Background- Atherosclerosis is a dynamic and progressive disease arising from the combination of endothelial dysfunction and inflammation. So, inflammatory mediators are important causative and progressive factors in atherosclerosis. Interleukin-18 (IL-18) is a pleiotropic cytokine which may have a key role in atherosclerosis, because the results of recent studies indicated that IL-18, either directly as a pro-inflammatory factor or indirectly as an interferon inducing factor, has central role in the inflammatory cascade. In present study, we evaluated the relation between blood concentration of IL-18 with atherosclerosis and its severity and also the relation of this cytokine with the other known risk factors of coronary artery disease (CAD). Methods - 138 patients, who underwent diagnostic cardiac catheterization and had the inclusion criteria for this study, were selected. In the beginning, a questionnaire containing personal information and medical history was completed for each of them and blood samples were collected 24 hours before catheterization. We measured blood level of IL-18 and CRP in all samples. The results of these tests and the angiography were entered in the questionnaire and then information was analyzed using regression analyzing, K2 and statistical T test. P values of<0.05 were considered statistically significant. Results- By using the results of angiography, patients were divided in two groups. 1- Control group or normal coronary arteries (32 people) 2- Case group (106 people) or patients who were suffering from CAD. In second group, 6 patients (5.6%) had minimal CAD, 44 patients (41.5%) had single-vessel disease (SVD), 27 patients (25.4%) had 2VD and 29 patients (27.5%) had 3VD. In the laboratory tests, the mean IL-18 blood level in patients with CAD was 258.1 pgr/ml but in normal coronary arteries group it was 216.6 pgr/ml. The average blood level of IL-18 in patients who had minimal CAD was 235.5 pgr/ml, in SVD was 247.2 pgr/ml, in 2VD was 263.7 pgr/ml and in patients with 3VD was 274.1 pgr/ml. Also average CRP blood level in normal group was 8.9 mgr/L while in patients with CAD it was 20.4 mgr/L. Conclusion- The results of this study indicated that there was a direct and significant correlation between blood IL-18 level with existence (P<0.001) and severity of CAD (P<0.01) and IL-18 can be an independent predictor risk factor of atherosclerosis.

Description and DefinitionSynonym: Edward syndrome Characterized by malformations of multiple organ systems, trisomy 18 has an incidence of 3 in 10000 live births. Abnormalities detectable by ultrasound Common findings Agenesis of the corpus callosum Choroid plexus cysts Posterior fossa abnormalities Micrognathia Low-set ears Microphthalmous Hypertelorism Short radial ray Clenched hand with overlapping index finger Clubbed foot Rocker-bottom foot Renal anomalies hydronephrosis Omphalocele Diaphragmatic hernia Cryptorchidism Heart defects Single umbilical artery Intrauterine growth restriction Polyhydramnios Nuchal lucency Occasional findings Meningomyelocele Ventriculomegaly Cleft lip and plate Major differential diagnoses Freeman-Sheldon syndrome (clenched hands and intrauterine growth restriction) Pena Shokeir syndrome (pseudo-trisomy 18) Smith-Lemli-Opitz syndrome (clenched hands and intrauterine grown restriction) Triploidy (intrauterine growth restriction) Trisomy 9 Other multiple malformation syndromes associated with intrauterine growth retardation, limb anomalies and/ or heart defects. Ultrasound diagnosis Prenatal; ultrasound diagnosis has been established in the first trimester, based on the finding of a nuchal lucency. Detectable features on the early second trimester include abnormal forearms, clenched hands, clubbed feet, omphalocele and a major heart defect. The features of trisomy 18 are detectable in 80% of affected fetuses in the second trimester. Sonography is often used to evaluate fetuses for the prsence of trisomy 18 when choroid plexus cysts are present, or when the triple screen results in a low level of maternal serum alpha- fetoprotein, estriol and human chorionic  gonadotropin combination. Although trisomy 18 occurs in 1 in 100 fetuses with choroid plexus cysts, if it is an isolated finding, the risk for trisomy 18 falls below 1 in 400. Documenting an open hand is very helpful as most fetuses with trisomy 18 are unable to unclench their hands. Heredity This is an autosomal trisomic syndrome. Natural history and outcome Fetuses with trisomy 18 often die in utero. Ninety percent of live- borns with this abnormality die in the first year of life. The 10% who survive are profoundly mentally retarded and handicapped. Reference: Beryl R Benacerrafe, M.D; Ultrasound of fetal syndromes: (322-324).