Frequency of thyroid pathologies in the central Black Sea Region: Ultrasound-based field study

Background

Thyroid pathologies are very common diseases. The most common thyroid pathologies are goiter and thyroid nodules. Thyroid ultrasonography is the most widely used examination method in the evaluation of thyroid pathologies. The aim of this field study is to determine the frequency of thyroid pathologies in the province of Tokat and to evaluate its relationship with some factors such as gender and dietary habits.

Materials and Methods

In this population-based prospective study, thyroid US examination was performed on a total of 822 patients. The examination procedure was carried out by one radiologist with at least 10 years of experience. During the examination, thyroid dimensions, parenchyma echo, presence of nodule, echo if any, number, size, and localization were evaluated. The relationships between thyroid pathologies and age, gender, body mass index (BMI), and chronic diseases in the participants were evaluated.

Results

Up to 45.2% (n = 372) of the participants were male and 54.8% (n = 417) were female. The ages of the participants ranged from 20 to 87 years. The mean age of the participants was 47.2. Up to 9.8% of the participants had an increase in thyroid size, defined as goiter. Parenchyma was homogeneous in 72.1% of the participants and heterogeneous in 27.9%. Thyroid nodules were present in the thyroid gland in 40.8% of the participants. There was a statistically significant relationship between thyroid pathologies and female gender, age, and obesity.

Conclusion

Thyroid diseases show regional differences. Older age, female gender, and obesity increase the frequency of thyroid pathologies.

Efficacy of Kinesio® tapes in obstetrical brachial plexus injury: a randomized controlled trial

OBJECTIVES

The purpose of this study was to investigate the effectiveness of Kinesio® tape application associated to exercise in patients with obstetric brachial plexus injury (OBPI).

MATERIALS AND METHODS

Ninety patients with Erb-Duchenne palsy secondary to OBPI participated in a 3-month study, in 2 groups; study group (n = 50) and control group (n = 40). Both followed the same physical therapy program, while the study group also received Kinesio® taping over the scapula and forearm. The patients were evaluated, pre- and post-treatment, using the Modified Mallet Classification (MMC), Active Movement Scale (AMS), and active range of motion (ROM) of the plegic side.

RESULTS

There were no statistically significant intergroup differences in age, gender, birth weight or plegic side (p > 0.05), or in pre-treatment MMC and AMS scores (p > 0.05). There were significant differences in favor of the study group for Mallet 2 (external rotation) (p = 0.012), Mallet 3 (hand on the back of the neck) (p < 0.001), Mallet 4 (hand on the back) (p = 0.001) and total Mallet score (p = 0.025), and for AMS shoulder flexion (p = 0.004) and elbow flexion (p < 0.001). ROM results before and after treatment (within groups) showed significant improvement in both groups (p < 0.001).

CONCLUSION

Since this a was a preliminary study, the results should be interpreted with caution in terms of clinical efficacy. The results suggest that associating Kinesio® taping to conventional treatment helps functional development in patients with OBPI.'

Coronary wave energy to predict functional recovery in patients with ischemic left ventricular dysfunction

Background

Invasive coronary angiography and non-invasive viability testing are the cornerstones of diagnosing and managing ischemic left ventricular dysfunction. At present there is no single test which serves both needs but, if developed, could revolutionise investigation of this condition. Coronary wave intensity analysis (cWIA) interrogates both contractility and microvascular physiology of the subtended myocardium [1,2] and therefore has the potential to fulfil this goal.

Objectives

We hypothesized that cWIA measured during coronary angiography would predict functional recovery with a similar accuracy to late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR).

Methods

Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. cWIA, fractional flow reserve and microvascular resistance were assessed with a simultaneous coronary Doppler and pressure-sensing guidewire during cardiac catheterization at rest, during hyperaemia and during low-dose dobutamine stress. Viability was assessed using LGE-CMR. Regional left ventricular function was assessed at baseline and 6-month follow up after optimization of medical therapy +/− revascularization, using transthoracic echocardiography. The primary outcome was regional functional recovery.

Results

Forty participants underwent baseline physiology, LGE-CMR and thirty had echocardiography at baseline and 6 months; 21/42 territories demonstrated functional recovery. Resting backward compression wave energy was significantly greater in recovering than non-recovering territories (−5240±3772 vs. −1873±1605 W m–2 s–1, p=0.099, Figure 1), and had comparable diagnostic accuracy to CMR (area under the curve 0.812 vs. 0.757, p=0.649, Figure 2); a threshold of −2500 W mm–2 s–1 had 86% sensitivity and 76% specificity at predicting recovery. Backward expansion wave energy did not predict recovery. FFR was numerically higher in recovering territories (0.81±0.17 vs. 0.71±0.16, p=0.058), whilst hyperaemic microvascular resistance did not differentiate recovering from non-recovering territories (1.97±0.73 vs. 2.29±1.00, p=0.287). The likelihood of functional recovery was similar in revascularised and non-revascularised territories (15/29 vs. 6/13 respectively, p=0.739). Low-dose dobutamine stress increased the energy of all waves, but did not improve the accuracy of cWIA in predicting recovery. In a regression model, resting backward compression wave energy and optimization of medical therapy predicted functional recovery; fractional flow reserve and hyperemic microvascular resistance did not.

Conclusions

Backward compression wave energy has similar accuracy to LGE-CMR in the prediction of functional recovery. cWIA has the potential to revolutionise the management of ischaemic left ventricular dysfunction, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Clinical Research Training Fellowship

Promoting and preserving safe and active mobility in Istanbul during the COVID-19 pandemic

The COVID-19 pandemic severely impacted all facets of daily life, including and especially mobility within urban centres. As part of efforts to control the virus by encouraging citizens to stay at home, local governments imposed public health and social measures (PHSMs) restricting the availability and use of public transit. The result was an immediate, sharp decline in the use of public transit, and later as the pandemic was brought under control in certain geographies, a reluctance to return to using public transportation due to sustained fears of virus transmission. In Istanbul, Turkey, the use of public transportation decreased by over 90%, coupled with a significant rise in the use of private motorised transportation. To counter this trend, the Istanbul Metropolitan Municipality (IMM) joined cities around the world in implementing a two-pronged strategy to support safe and active mobility during the pandemic. IMM first launched a communication campaign to promote adherence to PHSMs, to rebuild trust in the safety of public transportation as restrictions eased, and to educate citizens on transportation alternatives. Billboards, social media and digital screens on public transportation promoted continued mask use, hand-washing and physical distancing and encouraged citizens wary of returning to public transit to consider walking or cycling as a safe and healthy alternative to private car use. IMM simultaneously enhanced their cycling infrastructure, creating new temporary and permanent bike lanes that closed connectivity gaps within the city. This talk will further elaborate on IMM's actions and the results and explore how they and other cities can sustain the focus on safe and active mobility as a longer-term strategy to reduce private car use and improve health outcomes.

Effects of the dopamine D3 receptor agonist 7-hydroxy-2-(di-N-propylamino) tetralin in hyperthyroidism-induced premature ejaculation rat model

Various factors are involved in the aetiology of premature ejaculation (PE). Hyperthyroidism is one of the causes of acquired PE, but the exact mechanism by which it causes the disorder is not yet understood. The aim of this study was to evaluate the role of the dopaminergic system in hyperthyroidism-induced PE by the intracerebroventricular microinjection of the preferentially active dopamine receptor agonist 7-hydroxy-2-(di-N-propylamino) tetralin (7-OH-DPAT) in a rat model of this disorder. Wistar rats were randomly divided into hyperthyroid and control groups, and ejaculation was induced by the ICV administration of 7-OH-DPAT. To evaluate the emission and expulsion phases of ejaculation, measurements of seminal vesicle pressure (SVP) and electromyographic recordings of the bulbospongiosus muscle were taken. The interval between the 7-OH-DPAT administration and the first ejaculation was significantly less in the hyperthyroid group (p < .01) than in the control group, and the maximum amplitude of the SVP values revealed a statistically significant difference between the groups (p < .01). The intervals between contractions of the seminal vesicle and bulbospongiosus muscles were also significantly less in the hyperthyroid group (p = .0187) than in the control group. No other results differed significantly between the groups. This study determined that hyperthyroidism altered only the emission phase of ejaculation.

Preliminary results with non-centrifuged autologous fat graft and percutaneous aponeurotomy for treating Dupuytren's disease

The aim of this study was to describe our experience with treating Dupuytren's disease using needle aponeurotomy and non-centrifuged autologous fat grafting. The study included 17 patients (18 hands). Patients were treated with needle aponeurotomy and non-centrifuged autologous fat graft under general anesthesia. The fat grafts were injected into the surgical area so as to stay in contact with the operated site. An extension splint was used for 1 week postoperatively and the patients received hand therapy for 3 weeks. Before the treatment, the contracture in the proximal interphalangeal and metacarpophalangeal joints was a mean of 45.06 ± 13.44 degrees and 36.56 ± 13.09 degrees, respectively. It was 1.61 ± 1.65 and -0.56 ± 3.78 degrees at 3 months, respectively. The difference between these measurements was statistically significant. The mean follow-up period was 12 months. The results were satisfactory and no complications were observed during the follow-up period. Based on the results of the study, percutaneous aponeurotomy with non-centrifuged autologous fat grafting was found to have significantly beneficial effects in the treatment of Dupuytren's disease.

Evaluation of ureteral jet dynamics in pediatric kidney stone formers: A cross-sectional study

INTRODUCTION

The risk of kidney stone formation increases with urinary stasis, which is associated with decreased peristaltism. The relationship between nonobstructive kidney stone formation and ureteral jet dynamics, which can be measured with Doppler ultrasonography (US) and provide information about ureteral peristaltism, has been demonstrated in adults.

OBJECTIVE

To investigate the relationship between ureteral jet dynamics, which provide information about ureteral peristaltism, and stone formation in children.

STUDY DESIGN

Children admitted to Dokuz Eylul University Hospital with flank pain, and asymptomatic age-matched children for the control group, were prospectively enrolled and underwent Doppler US for diagnostic reasons and bilateral ureteral jet flow measurements. Children diagnosed with unilateral nonobstructive lower pole kidney stones formed Group 1, and the control group, without any evidence of stone disease, formed Group 2. Ureteral jet dynamics were compared between the affected renal units in Group 1, and healthy renal units in Group 1 and Group 2.

RESULTS

A total of 32 children were included for each group. The mean average jet flow-rate (JETave (cm/second)) in affected renal units in Group 1 was found to be significantly lower than in the healthy renal units in Group 1 and left and right healthy renal units in Group 2 (P < 0.05). The continuous JETpattern rate in affected renal units in Group 1 was found to be significantly higher compared with healthy renal units in Groups 1 and 2 (P = 0.012) (Table). The odds ratio for kidney stone formation was 5.6 for renal units with JETave <9.5 cm/s when compared with renal units with JETave ≥9.5 cm/s.

DISCUSSION

In a recent study, it was demonstrated in adults that low ureteral jet flow-rate and continuous JETpattern were significantly higher in affected renal units. The findings in children were also similar to adults: the mean JETave was significantly lower and determination rate of continuous flow pattern was significantly higher in affected renal units.

CONCLUSIONS

Children with low JETave and continuous JETpattern as a sign of decreased ureteral peristaltism are at an increased risk of kidney stone formation. However, it is vital that further studies are conducted to elaborate on this topic.

Protective effect of vitamin B5 (dexpanthenol) on cardiovascular damage induced by streptozocin in rats

OBJECTIVES

This study investigated whether Dexpanthenol (DEX) improves diabetic cardiovascular function and cardiac performance by regulating total oxidant and antioxidant status.

METHODS

Diabetes was induced by a single intraperitoneal injection of Streptozocin (50 mg/kg in 1 ml of saline) and treatment groups received DEX (300 mg/kg/day) for 6 weeks. Endothelium (in)dependent relaxation responses were assessed in thoracic aortic rings and coronary vasculature together with alpha receptor and voltage dependant contractile responses of aorta. Myocardial contractility has been recorded by an intra ventricular latex balloon. Total oxidant and antioxidant status were measured from the serum samples.

RESULTS

Induction of diabetes resulted in an apparent body weight loss, high blood glucose, endothelial dysfunction and increased serum oxidant status. DEX supplementation restored the endothelial dysfunction, antioxidant status and body weight whereas decreasing blood glucose level.

CONCLUSION

Along with the standard therapy of diabetes, DEX can be used as a safe and economical way of adjuvant therapy to diminish the burden of the disease (Tab. 3, Fig. 3, Ref. 30).

Low frequency of a decreased ankle brachial index and associated conditions in the practice of internal medicine in a Turkish population sample

AIM

Peripheral arterial disease (PAD) is a less known condition in the practice of internal medicine, mostly due to lack of specific symptoms and low rates of physician awareness. However, cardiovascular disease (CVD) incidence is not significantly different among patients with symptomatic or asymptomatic disease. Ankle brachial index (ABI) measurement is an easy and cost-effective tool for the diagnosis of PAD. In the present study, frequency of low ABI and associated factors were investigated in the setting of internal medicine practice.

METHODS

Patients over 70 years of age and patients between 50 and 69 years with CVD or at least one atherothrombosis risk factor were included in the study. ABI was determined with handheld Doppler. Measurements were determined for both lower extremities. Lower of the right or left ABIs was taken as the final value. Low ABI was defined as ≤0.9.

RESULTS

A total of 303 subjects between 50 and 83 years of age were enrolled (female/male: 186/117). Mean ABI was 1.14±0.15. A low ABI was detected in 15 cases (4.95%). Prevalence was 7% in females and 1.7% in males (P=0.039). Low ABI value was not associated with any of the demographic parameters, presence of major risk factors or basic laboratory values. A high ABI was found by 5.6%.

CONCLUSION

In the present study, frequency of PAD as determined by ABI was found lower than those reported previously in most European countries. Nonetheless, our results showed that PAD affects at least 1 in 20 outpatients in the practice of internal medicine.

Elective bladder preservation with multimodality treatment for bladder cancer

PURPOSE

To observe the outcome of maximal transurethral resection of bladder tumor (TURBT) followed by induction chemotherapy and concurrent chemoradiotherapy in medically inoperable patients with bladder cancer.

METHODS

This study included 30 patients with stage T 2-4 bladder cancer. The patients were first treated with TURBT, and then received 2 cycles of induction chemotherapy with gemcitabine and cisplatin, followed by concurrent chemoradiotherapy with gemcitabine.

RESULTS

Median follow up was 28.9 months. Radiologically, complete and partial response rates were 60 and 36.7%, while cystoscopically they were 40 and 30%, respectively. Local progression (4 cases) and distant metastasis (11 cases) were noted. Median overall survival and progressionfree survival were 32 and 21 months, respectively. One -and 2-year overall survival and progression-free survival rates were 97.60% and 83.49%, respectively.

CONCLUSION

The multimodal treatment performed in this study was well tolerated and achieved a high rate of bladder preservation in selected patients with bladder cancer.

Evaluation of vascular smooth muscle and corpus cavernosum on hypercholesterolemia. Is resveratrol promising on erectile dysfunction?

The aim of this study is to evaluate the effects of hypercholesterolemia in thoracic aorta (TA), mesenteric artery (MA), renal artery (RA), and corpus cavernosum (CC) isolated from cholesterol-fed rabbits. For determination of the maximum detrimental effect, vasorelaxation and vasoconstriction results of arteries and CC have been compared. Animals were fed with a diet that contained 2% w/w cholesterol and 2% w/w high cholesterol plus resveratrol (4 mg kg(-1) per day) for 6-week duration. Total cholesterol levels in the plasma were measured. Vascular and endothelial functions in RA, TA, MA, and CC were assessed by isolated tissue bath with cumulative doses of acetylcholine and sodium nitroprusside. The statistical significance of differences of groups was analyzed by means of one-way ANOVA or Student's t-test. P-values <0.05 were considered significant. There have been no significant changes on plasma total cholesterol levels between cholesterol and cholesterol + resveratrol-treated groups. Vasorelaxation responses to acetylcholine in resveratrol-treated group showed significant changes when compared with hypercholesterolemic group. No statistically significant differences were seen between non-receptor-mediated vasorelaxation responses between the three groups. Resveratrol might be an effective treatment in the prevention of atherosclerotic changes in arteries and CC. The initial effects of hypercholesterolemia on erectile dysfunction and endothelial dysfunction may be precluded with resveratrol. This protective effect may also ensure the prevention of coronary arterial diseases and renovascular diseases in hypercholesterolemic patients.

Effects of land-use changes on landslides in a landslide-prone area (Ardesen, Rize, NE Turkey)

Various natural hazards such as landslides, avalanches, floods and debris flows can result in enormous property damages and human casualties in Eastern Black Sea region of Turkey. Mountainous topographic character and high frequency of heavy rain are the main factors for landslide occurrence in Ardesen, Rize. For this reason, the main target of the present study is to evaluate the landslide hazards using a sequence of historical aerial photographs in Ardesen (Rize), Turkey, by Photogrammetry and Geographical Information System (GIS). Landslide locations in the study area were identified by interpretation of aerial photographs dated in 1973 and 2002, and by field surveys. In the study, the selected factors conditioning landslides are lithology, slope gradient, slope aspect, vegetation cover, land class, climate, rainfall and proximity to roads. These factors were considered as effective on the occurrence of landslides. The areas under landslide threat were analyzed and mapped considering the landslide conditioning factors. Some of the conditioning factors were investigated and estimated by employing visual interpretation of aerial photos and topographic data. The results showed that the slope, lithology, terrain roughness, proximity to roads, and the cover type played important roles on landslide occurrence. The results also showed that degree of landslides was affected by the number of houses constructed in the region. As a consequence, the method employed in the study provides important benefits for landslide hazard mitigation efforts, because a combination of both photogrammetric techniques and GIS is presented.

Serum and BAL cytokine and antioxidant enzyme levels at different stages of pneumoconiosis in coal workers

Coal workers’ pneumoconiosis (CWP) is an occupational pulmonary disease that occurs by chronic inhalation of coal dust. CWP is divided into two stages depending on the extent of the disease, as simple pneumoconiosis (SP) and progressive massive fibrosis (PMF). In the present study, serum and bronchoalveolar lavage (BAL) cytokine (interleukin-1β [IL-1β], IL-6, tumor necrosis factor-α [TNF-α], transforming growth factor-β [TGF-β]) and antioxidant enzymes levels, their relation with the disease severity, and whether they can be considered as biological markers were investigated. Serum and BAL levels of IL-1β, IL-6, and TNF-α were higher in SP and PMF patient groups compared with that in active and retired miner groups. Serum and BAL IL-1β, IL-6, and TNF-α levels were also found to be higher in patients with PMF compared with the SP group. BAL superoxide dismutase (SOD), glutathione peroxidase, and catalase levels and serum SOD level were increased in both patient groups compared with the control group. In addition, mean serum and BAL TGF-β levels were found to be increased in patients with SP compared with PMF group. Based on these results, BAL and serum cytokine and antioxidant enzymes levels were evaluated and discussed as potential biomarkers for different stages of CWP.

Results of postoperative radiotherapy in the treatment of uterine sarcomas: a retrospective analysis of 46 patients

PURPOSE

The aim of this study was to evaluate treatment outcome, survival data and prognostic factors in patients with uterine sarcoma treated by postoperative radiotherapy.

MATERIALS AND METHODS

The records of 46 patients treated between 1993 and 2003 were reviewed. Median age was 55 (range 31-75). There were 21 mixed mullerian tumors, 12 leiomyosarcomas, 11 endometrial stromal sarcomas and two adenosarcomas. According to FIGO classification 65.2% were Stage I, 17.4% Stage II, 13% Stage III and 4.3% Stage IV. All patients received external radiotherapy with 1.8 Gy daily fractions up to 50.4-64 Gy (median 50.4 Gy). Intracavitary brachytherapy was applied to 39 patients. Twelve patients received adjuvant chemotherapy.

RESULTS

Median follow-up time was 48 months (6-144 months). Seventeen patients (37%) developed distant metastases and one patient had local failure. Five-year overall, disease-free and local recurrence-free survival rates were 57.8%, 60.5% and 97.8%, respectively. Univariate analysis demonstrated that stage (p = 0.011), histologic subtype (p = 0.010), tumor size (p = 0.044), positive peritoneal cytology (p = 0.006) and the use of chemotherapy (p = 0.005) had a significant effect on overall survival. Prognostic factors influencing disease-free survival were stage (p = 0.009), positive peritoneal cytology (p = 0.000) and the use of chemotherapy (p = 0.002). The only prognostic factor affecting local control was stage (p = 0.000).

CONCLUSION

Postoperative radiotherapy seems to be an effective adjuvant treatment providing high local control rates in uterine sarcomas. However its efficacy should be clarified by randomized trials. The important prognostic factors influencing the treatment results were stage, histologic subtype, tumor size and positive peritoneal cytology.

Outcome of metastatic non-small cell lung carcinoma patients receiving docetaxelcisplatin combination chemotherapy: single institution experience

PURPOSE

Despite advances in the detection and treatment, the long-term survival of patients with advanced nonsmall cell lung cancer (NSCLC) remains poor, with a 5-year overall survival (OS) of less than 5%. We conducted this observational study to determine the influence of docetaxel plus cisplatin combination chemotherapy on response, time to progression (TTP) and OS, and to evaluate its tolerability in chemotherapy-naïve patients with metastatic NSCLC.

PATIENTS AND METHODS

Patients with histologically or cytologically confirmed stage IV NSCLC who met the following criteria were eligible for the study: no previous chemotherapy, Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2, objectively measurable disease, adequate bone marrow reserve, normal hepatic and renal function. Patients received docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2), both given on day 1. Cycles were repeated every 3 weeks and a total of 4-6 cycles were scheduled to be administered.

RESULTS

50 consecutive eligible patients were enrolled into the study. Median follow-up time was 6 months (range 1-21). Median age was 61.5 years (range 39-75). Forty-eight (96%) patients were male. Histological type was squamous cell carcinoma in 21 (42%) patients, adenocarcinoma in 11 (22%) and undifferentiated carcinoma in 18 (36%). The median OS time was 16 months (range 7.1-24.9; 95% CI: 8-24). One-year OS was 56.3%. Overall response rate was 44% with 40% partial (PR) and 4% complete responses (CR). Twenty-eight percent of patients had stable disease (SD) and 28% progressive disease (PD). The median TTP was 4 months (range 2-13; 95% CI: 2.4-5.5).

CONCLUSION

Docetaxel/cisplatin combination demonstrated efficacy comparable to other platinum-containing doublets.

The combined use of brachial artery flow-mediated dilatation and carotid artery intima-media thickness measurements may be a method to determine vasculogenic erectile dysfunction

The aim of this study was to investigate the relationship between penile color Doppler sonography (CDS) findings and sonographic endothelial parameters in patients with erectile dysfunction (ED), including intima-media thickness (IMT) of common carotid arteries (CCA) and flow-mediated dilatation (FMD) of brachial artery. Fifty-six ED patients were included in the study. Penile CDS, IMT of CCA and FMD of brachial artery were performed in all patients. According to penile CDS findings, 27 (48%) patients had non-vasculogenic and 29 (52%) patients had vasculogenic ED. Among 29 patients, 17 (30%) patients had cavernous veno-occlusive disease (CVOD) and 12 (22%) patients had arterial/combined insufficiency (AI). Median (interquartile range) FMD values of non-vasculogenic ED, CVOD and AI were 12.50 (6.54)%, 12.82 (7.41)% and 6.25 (7.17)%, respectively. FMD was found to be impaired significantly in AI group when compared to the other groups. FMD values of CVOD group were lower when compared to non-vasculogenic group, but the difference was not statistically significant. IMT values of vasculogenic ED patients were higher than non-vasculogenic ED patients (P<0.05). Although IMT values were higher in AI group when compared to CVOD, the difference was not statistically significant. The combined use of IMT and FMD established the diagnosis of vasculogenic ED with 100% sensitivity and 59.2% specificity. The positive predictive value was 72%, negative predictive value 100% and accuracy 80%. The combined use of brachial artery FMD and carotid arteries IMT measurements may be suggested as an alternative method to evaluate vasculogenic ED.

Outcome of non small cell lung carcinoma patients receiving chemotherapy in Kartal State Hospital, Turkey

17142

Background: Lung cancer has been the leading cause of cancer deaths in men worldwide, and is the second most common cause of cancer deaths in women. Non-small cell histology comprises about 70–80% of every diagnosis of lung cancer. Despite advances in the detection and treatment, the long-term survival of patients with advanced non-small cell lung cancer (NSCLC) remains poor, with a 5-year survival of less than 5%. We conducted this trial to determine the influence of treatment with docetaxel given in combination with cisplatin on survival and time to progression, and to evaluate its tolerability in chemotherapy naive patients with metastatic NSCLC. Methods: Patients with histological or cytological confirmed stage IV NSCLC who met the following criteria were eligible for the study: suitable for first-line chemotherapy with no previous chemotherapy, Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0–2, an objective measurable disease, an adequate bone marrow reserve, a normal hepatic and renal function. Cisplatin and docetaxel were delivered to the patients at one dose level through the courses repeated every 3 weeks for 4–6 cycles. Each patient received docetaxel at the doses of 75 mg/m2/day and cisplatin at the doses of 75 mg/m2/day both on day 1. Results: Fifty eligible patients with stage 4 NSCLC were enrolled into the study from June 2003 to September 2005. Median follow-up time was 6 months (1–21). Median age was 61.5 (39–75). Forty eight patients (96%) were male, and 2 patients (8%) were female. Histological type was squamous cell carcinoma in 21 patients (42%), adenocarcinoma in 11 patients (22%) and undifferentiated histologies in 18 patients (36%). The median overall survival time was 16 months (95%CI: 8–24). One-year survival rate was 56.3%. Overall response rate was 44% with 40% partial (PR), 4% complete response (CR). Twenty eight percent of patients had stable disease, and 28% of patients showed disease progression. The median time to progression was 4 months (95%CI: 2.4–5.5). Conclusion: Docetaxel/cisplatin demonstrated efficacy comparable to other platinum agent doublets.

No significant financial relationships to disclose.

Characteristics of vascular involvement in Behçet's disease

OBJECTIVE

Behçet's disease (BD) is a multisystemic inflammatory disorder classified among the vasculitides, which can affect all types and sizes of blood vessels. Vascular involvement may be seen in 25-50% of BD patients. In this study, we examined the characteristics of vascular involvement in patients with BD.

METHODS

One hundred and eighty patients with BD were included in the study. The diagnosis of vascular involvement was made on clinical signs, by Doppler ultrasonography and/or angiography using computed tomographic or magnetic resonance techniques where appropriate. Detailed clinical characteristics were recorded for each patient.

RESULTS

Seventy-one patients (39.4%) had vascular involvement. In patients with vascular lesions, the frequency of male sex was significantly higher than in patients without vascular lesions (89.8% vs. 63.3%, respectively; p < 0.001). Of 71 BD patients with vascular involvement, 68 had venous lesions (95.8%). Three patients had arterial lesions without venous thrombosis. Eleven patients had arterial involvement with venous thrombosis. The most frequent type of vascular involvement was deep venous thrombosis in the lower extremities (n = 56, 78.9%). There was a significant association between deep venous thrombosis and superficial thrombophlebitis (r = 0.325, p < 0.01). Twenty-four patients (33.8%) had vena cava thrombosis and two had vena hepatica thrombosis. In patients with vascular involvement, the frequency of erythema nodosum was significantly higher (p = 0.001) and the frequency of ocular involvement was significantly lower (p < 0.05) than in patients without vascular involvement.

CONCLUSION

Our study illustrates the frequency and significance of vascular involvement in BD.

Post-transfusion acute graft versus host disease in a 17-year-old girl with a malignant mesenchymal tumor--report of a case

Post-transfusion graft-versus-host disease (PT-GVHD) is seldom, but it has a high mortality rate, exceeding 90 percent. There is no standard treatment for PT-GVHD and irradiation of blood and its components before transfusion is broadly accepted for the prevention of PT-GVHD. In this report we present a case (a 17-year-old female) of PT GVHD, who died in spite of the use of all available therapeutic options.

Comparing open surgery with endoscopic releasing in the treatment of carpal tunnel syndrome

AIM

The aim of this study is to retrospectively assess the complications and result of cases that underwent open surgery or endoscopic releasing for carpel tunnel syndrome.

METHOD

A total of 50 cases of carpel tunnel syndrome, 30 of whom underwent endoscopic release using the biportal extrabursal technique described by Chow, and the other 20 that underwent open surgery were included in the study. Average age of the cases was 41 (24 - 62), 44 of them were females and 6 males.

RESULTS

Follow-up examinations of the patients at the first and third month after operation revealed no limitation of activity in 40 (80 %) cases, minimal limitation in 4 (8 %), moderate limitation in 5 (10 %) and significant limitation in 1 (2 %). Among the group that underwent endoscopic release, as a major complication, the median nerve was almost totally cut in a patient undergoing endoscopic release. During the same operation setting perifascicular neurorrhaphy was done. Fourth and fifth digital nerve lesions occurred in three cases. Among the group that underwent open surgery fourth and fifth digital nerve injury occurred in one case, and in another case severe inflammation requiring reoperation occurred.

CONCLUSION

Before intervention, cases of carpal tunnel syndrome should be examined well as regards which technique to use. Experience of the surgeon with the technique to be used should also be taken into consideration. Endoscopic carpal tunnel releasing, though a relatively easier procedure, leads to neurovascular injuries more frequently than open surgery; thus open surgery appears to be safer.

Somatosensory spinal cord evoked potentials in the evaluation of the effect of dexamethasone in experimental spinal cord injury

We studied the effects of high-dose dexamethasone on amplitude and latency values of spinal cord evoked potentials. Thirty-three rabbits were divided into three equal groups. The first group served as the control group, the others received high-dose (2.5 mg/kg) dexamenthasone, the second group 1 hour prior to and the third group immediately after the induction of a spinal cord trauma in segment T12. The spinal cord evoked potentials were recorded epidurally from T12 segment 5 min before and 5, 30, 60, 90, 120 and 150 min after trauma. Pretreatment with dexamethasone (group II) prevented the latency delay, and later treatment with dexemethasone (group III) prevented the latency delay partially. Our results suggest that when dexamethasone is given prophylactically it prevents latency alteration, while treatment with dexamethasone after lesioning prevents latency alteration partially. From our results we conclude that pretreatment with dexamethasone may involve different mechanisms than were activated in the posttreatment group.

[Oral findings in dyskeratosis congenita (a case report)]

Dyskeratosis congenita is a rare genokeratosis and characterized by, A) Reticular dermal atrophy and telangiectatic pigmentation, B) Distrophies of the nails, C) Oral leukokeratosis. In this article, a 22 year old male patient with Dyskeratosis congenita was presented and oral findings were discussed.