The effect of nadroparine on coagulation mechanisms: ultrastructural analysis.

Low molecular weight heparins are widely used in the prophylaxis and treatment of thrombotic disorders. The effect of low molecular weight heparins on coagulation was examined ultrastructurally in an animal model. A test and a control group was formed, each consisting of five rabbits. Nadroparine (225 Institute of Chaoy Unit/kg twice daily) was applied to the test group for 10 days. The control group received 1 ml saline solution subcutaneously. Blood and vascular tissue samples collected at the end of the 10th day were evaluated under a JEM 100 B electron microscope. Platelet degranulation and agglutination was observed in the control group. Fibrin materials were detected in the cytoplasms and surroundings of degranulated platelets. Erythrocyte accumulation was remarkable on the vascular endothelium with intact coagulation periods. In the test group, outer membranes of platelets, hyalomere, and granular structures in the granulomeres were detected to be nearly intact. There were rare erythrocytes in the large vascular lumens. The aggregation phase had occurred but no agglutination was detected. Nadroparine seems to preserve consistency of lipoprotein membranes of platelets and granular structures containing enzymes, which contribute to the coagulation mechanisms.     

Autistic disorder and 22q11.2 duplication.

Although several reports have described the co-occurrence of autism in subjects with chromosome 22 abnormalities including trisomy 22, translocation 20/22, 22q11.2 deletion, ring chromosome 22, and 22q13.3 deletion, there is no report with 22q11.2 duplication. We report a 9-year-old girl, referred to our department for her behavioural problems and language delay. She was diagnosed with autistic disorder according to DSM-IV criteria. Because of her dysmorphic characteristics comprising narrow face, narrow forehead, mandibular prognathism, synophrys, and operated cleft palate and cardiac problems, she had gone under cytogenetic analysis. Although she was ascertained as suspected velocardiofacial syndrome (VCFS), the duplication of 22q11.2 was detected by interphase fluorescence in situ hybridization. Previous reports on the psychiatric aspects of 22q11.2 duplication have shown the existence of hyperactivity, learning disability, speech problems, and aggressive behaviours but not autism. Moreover, the lack of reports of co-occurrence of autism and 22q11.2 duplication may be related to paucity as a result of technical problems.     

The interaction of the diltiazem with oral and intravenous cyclosporine in rats.

This study investigated the effect of diltiazem on the bioavailability of oral and intravenous cyclosporine (CsA) in rats. While control rats received normal saline, experimental groups received 60 or 90 mg/kg diltiazem orally for 3 days. Each group divided into 2 equal groups that received a single oral dose or i.v. injection of CsA. Pharmacokinetic parameters were analyzed by nonparametric analysis of variance. Pretreatment with 60 or 90 mg/kg diltiazem decreased the area under the blood CsA concentration-time curve (AUC) of oral CsA compared to control group (54.5% and 65.5% for AUC(0-24), 57.6% and 62.2% for AUC(0-infinity), respectively, p<0.05). Mean CsA maximum concentration (Cmax) decreased from 0.4 +/- 0.1 microg/ml to 0.1 +/- 0.0 microg/mL in rats pretreated with 90 mg/kg diltiazem (p<0.05). The absolute bioavailability after oral administration (F(p.o.)) in the 60 or 90 mg/kg diltiazem groups were lower than the control group (9.6% and 8.5% versus 22.6%). Pretreatment with 90 mg/kg but not 60 mg/kg of diltiazem increased the AUC(0-infinity), elimination half-life (t1/2) of intravenous CsA (116.0%, 219.2%, respectively, p<0.05) and decreased the intravenous CsA clearence (CL(i.v.)) (62.9%, p<0.05). Diltiazem decreased the bioavailability of oral CsA, while it increased the bioavailability of intravenous CsA. One must consider this interaction when administering oral or intravenous CsA concomitantly with diltiazem.     

Brachial plexus injury during open heart surgery--controlled prospective study

BACKGROUND: Postoperative brachial plexus injury is often reported because the brachial plexus is stretched by sternotomy and the use of sternal retractors during open heart surgery. In many studies, brachial plexus injuries have been demonstrated by postoperative electrophysiological studies in susceptible patients. In this study, we estimated the incidence, severity, and type of brachial plexus injuries by routine preoperative and postoperative electrophysiological studies of patients undergoing open heart surgery. METHODS: Patients undergoing coronary artery bypass grafting (CABG) surgery (Group 1), heart valve surgery (Group 2), or peripheral vascular surgery (Group 3) were included in the investigation. Electrophysiological studies of both upper extremities were performed five days before and three weeks after the operation. RESULTS: Peripheral nerve problems were found preoperatively in 23 of the 112 patients (21 %). These problems persisted, but similar findings were obtained postoperatively from the left upper extremities of six of the 42 CABG (14 %) and two of the 24 heart valve (8 %) patients who had had normal preoperative evaluations. The patients with injured nerves were older and had undergone longer operation times. There were no differences between the patients with injured nerves and the others with respect to mammary artery harvesting or other operative variables. CONCLUSIONS: There are no reports in the literature of routine preoperative and postoperative electrophysiological studies in large patient groups to evaluate brachial plexus injury during open heart surgery. It is known that heart surgery sometimes causes partial brachial plexus injury, especially in the lower trunk. However, these peripheral nerve problems are usually not considered clinically important and are not investigated. Patients undergoing open heart surgery must be closely followed up for peripheral nerve injury during the postoperative period.     

Plasma microRNA levels in childhood IgA vasculitis

Clinical Rheumatology - Immunoglobulin A vasculitis (IgAV) is the most common form of childhood systemic vasculitis. It is mostly self-limiting and characterized by skin, joint, gastrointestinal...     

Experimental study of rapid versus slow sagittal sinus occlusion in dogs

BACKGROUND: Clinical, radiological, postmortem and experimental studies are not enough for the definition of pathophysiological differences between rapid and slow-progressing cerebral venous system obstruction. AIMS: An experimental study was conducted to set some physiopathological differences between rapid and slow occlusion of the superior sagittal sinus. SETTINGS AND DESIGN: Eighteen dogs categorized into 3 groups were chosen as test subjects. The three groups were the rapid occlusion, slow occlusion and the control study groups and each group had six subjects. MATERIAL AND METHODS: Intracranial pressure values, histopathological findings, and the degree of cerebral edema formation, estimated by measuring the water content ratio of the brain and the angiographic results in the 2 different groups of subjects that underwent rapid and slow superior sagittal sinus obstruction were compared with that of the control subjects. STATISTICAL ANALYSIS: Statistical analysis was performed using GraphPad Prisma V.3 statistical software. Variables of the 3 groups were compared using non-parametric Kruskal Wallis ANOVA test and multiple comparisons were made using Dunn's multiple test. The comparison of initial and terminal intracranial pressure values obtained before and after the sinus occlusion, was made using the Wilcoxon test. A probability value of less than 0.05 was regarded as significant. RESULTS AND CONCLUSIONS: Comparison of the water content ratio of the brain in the 3 groups, the difference between the initial and terminal intracranial pressure values of the rapid occlusion study group, and the difference between the terminal intracranial pressure values of the 3 groups was statistically significant (P<0.05). Dunn's Multiple Comparison Test yielded significant differences in the water content ratio of the brain and in the intracranial pressure values between the rapid occlusion study group and the control group (P<0.05). Moreover, histopathological and radiological examination disclosed more prominent brain edema findings, and less apparent collateral venous flow in the rapid occlusion study group than in the slow occlusion one. To conclude, the clinical severity of sinus occlusion seems directly related to the quickness of the occlusion and the capacity of the collateral venous system.     

False aneurysm of perforating branch of the profunda femoris artery after external fixation for a complicated femur fracture

False aneurysm of the profunda femoris artery rarely occurs and is a serious complication following femur fracture. A 39-year-old man who developed a false aneurysm arising from the perforating branch of the profunda femoris artery following an external fixation for a complicated femur fracture was presented. Clinical diagnosis was confirmed by selective arterial angiography after occurrence of significant hemorrhage and swelling of the injured thigh. The false aneurysm was treated by ligation of the perforating branch of the profunda femoris artery and excision of the aneurysmal sac via the medial approach. Clinical status of the patient was uneventful postoperatively. The right thigh swelling decreased rapidly following the operation in 1 week. The patient was discharged on the 10th postoperative day with external fixation. False aneurysm in a branch of the profunda femoris artery is a very rare status following application of the external fixator due to complicated femur fracture. Related literatures and interventions were reviewed on the basis of this case.     

The value of the TIMI frame count method in the diagnosis of coronary no-reflow: a comparison with myocardial perfusion SPECT in patients with acute myocardial infarction

The state of no-reflow (i.e. inadequate myocardial tissue perfusion despite normal arterial flow proven in angiography after pharmacological or mechanical interventions) is considered to be a marker of a poor prognosis. Although the Thrombolysis in Myocardial Infarction (TIMI) flow grade is a valuable and widely used qualitative measure in angiography trials, it is limited by its subjective and categorical nature. Recently, the TIMI frame count method (TFC) was proposed for detecting no-reflow. In our study we aimed to compare TFC values with myocardial perfusion single photon emission computed tomography (SPECT) findings to investigate the additional role of the former method in the evaluation of no-reflow. Twenty patients (16 men and four women; mean age 58+/-9 years) with first acute myocardial infarction were included in the study after thrombolytic therapy. Coronary angiography (CAG) was performed 5-7 days later. The TIMI flow grade and TFC values were determined in angiography examinations. A TIMI flow of less than grade 3 and a TFC value >27 were considered to be pathologically decreased for coronary artery blood flow. Tc tetrofosmin myocardial rest SPECT was carried out 24 h after coronary angiography. SPECT images were scored on a four-point scale in 20 myocardial segments and the total defect score was calculated from the sum of defect scores in 20 segments. Wall motion was assessed using the wall motion score index in echocardiography (ECWSI). The occurrence rates of angiographic no-reflow, pathological TFC and perfusion defects in SPECT were calculated as 40% (8/20), 47% (8/17; non-measurable in three patients with TIMI grade 0), and 55% (11/20), respectively. Perfusion defects were present and the TIMI frame count value was increased in all patients with angiographic no-reflow (TIMI grade <3). The occurrence rate of perfusion defects and increased TFC was equal (42%) in all 12 patients having TIMI grade 3 flow. Increased TFC was demonstrated in four of five patients having perfusion defects and TIMI grade 3 flow (80% compatibility with SPECT). TIMI frame count and ECWSI values were significantly higher in patients having perfusion defects than in patients with normal perfusion ( <0.05). It is concluded that the TIMI frame count is a valuable method in the detection of patients with TIMI grade 3 flow, with no-reflow, and increases the specificity of coronary angiography in the evaluation of the response to thrombolytic therapy. A pathologically increased TFC value with TIMI grade 3 flow during CAG seems to be a good indication for the use of myocardial perfusion SPECT in the definitive diagnosis and/or follow-up of such patients.