Increased uptake on I-131 whole-body scintigraphy in Warthin tumor despite false-negative Tc-99m pertechnetate salivary gland scintigraphy

Whole-body I-131 scintigraphy is an important component of the postoperative follow-up of patients with well-differentiated thyroid cancer. However, false-positive scans showing abnormal uptake in the absence of residual thyroid tissue or metastases may occur. Unless recognized as false positive, these abnormal sites of uptake may lead to unnecessary administration of therapeutic doses of I-131. The authors report a patient with Warthin tumor whose I-131 whole-body scan demonstrated increased uptake in the parotid gland, despite a negative Tc-99m pertechnetate salivary gland scintigraphy.     

A preliminary open-label study of moclobemide treatment of pain disorder

Antidepressants appear to be useful in the treatment of pain disorders, although the exact underlying mechanisms are unknown. In this preliminary study, we examined the utility of moclobemide, a reversible inhibitor of monoamine oxidase, in the treatment of 14 patients with pain disorder. The drug was administered in doses up to 450 mg/day for 8 weeks. Assessments of perceived pain and psychological evaluations of patients were carried out weekly using visual assessment scores of pain, depression, anxiety, sleep, difficulty in concentration, dry mouth, sweating, and fatigue. The therapeutic effects of moclobemide on the sense of pain, depression, anxiety, sleepless, difficulty in concentration, dry mouth, sweating, and fatigue were analyzed using a repeated measures analysis of variance. Our findings suggest that moclobemide therapy may be an effective, useful option in the management of perceived pain, in addition to its beneficial effects on depression, somatization, and anxiety.     

Protective effect of IGF-1 on experimental liver cirrhosis-induced common bile duct ligation

BACKGROUND/AIMS: The causes of malnutrition in liver cirrhosis are multifactorial. Levels of IGF-1 (insulin like growth factor-1) that is a crucial regulator of intermediary metabolism decreases. The aim of this study was to analyze the effect of IGF-1 supplementation during liver cirrhosis induced by common bile duct ligation. METHODOLOGY: Rats were divided into five different groups: One sham and four experimental groups. Rats in three of four groups were treated with 2 micrograms/day IGF-1 with a different time of experiment in each group. Blood biochemical parameters, tissue malondialdehyde, glutathione levels and the activity of tissue antioxidant enzymes and conventional and immunohistochemical analysis of liver samples were studied for each group. RESULTS: Serum albumin, total protein, fibrinogen levels decreased and prothrombin time was prolonged in the bile duct ligated and transected experimental group but not in the IGF-I treated rats compared with the rats in sham group. Liver malondialdehyde levels significantly increased in control group but not in IGF-1 treated groups. The activities of antioxidant enzymes were decreased compared with the other groups. Histopathology findings of liver biopsy demonstrated intense degree fibrosis and overexpression of fibroblast growth factor and desmin in the control group but a lesser degree of those in the IGF-1 treated groups. CONCLUSIONS: IGF-1 treatment improves liver function and decreases oxidative liver damage and histopathological findings. Further studies are required to delineate the mechanisms of protective effects of IGF-1.     

Implantable cardioverter-defibrillator placement in patients with mild-to- moderate left ventricular dysfunction: hemodynamics and recovery profile with two different anesthetics used during deep sedation

OBJECTIVE: To compare the effects of thiopental and propofol during defibrillation threshold testing (DFT) on hemodynamics and recovery profile in patients requiring automatic internal cardioverter-defibrilator placement. DESIGN: Prospective clinical investigation. SETTING: University hospital. PARTICIPANTS: Thirty-four adult patients. INTERVENTIONS: After administration of midazolam, 0.025 mg/kg, and fentanyl, 0.5 to 1 mug/kg, surgery was performed under topical infiltration with 1% lidocaine. In group I (GI) (n = 17), patients received thiopental by slow injection and patients in group II (GII) (n = 17) received propofol before induction of ventricular fibrillation (VF). MEASUREMENTS AND MAIN RESULTS: Patients received 4.1 +/- 1.4 mg of midazolam, 114 +/- 34 mug of fentanyl, and 280 +/- 78 mg of thiopental in GI; and 4.6 +/- 1.7 mg of midazolam, 119 +/- 62 mug of fentanyl, and 147 +/- 40 mg of propofol in GII (p > 0.05). Hemodynamics did not show significant differences between the groups at any recording time. Average time needed to regain the pretest sedation level was 16.4 +/- 8.8 minutes in GI and 10.9 +/- 5.5 minutes in GII (p = 0.03). Time required to achieve a score of 10 using a modified Aldrete score was 26.4 +/- 9.3 minutes in GI and 17.4 +/- 4.9 in GII (p = 0.001). Seven patients in GII (41%) and 1 patient in GI (6%) became hypotensive after DFT (p = 0.04). CONCLUSIONS: Deepening the sedation level by slow injection of thiopental or propofol before DFT provided satisfactory conditions during brief episodes of VF. Delay in recovery of arterial pressure after DFT with propofol and delay in arousal and discharge of patients with thiopental are major disadvantages of the regimens.     

The evaluation of Chronic Progressive External Ophthalmoplegia with computerized tomography

Introduction: Chronic progressiveexternal ophthalmoplegia is characterisedby limitation of ocular motility in alldirections of gaze and ptosis.Innervational or myogenic factors wereclaimed to be responsible for thismotility disorder. The aim of thisstudy was toinvestigate the extraocular muscles inCPEO with computerized tomography in an attemptto distinguish extraocular musclemorphology caused by this disorderfrom that occurring in normal individuals.Methods: Eighteen orbits from 9patients diagnosed with CPEOwere included in the study. Axialand coronal scans were obtained for CTevaluation of extraocular muscles and thedimensions of extraocular muscles were measured.The control group consisted of40 orbits belonging to 20 individuals and,the results were compared with a student'st test.Results: The thickness (the verticaldimension of vertical recti and thehorizontal dimension of horizontal recti)of all rectus muscles wassignificantly decreased in comparison with the controlgroup, whereas the width (the horizontal dimensionof vertical recti and the verticaldimension of horizontal recti) was similar inboth the diseased and normal orbits.In all the rectus musclesof the diseased orbits,the normal fusiform shape was lost and the muscles appeared asthin bands.Discussion: The differentiation ofCPEO from other myogenic and neurogenicdisorders may present difficulty,and a cluster of criteria are required fora final diagnosis. CT has provento be a valuable tool in assessing extraocularmuscles [1, 2]. In this study, an extremeatrophy of all rectus muscles wasdemonstrated by means of CT. This diagnostic method mayconsequently contribute to a properdiagnosis of CPEO.     

Conformal radiotherapy in primary non-Hodgkin's lymphoma of the male urethra

Primary malignant lymphoma of the urethra is very rare. Fifteen cases arereported in the literature and only four of them belong to the male urethra.We present the fifth case of primary Non-Hodgkin's lymphoma of the maleurethra that is managed by conformal radiotherapy.     

The assessment of constipation in monosymptomatic primary nocturnal enuresis

Objective: Nocturnal enuresis and constipation are common pediatric problems. The aim of this study was to assess the incidence of constipation in children with or without monosymptomatic primary nocturnal enuresis.Methods: The study included 5350 children, ages 5–19 years, who were surveyed to detect the incidence of nocturnal enuresis. Of those surveyed, 679 (12.7%) had primary nocturnal enuresis. All children were questioned by mail with a standard form that addressed their micturition and defecation habits. The children those who had primary nocturnal enuresis were invited to the Pediatric Urology Section of the University Hospital. Of those 679 children, 125 kept that invitation. All 125 of those children underwent an abdominal ultrasound. Also, these children had serum creatinine levels drawn and plain abdominal films taken.Results: Constipation, defined as less than 3 bowel movements per week, was seen in 48 of 679 children with nocturnal enuresis (7.06%). Of those 4671 children without nocturnal enuresis, only 68 (1.45%) had constipation. The difference in constipation between the two groups was statistically significant (z = –9.251; p = 0.000). Of note, 10 of the 125 children (8%), evaluated at the hospital, had constipation. None of the children had an abnormal neurologic examination. Finally, faecal loading was detected on the plain films of 8 of the 125 children evaluated, 7 of who had constipation. The sensitivity of grading plain films for faecal loading to denote constipation in this population was 87.5%.Conclusions: Children with primary nocturnal enuresis should be thoroughly assessed for coexisting constipation.     

Paternalistic Leadership,Organizational Cynicism,and Intention to Quit One’s Job in Nursing

The aim of this study was to determine the relationship between paternalistic leadership, organizational cynicism, and the intention to quit one’s job among nurses. The implementation part of the study was carried out with nurses working in a public hospital in the city of Mersin, Turkey. Data were collected in January 2018 from 215 participants and then analyzed. The analyses indicate that the dimensions of organizational cynicism and paternalistic leadership explained 41.8% of the variance for the intention to quit. In addition, there were negative and significant relationships between paternalistic leadership and dimensions of organizational cynicism. As the participants’ perceptions of cognitive cynicism and behavioral cynicism increased, their intention to quit increased. In addition, as their perceptions of paternalistic leadership increased, their cognitive, affective, and behavioral cynicism decreased. This study will help managers of healthcare institutions better understand how paternalistic leadership is related to organizational cynicism and the intention to quit one’s job.