Osseous destruction and rupture of the extensor tendon caused by sarcoidosis of the finger.

We describe a woman with osseous destruction and rupture of the extensor tendon as a result of sarcoidosis in the left third finger with no evidence of systemic involvement. The tendon was repaired and she was successfully treated with prednisone.     

Laparoscopy or laparotomy for the management of endometrial cancer.

OBJECTIVE: The aim of this study was to evaluate the feasibility of laparoscopy in the management of early stage endometrial cancer. METHODS: Fifty-two patients with endometrial cancer who underwent surgical staging consisting of total hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node dissection, and cytology between 1998 to 2002 were included in the study. Laparotomy and laparoscopy were randomly offered to patients upon admittance. RESULTS: Of 52 patients, 26 underwent laparotomy and the remaining 26 underwent laparoscopic staging surgery. No significant difference existed between the demographic characteristics of the 2 groups. The mean number of harvested lymph nodes was 18.2 in the laparoscopic group and 21.1 in the laparotomic group (P>0.05). Pelvic lymph node metastases were detected in 7.7% of the patients in the laparoscopy group and 15.4% in the laparotomy group, and the difference was not significant. Adjuvant radiotherapy was applied later to 42.3% of the laparoscopy group and 38.5% of the laparotomy group. Operative morbidity was higher in the laparotomy group mainly because of postoperative wound infection, and the patients in the laparotomy group had a longer hospital stay. CONCLUSION: Laparoscopic surgery is a method that can be applied as well as laparotomy in the management of endometrial cancer. Lymph node number and detection of lymph node metastasis did not differ significantly in laparotomic and laparoscopic approaches. Wound infections were more frequent in laparotomies.     

Telomere-specific fluorescence in situ hybridization analysis of couples with five or more recurrent miscarriages

Fluorescence in situ hybridization analysis using telomere specific probes has been used to detect cryptic translocations in the chromosomal telomeric regions. This study was performed in five clinically normal couples who have had five or more spontaneous abortions and whose karyotypes were found to be normal using conventional cytogenetic techniques. Using the telomere specific probes, in one couple we determined a cryptic translocation between chromosome 3 and 10, and, in another couple, the signal in chromosome 20 was detected in another chromosome, which was probably a D group chromosome. Additionally, in the latter and also in two other couples, we observed a polymorphism. The approach will be helpful for screening cryptic translocations using telomere specific multiple probe sets in couples with recurrent miscarriages. As prenatal diagnosis will be available for these couples for future pregnancies, it will be possible to help these families to have healthy fetuses.     

Early impact of hormone replacement therapy on vascular hemodynamics detected via ocular colour Doppler analysis

Objective: To determine the effects of hormone replacement therapy (HRT) on ocular blood flow.

Study design: In a prospective controlled study, 40 healthy women who presented to the menopause clinic between December 2000 and December 2001 were randomly assigned into the study. The HRT-receiving group was administered estradiol 17-valerate 2 mg the first 11 days, and estradiol 17-valerate 2 mg plus ciproterone acetate 1 mg the next 10 days of the monthly cycle for 6 months. The control group did not receive any HRT for 6 months. The ocular colour Doppler analysis were performed at baseline and after 3 and 6 months. The ocular Doppler analysis was performed in the first half of the cycle in the HRT-receiving group.

Results: Central retinal artery and ophthalmic artery basal Doppler index (peak systolic velocity, end-diastolic velocity, resistive index and pulsatility index) values of the two groups at the beginning of the study did not show any statistically significant difference. Both the right and the left central retinal artery pulsatility index (PI) values of the study group, who received HRT at the end of the third and sixth months, showed a statistically significant decline (paired-samples test, P < 0.05), while the decrease in the resistive indexes was not significant.

Conclusion: These results suggest that 6 months of combined hormone replacement therapy with estradiol 17-valerate 2 mg plus ciproterone acetate 1 mg improves ocular vascular Doppler indices which may be a reflection of cerebral vascular status.     

Pelvic inflammatory disease and intrauterine devices: Prophylactic antibiotics to reduce febrile complications

In the present study, we tried to determine whether IUD insertion related PID and febrile complications could, be prevented by prophylactic use of antibiotics. We studied 300 patients who were admitted to our family planning clinic for IUD contraception. Of these, 150 patients received prophylactic Doxycycline (group 1) and the second 150 received no therapy (group 2). Five cases experienced fever with or without leucocytosis and none required hospitalization. PID was observed in one woman in each group.Positive culture (gonorrhea) was obtained in one woman who was then treated by relevant, antibiotics; the other woman required hospitalization for two days. The overall infection rates for group 1 and 2 were 2.1% and 2.9%, respectively and this difference was not significant. The incidence of PID infection and febrile complications was found to be very low for both groups when compared to other studies, suggesting that aseptic conditions with proper insertion reduce the risk of infection.

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Resumen En el presente estudio, intentamos determinar si la inflamación pélvica y las complicationes febriles relacionadas con la inserción, de DIU podían evitarse mediante la administración profiláctica de antibióticos. Estudiamos a 300 pacientes de nuestra clínica de planificación familiar que recibieron DIU. Se administró un tratamiento profiláctico de doxicilina a 150 pacientes (Grupo 1) mientras que las restantes no recibieron ningún tratamiento (Grupo 2). Hubo cinco casos de fiebre con o sin leucocitosis pero ninguno requirió hospitalización. La inflamación pélvica se observó en dos casos, uno de cada grupo. Se obtuvo un cultivo positivo (gonorrea) en uno de los casos, que fue tratado con antibióticos apropiados, y el segundo caso debió ser hospitalizado durante dos días. Las tasas generales de infección fueron para el Grupo 1 y el Grupo 2, respectivamente, del 2,1% y del 2,9%, diferencia que no es significativa. Una comparación con otros estudios permitió verificar que la incidencia de infección pélvica inflamatoria y complicaciones febriles era muy baja en los dos grupos, lo cual hace pensar que las condiciones de asepsia y la inserción correcta reducen el riesgo de infección.

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Resumé Dans la présente étude, nous avons tenté de déterminer si l'inflammation pelvienne et les complications fébriles liées à l'insertion de DIU pouvaient être évitées par une administration prophylactique d'antibiotiques. Nous avons suivi 300 patientes de notre clinique de planning familial, admises pour l'insertion, de DIU. Un traitement prophylactique de doxycycline a été administré à 150 de ces patientes (Groupe 1) et les autres n'ont reçu aucune, thérapie (Groupe 2). Nous avons eu cinq cas de fièvre avec ou sans leucocytose mais aucune de ces femmes n'a d être hospitalisée. L'inflammation pelvienne s'est manifestée dans deux cas, un dans chaque groupe. Une culture positive (gonorrhée) a été obtenue chez une de ces patientes, à laquelle un traitement aux antibiotiques appropriés a été administré, et la seconde a d être hospitalisée pendant deux jours. Les taux globaux d'infection ont été, respectivement pour le groupe 1 et le groupe 2, de 2,1% et 2,9%, ce qui ne représente pas une différence significative. Une comparaison avec d'autres études a permis, de constater que l'incidence d'infection pelvienne inflammatoire et de complications fébriles était très faible dans les deux groupes, ce qui laisse penser que les conditions d'asepsie et une insertion correcte réduisent le risque d'infection.

     

Use of the alkaline comet assay to monitor DNA damage in technicians exposed to low-dose radiation.

The exposure of human beings to ionizing radiation is still of great concern in occupational and environmental medicine, and the widespread use of radiotherapy in the treatment of cancer has led to anxiety about the possible hazards to staff who are at risk of such occupational exposure. In this study, DNA damage in the peripheral lymphocytes of 30 technicians employed in radiation oncology departments for at least 1 year were examined by the alkaline single-cell gel electrophoresis "comet" technique. The results were compared with those of 30 controls with comparable age, sex, and smoking habits who were not working in radiation oncology or chemotherapy services. The DNA damage observed in the lymphocytes of the technicians was significantly higher than that in the controls (P < 0.001). Cigarette smoking was also related to increases in DNA damage, and a significant association was found between the duration of occupational exposure to low-dose ionizing radiation and the DNA damage.     

Ventricular arrhythmias in patients with COPD are associated with QT dispersion

STUDY OBJECTIVE: QT dispersion (QTd) and late potentials derived from signal-averaged ECG (SAECG) have been proposed as noninvasive predictors of cardiac arrhythmias that occur in patients with COPD. In this study, we aimed to investigate QTd and SAECG in patients with COPD. DESIGN: Cross-sectional study. SETTING: Teaching chest disease hospital and cardiology center in a university hospital. PATIENTS: Thirty patients with COPD (28 men and 2 women; mean +/- SD age, 60 +/- 9 years) and 31 age- and sex-matched control subjects (28 men and 3 women; mean age, 57 +/- 7 years) were included. Measurements and results: Respiratory function tests, arterial blood gas analyses, echocardiographic examinations, rhythm Holter recordings, and heart rate variability (HRV) analyses were performed in addition to the measurements of QT intervals and SAECG. Patients with COPD had higher rate of ventricular premature beats (VPBs) as compared to control subjects (924 +/- 493 beats vs 35 +/- 23 beats, p = 0.009). Eight patients with COPD (27%) had nonsustained runs of ventricular tachycardia (VT). QTd rates were significantly increased in patients with COPD as compared to control subjects (57.7 +/- 9.9 ms vs 37.5 +/- 8.2 ms, p < 0.001). On comparing patients with COPD with and without runs of VT, patients with VT had longer QTd (67 +/- 10 ms vs 55 +/- 8 ms, p = 0.001). However no difference in any HRV and late potential parameters were found between patients with COPD with and without runs of VT. VPB rates were strongly correlated with QTd in patients with COPD (r = 0.61, p < 0.001). On SAECG analysis, patients with COPD had significantly increased total QRS duration as compared to control subjects. Nine of the 30 patients with COPD (30%) had positive late potentials. However, QTd and VPB rates were also similar between patients with COPD with and without late potentials. CONCLUSIONS: The development of ventricular arrhythmia in patients with COPD was associated with increased QTd. Increased QTd may be associated with autonomic changes seen in patients with COPD.     

Mycophenolate mofetil reduces tissue damage and inflammation in an experimental model of colitis in rats

BACKGROUND: Lymphocytes are widely believed to be responsible for persistent intestinal inflammation in inflammatory bowel diseases. Mycophenolate mofetil (MMF) is a potent immunosuppressant that inhibits lymphocyte proliferation and has been shown to be effective in preventing allograft rejection after organ transplantation. The purpose of this study was to assess the modulating effects of MMF on intestinal inflammation in an experimental model of colitis in rats. METHODS: Colitis was induced by rectal instillation of trinitrobenzenesulfonic acid (TNBS) in ethanol in male Sprague-Dawley rats. One group of rats (n = 10) was treated with MMF i.p. (25 mg/kg b.w.) daily for 1 week starting 24 h after induction of colitis. A second group of rats (n = 10) was treated with MMF at the same dose 2 days, I day and 1 h prior to induction of colitis. Control animals (n = 10) received vehicle only. After being killed, colonic tissue was macroscopically evaluated for necrosis and microscopically for ulcerations. Sections were stained and examined for the presence of granulocytes. RESULTS: Administration of MMF after induction of TNBS colitis reduced macroscopic injury by 62% compared to control animals (P = 0.01). Microscopic ulcerations were reduced by 64% compared to controls (P = 0.009). In addition, posttreatment significantly reduced the number of granulocytes. MMF pretreatment did not significantly prevent macroscopic or microscopic tissue damage, or change the number of granulocytes. CONCLUSION: Systemic administration of MMF significantly ameliorates tissue damage in a model of experimental colitis in rats suggesting that this compound may play an important role as an immunosuppressant in the therapy of inflammatory bowel diseases.