Cerebral hemodynamics in patients with ankylosing spondylitis.

OBJECTIVE: The aim of this study was to assess the cerebral blood flow velocity as a marker by using transcranial Doppler (TCD) ultrasonography in patients with ankylosing spondylitis (AS). METHODS: A total of 30 AS patients aged 20 to 50 were enrolled in the AS group (male/female: 4/26, mean age: 34.7 ± 5.9) consecutively. The control group (non-AS group; male/female: 4/26, mean age: 32.3 ± 4.7) consisted of 30 age- and sex-matched, randomly selected patients without AS who had other diagnoses such as fibromyalgia and did not have risk factors for atherosclerosis. Bilateral middle cerebral artery (MCA) peak-systolic, end-diastolic, and mean blood flow velocities, Gosling's pulsatility index values, and Pourcelot's resistance index values were recorded with TCD by a neurosonologist blinded to the AS and control groups. RESULTS: The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels and cerebral blood flow velocities of bilateral MCA were significantly higher in the AS group than in the control group. CONCLUSIONS: This study highlights that the increased cerebral blood flow is indirectly associated with atherosclerosis regarding persistent inflammation in patients with AS.

Severe cholestasis due to azathioprine in Behcet's disease.

Azathioprine (AZA) is an immunosuppressive drug that is widely used in the treatment of autoimmune diseases. Although AZA is used widely, many studies reported that AZA-related hepatotoxicity is rather rare. We aimed to present a case with severe cholestatic hepatitis due to AZA use for Behcet's disease. Three weeks after starting AZA for the treatment of uveitis, the patient was admitted to our clinic with cholestasis and constitutional symptoms. In liver biopsy, findings were in accordance with drug reaction, and the AZA treatment was stopped. After 2 months, bilirubin levels and liver tests results became normal. As a result, given that AZA may cause severe cholestasis, the drug should be stopped if idiosyncrasy or hypersensitivity develops. If there is a debate in the diagnosis, histopathological evaluation of the liver would be the major issue because of the correct diagnosis of the drug toxicity and excluding other aetiologies.

Changes in Cerebral Blood Flow in Patients with Familial Mediterranean Fever.

INTRODUCTION: It is known that there is a relationship between systemic inflammation and atherosclerosis. Atherosclerosis is one of the best-known causes of cerebrovascular diseases. The aim of this study was to assess cerebral blood flow velocity using transcranial Doppler (TCD) ultrasonography in patients with familial Mediterranean fever (FMF). METHODS: A total of 30 patients aged from 20 to 50 years with FMF were enrolled in the FMF group consecutively. The control group (non-FMF group) consisted of 30 age- and sex-matched randomly selected patients without FMF who had other diagnoses such as fibromyalgia and did not have risk factors for atherosclerosis. Bilateral peak-systolic, end-diastolic, and mean blood flow velocities in the middle cerebral artery (MCA), values of Gosling's pulsatility index, and values of Pourcelot's resistance index were recorded using TCD ultrasonography by a neurosonologist blinded to the FMF and control groups. RESULTS: There were 30 participants in the FMF group in remission (male/female: 4/26, mean age: 34.7±5.9 years) and 30 participants in the control group (male/female: 4/26, mean age: 32.3±4.7 years). C-reactive protein levels and bilateral blood flow velocities in the MCA were significantly higher in the FMF group than in the control group. CONCLUSIONS: This study suggests that persistent clinical and subclinical inflammation in patients with FMF causes an increase in cerebral blood flow velocities. Our findings provide an insight into this association between FMF and cerebrovascular diseases.

Incidental pheochromocytoma presenting with sublaboratory findings in asymptomatic surrenal masses: a case report.

INTRODUCTION: Adrenal incidentaloma can be described as adrenal lesions that are incidentally diagnosed during abdominal laparotomy or any abdominal screening without prior suspicion of adrenal disease. It is important to diagnose adrenal lesions to learn if they are hormonally active or malignant. The most common clinical sign of pheochromocytoma is sustained or paroxysmal hypertension, and the most common symptoms are headache, excessive truncal sweating, and palpitation. In some cases, the clinical symptoms are not clear. Roughly 70% of adrenal incidentalomas are non-functional. A small group of 5-7% of the functional ones (30%) may exist as pheochromocytoma. Ten percent of pheochromocytoma cases are diagnosed incidentally during computed tomography (CT) or magnetic resonance imaging (MRI) screenings for other reasons. The most frequent symptom of the pheochromocytoma is hypertension, and 90-100% of cases exhibit it. The literature indicates that incidental pheochromocytoma cases that are smaller than 1 cm have no clinical symptoms. Rarely, some large pheochromocytoma cases do not show any clinical symptoms, and it is difficult to diagnose very small ones. CASE PRESENTATION: A 45-year-old male patient experienced an epigastric ache and distended stomach for 7 years. The serum cortisol level was 19.2 ng/dL (normal range: 5-20 ng/dL), and urinary free cortisol excretion was 25.00 mug/24 h (normal range:10.00-100.00 mug/24 h). The serum basal level of adrenocorticotropic hormone (ACTH) was 21 pg/mL (normal range: 9 to 52 pg/mL). Plasma cortisol was under 1.00 mug/dL after low dose (1 mg) overnight dexamethasone suppression test. 24 hours urinary catecholamines level were vanil mandilic acid (VMA) 8.90 mg/day (normal range, 3 to 90 mg/day), metanefrin 330 mug/day (normal range, 52 to 341 mug/day), epinefrin 13 mug/day (normal range, 2 to 24 mug/day), norepinefrin 41 mug/day (normal range; 15 to 100 mug/day). During abdominal ultrasonography (USG), a tumor was diagnosed in the right perirenal space. A regular-shaped mass (dimension 36 x 35 x 35 mm) with a homogeneous and solid structure was diagnosed in CT. The density of the mass was 80 Hounsfield units (HU) in postcontrast CT. The patient was given a diagnosis of a non-functional adrenal incidental lesion, underwent a right adrenalectomy. Histopathological data correlated with pheochromocytoma as well CONCLUSION: Pheochromocytoma can be diagnosed by establishing an increase in catecholamines and metabolites in the plasma and urine. The level of catecholamines and metabolites in the plasma and urine provide 95% of the evidence of the disease. Because the dimensions of the lesion were large and the HU was very clear, the patient was underwent surrenalectomy. During laboratory investigation, there was no evidence of abnormality; we, therefore, think that these cases can be named sublaboratory pheochromocytoma.