Our results did not show a significant correlation between circulating ghrelin and clinical or laboratory markers of disease activity in RA. Surprisingly, obestatin correlated with some inflammatory markers. So, obestatin seems to be more valuable than ghrelin in the pathogenesis of RA.

We describe a 60-year-old woman who became comatose after a single dose of gabapentin for right-sided sciatalgia. The patient was improved by hemodialysis. Gabapentin toxicity should be considered when mental status changes develop in patients with renal failure after even a single dose.

No abstract

Thymomas are rare neoplasm arising in thymic epithelial cells and are the most common neoplasm in the anterior mediastinum. Although thymomas are often associated with autoimmune diseases, the incidence of extra-thymic neoplasia is higher in patients with thymoma than in the general population.1 Published series have focused on the incidence of both extra-thymic malignancies detected after and before the diagnosis of thymoma. In this case report we are presenting a patient operated due to synchronous rectal cancer and malign thymoma diagnosis. To the best of our knowledge, this is the first case presented with synchronous rectal cancer and malign thymoma.A 56-year-old female with hematemesis and pelvic pain was admitted to the gastroenterology outpatient department. A flexible rectoscopic examination revealed a rigid and painful mass encircled the lumen of rectum. A biopsy of the rectal mass confirmed a well-differentiated adenocarcinoma of rectum. Laparoscopic low anterior resection was performed and the tumor extended through the layers of the bowel wall and pericolic fatty tissue, not reaching the serosal surface. Twenty lymph nodes dissected from the pericolic fatty tissue and ten lymph nodes were diagnosed as metastatic rectal adenocarcinoma. Due to mediastinal mass observation in posterioanterior graphy in the post-operation period, the Thorax CT was initiated. In the analysis, a lobulated 5x4 cm sized enhancing mass and a lot of lymphadenopathy was found in anterior mediastinum. Also in PET CT analysis, a mass lesion evoking malignancy was found in anterior mediastinum. In order to make metastasis and second primary tumor differential diagnosis, trucut biopsy was initiated. Since the biopsy results were consistent with the malign thymoma, we have initiated the mass excision lymph node dissection. Pathology results revealed invasive thymoma and reactive lymph node. Final diagnosis was made as synchronous double malignancies; an adenocarcinoma of rectum with a clinical stage of T3N2bM0 and an invasive thymoma of the thymus with a clinical stage of B1. In order to treat rectal cancer, radiotherapy was given to anterior mediastinum following the initiation infusional 5-FU-based radio-chemotherapy. After then, adjuvant FOLFOX-4 therapy was started for the treatment of rectal cancer.The thymus plays an important role in both autoimmunity and cancer immunosurveillance. When there is depression of T-cell immunity, the incidence of cancer increases. Several series have confirmed an increased incidence of thymoma and additional neoplasms, with prevalence rates as high as 31%.2 Welsh and colleagues 1 reported that 28% of 136 patients with thymoma acquired extra-thymic cancers. The most common extra-thymic cancer in their series was colorectal carcinoma. Pan and coworkers 3 reported a series of 192 patients with thymoma from Taiwan.