Inhibition of calcification with citric acid in pericardial bioprosthetic heart valve material: a preliminary report

BACKGROUND AND AIM OF THE STUDY: Although current bioprosthetic heart valves have low thrombogenicity and favorable hemodynamic properties, their durability remains unsatisfactory. Valve failure usually occurs from calcific degeneration. The study aim was to investigate the effect of a chelating agent, citric acid (CA), on calcification in bovine pericardium. METHODS: Freshly excised bovine pericardium was dissected free from adhering fat tissue and cut into 1- cm2 pieces; these were rinsed in phosphate-buffered saline solution (PBS), transferred into +4 degrees C PBS containing 0.625% glutaraldehyde (GA) for initial fixation, and then allocated to two groups. Control samples received the same treatment in a fresh solution for 5 days. The other samples underwent an additional fixation step in PBS (pH = 7.4, 37 degrees C) containing 3.8% CA for a period of 48 h (30 ml/g tissue) and were then transferred into freshly prepared PBS + 0.625% GA solution at 37 degrees C for a further 3 days. To investigate calcification rate, pericardial patches were inserted into the dorsal pouches of 15 juvenile male Wistar rats for 42 days. Tissue calcium levels were measured with atomic absorption spectrophotometer, and also assessed histopathologically. RESULTS: The calcium content of CA-treated pericardium was significantly lower than that of controls (66.4 +/- 33.5 and 111.4 +/- 27.2 mg/g, respectively; p = 0.000). In general, the degree of calcification in histological sections agreed well with results of the chemical analyses. Control pericardial tissues showed moderate to severe solid mineral depositions, predominantly parallel to the implant surface, whereas only minor traces of calcium were found in CA-treated tissues. CONCLUSION: These preliminary data suggest that calcific degeneration in bovine pericardium may be reduced by using CA as a chelating agent.     

The effects of tamsulosin and alfuzosin on iris morphology: an ultrasound biomicroscopic comparison

Context: It is well known that Alpha-1 adrenergic receptor antagonists affect the receptors in the prostate and also iris dilator muscle, leading to loss of iris muscle tone.

Objective: To compare morphological alterations of iris secondary to tamsulosin and alfuzosin use.

Participants: Patients included in the study were grouped as follows: 16 patients treated with tamsulosin (Group 1), 14 patients treated with alfuzosin (Group 2) and 18 untreated controls (Group 3).

Materials and methods: All patients underwent ultrasound biomicroscopic and pupillometric examination. Iris thickness was measured at the dilator muscle region (DMR; measured at half of the distance between the scleral spur and the pupillary margin) and sphincter muscle region (SMR; Standardized at 0.75?mm from the pupillary margin). DMR/SMR was also calculated for each patient. Differences among groups were analysed. Main outcome measures were DMR, SMR, DMR/SMR and pupillary diameter.

Results: Mean duration of treatments were 2.4?±?0.96 years (1–4) and 2.3?±?1.01 years (1–4) in Groups 1 and 2. Pupillary diameters were reduced in Groups 1–2 compared to Group 3 (p?<?0.001, p?<?0.001). The SMR was similar in Groups 1 and 2 (p: 0.114). These values were not significantly different from that of Group 3 (p: 0.196, p: 0.209). However, thickness in the DMR in Groups 1–2 were significantly lower than that of controls (Group 3) whereas there was no significant difference between Groups 1 and 2 (p: 0.041, p: 0.039 and 0.986, respectively). Mean DMR/SMR ratios were significantly lower in Groups 1–2 than that of Group 3 (p: 0.040 and p: 0.040, respectively).

Conclusions: In patients using these medications, the iris seems to be thinner at the dilator muscle region, but preserving the sphincter muscle region.     

Endothelin-1 and nitric oxide concentrations and their response to exercise in patients with slow coronary flow.

In this study, the endothelin-1 (ET-1) and nitric oxide (NO) concentrations in slow coronary flow (SCF) patients were assessed before and at the peak of the exercise stress test and compared with the values from healthy controls. The study population was 25 patients who underwent coronary angiography and were diagnosed as SCF (11 females (44%), aged 56.7+/-9.8 years), and 20 normal subjects (9 females (45%), aged 54.3+/-9.2 years). Mean TIMI frame count in the patients was 54.1+/-13.4. Blood samples were drawn at rest and immediately at the end of exercise testing. The baseline ET-1 concentrations of the control subjects were lower than those of the patients (7.0+/-4.5 pg/ml vs 11.1+/-5.9 pg/ml p<0.0001) and this difference increased after exercise (6.2+/-4.3 pg/ml vs 20.1 +/-10.4 pg/ml, p<0.0001). Post-exercise ET-1 concentrations were significantly higher than baseline in patients with SCF (p<0.0001) and a reduction in the ET-1 concentrations was observed in control subjects (p<0.05). Baseline NO concentrations of the patients were lower than those of the control subjects (27 +/-5.1 micromol/L vs 31.2+/-4.9 micromol/L, p=0.0001). Although the NO concentrations in both groups were significantly increased after exercise (29.4 +/-5.9 micromol/L vs 33.3+/-5.6 micromol/L, p<0.05 for both), the difference was not significant. A significant negative correlation among post-exercise ET-1 concentrations and maximal heart rate, exercise duration and exercise rate - pressure product, and a significant positive correlation among post-exercise NO concentrations and maximal heart rate and exercise duration were observed in both groups. The results of this study show that endothelial function (assessed by ET-1 and NO concentrations) and its response to exercise were abnormal in SCF patients compared with healthy subjects, and this may play some pathophysiologic role.     

Treatment strategies in myocardial bridging: a case report

Myocardial bridging is one of the nonatherosclerotic causes of coronary artery disease and is characterized by muscles overlying the intramyocardial course of a major epicardial coronary artery segment, leading to systolic compression. Myocardial bridging is considered a benign condition in most cases, but has been associated with serious cardiac events such as myocardial infarction and sudden death. We discuss the case of a 63-year-old man who was admitted to our hospital with effort-induced angina, bradycardia, and left ventricular hypertrophy on electrocardiogram. On coronary angiography, we found significant myocardial bridging with total occlusion in the left anterior descending artery during systole. In patients with myocardial bridging, symptoms often manifest during exercise and with tachycardia. But it is interesting to note that our patient was bradycardic and became symptomatic with minimal effort. Thus, we thought that these emphasized its significance and affected treatment strategy.     

Pattern of neuropsychiatric manifestations and outcome in juvenile systemic lupus erythematosus

The aim of this study was to study the neuropsychiatric (NP) manifestations, diagnostic evaluation, treatment and outcome in juvenile systemic lupus erythematosus (SLE). We reviewed the charts of all children with SLE and evidence of NP manifestations as defined by the presence of at least one of the following: headache, cerebrovascular accident (CVA), chorea, seizure, papilledema, and psychiatric or spinal cord manifestations. Out of 90 children with SLE, 20 (16 female) had NP manifestations. The mean age at onset was 8.8 years. The mean period between onset of SLE and NP manifestations was 10.2 months. NP manifestations were the presenting feature in 3 patients. Eleven patients had headache, 10 had psychiatric manifestations, 10 had seizure and 6 had CVA. Coma was seen in 5 patients, chorea in 4, transverse myelitis in 2 and papilledema in 2. Anticardolipin antibodies were high in 12 patients. Five patients had an abnormal CSF study. Nine patients had EEG abnormalities and 13 showed MRI abnormalities. All patients received oral prednisone and 17 were treated with IVMP and immunosuppressive therapy (cyclophosphamide or azathioprine); 85% of our patients recovered completely, but 15% had persistent NP sequelae; 10% died from severe infection. In conclusion, NP involvement in juvenile SLE is common. However, early diagnosis and early treatment with adjunctive intravenous pulse cyclophosphamide may improve the outcome.Abbreviations CVA Cerebrovascular accident - IVMP Intravenous methylprednisolone - NP Neuropsychiatric - SLE Systemic lupus erythematosus     

Effectiveness of the sirolimus-eluting stent in the treatment of saphenous vein graft disease

The use of bare stents for the percutaneous intervention of saphenous vein bypass grafts (SVGs) is associated with a high subsequent rate of restenosis. To assess the impact of the sirolimus-eluting stent (SES), we studied 19 consecutive patients who underwent de novo SVG intervention treated solely with SES. Mean graft age was 10 years. Clinical presentation was an acute coronary syndrome in 68%. In total, twenty-two de novo lesions were treated with 35 SESs (mean=1.6 stents per lesion). Use of glycoprotein IIb/IIIa inhibitor therapy and distal embolization protection device were at operator discretion and were 42% and 32%, respectively. The rate of in-hospital major adverse cardiac events (MACE) was 11%, related to 2 patients with a creatine kinase rise consistent with peri-procedural acute myocardial infarction (AMI); a distal protection device was not utilized in either. Over a mean 12.5+/-2.6 month follow-up, one patient died from a non-cardiac cause, and there were no further AMIs. Target lesion revascularization was undertaken in 1 patient (5%); survival free of MACE was 84%. In conclusion, utilizing SESs for percutaneous intervention of degenerate SVGs is associated with a low rate of target vessel revascularization. Increased utilization of distal protection devices might reduce the peri-procedural rate of AMI.     

Acute phase reactants and cytokine levels in unilateral community-acquired pneumonia

BACKGROUND: Bacterial infection of the lower respiratory tract initiates an acute inflammatory response. Regulation of the inflammatory response in bacterial pneumonia depends on a complex interaction between immune cells and inflammatory cytokines. OBJECTIVES: We investigated the initial levels of proinflammatory cytokines and acute phase reactants (APR), e.g. C-reactive protein (CRP), upon presentation of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. METHODS: We prospectively studied 28 consecutive patients with unilateral CAP. Tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta, IL-6 and IL-8 concentrations were measured by ELISA in both bronchoalveolar lavage (BAL) fluid and serum. RESULTS: The concentrations of IL1-beta and IL-6 in BAL fluid were found to be significantly higher in the involved lung than those in either the uninvolved lung (p = 0.008 and p = 0.012, respectively) or serum (p = 0.002 and p = 0.025, respectively). Serum CRP concentrations were increased compared to those in the involved and uninvolved lung in BAL fluid (p = 0.000 and p = 0.000, respectively). In serum and BAL from involved lung, IL-6 concentrations were higher in the systemic inflammatory response syndrome (SIRS) group than in the non-SIRS group (p < 0.05), whereas CRP, TNF-alpha, IL-1beta and IL-8 concentrations showed no difference between SIRS and non-SIRS. There was no significant correlation between the acute physiology and chronic health evaluation II score and the cytokines. CONCLUSIONS: Our results indicate that the CRP level is higher in the serum than in the BAL fluid in the lung, and that IL-6 is the most important cytokine for the determination of the severity of the disease.     

Characteristics of 351 supernumerary molar teeth in Turkish population

Objective: The aim of the present study was to evaluate the demographic profile of supernumerary molar (SM) teeth in people in various regions of Turkey. Study Design: A retrospective analysis was carried out on an initial sample of 104,902 subjects drawn from the ortopantographics files from 10 clinics in 7 Turkish cities with documentation of demographic data, the presence of SM teeth, their location, eruption, morphology, and position within the arch. In one region associated patho­logies and treatments were also evaluated. Results: Three hundred fifty-one SMs were detected in 288 patients, constituting 0.33% of the study subjects, with a greater frequency in females (56.4%). SMs were found more frequently in the maxilla (87.7%) than in the mandible, and distomolars (62.9%) were more common than paramolars. The SMs encountered were mostly of conical shape (45.7%), impacted (81.1%), and in a vertical position (52.1). The 33% of SM teeth were related to impacted molar teeth. Conclusion: The most common complication involving these teeth was soft tissue irritation. Demographic data from such specific extensive studies are crucial for improved diagnosis of SM teeth. Early detection allows for measures against complications and more successful therapy. Key words:Supernumerary molars, distomolar, paramolar, prevalence.