Evaluation of circulating endothelial biomarkers in familial Mediterranean fever

The aim of this was to evaluate some of the vascular biomarkers and cytokines related with atherosclerosis in regularly treated and attack-free familial Mediterranean fever (FMF) patients. Forty (21 males [M] and 19 females [F], 31 [15–58] years) FMF patients and eighteen healthy controls (11 M and 7 F, 35.5 [19–46] years) with no known cardiovascular (CV) risk factors were included. All patients were receiving regular colchicine treatment, and examinations were performed during attack-free periods. Serum samples were used for the determination of high-sensitive C-reactive protein (hs-CRP), tissue factor (TF), tissue plasminogen activator (t-PA), osteoprotegerin (OPG), interleukin-6 (IL-6), IL-17, and IL-23. Plasma samples were used for the determination of asymmetric dimethylarginine (ADMA) and thrombomodulin (TM). Age, sex distribution, waist circumference, body mass index, smoking status, and serum lipids were similar between the patients and controls (P > 0.05). The concentrations of (hs-CRP) and IL-17 were significantly higher in FMF patients compared with controls (P < 0.05). On the other hand, IL-6 and IL-23 levels were not different between the groups (P > 0.05). ADMA, OPG, and TM concentrations were significantly lower in the patients’ group compared to those of controls (P < 0.05). However, vWF, TF, and t-PA levels were similar between the groups (P > 0.05). FMF patients receiving regular colchicine therapy during inactive disease state had significantly lower levels of vascular injury parameters.     

Mid-term outcome with surgery for type B aortic dissections: a single center experience

BACKGROUND: The approach to acute and chronic type B aortic dissection has changed significantly over the past years. In this aspect, we have reviewed our single-center experience in surgery for type B dissections and compared the current data presented by other centers. METHODS: Twenty-nine patients operated at our center for type B aortic dissection (14 acute, 15 chronic) were reviewed over the years between 1996 and 2004. All patient data in addition to immediate and late outcome following surgery were noted. RESULTS: The mean age in acute and chronic groups was 53 +/- 16 versus 62 +/- 12 years, respectively (p = 0.1). Hospital mortality was 4 patients. The mean period in the intensive care unit was 4.2 +/- 3.1 days. Follow-up time was 36 +/- 11 months. Median interval between the initial symptoms and surgery was 3.8 days for acute cases. No patients underwent reoperation in acute patients; whereas 3 underwent reoperation in the chronic group. False lumen patency rates in acute and chronic dissections were 16.7% versus 46% after 24 months (p< 0.05). Distal anastomoses included both true and false lumens in 83% of the chronic cases with false lumen patency. The mean reoperation-free survival was 79.35 months with standard error of 5.57 months (95% CI, 68.42 to 90.27) in all patients. CONCLUSIONS: Open surgery in acute type B dissections yielded excellent immediate and long-term durability in our series with no false lumen patency or aortic expansion. However, incorporation of both false and true lumina into distal anastomosis in patients with chronic dissection resulted in false lumen patency with aortic expansion.     

An alternative patch repair technique during valve replacement for native valve endocarditis

A patient with native valve endocarditis and vegetation on anterior mitral leaflet underwent aortic valve replacement with preservation of aortic noncoronary leaflet as a patch over the inflamed intervalvular fibrous body. This technique may minimize prosthetic material use, which is the most important risk factor for reinfection.     

Iloprost pretreatment before unilateral nephrectomy: an experimental study in rats

OBJECTIVE: To evaluate the effects of iloprost administration before unilateral nephrectomy on postoperative interleukin-6 (IL-6), nitric oxide (NO), and oxidant/antioxidant status. METHODS: Malondialdehyde, glutathione, catalase and Cu-Zn superoxide dismutase were measured in the blood and remnant kidney of Adult male Wistar albino rats to assess oxidant and antioxidant status. The rats were divided into three experimental groups: sham group (S) (n = 12); unilateral nephrectomized group (N) (n = 12); an hour before unilateral nephrectomy iloprost (1 ng/mL/kg, intraperitoneal) administered group (IN) (n = 12). RESULTS: Iloprost administration before unilateral nephrectomy lowered oxidant parameters and IL-6 levels significantly. NO levels were increased in both N and IN groups. CONCLUSION: Iloprost pretreatment before unilateral nephrectomy can reduce oxidative stress and IL-6, which increases due to anaesthesia and surgery and causes organ damage during surgery and in the short-term postoperative period.     

Mitral valve replacement with bileaflet preservation for complex annular calcification

Extensive calcification of mitral apparatus may preclude optimal valve repair, thus requiring debridement. We performed mitral valve replacement in a 55-year-old woman with a modified bileaflet preservation technique to avoid complications related to extensive debridement. Posterior transposition of the anterior leaflet as a buttress over the posterior ventricular wall provided extra support for the weakened tissues and covered the decalcified areas, which protected against debris embolism. This technique is safe and reproducible, especially for elderly patients who have complex calcification that requires extensive debridement, enables better preservation of ventricular function, and avoids disruption of the mechanical left ventricular wall.     

Alpha-lipoic acid protects against hepatic ischemia-reperfusion injury in rats

BACKGROUND AND AIM: To evaluate the protective effect of alpha-lipoic acid in reducing oxidative damage after severe hepatic ischemia/reperfusion (IR) injury. METHODS: Wistar albino rats were subjected to 45 min of hepatic ischemia, followed by 60 min reperfusion period. Lipoic acid (100 mg/kg i.p.) was administered 15 min prior to ischemia and immediately before reperfusion period. At the end of the reperfusion period aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) activity, and cytokine, TNF-alpha and IL-1beta levels were determined in serum samples. Malondialdehyde (MDA), and glutathione (GSH) levels and myeloperoxidase (MPO) activity were determined in the liver tissue samples while formation of reactive oxygen species was monitored by using chemiluminescence (CL) technique with luminol and lucigenin probes. Tissues were also analyzed histologically. Results: Serum ALT, AST, and LDH activities and TNF-alpha and IL-1beta levels were elevated in the I/R group, while this increase was significantly lower in the group of animals treated concomitantly with lipoic acid. Hepatic GSH levels, significantly depressed by I/R, were elevated back to control levels in lipoic acid-treated I/R group. Furthermore, increases in tissue luminol and lucigenin CL, MDA levels and MPO activity due to I/R injury were reduced back to control levels with lipoic acid treatment. CONCLUSION: Since lipoic acid administration alleviated the I/R-induced liver injury and improved the hepatic structure and function, it seems likely that lipoic acid with its antioxidant and oxidant-scavenging properties may be of potential therapeutic value in protecting the liver against oxidative injury due to ischemia-reperfusion.     

In vitro release--in vivo microbiological and toxicological studies on ketoconazole lipid granules

In some multidrug therapy programs, ketoconazole (KTZ) may be administered with some antacids that could modify its dissolution rate and reduce its absorption, thus leading to therapeutic failures. The primary aim of this study was to evaluate the influence of Compritol HD5 ATO and Compritol 888 ATO on this interaction in comparison with commercial KTZ tablets. The second aim was to prepare lipid granules of KTZ that could be an alternative to the commercial formulation. Therefore, six KTZ sustained-release granules were prepared with different lipid concentrations, because they were found to be more suitable than tablets that are dissolved only in gastric medium. The results confirmed that the dissolution rate of KTZ granules was significantly reduced in the presence of antacids. The ideal formulation was selected as granules including 5% of Compritol lipids in relation to the suitability of the target profile. Therapeutic effects of orally administered, ideal KTZ granule formulations, and commercial tablets were evaluated in vivo by the experimental model of murine vulvo-vaginal candidiasis (VVC) with and without antacids. It was found that formulations were very effective on VVC, and the therapeutic effect decreased significantly in the presence of antacids. Histopathological studies were carried out for vagina, stomach, and liver tissues and hepatoxicity was also examined. The levels of reduced glutathione (GSH) were measured to assess the oxidative stress induced by KTZ and function of the liver. It was observed that orally administered formulations of KTZ were successful in treating candidiasis in mice without irritancy in stomach. However, liver tissues were damaged. The decreased GSH levels indicated toxicity in our study. This study suggested that in vitro release and in vivo microbiological-toxicological properties of KTZ were affected by antacids and drug-excipient interactions. Lipid granules of KTZ prepared with Compritol 888 ATO could be proposed as a new KTZ solid dosage form with optimum dissolution and therapeutic characteristics.     

β-Glucan protects against chronic nicotine-induced oxidative damage in rat kidney and bladder

In this study, we investigated the protective effect of β-glucan against nicotine induced oxidative damage in urinary bladder and kidney tissues. Wistar albino rats were injected i.p. with nicotine hydrogen bitartarate (0.6mg/kg daily for 21 days) or saline. β-Glucan (50mg/kg, p.o.) was administered alone or with nicotine injections for 21 days. After decapitation, the urinary bladder and kidney tissues were taken for the measurement of malondialdehyde (MDA) and glutathione (GSH) levels, and myeloperoxidase (MPO) activity. Tissue samples were also examined histologically. In serum samples MDA, GSH, BUN, creatinine, TNF-α levels and LDH activity were analyzed. Chronic nicotine administration caused a significant decrease in GSH levels and increases in MDA levels and MPO activity in kidney and bladder tissues, suggesting oxidative organ damage, which was also histologically verified. Furthermore, β-glucan restored the reduced GSH levels, while it significantly decreased MDA levels and MPO activity. Renal function tests, LDH and TNF-α levels, which were increased significantly due to nicotine administration, were decreased with β-glucan treatment. The present data suggest that β-glucan supplementation effectively counteracts the chronic nicotine toxicity and attenuates oxidative damage of bladder and kidney tissues possibly by its antioxidant effects.     

Tempol reduces bacterial translocation after ischemia/reperfusion injury in a rat model of superior mesenteric artery occlusion

Purpose  We investigated whether Tempol, a water-soluble antioxidant, prevents the harmful effects of superior mesenteric ischemia/reperfusion on intestinal tissues in rats. Methods  The rats were divided into three groups of 10. In group 1, the superior mesenteric artery (SMA) was isolated but not occluded, and in groups 2 and 3 the superior mesenteric artery was occluded for 60 min. After that, the clamp was removed and reperfusion began. In group 3, 5 min before the start of reperfusion, a bolus dose of 30 mg/kg Tempol was administered intravenously and continued at a dose of 30 mg/kg for 60 min. All animals were euthanized after 24 h and tissue samples were collected for analysis. Results  There was a significant increase in myeloperoxidase activity, malondialdehyde levels, and the incidence of bacterial translocation in group 2, with a decrease in glutathione levels. These parameters were found to be normalized in group 3. The intestinal mucosal injury score in group 2 was significantly higher than those in groups 1 and 3. Conclusion  Tempol prevents bacterial translocation while precluding the harmful effects of ischemia/reperfusion injury on intestinal tissues in a rat model of superior mesenteric artery occlusion.     

Is low blood magnesium level associated with hemodialysis headache?

OBJECTIVE: The aim of this study was to evaluate the prevalence, demographic, clinical features, and possible risk factors for hemodialysis headache (HDH). BACKGROUND: HDH has been recognized for many years, but the pathophysiology of this condition is not known. High arterial blood pressure, decreased serum osmolality, sodium washout, and high blood urea nitrogen level are reported risk factors for HDH. Low serum magnesium (Mg) level is known to cause some types of headache, including migraine (menstrual migraine in particular), tension-type headaches, and cluster and posttraumatic headaches. Low Mg has also been reported in HDH patients. METHODS: A total of 250 hemodialysis (HD) patients were questioned about problems with headache. Of these, 75 were diagnosed with HDH according to the revised International Headache Society criteria for 2003. Eighty age- and sex-matched HD patients without HDH were selected as a control group. For each HDH and control subject, arterial diastolic and systolic blood pressure, body weight, and serum levels of sodium, blood urea nitrogen, creatinine, and Mg were measured before and after one HD session. Urea reduction rate and ultrafiltration were determined. Serum levels of phosphorus, calcium, albumin, and parathormone were measured only before the session. Findings in the HDH and control group were statistically compared. RESULTS: As noted, 75 (30%) of the total 250 HD patients surveyed were diagnosed with HDH. The mean headache duration in this group was 5.17 +/- 5 hours. Vertex location, bilateral headache, dull nature, and moderate severity were the most prevalent features of HDH. There were no statistically significant differences between the HDH and control groups with respect to causes of end-stage renal disease. There were no significant differences between the HDH and control groups with respect to predialysis values for blood urea nitrogen, body weight, and arterial blood pressure (P > .05), and the same was true for comparisons of the postdialysis values for these parameters. The mean predialysis sodium level in the HDH group was higher than in the control group (P= .003). Both the mean predialysis and mean postdialysis Mg levels in the HDH group were significantly lower than the corresponding levels in the control group (P= .05 and P= .02, respectively). CONCLUSIONS: The results suggest that low blood Mg level and high blood sodium level may be risk factors for HDH. Magnesium supplementation may help patients with HDH whose serum Mg levels are found to be low.