Central nervous system involvement of polyarteritis nodosa: a case report.

Polyarteritis nodosa (PAN) is a necrotizing vasculitis involving small and medium-sized arteries and it affects multiple organ systems in the body Central nervous system (CNS) involvement appears less frequently, and usually develops after the disease is established. Although aneurysms are common in visceral arteries in PAN, intracranial aneurysms are uncommon and have been documented rarely. This case is reported to raise awareness among radiologists as it has characteristic and rare, if not specific, imaging findings of CNS involvement of PAN.     

Transvaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse.

OBJECTIVE: The transvaginal sacrospinous ligament fixation technique was used as part of the vaginal repair procedure for marked uterovaginal prolapse, and in the treatment of vault prolapse. METHOD: Out of the 26 women treated with sacrospinous ligament suspension of the vaginal vault, 23 had marked uterovaginal prolapse and three had vault prolapse following hysterectomy. Patients with vault prolapse underwent posterior vaginal repair, obliteration of the enterocele sac and sacrospinous colpopexy. Patients with marked uterovaginal prolapse underwent vaginal hysterectomy with high ligation of the enterocele sac, anterior and posterior vaginal repair, and sacrospinous colpopexy. Bilateral salpingoopherectomy was added to the procedure in five patients. All patients were examined 6 weeks after the operation and, subsequently, on an annual basis. The mean follow-up period was 2.6 years (1-5 years). RESULTS: Out of the three patients with previous vault prolapse, none had recurrences. Out of the 23 patients with previous marked uterovaginal prolapse, only two had small cystocele, and one had small enterocele at 36 months following the operation. These patients were asymptomatic and did not need an operation. Vaginal vault prolapse was not observed in any of these patients. Two women had post-operative urinary tract infection and five had buttock discomfort, which subsided after 2 months. No other intra- or post-operative complications occurred. CONCLUSION: Transvaginal sacrospinous colpopexy can be performed together with vaginal hysterectomy, and anterior and posterior vaginal wall repair in patients with marked uterovaginal prolapse because of its high success in avoiding possible vault prolapse, and low intra- and post-operative complication rates.     

Evidence of association of Vitamin D receptor Apa I gene polymorphism with bone mineral density in postmenopausal women with osteoporosis

The vitamin D receptor (VDR) was the first candidate gene to be studied in relation to osteoporosis, and most attention has focused on polymorphisms situated near the 3′ flank of VDR. The aim of this study was to investigate the association about VDR gene Apa I polymorphism with bone mineral density (BMD) in postmenopausal women with osteoporosis. We studied a total of 136 postmenopausal women with a mean age of 56.36 ± 10.29 years. Among them, a total of 75 had osteoporosis, 37 had osteopenia, and 24 had normal BMD. Venous blood samples were obtained for evaluation of bone metabolism and genotyping. The VDR Apa I genotype was determined by polymerase chain reaction-restriction fragment length polymorphism. BMDs at the lumbar spine and hip were measured by dual-energy X-ray absorptiometry. Postmenopausal women with aa genotype had significantly lower BMD values (grams per centimeter square) at lumbar spines compared to persons with AA genotype. Also, postmenopausal women with AA genotype had significantly higher serum Ca level than the subjects with aa genotype. In conclusion, our result may indicate that VDR Apa I gene polymorphism may be responsible for a important part of the heritable component of lumbar spine BMD in postmenopausal women, possibly related to impaired calcium absorption from the bowel.     

Long acting beta-2 agonists in the treatment of asthma and their safety

Inhaled corticosteroids are the preferred primary long-term treatment for asthma. The first option in patients who are uncontrolled with inhaled steroids is adding long-acting beta-2 agonists. The addition of a long-acting beta-agonist to an inhaled corticosteroid has been accepted as effective therapy for almost two decades Despite the widespread use and their clinical benefit, controversy regarding their safety arose after their introduction. Concerns about the safety of long-acting beta-2 agonist therapy, has led to the appearance of multiple publications and recommendations. The evidence supports the use of long-acting beta-2 agonists plus inhaled corticosteroids in a single inhaler device to increase adherence and reduce the potential use of long-acting beta-2 agonists monotherapy. This review examines and commands on the available clinical data and safety concerns of long-acting beta-2 agonists use in patients with asthma.     

Clinical and radiographic features of pulmonary tuberculosis in non-AIDS immunocompromised patients.

SETTING: Department of Chest Diseases, Istanbul Faculty of Medicine, Istanbul University. OBJECTIVE: To determine the clinical and radiographic presentation of pulmonary tuberculosis in non-AIDS immunocompromised patients (ICP). DESIGN: A retrospective review of medical records of 143 patients (63 immunocompromised patients and 80 immunocompetent patients) with pulmonary tuberculosis from 1992 to 2001. RESULTS: In ICPs, fever was more frequently observed (84.1% vs. 40%, P = 0.0000002), tuberculosis was more frequently disseminated (23.8 vs. 3.8%, P = 0.0008), and lung infiltrations were more often lobar or segmental consolidation (20.6% vs. 0%, P = 0.00007) and miliary lesions (17.5 vs. 3.8%, P = 0.014) than in the control patients. Hilar and/or mediastinal adenopathy was also more frequently documented in ICPs (14.3% vs. 2.5%, P = 0.01). CONCLUSION: Fever, atypical chest radiograph and disseminated disease are common findings of pulmonary tuberculosis in ICPs.     

HRCT evaluation of the accessory fissures of the lung

INTRODUCTION: The purpose of this study was to classify the accessory fissures of the lung and to assess their frequency by using high-resolution CT. METHODS AND PATIENTS: HRCT scans of 115 patients were prospectively reviewed. 1 mm thin sections were obtained at 10 mm intervals with a scan time of 1.9 s. The fissure and its relationship to the segmental bronchovascular structures were then evaluated on transverse sections. RESULTS: Forty-four accessory fissures were detected in 35 of 115 patients. The most common accessory fissure was the inferior accessory fissure (12%). The second most common accessory fissure was the left minor fissure (8%). The right superior accessory fissure (5%), the accessory fissure between the medial and lateral segments of the right middle lobe (5%), and the accessory fissure between the superior and inferior segments of the lingula (5%) were seen in equal frequencies. Also, intersegmental accessory fissures, namely the fissure between the anterobasal and laterobasal of both the right (1%) and the left (2%) lower lobes were detected. We found only one subsegmental accessory fissure. DISCUSSION AND CONCLUSION: The inferior accessory fissure and the left minor fissure were the most common accessory fissures in our study.     

Interactions between verapamil and digoxin in Langendorff-perfused rat hearts: the role of inhibition of P-glycoprotein in the heart

P-glycoprotein (P-gp) is expressed in tumour cells as well as normal tissues including heart. Modulation of P-gp transport in vivo may lead to increased drug penetrance to tissues with resulting increases in toxicity. We aimed to investigate the effects of P-gp on the isolated heart by digoxin infusion in the absence and presence of verapamil. The study was performed in Langendorff isolated perfused rat hearts. After a 20 min. stabilisation period with Tyrode Buffer, digoxin (125 μg/5 mL) was infused for 10 min. in the control group (n = 7). The same dose of digoxin was infused during perfusion with verapamil (1 nm) containing Tyrode Buffer (n = 8) in the study group. Outflow concentration and cardiac parameters of digoxin were measured at frequent intervals for 40 min. AUEC((0-40 min)) for left ventricular developed pressure was significantly increased in the presence of verapamil (4260 ± 39.37 mmHg min versus 4607 ± 98.09 mmHg min; 95% CI -587.7 to -105.8; p = 0.0083). The significant increases in left ventricular developed pressure were at 20, 25, 30, 35 and 40 min. AUC((0-40 min)) value for outflow digoxin concentration-time curve was significantly lower in the presence of verapamil. Verapamil increased the positive inotropic effect of digoxin, probably through the inhibition of P-gp, which effluxes digoxin out of cardiac cells.     

Effect of atorvastatin on CYP2C9 metabolic activity as measured by the formation rate of losartan metabolite in hypercholesterolaemic patients

HMG-CoA reductase inhibitors (statins) have a potential to interact with substrates of the drug-metabolizing enzyme cytochrome P450 2C9 (CYP2C9). This may lead to concentration-dependent toxicity such as skeletal muscle side effects. Atorvastatin, a widely used statin, is presently inadequately investigated in vivo with regard to effects on CYP2C9 activity in human beings. The aim of this study was to determine the effect of atorvastatin on the activity of CYP2C9 in a group of Turkish hypercholesterolaemic patients. We prospectively investigated the atorvastatin effect on CYP2C9 activity in a sample of Turkish hypercholesterolaemia patients (11 women, 7 men) who commenced atorvastatin (10 mg/day). Losartan was used as a probe drug to determine CYP2C9 metabolic activity. A single 25-mg oral dose of losartan was given to the patients before, on the first day and after the fourth week of the atorvastatin treatment. Urinary concentrations of losartan and its metabolite, E3174, were measured by high-pressure liquid chromatography (HPLC). Urinary losartan/E3174 ratios were used as an index of CYP2C9 activity. As the baseline enzyme activity may influence the extent of drug-drug interactions, the CYP2C9*2 and 2C9*3 alleles were identified by using PCR-RFLP. In the patients with the CYP2C9*1*1 genotype (n = 12), atorvastatin treatment did not cause a significant change in losartan/E3174 ratios (medians; 95% CI) neither after the first day (0.73; 0.34-1.61) nor at the fourth week (0.71; 0.36-1.77) of the treatment as compared with the baseline activity (0.92; 0.57-1.74, p = 0.38). Similarly, no significant change in the baseline CYP2C9 activity (0.91; 0.30-1.60) was observed in patients with the CYP2C9*1*2 genotype as compared with those of the first day (1.08; 0.08-2.72) and fourth week (0.64; 0.0-3.82) of the atorvastatin treatment (n = 4, p = 0.86). These observations in a hypercholesterolaemic patient sample suggest that atorvastatin does not have a significant effect on enzymes encoded by the CYP2C9*1*1 and CYP2C9*1*2 genotypes when co-administered with a CYP2C9 substrate, losartan.     

Effect of dextromethorphan on reference memory assessed in rats by a three-panel runway task

The effects of dextromethorphan (DM, CAS 6700-34-1), a common over-the-counter cough suppressant, on the reference memory have been investigated by a three-panel runway setup in rats. This study was designed by using a repeated acquisition procedure such as a radialarm maze task or a water maze task. DM (20-40 mg/kg i.p.) produced a significant decrease in the number of errors (pushes made on the two incorrect panels of the three panel gates at four choice points) and latency. Systemically administered scopolamine (CAS 114-49-8) (1 mg/kg i.p.) impaired the performance on both parameters. DM (40 mg/kg i.p.) was effective in reversing the reference memory deficit induced by administration of scopolamine. DM acts as a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptors. Our results suggest that inhibition of NMDA receptors by DM supports its potential positive properties. This finding might present an oppurtunity for the evaluation of this old antitussive drug.