Soluble P-selectin and the success of thrombolysis in acute myocardial infarction.

BACKGROUND: P-Selectin mediates adhesive interactions between platelets, leukocytes and endothelium to form thrombi. Our purpose was to investigate plasma soluble(s) P-selectin levels in patients with acute myocardial infarction (aMI) and the effect of thrombolysis on P-selectin levels. METHODS: Patients with aMI within the first 6 h of chest pain were enrolled prospectively. sP-selectin levels were determined by ELISA in the plasma of patients with aMI (n=32), stable angina (n=18), and healthy controls (n=15). Samples were obtained before, 3 and 24 h after reperfusion therapy with tissue plasminogen activator. Seven patients showed recurrent angina or failure to reperfuse. RESULTS: sP-selectin levels were significantly higher in aMI group than other groups (86.7+/-8.7 ng/ml, P<0.05). sP-selectin levels were similar in stable angina and control groups (28.8+/-4.4 vs. 25.4+/-7.3 ng/ml, P=NS). A significant increase in sP-selectin levels was observed 3 h after successful thrombolysis and this was followed by a decrease to near the baseline level late after reperfusion. But patients with failed reperfusion showed sustained high sP-selectin levels after 24 h of thrombolysis (P<0.05). CONCLUSION: The plasma sP-selectin level is elevated in aMI and it increases further following thrombolytic therapy. This increase is probably induced by activation of endothelial cells or platelets after myocardial ischemia and reperfusion during aMI. As the elevated levels are sustained in patients with failed reperfusion, serial P-selectin levels may be used as a non-invasive indicator of successful thrombolysis in aMI.

A rare indication for stenting: persistent coronary artery spasm.

A 34-year-old man presenting with angina both at rest and on exertion was investigated. He developed severe ST segment elevation and a brief period of ventricular tachycardia during an exercise tolerance test. On coronary angiography, 60% fixed luminal narrowing was observed in the proximal left anterior descending coronary artery and a severe spasm developed at this site, leading to temporary total occlusion of the vessel. Successful coronary angioplasty (PTCA) was performed on this lesion, with a residual 15% narrowing. However, the patient had a recurrence of angina 3 weeks later, despite being administered high doses of nitrate and calcium antagonist. During control angiography, the lesion severity was unchanged, but spasm developed again following contrast injection. At this time, a Palmaz-Schatz stent was implanted. Calcium antagonist, nitrate, Ticlopidine and low molecular weight heparin therapy was started. There was no recurrence of symptoms during a 3-month follow-up. The exercise tolerance test, and myocardial perfusion scintigraphy findings were normal and the stent was patent without restenosis at the end of the 3-month follow-up. Intracoronary stent implantation for persistent coronary spasm refractory to conventional medical therapy can be considered a feasible and attractive treatment modality for the control of symptoms.

Takayasu arteritis in Turkey.

Takayasu arteritis is a non-specific inflammatory process of unknown etiology affecting the aorta and its branches. A retrospective study was done in 14 patients diagnosed as Takayasu arteritis. Eleven patients were female and three were male. Ages ranged from 12 to 30 years. Seven patients had type I arteritis, three patients type II arteritis, and four patients type III Takayasu arteritis. Successful angioplasty was performed in five cases.

[Analysis of early, late-phase and delayed skin reactions against 10 groups of antigens in 420 patients with allergic asthma]. / Allerjik astmali 420 hastanin 10 adet antijen grubuna karsi erken-geç faz ve geç deri reaksiyonlarinin analizi.

Immediate, late phase and delayed skin reactions against ten group of allergens were investigated in 420 patients with allergic asthma. The wheal and flare reaction were characteristic for type I IgE-mediated hypersensitivity reaction in human skin. This reaction develops rapidly after injection of antigen, peaks in 10-30 minutes, and then subsides within a few hours. However, careful observation for longer periods has shown that in many instances a late inflammatory response also appears at the same site and is quite different in appearance from the initial reaction. This late phase reaction sometimes lasts for 24 hours and it is characterized by a dense cellular infiltrate and is more oedematous than the early reaction. These late phase reactions can also be seen following challenge of the nasal mucosa and bronchi of allergic subjects and may be of major importance in the development of chronic asthma. In this study, we have investigated immediate, late phase also delayed phase skin reactivity incidence of the allergic asthma patients.

Mitral balloon valvuloplasty with transesophageal echocardiography without using fluoroscopy.

Balloon mitral valvuloplasty with Inoue technique was performed in two group of patients. In group I (n = 40) valvuloplasty was performed under fluoroscopy without using echocardiography, whereas in group II (n = 13) valvuloplasty was performed under the guidance of transesophageal echocardiography alone, without using fluoroscopy. Patients in two groups were comparable with regard to clinical variables and hemodynamic parameters. Two female patients in group II were pregnant. Transmitral pressure gradient decrease did not differ significantly between two groups (pressure gradient: 17 +/- 5 to 4 +/- 1 in group I and 15 +/- 4 to 3 +/- 1 mm Hg in group II). Mitral valvular area increase was also not different in two groups (1.09 +/- 0.2 cm2 to 2.3 +/- 0.5 cm2 in group I and 0.9 +/- 0.2 to 2 +/- 0.3 cm2 in group II). In 14 cases from group 1 and 2 cases from group II mitral regurgitation increased after valvuloplasty (p < .05). Left atrial perforation occurred in one patient from group 1 and 2 patients from group II. In conclusion, mitral balloon valvuloplasty under transesophageal echocardiographic guidance alone is a safe and effective procedure in the treatment of mitral stenosis.

[Analysis of early, delayed phase and late cutaneous reactions to ten groups of antigens in 581 patients with allergic rhinitis]. / Allerjik rinit'li 581 hastanin on grup antijene karsi erken-geç faz ve geç deri reaksiyonlarinin analizi.

Immediate, late phase and delayed skin reactions against ten group of allergens were investigated in 581 patients with allergic rhinitis. The wheal and flare reaction were characteristic for type 1 IgE mediated hypersensitivity reaction in human skin. This reaction develops rapidly after injection of antigen, peaks in 10-30 minutes, and then subsides within a few hours. However, careful observation for longer periods has shown that in many instances a late inflammatory response also appears at the same site and is quite different in appearance from the initial reaction. In this study, we have investigated immediate, late phase also delayed phase skin reactivity incidence of the allergic rhinitis patients.

[Immediate and delayed skin reactions against ten groups of antigens in 355 patients with urticaria and angioneurotic edema]. / Urtiker ve anjinörotik ödemli 355 hastanin on grup antijene karsi erken ve geç deri reaksiyonlarinin analizi.

Immediate and delayed skin reactions against ten group of allergens were investigated in 355 patients with urticaria and angioneurotic edema. The wheal and flare reaction were characteristic of the type I-IgE mediated hypersensitivity reaction in human skin. This reaction develops rapidly after injection of antigen, peaking 10-30 minutes, and then subsides within a few hours. However, careful observation for longer periods, has shown that in many instances a late inflammatory response also appears at the same site and is quite different in appearance from the initial reaction. In this study, we have investigated in immediate and also delayed-phase skin reactivity, incidence of the patients.

[Alpha fetoprotein titers in HBsAg positive hospital personnel]. / HBsAg olumlu çikan saglik personelinde alpha-fetöprotein durumu.

A survey was carried on the sera secured from the Ankara University Hospital for HBsAG. Out of 23 HBsAg positive sera, four sera was demonstrated containing high levels of Alpha-feto-protein, by haemagglutination test (Mochida). The cases were being followed up and within one year, second testing also proved high levels. One of them suffered from hepatitis two years ago and working at gynecology clinic as nurse.

Residual agglutinins against rickettsial agents in human sera from central and eastern Turkey and their relation to cardiovascular diseases.

Many workers have shown that the recrudescence of rickettsial infections may cause cardiovascular diseases of all kinds. As Turkey is a region where rickettsial infections in man are endemic, the relation between such infections and cardiovascular disease has been further studied there. Sera were collected from patients with cardiovascular diseases and also from healthy people and patients with diseases not affecting the heart, who served as a control group. A considerably higher percentage of positive sera was obtained from the patients with cardiovascular diseases, particularly for R. prowazekii, R. conorii and C. burnetii. It was also found that the highest percentage of positive sera was obtained from people in the 20-40 years age-group. Antistreptolysin-O (ASO) determinations were also made and it was found that, on average, agglutinin-negative sera had the higher ASO titres.