A thyrotropin‑secreting macroadenoma with positive growth hormone and prolactin immunostaining: A case report and literature review

Thyrotropin (thyroid stimulating hormone [TSH]) secreting pituitary adenomas (TSHoma) are rare adenomas presenting with hyperthyroidism due to impaired negative feedback of thyroid hormone on the pituitary and inappropriate TSH secretion. This article presents a case of TSH‑secreting macroadenoma without any clinical hyperthyroidism symptoms accompanying immunoreaction with growth hormone (GH) and prolactin. A 36‑year‑old female patient was admitted with complaints of irregular menses and blurred vision. On physical exam, she had bitemporal hemianopsia defect. Magnetic resonance imaging (MRI) evaluation showed suprasellar macroadenoma measuring 33 mm × 26 mm × 28 mm was detected on pituitary MRI. She had no hyperthyroidism symptoms clinically. Although free T4 and free T3 levels were elevated, TSH level was inappropriately within the upper limit of normal. Response to T3 suppression and thyrotropin releasing hormone‑stimulation test was inadequate. Other pituitary hormones were normal. Transsphenoidal adenomectomy was performed due to parasellar compression findings. Immunohistochemically widespread reaction was observed with TSH, GH and prolactin in the adenoma. The patient underwent a second surgical procedure 2 months later due to macroscopic residual tumor, bitemporal hemianopsia and a suprasellar homogenous uptake with regular borders on indium‑111 octreotide scintigraphy. After second surgery; due to ongoing symptoms and residual tumor, she was managed with octreotide and cabergoline treatment. On her follow‑up with medical treatment, TSH and free T4 values were within normal limits. Although silent TSHomas are rare, they may arise with compression symptoms as in our case. The differential diagnosis of secondary hyperthyroidism should include TSHomas and thyroid hormone receptor resistance syndrome.Key words: Inappropriate thyroid stimulating hormone, thyrotropin‑secreting pituitary adenoma, thyroid stimulating hormone adenom

An Examination of Story Narration by Monolingual and Bilingual Turkish Children

In the present case study, we aimed to explore whether there were any differences between monolingual Turkish and Turkish-Italian bilingual children in terms of their use of language structures in Turkish while narrating a story from a picture book titled “Frog, where are you?” by Mayer (1969). Four monolingual Turkish and three Turkish-Italian bilingual children narrated the story. The data from the recordings indicated some differences in terms of preference for certain language features like tense differences in their story narration. While younger monolinguals reported the events in the story with past tense markers like –mIş and –Iyor, bilingual children displayed a marked tendency for the past tense –mIş marker. The older children in both groups chose to use the –Iyor marker used by monolingual teenagers and adults. We argued that such differences in preferences might indicate an effect of Italian, or the interlanguage varieties might be responsible for the discrepancies. Explanations as to why these differences might have occurred and some practical suggestions for educators are provided in the study

A technical report on repair of amalgam-dentin complex

This clinical report describes a repair protocol for cusp fracture of a failed amalgam-dentin complex. A maxillary right first premolar with an amalgam restoration presented a buccal cusp fracture. Chairside repair has been undertaken by conditioning the existing amalgam restoration with silica coating (30 μm CoJet®-Sand), phosphoric acid etching the beveled enamel surface, priming dentin, and application of a bonding agent on both enamel and dentin. Thereafter, the amalgam was silanized (ESPE®-Sil), and opaque resin was applied and polymerized to mask the amalgam. The fractured buccal cusp was modeled using resin composite (Clearfil Photo Posterior) and photo-polymerized. Finally, the amalgam was refinished and refurbished and the composite was finished and polished

Testing early life connectivity supplying a marine fishery around the Falkland Islands

We used a wind-driven global circulation model to build spatially explicit predictions from rival hypotheses concerning advective supply of Patagonian toothfish (Dissostichus eleginoides) to a trawl fishery around the Falkland Islands, and tested the predictions using chemistry recorded in the otoliths of fish caught in the fishery. Model simulations indicated transport pathways from spawning aggregations off southern Chile to both the north and south of the fishing area. In contrast, simulated particles released from spawning aggregations around Burdwood Bank were transported to the south of the fishing area but not to the north, becoming fully entrained in the Subantarctic Front instead. Spatial heterogeneity in the chemistry laid down in the otolith nuclei during early life discounted the hypothesis of a single population with a spawning area on Burdwood Bank, and indicated that fish assemblages are structured by large-scale transport from both southern Chile and Burdwood Bank. By linking fish explicitly to their physical environment, the two techniques can help distinguish the life cycle trajectories necessary for populations to persist, and elucidate the interactions between hydrography and life history that structure the fish assemblages on which marine fisheries depend

The evaluation of brain natriuretic peptide changes and difficult airway predictors during perioperative period of pregnancy

Aim Airway changes, difficult ventilation, and intubation are the leading causes of morbidity and mortality in pregnancy, but no prospective study has evaluated the relationship between airway changes and brain natriuretic peptide (BNP) before and after cesarean section operations. The purpose of this study was to evaluate the relationship between BNP and airway changes in women undergoing delivery and during the postoperative period

A strain gauge analysis of microstrain induced by various splinting methods and acrylic resin types for implant impressions

PURPOSE: The aim of this study was to investigate the level of microstrain that is exerted during polymerization of acrylic resins used for splinting during implant impressions. MATERIAL AND METHODS: Two acrylic resins (GC Pattern Resin, Duralay II) and square transfer coping splinting methods were evaluated by means of strain gauge analysis. Two implants were embedded in a polyurethane block, and the abutments were positioned. Sixty specimens were prepared using two square transfer copings that were rigidly connected to each other using the acrylic resins. The specimens were randomly divided into three groups of 20 each for the splinting methods: Method 1 was a one-piece method; in method 2, the splint was separated and reconnected after 17 minutes; and in method 3, the splint was separated and reconnected after 24 hours. In each group, half the specimens were splinted with GC Pattern Resin and the other half were splinted with Duralay II. Three microstrain measurements were performed by four strain gauges placed on the upper surface of the polyurethane blocks at 5 hours after resin polymerization for all groups. The data were analyzed statistically. RESULTS: Both resin type and splinting method significantly affected microstrain. Interaction terms were also significant. Method 1 in combination with Duralay II produced significantly higher microstrain (1,962.1 με) than the other methods with this material (method 2: 241.1 με; method 3: 181.5 με). No significant difference was found between splinting methods in combination with GC Pattern Resin (method 1: 173.8 με; method 2: 112.6 με; method 3: 105.4 με). CONCLUSIONS: Because of the high microstrain generated, Duralay II should not be used for one-piece acrylic resin splinting, and separation and reconnection are suggested. For GC Pattern Resin, variations in splinting methods did not significantly affect the microstrain created

Normal and Tumour Tissue mRNA Expressions of Telomerase Complex Genes in Several Types of Cancer.

To investigate the changes in mRNA expression levels of telomerase-related significant proteins in several types of cancer

Clinical Outcomes Related to the Use of Bendamustine Therapy for Multiple Myeloma Patients Relapsed-Refractory to IMiDs and Proteasome Inhibitors

Objective: Multiple myeloma patients who are relapsed or refractory to both proteasome inhibitors (PIs) and immunomodulatory drugs (IMiDs) have been reported to have poor outcomes. Bendamustine has been reported to have an antitumor effect in newly diagnosed as well as relapsed/refractory multiple myeloma (RRMM). The aim of this retrospective study was to evaluate the efficacy of bendamustine therapy in heavily pretreated MM patients who were refractory to PIs and IMiDs. Materials and Methods: Nineteen RRMM patients treated either with bendamustine and steroids (n=13) or a combination of bendamustine with novel drugs (n=6) were included. The median number of previous treatment lines was 5 (minimum-maximum: 3-8) and median time from diagnosis was 6 years (minimum-maximum: 1-16). All of the patients were resistant to at least one of the IMiDs and one of the PIs. Bendamustine was given at doses ranging from 90 mg/m2 to 120 mg/ m2 on days 1 and 2 of 28-day cycles. Results: A median of 2 (minimum-maximum: 1-8) treatment cycles was administered per patient. The toxicity of bendamustine was mild and mostly of hematological origin. No complete remission was achieved. There was partial remission and stable disease in 21% and 11% of the patients, respectively. Sixty-eight percent of patients had progressive disease. The median progression-free survival and overall survival was 2 and 4 months, respectively. Conclusion: Bendamustine therapy was well tolerated but showed limited anti-myeloma activity in heavily pretreated patients who were refractory to IMiDs and PIs