The Effect of Antioxidants on Ischemia-Reperfusion Injury in Flap Surgery

Flap surgery has wide use in plastic surgery in the closure of tissue defects. In spite of the major advances in plastic surgery in the past years, flap surgery is still associated with significant mortality. Ischemia-reperfusion (I/R) injury, which is a complex injury associated with flap blood flow, is one of the most important causes of flap failure. The main pathophysiology underneath I/R injury is associated with reactive oxygen species, which can be prevented by certain antioxidant applications. Antioxidants have been widely used in flap surgery and I/R injury previously. There have been a lot of articles showing positive effects of antioxidants on I/R injury. In this chapter, we focus the mechanism of I/R injury and how antioxidants can able to diminish the damage, moreover demonstrating the effect of certain antioxidants on I/R injury that has been investigated previously

Current approach to hyponatremia

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Hiponatremi en sık karşılaşılan elektrolit bozukluğudur. Hiponatremi, altta yatan nedene ve başlangıç şekline göre çok değişken klinik bulgular ile ortaya çıkabilir. Dolayısıyla, hiponatremi tedavisi her hastaya göre değişkenlik gösterir. Akut başlangıçlı hiponatremi beyin ödemine yol açabileceğinden acil tedavi gerektirirken, kronik hiponatremi agresif tedavi edilirse ozmotik demiyelinasyon sendromu adı verilen ciddi bir nörolojik tabloya yol açabilir. Bu derlemede hiponatremiye güncel yaklaşım olgu sunumları eşliğinde anlatıldı.Hyponatremia is the most common electrolyte disorder. Hyponatremia may appear with a great variety of clinical findings depending on the underlying cause and way of onset. Thus, management of hyponatremia varies according to each patient. While acute onset hyponatremia requires emergent therapy since it may cause brain edema, chronic hyponatremia may cause a severe neurological condition named osmotic demyelination syndrome if treated aggressively. This review explains the current approach to hyponatremia with case reports

Multiple immunoassay interference in a patient with falsely elevated calcitonin

Calcitonin (CT) is a diagnostic and follow-up marker of medullary thyroid carcinoma. Heterophile antibodies (HAbs) may interfere during immunometric assay measurements and result in falsely high CT levels and different markers. A 50-year-old female patient was referred to our institution for elevated CT levels (3,199 pg/mL [0-11,5]). Physical examination and thyroid ultrasonography show no thyroid nodules. Because of the discrepancy between the clinical picture and the laboratory results, various markers and hormones were examined to determine whether there was any interference in the immunometric assay. Thyroglobulin (Tg) and Adrenocorticotropic hormone (ACTH) levels were also found inaccurately elevated. After precipitation with polyethylene glycol, CT, Tg, and ACTH levels markedly decreased, showing macro-aggregates. Also, serial dilutions showed non-linearity in plasma concentrations. Additionally, CT samples were pretreated with a heterophilic blocking tube before measuring, and the CT level decreased to < 0.1 pg/mL, suggesting a HAb presence. Immunoassay interference should be considered when conflicting laboratory data are observed. This may help reduce the amount of unnecessary laboratory and imaging studies and prevent patients from complex diagnostic procedures

The Diagnostic Role of FDG PET/CT in Patients with Fever of Unknown Origin

Objective: Fever of unknown origin (FUO) is a challenge for the physician and needs use of clinical, laboratory, and imaging studies and also invasive and/or non-invasive interventions to detect the etiology. The aim of present study was to assess the role of FDG PET/CT in determining the etiology in patients with FUO. Material and Methods: Twenty-four patients (median age 52, range 5-77 years, 6 female, 18 male) who were diagnosed with FUO were retrospectively analyzed in this study. Before the FDG PET/CT studies, none of them had a definitive reason for their diseases investigated by conventional radiological or scintigraphic methods, clinical and laboratory observations. Results: The positive result was achieved in 19 (79.2%) of 24 patients as findings of the FDG PET/CT. However, FDG PET/CT was useful for definitive diagnosis in 12 (63.2%) of 19 positive patients. Malignant diseases were determined to be the underlying cause of FUO in 5 (41.6%) of 12 patients. Noninfectious inflammatory causes were detected in 2 (16.7%) patients, infections were exhibited in 3 (25%) patients, and miscellaneous diseases demonstrated in 2 (16.7%) patients. In 7 patients the detected pathological uptakes on FDG PET/CT were not helpful for the definitive diagnosis. In remaining 5 patients who showed no pathological uptake in the FDG PET/CT, diagnosis could not be established by other methods, as well. The sensitivity, specificity, and positive and negative predictive values for the determination of FUO etiology were 92.3%, 45.4%, 63.1%, and 100% for FDG PET/CT. Conclusion: Our results demonstrate that FDG PET/CT seems to have considerable contribution to reveal the reason of undiagnosed patients with FUO investigated by conventional diagnostic methods, clinical and laboratory observations. (MIRT 2011; 20: 19-25

Improvement of Coronary Flow Velocity Reserve with Telmisartan in Patients with Autosomal-Dominant Polycystic Kidney Disease

Objectives: Endothelial dysfunction (ED) has been reported in patients with autosomal-dominant polycystic kidney disease (ADPKD). Coronary flow velocity reserve (CFVR) is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of this study was to investigate the effect of the angiotensin receptor blocker, telmisartan, on CFVR in patients with ADPKD

Intravascular radiation therapy with a Re-188 liquid-filled balloon in patients with in-stent restenosis

Objective The aim of this study was to evaluate the feasibility and safety of intravascular radiation therapy (IVRT) using Re-188 filled balloon system in patients with in-stent stenosis

Coronary flow velocity reserve and carotid intima media thickness in patients with autosomal dominant polycystic kidney disease: From impaired tubules to impaired carotid and coronary arteries

Background and objectives: Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease. Endothelial dysfunction, an early and reversible feature in the pathogenesis of atherosclerosis, is associated with increased vascular smooth muscle tone, arterial stiffening, and increased intima-media thickness. Coronary flow velocity reserve is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of the study was to investigate the carotid intima-media thickness and coronary flow velocity reserve in patients with autosomal dominant polycystic kidney disease

Coronary Flow Velocity Reserve and Carotid Intima Media Thickness in Patients with Autosomal Dominant Polycystic Kidney Disease: From Impaired Tubules to Impaired Carotid and Coronary Arteries

Background and objectives: Cardiovascular problems are a major cause of morbidity and mortality in patients with autosomal dominant polycystic kidney disease. Endothelial dysfunction, an early and reversible feature in the pathogenesis of atherosclerosis, is associated with increased vascular smooth muscle tone, arterial stiffening, and increased intima-media thickness. Coronary flow velocity reserve is a noninvasive test showing endothelial function of epicardial coronary arteries and coronary microcirculatory function. The aim of the study was to investigate the carotid intima-media thickness and coronary flow velocity reserve in patients with autosomal dominant polycystic kidney disease. Design, setting, participants, & measurements: Thirty normotensive patients with autosomal dominant polycystic kidney disease (10 male, 20 female) with well-preserved renal function and 30 healthy subjects (12 male, 18 female) were included in the study. Coronary flow velocity reserve was measured at baseline and after dipyridamole infusion by echocardiography. Coronary flow velocity reserve was calculated as the ratio of hyperemic to baseline diastolic peak velocities. Results: Carotid intima-media thickness was significantly higher in patients than in control subjects (0.80 ± 0.29 versus 0.54 ± 0.14 mm, respectively; P < 0.001). Moreover, coronary flow velocity reserve was significantly lower in patients than in control subjects (1.84 ± 0.39 versus 2.65 ± 0.68, respectively; P < 0.001). Conclusions: Normotensive patients with autosomal dominant polycystic kidney disease with well-preserved renal function have significantly increased carotid intima-media thickness and significantly decreased coronary flow velocity reserve compared with healthy subjects. These findings suggest that atherosclerosis starts at an early stage in the course of their disease in patients with autosomal dominant polycystic kidney disease

The role of neutrophil lymphocyte ratio to leveragethe differential diagnosis of familial Mediterraneanfever attack and acute appendicitis

BACKGROUND/AIMS: Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by attacks of fever and diffuse abdominal pain. The primary concern with this presentation is to distinguish it from acute appendicitis promptly. Thus, we aimed to evaluate the role of neutrophil lymphocyte ratio (NLR) to leverage the differential diagnosis of acute FMF attack with histologically proven appendicitis. METHODS: Twenty-three patients with histologically confirmed acute appendicitis and 88 patients with acute attack of FMF were included in the study. NLR, C-reactive protein and other hematologic parameters were compared between the groups. RESULTS: Neutrophil to lymphocyte ratio was significantly higher in patients with acute appendicitis compared to the FMF attack group (8.24 ± 6.31 vs. 4.16 ± 2.44, p = 0.007). The performance of NLR in diagnosing acute appendicitis with receiver operating characteristic analysis with a cut-off value of 4.03 were; 78% sensitivity, 62% specificity, and area under the curve 0.760 (95% confidence interval, 0.655 to 0.8655; p < 0.001). CONCLUSIONS: This study showed that NLR, the simple and readily available inflammatory marker may have a useful role in distinguishing acute FMF attack from acute appendicitis