Triglyceride-glucose index for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents.

OBJECTIVE: To evaluate the triglyceride-glucose index (TyG index) for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents. PATIENTS AND METHODS: Subjects with iliac artery stenosis, who underwent an iliac stent intervention and were followed up for at least 2 years were included in the study. Subjects were grouped according to TyG index (Group A, TyG index ≤8.848; Group B 8.849 ≤TyG index ≤9.382 and Group C TyG index ≥9.383). The subject's baseline characteristics, blood parameters, claudication distance, Transatlantic Intersociety Consensus classification, target lesion localization, stent direction, number of stents that were applied, and stent type were noted. Pre- and 1st and 2nd-year post-procedure Rutherford statuses, ankle-brachial index, and stenosis degree were recorded. To calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), Group B and Group C were combined and compared with Group A. RESULTS: In total, 255 subjects were evaluated (female, n=77-30.2%, male, n=178-69.8%). The mean age of the subjects was 66.00±10.00 years (range from 39 to 90 years). The pre-procedure Rutherford measurements were significantly different among the groups (p=0.001). The rates of mild claudication and resting pain in Group A were higher than those in Groups B and C. The rate of moderate claudication in Group C was higher than that in Groups A and B. The rate of severe claudication in Group B was higher than that in Groups A and C. One year after the procedure, there were more asymptomatic cases in Group A than in Groups B and C (p=0.001). The rate of mild claudication in Group C was lower than that in Groups A and B. The rate of moderate claudication in Group C was higher than that in Group A. The rate of severe claudication in Group C was higher than that in Groups A and B. Two years after the procedure, the Rutherford measurements and the rates of mild claudication in Groups A and B were higher than those in Group C. The rate of severe claudication in Group C was higher than that in Groups A and B (p=0.001). One year after the procedure, the computed tomography angiography (CTA) measurements and the rate of full patency in Group A were higher than that in Groups B and C. The rate of 0-50% stenosis in Group B was higher than that in Groups A and C. The rate of 50-70% stenosis in Group C was higher than that in Group A. Two years after the procedure, the CTA measurements and the rates of 70-99% stenosis and 100% occlusion in Group C were higher than those in Groups A and B. The TyG index has high specificity and NPV. However, specificity and PPV levels were found to be quite low. CONCLUSIONS: The TyG index was found to be an easy-to-use marker for predicting in-stent restenosis in patients with iliac artery stenosis after percutaneous intervention with stents.

Relationship between uric acid albumin ratio and peripheral artery disease complexity.

OBJECTIVE: Uric acid to albumin ratio (UAR) reflects inflammatory activity and its predictive value has been shown in various diseases. In this study, we sought to evaluate the value of uric acid to albumin ratio in patients with peripheral arterial disease (PAD). PATIENTS AND METHODS: Two hundred forty-three PAD patients were divided into TransAtlantic Inter-Society Consensus-II (TASC-II) A-B and TASC-II C-D groups, according to their TASC-II classification. Biochemical variables of the patients were recorded, and the UAR of each patient was calculated. RESULTS: Patients who had TASC-II A-B disease were younger than the patients who had TASC-II C-D disease (60.7±8.71 vs. 63.28±8.8 years, p=0.024). Quade ANCOVA results showed that patients with TASC-II C-D disease had higher values of UAR when age was used as a covariate (t=-5.045, p<0.001). Lymphocyte count was significantly lower, and UAR was significantly higher in patients with TASC-II C-D disease (p=0.035 and p<0.001, respectively). UAR and lymphocyte count showed a significant positive correlation and a negative correlation with the TASC-II class of the disease (r=0.403, and r=-0.299, p<0.001 for both). A UAR of 1.54 predicted TASC-II C-D disease with a sensitivity and specificity of 57.9% and 78.8%, respectively. UAR predicted severe PAD with an OR of 3.723. CONCLUSIONS: UAR was a better tool for predicting TASC-II C-D disease compared to uric acid and albumin levels. UAR is an easily calculable parameter that can be used in clinical practice.

A Study on Isolation and Molecular Identification of Bordetella avium from Iranian Commercial and Backyard Broiler Turkeys within 2016-2018.

Bordetellosis or turkey coryza, caused by Bordetella avium, has been an issue for turkey industry since its first description in 1967 when it was reported for the first time. Bordetella avium causes a highly contagious upper respiratory disease in turkeys. Therefore, this study aimed to isolate and characterize this species from commercial and backyard turkeys in Tehran, Isfahan, and Northern provinces of Iran. For the purpose of the study, 625 tracheal swabs were taken from 425 commercial poults and 200 backyard poults aged 2-6 weeks from September 2016 to September 2018. The swabs were immediately plated on MacConkey and blood agar plates and then pooled (5 swabs/pool) in tubes, containing 2 mL distilled water, to perform direct polymerase chain reaction (PCR) for the identification of B. avium. A total of 17 swab pools were found to be positive for B. avium. A subset of seven positive samples were sequenced for the flanking region of piuA gene. The analysis of the sequences indicated that the sequences were 98%, 96%, and 98% similar to B. avium 197N (AM167904.1), 4142 (AY925058.1), and 4156 (AY925068.1) sequences, respectively. To the best of our knowledge, the current study is the first attempt toward the molecular detection and characterization of B. avium in Iran. It is highly recommended to perform further studies to isolate, characterize, and differentiate the regional isolates in order to help the developing turkey industry of Iran meet the increasing demands for protein in the diet of the citizenry.

Thyroid nodules classified as atypia or follicular lesions of undetermined significance deserve further research: Analysis of 305 surgically confirmed nodules.

OBJECTIVE: The objective of the present study was to determine the malignancy risk for nodules categorised as atypia or follicular lesions of undetermined significance atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) and to investigate the predictors of malignancy. METHODS: All nodules diagnosed as AUS/FLUS on fine needle aspiration (FNAs) performed between January 2011 and December 2015 were retrospectively reviewed. Clinical data, ultrasonographic features, follow-up data and the final pathological results were recorded. After further exclusion, only nodules that underwent surgical excision were included in the final analysis. The malignancy rate and the range of malignancy rates were calculated. Clinical and ultrasound features were examined to determine the predictors of malignancy. RESULTS: During the study period, FNA was performed on 9938 nodules, and 1019 (10.2%) nodules were diagnosed as AUS/FLUS. After further exclusion, 976 nodules were evaluated. After the initial diagnosis of AUS/FLUS, 139 (14.2%) patients underwent surgery, 518 (53.1%) had repeated FNAs. A total of 305 (31%) had undergone surgical excision at different time points. For surgically confirmed nodules, the malignancy rate after the initial FNA was 34.5% (the lower and upper thresholds for the malignancy rate were 19.3% and 66.3%, respectively), and 37.9% after the repeated FNA. No ultrasound feature was determined as a predictor, whereas age (>55 years) was a predictor for malignancy. CONCLUSIONS: The overall malignancy rate for nodules diagnosed as AUS/FLUS and the malignancy rate for nodules that underwent repeated FNA after AUS/FLUS were higher than the expected malignancy rates of the National Cancer Institute. It is, therefore, suggested that the current recommendations should be reconsidered.

Total Thyroidectomy for Management of Benign Multinodular Goitre in an Endemic Region: Review of 620 Case.

INTRODUCTION: The aim of this study was to evaluate the safety and efficiency of total thyroidectomy (TT) when performed by an experienced surgeon in benign multinodular goitre (BMNG) in an endemic region. MATERIAL AND METHODS: A total of six hundred and twenty consecutive patients, who underwent a total thyroidectomy for BMNG between July 2004 and May 2012, were reviewed in this study. RESULTS: Of the one hundred and nine men and 511 women examined, the mean ± SD (standard deviation) ages were 48 ± 14 in men (range: 19-79) and 51 ± 16 in women (range: 18-84 years). The annual mean number of operation was 80 ± 14 (range: 68-86). The mean operation time lasted 64 ± 12 minutes (range: 48-95). About 2.3 ± 0.4 (range: 1-4) parathyroid glands were observed during thyroidectomy. Parathyroid auto transplantation was performed in seventy-eight patients (12.5%). Patient-stay in hospital was approximately 2.3 ± 0.3 days (range: 1-5). TT was performed in all patients as the primary operation. Pathologic findings revealed BMNG in four hundred and seventy (75.8%) cases, papillary carcinoma in 66 (10.3%), thyroiditis in 59 (9.5%), follicular carcinoma in 10 (1.6%), follicular adenoma in 5 (0.8%), and thyroid lymphoma in 3 cases (0.5%). Postoperatively, bilateral recurrent laryngeal nerve (RLN) injury was seen in one case (0.3%) and unilateral RLN injury in 5 (0.8%) cases. Three months later, only three cases (0.5%) were permanent. The histological diagnosis in all patients with permanent RLN injury was thyroiditis. Transient hypoparathyroidism was found in forty-eight cases (7.8%), three of which (0.5%) were permanent. Four cases were re-operated due to re-bleeding (0.6%). Seroma developed in three cases (0.5%) and wound infection in two (0.3%). CONCLUSION: TT can be performed safely by an experienced surgeon with a minimal risk in a high volume hospital.

Comparison of open and retroperitonoscopic donor nephrectomy in terms of lipid and protein peroxidation responses.

BACKGROUND: This study was designed to compare donors who underwent open (ODN) versus retroperitonoscopic nephrectomy (RDN) in terms of intra-operative oxidative stress and recipients graft function in the early postoperative period. METHODS: Among 40 patients who underwent donor nephrectomy, 23 were operated via an open method and 17 via retroperitonoscopic method. To analyze oxidative stress, we measured plasma levels of malondialdehyde (MDA), protein carbonyl, and protein sulfhydryl moieties in donor venous blood before induction of anesthesia and postoperatively at 0, 6, and 24 hours. The influence of oxidative stress on graft function was evaluated by means of the postoperative 5th day recipient creatinine and estimated glomerular filtration rate (eGFR) Modification of Diet in Renal Disease Formula (MDRD) to evaluate delayed graft function (DGF) status. RESULTS: ODN patients showed significantly higher 24-hour mean levels of MDA, (6,139 ± 1,854 vs 4,813 ± 1,771 nmol/L; P = .01), protein carbonyl (366 ± 64 vs 311 ± 62 µmol/L; P = .01) and protein sulfhydryl (468 ± 110 vs 386 ± 75 µmol/L; P = .01) moieties compared with those RDN patients. However, ODN and RDN recipients were similar in terms of 5th day mean creatinine and eGFR (1.1 ± 0.3 vs 1.4 ± 0.8 mg/dL and 69.15 ± 12.24 vs 56.31 ± 25.2, respectively) and DGF status (4.4% [1/23] vs 5.9% [1/17], respectively). CONCLUSIONS: Although ODN donors were more prone to intra-operative oxidative stress than RDN donors, based on significantly higher levels of oxidative stress markers, this difference seems to not significantly influence recipients early graft function.

Attitudes and behavior regarding organ donation and transplantation on the part of religious officials in the Eastern Black Sea region of Turkey.

AIM: This study evaluated the opinions and attitudes toward organ donation and transplantation on the part of religious officials in the Eastern Black Sea region of Turkey. METHOD: This descriptive study was performed between December 2008 and November 2009 with 550 among Muslim religious officials, including 541 males and 9 females, who attended educational seminars on the subject arranged in collaboration with Mufti Offices in the provinces of Trabzon, Rize, Gümüshane, and Giresun in the Eastern Black Sea region of Turkey. A supervised questionnaire administered before the seminars contained questions investigating whether subjects have volunteered to donate organs, reasons for not volunteering, whether they would donate the organs of a close relative in the event such a death, and what they would think in the event they required an organ transplantation themselves. Questions were also asked regarding permission for organ transplantation and donation in 5 main religions. RESULTS: Although no female religious officials had previously volunteered to donate organs, 4 men (0.7%) had done so. After attending seminars, 32 (5.9%) volunteered to donate. The main reasons cited for not volunteering to donate organs were lack of sufficient knowledge of the procedures involved (30.6%) and lack of interest (17.4%). Three hundred five religious officials stated they would not agree to organ donation in the event of the death of a close relative. When asked "What would you think about organ donation and transplantation if you needed an organ transplant now?", 46.0% replied "I would want an organ transplant." Finally, 83.3% of religious officials stated that Islam permits organ donation and transplantation, whereas 13.6% stated that Christianity permits it, other figures being 7.3% for Judaism, 2.5% for Buddhism, and 2.0% for Hinduism. CONCLUSIONS: Religious views affect organ donation. The fact that religious officials agreed to donate organs after appropriate education emphasized that Islam is the most sensitive faith on the subject, indicating that the issues can be improved through collaboration with religious officials.

Does nuclear factor-kappa B in peripheral mononuclear cells have a prognostic role during acute necrotizing pancreatitis in rats?

AIM: To investigate the prognostic role of nuclear factor-kappa B (NF-κB) activity in peripheral blood mononuclear cells (PBMNCs) during acute necrotizing pancreatitis (ANP) in rats. METHODS: ANP was induced by an intravenous infusion of cerulein over 6 h superimposed on glycodeoxycholic acid (10 mmol/l) into the biliary-pancreatic duct for 10 min. The rats were divided into five groups and the first group served as the control. ANP was induced in the remaining groups, which were followed for 6, 12, 24 and 48 h. The mortality rate, serum amylase, alanine transferase (ALT), urea, creatinine and calcium, pancreatic histology, and NF-κB activity in PBMNCs were investigated. The NF-κB activity in PBMNCs was measured as two subunits of NF-κB, p50 and p65. RESULTS: A significant increase in mortality rate, pancreatic damage, serum activity of amylase and ALT, urea and NF-κB p65 activity in PBMNCs were observed. There was a significant correlation between the mortality rate and pancreatic damage in conjunction with time, but there was no correlation between NF-κB p65 activity in PBMNCs and the mortality rate. CONCLUSION: The measurement of p65 levels of NF-kB in PBMNCs has no prognostic role during ANP in rats.

Information, attitude, and behavior toward organ transplantation and donation among health workers in the eastern Black Sea region of Turkey.

AIM: We sought to evaluate the information, attitude, and behaviors toward organ donation among health workers in the eastern Black Sea region of Turkey. METHOD: This descriptive study was performed between December 2008 and November 2009. It involved 1,545 health personnel in 8 state hospitals in the eastern Black Sea region of Turkey, excluding the university hospitals in the towns of Trabzon, Rize, Gümüshane, and Giresun. Educational seminars regarding organ transplantation and donation were arranged for the hospitals in the study. Questionnaires on the subject distributed to the participants were collected before the seminars began. They contained questions about occupation, gender, age, previous organ donation, whether the person would consider donating if they had not already volunteered (if not, the reasons why), whether any relatives had volunteered to donate organs, whether anyone close to them had volunteered to donate organs, whether they would donate organs in the event of a relative's death, and what they might think if they were to require an organ transplant. Following the seminars, participants were given the opportunity to obtain organ donation cards from a stand on site. Data were analyzed using the chi-square test. RESULTS: Eighty-one participants (5.2%), including 46 women (5.2%) and 35 men (5.3%), had previously officially volunteered to donate organs (P = .875). One hundred thirty-seven health personnel were willing to donate organs by visiting the donation stand after the seminars. The main reasons for participants who had not volunteered to donate organs failing to do so were lack of information about donation and procedures (28.4%), lack of interest in the subject (23.2%), and Islamic religious beliefs and/or traditions (19.6%). One hundred eighty health personnel (11.7%) had family members or relatives who had volunteered to donate organs. Asked whether they would donate that person's organs in the event of the death of a relative, 93 doctors (67.6%), 225 nonphysician health personnel (41.1%), and 345 other participants (43.1%) stated that they would not (P < .0005). CONCLUSIONS: Health workers play a key role to overcome the difficulties encountered regarding organ donation. This study showed the need for constant effective education seminars to enhance knowledge and sensitivity on the part of health workers.

Molecular epidemiology and antimicrobial resistance mechanisms of methicillin-resistant Staphylococcus aureus isolated from bovine milk.

The aim of this study was to identify methicillin-resistant Staphylococcus aureus (MRSA) strains gathered from 2002 to 2006 from milk samples in Aydin region in Turkey. Among 93 S. aureus strains isolated from bovine milk with mastitis, 16 were resistant to methicillin. Methicillin-resistant S. aureus strains were studied further for their staphylococcal cassette chromosome mec (SCCmec) types, pulsotypes, spa and MLST types, antimicrobial susceptibilities, mechanisms of resistance and presence of Panton-Valentine leucocidin (PVL) toxin gene. The MRSA strains were multi-drug resistant. The susceptibility rates to antimicrobials tested were 0%, 0%, 0%, 0%, 6.25%, 16.25% and 56.25% for erythromycin, clindamycin, chloramphenicol, gentamicin, tetracyclin, ciprofloxacin and vancomycin, respectively. All tetracycline and gentamicin resistant strains carried tet(M) and aac(6)-aph(2) gene, respectively. Among macrolide-resistant isolates, nine had erm(A), and seven had both erm(A) and erm(B) genes. The molecular characterization by pulsed-field gel electrophoresis showed presence of three pulsotypes with their variants. The pulsotype B strains were type IV with SCCmec typing, and representative of pulsotype B was t190 by spa typing and ST8 by MLST typing. The strains with pulsotype A and C were SCCmec III, and representative of these pulsotypes was t030 by spa typing. The MLST type of pulsotype A was ST239 and pulsotype C was one allele variant of ST239. None of the isolates harboured the PVL gene. Presence of hospital-related MRSA strains may indicate transmission of these strains between human and animals. In case of clonal spread beside the infected animals' treatment of MRSA carrier, farm workers should also be considered. Hygienic measures and rational antibiotic use may avoid resistance selection, clonal dissemination of resistant strains and decrease losses because of mastitis in dairy herds.

Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy.

BACKGROUND: Technical modifications and methods for gallbladder dissection to minimize the risk of gallbladder perforation during laparoscopic cholecystectomy (LC) are described. The authors aimed to investigate the effects of gallbladder aspiration during LC on the operative and postoperative course of patients. METHODS: For this study, 200 patients undergoing LC for symptomatic cholelithiasis were randomly divided into two groups. Gallbladders were aspirated before dissection in group A (n = 100), and they were not aspirated in group B (n = 100). Operative and postoperative data on the patients were collected. RESULTS: The rate of gallbladder perforation was significantly lower in group A than in group B (p = 0.0003). The operative time was significantly shorter in group A (46.70 +/- 15.93 min) than in group B (60.75 +/- 22.09 min) (p = 0.047). Postoperative complications were more numerous in group B. The hospital stay was significantly longer in group B (1.55 +/- 0.81 days) than in group A (1.3 +/- 0.5 days; p = 0.004). CONCLUSION: The findings demonstrate the advantages of gallbladder aspiration in elective cases.

Effects of omega-3 fatty acids on acute necrotizing pancreatitis in rats.

The aim of this study was to investigate the influence of omega-3 fatty acids (omega3FA) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. The induction of ANP resulted in significant increases in mortality rate, intestinal permeability, bacterial infection in pancreas and extrapancreatic organs, and serum activity of urea and amylase, alanine transferase (ALT), interleukin (IL)-6, tumor necrotizing factor-alpha (TNF-alpha), lactate dehydrogenase (LDH) in bronchoalveolar lavage (BAL) fluid, tissue activity of myeloperoxidase (MPO) and malondialdehyde (MDA) in the pancreas and lung, and a considerable decrease of concentrations of calcium, protein and albumin. The use of omega3FA reduced mortality, phenol sulfophthalein excretion in urine, bacterial infection in pancreas, liver, spleen, MPO and MDA levels in pancreatic and lung tissue, LDH level in BAL fluid and serum IL-6 and TNF-alpha values. Serum triglyceride increased only in the omega3FA groups. Serum amylase, ALT, calcium, urea, protein, IL-1, and degree of pancreatic damage indicated no difference between the pancreatitis groups. Increased intestinal permeability and cytokine levels, and free radical damage play an important role during the course of acute pancreatitis. The treatment with omega3FA improves these effects. omega3FA may be useful in the treatment during ANP in rats. Therefore, it can be beneficial in patients with pancreatitis.

Comparison of topical glyceryl trinitrate ointment and oral nifedipine in the treatment of chronic anal fissure.

This study was designed to compare the effect of topical glyceryl trinitrate (GTN) and oral nifedipine treatments on maximal anal resting pressure (MARP) and subsequently to assess their effectiveness in healing of chronic anal fissure (CAF). Patients were allocated randomly to receive either oral nifedipine retard (10 patients) 20 mg twice daily or instructed to apply glyceryl trinitrate (0.2 percent) ointment (10 patients) into the lower half of the anal canal twice daily. They were reviewed and assessed at the first visit and every fortnight for measurement of MARP, pain scores, blood pressure, pulse rate, healing of the fissure and adverse effects. Treatment were continued until healing had occurred or for up to 8 weeks. MARP values before and after application of the GTN ointment was 113.2 cm H2O and 72.5 cm H2O respectively (P < 0.001). Nifedipine caused a reduction in mean MARP from 105.2 to 74.0 cm H2O (P < 0.001). Linear analogue pain scores were significantly reduced after 2 weeks treatment with GTN and nifedipine (P < 0.001) and continued throughout the treatment period. At the end of the study; 7 of the 10 patients in the GTN group were deemed to be healed (5) or improved (2), compared with 6 of the 10 patients in the nifedipine group (5 healed, 1 improved). Headaches occurred in 3 patients in the GTN group, compared with one patient in the nifedipine group. There was no significant difference between GTN and nifedipine in terms of reduction in MARP and pain score, healing of the fissure and incidence of early recurrence and side effects of treatments. We conclude that GTN ointment and oral nifedipine are equally effective in the treatment of chronic anal fissure.

Effects of lazaroid U-74389G on acute necrotizing pancreatitis in rats.

The aim of this study was to investigate the influence of U-74389G on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. The induction of ANP resulted in a significant increase in mortality rate, pancreatic necrosis, and serum levels of amylase, alanine aminotransferase, interleukin-6, tumor necrosis factor alpha, and urea, in lactate dehydrogenase levels in bronchoalveolar lavage fluid, and in the activities of myeloperoxidase and malondialdehyde in pancreas and lung tissue; a significant decrease was observed in serum calcium levels, blood pressure, urine output, and pO(2). The use of U-74389G inhibited the changes in serum urea, pO(2), and tissue levels of myeloperoxidase and malondialdehyde in pancreas and lungs. Moreover, it indicated a limited effect on the course of ANP in the rats and did not reduce mortality and pancreatic damage. Therefore, it may be used in the treatment of lung injury during acute pancreatitis.

Surgical treatment of the sigmoid volvulus.

Sigmoid volvulus is not an uncommon cause of intestinal obstruction. The purpose of this study is to evaluate the clinical features and surgical treatment methods in patients with sigmoid volvulus. Thirty-two patients operated on between January 1991 and October 2002 were reviewed retrospectively. The demographic data of the patients, clinical features, preoperative radiological and operative findings, type of surgical procedure performed, postoperative complications, mortality and duration of hospital stay (DHS) after surgery were reviewed. There were 21 male (66%), 11 female patients (34%) and their age ranged from 61 to 87 years with a median of 73.5 +/- 8.38 years. Most frequent clinical features were abdominal pain, distension and constipation. The correct preoperative diagnosis was made in 44% (14/32) of cases. Surgical treatment consisted of sigmoidectomy with primary anastomosis (R&A) (n = 9, 28%), sigmoidectomy with colostomy (R&C) (n = 16, 50%), and detorsion with sigmoidopexy (D&P) (n = 7, 22%). Concomittant diseases were more frequent in R&C group (n = 14, 87%) and this was statistically significant as compared to R&A (n = 4, 44%) (P = 0.03). Postoperative complication rate in R&C group was more frequent and DHS longer but the difference between treatment groups was not significant statistically. Two recurrences were observed in D&P group. Sigmoidectomy should be the basic principle in management of sigmoid volvulus and primary anastomosis can be performed safely in selected patients without increasing morbidity and DHS.

Effects of N-acetylcysteine on acute necrotizing pancreatitis in rats.

The aim of this study was to investigate the influence of N-acetylcysteine (NAC) on acute necrotizing pancreatitis (ANP) induced by glycodeoxycholic acid in rats. The induction of ANP resulted in significant increase in mortality rate, pancreatic necrosis and serum activity of amylase, alanine aspartate transferase (ALT), interleukin-6 (IL-6), lactate dehydrogenase (LDH) in bronchoalveolar lavage (BAL) fluid, serum concentration of urea, tissue activity of myeloperoxidase (MPO) and malondialdehyde (MDA) in the pancreas and lung, and significant decrease of concentrations of calcium, blood pressure, urine output and pO(2). The use of NAC inhibited the changes in urine output, pO(2), tissue activity of MPO and MDA in pancreas and lungs, and the serum activity of IL-6, ALT, and serum concentrations of urea and calcium. NAC reduced the mortality and pancreatic damage. The use of NAC has a beneficial effect on the course of ANP in rats. It may be used in the treatment of acute pancreatitis.

Significance of antithrombin III, protein C and protein S in acute mesenteric ischemia patients.

It is well established that a condition of hypercoagulation due to deficiencies of antithrombin III, protein C and protein S may result in thrombo-embolism. To evaluate the possibility of hypercoagulation in acute mesenteric ischemia (AMI); clinical features, ECG changes, drug history, the length of intestine remaining after the resection and mortality of 15 consecutive patients were recorded and plasma levels of antithrombin III, Protein C and protein S were measured. Antihypertensive, antidiabetic and digitalis were the main drugs used by the patients. Atrial fibrillation was the main ECG finding (60%). AMI was attributed to thrombo-embolic phenomena because of atrial fibrillation in these patients. Levels of antithrombin III and protein S were lower in patients without atrial fibrillation compared to those with the condition (mean values 16.18 vs. 18.04 and 87.33 vs. 94.22 respectively) but the difference was not statistically significant. Levels of Protein C were lower and the length of intestine remaining after resection was shorter in patients without, compared to those with, atrial fibrillation (mean values 77.00 vs. 88.66, and 52.5 cm vs. 86.11 cm respectively). The difference was statistically significant (p < 0.05). Postoperative mortality rate was 33.3% (5 patients) and the length of intestine remaining after resection was the main determining factor in the prognosis of the patients. We conclude that a condition of hypercoagulation due to a deficiency of protein C has a significant role in the pathogenesis of AMI especially in patients without atrial fibrillation.