Band 2, Heft 3

The imaging obtained by endoscopic ultrasound (EUS) has improved our understanding of many disease states of the digestive tract. It was mostly utilized by gastroenterologists and surgeons. In this article, we highlight some of the indications and applications that may be noticed by other specialists such as non-small cell lung cancer (by a special EUS technique, i.e., endobronchial ultrasound), pancreatic neuroendocrine tumors, kidney and adrenal masses, rectosigmoid endometriosis, celiac plexus neurolysis and pseudocyst drainage.

Acute respiratory distress syndrome (ARDS) is not a genetic disease, but gene polymorphism influences the susceptibility, severity and prognosis of ARDS. It has been reported that the polymorphism of genes, such as angiotensin-converting enzyme and extracellular superoxide dismutase 3 genes, is related to ARDS. Research on the gene polymorphism of ARDS is currently in the preclinical stage, but it develops fast, In the future, ARDS-related gene polymorphism may play an important role in identifying susceptibility risk, assessing prognosis revealing new etiology and pathophysiological mechanisms, and optimizing diagnosis and treatment.

Patients with simple congenital heart disease such as isolated atrial septal defects (ASDs) are rapidly becoming a relatively large population with a variety of clinical problems that are often missed by pediatric physicians or grown up congenital heart disease specialists, and may involve different adult health professionals such as general cardiologists or internists. Isolated ASDs are common (7% of all cardiac anomalies) and can present at any age, sometimes in conjunction with other genetic disorders such as Down’s syndrome or in a familiar form. The diagnosis is often accidental: Doppler echocardiography and, recently, magnetic resonance imaging are mandatory to assess types and significance of ASDs. Surgical or percutaneous repair should be offered at any age unless associated with pulmonary vascular disease: Percutaneous closure should be preferred in isolated secundum ASD with sufficient rims on trans-esophageal echocardiography, whereas surgery remains the only option for primum and sinus defects. Follow-up of operated patients is based on Holter EKG and echocardiography that should be scheduled every 2 years for secundum and sinus defects and every year for primum defect with valve repair. ASDs in adolescents and adults may be suspected in any physician’s office and doctors should be acquainted with innovative imaging techniques and contemporary therapeutic options in order to deliver proper care to different types of ASDs and assist them after repair with appropriate follow-up strategies.

Diabetes is closely related with the gonadal endocrine functions. On one hand, the abnormal glucose metabolism may affect functions of the hypothalamic-pituitary-gonadal axis, which in turn leads to sex hormone disorders and, subsequently, hypogonadism both in male and female patients; on the other hand, abnormal secretion of sex hormones is associated with the risk of diabetes. The common hypogonadism diseases, such as hypergonadotropic hypogonadism (Klinefelter syndrome, Tuner syndrome) and hypogonadotropic hypogonadism (Kallmann syndrome, Prader-Willi syndrome), can significantly increase the prevalence of abnormal glucose metabolism. The exact mechanism underlying the interaction between gonadal diseases and diabetes remains unclear, yet it may be associated with insulin resistance, obesity, abnormal chromosome and abnormal secretion of sex hormone. Clinically, individualized treatment with considerations to both gonadal diseases and abnormal glucose could be advisable.

Parkinson’s disease (PD), a common neurologic disease, is an archetypal disorder of dopamine dysfunction characterized by motor, cognitive, behavioral and autonomic symptoms. The human nucleus accumbens (NA), a limbic-motor interface, is crucially involved in PD, not only in its pathogenesis and clinical manifestations but in the effects of several treatment efforts as well. NA atrophy in PD, Mavridis’ atrophy (MA), was discovered 4 years ago. The purpose of this article was to review the current knowledge regarding the role of ΜΑ in PD as well as to suggest future research directions. Summarizing the current knowledge regarding MA, we could say that this phenomenon begins in early-stage PD patients and is correlated with psychiatric symptoms that occur in PD, mainly apathy and impulsive behavior. Moreover, MA is also associated with cognitive PD symptoms. Thinking of how well we know the role of MA in PD, we are probably seeing just “the peak of the iceberg.” It is particularly important that we know that an unexplored “iceberg” exists, but we currently have just a look at its “peak.” Further research is necessary to enrich our knowledge and consequently improve our understanding of the significance of the role of MA in PD.

Background: Esophageal varices (EVs) are serious consequences of liver cirrhosis. Several studies have evaluated the possible non-invasive markers for the diagnosis of EVs to reduce the number of endoscopic procedures in patients with cirrhosis but without varices. This study was performed to evaluate the diagnostic performance of two such parameters (platelet count to splenic diameter ratio and splenoportal index) for the detection of EVs. Materials and Methods: A total of 111 patients with liver cirrhosis were analyzed after performing upper gastrointestinal endoscopy and non-invasive tests including platelet count and ultrasound abdomen including Doppler study. Appropriate statistical tests were applied to compare the non-invasive tests with the gold standard of endoscopy. Results: Of 111 liver cirrhotics, 80 (72.1%) were male and 31 (27.9%) were female. EVs were present in 68 (61.3%) patients and absent in 43 (38.7%) patients. In platelet count to splenic diameter ratio, a cut-off value of 1014 was obtained, which gave a sensitivity of 75.0%, specificity of 65.1%, positive predictive value (PPV) of 77.3%, negative predictive value (NPV) of 62.2% and diagnostic accuracy of 71.2%. In the splenoportal index, a cut-off value of 3.5 cm/s was obtained, which gave a sensitivity of 79.4%, specificity of 72.0%, PPV of 81.8%, NPV of 68.8% and diagnostic accuracy of 76.5% for the diagnosis of EVs. Conclusions: The platelet count to spleen diameter ratio and splenoportal index are non-invasive and fairly accurate alternatives in identifying the presence or absence of EVs in patients with compensated cirrhosis.

Background: Trigger finger is a common problem encountered in rheumatologic practice that causes a triggering or locking that may produce an uncomfortable sensation. There are various methods of treatment, ranging from conservative management to surgical release. Aim: To determine the effectiveness of corticosteroid injection and percutaneous release in terms of symptomatic relief, patient satisfaction and complications. Materials and Methods: In this prospective study, 50 patients who presented with trigger finger Grades 2 and 3 were randomized into two groups. One group received corticosteroid injection and, in the other group, percutaneous release was performed. These patients were then assessed weekly over a period of 6 weeks and their progress was noted. Results: Thirty cases (60%) were female and 20 cases (40%) were male. The age of the patients in this study was 40-65 years (mean: 48 years). Twenty-three cases (46%) were manual workers, 17 cases (34%) were semi-professionals and 10 cases (20%) were housewives. Most of the patients had involvement of the dominant hand (62%) and non-dominant hand involved in 38% of the cases. The most common presenting symptom was pain with triggering. In both groups, significant improvement in pain and triggering occurs in the first 2 weeks, but there was better improvement of pain and triggering in the corticosteroid group after 2 weeks. In terms of swelling of the digits, no difference was noted during the course of the treatment in the two groups. The corticosteroid group of patients had a complication rate of 6% and in the second group, the percutaneous group, had an 18% complication rate. There were a total of 12 patients who had recurrence (recurrence rate 24%): five (41.6%) cases in the first or corticosteroid group and seven (58.3%) cases in the surgery group. Conclusion: The group of patients treated with corticosteroid had a better relief of pain and triggering and had a lower complication rate. The recurrence was equal in both groups.

Background: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome can affect the natural course of tuberculosis (TB) and pose diagnostic difficulties and may negatively affect the treatment due to frequent drug interactions in the advanced state of disease. Targeted tuberculin skin testing (TST) for latent tuberculosis infection (LTBI) identifies persons at high risk for TB who would benefit by treatment of LTBI, if detected. Materials and Methods: A prospective observational study conducted at the Department of Pulmonary Medicine and Department of Internal Medicine, MIMSR Medical College, Latur, India from November 2012 to October 2013 included all HIV-positive patients attending the outdoor department. A total of 100 HIV-positive patients subjected to TST were studied. The clinical presentation, CD4 count and tuberculin test result were studied. Chi-square test was applied to know the test of significance. Results: In this study of 100 patients, 48 were male, 52 were female and the male to female ratio was 0.92:1, with majority of the cases in the age group of 31-40 years. The mean age of the patients was 35.89 years. The most common mode of transmission of HIV infection was heterosexual in 93 patients (93%), blood transfusion in four patients (4%) and injections in three patients (3%). Of the 100 patients studied, 56 patients were TST negative (56%), whereas 44 patients were TST positive (44%). Of the 100 patients studied, 48 patients had a CD4 count of <200 cells/mm3; of these 48 patients, 37 patients were TST negative and 11 patients were TST positive. Conclusion: TST reactivity varied directly and that of anergy inversely with absolute CD4 counts. TST should be correlated with CD4 count as indurations to protein purified derivative depend on CD4 count. TST in asymptomatic HIV cases, irrespective of CD4 count, would definitely guide regarding decision of chemoprophylaxis in LTBI. The role of TST in the decision to start chemoprophylaxis in LTBI should be considered cautiously in India, as the prevalence of both HIV and TB is high.

Spontaneous acute esophageal necrosis (AEN) has been reported to be extremely rare. The condition is defined as a dark pigmentation of the esophagus associated with histologic mucosal necrosis. The exact pathogenesis is still unknown, but several etiologies have been suggested including ischemia, gastric outlet obstruction, hypersensitivity to antibiotics, gastric volvulus and viral infection. We herein present a case of a middle-aged man with end-stage renal disease who presented with AEN following a hemodialysis session. Its diagnosis and management are discussed with reference to the pathogenesis of the condition.