Ebru Tekbas

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.

Mean platelet volume in predicting short- and long-term morbidity and mortality in patients with or without ST-segment elevation myocardial infarction

Abstract Mean platelet volume (MPV) is a marker of platelet activation. An increased MPV is associated with acute myocardial infarction (AMI) and long-term mortality. The aim of this study was to compare MPV in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Also, we investigated the value of MPV on in-hospital mortality and long-term prognosis of patients with STEMI and NSTEMI. We studied 429 patients with AMI (70.4% male, 61.9 ± 12.4 years; 279 patients with STEMI, 150 patients with NSTEMI). MPV and platelet count were similar in both groups. Elevated MPV increased the risk of death by 3.1-fold (p < 0.001) in STEMI group during the hospitalization. However, increased MPV was not associated with in-hospital mortality in NSTEMI group. The area under the receiver operating characteristic curve of MPV was 0.868 (95% CI, 0.830–0.907) for predicting two-year mortality. A cut-off point of 11.1 fL showed a sensitivity of 81% and a specifity of 77% for prediction of two-year mortality. Kaplan-Meier survival curve showed two-year mortality rate of 12.5% in patients with MPV >11.1 fL versus 9.9% in patients with MPV <11.1 fL (p < 0.001). Cox regression analysis showed MPV to be an independent predictor of two-year mortality (Hazard ratio 1.7; 95% CI 1.5–1.9; p < 0.001). An increased MPV is an independent predictor of in-hospital mortality in patients with STEMI. However, elevated levels of MPV did not predict in hospital mortality in NSTEMI group. The increase in MPV values was independently correlated with two-year mortality in all study patients.

The Relationship Between Serum Levels of Zn and Cu and Severity of Coronary Atherosclerosis

The essential trace elements play important roles in the maintainance of the normal structure and physiology of cells. Several research groups have demonstrated that they also play important roles in states of cardiovascular diseases. Our aim is to investigate whether there is a relationship between trace elements (Zn and Cu) and the degree of atherosclerosis. The sample consisted of 67 patients with coronary artery disease and 26 clinically healthy individuals. Ninety-three subjects were separated into four groups according to their Gensini scores, the number of diseased vessels, the presence of acute coronary syndrome, and ejection fraction. Each group was divided into three subgroups, and serum zinc and copper levels were measured for each individual. The serum levels of zinc and copper were found to be significantly lower in patients with atherosclerosis than in the control group, but there were no significant differences in the serum levels of Cu and Zn between severe atherosclerosis and mild atherosclerosis. In Spearman’s rank correlation, the zinc and copper levels were correlated with the Gensini score and the number of diseased vessels. The present study revealed a relationship between the serum levels of zinc and copper and atherosclerosis, but not between these levels and the severity of the disease.

The Relationship of Metabolic Syndrome With Disease Activity and the Functional Status in Patients With Rheumatoid Arthritis

Background The aim of this study is to investigate the frequency of metabolic syndrome (MS) in patients with rheumatoid arthritis (RA) and to determine the relationship between the clinical and laboratory parameters of RA and the components of the metabolic syndrome (MS). Methods Fifty-four patients with RA and 52 healthy individuals were enrolled in this study. The diagnosis of rheumatoid arthritis was based on the American College of Rheumatology criteria and the diagnosis of the metabolic syndrome was made according to the criteria set out in the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). The functional status and disease activity were also recorded in patients with RA. Results MS was diagnosed in 42.6% of the patients with RA and in 9.6% of the healthy controls. The systolic and diastolic blood pressure values were observed to be significantly higher in the patients with RA in comparison to the controls. Also, the frequency of MS was higher in the inferior functional group in relation to the higher functional group. A positive correlation was observed between the DAS28 scores and hypertension in patients with RA. Conclusions In this study, MS was more frequently detected in the patients with RA compared to the control group. Also, an inferior functional status in RA was also found to be associated with the presence of MS. Thus, the presence of MS in patients with RA may be associated with a higher cardiovascular risk.

Novel markers of endothelial dysfunction and inflammation in Behçet's disease patients with ocular involvement: epicardial fat thickness, carotid intima media thickness, serum ADMA level, and neutrophil-to-lymphocyte ratio.

The etiology of Behçet’s disease (BD) has not been fully elucidated. However, immunological and environmental factors, endothelial dysfunction (ED), and genetic susceptibility have been proposed to play a role. In this study, we aimed to evaluate epicardial fat thickness (EFT) together with serum asymmetric dimethylarginine (ADMA), carotid intima media thickness (CIMT), and neutrophil-to-lymphocyte ratio (NLR) in BD patients with ocular involvement. Thirty-six ocular BD patients (17 active and 19 inactive ocular involvement), and 35 age and sex-matched healthy controls were enrolled to this cross-sectional study. All patients underwent examinations with transthoracic echocardiography and carotid Doppler ultrasound. Serum ADMA levels, CIMT, EFT, and NLR were compared between groups, and their association with disease activity was evaluated. Behçet’s disease patients had higher WBC counts, neutrophil counts, NLR, CIMT, EFT values, and serum ADMA levels than do healthy controls. The other biochemical, hematological, and echocardiographic parameters were comparable between the two groups. Behçet’s disease duration was positively correlated with EFT and CIMT. Multivariate logistic regression analysis revealed that increased serum ADMA concentration and CIMT are independently associated with BD. Neutrophil counts, NLR, and serum ADMA level were higher, and lymphocyte count was lower in patients with active ocular BD compared to those of inactive ocular BD group. Carotid intima media thickness, serum ADMA level, EFT, and NLR were increased in ocular BD patients compared to healthy subjects. In addition, both serum ADMA level and NLR were associated with disease activity of ocular involvement. Increase in disease duration was associated with increase in CIMT and EFT which suggests that anatomical changes occur in time during the disease course. Increased CIMT, serum ADMA level, EFT, and NLR may provide new clues about the role of ED and inflammation in the etiopathogenesis of BD.

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.

Myocardial infarction secondary to unintentional ingestion of hydrogen peroxide

Ingestion of acid-containing household products, either accidentally or as a suicide attempt, is a common form of intoxication. A clear and odorless liquid, hydrogen peroxide is an oxidizing agent found in most households and many industrial environments. Cardiovascular manifestations of hydrogen peroxide ingestion are extremely rare. Here we report a 60 year-old woman with acute inferolateral myocardial infarction (MI) after hydrogen peroxide ingestion, who had no history of coronary artery disease. Physicians dealing with hydrogen peroxide ingestion in the emergency department should be aware of the probability of MI and obtain an electrocardiogram, even if the patient has no cardiac complaint.

Unusual metastatic localization of osteosarcoma in a teenager with ventricular tachycardia

Most malignant tumors of the heart are metastatic. Metastatic cardiac tumors are usually associated with Wilms tumor, neuroblastoma, and non-Hodgkin lymphoma in children (Br J Radiol 71:336-339). Osteosarcoma rarely metastasizes to the heart. Twenty-four cases have been reported in the literature so far. The right side of the heart is more commonly involved than the left, and the pericardium and/or myocardium is more frequently involved than the endocardium (Br J Radiol 71:336-339). We report a rare case of osteogenic sarcoma of the right femur with left ventricular metastases presenting with ventricular tachycardia that has not been reported previously. Cardiac tumors are extremely rare, found at a frequency of only 0.001% to 0.28% at autopsy series. The incidence of secondary cardiac tumors is much higher than that of primary cardiac tumors [1]. Secondary intracardiac neoplasms arise most frequently from renal cell carcinoma, bronchogenic carcinoma, Wilms tumor, chondrosarcoma, and osteogenic sarcoma [2]. There are several reports of metastatic childhood osteosarcoma involving the cardiac chambers. However, endocardial left cardiac chamber Fig. 1 Electrocardiogram prese 0735-6757/

Twin Circumflex Arteries with Left Sinus of Valsalva Origin: A Case Report

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Paraoxonase and Arylesterase Activities in Dipper and Non-Dipper Prehypertensive Subjects

Coronary artery anomalies are not uncommon. The importance of coronary anomalies varies from unimportant to life threatening. Herein, we report for the first time twin circumflex coronary arteries originating separately from the left sinus of Valsalva.