Diagnosing metabolic syndrome in type 2 diabetic Turkish patients: comparison of AHA/NHLBI and IDF definitions.

OBJECTIVES: The objective of this study was to determine the percentage of metabolic syndrome (MetS) in a Turkish population with type 2 diabetes mellitus (T2DM) according to the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and International Diabetes Federation (IDF) definitions and to assess the agreement among these definitions. BACKGROUND: It is essential to identify the prevalence of MetS in diabetic patients, as MetS is a stronger risk factor for cardiovascular disease in patients with T2DM than in non-diabetic subjects. METHODS: 235 consecutive patients with T2DM were included in the study. The MetS was defined according to AHA/NHLBI and IDF definitions. Cohen's kappa was used as a measure of agreement between the two definitions. Logistic regression analysis was performed to calculate the odds ratios. RESULTS: The percentage of MetS was 85.1% by AHA/NHLBI and 87.2% by IDF criteria. The agreement between AHA/NHLBI and IDF was fairly good (kappa = 0.55). Females were more affected than males. When the frequencies of each individual feature of the MetS according the definitions were assessed, hypertension was the most common feature in males, whilst abdominal obesity was in females. Serum triglyceride and waist circumference had the highest predictive ability for MetS according to AHA/NHLBI and IDF definitions, respectively. CONCLUSION: The MetS is a common condition among diabetic patients. Since diabetic patients carry a cluster of cardiovascular risk factors, correct identification of the MetS among this population is of great importance, for an integrated approach to reduce the high costs and the associated disabilities (Tab. 5, Fig. 2, Ref. 54).

Endovascular angioplasty-stenting as a definitive treatment for isolated spontaneous common carotid artery dissection. A case report.

Isolated spontaneous common carotid artery (CCA) dissection is rare. So far, surgical or medical treatment have only been reported in a few cases in the literature. We report a 39-year-old man, diagnosed as isolated spontaneous CCA dissection one year ago, who experienced a new minor stroke despite medical treatment. Because of the presence of new ischemic lesions on new magnetic resonance imaging despite medical treatment, and critical narrowing of internal carotid artery (ICA) orifice with jet and turbulence flow pattern at the bulbar portion of the ICA, endovascular management was performed with carotid stent deployment. To the best of our knowledge, this is the first case of spontaneous isolated CCA dissection treated with stenting of the carotid artery reported in literature. - ÖZET - Izole spontan common carotid arter (CCA) diseksiyonu nadirdir. Literatürde sadece birkaç adet, medikal veya cerrahi tedavi uygulanan, CCA diseksiyonu olgusu bildirilmistir. Bildirimizde, bir yil önce izole spontan CCA diseksiyonu tanisi almis ve medikal tedavi altinda iken yeni minor strok geçiren 39 yasinda erkek olguyu sunuyoruz. Olgunun yeni magnetik rezonans görüntülemesinde (MRG), sol posterior frontal ve pariyetal loblarda yeni iskemik lezyonlarin ortaya çiktigi görüldü. Renkli Doppler ultrasonografi (RDUS) incelemesinde eski incelemesine gore darligin arttigi izlendi. Karotis anjiografide de internal karotis arter baslangicinda jet ve türbülans akima neden olan kritik darlik saptanmasi üzerine endovasküler tedavi planlandi. Femoral girisimle koruyucu filtre kullanilarak self ekspandibl stent yerlestirildi ve postdilatasyon balon uygulandi. Islemden 24 saat sonra alinan difüzyon MRG incelemesinde yeni iskemik alan görülmedi. Birinci ve 3. ay kontrollerinde, nörolojik muayenesinde yeni bulgu saptanmadi. RDUS incelemelerinde stentin açik oldugu görüldü. Karotis artere stent yerlestirimesi cerrahiye alternatif bir tedavi olup daha az invazivdir. Stent uygulamasi, spontan ve travmatik internal karotis arter darliklarinda kullanilmis, ancak izole spontan CCA diseksiyonunda kullanilmamistir. Olgumuz nadir görülen izole spontan CCA diseksiyonu olgularindan biri olup stent yerlestirilerek tedavi edilmistir. Sonuç olarak, medikal tedaviye ragmen tekrarlayan semptomlari olan izole spontan CCA diseksiyonu olgularda tromboemboli kaynaginin kontrol altina alinmasi ve yeterli karotis akiminin saglanmasi için stent yerlestirilmesi gerekebilir.

Beta-adrenergic and arachidonic acid-mediated growth regulation of human breast cancer cell lines.

Adenocarcinoma of the mammary gland is the leading type of cancer in women. Among these breast cancers those that are estrogen-responsive respond well to existing therapeutic regimens while estrogen non-responsive cancers metastasize widely, demonstrate a high relapse rate, and respond poorly to therapy. Over-expression of the arachidonic acid-metabolizing enzymes cyclooxygenase-2 and lypoxygenases is frequently observed in breast cancer, particularly the non-estrogen-responsive type, suggesting a role of the arachidonic acid (AA) cascade in the growth regulation of these malignancies. Adenocarcinomas of the lungs, pancreas and colon also frequently over-express AA-metabolizing enzymes, and recent evidence suggests that the growth-regulating AA-cascade in these malignancies is under beta-adrenergic control. Our current experiments have therefore tested the hypothesis that in analogy to these findings adenocarcinomas of the breast are also regulated by beta-adrenergic receptors via stimulation of the AA-cascade. Analysis of DNA synthesis by [3H]-thymidine incorporation assays in three estrogen-responsive and three estrogen non-responsive cell lines derived from human breast cancers demonstrated a significant reduction in DNA synthesis by beta-blockers and inhibitors of cyclooxygenase or lipoxygenases in all cell lines. Analysis of AA-release in one of the most responsive cell lines demonstrated a time-dependent increase in AA-release in response to the beta-adrenergic agonist isoproterenol. Analysis by RT-PCR revealed expression of beta2-adrenergic receptors in all cell lines whereas beta1-adrenergic receptors were not found in two of the estrogen non-responsive cell lines. Our data suggest that a significant subset of human breast cancers is under control of beta-adrenergic receptors via stimulation of the AA-cascade. These findings open up novel avenues for the prevention and clinical management of breast cancer, particularly the non-estrogen-responsive types. Moreover, our findings suggest that cardiovascular disease and adenocarcinomas in a variety of organ systems, including the breast may share common risk factors and benefit from similar preventive and treatment strategies.

Tethered cord syndrome in adults.

BACKGROUND: The tethered cord syndrome (TCS) consists of an abnormally low conus medullaris tethered by a thickened filum terminale or various forms of spinal dysraphism. The adult variant of the syndrome seems not to be as rare as once thought. METHOD: This study includes 11 patients with a TCS. Clinical, radiological findings and outcome were reviewed in these adult patients with TCS. FINDINGS: The patients ranged in age from 18 to 34 years (mean 24.09 years). There were 7 men and 4 women. The presenting symptoms in order of frequency were as follows: low back pain radiating to legs, urinary complaints, weakness in legs and impotence. All patients had magnetic resonance imaging scans. Physical exercise in 8, birth delivery in 1 and carrying heavy objects in 1 patient were determined as the precipitating factors. No precipitating factor could be defined in one of the patients. All patients were operated on, except for one. None of the patients worsened after surgery. INTERPRETATION: The patients presenting with low back pain and sciatica responded to surgery better than those with sphincter problems.

Direct action by doxycycline against canine osteosarcoma cell proliferation and collagenase (MMP-1) activity in vitro.

BACKGROUND: Matrix metalloproteinases (MMPs) produced by tumor cells disrupt the integrity of the extracellular matrix (ECM). Inhibiting MMPs activity could significantly reduce tumor invasion and metastasis. MATERIALS AND METHODS: Canine osteosarcoma (OSA) cells were exposed to doxycycline in vitro to determine whether this chemically modified tetracycline had antiproliferative and anticollagenolytic activity. RESULTS: Doxycycline significantly reduced cell proliferation in a dose dependent manner. Doxycycline at the doses of 5 and 10 micrograms/ml suppressed cell number 50% and 72%, respectively. Furthermore, doxycycline significantly reduced collagenase activity at the doses of 10 and 20 micrograms/ml by 35% and 50%, respectively. OSA cells did not produce any endogenous collagenase in the culture medium. CONCLUSIONS: This study has shown that doxycycline at doses greater than 5 micrograms/ml in vitro significantly decreases cell proliferation and collagenase (MMP-1) activity. Prospective studies should be conducted to determine if doxycycline, a chemically modified tetracycline with low systemic toxicity, has specific anti-collagenase activity in vivo. Our studies indicate that canine osteosarcoma represents a suitable model for additional in vitro and in vivo studies.

Multiple brain abscesses following esophageal dilation.

A 6-year-old boy esophageal stricture due to the ingestion of caustic 7 months prior to admission. Eight esophageal dilations and a feeding gastrostomy were performed. He presented with seizure, right-sided weakness, fever, and somnolence. Computed tomographic scans revealed multiple brain abscesses. The abscesses were treated by burr-hole drainage. The patient improved and was discharged from the hospital without neurological deficit. Brain abscesses are not very common following esophageal dilation. It should be kept in mind that brain abscess is a potential complication of esophageal dilation.

Cerebellar mutism in an adult: case report.

Mutism occurring after posterior fossa surgery has been reported in children. We report an adult case of transient mutism after resection of a large tumor in the right cerebellar hemisphere. Although the patient was fully alert and without lower cranial nerve palsies and long tract signs, he had been mute for 4 days after surgery. Postoperative magnetic resonance imaging scan showed a slight hemorrhage in the region of the resected tumor. The relevant literature is reviewed.