Suprarenal aortic aneurysm closure with an atrial septal defect Amplatzer device.

Conventional repair of pararenal aortic aneurysms has been a technically challenging operation, with a significant morbidity rate of 28-35%. Endovascular stent grafting requires satisfactory landing zones for stent graft anchoring. Therefore, pararenal abdominal aortic aneurysms are usually contraindicated for this procedure because of difficulties associated with proximal graft fixation. In this case, we attempted to use a new strategy with an implanted atrial septal defect (ASD) Amplatzer device across the neck of the aneurysm. However, one month after this procedure the patient was referred to the hospital due to significant compression of the right inferior vena cava (IVC). Conclusion. In patients with an atrial septal defect and abdominal pain due to an aneurysm, implantation of an Amplatzer device across the aneurysm neck, may be beneficial.

Role of platelet parameters and haematological indices in myocardial infarction and unstable angina.

OBJECTIVE: To explore the significance of platelet parameters, including mean platelet volume, platelet count and other haematological indices, in patients of acute coronary syndrome. METHODS: In this one-year retrospective cross-sectional study in 2010, a total of 631 patients were enrolled at the Cardiovascular Research Institute, Tabriz University of Medical Sciences, Iran, and classified into three groups: myocardial infarction, unstable angina, and Control. Cardiovascular risk factors such as smoking, diabetes mellitus, hyperlipidaemia and hypertension status were compared. Blood samples were collected for the measurement of platelet count, mean platelet volume and other haematological indices, including prothrombin time, partial thromoplastin time, blood group and Rh, haematocrit, haemoglobin, and erythrocyte sedimentation rate. SPSS 18 was used for statistical analysis. RESULTS: Of the total, there were 210 (33.3%; 163 men, 47 women) with myocardial infarction whose mean age was 62.7 +/- 14.2 years; 211 (33.3%; 110 men, 101 women) had unstable angina with a mean age of 63.5 +/- 3.1 years and 210 (33.3%; 117 men, 90 women) health controls with a mean age of 60.6 +/- 12.8 years. The mean platelet volume values of patients in the first two groups were significantly higher than the control group (10.14 +/- 1.05 fL, 9.82 +/- 0.93 fL and 9.34 +/- 1.14 fL, respectively; p < 0.001). The platelet count was detected to be significantly lower in the patients than the controls (207.92 +/- 58.40 x 109/L, 220.18 +/- 65.81 x 109/L, 23 +/- 56.10x109/L, respectively, p < 0.001). While blood cell count was significantly higher in those with myocardial infarction compared to the unstable angina patients and control group ( P < 0.001). Differences in mean values of mean platelet volume between the two patient groups was not significant, but mean values of platelet count was statistically significant between these two groups ( p < 0.04). CONCLUSION: Mean platelet volume and platelet count may be considered prognostic markers for acute coronary syndrome.

Linkage of Fibroblast Growth Factor 23 and Phosphate in Serum: Phosphate and Fibroblast Growth Factor 23 Reduction by Increasing Dose of Sevelamer.

BACKGROUND: High serum phosphate and fibroblast growth factor-23 (FGF-23) levels are well-recognized independent risk factors of mortality and morbidity in patients with chronic kidney diseases (CKDs). Sevelamer, as a phosphate chelating agent, reduces serum phosphate and FGF-23 levels produced by bone osteocytes. This study aimed to determine the best dose at which sevelamer could successfully reduce serum phosphate and FGF-23 levels in rat models of adenine-induced CKD. METHODS: CKD was induced using adenine. Healthy and CKD-induced rats were divided into 6 groups as follows: healthy controls; CKD controls; rats treated with 1%, 2%, and 3% sevelamer for CKDs; and healthy rats administered 3% sevelamer. Biochemical factors and serum FGF-23 levels were measured using spectrophotometry and enzyme-linked immunosorbent assay methods. RESULTS: Serum phosphate levels were best decreased in rats receiving 3% sevelamer in their diet (5.91±1.48 mg/dL vs. 8.09±1.70 mg/dL, P<0.05) compared with the CKD control rats. A dose-dependent decrease in serum FGF-23 levels was observed, and the most significant results were obtained in rats receiving 3% sevelamer compared with the CKD control rats (142.60±83.95 pg/mL vs. 297.15±131.10 pg/mL, P<0.01). CONCLUSIONS: Higher sevelamer doses significantly reduced serum phosphate and FGF-23 levels in adenine-induced CKD rats.

Effect of Sevelamer on Serum Levels of Klotho and Soluble Tumor Necrosis Factor-like Weak Inducer of Apoptosis in Rats With Adenine-induced Chronic Kidney Disease.

INTRODUCTION: Nontraditional risk factors for cardiovascular disease (CVD), including mineral disorder, high fibroblast growth factor 23 (FGF23), low klotho, and low soluble TWEAK could predict the incipient risk of CVD in chronic kidney disease (CKD). The present study evaluates the effect of sevelamer on soluble tumor necrosis factor-like weak inducer of apoptosis (TWEAK), and klotho levels in adenine-induced CKD rats. METHODS AND MATERIALS: Normal control rats without sevelamer were compared with 3 groups of adenine-induced CKD rats, including CKD rats without sevelamer, CKD rats treated with 3% sevelamer, and rats receiving adenine and 3% sevelamer concurrently. After 4 weeks of sevelamer treatment, serum levels of klotho and soluble TWEAK were measured, along with biochemical parameters related to kidney function. RESULTS: Sevelamer significantly reduced serum levels of phosphate and increased serum levels of klotho and soluble TWEAK. Decreased levels of phosphate were negatively correlated with elevated levels of klotho and soluble TWEAK (r = -0.70, P = .003; r = -0.58, P = .02; respectively) in serum. CONCLUSIONS: Sevelamer successfully reduced serum levels of phosphate, and meanwhile, it led to an elevation in serum levels of klotho and soluble TWEAK in rat models of CKD.

One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries.

BACKGROUND: In recent years, stents are increasingly used in variety of coronary lesions. Ostial lesion of left anterior descending coronary artery (LAD) however remains a challenge area because of the invariable involvement of distal left main coronary artery (LMCA). This study was designed to evaluate the clinical and angiographic outcomes of everolimus-eluting stent (EES) implantation for ostial LAD. METHODS: EESs were implanted in 45 consecutive patients with ostial LAD stenoses. For complete lesion coverage, stent positing was extended into the distal LMCA in 6 patients (13.3%) with intermediated LMCA narrowing. We assess MACE during one-year follow-up. RESULTS: In-hospital success rate was 100%; neither cardiac death nor stent thrombosis in our patients, but two patients had myocardial infarction in non-related coronary artery during follow-up. Two patients had angiographic restenosis and underwent TLR. The cumulative MACE-free survival rate was 95.6% at one year. CONCLUSION: EES was in ostial LAD lesions with complete lesion coverage achieving high procedural success rate and acceptable clinical outcomes during one-year follow-up period.

Correlation between the level of cholesteryl ester transfer protein in follicular fluid with fertilization rates in IVF/ ICSI cycles.

BACKGROUND: Follicular fluid (FF) plays an important role in oocytes and embryo development, which may contribute to IVF/ICSI success rate. OBJECTIVE: The aim of this study was to investigate the correlation between cholesteryl ester transfer protein (CETP) level in FF and the success rate of IVF/ICSI. MATERIALS AND METHODS: In a cross-sectional study, FF samples, FF samples were obtained from 100 patients referred to Tabriz Alzahra Hospital. Seventy-nine subjects underwent IVF and the remaining 21 underwent ICSI. The levels of high-density lipoprotein cholesterol (HDL-C), apolipoprotein A-I and CETP were measured using enzymatic, turbidometric and ELISA methods respectively. RESULTS: Analysis of the subgroups with different levels of CETP showed a significant lower level of CETP in the subgroup with the lowest number of mature oocytes (p<0.05). The level of CETP was also considerably lower (18%, p=0.05) in subjects with<50% oocytes fertilization ratio than subjects with >70% of this ratio. CONCLUSION: While no association was found for pregnancy, the amount of CETP in FF was associated positively to the maturity and the percentage of oocyte fertilization.