İlker Akar

The role of asymmetric and symmetric dimethylarginine in acute deep vein thrombosis.

BACKGROUND In this study, we aimed to determine the importance of asymmetric dimethylarginine (ADMA), symmetric dimethyl arginine (SDMA), and l-arginine levels which are influenced by the endothelial dysfunction in acute deep vein thrombosis (DVT), and compare their pretreatment and post-treatment levels. METHODS A total of 34 cases (19 men and 15 women, age range 42 ± 14 years) diagnosed with acute DVT and 34 control subjects (22 men and 12 women, age range 45 ± 11 years) without any vascular disorders were included in the study. The patients were administered low-molecular-weight heparin subcutaneously. Blood samples were obtained to measure ADMA, SDMA, and arginine levels before treatment and during the treatment (on 10th day). ADMA, SDMA, and l-arginine levels were measured using high performance liquid chromatography method. RESULTS The ADMA and SDMA levels were significantly higher in acute DVT patients when compared with the controls (P = 0.001). Post-treatment decrease of ADMA and SDMA levels when compared with the pretreatment levels were found as statistically significant (P = 0.001). Increase in l-arginine levels were not found significant when compared with the control group (P = 0.12) or post-treatment levels (P = 0.16). CONCLUSIONS We concluded that ADMA and SDMA levels can be used as parameters in clinical follow-up for determining the efficacy of treatment in acute DVT patients, and further studies are needed to further clarify the subject.

Left atrial rupture due to blunt thoracic trauma.

Blunt traumatic cardiac rupture is rare and associated with high mortality. The most popular theory of cardiac rupture after blunt thoracic trauma is rapid deceleration with disruption of the atria from their connections to the vena cava and pulmonary veins. In cases with both massive hemothorax and hemopericardium, injury can usually originate from the heart and/or major vessels. Surgical approach through the median sternotomy can provide convenience to repair the defect. In this article, successful treatment with median sternotomy of a 33-year-old male case with a rupture of the left atrium after blunt thoracic trauma was reported.

Analyses of C-Reactive Protein, Endothelial Nitric Oxide Synthase and Interleukin-6 Gene Polymorphisms in Adolescents with a Family History of Premature Coronary Artery Disease: A Pilot Study

BACKGROUND Family history of premature atherosclerosis imposes a high risk to people. The relationship between atherosclerosis and gene polymorphisms of various biomarkers such as Endothelial Nitric Oxide Synthase (eNOS), C-Reactive Protein (CRP), and Interleukin-6 (IL-6) has shown in previous studies. AIMS The major aim of the study was to evaluate the CRP, eNOS, and IL-6 gene polymorphisms in a group of adolescents who have a parental history of early coronary artery disease (CAD). STUDY DESIGN Case-control study. METHODS Thirty-six volunteers with a father with obstructive CAD during the first four decades and 46 subjects with a father with normal coronary arteries documented with coronary angiography were included in the study. Polymerase chain reaction-restriction fragment length polymorphism techniques were used to analyze CRP, eNOS, and IL-6 polymorphisms. RESULTS We did not find any differences between the two groups with regard to age, sex, body mass index, renal functions, systolic and diastolic blood pressures, lipid profile, and fasting glucose, hemoglobin, and high sensitivity CRP. A significant difference was only observed in IL-6-572 G/C genotype distribution and allele frequency between two groups (Pc=0.036 OR=3.48 CI (95%) 1.17-10.32). CONCLUSION The present study showed a significant association between the IL-6-572 G/C gene polymorphism (presence of C allele) and adolescents with a parental history of premature CAD.

Brachiocephalic artery cannulation in proximal aortic surgery that requires circulatory arrest.

The brachiocephalic artery is an alternative cannulation site in the repair of ascending aortic lesions that require circulatory arrest. We evaluate the effectiveness and safety of this technique. Proximal aortic surgery was performed in 32 patients from 2006 through 2012 via brachiocephalic artery cannulation and circulatory arrest. Twenty-four (75%) of the patients were men. The mean age was 48.69 ± 9.43 years (range, 30-68 yr). Twelve had type I dissection, 2 had type II dissection, and 18 had true aneurysms of the ascending aorta. All operations were performed through a median sternotomy. The arterial cannula was inserted through an 8-mm vascular graft anastomosed to the brachiocephalic artery in an end-to-side fashion. In dissections, the distal anastomosis was performed without clamping the aorta. The patients were cooled to 24 °C, and circulatory arrest was established. The brachiocephalic and left carotid arteries were clamped, and antegrade cerebral perfusion was started at a rate of 10 mL/kg/min. Cardiopulmonary bypass was resumed after completion of the distal anastomosis and the initiation of rewarming. The proximal anastomosis was then performed. None of the patients sustained a major neurologic deficit, but 5 patients experienced transient postoperative agitation (<24 hr). There were 2 early deaths (6.25%), on the 3rd and the 11th postoperative days, both unrelated to the cannulation technique. Brachiocephalic artery cannulation through a graft can be a safe and effective technique in proximal aortic surgical procedures that require circulatory arrest.

Endothelin-1 Gene Polymorphism in Preoperative Myocardial Infarction with /or without Coronary Artery Bypass Graft

Abstract Atherosclerosis is a complex multifactorial and polygenic disorder resulting from endothelial dysfunction and excessive inflammatory response to various forms of injurious stimuli to the arterial wall. In this study, researchers aimed to investigate endothelin-1 (Lys198Asn and rs10478694) polymorphisms which are supposed to play roles in atherothrombotic process. Study group included 100 patients who had coronary artery bypass operation (CABG) without any history of a myocardial infarction with ST elevation (Group 1), and 80 patients who had a CABG operation after a myocardial infarction with ST elevation (Group 2). The control group consisted of 80 healthy people without coronary artery disease. Endothelin-1 gene polymorphisms of the subjects were determined by real time polymerase chain reaction method. Comparison of study groups, Groups 1 and 2, and control group (Group 3) did not show any statistically significant differences for endothelin-1 gene polymorphisms (p>0.05).The polymorphisms endothelin-1 gene which is thought to play a role in atherothrombotic process, were not supposed as risk factors in CABG patients. Studies on different polymorphisms of endothelin-1 gene may be beneficial.

Oxidative Stress And Prolidase Enzyme Activity In The Pathogenesis Of Primary Varicose Veins

Objectives Vascular endothelial dysfunction leads to the emerging of free oxygen radicals, deficiency of antioxidant system, forming of oxidative stress, inflammatory processes and release of proinflammatory cytokines. These things play big role in the development of primary varicose veins. Prolidase has been reported as an indicator of oxidative stress in diabetes, diabetic neuropathy, non-ulcerous dyspepsia, osteoporosis, polycystic over syndrome and many other diseases. The aim of this study is to evaluate the oxidative stress at venous insufficiency and to provide preliminary knowledge about the role of prolidase enzyme in varicose vein formation. Methods Ninety patients aged between 22 and 80 (47.35 ± 17.69) were included in the study and divided into 3 groups. Group1(n:30)(Serum control group): Patients without venous insufficiency. Group 2(n:30)(Tissue control group(healthy vein group): Patients underwent coronary artery bypass surgery (the remaining portion of great saphenous vein used as coronary artery bypass graft used as normal tissue) . Group 3(n:30)(Varicose vein group): Patients underwent varicose vein surgery (varicose vein and serum of these patients were used for study). Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Oxidative Stress Index (OSI) and Prolidase enzyme levels were detected in tissue and serum samples. Results No significant changes were detected between three groups’ serum samples in oxidative stress parameters and in the prolidase enzyme activity. The tissue TOS and OSI were higher in varicose vein group according to normal vein group and this was found statistically significant. And TAC levels in varicose vein group were significantly lower than normal vein group. Prolidase enzyme activity in varicose vein group was found higher according to normal vein group. Conclusion Oxidative stress plays a role at the development of primary varicose veins at biochemical level. Prolidase enzyme related with oxidative stress may play an important role in the pathogenesis of primary varicose veins.

Is There any Relationship Between Myocardial Repolarization Parameters and the Frequency of Ventricular Premature Contractions

Background Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. Objective In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. Methods This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. Results Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. Conclusions Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.