Nilufer Aylanc

Relationship between Abdominal Aortic Intima Media Thickness and Central Obesity in Children

Background: Childhood obesity is one of the important risk factors for early atherosclerosis. We aimed to evaluate the effect of obesity on abdominal aortic intima media thickness (aaIMT) in children. Methods: We consecutively recruited 60 obese and 28 healthy children from the outpatient clinic of pediatrics. In all patients, BMI, waist circumference (WC) and hip circumference (HC) were measured, and fasting serum lipid profile, plasma glucose and plasma insulin were studied. Homeostasis model assessment-estimated insulin resistance (HOMA-IR) was calculated for the obese group. All children underwent ultrasonography to evaluate hepatosteatosis and to measure aaIMT. Results: There was a significant difference between the groups in terms of aaIMT, insulin, glucose, HOMA-IR, total cholesterol, low-density lipoprotein, triglyceride and hepatosteatosis. aaIMT was 1.12 ± 0.25 and 0.61 ± 0.18 mm in the obese and nonobese groups, respectively (p < 0.001). In the obese group, there was a positive correlation between aaIMT and WC, WC/height ratio, BMI, HC and hepatosteatosis (p < 0.05 for all), with the highest significance for WC. Conclusions: This study showed that aaIMT was significantly higher in obese children than in nonobese children, and that WC was a strong predictor for aaIMT. Early detection of an increased aaIMT in obese children may guide the follow-up of these patients in terms of developing atherosclerosis and its complications.

The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor.

PURPOSE To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. METHODS Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness from 3 locations and meniscus injury were assessed by two specialist radiologists. RESULTS Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P = 0.033). CONCLUSIONS An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process.

Spleen and muscle metastasis in renal-cell carcinoma

A 64-year-old male patient was admitted with a mass complaint in the right breast. He had a history of right nephrectomy seven years previously due to a renal-cell carcinoma (RCC). Routine biochemistry, complete blood count, and urinalysis results were within normal ranges. There was neither a chronic disease history of cardiovascular or respiratory system, nor pathological findings. At the physical examination, mass in the right breast was characterized as hard and fixed. Abdominal ultrasonography showed no pathology except a simple cyst in the left kidney. Breast ultrasonography revealed a solid and hypoechoic mass, measuring 35x10 mm, in the muscle tissue. Due to history of malignity, the patient underwent abdominal and thoracic computed tomography (CT). Abdominal CT showed three hypervascular masses in the spleen (Figure 1). In addition, a mass with 25x23 mm size, located in pectoral muscles was observed in thoracic CT (Figure 2). Histopathological examination was performed with a preliminary diagnosis of metastasis and primary muscle tumor. The pathology result was reported as metastasis of RCC. Renal-cell carcinoma constitutes approximately 85% of all kidney malignancies (1). It is more common in males and elderly individuals and is rarely diagnosed in early stages. The main reasons for this are the lack of specific symptoms, non-palpable masses (unless it reaches large size) and lack of specific screening test (1). Lesions in early stages are often detected incidentally during radiological imaging. Smoking is a definite risk factor, and the risk often decreases after quitting smoking. Obese individuals have also two-fold increased risk for RCC. In additi-

Investigation of Blood Betatrophin Levels in Obese Children with Non-Alcoholic Fatty Liver Disease

Purpose The prevalence of obesity has significantly increased among children and adolescents worldwide and is becoming an important health care problem in parallel with the increased prevalence of obesity pediatric non-alcoholic fatty liver disease. Betatrophin is a newly define hormone that is commonly secreted by liver and plays role in glucose tolerance. This study aimed to investigate the relationship between serum betatrophin levels and non-alcoholic fatty liver disease in obese children. Methods The study included 40 obese children with a body mass index (BMI) above 95th centile, and 35 non-obese subjects with a BMI 3-85th centile, whose age and gender were similar to those of the patient group. For the evaluation of metabolic parameters fasting serum glucose, insulin, alanine aminotransferase, aspartate aminotransferase, lipid profile and serum betatrophin levels were measured. Total cholesterol: high-density lipoprotein cholesterol and low-density lipoprotein cholesterol: high-density lipoprotein cholesterol ratios were calculated as “atherogenic indices.” Results Serum betatrophin levels of the obese subjects were similar to that of non-obese subjects (p=0.90). Betatrophin levels were not correlated with the metabolic parameters. Conclusion In the present study, levels of betatrophin are not different between obese and insulin resistant children and non-obese subjects, and they are not correlated with atherogenic indices. To elucidate the exact role of betatrophin in obesity, further studies are required to identify the betatrophin receptor and/or other possible cofactors.

Gaucher's disease in a patient presenting with hip and abdominal pain

Gauchers disease is characterized by glucocerebroside accumulation in the cells of the reticuloendothelial system. There are three subtypes. The most common is type 1, known as the non-neuropathic form. Pancytopenia, hepatosplenomegaly and bone lesions occur as a result of glucocerebroside accumulation in the liver, lung, spleen and bone marrow in these patients. Findings associated with liver, spleen or bone involvement may be seen at radiological analysis. Improvement in extraskeletal system findings is seen with enzyme replacement therapy. Support therapy is added in patients developing infection, anemia or pain. We describe a case of hepatosplenomegaly, splenic infarction, splenic nodules and femur fracture determined at radiological imaging in a patient under monitoring due to Gauchers disease.

Evaluation of paravertebral muscle atrophy and fatty degeneration in ankylosing spondylitis.

Abstract Aim: The purpose of this study was to assess morphological changes in the paravertebral muscles in patients with ankylosing spondylitis. Materials and methods: Fifty-one patients diagnosed with ankylosing spondylitis and a 50 member control group were included in the study. The surface area of the multifidus and erector spinae muscles was measured at four levels between L1 and L5, and fatty degeneration in these muscles was scored. Lumbosacral and lumbar lordotic angles were determined for the patient and control groups. Results: Loss of muscle cross-sectional area compatible with atrophy was present at all four levels in the paraspinal muscles in patients with ankylosing spondylitis. A negative correlation was observed between paravertebral muscle area and duration of disease at three levels, but not at L1-2. Although muscle area decreased with the duration of disease at the L1-2 level, this was not statistically significant (r= −0.195, p = 0.171). Comparison of intramuscular fatty degeneration between the groups revealed increased intramuscular fat at all levels in patients with ankylosing spondylitis, with the exception of L3–4, and a positive correlation between fatty degeneration and duration of disease was determined at all levels. Conclusion: Chronic inflammation, cytokine-mediated fibrosis, immobilization, and postural changes in ankylosing spondylitis contribute to fatty degeneration and atrophy in the paravertebral muscles.

Posterior reversible encephalopathy with brainstem involvement

Primary clinical findings in PRES include headache, seizures, and visual impairment. Symptoms disappear when the underlying predisposing factor is removed. It can be seen at any age. It is often reported in elderly individuals and in patients with hypertension. However, cases developing after removing underlying acute post-streptococcal glomerulonephritis, Henoch–Schönlein purpura, and nephrotic syndrome are known in children [1]. Several mechanisms have been proposed in pathophysiology. According to one opinion, vasospasm caused by hypertension causes cytotoxic edema. According to the widely accepted second hypothesis today, the autoregulation mechanism in the bloodstream is disturbed. Normally, hyperperfusion is inhibited by the sympathetic nervous system in patients with hypertension. However, when the systemic blood pressure rises above a certain threshold, autoregulation is insufficient, and edema occurs [2]. Because the sympathetic system is poor in the posterior circulation, the posterior cerebral region is affected more frequently. In addition, since the cortex is more resistant to edema, subcortical area edema is more prominent [1, 2]. McKinney et al. evaluated 76 PRES cases with MRI [3]. They report that they see lesions most commonly in the parieto-occipital area (98.7%), 78.9% in the frontal lobe (78.9%), and 68.4% in the temporal lobe (68.4%). Cases with cerebral and brainstem involvement or with a small number of isolated brainstem involvement have been published. In their recent articles, Tortora et al. show isolated brainstem involvement in patients who developed post-abortion infection [4]. Cranial MRI is the gold standard in radiological diagnosis. Classical radiological findings are symmetrical, and these changes often affect the parieto-occipital region. Rarely, edema can be asymmetrical [5]. FLAIR Introduction

Amyand’s hernia detected incidentally in two patients

The appendix is rarely present inside the inguinal hernia sac. The risk of appendicitis increases in these patients since the blood supply to the appendix can be impaired. The condition is frequently asymptomatic, and even if symptomatic it gives rise to non-specific symptoms. There is no specific laboratory finding. Diagnosis is frequently made with radiological imaging. We report two cases diagnosed as Amyand’s hernia with CT.

The accuracy of urinary ultrasound in the diagnosis of urinary stone disease in patients with acute flank pain: is it influenced by the time of ultrasound performance during the day or week?

SummaryBackgroundThe aim of this article is to investigate the possible impact of timing of ultrasound (US) during the day or week on its diagnostic accuracy.MethodsWe analyzed the records of 500 patients who underwent an initial urinary US, followed by a noncontrast computed tomography (NCCT) for the assessment of urinary stone disease. The sensitivity, specificity, negative and positive predictive values, negative and positive likelihood ratio, and overall diagnostic accuracy rates of US and were analyzed at different times of the day or week.ResultsThe specificity and diagnostic accuracy of urinary US showed a decline toward the middle of the week followed by a steady rise by the end of the week, higher sensitivity for urinary US was noticed around mid-week. On the other hand, when urinary US results are subgrouped according to the time of the day they are performed, the specificity remained generally stable but the sensitivity and diagnostic accuracy showed lowest levels between 11:00 a.m. and 02:00 p.m. and between 04:00 p.m. and 05:00 p.m. Although some observational differences between sensitivity, specificity, and diagnostic accuracy of urinary US performed at different times of the day or week are seen, these differences were not statistically significant.ConclusionsOur study showed no significant influence of US timing on its diagnostic accuracy. A larger randomized prospective series is necessary to evaluate the impact of different factors on “precision” and “accuracy” in US reporting and, hence, the diagnostic accuracy of urinary US in identifying urinary stone disease.

Association of Congenital Left Renal Vein Anomalies and Unexplained Hematuria: Multidetector Computed Tomography Findings

Objectives: To investigate whether congenital renal vein anomalies are involved in the etiology of hematuria by analyzing abdominal multidetector computed tomography (MDCT) results. Methods: Six hundred and eighty patients undergoing MDCT for various abdominal pathologies in whom possible causes of hematuria were excluded were retrospectively assessed in terms of left renal vein anomalies, such as circumaortic left renal vein (CLRV), retroaortic left renal vein (RLRV) and multiple renal vein (MRV). Patients with CLRV, RLRV or MRV and patients with normal left renal veins were compared in terms of the presence of hematuria. Results: Left renal vein anomalies were detected in 100 patients (14.7%). RLRV, CLRV and MRV were identified in 5.4, 2.5 and 6.8% of patients, respectively. Hematuria was determined in 8.1% of patients with an RLRV anomaly and in 10.5% of patients with no RLRV anomaly (p = 0.633). Hematuria was detected in 23.5% of patients with a CLRV anomaly and 10.1% of those without (p = 0.074), and in 21.7% of patients with an MRV anomaly and 9.6% of those without (p = 0.009). Conclusions: In addition to increasing risk of complication during retroperitoneal surgery, numeric congenital renal vein anomalies are also significant in terms of leading to clinical symptoms such as hematuria.