Diagnosing metabolic syndrome in type 2 diabetic Turkish patients: comparison of AHA/NHLBI and IDF definitions.

OBJECTIVES: The objective of this study was to determine the percentage of metabolic syndrome (MetS) in a Turkish population with type 2 diabetes mellitus (T2DM) according to the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and International Diabetes Federation (IDF) definitions and to assess the agreement among these definitions. BACKGROUND: It is essential to identify the prevalence of MetS in diabetic patients, as MetS is a stronger risk factor for cardiovascular disease in patients with T2DM than in non-diabetic subjects. METHODS: 235 consecutive patients with T2DM were included in the study. The MetS was defined according to AHA/NHLBI and IDF definitions. Cohen's kappa was used as a measure of agreement between the two definitions. Logistic regression analysis was performed to calculate the odds ratios. RESULTS: The percentage of MetS was 85.1% by AHA/NHLBI and 87.2% by IDF criteria. The agreement between AHA/NHLBI and IDF was fairly good (kappa = 0.55). Females were more affected than males. When the frequencies of each individual feature of the MetS according the definitions were assessed, hypertension was the most common feature in males, whilst abdominal obesity was in females. Serum triglyceride and waist circumference had the highest predictive ability for MetS according to AHA/NHLBI and IDF definitions, respectively. CONCLUSION: The MetS is a common condition among diabetic patients. Since diabetic patients carry a cluster of cardiovascular risk factors, correct identification of the MetS among this population is of great importance, for an integrated approach to reduce the high costs and the associated disabilities (Tab. 5, Fig. 2, Ref. 54).

Serum N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and homocysteine levels in type 2 diabetic patients with asymptomatic left ventricular diastolic dysfunction.

AIMS: : The aim of this study was to determine serum NT-proBNP and plasma Hcy levels and to explore the relationship between serum NT-proBNP and plasma Hcy levels in type 2 diabetic patients with and without asymptomatic LVDD. METHODS: : NT-proBNP and Hcy levels were measured 31 patients with type 2 diabetes mellitus. According to echocardiographic data, diabetic patients were divided into two groups: normal LV function or LV diastolic dysfunction. RESULTS: : Serum NT-proBNP levels in diabetic patients with LVDD were significantly higher than in diabetic patients with normal LV function and controls. The area under the receiver-operating characteristic (ROC) curve for NT-proBNP to separate normal vs. diastolic dysfunction was 0.96 in type 2 diabetic patients. Plasma Hcy levels were significantly higher in both diabetic groups than in controls. Positive correlation was noted between NT-proBNP and Hcy levels in diabetic patients with LVDD (r=0.881, p=0.0001). CONCLUSIONS: : The correlation between elevated NT-proBNP and Hcy levels in diabetic patients with LVDD suggest an association between homocysteinemia and increased NT-proBNP secretion. Our data indicate that NT-proBNP may be a simple screening tool to select diabetic patients with LVDD requiring further examination with echocardiography.

Image-guided keyhole evacuation of spontaneous supratentorial intracerebral hemorrhage.

INTRODUCTION: Treatment of spontaneous supratentorial intracerebral hemorrhage (SICH) is controversial. This study aims to evaluate the outcome and invasiveness of one surgical approach that provides complete evacuation of SICH, the image-guided keyhole evacuation. METHODS: The technique was employed in 20 consecutive patients, nine of whom harbored deep hematomas. The hematoma was evacuated through a keyhole minicraniotomy, 2.5 cm in diameter. Computerised tomographic (CT) scan was performed at the end of the procedure to confirm completeness of evacuation. Invasiveness was assessed by comparing initial neurological status determined by Glasgow Coma Scale (GCS) scores and National Institutes of Health Stroke Scale (NIHSS) scores with the third and seventh postoperative day scores, and by radiological findings. Outcome at six months was assessed by the Extended Glasgow Outcome Scale, and by comparing the initial and 6 month modified Rankin Scale scores. RESULTS: Mean age was 63.7+/-14.8 years, mean volume was 41.6+/-17.5 mL, and mean time to surgery was 17.6+/-13.2 h. CT scans at the end of the procedure showed complete evacuation (mean 97.5%), and 60% decrease of both mean midline shift and mean edema volume (p=0.005). Neurological assessment at the end of the first postoperative week showed significant improvement (p<0.0001). At six months, 90% of the patients had achieved recovery to independence, and one patient had died. CONCLUSION: The image-guided keyhole approach allowed prompt evacuation of SICH and resulted in a high rate of functional recovery and low mortality. This is a minimally invasive technique that is highly effective in immediate and complete hematoma evacuation.

The effect of combined preinduction thoracic epidural anaesthesia and glucocorticoid administration on perioperative interleukin-10 levels and hyperglycemia. A randomized controlled trial.

AIM: Anti-inflammatory cytokines such as interleukin-10 (IL-10) play a key role in the anti-inflammatory cascade after cardiopulmonary bypass (CPB). Even moderate hyperglycemia can increase mortality/morbidity, stroke, and myocardial infarction after coronary artery bypass grafting (CABG). The purpose of our study was to investigate whether preinduction thoracic epidural anesthesia (TEA) and preinduction glucocorticoid have an effect on perioperative anti-inflammatory and perioperative hyperglycemia in patients undergoing CABG with CPB. METHODS: Sixty low-risk patients (n=60) undergoing elective CABG were randomly allocated into 4 groups: Group corticosteroid (Group S) (n=15) received 6-methylprednisolone 15 mg/kg IV 60 min before induction; Group TEA+corticosteroid (Group TEA+S) (n=15) received 20 mg bupivacaine in bolus 60 min before induction followed by 20 mg/h bupivacaine infusion intraoperatively and postoperatively via epidural catheter. Group TEA (n=15) received 20 mg bupivacaine in bolus 60 min before induction followed by 20 mg/h bupivacaine infusion intraoperatively and postoperatively via epidural catheter. Group control (Group C) (n=15) received neither preinduction TEA nor a preinduction steroid. Blood samples were sequentially taken before surgery (baseline), before CPB, 1 h after CPB, in the intensive care unit (ICU) and 24 h after surgery from an indwelling radial arterial catheter. RESULTS: Before CPB, circulating IL-10 levels were higher in groups TEA+S and S than in group C (P<0.05). At 1 h after CPB, IL-10 levels were higher in groups TEA+S and S than in group C (P<0.001). Before CPB and at 1 h after CPB, IL-10 levels were lower in group TEA than in group C (P<0.05). Before CPB, glucose levels were higher in group S than in groups TEA, C or TEA+S (P<0.001; P<0.05). There was no significant difference in glucose levels between groups TEA, TEA+S and C. At 1 hour after CPB, glucose levels were significantly lower in groups TEA and TEA+S than in groups S and C (P<0.001; P<0.05). At 1 hour after CPB, glucose levels were significantly higher in group S than in group C (P<0.05). At ICU, glucose levels were significantly lower in group TEA than in groups S, C and TEA+S (P<0.001; P<0.05). CONCLUSION: The study results show that preinduction TEA improves glucose homeostasis during the perioperative 24-h period in CABG surgery. In addition, we found that while preinduction TEA reduced blood IL-10 levels, preinduction glucocorticoid and TEA+S increased the circulating levels of IL-10.

The cardioprotective effects of thoracal epidural anestesia are induced by the expression of vascular endothelial growth factor and inducible nitric oxide synthase in cardiopulmonary bypass surgery.

AIM: The cardioprotective effects of thoracal epidural anesthesia (TEA) are induced by the expression of vascular endothelial growth factor (VEGF) and inducible nitric oxide synthase (i-NOS) in cardiopulmonary bypass (CPB) surgery. When general anaesthesia (GA) is combined with TEA during coronary artery bypass graft, we investigated whether TEA together with GA play a role on VEGF and i-NOS expression in human heart tissue in cardiac ischemia. METHODS: Right atrial biopsy samples were taken before CPB, before aortic cross clamp (ACC) and at 15 min after ACC release (after ischemia and reperfusion). Human heart tissues were obtained from the TEA+GA and GA groups. Immunocytochemistry was performed using antibodies for VEGF and i-NOS. RESULTS: Both VEGF and i-NOS immunoreactivity was observed in cardiomyocytes and arteriol walls. Although VEGF and i-NOS immunoreactivity was apparent in both groups,, immunostaining intensity was greater in the TEA+GA group than the GA group. Between groups, at 4 h and at 24 h after the end of CPB, the cardiac index (CI) was significantly higher in the TEA+GA group than GA group (3.4+/-0.8 L/min/m(2) vs 2.5+/-0.8 L/min/m(2); P<0.001), (3.8+/-1.1 L/min/m(2) vs 3.1+/-1.1 L/min/m(2); P<0.008) respectively. Within groups, at 4 and 24 h after the end of CPB, the CI was significantly higher in the TEA+GA group than baseline values, (3.4+/-0.8 L/min/m(2) vs 2.4+/-0.7 L/min/m(2); P<0.001), (3.8 +/-1.1 L/min/m(2) vs 2.4+/-0.7 L/min/m(2); P<0.001) respectively, but no difference was found in the GA group (2.6+/-0.8 L/min/m(2) vs 2.5+/-0.8 L/min/m(2); P>0.05), (2.6+/-0.8 L/min/m(2) vs 3.1+/-1.1 L/min/m(2); P>0.05) respectively. After ACC release, 11/40 (27.5%) patients in the TEA+GA group showed ventricular fibrillation (VF), atrial fibrillation or heart block versus 25/40 (62.5%) of those in the GA group. VF after ACC release in the TEA+GA group (9/20 patients, 22.5%) was significantly lower than in the GA group (21/40 patients, 52.5%); (P<0.006). Sinus rhythm after ACC release in the TEA+GA group (29/40 patients, 72.5%) was significantly higher than in the GA group (15/40 patients, 37.5%); (P<0.002). CONCLUSIONS: The results of the present study indicate that TEA plus GA in coronary surgery preserve cardiac function via increased expression of VEGF and i-NOS, improved hemodynamic function and reduced arrhythmias after ACC release.

General anesthesia with thoracic epidural anesthesia in the cardiopulmonary bypass surgery reduces apoptosis by upregulating antiapoptotic protein Bcl-2.

AIM: The aim of the paper was to investigate whether thoracic epidural anesthesia (TEA) together with general anaesthesia (GA) play a role on apoptosis in humans before cardiopulmonary bypass (CPB), before aortic cross clamp (ACC) and at 15 min after ACC release (after ischemia and reperfusion). METHODS: Eighty patients scheduled for elective CABG were randomized to receive either GA group (n: 40) or TEA+GA group (n: 40). The right atrial biopsy samples were taken before CPB, before ACC and at 15 min after ACC release from all patients. Human heart tissues were obtained from patients of TEA+GA group and GA group. The number of Bcl-2 positive cardiomyocytes was counted in multiple tissue sections of biopsies of 80 patients using light microscopy (magnification x 40) with an ocular micrometer system (Olympus). RESULTS: In the TEA+GA group, the Bcl-2 positive cardiomyocytes were distinctly statistically increased compared to the GA group (P<0.001). In addition, the intensity of the immunostaining was also increased in the TEA+GA compared with the GA group. The number of immunoreactive cardiomyocytes is as follows: before CPB, TEA+GA group 396+/-61, GA group 92+/-41, before ACC, TEA+GA group 333+/-47, GA group 94+/-18, at 15 min after ACC release, TEA+GA group 346+/-68.8, GA group 85+/-9.5. There were statistically significant differences between groups, (P<0.001). Between groups, at 4 h and at 24 h after the end of CPB, in the TEA+GA group, the CI was significantly higher than GA group respectively; (3.4+/-0.8 L/min/m(2) vs 2.5+/-0.8 L/min/m(2); P<0.001), (3.8+/-1.1 L/min/m(2) vs 3.1+/-1.1 L/min/m(2); P<0.008). Within groups, at 4 and 24 h after the end of CPB, in the TEA+GA group, the CI was significantly higher than baseline values, respectively, (3.4+/-0.8 L/min/m(2) vs 2.4+/-0.7 L/min/m(2); P<0.001), (3.8+/-1.1 L/min/m(2) vs 2.4+/-0.7 L/min/m(2); P<0.001). Whereas no difference was found in the GA group respectively, (2.6+/-0.8 L/min/m(2) vs. 2.5+/-0.8 L/min/m(2); P>0.05), (2.6+/-0.8 L/min/m(2) vs. 3.1+/-1.1 L/min/m(2); P>0.05). The number of patients showing ventricular fibrillation (VF), atrial fibrillation or heart block after release of the ACC was 11 of 40 (27.5%) in the TEA+GA group versus 25 of 40 (62.5%) in the GA group. The number of patients showing VF after release of ACC was 9 out of 20 patients (22.5%) in the TEA+GA group which was significantly lower than in the GA group (21 of 40 patients 52.5%); (P<0.006). Sinus rhythm after release of ACC, in the TEA+GA group was observed in 29 of 40 patients (72.5%) and was significantly higher than in the GA group (15 of 40 patients 37.5%); (P<0.002). CONCLUSION: The result of the present study indicate that TEA plus GA in coronary surgery had preserved cardiac function during intraoperative and postoperative period by means of reduced apoptosis, improved hemodynamic function and reduced arrhythmias after release of the ACC.

Effect of different levels of cigarette smoking on lipid peroxidation, glutathione enzymes and paraoxonase 1 activity in healthy people.

The purpose of this study was to examine the effect of different levels of cigarette smoking on lipid peroxidation, glutathione enzymes and paraoxonase 1 (PON1) activity in a healthy population. The study included 130 subjects who were classified as mild (20 cigarettes daily, Group III, n=33) and never smokers (controls, Group IV, n=32). Malondialdehyde (MDA) levels, PON1 and erythrocyte glutathione enzyme activities were measured. MDA levels were significantly higher in smokers than never smokers (P<0.05 for Group I, P<0.001 for Group II and III). PON1 activity was significantly lower in heavy smokers (P<0.001). Glutathione peroxidase (GSH-Px) activity was significantly lower in the smokers (P<0.0001). Glutathione reductase (GR) activity was significantly higher in smokers (P<0.0001). MDA levels negatively correlated with PON1 and GSH-PX activities (P<0.01), whereas they positively correlated with GR activities (P<0.001). At every level, cigarette smoking is associated with increased lipid peroxidation and causes an impairment in antioxidant systems.

Increased thickness of the carotid artery intima-media assessed by ultrasonography in Behçet's disease.

OBJECTIVE: Behçets disease (BD), is a unique systemic vasculitis, which affects almost all types and sizes of blood vessels. Carotid intima-media thickness (IMT) is an endothelial cell dysfunction (ECD) parameter which may also be associated with atherosclerosis. We aimed to search carotid IMT and plaque formation in BD, using high-resolution B-mode Doppler ultrasonography (USG). METHODS: We studied 114 BD patients (M/F: 68/46; mean age 38.15 +/- 9.44 years; disease duration 121 +/- 79 months), being followed up by Ege University Rheumatology Department. Age and sex-matched, 77 healthy controls, and as the disease control group 46 non-matched SLE patients were also included. Exclusion criteria for all the study participants were hypertension, hyperlipidemia, diabetes mellitus, obesity and history of cardiovascular or cerebrovascular disease. Comparison of the three groups were made by ANOVA and for post-hoc confirmation, Bonferoni test was used. RESULTS: The carotid IMT in BD (mean +/- SD, 0.55 +/- 0.14 mm) was significantly higher than in healthy controls (0.48 +/- 0.09 mm) (p = 0.004), but significantly lower than in SLE (0.66 +/- 0.24 mm) (p = 0.001). Likewise, plaque frequency in BD (5/114) was significantly higher than in healthy controls (0/77), but significantly lower than in SLE (8/46) (p < 0.001). CONCLUSION: Despite significantly higher carotid IMT and plaque frequency in BD compared with healthy controls, these parameters in BD were not as marked as in SLE. Less severe carotid artery abnormalities in BD, may partially explain why cardiovascular morbidity and mortality do not seem to be increased in BD, unlike in SLE.

Thoracic epidural anesthesia preserves myocardial function during intraoperative and postoperative period in coronary artery bypass grafting operation.

AIM: The purpose of this study was to investigate the effect of thoracic epidural anesthesia (TEA) in patients with poor ventricular function undergoing conventional coronary artery bypass graft surgery (CABG) during the intraoperative and the postoperative period. METHODS: Eighty patients (n = 80) undergoing elective CABG surgery with cardiopulmobary bypass (CPB) were divided into 4 groups: 1) General anesthesia (GA) plus poor ventricular (PV) function patients (Group GA plus PV) (n = 20), ejection fraction (EF) = or <40%; 2) GA plus good ventricular (GV) function patients (Group GA plus GV) (n = 20), EF >40%; 3) Thoracic epidural anaesthesia (TEA)+GA, poor ventricular function patients (Group TEA+GA plus PV) (n = 20), EF = or <40%; 4) TEA+GA, good ventricular function patients (Group TEA+GA plus GV) (n = 20), EF >40%. RESULTS: Within groups, at 4 h after the end of CPB, in the Group TEA+GA plus PV and Group TEA+GA plus GV, the cardiac index values were significantly higher than baseline values; P < 0.05, whereas no difference was found in the Group GA plus PV and Group GA plus GV. According to Tukey test, using repeated measures, between trend of groups, the cardiac index values were significantly different P < 0.05. In the Group TEA+GA plus PV, cardiac index values were significantly higher than the Group GA plus PV, P < 0.05. But in the Group GA plus GV, cardiac index values were not significantly different than the Group TEA+GA plus GV. The incidence of reperfusion ventricular fibrillation (VF) after release of aortic cross-clamp, in the Group TEA+GA plus PV (4 of 20 patients: 20%) was significantly lower than in the Group GA plus PV (11 of 20 patients: 55%); P < 0.05. The incidence of reperfusion VF after release of aortic cross-clamp, in the Group TEA+GA plus GV (5 of 20 patients: 25%) was not significantly different than in the Group GA plus GV (10 of 20 patients: 50%); NS. CONCLUSIONS: TEA seems to be effective in patients with poor left ventricular function. Our results (improved cardiac index, reduced arrhythmias after release of aortic clamp and decreased inotropic requirement) are better with TEA, particularly in patients with poor left ventricular function.

Beta2-microglobulin and cystatin C in type 2 diabetes: assessment of diabetic nephropathy.

BACKGROUND: Changes in glomerular filtration rate (GFR) provide a valuable indicator of the progression of diabetic nephropathy (DN). This study was designed to demonstrate the clinical values of serum cystatin C (Cys C) and beta2-microglobulin in the assessment of renal function in type 2 diabetics by comparing them with the GFR, estimated from the uptake phase of 99 m technetium dimetiltriamino pentaacetic acid renogram (GFR-DTPA) and creatinine clearances. MATERIALS AND METHODS: 68 type 2 diabetic patients with (urinary albumin excretions (UAE) 30 - 300 mg/24 h) (n = 39) and without (UAE < 30 mg/24 h) (n = 29) microalbuminuria and 32 controls were enrolled in the study. Serum Cys C, beta2-microglobulin, creatinine, urinary microalbumin levels, creatinine clearances and GFR-DTPA values were determined in all groups. Non-parametric ROC curves, using a cut-off GFR-DTPA of 60 mL/min/1.73 m (2), were obtained for these markers. RESULTS: Serum Cys C, beta2-microglobulin, glucose and HbA1c concentrations were significantly higher in the group with diabetes compared to controls. In the patients with microalbuminuria, serum Cys C and glucose concentrations increased significantly in comparison to patients with normoalbuminuria, while no differences were observed for beta2-microglobulin levels. Serum creatinine concentrations, GFR-DTPA values and creatinine clearances were not different between both diabetic groups and controls. Cys C was positively correlated with beta2-microglobulin and creatinine and negatively with GFR values; beta2-microglobulin was also positively correlated with serum creatinine in microalbuminurics. A significant inverse correlation was found between beta2-microglobulin and GFR values in both microalbuminurics and normoalbuminurics. CONCLUSIONS: Increased Cys C and beta2-microglobulin in diabetics may be early indicators of incipient DN. The diagnostic accuracies of Cys C and beta2-microglobulin are superior to that of serum creatinine in distinguishing between mild and moderately reduced GFR.

Which anesthetic agent alters the hemodynamic status during pediatric catheterization? Comparison of propofol versus ketamine.

OBJECTIVE: To compare the effects of propofol and ketamine on systemic and pulmonary circulations in pediatric patients scheduled for elective cardiac catheterization. DESIGN: Prospective, randomized, and blinded. SETTING: University hospital. PARTICIPANTS: Children (n = 41) undergoing cardiac catheterization. INTERVENTIONS: All children were premedicated with oral midazolam 60 minutes before the procedure. Patients were separated into 3 groups according to shunts diagnosed by transthoracic echocardiography before the catheterization procedure: patients without cardiac shunt (Group I, n = 11), left-to-right shunt (Group II, n = 12), and right-to-left shunt (Group III, n = 18). A continuous infusion of propofol (100-200 microg/kg/min) or ketamine (50-75 microg/kg/min) was randomly started in all groups to obtain immobility during the procedure. Hemodynamic data, including systemic venous, pulmonary artery and vein, aortic saturations and pressures, were recorded; Qp/Qs were calculated. The same set of data was recorded before discontinuation of infusions at the end of the procedure. MEASUREMENTS AND MAIN RESULTS: After the propofol administration, in all 3 patient groups propofol infusion was associated with significant decreases in systemic mean arterial pressure. In groups with cardiac shunts (Group II and III), propofol infusion significantly decreased systemic vascular resistance and increased systemic blood flow, whereas pulmonary vascular resistance and pulmonary blood flow did not change significantly. These changes resulted in decreased left-to-right shunting and increased right-to-left shunting; the pulmonary-to-systemic flow ratio decreased significantly. On the other hand, after ketamine infusion, systemic mean arterial pressure increased significantly in all patient groups, but pulmonary mean arterial pressure, systemic vascular resistance, and pulmonary vascular resistance were unchanged. CONCLUSION: In children with cardiac shunting, the principal hemodynamic effect of propofol is a decrease in systemic vascular resistance. In children with intracardiac shunting, this results in an increase in right-to-left shunting and a decrease in the ratio of pulmonary to systemic blood flow, which may lead to arterial desaturation. Ketamine did not produce these changes. The authors suggested that during cardiac catheterization in children, both the anesthesiologists and cardiologists need to know that anesthetic agents can significantly alter the hemodynamic status in children with complex congenital heart defects and affect the results of hemodynamic calculations that are important for decision-making and treatment of these patients.

Spuriously elevated inorganic phosphate level in a multiple myeloma patient.

We report the case of a patient with IgG multiple myeloma and pseudohyperphosphatemia. The patient had no clinical features of hyperphosphatemia. Subsequent investigations demonstrated that this hyperphosphatemia was spurious and was caused by a high concentration of the paraprotein. Deproteinization of the serum samples by sulfosalicylic acid resulted in normalization of the elevated phosphate values. This pseudohyperphosphatemia resulted from an increase in optic density because of interference between monoclonal immunoglobulin and the molybdic reagent used to determine phosphate in serum. These data indicate that the finding of marked hyperphosphatemia in multiple myeloma patients should always prompt an assay carried out on a deproteinized sample. In addition, knowledge of this phenomenon may avoid confusion, unnecessary testing and obviate confusion in the clinical evaluation of patients with multiple myeloma.

Does off-pump coronary artery bypass surgery reduce mortality in high risk patients?

BACKGROUND: The aim of this retrospective study was to compare outcome in two groups of patients who were classified according to their risk groups and underwent coronary revascularization with or without cardiopulmonary bypass. MATERIAL AND METHODS: Between January 1996 and July 2000, 480 cases that underwent coronary artery bypass surgery (CABG) were included in a retrospective nonrandomized manner for study. Group 1 included 210 patients who were revascularized using off-pump techniques. Octopus 2 and 3 (Medtronic, Inc., Minneapolis, MN) were used for tissue stabilization. Group 2 included 270 cases who underwent CABG using CPB. Emergency cases, combined operations, reoperations, and patients in cardiogenic shock were excluded. Demographic variables were comparable between two the groups. Using the Allegheny Clinic Risk Scoring Scale [Magovern 1996], patients in both groups were scored as low, moderate, and high risk. In Group 1, 37 % of patients consisted of high risk patients while Group 2 had 14% (p < 0.05). Student's t-test and chi-square test were used for statistical analysis and alfa < 0.05 was considered significant. RESULTS: Mortality was 1.4% in Group 1 and 1.5% in Group 2 (p = ns). Mean anastomosis per patient was 2.6 +/- 0.6 in Group 1 and 3.2 +/- 0.5 in Group 2 (p < 0.05). Patients in Group 1 needed less blood transfusions and less inotropic support postoperatively (p < 0.05). There were also fewer minor neurological events (p < 0.05) and pulmonary complications (Type 2) in Group 1. Atrial fibrillation rate, infection, and major neurological deficit (Type 1) were similar in both groups. Mortality was less among Group 1 high risk patients (3.9 %) in comparison to Group 2 high risk patients (7.9 %), but this did not reach statistical significance. CONCLUSIONS: In low or moderate risk patients, CABG can be performed safely with or without CPB. In high risk patients with several comorbidities, off-pump CABG seems to be a safe and efficient method that can improve outcome.

Association between homocysteine and neopterin in healthy subjects measured by a simple HPLC-fluorometric method.

OBJECTIVES: Neopterin and homocysteine promote vascular smooth muscle cell proliferation through the activation of nuclear factor(kappa) B. The aim of this study was to investigate the relation between these two compounds in healthy subjects by a rapid HPLC-fluorometric method which simplifies sample pretreatment for the measurement of neopterin in serum. DESIGN AND METHODS: In 40 healthy subjects (45.9 +/- 2.1 yr, mean +/- SEM, 10 males, 30 females) serum neopterin concentrations were measured by HPLC-fluorometry and enzyme-linked immunusorbant assay-ELISA and the results were compared. Urinary neopterin and plasma total homocysteine concentrations were assayed by HPLC-fluorometry. RESULTS: Serum neopterin concentrations measured by HPLC and ELISA were 7.5 +/- 0.4 and 7.4 +/- 0.3 nmol/L, respectively, r = 0.92, p < 0.01. Urinary neopterin level was 163.9 +/- 11.0 nmol/mmol creatinine and plasma total homocysteine 7.6 +/- 0.4 micromol/L. A significant positive correlation was observed between serum neopterin and plasma total homocysteine (r = 0.59, p < 0.01). CONCLUSIONS: A simple and rapid sample pretreatment for the measurement of neopterin in serum has been introduced. The significant positive correlation between neopterin and homocysteine implies that, interference with leukocyte function might be a new possible mechanism for the deleterious effects of homocysteine on vascular function.

Hyperhomocysteinaemia in Behçet's disease.

OBJECTIVE: Arterial and venous thrombosis are among the clinical features of Behçet's disease (BD), the pathogenesis of which is not completely understood. In this study, we investigated whether hyperhomocysteinaemia, being a well known risk factor for thrombosis, is also a contributive risk factor for the arterial and venous thrombosis of BD. METHODS: Eighty-four patients fulfilling the criteria of the International Study Group for Behçet's Disease (54 males, 30 females, mean age 36+/-9 yr) were enrolled. All the patients were carefully screened for a history of venous thrombosis and were separated into two groups with respect to thrombosis history. Thirty-six healthy individuals (23 males, 13 females), matched for age and sex with the BD group, were included as a negative control group. Patients were excluded if they had any condition that might affect plasma homocysteine concentration. As methotrexate (MTX) causes hyperhomocysteinaemia, we also included 29 rheumatoid arthritis patients (five males, 24 females) receiving MTX weekly. Fasting plasma homocysteine concentrations were measured by high-performance liquid chromatography. The data were analysed with the chi(2) test and Student's t-test. RESULTS: The highest homocysteine concentrations were found in the MTX group (17.5+/-5.3 micromol/l). Mean plasma homocysteine concentrations in BD patients were significantly higher than in the healthy controls (11.5+/-5.3 vs. 8.8+/-3.1 micromol/l, P<0.001). Among BD patients with a history of thrombosis, 20 of 31 (64%) had hyperhomocysteinaemia, and this was significantly higher than in those without thrombosis (9%). On the other hand, there was no significant difference between patients with non-thrombotic BD and healthy controls (P>0.05). In patients with thrombosis, we found no correlation between the duration of the post-thrombotic period and homocysteine concentration. Among all the variables investigated, only hyperhomocysteinaemia was found to be related to thrombosis. CONCLUSION: Hyperhomocysteinaemia may be assumed to be an independent risk factor for venous thrombosis in BD. Unlike the factor V Leiden mutation, hyperhomocysteinaemia is a correctable risk factor. This finding might lead to new avenues in the prophylaxis of thrombosis in BD.

The protective effects of high dose ascorbic acid and diltiazem on myocardial ischaemia-reperfusion injury.

In this study, we aimed to compare the myocardial protective effects of high dose ascorbic acid with the effects obtained by adding diltiazem to high dose ascorbic acid. We studied 30 elective cardiac surgery patients prospectively. In ascorbic acid group (group AA), ascorbic acid was given after induction and just before aortic declamping, 50 mg.kg-1 each time. In ascorbic acid + diltiazem group (group AA + D), diltiazem was added to ascorbic acid (0.3 mg.kg-1, i.v. after induction and then 2 micrograms.kg-1 min-1 i.v. infusion until declamping). Group C was the control group. There was no significant difference between groups in terms of cardiac enzyme levels. After declamping, the arterial and coronary sinus malondialdehyde levels, measured as a marker of lipid peroxidation, were increased significantly in the group C while remained stable in the other two groups. Ventricular fibrillation (VF) after declamping was positive in 3, 1 and 6 patients in the groups AA, AA + D and C respectively. In this study, we observed the prevention of lipid peroxidation in the group AA and group AA + D. The only positive result obtained by addition of diltiazem to high dose ascorbic acid was the decrease in the frequency of VF after declamping. We concluded that the prevention of lipid peroxidation in the groups AA and AA + D provided no measurable protection over myocardial ischaemia-reperfusion injury.

Age and gender dependent alterations in the activities of glutathione related enzymes in healthy subjects.

OBJECTIVES: Oxidative stress as a result of increased free radical production is implicated in the pathogenesis of several diseases. Specific antioxidant enzymes have a crucial role in the prevention of these deleterious effects. Since the activities of these enzymes differ significantly in different populations and seem to be affected by various environmental factors, in this study we aimed to determine the reference values of glutathione related antioxidant enzyme activities in the erythrocytes of healthy subjects and to investigate the possible variations as a function of age and gender in a healthy Turkish Mediterranean population. DESIGN AND METHODS: 130 healthy subjects (12-90 yr, 82 females, 48 males) were divided into six different age groups. Erythrocyte glutathione peroxidase (GSH-PX), glutathione reductase (GR) and glutathione-s-transferase (GST) activities were measured on a Hitachi 704 autoanalyser by the modification of previously described manual UV spectrophotometric methods. RESULTS: No significant differences were observed in erythrocyte GSH-PX, GR and GST activities between different age groups. Overall, GST activities were significantly higher in females compared with males (8.08 +/- 1.39, 6.88 +/- 1.51 U/g Hb respectively, mean +/- SD, p < 0.001). A significant positive correlation between GSH-PX and GR activities was observed (r = 0.49, p < 0.001). CONCLUSION: The results of this study suggested that the activities of GSH-PX, GR and GST did not depend. GST activities overall were higher in females. The reference values that we obtained were different than the previous reports. This situation implies that each population should determine its own reference values and should investigate the influence of environmental factors and life style habits on the activities of these enzymes that constitute a major part of the antioxidant defense system in the human organism.

Age-associated changes in nitric oxide metabolites nitrite and nitrate.

Aging is an important determinant of vascular disease. Endothelial dysfunction accompanying vascular disease may be related to cardiovascular risk factors such as aging, hypertension, and atherosclerosis. Experimental models suggest that endothelium-derived nitric oxide is reduced with aging, and this reduction is implicated in atherogenesis. The aim of this study was to determine whether increased age resulted in altered serum nitrite and nitrate levels, end-products of nitric oxide, in healthy subjects. Sixty-nine healthy individuals were divided into five different age groups: group I (6-15 years), group II (16-30 years), group III (31-45 years), group IV (46-60 years), and group V (>61 years). In these subjects, serum nitrite was measured by the Griess reaction and nitrate by the nitrate reductase method. Statistical analysis showed that serum nitrite levels were not significantly different in any of the groups, while serum nitrate concentrations exhibited significant differences (P<0.001). These findings suggest that nitric oxide synthesis and/or secretion is reduced with age and consequently endothelium-dependent vasodilation is impaired.