Browsing by Subject "disease severity"
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Item Familial pathologic myopia, corneal dystrophy, and deafness: A new syndrome(2001) Kurt E.; Günen A.; Sadkolu Y.; Öztürk F.; Tarhan S.; Sar R.A.; Fstk T.; Ar Z.Background: Numerous syndromes with myopia and hearing loss have been described up to now. We present a family with pathologic myopia, corneal dystrophy, and deafness distinct from these syndromes. Cases: Ten patients in the same Turkish family were evaluated by ophthalmologic, audiologic, physical, radiologic, genetic, serologic, and biochemical examinations. Observations: Ophthalmic examination indicated that all the cases had myopia, 7 of them had pathologic myopia, 1 had intermediate, and 2 had mild. Four of the patients with pathologic myopia had corneal dystrophy that was bilaterally manifest as white opacities in the posterior stroma near Descemet's membrane in an axial distribution; 1 of these 4 patients also had a tilted disc. Otolaryngologic examination revealed conductive hearing loss in 3 cases, mixed hearing loss in 2, and sensorineural hearing loss in 1. The results of karyotypic analyses of all cases were normal. The pedigree analysis showed the disease was inherited through successive generations as an autosomal dominant trait. The results of biochemical, serologic, and radiologic investigations were normal. The same pathophysiologic process in all cases seemed to account for the myopia, the corneal dystrophy and the deafness. Conclusions: To our knowledge, this type of case has not been reported in the literature. Therefore, we named this syndrome "familial pathologic myopia, corneal dystrophy and deafness." © 2001 Japanese Ophthalmological Society.Item The role of technetium-99m-HMPAO-labeled WBC scintigraphy in the diagnosis of orbital cellulitis(2001) Sayit E.; Söylev M.; Çapa G.; Durak I.; Ada E.; Yilmaz M.; Durak H.Bacterial orbital cellulitis is an infection of the soft tissues behind the orbital septum. Cellulitis is seen as a poorly defined area of increased CT density or T2 signal intensity within the fat. There is an amorphous enhancement following contrast infusion. Radiolabeled leukocytes or granulocytes are now established widely as a means of localizing various forms of inflammatory disease and infections. We report a case of orbital cellulitis detected with Tc-99m-HMPAO-labeled WBC scintigraphy and three-phase bone scintigraphy. Tc-99m-HMPAO-labeled WBC scintigraphy was superior to bone scintigraphy in delineating the extension and limits of the infectious process in the orbita. Tc-99m-HMPAO-labeled WBC scintigraphy is appropriate in the investigation of such infectious lesions, leading to early diagnosis and therapy to avoid severe complications.Item The use of intermittant dose azithromycin in children with sinusitis; [Çocukluk çaǧinda akut si̇nüzi̇t tedavi̇si̇nde i̇ntermi̇ttant doz azi̇tromi̇si̇n kullanimi](2001) Yüksel H.; Coşkun Ş.; Demir E.; Ikizoǧlu T.; Yilmaz D.; Onaǧ A.; Tanaç R.Aim: Antibiotic selection and the duration of its use are two of the most important factors that affect the prognosis of children with sinusitis. New effective antibiotherapy strategies with higher dose and short usage interval in children with sinusitis are needed because compliance to drug usage is difficult in childhood. In this study we aimed to compare 'single dose intermittent usage' of azithromycin (AZT) therapy and 'two doses per day for 15 days usage' of amoxisilin-clavunate (AMK) in the treatment of children with acute maxillary sinusitis. Material and Method: Sixty-one children diagnosed as having maxillary sinusitis (between 5 and 14 years old) were enrolled into study. Twenty-nine children were treated using single daily dose of AZT for five days. After a treatment- free period for 5 days, the drug was readministered for five days. Thirty-two children were treated using two doses of AMK for fifteen days. Clinical signs, symptom scores of sinusitis and compliance to the therapy were followed up for two weeks. Results: At the end of the first week, the mean symptom score of the AZT group was significantly lower than that of the AMK group (p<0.05). Although it was lower in AZT group, the symptom scores at the end of the second week were not significantly different between the two groups. Recovery rate from sinusitis was 93% in the AZT and 91% in the AMK group. Seven percent of the AZT group patients failed to use the total recommended dose and also 3% stopped the therapy earlier. In the AMK group, these were 24% and 15% respectively, and the difference between two groups was statistically significant (p<0.05). Satisfaction from using the drug was significantly higher in the AZT group than the AMK group. Conclusion: The therapy regimen with a single dose - intermittant usage of AZT for five days is as effective as two doses of AMK therapy for fifteen days. Furthermore, it was shown that intermittant dose AZT reduced symptom scores of sinusitis earlier. Thus, an intermittant dose of AZT recommendation may be a new, more compliant and effective therapy regiment in the treatment of children with sinusitis.Item Standard dose of inhaled albuterol significantly increases QT dispersion compared to low dose of albuterol plus ipratropium bromide therapy in moderate to severe acute asthma attacks in children(2001) Coskun S.; Yuksel H.; Tikiz H.; Danahaliloglu S.Background: Beta-2 agonist therapy has previously shown to increase the QT dispersion (QTd) in asthmatic patients and increased QTd has been well documented in association with cardiac arrhythmias and sudden death. However, the data concerning the effect of low doses of beta-2 agonist therapy in combination with the anticholinergic agents to potentiate bronchodilatation on QTd in asthmatic children are limited. The objectives of this study was to investigate the changes on QTd during both the standard dose of nebulized albuterol therapy and low dose nebulized albuterol plus inhaled ipratropium therapyn to assess the potential arrhytmogenic risk of these two treatment strategies in children with acute asthmatic attacks. Methods: Forty-three children with the diagnosis of moderate to severe acute asthma were enrolled in the study. Standard dose of nebulized albuterol therapy (0.15 mg/kg) were administered to 20 patients (group 1) and low dose of nebulized albuterol (0.075 mg/kg) plus nebulized ipratropium bromide therapy (250 μg/dose) were given to the remaining 23 patients (group 2). Respiratory distress score, peak expiratory flow rate, arterial blood pressure, O2 saturation, serum potassium and urea nitrogen levels were studied and QT interval parameters were measured from the standard 12-lead electrocardiograms at baseline and after treatment. Results: Significant improvement was achieved in respiratory distress score and peak expiratory flow rate after three dose inhalation. No significant difference was observed between the pre and post-treatment values of serum potassium, blood urea nitrogen, O2 saturation and arterial blood pressure values. The evaluation of the corrected QTd (QTcd) showed that while there was no statistical difference in the pre and post-treatment values in group 2 (30.4 ± 3.1 msn vs 32.1 ± 3.9 msn), QTcd was found to be significantly increased in group 1 after treatment (29.0 ± 3 msn vs 40.6 ± 5.1 msn, P < 0.0001). Conclusion: The data of the present study suggest that the increase of the QTd is more prominent with the use of a standard dose of albuterol compared to low dose albuterol plus ipratropium therapy. Therefore, it may be concluded that a low dose of albuterol plus ipratropium bromide therapy may be preferred to avoid rhythm disturbances in asthmatic children.Item Effects of interferon-α-2b and octreotide on healing of esophageal corrosive burns(2001) Kaygusuz I.; çelįk O.; Özkaya Ö.; Yalçin S.; Keleş E.; çetįnkaya T.Objective The aim of this study was to investigate the effect of interferon-α to 2b and octreotide on the treatment of esophagus corrosive burns. Method The experimental study was performed on 63 rabbits. Burn was obtained by treating a segment, isolated in cervical esophagus, with NAOH. The rabbits were allocated into three groups (control, interferon, and octreotide). On the fourth, eighth, and 20th days, 7 rabbits randomly selected from each group were killed. Comparisons among the groups were made by taking histopathologic findings, stenosis index, and hydroxyproline production into consideration. Cross-tabulation and analysis of variance tests were used for statistical analysis. Results There were no statistically significant differences among the groups in terms of epithelial changes, extension of inflammation, and severity of fibrosis. In terms of severity of inflammation, there was a statistically significant difference between the control and the other two groups. Also, a significant difference was found between the control group and the other two groups in terms of extension of fibrosis on the 20th day. The difference between the control and the two treatment groups was significant on the eighth day and the 20th day measurements. Comparison of the hydroxyproline values showed a statistically significant difference between the octreotide group and the other two groups on the eighth and 20th days. Conclusion Histopathologic and biochemical findings indicate that, by hindering fibrosis progress, octreotide (and interferon) might be new and promising alternatives in the treatment of corrosive burns of the esophagus. © 2001 The American Laryngological, Rhinological and Otalogical Society, Inc.Item Bile duct response to repeated cerulein induced pancreatitis in the rat(2002) Menteş A.; Aydede H.; Bayol Ü.; Yilmaz F.The typical morphology of common bile duct strictures in chronic pancreatitis suggests a pathogenesis not of encasement, but of mural changes in the common bile duct. Cerulein, 20 μg/kg was administered to male Wistar rats in four subcutaneous doses, hourly for 3 h, and was recorded as one application. Group A served as controls and received subcutaneous saline. Group B1 received one application of Cerulein and was sacrificed after 24 h. Group B2 was similar to B1, but was sacrificed two weeks later. Group B3 was given two applications of Cerulein with an interval of two weeks and was sacrificed two weeks after the second application. Group B4 received one application of Cerulein every week for four weeks and was sacrificed two weeks after the last application. Serum amylase levels, pancreatic edema and peripancreatic inflammatory infiltration scores increased with the severity and persistance of the insult. Bilirubin and alkaline phosphatase levels suggested cholestatic response in the groups that received repeated insults with Cerulein (Groups B3 and B4: p < 0.01). Moderate to strong immuno-histochemical positivity for type IV collagen at the wall of the common bile duct in animals with a persisting insult is suggestive of circumstantial evidence for mural changes as a causative factor of stricture formation in similar settings such as chronic pancreatitis with persistent inflammatory attacks.Item Relationship of retinopathy and hearing loss in type 2 diabetes mellitus(2002) Kurt E.; Öztürk F.; Günen A.; Sadikoglu Y.; Sari R.A.; Yoldas T.K.; Avsar A.; Inan Ü.Ü.This study investigated whether the degree of diabetic retinopathy correlates with degree of sensorineural hearing loss. Seventy-five diabetic patients and 45 sex- and age-matched healthy controls were evaluated audiologically. Patients were classified into groups by severity of retinopathy: group 1 (n=28), no retinopathy, group 2 (n=4), background retinopathy; and group 3 (n=23), proliferative or end-stage retinopathy. Diabetics had a statistically significant difference at all frequencies of hearing loss, as compared with controls.Item Fluorescein dye disappearance test in patients with different degrees of epiphora(Wichtig Editore s.r.l., 2002) Toprak A.B.; Erkin E.F.; Kayikçioǧlu Ö.; Seymenoǧlu G.; Güler C.; Unlu H.H.PURPOSE. To assess the diagnostic efficacy of a modification of the fluorescein dye disappearance test (DDT) in patients with different degrees of epiphora. METHODS. DDT was performed by instilling a drop of 2% fluorescein in the eye. Schirmer tear test strips were placed in the lower conjunctival fornix, after 3 and 10 minutes. The colour dilution on the strips was compared to a scale with known standards and the most closely comparable colour dilution was chosen and recorded as the visual scale test (VST) grade of the strip. The grey-scale value (GV) of each strip was calculated by computer image analysis. The control group comprised 44 patients, mean age 44.8 years (SD 7.5, range 30-60). There were 13 patients in group 1 with moderate epiphora; mean age was 44.2 years (SD 9.5, range 30-60). There were 17 patients in group 2 with severe epiphora; mean age was 48.3 years (SD 7.7, range 37- 60). RESULTS. VST and GV differed significantly between controls and group 1 patients at 3 minutes (p=0.002, p=0.001), and between controls and group 2 patients at 3 minutes (p<0.001, p<0.001). There was no difference between groups 1 and 2 patients in VST and GV at 3 minutes. The differences were highly significant between controls and group 1 at 10 minutes (p=0.001, p=0.007), and between controls and group 2 at 10 minutes (p<0.001, p<0.001). The differences in GV and VST between groups 1 and 2 were significant at 10 minutes (p=0.026, p=0.018). CONCLUSIONS. This modified DDT permits identification of different degrees of epiphora in a non-invasive manner, it can therefore be used to evaluate the outcome of different treatment strategies.Item Hypokalemic rhabdomyolysis aggravated by diuretics complicating Conn's syndrome without acute renal failure [1](Dustri-Verlag Dr. Karl Feistle, 2002) Özgür B.; Kürsat S.[No abstract available]Item Relationship between ossification of the stylohyoid ligament and enthesopathy: A comparative study(2002) Unlu Z.; Tarhan S.; Gunduz K.; Goktan C.Objective. Stylohyoid apparatus might be an anatomic region in the cervical spine involved by enthesopathy. The aim of this study was to assess the elongation and/or ossification at the stylohyoid apparatus in the degenerative or inflammatory diseases such as ankylosing spondylitis (AS), psoriatic arthropathy (PsA) and cervical spondyloarthrosis (CS) in which cervical spine involvement can be seen. Methods. Twenty-eight patients with AS, 25 patients with PsA, 31 patients with CS and 50 controls who did not have any complaints or symptoms related with elongated styloid process (SP) were included in the study. On the lateral cervical radiographs, the anterior and posterior aspects of each vertebral body and intervertebral disk were carefully evaluated for the presence and severity of syndesmophytes, osteophytes or ossification of the adjacent longitudinal ligaments in the patient group. The entire osseous length of the SP was measured on the lateral and lateral oblique mandibular or cervical views or the anteroposterior views radiographs in the patients and controls. Results. There were statistically significant differences between the patients with AS and control group and between the patients with PsA and control group with respect to the length of SP. The dimension of syndesmophytes or ligamentous ossification of the cervical spine involving C5-6 intervertebral disk level were significantly correlated with length of SP in the patients with AS. Conclusion. Elongated SP might be another manifestation of enthesopaty in cervical spine of the spondyloarthropathies.Item Lumbar stiffness but not thoracic radiographic changes relate to alteration of lung function tests in ankylosing spondylitis(2002) Cerrahoglu L.; Unlu Z.; Can M.; Goktan C.; Celik P.Involvement of the costovertebral (CV) and costotransverse (CT) as well as the sacroiliac (SI) joints is known to occur in patients with ankylosing spondylitis (AS). The functional significance of these changes is not clear. We have performed clinical and radiological evaluations and assessed the effect of joint involvement on pulmonary function. We detected radiologic evidence of involvement of the CV joint in 80% of patients and of the CT joint in 60 %. We found a direct relation between the severity of CV, CT and SI joint affliction, and the severity of CV and SI joints were related to time of evolution of the disease. Pulmonary function tests revealed neither restrictive nor obstructive defects. No relation was found between pulmonary function and CV and CT joint affliction. Patients with stiffer spines had a tendency to have pulmonary function tests within the lower limit of the normal range. In patients with AS diaphragmatic breathing might compensate the chest respiration to some extent.Item Anaesthetic management of severe bradycardia during general anaesthesia using temporary cardiac pacing(Oxford University Press, 2002) Toprak V.; Yentur A.; Sakarya M.There are few reports of management of severe bradycardia with temporary cardiac pacing. We describe a 65-yr-old female patient who developed bradycardia and hypotension on two occasions during general anaesthesia for laryngoscopy. The first episode was treated with atropine, ephedrine, and colloid infusion and the second with a temporary pacemaker and ephedrine.Item Esophageal motility changes in acute and late periods of caustic esophageal burns and their relation to prognosis in children(2002) Genç A.; Mutaf O.Background/Purpose: Esophageal burns as a result of accidental swallowing of caustic material are seen frequently in children. Severe motor function disorders of the esophagus after caustic burns are already reported covering the late periods. The aim of this study was to detect, follow, and report the clinical results of esophageal motility changes in acute as well as the late periods of caustic esophageal insult and its relation with prognosis in children. Methods: Esophageal motility was studied in 20 children aged 1.5 to 11 years (mean, 3.8). In the study group, motility of the esophagus was investigated on the fifth day of the burn (after decrease of the edema) and repeated at the end of the third month. To standardize the results, the amplitude and the duration of the pressure waves were recorded at 3 cm above the lower esophageal sphincter (LES), and the velocity in the distal esophagus was calculated. Then the mean values of amplitude, duration, and velocity of 15 swallows were obtained for each patient. Results: At the end of the fifth day, peristaltic response of the esophagus to swallowing was followed in 13 patients. Seven patients were able to swallow water, but no peristaltic response was detected. Therefore, the subjects were divided into 2 groups as motility (+) and motility (-), and each were compared with the control group separately. The amplitude of the pressure wave in the motility (-) group was significantly low when compared with the control group. All the subjects in this group had NaOH burns, and development of severe strictures was detected at the endoscopic examinations after 3 weeks. In motility (+) group, no pathologies were detected except significant decrease in the velocity of the peristaltic wave. Eleven of the subjects in this group had acid burns, and 2 had NaOH burns, and, at the follow-up endoscopic examination after 3 weeks, only one acid burn patient had a slight stricture. Motility measurements conducted at the end of the third month showed that the initial motility (-) group had no changes. No peristaltic response was detected after swallowing, and amplitude of the pressure wave measured at the distal esophagus was significantly lower than the controls. However, in the motility (+) group, decrease in the velocity of the peristaltic wave had disappeared, and there were no differences when compared with the control group. Conclusion: It is suggested that the manometric studies of the esophagus give important data about the severity of the initial esophageal injury and have an important role in determining the prognosis. © 2002, Elsevier Science (USA). All rights reserved.Item Effects of Low-Dose Combination Therapy with an Angiotensin-Converting Enzyme Inhibitor and a Diuretic on Flow-Mediated Vasodilation in Hypertensive Patients: A 6-Month, Single-Center Study(Excerpta Medica Inc., 2003) Sekuri C.; Bayturan O.; Gocer H.; Tavli T.; Tezcan U.K.Background: Combination therapy with an angiotensin-converting enzyme (ACE) inhibitor and a diuretic has been shown to be highly effective in hypertension. Clinical trials have demonstrated that ACE inhibitors may improve endothelial cell dysfunction in hypertension. However, the effectiveness of the combination treatment in endothelial cell dysfunction is unknown. Objective: This study investigated the effects of a new low-dose combination, perindopril 2 mg plus indapamide 0.625 mg, on brachial artery flow-mediated vasodilation (FMD) and left ventricular diastolic function in hypertension. Methods: Patients aged 18 to 75 with newly diagnosed stage 1 or 11 hypertension were eligible. Endothelium-dependent brachial artery FMD and endothelium-independent vasodilation were assessed at baseline. Patients were treated with oral perindopril 2 mg plus indapamide 0.625-mg tablets once daily for 6 months. FMD measurements were then repeated. Percentage changes in FMD from baseline to 6 months, as well as left ventricular diastolic function parameters (isovolumic relaxation time [IVRT] and mitral diastolic E-wave deceleration time [EDT]), indicated the effectiveness of the intervention. Results: Twenty-nine Turkish patients were enrolled (17 women, 12 men; mean [SD] age, 54.5 [9.5] years [range, 38-75 years]). The mean (SD) baseline FMD was 7.00% (2.39%) (endothelial cell dysfunction) and increased significantly to 8.68% (2.78%) at 6 months (P = 0.02); FMD improved in 15 patients (51.7%). At baseline and 6 months of therapy, mean (SD) IVRT was 101.7 (12.4) ms and 95.5 (7.7) ms, respectively (P < 0.001), and EDT was 234.7 (33.9) ms and 217.9 (25.6) ms, respectively (P < 0.001). Conclusions: In this small sample of hypertensive patients, a low-dose combination ACE inhibitor and diuretic significantly improved brachial artery FMD and left ventricular diastolic function. The improvement in FMD values was independent of the stage of hypertension. These findings suggest a relationship between improvement in endothelial cell function and diastolic function. Copyright © 2003 Excerpta Medica, Inc.Item Efficacy of handgrip stress test for evaluation of cilasapril treatment in patients with heart failure (multiple letters) [3](2003) Kurita A.; Takase B.; Tavli T.[No abstract available]Item Depression and anxiety in hypothyroidism(2003) Demet M.M.; Ozmen B.; Deveci A.; Boyvada S.; Adiguzel H.; Aydemir O.The aim of the study was to determine the prevalence and severity of depression and anxiety inpatients with hypothyroidism and to compare this with euthyroid patients. Thirty patients with hypothyroidism and 30 euthyroid controls attending the Endocrinology outpatient department of Celal Bayar University, Medical Faculty were included in the study. The hormonal screening was done by immunoassay and haemagglutination methods. Then, for psychiatric assessment, Hospital Anxiety and Depression Scale (HAD), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were used. There was no difference between the two groups in terms of demographic features. Total scores obtained from the scales used in the study did not differ significantly (p > 0.05). The frequency of items of both HAM-D and HAM-A did not show any differences in the two groups. By Wilks' Lambda discriminant analysis, depressive mood (HAM-D#1) was found to be the discriminating feature between the hypothyroid group and the euthyroid group. Therefore, depression and anxiety were not outstanding features in hypothyroidism. However, depression was more significant in the hypothyroid than euthyroid group.Item Treatment of mild-to-moderate hypertension with calcium channel blockers: A multicentre comparison of once-daily nifedipine gits with once-daily amlodipine(2003) Kes S.; Caglar N.; Canberk A.; Deger N.; Demirtas M.; Dortlemez H.; Kiliccioglu B.; Kozan O.; Ovunc K.; Turkoglu C.Background: Hypertension is one of the most important causes of cardiovascular disease, and treatment of hypertension leads to a significant reduction in cardiovascular mortality and morbidity. Although calcium channel blockers are regarded as an important part of the therapeutic armamentarium against cardiovascular diseases, and are among the most frequently prescribed antihypertensive medications, concern has been aroused about these drugs, particularly the short-acting dihydropyridine derivatives. However, the value of nifedipine GITS (Adalat-Crono*), the long-acting dihydropyridine, is in need of being re-established. Objective: To compare the effectiveness, safety and tolerability of once-daily nifedipine and amlodipine treatment in patients with mild-to-moderate essential hypertension. Design: Randomised multicentre trial with an open comparison of treatments for 12 weeks, with a preceding placebo run-in period of 2 weeks (patients on beta-blockers at the time of enrolment entered a mandatory 2-week wash-out period before being allowed in the placebo run-in period; this wash-out period was one week for patients using any antihypertensive medication other than beta-blockers). Setting: Nine centres (all university hospitals) in Turkey. Patients: 155 patients with essential hypertension (diastolic blood pressure 95-109 mmHg). Interventions: Initial treatment (step 1) consisted of 30 mg nifedipine GITS (n = 76; (Adalat-Crono tablets), or 5 mg amlodipine (n = 79; Norvasc† 5-mg tablets), either administered once daily, as a morning dose, or if the blood pressure was not below 140/90 mmHg, or the reduction in diastolic blood pressure was lower than 10 mmHg after a treatment period of 6 weeks, the dose was increased (Step 2) to 60 mg once daily in the nifedipine group, or 10 mg once daily in the amlodipine group. Main efficacy parameter: Diastolic blood pressure at trough after 12 weeks of active compound therapy adjusted to baseline. Results: After 12 weeks of treatment, the mean diastolic blood pressure was 83.1 and 81.9 mmHg, in the nifedipine and amlodipine groups, respectively (p = 0.436). The mean decrease in systolic blood pressure (28.5 ± 11.9 and 28.2 ± 11.2 mmHg in the nifedipine and amlodipine groups, respectively) and the mean decrease in diastolic blood pressure (16.4 ± 7.0 and 17.5 ± 6.9 mmHg in the nifedipine and amlodipine groups, respectively), as well as the responder rates (88.1 % and 92.1%, in the nifedipine and amlodipine groups, respectively) were comparable at the end of the study. No significant differences between groups were detected in the efficacy parameters assessed in this study. Both drugs were well tolerated. The overall incidence of adverse events was 7.9% in the nifedipine group and 10.1% in the amlodipine group. However, more patients discontinued treatment prematurely in the amlodipine group (13 patients; 19.7%), than in the nifedipine group (four patients; 5.6%). Conclusions: The results of this study demonstrated that once-daily nifedipine in GITS formulation and amlodipine are comparably safe and effective treatment options in patients with mild-to-moderate essential hypertension.Item The Role of Brain Natriuretic Peptide in the Prediction of Cardiac Performance in Coronary Artery Bypass Grafting(2003) Saribulbul O.; Alat I.; Coskun S.; Apaydin A.Z.; Yagdi T.; Kiliccioglu M.; Alayunt E.A.The relationship between brain natriuretic peptide and cardiopulmonary bypass has not been examined sufficiently. In this study, we prospectively examined brain natriuretic peptide levels in the plasma of 26 patients undergoing coronary artery bypass grafting. Brain natriuretic peptide measurements were carried out at 4 times: preoperatively, 3 hours after institution of cross-clamping, 24 hours after institution of cross-clamping, and on the 5th postoperative day. In addition, we measured individual variables and compared them to brain natriuretic peptide levels. Mean preoperative brain natriuretic peptide levels were significantly higher in patients with histories of myocardial infarction (P = 0.0047) and heart failure (ejection fraction ≤0.40) (P = 0.0001). There was a significant correlation between preoperative brain natriuretic peptide levels and cross-clamp times (P = 0.028), and an inverse correlation between those levels and preoperative cardiac indices (P = 0.001). The preoperative brain natriuretic peptide level also correlated inversely with left ventricular ejection fraction before (P = 0.001) and 5 days after (P = 0.01) operation. When the Clinical Severity Scoring System was applied, preoperative brain natriuretic peptide plasma concentrations in 19 patients with risk scores of 0-2 were significantly lower than in the 7 patients whose risk scores were 3-6 (P = 0.006). There was also a significant relationship between preoperative brain natriuretic peptide plasma concentrations and the postoperative requirement for inotropic agents (P = 0.027). This study suggests that plasma brain natriuretic peptide concentration could be one of the predictors of risk in patients undergoing coronary artery bypass grafting.Item An experimental model of hemolysis-induced acute pancreatitis(Associacao Brasileira de Divulgacao Cientifica, 2003) Saruc M.; Yuceyar H.; Turkel N.; Ozutemiz O.; Tuzcuoglu I.; Yuce G.; Huseyinov A.The literature indicates that acute pancreatitis is a complication of massive hemolysis with a prevalence of about 20%. We describe an experimental model of hemolysis-induced acute pancreatitis. Hemolytic anemia was induced in rats by a single ip injection of 60 mg/kg of 20 mg/ml acetylphenylhydrazine (APH) in 20% (v/v) ethanol on the first experimental day (day 0). One hundred and fifty Wistar albino rats weighing 180-200 g were divided into three groups of 50 animals each: groups 1, 2 and 3 were injected ip with APH, 20% ethanol, and physiological saline, respectively. Ten rats from each group were sacrificed on study days 1, 2, 3, 4 and 5. Serum amylase, lipase levels and pancreatic tissue tumor necrosis factor-α (TNF-α) and platelet-activating factor (PAF) contents were determined and a histological examination of the pancreas was performed. No hemolysis or pancreatitis was observed in any of the rats in groups 2 and 3. In group 1, massive hemolysis was observed in 35 (70%) of 50 rats, moderate hemolysis in seven (14%), and no hemolysis in eight (16%). Thirty-three of 35 (94.2%) rats with massive hemolysis had hyperamylasemia, and 29 of these rats (82.8%) had histologically proven pancreatitis. The most severe pancreatitis occurred on day 3, as demonstrated by histology. Tissue TNF-α and PAF levels were statistically higher in group 1 than in groups 2 and 3. Acute massive hemolysis induced acute pancreatitis, as indicated by histology, in almost 80% of cases. Hemolysis may induce acute pancreatitis by triggering the release of proinflammatory and immunoregulatory cytokines.Item β2-microglobulin and cystatin C in type 2 diabetes: Assessment of diabetic nephropathy(2004) Apakkan Aksun S.; Özmen D.; Özmen B.; Parildar Z.; Mutaf I.; Turgan N.; Habif S.; Kumanlioǧluc K.; Bayindir O.Background: Changes in glomerular filtration rate (GFR) provide a valuable indicator of the progression of diabetic nephropathy (DN). This study was designed to demonstrate the clinical values of serum cystatin C (Cys C) and β2-microglobulin in the assessment of renal function in type 2 diabetics by comparing them with the GFR, estimated from the uptake phase of 99 m technetium dimetiltriamino pentaacetic acid renogram (GFR-DTPA) and creatinine clearances. Materials and Methods: 68 type 2 diabetic patients with (urinary albumin excretions (UAE) 30-300 mg/24 h) (n = 39) and without (UAE < 30 mg/ 24 h) (n = 29) microalbuminuria and 32 controls were enrolled in the study. Serum Cys C, β2-microglobulin, creatinine, urinary microalbumin levels, creatinine clearances and GFR-DTPA values were determined in all groups. Non-parametric ROC curves, using a cut-off GFR-DTPA of 60 mL/min/1.73 m 2, were obtained for these markers. Results: Serum Cys C, β2-microglobulin, glucose and HbA1c concentrations were significantly higher in the group with diabetes compared to controls. In the patients with microalbuminuria, serum Cys C and glucose concentrations increased significantly in comparison to patients with normoalbuminuria, while no differences were observed for β2-microglobulin levels. Serum creatinine concentrations, GFR-DTPA values and creatinine clearances were not different between both diabetic groups and controls. Cys C was positively correlated with β2-microglobulin and creatinine and negatively with GFR values; β2-microglobulin was also positively correlated with serum creatinine in microalbuminurics. A significant inverse correlation was found between β2-microglobulin and GFR values in both microalbuminurics and normoalbuminurics. Conclusions: Increased Cys C and β2-microglobulin in diabetics may be early indicators of incipient DN. The diagnostic accuracies of Cys C and β2-microglobulin are superior to that of serum creatinine in distinguishing between mild and moderately reduced GFR.