Purpose: To evaluate the pathological correlation and prognostic significance of tissue stiffness measured by shear wave elastography (SWE) in bladder cancer. Materials and Methods: Patients with microscopic or macroscopic hematuria diagnosed with bladder tumors were included. SWE measurements were performed using a Samsung Medison RS80A Prestige ultrasonography device, with ten valid measurements taken for each tumor. Tumor specimens were collected via transurethral resection (transurethral resection of the bladder tumor) for histopathological analysis. Microvessel density (MVD) was assessed by immunohistochemical staining with anti-CD34 antibody using the hot-spot method. Correlations between tissue stiffness, MVD and tumor stage and grade were analyzed, and receiver operating characteristic (ROC) analysis determined the optimal SWE cutoff for differentiating tumor characteristics. Results: A total of 65 bladder urothelial carcinoma patients were included in the study (43 high-grade, 22 low-grade). SWE and MVD were significantly higher in the high-grade group (p=0.001, p=0.002, respectively). ROC analysis showed SWE could differentiate tumor grades (area under ROC curve=0.837, p<0.001), with a cut-off of 4.25 kPa (74% sensitivity, 86% specificity). Stiffness was also higher in recurrence (p=0.007). A strong positive correlation between SWE and MVD was found (rho=0.767, p<0.001).SWE may be a reliable, non-invasive tool for assessing tumor grade and recurrence risk. Conclusions SWE may be a reliable, non-invasive preoperative marker for bladder cancer, aiding in tumor characterization and clinical decision-making.

PURPOSE: This study aimed to verify the efficacy and safety of intravesical treatment with sodium chondroitin sulfate (CS) in patients with overactive bladder (OAB) who are refractory to previous antimuscarinic treatment. METHODS: This study was performed between June 2012 and January 2015 and included 31 consecutive women (mean age, 42.10+/-7.34 years) with OAB who had been previously treated with two types of antimuscarinic drugs. The results of gynecologic and cystoscopic examinations were normal, and OAB comorbidity was absent. Treatment with intravesical instillations containing 40 mL CS (0.2%; 2 mg/mL) was administered for 6 weeks; after weekly treatments, monthly treatments were administered. The OAB-validated 8 (OAB-V8) symptom scores, nocturia, frequency, urgency, urge incontinence, and urinary volumes measured by uroflowmetry were evaluated for all the patients. The values obtained before the treatment were statistically compared with those obtained six months after the treatment. RESULTS: The duration of the symptoms was 18.36+/-6.19 months. A statistically significant improvement of the patients' conditions was observed in terms of the OAB-V8 symptom scores, nocturia, frequency, urgency, urge incontinence, and urinary volumes measured by uroflowmetry after the treatment. CONCLUSIONS: Despite the limitations of this study, the outcomes confirmed that CS therapy is safe and effective for the treatment of OAB.
Administration, Intravesical ; Chondroitin Sulfates ; Chondroitin* ; Comorbidity ; Female ; Humans ; Nocturia ; Sodium* ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge

Marijuana is known to have been used for medicinal and recreational purposes for thousands of years. Although marijuana has some diverse effects on cardiovascular system, there is insufficient knowledge concerning acute myocardial infarction (AMI) associated with marijuana and its underlying mechanism. We report the case of a 26 year-old young man suffering from ST-elevated AMI caused by marijuana abuse, which was successfully treating with percutaneous coronary intervention. It should be kept in mind that marijuana could be one of the most probable causes of AMI observed in apparently healthy young persons who use this drug.
Cannabis ; Cardiovascular System ; Humans ; Marijuana Abuse ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stress, Psychological

INTRODUCTIONThere has been a resurgence of interest in studies concerning the role of elements in the development and maintenance of the skeleton. The aim of the study was to assess the plasma and red blood concentrations of some elements in postmenopausal women with osteoporosis.

MATERIALS AND METHODSSeventy-seven postmenopausal women with osteoporosis aged 61 years (median interquartile range, 7.5; range, 46 to 74) and 61 age- and BMI-matched healthy postmenopausal women aged 60 years (median interquartile range, 8.0; range, 44 to 76) were included in the study. Element concentrations in plasma and red blood cells including magnesium (Mg), zinc, copper, manganese, and selenium were measured by atomic absorption spectrophotometry in both postmenopausal women with osteoporosis and healthy postmenopausal women.

RESULTSOnly statistically significant difference between the osteoporotic (51.51 [15.40] microg/mL) and healthy subjects (54.54 [15.42] microg/mL) was observed in red blood cell (RBC) magnesium concentration (Z=-2.07, P=0.039). However, no significant difference was found between patient and control groups, both in plasma and in red blood concentrations, for zinc, copper, manganese, and selenium.

CONCLUSIONMg levels in red blood cells are significantly lower in postmenopausal women with osteoporosis. It is concluded that Mg transport mechanism(s) into the cell could be affected in patients with osteoporosis.

Aged ; Bone Density ; Case-Control Studies ; Copper ; blood ; Female ; Humans ; Magnesium ; blood ; Manganese ; blood ; Middle Aged ; Osteoporosis, Postmenopausal ; blood ; physiopathology ; Risk Factors ; Selenium ; blood ; Turkey ; Zinc ; blood

Aims: Diabetic foot infections (DFIs) represent one of the most important risk factors for lower extremity amputation. One of the major infection agents that causes DFIs is Staphylococcus aureus. Staphylococcus aureus is an important human pathogen causing variety of clinical manifestations which can lead to invasive infections, sepsis and even death. Outcomes of antibiotic treatment of diabetic foot infections may depend not only on the antimicrobial susceptibility of the etiological agents, but also their ability to produce diverse virulence factors. This study was aimed to investigate biofilm production and the presence of various virulence genes among Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-susceptible Staphylococcus aureus (MSSA) isolates obtained from patients with DFIs. Methodology and results: A total of 48 clinical MRSA and MSSA isolates obtained from diabetic foot patients were studied for their biofilm formation and the presence of 29 known virulence genes. The biofilm formation was observed, analyzed and quantified using the microtiter plate method. Biofilm production was observed as 95.50% and 92.00% in the MRSA and MSSA isolates, respectively. Among the 29 virulence genes tested on the 48 clinical isolates, 19 virulence genes were detected. It was found that aap (62.50%), etd (54.17%), icaD (50.00%), aae (50.00%), seh (31.25%) and icaADB (22.92%) were the most prevalent genes. A total of 10 virulence genes (etb, gehD, icaB, icaC, seb, hla_haem, hld_epid, altE, fbe and sesI) were absent in all the isolates used. Conclusion, significance and impact of study Virulence genes play important role in clinical infections. Our results showed the presence rates of biofilm formation and accumulation-associated factors that are high among MRSA as well as MSSA isolates from DFIs. These results confirmed the importance of biofilm formation as regarded for DFIs.
Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Diabetic Foot

OBJECTIVES: Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection. METHODS: Before and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used. RESULTS: All patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values. CONCLUSION: After BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.
Acoustics ; Botulinum Toxins* ; Deglutition Disorders ; Dyspnea ; Electromyography ; Female ; Humans ; Laryngeal Muscles* ; Muscles ; Paralysis* ; Phonation ; Quality of Life ; Spirometry ; Thyroid Gland ; Tracheotomy ; Vocal Cords* ; Voice

Although gynecomastia is a well-defined paraneoplastic syndrome in patients with non-small cell lung cancer, the association with pleomorphic carcinoma has not been reported. A 50-yr-old man presented with bilateral gynecomastia and elevated serum beta-human chorionic gonadotropin (beta hCG) level. Chest tomography showed a mass in the right middle lobe. Right middle lobectomy and mediastinal lymph node dissection were performed. beta hCG levels decreased rapidly after surgery. Histological examination revealed pleomorphic carcinoma with positive immunostaining for beta hCG. Serum beta hCG levels began to increase gradually on postoperatively 4th month. Computed tomography detected recurrence and chemotherapy was started. After second cycle of chemotherapy, beta hCG levels decreased dramatically again and tomography showed regression in mass. Patient died 6 months later due to brain metastasis. beta hCG expression may be associated with aggressive clinical course and increased risk of recurrence, also beta hCG levels may be used to evaluate therapy response in patients with pleomorphic carcinoma.
Brain Neoplasms/radiotherapy/secondary ; Carcinoma, Non-Small-Cell Lung/complications/*diagnosis/pathology ; Chorionic Gonadotropin, beta Subunit, Human/*blood ; Gynecomastia/*etiology ; Humans ; Lung Neoplasms/complications/*diagnosis/pathology ; Lymph Nodes/surgery ; Male ; Middle Aged ; Recurrence ; Risk Factors ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the decisive role of preoperative serum thrombopoietin levels in the discrimination of benign and malignant ovarian pathologies and its value in the evaluation of treatment response. METHODS: Fifty patients with diagnoses of adnexal masses (25 benign, 25 malignant) were included in the study. Blood samples were collected from all cases preoperatively. Age, menopausal status, adnexal mass size, preoperative CA-125 level, platelet count, the stage of the disease (FIGO stage), tumor grade, histologic subgroup, the residual tumor mass, ascites cytology, surgical procedures, and postoperative treatments were recorded for the malignant group. Response to treatment was evaluated based on the revised RECIST guideline. RESULTS: The preoperative serum thrombopoietin levels of the malignant cases (median, 98; range, 7 to 768) were significantly higher when compared with those of benign cases (median, 27; range, 13 to 131; p=0.004). The positive predictive value of CA-125 was found to be 79%, when it was used as a single marker; however it had risen to 85% when both CA-125 and thrombopoietin levels were used. There was no significant relationship between preoperative serum thrombopoietin levels and tumor grade, ascites cytology, presence of residual mass, and response to treatment. The preoperative serum thrombopoietin levels were significantly higher in stage III-IV cases and cases with serous histology. The post-treatment serum thrombopoietin levels in the malignant group were significantly lower as compared with the preoperative thrombopoietin levels. CONCLUSION: Thrombopoietin can play an additive role for prediction of ovarian cancer.
Ascites ; Discrimination (Psychology) ; Humans ; Neoplasm, Residual ; Ovarian Neoplasms ; Platelet Count ; Thrombopoietin ; Biomarkers, Tumor

The aim of this study was to determine the risk factors for nosocomial infections of imipenem-resistant Pseudomonas aeruginosa (IRPA). A prospective case-control study was performed at a tertiary care hospital in Ankara from January to December 2004. The patients with nosocomial P. aeruginosa infection were included in the study. The features of the patients with IRPA infections were compared to those with imipenem-sensitive P. aeruginosa (ISPA) infections. Only the first isolation of P. aeruginosa was considered. Nosocomial infections were defined according to Center for Disease Control (CDC) criteria. IRPA was isolated from 75 (44.1%) patients, and ISPA was isolated from 95 (55.9%) patients during the study period. IRPA were most frequently isolated from endotracheal aspirate (19%) cultures (p= 0.048), whereas ISPA were most frequently isolated from urine (28%) cultures (p= 0.023). In multivariate analysis, a longer duration of hospital stay until P. aeruginosa isolation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002-1.054, p=0.034), arterial catheter administration (OR, 2.508; 95% CI, 1.062-5.920, p=0.036), vancomycin (OR, 2.882; 95% CI, 1.130-7.349, p=0.027), piperacillin-tazobactam (OR, 6.425; 95% CI, 2.187-18.875, p=0.001), and imipenem (OR, 3.580; 95% CI, 1.252- 10.245, p=0.017) treatment within the 14 days before isolation of IRPA were independently associated with imipenem resistance. It was concluded that treatment with imipenem, vancomycin and piperacillin-tazobactam were major risk factors for IRPA infections in hospitalized patients. The nosocomial occurrence of IRPA was also strongly related to the duration of hospital stay, arterial catheter administration.
Adult ; Aged ; Anti-Bacterial Agents/*pharmacology/therapeutic use ; Case-Control Studies ; Cross Infection/drug therapy/epidemiology/*microbiology ; Drug Resistance, Multiple, Bacterial ; Female ; Humans ; Imipenem/*pharmacology/therapeutic use ; Length of Stay ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Multivariate Analysis ; Penicillanic Acid/analogs & derivatives/pharmacology/therapeutic use ; Piperacillin/pharmacology/therapeutic use ; Prospective Studies ; Pseudomonas Infections/drug therapy/epidemiology/*microbiology ; Pseudomonas aeruginosa/drug effects/*isolation & purification ; Risk Factors ; Vancomycin/pharmacology/therapeutic use

BACKGROUND/AIMS: The aim of this study was to investigate atrial conduction times and left atrial mechanical functions, the noninvasive predictors of atrial fibrillation, in prediabetic patients with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). METHODS: Study included 59 patients (23 males, 36 females; mean age 52.5 ± 10.6 years) diagnosed with IFG or IGT by the American Diabetes Association criteria, and 43 healthy adults (22 males, 21 females; mean age 48.5 ± 12.1 years). Conventional and tissue Doppler echocardiography were performed. The electromechanical delay parameters were measured from the onset of the P wave on the surface electrocardiogram to the onset of the atrial systolic wave on tissue Doppler imaging from septum, lateral, and right ventricular annuli. The left atrial volumes were calculated by the disk method. Left atrial mechanical functions were calculated. RESULTS: The mitral E/A and E′/A′ ratios measured from the lateral and septal annuli were significantly lower in the prediabetics compared to the controls. The interatrial and left atrial electromechanical delay were significantly longer in prediabetic group compared to the controls. Left atrial active emptying volume (LAAEV) and fraction (LAAEF) were significantly higher in the prediabetics than the controls. LAAEV and LAAEF were significantly correlated with E/A, lateral and septal E′/A′. CONCLUSIONS: In the prediabetic patients, the atrial conduction times and P wave dispersion on surface electrocardiographic were longer before the development of overt diabetes. In addition, the left atrial mechanical functions were impaired secondary to a deterioration in the diastolic functions in the prediabetic patients.
Adult ; Atrial Fibrillation ; Echocardiography, Doppler ; Electrocardiography ; Fasting ; Female ; Glucose ; Humans ; Male ; Methods ; Prediabetic State