Adem Karaman

Remarkable anatomic anomalies of coronary arteries and their clinical importance: a multidetector computed tomography angiographic study.

Objective: An anomalous origin and course of the coronary arteries can be benign or life threatening. Recently, because of new advances in computed tomography technology, radiologists have begun to interpret the diseases of coronary arteries. We aimed to demonstrate some remarkable anomalies of coronary arteries, some of which were not shown by multidetector computed tomography (MDCT) coronary angiography previously, and to discuss the clinical importance of these anomalies. Materials and Methods: Seven hundred twenty-five consequent patients referred to Florence Nightingale Hospital and Atatürk University Hospital for MDCT coronary angiography were included in this study. The patients were between the ages of 33 and 78 years (mean ± SD, 59 ± 13.86 years). Four hundred ninety-seven patients (68.6%) were men, and 228 (31.4%) were women. All the examinations were evaluated by both a radiologist and a cardiologist. Results: The incidence of anomalous anatomical origin and course of the coronaries found in our study group was 5.79% (n = 42). The anomalies found in our study are absence of the right coronary artery (RCA; n = 1, 0.13%), ectopic origin of RCA from the left anterior descending (LAD) artery (n = 1, 0.13%), absence of the left main coronary artery (n = 4, 0.52%), ectopic origin of the left main coronary artery from the right sinus of Valsalva (n = 1, 0.13%), double LAD and ectopic origin of LAD from RCA (n = 1, 0.13%), ectopic origin of the left circumflex artery from the right sinus of Valsalva (n = 3, 0.39%), ectopic origin of the left circumflex artery from RCA (n = 2, 0.26%), and myocardial bridging (n = 29, 4%). Conclusions: An anomalous origin of the coronary anatomy must be present in the interpretations because of its importance for patients, cardiologists, and surgeons. As a conclusion, our study showed that MDCT, especially volume rendering and maximum intensity projection techniques, may be useful for assessment of complex variations, when the conventional angiography may not be sufficient.

Boron containing poly-(lactide-co-glycolide) (PLGA) scaffolds for bone tissue engineering

Scaffold-based bone defect reconstructions still face many challenges due to their inadequate osteoinductive and osteoconductive properties. Various biocompatible and biodegradable scaffolds, combined with proper cell type and biochemical signal molecules, have attracted significant interest in hard tissue engineering approaches. In the present study, we have evaluated the effects of boron incorporation into poly-(lactide-co-glycolide-acid) (PLGA) scaffolds, with or without rat adipose-derived stem cells (rADSCs), on bone healing in vitro and in vivo. The results revealed that boron containing scaffolds increased in vitro proliferation, attachment and calcium mineralization of rADSCs. In addition, boron containing scaffold application resulted in increased bone regeneration by enhancing osteocalcin, VEGF and collagen type I protein levels in a femur defect model. Bone mineralization density (BMD) and computed tomography (CT) analysis proved that boron incorporated scaffold administration increased the healing rate of bone defects. Transplanting stem cells into boron containing scaffolds was found to further improve bone-related outcomes compared to control groups. Additional studies are highly warranted for the investigation of the mechanical properties of these scaffolds in order to address their potential use in clinics. The study proposes that boron serves as a promising innovative approach in manufacturing scaffold systems for functional bone tissue engineering.

Diagnostic performance of multidetector computed tomography for detecting aorto-ostial lesions compared with catheter coronary angiography: multidetector computed tomography coronary angiography is superior to catheter angiography in detection of aorto-ostial lesions.

Purpose: In this study, our goal is to determine the use of multidetector computed tomography (MDCT) in detection of aorto-ostial lesions. Materials and Methods: Thirty-three patients suspected to have aorto-ostial lesion by either catheter angiography (CA) or MDCT coronary angiography comprised our study population. In 19 patients (group 1), aorto-ostial lesion was suspected based on CA, then MDCT coronary angiography was performed. In the remaining 14 patients (group 2), aorto-ostial lesion diagnosis was made by MDCT coronary angiography, and then afterward, CA was performed. A cardiologist and a radiologist reevaluated both the CA and MDCT coronary angiography recordings of all patients and their consensus formed the diagnosis. We accepted this consensus diagnosis as our criterion standard because a universal criterion standard to compare CA and MDCT findings with is not available. Then, the previous diagnoses by CA and MDCT coronary angiography were compared with the consensus diagnoses. Results: Finally, 26 patients were diagnosed with aorto-ostial lesion, whereas 5 patients were found not to have aorto-ostial lesions. Two patients were diagnosed with abnormal origination of a coronary artery. When the results were evaluated in terms of the presence of aorto-ostial lesion, MDCT coronary angiography correctly diagnosed all 26 patients, and in the 5 patients with normal ostium, MDCT coronary angiography finding was also normal. However, 7 of 26 patients with aorto-ostial lesion were reported to be normal by CA, and also 5 patients with normal ostia were reported to have aorto-ostial lesion by CA. That is, 12 of 33 patients were misdiagnosed by CA. Moreover, CA missed the abnormal origination of the coronary arteries in 2 patients. When the results were evaluated in terms of the degree of stenosis in 26 patients with aorto-ostial lesion; MDCT coronary angiography predicted the final diagnosis in all 26 patients correctly. However, CA predicted the final degree of stenosis only in 12 patients. Catheter angiography underestimated the degree of the stenosis in 2 patients, overestimated in 5 patients and missed the lesion in 7 patients. Conclusions: Our findings suggest that MDCT is a reliable tool for diagnosing the presence and severity of aorto-ostial lesions. In addition, MDCT might be useful in preventing the false diagnosis due to the catheter-induced spasms in patients who were diagnosed with aorto-ostial lesion by CA. Moreover, if MDCT coronary angiography detects a lesion in aorto-ostial region, there is no need to perform CA to merely verify this pathology.

Silicosis Appears Inevitable Among Former Denim Sandblasters: A 4-Year Follow-up Study

BACKGROUND The course of denim sandblasting silicosis is unknown. We aimed to reevaluate former sandblasters studied in 2007 for incident silicosis, radiographic progression, pulmonary function loss, and mortality and to examine any associations between these outcomes and previously demonstrated risk factors for silicosis. METHODS We defined silicosis on chest radiograph as category 1/0 small opacity profusion using the International Labor Organization classification. We defined radiographic progression as a profusion increase of two or more subcategories, development of a new large opacity, or an increase in large opacity category. We defined pulmonary function loss as a ≥ 12% decrease in FVC. RESULTS Among the 145 former sandblasters studied in 2007, 83 were reassessed in 2011. In the 4-year follow-up period, nine (6.2%) had died at a mean age of 24 years. Of the 74 living sandblasters available for reexamination, the prevalence of silicosis increased from 55.4% to 95.9%. Radiographic progression, observed in 82%, was associated with younger age, never smoking, foreman work, and sleeping at the workplace. Pulmonary function loss, seen in 66%, was positively associated with never smoking and higher initial FVC % predicted. Death was associated with never smoking, foreman work, number of different denim-sandblasting places of work, sleeping at the workplace, and lower pulmonary function, of which only the number of different places worked remained in multivariate analyses. CONCLUSIONS This 4-year follow-up suggests that almost all former denim sandblasters may develop silicosis, despite short exposures and latency.

Roles of Ki-67, p53, transforming growth factor-β and lysyl oxidase in the metastasis of lung cancer

Most lung cancer (LC) patients have metastatic disease at time of diagnosis, which influence the treatment regimen and is the most important prognostic factor. The main purpose of our study was to evaluate the relationship between cell proliferation (Ki‐67 label index), p53, transforming growth factor‐β (TGF‐β) and lysyl oxidase (LOX), and the metastatic stages of different lung cancers. The secondary aim was to correlate these parameters with the standardized uptake value (SUVmax) of the primary lesion during positron emission tomography‐computed tomography (PET‐CT).

Effect of the reconstruction window obtained at the isovolumic relaxation period on the image quality in electrocardiographic-gated 16-multidetector-row computed tomography coronary angiography studies

Objective: To evaluate whether images obtained during the reconstruction window responding to the isovolumic relaxation period could be used for rapid and easy postprocessing. Methods: One hundred ten consecutive patients with suspected coronary artery disease who had previously had a multidetector computed tomography (MDCT) scan for imaging coronary arteries were enrolled in this study. The age of the patients was 59 ± 13 years (range: 33-78 years), and 77 (70%) were male. Multidetector computed tomography was performed on a 16-detector-row computed tomography scanner during 1 breath hold (16-24 seconds). Seven different sets of images reconstructed at every 10% of the R-R interval from 30% to 90% for contrast-enhanced scans at levels containing the first several centimeters of the left and right coronary arteries were analyzed. The best of these reconstruction windows were then compared with the images reconstructed at the isovolumic relaxation period, which is the last portion of the T wave at the end of the systole, where there is not any change in ventricular volume, which causes stepladder artifacts. The step artifact was classified as excellent, good, or poor. Image quality was assessed by 2 radiologists who were not aware of each others interpretation. Results: According to the routinely used reconstructions, there were 76 patients with excellent image quality, 28 with good image quality, and 6 with poor image quality. For the period of isovolumic relaxation, there were 74 patients with excellent image quality, 25 with good image quality, and 11 with poor image quality. Conclusion: If one begins image analysis with the isovolumic relaxation period reconstruction window, spending less time for postprocessing analyses, good image quality can be obtained such as with other good reconstruction windows.

Nephroprotective potential of carnitine against glycerol and contrast-induced kidney injury in rats through modulation of oxidative stress, proinflammatory cytokines, and apoptosis

OBJECTIVE Contrast media (CM) are a major cause of nephropathy in high-risk patients. The aim of this study was to examine the effects of carnitine (CAR) in advanced nephrotoxicity due to CM administration in rats with glycerol-induced renal functional disorder. METHODS 40 rats were divided randomly into five groups (n = 8): (1) healthy group; (2) glycerol only (GLY); (3) glycerol and CM (GLY + CM); (4) glycerol, CM and 200 mg kg(-1) carnitine (CAR200, Carnitene(®); Sigma-tau/Santa Farma, Istanbul, Turkey); and (5) glycerol, CM and 400 mg kg(-1) carnitine (CAR400). Kidney injury was induced with a single-dose, intramuscular injection of 10 ml kg(-1) body weight (b.w.) of GLY. CAR was administered intraperitoneally. CM (8 ml kg(-1) b.w. iohexol, Omnipaque™; Opakim Medical Products, Istanbul, Turkey) was infused via the tail vein to the rats in Groups 3-5. RESULTS l-carnitine administration significantly decreased serum creatinine and blood urea nitrogen levels. Superoxide dismutase and glutathione activity increased significantly in the treatment groups compared with the nephrotoxic groups. CAR400 significantly reduced malondialdehyde levels to healthy levels. In the treatment groups, tumour necrosis factor (TNF)-α, transforming growth factor 1β, interleukin 1β and caspase-3 gene expression decreased compared with the nephrotoxic groups. TNF-α and nuclear factor kappa-beta (NF-κB) protein expression increased after CM and CAR administration reduced both TNF-α and NF-κB expressions. Histopathologically, hyaline and haemorrhagic casts and necrosis in proximal tubules increased in the nephrotoxicity groups and decreased in the CAR groups. CONCLUSION The results reveal that l-carnitine protects the oxidant/antioxidant balance and decreases proinflammatory cytokines and apoptosis in CM-induced nephrotoxicity in rats with underlying pathology. ADVANCES IN KNOWLEDGE Depending on the underlying kidney pathologies, the incidence of CM-induced nephropathy (CIN) increases. Therefore, this is the best model to represent clinically observed CIN.

Usefulness of multidetector computed tomography coronary venous angiography examination before cardiac resynchronization therapy.

PurposeCardiac resynchronization therapy (CRT) is a treatment option for selected heart failure patients. In this study, the aim was to evaluate the usefulness of noninvasive cardiac vein imaging using multidetector computed tomography (MDCT) angiography before CRT.Materials and methodsThe MDCT scans of 34 patients (20 men; age range 47–65 years) with a history of cardiac failure were studied for CRT in two centers prospectively. The anatomy of the cardiac venous system, particularly the target veins [left marginal vein (LMV) and posterior vein of the left ventricle (PVLV)], was evaluated with noninvasive MDCT.ResultThe coronary sinus, anterior interventricular vein, and posterior interventricular vein were observed in all patients. The PVLV was present in 30 (88.2%) patients. The PVLV was chosen in 30 (88.2%) patients for CRT. If the PVLV had two or more branches, the widest branch was chosen for lead implantation. In four (11.7%) patients, the PVLV was absent and the LMV was chosen instead for lead implantation. In one patient (2.9%), partial thrombosis was detected in the coronary sinus with MDCT angiography.ConclusionMDCT can be used to guide interventionalists for CRT by providing anatomical details of the cardiac venous system rapidly and noninvasively.

Quantitative Magnetic Resonance Imaging of Brainstem Volumes, Plaques, and Surface Area in the Occipital Regions of Patients with Multiple Sclerosis

Purpose: To determine brainstem volumes, number of plaques, and surface areas in the occipital lobes of patients with relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS), and to investigate whether there is any correlation between brainstem volume and the number/surface areas of plaque in the occipital lobes. Material and Methods: Magnetic resonance imaging was obtained on 14 relapsing-remitting (RR) and 13 secondary progressive (SP) MS patients and 26 female control subjects. The Cavalieri method was used by modern design stereology to measure brainstem volume. The point-counting grid was used to evaluate sclerotic plaque surface areas in the occipital lobe. The number of plaques in the imaging section was calculated. Results: Brainstem volumes for RR and SP with multiple sclerosis and control subjects were 3647 mm3, 3515 mm3, and 4517 mm3, respectively. Mean number of plaques in the right-left occipital lobe was found to be 2.7–3.4 in RR-MS and 5.2–2.8 in SP-MS. Mean plaque surface area in the right-left occipital lobe was determined to be 58.52–88.24 mm2 in RR MS and 124.3–64.82 mm2 in SP MS. Brainstem volumes were significantly reduced in both groups of patients with MS compared to controls (P<0.01). Conclusion: Magnetic-resonance-estimated volume and surface area values in multiple sclerosis may facilitate our understanding of the clinical situation of patients and provide a simple index for evaluating therapeutic efficiency.

Frequency of Class I and II HLA alleles in patients with lung cancer according to chemotherapy response and 5-year survival

Lung cancer is the most common cause of cancer death in the world, and the most common type is non‐small‐cell lung cancer (NSCLC). At present, surgical resection, chemotherapy, and radiation therapy are the main treatments for patients with NSCLC, but unfortunately outcome remains unsatisfactory.