Chilling-Like Attacks Terminated by Slow Pathway Ablation.

Symptoms of patients or the way of presenting complaints by the patients may be indefinite, obscure or misleading for the diagnosis of supraventricular tachycardia. The content of the history shows variability depending on the present symptoms, patient concerns and priority. Herein, an unusual case of a young woman suffering from chilling-like attacks for one and half years and treated by slow pathway ablation has been presented.

Dendritic cell activation is blunted in patients with coronary artery disease and diabetes mellitus.

BACKGROUND: It has been shown that functional status of dendritic cells (DCs) in diabetic patients with unstable angina pectoris (UAP) are more mature and activated than diabetic patients without coronary artery disease (CAD) and none diabetic patients with UAP. Accordingly we aimed to assess the activation of DCs in patients with CAD with/and without Diabetes Mellitus (DM) and compare to those in subjects with normal coronary arteries (NCA). MATERIALS AND METHODS: Twenty three patients with severe CAD who were scheduled to coronary artery by-pass grafting surgery and 6 patients with angiographycally NCAs were included in the study. Activation of peripheral blood DCs have been analyzed by flow cytometric measures of CD86 activation. RESULTS: In patients with CAD and without DM, DC activation significantly increased after stimulation of oxidesized LDL (135 ±â€¯121 vs 248 ±â€¯197 p = 0.024). However this activation didn't significantly increased in patients with CAD and DM (100 ±â€¯20 vs 120 ±â€¯97, p = 0,54). Patients with NCAs and without DM showed marked activation of CD86 after stimulation with ox-LDL. CONCLUSION: We have documented that DC activation, upon stimulation of ox-LDL has blunted in patients with CAD compared to patients with NCAs. Moreover this defective activation is more pronounced in those with diabetic patients with CAD.

Inflammation in Coronary Artery Ectasia Compared to Atherosclerosis.

We have read with great enthusiasm the article recently published by Boles et al. [...].

Evaluation of microemulsion and liposomes as carriers for oral delivery of transforming growth factor alpha in rats.

The aim of the present study is to develop microemulsion and liposome carrier systems for oral administration of transforming growth factor alpha (TGF-α) and to investigate the effects of these carrier systems on the gastrointestinal efficiency in rats. Microemulsion (w/o) and liposomes (MLV) were developed and characterised. The carrier systems were administered intragastrically by gastric cannula to male Wistar rats. The highest reduction in the basal acid secretion was observed in the microemulsion containing TGF-α and aprotinin group (TAME).The gastric mucus secretion in microemulsion containing TGF-α (TME) and TAME treatment groups increased significantly compared to the other groups. TGF-α levels in both stomach and duodenum were significantly increased in the TAME group. As a result, it was determined through confocal laser scanning microscope (CLSM) studies that exogenous-applied TGF-α attached to endogenous EGF receptors. The microemulsion formulation was found to be a more suitable carrier system for oral administration of TGF-α.

Short-term effect of tibolone on C-reactive protein in hypertensive postmenopausal women.

OBJECTIVE: To evaluate the effects of tibolone on the serum C-reactive protein (CRP) in hypertensive postmenopausal women. METHODS: We enrolled 45 postmenopausal patients with hypertension and 17 normotensive postmenopausal women. Inclusion criteria were surgical menopause, the presence of vasomotor symptoms, and normal mammogram within 1 year, the absence of documented coronary artery disease, and normal electrocardiography. Forty hypertensive women and 17 normotensive women completed the 3-month period. Twenty-one hypertensive women received tibolone, whereas 19 served as control. At baseline and at 3 months, blood lipids and CRP were evaluated. RESULTS: Changes in lipid profile and CRP in the hypertensive and normotensive control groups during 3 months were not statistically significant. Total cholesterol levels decreased significantly after 3 months of tibolone treatment. A significant increase in CRP values was observed in the tibolone group (p=0.001). CONCLUSION: This trial demonstrated that tibolone treatment induced a significant increase in CRP and a significant decrease in total cholesterol in postmenopausal hypertensive women.

[A pneumonia case caused by Cedecea lapagei]. / Cedecea lapagei'nin neden oldugu bir pnömoni olgusu.

Cedecea spp. which are the members of Enterobacteriaceae family, are mostly isolated from sputum and their clinical importance is not yet demonstrated. This report presents a pneumonia case caused by Cedecea lapagei. A 38-years-old male patient admitted to Inonu University Faculty of Medicine Emergency department with prediagnosis of subarachnoid haemorrhage was operated and transferred to Intensive Care Unit of Reanimation where he underwent artificial ventilation. On the third day of hospitalization his temperature was 39 degrees C, white blood cell count was 27.000/ml and he was still unconscious. He had a history of chronic obstructive pulmonary disease. Chest X-ray revealed opacities in the right lower lobe and mucoid tracheal secretion ensued following tracheal entubation performed after operation. Direct microscopic examination of bronchoalveolar lavage (BAL) fluid yielded abundant number of leukocytes and gram-negative bacilli. Bacteria isolated from BAL specimen were identified as C. lapagei by Phoenix 100 (Becton Dickinson, USA) automated system and also by API 20E kit (Biomerieux, France). Upon the initiation of intravenous amikacin (1 x 1 g) and meropenem (3 x 1 g), the signs of infection decreased in intensity, however, the patient was lost due to subarachnoid hemorrhage on the 12th day of hospitalization. In this case it was estimated that C. lapagei pneumonia originated from the aspiration of upper airway secretion owing to unconsciousness of the patient. Although there were reports of Cedecea infections in the literature, this was the first documented case of C. lapagei pneumonia when the accessible related literature was concerned.

Comparison of the antibacterial activity of lidocaine 1% versus alkalinized lidocaine in vitro.

BACKGROUND: Infections after epidural and spinal blocks are rare. The topical anesthetic liclocaine used in these procedures has been found to have antibacterial effects on various microorganisms. OBJECTIVE: The aim of this study was to assess the antibacterial effects of alkalinized liclocaine on Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. METHODS: Lidocaine 2%, alkalinized lidocaine, and physiologic saline (as a control solution) were added to standard bacterial preparations. The final concentration of the lidocaine was 10 mg/mL (1%). At baseline and 3 and 6 hours after incubation at 37°C, 3-mL aliquots were vortexed and pipetted into sterile polystyrene spectrophotometer cuvettes. Baseline referred to the end of the period of preparation of the solution (≤20 minutes). Growth was measured as the optical density at a wavelength of 540 nm. RESULTS: Compared with the control, lidocaine significantly inhibited the growth of S aureus, E coli, and P aeruginosa at baseline and 3 and 6 hours after incubation (all, P < 0.05). Alkalinized lidocaine significantly inhibited the growth of S aureus at baseline and 3 and 6 hours (all, P < 0.05), while it significantly inhibited the growth of E coli and P aeruginosa only at 6 hours (both, P < 0.05). The growth of E coli was significantly less in lidocaine than in alkalinized lidocaine at 0 and 3 hours (both, P < 0.05). CONCLUSION: The antibacterial effect of lidocaine 1% on S aureus was not changed after alkalinization. The effect of alkalinized lidocaine on E coli and P aeruginosa was significant only at 6 hours. Lidocaine significantly inhibited the growth of these 3 microorganisms at all study periods.

Chlamydia pneumoniae and coronary artery disease: controversial results of serological studies.

I have read with great interest the article published by Carratelli et al. Briefly they have reported increased levels of inflammatory markers and elevated titers of IgG and IgA of C. pneumoniae by using both ELISA and MIF method. There are several factors which may underly the controversial results of seroepidemiological studies. I have commented on the report of Carratelli et al. regarding some of these factors.

Are polycystic ovaries associated with cardiovascular disease risk as polycystic ovary syndrome?

AIM: Our aim was to assess C-reactive protein (CRP) levels and insulin resistance in women with polycystic ovary syndrome (PCOS) or polycystic ovaries (PCO). METHODS: The study population included 30 women with PCOS, 30 with PCO and 30 healthy controls. CRP and insulin resistance index (IRI) (fasting glucose/insulin) were measured. A receiver-operator characteristic (ROC) curve was constructed to determine the cut-off value of CRP to predict increased cardiovascular risk. RESULTS: There were no statistically significant differences between the three groups with regard to age and body mass index. IRI was significantly lower in the PCOS group than in the PCO and control groups. No difference existed between the PCO and control groups. Median CRP levels in the control, PCO and PCOS groups were 0.75, 1.3 and 1.5 mg/l, respectively (p = 0.005). CRP could differentiate between women with and without increased cardiovascular risk at a cut-off value of 2.42 mg/l, with a sensitivity of 79% and a specificity of 81%. CONCLUSION: As in PCOS patients, women with PCO have higher serum CRP levels than healthy control women. This may contribute to increased cardiovascular disease risk in patients with PCO.

Clinical, microbiologic, and epidemiologic characteristics of Pseudomonas aeruginosa infections in a University Hospital, Malatya, Turkey.

BACKGROUND: Pseudomonas aeruginosa strains are generally resistant to many antibiotics, and nosocomial infections because of this species are one of the major problems in many hospitals. Molecular typing provides very useful information about origin and transmission of the strains. The aims of the present study were to investigate clinical and microbiologic characteristics of the nosocomial infections caused by P aeruginosa strains in a medical center and to bring up the cross-transmission level of this opportunistic pathogen in a university hospital by analyzing the clonal relationship among the isolates. METHODS: A total of 105 P aeruginosa strains had been identified among the 80 inpatients in a 1-year period from August 2003 to August 2004. Demographic, clinical, and epidemiologic data of the patients were prospectively recorded. The standardized disk-diffusion method was used to determine resistance of the strains to imipenem, ceftazidime, aztreonam, amikacin, gentamicin, mezlocillin, cefepime, tobramycin, meropenem, ceftriaxone, and ciprofloxacin. Clonal relatedness of the strains was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: Of the 105 P aeruginosa strains identified, 45 (43%) were isolated from the patients hospitalized in intensive care units. Thirteen patients had repeated pseudomonas infection (total 38 infections/13 patients); 26 of these repeated infections in 9 patients showed the same localization. Half of the patients had at least 1 underlying disease such as burn (48%), chronic illness (32%), and malignancy (20%). Fifty-seven patients (71%) had urinary and/or other catheterization. Urinary tract infection (35%) was the most frequent infection encountered, followed by respiratory tract infection (34%) and sepsis (13%). Resistance to the antibiotics tested was in the 12% to 88% range; amikacin was the most effective and ceftriaxone was the least effective antibiotic. The PFGE typing method showed that 28 of the 80 patients' isolates were clonally related, including 23 indistinguishable or closely related strains (29%), and 5 possibly related strains (6%). Epidemiologic data of the 16 patients (20% of the patients) confirmed a clonal relationship among the strains. Of the 26 isolates of the 9 patients having repeated infection in the same location, 18 (69%) were in the clonally related groups, whereas 11 of the 12 strains isolated from repeated infections on different body sites were clonally different. CONCLUSION: Our results indicated that P aeruginosa infections in our hospital mainly affected the patients hospitalized in intensive care units and those having catheterization, burn, and/or chronic illness. Amikacin was the best antibiotic as far as bacterial resistance was considered. Although lack of major PFGE type confirmed no P aeruginosa outbreak, typing results showed that cross transmission and treatment failure are the 2 main problems, which should be consider together to prevent this bacterial infection in medical centers.

[Distribution of bacteria isolated from urine cultures in Malatya University Hospital laboratory (letter)]. / Malatya Universite hastanesi Laboratuvarinda Idrar kültürlerinden izole edilen bakterilerin dagillmi.

The aim of this letter was to report the distribution of bacterial species isolated from the urine samples of patients in Malatya, which is located in Estern Anatolia part of Turkey. A total of 3.774 urine cultures were performed in the period of April-June 2006, and 792 (21%) of them yielded bacterial growth. The isolates have been identified by conventional methods and confirmed by Phoenix 100 (Becton-Dickinson) system. As a result, 702 (89%) Gram negative and 90 (11%) Gram positive bacteria were isolated from the samples. The most frequently isolated bacteria were Escherichia coli (58%), followed by Klebsiella spp. (14%), Pseudomonas spp. (6.4%), Enterococcus spp. (5%), Staphylococcus spp. (3.8%) and Streptococcus spp. (1.7%). The species distribution was found as follows; K. pneumoniae ssp pneumoniae (95/110), P. aeruginosa (48/51), E.faecalis (27/40), E. cloacae (19/29), P.mirabilis (19/22), C.freundii (8/12), coagulase negative staphylococci (19/30) and S. aureus (11/30). The first three array were shared by E. coli, Klebsiella spp. and Pseudomonas spp. for the samples of both outpatients and inpatients, while Pseudomonas spp. and E. coli were the most frequently isolated bacteria from the urine samples of intensive care unit patients. Our data was found parallel to the results of other national and international studies.

Plasma soluble adhesion molecules; intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and E-selectin levels in patients with isolated coronary artery ectasia.

UNLABELLED: Plasma soluble adhesion molecules, intercellular adhesion molecule-1 (ICAM)-1, vascular cell adhesion molecule-1 (VCAM-1) and E-selectin leves of patients with isolated coronary artery ectasia (CAE), patients with obstructive coronary artery disease without CAE and subjects with angiographically normal coronary arteries were evaluated. Patients with isolated CAE were detected to have significantly higher levels of plasma soluble ICAM-1, VCAM-1 and E-selectin in comparison with patients with obstructive coronary artery disease without CAE (ICAM, 673 +/- 153 versus 381 +/- 106, respectively, P < 0.001; VCAM-1, 2366 +/- 925 versus 1136 +/- 208, respectively, P < 0.001; E-selectin, 74 +/- 21 versus 61 +/- 18, respectively, P = 0.01) and subjects with normal coronary arteries (ICAM-1, 673 +/- 153 versus 303 +/- 131, respectively, P < 0.001; VCAM-1, 2366 +/- 925 versus 729 +/- 231, respectively, P < 0.001; E-selectin, 74 +/- 21 versus 49 +/- 9, respectively, P < 0.001), suggesting the presence of a more severe and extensive chronic inflammation in the coronary circulation in patients with isolated CAE. BACKGROUND: The common coexistence of coronary artery ectasia (CAE) with coronary artery disease (CAD) suggests that it may be a variant of CAD. However, it is not clear why some patients with obstructive CAD develop CAE whereas most do not. Inflammation has been reported to be a major contributing factor to both obstructive and aneurysmatic vascular disorders and therefore, in the present study, the plasma soluble adhesion molecules, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin levels in isolated CAE were investigated. METHODS: The study population consisted of three groups: the first consisted of 32 patients with isolated CAE without stenotic lesion; the second of 32 patients with obstructive CAD without CAE; and the third group of 30 control subjects with normal coronary arteries. Coronary diameters were measured as the maximum diameter of the ectasic segment by use of a computerized quantitative coronary angiography analysis system. According to the angiographic definition used in the Coronary Artery Surgery Study, a vessel is considered to be ectasic when its diameter is > or =1.5 times that of the adjacent normal segment in segmental ectasia. Plasma soluble ICAM-1, VCAM-1 and E-selectin levels were measured in all patients and control subjects using commercially available enzyme-linked immunosorbent assay kits. RESULTS: Patients with isolated CAE were found to have significantly higher levels of plasma soluble ICAM-1, VCAM-1, and E-selectin in comparison with patients with obstructive CAD without CAE (ICAM, 673 +/- 153 versus 381 +/- 106, respectively; P < 0.001; VCAM-1, 2366 +/- 925 versus 1136 +/- 208, respectively; P < 0.001; E-selectin, 74 +/- 21 versus 61+/-18, respectively; P = 0.01) and control subjects with normal coronary arteries (ICAM-1, 673 +/- 153 versus 303 +/- 131, respectively;, P < 0.001; VCAM-1, 2366 +/- 925 versus 729 +/- 231, respectively; P < 0.001; E-selectin, 74 +/- 21 versus 49 +/- 9, respectively; P < 0.001). In addition, we detected statistically significant positive correlation between the total length of ectasic segments and the levels of plasma soluble ICAM-1 (r = 0.625; P < 0.001), VCAM-1 (r = 0.548; P = 0.001) and E-selectin (r = 0.390; P = 0.027). Multivariate logistic regression analysis revealed a significant independent relation between isolated CAE and ICAM-1 [odds ratio (OR) = 1.023; 95% confidence interval (CI) = 1.0048-1.0414; P = 0.0129] and VCAM-1 (OR = 1.0057; 95% CI = 1.0007-1.0106; P = 0.0240). CONCLUSIONS: We have shown that patients with isolated CAE have raised levels of plasma soluble ICAM-1, VCAM-1 and E-selectin in comparison with patients with obstructive CAD without CAE and control subjects with normal coronary arteries, suggesting the presence of a more severe and extensive chronic inflammation in the coronary circulation in these patients.

The role of transforming growth factor alpha formulation on aspirin-induced ulcer healing and oxidant stress in the gastric mucosa.

PURPOSE: Transforming growth factor (TGF) alpha accelerates wound healing, especially in gastric ulcers. Transforming growth factor alpha can be affected by acid and pepsin in the gastric juice. Oxidative stress also plays a role in the formation of gastric lesions. This study was designed (1) to investigate the effects of microemulsion dosage form on the healing of gastric ulcers, and (2) to determine the relationship between oxidative mechanisms and TGF-alpha during ulcer healing. METHODS: Gastric ulcers were induced in Wistar rats (male, 200 +/- 25 g), by 150 mg/kg acidified aspirin application. The animals were divided into five groups consisting of 7-11 animals. The rats were killed after ulcer induction with aspirin (acute ulcer), or 2 days after ulcer induction (chronic ulcer), or after the daily application of microemulsion and TGF-alpha for 2 days. The ulcer area was measured planimetrically. Thiobarbituric acid reactive substance, glutathione, and gastric mucus levels of tissues were measured by spectrophotometric methods. The total nitric oxide level was measured by a VCl3/Griess assay. Statistical comparisons were made by an analysis of variance and the Mann-Whitney U-test. RESULTS: The ulcer area and malondialdehyde level of gastric tissue both decreased and the glutathione level increased to intact gastric tissue levels, while the mucus and total nitric oxide levels increased significantly after the application of intragastric TGF-alpha. CONCLUSION: These findings suggest that TGF-alpha accelerates the healing process after aspirin-induced gastric injury, and a relationship was observed between this application and the oxidative reactions.