In patients who have severe burn injuries with a large surface area, inflammatory response of the immune system, which is subsequently followed by anti-inflammatory response, results in immune dysregulation and this makes burn victims vulnerable to infection. With the disruption of skin integrity, the body becomes vulnerable to infection. Thermal injury disrupts cellular integrity, and eschar forms over the wound bed. Successive escharotomy procedures performed as part of treatment also lead to increased susceptibility to infection. The cytokine adsorber is a treatment modality that can be useful in preventing the transition to infection by removing inflammatory mediators from the blood. In our case series, we wanted to present the patients who were followed up for a prolonged period in our hospital’s burn intensive care clinic due to 75~90% 4th degree burns as a result of an explosion in a coal mine and periodically received cytokine adsorbents.

In patients who have severe burn injuries with a large surface area, inflammatory response of the immune system, which is subsequently followed by anti-inflammatory response, results in immune dysregulation and this makes burn victims vulnerable to infection. With the disruption of skin integrity, the body becomes vulnerable to infection. Thermal injury disrupts cellular integrity, and eschar forms over the wound bed. Successive escharotomy procedures performed as part of treatment also lead to increased susceptibility to infection. The cytokine adsorber is a treatment modality that can be useful in preventing the transition to infection by removing inflammatory mediators from the blood. In our case series, we wanted to present the patients who were followed up for a prolonged period in our hospital’s burn intensive care clinic due to 75~90% 4th degree burns as a result of an explosion in a coal mine and periodically received cytokine adsorbents.

In patients who have severe burn injuries with a large surface area, inflammatory response of the immune system, which is subsequently followed by anti-inflammatory response, results in immune dysregulation and this makes burn victims vulnerable to infection. With the disruption of skin integrity, the body becomes vulnerable to infection. Thermal injury disrupts cellular integrity, and eschar forms over the wound bed. Successive escharotomy procedures performed as part of treatment also lead to increased susceptibility to infection. The cytokine adsorber is a treatment modality that can be useful in preventing the transition to infection by removing inflammatory mediators from the blood. In our case series, we wanted to present the patients who were followed up for a prolonged period in our hospital’s burn intensive care clinic due to 75~90% 4th degree burns as a result of an explosion in a coal mine and periodically received cytokine adsorbents.

In patients who have severe burn injuries with a large surface area, inflammatory response of the immune system, which is subsequently followed by anti-inflammatory response, results in immune dysregulation and this makes burn victims vulnerable to infection. With the disruption of skin integrity, the body becomes vulnerable to infection. Thermal injury disrupts cellular integrity, and eschar forms over the wound bed. Successive escharotomy procedures performed as part of treatment also lead to increased susceptibility to infection. The cytokine adsorber is a treatment modality that can be useful in preventing the transition to infection by removing inflammatory mediators from the blood. In our case series, we wanted to present the patients who were followed up for a prolonged period in our hospital’s burn intensive care clinic due to 75~90% 4th degree burns as a result of an explosion in a coal mine and periodically received cytokine adsorbents.

OBJECTIVE: To assess the prognosis of surgically-staged non-invasive uterine clear cell carcinoma (UCCC), and to determine the role of adjuvant therapy. METHODS: A multicenter, retrospective department database review was performed to identify patients with UCCC who underwent surgical treatment between 1997 and 2016 at 8 Gynecologic Oncology Centers. Demographic, clinicopathological, and survival data were collected. RESULTS: A total of 232 women with UCCC were identified. Of these, 53 (22.8%) had surgically-staged non-invasive UCCC. Twelve patients (22.6%) were upstaged at surgical assessment, including a 5.6% rate of lymphatic dissemination (3/53). Of those, 1 had stage IIIA, 1 had stage IIIC1, 1 had stage IIIC2, and 9 had stage IVB disease. Of the 9 women with stage IVB disease, 5 had isolated omental involvement indicating omentum as the most common metastatic site. UCCC limited only to the endometrium with no extra-uterine disease was confirmed in 41 women (73.3%) after surgical staging. Of those, 13 women (32%) were observed without adjuvant treatment whereas 28 patients (68%) underwent adjuvant therapy. The 5-year disease-free survival rates for patients with and without adjuvant treatment were 100.0% vs. 74.1%, respectively (p=0.060). CONCLUSION: Extra-uterine disease may occur in the absence of myometrial invasion (MMI), therefore comprehensive surgical staging including omentectomy should be the standard of care for women with UCCC regardless of the depth of MMI. Larger cohorts are needed in order to clarify the necessity of adjuvant treatment for women with UCCC truly confined to the endometrium.
Adenocarcinoma, Clear Cell ; Chemotherapy, Adjuvant ; Cohort Studies ; Disease-Free Survival ; Endometrium ; Female ; Humans ; Neoplasm Invasiveness ; Omentum ; Prognosis ; Retrospective Studies ; Standard of Care ; Uterine Diseases

No abstract available.
Isotretinoin ; Purpura, Schoenlein-Henoch

No abstract available.
Isotretinoin ; Purpura, Schoenlein-Henoch

BACKGROUND AND OBJECTIVES: Fragmented QRS complexes (fQRS) are associated with increased morbidity and mortality. The causative relationship between fQRS and cardiac fibrosis has been shown, but whether the presence and the number of fQRS on admission of electrocardiogram (ECG) predicts ST segment resolution in patients undergoing primary percutaneous coronary intervention (p-PCI) has not been investigated until now. SUBJECTS AND METHODS: This study included one hundred and eighty-four consecutive patients with ST elevation myocardial infarction (STEMI) who underwent p-PCI. The presence or absence of fQRS on pre and post-PCI ECG and their relation with myocardial infarction and reperfusion parameters were investigated. RESULTS: Patients with fQRS on admission of ECG or newly developed fQRS after p-PCI had increased inflammatory markers, higher cardiac enzyme levels, increased pain to balloon time, prolonged QRS time, more extended coronary involvement and more frequent Q waves on ECG in comparison to patients with absence or resolved fQRS. The presence and higher number of fQRS on admission or post-PCI ECGs were significantly related with low percent of ST resolution and myocardial reperfusion parameters. The area under the receiver operating characteristics curve values for the presence and number of fQRS to detect Thrombolysis in Myocardial Infarction Blush Grade 0 and 1, were 0.682 and 0.703. CONCLUSION: In our study, fQRS was significantly related to infarction and myocardial reperfusion parameters before and after p-PCI. Successful myocardial reperfusion by p-PCI caused the reduction in number of fQRS and QRS time with higher ST resolution. fQRS may be useful in identifying the patients at higher cardiac risk with increased ischemic jeopardized or infarcted myocardium, and persistent or newly developed fQRS may predict low percent of ST segment resolution in patients undergoing p-PCI.
Electrocardiography ; Fibrosis ; Humans ; Infarction ; Myocardial Infarction ; Myocardial Ischemia ; Myocardial Reperfusion ; Myocardium ; Percutaneous Coronary Intervention ; Reperfusion ; ROC Curve

BACKGROUND AND OBJECTIVES: QRS complex fragmentations are frequently seen on routine electrocardiograms with narrow or wide QRS complex. Fragmented QRS complex (fQRS) is associated with increased morbidity and mortality, sudden cardiac death and recurrent cardiovascular events. In this study, we aimed to interrogate the relationship of systemic inflammation with the presence of fQRS in patients with acute coronary syndromes (ACS). SUBJECTS AND METHODS: Two-hundred and twenty eligible patients with ACS that underwent coronary angiography were enrolled consecutively in this study. Patients with significant organic valve disease and those with any QRS morphology that had a QRS duration > or =120 ms as well as patients with permanent pacemakers were excluded from this study. RESULTS: Patients with fQRS were of a higher age (p=0.02), had increased C-reactive protein (CRP) levels (p<0.001), prolonged QRS time (p<0.001), extent of coronary artery disease (CAD) (p<0.001), creatine kinase-MB (CK-MB) levels (p=0.006) and Q wave on admission electrocardiography (p<0.001) in comparison to patients with non-fragmented QRS. When we performed multiple logistic regression analysis, fQRS was found to be related to increased CRP levels {odds ratio (OR): 1.2, 95% confidence interval (CI): 1.045-1.316, p=0.007}, QRS duration (OR: 1.1, 95% CI: 1.033-1.098, p<0.001), extent of CAD (OR: 1.5, 95% CI: 1.023-2.144, p=0.037), Q wave (OR: 2.2, 95% CI: 1.084-4.598, p=0.03) and CK-MB levels (OR: 1.0, 95% CI: 1.001-1.037, p=0.04) independently. CONCLUSION: In our study, we found that fQRS was independently related to increased CRP. Fragmented QRS that may result as an end effect of inflammation at cellular level can represent increased cardiac risk by different causative mechanisms in patients with ACS.
Acute Coronary Syndrome ; C-Reactive Protein ; Coronary Angiography ; Coronary Artery Disease ; Creatine ; Death, Sudden, Cardiac ; Electrocardiography ; Humans ; Inflammation ; Logistic Models ; Risk Assessment

OBJECTIVE: Mental fatigue, cognitive disorders, and sleep disturbances seen in chronic fatigue syndrome (CFS) may be attributed to cholinergic deficit. A functional deficiency of cholinergic neurotransmission may cause the hypothalamic-pituitary-adrenal axis hypoactivity seen in CFS. Therefore, we investigated the alterations in stress hormones such as cortisol and dehydroepiandrosterone sulfate (DHEAS) in CFS patients before and after 4-week administration of galantamine hydrobromide, a selective acetylcholinesterase inhibitor, and aimed to investigate whether there are any relationships between the probable hormonal changes and cholinergic treatment. METHODS: Basal levels of cortisol and DHEAS were measured in 29 untreated CFS patients who were diagnosed according to Centers for Disease Control (CDC) criteria and in 20 healthy controls. In the patient group, four weeks after 8 mg/d galantamine hydrobromide treatment, cortisol and DHEAS levels were measured again. After the treatment 22 patients who stayed in study were divided into two subgroups as responders and nonresponders according to the reduction in their Newcastle Research Group ME/CFS Score Card (NRG) scores. RESULTS: Important findings of this study are lower pre-and post-treatment cortisol levels and in all CFS patients compared to controls (F=4.129, p=0.049; F=4.803, p=0.035, respectively); higher basal DHEAS values and higher DHEAS/cortisol molar ratios which were normalized following four weeks' treatment with 8 mg/d galantamine hydrobromide in the treatment-respondent group (F=5.382, p=0.029; F=5.722, p=0.025, respectively). CONCLUSION: The findings of the decrease in basal DHEAS levels and DHEAS/cortisol molar ratios normalizing with galantamine treatment may give some support to the cholinergic deficit hypothesis in CFS.
Acetylcholinesterase ; Axis, Cervical Vertebra ; Centers for Disease Control and Prevention (U.S.) ; Dehydroepiandrosterone ; Dehydroepiandrosterone Sulfate ; Fatigue Syndrome, Chronic ; Galantamine ; Humans ; Hydrocortisone ; Mental Fatigue ; Molar ; Synaptic Transmission