Relationship of the blood pressure's level and skinfold thickness]

OBJECTIVE: Hypertension is an important problem of the public health. Insufficient education of the people along with insufficient physical examination also plays a role in the poor success of the diagnosis and treatment of the hypertension. We investigated whether the skinfold thickness has an importance in the prediction of blood pressure or not. METHODS: In Aydin City area 110 women and 100 men selected by randomized sampling method were included into our study. Body mass index, blood pressure and skinfold thickness were measured according to the international guidelines. RESULTS: There was a moderate correlation between the skinfold and body mass index (r= 0.494, p=0.000) and there was a mild correlation between the body mass index and systolic and diastolic blood pressures (r=0.225, p=0.000 and r=0.300, p=0.000, respectively). There was no correlation between the skinfold thickness and systolic and diastolic blood pressures (r=0.058, p=0.400 and r=0.090, p=0.194, respectively). CONCLUSION: It is concluded that body mass index, not skinfold thickness, can be used for the prediction of the blood pressure. Some other factors independent from the body mass index might be the determinants of the skinfold thickness.     

Clinical, electrophysiological and magnetic resonance imaging findings in carpal tunnel syndrome

OBJECTIVE: To assess magnetic resonance imaging (MRI) findings in carpal tunnel syndrome (CTS) and to compare them with electrophysiological findings. METHODS: Routine motor and sensory nerve conduction examinations and needle EMG were performed in 42 hands of 22 patients, who were clinically diagnosed as having CTS in at least one wrist. RESULTS: Of 29 wrists with clinically and electrophysiologically confirmed CTS, MRI could detect abnormality in 18 wrists (62%). Median nerve was found to be abnormal in MRI in 1 of 2 wrists with suspected clinical symptoms and proven CTS by electrophysiological examination. MRI was abnormal in 1 of 4 wrists with normal clinical and electrophysiological examination. MRI was abnormal in 46, 7% of wrists with mild CTS, in 61.6% of moderate CTS and in 100% of severe CTS. Volar bulging of the flexor retinaculum was detected in a single wrist with severe CTS. Enlargement of median nerve was observed in 3 of 5 severe CTS. CONCLUSION: MRI could be useful in the diagnosis of unproven cases in CTS. It also provides anatomical information that correlate well with electrophysiological findings in regard of the severity of median nerve compression.     

Association of low cholesterol with primary intracerebral haemorrhage: a case control study

Objectives – Epidemiological studies have shown that the incidence of intracerebral haemorrhage (ICH) is high in patients with low cholesterol levels. The aim of this study was to investigate the correlation between ICH and low cholesterol in cases of primary ICH. Material and methods – Two hundred and fifty‐nine patients with primary intracerebral haemorrhage and 137 healthy individuals were included in this study. Patients with prior cerebrovascular accident, secondary ICH, hereditary lipid metabolism disorders, thyroid diseases and those using lipid‐lowering drugs were excluded. In all subjects, cholesterol levels were measured after 12 h of fasting. Results – Mean cholesterol levels were 205.8 ± 51.4 mg/dl in the ICH group and 230.2 ± 38.9 mg/dl in the control group. Mean cholesterol levels of patients were significantly lower than the controls (P < 0.000). In ICH group, the frequency of patients who had very low cholesterol levels was significantly higher than the control group (P < 0.000). Conclusions – Individuals with lower cholesterol levels have an increased risk of ICH. Therefore, before treatment with statins, clinicians must be aware of the possible ICH risk.     

Relation between intracranial volume and the surface area of the foramen magnum

Several investigators have estimated the intracranial volume (ICV) in the past which indirectly reflects the brain volume. Most of these studies have been made on the dry skulls using linear dimensions, packing methods or occasionally radiological methods. It is also reported that the etiology of cerebellar tonsillar herniation is closely related to the size of the foramen magnum (FM). In the present study the ICVs have been estimated in 28 dry skulls using filling water method and the surface area of FMs were measured planimetry method. The estimated mean ICV was 1,311 +/- 133 cm. Surface area of FM was 760 +/- 144 mm. Antero-posterior and lateral direct roentgenograms of the skulls were also taken and the width, height and length (WHL) of the skull were measured by means of the cephalometry on radiograms. The relationship between the ICV, WHL and surface area of FM were analyzed statistically. The ICV, WHL and surface area of FM was correlated well (r = 0.271, P < 0.005; r = 0.265, P < 0.005, respectively) and a regression formula was proposed. Our results showed that skulls with larger ICV and WHL have larger FM surface area. We also suggested a regression formula that could be used to predict the surface area of FM regarding to the ICV and WHL values. In the next step, we took roentgenograms of skulls and obtain ICV measuring the width, length and height of skulls by means of cephalometry and investigate the relation between the findings of cephalometry and surface area of FM. The cephalometry could apply on living subjects and, thereby, our findings could provide some data to evaluate the etiology of Arnold Chiari malformation and achondroplasia for living subjects.     

Relationships between the children and the parents for coronary risk factors

BACKGROUND: We aimed to investigate the relation of coronary risk factors in children to coronary heart disease (CHD) or coronary risk factors in their parents. METHODS: A sample of 252 parents of 164 children with two or more coronary risk factors were included in this study. The control group consisted of 175 parents of 114 children with no risk factors. Both groups were evaluated for coronary risk factors and CHD. The children in the groups were separated into sex and age groups consisting of 7 to 11-years-olds, 12 to 15-years-old and 16 to 18-years-old. RESULTS: Many lipid parameters related with coronary risk factors in the mothers of 7 to 11-year-old girls, in the fathers of 7 to 11-year-old girls and 16 to 18-year-old boys were at higher levels than in the control group. Anthropometric parameters, especially those of reflecting body fatness such as skinfold thickness measurements and total bodyfat percentage values were at higher levels in the fathers of 12-15- and 16 to 18-year-old girls. The higher levels of most of the anthropometric and biochemical parameters in the fathers of 16 to 18-year-old boys were striking. Hyperlipidemia prevalences in the fathers of 7 to 11-year-old girls and boys were higher than the control parents. In the study group, the girls positively correlated with both their parents for total cholesterol levels and positively correlated with only their mothers for height, bodyfat percentage, triglycerides and low-density lipoprotein- cholesterol (LDL-C) levels. However, the boys positively correlated with their mothers for weight and with their fathers for bodyfat percentage, diastolic blood pressure (BP) values and serum LDL-C levels. The proportion of individuals who had ischemic findings on treadmill exercise testing was significantly greater than control group in only the fathers of 12 to 15-year-old boys (P<0.05). CONCLUSIONS: The parents, especially the fathers of children with coronary risk factors have higher levels of coronary risk factors than those in the control group. There is a familial aggregation of body fatness and adverse lipid levels in the families of the children with coronary risk factors. The parents of children recognized as having coronary risk factors should be evaluated for these risk factors too.     

Peduncular hallucinosis: three cases with thalamic involvement

Three cases with peduncular hallucinosis are described. The occurrence of complex visual hallucinations in each case were abrupt at the onset of the stroke. Two patients were free of hallucinations after a few days, while in the other they persisted. Magnetic resonance imaging (MRI) or computerized tomographic (CT) brain scan findings revealed thalamic involvement in these three patients.     

Right cerebral hemiatrophy: Neurocognitive and electroclinical features

The purpose of this study was to retrospectively evaluate the cognitive and electroclinical characteristics of right cerebral hemiatrophy (Dyke–Davidoff–Masson syndrome [DDMS]). Cognitive assessments with a particular emphasis on visuospatial functions, electroclinical features, and neuroimaging characteristics were analyzed for five patients with a clinically and neuroradiologically confirmed diagnosis of right-sided DDMS. Intelligence tests revealed mental retardation in all but one. Neuropsychological assessments demonstrated consistent impairments in tasks that have a spatial component (spatial processing and orientation discrimination), whereas attention, executive functions and verbal memory domains were variably impaired. Electroclinically, the main seizure types were simple partial motor, complex partial, and secondarily generalized seizures. Interictal EEG delineated lower amplitudes and slow background activity in the affected hemisphere. Overall, the cognitive performance of patients with DDMS encompasses a broad spectrum of impairments affecting multiple domains. Our findings support the concept that dorsal visual pathways responsible for spatial processing may be lateralized to the right hemisphere.     

MRI reveals reversible lesions resembling posterior reversible encephalopathy in porphyria

We report a 20-year-old woman who had an attack of acute intermittent porphyria with seizures, hallucinations, autonomic and somatic neuropathy. T2-weighted MRI revealed multiple lesions which were no longer visible 3 months later. We suggest a similar mechanism to posterior reversible encephalopathy underlying cerebral symptoms in porphyria.     

Steroids and living liver donation increase tacrolimus blood levels in living donor liver transplantation

The aim of this study was to determine the tacrolimus blood levels in recipients of living donor liver transplants (LDLT) compared with recipients who undergo whole cadaveric liver grafts and to correlate the tacrolimus trough levels with the 12-hour area under the concentration (AUC) curve. From June 2002 to June 2003, the 10 LDLT were prospectively compared with 11 cadaveric transplants. The main immunosuppression was tacrolimus plus steroids. Intraoperative methylprednisolone was administered to all cadaveric organ recipients and only 6 of the 10 LDLT. Median tacrolimus trough levels at day 10 were 14.1 ng/mL for the LDLT group and 9.1 ng/mL for the CLT group (P = NS). The median tacrolimus AUC at day 10 were 185.2 ngxh/mL and 148.1 ngxh/mL for the LDLT group and the cadaveric group, respectively (P = NS). Median tacrolimus trough levels at day 2 were 24.3 ng/mL versus 9.9 ng/mL in the LDLT recipients with and without steroids, respectively (P < .05). Also, median tacrolimus AUC at day 2 were 239 ngxh/mL and 179.7 ngxh/mL when we compared LDLT recipients with and without steroids (P = NS). A significant correlation was observed between tacrolimus trough levels and AUC in the LDLT group (C.C. = 0.936; P < .0001). In conclusion, LDLT recipients display higher tacrolimus blood levels in comparison with cadaveric liver recipients, with a good correlation between tacrolimus trough levels and AUC. Intraoperative steroid administration induces higher tacrolimus levels in LDLT recipients.