Early postoperative hemodynamic performances of stented versus stentless aortic xenografts in aortic valve replacement in elderly patients: a comparative study.

BACKGROUND AND AIM: Surgical valve replacement is the most commonly performed for aortic stenosis. Randomized trials comparing stentless to stented bioprostheses for aortic valve replacement in elderly are scarce. The aim of our study was comparing and evaluating the early hemodynamic performances of Hancock™ stented and FreeStyle™ stentless xenograft aortic valves in aortic valve replacement in elderly patients. PATIENTS AND METHODS: The study involved 40 patients (27 females and 13 males) older than 75 years old. The study was done during the postoperative period. Aortic valve replacements of stented and stentless xenografts were performed to the patients in Group I and Group II, respectively. Investigations for the echocardiographic results were completed on the postoperative 8-10th days. Parameters for the evaluation of hemodynamics were peak pressure gradient, mean pressure gradient and effective orifice area. The parameters were calculated with Doppler echocardiography by using specific formulas. RESULTS: Peak pressure gradients in patients with stented valves were significantly higher than in stentless valves [Stented valve group 32.45 ± 7.58 vs Stentless valve group 21.50 ± 4.77 mmHg] (p < 0.05). Mean pressure gradients were found to be significantly higher in stented group compared with stented group [Stented valve group 11.050 ± 3.2521 vs Stentless valve group 19.350 ± 6.6036 mmHg] (p < 0.05). The effective orifice area index of implanted valve was significantly greater in the stentless group, as well [Stentless valve group 2.5050 ± 0.6022 vs Stented valve group 1.3050 ± 0.3316 cm2] (p < 0.05). CONCLUSIONS: In early postoperative period, effective orifice areas and pressure gradients were found higher in stentless valve group.

Pneumatosis intestinalis: a rare cause of lower gastrointestinal bleeding.

Pneumatosis intestinalis is an uncommon condition characterized by the presence of gas in the bowel wall. We present the case of a 49-year-old man admitted to our Clinic for his 4 day long haematochezia. Colonoscopy revealed pneumatosis coli as a cause of the lower gastrointestinal bleeding. A wide range of diagnostic methods didn't show any underlying disease related to the bleeding, other than the presence of gas. Patient is reported in order to draw attention to the primary pneumatosis coli presented as a rare cause of haematochezia.

An unusual case of retained bullet in the heart since World War II: a case report.

Although bullets penetrating into the heart are usually known as fatal, retained cardiac bullets can have a silent course without causing any cardiovascular complications. An 89 year-old patient with myocardial infarction was admitted to our department hemodynamically stable and widely awake. His electrocardiogram didn't show any evidence of ischemia. Cardiac catheterization revealed a three-vessel coronary artery disease. In addition, a circular structure projected on the area of the marginal branch and the V. magna cordis. Removal of the bullet showed that three quarters of myocardium were involved without any perforation. The history of the patient revealed an injury under the heavy fire during World War II. Thus, this case demonstrates that bullets can remain asymptomatic within in the heart for decades. The patient was dis-charged home at the 10th postoperative day after having an uneventful clinical course.

Which is a better treatment for carotid artery stenosis: stenting or endarterectomy?

Carotid stenosis amenable to surgical or interventional revascularization accounts for 5-12% of all new strokes. Several randomized trials have shown that carotid endarterectomy (CEA) for the treatment of symptomatic and asymptomatic carotid stenosis is superior to medical treatment. Application of a carotid artery stent (CAS) representing a good alternative for many patients. CAS application has become comparatively safe with the use of embolism-preventive systems developed in recent years. Complication rates reported in some randomized trials and case studies in the literature are similar with CEA. CAS may be recommended as the first choice or alternative treatment for patients with symptomatic stenosis carrying high risks for open surgery. However, more randomized studies are necessary to recommend CAS for patients carrying at low surgical risks or patients with asymptomatic stenosis. This is a systematic review of the literature investigating the effectiveness of the treatment methods for carotid artery stenosis.

Effects of caffeic acid phenethyl ester (CAPE) on membrane potential and intracellular calcium in human endothelial cells.

UNLABELLED: BACKGROUNG AND OBJECTIVES: Caffeic acid phenethyl ester (CAPE) is an active component of the resin propolis obtained from beehives. Propolis has a long history of medicinal use and a number of studies have already reported on some of its pharmaceutical properties. This study aimed to explore the effects of CAPE on the cytosolic Ca2+ concentration, cell proliferation, membrane potential and NO levels in human endothelial cells. MATERIALS AND METHODS: Isolated human umbilical vein endothelial cells (HUVEC) were incubated with CAPE (1-100 µM) at 37°C for 48 hours. Cell proliferation was estimated by counting cell numbers with use of a Neubauer chamber. The effect of CAPE (1-100 µM) on the membrane potential was measured with the fluorescence dye DIBAC4(3) whereas its effect on the cytosolic Ca2+ concentration was measured by use of the fluorescence probe Fluo-3 AM (Invitrogen, Leiden, Netherlands). NO production was assayed using the flourophore DAF~AM (Invitrogen, Leiden, Netherlands). Changes in fluorescence intensity was determined with the GENios plate reader (Genios, Tecan, Austria). RESULTS: A dose-dependent hyperpolarization of the endothelial cell membrane was observed with CAPE stimulation. The initial increase in the intracellular Ca2+ concentration showed a subsequent decrease over time. CAPE stimulation also resulted in an increase in NO production; however, at higher doses a decrease in NO levels was observed. HUVEC proliferation was inhibited by CAPE. CONCLUSIONS: Here we report on the effect of CAPE stimulation on the cytosolic Ca2+ concentration, cell proliferation, membrane potential and NO production in HUVEC in a dose-dependent manner. These findings provide important insights into some potential key roles that both calcium and the membrane potential play in the CAPE activation of endothelial cells in a concentration-dependent manner.

The effect of Amifostine (Ethyol) on intestinal anastomosis in rats with radiation enteritis.

BACKGROUND: Preoperative radiotherapy in colorectal cancers is being used as an adjuvant therapy with increasing frequency. Postoperative complications in early and late periods in various ratios are reported. It has also been shown that radiation has a delaying effect on wound healing and this effect is dose-dependent. AIM: This study investigated the effects of the Amifostine on healing of the irradiated colonic anastomosis. MATERIALS AND METHODS: 30 female Wistar rats were divided randomly into three groups equally (n=10). Colonic anastomosis were performed to all rats. Group I served as a control. 800 rad abdominopelvic irradiation on the 5th day of preoperation was given to group II and III. Rats in the group III, prior to radiation, were given Amifostine at a dose of 200 mg/kg. On the 5th postoperative day all the rats were sacrificed and the healing of anastomosis was measured with bursting pressure, hydroxyproline levels and histopathological evaluations. Statistical analyses were expressed by analysis of variance (ANOVA) test and p < 0.05 was regarded as significant. RESULTS: In group II, all parameters were found lower compared with control group and Amifostine+Radiation group. As compared with hydroxyproline values and the anastomotic wound healing scores, except group II, no significantly difference were determined between the two other groups. In bursting pressure levels, Group I and III were higher than group II, but not statistically significant (p > 0.05). In group III (Amifostine+Radiation group), the hydroxyproline levels and anastomotic wound healing scores were found significantly higher than group II (p < 0.05), and no significant difference were found between the control group. CONCLUSIONS: It is determined that radiation given on the 5th preoperative day has a negative effect on anastomotic wound healing and administered Amifostine prevent this negative effect. In the light of these data, the Amifostine may have a positive effect on preoperative irradiated colonic anastomosis and may play an important role in future on the supporting of the colonic anastomosis.

Unusual localization of a primary hydatid cyst: a subcutaneous mass in the paraumbilical region.

Hydatid cyst disease caused by Echinoccus granulosus is not a rare disease and mostly localized in liver and lung. The localization of the disease in the subcutaneous paraumbilical region without any other organ involvement is a unique existence that we present. A 63-year-old Turkish male complaining of abdominal distention and pain had an abdominal mass for one year. When the patient came to our Clinic, we detected a 4x5 cm mass in the left quadrant- paraumbilical region by using ultrasonography. Complete surgical resection of the mass was performed with uneventful post-operative recovery. Histopathological examination of the surgical specimen demonstrated a multive-sicular hydatid cyst. When a subcutaneous cystic mass is detected in a patient, regarding the region where he lives and endemicity, hydatid cyst should be considered.

The effects of different types of statins on proliferation and migration of HGF-induced Human Umbilical Vein Endothelial Cells (HUVECs).

BACKGROUND AND AIM: Statins are HMG-CoA reductase inhibitors within the framework of cholesterol biosynthesis and used to lower the low-density lipoprotein (LDL). There are other aspects of statins can deploy a protective effect, even without the LDL's lowering. The aim of this study is to investigate the effects of different type of statins on proliferative and migrative behaviors of Hepatocyte Growth Factor (HGF) induced human umbilical vein endothelial cells (HUVECs). MATERIALS AND METHODS: Human umbilical vein endothelial cells were isolated and cultured. Groups were designed in order to observe the effects of every individual substance. HUVECs were stimulated with HGF, statins and farnesylpyrophosphat ammonium salt (FPP) or geranylgeranyl-pyrophosphate (GGPP), respectively. Cell proliferations were counted 48 hours after initial stimuli and distances between migration fronts were used in migration analyses. RESULTS: All types of statins showed significant anti-migrative and anti-proliferative characters. Simvastatin and fluvastatin but not cerivastatin, were able to inhibit the HGF-depending migration and showed a significant effect on the inhibition of the isoprenylation (GGPP). Only simvastatin influenced the HGF-depending migration via inhibiting the isoprenylation process through GGPP. Cerivastatin significantly decreased the proliferation and Fluvastatin significantly enhanced the migration behaviors of HUVECs when they were co-incubated with methyl-8-cyclodextrin (MCD). CONCLUSIONS: Statins countermand the proproliferative and as well as the promigrative effect of HGF on HUVECs. The mechanisms which provoke this effect are dependent on the type of statin. Direct interactions of statins with lipid rafts play a significant role in the endothelial cell mechanisms.

The importance of anatomical region of local anesthesia for prostate biopsy; a randomized clinical trial.

INTRODUCTION: In our study, the efficiency and reliability of lidocaine (1 cc/1%) application during transrectal ultrasound-guided (TRUS) prostate biopsy to levatores prostate was studied. Levatores prostate was visualized on a cadaver dissection previously. PATIENTS AND METHODS: Eighty outpatients with lower urinary tract complaints or were suspected clinically to have prostate cancer were submitted to TRUS-guided prostate biopsy. The ages of outpatients were ranging from 45 to 81. Patients were randomized in 2 groups: Group-I, with 40 patients submitted to local anesthesia by periprostatic injection of 1 cc 1% lidocaine before biopsy; and group-II, with 40 controls the biopsy was performed without local anesthesia. The anatomical region for anesthesia was determined via dissection. The name of this anatomical region is levatores prostatae and it has got high nerve density. The process was explained to the patients and their approvals were obtained. Levatores prostatae was detected with TRUS before biopsy. Pain; related to digital rectal examination (DRE), probe insertion or biopsy, was scored via visual analog scale (VAS). The patients were evaluated about side effects of lidocaine and early and late complications of biopsy as well. RESULTS: Both groups were similar in terms of mean age, PSA levels, prostate volume and VAS scores (p > 0.05). As for VAS score, on the group submitted to anesthesia was determined 2.34 ± 1.08, while for VAS score on the group submitted conventional biopsy was determined 5.8 ± 1.6. Between two groups, there was a statistical difference in terms of VSA score (p < 0.05); but there was no statistical difference about early and late complications of biopsy. CONCLUSIONS: The periprostatic blockage use is clearly associated with more tolerance and patient comfort during TRUS-guided biopsy. Owing to the local anesthesia introduced to the periprostatic nerve bundle localization in levatores prostate area, the patients could tolerate the pain better.

Deep vein thrombosis and novel oral anticoagulants: a clinical review.

Deep vein thrombosis (DVT) is a common disease associated with high rates of mortality and significant morbidity. The diagnostic approach of DVT has evolved over the years. Algorithmical use of pretest probability, D-Dimer testing and ultrasonography allow safe and accurate investigation of DVT. The anticoagulation therapy, used to treat DVT, includes vitamin K antagonists (VKAs) and low-molecular-weight heparin (LMWH) or unfractionated heparin (UF). The duration of anticoagulation therapy depends on the cause of DVT and patient's clinical profile. Although these conventional therapies are effective, narrow therapeutic index, need for frequent monitoring and various food-drug interactions cause difficulties for patients. In recent decades, new oral anticoagulants have been developed. These drugs focus directly on inhibiting either Factor Xa (rivaroxaban, apixaban, edoxaban) or thrombin (dabigatran). In contrast to warfarin, these new agents have shorter half-life, fewer drug or food interactions, no necessity for a close monitoring and ease of administration. This review summarizes current knowledge about deep vein thrombosis and new treatment aspects with novel oral anticoagulants.

Giant aneurysm of the right coronary artery with fistula to right atrium.

Coronary artery aneurysms are rare entities with a prevalence of 0.15%-4.9%. Giant coronary artery aneurysms are known as more than 2 to 5 cm in size. We present a case of 74 year-old female who was admitted to our clinic with chest pain and dyspnea. Coronary angiography demonstrated a giant right coronary artery (RCA) aneurysm with a significant left-to-right shunt. The patient underwent an open heart surgery. During the exploration, an aneurysm of 40 mm in diameter of the RCA was seen. The aneurysmatic RCA was excluded and continuously closed with the support of intra-aortic balloon pump (IABP). The patient was discharged on the 13th postoperative day without any complication.

The protective effects of Ginkgo biloba EGb761 extract against renal ischemia-reperfusion injury in rats.

OBJECTIVE: The aim of the study was to investigate the protective effects of Ginkgo biloba EGb761 extract on renal ischemia-reperfusion (I/R) injury in rats. MATERIALS AND METHODS: 26 male Wistar albino rats were divided into four groups: First group (n=6), which served as control received only standard pellet; second group (IR) (n=6) was subjected to renal I/R injury; a third group (Gb) (n=7) was given additional EGb761 extract; and rats in the fourth group (IR-Gb) (n=7) had been treated with EGb761 extract before they were subjected to I/R injury. After rats were euthanized, renal tissues were analyzed microscopically, and tissue malondyaldehyde (MDA), catalase (CAT), and superoxide dismutase (SOD) levels were determined. RESULTS: MDA values were significantly high in the IR group when compared with the other groups. No significant difference in MDA values between the Control and Gb groups was observed. SOD enzyme activity was significantly lower in the IR group when compared with other groups. Furthermore, SOD values were found to be comparable in control, Gb and IR-Gb groups. The CAT enzymatic activity was significantly low in the IR group when compared with the other groups. Moreover, although no statistical significance was identified between control group and Gb group, CAT levels in these groups were higher compared to IR-Gb group. Microscopic examination showed no histopathological differences between the control and Gb groups. Cast formation and tubular necrosis in the IR group have been determined to be significantly high when compared with IR-Gb group. We further observed that the histopathological changes in the IR-Gb group were lesser in the advanced levels when compared with the IR group. CONCLUSIONS: Ginkgo biloba Egb761 extract applied before renal ischemia-reperfusion decreases the tissue damage.

Influence of HMG-CoA reductase inhibitors on leptin-induced endothelial cell proliferation, migration, and capillary-like tube formation.

OBJECTIVE: This study investigated the impact of the hepatic hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) on the leptin-induced human umbilical vein endothelial (HUVE) cell proliferation, migration, and capillary-like tube formation. METHODS: The HUVE cells were isolated and cultured, and stimulated with leptin, statins (cerivastatin, fluvastatin, simvastatin), mevalonate, farnesyl pyrophosphate, geranylgeranyl pyrophosphate, or methyl-ß-cyclodextrin. The endothelial cell proliferation was assessed using the Neubauer counting chamber. The migration of HUVE cells was examined with the planar migration assay. In vitro capillary sprouting was quantified by measuring the sprout length, number, and cumulative sprout length. RESULTS: The HMG-CoA reductase inhibitors significantly reduced leptin-induced proliferation and migration, which was reversed by mevalonate. Further, the inhibitory effect of the statins on leptin-induced migration was shown to be modulated by the prenylation of farnesyl pyrophosphate and geranylgeranyl pyrophosphate. Although stimulation with a leptin showed no significant effect, a marked increase in capillary-like tube formation was observed with a joint stimulation with HMG-CoA reductase inhibitors. Although statins caused inhibition of proliferation and migration, the same dose of the agents amplified the selective growth of capillary-like tube formation. Membranous cholesterol depletion by methyl-ß-cyclodextrin showed a weaker effect compared with statins. CONCLUSION: Through modulation of prenylation, leptin-induced pro-atherosclerotic events including proliferation and migration were inhibited by HMG-CoA reductase inhibitors.

Importance of large conductance calcium-activated potassium channels (BKCa) in interleukin-1b-induced adhesion of monocytes to endothelial cells.

OBJECTIVE: The present study investigated the role of the large conductance calcium-activated potassium channels (BKCa) in interleukin-1b (IL-1b) induced inflammation. MATERIALS AND METHODS: Human umbilical vein endothelial cells (HUVECs) were isolated and cultured. Endothelial cell membrane potential measurements were accomplished using the fluorescent dye DiBAC4(3). The role of BKCa was assessed using iberiotoxin, a highly selective BKCa inhibitor. Changes in the calcium intracellular calcium were investigated using Fura-2-AM imaging. Fluorescent dyes DCF-AM and DAF-AM were further used in order to measure the formation of reactive oxygen species (ROS) and nitric oxide (NO) synthesis, respectively. Endothelial cell adhesion tests were conducted with BCECF-AM adhesion assay and tritium thymidine uptake using human monocytic cells (U937). Expression of cellular adhesion molecules (ICAM-1, VCAM-1) was determined by flow cytometer. RESULTS: Interleukin-1b induced a BKCa dependent hyperpolarization of HUVECs. This was followed by an increase in the intracellular calcium concentration. Furthermore, IL-1b significantly increased the synthesis of NO and ROS. The increase of intracellular calcium, radicals and NO resulted in a BKCa dependent adhesion of monocytes to HUVECs. Endothelial cells treated with IL-1b expressed both ICAM-1 and VCAM-1 in significantly higher amounts as when compared to controls. It was further shown that the cellular adhesion molecules ICAM-1 and VCAM-1 were responsible for the BKCa-dependent increase in cellular adhesion. Additionally, inhibition of the NADPH oxidase with DPI led to a significant downregulation of IL-1b-induced expression of ICAM and VCAM, as well as inhibition of eNOS by L-NMMA, and intracellular calcium by BAPTA. CONCLUSIONS: Activation of the endothelial BKCa plays an important role in the IL-1b-induced monocyte adhesion to endothelial cells.

The prevalence of hepatitis B virus (HBV) among Turkish immigrants in Germany.

AIM: To determine the seroprevalence of Hepatitis B (HBV) among Turkish immigrants living in Germany. SUBJECTS AND METHODS: A cross-sectional, multi-centered study was conducted among 1319 Turkish immigrants who were living in Germany and admitted to the clinics for any reason. Participants were tested for Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (Anti-HBs) and antibodies to hepatitis B core antigen (Anti-HBc). RESULTS: 37.3% of the participants were tested positive for Anti-HBc. Of these, 45.8% percent was showed positivity for anti-HBc. 25.6% of all donors were showed positive results for Anti-HBc. HbsAg seroprevalence was found as 5%. Furthermore, 90% of participants with positive HBsAg had positive results for Anti-HBc. Males had significantly higher rates of Anti-HBc and HBsAg positivity than females. CONCLUSIONS: Turkish immigrants living in Germany represented higher seroprevalence rate of HBV than total population of Germany.

Effect of bauhinia bauhinioides kallikrein inhibitor on endothelial proliferation and intracellular calcium concentration.

OBJECTIVES: Proteinase inhibitors act as a defensive system against predators e.g. insects, in plants. Bauhinia bauhinioides kallikrein inhibitor (BbKI) is a serine proteinase inhibitor, isolated from seeds of Bauhinia bauhinioides and is structurally similar to plant Kunitz-type inhibitors but lacks disulfide bridges. In this study we evaluated the antiproliferative effect of BbKI on endothelial cells and its impact on changes in membrane potential and intracellular calcium. MATERIALS AND METHODS: HUVEC proliferation was significantly reduced by incubation with BbKI 50 and 100 µM 12% and 13%. Furthermore, BbKI (100 µM) exposure caused a significant increase in intracellular Ca2+ concentration by 35% as compared to untreated control. RESULTS: The intracellular rise in calcium was not affected by the absence of extracellular calcium. BBKI also caused a significant change in the cell membrane potential but the antiproliferative effect was independent of changes in membrane potential. CONCLUSIONS: BBKI has an antiproliferative effect on HUVEC, which is independent of the changes in membrane potential, and it causes an increase in intracellular Ca2+.