Habitual tea drinking and bone mineral density in postmenopausal Turkish women: investigation of prevalence of postmenopausal osteoporosis in Turkey (IPPOT Study)

AIM: In this epidemiological report, we assessed the prevalence of osteopenia and osteoporosis (OP) in postmenopausal Turkish women and the relationship between body mass index (BMI), and some nutritional factors (habitual tea, coffee, tobacco, and milk product consumption) with OP. METHODS: This multicenter study was done in postmenopausal women residing in five big cities, in four different regions of Turkey between August and November 2005. An inclusion criterion was being in the postmenopausal period for at least 12 months. A semi-structured questionnaire was completed by face-to-face interview, consisting of closed- and open-ended questions about demographic characteristics, nutritional status, and habits with two or more choices as possible responses. Bone mineral density (BMD) measurements were performed with a MetriScan Densitometer (Alara Inc., CA, USA). RESULTS: Seven hundred twenty-four women were included in the study. The mean age was 57.6 +/- 9.6 years, and mean age at natural menopause was 46.4 +/- 5.6 years. Of the participants, 51% were illiterate. According to WHO classification; 42.5% were normal in terms of BMD, 27.2% had osteopenia, and 30.2% had OP. Women with high education levels had better T-scores (p = 0.019). Increase in BMI also had a positive effect on T-scores (p < 0.0001). A linear correlation was found between age (r= -0.386, p < 0.0001), BMI (r = -0.175, p < 0.0001), and education (r = -0.317, p < 0.0001), with T-scores. The T-scores of women who consumed tea on a regular basis were found to be higher than non-consumers (-1.51 +/- 1.68 vs. -1.09 +/- 1.66; p = 0.070) [when smokers, those who received hormonal therapy (HT), and those > 65 years were excluded]. CONCLUSION: OP was determined in 1/3 of the women. Advanced age (> 65) and being illiterate were negative factors, while high education levels, being overweight, and being treated with HT had a positive effects on BMD. Habitual tea drinking also may have a positive effect on BMD. However, tea drinking was not found to be a statistically significant factor in the present study.     

Free testosterone levels and implications on clinical outcomes in elderly men

BACKGROUND AND AIMS: Aging is accompanied by a progressive decline in serum testosterone. Evidence concerning the clinical manifestations of low serum testosterone levels is contradictory. We aimed to examine the age-related decline in testosterone and the possible clinical outcomes, including erectile dysfunction, prostatism, cognitive function, daily life activities, depression, and osteoporosis. METHODS: One hundred and twenty men underwent comprehensive geriatric assessment. Testosterone and free testosterone levels were measured, geriatric assessment scales, International Index of Erectile Function (IIEF) and International Prostate Symptom Scale (IPSS) were performed, and bone mineral densities were determined. RESULTS: The mean age of the 120 men was 73.8+/-5.90. A significant decrease in testosterone and free testosterone levels with increasing age was determined (p=0.021). It was also found that erectile dysfunction, as determined by IIEF (r=0.66, p<0.001), and symptoms of prostatism determined by IPSS (r=-0.23, p=0.016), were significantly associated with low free testosterone levels. Laboratory parameters, obesity, osteoporosis, cognitive function, daily life activities, and cardiovascular diseases were not significantly different between groups with low and normal free testosterone levels. CONCLUSION: Age-related decrease in free testosterone may lead to erectile dysfunction and symptoms of prostatism in elderly men.     

Left ventricular free-floating ball thrombus complicating aortic valve stenosis

A 67-year-old man was referred for evaluation of near-syncopal attacks and left hemiparesis. Echocardiography revealed moderate to severe calcific aortic valve stenosis and a free-floating thrombus. Left ventricular (LV) systolic function was normal. No regional wall motion abnormality was detected in the left ventricle. On serial echocardiography, the thrombus began to fragment. Urgent surgery was commenced, during which the mass was seen to be a free-floating ball thrombus in the LV cavity, in addition to apical fibrin bands mimicking abnormal trabeculation. The thrombus was removed and aortic prosthetic valve replacement performed. No coagulation abnormalities were detected. The patient made a full recovery after surgery. Floating thrombus can embolize at any moment and require emergency treatment, notably because of a high mortality rate of systemic embolic events or acute hemodynamic decompensation caused by LV outflow tract obstruction. To the authors' knowledge, this is the first report of LV free-floating thrombus concomitant with isolated calcific aortic valve stenosis.     

Papillary muscle rupture secondary to infective endocarditis

Rupture of the mitral papillary muscle due to infective endocarditis is a very rare complication. There is no report regarding anterolateral papillary muscle rupture as a complication of infective endocarditis in the literature. We decided to report a case of anterolateral papillary muscle rupture due to infective endocarditis. Our case, which will be discussed later on, differs also in many ways from that in the literature.     

Seventeen Years of Experience with Reduction Mammaplasty Avoiding a Vertical Scar

BACKGROUND: It is important to reshape the breast with the least scar possible. This has led us to develop a technique for large breasts where the vertical scar was eliminated. METHODS: The new nipple is positioned at 19-21 cm. The level of the new inframammary line (IML) is marked 6 cm below the new areola. All the area between the marked IML and the present sulcus is de-epithelialized. The upper flap is undermined beginning from the new IML. The tissue excision is performed medially and laterally leaving a central pedicle that also carries the nipple-areola complex (NAC). The dermoglandular pedicle is shaped conically with breast-shaping sutures. The NAC is passed under the upper apron flap through its new opening. RESULTS: We retrospectively reviewed 145 patients who were operated on over the past 17 years. The mean age of the patients was 41 years. The mean distance preoperatively from midclavicle to nipple was 35.3 cm. The average weight of breast tissue excised was 1073 g per side. Seventeen patients (11%) suffered from minor complications. CONCLUSION: This technique works especially well in breast reduction cases where a large mass excision is required. The horizontal scar is obvious only when the patient is lying down and cannot be seen by the patient herself. There is no risk of destroying the circular feature of the areola, which is pulled inferiorly by the vertical scar in the other techniques.     

Intestinal Volvulus and Perforation Caused by Multiple Magnet Ingestion: Report of a Case

Ingested magnets can cause intestinal fistulas, perforation, and obstruction. There have been reports of magnet ingestion causing intestinal volvulus, but multiple magnet ingestion causing perforation and intestinal volvulus in a child is very unusual. We report the case of a 4-year-old girl, who ingested four magnets she acquired as toys, which caused intestinal volvulus and perforation as a result of pressure necrosis, several days after ingestion. At surgery we repaired two perforations, but additional bowel resection was not required. The patient was discharged on postoperative day 10. If multiple magnet ingestion is suspected in a child, the child must be monitored carefully. If there are signs of obstruction, emergency surgery is mandatory.     

Sexual function in women with coronary artery disease: a preliminary study

We investigated sexual function in female patients with coronary artery disease (CAD). A total of 20 consecutive female patients (38.2+/-3.8 years) with CAD diagnosed by coronary angiography and 15 healthy subjects (37.9+/-5.4 years) were enrolled in this study. The Female Sexual Function Index (FSFI) was used to assess sexual function in all the participants. Women with psychiatric disorders, gynecologic and systemic diseases that may affect sexual function were excluded from the study. The other exclusion criteria were usage of antidepressants and drugs affecting sexual function. Patients with CAD and healthy women were comparable in age, body mass index and education level. Female sexual dysfunction (FSD) was diagnosed in 12 of 20 women with CAD (60%), whereas five of 15 healthy women (33.3%) were found to have FSD (P<0.05). Patients with CAD had a significantly lower number of sexual intercourse episodes per month than healthy women volunteers (2.24 versus 5.2, respectively; P<0.05). The FSFI total score was clearly significantly decreased in the CAD group compared with that in healthy controls (17.8+/-2.9 and 26.0+/-4.8, P=0.001). When the subscores of each domain of FSFI were evaluated, all the subscores of FSFI, except the satisfaction domain, in patients with CAD were significantly lower than those of healthy subjects (P<0.05). This preliminary study demonstrates that female patients with CAD have distinct sexual dysfunction compared with healthy controls. Women with CAD should be evaluated also in terms of sexual function to provide better quality of life.     

Transthoracic echocardiographic predictors of the left atrial appendage contraction velocity in stroke patients with sinus rhythm

Systemic embolization is a potential complication in patients with thrombi situated in the left atrium and particularly, in the left atrial appendage (LAA). Reduced LAA contraction velocities, determined by the transesophageal echocardiography (TEE), are associated with increased risk of LAA spontaneous echocontrast and thrombus formation, and a history of systemic embolism. However, TEE remains a semi-invasive procedure, limiting its serial application as a screening tool. Therefore, it is desirable to obtain information regarding LAA function by transthoracic echocardiography in patients having cardioembolic stroke. The present study was designed to investigate various echocardiographic variables for patients with stroke to predict LAA dysfunction, reflected as reduced LAA contraction velocity. We studied a total of 61 patients with newly diagnosed acute embolic stroke (42 patients) and transient ischemic attack (19 patients). Computerized tomographic scanning was performed for the diagnosis of embolic stroke. Left atrial functional parameters determined by transthoracic echocardiography, such as left atrial active emptying fraction and acceleration slope of mitral inflow A wave, had significant correlations with the LAA contraction velocity (r = 0.57, p < 0.001; r = 0.54, p < 0.001, respectively). Left atrial volume index, left atrial active emptying volume and left atrial fractional shortening were also correlated with LAA contraction velocity (r = -0.44, p < 0.001; r = 0.38, p = 0.003; r = 0.37, p = 0.004, respectively). In conclusion, transthoracic echocardiography can provide valuable and reliable information about the LAA contraction velocity in stroke patients with sinus rhythm. This finding gives new insights for the appropriate strategy in the evaluation of an acute ischemic stroke.     

Impaired protection against diabetes and coronary heart disease by high-density lipoproteins in Turks

The issue of whether or not incident type 2 diabetes mellitus and coronary heart disease (CHD) can be predicted by high-density lipoprotein (HDL) cholesterol in both sexes needs investigation. A representative sample of 3035 middle-aged Turkish adults free of CHD at baseline was studied with this purpose prospectively over a mean of 7.8 years. High-density lipoprotein cholesterol levels were found to be correlated in women positively with plasma fibrinogen and weakly with waist girth and C-reactive protein, and to be not correlated with fasting insulin. High-density lipoprotein cholesterol protected men against future CHD risk (for a 12-mg/dL increment: relative risk = 0.80 [95% confidence interval, 0.69-0.95]) after multivariable adjustment in logistic regression analyses for age, smoking status, physical activity grade, hypertension, abdominal obesity, diabetes, and lipid-lowering drugs. However, men were not protected against risk of diabetes. In women, HDL cholesterol was not associated with risk for CHD, whereas intermediate (40-60 mg/dL) compared with lower HDL cholesterol levels proved protective against risk of diabetes (relative risk = 0.57 [95% confidence interval, 0.36-0.90]) after adjustments that included apolipoprotein A-I tertiles. Yet higher serum concentrations failed to yield protection against diabetes. It was concluded that HDL particles confer partially lacking protection against cardiometabolic risk among Turks, and this impairment is modulated by sex. This highly important observation may result from a setting of prevailing chronic subclinical inflammation.