Prescription of antidepressants is increased in Danish patients with polycystic ovary syndrome and is associated with hyperandrogenism. A population-based cohort study.

OBJECTIVE: Quality of life is impaired in polycystic ovary syndrome (PCOS). In this study, we compared the time to first prescription of antidepressants (ADM) in PCOS vs two control groups. DESIGN: Register-based cohort study. PATIENTS: One thousand and one hundred and twenty-four premenopausal women with hirsutism and/or PCOS, premenopausal women with hypertension (HT, n = 301), and age- and sex-matched population controls (controls, n = 4110). MEASUREMENTS: Prescriptions for ADM on secondary care contacts from regional registers. RESULTS: The median age at cohort entry in PCOS, HT and controls was 29, 34 and 29 years, respectively. Among PCOS, HT and controls, 227 (20%), 74 (25%) and 633 (15%), respectively, had prescriptions of ADM. The median time to first prescription of ADM in the PCOS, HT and control cohorts was 6·8, 6·6 and 7·2 years, respectively. The adjusted hazard ratio for time to prescription of ADM for HT vs PCOS was 1·36 [95% CI (1·02-1·82)], P = 0·039, and for controls vs PCOS, it was 0·75 [95% CI (0·64-0·88)], P < 0·001. Within patients with PCOS, hyperandrogenism contributed significantly to the model, likelihood ratio test P = 0·009. The adjusted hazard ratio for hyperandrogenism vs no hyperandrogenism was 1·97 (1·12-3·45), P = 0·018. CONCLUSION: Patients with PCOS had moderately but significantly decreased time to first prescription of ADM compared with age-matched healthy women, whereas patients with HT had the shortest time to prescription. In PCOS, prescription of ADM was associated with the presence of hyperandrogenism.

Characteristics and risk factors for colorectal cancer recurrence.

PURPOSE: To evaluate the characteristics of recurrence and examine the clinicopathological factors related to disease- free (DFS) and overall survival (OS) of patients with colorectal cancer (CRC) recurrence. METHODS: One hundred and sixteen CRC patients with stage II and III disease that had been resected curatively in our clinic between 1999 and 2006 were retrospectively evaluated. The parameters evaluated were gender, age, preoperative CEA levels, tumor localisation, duration of surgery, the units of perioperative blood transfusion, tumor differentiation, TNM stages and adjuvant therapies. The presence of preoperative intestinal obstruction, radical abdominopelvic lymph node (RAPL) dissection and lymphatic, vascular and perineural invasion were also evaluated. RESULTS: With 36.6+/-2 months follow-up, 49 (42%) patients developed local recurrence and/or distant metastases. Twenty-three (19.8%) patients presented with isolated local recurrence. Thirteen of 49 patients with local recurrence were successfully operated with R0 curative resection. The OS survival rates for those with curatively and palliatively resected recurrences were 29 and 19 months, respectively. In multivariate analysis, the factors related to DFS were tumor localisation and differentiation, neurovascular invasion, blood transfusion and RAPL dissection. Among these factors, only RAPL dissection was not statistically significant for OS. CONCLUSION: The factors increasing local recurrence rates of CRC should be clearly described. Local and systemic treatment modalities, like preoperative chemoradiotherapy should be planned for patients carrying these risk factors.

A giant solitary schwannoma of the arm mimicking cyst hydatid.

We present a 77-year-old female with a size of 9.5×9×7 cm3 giant schwannoma of musculocutaneous nerve volarly located in midarm, which was misdiagnosed as cyst hydatid on ultrasonographic and magnetic resonance image examination. There was not any neurologic sequele after the operation. In case of the similarity of their clinical and radiological findings, schwannoma should be included in the differential diagnosis of hydatid cysts especially in endemic countries.

The role of anti-CENP-B and anti-SS-B antibodies in breast cancer.

A close relationship between autoimmunity and malignant diseases has been supposed for a long time. In clinical practice, anti-SS-B and anti-CENP-B antibodies are used as serologic markers for autoimmune diseases. In this study, anti-SS-B and anti-CENP-B autoantibodies were studied in breast cancer patients and compared to a control group surgically treated due to benign diseases. These antibodies were evaluated by enzyme linked immunoassay and serum values >10 U/ml were accepted as positive. Fifty-five patients with breast cancer and 25 patients with benign diseases were prospectively included in the study. In the breast cancer group, both anti-CENP-B (33% vs. 8%) and anti-SS-B (44% vs. 24%) autoantibodies had higher positivity compared to the control group, but this difference reached statistical significance only for anti-CENP-B antibodies (p=0.02). Besides, anti-SS-B positivity was detected more frequently in breast cancer patients with axillary involvement (63% vs. 24%) (p=0.006) and increased as the number of involved lymph nodes increased in the axilla (p=0.03). Although the clinical significance of autoantibody detection in cancer patients is still not clear, autoantibodies especially detected in individuals without proven autoimmune diseases needs to be thoroughly evaluated for early diagnosis and treatment of various cancers.

Sonographic evaluation of the carpal tunnel after provocative exercises.

OBJECTIVE: Dynamic carpal tunnel syndrome (CTS) is a subtype of CTS in which symptoms usually subside with rest and return with repetitive motions. In this subgroup, nerve conduction studies, performed at rest, are often inconclusive. In this study, the diagnostic value of provocative sonography was evaluated in patients with dynamic CTS. METHODS: Twenty wrists of 13 patients with dynamic CTS and 10 control subjects were investigated with sonography before and immediately after provocative exercises imitating work-related stresses. In addition to conventional indices (palmar displacement, nerve area at the middle level, and swelling ratio before and after exercise), 2 newly formed indices (provocative nerve area ratio and provocative palmar displacement ratio) were investigated. RESULTS: In the pre-exercise period, there were no significant differences between patients and control subjects regarding palmar displacement and the swelling ratio. The difference was significant (P =.035) for the nerve area at the middle level. In the post-exercise period, all parameters were significantly different between patients and control subjects. The nerve area at the middle level and the swelling ratio had higher significance (P <.0001) than palmar displacement (P =.015). The post-exercise swelling ratio had the highest sensitivity (95%) in diagnosing dynamic CTS when a cutoff value of 1.26 was used. The provocative palmar displacement ratio had high sensitivity (80%) and the highest specificity (90%) for a cutoff value of 1.28. CONCLUSIONS: Provocative exercises increase sensitivity and specificity and contribute to the sonographic diagnosis of dynamic CTS. This examination should be performed if electrodiagnostic test results are negative.

Case report of a giant renal oncocytoma.

This report represents the third largest renal oncocytoma in English literature. The tumor was considered as a renal cell carcinoma preoperatively based on the physical examination and radiographic findings.

Serum Helicobacter pylori IgG and IgA levels in patients with gastric cancer.

The association between Helicobacter pylori and gastric cancer has been debated in the last decade and evidence for such a causal relationship has been claimed. This study aimed to detect the seroprevalence of Helicobacter pylori in patients with gastric cancer and compare it to the other cancer patients. In addition, the value of IgG and IgA in Helicobacter pylori detection was compared in patients with gastric cancer. Consecutive gastric and other cancer patients treated between 1999-2001 were prospectively studied. Serum Helicobacter pylori IgG and IgA levels were determined. Serological tests revealed IgA and IgG positivity as 53.9% and 50.9%, respectively, while 74.5% had positive results for either IgA or IgG. Serum IgA positivity was significantly higher in gastric cancer group compared to control group (p=0.02). In contrast, serum IgG positivity did not show a significant difference in both groups and either IgG or IgA seropositivity was significantly higher in patients with gastric cancer compared to control patients (p=0.04). This study revealed a higher seroprevalence of Helicobacter pylori in gastric cancer patients and IgA was a better predictor of Helicobacter pylori seropositivity in gastric cancer patients.

Rare case of neuroendocrine small cell carcinoma of the endometrium with paraneoplastic membranous glomerulonephritis.

Small cell carcinomas are well-recognized tumors known to occur predominantly in the lung. These neoplasms are occasionally associated with a variety of paraneoplastic syndromes. Four cases of paraneoplastic glomerulopathy associated with small cell lung carcinoma have been reported. However, there have been no reports in the literature indicating an association between endometrial small cell carcinoma and paraneoplastic glomerulopathy. We report a case of neuroendocrine small cell carcinoma of the endometrium associated with membranous glomerulonephritis (MGN), which appeared to be a component of an unusual paraneoplastic syndrome. A 33-year-old multiparous woman presented with abnormal vaginal bleeding and abdominal bloating. Endometrial biopsy revealed neuroendocrine small-cell carcinoma of the endometrium. On the eighth day of hospitalization the patient suddenly developed renal failure. Renal biopsy revealed MGN, probably due to tumor-antigen-related immune complex deposition. Small cell carcinoma of the endometrium may be associated with paraneoplastic MGN. Medical staff should take into account the possibility of a preexisting glomerular injury when managing a patient with small cell carcinoma of the endometrium.

Doppler waveforms and blood flow parameters of the superior and inferior mesenteric arteries in patients having Behçet disease with and without gastrointestinal symptoms: preliminary data.

OBJECTIVE: To evaluate hemodynamic changes in mesenteric arteries in patients with Behçet disease with and without gastrointestinal symptoms. METHODS: Doppler sonography of mesenteric arteries was performed in 25 symptomatic and 15 asymptomatic patients having Behçet disease and in 25 healthy control subjects. The peak systolic, minimal, and mean velocities, resistive and pulsatility indexes, inner diameter, cross-sectional area, and blood flow volume of mesenteric arteries were evaluated. The results were compared between patient groups and controls. RESULTS: The mesenteric artery flow was significantly greater in patients in the symptomatic group than in those in the asymptomatic group or in controls. In the superior mesenteric artery, mean velocity and mean blood flow volume (0.35 +/- 0.18 m/s and 711 +/- 404 mL/min, respectively; P < .0001) in the symptomatic group were significantly higher than in the asymptomatic group (0.16 +/- 0.07 m/s and 305 +/- 168 mL/min, respectively) or in controls (0.15 +/- 0.07 m/s and 290 +/- 123 mL/min, respectively). The mean peak systolic velocity (1.23 +/- 0.47 m/s; P < .005) in the symptomatic group was significantly higher than in controls (0.93 +/- 0.23 m/s). In the inferior mesenteric artery, mean velocity and mean blood flow volume (0.25 +/- 0.10 m/s and 139 +/- 79 mL/min) in the symptomatic group were significantly higher than in the asymptomatic group (0.16 +/- 0.07 m/s; P < .006; and 78 +/- 26 mL/min; P < .007) or in controls (0.17 +/- 0.07 m/s; P < .003; 83 +/- 48 mL/min; P < .004). CONCLUSIONS: In this study, symptomatic patients with gastrointestinal Behçet disease were associated with a significant increase in mesenteric artery flow that could be evaluated easily on spectral patterns of arteries during Doppler sonography. The Doppler sonographic findings also revealed that intestinal involvement in patients with Behçet disease without gastrointestinal symptoms is not significantly different from that of healthy controls.

Prognostic factors affecting survival in male breast cancer.

Male breast cancer is an uncommon disease and most of the data concerning its treatment and prognostic factors have been obtained from studies spanning a long period of time during which the main concepts of treatment in breast cancer have changed. In the current study, patients affected with male breast cancer treated in the last decade with a multidisciplinary approach were reported from a single Institution. Fifty-five patients with male breast cancer treated between 1990 and 1998 were included in this study. The median follow-up period was 36 months. Five-year disease-free and overall survival were 44.5% and 72.9%, respectively. Patients' age, tumor size, axillary status, tumor type and treatment modalities such as surgery, chemotherapy, radiotherapy, and hormonotherapy were evaluated as possible prognostic factors affecting the disease-free and overall survival periods. In univariate analysis, tumor size, axillary status and extent of surgery were found to be affecting overall survival significantly whereas axillary status, tumor type, extent of surgery and chemotherapy affected disease-free survival. In multivariate analysis, axillary status, extent of surgery and tumor type were found as independent prognostic factors for overall survival and radiotherapy was added to these factors for disease-free survival. In conclusion, the approach to male breast cancer patients should be similar to that for female patients. Modified radical mastectomy should be the gold standard followed by combined adjuvant therapy individualized for patients due to axillary status, tumor size and type.

Gastroduodenal metastases in a clear cell sarcoma patient.

Clear cell sarcoma is a rare tumor with an unpredictable clinical course and usually poor prognosis. Almost all of the patients will have pulmonary metastases during the clinical course. Other more common metastatic sites are bones, lymph nodes, liver and spleen. Treatment of clear cell sarcoma is primarily surgical aiming to achieve uninvolved margins. Role of chemotherapy, radiotherapy and immunotherapy is controversial and remission of metastases has been reported rarely. In this study we report a case of clear cell sarcoma, with gastroduodenal and pulmonary metastases and remission of these metastases in response to chemotherapy.

Primary gastrointestinal tract lymphomas.

AIM: To evaluate the prognostic factors and treatment modalities affecting survival in patients with primary gastrointestinal tract lymphoma. MATERIAL AND METHODS: Gastrointestinal tract lymphoma patients were retrospectively studied. Age and sex of patients, location and histopathological grade of tumour, stage of disease, extent of surgical resection and chemotherapy were evaluated as prognostic factors. Effects of clinicopathological and treatment associated factors on disease-free and overall survival were calculated in univariate and multivariate analyses. RESULTS: On univariate analysis, disease stage (p = 0.002), extent of surgical resection (p = 0.003) and chemotherapy (p = 0.001) were found to be significantly affecting overall survival and none of the studied factors were found to be related with disease-free survival. Multivariate analysis revealed that grade of the tumour (p = 0.042) and chemotherapy (p = 0.028) significantly affected disease-free survival and disease stage (p = 0.013) and chemotherapy (p = 0.0003) were independent prognostic factors for overall survival. In addition, surgery and chemotherapy in combination, significantly increased overall survival compared to surgery or chemotherapy only. CONCLUSION: Early stage patients have a better survival and it could be prolonged if surgery with no residual disease is performed; adjuvant chemotherapy provides an additional benefit.

Comparison of prognostic scoring system to tumor node metastases 1992 and 1997 staging systems in gastric cancer patients.

Tumor node metastases staging systems have been widely utilized to predict the prognosis of gastric cancer patients. The current study aimed to compare a prognostic scoring system to tumor node metastases 1992 and 1997 staging systems in predicting the outcome of resectable gastric cancer patients. Patients treated between 1996-1998 were retrospectively evaluated. Tumor depth in the gastric wall, anatomical location and number of metastatic lymph nodes, metastatic to retrieved lymph node ratio, extent of surgical resection, tumor location, type of lymph node dissection, macroscopic appearence and histologic type of tumor were recorded and patients were divided into groups I-III due to their scores. Patients were also staged according to both tumor node metastases systems. Survival data was analyzed by Kaplan-Meier method. For the comparison of power of the three systems in predicting survival, log-rank and Cox regression analysis were respectively used for univariate and multivariate analysis. 163 resectable gastric cancer patients were evaluated. Median follow-up and survival times were 26 and 23 months respectively. Overall 5-year survival was 37.6%. The number of patients in prognostic scoring groups I, II and III was 44, 109 and 10, respectively. According to tumor node metastases 1992 system, 13, 43, 101 and 6 patients were in stages I, II, III and IV while there were 13, 38, 78 and 34 patients in respective stages in tumor node metastases 1997 system. Although tumor node metastases 1992 (p=0.0088), 1997 (p=0.0029) and prognostic scoring systems (p=0.0006) significantly predicted the survival of patients in univariate analysis, prognostic scoring system was found to be superior compared to other two systems in multivariate analysis (p=0.0002). Prognostic scoring system is a practical, reliable and reproducible method that could be used as an adjunct to tumor node metastases systems in predicting survival of resectable gastric cancer patients.

Menstrual cycle and hormone receptor status in breast cancer patients.

Hormone receptors in normal breast tissue were reported to be under the influence of cyclic variations of serum hormones during the menstrual cycle. The current study aimed to demonstrate a similar relationship between the phase of the menstrual cycle and hormone receptor status in operable, premenopausal patients with breast cancer. Patients were prospectively categorized according to the first day of last menstrual period into clinically defined follicular/luteal, perimenstrual/mid-cycle and unopposed estrogen/rest of the cycle phases and hormonally defined follicular/luteal phases. Serum follicle-stimulating hormone, luteinizing hormone, estrogen and progesterone levels were determined on the day of the operation. Estrogen and progesterone receptors in the tissues were detected by immunohistochemistry. Eighty-eight consecutive premenopausal patients with breast cancer were included in the study. Estrogen and progesterone receptors were positive in 57 (64.8%) and 40 (70.2%) patients respectively. Forty-nine patients were in follicular, and 39 patients in luteal phases according to serum hormone levels. Estrogen receptor positivity was significantly higher in hormonally defined follicular phase (p=0.025) and also had a tendency to be higher in perimenstrual phase (p=0.048). In contrast, progesterone receptor status was found to be independent of the phases of the menstrual cycle. As a conclusion, hormone receptor status might change during different phases of the menstrual cycle due to a possible effect of the circulating hormones and if it is found as negative, should he re-evaluated concerning the phase of the menstrual cycle in which the operation was performed.

Tc-99m MDP scintimammography in palpable and nonpalpable breast lesions: comparison with mammographic probability of malignancy.

We evaluated the contribution of Tc-99m methylene diphosphonate (MDP) scintimammography (MDP-SMM) to the diagnosis of breast cancer in 96 patients with 109 (52 palpable, 57 nonpalpable) breast lesions and compared them with mammography. Mammographic classification of the lesions were done as probably malignant (29), indeterminate (29) and probably benign (51). There were 23 malignant and 86 benign lesions. MDP-SMM successfully detected 16 of 23 (70%) breast cancers. Twelve of the 13 palpable and 4 of the 10 nonpalpable cancers showed Tc-99m MDP accumulation. Eight of the 86 (9%) benign breast lesions showed Tc-99m MDP accumulation (false positives). In the mammographically indeterminate group, MDP-SMM changed 22 of the 24 false positives into true negatives and showed 2 false negatives. In the 35 lesions detected in dense breasts, 10 of the 13 false positives were changed into true negatives and showed 1 false negative. As a conclusion, combined use of MDP-SMM with mammography seems to be useful in cases with mammographically indeterminate breast lesions and dense breasts and may help to preclude unnecessary breast biopsies.

Gastric leiomyoblastoma: report of three cases.

Leiomyoblastoma is a rare smooth muscle tumor characterized by epithelioid cells with clear cytoplasms and an unknown biological behaviour. Since pre-operative diagnosis is difficult, the optimum strategy during the operation could be determined only by having a thorough knowledge about it beforehand. Leiomyoblastoma can be exogastric, intramural or endogastric. In the mostly benign exogastric leiomyoblastomas, total excision with resection of full thickness of gastric wall around the tumor is appropriate. Partial or total gastrectomy should be performed for intramural or endogastric tumors. We report one exogastric and two intramural gastric leiomyoblastoma cases treated in our hospital.