Determining the aflatoxin M1 levels in breast milk.

OBJECTIVE: Mycotoxins are different toxic substances at relatively smaller molecular weight produced by some types of fungi. Aflatoxin is the most common type of mycotoxin easily reproducing in food stored for a long time in unsuitable conditions. This study determined the aflatoxin M1 (AFM1) levels in breast milk samples collected from mothers who gave birth in Kirsehir, Turkey. MATERIALS AND METHODS: A total of 82 breast milk samples to be analyzed to determine the AFM1 levels were collected from voluntary breastfeeding mothers who gave birth in the Kirsehir Training and Research Hospital and who were randomly selected. The AFM1 levels were determined using the competitive ELISA kit. RESULTS: The AFM1 levels in the breast milk samples of mothers who did not consume milk were lower than those of other mothers. The AFM1 levels in the breast milk samples of mothers consuming fabrication milk were lower than mothers consuming homemade milk (p<0.01). Additionally, the AFM1 levels in the breast milk samples of mothers consuming homemade or self-made bread were lower (p<0.05). CONCLUSIONS: This study found that the nutritional habits of breastfeeding mothers affected the AFM1 levels in breast milk.

Evaluation of risk factors associated with first episode febrile seizure.

OBJECTIVE: Febrile convulsion (FC) is one of the most common neurological findings in children. This study was aimed to investigate the difference in laboratory parameters between Febrile Seizure and control groups. PATIENTS AND METHODS: In this study, 169 children admitted to the pediatric emergency department with their first episode of FS and 189 control groups were retrospectively analyzed. The demographic characteristics and laboratory parameters of children were obtained from their files. RESULTS: Upper respiratory tract infection (URTI) was determined the most common disease (81.6%) in the FC group followed by acute gastroenteritis (AGE) (15.4%) and urinary tract infection (UTI) (3%), respectively. Similarly, URTI was detected as the most common disease (81.8%) in control groups. It was determined that there was no statistically significant difference between the two groups in terms of diseases. The leukocyte and neutrophil counts of the children with FC were significantly higher but the mean corpuscular volume of lenfosit and lenfosit/neutrophil ratio was significantly lower than the control groups (p= 0.009, <0.001, 0.001, <0.001, <0.001, respectively). Children with FC had significantly higher blood glucose, urea, creatinine, creatine kinase, alkaline phosphatase and albumin levels compared with the control groups (p<0.001, in all parameters). On the other hand, the potassium, sodium and chlorine levels of the Children with FCs were significantly lower than control groups (p=0.017, <0.001, p <0.001, respectively). CONCLUSIONS: To conclude, febrile patients with high leukocyte counts, high neutrophil counts, and several biochemical parameters should be carefully monitored for FCs due to the increasing seizure risk.

A neglected etiology of bronchiectasis: External compression due to hiatal hernia.

AIM: To investigate the incidence of bronchiectasis supposed to be made by the external compression of hiatal hernia (HH) to bronchi. MATERIALS AND METHODS: The thorax computed tomography (CT) scans of patients which were carried out in Duzce University Hospital between February 2014 and August 2015 were retrospectively evaluated. The repeated scans in the same patient were excluded. RESULTS: A total of 4388 patients were included in the study. A total of 98 HH cases were detected of which 58 (59.2%) were female. The mean age was 73.30 ± 9.14 (45-90). The rate of HH according to small, moderate and large size was 45 (45.9%), 9 (9.2%), 44 (44.9%), respectively. The rate of hiatal hernia accompanied by bronchiectasis were similar in both males and females (P = 0.078). The prevalence of bronchiectasis was significantly high in large hernias with 81.4% rate (P = 0.009). Bronchiectasis rate was 12.343 times (OR: 12.343, 95% CI: 1.479-103.027, P = 0.009) higher in the large HH group compared to small and moderate HH groups. Hiatal hernia accompanied by bronchiectasis was 88.1% anatomically near to HH. CONCLUSIONS: Thus, hiatal hernia may cause bronchiectasis due to external compression rather than lymphadenopathy or the tumor as an etiology of bronchiectasis and should be considered in the differential diagnosis.

Development of primary central nervous system lymphoma in a systemic lupus erythematosus patient after treatment with mycophenolate mofetil and review of the literature.

Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma and four cases of PCNSL have previously been described in association with mycophenolate mofetil. We report the fifth case of PCNSL in a patient with lupus nephropathy while on mycophenolate mofetil treatment.

Assessment of anterior subcutaneous hypersignal on proton-density-weighted MR imaging of the knee and relationship with anterior knee pain.

PURPOSE: The purpose of this study was to evaluate the prevalence of anterior subcutaneous hypersignal indicating edema on proton-density (PD)-weighted MRI of the knee and to determine whether reporting anterior edema is clinically relevant. MATERIALS AND METHODS: One hundred and ninety-one knee MRIs from 162 patients were reviewed for anterior subcutaneous edema. There were 92 men and 70 women with a mean age of 41.72years±13.92 (SD) (range, 15-80years) years and a mean body weight of 75.94kg±12.54 (SD) (range, 50-130kg). The MRI findings were compared with patient age, gender, body weight, history of repetitive microtrauma and clinical findings. Patellar and trochlear chondropathy, medial plica, joint effusion, synovitis, infrapatellar fat-pad signal intensity, suprapatellar fat-pad signal intensity with mass effect, quadriceps and patellar tendon abnormalities were also reviewed. RESULTS: An anterior hypersignal on PD-weighted MRI was detected in 158/191 MR examinations (82.7%) and 104 (84.6%) of these cases had histories of anterior knee pain. No correlation between anterior pain and anterior edema was found (P=0.42). Age (P<0.0001), weight (P<0.0001), and repetitive microtrauma (P=0.001) were identified as significant variables associated with anterior edema. CONCLUSION: Anterior edema may be a physiological phenomenon or degenerative change related to patient age, weight, and knee movement or mechanics. It should not be reported as a pathological finding on MRI unless clinical findings support regional infection or inflammation.

Vertebrobasilar insufficiency and gamma-glutamyltransferase: An emerging relationship demonstrating inflammation and atherosclerosis.

OBJECTIVES: Vertebrobasilar insufficiency (VBI) is a pathology arising from the reduction in flow rate of vertebral arteries and mainly caused by inflammation and atherosclerosis. Gamma-glutamyltransferase (GGT) is a marker which has been recently recognized as a marker of inflammation and atherosclerosis. We aimed to investigate the relationship between GGT levels and VBI for the first time. METHODS: In this cross-sectional study, of 3100 subjects who had vertebrobasilar doppler ultrasonography (VBU) were evaluated and 1042 of them who met the inclusion criterias were included. VBU reports, GGT levels, blood chemistry, lipid profile were received from patients' files. Patients were evaluated according to VBU measurements and divided into two groups,VBI and non-VBI. RESULTS: Mean vertebral arterial blood flow volume values were 149.99±32.93 mL/m in VBI group and 286.88 ± 70.98 mL/m in non-VBI group. Mean GGT and CRP values were significantly higher in the VBI group than in the non-VBY group (p < 0.001) ( p < 0.001), respectively. Vertebral artery blood flow volume was negatively correlated with GGT (r: -0.208, p < 0.001) and CRP (r: -0.119, p < 0.001). CONCLUSION: We demonstrated a significant correlation between serum GGT levels and VBI. In addition, higher GGT level was an independent risk factor for the presence of vertebrobasilar system inflammation and atherosclerosis (Tab. 2, Fig. 3, Ref. 27).

Adrenal gland volume assessed by magnetic resonance imaging in women with polycystic ovary syndrome.

PURPOSE: To determine adrenal gland volume (AGV) in women with polycystic ovary syndrome (PCOS) by comparison with healthy control subjects and to investigate the relationship between AGV and hormonal status. PATIENTS AND METHODS: AGV was measured on transverse sections of T1-weighted MRI imaging data in 27 PCOS patients and 40 age-matched control subjects for this prospectively designed study. A comparative analysis of AGV in PCOS and controls was performed and possible correlations between AGV and hormonal parameters were evaluated. RESULTS: PCOS patients had significantly larger AGV compared to controls ((11.7±4.4 cm(3), 7.2±1.9 cm(3), respectively, P<0.001). A significant positive correlation was found between total AGV and dehydroepiandrosterone sulfate, 17-OH progesterone, and total and free testosterone levels in the PCOS group (r=+0.51, +0.48, +0.43, +0.62, respectively; P values<0.05). In addition, AGV was significantly negatively correlated with LH and LH/FSH ratio in the PCOS group (r= -0.55, P=0.02; r=-0.51, P=0.01, respectively). CONCLUSIONS: PCOS patients have significantly increased AGV as well as a positive correlation of AGV and androgens. We conclude that the assessment of AGV with MRI shows a significant correlation with the androgenic activity of the gland, and that hypertrophy of the adrenal gland may be involved in the pathogenesis of PCOS.

Ultrasonographic Tinel Sign: two case reports.

Peripheral nerve sonography has been regarded as an important tool for evaluating anatomic changes within nerves and muscles. Over the last few years, the role of ultrasonographic Tinel (UST) in diagnostic sensitivity and its relationship to neurophysiologic findings has increased. Ultrasonographic Tinel sign helps to interpret the ultrasonographic and clinical findings and have proven useful in making a diagnosis.

Association of the renal resistive index with microvascular complications in type 2 diabetic subjects.

Chronic complications are the leading causes of morbidity and mortality in the diabetic population. The intrarenal resistive index (RI) has been reported to be increased in hypertensive subjects with microalbuminuria and limited data is present for diabetic subjects. 101 subjects with Type 2 Diabetes Mellitus were included in the study. We grouped the study population according to the urinary albumin excretion (UAE). Group 1: UAE<30 mg/day (n=36); Group 2: UAE 30-300 mg/day (n: 37); Group 3: UAE>300 mg/day (n: 28). We also grouped the study population according to the intrarenal RI value. Group I consisted of subjects with RI≥0.70 and group II<0.70. The mean intrarenal RI values of patients in group 3 were higher than those of group 1 and group 2 (0.72 vs. 0.69 p=0.048; 0.72 vs. 0.69; p=0.048 respectively). The duration of diabetes, hip circumference, and hs-CRP levels were statistically significantly higher in subjects with intrarenal RI≥0.70 compared to those with intrarenal RI<0.70 (p:<0.001, 0.048 and 0.0148 respectively). Presence of retinopathy and neuropathy was statistically significantly higher in subjects with intrarenal RI≥0.70 compared to those with intrarenal RI<0.70. RI may predict the development of microvascular complications in diabetic subjects.

Ultrasound diagnosis of ulnar neuropathy: comparison of symptomatic and asymptomatic nerve thickness.

There is still no consensus on a normal value for the cross-sectional area of the ulnar nerve at the elbow. Such data would be valuable for the ultrasound diagnosis of ulnar neuropathy. Comparison of the symptomatic and contralateral asymptomatic sides has been recommended. The aim of this study was to investigate whether or not the asymptomatic ulnar nerve could be a reference value. High-resolution ultrasonic measurements of the cross-sectional areas of the ulnar nerves at the elbow were compared with 38 contralateral asymptomatic elbows of patients with unilateral ulnar neuropathy and 38 healthy controls. There were significant differences in the cross-sectional areas at all levels between the healthy control subjects and asymptomatic side of the ulnar neuropathy patients (p < 0.05). The findings of this study suggest that there is a limitation in using the asymptomatic side for obtaining reference values in ultrasonographic studies. Each ultrasonographic laboratory should determine its own reference values.

Maternal serum pregnancy-associated plasma protein-A levels in hyperemesis gravidarum: a prospective case control study.

PURPOSE: To investigate if maternal serum pregnancy-associated plasma protein-A levels are affected in hyperemesis gravidarum (HG). MATERIALS AND METHODS: A prospective case control study was conducted in 169 HG cases who had one or more antepartum hospitilization for HG. The control pregnancies were 132 and were selected randomly among all women who had first trimester prenatal screening in antenatal outpatient clinic between 2011 and 2012. RESULTS: Maternal serum pregnancy-associated plasma protein-A levels were significantly higher in hyperemesis gravidarum group compared with control group (p = 0.002 p < 0.05 95% CI). Power analysis of independent sample t-test, two-sided, for pregnancy-associated plasma protein-A was 0.88. Maternal serum free beta-human chorionic gonadotropin values were not different between two groups (p > 0.05). CONCLUSION: Increased pregnancy-associated plasma protein-A levels associated with HG, even after excluding potential cofounders.

Hemobilia and occult cystic artery stump bleeding after a laparoscopic cholecystectomy: endovascular treatment with N-butyl cyanoacrylate.

Hemobilia is a rare phenomenon. In this case report we present an emergent transcatheter glue embolization (in which N-butyl cyanoacrylate is used as an embolizing agent) due to arteriobilary fistula occurred following the laparoscopic cholecystectomy in a 41-year-old woman.

Segmental costovertebral anomaly presenting with horn-like appearance in the chest.

Several types of abnormalities of the ribs have been reported. Many of these anomalies usually result in the correct diagnosis thanks to the characteristic radiological appearances. But some of the anomalies are rare and it is important to recognize and get accustomed to differing appearances of these osseous abnormalities in order to differentiate the pathological processes and to diagnose the syndromes which may accompany rib anomalies. The localized costovertebral anomaly with horn-like appearance, which has not yet been described in literature, is presented in this paper.

Bilateral extra-adrenal perirenal myelolipomas: CT features.

Myelolipomas are rare benign tumours composed of adipose tissue and haematopoietic cells that are typically found in adrenal glands but have also appeared in extra-adrenal sites. Distinguishing between extra-adrenal myelolipomas and malignant tumours, such as liposarcomas, is crucial to avoid an invasive procedure. To this end, we present a comprehensive report of the CT imaging characteristics of a pathologically proven bilateral extra-adrenal perirenal myelolipoma.

Neurolytic phenol blockade of the obturator nerve for severe adductor spasticity.

BACKGROUND: In this study, we present the 3-month follow-up results of a retrospective analysis of obturator nerve (ON) phenol neurolysis performed between 2000 and 2007 in patients with adductor spasticity. METHODS: The study was performed by retrospective investigation of the clinical follow-up results of 80 ON phenol treatments in 62 patients. Neurolysis using 5-10 ml 6% phenol was applied with the guidance of fluoroscopy and a peripheral nerve stimulator. Pain, spasticity and hygiene were evaluated and the hip abduction range of motion (ROM) was measured at the end of the first week and in the first, second and third months following the intervention. RESULTS: The visual analogue scale scores decreased significantly in the first week, first month and the second month, but reached their initial values in the third month. A drastic increase in the ROM values was shown in hip abduction in the first week, first month and second month. An increase in the Ashworth Scale values was observed in the second and third months, but they did not reach their initial values. The hygiene score decreased drastically in the first week and the first and second months, but worsened in the third month. The success rate in nerve localization during ON neurolysis was 100%. CONCLUSION: ON phenol blockade with fluoroscopy and peripheral nerve stimulator guidance in patients with adductor spasticity led to a decrease in spasticity and pain with an increase in the ROM of the hip and better hygiene with an efficacy lasting for about 3 months.

Evaluation of the effect of local corticosteroid injection and anti-inflammatory medication in carpal tunnel syndrome.

BACKGROUND AND AIMS: To evaluate the effect of local corticosteroid injection versus non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of carpal tunnel syndrome (CTS), 32 patients were included in this study. METHODS: A prospective, randomised clinical trial, assessing functional findings by Functional Status Scale (FSS), (JTT) Jebsen Taylor Test and electrophysiologic examinations, analysed on initial visit and at the third month after treatment. Group A was treated with betamethasone injection and group B with NSAIDs, both with concomitant use of wrist splints. RESULTS: The mean age of the patients was 40.8 +/- 11.2 (range 21-64) years. There was a significant improvement in FSS in groups A and B at the third month. In JTT, 'writing', 'picking up small common objects' and 'picking up large heavy objects' activities were improved in group A; 'writing' and 'stacking checkers' activities were improved in group B. Statistically significant improvement was observed in peak sensory conduction velocity and distal motor latency in groups A and B. Mixed nerve conduction velocity and compound sensory action potential were improved in group A. CONCLUSIONS: The results showed that neither of the groups demonstrated superior results. We conclude that local steroid injection and NSAIDs with concomitant use of wrist splints may offer patients with CTS variable and effective treatment options for the management of functional scores and nerve conduction parameters.

Cypermethrin-induced histopathological and biochemical changes in Nile tilapia (Oreochromis niloticus), and the protective and recuperative effect of ascorbic acid.

The objective of this study was to investigate the effects of ascorbic acid on the toxicity of cypermethrin's on histopathological lesions in tissues and protein, glycogen levels in Oreochromis niloticus. Nile tilapia was exposed to 0.22 and 0.44 µg/l cypermethrin+control diet, 0.22 and 0.44 µg/l cypermethrin+ascorbic acid supplemented diet for 20 days. The fish were allowed recuperation period of 15 days in pesticide-free water and fed with ascorbic acid suplementation diet. In light microscopic investigation, histopathological lesions were observed in the gill, liver and kidney. The severity of lesions accreted depending on increased pesticide concentration and control diet. Some of the lesions were reversible or at least were less pronounced after recuperation period. Protein levels decreased in some groups after treatment period according to control groups (p<0.05). The highest depletions in liver, muscle and gill protein levels were found in 0.44 µg/l cypermethrin+ascorbic acid supplemented diet group (62.23%), in 0.22 µg/l cypermethrin+control diet group (53.12%) and in 0.44 µg/l cypermethrin+control diet group (61.87%) after 10 days, respectively. These levels increased at the end of the recuperation period. The highest depletion in liver glycogen levels was found in 0.22 µg/l cypermethrin+control diet group (50.50%) after 10 days (p<0.05). At the end of recuperation period, there was no difference between the groups (except 0.22 µg/l cypermethrin+ascorbic acid supplemented diet group) and controls. The decrease of muscle glycogen, except 0.22 µg/l cypermethrin+ascorbic acid supplemented diet group, was recorded at the end of 10 and 20 days. In the recuperation period, an increase was observed at all groups. These results revealed that the histopathology, protein and glycogen can work as good indicators of stress of a toxicant on fish. Ascorbic acid serves fish as an antitoxic agent against pesticide toxicity.

Ultrasound-guided botulinum toxin type A injection to the iliopsoas muscle in the management of children with cerebral palsy.

OBJECTIVE: To determine the effect of botulinum toxin type A (BTX-A) on spasticity and functional development in children with cerebral palsy (CP) in conjunction with a physiotherapy program. METHOD: In this prospective study, 18 CP patients were evaluated. Multilevel BTX-A injection was applied to children at a dose of 15 U/kg. Children were assessed before and at the 5th and 12th week post-injection using Thomas test, Duncan-Ely test, passive range of motion (pROM) measurement, Distance Between Knee (DBK), Selective Motor Control (SMC) scale, modified Ashworth Scale (MAS) and modified Physician Rating Scale (mPRS). To assess functional improvement, Gross Motor Function Measure (GMFM) and Functional Independence Measure for Children (WeeFIM) were used before and at the 12th week post-injection. RESULTS: At 5th week post-injection, a statistically significant decrease was determined in spasticity (p < 0.01). Improvement was observed in mPRS and pROM, but not in SMC. At the 12th week post-injection, GMFM (p< 0.001) and WeeFIM improved significantly (p< 0.001). The improvement in pROM and mPRS (p< 0.01) lasted until the 12th week post-injection, but the improvement in MAS (p > 0.05) and in the Tardieu test of hip adductors (p > 0.05) did not last after the 5th week. CONCLUSION: BTX-A injection enhances functional and motor abilities in the development process.