Carotid artery stenting with double cerebral embolic protection in asymptomatic patients - a diffusion-weighted MRI controlled study.

BACKGROUND: The aim of this study was to compare the simultaneous double-protection method (proximal balloon plus distal filter) with distal-filter protection or proximal-balloon protection alone in asymptomatic patients during carotid artery stenting. PATIENTS AND METHODS: 119 consecutive patients were investigated for carotid artery stentings in the extracranial internal carotid artery with the use of distal filters (n = 41, 34.4 %), proximal balloon (MoMa) protection (n = 40, 33.6 %) or double protection (n = 38, 31.9 %). Magnetic resonance imaging (MRI) was performed on all patients before the procedure, and control diffusion-weighted MRI (DW-MRI) was obtained within 24-48 h after the procedure. Procedural data, complications, success rate, major adverse cardiovascular events, and MRI findings were collected. RESULTS: New cerebral high-intensity (HI) lesions were observed in 47 (39.4 %) patients. HI lesions were observed in 22 (53.6 %), 15 (37.5 %), and 10 (26.3 %) of the patients with distal filters, proximal protection, and double protection, respectively (p = 0.004). The average number of HI lesions on DW-MRI was 1.80 in the distal-filter group, 0.90 in the proximal-balloon group, and 0.55 in the double-protection group (p < 0.001). Procedure and fluoroscopy times were slightly longer in the double-protection group compared to the distal- or proximal-protection groups (p = 0.001). CONCLUSIONS: The double (proximal plus distal) cerebral embolic protection technique is safe and effective for minimizing the risk of cerebral embolization, even in patients with asymptomatic carotid artery stenosis, despite slightly longer procedure and fluoroscopy times.
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Oxidative injury associated with stenting of asymptomatic carotid artery stenosis.

BACKGROUND: After carotid artery stenting (CAS), neurological complications that cannot be explained with imaging methods may develop. In our study we aimed to show, using oxidative stress markers, isolated oxidative damage and resulting neurological findings following CAS in patients with asymptomatic carotid artery stenosis. PATIENTS AND METHODS: We included 131 neurologically asymptomatic patients requiring CAS. The neurological findings were evaluated using the modified Rankin Scale (mRS) prior to the procedure, one hour post-procedure, and two days after. Patients with elevated mRS scores but with or without typical hyperintense lesions observed on an MRI and with changes of oxidative stress marker levels at the time (Δtotal-thiol, Δtotal antioxidative status [TAS], and Δtotal oxidant status [TOS]) were evaluated. RESULTS: In the neurological examination carried out one hour prior to the procedure, there were 92 patients with mRS = 0, 20 with mRS = 1, and 12 with mRS = 2. When Δtotal-thiol, ΔTAS, and ΔTOS values and the mRS were compared, it was observed that as the difference in oxidative parameters increased, clinical deterioration also increased proportionally (p = 0.001). CONCLUSIONS: We demonstrate a possible correlation between oxidative damage and neurological findings after CAS which could not be explained by routine imaging methods.

A Case of Thyroid Follicular Carcinoma Presented with Skin Metastasis.

Skin metastases due to thyroid carcinomas are extremely rare and represent advanced disease and poor prognosis. Diagnosing a skin nodule, which may appear as the first clinical symptom of latent malignancy with low metastatic potential, is likely to be challenging. Distant metastases of thyroid carcinomas need to be identified accurately and quickly; late diagnosis and treatment will lead to increased mortality in patients. A case of thyroid follicular carcinoma presenting with skin metastasis is very rare. Herein, we present a case of a nodular skin lesion in the left lumbar region of a 66-year female due to thyroid follicular carcinoma metastasis and discuss it in the light of existing literature. Key Words: Follicular thyroid carcinoma, Pulmonary nodule, Metastasis, skin.

Solitary Plasmacytoma in a Patient Presenting with Taste Disturbance.

Solitary plasmacytoma is a disease included in plasma cell dyscrasias, presenting outside of the bone marrow, and with the potential to turn into multiple myeloma. A 66-year male patient was admitted to the hematology clinic with the complaint of impaired taste. Physical examination revealed edema of the left pharynx. After excisional tissue biopsy, serum/urine protein electrophoresis, and immunofixation tests of the patient diagnosed with plasmacytoma were negative. An increase in atypical plasma cells was noted on bone marrow aspiration and biopsy. There was no systemic involvement outside the pharynx on the PET-CT examination. He was referred to the radiotherapy department for further management. Since the affected area is frequently the nasopharynx, sinuses, and larynx in extramedullary solitary plasmacytoma cases, they generally presented to the clinic with difficulty in swallowing, shortness of breath and pain symptoms. This case presented with a non-specific complaint of taste disturbance along with difficulty in swallowing. Key Words: Plasmacytoma, Nasopharynx, Multiple myeloma.

[Mental problems and impulsivity reported by adolescents: an epidemiological study]. / Ergenlerin Bildirdigi Dürtüsellik Belirtileri ve Ruhsal Sorunlar: Epidemiyolojik Bir Çalisma.

OBJECTIVE: To determine whether number of self-reported impulsivity symptoms was associated with conduct problems, substance use, academic problems, relational problems and exposure to physical violence in adolescents. METHOD: A survey was developed to be used in a nationally representative general community sample. A 2-staged, stratified and clustered sampling was used. For the first stage (school selection) an equal probability, systematic random sampling and for the second stage (class selection) a simple random selection was used. The statistical analysis included the full and usable surveys obtained from 26009 students (97.5% of the invited sample). RESULTS: After parental education, parental employment, economic status and age; presence of antisocial behaviors; substance abuse; and exposure to physical violence were controlled, presence of even one self-reported impulsivity symptom was associated with physical violence, frequent smoking, frequent alcohol use, substance use, self injurious behaviors, carrying weapons, gang membership, poor relations with others, academic failure and poor mental health. ORs increased with the number of self-reported impulsivity symptoms for several behaviors. Several other associations among conduct problems, substance use, academic failure and relational problems are also reported. CONCLUSION: Even one definite impulsivity symptom must be addressed since it is associated with serious behavioral and relational problems. There may be dose-response interaction between the number of definite impulsivity symptoms and behavioral and relational problems.