Thrombin lag time is increased in children with mild asthma.

BACKGROUND: Inflammation and coagulation are closely linked events. Thrombin is the key enzyme in coagulation system and also has roles in inflammation. OBJECTIVE: The aim of our study was to evaluate thrombin generation in children with mild asthma. METHODS: Forty-two children with mild asthma and 49 healthy children were included in the study. All patients performed spirometry. Thrombin generation tests (TGT) were performed with a calibrated automated thrombogram (CAT) in children without asthma exacerbation during the last six months. During CAT assay thrombogram curves were obtained. The area under the curve showed endogenous thrombin potentials and indicated the total amount of endogenous thrombin generated; the peak height showed the highest thrombin value, thrombin lag time and time to thrombin peak were measured. RESULTS: Thrombin lag time was significantly longer in children with asthma (3.98±1.2min) compared to those in the control group (3.29±0.6min) (p<0.01). Children with asthma also had longer thrombin tail time compared to the control group (19.5±8.9min vs. 16.7±2.9min, p=0.02). Thrombin peak was inversely correlated with FEF 25-75 (r=-0.41, p<0.01). Thrombin lag time was inversely correlated with FEF 25-75 (r=-0.39, p<0.01). CONCLUSION: Inflammation in mild asthma seems to disturb coagulation but this disturbance may not be so strong as to increase thrombin levels and may only affect the initiation phase of thrombin generation.

Single and multiple food allergies in infants with proctocolitis

Background: Food protein-induced allergic proctocolitis is a frequent cause of rectal bleeding in infants. Characteristics of infants with multiple food allergies have not been defined. Objective: This study aimed to identify characteristics of infants with proctocolitis and compare infants with single and multiple food allergies. Methods: A total of 132 infants with proctocolitis were evaluated retrospectively. All of the infants were diagnosed by a paediatric allergist and/or a paediatric gastroenterologist according to guidelines. Clinical features of the infants, as well as results of a complete blood count, skin prick test, specific immunoglobulin E, and stool examinations or colonoscopy were recorded. Results: Cow's milk (97.7%) was the most common allergen, followed by egg (22%). Forty-five (34.1%) infants had allergies to more than one food. Infants with multiple food allergies had a higher eosinophil count (613 ± 631.2 vs. 375 ± 291.9) and a higher frequency of positive specific IgE and/or positive skin prick test results than that of patients with a single food allergy. Most of the patients whose symptoms persisted after two years of age had multiple food allergies. Conclusions: There is no difference in clinical presentations between infants with single and multiple food allergies. However, infants with multiple food allergies have a high blood total eosinophil count and are more likely to have a positive skin prick test and/or positive specific IgE results (AU)

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Single and multiple food allergies in infants with proctocolitis.

BACKGROUND: Food protein-induced allergic proctocolitis is a frequent cause of rectal bleeding in infants. Characteristics of infants with multiple food allergies have not been defined. OBJECTIVE: This study aimed to identify characteristics of infants with proctocolitis and compare infants with single and multiple food allergies. METHODS: A total of 132 infants with proctocolitis were evaluated retrospectively. All of the infants were diagnosed by a paediatric allergist and/or a paediatric gastroenterologist according to guidelines. Clinical features of the infants, as well as results of a complete blood count, skin prick test, specific immunoglobulin E, and stool examinations or colonoscopy were recorded. RESULTS: Cow's milk (97.7%) was the most common allergen, followed by egg (22%). Forty-five (34.1%) infants had allergies to more than one food. Infants with multiple food allergies had a higher eosinophil count (613±631.2 vs. 375±291.9) and a higher frequency of positive specific IgE and/or positive skin prick test results than that of patients with a single food allergy. Most of the patients whose symptoms persisted after two years of age had multiple food allergies. CONCLUSIONS: There is no difference in clinical presentations between infants with single and multiple food allergies. However, infants with multiple food allergies have a high blood total eosinophil count and are more likely to have a positive skin prick test and/or positive specific IgE results.

Association between seroprevalence of measles and various social determinants in the year following a measles outbreak in Turkey.

OBJECTIVES: Despite an ongoing measles elimination programme, a measles outbreak occurred in 2013 in Turkey. Population-based seroprevalence studies are needed to determine seronegativity and explore the reasons for this outbreak. This study aimed to explore the seroprevalence of measles and its association with various social determinants in a provincial population in Turkey in the year following a measles outbreak. STUDY DESIGN: Cross-sectional study. METHODS: This study was conducted in Manisa Province in 2014 in a sample of 1740 people aged >2 years. The dependent variable was the seroprevalence of measles. Independent variables were sex, age, migration, household size, household density, income, education level, existence of chronic disease and occupational class. Blood samples were collected from participants at family health centres. The presence of specific measles antibodies in serum samples was determined using an anti-measles virus IgG enzyme-linked immunosorbent assay test. Chi-squared test and logistic regression analysis were performed. RESULTS: Overall, data from 1250 people were analysed. The seroprevalence of measles in the whole study population was 82.2% (95% confidence interval 80.0-84.2). Seroprevalence was 55.4% among subjects aged 2-9 years, 48.7% among subjects aged 10-19 years, 74.1% among subjects aged 20-29 years and 93.6% among subjects aged 30-39 years (P < 0.01). Seroprevalence in subjects aged >40 years was >95%. The lowest seroprevalence was found in primary school children (40.2%), followed by those below the age for primary education (69.8%) and secondary school graduates (75.1%). The prevalence of measles seronegativity was not associated with any of the social determinants when adjusted for age. CONCLUSIONS: The seroprevalence of measles was lower than expected in the study population and was particularly low in subjects aged <30 years of age despite previous vaccination. Seroprevalence was not associated with social determinants of health that confirmed either an even distribution of virus exposure or fair access to vaccination services. However, the current seroprevalence cannot be sufficiently effective to reach the measles elimination targets, suggesting that it may be necessary to re-evaluate the need for an extra dose of measles vaccine.

Rapid percutaneous nephrostomy catheter placement in neonates with the trocar technique.

PURPOSE: The purpose of this study was to assess the efficacy of a modified percutaneous nephrostomy procedure for grade III-IV hydronephrosis in neonates. MATERIAL AND METHODS: Eleven neonates (five girls, six boys) with a mean age of 13.7days±9.9 (SD) (range, 4-28days) with pronounced hydronephrosis had percutaneous nephrostomy using a modified procedure. In all patients, percutaneous nephrostomy was performed with a trocar catheter under ultrasound guidance and then the catheter was placed into the collecting system without prior dilatation. RESULTS: Technical success was achieved in all patients. There were no major procedure-related complications. There was no perirenal hematoma on control ultrasound examinations and no hematuria was observed after the procedure. The median drainage time was 75days (range: 42-120days). Two children had urinary tract infection, which was controlled by using antibiotics. CONCLUSION: The trocar nephrostomy is a practical and feasible method, which can be used for neonates with grade III-IV hydronephrosis.

Serum vitamin D levels decrease in children with acute urticaria.

BACKGROUND: Acute urticaria is an immune-inflammatory disease, characterised by acute immune activation. There has been increasing evidence showing that vitamin D deficiency is associated with increased incidence and severity of immune-inflammatory disorders. OBJECTIVE: The aim of this study was to evaluate serum vitamin D levels in acute urticaria. METHODS: We enrolled 30 children with acute urticaria and 30 control subjects. Concentrations of 25-hydroxyvitamin D [25(OH)D], a biomarker of vitamin D status, were measured in serum of acute urticaria patients and compared with the control group. RESULTS: There were no significant differences in baseline variables (age, gender, weight) between the groups. Vitamin D deficiency (<20ng/ml) was significantly higher in patients with acute urticaria than in control patients. Serum 25(OH)D levels were significantly lower in the study group compared to those in the control group (13.1±4.3 vs 28.2±7.4ng/mL, p<0.05). Moreover, we found negative correlation between mean duration of acute urticaria and serum vitamin D levels (p<0.01). CONCLUSION: This study revealed a significant association of lower serum 25(OH)D concentrations with acute urticaria and an inverse relationship with disease duration. These findings may open up the possibility of the clinical use of vitamin D as a contributing factor in the pathogenesis of acute urticaria and a predictive marker for disease activity in acute urticaria. A potential role of vitamin D in pathogenesis and additive therapy in acute urticaria needs to be examined.

[Comparison of the CMV antigenemia test and CMV-DNA PCR results in solid organ transplant recipients]. / Solid organ nakli alicilarinda CMV antijenemi testi ve CMV-DNA PCR sonuçlarinin karsilastirilmasi.

Cytomegalovirus (CMV) infection is among the most common important viral infections in solid organ transplant (SOT) recipients. Diagnostic tests for detecting CMV replication are widely used for this group of patients, however there is no clear agreement on the cut-off levels for interpretation of clinical decisions especially when the low level of viral load is detected. In this study, CMV pp65 antigenemia test results were compared with plasma CMV-DNA levels detected by quantitative real-time polymerase chain reaction (qPCR) in samples of kidney and liver transplant recipients in the Central Laboratory of Dokuz Eylul University Hospital between 2011 and 2013, and the correlation between these two tests and viral load equivalent to antigenemia positivity were determined. In the study, pp65 antigenemia and CMV-DNA qPCR results were evaluated retrospectively. The samples from the same patients were included if the time between antigenemia and CMV-DNA qPCR tests were less than 48 hours. SPSS v15.0 was used for correlation, regression and ROC curve analysis. The results of the 217 samples collected from 100 patients (59 male, 41 female; age range: 16-71, mean age: 46 ± 13 years), 36 liver and 64 kidney recipients were evaluated in the study. Of the patients 80% were CMV IgM negative, IgG positive; 1% was CMV IgG and IgM positive; 2% were CMV IgM and IgG negative, while for 17 patients serological results could not be reached. CMV pp65 antigenemia and CMV-DNA were both negative in 102 (47%) samples, while both were positive in 37 (17%) samples. The single sample from a case with CMV IgM and IgG positivity yielded negative results for both antigenemia and CMV-DNA tests. In 78 samples antigenemia were negative and CMV-DNA qPCR were positive, while there were no samples with antigenemia positive and qPCR negative. Mean values of antigenemia and qPCR tests were 23 positive cells/200.000 leukocytes (range: 1 to 230 positive cells) and 12.595 copies/ml (range: 180 to 106.311 copies/ml), respectively. There was a significant correlation between antigenemia and qPCR results among the samples that were positive by both assays (r= 0.785). ROC curve analysis showed that CMV viral load of 205 copies/ml in plasma corresponds to ≥ 1 pp65 antigen positive cells per 200.000 leukocytes (sensitivity: 91.7%, specificity: 90.3%). Higher analytical sensitivity of qPCR test can be explained by the results of CMV-DNA PCR positive and antigenemia negative samples. Non-existence of samples with antigen positive and PCR negative results supported this finding. ROC analysis showed that any sample with CMV-DNA qPCR result less than 205 copies/ml, could be accepted as pp65 antigenemia negative. This viral load value is valid only for the studied patient group and assays, therefore could be changed according to study population and tests.

Spontaneous retroperitoneal hemorrhage presenting as hemoperitoneum secondary to renal cyst rupture in a peritoneal dialysis patient with acquired cystic kidney disease.

Spontaneous retroperitoneal hemorrhage (SRH) is a rare and potentially fatal condition. Acquired cystic kidney disease (ACKD) may cause SRH in hemodialysis patients. However, presentation of retroperitoneal hematoma as hemoperitoneum in peritoneal dialysis (PD) patients is exceedingly rare. We report a 44-year-old male PD patient who presented with hemoperitoneum secondary to retroperitoneal hematoma. The reason of SRH was rupture of the cysts of ACKD. The patient underwent unilateral nephrectomy with subsequent disappearance of hemoperitoneum. The importance of this case lies in the fact that the patients who have been receiving dialysis for a long time should be under surveillance in terms of ACKD development and potential associated complications such as cyst hemorrhage and malignancy.

Complete ossification of the superior transverse scapular ligament in an Turkish male adult / Osificación completa del ligamento escapular superior transverso en un hombre adulto de Turquía

Scapula has three margins and angles and located posterolateral of thorax. One of the anatomical structures of scapula is suprascapular notch located medial to coracoid process base. Suprascapular notch can be seen in different shapes and depths. Suprascapular notch is surrounded by transverse scapular ligament which is a short and strong ligament. Suprascapular notch creates an osteofibrosis passage with this structure within suprascapular nerve passes. It has been reported that this osteofibrosis structure can intirely or partially ossify. All lesions of nerves occured in course as result of exposure to compression, tension and bending are called entrapment neuropathy. Like other peripheral nerves, suprascapular nerve can be exposed to compression while passing suprascapular notch. As a result of this compression suprascapular entrapment neuropathy may occur. There are direct trauma, repetitive microtrauma, neurit, progressive compressive lesions in suprascapular entrapment neuropathies etiology. A suprascapular notch taken foramen shape can be a predisposing factor to entrapment neuropathy. In the retrospective screening from Necmettin Erbakan University, Meram Medical Faculty, Department of Radiology archive, a male patient at age 68 with suprascapular notch variation has been detected. This patient's right suprascapular notch had became foramen by an osseous bridge. Diameters of foramen has been measured as 5.27 mm transverse 6.48 mm vertical. We believe having detailed knowledge of suprascapular notch is significant as a possible course of back and shoulder pain is entrapment of suprascapular nerve in suprascapular notch causing nerve paralyses, and it will give a right direction to clinicians in surgical practices.

La escápula tiene tres márgenes y tres ángulos, y se encuentra en la región posterolateral del tórax. Una de las estructuras anatómicas de la escápula es la incisura supraescapular situada medial a la base del proceso coracoides. La incisura supraescapular puede tener diferentes formas y profundidad. Está rodeada por el ligamento escapular transverso, un ligamento corto y fuerte. Con esta estructura, crea un pasaje osteofibroso por el cual pasa el nervio supraescapular. Se ha reportado que esta estructura osteofibrosa se puede osificar completa o parcialmente. Todas las lesiones de los nervios ocurren en su trayecto como resultado de la exposición a compresión, tensión y flexión, lo que se denomina neuropatía por atrapamiento. El nervio supraescapular puede estar expuesto a compresión al pasar por la incisura supraescapular, generando neuropatía por atrapamiento. Su etiología puede ser por traumatismo directo, microtraumatismo repetitivo y lesiones compresivas progresivas. Una incisura supraescapular de forma oval puede ser un factor predisponente para la neuropatía por atrapamiento. En un estudio retrospectivo realizado en la Universidad Necmettin Erbakan, Facultad de Medicina de Meram, Departamento de archivo de Radiología, se observó la imagen de un varón de 68 años con variación en la incisura supraescapular derecha, la cual se transformó en un foramen por un puente óseo. Los diámetros del foramen fueron 5,27 mm transversales y 6,48 mm verticales. Creemos que el conocimiento detallado de la incisura supraescapular es necesario en el diagnóstico y posible curso de dolor del hombro, debido al atrapamiento del nervio supraescapular en la incisura y la posible parálisis nerviosa, dando una guía a los clínicos en las prácticas quirúrgicas.

Peri-aortic fat tissue and malnutrition-inflammation-atherosclerosis/calcification syndrome in end-stage renal disease patients.

PURPOSE: Thoracic peri-aortic fat tissue (PFT) is considered as a metabolically active organ in atherosclerosis. Malnutrition, inflammation and atherosclerosis/calcification (MIAC) are the most commonly encountered risk factors of cardiovascular disease in end-stage renal disease (ESRD) patients. Calcification of the aorta was found to be an important cardiovascular risk marker predicting future events, morbidity and mortality in this population. We aimed to investigate the relationship between PFT, MIAC syndrome and thoracic aortic calcification (TAC) in ESRD patients. METHODS: Seventy-nine ESRD patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and 20 control subjects were enrolled in this cross-sectional study. PFT and TAC were assessed using a 64-MDCT scanner. Patients with serum albumin <3.5 g/dL were defined as patients with malnutrition; those with serum C-reactive protein level >10 mg/L had inflammation, and those with coronary artery calcification score (CACS) >10 had atherosclerosis/calcification. RESULTS: TAC and PFT were significantly higher in ESRD patients compared with control subjects. There was a statistically significant relationship between PFT and TAC in ESRD patients (r = 0.458, p < 0.0001). PFT was found to be significantly increased when the MIAC components increased. PFT was positively associated with age, BMI, uric acid, hemoglobin and CAC. The multivariate analysis revealed that age and uric acid were independent predictors of increased PFT. Twenty-four (30.4 %) patients had none, 30 (37.9 %) had one component, 17 (21.5 %) had two components, and 8 (10.2 %) had all MIAC components. PFT was highest among patients having all three components (28.6 cm(3)) and lowest among those who do not have the MIAC syndrome (8.54 cm(3)). TAC was highest among patients having all three components (179.2 HU) and lowest among those who do not have the MIAC syndrome (0 HU). CONCLUSIONS: We found a relationship between PFT and MIAC syndrome in ESRD patients.

El papel de FDG-PET/TAC en pacientes con cáncer de ovario con marcadores tumorales altos o lesión con sospecha con TAC con contraste en la evaluación de recurrencia y/o en la determinación de metástasis intraabdominales / The Role of FDG-PET/CT in Ovarian Cancer Patients with High Tumor Markers or Suspicious Lesion on Contrast-Enhanced CT in Evaluation of Recurrence and/or in Determination of Intraabdominal Metastases

Objetivos. Este estudio retrospectivo fue diseñado para investigar el papel de una tomografía por emisión de positrones con 18F-fluorodeoxiglucosa/tomografía axial computerizada (PET-FDG) (FDG- PET/CT) en la determinación de recurrencia y/o metástasis intraabdominal en pacientes con cáncer de ovario con marcadores tumorales aumentados o lesión de sospecha detectada con TAC abdominal con contraste (TAC-c). Materiales y métodos. Se realizó un estudio PET/TAC en 34 pacientes femeninos tratados por cáncer de ovario verificado histopatológicamente para reestratificación y sospecha de recurrencia. Se incluyeron a pacientes con informe patológico, niveles de marcador tumoral, TAC-c y PET/TAC dentro de un mes del estudio. Resultados. Se reclutaron a 34 pacientes, 25 de las cuales tenían un nivel alto del marcador tumoral CA 125. Las 9 pacientes restantes tenían sospecha de recurrencia en la imagen del TAC-c con niveles del marcador tumoral normales. Se confirmaron recurrencia con re-operación y biopsia (n=4), seguimiento clínico y de imagen (n=21) en 25 pacientes y marcadores tumorales elevados. No se encontraron enfermedad recurrente en 5 de 25 pacientes en la imagen TAC-c y 1 de 25 pacientes en la imagen PET/TAC con altos niveles de CA125. Tanto TAC-c y el PET/TAC demostraron enfermedad recurrente en 19 de 25 pacientes. La sensibilidad, especificidad y presión del PET/TAC fueron 96,1, 100 y 97%, respectivamente. Conclusión. PET/TAC es un método beneficioso para la detección de recurrencia en pacientes con un nivel de CA 125 en suero elevado y hallazgos negativos en la TAC, o con un nivel normal de CA 125 y recurrencia detectado por TAC llevado a cabo debido a síntomas clínicos(AU)

Objectives. This retrospective study was designed to investigate the role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in determination of recurrence and/or intraabdominal metastasis in patients with ovarian cancer having increased tumor markers or suspicious lesion detected by a contrast-enhanced abdominal CT (ceCT). Materials and methods. A total of 34 female patients who were treated for histopathologically proven ovarian cancer, underwent PET/CT examination for restaging and suspected recurrence. Patients with pathology report, tumor marker levels, ceCT and PET/CT performed within one month were included in the study. Results. A total of 34 patients were included in the study. 25 of 34 patients had high tumor marker (CA 125) level. The remaining 9 patients had suspected recurrence on ceCT imaging with normal tumor marker levels. Recurrence was confirmed by re-operation and biopsy (n=4), clinical and imaging follow-up (n=21) in 25 patients with elevated tumor markers. Recurrent disease was not shown in 5 of 25 patients on ceCT imaging and 1 of 25 patients on PET/CT imaging with high CA125 values. Both ceCT and PET/CT revealed recurrent disease in 19 of 25 patients. PET/CT showed more lesions in 11 of 19 patients. Sensitivity, specificity and accuracy of the PET/CT were 96.1%, 100% and 97%, respectively. Conclusion. PET/CT is found as a beneficial method for detection of the recurrence, in patients with increased serum CA 125 level and negative CT findings or with normal CA 125 level and recurrence detected by CT which was performed due to clinical symptoms(AU)

The role of FDG-PET/CT in ovarian cancer patients with high tumor markers or suspicious lesion on contrast-enhanced CT in evaluation of recurrence and/or in determination of intraabdominal metastases.

OBJECTIVES: This retrospective study was designed to investigate the role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in determination of recurrence and/or intraabdominal metastasis in patients with ovarian cancer having increased tumor markers or suspicious lesion detected by a contrast-enhanced abdominal CT (ceCT). MATERIALS AND METHODS: A total of 34 female patients who were treated for histopathologically proven ovarian cancer, underwent PET/CT examination for restaging and suspected recurrence. Patients with pathology report, tumor marker levels, ceCT and PET/CT performed within one month were included in the study. RESULTS: A total of 34 patients were included in the study. 25 of 34 patients had high tumor marker (CA 125) level. The remaining 9 patients had suspected recurrence on ceCT imaging with normal tumor marker levels. Recurrence was confirmed by re-operation and biopsy (n=4), clinical and imaging follow-up (n=21) in 25 patients with elevated tumor markers. Recurrent disease was not shown in 5 of 25 patients on ceCT imaging and 1 of 25 patients on PET/CT imaging with high CA125 values. Both ceCT and PET/CT revealed recurrent disease in 19 of 25 patients. PET/CT showed more lesions in 11 of 19 patients. Sensitivity, specificity and accuracy of the PET/CT were 96.1%, 100% and 97%, respectively. CONCLUSION: PET/CT is found as a beneficial method for detection of the recurrence, in patients with increased serum CA 125 level and negative CT findings or with normal CA 125 level and recurrence detected by CT which was performed due to clinical symptoms.

Polycythaemia vera presented with bilateral adrenal haemorrhage and adrenal insufficiency: a case report.

Adrenal insufficiency is rarely associated with adrenal haemorrhage. In this report, a case of polycythaemia vera with adrenal haemorrhage and insufficiency has been presented.

[Evaluation of a syphilis testing algorithm using a treponemal test for screening]. / Taramada Treponemal Test Kullanan Bir Sifiliz Tani Algoritmasinin Degerlendirilmesi.

Traditional testing algorithm for syphilis is initial screening with nontreponemal tests, then retesting positive samples for confirmation using a specific treponemal test. Commercial treponemal tests those are more sensitive than nontreponemal tests and suitable for automation are now commercially available to screen syphilis. Although the treponemal tests are offered as the first choice for syphilis screening by some of the guidelines, to date there is no consensus on recommendations in guidelines for followup testing. As some of the guidelines recommend to perform a nontreponemal test for persons with a positive treponemal screening test, the others recommend to confirm the result by another treponemal test. In this study, a testing algorithm using treponemal chemiluminescence microparticle enzyme immunoassay (CMIA; Architect Syphilis TP; Abbott Japan Co, Japan) for primary screening were retrospectively evaluated by reviewing laboratory data. A total of 12.195 serum samples obtained from 10.878 patients (7104 of them were female) who were screened by means of syphilis, between January 2007-February 2010 period have been included to the study. According to this algorithm, no further test was performed for CMIA negative samples. Samples positive by CMIA were retested by RPR (Rapid Plasma Reagin; Omega Diagnostics, UK) test. The test results of both CMIA and RPR positive samples were reported, while positive CMIA results were confirmed by TPHA (Treponema pallidum hemagglutination; Omega Diagnostics, UK) if any discrepancy in the results were identified. Screen test revealed positive results in 1.1% (120/10.878) of the patients and 2% (206/12.195) of the samples. In this study, quantitative values (sample/cut-off absorbance ratio; s/co) of positive CMIA samples were also compared with TPHA and RPR test results. It was observed that while 19.1% of CMIA positive samples with s/co ratios less than 12 were confirmed by TPHA, the confirmation rate was 100% with s/co ratios above 12. Additionally, RPR positive samples with a titer of ≥ 1/32 yielded CMIA s/co ratios above 21. As low s/co levels detected with CMIA may lead to false-positive results for syphilis, it was concluded that CMIA positive results should be confirmed by another treponemal test before RPR testing. A new syphilis testing algorithm in accordance with the results of this review and recommendations in new guidelines were established in the light of this study.

Aspergillus thyroiditis in a renal transplant recipient mimicking subacute thyroiditis.

Fungal pathogens are increasingly encountered after renal transplantation. Aspergillus causes significant morbidity and mortality in transplant patients. Fungal thyroiditis is a rare occurrence owing to unique features of the thyroid gland. Most cases are caused by Aspergillus species and have been described in immunocompromised patients. Presentation may be identical with that of subacute thyroiditis, in which hyperthyroidism features and painful thyroid are the prominent findings. Diagnosis can be ascertained by fine-needle aspiration of thyroid showing branching hyphae of Aspergillus. We describe a renal transplant patient who developed Aspergillus thyroiditis as part of a disseminated infection successfully treated with voriconazole.

Presentation of two cases with hypermobility syndrome and review of the related literature.

The aim of this study was to show that simple criteria like Beighton and Brighton criteria are sufficient to determine a diagnosis of hypermobility and may be useful prior to performing excessive diagnostic studies on children with variable joint pain and limited range of motion. Additionally, this study underlines how limitations of deformed joints can be restored with physiotherapy, which can also help preventing further complications of hypermobility. This study reports the case of a five-year-old girl and her 10-year-old brother, who both were suffering from difficulty in holding a spoon. Our diagnosis was hypermobility syndrome. The patients showed significant improvement with physiotherapy of the elbows. Evaluating patients for hypermobility in routine rheumatologic examination will prevent unnecessary diagnostic studies and treatments. Moreover, although the most common initial symptom of hypermobility is pain (usually in the knees), a limited range of motion due to subluxations in any other joints, like the elbows, may be the first symptom.

Accuracy of multidetector computed tomographic angiography for detecting hepatic artery complications after liver transplantation.

AIMS: The aim of this study was to evaluate the accuracy of multidetector computed tomographic angiography (MDCTA) for detecting hepatic artery complications after liver transplantation. METHODS: Between July 2001 and September 2006, 212 patients underwent liver transplantation including 110 (41 female and 69 male patients); of mean age, 24 years (range=6 months to 66 years) who were assessed with MDCTA. First, arterial phase images obtained after intravenous injection of 150 mL of contrast at a rate of 4 mL/s were acquired using the bolus triggering technique. Then portal and late-phase images were obtained. Axial and coronal maximum intensity projection (MIP) images and volume-rendered images were produced from the axial image data. Arterial vascular complications were noted. Stenosis was defined as severe (>75%), moderate (>or=50%), or mild (<50%) according to its diameter. Twenty-nine of the 38 individuals with hepatic artery complications detected by MDCTA had correlative digital subtraction angiography (DSA). Seven of 110 patients with normal hepatic artery and venous pathologies in MDCTA also had DSA to investigate venous complications. RESULTS: MDCTA showed hepatic artery complications in 38 of the 110 patients who were assessed with this modality. DSA confirmed the MDCTA findings in all but 1 of the 29 patients assessed with catheter angiography. Fourteen of the 38 individuals also underwent percutaneous interventions and treatment. Fifteen patients had early hepatic artery complications, and 23 late hepatic artery complications. The most common early complications were thrombosis (66.6%) and stenosis (26.6%). The most common late complications were stenosis (56.5%) and thrombosis (26%). If we evaluate the early and late complications, the incidence of late complications was greater than that of the early complications (61% vs 39%). There was no statistically significant difference in cadaveric and living donor liver transplants for early versus late or for type of complications. CONCLUSIONS: MDCTA is noninvasive imaging modality that accurately shows a variety of vascular complications after liver transplantation. We suggest that if we suspect any vascular complication with Doppler ultrasound, we must perform MDCTA for diagnosis. If we detect severe/moderate stenosis, the patient must undergo DSA.

Spatio-temporal genetic variation in populations of wild emmer wheat, Triticum turgidum ssp. dicoccoides, as revealed by AFLP analysis.

Genetic structure of natural populations of wild crop relatives has been the subject of many studies. Yet, most of them focused on the assessment of spatial genetic diversity, while information on long-term variation, affected by yearly changes, has been considered only in few cases. The present study aimed therefore, to estimate the spatio-temporal genetic variation in populations of wild emmer wheat, the progenitor of domesticated wheat, and to assess the contribution of spatial versus temporal factors to the maintenance of genetic variation in a population. Single spikes were collected in the years 1988 and 2002 from plants that grew in the same sampling points, from six different habitats in the Ammiad conservation site, Eastern Galilee, Israel. Seeds were planted in a nursery and DNA was extracted from each plant and analyzed by the AFLP method. Fourteen primer combinations yielded 1,545 bands of which 50.0 and 48.8% were polymorphic in the years 1988 and 2002, respectively. Genetic diversity was much larger within populations than between populations and the temporal genetic diversity was considerably smaller than the spatial one. Nevertheless, population genetic structure may vary to some degree in different years, mainly due to fluctuations in population size because of yearly rainfall variations. This may lead to predominance of different genotypes in different years. Clustering the plants by their genetic distances grouped them according to their habitats, indicating the existence of genotype-environment affinities. The significance of the results in relation to factors affecting the maintenance of polymorphism in natural populations is discussed.