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Introduction: Cushing's syndrome (CS) is rare in pregnancy because CS itself is a cause of anovulatory infertility due to excess cortisol secretion. Moreover it is also difficult to diagnose CS in pregnancy because placental production of corticotropin releasing and adrenocorticotropic hormone (ACTH), increased maternal production of estrogen induced corticosteroid binding globulin leads to physiological hypercortisolism during pregnancy. So physicians face a clinical overlap in many features of CS such as weight gain, fatigue, edema, hypertension, hyperglycemia, stretch marks, mood changes that can also be attributed to pregnancy. Thus their coexistence represents a diagnostic challenge. Herein we report a case of CS that was diagnosed and successfully treated during pregnancy. Clinical Case: A 43-year-old gravida 3 female was consulted at the 21st week of gestation with persistent high blood pressure and hyperglycemia for a month. She had an obstetric history of 2 spontaneous first term abortion, 2 healthy labor 18 years ago and she was healthy after. She was in such a depressive mood that she was consulted with psychiatry many times. On physical examination edema, proximal weakness of lower extremities and hirsutism (modified Ferriman–Gallwey score of 9) was detected. Initial laboratory tests were all within normal range except potassium level (2.7 mmol/L), the results were not consistent with preeclampsia and there was a suspicious adrenal mass detected on ultrasound. She was currently receiving high dose antihypertensive treatment with methyldopa, calcium channel blockers, rapid acting and detemir insulin for diabetes and i.v. potassium replacement. We ruled out conns syndrome with normal plasma aldosterone renin ratio and found catecholamine levels normal. Hormonal analyses revealed with high plasma cortisol levels, increased nocturnal cortisolemia, a suppressed plasma ACTH and dehydroepiandrosterone sulfate level and distinctly elevated 24-hour urinary cortisol greater than 3-fold the upper normal reference range. Non contrast magnetic resonance imaging demonstrated a 47×32 mm left adrenal mass. Laparoscopic adrenalectomy was performed in the 26th week of gestation and the following histopathology revealed an adrenocortical adenoma. Antihypertensive medication was progressively reduced, glycemic control and hypokalemia reversal were achieved. She was followed up with appropriate glucocorticoid replacement. At 34 weeks of gestation, after sudden labor pain and regular uterine contractions a 2586 g male infant with Apgar scores of 8 was born by cesarean section. They were discharged in good health. Conclusion: CS should be kept in mind especially in the case of hypertension and diabetes that started before the 20th gestational age. Analysis of the urinary free cortisol level and circadian rhythm of cortisol is necessary to diagnose. Despite the diagnostic challenge we can achieve better maternal and fetal outcomes with proper management. Figure 1. Non-contrast magnetic resonance imaging of the patient Table 1. Patient's laboratuary test results Table 2. Patient's laboratory test results [ABSTRACT FROM AUTHOR]

Splenic cyst was first described by Andral in 1929. Splenic cysts are divided into 2 groups as parasitic and non-parasitic. Splenic mesothelial cyst (SMC) is a rare form of splenic cysts, and its incidence is not known exactly. It is frequently observed in children and young adults. In this case report, a 21-year-old male patient who underwent laparoscopic splenectomy with a diagnosis of symptomatic splenic cyst is discussed. Total splenectomy was decided because of the splenic cyst localization in the splenic hilus. Laparoscopic splenectomy was performed to the patient. SMC is a rare primary splenic cyst and is usually asymptomatic. It is often detected incidentally by imaging modalities. Symptomatic cysts with a size of more than 5 cm should be treated. Spleen sparing techniques are accepted as the current treatment option. In this case report, a young adult patient who underwent laparoscopic splenectomy for symptomatic SMC is discussed in the light of the literature. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether the increased serum levels of testosterone secondary to Dutasteride therapy has any protective effect on cardiovascular system. Material and Methods: A prospective analysis of 50 patients diagnosed benign prostatic enlargement between May 2015 and May 2017 was performed. After randomization 25 patients treated with daily administration of 0.5 mg dutasteride (Dutasteride Group), and 25 patients were not given dutasteride (Control Group). We analyzed some serum novel cardiaovascular marker levels at baseline and after 6 months of the treatment. Echocardiography, carotid intima-media thickness and brachial artery resistive index (RI) were evaluated at baseline and after 6 months of the treatment. Statistical analyses were performed using SPSS, version 21. While “t test” was used for comparison the independent groups, paired t test was used in the matched groups. Statistical significance was considered at p<0.05. Results: The differences in serum Lp a, hs-CRP and NT-proBNP levels were not statistically significant (p>0.05). Additionally, echocardiographic parameters, carotid intima-media thickness and brachial artery RI were similar before and after dutasteride tratment. Conclusion: After the short-term use of dutasteride, there was not a statistically significant difference in serum Lp a, hs-CRP and NT-proBNP levels. Additionally, echocardiographic parameters, carotid intima-media thickness and brachial artery RI were also similar. [ABSTRACT FROM AUTHOR]

To compare intraoperative (IO) and postoperative (po.) boost radiotherapy (RT) in terms of local recurrence and cosmetic outcomes in patients with early-stage breast cancer during breast-conserving therapy (BCT). Patients who received BCT at our clinic in the past 60 months were analyzed based on their recorded data. Ninety-eight patients who received IO boost RT during breast-conserving surgery were classified as group A and 99 who received po. boost whole-breast RT afterward were classified as group B. Patients were graded using the LENT-SOMA (V06-7/2003) scale and compared using the chi-square test based on local recurrence and cosmetic outcomes at 1 year after the end of all RTs. Mean age of patients in groups A and B was 49 and 52 years; mean follow-up was 35 and 38 months; tumor diameter was 18 (4–30) mm and 19 (6–30) mm; and lymph node involvement was observed in 11 and 17 patients, respectively. The molecular subtypes were either luminal A or B in both groups. Histological analysis revealed 90 and 84 invasive ductal carcinomas, 8 and 5 invasive lobular tumors, respectively, and 10 mixed structure in group B. The boost area was planned so as to cover 15–20 mm of the surrounding tumor bed area in both methods. Local recurrence was not detected in group A; however, it was detected in two patients in group B at 20 and 32 months. According to the LENT-SOMA scale, 34 and 24 patients in groups A and B had grade 0, 41 each had grade 1, 21 and 29 had grade 2, and 2 and 5 had grade 3, respectively, but there was no significant difference between the two groups (p > 0.05). Based on the relatively superior results demonstrated by group A, IO boost RT can potentially improve both local control and cosmetic results. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether or not the age of spontaneous resolution of monosymptomatic nocturnal enuresis (MNE) was familial. Patients and Methods: A questionnaire was administered to more than 1,500 people, and 100 appropriate participants were identified from four referral hospitals. We included the participants who had MNE and whose parents also had MNE with spontaneous resolution. Then the association between the spontaneous resolution time of MNE in parents and that in their children was investigated. Results: The mean ages of spontaneous resolution were 10.7 (10-30 years), 9.4 (6-17 years) and 10.9 (6-18 years) in participants, their mothers and their fathers, respectively. According to the statistical analysis, there was a positive correlation between participants and both their mothers and fathers (p < 0.05). In addition, it was revealed that familial MNE history based on first- and second-degree relatives, in addition to their parents, was also associated with the increased spontaneous resolution age of MNE (p < 0.05). According to our results, gender and parents' education status were not statistically associated with the spontaneous resolution (p > 0.05). Conclusion: As a conclusion, the age of spontaneous resolution of MNE is familial. Although the exact reasons of spontaneous resolution still remain a mystery; further genetic investigations may be able to resolve this mystery. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Topical hemostatic agents are used as auxiliary agents for bleeding posttrauma and during operation. Ankaferd Blood Stopper (ABS) is an hemostatic agent that is produced in Turkey. We planned to demonstrate the efficacy of this agent in experimental splenectomy model and to compare it with Fibrin Glue (Tisseel®) used in clinics. Forty Wistar Albino female rats were divided in 5 groups. Group 1, Sham; Group 2, Control; Group 3, Suture; Group 4, Fibrin Glue (Tisseel®) and Group 5, Ankaferd Blood Stopper. Partial splenectomy bleeding model was applied to rats after initial hematocrit values were measured. Bleeding in each group was controlled by a different method. Bleeding times of the rats were determined. All the rats were sacrificed on the 5th day after the last hematocrit values were measured. Existence of intraabdominal hematoma and adhesiveness were evaluated and splectonomy was applied for pathological examination. Groups were compared with respect to bleeding time and blood loss and Group 5 and Group 2 were determined to be more effective than Group 3 but Group 4 was determined to be equivalent. Fewer side effects at significant levels were detected in terms of fibrosis and coagulation necrosis during pathological assessment. In conclusion, in spleen bleedings when compared with fibrin glue, Ankaferd Blood Stopper is equally effective and safe and its price is lower. [ABSTRACT FROM AUTHOR]

The anticarcinogenic and antioxidant properties of vitamins A, C, E and pro- or antioxidant properties of trace metals have recently attracted increased attention. We examined the levels of antioxidant vitamins (A, C and E), selenium and malondialdehyde (MDA), and trace metals (Fe, Ni, Zn, Co and Cu) in patients with prostate cancer. In total, 41 subjects (21 controls and 20 prostate cancer patients) were included in the study. The levels of trace elements and Fe in whole blood were determined by atomic absorption spectrophotometry. Serum levels of Se were determined using a fluorimetric method, while a HPLC method was used for serum levels of vitamins and MDA. The levels of vitamins A and E were significantly lower and MDA levels were significantly higher (p<0.001) in patients with prostate cancer compared to controls. Serum vitamin C was significantly lower in patients with prostate cancer when compared to controls (p<0.01). Moreover, Se and Zn levels were also significantly lower, and levels of Ni, Co, and Cu were higher (p<0.001) in patients with prostate cancer than in controls. Fe levels were not significantly different in patients compared to controls (p>0.05). Our findings, together with the results of previous animal studies, suggest that the administration of vitamins A, C, and E, and Se and Zn may be beneficial in the prevention and treatment of human prostate cancer. [ABSTRACT FROM AUTHOR]