Does “smoker’s paradox” exist in clopidogrel-treated Turkish patients with acute coronary syndrome

Previously conducted studies revealed that smoking enhanced the efficacy of clopidogrel by increasing formation of the active metabolite (AM) from the prodrug through induction of the cytochrome CYP1A2. The expression of cytochrome enzymes depends on genotype and no data exists in literature conducted in Turkish patients comparing the clopidogrel responsiveness between active smokers and non-active smokers treated with clopidogrel. In this study, our aim was to investigate the clopidogrel responsiveness in clopidogrel-treated Turkish acute coronary syndrome (ACS) patients according to their smoking status. We retrospectively enrolled 258 patients who were hospitalized due to ACS. Clinical variables of the patients, especially smoking status were recorded. Clopidogrel resistance was evaluated by using adenosine diphosphate (ADP) induced platelet aggregometry. Clopidogrel resistance was detected as a change in maximal aggregation ≤20% from baseline. A total of 139 patients were active smokers while 12 were former smokers. 107 patients did not have a history of smoking. Ten of the smokers were hyporesponsive to clopidogrel, whereas 36 of non-smokers were hyporesponsive to clopidogrel (p?612.5 predicted the clopidogrel resistance with a sensitivity of 60% (OR: 100.65, %95 CI?=?19.996–506.615 p?相似文献   

Left ventricular hypertrophy and remodeling after aortic valve replacement

Left ventricular geometric remodeling and regression of hypertrophy were assessed after aortic valve replacement with a mechanical prosthesis in 37 patients with aortic stenosis and 39 with aortic insufficiency, aged 54.2 +/- 14.3 and 52.6 +/- 16.6 years, respectively. The follow-up period was 2 years. In patients with aortic insufficiency, ejection fraction increased from 54.4 +/- 3.5 preoperatively to 59.6 +/- 3.4 after 6 months and 61.7 +/- 2.7 after 2 years. In patients with aortic stenosis, ejection fraction increased from 56.6 +/- 5.1 preoperatively to 63.9 +/- 4.4 after 6 months and 71.7 +/- 4.1 after 2 years. Geometric remodeling, regression of hypertrophy, and increased ejection fraction of the left ventricle were similar in both groups at 6 months after surgery, but after 2 years of follow-up, greater improvement was found in patients who had undergone valve replacement for aortic stenosis.     

Can impairments of thyroid function test affect prognosis in patients with respiratory failure?

Thyroid function test (TFT) impairments can be detected in extrathyroidal dysfunction, primarily in chronic obstructive pulmonary disease (COPD) with acute respiratory failure (RF). The aims of this study were to: (i) evaluate TFT impairments in patients with RF, (ii) compare TFT results to a control group without RF and (iii) assess the effects of thyroid dysfunction on clinical outcome and prognosis of RF. The TFT parameters were assessed in 65 patients (65.0 +/- 10.0 years, 49 males) with RF and compared to 18 patients (64.4 +/- 9.8 years, 13 males) with lung disease and no RF (p> 0.05). Arterial blood gas analysis, free T3 (FT3), free T4 (FT4) and TSH levels were all measured. The impairments of TFT were demonstrated in 34 (52.3%) patients with RF and 8 (44.4%) patients without RF (p> 0.05). The most common finding was a decrease in at least one of the TFT parameters in both groups (43.1% vs. 44.4%, respectively). In RF group, there was no significant association between TFT results and gender, age, diagnosis and co-morbid disease. However, need for invasive mechanical ventilation was higher both in patients with low FT3 and low FT4 when compared to those with normal TFT results (p= 0.001 and p= 0.003, respectively). In-hospital mortality rate was also higher both in the patients with low FT3 and low FT4 than the others (p= 0.006 and p= 0.01, respectively). We conclude that TFT impairments are not observed more frequently in patients with RF when compared to the patients without RF. However, low FT3 and FT4 levels increase the rates of invasive mechanical ventilation and mortality.     

Ventricular septal rupture and mitral regurgitation caused by trauma

We present a young patient with traumatic septal rupture following traffic accident in whom transthoracic echocardiography allowed comprehensive noninvasive assessment of location and size of the septal defect and structure atrioventricular valve apparatus.     

Removal of clival chordoma in an adolescent thorough combned pterional transsylvian and anterior temporal approach

Extensive and aggressive surgical removal is treatment of choice for patients who have chordomas of the cranial base. Well-developed microsurgical techniques, as well as good surgical judgment learned from experience are essential to avoid major morbidity. A 14-year-old female presented with progressive headaches and diplopia for three months. Cranial magnetic resonance imaging demonstrated a well-circumscribed mass in the clival region. The mass was totally excised via right combined pterional transsylvian and anterior temporal approach (+ orbitozygomatic osteotomy). The tumor was located extradurally. The resected tumor had the typical histological and immunohistochemical characteristics of chordoma. No radiation therapy or chemotherapy was administered.     

Management of a retained catheter in an arteriovenous malformation. Case report

The long-term effects of retained catheters in patients are not well known; therefore, the clinical presentation may differ. The authors present the case of a 21-year-old man with a pseudoaneurysm of the left common femoral artery, which developed 3 months after a transfemoral microcatheter embolization of a cerebral arteriovenous malformation (AVM) in which the catheter was inadvertently glued into the AVM and was retained at the groin.     

Antioxidant responses and metal accumulation in tissues of Nile tilapia Oreochromis niloticus under Zn,Cd and Zn + Cd exposures

We investigated the effects of Zn, Cd and a Zn + Cd mixture on antioxidant parameters and metal accumulation in Oreochromis niloticus. Fish were exposed to 0.5 and 5.0 mg l^?1 Zn, 0.1 and 1.0 mg l^?1 Cd, and 0.5 mg l^?1 Zn + 0.1 mg l^?1 Cd and 5.0 mg l^?1 Zn + 1.0 mg l^?1 Cd mixtures for 7 and 28 days to determine Zn and Cd accumulation, reduced glutathione (GSH) level and glucose‐6‐phosphate dehydrogenase (G6PD) activity in gill and liver. There was increasing accumulation of the metals in the tissues with increasing concentrations of metals in the exposure medium and with increasing duration of exposure (except at the lower concentration of Zn). Concentration of metals in the tissues of fish exposed to the Zn + Cd combination were significantly lower than in fish exposed to the single metal. The highest metal accumulation was observed in the liver. Exposure to the heavy metals affected the antioxidant parameters in the tissues, with both GSH level and G6PD activity in the gill and liver being increased under Zn, Cd and Zn + Cd exposures, especially in their higher concentrations. These increases in the antioxidant responses were higher with the Cd alone, and in combination with Zn, than with Zn alone. Furthermore, GSH level and G6PD activity increased with increasing exposure period only for Cd alone, and in Cd combination with Zn. The results indicate that O. niloticus resisted oxidative stress induced by heavy metal exposure by antioxidant mechanisms. Copyright © 2008 John Wiley & Sons, Ltd.