The level of awareness and the attitude of patients recommended for use of compression stockings in Turkish society, and investigation of the factors affecting their use.

OBJECTIVE: The purpose of this study was to reveal the treatment outlook, usage habits, and factors affecting these habits, in addition to providing suggestions for solutions for patients who are frequently recommended the use of compression stockings as treatment for conditions such as chronic venous insufficiency, deep vein thrombosis, lymphedema, and pregnancy. METHODS: The study was conducted as a face-to-face questionnaire session with 1,004 patients who had previously registered at the cardiovascular surgeon's polyclinic of Sivas Numune Hospital between March 29, 2017, and October 31, 2017. In the study, basic criteria such as the patients' history, physical examination findings, and the use of compression stockings were evaluated. The survey was conducted in patients who were recommended compression stockings treatment for conditions such as chronic venous insufficiency, deep vein thrombosis, lymphedema, or pregnancy. The patients were asked about their demographics, characteristics of the compression stockings, whether compression stockings were used or not, and doctor evaluations related to the diagnosis. RESULTS: At the end of the study, it was found that 20.5% of the patients who were recommended compression stockings never bought them and only 11.5% of the patients regularly used them. Another surprising detail was that only 54.7% of the patients thought that the compression stockings were part of the treatment and 44.0% of the patients thought that they would benefit from using them. CONCLUSION: In many guidelines, use of compression stockings is the cornerstone of treatment of venous diseases. However, when the treatment incompatibility of the patients is taken into account, many duties fall to the doctors. The first of these is to inform the patient about the treatment and to answer any questions from the patients. In addition, the socioeconomic and sociocultural status of patients should be considered by the doctors.

Familial genetic risk factors in premature cardiovascular disease: a family study.

Cardiovascular disease (CVD) is closely associated with familial predisposition. The aim of the present study was to investigate predisposing risk factors in the family of a young patient who underwent coronary artery bypass graft surgery due to CVD. The father and uncle of the patient died at an early age due to myocardial infarction. Various stages of CVD were identified in both of the patient's brothers (28 and 32 years of age). Biochemical tests (fasting blood glucose, lipid profile, urea, creatinine and liver enzymes) and a complete blood count (haemoglobin, haematocrit, white blood cell count, and platelet count) were performed. Physiological coagulation inhibitory factors (protein C, protein S, and antithrombin III), prothrombotic genetic risk factors (factor V Leiden, plasminogen activator inhibitor-1, methylenetetrahydrofolate reductase A1C and C6T, angiotensin-converting enzyme, ß-fibrinogen, glycoprotein IIIa and factor XIII) and homocysteine levels were evaluated in all cases. Defects were observed in many genetic factors and in the systems regulated by these factors. The results were compatible with those reported in the literature. In conclusion, it is possible to determine a specific family history in young adults with CVD. From this perspective, the emergence of more serious CVD may be prevented by providing disease-related information to the other family members and implementing preventive measures.

The role of the CCR2 gene polymorphism in abdominal aortic aneurysms.

OBJECTIVE: Chronic inflammation play an important role on abdominal aortic aneurysms (AAA) formation. Chemokine receptor-2 (CCR2) is involved in regulation of the inflammatory response. However, relation between CCR2 polymorphism and AAA formation in human has not yet been investigated. In this study, we aimed to investigate the relationship between AAA and CCR2-V64I gene polymorphism. METHODS: In this study, 100 consecutive patients with AAA and 138 individuals with normal aortic diameter were included. CCR2-V64I gene polymorphism were analyzed by PCR-RFLP technique. Genotype distribution and allele frequencies of CCR2-V64I gene polymorphism in patients with AAA and healthy subjects were compared. RESULTS: CCR2 heterozygote V64I polymorphism and allele frequency were more frequently observed in the AAA group (p = 0.01, p = 0.004). Significant relationship was observed between CCR2 V64I polymorphism (OR:2.31, 95% CI:1.19-4.46, p = 0.01) and presence of AAA in multivariate regression analysis. CONCLUSION: The present study, showed us a relationship between CCR2-V64I polymorphism and AAA.

Association between ApoE4 allele and deep venous thrombosis: a pilot study.

INTRODUCTION: Deep vein thrombosis (DVT) is a multifactorial disease with genetic and acquired risk factors playing in concert in its pathogenesis. ApoE gene polymorphisms seem to have some impact among patients with cardiovascular disease; however, association between DVT and ApoE gene polymorphism has not been evaluated. MATERIALS AND METHODS: We aimed to search the relative frequencies ApoE alleles among patients with DVT and healthy participants. We enrolled 59 consecutive patients with DVT and 59 age- and sex-matched healthy controls. RESULTS: In the DVT group, E3/E4 gene polymorphism was detected in 20 patients (33.9%), in the control group E3/E4 polymorphism was detected in six patients (10.2%; P = .002). In the multivariable regression analysis, E3/E4 was independently associated with 1.31-fold increased risk of DVT (odds ratio [OR] 1.31; 95% confidence interval [CI], 1.30-10.48). CONCLUSION: It seems there is a relationship between ApoE3/E4 gene polymorphism and DVT in the Turkish population. However, this pilot study should be supported with large-scale studies.

Association of deep venous thrombosis with prothrombotic gene polymorphism identified in lung cancer cases.

Venous thrombosis is a significant cause of morbidity and mortality in patients with malignancies. We aimed to investigate the association between prothrombotic gene polymorphisms detected in lung cancer cases and deep venous thrombosis (DVT). Totally 66 patients with an established diagnosis of lung cancer, of which 33 developed DVT, were enrolled. Multiplex PCR technique and reverse hybridization strip assay were performed on DNA extracted from peripheral blood, in order to analyze prothrombin G20210A, factor V G1691A, methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, angiotensin converting enzyme (ACE), plasminogen activator inhibitor-1 (PAI-1), and glycoprotein IIIa (Gp IIIa) gene mutations. Among prothrombotic gene polymorphisms investigated in this study, the commonest ones were PAI-1 4G/5G (56% heterozygous, 39% homozygous) and ACE gene mutations (58% heterozygous, 17% homozygous). The presence of homozygous MTHFR A1298C mutation was significantly associated with DVT (P=0.020). Comparing the lung cancer patients with and without DVT, only MTHFR A1298C gene polymorphism differed significantly (P=0.040). We determined a higher rate of prothrombotic gene mutations in lung cancer patients who developed DVT. However, statistical significance was achieved only for MTHFR A1298C gene mutation. Therefore, nongenetic factors for disturbance of hemostatic metabolism should also be considered in lung cancer patients.

Frequency of the mdr-1 C>T gene polymorphism in patients with COPD.

BACKGROUND AND AIM: The multi-drug resistant-1 (MDR-1) gene is located on human chromosome 7 and encodes a glycosylated membrane protein that is a member of the ATP-binding cassette transporters superfamily. The aim of the study was to reveal the role of the C3435T MDR-1 gene polymorphism in chronic obstructive pulmonary disease. METHOD: DNA samples from 41 patients with chronic obstructive pulmonary disease and 50 healthy control participants were used to compare MDR-1 gene profiles. Genotyping assays were performed using the StripAssay technique that is based on reverse-hybridization. RESULTS: The T allele polymorphism in the MDR-1 gene located at position 3435 in exon 26 was shown to correlate with chronic obstructive pulmonary disease. CONCLUSION: These preliminary results suggest that the T allele polymorphism of the MDR-1 gene is associated with chronic obstructive pulmonary disease.

eNOS G894T polymorphism and abdominal aortic aneurysms.

BACKGROUND: The genetic risk factors that contribute to the risk of developing abdominal aortic aneurysm (AAA) are poorly understood. We assessed the association of endothelial nitric oxide synthase (eNOS) gene polymorphism with AAA. METHODS: eNOS gene polymorphism of 61 patients with AAA and 62 control participants were analyzed by polymerase chain reaction (PCR)-restriction technique. RESULTS: eNOS G894 homozygote T/T genotype polymorphism and 894T allele frequency in patients with AAA were significantly higher than those of the control participants (P = .01, P = .03). Among patients with AAA, the eNOS G894 T/T polymorphism and 894T allele frequency were associated with larger AAAs. CONCLUSION: The current study, in a small group of participants, showed a relationship between eNOS G894T polymorphism and AAA.

Avicenna: messages from a great pioneer of ancient medicine for modern cardiology.

Avicenna deserves to be remembered for his contributions to the field of cardiovascular medicine. His masterpiece, the Canon of Medicine, has served as an essential medical encyclopedia for scholars in the Islamic territories and Europe for almost a millennium. The Canon, which is a general treatise on medicine, consists of five books. The eleventh section of the third book principally deals with various kinds of heart diseases, their causes, effects, and treatment. He has expressed that the heart is the noblest and the best of all the chief organs of the human body. Avicenna has tried to find out the causes of heart diseases and classify them in accordance with the different signs and symptoms. His legacy will continue to inspire his modern colleagues in investigating heart diseases.

Influence of albumin concentration in priming solution on blood viscosity under hypothermic conditions.

OBJECTIVE: Albumin is used routinely as a plasma volume expander in cardiopulmonary bypass operations. The effect of two different concentrations of albumin in Ringer's lactate on blood viscosity was explored in this study. METHODS: Ten healthy volunteers (all male) were included in the study, based on their haematocrit levels (42.6 +/- 0.96). Using a heparinised 50-ml syringe, 40 cm(3) of blood were drawn from the antecubital veins of fasting volunteers. Six ml of blood were haemodiluted with 2 ml of albumin (20%), 2 ml of Ringer's lactate containing albumin (1.3%), and 2 ml of Ringer's lactate, in order to simulate cardiopulmonary bypass conditions. Test tubes with the solutions were placed in a 15 degrees C water bath for 25 minutes. Viscosity was measured in the haemodiluted blood samples using an Ostwald viscometer. Relative viscosities of samples were assessed with SPSS software and the ANOVA test. RESULTS: The mean relative viscosity of Ringer's lactate was 4.19 (+/- 0.49), that of Ringer's lactate with 1.3% albumin was 4.30 (+/- 0.31), and of 20% albumin was 7.32 (+/- 0.71). The relative viscosity of Ringer's lactate and Ringer's lactate with 1.3% albumin were statistically similar, but that of 20% albumin was higher than the Ringer's lactate and Ringer's lactate with 1.3% albumin. CONCLUSION: Albumin is used as a plasma volume expander in priming solutions for cardiopulmonary bypass operations, but its effect on blood viscosity depends on the concentration of albumin used.

The influence of priming solutions used in cardiopulmonary bypass on blood viscosity in hypothermic conditions.

Vessel diameter, flow velocity, temperature, and viscosity are among the factors determining blood flow in vessels. To assess the influence of arterial blood flow on veins in a cardiac operation, the viscosity of blood diluted with priming solutions must be known. This study aimed to demonstrate the alteration of blood viscosity following dilution with priming solutions: hydroxyethyl starch (HES), gelatin, albumin, and Ringer's lactated solution (RL). Sixty volunteers were (15 female, 45 male) included in the study. Using a 50-ml syringe containing heparin, 40-ml fasting blood was drawn from antecubital veins. Six milliliters of blood was added to glass tubes previously filled with 2 ml of HES 6%, gelatin 4%, albumin, and RL solutions. Relative viscosity values of these mixtures were measured with an Ostwald viscometer device while the temperature was kept constant at 15 degrees C and 30 degrees C by means of a water bath. Measured viscosity values were compared with the calculated viscosity values and corrected values were obtained. All mixtures demonstrated decreased viscosity; however, it was evident that the mixtures containing HES and gelatin presented a lesser degree of decrease in viscosity when compared with the mixtures containing albumin and RL solution. Viscosity of all mixtures except RL decreased significantly at deep hypothermia (15 degrees C).

Multidetector computed tomographic angiography findings in a rare case of popliteal artery entrapment syndrome.

Popliteal artery entrapment syndrome (PAES) is a disorder of the young age group characterized by ischemia of the lower extremities due to an abnormal association between the popliteal artery and adjacent musculotendinous structures. Several underlying anatomical abnormalities causing this syndrome are described and classified. In this study, we present an unusual case of PAES along with multidetector computed tomographic angiography findings.

Early thrombosis in bovine mesenteric vein grafts after infrainguinal reconstruction.

INTRODUCTION: Autologous vein grafts are still the gold standard in infrainguinal arterial bypass grafting procedures. However, due to the unavailability of suitable autologous vein grafts, heterogeneous grafts are usually preferred. In the present study, surgical outcomes with bovine mesenteric vein grafts (ProCol, Hancock Jaffe Laboratories, USA) in the infrainguinal location in patients with ischemic leg infection or necrosis are presented. METHODS: Seven patients who underwent infrainguinal arterial reconstructions with ProCol grafts were evaluated retrospectively. RESULTS: Graft thrombosis was seen in two patients on postoperative day 1 (28.5%). The shortest and the longest patency durations were six and 18 months, respectively. Aneurysmal dilation developed postoperatively in two grafts (28.5%) after 12 and 18 months, respectively. CONCLUSION: In cases where infection accompanies ischemia, and autologous veins are not available as graft materials, ProCol grafts can be used as temporary grafts in infrainguinal arterial reconstructions. The use of the graft is believed to be unacceptable for any indication other than infection due to its low short- and long-term patency rates and high risk of aneurysm formation in this location.

Neuroprotective effects of diltiazem in rabbits with occluded aorta

OBJECTIVE: In the present study, we aimed to determine the protective effect of the perfusion of the distal aorta with diltiazem and ringer lactate solution on the spinal cord. METHODS: Twenty-seven New Zealand rabbits were used in which spinal cord ischemia was provided by occlusion of the aorta for thirty minutes. Experimental animals were divided into four groups: group A (n=4), the sham operation group; group B (n=8) in which intraaortic balloon occlusion alone was applied; group C (n=7), ringer lactate group in which ringer lactate was perfused into distal aorta at a rate of 40 ml/kg, hr, following intraaortic balloon occlusion; group D (n=8) diltiazem group in which diltiazem 40 mg/kg, hr, in Ringer lactate was perfused into distal aorta following intraaortic balloon occlusion. Motor function of hind limbs was evaluated by Tarlov's scoring system. After observation, spinal cords were removed for histopathological evaluation. RESULTS: The degree of histopathological injury was well correlated with neurological function. The most severe histopathological injury and neurological dysfunction occurred in group B, followed by group C, D and A respectively. No injury or neurological dysfunction occurred in the sham group. CONCLUSIONS: The protective effect of diltiazem on both histopathological injury and neurological function was significant in comparison with control groups.

OBJETIVO: O objetivo do presente trabalho é determinar o efeito protetor da perfusão na aorta distal com diltiazem e solução de Ringer lactato na medula espinal. MÉTODOS: Foram usados 27 coelhos da raça New-Zeland, nos quais se provocou isquemia da medula espinal por meio de oclusão da aorta durante 30 minutos. Os animais experimentais foram divididos em quatro grupos: grupo A (n=4), o grupo de cirurgia simulada (pseudocirurgia); o grupo B (n=8) no qual se aplicou somente a oclusão do balão intraaórtico; grupo C (n=7), o grupo do Ringer lactato, no qual a solução de Ringer lactato foi perfundida na aorta distal após oclusão do balão intra-aórtico; grupo D (n=8), grupo do dialtiazem, no qual 40 mg/kg/h de diltiazem, em solução de Ringer lactato, foram perfundidas na aorta distal após oclusão do balão intra-aórtico. A função motora dos membros posteriores foi avaliada pelo sistema de escore de Tarlov. Após observação, as medulas espinais foram removidas para avaliação histopatológica. RESULTADOS: O grau de lesão histopatologica estava bem correlacionado com a função neurológica. Lesões histopatológicas e disfunções neurológicas mais graves ocorreram no grupo B, seguido pelos grupos C, D e A, respectivamente. Não ocorreu nenhuma lesão ou disfunção neurológica no grupo de cirurgia simulada. CONCLUSÕES: O efeito protetor do diltiazem na lesão histopatológica e na função neurológica foi significativo em comparação com os grupos-controle.

Asymptomatic total anomalous pulmonary venous connection with double drainage in a young adult: a case report.

Total anomalous pulmonary venous connection is an uncommon congenital anomaly in which all pulmonary venous return drains to the right atrium or one of its tributaries. Survival beyond infancy without surgical palliation is unlikely, so this anomaly is not encountered in the adult population with congenital heart disease. The patient presented here was 22 years old on admission and had no total anomalous pulmonary venous connection-associated symptoms. He underwent transthoracic echocardiographic examination for atypical chest pain. Transthoracic echocardiography along with cardiac catheterization favored the presence of a total anomalous pulmonary venous connection. Surgical correction of pulmonary venous confluence (draining to both the coronary sinus and right atrium) was performed successfully. This is a rare case of total anomalous pulmonary venous connection with no reported symptoms in contrast to the majority of patients who are symptomatic during the first year of life.

Neuroprotective effects of diltiazem in rabbits with occluded aorta.

OBJECTIVE: In the present study, we aimed to determine the protective effect of the perfusion of the distal aorta with diltiazem and ringer lactate solution on the spinal cord. METHODS: Twenty-seven New Zealand rabbits were used in which spinal cord ischemia was provided by occlusion of the aorta for thirty minutes. Experimental animals were divided into four groups: group A (n=4), the sham operation group; group B (n=8) in which intraaortic balloon occlusion alone was applied; group C (n=7), ringer lactate group in which ringer lactate was perfused into distal aorta at a rate of 40 ml/kg, hr, following intraaortic balloon occlusion; group D (n=8) diltiazem group in which diltiazem 40 mg/kg, hr, in Ringer lactate was perfused into distal aorta following intraaortic balloon occlusion. Motor function of hind limbs was evaluated by Tarlov's scoring system. After observation, spinal cords were removed for histopathological evaluation. RESULTS: The degree of histopathological injury was well correlated with neurological function. The most severe histopathological injury and neurological dysfunction occurred in group B, followed by group C, D and A respectively. No injury or neurological dysfunction occurred in the sham group. CONCLUSIONS: The protective effect of diltiazem on both histopathological injury and neurological function was significant in comparison with control groups.

A temperatura da pele pode ser um indicador para hemorragia grave no pós-operatório? / Can skin temperature be a clue for predicting excessive postoperative bleeding?

OBJETIVO: O objetivo deste estudo é avaliar a hipotermia residual pós-operatória e sua duração, assim como discutir se a hipotermia tardia pode ser um marcador de sangramento excessivo. MÉTODO: Neste estudo retrospectivo, os registros de 12 pacientes que tiveram re-intervenção por causa de sangramento no período pós-operatório foram revisados e suas durações, que foram desde o primeiro minuto em Unidade de Terapia Intensiva até a pele alcançar uma temperatura de 36,5 graus Celsius. O tempo de duração da Circulação Extracorpórea (CEC) foi anotado. Também foi registrado o tempo ativado de coagulação (TCA). A temperatura mais baixa do corpo durante a operação foi medida. Um grupo de controle foi criado (n=16) aleatoriamente, formado por pacientes que não precisariam de re-intervenção e no qual a duração da CEC foi similar à do grupo de estudo. Todos os parâmetros foram comparados entre dois grupos com a versão do software SSPSs. RESULTADOS: As durações desde o primeiro minuto no tratamento intensivo até a temperatura da pele alcançar 36.5 graus Celsius foram significantemente mais longas no grupo de estudo (p=0,0001). TAC pré-operatório e pós-operatório não foram diferentes (p=0,312 e p=0,576 respectivamente). A menor temperatura do corpo não foi diferente (p=0,157). CONCLUSÕES: Nossos achados indicam que a temperatura da pele é importante no sangramento excessivo que leva à re-intervenção. Hipotermia pode ser o motivo ou a causa do sangramento.

OBJECTIVE: The purpose of this study was to investigate whether postoperative hypothermia evaluated by skin temperature can be a clue of excessive bleeding requiring re-exploration. METHODS: In this retrospective study, the records of 12 patients who needed re-exploration due to bleeding in the postoperative period were reviewed and the time from the first minute in the intensive care unit until the skin temperature reached 36.5°C was measured. Cardiopulmonary bypass (CPB) durations were noted as were preoperative and postoperative Activated Clotting Times (ACT) and the lowest body temperatures during the operation. A control group was formed of 16 randomly chosen patients who did not need re-exploration with CPB times similar to the study group. All parameters were compared between the two groups using the SPSS software version 10.0. RESULTS: The length of time from the first minute in the intensive care unit until skin temperatures reached 36.5°C were significantly longer in the study group (p=0.0001). Preoperative and postoperative ACT were not significantly different (p=0.312 and p=0.576 respectively). The lowest body temperatures were also not significantly different (p=0.157). CONCLUSIONS: Our findings show that skin temperature is an important indicator of excessive bleeding with a need for re-exploration. Hypothermia may be a reason for this or may be a result of the bleeding.