Vaspin, neutrophil gelatinase-associated lipocalin and apolipoprotein levels in patients with psoriatic arthritis.

OBJECTIVES: To examine the relationship between disease activity and vaspin, neutrophil gelatinase-associated lipocalin (NGAL) and apolipoprotein levels in patients with psoriatic arthritis (PsA). BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory arthritis, which is related with psoriasis. Adipokines are the mediators which play a role in metabolic homeostasis and inflammatory conditions. METHODS: The levels of vaspin, NGAL, apolipoproteins and their correlations with disease activity were compared in 50 psoriatic arthritis patients and 36 healthy controls. RESULTS: The levels of vaspin, NGAL and apolipoprotein B/A1 ratio were significantly higher in the patient group (p 0.05). CONCLUSION: This is the first study to have compared vaspin and NGAL levels in patients with PsA. Vaspin and NGAL can be used as a biomarker in PsA. Vaspin, NGAL and dyslipoproteinemia are not correlated with disease activity (Tab. 3, Ref. 63).

The novel diagnostic marker in low-LVEF heart failure patients.

OBJECTIVE: The structural and compositional changes in the myocardium seem to have a major role in the development of heart failure (HF).Imbalance between production and degradation in extracellular collagen results in increase of collagen synthesis biomarkers in the circulation as the carboxy-terminal propeptide of type I procollagen (PIP). Here we aimed to determine role of PIP in the diagnosis of chronic HF. MATERIAL AND METHODS: 87 patients with HF group and 80 healthy subjects were enrolled into the study. Echocardiographic examination was performed.At the beginning of the study, serum B type natriuretic peptide (BNP), PIP, high sensitive C-reactive protein (hs-CRP) were measured . The subjects were followed for one year then after. RESULTS: Average PIP value of HF group was significantly higher than that of the control group (p < 0.001). Both hs-CRP and BNP values were well correlated to PIP values (p < 0.001). In the HF group, PIP value of patients who died at the end of one year was similar to that of patients who survived at the end of first year. CONCLUSION: PIP may not mirror acute events in follow-up of chronic heart failure but it is a very beneficial biomarker in diagnosis of low-LVEF heart failure with high sensitivity and specificity (Tab. 2, Fig. 1, Ref. 16).

Left ventricular hypertrophy and arterial stiffness in essential hypertension.

AIM: The aim of this study was to evaluate the association between an increase in arterial stiffness and the development of left ventricular hypertrophy in essential hypertension patients. MATERIALS AND METHODS: One hundred forty essential hypertension patients were included in the study. Patients were divided into two groups based on echocardiographic measurements; with left ventricular hypertrophy (n=70) and without left ventricular hypertrophy (n=70). The criterion for hypertrophy was accepted as an intraventricular septum and posterior wall thickness in diastole of 11 mm or above. Aortic stiffness values of the patients groups were measured noninvasively by arteriography through the brachial artery. Pulse wave velocity (PWV) measurements were used as indicators of arterial stiffness. RESULTS: When compared to the group without left ventricular hypertrophy, elevated systolic blood pressure, mean blood pressure, and pulse pressure were located in the left ventricular hypertrophy group at a significant level (p > 0.01). A statistically significant difference was not observed in the diastolic blood pressure and pulse measurements of the groups. Pulse wave velocity, the indicator of arterial stiffness, was elevated to a significant degree in the left ventricular hypertrophy group (p > 0.01). While a positive correlation was found between pulse wave velocity and left ventricle mass index, microalbuminuria, high sensitive C-reactive protein (Hs-CRP), and left ventricle end-diastolic volume, a negative correlation was found between pulse wave propagation velocity and left ventricle E/A. CONCLUSIONS: In conclusion, pulse wave analysis is a valuable method for predicting cardiac hypertrophy in essential hypertension (Tab. 6, Ref. 25).

Evaluation of Transforming Growth Factor Beta-1 in the vein wall of males with varicocele.

OBJECTIVE: This study aims to investigate potential differences in the presence of Transforming Growth Factor-Beta 1 (TGF-ß1) between the vein walls of patients with varicocele and those of healthy individuals. PATIENTS AND METHODS: The study comprised a total of 40 participants, divided into two groups. The control group (Group 1) consisted of 20 patients who underwent coronary bypass surgery, while the varicocele group (Group 2) included 20 patients scheduled for varicocelectomy. The cytoplasmic and nuclear staining patterns of TGF-ß1 immunohistochemistry were assessed in tissue samples under light microscopy, identifying any differences in TGF-ß1 presence between varicocele patient vein walls and normal (saphenous) veins. RESULTS: The varicocele group demonstrated lower nuclear and cytoplasmic TGF-ß1 staining rates compared to the control group. After controlling for the independent factor of age, significantly lower nuclear and cytoplasmic staining was still observed in the varicocele group. CONCLUSIONS: This study is the first of its kind to compare TGF-ß1 staining in the vein walls of varicocele patients and healthy individuals. Previous studies focusing on varicose veins reported elevated TGF-ß1 expression. Contrarily, our study observed lower TGF-ß1 expression in varicocele patient veins, marking a unique contribution to the field.

Serum IL-36α, IL-36ß, and IL-36γ levels in patients with hidradenitis suppurativa: association with disease characteristics, smoking, obesity, and metabolic syndrome.

Hidradenitis Suppurativa (HS) is a chronic, inflammatory, and relapsing skin disease. Pathogenesis of the disease is not well understood, but many studies revealed the potential role of cytokines and interleukins. IL-36 expression was increased in tissue samples of HS patients with conflicting result regarding serum levels. To investigate serum IL-36 levels in HS patients and evaluate their relation to disease characteristics, 44 patients diagnosed with HS and 44 age and sex-matched healthy controls were included in the study. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum IL-36 concentrations. Serum levels of IL-36α, IL-36ß, and IL-36γ were significantly elevated in HS patients compared to healthy controls (all three p < 0.001). IL-36α, IL-36ß, and IL-36γ levels were significantly higher in current smokers compared to non-smokers and positively correlated with number of packs/year (p = 0.002, r = 0.402; p = 0.042, r = 0.242 and p = 0.001, r = 0.391, respectively). IL-36α, IL-36ß, and IL-36γ levels were also elevated in obese patients and patients with metabolic syndrome (p = 0.007, < 0.001, 0.038, 0.004, 0.006, and 0.048, respectively). After stratified and restricted analyses for smoking, obesity, and metabolic syndrome IL-36α, IL-36ß, and IL-36γ increased the risk of HS 11.0, 1.79, and 4.5 time, respectively (95% CI 1.7-71.28, p < 0.001; 95% CI 1.04-3.06, p = 0.005 and, 95% CI 1.007-20.106, p = 0.040, respectively). Elevated serum IL-36 levels may contribute to pathogenesis of HS and may be a candidate for future biological treatment of the disease.

Evaluation of Cases of Graft Nephrectomy After Graft Loss in Patients With Renal Transplantation.

INTRODUCTION: Renal transplantation is undoubtedly considered the best renal replacement therapy. Graft nephrectomy can be performed in patients with renal transplantation because of complications associated with the failed graft. We aimed to retrospectively investigate the characteristics of patients who underwent graft nephrectomy. MATERIALS AND METHODS: Between January 2000 and November 2013, the records of 757 patients who had renal transplantation in Ege University Faculty of Medicine Hospital Nephrology-Transplantation outpatient clinic were examined. Sixty-four patients who underwent graft nephrectomy were included in the study. Patients were divided into 2 groups according to the timing of graft nephrectomy. The group of 30 patients who underwent graft nephrectomy in the first 56 days after the renal transplantation was referred to as the "early group" and the group of 34 patients who underwent graft nephrectomy after 56 days was referred to as "late group." RESULTS: In our study, we found the body mass index to be significantly higher in those with early graft loss (P = .02). We found that there was a difference between the groups in terms of sex (P = .012). When the mortality and morbidity rates after graft nephrectomy were examined, mortality was observed in 3 of the 64 patients in the study and morbidity in 1 patient. CONCLUSION: According to our study, the body mass indices and ages of the subjects who need early graft nephrectomy are higher. However, male sex was significantly more prevalent in patients who underwent graft nephrectomy in the late period compared with the early period.

Predictive value of pre-operative inflammation-based prognostic scores (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in testicular sperm extraction: a pilot study.

To investigate the ability of some hematologic prognostic scores demonstrating inflammation in predicting sperm presence in testicular sperm extraction (TESE). We retrospectively investigated the medical data of 430 patients with the diagnosis of non-obstruc tive azoospermia (NOA) who had undergone TESE operation consecutively in our institution between the dates of January 2009 and February 2017. In all, 352 patients with the diagnosis of NOA, with bilaterally palpable vas deferens, who had undergone TESE for the first time, were included in the study. Patients with genetic anomalies, genital infection, history of surgery or vasectomy, chronic diseases, history of inflammatory, metabolic, rheumatologic, or malignant diseases, morbid obesity, with the diagnosis of clinical varicocele, or patients who had undergone TESE for the second time were excluded from the study. According to the results of TESE, the patients were divided into two groups as those with sperm retrieval and those without sperm retrieval. These groups were compared in terms of age, infertility duration, body mass index, hormone profile, hematologic parameters, neutrophil-to-lymphocyte ratio (NRL), monocyte-to-eosinophil ratio (MER), and platelet-to-lymphocyte ratio (PLR). The NLR and PLR levels were found to be significantly higher in patients without sperm retrieval at TESE compared to those with sperm retrieval. The logistic regression analysis showed NLR as an independent factor that showed the presence of spermatozoa at TESE (odds ratio: 4.786, %95 confidence interval: 2.667-8.589, p < 0.001). The area under the ROC curve (AUC) for the PLR was determined to be 0.574. As the calculated AUC value of the PLR was below 0.6, there was insufficient evidence determined at TESE to say that it was a reliable marker to indicate the presence of spermatozoa. The area of the MER value under the ROC curve was not statistically significant. It has been demonstrated that systemic inflammation negatively affects the probability of extracting spermatozoa in TESE and NLR is an independent factor indicating the presence of spermatozoa in TESE.

Blood-flow volume quantification in internal carotid and vertebral arteries: comparison of 3 different ultrasound techniques with phase-contrast MR imaging.

BACKGROUND AND PURPOSE: Optimal estimation of cerebral blood-flow volume (BFV) may be an important indicator for better evaluation of the patients with cerebrovascular disorders. In this study, we compared the BFV values at bilateral internal carotid and vertebral arteries of healthy volunteers obtained with color Doppler, power Doppler, and B-flow ultrasound (US) studies and tried to determine which examination is more correlated with MR phase-contrast quantification. METHODS: BFVs of the internal carotid and vertebral arteries of 40 healthy volunteers (19 men and 21 women; age range, 20-47 years) were measured by using color Doppler, power Doppler, B-flow US and MR phase-contrast imaging. The flow measurements obtained with the sonographic techniques were compared with MR phase contrast, which is accepted as the most reliable method for the estimation of cerebral BFV. RESULTS: Quantification with power Doppler imaging showed the highest values among sonography techniques, followed by color Doppler imaging, B-flow imaging (BFI), and MR phase-contrast flow quantification. There was a statistically significant difference between the flow-volume values obtained with these 4 different techniques (P < .05). BFI yielded the closest values (internal carotid arteries, 238.84 mL/min; vertebral arteries, 51.16 mL/min) to MR phase-contrast flow quantification study with higher correlation rates. CONCLUSION: Flow volumes obtained with BFI showed the highest correlation with MR phase-contrast imaging among 3 different sonography techniques. B-flow sonography may be a very effective and cost-efficient alternative for MR phase-contrast studies for the calculation of cerebral BFV.

THE EFFICIENCY OF ULTRASOUND ELASTOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF THYROID NODULES.

AIM: To evaluate the efficiency of ultrasound elastography (USE) in the differential diagnosis of thyroid nodules. METHODS: One hundred thyroid nodules in 100 patients (79 females, 21 males, age range 18-78; mean age = 45.6 years) were evaluated with real-time freehand USE, using Hitachi EUB 7500 equipment and elasticity scores were obtained. The elasticity was scored as follows: Score 1, elasticity in the entire nodule; Score 2, mainly elastic nodule with the presence of inelastic areas not constant during real time examination; Score 3, constant inelastic areas prevalently arranged at the periphery of the nodule; Score 4, constant inelastic areas prevalently arranged at the center of the nodule; Score 5, no elasticity in the nodule. Also mean strain ratio values were calculated for all nodules. RESULTS: Eighty-four (86%) of cases were benign and sixteen (16%) were malignant. Elasticity score 3 and higher and strain ratio higher than 2.485 had statistically significant relation with malignancy (p < 0.05). CONCLUSIONS: USE including strain ratio calculations besides subjective evaluation of elasticity scores is an efficient imaging method which may contribute to the differential diagnosis of thyroid nodules.

Intraocular tumors. The value of spectral and color Doppler sonography.

We evaluated the efficacy of spectral and color Doppler sonography as a screening procedure for intraocular tumors. Thirty patients who had intraocular tumors were included in the study. Abnormal Doppler shifts were demonstrated 19 of 20 patients with choroidal malignant melanomas, especially at the base of the tumors. The average maximum systolic blood flow velocity in the vessels of these tumors was 17 +/- 6.8 cm/sec (14 to 28 cm/sec). In one of the choroidal metastasis, blood vessels were seen around the lesion with a 14-cm/sec maximum peak systolic velocity. Intratumoral vascularity could not be demonstrated in the other tumors. Spectral and color Doppler imaging is a relatively new and promising modality in the management of intraocular tumors and may help to provide a more precise preoperative histological diagnosis noninvasively; however, long-term follow-up is needed.

Goiter prevalence, serum selenium, and urine iodine status in a previously iodine-deficient area in Turkey.

This study was planned to investigate goiter prevalence and serum selenium and urine iodine status among school-age children in the Ankara region of Turkey. Nine hundred five (905) children were investigated; 847 of them were included in the study. Thyroid ultrasound was performed on children who were suspected of being goitrous at physical examination. Serum TSH, thyroxine, triiodotyronine, thyroid antibody, and urine iodine concentrations (UIC) are also measured. Ultrasound measurements revealed a goiter in 107 (12.6%) of the 847 children. Goiter prevalence was significantly lower among iodized-salt users compared to the noniodized salt using group. UIC and serum selenium levels in the goitrous group were significantly lower compared to the nongoitrous group. Despite legally enforced table salt iodization, the region shows the characteristics of mild iodine deficiency. In addition to lower UIC, goitrous children have lower serum selenium levels compared to the nongoitrous ones. Thus, selenium deficiency plays an important role in goiter endemics in Turkey. It can be postulated that table salt iodization might not be enough for the preventive measures of goiter, but informing people about the correct ways of iodized salt consumption, enforcing the iodization of industrial salts, and, as important as these measures, taking selenium deficiency into consideration are essential for preventing goiters in endemic areas.

A decreased serum omentin-1 level may be an independent risk factor for peripheral arterial disease.

AIM: Recent evidence suggests that omentin-1, a visceral adipose-derived cytokine, may play a role in atherosclerosis The aim of this study was to evaluate whether serum omentin-1 levels are associated with peripheral artery disease (PAD) and its severity. METHODS: The present study was cross-sectional and observational. We enrolled 123 patients with PAD and 50 age-matched subjects without PAD. The cardiovascular risk factors, ankle-brachial index (ABI), and serum omentin-1 levels were assessed in all participants RESULTS: Patients with PAD had significantly lower omentin-1 levels than those without PAD (206. ±48.4 vs. 345. ±80 ng/mL, respectively; 0.001). A correlation analysis revealed positive correlations between the omentin-1 level and the ABI ( 0.52, P=0.008). After adjusting for cardiovascular risk factors, a decreased omentin-1 level was found to be an independent predictor of both PAD and its severity as measured by ABI in multivariate logistic regression analysis. CONCLUSION: The current study suggests a strong association between decreased serum omentin-1 levels and PAD and its severity. Thus, omentin-1 may be a novel biomarker for PAD.

An evaluation of diaphragmatic movements in hemiplegic patients.

OBJECTIVE: The aim of this study was to evaluate the effect of hemiplegia on diaphragmatic movements using motion-mode ultrasonography. METHODS: 23 hemiplegic patients who were diagnosed with a single-hemisphere lesion (mean age 60.5 years; 13 males and 10 females) and a control group of 20 patients (13 males and 7 females) were all evaluated by ultrasonography. Ultrasonography recordings were made of the amplitude of diaphragmatic movement during spontaneous and deep breathing. The patients underwent lung function tests. RESULTS: When the hemiplegic and control groups were compared, the forced vital capacity, forced expired volume in 1 s, maximum inspiratory pressure and maximum expiratory pressure values were significantly lower in the groups with right and left hemiplegia (p<0.05). When a comparison was made between the right hemiplegic group and the control group and between the left hemiplegic group and the control group in terms of diaphragmatic excursions, for both groups, no significant difference was determined between the movements of the right hemidiaphragm during spontaneous and deep breathing and those of the left hemidiaphragm in spontaneous respiration. In contrast, for both hemiplegic groups, a significant decrease was noted in the movements of the left hemidiaphragm in deep respiration. CONCLUSION: The diaphragm is both contralaterally innervated and ipsilaterally innervated, and innervation exhibits marked variations from person to person. This provides an explanation for varying diaphragmatic movements in hemiplegic cases during deep respiration.

Use of twinkling artifact in sonographic detection of intestinal pneumatosis.

Intestinal pneumatosis is a relatively rare condition that has been associated with a wide variety of abnormalities. Traditionally, this entity has been diagnosed by radiographic films, contrast series, or more accurately by computed tomography. However, reports describing findings of intestinal pneumatosis on sonographic examination, which is an important initial diagnostic tool for abdominal diseases, are limited. We suggest that twinkling artifact may be of value in the sonographic diagnosis of this condition. We report two cases of intestinal pneumatosis that were diagnosed initially by sonography with the aid of twinkling artifact.

Role of endosonography in the evaluation of gastric malignancies.

The aims of this study were to stage gastric malignancies and differentiate between carcinomas and lymphomas. Twenty-two patients were evaluated with endosonography. Tumoral infiltration depth (T stage) and presence of metastatic lymph nodes (N stage) were investigated. Five percent of the cases were staged as T2, 36% as T3, and 59% as T4. According to the endosonographic examination, 14% were NO, 68% were N1, and 18% were N2 malignancies. When compared with results of surgery and histopathologic examination, the accuracy was 82% for both T and N stages. It can be concluded that endosonography is a valuable imaging modality for the local staging of gastric malignancies. Early stage lymphomas can be differentiated from carcinomas, but in advanced stages both have similar appearance.

High-flow arterioportal fistula: treatment with detachable balloon occlusion.

Transarterial embolization is one of the treatment choices for symptomatic hepatic arterioportal fistula that has low mortality and morbidity. Proper selection of the technique and embolic material is very important for the success of the procedure. We present a case with high-flow arterioportal fistula treated with transarterial embolization using detachable balloons.

Benefits of tissue harmonic imaging in the evaluation of abdominal and pelvic lesions.

BACKGROUND: We compared tissue harmonic imaging (THI) and conventional ultrasonography to determine whether THI improves image quality and facilitates lesion characterization. METHODS: Eighty-nine various abdominal or pelvic lesions in 71 patients(34 men and 37 women; age range = 3-90 years, median age = 52 years) were evaluated with conventional ultrasonography and THI. Examinations were performed with frequencies of 2-5 MHz. All the images were stored on a hard disk and evaluated separately by three radiologists. RESULTS: According to the interpreters, THI improved overall image quality in 67 (74%) to 76 (84%) and lesion characterization in 28 (31%) to 36 (40%) of 89 lesions when compared with conventional ultrasonography. All three observers agreed that image quality and lesion characterization were improved in 62% and 17% of the lesions, respectively. Lesion groups containing five or more lesions were compared for any difference of improvement in overall image quality and lesion characterization. For overall image quality, a significant difference was found ( p < 0.05). For lesion characterization, there was no significant difference between groups ( p > 0.05). CONCLUSION: THI improved overall image quality and lesion characterization.

Primary stenting for complex atherosclerotic plaques in aortic and iliac stenoses.

PURPOSE: To evaluate the efficacy of primary stenting for complex atherosclerotic plaques in aortic and iliac stenoses that are not amenable to balloon angioplasty alone. METHODS: Nineteen patients with complex atherosclerotic plaques were treated with a Palmaz stent (n = 19), Wallstent (n = 1), Strecker stent (n = 1), or Memotherm stent (n = 1). A total of 22 stenoses presenting with complex plaque morphology including ulcerated plaques, ulcerated plaques with focal aneurysms, plaques with heavy calcification, severely eccentric plaques, plaques with overhanging edge, and plaques with spontaneous dissection were stented. The lesions were in the aorta (n = 1), common iliac artery (n = 19), or external iliac artery (n = 2). RESULTS: Immediate angiography after stent placement revealed restoration of patency of the stented segment. Focal aneurysms and ulcerated areas were occluded in the follow-up angiographies obtained 4-12 weeks after the procedure. In one case with poor distal runoff and multiple complex lesions of the iliac artery, subacute occlusion occurred. Clinical and angiographic follow-up (3-46 months) revealed patency of all other stented segments. CONCLUSION: Primary stenting is an effective and reliable approach for complex plaques in stenoses. Patency of the arterial segment with a smooth lumen can be created without the risk of acute complications such as distal embolization, dissection, or occlusion.

Scrotal arteriovenous malformation and its preoperative embolization.

Arteriovenous malformations of the scrotum are extremely rare. A case of scrotal arteriovenous malformation and its preoperative embolization in a child is presented.

Cost-effectiveness of computed tomography in the evaluation of patients with headache.

We report a retrospective study to determine the cost-effectiveness of cranial computed tomography in patients with headache without neurological finding. Five hundred ninety-two neurologically normal patients were examined between 1990 and 1993 for the complaint of headache. Examination results were reevaluated from written report and image archive systems. Results were divided into three groups. In group P0, we included patients with normal cranial computed tomography findings. In group P1, patients showed some minor pathologies like ischemic or atrophic changes. These findings neither explained the reason for headache nor changed the clinical or therapeutic approach. The third group (P2) was to include patients with gross intracranial pathology like space-occupying lesions or bleeding. Five hundred forty-six of 592 patients were in the P0 group (92%), and the remaining 46 patients were in the P1 group (8%). No patient was found to have serious intracranial pathology detected by computed tomography. Cost of detection of a case with significant pathology was calculated. It is our opinion that computed tomography is an unrewarding technique in the evaluation of patients with chronic headache whose neurological examinations are normal.