Audiological abnormalities in patients with alopecia areata.

BACKGROUND: Audiological abnormalities seen in various autoimmune disorders raises the question of whether such abnormalities also exist in alopecia areata. OBJECTIVE: This study was performed to detect possible audiological abnormalities in Alopecia areata (AA) patients. METHODS: The study population consisted of 51 patients with AA and 51 healthy controls. Autoscopic and audiometric examinations of both ears were performed in patients and controls. Audiometric examinations were performed using a pure tone audiometer in a silent cabin. Pure tone thresholds were determined for each ear at frequencies of 250-16000 Hz for air conduction. RESULTS: Sensorineural hypoacusis was found in 28 patients with AA (54.9%). Six of these 28 patients showed unilateral minimal hearing loss (>30 dB) at high frequencies only (4000-16 000 Hz), while 22 showed bilateral minimal hearing loss (>30 dB) at high frequencies only (4000-16 000 Hz). Hypoacusis was observed in 13 control subjects (25.4%). Sensorineural hypoacusis was significantly more frequent in AA patients than controls (P = 0.002). CONCLUSION: Follicular melanocytes may be an important target in the autoimmune process of AA and AA may have an effect on hearing function by affecting the melanocytes in the inner ear. Therefore, there may be a relationship between sensorineural hearing loss and the autoimmune disease, AA.

Prognostic factors that affect the response to topical treatment in patchy alopecia areata.

BACKGROUND: Alopecia areata (AA) is an organ-specific, T-cell-mediated autoimmune disease that is characterized by non-scarring hair loss. OBJECTIVE: We aimed to find the factors that may affect the response to topical therapy in AA. METHODS: The study included a total of 60 patients with AA and 30 healthy control patients. The AA patients were randomized into two groups. 40 patients used 0.05% clobetasol propionate cream, and 20 patients used petrolatum (placebo). Both groups applied topical treatments to their lesions twice daily for 12 weeks. RESULTS: The mean extent of AA was 21.88 ± 16.75% in patients with autoantibodies and 12.16 ± 13.55% in those who were negative for autoantibodies (P = 0.021). Ophiasic pattern and nail involvement were observed more frequently in patients with atopy (P < 0.05). Relapse was more frequent in patients with atopy (P = 0.002) and nail involvement (P = 0.02). CONCLUSIONS: We observed that the presence of autoantibodies was associated with more extensive AA, and that ophiasic hair loss pattern and nail dystrophy were significantly associated with atopy. Topical clobetasol propionate treatment produced a modest advantage in hair regrowth as compared with placebo. Notably, atopic AA patients have a higher risk of relapse and redevelopment of AA after completing a course of topical corticosteroid treatment.

Pregnancy-associated myocardial infarction : case report and review of the literature.

Acute myocardial infarction (AMI) is a rare, but possibly catastrophic event during pregnancy, delivery, or puerperium, leading to a high mortality rate. It has different pathogenic mechanisms, such as atherosclerosis, vasospasm, thrombosis, and coronary dissection. Although MI has been reported in pregnant women at all stages of pregnancy and postpartum, it occurs more commonly in the third trimester. Pregnancy-associated MI most commonly involves the anterior wall. Pregnancy itself is an independent risk factor for MI, conferring a fourfold higher risk than that of nonpregnant women matched for age. We report the case of a 27-year-old primigravida at 30 weeks' gestation presenting with anterior MI, secondary to severe stenosis of the left anterior descending coronary artery, treated with emergency percutaneous coronary intervention.

Effect of intra-articular injection of levobupivacaine on articular cartilage and synovium in rats.

OBJECTIVE: Intra-articular local anesthetics are often used for prevention of pain after arthroscopic knee surgery. However, the effect of local anesthetics other than bupivacaine on articular cartilage and synovium has not been studied. Also, complications associated with the injection of intra-articular bupivacaine have appeared in the literature. The aim of this study was to evaluate the effects of levobupivacaine on the articular cartilage and the synovium in rats. METHODS: Under aseptic conditions 0.25 ml (5 mg/ml) of levobupivacaine was injected into the right knee joint while 0.25 ml of saline was simultaneously injected into the left knee joint of 20 adult Sprague-Dawley rats. The purpose of saline injections was to serve as a control group. Groups of five rats were killed on days 1, 7, 14 and 21 after administration of injections. The knee joint samples were evaluated for the presence of inflammation in the articular and periarticular tissues and the synovium. RESULTS: There were no significant differences between the levobupivacaine and control groups with respect to inflammation in the articular and periarticular tissues and the synovium. CONCLUSIONS: Although more studies are needed before final recommendations can be made, by evaluating the results obtained from this study, the clinical use of intra-articular levobupivacaine can be recommended for arthroscopic knee surgery.

Comparison of Flexiblade and Macintosh laryngoscopes: cervical extension angles during orotracheal intubation.

SUMMARY: The Flexiblade(TM) is a new laryngoscope with a flexible blade, a handle and a lever, allowing gradual flexion over the distal half of the blade. In this study, we aimed to compare cervical vertebral movements during tracheal intubation with the Flexiblade and Macintosh laryngoscope in 32 patients undergoing elective surgery requiring general anaesthesia (n = 16 per group). Fluoroscopic images of cervical movement were captured before, during and after intubation and evaluated by a radiologist. C1-C2 cervical vertebral movement was significantly reduced during the intubation in the Flexiblade group (p < 0.0001). C2-C3 cervical movement was similar in both groups (p = 0.81). No significant differences were noted in success rates for intubation, oxygen saturation levels, haemodynamic variables or intubation-related injury. The decreased extension angle between C1-C2 during Flexiblade laryngoscopy compared with Macintosh laryngoscopy may be an advantage where neurological damage with cervical movement is a concern.

Comparison of two ketamine-propofol dosing regimens for sedation during interventional radiology procedures.

AIM: Invasive diagnostic and therapeutic interventional radiological procedures can be painful and anxiety provoking. The combination of propofol and ketamine may minimize the need for supplemental opioid analgesics and has the potential to provide better sedation with less toxicity than either drug alone. METHODS: Seventy-two consenting ASA physical status I- III patients undergoing interventional radiological procedures under sedation were recruited according to a randomized, double-blind, institutional review board-approved protocol. Patients were randomized to two groups. Group 1 received propofol 0.5 mg.kg-1 + ketamine 0.5 mg.kg-1, and group 2 received propofol 0.5 mg.kg-1 + ketamine 0.25 mg.kg-1 intravenously. RESULTS: There were no significant differences between the two groups with respect to demographic characteristics and the duration of the interventional radiological procedure, hemodynamic data, oxygen saturation, or side-effects. However, the mean propofol dosage was higher in group 2 (33.7+/-39.3 mg) than in group 1 (15.5+/-22.3 mg), and the number of oversedated patients (sedation score >4) was higher in group 2 (19 patients) than group 1 (6 patients) (P=0.019 and P=0.001, respectively). Sixteen patients (44%) in group 1 and 21 (58%) patients in group 2 required additional propofol during the procedure. The mean recovery times were 12.1+/-1 minutes in group 1 and 13.8+/-0.8 minutes in group 2 (P>0.05). CONCLUSION: In conclusion, the two different dosages of ketamine coadministered with propofol for sedation during interventional radiological procedures showed no clinically significant hemodynamic changes or side effects, and both appeared to prompt early recovery time. We recommend propofol 0.5 mg.kg-1 + ketamine 0.5 mg.kg-1 for sedation and analgesia during interventional radiological procedures, rather than propofol 0.5 mg.kg-1 + ketamine 0.25 mg.kg-1 because the former combination is associated with reduced rescue propofol requirements and therefore less oversedation.

Comparison of propofol-fentanyl with propofol-fentanyl-ketamine combination in pediatric patients undergoing interventional radiology procedures.

BACKGROUND: With an increase in the frequency of interventional radiology procedures in pediatrics, there has been a corresponding increase in demand for procedural sedation to facilitate them. The purpose of our study was to compare the frequency of adverse effects, sedation level, patient recovery characteristics in pediatric patients receiving intravenous propofol fentanyl combination with or without ketamine for interventional radiology procedures. Our main hypothesis was that the addition of ketamine would decrease propofol/fentanyl associated desaturation. METHODS AND MATERIALS: Sixty consenting American Society of Anesthesia physical status I-III pediatric patients undergoing interventional radiology procedures under sedation were studied according to a randomized, double-blinded, institutional review board approved protocol. Group 1 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + ketamine 0.5 mg.kg(-1), and group 2 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + same volume of %0.9 NaCl intravenously. RESULTS: While apnea was not observed in any of the groups, there were three cases (10%) in group 1, and nine cases (30%) in group 2 with oxygen desaturation (P = 0.052). In group 1, 12 (40%) patients and, in group 2, 21 (70%) patients required supplemental propofol during the procedure (P = 0.021). There was no evidence for difference between groups in terms of other side effects except nystagmus. CONCLUSIONS: In conclusion, addition of low dose ketamine to propofol-fentanyl combination decreased the risk of desaturation and it also decreased the need for supplemental propofol dosage in pediatric patients at interventional radiology procedures.

Rhino-orbito-cerebral mucormycosis: report of two cases and review of the literature.

Rhino-orbito-cerebral mucormycosis (ROCM) is a rare, fulminant opportunistic fungal infection that is mostly seen in immunocompromised or diabetic patients. The disease should be recognised and treated immediately. We present here MR imaging findings of two patients with histopathologically proven ROCM. One of the cases had a history of corticosteroid treatment and iatrogenic diabetes mellitus and although amphotericin B was started immediately, the disease progressed and surgical debridement was necessary. The second case was a patient with diabetes mellitus type 1 in whom ROCM had occurred following an abdominal surgery; amphotericin B treatment alone was adequate in this patient.

Comparison of propofol/fentanyl and ketamine anesthesia in children during extracorporeal shockwave lithotripsy.

OBJECTIVE: Extracorporeal Shockwave Lithotripsy (ESWL) is an effective and safe way for treatment of upper urinary system stones. For pediatric patients, throughout ESWL, sufficient sedation and analgesia is needed to cope with the procedural pain. In this study, our goal was to compare 2 methods of intravenous anesthesia, applied to pediatric patients during ESWL. METHODS: Forty patients, between 3 months and 15 years of age who were admitted to the Faculty of Medicine, Hacettepe University, Turkey between September 2003 to September 2004 with upper urinary system calculi were randomized into 2 groups. All patients received intranasal midazolam 0.3 mg/kg premedication. Group K received intravenous (iv) ketamine 2 mg/kg; Group PF received a bolus of iv propofol 3 mg/kg and iv fentanyl 1 microg/kg along with a propofol infusion of 1 mg/kg/hr throughout the procedure. Procedural, recovery and discharge times, incidences of intra and post-procedural complications were compared. RESULTS: Demographics, procedural and discharge times were similar in 2 groups. While recovery times and post-procedural complication incidence was higher for the Group K, intra-procedural complication incidence was higher for the Group PF. CONCLUSION: Although both protocols do not differ much according to ease of application and efficacy in providing sufficient analgesia for ESWL, they have their corresponding side effects and they can only be practiced safely by experienced anesthesiologists in a monitorized and well equipped setting.

Parental satisfaction with pediatric day case surgery.

BACKGROUND AND AIMS: Children make excellent candidates for day case surgery. Satisfaction is an important measure of the outcome. The aim of this study was to establish the degree of parental satisfaction with day-case surgery for their children. MATERIALS AND METHODS: Parents of one hundred children were questioned. They were asked to answer questions on their level of satisfaction in several areas; communication with doctors (surgeon and anesthesiologist), physical conditions, staff's care, patients' problems and 2 open ended questions. RESULTS: Parents were most satisfied with nursing care and most dissatisfied with physical conditions. Ninetyseven per-cent of parents stated that, if given a choice they would opt for day case surgery for their child again. CONCLUSIONS: There is a high rate of satisfaction with day case surgery, however, considerable effort is needed to prepare better physical conditions, better time schedule organizations, more anesthesia outpatient clinic consultations.

Lack of effect of N-acetylcysteine treatment to ameliorate the progression of multiple organ failure.

OBJECTIVE: To investigate whether prolonged infusion of the oxygen free radical scavenger N-acetylcysteine (NAC) that is commenced immediately after admission to intensive care unit (ICU) could ameliorate the development or progression of multiple organ failure (MOF). METHODS: After receiving ethical committee approval, a prospective randomized, double-blind, placebo controlled study was performed in the Anesthesiology and Reanimation Intensive Care Unit, Hacettepe University Hospital, Ankara, Turkey between December 2002 and May 2003. Twenty-six patients were randomized to receive either NAC in 5% dextrose 40 mg/kg/day or the same volume of 5% dextrose both in 4 divided doses. Two patients were withdrawn due to ICU stay <24 hours. Treatment effect on organ function was assessed by the sequential organ failure assessment (SOFA) scores according to physiological parameters of respiratory, hematological, hepatic, cardiovascular, central nervous system (CNS) and renal system scores that were obtained on admission, then daily. Chi-square, Mann Whitney U tests were used for statistical analysis. RESULTS: There was no significant difference between the 2 groups in any of the 5 organ dysfunction parameters, total maximum SOFA, delta SOFA length of intensive care stay, days of mechanical ventilation and mortality. In the NAC treatment group, the maximum SOFA coagulation score was higher than the control group (p<0.05). CONCLUSION: N-acetylcysteine (40 mg/kg/day) that was commenced immediately after admission to ICU did not ameliorate the progression of MOF in this small cohort of patients. We believe routine prophylactic use of low-dose NAC in all critically ill patients does not provide positive protection.

MR peritoneography in complications of continuous ambulatory peritoneal dialysis.

BACKGROUND: We evaluated the usefulness of magnetic resonance (MR) peritoneography for the examination of complications from continuous ambulatory peritoneal dialysis (CAPD). METHODS: MR peritoneography was performed in 20 patients who had suspected CAPD-related complications. Patients who had active peritonitis were not included in the study. Before MR imaging, a mixture of 2000 mL of peritoneal dialysis solution and 20 mL of gadopentetate dimeglumine was instilled into the peritoneal cavity. MR imaging was performed on a 1.0-Tesla system using a body coil. Axial, coronal, and sagittal fat-saturated fast spoiled gradient echo (repetition/echo times, 100/6.3 ms; flip angle, 90 degrees), axial fat-saturated T2-weighted fast spin echo (repetition/echo times, 6000/107 ms), and coronal fat-saturated T2-weighted fast spin echo (repetition/echo times, 3000/96.2 ms) images of the abdomen and the pelvis were obtained. After drain-age, triplanar fat-saturated fast spoiled gradient echo images were repeated with the same parameters. RESULTS: Homogeneous distribution of the dialysate in the peritoneal cavity was detected in 18 patients (90%). In 12 patients (60%), fluid leaks were discovered peripheral to the exit site, tunnel, and site of peritoneal entrance of the catheter. Fluid leaks through the abdominal wall in five patients (25%), retroperitoneum in one patient (5%), and a previous operation site in one patient (5%) were demonstrated. No abnormal finding was detected in three patients (15%) who had clinically suspected complications, whereas a dialysate leak was found in two patients (10%) who had no significant finding at physical examination. CONCLUSIONS: MR peritoneography provides detailed information about the anatomic distribution of dialysate leaks in patients treated with CAPD and poses no risks associated with ionizing radiation and nephrotoxic contrast medium.

Duodenal angiodysplasia: MR angiographic evaluation.

We describe a patient in whom endoscopy failed to determine the origin of gastrointestinal bleeding, and magnetic resonance angiography showed dilated inferior pancreaticoduodenal veins that were considered indirect signs of the duodenal angiodysplasia. Incidentally, a connection between the inferior vena cava and the inferior pancreaticoduodenal veins were also noted. Repeat endoscopy and catheter angiography confirmed the presence of the angiodysplasias.

Upper cervical vertebrae movement during intubating laryngeal mask, fibreoptic and direct laryngoscopy: a video-fluoroscopic study.

BACKGROUND AND OBJECTIVE: Minimizing cervical vertebrae motion during endotracheal intubation is important in patients with cervical instability. The aim of this study was to compare upper cervical spine extension during endotracheal intubation using three different techniques. METHODS: Duration of intubation and movement of upper cervical vertebrae during endotracheal intubation were compared in 33 patients undergoing lumbar laminectomy. Patients requiring tracheal intubation under general anaesthesia and neuromuscular blockade were randomly allocated into three groups - direct laryngoscopy, intubating laryngeal mask (LM) airway and fibreoptic laryngoscopy. The procedure was recorded by video-fluoroscopy and analysed with computer-assisted measurements. The maximum movement of the C1/C2 and C2/C3 vertebrae during intubation were obtained. Data were analysed using one-way analysis of variance with Bonferroni and Kruskal-Wallis tests. RESULTS: We found statistically significant movement between the first and second, but not between the second and third cervical vertebrae. The mean (+/-SD) movement at C1/C2 was 10.2 +/- 7.3 degrees with direct laryngoscopy, 5.0 +/- 6.3 degrees with LM and 1.6 +/- 3.2 degrees with fibreoptic laryngoscopy. This difference was statistically significant (P = 0.01) between the direct and fibreoptic laryngoscopy groups. The maximum movement at C2/C3 was 2.2 +/- 10.1 degrees with direct laryngoscopy, 3.5 +/- 5.1 degrees with LM and 0.5 +/- 3.2 degrees with fibreoptic laryngoscopy. Duration of intubation was significantly longer in the intubating LM group (P < 0.001). CONCLUSION: We conclude that fibreoptic laryngoscopy is the more suitable intubation technique when cervical spine movement is not desired.

Retrorectal dermoid cyst in a male adult: case report.

We describe a 48-year-old male patient who presented with rectal fullness and pain. Magnetic resonance imaging (MRI) and computed tomographic studies revealed a noncalcified, unilocular, cystic mass lesion with well-defined borders. On MRI nondependent fat spheres were detected inside the cyst. The same pattern has been described in dermoid cyst of the ovary. We suggest that this MRI pattern is specific to dermoid cysts.

Morphometric comparison of the human corpus callosum in professional musicians and non-musicians by using in vivo magnetic resonance imaging.

The purpose of this study was to determine the possible morphometrical differences of the corpus callosum between professional musicians and non-musicians. Certain callosal dimensions and areas were measured in 20 professional musicians and compared with 20 age-, sex- and handedness-matched control group by using in vivo magnetic resonance imaging (MRI). Sagittal T1-weighted midsagittal sections were traced with the digitizer and the metric scale of the system was used for the measurements. Results were statistically analysed by independent t test. There were significant differences between the two groups both for the anterior and posterior areas of the corpus callosum. Furthermore, significant differences between the two groups were found in the thicknesses of certain parts of the corpus callosum. Our results support the hypothesis that brain morphology is prone to plastic changes caused by environmental factors.

Intracranial lipoma with extracranial extension through foramen ovale in a patient with encephalocraniocutaneous lipomatosis syndrome.

We present CT and MR features of a large intracranial lipoma located in the left sphenocavernosal region in a patient with a history of spinal intradural lipoma excision. The lipomatous lesion surrounded the internal carotid artery and trigeminal nerve and extended extracranially into the infratemporal region through a smoothly dilated foramen ovale.

A rare cause of cervical spinal stenosis: posterior arch hypoplasia in a bipartite atlas.

We describe CT and MRI of a previously unreported combination of atlantoaxial anomalies consisting of posterior arch hypoplasia in a bipartite atlas with an os odontoideum, in a 30-year-old woman presenting with neck and left arm pain. MRI showed the os odontoideum, marked stenosis of the spinal canal at the level of the atlas, with cord compression and evidence of myelopathy. CT revealed a bipartite atlas with midline clefts in anterior and posterior arches, thickening in the anterior arch and hypoplasia of the posterior arch with incurving of both hemiarches. Flexion and extension radiographs demonstrated atlantoaxial instability.

Frontal sinus mucocele: a rare complication of craniofacial fibrous dysplasia.

We present plain radiographic, computed tomographic and magnetic resonance imaging (MRI) findings in a 25-year-old female patient with craniofacial fibrous dysplasia (FD). Although FD has a tendency to involve craniofacial bones in a unilateral fashion, the involvement was bilateral and extensive in this case. An additional feature was the presence of a frontal sinus mucocele, presumably due to the involvement of the sinus recess by the dysplastic process. This complication of the craniofacial FD has been reported very infrequently in the literature.