Determinación de la imagen corporal y los niveles de autoeficacia en pacientes después de un trasplante de córnea / Determination of body image and self-efficacy levels in patients after cornea transplantation

Objetivo: El estudio tuvo como objetivo determinar la imagen corporal y los niveles de autoeficacia después de la cirugía en pacientes con trasplante de córnea. Materiales y métodos: La población de este estudio descriptivo estuvo compuesta por 383 pacientes que acudieron a la unidad del banco de ojos de un Hospital Universitario tras un trasplante de córnea. El tamaño de la muestra de 193 pacientes se calculó con una potencia de 0,5 y un margen de error de 5%, lo cual representa 95% del universo. Los datos fueron recopilados a través de entrevistas presenciales con los pacientes por parte del investigador, y el estudio se completó con 178 pacientes desde septiembre a noviembre de 2022. Los datos fueron recolectados utilizando un formulario de información al paciente, la escala de imagen corporal y la escala de autoeficacia general. En el análisis de datos se utilizaron la distribución porcentual, la media aritmética y el análisis de correlación. Resultados: Se determinó que la puntuación media de la escala de imagen corporal de los pacientes trasplantados participantes en el estudio fue de 159,41±36,99 y la puntuación media de la escala de autoeficacia fue de 30,37±8,31. Cuando se examinó la comparación de las puntuaciones medias, la diferencia entre las puntuaciones medias de la escala de género, estado civil, ocupación y de imagen corporal fue estadísticamente significativa (p < 0,05), mientras que la diferencia entre las puntuaciones medias de autoeficacia no fue estadísticamente significativa (p < 0,05). Existió una relación significativa positiva moderadamente fuerte entre la imagen corporal y la autoeficacia de los pacientes (p < 0,01) (r = 0,57). Conclusión: Se constató que la imagen corporal y los niveles de autoeficacia de la paciente eran elevados, y la autoeficacia aumentaba a medida que aumentaba la imagen corporal.(AU)

Purpose: The study aimed to determine body image and levels after surgery in cornea transplant patients. Materials and methods: The population of this cross-sectional study was composed of 383 patients presented to the Eye Bank unit of a University Hospital after corneal transplantation. Sample size of 193 patients was calculated with 0.5 power, a margin of error of 5%, representing 95% of the universe. The data were collected through face-to-face interviews with the patients by the researcher and the study was completed with 178 patients in September - November 2022. The data were collected using a Patient Information Form, the Body Image Scale, and the General Self-Efficacy Scale. Parametric tests, Pearson Correlation, Student's T-test, and One-Way Analysis of Variance tests were performed were used in the data analysis. Results: It was determined that the mean Body Image Scale score of the transplant patients participating in the study was 159.41 ± 36.99 and the mean Self-Efficacy Scale score was 30.37±8.31. When the comparison of the mean scores was examined, the difference between the mean scores of gender, marital status, occupation, and body image scale was statistically significant (P < .05), while the difference between the self-efficacy mean scores was not statistically significant (P > .05). There was a positive, moderately strong significant relationship between body image and the self-efficacy of the patients (P < .01) (r = .57). Conclusion: It was found that the patient's body image and self-efficacy levels were high, and self-efficacy increased as the body image increased.(AU)

Other primary headache disorders: Data from the HEAD-MENA-A study in Africa, Asia, and the Middle East.

OBJECTIVE: Other primary headache disorders (OPHD) are under-investigated compared to frequent primary headache types like migraine, tension-type headache, and trigeminal autonomic cephalalgias. Knowledge of the distribution and characteristics of OPHD subtypes is crucial for their recognition. We aimed to determine the prevalence at the hospital and headache clinics and clinical characteristics of OPHDs in patients from 13 countries. METHODS: We analyzed a large dataset from the cross-sectional study Head-MENA-A (Middle East, North Africa, Asia). Consecutive patients over 10 years of age presenting with headaches were included from outpatient, inpatient, and emergency settings. A structured questionnaire addressing demographics, headache characteristics, accompanying symptoms, and triggers was administered. Headache subtypes were diagnosed according to the ICHD-3 criteria. RESULTS: Among patients complaining of headaches (n = 3722), 106 (2.9%) were diagnosed with OPHD. Fifty-two patients (1.4% of all headache patients) had only OPHD, while 54 (1.5%) had both OPHD and a co-existing primary headache (mostly migraine). All OPHDs were more common in females. The most frequent subtypes were new daily persistent headache and primary stabbing headache (0.2% each among all admitted patients). Photophobia and phonophobia were the most frequent accompanying symptoms, while physical activity (28.8%), stress (15.4%), and the Valsalva maneuver (15.4%) were the most common triggering factors. The majority of triggering factors were more pronounced in patients with both migraine and OPHD. CONCLUSIONS: Other primary headaches are rare and heterogeneous. Their high co-existence with migraine suggests shared predisposing factors, hinting at a "headache continuum" concept for primary headaches.

Cross-sectional, hospital-based analysis of headache types using ICHD-3 criteria in the Middle East, Asia, and Africa: the Head-MENAA study.

BACKGROUND: Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for planning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to carry out inter-regional comparisons by using current diagnostic criteria with evaluations of neurologists to delineate headache burden. METHODS: A cross-sectional study between April 1 and May 16, 2022 was conducted with the participation of 13 countries from the Middle East, Asia, and Africa. Patients were included in the study on a specific day each week during five consecutive weeks. All volunteers over the age of 18 and whose primary cause for admission was headache were examined. The patients admitted to NC or referred from emergency services/other services were evaluated by neurologists by means of the International Classification of Headache Disorders (ICHD-3) criteria. RESULTS: Among the 13,794 patients encountered in NC, headache was the primary complaint in 30.04%. The headache patients' mean age was 42.85 ± 14.89 (18-95 years), and 74.3% were female. According to the ICHD-3 criteria, 86.7% of the main group had primary headache disorders, 33.5% had secondary headaches, 4% had painful cranial neuropathies along with other facial and headaches, and 5.2% had headaches included in the appendix part showing some overlapping conditions. While the most common primary headache was migraine without aura (36.8%), the most common secondary headache was medication-overuse headache (MOH) (9.8%). Headaches attributed to COVID-19, its secondary complications, or vaccines continue to occur at rates of 1.2%-3.5% in current neurology practice. Pain severity was significantly lower in Ivory Coast and Sudan than in Türkiye, Turkish Republic of Northern Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan (p < 0.001). CONCLUSIONS: The study showed that migraine is still the most common motive for admissions to NC in different regions. Furthermore, MOH, an avoidable disorder, is the most common secondary headache type and appears to be a significant problem in all regions. Remarkably, pain perception differs between regions, and pain intensity is lower in Africa than in other regions.

Evaluation of effects of optokinetic and rotational stimuli with functional head impulse test (fHIT) in individuals with motion sickness.

OBJECTIVES: To evaluate effects of optokinetic and rotational stimulus in individuals with and without motion sickness (MS) using fHIT. METHODS: The study included subjects aged 18-40; 35 subjects with MS for MS group and 35 subjects without vertigo for control group. Percentage of the correct answer (% CA) with and without optokinetic stimulus (o-fHIT) in the frontal plane in the fHIT test was compared in both groups. In addition, both group subjects were seated on an ordinary rotating office chair. % CA was compared between groups by applying rotational fHIT (r-fHIT) test after the subjects were rotated randomly to the right and left and also simultaneously moved their heads in the vertical plane. RESULTS: There was no significant difference in % CA in fHIT o-fHIT and r-fHIT in the control group. Both groups showed a significant difference in % CA for fHIT, o-fHIT, and r-fHIT for all SCCs (p < 0.05). CONCLUSIONS: Since individuals with MS are affected by optokinetic and rotational stimuli, fHIT performed after these stimuli can be used as an objective confirming test for diagnosing MS.

Sonographic evaluation of subclinical entheseal involvement in patients with hypoparathyroidism: a case control study.

PURPOSE: Hypoparathyroidism is a disease characterized by low serum calcium, increased serum phosphorus and low PTH levels. Although patients are treated with active vitamin D and calcium, a proper serum calcium phosphorus balance cannot always be achieved. Ectopic calcifications that develop in organs during treatment are the most common complications. To date, there is not any published study on enthesopathy in patients with hypoparathyroidism. The aim of this study was to evaluate subclinical enthesopathy in patients with hypoparathyroidism with ultrasound and to compare the results with those of the control group. METHODS: The study included patients aged 18-65 years with postoperative hypoparathyroidism and hypothyroidism (group hypoP + hypoT), patients with postoperative hypothyroidism (group hypoT), and healthy age and sex-matched volunteers (group C). Ultrasonographic findings of enthesopathy in both extremities were documented according to the Glasgow Ultrasound Enthesitis Scoring System (GUESS). RESULTS: GUESS scores in group hypoP + hypoT, were significantly higher when compared to the other groups. There was a statistically significant correlation between the total GUESS scores and total enthesophyte scores and the duration of hypoparathyroidism (p < 0.05, r = 0.43) (p < 0.05, r = 0.39) respectively. In the correlation analysis of all groups, a significant negative correlation was found between serum Ca and PTH levels and the total GUESS scores (p < 0.01, r = - 0.37; p < 0.01, r = - 0.54, respectively). CONCLUSION: This study showed that GUESS scores were significantly higher in patients with hypoparathyroidism compared to those with hypothyroidism and control subjects. GUESS scores were positively correlated with disease duration. Patients with hypoparathyroidism need to be evaluated for subclinical enthesopathy during follow-up.

Microvesicular steatosis: a missed item in the management of nonalcoholic fatty liver disease?

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease and cirrhosis. In NAFLD, histological course of steatosis is usually macrovesicular (MacroS), but it may be accompanied by varying degrees of microvesicular steatosis (MicroS). Thus, in this study, we aimed to evaluate the prevalence and significance of MicroS in subjects with NAFLD. METHODS: A retrospective analysis of clinical and laboratory data of patients with histologically proven NAFLD was performed. The liver biopsy specimens which stained with hematoxylin eosin, reticulin, and Masson's Trichrome stains were evaluated by single expert liver pathologist. Scoring and semiquantitative assessment of steatosis and NAFLD severity was done according to Kleiner scale known as NAFLD activity score (NAS). Grading for steatosis, steatosis type, zonal distribution of steatosis and other histological findings were also determined. RESULTS: The prevalence of MicroS among the study population (n= 191) was 30.4%. There was no difference regarding the demographic and biochemical parameters between patients with or without MicroS. On the other hand, the prevalence of ballooning injury and megamitochondria were higher in patients with MicroS (p= 0.019 and p= 0.036, respectively). There was a significant association of MicroS with ballooning injury (OR 2.65, 95% CI= 1.26-5.55 ; p= 0.005) and the presence of megamitochondria (OR 3.72, 95% CI= 1.00-13.72 ; p= 0.037). CONCLUSION: MicroS is common in patients with NAFLD and is associated with early histological findings in this clinically relevant condition. Further longitudinal studies are needed to characterize the role of MicroS in the natural history of NAFLD.

Comparative efficacy of medical treatment versus surgical sphincterotomy in the treatment of chronic anal fissure.

BACKGROUND: Anal fissure which is defined as a longitudinal tear in anoderm below the dentate line is one of the most common benign diseases of anorectal area. Severe pain during the defecation and emotional stress that it causes may reduce people's quality of life. AIMS: In this randomized clinical trial, we aimed to compare the efficiency of the topical ointment with medical treatment and surgical lateral internal sphincterotomy. METHOD: This is a randomized clinical trial of 550 patients who were treated for chronic anal fissure. Patients were randomly divided into 4 groups according to the treatment type they received. RESULTS: In a vast majority of the patients, the primary complaint was pain (92.3%) and bleeding during defecation (62%). Both pain relief and healing of the fissure, which are the components of response to treatment, had not been observed in 56 (37.3%) patients of topical nitroglycerin ointment group until the second month. Among the recalcitrant patients in both topical nitroglycerin (56) and topical diltiazem ointment (47) groups, 27 (48.2%), and 36 (76.5%) patients underwent surgery, respectively. The best response to treatment was also obtained in lateral internal sphincterotomy group. CONCLUSION: LIS is still the gold standard for the treatment of chronic anal fissure when the physicians would like to avoid recurrence and obtain the best pain relief.

Plasma pentraxin-3 is associated with endothelial dysfunction in non-alcoholic fatty liver disease.

OBJECTIVE: Pentraxin-3 (PTX-3) is an acute-phase protein belonging to the PTX family. It has been reported that PTX-3 is significantly associated with obesity, metabolic syndrome, and cardiovascular diseases (CVD). Non-alcoholic fatty liver disease (NAFLD) is strongly associated with atherosclerosis and CVD. In this study, we aimed to investigate the relationship of PTX-3 with circulating markers of endothelial dysfunction and atherosclerosis in patients with NAFLD. PATIENTS AND METHODS: Seventy patients with biopsy-proven NAFLD and seventy healthy controls were enrolled in the study. Plasma asymmetric dimethylarginine (ADMA), adiponectin, and PTX-3 levels were determined using enzyme-linked immunosorbent assay (ELISA). High-sensitivity C-reactive protein (hsCRP) serum levels were measured with the immunoturbidimetric assay. Insulin resistance was estimated using the HOMA-IR index. RESULTS: PTX-3 and hsCRP levels were higher and adiponectin levels were lower in the NAFLD group compared to the healthy controls (p < 0.001 for all). In correlation analysis, a significant association was observed between PTX-3 and ADMA levels (r = 0.423, p < 0.001). CONCLUSIONS: Our study demonstrated for the first time that increased circulating PTX-3 is strongly associated with endothelial dysfunction in subjects with NAFLD. However, large prospective studies are needed to establish the independent predictive value of PTX-3 for CVD endpoints in this clinically relevant condition.

Effect of Short-term 900 MHz low level electromagnetic radiation exposure on blood serotonin and glutamate levels.

BACKGROUND: Long term exposure to low level electromagnetic radiation (LLER) by using cellular phones causes serious health problems. METHODS: Ten male Wistar Albino rats were anesthetized 30 min before the LLER exposure, 0.5 ml blood was taken from the tail vein of rats in order to determine control values. Rats were grouped by three and placed on a plexi-glass flat. A fixed equivalent frequency emitter device was used. A sign to be an electromagnetic field 15.14 V/m (608 mW/m(2)) in strength in the head region with 100 kHz FM modulation at 900 MHz was applied to the animals. After calculating the ideal position for the device, electromagnetic LLER energy was applied for 45 minutes from a distance to be equal with energy transmitted by a mobile phone from a 0.5-1 cm distance to their head regions. After 1.5 hours and before the rats awoke, 0.5 ml of blood was taken from the tail veins in order to determine the treatment values. RESULTS: Plasma 5-HT and glutamate levels were measured by enzyme immunoassay (EIA) using commercial kits. It was found that a single 45 min of LLER exposure increased the blood 5-HT level significantly, but did not change the glutamate level of rats. CONCLUSION: It was concluded that even a single 45 min of LLER exposure may produce an increase in 5-HT level without changing the blood glutamate level. Increased 5-HT level may lead to a retarded learning and a deficit in spatial memory (Tab. 2, Fig. 2, Ref. 24).

Effects of varying mandibular protrusion and degrees of vertical opening on upper airway dimensions in apneic dentate subjects.

INTRODUCTION: Despite numerous studies investigating the dimensional and therapeutic effects of mandibular advancement splints (MASs), data regarding the effects of differently designed individual and non-adjustable MASs on the upper airway in fully dentate apneic subjects in the sagittal plane including comparison of these effects with a placebo device are sparse. The present study aimed to determine the dimensional changes in the sagittal plane created by differently designed MASs in the upper airway in fully dentate apneic subjects and to compare these changes with the effects of a placebo device. MATERIALS AND METHODS: Magnetic resonance (MR) images of 9 dentate apneic subjects with 5 differently designed MASs and without a MAS were obtained. We measured the area of the entire pharynx (velopharynx, oropharynx, hypopharynx) on these MR images and compared the dimensional changes. RESULTS: The dimensional changes triggered by two specific MASs (75% of the maximum mandibular protrusion with 5 mm vertical opening, and 75% of the maximum mandibular protrusion with 10 mm of vertical opening) in the entire pharynx in the sagittal plane were statistically significant compared to the other MASs (p < 0.05). The MAS effecting 75% of the maximum mandibular protrusion and 10 mm of vertical opening created a significant dimensional increase only in the velopharyngeal area among the three pharyngeal sites (p ≤ 0.003). CONCLUSION: While the degree of mandibular protrusion created by the MAS affects the dimensions of the upper airway, the degree of the vertical opening exerts no significant dimensional effect in the sagittal plane in fully dentate apneic patients. The mandibular protrusion effect is comparatively larger in the velopharyngeal region.

Use of the Berlin Questionnaire to screen at-risk patients for obstructive sleep apnea.

OBJECTIVE: To investigate the value of the Berlin Questionnaire (BQ) for screening at-risk patients for obstructive sleep apnea (OSA). MATERIALS AND METHODS: This study included 217 subjects who were referred to a Department of Otolaryngology, Head and Neck Surgery for evaluation of suspected OSA. The subjects were classified as being at high or low risk of OSA according to their BQ score. The apnea hypopnea index (AHI), body mass index (BMI), Epworth sleepiness score, and BQ results were compared in the two risk groups, and the correlation of BQ with AHI was analyzed. The predictive accuracy of risk grouping was assessed for AHI > 5 and AHI > 15. RESULTS: The BQ identified 82.03% of the subjects as being at high risk of sleep apnea and 17.9% as being at low risk. Using a cut-off point of AHI > 5, the sensitivity was 83.4% and the specificity was 22.2%; the positive predictive value was 76.4% and the negative predictive value was 30.8%. Using a cut-off point of AHI > 15, the sensitivity was 89.3% and the specificity was 22.6%; the positive predictive value was 42.1% and the negative predictive value was 76.9%. CONCLUSIONS: These findings indicate that BQ is a poor predictor of OSA in patients who are at high risk of OSA. The BQ does not appear to be an appropriate screening tool for determining the risk of sleep apnea in this population.

Alpha fetoprotein levels and its relationship with histopathological findings in patients with non-alcoholic fatty liver disease.

BACKGROUND: Non alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of liver disorders ranging from simple steatosis (SS) to cirrhosis. In addition, increasing evidence indicates that hepatocellular carcinoma (HCC) may represent a late complication of NAFLD. Alpha-fetoprotein (AFP) serum levels can rise in adults with HCC. AIM: In the present study, we aimed to investigate circulating AFP concentrations in subjects with histologically proven NAFLD. In addition, the relationship of AFP with liver histology was also searched. PATIENTS AND METHODS: One hundred and three male NAFLD patients and 57 healthy male controls were enrolled in the study. In addition, patients with NAFLD grouped as nonalcoholic steatohepatitis (NASH) (n = 72) and SS (n = 31). AFP serum levels were measured in duplicate by the chemiluminescence's method. RESULTS: Age and gender were similar in subjects with NAFLD and controls. AFP serum levels were not different between two groups. In subgroup analysis, AFP levels were also found to be similar in patients with NASH and SS. Moreover, no significant relationship was found between AFP and histopathological findings in patients with NAFLD. CONCLUSIONS: The results of this preliminary study suggest that AFP is not involved in the pathogenesis of NAFLD.

Serum lipid hydroperoxide levels and paraoxonase activity in patients with lung, breast, and colorectal cancer.

OBJECTIVES: The objectives of this article are to investigate the serum lipid hydroperoxide (LOOH) levels and paraoxonase-1 (PON1) and arylesterase (ARE) activity in patients with lung, breast, and colorectal cancer. DESIGN AND METHODS: Serum PON1 and ARE activities and LOOH levels were measured in 110 patients with cancer and same number of age- and sex-matched controls. RESULTS: Serum LOOH levels were found to be increased while serum PON1 and ARE activities were found to be decreased in patients compared to controls. PON1 activity was found to be lower in patients with breast cancer than in patients with lung and colorectal cancer. There were positive correlations between the serum PON1 and ARE activities in patients with colorectal cancer. CONCLUSION: We concluded that decreased PON1 and ARE activities and increased LOOH levels might have a connection to carcinogenesis. PON1 activity is decreased in all patients but it does not seem to be related to metastase status except for colorectal cancer.

Hydatid cyst in abdominal incisional hernia.

Recurrence of hydatid cyst is one of the important complications of primary hydatid surgery. Here we present a very rare case of recurrent hydatid cyst inside an incisional hernial sac. A 50-year old male operated on for hydatid disease of the liver twice in 1998 and 2001 was admitted to our hospital for an abdominal mass formed under the old median incisional scar. On physical examination, a painless mass of 15 cm in diameter, stretched, hard and well bordered was palpated. There was also a fascial defect inferior to the mass. A herniated hydatid cyst was imaged with both of ultrasonography (US) and abdominal computed tomography (CT). As a surgical treatment hydatid cyst was excised totally together with primary repair of the fascial defect. The patient received preoperative Albendazole therapy, administered at a dose of 10 mg/kg body weight per day from 3 weeks before surgery to 6 months postoperatively. He had no problems in the 1-year follow up (Fig. 2, Ref. 19).

Membranous structures affecting the success of endoscopic third ventriculostomy in adult aqueductus sylvii stenosis.

BACKGROUND: The purpose of the present study was to observe Liliequist's membrane (LM) and membranous structures located in the prepontine cistern via 3-Tesla magnetic resonance imaging (MRI) with 3D driven equilibrium radio frequency reset pulse (DRIVE) sequence and multiplanar reformat (MPR) images and to evaluate the success of endoscopic third ventriculostomy (ETV) by assessing these membranes in adult aqueduct stenosis. PATIENTS: 29 patients (17 female, 12 male) with primary aqueductus sylvii stenosis were included in the study. 19 patients were diagnosed as long-standing overt ventriculomegaly in adults (LOVA) and patients had severe ventriculomegaly, macrocephalus, and aqueduct stenosis on MR imaging. 10 patients were diagnosed as aqueduct stenosis presented with acute onset of hydrocephalus with symptoms of raised ICP. All patients in the study group were analyzed with conventional and cine MRI before and after treatment. We performed 3D DRIVE sequence and MPR at 3-T MR equipment to determine the membranous structures in 3 dimensions. We correlated the success of the procedure considering the preoperative, postoperative MRI and intraoperative images. RESULTS: 5 patients (26.3%) with LOVA and 2 patients (20%) with aqueduct stenosis, in total 7 patients (24.1%), did not respond to ETV. Cerebrospinal fluid (CSF) flow was blocked by membranous structures located in the prepontine cistern in 4 of 8 patients. In 2 patients, CSF through the stoma was blocked either by the LM or closed tuber cinerum. In 1 patient insufficient CSF flow was observed through the stoma and the LM accompanying prepontine membranes.Totally closed membranes were observed in the prepontine cistern in 5 patients (17.24%) according to the postoperative MRI. LM was verified in all patients intraoperatively that were also demonstrated in the preoperative MRI. CONCLUSION: 3D sequences with MPR may help to observe not only the LM but also other membranes located through the prepontine cistern, which may be the reason of failed ETV.

Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis: midterm clinical outcomes.

OBJECT: The purpose of this study was to compare the methods of posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) in cases of isthmic Grades 1 and 2 lumbar spondylolisthesis, and to evaluate the clinical efficacy of the procedures. METHODS: Operations were performed in 50 patients with lumbar spondylolisthesis in the authors' clinics between 2001 and 2007. Indications for surgery were low-back pain with or without sciatica and neurogenic claudication that had not improved after at least 6 months of conservative treatment. The study included 33 female and 17 male patients, with mean ages of 50.6 years in the PLIF group and 47.3 years in the PLF group. These patients were randomly allocated into 2 groups: decompression, posterior transpedicular instrumentation, and PLF (Group 1; 25 patients) and decompression, posterior transpedicular instrumentation, and PLIF (Group 2; 25 patients). In the PLIF group, titanium cages were used, and autograft material was obtained from the decompression. In the PLF group, bone fragments collected from the iliac crest were used as autografts. A minimum 18-month follow-up was available in all patients. For clinical evaluation, a visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey were used. Improvements in pre- and postoperative spondylolisthesis, segmental angles, fusion ratios, and postoperative complications were evaluated radiologically. RESULTS: The average follow-up period was 3.3 years. Based on the etiologies, isthmic spondylolisthesis was detected in all patients. The spondylolisthesis levels in the patients who underwent PLIF were located at L3-4 (5 patients, 20%); L4-5 (14, 56%); and L5-S1 (6, 24%), whereas the levels in the ones treated with PLF were located at L3-4 (4 patients, 16%); L4-5 (13, 52%); and L5-S1 (8, 32%). In the clinical evaluations, good or excellent results were obtained in 22 (88%) cases in the PLIF group and 19 (76%) cases in the PLF group. Fusion ratios were 100% in the PLIF group and 84% in the PLF group. Both lumbar lordosis and the segmental angle showed greater improvement in the PLIF group. There was no difference in the complication rates for each group. CONCLUSIONS: Based on early clinical outcomes and the fusion ratios of adult isthmic spondylolisthesis, the authors found PLIF to be superior to PLF.

Minimally invasive focused parathyroidectomy without using intraoperative parathyroid hormone monitoring or gamma probe.

BACKGROUND: Minimally invasive parathyroidectomy (MIP) is widely used worldwide for the treatment of primary hyperparathyroidism (pHPT). It is usually combined with a perioperative adjunct for high success rate. AIM: To demonstrate that MIP can be successfully performed in a selected group of patients with presumabally solitary adenoma as the cause of pHPT without using any perioperative adjuncts. SETTINGS AND DESIGN: A prospective data analysis of two surgeons' series from a teaching hospital in Turkey. MATERIALS AND METHODS: Of the 47 patients referred with a diagnosis of pHPT during January 2004-May 2008, 30(63%) patients with sporadic pHPT with presumed solitary adenoma were included for analysis. These patients underwent MIP via focused lateral (n=24) or anterior (n=6) approach. Preoperative localization was done using 99 mTc-labelled sestamibi scan and ultrasonography. Only patients with concordant tests for single adenoma were selected for MIP. Serum parathyroid hormone and calcium levels were measured postoperatively and at follow-up visits. STATISTICAL ANALYSIS: Parametric data presented were analyzed with Excel XP (Microsoft, Redmond, WA, USA). RESULTS: Barring one patient, all other patients were initially biochemically cured by MIP. One patient remained hypercalcemic, who was found to have a second adenoma at the second operation. During a mean follow-up of 16 (3-55) months, all patients were normocalcemic with a mean serum calcium level of 9.4 (8.9-10.2) mg/dl. Parathormone levels were persistantly elevated only in one patient (3.4%). No postoperative permanent complication was encountered. CONCLUSION: The results of MIP achieved in high-volume endocrine surgery centers can be replicated in low-volume center without any intraoperative adjuncts, in patients with overt clinical pHPT and concordant results of sestamibi and ultrasound.

Levels of paraoxonase, an index of antioxidant defense, in patients with active sarcoidosis.

OBJECTIVE: Oxidative mechanisms are currently discussed as playing a crucial role in the genesis of inflammatory lung diseases. We aimed to evaluate the oxidant-antioxidant balance in the pathogenesis and activity of sarcoidosis and to search if the change in the level of PON can be taken as an activity marker. METHODS: 26 active sarcoidosis subjects aged 41.3+/-12.9 years, 37 inactive subjects aged 39.6+/-11.7 years and 48 control subjects aged 48.9+/-2.5 years were recruited in our study. Malondialdehyde (MDA), paraoxonase1 (PON1) and oxidized low density lipoprotein (oxLDL) levels in serum were analyzed by spectrophotometric, kinetic, and ELISA methods, respectively. RESULTS: PON1 levels were significantly lower in the active disease state than both the inactive form and control groups. MDA levels were significantly higher in active sarcoidosis than both the inactive disease and control groups, and oxLDL levels were significantly higher in the active disease group than the inactive group and control group. The level of PON1 in the inactive disease group is not significantly different from the control group while the oxLDL and MDA levels of inactive group is significantly higher than the control group (p<0.001). There was a negative correlation between the PON1 activities and MDA values in both active and inactive groups (p=0.008). CONCLUSION: Oxidative stress increases in sarcoidosis might be due to both increase in lipid peroxidation and decrease in antioxidant status (PON1) and the relationship between oxidative status and the activation of the disease should be discussed by comparing the previously known activation criteria.

The plasma levels of soluble P-selectin in subjects with prediabetes.

Prediabetes has been associated with an increased risk of cardiovascular disease and mortality. Soluble P-selectin (sP-selectin) is an index of platelet activation and also a risk factor for future vascular events. sP-selectin levels were investigated in prediabetic subjects who had no confounding factors such as hypertension, obesity or dyslipidaemia. sP-selectin, hsCRP levels and HOMA-IR indexes were measured in 40 prediabetic subjects (n = 24 for IFG and n = 16 for IGT) and age-, sex- and BMI-matched 40 healthy controls. sP-selectin levels in prediabetic subjects were not significantly different compared with those in controls (p = 0.12). Prediabetic group had similar hsCRP (p = 0.29), higher HOMA-IR indexes (p < 0.001) and lower HDL cholesterol levels (p = 0.001) when compared with healthy controls. The power of the study was 0.93 for sP-selectin, 0.7 for hsCRP and 1.0 for HOMA. Our data suggest that sP-selectin may not contribute to the prothrombotic state as well as the accelerated atherogenesis associated with prediabetes.