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Öğe A fatal complication after repair of post-infarction ventricular septal rupture: heparin-induced thrombocytopenia with thrombosis(Clinics Cardive Publ Pty Ltd, 2015) Nazli, Yunus; Colak, Necmettin; Demircelik, Bora; Alpay, Mehmet Fatih; Cakir, Omer; Cagli, KerimHeparin-induced thrombocytopenia (HIT) is a rare but potentially devastating and life-threatening complication from using heparin. HIT not only causes thrombocytopenia, but it also carries an increased risk for fatal thrombotic complications. In this report, we describe the case of a patient in whom fatal HIT developed after successful surgical repair of a posterior post-infarction ventricular septal rupture with cardiopulmonary bypass.Öğe Adropin: A New Marker for Predicting Late Saphenous Vein Graft Disease after Coronary Artery Bypass Grafting(Canadian Soc Clinical Investigation, 2014) Demircelik, Bora; Cakmak, Muzaffer; Nazli, Yunus; Gurel, Ozgul M.; Akkaya, Nermin; Cetin, Mustafa; Cetin, ZehraPurpose: Saphenous vein graft disease (SVGD), defined as an occlusion of 50% or more of the SVG excluding distal anastomotic occlusion, is an important predictor of morbidity after coronary artery bypass grafting (CABG). Late graft occlusion is a serious complication that often limits the use of the saphenous vein as a coronary bypass graft. Late graft occlusion is particularly common in old, degenerated venous grafts with advanced atherosclerotic plaques. Adropin has been implicated in the homeostatic control of metabolism. The purpose of this study was to investigate whether serum adropin levels are associated with late SVGD following CABG. Methods: Thirty-eight patients with SVGD involving at least one graft (occluded group; 14 females, 24 males) and 42 patients with a patent saphenous vein graft (patent group; 15 females, 27 males) were enrolled in this study. Venous blood samples were taken from all of the participants to measure plasma adropin levels using an enzyme-linked immunsorbent assay kit. Results: The mean adropin level was significantly lower in the occluded group than in the patent group (3.2 +/- 0.71 vs. 4.9 +/- 1.51 ng/ mL, p < 0.001). Multivariate regression analysis showed that the adropin level was the independent predictor of late saphenous vein graft occlusion. Conclusions: Adropin levels are lower in patients with late saphenous vein graft occlusion and these reduced adropin levels, together with other factors, may lead to saphenous vein graft occlusion. Larger and prospective studies are needed to determine if adropin plays a role in the pathogenesis of SVGD.Öğe Antiplatelet Effect of Sequential Administration of Cilostazol in Patients with Acetylsalycilic Acid Resistance(Taiwan Soc Cardiology, 2016) Cakmak, Muzaffer; Demircelik, Bora; Cetin, Mustafa; Cetin, Zehra; Isik, Serhat; Cicekcioglu, Hulya; Ulusoy, Feridun VasfiBackground: Acetylsalicylic acid (ASA) resistance in patients with coronary artery disease is an important medical problem that can affect treatment decision-making and outcomes. Cilostazol has been investigated to determine its effectiveness in patients with acetylsalicylic acid resistance. The aim of this study was to evaluate the antiplatelet efficacy of sequential administration of CLZ in patients with ASA resistance. Methods: A total of 180 patients were enrolled in our study. Patients with stable coronary artery disease were first given orally ASA 100 for 10 days, followed by collagen/epinephrine induced closure time (CTCEPI) measurements. Those who were found to be resistant to orally 100 mg of ASA were given orally 300 mg of ASA for an additional 10 days after which we repeated CTCEPI measurements. Those patients with resistance to orally 300 mg ASA were then given CLZ at a daily dose of orally 200 mg for 10 days followed by a final CTCEPI measurement. Results: The rate of resistance to 100 mg ASA was 81/180 (45%) compared to a rate of 35/81 (43.2%) with 300 mg ASA. Of the 35 patients found to be resistant to 300 mg ASA, 22 (62.9%) also failed to respond to CLZ treatment. Overall, sequential administration of 300 mg ASA and 200 mg CLZ resulted in a reduction in the number of non-responders from 45% to 12.2%. Conclusions: Initiation of CLZ could be of benefit in some patients with ASA-resistance for whom an effective anti-aggregant effect is of clinical importance.Öğe Association of Red Blood Cell Distribution Width with Coronary Artery Calcification(Elsevier Science Inc, 2013) Gurel, Ozgul Malcok; Bilgic, Ayse; Demircelik, Bora; Gunes, Mahmut; Yilmaz, Omer Caglar; Bozduman, Fadime; Kahyalar, Kemal[Abstract Not Available]Öğe Pharmacomechanical Thrombectomy in the Management of Deep Vein Thrombosis Using the Cleaner Device: An Initial Single-Center Experience(Elsevier Science Inc, 2015) Bozkurt, Alper; Kirbas, Ismail; Kosehan, Dilek; Demircelik, Bora; Nazli, YunusBackground: Pharmacomechanical thrombectomy (PMT) has appeared as an effective treatment modality for deep venous thrombosis (DVT). The study aimed to assess the efficacy of the Cleaner(TM) thrombectomy device for acute DVT. Methods: Sixteen consecutive patients presenting with extensive iliofemoral and/or femoropopliteal acute DVT and managed at our institution between February 2013 and May 2014 were retrospectively reviewed. The patients underwent PMT with the Cleaner device after insertion of vena caval filters. For underlying stenotic lesions, balloon angioplasty and/or stent placement was performed. Results: PMT with the Cleaner device was successful in 14 patients with complete restoration of flow. No clinical signs of pulmonary thromboembolism was recorded after the procedure. Thrombectomy failed in 2 patients. For the rest of the patients, balloon angioplasty was performed to relieve underlying stenotic lesions. Nine of them underwent additional stenting. Conclusions: Our initial experience suggests that the Cleaner device can be used in acute DVT. However, further studies involving larger patient populations are warranted to determine long-term results.Öğe The Effects of Valsartan and Amlodipine on the Levels of Irisin, Adropin, and Perilipin(Clin Lab Publ, 2015) Celik, Huseyin Tugrul; Akkaya, Nermin; Erdamar, Husamettin; Gok, Sumeyye; Kazanci, Fatmanur; Demircelik, Bora; Cakmak, MuzafferBackground: Hypertension and obesity are two major threats for public health. Up to the present, antihypertensive medications have been used to lower blood pressure, which seem to provide a better life with lower morbidity and mortality rates. Their effect on etiopathogenesis of hypertension is now an area of developing research. The association between hypertension and obesity also suggests the link between antihypertensive agents and energy hemostasis. We aimed to investigate the effects of antihypertensive treatment on the irisin, adropin, and perilipin levels in patients with essential hypertension and to compare them with healthy volunteers in terms of their effect on energy hemostasis. Methods: In total, 85 newly diagnosed patients with untreated essential hypertension were admitted to the outpatient clinic. Patients were randomized to one of the following treatment protocols: amlodipine or valsartan for a 12 week period. 42 patients were randomized into the valsartan group and 43 patients into the amlodipine group. Serum perilipin, irisin, and adropin levels were measured before and after drug treatment by ELISA kits. Results: We discovered that the hypertensive patients have lower levels of perilipin and higher levels of adropin compared with the control group. Both amlodipine and valsartan increased the levels of perilipin, irisin, and adropin after 12 weeks of treatment. Conclusions: In conclusion, in regulating energy balance, perilipin, irisin, and adropin, could be of pathogenic importance in obesity-induced hypertension. Hence, ongoing trials need to elucidate this mechanism.Öğe The Investigation of a Disintegrin and Metalloproteinase with ThromboSpondin Motifs (ADAMTS) 1, 5 and 16 in Thoracic Aortic Aneurysms and Dissections(Clin Lab Publ, 2016) Gunes, Mahmut Fatih; Akpinar, Mehmet Besir; Comertoglu, Ismail; Akyol, Sumeyya; Demircelik, Bora; Gurel, Ozgul Malcok; Aynekin, BusraBackground: Disintegrin-like and Metalloproteinase with Thrombospondin Motifs (ADAMTS) proteins that are fundamentally located in the extracellular matrix (ECM) have critical roles on different cellular processes by altering the ECM architecture. It has been known that expression of some members of these proteinases increases in aneurismal and dissectional aortic tissue. The purpose of this study is to investigate ADAMTS1, 5, 16 and tissue inhibitors of metalloproteinases-1,-2 (TIMP-1,-2) levels in aortic tissue obtained from patients with thoracic aortic aneurysms and dissections and to achieve new insights about the function of ADAMTS family members. Methods: We investigated ADAMTS1, 5, and 16 expression in human thoracic aortic aneurysms (TAA) (n = 22), thoracic aortic dissections (TAD) (n = 12), and thoracic aortas from age-matched control organ donors (n = 6) (a total number of 34 cases and 6 controls). The expression levels of ADAMTS proteins were determined by Western blot technique using anti-ADAMTS1, ADAMTS5, ADAMTS16, TIMP-1 and TIMP-2 antibodies. Results: ADAMTS1, 5, and 16 protein expressions were significantly higher in thoracic aortic aneurysm and dissection tissues compared to control aortic tissues. Furthermore, TIMP-1 protein levels decreased in TAA and TAD tissues, TIMP-2 did not change. Conclusions: Under the light of our findings, increased expression of ADAMTS1, 5, and 16 proteins may promote deceleration in thoracic aortic aneurysm progression. This is the first study that demonstrates ADAMTS5 and ADAMTS16 proteolytic activity in aneurysm and dissection.Öğe The relationship between 25-hydroxyvitamin D levels and ambulatory arterial stiffness index in newly diagnosed and never-treated hypertensive patients(Lippincott Williams & Wilkins, 2016) Malcok Gurel, Ozgul; Bilgic, Ayse; Demircelik, Bora; Ozaydin, Meltem; Bozduman, Fadime; Ayturk, Zubeyde; Yilmaz, HakkiObjectivesVitamin D insufficiency has been shown to be associated with cardiac dysfunctions, such as cardiac hypertrophy and hypertension, in animal studies. Arterial stiffness is a prognostic marker for cardiovascular disease. Previous studies have demonstrated that 25-hydroxyvitamin D [25(OH)D] levels were negatively correlated with arterial stiffness index. The aim of this study was to investigate the relationship between 25(OH)D levels and arterial stiffness, which is evaluated using an ambulatory arterial stiffness index (AASI), in patients who have untreated and newly diagnosed essential hypertension.DesignA total of 123 consecutive patients with newly diagnosed and untreated essential hypertension were included. Patients were divided into two groups according to their 25(OH)D levels. Vitamin D insufficiency was defined by 25(OH)D levels less than 20ng/ml. All patients were referred for ambulatory blood pressure monitoring. The regression slope of diastolic and systolic blood pressure was computed for each individual on the basis of ambulatory blood pressure readings. AASI was described as one minus the respective regression slope.ResultsThe mean AASI was significantly higher in patients with 25(OH)D levels less than 20 as compared with patients with 25(OH)D levels greater than or equal to 20 (0.500.20 vs. 0.34 +/- 0.17, P<0.001). In Pearson's correlation analysis, AASI had a significantly strong negative correlation with vitamin D levels (r=-0.385, P<0.001). In multivariate linear regression analysis, vitamin D levels were found to be significantly and independently associated with AASI (=-0.317, P=0.035).ConclusionArterial stiffness measured by AASI in newly diagnosed and untreated patients with essential hypertension were significantly related to vitamin D levels.Öğe The Relationship Between Adropin Levels and the Slow Coronary Flow Phenomenon(Springer India, 2015) Demircelik, Bora; Kurtul, Alparslan; Ocek, Hakan; Cakmak, Muzaffer; Cetin, Mustafa; Ureyen, Cagin; Eryonucu, BeyhanThere is accumulating evidence that inflammation plays a major role in the development of the slow coronary flow (CSF) phenomenon. In this study, we aimed to study the new biomarker adroin levels as it relates to CSF. Patients who underwent coronary angiography before and had no significant epicardial coronary disease were included in the study. Patients who had thrombolysis in myocardial infarction frame counts (TFCs) above the normal cutoffs were considered to have CSF and those within normal limits were considered to have normal coronary flow (NCF). NCF group over the age of 30 were selected from patients with normal coronary arteries. The adropin levels and biochemical profiles of all patients were studied and analyzed with coronary flow parameters. There were 58 patients in the CSF group and 50 patients in the NCF group. The mean adropin level was significantly lower in CSF group than in NCF group (3.2 +/- 0.71 vs. 4.9 +/- 1.51 ng/mL, p < 0.001). There was a significant correlation between the adropin levels and TFC (r = -0.676, p < 0.001). Multivariable regression analysis showed that the adropin levels were an independent predictor of the CSF phenomenon (odds ratio = 1.041, 95 % confidence interval: 1.004-1.114, p = 0.014). In this study, we show that patients with CSF have decreased levels of adropin. We further show a strong correlation between the adropin levels and coronary blood flow. We conclude that decreased adropin levels might be a useful tool in predicting CSF in patients who undergo coronary angiography.
