Stenotic double-orifice mitral valve after surgical repaired partial atrioventricular septal defect.

Double-orifice mitral valve (DOMV) is an uncommon congenital anomaly account for 1% of congenital heart disease. However, accurate diagnosis and evaluation of valve stenosis or regurgitation and other concomitant congenital anomalies due to DOMV are required to obtain suitable treatment. Two- and three-dimensional echocardiography can contribute valuable functional and anatomic information that can support to reach this goal. Here, we present a case of complete bridge-type DOMV that causes mitral stenosis after surgical repair of the partial atrioventricular septal defect in childhood.

The Clinical Value of Diffusion-Weighted Magnetic Resonance Imaging in Diabetic Foot Infection.

BACKGROUND: Osteomyelitis is a common complication in the diabetic foot that can conclude with amputation. The purpose of this study was to evaluate the role of diffusion-weighted magnetic resonance imaging (DWI) in the diagnosis of osteomyelitis in diabetic foot ulcer (DFU). METHODS: Thirty patients with type 2 diabetes mellitus and a DFU were enrolled. Both DWIs and conventional MRIs were obtained. Apparent diffusion coefficient (ADC) measurements were made by transferring the images to a workstation. The measurements were made both from bone with osteomyelitis, or nearest to the injured area if osteomyelitis is not available, and from the adjacent soft tissue. RESULTS: The patients comprised nine women (30%) and 21 men (70%) with a mean age of 58.7 years (range, 41-78 years). The levels of ADC were significantly low (P = .022) and the erythrocyte sedimentation rates were significantly high (P = .014) in patients with osteomyelitis (n = 9) compared with patients without osteomyelitis (n = 21). The mean ± SD bone ADC value (0.75 ± 0.16 × 10-3 mm2/sec) was significantly lower than the adjacent soft-tissue ADC value (0.90 ± 0.15 × 10-3 mm2/sec) in patients with osteomyelitis (P = .04). CONCLUSIONS: It is suggested that DWI contributes to conventional MRI with short imaging time and no requirement for contrast agent. Therefore, DWI may be an alternative diagnostic method for the evaluation of DFU and the detection of osteomyelitis.

The Value of Serum Prolidase Activity in Progression of Microalbuminuria in Patients With Type 2 Diabetes Mellitus.

BACKGROUND: Prolidase is a cytosolic exopeptidase that plays a pivotal role in collagen turnover. Diabetic nephropathy (DN) is associated with structural changes in glomerular basement membrane accompanied with increased amounts of collagen. Prolidase is known to be abundant in kidney and collagen accumulation is increased in DN, so we aimed to determine the value of serum prolidase activity (SPA) in predicting the progression of nephropathy in type 2 diabetes mellitus (DM). METHODS: Thirty type 2 DM patients having microalbuminuria (microalbuminuric group), 30 type 2 DM patients without albuminuria (normoalbuminuric group), and 28 healthy controls (control group) were enrolled. Study groups had similar age, sex distribution, and body mass index (BMI). RESULTS: Metabolic parameters, SPA and urinary microalbumin were determined. SPA was significantly higher in microalbuminuric group when compared with normoalbuminuric and control groups (P = 0.05 and P < 0.001, respectively). Triglyceride levels were significantly higher and high density lipoprotein cholesterol (HDL-C) levels were significantly lower in microalbuminuric group compared to control group (Both P < 0.05). SPA showed a negative correlation with HDL-C level and a positive correlation with urinary albumin excretion (r = -0.219, P < 0.05 and r = 0.39, P < 0.001 respectively). In regression analysis, albumin excretion was the sole parameter influencing SPA. CONCLUSION: SPA appears to be higher in type 2 DM patients having microalbuminuria compared to patients without microalbuminuria and healthy controls. The pathophysiological role and the significance of SPA in predicting DN need to be further evaluated.

Serum prolidase activity in diabetic foot ulcers.

Impaired wound healing is an important problem in diabetes mellitus; however, its pathogenesis remains unclear. We aimed to evaluate serum prolidase activity (SPA), an important marker of collagen turnover, in subjects with and without diabetic foot ulcers as compared with healthy controls. Twenty-seven patients with diabetic foot ulcers (foot ulcer group), 27 patients without diabetic foot ulcers (diabetic control group) and 27 healthy controls were enrolled. The study groups had similar age, sex distribution and body mass index. Metabolic and inflammatory parameters as well as SPA were determined. The diabetic foot ulcer group had significantly higher SPA (both p < 0.001) when compared with the diabetic and the healthy control groups. SPA showed a positive correlation with high-sensitive C-reactive protein and a negative correlation with high-density lipoprotein cholesterol levels (r = 0.313, p = 0.021 and r = -0.233, p = 0.036, respectively). No correlation was detected between SPA and glycaemic parameters. SPA appears to be higher in patients with diabetic foot ulcers when compared with patients without diabetic foot ulcers and healthy controls. The underlying mechanisms of elevated SPA and its clinical significance in predicting the natural course of wound healing in diabetic foot ulcers needs to be further evaluation.

Can first-trimester screening program detect women at high risk for gestational diabetes mellitus?

This study was designed to compare first-trimester maternal serum biochemical markers of aneuploidy and fetal nuchal translucency in pregnancies complicated by gestational diabetes mellitus and those of a control group. The study included 60 gestational diabetic and 60 control women who attended the first-trimester combined screening program for Down syndrome between 11 and 14 gestational weeks with complete follow-up data and delivered in our institution. Maternal serum free ß-human chorionic gonadotropin, pregnancy-associated plasma protein-A and fetal nuchal translucency were investigated. The combined risks, double test risks and age risks were calculated by PRISCA software version 4.0. Comparison of the results between the two groups yielded no significant differences in serum levels of free ß-human chorionic gonadotropin and fetal nuchal translucency. However, women who developed gestational diabetes mellitus had significantly lower pregnancy-associated plasma protein-A. And also, the combined risks and double test risks calculated by PRISCA software were statistically higher in gestational diabetic women than normal pregnant women. These results suggest that differences can be seen between diabetic and healthy pregnant women in first-trimester maternal serum biochemical markers of aneuploidy.

Overt and mild subclinical hypothyroidism do not influence mean platelet volume in premenopausal women having low cardiac risk.

Mean platelet volume (MPV) was studied in subclinical hypothyroidism (SH) and the results are conflicting. The aim of this study is to assess how MPV is affected in overt hypothyroidism (OH) and mild SH, the 2 end points of hypothyroidism, in patients having low cardiac risk. Premenopausal women without any cardiac risk, 18 with OH, 30 with mild SH, and 37 euthyroid controls were enrolled. Overt hypothyroidism group had higher low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels than the control group (P < .001 and P < .05, respectively). Increase in MPV was insignificant in OH group when compared with SH and control groups. No correlation was observed between MPV and metabolic and hormonal parameters. Both OH and SH did not influence MPV and high-sensitivity C-reactive protein (hs-CRP) in patients with low cardiovascular risk, but these findings need to be further evaluated in this patient group.

Recurrent symptomatic hypocalcemia during rifampicin therapy for brucellosis.

Drug-associated hypocalcemia is rare, but may occur during routinely administered drugs. We reported a case of vertebral brucellosis, which developed two hypocalcemic episodes associated with hypokalemic alkalosis with two drug combinations including rifampicin. Possible underlying mechanisms of hypocalcemia were discussed. The patient had carpopedal spasm at both hypocalcemic presentations. Laboratory analysis revealed hypocalcemia, hypokalemia, alkalosis with hypercalciuria, and low-normal parathormone (PTH) at first and elevated PTH at the second admission. The patient improved with cessation of drugs and appropriate management of hypocalcemia and hypokalemia with calcium, vitamin D, magnesium, and potassium replacement. The underlying mechanism of hypocalcemia in this patient seemed to be due to tubular damage resulting with Bartter-like syndrome, which is well defined with aminogylcosides. But the recurrence of hypocalcemia with an aminoglycoside-free antibiotic combination including rifampicin suggests a possible role of rifampicin on hypocalcemia associated Bartter-like syndrome that has never been reported before.

Paraoxonase-1 is not affected in polycystic ovary syndrome without metabolic syndrome and insulin resistance, but oxidative stress is altered.

Paraoxonase-1 (PON1) activity is decreased in polycystic ovary syndrome (PCOS) having metabolic syndrome (MetS) or insulin resistance (IR). We aimed to assess PON1 activity and oxidative stress in PCOS without MetS or IR. Metabolic and hormonal parameters, high-sensitive C-reactive protein (hs-CRP), oxidative stress parameters (total antioxidant status (TAS), total oxidative stress (TOS), oxidative stress index (OSI), lipid hydroperoxide (LOOH), total free sulfhydryl (--SH) groups), PON and arylesterase were analyzed in 30 normal weighed patients with PCOS without MetS or IR and 20 normal controls. Hs-CRP, PON, arylesterase, and TAS levels of PCOS and control groups were similar. LOOH, TOS, and OSI of PCOS group were higher than in the controls (p < 0.05; p < 0.001, and p < 0.001, respectively). - SH group levels showed a positive correlation with free testosterone (fT). TOS positively correlated with free androgen index (FAI), body mass index (BMI), waist-to-hip ratio (WHR), LOOH, and OSI. This study showed that oxidative stress is increased in PCOS even in the absence of MetS or IR. PON1 activity appears not to be affected in PCOS without MetS and IR. Several metabolic and antropometric risk factors may aggravate this altered oxidative state in PCOS.

Non-diabetic metabolic syndrome and obesity do not affect serum paraoxonase and arylesterase activities but do affect oxidative stress and inflammation.

OBJECTIVE: Paraoxonase-1 (PON-1), which has PON and arylesterase activities, is a high-density lipoprotein (HDL)-bound antioxidant enzyme that inhibits atherosclerosis. Diabetes has been shown to have an impact on oxidative stress. The effect of metabolic syndrome (MetS) on oxidative stress and PON-1 has been shown before, and PON-1 has been found to be related with accelerated atherogenesis. This study aimed to determine the oxidative state and PON and arylesterase activities in non-diabetic MetS and non-MetS obese patients. DESIGN: Thirty obese patients (3 M and 27 F) without MetS, 40 non-diabetic obese patients (3 M and 37 F) with MetS, and 30 controls (2 M and 28 F) were enrolled. METHODS: A 75 g glucose tolerance test was performed. PON-1, PON, arylesterase, total antioxidant status (TAS), high-sensitive C-reactive protein (hsCRP), and metabolic parameters were analyzed. RESULTS: PON and arylesterase activities were similar between the groups, while TAS was low in both MetS and obese groups compared to controls (P<0.01 and P<0.05 respectively). CRP was higher in the MetS group compared with the obese and control groups (P<0.01 and P<0.001 respectively). In both the obese and MetS groups, CRP showed a positive correlation with body mass index (BMI). TAS was negatively correlated with BMI, waist circumference, triglyceride levels, and systolic and diastolic blood pressures (P<0.001). CONCLUSIONS: Oxidative stress is altered in non-diabetic MetS and non-MetS obese patients, but PON and arylesterase activities seem not to be affected. This result may be due to the absence of diabetes, the most severe form of altered carbohydrate metabolism.

Asymmetric dimethylarginine levels and carotid intima-media thickness in obese patients with polycystic ovary syndrome and their relationship to metabolic parameters.

OBJECTIVE: To evaluate the plasma asymmetric dimethyl arginine (ADMA) levels and carotid intima-media thickness (IMT) in patients with polycystic ovary syndrome (PCOS). DESIGN: Prospective study. SETTING: University medical center. PATIENT(S): Thirty-five patients with PCOS and 31 healthy controls. INTERVENTION(S): Peripheral venous puncture, ultrasonography, oral glucose tolerance test (OGTT). MAIN OUTCOME MEASURE(S): Plasma ADMA, serum FSH, LH, dehydroepiandrosterone sulfate (DHEAS), free T and total T, insulin, fasting plasma glucose, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglyceride, homocysteine, fibrinogen, C-reactive protein, and carotid IMT. RESULT(S): The PCOS group had higher levels of androgens, triglycerides, homocysteine, insulin, and homeostasis model assessment of insulin resistance when compared with controls. There were no significant differences in ADMA levels and IMT between the two groups. The fasting plasma glucose, total cholesterol, HDL cholesterol, LDL cholesterol, fibrinogen, and C-reactive protein levels were not different among the groups. Intima-media thickness was significantly correlated with DHEAS, but there was no association between IMT and ADMA. CONCLUSION(S): Results of our study revealed that ADMA levels and carotid IMT in patients with PCOS are not different from healthy controls.

The factors that affect plasma homocysteine levels, pulse wave velocity and their relationship with cardiovascular disease indicators in peritoneal dialysis patients.

OBJECTIVE: The incidence of cardiovascular diseases (CVD) is high in end-stage renal disease (ESRD) population and hyperhomocysteinemia is an important CVD risk factor. The aims of this study are to asses the incidence of hyperhomocysteinemia and the factors that affect the homocysteine (Hcy) levels in peritoneal dialysis (PD) patients, and to analyze the relationships between Hcy levels and clinical and echocardiographic CVD, and the pulse wave velocity (PWV). STUDY DESIGN: Sixty ESRD patients undergoing PD for at least 6 months were included in the study. Biochemical parameters, echocardiography, and PWV were analysed for every subject. RESULTS: Mean Hcy level was 27.2 +/- 15.7 micromol/L and was high in 53 patients (88.3%). Fibrinogen, dialysate/plasma creatinine ratio and folic acid were found to be the independent predictors of Hcy level (P < 0.001; P < 0.01; P < 0.05, respectively). Patients with atherosclerosis had significantly higher plasma Hcy levels (P < 0.05). No significant relationship was found between plasma Hcy levels and echocardiographic findings and PWV. CONCLUSION: Hyperhomocysteinemia incidence seems high among PD patients and despite significant relationship between fibrinogen and Hcy in our study, it is essential to evaluate the link between Hcy levels and inflammation. Folic acid replacement even in normal folic acid levels, enough elimination of volume and solutes may be beneficial to control Hcy levels, whereas PWV was found to be related with comorbidities and and dialysate kinetics.

49,XXXXY syndrome with autoimmune diabetes and ocular manifestations.

OBJECTIVE: We report a rare case of 49,XXXXY syndrome with autoimmune diabetes (requiring insulin therapy), bilateral cataracts and unilateral glaucoma. CLINICAL PRESENTATION AND INTERVENTION: A 25-year-old man with mental retardation presented with multiple skeletal abnormalities, polyuria and polydipsia. He had high glucose concentrations, without ketonuria, and hypergonadotropic hypogonadism. Ophthalmic examination revealed a polar cataract in both eyes and increased intraocular pressure in the left eye. The anti-islet cell antibody test was positive, and anti-glutamic acid decarboxylase autoantibody levels were elevated. Karyotype analysis revealed 49,XXXXY. Intensive insulin therapy and testosterone replacements were started. CONCLUSION: The autoimmune nature of diabetes that we observed in our patient seems to be predisposed by hypogonadism. Cataract and glaucoma in this case seem to be the result of diabetes, and an association of these ocular manifestations with the syndrome 49,XXXXY seems unlikely.

Serum total antioxidant status and lipid peroxidation marker malondialdehyde levels in overt and subclinical hypothyroidism.

BACKGROUND: Mitochondria are the main production site of free oxygen radicals, which can cause organ dysfunction by oxidation of cellular macromolecules such as carbohydrates, lipids and proteins. Oxidative stress may result from either overproduction of these species or from failure of the antioxidant defence systems. Thyroid hormones have well-known effects on mitochondrial oxygen consumption, but data about how hypothyroidism affects oxidative stress are controversial, and little is known about oxidative stress in subclinical hypothyroidism. Total antioxidant status (TAS) gives information about all of the antioxidants in the organism, while malondialdehyde (MDA) is a lipid peroxidation marker used to assess lipid peroxidation due to increased oxidative stress. We aimed to determine how hypothyroidism and subclinical hypothyroidism affect serum MDA and TAS. SUBJECTS AND METHODS: Serum TAS, MDA, C-reactive protein levels and lipid compositions were studied in 20 hypothyroid, 40 subclinical hypothyroid and 40 healthy subjects. RESULTS: MDA was elevated in both hypothyroid and subclinical hypothyroid patients compared with controls, while TAS levels show no significant differences between groups. Low-density lipoprotein (LDL) cholesterol levels were significantly high in both hypothyroid and subclinical hypothyroid patients. Triglyceride levels were high only in hypothyroid patients when compared with the controls. MDA showed a correlation with LDL cholesterol, total cholesterol and triglyceride. CONCLUSIONS: These results suggest an increased oxidative stress in both hypothyroid and subclinical hypothyroidism states, which can be explained by both the insufficient increase in the antioxidant status and the altered lipid metabolism in these cases.

Intrasellar epidermoid cyst presenting as pituitary apoplexy.

We herein present a patient with intrasellar epidermoid cyst presenting as pituitary apoplexy, who was operated upon with a trans-sphenoidal approach. The clinical presentation, radiological and histological differential diagnosis and type of surgical intervention for intrasellar epidermoid cysts are discussed.

Frequency, risk factors, and responsible pathogenic microorganisms of asymptomatic bacteriuria in patients with type 2 diabetes mellitus.

Urinary tract infection is a serious problem in diabetic patients, and asymptomatic bacteriuria (ASB) in these patients is a risk factor for pyelonephritis and renal dysfunction. In the present study, we investigated the relationships between age, body mass index, duration of diabetes, HbA1c level, glucosuria, glomerular filtration rate and microalbuminuria in type 2 diabetic patients with ASB. One hundred and twenty-three patients with type 2 diabetes mellitus were included in the study. The patients were divided into two groups according to ASB; Group I consisted of 22 patients with ASB, and Group II of 101 patients without ASB. There were no significant differences between the groups in regard to age, body mass index, creatinine clearance or microalbuminuria, while there were significant differences in HbA1c, duration of diabetes mellitus, glucosuria and pyuria (P < 0.05). The most commonly isolated microorganism was Escherichia coli. The present study identified the duration of diabetes, high HbA1c, glucosuria and pyuria as risk factors for ASB in type 2 diabetic patients.