Origin and distribution anomalies of the left anterior descending artery in 70,850 adult patients: Multicenter data collection

OBJECTIVES

To present the clinical and angiographic properties of the left anterior descending artery anomalies.

BACKGROUND

Coronary artery anomalies are discovered in less than 1% of angiography series. Since the number of angiographies and coronary bypass operations are increasing significantly every day, these anomalies are of clinical importance. However, data about left anterior descending artery anomalies in literature is still scarce.

METHODS

We reviewed the records of 70,850 patients who had undergone coronary angiographies at 4 different cardiology center from 1999 to 2005 years.

RESULTS

Major congenital coronary anomalies were discovered in 171 of these cases (0,24%). The mean age of these patients was 61 +/- 11 (18-84) years. Ninety nine patients (58%) were male. Left anterior descending artery was involved in 12 patients (0.017%). In nine patients with the anomalous LAD there were concomittant congenital coronary artery anomalies. Concurrent coronary artery anomalies encountered were double left anterior descending artery type 4 (2 cases), double left anterior descending artery type 4 with double right coronary artery (1), double right coronary artery (1), double circumflex artery with anomalous left anterior descending artery (1), circumflex artery from right sinus of Valsalva (1), separate septal perforator and myocardial bridging of posterior descending artery (1), intercoronary communication, and ostial atresia of the left anterior descending artery and anomalous circumflex artery (1).

CONCLUSION

Our series is the biggest series where relatively sufficient clinical and angiographic information about the LAD anomalies were provided.

Oxidative stress in migraine with and without aura

Migraine is the most common neurological disorder, but the molecular basis is still not completely understood. An impairment of mitochondrial oxidative metabolism might play a role in the pathophysiology. The goal of this study was to investigate the differences in oxidative stress status with the measurement of erythrocyte superoxide dismutase (SOD), catalase activity, and malondialdehyde (MDA) levels in the migraine patients with or without aura and attack. There were 56 patients (46 female, 10 male) in the migraine group and 25 matched healthy subjects in the control group. The patients comprised 37 with migraine without aura (MWoA], 19 with migraine with aura (MWA), and 22 with headache attack. The MDA levels of patients in the migraine group were significantly higher than that in the control group. The SOD activity was significantly higher in the MWA as compared to MWoA. There was no significant correlation between these levels and headache attack period. Conclusively, in this preliminary study, we had found increased oxidative stress in the migraine patients especially the patients with MWA. Further knowledge about this issue may contribute the cause and complications of migraine and may be essential for development of treatment approaches.

Secondary hemophagocytosis in 3 patients with organic acidemia involving propionate metabolism

Hemophagocytic lymphohistiocytosis (HLH) may develop secondary to infections, malignancies, immune deficiency syndromes, and rheumatologic and metabolic disorders. Associations between HLH and inborn errors of metabolism, including lysinuric protein intolerance, multiple sulfatase deficiency, galactosemia, Gaucher disease, Pearson syndrome, and galactosialidosis, have previously been reported in the literature. In this report the authors present 3 children with disorders of propionate metabolism--1 with methylmalonic acidemia and 2 with propionic acidemia--who developed secondary HLH during their metabolic attacks. All patients fulfilled the 5 HLH criteria of the Histiocyte Society. Familial HLH was ruled out by molecular analysis. Plasma exchange was performed for 2 of them. Unfortunately 1 died of multiorgan failure despite intensive therapy. This is the first report of such an association.

Hematological features of pediatric systemic lupus erythematosus: suggesting management strategies in children

Aim: The aim of this study was to analyze the hematological features in children with systemic lupus erythematosus (SLE) and to review our current treatment protocols. Methods: We evaluated hematological findings of 43 children with SLE diagnosed and followed at the Pediatric Rheumatology Division of Hacettepe University, Turkey. Thirty-seven patients with hematological abnormalities were analyzed in detail. Results: Median age at presentation was 13 years. Hematological involvement was seen in 86% of patients. The most common hematological finding was anemia ( n = 30). Anemia was either a Coombs (+) hemolytic one, or was due to other causes. Hemolytic anemia was treated with steroids and intravenous gamma globulin (IVIG). Leucopenia and thrombocytopenia were detected in 35.1 % and 37.8 %, respectively. Bone marrow aspiration was performed in 15, mainly for cytopenia. Secondary dysplastic changes were common. Acute lymphoblastic leukemia (ALL) was diagnosed in one patient. Six patients were diagnosed as having macrophage activation syndrome (MAS). One patient died due to secondary infections and multiorgan failure despite aggressive treatment. In patients diagnosed early, treatment with steroids and cyclosporine resulted in an excellent response. Thrombotic microangiopathy was detected in two patients. Both were treated successfully with steroids and plasma exchange. Antiphospholipid and anticardiolipin antibodies were positive in 12 and 15 of the patients, respectively. Five developed deep vein thrombosis (DVT), one cerebral sinus thrombosis and one presented with purpura fulminans. They were effectively treated with anticoagulation protocol. Conclusion: Hematological findings should be carefully assessed and treated vigorously to prevent the morbidity and possible mortality.

Isolated single coronary artery: a series of 10 cases

BACKGROUND

Isolated single coronary artery (SCA) is an extremely rare congenital coronary anomaly. Some subgroups of SCA can lead to angina pectoris, acute myocardial infarction or even sudden death in the absence of atherosclerosis. Young patients, especially, have the risk of serious clinical events, but middle-aged-to elderly patients have a variable clinical course.

METHODS AND RESULTS

The aim of this study was to present the clinical and angiographic properties, relatively long-term follow-up (54+/-14 months) and management of adult patients (mean age 57+/-12 years) with SCA. The records of 70,850 patients undergoing coronary angiography between 1999 and 2005 were reviewed. Ten patients (0.024%) were found to have SCA, originating from the left sinus of Valsalva in 3 (30%) patients and from the right sinus of Valsalva in 7 patients (70%). No atherosclerotic involvement was seen in 7 (70%) patients. One patient was also treated by stent implantation to the SCA. Other patients were followed medically. All patients have been followed uneventfully.

CONCLUSION

Medical treatment is usually adequate for middle-aged to elderly patients with SCA in the absence of ischemia and/or acute coronary syndrome.

Posterior reversible encephalopathy syndrome caused by hypertensive encephalopathy and acute uremia

INTRODUCTION

The posterior reversible encephalopathy syndrome (PRES) is a recently proposed cliniconeuroradiological entity. The most common causes of PRES are hypertensive encephalopathy, eclampsia, cyclosporin A neurotoxicity, and the uremic encephalopathy. On magnetic resonance imaging (MRI) studies, edema has been reported in a relatively symmetrical pattern, typically in the subcortical white matter and occasionally in the cortex of the posterior circulation area of the cerebrum.

METHODS AND RESULTS

A 19-year-old woman undergoing chronic hemodialysis was admitted with encephalopathy. High signal intensity was seen bilaterally in the subcortical and deep white matter areas of the temporal, frontal, parietal, and occipital lobes on cranial MRI.

CONCLUSION

Particular attention needs to be given to PRES because initiation of appropriate intervention can reverse the encephalopathic condition in most cases. Cerebral lesions may be more prominent in the anterior circulation area in some patients.

Behçet’s disease as a causative factor of cerebral venous sinus thrombosis: subgroup analysis of data from the VENOST study

Objective

This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behçet’s disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST).

Methods

VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis.

Results

BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18–36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosis, followed by the superior sagittal sinuses. The most common symptom was headache (96.2%), followed by visual field defects (38%).

Conclusions

BD was found in 9.4% of patients in our VENOST series. Patients with BD were younger and showed a male predominance. The functional outcome of CVST in patients with BD was good; only 12% of patients presenting with cranial nerve involvement and altered consciousness at the beginning had a poor outcome (modified Rankin Score ⩾2).

Hoffmann's syndrome: a case report

OBJECTIVE

We report a very rare case of Hoffmann's syndrome with musclehypertrophy complicating hypothyroidism.

CLINICAL PRESENTATION

A 24-year-old man presented with a 2-year history of forgetfulness, swelling in his face, shoulder and calf, and motor weakness in his lower extremities. His calf and shoulder muscles were hypertrophic. Neurological examination revealed hoarseness of the voice, proximal muscle weakness, reduced deep tendon reflexes and a mildly ataxic gait. Laboratory tests indicated markedly elevated serum muscle enzymes and lipids, a high thyroid-stimulating hormone level and low free triiodothyronine and free thyroxine levels. Electromyographic evaluation showed myopathy.

INTERVENTION

Oral L-thyroxine treatment was started and at a 1-month follow-up examination, mental status and physical performance were improved.

CONCLUSION

This report shows that in the differential diagnosis of myopathy with pseudohypertrophy, Hoffmann's syndrome should be considered.

Urotensin-II, oxidative stress, and inflammation increase in hypertensive and resistant hypertensive patients

Objective: Hypertension is a multi-factorial process prevalent in developed as well as in developing countries. Urotensin-II, different antioxidants, free radicals, and inflammatory biomarkers play an essential role in the cardiovascular system. The aim of this study is to investigate Urotensin-II, oxidative stress, and inflammation markers in normotensive, hypertensive, and resistant hypertensive patients. Methods: Fifty resistance hypertensive (rHT) patients, 50 hypertensive patients, and 50 age gender matched normotensive controls (NT-control) were enrolled. Urotensin-II (UII), total oxidant status (TOS), total antioxidant status (TAS), native thiol (NT), total thiol (TT), disulfide (DIS), interleukin 1 beta (IL1β), interleukin 6 (IL6), tumor necrosis factor-alpha (TNFα), high sensitive c reactive protein (hsCRP), high-density lipoprotein (HDL) low-density lipoprotein (LDL), and total cholesterol (TC) were evaluated. Results: Serum levels of UII, IL1β, IL6, TNFα, DIS, TOS, and OSI were found higher in rHT and HT as compared to NT-control (p < .001). On the contrary, serum levels of TT, TAS, and NT were lower in rHT and HT as compared to NT-control (p < .001). While TC, hsCRP, TOS, OSI, UII, IL1β, IL6, and TNFα levels increase from HT to rHT group (p < .001); TAS and NT levels decrease from HT to rHT group (p < .001). Conclusions: UII levels, oxidative stress, and inflammation are higher in rHT and HT, while antioxidants and thiol levels are lower than the NT-control. Our study clearly showed that rHT and HT are more susceptible to impaired states of antioxidants, oxidative stress, and free radicals.

Clinical and radiological features in CADASIL and NOTCH3-negative patients: a multicenter study from Turkey

BACKGROUND

The diversity of clinical presentation and neuroimaging findings of CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) from different regions of the world has not yet been studied in depth. Here we investigated the variability of clinical, radiological and genetic data of 48 patients analyzed for NOTCH3 mutation in Turkey.

METHODS

Clinical evaluation was made according to a preformed questionnaire. Cranial neuroimaging findings were determined on the basis of T1, T2, FLAIR and proton-density magnetic resonance scans. For genetic analysis, polymerase chain reaction was performed with primers flanking exons 2-6 and 11 of NOTCH3 gene.

RESULTS

Twenty-five patients (52.1%) were diagnosed as CADASIL with NOTCH3 mutation, while 23 patients (47.9%) had no mutation (NOTCH3-negative patients). The mean age and age at stroke onset were lower in male CADASIL patients (p < 0.03). A family history of migraine (p = 0.012), stroke (p < 0.001), recurrent strokes (p = 0.020) and dementia (p = 0.012) was more common in CADASIL patients. Temporal pole involvement was more common in CADASIL patients (p = 0.004).

CONCLUSION

It is of clinical importance to identify the heterogeneity of CADASIL from different countries due to a low correlation of clinical and radiological data with respect to NOTCH3 mutation.

Changes in cerebral blood flow velocity in patients with hypothyroidism

BACKGROUND

At present, hypothyroidism is a well-known risk factor for cardiovascular disorders. The aim of this study was to assess the effects of hypothyroidism on cerebral blood flow velocity with transcranial Doppler (TCD) ultrasonography.

DESIGN AND METHODS

In this study, 30 subjects were enrolled for clinical, subclinical, and healthy control groups. Bilateral middle cerebral artery (MCA) peak-systolic, end-diastolic, and mean blood flow velocities; Gosling's pulsatility index values; and Pourcelot's resistance index values were recorded and compared with each other. TCD was performed in clinical hypothyroid patients after they became euthyroid with thyroid hormone replacement therapy (HRT). The initial and post-HRT results for the clinical hypothyroid group were then compared and evaluated.

RESULTS

There were 30 subjects in each group. Men/women ratio and mean age in clinical hypothyroid, subclinical hypothyroid, and control groups were 3/27, 4/26, and 5/25, and 37.4, 34.4, and 36.7 respectively. Peak-systolic, end-diastolic, and mean blood flow velocities of bilateral MCA were similar in clinical and subclinical hypothyroid groups but significantly higher when compared with the control group. After adequate thyroid HRT in clinical hypothyroid group, the peak-systolic, end-diastolic, and mean blood flow velocities were significantly decreased.

CONCLUSIONS

Increased cerebral blood flow velocities were observed in clinical and subclinical patients with hypothyroidism. The normalization of increased blood flow velocity with thyroid HRT suggests a reversible condition.

Intra-venous chlorpromazine with fluid treatment in status migrainosus

OBJECTIVE

To present the results of the intra-venous chlorpromazine with fluid treatment in patients with status migrainosus.

METHODS

Consecutive 21 patients with status migrainosus were received intra-venous chlorpromazine (maximum 25mg) with fluid treatment and their results were documented.

RESULTS

Complete recovery of headache and nausea were seen in 20/21 and 17/21 of the patients respectively. 15/21 of patients were headache free following at 10mg chlorpromazine infusion. Most patients went on sleep after 10mg chlorpromazine infusion and when they wake already up headache free. Side effects such as tachycardia, palpitation, flushing and hypertension were seen only one of 21 patients following first dose 5mg injection.

CONCLUSIONS

This study showed that intra-venous chlorpromazine with fluid treatment for status migrainosus seems a good option.

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study

PURPOSE

The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST).

METHOD

VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients.

RESULTS

The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter.

CONCLUSIONS

In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.

Acute lymphoblastic leukaemia in a child with systemic lupus erythematosus

Haematological involvement of systemic lupus erythematosus (SLE) - which ranges from the well-described haemolytic anaemia to macrophage activation syndrome - has a large impact on both morbidity and mortality. On the other hand, association between haematological malignities and SLE - in terms of pathophysiology and molecular genetics - is an obscure entity which has not been clarified evidently to date. Herein, we present a six-year-old female with the diagnosis of SLE who developed acute lymphoblastic leukaemia following a period of myelodysplasia. It could possibly be coincidental; however, persistent cytopenia, prominent dysplasia on bone marrow smears and azathioprine treatment may be considered as possible triggers for the development of leukaemia in the present case.

Nonalcoholic Wernicke's encephalopathy with prominent astasia and optic neuropathy

OBJECTIVE

To present a case with nonalcoholic Wernicke's encephalopathy (WE) developing astasia and optic neuropathy as major sequelae.

CLINICAL PRESENTATION AND INTERVENTION

A 47-year-old woman developed WE following operation for pyloric stenosis. She received total parenteral nutrition before and after operation, but on the second postoperative day she developed visual hallucination and confusion, followed by nystagmus, ophthalmoplegia, apathy, dysarthria and coma. Although the patient has recovered with thiamine treatment, astasia and optic neuropathy persisted s major morbidities.

CONCLUSION

The report shows that astasia and optic neuropathy may be prominent sequelae in some patients with WE.

Analysis of isolated cranial nerve manifestations in patients with cancer

The aim of this study was to assess the underlying causes of isolated cranial nerve (CN) manifestations in cancer patients. In a prospective study over a 16 month period, 20 of 242 patients presented with isolated CN manifestations, and were assessed for the following: primary site; CN symptoms and signs; length of time between primary diagnosis and neurological involvement; and survival following the neurological diagnosis. The most frequent primary site was determined as hematological malignancy (9/20). Thirteen of the 20 patients presented with single CN manifestations. Underlying causes of CN manifestations in 16 of the 20 patients were related to metastases. They included meningeal carcinomatosis (10/16), brain stem metastases (3/16), primary brain astrocytomas (1/16), and metastases out of the central nervous system (2/16). The remaining four patients' CN manifestations related to non-metastatic conditions. Although most of the isolated CN manifestations were due to systemic metastasis, in particular to the meninges, up to 20% were related to benign conditions.

Investigation of the Effects of Biochemical Parameters on Alzheimer's Disease

BACKGROUND

The most common type of dementia is an Alzheimer's disease which is a major concern in growing chronic diseases in the geriatric society, and its connection with biochemistry has not been sufficiently understood.

OBJECTIVE

This study aims to evaluate the effects of blood biochemistry on Alzheimer's disease.

METHOD

Eight participants aged 55+ with Alzheimer's disease were analyzed. A cross-sectional work has conducted. Eighty patients have been divided into 2 groups as group A and group B according to laboratory findings including glycosylated hemoglobin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TGA), vitamin D, folic acid, and vitamin B12. Mean Mini-Mental State Examination scores between these different 2 groups have been compared.

RESULTS

High levels of HDL, vitamin D, and folic acid correlate with cognitive scores, whereas high levels of total cholesterol, HbA1c, LDL show a negative effect on cognition scores.

CONCLUSION

High-density lipoprotein, vitamin D, folic acid, cholesterol, HgA1c, and LDL have an effect on dementia.

A. hierchuntica extract exacerbates genotoxic, cytotoxic, apoptotic and oxidant effects in B16F10 melanoma cells

Melanoma is a highly malignant tumor caused by melanocytes. Even though melanoma represents just 3% of all skin malignancies, it represents 75% of deaths. Extracts of A. hierchuntica were reported to have anti-inflammatory, hepatoprotective, and anti-melanogenic activities. This study aims to investigate the dose-related relationship and selectivity of the toxic effects of A. hierchuntica extracts (AHE) on melanoma cells and provide a new option that can be used in the future treatment of melanoma. B16F10 Mus musculus malign melanoma cells and L929 Mus musculus healthy fibroblast cells were treated with root and leaf AHEs in a dose-dependent manner. Intracellular glutathione levels, mitochondrial membrane potential activity, apoptosis, genotoxicity, and cytotoxicity of AHE were evaluated. This study is probably the first study to show a significant apoptotic and genotoxic activity of AHE in selected B16F10 cancer cell lines. Mitochondrial membrane potential and glutathione activity of B16F10 and L929 melanoma cells decreased with increasing concentrations of both leaf and root AHEs. However, viability and reactive oxygen species levels showed selectivity especially the AHEs concentrations between 400 μg/mL and 500 μg/mL. This selectivity based on doses was also validated in apoptosis and genotoxicity between healthy and cancer cells (p < 0.001). The results showed that when looking at melanoma-specific, AHE could be a source of inspiration as an active ingredient in future treatment protocols. AHE can be recommended as potential nutraceuticals in the prevention of human melanoma cancer.

An anomalous left main coronary artery with coronary torsion originating from the right sinus Valsalva

A 52-year old woman developed inferior ST elevation myocardial infarction and was found to have both an anomalous left coronary artery originating from the right sinus of Valsalva, and total atherosclerotic occlusion of the proximal right coronary artery. Coronary angiography showed the torsion of left main coronary artery. Multislice computed tomography was used to assess the left main coronary artery.

Central Macular Thickness in Diabetic Macular Edema

Context

Retinal microvascular dysfunction differs in macular edema lesions in the two eyes of the same patient with diabetic retinopathy.

Objective

To evaluate the relationship between central macular thickness (CMT) and metabolic/systemic factors including anthropometric and laboratory findings, in patients with regressed diabetic retinopathy and a history of pars plana vitrectomy (PPV) combined with internal limiting membrane peeling in one eye.

Subjects and Methods

Forty-two eyes with PPV and the same patients' fellow 42 eyes (without PPV) included this study. Fasting blood samples of these 42 diabetics were collected to study adiponectin levels and other routine parameters.

Results

The average hemoglobinA1c value was 7.3±1.3%. CMT of the vitrectomized eyes were significantly correlated with atherogenic index of plasma, total cholesterol, low density lipoprotein cholesterol and uric acid (UA). On the other hand, CMT of the nonvitrectomized fellow eyes significantly correlated with glucose levels and diabetes duration. Adiponectin, adiponectin/body mass index, adiponectin/fibrinogen were found significantly higher in the subgroup with CMT≥300μm in the vitrectomized eyes (P<0.05). UA levels were higher in the subgroup with CMT≥300μm in the fellow (nonvitrectomized) eyes (P<0.05).

Conclusions

Although there was no relationship between CMT and hemoglobinA1c values, CMT seemed to be affected by atherogenicity, prooxidant chemical alterations in the course of inflammation, so determination of adiponectin and UA levels may be suggested before surgery to predict the atherosclerotic damage and the postoperative CMT value. Vitrectomy performed at the proper time may be helpful in metabolic remodeling process of the retinal tissue along with life style changes, well control of diabetes, and intraocular treatments.

Peduncular hallucinosis due to brain metastases from cervix cancer: a case report

BACKGROUND

Brain metastases from cervical carcinoma are rare. Accompanying symptoms depend on the location of the metastatic lesions. Penduncular hallucinosis is a vivid form of hallucination with clinical findings indicating a lesion of the upper midbrain. We hereby report a probable first case of peduncular hallucinosis associated with brain metastases from cervical cancer.

CASE

A 42-year-old woman had been diagnosed with adenocarcinoma of cervix. On admission for her increasing pelvic pain, she had complex visual hallucinations comprising cartoon children, figurative people and a foggy room. Magnetic resonance imaging of the head revealed a lesion in the left mesencephalothalamic area.

CONCLUSION

Peduncular hallucinosis is well known for its vivid and life-like characteristics associated with a mesencephalic area lesion, and recognition of this may be useful of its diagnosis and differential diagnosis from confusion and other hallucinations.