A multi-center, open label, crossover designed prospective study evaluating the effects of lipid lowering treatment on steroid synthesis in patients with Type 2 diabetes (MODEST Study)

OBJECTIVE

It has been suggested that lipid-lowering treatment with the use of statins adversely affects the steroid hormones. However, the safety of lipid lowering treatment targeting very low levels of LDL with respect to the steroid hormones has not been established.

RESEARCH DESIGN AND METHODS

A prospective, randomized, multicenter trial was conducted involving 98 patients. The patients were randomized into 2 groups: group-I received 10 mg of atorvastatin plus 10 mg of ezetimibe and group-II 80 mg of atorvastatin for the first 3 months. After crossover, the first group received 80 mg of atorvastatin and the second group 10 mg of atorvastatin plus 10 mg of ezetimibe for the following 3 months. Cortisol, DHEAS, testosterone, and estradiol levels were measured at the enrollment and at the end of the 1st, 2nd, 3rd, and 6th months.

RESULTS

Along with a decrease in LDL level, the levels of DHEAS, testosterone, and estradiol decreased in both groups (p<0.001). While cortisol levels were maintained in the group given 10 mg of atorvastatin plus 10 mg of ezetimibe, it decreased significantly after the crossover to 80 mg of atorvastatin (p<0.001). The group initially given 80 mg of atorvastatin measured a lower level of cortisol for the first 3 months and it returned to normal levels after switching to 10 mg of atorvastatin plus 10 mg of ezetimibe.

CONCLUSION

Eighty milligrams of atorvastatin decreased all adrenal and gonadal steroids, whereas 10 mg of ezetimibe combined with 10 mg of atorvastatin had at least no impact on cortisol levels.

[Comparison of the mid-term results of complete subtalar release by the Cincinnati and the posteromedial incisions in clubfoot]

OBJECTIVES

Clinical and radiological results of complete subtalar release operations on idiopathic congenital clubfoot patients were compared for the Cincinati and the posteomedial incisions.

PATIENTS AND METHODS

Twenty-six patients (40 feet) that underwent complete subtalar release using the Cincinnati incision (group 1; 18 patients, 27 feet [12 boys, 6 girls; mean age 7.4 +/-3.8 month; range 5-24 months]) and posteromedial incision (group 2; 8 patients, 13 feet [6 boys, 2 girls; mean age 10.1 +/- 4.3 month; range 4-16 months]) for idiopathic congenital clubfoot with at least one year followup were assessed. Tarsal bone problems, intraoperative and postoperative complications were analyzed separately.

RESULTS

According to the Simon's criteria, the clinical results were successful in 27 feet (100%) in group 1 and in 11 feet (85%) in group 2 (p > 0.05). Radiological results were successful in 16 feet (59%) in group 1 and in two feet (15%) in group 2 (p< 0.05). Superficial skin necrosis occurred in five feet (18.5%) in group 1 at the early postoperative period and all resolved with conservative treatment. Skin necrosis did not occur in group 2 (p > 0.05). The cast was bivalved and opened due to soft tissue swelling at the early postoperative period in 21 feet (77.8%) in group 1 and only in one foot (7.6%) in group 2 (p < 0.05).

CONCLUSION

Posteromedial incision is a suitable and safety incision for complete subtalar release.

Symptomatic interrupted inferior vena cava: report of a case presenting with haematochezia

Interrupted inferior vena cava (IVC) is a rare developmental defect. IVC interruption is usually accompanied with azygos and hemiazygos continuation, and is asymptomatic. Here, we report the imaging findings of a patient with an interrupted IVC with diffuse collaterals between the infrarenal IVC and large renal veins, left gonadal, and perirectal haemorrhoidal-portal collateral veins with associated haematochezia. Depending on the haemodynamic changes, interrupted IVC may cause possible different clinical findings as presented here.

Variation of carrying angle with age, sex, and special reference to side

We measured the carrying angle using a universal full-circle manual goniometer on the dominant and non-dominant extremity of the elbow in 1275 healthy volunteers (631 males, 644 females) with a mean age of 22.87+/-15.99 years (range: 2-91 years). In the right arm dominant group, right carrying angle was 11.25 degrees +/- 3.73 degrees and left carrying angle was 10.57 degrees +/- 3.63 degrees (P<.001). In left arm dominant group, right carrying angle was 10.65 degrees +/- 3.99 degrees and left carrying angle was 12.93 degrees +/- 4.22 degrees (P<.001). The carrying angle of dominant arm was found to be significantly higher than the non-dominant arm in both sexes. The carrying angle of dominant and non-dominant arms were found to be significantly higher in patients aged >14 years than that of patients aged < or = 14 years; females ranked higher than males.

Value of computed tomography and magnetic resonance imaging for assessing severity of liver cirrhosis secondary to viral hepatitis

PURPOSE

The aim of this study was to assess the value of abdominal CT and MRI in determining the severity of cirrhosis secondary to hepatitis compared to Child-Pugh classification.

MATERIALS AND METHODS

The study included 23 patients who were clinically and histologically diagnosed with chronic liver disease secondary to viral hepatitis. Each patient underwent dynamic abdominal CT imaging and MRI within the same week. CT and MRI findings were retrospectively reviewed. The same parameters were used from the CT and the MR images for each patient. The parameters included liver volume index (posterior segment of the right lobe, medial and lateral segments of the left lobe), spleen volume index, ascites, portosystemic collaterals, contour irregularities of the liver and confluent fibrosis within the liver. The findings were compared with the patients' Child-Pugh grades. Multiple regression analysis was used for statistical analysis.

RESULTS

On MRI, liver volume index (P = 0.0001), and ascites (P = 0.009) were strongly correlated with Child-Pugh grades. With CT, only ascites was correlated with Child-Pugh grades (P = 0.002).

CONCLUSION

This study indicates that liver volume index on MRI, and ascites on CT and MRI are good indicators of clinical severity of cirrhosis secondary to hepatitis. To show the effect of the other parameters, more research is needed with larger patient groups.

Morphology and dynamics of the ulnar nerve in the cubital tunnel after percutaneous cross-pinning of supracondylar fractures in children's elbows: an ultrasonographic study

After the 12.6-month (3-30) follow-up period, the morphology and dynamics of the ulnar nerve in the cubital tunnel were examined with ultrasonography on operated (group 1) and opposite (group 2) elbows of 13 children who had percutaneous cross-pin fixation for displaced supracondylar humerus fractures. When we compared group 1 and group 2, nerve morphology was similar (P>0.05), but nerve dynamics were found to be decreased or absent for seven (54%) elbows in group 1 (P<0.05). The medial K-wire may damage the ulnar nerve dynamics in the cubital tunnel.

[Treatment of femoral shaft fractures and pseudoarthrosis with compressive and interlocking intramedullary nailing]

OBJECTIVES

We evaluated the results of compressive and interlocking intramedullary nailing in femoral shaft fractures.

METHODS

Thirty-three femoral fractures of 30 patients (23 males, 7 females; mean age 36.9 years; range 14 to 80 years) were treated by compressive and interlocking intramedullary nailing. There were 26 closed and seven open (2 type II, 5 type IIIA) fractures. In three femurs, intramedullary nailing was performed due to pseudoarthrosis. According to the Winquist classification, there were 13, 8, 8, and 4 type I to IV fractures, respectively. Clinical, radiographic, and functional results were evaluated according to the Thoresen criteria. The mean follow-up was 29 months (range 6 to 29 months).

RESULTS

The mean operation time was 105.7 minutes. Union was obtained in all the patients within a mean duration of 19.6 weeks. In six cases, dynamization was performed due to insufficient callus formation. The results were excellent in 17 patients (56.7%), good in eight patients (26.7%), fair in three patients (10%), and poor in two patients (6.7%). Complications included shortening (n=3; 2 to 4 cm), varus deformity (n=2; 8 and 11 degrees), external rotation (n=3), restriction in knee flexion (n=3), superficial infection (n=8), trochanteric bursitis (n=3), and irritation of the skin by distal screws (n=2).

CONCLUSION

High rates of union with low complication rates makes interlocking intramedullary nailing an appropriate method in the treatment of femoral shaft fractures in adults. Compression with top screws contributes to the stability of fixation by eliminating any looseness through the fracture line.

Age as a predictor of hyperphosphatemia after oral phosphosoda administration for colon preparation

BACKGROUND AND AIM

It has been reported that oral phosphosoda (OPS), commonly used in bowel cleansing, may cause complications such as hyperphosphatemia and hypocalcemia. This has been observed in patients with normal kidney function and in those with renal insufficiency. Few controlled studies have been performed with respect to age on healthy subjects after OPS administration.

METHODS

Seventy patients (38 men and 32 women; mean age 47 +/- 12 years, range 25-80 years) were enrolled in the present study. Half of the 90 mL total volume of OPS was ingested 18 h before colonoscopy, and the other half 6 h before the procedure. Creatinine clearance rate (CCR) and serum levels of sodium, potassium, calcium and phosphate were measured before and after OPS administration.

RESULTS

After OPS administration, serum calcium and potassium were significantly lower (P < 0.05), and serum phosphate and sodium were significantly higher than pretreatment levels (P < or = 0.01). The statistically significant changes in serum sodium, potassium and calcium were within normal laboratory ranges. The mean change in serum phosphate was positively correlated with age (Pearson's r = 0.705; p < 0.001).

CONCLUSION

Administration of OPS causes a significant rise in serum phosphate, even in patients with normal CCR. The elevation is significantly greater in elderly patients. Administration of OPS can be considered safe for young and middle-aged patients with normal renal function; however, it should be used with caution in elderly patients, even in those with normal CCR and serum creatinine values.

[Solitary osteochondroma of the elbow causing ulnar nerve compression: a case report]

We report ulnar nerve compression caused by solitary osteochondroma of the right elbow in a 34-year-old man. Two osteochondromas were detected originating from the olecranon and medial humeral epicondyle, respectively. The patient had severely restricted elbow motion, pain, and hypoesthesia of the forth and fifth fingers. The lesions were surgically removed, together with subcutaneous anterior transposition of the ulnar nerve. At the end of the postoperative eight months, complaints of the patient disappeared except for slight hypoesthesia in the fingers. Literature search revealed only a single case of solitary osteochondroma associated with peripheral nerve compression.

[Peroneal nerve palsy due to rare reasons: a report of three cases]

Peroneal nerve entrapment was diagnosed in three patients (2 males, 1 female) by clinical and electrophysiological studies. Of these, one patient had postural bilateral involvement due to prolonged squatting, while two patients had mechanically-induced entrapment. Initially, all the patients were treated conservatively with a drop-foot splint and vitamin B. One patient responded to treatment; in one patient with bilateral involvement, right-sided peroneal nerve palsy improved. Upon detection of no clinical and electrophysiological improvement after three months of conservative treatment, surgical decompression was performed in two patients, which resulted in a successful outcome in the patient with bilateral palsy. Incomplete recovery was obtained in the other patient with diabetic polyneuropathy.

[Early results of treatment for developmental dysplasia of the hip in children between the ages of one and four years]

OBJECTIVES

We evaluated the early results of treatment for developmental dysplasia of the hip in children between the ages of one and four years.

METHODS

Twenty-four patients were retrospectively divided into two groups according to whether they were below or above two years of age at the time of the initial treatment. Group I consisted of 13 patients (20 hips; mean age 19.1 months; range 14 to 24 months); 11 patients (15 hips; mean age 32.6 months; range 26 to 50 months) comprised group II. Initially, patients in group I were treated with closed or open reduction (12 hips) and open reduction with femoral and/or pelvic osteotomies (8 hips). Group II patients underwent open reduction with femoral and/or pelvic osteotomies. Clinical results were evaluated according to the modified McKay criteria, and radiographic results to the Severin classification. The mean follow-up periods were 29.1 months (range 12 to 60 months) and 37.3 months (range 12 to 66 months), respectively.

RESULTS

Subsequent operations were performed in nine hips in group I, and in two hips in group II (p<0.05). Avascular necrosis of the femoral head was noted in six hips (30%) in group I and in none of the hips in group II (p<0.05). Excellent or good radiographic results accounted for 85% and 86%, and clinical results for 90% and 100% in groups I and II, respectively.

CONCLUSION

The need for pelvic and/or femoral osteotomies should be considered in conjunction with closed or open reduction in the treatment of developmental dysplasia of the hip in children between the ages of one and four years.

[Pseudarthrosis of a calcaneus fracture: a case report]

Nonunion after a calcaneus fracture is rare. A forty-two-year-old man presented with complaints of extreme left heel pain on weight-bearing, that required him to use crutches. Clinical and radiological studies yielded a diagnosis of calcaneal nonunion. He had a history of an open calcaneal fracture that occurred in a traffic accident eight months before, for which he received cast treatment. He underwent surgical treatment (curettage, bone graft, and internal fixation) for the nonunion of the calcaneus. Eight months after the operation, no problem was observed at the union site, and the patient returned to his normal activity levels. He had a slight heel pain appearing only after walking long distances, which was attributed to the subtalar joint.

[Diffuse synovial hemangioma of the knee: a case report]

Synovial hemangioma is a rare benign tumor of joint cavities. It may be a cause of pain and recurrent joint swelling in children and young adults. Diffuse synovial hemangioma was diagnosed in a 25-year-old male patient with complaints of right knee pain and swelling of a 10-year history. Direct radiography, venography, magnetic resonance imaging, and diagnostic arthroscopy enabled the diagnosis. Surgical excision was not considered because of diffuse involvement and many pigmented areas in the skin; instead, the patient was monitored conservatively. At the end of a year, the severity of complaints and the size of the lesion did not increase. Since there is a high risk for recurrence following open synovectomy for diffuse synovial hemangiomas, conservative treatment may be an alternative approach in selected cases.

Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint

To evaluate the use of a two-prong splint for displaced, proximal, humerus, epiphyseal fractures, seven children with Neer-Horwitz Classification Type 3-4 fractures of the proximal humerus were retrospectively investigated. After closed reduction, fracture stabilization was accomplished with the use of a two-prong splint, and at an average follow-up of 54 months (range 48-62 months), all children were evaluated radiographically and functionally. There were no complications, and all patients had full painless range of shoulder and elbow motion, without malunion, joint incongruity, nonunion, avascular necrosis, and limb-length discrepancy. The results did not change over time. Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint gives satisfactory results while allowing immediate motion and gradual reduction of the fragments without anesthesia, and it may be the treatment of choice for such injuries in children.

Plasma total homocysteine level in mothers of children with clubfoot

The pathogenesis of clubfoot is unknown despite numerous hypotheses. To clarify the relationship between the plasma total homocysteine level and congenital idiopathic clubfoot, blood samples from mothers of children with congenital idiopathic clubfoot (group 1) and mothers of children without congenital anomaly (group 2) were studied. Groups were the same for factors affecting the plasma total homocysteine level. Mean plasma total homocysteine level was 16.34+/-4.78 micromol/L in group 1 and 11.02+/-1.85 micromol/L in group 2, and there was significant statistical difference between the groups (P<0.05). Congenital idiopathic clubfoot showed a significant association with high plasma total homocysteine level. This study may be a step toward clarification of clubfoot pathogenesis.

Mechanical performance of hybrid Ilizarov external fixator in comparison with Ilizarov circular external fixator

OBJECTIVE

The aim of this study was to determine the stiffness characteristics of the standard and hybrid Ilizarov fixators.

DESIGN

Five different frame models (one standard and four hybrid Ilizarov) were designed. Four full rings were used in the standard Ilizarov frame. Two rings were placed proximal and two rings were placed distal to the osteotomy line with two wires at 90 degrees to each other on each ring. The distal tibial fixation of all the hybrid configurations and standard Ilizarov fixator were the same, and only the proximal fixations were different. In hybrid models, different numbers of 90 degrees femoral arches (1-3) were fixed to the proximal segment by using the half-pins with different numbers (2-4) and different angles to each other (45 degrees and 90 degrees ).

BACKGROUND

Numerous investigations have been performed to compare the mechanical properties of different frames. The Ilizarov method of fracture fixation and limb lengthening has recently gained international recognition. But its application is difficult in some anatomic localization, so that hybrid ring fixation frames of various configurations are gaining clinical popularity.

METHODS

Five different frame models were applied to the sheep tibial bones. The midpoint of the tibial bones was osteotomised and the osteotomy distracted for 2 cm. Four identical samples for each model were created and each identical sample of each model (n=1) were tested four times in axial compression, antero-posterior and medio-lateral bending, and torsion.

RESULTS

In standard Ilizarov fixator, axial and bending stiffness was found to be more than all hybrid Ilizarov fixator models. Between the hybrid fixators, higher axial and bending stiffness was found when the number of femoral arches and half-pins were increased. Different angles between the half-pins formed 67% alteration in medio-lateral bending stiffness. No significant difference was found for torsional stiffness between the fixator models.

CONCLUSIONS

For optimum fixator stiffness in hybrid fixators, at least three femoral arches and four half-pins must be used and these half-pins should be placed at 90 degrees angles and at different planes to each other. However, it should be remembered that, hybrid fixator models had less axial and bending stiffness than standard Ilizarov fixator model.

RELEVANCE

For optimum fixator stiffness in hybrid fixators, at least three femoral arches and four half-pins must be used. However, it should be remembered that, hybrid fixator models had less axial and bending stiffness than standard Ilizarov fixator model.

[One-bone forearm operation for defective ulna osteomyelitis: a case report]

A four-year-old boy with forearm instability secondary to defective ulna osteomyelitis underwent one-bone forearm operation in neutral supination-pronation position. A year after the operation, shortening (3 cm) of the forearm was detected. Radiographs showed delayed union; however, a stable and functional forearm was obtained. The patient was able to use his fingers.

[Early results of complete subtalar release in congenital clubfoot deformity]

OBJECTIVES

We evaluated the radiological and clinical results of complete subtalar release in patients with congenital clubfoot deformity.

METHODS

We performed complete subtalar release in 30 feet of 20 patients (14 boys, 6 girls; mean age 8 months; range 3.5 to 18.5 months). We employed the Cincinnati incision in all cases. The results were evaluated according to the Simon's clinical and radiological criteria. Tarsal bone problems were analyzed separately. The mean follow-up period was 24.6 months (range 12 to 41 months).

RESULTS

Clinical results were satisfactory in 24 feet (80%) and unsatisfactory in six feet (20%). Radiologically, satisfactory and unsatisfactory results were encountered in 19 feet (63%) and 11 feet (37%), respectively. Undercorrection occurred in 13 feet (43.3%) and overcorrection in one foot (1.4%). Revision surgery which was recommended for five undercorrected feet (16.6%) with unsatisfactory clinical and radiological results could be performed in four feet (13.3%). Deep skin necrosis that occurred in two feet (one with Achilles tendon necrosis) was treated surgically. Superficial skin necrosis developed in five feet and soft tissue infection in one feet, all of which responded well to conservative treatment. Other complications included talar head hypoplasia and navicular hypoplasia in two feet, respectively.

CONCLUSION

Complete subtalar release allows to correct all components of clubfoot deformity in a single session. The results may appreciably be improved with enhanced surgical experience.

Pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle

We report the case of a 22-year-old woman with pycnodysostosis associated with bilateral congenital pseudarthrosis of the clavicle. The patient was first seen at the age of 19 years and had no symptoms during the 3-year follow-up period. The diagnosis of pycnodysostosis was made by typical clinical and radiological findings. Bilateral painless mid-clavicular mass and plain radiograms confirmed the diagnosis of bilateral congenital pseudarthrosis of the clavicle. Surgery was not performed for pseudarthrosis of the clavicles, just observation was preferred.

[Fibular transfer in a nine-week-old infant for complete congenital absence of the tibia]

The treatment of complete congenital absence of the tibia is controversial. The goal of the treatment is to construct a satisfactorily functioning knee joint, for which fibular transfer was described as an appropriate method. We performed reconstructive surgery using a modified Browns procedure in a nine-week-old boy with Jones type 1 congenital longitudinal deficiency of the tibia. In his final control at three years of age a good outcome was obtained according to the criteria by Epps et al. To our knowledge, this is the youngest patient to receive fibular transfer in the literature, to which we ascribed the satisfactory outcome.

[The results of surgical treatment in ankle fractures]

OBJECTIVES

We evaluated the results of surgical treatment for ankle fractures and the factors that play a role in these results.

METHODS

The study included 31 patients (20 men, 11 women, mean age 38.2 years) who underwent surgical treatment for ankle fractures and had an adequate follow-up. According to the Lauge-Hansen classification, the mechanism of occurrence was supination-external rotation in 13 (42%), pronation-external rotation in two (26%), pronation-abduction in four (13%), and supination-abduction in four patients (13%). In two patients (6%), the fractures could not be classified. Most of the fractures occurred with falling in winter months. The majority of fractures (55%) was of bimalleolar type. The mean follow-up was 26 months.

RESULTS

Union was obtained in all fractures. According to the objective criteria, the results were good, moderate, and poor in 18 (58%), eight (26%), and five (16%) patients, respectively. Subjective evaluation yielded good, moderate, and poor results in 17 (55%), eight (26%), and six (19%) patients, respectively. The results were poor especially in pronation-external rotation and fracture-dislocation type fractures. Two patients (6%) developed degenerative arthritis.

CONCLUSION

In our opinion, the best anatomical reduction may be achieved by surgical treatment of ankle fractures that present with a talar tilt, fibular shortening, and injury to the syndesmosis.

Open fractures of the proximal humerus treated with the Ilizarov method: 12 patients followed 3-8 years

We followed 12 patients who had been treated with the Ilizarov method for open proximal humeral fractures for more than 3 years. No wound infection occurred. Avascular necrosis and nonunion were each detected in 1 patient. According to Neer's criteria, the outcome was excellent or satisfactory in 8 patients.

Corona mortis: incidence and location

The right hemipelvis of 98 patients was examined by angiography to determine the occurrence and location of the corona mortis artery. This arterial anastomosis was found in 28.5% (28 of 98). Its incidence was 30.5% (18 of 59) in men and 25.6% (10 of 39) in women; this difference was not significant ( p>0.05). The distance from the symphysis pubis to the anastomotic artery averaged 33.4 mm (range 21.4-41 mm). It was 31.8 mm (range 21.4-39.3 mm) in men and 36.2 mm (range 25-41 mm) in women; this difference was significant ( p<0.05).

A case of Castleman's disease with "downhill" varices in the absence of superior vena cava obstruction

Downhill esophageal varices", classically defined as those that develop in the upper region of the esophagus, are less common than the "uphill" type, which is usually produced by portal hypertension. Various causes of downhill varices have been reported, but mediastinal tumor is the most common responsible lesion. Castleman's disease, or angiofollicular lymph node hyperplasia, is a rare pathological process of unknown etiology that usually develops in the mediastinum. We report the case of a 60-year-old woman whose large esophageal varices were detected incidentally. The cause was a mediastinal mass which was diagnosed as Castleman's disease on histopathological examination of a surgical specimen. This patient's varices most likely formed as a result of copious blood drainage from the tumor into the esophageal veins. Evidence for this was the lack of the classic downhill pattern, the absence of superior vena cava obstruction, and the fact that the varices resolved after the tumor was removed. It is our opinion that this type of varices should be renamed, and we suggest that "overflow varices" would be an appropriate term.

[A case of upper gastrointestinal system obstruction by duodenal intramural hematoma caused by using an oral anticoagulant drug]

Unwanted haemorrhage can be seen due to long-term oral anticoagulant use. Sometimes these may lead obstructions forming intramural haemotomas. We noticed a case of duodenal obstruction due to an intramural hematoma in a patient who is on chronic oral anticoagulant therapy. In Taksim Hospital 1st General Surgery Department in April 2000, we treated a patient who presented anaemia, jaundice, pyloric obstruction conservatively. As a result we implicated to treat such cases nonoperatively.

Two-prong splint in the treatment of proximal humeral fracture

Twenty-nine patients with two-, three- and four-part proximal humeral fractures were treated by two-prong splint. At the latest follow-up, 22 patients had excellent and satisfactory results according to the Neer criteria, with only two failures. Avascular necrosis was detected in only one patient. Given these results, we conclude that the present method can be the treatment of choice for these injuries.

A study on the carotid artery intima-media thickness and its association with lipid peroxidation

High resolution B-mode ultrasonography of the carotid arteries has been used to investigate the signs of early atherosclerotic vessel wall disease by measuring the intima-media thickness (IMT). We examined the association between IMT and lipid peroxidation and found IMT to be increased in a group of patients with respect to controls (1.430+/-0.341 mm versus 0.703+/-0.201 mm, P < 0.001). Plasma and erythrocyte malondialdehyde (MDA) levels were also significantly higher (P<0.001) and the erythrocyte reduced glutathione (GSH) levels were significantly lower (P <0.001) in the patients with respect to the controls. In the groups of patients there was no significant correlation between the mean IMT and the plasma and erythrocyte MDA levels or the erythrocyte GSH levels. In conclusion determination of lipid peroxides would be especially important and advisable in patients with increased carotid IMT. Type II diabetes and hypertension were also associated with increased IMT.