Is Ki-67 Index an Useful Labeling Marker for Invasion of Pituitary Adenomas?

The Ki-67 antigen is a protein expressed in cell nuclei throughout the entire cell cycle. It is related to the cell proliferation in a variety of pituitary tumors. Pituitary tumors are usually benign, but may be aggressive and invade surrounding tissues in about one third of the cases. The aim of this study is to determine the proliferative index of the pituitary adenomas, using MIB-1 monoclonal antibody in paraffin embedded sections and also to correlate this index with clinical parameters and radiological evidence of invasiveness. Twenty-eight patients (mean age, 46.46 +/- 13.14; range, 13-80 yr) who underwent surgery for pituitary adenomas were enrolled in this study. Immunohistochemical staining for anti-Ki-67 monoclonal antibody (MIB-1) was performed and the proliferative activity was determined as the percentage of MIB-1 labeled nuclei (MIB-1 index). The overall mean Ki-67 labeling index was 2.04 +/- 1.17 (range 1-5). This index was not associated with gender and age of the patients and functional status of pituitary adenomas. Although Ki-67 index was higher in suprasellar adenomas than in sellar adenomas, the difference was not statistically significant (2.20 +/- 1.15 for suprasellar adenomas vs. 1.85 +/- 1.21 for sellar adenomas; p=0.316). Ki-67 index was distributed almost the same amount between the groups of adenomas with (2 +/- 1.51) or without cavernous sinus invasion (2.05 +/- 1.03) (p=0.498). Unexpectedly, no significant relationship was identified between proliferation index and the invasiveness of pituitary adenomas in this study, but this raises the question whether proliferation markers in pituitary adenomas are useful or not

AKUT MYOKARD İNFARKTÜSÜNDE AKUT FAZ REAKTANLARINDAKİ DEĞİŞİM VE TROMBOLİTİK TEDAVİNİN BU DEĞİŞİME ETKİSİ

AKUT MYOKARD İNFARKTÜSÜNDE AKUT FAZ REAKTANLARINDAKİ DEĞİŞİM VE TROMBOLİTİK TEDAVİNİN BU DEĞİŞİME ETKİSİSerdar Fenercioğlu1, Mahmut Gümüş1, İbrahim Erbay1, Haluk Sargın1, Mehmet Sargın1, Mehmet Aliustaoğlu1, Taflan Salepçi1, Ali Yayla1Dr.Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi Dahiliye KliniğiMyokard infarktüsü, myokardın mutlak veya relatif ağır perfüzyon yetersizliği sonucu gelişen bölgesel nekrozudur. Yaptığımız çalışmada akut myokard infarktüsü seyrinde görülen, akut koroner olaylardan sorumlu faktörler olduğuna dair bulguların sürekli arttığı, inflamasyonun akut faz reaktanlarından olan C-reaktif protein (CRP), eritrosit sedimentasyon hızı (ESH) ve lökosit düzeylerinin trombolitik tedavi ile değişkenliği araştırılmıştır. Hastanemiz Koroner Yoğun Bakım Ünitesi'nde Ocak 2000-Aralık 2000 tarihleri arasında myokard infarktüsü nedeni ile trombolitik tedavi uygulanan 40 hasta ve AMİ tanısı alan fakat endikasyonu olmaması nedeni ile trombolitik tedavi uygulanmayan diğer 40 hasta çalışmaya alındı. Hastaların yatışlarının ilk saatinde kan şekeri, üre, kreatinin, ürik asit, kolesterol, trigliserid, yüksek dansiteli lipoprotein, karaciğer fonksiyon testleri, total protein, albumin, globulin, sodyum, potasyum, eritrosit sedimentasyon hızı, Anti-Streptolizin O (ASO), CRP, hemogram ölçümleri için kan örnekleri alındı. Ayrıca hastaların periferik yaymaları hazırlanıp boyanarak lökosit formülü yapıldı. Çalışmaya alınan hastaların 9'u (%11.3) kadın, 71 'i (%88.7) erkek idi. Yaş ortalamaları 54.4 ± 10.5 (28-70) yıl bulundu. Albumin, eritrosit sedimentasyon hızı, CRP, lökosit sayısı, hematokrit, platelet, polimorf nüveli lökosit (PNL), lenfosit, monosit ve eozinofil düzeylerindeki 1. ve 7. günler arasında değişim istatistiksel olarak anlamlı bulunurken, ASO düzeylerindeki değişimde ise istatistiksel olarak anlamlı fark saptanmamıştır. ESH, ASO, CRP, lökosit sayısı, hematokrit, platelet, PNL, lenfosit, monosit ve eozinofil düzeylerindeki değişimler trombolitik tedavi uygulanan ve uygulanmayan gruplar arasında değerlendirildiğinde ESH, ASO, hematokrit, platelet, PNL ve lenfosit düzeyleri açısından gruplar arasındaki fark istatistiksel olarak anlamlı bulunmuştur. CRP, lökosit, monosit ve eozinofil düzeyleri açısından ise istatistiksel olarak anlamlı fark saptanmamıştır. AMİ'nin l., 3. ve 7. günlerinde bakılan CRP düzeylerinin 3. günde en yüksek olduğu ve bu artışın akut koroner olaylardaki inflamasyonla ilişkili bulunduğu görülmektedir. Çalışmamızda incelenen diğer bir akut faz reaktanı olan albüminin 1. ve 7. günlerdeki değerlerine bakılmış, anlamlı bir düşme olduğu görülmüştür. Çalışmamızda 1., 3. ve 7. günlerde bakılan eritrosit sedimentasyon hızında belirgin bir artış saptanmış, trombolitik tedavi uygulanan hastalarda eritrosit sedimentasyon hızı, uygulanmayanlara göre anlamlı olarak daha düşük bulunmuştur. Reperfüzyonun bir göstergesi olarak CRP ile trombolitik tedavi etkinliği arasında çalışmamızda anlamlı bir ilişki kurulamamıştır.Anahtar Kelimeler:&nbsp;AKUT FAZ REAKTANLART, TROMBOLİTİK TEDAVİ, AKUT MYOKARD İNFARKTÜSÜTHE VARIABILITY OF ACUTE PHASE REACTANS IN ACUTE MYOCARDIAL INFARCTION AND EFFICACY OF THROMBOLYTIC TREATMENT TO THESE VARIABILITYSerdar Fenercioğlu1, Mahmut Gümüş1, İbrahim Erbay1, Haluk Sargın1, Mehmet Sargın1, Mehmet Aliustaoğlu1, Taflan Salepçi1, Ali Yayla1Dr.Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi Dahiliye KliniğiMyocardial infarction (MI) is a regional necrosis of heart and caused by absolute or relative perfusion insuffiensy. The variability of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte levels which were acute phase reactants of inflammation, were seen in AMI and have data that showed their responsibilities from acute coronary syndrome, were investigated with thrombolytic treatment in our study. Fourty patients who were put on thrombolytic treatment because of AMI and other 40 patients who were also diagnosed as AMI but were not thought to have an indication for thrombolytic treatment, were included into the study. They were hospitalized in intensive coronary care unit of our hospital between January-December 2000. Blood samples for blood glucose, urea, creatinine, uric acid, cholesterol, tryglyceride, high density lipoprotein, liver function enzymes, total protein, albumin, globulin, sodium, potassium, ESR, anti-streptolysin O (ASO), CRP, hemogram were obtained in the first hour after hospitalization of the patients. Nine (%11.4) of patients were female and 71 (%88.7) were male. Mean age was 54.4(10.5 years. Statistically significant difference was found between the first and 7th day levels of albumin, ESR, CRP, leukocyte, monocyte and eosinophyl counts; but not for ASO levels. When we compared the results by separating the patients into two groups as who have had thrombolytic treatment or not, there was a statistically significant differences between the groups according to ESR, ASO, hematocrite, platelet, PNL and lymphocyte levels. There was no difference between groups according to the CRP, leukocyte, monocyte and eosinophyl levels. CRP was highest at 3rd day when we analysed the results of the first, third and 7lh day of AMI and that increase was seen in relation with inflammation in acute coronary syndrome. Other acute phase reactant albumin levels were also evaluated and a statistically significant decrease was found between the first and 7lh day. In our study, a significant increase was detected in ESR and ESR was significantly lower in patients who were used thrombolytic treatment than the others. There was no correlation between efficacy of thrombolytic treatment and CRP as an indicator of reperfusion.Keywords:&nbsp;ACUTE PHASE REACTANTS, THROMBOLYTIC TREATMENT, ACUTE MYOCARDIAL INFARCTION</p

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults

Background: The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients

Influence of multidrug resistant organisms on the outcome of diabetic foot infection

Objectives: We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms