Potential Inherited Causes of Recurrent Prosthetic Mitral Valve Thrombosis in a Pregnant Patient Suffering from Recurrent Miscarriage

Macit Kalcik,M. Ozan Gursoy,Suleyman Karakoyun,Mahmut Yesin,Mehmet Ali Astarcioglu,Mehmet Ozkan 대한심장학회 2014 Korean Circulation Journal Vol.44 No.4

An effective anticoagulation is critical in pregnant patients with prosthetic heart valves. Inherited disorders may interfere with the coagu-lation cascade and may be associated with obstetrical complications as well as with prosthetic valve-derived complications. The patient inthe present case had a history of recurrent prosthetic heart valve thrombosis (PHVT) despite an effective anticoagulation. She underwenta thrombolysis with low-dose prolonged infusion of tissue-type plasminogen activator for the management of her recurrrent prostheticvalve thrombosis. The genetic testing showed homozygous mutations of methylenetetrahydrofolate reductase (MTHFR) A 1298 C andheterozygous mutations of ß-fibrinogen 455 G-A. Inherited disorders such as MTHFR A 1298 C and fibrinogen 455G/A polymorphismsmay be involved in the pathogenesis of recurrent PHVT and/or pregnancy loss.

Association of Syntax Score II with Contrast-induced Nephropathy and Hemodialysis Requirement in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Ibrahim Rencuzogullari,Metin Çağdaş,Süleyman Karakoyun,Yavuz Karabağ,Mahmut Yesin,Mustafa Ozan Gürsoy,İnanç Artaç,Doğan İliş,Süleyman Çağan Efe,Kevser Tural,Ibrahim Halil Tanboğa 대한심장학회 2018 Korean Circulation Journal Vol.48 No.1

Background and Objectives Contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (pPCI) and is associated with high mortality and morbidity and long hospital stay in patients with ST elevation myocardial infarction (STEMI). The Syntax Score (SS) has previously been studied in STEMI patients, and it was associated with increased CIN development and long-term mortality. This study investigates a possible relationship between CIN development and Syntax Score II (SSII) and compares SS and SSII by assessing CIN risk in STEMI patients treated with pPCI. Methods A total of 1,234 patients who underwent pPCI were divided into 2 groups according to CIN development. Patients with CIN were further divided into 2 groups according to whether or not they required hemodialysis. Reclassification tables, net reclassification improvement, and integrated discriminative improvement methods were used to assess the additive predictive value of SSII for predicting CIN. Results In the present study, 166 patients (13.5%) had CIN. Although both SS and SSII were significantly higher in CIN patients, only SSII was an independent predictor of CIN (odds ratio [OR], 1.031; 95% confidence interval [CI], 1.012–1.051; p<0.001) and hemodialysis requirement (OR, 1.078; 95% CI, 1.046–1.078; p<0.001). When comparing SSII and SS in their ability to determine CIN risk, we found SSII to have a reclassification improvement of 27.59% (p<0.001) and an integrated discrimination improvement of 9.1% (p<0.001). Conclusions The combination of clinical and anatomic variables can more accurately identify patients who are at high risk for CIN after pPCI. While SSII is harder to calculate than SS, it provides better prediction for CIN and hemodialysis requirement than SS.

Mean Platelet Volume and Vitamin D Level

Medine Cumhur Cure,Erkan Cure, M.D,Suleyman Yuce,TarkanYazici,Inanc Karakoyun,Hasan Efe 대한진단검사의학회 2014 Annals of Laboratory Medicine Vol.34 No.2

Background: Vitamin D deficiency and a high mean platelet volume (MPV) are related to cardiovascular disease. We investigated whether vitamin D deficiency is associated with high MPV. Methods: This study included 434 patients without chronic disease who were not taking vitamin D or calcium supplements. Vitamin D was measured by chemiluminescent mic- roparticle immunoassay on the Architect-I2000 system (Abbott Diagnostics, USA), and MPV was measured on the Cell-Dyn Ruby analyzer (Abbott Diagnostics). Patients were di- vided into Groups 1 (138 [men/women, 46/92]), 2 (148 [men/women, 54/94]), and 3 (148 [men/women, 50/98]) according to vitamin D levels of <10 ng/mL, 10-20 ng/mL, and >20 ng/mL, respectively. Results: The vitamin D level in Group 1 (7.7±1.9 ng/mL) was lower than that in Group 2 (15.1±1.6 ng/mL, P <0.001) and Group 3 (25.6±6.3 ng/mL, P <0.001). The MPV in Group 3 (7.5±1.0 fL) was lower than that in Group 1 (8.1±1.1 fL, P <0.001) and Group 2 (7.9±1.0 fL, P =0.009). Linear regression analysis showed that low levels of vitamin D (β=-0.109, P =0.019) was independently associated with increased MPV. Conclusions: There was a strong association between a low vitamin D level and a high MPV; therefore, vitamin D deficiency may be associated with increased MPV.

Multilevel Noncontiguous Spinal Fractures: Surgical Approach towards Clinical Characteristics

Mehmet Seçer,Fatih Alagöz,Ozhan Uçkun,Oğuz Durmuş Karakoyun,Murat Ömer Ulutaş,Ömer Polat,Ergün Dağlıoğlu,Ali Dalgıç,Deniz Belen 대한척추외과학회 2015 Asian Spine Journal Vol.9 No.6

Study Design: The study retrospectively investigated 15 cases with multilevel noncontiguous spinal fractures (MNSF). Purpose: To clarify the evaluation of true diagnosis and to plane the surgical treatment. Overview of Literature: MNSF are defined as fractures of the vertebral column at more than one level. High-energy injuries caused MNSF, with an incidence ranging from 1.6% to 16.7%. MNSF may be misdiagnosed due to lack of detailed neurological and radiological examinations. Methods: Patients with metabolic, rheumatologic diseases and neoplasms were excluded. Despite the presence of a spinal fracture associated clearly with the clinical picture, all patients were scanned within spinal column by direct X-rays, computed tomography and magnetic resonance imaging. When there were ≥5 intact vertebrae between two fractured vertebral segments, each fracture region was managed with a separated stabilization. In cases with ≤4 intact segments between two fractured levels, both fractures were fixed with the same rod and screw system. Results: There were 32 vertebra fractures in 15 patients. Eleven (73.3%) patients were male and age ranged from 20 to 64 years (35.9±13.7 years). Eleven cases were the American Spinal Injury Association (ASIA) E, 3 were ASIA A, and one was ASIA D. Ten of the 15 (66.7%) patients returned to previous social status without additional deficit or morbidity. The remaining 5 (33.3%) patients had mild or moderate improvement after surgery. Conclusions: The spinal column should always be scanned to rule out a secondary or tertiary vertebra fracture in vertebral fractures associated with high-energy trauma. In MNSF, each fracture should be separately evaluated for decision of surgery and planned approach needs particular care. In MNSF with ≤4 intact vertebra in between, stabilization of one segment should prompt the involvement of the secondary fracture into the system.

Effects of a Glutamine Enema on Anastomotic Healing in an Animal Colon Anastomosis Model

Mani Habibi,Osman Zekai Oner,Mehmet Tahir Oruc,Nurullah Bulbuller,Sebahat Ozdem,Sukru Ozdemir,Arsenal Sezgin Alikanooglu,Rojbin Karakoyun,Ugur Dogan,Ayper Ongen,Umit Koc 대한대장항문학회 2015 Annals of Coloproctolgy Vol.31 No.6

Purpose: Anastomotic leakage in colorectal surgery is a very important issue. Although many studies have shown the positive effects of enteral glutamine (Gln) on anastomotic healing, none has assessed the effects of administering Gln via an enema for anastomotic healing. To fill this study gap, this study investigated the intraluminal effect of administration of Gln enema on the healing of colonic anastomosis in a rat model. Methods: Thirty Wistar albino rats were divided into three groups containing 10 rats each and were subjected to distal left colon transection and anastomosis. Postoperatively, group I (the control group) was administered no treatment, group II was administered daily placebo enemas containing physiological saline, and group III was administered daily 2% L-Gln enemas. After sacrifice on postoperative day 5, anastomotic healing, burst pressure, tissue hydroxyproline levels, and histological parameters were measured, and group values were compared via statistical analysis. Results: Group III was found to have the highest mean bursting pressure and tissue hydroxyproline levels and the lowest mean ischemia score. While the values of these parameters were not found to differ significantly among the groups, the lack of significance may have been due to the limited number of subjects examined. Conclusion: Administration of a Gln enema may have a positive effect on anastomosis in terms of bursting pressure and histopathological parameters. Future research should examine administration of a preoperative Gln enema as a means of decreasing the traumatic effects of the enema and identifying its applicability in surgical practice.