Idiopathic membranous nephropathy preceding membranous lupus nephritis: a case report.

Membranous nephropathy is one of the most common causes of nephrotic syndrome in the adult population. According to the underlying etiology, membranous nephropathy is classified as either primary or secondary. Systemic lupus erythematosus is an autoimmune disease that can affect the kidneys in 50% of patients in the course of the disease. Renal disease may be the first manifestation of systemic lupus erythematosus and the development of systemic findings may be delayed for about 1-5 years following the diagnosis of lupus nephritis. We present a 59-year-old male patient who had a diagnosis of idiopathic membranous nephropathy since 2007 and developed membranous lupus nephritis during the 12-year follow-up without any extrarenal systemic lupus erythematosus findings.

The effect of lipoic acid in the prevention of myocardial infarction in diabetic rats.

OBJECTIVES: We aimed to investigate the effect of lipoic acid in the prevention of myocardial infarction in diabetic rats. METHODS: Rats were divided into five groups as control, ISO, LA+ISO, STZ+ISO and STZ+LA+ISO. To induce diabetes, single dose of streptozotocin was injected to STZ+ISO and STZ+LA+ISO groups. Lipoic acid (10 mg/kg/day) was injected for 14 days to LA+ISO and STZ+LA+ISO groups. To induce myocardial infarction, isoproterenol was injected to ISO, LA+ISO, STZ+ISO and STZ+LA+ISO groups on the days 13 and 14 of lipoic acid treatment. Cardiac necrosis and leucocyte infiltration were investigated histopathologically. Serum malondialdehyde levels, paraoxonase and lactonase activities were measured spectrophotometrically. RESULTS: Isoproterenol caused a significant increase in cardiac necrosis, leucocyte infiltration and serum lipid peroxidation whereas a significant decrease in serum paraoxonase and lactonase activities. In myocardial infarcted non-diabetic rats, while lipoic acid caused a significant decrease in cardiac necrosis, leucocyte infiltration and serum lipid peroxidation and a significant increase in serum paraoxonase and lactonase activities, it did not change these histopathologic or biochemical parameters in myocardial infarcted diabetic rats. CONCLUSION: Lipoic acid, at the dose of 10 mg/kg, is effective to prevent myocardial infarction in non-diabetic rats but it is insufficient in diabetic rats (Tab. 1, Fig. 2, Ref. 35).

Development of primary central nervous system lymphoma in a systemic lupus erythematosus patient after treatment with mycophenolate mofetil and review of the literature.

Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma and four cases of PCNSL have previously been described in association with mycophenolate mofetil. We report the fifth case of PCNSL in a patient with lupus nephropathy while on mycophenolate mofetil treatment.

Risk factors for peritoneal dissemination of gastric cancer.

AIM: Tumor dissemination, lymphnode involvement and surgical resection technique are the most important factors affecting patient prognosis with gastric cancer. Peritoneal dissemination adversely affects the survival rate in patients. Microscopic peritoneal dissemination can be detected with peritoneal lavage cytological examination. Peroperatively detected microscopic peritoneal dissemination changes the treatment plan for patients and can be useful when selecting patients who should undergo adjuvant chemotherapy. METHODS: At the Trakya Universtity Faculty of Medicine, General Surgery Department, a 41-year-old patient who was macroscopic peritoneal dissemination during the dates January-December 2011 was included in the study. Perioperative peritoneal lavage was performed and cytological examination of peritoneal aspirate carried out. Using tumor markers the relationship between lymph node metastasis, prognostic type, tumor location and perineural invasion was investigated on the serum and peritoneal fluid. RESULTS: Forty-one patients were operated on; 10 of them (24.4%) had positive malignant cytology and 31 (75.7%) had negative cytology. Just 1 (7.2%) patient was found to have positive cytology out of 13 (31.7%) that did not have serous invasion. Of the 28 (68.3%) patients with serous invasion, 9 patients (32.1%) were found to have positive cytology. No significant pattern was detected in the carcino-embryionic antigen, cancer antigen 19-9 and AFP levels in both the positive and negative cytology serum and peritoneal lavage fluid. Of the 41 patients operated on 5 (12.2%) were found to have cardia dissemination and 13 (31.7%) were found to have dissemination located at the corpus. Peritoneal dissemination was found to be significantly high in gastric cancer located in the cardia and corpus. Fourteen (34.1%) of the patients had stage I and stage II cancer and 27 (65.9%) of patient's had cancer in stages III and IV. Just 1 (7.1%) patient with stage I or II cancer was found to have positive malignant cytology, however 9 (33.3%) patient's of stage III and IV gastric cancer patients were tested positively for malignant cytology. CONCLUSION: A positive relationship was detected in the positive peritoneal cell malignancy with cancer stage, age, invasion depth and tumor location in patients.

Radioiodine-induced kidney damage and protective effect of amifostine: An experimental study.

BACKGROUND: Ablative radioiodine-131 ((131)I) therapy is used in the standart treatment procedure of thyroid carcinoma and procedures using (131)I represent the majority of Nuclear Medicine therapeutic procedures. The principal route of (131)I excretion after the administration of (131)I is the urine. Amifostine is an organic thiophosphate ester prodrug and the kidney concentrations of the active metabolite WR-1065 are about 100 times higher than tumour concentrations. To our knowledge, there is no published data in literature presenting acute effect of radioiodine on renal tissue during high dose I-131 radioiodine treatment (RIT). Additionally, it is not known whether amifostine takes role in this process. MATERIALS AND METHODS: In this study, 50 healthy female Wistar albino rats, weighing 200-250 g and averaging 16 weeks old were utilised. The rats were randomly divided into ten groups. 1- Sham group (n=5), 2- Amifostine group (n=5): rats pretreated with 1 cc amifostine (200 mg/kg) by intraperitoneal injection, 3- Radioactive iodine first day group (RI-1) (n=5): rats treated with 1 cc oral 185 MBq radioactive iodine-131 and sacrification performed after 1(st) day, 4- Amifostine + Radioactive iodine first day group (A+RI-1) (n=5): rats pretreated with amifostine (200 mg/kg) by intraperitoneal injection and rats treated with 5mCi radioactive iodine-131 and sacrification performed after 1(st) day. 5- Radioactive iodine third day group (RI-3) (n=5), 6- Amifostine + Radioactive iodine third day group (A+RI-3) (n=5), 7- Radioactive iodine fifth day group (RI-5) (n=5), 8- Amifostine + Radioactive iodine fifth day group (A+RI-5) (n=5), 9- Radioactive iodine seventh day group (RI-7) (n=5) and 10- Amifostine + Radioactive iodine seventh day group (A+RI-7) (n=5). The renal cast formation and tubular damage are evaluated by a pathologist in a blinded manner. RESULTS: Ablative radioiodine-131 therapy induced renal tubular damage was significantly higher in the radioactive iodine fifth day group (RI-5) when compared with the Sham group (p=0.01) and Amifostine group (p=0.01). CONCLUSIONS: A marked ablative radioiodine-131 induced renal toxicity was seen at fifth day of the therapy after a single RIT application and the main histopathological change was tubular damage. Amifostine have protective effects against ablative radioiodine-131 therapy and this effect is significant at fifth day of the therapy.

Giant malignant melanoma: a case report.

Malignant melanoma is an aggressive tumor of melanocytes whose primary function is producing melanin pigment. Though they vary according to the microscopical subtype, these tumors often arise in the sun-exposed skin of elderly individuals, in the acral regions and in the palms and soles of the hands and feet. A 56-year-old patient visited the emergency department of our hospital with complaints of a sudden hemorrhage from a mass on her left thigh which had appeared five months ago. On physical examination a brown-black mass with dimensions of 18 x 16 x 5 cm, protruding from the skin with a partially and actively hemorrhagic, ulcerated surface, was found on the left gluteal region. The mass was excised surgically with 3 cm safe surgical margins. Histopathologically the lesion was diagnosed as "nodular malignant melanoma - Clark level 5". A malignant melanoma of such a large size is very exceptional in the literature; thus it is presented here with its interesting rapid clinical course.

Radiographic size versus surgical size of renal masses: which is the true size of the tumor?

PURPOSE: The size of a renal neoplasm is important for staging, prognosis and selection of appropriate treatment. Our aim was to determine whether there is a discrepancy between the radiographic and pathological size of renal tumors. PATIENTS AND METHODS: The maximum size of 35 resected renal tumors was measured by computed tomography (CT) by 2 independent observers. The radiographic and pathological sizes were compared by size range and tumor radiological features. RESULTS: Although the radiographic and pathological size for all tumors was not statistically different (7.50 vs. 6.25 cm, p=0.452), the average radiographic size was larger than pathological tumor size in tumors smaller than 7 cm. Solid tumors showed more reduction in size (17.02%) compared with cystic and necrotic tumors (p=0.731). Only the radiographic size of ill-defined tumors was smaller than their pathological size (average 33.33%; p=0.865). The influence of tumor side (left or right kidney) and its location within the kidney did not influence the degree of decrease (p=0.147 and p=0.981, respectively). CONCLUSION: A reduction in the size of renal tumors is observed in tumors<7 cm, which is explained by vasoconstriction during the temporary renal artery occlusion, surface hypothermia and blood loss during the operation. If this reduction of size is secondary to surgery, the radiographic size of renal tumors should be considered in staging and selecting the appropriate treatment for tumors<7 cm for which the decision of surgical approach depends on the size of the tumor.

Successful treatment of primary non-Hodgkin's lymphoma of the vulva with radiation therapy.

Vulva, as a primary site of malignant lymphoma in women, is extremely rare. We report herein an 83-year-old patient with a primary, stage IIE vulvar, follicular center cell, B-cell lineage non-Hodgkin's lymphoma (NHL), with an excellent response to radiation therapy and event-free survival of 18 months. Early-stage primary vulvar NHL can be successfully treated only by limited field irradiation.

Resveratrol may reduce apoptosis of rat testicular germ cells after experimental testicular torsion.

The aim of the study is to evaluate the effects of resveratrol on apoptosis of testicular germ cells after experimental testicular torsion. Thirty Wistar albino rats were divided into 3 groups. Torsions were created by rotating the right testis 720 degrees in a clockwise direction for 4 h in all groups except the control group (group 1). They were then repaired by counter-rotation and replaced into the scrotum. In group 2, saline was infused 30 min before detorsion. In group 3, 30 mg/kg resveratrol was infused 30 min before detorsion. In groups 2 and 3, the bilateral testes were removed to determine germ cell apoptosis after 20 h of detorsion. The number of apoptotic cells was evaluated using the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) technique and caspase 3. Mean apoptotic score of ipsilateral testes in group 3 was lower than that of group 2 (p < 0.05). Mean apoptotic score of the contralateral testes in group 3 was not different from that of group 2 (p > 0.05). The present study demonstrates that intraperitoneal administration of resveratrol in rats may decrease germ cell apoptosis in the ipsilateral testes.