Search

Objectives We aimed to evaluate PON1 QR192 polymorphism’s (rs662) effects on levels of triglyceride, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, glucose, and c-reactive protein, and paraoxonase-arylesterase activities among deep vein thrombosis patients and healthy subjects. Methods Forty-five deep vein thrombosis patients and 45 healthy subjects participated in the study. Genetic analysis was performed by using polymerase chain reaction and sequencing. Paraoxonase and arylesterase enzyme activities were determined by a spectrophotometer. Serum levels of triglyceride, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, glucose, and c-reactive protein were measured by a similar method. Results There were no statistically significant differences between patients and controls regarding the frequency of variant allele for the PON1 QR192 polymorphism, activities of paraoxonase-arylesterase, and level of high-density lipoprotein-cholesterol. Triglyceride, total cholesterol, low-density lipoprotein-cholesterol, glucose, and c-reactive protein levels were significantly higher in patients compared to controls (p values were 0.005, 0.0002, 0.009, 0.0009, PON1 QR192 genetic polymorphism (pPON1 QR192 polymorphism with arylesterase activity and, levels of triglyceride, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, glucose, and c-reactive protein. Conclusions There was no statistically significant difference between deep vein thrombosis patients and healthy subjects regarding variant allele frequency for the PON1 QR192 genetic polymorphism. In addition, paraoxonase and arylesterase activities were similar among the groups. These results indicate that PON1 QR192 genetic polymorphism and activity levels of paraoxonase-arylesterase have no effect on the development of deep vein thrombosis.

Venous insufficiency and deep vein thrombosis (DVT) are the main venous system diseases. Although deep vein thrombosis (DVT) can lead to serious complications and even death, it is a treatable disease. Today, both DVT and pulmonary embolism (PE) are referred to by the common name of venous thromboembolism (VTE). Although COVID-19 mainly affects the respiratory system, it also tends to damage many organs and develop VTE due to its prothrombotic course. In patients recovering from COVID-19, the venous system is adversely affected due to the prothrombotic course of the disease and immobility. In our study, venous system diseases and their treatments after COVID-19 disease were reviewed. Thirty of the patients who applied to our hospital with the preliminary diagnosis of venous insufficiency after recovering from COVID-19 were included in our study. The physical examination findings and laboratory parameters of the patients were retrospectively reviewed. In all cases, besides routine laboratory tests, radiological and vascular Doppler ultrasonographic examinations were also performed. Of the 30 patients included in the study, 11 (36.6%) were male and 19 (63.3%) were female. Their ages ranged from 30 to 79 years, with a mean age of 59.4±12.77 years. Venous insufficiency was detected in all patients in venous Doppler ultrasonographic examination. In addition, DVT was also detected in four cases. Fifteen (50%) of our patients were hypertensive. Diabetes mellitus was also present in five of the hypertensive patients. Combined diosmin and hesperidin treatment may be preferred in cases of venous insufficiency developing after COVID-19. Since no adverse effects of warfarin have been observed in severe COVID-19 disease, it can be used safely in DVT cases that develop after the treatment of COVID19.

Livedo reticularis (LR) is a hyperpigmented discoloration of the skin characterized by a violet, reticulated cyanotic pattern, and is more common on the extremities and trunk. LR is in the form of intact circular networks. If the circular reticulated appearance is distorted and shows an irregular fracture pattern, it is defined as livedo racemosa (LRC). LR is a benign, primary disease that affects young and middle-aged women. LRC, on the other hand, is a secondary disease, pathological and permanent. In LR, the vivid cone discoloration is symmetrical, reversible, and uniform. In LRC, the vivid cone discoloration is irreversible, and fractured. Although it has been stated as a concept that the pathological livedoid form is LCR, there is no clear distinction between LR and LRC in clinical studies and generally 'livedo reticularis' is used to describe both. Our study includes eight patients diagnosed with livedo reticularis between January 2013 and May 2021. One of our patients was male and the other was female. Their ages ranged from 25 to 70 years and the mean age was 45.5±16.7 years. Although the main complaints were coldness, numbness and pain, aesthetic anxiety was prominent in all patients. On physical examination, violet-colored fishing net-like appearances were noted on the lower extremities of all patients. It was accompanied by venous insufficiency in six of the patients. As a result of the treatment we applied, there was improvement in venous insufficiency. However, as a result of the vasodilator treatment we applied for cosmological purposes, there was no obvious improvement in the reticulated appearances. Because of the risk of developing neurovascular and cardiovascular complications several years after the onset of livedoid vasculopathy, it is important to monitor these patients. Considering that LR may be seen before pulmonary symptoms during the COVID-19 pandemic period, necessary tests should be performed to rule out the diagnosis of COVID-19 in these cases.

GİRİŞ: Willis-Ekbom hastalığı da denilen huzursuz bacak sendromu (HBS), istirahatta kötüleşen ve bacak hareketleriyle hafifleyen semptomlarla karakterizedir Çoğu durumda, HBS sadece uykuya dalma veya uykuya devam etme için büyük bir engel olarak tanımlanır ve öncelikle bir "uyku bozukluğu" olarak sınıflandırılır. Geniş bir sunum yelpazesine sahip olan HBS’nun uzun süredir devam eden araştırmalara rağmen etiyolojisi ve patofizyolojisi henüz yeterince anlaşılmamıştır. Çalışmamızın amacı venöz yetmezlik ile HBS arasındaki ilişkiyi incelemektir. HASTALAR VE METOT: Pandemi döneminde venöz yetmezlik ve HBS tanısı konulan 20 hasta çalışma kapsamına alındı. HBS tanısı uluslararası HBS çalışma grubu (IRLSSG) kriterlerine göre kondu. Rutin laboratuvar ve vasküler Doppler ultrasonografik incelemelerin yanı sıra vitamin D, vitamin B12, magnezyum ve folat düzeyleri de ölçüldü. BULGULAR: Çalışma kapsamına giren 7 (%35) erkek ve 13 (%65) kadın hasta vardı. Yaşları 28 ile 84 arasında değişmekte ve ortalama yaş ise 58.9±15.9 yıldı. Birisi hariç tüm hastalarda D vitamini düzeyleri normalin altındaydı. Erkek hastalarda ortalama D vitamini düzeyi 14.9±6.1 ng/mL, kadın hastalardaysa 11.8± 9.2 ng/mL idi ve aradaki fark istatistiksel olarak anlamlıydı (p

lntroduction : lsolated venous aneurysm is defineci as an focal vascular dilatation thatcommunicates with normal size venou s stru cture through a single channel, and it should not haveany association with an arteriovenous communication ora pseudoaneurysm. Venous aneurysms may rarelybethrombosed. Here we present a female patientwith thrombosed venous aneurysm of the smallsaphenous vein.Case Report: A 49 year-old woman was admitted to our hospital with complaints ofa growing mass atthe left popliteal region during the last 18 months. Physical examination revealed a firmsubcutaneous mass on the left popliteal region. Color tlow duplex imaging (CFDI) confirmedthrombosed saccular venous aneurysm of the small saphenous vein extending to the saphenopoplitealjunction (SPJ) t h at measured approximately 3.2 cm in diameter. Surgical intervent ion wasperformed under spinal anesthesia . The aneurismal mass was relatively thin walled and was occludedby blood clot. Her postoperative course was uneventful and her symptoms resolved. Histologi cfindings were consistent withvenous aneurysm.Conclusion: in order to prevent the risk of deep venous thrombosis and even pulmonary embolism, wethink that thrombosed venous aneurysms close to the saphenopoplitealjunction should be operatedwithout delay.

Hipertansiyon dünya genelinde kardiyovasküler hastalıklar için modifiye edilebilen önemli bir risk faktörü olup, kardiyovasküler hastalık ile hipertansiyon arasında lineer bir ilişki vardır. Hipertansiyon kardiyovasküler sistemi ve hedef organları sinsice ve gittikçe artan derecede harap ederek, önemli komplikasyonlara ve ölüme yol açabilir. Bu yüzden ömür boyu tedavi edilmesi gereken ciddi bir rahatsızlıktır. Hipertansiflerde obeziteye sık rastlanır. Sağlıklı beslenme ile kilo kaybının serum glikoz ve lipit düzeyleri üzerine olumlu etkileri olduğu bilinmektedir. Klinik çalışmalar sağlıklı besinlerin kardiyometabolik parametreler üzerinde yararlı etkileri olduğunu göstermiştir. Sigaranın bırakılması, stresten uzak durulması, alkol alımının terk edilmesi, tuz alımının azaltılması, sebze ve meyve tüketiminin arttırılması, doymuş ve toplam yağ alımının azaltılması, fiziksel aktivitenin arttırılması ve vücut ağırlığının kontrolü gibi yaşam tarzı değişiklikleri hipertansiyon tedavisinin önemli komponentleridir. Bu yaşam tarzı değişiklikleri hipertansif hastalarda ilaç tedavisiyle birlikte uygulanmalıdır. Ayrıca, biyokimyasal parametreler de düzenli olarak izlenmelidir.

Background: Factor V Leiden (FVL), prothrombin gene (PT G20210A), and methylenetetrahydrofolate reductase (MTHFR) C677T mutations are known as molecular biomarkers to evaluate the predisposition of deep venous thrombosis (DVT). These hereditary risk factors affect the natural anticoagulant mechanisms and activate the coagulation mechanisms because of an imbalance between procoagulant and anticoagulant factors. Our study aimed to determine the prevalence of these mutations in Turkish patients presenting with idiopathic DVT. Methods: A total of 135 patients with idiopathic DVT admitted to our clinic were investigated for FVL, PT G20210A, and MTHFR (C677T, A1298C) gene mutations. Screening of polymorphisms was carried out by using SNaPshot® multiplex system (Applied Biosystems Inc.). Wild, heterozygous and homozygous genotypic distributions of these mutations were defined as number and percentage frequency. Results: There were 74 male and 61 female patients ranging in age from 18 to 85 years. FVL mutation was found in 66 (41.47%) patients (12 homozygotes 8.88%, 44 heterozygotes 32.59%), PT G20210A was found in 14 (10.36%) patients (1 homozygous 0.74%, 13 heterozygotes 9.62%). MTHFR C677T was found in 53 (39.25%) patients (10 homozygotes 7.40%, 43 heterozygotes 31.85%), and MTHFR A1298C was found in 84 (62.22%) patients (16 homozygotes 11.85%, 68 heterozygotes 50.37%).

Objectives . Coronary artery disease (CAD) is the leading cause of mortality in the world. It is a complex disorder resulting from the interaction between environmental risk factors and hereditary predisposition. The role of the factor V Leiden (FVL), protrombin gene (PT G20210A) and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphisms in the development of CAD is controversial. In this study, we investigated the incidence of these polymorphisms in order to delineate their roles in the development of CAD in a tertiary University hospital. Methods. This study included 58 consecutive CAD patients. Diabetic and hypertensive patients were excluded. FVL, PT G20210A, and MTHFR (C677T, A1298C) mutations were investigated in all patients. Polymerase chain reaction and the amplification refractory mutation system were used to identify these polymorphisms. Results. Thirty-six men and 22 women were enrolled with an age ranging between 41 to 85 (mean age: 62.75±9.18 years). The heterozygous PT G20210A genotype was identified in 5 (8.6%) patients (2 males, 3 females). The heterozygous FVL genotype was found in 8 (13.8%) patients (6 males and 2 females). The incidence of homozygous MTHFR C677T and homozygous MTHFR A1298 carriers was found to be 17.2% and 8.6%, respectively. There were no significant differences in the distribution of polymorphisms according to gender ( p >0.05). Conclusions. The FVL and PT G20210A polymorphisms most likely play a contributory role in the development of CAD. In contrast, the MTHFR C677T and MTHFR A1298C genotypes were not associated with a predisposition to the development of CAD. However, in compound MTHFR C677T/A1298C carriers, the presence of FVL or PT G20210 polymorphism may contribute the development of CAD. Further studies are needed to support these findings.

Aim: Bone disorders such as osteopenia or osteoporosis are the most common clinical manifestations seen in sickle cell disease (SCD) with a high of morbidity. There are many reasons, including vitamin D deficiency for the appearance of bone problems. In the present study we aimed to evaluate osteopathy in patients with SCD using bone mineral densitometry (BMD) and biochemical indices. Material and Method: 61 patients (29 female, 32 male) were included in the study. The age, gender, and biochemical parameters with BMD were evaluated using dual energy X-ray absorptiometry from lumbar vertebrae. According to Z scores, [-2] was considered as osteoporosis. Multivariate analysis was performed to determine the factors influencing BMD. Results: There were a total of 61 SCD patients. The average age was 21.06±5.06 (15-27) years and the mean BMI was 19.15±2.98 kg/m2. 23 patients were osteopenic (11 female, 12 male) (37.7%) and 26 were osteoporotic (12 female, 13 male) (44.3%). Twelve patients (6 female and 6 male) (18%) had normal Z scores. Vitamin D was found severely deficient (

Background: Obesity is associated with many risk factors, such as hyperlipidemia, hyperinsulinemia, hypertension and leads to early atherosclerosis. The aim of this study was to investigate the relation of the mean platelet volume (MPV) and the carotid intima media thickness (CIMT) on cardiac functions among obese children. Materials and Methods: Sixty obese children, with body mass index percentile were >95% and forty eight healthy controls were enrolled in the study. Triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), thyroid function tests, hemoglobin, white blood cell, MPV and insulin resistance were evaluated. CIMT was measured by using high-resolution ultrasound and echocardiography was performed to all individuals. Results: MPV and CIMT values were found significantly higher in obese children than controls. There was positive correlation between CIMT and age, body surface area (BSA), systolic and diastolic blood pressure, left ventricular meridional end-systolic wall stress (ESWSm), myocardial fiber stress (MFS), stroke volume (SV) and insulin and negative correlation with left ventricle end-systolic elastance by single beat technique (Ees(sb)) and arterial elastance (Ea). There was no correlation between LVM, cardiac risk profiles and CIMT. Multiple stepwise regression analyses revealed that ESWSm (β=0.337, P=0.049) was only independent factor on CIMT. MPV values showed negative correlation with ALT, AST, Free T4, thyroid stimulating hormone and positive correlation with age and BSA. Conclusion: Current study showed that obesity has an independent impact on CIMT and MPV values in children. Increased CIMT in obese children leads significant increase in ESWSm and decrease in Ea and Ees(sb).

Kardiyak cerrahi sonrası postoperatif hiperbilirubineminin sıklığı ve paterni ile komlikasyonları iyi tanımlanmamıştır. Karaciğer disfonksiyonuna bağlı postoperatif hiperbilirubinemi, artan morbidite ve mortalite ile ilişkili olabilir. Biz burada koroner arter bypass cerrahisi sonrası yapılan ekokardiyografide sağ ventrikül kollapsı ve perikardiyal hematom saptanan ve hematom boşaltılması sonucu hemodinamik tablosu düzelen hastayı sunduk. Hastanın total ve direkt bilirubin seviyeleri reoperasyonun birinci gününde, sırasıyla 8,3 mg/dl ve 2,3 mg/dl ye yükseldi. Takipte altıncı günde bilirubin seviyesi maksimum 23.1 mg/dl’ye çıktı. Ultrasonografide hepatik doku ve bilirubin kanalları normal olarak değerlendirildi. Alanin aminotransferaz (ALT), aspartat aminotransferaz (AST) ve gama glutamil transferaz (GGT) gibi hepatik fonksiyon testleri normal olan hastaya spesifik bir tedavi verilmeden hiperbilirubinemi normal değerlere geriledi., The pattern and frequency of hyperbilirubinemia after cardiac surgery and its effect on postoperative complications are not well described. Postoperative hyperbilirubinemia due to liver dysfunction may be associated with increased morbidity and mortality. We present a 60-year-old male patient that we detected pericardial hematoma and collapsed right ventricle after the coronary artery bypass surgery. Patient’s clinical status was improved after the operation for evacuating hematoma. Total bilirubin and direct bilirubin levels of patient were increased up to 8,3 mg/dl and 2,3 mg/dl respectively in the first day of re-operation. In follow up, bilirubin level reached to a maximum level of 23.1 mg/dl on sixth day. In ultrasonography hepatic tissue and bilirubin tract were normal. Hepatic function tests except bilirubin such as alanin aminotransferaz (ALT), aspartat aminotransferaz (AST) and gama glutamil transferaz (GGT) were in normal level. Hyperbilirubinemia resolved spontaneously without any specific treatment.

Objectives: Hyperhomocysteinemia has been considered as a potential risk factor for deep venous thrombosis (DVT) but it is still controversy. We aimed to evaluate the prevalence of hyperhomocysteinemia in patients with DVT . Our second objective was to document the prevalence of folate, Vitamin B6, and Vitamin B12 level in this patient population. Methods: Sixty patients with DVT aged from 23 to 84 years, were assessed regarding demographic characteristics, serum levels of homocysteine, folate, vitamin B12, and vitamin B6. The diagnosis of DVT was based upon Wells scoring system and serum D-dimer level and confirmed by deep venous Doppler ultrasonography of the lower limbs. Results: Mean serum homocysteine levels were found significantly higher in patients over the age of 40 years (10.81±4.26 µmol/L vs 9.13±3.23 µmol/L). Of all the patients, 9 patients had homocysteine level above the 15µmol/L, 26 had folic acid level below 3 ng/ml, one had vitamin B12 level below 150 pmol/L, and two had vitamin B6 level below 30 nmol/L. In the hyperhomocysteinemic group, five patients had low folic acid level, one had low vitamin B12 level, and two had low vitamin B6 level. Conclusions: Hyperhomocysteinemia, in women older than 40 years, may be a risk factor for DVT. Folic acid deficiency may also influence serum homocysteine concentrations. Folate therapy may be offered to the patients with DVT. However further studies are required to clarify the underlying molecular mechanisms.

Objectives: Purulent pericarditis is a collection of purulent effusion in the pericardial space. It has become a rare entity with the increased availability and use of antibiotics. In contrast to pleural empyema, there are few data regarding the biochemical parameters of purulent pericardial effusion to aid diagnosis. Therefore, in this study, we have evaluated the diagnostic utility of biochemical tests in patients with purulent pericarditis. Methods: Between September 2004 and September 2012, we treated fifteen children with purulent pericarditis and tamponade. There were 8 boys and 7 girls, ranging in age from 8 months to 14 years, with a mean age of 5.3 ± 3.2 years. Echocardiographic diagnosis of cardiac tamponade was made in all patients. All patients underwent immediate surgical drainage due to cardiac tamponade. The diagnosis of purulent pericarditis was supported by biochemical tests. Anterior mini-thoracotomy or subxiphoid approach was performed for surgical drainage. Results: The most common clinical findings were tamponade, hepatomegaly, tachycardia, fever refractory antibiotic therapy, dyspnea, tachypnea, cough, and increased jugular venous pressure. Central venous pressure decreased and arterial tension increased immediately after the evacuation of purulent effusion during operation in all patients. The pericardial effusion had high lactic dehydrogenase, and low glucose concentration, confirming purulent pericarditis. Also, pH (mean± SD) was 7.01 ± 0.06. The culture of pericardial effusions and blood samples were negative. Conclusion: Biochemical tests are useful guideline when assessing the pericardial effusions. However, these tests should be interpreted with the clinical and operative findings.

Diabetes insipidus (DI) results from inadequate output of Antidiuretic Hormone (ADH) from the pituitary gland (central DI) or the inability of the kidney tubules to respond to ADH (nephrogenic DI). ADH is an octapeptide produced in the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior lobe of the pituitary gland. Cardiopulmonary Bypass (CPB) has been shown to cause a six-fold increased circulating ADH levels 12 hours after surgery. However, in some cases, ADH release may be transiently suppressed due to cardioplegia (cardiac standstill) or CPB leading to DI. We present the postoperative course of a 60-year-old man who developed transient DI after CPB. He was successfully treated by applying nasal desmopressin therapy. Relevant biochemical parameters should be monitored closely in patients who produce excessive urine after open heart surgery.

Hydatid disease is a parasitic infestation frequently seen in sheep- and cattle-raising areas of the world, and has been known since the time of Galen and Hippocrates. We retrospectively evaluated patients who underwent surgery in our department due to complicated giant intrathoracic hydatid cysts.Twenty patients with complicated giant intrathoracic hydatid cysts were operated on between May 2001 and May 2007 in our department. There were 14 male and 6 female patients, with an age range from 10 to 47 years (mean 23.7+/-11.2 years).The most common symptoms were cough, chest pain, fever, and dyspnea. The most common physical finding was decreased breathing sounds at the affected hemi-thorax. There were signs of cyst perforation of the bronchial space in 14 patients. The cysts were ruptured to the pleural space in 5 patients, with pleural effusion or localized empyema; 4 of them required decortication due to air trapping in the lung. The cyst was found to be intact but infected in 1 patient with cardiac cyst. Cystotomy plus capitonnage was the most frequently used surgical procedure, which was performed in 18 patients, while lobectomy was performed in 1 patient, and left ventriculotomy plus cystotomy plus capitonnage was performed in 1 patient.All thoracic hydatid cysts should be operated on as soon as they are diagnosed in order to avoid complications, and surgery should be as conservative as possible. Since preoperative medical therapy can lead to perforation, additional adjuvant medical therapy should only be administered postoperatively to avoid recurrences.

Background: Obesity has a risk factor for sudden cardiac death, because of the tendency to develop arrhythmias. Delay in cardiac repolarization is reflected as QTc prolongation on electrocardiogram. The aim of this study was to investigate QTc interval in obese children and assess the relation between cardiac risk factors and QTc interval. Materials and Methods: Forty five obese children whose body mass index (BMI) persentil was > % 95th and eighty seven control group were enrolled in this study. QTc was derived using Bazett’s Formula. Results: Mean QTc value was found significantly longer in obese children (413.89±23.27ms) than control group (398.95±24.28ms) (p= 0,001) and also prolonged QTc frequency was more than six times in obese (% 15.6) than control group (%2.4). BMI, systolic and diastolic BP, total cholesterol, triglyceride, low-density lipoprotein (LDL), fasting glucose, insulin, left ventricular mass (LVM) and carotid intima media thickness (CIMT) were significantly higher and high-density lipoprotein (HDL) levels and HOMA-IR values were lower in obese group compared with the controls. There was no correlation between QTc, metabolic parameters, systolic and diastolic BP, BMI, LVM and CIMT in obese group. Conclusion: QTc prolongation can be seen more common in obese children and may result in sudden death. So obese children must be followed closely regarding QTc interval.

Background We hypothesized that since asthma is a chronic inflammatory disease, it could lead to the early development of atherosclerosis in childhood-onset asthma. The aim of this study was to investigate arterial stiffness, distensibility, and strain of different peripheral arteries, the parameters of which can be used to detect atherosclerosis in asthmatic children. Material/methods We studied 22 pediatric patients with asthma and 18 healthy children. Fasting blood glucose and cholesterol levels were evaluated to exclude children with diabetes and hyperlipidemia, which are risk factors for atherosclerosis. Renal, carotid, and brachial arteries diameters were measured. Using the measured data, stiffness, distensibility, and strain of the arteries of all children were calculated. Results Pulse pressure, systolic and diastolic blood pressure, heart rate, cholesterols, and glucose levels of the obese individuals were similar to the controls. In carotid arteries there were no statistical differences regarding stiffness, distensibility, and strain. According to multiple ANCOVA analysis, distensibility and strain of right and left brachial arteries and right renal artery were higher, whereas right renal artery stiffness was lower in asthmatic children than in controls. Approximately one-fifth of the change in the left and right brachial arteries and right renal artery distensibility and strain and a small portion of the change in the right renal artery stiffness were associated with asthma. In contrast, left renal artery distensibility, strain, and stiffness were not associated with asthma. Conclusions Peripheral arteries had higher distensibility and strain, and lower stiffness in asthmatic children than in controls.