Synchronous parathyroid adenoma and papillary thyroid carcinoma: 99mTc-MIBI Scan Findings

Simultaneous existence of parathyroid adenoma and thyroid nonmedullary carcinoma is rarely observed. A 52-year-old female was diagnosed approximately 4 years ago with primary hyperparathyroidism (PHPT) on the basis of hypercalcemia and elevated serum parathyroid hormone (PTH) level. Clinically, PHPT diagnosed patient was examined with Tc-99m MIBI scintigraphy to investigate parathyroid adenoma. Early Tc-99m MIBI images showed focal focused enhanced activity retention on both thyroid left lobe upper pole and thyroid lower pole inferior neighborhood. However, late images indicated thyroid activity washout and persistence of activity on left lobe lower pole. The observed lesion on left lobe lower pole neighborhood was identified as parathyroid adenoma. One-day thyroid scintigraphy was also conducted to correlate enhanced activity retention on the left lobe upper pole. Results on thyroid scintigraphy showed hypoactivity, and thyroid fine-needle aspiration cytology process was suggested from the nodule. Simultaneous existence of parathyroid adenoma and thyroid nonmedullary carcinoma is rarely observed. Diagnosis and treatment of hyperparathyroidism is crucial during preoperative period. Even observed rarely, parathyrotoxicosis diagnosed patients can develop thyroid cancer along with parathyroid adenoma.

Is BECLIN-1 Immunoreactivity More Effective than HBME-1 in Diagnosis of Papillary Thyroid Cancer?

BACKGROUND

Even though morphologic findings are generally important in the diagnosis of thyroid tumors, in some cases, morphologic similarities between benign and malignant lesions lead to noticeable differences in evaluation and different diagnoses in the same cases. In our study, we researched whether the autophagy-related protein Beclin-1 (BECN1) is a diagnostic marker in thyroid tumors, as well as its correlation with HBME-1, which has high sensitivity and specificity in distinguishing malignant thyroid lesions.

METHODS

Samples from 136 patients that received a thyroidectomy were fixed in 10% formalin. All cases had hematoxylin & eosin (H&E) stains available for review and paraffin blocks for immunohistochemical staining. In immunochemistry tests, BECN1, HBME-1, and Ki-67 were studied.

RESULTS

BECN1 immunoreactivity rates were found to be 98.9% in papillary thyroid carcinoma (PTC), 57.1% in follicular carcinoma (FC), and 21.4% in follicular adenoma (FA). HBME-1 immunoreactivity was 100% in PTC, 85.7% in FC, and 64% in FA. In thyroid carcinomas, BECN1 was as effective as HBME-1 as a marker for the diagnosis of malignancy.

CONCLUSIONS

We revealed an important role of autophagy in thyroid carcinogenesis, as evidenced by the high rate of BECN1 immunoreactivity in PTC and FC. Moreover, we found that autophagy plays a more important role in PTC, as evidenced by the high immunoreactivity rates. According to our results, BECN1 is a more specific marker than HBME-1 in PTC and has a higher correlation with Ki-67. In routine studies, BECN1 will be more helpful than HBME-1 in the diagnosis of PTC.

Differential expression of e-cadherin in normal, metaplastic and dysplastic esophageal mucosa - a putative biomarker

Barrett's mucosa is a potentially premalignant columnar lined metaplastic epithelium in the oesophagus about which little is known regarding maintenance of cell adhesion. In this regard E-Cadherin (E-cad) is a 120 kDa polypeptide present in all epithelial tissues and it is the prime mediator of cell-cell interactions. An immunohistochemical technique utilised the monoclonal antibody HECD-1 to evaluate E-cad expression in microwave treated, paraffin embedded sections from 120 patients. The phenotype of the specimens from the patients were metaplastic [41] and dysplastic mucosa [24], invasive squamous carcinoma [15] and adenocarcinoma [18] and corresponding metastatic lesions [10] as well as 12 specimens of normal oesophageal mucosae. Surface expression was high in non-metaplastic tissue and in non-dysplastic metaplasia but was reduced extensively in dysplasia. In addition in squamous carcinoma and adenocarcinoma E-cad was characteristically expressed in the cytoplasm and this was associated with poor morphological differentiation. SDS-PAGE gel protein analysis revealed the characteristic 120 kDa sized protein in normal squamous oesophageal tissue. In Barrett's metaplastic tissue and carcinoma, however, stronger bands at 108 kDa and 45 kDa were also present, suggesting either decreased glycosylation or a truncated protein in the metaplastic and neoplastic tissue, respectively. In conclusion changes in E-cad immunoreactivity and cellular localisation occur in premalignant metaplastic epithelium of the oesophagus. Further studies are in progress to evaluate whether the abnormal E-cad protein reflects both loss of function and may be used as a biomarker in pre-malignant lesions.

N-acetyl cysteine promotes angiogenesis and clearance of free oxygen radicals, thus improving wound healing in an alloxan-induced diabetic mouse model of incisional wound

BACKGROUND

This study investigated whether N-acetyl cysteine induces any favourable effects on cutaneous incisional wound healing in diabetic and nondiabetic mice. The wounds were assessed using detection of vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (iNOS) expression, and wound-breaking strength (WBS) measurements.

METHODS

In total, 48 BALB/c mice were used. These were divided into four groups, each consisting of 12 mice. Incisional wounds were made on the back of each mouse. Two of the groups consisted of healthy animals and the other two groups consisted of mice with alloxan-induced diabetes. One group of healthy mice and one group of diabetic mice received intraperitoneal N-acetyl cysteine (NAC) 150 mg/kg for 5 consecutive days, while the other two groups were untreated. On the fifth day all animals were killed, and the WBS, oxidative stress parameters, histopathological and immunohisotchemical results were assessed.

RESULTS

Both diabetic and nondiabetic mice receiving NAC had lower levels of oxidative stress markers and higher WBS measurements than untreated counterparts.

CONCLUSIONS

A mouse model of incisional wound treated with NAC resulted in lower levels of tissue oxidative stress, higher levels of tissue glutathione, and downregulation of iNOS expression coupled with upregulation of VEGF expression, producing an overall favourable clinical outcome of higher WBS and a shorter wound-healing period both in diabetic and nondiabetic mice. Both antioxidant and anti-inflammatory properties of NAC may be involved in this improved healing process for incisional wounds.

Partial trisomy due to a de novo duplication 22q11.1-22q13.1: a cat-eye syndrome variant with brain anomalies

We report a case of partial trisomy 22q with de novo duplication of chromosomal region 22q11.1-22q13.1, also confirmed by microarray comparative genomic hybridization (Array-CGH) analysis. The fetus had interhemispheric cyst and corpus callosum agenesis diagnosed by MRI which has not been reported in the literature. This novel phenotype differs from the reported cat eye syndromes by the absence of heart defects and the presence of brain anomalies.

Use of warm priming solution in open heart surgery: its effects on hemodynamics and acute inflammation

Cardiac surgery causes an acute inflammatory response and organ damage. In this study, for the first time in the literature, we compared the effects of priming solutions at 20°C and 36°C on acute inflammatory markers and hemodynamic parameters. Forty patients were recruited and randomized into two groups, each consisting of 20 participants who underwent elective coronary artery bypass grafting operation. Groups were primed with the same solution at different temperatures. Hemodynamic parameters were recorded. Blood samples were drawn pre-operatively and at the 15th and 60th minutes of aortic cross-clamping and the 24th hour following surgery. Serum pre-albumin, α-1 antitrypsin, and tumor necrosis factor-α levels were determined. The groups were compared statistically. Both of the groups were comparable for mean aortic cross-clamping time and mean time for cardiopulmonary bypass. Mean blood pressure value was significantly lower and the mean amount of ephedrine hydrochloride used was significantly higher in the cold priming group. Spontaneous beating of the heart after removal of aortic cross-clamp significantly was more frequent in the warm priming group. A significant rise was observed in systemic inflammatory markers in the cold priming group. In our study, the lesser amount of ephedrine hydrochloride used and the higher frequency of spontneous beating of the heart in the warm priming group may be considered as improvements in hemodynamic status. Use of warm priming solution also induced a significant improvement in the acute inflammatory markers. We recommend the use of warm priming solution in open heart surgery.

The use of the retinal nerve fiber layer thickness measurement in determining the effects of cardiopulmonary bypass procedures on the optic nerve

BACKGROUND

Our aim was to determine the effects of cardiopulmonary bypass procedures on the optic nerve by retinal nerve fiber layer thickness measurements.

METHODS

Retinal nerve fiber layer thickness was measured using the GDx Nerve Fiber Analyser, 1 day before the surgery and on postoperative days 1, 5 and 30 in 20 patients undergoing coronary artery bypass grafting surgery.

RESULTS

Postoperative mean values for retinal nerve fiber layer thickness, except symmetry on the first day and except symmetry and superior nasal ratio on the fifth day, were statsitically decreased. Only the value for the inferior ratio was significantly lower at the end of the first month.

CONCLUSIONS

Cardiopulmonary bypass procedures cause a temporary decrease in retinal nerve fiber layer thickness.

Comparison of the efficacy of tigecycline and teicoplanin in an experimental methicillin-resistant Staphylococcus aureus osteomyelitis model

We evaluated the efficacy of tigecycline and teicoplanin in a rat model of MRSA osteomyelitis. Osteomyelitis was induced with an intramedullary injection of 10(8 )colony-forming units (cfu) of MRSA. After osteomyelitis formation was confirmed on Day 14, infected rats were randomly divided into three groups: tigecycline (n=13), teicoplanin (n=13), and no-treatment control (n=14). A 28-day antibiotic therapy with a subcutaneous injection of tigecycline (14 mg/kg twice daily) or intramuscular administration of teicoplanin (20 mg/kg daily) was administered. Rats were then sacrificed, and the tibias were harvested. The bones were weighed and then cultured. Our results indicated that bacterial growth was significantly reduced in teicoplanin and tigecycline groups, compared to the control group (p=0.019 and p=0.006, respectively). However, no difference was detected between the two antibiotic groups (p=1.000). No bacterial growth was detected in 7 out of 13 and 9 out of 13 specimens of the teicoplanin and tigecycline treated groups, respectively. Although this result was numerically in favor of tigecycline, the difference was not statistically significant (p=0.427). In conclusion, tigecycline, a novel antibiotic, appears as an effective alternative to teicoplanin in the treatment of osteomyelitis caused by MRSA.

Effect of low dose electrocautery usage during radial artery harvesting on the neurological outcome of the forearm: a neuroelectrophysiological study

BACKGROUND

The present study aimed to investigate whether electrocautery caused any thermal injury to the forearm nerves or not.

METHODS

We compared the neurological outcome of two different radial artery harvesting techniques through neuroelectrophysiological studies. Preoperative values and postoperative conduction changes after one month were compared in two groups of patients. Each of the groups consisted of 20 patients. Radial arteries were harvested using scissors in Group 1 and with a low dose diathermy technique in Group 2.

RESULTS

The mean amplitude of sensory action potentials of radial nerves was significantly reduced postoperatively at the end of the first month in both groups (P = 0.01, P = 0.001). But there were no significant differences between groups with respect to the sensory action potentials of ulnar and median nerves postoperatively. There were no significant differences between groups with respect to radial, ulnar and median nerve motor conduction recordings.

CONCLUSION

Low dose electrocautery does not cause excessive nerve injury compared with the scissors technique in radial artery harvesting. Electrocautery may be used safely for RA harvesting in the forearm.

Postoperative radiotherapy results in soft tissue sarcomas

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Background: Postoperative radiotherapy results with higher local rates than surgery alone. In this trial we have evaluated and studied factors that affects local recurrence rates. Methods: A retrospective clinical study of 125 eligible patients with soft tissue sarcoma diagnosis from SB Okmeydani Educational Hospital-Oncology Department treated between 1998–2002 years was performed. Tumor size, surgery margin histopathologic grade and type were evaluated. At subgroup analysis local recurrense rates were studied in groups with or without postoperative radiotherapy. Results: In 125 patients, 70 were tumor free, 45 were tumor positive or with suspicious margin after the surgery. Subgroup of 25 patients which have tumor size smaller than 5 cm and negative margin had no radiotherapy and had no local recurrens. In an other group of 45 patients which have tumor size larger than 5 cm and tumor negative after excision 18 patients did not have any postoperative radiotherapy and 4 of them (% 22) had local failure. The rest of the 27 patients of this group who had postoperatif radiotherapy had 2 (% 7) local failure. Among 55 patients with positive or suspicious margins; 18 had no postoperative radiotherapy and there were 6 (% 33) local recurrens while the 37 patients with radiotherapy had 7 (% 18) local recurrens rates. Conclusions: In operable soft tissue sarcomas tumor size, hystopathological grade, postoperatif surgery margins are the most important factors which affects local recurrens rates.

[Table: see text]

No significant financial relationships to disclose.

Coronary reoperations without the use of cardiopulmonary bypass

BACKGROUND

Reoperations of coronary artery surgery still carry a higher mortality and morbidity rate, compared to primary revascularization procedures. Coronary artery bypass reoperations without the use of cardiopulmonary bypass (CPB) is a potential strategy that has been developed to decrease mortality and morbidity.

MATERIALS AND METHODS

Between 1978 and 2000, 113 patients were reoperated for coronary artery revascularization, 32 (28.3%) cases on beating heart without the use of CPB (Group II) and 81 (71.7%) cases under CPB and cardioplegic arrest (Group I). Mean age of Groups I and II were 61.3+/-5 and 57.4+/-7.3 years, respectively.

RESULTS

Statistically significant difference was found between the two groups, favoring off pump surgery in the early postoperative findings with respect to low cardiac output, postoperative myocardial infarction and postoperative hospitalization duration until discharge. Operative mortality was not statistically different between groups and these figures for cardiopulmonary and off pump groups were 11/81 (13.5%), 1/32 (3.1%), respectively.

CONCLUSION

Reoperations of coronary artery revascularization surgery without the use of CPB is more economic, necessitating less manipulations, free of side effects of CPB, less time consuming surgical procedure compared to reoperations performed under standard techniques. When performed with a refined technique and true indications, off pump coronary reoperations have mortality and morbidity advantages over the surgery performed under CPB, improvements in techniques and instruments off pump strategy must be in the surgeons armamentarium in coronary reoperations.

Inhibition of systemic inflammatory response with sodium nitroprusside in open heart surgery

BACKGROUND

A nitric oxide donor, sodium nitroprusside has been reported to reduce the inflammatory response during cardiopulmonary bypass (CPB). To investigate this, a double-blind and prospective study was conducted.

METHODS

Twenty patients with multi vessel coronary disease were randomly chosen to form study (SNP) and control groups. In the SNP group, 0.5 microg/kg/min sodium nitroprusside were administered for 20 min right after the release of the aortic crossclamp. Mac-1 (CD11b/CD18) leukocyte adhesion molecule expressions, interleukin-6 levels were measured from radial artery blood as well as leukocyte and platelet counts in both groups at 6 different time points: a) before anesthesia, b) after heparin administration, c) after aortic crossclamp release, d) after protamine administration, e) 3 hours after the termination of CPB, f) 24 hours after the termination of CPB.

RESULTS

The increase in Mac-1 expressions were not different between the two groups at any time point except the measurements after the administration of protamine. At this time point, Mac-1 expressions were not different between the groups (99.8+/-30.7 vs 134.6+/-95.1%, p=0.076), but higher when compared with the preinduction levels. IL-6 levels for SNP and control groups was 89+/-43 and 215+/-131 pg/dL, respectively (p=0.016) 3 hours after the termination of CPB. Twenty-four hours after the termination of CPB, IL-6 levels were still significantly higher in the control group (47+/-27 vs 111+/-68 pg/dL, p=0.039). Leukocyte and platelet counts were not different at any time point between the groups.

CONCLUSIONS

Systemic inflammatory response in patients undergoing CPB can be reduced to a certain level with sodium nitroprusside, especially the activation of vascular endothelial cells can be inhibited, but activation of leukocytes still takes place.

Inducible nitric oxide synthase expression in chronic viral hepatitis and its relation with histological severity of disease

The role of nitric oxide in the pathogenesis of chronic viral hepatitis is not known. Elevated nitric oxide production is assumed to be responsible for the pathological changes in many inflammatory conditions, mainly via peroxynitrite, a potential oxidant that is produced by the reduction of superoxide anion with nitric oxide. The intensity and the distribution of the immunohistochemical staining of intrahepatic inducible nitric oxide synthase were studied in the biopsy specimens obtained from 63 patients with viral hepatitis and 13 patients with elevated transaminase levels of various aetiologies. Hepatic inducible nitric oxide synthase staining was significantly more intense in the viral hepatitis group (P = 0.000). Inducible nitric oxide synthase staining levels correlated well with the severity of the viral hepatitis using the Knodell's liver histological activity index (r = 0.393, P = 0.002) Among the viral hepatitis group, the pathological distribution of the inducible nitric oxide synthase staining favoured the periportal hepatocytes (zone 1) whereas less staining was observed in parenchymal hepatocytes zone of 2 and 3 and bile duct epithelium. As nitric oxide mediated nitration of hepatocellular proteins is elevated in inflamed hepatic tissues and is correlated with the severity of the disease, we suggest that inducible nitric oxide synthase can possibly have a critical role in the pathogenesis of chronic viral hepatitis.

A rare clinical entity: Pott's puffy tumor. A case report

Pott's puffy tumor is a rare clinical entity described as osteomyelitis of the frontal bone associated with subperiosteal abscess. The causative factors and treatment modalities are discussed in light of the literature.

Cellular kinetics in Barrett's epithelium carcinogenic sequence: roles of apoptosis, bcl-2 protein, and cellular proliferation

To gain insight into the neoplastic progression of Barrett's epithelium (BE), we assessed the expression of Ki-67 antigen and bcl-2 protein and the occurrence of apoptosis in metaplastic epithelium with and without regenerative atypia (RA), low-grade dysplasia, and high-grade dysplasia (HGD). To refine our understanding of the epithelial kinetics during the carcinogenic sequence, we performed separate analyses of four different mucosal regions, i.e., surface epithelium, upper and lower crypts, and glands. Expansion of the proliferative zone was noted in dysplasia and to a mild degree in epithelium with RA but not in BE. Expression of bcl-2 protein was seen in the proliferative zone in BE and showed a significant increase in RA but was essentially absent in HGD. Numerous apoptotic nuclei were seen in HGD, decreasing along the cellular gradient from gland to surface. We noted a positive correlation between Ki-67 and bcl-2 in the proliferative zone of BE and RA, whereas a negative correlation was present on the surface of RA. Ki-67 was positively correlated with apoptosis in the lower crypts of HGD. bcl-2 expression was negatively correlated with apoptosis in all regions except the proliferative zone of dysplastic areas. Our findings suggest that overexpression of bcl-2 protein is not an important step in the carcinogenesis of BE. We confirm the upward shift of cellular proliferation in dysplastic epithelia. Apoptosis that is increased in dysplasia might play a significant role in carcinogenesis by restraining increased cellular proliferation.

Comparison of topical silver nitrate and flunisolide treatment in patients with idiopathic non-allergic rhinitis

In this study, 90 patients with idiopathic non-allergic rhinitis were divided into three groups. Silver nitrate was given to Group I, flunisolide to Group II, and placebo to Group III. Healing results according to symptoms, physical findings, nasal smear findings and biopsy findings were compared. Improvement ws noticed in symptoms (rhinorrhea 93%, sneezing 89%, nasal congestion 80%), physical findings (color of mucosa 89%, concha hypertrophy 87%, rhinorrhea 82%), nasal smear findings (94%) and biopsy findings (epithelium 76%, basal membrane 80%, edema 84%, eosinophilia 95%, inflammation 87%) in Group I. Recurrence was observed in symptoms and physical findings of 30% of the patients in Group I during the 6 months-follow-up period. In Group II, improvement was noticed in symptoms (rhinorrhea 73%, sneezing 70%, nasal congestion 61%), physical findings (color of mucosa 72%, concha hypertrophy 69%, rhinorrhea 62%), nasal smear findings (87%) and biopsy findings (epithelium 67%, basal membrane 63%, edema 70%, eosinophilia 77%, inflammation 70%). But symptoms recurred in all patients in approximately 1-3 months after competition of treatment. There was a statistically significant difference between silver treatment and flunisolide or placebo treatment.

The effects of octreotide in a patient with Nelson's syndrome

We have administered octreotide, 100 micrograms tid, to a 27-year-old man with Nelson's syndrome. After seven days of therapy, adrenocorticotropin levels fell to 54% of initial values, and some shrinkage of the tumour was observed. This study indicates that octreotide therapy may have a role in the treatment of Nelson's syndrome.

Colonic subepithelial collagenous thickening in diabetic patients

PURPOSE

This study was designed to investigate the effect of intestinal subepithelial collagenous thickening on diabetic diarrhea because one of the seven patients diagnosed with collagenous colitis was diabetic.

METHODS

Rectosigmoidoscopic rectal biopsies were taken from 50 diabetic patients (8 with and 42 without diarrhea), 20 nondiabetic patients with diarrhea, and 10 healthy patients. Histopathologic examinations and measurements of subepithelial collagen layers were performed on these biopsies.

RESULTS

In diabetic patients who had diarrhea, the subepithelial collagen layer (SCL) was thicker than it was in diabetics without diarrhea (P < 0.05). In diabetic groups, the SCL was thicker than it was in both nondiabetics with diarrhea and those without diarrhea (P < 0.05). There was no statistical difference between nondiabetics with diarrhea and those without (P > 0.05). There was no correlation between collagen thickness, age, and diabetes duration (P > 0.05).

CONCLUSIONS

It was concluded that there was a thickening of the colonic SCL in diabetic patients.

Sarcomatoid squamous cell carcinoma of the right renal pelvis with liver metastasis: case report

We report on a man with sarcomatoid squamous cell carcinoma of the right kidney with liver metastases. Bilateral renal lithiasis and well differentiated squamous cell carcinomas of the right renal pelvis were also noted. This uncommon case is discussed and the literature is reviewed.

Changes in E-cadherin immunoreactivity in the adenoma-carcinoma sequence of the large bowel

We have used an avidin-biotin immunoperoxidase technique to localise epithelial cadherin (E-cadherin), a calcium-dependent cell-cell adhesion molecule, in 107 paraffin-embedded sections from 93 patients consisting of 24 with colorectal adenoma, 55 with rectal carcinoma and 14 with liver metastases. The corresponding primary colorectal tumours were also studied in these cases. E-cadherin was expressed by normal colorectal epithelial cells with typical membranous staining at the intercellular junctions. Loss of normal membranous E-cadherin expression and presence of cytoplasmic staining were found frequently in adenomas larger than 1 cm (P < 0.01), with high grade dysplasia and villous histology (P < 0.01). In primary rectal cancers, loss of membranous expression correlated with high tumour grade. No correlation was seen with Dukes and Jass stage, local extramural spread and 5-year recurrence rate. Complete loss of membranous E-cadherin immunoreactivity was seen in 7/14 (50%) liver metastases in which 6/7 (86%) showed intense membranous E-cadherin immunoreactivity in the corresponding primary tumour. Our data indicate that changes in E-cadherin immunoreactivity and cellular localisation correlate with size, severe dysplasia in adenomas and tumour grade in carcinomas. However, there seems to be no correlation between loss of membranous E-cadherin immunoreactivity and the invasive and metastatic potential of the carcinomas.

The therapeutic value of naloxone and mannitol in experimental focal cerebral ischemia. Neurological outcome, histopathological findings, and tissue concentrations of Na+, K+ and water

In this study, the effect of naloxone and mannitol was investigated on focal cerebral ischemia induced by middle cerebral artery occlusion with the transorbital approach in the rabbit model. Rabbits were randomly and blindly assigned to one of three groups (six animals in each): (1) a control group that received equal volumes of physiological saline solution; (2) a naloxone group that received a 5 mg/kg bolus of naloxone i.v. 1 h after occlusion, followed by 2 mg/kg per hour i.v. infusion for 5 h; (3) a mannitol group that received 0.2 g/kg twice with an interval of 10 min at 5 h. The neurological outcome was better in rabbits treated with naloxone than in the others. The ratio of ischemic to total neurons in the cortex was smaller in the naloxone group than in the control and mannitol groups (P < 0.05). In addition, there was a statistically significance reduction in infarct size in the naloxone group compared with the other groups (P < 0.05). Edema was severe in the control and mannitol groups, but moderate in the naloxone group. There was no statistically significant difference in Na+, K+, and water content between groups. Our data provide evidence for the beneficial effects of naloxone on promoting neurological recovery and preserving the ischemic area.

Temporal artery inflammation as a complication of anthrax

A 41-year-old male patient was treated with penicillin for cutaneous anthrax affecting the region of the right eye. He was also given dexamethasone for 3 days to combat extensive oedema which was causing respiratory difficulty because of tracheal compression. After the oedema had resolved and the typical necrotic black eschar of anthrax had evolved, he developed acute inflammation of the right temporal artery. We believe this is the first report of this type of complication of anthrax.

Tolerability, safety and efficacy of two formulations of Parlodel--a slow release oral form (SRO) versus registered Parlodel capsules

Twenty hyperprolactinemic patients who entered a randomized parallel-group, double-blind, double-dummy study were investigated regarding safety, tolerability and efficacy. Half of the patients received 5 mg Parlodel SRO plus placebo for Parlodel while the other half received 2.5 mg Parlodel b.i.d. and placebo for Parlodel SRO for a period of 15 days. In the second following period of 15 days, the daily dose was increased to 10 mg Parlodel administered either as a single dose of Parlodel SRO or two doses of Parlodel 5 mg. The plasma prolactin levels, clinical signs and symptoms of hyperprolactinemia, physical examination, blood pressure, heart rate assessments and adverse events were recorded during the study. Complete blood count, blood chemistry and standard ECG were performed before and at the end of treatment. In conclusion, both formulations are equally efficacious, well tolerated and safe. Due to the comfort of once-a-day administration and the excellent compliance, one could recommend to replace the b.i.d. or t.i.d. administration of Parlodel with the once-a-day Parlodel SRO in hyperprolactinemic patients.

Bone mineral density in Turkish postmenopausal women

OBJECTIVE

To determine the bone mineral density curve in Turkish postmenopausal women and to evaluate the efficacy of estrogen replacement therapy in the prevention of bone loss.

METHOD

Spinal bone mineral density was measured using dual photon absorptiometry in 118 postmenopausal women, prospectively. Parity, previous and current use of estrogen preparations were correlated with BMD using Student's t-test and the chi 2-test.

RESULTS

With a mean BMD value of 0.967 +/- 0.013 g/cm2, 62.5% of our postmenopausal study population had a mean BMD value of < 1.0 g/cm2 and 33.7% were already osteoporotic (< 0.9 g/cm2). Bone loss was faster and more intense in the surgically menopausal than in the naturally menopausal group (P < 0.05). Parity after the fourth delivery dropped the mean BMD value (P < 0.05). Previous and current use of estrogen treatment seemed to decrease bone mineral loss in the postmenopausal years.

CONCLUSION

Our data stress the need for locally obtained normal BMD values in every country in the world. High parity, surgical menopause and duration of 5 or more years of natural menopause are risk factors for bone loss. Estrogen replacement diminishes the annual bone loss.

Bone loss in young women with primary hypogonadism and its prevention with calcitonin

A total of 63 healthy young women with primary amenorrhea, 37 control women at the same age with normal ovarian function and 118 postmenopausal women underwent bone mineral density (BMD) measurements at the lumbar spine (L2-L4) by dual photon absorptiometry. Mean +/- SE BMD value in the primary amenorrheic patients (0.878 +/- 0.015 g/cm2) was significantly lower than in both the control ovulatory women (1.069 +/- 0.026 g/cm2) and the postmenopausal patients (0.967 +/- 0.013 g/cm2) (p < 0.05). When hormonal parameters were compared between primary amenorrheic and ovulatory control cases, only the prolactin mean levels were found to be significantly lower in the first group (8.74 +/- 0.86 vs. 16.31 +/- 1.05 ng/ml; p < 0.001). Serum total alkaline phosphatase activity and LDL-cholesterol were negatively correlated with bone mineral density. Total cholesterol and lipid levels were significantly higher in women with primary amenorrhea when compared with the eumenorrheic control group (p < 0.001).