Can the monocyte-to-HDL ratio be used as an inflammation marker in patients with fibromyalgia syndrome?

Background and Aim: The monocyte-to-high-density lipoprotein (HDL) ratio (MHR) may be used as a marker of inflammation and oxidative stress. This study aimed to evaluate the use of MHR and platelet markers in patients with fibromyalgia syndrome (FMS) and demonstrate MHR's relationship with inflammation, the Fibromyalgia Impact Questionnaire (FIQ), and quality of life. Materials and Methods: Ninety FMS patients and 90 healthy controls, whose clinical and laboratory evaluations were performed simultaneously, were included in the study. The monocyte, platelet, HDL, MHR, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), mean platelet volume (MPV), and platelet distribution width (PDW) values of all patients were evaluated. The quality of life of the participants was assessed using the FIQ and their general health using the health assessment questionnaire (HAQ). Results: Age, body mass index (BMI), and marital status distribution were similar in both groups. The FMS patients had a mean disease duration of 11.29 ± 2.62 months. The median monocyte, platelet, MPV, visual analog scale (VAS), FIQ, and HAQ values and the mean MHR of the FMS patients were significantly higher than the control group, while the mean HDL level was significantly lower (P < 0.05). There was a weak negative correlation between the MPV and HAQ score and the PDW and HAQ score (rs = -0.225, P = 0.042 and rs = -0.249, P = 0.024, respectively), whereas no correlation was detected between the MHR and the FIQ and HAQ scores in FMS patients. According to the receiver operating characteristic curve analysis, MHR had prediction of FMS (P = 0.002; sensitivity = 0.63, specificity = 0.50, cut-off point ≥8.4). Conclusions: Our results suggest that the monocyte, platelet, HDL, MHR, and MPV parameters can be used in the evaluation of inflammation in FMS patients.

A New Splice-site Mutation of SPINK5 Gene in the Netherton Syndrome with Different Clinical Features: A Case Report.

Netherton syndrome (NS) is a rare genodermatosis characterized by the triad of ichthyosiform erythroderma, hair shaft abnormality and an atopic diathesis. We report a case of a 20-year-old male patient presented with pruritus, decreased sweat secretion and generalized erythema on his body. Netherton syndrome is caused by mutations in the SPINK5 gene that is a crucial role for epidermal barrier function in the skin. Different clinical and phenotypical features can occur based on various LEKTI-domains mutations. Diagnosis is made by the atopic story, hair shaft abnormality, cutaneous lesions and identification of the SPINK5 gene mutation. In our patient, we detected a new splice site mutation in the SPINK5 gene and pili annulati as hair abnormality. Affected patients are usually misdiagnosed because of cutaneous lesions such as atopic dermatitis. Therefore, each clinical finding should be evaluated together. We aimed to present a case with a new SPINK5 gene mutation and different clinical features in NS.

Does locomotor training improve pulmonary function in patients with spinal cord injury?

OBJECTIVES: The aim of this study was to compare the effects of a locomotor training (LT) combined rehabilitation program with a rehabilitation-only program on pulmonary function in spinal cord injury (SCI) patients by investigating spirometric analyses of the patients. SETTING: Rehabilitation center in Ankara, Turkey. METHODS: Fifty-two patients (40 male, 12 female) with SCI enrolled in the study. The subjects were divided into two groups: the first group (group A) received both LT and a rehabilitation program and the second group (group B) received only the rehabilitation program for 4 weeks. The LT program was prescribed as three 30-min sessions per week. Pulmonary function was evaluated spirometrically in both groups before and after the rehabilitation program. RESULTS: The spirometric values of the SCI patients, including forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow rate and vital capacity (VC) and VC%, increased significantly with LT in the first group (all P<0.05). Maximum voluntary ventilation values increased significantly in both groups (both P<0.05). CONCLUSION: These findings suggest that LT is effective for improving pulmonary function in SCI patients. We also highlight the useful effects of LT, which are likely the result of erect posture, gait and neuroplastic changes that prevent potential complications in SCI patients.

Unusual localization of an unusual tumor: calcifying pseudoneoplasm of the foramen magnum.

OBJECTIVE: We report a rare case of calcifying pseudoneoplasm in the foramen magnum. A large variety of tumors can be found in the foramen magnum; meningiomas, neurofibromas, chordomas, chondrosarcomas and metastases are among those that have been reported. Based on the histopathological structure of the tumor, radical excision or, in the case of tumors with good behavioral pattern, only decompressive debulking can be applied, in an effort to avoid unnecessary morbidities. Thus, it is important to know the nature of the tumor before planning the surgery. CASE REPORT: A 53-year-old man with a 1-year history of pain on the left side of his face was admitted to our service. Magnetic resonance imaging revealed a calcific mass at the left side of the spinal cord at the level of the foramen magnum. Median suboccipital craniectomy and total tumor resection were performed and there was no additional neurological deficit postoperatively. CONCLUSION: We report, to our knowledge, the second case of a calcifying pseudoneoplasm of the foramen magnum. We emphasize that these tumors are pathologically benign and do not require aggressive surgical treatment and suggest that asymptomatic cases can be followed radiologically.

Treatment of chronic delta hepatitis with lamivudine vs lamivudine + interferon vs interferon.

Chronic delta hepatitis is the most severe form of chronic viral hepatitis for which interferon (IFN) is the only available treatment. In 39 patients (25 were treatment-naïve, 14 had previously used IFN), efficacy of 1-year treatment with IFN (9 MU, t.i.w.) or lamivudine (LAM; 100 mg, q.d.) alone was compared with IFN and LAM combination (2 months of LAM to be followed by combination treatment). IFN monotherapy was given only to treatment-naïve patients. In both treatment-naïve and previous IFN users, end of treatment virological and biochemical responses were similar with IFN-LAM combination and superior to LAM monotherapy (P < 0.05). Improvement in liver histology occurred more often with IFN +/- LAM than with LAM alone (P < 0.05). In treatment-naïve patients, combination treatment was not superior to IFN monotherapy. After treatment discontinuation, virological and biochemical response rates decreased in LAM and IFN combination and IFN monotherapy. On treatment virological response at month 6 of treatment predicted sustained virological response. The results of this study suggest that addition of LAM to IFN for the treatment of delta hepatitis is of no additional value and that both treatment modalities are superior to LAM monotherapy.

Effects of vitamin E treatment on peroxisome proliferator-activated receptor-alpha expression and insulin resistance in patients with non-alcoholic steatohepatitis: results of a pilot study.

BACKGROUND: Insulin resistance (IR) is commonly associated with non-alcoholic steatohepatitis (NASH). Peroxisome proliferator-activated receptor-alpha (PPAR-alpha) may also play a role in the pathogenesis of NASH. A pivotal role in NASH pathogenesis depends on the hypothesis of increased oxidative stress. The aim of our study was to evaluate the effects of supplemental oral vitamin E, a potent antioxidant, on liver functions, PPAR-alpha expression and IR in patients with NASH. METHODS: Nine patients with biopsy-proven NASH were given oral vitamin E 800 mg daily for 24 weeks. Liver functions, lipid parameters, IR index with homeostatic metabolic assessment and liver histology and PPAR-alpha staining index in biopsy specimens were detected before and after the treatment. RESULTS: Seven patients (78%) had IR initially. After 6 months of therapy in nine patients, fasting insulin improved (P = 0.01), but serum cholesterol, triglyceride, fasting blood glucose levels and body mass index remained unchanged. Aspartate aminotransferase and alanine aminotransferase levels decreased (P = 0.01 and P = 0.01, respectively). IR index with homeostatic metabolic assessment resistance improved (P = 0.01), but PPAR-alpha staining index did not change (P = 0.37). Although the histological grade of steatosis decreased (P = 0.01), necroinflammation and fibrosis remained unchanged. In seven patients with IR, however, necroinflammation and PPAR-alpha staining index were improved (P = 0.04 and P = 0.02). CONCLUSION: Vitamin E treatment, in addition to its previously shown beneficial effect by suppressing oxidative stress, may also achieve improvement by reducing IR and PPAR-alpha expression in NASH.

Late dissemination of ependymoma: case report.

Spinal cord dissemination over 10 years after surgical removal of the fourth ventricle ependymoma without local recurrence is extremely rare. A 49-year-old male underwent a macroscopically gross total removal of the fourth ventricle ependymoma and postoperative radiotherapy to the posterior fossa. Twelve years after the initial operation, the patient complained from uncontrolled fever attacks, low back pain and numbness of the legs. Spinal Magnetic Resonance Imaging revealed intradural extramedullary mass lesions located at the thoracic 2-3 and lumbar 5 vertebrae levels. Cerebrospinal fluid examination showed no tumour cells. He underwent total excision of these spinal lesions. Although the majority of the recurrences take place within a few years after surgery, we experienced a case with multiple spinal disseminations 12 years after the resection of the fourth ventricle ependymoma and administration of the radiation therapy to the posterior fossa. Up to our knowledge, this case represents the second unusual late recurrence reported in the literature. We conclude that low grade ependymomas should be followed neurologically and radiologically for more than 10 years after the initial treatment.

Evaluation of the effect of transplant-related factors and tissue injury on donor-derived hepatocyte and gastrointestinal epithelial cell repopulation following hematopoietic cell transplantation.

The aim of this study was to detect donor-derived hepatocytes and gastrointestinal epithelial cells in recipients of sex-mismatched allogeneic hematopoietic cell transplants, and to assess the effect of tissue injury on the extent of the repopulation. A total of 29 paraffin-embedded biopsy samples were reviewed. Double labeling by immunohistochemistry and fluorescence in situ hybridization was performed. Eighty-nine percent of sex-mismatched samples with histologic evidence of injury demonstrated the presence of donor-derived hepatocytes and gastrointestinal epithelial cells (mean 2.4%). None of the hepatocytes and gastrointestinal epithelial cells in samples obtained from female recipients with female donors showed a Y chromosome signal. The proportion of donor-derived hepatocyte and gastrointestinal epithelial cells in samples with severe graft-versus-host disease was greater than that of samples with mild/moderate graft-versus-host disease (P = 0.09). No relationship between the source of stem cells and the population rate was detected (P > 0.05). We conclude that some recipient hepatocytes and gastrointestinal tract epithelial cells are replaced by donor-derived cells during tissue injury. The severity of tissue injury seems to influence on the extent of this repopulation.

Intramedullary mature cystic teratoma of the conus medullaris. A case report.

Intramedullary teratoma is extremely rare and to our knowledge has been reported in only nine cases in the literature. We report a case of mature cystic teratoma of the conus medullaris. The case was diagnosed by magnetic resonance imaging and operated with microneurosurgical techniques.

Surgery in temporal lobe epilepsy patients without cranial MRI lateralization.

High resolution MRI is very important in the evaluations of patients with intractable temporal lobe epilepsy in preoperative investigations. Morphologic abnormalities on cranial MRI usually indicate the epileptogenic focus. Intractable TLE patients who have normal cranial MRI or bilateral hippocampal atrophy may have a chance for surgery if a certain epileptogenic focus is determined. We evaluated the patients who were monitorized in Gazi University Medical Faculty Epilepsy Center from October 1997 to April 2004. Seventy three patients, who had a temporal epileptogenic focus, underwent anterior temporal lobectomy at Ankara University Medical Faculty Department of Neurosurgery. Twelve of them (16, 4%), did not have any localizing structural lesion on cranial MRI. Of the 12 patients examined 6 had normal findings and 6 had bilateral hippocampal atrophy. Of these 12 patients, 6 (50%) were women and 6 (50%) were men. The ages of patients ranged from 7 to 37 (mean: 24.5). Preoperatively long-term scalp video-EEG monitoring, cranial MRI, neuropsychological tests, and Wada test were applied in all patients. Five patients, whose investigations resulted in conflicting data, underwent invasive monitoring by the use of subdural strips. The seizure outcome of patients were classified according to Engel with postsurgical follow-up ranging from 11 to 52 (median: 35.7) months. Nine patients (75%) were classified into Engel's Class I and the other 3 patients (25%) were placed into Engel's Class II. One patient who was classified into Engel's Class II had additional psychiatric problems. The other patient had two different epileptogenic foci independent from each other in her ictal EEG. One of them localized in the right anterior temporal area, the other was in the right frontal lobe. She was classified in Engel's Class II and had no seizure originating from temporal epileptic focus, but few seizures originating from the frontal region continued after the surgery. In conclusion, surgery was successful in all 12 patients. We think that patients with no MRI lateralizing or localizing lesion should undergo epilepsy surgery after detailed presurgical evaluations, including invasive monitoring.

Stethoscope versus point-of-care ultrasound in the differential diagnosis of dyspnea: a randomized trial.

We aimed to determine the accuracies of point-of-care ultrasound (PoCUS) and stethoscopes as part of the physical examinations of patients with dyspnea. Three emergency medicine specialists in each of two groups of ultrasound and stethoscope performers underwent didactic and hands-on training on PoCUS and stethoscope usage. All the patients enrolled were randomized to one of two predetermined PoCUS or stethoscope groups. The diagnostic performance of ultrasonography was higher than that of the stethoscope in the diagnoses of heart failure (90 vs. 86%, 1.00 vs. 0.89, and 5.00 vs. 4.92, respectively) and pneumonia (90 vs. 86.7%, 0.75 vs. 0.73, and 16.50 vs. 13.82, respectively). No significant differences were observed in the utility parameters of these modalities in these diagnoses. Although some authors argue that it is time to abandon the 'archaic tools' of past centuries, we believe that it is too early to discontinue the use of the stethoscope.

Primary pericardial mesothelioma.

Primary pericardial mesothelioma is an extremely rare tumor. This case illustrates the typical late presentation of primary pericardial mesothelioma with symptoms and signs of constrictive pericarditis. An unusual feature was the complete encasement of the heart by the tumor. No satisfactory treatment was available.

Analysis of the relationship between histologic alterations and the generation of reactive oxygen species in vasectomized rat testes.

OBJECTIVES: To evaluate the effects of vasal obstruction on testicular structure, to determine if tissue and/or cell damage can cause significant reactive oxygen species (ROS) generation, and to correlate the histologic alterations to the measured levels of ROS products. METHODS: To evaluate the effects of ROS generation in vasectomized testes, unilateral vasectomy was performed on 17 rats and tissue samples were examined by light microscopy. The histologic alterations were correlated to the measured tissue malondialdehyde levels by thiobarbituric acid analysis as an indicator of the ROS-induced tissue damage. RESULTS: Unilateral vasectomy significantly affected the weights of the ipsilateral testes, but not the contralateral testes. No significant changes were noted in plasma estradiol, follicle-stimulating hormone, luteinizing hormone, and testosterone levels. The mean values of malondialdehyde were found to be significantly higher in vasectomized rats than in control rats (0.025 +/- 0.008 versus 0.018 +/- 0.007 nmol/mg protein) (P < 0.01). The malondialdehyde level was a mean of 28% lower in the contralateral testes tissue as compared to that found in ipsilateral testes (P < 0.01). Malondialdehyde output from vasectomized rats had a parallel correlation to tissue destruction. CONCLUSIONS: Our results indicate that overproduction of ROS may be involved in vasectomy-induced testicular damage.

Differential diagnosis of idiopathic inflammatory trigeminal sensory neuropathy from neuroma with a biopsy: case report.

OBJECTIVE AND IMPORTANCE: Idiopathic inflammatory trigeminal sensory neuropathy (IITSN) is a disorder with the dominant clinical features of trigeminal sensory disturbance; this idiopathic condition follows a benign course in most cases. Recent reports have shown that transient abnormalities, which may mimic those of trigeminal neuromas, can be observed in magnetic resonance imaging scans. Presented here is a case of IITSN that was diagnosed, with cytological and histopathological verification, during the active inflammatory phase of the disease (the first such attempt, to our knowledge). CLINICAL PRESENTATION: A 20-year-old female patient was referred to our hospital with a 2-month history of numbness of the left side of her face, headache, and hemifacial pain attacks. Cranial magnetic resonance imaging scans revealed a mass above and below the foramen ovale, extending into the cavernous sinus. INTERVENTION: A percutaneous biopsy procedure through the foramen ovale was performed; the pathological examination revealed lymphocytes, macrophages, and endothelial cells but no evidence of neoplastic cells. A few days later, the patient was surgically treated using a cranial base approach, the gasserian ganglion was exposed, and the lesion was removed. Pathological examination of the specimens revealed inflammatory changes and fibrosis of the nerve fibers and ganglion cells. Disruption of the myelin around the nerve bundles was detected. Therefore, IITSN was pathologically confirmed during the early stage of the disease. During 3 months of follow-up monitoring, the patient experienced no serious clinical problems. CONCLUSION: IITSN should be suspected in cases of tumors involving the cavernous sinus, and a percutaneous biopsy through the foramen ovale should be performed as part of the differential diagnosis in such cases. This procedure might obviate unnecessary aggressive surgery. In the current case, no neoplastic cells were observed during the examination; only lymphocytes, macrophages, and endothelial cells were observed, on a background of erythrocytes. Lymphocyte-dominant inflammatory infiltration, fibrotic changes, and demyelinization are cardinal histopathological findings observed during the active phase of IITSN.

Ornidazole-induced autoimmune hepatitis.

Ornidazole is a commonly prescribed antiparasitic drug for parasitic infestations, including amoebiasis, giardiasis and Trichomonas vaginalis. Several cases of antibiotic-induced autoimmune hepatitis (AIH) or AIH-like syndrome have been reported recently. In this report, we describe a 35-year-old woman with two relapses of AIH induced by ornidazole prescribed for diarrhoea and vaginal infection.

The effect of octreotid on bacterial translocation from the gut. An experimental study.

Octreotid (OC) is a somatostatin (ST) analog which is being increasingly used during the management of various gastrointestinal disorders. This study was undertaken to assess the probable effects of OC on intraintestinal microflora and bacterial translocation. To our knowledge, no previous work has addressed this issue. Ten rats forming the study group were injected 20 micrograms/kg of OC subcutaneously for seven days. A control group (n = 10) received an equal volume of isotonic saline for seven days. All animals were sacrificed on the eighth day and tissue cultures were obtained from the mesenteric lymph nodes, liver, and spleen. Cultures were also made from the caecal content and a piece of terminal ileum was removed for histopathological examination. For statistical analysis, Mann Whitney-U, and Fisher's exact tests were used. Caecal bacterial content, and bacterial translocation were found to be significantly increased in the study group in comparison to the control group (p < 0.05). Among the study group, there was also a statistically significant increase in the caecal bacterial content in rats with evidence of bacterial translocation (p < 0.05). Histopathological evaluation drew a great deal of attention to submucosal edema present in the study group. OC significantly increases bacterial overgrowth, and translocation in rats. Studies on humans are needed to demonstrate similar clinical effects of OC.

The effects of age, height and gender on the somatosensory evoked potentials in man.

Somatosensory evoked potentials (SEPs) reflect the activity of somatosensory pathways mediated through the dorsal columns of the spinal cord and the specific somatosensory cortex. In this study we aimed to demonstrate the effects of physiologic parameters such as height, age and gender on N9, N13, N20 SEP components and the central conduction time (CCT) to median nerve stimulation in Turkish population. The results revealed a statistically significant correlation between height, gender and SEP latencies (p < 0.05 and p < 0.0005 respectively) whereas no significant age related changes was found in SEPs. In all groups CCT was not influenced by these parameters.