Celal Yavuz

Platelet Count and Mean Platelet Volume in Patients With In-Hospital Deep Venous Thrombosis

Aim: To investigate the relationship between mean platelet volume (MPV) and in-hospital deep venous thrombosis (DVT). Material and methods: 147 patients with the diagnosis of DVT and 149 control participants were included in the study. For all participants, clinical risk factors, smoking status, and other demographic data were recorded from hospital registries. The data of patients with DVT were compared with the control participants. Results: Mean MPV was significantly higher in patients with DVT than the control group (8.91 ± 1.86 vs 7.86 ± 0.9; P < .001). Body mass index, smoking frequency, hematocrit, and platelet count were significantly correlated with MPV. Independent predictors of in-hospital DVT were MPV (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2-1.87; P ≤ .001), body mass index (OR = 1.17; 95% CI = 1.04-1.34; P = .012), and smoking (OR = 1.83; 95% CI = 1.09-3.08; P = .023). Conclusion: Mean platelet volume was significantly higher in patients with DVT, and it is an independent predictor of in-hospital DVT.

Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience.

Background: Ventricular shunts are used to drain cerebrospinal fluid into extra-cranial spaces. Ventriculoatrial (VA) shunts are provided to transfer cerebrospinal fluid from the cerebral ventricle into the right atrium of the heart. A single center experience of indications, procedure, and clinical outcomes in VA shunt was presented in current study. Methods: VA shunts were applied in 10 patients who had repeated previous shunt dysfunction or infection. The reasons, clinical findings, replacement methods, and postoperative clinical follow-ups and outcomes were recorded retrospectively. Results: There were seven female (70%) and three (30%) male patients; their ages ranged from 5 to 13 years (mean ± SD; 8.5 ± 2.6 years). Shunt re-placement reasons were as follows: Shunt occlusion in five patients, intraperitoneal infection in four patients and a distal catheter was kinked and knotted in one patient. Postoperative early complications were seen in one patient as early catheter thrombosis and catheter revision were applied. Late complications were seen in two patients as follows: Catheter infection and infective endocarditis occurred in one patient and pulmonary thrombus occurred in one other patient. There was not any catheter-related mortality observed at the one year follow-up period. Conclusion: VA shunts may be an option for cerebrospinal fluid drainage at necessary conditions. However, sterilization and general training on asepsy and antisepsy are the most important determinants affecting the clinical outcome due to the cardio systemic relationship.

The relationship between complete blood count parameters and Fontaine’s Stages in patients with peripheral arterial disease

Objective The aim of the present study is to evaluate whether blood count parameters differ according to the stages of Fontaine’s classification and to investigate the relationship between hemogram parameters and the severity of the disease. Method Eighty-two peripheral arterial disease patients were examined prospectively. Patients were classified according to the Fontaine classification system. Fifty newly diagnosed patients were included in the study. The neutrophil-to-lymphocyte ratio, mean platelet volume, and red blood cell distribution width values were recorded. Results Mean neutrophil-to-lymphocyte ratio values were found to be 3.31 ± 1.1% in Stage I, 3.11 ± 1.3% in Stage II, and 3.48 ± 1.1% in Stage III (p > 0.05). Mean platelet volume values were found to be 7.8 ± 0.6 fl (Stage I), 8.2 ± 1.0 fl (Stage II), and 9.0 ± 0.9 fl (Stage III) (p < 0.05). Red blood cell distribution width values were found to be 13.6 ± 1.0% in Stage I, 14.8 ± 1.7% in Stage II, and 15.4 ± 2.3% in Stage III, being significantly different among all three stages (p < 0.05). Conclusion Both red blood cell distribution width and mean platelet volume are found to be associated with the severity of atherosclerotic disease in patients with peripheral arterial disease. This finding hypothesizes that complete blood counting parameters may serve as a beneficial and cost-effective method for monitoring atherosclerotic peripheral disease.

Evaluation of pulmonary vein variations and anomalies with 64 slice multi detector computed tomography.

ZusammenfassungDie Lungenvenen sind eine der bedeutendsten Strukturen des Kreislaufs. Im letzten Jahrzehnt wurde erkannt, dass die Lungenvenen eine bedeutende Rolle beim Vorhofflimmern als auslösender Fokus der elektrischen Aktivität spielen. Die primäre Behandlungsmethode des Vorhofflimmerns ist die Ablation des Fokus in den Lungenvenen. Für den besten Erfolg dieser Maßnahme sollte die Anatomie der Lungenvenen vorher gut bekannt sein. MATERIAL UND METHODEN: In unserer Abteilung für Radiologie wurde zwischen Jänner 2008 und Mai 2010 bei 783 Patienten eine computertomographische Angiographie durchgeführt. Die Patienten waren zur Coronar-CT wegen einer bekannten oder suspizierten koronaren Herzerkrankung, bzw. zur CT Angio wegen des Verdachtes auf Pulmonalembolie zugewiesen worden. Alle Untersuchungen wurden auf einem Phillips Brilliance 64 Zeiler Multidetektor CT Gerät durchgeführt. 402 der Patienten waren männlich, 381 weiblich. Das mittlere Alter der Patienten lag bei 48 (14–89) Jahren. Die CT Ergebnisse zur Identifikation der Anatomie der Lungenvenen (inklusive ihrer Varianten und Anomalien) wurden retrospektiv erhoben. ERGEBNISSE: Bei dem Großteil der Fälle mündeten zwei Lungenvenen in den linken Vorhof auf jeder Seite. 18 Variationen wurden rechts und 8 Variationen links entdeckt. Die häufigste kombinierte Variante waren 2 rechts und 4 links (32,3 %) einmündende Lungenvenen. Vier links einmündende Lungenvenen war der häufigste Einfach-Variations Typ (76 %). Zusätzlich wurden ein Situs inversus totalis (0,12 %), 2 partiell anormale pulmonal venöse Rückströme (0,25 %) und ein Szimitar Syndrom (0,12 %) gefunden. SCHLUSSFOLGERUNGEN: Diese Studie zeigt, dass viele Variationen der Lungenvenen mit zunehmender Patientenzahl beobachtet werden. Um eine erfolgreiche und komplikationslose Ablation bzw. Operation zu gewährleisten, sollte die Anatomie der Lungenvenen vor der Prozedur bekannt sein. Die Multidetektor CT ist eine verlässliche bildgebende Methode für die Erfassung der Querschnitts und 3-dimensionalen Anatomie.SummaryPulmonary Veins are one of the major structures of circulation. In the last decade, pulmonary veins have been known to play an important role as the triggering focus of the electrical activity in atrial fibrillation. Primary treatment method of AF is RF ablation of the focus. For the best ablation, the anatomy of PVs should be well established before the procedure. MATERIAL AND METHODS: In our radiology department, 783 patients underwent computed tomography angiography between January 2008 and May 2010. Patients were referred for coronary CTA because of known or suspected coronary artery disease or computed tomography pulmonary angiography (CTPA) because of known or suspect pulmonary embolism. All scanning was performed on Philips Brilliance 64 slice Multidetector CT. The group consisted of 402 male and 381 female patients with the average age of 48 (range 14–89). CT data of patients were retrospectively reviewed to identify the PV anatomy and to determine anatomic variants and anomalies. RESULTS: In the majority of cases, two pulmonary veins drain into the left atrium on each side. Eighteen and eight variations were found in the right and left sides, respectively. Most frequent combined variations were 2R-4L (32.3%) and 4L was the more frequent single variation type (76%). In addition to that one Situs inversus totalis (0.12%), two partial anomalous pulmonary venous returns (0.25%) and one scimitar syndrome (0.12%) were found. CONCLUSION: This study showed that multiple types of variations of PVs can be found with increasing patient number. Therefore, for the successful ablation and surgery without any complications, the anatomy of PVs should be known before the procedure. MDCT is a reliable imaging method for the detailed cross-sectional and 3D anatomy.

Rosuvastatin may have Neuroprotective Effect on Spinal Cord Ischemia Reperfusion Injury

Ischemia reperfusion injuries can be threatening to end organ viability and can progress, with mortal and morbid outcomes. In particular, neural tissues are highly sensitive to hypoxia and reperfusion stress. This study aimed to determine the neuroprotective effects of rosuvastatin on spinal cord ischemia reperfusion injury. Forty male Sprague- Dawley rats were divided into four equal groups: group I (control), group II (sham with simple laparotomy), group III (ischemia-reperfusion), group IV (ischemia-reperfusion group with continuous rosuvastatin utilization), and group V (ischemia-reperfusion group with rosuvastatin-withdrawal after reperfusion). Spinal cord ischemia was induced by clamping the aorta below the left renal artery and above the aortic bifurcation. Reperfusion was provided after 72(nd) hours of ischemia. After reperfusion, blood samples and spinal cord tissue samples were taken from all the rats. Oxidative and antioxidant markers from both serum and tissue samples were evaluated, and tissues were examined histopathologically. There were no significant differences between the control and sham groups. A notable increase in oxidative markers was observed in group III compared to group I. In addition, a significant decrease in antioxidant markers was detected in group III. However, there was a marked preservation in the tissue and blood samples of groups IV and V compared to group III in terms of oxidative damage. Additionally, definitive prophylaxes were seen in the histopathological examination of the tissue samples in groups IV and V compared with group III. These significant findings show that rosuvastatin has a considerable protective effect on neural tissue against oxidative damage. Likewise, the early withdrawal of rosuvastatin has a clear neuroprotective effect similar to that of continuous therapy. Nevertheless, other systematic effects and beneficial neural effects of statins should be investigated in further clinical trials.

Iloprost reduces myocardial edema in a rat model of myocardial ischemia reperfusion

Objective: Myocardial ischemia severely reduces myocyte longevity and function. Extensive interstitial edema and cell damage occur as a result of myocardial reperfusion injury. Current therapies are directed at prevention of ischemia-induced damage to cardiac tissue. Iloprost is a novel pharmaceutical agent for the treatment of ischemia. Methods: Twenty rats were segregated into four experimental groups. The procedure control group consisted of four rats undergoing a sham operation. The remaining 16 rats were divided into two equal groups. The first group (control group) received a continuous intravenous infusion of physiological serum immediately prior to the procedure. Iloprost was administered by a continuous intravenous infusion into the right jugular vein at an infusion rate of 100 ng/kg/min for 30 minutes prior to reperfusion in the experimental group (study group). Following the infusion treatments, ligation of the left coronary artery was conducted for 30 minutes to induce myocardial ischemia. The rats were euthanized 24 hours after reperfusion and cardiac tissue was harvested from all specimens for analysis. Results: Histological examination revealed three myocardial tissue specimens with grade II damage and five myocardial tissue specimens with grade III reperfusion injury in the control group. However, the study group consisted of two grade III myocardial tissue specimens, five grade II myocardial tissue specimens and one grade I myocardial tissue specimen. Moreover, a statistically significant reduction in myocardial edema was observed in the study group (p=0.022). Conclusion: Our results support the hypothesis that iloprost enhances protection against cardiac ischemia reperfusion injury. This protective effect may be associated with vasodilation, antioxidant or anti-edema mechanisms.

Simple blood tests as predictive markers of disease severity and clinical condition in patients with venous insufficiency.

Chronic venous insufficiency (CVI) is a progressive inflammatory disease. Because of its inflammatory nature, several circulating markers were investigated for predicting disease progression. We aimed to investigate simple inflammatory blood markers as predictors of clinical class and disease severity in patients with CVI. Eighty patients with CVI were divided into three groups according to clinical class (grade 1, 2 and 3) and score of disease severity (mild, moderate and severe). The basic inflammatory blood markers [neutrophil, lymphocyte, mean platelet volume (MPV), white blood cell (WBC), platelet, albumin, D-dimer, fibrinogen, fibrinogen to albumin ratio, and neutrophil to lymphocyte ratio] were investigated in each group. Serum neutrophil, lymphocyte, MPV, platelet count, D-dimer and neutrophil to lymphocyte ratio levels were similar among the groups (P > 0.05). Although the serum WBC levels were significant in the clinical severity groups (P < 0.05), it was useless to separate each severity class. However, albumin, fibrinogen and the fibrinogen to albumin ratio were significant predictors of clinical class and disease severity. Especially, the fibrinogen to albumin ratio was detected as an independent indicator for a clinical class and disease severity with high sensitivity and specificity (75% sensitivity and 87.5% specificity for clinical class and 90% sensitivity and 88.3% specificity for disease severity). Serum fibrinogen and albumin levels can be useful parameters to determine clinical class and disease severity in patients with CVI. Moreover, the fibrinogen to albumin ratio is a more sensitive and specific predictor of the progression of CVI.

Using oxidant and antioxidant levels to predict the duration of both acute peripheral and mesenteric ischemia

Objective: The aim of this study was to determine the relationship between oxidative stress markers and the duration of ischemia in rat mesenteric and peripheral ischemia models. Methods: Forty rats were divided into five equal groups, as follows: rats in Group I (control group) were sacrificed to determine the baseline characteristics of the serum markers; the superior mesenteric artery was clamped via a simple laparotomy to induce mesenteric ischemia in Groups II and III; the right common femoral artery was clamped to induce peripheral ischemia in Groups IV and V. Blood samples were taken at 2 (Groups II and IV) and 6 (Groups III and V) hours after these procedures. The serum total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and paraoxonase-1 (PON-1) enzyme activities were evaluated in the samples obtained from each group. Results: The OSI level of the control group was 91.00±5.46 (mean ± SD). The OSI levels taken 2 hours after the induction of mesenteric ischemia and peripheral ischemia were significantly higher (194.50±11.16 and 301.75±19.98, respectively (p<0.05)). However, these levels decreased to 151.88±17.02 (mesenteric ischemia) and 108.88±9.46 (peripheral ischemia) after 6 hours. The PON-1 levels of Group III (mesenteric ischemia at 6 hours) (99.75±7.26), Group IV (peripheral ischemia at 2 hours) (96.88±4.09), and Group V (peripheral ischemia at 6 hours) (111.25±10.33) were slightly elevated over that of the control group (87.38±5.31). However, the PON-1 level of Group II (mesenteric ischemia at 2 hours) (42.88±3.14) was lower than that of the other groups (p<0.05). Conclusion: Despite the increment of oxidative markers in early periods of ischemia (2nd hour), which was a hypoxic response of ischemic cells, they have decreased markedly in prolonged ischemia. This might have been caused by the opening of some collateral circulation or the destruction of the ischemic cells.

Serum ischaemia–modified albumin level is an irrelevant predictive factor for ischaemic duration in mesenteric ischaemia

Background: Acute mesenteric ischaemia is an emergency condition that requires urgent and expeditious diagnosis and immediate surgical or medical intervention. The initial hours are critical for the recovery of the affected bowel segment. Thus, its clinic diagnostic biomarkers are important when it comes to reducing mortality and morbidity rates. Methods: Twenty-four male Sprague–Dawley rats were included in the study. The rats were divided into three equal groups. Those in Group I were sacrificed to determine the basal serum values of ischaemia-modified albumin (IMA) after a simple laparotomy. The superior mesenteric artery (SMA) was clamped in a simple laparotomy in Groups II and III; blood samples were taken at 120 minutes in Group II and 360 minutes in Group III. The serum IMA levels were identified from the blood samples and the results obtained were compared statistically. Results: The serum IMA levels were determined to be 22±6 (22) μ/L, 34±7 (34) μ/L and 36±4 (37) μ/L in Groups I, II and III, respectively. The differences between the groups were not statistically significant. Conclusion: Our results showed that the serum IMA level is not an appropriate biomarker for acute mesenteric ischaemia. Additionally, the IMA level is not an appropriate biomarker for the detection of ischaemia duration. However, future studies should be conducted to clarify the efficacy of serum IMA levels under different ischaemic conditions.

CAFFEIC ACID PHENETHYL ESTER PROTECTS KIDNEYS AGAINST ACETYLSALICYLIC ACID TOXICITY IN RATS

Aim: The aim of this study was to investigate the protective effect of caffeic acid phenethyl ester (CAPE) on acetylsalicylic acid (ASA)-induced renal damage in rats. Materials and methods: A total of 40 rats were randomly divided into five groups, with eight rats in each group—group 1: control, not receiving any medication; group 2: ASA (50 mg/kg/day); group 3: ASA (50 mg/kg/day) + CAPE (20 μg/kg/day); group 4: ASA (100 mg/kg/day); and group 5: ASA (100 mg/kg/day) + CAPE (20 μg/kg/day). ASA and CAPE were given via orogastric gavage for 5 days. The total oxidant status (TOS), total antioxidant capacity (TAC), and paraoxonase-1 (PON-1) activity of the blood samples and kidney tissues were determined. Histopathological examinations of the kidneys were performed using light microscopic methods. Results: The TOS level in the serum of rats and kidney tissues given ASA (groups 2 and 4) significantly increased, but the levels of TAC and PON-1 in these tissues significantly decreased in group 4 when compared with the control rats (p < 0.05). The levels of TAC and PON-1 in the kidney tissues increased and the levels of TOS decreased in the CAPE treatment groups (groups 3 and 5) when compared with the rats in the no CAPE treatment groups (groups 2 and 4). The PON-1, TAC, and TOS values reverted to normal levels in group 5 when compared to group 4 (p < 0.05). These results were supported by histopathological observation. Conclusion: Oxidative stress plays an important role in ASA-induced nephrotoxicity, and CAPE may protect against ASA-induced nephrotoxicity in rats.