Surgical management of coronary artery stenosis and peripheral artery occlusive disease of the lower extremity in a patient with neurofibromatosis: Report of a case

We herein report the case of a patient demonstrating both coronary artery and peripheral artery occlusive disease with neurofibromatosis, which were successfully treated during the same session with coronary artery bypass graft surgery and a femoropopliteal bypass graft surgery procedure. The recognition of a possible association between neurofibromatosis and coronary artery and other vascular structures will further facilitate the successful surgery and clinical management of this rare clinical entity.     

Primary omental torsion as a cause of acute abdomen: case report

Torsion of the omentum is a rare pathology that was described 100 years ago. The characteristic appearance of omental torsion and a review of the literature are presented with respect to a case of primary omental torsion that was causing acute abdomen. Excision of the ischemic omentum is the proper treatment for omental torsion.     

Adrenal axis functions in patients with familial Mediterranean fever

Objective: Familial Mediterranean fever (FMF) is a hereditary disease characterized by recurrent attacks of fever with peritonitis, arthritis, pleuritis or erysipelas-like rash. It is unclear what effects of FMF itself on endocrine system and hormones are. None of the FMF patients without amyloidosis have been reported to have any endocrine disorders, except those who developed colchicine-induced diabetes insipidus. There is a large body of evidence to show that cytokines (IL-1, IL-6 and TNF-α) activate the hypothalamic-pituitary-adrenal (HPA) axis. We have designated this study to investigate the HPA axis in FMF patients without amyloidosis. Methods: Twenty-one patients with FMF were included. ACTH stimulation test was performed on the healthy subjects and during attack period in the patients. In the patient group, same test was repeated during remission period. Results: Peak cortisol levels were significantly higher in the attack period than those in the remission period of patients (p<0.05). Conclusion: The cytokines play a role on the activation of the HPA axis; we thought the axis would be affected in this disease. The response of cortisol to 250 μg ACTH was significant in attack period when compared with remission period. This result reveals that HPA axis is more activated in an FMF attack. Previous studies suggest that the adrenal hormones increase in acute inflammatory events, and eventually, the changes on these hormones are related to TNF and IL-6 levels. During the FMF attack, HPA axis may be stimulated by cytokines. It seems that HPA axis is regulated normally in FMF patients.An erratum to this article can be found at     

Effect of obesity and morbid obesity on the growth hormone (GH) secretion elicited by the combined GHRH + GHRP-6 test

OBJECTIVE: Obesity is characterized by low basal levels of growth hormone (GH) and impeded GH release. However, the main problem arises in the diagnosis of GH deficiency in adults, as all accepted cut-offs in the diagnostic tests of GH reserve are no longer valid in obese subjects. In this work, the role of obesity in the GH response elicited by the GHRH + GHRP-6 test was assessed in a large population of obese and nonobese subjects. PATIENTS: GHRH + GHRP-6-induced GH peaks were evaluated in 542 subjects. One hundred and five were healthy obese, 50 were morbid obese, and 261 were nonobese (both normal weight and overweight). One hundred and seventy-six GH-deficient patients (obese and nonobese) were also studied. RESULTS: A regression analysis of the 366 subjects with normal pituitary function indicated that adiposity had a negative effect on the elicited GH peak (r = -0.503, P < 0.0001). A receiver operating characteristic (ROC) curve analysis showed that in subjects with a BMI < or =35, the currently accepted cut-offs of the GHRH + GHRP-6 test (GH peaks > or =20 microg/l: normal secretion; GH peaks < or =10 microg/l: GH deficiency), were fully operative. However, in subjects with a BMI > 35, normality was indicated by GH peaks > or =15 microg/l and GH deficiency by peaks < or =5 microg/l (1 microg/l = 2.6 mU/l). CONCLUSIONS: This study confirms: (a) that the combined provocative test is adequate to separate normal and GH-deficient subjects; (b) the negative effect of obesity on GH secretion; (c) that obesity accounts for 25% of the reduction of GH release; and (d) that present cut-off values are applicable to normal weight, overweight and grade I obesity subjects, whereas in obese subjects with a BMI exceeding 35, all the normative limits of the GHRH-GHRP +6 test must be reduced by 5 microg/l.     

Relation between middle ear pressure changes and postoperative nausea and vomiting in pediatric strabismus surgery

STUDY OBJECTIVE: To investigate the effects of tympanometric changes on the frequency of postoperative nausea and vomiting (PONV). DESIGN: Prospective, observational study. SETTING: University hospital. PATIENTS: 49 ASA physical status I, nonpremedicated children undergoing elective strabismus surgery. INTERVENTIONS: Frequency of PONV was assessed at various time intervals (0-2, 2-6, and 6-24 hours) with a 4-point scale (0, no nausea; 1, nausea but no vomiting; 2, one episode of vomiting; 3, two or more episodes of vomiting), and correlation with tympanometric data was investigated. MEASUREMENTS: Tympanogram was obtained before induction of standardized anesthesia and after full recovery. Fourteen (28.6%) patients had nausea, and 10 (20.4%) patients vomited. The tympanic gradient, compliance, and pressure values were found to be significantly higher in postoperative measurements than their preoperative counterparts (P < 0.05). The volumes of both ears increased postoperatively, but these differences were not statistically significant (P > 0.05). Changes in middle ear pressure, volume, compliance, and gradient did not correlate with PONV (P > 0.05). CONCLUSIONS: Gradient, compliance, volume, and pressure changes in middle ears were not found to be related to the frequency of nausea and vomiting after strabismus surgery.     

B7-H1 (PD-L1) on T cells is required for T-cell-mediated conditioning of dendritic cell maturation

Studies have shown that T-cell-dendritic cell (DC) interaction is required for efficient DC maturation. However, the identities of the molecules that mediate the interaction in vivo are largely unknown. Here, we show that maturation of DCs as well as CD8 T-cell responses were impaired in B7-H1-deficient (B7-H1^−/−) mice to influenza virus infection. Both defects were restored by transferring B7-H1-expressing naïve T cells into B7-H1^−/− mice. Similarly, transferring DCs from wild-type mice or from RAG1^−/− mice that had been injected with B7-H1-expressing naïve T cells also restored CD8 T-cell responses in B7-H1^−/− mice. These results demonstrate that B7-H1 on naïve T cells is required to condition immature DCs to undergo efficient maturation when they encounter microbial infection. In return, the mature DCs stimulate a robust T-cell reponse against the infecting pathogen.     

High risk of hypopituitarism after traumatic brain injury: a prospective investigation of anterior pituitary function in the acute phase and 12 months after trauma

CONTEXT: Recent data have demonstrated that traumatic brain injury (TBI)-mediated hypopituitarism could be more frequent than previously known. However, most previous data were obtained from retrospective studies. OBJECTIVES: The aim of this study was to determine 1) the prevalence of anterior pituitary hormone deficiencies in the acute phase of TBI and after 12 months, 2) whether severity of trauma correlated with basal hormone levels, and 3) whether initial hormone deficiencies predicted medium-term hormonal status. DESIGN AND PATIENTS: Fifty-two TBI patients (43 men and nine women) were included in the prospective study. Pituitary function was evaluated within 24 h of admission and after 1 yr. RESULTS: Some 5.8% of the patients had TSH deficiency, 41.6% had gonadotropin deficiency, 9.8% had ACTH deficiency, and 20.4% had GH deficiency (GHD). Twelve months after TBI, 5.8% had TSH deficiency, 7.7% had gonadotropin deficiency, 19.2% had ACTH deficiency, and 37.7% had GHD. Twenty-six patients (50.9%) had at least one anterior pituitary hormone deficiency, 21 patients (41.2%) had isolated hormone deficiencies, and five patients (9.7%) had combined hormone deficiencies. Overall, the pituitary hormone deficiencies recovered in 30 (57.7%) patients after 1 yr, and new pituitary hormone deficiencies were present in 27 (51.9%) patients after 1 yr. CONCLUSIONS: GHD is the most common pituitary deficit 12 months after TBI, and 50.9% of the patients had at least one anterior pituitary hormone deficiency. Pituitary function may improve or worsen in a considerable number of patients over 12 months.     

Comparison of Peripheral Blast Clearance and Day 14 Bone Marrow Biopsy in Predicting Remission Status and Survival After 7+3 Induction in Acute Myeloid Leukemia

Introduction

Induction chemotherapy with cytarabine and an anthracycline (7+3) remains the standard of care for acute myeloid leukemia (AML).