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    Measuring holotranscobalamin II, an early indicator of negative vitamin B12 balance, by radioimmunoassay in patients with ischemic cerebrovascular disease
    (Springer, 2008) Serefhanoglu, Songul; Aydogdu, Ismet; Kekilli, Ersoy; Ilhan, Atilla; Kuku, Irfan
    Circulating homocysteine is a risk factor of cardiovascular and cerebrovascular events. Hyperhomocysteinemia may be an early indicator for vitamin B-12 disorders because cobalamin is a cofactor in the remethylation process of homocysteine. Serum holotranscobalamin (holoTC II) becomes decreased before the development of metabolic dysfunction. In this study, we assessed circulating holoTC II to estimate the diagnosis of vitamin B-12 deficiency in the first ischemic cerebrovascular attack. We also compared the efficacy of the measurement of plasma holoTC II with the other standard biochemical and hematological markers used to reach the diagnosis of cobalamin deficiency. Forty-five patients (age 71 years (range 35-90), 16 men/29 women) within the first ischemic cerebrovascular event were included in this prospective study. All the enrolled patients have been administered vitamin B-12 1 mg intramuscular injection once a day for 10 days. At the baseline and on the tenth day of treatment, plasma levels of holoTC II and the proper biochemical and hematological markers in diagnosing cobalamin deficiency were measured. After admission, anemia and diminished serum vitamin B-12 levels were determined to be only 20% (9/45) and 44% (20/45), respectively; 78% (35/45) of the patients had low serum holoTC II (< 37 pmol/l). Serum homocysteine was higher in patients (49% of them) who had previously suffered a stroke. Thrombocytopenia, hypersegmentated neutrophils, and indirect hyperbilirubinemia were observed in 20% of the patients. Leukopenia and macrocytosis were not evident in any of them. In 18 of 27 patients (67%) that had low holoTC II levels after joining the study and who remained in the study until the end of cobalamin treatment, serum holoTC II levels returned to normal values. Cobalamin deficiency should be considered in patients with cerebrovascular diseases, even if anemia, elevated mean cell volume, depression of the serum cobalamin, or other classic hematological and/or biochemical abnormalities are lacking. Furthermore, measurement of serum holoTC II looks promising as a first-line of tests for diagnosing early vitamin B-12 deficiency.
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    Septic pulmonary embolism secondary to dental focus
    (Quintessence Publishing Co Inc, 2008) Serefhanoglu, Kivanc; Bayindir, Yasar; Ersoy, Yasemin; Isik, Kubilay; Hacievliyagil, Suleyman Savas; Serefhanoglu, Songul
    A 24-year-old female was admitted to an infectious diseases unit with complaints of dyspnea and fever. She had suffered from multiple episodes of fever for 1 year. The diagnostic workup revealed multiple pulmonary nodules on the chest CT scan, suggesting septic pulmonary embolism, and a periapical abscess around the maxillary right central incisor. Because no other infectious source was found and resolution of the fever and the pulmonary lesions occurred only after extraction of the affected tooth and antibiotic therapy, the condition was diagnosed as a periapical abscess complicated by septic pulmonary embolism. (Quintessence Int 2008:39:753-756)