Are there any differences at gray matter sites between severe obstructive sleep apnea patients and healthy controls?

OBJECTIVES: Obstructive sleep apnea (OSA) is a disease that may cause many medical conditions. Neurocognitive disorders may be triggered by OSA. In recent studies, selectively decreased gray matter tissue was observed in patients with OSA. We aimed to determine if there was a substantial difference in patients with extreme OSA by comparing the microstructural changes in different gray matter sub-areas with healthy controls using diffusion-weighted imaging methods. METHODS: We studied 15 diagnosed severe OSA subjects before any treatment and 32 healthy control subjects. High resolution Magnetic Resonance Imaging (MRI) T1 and T2-weighted scans were visually examined to assess any major brain lesions. RESULTS: There were no statistically significant differences of age and gender between the groups.The left and right globus pallidus, putamen and thalamus values did not differ significantly between OSA and control subjects. Right putamen values was negatively correlated with Apnea Hypopnea Index (AHI), supine AHI and non-REM AHI in OSA subjects, but no correlations appeared with left putamen values. The other gray matter parameters did not show any correlations with PSG parameters. AHI, Supine AHI, Non-Supine AHI, REM and NON-REM AHI values was not show any correlation with Right and Left Putamen volume sizes. CONCLUSIONS: We made a morphological comparison of various gray matter areas of OSA patients and healthy volunteers in our study. We observed a significant decrease in right putamen gray matter volumes in patients with higher AHI values. Decreased cognitive functions are found in patients with OSA. In order to demonstrate this cognitive loss in patients with morphologically there is a need for further prospective studies with larger sample sizes.

Utility of gray-scale histogram analysis in the assessment of treatment response in patients with infected cirrhotic ascites.

OBJECTIVE: To evaluate the utility of B-mode gray-scale histogram analysis in the management of patients with infected cirrhotic ascites. METHODS: A total of 97 patients (mean(SD) age : 66.8(14.2) years, 50.5% were males) diagnosed with cirrhotic ascites were included in this non-interventional study. Paracentesis for ascitic fluid analysis [culture tests, white blood cell count, albumin and protein levels, serum ascites albumin gradient (SAAG)] and gray-scale histogram analysis for ascites/subcutaneous echogenicity ratio (ASER) were performed at baseline in each patient and on Day 2 and Day 5 of treatment in patients with infected ascites. Receiver operating characteristics (ROC) curve was plotted to determine performance of ASER in identification of antibiotic resistance with calculation of area under curve (AUC) and ideal cut-off value of % change in ASER to detect antibiotic resistance. RESULTS: Treatment was associated with a significant decrease in median (min-max) ASER [from 0.005(0.0002-0.02) at baseline to 0.003(0.0001-0.01) on Day 2 and 0.0005(0.0001-0.009) on Day 5] and ascitic fluid polymorphonuclear leukocyte (PMNL) count [from 600(300-2200) at baseline to 350(50-1250) on Day 2 and 100(50-1100) on Day 5] (p<0.001 for each). ROC analysis revealed that less than 38% reduction in ASER [AUC: 0.923, 95% CI (0.797-0.982), p<0.001] was a potential marker of antibiotic resistance with a sensitivity of 90.9% and a specificity of 95.0%. CONCLUSIONS: In conclusion, our findings emphasize potential utility of gray-scale histogram based quantitative analysis of ascitic fluid echogenicity as an adjunct non-invasive method in the assessment of treatment response and early recognition of treatment failure in patients with infected ascites.

Utility of biochemical markers and RVD/LVD ratio in acute pulmonary embolism risk classification in Emergency Department.

OBJECTIVE: We aimed to determine the efficacy of troponin I, D-dimer, and lactate levels and right ventricular diameter (RVD)/left ventricular diameter (LVD) ratio on pulmonary computed tomography angiography (PCTA) in the risk classification of patients who were diagnosed with acute pulmonary embolism (APE) in Emergency Department (ED). PATIENTS AND METHODS: Patients who were diagnosed as having APE by PCTA in ED were included in this retrospective study. Patients were grouped as high-risk (undergoing cardiopulmonary resuscitation or given thrombolytic therapy), moderate-risk (with non-high-risk and positive ECO findings) and low risk (others). Troponin I, D-dimer, and lactate levels of patients were determined. RVD, RVD/LVD ratio, and interventricular septum deviation were calculated from PCTA images. RESULTS: A total of 121 patients were included (35 high, 36 moderate, 50 low risk). Lactate was different in the high-risk group from the other groups, whereas there was no difference between the moderate and low-risk groups. Troponin I levels were not different between the high-risk and moderate-risk groups. There were statistically significant differences between the high, moderate, and low-risk groups in terms of mean RVD/LVD ratios. ROC analyses performed in order to define high-risk group revealed a cut-off value of > 2.3 (AUC = 0.848, sensitivity = 70%, specificity = 90%, + Likelihood ratio (LR) = 7, -LR = 0.33, 95% CI = 0.752-0.943) for lactate and > 1.40 (AUC = 0.695 sensitivity = 71%, specificity = 80%, + LR = 3.6, -LR = 0.36, 95% CI = 0.668-0.822) for RVD/LVD ratio. CONCLUSIONS: Lactate levels and RVD/LVD ratio were shown to be useful in distinguishing high-risk patients from other patient groups. Troponin I is important in terms of showing cardiac involvement, but it is inadequate in distinguishing between high and moderate-risk patients. Lactate, troponin I, and RVD/LVD ratio may be used together for a more accurate separation of patients with high, intermediate and low-risk.

Differentiation between idiopathic granulomatous mastitis and malignant breast lesions using strain ratio on ultrasonic elastography.

PURPOSE: The goal of this study was to investigate the strain elastography imaging characteristics of idiopathic granulomatous mastitis (IGM) and compare strain ratio values of IGM with those of breast cancer. MATERIAL AND METHODS: Twenty-three consecutive women with IGM (mean age, 37.9±6.6 [SD] years; range: 26-52 years) and 45 women with malignant breast tumor (mean age, 52.8±12.0 [SD], range, 32-77 years) who had been scheduled for ultrasound-guided core biopsy were recruited to the study. All had ultrasonography with elastography before biopsy. The strain ratios of lesions were calculated using surrounding normal breast tissue as the reference in both groups and compared between the two groups. Receiver-operating-characteristics (ROC) curves were formed. Sensitivity, specificity, cut-off, and area under curve (AUC) values were calculated. RESULTS: The mean strain ratio on sonoelastography was 1.5±0.8 (SD) (range: 0.2-4.0) for IGM and 5.3±5.2 (SD) (range: 1.4-33) for malignant lesions. Strain ratio values in IGM lesions were significantly lower than in malignant lesions (P˂0.05). ROC test yielded an AUC value of 0.939 (95% confidence interval, 0.882-0.995; P<0.0001). Optimal cut-off value for strain ratio value was 2.5 yielding 87% sensitivity and 96% specificity for the diagnosis of IGM. CONCLUSION: Sonoelastographic strain ratio contributes to differentiate IGM from malignant breast lesions, thus has potential to influence clinical decision making for further biopsies.

Osteoblastoma originating from frontoethmoidal sinus causing personality disorders and superior gaze palsy.

Osteoblastoma is a rare, solitary benign tumor that is usually situated in axial skeleton mainly in vertebra. It is rarely seen in ethmoid and frontal sinuses. A 40-year-old man who had osteoblastoma originated from frontal and ethmoidal sinuses that extends up to frontal lobe and gave rise to personality disorders by compressing the frontal lobe, and caused superior gaze palsy by compressing the superior rectus muscle. We present this rare case with clinical, radiological and histopathological findings.

Protective effects of dexmedetomidine in pneumoperitoneum-related ischaemia-reperfusion injury in rat ovarian tissue.

OBJECTIVES: To determine the effects of dexmedetomidine on pneuomoperitoneum-related ischaemia-reperfusion (I/R) injury in rat ovarian tissue. STUDY DESIGN: Animals were randomized into three groups: Group S (n=8), no pneumoperitoneum; Group C (n=8), pneumoperitoneum; and Group D (n=8), 100µg intraperitoneal dexmedetomidine 30min before pneumoperitoneum. Ovarian tissue was collected from all rats 30min after desufflation, and fresh frozen for histological and biochemical evaluation. RESULTS: Body weight was similar in all three groups (202.62±28.86, 211.00±14.45 and 212.87±15.71g in Groups S, D and C, respectively). The mean malondialdehyde level was higher in Group C than the other groups (p<0.03). When the histological samples of ovarian tissue were compared, vascular congestion, haemorrhage, follicular cell degeneration and infiltrative cell infiltration scores were higher in Group C compared with the other groups (p<0.05). Significantly lower scores for the histological parameters were found in Group D compared with Group C (p<0.05). Similar scores for follicular cell degeneration and inflammatory cell infiltration were found in Group D and Group S (p>0.05). Although vascular congestion and haemorrhage scores were significantly lower compared with Group C, higher scores were found for Group D compared with Group S (p<0.05). CONCLUSION: Pneumoperitoneum caused oxidative injury in rat ovarian tissue. Dexmedetomidine reduced oxidative stress and histological injury related to I/R.

Postoperative repeated respiratory insufficiency and thyrotoxicosis in molar pregnancy.

Following the removal of a hydatiform mole in a 34-year-old, 14-week pregnant patient, thyrotoxicosis and respiratory insufficiency attacks were twice unexpectedly repeated. The symptoms were resolved with the administration of plasmapheresis, antithyroid and ß-blocker drugs and non-invasive mechanical ventilation; however, she was again operated due to prolonged elevated ß-hCG.

Awake caudal anesthesia for inguinal hernia operations: successful use in low birth weight neonates.

Neonates with inguinal hernia face a relatively high risk of incarcerated hernia and bowel obstruction and this therefore requires surgical treatment. Complications following general anesthesia even for minor surgery are more common in low birth weight neonates than in term neonates. Caudal epidural anesthesia without adjunct general anesthesia has been recommended for neonates to reduce the risk of postoperative complications. The successful application of awake caudal anesthesia with levobupivacaine for inguinal hernia repair in 15 low birth weight neonates is reported. Single dose caudal epidural anesthesia was administered for inguinal hernia surgery to avoid complications associated with general anesthesia. Caudal block was performed with 2.5 mg/kg body weight (BW) levobupivacaine. Caudal anesthesia can be recommended as an effective technique for avoiding postoperative anesthetic complications in low birth weight neonates.