Relationship Between the Levels of Holotranscobalamin and Vitamin B<Subscript>12</Subscript> in Children

The purpose of this study was to evaluate the relationship between the plasma holoTC and serum vitamin B₁₂ in children and to identify a cutoff cobalamin values according to holoTC. One hundred and fifty-five children were enrolled into the study. All children were evaluated for hemoglobin, vitamin B₁₂, folate, ferritin and holoTC levels. Children were grouped as with low vitamin B₁₂ level (≤200 pg/mL, group I) and normal vitamin B₁₂ (>200 pg/mL, group II). Serum vitamin B₁₂, and holoTC levels were performed in each patient in the study. In 101 patients with low vitamin B₁₂ (group I) the mean holoTC was 21.74 ± 1.14 pmol/L. In 54 children with normal vitamin B₁₂ (group II) mean holoTC was 44.0 ± 2.7 pmol/L (p < 0.01). A ROC curve analysis was performed to delineate the optimum cut-off point for vitamin B₁₂ level and it was found to be 165 pg/mL with a sensitivity of 70% and specificity of 74%; the area under curve was 0.783 (p < 0.01). Our study displayed a positive correlation between vitamin B₁₂ and holoTC, and defined an optimum cutoff value for vitamin B₁₂ as 165 pg/mL. Further studies using the markers both MMA, tHcy and holoTC to confirm the findings are needed.     

Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke

Vertebral artery hypoplasia (VAH) is a frequent anatomical variation of vertebral arteries, with emerging evidence suggesting that it contributes to posterior circulation ischemia. However, the relationship between VAH and ischemic stroke remains unknown. Hence, this study aimed to determine the prevalence of VAH in patients diagnosed with acute ischemic stroke who were followed up in a neurology clinic and to determine if it can potentially be a risk factor for atherosclerotic stenosis in vertebrobasilar circulation.This retrospective study included 609 patients diagnosed with acute ischemic stroke between January 1, 2019 and January 1, 2020. Demographic of patients, risk factors, radiological and clinical characteristics were evaluated.Posterior circulation was very common in patients with VAH, and the most common locations of atherosclerotic stenosis were V1 and V4 segments of the vertebral artery and the middle segment of basilar artery. Analysis of the risk factors for atherosclerotic stenosis in patients with posterior circulation acute ischemic stroke suggested that VAH was an independent risk factor.Findings of the study suggest that VAH pre-disposes atherosclerotic stenosis in vertebrobasilar circulation, although its mechanism remains unknown. Hemodynamic parameters associated with atherosclerosis could not be measured in vivo. Thus, to better understand the underlying mechanism, conducting studies that examine blood flow parameters with high-resolution magnetic resonance angiography in patients diagnosed with acute cerebral ischemia patients with VAH is warranted.     

Acquired von Willebrand syndrome in a patient with Ewing sarcoma

Acquired von Willebrand syndrome is a rare bleeding disorder with clinical and laboratory features closely resembling to hereditary von Willebrand disease. The syndrome may accompany various conditions, including malignant disorders, most often with Wilms tumor and adrenal cell carcinoma. In this report, the authors present a patient with AvWS in association with Ewing sarcoma for the first time in the literature. The abnormal bleeding tendency was successfully treated with fresh frozen plasma and did not recur after the first two courses of chemotherapy with clinical improvement.     

Objective voice changes in nondysphonic Parkinson's disease patients

OBJECTIVE: To obtain objective acoustic analysis results from Parkinson's disease patients who do not have voice symptoms and to compare these results with those from age- and sex-matched control subjects. DESIGN: Prospective. SETTING: Tertiary reference hospital. METHOD: The objective acoustic analysis results from 14 female Parkinson's disease patients with no voice symptoms were compared with those of 22 age- and sex-matched normal subjects. RESULTS: Statistical analysis revealed no differences in mean fundamental frequency and shimmer values. However, differences in jitter values, loudness, and the harmonics to noise ratio were statistically significant between the two groups (p < .05). CONCLUSION: With this study, it was shown that Parkinson's disease patients who do not have any voice symptoms have objectively different acoustic values than their age- and sex-matched controls. Clinicians must be aware of these initial findings on the voice changes of Parkinson's disease patients.     

Cystoid macular oedema following pneumatic retinopexy vs scleral buckling

AIMS: To determine the incidence of angiographic cystoid macular oedema (CMO) following pneumatic retinopexy (PR) and scleral buckling (SB) in consecutive case series. METHODS: Patients who had successful anatomical attachment following PR and SB were included in our study; 132 patients had PR and 121 patients had SB. We evaluated the demographic characteristics, visual acuity, lens status, macular status, and previous ocular history in all patients. CMO was evaluated by fluorescein angiography (FA) in a masked pattern, 6 and 12 weeks after surgery in all cases. We analysed the CMO incidence and its correlation with preoperative ocular status and visual outcome. Chi2 and Fisher's exact tests were used in statistical analysis. RESULTS: CMO was present in 15 of 132 (11%) PR, and 35 of 121 (29%) SB patients at 6 weeks (P=0.0005); the oedema was persistent in eight of 132 (6%) PR and 21 of 121 (17%) SB patients at 12 weeks (P=0.0005). Eight of 106 (8%) phakic and seven of 26 (27%) pseudophakic patients developed CMO following PR (P=0.02). In the SB group, 26 of 72 (36%) patients who had preoperative macular detachment developed CMO (P=0.03). Visual improvement was limited in patients who developed angiographic CMO despite anatomical re-attachment of the retina. CONCLUSIONS: CMO may occur following both PR and SB and deteriorate the visual outcome. Previous cataract surgery and macular detachment may increase the CMO rates following PR and SB, respectively.     

Peyronie＇s disease： a silent consequence of diabetes mellitus

Aim： To investigate the clinical characteristics of patients with Peyronie＇s disease （PD） and diabetes mellitus （DM）. Methods： During an 8-year period, a total of 307 men seen at our outpatient clinic were diagnosed with PD. Clinical characteristics, penile deformities and the erectile status of patients with PD and DM together （n = 102） were retrospectively analyzed and compared to patients with PD alone with no risk factors for systemic vascular diseases （n = 97）. Results：The prevalence of PD among men with DM and sexual dysfunction was 10.7 %. The mean age of diabetic patients with PD was （55.9 ± 8.9） years; in the no risk factor group it was （48.5 ± 9.0） years （P 〈 0.05）. The median duration of DM was 5 years. The majority of diabetic patients with PD （56.0 %） presented in the chronic phase （P 〈 0.05）, and they were more likely to have a severe penile deformity （〉 60°） than the no risk factor group （P 〈 0.05）. In the diabetic group, the most common presenting symptom was penile curvature （81.4%）, followed by a palpable nodule on the shaft of the penis （22.5%） and penile pain with erection （14.7%）. A total of 19.6% of patients were not aware of their penile deformities in the diabetic group. Erectile function, provided by history and in response to intracavernosal injection and a stimulation test, was significantly diminished in patients with PD and DM （P 〈 0.05）. Conclusion： DM probably exaggerates the fibrotic process in PD. Diabetic patients with PD have a higher risk of severe deformity and erectile dysfunction （ED）. PD seems to be a silent consequence of DM and should be actively sought in diabetic men. （Asian JAndrol 2006 Jan; 8： 75-79）     

Surgical treatment of abdominal aortic aneurysms associated with horseshoe kidney

Abdominal aortic aneurysm surgery associated with a horseshoe kidney (HSK) is a serious technical challenge for the surgeon. We reviewed our experience with 127 patients electively operated on between 1990 and 2004 for abdominal aortic aneurysm. Pre- and perioperative medical, surgical, and radiologic data were retrospectively reviewed. Preoperative diagnosis was achieved with computed tomography with or without angiography or with additional conventional aortography.Seven patients were recognized to have had a HSK, with a mean age of 67.29 +/- 2.43 years. Preoperative serum creatinine levels were similar in patients with or without HSK (1.0 +/- 0.08 vs 0.9 +/- 0.12 mg/dL; not significant). In five of the patients with HSK, reimplantation of the anomalous renal artery was necessary. In all 127 patients, hospital mortality consisted of 5 patients, none of whom had an HSK. Dealing with HSK seemed to increase aortic clamp times (30.43 +/- 3.55 vs 27.04 +/- 3.92 minutes; p < .05) slightly. Patients with or without HSK were given similar amounts of intravenous fluid replacement (2,214.2 +/- 441.3 vs 1,923.3 +/- 433.6 mL/patient; not significant) and allogeneic blood transfusion (0.71 +/- 0.49 vs 0.9 +/- 0.4 U/patient; not significant) and had a similar intensive care unit stay.Abdominal aortic aneurysms associated with HSK have been managed without division of the isthmic tissue. The left retroperitoneal approach provided adequate exposure for all patients with HSK.     

Serum amyloid A (SAA) in induced sputum of asthmatics: a new look to an old marker

BACKGROUND: Some cellular and soluble markers of inflammation in induced sputum have been used for studying airway inflammation in asthma. The aim of this study was to assess the usefulness of systemic inflammation marker serum amyloid A (SAA) in blood and induced sputum to monitor the airway inflammation in asthmatic patients. METHOD: Seventeen non-smokers newly diagnosed mild to moderate asthmatic patients and 10 healthy volunteers were included in this prospective parallel designed study. Inflammatory cell counts, SAA and eosinophil cationic protein (ECP) levels were measured in sera and induced sputum of both groups. All tests were repeated in the asthma group after 6 months of inhaled steroid therapy. The diagnostic accuracy and reproducibility of sputum and blood SAA were estimated. RESULTS: Serum and induced sputum SAA and ECP levels, sputum eosinophils and neutrophils of untreated asthmatic patients were significantly greater compared to the control group. Sputum and sera SAA levels and sputum neutrophils remained unchanged after the 6 months of anti-inflammatory therapy, although ECP levels, sputum eosinophils and macrophages were significantly reduced. The area under the curve (AUC) for sputum SAA was found equal to AUC for sputum ECP (0.87). The reproducibility of sputum SAA was satisfactory (ICC=0.84) as well. CONCLUSION: Our findings suggest that systemic inflammatory marker SAA may be used as a reliable inflammatory marker in asthma. The facts that whether it remarks an ongoing inflammation unresponsive to treatment in the airways or reflects a systemic inflammation needs to be clarified with further studies.