Alexithymia and anger in patients with fibromyalgia

Our objective was to delineate the relevance of the personality construct alexithymia and anger-in in patients with fibromyalgia syndrome. Fifty subjects with fibromyalgia syndrome were compared to 20 subjects with rheumatoid arthritis and 42 healthy controls on the measures of anxiety, depression, anger, alexithymia, pain intensity and disability. There was a significant difference on the measures of anxiety and anger between FMS and RA groups, and also between FMS patients and healthy controls. There was a significant difference between FMS patients and healthy controls on the measures of depression, difficulty in identifying feelings subscale of TAS (TAS-dif), and total alexithymia scores. When the severity of pain was controlled for, there was a significant difference on the measures of anger and alexithymia between the FMS and the RA groups. Fibromyalgia patients were more alexithymic than rheumatoid arthritis patients even when the level of depression was controlled for. Anger towards oneself, which is anger-in, was higher in patients with fibromyalgia patients than in the rheumatoid arthritis sample. A stepwise regression model showed that the anger-out scores and the anxiety scores predicted the level of pain severity, and this explained 32% of the variance in the fibromyalgia syndrome group. Although anger-in is consistently higher in fibromyalgia patients, it is the behavioral expression of anger, together with anxiety, that predicts the severity of the pain. The difficulty of identifying feelings, rather than other dimensions of alexithymia, seems to be associated with fibromyalgia.Abbreviations CLBP Chronic low back pain - FMS Fibromyalgia syndrome - RA Rheumatoid arthritis - VAS Visual analog scale     

Leptin might be a regulator of serum uric acid concentrations in humans

Increased serum urate concentration is a frequent finding in patients with hypertension. Since hyperuricemia is associated with obesity, renal disease, hyperlipidemia, and atherosclerosis, whether or not serum urate is a cardiovascular risk factor per se has remained elusive. The subjects were 210 Turkish male and 210 female adults over 20 years of age. None had diabetes mellitus, endocrine diseases, or renal or hepatic disease, and those receiving antihypertensive drugs, systemic corticosteroids, or lipid-lowering drugs were excluded. Height, weight, blood pressure, serum glucose, lipid profiles, serum insulin, DHEA-SO4, and leptin were measured in the morning after an overnight fast. Women had significantly higher mean leptin (20.3 +/- 0.88 ng/mL vs 5.78 +/- 0.39 ng/mL, P < 0.001) and lower mean uric acid (248.03 +/- 4.76 micromol/L vs 311.6 +/- 5.35 micromol/L, P < 0.001), triglyceride (1.42 +/- 0.06 mmol/L vs 1.61 +/- 0.06 mmol/L, P < 0.001), and DHEA-SO4 (3.02 +/- 0.17 micromol/L vs 4.43 +/- 0.19 micromol/L, P < 0.001) concentrations than men, even when adjusted for BMI. On univariate correlation analysis, leptin showed the strongest association with BMI in both sexes and also correlated significantly with BMI, insulin, uric acid, glucose, total cholesterol, and triglycerides in males and BMI, insulin, uric acid, total cholesterol, apo B, and creatinine in females after adjustment for age and BMI. A statistical model containing creatinine, leptin, insulin, and triglycerides accounted for 34% of the variance in serum uric acid levels in men, whereas another consisting of creatinine, triglycerides, leptin, SBP, and insulin explained 42% of the variance in serum uric acid in women. The present study suggests that leptin could be one of the possible candidates for the missing link between obesity and hyperuricemia. Our study may also suggest that hyperuricemia is not only a metabolic end product but also a marker of a major pressor or pathogenic mechanism underlying the hypertension in obesity.     

Colour Doppler ultrasound evaluation of orbital vessels in diabetic retinopathy

The aim of this study was to determine the role of colour Doppler imaging in the retrobulbar vascular circulation in diabetic retinopathy (DR). Maximum (V(max)), end-diastolic (V(min)) and average (V(mean)) velocities of blood flows and pulsatility index and resistivity index (RI) in central retinal artery (CRA), short branches of posterior ciliary artery (PCA) and ophthalmic artery of the 65 diabetic and 22 control eyes were measured. The CRA V(max) level in the control group was significantly higher than in DR groups. The CRA V(mean) level was also significantly higher in the control group than in the mild nonproliferative diabetic retinopathy (NPDR) and the moderate NPDR groups. The CRA RI value was significantly higher in the control group than in the nonretinopathy group. The CRA V(min) and the ophthalmic artery RI values were found significantly higher in the nonretinopathy group than in the moderate NPDR group. There were significant decreases in the some CRA and PCA values as glycated haemoglobin (HbA1c) levels increase in diabetic group. There was a positive correlation between the duration of diabetes and HbA1c levels. This study showed the presence of some dynamic circulatory alterations in the nonretinopathy group with diabetes and DR groups. It was also shown that there is a negative correlation between HbA1c and some orbital vascular velocities.     

The effects of oxidative stress on the liver and ileum in rats caused by one-lung ventilation

BACKGROUND AND AIM: Reactive oxygen radicals that cause remote organ injury are increased after the one-lung ventilation frequently used in thoracic surgery. The aim of this study was to examine the effects of one-lung ventilation on the liver and ileum. MATERIALS AND METHODS: Thirty rats were divided into five groups: a sham group; 3- and 4-h mechanical ventilation groups; and 1- and 2-h left lung collapse/2-h re-expansion groups (n = 6 for each group). In the collapse groups, the left lung was collapsed by bronchial occlusion for 1 and 2 h and then re-expanded and ventilated for an additional 2 h. At the end of the study, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were determined to assess liver functions. Myeloperoxidase (MPO) and malondialdehyde (MDA) activity were determined in the liver and ileum tissues. The tissues were also examined by light and electron microscope. Apoptosis was assessed using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) assay. RESULTS: Plasma ALT and AST, tissue MDA, and MPO activities in both tissues were significantly higher in the 2-h collapse/2-h re-expansion group than in the 4-h mechanical ventilation group (P < 0.05). Moreover, the levels were significantly higher in the 2-h collapse group compared to the 1-h collapse group (P < 0.016). Tissue damage and apoptotic index were most prominent in the 2-h collapse/2-h re-expansion group. CONCLUSION: Our findings showed that one-lung ventilation causes tissue damage in the liver and ileum and that this damage increases as occlusion duration rises.     

Factors Contributing to Regular Smoking in Adolescents in Turkey

PURPOSE: The objectives of this study were to determine the levels of lifetime cigarette use, daily use, and current use among young people (aged 15-19 years) and to examine the risk factors contributing to regular smoking. METHODS: The number of students was determined proportionately to the numbers of students in all the high schools in the province of Trabzon in Turkey. The data were gathered using the questionnaire method. A total of 4666 students participated in the study. The chi-square test and logistic regression analysis were used in data analysis. RESULTS: Of the 4666 students who took part in the study, the level of lifetime cigarette use was 38.2% (n = 1796), that of lifetime daily cigarette use was 10.5% (n = 491), and that of current cigarette use was 9.5% (n = 447). Male students (P < .0005), those whose mothers were smokers (P < .0005), those whose fathers smoked (P = .005), those whose siblings smoked (P<.0005), those whose friends smoked (P < .0005), those whose teachers smoked (P = .001), and low achievers in school (P < .0005) stated that they significantly smoked on a more regular basis. According to the results of the logistic regression analysis, the following risk factors were statistically significant: male students smoked 3.02 times (95% CI 2.20-4.16) more than females, those whose mothers were smokers smoked 1.57 times (95% CI 1.09-2.28) more than those whose mothers were not, those whose friends were smokers smoked 2.42 times (95% CI 1.73-3.39) more than those whose friends were non-smokers, poor achievers in school smoked 2.62 times (95% CI 1.97-3.49) more than high achievers, and those without poor grades smoked 1.75 times more (95% CI 1.23-2.40), the risk rising 1.06 times (95% CI 1.01-1.11) with earlier age at first experimentation. The risk of daily cigarette use was observed to decline by 0.91 times (95% CI 0.84-0.98) with increasing numbers of siblings. CONCLUSION: Effective smoking prevention programs should take into account the dominant influence of peer groups in the onset and continuation of smoking.     

Ischemia-modified albumin in the diagnosis of acute mesenteric ischemia: a preliminary study

Ischemia-modified albumin (IMA) is a sensitive marker of myocardial ischemia, skeletal muscle ischemia, pulmonary embolism, and stroke. However, there are no studies showing whether IMA increases in mesenteric ischemia. The aim of this study was to determine whether IMA was elevated in acute mesenteric ischemia. This case-controlled study was performed in an emergency department of a university hospital. The measurement of IMA levels in patient plasma yielded means of 0.264 +/- 0.057 absorbance units (ABSU) in the thromboembolic occlusion of the superior mesenteric artery (SMA) group and 0.163 +/- 0.025 ABSU in the control group. When plasma IMA levels in the thromboembolic occlusion SMA group were compared with those in the control group, statistically significant increases in IMA were observed in the occlusion group (P = .003). Findings indicating that IMA may have a place in the diagnosis of acute mesenteric embolism were obtained in this preliminary study. Further prospective studies are needed to see if IMA is clinically useful in the early detection of thromboembolic occlusion of the SMA.     

Retinal break following an intravitreal triamcinolone acetonide injection

PURPOSE: To report a case of an unusual localization of retinal break following intravitreal triamcinolone acetonide (IVTA) injection. SUBJECTS AND METHODS: A 58-year-old male patient was admitted to our department for visual loss lasting more than 6 months. The patient was diagnosed as having proliferative diabetic retinopathy and diffuse macular edema. Therapy in the form of IVTA injection was given. RESULTS: During the first follow-up examination, 1 week after the IVTA injection, a retinal break with an attached flap on the nasal retinal area was observed. The retinal break was covered with laser photocoagulation. CONCLUSION: Although a rare possibility, a careful retinal examination during the follow-up period after IVTA injection may prevent retinal detachment.     

Value of ischemia-modified albumin in the diagnosis of pulmonary embolism

Background

Pulmonary embolism (PE) is a common condition, but the diagnostic strategy for the evaluation of suspected PE is somewhat controversial. Despite the use of various biochemical markers (such as D-dimer and C-reactive protein) and various probability calculation algorithms based on clinical findings for that purpose, there is still a need for more specific and practical markers in PE diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of PE.

Methods

This case-control study was performed in the emergency department between March and September 2006. The serum IMA levels of a total of 60 individuals, consisting of 30 PE patients who had been definitively diagnosed via spiral computed tomographic angiography and 30 healthy volunteers, were examined.

Results

The measurement of IMA levels in patient plasma yielded mean values of 0.724 ± 0.122 absorbance unit (ABSU) in the PE group and 0.360 ± 0.090 ABSU in the control group. When plasma IMA levels in the PE group were compared with those in the control group, statistically significant increases in IMA were observed in the former (t = 13.19, df = 56, P < .0005). The value of 0.540 ABSU was calculated as the upper limit of reference interval. In the PE group, 97.7% (n = 29) had values exceeding 0.540 ABSU; none of the control subjects had values exceeding this cutoff value.

Conclusions

In conclusion, our data suggest that IMA levels may be useful as a discriminative marker to exclude pulmonary embolism.     

Evaluation of flow characteristics of the left internal thoracic artery graft: perioperative color Doppler ultrasonography versus intraoperative free-bleeding technique

From October 2000 through April 2001, we prospectively evaluated the flow characteristics of the left internal thoracic artery (LITA) graft in a homogenous group of 44 men with isolated severe proximal left anterior descending coronary artery stenosis who underwent elective coronary artery bypass grafting with cardiopulmonary bypass. We performed transthoracic color Doppler ultrasonography preoperatively and repeated this examination in each patient between the 5th and 7th postoperative days, obtaining cross-sectional area, total flow volume, diastolic velocity, systolic velocity, mean velocity, pulsatility index, and resistance index. These results were compared with those of the intraoperative free-bleeding technique. Good-quality Doppler images of the LITA were easily obtained with a combined supraclavicular-parasternal approach. After surgery, systolic flow velocity, pulsatility index, and resistance index decreased significantly, but diastolic flow velocity and mean flow velocity increased significantly. The intraoperative flow volume obtained by the free-bleeding technique (32.42 +/- 12.33 mL/min) was significantly less than both pre- and postoperative ultrasonographic values (42.22 +/- 10.77 mL/min and 45.36 +/- 19.52 mL/min, respectively). No significant difference was found when changes in LITA values were compared between patients with (n=19) and without (n=25) normal anterior wall motion. We conclude that color Doppler ultrasonography is a reliable noninvasive technique for preoperative evaluation of the LITA as a graft and for postoperative long-term follow-up of graft function. However the intraoperative free-bleeding technique is not reliable for flow-volume measurement due to anesthesia-related hemodynamic changes and vasospasm. Color Doppler can prevent useless LITA harvesting and decrease the need for postoperative LITA angiography.