The evaluation of left ventricular dyssynchronization in patients with hypertension by phase analysis of myocardial perfusion-gated SPECT.

PURPOSE: Hypertension is one of the most important risk factors for cardiovascular disease. However, hypertension may also result in left ventricular dyssynchrony (LVD) which is characterized by delayed activation of certain ventricular segments leading to uncoordinated contraction. The aim of this study was to evaluate the LVD measured by phase analysis of gated single-photon emission computed tomography (SPECT) imaging in patients with hypertension. METHODS: We retrospectively reviewed the records of the patients who have referred to our institution for myocardial perfusion imaging (MPI) with a diagnosis of cardiovascular disease. In this study, total of 196 patients (127 females and 69 males, with a mean age of 59.62 ± 10.27 years) with and without hypertension (123 and 73, respectively) were included. Phase analysis parameters were compared in patients with and without hypertension which are derived using Emory Cardiac Toolbox. Among these 196 patients, 72 had echocardiography results. The findings of echocardiographic and phase analysis were also compared. Student's t test, Kruskal-Wallis, Mann-Whitney U test and Spearman correlation test were used to compare the results. RESULTS: There were statistically significant differences in the phase standard deviation (p = 0.005) and histogram bandwidth (p < 0.001) parameters of the phase analysis between the patients with and without hypertension groups, respectively. Furthermore, echocardiographic findings were significantly correlated with the result of the phase analysis. CONCLUSION: This study suggested that routine use of phase analysis-gated SPECT imaging will be beneficial for the diagnosis of LVD.

Comparison of fragmented QRS and myocardial perfusion-gated SPECT findings.

AIM: Fragmented QRS (fQRS) complex is an ECG parameter that has recently been introduced and investigated. It is assumed that fQRS occurs because of disruptions in ventricular conduction due to ventricular infarction and ischemia. Therefore, in this article, we aimed to investigate the relationship between the detection of infarction and ischemia on myocardial perfusion-gated single-photon emission computed tomography images and appearance of fQRS on ECG. MATERIALS AND METHODS: We retrospectively reviewed the records of patients with a diagnosis of coronary artery disease who were referred to our institution for myocardial perfusion scintigraphy. In total, 261 patients (122 women and 139 men, with a mean age of 61±10.33 years) with and without fQRS (136 and 125, respectively) were included in the present study. The myocardial perfusion scintigraphy results were evaluated for the presence or absence of myocardial ischemia and infarction by visual and quantitative (summed stress score, summed rest, summed difference score, summed motion score, and summed thickening score) assessments. Statistical analysis was performed to determine the relationship between the presence of fQRS and myocardial ischemia and/or infarction. Student's t-test and the Mann-Whitney U-test were used for comparing the results. Pearson's χ2-test and Fisher's exact tests were also used to compare the distribution of variables between the two groups. RESULTS: The prevalence of ischemia and infarction were found to be, respectively, 4.38-fold and 5.95-fold higher in patients with fQRS compared with the control group. Moreover, the prevalence of both ischemia and infarction was found to be 10.54-fold higher in patients with fQRS compared with the control group. CONCLUSION: There is a highly statistically significant possibility of detecting ischemia and infarction in perfusion myocardial scintigrams of patients whose ECGs have fQRS.

The influence of α-adducin gene polymorphism on response of blood pressure to exercise in patients with hypertension.

OBJECTIVE: Clinical studies have indicated that an excessive response of blood pressure (BP) to exercise predicts risk of cardiovascular mortality. Although the mechanism responsible for the excessive BP response to exercise has not been revealed, there are some plausible mechanisms linking with underlying structural abnormalities in the cardiovascular system. Carriers of the Trp460 allele of the α-adducin Gly460Trp polymorphism have an increased risk of hypertension. The aim of the present study was to examine the influence of α-adducin gene polymorphism on response of BP to exercise in patients with hypertension. METHODS: The cross-sectional observational study consisted of 49 hypertensive patients (29 women and 20 men; mean age, 53.1±8.8 years). All participants underwent a multistage exercise treadmill test according to the Bruce protocol. Arterial BPs were compared at rest, peak exercise and end of the recovery phase. Patients were classified according to their α-adducin gene polymorphisms; Gly460Gly homozygotes - Group 1 (n=28) and Trp460Trp homozygotes and Gly460Trp heterozygotes - Group 2 (n=21). Statistical analysis was performed using Chi-square, unpaired t, Mann-Whitney U and ANCOVA tests. RESULTS: Mean exercise duration and mean exercise capacity in metabolic equivalents were not different between Group 1 and 2. The major finding of the study was that systolic BP responses at peak exercise and recovery period (3. min) were significantly higher (p=0.036) in hypertensive patients carrying at least one Trp460 allele of the α-adducin gene. CONCLUSION: Our results suggest that genetic variants that alter renal function and/or vasoreactivity are logical candidates to explain some of the individual variability in the BP response to exercise.

The role of diffusion-weighted MRI in the classification of liver hydatid cysts and differentiation of simple cysts and abscesses from hydatid cysts.

PURPOSE: The purpose of this study is to identify the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the classification of liver hydatid cysts (HCs) and their differentiation from simple cysts and liver abscesses. MATERIALS AND METHODS: Twenty-two patients that were sent to our department with preliminary diagnoses of HCs or abscess were included in the study. Thirty lesions were evaluated. MRI included T1-weighted fast gradient echo, T2-weighted half-Fourier acquisition single-shot turbo spin echo, and DW single-shot echo planar pulse sequencing (b, 0, 50, and 1000 s/mm²). The apparent diffusion coefficient (ADC) values (mm²/s) of the HCs, abscesses, and simple cysts were calculated. RESULTS: No statistically significant difference was found between the ADC values of type 1 and 3 (P > 0.05) HCs and of simple cysts and type 1 HCs (P > 0.05). The ADC values of abscesses were significantly lower than those of type 1 and type 3 HCs, and simple cysts. No statistically significant difference was found between the ADC values of abscesses and type 4 HCs (P > 0.05). Type 4 lesions exhibited significantly lower ADC values in comparison to type 1 and 3 HCs. CONCLUSION: DW-MRI helps differentiate type 4 lesions from other cysts and can distinguish abscesses from hydatid cysts other than type 4 as well as from simple cysts. Type 1 HCs cannot be differentiated from simple cysts using ADC values alone, and type 4 lesions are indistinguishable from abscesses.

The effect of blood albumin and total lymphocyte count on short-term results in elderly patients with hip fractures.

BACKGROUND: A study was performed to determine the effects of blood albumin and total lymphocyte count on the postoperative one-year period in 74 elderly hip fracture patients. METHODS: In 2006, 74 patients (52 female, 22 male) with hip fracture who were 65 years of age or older were included in the study. Admission albumin levels and total lymphocyte counts were recorded. The outcomes examined were mortality, length of hospital stay and ambulatory ability. Ambulatory ability was assessed according to Parkland and Palmer criteria. RESULTS: There were 61 patients aged 65-84 years, and 13 patients aged 85-105 years. Forty-one patients (55.4%) had hypoalbuminemia and 23 patients (31.1%) had low total lymphocyte count. Low albumin and total lymphocyte counts were associated with higher mortality (p = 0.011). Patients with low albumin levels had longer length of hospital stay (p = 0.002). Patients with normal albumin and total lymphocyte counts had higher mobility score meaning better function (p = 0.012). Multivariate analysis yielded that low total lymphocyte count, American Society of Anesthesiologists (ASA) 3-4 and female gender remained significant independent predictors of one-year mortality. No single blood parameter was found to be effective on ambulatory status. CONCLUSION: Risk of mortality in elderly hip fracture patients increases with female gender, ASA 3-4 and low total lymphocyte counts. Hypoalbuminemia is associated with longer hospitalization. Identification of these risk factors can help in the case management for a more favorable outcome.

Elevated serum levels of caspase-cleaved cytokeratin 18 (CK18-Asp396) in patients with nonalcoholic steatohepatitis and chronic hepatitis C.

BACKGROUND: Caspase-cleaved cytokeratin 18 (CK18-Asp396) is released from hepatocytes during apoptosis. Recent studies have indicated that serum levels of CK18-Asp396 could be a clinically useful biomarker of chronic liver disease. To shed more light on the rate of hepatocyte loss by apoptosis in chronic liver disease, serum levels of CK18-Asp396 were examined in patients with nonalcoholic steatohepatitis (NASH) and chronic hepatitis C. MATERIAL/METHODS: Apoptotic CK18-Asp396 levels were quantified in sera from 35 patients with nonalcoholic steatohepatitis (NASH), 21 patients with chronic hepatitis C (HCV), and 18 healthy controls. RESULTS: Analysis of serum CK18-Asp396 levels showed an increasing trend starting from healthy controls (median: 54.5 U/l), to HCV patients (80.1 U/l), to patients with NASH (144.1 U/l, Kruskall-Wallis test: P<0.001). Post hoc analyses revealed that CK18-Asp396 levels were significantly higher in the NASH patients than in both HCV patients (P=0.008) and healthy controls (P<0.001). Moreover, the levels were significantly higher in patients with HCV than in control individuals (P<0.05). In patients with chronic HCV infection there was a significant positive correlation between serum CK18-Asp396 levels and AST (r=0.442, P<0.05), the ultrasonographic grade of steatosis (r=0.446, P<0.05), and the histological steatosis score (r=0.759, P<0.001). CONCLUSIONS: Although subject to future confirmation, these pilot findings seem to indicate that serum levels of caspase-cleaved cytokeratin 18 (CK18-Asp396) are higher in patients with NASH than in those with chronic HCV infection. These data suggest that NASH patients have an increased hepatocyte loss by apoptosis compared with chronic hepatitis C patients.

The effects of phytoestrogens on fracture healing: experimental research in New Zealand white rabbits.

BACKGROUND: Phytoestrogens are plant-derived natural molecules having some bone forming and bone substituting effects. In the present study, the role of phytoestrogens on bone healing was investigated in a rabbit fracture model. METHODS: Twenty-two New Zealand white rabbits with right tibia fracture were divided into two groups randomly. The plant derived extract of Vitex agnus-castus L. (Verbenaceae) prepared before the study was administered intramuscularly in group 1 and group 2 was chosen as control. Fracture healing was monitored in weekly basis with blood alkaline phosphatase level, radiographs of extremities and 99m-Tc MDP bone scintigraphy. The study was finished at the end of the 3rd week. The extremities including tibial fractures were collected for histological examination. RESULTS: Radiographic evidence of fracture healing obtained on postoperative day seven was superior in group 1 than control group (p<0.01). The 99m-Tc MDP bone scintigraphy uptake ratios on postoperative seventh day showed higher uptake in group 1 than in group 2 (p<0.05). The differences of scintigraphic uptakes in fractured tibias calculated on postoperative seventh day and postoperative 14th in group 1 were higher than group 2 (p=0.04). The histopathologic evaluation performed after sacrification of all rabbits on postoperative 25th day showed no significant difference between both groups. No statistical difference was determined related to the other variables. CONCLUSION: Flavonoids affected positively the early periods of fracture healing mechanism in New Zealand white rabbits. We suggest further studies with phytoestrogens to determine the effects of various dosages and administration ways.

Glial fibrillary acidic protein (GFAP) and CD34 expression in the human optic nerve and brain in methanol toxicity.

INTRODUCTION: The toxicity of methanol is as a result of its metabolites, formaldehyde and formic acid. Formic acid induces severe metabolic acidosis causing death, and is the primary agent responsible for ocular toxicity. Glial fibrillary acidic protein (GFAP) immunostaining is the most commonly used method for examining astrocyte proliferation and hypertrophy after various central nervous system injuries. The antigen CD34 is expressed widely on vascular endothelium, including that of the central nervous system and high endothelial venules. METHODS: In this study, GFAP and CD34 were immunohistochemically localised in the post-mortem optic nerve head, and brain tissue (basal ganglia putamen) samples were collected from methanol-exposed and non-methanol-exposed (control) subjects. RESULTS: There was a positive correlation between the GFAP and CD34 intensity of staining scores in the methanol-exposed group (P=0.711, P=0.010). Furthermore, there was also a positive correlation between the brain putamen and optic nerve head GFAP extent of staining in the methanol-exposed group (P=0.720, P=0.008). A statistically significant difference was found between the methanol-exposed group and the control group optic nerve CD34 intensity scores (P=0.014), but no significant difference was found between optic nerve CD34 and GFAP extent scores (P=0.05). CONCLUSION: The study revealed that methanol affects brain putamen and the optic nerve selectively. We detected a positive significant correlation between brain and optic nerve GFAP expression. CD34 expression was markedly decreased by the toxic effects of methanol.

Radiographic changes in the lumbar spine in former professional football players: a comparative and matched controlled study.

Heavy physical work and activity lead to degenerative changes, especially in the lumbar spine. We aimed to find out the occurence of radiographic changes (vertebral osteophytes, heights of lumbar dicsc, concavity index) and abnormalities of the lumbar spine in former professional football (association football or soccer) players according to their specialization (goalkeeper, defender, midfielder, forward) in their past professional sport life. We included 70 male former professional football players and 59 men as the control group. The football players group consisted of 15 defenders (21%), 29 midfielders (41%), 18 forwards (26%) and 8 goalkeepers (12%). Their mean professional football life was 11.04 years and the mean time period after their retirement was 13.87 years. Radiographs of both groups were taken to measure the disc height, concavity index and to determine osteophytes and abnormalities of the lumbar spine. FFbH-R score was assessed for daily activities. The mean FFbH-R score of football players was lower than that of the control group (P = 0.005). The total number of osteophytes in the player group was higher than in the control group (P = 0.001). The mean disc height of L1-L2 in football players was higher than in the control group (P = 0.045). The mean disc height of T12-L1 in goalkeepers was higher than in forward players (P = 0.019). The mean concavity index of L1 in forward players was lower than in defenders (P = 0.018). The mean disc heights of T12-L1 and L2-L3 were both higher in players whose professional sport life was >10 years than in players with

Road traffic collisions in Bursa, Turkey, during 2003, 2004 and 2005.

AIM: To highlight the demographic pattern of road traffic injuries in Bursa and to improve emergency care and health facility-based treatment. METHODS: Records of all registered road traffic collisions maintained by the Uludag University Emergency Department in Bursa for the period 2003 to 2005 and trauma files of 1307 road traffic collision victims were examined in this study. A form was designed to document patients' age, gender, type of trauma, time of trauma (hour, day, month and year), type and time to hospital of transport, presence of safety devices, presence of alcohol and blood alcohol concentration, localisations of wounds, trauma scores and outcomes. RESULTS: Of the 1307 cases, 418 (32%) were female and 889 (68%) were male. Ages ranged from 3 months to 87 years; mean age (+/-S.D.) was 34.8 (+/-17.3) years. The mean (+/-S.D.) ages of women and men were 35+/-17.6 and 34.7+/-17.2 years, respectively. Trauma was most commonly sustained within the motor vehicle (72.2%), followed by pedestrian injuries (21.7%), motorcycle injuries (5.5%) and bicycle injuries (0.6%). Collisions were most frequent in summer (34.7%) and on Fridays and weekends (48.5%). Seat belts were used in only 1.8% of incidents. In 90 cases (6.9%) alcohol was found in the blood; mean blood alcohol concentration was 139.2+/-88.3mg/dl. CONCLUSIONS: The identification of RTC characteristics may contribute to the development of injury prevention measures. Road travel requires extra attentiveness at peak accident times. Seat-belt use should increase, as well as use of other safety equipment such as collision helmets. Shorter transportation time of casualties to hospital would improve outcome.

The significance of hemosiderin deposition in the lungs and organs of the mononucleated macrophage resorption system in infants and children.

Hemosiderin deposition is not often recognized on routine examination with hematoxylin and eosin staining; however, iron stains may be helpful in the evaluation of hemosiderin deposition in infant autopsies. This report describes the data obtained from autopsy of 86 infants and children whose deaths were investigated at the Forensic Medicine Council Bursa Morgue Department from January 2000 to January 2003. A histochemical technique was used to identify hemosiderin in lung, liver and spleen specimens, which was correlated with other descriptive variables such as the reported cause of death, postmortem interval, trauma history, gender, and age. There was a weakly positive but significant correlation between lung and liver hemosiderin scores (Spearman's rank correlation coefficient, rho=0.348, p=0.001); i.e., given an increase in lung hemosiderin scores, an increase in liver hemosiderin scores was also observed. Similarly, a marked positive correlation between spleen and liver hemosiderin scores (Spearman's rank correlation coefficient, rho=0.335, p=0.002) was observed. The probability of spleen hemosiderin-positive cases belonging to the age group under 6 months was found to be 4.3 times greater than those who were hemosiderin-negative (95% confidence interval, 1.6-11.8). After the major differential diagnoses were ruled out, this study demonstrated, that depending on the statistically assessed morphometric grounds, the presence of hemosiderin deposits in the liver and spleen were significantly higher in the age group under 6 months.

Trends in the annual incidence rates of narcotics felons arrested over the last 30 years in metropolitan Bursa, Turkey.

Illegal substance use is a serious problem all over the world. In order to effectively combat substance abuse it is important that both the particular features of drug users and the culture-specific risk factors that go along with drug abuse be identified. The present study was carried out in Bursa, Turkey, in order to document annual changes in the frequency of felons arrested of narcotics offenses and to establish the socio-demographics of these narcotics felons. Among the 2,230 narcotics felons reviewed, 24.3% had been charged with drug dealing but not consumption (profit-driven felons [PDFs]), 19.0% were narcotics felons charged with both dealing and consumption ([hard core drug users HCDUs]), and 56.7% were narcotics felons charged only with consumption and possession (not so hard core drug users [NHCDUs]). The NHCDUs were younger (< 30 years) than both the HCDUs and PDFs, while most of the PDFs and HCDUs were married. Despite the fact that the male/female ratio of the Bursa population was nearly 1:1 for the past 30 years, 93.0%, 95.0% and 96.0% of the PDFs, HCDUs, and NHCDUs, respectively, were male. It was also found that the most commonly used illicit substance in Bursa over this period of time was cannabis. Over the course of the 30-year period examined, the annual incidence rate of narcotics felons arrested increased from 0.4257 per 10,000 to 1.2389 per 10,000. Determining the socio-demographic characteristics of HCDUs and NHCDUs would be useful in preventing substance use before substance users become addicted.

Soluble forms of extracellular cytokeratin 18 may differentiate simple steatosis from nonalcoholic steatohepatitis.

AIM: To investigate whether serum levels of two soluble forms of extracellular cytokeratin 18 (M30-antigen and M65-antigen) may differentiate nonalcoholic steatohepatitis (NASH) from simple steatosis in patients with nonalcoholic fatty liver disease (NAFLD). METHODS: A total of 83 patients with suspected NAFLD and 49 healthy volunteers were investigated. Patients with suspected NAFLD were classified according to their liver histology into four groups: definitive NASH (n=45), borderline NASH (n=24), simple fatty liver (n=9), and normal tissue (n=5). Serum levels of caspase-3 generated cytokeratin-18 fragments (M30-antigen) and total cytokeratin-18 (M65-antigen) were determined by ELISA. RESULTS: Levels of M30-antigen and M65-antigen were significantly higher in patients with definitive NASH compared to the other groups. An abnormal value (> 121.60 IU/L) of M30-antigen yielded a 60.0% sensitivity and a 97.4% specificity for the diagnosis of NASH. Sensitivity and specificity of an abnormal M65-antigen level (> 243.82 IU/L) for the diagnosis of NASH were 68.9% and 81.6%, respectively. Among patients with NAFLD, M30-antigen and M65-antigen levels distinguished between advanced fibrosis and early-stage fibrosis with a sensitivity of 64.7% and 70.6%, and a specificity of 77.3% and 71.2%, respectively. CONCLUSION: Serum levels of M30-antigen and M65-antigen may be of clinical usefulness to identify patients with NASH. Further studies are mandatory to better assess the role of these apoptonecrotic biomarkers in NAFLD pathophysiology.

The levels of caspase-cleaved cytokeratin 18 are elevated in serum from patients with lung cancer and helpful to predict the survival.

Caspase-cleaved cytokeratin 18 fragments (M30 antigen) can be detected in the circulation of patients with carcinoma and are believed to reflect cell death of tumors of epithelial origin. M30 antigens cleaved at Asp396 are detected using an epitope-specific antibody (M30 antibody). We here measured the levels of such fragments in patients with lung cancer (n=60), patients with benign lung disease (n=22) and healthy control subjects (n=32). A statistically significant difference was observed between these groups (p<0.001; Kruskal-Wallis). Basal M30 antigen levels were evaluated with regard to their predictive power of survival. The best cut-off value for M30 antigen level for the prediction of death was 43.8 U/L. Patients with basal M30 antigen levels higher than 43.8 U/L had significantly shorter median survival than those with lower basal M30 antigen levels (p=0.013; hazard ratio: 3.9) (95% CI=1.3-11.4). To determine whether cytotoxic therapy increases serum M30 antigen in lung cancer patients, we monitored the levels of M30 antigen in 18 lung cancer patients before chemotherapy and after 24 and 48 h. An approximately four-fold increase in M30 antigen levels was observed at 48 h (p<0.001). These results suggest as a first time that serum M30 antigen might be used as a novel biomarker for prediction of survival as well as for monitoring the efficiency of chemotherapy in lung cancer patients.

A comparison of the efficacy and tolerability of reboxetine and sertraline versus venlafaxine in major depressive disorder: a randomized, open-labeled clinical trial.

The aim of the study was to compare the efficacy and tolerability of the combination of reboxetine and sertraline to venlafaxine XR (extended release) in major depressive disorder (MDD). The study consisted of 40 patients with MDD, aged 18-65 years. Patients were evaluated six times during a 10-week period. Treatment was started as venlafaxine XR 75 mg/day once a day (od) or reboxetine 4 mg/day twice a day (bid)+sertraline 50 mg/day od. In the second week, venlafaxine XR was increased to 150 mg/day od and reboxetine 8 mg/day bid while sertraline was kept at the same dose. The Hamilton Depression Rating Scale (HDRS), Montgomery and Asberg Depression Rating Scale, Clinical Global Impressions-Severity of Illness and Clinical Global Impressions-Global Improvement Scale were applied on each visit. Beginning from the second visit, both groups showed significant declines in each scale. There were no significant differences between treatment response rates. Remission rates defined as HDRS

Comparison of efficacy and tolerability of reboxetine and venlafaxine XR in major depression and major depression with anxiety features: an open label study.

OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of reboxetine in the treatment of major depressive disorder (MDD) and MDD with anxiety features to venlafaxine XR. METHOD: Patients with MDD, aging 18 between 65 years, were randomly allocated to two groups receiving either open-label venlafaxine XR capsules (n = 50) or reboxetine tablets (n = 43). Subjects were administered Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A) at baseline and 2, 4, 7, 10 weeks after the baseline visit. RESULTS: Response rates to antidepressant treatment were significantly higher in the venlafaxine XR group at 10th week. When patients having anxious depression were analysed separately; response rate for anxiety of reboxetine group was significantly higher at 7th week only. Mean number of side effects were significantly higher in reboxetine group. Only one subject in each group was dropped out due to side effect. CONCLUSION: We may suggest that reboxetine is as effective and tolerable as venlafaxine XR in the treatment of MDD and MDD with anxiety features, and it may be considered a treatment option to venlafaxine XR.

Clinical characteristics of tension-type headache and migraine in adolescents: a student-based study.

BACKGROUND AND OBJECTIVES: Adolescent headaches, particularly migraine, might present with different features from adult headaches. The objectives of this study were to investigate the characteristics of tension-type headache and migraine, to find the sensitivity and specificity of the diagnostic criteria of the IHS classification according to age and gender. METHODS: A multistep, stratified, cluster sampling method was used for subject selection. The estimated sample size was 2387. The study was conducted in two phases: the questionnaire and the face to face interview phases. During the semistructured interview, a clinical diagnosis has been made and clinical characteristics have been recorded. RESULTS: All headaches fulfilled the criteria of duration. The most common feature of migraine was moderate to severe (92.4%), pulsating pain (79.2%). For ETTH, bilateral localization (91.3%) and mild to moderate pain intensity (90.6%) were the most common features. Younger adolescents showed mixed headache characteristics. Highest sensitivities for migraine were duration (100%), moderate to severe pain (92.4%), and pulsating quality of pain (79.2%). Vomiting, trigger factors food and alcohol had a high specificity for migraine. CONCLUSIONS: Our data strongly support continuum hypothesis. In early adolescence headaches might present with mixed headache characteristics. Age and gender have some influence on headache characteristics, particularly on migraine. The sensitivity and specificity of case definition criteria of ICHD-2 for adolescent migraine is moderate and need to be reconsidered.

Headache prevalence in adolescents aged 12 to 17: a student-based epidemiological study in Bursa.

BACKGROUND AND OBJECTIVES: The objective of this study was to investigate the prevalence and sociodemographic characteristics of headaches among Turkish adolescents aged 12 to 17 years old in Bursa province of Turkey. METHODS: A multistep, stratified, cluster sampling method was used for subject selection. The estimated sample size for 12- to 14-year-old students was 1,270 and for 15- to 17-year-old students was 1,117. Our study sample included 6.5% of the secondary schools and 1.8% of the students aged 12 to 17 years old. The study was conducted in two phases; the questionnaire phase and the face-to-face interview phase. RESULTS: The prevalence of recurrent headache in the study population was 52.2%. Girls (59.8%) had significantly more recurrent headache than boys (45.1%) The prevalence of recurrent headache increased from 42.2% up to 60.7% by age. In multivariate logistic regression analysis age and gender differed significantly between adolescents with and without recurrent headache groups. Frequent episodic tension-type headache was the most common (25.9%) headache among Turkish adolescents, followed by migraine (14.5%). CONCLUSIONS: Age and gender appeared to be demographic factors increasing adolescent headache prevalence. Frequent episodic-tension type headache was the most common headache followed by migraine. Our migraine prevalence was slightly higher than most of the previously reported prevalence rates. This might be due to the new classification criteria of headache released by International Headache Society.

Comparison of the effectiveness and side-effects of tolterodine and oxybutynin in children with detrusor instability.

BACKGROUND: Treatment with anticholinergic agents is the mainstay of therapy for detrusor instability (DI), a chronic and morbid condition characterized by urge urinary incontinence. The aim of this study is to assess the effectiveness and tolerability of tolterodine and oxybutynin in children with DI. METHODS: A total of 60 children with DI were enrolled, 30 (14 male, 16 female, mean age 7.97+/-2.71 years) in the tolterodine group and 30 (12 male, 18 female, mean age 7.33+/-2.23 years) in the oxybutynin group. In this prospective study we reviewed data from 60 children followed for at least 6 months. All of the patients in the study population had a history of dysfunctional voiding. Urodynamic investigations were conducted in all of the patients before and after anticholinergic treatment. Episodes of urge urinary incontinence and adverse events were also evaluated. RESULTS: Improvements in urge incontinence episodes were similar for the children who received tolterodine or oxybutynin. Improvements in the urodynamic parameters were also the same in the two groups. Adverse events were significantly lower in the tolterodine group (13 events in 13 patients) compared to the oxybutynin group (27 events in 20 patients; P=0.027). CONCLUSION: Reductions in urge urinary incontinence episodes were similar with tolterodine and oxybutynin in children with DI. Side-effects were more common with oxybutynin. Treatment of children with DI with tolterodine shows significantly better tolerability and this may enhance children's compliance during long-term treatment.

Value of chemical shift subtraction MRI in characterization of adrenal masses.

OBJECTIVE: The purpose of this study was to assess the advantages of the image subtraction technique in chemical shift MRI for the differentiation of adrenal adenomas from nonadenomas. SUBJECTS AND METHODS: Thirty-five patients with 42 adrenal masses (eight metastases and 34 nonfunctioning adenomas) underwent chemical shift MRI using a double-echo fast low-angle shot sequence. Subsequently, opposed-phase chemical shift MR images were subtracted from in-phase images. The subtraction images were assessed quantitatively and qualitatively. For quantitative assessment, the signal intensity values of the adrenal masses were measured by one investigator with manually defined regions of interest. Qualitative assessment of the subtraction images was performed independently by two investigators, who reported their confidence in diagnosing adenomas versus nonadenomas based on signal intensity of the adrenal masses on subtraction images. RESULTS: The mean signal intensities were significantly different between adenomas and metastases on subtraction images (213 vs 18; p < 0.0001). There was no overlap in signal intensities between adenomas and metastatic tumors. The accuracy in distinguishing adenomas from metastatic tumors was 100% if the cutoff value of the signal intensity selected was 36-106. Quantitative results corresponding to 100% specificity were also observed, with similar sensitivity. No difference in interpretation between the two investigators occurred. CONCLUSION: Chemical shift subtraction MRI provides a high confidence level in distinguishing adrenal adenomas from adrenal metastases. The image subtraction technique also facilitates quantitative and qualitative evaluation of adrenal masses in chemical shift MRI.