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AIM: Clinical and histopathological factors that affect lymph node involvement in cervical cancer and the prognostic importance of these factors were evaluated in this study. MATERIALS AND METHODS: A total of 179 patients were diagnosed with cervical cancer between January 2001 and June 2010 and were included in this study. The patients' charts were evaluated retrospectively and information was collected by reaching 89 patients and asking questions. RESULTS: When the prognostic factors that affect pelvic lymph node involvement were evaluated, increased tumor size and increased invasion depth, presence of lymphovascular area involvement, and an advanced stage were observed to statistically significantly increase pelvic lymph node involvement. No relationship was found between tumor histology and grade; parametrial, endometrial, vaginal involvement, and pelvic lymph node involvement. CONCLUSION: Knowledge of prognostic factors in cervical cancer plays an important role in determining the morbidity and mortality and the treatment strategies.

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Cardiac involvement in childhood brucellosis is rare and, when present, findings are usually seen in acute rheumatic fever with endocarditis. We report a successfully treated case of Brucella endocarditis in which the aortic valve was affected. Medical therapy did not cure this patient who, due to hemodynamic deterioration, required valve replacement. This case report suggests that successful management of Brucella endocarditis requires a combination of medical and early surgical therapy.

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OBJECTIVE: To define the incidence, possible causes, operative procedure, and early and medium term results of patients undergoing reoperation for coronary artery disease. DESIGN: A retrospective analysis of patients undergoing reoperation in one hospital during a 10 year period. SETTING: A regional cardiothoracic centre. PATIENTS: 115 patients had reoperation for recurrent angina, 1-17 years (mean (SD) 7.4 (3.9)) after primary revascularisation. MAIN OUTCOME MEASURES: They received 279 grafts (2.4 grafts per patient); 58% of the grafts were anasatomosed to previously grafted vessels. The internal mammary artery was used in 87% of patients who required grafts to the left anterior descending coronary artery. RESULTS: Reoperation accounted for 8.3% of the total number of patients who underwent coronary bypass grafting. Graft failure alone or in combination with other factors was judged to be the cause of recurrence of symptoms in 87%. 42% of patients had two or more coronary risk factors. The early mortality was 5.2% and the actuarial survival at five and 10 years was 90.4% and 88.4% respectively. 85% of the survivors had initial complete relief of angina and 14% had partial improvement. Freedom from recurrent symptoms at five and 10 years was 66.6% and 34.6% respectively. CONCLUSIONS: Vein graft failure either alone or in combination with progression of native coronary disease is the main cause for symptomatic deterioration after bypass grafting. Reoperation can be performed with slightly increased risk and can give good early and medium term results.

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Between December 1983 and April 1989, 222 combined heart and lung transplant operations were performed for treatment of pulmonary vascular disease and parenchymal lung disease at Harefield Hospital. Seventeen of these patients had emphysema, and 11 of them were followed up for a minimum of 1 year. There were nine male and two female patients. Their mean age was 39 (range, 32 to 54) years. Seven had alpha 1-antitrypsin deficiency. Six patients were receiving continuous oxygen therapy, and two patients were dependent on a ventilator. Postoperatively, the patients' lungs were ventilated for a median of 3 days (range, 24 hours to 2 weeks). Two patients subsequently required further periods of ventilation. Immunosuppression consisted of azathioprine and cyclosporine. Three patients also received low-dose oral steroids. There was one early death, which occurred on the second postoperative day. The remaining patients were followed up for 12 to 53 (mean, 22) months. One patient had cytomegalovirus pneumonitis 6 weeks postoperatively that responded to treatment. There was one late death at 14 months after reoperation for treatment of obliterative bronchiolitis. The overall survival was 91% at 1 year. All survivors achieved an excellent level of rehabilitation. It is concluded that the medium-term results of heart and lung transplantation for treatment of emphysema are good and that patients with alpha 1-antitrypsin deficiency may undergo transplant procedures without substitution therapy.

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In this study we investigated the factors influencing the development of hypertension in 488 consecutive heart transplant recipients. The cumulative probability of hypertension (blood pressure persistently above 150/95 mm Hg) developing was 52% at 1 year, 67% at 2 years, 73% at 3 years, and 77% at 4 years after transplantation. The incidence was higher in patients receiving cyclosporine and azathioprine compared with those receiving prednisone and azathioprine immunosuppression. The dose of cyclosporine used did not appear to influence the development of hypertension. Intermittent steroid exposure did not increase the incidence in the cyclosporine group. Male transplant recipients and those older than 20 years appeared more prone to the development of hypertension. A family history of cardiovascular disease also increased the incidence. Preoperative and postoperative kidney dysfunction and transplantation because of ischemic heart disease did not appear to affect the incidence of hypertension. Donor characteristics, including the use of hearts from donors who weighed more than the recipients and from patients dying of spontaneous intracranial hemorrhage, did not appear to increase the incidence of hypertension after heart transplantation.

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The association of amyloidosis with Behçet's disease has infrequently been reported in published works. Twenty four such cases have been observed in the world, of which 12 are from Turkey, including eight of ours. In all our eight cases renal biopsy showed amyloidosis of type AA. Behçet's disease of male preponderance, long duration, complete type, multiple organ involvement, and positive skin pathergy test were the main characteristics of all 24 cases of Behçet's disease with amyloidosis. We conclude that amyloidosis associated with Behçet's disease is a secondary AA amyloidosis occurring as an intrinsic manifestation of Behçet's disease.

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A dislodged Pudenz ventriculo-atrial shunt catheter removed from the main pulmonary artery by arteriotomy is reported in a 21-year-old man.

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A series of 14 patients with Wilson's disease were evaluated in order to determine the characteristic bone changes found in this metabolic disorder. The following radiologic and clinical findings deserve to be summarized: (1) Osteoarticular pains as first manifestations of Wilson's disease were found in six patients. (2) In all but 2 of our patients, minor or moderate or even severe bone abnormalities characteristic for Wilson's disease were observed. (3) There were three groups of sibs. Among these sibs, the lesions were not only similar in type but were also acquired approximately at the same time, showing the influence of the different genes responsible for this metabolic disorder.

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