Effect of Aerodiol administration on ocular arteries in postmenopausal women

Objective. The aim of the present study was to evaluate the alteration of ocular blood hemodynamics after intranasal administration of 17β-estradiol, through measurement of the ophthalmic artery (OA) and the central retinal artery (CRA) using color duplex sonography.

Methods. Thirty healthy women who had been naturally postmenopausal for at least 1 year were enrolled in the study. A randomized, placebo-controlled, crossover, double-blinded study was conducted of the acute effect of 17β-estradiol (Aerodiol®; Servier, Chambrayles-Tours, France) on OA and CRA blood flow using color duplex sonography.

Results. The peak systolic and end diastolic velocities of the CRA were increased significantly after 17β-estradiol administration compared with placebo. A significant decrease was also found in the pulsatility and resistive indices of the CRA. However, there were no statistically significant differences in OA flow velocities or pulsatility and resistive indices.

Conclusions. Nasal 17β-estradiol administration in postmenopausal women causes an improvement in the ocular vascular Doppler indices. These results suggest that there could be a positive effect of Aerodiol® on middle-sized arteries and arterioles.     

Diagnostic Imaging of Pulmonary Embolism Using Endobronchial Ultrasound

Endobronchial ultrasound (EBUS) is a new technique that can be used for the diagnostic imaging of central pulmonary thromboembolism (PE). In eight cases at our clinic, EBUS was used because of mediastinal lymphadenopathies or paramediastinal nodular lesions and at the same time images of a PE were obtained by means of EBUS. The PE was diagnosed before the EBUS with computed tomography (CT) of the lungs in all cases (5 women and 3 men). The repletion defects of all the cases compatible with a PE were clarified with CT-angiography. EBUS may be an alternative method for the diagnosis of PE, since it can indicate the presence of a thrombus in the central pulmonary arteries in hemodynamically stable cases.     

Neonatal onset atypical hemolytic uremic syndrome successfully treated with eculizumab

Background

Atypical hemolytic uremic syndrome (aHUS) is characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment. Neonatal cases are extremely uncommon. Plasma therapy is the first choice therapy in patients with aHUS based on the belief of an underlying complement dysregulation. Alternatively, eculizumab, which targets complement 5, is used to block complement activation.

Case-diagnosis/treatment

Sudden onset macroscopic hematuria, hypertension, and bruises over the entire body were noted in a 5 day-old newborn. Investigations revealed hemolytic anemia, thrombocytopenia, renal impairment, and a low serum C3, leading to the diagnosis of aHUS. Fresh frozen plasma (FFP) infusions and peritoneal dialysis for acute kidney injury were initiated. This approach yielded full renal and hematological remission. The patient was discharged with FFP infusions, but subsequently developed three life-threatening disease recurrences at 1, 3, and 6 months of age. The last relapse presented with uncontrolled hypertension and impaired renal function while the patient was receiving FFP infusions. After the first dose of eculizumab, his renal and hematological parameters returned to normal and his blood pressure normalized. Genetic screening of the CFH gene revealed a novel homozygous p. Tyr1177Cys mutation.

Conclusion

Eculizumab can be considered as an alternative to plasma therapy in the treatment of specific patients with aHUS, even in infants.     

Imaging features of Burkitt lymphoma in pediatric patients

Burkitt lymphoma is an aggressive and rapidly growing tumor that is curable and highly sensitive to chemotherapy. It can affect almost every tissue in the body, producing various clinical presentations and imaging appearances, according to the predilection of the different subtypes for certain sites. Awareness of its diagnostically specific imaging appearances plays an important role in rapid detection and treatment. In this pictorial review, we aimed to identify the most common imaging features of Burkitt lymphoma in pediatric patients.Burkitt lymphoma (BL) is an aggressive subtype of non-Hodgkin lymphoma (NHL) with a doubling time of 24–48 h. Even with its aggressive character, BL is curable and highly sensitive to chemotherapy. Thus, early diagnosis and treatment are critical before life-threatening complications, such as airway compromise or spinal cord compression, set in. Knowledge about the imaging appearances assists in rapid detection and treatment. In this pictorial review, we illustrated the most common imaging features of BL.In 1958, Denis Burkitt first described BL in Uganda, after encountering many children with rapidly growing jaw tumors. In 1964, some viral particles, termed Epstein-Barr virus (EBV), were identified in the tumor (1, 2). Since then, BL has been classified into three main clinical variants: endemic, sporadic, and immunodeficiency-associated. The endemic variant is linked to EBV infection and is observed particularly in Africa, where malaria is also endemic. The sporadic variant is the most common form in the rest of the world, where malaria in not endemic. The immunodeficiency-related type is observed after organ transplantation and in patients with human immunodeficiency virus infection or congenital immunodeficiency diseases, including Wiskott-Aldrich syndrome, ataxia telangiectasia, and X-linked lymphoproliferative disease (1–5).The least common type of lymphoma in all age groups is generally BL with an incidence of 1%. During childhood, it is the most frequent subtype of NHL with an incidence of 40%. As BL can involve various sites of the body, the clinical presentation and radiologic appearances differ; it may be localized or disseminated and can affect a wide variety of locations. In the endemic variant, head and neck involvement is more common; however abdominal involvement is more commonly observed in the sporadic form (1, 6).     

The prognostic importance of fibronectin and sialic acid levels in human pituitary adenomas

In this study, fibronectin and sialic acid levels were determined in human pituitary adenomas. The mean fibronectin and sialic acid levels for human pituitary adenomas were found to be 31.64 ± 15.82 μg/mg protein and 21.90 ± 9.82 μg/mg protein, respectively, versus 6.30 ± 2.96 μg/mg protein and 9.88 ± 2.81 μg/mg protein for the normal brain tissues. Fibronectin and sialic acid levels were significantly higher (P < 0.001) in human pituitary adenomas than the normal brain tissues. In human infiltrative and non-infiltrative pituitary adenomas, the mean fibronectin and sialic acid levels were found to be 40.87 ± 15.90 μg/mg protein, 27.59 ± 11.10 μg/mg protein and 22.40 ± 9.51 μg/mg protein, 16.21 ± 3.20 μg/mg protein, respectively. Fibronectin and sialic acid levels were slightly elevated (P < 0.05) in human infiltrative pituitary adenomas compared with non-infiltrative adenomas.     

Comparison of nickel patch test reactivity in phases of the menstrual cycle

BACKGROUND: In earlier studies, it has been shown that severity of some diseases varies with menstrual cycle. Severity of skin diseases such as atopic dermatitis, lupus erythematosus, infections due to herpes virus, urticaria and acne were also reported to increase in the premenstrual phase. Effect of estradiol on the cellular immune system was investigated and it was found to depress the cellular immune response. In our study, we investigated whether nickel patch test reactivity was different during phases of the menstrual cycle and whether there was an increase in sensitivity to nickel during the premenstrual cycle in nickel-sensitive women. METHODS: The study consisted of 30 women who had a history of nickel sensitivity. Finn Chamber nickel patch test was applied to all 30 women by dividing them into two groups of 15 and applying the test first on days 7-10 and then on days 20-24 of the menstrual cycle or vice versa. RESULTS: The reactions of both the groups on days 20-24 were more severe than those on days 7-10 even though the results were not statistically significant. CONCLUSIONS: Estrogens not only impair the skin barrier but also have a negative impact on the immune system. Estradiol has been proved to suppress cellular immunity. In a few studies conducted to date, the relationship between phases of the menstrual cycle and the severity of patch test reactivity has been examined with equivocal results. In our study, we observed that the presence of reactions due to nickel sensitivity was independent of the phases of the menstrual cycle. Nevertheless, we would like to point out the fact that the reactions seen in the second phase of the menstrual cycle were more severe than those seen in the first phase.     

Effects of intravenous triiodothyronine during coronary artery bypass surgery

A prospective randomized and double-blind study was performed to evaluate whether perioperative triiodothyronine administration has any effect on cardiovascular performance after coronary artery bypass surgery. Sixty patients were assigned to 2 groups of 30 each. When crossclamping ended, group A received an intravenous bolus of triiodothyronine, followed by infusion for 6 hours. Group B received a placebo. Serum triiodothyronine levels and hemo-dynamic parameters were serially measured. Mean postoperative cardiac index was slightly, but not significantly, higher in group A, whereas systemic vascular resistance was significantly lower in group A. Compared with preoperative values, serum triiodothyronine levels dropped significantly in group B at the end of cardiopulmonary bypass and remained low 12 hours postoperatively, while levels rose significantly in group A. No significant differences were detected between the groups in the incidence of arrhythmia, the need for inotropic support, intensive care unit stay, mortality, and morbidity. Perioperative administration of triiodothyronine increased cardiac output slightly and decreased systemic vascular resistance, but it had no effect on operative outcome. Routine use after coronary surgery is thus not recommended.