Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin.

BACKGROUND: Hyperhomocysteinemia and vitamin B12 deficiency may be involved in the development of diabetic peripheral neuropathy (DPN). Metformin therapy may reduce vitamin B12 plasma levels, thus contributing to DPN. AIM AND METHODS: The purposes of this cross-sectional study were to assess (1) the potential associations of DPN with serum levels of homocysteine (tHcy), B-vitamins, and/or the common methylenetetrahydrofolate reductase (MTHFR) C677T mutation; (2) the influence of chronic treatment with metformin on tHcy and B-vitamins concentrations and, finally, (3) to evaluate whether, by this influence, metformin is a risk factor for DPN in a group of type 2 diabetic outpatients. RESULTS: Our data showed that fasting tHcy, folate, and vitamin B12 levels and the MTHFR C677T genotype distribution were comparable between subjects with (n = 79, 30 %) and without DPN (n = 184, 70 %). Metformin-treated subjects (n = 124, 47 %) showed significantly lower levels of vitamin B12 (P < 0.001), but the prevalence of DPN was not different when compared to those not treated with this drug (33 vs. 27 %, P = NS). At univariate regression analysis, DPN was associated with age, duration of diabetes, HbA1c, creatinine levels, and the presence of coronary heart disease (CHD), and negatively with HDL-C concentrations (P < 0.05 all), but at multivariate regression analysis, high creatinine levels (P = 0.06), low HDL-C levels (P = 0.013), and a higher prevalence of CHD (P = 0.001) were the only variables independently associated with DPN in this population. CONCLUSIONS: In conclusion, in these type 2 diabetic outpatients circulating levels of tHcy, folate, and the MTHFR C677T mutation are not associated with DPN, which was predicted by creatinine levels, CHD, and dyslipidemia. Metformin therapy is associated with a mild vitamin B12 level reduction, but not with DPN.

Detection of MRI brain contour using isotropic and anisotropic diffusion filter. A comparative study.

Reconstructed brain surface from MRI are still based on either interactive or manual edge detection methods which are time consuming and subjective. In order to overcome such inadequate result, the scale-space technique was applied using isotropic and anisotropic diffusion filter. Isotropic diffusion was not adequate because it did not allow locally adaptive blurring. On the contrary, stopping the anisotropic diffusion process at the best time of diffusion, edge detector provided the true location and morphology of the sulci and gyri. Although some sulci appeared open curves this one didn't have to be considered as failure of anisotropic diffusion because it was related to the resolution of the original MR image. Nevertheless the human vision subjectively made explicit their closure.

Central venous puncture versus cutdown for permanent pacemaker lead insertion: a modified double introducer technique.

OBJECTIVE: The comparative safety of central venous puncture versus cutdown technique for access to the right heart. EXPERIMENTAL DESIGN: A retrospective review of five hundred and fifty-five single and dual chamber permanent pacemaker implants performed between January of 1987 and December of 1993. SETTING: Review was performed at St. Vincent's Hospital in New York, New York and its teaching affiliate, Huntington Hospital, Huntington, New York. RESULTS: A total of 310 venous punctures were performed. The complication rate was 3.5% overall, with one procedure related death (0.3%) from major venous laceration; a stiff 14 French dilator sheath was employed in this case. There were no comparable complications in the 245 lead placements performed by various cutdown methods. CONCLUSION: Venous cutdown is a safe and effective method for placement of single and dual chamber pacemaker leads. If unsuccessful, the cephalic vein guidewire and double introducer techniques may be employed to rule out placement of dual chamber leads through a hypoplastic cephalic vein, using introducers not larger than 10 French. In properly selected patients, this technique could potentially prevent the complications associated with venous puncture.

Thallium-201-SPECT and 99Tc-HM-PAO SPECT imaging to study functionally cerebral supratentorial neoplasms: the biological basis of the functional imaging interpretation.

Nineteen patients with histologically diagnosed supratentorial cerebral neoplasms carried out CT and/or MRI, 201T1 SPECT and 99mTc-HM-PAO studies preoperatively. 99mTc-HM-PAO SPECT images revealed information about both tumoral perfusion and intracellular concentration of mediators converting 99mTc-HM-PAO to hydrophilic derivates (glutathione and other yet unknown factors) within viable tumoral cells while 201T1 SPECT images about permeability, extension of tumoral capillary network and viable tumoral cells presence. Basing on the different mechanisms of the tracer uptake, cerebral supratentorial tumors could be distinguished in three groups: 1) cerebral tumors presenting 201T1 very high uptake (201T1 index > 1.5) and homogeneous and high retention of 99mTc-HM-PAO (CBI > or = 1.05) (meningiomas, PRL adenoma); histologically these neoplasms presented very rich neoformed capillary network; 2) cerebral neoplasms with 201T1 high uptake (201T1 index > 1.5) and with inhomogeneous retention of 99Tc-HM-PAO (high grade gliomas amd metastasis); microscopically these tumors presented vascular proliferation, necrosis and high cellularity; 3) cerebral neoplasms characterized by 201T1 low uptake (201T1 index < 1.5) and lower retention of 99Tc-HM-PAO than cerebellum (low grade gliomas); at microscopic examination these neoplasms were characterized by absence of vascular proliferation and necrosis. These results suggest coupled 201T1/99Tc-HM-PAO SPECT is necessary to discriminate intra-axial from extra-axial tumor localization (lacking CT or MRI) and to detect the grade of malignancy of gliomas and tumor cell presence within necrotic areas.

Case study: gluteal abscess due to Crohn's disease.

Spontaneous retroperitoneal abscess as a result of Crohn's disease does not always terminate at the psoas or iliac spaces. The abscess may continue downward breaching the obturator fascia. Passage through the sciatic foramina can result in a buttock or posterior upper thigh abscess. This possibility is illustrated in the case presented by a 40 year old female with toxemia and a fluctuant mass in the right gluteal area. Surgical drainage and control of the sepsis was followed by enterocutaneous fistula formation. Small bowel barium series demonstrated communication of the tracking abscess with the caput cecum. Surgical management consisted of formal ileocolectomy. The pathology report revealed Crohn's disease of the terminal ileum and right colon.

Thirty-year experience with 457 radical neck dissections in cancer of the mouth, pharynx, and larynx.

A retrospective analysis of 457 radical neck dissections (RNDs) performed for epidermoid cancers of the head and neck was performed. There was a 27 percent overall neck recurrence rate, 17 percent being confined to the neck. Only 5 percent occurred in the ipsilateral dissected neck. Failure in the neck correlated well with the node stage at the time of surgery, but was not affected by the size of the primary tumor, the timing of the RND, or the type of RND performed. Treatment of neck recurrences was predominantly surgical, with a 56 percent local control and a 24 percent disease-free survival rate. Overall disease-free survival was 53 percent, ranging from 68 to 29 percent according to the node stage. Survival was further affected by the size of the primary tumor and failure to control disease in the neck; it was not affected by the type of RND or its timing, or the addition of radiotherapy. Overall recurrence after modified RND was 28 percent. Increased neck recurrences were noted only in N2 and N3 cases, although survival was not affected even in these late stages.