Increased visfatin and leptin in pregnancies complicated by pre-eclampsia

Objective.?To evaluate the role of the adipokines, visfatin and leptin in the pathophysiology of pre-eclampsia and how their concentrations correlate with the severity of the disease and abnormal Doppler velocimetry.

Methods.?A cross-sectional study was carried out in 72 pregnant women (30 patients with mild pre-eclampsia, 20 patients with severe pre-eclampsia and 22 healthy normotensive pregnant women) during the third trimester of pregnancy. The maternal levels of plasma visfatin and serum leptin were determined in all cases by enzyme immunoassay and enzyme-linked immunosorbent assay, respectively. The uterine artery and umbilical artery RI were determined by Doppler analysis in all cases.

Results.?Plasma visfatin levels and serum leptin levels were higher in patients with pre-eclampsia than in the normotensive pregnant women. Six patients with mild pre-eclampsia and five patients with severe pre-eclampsia had abnormal Doppler velocimetry. Visfatin and leptin levels of pre-eclamptic patients with abnormal Doppler velocimetry were significantly higher than they were in those with normal Doppler velocimetry. Serum leptin levels were positively correlated with plasma visfatin level in cases of pre-eclampsia.

Conclusions.?These findings suggest that increased maternal levels of leptin and visfatin may be involved in the pathogenesis of pre-eclampsia, and measurement of these adipokines may be useful in assessment of the severity of disease.     

Modified Limberg Transposition Flap for Sacrococcygeal Pilonidal Sinus

Purpose. To investigate the results of wide rhomboid excision with Limberg transposition flap reconstruction to treat pilonidal sinus.Methods. We analyzed the well-documented records of 238 patients with sacrococcygeal pilonidal sinus who underwent wide excision with a Limberg transposition flap and were followed up for longer than 1 year postoperatively. After the first 40 operations, we modified this flap reconstruction by tailoring the rhomboid excision asymmetrically to place the lower pole of the flap 1–2cm lateral to the midline. Wound infection rates, hospitalization, time required for free mobilization, and recurrence rates were recorded.Results. Postoperative infection developed in two patients (0.8%), which was easily managed by wound care, antibiotics, removal of skin staples, prolonged drainage, or a combination of these treatments. The mean hospitalization was 2.10 ± 0.20 days (range 1–3 days), and the mean time required for recovery and return to daily activities was 8.00 ± 2.50 days (range 4–17 days). There were only three recurrences (1.26%) after a mean follow-up of 29.20 ± 3.10 months (range 12–38 months). Since we started performing our modification of the technique by lateralization of the inferior apex, no further recurrences have been seen. The recurrence rate differed significantly between the classical Limberg flap group and the modified Limberg flap group (P = 0.004)Conclusion. These results provide further evidence that wide excision with a Limberg transposition flap reconstruction is an effective surgical method for primary or recurrent pilonidal sinus, associated with a low complication rate, short hospitalization and disability, and a low recurrence rate. A modification of the technique was devised to further enhance wound healing and reduce the risk of recurrence.     

Accuracy of magnetic resonance imaging for preoperative detection of portal vein thrombosis in liver transplant candidates.

The detection of main portal vein thrombosis (PVT) on preoperative imaging of liver transplant candidates has important technical implications for the transplantation procedure. Data are scarce regarding the accuracy of magnetic resonance imaging (MRI) at detecting PVT. The aim of our study was to compare preoperative findings of the portal vein on MRI to operative findings at liver transplantation. Abdominal MRI and clinical records of 172 consecutive patients who received liver transplants between January 1999 and September 2004 were reviewed. Two radiologists independently evaluated the last abdominal magnetic resonance examinations obtained before liver transplantation, blinded to the original reading, operative findings, and clinical data. Findings on MRI were compared with intraoperative findings at transplantation. Main PVT was detected in 12 patients, in whom 8 were found to have thrombus at surgery, with 6 requiring a jump graft or thrombectomy. Sensitivity and specificity of MRI for detecting main PVT were 100% and 98%, respectively. The cause of discordance between findings on MRI and at transplantation in 2 cases was a diminutive caliber of the main portal vein that was interpreted as recanalized chronic thrombosis on MRI. In conclusion, in our study group MRI detected PVT in all liver transplant recipients requiring jump grafts at transplantation. The major reason for a false-positive MRI was a diminutive but patent portal vein.     

Necdin–E2F4 interaction provides insulin-sensitizing effect after weight loss induced by gastric bypass surgery

BackgroundThe insulin-like growth factor-1 (IGF-1) signaling pathway promotes adipocyte differentiation and, therefore, insulin sensitivity by suppression of necdin expression, which represses peroxisome proliferator-activated receptor-gamma promoter activity by interaction with E2F4 in mouse adipocytes. The aim of the present study was to test the hypothesis that this pathway represents one of the mechanisms by which Roux-en-Y gastric bypass surgery (RYGB) induces resolution of insulin resistance.MethodsClinical samples were collected and the key biomarkers measured to test the hypothesis that the IGF-1 pathway represents 1 of the mechanisms by which RYGB induces resolution of insulin resistance in obese individuals.ResultsFree IGF-1 levels were significantly greater in the post-RYGB patients than in the pre-RYGB obese patients (2.55 ± 1.54 versus 1.32 ± .65 μg/L, P = .03) and similar to that in normal weight controls (2.54 ± 1.27 μg/L). Necdin and E2F4 gene expression in the adipose tissue was significantly downregulated after RYGB compared with obese and were similar to the levels observed in the controls. In mature human adipocytes cultured in vitro, treatment with des-IGF-1 induced downregulation of necdin and E2F4 gene expression in a dose-dependent manner (P = .01).ConclusionAfter RYGB, the insulin/IGF-1 signaling pathway is activated and could account for the observed decrease in the expression of necdin, which represses peroxisome proliferator-activated receptor-gamma promoter activity by interaction with E2F4. This could represent one of the mechanisms that induce resolution of insulin resistance after RYGB.     

Volumetric MRI assessment of brain regions in patients with refractory obsessive-compulsive disorder

No prior study to date has examined the comparisons of the structures that have been implicated in obsessive-compulsive disorder (OCD) in patients with refractory OCD, those who are treatment-responded and healthy controls concurrently. Therefore, we performed a volumetric MRI study in patients with refractory OCD, those with treatment responding OCD and healthy controls. Morphometric MRI was used to compare in thirty patients with OCD and ten healthy controls. Of the patient group, ten were first applying patients, ten were treatment-responded and the rest were refractory OCD patients. As a whole group, OCD patients had increased white matter volume than healthy controls. First applying patients had significantly smaller left and right orbito-frontal cortex (OFC) volumes compared with treatment-responded patients and healthy controls, with a significant difference between refractory patients and treatment-responded patients and with no significant difference was found between the volume of first applying patients compared to that of refractory patients. Anterior cingulate exhibited a near-significant difference only between first applying patients and healthy controls on left side. First applying patients had significantly greater left and right thalamus volumes compared with treatment-responded patients and healthy controls and there was a considerable difference in regard to thalamic volumes between refractory patients and treatment-responded patients. Taken together, our findings suggest that reductions in OFC and increase in thalamic volumes may be associated with refractoriness of OCD and may not be due to changes in cingulate and caudate regions.     

Association of SNAP-25 Gene Ddel and Mnll Polymorphisms with Adult Attention Deficit Hyperactivity Disorder

Objective

The synaptosomal-associated protein of 25 kDa (SNAP-25) gene is a presynaptic plasma membrane protein and an integral component of the vesicle docking and fusion machinery mediating secretion of neurotransmitters. Previously, several studies reported association between SNAP-25 and attention deficit hyperactivity disorder (ADHD). We investigated whether these SNAP-25 polymorphisms (MnlI T/G and DdelI T/C) were also associated with ADHD in the Turkish population.

Methods

Our study comprised unrelated 139 subjects who met DSM-IV criteria for ADHD and 73 controls and all were of Turkish origin. Genetic analyses were performed and patients were evaluated with Wender-Utah Rating Scale and Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale.

Results

SNAP-25 DdelI polymorphism was not associated with ADHD but there was a statistically significant difference between ADHD patients and controls for SNAP-25 MnlI polymorphism. For SNAP-25 MnlI polymorphism patients with G/G genotype of the SNAP-25 gene MnlI polymorphism had higher Wender-Utah scores and higher scores in the 1st and 3rd parts of adult ADD/ADHD Scale.

Conclusion

We detected a significant association of the MnlI polymorphism in our ADHD sample which was similar to previous findings. Our study also revealed that SNAP-25 MnlI polymorphism was also associated with symptom severity of ADHD. This study is also, the first report on the association of SNAP-25 with ADHD in the Turkish population.     

Is multiple sclerosis a risk factor for atherosclerosis?

BackgroundMultiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. We aimed to discuss possible predisposing factors to atherosclerosis such as carotid intima-media thickness (CIMT) and high-sensitivity C-reactive protein (Hs-CRP) levels in MS.MethodsThirty-five ambulatory patients with relapsing-remitting MS (RRMS) (22 females and 13 males) and 34 healthy controls (21 females and 13 males) with similar demographic variables were included. Blood cell counts, cholesterol levels, vitamin D and B12, Hs-CRP levels, body mass index (BMI), history of smoking, and CIMT of both groups, Expanded Disability Status Scale (EDSS) scores, and disease duration of patients were recorded. Patients with a history of other vascular diseases such as hypertension, diabetes mellitus, peripheral artery disease, and acute relapses were excluded.ResultsSixty-nine participants were included. The mean age of the study population was 35.8 ± 7.1 years. Right CIMT was significantly greater in the patient population (P < 0.001). Spearman's correlation coefficient between age and right CIMT was r = 0.41, P = 0.01. When we compared the Hs-CRP with a cut-off value of ≤ 3, the right, left, and mean CIMT levels were not statistically significant (P = 0.17; P = 0.22; P = 0.15). The mean serum vitamin D levels were higher in the patient group and this was statistically significant (P < 0.001). The statistically significant factors identified with univariate analysis with P < 0.2 were further entered into multivariate modelling.ConclusionCIMT seems to be affected in patients with MS by means of the disease itself and age. Thus, CIMT might reflect the predisposition to subclinical atherosclerosis more than Hs-CRP. Further investigation in a large MS population is still needed.     

Hemihypomimia,a rare persistent sign in Parkinson’s disease

Background Typical hypomimia develops in almost all Parkinson’s disease (PD) patients. We observed the presence of hemihypomimia (HH) in some of our PD patients. Objective To discern the presence of hemihypomimia, to compare clinical features of these patients with the patients without HH and then to evaluate HH prospectively. Methods Among 353 patients with PD followed-up between September 2003 and December 2004, 204 patients in stage 2 of Hoehn-Yahr were evaluated and hemihypomimia was observed in 13 PD patients (6.4%). Two groups were compared with respect to the age of onset of the first PD symptom, duration of PD and the body side affected predominantly. In addition, persistence of HH was prospectively evaluated in 11 of 13 patients with HH up to two-year-follow up period. Results Hemihypomimia was interestingly on the right side of the face in all patients. Of these 13 HH patients, all but one had predominantly right-sided PD symptomatology. In the comparison of HH patients with the remaining group (n = 191), patients with HH had significantly earlier onset of PD symptoms (mean: 53.9 vs 58.5 years), and shorter PD duration (mean: 4.0 vs 6.2 years) (p < 0.01). Up to two-year-follow up, hemihypomimia, which was not changed by several triggered emotional facial expressions, clinically persisted. Conclusion Our observations suggest that hemihypomimia is a rare phenomenon in PD, especially in PD patients having early-onset and shorter PD duration which may persist for several years in concordance with typical asymmetrical involvement of the limbs. HH developed in the right side, prominently on the lower part of the face. Understanding the underlying mechanism(s) about how hemihypomimia appears, and why it dominantly affects the right side of the face deserves further assessment. Received in revised form: 23 April 2006     

Iniencephaly and long-term survival: a rare case report

Introduction Iniencephaly, a neural tube defect involving occiput and inion and combined with rachischisis of the cervical, thoracic spine, and retroflexion position of the head is a very rare congenital abnormality of the fetus–newborn with a 0.1–10 of 10,000 prevalence. This abnormality’s prognosis is thought to be dismal. This abnormality can be associated with other abnormalities such as anencephaly, encephalocele, hydrocephalus, cyclopia, absence of the mandible, cleft lip and palate, cardiovascular disorders, diaphragmatic hernia, renal abnormalities, overgrowth of the arms compared to the legs, and club food and gastrointestinal atresia. Discussion Most of the patients are dead born, and the others die in a few hours. There are only six previously documented long-term survivors. In our case, our patient with iniencephalic signs and findings is still living. She is 2 years old now. We think that this patient presents a mild form of iniencephaly.