[Multiple myeloma : an overview of advances in biology and treatment]

Multiple myeloma is the second most common hematological malignancy, characterized by an uncontrollable proliferation of clonal plasma cells. Although progresses in understanding its pathobiology and its treatment are made every day, it remains incurable. Since myeloma is more and more common, especially in the elderly, we would like to propose an overview of its pathobiology, diagnostic criteria and treatment «guidelines».

Histopathology of ipsilateral and contralateral ovaries and plasma interleukin 6 levels after unilateral ovarian torsion

OBJECTIVE

The aim of the present study was to evaluate the time-dependent histopathologic changes in both ovaries and to determine the time-dependent levels of plasma interleukin 6 (IL-6) after unilateral ovarian torsion.

MATERIALS AND METHODS

An experimental animal study included 48 female Sprague-Dawley rats which were distributed to six groups: control group (Group 1), sham-operated control group (Group 2), and four unilateral ovarian torsion groups with torsion duration of three, six, 12, and 24 hours (Group 3, 4, 5, and 6, respectively). Histopathologic criteria (follicular degeneration, vascular congestion, hemorrhage, inflammatory cell infiltration, and total tissue damage score) were evaluated in both ovaries, and plasma IL-6 levels were measured.

RESULTS

At 24 hours after torsion began, mean total tissue damage score was similar between ovaries that had torsion and contralateral ovaries. Mean plasma IL-6 level did not change during the 24 hours after torsion began (p = 0.584).

CONCLUSIONS

In addition to ovaries that had torsion, histopathologic abnormalities also occurred in contralateral ovaries. These results suggest that contralateral ovaries are not quiescent after unilateral ovarian torsion. Plasma IL-6 levels did not change significantly during the 24 hours after ovarian torsion began, resulting in a limitation of its diagnostic use in the early course of the disease.

The Technical and Financial Effects of Parenteral Supplementation with Selenium and Vitamin E during Late Pregnancy and the Early Lactation Period on the Productivity of Dairy Cattle

This study aimed to determine the effects of parenteral selenium (Se) and vitamin E supplementation on economic impact, milk yield, and some reproductive parameters in high-yield dairy cows in the dry period and in those at the beginning of lactation. At the beginning of the dry period, cows (n = 323) were randomly divided into three groups as follows: Treatment 1 (T1), Treatment 2 (T2), and Control (C). Cows in group T1 received this preparation 21 days before calving and on calving day, and cows in group T2 received it only on calving day. The cows in the control group did not receive this preparation. Supplementation with Se increased Se serum levels of cows treated at calving day (p<0.05). Differences in milk yield at all weeks and the electrical conductivity values at the 8th and 12th weeks were significant (p<0.05). Supplementation with Se and Vitamin E decreased the incidence of metritis, the number of services per conception and the service period, but had no effects on the incidence of retained fetal membrane. A partial budgeting analysis indicated that Se supplementation was economically profitable; cows in group T1 averaged 240.6$ per cow, those in group T2 averaged 224.6$ per cow. Supplementation with Se and Vitamin E has been found to increase serum Se levels, milk yield, and has positive effects on udder health by decreasing milk conductivity values and incidence of sub-clinical mastitis.

Manual versus computer-automated semen analysis

OBJECTIVE

To evaluate agreement of conventional sperm analysis with computer-aided semen analysis (CASA) regarding concentration, motility, and morphology using samples from infertile men.

MATERIALS AND METHODS

In this study a total of 195 male partners of couples who underwent evaluation of infertility were included. All semen samples were examined by conventional method and CASA in terms of morphology, motility, and concentration. Pearson correlation analysis and the Bland-Altman method were used to assess correlation and agreement between conventional semen analysis and CASA measurements.

RESULTS

When the two methods were compared in terms of concentration, motility, and morphology, there was a statistically significant correlation in all variables. The best correlation was obtained for sperm concentration. However, there was a poor correlation for sperm morphology between conventional method and CASA. Sperm concentration and morphology obtained by CASA were 14% and 87% lower, respectively; motility was 21% higher than the conventional method.

CONCLUSION

Although CASA systems are objective and rapid, they should be evaluated in terms of cost-effectiveness, however they may be useful in over-loaded assisted reproductive technique (ART) clinics.

Can combination of Day 3 and Day 5 embryo morphology be useful to predict pregnancy in in-vitro fertilization cycles?

OBJECTIVE

To determine whether embryos having all top qualified both on Day 3 and Day 5 have higher pregnancy rates than the oth- ers.

MATERIALS AND METHODS

The study included 143 consecutive cycles were recruited in which Day 5 embryo transfer was available. Cleavage stage embryos were graded according to 1 to 4 scoring system, based on fragmentation, cell symmetry, and blastomere num- ber. Among cleavage stage embryos, Grade 1 and Grade 2a/2b were further stratified as 'top quality' embryos to be transferred, others were defined as control group. Blastocyst stage embryos were graded from 1 to 6 according to intracellular mass (ICM) and trophec- toderm (TE). Day 5 fresh embryo transfer was performed in all cases using soft catheter. Positive pregnancy test was accepted when serum beta-human chorionic gonadotrophin (1-hCG) exceeded 20 mIU/ml.

RESULTS

On the cleavage stage, top quality embryo was available in 47 of 143(32.9%) cases. Of the 47 embryos, the number of cases reaching any Grade 4, 3 quality, and early blastocyst on Day 5 were 22 (46.8%), 15 (31.9%), and 10 (21.3%). The respective figures on the control group (n = 96) were 33 (34.4%), 37 (38.5%), and 26 (27.1%) (p > 0.05). The pregnancy rates were also similar.

CONCLUSION

All top qualified embryos both on Day 3 and 5 did not reveal higher pregnancy rate than the others.

Use of an individual mandibular advancement device for an?obstructive sleep apnoea patient with facial paralysis: a short-term follow-up case report

This case report aimed to describe the fabrication procedure and treatment efficacy of an individual, one-piece, non-adjustable mandibular advancement device (MAD) for a moderate obstructive sleep apnoea patient with facial paralysis (FP). Mandibular advancement device was fabricated with autopolymerising acrylic resin. The intermaxillary relations were recorded such as to fix the mandible at a protruded position with increased vertical dimension. Initial evaluation of the MAD was made with axial magnetic resonance imaging and polysomnography on the first day of usage. Following evaluations were made on the third and sixth month. After a follow-up period of 6 months, Apnoea/Hypopnea Index (AHI) significantly decreased from 26·7 to 3·0. However, the average oxygen saturation did not improve as expected initially. The MAD therapy decreased the AHI scores of a patient with FP. At the end of a follow-up period of 6 months, the patient did not report any serious complaint except temporary tooth pains.

Subcutaneous lispro and intravenous regular insulin treatments are equally effective and safe for the treatment of mild and moderate diabetic ketoacidosis in adult patients

In this prospective, randomised, open trial, we wanted to evaluate the efficacy and safety of hourly subcutaneous (SC) insulin lispro administration in the treatment of diabetic ketoacidosis (DKA) in comparison with intravenous (IV) regular insulin treatment. Twenty patients were enrolled in the study. The patients were randomly assigned into two groups. Following a bolus injection of 0.15 U/kg IV regular insulin, group L received half of this dose as hourly SC insulin lispro while group R was treated conventionally with IV regular insulin infusion. At the end of treatment period, time that needed for normalisation of serum glucose, beta-hydroxybutyrate, blood pH and urine ketone levels were not different in groups L and R. There was no mortality or serious side effects in both groups. In this study, we revealed that treatment of mild and moderate DKA with SC insulin lispro is equally effective and safe in comparison with IV regular insulin.

Sphenoid sinus brown tumor, a mass lesion of occipital bone and hypercalcemia: an unusual presentation of primary hyperparathyroidism

Brown tumor is a focal lesion of the bone caused by primary or, less commonly, secondary or tertiary hyperparathyroidism (HPT). While the mandible is the most frequently involved bone in the head and neck region, atypical involvement of the cranium in the area of the sphenoid sinus is exceedingly rare. In the literature, a unique case of brown tumor of the sphenoid sinus was reported in a patient with primary HPT. We present a case of sphenoid sinus and occipital bone brown tumor associated with primary HPT. A 47-yr-old woman presented a 2-yr history of headaches, dizziness, diffuse body and articular pain, fatigue, and a 6-month history of intermittent nausea and vomiting, polydipsia, and polyuria. Magnetic resonance imaging (MRI) demonstrated an expansive mass lesion in the sphenoid sinus with erosion of the sellar floor and medial wall of the right orbit, and expansion in the medulla of bone. Examination of biopsy specimens obtained from sphenoid sinus mass confirmed the diagnosis of brown tumor. The biochemical laboratory studies showed elevation of parathyroid hormone and confirmed the diagnosis of primary HPT. Excision of a parathyroid adenoma affected the metabolic status into normalizing. At the follow-up of 12 months postoperatively, the size of sphenoid sinus brown tumor decreased and the mass of occipital bone disappeared. In conclusion, this is a first report of primary HPT masquerading as a destructive fibrous sphenoid sinus brown tumor associated with a mass lesion of occipital bone and hypercalcemia in the literature.