Aggressive squamous cell carcinoma of the renal pelvis.

Squamous cell carcinoma (SCC) of the renal pelvis is a particularly rare tumor that accounts for a minor portion of renal malignancies and is aggressive with an unfavorable prognosis. It is usually diagnosed after surgery and at advanced stages as it does not possess specific clinical and radiological properties. The pathological examination of a 38-year-old female patient who had undergone nephrectomy due to a nonfunctioning right kidney caused by long-standing staghorn calculus revealed moderately differentiated renal pelvis SCC invading the renal parenchyma. The patient who experienced severe lumbar pain in the second postoperative month presented lymphadenopathy, which could not be detected with ultrasonography but was diagnosed with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT). The patient received systemic treatment following the early diagnosis and survived past the average survival time. It was concluded that in cases where SCC was diagnosed after nephrectomy, investigating metastasis with 18FDG PET/CT and initiating early systemic treatment in the presence of metastasis could contribute to survival.

A case of hyperpigmentation and acanthosis nigricans by testosterone injections.

Drug-related skin disorders may occur in many different ways. Despite pigmentary changes being less important for morbidity, these changes precipitate depressed mood and reduce self-confidence. Testosterone is a steroid hormone from the androgen group and primarily used for the treatment of hypogonadism in males. Testosterone replacement can cause skin problems like acne, hair loss, redness, pain, or infection at the injection site. The study was conducted on a 49-year-old man with adult onset idiopathic hypogonadotropic hypogonadism, which is an acquired form of isolated gonadotropin-releasing hormone deficiency. He was presented with lack of energy and decreased sexual function 10 years ago and was given an oil-based injectable blend of four esterized testosterone compounds as hormone replacement treatment in a urology polyclinic. He was referred to our polyclinic by endocrinologist because of progressive hyperpigmentation marked on his face and oral mucosa. In the present study, we report the first testosterone therapy-related facial and oral mucosal hyperpigmentation and acanthosis nigricans in the same patient.

Presence of low lipid levels in patients with Behcet' s disease as a protector against atherosclerosis.

BACKGROUND: A relapsing systemic inflammatory process is a well-known feature of Behcet's disease. Because systemic inflammation and dyslipidemia are involved in the pathogenesis of atherosclerosis, Behcet's disease may play a part in the development of atherosclerosis. Lipid profile in Behcet's disease and the development of atherosclerosis remain to be controversial. In order to learn more about this relationship, our study compared blood lipid levels in healthy controls to those in patients with Behcet's disease during both their active and inactive stages. PATIENTS AND METHODS: Between December 2010 and March 2012, this prospective, observational study was designed to evaluate three groups The study included 91 Behcet's patients (36 in active and 55 in inactive period) and 61 healthy control subjects matched for age, gender, and body mass index. Data from lipid profiles included total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein. Acute phase reactants were also recorded, including high sensitive C-reactive protein and erythrocyte sedimentation rate levels. RESULTS: Total cholesterol, low density lipoprotein, and high density lipoprotein cholesterol levels of patients in active stage were significantly lower than those in inactive stage, while total cholesterol and low density lipoprotein levels were lower in the control group (p < 0.05). CONCLUSIONS: Patients with Behcet's disease in the active period may be less susceptible to atherogenic events as compared with the controls and those in the inactive period of the disease.

Increased epicardial fat tissue is a marker of subclinical atherosclerosis in patients with psoriasis.

BACKGROUND: Carotid intima-media thickness (CIMT) is a potential indicator of subclinical atherosclerosis in patients with psoriasis. Epicardial fat thickness (EFT) is proposed as a new cardiometabolic risk factor. OBJECTIVE: To evaluate the association between EFT and CIMT in patients with psoriasis. METHODS: This was a cross-sectional and observational study; 65 patients with psoriasis and 50 age- and sex- matched control subjects were included. Data about echocardiographic EFT, CIMT, anthropometric measurements and metabolic profile were obtained. RESULTS: The EFT and CIMT were significantly increased (7.3 ± 0.5 vs. 6.5 ± 0.5 mm, P < 0.01; 0.74 ± 0.11 vs. 0.60 ± 0.07 mm, P < 0.01, respectively) in patients with psoriasis compared with the controls. EFT was significantly correlated with CIMT (r = 0.69, P < 0.01). In a multiple linear regression model in which EFT was independently associated with psoriasis (ß = 0.45, P < 0.01), age (ß = 0.33, P = 0.01), CIMT (ß = 0.50, P < 0.01), body mass index (ß = 0.25, P = 0.01), high-sensitivity C-reactive protein (ß = 0.32, P < 0.01) and duration of disease (ß = 0.34, P = 0.03). CONCLUSIONS: We demonstrated that EFT and CIMT are increased in patients with psoriasis, and that echocardiographic EFT is closely correlated with CIMT in patients with psoriasis. The echocardiographic assessment of EFT may have the potential to be a simple marker of subclinical atherosclerosis and increased cardiovascular risk in patients with psoriasis.

Investigation of early atherosclerotic changes in acromegalic patients.

BACKGROUND: Functional and morphological changes of endothelium were risk factors for mortality attributed to atherosclerosis. Studies investigating early atherosclerotic alterations and the effect of the treatment of acromegaly on these alterations gave conflicting results. OBJECTIVE: Surrogate markers of early atherosclerotic changes, i.e. brachial artery flow-mediated dilation (FMD) and carotid artery intima-media-thickness (IMT) in active and inactive acromegalic patients were compared with control subjects matched to patients for age, sex and cardiovascular risk factors to find out the direct effects of growth hormone (GH)/insulin-like growth factor-1 excess. METHODS: In 14 active acromegalics and their 14 matched controls, 14 inactive acromegalics and their 14 matched controls, carotid artery IMT and FMD of brachial artery were measured. Inactive acromegalics were in remission for at least 1 year. RESULTS: Active acromegalics had higher IMT than matched controls and inactive acromegalics (0.85 +/- 0.20 mm, 0.64 +/- 1.77 mm, 0.66 +/- 0.20 mm respectively; p < 0.005, p < 0.05) and IMT of inactive acromegalics was not different from their matched controls (0.61 +/- 0.12 mm). FMD was significantly lower in active acromegalics than in matched controls and inactive acromegalics (2.910 +/- 2.00 mm, 6.5 +/- 2.81 mm, 5.68 +/- 2.9 mm respectively; p < 0.005, p < 0.05). FMD of inactive acromegalics was not significantly different from their matched controls (7.96 +/- 3.12 mm). A significant inverse relationship was found between GH and FMD in active acromegalics (r = -0.659, p = 0.010). CONCLUSION: In active acromegalics, early atherosclerotic changes are not only attributed to the high prevalence of risk factors, but also to the abnormal GH secretion itself.

Synthesis and ESR studies of redox reactivity of bis (3,5-di-tert-butyl-1,2-benzoquinone-2-monooximato)Cu(II).

Complexing of 3,5-di-tert-butyl-1,2-benzoquinone-2-monooxime with Cu(II) in air and under N2 gave Cu(qo)2 and Cu(qo)2 x H2O (where qo is 3,5-di-tert-butyl-1,2-benzoquinone-2-monooximato-anion) complexes, respectively. The ESR spectroscopy showed that the reduction of these complexes with P(PhX)3 (X = H, m-Cl, m-CH3, p-Et2N-) and 1,4-bis(diphenyldiphosphino) butane (dppb) proceeds via the radical formation (phenoxazine, amino phenoxy and nitrene type radical intermediates) and pathways of reduction depend on the structure of these complexes. The reaction of Cu(qo), with dppb and P(PhX)3 phosphines gave essentially identical ESR spectra. At the same time, reduction of Cu(qo)2 x H2O with PPh3 result in entirely different unstable radical spectrum (g = 2.0046) which is further converted to another relatively stable Cu-containing radical signal (g = 2.0052). The unstable radical species attributed to nitrene type radicals. The initial complexes and all radical products were characterized by their ESR and optical spectra.