The relationship between the MEFV genotype, clinical features, and cytokine-inflammatory activities in patients with familial mediterranean fever

Familial Mediterranean Fever (FMF) is an autosomal recessive disease characterized by periodic attacks of fever and polyserositis. The effects of the MEFV genotype differences on clinical picture and inflammatory activity have not been well documented. The aim of this study was to investigate levels of conventional inflammation markers, procalcitonin, interleukin levels, TNF-alpha, and C5a levels in patients with FMF who had different MEFV genotypes and compare them with those of healthy subjects. The study consisted of 41 patients with FMF (F/M: 23/18), and 31 healthy subjects (F/M: 18/13). Tests were performed during the attack-free period. White-blood cell count, CRP and IL-8 levels were higher in patients with FMF than in healthy subjects (p < 0.05) and also higher in M680I carriers than in the patients with M694V allele carriers. However, ESR, fibrinogen, procalcitonin, IL-6, C5a, TNF-alpha, and IgD levels were not significantly different between patients and healthy subjects (p > 0.05). Arthralgia or arthritis was significantly higher in M694V carriers than in non-M694V carriers (p < 0.05). It is concluded that the clinical features and inflammatory-cytokine activities were higher in patients with FMF during the attack-free period than in healthy subjects, and the different genotype might be related to different clinical pictures.     

Harvesting of the radial artery: subfasciotomy or full skeletonization: a comparative study

BACKGROUND: Long fasciotomy of the posterior aspect of the radial artery (RA) for the purpose of sympathectomy is one of the surgical techniques for the preparation of this graft. We compared the early results of this technique with those of the RA graft harvested as a pedicle in the conventional fashion. METHODS: The study patients have been selected from the patients who underwent coronary artery bypass grafting (CABG) using the RA graft harvested either with a long posterior fasciotomy (group 1) or as a whole with a pedicle in the classical manner (group 2). Only the patients with a flow study have been included. The flow index was described as the bleeding amount of the RA in a minute per body surface area (mL/m2 min). The flow index has been performed before and after fasciotomy in group 1, and after full skeletonization in group 2. The clinical and demographic parameters and flow indices were measured and compared between the groups, and in group 1, before and after fasciotomy. RESULTS: From 218 patients with CABG using the RA between January 1998 and August 2005, a total of 57 patients were recruited into the study. Group 1 consisted of 25 patients. Thirty-two patients constituted group 2. Subfascial dissection of the RA increased the blood flow index from 48 +/- 20 mL/m2 min to 51 +/- 19 mL/m2 min (p < 0.001). The comparison of the clinical, perioperative characteristics of the patients was not different between the groups. CONCLUSIONS: The necessity of total skeletonization of the RA should not be the only option when the aim is to reduce the spasm. While subfascial dissection (sympathectomy) of the pediculed RA alone provides a satisfactory increase in the blood flow index, it also reduces the manipulation time as well as the risk of injury to the graft.     

Results of the Probe Technique for Transatrial Repair of Tetralogy of Fallot

Abstract Objective: Total correction of classical tetralogy of Fallot (TOF) by transatrial approach has become a standard procedure in the goal to minimize structural damage to the pulmonary pump. The most critical point in transatrial repair of TOF is infundibular dissection. Right atrial approach provides better surgical exposure for parietal extension of the infundibular septum when compared to the right ventricular approach. However it is not always easy to determine the localization and amount of muscle bundles to be resected and this surgical maneuver requires experience. Methods: Nineteen patients who had repair of isolated TOF using this technique from 1993 to 2001 were reviewed. The mean age of patients were 5 ± 2 years. Transatrial‐transpulmonary approach were performed for all patients. To make easier the infundibular muscle bundles resection and to determine the localization and amount of muscle bundle to be resected, we placed a Hegar dilator into the right ventricle through pulmonary arteriotomy. The muscle bundles between the dilator and the anterior leaflet annulus of the tricuspid valve were totally excised until the intraventricular part of the dilator and pulmonary annulus became completely visible. The area between the Hegar dilator and the margins of the ventricular septal defect (VSD) was left untouched. None of the patients had transannular patch. To improve exposure, tricuspid valve detachment was performed in 11 patients. All patients were followed‐up in our clinic every 6 months using echocardiography. Results: There were no early or late deaths, and no reoperation for residual VSD or residual right ventricle (RV) outflow obstruction. All patients were in NYHA Class I. RV on the echocardiography was spared late dilatation and had a good late functional status. Eighteen patients had no or mild pulmonary regurgitation. One patient who had undergone tricuspid anterior leaflet detachment showed mild tricuspid insufficiency. Conclusion: On the basis of hemodynamic outcomes, this procedure for elective repair of TOF in selected cases shows excellent early and mid‐term results.     

Posttransplant Proteinuria Is Associated With Higher Risk of Cardiovascular Disease and Graft Failure in Renal Transplant Patients

In this study, we sought to determine whether proteinuria after renal transplantation was associated with cardiovascular disease (CVD), patient survival, and long-term allograft survival. One hundred twenty-six patients included 102 males and 24 females of mean age 30.7 ± 8.9 years. Their mean follow-up was 63.21 ± 19.9 months. All patients were evaluated for CVD, namely, ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. Proteinuria was defined as urinary protein ≥500 mg/d which persisted for >6 months after transplantation. We retrospectively examined pre- and posttransplant data, including sex, age at transplantation, smoking, pretransplant dialysis duration, donor status, number of acute rejection episodes, body mass index, systolic and diastolic blood pressure levels, lipid profile and other biochemical parameters, immunosuppressive regimens, as well as pulse steroid dose. Proteinuria was significantly associated with CVD (P = .001; RR = 6.43; confidence interval [CI] 2.15-19.22). Patients with proteinuria showed significantly lower graft survival rates than those without proteinuria (58.62% vs 80.41%; P = .02). The mean time to appearance of proteinuria was 14.1 ± 11.4 months (range, 1-36 months). There was no significant association between proteinuria and patient survival. Patients with persistent proteinuria displayed a greater number of acute rejection episodes (1.20 ± 1.17 vs 0.62 ± 0.85; P = .004) and higher pulse steroid dosages (4380.0 ± 3123.4 vs 2800.0 ± 2766.7; P = .022). In conclusion, persistent proteinuria is a strong risk factor for CVD among renal transplant patients. Therefore, an etiologic search and antiproteinuric strategy should be considered routinely to improve patient and graft outcomes.     

Clinical, biochemical and histochemical assessment of pretreatment with glucose-insulin-potassium for patients undergoing mitral valve replacement in the third and fourth functional groups of the New York Heart Association.

In this study, the potentially beneficial effects of preoperative treatment with glucose, insulin and potassium in a randomized series of 30 consecutive patients undergoing mitral valve replacement, who were in the third and fourth functional groups of the New York Heart Association scale, were investigated. Fifteen patients received glucose, insulin and potassium, and 15 patients received the same volume of normal saline. The characteristics of the groups did not differ. Papillary muscle-biopsy samples were obtained at the time of surgery and analysed for glycogen, both biochemically and histochemically. The clinical course of all patients was monitored closely during the first 24 hours after surgery. The patients receiving glucose, insulin and potassium had higher glycogen levels (43 +/- 13.54 micromol/g) (P < 0.001). In addition, they required less inotropic pharmacological support (scored by the Gradinac method), had fewer ventricular arrhythmias and exhibited improved haemodynamic indices: cardiac output increased (P < 0.025 to P < 0.005), while systemic vascular resistance decreased (P < 0.001). Pretreatment with glucose, insulin and potassium did not, however, affect the patients' postoperative wedge pressure and mortality. The results of this study suggest that glucose, insulin and potassium pretreatment may be beneficial in unfit patients undergoing mitral valve replacement.     

Back ache in helicopter pilots]

Due to low back pain (LBP) and harmful effects of flying, questionnaires were sent to 71 helicopter pilots of the experimental group, 22 mechanics helicopter flyers and to the control group of 28 air-traffic controllers. The prevalence of LBP was the highest in helicopter pilots, then in helicomechanics and air-traffic controllers (53%, 50% and 36%). Effects of exposure to vibration, body posture and working load have not contributed significantly to the occurrence of LBP. LBP has not lead to an important difference in the strength of the back musculature, body mass index and spondylosis, that is, scoliosis. The necessity of further study of LBP and maintaining of specific preventive measures are indicated.     

Humphrey visual field analysis, visual field defects, and ophthalmic findings in patients with macro pituitary adenoma

OBJECTIVE: To evaluate the Humphrey visual field parameters in patients with pituitary adenoma and classify the visual field defects in this patient group. METHODS: Forty primary pituitary adenoma patients underwent neuro-ophthalmological examination and Humphrey Perimetry 30-2 visual field test at Baskent University, Departments of Ophthalmology, and Neurosurgery, between 2003 and 2005. Global indices, mean+/-SD and pattern standard deviation (PSD) of pituitary adenoma patients (group 1) were taken as the test parameters and compared with age- and sex- matched controls (group 2). RESULTS: There were no significant differences between groups 1 and 2 with respect to mean age or gender distribution (p>0.05). The MD and PSD results of group 1 according to the age groups and gender were not statistically significant (p>0.05). The MD and PSD results of subjects in group 2 were within normal limits, and no special visual field defects were observed. When compared with healthy controls, the MD and PSD values of patients with hypophyseal adenomas were statistically significantly (p<0.05). In group 1, the mean adenoma size was 13.34 mm and no statistically significant correlation was found between the adenoma size and either the MD or PSD values (p>0.05). Sixteen (40%) patients had visual field defects, the specific complete bitemporal hemianopsia was found in 5 (12.5%) patients. Only in 3 patients (7.5%) the primary diagnosis was made by ophthalmologic examination. CONCLUSION: Although ophthalmologists rarely have a role in the primary diagnosis of hypophyseal adenoma, routine ophthalmologic examination is still important. To detect early visual field abnormalities, automated perimetry should be performed as a part of routine examination in patients with suspected hypophyseal adenomas.     

Prophylactic use of melatonin protects against focal cerebral ischemia in mice: role of endothelin converting enzyme-1

Melatonin has previously been shown to be neuroprotective in rodent models of ischemic stroke. Herein, we tested whether this antioxidant may also be suitable for prophylactic use against stroke. To clarify this issue, melatonin was administrated orally for 9 wk (4 mg/kg/day) in mice and its effects on subsequent injury development after 90 min of intraluminal middle cerebral artery (MCA) occlusion were tested. To evaluate its neuroprotective properties, the protective actions of prophylactic melatonin were compared with both acute melatonin (4 mg/kg, i.p.) administration and with a diluent (sham)-treated control condition. MCA occlusion resulted in reproducible ischemia, as revealed by laser Doppler flowmetry; this was followed by a rapid restoration of blood flow immediately after reperfusion onset. Laser Doppler flow values after reperfusion onset were moderately elevated by melatonin, both when the indole was given prophylactically and when acutely administrated after stroke. In control animals, reproducible brain infarcts were observed 24 hr after reperfusion onset. Treatment with melatonin significantly reduced the infarct size by approximately 30-35%, independent of whether the indole was given prophylactically before or acutely after ischemia. To test whether brain protection involved vascular mechanisms, as suggested earlier, the effects of melatonin on endothelin converting enzyme-1 (ECE-1) levels were studied using Western blots. Interestingly, delivery of melatonin was accompanied by a marked inhibition of ECE-1 levels, which was similarly seen after both acute and chronic melatonin treatment. Our data suggest that melatonin, given at pharmacological doses, may be suitable as a prophylaxis against stroke. Tissue protection may involve an inhibition of ECE-1, which improves vasodilation, after ischemia.