Serum Sulphate Levels in Hemodialysis Patients.

OBJECTIVE: Sulphur, similar to phosphorus, is easily attached to organic compounds. The inadequate elimination of sulphate may cause high sulphate concentrations in hemodialysis (HD) patients because sulphate is low in free form in plasma. Although we are well aware of the accumulation of phosphorus in chronic dialysis patients, we do not have an adequate knowledge database about the sulphur compounds. This study was designed to determine the level of sulphate in hemodialysis patients. MATERIALS AND METHODS: Ninety-four prevalent HD patients and 33 patients without renal failure were included in the study. The serum inorganic sulphate levels were measured by turbidimetric technique. Moreover, the serum level of urea, creatinine, albumin, calcium, phosphorus, and parathyroid hormone concentrations was simultaneously recorded. RESULTS: Mean levels of plasma sulphate were significantly higher (0.56 ± 0.17 mM vs 0.31 ± 0.13 mM, p < 0.001) in HD patients. Serum sulphate level correlated with patient's age, serum albumin, serum BUN and creatinine, and serum phosphorus level in HD patients. Serum sulphate levels were not associated with serum parathyroid hormone levels. CONCLUSION: Serum sulphate levels were approximately twofold higher in HD patients than in the normal control group. Inorganic sulphate does not seem to accumulate in long-term dialysis patients, and mild increased serum levels of sulphate has no poor clinical outcome in these patients.

Pure large cell neuroendocrine carcinoma of the bladder without urological symptoms.

Neuroendocrine carcinoma is one of the uncommonly seen pathologies of the urinary bladder. Macroscopic hematuria is frequently encountered symptom in patients with neuroendocrine carcinoma. We report a 45-year-old man with left solitary kidney and oliguria for five days the development of acute renal failure (ARF) with the impaired general condition. The underlying cause being identified as pure type large-cell neuroendocrine carcinoma of the bladder. Large-cell neuroendocrine carcinoma of the bladder is an uncommon fatal tumor. No macroscopic hematuria or urological symptom was observed in our case. Advanced ectasia was not observed in the kidney, and the patient's clinical status was complicated with ARF. It must not be forgotten that in some bladder tumors, the patient's general condition may be impaired without urological symptoms.

The efficacy of low-dose tadalafil in patients undergoing hemodialysis with end-stage renal disease.

BACKGROUND: Erectile dysfunction (ED) is a disorder that is frequently observed in people with chronic kidney disease who undergo hemodialysis (HD). In the context of evidence-based medicine, we aimed to investigate the effect of low-dose tadalafil on sexual function in patients undergoing HD. METHODS: The medical records of 30 males (aged 29-65 years) with end-stage renal disease (ESRD) on a HD program, and who had received 5 mg tadalafil twice weekly, were retrospectively evaluated. Changes in erectile and ejaculatory function were evaluated using the International Erectile Function Index questionnaire, the Erection Hardness Scale (EHS), and the Male Sexual Health Questionnaire (MSHQ). RESULTS: The mean age of the patients was 47.6 ± 10.1 years, their mean body mass index was 24.3 ± 4.2 kg/m2, their mean hemoglobin was 11.9 ± 0.9 g/dL, and their mean creatinine clearance was 5.8 ± 1.1 mL/min. At the third month of treatment, 36.6% of the patients had no ED, 40% had mild ED, 10% had mild-to-moderate ED, and 13.3% had moderate ED. The mean MSHQ scores (p < .05) and the mean EHS scores (p = .001) were significantly improved. There was no significant difference between Beck's Depression Inventory scores (p > .05), but Hamilton anxiety rate scores decreased significantly (p = .001). The quality-of-life score improved throughout the study period (p < .05). CONCLUSIONS: Tadalafil therapy is an effective therapeutic option in patients with ESRD who undergo HD, not only for the treatment of ED, but also for ejaculatory function, with acceptable adverse effects.

The efficacy of udenafil in end-stage renal disease patients undergoing hemodialysis.

INTRODUCTION: Erectile dysfunction (ED) is frequently observed in end-stage renal disease (ESRD) patients on hemodialysis (HD) compared to non-uremic patients. This situation causes severe psychogenic problems in patients and disrupts the quality of life. Different phosphodiesterase type 5 (PDE-5) inhibitors have been used, and efficacies revealed, for the treatment of ED in HD patients; however, there are no studies related to udenafil use or results for HD patients. This study retrospectively evaluated the efficacy and reliability of udenafil for HD patients. MATERIALS AND METHODS: The laboratory findings, side effects after treatment, and International Index of Erectile Function (IIEF) scores before and after treatment were compared and evaluated for HD patients who applied to our urology clinic with ED complaints and were treated with udenafil. RESULTS: The results showed that in the HD patient group with ED, apart from ED, there were severe rates of other sexual dysfunction. In our patient group, there was a statistically significant improvement in all scores for erectile function (p = 0.033), orgasmic function (p < 0.001), sexual desire (p < 0.001), relationship satisfaction (p < 0.001), and general satisfaction (p < 0.001) after treatment. The reported side effects were headache in one patient and dyspepsia in one patient. CONCLUSION: We concluded that udenafil is an effective and reliable treatment approach for HD patients; however, our results require support from prospective randomized crossover studies with sildenafil.

Reversible Myocarditis and Pericarditis after Black Widow Spider Bite or Kounis Syndrome?

Clinical manifestation of black widow spider bite is variable and occasionally leads to death in rural areas. Cases of myocarditis and pericarditis after black widow spider bite are rare and the associated prognostic significance is unknown. Kounis syndrome has been defined as an acute coronary syndrome in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults that manifests as vasospastic angina or acute myocardial infarction or stent thrombosis. Allergic myocarditis is caused by myocardial inflammation triggered by infectious pathogens, toxic, ischemic, or mechanical injuries, such as drug-related inflammation and other immune reactions. A 15-year-old child was admitted to the emergency department with pulmonary edema after spider bite. ST segment depression on ECG, elevated cardiac enzymes and global left ventricular hypokinesia (with ejection fraction of 22%), and local pericardial effusion findings confirmed the diagnosis of myopericarditis. After heart failure and pulmonary edema oriented medical therapy, clinical status improved. Patient showed a progressive improvement and LV functions returned to normal on the sixth day. Myopericarditis complicating spider bite is rare and sometimes fatal. The mechanism is not clearly known. Alpha-latrotoxin of the black widow spider is mostly convicted in these cases. But allergy or hypersensitivity may play a role in myocardial damage.

Association between colchicine resistance and vitamin D in familial Mediterranean fever.

Although colchicines are the only effective treatment of familial Mediterranean fever (FMF), resistance to colchicines (CR) which is observed in up to 30% of the patients is still a problem. Clinically, resistance to colchicine is defined as three or more attacks within the last 6 months period while using ≥2 mg/day colchicine. Previous studies have shown decreased vitamin D levels in FMF patients compared with healthy controls. The aim of this study is to evaluate whether vitamin D levels differ between CR and non-CR FMF patients. This study included 64 FMF patients who were being followed in Nephrology Clinic of Samsun Research and Education Hospital for at least 1 year. FMF was diagnosed according to the criteria defined by Livneh et al. Serum 25-hydroxy vitamin D (25-OHD) concentration (ng/mL) was detected in all FMF patients who were not in an acute attack period. From 64 patients 29 were accepted as CR. Mean 25-OHD level was 9.39 ± 1.00 ng/mL in CR patients and 18.48 ± 1.09 ng/mL in colchicine responsive patients (p < 0.001). Plasma vitamin D levels were significantly lower in colchicine resistant patients. Vitamin D deficiency may be a factor in etiopathogenesis of CR. Studies in larger patient samples that particularly evaluate the response to vitamin D replacement in CR FMF patients are needed.

Catheter-related atrial thrombus: tip of the iceberg?

Although guidelines recommend catheters as a last resort for establishing a vascular access in patients undergoing dialysis, they continue to be used widely for this purpose. Catheter-related atrial thrombus (CRAT) is rarely reported in this group of patients, and it can lead to serious complications. The aim of this study was to determine the incidence of CRAT in patients undergoing hemodialysis with permanent-tunneled catheters. A total of 50 patients undergoing hemodialysis with permanent catheters were included in this study. The diagnosis of CRAT was based on transthoracic echocardiography findings. Thrombus was present in nine patients (18%) and related to the tip of the catheter in all cases. Except for one patient with two foci of thrombus, all patients had a single focus. There were no significant associations between the development of thrombus and the duration of catheter use or the location of the catheter. Furthermore, catheter-related atrial thrombus did not appear to have a significant effect on mortality. The asymptomatic character of CRAT can be responsible for the low reporting rates, and its exact role in increased mortality and morbidity related with catheter use remains unknown. While planning management strategies, information on different options for vascular access routes and possible catheter-related complications should be provided to all patients who will undergo dialysis, together with a discussion involving other replacement alternatives for end-stage renal disease.

Secular changes in the height of the inhabitants of Anatolia (Turkey) from the 10th millennium B.C. to the 20th century A.D.

We use human-skeleton samples to estimate the height of adults living in Anatolia during the Neolithic period. We also report the results of surveys taken in the 20th century on the height of the Turkish population. Neolithic and the Chalcolithic (5000-3000 B.C.) male heights are estimated as 170.9 cm and 165.0 cm, respectively. Pronounced increases were observed for both sexes between the Chalcolithic and Iron (1000-580 B.C.) periods and sharp decreases among both males and females in the Hellenistic-Roman period (333 B.C. to 395 A.D.). Moreover, recovery to the Iron Age levels was achieved in the Anatolian Medieval period (395-1453 A.D.) for both sexes (169.4 cm for males and 158.0 cm for females). In 1884 the mean height of men was 162.2 cm and by the beginning of the 1930s it increased to 166.3 cm. In the first nationwide survey in 1937 males mean height was 165.3 cm, and females was 152.3 cm, where today current heights are 174.0 cm and 158.9 cm, respectively.

The early Upper Paleolithic occupations at Uçagizli Cave (Hatay, Turkey).

This paper summarizes results from excavations at Uçagizli Cave (Hatay, Turkey) between 1999 and 2002 and 2005. This collapsed karstic chamber contains a sequence of early Upper Paleolithic deposits that span an interval between roughly 29,000 and 41,000 (uncalibrated) radiocarbon years BP. Lithic assemblages can be assigned to two major chronostratigraphic units. The earliest assemblages correspond with the Initial Upper Paleolithic, whereas the most recent ones fit within the definition of the Ahmarian. Substantial assemblages of stone tools, vertebrate faunal remains, ornaments, osseous artifacts, and other cultural materials provide an unusually varied picture of human behavior during the earliest phases of the Upper Paleolithic in the northern Levant. The sequence at Uçagizli Cave documents the technological transition between Initial Upper Paleolithic and Ahmarian, with a high degree of continuity in foraging and technological activities. The sequence also documents major shifts in occupational intensity and mobility.

Sex determination using the femur in an ancient Japanese population.

Determination of sex from the femur measurements has been attempted in several populations and various studies have demonstrated the importance of population specific standards in the metric assessment of sex. The present study attempts to establish metric standards for sex determination by using femur measurements for ancient Japanese populations. Osteometric data were obtained from 151 adult skeletal remains from Jomon period, Yoshigo human skeletal collection. Eight femur measurements were taken and the data were analyzed by discriminant analysis using SPSS version 10.0. For the univariate discriminant function derived, precision of sex determination was 93% with the condyle breadth. Prediction values showed that sex differentiation could be done by femur measurements with reliability between 66.9 and 100%, with values for males higher than for females. It is suggested that discriminant formulas developed by femur measurements in this study, can be used for sex determination accurately on fragmentary skeletal remains in ancient Japanese populations.

Diffusion-weighted MR imaging of kidneys in renal artery stenosis.

OBJECTIVE: The purpose of our study was to evaluate perfusion and diffusion of kidneys in renal artery stenosis (RAS) and any correlation between stenosis and ADC values and whether this imaging modality may be a noninvasive complementary assessment technique to MR angiography before interventional procedures. MATERIALS AND METHODS: Twenty consecutive patients suspected of having renal artery stenosis were evaluated with renal MR angiography to exclude stenosis and were then included in the study. Transverse DW multisection echo-planar MR imaging was performed. In the transverse ADC map, rectangular regions of interest were placed in the cortex on 3 parts (upper, middle, and lower poles) in each kidney. ADCs of the kidneys were calculated separately for the low, average, and high b-values to enable differentiation of the relative influence of the perfusion fraction and true diffusion. The ADC values of 39 kidneys (13 with renal artery stenosis and 26 normal renal arteries) were compared, and the relationship between stenosis degree and ADC values was calculated. RESULTS: RAS was detected in 11 of 20 (55%) patients with MRA. Thirteen of 39 kidneys demonstrated RAS, and 26 were normal. The ADClow (1.9+/-0.2 versus 2.1+/-0.2; P=.020), ADCaverage (1.7+/-0.2 versus 1.9+/-0.1; P=.006), and ADChigh (1.8+/-0.2 versus 2.0+/-0.1; P=.012) values were significantly lower in patients with kidneys with arterial stenosis than that in patients with kidneys with normal arteries. Statistical analysis revealed that stenosis degree correlated strongly with ADClow (r=-.819; P=.001), ADCaverage (r=-.754; P=.003), and ADChigh (r=-.788; P=.001). The ADClow, ADCaverage, and ADChigh values were significantly lower in patients with kidneys with arterial stenosis than that in patients with kidneys with normal arteries. CONCLUSION: We think that DW MR imaging of kidneys with RAS can help determine the functional status of a renal artery stenosis.

Association between serum uric acid levels and coronary flow reserve in hypertensive patients without concomitant risk factors.

BACKGROUND: Hyperuricemia is associated with hypertension, vascular disease and cardiovascular (CV) disease. However, the role of serum uric acid (SUA) level as an independent risk factor for CV and renal morbidity in hypertension remains controversial. Accordingly, we aimed to determine whether SUA levels are independently and specifically associated with coronary flow reserve (CFR) impairment in hypertensive patients. METHODS: We examined 80 never treated and newly diagnosed hypertensive individuals. The hypertensive individuals were divided into two groups based on CFR values. RESULTS: Subjects with altered CFR (<2) had significantly higher SUA levels compared with those with normal CFR (> or = 2) (346.0 +/- 98.1 vs 260.7 +/- 75.6 micromol/l, p<0.0001). After adjusting for potential confounders, including age, sex, body mass index, blood pressure, lipids and creatinine, we found that SUA levels were independently associated with CFR impairment (beta = -0.417, p<0.0001). We also found that SUA levels were a good predictor of low CFR at the receiver-operating characteristic curve. Area under the curve was 76% (95% CI 0.64-0.88), and SUA levels were significantly predictive of low CFR (p<0.0001). CONCLUSIONS: These results support a role for SUA level as an independent marker of target organ damage in hypertension.

Evaluation of the gonial angle in the Anatolian populations: from past to present.

Biometrical studies on ancient skeletal series and comparison with modern people by using radiological methods are quite limited in Turkey. Previous studies showed that measurements obtained from orthopantomographs are highly correlated with the actual size of the bones. The aim of the present study is to determine the possible change in gonial angle over time in ancient Anatolian populations with the present. Also an aim was attempted to demonstrate the symmetry of the gonial angle in the jaws and the sexual dimorphism. Gonial angle values (right and left) were taken from 267 Turkish adults with no craniomandibular disorders, orthodontic history or treatment by using panoramic radiographs. Data of the past populations were collected from previous studies. Comparison between right and left sides and the sexual differences were tested by paired student t-test and discriminant analyses were conducted. The results showed that there were no significant differences between the right and left gonial angles of the individuals but there was a significant difference at the left gonial angle between sexes (p < 0.01). Furthermore, no statistically significant difference was found for the gonial angle between the selected past populations with the present sample.

Effects of normal blood pressure, prehypertension, and hypertension on coronary microvascular function.

BACKGROUND: The assessment of coronary flow reserve (CFR) by transthoracic Doppler echocardiography has recently been introduced into clinical practice, and reduced CFR has been suggested to be a sensitive indicator of hypertensive end-organ damage; however, to date, this methodology has not been used to evaluate CFR in subjects with prehypertension. Accordingly, the present study was designed to evaluate CFR in subjects with prehypertension. METHODS AND RESULTS: We measured CFR of 40 subjects with prehypertension, 60 patients with hypertension, and 50 normotensive healthy volunteers using transthoracic Doppler echocardiography. None of the subjects had any systemic disease. Age, gender, body mass index, heart rate, lipid profiles, fasting glucose levels, and hemoglobin were similar among the 3 groups. CFR was significantly lower in the hypertension group than in the prehypertension and control groups; in addition, it was significantly lower in subjects with prehypertension than in control subjects (2.23+/-0.47, 2.54+/-0.48, and 2.91+/-0.53, respectively). Furthermore, we found that prehypertension (beta=-0.31, P<0.01) and hypertension (beta=-0.57, P<0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r=-0.20, P=0.01), systolic blood pressure (r=-0.51, P<0.01), diastolic blood pressure (r=-0.47, P<0.01), high-sensitivity C-reactive protein levels (r=-0.21, P=0.01), left atrium diameter (r=-0.22, P<0.01), mitral E deceleration time (r=-0.19, P=0.02), and mitral A velocity (r=-0.27, P<0.01), whereas mitral E/A ratio was significantly and positively correlated with CFR (r=0.26, P<0.01). CONCLUSIONS: CFR is impaired in subjects with prehypertension, but this impairment is not as severe as that in hypertension.

Sex determination using the scapula in medieval skeletons from East Anatolia.

Sex determination from skeletal human remains by discriminant function analysis is one of the methods utilized in the forensic and osteoarcheological sciences. The purpose of the present study is to establish metric standards for sex determination for medieval Anatolian populations using scapular measurements. The database for this research consisted of 93 adult skeletal remains (47 males and 46 females) from the Dilkaya medieval collection. Four measurements were taken: maximum scapular height, maximum scapular breadth, glenoid cavity height, glenoid cavity breadth, and subjected to discriminant function analysis. All measurements demonstrated some degree of sexual dimorphism, with the highest accuracy of sex determination (94.8%) obtained using maximum scapular breadth. Overall accuracies of the functions ranged from 82.9% to 95.0%, with a higher accuracy rate obtained for female skeletons than for males. Population specific discriminant formulas were developed using combinations of measurements, which can be used in ancient Anatolian populations.

Aortic elastic properties and left ventricular diastolic function in white-coat hypertensive individuals.

OBJECTIVES: Although white-coat hypertension may be present in 25% or more of hypertensive individuals, its prognostic significance and predisposition to end organ damage is unknown. To evaluate whether white-coat hypertension is associated with end organ damage, we compared prognostically relevant measures of target-organ damage among 35 individuals with white-coat hypertension and age and sex-matched groups of sustained hypertension and normotensive individuals classified by clinical and 24-h ambulatory blood pressures. METHODS: We evaluated left ventricular diastolic function and aortic elastic properties of 35 individuals with white-coat hypertension, 50 patients with sustained hypertension, and 35 normotensive healthy volunteers using transthoracic Doppler echocardiography. None of the study participants with sustained hypertension and white-coat hypertension, who were newly diagnosed and never treated, had any systemic disease or coronary risk factor except hypertension. RESULTS: Age, sex, and body mass indexes were similar among the three groups. Left ventricular diastolic function was more significantly impaired in the sustained hypertension and white-coat hypertension groups than in the control group, but it was not significantly different between the white-coat hypertension and sustained hypertension groups. Aortic distensibility was significantly lower, and aortic stiffness index was significantly higher in the sustained hypertension group than in the white-coat hypertension and control groups. Furthermore, aortic elastic properties were slightly impaired in the white-coat hypertension group compared with those in the control group. We also found a significant correlation between aortic elastic properties and left ventricular diastolic function. CONCLUSIONS: White-coat hypertension may alter left ventricular diastolic function and aortic elastic properties. These alterations, however, might not be as remarkable as those caused by sustained hypertension. In this respect, individuals with white-coat hypertension are not at such a risk for end organ damage as patients with sustained hypertension.

Sex determination using the femur in an ancient Anatolian population.

Determination of sex from the femur measurements has been attempted in several populations. Numerous studies have also demonstrated the importance of creating population specific standards in the metric assessment of sex. The present study attempts to establish metric standards for sex determination by using femur measurements for ancient Anatolian populations. Osteometric data were obtained from skeletal remains of 130 adults (67 males and 63 females) from the Dilkaya medieval collection. Eight femur measurements were taken and the data were analyzed using t-test and discriminant analysis with the help of Statistical Package for the Social Sciences (SPSS). The basic statistics showed that all measurements were sexually dimorphic. For the univariate discriminant function derived, precision of sex determination was 86.5 % with the condyle breadth. Our prediction values showed that sex differentiation can be done by femur measurements with reliability between 76 % and 88.5 %, with values for female slightly higher than for males. It is suggested that discriminant formulas developed by combinations of femur measurements in this study can be used for sex determination accurately on fragmentary skeletal remains in ancient Anatolian populations.

Transfusion-associated graft-versus-host disease in an immunocompetent individual following cardiac surgery.

A 65-year-old man underwent coronary artery bypass graft surgery at our tertiary care hospital. Perioperatively, he was transfused with four units of nonirradiated whole blood from first-degree relatives and discharged from the hospital at postoperative day seven. He presented six days later with fever, skin rash, elevated liver enzymes, and progressive pancytopenia. Elevated bilirubin levels and diarrhea were added to the clinical picture over the following days. Clinical findings and results of a skin biopsy specimen were consistent with transfusion-associated graft-versus-host disease. The patient died 20 days after transfusion.