Alptekin Yasim

Serum concentration of procoagulant, endothelial and oxidative stress markers in early primary varicose veins

Abstract Objective Endothelial disorders of the veins are considered to play a role in the pathogenesis of primary varicose veins and oxidative stress is implicated in these disorders. With this aim, we investigated vascular endothelial marker levels and the effect of endothelial damage on coagulation parameters and vasodilator substances to determine metabolic markers of oxidative stress in patients with varicose veins and vascular endothelial damage caused by oxidative stress. Methods We investigated the levels of malondialdehyde (MDA), protein C, protein S, fibrinogen, von Willebrand factor (vWf), tissue plasminogen activator (tPA), vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), interleukin-12 (IL-12) and nitric oxide (NO) in the blood taken from the brachial vein of 25 patients with primary varicose veins (study group) and compared the results with 25 healthy volunteers (control group). We also investigated the urinary levels of prostaglandin I2 (PGI2) in the study group and compared the results with the control group. Results There was no statistically significant difference between the study group and the control group with respect to the plasma levels of MDA, protein C, fibrinogen, tPA, IL-6, NO and urinary levels of PGI2. But plasma levels of protein S, vWf, VEGF and IL-12 were found to be statistically significantly higher in the study group than in the control group. Conclusions Although the systemically measured levels of protein S, vWf, VEGF and IL-12 were found to be higher in patients of primary varicose veins, levels of protein C, fibrinogen, homocysteine and PGI2 were not found to be statistically significant. No systemic increased oxidative stress seems to be related to the early stages of chronic venous insufficiency. Further studies are warranted for understanding the role of molecules such as NO, oxidative stress parameters and cytokines.

Zinc Aspartate Alleviates Lung Injury Induced by Intestinal Ischemia-Reperfusion in Rats

BACKGROUND Intestinal ischemia-reperfusion (II/R) induced acute lung injury is mediated by activated neutrophils and formation of free radicals. Several antioxidants have been shown to attenuate such remote organ injury. We studied the effects of zinc aspartate on lung injury induced by II/R in rats. MATERIALS AND METHODS Twenty-four Sprague-Dawley rats were randomized into three groups. Group I was the control. Animals in Groups II and III (II/R + zinc aspartate [ZA]) underwent 60 min of ischemia and 60 min of reperfusion, respectively. Rats in Group III also received 50 mg/kg zinc aspartate before 15 min of reperfusion. Lung tissue samples and bronchoalveolar lavage fluid were obtained to assess lung tissue myeloperoxidase (MPO), adenosine deaminase (ADA), xanthine oxidase (XO), glutathione peroxidase (GPx) activities, and nitric oxide (NO), malondialdehyde (MDA) levels. Also, the levels of MDA, NO, and MPO activity were determined in bronchoalveolar lavage fluid. RESULTS Compared with the control, lung tissue MDA, NO levels, and MPO, ADA, XO activities were markedly increased (P < 0.05), whereas GPx activity significantly decreased in the II/R group (P < 0.05). However, administration of ZA significantly reversed these effects by reducing the levels of MDA, NO, and decreasing MPO, ADA, XO activities (P < 0.05). In addition, ZA significantly increased GPx activity (P < 0.05). The activity of MPO and the levels of NO and MDA were found to be higher in bronchoalveolar lavage fluid in II/R group than the control (P < 0.05). Zinc aspartate significantly diminished MPO activity and the levels of NO and MDA compared with that of control rats (P < 0.05). CONCLUSION Our results indicate that zinc aspartate alleviates lung injury induced by II/R attributable to its antioxidant and antiinflammatory effects.

A new non-tumescent endovenous ablation method for varicose vein treatment: Early results of N-butyl cyanoacrylate (VariClose®)

Objective This report aims to present the early results of a retrospective study of the use of N-butyl cyanoacrylate (VariClose®)-based non-tumescent endovenous ablation for the treatment of patients with varicose veins. Method One hundred and eighty patients with varicose veins due to incompetent saphenous veins were treated with the VariClose® endovenous ablation method between May 2014 and November 2014. The patient sample consisted of 86 men and 94 women, with a mean age of 47.7 ± 11.7 years. The patients had a great saphenous vein diameter greater than 5.5 mm and a small saphenous vein diameter greater than 4 mm in conjunction with reflux for more than 0.5 s. Patients with varicose veins were evaluated with venous duplex examination, Clinical, Etiological, Anatomical and Pathophysiological classification (CEAP), and their Venous Clinical Severity Scores were recorded. Results The median CEAP score of patients was three, and the saphenous vein diameters were between 5.5 and 14 mm (mean of 7.7 ± 2.1 mm). A percutaneous entry was made under local anesthesia to the great saphenous vein in 169 patients and to the small saphenous vein in 11 patients. Duplex examination immediately after the procedure showed closure of the treated vein in 100% of the treated segment. No complications were observed. The mean follow-up time was 5.5 months (ranging from three to seven months). Recanalization was not observed in any of the patients during follow-up. The average Venous Clinical Severity Scores was 10.2 before the procedure and decreased to 3.9 after three months (p < 0.001). Conclusion The application of N-butyl cyanoacrylate (VariClose®) is an effective method for treating varicose veins; it yielded a high endovenous closure rate, with no need for tumescent anesthesia. However, long-term results are currently unknown.

Mid-term results in the treatment of varicose veins with N-butyl cyanoacrylate

Aim To present mid-term results of patients with varicose veins treated with N-butyl cyanoacrylate (VariClose®), a nontumescent endovenous ablation technique. Patients and method Endovenous ablation was performed on 180 patients with saphenous vein incompetence between May and October 2014. One hundred sixty-eight subjects capable of being followed-up for 30 months were included. Patients’ pre- and postoperative data were recorded. Results Procedures were performed on the great saphenous vein in 159 patients and on the small saphenous vein in nine patients. Saphenous vein diameters ranged between 5.5 mm and 14 mm. Full ablation was achieved in all patients following the procedure. No complications were encountered. Patients were monitored for 30 months. Ablation rates were 100% at the 3rd month, 98.3% at the 6th month, 96.6% at 1 year, and 94.1% at 30 months. Mean venous clinical severity score was 10.2 before procedures, decreasing to 3.9 at 3 months, 4.2 at 6 months, 2.9 at 12 months, and 2.7 at 30 months (p = 0.000). Conclusion Due to its high success rate, absence of complications, no tumescent anesthesia requirement and high patient satisfaction, endovenous ablation with N-butyl cyanoacrylate is a good method. However, long-term follow-up results are now needed.

Effect of Atorvastatin and Ezetimibe Treatment on Serum Lipid Profile and Oxidative State in Rats Fed With a High-Cholesterol Diet

Introduction:The effects of ezetimibe and atorvastatin on serum lipid profile and oxidant-antioxidant system were investigated in rats. Methods:Seventy-two Sprague-Dawley rats were assigned to 6 groups. Group 1 was fed with standard rat chow. Group 2 and the other 4 groups were fed with a high-cholesterol diet: 10 mg/kg/d atorvastatin to group 3; 1 mg/kg/d atorvastatin to group 4; 10 mg/kg/d atorvastatin and 1 mg/kg/d ezetimibe to group 5; and 1 mg/kg/d ezetimibe to group 6. After 3 months, serum total, low-density lipoprotein, high-density lipoprotein cholesterol, and triglyceride levels, and the activities of malondialdehyde, glutathione peroxidase, and superoxide dismutase were measured in the plasma. In addition, the left anterior descending and femoral arteries were examined histopathologically. Results:Serum total, low-density lipoprotein cholesterol, and triglyceride levels decreased slightly in group 3. However, administration of 1 mg/kg/d atorvastatin or 1 mg/kg/d ezetimibe did not significantly change lipid parameters. Plasma malondialdehyde levels slightly increased in group 2 compared with controls and decreased compared with both the atorvastatin regimens. However, malondialdehyde levels increased with the addition of ezetimibe to atorvastatin. Only the administration of ezetimibe significantly elevated the levels of malondialdehyde. Glutathione peroxidase and superoxide dismutase levels were also found to be significantly reduced in the groups receiving ezetimibe when compared with atorvastatin groups. Conclusions:Atorvastatin has a beneficial effect on oxidative stress in rats fed with high-cholesterol diet. A combination of ezetimibe with atorvastatin diminishes the beneficial effects of atorvastatin. Conversely, the sole administration of ezetimibe increases oxidative stress.

Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varicose Veins in the Same Patient

Purpose: To compare endovenous laser ablation (EVLA) and radiofrequency venous ablation (RFA) in different legs in the same patients with venous insufficiency. Methods: Sixty patients with bilateral saphenous vein insufficiency were included. Endovenous laser ablation or RFA was applied to one of the patient’s legs and the remaining procedure, RFA or EVLA, to the other leg. Results: Minor complications in EVLA and RFA were hyperemia at 20.7% and 31.0%, ecchymosis at 31.0% and 51.7% and edema at 27.6% and 65.5%, respectively. The rate of recanalization was 6.8% in the RFA group. No recanalization was observed in the EVLA group. The level of patients satisfied with EVLA was 51.7%, compared to 31.0% for RFA, while 17.2% of patients were satisfied with both the procedures. Times to return to daily activity were 0.9 days in the EVLA group and 1.3 days in the RFA group. Conclusion: The EVLA procedure may be superior to RFA in certain respects.

Which prosthesis is more resistant to vascular graft infection: polytetrafluoroethylene or Omniflow II biosynthetic grafts?

PurposeThe aim of this study was to determine whether polytetrafluoroethylene grafts or Omniflow II biosynthetic grafts are more resistant to infection caused by Staphylococcus aureus.MethodsSixty rats were divided into six groups. In Groups 1A, 1B and 1C, a polytetrafluoroethylene graft was implanted in each rat, and, in Groups 2A, 2B and 2C, a biosynthetic graft was implanted in each rat. Staphylococcus aureus was inoculated into Groups 1B, 1C, 2B and 2C, and the rats in Groups 1C and 2C were treated with teicoplanin. One week later, the rats were euthanized, the grafts were removed and a microbiological count was performed. A histopathological examination was subsequently carried out, and the C-reactive protein, prealbumin and leukocyte levels were investigated.ResultsThere were no significant differences in the C-reactive protein, prealbumin and leukocyte levels. The differences in the results of the microbiological evaluations between the groups were significant. The quantitative culture results showed no bacterial growth in Groups 1A, 1C and 2A. The number of bacteria in Group 1B was statistically lower than that in Group 2B. When the groups receiving treatment were compared, Group 2C had bacterial growth, whereas Group 1C did not. The histopathological examinations showed similar results.ConclusionsOmniflow II grafts are more susceptible to infection than polytetrafluoroethylene grafts.

Efficacy of Linezolid, Teicoplanin, and Vancomycin in Prevention of an Experimental Polytetrafluoroethylene Graft Infection Model caused by Methicillin-Resistant Staphylococcus aureus

Background The aim of this study was to evaluate the effectiveness of linezolid, teicoplanin, and vancomycin in prevention of prosthetic vascular graft infections in a vascular graft infection model. Material/Methods Fifty rats were divided into 5 groups. A polytetrafluoroethylene graft was implanted on the back of each rat. Methicillin-resistant Staphylococcus aureus (MRSA) strain was inoculated into all rats except Group 1. Group 2 was not given any treatment, Group 3 received linezolid, Group 4 received vancomycin, and Group 5 received teicoplanin. The grafts were removed for microbiological and histological examinations on the 7th day. In addition, C-reactive protein and prealbumin levels and leukocyte counts in obtained blood specimens were determined. Results Group 1 did not have infection. Group 2 had bacteria 5.7×104 CFU/cm2. Group 3 and Group 4 had less bacterial growth. Group 5 had no bacterial growth. The number of bacteria was significantly higher in Group 2 than in the other experimental groups and the control group (p<0.001). Although there was no bacterial growth in Group 5, it did not significantly differ from Group 3 and Group 4. Group 2 had a significantly higher CRP level and leukocyte count and a significantly lower prealbumin level than the other groups. Conclusions Linezolid, teicoplanin, and vancomycin are effective in prevention of prosthetic vascular graft infections.

Clinical and Subclinical Varicocele Incidence in Patients With Primary Varicose Veins Requiring Surgery

BACKGROUND The purpose of this study was to analyze the incidence of clinical and subclinical varicocele in patients with primary varicose veins requiring surgery. METHODS A total of 100 patients with primary varicose veins requiring surgery were evaluated. Clinical varicocele was found in each patient through physical examination. Each patient was also evaluated with ultrasound because of evidence of subclinical varicocele. RESULTS Among the patients with varicose veins, 28 had no clinical sign of varicocele, whereas the remaining 72 had varicocele with different clinical levels (72%). Doppler ultrasound revealed that 32 patients had no reflux flow, whereas the other 68 had different grades of reflux flow (68%). CONCLUSIONS Clinical or subclinical varicocele may be highly present in patients with severe venous disease. However, these types of varicoceles do not cause infertility in most patients. Nevertheless, infertility may occur in subsequent years, especially in young patients who have venous disease and undergo surgery, and they should be aware of this condition.

Open heart surgery in a patient with diabetes insipidus

Diabetes insipidus is an unusual case in patients who underwent open heart surgery. In this article, we aimed to present our experience of performing an atrial septal defect operation in a patient with diabetes insipidus who drank 30 l of water and urinated almost the same per day.