Carotid intima-media thickness in relation to macrovascular disease in patients with type 2 diabetes mellitus

BACKGROUND: Increased carotid intima-media thickness is regarded as a marker of atherosclerosis. Type 2 diabetes mellitus is associated with a high prevalence of macrovascular disease. MAIN PURPOSE: The present study aimed to examine the relationship between carotid intima-media thickness and the presence of macrovascular disease in patients with type 2 diabetes. METHODS: 71 patients with type 2 diabetes mellitus were studied. The distal common carotid artery and carotid bifurcation intima-media thickness were measured bilaterally with high-resolution ultrasonography. The relationship between the presence of coronary artery disease, cerebrovascular disease and peripheral arterial disease and carotid intima-media thickness was evaluated. RESULTS: Patients with coronary artery disease had significantly (p = 0.048) increased intima-media thickness of the distal common carotid artery. This difference ceased to be significant after adjustment for cardiovascular risk factors. Patients with peripheral arterial disease had a significantly higher bifurcation (p < 0.0001), distal common carotid (p = 0.03) and mean intima-media thickness (p = 0.0008) than did those without peripheral arterial disease. This difference remained significant even after adjustment for other cardiovascular risk factors. In the multiple linear regression analysis, the presence of peripheral arterial disease, age and male gender significantly predicted bifurcation intima-media thickness, while age and the presence of peripheral arterial disease significantly predicted mean intima-medial thickness. CONCLUSIONS: In the present study, the increased carotid intima-media thickness in patients with type 2 diabetes mellitus was related to the presence of peripheral arterial disease. This finding probably reflects morphologic and hemodynamic similarities between the two vascular beds and indicates that increased carotid intima-media thickness in patients with type 2 diabetes may be a marker of atherosclerosis in different locations.     

Neonatal osteofibrous dysplasia associated with pathological tibia fracture: a case report and review of the literature

Osteofibrous dysplasia is a rare and benign disease that originates from the tibia or fibula. The symptoms of osteofibrous dysplasia include painless enlargement and bowing of the tibia and pain occurring in the presence of pathological fracture. Herein a male infant who was admitted with redness and swelling on the right leg and diagnosed as pathological tibia fracture due to left tibia osteofibrous dysplasia on the third day of life was presented. To our knowledge, this is the earliest presentation of osteofibrous dysplasia with a pathological fracture in a neonate. Therefore, it must be suspected in neonatal bone fractures.     

Assessment of Pollution in Ataturk Dam Lake (Adiyaman,Turkey) Using Several Biochemical Parameters in Common Carp, <Emphasis Type="Italic">Cyprinus carpio</Emphasis> L.

Ataturk Dam Lake, the largest impounded lake in Turkey, has been contaminated by domestic, industrial and agricultural effluents coming from Adiyaman city. In this study, we investigated the possible effects of pollutants on several biochemical parameters in the cyprinid fish, Cyprinus carpio, by comparing the parameters in fish collected from a polluted area (Sitilce) to a relatively clean area (Samsat) in August 2011. The activities of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and lactate dehydrogenase and levels of cortisol, glucose, and K increased while total protein, cholesterol, Ca, Na and Cl levels decreased in fish from the Sitilce site when compared to the Samsat site. The observed alterations in these biochemical parameters indicate that the Ataturk Dam Lake is affected by untreated wastewater discharges.     

Lipid levels and their genetic regulation in patients with familial hypercholesterolemia and familial defective apolipoprotein B-100: the MEDPED Slovakia Project

We examined, from a cohort of 165 families, 529 individuals for familial hypercholesterolemia (FH). Utilising clinical criteria for diagnosis, we identified 122 patients (n=41 families) as having FH. With PCR testing, 31 individuals (n=12 families) were found to have familial defective Apo B-100 (FDB). From the cohort, 102 normolipidemic (NL) individuals served as a control group. Patients with FH had the highest levels of total cholesterol (TC), LDL-cholesterol (LDL-C) and apolipoprotein B (Apo B), followed by FDB patients and the normolipidemic relatives had the lowest levels (P<0.0001 for all parameters). We did not find any effect of Apo E genotypes on lipid levels in the NL or FH group. Therefore, other genetic and/or environmental factors may be responsible for the diversity in the clinical expression in these populations.     

Effect of beta radiation brachytherapy in the treatment of restenosis of coronary stents

Brachytherapy currently represents the only treatment method for in-stent restenosis (ISR) confirmed in randomised clinical studies. In a group of 46 patients, selected for brachytheraphy on the bases of clinical signs of restenosis accompanied with development or deterioration of angina pectoris and with angiography results showing significant in-stent restenosis, we used a beta radiation system BetaCath NOVOSTE. This therapy was safe. Results of acute angiography were positive in 91% of patients. Clinical restenoses within 6 month of clinical monitoring occurred in 8.6% of patients. Due to impairment of more arteries in the majority of patients from the sample, following revascularisation of nontarget vessels was necessary in 19.6% of patients. We haven't observed late thrombosis. It was probably eliminated by prolonged administration of a combination of aspirin and clopidogrel. Dosimetry results during brachytherapy showed that doses of radiation both for a surgeon and a patient corresponded to a fraction of doses received from an x-ray apparatus during fluoroscopy and acquisition. Both an edge restenosis and a diffuse restenosis were identified in stenoses of patients with in-stent restenosis. Brachytherapy with beta radiation seems to be an efficient method for treatment of coronary in-stent restenosis.     

Homocystinuria due to cystathionine β-synthase deficiency: Novel biochemical findings and treatment efficacy

To explore the pathogenesis of cystathionine beta-synthase (CBS) deficiency and to test the efficacy of pharmacological therapy we examined a panel of metabolites in nine homocystinuric patients under treated and/or untreated conditions. Off pharmacological treatment, the biochemical phenotype was characterized by accumulation of plasma total homocysteine (median 135 micromol/L) and blood S -adenosylhomocysteine (median 246 nmol/L), and by normal levels of guanidinoacetate and creatine. In addition, enhanced remethylation was demonstrated by low serine level (median 81 micromol/L), and by increased concentration of methionine (median 76 micromol/L) and N -methylglycine (median 6.8 micromol/L). Despite the substantially blocked transsulphuration, which was evidenced by undetectable cystathionine and severely decreased total cysteine levels (median 102 micromol/L), blood glutathione was surprisingly not depleted (median 1155 micromol/L). In 5 patients in whom pharmacological treatment was withdrawn, the differences of median plasma total homocysteine levels (125 micromol/L after withdrawal versus 33 micromol/L under treatment conditions), total cysteine levels (139 versus 211 micromol/L) and plasma serine levels (53 versus 103 micromol/L) on and off treatment demonstrated the efficacy of long-term pyridoxine/betaine administration ( p <0.05). The treatment also decreased blood S -adenosylhomocysteine level (133 versus 59 nmol/L) with a borderline significance. In summary,our study shows that conventional treatment of CBS deficiency by diet and pyridoxine/betaine normalizes many but not all metabolic abnormalities associated with CBS deficiency. We propose that the finding of low plasma serine concentration in untreated CBS-deficient patients merits further exploration since supplementation with serine might be a novel and safe component of treatment of homocystinuria.     

Doppler-guided hemorrhoidal artery ligation: experience with 2 years follow-up

Doppler-guided hemorrhoidal artery ligation (DGHAL) is a nonexcisional surgical technique for the treatment of hemorrhoidal disease, consisting of the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of hemorrhoidal plexus resulting in fibrosis. The aim of the study was to assess the efficacy and safety of DGHAL, define its indications, and identify its possible advantages and limitations for the treatment of second- and third-degree hemorrhoids. The procedure was performed using a specially designed proctoscope. The Doppler probe was used to locate all the terminal branches of hemorrhoidal arteries, which were then sutured. Patients were followed up for 2 years. From November 2006 to May 2009, 50 patients (29 female, mean age 38.2 years) underwent this procedure. The procedure was performed under local anesthesia. An average of five ligatures was placed. Average length of hospital stay was 2 hours and return to work was 2.5 days. The mean postoperative pain score was 1.72. There were no intra- or immediate postoperative major complications. In 44 patients (88%), surgery resolved the symptoms completely in a 2-year follow-up period. DGHAL is a safe and effective procedure. DGHAL can be the choice for second- and third-degree hemorrhoids with minimal postoperative pain and quick recovery.     

Is flow cytometry crossmatch analysis using sera with different dilutions important for pretransplant analysis? A case report

The most effective form of treatment for chronic renal failure is kidney transplantation from a cadaver or a living donor. For a kidney transplant to be successful, tissue compatibility and a lack of donor-specific anti-human leukocyte antigen (HLA) antibodies in the circulation of the patient are vital, in addition to ABO blood group compatibility. The presence of anti-HLA antibodies is assayed before transplantation using various methods, but because organ rejections have been observed in previous studies, different techniques are required to detect anti-HLA antibodies. Today, flow cytometry crossmatching is one of the most important and effective techniques in testing for donor-specific anti-HLA antibodies (DSAs). If weakly positive serum is assayed after serial dilution, it can yield high positivity. Herein, we describe the differences between the results for diluted and undiluted weakly positive sera studied using the flow cytometry crossmatch (FCXM) technique. In a recent study, the sera of weakly FCXM-positive patients were diluted 1/50, and the FCXM test was repeated. The use of diluted serum eliminated the effect of the prozone so that the DSAs could be detected.