Tracheobronchomalacia as a rare cause of chronic dyspnea in adults

Objective: To emphasize the importance of a careful clinical evaluation to prevent unnecessary interventions and treatments

Clinical Presentation and Intervention: A 76-year-old female patient had been diagnosed with asthma during previous admissions to different hospitals. She had also undergone fiberoptic bronchoscopy [FOB] on 2 occasions for evaluation of right middle lobe atelectasis observed on computed tomography. A repeated FOB revealed tracheobronchomalacia and nodular bronchial amyloidosis. A silicone Y stent was inserted, but the dyspnea increased. Excessive granulation tissue developed, and the patient died despite ventilatory support

Conclusion: The stenting technique used did not prevent the development of respiratory failure and death in this patient. Hence, a surgical procedure could be considered as an alternative to stenting in such cases

Signet ring cell adenoma of the thyroid: a very rare entity

To report a case of signet ring cell adenoma of the thyroid which is an extremely rare thyroid lesion. A 25-year-old female patient presented with a goiter and dysphagia that had been present for the last 1 year before admission. Physical examination revealed a palpable solitary nodule in the right lobe of the thyroid. The ultrasonogram demonstrated multiple nodules among which the most remarkable one was 15 x 24 mm in size, in the right lobe of the thyroid. After surgical excision, the lesion was found to be consistent with signet ring cell adenoma characterized by the presence of round to oval signet ring cells with large cytoplasmic vacuoles and hyperchromatic eccentric nuclei. Intracytoplasmic thyroglobulin, periodic acid-Schiff [PAS] with and without diastase and combined Alcian-blue-PAS were all positive. Pathologists should keep this rare primary tumor of the thyroid in mind when examining thyroid lesions and should not confound it with metastatic signet ring cell carcinoma of the thyroid

randomized trial of smoking cessation. medication versus motivation

A prospective randomized study was undertaken to assess the effectiveness and side effect profiles of nicotine patch and bupropion therapies for smoking cessation. Three hundred and fifty patients were referred to our smoking cessation program in the Department of Pulmonary Diseases, Gaziantep University between September 2002 and July 2003. Of these, only 131patients fulfilled the trial criteria. We randomized the patients into nicotine patch [n=50], bupropion [n=50] and control groups [n=31]. Cases were followed up for 24 weeks. Questionnaires including the Fagerstrom test for nicotine dependence and Beck Depression Inventory were carried out at initial evaluation. Declaration of quitting and exhaled carbon monoxide level less than 10 ppm was accepted as success criteria. Success rates were 26% for nicotine patch group, 26% for bupropion and 16% for control group at the end of the 24th week [p=0.56]. Beck depression inventory scores did not differ significantly between the groups, however none of the cases with scores greater than 13 succeeded regardless of the group. Mean body weight at baseline and change at 6 months did not differ significantly between the groups. Sleep disturbance was significantly more common in nicotine patch and bupropion groups than the control group [p=0.008]. The present study reinforces the role of medical doctors and importance of close follow up in smoking cessation, and directed counseling is quite as effective as pharmacologic therapy and is the sole approach without any adverse effects

Breast carcinogenesis. Transition from hyperplasia to invasive lesions

To examine the balance loss between proliferation and apoptosis that play a role in breast cancer development, and to explore the places of various genes and molecules within this process in this supposed multistep process. We obtained the specimens from 40 patients between 2002 and 2004 at the Department of Pathology, Medical Faculty, Adnan Menderes University, Aydin, Turkey. We categorized the lesions ductal hyperplasia [DH], atypical ductal hyperplasia [ADH], in situ ductal carcinoma [DCIS], and invasive ductal carcinoma [IDC]. We determined the tumor size, histological grade and lymph node status of invasive cases and we used nottingham prognostic index [NPI]. We applied ER, PR, c-erbB2, p53, Ki-67, bcl-2, dUTP nick end labeling [TUNEL], breast cancer gene-1, matrix metalloproteinases-1 and tissue inhibitor matrix metalloproteinases-1 stains to each lesion using the immunohistochemical method. We observed that ER and PR decreased in ADH when compared with DH [p=0.0001 and p=0.019]. However, we determined that in DCIS as c-erbB2 [p=0,005] and Ki-67 [p=0.004] increase, TUNEL [p=0.04] and bcl-2 [p=0.005] decrease, when compared with ADH. When compared with DCIS lesions, we observed the existence of a higher c-erbB2 [p=0,003] and a lower TUNEL [p=0,012] in invasive tumors. Furthermore, we found that there is a higher MMP-1 [p=0,04] in invasive lesions, when compared with non-invasive lesions. We detected higher PR [p=0,049], lower TUNEL and c-erbB2 [p=0,017] in low grade group of NPI, when compared with high grade group of NPI. As a result, it has been shown that together with increase in proliferation, decrease in apoptosis, too, contributes to the proliferation/apoptosis imbalance that occurs in breast carcinogenesis. Increase in proliferation and decrease in apoptosis are parallel with the progression of lesions. We also showed that the changes, beginning with loss of ER and PR in ADH step, can cause malign transformation, which is especially notable both in DCIS step due to Ki-67 and c-erbB2 increase, and also with bcl-2 and TUNEL decrease