Prognostic significance of red cell distribution width in acute mesenteric ischemia.

OBJECTIVE: Acute mesenteric ischemia (AMI) is an infrequent, but complicated, life-threatening condition. Given this poor outcome, an estimation of mortality would aid in decision making for physicians, patients and their families. Red cell distribution width (RDW) is reflective of systemic inflammation. RDW is a remarkable prognostic marker for determining the risk of mortality in a wide range of clinical manifestations. The objective of this study was to investigate the association between RDW and mortality in patients with AMI. METHODS: The medical records of patients who underwent laparotomy with a preoperative diagnosis of AMI were reviewed retrospectively. Primary outcome variable was the hospital mortality rate. RESULTS: Estimating the receiver operating characteristic area under the curve showed that RDW has good discriminative power for mortality (area under the curve = 0.713; 95% confidence interval, 0.584-0.841). With a cut-off value of 14.85 for RDW, mortality could be correctly predicted in approximately 70% of cases. CONCLUSIONS: Increased RDW at admission was a predictor of the extent of necrosis and mortality in AMI patients. Further prospective studies are necessary to more accurately assess the importance of RDW in these patients.

Relationship of galectin-3 to left ventricular geometry and hypertrophy in chronic hemodialysis patients.

AIM AND BACKGROUND: Galectin-3 (Gal-3) is used to determine the prognosis of heart failure. Some studies revealed that Gal-3 promoted cardiac hypertrophy but there is no study in which the relationship between Gal-3 and left ventricular hypertrophy (LVH) geometry in patients without diastolic and systolic function impairment has been explored. The aim of the study was to analyze associations between plasma Gal-3 levels, LVH, and LV geometry in maintenance hemodialysis (HD) patients without systolic and diastolic dysfunction. PATIENTS AND METHODS: The study group included 105 patients (53 women and 52 men)--with an average age of 58.2 ± 12.6 years, treated with HD for an average of 45 ± 32 months--and 60 healthy controls. The Gal-3 and other biochemical parameters were measured and color Doppler echocardiography was performed. For this study LVH was considered present when the LV mass index (LVMI) exceeded 95 g/m(2) in women and 115 g/m(2) in men. Left ventricular geometry was classified into the four groups on the basis of left ventricular mass and relative wall thickness (RWT). RESULTS: Concentric hypertrophy (CH, 40.9 %, n = 43) was the commonest geometric pattern in our study. The Gal-3 levels in CH patients were not different from the patients with eccentric hypertrophy (EH). Plasma levels of Gal-3 correlated with LVMI (r = 0.617, p < 0.001), parathyroid hormone (PTH, r = 0.408, p < 0.001), uric acid (r = 0.281, p = 0.004), C-reactive protein (CRP, r = 0.412, p < 0.001), and RWT (r = 0.281, p = 0.004) but were inversely correlated with albumin (r = - 0.466, P < 0.001) in the whole group. Plasma levels of Gal-3 were associated with LVMI (r = 0.812, P < 0.001), RWT (r = 0.318, p = 0.001), and CRP(r = 0.381, p < 0.001) in maintenance hemodialysis patients. CONCLUSION: The Gal-3 level is related to left ventricular hypertrophy and it is independent of left ventricle geometry. The relationship between LVH and Gal-3 might be direct or it may also be inflammation-related.

Serum bFGF concentrations in gastric cancer patients.

BACKGROUND: Angiogenetic factors play an important role in the formation of new blood vessels involved in the growth and metastatic spread of solid tumors, but there is limited information regarding the clinical significance of serum bFGF levels in gastric cancer patients. PATIENTS AND METHODS: Serum bFGF concentrations were measured by quantitative sandwich enzyme immunoassay technique in 30 controls and in 30 gastric cancer patients before surgery. The association between preoperative serum bFGF levels and clinical pathological features were evaluated. RESULTS: Preoperative serum bFGF levels in patients with gastric cancer were significantly higher than those in control patients (p=0.027). On the other hand; there is no relationship between serum bFGF levels and clinical-pathologic parameters in gastric cancer patients. CONCLUSION: Circulating bFGF might not be a marker suitable for assessing tumor progression (Tab. 1, Ref. 7). Full Text (Free, PDF) www.bmj.sk.

Evaluation of risk factors for mortality in perforated peptic ulcer in Ankara Numune Teaching Hospital, Ankara, Turkey.

OBJECTIVE: To assess the risk factor that influence mortality from perforated peptic ulcer. DESIGN: Retrospective study. SETTING: Ankara Numune Teaching and Research Hospital, Ankara, Turkey. SUBJECTS: A total of 342 patients with perforated peptic ulcer disease were identified from April 1997 to January 2004. Data for the patients were extracted from the hospital records, operative notes and clinic charts. MAIN OUTCOME MEASURES: Age, sex, coexisting medical illness, use of non-steroidal anti-inflammatory drugs (NSAID) or steroids, preoperative shock, delay in treatment location of ulcer size, type of operation time, albumin concentration postoperative complications, postoperative hospitals stay and mortality results for all patients were obtained. RESULTS: Patients were aged from 17 to 80 years (mean 63 years, median 68 years) there were 210 males and 132 females. The mortality rate was 8.8% (30/342), and 62 patients had postoperative complications. Multivariate analysis showed that co-existing medical illness, preoperative shock, delay in treatment and low albumin concentrations were independent risk factors that significantly contributed to mortality. CONCLUSION: This study confirms co-existing medical illness, preoperative shock, delay in treatment and low albumin concentration as significant risk factors that increase mortality in patients with perforated peptic ulcers. These factors could serve as a guide to opine the risk and to improve the outcome in patients with perforated peptic ulcer. Mortality could be reduced by preventing delay in diagnosis and treatment for any co-existing medical illness and providing appropriate nutrition support.

Effects of shock waves on the rat foetus.

Controversy exists concerning whether shock wave lithotripsy (SWL) is contraindicated during pregnancy (4, 5). The effects of shock waves on a variety of cells are well documented in both clinical and experimental studies, but their effect on the foetus remains unclear. In this study, we investigated the effects of SWL on the rat foetus. On the 8th, 11th, 14th and 17th days of pregnancy, 100, 250 or 500 shock waves were administered with a Multimed 2001 ELMED Systems Lithotriptor. In ongoing pregnancy, the effects of SWL on the foetus ranged from early mild effects to later moderate effects and fatal effects. There were no viable foetuses in the latest period of pregnancy in rats receiving 500 shocks waves. Histological changes were observed in the brain, lungs and subcutaneous tissue. Fusion and necrosis were found in many dead foetuses. Our study demonstrates that SWL causes foetal damage and death in the late period of pregnancy in rats.