The LDL/HDL ratio and atherosclerosis in ankylosing spondylitis.

OBJECTIVES: In ankylosing spondylitis (AS) patients, cardiac and vascular involvement may manifest as atherosclerosis and coronary artery disease. Systemic inflammation, oxidative stress, increased low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol constitute a significant risk for atherosclerosis. This study investigated the relationship between carotid intima-media thickness (CIMT), LDL/HDL ratio, total oxidant status (TOS; an indicator of oxidative stress) and ischemic modified albumin (IMA; an ischemic marker in AS patients). PATIENTS AND METHODS: Sixty AS patients were diagnosed using the Modified New York Criteria; 54 age- and gender-matched participants were included as controls. CIMT, LDL/HDL ratio, TOS and IMA were measured using the most appropriate methods. RESULTS: IMA was higher in AS patients compared to controls (p < 0.0001). TOS was also increased in AS patients (p = 0.005); as was CIMT (p < 0.0001). The LDL/HDL ratio was also greater in AS patients compared to controls (p = 0.047). A positive correlation was found between CIMT and LDL/HDL ratio among AS patients. CONCLUSION: Elevated CIMT, IMA and TOS levels suggest an increased risk of atherosclerotic heart disease in AS patients. The LDL/HDL ratio was higher in AS patients compared to controls, and there was a correlation between LDL/HDL ratio and CIMT, albeit statistically weak. Therefore, the LDL/HDL ratio is not a reliable marker to predict atherosclerotic heart disease in AS patients.

The association of total sialic acid and malondialdehyde levels with metabolic and anthropometric variables in obesity.

Serum sialic acid levels are abnormally high in pathological states that exhibit tissue destruction, tissue proliferation or inflammation. We measured total serum sialic acid levels in 139 women and 125 men. Subjects were divided into quartiles according to their body mass index (BMI): Q1 (18-24.9 kg/m(2)), Q2 (25-29.9 kg/m(2)), Q3 (30-39.9 kg/m(2)) and Q4 (> 40 kg/m(2)). The patients in Q1 constituted the control group. Serum sialic acid levels of subjects in Q2, Q3 and Q4 were significantly higher than those in Q1. Higher BMI quartiles also were associated with higher levels of serum glucose, insulin, total cholesterol, LDL-cholesterol, triglycerides, high-sensitivity C-reactive protein, malondialdehyde levels, waist circumference, blood pressure and homeostasis model assessment of insulin resistance in both women and men. Lower BMI quartiles were associated with higher levels of serum HDL-cholesterol levels in both women and men. We found positive associations among serum sialic acid levels, BMI and oxidative stress. Serum sialic acid also is related to some conventional cardiovascular risk factors including elevated lipid profile, increased blood pressure, increased serum glucose and insulin levels, and insulin resistance in obese people.

The effects of forskolin and rolipram on cAMP, cGMP and free fatty acid levels in diet induced obesity.

Obesity is a major health problem. We investigated the effects of forskolin and rolipram in the diet of animals in which obesity had been induced. We used 50 female albino Wistar rats that were assigned randomly into five groups as follows: group 1, control; group 2, high fat diet; group 3, high fat diet + forskolin; group 4, high fat diet + rolipram; and group 5, high fat diet + rolipram + forskolin. The rats were fed for 10 weeks and rolipram and forskolin were administered during last two weeks. The animals were sacrificed and blood samples were obtained. Serum cAMP, cGMP and free fatty acids (FFA) levels were measured using ELISA assays. We also measured weight gain during the 10 week period. cAMP and FFA levels of groups 3, 4 and 5 were significantly higher than those of groups 1 and 2. We found no significant differences in serum cGMP levels among the groups. The weight gain in groups 3, 4 and 5 was significantly less than for group 2. We also found that the weight gain in group 5 was significantly less than in groups 3 and 4. We found that both forskolin and rolipram stimulated lipolysis and inhibited body weight increase by increasing cAMP levels. Also, combination therapy using the two agents may be more effective in preventing diet induced obesity than either agent alone. We found also that these agents did not effect cellular cGMP levels in diet induced obesity.

The role of ischemia modified albumin in acute pulmonary embolism.

BACKGROUND: Acute pulmonary embolism (PE) is a life-threatening and a relatively common cardiovascular pathology. Although the pathogenesis of PE is well defined, there is no ideal diagnostic biochemical marker. Previous studies showed an increased ischemia modified albumin (IMA) levels in acute PE; however, the relationship between IMA and right ventricular (RV) dysfunction has not been examined. The aim of this study was to evaluate the diagnostic value of IMA and the relationship with RV dysfunction in acute PE. MATERIALS AND METHODS: A total of 145 patients (70 females) with suspected acute PE was enrolled to the study. Eighty-nine patients were diagnosed with acute PE via computed tomographic pulmonary angiography. Sixty-five patients with similar demographic and clinical characteristics were assigned to the control group. All patients were evaluated for RV dysfunction using transthoracic echocardiography. RESULTS: Serum IMA levels were significantly increased in acute PE compared with control group (0.41 ± 0.06 vs. 0.34 ± 0.11, P = 0.001). There was no relationship between serum IMA levels and RV dysfunction. IMA levels were positively correlated with shock index and heart rate. Receiver operating curve analysis demonstrated that serum IMA levels higher than 0.4 put the diagnosis at sensitivity of 53.85% and at specificity of 85.96%. CONCLUSIONS: Although IMA levels are increased in patients with acute PE, it failed to predict RV dysfunction.

Radiologic diagnosis of a type-III pleuropulmonary blastoma.

Pleuropulmonary blastoma (PPB) is a rare and aggressive dysontogenic neoplasm, occurring in children under the age of 6 years in most cases. CT and MRI findings are well-known, a mixed solid and cystic lesion with variable contrast enhancement and a necrotic centre. We report the radiologic features of type III PPB case.

Rocuronium and sugammadex in patients with myasthenia gravis undergoing thymectomy.

BACKGROUND: The use of neuromuscular blocking agents is still controversial in myasthenic patients but rocuronium could be useful after the introduction of sugammadex as a selective antagonist. The aim of the study was to evaluate the use of rocuronium-sugammadex in myasthenic patients undergoing thoracoscopic thymectomy. METHODS: After ethical approval, 10 myasthenic patients undergoing videothoracoscopic-assisted thymectomy were enrolled in the study. Neuromuscular block was achieved with 0.3 mg/kg rocuronium and additional doses were given according to train-of-four (TOF) monitoring or movement of the diaphragm. Sugammadex 2 mg/kg was given after surgery. Recovery time (time to obtain a TOF value > 0.9) was recorded for all subjects. RESULT: All patients were extubated in the operating room after administration of sugammadex. Mean rocuronium dose was 48 mg and the average operation time was 62 min. Recovery time after sugammadex administration was 111 s (min 35; max 240). CONCLUSIONS: A rapid recovery of neuromuscular function was found in myasthenic patients receiving rocuronium when sugammadex was used for reversal. This combination could be a rational alternative for myasthenic patients for whom neuromuscular blockade is mandatory during surgery.

Serum homocysteine, arginine, citrulline and asymmetric dimethyl arginine levels, and histopathologic examination of the abdominal aorta in rats exposed to acrylamide.

We investigated serum homocysteine, arginine, citrulline and asymmetric dimethyl arginine (ADMA) levels and conducted a histopathologic examination of the abdominal aorta in rats given acrylamide (AA) for long periods. We used 25 male and 25 female Wistar rats. Females were divided into three groups; two were experimental groups and one was the control group. Each experimental group consisted of ten animals and each control group consisted of five animals; male animals were divided in the same way. AA, 2 or 5 mg/kg/day, was administered to the experimental groups in drinking water for 90 days. At the end of the experiment, serum samples were analyzed for homocysteine, arginine, citrulline and ADMA using high performance liquid chromatography. Serum homocysteine, citrulline and ADMA levels were significantly higher than controls in both female and male rats when AA was administered at a concentration of 5 mg/kg/day. Serum citrulline levels also were significantly higher than controls when administered AA at a concentration of 2 mg/kg/day in female rats. There was no difference in serum arginine levels among the groups. Histopathologic examination of the abdominal aorta revealed degeneration of the external elastic lamina in rats treated with 5 mg/kg/day AA. Our findings show that long term ingestion of high dose AA with food might contribute to the development of atherosclerosis.

Pediatric liver transplantation - ethical dilemmas in a disabled patient.

Allocation of medical resources, especially resources with absolute scarcity such as organs for transplant, is a difficult task. Medical, surgical, and ethical considerations should be evaluated. In solid organ transplantation, ethics committees are the gate keepers that deal with moral philosophy when moral values are in conflict. Often, no good solution to a dilemma in these medical ethics exists. Our case presents split living liver donation for retransplantation in a mentally disabled girl, with few medical ethics principles at stake.

Glatiramer acetate treatment directly targets CD11b(+)Ly6G(-) monocytes and enhances the suppression of autoreactive T cells in experimental autoimmune encephalomyelitis.

Glatiramer acetate (GA) is used for the treatment of relapsing-remitting multiple sclerosis (MS) and can suppress experimental autoimmune encephalomyelitis in animals. Effective GA treatment is associated with the induction of anti-inflammatory T(H)2 responses and antigen-specific expansion of CD25(+)/Foxp3(+) Tregs through the modulation of antigen-presenting cells. Here, we show that intravenous injection of fluorochrome-labelled GA resulted in rapid and specific binding of GA to CD11b(+) F4/80(lo) Ly6G(-) blood monocytes via an MHC class II-independent mechanism. Intravenous GA treatment enhanced the intrinsic capability of these monocytes to directly suppress T cell proliferation in vitro. The suppressive function correlated with reduced proliferation of myelin-specific T cells in vivo after intravenous GA treatment. In contrast, subcutaneous treatment with GA inhibited the pro-inflammatory IFNγ-producing T cell phenotype rather than suppressing T cell proliferation. These data indicate that (1) GA engages directly with circulating monocytes to induce type II monocyte suppressor function; and (2) the therapeutic efficacy of GA may be expanded by employing different routes of GA administration to engage alternative mechanisms of suppression of autoreactive T cells in MS.

Isokinetic muscle strength after thoracotomy: standard vs. muscle-sparing posterolateral thoracotomy.

BACKGROUND: The aim of the study was to compare the effects of conventional posterolateral thoracotomy and muscle-sparing posterolateral thoracotomy on pulmonary and muscle strength. METHODS: From January 2003 to December 2004, 50 randomized patients with a diagnosis of primary lung cancer underwent pulmonary resection. The patients were divided into two groups: Group I (n=25) underwent conventional posterolateral thoracotomy, while Group II (n=25) had muscle-sparing thoracotomy. The groups were compared in terms of shoulder abduction/adduction isokinetic muscle strength and respiratory muscle strength. RESULTS: A comparison of maximal expiratory pressure and maximal inspiratory pressure preoperatively and postoperatively and of maximal expiratory pressure and maximal inspiratory pressure preoperatively and at 3 months postoperatively showed statistically significant differences (P<0.05). CONCLUSION: For the preservation of muscle strength, especially in patients whose jobs involved manual work, muscle-sparing posterolateral thoracotomy should be the first choice rather than conventional thoracotomy. Moreover, if necessary, the latissimus dorsi muscle can be used more extensively as a flap after muscle-sparing posterolateral thoracotomy procedures.

Malignant phaeochromocytoma with cavoatrial extension: transcaval removal of tumor without cardiopulmonary bypass A case report.

Adrenal carcinoma is a rare tumor and with metastasis usually in lungs, lymph nodes, liver, and bones. However, intracaval invasion extending into the right atrium is very rare. The surgical approach to adrenal tumor extending into the vena cava is challenging. The optimal surgical approach of tumor with inferior vena cava extension depends on the level of vena cava involvement. This article reports a case of malignant pheochromocytoma extending into the cavoatrial junction in a young man.

Bronchogenic cyst invading right atrium in a 5-year-old.

Primary bronchogenic cysts of cardiac origin or extension are rare. We report here on a 5-year-old girl with a bronchogenic cyst with a diameter of 5.0 x 4.5 x 4.5 cm extending to the right atrial wall. Tumor enucleation and resection of the cyst together with the invaded right atrial wall was performed through a right posterolateral thoracotomy and an opening in the lateral pericardium. Resection of intrapericardial bronchogenic cysts is possible, although extensive invasion of cardiac structures may necessitate the use of cardiopulmonary bypass through a sternotomy.

Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation.

BACKGROUND: In this clinical randomized study, the effects of four anaesthesia techniques during one-lung ventilation [total intravenous anesthesia (TIVA) with or without thoracic epidural anaesthesia (TEA) (G-TIVA-TEA and G-TIVA), isoflurane anaesthesia with or without TEA (G-ISO-TEA and G-ISO)] on pulmonary venous admixture (Qs/Qt) and oxygenation (OLV) were investigated. METHODS: In 100 patients (four groups, 25 patients in each) undergoing thoracotomy, a thoracic epidural catheter was inserted pre-operatively. In G-TIVA-TEA and G-ISO-TEA, bupivacaine 0.1% + 0.1 mg/ml morphine was administered intra-operatively (10 ml of first bolus + 7 ml/h infusion). Propofol infusion or isoflurane concentration was adjusted to keep a bispectral index (BIS) of between 40 and 50 in all groups. FiO(2) was 0.8 during OLV and 0.5 before and after OLV. Partial arterial and central venous oxygen pressures (PaO(2) and PvO(2)), arterial and venous oxygen saturations and Qs/Qt values were recorded before, during and after OLV. RESULTS: During OLV, PaO(2) was significantly higher and Qs/QT significantly lower in G-TIVA-TEA and G-TIVA compared with G-ISO-TEA and G-ISO (PaO2: 188 +/- 36; 201 +/- 39; 159 +/- 33; 173 +/- 42 mmHg, respectively; Qs/Qt: 31.2 +/- 7.4; 28.2 +/- 7; 36.7 +/- 7.1; 33.7 +/- 7.7%, respectively). No statistical changes were observed in patients with TEA compared with without TEA in any measurement. CONCLUSION: During OLV, TEA does not significantly affect the oxygenation and Qs/Qt and can be used safely regardless of whether TIVA or inhalation techniques are used.

Prediction of cardiopulmonary morbidity after resection for lung cancer: stair climbing test complications after lung cancer surgery.

BACKGROUND: The objective of this study was to assess the role of a modified stair climbing test in predicting postoperative cardiopulmonary complications. METHODS: A consecutive series of 150 patients who had undergone pulmonary resection for lung carcinoma formed the prospective database of this study. All patients performed a preoperative modified stair climbing test. Univariate and multivariate analyses were performed to identify predictors of postoperative cardiopulmonary complications. RESULTS: With univariate analysis, the patients with complications had a lower pre-exercise and postexercise percentage of oxygen saturation. PaO (2) levels were found to be lower and a greater change in oxygen desaturation during exercise was noted. Logistic regression analysis showed that the percent of oxygen saturation pre-exercise and the change in percent of oxygen desaturation during exercise were independent and reliable predictors of cardiopulmonary morbidity. CONCLUSIONS: A modified stair climbing test is a safe, economical and simple test capable of predicting cardiopulmonary complications.

Isolated lung perfusion with Paclitaxel and docetaxel: comparison of the early effects on pulmonary physiology.

BACKGROUND: This study was designed to compare the early effects of docetaxel and paclitaxel on pulmonary physiology after isolated lung perfusion. METHODS: Rats underwent isolated left lung perfusion with docetaxel in group 1 (n = 5), paclitaxel in group 2 (n = 5), and 0.9 %NaCl in the control group (n = 5). Ventilation pressures, compliance of the lungs, blood gas analysis and histopathological results were compared between the groups. RESULTS: In group 1 and group 2, the decrease in PaO (2) (p = 0.008) and increase in ventilation pressures were significantly higher than in the control group ( P = 0.016). In group 2, pCO (2) retention was higher compared to the docetaxel perfusion group ( P = 0.016). In the histochemical assessment, intra-alveolar hemorrhage and mononuclear cell infiltration were dense and perivascular edema was not present in group 1. In group 2, perivascular and intraalveolar edema were found to be dense. CONCLUSION: Perfusion by either of the chemotherapeutics resulted in an alteration of lung physiology in rat lungs. If isolated lung perfusion is administered using chemotherapeutics from the taxanes group, it is suggested that docetaxel could be the first choice for isolated lung perfusion.

Treatment of a benign tracheoesophageal fistula in a ventilator dependent quadriplegic patient.

Management of an acquired benign tracheoesophageal fistula in a patient who is dependent on mechanical ventilation is controversial, since the usual procedure is weaning before repair. Here, we describe surgical treatment of a tracheoesophageal fistula in a quadriplegic patient with 28 months of follow-up, who has to remain permanently on mechanical ventilation with a tracheostomy cannula.

An external support technique for the malacic trachea--treatment of tracheomalacia.

A 76-year-old woman was found to have a large, substernal, intrathoracic goiter. During excision, the trachea was found to be malacic. The trachea was sutured to a 16-mm ringed Gore-Tex (Gore & Associates, Arizona, USA) graft with Vicryl (Ethicon, Johnson & Johnson, USA) sutures. The graft was placed on the external surface of the trachea and surrounded the trachea almost 300 degrees. The patient was discharged on postoperative day seven without complications. She was seen at follow-up six months later and found to be free of complications.