Increased immunoglobulin E response in acute coronary syndromes

The role of inflammation and mast cell activation has been implicated in atherosclerotic plaque destabilization and rupture. To investigate the role of immunoglobulin E (IgE) in acute coronary syndrome, a prospective clinical study was conducted in patients with acute myocardial infarction (AMI), unstable angina pectoris (UAP), stable angina pectoris (SAP), and healthy controls. IgE levels were serially measured and compared in consecutive patients with AMI (n = 16) and UAP (n = 14) on days 1, 3, 7, 21 after admission and 3 months later and only once in stable angina pectoris (n = 15) and healthy controls (n = 14). In addition, blood eosinophil and basophil levels on admission were measured in all groups and compared. Initial IgE levels determined at admission in patients with AMI, UAP, and SAP were significantly higher than levels in the control group (p = 0.002). Initial high IgE level in AMI on day 1 increased to a peak by day 7 (p = 0.024), then gradually decreased by day 21 and at 3 months (p = 0.052). High IgE level in UAP persisted by day 7 and gradually decreased by day 21 and 3 months (p = 0.037 and p = 0.018, respectively). Blood eosinophil count on admission was significantly higher in UAP than in the control group (p = 0.005). Basophil levels of both AMI and UAP groups on admission were found to be elevated as opposed to control group (p = 0.02 and p = 0.012, respectively). This study demonstrates that the level of IgE significantly increased during the acute phase of acute coronary syndromes and gradually decreased, supporting the role of acute inflammatory response and mast cell involvement in plaque rupture.     

Pulmonary manifestations of antiphospholipid syndrome: a retrospective analysis of 67 patients

Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by arterial and/ or venous thrombosis accompanied by persistently elevated levels of antiphospholipid antibodies (aPLs). The aim of this study is to evaluate the pulmonary manifestations of APS and compare the levels of aPLs in patients with and without pulmonary involvement. We retrospectively reviewed the files of patients with the diagnosis of APS between October 2010 and May 2017. Demographic data, clinical, radiological and laboratory findings were recorded. The study included 67 patients (56 female/11 male) with a mean age of 39?±?13 years. Pulmonary manifestations such as parenchymal and/or vascular involvement were seen in 12 (17.9%) patients. The patients with and without pulmonary manifestations were not significantly different in terms of age (p?=?0.46), comorbidities (p?=?0.48) and APS duration (p?=?0.66). Acute pulmonary thromboembolism (PE) was determined in 11 (16.4%), alveolar hemorrhage in 2 (3%) patients. Four patients with acute PE (36%) developed chronic thromboembolic pulmonary hypertension (CTEPH). One patient developed both CTEPH and diffuse alveolar hemorrhage after acute PE during follow up. Antiphosholipid antibody IgM was highly positive in patients with PE compared to patients without PE (p?=?0.005). Other antibodies and lupus anticoagulant were not significantly different in patients with and without PE. None of the patients were deceased due to pulmonary manifestations of APS. PE was the most common pulmonary manifestation of APS. The development of CTEPH was high among APS patients. Patients with APS should be closely followed for the onset of PE and CTEPH.

     

Indications for eye removal surgeries: A 15-year experience at a tertiary military hospital

Objectives:

To analyze the indications and types of eye removals at a military tertiary care hospital in Turkey.

Methods:

The medical records (age, gender, affected eye, type of surgical procedure, indications of surgery) of 123 patients who underwent evisceration and enucleation in the course of a 15-year period (January 2000 to December 2014) at Gulhane Military Medical Academy, Ankara, Turkey were reviewed retrospectively.

Results:

The mean age was 35.61±18.52 (range 3-80 years). The number of male in the patient group was 92 (74.8%) and female was 31 (25.2%). Patients who underwent evisceration were 95 (77.2%), whereas 28 (22.8%) of them underwent enucleation. The mean age of the eviscerated patients was 30.63±13.08, whereas the mean age of the enucleated patients was 52.50±23.92 (p<0.001). The leading indications for eye amputations were trauma (n=62, 50.4%), malignancy (n=20, 16.3%), painful blind eye and absolute glaucoma (n=20, 16.3%), endophthalmitis (n=12, 9.7%), and phthisis bulbi, and cosmetic reasons (n=9, 7.3%).

Conclusion:

Trauma was the most common etiology for evisceration, and malignancy was the most common etiology for enucleation. Using protective eyewear and early detection of intraocular malignancy and glaucoma through routine ophthalmic examinations are essential for providing non-invasive treatment modalities instead of eye removal.Eye removals are performed in cases of severe trauma, eye malignancy, endophthalmitis unresponsive to medical treatment, painful blind eye, and absolute glaucoma, as well as phthisic eyes with severe cosmetic defects.1-4 Evisceration is the removal of intraocular structures other than the sclera, whereas enucleation is the removal of the entire eyeball including the sclera leaving behind only the orbital structures.5 Evisceration surgery is usually preferred in extremely severe trauma cases, while enucleation is used in advanced cases of intraocular malignancy.1,3,6 The aim in such surgeries is to remove the damaged eye, provide sufficient comfort, replace the lost volume, and renew functional and cosmetic appearance.7 Removal is a difficult decision for both patients and physicians, and is considered as the last resort. In addition to clinical indications, the potential sight of the eye and patient’s psychological aspects should also be taken into consideration.1 In developed countries, the most common reasons for eye amputations are malignancy3 and trauma,6 whereas in developing countries, infections are the dominating factors.1,8 In this study, the etiology and surgery methods of 123 eye amputations performed in the Gulhane Military Medical Academy (GATA) between January 2000 and December 2014 were analyzed, and possible public health and preventive programs regarding this matter were evaluated.     

Effect of the body mass index on outcomes of flexible ureterorenoscopy

The aim of the study to compare outcomes of flexible ureterorenoscopy in patients with different body mass index (BMI) scores and to explore whether the BMI has an effect on outcomes of RIRS. Five hundred and two patients who underwent flexible URS in 3 centers between 2008 and 2012 for the management of single upper urinary tract calculi were retrospectively reviewed. Patients were categorized as normal weight BMI 18.5 to 24.99 kg/m², overweight 25 to 29.99 kg/m², obese 30 to 39.99 kg/m² and morbid obese >40 kg/m².The groups were assessed in terms of demographic parameters including age, gender, stone size, intraoperative and postoperative variables. The mean patient age was 41.3 ± 15.51 (18–81) years and with an average BMI 26.68 ± 5.2 kg/m² (16.64–55.15 kg/m²). Of the patients, 43.2 % had normal weight (NW), 32.2 % were overweight (OW), 21.9 % were obese (O) and 2.5 % were morbidly obese (MO). Stone-free rates after single procedure in NW, OW, O, MO groups were 60.8, 61.7, 73.6, 61.5 %, respectively (p = 0.079). Overall targeted stone-free rates were also similar in four groups (88.9, 90.1, 93.6, 90.4 %, p = 0.586). There were no statistically significant differences in the frequency of complications and mean hospitalization time among the groups (p > 0.05). In conclusion, this study demonstrated that flexible URS is a valuable option for the treatment of kidney stone in both obese and non-obese patients. BMI did not influence the postoperative outcomes.     

Circumcision during the phallic period: does it affect the psychosexual functions in adulthood?

The aim of this study was to elucidate whether circumcision during the phallic period (3‐to 6‐year old) has a negative impact on psychosexual functions in adulthood. Over a 6‐month period, healthy and sexually active men between 30 and 40 years without any comorbidities were involved. Participants were evaluated with detailed history, physical examination, International Index of Erectile Function (IIEF), Premature Ejaculation Diagnostic Tool (PEDT) and Beck Depression Inventory. Cases were divided into two groups according to the age at circumcision (group‐1: phallic period, group‐2: nonphallic period). Student's t‐test and Kruskall–Wallis were used for statistical analysis. Of the 321 participants, a total of 302 men were eligible for the study (group‐1: n = 135, group‐2: n = 167). No statistical difference was found between the mean total IIEF scores (group‐1: 25.1 ± 4.8, group‐2: 25.4 ± 4.6, P > 0.05). The subdomains of IIEF; erectile function, orgasm, sexual desire, intercourse satisfaction, overall satisfaction were also found to be comparable. Additionally, the PEDT scores were similar between the two groups (group‐1: 8.2 ± 4.8, group‐2: 8.7 ± 5.4, P > 0.05). Finally, Beck depression scores were also found to be comparable between the groups (group‐1: 10.8 ± 10.4, group‐2: 9.8 ± 8.9, P > 0.05). Our results suggest that circumcision during the phallic period does not negatively affect the psychosexual functions in adulthood.     

Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy

The micro-percutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that is performed through a 4.8Fr all-seeing needle. We aimed to measure the intrarenal pelvic pressure (IPP) during microperc and compare it with the levels of conventional PNL. A total of 20 patients with 1- to 3-cm renal calculi resistant to shock wave lithotripsy were treated either with microperc (Group-1, n: 10) or conventional PNL (Group-2, n: 10) by the same surgical team. The IPP was measured during different stages (entrance into the collecting system, stone fragmentation, and before termination) of the procedures by an urodynamic machine using the 6Fr ureteral catheter. All the variables were statistically compared between the two groups. The demographic values of the patients were similar. The operation time and duration of hospitalization were significantly prolonged in conventional PNL group (p = 0.034, p = 0.01, respectively). The mean drop in hematocrit levels was significantly lower in microperc group (3.5 ± 1.5 vs. 1.8 ± 0.8; p = 0.004). The IPP was significantly higher in microperc group during all steps of the procedure. The highest level of the IPP was measured as 30.3 ± 3.9 and 20.1 ± 3.1 mmHg in Group 1 and Group 2, respectively (p < 0.0001). However, the complication and success rates were found comparable. In conclusion, we demonstrate that the level of IPP is significantly increased during microperc compared to conventional PNL. Microperc should be used cautiously in cases with impaired drainage of the collecting system.