Erkan Yildirim

Relationship of serum uric acid to measures of endothelial function and atherosclerosis in healthy adults

Although uric acid (UA) is considered as an antioxidant, the relationship between serum UA levels and cardiovascular diseases is not clear yet. Higher brachial artery resting diameter (BD), impaired brachial artery flow‐mediated dilatation (FMD), increased carotid intima‐media thickness (IMT), decreased aortic distensibility (AoD), and increased aortic stiffness index (AoSI) and elastic modulus (AoEM) are predictors for development and/or progression of atherosclerosis. In this study, BD, FMD, carotid IMT, AoD, AoSI and AoEM were studied in healthy subjects with UA concentrations in physiological range.

CT-guided cutting needle lung biopsy using modified coaxial technique: Factors effecting risk of complications

PURPOSE We present our 7-year experience with coaxial computed tomography (CT)-guided cutting needle lung biopsy and evaluate the factors affecting risk of complications. MATERIAL AND METHOD Between June 2000 and March 2007, we performed 225 CT-guided coaxial lung biopsies in 213 consecutive patients (161 men, 52 women). Lesion size, lesion depth, lesion location, needle-pleural angle, presence of pleural effusion, patients position, and complications secondary to biopsy procedure (pneumothorax and bleeding) were noted. Pneumothorax was graded as mild, moderate, and severe. Bleeding complications were graded as mild, moderate, and severe. RESULTS Two hundred twenty-five biopsy procedures were performed in 213 patients. The mean diameter of the lung lesion was 41.3+/-20.1mm. The mean distance from the peripheral margin of the lesion to the pleura was 17.3+/-19.2mm. After 225 procedures, there were 42 mild (18.6%), 13 moderate (5.7%), and 4 severe (1.7%) pneumothoraxes. Small hemoptysis occurred in 27 patients (12%), and mild parenchymal hemorrhage occurred in 2 patients (0.8%). The overall complication rate was 39.1%. Although, a statistically significant correlation was found between female sex, presence of emphysema, lesion depth, and pneumothorax, none of these factors had a predictive value for pneumothorax. Although, statistically significant correlations were found between female sex, lesion size, and bleeding, only lesion size had a predictive value for bleeding. CONCLUSION The most frequent and important complications of this procedure are pneumothorax and bleeding. But any factor is the predictor of pneumothorax and lesion depth is a poor predictor of bleeding complication.

A Truncating Mutation in SERPINB6 Is Associated with Autosomal-Recessive Nonsyndromic Sensorineural Hearing Loss

More than 270 million people worldwide have hearing loss that affects normal communication. Although astonishing progress has been made in the identification of more than 50 genes for deafness during the past decade, the majority of deafness genes are yet to be identified. In this study, we mapped a previously unknown autosomal-recessive nonsyndromic sensorineural hearing loss locus (DFNB91) to chromosome 6p25 in a consanguineous Turkish family. The degree of hearing loss was moderate to severe in affected individuals. We subsequently identified a nonsense mutation (p.E245X) in SERPINB6, which is located within the linkage interval for DFNB91 and encodes for an intracellular protease inhibitor. The p.E245X mutation cosegregated in the family as a completely penetrant autosomal-recessive trait and was absent in 300 Turkish controls. The mRNA expression of SERPINB6 was reduced and production of protein was absent in the peripheral leukocytes of homozygotes, suggesting that the hearing loss is due to loss of function of SERPINB6. We also demonstrated that SERPINB6 was expressed primarily in the inner ear hair cells. We propose that SERPINB6 plays an important role in the inner ear in the protection against leakage of lysosomal content during stress and that loss of this protection results in cell death and sensorineural hearing loss.

Long-Term Results of Angioplasty and Stent Placement for Treatment of Central Venous Obstruction in 126 Hemodialysis Patients: A 10-Year Single-Center Experience

OBJECTIVE The objective of our study was to report and compare long-term results of percutaneous transluminal angioplasty and stenting of central venous obstruction in hemodialysis patients. MATERIALS AND METHODS Hemodialysis patients who underwent successful endovascular treatment of central venous obstruction were retrospectively evaluated. Stenotic lesions greater than 50% or inducing extremity swelling were subject to treatment. The primary treatment was angioplasty, and stent placement was accomplished in angioplasty-resistant obstructions. Angioplasty was the primary treatment of recurrence after stent placement. Additional stenting was reserved for angioplasty-resistant recurrences. RESULTS One hundred forty-seven veins in 126 patients (63 males, 63 females) between 15 and 82 years old primarily underwent 101 angioplasties and 46 stent placements. The mean follow-up was 22.1 +/- 16.3 (SD) months. The average number of interventions per vein in the stent group (2.7 +/- 2.4 interventions) was significantly higher than that in the angioplasty group (1.5 +/- 1.0 interventions). Primary patency was significantly higher in the angioplasty group (mean, 24.5 +/- 1.7 months) than that in the stent group (mean, 13.4 +/- 2.0 months). Assisted primary patency of the angioplasty group (mean, 31.4 +/- 2.0 months) and that of the stent group (mean, 31.0 +/- 4.7 months) were equivalent. The overall mean primary patency was 21.1 +/- 1.4 months, and the overall mean assisted primary patency was 31.7 +/- 2.5 months. There were no significant differences in patency rates with regard to patient sex, the type of stent used, the vein or veins treated, or the type of lesions. CONCLUSION Endovascular treatment of central venous obstruction is a safe and effective procedure in hemodialysis patients. Stenting has a significantly lower primary patency rate than angioplasty but adds to the longevity of vein patency in angioplasty-resistant lesions; therefore, stent placement should be considered in angioplasty-resistant lesions.

Light cigarette smoking impairs coronary microvascular functions as severely as smoking regular cigarettes

Background: Smoking is the most prevalent and most preventable risk factor for cardiovascular diseases. Smoking low-tar, low-nicotine cigarettes (light cigarettes) would be expected to be less hazardous than smoking regular cigarettes owing to the lower nicotine and tar yield. Objective: To compare the chronic and acute effects of light cigarette and regular cigarette smoking on coronary flow velocity reserve (CFVR). Methods: 20 regular cigarette smokers (mean (SD) age 24.8 (5.0)), 20 light cigarette smokers (mean age 25.6 (6.4)), and 22 non-smoker healthy volunteers (mean age 25.1 (4.2)) were included. First, each subject underwent echocardiographic examination, including CFVR measurement, after a 12 hour fasting and smokeless period. Two days later, each subject smoked two of their normal cigarettes in a closed room within 15 minutes. Finally, within 20–30 minutes, each subject underwent an echocardiographic examination, including CFVR measurement. Results: Mean (SD) CFVR values were similar in light cigarette and regular cigarette smokers and significantly lower than in the controls (2.68 (0.50), 2.65 (0.61), 3.11 (0.53), p = 0.013). Before and after smoking a paired t test showed that smoking two light cigarettes acutely decreased the CFVR from 2.68 (0.50) to 2.05 (0.43) (p = 0.001), and smoking of two regular cigarettes acutely decreased CFVR from 2.65 (0.61) to 2.18 (0.48) (p = 0.001). Conclusion: Smoking low-tar, low-nicotine cigarettes impairs the CFVR as severely as smoking regular cigarettes. CFVR values are similar in light cigarette and regular cigarette smokers and significantly lower than in controls.

Endovascular Stent-Graft Placement as Emergency Treatment for Ruptured Iliac Pseudoaneurysm

Abstract A 65-year-old woman with advanced mucinous carcinoma of the ovary presented with massive rectal bleeding caused by rupture of an iliac artery pseudoaneurysm into the bowel. Surgery was contraindicated due to the patient’s poor clinical condition. We successfully placed an endovascular stent-graft that excluded the pseudoaneurysm. There were no complications, and the patient recovered well.

Acute spontaneous spinal subdural hematoma in a patient with bilateral incarcerated inguinal hernia.

OBJECTIVE Acute spinal subdural hematoma is an infrequent and devastating condition that occurs mostly in patients with coagulopathy or receiving anticoagulants. It may also develop after trauma, spinal surgery or iatrogenically (lumbar puncture and/or spinal anaesthesia). Spinal vascular malformations or spinal tumours can also be the origins of subdural hematomas. However, acute spinal subdural hematomas, which are not associated with these risk factors, are seen even more infrequently. In this report, we have described a case of spontaneous acute spinal subdural hematoma that occurred in a patient with bilateral incarcerated inguinal hernia and discussed the possible pathomechanisms. METHODS A 50-year-old male was admitted to the emergency department for the acute onset of interscapular pain, slight weakness in both legs and urinary retention. Neurological examination revealed paraparesis (3/5 in left, 4/5 in right) and hypoesthesia below T5 dermatome. He had long-standing bilateral inguinal hernia and constipation for the last 5 days. Magnetic resonance imaging of the spine displayed an extramedullary acute hematoma at the T4-8 levels but it was impossible to identify whether the hematoma was extradural or intradural exactly. The patient underwent an urgent operation via T4-6 laminectomy. After opening the dura, an extensive, partially organized hematoma was completely removed by aspiration. Muscle strength was improved immediately; urinary retension was recovered on postoperative day 7. Constipation was relieved on postoperative day 4. CONCLUSION Acute spinal subdural hematoma is an emergency condition in case of neurological compromise. Urgent surgical evacuation of hematoma results in good outcome. In the case of unidentified etiologies, the conditions that could play a role in increased intraabdominal and/or intrathoracic pressure should be considered always.

Ultrasound-Guided Glue Injection as Alternative Treatment of Femoral Pseudoaneurysms

The interventional angiographic techniques using the percutaneous femoral approach for endovascular revascularization are becoming increasingly more popular. These methods usually require larger sheaths, and most patients need postprocedural anticoagulation or antiplatelet therapy. As a consequence, the interventional procedure is associated with a higher rate of complications at the arterial entry site compared to diagnostic angiography [1,2]. The reported incidence of iatrogenic pseudoaneurysm formation after coronary artery interventions ranges from 3.2% [1] to 7.7% [3], and the rates noted after diagnostic angiography range from 0.2% [1] to 1% [4].Peripheral pseudoaneurysms have traditionally been treated by surgical intervention, but nonsurgical alternatives, such as ultrasound (US)-guided compression, coil embolization, stent-graft placement, and percutaneous thrombin injection with or without balloon occlusion have also been documented. Of these alternatives, direct percutaneous embolization with embolic agents is the most popular method. The tissue adhesive n-butyl cyanoacrylate (NBCA) (Hystoacryl) (B. Braun, Melsungen, Germany) is one of the most popular occluding agents for neurovascular interventions, and has been widely used for more than 20 years [5,6]. In this study, we evaluated the efficacy and utility of direct percutaneous injection of NBCA for embolization of femoral pseudoaneurysms.

Unusual cause of dizziness: occult temporal lobe encephalocele into transverse sinus.

Encephaloceles are rare manifestations, and occur most freuently in the occipital region. Temporal lobe encephaloceles are efined as pathological herniations of brain parenchyma through ura mater and bone, and they involve the middle cranial fossa r lateral temporal cranial vault. The majority of cases of tempoal encephalocele reported in the literature to date have presented ith complaints of epilepsy or ear disturbance (e.g., hearing loss, torrhea, otitis media with or without rhinorrhea, and recurrent eningitis) [1]. We present herein a rare case of lateral temporal encephaloele presenting with dizziness and imbalance. Interestingly, the ncephalocele sac was bulging into the left transverse sinus. The atient’s complaints were considered to be due to the impact of he encephalocele sac on the shape and flow hemodynamics of he transverse sinus, which is also another unusual aspect of the ase.

Use of cutting balloon in the treatment of urethral stricture: a novel technique.

The peripheral cutting balloon has been used to treat various nonvascular strictures as well as vascular stenosis. In this article, we describe for the first time the use of the cutting balloon in the treatment of patients with urethral stricture. Four patients with bulbar urethral stricture were included in the study. All strictures were successfully dilated with the cutting balloon, and patients were free of symptoms at 6-month follow-up. Cutting-balloon dilatation is a safe, easy-to-perform, and effective treatment for patients with tight urethral strictures.