Synchronous Ovarian and Endometrial Endometrioid Adenocarcinoma Presenting with Nonbacterial Thrombotic Endocarditis and Pulmonary Thromboembolism: Adenocarcinoma with Thrombotic Events.

Introduction. Nonbacterial thrombotic endocarditis (NBTE) is a rare manifestation of hypercoagulability in patients with malignant neoplasms. Case Report. A fifty-six-year-old woman presented to the emergency service; the clinical workup revealed deep vein thrombosis in right leg and bilateral massive PTE. As the abdominal sections on the spiral CT revealed a giant pelvic mass of ovarian origin, she was referred to our hospital's gynecologic oncology department. She was scheduled for surgery under enoxaparin. She described numbness on one side of her face. Cranial imaging findings revealed acute ischemic cerebral lesions and transesophageal echocardiogram showed vegetation on the aortic cusp. Under anticoagulation treatment, she underwent hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. After tumor resection, her neurological symptoms dissolved with aggressive anticoagulant treatment. Pathology result was synchronous endometrial and ovarian adenocarcinoma. Discussion. NBTE is a rare condition often associated with advanced malignancies. Peripheral embolism and venous thrombosis are complications that have been associated with NBTE due to hypercoagulable state. These disorders could be resistant to routine anticoagulant treatment. In case of a thrombotic complication due to ovarian malignancy, surgical resection of the primary tumor may increase the effect of anticoagulant treatment.

Endothelium and angiogenesis in white coat hypertension.

Hypertensive patients are at particular risk of cardiovascular complications, possibly related to endothelial damage or dysfunction, or to abnormal angiogenesis. The aim of this study was to compare the risk conferred by white coat hypertension (WCH) vs sustained hypertension in the development of the endothelial dysfunction and abnormal angiogenesis by evaluating nitric oxide (NO=NO2+NO3), endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and E-selectin levels in plasma. The study group included 102 subjects, 34 with WCH (17 male and 17 female patients) aged 49+/-11 years, 34 sustained hypertensives (HT) (15 male and 19 female patients) aged 47+/-11 years and 34 normotensive control subjects (NT) (16 male and 18 female patients) aged 48+/-10 years. WCH was defined as clinical hypertension and daytime ambulatory blood pressure less than 135/85 mmHg. The subjects were matched for age, gender, body mass index and the patients with smoking habit, dyslipidaemia, and diabetes mellitus were excluded from the study. The NO, ET-1, VEGF and E-selectin levels were analysed by ELISA technique. The WCH subjects had significantly higher levels of NO than the HT (41.68+/-2.23 vs 32.18+/-2.68 micromol/l; P<0.001) and significantly lower values than the NT (48.24+/-4.29 micromol/l; P<0.001). ET-1 levels of the WCH group were significantly higher than the NT (8.10+/-0.92 vs 5.95+/-0.26 ng/ml; P<0.001) and significantly lower than the HT (11.46+/-0.59 ng/ml; P<0.001). Considering with VEGF, the WCH group had significantly higher levels than the NT (195.88+/-11.84 vs 146.26+/-18.67 pg/ml; P<0.001), but the difference from the HT group was not significant (203.35+/-7.48 pg/ml; P=0.062). E-selectin in the WCH group was significantly lower than the HT (4.77+/-0.52 vs 8.49+/-2.85; P<0.001), but the difference from the NT group was not significant (3.86+/-0.67; P=0.077). Our data demonstrate that WCH is associated with endothelial dysfunction and abnormal angiogenesis. The degree of these changes is not as severe as observed in hypertensive population.

Oxidative stress in white coat hypertension; role of paraoxonase.

Oxidative stress in sustained hypertension was shown with several biochemical parameters. Oxidized low-density lipoprotein (oxLDL) plays an important role during the atherosclerosis process and paraoxonase (PON1) can significantly inhibit lipid peroxidation. Serum PON1 activity, oxLDL and malondialdehyde (MDA) concentrations and their relationship with serum lipid parameters and systolic and diastolic blood pressures (SBP and DBP) were determined in subjects with white coat hypertension (WCH), sustained hypertension (HT) and normotension (NT). The study group consisted of a total of 86 subjects, 30 with WCH (14 male, 16 female subjects), 30 with HT (13 male, 17 female subjects) and 26 with NT (12 male, 14 female subjects). Both white coat hypertensive and hypertensive subjects had significantly higher levels of MDA than normotensives (P<0.026 and P<0.001, respectively). The oxLDL level of the HT group was significantly higher than the NT group (P<0.023). The WCH group had an oxLDL level similar to both hypertensive and normotensive groups. HT and WCH groups had significantly lower PON1 levels than the normotensive group (P<0.001). oxLDL correlated with MDA positively (P=0.008), and PON1 negatively (P=0.008). A negative correlation between MDA and PON1 (P=0.014) was detected. MDA correlated positively with both SBP and DBP (P=0.001), while PON1 correlated with both of them negatively (P=0.01 and P=0.008, respectively). OxLDL correlated with diastolic blood pressure positively (P=0.008). Our data demonstrate that oxidative stress increase in WCH is associated with a decrease in PON1 activity. The reduction in PON1 activity may be one of the factors leading to an increase in oxidative status in WCH.

Gaucher disease and brucella: just a mere coincidence?

Gaucher disease type I and brucellosis are chronic diseases with similar symptoms and physical signs though the former is the most common lysosomal storage disease and the latter is an infectious disease. The similarities between these diseases make differential diagnosis difficult. Immunodeficiency is a feature of Gaucher disease type I and increases the susceptibility towards infections. A Gaucher disease type I patient with brucellosis is presented with improvement after treatment of brucellosis.

Target organ damage and changes in arterial compliance in white coat hypertension. Is white coat innocent?

The aim of this study was to perform an extensive evaluation of target organ status, metabolic abnormalities and hemodynamic alterations in white coat hypertension (WCH). Fifty normotensive (NT), 90 WCH (ambulatory daytime blood pressure < 135/85 mmHg) and 101 hypertensive (HT) subjects underwent extensive biochemical, echocardiographic, fundoscopic examination. In a subgroup study, arterial compliance and intima-media thickness (IMT) were measured by Doppler ultrasound in left common carotid artery. WCH subjects were found to have higher body mass index (BMI) than the NTs (p = 0.042). Left ventricle mass index (LVMI) was greater in the WCHs than the NTs (p < 0.001), but significantly less than the HTs (p < 0.001). Hypertensive retinopathy was observed in the WCHs, but was less severe and rare compared to the HTs (13% vs 27%). Both WCHs and HTs had high levels of urinary albumin excretion (UAE) (p = not significant). Total cholesterol was higher in WCHs than in the NTs (p = 0.04) The distensibility coefficient (DC) of the WCHs was significantly greater than the HTs (p < 0.01), while significantly smaller than the NTs (p < 0.01). The compliance coefficient (CC) of the WCHs was significantly higher than the HTs (p < 0.01), and significantly less than the NTs (p < 0.01). The IMT in the HTs was significantly higher than the WCHs (0.81 +/- 0.05 vs 0.70 +/- 0.04 mm; p < 0.001) and the NTs (p < 0.001). The difference between the NTs and the WCHs was not significant. Our data indicate that patients with WCH represent an intermediate group between NTs and sustained HTs where target organ damage and cardiovascular risk is concerned.

The value of TPS in breast cancer.

The serum concentration of the cell proliferation marker TPS (Tissue Polypeptide-Specific Antigen) was compared with 7 different common tumor markers (CEA, CA 12-5, CA 19-9, CA 15-3, ferritin, AFP and beta 2-Microglobulin) in order to assess its practical value in the management of breast cancer. The new monoclonal TPS assay utilizing the specific epitope M3 is used to monitor cell multiplication in cancer patients. The values are not related to tumor burden but rather reflect the tumor proliferation rate. In our study no association was found between the TPS values and the age of the patients and histologic tumor types. Significant correlation was observed between the TPS values and the menopausal status of the patient. The regression analyses between TPS and the other markers did not reveal a correlation. Association between the TPS values and the CA 15-3 was not found. However, strong correlation between CA 15-3 and four other markers was observed. Therefore, it was concluded that TPS can provide additional information when used in combination with CA 15-3.

Diagnostic value of the tumor markers in breast cancer.

The use of the most common tumor markers in breast cancer was reassessed in terms of cost effectiveness and the validity of their predictive information during the evaluation of the patients. Sera from 159 patients were studied. Acceptable diagnostic specificity was found only for CA 15-3. In predicting the presence of metastases the combination of CA 15-3 and CEA was observed to correlate with lymph node metastases. Introduction of MCA did not result in diagnostic improvement. Our results suggest that in practice a diagnostic panel for breast cancer can be confined to CA 15-3 and CEA.

Use of the face mask in the treatment of maxillary retrusion--a case report.

A case report is presented of a Class III malocclusion with a Class III skeletal pattern and maxillary retrusion. The patient, an 11-year-old girl, was treated with an orthopaedic face mask in conjunction with standard Edgewise mechanics. Treatment was completed after 14 months, and proved to be stable following the active treatment and at recall 4 years later.

The effect of neuromuscular diseases on the development of dental and occlusal characteristics.

Fourteen patients suffering from primary muscular disease (myopathies), including seven with Duchenne's muscular dystrophy, were compared to 11 patients whose neuromuscular disorders were of neuropathic origin. Mesioclusion was observed only in the group with Duchenne's muscular dystrophy. Posterior crossbite, anterior open bite, mouth breathing, and large tongue were also more prevalent in the group with myopathies, especially the Duchenne's patients, than they were in the group with neurogenic disorders. The Duchenne's patients exhibited a statistically significant delay in dental emergence, unlike the patients with other myopathies and those with neurogenic disorders. Dentition and occlusion may be more affected in patients with myopathies, especially Duchenne's muscular dystrophy, than they are in patients with neurogenic disorders.

[The treatment of cross-bites in the Angle Class I cases with modular 3 D lingual appliances]. / Angle sinif I anomalisi gösteren bireylerde çapraz kapanisin modüler 3 D lingual apareyler ile tedavisi.

Anterior cross-bites which involve one tooth or a group of teeth is commonly seen in every age groups. Removable or fixed appliances are used in the treatment of these cases. Both of these appliances have some advantages and disadvantages. The objective of this study is to evaluate the effectiveness of the Modular 3 D Adapter in the treatment of the anterior cross-bites. All of the 14 patients aged between 10 years 1 month and 24 years 2 months showed Angle Class I anterior Cross-bite malocclusion. Only the first molar tooth or teeth were banded, then 0.025 inch Adapter appliance was used Lingually. By applying a force between 60-70 grams, the normal occlusions were gained after 2 months.

[Delaire's architectural and structural cranio-facial analysis in cephalometric evaluation]. / Sefalometrik degerlendirmede Delaire yapisal ve mimari kranio-fasiyal analizin yeri.

In this study, the main rules of architectural and Structural cranio-facial analysis developed by Delaire is explained. This architectural and structural cranio-facial analysis of the lateral cephalometric radiograph clarifies the mutual balance of the various bony structures of the cranium and face, individualizes certain of the structures, and specifies their normal of pathologic relationships. Five cephalometric, films were evaluated according to Delaire's architectural and structural analysis and according to classic cephalometric analysis. The results we obtained are presented.