Gabapentin therapy improves heart rate variability in diabetic patients with peripheral neuropathy

PurposeDiabetic cardiac neuropathy, which is characterized by reduced heart rate variability (HRV), frequently coexists with peripheral neuropathy. Gabapentin has been used for the treatment of diabetic neuropathy. We aimed to evaluate the possible effect of gabapentin treatment on autonomic function in patients with type 2 diabetes via HRV.MethodsThirty patients with type 2 diabetes mellitus and peripheral neuropathy and 28 age- and sex-matched healthy controls were consecutively registered. Each patient underwent HRV measurements, and diabetic patients were administered gabapentin. After 3 months of gabapentin therapy, HRV parameters were measured again.ResultsBaseline HRV parameters were blunted in patients with diabetes mellitus according to the controls [standard deviation of all NN intervals (SDNN, ms): 106.3±29.9 vs. 148.8±36.5, P=.001; power spectrum of the high-frequency band (HF, ms²): 133.6±98.3 to 231.4±197.6, P=.02; power spectrum of the low-frequency band (LF, ms²): 341.8±247.8 to 511.5±409.4, P=.048; LF/HF ratio: 3.3±2.4 to 2.6±1.5, P=.33]. After 3 months of treatment with gabapentin, some HRV parameters showed some improvement. SDNN (106.2±29.8 to 119.4 ± 25, P=.016) and HF (133.6±98.3 to 167.6±118.3, P=.021) increased significantly. LF/HF ratio decreased (from 3.3±2.4 to 2.3±1.9, P=.039) and LF remained unchanged (341.8±247.8 to 352.3±228.9, P=.88).ConclusionsTherapeutic doses of gabapentin not only alleviate neuropathic symptoms but also improve cardiac autonomic function in diabetic patients with peripheral neuropathy.     

Assessment of atrial conduction time by tissue Doppler echocardiography and P-wave dispersion in patients with mitral annulus calcification

The aim of our study was to investigate atrial conduction time in patients with mitral annulus calcification (MAC) using P-wave dispersion (PWD) and electromechanical coupling measured with the surface electrocardiogram and the tissue Doppler echocardiography. Fifty-nine patients with MAC and 43 control subjects underwent resting the surface electrocardiogram and tissue Doppler echocardiography. The difference between the maximum (Pmax) and minimum P-wave durations was calculated and defined as PWD. Interatrial and intraatrial electromechanical delays were measured with tissue Doppler echocardiography. Both Pmax and PWD were higher in patients with MAC compared with controls (111.4 ± 15.8 vs 97.3 ± 18.8 milliseconds; P < .0001 and 46.4 ± 14.6 vs 31.4 ± 13.1 milliseconds; P < .0001, respectively). Both interatrial and intraatrial conduction time were also delayed in patients with MAC compared with controls (29.8 ± 13.3 vs 17.6 ± 12.5 milliseconds; P < .0001; 9.4 ± 5.1 vs 6.8 ± 4.0 milliseconds; P < .008, respectively). Left atrial (LA) diameter was significantly higher in patients with MAC compared with controls (35.4 ± 5.0 mm vs 32.3 ± 4.2 mm; P < .001). The LA diameter correlated significantly with both interatrial conduction times and PWD (r = 0.56; P < .0001 and r = 0.47; P < .0001, respectively). There is a delay in both intraatrial and interatrial electromechanical coupling intervals in patients with MAC.     

Comparison of the effects of octreotide and melatonin in preventing nerve injury in rats with experimental spinal cord injury.

In this study, we aimed to investigate the biochemical and histopathological protective effects of octreotide and melatonin in an experimental model of spinal cord injury. Fifty- six male albino Wistar rats were divided into four groups. Rats in the G1 group (n=7; control group) did not undergo any treatment except for anesthesia prior to being killed. Rats in the G2 group (n=7) underwent laminectomy and aneurysmal clip application at the T4-5 level. G3 group rats (n=14) were either treated with a 7.5 mg/kg intraperitoneal dose of melatonin (Sigma, St. Louis, MO, USA) immediately after laminectomy, then the same dose again on the day following injury (G3a), or given three equal doses over 10 days to achieve a total dose of 7.5 mg/kg/day (G3b). G4 group rats (n=14) were either treated with a 30microg/kg intraperitoneal dose of octreotide (Sandostatin; Novartis, Istanbul, Turkey) immediately after laminectomy, then the same dose again on the day following injury (G4a), or given three equal doses over 10 days to achieve a total dose of 30miocrog/kg/day (G4b). Rats in the G3 and G4 groups were sacrificed on days 1 and 10 after spinal cord injury (n=7 at each time point) and spinal cord samples were obtained. Tissue malonyldialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) levels were assayed. G3a, G3b and G4b had significantly lower levels of MDA than G2 (p<0.01). G3b had significantly higher SOD and GSH-Px levels than G2 (p<0.01). Histopathologically, melatonin significantly reduced necrosis and degeneration in both the initial and late stages (p<0.01). Octreotide had significant effects on necrosis and degeneration during the late stages, and on edema and congestion in both the initial and the late stages of injury (p<0.01). Melatonin was found to be superior to octreotide with respect to the prevention of congestion, edema, axonal degeneration and necrosis.     

Intraocular antibody synthesis against rubella virus and other microorganisms in Fuchs' heterochromic cyclitis

Introduction  

Fuchs' heterochromic cyclitis (FHC) is a common intraocular disease of uncertain etiology that has recently been related to rubella virus (RV) infection.     

Effects of posterior capsular opacification on the evaluation of retinal nerve fiber layer as measured by Stratus optical coherence tomography

ObjectiveTo evaluate the effects of posterior capsular opacification (PCO) and Nd:YAG laser capsulotomy on the evaluation of peripapillary retinal nerve fibre layer (RNFL) as measured by Stratus (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography (OCT).DesignProspective interventional case series.ParticipantsWe studied 98 eyes of 89 patients experiencing PCO.MethodsWe performed a complete ophthalmologic examination and evaluation of RNFL as measured by Stratus OCT before and after Nd:YAG capsulotomy. The patients were classified on the basis of PCO score or signal strength (SS) obtained by prelaser OCT scans.ResultsThe preoperative and postoperative peripapillary RNFL thicknesses were 90.24 ± 15.9 μm and 98.27 ± 14.1 μm, respectively (p < 0.001). The mean preoperative SSs were 5.4 ± 1.6, and they improved to 9.5 ± 0.5 postoperatively (p < 0.001). Prelaser and postlaser RNFL thicknesses differed significantly in eyes with preoperative SSs less than 7 (p < 0.05). Also, in patients with preoperative PCO grades higher than 2, there were significant increases in RNFL thickness after laser capsulotomy (p < 0.05).ConclusionRNFL thickness measured by the Stratus OCT is affected by PCO. RFNL thickness may be underestimated in eyes with preoperative PCO grades higher than 2 and in eyes with preoperative SSs lower than 7.     

C-reactive protein, procalcitonin, interleukin-6, vascular endothelial growth factor and oxidative metabolites in diagnosis of infection and staging in patients with gastric cancer

AIM: The current study was to determine the serum/plasma levels of VEGF, IL-6, malondialdehyde (MDA), nitric oxide (NO), PCT and CRP in gastric carcinoma and correlation with the stages of the disease and accompanying infection. METHODS: We examined the levels of serum VEGF, IL-6, PCT, CRP and plasma MDA, NO in 42 preoperative gastric cancer patients and 23 healthy subjects. There were infection anamneses that had no definite origin in 19 cancer patients. RESULTS: The VEGF levels (mean+/-SD; pg/mL) were 478.05+/-178.29 and 473.85+/-131.24 in gastric cancer patients with and without infection, respectively, and these values were not significantly different (P>0.05). The levels of VEGF, CRP, PCT, IL-6, MDA and NO in cancer patients were significantly higher than those in healthy controls and the levels of CRP, PCT, IL-6, MDA and NO were statistically increased in infection group when compared with non-infection group (P<0.001). CONCLUSION: Although serum VEGF concentrations were increased in gastric cancer, this increase might not be related to infection. CRP, PCT, IL-6, MDA and NO have obvious drawbacks in the diagnosis of infections in cancer patients. These markers may not help to identify infections in the primary evaluation of cancer patients and hence to avoid unnecessary antibiotic treatments as well as hospitalization. According to the results of this study, IL-6, MDA, NO and especially VEGF can be used as useful parameters to diagnose and grade gastric cancer.     

Vascular endothelial function and plasma homocysteine levels in Behcet's disease

The purpose of the present study was to test endothelial function and to determine if plasma homocysteine levels are associated with endothelial injury in patients with Behcet's disease (BD). Flow-mediated dilation in patients with BD was smaller than that of control subjects (p = 0.001), and mean plasma homocysteine levels in patients with BD were significantly higher (p = 0.0001). On regression analysis, only mean plasma homocysteine concentration was independently related to flow-mediated dilation (F = 5.7, p = 0.001).     

Irreducible open posterolateral knee dislocation due to medial meniscus interposition

Posterolateral knee dislocations are generally irreducible due to the interposition of the medial capsule and retinaculum. These injuries have a 'dimple sign' which shows the invagination of the tissues in the medial joint line. We present an unusual case of an open posterolateral traumatic knee dislocation (KD-4 [ACL/PCL/MCL/LCL-PLC torn] open knee dislocation) without a 'dimple sign'. Closed reduction attempts were unsuccessful. In surgery, it was found that the medial meniscus was detached from the meniscocapsular junction and entrapped in the joint. The medial meniscus was extracted from the joint, and the joint was reduced. The medial meniscus was sutured to the meniscocapsular junction with anchors. This is the first study reporting medial meniscus interposition in an open posterolateral knee dislocation. Moreover, the presented case is peculiar because although it was a posterolateral knee dislocation, the posterolateral ligament complex was also torn.