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    Changes in plasma levels of adhesion molecules after percutaneous mitral balloon valvuloplasty
    (Elsevier Science Inc, 2004) Yetkin, E; Erbay, AR; Turhan, H; Balci, M; Yetkin, F; Yetkin, G; Ileri, M
    Background: Adhesion molecules are expressed on vascular endothelium and on immune and inflammatory cells. Recently increased levels of adhesion molecules have been shown in patients with rheumatic mitral stenosis. This study examined the serum levels of the adhesion molecules intercellular adhesion molecule I (ICAM-1), vascular cell adhesion molecule I (VCAM-1), and E-selectin in patients with rheumatic mitral stenosis and the effects of percutaneous mitral balloon valvuloplasty (PMBV) on these adhesion molecules. Materials and methods: Thirty five patients (3 men, 32 women, mean age 39 5 years) with severe rheumatic mitral stenosis who underwent percutaneous balloon mitral valvuloplasty, and 35 age and sex matched healthy control subjects were included in the study. Serum levels of ICAM-1, VCAM-I, and E-selectin were measured in all patients who underwent PMBV and in all control subjects. Blood samples were taken for measurement of adhesion molecules immediately before and 24 h after the mitral balloon valvuloplasty. Results: The plasma levels of soluble adhesion molecules E-selectin, ICAM-I and VCAM-I were significantly elevated in patients with mitral stenosis compared to control subjects: E-selectin, 97 +/- 59 vs. 45 +/- 24 ng/ml (P=.001), sICAM-1, 874 +/- 301 ng/ml vs. 238 82 ng/ml (P<.0001); sVCAM-1, 3056 +/- 763 ng/ml vs. 985 +/- 298 ng/ml (P<.0001). Plasma levels of VCAM-1 significantly increased 24 h after the valvuloplasty procedure (3056 +/- 763 ng/ml vs. 3570 +/- 1225 ng/ml P=.013). Plasma levels of E-selectin showed a significant decrease after PMBV (97 +/- 59 vs. 70 +/- 58 ng/ml, P=.043) and plasma levels of ICAM-I did not show any change after PMBV (874 +/- 301 vs. 944 +/- 3 77 ng/ml, P=.356). Conclusion: Cellular adhesion molecules, sICAM-1, E-selectin, sVCAM-1 have shown changes in different directions in response to PMBV These results necessitate further studies to clarify the mechanism underlying the association between adhesion molecules and PMBV as well as rheumatic mitral stenosis. (C) 2004 Elsevier Inc. All rights reserved.
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    Predictors of left ventricular thrombus formation in patients with dilated cardiomyopathy: role of activated protein C resistance
    (Lippincott Williams & Wilkins, 2004) Erbay, AR; Turhan, H; Senen, K; Yetkin, F; Ayaz, S; Kara, F; Buyukasik, NS
    Objectives The aim of this study was to investigate the association between left ventricular thrombus formation and natural anticoagulant systems including the protein C, protein S and antithrombin in patients with dilated cardiomyopathy. Materials and methods Sixty patients with dilated cardiomyopathy who met the inclusion criteria were included in the study. Patients were divided into two groups: group I consisted of 22 patients with left ventricular thrombus and group II consisted of 38 patients without left ventricular thrombus. Our main inclusion criteria were ejection fraction less than or equal to 35% and left ventricular end-diastolic diameter greater than or equal to 6.0 cm. These two groups were compared for clinical and hematologic parameters (activated protein C resistance, protein S and antithrombin). Results There were no statistically significant differences between patients with or without left ventricular thrombi with respect to left ventricular end-diastolic and end-systolic dimensions, ejection fraction, fractional shortening and left atrial diameter. There were no statistically significant differences between patients with and without left ventricular thrombus with respect to platelet count (252 +/- 64/mm(3) x 10(3) compared with 260 +/- 74/mm(3) x 10(3) respectively, P=0.68), prothrombin time (12.94 +/- 1.9s compared with 12.86 +/- 1.3 s respectively, P=0.82), activated partial thromboplastin time (32 +/- 5 compared with 30 +/- 4 s respectively, P= 0.32) and fibrinogen levels (36 +/- 9 mg/dl compared with 34 +/- 8 mg/dl respectively, P=0.41). None of the patients had protein S and antithrombin deficiency. Activated protein C resistance was found in 12 patients (12 out of 22, 54%) in group I and four patients (four out of 38, 9.5%) in group II (P < 0.01). It was also shown to be an independent predictor of left ventricular thrombus (P < 0.05). Conclusion Activated protein C resistance is found to be an independent predictor of left ventricular thrombus in patients with dilated cardiomyopathy who have ejection fractions less then 35% and left ventricular end-diastolic dimensions > 6.0 cm.