Serkan Sivri

Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use

Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation. Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4. Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma.

Relation between lymphocyte to monocyte ratio and short-term mortality in patients with acute pulmonary embolism.

The relationship between inflammation and mortality after acute pulmonary embolism (APE) has previously been investigated with different variables (platelet/lymphocyte ratio, etc).

Low-dose oral contraceptive-induced acute myocardial infarction

Abstract Objectives: Since their introduction, oral contraceptives (OCs) have been associated with risk to both the venous and the arterial systems. Studies have shown that OC use is associated with a risk of venous thromboembolism, ischaemic stroke and acute myocardial infarction (MI). MI is rarely seen in patients using OCs, particularly in the absence of clinical risk factors or smoking. Case: We report a case of acute inferior MI in a 20-year-old non-smoker who had used a low-dose OC (3 mg drospirenone and 30 μg ethinyl estradiol) for 1 month. As far as we know, this is the youngest case of acute MI associated with a low-dose OC. Conclusion: Low-dose OCs may also be responsible for acute MI even in a very young female without any cardiovascular risk factors. Therefore, the clinicians should be aware of this mortal events during follow-up of the patient using OCs.

A rare complication of warfarin: late onset warfarin induced skin necrosis

Warfarin is an oral anticoagulant, can lead to skin necrosis quite rarely that is a serious complication. However this complication is observed usually during the first 10 days of treatment, the presented case, as a result of inappropriate drug withdrawal and restarting, has emerged after two years from the start of treatment as late onset. After stopping the warfarin therapy , the patient was treated with oral acetylsalicylic acid and skin necrosis regressed within days without recurrence. In the treatment of this complication, parenterally and the new oral anticoagulant agents are the other treatment options.

Relationship Between Monocyte/High-Density Lipoprotein Cholesterol Ratio and Angiographic Severity and Extent of Coronary Artery Disease

Introduction: Circulating monocyte count is predictive of new atherosclerotic plaque development. In addition, there is a strong inverse relationship between high-density lipoprotein (HDL) cholesterol and atherosclerosis. We aimed to investigate the relationship between the monocyte/HDL cholesterol ratio and severity of coronary artery disease. Patients and Methods: A total of 760 patients who underwent coronary angiography were included in the study. The severity of coronary atherosclerosis was calculated by the Gensini score, and the patients were grouped as having low (< 20) and high (> 20) Gensini scores. Baseline characteristics and laboratory parameters were recorded and compared between patients with low and high Gensini scores. Results: Hypertension, diabetes mellitus, hyperlipidaemia, advanced age and smoking were more common in patients with a high Gensini score. Fasting blood glucose levels, creatinine levels and monocyte/HDL cholesterol ratio were significantly lower in patients with a low Gensini score than in those with a high Gensini score. Logistic regression analysis revealed that older age, fasting blood glucose levels, hyperlipidaemia, family history of coronary artery disease and male gender were independent predictors of a high Gensini score. We observed a correlation between the monocyte/HDL cholesterol ratio and Gensini score (p< 0.001). However, this correlation was weak (Spearman’s rho = 0.159). Conclusion: We observed a positive but weak correlation between the monocyte/HDL cholesterol; ratio and increased coronary atherosclerotic burden, as calculated by Gensini scoring. Further studies are required to demonstrate the relationship between the monocyte/HDL cholesterol ratio and atherosclerotic cardiovascular disease.

Does Monocyte/High-Density Lipoprotein Cholesterol Ratio Predict Saphenous Vein Graft Patency in Patients with Stable Angina Pectoris?

Giris: Dolasimdaki monosit sayisi yeni aterosklerotik plak gelisimi icin ongordurucu bir faktordur. Ayrica, yuksek dansiteli lipoprotein kolesterol (HDL) ile ateroskleroz arasinda guclu bir ters iliski vardir. Monosit sayisi/HDL oraninin (MHR) yeni bir inflamatuvar belirtec oldugu gosterilmistir. Biz MHR ile safen ven greft hastaligi (SVGD) arasindaki iliskiyi arastirmayi amacladik. Hastalar ve Yontem: Toplam 369 hasta 3 gruba bolundu (SVGD olan grup= 150, SVGD olmayan grup= 89, normal koroner arter grubu= 130). Bazal karakteristikler ve laboratuvar parametreleri kayit edildi ve gruplar arasinda karsilastirildi. Bulgular: Bazal karakteristiklere gore SVGD olan ve olmayan gruplarda, SVG yasi ve sol ventrikul ejeksiyon fraksiyonu haricinde istatistiksel farklilik yoktu. C-reaktif protein, aclik kan sekeri ve ortalama platelet hacmi SVGD olan grupta SVGD olmayan gruba gore daha yuksekti (sirasiyla p degerleri= 0.008, 0.048 ve 0.042). MHR degeri SVGD olan, SVGD olmayan (p= 0.169) ve normal koroner arter gruplari (p= 0.364) arasinda istatistiksel farklilik gostermedi. CRP, SVGD icin bagimsiz ongordurucu faktor olarak bulundu. Sonuc: MHR ve koroner ateroskleroz arasinda iliski yoktu. MHR, SVGD icin bir ongordurucu faktor degildi.

Successful simultaneous ipsilateral stenting of common iliac artery stenosis and transfemoral aortic valve replacement.

Atherothrombotic disease increase with age and that the prevalence of the elderly population is continuously growing. Antithrombotic therapy represents the cornerstone of prevention of atherothrombosis. The choice of the antithrombotic therapy in elderly patients remains an ongoing challenge. Althoug the benefits of antiplatelet therapy in the elderly are demonstrated, the elderly are generally more vulnerable to the adverse effects of antithrombotic drugs. Because of them, understanding strategies of antithrombotic management in elderly is important.

Evaluation of local carotid stiffness and inflammatory biomarkers in stable angina pectoris

Introduction Arterial stiffness (AS) is a well-accepted and reliable predictor of atherosclerotic diseases. Inflammation plays an important role in the development of AS. Aim To evaluate local carotid stiffness (CS) together with fibrinogen and high-sensitivity C-reactive protein (hsCRP) levels in stable angina pectoris (SAP) patients. Material and methods The study consisted of 353 consecutive patients with SAP. All underwent coronary angiography (CAG) after the evaluation of local CS parameters and carotid intima-media thickness (IMT) from both common carotid arteries by a real-time echo-tracking system. Baseline inflammatory biomarkers, serum hsCRP and fibrinogen levels were measured. Based on CAG findings, the patients were classified into 4 groups: control subjects with normal coronary arteries (group 1, n = 86), single-vessel disease (group 2, n = 104), double-vessel disease (group 3, n = 95) and triple-vessel disease (group 4, n = 68). Results The mean carotid pulse wave velocity (PWV) in patients with angiographically confirmed coronary artery disease (CAD) was significantly higher than that in patients with normal coronary arteries (7.82 ±1.76 vs. 6.51 ±0.85 cm/s, p = 0.001). The mean carotid IMT was detected to be significantly higher in group 4 patients compared to those in group 1 (p < 0.001) and group 2 (p = 0.001). Significant correlations were observed between both inflammatory biomarkers and the number of diseased vessels and carotid PWV. Using multi-variate analysis, carotid stiffness, carotid IMT, hsCRP and fibrinogen were independently associated with the presence and extent of CAD. Conclusions Local CS, carotid IMT, hsCRP and fibrinogen levels are significant predictors of atherosclerotic burden and they may facilitate the identification of high-risk patients for the early diagnosis and prompt treatment of CAD.

Epicardial fat tissue thickness is increased in patients with lichen planus and is linked to inflammation and dyslipidemia.

BACKGROUND AND OBJECTIVES Lichen planus (LP) is a mucocutaneous inflammatory disease. Inflammation plays a major role in the progression of atherosclerosis. Epicardial fat tissue (EFT) has been shown to produce and secrete various proatherogenic and proinflammatory hormones and cytokines. The aim of this study was to assess EFT in patients with lichen planus. METHODS Fifty-four patients with LP and 50 controls were enrolled in the study. LP was diagnosed according to the World Health Organization criteria. EFT was measured on the free wall of the right ventricle in parasternal long-axis view, as previously described and validated. RESULTS There were positive correlations between EFT thickness and platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, duration of LP, and high-sensitivity C-reactive protein (hsCRP) (p<0.001, p<0.001, p=0.002 and p<0.001, respectively). In multivariate analysis, after adjustments for relevant confounders, LDL cholesterol, hsCRP, platelet/lymphocyte ratio and duration of LP were independent predictors of EFT thickness in patients with LP (β=0.231, p=0.014; β=0.205, p=0.037; β=0.361, p=0.001 and β=0.133, p=0.047, respectively). CONCLUSION EFT is increased in patients with LP compared to control subjects. Duration of LP is correlated with EFT, and duration of LP is also an independent predictor of increased EFT, which is a predictor of subclinical atherosclerosis.

Is Coronary Circulation the Most Important Parameter for Right Ventricular Functions

altered LV functions, for which there are several possible explanations. Balci et al. [3] suggested that the RV cavity has a thinner wall. Nouette-Gaulain et al. [4] showed that, in the case of chronic hypoxia, the mitochondrial energy metabolism-adaptation mechanisms in the right and left ventricles are different. Saari and Johnson [5] showed there to be distinct calcium kinetics in the right and left ventricles. Hence, the preserved RV functions could be explained by the mechanisms mentioned above. We wonder, however, whether the results would have been the same if the patients had been divided into 2 subgroups, i.e. RV circulation: right coronary artery and dominant circumflex artery, and LV circulation: left anterior descending artery and circumflex artery?