Life-threatening angiomyxoma of the larynx.

BACKGROUND: Angiomyxoma is a benign proliferative mesenchymal tumor and a very rare mass in the larynx. There is not enough information about the etiology, clinical finding, treatment and prognosis of laryngeal angiomyxoma. CASE DETAILS: A 52 years old man presented with respiratory distress. Also, he had suffered from dysphagia, dysphonia, cough, and obstructive sleep apnea in the supine position for 6 months. He was operated on via transoral approach under general anesthesia with orotracheal intubation. The mass was encapsulated and completely removed. The histopathologic diagnosis was reported as angiomyxoma. CONCLUSION: Angiomyxoma should be considered in the differential diagnosis of the larynx masses. The treatment of angiomyxomas of the larynx is surgical. The mass can be usually excised intraorally or endoscopically.

Color Doppler Imaging of the Orbital Vessels in Ankylosing Spondylitis.

PURPOSE: To analyze the hemodynamic features of orbital blood flow velocities using Doppler ultrasonography in ankylosing spondiylitis (AS) patients, as well as to compare these results with those of healthy controls. METHODS: 33 AS patients and 32 healthy controls were consecutively included in the study groups. The same radiologist performed ocular blood flow measurements. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured in the central retinal artery (CRA), posterior ciliary arteries (PCAs), and ophthalmic artery (OA). Resistive index was used to assess arterial resistance; it was automatically calculated as RI [(PSV-EDV)/PSV]. RESULTS: There were no significant differences in the PSV, EDV, and RI of the OA, CRA, and PCAs between AS patients and controls. CONCLUSION: This result suggests no possible contributory role of vascular structures in formation of uveitis in AS. We believe that our preliminary results need to be complemented with further studies, particularly including AS patients with uveitis and rheumatic diseases with other ocular involvement.

Hormone replacement therapy-related changes in the early postmenopausal period (critical window): an in vivo brain proton magnetic resonance spectroscopy study.

AIM: Findings from clinical studies in postmenopausal women with late initiation of hormone replacement therapy (HRT) that test whether HRT protects cognitive functions in women are inconsistent. The aim of this study was to investigate the effects of HRT on brain metabolite ratios when initiated in the early postmenopausal period (critical window). MATERIALS AND METHODS: Proton magnetic resonance spectrometry (1H MRS) was performed in 4 brain regions of 47 healthy postmenopausal women (21 received HRT, 26 did not). The subjects were aged between 45 and 65 years. The duration of HRT ranged from 1 to 12 years (mean: 6.3 years). The duration of menopause was 2-12 years (mean: 6.1 years) for HRT users and 1-20 years (mean: 7.8 years) for non-HRT users. Metabolite ratios [N-acetyl aspartate/choline (NAA/Cho), NAA/creatine (Cr), and Cho/Cr] were evaluated. RESULTS: Cho/Cr ratios were significantly increased and NAA/Cho ratios significantly decreased in all 4 regions in the HRT user group compared to the other group after elimination of the effects of age and menopause duration. Regression analysis revealed an association only between NAA/Cho and duration of menopause. CONCLUSION: HRT-related changes in metabolite ratios are found in all brain regions. Decreased NAA/Cho and increased Cho/Cr levels do not support the neuroprotective role of HRT in the critical window.

Relation between radiographic BI-RADS scores and triple negativity in patients with ductal carcinomas.

UNLABELLED: The aim of this study was to investigate association of radiographic (BI-RADS 4 and 5) results and prognostic factors of invasive ductal carcinomas with their histopathological subtypes. A total of 103 patients histopathologically diagnosed with invasive ductal carcinoma of breast with in last five years period were enrolled. Of them, 69 patients who had radiological reports in were included from registry of Radiology Department; Duzce University Training and Research Hospital archives. BI-RADS scores (4 and 5) of radiological reports and subtypes of ductal carcinoma were compared. Of 69 cases, 12 of 22 cases with BIRADS 4 score were Triple negative (TN) while 5 of 47 cases with BIRADS 5 score were TN (p = 0.001). The patients with TN tumors were found to have lower average age, higher grade, higher Ki67 proliferative index and fewer lymph node metastasis than those with non-TN ductal carcinomas (p = 0.048; 0.019; 0.02; 0.048 respectively). CONCLUSIONS: Patients who had radiological BIRADS 4 score were significantly more frequent TN type carcinoma than BI-RADS 5. It is important to pay attention to this issue when clinicians evaluate patients with BI-RADS 4 score breast lesions.

Spectrum and prevalence of nodular thyroid diseases detected by ultrasonography in the Western Black Sea region of Turkey.

OBJECTIVE: The aim of the study was to investigate thyroid diseases and the prevalence of goiter by ultrasonography (US) in a moderately iodine deficient area. MATERIAL-METHODS: The MELEN Study is a prospective cohort study on the prevalence of thyroid diseases in Turkish adults. A total of 2233 subjects with a mean age of 50 (age range 18 to 92) were submitted to study. Thyroid US was performed and interpreted by the same experienced physician. Goiter prevalence was defined according to Gutekunst's criteria. RESULTS: The most common thyroid disease was multinodular goiter (MNG) (42%), followed by nodular goiter (NG) (14.6%). The crude prevalence of nodular disease in the region was 56.6%. In the study cohort, thyrotoxicosis (TSH <0.35 µIU/ml) prevalence was 12 % and subclinical and overt hypothyroidism (TSH > 4.5 µIU/ml) prevalence was 6.5 %. CONCLUSION: We found that thyrotoxicosis and nodular thyroidal diseases are more important public health issues in moderate iodine deficient geographical areas. We recommend the increased rates of US screening especially in the endemic regions in order to detect thyroidal nodules earlier.

Giant myoepithelioma of the soft palate.

Myoepitheliomas are benign salivary gland tumors and account for less than 1% of all salivary gland tumors. They are usually located in the parotid gland. The soft palate is very rare affected site. The differential diagnosis of myoepitheliomas should include reactive and neoplastic lesions. The treatment of myoepitheliomas is complete removal of the tumor. Herein, we report a case with giant myoepithelioma of the soft palate, reviewing the related literature.

Dual diagnosis: rheumatoid arthritis and multiple sclerosis.

Juvenile rheumatoid arthritis (JRA) is the most common rheumatologic disease in children. Moreover, multiple sclerosis (MS) is the most frequent demyelinating disease and has been associated with various chronic inflammatory diseases. However, its association with JRA has not been frequently described. Autoimmunity in both JRA and MS has been documented in the scientific literature, although there has been no definitive finding that patients with JRA are prone to the development of MS. An increasing frequency of MS resulting from an increased use of antitumor necrosis factor agents in the treatment of rheumatoid arthritis and other chronic inflammatory diseases has been reported recently. In this study, we report on the development of MS in a patient with JRA who did not have a history of antitumor necrosis factor use.

Minimally invasive treatment of giant haemangiomas of the liver: embolisation with bleomycin.

PURPOSE: The management of patients with giant haemangioma of the liver remains controversial. Although the usual treatment method for symptomatic giant haemangioma is surgery, the classical paradigm of operative resection remains. In this study, we evaluated the symptomatic improvement and size-reduction effect of embolisation with bleomycin mixed with lipiodol for the treatment of symptomatic giant hepatic haemangioma. METHODS: This study included 26 patients [21 female, five male; age 41-65 years (mean 49.83 ± 1.53)] with symptomatic giant haemangioma unfit for surgery and treated with selective embolisation by bleomycin mixed with lipiodol. The patients were followed-up (mean 7.4 ± 0.81 months) clinically and using imaging methods. Statistical analysis was performed using SPSS version 16.0, and p < 0.05 was considered to indicate statistical significance. RESULTS: Embolisation of 32 lesions in 26 patients was performed. The mean volume of the haemangiomas was 446.28 ± 88 cm(3) (range 3.39-1559 cm(3)) before intervention and 244.43 ± 54.38 cm(3) (range 94-967 cm(3)) after intervention. No mortality or morbidity related to the treatment was identified. Symptomatic improvement was observed in all patients, and significant volume reduction was achieved (p = 0.001). CONCLUSION: The morbidity of surgical treatment in patients with giant liver hemangioma were similar to those obtained in patients followed-up without treatment. Therefore, follow-up without treatment is preferred in most patients. Thus, minimally invasive embolisation is an alternative and effective treatment for giant symptomatic haemangioma of the liver.

The prevalence of fibromyalgia among patients with hepatitis B virus infection.

Fibromyalgia (FM) is a syndrome characterized by widespread and chronic musculoskeletal pain, fatigue, morning stiffness, and sleep disturbance. However, the etiopathogenesis of FM remains unclear. Various etiological factors have been suggested to trigger FM. These include systemic rheumatismal disease, physical trauma, psychological disorders, and chronic infections. We determined the prevalence of FM in patients with chronic active hepatitis B virus (HBV) and inactive hepatitis B carriers, compared with matched healthy controls. Seventy-seven HBV patients (39 HBV carriers and 38 with chronic active hepatitis), were evaluated for FM syndrome. Seventy-seven HBsAg-negative healthy subjects were enrolled as a control group. We found that FM was very prevalent in patients with HBV infections (22% of the total). We found no difference in FM prevalence when patients with chronic active hepatitis B infections (21% FM prevalence) and those who were inactive hepatitis B carriers (23% FM prevalence) were compared. FM was not associated with the levels of HBV-DNA, ALT, or AST. Recognition and management of FM in HBsAg-positive patients will aid in improvement of quality-of-life. We fully accept that our preliminary results require confirmation in studies including larger numbers of patients. More work is needed to allow us to understand the role played by, and the relevance of, infections (including HBV) in FM syndrome pathogenesis.

The evaluation of atherosclerosis in migraine patients.

A potential association might exist between atherosclerosis and migraine. Carotid intima-media thickness (CIMT) is a marker of generalized atherosclerosis; hence, we aimed to assess CIMT in migraine patients. This study included 30 patients and 60 healthy controls aged between 20 and 40 years. Episodic migraine diagnosis was made according to the criteria of International Headache Society (IHS). Healthy controls who do not suffer any headache problems were selected from among hospital and laboratory staffs. All subjects were evaluated regarding some parameters and features known to be associated with migraine and vascular changes, that is, gender, age, body mass index, blood pressure, cholesterol, smoking habits, used hormonal contraceptives, and history of disease. The left common carotid arteries of the subjects were examined, and CIMT was measured with real-time gray-scale sonography. Mean values and standard deviations were calculated. All measurements were made in migraine-free periods. Migraine patients and control subjects were well matched for those parameters known to be associated with vascular changes, that is, gender, age, BMI, blood pressure, and cholesterol. CIMT values were higher in patients. The results showed that the mean CCA IMT values were 0.493 ± 0.074 mm and 0.409 ± 0.053 mm in migraine patients and controls, respectively (P < 0.001). There is a relationship between atherosclerosis and inflammation in migraine patients. The risk of cranial inflammatory arteriopathy increases in repeated attacks of migraine. Our study also supports that high number of attacks and attack duration are important in the development of atherosclerosis.

Do energy drinks cause epileptic seizure and ischemic stroke?

Energy drinks are popular among young individuals and marketed to college students, athletes, and active individuals between the ages of 21 and 35 years. We report a case that had ischemic stroke and epileptic seizure after intake of energy drink with alcohol. To the best of our knowledge, the following case is the first report of ischemic stroke after intake of energy drink. A previously healthy 37-year-old man was brought to the emergency department after a witnessed tonic-clonic seizure. According to his wife's testimony, just before loss of consciousness, the patient had been drinking 3 boxes of energy drinks (Redbull, Istanbul, Turkey, 250 mL) with vodka on an empty stomach. He did not have a history of seizures, head trauma, or family history of seizures or another disease. In cranial diffusion magnetic resonance imaging, there were hyperintense signal changes in bilateral occipital area (more pronounced in the left occipital lobe), right temporal lobe, frontal lobe, and posterior parietal lobe. All tests associated with possible etiologic causes of ischemic stroke in young patients were negative. Herein, we want to attract attention to adverse effect of energy drink usage.

May headache be the first sign of mutation in the MTHFR gene?

BACKGROUND: Cerebral venous thrombosis (CVT) is a rare disease and it has different etiologies. Inherited or acquired prothrombotic state plays a key role in the development of CVT. METHODS: A 28-year-old man who presented to our emergency department with persistent headache and accompanied by complaints of nausea and vomiting over a week. Neurologic examination revealed bilateral papilledema. Brain computed tomography showed a hyperdense area on the posterior part of the occipital lobe. Brain magnetic resonance imaging and magnetic resonance venography revealed thrombosis of CVT. Homozygous mutations were found for methylenetetrahydrofolate reductase (MTHFR). MTHFR CG677T gene mutation and blood tests showed elevated homocysteine levels on the etiological screening. There was no other etiology for CVT. RESULTS: Headache and other complaints were improved after treatment of heparin, warfarin, and vitamin B12. No recurrence of symptoms was observed upon outpatient follow-up. CONCLUSION: Since CVT is an important cause of headache, we recommend etiology screening for patients who present with CVT for MTHFR gene mutations and family counseling should be provided.