Serum apelin levels and cardiovascular diseases

Apelin is a G protein-linked receptor endogenous ligand, synthesized as a 77-amino acid pre-propeptide. Increased expression of apelin is present in many cardiovascular (CV) tissues, including cardiomyocytes. It is a peripheral vasodilator and one of the most potent stimulants of ventricular contraction. Apelin may be a valuable therapeutic for both blood pressure regulation and myocardial performance. More information is needed for the CV pathophysiology of apelin. We will discuss the importance of apelin level in CV diseases in this review

A case of gastric adenocarcinoma with rectal metastasis in the form of linitis plastica presenting as primary rectum carcinoma

Gastrointestinal sistemde linitis plastika şeklindeki metastazlar nadir olup sıklıkla primer tümörün mide olduğu bildirilmektedir. Biz rektuma linitis plastika şeklinde metastaz yapan mide adenokarsinom olgumuzu ender rastlanması ve primer lokal ileri rektum kanseri şeklinde karşımıza çıkması sebebiyle literatür bilgileri ışığında, gastrik adenokarsinomaların intestinal metastazlarının klinik, radyolojik ve patolojik özelliklerini de tartışarak sunmayı amaçladık.It is often reported that metastases in the form of linitis plastica developed in the gastrointestinal system are rare cases and frequently the primary tumor is located in the stomach. We presented a case of gastric adenocarcinoma developing a metastasis in the rectum in the form of linitis plastica, which appeared as a primary local advanced rectum cancer. We discussed the clinical, radiological, and pathological characteristics of the intestinal metastases of gastric adenocarcinomas

The impact of Ki-67 index, squamous differentiation, and several clinicopathologic parameters on the recurrence of low and intermediate-risk endometrial cancer

Endometrial endometrioid carcinoma (EEC) represents approximately 75-80% of endometrial carcinoma cases. Three hundred and thirty-six patients with EEC followed-up in the authors’ medical center between 2010 and 2018 were included in our study. Two hundred and seventy-two low and intermediate EEC patients were identified using the European Society for Medical Oncology criteria and confirmed by histopathological examination. Recurrence was reported in 17 of these patients. The study group consisted of patients with relapse. A control group of 51 patients was formed at a ratio of 3:1 according to age, stage, and grade, similar to that in the study group. Of the 17 patients with recurrent disease, 13 patients (76.5%) were Stage 1A, and 4 patients (23.5%) were Stage 1B. No significant difference was found in age, stage, and grade between the case and control groups (p > 0.05). Body mass index, parity, tumor size, lower uterine segment involvement, SqD, and Ki-67 index with p<0.25 in the univariate logistic regression analysis were included in the multivariate analysis. Ki-67 was statistically significant in multivariate analysis (p = 0.018); however, there was no statistical significance in SqD and other parameters. Our data suggest that the Ki-67 index rather than SqD needs to be assessed for recurrence in patients with low- and intermediate-risk EEC

Fetal rubella syndrome: Diagnostic challenges

Fetal rubella sendromu konjenital bir enfeksiyondur. Fetal enfeksiyon virüsünün transplasental geçişiyle oluşmaktad›r. Enfeksiyonun sıklığı ve şiddeti değişkenlik göstermekle birlikte mental retardasyon, konjenital katarakt, kalp defektleri ile karakterizedir. Üreme çağındaki kadınların yaklaşık %75-85'inin seropozitif olduğu belirtilmektedir. Maternal kanda IgM seropozitifliği saptanması durumunda, maternal kanda IgG aviditesinin bakılması tanıda yardımcı incelemelerdir. Fetal enfeksiyonun tanısı için kordosentezle 21. gebelik haftasından sonra fetal kanda rubella antikorlarının taranması gereklidir. Ancak, fetal kanda negatif IgM fetal enfeksiyonu tamamen dışlamamaktadır. Gebeliğin ilk 12 haftasında enfeksiyonun fetüse bulaşma oranı (%90) ve anomali riski çok yüksektir ve gebeliği sonlandırma endikasyonu bulunmaktadır. Gebeliğin 12.-16. haftaları arasında fetusun etkilenme olasılığı %35-50 seviyesindedir ve prenatal tanı endikasyonu bulunmaktadır. Eğer fetal enfeksiyon saptanırsa riskler aileye anlatılmalı ve istekleri doğrultusunda gebeliğin sonlandırılabileceği belirtilmelidir. Kliniğimize rutin gebelik kontrolü amacıyla gelen G:1 P:0 olan 22 yaşındaki hastanın transvajinal sonografisinde 8 hafta 4 günlük, canlı bir embryo saptandı. Rutin incelemelerinde TORCH enfeksiyon parametrelerinden rubella IgM ve rubella IgG pozitifliği saptanmıştır. Aktif rubella enfeksiyonunun doğrulanması amacıyla başka bir laboratuvardan da rubella antikorları istendi. Başka bir laboratuvarda IgM negatif, rubella IgG pozitif ve rubella IgG aviditesinin %84 olması üzerine hasta durumla ilgili bilgilendirildi. Hastanın isteği ile gebeliğin devam edilmesine karar verildi. Gebeliğin rutin izlenmesinde herhangi bir anormallik gelişmeyen hasta sağlıklı bir bebek doğurmuştur. iki aylık olan bebekte neonatal dönemde herhangi bir problem oluşmadı. Bu olgu sunumunda rubella taramasının gebelikteki önemi ve laboratuvar tetkiklerinde karşılaşılabilecek çelişkili sonuçlar tartışılmıştır.Fetal rubella syndrome is a congenital infection. The infection is spread via transplasental viral dissemination. The syndrome has a wide spectrum of clinical complications but mental retardation, congenital cataract and cardiac defects are the most characteristic ones. It is known that 75-80% of women in the reproductive ages are seropositive for rubella virus. If maternal blood shows seropostivity for Anti-rubella IgM, IgG avidity should be checked as an additive diagnostic tool. For determining fetal infection, rubella anticors should be looked for in cordocentesis blood after 21 weeks of gestation. An infection in the first 12 weeks of gestation has a very high (90%) fetal infection risk and will be an indication for termination of pregnancy. After 12 weeks of gestation the fetal rate is still very high (35-50%) and prenatal diagnostic tests should be planned. When a fetal infection is detected the parents should be counselled for the potential risks. Here we report a case (age, 22 years, Gravida 1, Para 0), who was diagnosed to have Anti-rubella IgG ang IgM seropositivity in the 9th week of gestation. In the confirmation tests for rubella infection -which were perfomed in another laboratory- Anti rubella IgG and IgM were negative, and rubella IgG avidity was in normal ranges (84%). After counselling the patient, she decided to continue her pregnancy. She gave birth to a healthy newborn, who is 2 months of age. The neonatal period was uneventful. The importance of rubella screening in pregnancy is discussed and challenges in the diagnosis and laboratory tests of rubella infection during pregnancy are presented

A Case of Pulmonary Mucormycosis Presenting with Endobronchial Involvement

Mucormycosis is an opportunistic fungal infection that is rare but has a fatal course, occurs especially in patients with immunodeficiency, and is caused by fungi in the Zygomycetes class. Since the infection is generally caused by inhalation of spores, mostly the paranasal sinuses and lungs are affected. Diabetes mellitus and hematologic malignancies are the most common underlying diseases. It usually initiates like bacterial pneumonia, and its clinical and radiologic findings are nonspecific. Thus, a high index of suspicion is necessary. Combined medical and surgical treatment methods are recommended. We aimed to present a case of pulmonary mucormycosis with a course of endobronchial involvement.Mucormycosis is an opportunistic fungal infection that is rare but has a fatal course, occurs especially in patients with immunodeficiency, and is caused by fungi in the Zygomycetes class. Since the infection is generally caused by inhalation of spores, mostly the paranasal sinuses and lungs are affected. Diabetes mellitus and hematologic malignancies are the most common underlying diseases. It usually initiates like bacterial pneumonia, and its clinical and radiologic findings are nonspecific. Thus, a high index of suspicion is necessary. Combined medical and surgical treatment methods are recommended. We aimed to present a case of pulmonary mucormycosis with a course of endobronchial involvement

Clinical and ultrasonographic evaluation of pelvic masses

AMAÇ: Bu çalışmada pelvik kitle tanısı almış hastaların ultrasonografik bulguları, Ca125 değerleri, malignite indeks riski (RMI), rezistans indeksi ve patoloji sonuçlarının malign ve benign ayrımını sağlamadaki etkinlikleri incelenmiştir. Materyal ve Metot: İki bin iki ile 2004 yılları arasında pelvik kitle tanısı alan 114 hasta değerlendirildi. Pelvik kitlelerin ultrasonografik malignite kriterleri (4 cm’den büyük kitle, solid, kistik, multiloküle, septalı, komplike kist, asit varlığı, düzensiz kist cidarı ve papiller yapı), Ca125 değerleri (?35U/ml), Doppler sonografik rezistans indeksi (RI?0.42) ve malignite risk endeksi (RMI?200) değerleri incelendi. Postoperatif patolojik tanılarına göre ovaryen karsinom ve borderline tümörler “malign” grubuna alınırken, fonksiyonel kistler benign pelvik kitleler grubunda değerlendirildi. Bahsi geçen parametrelerin preoperatif dönemde benign/malign kitlelerin ayrımını sağlayıcı etkinlikleri ile ilgili tanımlayıcı istatistikleri yapıldı. BULGULAR: Hastaların ortalama yaşı 39 (sınırlar 12-75) idi. On altı hasta postmenopozal idi. Yüz on dört hastanın 91’i ( %79) opere edildi. Hastaların 54’ü ( %59) operatif laparoskopi ile (malign tanı yok), 37’si ( %41) eksploratif laparotomi (13’ü malign) ile opere edildi. Cerrahi tedavi gerekli görülmeyen hastaların 18’i ultrasonografi ve Ca125 ile 5’i de ultrasonografik kist aspirasyonu sonrasında takip edildi. Opere edilmeyip takip edilen hastaların hiçbirinde 1 yıllık takip sonrası ovaryen malignite düşündüren bir bulgu saptanmadı. On üç hastanın postoperatif histopatolojisi malign idi (1 clear cell karsinom, 1 undiferensiye karsinom, 1 adenokarsinom, 1 malign Brenner tümörü, 1 karsinom metastazı, 4 borderline ovaryen tümör). Yetmiş sekiz hastanın histopatolojisi benign (13 endometrioma, 3 matür kistik teratom, 3 torsiyon, 2 tuboovaryen abse, 1 dejenere myom, 56 benign kist) idi. Malign/benign ayrımında RMI, Ca125 ve RI değerlerinin sensitivitelerinin %38 ile %69 arasında, spesifitelerinin %71 ile %99 arasında, pozitif prediktif değerlerinin %23 ile %83 arasında, negatif prediktif değerlerinin de %92 ile %94 arasında bulunduğunu göstermektedir. TARTIŞMA: Doppler ultrasonografinin malign/benign ayrımında sadece ultrasonografi ve Ca125 değerinin kombine edilmesi, ya da sadece malignite risk endeksine göre daha etkin olduğu saptandı. Malignite risk endeksinin literatürdeki bazı verilerden farklı olarak düşük sensitivitesinin sunulan çalışmadaki vaka sayısının az olmasıyla bağlantılı olabileceği düşünülmüştür. Ca125, Malignite risk endeksi ve Doppler sonografinin kombine kullanımı pelvik kitlelerin değerlendirmesinde tanısal etkinliği artırmaktadır.OBJECTIVES: Ultrasonographic findings, Ca125 levels, risk of malignity index, resistance index and pathologic results of pelvic masses were examined to determine their efficiency in malignant and benign differentiation. MATERIALS-METHODS: Onehundredfourteen patients with a diagnosis of pelvic mass between the years 2002-2004 were evaluated. The menopausal status, ultrasonographic appearance (mass lesion greater than 4 cm, solid, cystic, multiloculated, uniloculated, septated, complicated and existence of papillary structures), serum Ca125 levels (cut-of&amp;#8805; 35U/ml), Doppler sonographic resistance index (cut-off&amp;#8804; 0.42) and RMI (risk of malignancy index, cut-off&amp;#8805;200) were recorded. Ovarian carcinomas and borderline tumours were classified in the malignant group in the evaluation of the efficiency of these paramaters in malignant/benign differentiation. RESULTS: Patients mean age was 39 (Range 12-75). Sixteen patients were postmenopausal. Ninety one (79 %) of 114 patients were operated. Fifytfour patients (59 %) were laparoscopically operated (none of them was malignant), whereas explorative laparotomy was performed for 37 (41 %) patients (13 of them were malignant). Eighteen (15.8 %) of the remaing patients were followed-up by ultrasonography and serum Ca-125 determinations, and ultrasonographic cyst aspiration was performed in 5 patients (4.4 %). Postoperative histopathology of 13 patients showed malignant characteristics (1 clear-cell carcinoma, 1 undifferentiated carcinoma, 1 adenocarcinoma, 1 Brenner tumor, 1 carcinoma metastasis, and 4 borderline tumors) and 78 patients showed benign characteristics (13 endometriomas, 3 mature cystic teratomas, 3 ovarian torsions, 2 tuboovarian abcesses, 1 degenerated myoma, 56 benign cysts). The sensitivity of RMI, CA125 and RI in the differentiation of malignant/benign tumors ranged between 38-69 %, the specifity between 71-99 %, the positive predictive value between 23-83 % and the negative predictive value between 92-94 %. DISCUSSION: In the differentiation of malignant/benign lesions Doppler ultrasonography was found to be more effective than only ultrasonography and Ca125 or RMI. The low sensitivity of RMI was attributed to the insufficient number of cases in our study. The combination of these 3 parameters will increase the effectivity of clinical judgement of pelvic masses

Disseminated tuberculosis in a non immun compromised patient with a complicated diagnosis

Tuberculosis (TB) has become a global emergency worldwide. The long time period between the exposure to TB bacillus and the onset of symptoms cause a delay in diagnosis. Herein, we report a case of 64-year-old female patient suffering from dyspepsia, anorexia, weight loss and abdominal pain for the last 8 months. Physical examination, ascites fluid evaluation, chest radiography, ultrasonographic and tomographic scans, histopathological analysis of the lymphadenopathy (LAP) and endometrial tissue revealed TB. A fourfold antituberculous treatment with isoniazid, pyrazinamide, rifampicin and ethambutol was prescribed for two months and for four months maintenance therapy with isoniazid and rifampicin was given. On the fourth month of the medical treatment the patient clinically recovered. Since the diagnosis of TB is difficult, high grade suspicion, combination of the radiologic, microbiologic and histopathological examinations are needed to achieve a diagnosis

Serum Vitamin D and Parathyroid Hormone Levels in Patients with Obstructive Sleep Apnea Syndrome

Amaç: Obstrüktif uyku apne sendromunda (OUAS) tekrarlayıcı solunum durmaları sonucu gelişen hipoksi-reoksijenizasyon peryodları sonucu artan sempatik aktivite artışı çeşitli kardiyovasküler ve metabolik değişikliklere neden olmaktadır. Bu çalışmada OUAS'ın vitamin D ve parathormon (PTH) üzerine etkisini incelemeyi amaçladık. Yöntemler: Çalışmaya polisomnografi ile yeni tanı alan 103 erkek, OUAS grubu olarak ve yaş, cinsiyet, vücut kitle indeksi (VKİ) açısından eşleşen ve apnesi olmayan 58 erkek, kontrol grubuna dahil edildi. Serum kalsiyum, fosfor, vitamin D ve PTH düzeyleri ölçüldü. Bulgular: Yaş, VKİ, sigara kullanımı, hipertansiyon ve hiperlipidemi açı- sından OUAS ve kontrol gurubu arasında anlamlı fark saptanmadı. Vitamin D düzeyleri OUAS gurubunda kontrol gurubuna kıyasla anlamlı olarak daha düşük iken (sırasıyla 22,4±7,5 ng/mL, 31±7,9 ng/mL, p<0,001), PTH düzeyleri anlamlı olarak daha yüksek saptandı (sırasıyla 56,6±18.8 pg/mL, 42,3±17,6 pg/mL, p<0,001). OUAS alt grup analizinde; OUAS şiddeti arttık- ça vitamin D düzeylerinde anlamlı azalma, PTH düzeylerinde ise anlamlı artış izlendi (p<0,001). Vitamin D düzeyleri ile apne-hipopne indeksi, oksijen desatürasyon indeksi, PTH ve ortalama oksijen satürasyonu arasında anlamlı korelasyon tespit edildi (p<0,001). Sonuç: Çalışmamız düşük vitamin D ve yüksek PTH düzeyi prevalansının OUAS hastalarında yüksek olduğunu ve bu durumun hastalığın şiddeti ile de artış gösterdiğini ortaya koymuşturIntroduction: An increase in sympathetic activity caused by intermittent hypoxia and reoxygenation that develops an obstruction of the upper respiratory tract in obstructive sleep apnea syndrome (OSAS) results in cardiovascular and metabolic changes. This study aimed to assess the effects of OSAS on serum vitamin D and parathyroid hormone (PTH) levels. Methods: The study population comprised 103 male patients with newly diagnosed OSAS and 58 male non-apnoeic controls matched for age, sex, and body mass index (BMI). Serum calcium, phosphorus, vitamin D, and PTH levels were measured. Results: There were no significant differences between patients with OSAS and the controls in terms of age, sex, BMI, smoking status, hypertension, and hyperlipidemia. Serum vitamin D levels were significantly lower in the OSAS group than in the control group (22.4±7.5 ng/mL vs. 31±7.9 ng/mL, respectively; p<0.001), whereas PTH levels were significantly higher in the OSAS group than in the control group (56.6±18.8 pg/mL vs. 42.3±17.6 pg/mL, respectively; p<0.001). On subgroup analysis, vitamin D levels were significantly lower in patients with severe OSAS than in those with mild/moderate OSAS (p<0.001). Vitamin D levels significantly correlated with the apnea-hypopnea index, oxygen desaturation index, PTH levels, and mean oxygen saturation. Conclusion: These results showed that OSAS is associated with low vitamin D levels and elevated PTH levels, which is related severity of OSAS

Chylothorax due to leukemic infiltration in a patient with chronic lymphocytic leukemia

Chylothorax is characterized by accumalation of milky fluid called chyle into the plural space. Most common causes of cyhlothorax are trauma or surgery of thoracic duct and malignancies. Among the malignancies lymphoma is responsible approximately 70% of cyhlothorax but other lymphocytic tumors including chronic lymphocytic leukemia (CLL) is rarely reported. A 71 years old man with known CLL, presented with dispnea and pleural effusion and diagnosed cyhlothorax due to leukemic infiltration that confirmed by immuno flow cytometric analyse