An experimental rat model of electric shock injury with isolated electric shock and water conduction: the histopathological changes on the skin and internal organs and the effect on biochemical parameters.

It is difficult to determine the cause of death in electric shock injuries when no trace can be determined on the skin, and this is accepted as a reason for negative autopsy. We aimed to determine useful parameters in the definition of the cause of deaths associated with electric shock and particularly those formed with water conduction. This study used a total of 42 rats, applied with fatal electric shock formed of isolated electric shock at 220 V and with water conduction. The serum NT-ProBNP and H-FABP levels were examined together with histopathological changes in the brain, cerebellum, brainstem, heart, liver and skin and the Bax, caspase-3 and HSP-60 antibody status in these tissues. A statistically significant difference was determined between the groups in respect of the serum H-FABP values and the immunohistochemical staining of the samples taken from the organs. In conclusion, this study is the first in literature with an experimental model of electric shock with water conduction. Using immunohistochemical and biochemical markers in deaths associated with isolated electric shock and electric shock with water conduction, the results of this study can contribute to the clarification of one of the reasons for negative autopsy in forensic medicine.

The investigation of serum levels of ADAMTS 5 and 8 (the A disintegrin and metalloproteinase with thrombospondin motifs) in the etiology of endometrial cancer.

The aim of this study was to investigate the serum levels of the A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 5 and 8 in patients diagnosed with endometrial cancer. Our study included 41 patients diagnosed with endometrial cancer. The control group consisted of 41 patients diagnosed with benign endometrial pathology. The serum samples were centrifuged and stored at -80 °C. The serum levels of ADAMTS were significantly higher (p<.001), whereas the levels of ADAMTS 8 were significantly lower in patients diagnosed with cancer (p<.001). In addition to the presence of known factors in the aetiology of endometrial cancer, the effect of inflammatory factors and some new proteins has centred on the causes of tumourigenesis in recent years. In this sense, these proteins, called the ADAMTS, are the source of new studies.Impact StatementWhat is already known on this subject? When the recent studies about endometrial cancer are evaluated, it is seen that the effects of chronic inflammation and cytokines have gained importance in its aetiology. The A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) gene family consist of 19 proteases that play essential role in the formation of the extracellular matrix (ECM) and interact with inflammatory cytokines. These proteases and their substrates provide a wide range of functions in different tissues, including ECM remodelling, angiogenesis, fibrosis and coagulation.What the results of this study add? ADAMTS 5, which causes the degradation of the ECM with Aggrecanase activity, was found to be significantly higher in patients diagnosed with cancer and ADAMTS 8 with anti-angiogenesis activity was significantly lower in patients diagnosed with endometrial cancer.What the implications are of these findings for clinical practice and/or further research? In this study, it is understood that the effect of inflammatory mediators is remarkably important in the aetiology of endometrial cancer, as in many types of organ specific cancer.

Serum Nickel and Titanium Levels after Transcatheter Closure of Atrial Septal Defects with Amplatzer Septal Occluder.

INTRODUCTION: There is a concern about release of nickel and titanium after implantation of nitinol-containing devices. OBJECTIVE: To evaluate serum nickel and titanium release after implantation of Amplatzer occluder. MATERIALS AND METHODS: In 38 pediatric patients with no history of nickel sensitivity, blood samples were drawn 24 hours before and 24 hours, 1, 3, 6, and 12 months after implantation. Nickel and titanium concentrations were measured by atomic absorption spectrophotometry. RESULTS: The median serum nickel level which was 0.44 ng/mL before the implantation increased to 1.01 ng/mL 24 hours after implantation and 1.72 ng/mL one month after implantation. The maximum level was detected 3 months after implantation, with a median level of 1.96 ng/mL. During follow-up, the nickel levels decreased to those measured before implantation. Serum nickel levels at the 24th hour, 1st month, and 3rd month following implantation were found to have increased significantly. No patients showed a detectable serum titanium level. DISCUSSION: This is the first study that evaluated both serum nickel and titanium release after implantation of the Amplatzer occluder. Our study shows that nickel is released from the device in the first few months after implantation. Therefore, in patients with nickel allergy, other devices may be considered.

Metabolic and carbohydrate characteristics of different phenotypes of polycystic ovary syndrome.

OBJECTIVE: To compare the prevalence of various metabolic and cardiovascular risk factors and insulin resistance between polycystic ovary syndrome (PCOS) patients with or without hyperandrogenism. MATERIAL AND METHODS: This is a retrospective cross-sectional study involving women with PCOS as diagnosed according to the Androgen Excess (AE) Society definition (n=504) and women with normoandrogenemic PCOS (n=183). Anthropometrics, lipid profile, glucose, insulin, oral glucose tolerance test (OGTT), and reproductive hormone levels were evaluated. RESULTS: Women with PCOS diagnosed according to the AE Society had a significantly higher prevalence of metabolic syndrome compared with the normoandrogenemic PCOS phenotype: odds ratio (OR) 2.95 [95% confidence interval (CI) 1.21-7.21]. There was no significant difference in the prevalence glucose intolerance test between the groups [OR: 2.15, 95% CI 0.71-6.56]. The prevalence of low high density lipoprotein (HDL)-cholesterol in the group under the AE-PCOS Society criteria was higher than that of the normoandrogenemic PCOS group [OR: 2.82, 95%CI 1.29-3.36]. CONCLUSION: The risks of metabolic syndrome and cardiovascular disease may vary among the phenotypes of PCOS based on the Rotterdam criteria. This new data may be of reference in informing women with PCOS, although further prospective studies are needed to validate this proposition.

Acute physiological changes in elite free-style wrestlers during a one-day tournament.

BACKGROUND: The purpose of this study was to examine free radical production, muscle damage and inflammation responses of well-trained wrestlers to a simulated one-day tournament of free-style wrestling. METHODS: Twelve elite competitive wrestlers with mean age (±SD) of 24.09±6.20 years, body mass 74.09±11.50 kg, and body height 174.90±8.8 cm and who had competed for national teams completed five matches according to the official Olympic wrestling tournament regulations. Blood sampling was collected before and after fifth match. Baseline blood testing was measured at 10:00 a.m. and then matches started at 12:00. Each match was implemented within one hour. Also, the resting time was 45 minutes following each match. The measurements were analyzed by Wilcoxon Signed Ranks Test, which is used to test for significant differences between pre- and post-test. RESULTS: The post-match lactate dehydrogenase (LDH), creatine kinase (CK), and interleukin (IL)-6 levels were significantly increased compared with the baseline status. However, baseline malondialdehyde levels were not found significantly different compared with post-match. CONCLUSIONS: The current study ensured that one-day Free-Style wrestling tournament brings about significantly increasing on CK, LDH of muscle damage markers. Also, inflammatory status showed a progressive worsening during the course of one-day tournament. The study showed enhanced muscle damage markers and inflammatory status after one-day Free-Style wrestling tournament. Therefore, it appears that one-day free-style wrestling tournament imposes significant physiological demands on wrestlers that may adversely affect their performance and inflammatory status, thereby putting the athletes in a greater risk for injury.

Relationship between vitamin D and lung function, physical performance and balance on patients with stage I-III chronic obstructive pulmonary disease.

OBJECTIVES: vitamin D is important for muscle function and it affects different aspects of muscle metabolism. This study aim to determine whether serum 25(OH) D levels are related to lung functions, physical performance and balance in patients with chronic obstructive pulmonary disease (COPD). METHODS: in 90 patients with COPD and 57 healthy controls lung function tests, physical performance tests (time up and go, gait velocity test, sit-to-stand test, isometric strength, isokinetic strength), static (functional reach test) and dynamic (time up and go) balance tests and the association of 25(OH)D levels with lung functions, physical performance and balance were evaluated. RESULTS: the COPD patients had significantly more deficit in physical function and balance parameters, and in dynamic balance test (p<0.005). Isokinetic knee muscle strength (flexor and extensor) in COPD patients was significantly lower than in the controls (p<0.05); FEV1 (p=0.008), FVC (p=0.02), FEV1/FVC (p=0.04), TLC (p=0.01) were lower in COPD patients with vitamin D deficiency [25(OH) D less than 15 ng/mL] than in COPD patients without vitamin D deficiency. Hand grip test (p=0.000) and isokinetic knee muscle strength (flexor and extensor) (p<0.05) were also lower in COPD patients with vitamin D deficiency. Vitamin D deficiency was more pronounced in patients with stage III COPD (p<0.05). CONCLUSION: patients with COPD had worst physical functioning, poor balance and less muscle strength. Severe disturbed lung and peripheral muscle functions are more pronounced in COPD patients with vitamin D deficiency.

Relationship between vitamin D and lung function, physical performance and balance on patients with stage I-III chronic obstructive pulmonary disease / Relação entre vitamina D e função pulmonar, desempenho físico e equilíbrio em pacientes em estágio I a III de doença pulmonar obstrutiva crônica

Summary Objectives: vitamin D is important for muscle function and it affects different aspects of muscle metabolism. This study aim to determine whether serum 25(OH) D levels are related to lung functions, physical performance and balance in patients with chronic obstructive pulmonary disease (COPD). Methods: in 90 patients with COPD and 57 healthy controls lung function tests, physical performance tests (time up and go, gait velocity test, sit-to-stand test, isometric strength, isokinetic strength), static (functional reach test) and dynamic (time up and go) balance tests and the association of 25(OH)D levels with lung functions, physical performance and balance were evaluated. Results: the COPD patients had significantly more deficit in physical function and balance parameters, and in dynamic balance test (p<0.005). Isokinetic knee muscle strength (flexor and extensor) in COPD patients was significantly lower than in the controls (p<0.05); FEV1 (p=0.008), FVC (p=0.02), FEV1/FVC (p=0.04), TLC (p=0.01) were lower in COPD patients with vitamin D deficiency [25(OH) D less than 15ng/mL] than in COPD patients without vitamin D deficiency. Hand grip test (p=0.000) and isokinetic knee muscle strength (flexor and extensor) (p<0.05) were also lower in COPD patients with vitamin D deficiency. Vitamin D deficiency was more pronounced in patients with stage III COPD (p<0.05). Conclusion: patients with COPD had worst physical functioning, poor balance and less muscle strength. Severe disturbed lung and peripheral muscle functions are more pronounced in COPD patients with vitamin D deficiency. .

Resumo Objetivos: a vitamina D é importante para a função muscular e afeta diferentes aspectos do metabolismo muscular. O objetivo é determinar se os níveis séricos de 25 (OH) D estão relacionados com as funções pulmonares, desempenho físico e equilíbrio em pacientes com doença pulmonar obstrutiva crônica (DPOC). Métodos: em 90 pacientes com DPOC e 57 controles saudáveis, testes de espirometria, testes de desempenho (tempo de levantar e ir, teste de velocidade da marcha, teste sitto-stand, força isométrica, força isocinética) e testes de estática (teste de alcance funcional) e dinâmica (tempo de levantar e ir) de equilíbrio foram realizados; e foram avaliados a associação de níveis de 25 (OH) D com as funções pulmonares, desempenho físico e equilíbrio. Resultados: os pacientes com DPOC apresentaram significativamente mais déficit nos parâmetros de função e equilíbrio físico, e no teste de equilíbrio dinâmico (p<0,005). Força muscular isocinética do joelho (flexores e extensores) em pacientes com DPOC foi significativamente menor do que nos controles (p<0,05); VEF1 (p=0,008), CVF (p=0,02), VEF1/CVF (p=0,04), CPT (p=0,01) foram mais baixos em pacientes com DPOC e com deficiência de vitamina D [25 (OH) D menor do que 15 ng/ml] do que em pacientes com DPOC sem deficiência de vitamina D. Os resultados do teste da força de preensão manual (p=0,000) e força muscular isocinética do joelho (flexor e extensor) (p<0,05) também foram menores nos pacientes com DPOC e com deficiência de vitamina D. A deficiência de vitamina D foi mais pronunciada em pacientes em estágio III da DPOC (p<0,05). Conclusão: pacientes com DPOC tiveram pior desempenho físico, falta de equilíbrio e menor força muscular. Perturbações graves das funções pulmonares e musculares periféricas são mais pronunciadas em pacientes com DPOC e com deficiência de vitamina D. .

Association of folic acid receptor α in maternal serum with neural tube defects.

OBJECTIVE: To evaluate whether serum folic receptor α levels are changed in women whose previous pregnancies were complicated with neural tube defects (NTDs). METHODS: This was a case-control study that included 41 women as the control group who had previously had at least one healthy pregnancy and 37 women as the study group who had a previous pregnancy complicated with NTDs. Blood samples were obtained from all of the participants six weeks after the termination of pregnancy or delivery of a baby. Serum folate receptor α concentrations were analyzed using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: The mean concentrations of serum folate receptor α were significantly lower in the NTD cases compared to those in the control group (p = 0.02). There was no significant difference in mean serum folate titers between the NTD cases and the control group (p = 0.07). CONCLUSION: Low serum folic acid receptor α levels in the current study did not appear to be a regulatory marker of maternal folate homeostasis per se but rather a factor that contributed to the development of NTDs.

Serum Pentraxin 3 and hs-CRP Levels in Children with Severe Pulmonary Hypertension.

BACKGROUND: Pulmonary arterial hypertension secondary to untreated left-to-right shunt defects leads to increased pulmonary blood flow, endothelial dysfunction, increased pulmonary vascular resistance, vascular remodelling, neointimal and plexiform lesions. Some recent studies have shown that inflammation has an important role in the pathophysiology of pulmonary arterial hypertension. AIMS: The aim of this study is to evaluate serum pentraxin 3 and high sensitive (hs)-C reactive protein (hs-CRP) levels in children with severe pulmonary arterial hypertension (PAH) secondary to untreated congenital heart defects and evaluate the role of inflammation in pulmonary hypertension. STUDY DESIGN: Cross sectional study. METHODS: After ethics committee approval and receiving consent from parents, there were 31 children were selected for the study with severe PAH, mostly with a left-to-right shunt, who had been assessed by cardiac catheterisation and were taking specific pulmonary vasodilators. The control group consisted of 39 age and gender matched healthy children. After recording data about all the patients including age, gender, weight, haemodynamic studies and vasodilator testing, a physical examination was done for all subjects. Blood was taken from patients and the control group using peripheral veins to analyse serum Pentraxin 3, N-terminal pro-Brain Natriuretic Peptide (NT-ProBNP) and hs-CRP levels. Serum Pentraxin-3 levels were measured by enzyme linked immunosorbent assay (ELISA) and expressed as ng/mL. Serum hs-CRP levels were measured with an immunonephelometric method and expressed as mg/dL. The serum concentration of NT-proBNP was determined by a chemiluminescent immunumetric assay and expressed as pg/mL. RESULTS: Serum Pentraxin- 3 levels were determined to be 1.28±2.12 (0.12-11.43) in the PAH group (group 1) and 0.40±0.72 (0.07-3.45) in group 2. There was a statistically significant difference between the two groups (p<0.01). Serum hs-CRP levels were measured as 2.92±2.12 (0.32-14.7) mg/dL in group 1 and 0.35±0.16 (0.07-3.45) mg/dL in group 2. The hs-CRP level was increased in the PAH group to a significant degree (p<0.01). CONCLUSION: Our study showed that pentraxin 3 and hs-CRP levels were increased significantly in the PAH group. We consider that inflammation plays an important role in severe pulmonary hypertension and progressive pulmonary arterial hypertension in children with PAH.

Evaluation by N-terminal prohormone of brain natriuretic peptide concentrations and ross scoring of the efficacy of digoxin in the treatment of heart failure secondary to congenital heart disease with left-to-right shunts.

This study aimed to evaluate the effectiveness of digoxin in children with heart failure secondary to left-to-right shunt lesions and normal left ventricular systolic function. The study registered 37 such patients (ages 10 days to 24 months, groups 1 and 2) and used 20 healthy children as a control group (group 3). Left ventricular systolic function, as assessed by conventional echocardiography, was normal in all the subjects. Congestive heart failure was diagnosed by clinical evaluation and modified Ross scoring. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP) concentrations and complete blood counts were assessed in all the children. Group 1 was treated with digoxin, enalapril, and furosemide and group 2 with enalapril and furosemide. Approximately 1 month after starting treatment, the patients were reevaluated by physical and echocardiographic examinations, modified Ross scoring, plasma NT-proBNP concentrations, and complete blood counts. The pre- and posttreatment Ross scores of group 1 (p = 0.377) and group 2 (p = 0.616) did not differ significantly. The NT-proBNP values in both groups decreased after treatment (p = 0.0001). The pre- and posttreatment NT-proBNP values did not differ significantly in group 1 (p = 0.094)) and group 2 (p = 0.372). The pretreatment NT-proBNP values in groups 1 and 2 (p = 0.0001) were significantly higher than in the control group (p = 0.003). A smaller difference was observed between posttreatment NT-proBNP values in group 1 and the control group (p = 0.045). We found no significant difference between the posttreatment NT-proBNP values of group 2 and those of the control group (p = 0.271). The study showed that both treatments currently used to treat heart failure secondary to congenital heart disease with left-to-right shunts and preserved left ventricular systolic function are effective and do not differ significantly. Thus, digoxin does not provide any extra benefit in the treatment of such patients.

Independent predictors of cardiovascular risk in polycystic ovarian syndrome.

We aimed to determine the independent predictors of cardiovascular risk in polycystic ovarian syndrome (PCOS). Ninety-one PCOS and 51 control patients were enrolled to our prospective cross sectional case-control study. In early follicular phase hormonal and lipid profile, fasting insulin and CRP (hs-CRP) levels and glucose levels on fasting and 2 h after the 75 g glucose intake were determined. Insulin resistance (IR) was evaluated with homeostasis model assessment and free testosterone was determined with free androgen index. PCOS was found to be associated with dyslipidemia, hyperandrogenism, IR and sub-clinical inflammation. The prevalence of overweight-obesity (41.8% vs. 25.5%, p = 0.038), IR (42.9% vs. 23.5%, p = 0.035) and glucose intolerance (15.38% vs. 1.96%, p = 0.043) were significantly higher in PCOS compared to control group. Independent predictors of the risk of elevated hs-CRP level were PCOS status (OR = 5, 95% CI: 1.55-16.14, p = 0.007) and high BMI (OR = 4.2, 95% CI: 1.2-14.2, p = 0.022) and high BMI (OR = 1.2, 95% CI: 1.05-1.4, p = 0.007) and of TC/HDL ratio was high BMI (OR = 1.21, 95% CI: 1.05-1.4, p = 0.009) and increasing age (OR = 1.11, 95% CI: 1.01-1.2, p = 0.04). The presence of PCOS, independent from obesity and IR, is the strongest predictor of elevated hs-CRP level. Obesity and advanced age further increases the cardiovascular risk in PCOS.

[Serum zinc (Zn) levels in patients with giardiosis]. / Giardiosisli hastalarda serum Cinko (Zn) düzeyleri.

A decrease may occur in the levels of trace elements due to absorption deficiency resulting from giardiosis. This study was designed in order to reveal the difference in serum zinc levels between patients with giardiosis and healthy controls. Thirty one patients who were diagnosed as having giardiosis after detection of G. intestinalis and 31 healthy controls participated in the study. A significant decrease was observed in serum zinc levels of patients with giardiosis compared to those of controls (p < 0.0001). In conclusion, we suggest that parasitic diseases should also kept in mind in the differential diagnosis of cases characterized by low serum zinc levels.

Serum levels of selenium, zinc and copper in patients with coronary artery ectasia.

BACKGROUND: It is well established that the deficiency of trace elements may lead to oxidative stress in many tissues. Several studies have shown that the deficiency of trace elements may play a role in the pathogenesis of various heart diseases, including coronary artery disease. This study was designed to determine the serum levels of trace elements, such as selenium, zinc, and copper, in patients with isolated coronary artery ectasia and to confirm previously documented changes in the trace element status in coronary artery disease. It also investigated the relationship between the level of trace elements and the extent of ectatic involvement in patients of coronary artery ectasia. METHODS AND RESULTS: The serum selenium, zinc and copper levels were measured in 37 patients of coronary artery ectasia, 56 patients of coronary artery disease and 30 controls. The trace element levels were measured by atomic absorption photometry methods. The serum selenium (Se) and zinc (Zn) levels in both sets of patients were significantly lower than in the control group (Se: 127 +/- 10 microg/L and 126 +/- 9 microg/L vs. 147 +/- 12 microg/L, p < 0.001; Zn: 557 +/- 11 microg/L and 554 +/- 13 microg/L vs. 620 +/- 13 microg/L, p < 0.001). However, the serum copper (Cu) levels were similar in all patients and controls (964 +/- 12 microg/L and 973 +/- 14 microg/L vs. 956 +/- 17 microg7/L, p > 0.05). CONCLUSION: These results suggest that coronary artery ectasia is associated with the deficiency of the trace elements selenium and zinc. Thus, these elements may play an important role in the pathogenesis of coronary artery ectasia, as well as in coronary artery disease.

Trace element status (Se, Zn, Cu) in heart failure.

OBJECTIVE: It has been speculated that trace elements may play a role in the pathogenesis of heart failure. In the present study, we aimed to assess serum concentrations of selenium (Se), zinc (Zn) and copper (Cu) in patients with heart failure (HF) and to compare idiopathic dilated cardiomyopathy (IDCM) and ischemic cardiomyopathy (ICM) patients with healthy controls. METHODS: This study population included 54 HF patients (26 IDCM patients and 28 ICM patients) and 30 healthy subjects. Serum levels of selenium, zinc, and copper were assessed by atomic absorption spectrophotometry method. RESULTS: Serum concentrations of Se and Zn in HF patients were significantly lower than in healthy controls (p=0.000 and p<0.01, respectively). However, serum Cu concentrations in these patients were significantly higher than in controls (p=0.000). There were no significant difference in the trace elements status between IDCM and ICM patients (p>0.05 for all parameters). Relationships of the serum trace element concentrations studied with echocardiographic and hemodynamic parameters were not statistically significant. CONCLUSION: Our study showed that heart failure is associated with lower Se and Zn concentrations, and higher Cu concentration, and serum Se, Zn and Cu element profiles were similar in IDCM and ICM.

Increased micronucleus frequencies in peripheral blood lymphocytes in women with polycystic ovary syndrome.

OBJECTIVE: We aimed to assess possible genomic instability in women with polycystic ovary syndrome (PCOS). DESIGN: The frequency of micronuclei in cultured peripheral lymphocytes was used as a biomarker of genomic instability in somatic cells. METHODS: Nineteen women, diagnosed with PCOS and 19 healthy female volunteers of corresponding ages and body-mass index (BMI) were included in the study. Micronuclei frequencies were assessed in cytokinesis-blocked lymphocytes. RESULTS: The frequency of micronucleated cells (per thousand) was 9.00 (5.00) (interquartile range in parentheses) for patient group and 3.0 (3.0) for the control group (P < 0.0001, Mann-Whitney U-test). The serum levels of follicle-stimulating hormone (FSH), estradiol, prolactin, glucose and dehydroepiandrosterone sulfate (DHEAS) and the homeostasis model of assessment of insulin resistance (HOMA-IR) were not different between the two groups (P > 0.05). Serum total testosterone, luteinizing hormone (LH) and insulin levels and hirsutism score in the PCOS group were significantly (P = 0.007, P < 0.0001, P = 0.009 and P < 0.0001 respectively) higher than those of the control group (2.3 (2.1) nmol/l vs 1.7 (0.4) nmol/l; 8.5 (5.88) mU/ml vs 4.8 (4.4) mU/ml; 6.8 (5.1) microU/ml vs 9.7 (4.2) microU/ml; 19.5 (6.5) vs 4.0 (2.5) respectively). However, the mean level of sex hormone-binding globulin (SHBG) in PCOS group was significantly (P = 0.004) lower than in control group (36.4(22.6) nmol/l vs 48.6(25.2) nmol/l respectively). CONCLUSION: These findings suggest that women with PCOS have a high incidence of genomic instability, and this condition is positively correlated with the hirsutism score, BMI, LH and serum total testosterone and insulin levels, and is negatively correlated with SHBG.

Diabetic muscle infarction: an unusual cause of muscle pain in a diabetic patient on hemodialysis.

Diabetic muscle infarction (DMI) is a rare, painful and potentially serious complication in patients with poorly controlled diabetes mellitus and frequently misdiagnosed clinically as abscess, neoplasm, or myositis. A 36-year-old diabetic woman referred to our clinic with severe pain in the left antero-medial thigh. She had a 15-year history of Type 2 diabetes mellitus (DM). She was complicated by diabetic nephropathy and requiring hemodialysis. She had first noticed pain and swelling in her left thigh after a minimal trauma for 2 days prior to presentation. Clinical and laboratory evaluation, and muscle biopsy revealed the diagnosis of muscle infarctions. She did no respond to the conservative therapy. Pain and swelling in her thigh worsened progressively. She underwent surgical debridment and then, her clinical status improved. We describe the characteristic clinical and pathologic findings and the course of the illness with emphasis on the importance of recognition of the syndrome so that unnecessary investigation and overzealous therapy can be avoided.

Possible malignant neuroleptic syndrome that associated with hypothyroidism.

A 54-year-old woman with schizophrenia presented to hospital with unconsciousness, fever and marked muscle rigidity. She had been given fluphenazine decanoete 20 mg intramuscularly 15 days before the admission and she had continued taking haloperidol 20 mg daily and oral biperiden 2-4 mg. She was extremely rigid and unresponsive. On laboratory investigations revealed: serum sodium 120 mEq/l, creatinine phosphokinase 12,980 IU/l (normal up to 170), lactate dehydrogenase 1544 IU/l (150-500), free trioidothyronine < 1.00 pg/ml (1.5-4.5), free throxyine 0.76 ng/dl (0.8-1.9), thyroid stimulating hormone 1.14 microU/ml (0.4-4), cortisol (at 8.00 a.m.) 9 microg/dl (5-25). Antipsychotic drugs were withdrawn after admission. A diagnosis of secondary adrenal insufficiency and secondary hypothyroidism was made. Hormonal substitution with hydrocortisone and levothyroxine and correction of hyponatremia with intravenous hypertonic saline solution resulted in rapid improvement of symptoms and signs. It seems that the symptoms and signs of hypothyroidism and hyponatremia were attributed to acute psychosis in this patient. As a conclusion failure to recognize the endocrinopathy may not only produce recovery difficulties but also psychiatric and endocrine repercussions if psychotropic medications are given in such masked cases.

Psychiatric disorders and large interdialytic weight gain in patients on chronic haemodialysis.

AIMS: Psychiatric disorders have been considered in terms of non-compliant behaviour and low life quality in haemodialysis patients. The aim of this study is to investigate the potential association of psychiatric disorders with compliance of fluid restriction and nutritional status and to measure the effects of psychiatric disorders on the life quality in chronic renal failure patients on haemodialysis. METHODS: The study was conducted between April 2002 and December 2002 at a University hospital haemodialysis unit. The study population included 40 chronic renal failure patients (15 females/25 males). The Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS) and Primary Care Evaluation of Mental Disorders (PRIME-MD), The Mini Mental State Examination (MMSE) and Short Form Health Survey 36 (SF-36) were used for patient assessment by a trained psychiatrist. The subjects' medical charts were reviewed by a physician who was unaware of the the results of the psychiatric assesments. Interdialytic weight gain (IDWG %) and nutritional status were used as an index of diet compliance. Nutrition was assessed by using subjective global assessment (SGA), serum albumin, predialysis phosphorus and potassium levels. RESULTS: All patients' MMSE were normal. A diagnosis of a depressive or anxiety or somatoform disorder by the PRIME MD was made in 65% of the patients. Fourteen (35%) of the patients had a depressive disorder, 13 (32.5%) of the patients had a somatoform disorder, and 12 (30%) had an anxiety disorder. We found no relationship between any psychiatric disorder and age, sex, duration of dialysis therapy, education, marital status, employment, socioeconomic status, serum albumin, phosphorus, potassium or SGA (P > 0.05). In patients with depression or a somatoform disorder, the interdialytic weight (%) was significantly higher than those of the patients without these disorders (P < 0.05). All indices of quality of life decreased in patients diagnosed with a psychiatric disorder. CONCLUSION: Depressive symptoms are important determinants of patients' large interdialytic weight gain and psychiatric disorders that effect a patients' overall quality of life. Evaluation of psychiatric status should be part of the care provided to haemodialysis patients.

Leptin levels increase during flutamide therapy in women with polycystic ovary syndrome.

AIM: To evaluate the serum leptin levels and the effects of flutamide treatment on the leptin levels in women with polycystic ovary syndrome (PCOS). METHODS: 20 women with PCOS and 20 controls were enrolled in the study. Leptin levels and leptin response to an oral glucose tolerance test were assessed in both groups before and after a 4-week flutamide therapy period. RESULTS: The leptin levels were similar in both groups at baseline. In the PCOS group, leptin levels and area under curve for leptin levels increased significantly after flutamide treatment. CONCLUSIONS: Women with PCOS had similar leptin levels to those of controls with similar age and body mass index. Flutamide treatment led to increased leptin levels and leptin responses to oral glucose tolerance tests in PCOS patients. Further studies are needed to gain insights into the clinical consequences of these effects of flutamide.