Early Outcomes of Pharmacomechanical Thrombectomy in Acute Deep Vein Thrombosis Patients.

BACKGROUND: Acute lower extremity deep vein thrombosis (DVT) occurs due to obstruction of large veins by thrombus and its clinical findings are pain and swelling. If not treated, it can cause morbidity and mortality. Oral warfarin or low molecular weight heparin are applied in traditional treatment. However, recently, endovascular procedures have gained increasing popularity in deep vein thrombosis. In this study we aimed to compare our early results of pharmacomechanical thrombectomy (PMT) versus oral anticoagulation for acute deep vein thrombosis. METHODS: We comprised 50 patients presented with acute DVT between January 2013 and June 2014, who received either adjusted subcutaneous low molecular weight heparin (LMWH) or PMT followed by intravenous unfractionated heparin (UFH) for 5 days. Warfarin was administered to PMT patients for 3 months and at least 6 months for the control group. RESULTS: Median follow-up was 14 months (6-18 months). Recanalization within 6 months was found in 84.0%, femoral venous insufficiency was found in 36.0%, and postthrombotic syndrome (PTS) was found in 28.0% of the patients who received PMT treatment. The mean duration of symptoms was 11.0 days (range, 3-20 days). The mean duration of the procedure was 78.1 minutes (range, 55-100 min). CONCLUSION: In contrast to medical therapy in the treatment of deep vein thrombosis, usage of catheter-directed thrombolysis experienced early recanalization with higher thrombus resolution. PMT with adjunctive thrombolytic therapy is an effective treatment modality in patients with significant DVT. Also, early thrombus removal in patients with acute DVT prevents development of postthrombotic morbidity. We believe that the efficacy and usage will increase with the experience of surgeons in the future.

TIR-domain-containing adaptor protein gene TIRAP S180L polymorphism is not increased in Behçet's disease patients in two ethnic cohorts.

OBJECTIVES: The single nucleotide polymorphism (SNP) of TIRAP (Serine 180 leucine, S180L) that is shown to be associated with Behçet's disease (BD) in a European-derived cohort, but not in Middle Eastern patients is investigated in two other populations. METHODS: Two cohorts of BD patients and controls from Turkey (n=797) and Italy (n=633) were genotyped by sequence specific primer-polymerase chain reaction (SSP-PCR) or TaqMan q-PCR assays. RESULTS: Genotype and allele frequencies in TIRAP S180L (rs8177374) were not different between BD patients and controls in either ethnicity. Furthermore, a meta-analysis between the Turkish and the Italian BD cohorts did not reveal an association between this non-synonymous SNP in TIRAP and BD (meta-analysis OR=0.94, meta-analysis p=0.61, Q statistic heterogeneity p=0.11). CONCLUSIONS: TIRAP S180L gene polymorphism, which was previously shown to be associated with BD in a Caucasian population, has been replicated in either Turkish or Italian population in our study.

Relationship between clinical findings and genetic mutations in patients with familial Mediterranean fever.

BACKGROUND: Familial Mediterranean fever (FMF) is one of the most frequent genetic diseases encountered in the Mediterranean region. We aimed to investigate the correlation between genetic mutations and the clinical findings in 562 patients with FMF. METHODS: In this retrospective cross-sectional study conducted with patients' files between 2006, and 2013, reverse hybridization assay for MEFV gene mutations was used and the 12 most frequent mutations were screened. Mutation types and clinical findings were compared with variance analysis. RESULTS: The mean age was 6.9 ± 3.4 years (range, 1.8-11.6 years). The most common symptom was fever (97.3%). Thirty-four of the patients (6.04%) were admitted with periodic fever only. Of these patients, M694V was the most common mutation type (73.5%). The percentage of the patients predominantly presenting with recurrent abdominal pain was 77.78% and the most frequent mutations were M694V and E148Q. The rate of arthritis and arthralgia was significantly higher in patients with M694V and E148Q mutations. Chest pain was reported more often in patients homozygous for M694V (61.4%). Pericardial effusion was documented in the echocardiography of 10.9% of the 229 children with chest pain. Some patients had both FMF and Henoch Schönlein purpura (HSP), and were more likely to harbor either homozygote M694V or E148Q mutations. The frequency of episodes was higher in patients with homozygous M694V mutations (number of attacks = 4.4 ± 1.6/month). Proteinuria was detected in 106 patients of cases (29.2%), at an average of 854 ± 145 mg/L. Most of the patients with proteinuria and elevated serum amyloid-A had homozygous M694V mutation. CONCLUSION: The most common mutation in children in Turkey with FMF is the M694V mutation. Recurrent abdominal pain, arthritis or arthralgia, chest pain, and pericarditis were commonly seen in patients with M694V and E148Q mutations.