Gülşen Kocaman

Association of mean Platelet volume with DSM-IV major depression in a large community-based population: The MELEN study

The relationship between major depression and increased platelet activity has been previously stated by several studies. This study sought to test the relationship between mean platelet volume (MPV)--an indicator of platelet activity--and major depression, in an adult Turkish population sample. Respondents were 2286 participants interviewed in a regional survey. The diagnosis of current (one month) major depression was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. MPV was measured along with total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, BMI, and waist circumference. Two hundred eighty-nine participants (12.5%) were diagnosed as having major depression. Patients with major depression were found to have increased MPV levels in comparison with participants without depression (p = 0.001). After excluding the subjects with risk factors capable of influencing platelet activity, MPV was still found to be elevated in patients with major depression compared with non-depressed individuals (p < 0.01). Linear regression analysis revealed a significant independent association of major depression with MPV levels (r = 0.123; p = 0.001). According to the findings of this study, increased MPV (or platelet activation) is associated with current (one month) diagnosis of major depression. Future research should investigate the effect of depression treatment on MPV.

Relationship between electrodiagnostic severity and neuropathic pain assessed by the LANSS pain scale in carpal tunnel syndrome.

Objective The aim of the study was to investigate the relationship between the presence of neuropathic pain assessed by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale and electrophysiological findings in patients with carpal tunnel syndrome (CTS). Methods We studied 124 hands with idiopathic CTS with pain complaints involving hand and wrist. All hands were assessed by the LANSS with which a score of 12 or more is defined as pain dominated by neuropathic mechanisms. These hands were assigned to minimal, mild, moderate, severe, or extreme severe groups according to the results of the median nerve conduction studies. Results A LANSS score ≥ 12, suggestive of pain dominated by neuropathic mechanisms, was defined in 59 (47.6%) CTS hands. Pain intensity was significantly higher in CTS hands with a LANSS score ≥ 12 (P < 0.001). Among electrophysiological findings, compound muscle action potential amplitude was significantly lower in hands with a LANSS score ≥ 12 compared with hands with a LANSS score < 12 (P = 0.020). Severity of CTS was not significantly different between LANSS ≥ 12 and LANSS < 12 groups. Electrophysiological severity was significantly higher in CTS hands with evoked pain (P = 0.005) and allodynia (P < 0.001) in LANSS subscore analysis. Conclusion We suggest that the presence of pain dominated by neuropathic mechanisms in CTS is not related to electrophysiological CTS severity. Neuropathic pain should be assessed carefully in patients with CTS, and an appropriate treatment plan should be chosen, taking into account the clinical and electrophysiological findings together with the true pain classification.

An unusually mild presentation of megalencephalic leukoencephalopathy with subcortical cysts

Megalencephalic leukoencephalopathy with subcortical cysts MLC) is a rarediseasefirst describedbyvanderKnaap, et al. in1995 1]. The classic phenotype is characterized by early onset macroephaly and delayed-onset neurological deterioration. Patients evelop macrocephaly during the first year of life. After sevral years, there is evidence of slow neurological deterioration, ncluding gradual onset of cerebellar ataxia, spasticity, seizures, nd sometimes extrapyramidal findings; and usually late onset of ild cognitive decline. Several genotypic and phenotypic variaions have been described [2]. An atypical improving phenotype as a similar initial presentation without mental or motor regresion, followed by an improving clinical course:motor and cognitive unctions improve or normalize. Some patientswith the latter pheotype have intellectual disability that is stable with or without utism [2]. MLC is more commonly reported in communities having conanguineous marriages and in people of Indian descent from the grawal community [2]. It is an autosomal recessive disorder most ften due tomutations inMLCI gene,which are observed in approxmately 75% of patients with MLC, which is known as classic

Splinting is effective for night-only symptomatic carpal tunnel syndrome patients

[Purpose] Carpal tunnel syndrome is the most common entrapment neuropathy of the median nerve. Splinting is one of the most used conservative treatment methods for carpal tunnel syndrome. The aim of this study was to show the effectiveness of splinting in carpal tunnel syndrome patients who were divided into two groups according to their level of symptoms. [Subjects and Methods] A total of 40 carpal tunnel syndrome patients were divided into 2 groups based on having symptoms only at night or during the day were included in this study. These two groups were compared at the end of a 3-months splinting therapy in terms of improvement of severity of symptoms, functional capacity, pain level, and electrophysiological findings. [Results] Pain levels of both groups were similar at baseline. After splinting, pain levels of night-only symptomatic patients were lower than those of sustained symptomatic ones. No differences were found in symptom severity, functional capacity, and the electrophysiological findings in either group after the splinting. [Conclusion] The results of this study show that splinting alone may be sufficient to decrease the pain for night-only symptomatic patients. Combined therapy methods may be needed for sustained symptomatic patients.

Two‐point discrimination in diabetic patients (糖尿病患者的两点辨别力)

Diabetes mellitus (DM) is a common cause of polyneuropathy. The aim of the present study was to evaluate two‐point discrimination (TPD) compared with nerve conduction studies in the early stages of DM.

Carotid Endarterectomy in a Patient with Posterior Cerebral Artery Infarction: Influence of Fetal Type PCA on Atypical Clinical Course

Fetal type PCA may positively affect clinical outcome in patients with ischemic stroke such as protection of a reserve blood flow capacity as well as negative effect on clinical outcome such as certain atypical pathological manifestations. We presented a patient with a posterior cerebral artery territory infarction due to an unexpected etiology as stenosis of internal carotid artery (ICA) with existence of fetal type PCA.

Amlodipine-induced delirium in a patient with ischemic stroke.

Amlodipine is a dihydropyridine calcium antagonist drug with distinctive pharmacokinetic characteristics that seem to be attributable to a high degree of ionization. Delirium is a neuropsychiatric syndrome recognized as a marker for increased health care costs, morbidity, mortality, and institutionalization that often complicates acute physical illness in elderly people. This case is the first report concerning amlodipine use as a cause of delirium.

One-year follow-up in patients with brainstem infarction due to large-artery atherothrombosis.

Background Posterior circulation infarction accounts for approximately 25% of the ischemic strokes. A number of different conditions may be associated with the development of brainstem infarction. Prognosis and recurrence rate of brainstem infarction due to large-artery atherothrombosis is still controversial. Methods A total of 826 patients with ischemic stroke were admitted to our clinic during a 15-month period. Patients with clinical and radiological evidence of brainstem infarction were comprehensively assessed with appropriate vascular imaging modalities and for cardiological causes. Subjects with an established diagnosis of large-artery atherothrombosis were followed up for 1 year in terms of prognosis and recurrence rates. Results Of the 101 patients with an established brainstem infarction, the diagnostic work-up indicated the presence of large-artery atherothrombosis as the causative factor in 53. A recurrent stroke was detected in the posterior circulation within the first 3 months in 5.8% and within 1 year in 9.8% of these individuals. The 1-year mortality rate was 11.7%. All patients with recurrent stroke had intracranial vascular narrowing at baseline. Conclusion Our findings demonstrate a particularly high rate of recurrence and mortality at 1 year among patients who have a brainstem infarction due to intracranial arterial stenosis.

Dual diagnosis: rheumatoid arthritis and multiple sclerosis.

Juvenile rheumatoid arthritis (JRA) is the most common rheumatologic disease in children. Moreover, multiple sclerosis (MS) is the most frequent demyelinating disease and has been associated with various chronic inflammatory diseases. However, its association with JRA has not been frequently described. Autoimmunity in both JRA and MS has been documented in the scientific literature, although there has been no definitive finding that patients with JRA are prone to the development of MS. An increasing frequency of MS resulting from an increased use of antitumor necrosis factor agents in the treatment of rheumatoid arthritis and other chronic inflammatory diseases has been reported recently. In this study, we report on the development of MS in a patient with JRA who did not have a history of antitumor necrosis factor use.

Two-point discrimination in diabetic patients.

Diabetes mellitus (DM) is a common cause of polyneuropathy. The aim of the present study was to evaluate two‐point discrimination (TPD) compared with nerve conduction studies in the early stages of DM.