[Show abstract][Hide abstract] ABSTRACT: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic diseases. The purpose of this study was to evaluate the association between RI values of orbital arteries by using the color Doppler imaging (CDI) in type II diabetes mellitus (DM) patients with microalbuminuria.
We evaluated 91 type II DM patients with microalbuminuria and 27 healthy subjects. The DM patients with microalbuminuria were grouped into two: group 1 consisted of patients with retinopathy (n = 51) and group 2 consisted of patients without retinopathy (n = 40). Healthy subjects constituted group 3 (n = 27). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI.
Compared to diabetic group 2, group 1 had significantly higher mean RIs of OA, CRA, PCA, and HbA1c levels (p < 0.001 for all). Besides, there were no statistical differences in mean RIs of OA, CRA, and PCA between the control group and group 2 (p = 1.0; p = 0.44; p = 0.67, respectively). Mean RIs of OA and PCA were significantly correlated with age in group 1 (r = 0.549, p < 0.001; r = 0.407, p = 0.003, respectively). Mean RI of CRA was significantly correlated with the duration of diabetes and age in group 1 (r = 0.296, p = 0.035; r = 0.486, p < 0.001, respectively).
Our study indicates that RI might be a useful marker for early diagnosis and follow-up of diabetic retinopathy, and orbital RI assessment would be beneficial for diabetic patients with retinopathy.
[Show abstract][Hide abstract] ABSTRACT: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage.
The purpose of this study is to evaluate the association between RI values of orbital and intrarenal arteries by means of Doppler ultrasonography (US).
We evaluated 103 diabetic patients. As a control group, 30 subjects were examined. The patients were divided into two groups. Group 1 consisted of patients with urinary albumin excretion (UAE) <300 mg/day and estimated glomerular filtration rate (eGFR) levels >90 ml/min (n = 50); Group 2 had a UAE >300 mg/day and/or eGFR levels between 89 and 60 ml/min (n = 53). The association between RI values obtained with Doppler US of the ophthalmic artery, central retinal artery, posterior ciliary artery and intrarenal arteries were calculated.
Both orbital and intrarenal arterial RI values in Group 1 and Group 2 were higher than the control group (p = 0.001); furthermore, values were higher in Group 2 than in Group 1 (p = 0.0004/0.029/0.036, p = 0.016, respectively). A positive correlation was found between orbital and intrarenal arterial RI values in Group 2 (r = 0.475, 0.285, 0.363, p < 0.01, respectively).
Both orbital and renal arterial RI values were shown to be higher than the control group. Further, a trend towards higher RI values was observed with renal disease. RI may be useful as one of the markers for early diagnosis and follow-up of diabetic nephropathy and retinopathy.
No preview · Article · Mar 2012 · Kidney and Blood Pressure Research
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION AND AIMS: Physical inactivity is common in patients undergoing dialysis and it is associated with insulin resistance as well as an
over expression of muscle fibre type 2X.
Thus the aim of the present study was to investigate the effects of high-load strength training in patients undergoing dialysis,
on insulin sensitivity and muscle fibre distribution.
METHODS: All 18 patients (aged 51 ± 14 (mean ± SD), 11/7 male/female) on hemodialysis (n=15) and peritoneal dialysis (n=3) went through
a control period of 16 weeks before participating in 16 weeks of strength training. The training consisted of 5 minutes of
warm-up and up to 5 sets of three obligatory exercises three times a week: leg press, leg extension, and leg curl. The period
of rest between each set was of 60-90 seconds duration. During the intervention period the load was increased and the repetition
maximum was decreased from 15 to 6. The progression during the intervention was adjusted according to changes of strength
during the period.
The patients received an isocaloric drink immediately after each training session, which was randomly assigned to provide
either a protein (Renilon 7.5, Nutricia) or non-protein (Calogen, Nutricia) source. Insulin sensitivity was tested using the
2-hour oral glucose tolerance test after an over-night fast.
Muscle biopsies taken from the m. vastus lateralis were cut using a cryostat and ATPase stained before being fibre typed: distribution and size.
RESULTS: Three patients were not retested with the oral glucose tolerance test due to insulin treatment, illness, and problems arising
from the test. Fasting and 2-Hour blood glucose was unchanged during the control and the training period. Likewise, insulin
values remained unchanged during the control period, but were significantly decreased after training (fasting from 76 ± 52
to 47 ± 26 pmol/l and 2-Hour from 396 ± 206 to 251 ± 172 pmol/l). When data were transformed using the Matsudas Index (higher
value indicates less insulin resistance) there was no change during the control period and an improvement after training from
4.0 ± 1.9 to 5.6 ± 2.3. HOMA (lower value indicates less insulin resistance) was found to be unchanged during the control
period and to decrease from 3.1 ± 3.9 to 1.6 ± 1.2 with training.
Muscle fibre distribution remained unchanged during the control period, but changed significantly with training from 42 ±
15% type 1; 35 ± 12% type 2a; 22 ± 17% type 2b to 44 ± 15% type 1; 40 ± 12%; 15 ± 13% type 2X. Muscle fibre size remained
unchanged throughout both the control and training periods.
An initial unadjusted analysis did not reveal any benefits of combining the training period with protein intake.
CONCLUSIONS: This simple high-load strength training program was found to be associated with a significant improvement in insulin sensitivity.
Furthermore, the number of type 2X fibres decreased as was anticipated. These results have important clinical implications,
since insulin resistance is a common confounding problem in individuals undergoing dialysis treatment.
No preview · Article · Jun 2011 · CKJ: Clinical Kidney Journal
[Show abstract][Hide abstract] ABSTRACT: The aim of the kyphoplasty method for the treatment of traumatic osteoporotic vertebral compression fractures in geriatric patients is to improve the patient's quality of life. In this report we present two elderly patients who were suffering of traumatic osteoporotic vertebral compression fractures and underwent successful kyphoplasties. Percutaneous kyphoplasty method for the surgical treatment of these fractures decreases the hospitalization, morbidity and mortality in these patients.
Full-text · Article · Jan 2010 · Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery: TJTES
[Show abstract][Hide abstract] ABSTRACT: We present herein a case in which salmonella infected a pre-existing chronic subdural hematoma. A one-year-old male infant was admitted to our hospital with complaints of loss of consciousness, seizure, and left hemiparesis. Irrigation and drainage through two burr-holes were performed to the left frontoparietal region with the diagnosis of chronic subdural hematoma according to CT findings. Operative findings revealed an infected subdural hematoma. Salmonella typhi grew in cultures of the subdural hematoma. According to the result of the culture antibiogram, ciprofloxacin therapy was initiated. Because of continued lethargy six days after the operation, a contrasted MRI was performed. The patient was reoperated with drainage and irrigation according to the MRI result. The antibiotic therapy was changed to a combination of vancomycin and meropenem. The following physical and neurological examinations of the patient were uneventful and the patient was discharged after six weeks of antibiotic therapy. The follow-up CT and neurological examination were normal after six months.
No preview · Article · Feb 2009 · Turkish Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Inguinal hernia is one of the most common surgical pathologies in childhood. Any of the abdominal organs can slide into the hernial sac and become incarcerated there. In girls, the fallopian tubes, ovaries, uterus, and-rarely-ovarian cysts can form the sliding component of an inguinal hernia. The aim of this study was to investigate the diagnostic value of preoperative sonographic examination in girls with nonreducible inguinal masses.
Nine girls ranging in age from 2 months to 8 years who were admitted to our clinic with nonreducible inguinal masses were included in the study. All patients underwent sonographic examination followed by surgery on the day of admission.
A definitive diagnosis was obtained in 6 patients on preoperative sonographic evaluation, whereas 3 patients were misdiagnosed. One patient was diagnosed sonographically as having lymphadenopathy, but surgery revealed an ovarian cyst sliding into the hernial sac. A second patient was found to have an infected lymph node at surgery instead of a strangulated bowel loop as diagnosed on sonographic examination. In the third patient, the preoperative sonographic diagnosis was an ovarian cyst in the hernia sac, but surgery revealed a cyst of the canal of Nuck.
Inguinal masses in young girls must be carefully evaluated, because the sonographic preoperative diagnosis may be misleading.
Full-text · Article · Jun 2008 · Journal of Clinical Ultrasound
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to evaluate the alteration of ocular blood hemodynamics after intranasal administration of 17beta-estradiol, through measurement of the ophthalmic artery (OA) and the central retinal artery (CRA) using color duplex sonography.
Thirty healthy women who had been naturally postmenopausal for at least 1 year were enrolled in the study. A randomized, placebo-controlled, crossover, double-blinded study was conducted of the acute effect of 17beta-estradiol (Aerodiol; Servier, Chambrayles-Tours, France) on OA and CRA blood flow using color duplex sonography.
The peak systolic and end diastolic velocities of the CRA were increased significantly after 17beta-estradiol administration compared with placebo. A significant decrease was also found in the pulsatility and resistive indices of the CRA. However, there were no statistically significant differences in OA flow velocities or pulsatility and resistive indices.
Nasal 17beta-estradiol administration in postmenopausal women causes an improvement in the ocular vascular Doppler indices. These results suggest that there could be a positive effect of Aerodiol on middle-sized arteries and arterioles.
No preview · Article · May 2008 · Gynecological Endocrinology
[Show abstract][Hide abstract] ABSTRACT: A pneumatocyst in the cervical spine is extremely rare and to our knowledge only a few reports have been published in the English literature. Although the etiology and natural course of vertebral body pneumatocyst is unclear, nitrogen gas accumulation is claimed. A 65-year-old-man was admitted to the emergency department with neck pain and numbness and incapacity in his both hands and fingers. The radiological images revealed a vertebral located pneumatocyst in the C4 cervical vertebra. In this report, we present a case of cervical pneumatocyst located in the C4 vertebral body. The clinical and radiological features and natural course of the pneumatocyst were evaluated.
Full-text · Article · Feb 2008 · Turkish neurosurgery
[Show abstract][Hide abstract] ABSTRACT: Atherosclerotic vascular disease is a major cause of morbidity and mortality for patients with end-stage renal disease on maintenance hemodialysis. Early atherosclerotic changes of the arterial wall can be evaluated by intima-media thickness (IMT), presence and structure of plaques and parameters of vascular resistance. The aim of the present study has been to investigate the relationship between carotid IMT and pulsatility index (PI) or resistive index (RI) values in hemodialysis patients.
We studied 36 hemodialysis patients (21 female, 15 male; median age 39.5 years, IQR 33.0-54.7 years) and 38 healthy volunteers (20 women, 18 men; median age 41.0 years IQR 32.5-53.5 years). All subjects underwent ultrasonography of common carotid artery, with determination of IMT, PI and RI.
Bilateral and mean carotid IMT were found to be significantly higher in hemodialysis patients than in the control group (P<0.0001). Right and left carotid artery RI values were determined to be lower in hemodialysis patients than in the control group (P=0.007 for both). Similarly, right and left carotid PI values were also determined significantly lower in the hemodialysis group (P=0.005 and P=0.004, respectively). There was a moderate negative correlation between the right carotid IMT and right PI (r=-0.258, P=0.026).
In contrast to previous studies in patients with diabetes, hypertension or cerebrovascular disease, PI and RI values decrease when IMT increases in hemodialysis patients. This finding may be a result of peripheral vasodilatation secondary to anemia in hemodialysis patients.
Full-text · Article · Feb 2008 · International Urology and Nephrology
[Show abstract][Hide abstract] ABSTRACT: Obesity is associated with insulin resistance, which is the main pathogenic factor for nonalcoholic fatty liver disease (NAFLD). NAFLD can progress without associated elevations in liver enzymes. Therefore, we investigated the effects of weight loss on normal transaminase levels in obese subjects who are at risk for NAFLD.
Thirty-seven obese patients with normal ALT levels were evaluated. All patients received an individualized low-calorie diet over at least 6 months. Twenty-two patients who achieved weight loss of at least 5% body weight were identified as the study group and the others as the control group. Transaminases, insulin resistance, and body mass index were compared before and after the intervention.
Hepatic steatosis was found in 83.8% of obese patients. ALT was correlated with HOMA-IR in all patients at baseline (r = 0.363, P = 0.027). At the end of the follow-up, mean weight loss achieved in the study and control groups were 9.2% (8.7 +/- 3.0 kg) and 0.3% (0.5 +/- 2.8 kg), respectively. In the study group, HOMA-IR and ALT decreased from 4.0 +/- 1.8 to 2.4 +/- 0.9 and from 21.4 +/- 6.6 IU/L to 16.8 +/- 5.5 IU/L, respectively (P = 0.005 and P = 0.044).
The results demonstrate that weight loss results in a decrease in normal ALT levels as well as insulin resistance. Therefore, the normal range for ALT may need to be reassessed.
Full-text · Article · Dec 2007 · The American Journal of the Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Although there is an increased prevalence of pulmonary hypertension in hemodialysis patients, the relationship between arteriovenous (AV) fistula blood flow and pulmonary hemodynamics is not known. The aim of this study was to evaluate the relationship between blood flow rate of AV fistula and pulmonary artery pressure (PAP) in hemodialysis patients.
Thirty-two hemodialysis patients were included in this study. Within 1 h of completion of dialysis, blood flow rate of AV fistula and pulmonary hemodynamics were evaluated using Doppler sonography. Pulmonary hypertension was defined as mean PAP > or = 25 mmHg at rest.
Mean PAP, median blood flow rate of AV fistula, and mean cardiac index were 22.5 +/- 10.0 mmHg (range 8-39), 978.0 ml/min (interquartile range 762.0-1,584.5) and 3,043.0 +/- 694.3 ml/ min per m2 (range 1,251-4,140), respectively. Mean PAP has a relationship to cardiac index (r = 0.453, P = 0.014). However, there was no correlation between mean PAP and blood flow rate of AV fistula, hemoglobin, calcium-phosphorus (CaxP) product, and parathormone. Pulmonary hypertension was present in 43.7% of patients. Patients with pulmonary hypertension had significantly higher cardiac index (P = 0.036).
We found there was no direct relationship between blood flow rate of AV fistula and PAP. Other factors may play a role in the development of pulmonary hypertension.
Full-text · Article · Nov 2007 · International Urology and Nephrology
[Show abstract][Hide abstract] ABSTRACT: To evaluate the effects of sonographic characteristics of thyroid nodules, the diameter of needle used for sampling, and sampling technique on obtaining sufficient cytological material (SCM).
We performed sonography-guided fine-needle biopsy (FNB) in 232 solid thyroid nodules. Size-, echogenicity, vascularity, and localization of all nodules were evaluated by Doppler sonography before the biopsy. Needles of size 20, 22, and 24 G were used for biopsy. The biopsy specimen was acquired using two different methods after localisation. In first method, the needle tip was advanced into the nodule in various positions using a to-and-fro motion whilst in the nodule, along with concurrent aspiration. In the second method, the needle was advanced vigorously using a to-and-fro motion within the nodule whilst being rotated on its axis (capillary-action technique).
The mean nodule size was 2.1+/-1.3 cm (range 0.4-7.2 cm). SCM was acquired from 154 (66.4%) nodules by sonography-guided FNB. In 78 (33.6%) nodules, SCM could not be collected. There was no significant difference between nodules with different echogenicity and vascularity for SCM. Regarding the needle size, the lowest rate of SCM was obtained using 20 G needles (56.6%) and the highest rate of adequate material was obtained using 24 G needles (82.5%; p=0.001). The SCM rate was 76.9% with the capillary-action technique versus 49.4% with the aspiration technique (p<0.001).
Selecting finer needles (24-25 G) for sonography-guided FNB of thyroid nodules and using the capillary-action technique decreased the rate of inadequate material in cytological examination.
No preview · Article · Aug 2007 · Clinical Radiology
[Show abstract][Hide abstract] ABSTRACT: We describe the case of a 37-year-old patient with mycotic aneurysm of the right peroneal artery associated with episodes of endocarditis. There are only 7 cases of mycotic aneurysms of the crural arteries reported in the literature. To the best of our knowledge, this is the first reported case of a mycotic aneurysm of the peroneal artery in an adult.
No preview · Article · Jul 2007 · Journal of Clinical Ultrasound
[Show abstract][Hide abstract] ABSTRACT: In this study of obstructive sleep apnoea (OSA), glucose tolerance and liver steatosis in females from an obesity unit, 45 patients (mean age 46.8 years, mean body mass index 39.4 kg/m(2), all non-diabetic and alcohol abstainers) underwent nocturnal polysomnography, a 2 h oral glucose tolerance test and abdominal ultrasonography. OSA, defined as an apnoea-hypopnoea index (AHI) of > or = 10 events/h, was present in 20 patients (44%). Impaired glucose tolerance (IGT) was found in eight patients (40%) with OSA and three patients (12%) without OSA; there was a positive linear relationship between AHI and post-load glucose levels. On multivariate logistic regression analysis, IGT was predicted by OSA independently of age, waist circumference, systolic blood pressure and current smoking. Liver steatosis was present in 37 women (82.2%), of whom six had grade III steatosis. Of the variables tested, IGT was the only predictor of grade III steatosis. In conclusion, OSA is an independent predictor of IGT which, in turn, is associated with severe liver steatosis in an obesity unit-based sample of women.
Full-text · Article · Jul 2007 · The Journal of international medical research
[Show abstract][Hide abstract] ABSTRACT: We investigated the diffusion-weighted MRI changes, apparent diffusion coefficient (ADC) values, and conventional MRI findings in specific brain areas during migraine attacks in patients with and without aura.
Included in the study were 22 patients (2 male, 20 female) aged between 17 and 49 years who were diagnosed as having migraine according to the diagnostic criteria of the International Headache Society. Also included in the study were 18 age- and sex-matched healthy volunteers. Hyperintense lesions were evaluated in conventional MR images. Heavily diffusion-weighted images, ADC maps, and segmented ADC maps generated for regional ADC (rADC) measurements, were also studied. ADC values from specific brain areas were used with appropriate region of interests (ROI).
Migraine with aura was diagnosed in 13 patients and migraine without aura was diagnosed in 9 patients. A total of 23 hyperintense lesions within the periventricular white matter and deep white matter were detected in five patients (21.8%). All of these hyperintense lesions were seen in migraine patients with aura. In only one patient did a hyperintense lesion show an increased diffusion pattern on diffusion-weighted images and ADC maps. One hyperintense lesion was detected in the control group (5.5%). There was no significant difference in ADC values between the migraine and control groups.
T2-weighted hyperintense lesions were significantly more frequent in migraine patients especially in those with aura than in the control group. No diffusion alterations in diffusion-weighted images were detected in the infra- and supratentorial brain areas during migraine attacks in patients with and without aura.
[Show abstract][Hide abstract] ABSTRACT: We aimed to evaluate the effects of l-dopa use on apparent diffusion coefficient (ADC) values of different brain regions in Parkinson's disease (PD) patients. Thirty-five subjects underwent magnetic resonance imaging (MRI), including 21 PD patients (13 men, 8 women; mean age, 63 years+/-8), and 14 sex and age-matched control subjects. PD patients were separated into two groups according to the duration of l-dopa usage: patients using l-dopa less and more than 1 year. According to the disease duration two other groups were formed: patients diagnosed less and more than 1 year. Unified Parkinson Disease Rating Scale (UPDRS) scores of PD patients were detected. Diffusion weighted images (DWI) and ADC maps of patients and controls were evaluated and regional ADC (rADC) measurements were performed. Patients' age was not significantly different between groups. UPDRS was significantly different between the patient groups. There was no significant difference of rADC values between PD and control groups, and within the different PD groups. Short- and long-term l-dopa usage in PD patients did not cause any change rADC values in various brain regions.
No preview · Article · May 2007 · Neuroscience Letters
[Show abstract][Hide abstract] ABSTRACT: To assess via Doppler sonography the hemodynamic changes in the cephalic vein after creation of an arteriovenous fistula, and to compare radiocephalic and brachiocephalic fistulas.
Thirty-three hemodialysis patients and 54 controls were enrolled in the study. The cephalic vein was examined with a 7.5-MHz linear-array transducer. Doppler waveform parameters (resistance index, pulsatility index), time-averaged maximum flow velocity (TAV), peak systolic velocity (PSV), end-diastolic velocity (EDV), and the cross-sectional area of the vessel (A) were measured. Cephalic vein flow volume (CVFV) was calculated as TAV x A.
CVFV, PSV, EDV, A, RI, and PI were 45.5, 7.2, 6.7, 7.7, 1.2, and 1.32 times higher, respectively, in the cephalic vein of hemodialysis patients compared with controls. Both CVFV and A were higher in brachiocephalic patients compared with radiocephalic patients (1,983 +/- 1,199 versus 870 +/- 322 ml/min [p < 0.05] and 50.3 +/- 38.9 versus 21.0 +/- 7.8 mm(2) [p < 0.05], respectively).
The increase in cross-sectional area and flow volume of the cephalic vein is larger in patients with brachiocephalic fistulas than in those with radiocephalic fistulas; however, flow velocities and waveform parameters are not different.
Full-text · Article · Mar 2007 · Journal of Clinical Ultrasound
[Show abstract][Hide abstract] ABSTRACT: We present diffusion MR imaging findings and ADC values in acute methanol intoxication in a 32-year-old man. T2-weighted and FLAIR images showed bilateral increased signal in the caudate nuclei, putamen, cerebral peduncle, and centrum semiovale. Diffusion MR showed hyperintensity in same localization, and splenium of corpus callosum. ADC values of these areas were markedly reduced consistent with restricted diffusion.
No preview · Article · Feb 2007 · European Journal of Radiology Extra