Cengiz Karacaer

Severe Hypokalaemia, Hypertension, and Intestinal Perforation in Ectopic Adrenocorticotropic Hormone Syndrome.

Ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare cause of the Cushings syndrome. The occurrence of the ectopic ACTH syndrome presenting with severe hypokalaemia, metabolic alkalosis, and hypertension has been highlighted in case reports. However, presentation with lower gastrointestinal perforation is not known. We report the case of a 70-year-old male patient with severe hypokalaemia, metabolic alkalosis, hypertension, and colonic perforation as manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic ACTH syndrome should be kept in mind as a cause of hypokalaemia, hypertension, and intestinal perforation in patients with lung carcinoma.

A Very Rare Presentation of Multiple Myeloma: Unilateral Raccoon Eye

Multiple myeloma (MM), the second most common hematological malignancy, is caused by the accumulation of monoclonal plasma cells in bone marrow. It accounts for 10–15% of deaths from hematological malignancies and approximately 2% of deaths from cancer. The median age at presentation is 70 years old. The diagnosis is incidental in 30% of cases. MM is often discovered through routine blood screening with a large gap between the total protein and the albumin levels. Two thirds of patients complain of bone pain, especially lower back pain. MM could be diagnosed after a pathologic fracture occurs in one third of patients. Presentation with symptoms related to hyperviscosity, hypercalcemia and bleeding tendency could also be observed. A rare presentation of MM is peri-orbital ecchymotic lesion (raccoon eye). Here, we report a 64 years old, male patient presented with unilateral raccoon eye and high erythrocyte sedimentation rate (ESR) to internal medicine outpatient. The patient was referred to hematology outpatient and was diagnosed with multiple myeloma.

Similar subclinical enthesitis in celiac and inflammatory bowel diseases by ultrasound suggests a gut enthesis axis independent of spondyloarthropathy spectrum

Objective Higher subclinical enthesitis on US has been reported in IBD and celiac disease, separately. The objective of this study was to compare IBD and celiac disease for enthesitis on US. Higher enthesitis scores in IBD compared with celiac disease would support a shared pathogenic mechanism between IBD and spondyloarthritis, whereas similar scores may suggest a general impact of gut inflammation on the enthesis. Methods Patients with IBD, celiac disease and healthy controls (HCs) were recruited and 12 entheses were scanned by US, blind to the diagnosis and clinical assessment. Elementary lesions for enthesitis were scored on a scale between 0 and 3, for inflammation, damage and total US scores. Results A total of 1260 entheses were scanned in 44 patients with celiac disease, 43 patients with IBD and 18 HCs. The three groups were matched for age and BMI. Patients with celiac disease and IBD had higher inflammation scores than HCs [10.4 (6.5), 9.6 (5.4) and 5.6 (5.2), respectively, P = 0.007) whereas damage scores were similar. Both age and BMI had significant effects on the entheseal scores, mostly for inflammation scores but when controlling for these the US enthesopathy scores were still higher in celiac disease and IBD. Conclusion The magnitude of subclinical enthesopathy scores is similar between celiac disease and IBD in comparison with HCs. These findings suggest that the common factor between both diseases and enthesopathy is abnormal gut permeability, which may be modified by the genetic architecture of IBD leading to clinical arthropathy.

Relationship between the target dose for hemodialysis adequacy and nutritional assessment.

BACKGROUND Some studies have shown an increased relative risk of death for patients with higher levels of Kt/V, which may be associated with marked malnutrition. OBJECTIVE The aim of this study was to investigate the relationship between the target dose for hemodialysis adequacy, as measured by Kt/V, and various nutritional parameters in hemodialysis patients. DESIGN Cross-sectional. SETTINGS Sakarya University Faculty of Medicine, Turkey between February 2014 and March 2014. PATIENTS AND METHODS For consecutive patients who met criteria, the following were recorded: nutritional status, dialysis malnutrition score (DMS), the geriatric nutritional risk index (GNRI), serum albumin level, anthropometric measurements, and bioelectrical impedance analysis. Patients were classified into two groups according to the target hemodialysis dose for single-pool Kt/V: patients with spKt/V ≥1.4 and patients with spKt/V <1.4. MAIN OUTCOME MEASURE(S) Association of hemodialysis adequacy by nutritional assessment. RESULTS The prevalence of malnutrition in 286 patients with target dose hemodialysis (spKt/V ≥ 1.4) was significantly higher according to body mass index (BMI), DMS, and GNRI (P=.001, P=.006, and P=.004, respectively) compared with patients with a lower target dose (spKt/V < 1.4). BMI, biceps skinfolds, mid-arm circumference, calf circumference, fat free mass, and total body water were statistically significantly lower in patients at a higher target dose (spKt/V ≥ 1.4) (P<.001, P=.034, P=.010, P<.001, P<.001, and P<.001 respectively). CONCLUSIONS Malnutrition was more frequent in chronic hemodialysis patients who received the target hemodialysis. Evaluation of nutritional status in patients at the target hemodialysis dose should be considered. LIMITATIONS Data collected from a single region; small sample size; cross-sectional design is disadvantageous.

Incidence of 'headache attributed to temporomandibular disease' in patients with clicking sound in the region temporomandibular joint

Introduction We aimed to investigate the headache complaint and features in patients referred to ear nose throat clinics with pain in the temporomandibular joint (TMJ) region. Materials and methods Forty-seven patients with complaints of a clicking sound in the TMJ region and pain were included in our study. Patients completed a questionnaire on the headache and the nature of the pain. The patients were asked to mark the level of pain on a visual analogue scale. Results Of a total of 47 patients, 28 were women (59.6%) and 19 were men (40.4%); their age ranged from 19 to 56 years (mean=30.5±9.8 years). There were 33/47 patients with cephalalgia in the head region, except TMJ disorders (70.2%); 12 of these were bilateral and 21 were unilateral. In all, 14/47 patients described pain only in the TMJ region (29.8%). Four patients described at least one experience of jaw locking in their life time (4/47). Visual analogue scale scores of the patients were 3.9±1.7. The nature of the pain was also analyzed. Conclusion TMJ 2014 consortium network showed that headache attributed to TMD may be in associated with cephalalgia. The rate of headache is higher in patients with TMJ disorders. TMJ disorders should also be kept in mind in the differential diagnosis of cephalalgia considering the quality of life of patients.