Aytekin Guven

Plasma homocysteine and lipoprotein (a) levels in Turkish patients with metabolic syndrome

High serum total homocysteine (tHcy) and lipoprotein (a) [Lp(a)] levels are independent risk factors for cardiovascular disease. In this study, we examined the relationship of tHcy and Lp(a) levels with the components of metabolic syndrome. Fifty-one patients diagnosed with metabolic syndrome (median age: 38 [range 25–48] years) and 50 healthy subjects (median age: 35 [26–48] years) were included in the study. We used the National Cholesterol Education Program criteria to define metabolic syndrome. Total tHcy concentrations were measured by using an IMX (Abbott Diagnostics, Abbott Park, IL, USA). Lipoprotein (a) was measured by immunonephelometry using Behring nephrometer method (Behring BN 100, Behring, Germany). Total homocysteine and Lp(a) levels were found to be higher in the metabolic syndrome group than in the control group (tHcy: 24.2 vs 13.4 µmol/l, P < 0.01 and Lp(a): 34.9 vs 15.8 mg/dl, P < 0.01). Vitamin B12 levels were lower in the metabolic syndrome group than in the control group (214 pg/ml vs 247 pg/ml, P < 0.01). In partial correlation, tHcy and Lp(a) concentrations were unrelated to metabolic syndrome or to the components of metabolic syndrome, including fasting serum triglycerides, HDL-cholesterol, fasting glucose, blood pressure, or body mass index. tHcy levels were strongly related only to the vitamin B12 concentration. The risk of cardiovascular disease is higher in patients with metabolic syndrome compared with the normal population. High tHcy and Lp(a) levels should be evaluated in this group of patients in addition to the evaluation of the parameters of metabolic syndrome.

Leptin levels in obese women with and without type 2 diabetes mellitus

INTRODUCTION The role of leptin has been more clear in the endocrinology area after the discovery of its secretion from the adipose tissue. The aim of the study is to investigate the leptin levels in obese women in whom type 2 diabetes mellitus were present or absent. MATERIALS AND METHODS Thirty-five obese women with type 2 diabetes mellitus (group 1) and 34 obese women without type 2 diabetes mellitus (group 2) were enrolled in the study. In both groups the body mass index (BMI), waist circumference, and waist-to-hip ratio were measured. Leptin, HbA1c, creatinine and the lipid profile were assessed. RESULTS Leptin was found to be statistically significantly lower in group 1 than in group 2 (40.22 +/- 17.77 ng/ml versus 50.12 +/- 15.51 ng/ml, respectively; p = 0.019). It was well correlated with BMI in group 1 (r = 0.60, p = 0.0001). In group 1 also, correlation of leptin was moderate with creatinine and high-density lipoprotein-cholesterol (r = 0.36, p = 0.037 versus r = 0.37, p = 0.027, respectively), whereas triglyceride had a negative correlation (r = -0.34, p = 0.046). In group 2, the only significant correlation with leptin was BMI (r = 0.41, p = 0.02). Leptin was also significantly lower in 17 subjects with poorly controlled diabetes mellitus than in 18 well-controlled diabetics (33.54 +/- 15.82 ng/ml versus 44.61 +/- 17.54 ng/ml, respectively; p = 0.038). CONCLUSION Since leptin is lower in obese women with diabetes than without diabetes and additionally it is even lower in the poorly controlled diabetes subgroup, we think that further studies a rerequired to make clear the issue for lower leptin levels, whether it is a reason or an outcome.

Effects of the sibutramine therapy on pulmonary artery pressure in obese patients

Aim:  Obesity is a major global public health problem. Previous drugs (dexfenfluramine and fenfluramine) used for the treatment of obesity have been withdrawn due to various cardiac side effects. Sibutramine is an anti‐obesity agent. The purpose of this study was to assess cardiac valve disease and pulmonary artery pressure (PAP) of the patients who used once daily doses of sibutramine.

High-sensitivity C-reactive protein in patients with metabolic syndrome

,!High-sensitivity C-reactive protein (CRP) has been shown to predict cardiovascular disease. Metabolic syndrome has been found to play a critical role in the development of cardiovascular disease. The purpose of this report is to assess the relationship between CRP and the metabolic syndrome. A total of 50 patients with metabolic syndrome and 40 healthy persons were included in the study. Plasma concentrations of CRP were measured by means of particle-enhanced immunonephelometry with the Behring nephelometer using N Latex CRP mono reagent. CRP levels were higher in patients with metabolic syndrome than control group (10.6 ±5.4 mg/L vs 3.5 ±0.8 mg/L, p<0.001). In partial correlation, plasma CRP positively correlated with body mass index (p<0.001), waist circumference (p<0.001), waist-to-hip ratio (p<0.01), total cholesterol (p<0.001), LDL-cholesterol (p=0.033), triglyceride (p=0.023), and fasting blood glucose (p=0.043) in patients with metabolic syndrome. HDL-cholesterol did not significantly correlate with CRP (p>0.05). In multiple regression analysis, body mass index (p<0.01), waist circumference (p<0.01), and fasting blood glucose (p<0.01) showed independent correlations with plasma CRP. CRP levels were found higher in patients with metabolic syndrome. These results suggest that abdominal obesity is the critical correlates of elevated plasma CRP levels found in patients with metabolic syndrome. These patients carrying high risk for cardiovascular events must be followed closely.

Management of 28 consecutive iatrogenic femoral pseudoaneurysms with ultrasound-guided compression.

We attempted to evaluate nonsurgical methods of treating postcatheterization iatrogenic femoral pseudoaneurysms at our hospital and compared the results with those in the literature. The hospital records of 25 273 patients who underwent femoral catheterization at our institution from September 1997 to December 2002 were collected retrospectively. All complications were detected and femoral pseudoaneurysm cases were selected. Diagnostic criteria and treatment strategy were documented. All results were compared with those in the literature. Twenty-eight patients were diagnosed as having a pseudoaneurysm (0.11%). In 11 patients the pseudoaneurysms closed by themselves within 3–7 days. Ultrasound-guided compression therapy was applied to the remaining 17 and was effective in 10 of them. The last 7 patients were operated on with success. Ultrasound-guided compression is also an effective and noninvasive method of therapy for femoral pseudoaneurysms. Surgical therapy can be reserved for progressive and complicated lesions.

Comparison of the echocardiographic and pulmonary function test findings in orderly treated and untreated essential hypertensive patients

Objective: Although it has been well established that hypertension effects pulmonary functions negatively, the effect of regular antihypertensive therapy on pulmonary functions is not known. In this study, we aimed to compare the pulmonary function tests of the hypertensive patients taking regular antihypertensive therapy with those of the ones not taking any antihypertensive medicine, to document the differences in pulmonary functions of both hypertensive groups. Materials and Methods: Patients who had received antihypertensive treatment (Group I: 29 males, 24 females, mean age 42.3 ± 8.2 years), and untreated cases (Group II: 28 males, 22 females, mean age 43.4 ± 6.4 years) were included in the study. Patients with a history of coronary heart disease, respiratory diseases, smokers and those who were obese were excluded from the study. Results: Forced vital capacity (FVC) and forced expiratory volume at the first second (FEV 1 ) levels were found significantly lower in Group II (p < 0.05). In echocardiographic evaluation, the mitral E/A ratio of Group II was lower than that of Group I (p < 0.05). Isovolumetric relaxation time and deceleration time was higher in Group II than in Group I (p < 0.05). There was a significant association between pulmonary function tests and impaired left ventricular diastolic parameters; especially, mitral E/A ratio was significantly associated with decreased FVC and FEV 1 in Group II (respectively r = −0.695, p = 0.01 and r = −0.591, p = 0.03). Conclusion: FVC and FEV 1 levels in untreated hypertensive cases were lower than in those of treated hypertensive cases, and this may be caused by diastolic function rather than the systolic function. In the evaluation of dyspnea in hypertensive patients, it would be useful to examine respiratory function in addition to echocardiographic investigation.

Aneurysm involving bifurcation of left main coronary artery presenting with transient ischemic attack, paroxysmal atrial fibrillation and ventricular tachycardia

Coronary artery aneurysm, especially left main coronary artery (LMCA) aneurysm is a rare phenomenon. The disease may be congenital or acquired. The most common cause of coronary artery aneurysm is atherosclerosis. We presented a man with a large LMCA aneurysm presenting with unstable angina, transient ischemic attack, ventricular tachycardia and paroxysmal atrial fibrillation.

A Case of Aortic Aneurysm Hospitalized as Acute Coronary Syndrome

Saccular type of thoracic aortic aneurysm is a rarely seen phenomenon. Here, we present a case of saccular-type aortic aneurysm admitted to coronary care unit with a diagnosis of acute coronary syndrome. A 63-year-old woman presented to our clinic with chest pain lasting for 2-3 hours. Because her chest pain persisted despite intensive medical treatment, she underwent coronary angiography. Coronary arteries appeared normal but a saccular type aneurysm of ascending aorta was detected on aortography. The patient underwent urgent surgery. The aneurysmal segment was resected and tube graft inserted. The patient was discharged without any postoperative complication.