Tolga Kocum

Mean platelet volume is elevated during paroxysmal atrial fibrillation: a marker of increased platelet activation?

Paroxysmal atrial fibrillation might be a risk factor for stroke such as chronic atrial fibrillation. We examined the relation between mean platelet volume and paroxysmal atrial fibrillation to determine the effect of paroxysmal atrial fibrillation on the thrombotic state via elevated mean platelet volume. Mean platelet volume is a marker of platelet size, function, and activation. Increased mean platelet volume reflects active and large platelets that release more thromboxane A2 than smaller ones. We hypothesized that mean platelet volume is elevated in patients with paroxysmal atrial fibrillation. The study population comprised 103 consecutive patients who were detected to have paroxysmal atrial fibrillation by 24-h Holter monitoring and 87 control individuals with normal Holter monitoring. Mean platelet volume and inflammatory parameters were measured. Comprehensive clinical and echocardiographic data were collected. Patients with aortic and mitral stenosis, hyperthyroidism, hypothyroidism, malignancy, infection, and pregnancy were excluded from the study. Mean age of the patients was 63 ± 11 vs. 45 ± 14 years (P < 0.001) in paroxysmal atrial fibrillation and control groups, respectively. Fifty-seven patients (55%) in paroxysmal atrial fibrillation and 19 (21%) (P < 0.001) patients in control group were men. Mean platelet volume was significantly higher in the paroxysmal atrial fibrillation group when compared with control group (10.0 ± 2.0 vs. 8.3 ± 1.5 fl, respectively; P < 0.001). C-reactive protein (18.5 ± 28 vs. 3.8 ± 2 mg/l, respectively; P = 0.004) and erythrocyte sedimentation rate (21 ± 21 vs. 12 ± 7 mm/h, respectively; P = 0.01) were also higher in the paroxysmal atrial fibrillation group. There was no difference in white blood cell and platelet counts between groups. In a multivariate analysis, elevated mean platelet volume was associated with the occurrence of paroxysmal atrial fibrillation before and after adjustment for age and sex. Our results indicate that inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate and the marker of platelet size and activity mean platelet volume are elevated in patients with paroxysmal atrial fibrillation.

An unusual cause of mismanagement in an acute myocardial infarction case: pseudothrombocytopenia

Thrombocytopenia determined by an automated counter may represent a benign, incidental finding in an asymptomatic patient or a potentially life-threatening disorder. Even if the low platelet count actually is a benign condition itself, in some conditions, any delay resulting from this condition consequently may be seriously hazardous. Low platelet count may alter the decision of heparin administration, which is an essential part of management during acute coronary syndromes. EDTA-dependent pseudothrombocytopenia (PTCP) is reported to have a prevalence of 0.1% in a general hospital; however, it is also reported that around 15% of the patients referred for a specialized center for isolated thrombocytopenia are actually cases of PTCP. In this report, we describe a patient with PTCP who could not receive reperfusion therapy during acute myocardial infarction because of the low platelet counts reported by an automated counter.

Does atorvastatin affect androgen levels in men in the era of very-low LDL targeting therapy?

BACKGROUND An adequate pool of free intracellular cholesterol is essential for steroidogenesis in gonads and LDL is the major source of cholesterol used in this pathway. Effect of peripheral LDL on the synthesis of steroids is dose dependent and although LDL levels around 100 mg/dl is demonstrated to be safe in terms of steroidogenesis, effect of LDL levels <70 mg/dl with higher doses of statins on steroidogenesis remains controversial. MATERIAL AND METHODS Androgen and gonadotropin levels are prospectively evaluated at baseline and after 12 weeks of treatment in 77 male coronary heart disease patients receiving high doses of atorvastatin (40-80 mg daily) targeting serum LDL levels <70 mg/dl and in 83 male coronary heart disease patients receiving regular doses of atorvastatin (10-20 mg daily) targeting serum LDL levels <100 mg/dl. RESULTS At the end of the study, mean LDL levels of the high and regular dose atorvastatin groups were 77+/-9 mg/dl and 98+/-10 mg/dl respectively. After twelve weeks of treatment, there were no significant alterations in serum total testosterone, free testosterone, sex hormone binding globulin, luteinizing hormone and follicle stimulating hormone levels between two groups. CONCLUSION High dose atorvastatin in order to reach serum LDL levels around 70 mg/dl seems to be as safe as regular doses in order to reach serum LDL levels around 100 mg/dl, in terms of gonadal steroidogenesis in men with coronary heart disease.

Epidural Anesthesia for Cesarean Section in a Patient With Severe Mitral Stenosis and Pulmonary Hypertension

Mitral stenosis (MS) is the most prevalent clinically signifcant cardiac disease in pregnant women.1 It is considered evere when the mitral valve area is 1 cm2 or less, and maternal ortality rate may reach 15% if MS is accompanied by sympomatic pulmonary hypertension.2 Although it previously has been described that delivery may be afely managed via graded epidural anesthesia for mild-to-modrate MS cases, there are very few reports of women with severe S undergoing caesarean section via epidural anesthesia.3,4 The uthors present a parturient with severe MS and secondary severe ulmonary hypertension who underwent a cesarean section. A 3-year-old, 164-cm, 78-kg woman was admitted at the 32nd eek of gestation with breathlessness and hemoptysis. She was ot on any cardiovascular medication during her gestation. Echoardiography revealed severe MS (mitral valve area 0.67 cm2, ean gradient 17 mmHg), severe tricuspid regurgitation, and ulmonary hypertension (pulmonary artery systolic pressure PASP] 100 mmHg). The left ventricular systolic function was ormal. Obstetric ultrasonography revealed intrauterine growth etardation. The patient’s symptoms improved with diuretic (fuosemide, 80 mg/d intravenously) and -blocker (metoprolol, 25 g/d orally) treatment, and she underwent cesarean delivery on he 7th day of her admission. On the day of surgery, physical examination revealed clear lung elds bilaterally; an electrocardiogram showed sinus rhythm, and n echocardiogram revealed a PASP of 90 mmHg. Her preopertive blood pressure was 132/90 mmHg, her heart rate was 101 eats/min, and her oxygen saturation without any oxygen suppleentation was 94%. Epidural anesthesia with invasive arterial and entral venous pressure (CVP) monitoring was established. After nvasive arterial blood pressure monitoring, the epidural catheter as placed in the L3-4 interspace. A test dose of 2 mL of lidocaine % was administered, and then 18 mL of bupivacaine 0.5% was ncrementally administered epidurally over 20 minutes. The opertion started when the sensorial block reached the T4 level 15 inutes after the last dose of bupivacaine. A healthy neonate, with 5-minute APGAR score of 10, was delivered after 2 minutes ollowing the skin incision. Oxytocin, 20 IU, was infused over an our after delivery. Lactated Ringer’s solution, 500 mL, had been infused 2 ours before surgery, and infusion continued with a rate of 100 L/h during the operation. Intraoperatively, blood pressure emained between 92/53 and 141/84 mmHg, heart rate between 0 and 117 beats/min, and CVP between 15 and 21 mmHg. She id not require any additional analgesic or vasopressor treatp