Fatih Borlu

Signet Cell Carcinoma of Colon in a Nineteen-Year-Old Patient: A Case Report

Signet cell carcinoma, which is a subtype of adenocarcinoma, usually originates from the stomach. However, it can also originate from the colon, rectum, gallbladder, pancreas, urinary bladder, and breast. We represent a 19-year-old boy diagnosed with signet cell tumour while he was being evaluated for an initial diagnosis of inflammatory bowel disease.

[The effect of levosimendan and dobutamine treatment on QT dispersion in patients with decompensated heart failure: a prospective study].

OBJECTIVE We investigated the effect of intravenous levosimendan on QT dispersion compared with intravenous dobutamine in patients with acute decompensated heart failure. METHODS This prospective cohort study included 38 patients who were admitted with acute decompensated heart failure (New York Heart Association functional class III-IV). Twenty-five patients (11 men, 14 women; mean age 70.5 ± 11.13 years) were treated with levosimendan infusion and 13 patients (5 men, 8 women; mean age 71.08 ± 6.86 years) were treated with dobutamine infusion. Intravenous levosimendan was administered with an initial bolus dose of 12 μg/kg for 10 min, followed by a continuous infusion of 0.1 μg/kg/min for 1 hour and 0.1 μg/kg/min 23 hours. Intravenous dobutamine was administered with a continuous dose of 10 μg/kg /min for 24 hours. Transthoracic echocardiography was performed and electrocardiograms were obtained before and after drug infusions. QTc dispersion was defined as the difference between the maximum and the minimum QT intervals and the value was corrected for heart rate. Chi-square test, Wilcoxon test and Mann-Whitney U tests were used for data analysis. RESULTS No significant differences were found before and after treatment of both levosimendan and dobutamine with respect to minimum QT intervals, maximum QT and QT dispersions. (Pretreatment and 24th hour values of levosimendan group were; 0.43 ± 0.04 s, 0.44 ± 0.04s; 0.49 ± 0.05s, 0.50 ± 0.05s; 0.06 ± 0.03s, 0.06 ± 0.03s; in dobutamine group values are - 0.39 ± 0.05 s, 0.41 ± 0.05s; 0.45 ± 0.05s, 0.48 ± 0.05s; 0.06 ± 0.04s, 0.06 ± 0.04s, respectively) (p>0.05). No side effects related to drugs were seen during follow-up in all two treatment groups. CONCLUSION Our results suggest that, therapeutic doses of levosimendan infusion do not have a significant effect on QT parameters - the predictors of arrhythmias-, in patients with decompensated heart failure when compared with dobutamine infusion.

[Effects of different statins, ezetimibe/simvastatin combination on hsCRP levels in unstable angina pectoris and non-ST elevation myocardial infarction patients: a randomized trial].

OBJECTIVE The aim of our study was to evaluate the effects of two different statins and a statin/ezetimibe combination on high sensitive C-reactive protein (hsCRP) values, which were given at high doses in the early period of acute coronary syndromes. METHODS A total of 150 patients with non-ST elevation myocardial infarction and unstable angina pectoris were enrolled to our prospective, randomized, single-blind study. Patients were divided into three groups by block randomization method. One group received 20 mg/day atorvastatin, one group received 10 mg/day rosuvastatin and the other group received 10 mg/day ezetimibe/simvastatin combination therapy, which was initiated within the first 24 hours of admission. Follow-up duration was 2 months . Biochemical investigations and hsCRP levels (by nephelometric method) were performed with 138 patients evaluated at baseline, 10th and 60th days of therapy. Decreases of hsCRP levels were analyzed with one-way MANOVA and repeated measures of ANOVA methods. Post-hoc Tukey HSD test was performed for finding the different group, when the difference was detected between the groups. RESULTS Tenth day hsCRP levels in ezetimibe/simvastatin group was significantly lower than the other groups (p<0.001). Further, after 60 days of follow-up a significant reduction was seen in hsCRP levels in ezetimib/simvastatin group (in ezetimibe/simvastatin group the mean hsCRP was reduced from 38.4±15.0 mg/L to 2.4±1.3 mg/L, in atorvastatin group the mean hsCRP was reduced from 27.3±11.7 mg/L to 4.1±2.4 mg/L and in rosuvastatin group the mean hsCRP was reduced from 22.0±6.9 mg/L to 3.6±1.7 mg/L (F (1.1, 148.2) = 746.9, p<0.01 and the difference between drugs; F (2.2, 148.2) = 32.1, p<0.01). No side effects related to drugs were seen during follow-up in all three treatment groups. CONCLUSION This study showed that ezetimibe/simvastatin 10 mg/day combination treatment was superior to atorvastatin 20 mg/day and rosuvastatin 10 mg/day treatment in reducing the inflammatory markers when high dose statins was started in the early period of unstable angina and non ST elevation myocardial infarction.

Hepatosplenomegaly and Pernicious Anaemia

Sir, Pernicious anaemia (PA) is the end stage of atrophic gastritis which results in the loss of parietal cells in the fundus and body of the stomach. Loss of parietal cells is associated with the failure of intrinsic factor production and results in vitamin B12 deficiency and megaloblastic anaemia. Only two cases of splenomegaly coexisting with PA have been reported, but both splenomegaly and hepatomegaly has not been reported yet [1,2]. In this report, we aimed to describe a patient with hepatosplenomegaly due to PA. To the best of our knowledge this is the first documented case of hepatosplenomegaly due to PA and totally resolved by vitamin B12 therapy. A 20-year-old male patient was admitted to our hospital with the complaints of fatigue, weakness, anorexia and palpitation. His complaints had been continued for the past one month. He had no history of another disease or medication. Pallor, subikterus, 3/6 systolic murmur in all valves, palpable splenomegaly at 4 cm below the left costal margin and palpable hepatomegaly 2 cm below the right costal margin were detected on the physical examination. Laboratory examinations revealed the following: LDH: 8440 U/L, AST: 91 U/L, ALT: 45 U/L, total bilirubin: 2.8 mg/dL, indirect bilirubin mg/dL: 2.14, Hgb: 3.9 g/dL, Hct: 12.3%, Wbc: 1400 /uL, Plt: 22000 /uL, MCV: 96 fL, corrected retikulocyte count: 0.25%, direct coombs (-), indirect coombs (-).Hepatitis markers were normal. Hepatosplenomegaly was confirmed using abdominal ultrasonography; the longitudinal spleen size was 182 mm and the craniocaudal liver size was 160 mm, and were found to be increased. The peripheral blood smear contained oval macrocytes, hypersegmented neutrophils, trombocytopenia, leucopenia and low reticulocyte count. Leukemia blasts or atypical cells were not seen on marrow aspiration and biopsy, thus hemolytic anaemia and leukemia were excluded from the differential diagnosis. Bone marrow biopsy was compatible with megaloblastic anaemia. To find the cause of megaloblastic anaemia, the level of vitamin B12 was found 30 pg/mL (197-886 pg/mL), and folic acid level was found in normal ranges. Atrophic gastritis was revealed by gastroscopy and verified in pathological examination. Anti parietal cell antibody was detected positive in blood test. There was no other endocrinopathy accompanying to B12 deficiency; TSH, cortisol, antiadrenal antibody and antithyroid peroxidase levels were found to be normal. Patient was diagnosed as pernicious anaemia due to atrophic gastritis and was given parenteral vitamin B12 treatment. Reticulocyte crisis was seen on the 5th day and leukocyte, hemoglobin, platelet levels were increased on the 3rd week of the treatment without transfusion. In the second month of the treatment there was no hepatosplenomegaly at ultrasonographic scan. The patient has no complaints during the one year follow-up while being monitored from the outpatient clinic. Even though severely anaemic patient with PA may have spleno- megaly, hepatosplenomegaly co-existing with pernicious anaemia is not considered to be a characteristic feature of PA, [1,2]. PA should be kept in mind in the differential diagnosis of hepatosplenomegaly like in our patient. According to the literature the relationship between PA and splenomegaly has been well established, but hepatomegaly of this association has not been mentioned. In our opinion, it might be resulted from extramedullary hematopoiesis, because hepatomegaly was regressed after the treatment of severe anaemia by vitamin B12. Plasma B12 levels, gastroscopy, peripheral blood smear, bone marrow biopsy should be considered, especially in pancytopenic patients with hepatosplenomegaly.

Primer Psoas Absesi: Bir Olgu Sunumu -

psoas abscess is a rare clinical situation which if not considered, the diagnosis is very difficult It is classified as primary or secondary. Staphylococcus aureus is the most commonly causative pathogen in primary psoas abscess and secondary psoas abscess usually occurs as a result of underlying diseases. The delay of the treatment is related with high morbidity and mortality rates. In this article, 46 years old patient with severe backache having an abscess in the psoas muscle determined by magnetic resonans imaging is discussed.