Alterations in neuroendocrine axes in brain-dead patients.

PURPOSE: To identify changes in anterior pituitary gland hormone levels in brain-dead patients and alterations in free triiodothyronine (fT3), free thyroxine, cortisol, testosterone, and estradiol levels. METHODS: Ten postmenopausal women and 22 men with brain death (BD) were included. The first blood sample for determination of hormones (pre-BD) was collected when the clinician observed the first signs of BD. The second blood sample (BD day) was drawn after BD certification. RESULTS: Female patients exhibited lower follicle-stimulating hormone and prolactin levels pre-BD and luteinizing hormone, follicle-stimulating hormone, and prolactin levels on BD day than the age-matched controls. Male patients' sex hormone levels were similar to those of the age-matched controls, except for testosterone levels, which were low in both consecutive measurements. All gonadotropins and prolactin levels were above the tests' lower detection limits (LDLs), except for one male patient with gonadotropin levels below the LDLs of the tests. Estradiol levels in both sexes ranged from normal to elevated. FT3 levels were significantly decreased in the two measurements. Thyroid-stimulating hormone (TSH) levels were low in eight patients and all low TSH levels were above the test's LDL. The remaining patients had normal or elevated TSH levels. The median adrenocorticotropic hormone (ACTH) and cortisol levels were within normal limits. All cortisol and ACTH levels were above the tests' LDLs, except for one patient with ACTH levels below the LDL in both measurements. CONCLUSION: This study supports the hypothesis that the anterior pituitary gland continues to function in the brain-dead state.

Visual evoked potential changes following Botox administration in patients with blepharospasm.

PURPOSE: To examine visual evoked potential (VEP) changes following botulinum toxin type A (BTA) administration in patients with blepharospasm. METHODS: Patients diagnosed with blepharospasm receiving BTA administration were included in the study. Three groups, a control group and two study groups (patients examined 14 days after BTA administration-Study Group 1, and patients examined 28 days after BTA administration-Study Group 2) were evaluated. Dilated fundus examinations were performed following detailed ophthalmological examinations and VEP tests. Keypoint (Dantec, Denmark) and ISCEV criteria were adopted for pattern VEP (PVEP) recording. BTA was applied in the form of local injections at a total 15-30 units, at 2.5-5 units per injection. RESULTS: A mean 19.4 ± 3.2 units of BTA was used for each eye. N70 (ms), P100 (ms), and P100 (uV) values were statistically significantly lower in both study groups following drug administrations compared to the control group (p < 0.001 for all). Significant positive correlation was observed between increased P100 amplitudes and age in the control group (p = 0.008, r = 0.200). Significant negative correlation was observed between the BTA units used and decreased P100 amplitudes in both study groups 1 and 2 following drug administrations (p = 0.017, r = - 0.180 and p = 0.043, r = - 0.153, respectively). CONCLUSION: VEP may be an important method in the diagnosis and follow-up of blepharospasm and in determining the success of drug administration and additional therapeutic requirements.

Comparison of peripheral nerve repair using ethyl-cyanoacrylate and conventional suture technique in a rat sciatic nerve injury model.

OBJECTIVE: The aim of this study was to compare the outcomes of primary nerve repair using either ethyl-cyanoacrylate or conventional microsuture technique in a rat peripheral nerve injury model. METHODS: In this study, a total of 30 Wistar Albino rats weighing between 220 and 275 g were used. The rats were randomly divided into three groups (10 in each), including one control (group 1) and two experimental groups (group 2, conventional microsuture repair; group 3, cyanoacrylate repair). In each group, the sciatic nerve was identified and transected. No further intervention was performed in group 1. The nerve was repaired using the epineural technique with a 10/0 atraumatic nylon in group 2 and synthetic cyanoacrylate adhesive in group 3. At the fifth postoperative week, needle electromyography (EMG) was performed to measure distal latency, combined muscle action potential (CMAP), and motor nerve conduction velocity (MNCV). Following the EMG recordings, animals were euthanized. Nerve samples were collected to evaluate vacuolar degeneration, fibrosis, and foreign body reaction histopathologically. RESULTS: In the EMG analysis, mean distal latency was significantly shorter in group 1 (0.85±0.09 ms) than in groups 2 (1.17±0.25 ms) (p=0.0052) and 3 (1.14±0.14 ms) (p=0.0026) while no significant differences existed between groups 2 and 3 (p>0.9999). The mean CMAP was greater in group 1 (10.5±0.35 mV) than in groups 2 (2.86±1.28 mV) (p=0.011) and 3 (2.16±1.34 mV) (p=0.0002), but there was no significant difference between groups 2 and 3 (p>0.9999). The mean MNCV was 53.5±5.95, 39.62±7.31, and 39.84±4.73 mm/sec in groups 1, 2, and 3, respectively. There was a significant difference between groups 1 and 2 (p=0.0052) and between 1 and 3 (p=0.0026), but not between 2 and 3 (p>0.9999). In the histopathological evaluation, the mean vacuolar degeneration score was 0, 2.12, and 1.88 in groups 1, 2, and 3, respectively. No obvious difference was observed between groups 2 and 3 (p=0.743). The mean fibrosis score was 0, 1.62, and 1.77 in groups 1, 2, and 3, respectively. There was no significant difference between groups 2 and 3 (p=0.888). The mean foreign body reaction score was 0, 2.5, and 2.44 in groups 1, 2, and 3, respectively. No difference was present between groups 2 and 3 (p=0.743). CONCLUSION: Primary nerve repair using the cyanoacrylate adhesive may provide similar electrophysiological and histopathological results as compared to the conventional microsuture repair.

Alterations in thyroid hormones in brain-dead patients are related to non-thyroidal illness syndrome.

INTRODUCTION: Alterations in thyroid hormone levels occur in patients with acute neurological disease states. The aim of this study is to study changes in thyroid hormones in patients with brain death (BD). MATERIAL AND METHODS: Eleven brain-dead patients were studied prospectively. Thyroid hormones were measured on admission to the intensive care unit, the day before BD diagnosis (BD before), and the day after BD diagnosis (BD day). RESULTS: Thyroid stimulating hormone (TSH) and free triiodothyronine (fT3) concentrations were found to be significantly low on ad-mission, BD before, and BD day compared to age-matched healthy controls. TSH levels were shown to be increasing on BD day. Free thyroxine (fT4) levels were within normal limits in all cases except in one case having low fT4 levels with normal TSH levels. No statisti-cally significant changes were encountered between admission thyroid hormone levels and BD-before and BD-day thyroid hormone levels. Six patients were on steroid therapy when BD-before blood samples were drawn, and no difference in thyroid hormone levels was encountered between steroid users and non-users. Correlation analysis showed a positive correlation between GCS and TSH, but a negative association between fT3 and APACHE II. CONCLUSION: We have shown that patients with BD have altered thyroid hormones days before BD diagnosis, and these alterations con-tinue until the diagnosis of BD. The changes in thyroid hormones are compatible with non-thyroidal illness syndrome.

Frequency of migraine in patients with allergic rhinitis.

OBJECTIVES: Allergic rhinitis (AR) is an IgE mediated disease which is released by activation of mast cells and basophils, and often leads to sinus headache. Histamine which is the key mediator in the pathogenesis of AR, also plays an important role in the pathogenesis of migraine with nitric oxide (NO). Aim of our study was to investigate the frequency of migraine in patients with AR. METHODOLOGY: Headache assessment and neurological examination was performed on patients diagnosed as AR in the outpatient ear nose and throat clinic with age-matched controls. Participants with headache were classified according to the International Headache Society criteria, and migraine frequency was investigated in the patients with AR and control groups. RESULTS: Migraine headache was detected in 50% of the patients with AR. Among these, 95% were migraine without aura, and 5% were migraine with aura. Migraine frequency in the control group was 18.75% in the control group, and all was migraine without aura. Migraine frequency in the patients with AR was four times higher when compared with the control group. CONCLUSION: While a histamine and IgE associated common mechanism is responsible in the pathogenesis of AR and migraine, not only sinus headache but also migraine headache should be kept in mind. Headache assessment of the patients with AR, and in case of headache existence, referral of these patients to neurology outpatient clinics for differential diagnosis and, to maintain appropriate therapy should not be forgotten.

Susac's syndrome: a case of simultaneous development of all three components of the triad.

Susac's syndrome is characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. We here report a case of 46 year old woman with a sudden diminution in visual acuity at the left eye, headache and decreased hearing at the right ear with mild confusion considered as Susac's syndrome with complete triad. Although it's a relatively rare entity, it should be kept in mind in differential diagnosis of the neurological disorders, especially in women in 20- to 40-year of age presenting with acute hearing loss.

Sympathetic skin responses of the face and neck evoked by electrical stimulation.

The sympathetic skin responses (SSRs) were recorded from different facial regions and neck in 25 subjects evoked by electrical stimulation of the median nerve at the wrist. Recordings from all regions were cross-compared with each other and within right and left sides individually. In one subject postauricular SSR, and in another subject upper lip SSR could not be elicited on both sides. Other responses could be obtained in all the remaining subjects. In 11 subjects, the responses did not appear by the first stimulus, and began to appear by repeated stimuli. Mean latencies and the highest amplitudes of the responses were similar for both sides. Gradual amplitude increase was observed in the first three or four set of responses in 20 subjects, although the stimulus intensity was constant. In conclusion, face and neck SSRs are symmetric, can be evoked by electrical stimulation and can be used to investigate the sympathetic innervation of these areas.

Helicobacter pylori infection in epileptic patients.

It is well known that there might be an epidemiological association between Helicobacter pylori infection and extraintestinal diseases. This study aimed at determining H. pylori infection in epileptic patients. Forty-seven cryptogenic epileptic patients (Group 1) and 35 healthy people (Group 2) participated in this study. Presence of H. pylori infection was examined by H. pylori stool antigen (HpSA), H. pylori IgG, and IgM. HpSA was detected in 21 participants (44.6%) in Group 1 and in 3 participants (8.5%) in Group 2. H. pylori IgM was positive in 27 participants (57.4%) in Group 1 and in 8 participants (22.8%) in Group 2. H. pylori IgG was positive in 37 participants (78.7%) in Group 1 and in 13 participants (38%) in Group 2. The difference of rates of HpSA, H. pylori IgM and IgG in Groups 1 and 2 were found statistically significant (chi2=4.18, p=0.04; chi2=9.18, p=0.0017; chi2=14.58, p<0.001, respectively). We also compared presence of H. pylori infection between the epileptic patients with poor and good prognosis; HpSA positivity was detected in 15 (62.5%) of 24 and 6 (26%) of 23, respectively, and the differences were statistically significant (chi2=6.30, p=0.012). H. pylori IgM positivity was detected in 16 (66%) of 24 patients with poor prognosis and 11 (47.8%) of 23 patients with good prognosis (p>0.05). H. pylori IgG positivity was detected in 18 (75%) of 24 patients with poor prognosis and 19 (82.6%) of 23 patients with good prognosis. The differences of H. pylori IgM and IgG positivity rates in epileptic patients with poor and good prognosis were not found statistically significant (p>0.05). These results suggest a probable association between the acute H. pylori infection and epilepsy, especially with poor prognosis.

Subacute sclerosing panencephalitis (SSPE) associated with congenital measles infection.

A 13-month-old male presented with repetitive episodes of myoclonic jerks of the head and extremities for two months. His past medical history revealed that his non-immunized mother had measles at the time of delivery. Measles antibody titers in serum and cerebrospinal fluid (CSF) were 1/512 (hemagglutinin inhibition [HI]) and 1/128 HI, respectively. Immunofixation electrophoresis of CSF revealed an oligoclonal IgG band. The magnetic resonance imaging (MRI) of the brain on T2-weighted images showed lesions of high signal intensity in the subcortical white matter. Electroencephalography (EEG) revealed periodic high-amplitude slow waves. Diagnosis of subacute sclerosing panencephalitis (SSPE) was based upon clinical presentation, a characteristic EEG, and abnormal CSF studies. MRI findings supported the diagnosis. To the best of our knowledge, this is only the 3rd case to date, of SSPE-associated congenital measles in the literature.

Intestinal parasitic infection in children in post-disaster situations years after earthquake.

BACKGROUND: Two earthquakes in the north-west region of Turkey destroyed 80% of the houses and schools in Duzce in 1999. This study was conducted to determine the parasitic infection rate associated with the post-earthquake unhealty living conditions and related epidemiological risk factors. METHODS: Two populations living and studying in different socioeconomic conditions as a result of the earthquake were compared: Group 1 (study group) consisted of 326 children living and studying in transitory houses and classes. Group 2 (control) consisted of 127 children living in normal houses and studying in normal school classes. Fecal samples were obtained from both groups and examined for intestinal parasites' eggs and trofozoid forms. In addition, selotype procedure was applied to both populations. Epidemiological data determining the socioeconomic status of the populations were collected by questionnaire. RESULTS: In group 1, Giardia lamblia (G. lamblia) cysts were observed in 10.4% of the fecal samples and Enterobius vermicularis (E. vermicularis) eggs were observed in 13.5% of selotype samples. In group 2, Giardia cysts were observed in 3.1% of the samples and E. vermicularis eggs were observed in 5.5% of selotype samples. The rate of Giardiasis and Enterobiasis was found to be significantly higher in children still living and studying in temporary houses and schools years after the earthquakes (P < 0.05). The following pidemiological and social factors arising after the earthquakes were associated with increased rate of G. lamblia and E. Vermicularis infections: number of communal toilets per child at school, socioeconomic level of the children, dimensions of the classrooms where the children are studying and living and frequency of hand-washing at school. These parameters are significantly different between the groups (P < 0.05). CONCLUSION: Giardiasis should be considered as an emerging disease in postdisaster situations and adequate prevention measures should be implemented in these circumstances. It should also be known that the rate of Enterobiasis is increased in populations living in crowded unhealthy conditions.

[Endoscopic carpal ligament release using the Chow technique: early clinical results]. / Endoskopik karpal tünel gevsetme: Chow teknigi ve erken dönem klinik sonuçlari.

OBJECTIVES: We evaluated the clinical results of endoscopic carpal ligament release in patients with carpal tunnel syndrome. METHODS: Twenty-six hands of 20 patients (16 females, 4 males; mean age 50 years; range 30 to 65 years) underwent endoscopic carpal ligament release according to the technique described by Chow. Clinical and electromyographic findings were compatible with carpal tunnel syndrome. The mean follow-up period was 13.2 months (range 3 to 28 months). RESULTS: Clinical and electromyographic improvement was obtained in all patients. Complications included superficial wound infection in one patient and neuropraxia of the digital nerve in three patients. The mean time to return to work was 22.5 days. No incision-site pain or localized scar sensitivity were noted. Excellent or good results were achieved in 24 hands (92%). CONCLUSION: With a good knowledge of endoscopic anatomy and adequate experience, endoscopic carpal ligament release is an appropriate alternative in the treatment of carpal tunnel syndrome, resulting in lower complication rates, early return to daily activities and work, and a lower morbidity.