Splenic Hydatid Cysts: 17 Cases

Hydatid cyst disease, which is endemically observed and an important health problem in our country, involves the spleen at a frequency ranking third following the liver and the lungs. In this study, we aimed to evaluate the efficacy and results of management in splenic hydatid cysts. The demographic data, localization, diagnosis, treatment methods, and the length of postoperative hospital stay of patients with splenic hydatid cysts in a 12-year period were evaluated retrospectively. Seventeen cases were evaluated. Among these, 13 were females and four were males. Seven had solitary splenic involvement, eight had involvement of both the spleen and the liver, and two had multiple organ involvement. Ten had undergone splenectomy, one had undergone distal splenectomy, and the remaining cases had undergone different surgical procedures. The patients had received albendazole treatment in the pre- and postoperative period. One patient had died secondary to hypernatremia on the first postoperative day. The clinical picture in splenic hydatid cysts, which is seen rarely, is usually asymptomatic. The diagnosis is established by ultrasonography and abdominal CT. Although splenectomy is the standard mode of treatment, spleen-preserving methods may be used.     

Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study

BACKGROUND: Injuries due to falls are one of the most important public health concerns for all ages, but especially for frail elderly people. Although a small number of falls have a single cause, the majority have many different causes resulting from the interactions between intrinsic or extrinsic risk factors. METHODS: We conducted an observational study on data from a large population of community-dwelling elderly people to tests the hypothesis that the current use of different classes of psychotropic medications, including antipsychotic agents, benzodiazepines, nonbenzodiazepine sedative-hypnotics, and antidepressants, increases the risk for falls. We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programs (n = 2854). RESULTS: After adjusting for all potential confounders, users of any psychotropic drugs had an increased risk of fall of nearly 47% (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.24-1.74). Similarly, compared with nonusers, users of atypical antipsychotic drugs also had an increased risk of falling at least once (OR, 1.45; 95% CI, 1.00-2.11). Among benzodiazepine users, patients taking agents with long elimination half-life (OR, 1.45; 95% CI, 1.00-2.19) and patients taking benzodiazepines with short elimination half-life (OR, 1.32; 95% CI, 1.02-1.72) had an increased risk of falls. Patients taking antidepressants did not show a higher risk of falling compared to nonusers (OR, 0.92; 95% CI, 0.83-1.41). CONCLUSIONS: Our data suggest that, among psychotropic medications, antipsychotic agents and benzodiazepines are associated with an increased risk of falls. Our findings do not support the hypothesis that preferential prescribing of short-acting benzodiazepines instead of long-acting agents or atypical antipsychotic medications instead of typical agents will substantially decrease fall risk associated with the use of these classes of drugs.     

Evaluation of salivary total oxidant-antioxidant status and DNA damage of children undergoing fixed orthodontic therapy

Objective:To determine the total oxidant status (TOS), total antioxidant status (TAS), and the 8-hydroxy-2′-deoxyguanosine (8-OHdG) levels and their interrelationship in the saliva of children undergoing fixed orthodontic therapy.Materials and Methods:Thirty children were randomly divided into three groups. The attachments were bonded to all of the teeth using three different orthodontic composites: Transbond XT, Kurasper F, and GrenGloo. The salivary levels of TOS, TAS, and 8-OHdG were determined three times, as follows: before treatment (T₁) and at 1 month (T₂) and 3 months (T₃) following appliance placement. All data were statistically analyzed.Results:There were no significant differences in TOS, TAS, and 8-OHdG within the same time periods among the three different orthodontic composites (P > .05). TAS in all composite groups decreased over time. These decreases were found to be significant for Kurasper F and GrenGloo at the T₁–T₃ and T₂–T₃ time periods (P < .05). In all composite groups 8-OHdG decreased between T₁ and T₂ (P < .05). However, 8-OHdG in all composite groups increased from T₂ to T₃. These differences in 8-OHdG were significant in Kurasper F and GrenGloo (P < .05).Conclusions:Fixed orthodontic appliances bonded with the tested composites did not increase the cytotoxicity markers in saliva.     

Hemoglobin levels and skeletal muscle: results from the InCHIANTI study

BACKGROUND: Anemia is associated with reduced physical performance and muscle strength. The aim of the study was to explore whether anemia and hemoglobin levels are associated with differences in quantitative and qualitative measures of muscle and fat. METHODS: The study sample consisted of 909 participants 65 years and older enrolled in the "Invecchiare in Chianti" (InCHIANTI) study, a prospective population-based study of older people aimed at identifying risk factors for late-life disability. All the analyses were performed considering continuous hemoglobin levels as well as the dichotomous anemia variable (defined according to World Health Organization criteria as hemoglobin <12 g/dL in women and <13 g/dL in men). A peripheral quantitative computed tomography (pQCT) scan was performed in all participants to evaluate total, muscular, and fat cross-sectional areas of the calf and relative muscle density. Ankle extension strength was measured using a hand-held dynamometer. Linear regression analyses were used to assess the multivariate relationship of pQCT and skeletal muscle strength measures with hemoglobin levels and anemia after adjustment for demographics, chronic conditions, medication use, and other biological variables. RESULTS: Participants were aged 74.8 +/- 6.8 years. In our sample, 94 participants (10.3%) were anemic. Hemoglobin levels were significantly associated with muscle density (beta = 0.225 [SE, standard error 0.098], p=.02), muscle area/total area ratio (beta=0.778 [SE 0.262], p=.003), fat area/total area ratio (beta=-0.869 [SE 0.225]; p<.001). Skeletal muscle strength and muscle density were highly associated with anemia (beta=-3.266 [SE 1.173], p=.005 and beta=-0.816 [SE 0.374], p=.03, respectively). Results did not change when analyses were rerun in a restricted sample of participants not affected by major medical conditions. CONCLUSION: The present study shows that hemoglobin levels are associated with the parameters of body composition obtained by pQCT, and that decreases in muscular strength measures occur in the presence of anemia.     

Epinephrine-secreting cystic pheochromocytoma presenting with an incidental adrenal mass: a case report and a review of the literature

Cystic adrenal masses are a relatively rare condition, and are usually nonfunctioning and asymptomatic. Differential diagnosis includes pheochromocytoma (PHEO) and adrenal carcinoma; 8-10% of patients with PHEO may be completely asymptomatic. Moreover, fewer than 10% of PHEOs secrete pure epinephrine. We report a case of a E-secreting pure cystic PHEO presenting with an incidental adrenal mass. A 49-year-old Turkish woman was hospitalized at Farabi Hospital for further examinations of a right adrenal cystic mass with a thick wall that was incidentally discovered by abdominal ultrasonography during examination for nausea, vomiting, headache, and angina-like chest pain in another hospital. On admission, her blood pressure was 100/60 mmHg. Tension Holter monitoring revealed paroximal hypertension (178/136 mmHg) and hypotension (78/54 mmHg) attacks. Of urinary catecholamines and its metabolites, only urine metanephrine was markedly increased, despite a urine epinephrine level near the upper limit of normal ranges. Abdominal computed tomography and magnetic resonance imaging studies revealed a cystic round tumor approx 5 cm in diameter, located in the right adrenal gland. Right adrenalectomy was performed; the surgical specimen revealed pure cystic PHEO. Postoperatively, the urine metanephrine level returned to normal range and urine epineprine level was decreased approx 60%. In conclusion, a diagnosis of E-secreting PHEO should be considered in patients with nonspecific symptoms, presenting with an incidental cystic adrenal mass, even in the absence of hypertension.     

The evaluation of the tendon and muscle changes of lower extremity in patients with acromegaly

Pituitary - Although it is well known that acromegaly causes enlargement in the extremities, studies investigating the effects of acromegaly on tendons, muscles and soft tissue are limited. The...     

Lead Exposure Is Related to Impairment of Aortic Elasticity Parameters

Arterial hypertension is one of the physical complications of chronic lead exposure. Hypertension has effects on aortic elastic properties. The aim of this study was to evaluate the aortic elastic properties in workers occupationally exposed to lead. Forty‐one workers who were exposed to lead and 39 healthy controls were included in the study. All patients underwent transthoracic echocardiography for detecting aortic elastic parameters. There were no differences in baseline characteristics between the lead‐exposure group and controls. Aortic strain (9.4%±4.5% vs 12.4%±4.2%, P=.004) and aortic distensibility (0.45±0.21 cm²/dyn vs 0.55±0.20 cm²/dyn, P=.046) were decreased in patients with lead exposure compared with controls. There was a negative significant weak correlation between aortic strain and (r=−0.294, P=.008) lead levels. There was no significant correlation between aortic distensibility and any other echocardiographic parameters. This study suggests that chronic exposure to lead is related to impairment of aortic elasticity parameters.

Lead contamination (such as that emitted from house paint, gasoline, batteries, and other sources) may cause a wide variety of body organ complications.¹ Despite the still manifested divergences of opinion, it seems that chronic exposure to lead represents a risk for arterial hypertension development. Functional changes within the arterial wall both in smooth muscles and the endothelium might result in arterial hypertension caused by chronic exposure to lead compounds.² Blood pressure (BP) was found to be increased in workers with blood lead concentrations of 7 μg/L on average.³ According to the World Health Organization (2000), the level of 400 μg/L is accepted as safe to avoid possible adverse health effects, but American Conference Governmental and Industrial Hygienists suggest an even lower value of <300 μg/L.Hypertension has effects on the aorta (decreased aortic distensibility and increased aortic stiffness). Aortic strain is a simple and useful parameter of transthoracic echocardiography. Some studies have suggested that aortic elastic parameters can be used as an independent predictor of all‐cause and cardiovascular mortality in hypertensive patients.⁴, ⁵ In previous studies, the relationship between lead exposure and arterial hypertension has been demonstrated, and findings suggest that arterial hypertension and organ complications of arterial hypertension are more frequent in workers with lead exposure. Until now, there have been no data on the effects of lead exposure on aortic stiffness. The aim of this study was to evaluate the effects of lead on aortic elasticity parameters.     

Atrial electromechanical coupling intervals in pregnant subjects

Atrial fibrillation (AF), which is the most common cardiac arrhythmia, may cause serious symptoms and impair quality of life.1 The development of AF is associated with many risk factors, including age, male gender, hypertension, heart failure, valvular disease, diabetes mellitus (DM) and left atrial (LA) enlargement.2-4 Electrical and/or mechanical remodelling of the atria is thought to be a pathophysiological characteristic of AF.5The pregnant state may be pro-dysrhythmic. This is related to the cardiovascular, hormonal, haemodynamic and autonomic changes during healthy pregnancy. Levels of oestrogen and β-human chorionic gonadotropin increase dramatically. Haemodynamic changes include an increase in circulating blood volume, which increases cardiac output. This results in myocardial stretch and an increase in cardiac end-diastolic volume. High plasma catecholamine concentrations and adrenergic receptor sensitivity increase sympathetic tone. All these changes in pregnant women may make them more prone to dysrhythmogenesis.6Most pregnant women complain of palpitations, dizziness and even syncope, but these symptoms are rarely associated with cardiac dysrhythmias. AF is the most common clinically significant cardiac arrhythmia in the general population but it is rarely seen in pregnant women. When it occurs, it can represent a benign, self-limited lone episode of AF or may be secondary to congenital or rheumatic valvular disease, hypertrophic cardiomyopathy, thyroid disease, or pre-excitation syndrome.Two simple electrocardiogram (ECG) markers, namely maximum P-wave duration (Pmax) and P-wave dispersion (PD), have been used to evaluate intra- and inter-atrial conduction times and the inhomogeneous propagation of sinus impulses, which are well-known electrophysiological characteristics of the atrium prone to fibrillation.7,8 Prolonged Pmax and PD have been reported to represent an increased risk for AF in patients with no underlying heart disease.7,8 Besides, evidence from laboratory and epidemiological research suggests that systemic inflammation may play a role in AF aetiology.9 It has also been demonstrated that atrial electromechanical coupling, measured by tissue Doppler imaging (TDI), as significantly longer in patients with paroxysmal AF than in control groups.10,11To our knowledge, no study evaluating PD and atrial electromechanical coupling has been investigated in pregnant subjects without additional systemic disease. Therefore, in this study we aimed to examine atrial electromechanical coupling and PD, reflecting inter-atrial conduction times in pregnant subjects.