Early Reverse Cardiac Remodeling Effect of Laparoscopic Sleeve Gastrectomy.

BACKGROUND: This study evaluated the early postoperative benefits of laparoscopic sleeve gastrectomy (LSG) on the left ventricular (LV) function and left atrial (LA) structural, mechanical, and electrical functions in severely obese patients. METHODS: Thirty-two patients with severe obesity who were consecutively scheduled for LSG and 30 healthy controls were included in the study. LV global longitudinal strain (LGS), peak atrial longitudinal strain (PALS), and strain rates (S-Sr, E-Sr, and A-Sr) of the lateral and septal LA walls, and intra- and interatrial dyssynchrony periods for all subjects were evaluated using strain echocardiography. The measurements were repeated in patients 1 month after surgery. RESULTS: LGS of the LV was significantly depressed in the patient group compared with the control group (p < 0.001). LA peak septal and lateral wall strain values were significantly lower in patients than in controls (both p values <0.001). LA intra- and interatrial dyssynchrony periods were longer in patients than in controls (p = 0.012 and p = 0.004, respectively). LGS significantly improved after LSG (p < 0.001). Significant reductions were noted in the LA antero-posterior diameter (p < 0.001), LA volume index (LAVI, p = 0.001), and in the mitral velocity to the early diastolic velocity of the mitral annulus ratio (E/e' ratio, p = 0.046). The PALS of the septal and lateral LA walls significantly increased (p = 0.001 and p < 0.001, respectively). S-Sr, E-Sr, and A-Sr values of the septal LA wall (p = 0.049, p < 0.001, and p = 0.001, respectively) and the lateral LA wall (p = 0.009, p = 0.007, and p = 0.002, respectively) significantly improved postoperatively. Intra- and interatrial dyssynchrony significantly decreased (p = 0.001 and p < 0.001, respectively). Weight loss positively correlated with changes in LGS (R = 0.39, p = 0.039), LAVI (R = 0.39, p = 0.034), intra-atrial dyssynchrony (R = 0.45, p = 0.021), interatrial dyssynchrony (R = 0.42, p = 0.038), septal LA wall peak strain (R = 0.44, p = 0.027), lateral LA wall peak strain (R = 0.46, p = 0.017), septal LA wall A-Sr (R = 0.43, p = 0.028), and lateral LA wall A-Sr (R = 0.46, p = 0.019). The comparison of postoperative findings of the patients with controls revealed that the LA diameter, both LA volume and volume index (LAVI), E/e' ratio, S-Sr and E-Sr of both lateral and septal LA walls, intra- and interatrial LA dyssynchrony of the patient group became similar to the control group (all p value >0.05). Postoperative A-Sr values of both LA walls (both p value <0.001) were higher in patients than controls. CONCLUSION: The benefits of LSG on LV and LA function may be observed even in the early postoperative phase. The resulting weight loss correlates with LV and LA reverse remodeling in severely obese patients.

Effects of isotretinoin on the thyroid gland and thyroid function tests in acne patients: A preliminary study.

BACKGROUND: Isotretinoin is widely used in the treatment of acne. AIMS: We investigated the effects of isotretinoin on thyroid function tests and thyroid volume in acne patients. METHODS: In this prospective study, a total of 104 acne patients were included. Sixty-six patients were treated with isotretinoin for at least 4 months. Thirty eight patients were included in the control group. The levels of thyroid stimulating hormone, free triiodothyronine, free thyroxine, antithyroglobulin and antithyroid peroxidase antibodies were measured and a thyroid ultrasound was performed in all the subjects before treatment and 4 months after treatment. A "p" value of < 0.05 was considered significant. RESULTS: In the isotretinoin-treated group, thyroid stimulating hormone levels increased significantly during isotretinoin treatment (P = 0.018). Free triiodothyronine, free thyroxine, anti-thyroid peroxidase levels and thyroid volume decreased significantly during treatment (P = 0.016, P= 0.012, P= 0.006, P = 0.020 respectively). LIMITATIONS: The major limitation of this study is the lack of follow-up data after the cessation of isotretinoin therapy in acne patients. CONCLUSION: Patients treated with isotretinoin should be monitored with thyroid function tests.

Polycystic ovary syndrome is associated with increased osteopontin levels.

OBJECTIVE: Osteopontin (OPN) is a multi-functional secreted glycoprotein that plays a crucial role in glucose metabolism and inflammatory process. Growing evidence suggests that there is a link between OPN and ovarian function. However, no such link has yet been found for OPN in polycystic ovary syndrome (PCOS). Our aim was to ascertain whether circulating OPN levels are altered in women with PCOS and to determine whether OPN levels differ between the follicular phase and mid-cycle of the menstrual cycle in eumenorrheic women. DESIGN AND METHODS: In total, 150 women with PCOS and 150 age- and BMI-matched controls without PCOS were recruited for this prospective observational study. OPN levels were measured using ELISA. Metabolic parameters were also determined. RESULTS: Circulating OPN levels were significantly elevated in PCOS women compared with controls (69.12±31.59  ng/ml vs 42.66±21.28  ng/ml; P<0.001). OPN levels were significantly higher at mid-cycle than in the follicular phase in eumenorrheic women. OPN was positively correlated with BMI, homeostasis model assessment of insulin resistance (HOMA-IR), free testosterone, and high sensitivity C-reactive protein (hs-CRP). Multivariate logistic regression analyses revealed that the odds ratio (OR) for PCOS was 3.64 for patients in the highest quartile of OPN compared with those in the lowest quartile (OR=3.64; 95% CI=2.42-5.57; P=0.011). Our findings indicate that BMI, HOMA-IR, hs-CRP, and free testosterone are independent factors influencing serum OPN levels and that OPN is an independent predictor for HOMA-IR. CONCLUSION: PCOS is associated with increased OPN levels.

Relationship Between Serum Fetuin-A Levels and Carotid Intima-media Thickness in Turkish Patients with Mild to Moderate Psoriasis. A Case-control Study.

Previous studies have associated severe psoriasis and psoriatic arthritis with an increased risk of atherosclerosis. However, the association between patients with mild-to-moderate plaque-type psoriasis and atherosclerosis has yet to be studied in depth. This study investigates a) possible correlations between carotid intima-media thickness (CIMT) and serum fetuin-A levels in patients with mild-to-moderate psoriasis and b) correlations between psoriasis severity index (PASI) and fetuin-A levels. The latter correlation was recently reported to be important for wound healing and vascular calcification. In this prospective study, a total of 70 patients with mild-to-moderate psoriasis and 66 control participants were included. PASI, CIMT, and serum fetuin-A levels were examined in all patients. Although the difference in fetuin-A values was not statistically significant between patients with mild-to-moderate plaque-type psoriasis and control groups (P=0.401), the CIMT levels in the psoriasis group were significantly higher than the control group (P=0.002). There were no correlations among fetuin-A levels, CIMT, and PASI. This study establishes an association between mild to moderate psoriasis and atherosclerosis. This study also concludes that, similarly to patients with severe psoriasis, CIMT levels are a better indicator of cardiovascular risk than serum fetuin-A levels in patients diagnosed with mild-to-moderate plaque-type psoriasis.

Bilateral metachronous adrenal metastases of operated renal cell carcinoma.

BACKGROUND: The adrenal glands are among the target metastatic organs due to the potential of systemic metastasis from renal cell carcinoma (RCC). The number of cases with bilateral metachronous metastases from RCC is about twenty. PATIENTS AND METHODS: A sixty-one-year-old man presented for routine checks due to an operated left renal tumor (clear cell carcinoma, PT2N0M0, Fuhrman grade III). The patient underwent 18FDG-PET/CT in order to re-stage the disease upon observation of bilateral adrenal masses on ultrasound and CT. A bilateral metachronous metastasis was found, whose SUVmax was 6.7 x 50 x 38 x 20 cm on the left adrenal gland, and another metastasis whose SUVmax was 5.5 40 x 29 x 20 on the right adrenal gland. RESULTS: The patient underwent a CT-guided biopsy and diagnosis of adrenal metastasis was made by pathological and immunohistochemical examination. The laparoscopic treatment was performed. CONCLUSIONS: There is no standard approach for the treatment of these patients in the literature. But metastasectomy is the most realistic part of the treatment. Making definitive diagnosis with biopsy, following hormonal examination and treatment with minimally invasive adrenal sparing surgical procedure containing frozen-section are strongly recommended. Cancer specific survival significantly increases with metastasectomy.

Evaluation of Arterial Stiffness in Patients with Behçet's Disease by Using Noninvasive Radiological Methods such as Intima-Media Thickness of the Carotid, Ankle-Brachial Pressure Index, Coronary Artery Calcium Scoring, and Their Relation to Serum Fetuin-A Levels: A Case-Control Study.

BACKGROUND: Behçet's disease (BD) is a chronic, recurrent inflammatory systemic vasculitis. Evidence for increased atherosclerosis in BD has been observed. The relation between cardiovascular risk factors and increased atherosclerosis in patients with BD is still controversial. OBJECTIVE: We performed this study to evaluate arterial stiffness in patients with BD by using noninvasive radiological methods such as carotid artery intima-media thickness (CIMT), ankle-brachial pressure index (ABPI), coronary artery calcium score (CACaS), and their relation to serum fetuin-A levels, which was recently found to be important in vascular calcification. METHODS: This prospective study included 26 patients with BD and 25 control subjects. In all patients, the CIMT, ABPI, CACaS, and serum fetuin-A levels were examined. RESULTS: The CIMT and CACaS were statistically higher and the ABPI was statistically lower in BD patients than in the control group. All p-values were <0.001. Positive correlations were found between the CACaS and CIMT, and negative correlations were found between the CACaS and ABPI. Although the values of fetuin-A were higher in BD, the difference was not statistically significant (p=0.064). However, the correlations found between fetuin-A levels and CIMT and between fetuin-A levels and CACaS were significant. CONCLUSION: The CIMT, CACaS, and ABPI are all useful in detecting structural and functional vascular damage in BD.

Effects of the 755-nm Alexandrite laser on fine dark facial hair: review of 90 cases.

Laser hair removal is a relatively effective method for thick hair. Despite the risk for induction of fine hair growth, application of laser for fine dark hair is sometimes inevitable. We investigate the effects of 755-nm Alexandrite laser on fine dark facial hair and evaluate the induction rates of fine hair growth and case satisfaction. In the present study, the thickening rate of hairs (33.33%) was found to be higher than the previously published rates. However, reduction of hair density can be obtained when the laser sessions are continued.

Amelanotic melanoma misdiagnosed as a diabetic foot ulcer.

Amelanotic melanoma often leads to delayed clinical diagnosis because of its wide range of clinical appearances and lack of pigmentation. Misdiagnosis of amelanotic melanoma is also common, particularly when it is located at the foot. We report here a 71-year-old male patient with a 17-year history of type 2 diabetes mellitus who presented with a small ulcer under his fifth metatarsal head, which was previously misdiagnosed as a diabetic foot ulcer. The patient was treated with local wound care and systemic antibiotics without any improvement of the ulcer. Further investigation of the patient in our clinic revealed plantar amelanotic melanoma.

The beneficial effects of lipid-lowering drugs beyond lipid-lowering effects: a comparative study with pravastatin, atorvastatin, and fenofibrate in patients with type IIa and type IIb hyperlipidemia.

Hyperlipidemia is an important risk factor for atherosclerosis. Hemorheological factors contribute to morbidity and mortality in patients with dyslipidemia. We evaluated the effects of 3 antihyperlipidemic drugs (pravastatin, atorvastatin, and fenofibrate), which have different mechanisms of action and different patterns of action on lipid profiles, on erythrocyte deformability and fibrinogen levels in patients with type IIa and type IIb hyperlipidemia. Twenty-one patients ( 4 men and 17 women) with type IIa and IIb hyperlipidemia were randomized to 3 drugs (pravastatin 20 mg/d, atorvastatin 10 mg/d, fenofibrate 250 mg/d) for 8 weeks. Plasma glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) analysis were performed on a BM-Hitachi 747-200 autoanalyzer (Hitachi-Roche, Tokyo, Japan). Fibrinogen analysis was performed according to Clauss method. Erythrocyte deformability was assessed with cell transit analysis device. There was no significant difference in body mass index, lipid profile, fibrinogen level, and erythrocyte deformability index values among the groups before treatment ( P > .05). In all groups, there were statistically significant reductions in total LDL-C levels ( P < .05). The triglyceride levels were significantly reduced in the atorvastatin and fenofibrate groups ( P < .05), but not in the pravastatin group ( P > .05). There was no significant change in HDL-C levels during the treatment with statins ( P > .05), but there was a significant increase in the fenofibrate group ( P < .05). Mean erythrocyte deformability index was improved in all the groups ( P < .05). There was no significant change in fibrinogen levels during the treatment of pravastatin and atorvastatin ( P > .05), but in fenofibrate group, fibrinogen levels were significantly decreased ( P < .05). The 3 groups of antihyperlipidemic drugs have beneficial effects on the erythrocyte deformability index. Only fenofibrate has significant beneficial effects on the fibrinogen levels.