Corticotropin and cortisol response to maximal exercise testing in central diabetes insipidus

BACKGROUND: It is known that arginine vasopressin (AVP) has a stimulatory effect on corticotropin (adrenocorticotropic hormone; ACTH) and cortisol secretion especially during stress. The present study was designed to investigate the effect of stress on ACTH and cortisol levels in patients with central diabetes insipidus (DI) with endogenous AVP deficiency receiving AVP therapy, and to determine whether these children need steroid replacement during stress. METHODS: Seven patients with a median age of 12 years (range 7-13 years) with idiopathic central DI on appropriate Desmopressin (DDAVP) therapy (group 1) and seven healthy controls with a median age of 15 years (range 13-20 years; group 2) were included in the study. Acute stress was produced in all children by treadmill exercise, assessed by maximal oxygen consumption and heart rate. ACTH and cortisol levels were determined before and after exercise. RESULTS: In group 1, median ACTH level after exercise (28.3 pg/mL) was not different from the median value (24.0 pg/mL) before exercise. However, median cortisol level (10.5 microg/dL) was significantly increased (14.9 microg/dL; P < 0.05) with exercise. In group 2, cortisol (median 9.3 microg/dL) and ACTH levels (median 6.3 pg/mL) were significantly increased after exercise (15 mug/dL and 13.6 pg/mL, respectively; P < 0.05). There was no significant difference between the groups with respect to cortisol levels before and after exercise, but the stimulated ACTH levels after exercise were higher in patients with DI than in the controls (P < 0.05). A positive correlation was observed between total daily DDAVP dose and cortisol level after exercise (r(s)= 0.786, P < 0.05). CONCLUSIONS: Cortisol response during acute stress is normal in children with DI and these patients do not need extra steroid treatment during stress. In contrast, the normal cortisol response obtained by increased ACTH levels in these patients indicates an increased sensitivity of corticotroph cells.     

Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options

Objectives

We aimed to present our experience regarding the unusual vascular complications and specific treatment strategies in patients who underwent transradial coronary procedure (TRC).

Background

Transradial access provides lower vascular access site complication rates compared with transfemoral access. However, there is lack of data obtained from large study populations concerning the incidence and treatment strategies of hemorrhagic and vascular complications following a TRC in the literature.

Methods

10,324 patients (2,652 patients with percutaneous coronary intervention and 7,672 patients with a diagnostic transradial coronary angiography) who underwent a TRC from February 2010 to December 2014 were reviewed to identify cases of large hematoma, perforation, arteriovenous fistula, and pseudoaneurysm.

Results

The observed incidence was 0.44% (45 patients) for all unusual vascular and hemorrhagic complications. Of these 45 patients; 32 patients (0.31%) presented with large hematoma (≥6 cm), 8 patients (0.08%) presented with perforation, 4 patients (0.04%) presented with arteriovenous fistula (AVF), and only 1 case (0.009%) presented with radial artery pseudoaneurysm. Forty‐one of forty‐five patients were managed with mechanical compression. Surgery was performed in only 3 cases; a patient with a brachial artery perforation leading to compartment syndrome, a patient with AVF resulting in limb ischemia, and a patient with radial artery pseudoaneurysm. A right internal mammarian artery perforation resulting in huge breast hematoma was treated via endovascular graft stent implantation.

Conclusions

Hemorrhagic and vascular complications are rarely seen during TRC. However, majority of these complications could be managed conservatively without a requirement for surgical reconstruction. (J Interven Cardiol 2015;28:305–312)

     

Elevation of serum and urinary carbohydrate antigen 19-9 in benign hydronephrosis

OBJECTIVE: The aim of this study was to find out the predictive role of serum and urinary carbohydrate antigen 19-9 levels in benign hydronephrosis and whether these levels are helpful for differentiation of complete or partial urinary obstruction. MATERIALS AND METHODS: Fifty-four patients with, and 23 without, benign hydronephrosis were enrolled in this study. Serum and urinary carbohydrate antigen 19-9 were determined by the chemiluminescence enzyme immunometric assay method and these levels were correlated with clinical factors. RESULTS: The mean serum (P < 0.0001) and urinary (P < 0.0001) carbohydrate antigen 19-9 and serum creatinine (P < 0.008) levels were significantly higher in the hydronephrosis group than the control group. There was significant correlation between serum and urinary carbohydrate antigen 19-9 levels in the hydronephrosis group (r = 0.639, P < 0.0001). In the hydronephrosis group, there were no significant differences between the serum creatinine, serum or urinary carbohydrate antigen 19-9 levels and the clinical features except symptom duration. The best cut-off value for the serum and urinary carbohydrate antigen 19-9 were found to be 4.84 U/mL and 29.35 U/mL, respectively. CONCLUSION: Serum and urinary carbohydrate antigen 19-9 levels correlated with each other, were significantly elevated in patients with hydronephrosis and did not predict complete urinary obstruction. Benign hydronephrosis should be considered in the differential diagnosis of carbohydrate antigen 19-9 increments, as this is what is of most importance in clinical practice.     

Feasibility of neonatal hearing screening program with two-stage transient otoacoustic emissions in Turkey

BACKGROUND: The objective of this study was to investigate the incidence of hearing loss in neonates and evaluate the feasibility of a two-stage Transient Evoked Otoacoustic Emission (TEOAE) screening test. Maternal concerns about hearing screening were also studied. METHODS: Neonatal intensive care patients and well babies were screened using a two-stage TEOAE test, which was followed by an Auditory Brainstem Response (ABR) test for those babies who failed the first test twice. RESULTS: In total, 711 neonates were screened. At the end of the two TEOAE tests, the cumulative pass rate was 99.3% and false-positive rate was 0.3%. Five neonates (0.7%) were referred for the ABR test. Sensorineural hearing loss was found in three of them (0.4%). Of these three neonates, one was from the well baby nursery and two were from the NICU population. Families generally welcomed the screening program, with no refusals. Positive test results have not caused important maternal concerns. CONCLUSIONS: Congenital hearing impairment is a prevalent disease in Turkey. The two-stage TEOAE program is suitable for the neonatal hearing screening program. In general, hearing screening tests do not cause notable maternal concerns.