The effect of chronic cadmium toxicity on blood pressure and plasma viscosity

Cadmium (Cd) is a heavy metal which affects many systems in humans and animals as a consequence of environmental and industrial pollution. The aim of this study was to investigate the effect of chronic Cd toxicity on blood pressure and plasma viscosity. Experimental group rats were given doses that contained 15 ppm CdCl(2) in drinking water for 8 weeks. The systolic blood pressure and heart rate were measured from rats' tails and recorded by plethysmography every two weeks. Blood samples were drawn, Cd levels were determined by atomic absorption spectrophotometer and plasma viscosity values by viscometer. Blood Cd levels were found to be significantly higher in the experimental group compared to the control group (p < 0.001). The whole blood analysis was made by an analyzer. Polymorphonuclear leukocytes and monocytes increased (p < 0.01) and lymphocyte number (p < 0.05) decreased in the experimental group. Viscosity values were 2.21 ± 0.54 and 1.62 ± 0.31 centipoises in the experimental and control groups, respectively (p < 0.001). In the experimental group, changes in systolic blood pressure between weeks were significant (p < 0.001) and were found to be correlated with plasma viscosity (p < 0.001). In the experimental group, changes in heart rate between weeks were significant (p < 0.001). According to our findings, Cd toxicity may lead to an increase in blood pressure by increasing plasma viscosity.     

Analysis of Factors Affecting Patient Satisfaction

Background

Patient satisfaction is regarded as an important indicator in assessing the quality of care. Over the past 20 years, in particular, there has been increasing interest in patients’ perceptions about the provision of healthcare. Although asthma is a disease that increases the burden on health expenditure and has high cost requirements, there have been few studies evaluating the views of asthma patients about their treatment. The aims of this study were to identify factors affecting the satisfaction of asthma patients and to contribute to the sparse literature on this topic.

Methods

The study sample consisted of 387 asthma patients who were referred to Hacettepe University’s Chest Diseases Polyclinic and Allergy Unit in Ankara, Turkey, between August 2000 and March 2001. A questionnaire consisting of 66 questions was developed to explore demographic characteristics (11 questions), quality of life (32 questions), severity of disease (2 questions), and patient satisfaction with the care received (21 questions). The items for the satisfaction part of the questionnaire were selected from three separate questionnaires used in three independent studies, including the Patient Satisfaction Questionnaire. Factor analysis was performed on the satisfaction items, which revealed five dimensions in which the items were grouped: (i) doctor competency; (ii) provision of information; (iii) quality of care; (iv) waiting time; and (v) hospital quality. The general reliability coefficient was 0.87. Regression analyses were carried out to determine how patient’satisfaction with their medical treatment was affected by the following variables: demographic characteristics (age, other diseases, sex, education, duration of treatment), severity of disease, quality of life, whether medical tests were performed, and whether treatment was received from academic physicians (professors and associate professors) or from consultants and assistants.

Results

The results of the regression analyses revealed that patients who had undergone medical tests or who had received treatment from academic physicians (rather than from consultants or assistants) had higher satisfaction levels than their counterparts. Furthermore, female patients had higher levels of satisfaction than their male counterparts. In addition, it was found that the five satisfaction dimensions were all significantly correlated with each other and that patients’ general satisfaction was also significantly correlated with all five satisfaction dimensions. The percentages of patient satisfaction that were likely to be explained by the variables used in the study were 22.7% for doctor competency, 25.6% for provision of information, 46.2% for quality of care, 13.7% for waiting time, and 9% for hospital quality. Overall, 32.4% of satisfaction was explained by the variables used in the study.

Conclusion

The fact that only 32.4% of general patient satisfaction was explained by the variables used in the study indicates that there are still very important gaps in our understanding of factors affecting patient satisfaction. This study found that the levels of patient satisfaction with care were influenced by provider characteristics (academic status) rather than patient characteristics. After controlling for patient characteristics, patients of professor and associate professor physicians were more satisfied than patients of assistant physicians, especially in regard to doctor competency, quality of care, provision of information, waiting time, and overall satisfaction. Medical education should continue to emphasize the importance of these aspects of the physician-patient encounter. A qualitative approach could be used in further research to investigate the variance that cannot be explained by other models.

     

Cyclic sciatica caused by infiltrative endometriosis: MRI findings

Endometriosis, an important gynecological disorder of reproductive women, affects most commonly the ovaries and less frequently the gastrointestinal tract, chest, urinary tract, and soft tissues. Endometriosis classically appears on MRI as a mass with a large cystic component and variable signal intensities on T1- and T2-weighted images due to the presence of variable degradation of hemorrhagic products. Endometriosis in an atypical location, an infiltrative appearance and without cystic-hemorrhagic components has rarely been described. We report on a 33-year-old woman with cyclic sciatica due to histologically documented infiltrative endometriosis involving the area of the left sciatic notch.     

Mapping of internal mammary vessels by multidetector computed tomography for parasternal transthoracic intervention guidance

OBJECTIVE: To measure the distances between the internal mammary arteries (IMAs) and the sternum for determining a route for parasternal transthoracic interventions. METHODS: Coronal reconstructed multidetector computed tomography images of 202 patients were evaluated to measure the distances between the IMAs and sternum at 3 levels (manubrium, midsternal corpus, and distal sternal corpus). The arrangements (2 veins-single artery or single vein-single artery) were documented. RESULTS: The most frequently encountered arrangement (42.1%) was a single vein and single artery on both sides. Mean distances on the right and left sides were 10.2 and 10.1 cm at the manubrium, 14.5 and 14.3 cm at the midsternal corpus, and 17.9 and 17.5 cm at distal sternal corpus, respectively. CONCLUSION: To be aware of the courses of the IMAs at different sternal levels is important during attempts at transthoracic intervention via a parasternal approach.     

Medullary thyroid carcinoma,follicular variant

We report here a 48-yr-old woman presenting with a solitary thyroid nodule in the left lobe of the thyroid. The aspiration cytology of the nodule was reported as follicular neoplasia and she underwent surgery. Frozen section was suspicious for medullary thyroid carcinoma and a total thyroidectomy was performed. The pathology report revealed medullary thyroid carcinoma, follicular variant. Immunohistochemical analysis was negative for thyroglobulin and positive for calcitonin. A few patients with this variant have been reported in the literature, mainly diagnosed by immunohistochemical features of the tumor. In light of the limited information we have obtained from the literature, it is reasonable to emphasize that these cases should be distinguished from the mixed medullary-follicular thyroid carcinomas and medullary carcinomas with entrapped follicles. Immunohistochemical examination with calcitonin and thyroglobulin is also essential.     

Clinical importance of vascular endothelial growth factor (VEGF) for papillary thyroid carcinomas

Vascular endothelial growth factor (VEGF) is a major regulator of angiogenesis and may be produced by some cancer cells. Several recent reports have documented that increased expression of VEGF is associated with risk of recurrence or decreased recurrence-free survival in papillary thyroid cancers (PTC). The aims of this study were to determine whether immunohistochemical expression of VEGF is related to local and distant recurrence of PTC and to evaluate the relationship between hypervascularization and VEGF expression in papillary thyroid carcinomas. VEGF expression was examined immunohistochemically in 48 papillary carcinomas. Ten normal thyroids were used as controls. Patients were followed for 61.7 (range 24-143) months. Twelve of the patients had local and distant recurrences. VEGF immunostaining, blinded for clinicopathological data, was evaluated semiquantitatively by two pathologists. The difference between the recurrent (n:12) and nonrecurrent (n:36) carcinomas was statistically significant (p:0.001). VEGF expression was also stronger in papillary thyroid carcinomas than in normal thyroid tissues. The mean microvascular densities were significantly higher than in normal thyroid tissues. These data indicate that VEGF staining is strongly associated with increased frequency of local and distant recurrence in PTC and that the immunohistochemical profile of the expression may be used as a marker for predicting which tumors have metastatic potential.     

Differences in liver pathology and clinical outcome between two patients with hepatitis B virus and graft verses host disease

Our two patients undergoing allogeneic bone marrow transplantation (AlloBMT) had both Hepatitis B virus (HBV) and graft-versus-host disease (GVHD). In the first patient, liver enzymes elevated three months after AlloBMT, and GVHD was diagnosed. Two weeks after the diagnosis of GVHD, HBsAg appeared in his serum. At that time, liver biopsy was not able to discriminate two disorders, but his sequential liver biopsies disclosed GVHD. Despite the patient was treated with cyclosporin A (CsA), he died for chronic GVHD. In contrast to the first patient, the second patient had HBsAg prior to GVHD. His liver enzymes deterioration was detected in the first month after AlloBMT, and reached the highest level in the third month while withdrawing CsA. In the fifth month he developed scleradermatous skin changes, and skin biopsy revealed chronic GVHD, whereas concurrent liver biopsy revealed chronic active hepatitis. This observation showed that immunosuppressive conditions such as GVHD or its prophylaxis may affect the appearance of liver pathology caused by HBV, which depends on the time of GVHD development, and the duration and depth of GVHD prophylaxis.     

Primary breast lymphoma cytologic diagnosis

Primary non-Hodgkin lymphoma of the breast is a rare pathology, and bilateral involvement is exceptional. We report a case of bilateral primary non-Hodgkin lymphoma of the breast in a 40-year-old woman. Predominantly atypical lymphocytes and rare plasma cells were found in the microscopic evaluation of the fine-needle aspiration biopsy of the right and left breasts. Microscopic findings of the incisional biopsy of the left breast were in accordance with non-Hodgkin diffuse large B-cell lymphoma. The patient received systemic chemotherapy and is alive with no evidence of recurrence for 2 years.