Successful treatment of multidrug-resistant hypertension with catheter-based renal denervation in a patient with a renal artery stent

Renal artery stenting (RAS) and its effectiveness in the treatment of atherosclerotic renal artery disease are controversial.1 Catheter-based renal denervation (RDN) has been shown to reduce blood pressure in the treatment of multidrug-resistant hypertension.2 In this case, we presented the successful regulation of multidrug resistant hypertension after renal denervation in a patient with renal artery stent.

The effect of interarm blood pressure difference on coronary collateral flow in patients with ST-segment elevation myocardial infarction who had undergone primary percutaneous coronary intervention

OBJECTIVE

In patients with acute myocardial infarction, coronary collateral circulation (CCC) is associated with reduced infarct size, preserved cardiac function, and decreased mortality. An interarm blood pressure difference (IABPD) is shown to be independently associated with cardiovascular and all-cause of mortality. We aimed to determine the effect of IABPD on coronary collateral flow in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (p-PCI).

PATIENTS AND METHODS

We prospectively investigated 1,348 consecutive patients who were hospitalized for STEMI and underwent p-PCI. The Rentrop classification was used to assess CCC. According to this classification, we defined Rentrop 0 and 1 as poor CCC, and Rentrop 2 and 3 as good CCC. A 10 mm Hg difference is considered the upper limit of IABPD.

RESULTS

Patients were divided into two groups according to the collateral circulation, 325 patients (24%) had good collateral, while 1,023 patients (76%) had poor collateral. IABPD was significantly higher in the poor collateral group (57 patients, 5.6%) than in the good collateral group (9 patients, 2.8%) (p=0.04). Pre-infarction angina and IABPD were identified as independent predictors of poor collateral (OR: 0.516, 95% CI 0.370-0.631, p=0.007; OR: 3.681, 95% CI: 1.773-7.461, p=0.01, respectively) in multivariate analysis.

CONCLUSIONS

The IABPD was shown as an independent predictor of poor collateral circulation in patients with STEMI who underwent p-PC.

Effect of gadolinium perfusion magnetic resonance imaging on surgeons' management preferences in kienböck's disease. A survey study

In literature, the use of gadolinium perfusion magnetic resonance imaging (GP-MRI) is recommended in Kienböck's disease to evaluate the lunate bone's perfusion. This survey study sought to assess how GP-MRI findings affect the management preferences of hand surgeons. A questionnaire consisting of 11 scenarios differing in ulnar variance, GP-MRI findings and management preferences was developed. The scenarios were designed based on the last published clinical guidelines. The questionnaire was sent to the members of a national hand surgery society consisting of 160 hand surgeons. Sixty-six surgeons completed the questionnaire. The surgeons' preferences changed significantly by ulnar variance in stages II and IIIA, and by GP-MRI in stages I and II. No need for other diagnostic tools was found in any of the scenarios. Management preferences of the study participants related to alterations in ulnar variance and treatment choices in all stages were in accordance with previously published clinical and survey studies. This study showed that GP-MRI findings significantly changed the management preferences of hand surgeons in early stages of Kienböck's disease. There was no significant tendency among the participants to use further assessment tools beyond direct radiography, MRI, and GP-MRI. Given the study results and the literature, we emphasize the limited and well-defined indications of GP-MRI in Kienböck's disease.

Metastatic Pancreatic Cancer Second-Line Treatment Options: Is the Difference Only in Cost?

İNTRODUCTION: Although pancreatic cancer ranks seventh in cancer-related deaths, it is an extremely fatal disease, and more than 330,000 people die from this disease worldwide. Although there are many first-line treatment studies in the literature, there are almost no prospective studies regarding second-line therapy. Therefore, there is no standard approach in the second-line treatment of pancreatic cancer. We decided to conduct this study to investigate second-line treatments with problems such as cost, treatment efficacy, and toxicity.

METHODS

Patients older than 18 years old who applied to Ege University Hospital medical oncology department with a diagnosis of metastatic pancreatic cancer, who received first-line chemotherapy due to their illness, and who had progressed afterwards were included in the study. The files of the patients who applied between 2013 and 2017 were examined.

RESULTS

Our study's primary endpoint was progression-free survival, and it was found that the median progression-free survival was 3.2 months in the Xelox patients, 3.7 months in the gemcitabine-nab paclitaxel patients, and 3.5 months in the other regimens. When the secondary endpoint was evaluated, overall survival, the median overall survival was 5.9 months in the Xelox patients, 5.3 months in the gemcitabine-nab paclitaxel patients, and 4.8 months in the other regimens.

CONCLUSION

As a result, second-line treatments were compared, and no statistically significant difference was found between them. For this reason, the side effects of previously used drugs and the side effects of new drugs to be used, as well as their costs, should be evaluated when choosing a treatment.

A toddler with a novel LEPR mutation

There are numerous causes, such as environmental factors, medications, endocrine disorders, and genetic factors, that can lead to obesity. However, severe early-onset obesity with abnormal feeding behavior, mental retardation, dysmorphic features, organ-specific developmental abnormalities, and endocrine disorders suggest a genetic etiology. Mutations in genes related to the leptin-melanocortin pathway play a key role in genetic obesity. This pathway controls hypothalamic regulation of food intake. A few cases have been reported to have mutations in leptin (LEP) or leptin receptor (LEPR) genes. The cases had severe early-onset obesity, hyperphagia, and additional features, such as altered immune function, hypogonadism, and hypothyroidism. We present a 3-year-old male patient with severe early-onset obesity whose genetic analysis revealed a homozygous, novel, and pathogenic variant (c.1603+2T>C) in LEPR.

THE ROLE OF THYROID FINE-NEEDLE ASPIRATION CYTOLOGY IN THE TREATMENT AND FOLLOW-UP OF THYROID NODULES IN THE PEDIATRIC POPULATION

Objective

Thyroid fine-needle aspiration (FNA) and cytology is a reliable diagnostic method used in the assessment of malignancy when evaluating thyroid nodules, in conjunction with clinical and ultrasonographic findings. The aim of this study is to compare clinical, ultrasonographic, cytological and histopathological findings in children who underwent thyroid FNA.

Methods

Subjects comprised 80 patients (52 female) aged 13.7±2.8 years at the time of FNA who where evaluated for thyroid nodules. Clinical, ultrasonographic and cytological findings of patients were evaluated retrospectively.

Results

Autoimmune thyroiditis was present in 30% and history of radiotherapy to the head or neck in 10%. The cytological diagnosis of patients included: inadequate or hemorrhagic sample in 10%; benign in 42.5%; atypia or follicular lesion of undetermined significance (AUS/FLUS) in 15%; suspicion of follicular neoplasia (SFN) in 7.5%; suspicion of malignancy (SM) in 8.8%; and malignant in 16.3%. Thirty-seven patients underwent thyroidectomy. Malignancy rates for histopathologic follow-up were 75%, 85.7% and 100% for SFN, SM and malignant categories, respectively. Only one benign and two AUS/FLUS FNAs were found to be malignant on histopathological examination. Among patients who had received radioiodinetherapy, 87.5% had malignancy. In this study, the sensitivity of FNA was 96%, specificity 50%, positive predictive value 90.9%, negative predictive value 75%, and diagnostic value of FNA was 89.2%.

Conclusion

Thyroid FNA results were highly compatible with histopathological examination. Sensitivity, positive predictive value and diagnostic value of FNA were high.

Synthesis and structural investigation of (4-methoxy-phenyl)-[4-(4-methoxy-phenyl)-1-(1-phenylethylidene-amino)-2-thioxo-1,2-dihydro-pyrimidin-5-yl]-methanone

The crystal structure of (4-methoxy-phenyl)-[4-(4-methoxy-phenyl)-1-(1-phenylethylideneamino)-2-thioxo-1,2-dihydro-pyrimidin-5-yl]-methanone, has beeen determined by single-crystal X-ray diffraction at 183(2) K. The compound crystallizes in the monoclinic system, space group P21/c. The O3 and C19 atoms in the methoxy group shows conformational disorder. In the title compound, the pyrimidine ring is slightly nonplanar. The angle between the planes formed by the ring atoms N2–C2–C3 and C1–N1–C4 is 4.0 (1)°. The three phenyl rings form dihedral angles of 147.9 (1), 113.0 (1) and 103.2 (1)° with the pyrimidine ring. The structure is stabilized by weak intermolecular C–H...O interactions.