Influence of obstructive sleep apnea on ischemia-modified albumin levels and carotid intima-media thickness

Obstructive sleep apnea (OSA) is associated with an increased risk of atherosclerosis. Carotid intima-media thickness (CIMT) is strongly associated with the presence of significant risk factors for cardiovascular disturbances. A disturbance in the oxidative/antioxidative balance is involved in the pathogenesis of OSA and cardiovascular diseases. Ischemia-modified albumin (IMA) is suggested as a novel marker of oxidative stress; IMA can be defined as decreased binding of transitional metal ions to serum albumin in oxidative status. The purpose of this research was to evaluate the influence of OSA on IMA levels and CIMT. In total, 61 individuals with OSA with no comorbidities and 24 healthy controls with a similar body mass index and age were enrolled in this study. Serum levels of IMA, CIMT (estimated radiologically), and polysomnographic parameters, were determined and interpreted. Serum IMA levels were significantly higher in individuals with OSA compared with the control group (p=0.0003). CIMT was significantly higher in the OSA group compared with the control group (0.88± 0.26 mm vs 0.75±0.17 mm, p=0.005). The CIMT and serum IMA levels were positively correlated with the apnea-hypopnea index (r=0.35 and r=0.32, respectively), and with the oxygen desaturation index (r=0.34 and r=0.29, respectively) at baseline. Increased IMA levels and CIMT may be related to increased oxidative stress and risk of atherosclerosis in individuals with OSA.

Multidetector computed tomography angiography to evaluate the subscapular arterial tree

OBJECTIVE

The subscapular artery has an important place in reconstructive surgery. The major pedicles of several different flaps used widely in reconstructive surgery take their roots from this arterial tree. This study aimed to provide anatomical data relating to these vessels through the use of multidetector computed tomography angiography (MDCTA) and to evaluate the clinical utility of MDCTA tool prior to surgery.

METHODS AND MATERIALS

A radiological evaluation using a MDCTA was made of the bilateral subscapular arteries and branches measuring >0.5 mm in diameter that could be sufficiently identified as vascular structures in 92 patients (44 men and 48 women) with pneumonia, pleural effusion, lung masses, or nodules for which a thoracic MDCTA was requested for the purpose of diagnosis.

RESULTS

The mean diameter of the subscapular artery origin was 3.86 ± 0.60 mm on the left and 3.93 ± 0.62 mm on the right. The mean diameter of the circumflex scapular artery origin was 2.41 ± 0.37 mm on the left and 2.44 ± 0.39 mm on the right. The mean diameter of the thoracodorsal artery origin was 2.29 ± 0.27 mm on the left and 2.31 ± 0.29 mm on the right. Mean length of the circumflex scapular artery was 46.34 ± 9.41 mm on the left and 46.10 ± 8.81 mm on the right. Mean length of the latissimus dorsi branch of the thoracodorsal artery from the origin of the subscapular artery was 110.11 ± 17.42 mm on the left and 112.21 ± 14.60 mm on the right. Mean length of the serratus anterior branch was 124.25 ± 19.00 mm on the left and 120.84 ± 15.67 mm on the right. No differences were detected between the left and right sides or between sexes. Doubled circumflex scapular arteries were found in 4.3% of patients, and the circumflex scapular artery branched directly off the axillary artery in 3.2% of patients.

CONCLUSION

This study showed that MDCTA is a highly valuable, non-invasive imaging tool for studying vascular anatomy and detecting variations in vascular structure during preoperative planning, thus enhancing surgical safety.

The dome procedure: a new technique for the reconstruction of the umbilicus

PURPOSE

The absence of the umbilicus is, in essence, an aesthetic deformity of the abdominal wall. The goal of reconstructing the umbilicus is to obtain a natural, three-dimensional appearance. In this study, we present a new technique called the "dome procedure" for the reconstruction of the umbilicus.

METHODS

This procedure can be applied under local anaesthesia on an outpatient basis and the drawing of the design is simple. The technique was applied to six patients who presented with an absence of the umbilicus following repair of a large incisional and umbilical hernia.

RESULTS

No major or minor complications were encountered. Patient satisfaction was high after surgical intervention.

CONCLUSIONS

The dome procedure, which enables the umbilicus to have a natural appearance with sufficient depression and normal-appearing wrinkles, is simple, easy to perform, and safe.

Comparison of MMF with prednisone in terms of rejection and duration of activity of transplant in rabbits that underwent retroperitoneal heterotopic heart transplantation

AIM

In this study, mycophenolate mofetil (MMF) and methylprednisolone (MP) were compared in terms of rejection and duration of activity of the transplant in New Zealand rabbits that underwent retroperitoneal heart transplantation.

METHODS

Retroperitoneal heart transplantation was performed in New Zealand white rabbits. The animals were divided into two groups. MMF group (group 1) (10 donors, 10 recipients): 12.5 mg/kg MMF was administered orally for two days prior to the surgery; MP group (group 2) (nine donors, nine recipients): 2 mg/kg MP was administered intramuscularly for two days prior to the surgery. After the operation, we waited until all motor activity in the transplanted heart had stopped. The transplant was then removed and the recipient was sacrificed. A donor in the MP group was excluded since it died before the motor activity had stopped.

RESULTS

No statistically significant difference was found between the groups in terms of rejection score (p = 0.865). However, duration of motor activity was found to be statistically significantly longer in the MMF group, compared to the MP group (p = 0.013).

CONCLUSION

In this experimental study, MMF was similar to MP in terms of rejection but had better efficacy in terms of duration of motor activity of the transplant.

Thoracic periaortic adipose tissue is increased in patients with subclinical hypothyroidism

OBJECTIVE

To evaluate thoracic periaortic adipose tissue (TAT) volume in patients with subclinical hypothyroidism (SH) in comparison with controls and in relation to cardiovascular risk factors.

METHODS

The study population consisted of 28 newly diagnosed SH patients (mean (s.d.) age: 37.3 (±11.4) years, 85.7% were females) and 37 healthy volunteers (mean (s.d.) age: 35.3 (±10.7) years, 81.5% were females). Comparisons between patient and control groups used demographic characteristics, anthropometrics, and laboratory findings. All participants underwent thoracic radiographic assessment in the supine position, using an eight-slice multidetector computed tomography scanner and TAT volume was measured.

RESULTS

The TAT volume was determined to be 27.2 (±12.7) cm(3) in the SH group and 16.3 (±8.1) cm(3) in the control group, and the difference was statistically significant (P<0.001). In addition, TSH levels were significantly higher in the patient group compared with the control group (P<0.001). A significant correlation was also found between TSH levels and TAT volume (r=0.572; P<0.001). In SH patients, no significant difference was noted in TAT levels with respect to sex (P=0.383) or concomitant smoking status (P=0.426).

CONCLUSIONS

Our findings indicate that SH patients have significantly higher TAT values than controls and that increased TAT levels correlate with increased TSH levels.

Cross-sectional Imaging Features of Primary Retroperitoneal Tumors and Their Subsequent Treatment

Basically malignant tumors in the retroperitoneal region arise from a heterogeneous group of tissues: mesodermal, neurogenic, germ cell, and lymphoid. Although rare, benign tumors and cystic masses can be also encountered in retroperitoneal space. Developments in computed tomography (CT) and magnetic resonance imaging (MRI) have contributed to both diagnosis and staging of the retroperitoneal tumors. High spatial resolution and superiority in calcification make CT indispensable; on the other hand, MRI has a better soft-tissue contrast resolution which is essential for the assessment of vascular invasion and tissue characterization. The aim of this article is to review the CT and MRI features of retroperitoneal tumors and their subsequent management.

Management of patients with retroperitoneal tumors and a review of the literature

Background

Retroperitoneal tumors (RTs) develop insidiously and are generally seen as large masses, and 50% of RTs are larger than 20 cm at the time of diagnosis. In this article, we share our experience of 5 years of surgical management of RTs.

Methods

We evaluated 28 RT cases operated on in three education hospitals in Turkey from January 2008 onwards, with regard to patients’ demographic characteristics, complaints, weight loss figures, the location and size of the tumor, blood transfusion, intra-operational time, metastases (in malignant cases), additional organ resection, histological grade, local recurrences, average life expectancy, and post-operative treatment methods.

Results

The mean age of the patients was 49 years (range, 18 to 78 years). Twenty (71.43%) were female, and 8 (28.57%) were male. The primary complaint was abdominal pain in 18 patients (64.28%). CT scans were performed in 17 (61%) patients, 10 (35.4%) underwent abdominal MR imaging, and 1 (3.6%) underwent both abdominal CT and abdominal MR imaging. A mass was palpated in the pelvis (suprapubic region) in seven (25%) of the patients during physical examination. The largest tumors were detected in the left lumbar area. The mean tumor size was 12.78 cm (range, 2 to 30 cm). The mean intra-operational time was 192 min (range, 70 to 380 min). The mean hospitalization period was 11 days (range, 8 to 23 days). Seven (25%) patients were reported to have benign tumors, while 21 (75%) were reported to have malignant tumors. The most frequently seen malignant pathology was liposarcoma (eight cases; 38.09%) followed by leiomyosarcoma (five cases; 23.8%) and malignant fibrous histiocytoma (four cases; 19.04%). The earliest local recurrence was detected in the 12th month and the latest in the 28th month. A total of 11 (52.3%) of the total of 21 malignant cases experienced local recurrence within 3 years. The 3-year average life expectancy was 85.7% in the 18 malignant cases.

Conclusions

Due to the low response rate of all but two types of RT to chemotherapy, the best remaining treatment option is surgery with wide resection margins, whereby all macroscopic traces of tumor are removed.

Association of neutrophil/lymphocyte ratio with obstructive coronary artery disease and coronary artery calcium score detected by multislice computed tomography in type 2 diabetes mellitus patients

OBJECTIVE

The aim of the present study was to investigate the association of neutrophil/lymphocyte ratio (NLR) with coronary artery calcium score (CACS) and obstructive coronary artery disease (CAD) detected by multislice computed tomography (MSCT) angiography in type 2 diabetes mellitus (T2DM) patients.

METHODS

Two hundred and ninety-two T2DM patients, who were either asymptomatic or symptomatic (but noncharacteristic) for coronary artery disease (CAD) and underwent MSCT angiography in our clinic between May 2009 and June 2014, were enrolled. All patients were divided into two groups according to their mean NLR values. Patients with NLR ≤2.05 were assigned to Group 1 and patients with NLR >2.05 were assigned to Group 2. The association of NLR with CACS and obstructive CAD, which were detected by MSCT angiography, was investigated in T2DM patients.

RESULTS

According to the Agatston scoring method, the mean CACS was 129.5±209.8 Au in Group 1 and 290.3±399.6 Au in Group 2 (P<0.001). Obstructive CAD was detected in 40 (26.8%) patients in Group 1 and in 56 (39.2%) patients in Group 2 (P<0.05, P<0.021).

CONCLUSION

The rate of obstructive CAD was significantly higher in the T2DM patients with NLR >2.05 than that in the T2DM patients with NLR ≤2.05. In addition, the CACS was also significantly higher in the T2DM patients with NLR >2.05 than that in the T2DM patients with NLR ≤2.05.

Relationship of coronary artery disease with pericardial and periaortic adipose tissue and their volume detected by MSCT

INTRODUCTION

The relationship of pericardial and periaortic adipose tissue with coronary artery disease (CAD) and the significance of this relationship were investigated.

METHODS

The present study included 323 subjects, with or without cardiac symptoms, who underwent multislice computed tomography coronary angiography between May 2009 and January 2013. Patients were divided into two groups according to the mean values of pericardial adipose tissue volume (PCFV) and periaortic adipose tissue volume (PAFV). In the grouping based on PCFV, subjects with PCFV<157.7 cm3 comprised Group 1, and those with PCFV≥157.7 cm³ comprised Group 2. According to PAFV values, Group 1 consisted of subjects with PAFV<24.3 cm³, and Group 2 subjects with PAFV≥24.3 cm³. The relationship of CAD with each of PCFV and PAFV was investigated.

RESULTS

Based on PCFV measurements, there were 79 (43.6%) and 113 (79.6%) patients with CAD in Groups 1 and 2, respectively. Based on PAFV measurements, Group 1 comprised 90 (48.1%) and Group 2 comprised 102 (75%) CAD patients.

CONCLUSIONS

In both groupings, the prevalence of CAD was significantly higher in Group 2 versus Group 1 (p<0.01 for both). There was a significant relationship between CAD and PAFV (p<0.05), but the relation between CAD and PCFV was more significant (p<0.01).

Thoracic periaortic adipose tissue in relation to cardiovascular risk in type 2 diabetes mellitus

OBJECTIVE

To evaluate thoracic periaortic adipose tissue (TAT) burden in patients with type 2 diabetes mellitus (DM) in comparison with controls and in relation to cardiovascular risk factors.

METHODS

A total of 93 patients with type 2 DM (mean (standard deviation; SD) age: 56.7 (11.2) years, 71.0 % were men) and 85 nondiabetic control subjects (mean (SD) age: 54.6 (10.9) years, 58.8 % were men) who were admitted to Mevlana University hospital between January 2011 and June 2013 and underwent multidetector computed tomography for any reason were included in this retrospective cohort study. Patient and control groups were compared in terms of demographic characteristics, anthropometrics, and laboratory findings. TAT volume was evaluated in both groups, while correlates of TAT were determined via linear regression analysis among patients.

RESULTS

In patients with type 2 DM, TAT volume (40.1 (23.9) versus 16.9 (7.7) cm(3), p < 0.001), fasting blood glucose (p < 0.001), total cholesterol (p < 0.001), triglyceride (p = 0.017), and low-density lipoprotein (LDL) cholesterol (p = 0.034) levels were significantly higher compared with the control group. Strong positive correlation of TAT was noted with body mass index (r = 0.339, p = 0.001) and serum levels for fasting blood glucose (r = 0.343, p < 0.001), hemoglobin A1c (HbA1c; r = 0.615, p < 0.001), total cholesterol (r = 0.269, p = 0.009), and LDL cholesterol (r = 0.258, p = 0.013). In stepwise regression analysis, Hba1c emerged as a significant predictor of TAT (b = 0.610, p < 0.001), contributing to 19 % of its variability.

CONCLUSION

In conclusion, our findings indicate significantly higher values for TAT in diabetics than controls, being associated positively with body weight, poor glycemic control, and dyslipidemia and strongly predicted by HbA1c levels in diabetic patients, while not differing with respect to gender, smoking status, and concomitant hypertension.

Investigation of relation between visceral and subcutaneous abdominal fat volumes and calcified aortic plaques via multislice computed tomography

OBJECTIVE

The present study investigated effect of subcutaneous fat volume and abdominal visceral fat volume on aortic atherosclerosis via multislice computed tomography.

MATERIALS AND METHODS

The present study comprised 424 subjects who underwent non-contrast-enhanced abdominal CT in our clinic between June 2012 and June 2013. Using dedicated software visceral fat volume was calculated for each individual and then subcutaneous fat volume was calculated by subtracting visceral fat volume from total fat volume. By dividing visceral fat volume/subcutaneous fat volume participants were assigned to three groups according to their mean visceral fat volume/subcutaneous fat volume: Group 1 consisted of subjects with visceral fat volume/subcutaneous fat volume lower than 0.48 (Group 1 < 0.48); Group 2 consisted of subjects with visceral fat volume/subcutaneous fat volume equal to or higher than 0.48 and lower than 0.69 (0.48 ≤ Group 2 < 0.69); and Group 3 consisted of subjects with visceral fat volume/subcutaneous fat volume equal to or higher than 0.69 (Group 3 ≥ 0.69).

RESULTS

The mean abdominal aortic calcium scores according to Agatston scoring (au) were 136.8 ± 418.7 au in Group 1, 179.9 ± 463 au in Group 2 and 212.2 ± 486.9 in Group 3, respectively.

CONCLUSIONS

We have demonstrated a significant correlation between visceral fat volume and abdominal aorta atherosclerosis, while there was absence of significant correlation between subcutaneous fat volume and abdominal atherosclerosis.

Epicardial Fat Tissue Predicts Increased Long-Term Major Adverse Cardiac Event in Patients With Moderate Cardiovascular Risk

We investigated the relationship between epicardial fat volume (EFV) measured by multislice computed tomography (MDCT) and long-term major adverse cardiac events (MACEs). Consecutive patients (n = 564) were enrolled in this retrospective study. Patients were divided into tertiles according to EFV. Patients were followed up for an average of 18 months. Patients in each tertile were similar in terms of gender and risk factors. Patients with greater EFV in the third group were more likely to be overweight ( P = .001) and older ( P = .001). High-density lipoprotein cholesterol levels were relatively lower in the third tertile (45 ± 9, 45 ± 11, and 43 ± 9 mg/dL, respectively; P = .018). The third group had a significantly higher rate of myocardial infarction (0.6%, 1.1%, and 3.7%, respectively; P = .043). The incidence of MACEs during the follow-up period was highest in the third group 15.9% (4.1%, 7.7%, and 15.9%, respectively; P = .001). Epicardial fat volume measured by MDCT was associated with increased long-term cardiovascular risk.

Effectiveness of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy

OBJECTIVE

To evaluate effectivenes of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy.

MATERIALS AND METHODS

Retrospective chart review of 67 cases, with symptomatic myoma uteri and undertaken abdominal myomectomy, was performed. Myomectomy was performed in Group 1 (n = 34) by Foley catheter tourniquet around both uterin vessels and in Group 2 (n = 33) the tourniquet was not performed.

RESULTS

The average blood loss during myomectomy was 286.4 +/- 137.5 ml for the tourniquet group and 673.8 +/- 172.3 ml for the control group. Postoperative blood transfusion was necessary in two patients from the control group. Technique significantly reduced the intraoperative blood loss and postoperative hemoglobin fall in patients. No serious complications occured on account of the tourniquet technique.

CONCLUSIONS

The pericervical tourniquet by Foley catheter is a safe and effective method for reducing blood loss during abdominal myomectomy, although it should be evaluated in a randomized controlled trial.

Assessment of the relationship between non-alcoholic fatty liver disease and CAD using MSCT

Background

Some risk factors for atherosclerosis are followed by non-alcoholic fatty liver disease (NAFLD). We wanted to use Multislice computed tomography (MSCT) as technique for searching relationship between NAFLD and coronary artery disease (CAD).

Objective

The relationship between NAFLD and CAD was investigated using MSCT.

Methods

A total of 372 individuals with or without cardiac symptoms who had undergone MSCT angiography were included in the study. The patients were divided into two groups according to the presence of NAFLD. Coronary artery segments were visually evaluated via MSCT angiography. Based on the coronary artery stenosis degree, those with no or minimal plaques were considered normal, whereas those who had stenosis of less than 50% and at least one plaque were considered to have non-obstructive coronary artery disease (non-obsCAD). The patients who had at least one plaque and coronary artery stenosis of 50% or more were considered to have obstructive coronary artery disease (obsCAD). NAFLD was determined according to the MSCT protocol, using the liver density.

Results

According to the liver density, the number of patients with non-alcoholic fatty liver disease (group 1) was 204 (149 males, 54.8%) and with normal liver (group 2) was 168 (95 males, 45.2%). There were 50 (24.5%) non-obsCAD and 57 (27.9%) obsCAD cases in Group 1, and 39 (23.2%) non-obsCAD and 23 (13.7%) obsCAD cases in Group 2.

Conclusions

The present study using MSCT demonstrated that the frequency of coronary artery disease in patients with NAFDL was significantly higher than that of patients without NAFDL.

Portal and splenic hemodynamics in cirrhotic patients: relationship between esophageal variceal bleeding and the severity of hepatic failure

BACKGROUND

The relationship between portal and splenic vein hemodynamics, liver function, and esophageal variceal bleeding in patients with cirrhosis remains unclear. The aim of the present study was to investigate quantitative Doppler parameters of splanchnic hemodynamics in cirrhotic patients and to determine the value of the Doppler parameters in predicting esophageal variceal bleeding.

METHODS

With the help of pulsed Doppler ultrasonography, we investigated portal and splenic hemodynamics in 18 healthy controls and in 45 patients with liver cirrhosis, in whom the relationship of splenic hemodynamics with esophageal variceal bleeding and the grade of cirrhosis was examined.

RESULTS

Portal flow velocity was decreased in cirrhotic patients with Child's C cirrhosis, as compared to those with Child's A cirrhosis ( P < 0.001). The portal blood flow volume in Child's C cirrhosis were also significantly low compared to patients with Child's A and Child's B cirrhosis ( P < 0.001 and P < 0.05, respectively). There was a significant increase in the portal vein congestion index and splenic vein congestion index in patients with Child's C cirrhosis as compared to patients with Child's A cirrhosis ( P < 0.001). Among cirrhotic patients, the group with esophageal variceal bleeding had significantly greater splenic blood flow volume and splenic vein congestion index ( P < 0.001). Patients with ascites had significantly lower portal flow velocity ( P < 0.001) and higher portal vein congestion index and splenic vein congestion index ( P = 0.003 and P = 0.05, respectively) as compared to those without ascites.

CONCLUSIONS

In this report we have shown that the decrease in blood flow and increased congestion indexes in the portal vein and splenic vein are related to the impairment of liver function in cirrhotic patients; these indexes may be valuable factors for predicting esophageal variceal bleeding.