Cerebral fat embolism: pulmonary contusion is a more important etiology than long bone fractures.

Lipid embolism is a serious and life-threatening problem and usually arises as a complication of severe trauma associated with long bone or pelvic fractures. It is generally thought that fat droplets enter the circulation at the site of fracture. In the systemic circulation, they become emboli to brain, kidney and other areas. Lipids are absorbed from the intestinal tract and transported into pulmonary tissue via thoracic duct and exposed to first catabolic procedures in the lungs. We have predicted that systemic lipid embolism may not occur unless bone fractures lead to pulmonary injury. This study was planned to investigate this hypothesis with respect to the role of pulmonary contusion and long bone fractures in the formation of cerebral fat embolism. Twenty male hybrid rabbits were included in this study. Pulmonary contusion was performed on half of the rabbits (n = 10) and femur fracture was applied to the remaining ones (n = 10). Ten days after procedure, all rabbits were sacrificed. Brain specimens were taken by frozen-section method and stained with Sudan black. Intraarteriolar lipid particles in the brain were examined microscopically. Cerebral fat embolism was detected in seven animals exposed to pulmonary contusion and only in one animal exposed to femur fracture. The mean number of branches of middle cerebral artery at midparietal level occluded with fat particles were higher in the pulmonary contusion group than in the long bone fracture group. In conclusion, we found that pulmonary contusion had more deleterious effects than long bone fracture in the formation of cerebral fat embolism.

Protective effects of cisternal irrigation on leptomeningeal and cortical structures in meningitis: an experimental study.

BACKGROUND: Meningitis, termed as foreign material collection in the subarachnoid space, leads to various meningeal, cerebral and spinal cord pathologies. Meningitis still remains a problematic disease with severe complications in spite of advanced medical technology. AIMS: In this study, we aimed to investigate the role of cisternal irrigation in the prevention of meningitis complications. SETTING AND STUDY DESIGN: Experimental study was done in the Social Security Hospital of Erzurum. Histopathological specimens were evaluated in the Pathology Department in the Ataturk University Research Hospital, Erzurum, Turkey. MATERIALS AND METHODS: This study was conducted on twelve lambs. Experimental meningitis was achieved with streptococcus pneumonia. Two animals were not treated. Ten animals were given Cefotaxime (4 x 1g/day) for 20 days, and additionally half of these animals underwent cisternal irrigation. Then, all animals were sacrificed and brains were observed histopathologically. RESULTS: Massive purulent CSF formation, hemorrhagic cortical lesions, vascular congestion, leptomeningeal and cortical adhesions and brain edema were observed in the non-irrigated group, but these findings were observed slightly or absent in the irrigated group. CONCLUSION: Meningitis can affect all central neural tissues, consequently serious central nervous system lesions may develop. The irrigation procedure may decrease the percentage and severity of meningitis complications by way of the excretion of inflamed purulent collection from the subarachnoid spaces.

Examination of the effects of thiamine and thiamine pyrophosphate on Doxorubicin-induced experimental cardiotoxicity.

BACKGROUND AND PURPOSE: To investigate the effect of thiamine and thiamine pyrophosphate on doxorubicin-induced cardiotoxicity biochemically and histopathologically and to examine whether doxorubicin cardiotoxicity is related to the conversion of thiamine into thiamine pyrophosphate and inhibition of thiamine pyrophosphokinase (TPK) enzyme. EXPERIMENTAL APPROACH: A total of 48 Albino Wistar male rats were used. Rats were divided into groups as thiamine + doxorubicin (TIA + DOX), thiamine pyrophosphate + doxorubicin (TPP + DOX), DOX, and healthy (HEA) groups. One hour after the administration of thiamine and TPP in 25 mg/kg doses, 5 mg/kg doxorubicin were injected to all groups except HEA group during 7 days. Then, the samples were collected for biochemical (glutathione [GSH], malondialdehyde [MDA], DNA damage, creatine kinase (CK), CK-MB, and troponine I [TP-I]), molecular (TPK), and histopathological examinations. KEY RESULTS: Oxidant parameters (MDA and DNA damage) decreased and antioxidant parameter (GSH) increased in TPP + DOX group. In addition, levels of CK, CK-MB, and TP-I were low in the TPP + DOX group and high in the TIA + DOX and DOX groups. Cardiac tissue was protected in TPP + DOX group, and no protective effect was observed in TIA + DOX and DOX groups. Messenger RNA expression of TPK was decreased in DOX and TIA + DOX groups. CONCLUSION AND IMPLICATIONS: The cardiotoxic effect of doxorubicin originated from the inhibition of TPK enzyme resulting in insufficient production of thiamine pyrophosphate.

Prevalence of coronary artery anomalies in patients undergoing coronary artery angiography: a review of 16768 patients. A retrospective, single-center study.

AIM: Coronary artery anomalies (CAAs) most of the time are detected at birth. The aim of this study was to report the prevalence of CAAs by investigating coronary artery angiography (CAG) images of patients admitted to the authors' hospital, a tertiary healthcare provider. METHODS: Images of 16,768 patients who underwent CAG in our hospital were evaluated regarding CAAs. RESULTS: CAAs were detected in 120 (0.7%) cases. Anomalous origin and course of arteries were observed in 86 (0.51%) cases. Seven of these cases were diagnosed with acute coronary syndrome and 5 of them were treated with angioplasty without any complication. Absence of LMCA was revealed as the most frequent anomaly in the subgroup analysis of origin and course anomalies by being spotted in 59 (49.9 %) cases of total 120. Myocardial bridge, which constituted all intrinsic coronary anomalies in our study, was determined in 18 (0.1%) patients. All of the anomalies of coronary termination were coronary artery fistulas which were seen in 16 (0.09%) of patients and 2 of them were occluded with coil. CONCLUSION: Absence of LMCA was the most frequently encountered anomaly. Although CAAs are rare cases, they can cause difficulties in CAG interventions and surgical operations. This study presents CAA frequencies of patients who performed CAG.

Reduced lecithin: cholesterol acyltransferase (LCAT) and Na+, K+, ATPase activity in diabetic patients.

OBJECTIVE: To investigate the plasma concentrations of lecithin:cholesterol acyltransferase (LCAT EC 2.3.1.43) and erythrocyte membrane Na+, K+, ATPase and the correlation of these parameters in diabetes mellitus. DESIGN AND METHODS: Na+, K+, ATPase was measured with spectrophotometric method and LCAT with radioactive method in 19 patients with insulin-dependent diabetes mellitus (IDDM), in 20 with non-insulin-dependent diabetes mellitus (NIDDM) and in 20 healthy volunteers as the control group. RESULTS: Compared with the control group, plasma LCAT concentrations were found to be decreased in both of the patient groups (p < 0.01 for both). Erythrocyte membrane Na+, K+, ATPase activities were higher in the controls than both in the NIDDM and IDDM groups (p < 0.01 and p < 0.001, respectively). There were significant correlations between LCAT and Na+, K+, ATPase in IDDM (r = 0.82, p < 0.001) and in NIDDM (r = 0.74, p < 0.001). In order to investigate the effect of cholesterol (C) and lysophosphatidylcholine (LPC) on Na+, K+, ATPase activity, this enzyme's activity was determined in erythrocyte membranes obtained from diabetic subjects after in vitro incubation with increasing concentrations of LPC and C (2-10 microM). Enzymatic activity was significantly reduced by in vitro C at increasing concentrations but significantly increased by in vitro LPC at increasing concentrations. CONCLUSIONS: From these data, it is to be concluded that the decrease in Na+, K+, ATPase activity in diabetes might be due to decreased LCAT concentrations and that may explain the development of atherosclerosis in diabetics.

Serum 1,25 dihydroxy vitamin D (1,25(OH)2D3), 25 hydroxy vitamin D (25(OH)D) and parathormone levels in diabetic retinopathy.

OBJECTIVES: To investigate whether there is a relationship between serum 1,25 dihydroxy vitamin D3 [1,25(OH)2D3], which is an inhibitor of angiogenesis, concentrations and severity of diabetic retinopathy (DR). DESIGN AND METHODS: Serum 1,25(OH)2D3, 25 hydroxy vitamin D [25(OH)D] and parathormone (PTH) concentrations were measured in diabetic patients (n = 66) and nondiabetic healthy subjects (n = 20). RESULTS: The mean serum 1,25(OH)2D3 concentration in diabetic patients was lower than that in nondiabetics (57.3+/-21.44 vs. 89.4+/-18.01 pmol/L, p<0.001); mean 1,25(OH)2D3 concentrations fell with increasing severity of DR [being 63.4+/-17.26 pmol/L for background DR (BDR), 47.7+/-13.27 pmol/L for preproliferative DR (pre-PDR), and 43.1+/-19.45 pmol/L for proliferative DR (PDR)]. Compared with the control group, serum 25(OH)D concentrations were found to be decreased in diabetic patients (p<0.001). There were negative correlations between 1,25(OH)2D3 and age (r = -0.331, p<0.01) and duration of diabetes (r = -0.255, p<0.05). CONCLUSION: From these findings, it was found that there was an inverse relationship between the severity of the retinopathy, i.e., neovascularization, and serum 1,25(OH)2D3 concentrations, being the lowest in PDR and the highest in diabetic patients without retinopathy (NDR) patients. The measurement of serum 1,25(OH)2D3 concentrations might be helpful to predict severity of DR in patients with diabetes mellitus.

Correlation of P-selectin and lipoprotein(a), and other lipid parameters in preeclampsia.

Preeclampsia is a pregnancy specific disorder and is thought to be associated with generalized endothelial dysfunction. P-selectin, an adhesion molecule, mediates the interaction of monocytes, platelets, and endothelial cells. Increased P-selectin levels and altered lipid and lipoprotein metabolism were reported in preeclampsia and during pregnancy. In order to investigate the relationship between serum P-selectin and lipoprotein(a), and other lipid parameters, 28 preeclampsia [13 severe (group I) and 15 mild preeclampsia (group II), 15 healthy pregnant (group III) and 20 non-pregnant (group IV)] women were investigated. Serum P-selectin, lipoprotein(a), total cholesterol, triglyceride, and high density lipoprotein cholesterol were measured and low-density lipoprotein cholesterol was derived. Serum P-selectin concentrations were consistently and significantly higher in the severe preeclampsia group than in the mild preeclampsia, healthy pregnancy, and non-pregnant control groups (P<0.0001, for all). The mild preeclampsia group also had increased serum P-selectin concentrations compared with the healthy pregnancy group and non-pregnant controls (P<0.05 and P<0.0001, respectively). Serum P-selectin and lipoprotein(a) levels revealed a significant and linear increase with the severity of preeclampsia. There were also significant (in groups I and II) and borderline (in groups III and IV) correlations between P-selectin and total cholesterol. The present study suggests that P-selectin may be an additional risk marker for preeclampsia, and may be useful in distinguishing women with mild and severe preeclampsia and normal pregnancy.

Effect of corticosteroid therapy on serum and CSF malondialdehyde and antioxidant proteins in multiple sclerosis.

OBJECTIVE: Multiple sclerosis (MS) is a disease characterised by perivascular infiltrates and demyelination of the white matter in the central nervous system. Although the precise cause of MS remains unknown, some investigations have been carried out on antioxidant mechanisms in these patients. METHODS: In this study, malondialdehyde (MDA), as a lipid peroxidation marker, and ceruloplasmin (Cp) and transferrin (Trf), as antioxidant proteins, levels were determined in cerebrospinal fluid (CSF) and serum of 30 MS patients before and after corticosteroid therapy and in 20 control subjects. Transferrin and Cp levels were measured by the nephelometric method and MDA was measured spectrophotometrically. RESULTS: Mean MDA(serum) and MDA(CSF) levels were found to be highest in the pretreatment group and lowest in the control group. Although there was no significant difference in terms of serum Trf level, serum Cp was found higher in pre- and posttreatment groups than in the control groups. Ceruloplasmin and Trf levels of CSF were not detectable using the nephelometric method. A significant correlation was found between MDA(CSF) and MDA(serum) in the pretreatment group (r=0.58). CONCLUSIONS: These data revealed that lipid peroxidation was increased in serum and particulary in CSF of MS patients and was reduced with corticosteroid therapy.

Serum E-selectin and beta 2-microglobulin levels in Behçet's disease.

Behçet's disease is a systemic vasculitis of unknown aetiology. Endothelial cell injury plays an important role in the pathogenesis and immunopathology of systemic vasculitises, but an immunopathogenic basis is also probable in Behçet's disease. E-selectin is an indicator of endothelial injury, and beta 2-microglobulin (beta 2M) is increased in immunological disorders. The serum concentrations of these two markers were determined in 40 patients with active Behçet's disease and 40 healthy controls. E-selectin was determined by enzyme-linked immunosorbent assay and beta 2M was determined by the nephelometric method. The mean (+/- SD) serum concentration of E-selectin was 122.13 +/- 62.32 ng/ml and that of beta 2M was 0.31 +/- 0.05 mg/dl. Both concentrations were statistically significantly increased in patients with Behçet's disease compared with controls. More comprehensive studies are needed to determine whether these parameters are useful indicators of the activity of Behçet's disease.

Gastroprotective and antiulcerogenic effects of Rumex patientia L. extract.

Gastroprotective and antiulcerogenic effects of the aqueous extract of Rumex patientia L. roots (D-1) were investigated in rats and compared to non-steroidal antiinflammatory drugs (NSAIDs). Whereas oral administration of high doses of NSAIDs caused stomach damage, D-1 (aqueous extract of Rumex patientia roots, 150 and 500 mg/kg) and nimesulid (100 and 300 mg/kg) did not cause any damage. In rats, the number of stress ulcers induced by the administration of 150 mg/kg of D-1 were identical to that of the control group. However, compared to the control group, the number of stress ulcers decreased 1.9 times and the size of ulceration areas decreased 1.1 times in the group treated with 500 mg/kg of D-1.

Estradiol and nitric oxide in men over 50 years of age.

We measured the circulatory levels of nitric oxide and estradiol in men over 50 years with estrogenisation findings. We investigated relation between nitric oxide, which is the principal signal for relaxation of vascular smooth muscle cells, and estradiol levels in serum in men over 50 years with estrogenisation. This study included 14 men with (group 1) and 20 without estrogenisation findings (group 2). Mean nitric oxide and estradiol levels were found to be significantly lower in group 2 than group 1. Group 2 had lower levels sex-hormone binding globin and higher both systolic and diastolic blood pressure values than group 1. There was a significant correlation between nitric oxide and estradiol in esrogenisation group.

The importance of serum transferrin receptor level in the diagnosis of functional iron deficiency due to recombinant human erythropoietin treatment in haemodialysis patients.

In haemodialysis (HD) patients, functional iron deficiency frequently appears due to recombinant human erythropoietin (r-HuEPO) treatment. However, the diagnosis of iron deficiency is not always easy in such patients. Recent studies have shown that the serum transferrin receptor (s-TfR) level is a sensitive, quantitative measure of tissue iron deficiency. In this study, we examined the changes in s-TfR levels in patients with iron deficiency anaemia due to r-HuEPO treatment. We compared s-TfR levels of 24 patients with i.v. administered r-HuEPO (50-70 U/kg/dose) at the end of each dialysis session (three times a week) and diagnosed as having iron deficiency anaemia by routine laboratory methods (ferritin <50 microg/l and transferrin saturation <16%) with s-TfR levels of 32 patients not receiving r-HuEPO and without iron deficiency anaemia. Also, 40 healthy volunteer subjects were included in the study as a control group. Serum ferritin and transferrin receptor levels were measured with ELISAs using monoclonal reagents. There were no differences between the two groups with and without iron deficiency anaemia with respect to mean age, body weight, haemodialysis duration, haemoglobin and serum creatinine levels (p>0.05). For s-TfR levels, while no difference was present between the control and the non-iron deficiency groups (p>0.05), the iron deficiency group had higher s-TfR values than those of both the control and non-iron deficiency groups (p<0.001). Besides, there was an inverse correlation between haemoglobin and s-TfR levels in patients with iron deficiency anaemia (r = -0.85, p<0.0001). We conclude that the measurement of s-TfR levels may be useful in the diagnosis of functional iron deficiency in haemodialysis patients receiving r-HuEPO.

The prevention of ischemia/reperfusion induced oxidative damage by venous blood in rabbit kidneys monitored with biochemical, histopatological and immunohistochemical analysis.

The purpose of this study was to investigate the biochemical, histopathological and immunohistochemical effects of venous blood on ischemia/reperfusion-induced oxidative DNA damage and mutation in rabbit kidneys in comparison to melatonin treatment, which has a known protective effect against ischemia/reperfusion (IR) injury. The rabbits were divided into five groups: renal ischemia (RI), renal ischemia-reperfusion (RIR), renal ischemia-venous blood-reperfusion (RIVR), melatonin + renal ischemia-reperfusion (MRIR), and the healthy sham control group (HG). Melatonin (2.5 mg/kg delivered intraperitoneally) was administered one hour prior to ischemia. In the RIVR group, 1 ml of venous blood was administered 5 minutes before the reperfusion. The xanthine oxidase activity in the kidney tissue was determined as 53.50 ± 1.72, 31.00 ± 6.39, 45.66 ± 9.20, 28.66 ± 6.05 and 14.33 ± 1.28 U/g protein; the MDA levels were 6.32 ± 0.02, 19.50 ± 1.33, 7.00 ± 0.96, 7.50 ± 0.76 and 4.75 ± 0.34 mmol/g protein; and the GSH levels were 4.50 ± 1.08, 2.76 ± 0.13, 5.48 ± 0.22, 4.93 ± 0.55 and 6.98 ± 0.33 nmol/g protein in the RI, RIR, RIVR, MRIR and HG groups, respectively. Blood, blood urea nitrogen (BUN) and creatinine levels were classified as high only in the RIR group. The MRIR and RIVR groups, in which oxidative stress was best suppressed, had much milder histopathological and immunohistochemical findings compared to the RIR group. This study has revealed that it is useful to initiate reperfusion of the ischemic tissue with venous blood.

Endurance training attenuates the oxidative stress due to acute exhaustive exercise in rat liver.

The aim of this study was to investigate whether an 8-week treadmill training attenuates exercise-induced oxidative stress in rat liver. Male rats were divided into untrained and trained groups. Endurance training consisted of treadmill running at a speed of 2.1 km/h, 1.5 h/day, 5 days a week for 8 weeks. To see the effects of endurance training on acute exhaustive exercise induced oxidative stress, untrained and trained rats were further devided into two groups: animals killed at rest and those killed after acute exhaustive exercise, in which the rats run at 2.1 km/h (10% uphill) until exhaustion. Acute exhaustive exercise increased malondialdehyde level in untrained but not in trained rats. It decreased the activity of glutathione peroxidase and total (enzymatic plus non-enzymatic) superoxide scavenger activity in untrained rats and catalase activity in trained rats. However, it did not affect glutathione S-transferase, glutathione reductase, superoxide dismutase and non-enzymatic superoxide radical scavenger activities in both trained and untrained rats. On the other hand, endurance training decreased glutathione peroxidase and glutathione S-transferase activities. The results suggested that endurance training attenuated exercise-induced oxidative stress in liver, probably by preventing the decreases in glutathione peroxidase and total superoxide scavenger activities during exercise.

Serum nitric oxide levels in children with Wilson's disease.

BACKGROUND: It is known that the synthesis of nitric oxide (NO) is increased in cirrhosis. In humans, NO levels were investigated mostly in adult cirrhotics with portal hypertension. Because there is no study investigating NO status in childhood cirrhosis and because Wilson's disease (WD) has some specific properties due its copper overload with powerful prooxidant action, we aimed to determine serum NO levels in children with untreated WD and to investigate the probable relationship between NO level and both clinical presentation and the severity of the disease. METHODS: Twenty children with newly diagnosed WD and sex and age matched 14 healthy children were included. Serum NO levels were determined by spectrophotometric method using Griess reaction. RESULTS: Serum NO level of children with WD and of healthy children were 156.8 +/- 28.2 and 135.6 +/- 21.17 micromol/l respectively (p = 0.024). Serum NO level was not different in respect with the clinical presentation, such as presence of ascites, neurological involvement, cholestasis or haemorrhagic diathesis. Severity of the disease did not influence the serum NO level. Serum NO levels of patients with low and normal ceruloplasmin levels were not different. CONCLUSION: It was demonstrated that serum NO level was higher in children with WD compared to healthy children. Because we could not find a correlation between raised NO and any clinical or biochemical findings in the present study, we concluded that NO could not be used as a prognostic or predicting factor in children with WD.

Correlation between the serum values of soluble intercellular adhesion molecule-1 and total sialic acid levels in patients with breast cancer.

BACKGROUND: In this study, we aimed to investigate serum total sialic acid (TSA) and soluble intracellular adhesion molecule-1 (sICAM-1) levels in breast cancer patients to find a correlation with the cancer stage. METHODS: The parameters from sera of 61 patients with breast cancer were measured. The concentrations of serum sICAM-1 and TSA were measured in serum samples from 61 patients with breast cancer and 25 healthy control subjects using enzyme-linked immunoassay and thiobarbituric acid method. RESULTS: Mean serum sICAM-1 and TSA levels were significantly higher in the total patient group than in the control group (p < 0.001). Thus, the correlation between TSA and sICAM-1 became more significant in metastatic breast cancer. There were significant positive correlations between TSA and sICAM-1 in stage I+II (r = 0.59, p < 0.05), stage III (r = 0.47, p < 0.05), and stage IV (r = 0.89, p < 0.01), and total patient group (r = 0.56, p < 0.001). CONCLUSION: SerumsICAM-1 and TSA levels were higher in patients with breast cancer, than that of the control group, and also in the metastatic breast cancer group. Significant correlations between serum sICAM-1 and TSA may reflect the similar function of these molecules as adhesion molecules, and their roles in the carcinogenesis of breast cancer as well as metastasis.