PubMed Health⌕ Search

Biomedical subjects

M Unlu

Publications and source records attributed to M Unlu.

17 recordsLinked to original sources

Brugada-like electrocardiographic changes induced by fever.

As "time is myocardium" in the settings of acute myocardial infarction, it is important to make the diagnosis as quickly as possible, and a high clinical suspicion is needed to avoid missing the diagnosis, resulting in unwarranted interventions. The electrocardiogram is a crucial tool in the identification of acute chest pain, enabling a detailed analysis of patterns of ST-segment elevation. We describe the case of a 22-year-old man who presented with fever, with dynamic electrocardiographic changes similar to the Brugada syndrome. These electrocardiographic anomalies disappeared when the temperature returned to normal.

Adult↗

Beneficial effects of supplemental nitric oxide donor given during reperfusion period in reperfusion-induced lung injury.

BACKGROUND: Reperfusion injury is a perplexing cause of early graft failure after lung transplantation and today we know that reperfusion may be more harmful to tissues than the preceding ischemia. We hypothesized that administration of the nitric oxide donor nitroglycerin (NTG) during flush perfusion and reperfusion periods would ameliorate reperfusion-induced lung injury. METHODS: Using an IN SITU normothermic ischemic lung rabbit model, three groups were studied (n = 7/group): (1) NTG given during flush perfusion (ischemia group); (2) NTG given in the flush perfusion and the reperfusion period (reperfusion group); and (3) no NTG (control group). All groups were flushed with low potassium dextran glucose solution. Blood gas analysis, tissue nitrite (nitric oxide metabolite) level analysis, bronchoalveolar lavage (BAL) fluid examination and morphological examinations were performed. RESULTS: Compared with the ischemia group, the reperfusion group had significantly improved arterial oxygenation (318 +/- 31.4 mmHg vs. 180 +/- 14.7 mmHg, P < 0.05), decreased BAL fluid neutrophil percentage (21 +/- 1.9 % vs. 30 +/- 5.6 %, P < 0.05), increased tissue nitrite level (32.55 +/- 4.12 nmol/g vs. 27.81 +/- 1.05 nmol/g, P < 0.05), and decreased tissue histopathological lesion scores (0.42 +/- 0.53 vs. 1.14 +/- 0.37, P < 0.05). CONCLUSIONS: This study suggests that nitric oxide donors supplemented during flush perfusion and reperfusion have more beneficial effects on lung functions against reperfusion injury than any other treatment modalities during IN SITU normothermic ischemic lung model.

Analysis of Variance↗

Cardiac innervation and clinical correlates in idiopathic Parkinson's disease.

We evaluated the cardiac innervation status of patients with idiopathic Parkinson's disease (IPD), in order to recognize cardiac dysautonomia at an early clinical stage, using I- -iodobenzylguanidine ( I-MIBG) scintigraphy and its relation to other clinical and laboratory parameters. Fourteen patients with IPD at Hoehn-Yahr stage I and 11 age-matched controls were studied. Patients were scored according to the Unified Parkinson's Disease Rating Scale (UPDRS) in aspects of daily life activities, cognitive and emotional status and motor examination. All patients underwent 5 min electrocardiographic recordings in order to assess the heart rate variability. Planar I-MIBG studies at 15 min and 3 h after intravenous injection of 185 MBq were performed. Heart-to-mediastinum (H/M) ratios were calculated. Plasma catecholamine levels were also evaluated. The mean H/M ratios in patients and controls were 1.84+/-0.40 and 2.35+/-0.29, respectively (P <0.05). Although the mean plasma adrenaline and noradrenaline levels were in the normal range, a weak inverse correlation existed between the noradrenaline levels and late I-MIBG H/M ratios (r =-0.442), which was not statistically significant. There were no correlations between the other parameters. Eight patients had normal electrocardiography, whereas four had findings of autonomic imbalance. In conclusion, cardiac dysautonomia is common and seems to occur independent of the clinical stage and symptoms in patients with IPD. I-MIBG scintigraphy is a powerful tool in its assessment.

3-Iodobenzylguanidine↗

Pulmonary microvascular injury following general anaesthesia with volatile anaesthetics--halothane and isoflurane: a comparative clinical and experimental study.

Pulmonary microvascular injury has become a recently studied phenomenon that may be responsible for most of the complications associated with the lungs. Thirty patients undergoing partial hemilaminectomy or discectomy due to hernia of nucleus pulposus underwent Tc-99m HMPAO lung clearance as well as Tc-99m pertechnetate lung scintigraphy pre-operatively, and following general anaesthesia with halothane and isoflurane (third, fourth and tenth post-operative days). The results were compared with conventional techniques and haemodynamic parameters during the peri-operative period. In order to demonstrate acute phase changes under general anaesthesia and to perform pathological examinations, 21 New Zealand rabbits underwent radionuclide studies with Tc-99m HMPAO or Tc-99m pertechnetate. Lung biopsies were also performed. Despite no significant differences in any of the conventional diagnostic techniques, Tc-99m pertechnetate lung scintigraphy was performed for both the halothane and isoflurane groups, and Tc-99m HMPAO lung clearance was performed for the isoflurane group pre- or post-operatively. Tc-99m HMPAO lung clearance was impaired significantly in the halothane group on the third post-operative day (half time: 6.4 +/- 1.6 pre-operative and 13.76 +/- 3.3 s, P < 0.001) decreasing to pre-operative levels on the tenth post-operative day. Acute phase exposure to halothane was characterized with extremely abnormal Tc-99m HMPAO lung clearance in rabbits with respect to isoflurane, diminishing to control levels on the third day (half time: 8.7 +/- 86 control and 28.65 +/- 4.6, P < 0.001). Pathological examinations also demonstrated endothelial damage on acute exposure in the halothane group. General anaesthesia with halothane may give rise to alveolar microvascular injury, which generally seems to be underdiagnosed and may lead to serious post-operative complications.

Adult↗

Psychiatric complications of cardiac surgery postoperative delirium syndrome.

Psychiatric disturbances due to cardiopulmonary bypass, especially postoperative delirium syndrome, are among the immediate complications of open-heart surgery. In a series of 32 male and 18 female patients the prevalence of such disorders was investigated and search was made for possible risk factors for their occurrence. Psychiatric, neurologic and electroencephalographic evaluation was made pre- and postoperatively, in addition to haemodynamic, echocardiographic, angiographic and regional cerebral blood flow studies. Nine of the 50 patients had significantly reduced perfusion of certain cerebral lobes in single photon emission computed tomography, and in six of them the psychiatric tests indicated postoperative delirium; three of these six also had moderate electroencephalographic changes. The cerebral hypoperfusion persisted on day 15 in four patients, while psychiatric tests were negative. The study showed possible risk factors to be patient age, long aortic cross-clamp time, high-dose inotropic support and excessive transfusion of blood or blood products.

Adult↗

Bland-White-Garland syndrome in an adult. Case report and review of diagnostic and predictive strategies.

In a 27-year-old man with Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery), comparison was made between conventional diagnostic techniques and radionuclide imaging for selection of surgical procedure and evaluating the outcome. Dynamic 99mTc imaging exactly located the left coronary artery orifice, which was not seen on angiography, thereby determining the surgical approach, and 123I study revealed that, despite absence of symptoms, the adrenergic activity of the heart was globally diminished, with limited response to revascularization.

Adult↗

The v-Jun oncoprotein replaces p39 c-Jun as the predominant AP-1 constituent in ASV17-transformed fibroblasts: implications for SAPK/JNK-mediated signal transduction.

We have investigated the expression of Jun family proteins and composition of AP-1 in chicken embryo fibroblasts before and after transformation by the v-Jun oncoprotein of ASV17. We show that p39 c-Jun is the predominant Jun family protein expressed in normal fibroblasts, and that heterodimers of c-Jun and Fos-related partners (Fra's) account for the majority of the AP-1 DNA binding activity. Unexpectedly, because ASV17-transformed fibroblasts do not express p39 c-Jun, v-Jun replaces c-Jun as the predominant AP-1 constituent in association with similar or identical Fra's. This substitution has little effect on the overall level of TRE-specific DNA binding activity, however it results in a profound reduction in TRE-dependent transcriptional activity and a striking defect in signal-regulated phosphorylation of the Jun component of AP-1; whilst agonists of SAPK/JNK kinases trigger transient N-terminal phosphorylation of c-Jun in normal fibroblasts, no corresponding modification of v-Jun occurs in ASV17-transformed cells. Because SAPK/JNK-mediated phosphorylation is thought to regulate c-Jun transcriptional activity and thereby cellular gene expression in response to extracellular signals, we propose that subversion of this signal transduction process by v-Jun is likely to contribute to oncogenesis by ASV17.

3T3 Cells↗

Translocation of Src kinase to the cell periphery is mediated by the actin cytoskeleton under the control of the Rho family of small G proteins.

We have isolated Swiss 3T3 subclones that are resistant to the mitogenic and morphological transforming effects of v-Src as a consequence of aberrant translocation of the oncoprotein under low serum conditions. In chicken embryo and NIH 3T3 fibroblasts under similar conditions, v-Src rapidly translocates from the perinuclear region to the focal adhesions upon activation of the tyrosine kinase, resulting in downstream activation of activator protein-1 and mitogen-activated protein kinase, which are required for the mitogenic and transforming activity of the oncoprotein. Since serum deprivation induces cytoskeletal disorganization in Swiss 3T3, we examined whether regulators of the cytoskeleton play a role in the translocation of v-Src, and also c-Src, in response to biological stimuli. Actin stress fibers and translocation of active v-Src to focal adhesions in quiescent Swiss 3T3 cells were restored by microinjection of activated Rho A and by serum. Double labeling with anti-Src and phalloidin demonstrated that v-Src localized along the reformed actin filaments in a pattern that would be consistent with trafficking in complexes along the stress fibers to focal adhesions. Furthermore, treatment with the actin-disrupting drug cytochalasin D, but not the microtubule-disrupting drug nocodazole, prevented v-Src translocation. In addition to v-Src, we observed that PDGF-induced, Rac-mediated membrane ruffling was accompanied by translocation of c-Src from the cytoplasm to the plasma membrane, an effect that was also blocked by cytochalasin D. Thus, we conclude that translocation of Src from its site of synthesis to its site of action at the cell membrane requires an intact cytoskeletal network and that the small G proteins of the Rho family may specify the peripheral localization in focal adhesions or along the membrane, mediated by their effects on the cytoskeleton.

3T3 Cells↗

Functions of the v-Src protein tyrosine kinase.

The peripheral non-receptor tyrosine kinase oncoprotein, v-Src, has pleiotropic effects. It is a mitogen for quiescent cells, substituting for both competence and progression factor-mediated signals but it also induces cellular morphological transformation. We are dissecting the activities of v-Src by studying mutant proteins, including those with temperature sensitive (ts) effects, in different cellular backgrounds. Activation of a ts v-Src kinase rapidly increases activity of both the transcription factor, AP-1, and MAP kinase, an enzyme that enhances AP-1 activity by both phosphorylation of c-Jun and increased c-fos transcription; the relative contribution of these two events depends on the cells in which v-Src is expressed. Transient early AP-1 activation requires proper location of v-Src at the cell periphery and it is essential for mitogenesis. It is not, however, sufficient for entry into S-phase, there being a second need for v-Src later in G1. Transformation by v-Src does not require AP-1 activation but seems linked to events at the cell periphery, notably phosphorylation of proteins that bind to the v-Src SH3 domain such as the p85 subunit of PI-3 kinase.

Animals↗

Decision-making for surgery in patients with end-stage coronary artery disease: the role of dual isotope myocardial perfusion SPECT after dobutamine infusion.

Dobutamine pharmacologic stress test coupled with dual isotope-stress hexakis 2-methoxy-isobutyl-isonitrile (MIBI), rest Thallium 201-perfusion SPECT was performed to a patient with an end-stage coronary artery disease who has physical limitations and cannot achieve a desired stress level with conventional stress protocols. Although this patient was assessed to be an inoperable case according to coronary angiography or echocardiography data, he was operated on the basis of imaging of a viable myocardium and reversible coronary ischemia to a significant extent in the dobutamine stress coupled with dual isotope study. The objective benefits of the operation was also shown on the postoperative data. We'd like to discuss an alternative diagnostic option contributing more appropriate solutions for patients with an end-stage coronary artery disease.

Coronary Angiography↗

Dual isotope myocardial perfusion SPECT in the detection of coronary artery disease: comparison of separate and simultaneous acquisition protocols.

A time-saving dual isotope acquisition protocol was carried out for the simultaneous assessment of stress and rest myocardial perfusion, and the diagnostic value of the technique was evaluated using coronary angiography results as a reference. Fifty-five patients undergoing coronary angiography before surgery were included in the study. Stress tests were applied, either with a treadmill (25 patients) or dobutamine infusion (30 patients in 5-40 micrograms/kg/min doses). All patients received 3 mCi of thallium-201 at rest. Stress tests were applied 30 minutes later, and at peak stress 7 mCi of 99mTc-MIBI was administered. A dual isotope SPECT study was carried out one hour after the administration of 99mTc-MIBI. Tracer doses were optimised with phantom studies, and the down-scatter of each radioisotope on the other data was investigated. In 30 patients, 10 minutes after the 201Tl injection a separate rest 201Tl acquisition was also performed, to compare the data with dual acquisition. 201Tl rest imaging SPECT data was evaluated by segmental analysis according to coronary artery regions. In 55% of the segments stress defects were observed. Similar results were obtained for the detection of defect reversibility; i.e. stress MIBI/rest 201Tl (75%) and stress MIBI/simultaneous 201Tl (78%). The overall sensitivity and specificity of simultaneous dual isotope SPECT with respect to coronary angiography results were 88% and 84%, respectively. A good correlation and no significant difference was observed between the two acquisition methods. However, the simultaneous acquisition protocol has many advantages, i.e. halving the acquisition time, shortening the overall decision-making time, and decreasing unmatched stress-rest artifacts.

Coronary Angiography↗

Rapid identification of the Candida species from direct blood cultures by CHROMagar Candida.

We evaluated the ability of CHROMagar Candida to identify Candida species isolated directly from blood cultures. A total of 50 clinical isolates of Candida were incubated at 35 degrees C, and once growth was established, an aliquot of each was plated onto CHROMagar Candida medium. A control specimen was plated directly from Sabouraud's dextrose agar. Following incubation at 30 degrees C, all yeast isolates were identified by colony morphology and colour. We were able to identify all isolates of C. albicans (n = 20), C. tropicalis (n = 14), C. glabrata (n = 6), and C. krusei (n = 5), which were isolated from blood or from control cultures. This study demonstrated that CHROMagar Candida reliably isolated and identified yeast taken directly from blood cultures. We conclude that this rapid and easy method of identifying Candida species will enable clinicians to quickly choose the appropriate antifungal agent. This should decrease patient morbidity and mortality.

Blood↗

Insulin-like growth factor (IGF)-I and IGF-binding protein-3 in relation to hemoglobin concentration in healthy term infants.

In order to evaluate the role of insulin-like growth factor-I (IGF-I) and insulin-like growth factor binding protein-3 (IGFBP-3) in the maintenance of blood Hb concentration in infants, we studied the serum concentrations of IGF-I and IGFBP-3 in relation to blood hemoglobin values in 25 healthy term infants at birth and two months of age. The mean concentration of IGF-I was 18.6+/-7.1 ng/ml and IGFBP-3 was 1240+/-498 ng/ml at birth. Positive correlation was observed between the blood Hb concentrations and both IGF-I (r = 0.56, p = 0.004) and IGFBP-3 levels (r = 0.38, p = 0.04) at the first examination. Our results show that blood Hb is positively correlated to serum IGF-I levels indicating indirectly the involvement of mediators of growth hormone in the regulation of physiologic Hb concentrations at birth. As no relationship was found between IGF-I, IGFBP-3 and Hb levels at the second examination, the same association could not be demonstrated at two months of age.

Female↗