Active breathing control guided stereotactic body ablative radiotherapy for management of liver metastases from colorectal cancer.

Background: Liver metastases may occur during the course of several cancer types and may be associated with significant morbidity and mortality. There is paucity of data regarding the utility of Active Breathing Control (ABC) guided Stereotactic Ablative Body Radiotherapy (SABR) for management of Liver Metastases from Colorectal Cancer (LMCC). Our aim is to investigate the role of ABC guided SABR for management of liver metastases. Patients and methods: 42 liver metastases of 29 patients treated with ABC guided SABR between February 2015 and October 2018 were retrospectively assessed for local control (LC), overall survival (OS), and toxicity outcomes. Primary endpoint was LC. Secondary endpoints were OS and treatment toxicity. Results: At a median follow up duration of 16 months (range: 9-74 months), median OS was 20 months and 3 patients were still alive at last follow up. 1-year OS was 83% and 2-year OS was 28%. LC rates were 92% and 61% at 1 and 2 years, respectively. Comparative analysis of Biological Effective Dose (BED) values revealed that higher BED10 values were associated with higher LC rates (p=0.007). While LC rates for BED10 ≥ 100 Gray (Gy) were 94% and 86% at 1 and 2 years, corresponding LC rates for BED10 < 100 Gy were 89% and 36%, respectively with statistical significance (p=0.007). Assessment of acute and late toxicity outcomes revealed that most common toxicity was fatigue, however, no patients had ≥ grade 3 toxicity. Conclusion: ABC guided SABR is an effective and safe treatment modality for LMCC management.

Lawsonia inermis - an alternative treatment for hyperthyroidism?

AIM: The goal of our study was to determine the effects of Lawsonia inermis (L. inermis) in mice, in which hyperthyroidism had been caused by thyroid stimulant hormone (TSH). MATERIAL AND METHOD: The first phase of the study aimed to detect the effects of L. inermis on the amount of ionized hydrogen (pH) in cells. For this aim, the effect of L. inermis on pH levels in the liver tissues of mice, in whom Escherichia coli (E. coli) had caused peritonitis, was examined. In the second phase of the study, the effect of L. inermis on the serum T4 levels in the 24th and 48th hour in mice, whose thyroid cells showed an increased activity by TSH was measured. RESULTS: In the first phase, in mice, in whom E.coli had caused peritonitis, the pH in the liver tissue of the group that had been given L. inermis was found to be significantly alkaline (p<0.05). In the second phase, in mice, in whom TSH had caused hyperthyroidism, it was noted that serum total T4 levels were significantly lower than in the group that had been given L. inermis in the 48th hour (p<0.05). CONCLUSION: In our study, we detected that L. inermis significantly decreased serum total T4 levels in the 48th hour in mice in whom TSH had caused hyperthyroidism. These results suggest that L. inermis can be used as an alternative treatment for the Graves' disease (Tab. 2, Fig. 1, Ref. 34).

High sensitive C-reactive protein: a new marker for urinary tract infection, VUR and renal scar.

BACKGROUND: Accurate diagnosis and early treatment of urinary tract infections (UTI) are important because of its association with renal scarring (RS). AIMS: To investigate the serum levels of fibronectin, high sensitive CRP (Hs-CRP), urinary fibronectin, and beta-2 microglobulin (beta2MG) levels in patients with UTI and relationship of these parameters with VUR (vesicoureteral reflex) and RS. PATIENTS AND METHODS: 72 patients were included in study and divided into three groups: Group I (20 patients with first UTI); Group II (16 patients with recurrent UTI with VUR); Group III (16 patients without UTI with VUR). RESULTS: Serum and urine fibronectin levels were similar in all study groups and controls. Urinary beta2MG levels were higher in Group II (302±179 ng/ml) than in the Group I (134±90 ng/ml) (p < 0.001). Moreover, beta2MG levels were similar in Group II (302±179 ng/ml) and group III (218±147 ng/ml). By contrast, beta2MG levels were higher in Group III (218±147 ng/ml) than in the controls (64±32 ng/ml) (p < 0.001). Hs-CRP levels were higher in Group I (1.8±2.7 mg/L), Group II (23.1±32 mg/L), and III (0.4±0.1 mg/L) than the controls (0.2±0.08 mg/L) (p < 0.001). Hs-CRP levels were higher in Group II (23.1±31.9 mg/L) than in the Group I (1.8±2.7 mg/L) (p < 0.001). Hs-CRP levels were higher in Group I (1.8±2.7 mg/L) and Group II (23.1±31.9 mg/L) than in the Group III (0.4±0.1 mg/L) (p < 0.001). Hs-CRP levels were higher in group III (0.37±0.17 mg/L) than in the controls (0.2±0.08 mg/L) (p < 0.001). Hs-CRP (18.8±25 mg/L) and beta2MG levels (349.4±128.5 ng/ml) were different in UTI with RS from the controls (0.2±0.08 mg/L and 64±32 ng/ml respectively, p < 0.001). Fibronectin levels were similar in patients with and without RS. CONCLUSIONS: Increased urinary beta2MG and Hs-CRP were observed in initial UTI and recurrent UTI with VUR. Fibronectin levels were not useful for detection of first and recurrent UTI with VUR and RS. Elevated Hs-CRP levels can help us predetermine the patients with VUR prone to proceed to clinical chronic renal failure.

Preoperative serum vascular endothelial growth factor (VEGF) in ovarian masses.

PURPOSE OF THE INVESTIGATION: To determine the diagnostic value of serum vascular endothelial growth factor (VEGF) in the preoperative assessment of the nature of ovarian masses. MATERIALS AND METHODS: A prospective cohort study was conducted from August 2001 to September 2002 on 40 premenopausal and 23 postmenopausal patients with ovarian masses. During preoperative workup, patient age, serum Ca-125 levels, serum VEGF levels, and tumor volume based on ultrasonographic examination were determined. Laparoscopic (n=23) or laparotomic (n=39) approaches were undertaken to obtain the final pathologic result. According to the final ovarian pathology, follicular cysts, corpus luteum cysts and endometriomas were grouped as non-neoplastic ovarian masses (n=40, group I). Serous or mucinous cyctadenomas, dermoid tumors and fibromas were allocated into the neoplastic benign ovarian mass group (n=10, group II). Primary malignant ovarian neoplasms were categorized into the neoplastic-malign group (n=12, group III). RESULTS: Mean ages of cases among groups I, II and III were 39.0 +/- 2.0, 42.2 +/- 5.2 and 56.9 +/- 4.2, respectively. As age of the cases enrolled in this sudy increased, the more likely was the occurrence of neoplastic malign ovarian pathologies (p < 0.001). Among postmenopausal cases diagnosed with an ovarian mass, serum Ca-125 levels were 113.5 +/- 20 IU/ml compared to those in premenopausal cases (85.8 +/- 16.0, p = 0.05). The values for serum VEGF values among pre- and postmenopausal ovarian masses were 46.2 +/- 6.7 pg/ml and 68.2 +/- 7.9, respectively (p = 0.04). In group I, serum VEGF levels of endometriomas (56.5 +/- 1.5 pg/ml) were higher compared to those of follicular or corpus luteum cysts (30.6 +/- 2.8, p = 0.05). In contrast, tumor size appeared to be larger in non-endometriotic. non-neoplastic cysts (10.1 +/- 2.0 cm), compared to endometriomas (6.4 +/- 0.6 cm, p < 0.01). Serum VEGF levels of group III were higher than other groups (p < 0.001). With respect to the discriminating benign or malign nature of the mass, with a specific cut-off value of serum VEGF level of 68.7 pg/ml, the sensitivity, specificity, positive and negative likelihood ratios were 92.3%, 88.0%, 3.3 and 0.1, respectively. For serum Ca-125 levels, the sensitivity, specificity, positive and negative likelihood ratio with a statistically relevant cut-off value of 102 IU/ml were, 76.9%, 76.0%, 3.21 and 0.3, respectively. Area under curve (AUC) for serum VEGF and Ca-125 values were 0.938 (95% CI: 0.81-0.96) and 0.769 (95% CI: 0.64-0.86), respectively (p = 0.02). Among the postmenopausal group, AUC for serum VEGF and Ca-125 was detected as 0.902 (95% CI: 0.70-0.98) and 0.873 (95% CI: 0.66-0.91) (p = 0.14). CONCLUSION: Serum VEGF has the potential to be considered as a tumor marker with a good diagnostic relevance in differentiating the nature of ovarian masses.

Early blunted cortisol response to insulin induced hypoglycaemia in familial Mediterranian fever.

OBJECTIVE: To study cortisol, adrenocorticotropic hormone and C-reactive protein responses to specific stimuli in familial Mediterranean fever (FMF). METHODS: For the purpose of measuring cortisol, ACTH, and CRP responses to insulin induced hypoglycaemia during attack-free periods, 14 FMF patients, 11 patients with ankylosing spondylitis or Behçet's disease as disease controls (DC), and a further 10 healthy control subjects (HC) were involved in this study. None of the subjects had ever received corticosteroids before this study. Cortisol and ACTH levels were measured by chemiluminescence enzyme immunoassay. RESULTS: No attack was observed among FMF patients during the test. No significant difference in the mean cortisol values after insulin induced hypoglycaemia was observed between the groups involved at any stage of the test. The integral cortisol response to hypoglycaemia expressed as the AUC (0-90 min) was found not to differ among the study groups (1827 +/- 115.6 in FMF; 2196 +/- 205.4 in DC, p = 0.12; 1771 +/- 98.4 in HC, p = 0.9). The delta response of cortisol to insulin induced hypoglycaemia wasfound to be statistically lower (-4 +/- 0.8 mg/dl vs. -1.9 +/- 0.7 microg/dl; p<0.03) only for the 0 to 30 min interval in patients with FMF compared to HC respectively. Similar results, though of no statistical significance, were also found for the 0 to 45 min interval (1.17 +/- 2.2 microg/dl in FMF patients vs. 3.3 +/- 2 microg/dl in HC; p = 0.6). The mean basal CRP level of patients with FMF was remarkably higher than that in HC. Although the mean CRP level at 90 min for FMF cases with cortisol levels under 12 microg/dl at 30 min was found to be higher than those with cortisol levels over 12 microg/dl at 30 min, no significant difference was observed. CONCLUSION: An early blunted cortisol response observed in a stressful situation in FMF patients may well account for the curious relationship between stress and an inflammatory reaction and/or attack. Furthermore, the fact that the CRP level was relatively higher in FMF patients with lower cortisol levels might also highlight the importance of endogen cortisol in the inflammatory feature of this disease.

Protective effect of fucoidin (a neutrophil rolling inhibitor) on ischemia reperfusion injury: experimental study in rat epigastric island flaps.

The objective of this study was to examine whether a decrease in neutrophil-mediated tissue injury using Fucoidin, a nontoxic neutrophil rolling inhibitor, would improve flap survival in an island flap model after ischemia-reperfusion. Myeloperoxidase activity (an indirect index of tissue neutrophil count) and malondialdehyde (an indicator of lipid peroxidation), the degree of neutrophil infiltration by direct counting, and macroscopic flap survival were assessed in the flap after arterial ischemia-reperfusion. Epigastric island skin flaps were elevated in 56 rats. The first group of 21 rats was subjected to 6 hours of arterial ischemia. The second group of 21 rats was subjected to 10 hours of arterial ischemia, and the rest of the rats were used as nonischemic controls (sham flaps). For inhibiting neutrophil rolling, a nontoxic polysaccharide agent-Fucoidin-was used. Each ischemic group was divided further into three subgroups: Subgroup I (control rats) received saline, subgroup II received 10 mg per kilogram Fucoidin, and subgroup III received 25 mg per kilogram Fucoidin before reperfusion. The results were evaluated as tissue neutrophil counts, tissue malondialdehyde content, tissue myeloperoxidase activity, and flap survival. Neutrophil counts and tissue myeloperoxidase activity were decreased significantly (p <0.001) in subgroup III, but lipid peroxidation by means of tissue malondialdehyde content was not affected by Fucoidin administration. The authors conclude that administration of Fucoidin before reperfusion can limit tissue injury apparently by inhibiting neutrophil rolling in a dose-dependent manner.

Soluble interleukin-2 receptor and interleukin-8 plasma levels during and after cardiopulmonary bypass: correlations with creatine kinase and creatine kinase MB.

In this study, soluble receptor of interleukin-2, interleukin-8, creatine kinase, and creatine kinase MB isoenzyme levels were determined serially before, during, and after cardiopulmonary bypass in blood samples of 24 patients. Interleukin-2 receptor levels were 683+/-80 U/ml in the preoperative period and 640+/-60 U/ml during hypothermia. Subsequently, these levels increased significantly at the end of the procedure (791+/-70 U/ml, P<0.01), remaining elevated 1 h after (882+/-92 U/ml, P<0.001) and reaching peak values 24 h postoperatively (1,752+/-200 U/ml, P<0.001). Preoperative plasma values of interleukin-8 were 230+/-43 pg/ml. Interleukin-8 concentrations were 185+/-25 pg/ml during hypothermia. The peak interleukin-8 levels were observed at the end of cardiopulmonary bypass (754+/-94 pg/ml, P<0.001) and tended to decrease 1 h after the procedure (643+/-76 pg/ml, P<0.001), declining to preoperative values, 24 h postoperatively (273+/-41 pg/ml). Interleukin-2 receptor levels correlated well with creatine kinase levels during the procedure. Furthermore, creatine kinase MB levels were correlated with interleukin-2 receptor values only at the end and 1 h after completion of cardiopulmonary bypass. We concluded that interleukin-8 and Interleukin-2 receptor levels are elevated after cardiopulmonary bypass and may contribute to myocardial injury as reflected by increased levels of creatine kinase and creatine kinase MB and correlations between interleukin-2 receptor and both creatine kinase and creatine kinase MB levels.

Fluticasone propionate and budesonide do not influence bone metabolism in the long term treatment of asthma.

BACKGROUND: Inhaled corticosteroids (ICS) are recommended in the treatment of asthmatic patients. They have been said to be efficacious in the treatment of asthma in respect to cortisol and bone metabolism. METHODS: The effects of the two inhaled corticosteroid, budesonide (BUD) and fluticasone propionate (FP) on bone metabolism, morning cortisol and their effects on the clinical parameters (FEV1, diurnal variation of peak expiratory flow rate = PEFR and log PC20) were examined in a group of 16 asthmatic patients. Eight patients used 800 micrograms/daily BUD and 8,400 micrograms/daily FP during 6 months period. RESULTS: Both BUD and FP improved clinical parameters as determined by FEV1 (p < 0.05) and PEFR (p < 0.01). There was no difference in respect to log PC20 values in either group (p > 0.05). Both treatments didn't change morning cortisol (p < 0.05). Both FP and BUD didn't change any indices of bone formation as determined by serum alkaline phosphatase, bone alkaline phosphatase, osteocalcin and carboxyterminal propeptide of type 1 procollagen and bone resorption as determined by urinary calcium and deoxypyridinoline (p > 0.05). In addition there was no significant effect on calcium and phosphate metabolism (serum calcium, phosphate and parathyroid hormone). CONCLUSION: As a result, having no adverse effect on bone metabolism and adrenal function, in the regard to clinical efficacy, FP is as effective as the double dose of BUD on PEFR and FEV1.

Diagnostic value of CEA, CA 15-3, CA 19-9, CYFRA 21-1, NSE and TSA assay in pleural effusions.

The aim of this study was to evaluate the individual and combined diagnostic utility of six tumor markers in patients with pleural effusion. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), carbohydrate antigen 19-9 (CA 19-9), cytokeratin fragment 19 (CYFRA 21-1), neuron-specific enolase (NSE) and total sialic acid (TSA) were assayed in 74 patients with pleural effusions (44 malignant and 30 benign). All tumor markers except TSA and NSE were increased in both serum and pleural fluid of patients with malignant diseases. Using the cut-off values 3 ng/ml, 14 U/ml, 5 U/ml, 8 ng/ml and 70 mg/dl for pleural fluid CEA, CA 15-3, CA 19-9, CYFRA 21-1 and TSA, respectively, the sensitivity (%) and specificity (%) of these tumor markers were as follows: CEA; 52/77, CA 15-3; 80/93, CA 19-9; 36/83, CYFRA 21-1; 91/90, TSA; 80/67, for differentiating malignant effusions from benign. When CA 15-3 and CYFRA 21-1 combined, the sensitivity and specificity were increased (100 and 83%, respectively). Classifying the malignant effusions as bronchial carcinoma and malignant pleural mesothelioma, CEA was shown to have the highest sensitivity and specificity (88 and 90%, respectively) while the combination of CEA with other tumor markers increased sensitivity but decreased specificity. According to our results, tumor markers are not suitable for the differential diagnosis of malignancy.

Fluticasone propionate and budesonide does not influence bone metabolism in the long term treatment of asthma

Background: inhaled corticosteroids (ICS) are recommended in the treatment of asthmatic patients. They have been said to be efficacious in the treatment of asthma in respect to cortisol and bone metabolism. Methods: the effects of the two inhaled corticosteroid, budesonide (BUD) and fluticasone propionate (FP) on bone metabolism, morning cortisol and their effects on the clinical parameters (FEV1, diurnal variation of peak expiratory flow rate = PEFR and log PC20) were examined in a group of 16 asthmatic patients. Eight patients used 800 μg/daily BUD and 8,400 μg/daily FP during 6 months period.Results: both BUD and FP improved clinical parameters as determined by FEV1 (p < 0.05) and PEFR (p < 0.01). There was no difference in respect to log PC20 values in either group (p > 0.05). Both treatments didn't change morning cortisol (p < 0.05). Both FP and BUD didn't change any indices of bone formation as determined by serum alkalin phosphatase, bone alkalin phosphatase, osteocalcin and carboxyterminal propeptide of type 1 procollagen and bone resorption as determined by urinary calcium and deoxypyridinoline (p > 0.05). ln addition there was no significant effect on calcium and phosphate metabolism (serum calcium, phosphate and parathyroid hormone). Conclusion: as a result, having no adverse effect on bone metabolism and adrenal function, in the regard to clinical efficacy, FP is as effective as the double dose of BUD on PEFR and FEV1 (AU)

Antecedentes: en el tratamiento de pacientes asmáticos se recomiendan corticoides inhalados (CSI).Se ha documentado que son eficaces en el tratamiento del asma con respecto al cortisol y al metabolismo óseo.Métodos: en un grupo de 16 pacientes asmáticos, se examinaron los efectos de dos corticoides inhalados, budesonida (BUD) y propionato de fluticasona (PF), sobre el metabolismo óseo, cortisol matutino y sus efectos sobre los parámetros clínicos (FEV1) y variación diurna de la tasa de flujo espiratorio máximo (PEFR y log PC20). Durante un período, de 6 meses, 8 pacientes utilizaron 800 g/día de BUD y 8, 400 g/día de PF.Resultados: tanto la BUD como el PF mejoraron los parámetros clínicos según lo determinado mediante el FEV1 (p 0,05). Ninguno de ambos tratamientos modificó los valores de cortisol matutino (p 0,05). Además, no se identificó un efecto significativo sobre el metabolismo del calcio y del fosfato (valores séricos de calcio, fosfato y paratormona).Conclusión: como consecuencia, puesto que el PF carece de efectos adversos sobre el metabolismo óseo y la función suprarrenal, desde un punto de vista clínico, es tan eficaz como una dosis doble de BUD sobre el PEFR y el FEV1 (AU)

Octreotide prevents postoperative adhesion formation by suppressing peritoneal myeloperoxidase activity.

BACKGROUND/AIMS: Despite a great deal of effort to prevent the adhesion formation, an ideal therapy or drug remains to be identified. The aim of this study was to investigate the effect of octreotide on adhesion prevention and neutrophil infiltration. METHODOLOGY: Fourteen female Sprague-Dawley rats were subjected to a standard intraabdominal adhesion model operation. Octreotide group (n = 7) rats were administered 20 micrograms/kg octreotide intramuscular while control group (n = 7) rats were given no treatment. On the 10th day the rats were decapitated and the degrees of adhesions were recorded and the plasma, peritoneal fluid, peritoneal tissue myeloperoxidase levels were determined. RESULTS: Intraabdominal adhesions and peritoneal tissue myeloperoxidase levels were significantly reduced in the octreotide group as compared to saline treated adhesion group. CONCLUSIONS: We concluded that octreotide reduces the intraabdominal adhesions. This adhesion-preventive effect may be due to the inhibition of neutrophil infiltration.

Octreotide inhibits myeloperoxidase activity in rat uterus.

OBJECTIVE: Several studies have demonstrated that synthetic somatostatin-analog octreotide could affect the functions of the hypothalamus, anterior pituitary gland and ovary. To date, very few studies on the effect of octreotide on uterine function have been reported. We investigated the effects of octreotide on neutrophil functions in rat uterus. METHODS: Twenty Sprague-Dawley rats were subjected to a standardized uterine horn excision. To evaluate the effect of octreotide, the rats were assigned randomly to treatment (octreotide 20 microgr/kg, SC) and control groups. After two weeks relaparotomy was performed and contralateral uterine horns were excised in the same standardized manner. The excised segment was washed in cold saline solution and was frozen in liquid nitrogen immediately and homogenized. Myeloperoxidase (MPO) and elastase concentrations were determined in homogenates of uterine horns. The data were analyzed by Mann-Whitney U test. RESULTS: In octreotide-treated rats the MPO activity was significantly reduced after 14 days (14.79+/-2.08 versus 6.62+/-1.72 U/mg protein; p=0.012). There was also a significant difference in mean MPO levels between the two groups at the end of the experiment (6.62+/- 1.72 versus 18.56+/-2.49 U/mg protein; p=0.001). The octreotide administration did not affect elastase levels significantly. No differences were found in mean elastase levels in both groups after the treatment. CONCLUSION: This study demonstrates that octreotide has a significant effect on the neutrophil function in terms of MPO activity in rat uterus. Further studies are needed to clarify the clinical relevance of the inhibitory effect of octreotide in the uterus and the possibility of its applications.

Coronary risk factors in Turkish schoolchildren: randomized cross-sectional study.

BACKGROUND: There is a strong association between the extent of atherosclerotic lesions in aorta and coronary arteries and antemortem risk factors in children and young adults. Cardiovascular diseases are the most common cause of death in adults in Turkey. However, the data about the extent of coronary risk factors in Turkish children is very limited. The aim of this cross-sectional study was to investigate the prevalence of coronary risk factors in Turkish schoolchildren living in Eskisehir, Turkey. METHODS: A randomly selected population of 4026 schoolchildren, aged between 7 and 18 years, residing in urban and rural parts of Eskisehir were evaluated for coronary risk factors, using previously predicted risk threshold values. RESULTS: Hypertension was found in 4.8% of the girls and 3.8% of the boys, 14.9% of the girls and 10.8% of the boys had abnormal lipid values, 18.2% of the girls and 26.4% of the boys had elevated total body fat percentages, 20.7% of the girls and 14.5% of the boys had physical inactivity and 3.8% of the girls and 11.4% of the boys were regular smokers. Urban children had higher rates of hypercholesterolemia; however, rural children had higher rates of physical inactivity. When the modifiable risk factors were considered, excluding family history, 47.7% of the children had at least one risk factor and 11.7% of them exhibited two or more risk factors. CONCLUSIONS: Turkish schoolchildren living in Eskisehir had considerably high levels of coronary risk factors. The interventional measures established in childhood, during which the lifestyle and habits responsible for coronary heart diseases are acquired, will be very effective for preventing and modifying the risk factors predisposing children to coronary heart disease.

Clinical, biochemical and histochemical assessment of pretreatment with glucose-insulin-potassium for patients undergoing mitral valve replacement in the third and fourth functional groups of the New York Heart Association.

In this study, the potentially beneficial effects of preoperative treatment with glucose, insulin and potassium in a randomized series of 30 consecutive patients undergoing mitral valve replacement, who were in the third and fourth functional groups of the New York Heart Association scale, were investigated. Fifteen patients received glucose, insulin and potassium, and 15 patients received the same volume of normal saline. The characteristics of the groups did not differ. Papillary muscle-biopsy samples were obtained at the time of surgery and analysed for glycogen, both biochemically and histochemically. The clinical course of all patients was monitored closely during the first 24 hours after surgery. The patients receiving glucose, insulin and potassium had higher glycogen levels (43 +/- 13.54 micromol/g) (P < 0.001). In addition, they required less inotropic pharmacological support (scored by the Gradinac method), had fewer ventricular arrhythmias and exhibited improved haemodynamic indices: cardiac output increased (P < 0.025 to P < 0.005), while systemic vascular resistance decreased (P < 0.001). Pretreatment with glucose, insulin and potassium did not, however, affect the patients' postoperative wedge pressure and mortality. The results of this study suggest that glucose, insulin and potassium pretreatment may be beneficial in unfit patients undergoing mitral valve replacement.

Measurement of troponin T to detect cardioprotective effect of trimetazidine during coronary artery bypass grafting.

BACKGROUND: The aim of the present study was to evaluate potential myocardial protection by trimetazidine by measurement of the cardiac marker protein troponin T (TnT) during coronary bypass operations. METHODS: We conducted a double-blind, placebo-controlled study on 30 randomized patients who had aorta-coronary artery bypass operations. The TMZ group was composed of 15 patients and the placebo group of 15 patients in New York Heart Association class III or IV. Pretreatment was started 3 weeks preoperatively with trimetazidine (60 mg orally per day) or the placebo. In the trimetazidine TMZ group, there were 2 women and 13 men with a mean age of 57.1+/-2.2 years and mean cross-clamp time of 44+/-1.8 minutes. In the placebo group, there were 5 women and 10 men with a mean age of 58.4+/-1.2 years and a mean cross-clamp time of 42+/-2.4 minutes. Serial blood samples were collected before and after the operation, and serum concentrations of cardiac TnT were measured. RESULTS: The preoperative serum concentration of TnT was 0 to 0.39 ng/mL in all patients. The mean TnT levels were measured 5 minutes after completion of cardiopulmonary bypass (1.5+/-0.3 ng/mL) and 12 (1.4+/-0.1 ng/mL), 24 (0.9+/-0.1 ng/mL), and 48 hours postoperatively (0.1+/-0.1 ng/mL) in the trimetazidine group. Troponin T levels in the placebo group measured at the same time periods were 4.4+/-0.4, 4.8+/-0.7, 2.8+/-0.4, and 0.7+/-0.1 ng/mL. In the trimetazidine group, TnT levels were significantly less than those of the placebo group (p < 0.001). The levels of TnT were tested by creatine kinase-MB levels of both groups. Mean cardiac index was evaluated in all patients preoperatively and postoperatively. There was no significant difference in perioperative hemodynamics (blood pressure and cardiac index) between groups. CONCLUSIONS: These results obtained by measurement of cardiac TnT suggested that pretreatment with trimetazidine reduces ischemic-reperfusion damage during coronary bypass operations but did not affect postoperative hemodynamics.

The effect of Ginkgo biloba on the activity of catalase and lipid peroxidation in experimental strangulation ileus.

This study was designed to assess the therapeutic effect of Ginkgo biloba extract (EGb 761) in experimental strangulation ileus. Rats were divided into control (n = 7), placebo (n = 11), and EGb-treated (n = 11) groups. No surgical procedure was carried out on the control group. Strangulation ileus was produced in the placebo and EGb groups for 2.5 h. At the end of this period, 100 mg/kg EGb in 1 ml of saline was injected intraperitoneally to the EGb-treated group. In the placebo group, animals received an equivalent amount of saline intraperitoneally; 24 h later, repeat laparotomies were performed to take blood and intestinal tissue samples. The EGb treatment decreased tissue malondialdehyde levels and increased catalase activities compared with the placebo group (P < 0.05 for both). Serum creatine kinase and phosphorus levels were also determined in all groups. In the placebo group these were significantly higher than in the control group (P < 0.01 and P < 0.05, respectively). In the EGb group these were not different from controls and the increase in creatine kinase activity in the EGb group was not as high as in the placebo group (P < 0.05). Our results suggest that EGb could be preventive against the effects of strangulation ileus in a rat model.

Comparative analysis of biochemical parameters for differentiation of pleural exudates from transudates Light's criteria, cholesterol, bilirubin, albumin gradient, alkaline phosphatase, creatine kinase, and uric acid.

The differentiation of pleural effusions as being either transudate or exudate is the first step in the diagnosis of pleural effusions. The aim of this study was to compare the efficiency of the various biochemical parameters to the traditional criteria of Light et al., for differentiating exudates from transudates. Ninety-three pleural fluid and sera specimens were obtained and classified as transudates or exudates on the basis of their diagnosis. Of the 93 pleural fluids, 21 were transudates, 72 were exudates. The efficiencies of different parameters for detection of exudates were as follows: The criteria of Light 96%; effusion cholesterol concentration 77%; serum-fluid albumin gradient 67%, pleural/serum alkaline phosphatase ratio 83%; effusion creatine kinase levels 91%; pleural/serum creatine kinase ratio 83%, and effusion uric acid 71%. Pleural/serum uric acid ratio was insignificant for the purpose of this study.

Beneficial effects of allopurinol on glutathione levels and glutathione peroxidase activity in rat ischaemic acute renal failure.

The protective effect of allopurinol, an inhibitor of the enzyme, xanthine oxidase, against the renal ischaemia-reperfusion of the rat was investigated. Rats were subjected to renal ischaemia by clamping of the left renal artery and vein for 45 min, and were then reperfused for 24 h; these animals were randomized to receive either saline (n = 10) or allopurinol (n = 10) at a dose of 50 mg/kg bolus intraperitoneally 5 min before reperfusion. The control group comprised seven healthy rats not exposed to ischaemia or reperfusion. The blood urea nitrogen and plasma creatinine levels were increased in the allopurinol group, but the increase was less than that in the placebo group, compared with the controls. The kidney glutathione level was significantly reduced in the placebo group but not in the allopurinol group compared with the controls. The glutathione peroxidase activity in the kidney tissues was reduced more than two-fold in the placebo group compared with the controls, but the reduction in glutathione peroxidase was considerably less in the allopurinol group. Renal tissue lactate dehydrogenase, aspartate amino-transferase, gamma-glutamyl transferase and alkaline phosphatase activities were reduced almost two-fold in the placebo group, but allopurinol treatment maintained these enzyme activities close to the control activities. These results provide evidence that allopurinol treatment may have beneficial effects on antioxidant defences against ischaemia-reperfusion injury of rat kidneys.

Osteocalcin metabolism in late fetal life: fetal and maternal osteocalcin levels.

To clarify the osteocalcin metabolism in the fetus, we determined venous osteocalcin levels of 13 women and umbilical arterial and venous osteocalcin levels of their newborns at delivery. Calcium, phosphorus and alkaline phosphatase levels were also established. Umbilical arterial and venous blood calcium and phosphorus levels were significantly higher than maternal venous blood values (P < 0.001 for all). Umbilical arterial calcium was 2.46 +/- 0.02 mmol/l, phosphorus 1.48 +/- 0.04 mmol/l, umbilical venous calcium 2.50 +/- 0.03 mmol/l, phosphorus 1.45 +/- 0.04 mmol/l, maternal calcium 2.16 +/- 0.03 mmol/l, phosphorus 0.98 +/- 0.04 mmol/l. Both umbilical venous (5.85 +/- 0.66 nmol/l) and arterial (3.49 +/- 0.51 nmol/l) osteocalcin levels were significantly higher than maternal values (1.42 +/- 0.15 nmol/l). The high umbilical venous osteocalcin levels may be due to increased osteocalcin degradation in fetus or placental osteocalcin synthesis.