Arterial dysfunction in early autosomal dominant polycystic kidney disease independent of fibroblast growth factor 23.

INTRODUCTION: Recent studies report reduced vascular compliance and elevated levels of fibroblast growth factor 23 (FGF23) in patients with autosomal dominant polycystic kidney disease (ADPKD) and preserved kidney function. In the present study, we investigated the relationship between vascular compliance and FGF23 in patients in early phases of ADPKD. MATERIALS AND METHODS: We studied 54 ADPKD patients with preserved kidney function and 24 healthy individuals. All participants underwent noninvasive pulse wave analysis in order to determine large arterial elasticity index (LAEI) and small arterial elasticity index (SAEI) using a modified Windkessel model. Levels of FGF23 in addition to several cardiovascular risk factors were evaluated. Linear regression analyses were performed to determine independent correlates of LAEI, SAEI, and FGF23. RESULTS: In the ADPKD group, 33 patients were hypertensive and the remaining patients were normotensive. Serum FGF23 levels of both ADPKD groups were significantly higher than that in the controls. Both hypertensive and normotensive ADPKD patients had lower LAEI and SAEI levels compared to the controls. There was no significant correlation between vascular compliance parameters and FGF23 levels. Having ADPKD was independently associated with increased FGF23 levels and decreased SAEI. CONCLUSIONS: Fibroblast growth factor 23 was found substantially elevated and arterial compliance was found significantly decreased in early ADPKD patients regardless of hypertension. However, there was no significant correlation between FGF23 levels and arterial function parameters. Additional studies are required to determine possible mechanisms of these disturbances and cardiovascular effects of FGF23 in ADPKD patients.

Laparoscopic treatment of recurrent ectopic pregnancy in the ipsilateral salpinx after ovulation induction and intrauterine insemination.

OBJECTIVE: To report a case of recurrent ectopic pregnancy in the ipsilateral salpinx after and intrauterine insemination treated by laparoscopy. CASE REPORT: A 33-year-old woman with unexplained infertility sought evaluation at our hospital due to pelvic pain after ovulation induction and intrauterine insemination. She had a history of a right salpingectomy. Transvaginal ultrasonography did not reveal an intrauterine pregnancy, but showed a suspected extrauterine gestational sac on the operated adnexal area with free fluid in the pouch of Douglas. The patient was diagnosed with a recurrent ruptured ectopic pregnancy and an emergency laparoscopy was performed. CONCLUSION: Recurrent ectopic pregnancy in the ipsilateral fallopian tube is rare, but it is important to be suspicious of the diagnosis to prevent serious morbidity. This case also demonstrates transtubal or transperitoneal migration of the gametes because ovulation and ectopic pregnancy occurred on opposite sides.

Complications of pediatric denture misuse: a case report.

The multiple loss of primary molars due to caries or other reasons in the primary or mixed dentition can lead to severe mutilation of the developing dentition. It is advisable to construct a removable appliance to maintain the relationship of the remaining teeth and to guide the eruption of the developing teeth in order to prevent the child from developing psychological and speech problems. However, parental and patient cooperation are imperative if the pediatric patient is to exercise the necessary care to maintain the denture in a clean and healthy condition. This case report identifies the complications that can arise from the uncontrolled misuse of a pediatric denture. It is concluded that as well as the parents, the pediatric dentists play an important role in the follow-up of the young patients for whom pediatric dentures are constructed. Additionally, patients should be re-called for check-up visits or instructed to refer to the dental clinics in 6-month intervals. Brochures that inform the patients and their parents about the application and care of pediatric dentures and space maintainers should be given.

Brain MR spectroscopy in children with a history of rheumatic fever with a special emphasis on neuropsychiatric complications.

PURPOSE: To investigate whether there are metabolite changes in basal ganglia of children with complete healing of rheumatic fever (RF), history of Syndenham chorea (SC) and obsessive compulsive-tic disorder (OCTD) developed after RF when compared with healthy controls and each other. MATERIAL AND METHODS: A total of 49 children with history of RF and 31 healthy controls were included into the study. All patients and control group underwent a detailed neuropsychiatric evaluation. Children with the history of RF were classified into three groups as; group 1: with history of RF without neuropsychiatric complications (NCRF), group 2: only with history of SC (HSC), group 3: with HSC and OCTD (OCTD). After MR imaging, single voxel MR spectroscopy was performed in all subjects. Voxels (15 x 15 x 15 mm) were placed in basal ganglia. N-acetyl aspartate (NAA)/creatin (Cr), and choline (Cho)/Cr ratios were calculated. RESULTS: OCTD were detected in 13 children with HSC. NAA/Cr ratio was found to be decreased in these children when compared with NCRF (n:29), HSC without OCTD (n:7) and control groups (n:31). No significant difference was found in metabolite ratios of children with HSC without OCTD when compared with NCRF and control groups. There were no significant differences in Cho/Cr ratio between patient and control groups. CONCLUSION: Although MR imaging findings was normal, MR spectroscopy findings (decreased NAA/Cr ratio) in our study support the neuronal loss in basal ganglia of children with OCTD and could indicate the development of permanent damage.