Effect of pulse methylprednisolone on prognosis in SARS-CoV-2 patients with severe pneumonia.

OBJECTIVE: This study aimed to evaluate the effect of pulse methylprednisolone treatment on prognosis in severe COVID-19 pneumonia. PATIENTS AND METHODS: This retrospective cohort study included 128 patients hospitalized in our clinic for severe COVID-19 between March 2020 and February 2021. Standard treatment (plaquenil, favipravir, low molecular weight heparin, and antibiotics when necessary) was given to the patients in accordance with the Turkish Ministry of Health guidelines. After steroid treatment was included in the guidelines, dexamethasone 6 mg/day was administered along with standard treatment. In patients whose clinical condition did not improve despite this treatment, 250 mg/day methylprednisolone (pulse steroid therapy) was administered intravenous (i.v.) for 3 days, followed by a 40 mg/day maintenance dose. The group receiving methylprednisolone 250 mg/day for 3 days and the group receiving standard treatment without steroids were compared in terms of symptoms, comorbidities, laboratory and radiological findings, length of hospitalization, prognosis, intensive care unit (ICU) admission, and intubation. RESULTS: Of the 128 patients included in the study, 85 (66.4%) were male, and the mean age was 61.7 ± 13.2 years (min: 25; max: 88). A total of 50 (39.1%) patients were transferred to the ICU, while the number of intubated patients was 37 (28.9%). Pulse methylprednisolone treatment was given to 98 (76.6%) patients, compared to the 30 (23.4%) patients who received only standard treatment. In total, 37 patients (28.9%) died. The presence of comorbid diseases (34.3% vs. 1.5%, p = 0.012), advanced age (67.7 vs. 59.3, p = 0.001), and not receiving steroid treatment (p = 0.046) significantly increased mortality. The mortality rate was 24.4% (24/98 patients) in the steroid therapy group and 43.3% (13/30 patients) in patients not receiving steroid therapy, and the difference was statistically significant (p = 0.046). Pulse steroid therapy also significantly decreased the rate of intubation (p = 0.014) and ICU admission (p = 0.007). In the logistic regression analysis that included comorbidity, advanced age, and pulse steroid therapy, advanced age (p = 0.022) and pulse steroid therapy (p = 0.048) were found to be effective independent variables of mortality. CONCLUSIONS: The results showed that pulse i.v. methylprednisolone significantly reduced mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with severe pneumonia requiring hospitalization, in addition to significantly reducing the need for intensive care and intubation. In SARS-CoV-2 patients with severe pneumonia, pulse i.v. methylprednisolone may be useful as a standard treatment in patients who do not respond to dexamethasone.

Vascular calcification is not related to serum fetuin-A and osteopontin levels in hemodialysis patients.

INTRODUCTION: Vascular calcification (VC) in hemodialysis (HD) patients is a sign of severe cardiovascular disease and can predict cardiovascular outcomes. Fetuin-A and osteopontin (OPN) inhibit VC. Serum fetuin-A levels are lower in patients with end-stage kidney disease (ESKD) and in those who are on chronic HD therapy. However, there are limited data concerning OPN in patients who are on dialysis. The aim of our study was to determine VC in HD patients, the relationship between VC and 25-OH-vitamin D, fetuin-A, and OPN levels, and independent predictors of VC. MATERIALS AND METHODS: Ninety-three patients with ESKD on HD therapy were recruited. Among these patients, 44 were male and 49 were female. The patient group was compared with a group of 20 healthy controls of similar age and sex. A plain radiograph of the hand was taken using a mammography machine for the evaluation of VC. Serum fetuin-A, OPN, and 25-OH-vitamin D levels of both patients and controls were measured. RESULTS: VC was detected in 45 (48.4%) HD patients. When patients were compared with healthy controls, fetuin-A levels (p < 0.029) were significantly lower in patients, whereas OPN (p < 0.000) and VC (p < 0.002) were significantly higher in the patient group. Age [odds ratio (OR) 1.036], the presence of diabetes mellitus (DM) (OR 17.527), and high parathyroid hormone (PTH) levels (OR 1.002) were independent predictors of VC in a logistic regression model including the following factors: age, the presence of DM, HD duration, and serum albumin, phosphate, PTH, 25-OH-vitamin D, fetuin-A, OPN, and calcium levels. No significant correlation was found between patients with VC and patients without VC in terms of fetuin-A, OPN, and 25-OH-vitamin D levels. CONCLUSIONS: VC is a frequent sign in patients undergoing HD and is not related to serum fetuin-A and osteopontin levels. Age, the presence of DM, and high PTH levels were independent predictors of VC in patients undergoing HD. Further studies are warranted to understand the mechanism underlying and the factors contributing to VC.

The evaluation of MDCT and quantitative first-pass perfusion in lung cancers.

OBJECTIVES: The aim of this study was the in vivo evaluation of tumor angiogenesis in lung cancers grouped according to their histopathological diagnosis, localization and necrosis characteristics determined using CT first-pass parameters. MATERIALS AND METHODS: The study was performed between January and April 2012 on 44 patients consisting of 38 males and 6 females who were diagnosed with lung cancer as a result of cytological and/or histopathological evaluations. Patients who had not received radiotherapy and/or chemotherapy previously were included in the study. Images were obtained for each patient by using the 64-detector MDCT scanner. Colored perfusion maps were created from the obtained images. Perfusion parameter measurements were performed by placing ROI at 3 different locations in the solid sections, avoiding the necrotic cystic areas of the masses. Obtained BV, BF, TTP, and MTT perfusion parameters were recorded. RESULTS: The BF values of central and peripherally located lung cancers that showed normal distribution were found to be statistically significantly different. No statistically significant difference was found between TTP values. The BV values of central and peripherally located lung cancers that did not show normal distribution showed a statistically significant difference. There was a statistically significant difference between the BV and BF values of lung cancer with and without necrosis that did not show a normal distribution and the BV and BF values of lung cancers with and without necrosis. CONCLUSIONS: Non-invasive evaluation of tumor perfusion of first-pass perfusion CT in lung cancers provides valuable information about tumor angiogenesis. However, we believe that peripheral and solid lung cancers will benefit more from treatments such as anti-angiogenetic drugs, radiotherapy and chemotherapy more than the centrally located and necrotic lung cancers and that perfusion CT will play a greater role in the evaluation of the efficiency of these treatments in the future.

A kidney transplant center's initial experiences in eastern Turkey.

OBJECTIVES: Kidney transplantation is the best treatment method associated with improved quality of life and better survival for patients with end-stage renal disease. We started performing kidney transplantations in November 2010. We have performed 19 kidney transplantations so far. Fourteen of these were from living donors and five from deceased donors. Here, we present our initial experiences with 14 kidney transplant recipients from living donor kidney transplantations. MATERIALS AND METHODS: All recipients and their donors underwent detailed clinical history and examination. Recipients and their donors were followed in the transplant clinic during hospitalization. RESULTS: The male-to-female ratio was 11:3 in recipients. The mean age of recipients was 27.8 years (range 4-58 years). The number of the related, emotionally related, and unrelated transplantations were 9, 3, 2, respectively. The mean warm ischemic time was 95.7 seconds (range 52-168 seconds). Urine output started immediately after vascular anastomosis in all. The mean time of discharge from hospital was postoperative day 8 (range 4-18 days). The mean flow up was 125 days (range 18-210 days). Graft survival was 100% in this period, but one patient died from sepsis after 56 days. No kidney was lost from rejection, technical causes, infection, or recurrent disease. CONCLUSION: If transplant centers are as equipped and experienced as ours, kidney transplant programs should be started immediately so that they can reduce the number of the patients in waiting list for kidney transplantation.

Blindness following rupture of hepatic hydatid cyst: a case report.

A 19 year-old woman admitted to Emergency Department with hypotension, sudden loss of vision and acute abdominal pain. Ultrasound and computed tomography demonstrated an occipital infarct in brain and ruptured intraperitoneal cyst of hydatid liver disease. Urgent laparotomy was performed and it included aspiration of cyst contents, peritoneal washing and drainage. Her vision loss improved by 15 hours postoperatively but generalized seizures were started. Weakness in all extremities was present. Cranial MRI demonstrated ischemia in the areas of middle, posterior and anterior cerebral arteries. She was discharged from the hospital with severe neurological deficits (unable to walk, not able to eat herself). Neurological deficits were improved with physiotherapy after two years. There was no recurrence of hydatid cysts in the follow-up of three years. We assumed that anaphylaxis after intraperitoneal rupture of hydatid liver cyst resulted with hypotension and reduced cerebral perfusion, caused the acute vision loss and other neurological symptoms. This unusual presentation of intraperitoneal rupture should be kept in mind particularly in endemic areas of hydatid disease.

Brain metabolite changes on proton magnetic resonance spectroscopy in children with poorly controlled type 1 diabetes mellitus.

The metabolite changes in the brains of children with poorly controlled type 1 diabetes mellitus (DM) were investigated by proton magnetic resonance spectroscopy (MRS). A total of 30 subjects and 14 age-matched healthy volunteers underwent single-voxel MRS (TE: 136). The duration of disease, medication, presence of hypoglycaemia episodes and the level of haemoglobin A1C (HbA1C) in the patients were noted. Voxels were placed in the pons, left basal ganglion (LBG) and left posterior parietal white matter (PPWM). N-acetylaspartate (NAA)/creatinine (Cr) and choline (Cho)/Cr ratios were calculated. The average HbA1c level was 11.9 +/- 3.4 (8.2-19.4). The average number of keto-acidosis episodes was 1.9 +/- 2.2 (0-9) and the average number of daily insulin injections was 2.8 +/- 0.97 (2-4). MRS revealed lower NAA/Cr and Cho/Cr ratios in the pons and lower NAA/Cr ratio in the PPWM of patients with DM than in control subjects. No significant correlation was observed between the number of hypoglycaemia episodes and metabolite ratios. Metabolic abnormalities have been observed by MRS in the brain of poorly controlled type 1 DM children. These metabolic changes, in particular in the pons region, include a decrease in NAA, indicating neuronal loss or functional impairment, and likely explanations for a decrease in Cho may be dynamic changes in membrane lipids and/or decreased membrane turnover.

Diffusion-weighted imaging in chronic Behçet patients with and without neurological findings.

Our aim was to investigate whether neurological impairment in chronic Behçet's disease (BD) patients with normal appearing brain can be assessed by means of diffusion-weighted imaging (DWI). The averaged apparent diffusion coefficient (ADC) values were calculated in 22 different radiologically normal appearing brain regions in 32 patients with and without neurological findings and 20 control subjects. The ADC values in bilateral frontal, temporal and occipital normal appearing white matter were significantly higher in the patient groups compared with the control subjects (p < 0.05). In these brain regions, DWI revealed differences in the ADC values between patients with neurological findings (including symptomatic and neuro-Behçet patients) and the asymptomatic patient group. The similarity of the ADC values of patients without symptoms to those of the control group allowed clear discrimination between patients with and without neurological findings. DWI may serve to assess subclinical neurological involvement in BD, even when structural changes are absent.

Maxillary brown tumor and uremic leontiasis ossea in a patient with chronic renal insufficiency.

Findings of renal osteodystrophy in cranial bones are not uncommon and include osteomalacia, osteosclerosis, erosion of the cortical bone, brown tumors and resorption of the lamina dura. However, massive thickening of the cranial vault and facial bones, called uremic leontiasis ossea, have been reported very rare. In the present article, we describe the case of an uncooperative female patient with a brown tumor, involving the left maxillary sinus and massive thickening of the cranial vault and facial bones, secondary to severe secondary hyperparathyroidism during 8 years of regular hemodialysis treatment.

Diffusion-weighted MR imaging of pleural fluid: differentiation of transudative vs exudative pleural effusions.

The aim of this study was to evaluate the ability of diffusion-weighted MRI in differentiating transudative from exudative pleural effusions. Fifty-seven patients with pleural effusion were studied. Diffusion-weighted imaging (DWI) was performed with an echo-planar imaging (EPI) sequence (b values 0, 1000 s/mm(2)) in 52 patients. The apparent diffusion coefficient (ADC) values were reconstructed from three different regions. Subsequently, thoracentesis was performed and the pleural fluid was analyzed. Laboratory results revealed 20 transudative and 32 exudative effusions. Transudates had a mean ADC value of 3.42+/-0.76 x 10(-3) mm(2)/s. Exudates had a mean ADC value of 3.18+/-1.82 x 10(-3) mm(2)/s. The optimum cutoff point for ADC values was 3.38 x 10(-3) mm(2)/s with a sensitivity of 90.6% and specificity of 85%. A significant negative correlation was seen between ADC values and pleural fluid protein, albumin concentrations and lactate dehydrogenase (LDH) measurements ( r=-0.69, -0.66, and -0.46, respectively; p<0.01). The positive predictive value, negative predictive value, and diagnostic accuracy of ADC values were determined to be 90.6, 85, and 88.5%, respectively. The application of diffusion gradients to analyze pleural fluid may be an alternative to the thoracentesis. Non-invasive characterization of a pleural effusion by means of DWI with single-shot EPI technique may obviate the need for thoracentesis with its associated patient morbidity.

Proton MRS in Behçet's disease with and without neurological findings.

Our aim was to investigate whether neurological impairment in Behçet's disease (BD) can be assessed by means of proton MRS and whether it can assist in prognosis. We used single-voxel MRS to measure metabolites in regions of normal-appearing pons, basal ganglia and periventricular white matter (PWM) in 32 patients with chronic BD patients with and without neurological deficits and 29 control subjects. Patients had significantly higher N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios in the basal ganglia than the controls. The Cho/Cr ratio in the PWM was also significantly higher in the patients. MRS enabled clear discrimination of patients and controls and also revealed spectral differences between non-neuro-Behçet's disease and neuro-Behçet's disease in the basal ganglia. MRS can be used to assess brain involvement in BD even if structural changes are absent.

Early MRI findings in stab wound of the cervical spine: two case reports.

MR imaging was found to be the most sensitive modality for the detection of spinal cord abnormalities in the acutely injured spine. Although it is reported that traumatic pneumomyelogram indicates a base-of-skull or middle cranial fossa fracture and is almost certainly associated with intracranial subarachnoid air, early MR imaging may demonstrate subarachnoid air in penetrating trauma of the spinal cord without head injury. We report two cervical-spine stab-wound cases, one of which had subarachnoid air on early MR findings.

Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis.

PURPOSE: The purpose of this study was to evaluate the Doppler sonographic blood-flow parameters and spectral patterns in the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA) in patients with active and inactive (remission-phase) ulcerative colitis (UC). METHODS: The IMAs and SMAs of 25 patients with active-phase UC (group 1), 19 patients with remission-phase UC (group 2), and 22 healthy, asymptomatic subjects (control group) were evaluated by duplex Doppler sonography. The 25 patients in group 1 were categorized into 2 subgroups on the basis of the extent of disease as determined by double-contrast barium enema x-ray study and colonoscopy. The first subgroup (group 1a) consisted of 11 patients with active involvement of the left colon from the rectum to the splenic flexure. The second subgroup (group 1b) consisted of 14 patients with active involvement of the entire colon. The peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vmean), resistance index (RI), and pulsatility index (PI) were determined from the Doppler spectral analysis. The inner diameter and cross-sectional area of the IMA and SMA were measured, and the blood-flow volume was calculated. The results were compared between the patient groups and control subjects. RESULTS: In the IMA, the mean blood-flow volume, mean PSV, mean EDV, and Vmean were significantly higher, the mean PI was significantly lower, and the mean diameter and the mean cross-sectional area were significantly larger in group 1 than in group 2 or in the control group (p < 0.001). The mean PSV and the Vmean of the IMA were significantly higher in group 1a than in group 1b (p < 0.05). The mean blood-flow parameters in the SMA were not significantly different between groups 1 and 2 or between either group 1 or group 2 and the control subjects. The mean EDV in the SMA was significantly higher and the mean PI and the mean RI were significantly lower in group 1b than in group 1a (p < 0.01). CONCLUSIONS: Duplex Doppler sonography of the IMA and SMA can be used to evaluate inflammatory disease of the large bowel, to assess disease extent, and to document response to therapy.

Supercritical CO(2) extraction of beta-carotene and lycopene from tomato paste waste.

Lycopene and beta-carotene were extracted from tomato paste waste using supercritical carbon dioxide (SC-CO(2)). To optimize supercritical fluid extraction (SFE) results for the isolation of lycopene and beta-carotene, a factorial designed experiment was conducted. The factors assessed were the temperature of the extractor (35, 45, 55, and 65 degrees C), the pressure of the extraction fluid (200, 250, and 300 bar), addition of cosolvent (5, 10, and 15% ethanol), extraction time (1, 2, and 3 h), and CO(2) flow rate (2, 4, and 8 kg/h). The total amounts of lycopene and beta-carotene in the tomato paste waste, extracts, and residues were determined by HPLC. A maximum of 53.93% of lycopene was extracted by SC-CO(2) in 2 h (CO(2) flow rate = 4 kg/h) at 55 degrees C and 300 bar, with the addition of 5% ethanol as a cosolvent. Half of the initially present beta-carotene was extracted in 2 h (flow rate = 4 kg/h), at 65 degrees C and 300 bar, also with the addition of 5% ethanol.

The crowned dens syndrome: a rare form of calcium pyrophosphate deposition disease.

The crowned dens syndrome has been termed as acute neck pain ascribed to CPPD deposits associated with a tomographic appearance of calcification surrounding the odontoid process. This rare entity resulting in cervical cord compression is generally seen in older female patients. We present a 26-year-old woman with cervical cord compression due to massive calcification in the periodontoid area and discuss the X-ray and CT findings of the disease.

Follicular thyroid cancer presenting initially with soft tissue metastasis.

Follicular thyroid cancer rarely manifests itself as a distant metastatic lesion. We report a case of an otherwise asymptomatic 58-year-old woman with follicular thyroid cancer who initially presented with a soft tissue mass on the right scapular region. An incisional biopsy specimen of soft tissue metastasis showed thyroid follicular neoplasm. Upon this diagnosis, the thyroid gland was re-evaluated by ultrasound, which demonstrated a solitary, hypoechoic nodule in the right lobe. Ultrasonography guided fine-needle aspiration biopsy of the thyroid nodule confirmed follicular neoplasm and the diagnosis of metastatic follicular thyroid cancer was established. The patient refused any type of treatment and left hospital against medical advice. 2.5 years later the patient was admitted to the hospital with giant, sarcoma-like multiple soft tissue masses. On this admission, the serum thyroglobulin level was extremely elevated (3500 ng/ml) and she only accepted to receive chemotherapy. Epirubicin and cyclophosphamide were administered. She received three courses of chemotherapy and is alive with a stable disease after 3 months of follow-up. This case of follicular thyroid cancer is reported because of its uncommon initial presentation with soft tissue metastasis which spread to multiple areas as giant soft tissue masses during follow-up.

Ruptured intracranial aneurysm associated with isolated aortic arch interruption.

Interruption of the aortic arch is a very rare congenital defect consisting of discontinuity between the ascending and descending aorta. Few patients survive to adulthood, due to effective collateral arterial flow to the descending aorta. An intracranial aneurysm is reported in only one patient with aortic arch interruption. We report a 16-year-old boy with an isolated aortic arch interruption and a ruptured anterior communicating artery aneurysm.

Cervical myositis ossificans traumatica: a rare location.

An unusual case of myositis ossificans traumatica lesion located in the paraspinal region is reported. Despite the contiguity of the lesion with the cervical vertebrae and ominous appearance of the biopsy material, the history of antecedent trauma and computed tomography findings allowed preoperative accurate diagnosis. To our knowledge, myositis ossificans traumatica located in the cervical paraspinal region is very rare.