Browsing by Author "Zaim, C."
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Item Open Access Apoptotic vascular smooth muscle cell depletion via BCL2 family of proteins in human ascending aortic aneurysm and dissection(Blackwell Publishing Ltd, 2012) Durdu, S.; Deniz, G. C.; Balci, D.; Zaim, C.; Dogan, A.; Can, A.; Akcali, K. C.; Akar, A. R.Aims: This study investigates the expression patterns of BCL2 (B-cell CLL/lymphoma2) family of proteins and the extent of vascular smooth muscle cell (VSMC) apoptosis in thoracic aortic aneurysms (TAA), type-A aortic dissections (TAD), and nondilated ascending aortic samples. Methods: Aortic wall specimens were obtained from patients undergoing surgical repair for TAA (n = 24), TAD (n = 20), and normal aortic tissues from organ donors (n = 6). The expression pattern of BCL2, BCL2L1 (BCL2-like1), BAK1 (BCL2-antagonist/killer1), and BAX (BCL2-associated X protein) proteins was investigated by immunohistochemistry. Furthermore, colocalization of alpha smooth muscle actin (ACTA2) and caspase3 (CASP3) in aortic VSMCs was analyzed by double-immunofluorescence staining. Onset of DNA fragmentation was measured by TUNEL assay. Results: Apoptotic index was significantly increased in both TAD group (31.3 ± 17.2, P < 0.001) and TAA group (21.1 ± 12.7, P = 0.001) relative to control aortas (2.0 ± 1.2). Anti-CASP3 and ACTA2 double-immunostaining confirmed apoptosis in VSMCs in TAA and TAD groups but not in controls. Proapoptotic BAX expression was significantly elevated in VSMCs of TAA patients, compared with that of controls (OR = 20; P = 0.02; 95% CI, 16-250). In contrast, antiapoptotic BCL2L1 expression was higher in controls compared with that of TAA group (OR = 11.2; P = 0.049; 95% CI, 1.0-123.9). Furthermore, BAX/BCL2 ratio was significantly increased in both TAA (1.2 ± 0.7, P < 0.001) and TAD (0.6 ± 0.4, P = 0.05) groups relative to controls (0.2 ± 0.1, P < 0.001). Conclusions: Apoptotic VSMC depletion in human TAA/TAD is associated with disturbance of the balance between proapoptotic and antiapoptotic members of the BCL2 family proteins, which may have a role in the pathogenesis of vascular remodelling in aortic disease. In light of the future studies, targeting apoptotic pathways in TAA and TAD pathogenesis may provide therapeutic benefits to patients by slowing down the progression and even possibly preventing the TAD. © 2012 Blackwell Publishing Ltd.Item Open Access Endovenous laser ablation of great saphenous vein for the treatment of lower extremity: Two years experience(Turkiye Klinikleri, 2014) Zaim, C.; Kahraman, D.; Koujan, A.; Kaya, K.; Yiğit, L.; Özyurda, Ü.Objective: Chronic venous insufficiency and varicose veins are very common in the society, and in some clinical cases can lead to serious complications. Especially in the lower extremity superficial venous insufficiency depends more frequently on vena saphena magna, less frequently depending on the vena saphena parva. In the treatment of venous insufficiency, surgical methods was applied previously but nowadays endovenous laser (EVLA) and radiofrequency (RFA) methods are used. Material and Methods: In our study, a total of 207 patients with 220 extremity saphenous veins treated with EVLA [Radial-Emitting Fiber (REF) Advanced Fiber Tools, Germany)] procedure. The entire procedure was performed under doppler ultrasound (General Electric Logiq 500 pro, USA) guided with combination of spinal anestesia and tumescent local anesthesia (Nouvag Dispenser DP20, Switzerland). Before the procedure, all patients the clinical severity, etiology, anatomy, pathophysiology (CEAP) were classified according to the classification. Results: EVLA application of the 220 extremities, all (100%) pathophysiology, was determined depending on reflux. The preoperative diameter of the VSM at the knee level was between 3.8 mm and 6.2 mm (mean 4.6±1.8), while in saphenofemoral junction was found to be between 5.2 mm and 12.4 mm (mean 8.6±2.2). Postoperative diameter of the VSM, especially in the 3rd month of the knee level diameter was 1.7 mm to 3.9 mm (mean 2.2±0.8 p<0.05), in saphenofemoral junction between 2.3 mm to 4.8 mm (mean 3.9±1.8 p<0.05) was changed. As a result of the six-month follow-up of 216 patients (98.6%) showed complete occlusion. There were no major complications was detected but minor complications as cellulite in 6 patients, thrombophlebitis in 8 patients, hematoma in 4 patients and 10 patients paresthesia at knee level demonstrated. Conclusion: EVLA treatment can be performed safely with early mobilization, less pain and lower morbidity rates. Copyright © 2014 by Türkiye Klinikleri.