The prevalence and clinical correlates of metabolic syndrome in patients with schizophrenia: findings from a cohort in Turkey.

Most studies point to an increased prevalence of metabolic syndrome (MS) and an increased risk of coronary heart disease (CHD) in schizophrenia patients with MS. The aims of this study were to compare the prevalence of MS in schizophrenia patients with the general population, to explore the clinical correlates and predictors of MS and to evaluate the risk for CHD within 10 years. Consecutive 319 patients, aged 18-75 years, with a diagnosis of schizophrenia according to the DSM-IV were enrolled. The ATP-III, the ATP-IIIA and the IDF criteria were used to define MS. 10-year risk of CHD events was calculated with the Framingham score. One hundred nine (34.2%) patients met the ATP-III criteria, 118 (37%) the ATP-IIIA and 133 (41.7%) the IDF criteria for MS. Patients with MS were older, had a later onset of illness and an older age at first hospitalization. The prevalence of MS in schizophrenia patients was higher from the general population only within the 20-29 age group. Patients with MS had a higher age and sex-corrected 10-year risk of CHD events. The only predictor of MS was the age of illness onset. In conclusion, countries where the general population prevalence of MS is already too high, schizophrenia patients younger than 30 years of age might be under higher risk of morbidity and mortality related with MS. This study points to the necessity for aggressive interventions to correct MS in schizophrenia as early as possible, within the first 10 years of post detection.

No alteration in bone mineral density in patients with periodontitis.

Alveolar bone destruction can be magnified in the presence of generalized skeletal disorders. We questioned whether severe generalized periodontitis patients display signs of bone metabolism disturbances. Our objective was to assess skeletal bone mineral density (BMD) and biochemical bone parameters in premenopausal women with periodontitis. Forty-five patients and 40 control individuals were included in the study. We measured BMD by dual-energy x-ray absorptiometry. The results showed no difference in BMD values between the periodontitis and control groups (p > 0.05). A positive relationship between the clinical attachment level and Body Mass Index (BMI) scores was observed (p = 0.03). Increased serum creatinine levels were noted in the periodontitis group (p = 0.04). Analysis of the data suggests that there is no evidence for an association between skeletal BMD and severe periodontitis in premenopausal women. There may be a link between elevated creatinine levels and periodontitis. The persons with high BMI scores seemed to be at risk for periodontitis.

Capture-recapture methods for estimation of fertility and mortality in a rural district of Turkey.

The study used capture-recapture methods to determine if information on births, deaths and family planning use obtained from two data sources provides the same or more complete information than that available from a single source. Five different data sources used were: village heads (mukhtars), community health volunteers, primary health care centres, maternal and child care units and local administrative units (health group presidencies) in 10 selected villages in a rural area of Turkey from May to October 1999. Although the numbers of deaths and births were estimated, no estimation of the number of women using any family planning method could be made. The study highlights some data collection problems of the surveillance system in Turkey and recommends that the routine surveillance systems be strengthened.

Capture-recapture methods for estimation of fertility and mortality in a rural district of Turkey

The study used capture-recapture methods to determine if information on births, deaths and family planning use obtained from two data sources provides the same or more complete information than that available from a single source. Five different data sources used were: village heads [mukhtars], community health volunteers, primary health care centres, maternal and child care units and local administrative units [health group presidencies] in 10 selected villages in a rural area of Turkey from May to October 1999. Although the numbers of deaths and births were estimated, no estimation of the number of women using any family planning method could be made. The study highlights some data collection problems of the surveillance system in Turkey and recommends that the routine surveillance systems be strengthened

Acute disseminated encephalomyelitis in children: outcome and prognosis.

BACKGROUND: Acute disseminated encephalomyelitis (ADEM) is the most common demyelinating disorder of childhood. Its clinical features, prognosis and treatment vary in different reports. OBJECTIVES: To examine a series of children with ADEM for clinical findings, course, recurrences, and possible variables affecting outcome. METHODS: Multicentric data collected from 7 tertiary referral centers were registered and evaluated in a central database in 1990 - 2001 for clinical, laboratory, and MRI features. Course and prognosis were assessed in patients with at least 12 months' follow-up. RESULTS: Forty-six patients were evaluated. Median age at onset was 8 years, M/F ratio, 1.7/1. Most common symptoms and signs pertained to the motor system and consciousness. Of 39 children with 12 months' follow-up, 71 % recovered completely. Thirteen (33 %) children had relapses. Patients who had more than one relapse (n = 4) presented with new symptoms at each attack. Treatment with high-dose methylprednisolone was associated with complete recovery, and tapering over more than 3 weeks, with a lower rate of relapses. MRI lesions could persist even in asymptomatic patients; in particular, periventricular lesions tended to disappear later than others. CONCLUSIONS: Complete clinical recovery is common and serious complications are rare in childhood ADEM, but the rate of relapses is considerable. Clinical picture at first relapse may help to identify patients likely to experience multiple relapses. The timing and duration of steroid treatment affects outcome.

Scanning laser polarimetric analysis of retinal nerve fiber layer thickness in Turkish patients with glaucoma and ocular hypertension.

PURPOSE: To assess the thickness of the retinal nerve fiber layer (RNFL) in patients with different stages of glaucoma, in comparison with ocular hypertensive (OHT) and healthy subjects in a Turkish population. METHODS: Scanning laser polarimetry was done with a GDx Nerve Fiber Analyzer (NFA, GDx version, 1.0.08) on 270 eyes with glaucoma, 52 OHT eyes, and 81 normal eyes. The eyes were classified as having early (146 eyes), moderate (66 eyes) and severe (58 eyes) glaucoma based on the Humphrey Visual Field indices. We compared 14 NFA parameters by analysis of variance (ANOVA) and Scheffe multiple comparison analysis. Receiver operator characteristic curves (ROC) and Fisher linear discriminant analysis (LDF) were used to measure the sensitivity and specificity of the NFA parameters. RESULTS: Except for symmetry, all NFA parameters showed significant differences between the groups (p<0.05). The eyes with glaucoma had significantly thinner RNFL than healthy eyes (p<0.01). The RNFL retardation measurements of OHT eyes were lower than controls, but higher than the early glaucoma group. The sensitivity and specificity of the GDx System were 87% and 72.8%, respectively. Applying LDF, the group with the highest sensitivity and specificity (85.9% and 74.1%) was determined as inferior ratio, superior/nasal ratio, superior maximum and the Number. CONCLUSIONS: Assessment of RNFL thickness with scanning laser polarimetry can distinguish glaucoma, OHT and normal subjects with relatively high sensitivity and specificity.

Renal pelvic pressure responds with augmented increases to increments in intraabdominal pressure.

BACKGROUND/PURPOSE: Flow of a fluid through a collapsible tube is under the influence of various factors including the external compressing pressure. Because the intraabdominal pressure may compress the ureter, an experimental study has been planned to determine and compare the normal intraabdominal and renal pelvic pressures and the alterations in renal pelvic pressure in response to the increments in intraabdominal pressure in the rabbits. METHODS: Eight adult rabbits were used for the experiment. Under general anesthesia, an urethral catheter, a nasogastric tube, and an intraperitoneal catheter were placed to measure intravesical (IVP), intragastric (IGP), and intraabdominal pressures (IAP), respectively. Intracranial pressure monitorization catheter was placed into the renal pelvis to monitor intrapelvic pressure (IPP). Basal pressure measurements have been recorded. The pressures have been recorded in every 5 minutes, and IAP has been increased gradually about 3 to 4 cm of water pressure in every step for 30-minute periods. RESULTS: Increases in the intrapelvic pressure values have been significantly higher than the increases in the IAP (P < .001). A significant correlation has been found between IPP and IAP (P = .000, r = 0.866). By using linear regression analysis the relationship has been found to be IPP = 7.303 + 1.985 (IAP). Intragastric pressure values have been higher compared with IAP values (P < .001), whereas intravesical pressures have not differed from IAP (P > .05). CONCLUSIONS: Elevations in IAP results in augmented increases in the IPP. Poiseuille and Laplace Laws suggest this augmented increase to resemble proximal ureteric obstruction. Increases in IAP may simulate proximal ureteric obstruction and may take part in the pathogenesis of hydronephrosis. J Pediatr Surg 36:901-904.

Functional magnetic resonance imaging in children with Asperger's syndrome.

Asperger's syndrome is a pervasive developmental disorder of unknown etiology. We evaluated children with this syndrome (n = 9) and control (n = 8) children by functional magnetic resonance imaging (MRI) during a task involving social judgment. All control and 5 of 9 subjects with Asperger's syndrome showed signal intensity changes in frontal regions. Four patients with Asperger's syndrome, including one case with right frontal dysplasia, had no signal intensity change during the task. In this first functional MRI study of childhood Asperger's syndrome, frontal activation patterns demonstrated some differences between patients and normal subjects. Further studies using other functions frequently impaired in Asperger's syndrome are warranted.

MR imaging of pelvic and thigh muscles in congenital muscular dystrophy.

To define and compare the magnetic resonance (MR) imaging findings of pelvic and thigh muscles in merosin-deficient and merosin-positive congenital muscular dystrophy, 10 patients with merosin-positive and six patients with merosin-deficient muscular dystrophy were examined in a 0.5 T MR imaging unit. Intensity and atrophy scores were given to individual muscles by two radiologists and were calculated for three muscle groups (pelvic, anterior thigh and posterior thigh muscles). Rectus femoris was affected less than the vastus muscles in 40 percent of cases in merosin-positive patients, whereas there was no selective sparing in merosin-deficient patients. Sartorius and gracilis were relatively spared in both groups. The most consistently affected muscles were gluteus maximus, adductor magnus and brevis in merosin-positive patients. Atrophy was more prominent in the adductor muscles in the merosin-deficient group. Intensity scores of anterior thigh muscles of the merosin-positive group were significantly higher than those of the merosin-deficient group (U = 8, p = 0.016). When stepwise logistic regression model was applied, intensity score of the anterior thigh muscles was found to be the best differentiating variable. The regression analysis model formed was able to differentiate the two forms with a sensitivity of 80 percent and specificity of 83 percent.

Retinal nerve fiber layer analysis and interpretation of GDx parameters in patients with tilted disc syndrome.

This study was conducted to determine abnormalities of the GDx Glaucoma Scanning System parameters in patients with tilted discs, in order to set guidelines for the evaluation of glaucomatous damage in this situation. The objective was to determine which GDx parameters displayed the highest level of variation, and which remained unchanged in tilted disc syndrome. RNFA was polarimetrically conducted on 45 eyes from 26 subjects with tilted discs, and 43 normal eyes with Nerve Fiber Analyzer II (Laser Diagnostic Technologies). All parameters except inferior maximum, average thickness, ellipse average, and inferior average displayed a significant difference between the two groups (p < 0.05). Although NFA is useful in glaucoma diagnosis, the majority of the GDx parameters, as shown in our study, are unreliable in tilted disc syndrome in this respect.

Polarimetric nerve fiber analysis in patients with visible optic nerve head drusen.

OBJECTIVE: To evaluate the effect of visible optic nerve head drusen (ONHD) on retinal nerve fiber layer (RNFL) thickness retardation by using scanning laser polarimetry. METHODS: Twenty-three eyes of 13 patients with visible ONHD and 26 eyes of 13 age- and sex-matched control subjects were involved in the study. Ophthalmologic examination, scanning laser polarimetry with nerve fiber analyser (NFA) type II GDX, automated Humphrey visual field testing, and red-free fundus photography were performed. Eyes with ONHD were classified from grade 0 to III according to the amount of visible drusen. Thus, grade 0 discs had no clinically visible ONHD and grade III discs represented the presence of dense drusen. RESULTS: Measurements with NFA of RNFL thickness retardation showed significant decrease in eyes with visible ONHD compared with control eyes (P < 0.05). Although no significant difference was found between grade I and grade II discs regarding NFA measurements, grade III discs had significantly lower values, indicating the greater amount of RNFL loss with higher grade ONHD. Documentation of increased percentage of visual field defects with higher grade drusen was also in accordance with this finding. CONCLUSIONS: NFA can quantitatively detect the decrease in retardation of RNFL thickness in eyes with visible ONHD and can be used as an indicator of nerve fiber layer loss in these cases.

Individual and associated effects of length of inguinal canal and caliber of the sac on clinical outcome in children.

PURPOSE: The caliber of processus vaginalis is accepted to define the clinical outcome to be an inguinal hernia or hydrocele not based on any evaluation. The caliber of sacs and length of inguinal canals of boys and girls were evaluated to define the relation of sex, age, and the diagnosis with caliber of the sac and the length of inguinal canal. METHODS: A total of 217 inguinal canals in 24 girls and 112 boys with inguinal hernia, 30 boys with hydrocele or hydrocele of the cord, and 31 boys with undescended testis have been evaluated. Twenty patients had bilateral involvement. The length of inguinal canal, and the circumference of the sac were measured. A formula was developed to predict the length of inguinal canal according to the age and sex. The circumferences of the sacs, length of inguinal canals, and the ratios of the circumference to the length were compared according to the clinical pictures. RESULTS: The regression model of the relationship between the age and the length of the inguinal canal is an equation of third degree (inguinal canal in millimeters) = 0.0000119 x age 3 (months) - 0.00292 x age 2 (months) + 0.3168 x age (months) + 19.979 (r2 = 0.47). Inguinal canal is longer in boys (25.133 and 27.996 mm; P = .018), and length does not differ among diagnoses but differs according to age showing a linear growth after 24 months. Although the circumference as a sole parameter could classify only 55.3% of boys correctly, the ratio of length of inguinal canal to circumference of the sac has been the significant parameter in classifying boys into 1 of 3 groups including inguinal hernia, undescended testis, and hydrocele with a 70.2% success rate. CONCLUSIONS: Inguinal canal that shows a linear growth after 24 months of age is longer in boys. Caliber is not the unique factor that determines the clinical outcome. Although the ratio of length of inguinal canal to the circumference of the sac defines the clinical picture best, even this parameter cannot classify the cases correctly. Therefore, some factors in addition to the caliber and length of inguinal canal might have roles in determining the clinical outcome.

Clinicopathological implication of cripto expression in early stage invasive cervical carcinomas.

This study evaluates the expression of cripto (CR-1) protein in matched sets of non-neoplastic cervical epithelium, primary cervical carcinoma and metastatic tumours in the lymph nodes to investigate its role in uterine cervical cancer development and progression. Ninety-four primary cervical carcinomas in an early clinical stage and having the same surgical treatment modality were analysed. Immunoreactivity in the primary tumour was compared with that of non-neoplastic cervical epithelium and metastatic lymph nodes. The conventional clinicopathological prognostic variables for cervical carcinomas such as grade, tumour size, depth of invasion, parametrial and endometrial extension, lymphovascular space involvement and lymph node metastasis status were also compared with CR-1 expression of the primary tumour. Strong CR-1 immunopositivity was significantly correlated with tumour size and lymphovascular space involvement (P < 0.05). Furthermore, a significant relationship was found between CR-1 immunoreactivity and endometrial extension as well as parametrial involvement (P < 0.05). Interestingly, the CR-1 expression level was increased in metastatic lymph nodes compared with their primary tumours. These results suggest that CR-1 may contribute to disease progression in cervical carcinomas.

Intraabdominal pressure: a parameter helpful for diagnosing and predicting a complicated course in children with appendicitis.

BACKGROUND/PURPOSE: The intraabdominal pressure (IAP) of children presenting with acute, perforated, or suspected appendicitis were determined and compared to define if the IAP has any diagnostic value or helps to predict a complicated course. METHODS: Eighty-four patients with a initial diagnosis of appendicitis were evaluated. In addition to preoperative measurements, IAP of each patient was determined repeatedly on the postoperative first, second, and third days. The patients were grouped according to the final diagnoses as acute, perforated, or suspected appendicitis or negative exploration. The preoperative and postoperative IAP of the patients were compared among the groups. Postoperative complications were recorded, and IAP of those patients were additionally compared with the others in the same group. RESULTS: Whereas a normal appendix was found in 4 of the operated patients, 27 and 38 patients had acute and perforated appendicitis, respectively. The mean preoperative values of IAP for acute, perforated, or suspected appendicitis and negative exploration were 6.2 +/- 0.4, 9 +/- 0.3, 0.3 +/- 0.4, and 3 +/- 0.4 cm H2O, respectively (P< .001). Postoperative first day and second day values of the IAP for acute appendicitis, perforated appendicitis, and negative laparotomy groups were 2 +/- 0.2 and 0.6 +/- 0.1,3 +/- 0.1 and 1.5 +/- 0.1,0.5 +/- 0.6 and -0.2 +/- 0.6 cm H2O, respectively. The difference between acute and perforated appendicitis groups was significant (P< .05). Wound infection was encountered in 7 among 38 patients with perforated appendicitis. The preoperative and first postoperative day IAP values of patients with perforated appendicitis who experienced a wound infection and who were without a wound infection have been 11.8 +/- 0.4 and 4.8 +/- 0.2, and 8.4 +/- 0.2 and 3.1 +/- 0.3 cm H2O (P< .001). Discriminant analysis has shown that 93.3%, 70.4%, and 73.3% of patients with suspected, acute, and perforated appendicitis have been within the expected groups. IAP less than 1.39 cm H2O has excluded appendicitis with a 95% confidence interval. Although the interval has been between 5.40 and 7.04 cm H2O for acute appendicitis, it has varied between 8.46 and 9.70 cm H2O for perforated appendicitis. CONCLUSIONS: Although the IAP does not increase in conditions mimicking appendicitis, it increases among children with appendicitis. A further increase is encountered among children with perforated appendicitis. Complicated course is encountered among children with highest IAP values. Therefore, IAP may be used both as a diagnostic parameter and a predictor of a complicated course associated with appendicitis in children.

CD34/CD117 co-expression in childhood acute leukemia.

CD117 protein is expressed by the primitive CD34 positive haemopoietic stem cells and also demonstrated on the blasts of 30-100% of AML cases, but rarely on lymphoblasts. Therefore several investigators have used CD117 expression to exclude lymphoblastic origin of blasts. However, conflicting results exist in the literature. We investigated CD34 and CD117 status at initial presentation of 232 children with acute leukemia. CD34 was commonly expressed in all types of acute leukemias, whereas CD117 molecule seemed to be a more specific marker for leukemia of myeloid origin being demonstrated on > 5% of blasts in 60 out of 73 cases of AML patients, but rarely detected in ALL (9/140 patients). Moreover, co-expression of CD34/CD117 was extremely rare on lymphoblasts with only 3/140 ALL patients demonstrating > 5% co-expression of CD34 and CD117, and therefore we suggest that it should be used in the exclusion of ALL.

Turkish children's performance on Denver II: effect of sex and mother's education.

One thousand and ninety-one healthy Turkish children were tested with the Denver II developmental screening test and the data were analysed for sex and sociocultural differences. Few and inconsistent differences were observed between boys and girls. On the other hand, there were marked differences between sociocultural groups, particularly in terms of fine motor and language areas and in older preschool children. The effect of maternal education on the child's development is more important in countries where preschool education is not commonly available. Whether this effect diminishes after 1 or 2 years of schooling is to be investigated.

The importance of increasing the number of gastric biopsies in the diagnosis of Helicobacter pylori.

BACKGROUND/AIMS: The role of Helicobacter pylori in various gastroduodenal diseases is universally accepted. In this study, we aimed to determine the proper number and sites of the gastric biopsies in order to achieve the highest diagnostic yield through the use of a urease test and histopathology. We also compared the histological findings encountered in patients who had Helicobacter pylori (H. pylori) colonization. METHODOLOGY: Fifty patients referred for upper gastrointestinal endoscopy for dyspeptic complaints were included in the study. Our mapping protocol included 2 biopsies from antrum and 2 biopsies from corpus. We obtained 2 biopsies from each biopsy site for urease test and histopathological assessment. Golden standard positivity for the presence of H. pylori colonization was defined as concomitantly positive urease test and histologically detected bacteria found at the same biopsy site. RESULTS: Forty-three patients had H. pylori colonization. Colonization rates of H. pylori, sensitivities of urease testing, and histopathology in 4 biopsy sites were not statistically different. Sensitivity of urease testing was 81.4% for 1 biopsy and 100% for 4 cumulative biopsies. Sensitivities of histological assessment were 93% and 100% for 1 and 4 biopsies, respectively. CONCLUSIONS: Results of this study suggest that 2 biopsies for urease testing and 1 biopsy for histopathology obtained from the antrum or corpus of the stomach were sufficient to obtain the highest statistically significant diagnostic sensitivity.

A questionnaire for the assessment of quality of life in cancer patients in Turkey.

In this study, we developed a reliable scale to measure the quality of life (QOL), which would reflect the cultural characteristics of cancer patients in Turkey. We used the Rolls-Royce model and determined a form with 49 items in eight dimensions such as general well-being, physical symptoms and activity, sleep dysfunctions, appetite, sexual dysfunction, cognitive functions, medical interaction, social participation and work performance. The forms were used for assembling data from 100 subjects (10 physicians, 19 healthy volunteers, 18 patients relatives, 28 patients on chemotherapy, 25 patients off chemotherapy). Half-split reliability and the signal effect were used to demonstrate reliability and responsiveness. After demonstrating the validity of the test, the final form was constructed. When these eight dimensions were factor analysed, it was found that the general well-being and sexual dysfunction were the most important determinants of QOL.