Novel cardiovascular risk factors and cardiac event predictors in female inactive systemic lupus erythematosus patients

Systemic lupus erythematosus (SLE) is associated with severe and premature cardiovascular disease, which cannot be explained by traditional risk factors alone. This study aims to investigate novel cardiovascular risk factors and cardiac event predictors in inactive SLE female patients who do not have any major cardiovascular risk factors. Twenty-five inactive (SLE disease activity index score <4) SLE female patients and 22 healthy control women were studied. SLE patients with a history of diabetes mellitus, hypertension, hyperlipidemia, smoking, or coronary artery disease (CAD) were excluded. Venous blood samples were analyzed for lipid subfractions and novel cardiovascular risk factors such as lipoprotein (a), homocysteine, fibrinogen, high-sensitivity C-reactive protein (hs-CRP), and serum amyloid A (SAA) levels. Endothelial dysfunction was assessed by flow-mediated dilatation (FMD) from the brachial artery at baseline and during reactive hyperemia. SLE patients and controls were similar in terms of age (40±10 years vs 38±10 years, p = NS). No significant difference was found between the groups regarding family history of premature CAD, blood pressure, body mass index, lipoprotein (a), homocysteine, fibrinogen, SAA, apoprotein A-1 and B levels. Compared with the controls, SLE patients had higher levels of hs-CRP [median (range): 1.82 (0.02–0.98) vs 0.68 (0.02–0.35), p=0.04]. FMD was lower in SLE patients than controls (7.1±2.1 vs 11.4±1.2%, p<0.001). Increased levels of hs-CRP and decreased FMD were found in inactive SLE patients. Increased hs-CRP levels may reflect ongoing low-grade inflammation that could be a cause of impaired FMD in SLE patients. These findings suggest that SLE patients without traditional major cardiovascular risk factors may have increased risk of cardiovascular disease and future cardiac events.     

Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?

This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6 ± 8.1 years (range 2–33 years) and all were on colchicine therapy with a mean colchicine dosage of 1.2 ± 0.4 mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93 ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12 ± 0.96] vs 0.095 [0.01–0.80] p < 0.001, respectively). PCT levels higher than 0.5 ng/ml were found in 11% (3/28) of FMF patients compared to 62% (18/29) of acute appendicitis patients (p < 0.001). Our results suggest that PCT could be a useful test in the differentiation of abdominal FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.     

Impact of scanning direction on heart rate at certain levels of heart in electrocardiogram-gated 16-multidetector computed tomography angiography of coronary artery bypass grafts

OBJECTIVE: To assess impact of scanning direction on heart rates at certain levels of heart in electrocardiogram-gated 16-multidetector computed tomography (MDCT) detection of coronary artery bypass grafts and native coronary arteries. METHODS: Ninety patients with 219 grafts were studied by 16-MDCT. Forty-five patients were scanned craniocaudally. The remaining 45 patients were scanned caudocranially. Heart rates at each level were noted and compared between the 2 groups. RESULTS: The difference between mean heart rates of craniocaudal and caudocranial groups was found to be statistically significant at midcardiac, internal mammary artery origin, and cardiac base levels (P < 0.05). For the remaining levels, there was no statistically significant difference in mean heart rates. CONCLUSIONS: Performing electrocardiogram-gated 16-MDCT angiography for the evaluation of coronary arteries and bypass grafts in caudocranial direction provides lower heart rate at midcardiac and cardiac base levels of the heart, which are more prone to motion artifacts.     

Sexual problems in a sample of the Turkish psychiatric population

Introduction

Sexual functioning has received little attention as an important aspect of patient care for those who have severe mental disorders.

Aim

The aim of this study is to compare sexual difficulties seen in Turkish psychiatric patients and healthy control subjects.

Methods

Study group consisted of outpatients in remission with schizophrenia (n = 84), bipolar affective disorders (n = 90), heroin addiction (n = 88), and healthy control group (n = 98). A sociodemographical data form and the Golombok Rust Inventory of Sexual Satisfaction were applied to all groups (N = 360).

Results

Half of the patient groups and 72.8% of control subjects reported that they had regular sexual life. The patients with heroin addiction complained about more problems in their sexual life than in the other groups. Controls (86.2%) felt more satisfied with their sexual life. Female patients with heroin addiction had statistically significant higher scores in nonsensuality subscale of Golombok Rust Inventory of Sexual Satisfaction. Female patients with schizophrenia and bipolar disorder had statistically significant higher scores in vaginismus subscale than in control group. Between the groups, male patients with bipolar disorder had higher score in most of the items except noncommunication and erectile dysfunction and also had higher total score than in the controls. More men (especially with heroin addiction) thought that their illness and drugs were responsible for their sexual problems, knew the effect of the illness and drugs on their sexual life, and asked questions to their psychiatrists about the problems more than women.

Conclusion

Patients with bipolar disorders and schizophrenia were unaware of effects of their medication on their sexual life. Finally, it was also found that clinicians in our country do not pay sufficient attention to the sexual problems of psychiatric patients.     

The role of PET-CT in the differential diagnosis of thymic mass after treatment of patients with lymphoma

Thymic hyperplasia is a common phenomenon in both children and young adults after chemotherapy and may explain the finding of a mediastinal mass in patients with malignant lymphoma after complete remission. In the present study, we report 5 cases with malignant lymphoma presenting with a mediastinal mass on CT scan after completion of chemotherapy diagnosed as thymic hyperplasia by PET-CT imaging. We retrospectively analyzed 5 patients who presented with anterior mediastinal masses a median of 4 months (range 3–6) after achieving complete remission following successful treatment for malignant lymphoma. Three patients were diagnosed with Hodgkin’s lymphoma (HL) and the others with non-Hodgkin’s lymphoma (NHL). The median age of the patients was 23 (range of 18–47). PET-CT was performed on these patients to determine the characteristics of a mass which had been detected on CT. PET-CT was performed for all patients, and the thymic masses demonstrated only mild FDG uptake considered to be consistent with thymic hyperplasia. During a median of 24 months of follow-up, all patients were recurrence-free with a median survival of 15 months (range 10–26 months). It is important to be aware of the possibility of thymic hyperplasia after chemotherapy to avoid misdiagnosis or over-staging of disease, as well as unnecessary biopsies, especially when the presenting anterior mediastinal mass was originally located near the thymus on CT scan. Mild FDG PET uptake was sufficient for the diagnosis of benign disease in the cases in this study.     

Tuberculosis of the knee joint: a case report

Tuberculosis may develop in the skeletal system apart from its primary location, the lungs. A 22-year-old male patient presented with complaints of severe pain and swelling in the left knee and difficulty in walking. The symptoms first appeared 12 years before and he underwent open surgical debridement and arthroscopic debridement at two other centers, at which time aspiration cultures taken from the knee yielded no growth. Physical examination showed a painful left knee with swelling, increased temperature, effusion, and limited range of motion. Based on history, physical examination, radiological studies, and laboratory findings, knee osteoarthritis was considered secondary to nonspecific septic arthritis and knee arthrodesis was performed. At surgery, marked destruction of articular cartilage and synovial hypertrophy were observed. In addition, a cavitary lesion was detected, about 1 x 1 cm in size, in the lateral femoral condyle without articular involvement. Biopsy cultures taken from the lesion showed growth of Mycobacterium tuberculosis in the third week. This enabled a diagnosis of tuberculosis of the knee joint and antituberculous drug therapy was instituted. At six months postoperatively, the patient was on antituberculous treatment and had a painless knee.     

Gastric volvulus after laparoscopic left adrenalectomy: case report

In this era of modern technologies, laparoscopic adrenalectomy is a gold standard surgical treatment for benign adrenal lesions. However, being aware of its difficulties and their managements is a very important issue for the surgeons who are interested in minimal invasive surgery. In this article, we are presenting a case of a 57-year-old woman who has undergone laparoscopic left adrenalectomy and in the third postoperative month, had an acute gastric volvulus requiring surgical open treatment. To the best of our knowledge, this report is the first article about a gastric volvulus case after left laparoscopic adrenalectomy.     

Juvenile dermatomyositis presenting with anasarca

Generalized edema can occur during the course of juvenile dermatomyositis. In this article, a 4-year-old boy with generalized nonpitting edema and proximal weakness is reported. Characteristic cutaneous lesions, laboratory tests, results of electromyography, and magnetic resonance imaging findings resulted in a diagnosis of juvenile dermatomyositis. He was treated with corticosteroids and methotrexate. It is concluded that the generalized edema may appear as the presenting cutaneous manifestation of juvenile dermatomyositis.