A rare complication of recurrent cerebrovascular infarct: Bilateral vocal cord paralysis

Bilateral vocal cord paralysis (BVCP) is usually the result of an iatrogenic injury especially secondary to thyroid and parathyroid surgery. However, BVCP that cause airway obstruction due to serebral cortical stroke very rarely has been reported. We, herein report a case of BVCP that resulted in respiratory arrest as a late and life threatening complication of recurrent cerebral infract. A 67 years old male patient admitted the emergency room with complaint of respiratory insufficiency. His complaint was progressed during last 3-4 months. He had two cerebral infractions attacks in a month approximately one year ago. On admission, physical examination revealed that, he had bilateral wheezing and stridor. He had right sided hemiplegia and had no history of heart failure or chronic obstructive lung disease. Endoscopic laryngoscopy was performed to evaluate upper airway obstruction. Laryngoscopy revealed that bilateral vocal cords were fixed and immobile at midline. Due to recurrent respiratory arrest, insufficient and fixed BVCP, open tracheostomy was perormed. After operation, he had no respiratory insufficiency or any complications. So he discharged from hospital with normal respiratory function

Evaluation of thyroid diseases and metabolic factors in district of Yiğilca in Duzce province

YÖK Tez No: 319230Amaç: Tiroid bezinin en sık karşılaşılan hastalığı, tiroid bezi nodülleridir ve ülkemizde de yaygın olarak görülmektedir. Metabolik sendrom (MS), insülin rezistansı (IR) temelinde ortaya çıkan, klinik tablosunda glukoz tolerans bozukluğu, diyabetes mellitus (DM), santral obezite, esansiyel hipertansiyon, dislipidemi, proinflamatuar ve protrombotik öğeleri bulunduran, prematür aterosklerozun yer aldığı, kardiyovasküler hastalık riskinin artışı ile ilişkili olan bir risk faktörleri topluluğudur. Her iki patoloji (nodüler guatr ve MS) de endüstrileşmiş toplumlarda sıkça görülür ve yapılan çalışmalar MS komponentlerinin tiroid nodülü oluşumunu ve tiroid hacmini herhangi bir klinik ya da subklinik tiroid disfonksiyonu olmadan da etkileyebileceğini ve bu etkilerin tiroid hormonlarının etkilerinden bağımsız olabileceğini göstermektedir. Yapılan çalışmalar her iki durum arasındaki ilişkinin insülin etkisiyle ilişkili olabileceğini, yani tiroid bezinin IR sendromunun başka bir kurbanı olabileceğini göstermektedir. Bu çalışmada amacımız tiroid nodülaritesi ile metabolik sendrom arasındaki ilişkiyi değerlendirmektir.Materyal-metod: MELEN Çalışması Düzce ilinin kuzey-doğusundaki Yığılca ilçesinde yaşayan yaş ortalaması 50 olan 2298 kişiyi incelemeye alan ve Türk halkının kardiyometabolik risk faktörlerinin prevalansını değerlendirmeyi amaçlayan prospektif şekilde tasarlanmış bir çalışmadır. İlk değerlendirmeler Mayıs-Haziran 2010 tarihlerinde ilçe sosyal sağlık merkezinde yapılmış olup iki yılda bir takip yapılması planlanmıştır. Veriler anket, fizik muayene ve ölçümler, karotis intima media kalınlığı, vücut yağ kompozisyonu, tiroid ultrasonografi (TUS), elektrokardiografi, ekokardiografi (EKO) ve kan örnekleri aracılığı ile toplandı. Son çalışma grubunu 2233 katılımcı (1430 kadın, 803 erkek) oluşturdu.Bulgular: Katılımcıların % 30.5'inde guatr saptanırken, % 80'ninin ötiroid olduğu görüldü. Tiroid nodülü (MNG ve NG) saptanma oranı ise % 58.4 ile oldukça yüksekti. Guatr saptanan katılımcılarda ultrasonografik tiroid hastalığı, TSH bozuklukları ve komorbidite oranlarının anlamlı derecede daha yüksek olduğu gözlendi. Ötiroid alt grupta yapılan değerlendirmelerde nodülarite artışı ile metabolik parametreler arasındaki ilişkinin TSH değerinden bağımsız olduğu görüldü. MS varlığında guatr varlığı ve MNG oranı (% 61.5) anlamlı yüksek saptandı. MS grubunda VKI, ortalama tiroid hacmi, HOMA-IR değerlerinin anlamlı yüksek olduğu ve IR'nın tiroid nodülaritesi ve ortalama tiroid hacmi üzerinde anlamlı etkisinin olmadığı görüldü. Lojistik regresyon analizlerinde yaş, cinsiyet, aktif sigara kullanımı, alkol kullanımı ve MS varlığı değerlendirildiğinde, NG varlığını etkileyen tek faktörün yaş olduğu, MNG varlığının ise yaş, doğum sayısı ve MS varlığı ile ilişkili olduğu saptandı. Sonuç olarak MS varlığının NG'dan ziyade MNG varlığı ile ilişkili olduğu kanısına varıldı. MNG varlığı ile MS komponentlerinin ilişkisi değerlendirildiğinde ise sadece sistolik kan basıncı yüksekliğinin anlamlı olduğu, IR, bel çevresi ve lipid parametrelerinin anlamlı bir etkisinin olmadığı görüldü.Sonuç: Sonuç olarak MS'un TSH'dan bağımsız olarak tiroid hücre büyümesi üzerinde etkili olduğu görülmektedir. Her ne kadar bu etkileşim için etken olarak ana yolun insülin etkisiyle olduğu düşünülmüş ve bazı çalışmalarda gösterilmiş olsa da çalışmamızda tiroid nodülaritesi ve insülin rezistansı arasında anlamlı bir ilişki saptanamadı. Sonuçlar değerlendirildiğinde MNG varlığının yaş, sistolik kan basıncı ve doğum sayısında artış ve MS varlığı ile yakın olarak ilişkili olduğu görülmektedir. Sonuç olarak, özellikle MS saptanan kişilerde tiroid hastalığı taraması yapılmasının tiroid hastalıklarının erken tanısında faydalı olabileceği öngörülebilir.Introduction: The most common disease of the thyroid gland is thyroid gland nodules and it is also seen commonly in our country. Metabolic Syndrome (MS) is a cluster of risk factors related with increased risk for cardiovascular diseases including premature atherosclerosis, impaired glucose metabolism, diabetes mellitus (DM), abdominal obesity, essential hypertension, dyslipidemia and with proinflammatory and prothrombotic components. Both pathologies (nodular goiter and MS) are quite frequent in the adult populations of industrialized countries and studies showed that some constitutive traits of MS could influence thyroid size and the occurence of thyroid nodules in the absence of clinical or subclinical thyroid dysfunction and this may occur independently of the effects of thyroid hormones. And also studies showed that the relationship between the both pathology could be related with insulin effect, so thyroid gland could be another victim of the insulin resistance syndrome. In this study, our aim is to evaluate the relationship between the thyroid nodularity and metabolic syndrome.Material - Method: The MELEN Study is a prospectively designed survey on the prevalence of cardio metabolic risk factors in 2298 Turkish adults with a mean age of 50. The baseline visits were carried out in May and June, 2010 and biennial follow-up visits were planned. Datas were collected by questionnaires, pysical examination and measurements, doppler ultrasound examination of carotid intima media thickness, echocardiographic examination, ECG recording, bioempedance meter analysis of body composition, thyroid ultrasonography and various biochemical analysis. The final study cohort was included 2233 participants (1430 women, 803 men).Results: In our study, 30.5% of the participants had goiter and also 80% of them were euthyroid. Thyroid nodule (MNG ve NG) detection rate was very high with 58.4%. In participants with goiter, rates of ultrasonographic thyroid disease, TSH abnormalities and comorbidities were found to be significantly higher. The relationship between metabolic parameters and the increase in nodularity was almost independent of TSH value in the assessments of euthyroid sub-group. In the presence of MS, the presence of goiter and MNG rate (61.5%) were detected as significantly higher. In MS group, BMI, mean thyroid volume, HOMA-IR values were significantly higher and there was no meaningful effect of IR on the mean thyroid volume and thyroid nodularity. In logistic regression analysis, when age, gender, active smoking, alcohol use and the presence of MS evaluated, the only factor affecting the presence of NG was found to be as age, but in the presence of MNG, age, parity, and the presence of MS were found to be associated with. So the presence of MS suggested to be associated with the presence of MNG rather than NG. When the relationship between the presence of MNG and MS components were assessed only significant effect of systolic blood pressure elevation was detected but there was not any effect of IR, waist circumference, and lipid parameters.Conclusion: As a result, MS, regardless of TSH values, have effects on thyroid cell growth. Although the main pathway for this interaction was thought to be the effect of insulin and also has been shown in some studies, in our study there was no significant correlation between insulin resistance and thyroid nodularity. When the results are evaluated, the presence of MNG is seen to be closely associated with age, systolic blood pressure, increase in number of births and the presence of MS. In conclusion, especially in MS patients, screening of the thyroid diseases may be useful in early diagnosis of thyroid diseases

The Relationship between variability in measured hba1c values and survival in diabetic patients undergoing hemodialysis treatment

Hemodiyaliz hastalarının yaklaşık üçte birini oluşturan diyabetik grupta sağkalım diyabetik olmayanlara kıyasla daha kısadır. Diyabetik hastalarda glukoz ve HbA1c değişkenliğinin artmasının, sağkalımı olumsuz yönde etkilediği gözlenmiştir. Çalışmamızda hemodiyaliz yapılan diyabetik hastalarda HbA1c ölçümlerindeki değişkenlik ile sağkalım arasındaki ilişkiyi değerlendirmeyi amaçladık. Çalışmamızda Ocak 2006 ile Aralık 2014 tarihleri arasında en az bir yıl süreyle merkezimizde hemodiyaliz yapılmış ve en az dört adet HbA1c ölçümü olan diyabetik böbrek yetmezliği hastaları retrospektif olarak değerlendirildi. Her hasta için değişkenlik ölçütü olarak hemodiyaliz yapıldığı süreçte ölçülen HbA1c, hemoglobin ve glukoz ölçümlerinin standart sapma (SD) ve varyasyon katsayısı (CV) kullanıldı. Çalışmaya dahil edilen 38 hastanın (21E, 17K) yaş ortalaması 62,1±11,86 (24-81) yıl ve ortalama sağkalım süresi 67,4±40,6 ay olup 20’si (%52,6) hayatını kaybetmişti. Hastalarda ortalama hemoglobin 10,8±1,0 mg/dl, glukoz 87±68 mg/dl ve HbA1c %7,1±1,4’tü. Değişkenlik en fazla glukozda (%31,7) sonra HbA1c’de (%12,4) ve en az hemoglobindeydi (%10,6). Cox regresyon analizinde sağkalım süresiyle yaş, kronik böbrek hastalığı süresi, ortalama hemoglobin ve HBA1c ilişkili bulundu (p=0,036, p=0,001, p=0,001, p=0,001, sırasıyla). Hastaların HbA1c, glukoz ve hemoglobin ölçümleri için hesaplanan SD ve CV değerleriyle sağkalım süreleri arasında ilişki saptanmadı (p>0,05, her biri için). Hastalar HbA1c’ye göre iki gruba ayırıldı (Grup 1: 0.05, for all). The patients were divided into two groups according to HbA1c values (Group 1:<8.5% and group 2:≥8.5%). and a statistically significant difference was found between the groups by Kaplan-Meier method (p=0.021). We found that the increased HbA1c and decreased hemoglobin values in diabetic hemodialysis patients are associated with an increased risk of mortality, but HbA1c variability is not associated with survival unlike diabetic patients with normal renal function

Relationship between metabolic syndrome and nodular thyroid diseases

WOS: 000424952600002PubMed: 29141453Nodular thyroid diseases are common in Turkey. Insulin resistance (IR) is considered as the most important component of metabolic syndrome (MetS), and it is thought to directly affect thyroid diseases, together with other components of MetS. The aim of this study was to evaluate potential factors associated with thyroid nodularity. This study was part of the prospective MELEN study. In total, randomly selected 2233 subjects were evaluated. A euthyroid subgroup of participants (n=1432) was selected and 421 of them had MetS. Both goitres and multinodular goitres (MNGs) were significantly more common in the MetS (+) group (p<.001). Older age was the only factor that significantly affected the presence of a nodular goitre (NG) (p<.001). The presence of a MNG was associated with older age (p<.001), systolic blood pressure level (p<.008) and MetS (p<.001). There was no difference in the thyroid volume or presence of nodular thyroid diseases between the IR (+) and (-) groups. Both the thyroid volume and the presence of MNGs were significantly associated with MetS, independent of thyroid-stimulating hormone (TSH) and IR. We suggest that the individual components of MetS may influence thyroid nodularity to some degree and that together they exert a cumulative effect on the thyroid gland. As a result, in the absence of MetS, we further suggest that IR alone does not explain the increase in thyroid volume and thyroid nodule formation.Duzce University Scientific Research FundDuzce UniversityThis research is supported by Duzce University Scientific Research Fund

Mortal bilateral psoas abscess caused by urogenital infection in geriatric age

Psoas apsesi nadir rastlanan, tanısı zor ve geç konulan bir durumdur. Primer ve sekonder olarak sınıflandırılır. Erişkin hastalarda üriner sistem enfeksiyonlarına sekonder psoas apsesi gelişmesi nadir bir durumdur. Olgumuz 79 yaşında erkek hasta, ürosepsis tanısıyla yatırıldı. Uygun antibiyotik tedavisine rağmen genel düşkünlük hali, hipotansiyon ve ateş kliniği devam etti. Çekilen batın bilgisayarlı tomografide bilateral iliopsoas kasında retroperitoneal alana kadar uzanım gösteren apseler izlendi. İliopsoas apselerine perkütan yolla drenaj kateteri yerleştirildi. Kontrol tomografide batın içinde yaygın kistik-apse odakları saptandı. Cerrahi drenaj için hazırlanırken gelişen ani kardiak arrest nedeniyle hasta exitus oldu. Psoas apsesi özgün olmayan klinik bulguları ve nadir görülen bir durum olması nedeniyle tanısı geciken, yanlış tanılar ile mortalite oranı yükselen ve apse drenajı yapılmayan vakalarda mortalite oranı %100'e ulaşan bir durumdur.Psoas abscess (PA) is a rare condition which is difficult to diagnose, so its diagnosis may be delayed. It is classified as primary and secondary psoas abscess. In adult patients, PA caused by urinary tract infections is a rare entity. Our case, a 79 year old male patient was hospitalized with a diagnosis of urosepsis. In his follow-up despite the appropriate antibiotic therapy the symptoms of fever, hypotension and general weakness persisted. Abdominal computed tomography, showed bilateral iliopsoas muscle abscesses extending to the retroperitoneal area. Percutaneous drainage catheters were inserted into iliopsoas abscesses. Control computed tomography revealed disseminated cystic-abscess centers in the abdomen. During preoperative management for surgical drainage of abscesses, the patient died due to a sudden cardiac arrest. Psoas abcesess is an entity, with delayed diagnosis because of its nonspecific clinical features and infrequency. Its mortality rate is high due to misdiagnosis and may even reach upto 100% in the absence of abscess drainage

Rheumatoid arthritis masquerading as acromegaly recurrence: report of two cases

WOS: 000308111400048PubMed: 20369240Acromegaly is a chronic endocrinopathy characterized by hypersecretion of growth hormone (GH) and consequently of insulin-like growth factor-1 (IGF-1). The arthropathy in acromegaly is the most frequent and important cause of morbidity and functional disability in acromegaly. Rheumatoid arthritis (RA) is a rarely reported clinical situation in patients with acromegalic. We herein report 57- and 45-year-old two women, who complained bilateral, symmetric pain, swelling and morning stiffness in the joints of hands after optimal acromegaly treatment resembling acromegaly arthropathy. There was not arthralgia in other joints of the patients. Laboratory and radiological evaluations were carried out. After excluding the acromegaly activation and arthropathy by GH and IGF-1 measurement, according to clinical presentation, laboratory and radiological assessments, patients were diagnosed as RA

Bullous skin reaction seen after extravasation of calcium gluconate

WOS: 000314975800009PubMed: 22830330Intravenous (IV) calcium is usually given to temporarily treat the effects of hyperkalaemia on muscle and heart. When extravasation of a calcium gluconate infusion occurs, there may be rapid and marked swelling and erythema, with signs of soft-tissue necrosis or infection, and ensuing extensive local calcification, called calcinosis cutis. We report a 26-year-old woman who was hospitalized for exacerbation of acute intermittent porphyria. She had a history of hypertension and chronic renal failure. On the second day of her hospitalization, she developed hyperpotassaemia (6.7mEq/L potassium; normal range 3.55mEq/L). She was given an IV infusion of 10mL calcium gluconate into the left dorsal pedal vein. Bullous skin reactions occurred in the infusion area nearly 2h after administration. The patient's leg was elevated and the lesions cleaned with 0.9% saline. By day 9 of hospitalization, the lesions had markedly regressed. Several drugs have been associated with dermoepidermal blistering as an adverse drug reaction, but there is only one existing report in the literature about this side-effect associated with calcium gluconate. Clinicians should be alert to the possibility of bullous skin reactions, which may be a predictor of extravasation and necrosis, when treating patients with IV calcium gluconate

Nadir bir klinik durum: Farkl yakla?m ve sonlanmlarla iki retroperitoneal fibrozis olgusu

Retroperitoneal fibroz, kronik inşamasyon ve belirgin fibroz içeren sıklıkla üreterleri ya da diğer intraabdominal organları çevreleyen retroperitoneal bir dokunun varlığı ile karakterize nadir bir hastalıktır. Erken dönem semptomları karında ve lumbar bölgede rahatsızlık şeklinde nonpesifik özelliktedir. Fibroz ilerledikçe oluşan bası etkisi septomlarda artışı belirler. Nadir bir klinik durum olması ve klinik ve fizik muayene bulgularının nonspesifik olması çoğu zaman teşhisi geciktirir ve kalıcı organ yetmezliği ve mortaliteye yol açar. Biz burada hastalığın farklı evrelerinde tanı almış ve farklı şekillerde sonuçlanmış iki retroperitoneal fibroz olgusunu sunduk. Amacımız erken teşhisin organ fonksiyonlarını korumadaki önemini vurgulamaktır.Retroperitoneal fibrosis is a rare disease, characterized by the presen- ce of a retroperitoneal tissue, consisting of chronic inflammation and marked fibrosis, which often entraps the ureters or other abdominal organs. Early symptoms are nonspecific as abdominal or lumbar dis- comfort. As the fibrosis progresses, the compressive effects determi- ne the symptomatic evolution. Retroperitoneal fibrosis diagnosis is usually delayed, which can result in permanent organ failure and mor- tality. We present herein two cases of retroperitoneal fibrosis diagno- sed in different stages of the disease and resulting in different outco- mes. Our aim is to stress the importance of early diagnosis in preser- ving organ function

Serebrovasküler infarktın nadir bir komplikasyonu: İki taraflı ses teli felci

İki taraflı ses teli felci (İSTF) sıklıkla tiroid ve paratiroid cerrahisi gibi iyatrojenik bir hasar sonucu oluşur. Fakat serebral infarkt sonrası hava yolu tıkanıklığına neden olan BVKP nadir olarak bildirilmiştir. Bu yazıda tekrarlayan serebral infarktın, geç ortaya çıkan ve hayatı tehdit eden bir komplikasyonu olarak solunum durması ile sonuçlanan bir İSTF olgusu sunduk. Atmış yedi yaşında erkek hasta, son 3-4 aydır giderek artan solunum yetmezliği şikayetiyle acil servisimize başvurdu. Özgeçmişinde kalp yetmezliği ve kronik obstruktif akciğer hastalığı öyküsü olmayan hasta, yaklaşık bir yıl önce bir ayda iki kez serebral infarkt geçirmişti. Yapılan solunum sistemi muayenesinde bilateral wheezing ve stridor; nörolojik muayenesinde ise sağ tarafta kuvvet kaybı mevcuttu. Üst solunum yolu obstruksiyonunu değerlendirilmek üzere endoskopik laringoskopi yapıldı. Laringoskopide iki taraflı ses tellerinin orta hatta sabit ve hareketsiz olduğu görüldü. Solunum yetmezliğinde artma ve tekrarlayan solunum durması nedeniyle hastaya trakeostomi açıldı. Operasyon sonrası hastanın solunum yetmezliği geriledi. Solunum fonksiyonları normale dönen hasta taburcu edildi.Bilateral vocal cord paralysis (BVCP) is usually the result of an iatrogenic injury especially secondary to thyroid and parathyroid surgery. However, BVCP that cause airway obstruction due to serebral cortical stroke very rarely has been reported. We, herein report a case of BVCP that resulted in respiratory arrest as a late and life threatening complication of recurrent cerebral infract. A 67 years old male patient admitted the emergency room with complaint of respiratory insufficiency. His complaint was progressed during last 3-4 months. He had two cerebral infractions attacks in a month approximately one year ago. On admission, physical examination revealed that, he had bilateral wheezing and stridor. He had right sided hemiplegia and had no history of heart failure or chronic obstructive lung disease. Endoscopic laryngoscopy was performed to evaluate upper airway obstruction. Laryngoscopy revealed that bilateral vocal cords were fixed and immobile at midline. Due to recurrent respiratory arrest, insufficient and fixed BVCP, open tracheostomy was perormed. After operation, he had no respiratory insufficiency or any complications. So he discharged from hospital with normal respiratory functions

The relationship between mean platelet volume with metabolic syndrome in obese individuals

WOS: 000306108300006PubMed: 22473052The metabolic syndrome is closely associated with atherosclerotic risk factors and increased mortality. Mean platelet volume (MPV) is an indicator of platelet activation which also shows a close relationship with cardiovascular risk factors, such as diabetes mellitus, hypertension, hypercholesterolemia, obesity, metabolic syndrome. The aim of this study was to investigate the correlates of metabolic syndrome, its components and MPV adjusted for obesity in a large population study. A total of 2298 individuals with a mean age of 50 (age range 18-92) were interviewed. Nine hundred and twenty obese participants, who had BMI 30 kg/m(2) or more, further evaluated for the presence of metabolic syndrome. Five hundred and thirteen [396 women (70.2%)] had metabolic syndrome and the rest 407 individuals [324 women (79.6%)] served as the control group. The BMI, SBP, DBP, waist circumference, fasting plasma glucose, visceral fat, total cholesterol, high-density lipoprotein-cholesterol, and triglyceride was higher significantly in metabolic syndrome group (P=0.002 for BMI and P0.05 for all). The presence of metabolic syndrome and its components do not constitute a difference in MPV values in obese patients with a BMI 30 kg/m(2) or more. Blood Coagul Fibrinolysis 23:388-390 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins