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Introduction: Bone metastases may change the primary treatment modality, especially if the bone is the only site of metastasis in patients considered to be in the early stage of lung cancer. It is usually diagnosed by imaging techniques. However, the diagnostic yields of imaging methods are limited. Some bone markers such as propeptides of type-1 collagen, pyridinoline cross-links and deoxypyridinoline (D-PYD) cross-links, serum osteocalcin, alkaline phosphatase are thought to be useful in the detection of bone metastasis in lung cancer. Thus, we aimed to determine the clinical usefulness of bone turnover markers in the assessment of bone metastases in patients with lung cancer., Material and Methods: Urinary D-PYD, calcium, and serum osteocalcin, calcium and total alkaline phosphatase (T-ALP) were measured in 60 lung cancer patients. Patients were evaluated by technetium 99 (99Tc) bone scintigraphy. The comparisons of measured values in patients with and without bone metastasis were done by using appropriate statistical methods., Results: Fifty-four males and six females were included into study. Twenty-two patients had bone metastases, while 38 did not. Forty-two patients were nonsmall-cell lung cancer, whereas 18 were small-cell carcinoma. Urinary D-PYD level was the unique value that was statistically significantly higher in patients with bone metastases than that level in patients without bone metastasis (p < 0.05)., Conclusion: Our study suggests that urinary measurement of D-PYD might be helpful in detecting bone metastasis in lung cancer. The high urinary D-PYD level may be an early sign of occult metastases in patients with no bone metastasis assessed by scintigraphic techniques.

Infective endocarditis is an infection of the endocardium that usually involves the valves and adjacent structures. The classical fever of unknown origin presentation represents a minority of infective endocarditis. The presented case was a 21-yearold young lady presenting with acute renal failure and fever to the emergency room. Cardiac auscultation revealed a soft S1 and 4/6 apical holosystolic murmur extended to axilla. Echocardiography showed mobile fresh vegetation under the mitral posterior leaflet. She was diagnosed as having infective endocarditis. Hemodialysis was started with antimicrobial therapy. However, because of the presence of severe mitral regurgitation with left ventricle dilatation and large mobile vegetation, mitral prosthetic mechanical valve replacement was performed. Although treated with antibiotics combined with surgery, renal functions were deteriorated and progressed to chronic renal failure.

Introduction: One of the most common and important side effects of 5-fluorouracil (5-FU) is mucositis with ulcerations in the oral cavity. We investigated the effects of local cryotherapy on mucositis incidence administrated durng 5-FU treatment., Methods: In a total of 99 courses, 5-FU and folinic acid combination chemotherapy was given to 40 patients. In our study, we considered every course as a single case, and cryotherapy was given to the same patient in one course but not given in the next., Results: While mucositis developed in 6.7% of the courses given with cryotherapy, this ratio was 38.9% in courses given without cryotherapy. In the logistic regression analysis, development of mucositis had been found to correlate only with cryotherapy. Odds ratio (OR) = 11.5; in the 95% confidence interval (CI) = 3.2 - 41.9; (p = 0.001)., Discussion: Results of initial studies evaluating the effects of cryotherapy in preventing mucositis due to 5-FU based chemotherapy regimens were promising. We concluded that oral cooling prevents 5-FU induced mucositis. This effective prophylactic treatment should be used in patients who are at increased risk for developing 5-FU induced mucositis.

Background: Brucellosis, constituting a major health problem in many parts of the world--particularly in the Mediterranean and the Middle East--is a multisystem disease with a broad spectrum of clinical manifestations. Hematological abnormalities ranging from a fulminant state of disseminated intravascular coagulopathy to subtle hemostatic alterations have been reported in brucella infection. Immunemediated thrombocytopenia is also a clinically important mechanism that can be encountered during brucellosis., Case: A young lady with fever was referred to a university hospital because of thrombocytopenia. The provisional diagnosis was idiopathic thrombocytopenic purpura, as the bone marrow examination showed an increased number of megakaryocytes and the absence of fever after hospitalization. The patient responded well to corticosteroid treatment. However, she was finally diagnosed with brucellosis with positive bone marrow and blood cultures for B. abortus and agglutination test of 1:320. The patient was discharged from the hospital 10 days later in good health on rifampicin and doxycycline therapy. The follow-up of the patient revealed normal hematological findings together with a progressive reduction in the titer of the agglutination test for brucella., Conclusion: Brucella infection may cause severe thrombocytopenia, mimicking a primary hematological disease that is reversible after appropriate antimicrobial therapy. In cases of brucellosis-induced immune thrombocytopenic purpura, a short-term standard dose of corticosteroid treatment might be an alternative and additional treatment as an urgent approach for thrombocytopenia while initiating antibrucellosis treatment.

Objective: Lactate dehydrogenase (LDH), a tetrameric protein composed of four monomers, is expressed as five isoenzymes. Serum LDH isoenzymes may be useful in differential diagnosis of ascites etiology since tissue damage releases isoenzymes contained therein, leading to a change in their pattern., Materials and Methods: We determined ascitic fluid LDH level and LDH isoenzyme activities in patients with malignant and nonmalignant ascites in a total of 76 patients (43 males and 33 females)., Results: LDH level, LDH-4 activity and LDH-5 activity were found to be significantly higher, and LDH-1 activity was found to be lower in malignant ascites when compared with nonmalignant ascites. LDH-1 activity was detected to be significantly higher in the sterile cirrhotic ascites when compared with spontaneous bacterial peritonitis, malignant ascites, tuberculous ascites and congestive heart failure-related ascites. LDH-2 activity was found to be higher in spontaneous bacterial peritonitis when compared with the other groups. LDH-3 activity was detected to be higher in spontaneous bacterial peritonitis, malignant ascites and tuberculous ascites when compared with the sterile cirrhotic ascites. In the diagnosis of malignant ascites, the sensitivity and specificity were 96% and 76% for LDH level, 90% and 70% for LDH-1 activity, 94% and 62% for LDH-4 activity, and 100% and 56% for LDH-5 activity, respectively., Conclusion: Ascitic LDH and its isoenzyme pattern may be helpful for the differential diagnosis of the most common causes of ascites: cirrhosis, spontaneous bacterial peritonitis, congestive heart failure, tuberculosis and malignancy.

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Autosomal dominant polycystic kidney disease is a multisystem disorder characterized by multiple, bilateral renal cysts and is also associated with cysts in other organs, such as the liver, pancreas, and arachnoid membranes. Dermatomyositis is a disease which mainly involves the skin and muscles, although occasionally other organs are affected. In this report, a 56-year-old male patient with a four-year history of autosomal dominant polycystic kidney disease was presented. Renal failure was exacerbated by a coexisting dermato-polymyositis. Prednisone treatment with hemodialysis improved the situation. This is the first report renal failure in a patient with autosomal dominant polycystic kidney disease and dermato-polymyositis.

Prolonged fever of unknown origin (FUO) is a challenging and important medical problem. Tuberculosis is the most frequent cause of FUO, especially in endemic regions, such as developing countries. We present a case of cervico-mediastinal tuberculous lymphadenitis that had been searched and followed up as a prolonged FUO. Especially in endemic areas, tuberculosis should be borne in mind in the differential diagnosis of FUO cases with granulomatous lymphadenitis presenting as prolonged or recurrent fever, even if the cultures and polymerase chain reaction for Mycobacterium tuberculosis are negative.

Compliance with prescribed medication is an important but complex issue which is incompletely understood. Depression is also a factor that can lead to noncompliance. A 30-year-old lady was seen in the outpatient clinic with complaints of palpitations and tremor. Her medical history revealed a subtotal thyroidectomy for multinodular goiter five years earlier. During a period of depression, she stopped taking levothyroxine for 45 days. Discontinuation of therapy worsened her depression. At her visit, the dosage of levothyroxine was increased, and the symptoms of depression improved. However, increasing the dosage of thyroid supplement resulted in a hyperthyroid state. The role of depression on noncompliance is also discussed.

Electrolyte disorders in hypothyroidism are frequently subtle and rarely observed in clinical practice. A 50-year-old woman was admitted to the emergency room with complaints of nausea, weakness, and lethargy. Her medical history revealed total thyroidectomy two years earlier. She was commenced on L-thyroxine after the surgery. However, the patient stopped the treatment for three months. Thyroid function tests showed free T3 0.80 pg/ml (n: 1.8-4.2), free T4 <0.20 ng/dl (n: 0.8-1.9), TSH 56.84 microU/ml (n: 0.4-4.0). Her biochemical and laboratory investigations were normal, except for a plasma sodium value of 114 mmol/L (n: 135-145). Hypertonic saline treatment with L-thyroxine was immediately started. Symptomatic hyponatremia caused by hypothyroidism was the direct consequence of cessation of L-thyroxine treatment. The patient was followed up for a year and still using L-thyroxine (0.1 mg). In conclusion, it should be kept in mind that life-threatening hyponatremia may occur in patients with total thyroidectomy-induced hypothyroidism; L-thyroxine should be immediately started if stopped for any reason.