Reversible reduction of apparent diffusion coefficient values in bilateral internal capsules in transient hypoglycemia-induced hemiparesis

A woman aged 68 years who experienced recurrent right hemiparesis caused by hypoglycemia was admitted to our hospital. When she was experiencing a low level of glucose, diffusion-weighted MR imaging showed the presence of hyperintensity lesions in the bilateral internal capsule. Diffusion-weighted MR imaging has been infrequently performed in patients with hypoglycemia. We report the reversible hyperintensity lesions on diffusion-weighted MR imaging in a hypoglycemic period in a patient with reversible hemiparesis. A reduction of apparent diffusion coefficient in a hypoglycemic period was clearly shown.     

Ultrasound-guided injection for MR arthrography of the hip: comparison of two different techniques

Objective

The purpose of this study was to prospectively evaluate the two different ultrasound-guided injection techniques for MR arthrography of the hip.

Materials and methods

Fifty-nine consecutive patients (21 men, 38 women) referred for MR arthrographies of the hip were prospectively included in the study. Three patients underwent bilateral MR arthrography. The two injection techniques were quantitatively and qualitatively compared. Quantitative analysis was performed by the comparison of injected contrast material volume into the hip joint. Qualitative analysis was performed with regard to extraarticular leakage of contrast material into the soft tissues. Extraarticular leakage of contrast material was graded as none, minimal, moderate, or severe according to the MR images. Each patient rated discomfort after the procedure using a visual analogue scale (VAS).

Results

The injected contrast material volume was less in femoral head puncture technique (mean 8.9?±?3.4?ml) when compared to femoral neck puncture technique (mean 11.2?±?2.9?ml) (p?<?0.05). The chi-squared test showed significantly more contrast leakage by femoral head puncture technique (p?<?0.05). Statistical analysis showed no difference between the head and neck puncture groups in terms of feeling of pain (p?=?0.744) or in the body mass index (p?=?0.658) of the patients.

Conclusion

The femoral neck injection technique provides high intraarticular contrast volume and produces less extraarticular contrast leakage than the femoral head injection technique when US guidance is used for MR arthrography of the hip.     

Mental health and quality of life in patients with chronic otitis media

The present study focused on the comparison of mental health and quality of life (QoL) between chronic otitis media (COM) patients and the hearing population. The patients with chronic otitis media and healthy control group were enrolled in the study. The duration and severity of the auditory impairment were recorded. In addition to hearing loss (HL), the findings of each patient’s other ear disorders (ear discharge and tinnitus) were also recorded. In both the groups, psychological symptom profile and health-related QoL were evaluated and compared using a sociodemographic questionnaire, the Symptom Check List 90-Revised Form (SCL-90-R), and the Short Form-36 (SF-36). According to SCL-90-R, somatization (p < 0.001), interpersonal sensitivity (p < 0.001), depression (p < 0.001), phobic anxiety (p < 0.001), and other subscores, and also global severity index score (p < 0.001) were significantly high in patient group when compared to the control group. The patients with COM reported significantly lower levels of QoL in terms of physical role difficulty (p < 0.001), general health perception (p < 0.004), social functioning (p < 0.001), and mental health (p < 0.017) than those of control subjects. Our results indicated that COM patients with mild or moderate HL have poorer life quality and higher psychological problems. Psychological well being should be also considered in assessment of COM patients in addition to the clinical evaluation and audiological tests.     

Neck masses: diagnostic analysis of 630 cases in Turkish population

Neck masses can be classified into three main categories: congenital, inflammatory and neoplastic. Our aim was to determine the distribution of diagnosis in patients who were followed-up for a neck mass and had undergone surgery for diagnostic indications. Six hundred and thirty cases referred to the Otorhinolaryngology and Head Neck Surgery Department of Haseki Research and Training Hospital between January 2005 and February 2012 with a neck mass who underwent excisional or incisional biopsy to establish a histopathologic diagnosis were retrospectively evaluated. Patients with a diagnosis of upper aerodigestive tract malignancy were excluded from the study. As well as the patients with thyroid masses were excluded. Only unknown primary neck masses were included in the study. The neck masses were categorized as inflammatory (33.49 %), congenital (18.9 %) or neoplastic (47.6 %). Neoplastic masses were either benign (51 %) or malignant (49 %) tumors. The most common causes were tuberculous lymphadenitis (40.28 %) among inflammatory masses, thyroglossal duct cysts (32.77 %) among congenital masses, pleomorphic adenoma (22.33 %) among benign neoplastic masses, and lymphoma (20 %) among malignant neoplastic masses. The most common types of mass were congenital in the 0–20 year age group, benign neoplastic in 21–40-year-old and malignant neoplastic in the >40-year group. Any neck mass, especially in an elderly patient, should be managed with caution as a considerable proportion may be malignant. In children and adolescents, a neck mass requiring surgery is most likely to be congenital. Tuberculosis should be considered as a cause of a neck mass due to a long-term inflammatory process in a developing country.     

The Differential Effects of Chaplain Interventions on Patient Satisfaction

There is an acute need to define the specific skills that make chaplains integral to the healthcare team. This prospective study attempts to identify those skills that may be specific to chaplains, for whom no other member of the health care team has similar training, and to examine if these skills have a differential effect on patient satisfaction. A total of 59 interventions were identified and grouped into 10 categories by focus groups comprised of chaplains. Subsequently, Principal Component Analysis yielded two independent variables; Component 1 representing the “Religious/Spiritual” dimension, and Component 2 representing the “Psychosocial” dimension of chaplains’ work. The two components were used in an OLS regression model to measure patient satisfaction. Interventions that comprise the “Religious/Spiritual” dimension may be considered to be specific skills that chaplains contribute to patient care and these have a slightly stronger correlation with patient satisfaction than the interventions of the “Psychosocial” dimension.     

Head posture in cleft lip and palate patients with oronasal fistula and its relationship with craniofacial morphology.

OBJECTIVE: This study aimed to evaluate the relationship between head posture and craniofacial morphology in nonsyndromic cleft lip and palate children with oronasal fistula. PATIENTS: A total of 31 cleft lip and palate patients with a mean skeletal age of 7.59 (+/-2.11) years were involved. Fifteen had complete unilateral cleft lip and palate, 13 had complete bilateral cleft lip and palate, and three had complete cleft palate. Each of the cleft patients was matched with a noncleft Class I subject, on the basis of sex and skeletal age. DESIGN: Lateral cephalograms were taken of all subjects in the standardized upright posture and in orthoposition. Sixteen postural parameters and 44 morphological parameters were evaluated. RESULTS: The correlations with the cranio-cervical and mandibulo-cervical parameters indicated a trend of retrusion in the incisors with extention of the head. The positive nontopographical relationship between the nasolabial angle and some of the postural parameters supplemented the retrusion tendency in the upper incisors with head extension. Vertical skeletal morphological parameters correlated with the postural parameters. Cranio-cervical parameters seemed to be mostly related to mandibular position. CONCLUSION: Most of the cranio-cervical parameters measured confirmed an increased cranio-cervical angulation in the cleft sample when compared to controls. This head posture change was associated with alterations in tooth position and craniofacial morphology when comparisons were made to the control group.     

Relationship Between Skin Diseases and Extracutaneous Complications of Diabetes Mellitus: Clinical Analysis of 750 Patients

Background

The relationship between skin diseases and extracutaneous complications in diabetes mellitus (DM) is unclear.

Objective

We aimed to investigate the relationship between skin disorders and diabetic neuropathy, nephropathy, and retinopathy in patients with DM.

Methods

A total of 750 patients with DM were prospectively enrolled. Demographic and clinical features, skin disorders, glycosylated hemoglobin (HbA_1c) levels, and presence of nephropathy, neuropathy, and retinopathy were noted.

Results

Of the patients, 38.0 % had neuropathy, 23.3 % had nephropathy, and 22.9 % had retinopathy. Any skin disorder was present in 79.2 % (n = 594) of patients. The most common skin manifestations were cutaneous infections (47.5 %), xerosis (26.4 %), and inflammatory skin diseases (20.7 %). The frequency of cutaneous infections, fungal infections, diabetic foot, rubeosis faciei, and pigmented purpuric dermatitis was higher in patients with nephropathy than in those without nephropathy. Cutaneous infections, diabetic foot, rubeosis faciei, and diabetic dermopathy were more common in patients with neuropathy. Fungal infections, diabetic foot, rubeosis faciei, diabetic dermopathy, and pigmented purpuric dermatitis were more frequent in patients with retinopathy. Patients with HbA_1c ≥8 mmol/mL had more skin disorders than those with HbA_1c <8 mmol/mL (P < 0.05 for all).

Conclusion

Skin disorders may be clues to the presence of associated microvascular complications of DM.     

Basal serum nitric oxide levels in patients with type 2 diabetes mellitus and different stages of retinopathy

PURPOSE: To compare the basal serum levels of nitric oxide (NO) in patients with type 2 diabetes mellitus and different stages of diabetic retinopathy (DR) with the levels in nondiabetic control subjects. METHODS: The 39 patients with type 2 diabetes included in this study were divided by stage of DR into 3 groups: group A, those without DR; group B, those with background/preproliferative DR; and group C, those with proliferative DR. Eleven nondiabetic subjects made up the control group (group D). The NO concentration was determined indirectly by measuring the serum level of nitrite (NO2-) plus nitrate (NO3-) (NOx = NO2- plus NO3-) using a spectrophotometric method based on the Griess reaction. RESULTS: The patients with type 2 diabetes had significantly higher levels of serum NOx than the nondiabetic controls (p = 0.0001). In addition, the levels in the patients with proliferative DR were significantly higher (p = 0.002) than the levels in the patients with nonproliferative or no DR. CONCLUSION: Our study demonstrated both elevated levels of serum NOx in diabetic patients as compared with nondiabetic controls and a relationship between NOx and DR severity. Hence, abnormal NO metabolism may have a role in the pathogenesis of DR.