Zuhal Arıtürk Atılgan

Association between neutrophil to lymphocyte ratio and severity of coronary artery disease.

The aim of this study is to investigate the association between neutrophil to lymphocyte ratio (NLR) and severity of coronary atherosclerosis. A total of 172 patients undergoing coronary angiography were included in the study. Control group consisted of patients with normal coronary arteries. Patients with coronary stenosis were divided into 2 groups by use of Gensini scores. The NLR was higher in severe atherosclerosis group compared with mild atherosclerosis and control groups (P < .001). In correlation analysis, NLR showed significant correlation with Gensini score. A cutoff value of 2.5 for NLR predicted severe atherosclerosis with a sensitivity and specificity of 62% and 69%, respectively. After multivariate analysis, high levels of NLR were independent predictors of severe atherosclerosis together with glucose and high-density lipoprotein. Our study suggests that the NLR is a predictor of severe atherosclerosis that may be useful for cardiac risk stratification in patients with coronary artery disease.

Platelet Count and Mean Platelet Volume in Patients With In-Hospital Deep Venous Thrombosis

Aim: To investigate the relationship between mean platelet volume (MPV) and in-hospital deep venous thrombosis (DVT). Material and methods: 147 patients with the diagnosis of DVT and 149 control participants were included in the study. For all participants, clinical risk factors, smoking status, and other demographic data were recorded from hospital registries. The data of patients with DVT were compared with the control participants. Results: Mean MPV was significantly higher in patients with DVT than the control group (8.91 ± 1.86 vs 7.86 ± 0.9; P < .001). Body mass index, smoking frequency, hematocrit, and platelet count were significantly correlated with MPV. Independent predictors of in-hospital DVT were MPV (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2-1.87; P ≤ .001), body mass index (OR = 1.17; 95% CI = 1.04-1.34; P = .012), and smoking (OR = 1.83; 95% CI = 1.09-3.08; P = .023). Conclusion: Mean platelet volume was significantly higher in patients with DVT, and it is an independent predictor of in-hospital DVT.

The Relationship Between Serum Levels of Zn and Cu and Severity of Coronary Atherosclerosis

The essential trace elements play important roles in the maintainance of the normal structure and physiology of cells. Several research groups have demonstrated that they also play important roles in states of cardiovascular diseases. Our aim is to investigate whether there is a relationship between trace elements (Zn and Cu) and the degree of atherosclerosis. The sample consisted of 67 patients with coronary artery disease and 26 clinically healthy individuals. Ninety-three subjects were separated into four groups according to their Gensini scores, the number of diseased vessels, the presence of acute coronary syndrome, and ejection fraction. Each group was divided into three subgroups, and serum zinc and copper levels were measured for each individual. The serum levels of zinc and copper were found to be significantly lower in patients with atherosclerosis than in the control group, but there were no significant differences in the serum levels of Cu and Zn between severe atherosclerosis and mild atherosclerosis. In Spearman’s rank correlation, the zinc and copper levels were correlated with the Gensini score and the number of diseased vessels. The present study revealed a relationship between the serum levels of zinc and copper and atherosclerosis, but not between these levels and the severity of the disease.

Myocardial infarction secondary to unintentional ingestion of hydrogen peroxide

Ingestion of acid-containing household products, either accidentally or as a suicide attempt, is a common form of intoxication. A clear and odorless liquid, hydrogen peroxide is an oxidizing agent found in most households and many industrial environments. Cardiovascular manifestations of hydrogen peroxide ingestion are extremely rare. Here we report a 60 year-old woman with acute inferolateral myocardial infarction (MI) after hydrogen peroxide ingestion, who had no history of coronary artery disease. Physicians dealing with hydrogen peroxide ingestion in the emergency department should be aware of the probability of MI and obtain an electrocardiogram, even if the patient has no cardiac complaint.

Unusual metastatic localization of osteosarcoma in a teenager with ventricular tachycardia

Most malignant tumors of the heart are metastatic. Metastatic cardiac tumors are usually associated with Wilms tumor, neuroblastoma, and non-Hodgkin lymphoma in children (Br J Radiol 71:336-339). Osteosarcoma rarely metastasizes to the heart. Twenty-four cases have been reported in the literature so far. The right side of the heart is more commonly involved than the left, and the pericardium and/or myocardium is more frequently involved than the endocardium (Br J Radiol 71:336-339). We report a rare case of osteogenic sarcoma of the right femur with left ventricular metastases presenting with ventricular tachycardia that has not been reported previously. Cardiac tumors are extremely rare, found at a frequency of only 0.001% to 0.28% at autopsy series. The incidence of secondary cardiac tumors is much higher than that of primary cardiac tumors [1]. Secondary intracardiac neoplasms arise most frequently from renal cell carcinoma, bronchogenic carcinoma, Wilms tumor, chondrosarcoma, and osteogenic sarcoma [2]. There are several reports of metastatic childhood osteosarcoma involving the cardiac chambers. However, endocardial left cardiac chamber Fig. 1 Electrocardiogram prese 0735-6757/

Paraoxonase and Arylesterase Activities in Dipper and Non-Dipper Prehypertensive Subjects

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Miyokard perfüzyon sintigrafisi, eforlu EKG ve koroner anjiografi sonuçlarının karşılaştırılması

AbstractParaoxonase-1, a high-density lipoprotein linked enzyme complex, was shown to be decreased in several cardiovascular diseases. We aimed to explore whether serum paraoxonase and arylesterase activities differ in dipper and non-dipper prehypertensive subjects compared to healthy controls.Sixty prehypertensive subjects and 30 controls were enrolled. All subjects underwent echocardiographic assessment and 24-hour ambulatory blood pressure monitoring (ABPM). According to the blood pressure (BP) course on ABPM, prehypertensive subjects were categorized into two: non-dipper prehypertensive (NDPH) and dipper prehypertensive (DPH) groups. Serum paraoxonase and arylesterase activities were detected spectrophotometrically.Paraoxonase and arylesterase activities were significantly lower in patients with NDPH compared to both DPH and control groups. Both paraoxonase and arylesterase activities showed significant negative correlations with BP and left ventricular mass index.We have demonstrated that NDPH subjects have lower paraoxonase and arylesterase activities compared to DPH subjects and normotensives. Further prospective studies are needed to clarify the role of paraoxonase and arylesterase activities in the development of overt hypertension in prehypertensive subjects.

Carotid artery stiffness in patients with neurally mediated syncope.

Brucellosis, is an endemic disease in our country, may lead to bacteremia and cause different clinic manifestations. A 44-year-old male patient admitted to our policlinic with high fever, shivering, chilling, pollacuria, and left costovertebral pain, and interned with diagnosis of acute pyelonephritis. Subsequently, acute pyelonephritis due to acute brucellosis was detected in the clinical and laboratory examination. Antibiotic treatment for brucellosis was given to patient for eight week and after treatment full recovery was seen. Patients with brucellosis may refer with symptoms of acute pyelonephritis in endemic areas for brucellosis. By using brucellos serologies to patients who have the symptoms of acute pyelonephritis may available in the diagnosis of this rare complication in areas where brucellosis is endemic.Objectives: Internal splinting is defined as early tendon transfer performed during or just after nerve repair followsing nerve injury and is a controversial issue. The objecstives of internal splinting are avoiding the use of long term external splinting, avoiding permanent hand deformities until the injured nerve is reinnervated and supporting sensorial recovery. In this paper we present our clinical cases of internal splinting and discuss the results in terms of indications, timing, advantages, and disadvantages of internal splinting. Materials and Methods: We applied internal splinting in 11 patients, 3 patients with radial nerve injury and 8 patients with ulnar nerve injury. Internal splinting was performed contemporarily with the nerve repair in 5 pastients, in 2 weeks following nerve repair in 1 patient and in 4 weeks following nerve repair in 5 patients. Pronator teres was transferred to extensor carpi radialis brevis and flexor carpi radialis was transferred to extensor digitorum communis in radial nerve injuries. Omer\s superficial Y technique and its modification were used for ulnar nerve injuries. Results: Patients were followed up for at least 1 year with physical examination and electroneuromyelography and recovery of sensorial and motor functions were achieved in all of them. Conclusion: We concluded that internal splinting is usesful for avoiding external splint usage and preventing the establishment of hand deformity until recovery of the nerve. The contribution of internal splinting to sensorial recovery was noteworthy as stated in the literature but the lack of control group and the small number of our cases was limited to come to a definite conclusion. We did not experience any disadvantage of internal splinting.

Ostial coronary stenosis and severe aortic stenosis in a patient with familial hypercholesterolemia.

Neurally mediated syncope is defined as a transient loss of blood flow to the brain, resulting in vasodilatation, bradycardia, or both. The pathophysiologic mechanisms of neurally mediated syncope are not clear. In this study, we investigated carotid artery elasticity parameters in patients with neurally mediated syncope.

Romatoid artritli hastalarda kardiyak sempatovagal aktivitenin kalp hızı değişkenliği ile değerlendirilmesi

A 33-year-old female presented with the typical angina symptoms of dyspnea on exertion. Five years prior, the patient had been diagnosed with familial hypercholesterolemia, as had her living siblings (a brother and a sister). The patients family history included 2 brothers and 2 sisters that died in childhood due to unknown etiology. Although she was being treated with 80 mg atorvastatin and 10 mg ezetimibe, her total cholesterol level was 607 mg/dL, her low density lipoprotein (LDL) level was 555 mg/dL, her high density lipoprotein (HDL) level was 26 mg/dL, and her triglyceride level was 126 mg/dL. Monthly LDL apheresis was started as an adjunct to drug therapy.1) On physical examination, she had xanthelasma and plantar xanthomas. Cardiac examination revealed sinus tachycardia of 120 bpm, blood pressure of 110/75 mm Hg, and grade 3/6 systolic ejection murmur that was most prominent over the second intercostal space on the right sternal border. Electrocardiography showed ST depressions in the inferolateral derivations. Transthoracic echocardiography revealed normal left ventricular systolic function, mild hypertrophy of the left ventricle, and calcified aortic stenosis with a peak gradient of 95 mm Hg and a mean gradient of 62 mm Hg (Figs. 1 and ​and2).2). Fluoroscopic examination revealed severe calcification of the aortic root (Fig. 3). Coronary angiography demonstrated a 90% narrowing in the osteal part of the left main coronary artery (Fig. 4, arrows) and 80% in the proximal right coronary artery (Fig. 5, arrow). The patient was referred for surgery.2) Intraoperatively, extensive calcifications of the whole aortic root (porcelain aorta) required a modified Bentall procedure with a mechanical valve conduit.3) The left anterior descending artery was bypassed using the left internal mammary artery, the right coronary artery using the right internal mammary artery, and both diagonal and OM using sequential saphenous veins. Despite inotropic and intraaortic balloon pump support, the patient died during the early postoperative period due to prolonged cardiopulmonary bypass and heart failure. Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5