Mustafa Mahmut Barış

Serum osteoprotegerin is associated with carotid intima media thickness in women with previous gestational diabetes

Circulating levels of osteoprotegerin (OPG) have been shown to be increased in patients with cardiovascular disorders and diabetes. The aim of this study was to determine serum OPG levels in women with previous gestational diabetes (GDM), and to investigate the relationship between OPG and carotid intima media thickness (IMT) and circulating cardiovascular risk factors. Serum OPG was measured in 46 women with previous GDM and 30 age-matched healthy controls. Carotid IMT was evaluated. Serum lipid, insulin and hsCRP levels, plasma fibrinogen, vWF and PAI-1 levels were measured. Serum OPG levels tended to be increased in women with previous GDM (p=0.058). Carotid IMT was increased in the study group. Women with previous GDM had elevated levels of hsCRP and PAI-1. OPG levels were positively correlated with age, fasting and post-load glucose levels, hsCRP, and carotid IMT. Multiple regression analysis showed that serum OPG was a statistically significant predictor for elevated carotid IMT. Our results revealed that OPG levels tended to be elevated in women with previous GDM. Significant association of OPG with carotid IMT suggested that OPG might play a role in the pathogenesis of endothelial dysfunction in women with previous GDM.

Is there an association between non-functioning adrenal adenoma and endothelial dysfunction?

Background and aim: Subtle changes in hypothalamic-pituitary-adrenal (HPA) axis of subjects with non-functioning adrenal adenoma may be associated with endothelial alterations. We sought to investigate endothelial function, visceral adiposity and osteoprotegerin (OPG) and interleukin-18 (IL-18) levels in subjects with non-functioning adrenal adenomas. Subjects and methods: The adenoma group included 40 subjects without clinical and subclinical findings of hypercortisolism or other adrenal gland disorders. Twenty-two body mass index-matched controls were also enroled. The patients and control subjects underwent hormonal evaluation and assessment of anthropometric and metabolic parameters. Endothelial function was assessed with flow-mediated dilatation (FMD) of the brachial artery and intima media thickness (IMT) of common carotid arteries. Visceral adipose tissue area was measured by computed tomography. Plasma OPG and serum IL-18 levels were also measured. Results: When compared with healthy controls, the adenoma group had elevated systolic blood pressure, post-dexamethasone suppression test cortisol and reduced DHEAS. Visceral adipose tissue area and IMT of common carotid arteries were comparable. In the adenoma group, FMD of the brachial artery was significantly impaired and IL-18 level was significantly elevated. Visceral adipose tissue area was independently related with FMD. Homeostasis model assessment (HOMA) was the independent factor associated with visceral adipose tissue area. Cortisol, DHEAS and visceral adipose tissue area were independently associated with HOMA. Conclusions: We achieved evidence that could be attributable to endothelial alterations in subjects with non-functioning adrenal adenomas. Impaired FMD appeared to be a consequence of subtle changes in HPA axis in terms of elevated cortisol and reduced DHEAS as these conditions were known to disturb endothelial-dependent vasodilatation.

Role of mass effect, tumor volume and peritumoral edema volume in the differential diagnosis of primary brain tumor and metastasis

INTRODUCTION The differentiation of metastatic and primary brain tumors with certainty is important since clinical management and treatment of these two types of tumors are radically different. The purpose of the present study was to evaluate the effect of peritumoral edema volume, tumor volume and mass effect of tumor on differential diagnosis of metastatic and primary brain tumors. Also we have planned to investigate if the relationship between edema volume and mass affect can contribute to the differential diagnosis. MATERIAL AND METHODS We retrospectively reviewed MR images of patients with primary (n=40) and metastatic (n=40) intra-axial supratentorial brain tumor. Supratentorial primary solitary brain tumor group was also subdivided as GBM subgroup (n=24) and other than GBM subgroup (n=16) for statistical analysis. Metastasis at suitable localization which can lead to midline shift (due to mass effect) were selected. Tumor volume, peritumoral edema volume and mass-edema index (peritumoral edema volume/tumor volume) were calculated. Displacement of the midline structures (subfalcian herniation) was measured. Metastasis, GBM and other than GBM groups were evaluated for subfalcian shift, shift grade, tumor volume, peritumoral edema volume and mass-edema index by using Kruskal-Wallis test after Bonferroni correction. Mann-Whitney U test was used to analise subfalcian shift, tumor volume, peritumoral edema volume and mass-edema index of primary tumor and methastasis groups since the data was not normally distributed. Shift grade of the two groups was analised with chi-square test. RESULTS Midline shift, tumor volume and mass-edema index were significantly different between metastasis and primary tumor groups (p=0.001, p<0.001, p=0.001 respectively). Midline shift and tumor volume of the primary tumor group were greater than metastasis group while mass-edema index was less. Shift grade of metastasis and primary tumor groups was also significant (p=0.041). A midline shift more than 5mm (grade 2) was more common in primary tumors. There was no significant difference between GBM and other than GBM groups. CONCLUSION Measurement of midline shift, tumor volume and mass-edema index may contribute to the differential diagnosis of brain metastasis from primary brain tumors. Also mass-edema index can be a useful tool for differential diagnosis in the future. But further studies with larger series are needed.

Interference in ACTH immunoassay negatively impacts the management of subclinical hypercortisolism

PurposeLow plasma corticotropin is considered a useful parameter for the diagnosis of subclinical hypercortisolism in patients with an adrenal incidentaloma. However, immunoassays are vulnerable to interference from endogenous antibodies. In this study, subjects who underwent Hypothalamus-pituitary-adrenal axis evaluation for the assessment of subclinical hypercortisolism were evaluated. The objective of the study was to ascertain whether antibody interference in corticotropin immunoassay affected the diagnostic work-up and clinical decisions.MethodsThe 437 consecutive patients with incidentally discovered adrenal adenomas were included in this single centre study. Patients who had a combination of a nonsuppressed corticotropin concentration (>4.4 pmol/L) and a non-suppressed cortisol concentration after 1 mg overnight dexamethasone suppression test (>50 nmol/L) were selected. Eight eligible subjects without specific features of Cushings syndrome were identified and recruited for interference studies and follow-up. Nine controls including one patient with unilateral adrenalectomy and one patient with Cushings disease were recruited as well.MeasurementsEligible subjects and controls were subjected to hormonal tests and investigations for suspected interference. Interference studies included measurement of corticotropin on a different analytical platform, serial dilutions, polyethylene glycol precipitation and heterophilic antibody analysis. Patients were followed with clinical and laboratory parameters for a median duration of 30 (12–90) months.ResultsAntibody interference was identified in four patients. Rheumatoid factor was responsible for the interference in one patient. Clinical management of the patients was affected by the erroneous results. Interference tests were negative in control subjects.ConclusionsErroneous results associated with analytical interference negatively impacted on clinical decision making in this patient group. This should be considered particularly in conditions such as subclinical hypercortisolism which decisions depend on laboratory investigations mainly. Analytical interference could explain the high variability observed both in field measurements from patients who were expected to have lower corticotropin concentrations and in subclinical hypercortisolism prevalence reported by different studies. Many problems can be resolved by ensuring good communication between clinical and laboratory staff.

Autonomous cortisol secretion in adrenal incidentalomas and increased visceral fat accumulation during follow‐up

Autonomous cortisol secretion of adrenal incidentalomas (AIs) is associated with poor cardiovascular outcome. Because centripetal obesity is a cardiovascular risk factor, we aimed to investigate whether autonomous cortisol secretion is associated with increased visceral fat accumulation.

Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies

Background: Chest radiography is the initial choice for thoracic imaging. However, the wide availability of computed tomography (CT) has led to a substantial increase in its use in the emergency department (ED). We evaluated the utility of chest CT after a chest X‐ray in patients presenting to the ED with non‐traumatic thoracic emergencies, and determined if the diagnosis and management decision changed after CT. Methods: The study enrolled 500 consecutive patients with both chest X‐rays and CT who presented to the ED with non‐traumatic complaints. Chest X‐rays and CT images obtained within 12 h before any definitive treatment were randomly evaluated in consensus by two radiologists blinded to the clinical information. Results: The chest X‐ray and CT image findings were concordant in 49.2% of the 500 patients and this concordance was negatively correlated with patient age. Leading diagnosis and management decisions based on the chest radiograph changed after CT in 35.4% of the study group and this finding was also correlated with age. In 55% of 205 patients, pneumonic infiltrations were undiagnosed with radiography. Pulmonary edema was the most specific (93.3%) and sensitive (85.4%) radiography finding. Posteroanterior chest radiographs taken in the upright position had higher concordance with CT than anteroposterior (AP) radiographs taken in the supine position. Conclusions: Chest CT may be an appropriate imaging choice in patients presenting to the ED for non‐traumatic reasons, particularly for elderly patients and when the radiograph is taken with the AP technique in a supine position. HighlightsFindings of chest radiographs and CT images were concordant in 49.2% of 500 patients.Leading diagnosis and management decisions changed after CT in 35.4% of patients.In 55% of 205 patients, pneumonic infiltration was undiagnosed with radiography.Pulmonary edema was the most specific and sensitive finding of radiography.

A case of concomitant intralobar bronchopulmonary sequestration and situs inversus totalis

Situs inversus is a rare congenital abnormality involving partial or complete transposition of the thoracic or abdominal viscera. In situs inversus totalis, both the thoracic and abdominal viscera are transposed. The incidence of this condition is 0.01% to 0.02%. Bronchopulmonary sequestration (BPS) is a rare congenital abnormality of the respiratory tract with an incidence of 0.15% to 1.80%. Intralobar sequestration is uncommonly associated with congenital anomalies.

Balık kılçığına bağlı intestinal perforasyon

Gastrointestinal sistemin yabanci cisim yutmaya bagli gelisen perforasyonu %1 den az gorulen nadir bir durumdur. Balik kilcigi, uzun ve keskin uclu olmasi nedeniyle gastrointestinal system perforasyonuna en sik yol acan yabanci cisimdir. Yabanci cisim yutmaya bagli gelisen perforasyon, belirtilerinin nonspesifik ve genis bir spektrumda olmasi ve hastalarin genellikle yabanci cisim yuttugunu hatirlamamasi nedeniyle operasyon oncesinde koyulmasi zor bir tanidir. Ancak akut abdominal bulgularla bas vuran hastalarda her zaman akilda tutulmalidir. Bu olgu sunumunda, balik kilcigina bagli intestinal perforasyon olgusunun cok kesitli blgisayarli tomografi bulgulari sunulacaktir. Cok kesitli blgisayarli tomografi sayesinde, yabanci cisim yutma oykusu bulunmayan hastada operasyon oncesinde yabanci cisme bagli intestinal perforasyon tanisi koyulmus ve derhal uygun cerrahi tedavi yapilmistir.

Unusual case of spinal epidermoid cyst and a concomitant spinal arachnoid cyst

A 38-year-old woman presented with a 12-month history of subjective weakness and pain in her legs. Thoracolumbar MRI revealed two spinal intradural cystic lesions at T5–6 and T11 levels, respectively. The lesion located at the T5–6 level was heterogeneously hyperintense on T2-weighted images and heterogeneously hypointense on T1-weighted images. This lesion showed high signal intensity on diffusion weighted MRI (DWI) and low signal intensity on apparent diffusion coefficient images (ADC). According to the MRI findings, we reported this tumour as a spinal epidermoid cyst. The pathology result suggested that the lesion was an epidermoid cyst. The second intradural lesion, at the T11 level, showed a hypointense signal on T1 and hyperintense signal on T2 images. However, in contrast to the superior lesion, this lesion was hypointense on DWI and hyperintense on ADC. We evaluated the second lesion as an arachnoid cyst according to the MRI findings.