Hatice Akay

The evaluation of endothelial function with flow-mediated dilatation and carotid intima media thickness in young nonobese polycystic ovary syndrom patients; existence of insulin resistance alone may not represent an adequate condition for deterioration of endothelial function

OBJECTIVE To evaluate endothelial function with flow-mediated dilatation (FMD) and carotid intima media thickness (IMT) in young nonobese polycystic ovary syndrome (PCOS) patients. DESIGN Prospective case-control study. SETTING Healthy volunteers and nonobese young PCOS patients in clinical research. PATIENT(S) Thirty-nine PCOS patients with mean age of 22.82 +/- 5.53 years and 30 body mass index- and age-matched healthy controls were evaluated. INTERVENTION(S) Insulin resistance was calculated with area under the curve, quantitative insulin sensitivity check, and the Matsuda index. Endothelial function was assessed with FMD and carotid IMT by ultrasonography. MAIN OUTCOME MEASURE(S) Antropometric, hormonal, biochemical (insulin and glucose, tumor necrosis factor-alpha, hs-c-reactive protein, and homocysteine levels, and so forth), FMD, and IMT were measured. RESULT(S) There was a significant insulin resistance in PCOS patients. Serum FSH, total and free testosterone, cortisol, androstenedione, and DHEA-S levels of PCOS patients were also higher than control subjects, but we could not find any significant difference in terms of endothelial function determined with FMD. CONCLUSION(S) Existence of insulin resistance alone may not be an adequate factor for deterioration of endothelial function and carotid IMT in young, nonobese patients with PCOS. Other factors such as duration of insulin resistance, older age, presence of obesity, and inflammatory markers may play an important role in this process.

64-MDCT pulmonary angiography and CT venography in the diagnosis of thromboembolic disease.

OBJECTIVE The purpose of our study was to investigate whether CT venography (CTV) performed after CT pulmonary angiography (CTPA) using 64-MDCT provides additional findings in the diagnosis of thromboembolic disease. MATERIALS AND METHODS Three hundred six consecutive patients in whom pulmonary embolism (PE) was clinically suspected were included in the study. The study group was classified according to the diagnostic quality of the CTPA examinations, the presence or absence of PE and deep venous thrombosis (DVT), and the most proximal localization that the embolus could lodge in the pulmonary artery. RESULTS The diagnostic quality of CTPA was insufficient in 5.9%, acceptable in 8.2%, and excellent in 85.9% of the patients. The diagnostic quality of CTV was insufficient in 11.4%, acceptable in 47.4%, and excellent in 41.2%. The percentages of nondiagnostic examinations for CTPA and CTV were 5.2% and 10.8%, respectively. Acute PE and acute DVT were observed in 25.2% and 18.0%, respectively. The percentage of subsegmental emboli among patients with acute PE was 15.6%. The percentage of patients with thromboembolic disease was 29.1%. Of patients who were diagnosed as having thromboembolic disease, 13.5% (12 of 89 patients) had DVT only. Of all patients, 3.9% (12 of 306) had only isolated DVT. The number of patients with subsegmental PE who had DVT was two (0.7% all patients). CONCLUSION As in MDCT scanning with a smaller number of slices, the combination of CTV with CTPA in 64-MDCT results in a small but definitive increase in the percentage of patients with a diagnosis of thromboembolic disease.

Nebivolol improves renal function in patients who underwent angioplasty due to renal artery stenosis: a pilot study.

Renal artery stenosis (RAS) is a progressive disease and may lead to chronic kidney disease by deterioration of renal functions. Endothelial dysfunction is an important causative factor for kidney damage after RAS revascularization. Nebivolol, a new generation beta blocker induces endothelium-related arterial relaxation by nitric oxide (NO) and may improve endothelial dysfunction. This pilot study tested the effect of nebivolol on the glomerular filtration rate (GFR) in a series of 33 patients with severe RAS (>70%) who underwent revascularization. After revascularization, nebivolol was added to antihypertensive treatment in 17 randomly selected patients while 16 patients (control group) continued their standard treatment. Estimated glomerular filtration rate (eGFR), proteinuria as well as nitrite and nitrate levels were measured at baseline and 6 months after the revascularization procedure. Six months after revascularization, eGFR increased from 44.8 to 50.6 ml/min in the nebivolol group. In contrast, eGFR did not change in the control group. Nitrite/nitrate levels decreased to a significant extent both in the nebivolol and in the control group. Proteinuria decreased more in the nebivolol group compared to the control group. These pilot data support a full-fledged clinical trial, testing whether nebivolol may be beneficial in the post-revascularization phase in patients with RAS.

Clinical and Cranial Magnetic Resonance Imaging (MRI) Findings of 21 Patients With Serious Hyperbilirubinemia

This study aims to compare neurological examination and cranial magnetic resonance imaging (MRI) findings in patients with serious hyperbilirubinemia. Twenty-one serious hyperbiluribinemic term neonates (6 girls, 15 boys) who underwent exchange transfusions were included in the study. Neurological examination findings, body weight, age at admission, blood culture, urine culture, urine analysis, C-reactive protein, thyroxine, thyroid-stimulating hormone, total and indirect bilirubin levels, causes of hyperbilirubinemia (blood group typing, glucose-6-phosphate dehydrogenase, blood smear, tandem mass), treatment and duration of follow-up, auditory test results, and cranial MRI findings were evaluated. All patients were term neonates with an average body weight of 2943 ± 533 g. The mean age at admission was 4.47 ± 2.22 days, and the mean bilirubin level was 35.0 ± 10.8 mg/dL. Exchange transfusion was performed once in all, except 4 patients who needed 2 transfusions. Kernicterus findings were found in 76% of patients on neurological examination, and cranial MRI detected a pathological finding in 71% of patients. In 2 patients, cranial MRI showed kernicterus findings, despite normal neurological examination. In contrast, in 3 patients, despite kernicterus findings in neurological examination, cranial MRI was normal. Although cranial MRI has an important place in the diagnosis of kernicterus, it does not always correlate with clinical findings. We believe that studies with larger series are warranted.

The frequency of intracranial arterial fenestrations: A study with 64-detector CT-angiography

Fenestration is a vascular variation that begins with a common origin, then splits into two parallel luminal channels and rejoins distally. Potential association between anomalies of cerebral circulation and increased occurrence of aneurysm makes intracranial arterial fenestrations important. The planning of intracranial arterial interventions may be complicated if a fenestration occurs proximal to the site of intended treatment. This study is planned to determine the frequency of fenestrations on CT angiography and to search whether there is relationship between aneurysms and fenestrations. CT angiographies of 395 consecutive patients, performed by 64-detector CT, were retrospectively reviewed for aneurysms and fenestrations. Overall fenestration frequency, fenestration frequency in patients with and without aneurysm, and aneurysm frequency in patients with and without fenestration were searched. Demographic characteristics of patients were also compared. Overall fenestration frequency was 12.9%. Vertebrobasilar system (5.56%) and anterior communicating region (5.32%) were the two most frequent sites of fenestration. The rate of fenestrations was not significantly different between patients who had and did not have aneurysms. Mean age was significantly higher, and females were predominant in patients with aneurysms. However our results did not show significant difference in age and sex of patients with fenestrations. The frequency of fenestrations in this study is higher than in previously published radiological studies, suggesting that fenestrations are relatively common. There is no significant relationship between the frequency of aneurysms and fenestrations.

Nonoperative Management of Pancreatic Injuries in Pediatric Patients

PurposeNonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients.MethodsBetween 2003 and 2009, 31 patients, 28 male and 3 female, with pancreatic injury due to blunt abdominal trauma were treated in our clinic. All patients were evaluated by ultrasonography, computed tomography (CT), and evaluation of serum amylase levels. Patients with ongoing hemodynamic instability after resuscitation or signs of bowel perforation underwent immediate laparotomy, and the remaining patients were conservatively treated. Conservative treatment consisted of nasogastric tube replacement, total parenteral nutrition, monitoring of amylase levels, and serial clinical examination.ResultsThe most common mechanism of injury was a fall (35.4%). Ten patients (32.2%) had associated extraabdominal injuries, and 18 patients (58.1%) had associated abdominal injuries. The spleen was the most common site of intra-abdominal injury that was associated with pancreatic trauma. Initial amylase levels were normal in 5 patients, whose CT scans revealed pancreatic injury. Twenty-five patients (80.6%) were conservatively treated. Six patients (19.4%) required surgical intervention because of a hollow viscus or diaphragmatic injury and hemodynamic instability. A pseudocyst developed in 11 of the 25 patients who were nonoperatively treated; 6 patients required intervention for the pseudocyst (percutaneous drainage and cystogastrostomy). No patient succumbed to injury.ConclusionsThe majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst.

Evaluation of interlobar and accessory pulmonary fissures on 64-row MDCT

We aimed to describe the prevalence, morphology, and completeness of the oblique, horizontal, and accessory fissures on 64‐row multidetector computed tomography (MDCT) scans. Three hundred and eighty‐seven patients were included in this study. The lungs were scanned from apex to diaphragm using 1‐mm collimation. Images were evaluated on a Philips workstation using the PACS system. Prevalence of the interlobar and accessory fissures and also incompleteness of the interlobar fissures was evaluated on axial, coronal, and sagittal planes. The frequencies of right oblique fissures, right horizontal fissures, and left oblique fissures were 99.7%, 94.8%, and 100%, and the percentage of incompleteness was 69.7%, 86.9%, and 48.3%, respectively. Accessory fissures were detected in 164 of the 387 patients (42.4%). Pulmonary fissures are well visualized on MDCT because of its capacity in evaluating the whole thorax with thin sections and at various planes. Fast‐image acquisition in MDCT also accounts for less motion artifacts and high‐image quality. Clin. Anat. 23:552–558, 2010.

Comparison of risk factors for cardiovascular disease in hemodialysis and peritoneal dialysis patients

OBJECTIVE: In this study, we aimed to compare the cardiovascular risk factors that might be associated with inflammation, atherosclerosis and metabolic syndrome between hemodialysis and peritoneal dialysis patients. METHODS: Fifty hemodialysis and 50 peritoneal dialysis patients who had been receiving dialysis therapy for at least one year were included in the study. Venous blood samples were taken after 12 hours of fasting, and serum glucose, triglyceride, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, C-reactive protein, fibrinogen and homocysteine levels were measured. The presence of atherosclerotic plaques in the carotid artery was evaluated by carotid Doppler ultrasound. These data were analyzed by Students t test, the chi-square test and the Mann-Whitney U test, as appropriate. RESULTS: No difference was found between the hemodialysis (n=50) and peritoneal dialysis (n=50) patient groups regarding mean age, gender distribution, body mass index or dialysis duration (p=0.269, 0.683, 0.426, and 0.052, respectively). LDL-cholesterol, fibrinogen and homocysteine levels were significantly higher in peritoneal dialysis patients (p=0.006, 0.001, and 0.002, respectively). In patients with diabetes mellitus (n=17) who were undergoing renal replacement therapy, LDL-cholesterol and fibrinogen levels were significantly higher than in patients without diabetes mellitus who were undergoing renal replacement therapy (p=0.001 and 0.004, respectively). CONCLUSION: In our study, cardiovascular risk factors (especially LDL-cholesterol) were more frequent in peritoneal dialysis patients than in hemodialysis patients.

Diameters of normal thoracic vascular structures in pediatric patients

PurposeTo determine the normal range of aortic and pulmonary artery diameters on chest CT, and to search a constant ratio when the diameters of thoracic vascular structures are compared with an internal reference.MethodsContrast-enhanced chest CT scans of 133 pediatric patients were retrospectively evaluated. Diameters of ascending and descending aorta, main pulmonary artery, right and left pulmonary arteries and a constant thoracic vertebra were measured. The mean ratios of thoracic vascular diameters to the diameter of the thoracic vertebra were calculated.ResultsThere was a positive correlation between the age of the patients and vascular diameters. The mean ratios of vascular diameters to the diameter of thoracic vertebra, ranged from 1.1 for the ascending aorta to 0.70 for the right and left pulmonary arteries, were consistent.ConclusionsDiameters of thoracic vascular structures increase with age. The consistent vertebral to vessel ratios can be useful in evaluation of chest CT of pediatric patients.

Acute Kidney Injury due to Rhabdomyolysis in H1N1 Influenza Infection

Acute kidney injury (AKI) is rarely reported in the clinical course of H1N1 infection and this condition is strongly related with increasing of mortality risk. However, there are no sufficient data about the development of AKI due to H1N1 infections. The recent reports were documented for elevation of creatinine phosphokinase levels in the course of influenza infection, but rhabdomyolysis was rarely reported. Herein, we present a 28-year-old female patient and a 19-year-old male patient with AKI in the course of H1N1 influenza infection due to rhabdomyolysis.