The effect of overt and subclinical hypothyroidism on the development of non-dipper blood pressure

Introduction: ′Non-dippers′ are individuals without the anticipated nocturnal decrease in blood pressure. An increased incidence of target organ damage and a worse outcome in terms of cardiovascular events have been reported in this group of people. The pathogenesis of non-dipper hypertension is not clear at present. We aimed to investigate the effects of overt and subclinical hypothyroidism on the development of a non-dipper blood pressure pattern via 24-hour ambulatory blood pressure monitoring. Material and methods: 109 normotensive patients with overt and subclinical hypothyroidism were evaluated, and 95 of these patients without reverse dipping and masked hypertension were included in the study. The control group consisted of 75 gender- and age-matched, normotensive, euthyroid healthy individuals. Results: Median serum TSH levels were 7.61 and 1.59 mUmL in patient and control groups, respectively. The number of non-dippers according to systolic, diastolic and mean blood pressure was significantly higher in the patients with hypothyroidism compared to the control group. In linear regression analysis, TSH had a negative effect on the night/day ratio of the systolic, diastolic and mean blood pressures. Conclusion: Despite the fact that the effect of hypothyroidism on non-dipper blood pressure pattern is not known, the present study has revealed that elevated TSH levels are likely to increase the risk of non-dipping in normotensive patients with either overt or subclinical hypothyroidism. (Pol J Endocrinol 2012; 63 (2): 97–103)Wstęp: U osób określanych jako non-dippers nie występuje fizjologiczne obniżenie ciśnienia tętniczego w godzinach nocnych. Jak wynika z doniesień, w tej grupie chorych częściej dochodzi do zmian narządowych i zdarzeń sercowo-naczyniowych. Patogenezy nadciśnienia tętniczego typu non-dipper dotychczas nie wyjaśniono. Celem autorów było zbadanie wpływu jawnej i subklinicznej niedoczynności tarczycy na rozwój profilu dobowej zmienności ciśnienia tętniczego typu non-dipper metodą całodobowego automatycznego pomiaru ciśnienia tętniczego. Materiał i metody: Spośród 109 chorych z prawidłowym ciśnieniem i z jawną lub subkliniczną niedoczynnością tarczycy do analizy włączono 95 osób, u których nie występował nocny wzrost ciśnienia tętniczego (reverse dipping) ani utajone nadciśnienie tętnicze. Grupa kontrolna składała się z 75 zdrowych osób z prawidłowym ciśnieniem tętniczym i prawidłową czynnością tarczycy odpowiednio dobranych pod względem płci i wieku. Wyniki: Mediany stężeń TSH w surowicy w grupach badanej i kontrolnej wynosiły odpowiednio 7,61 i 1,59 mUml. Liczba osób, u których nie występował nocny spadek wartości skurczowego, rozkurczowego i średniego ciśnienia tętniczego, był istotnie wyższy w grupie chorych z niedoczynnością tarczycy niż w grupie kontrolnej. W analizie regresji liniowej wykazano istnienie odwrotnej zależności między stężeniem TSH a stosunkiem między nocnymi i dziennymi wartościami ciśnienia skurczowego, rozkurczowego i średniego ciśnienia tętniczego. Wnioski: Mimo że nie wiadomo, jaki jest mechanizm oddziaływania niedoczynności tarczycy na rozwój dobowego profilu ciśnienia tętniczego typu non-dipper, w niniejszym badaniu wykazano, że podwyższone stężenie TSH może zwiększać ryzyko wystąpienia takiego profilu ciśnienia tętniczego u osób z prawidłowym ciśnieniem tętniczym i jawną lub subkliniczną niedoczynnością tarczycy. (Endokrynol Pol 2012; 63 (2): 97–103

A 54-year-old male patient with amaurosis fugax

Takayasu arteritis is an idiopathic chronic large vessel vasculitis. It is a rare chronic disease of the aorta and its branches, and is mostly seen in children and young women. The clinical picture includes non-specific systemic symptoms along with those related to the problematic artery. However, patients can sometimes be asymptomatic at the time of diagnosis. The most common symptoms include upper extremity claudication, systemic hypertension, pain around the carotid artery, dizziness, and vision problems. Diagnosis is based on clinical criteria and the golden rule in identifying arterial lesions in Takayasu arteritis is angiography. Herein we report a 54-year-old male patient with amaurozis fugax, who was later diagnosed as Takayasu arteriti

Infrared coagulation and rubber band ligation in the treatment of early stage hemorrhoids

Giriş ve amaç: Semptomatik hemoroidlerin tedavisi için cerrahi dışı farklı yöntemler olmasına rağmen bunların hangisinin daha üstün olduğu tartışmalıdır. Bu çalışmada erken evre hemoroidlerin tedavisinde lastik bant ligasyon (LBL) ve infrared koagulasyon (IRK)’un etkinliğinin ve komplikasyonlarının araştırılması amaçlandı. Gereç ve yöntem: Randomize prospektif bu çalışmada fleksible sigmoidoskopi ve anoskopik inceleme ile 2. derece internal hemoroid tanısı konulan, daha önce tedavi edilmemiş 51’i kadın, 40’ı erkek, median yaşı 42 (21–64) yıl olan 91 hastaya semptomlar kaybolana kadar 4 hafta ara ile bir veya daha fazla seansta LBL (n45) veya IRK (n46) uygulandı. Her seanstan bir hafta sonra ve son seanstan 2, 12 ve 24 ay sonra tedavilerin etkinliği ve komplikasyonları değerlendirildi. Ağrı değerlendirmesi 0 ile 10 arasında skorlanan vizüel analog skala (VAS) ile yapıldı. Bulgular: LBL ve İRK gruplarında ortalama tedavi seans sayısı benzerdi (1.730.45 ve 1.780.42, p0.05). Postoperatif birinci hafta sonunda spontan ağrı için ortalama VAS skorları LBL ve IRK gruplarında sırası ile 3.82.1 ve 2.42.0 idi (p0.05). LBL grubunda VAS skoru 5 olan hasta sayısı 5 iken, IRK grubunda 0 idi (p0.05). Birinci hafta sonunda rektal tenezm sıklığı LBL grubunda %26.6, IRK grubunda %6.5 bulundu (p0.01). Sekizinci hafta sonunda iki grupta da hiçbir hastanın rektal ağrı ve/veya tenezm yakınması yoktu. LBL ve IRK’nın rektal kanamayı önlemedeki başarısı sırası ile 2. ayda %97.8 ve %89.1 (p0.05), 12. ayda %88.9 ve %82.6 (p0.05), ve 24. ayda %86.7 ve %54.3 (p0.01) idi. Sonuç: LBL ikinci derece hemoroidlerin kanama kontrolünde IRK’dan daha etkilidir. Ancak postoperatif erken komplikasyonlar LBL’de daha sıktır. Postopreratif 2. yıl nüks IRK’da daha sık olmasına rağmen komplikasyonların azlığı nedeni ile erken evre hemoroidlerin tedavisinde IRK ilk basamak tedavi seçeneği olabilir.Background/aim: Although there are different non-surgical methods for the treatment of symptomatic hemorrhoids, which method is superior remains controversial. The aim of this study was to investigate the effectiveness and complications of rubber band ligation (RBL) and infrared coagulation (IRC) in the treatment of early stage hemorrhoids. Materials and methods: In this randomized prospective study, previously untreated 91 patients (51 female, 40 male; median age 42 (21-64) yrs) with second degree internal hemorrhoids diagnosed by flexible sigmoidoscopy and anoscopic examination underwent either RBL (n45) or IRC (n46) in two sessions with a four-week interval. Effectiveness, adverse effects and complications of each treatment method were evaluated at the end of the first week after each treatment session and at the 2nd, 12th and 24th months after the last session. Pain was evaluated with visual analogue scale (VAS) scored between 0-10. Results: The average treatment sessions were similar in both groups (RBL 1.73±0.45, IRC 1.78±0.42, p>0.05). The mean VAS scores for spontaneous pain at the end of the first week in the RBL and IRC groups were 3.8±2.1 and 2.4±2.0, respectively (p0.05) at the 2nd month, 88.9% and 82.6% (p>0.05) at the 12th month, and 86.7% and 54.3% (p<0.01) at the 24th month. Conclusion: RBL is more effective than IRC in the prevention of bleeding in second degree hemorrhoids. However, postoperative early complications are more frequent with RBL than with IRC. Although postoperative second year recurrence rate is more frequent in patients treated with IRC, it may be the first choice in the treatment of early stage hemorrhoids due to the rarity of complications

Diyaliz hastalarında lipid peroksidasyon ve antioksidan kapasitesi: farklı diyaliz membranları ile yapılan tek bir diyaliz seansının etkileri

Amaç: Bu çalışmanın amacı diyaliz hastalarının lipid peroksidasyon ve antioksidan savunma kapasitelerini tespit etmek ve değişik tipteki diyaliz membranlarının bu parametreler üzerine etkilerini göstermektir. Metot: Çalışmaya 54 diyaliz hastası ve kontrol grubu olarak 30 sağlıklı birey alındı. 54 diyaliz hastasının 10’u periton diyalizi, 44’ü hemodiyaliz hastasından oluşmaktaydı. Hemodiyaliz hastaları polikarbonat (n10) ya da hemophan membran (n34) kullanılarak hemodiyalize alınmaktaydı. Polikarbonat membran kullanılan grupta, sonraki diyaliz seansında membranlar vitamin-E kaplı dializer ile değiştirildi. Antioksidan savunma kapasitesi ve lipid peroksidasyonunu belirlemek için total antioksidan durumu ve malondialdehid seviyeleri diyaliz öncesi ve diyaliz sonrasında çalışıldı. Sonuçlar: Kontrol grubu ile karşılaştırıldığında tüm diyaliz hastalarında plazma total antioksidan seviyesi daha düşük (1.510.2 mmol/L ‘ye karşı 1.750.20 mmol/L p0.05) ve malondialdehit seviyesi daha yüksek (2.21.17 nmol/mL’ ye karşı 0.600.20nmol/mL p0.05) bulundu. Bir hemodiyaliz seansı sonrasında tüm diyaliz membranları için parametrelerde anlamlı değişiklik tespit edilmedi. Sonuç: Tüm diyaliz hastaları artmış bir oksidatif duruma sahiptirler. Farklı tipte diyaliz membranları ile yapılan tek bir diyaliz seansı oksidan ve anti-oksidan seviyelerini anlamlı olarak değiştirmiyor gibi gözükmektedir.Objective: To estimate lipid peroxidation and the antioxidant defense capacity of dialysis patients and the effects of different types of dialysis membranes on these parameters. Methods: Fifty-four dialysis patients and 30 healthy controls were included in this study. Ten of the dialysis patients were on continuous ambulatory peritoneal dialysis treatment and the rest were on hemodialysis with either polycarbonate membrane (n10) or hemophan membrane (n34). Polycarbonate membranes were switched with a vitamin E-coated dialyzer in the subsequent dialysis session. Total antioxidant status and malondialdehyde levels were studied to determine the antioxidant defense capacity and lipid peroxidation, respectively, before and after the dialysis session. Results: Plasma total antioxidant status levels were lower (1.51±0.2 mmol/l vs. 1.75±0.20 mmol/l p<0.05) and malondialdehyde levels were higher (2.2±1.17 nmol/ml vs. 0.60±0.20 nmol/ml p<0.05) in all dialysis patients compared to the control group. After one hemodialysis session, there were no significant alterations in parameters for either type of dialysis membrane. Conclusion: All dialysis patients have an increased oxidative status. A single hemodialysis session with different dialysis membranes does not seem to significantly change the oxidant or antioxidant levels