Objectives Nondipping status; probably a result of sympathetic hyperacitivity; is clinically associated with poor prognosis. In this study we aimed to evaluate the variation of daytime and nighttime heart rate among dipper and nondipper patients probably due to sympathetic hyperactivity. Material and Method 116 patients were enrolled and performed 24 hour ambulatory blood pressure monitoring. 24-hour daytime and nighttime systolic and diastolic blood pressures and heart rates were compared between the dipper and non dipper hypertensive patients. Statistical analysis was performed by Independent Samples t test using SPSS 11.0 for Windows. Results Daytime heart rates were higher in nondipper patients than dipper patients (78,3±9 vs 75,2±9, p=0.1>0.05), but the difference was not statistically significant. Also nighttime heart rates were significantly higher in non dipper patients (65,9±8,7 vs 61,7±7,8, p=0.02<0.05). Nighttime heart rate dipping is significantly lower in nondipper patients (%14.2±6.1 vs %17.8±5.9 p<0.05). Conclusion Increased heart rates of daytime and nighttime period in nondipper patients are clinical finding of sympathetic hyperactivity which was accounted for nondipping. Since nondipping status is closely associated increased risk for cardiovascular events, effective treatment of nondipper patients and modifications in drug therapy may reduce cardiovascular morbidity and mortality.

ABSTRACT Objectives To analyze the diffusion properties of intracranial hematomas and to understand the contribution of diffusion MR imaging of hematomas on clinical diagnosis in the patients with acute stroke. Methods The MR images of 37 patients with primary intracranial hemorrhage were retrospectively reviewed. Variations in T2- weighted echo planar images, DW (diffusion weighted) imaging signal intensity, and apparent diffusion coefficient (ADC) ratios (core of hematoma/contralateral hemisphere) were analysed according to the putative stages of hematoma, as seen on T1- and T2- weighted images. Results On both T2-weighted echo planar and DW images, the core of hematoma was hyperintense at the hyperacute (oxyhemoglobin, n=4) and late subacute stages (extracellular methemoglobin, n=11), while being hypointense at the acute (deoxyhemoglobin, n=11) and early subacute stages (intracellular methemoglobin, n=11). There was a positive correlation between signal intensity ratio on T2-weighted echo planar and DW images (r=0,698, r=0,940, p<0.05) in acute and early subacute stage. ADC values were decreased in the whole population and it was significantly different in acute and early subacute stage (p<0.05). Conclusions The core of hematoma is hyperintense on DW images with decreased ADC values at the earliest time, and thus mimic arterial stroke on DW images. ADC values are decreased during hyperacute, acute and subacute stages.

We report the diffusion-weighted imaging findings (DWI) of a case with urachal abscess. Magnetic resonance imaging revealed an enhancing thick, walled cystic mass arising from the superior surface of the urinary bladder and extenting to the level of the umbilicus. DWI revealed restricted diffusion of the cyst content consistent with abscess formation with an ADC value of 0.76 x 10¯³ mm²/s.

Tortuosity of the internal carotid artery is rarely seen in otolaryngologic practice. It can be presented with abnormal sensation or may be asymptomatic. Diagnosis is important especially if a surgical procedure is planned and CT can be preferred as the diagnostic modality. In this case, we present a tortuous internal carotid artery, causing an oropharyngeal bulging, mimicking a mass lesion, diagnosed by computed tomography.

The authors present a case of large gluteal defect developed due to pressure of a giant gluteal hematoma resulted from a pelvic fracture. The defect is reconstructed with a vertical split local gluteus maximus flap. Giant hematoma after a pelvic fracture is an unusual complication and to our knowledge, in the literature this is the first case of a gluteal defect resulting from a hematoma.

Lesch-Nyhan disease is a rare X-linked recessive genetic disorder caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase enzyme. The patients with Lesch-Nyhan Syndrome have several problems such as positioning and difficult intravenous cannulation because of spasticitiy. Also these patients have risk for bradycardia, pulmonary aspiration, convulsion and sudden death. Anesthetic implications of the patients with Lesch- Nyhan Syndrome are not well described. Here we report our anesthesia experience in a 4 years-old child with Lesch-Nyhan syndrome, who underwent cataract surgery. Patients with Lesch-Nyhan syndrome should be carefully evaluated in the preoperative period especially to determine the difficulties in venous access and positioning. These patients should be closely monitored for the potential of pulmonary aspiration, and sudden death postoperatively.