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    Comparison of effects of iloprost and pentoxiphylline on walking capacity and skin oxygenation in diabetic patients with peripheral artery disease
    (Academic Journals, 2012) Topal, Askin Ender; Eren, Mehmet Nesimi
    Diabetes is in close relation with peripheral artery disease (PAD) and there are conflicting results regarding efficacy of iloprost in PAD. The aim of this study was to investigate the efficacy of iloprost in improving walking capacity and increasing oxygenation to diseased tissues in PAD patients with diabetes, compared to pentoxiphylline. Data of 80 patients were recorded contemporaneously. Patients were divided into two groups (Group 1: Users of iloprost and pentoxiphylline; Group 2: Users of only pentoxiphylline). O-2 saturations in diseased limbs were significantly improved at three-months follow-up in both groups (both p<0.001). The difference between groups was in favor of Group 1 (p = 0.012). Maximum walking capacity was also increased significantly in both groups (both p<0.001). However, the improvements in walking distance were at similar extent (p = 0.226). In comparison with pentoxiphylline, iloprost has no superior effect on walking capacity of diabetic patients with intermittent claudication. However, iloprost improves oxygenation of tissues better than pentoxiphylline, therefore iloprost may be preferred especially in diabetic patients with critical limb ischemia as an adjunctive therapy followed by pentoxiphylline or cilostazol. Usage of iloprost may contribute to the recovery of diabetic ulcers and also, it may postpone occurrence of diabetic ulcers.
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    Gradually increasing predominance of self-mutilation in upper extremity arterial injuries: less morbidity but with high threat to society
    (Turkish Assoc Trauma Emergency Surgery, 2010) Topal, Askin Ender; Eren, Mehmet Nesimi
    BACKGROUND Although vascular trauma of the upper extremity is increasingly more common, mortality and morbidity rates remain low, at between 0-8%. Self-mutilation has become evident in recent years. We planned this study to compare the results of self-mutilation with other penetrating trauma in upper extremity vascular injuries and also to emphasize the dangers of self-mutilation for society. METHODS Data of 249 patients with penetrating vascular injury of the upper extremity were retrospectively analyzed. There were 214 male (86%) and 35 female (14%) patients, with a mean age of 24.76 +/- 11.28 years (range: 2-69 years). Of these, 129 (52%) were self-mutilators. RESULTS The ulnar artery was the most frequently affected (n=140, 56%). There was no mortality or limb loss. However, eight (3.21%) patients, who had penetrating trauma, had restriction in finger motions. Male predominance, substance abuse and associated nerve injury were significantly more common among self-mutilators (p values <0.001, <0.001 and 0.005, respectively), whereas brachial artery injury, vein graft interposition and fasciotomy rates were higher among the penetrating trauma group (p<0.001 for all). CONCLUSION The form of and reason for injuries and presence of substance abuse in case of self-mutilation must be investigated cautiously, and the immediate commencement of psychiatric treatment must be provided to the self-mutilators.
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    Impact of N-acetylcysteine and Etodolac Treatment on Systolic and Diastolic Function in a Rat Model of Myocardial Steatosis Induced by High-Fat-Diet
    (Bentham Science Publ Ltd, 2014) Topal, Askin Ender; Akkoc, Hasan; Kelle, Ilker; Yilmaz, Sedat; Topal, Derya; Akkus, Murat
    Objectives: Obesity is a worldwide problem, leading to cardiomyopathy. Oxidative stress and inflammation have been reported to play significant roles in developing obesity cardiomyopathy. N-acetylcysteine is a glutathione prodrug that preserves liver against steatosis via constraining the production of reactive oxygen species. Etodolac is a nonsteroidal anti-inflammatory drug which has been demonstrated to protect liver against fibrosis. The aim of the present study was to evaluate and compare the effects of N-acetylcysteine and etodolac on impaired cardiac functions due to high-fat-diet (HFD) induced myocardial steatosis in rats. Material and Methods: Thirty-two male Sprague-Dawley rats were randomly divided into four groups. Control group was maintained on standard-rat-basic-diet (SD) for 20 weeks, while HFD was given to three study groups for 20 weeks. Then N-acetylcysteine was given to one of the study groups (HFD+NAC), and etodolac to another group (HFD+ETD) as a supplement for 4 weeks while all groups were continued on SD. At the end of the study periods, hearts were examined by Langendorff technique and rat livers were evaluated histologically. Results: HFD and HFD+ETD groups presented with significantly higher steatosis and fibrosis in liver compared to other groups. HFD+NAC preserved diastolic functions. Also HFD+NAC and HFD+ETD groups had significantly better systolic funtions than HFD group. Conclusions: Obesity is associated with diastolic dysfunction rather than systolic dysfunction. NAC may protect the heart against diastolic dysfunction due to obesity. NAC and etodolac treatment improve systolic function, even in the absence of systolic dysfunction.
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    Left Ventricle and Left Atrium Remodeling after Mitral Valve Replacement in Case of Mixed Mitral Valve Disease of Rheumatic Origin
    (Wiley, 2010) Topal, Askin Ender; Eren, Mehmet Nesimi; Celik, Yusuf
    P>Background: The objective of this study was to evaluate the recovery of the left ventricle (LV) function, and to analyze postoperative size reduction of LV and left atrium (LA), after mitral valve replacement (MVR) in patients with chronic rheumatic mitral disease. Methods: Thirty consecutive elective patients with MVR for mixed mitral disease of rheumatic origin formed the study group. Of these, 21 (70%) were women and the mean age was 37 years. Transthoracic echocardiography was performed prior to surgery, at three-month follow-up, and at three-year follow-up except for the latest nine patients. Results: The mean duration of follow-up was 3.6 +/- 1.8 years. MVR surgery improved the functional class (mean New York Heart Association [NYHA] class) at three-year follow-up (p = 0.008). LV end-diastolic diameter and LA sizes decreased after MVR. Total chordal preservation causes better outcome, regarding to LV ejection fraction (LVEF) and NYHA functional class of patients. Preoperative high NYHA class, low LVEF, and high LV end-systolic diameter (LVESd) resulted with postoperative LV dysfunction (p were < 0.001, < 0.001, and 0.006, respectively). Conclusion: In patients with mixed mitral valve disease, MVR enhanced LV and LA remodeling resulting in better NYHA function. Preoperative NYHA, LVEF, and LVESd were significant predictors of postoperative LV function. (J Card Surg 2010;25:367-372).
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    Lower extremity arterial injuries over a six-year period: outcomes, risk factors, and management
    (Dove Medical Press Ltd, 2010) Topal, Askin Ender; Eren, Mehmet Nesimi; Celik, Yusuf
    Purpose: Limb loss following lower extremity arterial injury is not uncommon and has serious implications on the patient's life and functionality. This retrospective study was performed to analyze the results of lower extremity arterial injuries and to identify the risk factors associated with amputation. Methods: Between 2002 and 2009, retrospectively collected data on 140 patients with 173 lower extremity arterial injuries were analyzed. Results: There were 133 males (95%) and 7 females (5%). The mechanism of injuries was gunshot wounds in 56.4% of cases, stab wounds in 30%, and blunt trauma in 13.4%. Associated injuries included vein injury in 45% of cases, nerve injury in 16.4%, and bone fracture in 31.4%. The most frequently injured artery was superficial femoral artery (31.2%). More than 1 artery was injured in 18.6% of patients. Surgery was carried out, with a limb salvage rate of 90.4% and a survival of 97.1%. Amputation was performed in 75% of patients in whom only 1 artery was repaired, although all crural arteries were injured. Multivariate logistic regression analysis showed that significant risk factors of outcome were below-knee multiple arterial injuries (odds ratio [OR] 6.62, P < 0.001), associated 2-bone fractures (OR 2.71, P = 0.003), development of compartment syndrome (OR 1.94, P = 0.042), and great soft tissue disruption (OR 1.74, P = 0.010). Conclusions: Limb loss may be decreased by performing prophylactic fasciotomy more often and by repairing at least 2 crural arteries.
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    Metformin HCl has curative effect on rebuilding of ventricular diastolic functions in high-fat-diet fed rats
    (Univ Karachi, 2017) Topal, Askin Ender; Kelle, Ilker; Akkoc, Hasan; Yilmaz, Sedat; Akkus, Murat
    Myocardial lipid accumulation due to diabetes and/or obesity plays a role in the progression of left ventricular diastolic dysfunction. Our aims were to exhibit the correlation between histopathologic stage of the liver and cardiac functions, and to evaluate the effects of metformin HC1 and rosiglitazone on myocardial functions. Thirty-two male Sprague-Dawley rats were divided into four groups to exhibit the correlation between histopathologic stage of the liver and cardiac functions and to determine whether metformin HC1 and rosiglitazone have effects on cardiac functions. For 20 weeks, one group was fed standard rat basic diet, whereas the other groups were on high-fat-diet. During the last 4 weeks, metformin HC1 was given to the third group, rosiglitazone to the fourth group. Histological evaluation of rat livers yielded significantly higher steatosis grade in high-fat-diet group and different fibrosis stages among groups. Also, there was significant correlation between diastolic functions and steatosis grade/fibrosis stage of rat liver. Electrophysiological study of hearts via Langendorff technique showed better coronary perfusion pressures and diastolic functions in standard -diet and metformin HC1 groups compared to other groups. Metformin HC1 improves LV diastolic dysfunction and coronary perfusion pressures.
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    Predictors of atrial fibrillation occurrence after coronary artery bypass graft surgery
    (Springer Japan Kk, 2011) Topal, Askin Ender; Eren, Mehmet Nesimi
    Purpose. Postoperative atrial fi brillation (AF) is the most common complication after coronary artery bypass graft (CABG) surgery, with an incidence of 20%-50%. The objective of this study was to investigate perioperative risk factors of postoperative sustained AF by the way of logistic regression analysis. Methods. Data for the last 98 patients who had undergone CABG surgery before January 2010 were retrospectively collected and analyzed. Results. Postoperative sustained AF was detected in 34 (34.7%) patients. Mean arterial blood pressure, previous hypertension (HT), previous AF, previous chronic obstructive pulmonary disease, aortic cross-clamp time, cardiopulmonary bypass time, postoperative urea, postoperative creatinine, postoperative potassium, extubation time, chest tube drainage, units of transfused packed red blood cells (pRBC), and postoperative pneumonia were associated with higher occurrence of postoperative sustained AF according to the univariate analysis. Upon logistic regression analysis, pRBC transfusion, previous AF, and preoperative HT remained independent predictors for the development of postoperative sustained AF. Conclusion. On-pump versus off-pump CABG is not significantly associated with AF development so long as the operating time does not extend over a certain time period. pRBC transfusion was the single risk factor that is amenable to intervention at the time of operation. Unneeded transfusion of pRBCs must be prohibited. Also, serious precautions must be taken against postoperative pneumonia to avoid postoperative AF occurrence.