Factors associated with clinical outcome in geriatric acute cholangitis patients.

OBJECTIVE: We aimed to determine the risk factors associated with the clinical outcome in cases of acute cholangitis among the geriatric age group. PATIENTS AND METHODS: Patients aged >65 years hospitalized with the diagnosis of acute cholangitis in an emergency internal medicine clinic were included in this study. RESULTS: The study population comprised 300 patients. In the oldest-old group, the rates of severe acute cholangitis and intensive care unit hospitalization (39.1% vs. 23.2%, p<0.001) were higher. The mortality rate was also higher in the oldest-old group (10.4% vs. 5.9%, p=0.045). The presence of malignancy, ICU hospitalization, decreased platelet levels, decreased hemoglobin levels, and decreased albumin levels were associated with mortality. In the multivariable regression model in which variables associated with Tokyo severity were included, the associated factors for membership in the severe risk group compared to the moderate risk group were decreased platelet count (OR: 0.96; p=0.040) and decreased albumin level (OR: 0.93; p=0.027). Increasing age (OR: 1.07; p=0.001), malignancy etiology (OR: 5.03; p<0.001), increasing Tokyo severity (OR: 7.61; p<0.001), and decreasing lymphocyte count (OR: 0.49; p=0.032) were determined to be associated with ICU admission. Decreasing albumin levels (OR: 0.86; p=0.021) and ICU admission (OR: 16.43; p=0.008) were determined to be factors associated with mortality. CONCLUSIONS: Worse clinical outcomes occur among geriatric patients with increasing age.

A novel risk prediction tool for contrast-induced nephropathy in patients with chronic kidney disease who underwent diagnostic coronary angiography.

OBJECTIVE: The incidence of contrast-induced nephropathy (CIN) is higher than 20% in patients with chronic kidney disease. In this study, we sought to define the predictors of CIN and develop a risk prediction tool in patients with chronic kidney disease. PATIENTS AND METHODS: Patients aged 18 years and older who underwent invasive coronary angiography with an iodine-based contrast media between March 2014 and June 2017 were retrospectively analyzed. Independent predictors for CIN development were identified and a new risk prediction tool was created that included these predictors. RESULTS: In total, 283 patients included in the study were divided into those who developed CIN (n=39, 13.8%) and those who did not (n=244, 86.2%). Male gender (OR: 4.874, 95% CI: 2.044-11.621), LVEF (OR: 0.965, 95% CI: 0.936-0.995), diabetes mellitus (OR: 1.711, 95% CI: 1.094-2.677), and e-GFR (OR: 0.880, 95% CI: 0.845-0.917), were identified as independent predictors for the development of CIN in the multivariate analysis. A new scoring system has been designed that can score a minimum of 0 and a maximum of 8 points. Patients with a new scoring system score of ≥4 were at approximately 40 times higher risk of developing CIN than others (OR: 39.9, 95% CI: 5.4-295.3). The area under the curve value of CIN's new scoring system was 0.873 (95% CI, 0.821-0.925). CONCLUSIONS: We found that four easily accessible and routinely collected variables, including sex, diabetes status, e-GFR, and LVEF, were independently associated with the development of CIN. We believe that using this risk prediction tool in routine clinical practice may guide physicians to use preventive medications and techniques in high-risk patients for CIN.

The role of triglyceride-glucose index in determining subclinical atherosclerosis in patients with primary hypertension.

OBJECTIVE: With the current study, we aimed at examining the relationship between the triglyceride-glucose (TyG) index and subclinical atherosclerosis in patients with primary hypertension. PATIENTS AND METHODS: 185 patients with primary hypertension were included in this study. The following findings were considered to be associated with target organ damage (TOD): urinary protein excretion > 150 mg/dL and microalbumin excretion > 30 mg/dL, carotid intima-media thickness (CIMT) ≥ 0.9 mm or carotid plaque and/or left ventricular mass index (LVMI) > 95 g/m2 in women, > 115 g/m2 in men. RESULTS: TyG index values were positively correlated with levels of CIMT (r=0.434; p<0.001), LVMI (r=0.351; p<0.001), microalbuminuria (r=0.347; p<0.001), and proteinuria (r=0.355; p<0.001). In the multivariable regression model, in which the variables associated with the presence of TOD were included, increased age (OR: 1.04, p=0.025), increased body mass index (OR: 1.10, p=0.042), and increased TyG index value (OR: 1.05, p<0.001) had independent associations with TOD. The threshold value of the TyG index for the presence of TOD was determined as > 8.85 with 79.0% sensitivity and 77.1% specificity (AUC±SE: 0.859±0.03, +PV: 70.6%, -PV: 84.0%, p<0.001). The TyG index had a superior diagnostic discrimination compared to its components in predicting the presence of TOD. CONCLUSIONS: Increased TyG index values in patients with primary hypertension are associated with damage to target organs, not merely subclinical atherosclerosis.

Are neutrophil-to-lymphocyte ratios and large unstained cells different in hospitalized COVID-19 PCR-positive patients with and without diabetes mellitus?

OBJECTIVE: SARS-CoV-2 might present with multisystem involvement due to its entry into many cells with ACE2 receptors on their surfaces, such as heart, endothelial, and lung alveoli cells. Studies have indicated that COVID-19 infection causes a severe clinical presentation in diabetic patients due to dysregulation of the metabolic and immune systems. The hematological effects of COVID-19 and the relationship of lymphopenia with the severity of the disease have been reported previously. The parameter of percentage of large unstained cells (LUCs) reflects active lymphocytes and peroxidase-negative cells. The neutrophil-to-lymphocyte ratio (NLR) is another reliable marker of inflammation in cases of cardiac diseases, solid tumors, and sepsis. The present study aimed to evaluate whether the parameters of LUCs and NLR differed between diabetic and nondiabetic individuals with COVID-19. Associations with disease severity were also sought. MATERIALS AND METHODS: In our retrospective study, the data of 1,053 patients [230 diabetic patients (21.83%) and 823 nondiabetic patients (78.15%)] were reviewed. The white blood cell (WBC) count, neutrophil count, neutrophil%, lymphocyte count, lymphocyte%, LUC count, %LUCs, NLR, platelet count, hemoglobin level, HbA1c, history of diabetes, surveillance during hospitalization, and pulmonary infiltration status within the first 24 hours after admission to the hospital were analyzed from the records. RESULTS: When diabetic patients were compared with nondiabetics, the age [65 (20-90) vs. 42 (18-94) years], WBC count [6.72 (2.6-24.04) vs.  5.91 (1.35-52.68)], neutrophil count [4.29 (1.28-65) vs. 3.68 (0.02-50.47)], neutrophil% [67.53±12.3 vs.  64.08±13.28], NLR [3.35 (0.83-38.11) vs. 2.48 (0.01-68.58)], and LUC count [0.11 (0.03-0.98) vs. 0.1 (0.02-3.06)] of the diabetic group were found to be higher and these differences were statistically significant (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, and p=0.015, respectively). CONCLUSIONS: We determined that LUC counts and NLR values in COVID-19-positive patients with diabetes were statistically significantly higher compared to nondiabetic patients.

COVID-19 outcomes in patients with antiphospholipid syndrome: a retrospective cohort study.

BACKGROUND: Aim of this study is to investigate COVID-19 outcomes in patients with antiphospholipid syndrome (APS). METHODS: A retrospective cohort was formed from APS patients. Patients were screened for a record of positive SARS-CoV 2 PCR. In PCR­positive patients, clinical data and information regarding COVID-19 outcomes were collected from medical records. RESULTS: A positive PCR test was detected in 9/53 APS patients, while 66.7 %, 33.3 % and 11.1 % of APS patients with COVID-19 were under hydroxychloroquine, LMWH or warfarin, and acetylsalicylic acid, respectively. There were 3/9 patients found to be hospitalized and one died. No new thrombotic event was reported in any of the patients during COVID-19 infection. CONCLUSION: Baseline use of hydroxychloroquine, antiaggregants and anticoagulants may be associated with an absence of new thrombotic event (Tab. 2, Ref. 33).

Diagnostic utility of oxidative and non-oxidative markers for spontaneous bacterial peritonitis in non-malign ascites.

OBJECTIVE: In this study, we aimed to investigate the diagnostic availability of oxidant and antioxidant parameters in ascites for spontaneous bacterial peritonitis (SBP). MATERIAL AND METHODS: This study was carried out between July and October 2018 with 25 patients with SBP and 24 patients without SBP. Patients with acute infection, those taking vitamin supplements and antioxidant medication, smoking and drinking alcohol, and patients without ascites culture were excluded from the study. RESULTS: In patients with SBP compared those without SBP median paraoxonase (3.1 vs 15.6 ; p <0.001), median stimulated paraoxonase (12.6 vs 53.1 ; p <0.001), median arylesterase (769,9 vs 857,5 ; p = 0,003) and median catalase (10 vs 22,2 ; p = 0,003) were found to be lower and median myeloperoxidase (8.1 vs 1.1 ; p <0.001) were found to be higher. There was a positive correlation between paraoxonase levels and stimulated paraoxonase levels, arylesterase levels and catalase levels, there was a negative correlation between paraoxonase levels and myeloperoxidase levels. Paraoxonase levels 3.7 and lower, stimulated paraoxonase levels 25.8 and lower, arylesterase levels 853.4 and lower, catalase levels 11.8 and lower and myeloperoxidase levels 2.7 and more predicted the the presence of SBP with high specificity and high sensitivity. Paraoxonase and stimulated paraoxo-nase levels were found to have superior performance in predicting the presence of SBP compared to arylesterase levels (p <0.05). CONCLUSION: In this study it was shown that paraoxonase, stimulated paraoxonase, arylesterase, catalase and myeloperoxidase activities can be used for the diagnosis and severity of SBP.

Prognostic Utility of Hypokalemia in Cirrhotic Patients.

BACKGROUND AND AIM: We researched the relationships between serum potassium level and prognostic scores and complications of cirrhosis, and mortality. METHODS: This study was performed retrospectively in Turkish High Specialty Training and Research Hospital between 2009 and 2015. Patients who had missing patient files and electrolyte disorder for another reason, showed complications at the time of application and were using diuretics were excluded from the study. RESULTS: 218 patients were included in the study. During the follow-up period, 23.4% (n: 51) of the entire population passed away. Compared to the patients who survived, the patients who passed away had higher HCC and HES development rate, mean Child-Pugh and MELD score and lower mean blood potassium level. The stepwise multivariable Cox regression model which included significant independent predictors showed that ChildPugh score (HR: 1.29; p <0.001), MELD score (HR:1.13; p= 0.006), and potassium level (HR: 0.18; p< 0.001) were independent predictors of mortality. The cut off value for potassium level in predicting mortality was found to be ≤ 3.4 mmol/L with 80.4% sensitivity and 100% specificity. Compared to the patients with a potassium level > 3.4 mmol/L, the patients with a potassium level ≤ 3.4 mmol/L had higher mortality rate, HCC and HES development rate, mean Child-Pugh and mean MELD scores. CONCLUSION: Hypokalemia is an important prognostic factor in cirrhotic patients.

Factors associated with increased irisin levels in the type 1 diabetes mellitus.

OBJECTIVE: The aim of the present study was to determine the irisin levels in patients with the type 1 diabetes mellitus (T1DM) and to examine the relation of irisin levels with the inflammation and autoimmunity. METHODS: This study included 35 cases diagnosed with T1DM and 36 healthy volunteers. Antiglutamic acid decarboxylase (anti-GAD), islet cell antibody (ICA), and insulin autoantibody levels were measured in patients at the time when they were included into the study and recorded from the patient files. Serum irisin levels were measured by ELISA kit. RESULTS: The median irisin levels were determined higher in T1DM group compared to the control one (6.8 ng/ml vs. 4.8 ng/ml, p=0.022; respectively). Median irisin levels were higher in anti-GAD (p=0.022) and ICA (p=0.044) positive groups compared to negative groups. In T1DM group, irisin levels displayed positive correlation with glycosylated hemoglobin (HbA1c) (r=0.377, p<0.001) and anti-GAD (r=0.392, p=0.020) and negative correlation with creatinine (r=-0390, p=0.021). In multivariate regression model, HbA1c (B±SE: 2.76±17683, p<0.001), and anti-GAD (B±SE: 2.311±0.610, p=0.001) were determined as independent predictors for predicting the irisin levels. CONCLUSION: In patients with T1DM, which chronic inflammation and autoimmunity take part in their etiopathogenesis, anti-GAD levels were an independent risk factor for the irisin. Th is may suggest that factors such as inflammation and autoimmunity can be effective in the synthesis of irisin.

Choice of marker for assessment of RV dysfunction in acute pulmonary embolism : NT-proBNP, pulmonary artery systolic pressure, mean arterial pressure, or blood pressure index.

BACKGROUND: We aimed to examine the value of NT-proBNP, pulmonary artery systolic pressure (PASP), blood pressure index (BPI), and mean arterial pressure (MAP) in the determination of right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). PATIENTS AND METHODS: A total of 547 patients diagnosed with APE were included in the study. Demographic characteristics and comorbid conditions of patients were recorded in patient files. For blood pressure measurement, a calibrated digital blood pressure monitor was used at regular intervals. Blood samples were taken from patients at the time of admission for hemogram, biochemical, and hemostasis blood tests. Echocardiography was performed on all patients to detect RVD and evaluate pulmonary artery pressure. RESULTS: PASP (p < 0.001), MAP (p < 0.001), diastolic blood pressure (p < 0.001), D­dimer (p = 0.001), NT-proBNP (p = 0.001), white blood cell (p < 0.001), and platelet (p = 0.001) counts were higher in APE patients with RVD compared with those without RVD, whereas the mean BPI level (p < 0.001) was lower. BPI had a negative correlation with PASP, NT-proBNP, platelet count, and triglyceride levels in patients with RVD. In regression analysis, BPI and PASP were found to be independent predictors of RVD. In receiver operating characteristic curve analysis, BPI (AUC ± SE = 0.975 ± 0.006; p < 0.001) was found to be the best predictor of RVD with a higher sensitivity (92.8%) and specificity (100%). CONCLUSION: We found that BPI had a better diagnostic discrimination for RVD compared with PASP and NT-proBNP.

Accessory spleen hypertrophy mimicking colon cancer metastasis.

Accessory spleen is a congenital form of an ectopic splenic tissue. In this report, we present a case of a patient who was followed with the diagnosis of rectal and sigmoid colon cancer and an accessory spleen hypertrophy, which was thought to be colon cancer metastasis in the left hypochondriac region. After colectomy and splenectomy, accessory spleen that mimics cancer metastasis was diffrentially diagnosed using scintigraphy.

Newly diagnosed primary hypothyroidism applicant with massive pericardial effusion and acute renal failure.

OBJECTIVE: While non-symptomatic pericardial effusion is seen in primary hypothyroidism, massive pericardial effusion is a very rare finding. In the literature, newly diagnosed primary hypothyroidism cases presenting with massive pericardial effusion or acute renal failure are present, but we did not encounter any case first presenting with combination of two signs. In this case report, primary hypothyroidism case that presenting with massive pericardial effusion and acute renal failure will be discussed. Subject and Results. Forty-eight years old male patient was hospitalized with shortness of breath, chest pain, swelling of the eyelids and bilateral limbs complaints. On chest radiograph heart shadow was deleted, pleural effusion was present until the middle zone of the left lung. Biochemical parameters (urea, creatinine, alanine aminotransferase aspartate aminotransferase, lactate dehydrogenase, sodium, potassium, creatine kinase, Troponin I, CK-MB, erythrocyte sedimentation rate, c-reactive protein) and thyroid stimulating hormone (TSH, 52.6 µg/ml), free triiodothyronine (T3, 0.61pg/ml), free thyroxine (T4, 0.12 ng/dl), anti thyroperoxydase (343 IU/ml), anti thyroglobulin (1604 IU/ml), were analyzed. The patient underwent pericardiocentesis. Levothyroxine treatment started with a dose of 0.05 mg per day and increased gradually until the optimum dose provided. At the end of the third month, the values of TSH, free T4, and free T3 were measured (2.3 µg/ml, 1.1 ng/dl, 2.54 pg/ml, respectively). The patient recovered completely and pericardial effusion was not detected in echocardiography. CONCLUSION: Massive PE and acute renal failure due to primary hypothyroidism is a rare clinical condition. Primary hypothyroidism should be kept in mind in patients with symptoms like shortness of breath, chest pain, and generalized edema; moreover, when acute renal failure and PE were detected. It should be considered that patient's biochemical parameters can improve starting from the two weeks after levothyroxine treatment started with pericardiocentesis in severe symptomatic patients.

Relationship between blood pressure variability and renal activity of the renin-angiotensin system.

Local renin-angiotensin system (RAS) activity in the kidneys is a pathogenetic factor in patients with primary hypertension. This study aimed to determine the relationship between local kidney RAS activity and blood pressure variability, as the literature currently lacks any such study. The study included 73 consecutive primary hypertensive patients. All patients underwent 24-h ambulatory blood pressure monitoring to determine the average real variability (ARV) index, as an indicator of blood pressure variability. Local RAS activity was determined using the urine angiotensinogen/creatinine (UAGT/UCre) ratio. The high UAGT/UCre ratio group had significantly higher mean 24-h systolic ARV than the low UAGT/UCre ratio group (13.2±3.4 vs 11.0±2.6, P=0.003). Similarly, the high UAGT/UCre ratio group had significantly higher mean 24-h diastolic ARV than the low UAGT/UCre ratio group (10.8±3.2 vs 8.7±2.2, P=0.001). Multivariate regression analysis showed that Log(UAGT/UCre) was an independent predictor of both 24-h diastolic ARV and 24-h systolic ARV. Local RAS activity in the kidneys might have a role in blood pressure variability. On the basis of these findings, we think that additional prospective studies are needed to more fully discern the effect of local RAS activity on blood pressure variability.

Kidney Transplantation From Elderly Donor.

AIM: In recent years, there has been an increase in usage of grafts from advanced-age donors because of the shortage of organ availability. Acceptance of elderly living-kidney donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications. The objective of this study was to evaluate the graft function and patient survival using kidneys from living-related and unrelated donors who were older than 65 years of age. MATERIALS AND METHODS: From December 2008 until December 2013 we compared the outcomes of 294 patients (mean age, 47.67 ± 12.4 years; range, 16 to 74 years old) who received grafts from donors ≥ 65 years old to 2339 patients who received grafts from donors who were younger than 65 years old. RESULTS: We observed no significant differences in sex, time on dialysis, or cold ischemia time between the groups. The recipient ages between two groups were similar. For survival analysis we used the Kaplan-Meier survival estimator. Patient survival at 1, 2, and 3 years was 91.1%, 89.1%, and 88.5%, respectively, for patients transplanted with kidneys from donors ≥ 65-years-old vs 96.7%, 95.9%, and 95.0%, respectively, in the <65-year-old donor group. Multivariate analysis showed the variables associated with patient survival to be donor age at time of transplantation in years (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.59-1.71; P < .05), time on dialysis in months (HR, 1.22; 95% CI, 1.21-1.23; P = .002). Graft survival rates at 1, 2, and 3 years censored for death with functional graft at was 97.6%, 96.4%, and 94.1%, respectively, for patients transplanted with kidneys from donors older than 65 years vs 97.5%, 96.8%, and 95.2%, respectively, in the <65-year-old donor group. Multivariate analysis, HLA-DR mismatches (HR, 1.23; 95% CI, 1.12-1.55; P = .050), delayed graft function (HR, 1.77; 95% CI, 1.53-2.07; P = .021), and perhaps acute rejection (HR 1.14; 95% CI, 0.82-1.95; P = .093) were the variables associated with graft survival. CONCLUSION: We concluded that the use of kidneys from donors older than 65 years of age allows us to increase the rate of renal transplantation to approximately 15 to 20 per million population, with good graft and patient survivals provided that the protocol for expanded criteria organs ensured proper macroscopic and microscopic evaluation of the organ for transplantation.

Donors With Hepatitis B Surface Antigen Positivity.

OBJECTIVE: There is a still controversy among transplantation centers regarding acceptance of hepatitis B surface antigen (HBsAg)-positive donors for renal transplantation. However, some reports show that these donors can be used under a special protocol. In this study, we compared the clinical and biochemical parameters of patients who received kidneys from HBsAg-positive (group 1) versus other living-related kidney donors (group 2). MATERIALS AND METHODS: We retrospectively analyzed the outcomes of 2168 living-related renal transplantations performed between December 2008 and April 2014 at Medical Park Hospital Transplantation Center, Antalya, Turkey. One hundred eleven donors were HbsAg-positive (group 1), and 2057 donors were HbsAg-negative (group 2). Group 1 kidney transplantations were undertaken only if the recipient displayed a hepatitis B antibody titer >10 mIU/mL and donor hepatitis B virus DNA was negative. RESULTS: Demographic characteristics; 1-, 2- and 4-year serum creatinine levels; glomerular filtration rates; and liver function test results were similar between the two groups. There were no new hepatitis B virus infections throughout the study period. Acute rejection rates (26/111 in group 1 vs 375/2168 in group 2; P = .887), graft loss (4/111 in group 1 vs 123/2168 in group 2; P = .546), and patient loss (6/111 in group 1 vs 102/2168; P = .132) were similar between the two groups. CONCLUSION: Our study showed that hepatitis B surface antigen positivity was not a contraindication to living-kidney donation.

Renal Transplantation in Recipients Older Than 65 Years: Retrospective Analysis of the Results of a 4-year (2008-2012) Experience.

BACKGROUND: We analyze the results of renal transplantation among recipients older than 65 years old over a 4-year period (2008-2012) from a single renal transplantation unit and compare results with younger recipients. METHODS: We retrospectively analyzed the outcomes of 2018 renal transplantations performed between November 2008 and December 2012. The χ(2) test was used for the comparison of categorical data, and the Student t test was used for the analysis of continuous variables. Patient and graft cumulative actuarial survivals were calculated using the Kaplan-Meier analysis and we tested for differences with the Mantel-Cox log-rank test. RESULTS: Seventy-five (3.7%) recipients were aged ≥ 65 years with a median age of 68 (range, 65 to 82) years. Actuarial graft survivals at 1, 2, and 3 years were 93.8%, 92.5%, and 90.3%, respectively, for the <65 group and 89.7%, 88.1%, and 83.1%, respectively, for the ≥ 65 group (P < .03). Actuarial patient survivals at 1, 2, and 3 years were 96.3%, 95.5%, and 94.7%, respectively, for the younger and 91.8%, 90.2%, and 88%, respectively, for the older samples (P < .03). When graft survival was censored for patient death with a functioning kidney at 1, 2, and 3 years, the results were similar between groups with 95.5%, 94%, and 92.8%, respectively, for recipients aged <65 years and 94.7%, 89.2%, and 89.2%, respectively, for recipients aged ≥ 65 years (P = .213). CONCLUSIONS: Our results showed that renal transplantation in selected patients older than 65 years was associated with good outcomes; this indicates that it seems safe and effective to treat end-stage renal disease in the elderly knowing there are acceptable rates of graft and patient survival.

The platelet-to-lymphocyte ratio as an inflammation marker in non-dipper hypertensive patients.

BACKGROUND: Non-dipper hypertensive patients have a higher risk of cardiovascular disease (CVD) than dipper hypertensive patients. Inflammation plays an important role in the pathogenesis and progression of CVD. This study aimed to determine the relationship between the platelet-to-lymphocyte ratio (PLR), and dipper and non-dipper hypertension. MATERIALS AND METHODS: This prospective study included 199 consecutive patients that were diagnosed with primary hypertension. According to ambulatory blood pressure monitoring measurements, non-dipper and dipper group were determined. PLR was determined based on the platelet count and lymphocyte count in the complete blood count. RESULTS: The non-dipper group included 103 patients (74 females and 29 males; mean age: 52.37 ± 10.7 years) and the dipper group included 96 patients (65 females and 31 males; mean age: 48.40 ± 11.1 years). Mean systolic blood pressure was significantly higher in the non-dipper group than in the dipper group (124 ± 15.1 mmHg versus 120 ± 11.2 mmHg, p =0.032) and the median PLR was significantly higher in the non-dipper group than in the dipper group [132.15 (range: 69.64-400) versus 117.0 (range: 53.52-192.26), p = 0.001], whereas the mean white blood cell count (6.86 ± 1.43 × 10³/ µL versus 7.24 ± 1.26 × 10³/µL, p =0.046) and median lymphocyte count [2.09 (range: 0.95-3.92)  × 10³/µL versus 2.24 (range: 0.97-3.98) × 10³/µL, p =0.001) were significantly lower in the non-dipper group. CONCLUSION: Median PLR was significantly higher in the non-dipper hypertensive patients than in the dipper hypertensive patients. We think this finding further supports the role of an increase in inflammatory response in non-dipper hypertension. Hippokratia 2015; 19 (2):114-118.

Unusual metastases of lung cancer: bulbus oculi and maxillary sinus.

Lung adenocarcinoma often makes metastasis to the brain, liver, kidneys, bone, bone marrow and adrenal glands. It can also make metastasis to other parts of the body rarely for example eye, nose, parotid gland and paranasal sinus. We did not encounter with combined ocular bulbus and the maxillary sinus metastases of lung cancer in the accessible literature. In this case report, a patient who was combined ocular bulbus and the maxillary sinus metastases of lung adenocarcinoma will be discussed.

Proliferative response of peripheral blood lymphocytes and lymphocyte subpopulations in n-Hexane, toluen, and methyl ethyl ketone co-exposed workers.

To estimate the quantitative relation between chronic co-exposure to airborne n-hexane, toluen, methyl ethyl ketone (MEK) and various markers of immune function such as proliferative response of peripheral blood lymphocytes and lymphocyte subpopulations, a group of workers employed in a shoe factory were examined and compared with the unexposed controls. A significant increase was observed in the proliferative response of the peripheral lymphocytes to 2.5 and 5 µg PHA in the exposed group compared with that of the control group. There was no significant change in the percentage of circulating CD3(+), CD4(+), CD8(+), CD19(+), CD16(+) lymphocytes even in those workers with 3.3-fold higher mean levels of urine 2,5-hexanedione (2,5-Hxdn) and approximately twofold higher mean levels of urine hippuric acid (HA) as compared to controls. No difference was also observed between the mean granulocyte, monocyte, lymphocyte percentages of the groups, but a significant increase was observed in mean serum C3 level of the workers. Our results suggest that while lymphocyte subpopulations and leucocyte percentages are not affected, the proliferative response of the peripheral lymphocytes is stimulated after chronic co-exposure to n-hexane, toluen and MEK at the defined levels.