Increased incidence of congenital hypothyroidism due to iodine deficiency

BACKGROUND: The incidence of congenital hypothyroidism (CH) is expected to be elevated in iodine-deficient areas. In this study, the authors aimed to determine the incidence of transient and permanent CH in a large city which is known to be in the zone of moderate iodine deficiency. METHODS: Newborn babies in Bursa, Turkey, were screened by measurement of serum thyroid-stimulating hormone (TSH) obtained by heel prick. The babies who had a serum TSH >20 mIU/L were recalled for measurement of T4 and TSH in venous serum. RESULTS: A total of 11 770 newborns were screened over a period of 9 years. The incidence of CH was found to be 1/840. However, after excluding the transient cases, permanent CH was diagnosed in 1/2354. It was impossible to distinguish transient patients from permanent CH by initial laboratory tests (P > 0.05). The estimated power of the study in determining the incidence of CH in the population was 90% (P < 0.05). CONCLUSION: The authors conclude that the incidence of CH is very high in their population which warrants a country-wide neonatal screening program. Since transient cases cannot be distinguished and untreated transient hypothyroidism may also cause mental retardation, treatment must be started as early as possible with frequent monitoring to optimize the outcome and identify the transient patients.     

Twenty-four-hour Variations in the Effect of Nitrodilators in Rat Aorta: Lack of Influence of the Endothelium

Time-dependent variations of the vasodilator effects of sodium nitroprusside and glyceryl trinitrate on isolated smooth muscle have been studied on rings of rat thoracic aorta, both endothelium-intact and endothelium-denuded. For most of the concentrations of sodium nitroprusside used the induced relaxations were significantly dependent on the time the tissues were obtained. However, significant temporal differences were obtained for glyceryl trinitrate-induced relaxations at lower concentrations only for both endothelium-intact and endothelium-denuded preparations. EC50 values of sodium nitroprusside and glyceryl trinitrate (i.e. the concentrations inducing half the maximum response) were also significantly different and they had quite similar rhythmic features both in endothelium-intact and in endothelium-denuded preparations. These results clearly show that the in-vitro sensitivity of rat thoracic aorta to nitrodilator agents varies over a 24-h period and thus depends on when the animals were killed; the presence of endothelium does not change the rhythm of nitrodilator activity. These variations might be a result of circadian rhythm in the guanylate cyclase-cGMP system which mediates responses to nitrodilator agents.     

Renal replacement therapies in pediatric intensive care patients: Experiences of one center in Turkey

BACKGROUND: Despite constant improvements in caring for critically ill neonates and infants with congenital cardiac disease, sepsis, bone marrow and solid organ transplantation, acute renal failure (ARF) is an important problem in these children. ARF, severe fluid overload and inborn errors of metabolism are some of the indications for acute dialysis in infants and children. METHODS: The authors had retrospectively evaluated the medical records of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey patients who had required acute renal replacement therapy between the dates of January 2002 to February 2005. RESULTS: Medical records of 332 patients were reviewed. Acute renal replacement therapy was performed in 21 patients (6.3%; mean age, 9.6 +/- 7.4 years). Dialysis modalities were peritoneal dialysis in 15 patients (71.4%; mean age, 3.9 +/- 5.6 years) and hemodialysis in six patients (28.6%; mean age, 12.1 +/- 3.2 years). A total of 90% of patients had severe systemic disease leading to ARF. A total of 95% of patients had multiple organ dysfunction syndrome. The most common cause of ARF was refractory shock. At the beginning of renal replacement therapy, 10 patients were anuric, nine patients had volume overload, seven patients had decompensated metabolic acidosis and nine patients had hypotension. The average dialysis period was 4.7 +/- 6.4 days. Mortality rate was 66.7%. Eight patients recovered from ARF and chronic renal failure had developed in one patient. CONCLUSION: In the Pediatric Intensive Care Unit, ARF is frequently seen together with multiple organ dysfunction syndrome and the mortality rate is high. Both peritoneal dialysis and hemodialysis are important renal replacement treatment modalities in patients with ARF. The age and hemodynamic status of the patients are important when choosing treatment modality; generally peritoneal dialysis is preferred in infants and toddler, while hemodialysis is preferred in older children.     

Interaction of life quality with alexithymia,temperament and character in male alcohol‐dependent inpatients

Introduction and Aims. The aim of this study was to investigate the relationship of life quality with alexithymia, temperament and character dimensions of personality. Design and Methods. Participants were 156 consecutively admitted male alcohol dependents. Patients were investigated with the Toronto Alexithymia Scale, the Temperament and Character Inventory, the Michigan Alcoholism Screening Test and the Medical Outcomes Study Short Form 36‐item health survey. Results. Among alcohol‐dependent inpatients 30.1% were considered as alexithymic. Severity of alcohol related problems was higher in alexithymic group, whereas quality of life (QoL) was lower. Alexithymia, novelty seeking (NS) and harm avoidance (HA) were negatively, reward dependence, self‐directedness and cooperativeness were positively correlated with QoL scores. ‘Difficulty in identifying feelings’ (DIF) factor of alexithymia and HA were the determinants of physical dimension of Life Quality in Linear Regression model, whereas DIF, HA and NS were the predictors of mental dimension score. Discussion and Conclusions. Among alcohol‐dependent men, DIF factor of alexithymia and personality dimensions, particularly HA and NS are associated with impairment of QoL. Direction of this relationship and factors that may mediate this relationship is unclear. [Evren C, Dalbudak E, Durkaya M, Cetin R, Evren B. Interaction of life quality with alexithymia, temperament and character in male alcohol‐dependent inpatients. Drug Alcohol Rev 2009]     

PSORIASIS-LIKE LESIONS IN GUINEA PIGS RECEIVING PROPRANOLOL

Background. β-Blockers cause a psoriasiform eruption. We investigated the skin effects of systemic propranolol in a formal protocol. Methods. Propranolol, 0.1 mg/day, was used systemically by gavage in eight albino guinea pigs. Normal saline was given to another group of seven guinea pigs. Results. Propranolol produced psoriasiform lesions in five of seven guinea pigs on the 30th day. Biopsies showed acanthosis, parakeratosis, microabscesses, and cellular infiltration of upper dermis. Topical application of propranolol did not produce clinical psoriasiform changes, while acanthosis and papillomatosis was observed in six of the six guinea pigs. Conclusions. Systemically given propranolol can lead to psoriasis-like lesions, which might be due to a serum factor.     

Prediction of Head‐Up Tilt Test Result: Is it Possible?

Background: The determination of early, accurate, predictive criteria for a positive result would permit a reduction in the duration of the head‐up tilt testing (HUTT). Previous studies propounded that existence of early sympathetic overreactivity (rapid and sustained increase in heart rate) during HUTT predicts positive result. However, the exact value of this variable is unknown. We analyzed the early heart rate (HR) responses to HUTT and evaluated their ability to predict HUTT result. Methods: Consecutive patients referred to the syncope unit of our center for recurrent unexplained syncope were studied. Results: We studied 189 consecutive patients and 67 (35%) patients had a negative HUTT; 122 (65%) patients had a positive HUTT. The early HR increase was defined as the maximum HR during the first 10 minutes of tilting minus the resting HR before tilting. The receiver–operator curves (ROCs) show the overall performance of the HR changes for predicting the HUTT result. For all variables, area under the ROC curve (AUC) was nearly equivalent to 0.50 and early HR increase was not a predictor of the negative result of HUTT (AUC = 0.546). Also there was no any significant correlation between the magnitude of early HR increase and patient age (r =?0.03, P = 0.76). Conclusions: The results suggest that the early increase in HR during the first 10 minutes of the HUTT may not be a useful parameter for predicting the test result. Many factors, such as late exaggeration in sympathetic activity during HUTT and age‐dependent reduction in baroreflex sensitivity, may attenuate the predictive value of early HR increase. (PACE 2010; 33:153–158)     

Intrascrotal calculi: A very rare stone disease

A stone in the hydrocele sac is very rarely encountered, whereas the occurrence of multiple stones in the hydrocele cavity has not been reported before. Numerous intrascrotal stones were encountered in the hydrocele sac of a patient during operation and has prompted us to report this case.     

Autoradiographic determination of marginal leakage of a pressed glass ceramic inlay

summary The marginal integrity and microleakage of pressed glass ceramic inlays were evaluated using autoradiography. IPS/Empress ceramic inlays were fabricated for 10 human molar mandibular teeth. After adjusting the inlays, they were etched with 37% phosphoric acid gel for 30 s and silanized with Monobond S for 30 s. Before cementation with dual cure resin cement the inlays and cavity walls were gently covered with a thin layer of bonding agent. When the cementation process was completed the samples were cycled 300 times between a 55°C hot bath and a 5°C cold bath. The samples were placed in each bath for 60s, with 5 s intervals between immersions, then the specimens were immersed in an aqueous solution of Ca-45. After 24 h the inlay and tooth assemblies were removed, rinsed with water and placed in cold-cured acrylic resin, then sectioned through the long axis for autoradiographic analysis. According to the penetration of Ca-45, the microleakage level was scored for each section. The results indicated slight penetration of Ca-45 on autoradiographic films.     

Premature thelarche in Kabuki make-up syndrome

A 2 year old girl who has Kabuki make-up syndrome with isolated premature thelarche is presented. She has unique ocular abnormalities which have not been reported previously. In the literature at least 85 patients, most of them from Japan, have been reported. This is the first reported non-Japanese Asian case.