Ibrahim Tek

Cerebrospinal fluid viscosity: a novel diagnostic measure for acute meningitis.

Introduction: Early diagnosis of acute meningitis has paramount importance in clinical practice because of mortality and morbidity of the disease. Examination of cerebrospinal fluid (CSF) has critical value for the diagnosis of acute meningitis and discrimination of bacterial and aseptic meningitis. It has been previously reported that plasma viscosity can be used as an inflammatory marker. In this study we aimed to evaluate the role of CSF viscosity as a complementary measure for diagnosis of meningitis in suspected patients. Methods: Forty-one consecutive patients who underwent lumbar puncture to rule out meningitis were studied prospectively. Twenty-seven patients were diagnosed with meningitis, of whom 13 patients had aseptic meningitis and 14 patients had bacterial meningitis. Meningitis was ruled out in 14 patients. Results: CSF protein and CSF viscosity were significantly higher in patients with meningitis compared to nonmeningitis. Receiver operator characteristic (ROC) analysis revealed that CSF viscosity was highly sensitive (100%) and specific (93%); measures for the diagnosis of meningitis in the study population was comparable to those of CSF protein. Additionally, patients with meningitis were also divided into two groups as having bacterial and aseptic meningitis. CSF viscosity also significantly differed between bacterial and aseptic meningitis. Conclusion: The CSF viscosity is a simple and easy method and can be used as an adjunctive measure for the diagnosis of meningitis. With the support of further and larger clinical studies, CSF viscosity may have a role in the discrimination of bacterial versus aseptic meningitis.

Role of pleural viscosity in the differential diagnosis of exudative pleural effusion.

Objective and background:  Determining the aetiology of an effusion involves assessing if it is an exudate or a transudate. However, a reliable test for determining the aetiology of a pleural effusion is lacking. Pleural viscosity has a high sensitivity and specificity and a high positive and negative predictive value for discriminating exudative and transudative pleural effusions. The aim of this study was to use pleural fluid viscosity to discriminate between various aetiologies of exudative effusions, namely malignant, parapneumonic and tuberculous.

Effects of replacement fluids on coagulation system used for therapeutic plasma exchange

Therapeutic apheresis is a widely used treatment alternative for several diseases. In 29 patients with different diseases, we have monitored the PT, aPTT, thrombin time (TT), fibrinogen, D-dimer, factor VIII, IX, X, XI, XII, VWF, Protein C, S, Active Protein C Resistance (APCR) and Antithrombin-III during TPE. Patients were divided into four groups based on the replacement fluids used: 3% VARIHES or ISOHES + 4% albumin (1:1) (group 1), fresh frozen plasma (FFP) (group 2), 3% VARIHES or ISOHES (group 3) and 4% albumin (group 4). In our study, the fibrinogen level decreased to 83% of the base line level after the end of 48 h therapy. The APTT, PT, and TT increased during TPE. However no statistical difference was observed between the groups. We found a significant change in factor levels with time, only the difference in factors IX and XI between the groups was significant. In addition, factor levels measured at 48 h were close to the levels measured before aphereses. In our study, time the related change in AT-3 values was significant. Time-related changes of the Protein S and APCR were not statistical significant significant but on the other hand, we found a significant difference in AT-III and Protein C values between groups. The side effects of HES on coagulation factors and tests were comparable to those of other replacement fluids. Its low cost makes it favourable.

The effect of venous thromboembolism on survival of cancer patients and its relationship with serum levels of factor VIII and vascular endothelial growth factor: a prospective matched-paired study.

BACKGROUND Venous thromboembolism (VT) increases mortality and morbidity in cancer patients. The primary aim of this study was to evaluate the effect of VT on the survival of cancer patients and its relationship with serum vascu-lar endothelial growth factor (VEGF) and plasma factor VIII levels. PATIENTS AND METHODS Eighty-two patients with locally advanced or metastatic cancer were included in this study between September 2001 and March 2004, and 31 of them had VT. Fifty-one matched-paired cancer patients without VT were prospectively selected as a control group in the same period. Criteria for the selection of control group patients were hav-ing the same malignancy, stage, metastatic site, performance status and age (5 years) as patients in the VT group. RESULTS Plasma factor VIII and serum D-dimer levels in the VT group were significantly higher than those in the control group (p=0.030 and p=0.016, respectively). However, mean serum VEGF levels were similar in both groups (p=0.199). In the VT group, the median survival of patients who had higher serum VEGF levels (>150 pg/mL) was significantly shorter than that of patients in the same group with lower serum VEGF levels (p=0.005). The median survival of the VT group was 14 months, whereas it was 25 months in the control group (p=0.199). CONCLUSION There was a worse prognostic trend for cancer patients with VT. Nevertheless, the difference in survival was not statistically significant between the groups. Plasma factor VIII and serum D-dimer levels might have prognostic value in cancer patients with VT. Cancer patients with VT and higher serum VEGF levels had a significantly poorer prognosis.

Effects of replacement fluids on plasma viscosity used for therapeutic plasma exchange.

Abstract:  Plasmapheresis is a widely used alternative treatment for several diseases. Recently, synthetic plasma expanders have been used to reduce the cost of therapeutic plasma exchange (TPE). Hydroxyethyl starch (HES) is a polysaccharide colloid. Isohes and Varihes are plasma volume expanders containing 6% HES in 0.9% NaCl solution. In this study, we aimed to compare the effects of several replacement fluids used for TPE on plasma viscosity profile. At the same time, we evaluated the correlation between plasma viscosity and fibrinogen level. Twenty‐nine patients were enrolled for this study. Patients were divided into four groups based on replacement fluids used: 3% HES + 4% albumin (group 1), FFP (group 2), 3% Varihes (450 000/0.7)/Isohes(200 000/0.5) (group 3), and 4% albumin (group 4). The choice of replacement fluids used was randomly assigned, as long as there were no contraindications for the patient. Seven samples were collected to determine plasma viscosity and fibrinogen level during TPE cycles. There was a positive exponential correlation between plasma viscosity and fibrinogen levels. At the second plasmapheresis procedure, plasma viscosity and fibrinogen levels decreased by 20% compared with first cycle. The effect of plasmapheresis solutions on hemorheology were roughly the same. Effects of replacement fluids on plasma viscosity were comparable.

Kartagener’s syndrome with dextrocardia and corrected transposition of great arteries

Abstract Kartegener syndrome is characterized with sinusitis, bronchiectasia and dextrocardia. There may be rhythm and conduction abnormalities. Due to the cilial dysfunction lung abscesses and disorders of sperm motilities may also be seen. Additional cardiac abnormalities is very rare. We reported a case with Kartageners syndrome with a corrected transposition.

Does reactive thrombocytosis observed in iron deficiency anemia affect plasma viscosity

Objective: The accompanying thrombocytosis is referred to as the major factor associated with thromboembolism in iron deficiency anemia (IDA). Increased viscosity may increase the risk of thrombosis. We hypothesized that increased platelet count -with reactive thrombocytosis- might also affect plasma viscosity. We planned to evaluate the influence of normal and high platelet count on plasma viscosity in IDA patients. Material and Methods: The patient population consisted of fifty-three newly diagnosed and untreated women aged between 18 and 62 years with IDA. Group 1 consisted of 33 patients, platelet levels below 400 x 109/L. Group 2 consisted of 20 patients, platelet levels above 400 x 109/L. Measurements of plasma viscosity were performed using Brookfield viscometer. Results: Mean plasma viscosity was found as 1.05 ± 0.08 mPa.s. in Group 1, and 1.03 ± 0.06 mPa.s. in Group 2. Mean plasma viscosity was not statistically different. White blood cell count was significantly higher in Group 2. Vitamin B12 levels were significantly higher in Group 2, while folic acid levels were higher in Group 1 (p=0.011 and p=0.033). Plasma viscosity was correlated with erythrocyte sedimentation rate (r=0.512 p=0.002) in Group 1 and inversely correlated with vitamin B12 (r=−0.480 p=0.032) in Group 2. Conclusion: Despite the significant difference between groups in terms of platelet count, no significant difference was detected in plasma viscosity and this finding could be explained as the following; 1-These platelets were not thrombocythemic platelets; 2-Similar to the theory about leukocytes, higher platelet counts – even non-thrombocythemic – may increase plasma viscosity; 3-Evaluating platelet count alone is not sufficient and the associating red-cell deformability should also be taken into account; and 4-Although other diseases that could affect viscosity are excluded, some definitely proven literature criteria such as fibrinogen, hyperlipidemia, and the inflammatory process should also be evaluated by laboratory and clinical measures.

Influence of Febrile Neutropenia Period on Plasma Viscosity at Malignancy

Cancer, chemotherapy, and infections all together make changes in blood rheology and may affect the defense mechanisms by changing the thrombocyte function and endothelial cell. We have examined changes of blood rheology on plasma viscosity to put on probable following criteria for starting the treatment of febrile neutropenia immediately. A total of 27 postchemotherapy patients (16 males and 11 females) with febrile neutropenia diagnosed according to international guidelines have been included into the study. The plasma viscosity of the patients whose febrile neutropenia has been successfully treated was also measured to assess the impact of the duration of neutropenia on viscosity. The plasma viscosities of the patients were significantly higher during neutropenic episode than in nonneutropenic state (P = 0.006) except for alkaline phosphatase. All study parameters, particularly acute phase reactants, were statistically similar during both states. In the correlation of analysis with study parameters and stages, significant correlation was not observed between plasma viscosity alteration and leukocyte-neutrophil alteration, also other study parameters. We have demonstrated significantly elevated plasma viscosity in our patients during febrile neutropenic episode. Despite normal values of various parameters known to trigger plasma viscosity, particularly fibrinogen, it can be easily argued that the main mechanism may be the endothelial injury during infectious process and immune response mediated microcirculatory blood flow alterations.

Oligoklonal gammopati ile prezante olan bir ig a multipl miyelom olgusu

brahim Tek1, Dilsa M zrak2, Gungor Utkan1, Selami Kocak Toprak3, Huseyin Tutkak4, Abdullah Buyukcelik1, Bulent Yalc n1, Hakan Akbulut1, Fikri cli1 1Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey 2Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey 3Department of Hematology, Ankara University School of Medicine, Ankara, Turkey 4Department of Clinical Immunology and Rheumatology, Ankara University School of Medicine, Ankara, Turkey

Pnömonili hastalarda akut faz reaktanı olarak plazma viskozitesi

Purpose:Plasma viscosity is determined by various macromolecules, eg, fibrinogen, immunglobulins, and lipoproteins. Eritrocyte sedimentation rate (ESR) and fibrinogen levels are well known acute phase reactants.We aimed to evaluate the correlation between plasma viscosity and fibrinogen levels and ESR in patients with pneumonia.Methods: Nineteen patients (7 women, 12 men , mean age=56±12 years) with noncomplicated pneumonia were included in the study. Plasma viscosity, serumfibrinogen levels and ESR were measured in all patientsbefore and after the antibiotic treatment.Results: All patients were succesfuly treated after antibiotic administration (10±4 days). There weresignificant decrease in fibrinogen levels, ESR and plasma viscosity after antibiotic treatment. There was astatistically significant correlation between the decrease of plasma viscosity and fibrinogen levels (r=0.79, p