Adiponectin and visfatin levels in extremely low birth weight infants; they are also at risk for insulin resistance.

AIM: The aim of this study was to assess adiponectin, visfatin, HOMA-IR, glucose and triglyceride levels in term, preterm and extremely low birth weight (ELBW) babies. Each of these three groups was subdivided into two groups as small-for-gestational age (SGA), and appropriate-for-gestational age (AGA). 30 term, 30 preterm and 30 extremely low birth weight infants were included into the study. RESULTS: There was no significant difference in term and preterm infants for serum adiponectin, visfatin, and HOMA-IR levels. There were also no significant differences between term and preterm infants for glucose and triglycerides. The serum visfatin, insulin and HOMA-IR levels (p = 0.001, p = 0.001 and p < 0.05, respectively) were higher in ELBW group than preterm group. Comparing the subgroups as SGA and AGA in all main groups, only in ELBW group there were no significant differences in serum adiponectin, visfatin, HOMA-IR and insulin levels. CONCLUSIONS: We suggest that visfatin can be used as an early indicator of insulin resistance. Independent of being SGA, ELBW itself may be a risk factor for insulin resistance. In the follow-up of these babies the risk of obesity, metabolic syndrome and cardiovascular diseases may be increased as in SGA babies.  

Is heparinization necessary in the early postoperative period of renal transplantation from cadaveric donors?

INTRODUCTION: Venous thromboemboli and bleeding are the complications that threaten the graft and patient's life in the early postoperative period after cadaveric renal transplantation. For this reason, heparin administration after renal transplantation should be administered carefully. The aim of this study was to evaluate the necessity for heparinization after cadaveric renal transplantation. METHODS: Between March 2009 and October 2010, we formed 2 study groups among 50 recipients who underwent either cadaveric (n = 25) or living donor transplantations (n = 25). We did not observe any risk factors for thromboembolism while group 1 did not undergo heparinization, group 2 received a prophylactic dose of low-molecular weight heparin for 1 week. Doppler ultrasonography (USG) was performed between postoperative 24-48 hours to examine the transplanted kidney vessels, and in one group 1 case for a bilateral lower extremity venous system examination. We were also compared postoperative thromboembolic and hemorrhagic complications, lymphorrhagia, and serum creatinine levels. RESULTS: The female/male ratios in group 1 and 2 were 14/11 and 8/17 with mean ages of 36.7 (range, 17-51) and 35.9 (range, 17-59) years, respectively. The mean preoperative serum creatinine levels were 7.9 ± 2.9 mg/dL and 6.8 ± 2.4 mg/dL, and at postoperative week 1, they were 5.1 ± 4.3 mg/dL and 1.2 ± 0.5 mg/dL, respectively. We did not encounter any partial or total thrombus upon doppler USG studies for renal and lower extremity venous systems. No clinical symptoms of pulmonary emboli were detected in any patients. Only 1 subject group 2 experienced massive postoperative bleeding. CONCLUSION: Herein, we have reported that, except for the patients with risk factors for venous thromboemboli, heparinization was not necessary in the early postoperative period and did not add benefits to outcomes of cadaveric renal transplant recipients.

Cervical Castleman's disease: imaging findings.

Castleman's disease, a lymphoproliferative disease of unknown etiology, rarely causes a neck mass and may mimic granulomatous, inflammatory and metastatic lymph nodes, or lymphoma with its nonspecific imaging findings. Definitive diagnosis and treatment is possible with complete surgical resection. Imaging findings of a case with Castleman's disease detected during multinodular goiter surgery and later verified through excisional biopsy are presented. This report, as far as we know, is the first evaluation of the disease with sonography, Doppler sonography, CT, MR imaging, and digital subtraction angiography (DSA) findings.

Management of vascular injuries of the extremities. One hundred and fifteen cases.

In between the years 1984-1989, 115 peripheral arterial injuries were admitted to the Emergency Surgical Unit of Istanbul Medical Faculty. Seventy-two patients (62%) had upper extremity and 43 patients (38%) had lower extremity vascular injuries. Twenty-eight of these cases (24%) were due to blunt trauma, angiographic studies were obtained in 26 patients. There were 9.5% mortality and 7% amputation rate. We conclude that arterial injuries deserves early recognition, rapid fixation of osseous injuries, wide debridement, fasciotomy in blunt injuries and proper antimicrobial therapy.

Spontaneous perirenal haematoma due to polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a systemic disease which involves the kidneys in 70% of cases. We report a case in which the pre-operative diagnosis was perirenal abscess or perirenal tumour, but at operation a perirenal haematoma was found. After pathological examination, it was recognised as renal involvement with PAN. The diagnosis of PAN is often difficult. Renal arterial changes, including aneurysm formation, are frequent. Since Kussmaul and Maier first described PAN in 1866, diagnosis has remained difficult because it is based upon tissue examination obtained at biopsy or post-mortem. In this report we present a case of renal involvement of PAN resulting in a perirenal haematoma due to spontaneous rupture of intrarenal arterial aneurysms.