-bonded cast metal inlay retainers: a report of 60 cases followed for 6 years

Between May 1989 and July 1994, 60 adhesive fixed partial posterior dentures retained by resin-bonded cast metal inlays were placed under controlled conditions. The influence of various prognostic factors on the event free and overall service duration was investigated with univariate and multivariate analysis. The majority of the failures (16 of 18) were caused by loss of adhesion at the metal cement interface and were observed either as debonding of the restorations completely or dislodgement of a single retainer. The other two failures appeared as secondary caries. Univariate analysis demonstrated that, retainer type, approximal configuration and dentine exposition had no effect on the event free service duration. On the other hand, gingival finishing level and luting agent were found to have an effect. Univariate testing was also conducted for the overall service duration and none of the variables were found to have an effect. Multivariate Cox Regression Analysis was performed to estimate the influence of categorical covariates: type of retainer, approximal preparation modification, gingival finishing level, preparation depth and luting agent on survival rates of event free and overall service duration. Luting agent was found to be the single independent prognostic variate (P < 0.0001) for the event free service duration and the other covariates were rejected. For overall service duration, none of the variables were found to be effective.

External radiotherapy in macular degeneration: our technique, dosimetric calculation, and preliminary results

PURPOSE

This study was performed to determine the toxicity and efficacy of external-beam radiotherapy in patients with age-related subfoveal neovascularization.

METHODS AND MATERIALS

Between January 1996 and September 1996, 25 patients with a mean age of 70.5 (60-84) years were enrolled. All patients underwent fluorescein angiographic evaluation and documentation of their neovascular disease prior to irradiation. A total of 25 patients were treated with a total dose of 12 Gy in 6 fractions over 8 days. We used a lens-sparing technique and patients were treated with a single lateral 6-MV photon beam. To assess the risk of radiation carcinogenesis after treatment of age-related subfoveal neovascularization, we estimated the effective dose for a standard patient on the basis of tissue-weighting factors as defined by the International Commission on Radiological Protection (ICRP). The calculations were made with TLD on a male randophantom. The lens dose was found to be 0.217 Gy per fraction.

RESULTS

No significant acute morbidity was noted. Visual acuity was maintained or improved in 76% and 80% of treated patients at their 1- and 3-month follow-up examinations, respectively. On angiographic imaging, there was stabilization of subfoveal neovascular membranes in 23 patients (92%) at 3 months after irradiation.

CONCLUSION

Our observations on these 25 patients in this study indicate that many patients will have improved or stable vision after radiotherapy treatment with low-dose irradiation.

Bilateral male breast cancer and prostate cancer: a case report

Male breast cancer, consisting only 1% of all breast cancers, is occasionally associated with other primary malignancies, especially in patients with familial breast cancer history. Sporadic male breast cancers with another primary tumor are extremely rare. We report a 67-year-old male with asynchronous bilateral breast cancer and prostate cancer without familial breast cancer history.

The visualization of pulmonary tuberculosis with Tc-99m (V) DMSA and Tc-99m citrate in comparison to Ga-67 citrate

Two patients with active tuberculosis confirmed by chest radiography and positive sputum smears were included in this study to determine whether a Tc-99m labeled agent, such as DMSA or citrate could localize such lesions in comparison to Ga-67 citrate. Both patients had Tc-99m (V) DMSA, Tc-99m citrate, and Ga-67 citrate scanning at 1-day to 5-day intervals. Both patients had positive scan findings with all three radiopharmaceuticals. However, the quality of Tc-99m (V) DMSA scans was superior to Tc-99m citrate, which showed faint uptake. Tc-99m (V) DMSA may be a better alternative to Ga-67 citrate in the assessment of the activity and extent of tuberculosis.

Persistent müllerian duct syndrome

Persistent müllerian duct syndrome is a rare form of pseudohermaphroditism, in which well developed müllerian structures are present in an otherwise normal male, possibly resulting from absence of müllerian duct inhibiting factor. Two cases of the syndrome are presented. The diagnosis, as in most cases, was confirmed at herniorrhaphy or exploration for undescended testis.

Effect of postnecrotic and alcoholic hepatic cirrhosis on development of benign prostatic hyperplasia

BACKGROUND

The object of this study was to investigate the effects of hepatic cirrhosis on the development of benign prostatic hyperplasia and consequent effects on prostatic volume, serum prostate-specific antigen (PSA), and prostatism symptoms.

METHODS

Sixty patients with postnecrotic cirrhosis and alcoholic cirrhosis at age 40 and over, and 20 voluntary subjects in the same age group with normal hepatic functions, were evaluated with prostatic volume calculation by transrectal ultrasound, symptom scoring according to American Urology Association (AUA) criteria, measurement of serum prostate-specific antigen (PSA), serum total testosterone (TT), free testosterone (FT), estradiol (E2), and calculation of E2/FT ratios, and the results were analyzed statistically by the Mann-Whitney U-test.

RESULTS

Serum FT and TT levels were significantly lower in the hepatic cirrhosis group compared to the control group (P = 0.0000 and P = 0000, respectively). Though mean serum E2 level was a little higher in cirrhotic patients compared to controls, the difference was not significant; however, the higher E2/FT ratio in the cirrhotic group was statistically significant (P = 0.27 and P = 0.0002, respectively). In the cirrhotic group, the decrease in FT and TT levels was greater, as the disease advanced. While E2 and E2/FT ratio increase, correlate with poor prognosis, no statistically significant differences were found. Mean prostatic volume, serum PSA level, and total symptom score were significantly higher in the control group, compared to the cirrhotic group (P = 0.0001, P = 0.0006, and P = 0.002, respectively). Prostatic volume decreased parallel to severity of disease in cirrhotic patients.

CONCLUSIONS

The main reason for the decrease in mean prostatic volume in cirrhotic patients compared to subjects in the same age group with normal hepatic functions was the decrease in serum FT and TT levels, and the secondary cause was the increase in E2/FT ratio, indicating estrogenic predominance.

Effects of aluminum chloride on some trace elements and erythrocyte osmotic fragility in rats

Aluminum (Al) is a nonessential, toxic element to which humans are constantly exposed as a result of an increase in industrialization and improving technology practices. The aim of the study was to investigate the effects of different durations and doses of Al exposure on serum and tissue element levels and erythrocyte osmotic fragility in rats. A total of 40 male Wistar Albino rats were divided into five groups: control, group I (3 weeks, 8 mg/kg), group II (6 weeks, 8 mg/kg), group III (3 weeks, 16 mg/kg), and group IV (6 weeks, 16 mg/kg). Al chloride (AlCl3) was injected intraperitoneally (i.p.) five times a week. At the end of the experimental period, levels of Al, iron (Fe), copper (Cu), and zinc (Zn) in serum, liver, and kidney tissues were measured using inductively coupled plasma optical emission spectrometry. Osmotic fragility was determined using a spectrophotometer. The results of the experiment indicate that Al induced a statistically significant increase in Al and Fe concentrations in liver and serum as well as in Cu in the kidney. The Fe concentration in serum and kidney tissues was significantly lower in all the groups. As a result of our study, it may be concluded that tissue Al accumulation may lead to an increase in osmotic fragility of erythrocytes and abnormal trace element levels.

A comparison of fluid absorption during transurethral resection and transurethral vaporization for benign prostatic hyperplasia

OBJECTIVES

To compare the absorption of irrigant fluid during transurethral vaporization of the prostate (TUVP) and transurethral resection of the prostate (TURP).

PATIENTS AND METHODS

Thirty patients with clinical benign prostatic hyperplasia were randomly assigned to undergo TURP or TUVP; 1.5% glycine +1% ethanol solution was used as the irrigating solution. The volume of irrigant absorbed during surgery was estimated from the ethanol concentration in the patient's expired breath, sampled every 10 min.

RESULTS

In both groups, the estimated absorbed fluid volume increased with the duration of surgery (P < 0.05). At the end of surgery, the mean (median, range) fluid absorption during TUVP was 672 (606, 0-1400) mL and during TURP was 1347 (975, 453-2965) mL; the difference was statistically significant (P < 0.05).

CONCLUSION

Although TURP has a greater associated risk of fluid absorption than TUVP there may still be severe fluid absorption with the latter. Even though TUVP is potentially less harmful than TURP in poor-risk patients, ethanol monitoring is beneficial for increasing patient safety.

Recurrent Spontaneous Pneumothorax following High-Dose Chemotherapy in a Patient with Non-Seminomatous Testicular Cancer with Pulmonary Metastases

With modern treatment modalities it is possible to obtain a long survival in patients with non-seminomatous testicular cancer. Chemotherapy is the mainstay of treatment in metastatic cases. High-dose chemotherapy and autologous peripheral blood stem cell transplantation is a good salvage treatment for recurrent cases. However, the modality has serious complications. We present a rare case of recurrent spontaneous pneumothorax due to rupture of residual cystic lesions after high-dose chemotherapy in a patient with pulmonary metastases. Such a situation has been rarely reported.

Tensile bond strength of enamel-resin-metal joints

This study observed the effects of the alloy type, resin type, and simulated occlusal loading on enamel-resin-metal tensile bond strength. Three different dental alloy samples were sandblasted with 50 microns of desiccant alumina and then bonded to the buccal and lingual halves of extracted human molars with four different dental resins. Specimens were divided into two groups, which included different halves of tooth samples. For one group tensile strength was tested after 19.8 N per 60,000 loading cycles. For the other group tensile testing was performed without cyclic loading. The results revealed that enamel-resin-metal bond strength was not affected by alloy type. However, a close relationship between the resin type and the bond strength was found. It was demonstrated that Panavia Ex and Concise resins produced greater bond strengths than did ABC and MBA cements. Also, a significant decrease in tensile bond strength values occurred after cyclic loading.

A giant bladder stone: managed with osteotome

An unusual case of bladder stone is presented. The size of stone and the operation technique were exceptional in the urologic literature. The stone could be palpated on physical examination. The stone was removed by fragmentation with osteotome because of adherence of the stone to the bladder wall. The stone weighed 570 g.

Development of hyperthyroidism during long term interferon therapy in a patient with chronic myelogenous leukemia: case report

In this case report a patient with thyroid dysfunction who received chronic treatment with interferon-alpha (INF-alpha) following a diagnosis of chronic myelogenous leukemia (CML) is described. Generally INF-alpha induced dysthyroidism develops in the earlier phase of INF-alpha treatment. This is a case report of thyroid dysfunction which occurred 4 years after the patient began to receive INF-alpha administration. In addition, INF-alpha was administered to this patient for a longer period than those reported in the literature.

Antispermatozoal antibody values after varicocelectomy

Although there are many causes of the production of antispermatozoal antibodies, there are still unknown aetiological factors. Antispermatozoal antibodies were investigated in the postoperative period in 25 infertile men with varicocele whose antispermatozoal antibody tests were negative in the preoperative period. Antispermatozoal antibodies were found in the serum in 4 of the 25 (16%) infertile men after varicocele operation. Postoperative genital infections were detected in 6 patients and antispermatozoal antibodies were present in only 2 of them. The correlation between these antibodies and varicocele has been demonstrated but there is no report on the association of antibodies with varicocelectomy in the literature to date.

Spontaneous fragmentation of a double J stent

A variety of indications have made the use of double J stents routine in urology. Minimal and moderate side effects of ureteral stent are common, when the indwelling time exceeds 6 weeks the incidence of severe complications, like fragmentation increase. We report a case of stent fragmentation after an indwelling period of 12 months. Despite the variety of complications the severity requires close monitoring of the patient.

Primary Non-Hodgkin's Lymphoma of the Liver (Case Report)

Primary non-Hodgkin's lymphoma of the liver is very uncommon, and fewer than 100 cases have been reported in the literature. Most reports describe either solitary or multiple mass lesions in the liver. A diffuse lesion without nodule formation is a relatively rare form of the disease. The histologic feature of the disease is a predominantly large cell lymphoma of B-cell lineage. We report a case of primary B-cell non-Hodgkin's lymphoma which had diffusely infiltrated the liver without nodule formation.