Discriminative role of brachial artery Doppler parameters in correlation with hemodialysis arteriovenous fistula.

PURPOSE: The aim of this study was to evaluate the flow volume and resistive index parameters of the brachial artery in the functioning and dysfunctioning radiocephalic and brachiocephalic hemodialysis arteriovenous fistula (AVF). METHODS: 82 patients were distributed into three groups according to their hemodialysis function - as normal function, decreased pump flow and increased venous pressure. Flow volumes and resistive indexes (RI) of the brachial artery of radiocephalic and brachiocephalic AVFs were measured by Doppler ultrasound. Flow parameters of the groups were compared. RESULTS: A statistically significant difference was found between the normal and decreased pump flow groups in terms of flow volume and resistive index values. 770 ml/min flow volume of the brachial artery has a 94% sensitivity and 84% specificity and 0.52 value of RI has an 89% sensitivity and 88% specificity in the the differentiation of normal and decreased pump flow groups. CONCLUSION: Doppler parameters of the brachial artery such as flow volume and RI can provide valuable information about AVF function.

Percutaneous treatment of thrombosed hemodialysis arteriovenous fistulas: use of thromboaspiration and balloon angioplasty.

BACKGROUND: Endovascular strategies have been used to manage patients with thrombosed vascular access for hemodialysis. We analyzed primary success rate and patency rates of balloon angioplasty following mechanical thrombectomy for the treatment of thrombosed native arteriovenous fistulas. METHODS: This was a retrospective study of 24 patients with thrombosed native arteriovenous fistulas who were referred for treatment in the intervention unit of the Radiology Department. All patients had been performed percutaneous thrombo-aspiration and balloon angioplasty. Technical and clinical success rates as well as the 6th and 12th months primary and secondary patency of fistulas were evaluated. RESULTS: Technical and clinical success was 83%. In the 6 of 20 patients, early re-thrombosis were detected. Patent AVF with primary and secondary patency rates at 6 and 12 months was 55%-40%. The secondary patency rates at 6 and 12 months were 75% and 70%. CONCLUSION: Mechanical thrombectomy with balloon angioplasty is a minimally invasive and effective procedure for the treatment of thrombosed native arteriovenous fistula. Advantages of this technique are minor complication rates, cost effectiveness, high technical success rate.

Relationship between asymmetric dimethylarginine and endothelial dysfunction in patients with rheumatoid arthritis.

OBJECTIVE: In rheumatoid arthritis (RA), endothelial dysfunction caused by the inflammatory process increases the risk of cardiovascular disease. Asymmetric Dimethylarginine (ADMA) leads to vascular dysfunction, whereas atherosclerosis and increased ADMA is associated with cardiovascular disease risk factors. Flow-mediated Dilation (FMD) is a radiological method to demonstrate endothelial dysfunction. In the present study, we assessed the availability of ADMA as a marker for endothelial dysfunction in RA patients. ADMA can be used as a simple and cheaper method for the determination of endothelial dysfunction. MATERIAL AND METHODS: Forty patients (1 male, 39 female) diagnosed with RA according to the classification criteria and 29 healthy volunteers (2 males, 27 females) were included in this study. ADMA was studied by enzyme-linked immunosorbent assay (ELISA). Chi-square, Fisher's exact test, Mann-Whitney U test, and Spearman's correlation tests were used for analytical analysis, and p<0.05 was considered as the level of statistical significance. RESULTS: In our study, ADMA levels were significantly higher in RA patients. The ADMA level was inversely correlated with FMD. Although high levels of both C-reactive protein and ADMA were detected in patients with high disease activity, there was no statistically significant difference between these parameters (p=0.18). There were statistically significant negative correlations between FMD and age and disease duration (p=0.01, p=0.01). However, there were no statistically significant correlations with erythrocyte sedimentation rate, rheumatoid factor, and disease activity score (p=0.68). In RA patients, there was a statistically significant positive correlation between disease duration and ADMA, whereas a negative correlation was found between FMD and ADMA (p<0.05). CONCLUSION: Our results support the hypothesis that ADMA may be used in the assessment of endothelial dysfunction in patients with RA. It will be cost-effective when commonly used. ADMA may be used in the assessment of endothelial dysfunction in patients with RA.

Polyarteritis nodosa complicated by posterior reversible encephalopathy syndrome: a case report / Complicación de la poliarteritis nodosa por síndrome de encefalopatía posterior reversible. Caso clínico

La hipertensión es uno de los principales problemas de salud pública, que afecta a muchas personas en todo el mundo. Se sabe que es un importante factor de riesgo para el desarrollo de enfermedades cerebrovasculares y cardiovasculares. Su clasificación como «primaria» o «secundaria» depende del proceso subyacente. En el 5-10% de los pacientes hipertensos, se trata de un problema «secundario» a otro proceso de creciente frecuencia en los centros de atención terciaria. Las causas más frecuentes de la hipertensión secundaria son: enfermedades del parénquima renal, estenosis de la arteria renal, hiperaldosteronismo primario, feocromocitoma y el síndrome de Cushing. La poliarteritis nodosa puede afectar a cualquier órgano y en diferentes grados. A continuación presentamos a un paciente joven hipertenso al que se le ha diagnosticado poliarteritis nodosa, cuya angiografía muestra múltiples microaneurismas que afectan al tronco celíaco, a la arteria renal y a la arteria mesentérica superior, asociada a un síndrome de encefalopatía posterior reversible de entidad neurológica poco visto (AU)

Hypertension (HT) represents a major public health problem affecting many individuals worldwide. It is well known to be an important risk factor for the development of cerebrovascular and cardiovascular diseases. Classifying hypertension as ‘primary’ or ‘secondary’ depends on the underlying mechanism. In 5 to 10% of hypertensive patients, HT develops ‘secondary’ to a separate mechanism that has been encountered with increasing frequency in the tertiary refferral centers. The frequent causes of secondary hypertension include renal parenchymal disease, renal artery stenosis, primary hyperaldosteronism, phaeochromocytoma and Cushing's syndrome. Polyarteritis nodosa (PAN) can involve any organ and in varying degrees. Here we present a young hypertensive patient diagnosed as PAN with the angiographic findings of multiple microaneurysms involving celiac, renal and superior mesenteric arteries and associated with a rarely seen neurological entity-PRES syndrome (AU)

Polyarteritis nodosa complicated by posterior reversible encephalopathy syndrome: a case report.

Hypertension (HT) represents a major public health problem affecting many individuals worldwide. It is well known to be an important risk factor for the development of cerebrovascular and cardiovascular diseases. Classifying hypertension as ‘primary’ or ‘secondary’ depends on the underlying mechanism. In 5 to 10% of hypertensive patients, HT develops ‘secondary’ to a separate mechanism that has been encountered with increasing frequency in the tertiary refferral centers. The frequent causes of secondary hypertension include renal parenchymal disease, renal artery stenosis, primary hyperaldosteronism, phaeochromocytoma and Cushing's syndrome. Polyarteritis nodosa (PAN) can involve any organ and in varying degrees. Here we present a young hypertensive patient diagnosed as PAN with the angiographic findings of multiple microaneurysms involving celiac, renal and superior mesenteric arteries and associated with a rarely seen neurological entity-PRES syndrome.

Malnutrition due to bisphosphonate-related osteonecrosis of the jaw in a chronic dialysis patient: case report.

Adequate nutrition is imperative for a successful outcome in dialysis patients. Excellent oral hygiene and an efficient mastication can help to correct several metabolic and endocrine disturbances as well as delay initiation of dialysis in patients with chronic renal failure. However, concerns exist about the risk of malnutrition and protein depletion. On the other hand, intravenous bisphosphonates are the current standard of care for the treatment of hypercalcemia of malignancy and for the prevention of skeletal complications associated with bone metastases. Recently, retrospective case studies have reported an association between long-term bisphosphonate therapy and osteonecrosis of the jaws. This complication occurs either spontaneously or after minor dento-alveolar surgery including extraction of teeth. A malnourished dialysis patient who showed the typical clinical features of bisphosphonate-related osteonecrosis of the jaw (BRONJ) without any obvious radiological changes in his panoramic radiograph is reported. To minimize the risk of BRONJ, patients initiated on bisphosphonates should optimize routine dental care and have their baseline oral health evaluated by both clinical and radiographic examinations before initiation of bisphosphonate therapy.

Renal cyst infection caused by Brucella abortus.

A 49-year-old man with a medical history of polycystic kidney disease was presented to the emergency department with fever and left flank pain. Abdominal examination revealed an enlarged and painful left kidney. The C-reactive protein level was significantly high and the magnetic resonance imaging revealed areas of abnormal intensity and fluid-fluid levels in renal cysts. Brucella abortus was yielded from both blood and cyst fluid culture. Standard therapy (rifampicin plus doxycycline) of brucellosis was started, but the clinical and laboratory signs subsided after the addition of ciprofloxacin. There was no need for aspiration of infected cyst fluid. Hereby, according to the medical database search, we report that the first renal cyst infection caused by B. abortus was successfully treated with triple antibiotic therapy.

Sonographic features of histopathologically benign solid breast lesions that have been classified as BI-RADS 4 on sonography.

PURPOSE: To describe the sonographic (US) features associated with ultrasonography BI-RADS category 4 lesions that have a benign histopathological outcome. METHODS: One hundred seventy-two histopathologically proven benign lesions in 169 patients, which had been classified as BI-RADS category 4 with ultrasonography, were retrospectively evaluated. Ultrasonography and histopathology findings were analyzed. The frequency of sonographic findings according to the histopathological diagnosis was determined. RESULTS: Among the 172 lesions, there were 66 (38%) fibroadenomas, 31 (18%) sclerosing adenoses, 24 (14%) fibrocystic changes, 16 (9%) mastitis/inflammations, 9 (5.5%) intraductal papillomas, 8 (5%) focal fibroses, 4 (2.5%) atypical ductal hyperplasias, 4 (2.5%) fat necroses, 2 (1%) phyllodes tumors, 1 (0.5%) tubular adenomas, 1 (0.5%) epidermal inclusion cysts, and 6 (3.5%) "other benign lesions." The most frequent sonographic findings were heterogeneity, indistinct margin, microlobulation in fibroadenomas; heterogeneity, irregular-indefinite margin, and antiparallel orientation in sclerosing adenosis; heterogeneity, microlobulation, and acoustic shadowing in fibrocystic changes. CONCLUSIONS: BI-RADS category 4 lesions demonstrate more than one suspicious ultrasonography feature, and biopsy is necessary to diagnose malignancy captured in 33% of lesions in this study. At this time, any lesion with more than one suspicious BI-RADS US feature cannot avoid a diagnostic biopsy.

Polyarteritis nodosa and Henoch-Schönlein purpura nephritis in a child with familial Mediterranean fever: a case report.

Familial Mediterranean fever is an autosomal recessive disease characterized by recurrent self-limited attacks of fever accompanied by peritonitis, pleuritis, and arthritis. Approximately 5% of individuals with familial Mediterranean fever have been reported to have Henoch-Schonlein purpura and about 1% to have polyarteritis nodosa. A 7-year-old girl presenting with complaints of purpuric rash, abdominal pain, arthritis, hematuria, and proteinuria and having IgA depositions on renal biopsy was diagnosed as Henoch-Schönlein nephritis. She had a history of recurrent fever, abdominal and joint pain and M694 V compound homozygote mutation. Colchicine treatment was started for the diagnosis of FMF. When constitutional symptoms such as myalgia, weight loss, fatigue, fever, and hypertension were added to the clinical picture, the diagnosis of polyarteritis nodosa HSP was thought and confirmed by the demonstration of microaneurisms on renal arteries. There was no response to corticosteroid and cyclophosphamide treatments; however, the symptoms were rapidly and dramatically reduced after the administration of intravenous immunoglobulin. In conclusion, polyarteritis nodosa and Henoch-Schonlein purpura can be seen together with familial Mediterranean fever. It is also suggested that IVIG might be an important adjunct therapy in selected patients with polyarteritis nodosa, especially in the lack of response to steroids and immunsuppressive drugs.

Takayasu arteritis with intracranial involvement mimicking epilepsy: case report and review of the literature.

The symptoms of Takayasu arteritis (TA) are related to end organ ischemia. Here we present a patient with convulsions and intracranial involvement. A 15-year-old young woman was admitted with the complaint of convulsions since one and a half months previously. Her physical examination showed absent pulses and unobtainable blood pressure in both arms. Electroencephalography was normal. An arcus aorto-abdominal aortography, performed for TA prediagnosis, revealed that the subclavian artery ended as a stump at its origin on the right and was occluded by tapering on the left. Arcus aorta was normal. The right renal artery was occluded up to 80-90%. Magnetic resonance imaging of the brain revealed abnormal signal intensity in the deep white matter bilaterally. Cerebral catheter angiography showed focal stenosis of cerebral vessels; it was classified as type V according to the classification of the Takayasu Conference of 1994. A diagnosis of TA was made and 1 mg/kg steroid was given, and after a month methotrexate (15 mg/week) was added. On the tenth treatment day her pulse could be revealed. During the control period she had no convulsion. In young patients TA should be kept in mind as a rare cause in convulsion etiology. Intracranial involvement of TA must be evaluated especially if there is a headache and convulsion.

Sclerosing adenosis of the breast: radiologic appearance and efficiency of core needle biopsy.

PURPOSE: To examine the mammography and ultrasonography findings of patients who have a final histopathological diagnosis of sclerosing adenosis after breast biopsy, and to evaluate the follow-up results of patients who underwent core needle biopsies. MATERIALS AND METHODS: Seventy-six of the 723 patients who underwent breast biopsy in our institution were diagnosed with sclerosing adenosis on histopathological examination. Mammography and ultrasonography findings from these 76 lesions were analyzed retrospectively. Thirty-seven of these lesions were sampled by image-guided core needle biopsy; the remaining lesions were excised surgically. Mammograms and ultrasound images of the lesions were re-evaluated, and the post-biopsy medical records of these patients were evaluated. RESULTS: Sclerosing adenosis was the main diagnosis in 41 patients and the complementary diagnosis in 35 patients. Among the first 41 lesions in which sclerosing adenosis was the main diagnosis, there were 18 (44%) mass lesions, 16 (39%) microcalcification clusters, two (5%) lesions with asymmetrical opacity, three (7%) lesions with architectural distortion, and two (5%) lesions with focal acoustical shadowing that was only detected by ultrasonography. No alterations suggesting malignancy were noted during the follow-up examinations of 35 patients who underwent core needle biopsy. CONCLUSION: Sclerosing adenosis is a benign proliferative disease of the breast that can be confused with malignancy on clinical, radiological, and even histopathological examination. There is no typical radiological criterion for diagnosis. Core needle biopsy or excisional biopsy can be used, depending on the lesion's characteristics. Core needle biopsy can be the first step in the diagnosis of sclerosing adenosis.

Color Doppler US evaluation of feeding artery after balloon angioplasty of the drainage vein in dysfunctional hemodialysis AVF.

PURPOSE: The aim of this study was to investigate flow rate and resistive index (RI) parameters of the feeding artery after balloon angioplasty of the drainage vein in dysfunctional hemodialysis arteriovenous fistula (AVF) due to venous stenosis/thrombosis. METHODS: A cohort of 10 patients with native dysfunctional hemodialysis AVF was evaluated prospectively. Three of the 10 patients had a thrombosed drainage vein, and the remaining seven patients had a stenotic drainage vein. Flow rate and RI of the feeding artery of AVF were calculated by Color Doppler ultrasound (CDU) before and after balloon angioplasty and in the follow-up period. The flow rates and RI values before and after angioplasty and in the follow-up were compared. RESULTS: Increased flow rate and decreased RI values were detected after balloon angioplasty in all patients. We detected restenosis or thrombosis of drainage vein in six of the patients in the follow-up period. Decreased flow rate and increased RI values compared with previous measurements were calculated in these patients. CONCLUSIONS: Increased flow rate and decreased RI in the feeding artery of native dysfunctional AVF were demonstrated in patients who underwent balloon angioplasty on the stenotic vein. If restenosis develops in the follow-up period, the previous high resistance flow pattern is observed again. Feeding artery flow parameters as calculated by CDU can be used as a simple indicator of possible drainage vein problems of native AVF.

[The effect of losartan on the intima-media thickness of carotid artery]. / Losartanin karotid arter intima-media kalinligina etkisi.

OBJECTIVE: There are findings about negative effects of angiotensin 1 (AT1) receptor stimulation at every stage of atherosclerosis formation. Recently, AT1 receptors, especially the effects of AT1 receptor antagonists on the regression of atherosclerosis, are being researched intensively. Measurement of carotid artery thickness has been accepted as a marker of atherosclerosis. In our study, we investigated the effect of AT1 receptor antagonist, losartan, on the carotid artery intima-media thickness of newly diagnosed hypertensive patients. METHODS: We reached to 450 individuals by the stratified and random sampling method and measured their blood pressure to find out undiagnosed hypertensive patients. Fifty-one patients (mean age 54+/-9 years) were accepted to participate in our study. Forty-nine of them (33 women and 16 men) completed the study. After the measurements of the carotid artery intima-media thicknesses by B-mode Doppler ultrasonography, their blood tests were performed and arterial blood pressures were measured. Soon after, treatment with losartan as an antihypertensive agent was begun. All measurements were repeated on the eighth month of this therapy. RESULTS: The mean systolic and diastolic blood pressure of the cases were 167+/-14 mmHg and 102+/-8 mmHg, respectively. At the end of the eighth month these measurements regressed to 139+/-11 mmHg and 84+/-8 mmHg, respectively (p<0.05). Meaningful regression of carotid artery intima-media thickness was established. The mean regression was 0.10+/-0.19 mm (p=0.004) for women, 0.18+/-0.29 mm (p=0.007) for men and 0.13+/-0.23 mm (p<0.001) for the study population. No relation was seen between the carotid artery intima-media thickness and first systolic and diastolic blood pressure measurements of the patients (r=0.122, p=0.403 and r=0.032, p=0.828, respectively). CONCLUSION: We think that losartan should be recommended to use for protection against atherosclerosis at the young aged individuals that have multiple risks for atherosclerosis, other than hypertension.

Effects of postmenopausal hormone replacement therapy on body fat composition.

AIM: To evaluate the effects of different types, regimens and administration routes of hormone replacement therapy (HRT) on body fat composition indices in postmenopausal women at increased risk of anthropometry-related cardiovascular disease (CVD). METHODS: Fifty-nine postmenopausal women (aged 41-57 years, mean +/- standard deviation: 49.9 +/- 3.8 years) with body mass index (BMI) > or =25 kg/m(2) participated in this 6-month, prospective, randomized single-blind study. Subjects were assigned into three groups and received transdermal estradiol (E2)/norethisterone acetate (NETA) (50 microg E2 daily for 14 days followed by 50 microg E2/0.25 microg NETA daily for 14 days; transdermal group, n = 19), transdermal continuous E2/oral medroxyprogesterone acetate (MPA) (50 microg E2/5 mg MPA daily; transdermal/oral group, n = 19) or oral continuous E2/NETA (1 mg E2/0.5 mg NETA daily; oral group, n = 21). Anthropometric indices (body weight, height, and hip and waist circumferences) were measured, and BMI and waist-to-hip ratio (WHR) were calculated, before and after treatment. Also, the thickness of subcutaneous abdominal fat was measured by ultrasound. Depending on waist circumference (WC), the subjects were divided into two risk groups: increased-risk group with WC <88 cm (n = 32) and high-risk group with WC > or =88 cm (n = 27). Also, the effects of HRT were evaluated separately in subjects with median subcutaneous fat of <33 mm (n = 29) and those with median subcutaneous fat of > or =33 mm (n = 30). RESULTS: Overall, all three types of HRT caused a significant decrease in both WC and subcutaneous fat (p < 0.001), and also in WHR (p < 0.05). There was no significant difference in baseline (p > 0.05) and final values (p > 0.05) between HRT groups. In each group, all types of HRT significantly decreased WC and subcutaneous fat (transdermal group: p < 0.001 and p < 0.05; transdermal/oral group: p < 0.001 and p < 0.01; oral group: p < 0.001 and p < 0.001, respectively), while body weight, BMI and WHR changed only insignificantly (p > 0.05). In the increased-risk group, body weight increased significantly (p < 0.05) while WC and subcutaneous fat decreased significantly (p < 0.001 and p < 0.001). As for the high-risk group, there was a significant decrease in WC and subcutaneous fat (p < 0.001, p < 0.001) while the remaining parameters did not change significantly. However, BMI showed a tendency to increase in the increased-risk group, while there was a decrease in all measurements in the high-risk group. Regardless of the drugs used and baseline subcutaneous fat, WC and subcutaneous fat decreased significantly at the end of the treatment (subcutaneous fat <33 mm: p < 0.001 and p < 0.01; subcutaneous fat > or =33 mm: p < 0.001 and p < 0.001, respectively). CONCLUSIONS: The three different types of HRT have comparable effects on central fat tissue in women at increased risk of anthropometry-related CVD. Indeed, the three combinations of HRT reduced fat tissue in the central part of the body. However, the overall effect of HRT was more marked in women with WC > or =88 cm and subcutaneous fat > or =33 cm. Whether HRT increases body weight depends on the body composition indices of individuals before treatment.

Mammographically detected breast arterial calcifications: indicators for arteriosclerotic diseases?

PURPOSE: To determine the prevalence of breast arterial calcifications (BAC) detected on mammography and search for conditions that may influence their existence. MATERIALS AND METHODS: The mammograms of 6156 consecutive patients were reevaluated for the presence of BAC. Four hundred eighty-five women having BAC were enrolled in the patient group. Additionally, randomly selected 500 women, without BAC constituted the control group. Hospital records of the participants were reviewed for parity, menopausal status, oral contraceptive agent (OCA) usage, hormone replacement therapy (HRT) usage, presence of diabetes, hypertension, hyperlipidemia, albuminuria and history of myocardial infarction (MI). RESULTS: Prevalence of BAC was 7.9% on mammograms. Ninety-four women were aged between 40 and 49 years, 165 were aged between 50 and 59 years and 226 were over 60 years among BAC positive 485 women. A significant relationship was found for the frequency of BAC versus age and HRT usage in all age groups (p<0.05). Similarly, significant relationships were also found for the frequency of BAC versus OCA usage, HRT usage, hyperlipidemia and diabetes in age group of 40-49 and in age group of 50-59, and for the frequency of BAC versus albuminuria in age group of 40-49, BAC versus history of myocardial infarction in age group of 59-59 and over 60 years (p<0.05). The correlations were not significant for the relationships of BAC with OCA usage, hyperlipidemia, diabetes and albuminuria in women over 60 years (p>0.05). CONCLUSION: Most benign findings like BAC are not routinely reported during mammographic evaluation. Our study showed that, presence of BAC on mammography was strongly related to advancing age. However, these findings may signify a systemic risk and can be used as precautious indicators for undocumented systemic diseases, especially in premenopausal women.

Effects of oral continuous 17beta-estradiol plus norethisterone acetate replacement therapy on abdominal subcutaneous fat, serum leptin levels and body composition.

AIM: To evaluate the effects of oral continuous 17beta-estradiol plus norethisterone acetate (E2/NETA) replacement therapy on abdominal subcutaneous fat, serum leptin level (SLL) and body composition in postmenopausal women. MATERIALS AND METHODS: A 6-month, prospective, randomized, double-blind and placebo-controlled study was conducted. Forty-three healthy naturally postmenopausal women aged 43-65 years were randomly assigned to receive E2/NETA (2 mg E2 plus 1 mg NETA, n = 22) or placebo (n = 21). Fasting SLL by enzyme-linked immunosorbent assay, subcutaneous abdominal fat thickness (STh) by ultrasound and the anthropometric indices of body weight (BW), body mass index (BMI), waist and hip circumference (WC, HC) and waist-to-hip ratio (WHR) were recorded at the beginning and the end of the study. RESULTS: After 6 months of therapy, BW and SLL increased in the placebo group (p = 0.043 and 0.033, respectively). WC, HC and STh decreased significantly in the E2/NETA group (p = 0.002, 0.006 and 0.000, respectively) and they were also significantly lower in women receiving E2/NETA than in women taking placebo (p = 0.000, 0.034 and 0.000, respectively). At baseline, SLL and STh were positively correlated with all anthropometric indices except WHR. CONCLUSION: Oral continuous combined regimen of E2/NETA significantly reduced central fat accumulation as assessed by WC and STh, and attenuated the increase in SLL. The observed changes in SLL were highly and positively related to changes in STh. The oral continuous combined E2/NETA regimen appears to have protective effects on cardiovascular function and probably on metabolic diseases by its slimming effect upon WC in postmenopausal women.

Effects of tibolone on abdominal subcutaneous fat, serum leptin levels, and anthropometric indices: a 6-month, prospective, randomized, placebo-controlled, double-blind study.

This study was undertaken to evaluate the effects of tibolone on abdominal subcutaneous fat, serum leptin levels (SLLs), and anthropometric indices, and to investigate potential relationships between SLLs, subcutaneous abdominal fat thickness, and anthropometric indices in postmenopausal women. In a 6-mo, prospective, randomized, double-blind, placebo-controlled study, 40 healthy postmenopausal women aged 42 to 67 y (mean: 50+/-4.7 y) were randomly assigned to 1 of 2 groups; during a 6-mo treatment period, the first group received tibolone (Livial tablet; Organon, The Netherlands; 2.5 mg/d; n=19) and the other group was given placebo (n=21). Fasting SLLs determined by enzyme-linked immunosorbent assay, subcutaneous abdominal fat thickness assessed by ultrasound, and anthropometric indices of body weight, body mass index, waist and hip circumference, and waist-to-hip ratio (WHR) were recorded at the beginning and the end of the study. Statistical analyses were performed with Mann-Whitney, Wilcoxon, and Spearman tests. P values <.05 were considered significant. No significant differences between the 2 groups were reported in terms of all baseline characteristics. After 6 mo, body weight (+0.77+/-0.43 kg) and SLLs (+14.7+/-6.4 ng/mL) increased in the placebo control group, whereas waist circumference (-2.6+/-3.0 cm), hip circumference (-3.6+/-3.5 cm), and subcutaneous abdominal fat thickness (-4.3+/-4.8 cm) decreased significantly in the tibolone group (P<.05). At the end of the study, group comparisons revealed significant differences in waist and hip circumference and subcutaneous abdominal fat thickness (P<.05). At baseline, SLLs were correlated with subcutaneous abdominal fat thickness and all anthropometric indices except WHR (P<.05). Subcutaneous abdominal fat thickness was also highly correlated with all indices except WHR (P<.0001). Tibolone was found to decrease waist and hip circumference, as well as subcutaneous abdominal fat thickness. Also, tibolone appeared to attenuate weight gain and leptin increase. SLLs and subcutaneous abdominal fat thickness were positively correlated with all anthropometric indices except WHR.

Reversible metastatic visceral calcification detected by 99mTc-methylene diphosphonate bone scanning in breast cancer.

Diffuse metastatic visceral calcification is rare in breast cancer. We report on a 57-year-old woman with breast cancer and hypercalcemia who had diffuse metastatic visceral calcifications on lungs, myocardium, stomach, and thyroid on a (99m)Tc-methylene diphosphonate bone scan. Visceral calcifications were completely resolved 6 months after successful anticancer and zoledronic acid treatments. Bone scanning offers a useful diagnostic tool for both identifying visceral calcification and assessing the response to therapy in chemosensitive malignities with hypercalcemia such as breast cancer.

Transient hepatic attenuation differences at biphasic spiral CT examinations.

Transient hepatic attenuation difference (THAD) is a perfusion disorder that can sometimes be observed in hepatic arterial phase of a biphasic spiral CT examination. The involved site of liver by THAD appears as an area of high attenuation on the hepatic arterial phase image and returns to normal attenuation on portal venous phase image. The knowledge of the shape, distribution and causes of THAD is essential to differentiate the THAD from other pathologies such as neoplasm.