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Kucuk H.O.,Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital | Kucuk U.,Gulhane Military Medical Academy Haydarpasa Training Hospital | Ozdemir M.,Gazi University
International Journal of Clinical and Experimental Medicine | Year: 2015

Background: Clinical and epidemiological data well defines the role of atherosclerotic risk factors in pathogenesis of aortic stenosis. Especially dyslipidemia with elevated total and LDL cholesterol levels exerts certain histopathological changes on calcified valve tissue. Exact role of HDL in this process is not known. Objective: To evaluate the lipid profiles of patients with mild aortic valve stenosis with special focus on HDL; HDL subspecies, serum apoA1 levels, HDL related PON1 and PAF-AH enzyme activities and to correlate this with disease progression rates. Method: 42 patients (26 female; 16 male), with calcific aortic valve stenosis were enrolled in the study. Serum fasting lipid parameters, HDL subspecies (HDL2, HDL3), serum apoA1 levels and HDL related PON1 and PAF-AH enzyme activities were determined. All participants underwent detailed follow-up transthoracic echocardiography examination. Results: Among 42 study participants mean serum total cholesterol level was 195 ± 27.3 mg/dl, LDL-c level was 123 ± 19.1 mg/dl, HDL-c level was 44 ± 10.3 mg/dl and total cholesterol/HDL-c ratio was 4.64 ± 1.13. Basal peak aortic jet velocity (Vmax2) was 2.67 ± 0.39 m/sec, mean pressure gradient (Pmean2) was 15.6 ± 5.5 mmhg. Annual progression rate in peak aortic jet velocity (Vmax) was 0.23 ± 0.17 m/sec, in mean pressure gradient (Pmean) was 3 ± 2.1 mmhg. Annual progression rate in Pmean was most strongly correlated with serum HDL-c level and total/HDL-c ratio (r=-0.528 and 0.505; <0.001 and 0.001 respectively). Progression in Vmax values was positively correlated with serum LDL-c level and total/HDL-c ratio while negatively correlated with serum HDL-c levels (r=0.328, 0.499 and -0.464; P=0.034, 0.001 and 0.002 respectively). Among HDL subspecies HDL2 was the predominant type. HDL2 levels were found to be positively correlated with progression rates. There was no significant correlation between apolipoprotein A1 level and annual progression rate. Serum PON1 activity level was determined to be negatively correlated to doppler echocardiographic progression parameters while HDL related PAF-AH activity was independent of disease progression. Conclusion: Present study demonstrated a positive correlation between disease progression and serum total cholesterol/HDL-c ratio. Serum HDL-c level was inversely correlated with hemodynamic progression. The majority of HDL was HDL2 subtype. Among HDL related enzymes PON1 enzyme activity exhibited an inverse correlation with disease progression. © 2015, International Journal of Clinical and Experimental Medicine. All rights reserved. Source


Altay S.,Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital | Cakmak H.A.,Istanbul University | Boz G.C.,Goztepe Training and Research Hospital | Koca S.,Goztepe Training and Research Hospital | Velibey Y.,Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital
Cardiovascular Journal of Africa | Year: 2012

Superwarfarins (brodifacoum, difenacoum, bromodialone and chlorphacinone) are anticoagulant rodenticides that were developed in 1970s to overcome resistance to warfarin in rats. A 26-year-old previously healthy man was admitted to the emergency department with epigastric pain, severe upper and lower gastrointestinal haemorrhage, gingival bleeding and melena. The patient stated that he had been healthy with no prior hospital admissions and no personal or family history of bleeding diathesis. The patient, who later admitted attempted suicide, stated that he had taken 400 g rodenticide including brodifacoum orally for five days prior to admission to hospital. He had oral mucosal bleeding, numerous bruises over the arms, legs and abdomen, and an abdominal tenderness, together with melena. Laboratory tests revealed a haemoglobin level of 12.3 g/dl, leucocyte count of 9.1 × 109 /l, haematocrit of 28% and platelet count of 280 × 109 /l. The prothrombin time (PT) was > 200 s (normal range 10.5-15.2 s) and the activated partial thromboplastin time (aPTT) was 91 s (normal range 20-45 s). The INR (International normalised ratio) was reported to be > 17 (normal range 0.8-1.2). The thrombin time and plasma fibrinogen levels were in the normal range. The results showed the presence of brodifacoum at a concentration of 61 ng/ml, detected by reversedphase liquid chromatography. Source


Altay S.,Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital | Cakmak H.A.,Istanbul University | Erer B.,Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital | Kemaloglu T.,Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital | And 2 more authors.
Acta Cardiologica Sinica | Year: 2012

A twenty-year old female with a history of allergic asthma and Raynaud's phenomenon was admitted to our emergency department with retrosternal chest pain of one hour duration accompanied by generalized erythema, urticarial rashes, moderate dyspnea, nausea and vomiting. Her symptoms developed after taking a dose of naproxen sodium for dysmenorrhea. ECG showed ST segment elevation in leads I and aVL and ST segment depression in leads III and aVF. The patient's chest pain relieved and ST elevations resolved during her transport to the catheterization laboratory. Immediate angiography revealed normal coronary arteries. This coronary syndrome was thought to be secondary to allergy-induced coronary vasospasm known as "Kounis syndrome". The main pathophysiological mechanism of coronary spasm in Kounis syndrome is the inflammatory mediators released during a hypersensitivity reaction triggered by food, insect bites or drugs. Here, we report a case of coronary spasm secondary to allergic reaction following naproxen sodium intake. Source

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