Objective Previous research revealed that a low concentration of serum insulin-like growth factor-1 (IGF-1) is associated with risks of myocardial infarction and heart failure. We hypothesized that the serum IGF-1 level affects clinical outcome in acute myocardial infarction (AMI). We examined the impact of serum IGF-1 in acute phase of AMI on 90-day mortality. Patients and Methods In 54 patients with AMI, we measured serum total IGF-1 concentration on admission, in acute phase (1.9±0.5 days) and in chronic phase (28.5±6.7 days). We measured plasma brain natriuretic peptide (BNP), glucose and insulin in acute phase, and calculated insulin resistance (HOMA-R). Results Serum IGF-1 was 135.6±51.1 ng/ml on admission and significantly decreased to 105.5±42.2 ng/ml in acute phase, and then returned to baseline of 136.7±52.2 ng/ml in chronic phase. Five patients died of cardiac reasons within 90 days, all of whom had lower IGF-1 on admission and lower IGF-1 in acute phase than their median of 54 patients. Patients with the concentration of IGF-1 on admission below the median (<131 ng/ml) had significantly lower survival rate than those at or above the median (log-rank test p=0.0169). However, patients with BNP concentration at or above the median (≥227 pg/ml) had a similar survival rate to those below the median (log-rank test p=0.6797). Multivariate analysis clarified that IGF-1 on admission was the sole independent predictor of 90-day mortality (p=0.007, risk ratio=0.927). Conclusion A low concentration of serum IGF-1 on admission was associated with a poor early prognosis of acute myocardial infarction.
Objective This study examined the sensitivity of routine abdominal ultrasound scanning in the detection of colonic malignancy. Patients and Methods A case control prospective study included 101 patients hospitalized at the Department of Gastroenterology and Liver Diseases of Zemun Clinical Hospital over a four-year period. Since the complaints pointed to colonic malignancy, the patients underwent routine golden standard diagnostic procedures. These patients were referred to an experienced abdominal ultrasound operator who searched for some characteristic signs of colonic malignancy. All of the participants were surgically treated after the completion of relevant procedures for diagnosing colonic malignancy. SPSS for Windows 10.0 was used for data analysis. Results The sensitivity of an abdominal ultrasound scan in the detection and location of pathological changes pointed to colonic malignancy was different- 76% and 84% respectively. This method was very reliable in detecting right-sided colonic carcinoma (100%). Some specific ultrasonographic signs of colonic carcinoma were observed at the advanced stages of disease. Conclusions The routine abdominal ultrasonography can be used for the screening of colonic malignancy owing to its high sensitivity, particularly in advanced disease, but solely in conjunction with other methods. Finally, abdominal ultrasonography cannot be a definitive diagnostic tool for colonic carcinoma.
Background As reported recently, some gene polymorphisms are suspected to determine susceptibility to sarcoidosis and are held responsible for the extent and progression of the disease. Polymorphism at -857 locus of tumor necrosis factor (TNF)-α gene is considered to be a predisposition factor in sarcoidosis and held responsible for pathogenesis of the disease. We compared these polymorphisms in healthy Turkish control subjects and Turkish patients with sarcoidosis. Methods We examined gene polymorphisms in 90 cases which were histopathologically diagnosed as sarcoidosis and 110 healthy subjects without any history of a chronic disease. TNF-α-857 gene polymorphisms were determined using a polymerase chain reaction (PCR)-based method after DNA isolation. Genotype distributions of the groups were evaluated by the Hardy-Weinberg equilibrium test. Results Genotype distributions were in agreement with the Hardy-Weinberg equilibrium both in sarcoidosis patients and healthy subjects. TNF-α gene (C/T) polymorphism, at position -857, revealed no differences in genotype and allele frequency between patients and control subjects but more relapses and more frequently involvement of three or more organs were found in sarcoidosis patients who have this polymorphism (p<0.05, p<0.01 respectively). Conclusion T allele at -857 locus of TNF gene is a marker for more extensive disease in Turkish sarcoidosis patients.
Here we report two patients with hematological malignancies associated with complications of fatal cardiac zygomycosis. The first case, a 72-year-old man with myelodysplastic syndrome being treated with low-dose cytarabine, died of sudden cardiac arrest. An autopsy revealed disseminated zygomycosis accompanied with occlusion of the coronary artery by fungal thrombi. The second case, a 52-year-old woman with acute lymphoblastic leukemia, developed febrile neutropenia and skin eruptions with induration on the face and extremities during the first induction chemotherapy. She experienced sudden bradycardia with unstable hemodynamics and died of acute myocardial infarction. Histological examination of a skin biopsy demonstrated zygomycosis. In light of the above, it should be kept in mind that cardiac zygomycosis might occur in hematologically compromised patients presenting with acute myocardial infarction.
The characteristic of right-bundle branch block (RBBB) pattern in Brugada syndrome (BS) is an atypical pattern without a wide S wave in left leads. We present a case of a patient with BS who had a typical ECG pattern of complete RBBB (CRBBB) with a wide S wave in the left leads which was disclosed by a febrile illness. Our observations suggest that physicians should be careful to evaluate ECG change in response to a febrile state, even if the ECG shows a typical CRBBB pattern with deep and wide S waves in the left leads.
A 28-year-old woman with severe ketoacidosis was admitted to our hospital on day 11 after giving birth. However, her HbA1C level was normal (5.2%) and both GAD and anti-insulin autoantibody were negative, and the WBC count was extremely high (57,500/ml) with immature leucocytes in the peripheral blood. Her WBC count decreased along with control of ketoacidosis and reduction of the plasma glucose level, and was normalized on day 5 after admission. Bone marrow aspiration subsequently showed no malignant cells, so the final diagnosis was fulminant type 1 diabetes combined with a leukemoid reaction. This is the first report of a patient with both fulminant type 1 diabetes and a leukemoid reaction. The mechanism that triggered the leukemoid reaction could not be clarified, but severe ketoacidosis may have been involved.
A 40-year-old man developed weakness and myalgia of the shoulders and brachia nine hours after eating a cowfish (Umisuzume, Lactoria diaphana). A clinical symptom showed rhabdomyolysis and serum creatine phosphokinase was elevated to 180,000 IU/L on day 3. Cardiopulmonary arrest and acute renal failure developed after 59 hours and hemodiafiltration was performed. Cerebral death was diagnosed on day 9 and the patient died on day 16. The case has the characteristic clinical course of palytoxin poisoning, which has also been reported as blue humphead parrotfish poisoning from other kinds of fish.
The clinical features of chronic hypersensitivity pneumonitis (HP) are similar to idiopathic interstitial pneumonias (IIPs) including idiopathic pulmonary fibrosis (IPF). We report 2 cases of chronic summer-type HP with insidious onset. They were misdiagnosed as having IIPs before referral to our hospital. Anti-trichosporon antibodies were positive in these cases. Their disease progressed due to the intermittent or continuous exposure to the antigen. Chronic summer-type HP should be included in the list of differential diagnosis of chronic interstitial lung diseases. Environmental investigation for an accurate diagnosis is important to convince the patient of the necessity to strictly avoid any future exposure to antigen.
Hematological complications have been frequently associated with acute brucellosis, but pancytopenia is less frequently seen. Also, capillary leak syndrome has been rarely reported in the literature. In this report, we present a case of brucellosis with pancytopenia leading to capillary leak syndrome. A 21-year-old man was admitted to hospital with complaints of a one-month history of weakness, sweats, and fever and he had hepatosplenomegaly and edema over the pretibial areas. Hemogram revealed pancytopenia and biochemical tests revealed moderate hypoalbuminemia, elevations of lactate dehydrogenase and aspartate aminotransferase. He was diagnosed as brucellosis and capillary leak syndrome. He was given doxycycline and rifampicin. The patient's symptoms were resolved after treatment.
Reversible posterior encephalopathy syndrome (RPES) is a clinical entity characterized with headache, nausea, vomiting, seizures, consciousness disturbance, and frequently visual disorders associated with neuroradiological findings, predominantly white matter abnormalities of the parieto-occipital lobes. The central nervous system manifestations of systemic lupus erythematosus (SLE) are highly diverse. However, SLE-associated RPES has been seldom reported. Here, we report a case with RPES in SLE and lupus nephritis with exclusive involvement of parietal and occipital cortices. A systematic review of the literature on the pathogenesis and treatment of SLE-associated RPES is included.
Total dysgeusia, an inability to interpret all of the basic tastes, often occurs with zinc deficiency. Partial dysgeusia (dissociation dysgeusia) is a rare inability to interpret a limited number of these basic tastes. We present the case of a patient with myasthenia gravis who became unable to discern sweet taste, but other basic tastes were unaffected. Such dysgeusia can be explained by obstruction of selective taste receptors in taste cells. We considered that this symptom was induced by an autoimmune mechanism related to myasthenia gravis.