Preservation of anterior leaflet chordae with modified miki technique: how to do it

During mitral valve replacement, total chordae preservation is very important for left ventricular functions. But leaving anterior leaflet and chordae may cause serious complications, such as left ventricular outflow tract obstruction and impairment in prosthetic valve functions. In this article, we present the anterior leaflet preservation technique by excising the central portion of the anterior leaflet. The rim of the leaflet tissue containing the marginal chordae was divided in two parts without destroying the chordae, and then the rim of leaflet tissue was sutured to the left atrium. This technique provided optimal chordae tension and improved avoidance of complications due to total chordae preservation, in mitral valve replacement operations.     

The factors affecting the relation between the menarcheal age of mother and daughter

BACKGROUND: Menarche is one of the most important biologic signals in the life of a woman. Menarche is a biological variable which has a significant genotypic component in girls. In recent years, many studies reporting the earlier onset of menarche owing to the improvement of socio-economic conditions have been published. DESIGN: We asked some questions about menarche to 1017 female students studying in the high schools of Manisa region in order to determine the menarcheal age and the correlation of menarcheal age between the mothers and daughters in our region. RESULTS: The mean age at menarche for the girls was 12.82+/-1.07 years and for the mothers was 13.6+/-1.39 years. The mean menarcheal age of the mothers was higher than the mean menarcheal age of the girls (P<0.001). This difference persisted independent of the socio-economic status, nutritional state and physical activity of the girls. There was a significant correlation between the menarcheal age of the girls and their mothers (r=0.262, P<0.001). This correlation existed in all the girls with different socio-economic status, nutritional state and physical activity. However, this correlation disappeared in girls with body mass index (BMI)>25 (r=0.04, P=0.813). In girls with BMI<25, there was a correlation between the menarcheal age of the girls and mothers (r=0.282, P<0.001). CONCLUSION: These results suggest that the menarche occurs earlier in the daughters than their mothers. The correlation between the menarcheal age of the girls and their mothers persists under all circumstances except in obesity. The mother's menarcheal age is a good predictor of the daughter's menarcheal age in non-obese girls and the BMI is an important factor.     

Interaction between the 90-kDa heat shock protein and soluble guanylyl cyclase: physiological significance and mapping of the domains mediating binding

The 90-kDa heat shock protein (hsp90) regulates the stability and function of many client proteins, including members of the NO-cGMP signaling pathway. Soluble guanylyl cyclase (sGC), an NO receptor, was recently reported to be an hsp90-interacting partner. In the present study, we show that hsp90 binds to both subunits of the most common sGC form (alpha(1)beta(1)) when these are expressed individually but only interacts with beta(1) in the heterodimeric form of the enzyme. Characterization of the region of hsp90 required to bind each subunit in immunoprecipitation experiments revealed that residues 310 to 456 of hsp90 interact with the sGC subunits. The region of beta(1) responsible for binding to hsp90beta was mapped using in vitro binding assays and immunoprecipitation experiments and was found to lie in the regulatory domain. The physiological importance of the hsp90/sGC interaction was investigated by treating rat smooth muscle cells with the hsp90 inhibitors radicicol and geldanamycin (GA) and determining both sGC activity and protein levels. Long-term (24 or 48 h) inhibition of hsp90 resulted in a strong decrease of both alpha(1) and beta(1) protein levels and sGC activity. Moreover, incubation of smooth muscle cells with the proteasome inhibitor N-benzoyloxycarbonyl (Z)-Leu-Leu-leucinal (MG132) blocked the GA-induced down-regulation of sGC. We conclude that the N-terminal region of the beta(1) subunit mediates binding of the heterodimeric form of sGC to hsp90 and that this interaction involves the M domain of hsp90. Hsp90 binding to sGC regulates the pool of active enzymes by affecting the protein levels of the two subunits.     

Unusual manifestation of subacute sclerosing panencephalitis: case with intracranial high-pressure symptoms

Subacute sclerosing panencephalitis can show variations in clinical course, and some ophthalmologic abnormalities can be seen as cortical blindness and optic atrophy. A 4-year-old girl was referred to our hospital with a complaint of diplopia, vomiting, and ataxia. On physical examination, she was found to have stage IV papilledema with retinal hemorrhage. She was diagnosed as having idiopathic intracranial high pressure until magnetic resonance imaging demonstrated T2-weighted hyperintense lesions. After observation of head drop attacks and detection of elevated antimeasles antibodies in cerebrospinal fluid, the diagnosis of subacute sclerosing panencephalitis was established, and isoprinosine and carbamazepine were started for treatment. However, because carbamazepine failed to control the head drop attacks, topiramate was also included, and the attacks were kept under control with topiramate. The case presented in this article is a good example of subacute sclerosing panencephalitis in which, at early stages, some of the signs and symptoms can lead to an erroneous diagnosis. In addition, we have demonstrated that topiramate might be a good choice for treatment for the persistent myoclonus seen in this type of patient.     

A rare cause of wound infection: Shewanella putrefaciens

Shewanella putrefaciens has a wide geographical distribution, including all forms of sea water, fresh water, fish and soil. In humans, it is an unusual pathogen of wound infections. In this report, a wound infection was presented in a previously healthy man.     

Unusual clinical presentations of brucellosis

The purpose of this paper is to draw attention to atypical presentations of brucellosis. A prospective study identified 240 consecutive patients with brucellosis admitted to our department between December 1999 and July 2002. From these cases we present 11 patients with unusual clinical presentations. Neurobrucellosis, peritonitis, pericarditis, pancytopenia, and uveitis were diagnosed in 2 patients each and 1 presented with epididymo-orchitis.     

The interrelationship between insulin secretion and action in type 2 diabetes mellitus with different degrees of obesity: evidence supporting central obesity

This paper investigates the relative role of the impairment of insulin secretion and action in the pathogenesis of Type 2 diabetes mellitus (T2DM). The parameters indicating insulin secretion and action were calculated from the data obtained during oral glucose tolerance test (OGTT), in 156 age- and sex-matched T2DM patients divided in 4 groups according to their body mass index (BMI, I = 20.0-24.9, II = 25.0-29.9, III = 30.0-39.9 and IV > 40.0 kg/m2). After obtaining baseline biomedical parameters (plasma glucose, serum insulin, cholesterol, HDL-cholesterol, triglycerides, BMI, and amount of fat tissue), the rates of insulin secretory capacity and insulin action were obtained from OGTT and compared between the T2DM patients with normal body weight and different grades of obesity. Beta-cell secretory capacity of the participants was found to be proportionally and significantly higher in graded obese than that of the normal body weight patients. The rates of hepatic as well as peripheral insulin resistance in obese groups proportionally and significantly rise in comparison with that of non-obese diabetics. In addition, these parameters are shown to be related to the body fat, presumably visceral in origin. In conclusion, hyperglycemia-hyperinsulinemia observed in obese and T2DM patients might be due, in part, to increased capacity of insulin secretion, and to exaggerated hepatic glucose production because of hepatic insulin resistance, respectively.     

Differential effects of lidocaine and tramadol on modified nerve impulse by 4-aminopyridine in rats

We have used the sucrose gap method to measure the effects of drugs on the electrophysiological properties of rat sciatic nerves. The results showed that 4-aminopyridine produced a slight conduction block, prolonged the duration of action potential, enhanced the hyperpolarizing afterpotential, and elicited a hump that followed the action potential. In the presence of 4-aminopyridine, the impulse-blocking activity of lidocaine and tramadol was enhanced. Both lidocaine and tramadol effectively depressed the delayed depolarization generated by 4-aminopyridine. While tramadol decreased the activity-evoked hyperpolarizing afterpotentials, lidocaine completely removed them. These findings indicate that lidocaine may be more effective in blocking the Na(+) channels than tramadol. Tramadol may be more effective on the delayed rectifier K(+) channels than lidocaine.     

Results of endocardial radiofrequency ablation of atrial fibrillation during mitral valve surgery

AIM: The aim of the study is to evaluate the efficacy of thermocontrolled endocardial radiofrequency (RF) ablation for the patients with mitral valve disorder and associated chronic atrial fibrillation during mitral valve replacement operation. METHODS: Between February 2002 and January 2004, 43 patients with mitral valve disease and associated chronic atrial fibrillation underwent mitral valve replacement and thermocontrolled endocardial RF ablation with Cobra RF system flexible probe at Gulhane Military Academy of Medicine, Department of Cardiovascular Surgery. Eighteen of the patients (41.8%) were males, while the remaining 25 (58.2%) were females. The average age of the patients was 44+/-14.21 (18-66) years. Functional capacity of the patients was class II in 15 (34. 9%), class III in 24 (55.8%), class IV in 4 (9.3%) according to the NYHA classification. At the preoperative period all of the patients were evaluated routinely by twelve-lead ECG, chest film and transthoracic echocardiography (TTE). For the patients over 40 years of age, we performed additional coronary angiography to delineate any coronary lesions. The patients were evaluated at months 1, 3, 6 and annually by twelve-lead ECG, TTE and holter monitoring after discharge. RESULTS: There were not any complications related to the performed technique. No operative and hospital mortality were recorded. At the follow-up period for 35 of 43 patients (81.4%) sinus rhythm was restored. The mean follow-up time was 24.3+/-11.2 (12-35) months. CONCLUSION: Endocardial RF ablation especially during mitral valve surgery is a simple technique to be performed. Early and midterm results of the cohort are satisfying.