Nebivolol protects erectile functions compared to Metoprolol in hypertensive men with atherogenic, venogenic, psychogenic erectile dysfunction: A prospective, randomized, cross-over, clinical trial.

INTRODUCTION: Both hypertension and ß-blocker drugs used for treating hypertension (HT) can cause erectile dysfunction (ED). Nebivolol, unlike other ß-blockers, may not cause impotence since it increases the release of Nitric Oxide (NO), which is the main mediator of erection. This study investigated the effect of Nebivolol and Metoprolol on erectile functions in hypertensive men. MATERIALS AND METHODS: Married men whose blood pressure were >140/90 mmHg were included in the study. All patients were assessed for ED, and the cause of ED was then investigated. Nebivolol or Metoprolol was started for one month in all patients. After one-month drugless period, the ß-blockers were switched. Blood pressures, pulses and sexual function tests were evaluated, and plasma NO levels were measured at the end of the treatments and during the drugless period. RESULTS: There was no difference in antihypertensive efficacy between the two drugs (p = 0.828;0.194 for systolic and diastolic BP). Metoprolol caused a significant decrease in IIEF-5 score, whereas Nebivolol did not cause a decrease in IIEF-5 score on patients with psychogenic, arteriogenic, and venous failure related ED (respectively, p<0.001,0.004,0.005 for Metoprolol; p = 0.201,0.598,0.088 for Nebivolol). In the non-ED group, both drugs decreased the IIEF-5 score, but the decrease for Metoprolol (p = 0.001) was more than that for Nebivolol (p = 0.012). Plasma NO levels did not change with Metoprolol (p = 0.268) but increased with Nebivolol (p<0.001). There was a positive correlation between plasma NO values and IIEF-5 score used for the assessment of sexual functions (r = 0.284, p = 0.026). CONCLUSION: Nebivolol may be advantageous in terms of preserving sexual functions because of increasing NO in eligible hypertensive male patients.

Flow-through free latissimus dorsi flap for reconstruction of injured limbs: Evaluation of hemodynamic effects on extremity circulation.

Management of vascularized injured extremity requires careful reconstruction for continuity of leg circulation. Protection of the remaining intact vessels during free flap transfer provides condition for blood flow maintenance in the distal extremity. Latissimus dorsi muscle has the correct vessel anatomy for applying flow-through flap because it protects recipient vessel integrity during soft tissue reconstruction. Flow-through flap circulation may cause decreasing blood flow in the recipient artery and steal phenomenon in distal circulation although the main vessel remains intact. The purpose of this study was to describe blood flow changes in the recipient artery, flap pedicle, and distal leg circulation at early and long-term follow- up periods. For this purpose, evaluations of blood flows by using Doppler ultrasonography were performed in 2 vascularized injured extremities which were reconstructed with flow-through free latissimus dorsi musculocutaneous flaps. The results demonstrate that flow-through flaps in our vascularized injured extremity did not disturb distal leg circulation in spite of increased blood flow in the recipient and pedicle arteries.

Comparison of contact surface areas of metatarsal diaphyseal osteotomies for correction of hallux valgus: Experimental study.

OBJECTIVE: This study aimed to determine, pre-correction, the potential change in the osteotomy-site bony contact surface area that would occur during standard metatarsal diaphyseal procedures with the Baran-Unal modification of Mau osteotomy and then to compare it, post-correction, with the actual osteotomy-site bony contact surface area changes for a standard degree of deformity correction. METHODS: A total of 30 standard, same sized, biomechanically equivalent, left first metatarsal sawbones were included in this experimental study. They were divided equally into five groups for each of the planned osteotomy techniques: Myerson's modification of Ludloff, Mau, scarf, Offset V, and Baran-Unal modification of Mau osteotomy. The normal osteotomy for each sample was considered as the control, while the corrective osteotomy was the test. Computerized tomography scans and three-dimensional (3D) reconstruction imaging were performed for objective and accurate measurements. The techniques of the osteotomy and post-corrective osteotomy bony contact surface areas were investigated by the two independent research assistants. RESULTS: There was a statistically significant difference between the contact surface area changes of all pre- and post-corrective osteotomy groups (P<0.05). When the pre- and post-correction contact surface areas of any one group were compared with the other groups, the differences were or were not statistically significant. Mean differences between pre-correction and post-correction areas for Ludloff, Mau, scarf, Offset V, and Baran-Unal osteotomies were 180.7, 122.3, 226.2, 191.9, and 68.9 mm2, and the percentages of area loss were 22.9%, 15.5%, 28.6%, 24.3%, and 8.7%, respectively. The most bony contact area was found in the scarf osteotomy group (mean pre-correction area: 490.5 mm2 and mean post-correction area: 264.3 mm2), but the Baran-Unal modification group has significantly the highest post-correction bony contact area among the all other groups (mean pre-correction area: 413.3 mm2 and mean post-correction area: 344.4 mm2). CONCLUSION: Metatarsal diaphyseal osteotomies for hallux valgus deformity have the potential not only for deformity correction, but also for contact surface area preservation. This study reaffirms the considerable potential of this new Baran-Unal modification to confer outstanding contact surface area values, even with the operative correction of hallux valgus deformity.

Aplastic anemia, mucormycosis and aspergillosis in infectious mononucleosis: success is possible.

Infectious mononucleosis (IM) is a rare cause of aplastic anemia in adults. We report of a patient in whom aplastic anemia, mucormycosis and aspergillosis complicated during the course of IM and successfully treated with liposomal amphotericin B. According to our searches in literature, we could not find a similar patient complicated and successfully treated like ours.

Prenatal diagnosis of intracranial pial arteriovenous fistula and endovascular treatment during the neonatal period.

We present a case with prenatal diagnosis of an intracranial high-flow pial arteriovenous fistula that was draining into the vein of Galen in the third trimester of pregnancy. The child was treated by transcatheter embolization with N-butyl 2-cyanoacrylate (NBCA) via the umbilical artery in the early neonatal period due to intractable cardiac failure. Hydrocephalus developed and a ventriculoperitoneal shunt was placed. At the time this report was prepared, the patient was 20 months old and without cardiac failure, but with a delay in neurological development. Prenatal diagnosis and endovascular treatment in the early neonatal period is important in preventing heart failure and resultant mortality due to such high-flow vascular malformations. To the best of our knowledge, the combination of prenatal diagnosis of an intracranial high-flow pial arteriovenous fistula draining into the vein of Galen and endovascular treatment in the early neonatal period is presented here for the first time.

What is the relationship between chronic sinus disease and isolated nasal septal deviation?

OBJECTIVE: The aim of this retrospective study is to examine the role of isolated nasal septal deviation (NSD) in the pathogenesis of chronic rhinosinusitis (CRS). STUDY DESIGN AND SETTING: The interaction between isolated NSD and chronic sinus disease were retrospectively evaluated in 1452 patients. Out of 1452 patients, 152 patients were included in the study. Patients with anatomical variants other than NSD were excluded from the study. Patients with NSD were enrolled in the study group and patients without NSD were enrolled in the control group. RESULTS: There was no statistically significant difference between NSD group and non-NSD group with respect to the CRS. CONCLUSIONS: The mild to moderate degree of NSD was not a risk factor for chronic sinus disease. Only gross deviation of the nasal septum itself is a risk factor for the development of CRS. SIGNIFICANCE: Excluding the subjects with ostiomeatal anatomic variations has differentiated this study from the previously reported researches (isolated NSD).

The upper extremity musculoskeletal complications in dialysis patients: comparison between hemodialysis and peritoneal dialysis.

OBJECTIVES: The aim of this study was to compare the upper extremity musculoskeletal complications in the patients who had been receiving hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). MATERIAL AND METHODS: The patients who had been receiving HD (n=17) or CAPD (n=15) were included to the study. The age, gender, duration of dialysis were recorded. The physical findings related to musculoskeletal system in the upper extremity were researched. The cervical, shoulder, hand standard radiographies and shoulder magnetic resonance imaging were investigated. RESULTS: The mean duration of HD and CAPD were 53.60 ± 36.03 and 49.17 ± 33.14 months, respectively (p=0.720). Only 6.3% of the CAPD group had signs of carpal tunnel syndrome (CTS). There were not any differences in the frequency of cervical destructive spondyloarthropathy, decreased height of vertebral corpus in the examination of cervical radiography (p=0.579) and also in the frequency of erosions in the humeral head and bones of hand, cyst in the clavicula, erosive osteoarthropathy and osteoporosis detected in the bones of hands (p> 0.005). In the examination of shoulder MR imaging, 80% of the HD group and 47.1% of the CAPD group had supraspinatus tendinitis (p=0.059). The frequency of subscapularis, biceps and infraspinatus tendinitis were not different in HD and CAPD groups (p> 0.05). CONCLUSION: The musculoskeletal system complications of the upper extremity were common in the patients undergoing dialysis therapy. The most common complications were osteoporosis of the hand region and supraspinatus tendinitis. LEVEL OF EVIDENCE: Prospective, Level 2b.

Hemodynamic differences in blood flow between free skin and muscles flaps: prospective study.

We used Doppler ultrasound to evaluate postoperative hemodynamic changes in blood flow in skin (n = 11) and muscle (n = 4) flaps. The minimum velocities, resistance indexes, and diameters of the pedicle, the recipient, and control artery (the corresponding contralateral artery that served as a recipient vessel) were recorded intraoperatively and at 10 days, 1 month, 3 months, 6 months, and 12 months after surgery. The minimum velocities and blood flow in recipient and pedicle arteries in both groups increased after flap transfer. In control arteries, these values decreased over the follow-up period. The decrease of blood flow in recipient arteries for the skin flaps started at 10 days and in the muscle flap at 1 month. The decrease in minimum velocity was noted after 10 days and 1 month for skin and muscle flaps, respectively. Resistance indexes were higher in skin flaps (99 +/- 6) compared with muscle flaps (89 +/- 9). Also, recipient blood flow after flap transfer, independent from intraoperative values, changed according to flap size; muscle flaps that were larger than skin flaps caused significantly higher blood flow in recipient artery.

Gallbladder function and dynamics of bile flow in asymptomatic gallstone disease.

AIM: To investigate the effects of gallbladder stones on motor functions of the gallbladder and the dynamics of bile flow in asymptomatic gallstone disease. METHODS: Quantitative hepatobiliary scintigraphy was performed to detect the parameters of gallbladder motor function [gallbladder ejection fraction (GBEF), gallbladder visualization time (GBVT), gallbladder time to peak activity (GBT(max)), gallbladder half emptying time (GBT(1/2)), and transit time of bile to duodenum (TTBD)] in 24 patients with asymptomatic cholelithiasis who were diagnosed incidentally during routine abdominal ultrasonographic examination and 20 healthy subjects with normal gallbladder. RESULTS: Even though there was no significant difference in the clinical and laboratory parameters between the patient and control groups, all parameters of gallbladder function except TTBD were found to differ significantly between the two groups. GBEF in the patient group was decreased (P = 0.000) and GBVT, GBT(max), GBT(1/2) in the patient group were longer (P = 0.000, P = 0.015, P = 0.001, respectively). CONCLUSION: Our results showed that even if there were not any clinical and laboratory findings, gallbladder filling and emptying could be impaired in patients with gallstone disease.

Value of Computed Tomography (CT) in Imaging the Morbidity of Submerged Molars: A Case Report.

Submerged primary molars can be difficult to manage due to the developing dentition. Rarely in some severe cases, may the surgical interventions be required while ensuring the vital structures are protected. Therefore these cases require sophisticated imaging techniques in order to locate the vital structures.In this case report, a 17 year old girl who had a retained and submerged deciduous molar which caused impaction of the second premolar and tipping of the first molar was presented. In addition, value of computed tomography (CT) for locating the vital anatomic structures was discussed.In our case, CT has been supplied effective information about localization of the vital structures and amount of bone volume during the diagnosis and treatment planning period in addition to the routine dental radiographies.

Higher incidence of cholelithiasis in chronic renal failure patients with secondary hyperparathyroidism undergoing peritoneal dialysis.

BACKGROUND: In this study, we endeavored to determine whether the incidence of cholelithiasis (CL) was increased in chronic renal failure (CRF) patients with secondary hyperparathyroidism on a peritoneal dialysis (PD) program. We also evaluated the factors that might have some influence on the development of CL. METHODS: A total of 59 CRF patients undergoing PD were included in the study. We studied the following groups to determine whether parathyroid hormone (PTH) levels were increased in CRF-PD patients: twenty patients with secondary hyperparathyroidism (group 1) and 39 patients with normal PTH levels (group 2). PTH levels were maintained at three times the upper limit of normal. Biochemical parameters were obtained for each CRF-PD patient. All patients underwent abdominal ultrasonography to screen for the presence of cholelithiasis. For statistical analysis, chi2, t test, and logistic regression analysis were used; p < 0.05 was considered as significant. RESULTS: We found an almost ten times higher incidence (25% vs. 2.6%) of CL in group 1 patients with statistical significance (p = 0.007). When the incidence of CL according to sex, creatinine, and PTH levels were considered, female gender, creatinine, and PTH levels were higher in group 1, which was also significant statistically. No significant relationship was detected between gallbladder stone formation and the other analyzed biochemical parameters. CONCLUSIONS: We found that the incidence of CL in CRF-PD patients with secondary hyperparathyroidism was higher than CRF-PD patients with normal PTH levels. It was also detected that female gender, high creatinine levels, and elevated PTH levels might influence the development of CL in CRF-PD patients.

Intracranial lipomas: importance of localization.

Intracranial lipomas are rare congenital malformations. They are usually pericallosal asymptomatic midline lesions. Other brain malformations are often seen in association with intracranial lipomas. We describe the findings of imaging studies, including computed tomography (CT), magnetic resonance (MR) imaging, and MR angiography, along with a brief review of the literature. The frequency and the spectrum of the associated brain malformations are also discussed. We retrospectively reviewed CT and MR findings of 24 patients (14 female, 10 male, mean age 38.6 years) diagnosed with intracranial lipoma between December 2000 and June 2004 in two different radiology departments. Seventeen of the patients were diagnosed using cranial MR and seven with cranial CT. The CT density of all lesions was measured. Imaging characteristics of lipomas, morphological findings and associated malformations were described. The intracranial locations of the lipomas were left-sided quadrigeminal cistern (n=3), right-sided quadrigeminal cistern (n=4), interpeduncular cistern (n=1), sylvian fissure (n=3), interhemispheric fissure (n=3), choroid plexus (n=2), intercerebellar fissure (n=3), corpus fornicis (n=1) and the periphery of the corpus callosum (n=4). Eighteen of the intracranial lipomas were tubulonodular; six were curvilinear. Associated anomalies were observed in six patients. All of the patients with sylvian fissure lipoma had seizures. The two preferential sites of intracranial lipomas were pericallosal and dorsal mesencephalic. Most intracranial lipomas are found incidentally during neuroradiological investigations. CT and MR examination usually lead to the diagnosis, because of the very low attenuation values of lipomas on CT and the short T1 and T2 on MR. Midline anomalies and other malformations such as aneurysms are frequently associated with intracranial lipomas. Careful radiologic evaluation is therefore necessary to evaluate associated pathologies. Sylvian fissure lipomas should be considered in the differential diagnosis of patients with epilepsy.

The effect of long-term low-dose lead exposure on thyroid function in adolescents.

This study investigated blood lead (Pb-B) levels and Pb-B effects on thyroid functions in long-term low-level-lead-exposed male adolescents who work as auto repairers. Pb-B and ALAD index (logarithm of activated delta-aminolaevulinic acid dehydratase/nonactivated delta-aminolaevulinic acid dehydratase) were measured as indicators of exposure to lead. Thyroid function tests including free thyroxine (FT4), free triiodothyronine (FT3), and thyrotrophin (TSH) were conducted and thyroid ultrasounds were performed in 42 lead-exposed adolescents and 55 healthy control subjects. Mean Pb-B levels and ALAD index were found significantly higher in the study group than in the normal control group (7.3+/-2.92 microg/dl vs. 2.08+/-1.24 microg/dl, P < 0.001 and 0.44+/-0.26 vs. 0.29+/-0.23, P < 0.05, respectively). FT4 levels were found significantly lower in the study group (1.02+/-0.18 mI/mL and 1.12+/-0.14 mIU/mL, P < 0.05). No subject in the control group had an abnormal FT4 level, but FT4 levels were found under normal limits in 11 subjects (26%) in the study group. FT3 and TSH levels in the study and control groups did not differ (P > 0.05). Thyroid volumes in the study and control groups did not exhibit any significant differences (P > 0.05). Pb-B was found to be negatively correlated to FT4 levels (r = -0.20, P = 0.044). This study revealed that long-term low-level lead exposure may lead to reduced FT4 level without significant changes in TSH and T3 levels in adolescents even at low Pb-B levels.

Diameter of the infrarenal abdominal aorta in children with cerebral palsy.

The diameters of the infrarenal abdominal aorta by ultrasonography have not yet been reported in children with cerebral palsy (CP). Because the demand for the surgical applications of the abdominal aorta probably increases in the CP population owing to their prolonged life-span, we planned a study to assess the diameter of the infrarenal abdominal aorta by ultrasonography in children with CP and to compare them with those of healthy subjects. The study comprised 60 children with CP and 95 age- and sex-matched healthy children. The diameter of the infrarenal abdominal aorta was measured by B-mode ultrasonography. The correlation between the aortic diameter, weight, height, body surface area (BSA), and body mass index was studied. The diameter of the infrarenal abdominal aorta was found to be smaller in children with CP than in healthy children (p < 0.05). There was a significant correlation between the aortic diameter, weight, height, and BSA in both groups (p < 0.05). When a vascular surgical treatment is needed in children with CP, the probability of a small-diameter infrarenal abdominal aorta should be considered.

Rapidly growing sublingual dermoid cyst throughout pregnancy.

Dermoid cysts (DCs) are subcutaneously located cystic masses that contain epithelium and adnexal structures. They are most commonly located in the ovaries and sacral region. Seven percent of DCs are found in the head and neck. Sublingual DCs may develop above the mylohyoid, presenting in the floor of the mouth or below it, causing a submental or submaxillary mass. We presented a case with a sublingual giant DC enlarged rapidly during pregnancy manifesting deglutition and mild respiratory problems. The growth of a DC of the neck may be accelerated in pregnancy period and may ensue severe symptoms challenging both mother and fetus. We proposed the removal of sublingual DCs before attempting to conceive to eliminate the risk of rapid growth of DC that results in respiratory and deglutition problems.

Ileoileal invagination without obstruction in a four-year-old boy.

Intussusception is one of the most common causes of acute abdomen in the first year of life. Its clinical presentation is vomiting, bloody stools, severe colicky abdominal pain, and mass. The authors reported a case of intussusception with an inappropriate clinical picture, but both characteristic ultrasonography and computed tomography findings led to the diagnosis of ileo-ileal intussusception.

[Incidence of left renal vein anomalies in routine abdominal CT scans]. / Rutin abdomen BT'de sol renal ven anomalilerinin görülme sikligi.

PURPOSE: To study the appearance and incidence of left renal vein anomalies in abdominal CT examinations. MATERIALS AND METHODS: One thousand and three abdominal CT examinations were reviewed retrospectively for the presence of left renal vein anomalies. Nineteen CT scans were excluded from the study because of technical or patient-dependent factors. The course of the left renal vein was assessed on the CT slices to detect any anomalies. RESULTS: Left renal vein anomaly was detected in 32 (3.2%) of 984 cases. Twenty-three (2.3%) of them were a retroaortic and 9 (0.9%) of them were a circumaortic left renal vein. CONCLUSION: It is important to detect left renal vein anomalies before retroperitoneal surgery or interventional procedures. These anomalies can be identified in routine abdominal CT examinations with a careful inspection.