Comparison of the effectiveness of liposomal doxorubicin and gemcitabine in patients with platinum-sensitive recurrent ovarian cancer receiving third-line chemotherapy.

OBJECTIVE: In this retrospective study, we compared the effectiveness and reliability of the third-line chemotherapies gemcitabine and liposomal doxorubicin, in patients with platinum-sensitive ovarian cancer (OC). PATIENTS AND METHODS: The retrospective study included platinum-sensitive epithelial ovarian cancer patients who had previously received paclitaxel and carboplatin therapy. Between 2013-2021, cross-matched 45 patients who received gemcitabine and 48 who received liposomal doxorubicin as third-line therapy were compared based on clinicopathological characteristics, biomarkers, and blood cancer antigen (CA) 125 levels. Time to treatment failure, survival, and quality of life were additional objectives. RESULTS: The study included a total of 93 patients. The reported mean survival durations for treatments, 19.45 months for gemcitabine and 17 months for liposomal doxorubicin, did not statistically significantly differ (p=0.398). The mean CA 125 levels for the liposomal doxorubicin and gemcitabine groups after treatment were 54.4±11.4 U/ml and 54.7±11.1 U/ml, respectively. There was no noticeable difference between the treatments when comparing the postop CA 125 value (p=0.37). CONCLUSIONS: For both pegylated liposomal doxorubicin (PLD) and gemcitabine as single agents in the third line, our data revealed comparable effectiveness results, and there was no substantial difference in progression-free survival (PFS) for recurrent ovarian cancer. These therapies were tolerated with an expected incidence of hematological toxicities.

Determination of phytochemical content by LC-MS/MS, investigation of antioxidant capacity, and enzyme inhibition effects of nettle (Urtica dioica).

OBJECTIVE: Urtica dioica L. Subsp. dioica is an annual or perennial herbaceous plant belonging to the Urticaceae family that has an important place in ethnobotany. This study aimed to investigate the phytochemical content and the inhibition effect on acetylcholinesterase (AChE), which interact with beta-amyloid to promote the deposition of amyloid plaques and paraoxonase (PON1). This plays a role in the regulation of HDL and LDL and an antiatherogenic, and antioxidant capacity of Urtica dioica. MATERIALS AND METHODS: Phytochemical content was determined by the liquid chromatography/mass spectrometry (LC-MS/MS), and to assess the enzyme inhibition and antioxidant capacity the spectrophotometer technique was used. The antioxidant capacity of U. dioica extracts (methanol, hexane, and water) was determined by applying 2,2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS•+), 2,2-diphenyl-1-picrylhydrazyl (DPPH•+), ferric reducing antioxidant power (FRAP), and cupric ion reducing antioxidant capacity (CUPRAC) methods. RESULTS: The methanol extract of the U. dioica exhibited significant inhibition on the AChE (IC50= 0.098 ± 0.011 mg/mL). However, methanol and water extracts of the U. dioica did not exhibit the inhibition effect on PON1. The highest activity for ABTS•+ was in the hexane extract (55.97%), and for DPPH•+ was in the methanol extract (62.42%). Compared to other solvents (hexane and water), the methanol extract of the U. dioica showed the highest activity for FRAP and CUPRAC methods. Results (as absorbance) were 0.302 for CUPRAC and 0.147 for FRAP in the methanol extract of the U. dioica. The acetohydroxamic acid, gallic acid, caffeic acid, ellagic acid, p-hydroxybenzoic acid, and quercetin were qualified and quantified in LC-MS/MS analyses of Urtica dioica extract. CONCLUSIONS: U. dioica, which has antioxidant, anti-atherosclerotic and neuroprotective effects, has a natural medicine potential if compared to synthetic drugs used in Alzheimer's patients.

Infra-Low Frequency Neurofeedback in Tension-Type Headache: A Cross-Over Sham-Controlled Study.

Primary headaches are highly prevalent and represent a major cause of disability in young adults. Neurofeedback is increasingly used in the treatment of chronic pain; however, there are few studies investigating its efficacy in patients with headaches. We report the results of a cross-over sham-controlled study on the efficacy of neurofeedback in the prophylactic treatment of tension-type headache (TTH). Participants received ten sessions of infra-low frequency electroencephalographic neurofeedback and ten sessions of sham-neurofeedback, with the order of treatments being randomized. The study also included a basic psychotherapeutic intervention - a psychoeducational session performed before the main study phases and emotional support provided throughout the study period. The headache probability was modeled as a function of the neurofeedback and sham-neurofeedback sessions performed to date. As a result, we revealed a strong beneficial effect of neurofeedback and no influence of the sham sessions. The study supports the prophylactic use of infra-low frequency neurofeedback in patients with TTH. From a methodological point of view, we advocate for the explicit inclusion of psychotherapeutic components in neurofeedback study protocols.

The success of dorsal onlay buccal mucosal graft urethroplasty in challenging urethral stricture cases after multiple failed urethrotomies.

Background: Urethroplasty is the gold standard treatment procedure for male patients with urethral stricture and is becoming increasingly popular among urologists worldwide. Procedure success rates have risen with increased experience. Aims: Here we aimed to examine the results of urethroplasty in challenging cases of urethral stricture and its effect on sexual function. Patients and Methods: Data were collected retrospectively from the patients who had undergone urethroplasty after multiple failed direct vision internal urethrotomy (DVIUs) from 2017 to 2020. All patients were monitored for a minimum of 12 months. Outcomes of urethroplasty were analyzed according to stricture location, length, and the number of prior DVIUs. Penile length and sensation, erectile, and ejaculatory function of the patients were evaluated pre- and postoperatively. Results: The patient cohort consisted of 36 males with a mean age of 63 ± 3.2 years. The most prevalent stricture etiology was iatrogenic (83%). Patients who underwent three or more DVIUs before urethroplasty and stricture length >4 cm were included in the analysis. Accordingly, the overall success rate was 83% (30/36). When the success rate and the IIEF5 scores were assessed separately, there was no significant relationship between the number of DVIUs (P > 0.05). Similarly, no significant relationship was also found with the stricture length (P > 0.05). Conclusion: Appropriate and correctly applied surgical technique does not impair sexual activity, even in patients with severe urethral stricture, regardless of the length or location of the stricture and the number of prior endoscopic procedures.

A Significant Association in Paediatric Emergency Department, Cerebral Sinovenous Thrombosis and Ulcerative Colitis: Review of Literature

ABSTRACT Objective: To discuss cerebral sinovenous thrombosis (CSVT), an important mortality and morbidity factor, developing in the progression of ulcerative colitis (UC) in childhood age, in the light of the literature. Methods: A search of PubMed and Google Scholar database was conducted on April 2014. This study retrospectively investigates the cases diagnosed with UC with complication of CSVT below 18 years of age between years 1971 and 2014. The cases were analysed with respect to age, gender, disease duration and treatment, potential risk factors, clinical findings, location of thrombosis, thrombolytic therapeutical applications, and clinical progressions. Results: Twenty-four paediatric patients aged 5 and 18 years were included in the study. Cerebral sinovenous thrombosis had developed during active disease period in 23 (95.8%) patients. The most common complaints were headache (79.1%) and emesis (29.1%). The most frequently detected risk factors for CSVT were anaemia (58.3%) and thrombocytosis (45.8%). Inherited thrombotic disorders were encountered in 10 (41.6%) of the cases. The most common location sites for CSVT were the transverse (33.3%) and the sigmoid (33.3%) sinuses. It had been discovered that 19 (79.2%) of the cases were healed completely without a sequelae, whereas neurological sequelae remained in three (12.5%) of the cases and two (8.3%) of the cases died. Conclusion: In the presence of a prior diagnosis of UC and emergency presentation with emesis, headache, mood changes and particularly seizure, the presence of CSVT should certainly be considered.

Spontaneous regression of lumbar disc herniations: A retrospective analysis of 5 patients.

The aim of this study is to describe patients who represent spontaneous regression of lumbar disc herniations (LDHs) subsequent to conservative treatments. In this retrospective study, medical records of 862 patients who had presented to our neurosurgery department with LDHs between May 2014 and May 2016 were studied. All of these patients had a history of low back pain and radiculopathy. Lumbar magnetic resonance imaging (MRI) scans were performed to diagnose them.LDHs were categorized into four subtypes including disc bulging, protrusion, extrusion, and sequestration. Five patients developed spontaneous regression of LDHs according to spinal MRI scans. All patients relieved radiculopathy symptoms in 2 to 4 weeks and low back pain symptoms in 3 to 8 weeks except one patient. In one patient hypoesthesia symptom, in one patient motor deficit, and in one patient low back painremained after the regression. The clinical and diagnostic imaging characteristics and outcomes of these five patients are described and the pertinent literature regarding spontaneous regression of LDHs is reviewed. Sequestrated disc herniations represent the main candidates for spontaneous regression according to our clinical research and the pertinent literature. Dehydration and inflammation-related resorption are the main mechanisms for this event. Conservative treatment modalities should not be underestimated for the treatment of such patients in the absence of definitive surgical indications.

Effect of pregnancy on recurrence of symptomatic uterine myomas in women who underwent myomectomy.

BACKGROUND: There is no consensus in the literature regarding risk factors associated with recurrence of uterine leiomyomas. In this study, we evaluated the factors that affect the recurrence of uterine leiomyomas in women who underwent laparotomic or endoscopic myomectomy. METHODS: This retrospective study included 378 patients that underwent myomectomy. Patient follow-up ranged from two to eight years, and they were classified according to the recurrence of myoma uteri. Age, gravidity, parity, presenting complaints, prior surgery, comorbidity, smoking status, intraoperative and postoperative features, and Ca 125 levels were obtained from the hospital records and patient files. RESULTS: Recurrence was detected in 67 women (17.72 %). No statistically significant differences were observed in the demographic data and past obstetric history between the recurrent and non-recurrent groups. The number of myomas was higher in the recurrence group as compared to the non-recurrence group [2 (range: 1-41) vs 1 (1-19), respectively, p =0.022]. Pregnancy rates were statistically higher in the recurrence group as compared to the non- recurrence group (17.9 % vs 7.1 %, respectively, p =0.005). Pregnancy after myomectomy increased the risk of recurrence by 2.8-fold (odds ratio: 2.87; 95 % confidence interval: 1.34-6.13). No significant differences were observed between the two groups regarding the surgical route, fibroid size, uterine location, and position of the myomas in the uterus. CONCLUSION: Women who had more than two myomas should be informed of the possibility of recurrent myoma uteri. Additionally, pregnancy in women who previously had a myomectomy was found to be a risk factor for recurrence of the uterine myoma. HIPPOKRATIA 2018, 22(3): 122-126.

Factors affecting recurrence after surgery for ovarian mature cystic teratoma.

We aimed to evaluate the risk factors for recurrence of surgically managed ovarian mature cystic teratoma (MCT). A total of 178 women with MCT managed surgically at our clinic were included in this retrospective study. The cases were followed for a minimum of 34 months. Risk factors recorded were age, gravidity, diameter of MCT, tumour markers, bilaterality, operation time and recurrence time. One hundred forty-one women (79.2%) underwent laparoscopy and the other thirty-seven patients (20.8%) underwent laparotomy. The mean age of patients with cyst recurrence was significantly lower than that of patients without recurrence (p = 0.02). There was a significantly lower median gravidity and parity in this group. The capacity of younger age, lower gravidity and parity in predicting the recurrence of ovarian MCT was analysed using receiver operating characteristic curve analysis. The cut-off value of age, number of gravidity and parity was 26, 1 and 0, respectively. In conclusion, younger age and lower gravidity and parity were predictive of recurrence due to a more conservative approach in young and nulliparous patients. Therefore, we suggest regular follow-up visits during the postoperative period, especially for younger patients and those with lower numbers of gravidity and parity.

Assessment of primary radical hysterectomy and neoadjuvant chemotherapy followed by radical hysterectomy in Stage IB2, IIA bulky cervical cancer.

OBJECTIVE: Uncertainty concerning the treatment of Stage IB2-IIA (bulky) cervical cancer is still continuing. In this study, an analysis of Stage IB2-IIA (bulky) cervical cancer was performed. The efficacy of primary radical surgery and neoadjuvant chemotherapy followed by a radical surgery was investigated. MATERIALS AND METHODS: Medical data of 50 patients who were diagnosed with Stage 1B2-IIA (bulky) cervical cancer and treated between 2002-2009 were retrospectively assessed. In the radical surgery group, radical hysterectomy + bilateral pelvic + para-aortic lymphadenectomy were performed. In the neoadjuvant chemotherapy group, a combination of cisplatin/topotecan or paclitaxel/carboplatin was given to the patients and then radical surgery was performed. Each group was evaluated individually. Prognostic factors were determined and survival rates were compared between the groups. Ap value was taken < 0.05 for the statistical significance level for all results. RESULTS: Radical surgery after neoadjuvant chemotherapy was performed in 21 and primary radical surgery in 29 patients. Median follow-up time was 36.0 +/- 14.0 months. Average of the tumor size before treatment was 50.2 +/- 7.6 mm. In the radical surgery after neoadjuvant chemotherapy group, lymphovascular space invasion (LVSI) and tumor size (before and after treatment) were determined to be significant factors for each of disease-free survival (DFS) and overall survival (OS). On multivariate analysis, tumor size (before treatment) was found to be an independent prognostic factor for both of DFS (p = 0.006) and OS (p = 0.010). No significant difference in survival periods was observed among the groups. CONCLUSION: There was no significant superiority among the two treatment options. Nonetheless, further studies are needed to compare the multimodal approaches in these stages of cervical cancer.

Ameliorative effect of Leflunomide on lung injury following an aspiration.

BACKGROUND: We aimed to investigate the therapeutic effectiveness of leflunomide (LEF) in lung injury after an aspiration of unknown pathophysiology. MATERIAL AND METHODS: Forty-two healthy Sprague Dawley rats were anesthetized and allocated to six experimental groups: saline (S) aspirated, S+LEF, hydrochloric acid (HCl) aspirated, HCl+LEF, formula aspirated (FOR), and FOR+LEF. The treatment groups (S+LEF, HCl+LEF, and FOR+LEF) received 20 mg/kg/day intraperitoneal (i.p.) injection of LEF for seven days. At the end of the seven days, blood and tissue samples were taken from the rats for histopathological, biochemical, and immunohistochemical examination. RESULTS: There was a significant increase in serum levels of YKL-40, a chitinase-like protein, in the HCl group after the aspiration (p<0.01). The increase in serum YKL-40 levels decreased significantly with LEF treatment (p<0.01). There was no significant difference in serum YKL-40 levels in the FOR group compared to the control group at pretreatment and in the FOR+LEF group at post-treatment. There was a significant increase in serum thiobarbituric acid-reactive species (TBARS) values in the HCl and FOR groups compared to the control group (p=0.001 and p<0.01, respectively). In both treatment groups, the serum TBARS values significantly decreased after treatment with LEF (p=0.001 and p<0.05, respectively). There was a significant improvement in the histopathological scores, which deteriorated after the aspiration, and in the number of inducible nitric oxide synthase (iNOS)-positive cells after treatment with LEF.

Attenuation of bleomycin induced lung fibrosis by erdosteine and inhibition of the inducible nitric oxide synthase.

BACKGROUND AND OBJECTIVES: Despite advances in treatment modalities, the discovery of optimal medical therapies still remains a necessity in the management of pulmonary fibrosis. MATERIAL AND METHODS: The experiments were performed in 35 adult Sprague Dawley rats, randomly allotted into one of five groups (n=7). The control group was treated with 1 ml/kg, 0.9 % saline; the BLM group was given a single dose of BLM (2.5 U/kg); the BLM+ER group was treated with ER (10 mg/kg/day po) for 14 days after BLM administration; the BLM+SMT group was treated with i.p injections of SMT (20 mg/kg/ day) for 14 days after BLM administration; the BLM+ER+SMT group was treated with ER and SMT for 14 days after BLM administration. At the end of day 14, the results of histopathological, biochemical, and immunohistochemical investigations were analyzed. RESULTS: Serum TNF-α, nitrate/nitrite, and TBARS levels significantly increased in BLM group compared to control group (p < 0.001, p < 0.001 and p < 0.05 respectively). Lung tissue content of IL-6 was found to be lower in BLM+ER, BLM+SMT and BLM+ER+SMT groups compared to BLM group by immunhistochemical examinations (p < 0.01, p < 0.01 and p < 0.001, respectively). Similarly, the TNF-α reactions (p < 0.01 for each group) and NF-kB expressions were shown to be significantly different among the study groups (p < 0.05, p < 0.05 and p < 0.001, respectively). CONCLUSION: Based on our study, ER and SMT attenuate BLM-induced pulmonary fibrosis; the combination of two agents has a greater protective efficacy against fibrosis than one alone, reducing the inflammatory markers (Tab. 2, Fig. 2, Ref. 31).

Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess.

This study assessed the risk factors for poor clinical outcomes in patients with tubo-ovarian abscess (TOA). Patients managed with medical therapy and discharged within 7 days without complications constituted the favourable prognosis group (n = 22), whereas those who were managed surgically or discharged after 7 days of antibiotic therapy constituted the poor prognosis group (n = 87). Variables including age, gravidity, number of dilation and curettage procedures, caesarean delivery, smoking status, serum C-reactive protein levels, serum white blood count, body temperature, abscess diameter, presence of an intrauterine device (IUD), duration of IUD placement and length of hospitalisation were evaluated to assess their relationship with the clinical prognosis of TOA. Abscess diameter of ≥ 6 cm was a significant parameter that increased the risk eightfold for poor prognosis. No significant differences were observed regarding the other variables.

Cardioprotective effect of aminoguanidine in combination with steroid therapy after blunt chest trauma.

BACKGROUND: Cardiac contusion is an important cause of mortality after blunt chest trauma (BCT). The aim of this study was to investigate the therapeutic efficacy of the usage of aminoguanidine (AG), in myocardial damage occurring after BCT, alone and in combination with methylprednisolone (MP). METHODS: Thirty-five female Wistar albino rats were randomly assigned to five groups (n = 7) including: sham controls (S); only cardiac contusion (CONT); cardiac contusion treated with methylprednisolone (CONT+MP); cardiac contusion treated with aminoguanidine (CONT+AG); and cardiac contusion treated with methylprednisolone and aminoguanidine (CONT+MP+AG). Seven days following the treatments, heart and serum specimens were evaluated histopathologically, immunohistochemically, and biochemically in all groups. RESULTS: Serum AOPP and Tn-I levels increased significantly after cardiac contusions. Haemorrhage, tissue degeneration, and necrosis development was evident following contusions. Increased iNOS expression in myocardial tissue was significantly decreased in the CONT+AG+MP group compared to CONT+AG and CONT+MP groups (p = 0.001 and p = 0.011, respectively). The combined treatment of AG and MP increased Bcl-2 expression significantly after contusions compared to the other treatment groups. CONCLUSIONS: Combined usage of AG, a selective iNOS inhibitor, with MP, in cardiac contusions, showed a more powerful cardioprotective effect by increasing Bcl-2 expression and reducing iNOS expression (Tab. 3, Fig. 4, Ref. 33).

Recurrence factors in women underwent laparoscopic surgery for endometrioma.

AIM: The aim of this paper was to assess the risk factors for endometrioma recurrence in women underwent laparoscopic surgery for endometrioma. METHODS: This retrospective designed study included 113 cases that underwent laparoscopic surgery for endometrioma; of these women, recurrent endometrioma was detected in 33 (29.20%) subjects and other showed no recurrence (70.80%). Age, gravidity, parity, diameter of the mass, bilaterality, previous pelvic surgery, operation type, presence of adhesions, Ca 125 levels and recurrence time was obtained from hospital records and special gynecology forms. RESULTS: Demographic and obstetric past history of the cases showed no statistically significant difference between the groups (P>0.05). Higher diameter of the mass, previous pelvic surgery, operation type, presence of adhesion and higher Ca 125 levels were risk factors for endometrioma recurrence (P<0.05). Receiver operator curve (ROC) analysis demonstrated that diameter of the mass, previous pelvic surgery and Ca 125 levels may be discriminative risk factors for endometrioma recurrence. CONCLUSION: Endometriomas ≥ 4.5 cm, especially in cases with pelvic adhesions, previous pelvic surgery and higher Ca 125 levels should be excised totally.

A prospective randomized trial of postoperative pain following different insufflation pressures during gynecologic laparoscopy.

OBJECTIVE: To determine the effects of different intra-abdominal pressure values on visceral pain following gynecologic laparoscopic surgery in the Trendelenburg position. STUDY DESIGN: This randomized, controlled prospective trial was conducted at a tertiary education hospital and included 150 patients who underwent gynecologic laparoscopy with different abdominal insufflation pressures. There were 54 patients in the 8 mmHg low pressure group (LPG), 45 in the 12 mmHg standard pressure group (SPG), and 51 in the 15 mmHg high pressure group (HPG). We assessed mean age, body mass index (BMI), duration of surgery, analgesic consumption, length of hospital stay, amount of CO2 expended and volume of hemorrhage. Visceral pain and referred visceral pain were assessed 6, 12, and 24 h postoperatively using a visual analog scale (VAS). RESULTS: There was no significant difference in age, BMI, analgesic consumption or length of hospital stay among groups. The mean operative time and total CO2 expended during surgery were higher in the LPG compared with the SPG and HPG. The mean intensity of postoperative pain assessed by the VAS score at 6 and 12 h was less in the LPG than in the SPG and HPG and was reduced significantly at 12 h. VAS scores at 24 h in the LPG and SPG were lower than in the HPG. CONCLUSION: Pain is reduced by low insufflation pressure compared with standard and high insufflation pressure following gynecologic laparoscopic surgery in the Trendelenburg position. However, low insufflation pressure may result in longer operation times and increased hemorrhage.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg−1·day−1), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats.

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg(-1)·day(-1)), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

The relationship between ovarian volume and serum CA-125 levels.

PURPOSE: The aim of this study was to investigate the relationship between ovarian volume and serum CA-125 levels. MATERIALS AND METHODS: Serum CA-125 levels and ovarian volume were compared among the cases with benign ovarian neoplasms, primary epithelial ovarian cancer (EOC), controlled ovarian hyperstimulation, and ovarian hyperstimulation syndrome (OHSS). Also, the correlation between CA-125 levels and ovarian volume were evaluated in the presence of peritoneal fluid and/or peritoneal carcinomatosis. RESULTS: Although ovarian volume was not different among the groups, CA-125 levels were higher in the cases with EOC than with benign ovarian tumors (p = 0.001). Baseline CA-125 levels were not found to have increased while ovarian volume went up with controlled hyperstimulation in the infertile group (p = 0.555). However, uncontrolled hyperstimulation of the ovaries and the presence of peritoneal fluid caused an increase in the levels of CA-125 (p = 0.001). There was no correlation between ovarian volume and CA-125 levels in the cases with malignant ovarian tumors (r = 0.083). CONCLUSIONS: The results of this study have confirmed that CA-125 is a peritoneal marker and increased ovarian volume with benign ovarian neoplasms or controlled hyperstimulation does not increase CA-125 levels in the same way. The presence of peritoneal carcinomatosis and/or peritoneal fluid seems to be an important factor for high CA-125 levels in patients with epithelial ovarian cancer (EOC).

Amitriptyline overdose in emergency department of university hospital: evaluation of 250 patients.

OBJECTIVE: The purpose of this study was to evaluate the patients with acute amitriptyline poisoning and investigate predictive factors for the development of life-threatening complications. METHODS: Demographics, clinical, laboratory, and electrocardiographic (ECG) findings of 250 patients were evaluated retrospectively. Predictive parameters for the development of serious complications were studied. RESULTS: Median age of patients was 14.6 years, of which, 70% of patients were female and 66% were in pediatric age group. The most common pathological clinical finding and laboratory abnormality were alteration of consciousness and hyponatremia. The rate of convulsive seizure, arrhythmia, and respiratory depression were 17 (6.8%), 16 (6.4%), and 11 (4.4%), respectively. These complications were more seen in pediatric patients than adults (15.8% and 1.2%). The incidence of hyponatremia was more in pediatric patients and severe poisoning groups (38.8 and 53.4%, respectively). The levels of amitriptyline and nortriptyline were significantly higher in the group with complications than the group without complications (p < 0.05). All adult patients were discharged with good prognosis. In pediatric age group, one patient was discharged with severe neurological sequelae and one patient died. QRS duration >100 ms, long corrected QT duration interval, and low Glasgow Coma Score (GCS) at admission were identified as independent risk factors for the development of life-threatening complications (odds ratio: 69.4, 1.9, and 1383, respectively; p < 0.05). CONCLUSION: Amitriptyline poisoning may be associated with life-threatening complications, especially in pediatric age group and in patients with hyponatremia. Low GCS, presence of hyponatremia, high serum drug levels, and pathological ECG findings on admission may be helpful in predicting the development of complications and poor prognosis.