Autonomic nervous system functions in childhood essential hypertension

The etiopathology of essential hypertension (EH) is still controversial, different pathologic mechanisms have been estimated as a cause of EH. One of these mechanisms is autonomic nervous system dysfunction (ANSD). Although there are different studies showing ANSD in adult EH, limited studies on ANSD in childhood EH are present. The present study was planned to investigate the role of ANSD in childhood EH. The study group (SG) consisted of 24 children with EH and the control group (CG) was 24 healthy children. Non-invasive autonomic nervous system function tests: the orthostatic test, Valsalva ratio, 30/15 ratio and heart rate responses to deep breathing were performed on members of both groups. The mean differences in systolic blood pressure between supine resting and standing positions in the study and control groups were significant (z = ?2.577, P = 0.0051). The mean differences in diastolic blood pressure between supine resting and standing positions in SG and CG were found to be statistically meaningful (z= ?2.722, P = 0.0033). The mean differences in heart rate variation during hyperventilation in SG and CG were significant (z = ?2.54, P = 0.0055). The mean differences in the Valsalva ratio between SG and CG were not statistically meaningful (z = 1.52, P = 0.0643). The mean differences in the 30/15 ratio in SG and CG were not found to be significant (z= ?1.455, P = 0.0735). In the light of these results, both sympathetic and parasympathetic autonomic nervous system dysfunction in childhood essential hypertension were found.     

Evaluation of a tactile hardness test in indirect pulp capping

Summary. The value of a tactile hardness test in indirect pulp capping was investigated by comparing hardness values with the biochemical analysis for phosphorus. Statistically significant differences were found between the 6-month evaluation groups recorded as soft or medium and those recorded as hard. However, there were no differences between groups evaluated as soft or medium before or after treatment.     

Wound approximation with tissue glue in circumcision

BACKGROUND: To assess the feasibility of using tissue glue in the approximation of circumcision wounds in children. PATIENTS AND METHODS: A prospective randomized trial was carried out on 30 boys (age, 1-10 years) admitted to the Kahramanamaras Sutcuimam University Medical Faculty, Turkey. The results of wound approximation in circumcision with cyanoacrylate tissue glue and suturing with interrupted 5/0 plain catgut were compared. The operations were carried out by the same surgeon using an identical technique. The wounds were assessed 1 day, 3 days, 1 week and 1 month postoperatively. RESULTS: There was no difference between the two groups in the rates of wound inflammation, infection, bleeding and dehiscence, although cosmetic appearance was better in the tissue glue group. The operation time was also shorter in this group. CONCLUSION: Using tissue glue for wound approximation in circumcision is a feasible alternative.     

Effect of renin–angiotensin–aldosterone system (RAAS) blockade on visfatin levels in diabetic nephropathy

Aim: Plasma visfatin levels are elevated in diabetic nephropathy in parallel to the severity of proteinuria and glomerular filtration rate. The aim of this study was to find out whether the renin–angiotensin–aldosterone system (RAAS) blockage has any effect on the plasma visfatin levels. Methods: Thirty‐two patients with diabetic proteinuria (>500 mg/day) with a normal glomerular filtration rate (GFR) and 33 healthy subjects were enrolled. Patients were treated with ramipril 5 mg daily for 2 months. Proteinuria, GFR, high‐sensitivity C‐reactive protein (hsCRP), visfatin, flow‐mediated dilatation (FMD) and homeostasis model assessment of insulin resistance (HOMA‐IR) index measurements were performed both before and after the treatment. Results: The plasma visfatin, and hsCRP levels of the patients were significantly higher and the FMD was significantly lower (P < 0.001 for all). The visfatin levels were significantly correlated to FMD, systolic and diastolic blood pressures, proteinuria, eGFR, HOMA‐IR and hsCRP. Ramipril treatment resulted in a significant decrease in plasma visfatin, proteinuria, hsCRP, HOMA‐IR and increase in FMD (P < 0.001) in patients (P < 0.001 for all). Conclusion: The present study suggests that plasma visfatin levels are related to the endothelial functions, inflammation and the severity of proteinuria in diabetic nephropathy. Treatment with ramipril causes a significant decrease in visfatin levels along with the improvement of proteinuria, endothelial dysfunction and inflammatory state in diabetic nephropathy.     

Irritable bowel syndrome in haemodialysis: Prevalence,link with quality of life and depression

Aim: Health‐related quality of life (HRQOL) is decreased in haemodialysis (HD) patients. Irritable bowel syndrome (IBS) is highly prevalent in general population. This study evaluated the prevalence of IBS and its association with HRQOL and depression in HD. Methods: Sociodemographic and laboratory variables were recorded. Severity of depressive symptoms and HRQOL were assessed by the Beck Depression Inventory (BDI) and Short Form 36 (SF‐36), respectively. Diagnosis of IBS was based on Rome II criteria. Results: Among 236 patients 69 (29.2%) had IBS. Patients with IBS had lower SF‐36 scores and had higher depressive symptoms than patients without IBS. Presence of IBS was associated with sleep disturbance (odds ratio (OR) = 2.012; P = 0.045), physical component summary score (OR = 0.963, P = 0.029), mental component summary score (OR = 0.962, P = 0.023), BDI score (OR = 1.040, P = 0.021) and albumin (OR = 0.437, P = 0.01). Conclusion: IBS is highly prevalent in HD patients. Presence of IBS is closely related with HRQOL and depression.     

Color Doppler sonography examination of partially obstructed kidneys associated with ureteropelvic junction stone before and after percutaneous nephrolithotripsy: Preliminary report

AIM: To evaluate resistive index (RI) changes before and after unilateral percutaneous nephrolithotripsy in chronic partially obstructed kidneys due to ureteropelvic junction (UPJ) stones. METHODS: Intrarenal RI of obstructed and contralateral normal kidneys of 18 patients were recorded immediately before the operations and at postoperative days 1, 7 and 30. Postoperative RI measurements were compared with baseline values for all patients without grouping and separately for different groups according to the preoperative RI value of the obstructed kidney. RESULTS: Mean age and symptom duration were 27.5 years and 43.8 weeks, respectively. Preoperatively and at all postoperative controls, kidney diameters and renal parenchyma thicknesses were normal in all patients. Mean RI of obstructed kidneys decreased from 0.68 to 0.63 for all patients (P=0.032), from 0.64 to 0.63 for those with preoperative RI<0.70 (P=0.850) and from 0.73 to 0.62 for those with preoperative RI>or=0.70 (P=0.001). In patients with preoperative RI>or=0.70 in obstructed kidney, significant RI decreases were recorded at postoperative day 7 and RI differences between obstructed and contralateral kidneys disappeared after then. No difference was present pre- and postoperatively between the mean RI of obstructed and contralateral kidneys of the patients with RI<0.70. Mean RI of contralateral kidneys were normal preoperatively and showed no significant change postoperatively. CONCLUSIONS: Preoperative RI levels may indirectly reflect the presence of functionally significant obstruction in chronic obstructed kidneys related to UPJ stones. Patients with RI>or=0.70 may have a good indication for a surgical approach. Normalization of high RI occurs rapidly after percutaneous nephrolithotripsy.     

Interventional Versus Surgical Closure of Atrial and Ventricular Septal Defects: Advantages and Limitations of the Catheter-Based Approach

New techniques and devices have revolutionized the transcatheter techniques used to close congenital intracardiac shunts. The advantages, compared to surgery, are the avoidance of a thoracotomy, postoperative pain and morbidity, a long hospital stay, and most often general anesthesia. Atrial septal defect closure has become a routine procedure in many centers. It is amenable in about 80% of the patients with a secundum-type defect. The success rate today is dx > 99% and the rate of any complication is < 0.5%. Ventricular septal defect closure, however, is still in its infancy. Apical, mid-muscular, and selected perimembraneous VSDs with a significant septal rim between the defect and the aortic valve can be closed with the devices currently available. Analysis is still needed to prove the long-term safety and efficacy of ASD or VSD closure.