Relationship between red cell distribution width levels and severity of coronary artery ectasia.

OBJECTIVE: Coronary artery ectasia (CAE) is defined as abnormal dilatation of coronary arteries. Inflammation is thought to be important in the pathogenesis of CAE. Red blood cell distribution width (RDW) is also an inflammatory marker. In this study, we examined the association between RDW levels and CAE severity. PATIENTS AND METHODS: A total of 6737 patients who were admitted to the Cardiology Clinic of our hospital between January 2010 and December 2015 and diagnosed with coronary artery disease (CAD) were evaluated for inclusion. Of them, 126 patients who had CAE as a result of retrospective scanning, 104 randomly selected patients with CAD, and 76 patients who had normal coronary arteries were included in the study (n = 306). RESULTS: The severity and prevalence of CAE were evaluated according to the Markis ectasia classification, and the RDW value for type 1 CAE was significantly higher than that of other types of CAE. The RDW values for types 1-4 were 19.48 ± 11.81, 15.26 ± 9.17, 15.51 ± 8.07, and 15.33 ± 7.26, respectively (p= 0.098; r = 0.114). CONCLUSIONS: High RDW values are associated with CAE and CAD, and correlate with the severity of CAE. These findings indicate that RDW values can be used to estimate the severity of CAE disease.

Screening of coronary artery anomalies in 11,707 patients reveals that the radial approach is safe for cannulating coronary anomalies.

OBJECTIVE: This study evaluated the transradial approach for its ability to diagnose coronary artery anomalies, its requirement for catheter usage, the number of images obtained and fluoroscopy time required. PATIENTS AND METHODS: A total of 11,707 patients' coronary angiograph reports from January 2009 to January 2016 were evaluated with 179 patients identified as having coronary artery anomalies. Subsequent analyses compared patients' access sites with multiple angiographic parameters, including the number of images obtained, catheters used, and the fluoroscopy time required. RESULTSesults: The frequency of coronary artery anomalies identified by angiographies was 0.015%. Coronary anomalies were detected by transradial access (TRA) in 133 patients and by transfemoral access (TFA) in 46 patients. The most common anomaly was in the right coronary artery originating from the left sinus Valsalva (71 patients; 39.2%). The fluoroscopy times required and the number of catheters used was similar between the TRA and TFA groups (p = 0.887 and 0.302, respectively) while the number of images obtained during coronary angiographies was higher in the TFA group (p = 0.021). CONCLUSIONS: TRA is safe and effective for cannulation and the diagnosis of congenital coronary artery anomalies.

Total pulmonary vein diameter is a strong predictor of atrial fibrillation after coronary artery bypass graft surgery.

OBJECTIVE: Recent studies have shown that the pulmonary veins are important in atrial fibrillation (AF). This study evaluated the relationship between total pulmonary vein diameter and postoperative AF in on-pump coronary artery bypass graft (CABG) patients. PATIENTS AND METHODS: Our study enrolled 149 patients undergoing on-pump CABG. The primary endpoint was defined as postoperative new-onset in-hospital AF. All patients underwent preoperative non-contrast tomography to measure pulmonary vein diameter. RESULTS: The patients who developed AF had significantly greater total pulmonary vein diameters than those who remained in sinus rhythm. Logistic multivariate regression analysis revealed that only total pulmonary vein diameter was an independent predictor of the development of new-onset AF. CONCLUSIONS: To our knowledge, this is the first report of an association between total pulmonary vein diameter and the development postoperative AF. The identification of high-risk patients using pulmonary vein diameters should facilitate preventive measures.

Long-term endocrinologic complications of cystinosis.

AIM: Cystinosis is a rare autosomal recessive disorder that is characterized by defective cystine transport from lysosomes to cytoplasm and cystine crystal accumulation damaging many organs and tissues especially kidneys but extrarenal systems such as endocrine system. We aim to investigate endocrinologic complications of cystinosis METHODS: In our study, twenty one patients were reviewed retrospectively for endocrinologic complications. RESULTS: Eighteen (85.7%) had short stature, out of nine patients who reached pubertal age, five (55.5%) had pubertal delay, five patients (23.8%) had overt hypothyroidism and five patients (23.8%) had subclinical hypothyroidism with only elevated thyroid stimulating hormone (TSH) levels, seven (33.3%) had glucose intolerance, two (9.5%) had diabetes mellitus. Relation of these complications to age, renal functions and the dosage of cysteamine were studied. CONCLUSION: Endocrinologic complications of cystinosis can be seen in pediatric population and it is important to understand underlying mechanisms.

Association of adiponectin, resistin and high sensitive CRP level with the metabolic syndrome in childhood and adolescence.

Early markers are required in pathophysiological process of obesity, MS and type 2 diabetes. We aimed to clarify the usefulness of serum adipokines (adiponectin, AD and resistin) and inflammatory markers to identify obese and overweight children with MS. Three hundred and seven of 2 491 subjects aged 11-19 with BMI> or =85 centile selected with a multistage, stratified sampling were included. Their height, weight and waist circumference were measured, all subjects underwent physical examination and standard OGTT. AD, resistin and hs-CRP were measured from baseline blood sample. The mean age of subjects was 14.2+/-1.8, 57.7% was girl (n=177) and 42.3% (n=130) boy. Of the 307 subjects 40 (13%) were classified as having MS. Serum AD levels were significantly lower in boys (p=0.02), and decreased while BMI increased, but this trend was not significant (p>0.05). Although median resistin values were higher in obese than others (20, 18.5, 17 ng/ml, respectively) it was not significant (p>0.05). In obese subjects, hs-CRP levels were significantly high (0.21 mg/L) (p=0.000). All three markers in obese and overweight children with and without MS were not significant (p>0.05). Girls with MS had lower adiponectin levels than those without MS. Waist circumference had the highest sensitivity and specificity for predicting MS in ROC analysis. The area under the curve (AUC) was 0.831 for WC standard error (SE) 0.033; 95% CI 0.767-0.896; p<0.0001. But the AUCs for the adiponectin, resistin, hs-CRP were not significant. In this study, we observed that adipokines or inflammatory markers have no predictive value in the diagnosis of MS. We concluded that the best marker for MS diagnosis is the measurement of waist circumference.

Double opposing semicircular flap: a modification of opposing Z-plasty for closing circular defects.

A new method is presented for the closure of circular skin defects without altering their original shapes and excision of additional healthy skin. The authors hypothesized that two semicircular flaps prepared from opposite sides of a circular defect could close the defect without additional healthy tissue excision from the defect or the raised flaps; this technique was called double opposing semicircular flaps. It was first studied on an animal model followed by application on our patients with satisfactory results. This procedure has been performed with success on various body surfaces for defects of a size range of 2 to 5 cm in diameter. In this article, technical details and four clinical cases are presented.