Analysis of Isotretinoin-Induced Alterations in the Levels of Plasma Trace Elements: Investigation of the Relationship Between Magnesium, Phosphorus, Potassium, Zinc, and Treatment-Related Side Effects.

Isotretinoin is an effective treatment against acne vulgaris, but it also causes many side effects during and after the treatment. The relationship between the changes in the levels of plasma trace elements of patients with AV after 3 months of isotretinoin treatment and the side effects was investigated in the study. Plasma samples of 35 patients were collected before and after isotretinoin treatment. Samples were analyzed by Inductively Coupled Plasma-Mass Spectrometer. After treatment, the levels of phosphorus, magnesium, and zinc in plasma increased statistically, while the level of potassium decreased (p < 0.05). The treatment had differing effects on zinc levels based on the gender of the individuals. With treatment, the levels of zinc in the plasma of men showed a greater increase compared to women (p = 7.3e-04). Additionally, the correlation matrix analysis revealed a strong correlation (R > 0.8) between magnesium and calcium. According to the study results, the change in phosphorus and potassium levels shows that isotretinoin affects kidney functions. The results suggest that phosphorus, potassium, magnesium, and zinc are associated with fatigue, dry skin and chapped lips, hair loss, and sebum secretion, respectively. Consequently, the study emphasizes the need for a comprehensive pre-treatment assessment, including monitoring of liver and kidney function as well as the levels of phosphorus and potassium in patients.

Long-term follow-up results of multiparametric prostate MRI and the prognostic value of PI-RADS: a single-center retrospective cohort study.

PURPOSE: We aim to examine the long-term outcomes of patients who underwent multiparametric prostate magnetic resonance imaging (mp-MRI) for suspected prostate cancer (PCa), specifically based on their initial Prostate Imaging Reporting and Data System (PI-RADS) categories and various clinical factors. Our secondary aim is to evaluate the prognostic value of the PI-RADS through the National Comprehensive Cancer Network (NCCN) risk group distribution. METHODS: This research was conducted as a single-center retrospective cohort study in a tertiary care hospital. A total of 1,359 cases having at least one histopathological examination after the initial mp-MRI and/or adequate clinical/radiological follow-up data were included in the clinically significant PCa (cs-PCa) diagnosis-free survival analysis. Initial mp-MRI dates were accepted as the start of follow-up for the time-to-event analysis. The event was defined as cs-PCa diagnosis (International Society of Urological Pathology ≥2). Patients who were not diagnosed with cs-PCa during follow-up were censored according to predefined literature-based criteria at the end of the maximum follow-up duration with no reasonable suspicion of PCa and no biopsy indication. The impact of various factors on survival was assessed using a log-rank test and multivariable Cox regression. Subsequently, 394 cases diagnosed with PCa during follow-up were evaluated, based on initial PI-RADS categories and NCCN risk groups. RESULTS: Three main risk factors for cs-PCa diagnosis during follow-up were an initial PI-RADS 5 category, initial PI-RADS 4 category, and high MRI-defined PSA density (mPSAD), with average hazard ratios of 29.52, 14.46, and 3.12, respectively. The PI-RADS 3 category, advanced age group, and biopsy-naïve status were identified as additional risk factors (hazard ratios: 2.03, 1.54-1.98, and 1.79, respectively). In the PI-RADS 1-2 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 99.1%, 96.5%, and 93.8%, respectively. For the PI-RADS 3 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 94.9%, 90.9%, and 89.1%, respectively. For the PI-RADS 4 cohort, 1, 3, and 5-year cs-PCa diagnosis-free survival rates were 56.6%, 55.1%, and 55.1%, respectively. These rates were found to all be 24.2% in the PI-RADS 5 cohort. Considering the 394 cases diagnosed with PCa during follow-up, PI-RADS ≥4 cases were more likely to harbor unfavorable PCa compared to PI-RADS ≤3 cases (P < 0.001). In the PI-RADS 3 subgroup analysis, a low mPSAD (<0.15 ng/mL2) was found to be a protective prognostic factor against unfavorable PCa (P = 0.005). CONCLUSION: The PI-RADS category has a significant impact on patient management and provides important diagnostic and prognostic information. Higher initial PI-RADS categories are associated with decreased follow-up losses, a shorter time to PCa diagnosis, increased biopsy rates, a higher likelihood of developing cs-PCa during follow-up, and a worse PCa prognosis. Combining mPSAD with PI-RADS categories could enhance diagnostic stratification in the identification of cs-PCa.

Portable manipulation system for commercial robotic surgery forceps.

BACKGROUND: Transition from the utilisation of traditional instruments to new robotic methodologies in surgical operations occurs rapidly. Although the implementation of these methodologies to classical surgery operations is advantageous due to increased precisions and enhanced motion capabilities of robotic systems, overall worldwide accessibility and adaptation are still limited due to high equipment costs and special infrastructure requirements. METHODOLOGY: The design of four degrees of freedom low cost, compact and portable manipulation system was proposed to allow the utilisation of commercial robotic surgery forceps like a conventional laparoscopy instrument without the necessity of bulky manipulation systems. RESULTS: The structural design of the system was carried out along with necessary kinematic and coupled motion analysis. Prototypes were constructed. Hardware verification of the system was executed using implemented control methodology. CONCLUSIONS: The proposed design successfully demonstrated the advantages of multi degree of freedom robotic surgery forceps in a portable handheld system compared to classical laparoscopy instruments.

Utilization of Function Generation Synthesis on Biomimetics: A Case Study on Moray Eel Double Jaw Design.

Throughout history, humans have observed living or non-living things in nature and then imitated them in relation to these observations. This is due to the fact that the energy found in nature is generally consumed at an optimal level in order for it to endure. Biomimetic inspiration in many designs and applications is widely displayed, including within the field of engineering. In this paper, we were inspired by the double set of jaws found in the moray eel, which gives this fish a huge advantage while hunting, with a mobile pharyngeal jaw that works together with its oral jaw in order to overcome ineffective suction capabilities. A procedure that mimics the hunting motion of the moray eel was utilized by considering the overall movement as a single degree of freedom with multiple outputs on account of the repeating motion that is required during hunting. This procedure includes structural and dimensioning synthesis, wherein the latter was utilized with analytic kinematic synthesis for each linkage transfer. The flexibilities in parameters were taken into account with a novel multiple iterative kinematic synthesis algorithm that resulted in various mechanisms with the same purpose. Among the excessive number of resultant mechanisms, the optimization was carried out by considering the highest torque transmission ratio at critical timings that were specified as bio-constraints. In the end, the kinematic movement validation was utilized.

Effect of age on computed tomography findings: Specificity and sensitivity in coronavirus disease 2019 infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019. Although the real-time reverse tr-anscription PCR test for viral nucleic acids is the gold standard for COVID-19 diagnosis, computed tomography (CT) has grown in importance. AIM: To evaluate the sensitivity and specificity of thoracic CT findings of COVID-19 pneumonia according to age groups. METHODS: PCR and CT results from 411 patients were reviewed. The diagnosis of COVID-19 pneumonia was made by three radiologists. Lymphadenopathy, pericardial effusion, pleurisy, pleural thickening, pleural effusion, location features of the lesions, ground glass, consolidation, air bronchogram, vascular enlargement, bronchial dilatation, halo finding, inverted halo sign, nodularity, air bubble, subpleural band (curvilinear density), reticular density, crazy paving pattern, and fibrosis findings were recorded. The patients were divided into nine groups by decades while calculating the sensitivity, specificity, and diagnostic efficacy for CT positivity. RESULTS: The mean age of the cases was 48.1 ± 22.7 years. The CT finding with the highest diagnostic power was ground glass. Vascular enlargement and bronchial dilatation followed ground glass. Peri-cardial effusion was the finding with the lowest diagnostic accuracy. The incidence of lymphadenopathy, pleurisy, pleural thickening, peripheral localization, bilateral, ground glass, vascular enlargement, bronchial dilatation, subpleural band, reticular density, crazy paving appearance, and fibrosis all increased increase significantly with age in patients with positive real-time reverse transcription PCR test. CONCLUSION: There are few publications comparing sensitivity and specificity of thoracic CT findings according to age. In cases of COVID-19 pneumonia, there is an increase in the variety and frequency of CT findings with age, and parallel to this the sensitivity and specificity of the findings increase. COVID-19 cases in the pediatric age group have fewer lung findings than adults, and this situation decreases the diagnostic value of CT in pediatric patients.

Pathology associated with adherent perirenal fat and its clinical effect.

INTRODUCTION: The dissection of perirenal fat is of critical importance to kidney surgery and ease of dissection is more important when using minimally invasive approaches. This study aimed to determine the clinical, radiological, and pathological significance of adherent perirenal fat (APF). MATERIALS AND METHODS: This prospective study included 22 patients scheduled for partial nephrectomy and 40 patients for donor nephrectomy. Intraoperative fat dissection time was recorded, and the complexity of perirenal fat dissection was surgeon-classified as easy, moderate, and difficult. Perirenal fat and subcutaneous fat thickness were measured. Measurement of perirenal fat depth and the Hounsfield unit (HU) for both perirenal and subcutaneous fields were performed using computed tomography (CT) images. All specimens were submitted for histopatological analysis. Researchers in each arm were blinded to other researchers' data. RESULTS: Mean age of the patients was 51.3 ± 12.7 years. Mean perirenal fat dissection time was 15.0 ± 13.5 minutes. Patient demographics, BMI, nor occupational status differed between the 3 complexity of perirenal fat dissection groups. Radiological findings showed that there was a significant correlation between perirenal fat depth and complexity of perirenal fat dissection (P < .05), but not with HU measurements or subcutaneous fat thickness. Surgeon classification of the complexity of perirenal fat dissection was in accordance with the duration of dissection (P < .05). Perinephric fat contained more fibrous tissue in the patients with histologically proven APF than in those without (P < .05). CONCLUSIONS: APF is a challenge during kidney surgery. Difficult dissection prolongs the duration of perirenal fat dissection and surgery. Perirenal fat thickness measured via preoperative CT might be used to predict APF.

Determination of risk factors for progression in patients with viable tumor at post-chemotherapy lymph node dissection due to disseminated non-seminomatous germ-cell tumors.

BACKGROUND: To assess the clinical variables that effect progression in patients with viable tumor after post-chemotherapy lymph node dissection due to disseminated non-seminomatous germ-cell tumors. METHODS: We performed a retrospective analysis of 32 patients with viable tumor after PC-RPLND, operated between 1990 and 2016. Patients were categorized into 2 groups as favorable and non-favorable (intermedia and poor) according to International Germ Cell Consensus Classification (IGCCC). Tumor size was determined as the largest dimension of retroperitoneal mass. Clinical factors and adjuvant chemotherapy were evaluated to impact on recurrence free survival (RFS) and overall survival (OS). RESULTS: The median age of the patients and follow-up duration were 28.5 (17-51) years and 51.5 (4-253) months, respectively. 5-year RFS and OS were 57.8-66.8%, respectively. On univariate analysis, percentage of viable tumor, IGCCC risk group, primary site, second-line chemotherapy and surgical margin status were significant for RFS (p = 0.034, p = 0.002, p < 0.001, p = 0.011 and p < 0.001, respectively), while IGCCC risk group, second-line chemotherapy and surgical margin status were significant for OS (p = 0.004, p = 0.010 and p < 0.001, respectively). On multivariate analysis, second-line chemotherapy and surgical margin were independent risk factors for RFS (p = 0.016, HR 4.927 95% CI 1.34-18.02 and p < 0.001, OR 9.147 95% CI 2.61-31.98, respectively) and surgical margin status was the only predictor of OS (p = 0.038, HR 3.874 95% CI 1.07-13.69). CONCLUSION: Retroperitoneal lymph node dissection with negative surgical margin is essential for patients with viable residual tumor after chemotherapy. Need for second-line chemotherapy shows risk of progression.

Simultaneous Biofortification of Rice With Zinc, Iodine, Iron and Selenium Through Foliar Treatment of a Micronutrient Cocktail in Five Countries.

Widespread malnutrition of zinc (Zn), iodine (I), iron (Fe) and selenium (Se), known as hidden hunger, represents a predominant cause of several health complications in human populations where rice (Oryza sativa L.) is the major staple food. Therefore, increasing concentrations of these micronutrients in rice grain represents a sustainable solution to hidden hunger. This study aimed at enhancing concentration of Zn, I, Fe and Se in rice grains by agronomic biofortification. We evaluated effects of foliar application of Zn, I, Fe and Se on grain yield and grain concentration of these micronutrients in rice grown at 21 field sites during 2015 to 2017 in Brazil, China, India, Pakistan and Thailand. Experimental treatments were: (i) local control (LC); (ii) foliar Zn; (iii) foliar I; and (iv) foliar micronutrient cocktail (i.e., Zn + I + Fe + Se). Foliar-applied Zn, I, Fe or Se did not affect rice grain yield. However, brown rice Zn increased with foliar Zn and micronutrient cocktail treatments at all except three field sites. On average, brown rice Zn increased from 21.4 mg kg-1 to 28.1 mg kg-1 with the application of Zn alone and to 26.8 mg kg-1 with the micronutrient cocktail solution. Brown rice I showed particular enhancements and increased from 11 µg kg-1 to 204 µg kg-1 with the application of I alone and to 181 µg kg-1 with the cocktail. Grain Se also responded very positively to foliar spray of micronutrients and increased from 95 to 380 µg kg-1. By contrast, grain Fe was increased by the same cocktail spray at only two sites. There was no relationship between soil extractable concentrations of these micronutrients with their grain concentrations. The results demonstrate that irrespective of the rice cultivars used and the diverse soil conditions existing in five major rice-producing countries, the foliar application of the micronutrient cocktail solution was highly effective in increasing grain Zn, I and Se. Adoption of this agronomic practice in the target countries would contribute significantly to the daily micronutrient intake and alleviation of micronutrient malnutrition in human populations.

Distribution of Trace Metals in Street Dusts and Tree Leaves and Their Source Identification in a Mid-Populated Anatolian City.

Sivas is a central Anatolian city in Turkey with mid-population. Due to its geographical structure high air pollution episodes can be observed in the atmosphere of Sivas. A study with city wide sampling campaign can help to identify the possible sources. Therefore, we aimed to investigate the multi-elemental and multi-point analysis of trace metals in street dusts and tree leaves in Sivas. In the street dusts, Ca concentration was > 10%. Fe, Cl, and K contribution was 2.5%, 1.75%, and 1.1%, respectively. The average S and Ti concentrations were between 1 and 10 mg/g, I, Mn, Sr, Cr, V, Ba, Zn, Ni, Zr, and Cu were between 1 and 0.1 mg/g, and W, Pb, Sn, Th, Rb, Sb, Co, Bi, As, U were between 0.1 and 0.01 mg/g, in the ascending order. The same elements were investigated for vegetation. Ca, K, S, and Cl were the elements with highest contribution.

Fate and Bioaccessibility of Iodine in Food Prepared from Agronomically Biofortified Wheat and Rice and Impact of Cofertilization with Zinc and Selenium.

Enrichment of food crops with iodine is an option to alleviate dietary deficiencies. Therefore, foliar iodine fertilizer was applied on wheat and rice, in the presence and absence of the other micronutrients zinc and selenium. This treatment increased the concentration of iodine, as well as zinc and selenium, in the staple grains. Subsequently, potential iodine losses during preparation of foodstuffs with the enriched grains were studied. Oven-heating did not affect the iodine content in bread. Extraction of bran from flour lowered the iodine in white bread compared to wholegrain bread, but it was still markedly higher compared to the control. During subsequent in vitro gastrointestinal digestion, a higher percentage of iodine was released from foods based on extracted flour (82-92%) compared to wholegrain foods (50-76%). The foliar fertilization of wheat was found to be adequate to alleviate iodine deficiency in a population with a moderate to high intake of bread.

A Comprehensive sLORETA Study on the Contribution of Cortical Somatomotor Regions to Motor Imagery.

Brain-computer interface (BCI) is a technology used to convert brain signals to control external devices. Researchers have designed and built many interfaces and applications in the last couple of decades. BCI is used for prevention, detection, diagnosis, rehabilitation, and restoration in healthcare. EEG signals are analyzed in this paper to help paralyzed people in rehabilitation. The electroencephalogram (EEG) signals recorded from five healthy subjects are used in this study. The sensor level EEG signals are converted to source signals using the inverse problem solution. Then, the cortical sources are calculated using sLORETA methods at nine regions marked by a neurophysiologist. The features are extracted from cortical sources by using the common spatial pattern (CSP) method and classified by a support vector machine (SVM). Both the sensor and the computed cortical signals corresponding to motor imagery of the hand and foot are used to train the SVM algorithm. Then, the signals outside the training set are used to test the classification performance of the classifier. The 0.1-30 Hz and mu rhythm band-pass filtered activity is also analyzed for the EEG signals. The classification performance and recognition of the imagery improved up to 100% under some conditions for the cortical level. The cortical source signals at the regions contributing to motor commands are investigated and used to improve the classification of motor imagery.

A rare and overlooked mechanical complication of partial nephrectomy: Accelerated hypertension due to renal artery stenosis.

Secondary hypertension accounts for 5% to 10% of all hypertensive cases, and renal artery stenosis is one of the most common causes of secondary hypertension. Although atherosclerotic vascular disease and fibromuscular dysplasia are the leading causes of renal artery stenosis, there are other, rare etiologies, such as vasculitis and trauma. A partial nephrectomy is the standard of care treatment option for early stage renal carcinoma patients. Traumatic renal artery stenosis can occur during this surgical intervention, though it is a very rare adverse event, and only a few case reports have been reported in the literature. This report is the description of successful percutaneous treatment of accelerated hypertension secondary to traumatic renal artery stenosis after a partial nephrectomy.

Distribution of childhood skin diseases according to age and gender, a single institution experience.

AIM: Studies on pediatric skin diseases in Turkey are not yet sufficient. It was aimed to characterize the prevalence of skin diseases, age and gender distribution in children living in the Erzincan region. MATERIAL AND METHODS: 10,115 children aged 0-16 years who reached to our outpatient clinic between 01.11.2014 and 30.11.2016 were included in the study. The frequency, age and gender distribution of the skin diseases were examined. The cases were divided into 4 groups; infantile period (0-2 years), preschool period (3-5 years), school period (6-11 years) and adolescence period (12-16 years). Skin diseases were categorized in 10 groups. A total of 148 skin diseases were identified. RESULTS: 5376 of the patients were female (%53.14) and 4739 were male (%46.86). The most common disease groups are; infectious diseases (24.62%), eczema (21.95%), acne&follicular diseases (18.45%) and allergic skin diseases (11.02%). The most common diseases were acne vulgaris (17.82%), warts (10.03%) and irritant contact dermatitis (9.42%). The most common skin diseases in regard of different age groups are; contact dermatitis in the 0-2 years and 3-5 years age groups, warts in the 6-11 years age group, and acne vulgaris in 12-16 years age group. CONCLUSION: Most common diseases in our study are diseases that can be reduced by preventive health care and health education programs. There is a need for broad-based epidemiological studies in this area to establish preventive health care policies and to develop education programs.

Percutaneous Nephrolithotomy in Solitary Kidneys: 17 Years of Experience.

OBJECTIVE: To compare the demographics and the results of patients who underwent percutaneous nephrolithotomy (PCNL) with solitary and bilateral kidneys. MATERIALS AND METHODS: Between January 1998 and August 2014, 2268 patients underwent PCNL at Hacettepe University Hospital. We retrospectively analyzed the data of 91 patients with a solitary kidney and 2177 patients with bilateral kidneys treated by PCNL. We compared the success and complication rates between patients with solitary and bilateral kidneys. Additionally, we determined the factors affecting success and serious complications for patients with a solitary kidney. All statistical analyses were performed using SPSS 17.0 for Windows. The threshold for statistical significance was set at P <.05. RESULTS: The median age was 48 years and 61 patients (67%) were male. The median stone burden was 400 mm2. The stones were located in the renal pelvis in 27 patients (30%), in calices in 50 patients (55%), and in the staghorn in 14 patients (15%). A total of 57 patients (62%) underwent a left-side surgery. The comparison between solitary and nonsolitary patients showed that stone free, transfusion, and postoperative urinary tissue infection rates were similar. Complication rates, postoperative JJ stent requirements, and length of hospital stay were statistically higher in patients with a solitary kidney. The presence of a staghorn stone, the stone number (single-multiple), and male gender were found to have a negative impact on success. The existence of upper-pole stones was found to be the only factor that led to serious complications (Clavien 3-4). CONCLUSION: PCNL is an effective but more complicated option in patients with a solitary kidney, with stone-free rates similar to patients with bilateral kidneys.

Laparoscopic upper pole heminephrectomy in adults for treatment of duplex kidneys.

PURPOSE: To present our results of laparoscopic upper pole heminephrectomy in adult patients with duplex kidney. MATERIALS AND METHODS: A total of 10 patients with an age range of 27 to 54 years old underwent laparoscopic upper pole heminephrectomy for complete duplication of the renal collecting system. The key point of the technique included the placement of a catheter in the normal ureter at the beginning of the procedure. The patient was positioned in a 45-90 degrees lateral decubitus position and a 4-port transperitoneal or 3-port retroperitoneal technique was applied followed by the mobilization of the upper pole ureter away from the renal hilum. Afterwards, the vasculature supplying the upper pole was precisely identified and ligated. Followed by transection of the ureter and its transposition cephalad to the hilum, the upper pole moiety was fully transected using the harmonic scalpel. RESULTS: Eight patients were operated on using the transperitoneal approach and 2 using the retroperitoneal technique. One patient required preoperative percutaneous drainage due to pyonephrosis. The operation time ranged between 150 to 350 min with minimal blood loss (0-200 mL). Hemostasis was achieved with an Argon laser in one patient. The lower pole calyceal system was perforated in one patient and repaired intracorporally. No major intraoperative complications occurred. All of the patients except two had their drains removed in 72 h after the operation and were generally discharged on postoperative day 3. CONCLUSION: Laparoscopic upper pole heminephrectomy for an ectopic ureter is safe and reproducible and offers benefits of laparoscopic surgery even in patients with complicated urinary tract infection.

The importance of gamma-glutamyltransferase activity in patients with coronary artery disease.

BACKGROUND: In this study, we sought to investigate the relation of gamma-glutamyltransferase (GGT) levels with the significance of coronary artery disease (CAD), clinical presentation, left ventricular (LV) function, and inflammatory activity. METHODS: A total of 235 patients (mean age: 60.1 +/- 10.5 years, 166 [70%] males) who had coronary angiography were included in the study. Patients who had CAD constituted the study group (Group 1, n=189) and patients who had insignificant coronary disease or normal coronary activity constituted the control group (Group 2, n=46). RESULTS: GGT levels were higher in Group 1 than Group 2 (38.7 +/- 30.9 U/L versus 27.5 +/- 17.5 U/L, p =0.025). Left ventricular ejection fraction (LVEF) was lower in Group 1 than Group 2 (52.6% +/- 11.7% versus 58.8% +/- 11.3%, p < 0.002). GGT activity (40.2 +/- 32.5 U/L versus 29.1 +/- 18.3 U/L, p < 0.002) and c-reactive protein (CRP) levels (33.9 +/- 43.6 mg/dl versus 17.8 +/- 29.8 mg/dl, p < 0.002) were higher, LVEF (52.6% +/- 12.1% versus 56.5% +/- 11.0%, p =0.021) was lower in patients with acute coronary syndrome compared with stable CAD group. In regression analysis, CRP levels (p < 0.0001, odds ratio [OR]=3.77, 95% confidence interval [CI] 0.10 < OR < 0.32), LVEF (p =0.016, OR=- 2.44, 95% CI - 0.95 < OR < - 0.10) and LV end-diastolic pressure (p =0.015, OR=4.31, 95% CI - 1.19 < OR < - 0.13) were independent predictors of GGT activity. CONCLUSIONS: The increased GGT activity is related to LV function, clinical stability, and inflammatory activity rather than the severity of CAD. Measurement of GGT activity may be useful in predicting cardiovascular risk.

Intracoronary guidewire emboli: a unique complication and retrieval of the wire.

The breakdown of the guidewire during percutaneous coronary intervention (PCI) and the retention of the broken part inside the coronary or systemic vascular system is a rare complication. With the use of a flexible guidewire, the incidence of these complications has markedly decreased. In this case report, we report the withdrawal of a broken guidewire from the distal coronary during PCI.

The diagnostic value of multislice computed tomography in evaluation of coronary artery disease in patients with left bundle branch block.

OBJECTIVE: Noninvasive diagnostic methods do not supply sufficient data for patients with left bundle branch block (LBBB) accompanied with coronary artery diseases (CAD). Therefore, generally coronary angiography is required for these patients. Our aim was to evaluate the diagnostic value of multislice spiral computed tomographic (MSCT) coronary angiography to detect CAD in patients with LBBB. METHODS: Sixty one patients (31 males, 30 females, mean age: 56+/-13 years) with LBBB who have determined stenosis higher than 50% in quantitative coronary angiography were included in the cross-sectional study. The MSCT coronary angiography was applied to the patients with a 16-detector MSCT scanner that has an electrocardiographic synchronization unit. Each coronary artery was evaluated segmentally in the images acquired from MSCT coronary angiographies and any detected stenosis higher than 50% was recorded. RESULTS: The data of 793 coronary artery segments achieved from MSCT coronary angiographies of 61 patients (13 segments for each patient) were compared with the results of conventional coronary angiographies of the same patients. When all the segments evaluated were included in this comparison, the diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of MSCT coronary angiography to detect stenosis higher than 50% were 91%, 67%, 97%, 85% and 92%, respectively. Also, it was observed that, MSCT coronary angiography has 80% sensitivity and 90% specificity to detect, at least, one segment coronary artery stenosis. CONCLUSION: The MSCT coronary angiography can be utilized as a noninvasive diagnostic method for patients with LBBB, in order to evaluate coronary artery disease.

The effect of glucose-insulin-potassium treatment on myocardial oxidative stress in patients with acute coronary syndromes undergoing percutaneous coronary intervention.

OBJECTIVES: In this study, we sought to examine the effect of glucose-insulin-potassium (GIK) treatment on oxidative stress in patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary interventions (PCIs). METHODS: Patients with ACSs who had been electively treated with a stent implantation into the culprit vessel were included in this study. Patients were divided into two groups and were randomly administered either the GIK treatment (GIK group; n=28) or isotonic NaCl (control group; n=19) infusion during PCI. Blood samples from the coronary artery ostium (CO) were collected through the femoral artery and from the coronary sinus (CS) through the femoral vein, before and immediately after PCI. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) activities were measured. RESULTS: A total of 47 patients were included in the study. SOD, CAT, and GSH-Px activities, whether in the CO or the CS, were similar in both the GIK and control groups before the intervention (P>0.05). In the control group, SOD (in both the CO and the CS), CAT (in the CS), and GSH-Px (in the CS) activities were higher compared with baseline values (P<0.05). Such increases were, however, not seen in the GIK group (P>0.05). Although the CS-CO activity differences (venous-arterial) of SOD, CAT, and GSH-Px, which are parameters of myocardial reactive antioxidant enzyme production, were increased in the control group, there was no increase in the GIK group. CONCLUSIONS: In patients with ACSs, reactive local enzyme activity increases for the scavenging to myocardial-free radicals during PCI. Administration of a solution of GIK as a metabolic support agent might prevent oxidative stress in the myocardial level, in these patients.