Endothelial constitutive nitric oxide synthase, angiotensin converting enzyme, angiotensin II type 1 receptor gene polymorphisms and endothelial functions in healthy individuals.

INTRODUCTION: Endothelial dysfunction is recognized as an early and initiating event in the pathogenesis of coronary artery disease. Gene polymorphisms of endothelial constitutive nitric oxide synthase (ecNOS), angiotensin converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) have been found to be associated with atherosclerosis.  We aimed to investigate the possible effects of ecNOS, ACE and AT1R gene polymorphisms on endothelial functions in healthy population. MATERIALS AND METHODS: In 255 healthy subjects (male/female: 119/136 mean age 35.1±2.3 years)  ecNOS, ACE and AT1R gene polymorphisms were assessed by polymerase chain reaction (PCR). Endothelium dependent (EDD, flow-mediated) and endothelium independent vasodilation (EID) were measured by high resolution brachial artery ultrasound and 0.5 mg sublingual nitroglycerine respectively. RESULTS: ecNOS and ACE genes had no significant effect on EDD and EID. However, subjects with AT1RAC+CC genotypes had lower EDD compared to subjects with AT1RAA genotype in females (19.4 ± 6.6% vs 21.5 ± 7.8%, p = 0.041). EDD and EID were significantly negatively associated with  age, body mass index, serum creatinine, glucose, uric acid and hemoglobin levels. When the data on age, uric acid, BMI, glucose, creatinine, and hemoglobin were split into 3 as low-1/3, mid-1/3 and  high 1/3, there was significant graded decrease in EDD and EID with these parameters. In multiple regression analysis, age and presence of AT1RAC+CC genotype  retained as significant independent factors predicting endothelial functions. CONCLUSIONS: Gene polymorphisms of endothelial constitutive nitric oxide synthase and  angiotensin converting enzyme had no effect on endothelial functions. However, the presence of angiotensin II type 1 receptor polymorhism (AT1RAC+CC genotype) seemed to adversely affect the endothelial functions as reflected by impaired endothelium dependent and independent vasodilatation in healthy individuals.

The outcomes of surgical treatment in fistulous dacryocystitis.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the outcomes of surgical management in fistulous dacryocystitis cases associated with nasolacrimal duct (NLD) obstruction. MATERIALS AND METHODS: Twenty-two patients (14 female, 8 male) with fistulous dacryocystitis were included. The patients were divided into two groups as congenital (Group I) and acquired (Group II) groups. Fistula excision (FE) together with external dacryocystorhinostomy (DCR) and bicanalicular silicon tube (FCI Ophthalmics, Marshfield Hills, MA, USA) intubation (BSTI) were performed following medical therapy (Ofloxacin 0.3 % four times a day,intravenous cefazolin (50 mg/kg/day in children and 2 g/day in adults and gentamicin (5 mg/kg/day in children and 3 mg/kg/day in adults). The groups were compared with each other in terms of preoperative medical therapy duration, time of silicone tube extubation, follow-up time, and surgical outcomes. RESULTS: Group I included five patients with acute dacryocystitis and seven patients with recurrent dacryocystitis following probing, whereas Group II was comprised of 8 acute dacryocystitis and two recurrent fistulous dacryocystitis. Mean length of preoperative medical therapy was 14.1±6.5 days for Group I and 11.9±2.5 days for Group II. Extubation of the silicone tube was performed after 4.5±1.2 months in Group I and after 4.6± 1.1 months in Group II. The patients were followed up for 13.5±4.8 months in Group I and 14.3±3.7 months in Group II. There was no significant difference between the two groups in length of preoperative medical therapy, time of extubation of the silicone tube, and follow-up time (p > 0.05). Postoperatively, patency of the nasolacrimal drainage system was verified by irrigation of the lacrimal ducts and use of fluorescein eye stain. In both groups, all patients underwent surgical treatment were treated successfully. CONCLUSIONS: In fistulous dacryocystitis cases associated with the obstruction of NLD application of FE, external DCR treatment and BSTI appears as a valid surgical treatment option.  

Long-term prognostic value of coronary flow velocity reserve in renal transplant recipients.

BACKGROUND: In this prospective study, we sought to investigate the long-term prognostic value of coronary flow reserve (CFR) and carotid intima media thickness (IMT) estimates in renal transplant recipients without known coronary artery disease. METHODS: The 20 renal transplant recipients included in this study underwent CFR recordings performed by trans-thoracic Doppler echocardiography (TTDE) and carotid IMT measured by carotid Doppler ultrasonography. RESULTS: During a 3-year follow-up only one patient experienced a cardiac event. The baseline CFR and carotid IMT values of the patients were 1.77 ± 0.47 and 0.67 ± 0.15 mm, respectively. After 3 years of follow-up, there were no significant differences compared with baseline measurements with regard to CFR and IMT values. CFR values at the third year of follow-up showed significant correlation with age as well as IMT at baseline and at the third year. Upon multivariate analysis, baseline carotid IMT (ß = -0.562; P = .05) was a significant independent predictor of CFR at the third year. CONCLUSION: Carotid IMT showed a greater predictive value for impaired CFR in renal transplant recipients. CFR was not an independent predictor for cardiovascular events among renal transplant recipients within the first 3 years of follow-up measurements.

Fetuin-A, inflammation, and coronary artery calcification in hemodialysis patients.

Hemodialysis patients have extremely increased cardiovascular mortality. Vascular calcification, inflammation, and low serum fetuin-A levels are implicated for increased mortality. In this study, relationship between coronary artery calcification, inflammation, and serum fetuin-A levels were investigated. Seventy-eight hemodialysis patients (38 male, 40 female, mean age: 52±14.5 years) were included. All patients were on dialysis for more than 6 months. Coronary artery calcium scores (CACS) are determined by electron-beam computed tomography. Serum CRP, IL-1ß, IL-6, TNF-α, and serum fetuin-A levels were measured. Mean CACS value was 488.5±94.5. Serum fetuin-A levels were negatively correlated with CACS (r:-0.30, P=0.009). Patients are divided into two groups according to total CACS value; group 1 (CACS<10), group 2 (CACS≥10). There was a statistically significance difference in fetuin-A levels between CACS group 1 and group 2 (P=0.001). In this study, serum fetuin-A levels were associated with total CACS. This Fetuin-A may play a role in increased mortality in this group of patients via facilitating CAC.