Excimer laser coronary angioplasty after primary unsuccessful PTCA]

Excimer laser coronary angioplasty is a new technique for ablation of coronary stenosis, however, the indications for its application are still controversial. We describe two male patients, 60 and 65 years old, who underwent unsuccessful balloon PTCA with a short, concentric and calcified coronary stenosis, although balloon inflation pressure was increased to a maximum in both cases. Excimer laser angioplasty following the failed procedures showed no evidence for tissue ablation angiographically, but a repeat attempt with balloon angioplasty was successful in both cases. Thus, laser angioplasty may be considered as an adjunct technique to balloon angioplasty after a failed PTCA in resistant, non-inflatable lesions.     

Effect of body position on tongue posture in awake patients with obstructive sleep apnoea

BACKGROUND: Snoring and obstructive sleep apnoea (OSA) are worse or may only occur in the supine position. The effect of body position on upper airway size has been reported, but the effect on tongue posture has not previously been examined. METHODS: Detailed measurements were made of tongue posture from upright and supine lateral cephalograms on 24 men with OSA and 13 men with non-apnoeic snoring matched for age, body mass index, and craniofacial skeletal pattern. Patients with OSA had apnoea/hypopnoea indices (AHI) of > 50/hour and/or apnoea indices (AI) of > 25/hour while non-apnoeic snorers had AHI of < 10/hour and AI of < 5/hour. RESULTS: In non-apnoeic snorers the tongue depth measurements for the superior-posterior portion of the tongue were larger in the supine than in the upright position (p < 0.05). There was no significant difference in tongue depth measurements between the upright and the supine position in the patients with OSA. CONCLUSIONS: When awake patients with OSA move from the upright to the supine position they maintain their upright tongue posture which may tend to protect against upper airway collapse secondary to the increased gravitational load on the tongue. In contrast, when awake non-apnoeic snorers move from the upright to the supine position a significant dorsal movement in the superior-posterior portion of the tongue is observed.


     

Evaluation of leukocyte arylsulphatase a, serum interleukin-6 and urinary heparan sulphate following tamoxifen therapy in breast cancer.

Leukocyte arylsulphatase A (AS-A) was shown to be significantly high in newly-diagnosed breast cancer patients. Previous reports imply a connection between serum interleukin-6 (IL-6) and breast cancer, possibly through a modulation of enzymes involved in estrogen synthesis. Abnormal distribution of heparan sulphate proteoglycans (HSPGs) in malignant breast epithelial cells suggests that they play a key role in the regulation of cell growth. Estradiol is believed to be effective in modulating glycosaminoglycans (GAGs) and their depolymerizing enzymes. Therefore, in this study, attempts were made to evaluate the activity of leukocyte arylsulphatase A, serum interleukin-6, urinary GAGs and heparan sulphate (HS) in response to tamoxifen (TAM) therapy in mastectomised breast cancer patients. Thirty-four patients (aged 30-82 years) were administered TAM (20 mg twice daily). Blood and urine samples of each patient were collected three times (at the beginning, and in third and sixth month of TAM therapy), and biochemical parameters were measured. There was no difference between baseline leukocyte AS-A activity and that measured after three months. At the end of six months, enzyme activity was significantly higher than the former values (p=0.022), but within the reference intervals reported in the literature. Although this increase might imply a normalization, the duration of TAM therapy is not long enough to make a decision about either regression or aggravation of the disease. TAM did not have any effect on serum IL-6, urinary HS and GAG levels which may be due to insensitivity of these variables to TAM during the short period of therapy. Both urinary GAG and HS levels measured at sixth month exhibited a positive correlation with the baseline level of leukocyte AS-A (p=0.005 and 0.009, respectively), suggesting that positive responses to the drug might be seen in patients with low AS-A activity.     

Intracoronary shunt reduces postoperative troponin leaks: a prospective randomized study.

OBJECTIVE: The purpose of this study was to evaluate whether intracoronary shunt usage reduced the myocardial damage on the basis of the cardiac markers when compared with the shuntless anastomosis in off-pump coronary artery bypass grafting (OPCABG) surgery of isolated left anterior descending artery lesions. METHODS: Forty patients who had stable angina with isolated left anterior descending (LAD) coronary artery lesion undergoing OPCABG surgery were randomized into two groups. Shunt group consisted of 20 patients who had OPCABG using intracoronary shunt, whereas the shuntless group consisted of 20 patients who underwent OPCABG without using intracoronary shunt. Cardiac troponin I, CK, and CK-MB before and 24h after the surgery were assessed in the groups. RESULTS: There were no deaths in the study. The two groups were similar with respect to sex and age. Duration of LIMA-LAD anastomosis was significantly higher in the shunt group (p=0.01). There was no significant difference between the groups concerning the preoperative and postoperative CK and CK-MB levels. The preoperative troponin I levels of the groups were not different (p=0.238; NS), whereas postoperative levels of this marker was significantly higher in the shuntless group (p=0.003). CONCLUSION: Intracoronary shunt reduced the postoperative troponin I levels significantly, so it may be indicated in the patients who are thought to be susceptible to transient ischemia.     

Season of birth and fluctuating asymmetry.

Fluctuating asymmetry (FA) refers to random, small deviations from perfect bilateral symmetry in morphological traits. These minor deviations from the ideal phenotype reflect environmental and genetic perturbations experienced during ontogeny. FA has been associated with negative health outcomes and many developmental disorders in humans. The prevalence of developmental disorders and adult health vary according to the month of birth, suggesting that seasonal stressors may leave enduring signs in the adult body, marked by high FA. The current study examined the relationship between FA and birth season. Data were collected for 205 males and females (average age = 20.39 years) on FA of 10 bilateral traits (second, third, fourth, and fifth digit length, palm height, wrist diameter, elbow width, ear height, foot breadth, and ankle circumference). Additional relationships were also investigated among FA, testosterone (T), and birth order. Results indicate that ear FA was lower for fall births compared to winter births in males. In females, palm FA was lower for fall births compared to those of the spring. FA of the digits was positively associated with T in males. Average FA, excluding the digits, decreased as the number of maternal siblings increased for both sexes. T concentrations in males were positively associated with the number of younger brothers. Our results generally confirm previous research on seasonal variation in adult longevity and neurological and psychiatric disorders, suggesting that winter and spring births are at risk for asymmetric developmental trajectory.     

Sequence analysis of rpoB mutations in rifampin-resistant clinical Mycobacterium tuberculosis isolates from Turkey

Drug-resistant tuberculosis is a serious problem throughout the world. Resistance to Rifampicin (RIF) is mainly caused by the mutations in the rpoB gene coding the beta-subunit of RNA polymerase. In this study, we aimed to detect the distribution of rpoB gene mutations in 80 RIF-resistant clinical Mycobacterium tuberculosis (MTB) isolates from Turkey. The rpoB gene was amplified by PCR and mutations leading to RIF resistance were determined by automated sequence analysis. A total of 72 of the 80 isolates (90%) were found to carry mutations in the amplified region, whereas eight isolates (10%) carried no mutations. Overall, 24 different missense mutations affecting 14 codons, and two deletion mutants were identified. Nine new mutations, six in the hot-spot region and three outside this region, were found. The codon numbers of the most frequently encountered mutations were 531 (51.4%), 526 (18.1%), 516 (13.9%), and 513 (12.5%). As a result, 90% of the RIF-resistant MTB isolates from the Turkish patients were found to carry a mutation in the rpoB gene, Ser531Leu being the most frequent one. Although molecular methods identify mutations leading to RIF resistance very quickly, results of the antimycobacterial susceptibility tests must be taken into consideration for the patients carrying no mutations in this region.     

The role of cartilage canals in endochondral and perichondral bone formation: are there similarities between these two processes?

We investigated the development of cartilage canals to clarify their function in the process of bone formation. Cartilage canals are tubes containing vessels that are found in the hyaline cartilage prior to the formation of a secondary ossification centre (SOC). Their exact role is still controversial and it is unclear whether they contribute to endochondral bone formation when an SOC appears. We examined the cartilage canals of the chicken femur in different developmental stages (E20, D2, 5, 7, 8, 10 and 13). To obtain a detailed picture of the cellular and molecular events within and around the canals the femur was investigated by means of three-dimensional reconstruction, light microscopy, electron microscopy, histochemistry and immunohistochemistry [vascular endothelial growth factor (VEGF), type I and II collagen]. An SOC was visible for the first time on the last embryonic day (E20). Cartilage canals were an extension of the vascularized perichondrium and its mesenchymal stem cell layers into the hyaline cartilage. The canals formed a complex network within the epiphysis and some of them penetrated into the SOC were they ended blind. The growth of the canals into the SOC was promoted by VEGF. As the development progressed the SOC increased in size and adjacent canals were incorporated into it. The canals contained chondroclasts, which opened the lacunae of hypertrophic chondrocytes, and this was followed by invasion of mesenchymal cells into the empty lacunae and formation of an osteoid layer. In older stages this layer mineralized and increased in thickness by addition of further cells. Outside the SOC cartilage canals are surrounded by osteoid, which is formed by the process of perichondral bone formation. We conclude that cartilage canals contribute to both perichondral and endochondral bone formation and that osteoblasts have the same origin in both processes.     

Long-term use and tolerability of cyclooxygenase-2 inhibitors in patients with analgesic intolerance.

BACKGROUND: Cyclooxygenase-2 (COX-2) inhibitors are reported to be well tolerated in patients with analgesic intolerance (AI). However, limited data are available about the long-term tolerability of these drugs. OBJECTIVE: To determine the long-term tolerability of COX-2 inhibitors in patients with Al. METHODS: Patients with AI who previously underwent single-masked, placebo-controlled oral provocation tests and were found to tolerate nimesulide, meloxicam, rofecoxib, or celecoxib were interviewed regarding the long-term use and tolerability of these drugs. RESULTS: Of 87 patients, 61 (70%) had used the recommended COX-2 inhibitor(s). Of the 61 users, 54 (89%) tolerated the drug(s) well and 7 (11%) reported adverse events. Three patients reporting adverse events were rechallenged with the responsible COX-2 inhibitor, and their results were found to be negative. CONCLUSIONS: Long-term use of COX-2 inhibitors was tolerated well by most patients with AI, and placebo-controlled oral provocation tests, as a single test, seemed to predict tolerability. Furthermore, self-reported positive reactions in the long-term should also be confirmed with rechallenge tests for definite diagnosis.