Heart rate variability in patients with allergic rhinitis

Considering the role of autonomic imbalance in the pathogenesis of hypersensitivity reactions, we evaluated the autonomic system through time-domain analysis of heart rate variability (HRV) in patients with allergic rhinitis. Twenty-four patients with allergic rhinitis and 22 healthy subjects (mean age, 41 +/- 8 years and 37 +/- 9 years, respectively) were enrolled in the study. The diagnosis of allergic rhinitis was based on the history, symptoms, and skin prick tests results. Twenty-four-hour ambulatory electrocardiographic recordings were obtained, and the time-domain indices were analyzed. Analysis of HRV revealed that the SD of normal RR intervals, SD of successive differences in normal cycles, and HRV triangular index were not significantly different between the groups, but the root mean square successive difference, number of RR intervals exceeding 50 milliseconds, and percentage difference between adjacent normal RR intervals exceeding >50 milliseconds were significantly greater in the study group, compared with the control group. Our findings showed that HRV indices, which predict parasympathetic predominance, were increased in patients with allergic rhinitis. This finding shows that vagal activation is present not only in the nose but also in other systems, including the cardiovascular system.     

Nasal Septal Perforation in an Adolescent Girl with Crohn’s Disease: A Rare Extraintestinal Manifestation

Crohn's Disease (CD) is a chronic granulomatous inflammatory bowel disease which may also involve the extraintestinal organs such as joints, liver, skin and perianal tissue. Involvement of the aerodigestive tract is quite rare in CD. We report a 16-year-old girl with CD and nasal perforation as an extraintestinal manifestation of the disease.     

Development of acute inflammatory arthritis by granulocyte-macrophage colony-stimulating factor during autologous stem cell transplantation for cryoglobulinemia

Hematopoietic growth factors (HGFs) are now known to influence the function of mature myeloid cells as well as their traditional roles as regulators of hematopoiesis. It became apparent that they could take part in inflammatory and immune responses by activating monocytes/macrophages to release mediators of such responses. We describe a 53-year-old male who developed acute inflammatory arthritis by granulocyte-macrophage colony-stimulating factor (GM-CSF) following autologous stem cell transplantation for cryoglobulinemia. Arthritis improved dramatically soon after GM-CSF was withdrawn and steroid therapy was admitted. This case may lead to further attention for this potential problem since HGFs are frequently used in a variety of clinical settings.     

Spontaneously resorbed idiopathic syringomyelia: a case report

A 28-year-old female patient presented with severe neck and back pain in 2003. No abnormality was observed at neurological examination. Syringomyelia in the cervical region was determined at MRI. MRI examination of the cranial, thoracal and lumbosacral regions was normal. The patient refused surgery and was followed up. A control cervical MRI 17 months later showed that the syringomyelia had disappeared. This spontaneously resorbed case of idiopathic syringomyelia, presenting solely due to neck and back pain and with a normal neurological examination, was evaluated in the light of syringomyelia pathogenesis as only three similar cases have been identified in the literature.     

Interruption or congenital stenosis of the inferior vena cava: prevalence, imaging, and clinical findings

OBJECTIVE: To present the prevalence, clinical, and imaging findings of interruption or congenital stenotic lesions of the inferior vena cava (IVC), associated malformations, and their clinical relevance. MATERIALS AND METHODS: Between March 2004 and March 2006, 7972 patients who had undergone consecutive routine abdominal multidetector row computed tomography were analyzed for interruption or stenotic lesion of the IVC. RESULTS: Prevalence of interruption (n=8) or congenital stenosis (n=4) of the IVC occurred in 12 (0.15%) of 7972 patients. Four patients with interruption and four patients with congenital stenosis of the IVC were symptomatic with DVT (n=4), leg swelling (n=4), leg pain (n=2), lower extremity varices (n=2), hepatic vein thrombosis (n=1), and hematochezia (n=1). All four of the asymptomatic patients were from the interruption group, and these patients had interrupted IVC with well-developed azygos/hemiazygos continuation. Eight symptomatic patients did not have a well-developed azygos/hemiazygos continuation, and drainage of lower extremity was mainly from collateral veins. Additional findings in eight symptomatic patients were abdominal venous collaterals (n=8), venous aneurysm (n=2), lower extremity varices (n=2), varicocele (n=2), and pelvic varices (n=1). CONCLUSION: Interruption or stenosis of the IVC are rare on routine abdominal CT examinations and may cause different clinical findings depending on the variant drainage patterns or collaterals. Interrupted IVC is commonly asymptomatic if associated with well-developed azygos/hemiazygos continuation, whereas commonly symptomatic if well-developed azygos/hemiazygos continuation is not present.     

Leiomyosarcoma of the inferior vena cava

Primary vascular leiomyosarcoma is a rare tumor, which arises mainly from the inferior vena cava. Clinical signs are non-specific. Systemic metastasis occurs in the late stage. Imaging with color Doppler ultrasonography, contrast-enhanced computed tomography, or magnetic resonance imaging can significantly contribute to the diagnosis. We present a case of leiomyosarcoma of the inferior vena cava that extended into the right renal vein and the right iliac vein, as it is a rare case and emphasize the significance of the imaging methods in its diagnosis.     

Mental health and HIV risk in men who have sex with men

Evidence-based HIV prevention interventions with men who have sex with men (MSM) in the United States have moderate effect sizes in reducing HIV sexual risk behavior. Mental health and psychosocial problems, which both disproportionately affect MSM populations and are implicated in HIV transmission risk behaviors, also likely interfere with the uptake of HIV behavioral interventions. Moreover, given that mental health and psychosocial problems such as depression, substance use, and violence frequently co-occur for many MSM (eg, as syndemic conditions), what is probably needed are combination prevention efforts, or prevention "cocktails," similar to treatment "cocktails," that address the psychological and behavioral mechanisms that interact to produce elevated risk for HIV. Such interventions should incorporate a holistic framework to address the sexual health and overall well being of MSM. Addressing co-occurring psychosocial risk factors is apt to improve effect sizes of current HIV prevention interventions and allow for more effective uptake by MSM.     

The metabolic profile in patients with skin tags

Although skin tags are associated with diabetes mellitus, insulin resistance, hypertension, obesity, atherogenic lipid profile, no data in the literature show that the presence of skin tags is associated with serum high-sensitive C-reactive protein, uric acid, free fatty acid and leptin level. The purpose of this study was to evaluate the frequency of hypertension, dyslipidemia, insulin resistance and obesity in patients with skin tags and to compare patients with skin tags and normal healthy subjects for insulin resistance, serum lipids, insulin, glucose, leptin, high-sensitive C-reactive protein, free fatty acid levels. We evaluated 113 patients with skin tags and 31 healthy subjects. The two groups were compared with respect to BMI, lipid profile, blood pressure, insulin resistance, serum lipids, insulin, glucose, leptin, high-sensitive C-reactive protein, free fatty acid and homeostatic model assessment of insulin resistance (HOMA-IR). Total 53.9 and 33.6% of patients with skin tags were overweight and obese, respectively. The frequency of hypertension 30.1%, dyslipidemia 59.3% and insulin resistance 21.2% were detected. HOMA-IR (P < 0.001) and serum glucose (P < 0.001), insulin (P = 0.002), high-sensitive C-reactive protein (P = 0.001), uric acid (P = 0.001), free fatty acid (P = 0.002), HbA1c (P < 0.001), total cholesterol (P = 0.018), LDL-cholesterol (P = 0.023), and triglyceride levels (P = 0.001) were higher in patients with skin tags than control group. Overweight and/or obesity, dyslipidemia, hypertension, insulin resistance and elevated high-sensitive C-reactive protein are seen in patients with skin tags. Skin tags may be a marker of increased risk of atherosclerosis and cardiovascular disease.     

Comparing the relaxing effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated myometrium in both pregnant and nonpregnant rats

In this study, the effects of 2 volatile anesthetics, desflurane and sevoflurane, on oxytocin-induced contractions of isolated myometrium in pregnant and nonpregnant rats were compared. Twenty pregnant and 20 nonpregnant Wistar albino rats were studied at 19 to 20 days’ gestation (term, 22 days). A total of 40 myometrial strips were obtained from pregnant and nonpregnant rats, and each of these was randomly assigned to 1 of 4 groups (n=10, each group). After spontaneous myometrial contractions were induced in the De Jalon solution, the effects of 0.5, 1, and 2 minimum alveolar anesthetic concentrations (MAC) of desflurane or sevoflurane, in the absence and presence of oxytocin (2×10⁻⁹ M), were investigated. Oxytocin significantly increased the amplitude and duration of spontaneous contractions in longitudinal myometrial strips (P < .05), but not the frequency. Both agents (except for 0.5 MAC in the nonpregnant group) inhibited the duration, amplitude, and frequency of induced contractions in a dose-dependent manner. The inhibitory potencies of desflurane and sevoflurane were similar. It was found that isolated strips of pregnant rat myometrium were more sensitive to the inhibitory effects of both agents than were the nonpregnant rat myometrial strips.