Color Doppler sonography of orbital and vertebral arteries in migraineurs without aura

PURPOSE: The objective of this study was to investigate whether the retrobulbar hemodynamics in the ophthalmic (OA), posterior ciliary (PCA), central retinal (CRA), and vertebral (VA) arteries are affected in migraineurs without aura. METHODS: The eyes of migraineurs without aura and those of healthy control subjects were evaluated during both headache and headache-free periods. Retrobulbar and vertebral blood flow velocities in the OA, PCA, CRA, and the extracranial part of the VA were measured bilaterally using color Doppler sonography. The peak systolic and end-diastolic flow velocities and the pulsatility (PI) and resistance (RI) indices were determined for all arteries. RESULTS: In total, we enrolled 30 migraineurs and 31 healthy control subjects. Statistically significant differences between headache-free migraineurs and control subjects were observed in the PI and RI of both right and left PCAs and in the RI of both right and left CRAs. The PI and RI of the left VA of the migraineurs were significantly lower during both headache and headache-free periods than were those of the control subjects. Among the migraineurs, the peak systolic and end-diastolic velocities of the left VA were increased during headache periods relative to those found during the headache-free periods. CONCLUSIONS: The retrobulbar circulation and flow hemodynamics in the left VA may be altered in both headache and headache-free periods in migraineurs without aura. The differences found between migraineurs and control subjects may implicate autonomic dysfunction in migraineurs.     

Reliability and validity of Turkish version of the patient rated tennis elbow evaluation

The objective of this study was to test the reliability of the Turkish version of PRTEE (PRTEE-T) as a specific scale for LE, and to investigate the validity of this version by correlating and comparing its outcomes with those of the scales DASH (the Disabilities of the Arm, Shoulder, and Hand questionnaire) and Quick DASH (QDASH), pain (VAS), tenderness, and maximal grip strength (MGS). Fifty patients (14 males and 36 females) with the diagnosis of lateral epicondylitis were included in this study. PRTEE Questionnaire was translated into Turkish according to the guideline for the cross-cultural adaptation process. All patients filled the PRTEE-T questionnaire. Maximal grip strength, pain, and tenderness were measured. Next, the patients filled the DASH forms. The patients were asked to reevaluate PRTEE-T 2 h after they filled the first form. The internal consistency reliability of PRTEE-T was assessed by calculating ‘if item deleted’ using Cronbach alpha and ‘Item–total correction’ coefficient for each item of the questionnaire. Consistency of subscales was assessed using Spearman’s rho correlation coefficient. In addition to correlation analysis, test–retest values were compared using Wilcoxon test to assess the changes on the basis of the items. Criterion validity of the scale was measured using DASH and QDASH scales, and construct validity was measured using tenderness and maximal grip strength values by Spearman’s rho correlation coefficient. For internal reliability; Cronbach alpha coefficient was calculated 0.837 by the overall assessment of the scale. For test–retest reliability; correlation coefficient was found 0.920 (P < 0.001). Comparison of the scores obtained from test–retest measurements showed no significant difference (P > 0.05). The pain sub-scale, the function sub-scales, and the overall score from the PRTEE-T each showed significant correlations with the DASH score (P < 0.001), QDASH score (P < 0.001), and maximal grip strength (P < 0.001). Significant correlation was found between the sub-scales of the scale. The results of our study have shown that the Turkish version of a specific and practical scale developed for LE can be both valid and reliable. PRTEE-T is easy to apply in a relatively short period and may prove to be valuable for evaluation and follow up of the patients in daily clinical practice.     

Brown tumor of the sacral spine in a patient with low-back pain

We present a case of a 44-year-old woman with an unusual location of a brown tumor in the sacral vertebrae due to parathyroid adenoma. She was admitted to our clinic with the complaint of low-back pain and was later diagnosed to have a brown tumor. The patient underwent surgery and partial sacrectomy and iliac wing resection was performed in Orthopedic Surgery Department. Subsequently the patient underwent parathyroid adenoma excision in General Surgery Department. On her control examination at postoperative 3 months, she had no pain and was able to perform daily activities without any problem. We believe it is an interesting clinical case both because it shows a very rare localization of brown tumor and points out the importance of employing a wide clinical scope in the differential diagnosis of back pain.     

Determinants and definition of abdominal obesity as related to risk of diabetes, metabolic syndrome and coronary disease in Turkish men: a prospective cohort study

We aimed to investigate determinants of abdominal obesity and its clinical impact on metabolic syndrome (MS), diabetes (DM) and coronary heart disease (CHD) in men. METHODS: Prospective evaluation of 1638 male participants (aged 48.5+/-12.3), representative of Turkey's men who have a high prevalence of MS. For components of MS, criteria of NCEP guidelines were adopted, modified for abdominal obesity. Follow-up constituted 9650 person-years. RESULTS: Insulin level (relative risk [RR] 1.40 for doubling), C-reactive protein (CRP) and heavy smoking (protective) were independent predictors of newly developing abdominal obesity. High triglyceride and low HDL-cholesterol were significantly associated already with waist girth quartile II, apolipoprotein B with quartile III. Waist girth significantly predicted future MS from quartile II on, independent of insulin resistance (IR) by homeostatic model assessment, whereby its hazard ratio (HR, 2.6) exceeded double that of HOMA. CRP independently predicted MS. Age-adjusted HR of waist girth (1.59) was significant in predicting DM. Age- and smoking-adjusted top waist quartile conferred significant risk for incident CHD (RR 1.71) but not for overall mortality. As judged by sensitivity and specificity rates for future CHD, DM and MS, abdominal obesity was most appropriately defined with a waist girth of >or=95 cm, and an action level 1 of >or=87 cm was proposed for MS in this population. CONCLUSIONS: Serum insulin, CRP levels and (inversely) heavy smoking are predictors for abdominal obesity in Turkish men. Atherogenic dyslipidemia and elevated blood pressure are associated significantly already with modest rises in waist girth adjusted for age and smoking. Abdominal obesity shows substantial independence of IR in the development of MS. Increasing waist girth was predictive of MS, more strongly than of DM. Risk for CHD imparted by abdominal obesity is essentially mediated by risk factors it induces.     

Biomechanical evaluation in osteoporosis: ovariectomized rat model

The aim of our study was to investigate the effects of ovariectomy on rat femur biomechanical parameters. Bone mineral density (BMD) and histological investigation were also evaluated. Fourteen female Sprague–Dawley rats (seven ovariectomized, seven control) were used. BMD was measured by dual-energy X-ray absorbsiometry. Bone biomechanical parameters were measured in femoral midshaft with tensile test using a biomaterial testing machine and maximum load, stiffness, energy absorption capacity (structural properties), ultimate stress, ultimate strain, and elastic modulus (material properties) were calculated. Diaphyseal cortical bone thickness was measured by using histological method. The ovariectomized (OVX) rat femur’s BMD was 14% lower than control rats (p=0.006). Mean maximum load was 55% less than the control group’s (p=0.0001). Stiffness was 72% less in OVX rats (p=0.05). Femurs of rats with OVX had 32% less absorbed energy than controls (p=0.09). From the stress–strain curve ultimate stress, ultimate strain and elastic modulus was calculated. Elastic modulus was 53% less than controls (p=0.05). Ultimate stress decreased 21% in OVX rats (p=0.097). Ultimate strain was 25% less than controls in OVX rats. Cortical thickness was significantly decreased in OVX rats than in controls (p<0.05). In conclusion, femur biomechanical parameters are decreased in osteoporosis.     

Aberrant IgG galactosylation precedes disease onset,correlates with disease activity,and is prevalent in autoantibodies in rheumatoid arthritis

Objective

To examine the association between aberrant IgG galactosylation and disease parameters in rheumatoid arthritis (RA).

Methods

Analysis of N‐glycan in serum samples from multiple cohorts was performed. The IgG N‐glycan content and the timing of N‐glycan aberrancy relative to disease onset were compared in healthy subjects and in patients with RA. Correlations between aberrant galactosylation and disease activity were assessed in the RA cohorts. The impact of disease activity, sex, age, anti–cyclic citrullinated peptide (anti‐CCP) antibody titer, disease duration, and C‐reactive protein level on aberrant galactosylation was determined using multivariate analysis. The N‐glycan content was also compared between epitope affinity–purified autoantibodies and the remaining IgG repertoire in RA patients.

Results

Our results confirm the aberrant galactosylation of IgG in RA patients as compared with healthy controls (mean ± SD 1.36 ± 0.43 versus 1.01 ± 0.23; P < 0.0001). We observed a significant correlation between levels of aberrant IgG galactosylation and disease activity (Spearman's ρ = 0.37, P < 0.0001). This correlation was higher in women (Spearman's ρ = 0.60, P < 0.0001) than in men (Spearman's ρ = 0.16, P = 0.10). Further, aberrant IgG galactosylation substantially predated the onset of arthritis and the diagnosis of RA (3.5 years) and resided selectively in the anticitrullinated antigen fraction.

Conclusion

Our findings identify aberrant IgG galactosylation as a dysregulated component of the humoral immune response in RA that begins prior to disease onset, associates with disease activity in a sex‐specific manner, and resides preferentially in autoantibodies.

     

Severe coronary artery disease in a 21-year-old girl with pseudoxanthoma elasticum and anomalous origin of the right coronary artery

Pseudoxanthoma elasticum (PXE) is a genetic disorder characterized by progressive calcific degeneration and fragmentation of the elastic fibres.We present a patient with PXE who had premature atherosclerosis that had involved severely all major coronary vessels as well as an anomalous origin of right coronary artery.