Plasma testosterone response at 1st and 4th day after short- and long-term hCG stimulation test

Human chorionic gonadotropin (hCG) stimulation test is a reliable dynamic test for the evaluation of testicular function during childhood. Several protocols have been recommended but their reliability is controversial. In order to decide the best timing to measure stimulated testosterone levels in short- and long-term hCG protocols, we evaluated 83 prepubertal patients in two group. In group A, 34 patients with isolated micropenis and in group B, 49 inguinal cryptorchidic patients were enrolled. In group A short-term hCG protocol (3000 IU/m2/im/3 days) and in group B long-term hCG protocol (1500 IU/m2/im; thrice a week for 3 weeks) was administered. Blood samples were drawn at the initiation of the test and then at the 1st and 4th days after the last hCG injection. Each case's peak stimulated testosterone (Tmax) and the incremenet in plasma testosterone (deltaT) were calculated and compared with the 1st and 4th day responses within the group. In the short-term protocol the 4th day responses were higher than the 1st day responses (p<0.01). Interestingly, while four patients had insufficient responses at the 1st day, three had sufficient Leydig cell response at the 4th day. In the long-term protocol group, in contrast to the short-term group, the 1st day responses were higher than the 4th day (p<0.01). According to our results, while performing hCG test in a patient, if a short-term protocol is planned, it is more convenient to check the 4th day testosterone response. On the other hand, in a long-term protocol it is best to check the 1st day response. We suggest that even if a patient's 1st day response is inadequate, the 4th day response should be checked in order to avoid misdiagnosis.     

The analgesic efficacy of dipyrone during removal of nasal packings after septal surgery

Abstract Septoplasty is one of the most common nasal operations performed in otorhinolaryngological practice. At the end of the operation, most surgeons place nasal packings and remove them after 48–72 hours. The removal of the packings may be very painful. The objective of this study was to evaluate the analgesic effectiveness of dipyrone, when given before the procedure in a placebo-controlled, randomised design. Thirty-eight patients undergoing septal surgery at the Department of Otorhinolaryngology, Ankara University were included in this study. Twelve patients did not get any analgesic treatment during removal (control group). Ten patients received 2 ml of intramuscular (i. m.) physiological saline solution (placebo group) and sixteen patients were pretreated with 1 g of i. m. dipyrone 45 min prior to the removal of the nasal packings (treatment group). Pain intensity was measured prior to the procedure, just after the packings were removed (0 min) and then at 5, 10, 15, 20, 30, 60 and 120 min after the removal by using visual analogue scales, verbal scales and the percentage score. The groups were compared by using Kruskal–Wallis and Mann–Whitney tests. No significant difference in baseline pain scores was found before the procedure started. At 0, 5 and 10 min the dipyrone group showed significant lower pain intensity when compared to the control and placebo groups. Dipyrone was found to be effective in lowering initial pain intensity and in reducing it during the first 10 min after removal. We conclude that dipyrone is an effective agent when given before the procedure of removal of nasal packing-induced postprocedural pain.This study has been presented at the 6th Congress of the European Association for Clinical Pharmacology and Therapeutics, 24–28 June 2003, Istanbul     

Oxidative stress and antioxidant status in elderly diabetes mellitus and glucose intolerance patients

Increased oxidative stress and impaired anti-oxidant defense have been suggested as contributory factors for initiation and progression of complications in diabetes mellitus. Aging itself has been shown to be along with increased oxidative stress and lower anti-oxidant defense. We aimed at investigating oxidative stress and anti-oxidant enzymes in 61 elderly subjects. Fifteen healthy individuals (group 1, mean age 72.2 +/- 5.13), 13 glucose intolerant patients (group 2, mean age 71.7 +/- 4.9), 19 patients with type 2 diabetes mellitus (T2DM) without any complication (group 3, mean age 70.0 +/- 6.0), and 14 patients with T2DM with at least one complication (group 4, mean age 69.8 +/- 4.7) were included in the study. Whilst plasma levels for malondialdehyde (MDAP) and erythrocyte malondialdehyde (MDAE) were measured as markers of oxidative stress, activity of erythrocyte superoxide dismutase (SOD), glutathion peroxidase (GSH-Px), and catalase (CAT) were taken as markers of oxidative defense system. MDAP level was significantly elevated in group 4 (P = 0.001). MDAE was elevated in patients with T2DM, particularly in group 4, however, the difference between the groups was of borderline significance (P = 0.07). Whilst CAT was elevated in groups 3 and 4 compared to control subjects (P = 0.025 and 0.002, respectively), no difference was found for SOD between the groups. GSH-Px activity was found to be increased in groups 2, 3 and 4, it did not reach statistical significance (P = 0.106). There were significant correlations between CAT and MDAE (P < 0.0001, r = 0.056) and MDAP (P = 0.016, r = 0.306). These results suggest that there was an increased oxidative stress in elderly diabetics, however, this is not due to reduced erythrocyte antioxidant defense potential but, rather, increased free radical production possibly due to hyperglycemia.     

Diaphragmatic and crural FDG uptake in hyperventilating patients: a rare pattern important to recognize

The authors describe various patterns of F-18 fluorodeoxyglucose (FDG) accumulation in the diaphragm and crura. They present 6 patients in whom incidental diaphragmatic and crural uptake of FDG was observed during positron emission tomography (PET). Hyperventilation is thought to be the potential underlying mechanism of this condition.     

Structural and functional abnormalities in the islets isolated from type 2 diabetic subjects

Type 2 diabetic subjects manifest both disordered insulin action and abnormalities in their pancreatic islet cells. Whether the latter represents a primary defect or is a consequence of the former is unknown. To examine the beta-cell mass and function of islets from type 2 diabetic patients directly, we isolated islets from pancreata of type 2 diabetic cadaveric donors (n = 14) and compared them with islets from normal donors (n = 14) matched for age, BMI, and cold ischemia time. The total recovered islet mass from type 2 diabetic pancreata was significantly less than that from nondiabetic control subjects (256,260 islet equivalents [2,588 IEq/g pancreas] versus 597,569 islet equivalents [6,037 IEq/g pancreas]). Type 2 diabetic islets were also noted to be smaller on average, and histologically, islets from diabetic patients contained a higher proportion of glucagon-producing alpha-cells. In vitro study of islet function from diabetic patients revealed an abnormal glucose-stimulated insulin release response in perifusion assays. In addition, in comparison with normal islets, an equivalent number of type 2 diabetic islets failed to reverse hyperglycemia when transplanted to immunodeficient diabetic mice. These results provide direct evidence for abnormalities in the islets of type 2 diabetic patients that may contribute to the pathogenesis of the disease.     

Cardioprotection with resveratrol pretreatment: improved beneficial effects over standard treatment in rat hearts after global ischemia

OBJECTIVE: The major objective of the present study is to evaluate the potential role of resveratrol (RVT), a natural antioxidant found in grapes and red wine, in protecting the myocardium from the deleterious effects of ischemia-reperfusion (I/R) injury using isolated rat hearts. METHODS: Langendorff perfused isolated rat hearts were subjected to 60 min of global ischemia following 60 min of reperfusion. RVT was given according to chronic pretreatment and/or acute treatment protocols. Animals received RVT at the dose of 20 mg/kg via an intragastric tube for 14 days before the experiment and/or at the infusion concentration of 10 microM for 30 min before the onset of ischemia. The myocardial postischemic recovery was compared using hemodynamic data (peak systolic pressure, end diastolic pressure, and +dP/dtmax), coronary flow, biochemical parameters (LDH, CK-MB, cTnI, myoglobin) from coronary effluent, and oxidative stress markers (MDA, GSH, carbonyl) from heart tissue homogenates in each group. RESULTS: RVT pretreatment and treatment protocols have provided increased preservation in myocardial recovery following global ischemia compared to a non-treated group. Furthermore, the ischemic damage of myocardium was significantly lower in chronic pretreated rats than in the acutely treated group. In contrast, no significant difference was observed in cardioprotective effects of RVT between the only pretreated group, and both the pretreated and treated group throughout reperfusion. CONCLUSION: The findings from this study indicate that RVT has potent cardioprotective properties against I/R injury in rat hearts. The study also highlighted that the administration of RVT, as pretreatment, has amplified the beneficial effects over the standard treatment.     

Major determinants of optic nerve head topographic characteristics in a normal Turkish population

Aim: To determine the factors affecting the topographic characteristics of the optic nerve head in a normal Turkish population. Methods: A cross‐sectional study was performed on the optic nerve head of the right eyes of 613 healthy subjects of both sexes aged 11?77 years using a confocal scanning laser ophthalmoscope. The study population was divided into three groups (<20 years, 20?50 years, and>50 years) to evaluate age‐related changes in the optic nerve head topography. A total of 15 variables were determined. Statistical analysis was performed using Student's t‐test, anova, Tukey HSD test, linear regression analysis and Pearson's correlation coefficient. Results: Four eyes were excluded from the study due to poor image quality. There were 307 female subjects and 302 male subjects. The mean age of the subjects was 42.1 ± 15.1 years. The mean optic disc areas were 1.99 ± 0.45 mm² and 1.97 ± 0.41 mm² for male and female subjects, respectively. The disc area of the subjects ranged between 1.01 and 4.19 mm². Disc area was found to be associated with all of the optic nerve head variables studied, and was also found to be significantly increased with advancing age (P < 0.05). The only variable that showed a sex‐related difference was neuroretinal rim volume, which was found to be higher in female subjects in all cases. Conclusion: Optic disc area was found to be the main determinant of the optic nerve head topography in a normal population. Optic disc area was found to be significantly increased with ageing in a normal population. These acquired changes to the optic disc could suggest stretching of the scleral ring, which may highlight the role of advancing age on the pathogenesis of glaucomatous optic neuropathy.     

Lateral pectoral nerve conduction

The aim of this study was to measure the motor conduction time (MCT) and velocity of the lateral pectoral nerve (LPN) in normal subjects and patients with neuropathy. For the LPN, we determined thus the average MCT was 3.9 m/s using Erb stimulation with needle recording, and the average motor conduction velocity was 70.6 m/s using Erb stimulation and axilla stimulation with needle recordings in normal subjects. In patients, prolonged MCT in LPN was found in 3 of 6 patients with unilateral plexopathy and 3 of 4 patients with polyneuropathy. It was determined that MCT and motor conduction velocity in LPN was as sensitive as biceps brachii MCT in patients with unilateral plexopathy. Furthermore, the motor conduction velocity in the LPN may be beneficial to elucidate the localization of involvement in polyneuropathies, such as distal or proximo-distal.     

A fatal complication due to radiofrequency ablation for atrial fibrillation: atrio-esophageal fistula

Treatment of chronic atrial fibrillation with intraoperative radiofrequency ablation is gaining more acceptance in patients with rheumatic valve disease. This article reports a case of fatal atrio-esophageal fistula after radiofrequency ablation in a patient with rheumatic mitral and aortic valve disease with chronic atrial fibrillation.